[ { "question_id": "116", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Eating well with Canada's food guide (CFG) was developed by Health Canada as an education tool to encourage the Canadian public to have eating habits that meet nutrient needs, promote health, and reduce the risk of nutrition-related chronic disease. One potential approach to naturally managing health conditions like sleep apnea could be to follow a diet similar to the CFG, which emphasizes a diet rich in grains, fruits, and vegetables, potentially supporting overall health [18461106]. Additionally, it is important to consider that certain botanical supplements, such as Sutherlandia, may interfere with conventional treatments for conditions like tuberculosis due to their antioxidant properties. Thus, patients with sleep apnea should be cautious about using supplements that may impact their treatment [27155670].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Eating well with Canada's food guide (CFG) was developed by Health Canada as an education tool to encourage the Canadian public to have eating habits that meet nutrient needs, promote health, and reduce the risk of nutrition-related chronic disease.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "One potential approach to naturally managing health conditions like sleep apnea could be to follow a diet similar to the CFG, which emphasizes a diet rich in grains, fruits, and vegetables, potentially supporting overall health [18461106].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18461106", "evidence_support": "Although the two guides differ in their recommendations for red wine, fats, and meat and meat alternatives, they both promote a diet rich in grains, fruits, and vegetables.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, it is important to consider that certain botanical supplements, such as Sutherlandia, may interfere with conventional treatments for conditions like tuberculosis due to their antioxidant properties.", "answer_sentence_relevance": "inappropriate", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Thus, patients with sleep apnea should be cautious about using supplements that may impact their treatment [27155670].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "27155670", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Weight reduction can benefit people with sleep apnea, particularly those who are obese [33659106, 29517065, 19037617]. Quitting alcohol and avoiding central nervous system depressants can also help treat sleep apnea [33659106, 38022002, 19037617]. Positional therapy, such as sleeping in the lateral position and avoiding the supine position, can be effective for mild to moderate cases [24118690, 25771294, 19037617]. Mandibular advancement devices and oral appliances are useful treatments [18250210, 28126502, 18982969]. Physical activity and myofunctional therapy, including oropharyngeal exercises, can reduce sleep apnea severity [33659106, 30177246, 24037015]. Treating nasal congestion and abstaining from sedatives are conservative treatments for mild sleep apnea [14971838, 18651518, 21603432]. Electrical stimulation of the hypoglossal nerve and bariatric surgery can improve sleep apnea in appropriate patients [16944671, 28126502, 20875158]. Compression stockings, salt restriction, and fluid restriction can also reduce sleep apnea severity [30177246]. Avoiding tobacco use is beneficial [33659106, 21603432, 19201228]. Ensuring sufficient sleep is another conservative approach [14971838, 30722731]. Combining these strategies can provide a comprehensive natural treatment plan for managing sleep apnea [33659106, 14971838, 38022002].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Weight reduction can benefit people with sleep apnea, particularly those who are obese [33659106, 29517065, 19037617].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33659106", "evidence_support": "Reducing weight, quitting alcohol and smoking, eating a nutritional diet, and exercising are the modifications to benefit people.", "evidence_relation": "supporting" }, { "cited_pmid": "29517065", "evidence_support": "The major preventable risk factors to decrease obesity are the awareness of lifestyle modification (eating behaviors, smoking, drinking alcohol, etc.) and understanding the importance of exercise", "evidence_relation": "neutral" }, { "cited_pmid": "29517065", "evidence_support": "If these lifestyle modifications are widely applied, then not only will the consequences of obesity and sleep apnea be reduced, but also the incidence of cardiovascular disease will decrease greatly.", "evidence_relation": "supporting" }, { "cited_pmid": "19037617", "evidence_support": "Weight loss as well as avoidance of alcohol and other CNS depressants is generally recommended. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "10", "answer_sentence": "Ensuring sufficient sleep is another conservative approach [14971838, 30722731].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14971838", "evidence_support": "In patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, abstaining from the use of alcohol and sedatives, losing weight, and avoiding the supine position during sleep.", "evidence_relation": "supporting" }, { "cited_pmid": "30722731", "evidence_support": "Supporting measures are regular and sufficiently long sleeping times, avoidance of smoking and alcohol consumption in the evening as well as weight reduction for obese patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "11", "answer_sentence": "Combining these strategies can provide a comprehensive natural treatment plan for managing sleep apnea [33659106, 14971838, 38022002].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33659106", "evidence_support": "Reducing weight, quitting alcohol and smoking, eating a nutritional diet, and exercising are the modifications to benefit people.", "evidence_relation": "supporting" }, { "cited_pmid": "14971838", "evidence_support": "In patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, abstaining from the use of alcohol and sedatives, losing weight, and avoiding the supine position during sleep.", "evidence_relation": "supporting" }, { "cited_pmid": "38022002", "evidence_support": "It is advised to start with lifestyle changes such as quitting alcohol and sedative use, losing weight, and exercising frequently. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Quitting alcohol and avoiding central nervous system depressants can also help treat sleep apnea [33659106, 38022002, 19037617].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33659106", "evidence_support": "Reducing weight, quitting alcohol and smoking, eating a nutritional diet, and exercising are the modifications to benefit people.", "evidence_relation": "supporting" }, { "cited_pmid": "38022002", "evidence_support": " It is advised to start with lifestyle changes such as quitting alcohol and sedative use, losing weight, and exercising frequently.", "evidence_relation": "supporting" }, { "cited_pmid": "19037617", "evidence_support": "Weight loss as well as avoidance of alcohol and other CNS depressants is generally recommended. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Positional therapy, such as sleeping in the lateral position and avoiding the supine position, can be effective for mild to moderate cases [24118690, 25771294, 19037617].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24118690", "evidence_support": "Considering the fact that the vast majority of mild-moderate OSA patients are positional patients (between 65 and 87%), positional therapy may be a simple, cheap and effective solution for them.", "evidence_relation": "supporting" }, { "cited_pmid": "25771294", "evidence_support": "The position device utilized in this study was effective in reducing supine sleep and AHI, which was significant in those with baseline AHI \u226520.", "evidence_relation": "supporting" }, { "cited_pmid": "19037617", "evidence_support": "Positional training, oral appliances and surgery of the upper airways are used in selected cases.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Mandibular advancement devices and oral appliances are useful treatments [18250210, 28126502, 18982969].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18250210", "evidence_support": "Although positive airway pressure is the most efficacious treatment for obstructive sleep apnea (OSA), its clinical effectiveness is limited by its obtrusive interface.", "evidence_relation": "neutral" }, { "cited_pmid": "18250210", "evidence_support": "Two alternative treatment modalities used in clinical practice are mandibular advancement devices (MADs) and positional therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "28126502", "evidence_support": "Oral appliance therapy (OAT) is the main therapeutic alternative to continuous positive airway pressure (CPAP). OAT has been recommended as an appropriate first-line treatment option for moderate obstructive sleep apnea-hypopnea syndrome (OSAHS) in patients without severe cardiovascular comorbidity.", "evidence_relation": "supporting" }, { "cited_pmid": "18982969", "evidence_support": "A mandibular advancement prosthesis was fabricated for a 35-year-old male patient suffering from obstructive sleep apnea. The prosthesis was fabricated at a raised vertical dimension, with the central area open for the air passage. This advanced mandibular position enhanced the patency of the oropharynx.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Physical activity and myofunctional therapy, including oropharyngeal exercises, can reduce sleep apnea severity [33659106, 30177246, 24037015].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33659106", "evidence_support": "Reducing weight, quitting alcohol and smoking, eating a nutritional diet, and exercising are the modifications to benefit people.", "evidence_relation": "supporting" }, { "cited_pmid": "30177246", "evidence_support": "This review will focus on interventions that counteract fluid shift, such as diuretics, ultrafiltration/dialysis, physical activity, compression stockings and salt/fluid restriction, which have been shown to have efficacy in reducing sleep apnea severity.", "evidence_relation": "supporting" }, { "cited_pmid": "24037015", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Treating nasal congestion and abstaining from sedatives are conservative treatments for mild sleep apnea [14971838, 18651518, 21603432].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14971838", "evidence_support": "In patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, abstaining from the use of alcohol and sedatives, losing weight, and avoiding the supine position during sleep.", "evidence_relation": "supporting" }, { "cited_pmid": "18651518", "evidence_support": "In addition to continous positive airway pressure therapy, precautions such as weight loss, avoidance of central nervous system depressants, treatment of nasal congestion and sleeping in the lateral position may help to treat OSA. ", "evidence_relation": "supporting" }, { "cited_pmid": "21603432", "evidence_support": "However, conservative approaches, such as weight loss and alcohol and tobacco cessation, are also strongly encouraged in the patient with obstructive sleep apnea.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Electrical stimulation of the hypoglossal nerve and bariatric surgery can improve sleep apnea in appropriate patients [16944671, 28126502, 20875158].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16944671", "evidence_support": "Although bariatric surgery is increasingly performed for refractory medically complicated obesity, its long-term effectiveness in treatment of obstructive sleep apnea in morbidly obese patients is not yet demonstrated.", "evidence_relation": "contradicting" }, { "cited_pmid": "28126502", "evidence_support": "Electrical stimulation of the hypoglossal nerve is a promising treatment approach for moderate to severe OSAHS.", "evidence_relation": "supporting" }, { "cited_pmid": "28126502", "evidence_support": "Weight-loss intervention is a central component of the strategies used to improve the cardiovascular risk-factor profile in patients with OSAHS and obesity.", "evidence_relation": "neutral" }, { "cited_pmid": "20875158", "evidence_support": "Surgeries that have been used to treat OSA include septoplasty, tonsillectomy adenoidectomy, uvulopalatopharyngoplasty, mandibular advancement procedures, tongue reduction surgery, hyoid bone suspension, maxillofacial surgery, and bariatric procedures.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Compression stockings, salt restriction, and fluid restriction can also reduce sleep apnea severity [30177246].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30177246", "evidence_support": "This review will focus on interventions that counteract fluid shift, such as diuretics, ultrafiltration/dialysis, physical activity, compression stockings and salt/fluid restriction, which have been shown to have efficacy in reducing sleep apnea severity.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "9", "answer_sentence": "Avoiding tobacco use is beneficial [33659106, 21603432, 19201228].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33659106", "evidence_support": "Reducing weight, quitting alcohol and smoking, eating a nutritional diet, and exercising are the modifications to benefit people.", "evidence_relation": "supporting" }, { "cited_pmid": "21603432", "evidence_support": "However, conservative approaches, such as weight loss and alcohol and tobacco cessation, are also strongly encouraged in the patient with obstructive sleep apnea.", "evidence_relation": "supporting" }, { "cited_pmid": "19201228", "evidence_support": "The principal purpose of these behavioral measures is to reduce risk factors which may underlie or exacerbate the disorder (e.g., weight reduction, smoking cessation, reduction/elimination of alcohol consumption, change in sleeping posture and sleep hygiene)", "evidence_relation": "supporting" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Preventing or treating obstructive sleep apnea (OSA) naturally involves lifestyle modifications and positional therapy.Weight loss is a critical factor, as obesity is a significant risk factor for OSA, and reducing body weight can alleviate symptoms [33659106, 29517065]. Avoiding alcohol and smoking, which can exacerbate airway collapse, is also recommended [33659106, 14971838]. Positional therapy, which involves avoiding the supine sleeping position, can be particularly effective for patients with positional OSA, as it significantly reduces apneas and hypopneas [24118690, 25771294]. Additionally, managing fluid retention through physical activity, compression stockings, and dietary modifications can reduce overnight rostral fluid shift, thereby decreasing OSA severity [30177246]. These non-invasive approaches can be beneficial, especially for patients with mild to moderate OSA, and may improve overall sleep quality and reduce associated health risks [33659106, 14971838, 29517065].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Preventing or treating obstructive sleep apnea (OSA) naturally involves lifestyle modifications and positional therapy.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Weight loss is a critical factor, as obesity is a significant risk factor for OSA, and reducing body weight can alleviate symptoms [33659106, 29517065].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33659106", "evidence_support": "Reducing weight, quitting alcohol and smoking, eating a nutritional diet, and exercising are the modifications to benefit people.", "evidence_relation": "supporting" }, { "cited_pmid": "29517065", "evidence_support": "One of the main components contributing to sleep apnea is obesity; as well as diabetes mellitus type 2 (T2DM), hypercholesterolemia, and hypertension.", "evidence_relation": "supporting" }, { "cited_pmid": "29517065", "evidence_support": "These preventive actions, screening measures, and treatment strategies for obesity and OSA can significantly reduce the incidence of obesity, as well as OSA and the related comorbidities such as cardiovascular disease, atherosclerosis, and depression. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Avoiding alcohol and smoking, which can exacerbate airway collapse, is also recommended [33659106, 14971838].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33659106", "evidence_support": "Reducing weight, quitting alcohol and smoking, eating a nutritional diet, and exercising are the modifications to benefit peop", "evidence_relation": "supporting" }, { "cited_pmid": "14971838", "evidence_support": "In patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, abstaining from the use of alcohol and sedatives, losing weight, and avoiding the supine position during sleep", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Positional therapy, which involves avoiding the supine sleeping position, can be particularly effective for patients with positional OSA, as it significantly reduces apneas and hypopneas [24118690, 25771294].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24118690", "evidence_support": "Simply, by sleeping in the lateral postures, they eliminate or reduce significantly the number of apneas and hypopneas.", "evidence_relation": "supporting" }, { "cited_pmid": "25771294", "evidence_support": "The position device utilized in this study was effective in reducing supine sleep and AHI, which was significant in those with baseline AHI \u226520.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, managing fluid retention through physical activity, compression stockings, and dietary modifications can reduce overnight rostral fluid shift, thereby decreasing OSA severity [30177246].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30177246", "evidence_support": "This review will focus on interventions that counteract fluid shift, such as diuretics, ultrafiltration/dialysis, physical activity, compression stockings and salt/fluid restriction, which have been shown to have efficacy in reducing sleep apnea severity.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "These non-invasive approaches can be beneficial, especially for patients with mild to moderate OSA, and may improve overall sleep quality and reduce associated health risks [33659106, 14971838, 29517065].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "29517065", "evidence_support": "The major preventable risk factors to decrease obesity are the awareness of lifestyle modification (eating behaviors, smoking, drinking alcohol, etc.) and understanding the importance of exercise. If these lifestyle modifications are widely applied, then not only will the consequences of obesity and sleep apnea be reduced, but also the incidence of cardiovascular disease will decrease greatly.", "evidence_relation": "supporting" }, { "cited_pmid": "33659106", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "14971838", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Preventing sleep apnea or treating it naturally can be achieved through lifestyle modifications and conservative treatments. Weight loss is a recommended approach, as it can significantly reduce the severity of sleep apnea [33659106, 38022002, 29517065]. Avoiding alcohol and sedatives, quitting smoking, and exercising regularly are also beneficial [33659106, 38022002, 21603432]. Additionally, positional therapy, which involves avoiding the supine position during sleep, can be effective in reducing sleep apnea severity [24118690, 17762999, 28126502]. Other natural approaches include using a mandibular advancement device or an oral appliance to advance the mandible and keep the airway open [18250210, 18982969, 20875158]. Furthermore, reducing fluid overload and preventing overnight rostral fluid shift can also help alleviate sleep apnea symptoms [30177246, 28126502]. These conservative treatments can be used alone or in combination with other therapies to manage sleep apnea.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Preventing sleep apnea or treating it naturally can be achieved through lifestyle modifications and conservative treatments.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Weight loss is a recommended approach, as it can significantly reduce the severity of sleep apnea [33659106, 38022002, 29517065].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33659106", "evidence_support": "Reducing weight, quitting alcohol and smoking, eating a nutritional diet, and exercising are the modifications to benefit people.", "evidence_relation": "supporting" }, { "cited_pmid": "38022002", "evidence_support": "It is advised to start with lifestyle changes such as quitting alcohol and sedative use, losing weight, and exercising frequently.", "evidence_relation": "supporting" }, { "cited_pmid": "29517065", "evidence_support": "The major preventable risk factors to decrease obesity are the awareness of lifestyle modification (eating behaviors, smoking, drinking alcohol, etc.) and understanding the importance of exercise.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Avoiding alcohol and sedatives, quitting smoking, and exercising regularly are also beneficial [33659106, 38022002, 21603432].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33659106", "evidence_support": "Reducing weight, quitting alcohol and smoking, eating a nutritional diet, and exercising are the modifications to benefit people.", "evidence_relation": "supporting" }, { "cited_pmid": "38022002", "evidence_support": "It is advised to start with lifestyle changes such as quitting alcohol and sedative use, losing weight, and exercising frequently.", "evidence_relation": "supporting" }, { "cited_pmid": "21603432", "evidence_support": "However, conservative approaches, such as weight loss and alcohol and tobacco cessation, are also strongly encouraged in the patient with obstructive sleep apnea.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, positional therapy, which involves avoiding the supine position during sleep, can be effective in reducing sleep apnea severity [24118690, 17762999, 28126502].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24118690", "evidence_support": "Simply, by sleeping in the lateral postures, they eliminate or reduce significantly the number of apneas and hypopneas.", "evidence_relation": "supporting" }, { "cited_pmid": "17762999", "evidence_support": "A 'Positioner' preventing sleeping on the back can effectively reduce obstructive sleep apnea (OSA), but not always snoring for patients with long-term OSA.", "evidence_relation": "supporting" }, { "cited_pmid": "28126502", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Other natural approaches include using a mandibular advancement device or an oral appliance to advance the mandible and keep the airway open [18250210, 18982969, 20875158].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18250210", "evidence_support": "Two alternative treatment modalities used in clinical practice are mandibular advancement devices (MADs) and positional therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "18982969", "evidence_support": "This article describes the success achieved in a case treated with conservative therapy, that is, intraoral prosthesis", "evidence_relation": "supporting" }, { "cited_pmid": "20875158", "evidence_support": "If PAP fails to adequately treat the OSA, oral appliances that enlarge the airway (mandibular advancement devices primarily, or the tongue retaining device if the patient has no dentition) are the next line of therapy.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Furthermore, reducing fluid overload and preventing overnight rostral fluid shift can also help alleviate sleep apnea symptoms [30177246, 28126502].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30177246", "evidence_support": "Overnight rostral fluid shift has been implicated in the pathogenesis of sleep apnea, particularly in conditions associated with fluid overload.", "evidence_relation": "supporting" }, { "cited_pmid": "30177246", "evidence_support": "As a result of this observation, it has been suggested that the prevention of overnight fluid shift may reduce sleep apnea severity.", "evidence_relation": "supporting" }, { "cited_pmid": "28126502", "evidence_support": "Avoiding the supine position during sleep and reducing the overnight rostral fluid shift from the legs to the neck can also achieve a partial improvement of sleep-disordered breathing.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "These conservative treatments can be used alone or in combination with other therapies to manage sleep apnea.", "answer_sentence_relevance": "borderline", "citation_assessment": null } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "There are several natural treatments and lifestyle modifications that can help prevent and treat sleep apnea [36088151, 37532368, 15162258]. Weight loss is often recommended, as it can reduce the severity of sleep apnea in overweight individuals [36088151, 37532368, 16944672]. Avoiding alcohol and sedatives, which can relax the muscles in the throat and worsen sleep apnea, is also advised [15162258, 15334045]. Sleeping on one's side instead of back can help prevent the tongue and soft palate from falling back and blocking the airway [16944672, 15162258, 30204000]. Raising the head of the bed by about 4-6 inches can also help prevent the tongue and soft palate from falling back [16944672]. Additionally, oral appliances that advance the position of the lower jaw can be effective in treating mild to moderate sleep apnea [28901030, 15162258, 21642831]. Nasal dilators, saline nasal sprays, and humidifiers can also help improve breathing and reduce congestion [30204000]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "There are several natural treatments and lifestyle modifications that can help prevent and treat sleep apnea [36088151, 37532368, 15162258].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36088151", "evidence_support": "With rising obesity rates, weight loss and lifestyle programs seem to be the most favorable integrative methods to combine with conventional OSA therapies.", "evidence_relation": "supporting" }, { "cited_pmid": "36088151", "evidence_support": "With rising obesity rates, weight loss and lifestyle programs seem to be the most favorable integrative methods to combine with conventional OSA therapies.", "evidence_relation": "supporting" }, { "cited_pmid": "15162258", "evidence_support": "Weight-loss recommendation, no alcohol and no sedatives are the first therapeutic approaches for patients with the obstructive sleep apne syndrome", "evidence_relation": "supporting" }, { "cited_pmid": "37532368", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Weight loss is often recommended, as it can reduce the severity of sleep apnea in overweight individuals [36088151, 37532368, 16944672].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36088151", "evidence_support": "With rising obesity rates, weight loss and lifestyle programs seem to be the most favorable integrative methods to combine with conventional OSA therapies.", "evidence_relation": "supporting" }, { "cited_pmid": "36088151", "evidence_support": "With rising obesity rates, weight loss and lifestyle programs seem to be the most favorable integrative methods to combine with conventional OSA therapies.", "evidence_relation": "supporting" }, { "cited_pmid": "16944672", "evidence_support": "Weight loss has additional health benefits and should be routinely recommended to most overweight patients.", "evidence_relation": "supporting" }, { "cited_pmid": "37532368", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Avoiding alcohol and sedatives, which can relax the muscles in the throat and worsen sleep apnea, is also advised [15162258, 15334045].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15162258", "evidence_support": "Weight-loss recommendation, no alcohol and no sedatives are the first therapeutic approaches for patients with the obstructive sleep apne syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "15334045", "evidence_support": "General management includes addressing lifestyle issues, particularly weight loss and the avoidance of sedatives. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Sleeping on one's side instead of back can help prevent the tongue and soft palate from falling back and blocking the airway [16944672, 15162258, 30204000].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15162258", "evidence_support": "If there is a postural component in mild cases sleeping on the side can help.", "evidence_relation": "supporting" }, { "cited_pmid": "16944672", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "30204000", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Raising the head of the bed by about 4-6 inches can also help prevent the tongue and soft palate from falling back [16944672].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16944672", "evidence_support": "Supplemental oxygen and positional therapy may benefit subsets of patients, but whether these therapies reduce morbidities as PAP therapy does will require rigorous randomized trials.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Additionally, oral appliances that advance the position of the lower jaw can be effective in treating mild to moderate sleep apnea [28901030, 15162258, 21642831].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28901030", "evidence_support": "Oral appliance (OA) therapy is currently widely used for the treatment of snoring, mild, moderate and severe OSA.", "evidence_relation": "supporting" }, { "cited_pmid": "15162258", "evidence_support": "Oral appliances are are indicated for primary snoring or mild obstructive sleep apnea.", "evidence_relation": "supporting" }, { "cited_pmid": "21642831", "evidence_support": "Oral appliances are of 3 types and are generally indicated in mild to moderate obstructive sleep apnea.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Nasal dilators, saline nasal sprays, and humidifiers can also help improve breathing and reduce congestion [30204000].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30204000", "evidence_support": "In general, isolated nasal treatments are the least effective, whereas treatments that bypass the upper airway, significantly open the upper airway, and/or address multiple levels of the upper airway are more effective in improving apnea-hypopnea index and lowest oxygen saturation.", "evidence_relation": "contradicting" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Weight loss, avoiding alcohol and sedatives, and sleeping on the side can help prevent sleep apnea in mild cases [14971838, 28126502, 15162258]. For patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, losing weight, and avoiding the supine position during sleep [28126502, 17131687, 14971838]. Oral appliances are indicated for primary snoring or mild obstructive sleep apnea, and can be used for patients who prefer them to CPAP therapy or for whom CPAP therapy has failed or cannot be tolerated [14971838, 28126502, 19744402]. Some patients with sleep apnea can benefit from avoiding the supine sleep position, which can eliminate or reduce the number of apneas and hypopneas [24118690, 28126502, 17131687]. In some cases, positional therapy may be a simple, cheap, and effective solution for mild-moderate sleep apnea patients [24118690, 17131687, 15162258]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Weight loss, avoiding alcohol and sedatives, and sleeping on the side can help prevent sleep apnea in mild cases [14971838, 28126502, 15162258].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14971838", "evidence_support": "In patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, abstaining from the use of alcohol and sedatives, losing weight, and avoiding the supine position during sleep.", "evidence_relation": "supporting" }, { "cited_pmid": "15162258", "evidence_support": "Weight-loss recommendation, no alcohol and no sedatives are the first therapeutic approaches for patients with the obstructive sleep apne syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "28126502", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "For patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, losing weight, and avoiding the supine position during sleep [28126502, 17131687, 14971838].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28126502", "evidence_support": "Avoiding the supine position during sleep and reducing the overnight rostral fluid shift from the legs to the neck can also achieve a partial improvement of sleep-disordered breathing. ", "evidence_relation": "supporting" }, { "cited_pmid": "17131687", "evidence_support": "As conservative approaches oral appliances and conditioning (to avoid supine sleeping position) show promising results", "evidence_relation": "supporting" }, { "cited_pmid": "14971838", "evidence_support": " In patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, abstaining from the use of alcohol and sedatives, losing weight, and avoiding the supine position during sleep.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Oral appliances are indicated for primary snoring or mild obstructive sleep apnea, and can be used for patients who prefer them to CPAP therapy or for whom CPAP therapy has failed or cannot be tolerated [14971838, 28126502, 19744402].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14971838", "evidence_support": "Oral appliances are inconsistently effective in the management of obstructive sleep apnea but may be an option in patients with mild disease who cannot tolerate CPAP.", "evidence_relation": "supporting" }, { "cited_pmid": "28126502", "evidence_support": "Oral appliance therapy (OAT) is the main therapeutic alternative to continuous positive airway pressure (CPAP).", "evidence_relation": "supporting" }, { "cited_pmid": "19744402", "evidence_support": "Oral appliances can be used for patients with symptomatic mild or moderate sleep apnea who prefer them to PAP therapy or for whom PAP therapy has failed or cannot be tolerated. Oral appliances also may be used for patients with severe obstructive sleep apnea who are unable or unwilling to undertake PAP therapy or surgery.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Some patients with sleep apnea can benefit from avoiding the supine sleep position, which can eliminate or reduce the number of apneas and hypopneas [24118690, 28126502, 17131687].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24118690", "evidence_support": "Simply, by sleeping in the lateral postures, they eliminate or reduce significantly the number of apneas and hypopneas.", "evidence_relation": "supporting" }, { "cited_pmid": "28126502", "evidence_support": "Avoiding the supine position during sleep and reducing the overnight rostral fluid shift from the legs to the neck can also achieve a partial improvement of sleep-disordered breathing.", "evidence_relation": "supporting" }, { "cited_pmid": "17131687", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In some cases, positional therapy may be a simple, cheap, and effective solution for mild-moderate sleep apnea patients [24118690, 17131687, 15162258].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24118690", "evidence_support": "Considering the fact that the vast majority of mild-moderate OSA patients are positional patients (between 65 and 87%), positional therapy may be a simple, cheap and effective solution for them.", "evidence_relation": "supporting" }, { "cited_pmid": "17131687", "evidence_support": "As conservative approaches oral appliances and conditioning (to avoid supine sleeping position) show promising results.", "evidence_relation": "supporting" }, { "cited_pmid": "15162258", "evidence_support": "If there is a postural component in mild cases sleeping on the side can help.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "There are several natural ways to prevent and treat sleep apnea [22014867]. Lifestyle modifications such as weight loss, avoiding alcohol and sedatives, and sleeping on one's side can help alleviate symptoms [28126502, 14971838, 15162258]. Dietary modifications, such as those described in a case report of a 55-year-old man who no longer required a CPAP device after adhering to dietary changes for 3 months, may also be effective [22014867]. Additionally, oral appliances, conditioning to avoid the supine sleeping position, and inclined pillows can be used to treat mild to moderate sleep apnea [28126502, 30204000, 15162258]. Furthermore, alternative treatments such as hypoglossal nerve stimulation, body positioning, and oxygen treatment may also be effective [28126502, 30204000, 27134515]. It is essential to note that while these natural methods can be helpful, they may not be as effective as continuous positive airway pressure (CPAP) therapy, which is the gold standard treatment for sleep apnea [19744402, 16493160, 15162258]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "There are several natural ways to prevent and treat sleep apnea [22014867].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Lifestyle modifications such as weight loss, avoiding alcohol and sedatives, and sleeping on one's side can help alleviate symptoms [28126502, 14971838, 15162258].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28126502", "evidence_support": "Avoiding the supine position during sleep and reducing the overnight rostral fluid shift from the legs to the neck can also achieve a partial improvement of sleep-disordered breathing", "evidence_relation": "supporting" }, { "cited_pmid": "28126502", "evidence_support": "Weight-loss intervention is a central component of the strategies used to improve the cardiovascular risk-factor profile in patients with OSAHS and obesity", "evidence_relation": "supporting" }, { "cited_pmid": "14971838", "evidence_support": "In patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, abstaining from the use of alcohol and sedatives, losing weight, and avoiding the supine position during sleep.", "evidence_relation": "supporting" }, { "cited_pmid": "15162258", "evidence_support": "Weight-loss recommendation, no alcohol and no sedatives are the first therapeutic approaches for patients with the obstructive sleep apne syndrome. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Dietary modifications, such as those described in a case report of a 55-year-old man who no longer required a CPAP device after adhering to dietary changes for 3 months, may also be effective [22014867].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "This report describes the chiropractic management and resolution of OSAS with dietary modifications in a 55-year-old man who wore a CPAP for 10 years.", "evidence_relation": "supporting" }, { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, oral appliances, conditioning to avoid the supine sleeping position, and inclined pillows can be used to treat mild to moderate sleep apnea [28126502, 30204000, 15162258].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28126502", "evidence_support": "OAT has been recommended as an appropriate first-line treatment option for moderate obstructive sleep apnea-hypopnea syndrome (OSAHS) in patients without severe cardiovascular comorbidity.", "evidence_relation": "supporting" }, { "cited_pmid": "15162258", "evidence_support": "Oral appliances are are indicated for primary snoring or mild obstructive sleep apnea.", "evidence_relation": "supporting" }, { "cited_pmid": "30204000", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, alternative treatments such as hypoglossal nerve stimulation, body positioning, and oxygen treatment may also be effective [28126502, 30204000, 27134515].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28126502", "evidence_support": "Electrical stimulation of the hypoglossal nerve is a promising treatment approach for moderate to severe OSAHS.", "evidence_relation": "supporting" }, { "cited_pmid": "30204000", "evidence_support": "Treatments identified included surgeries, drugs, behavior modifications, nonsurgical weight loss, medical devices, body positioning, and oxygen treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "27134515", "evidence_support": "Other treatment options for OSA include improving CPAP tolerability, increasing CPAP adherence through patient interventions, weight loss/exercise, positional therapy, nasal expiratory positive airway pressure, oral pressure therapy, oral appliances, surgery, hypoglossal nerve stimulation, drug treatment, and combining 2 or more of the aforementioned treatments.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "It is essential to note that while these natural methods can be helpful, they may not be as effective as continuous positive airway pressure (CPAP) therapy, which is the gold standard treatment for sleep apnea [19744402, 16493160, 15162258].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "19744402", "evidence_support": "The gold standard for treatment in adults is positive airway pressure (PAP) therapy: continuous PAP (CPAP), bilevel PAP, autotitrating CPAP, or autotitrating bilevel PAP.", "evidence_relation": "supporting" }, { "cited_pmid": "16493160", "evidence_support": "Continuous positive airway pressure remains the most consistently effective approach, although oral appliances (generally mandibular-advancing devices) and a number of surgical procedures have some demonstrated efficacy.", "evidence_relation": "supporting" }, { "cited_pmid": "15162258", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "There are several natural ways to prevent and treat sleep apnea [15162258, 22014867]. Lifestyle modifications such as weight loss, avoiding alcohol and sedatives, and sleeping on one's side can help alleviate symptoms [14971838, 15162258, 28126502]. Dietary modifications, such as those described in a case report of a 55-year-old man who no longer required a CPAP device after adhering to dietary changes for 3 months, may also be effective [22014867]. Additionally, oral appliances, conditioning to avoid the supine sleeping position, and inclined pillows can be used to treat mild to moderate sleep apnea [15611895, 24118690, 23669094]. Furthermore, alternative treatments such as hypoglossal nerve stimulation, body positioning, and oxygen treatment may also be effective [27689226, 26394258, 27134515]. It is essential to note that while these natural methods can be helpful, they may not be as effective as continuous positive airway pressure (CPAP) therapy, which is the gold standard treatment for sleep apnea [27242272, 28287009, 25407131]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "There are several natural ways to prevent and treat sleep apnea [15162258, 22014867].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15162258", "evidence_support": "Weight-loss recommendation, no alcohol and no sedatives are the first therapeutic approaches for patients with the obstructive sleep apne syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Lifestyle modifications such as weight loss, avoiding alcohol and sedatives, and sleeping on one's side can help alleviate symptoms [14971838, 15162258, 28126502].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14971838", "evidence_support": "In patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, abstaining from the use of alcohol and sedatives, losing weight, and avoiding the supine position during sleep.", "evidence_relation": "supporting" }, { "cited_pmid": "15162258", "evidence_support": "Weight-loss recommendation, no alcohol and no sedatives are the first therapeutic approaches for patients with the obstructive sleep apne syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "28126502", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Dietary modifications, such as those described in a case report of a 55-year-old man who no longer required a CPAP device after adhering to dietary changes for 3 months, may also be effective [22014867].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "After adhering to dietary modifications for 3 months, the patient no longer required the use of the CPAP device and continues to have a normal active lifestyle almost 7 years later.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, oral appliances, conditioning to avoid the supine sleeping position, and inclined pillows can be used to treat mild to moderate sleep apnea [15611895, 24118690, 23669094].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15611895", "evidence_support": "The study was performed to determine the ability of a new inclined pillow to treat snoring and obstructive sleep apnea syndrom", "evidence_relation": "supporting" }, { "cited_pmid": "15611895", "evidence_support": "A uniquely designed pillow (SONA Pillow) is effective in reducing the number of events in patients with mild to moderate obstructive sleep apnea. Using this pillow also reduces snoring.", "evidence_relation": "supporting" }, { "cited_pmid": "24118690", "evidence_support": "Simply, by sleeping in the lateral postures, they eliminate or reduce significantly the number of apneas and hypopneas.", "evidence_relation": "supporting" }, { "cited_pmid": "23669094", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, alternative treatments such as hypoglossal nerve stimulation, body positioning, and oxygen treatment may also be effective [27689226, 26394258, 27134515].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27689226", "evidence_support": "Recently an alternative surgical treatment has become available for these patients, which uses established techniques to stimulate the hypoglossus nerve to open the upper airway during sleep.", "evidence_relation": "supporting" }, { "cited_pmid": "26394258", "evidence_support": "Hypoglossal nerve stimulation appears to be a very promising treatment for patients with moderate-to-severe OSA.", "evidence_relation": "supporting" }, { "cited_pmid": "27134515", "evidence_support": "Other treatment options for OSA include improving CPAP tolerability, increasing CPAP adherence through patient interventions, weight loss/exercise, positional therapy, nasal expiratory positive airway pressure, oral pressure therapy, oral appliances, surgery, hypoglossal nerve stimulation, drug treatment, and combining 2 or more of the aforementioned treatments.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "It is essential to note that while these natural methods can be helpful, they may not be as effective as continuous positive airway pressure (CPAP) therapy, which is the gold standard treatment for sleep apnea [27242272, 28287009, 25407131].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "27242272", "evidence_support": "Although continuous positive airway pressure is the gold standard for sleep apnea treatment, its effects on quality of life are not well defined", "evidence_relation": "supporting" }, { "cited_pmid": "28287009", "evidence_support": "Continuous positive airway pressure (CPAP) is considered the gold standard therapy that delivers pressurized air into the upper airway to relieve obstruction during sleep", "evidence_relation": "supporting" }, { "cited_pmid": "25407131", "evidence_support": "Positive airway pressure (PAP) (continuous positive airway pressure [CPAP] or bilevel positive airway pressure [BiPAP]) applications are the gold-standard treatment of sleep apnea", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "There are several natural ways to prevent and treat sleep apnea [22014867, 15162258]. Lifestyle modifications such as weight loss, avoiding alcohol and sedatives, and sleeping on one's side can help alleviate symptoms [15334045, 28126502, 15162258]. Dietary modifications, such as those described in a case report of a 55-year-old man who no longer required a CPAP device after adhering to dietary changes for 3 months, may also be effective [22014867]. Additionally, oral appliances, conditioning to avoid the supine sleeping position, and inclined pillows can be used to treat mild to moderate sleep apnea [24118690, 23669094, 15611895]. Furthermore, alternative treatments such as hypoglossal nerve stimulation, body positioning, and oxygen treatment may also be effective [26394258, 30054649, 27689226]. It is essential to note that while these natural methods can be helpful, they may not be as effective as continuous positive airway pressure (CPAP) therapy, which is the gold standard treatment for sleep apnea [28287009, 25407131, 27242272]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "There are several natural ways to prevent and treat sleep apnea [22014867, 15162258].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS", "evidence_relation": "supporting" }, { "cited_pmid": "15162258", "evidence_support": "Weight-loss recommendation, no alcohol and no sedatives are the first therapeutic approaches for patients with the obstructive sleep apne syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "15162258", "evidence_support": "Different nonprescription therapies are available (internal and external nasal dilators, nasal and oral lubricants, dietary supplements, magnetic pillows and matresses) but their usefulness for the treatment has not been demonstrated.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Lifestyle modifications such as weight loss, avoiding alcohol and sedatives, and sleeping on one's side can help alleviate symptoms [15334045, 28126502, 15162258].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15334045", "evidence_support": "General management includes addressing lifestyle issues, particularly weight loss and the avoidance of sedatives.", "evidence_relation": "supporting" }, { "cited_pmid": "15162258", "evidence_support": "Weight-loss recommendation, no alcohol and no sedatives are the first therapeutic approaches for patients with the obstructive sleep apne syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "28126502", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Dietary modifications, such as those described in a case report of a 55-year-old man who no longer required a CPAP device after adhering to dietary changes for 3 months, may also be effective [22014867].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "This report describes the chiropractic management and resolution of OSAS with dietary modifications in a 55-year-old man who wore a CPAP for 10 years.", "evidence_relation": "supporting" }, { "cited_pmid": "22014867", "evidence_support": "After adhering to dietary modifications for 3 months, the patient no longer required the use of the CPAP device and continues to have a normal active lifestyle almost 7 years later.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, oral appliances, conditioning to avoid the supine sleeping position, and inclined pillows can be used to treat mild to moderate sleep apnea [24118690, 23669094, 15611895].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24118690", "evidence_support": "Simply, by sleeping in the lateral postures, they eliminate or reduce significantly the number of apneas and hypopneas", "evidence_relation": "supporting" }, { "cited_pmid": "24118690", "evidence_support": "In this paper we intend to argue that positional therapy, i.e., avoidance of the supine posture during sleep, could represent a valuable therapy mainly for mild-moderate OSA.", "evidence_relation": "supporting" }, { "cited_pmid": "23669094", "evidence_support": "Avoidance of the supine posture is efficacious, but long term compliance data and well powered randomized controlled trials are lacking", "evidence_relation": "supporting" }, { "cited_pmid": "15611895", "evidence_support": "The study was performed to determine the ability of a new inclined pillow to treat snoring and obstructive sleep apnea syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "15611895", "evidence_support": "A uniquely designed pillow (SONA Pillow) is effective in reducing the number of events in patients with mild to moderate obstructive sleep apnea", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, alternative treatments such as hypoglossal nerve stimulation, body positioning, and oxygen treatment may also be effective [26394258, 30054649, 27689226].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26394258", "evidence_support": " Hypoglossal nerve stimulation appears to be a very promising treatment for patients with moderate-to-severe OSA. ", "evidence_relation": "supporting" }, { "cited_pmid": "30054649", "evidence_support": "Alternative treatments include mandibular advancement devices or positional devices to prevent patients sleeping on their back, as well as anatomy-altering surgical procedures. For several years now, an additional surgical treatment-hypoglossal nerve stimulation-has been available for selected OSA patients. Hypoglossal nerve stimulation is a\u00a0dynamic surgical approach that uses electrical stimulation to activate key muscles of the upper airway to achieve airway patency.", "evidence_relation": "supporting" }, { "cited_pmid": "27689226", "evidence_support": "Recently an alternative surgical treatment has become available for these patients, which uses established techniques to stimulate the hypoglossus nerve to open the upper airway during sleep.", "evidence_relation": "supporting" }, { "cited_pmid": "27689226", "evidence_support": "Currently, two systems are available on the market: respiratory-driven hypoglossal nerve stimulation (Inspire Medical Systems) and continuous hypoglossal nerve stimulation (ImThera Medical). For respiratory-driven hypoglossal nerve stimulation, a solid body of evidence is available and the therapy has been investigated in numerous multicenter clinical studies with regard to safety and efficacy. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "It is essential to note that while these natural methods can be helpful, they may not be as effective as continuous positive airway pressure (CPAP) therapy, which is the gold standard treatment for sleep apnea [28287009, 25407131, 27242272].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "28287009", "evidence_support": "Continuous positive airway pressure (CPAP) is considered the gold standard therapy that delivers pressurized air into the upper airway to relieve obstruction during sleep.", "evidence_relation": "supporting" }, { "cited_pmid": "28287009", "evidence_support": " therapy is the gold standard treatment option and should continue to be offered to those who suffer from OSA.", "evidence_relation": "supporting" }, { "cited_pmid": "25407131", "evidence_support": "Positive airway pressure (PAP) (continuous positive airway pressure [CPAP] or bilevel positive airway pressure [BiPAP]) applications are the gold-standard treatment of sleep apnea.", "evidence_relation": "supporting" }, { "cited_pmid": "27242272", "evidence_support": "Although continuous positive airway pressure is the gold standard for sleep apnea treatment, its effects on quality of life are not well defined", "evidence_relation": "neutral" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "There are several natural ways to prevent and treat sleep apnea [15162258, 22014867]. Lifestyle modifications such as weight loss, avoiding alcohol and sedatives, and sleeping on one's side can help alleviate symptoms [15334045, 15162258]. Dietary modifications, such as those described in a case report of a 55-year-old man who no longer required a CPAP device after adhering to dietary changes for 3 months, may also be effective [22014867]. Additionally, oral appliances, conditioning to avoid the supine sleeping position, and inclined pillows can be used to treat mild to moderate sleep apnea [24118690, 23669094, 15611895]. Furthermore, alternative treatments such as hypoglossal nerve stimulation, body positioning, and oxygen treatment may also be effective [27134515, 27689226, 26394258]. It is essential to note that while these natural methods can be helpful, they may not be as effective as continuous positive airway pressure (CPAP) therapy, which is the gold standard treatment for sleep apnea [27242272, 28287009, 25407131]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "There are several natural ways to prevent and treat sleep apnea [15162258, 22014867].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15162258", "evidence_support": "Weight-loss recommendation, no alcohol and no sedatives are the first therapeutic approaches for patients with the obstructive sleep apne syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Lifestyle modifications such as weight loss, avoiding alcohol and sedatives, and sleeping on one's side can help alleviate symptoms [15334045, 15162258].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15334045", "evidence_support": "General management includes addressing lifestyle issues, particularly weight loss and the avoidance of sedatives.", "evidence_relation": "supporting" }, { "cited_pmid": "15162258", "evidence_support": "Weight-loss recommendation, no alcohol and no sedatives are the first therapeutic approaches for patients with the obstructive sleep apne syndrome.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Dietary modifications, such as those described in a case report of a 55-year-old man who no longer required a CPAP device after adhering to dietary changes for 3 months, may also be effective [22014867].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "After adhering to dietary modifications for 3 months, the patient no longer required the use of the CPAP device and continues to have a normal active lifestyle almost 7 years later.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, oral appliances, conditioning to avoid the supine sleeping position, and inclined pillows can be used to treat mild to moderate sleep apnea [24118690, 23669094, 15611895].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24118690", "evidence_support": "In this paper we intend to argue that positional therapy, i.e., avoidance of the supine posture during sleep, could represent a valuable therapy mainly for mild-moderate OSA.", "evidence_relation": "supporting" }, { "cited_pmid": "24118690", "evidence_support": "positional therapy may be a simple, cheap and effective solution for them.", "evidence_relation": "supporting" }, { "cited_pmid": "23669094", "evidence_support": "There are conflicting data on the utility of oral appliances, while the effectiveness of weight loss and nasal expiratory resistance remains unclear. Avoidance of the supine posture is efficacious, but long term compliance data and well powered randomized controlled trials are lacking.", "evidence_relation": "contradicting" }, { "cited_pmid": "15611895", "evidence_support": "The study was performed to determine the ability of a new inclined pillow to treat snoring and obstructive sleep apnea syndrome.", "evidence_relation": "neutral" }, { "cited_pmid": "15611895", "evidence_support": "The pillow was found to be an effective and easily used treatment for mild (respiratory disturbance index [RDI] 5 to 19) and moderate (RDI 20 to 40) obstructive sleep apnea and snoring.", "evidence_relation": "supporting" }, { "cited_pmid": "15611895", "evidence_support": "A uniquely designed pillow (SONA Pillow) is effective in reducing the number of events in patients with mild to moderate obstructive sleep apnea.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, alternative treatments such as hypoglossal nerve stimulation, body positioning, and oxygen treatment may also be effective [27134515, 27689226, 26394258].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27134515", "evidence_support": "Other treatment options for OSA include improving CPAP tolerability, increasing CPAP adherence through patient interventions, weight loss/exercise, positional therapy, nasal expiratory positive airway pressure, oral pressure therapy, oral appliances, surgery, hypoglossal nerve stimulation, drug treatment, and combining 2 or more of the aforementioned treatments. ", "evidence_relation": "supporting" }, { "cited_pmid": "27689226", "evidence_support": "Recently an alternative surgical treatment has become available for these patients, which uses established techniques to stimulate the hypoglossus nerve to open the upper airway during sleep.", "evidence_relation": "supporting" }, { "cited_pmid": "26394258", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "It is essential to note that while these natural methods can be helpful, they may not be as effective as continuous positive airway pressure (CPAP) therapy, which is the gold standard treatment for sleep apnea [27242272, 28287009, 25407131].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "27242272", "evidence_support": "Although continuous positive airway pressure is the gold standard for sleep apnea treatment, its effects on quality of life are not well defined.", "evidence_relation": "contradicting" }, { "cited_pmid": "28287009", "evidence_support": "Areas covered: Continuous positive airway pressure (CPAP) is considered the gold standard therapy that delivers pressurized air into the upper airway to relieve obstruction during sleep.", "evidence_relation": "supporting" }, { "cited_pmid": "25407131", "evidence_support": "Positive airway pressure (PAP) (continuous positive airway pressure [CPAP] or bilevel positive airway pressure [BiPAP]) applications are the gold-standard treatment of sleep apnea.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "There are several natural ways to prevent and treat sleep apnea [22014867, 15162258]. Dietary modifications, such as those described in a case report of a 55-year-old man who no longer required a CPAP device after adhering to dietary changes for 3 months, may also be effective [22014867]. Additionally, oral appliances, conditioning to avoid the supine sleeping position, and inclined pillows can be used to treat mild to moderate sleep apnea [17699143, 25937875, 20362917]. Furthermore, alternative treatments such as hypoglossal nerve stimulation, body positioning, and oxygen treatment may also be effective [21881511, 26394258, 30204000]. It is essential to note that while these natural methods can be helpful, they may not be as effective as continuous positive airway pressure (CPAP) therapy, which is the gold standard treatment for sleep apnea [27134515, 25407131, 19362029]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "There are several natural ways to prevent and treat sleep apnea [22014867, 15162258].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS.", "evidence_relation": "supporting" }, { "cited_pmid": "15162258", "evidence_support": "Different nonprescription therapies are available (internal and external nasal dilators, nasal and oral lubricants, dietary supplements, magnetic pillows and matresses) but their usefulness for the treatment has not been demonstrated. The treatment of choice for sleep-related obstructive breathing disorders is nCPAP", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Dietary modifications, such as those described in a case report of a 55-year-old man who no longer required a CPAP device after adhering to dietary changes for 3 months, may also be effective [22014867].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "This report describes the chiropractic management and resolution of OSAS with dietary modifications in a 55-year-old man who wore a CPAP for 10 years.", "evidence_relation": "supporting" }, { "cited_pmid": "22014867", "evidence_support": "After adhering to dietary modifications for 3 months, the patient no longer required the use of the CPAP device and continues to have a normal active lifestyle almost 7 years later.", "evidence_relation": "supporting" }, { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, oral appliances, conditioning to avoid the supine sleeping position, and inclined pillows can be used to treat mild to moderate sleep apnea [17699143, 25937875, 20362917].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17699143", "evidence_support": "Oral appliances for the treatment of obstructive sleep apnea (OSA) are worn during sleep to maintain the patency of the upper airway by increasing its dimensions and reducing its collapsibility.", "evidence_relation": "supporting" }, { "cited_pmid": "17699143", "evidence_support": "The updated practice parameters of the American Academy of Sleep Medicine now recommend their use for mild-to-moderate OSA, or for patients with severe OSA who are unable to tolerate CPAP or refuse treatment with CPAP", "evidence_relation": "neutral" }, { "cited_pmid": "25937875", "evidence_support": "Treatment with a mandibular advancement device is very effective in treating mild and moderate obstructive sleep apnea.", "evidence_relation": "supporting" }, { "cited_pmid": "20362917", "evidence_support": "Oral appliances such as the PMPositioner are an alternative for treating obstructive sleep apnea in partly edentulous patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, alternative treatments such as hypoglossal nerve stimulation, body positioning, and oxygen treatment may also be effective [21881511, 26394258, 30204000].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21881511", "evidence_support": "The current study reviews a new treatment modality, hypoglossus stimulation, recently evaluated by multiple physiological studies and currently assessed by several clinical studies.", "evidence_relation": "supporting" }, { "cited_pmid": "21881511", "evidence_support": "Ongoing research, including recent initiation of a large multicenter phase-III study, suggests that hypoglossus nerve stimulators are likely to be available as a new treatment modality within a few years.", "evidence_relation": "supporting" }, { "cited_pmid": "21881511", "evidence_support": "Additional data are needed to define which OSA patients are most likely to benefit from hypoglossus nerve stimulation", "evidence_relation": "neutral" }, { "cited_pmid": "26394258", "evidence_support": "Hypoglossal nerve stimulation appears to be a very promising treatment for patients with moderate-to-severe OSA.", "evidence_relation": "supporting" }, { "cited_pmid": "30204000", "evidence_support": "Treatments identified included surgeries, drugs, behavior modifications, nonsurgical weight loss, medical devices, body positioning, and oxygen treatment. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is essential to note that while these natural methods can be helpful, they may not be as effective as continuous positive airway pressure (CPAP) therapy, which is the gold standard treatment for sleep apnea [27134515, 25407131, 19362029].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27134515", "evidence_support": "The current \"gold standard\" treatment for OSA is continuous positive air pressure (CPAP), which pneumatically stabilizes the upper airways.", "evidence_relation": "supporting" }, { "cited_pmid": "27134515", "evidence_support": "Despite the many options available to treat OSA, none of them are as efficacious as CPAP.", "evidence_relation": "supporting" }, { "cited_pmid": "25407131", "evidence_support": "Positive airway pressure (PAP) (continuous positive airway pressure [CPAP] or bilevel positive airway pressure [BiPAP]) applications are the gold-standard treatment of sleep apnea. ", "evidence_relation": "supporting" }, { "cited_pmid": "19362029", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "There are several natural ways to prevent and treat sleep apnea, such as dietary modifications [22014867]. Studies have shown that certain lifestyle changes, like chiropractic care and dietary adjustments, may be effective in managing obstructive sleep apnea syndrome (OSAS) [22014867]. Lifestyle modifications such as weight loss, avoiding alcohol and sedatives, and sleeping on one's side can help alleviate symptoms [37969463]. Dietary modifications, such as those described in a case report of a 55-year-old man who no longer required a CPAP device after adhering to dietary changes for 3 months, may also be effective [22014867]. Additionally, oral appliances, conditioning to avoid the supine sleeping position, and inclined pillows can be used to treat mild to moderate sleep apnea [15611895, 19710614]. Furthermore, alternative treatments such as hypoglossal nerve stimulation, body positioning, and continuous positive airway pressure therapy may also be effective for treating obstructive sleep apnea (OSA) [31699408].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "There are several natural ways to prevent and treat sleep apnea, such as dietary modifications [22014867].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Studies have shown that certain lifestyle changes, like chiropractic care and dietary adjustments, may be effective in managing obstructive sleep apnea syndrome (OSAS) [22014867].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Lifestyle modifications such as weight loss, avoiding alcohol and sedatives, and sleeping on one's side can help alleviate symptoms [37969463].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37969463", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Dietary modifications, such as those described in a case report of a 55-year-old man who no longer required a CPAP device after adhering to dietary changes for 3 months, may also be effective [22014867].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "This report describes the chiropractic management and resolution of OSAS with dietary modifications in a 55-year-old man who wore a CPAP for 10 years.", "evidence_relation": "supporting" }, { "cited_pmid": "22014867", "evidence_support": "After adhering to dietary modifications for 3 months, the patient no longer required the use of the CPAP device and continues to have a normal active lifestyle almost 7 years later.", "evidence_relation": "supporting" }, { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, oral appliances, conditioning to avoid the supine sleeping position, and inclined pillows can be used to treat mild to moderate sleep apnea [15611895, 19710614].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15611895", "evidence_support": " pillow was found to be an effective and easily used treatment for mild (respiratory disturbance index [RDI] 5 to 19) and moderate (RDI 20 to 40) obstructive sleep apnea and snoring", "evidence_relation": "supporting" }, { "cited_pmid": "15611895", "evidence_support": "A uniquely designed pillow (SONA Pillow) is effective in reducing the number of events in patients with mild to moderate obstructive sleep apnea.", "evidence_relation": "supporting" }, { "cited_pmid": "19710614", "evidence_support": "Oral appliances are an alternative to continuous positive airway pressure (CPAP) for the treatment of obstructive sleep apnea (OSA).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Furthermore, alternative treatments such as hypoglossal nerve stimulation, body positioning, and continuous positive airway pressure therapy may also be effective for treating obstructive sleep apnea (OSA) [31699408].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31699408", "evidence_support": "Hypoglossal nerve stimulation is a novel strategy for the treatment of obstructive sleep apnea (OSA).", "evidence_relation": "supporting" }, { "cited_pmid": "31699408", "evidence_support": "Patients who use the device not only show improvement in symptoms but also tolerate the device well with high rates of adherence to therapy as well as a high majority preferring it over continuous positive airway pressure therapy.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "There are several natural ways to prevent and treat sleep apnea [15162258, 22014867]. Lifestyle modifications such as explaining the basic physiology of sleep, discussing misconceptions, adopting a strategy of'stimulus control', and moderate, regular physical exercise, especially in the morning, can help alleviate symptoms of sleep disorders [19536941, 17508101]. Dietary modifications, such as those described in a case report of a 55-year-old man who no longer required a CPAP device after adhering to dietary changes for 3 months, may also be effective [22014867]. Additionally, oral appliances, conditioning to avoid the supine sleeping position, and inclined pillows can be used to treat mild to moderate sleep apnea [20362917, 24223313, 23493439]. Furthermore, alternative treatments such as hypoglossal nerve stimulation, body positioning, and oxygen treatment may also be effective [26394258, 22420172, 21881511].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "There are several natural ways to prevent and treat sleep apnea [15162258, 22014867].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15162258", "evidence_support": "Weight-loss recommendation, no alcohol and no sedatives are the first therapeutic approaches for patients with the obstructive sleep apne syndrome. ", "evidence_relation": "supporting" }, { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Lifestyle modifications such as explaining the basic physiology of sleep, discussing misconceptions, adopting a strategy of'stimulus control', and moderate, regular physical exercise, especially in the morning, can help alleviate symptoms of sleep disorders [19536941, 17508101].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19536941", "evidence_support": "One effective approach is to explain the basic physiology of sleep, to discuss misconceptions, and to adopt a strategy of \"stimulus control\"", "evidence_relation": "supporting" }, { "cited_pmid": "19536941", "evidence_support": "Moderate, regular physical exercise, especially in the morning, seems to help some patients, but the evidence is weak", "evidence_relation": "supporting" }, { "cited_pmid": "17508101", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Dietary modifications, such as those described in a case report of a 55-year-old man who no longer required a CPAP device after adhering to dietary changes for 3 months, may also be effective [22014867].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "This report describes the chiropractic management and resolution of OSAS with dietary modifications in a 55-year-old man who wore a CPAP for 10 years.", "evidence_relation": "supporting" }, { "cited_pmid": "22014867", "evidence_support": "After adhering to dietary modifications for 3 months, the patient no longer required the use of the CPAP device and continues to have a normal active lifestyle almost 7 years later.", "evidence_relation": "supporting" }, { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, oral appliances, conditioning to avoid the supine sleeping position, and inclined pillows can be used to treat mild to moderate sleep apnea [20362917, 24223313, 23493439].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20362917", "evidence_support": "We report on the use of an oral appliance fitted to a few maxillary and mandibular teeth to treat obstructive sleep apnea syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "20362917", "evidence_support": "Oral appliances such as the PMPositioner are an alternative for treating obstructive sleep apnea in partly edentulous patients.", "evidence_relation": "supporting" }, { "cited_pmid": "24223313", "evidence_support": "Supine sleep posture is consistently associated with more severe obstructive sleep apnea indices in adults.", "evidence_relation": "neutral" }, { "cited_pmid": "23493439", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, alternative treatments such as hypoglossal nerve stimulation, body positioning, and oxygen treatment may also be effective [26394258, 22420172, 21881511].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26394258", "evidence_support": "Hypoglossal nerve stimulation appears to be a very promising treatment for patients with moderate-to-severe OSA.", "evidence_relation": "supporting" }, { "cited_pmid": "21881511", "evidence_support": "Ongoing research, including recent initiation of a large multicenter phase-III study, suggests that hypoglossus nerve stimulators are likely to be available as a new treatment modality within a few years.", "evidence_relation": "supporting" }, { "cited_pmid": "22420172", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "There are several natural ways to prevent and treat sleep apnea [22014867, 15162258]. Lifestyle modifications such as weight loss, avoiding alcohol and sedatives, and sleeping on one's side can help alleviate symptoms [19011153, 15162258]. Dietary modifications, such as those described in a case report of a 55-year-old man who no longer required a CPAP device after adhering to dietary changes for 3 months, may also be effective [22014867]. Additionally, oral appliances, conditioning to avoid the supine sleeping position, and inclined pillows can be used to treat mild to moderate sleep apnea [15611895, 33510821, 17699143]. Furthermore, alternative treatments such as hypoglossal nerve stimulation, body positioning, and oxygen treatment may also be effective [23493498, 33610579]. It is essential to note that while these natural methods can be helpful, they may not be as effective as continuous positive airway pressure (CPAP) therapy, which is the gold standard treatment for sleep apnea [35625748, 19362029, 19744402]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "There are several natural ways to prevent and treat sleep apnea [22014867, 15162258].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "After adhering to dietary modifications for 3 months, the patient no longer required the use of the CPAP device and continues to have a normal active lifestyle almost 7 years later.", "evidence_relation": "supporting" }, { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS.", "evidence_relation": "neutral" }, { "cited_pmid": "15162258", "evidence_support": "Weight-loss recommendation, no alcohol and no sedatives are the first therapeutic approaches for patients with the obstructive sleep apne syndrome. ", "evidence_relation": "neutral" }, { "cited_pmid": "15162258", "evidence_support": "Different nonprescription therapies are available (internal and external nasal dilators, nasal and oral lubricants, dietary supplements, magnetic pillows and matresses) but their usefulness for the treatment has not been demonst", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Lifestyle modifications such as weight loss, avoiding alcohol and sedatives, and sleeping on one's side can help alleviate symptoms [19011153, 15162258].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19011153", "evidence_support": "The lifestyle intervention was found to effectively reduce body weight (-10.7 +/- 6.5 kg; body mass index, -3.5 +/- 2.1 [mean +/- SD]). ", "evidence_relation": "supporting" }, { "cited_pmid": "19011153", "evidence_support": "VLCD combined with active lifestyle counseling resulting in marked weight reduction is a feasible and effective treatment for the majority of patients with mild OSA, and the achieved beneficial outcomes are maintained at 1-year follow-up.\n", "evidence_relation": "supporting" }, { "cited_pmid": "15162258", "evidence_support": "Weight-loss recommendation, no alcohol and no sedatives are the first therapeutic approaches for patients with the obstructive sleep apne syndrome.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Dietary modifications, such as those described in a case report of a 55-year-old man who no longer required a CPAP device after adhering to dietary changes for 3 months, may also be effective [22014867].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "This report describes the chiropractic management and resolution of OSAS with dietary modifications in a 55-year-old man who wore a CPAP for 10 years.", "evidence_relation": "supporting" }, { "cited_pmid": "22014867", "evidence_support": "After adhering to dietary modifications for 3 months, the patient no longer required the use of the CPAP device and continues to have a normal active lifestyle almost 7 years later.", "evidence_relation": "supporting" }, { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, oral appliances, conditioning to avoid the supine sleeping position, and inclined pillows can be used to treat mild to moderate sleep apnea [15611895, 33510821, 17699143].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15611895", "evidence_support": "uniquely designed pillow (SONA Pillow) is effective in reducing the number of events in patients with mild to moderate obstructive sleep apnea", "evidence_relation": "supporting" }, { "cited_pmid": "33510821", "evidence_support": "We concluded that the SAP is an effective positional therapy device for patients with OSAS of mild-to-moderate severity", "evidence_relation": "supporting" }, { "cited_pmid": "17699143", "evidence_support": "Oral appliances have been shown to have a beneficial impact on a number of important clinical end points, including the polysomnographic indexes of OSA, subjective and objective measures of sleepiness, BP, aspects of neuropsychological functioning, and quality of life.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, alternative treatments such as hypoglossal nerve stimulation, body positioning, and oxygen treatment may also be effective [23493498, 33610579].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23493498", "evidence_support": "Oxygen (O2) administration has been used as an alternative treatment in patients with obstructive sleep apnea (OSA) who do not adhere to continuous positive airway pressure (CPAP) in order to reduce the deleterious effects of intermittent hypoxemia during sleep. ", "evidence_relation": "supporting" }, { "cited_pmid": "33610579", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "It is essential to note that while these natural methods can be helpful, they may not be as effective as continuous positive airway pressure (CPAP) therapy, which is the gold standard treatment for sleep apnea [35625748, 19362029, 19744402].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19744402", "evidence_support": "The gold standard for treatment in adults is positive airway pressure (PAP) therapy: continuous PAP (CPAP), bilevel PAP, autotitrating CPAP, or autotitrating bilevel PAP.", "evidence_relation": "supporting" }, { "cited_pmid": "35625748", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "19362029", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Preventing or treating obstructive sleep apnea (OSA) naturally involves several lifestyle modifications and behavioral strategies.Weight loss is a critical factor, as obesity is a major risk factor for OSA, and reducing body weight can significantly improve symptoms [33659106, 16944671, 14971838]. Positional therapy, which involves avoiding the supine sleeping position, can be particularly effective for patients with positional OSA, as it reduces the frequency of apneas and hypopneas [24118690, 25771294, 18250210]. Additionally, regular physical activity and dietary modifications, such as reducing salt and fluid intake, can help manage fluid retention and reduce overnight rostral fluid shift, thereby decreasing the severity of OSA [30177246, 16944671]. Avoiding alcohol and central nervous system depressants, which can exacerbate airway collapse, is also recommended [33659106, 14971838, 19037617]. These natural interventions can be beneficial, especially for patients with mild to moderate OSA, and may serve as adjuncts to other treatments like continuous positive airway pressure (CPAP) or mandibular advancement devices [18250210, 33713177].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Preventing or treating obstructive sleep apnea (OSA) naturally involves several lifestyle modifications and behavioral strategies.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Weight loss is a critical factor, as obesity is a major risk factor for OSA, and reducing body weight can significantly improve symptoms [33659106, 16944671, 14971838].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33659106", "evidence_support": "Reducing weight, quitting alcohol and smoking, eating a nutritional diet, and exercising are the modifications to benefit people.", "evidence_relation": "supporting" }, { "cited_pmid": "16944671", "evidence_support": "The role of an organized, targeted weight-loss program either as a single therapy or as a supplement to PAP needs to be clarified.", "evidence_relation": "supporting" }, { "cited_pmid": "14971838", "evidence_support": "In patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, abstaining from the use of alcohol and sedatives, losing weight, and avoiding the supine position during sleep.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Positional therapy, which involves avoiding the supine sleeping position, can be particularly effective for patients with positional OSA, as it reduces the frequency of apneas and hypopneas [24118690, 25771294, 18250210].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24118690", "evidence_support": "Positional patients show most of their breathing abnormalities while sleeping in the supine position. Simply, by sleeping in the lateral postures, they eliminate or reduce significantly the number of apneas and hypopneas.", "evidence_relation": "supporting" }, { "cited_pmid": "24118690", "evidence_support": "In this paper we intend to argue that positional therapy, i.e., avoidance of the supine posture during sleep, could represent a valuable therapy mainly for mild-moderate OSA.", "evidence_relation": "supporting" }, { "cited_pmid": "25771294", "evidence_support": "The position device utilized in this study was effective in reducing supine sleep and AHI, which was significant in those with baseline AHI \u226520.", "evidence_relation": "supporting" }, { "cited_pmid": "18250210", "evidence_support": "By avoiding supine sleep, positional therapy improves the patency of the upper airway in those with positional OSA.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, regular physical activity and dietary modifications, such as reducing salt and fluid intake, can help manage fluid retention and reduce overnight rostral fluid shift, thereby decreasing the severity of OSA [30177246, 16944671].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30177246", "evidence_support": ". It has recently been shown that interventions targeting fluid overload and daytime fluid accumulation in the legs consistently attenuate nocturnal fluid shift and sleep apnea, as greater reductions in fluid shift are correlated with greater reductions in sleep apnea severity.", "evidence_relation": "supporting" }, { "cited_pmid": "16944671", "evidence_support": "Several of these therapies such as weight loss and positional therapy hold some promise", "evidence_relation": "supporting" }, { "cited_pmid": "16944671", "evidence_support": "The role of an organized, targeted weight-loss program either as a single therapy or as a supplement to PAP needs to be clarified. Although bariatric surgery is increasingly performed for refractory medically complicated obesity, its long-term effectiveness in treatment of obstructive sleep apnea in morbidly obese patients is not yet demonstrated", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Avoiding alcohol and central nervous system depressants, which can exacerbate airway collapse, is also recommended [33659106, 14971838, 19037617].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33659106", "evidence_support": "Reducing weight, quitting alcohol and smoking, eating a nutritional diet, and exercising are the modifications to benefit people.", "evidence_relation": "supporting" }, { "cited_pmid": "14971838", "evidence_support": "In patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, abstaining from the use of alcohol and sedatives, losing weight, and avoiding the supine position during sleep.", "evidence_relation": "supporting" }, { "cited_pmid": "19037617", "evidence_support": "Weight loss as well as avoidance of alcohol and other CNS depressants is generally recommended.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "These natural interventions can be beneficial, especially for patients with mild to moderate OSA, and may serve as adjuncts to other treatments like continuous positive airway pressure (CPAP) or mandibular advancement devices [18250210, 33713177].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "18250210", "evidence_support": "By avoiding supine sleep, positional therapy improves the patency of the upper airway in those with positional OSA.", "evidence_relation": "supporting" }, { "cited_pmid": "33713177", "evidence_support": "Alternative treatments including mandibular advancement device, hypoglossal nerve stimulator, positional therapies, and surgical options coupled with weight loss and exercise offer possibilities of an individualized personal approach to OSAS.", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Preventing or treating sleep apnea naturally involves lifestyle modifications that target risk factors.Weight loss is crucial, as obesity is a significant contributor to obstructive sleep apnea (OSA).Regular physical activity can improve respiratory function and reduce apnea episodes.Positional therapy, such as sleeping on one's side, can prevent airway obstruction in some patients.Avoiding alcohol and sedatives before bedtime is important, as these substances relax throat muscles and exacerbate apnea.Smoking cessation is also beneficial, as smoking can increase inflammation and fluid retention in the upper airway.Nasal decongestants or allergy treatments may help if nasal congestion is a contributing factor.While these measures can be effective for mild cases, moderate to severe sleep apnea often requires medical interventions such as continuous positive airway pressure (CPAP) therapy or surgical options.Always consider individual patient factors when recommending natural treatments.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Preventing or treating sleep apnea naturally involves lifestyle modifications that target risk factors.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Weight loss is crucial, as obesity is a significant contributor to obstructive sleep apnea (OSA).Regular physical activity can improve respiratory function and reduce apnea episodes.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Positional therapy, such as sleeping on one's side, can prevent airway obstruction in some patients.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Avoiding alcohol and sedatives before bedtime is important, as these substances relax throat muscles and exacerbate apnea.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Smoking cessation is also beneficial, as smoking can increase inflammation and fluid retention in the upper airway.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Nasal decongestants or allergy treatments may help if nasal congestion is a contributing factor.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "While these measures can be effective for mild cases, moderate to severe sleep apnea often requires medical interventions such as continuous positive airway pressure (CPAP) therapy or surgical options.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "8", "answer_sentence": "Always consider individual patient factors when recommending natural treatments.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Preventing sleep apnea or treating it naturally can be achieved through various lifestyle modifications and conservative approaches.Weight loss is a recommended treatment for mild sleep apnea, as it can significantly reduce the severity of the condition [33659106, 14971838, 19037617]. Avoiding the supine sleep position, also known as positional therapy, can also be effective in reducing sleep apnea severity, particularly in positional patients [24118690, 17762999, 25771294]. Additionally, avoiding alcohol and sedatives, getting sufficient sleep, and exercising regularly can also help alleviate symptoms [14971838, 21728019]. Furthermore, a holistic approach to managing obstructive sleep apnea, including identifying patients at risk and developing strategies to prevent the condition, is also important [30709524]. These natural and conservative approaches can be used in conjunction with other treatments, such as continuous positive airway pressure (CPAP) therapy, to effectively manage sleep apnea.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Preventing sleep apnea or treating it naturally can be achieved through various lifestyle modifications and conservative approaches.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Weight loss is a recommended treatment for mild sleep apnea, as it can significantly reduce the severity of the condition [33659106, 14971838, 19037617].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14971838", "evidence_support": "In patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, abstaining from the use of alcohol and sedatives, losing weight, and avoiding the supine position during sleep.", "evidence_relation": "supporting" }, { "cited_pmid": "19037617", "evidence_support": "Weight loss as well as avoidance of alcohol and other CNS depressants is generally recommended.", "evidence_relation": "supporting" }, { "cited_pmid": "33659106", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Avoiding the supine sleep position, also known as positional therapy, can also be effective in reducing sleep apnea severity, particularly in positional patients [24118690, 17762999, 25771294].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24118690", "evidence_support": "Simply, by sleeping in the lateral postures, they eliminate or reduce significantly the number of apneas and hypopneas.", "evidence_relation": "supporting" }, { "cited_pmid": "24118690", "evidence_support": "In this paper we intend to argue that positional therapy, i.e., avoidance of the supine posture during sleep, could represent a valuable therapy mainly for mild-moderate OSA.", "evidence_relation": "supporting" }, { "cited_pmid": "17762999", "evidence_support": "Preventing sleeping on the back is a way to treat OSA.", "evidence_relation": "supporting" }, { "cited_pmid": "25771294", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, avoiding alcohol and sedatives, getting sufficient sleep, and exercising regularly can also help alleviate symptoms [14971838, 21728019].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14971838", "evidence_support": "In patients with mild sleep apnea, conservative treatment measures include getting sufficient sleep, abstaining from the use of alcohol and sedatives, losing weight, and avoiding the supine position during sleep. ", "evidence_relation": "supporting" }, { "cited_pmid": "21728019", "evidence_support": "In our practice, a multifaceted management model consisting of behavioral modification incorporating weight loss education, sleep hygiene education, and avoidance of exacerbating factors such as alcohol is usually employed in addition to positive airway pressure.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, a holistic approach to managing obstructive sleep apnea, including identifying patients at risk and developing strategies to prevent the condition, is also important [30709524].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30709524", "evidence_support": "A holistic approach is pertinent in managing obstructive sleep apnea (OSA). ", "evidence_relation": "supporting" }, { "cited_pmid": "30709524", "evidence_support": "The future of OSA management lies in identifying patients at risk of developing OSA and developing strategy to prevent OSA from taking root.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "These natural and conservative approaches can be used in conjunction with other treatments, such as continuous positive airway pressure (CPAP) therapy, to effectively manage sleep apnea.", "answer_sentence_relevance": "borderline", "citation_assessment": null } ] }, "ten-shot-gemini-flash": { "answer": "While continuous positive airway pressure (CPAP) is the most common treatment for obstructive sleep apnea (OSA), its effectiveness is limited by low adherence rates [26394258]. Therefore, alternative approaches are being explored, including neuromodulation to maintain an open airway [26394258]. Dietary modifications have shown promise in managing OSA, as one case study demonstrated resolution of OSA after 3 months of dietary changes [22014867]. This suggests that dietary modifications may be an effective tool for OSA management [22014867]. Additionally, addressing risk factors like obesity and hypothyroidism is crucial for OSA treatment [11283828]. Lifestyle changes, such as weight loss and avoiding alcohol and sedatives before bed, can also help prevent and manage OSA [11096715]. However, the long-term prognosis of OSA in children is still unknown [10065221].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "While continuous positive airway pressure (CPAP) is the most common treatment for obstructive sleep apnea (OSA), its effectiveness is limited by low adherence rates [26394258].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26394258", "evidence_support": "Continuous positive airway pressure (CPAP) is the most commonly used treatment and is highly effective, but its use is limited by low long-term adherence rates and overall poor acceptance among the patients. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Therefore, alternative approaches are being explored, including neuromodulation to maintain an open airway [26394258].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "26394258", "evidence_support": "Therefore, there is a need for developing alternative approaches to OSA treatment, including a more 'natural' concept of maintaining an open airway through neuromodulation. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Dietary modifications have shown promise in managing OSA, as one case study demonstrated resolution of OSA after 3 months of dietary changes [22014867].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "After adhering to dietary modifications for 3 months, the patient no longer required the use of the CPAP device and continues to have a normal active lifestyle almost 7 years later.", "evidence_relation": "supporting" }, { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "This suggests that dietary modifications may be an effective tool for OSA management [22014867].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, addressing risk factors like obesity and hypothyroidism is crucial for OSA treatment [11283828].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "11283828", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Lifestyle changes, such as weight loss and avoiding alcohol and sedatives before bed, can also help prevent and manage OSA [11096715].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "11096715", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "7", "answer_sentence": "However, the long-term prognosis of OSA in children is still unknown [10065221].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "10065221", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "While limited preventive and treatment methods are currently available for sleep apnea [35965683], some natural approaches may help manage the condition. Dietary modifications have been shown to be effective in improving obstructive sleep apnea syndrome (OSAS) [22014867]. In one case, a patient who had used a CPAP device for 10 years was able to discontinue its use after adhering to dietary modifications for 3 months [22014867]. Additionally, addressing significant risk factors such as obesity and hypothyroidism can contribute to treatment [11283828]. It is important to note that these natural approaches may not be suitable for all individuals and should be discussed with a healthcare professional. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "While limited preventive and treatment methods are currently available for sleep apnea [35965683], some natural approaches may help manage the condition.", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "35965683", "evidence_support": "Limited preventive and treatment methods are currently available for this condition.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Dietary modifications have been shown to be effective in improving obstructive sleep apnea syndrome (OSAS) [22014867].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "Dietary modifications may be an effective tool to improve the management of OSAS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In one case, a patient who had used a CPAP device for 10 years was able to discontinue its use after adhering to dietary modifications for 3 months [22014867].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "22014867", "evidence_support": "After adhering to dietary modifications for 3 months, the patient no longer required the use of the CPAP device and continues to have a normal active lifestyle almost 7 years later.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, addressing significant risk factors such as obesity and hypothyroidism can contribute to treatment [11283828].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "11283828", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is important to note that these natural approaches may not be suitable for all individuals and should be discussed with a healthcare professional.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gpt4o-mini": { "answer": "To prevent and treat sleep apnea naturally, several lifestyle changes are recommended. Weight loss is crucial, as it can significantly reduce the severity of obstructive sleep apnea (OSA) and improve related health issues [20202954, 29058628]. Avoiding alcohol and sedatives, especially in the evening, is also advised [17028491, 38022002]. Additionally, positional therapy, such as avoiding sleeping on the back, can help alleviate symptoms [17028491, 30054649]. \n\nOral appliances, like mandibular advancement devices, can improve nocturnal breathing and are considered effective alternatives to continuous positive airway pressure (CPAP) therapy [26321833, 23585745]. Other options include exercise training, which has shown favorable effects on OSA severity [29058628, 24947878]. For mild cases, mouth-taping has been reported to reduce snoring and apnea severity [36141367].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "To prevent and treat sleep apnea naturally, several lifestyle changes are recommended.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Weight loss is crucial, as it can significantly reduce the severity of obstructive sleep apnea (OSA) and improve related health issues [20202954, 29058628].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20202954", "evidence_support": "Weight loss has been accompanied by improvement in characteristics related not only to obesity but to OSA as well, suggesting that weight loss might be a cornerstone of the treatment of both conditions. This review seeks to explore recent developments in understanding the int", "evidence_relation": "supporting" }, { "cited_pmid": "20202954", "evidence_support": "Weight loss helps reduce OSA severity and attenuates the cardiometabolic abnormalities common to both diseases.", "evidence_relation": "supporting" }, { "cited_pmid": "29058628", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Avoiding alcohol and sedatives, especially in the evening, is also advised [17028491, 38022002].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17028491", "evidence_support": "Weight loss, avoidance of nocturnal sedatives, cessation of evening alcohol ingestion, and avoidance of the supine position during sleep are initial therapeutic actions in mild obstructive sleep apnea syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "38022002", "evidence_support": "It is advised to start with lifestyle changes such as quitting alcohol and sedative use, losing weight, and exercising frequently.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, positional therapy, such as avoiding sleeping on the back, can help alleviate symptoms [17028491, 30054649].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17028491", "evidence_support": "avoidance of the supine position during sleep are initial therapeutic actions in mild obstructive sleep apnea syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "30054649", "evidence_support": "Alternative treatments include mandibular advancement devices or positional devices to prevent patients sleeping on their back, as well as anatomy-altering surgical procedures", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Oral appliances, like mandibular advancement devices, can improve nocturnal breathing and are considered effective alternatives to continuous positive airway pressure (CPAP) therapy [26321833, 23585745].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26321833", "evidence_support": "oral appliance for the treatment of OSA is considered as an effective, low-risk alternative to CPAP.", "evidence_relation": "supporting" }, { "cited_pmid": "26321833", "evidence_support": "Custom made oral appliance is a useful treatment option for improving quality of sleep and can be considered as an alternative treatment modality", "evidence_relation": "supporting" }, { "cited_pmid": "23585745", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Other options include exercise training, which has shown favorable effects on OSA severity [29058628, 24947878].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29058628", "evidence_support": "Clinical trials have shown a favorable effect of exercise training on OSA severity in middle-aged adults.", "evidence_relation": "supporting" }, { "cited_pmid": "29058628", "evidence_support": "Exercise is a low-cost intervention that could help to detain the trend towards age-dependent loss of pharyngeal motor units and progressive severity of obstructive sleep apnea", "evidence_relation": "supporting" }, { "cited_pmid": "24947878", "evidence_support": "Exercise training may improve components of metabolic syndrome and obstructive sleep apnea syndrome (OSAS). ", "evidence_relation": "supporting" }, { "cited_pmid": "24947878", "evidence_support": "IET reduced OSAS severity with improvement of metabolic syndrome components with concomitant loss in body fat in sedentary adults. If confirmed on a larger scale, a comprehensive rehabilitation program could constitute an additional or alternative treatment for moderate to severe OSAS patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "For mild cases, mouth-taping has been reported to reduce snoring and apnea severity [36141367].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36141367", "evidence_support": "We used 3M silicone hypoallergenic tape was used to seal the mouths of the participants during sleep.", "evidence_relation": "supporting" }, { "cited_pmid": "36141367", "evidence_support": "Mouth-taping during sleep improved snoring and the severity of sleep apnea in mouth-breathers with mild OSA, with AHI and SI being reduced by about half.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Unfortunately, there are no relevant snippets provided to construct an answer regarding natural remedies for preventing and treating sleep apnea. If you have specific studies or information related to this topic, please share them, and I would be happy to help formulate a concise response based on that information.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Unfortunately, there are no relevant snippets provided to construct an answer regarding natural remedies for preventing and treating sleep apnea.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "If you have specific studies or information related to this topic, please share them, and I would be happy to help formulate a concise response based on that information.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-1": { "answer": "There are ways to prevent and treat sleep apnea naturally, such as managing nasal passage diseases and using medications to treat them, and managing both insomnia and sleep apnea together [37082825,20425226,36333079]. However, the progress in developing therapies to prevent and treat neural injury in obstructive sleep apnea is palpable [23293626,20425226].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "There are ways to prevent and treat sleep apnea naturally, such as managing nasal passage diseases and using medications to treat them, and managing both insomnia and sleep apnea together [37082825,20425226,36333079].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37082825", "evidence_support": "The successful management of chronic rhinosinusitis can improve positive airway pressure tolerance and adherence. A wide range of over-the-counter and prescription pharmacotherapy is available, with data supporting intranasal over oral treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "36333079", "evidence_support": "Approximately 30% to 50% of sleep clinic patients with sleep apnea report comorbid insomnia symptoms. ", "evidence_relation": "neutral" }, { "cited_pmid": "36333079", "evidence_support": "Comorbid insomnia is associated with lower adherence to positive airway pressure therapy for obstructive sleep apnea.", "evidence_relation": "neutral" }, { "cited_pmid": "20425226", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "However, the progress in developing therapies to prevent and treat neural injury in obstructive sleep apnea is palpable [23293626,20425226].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23293626", "evidence_support": "Collectively, this information sets the stage for developing and testing novel therapeutic approaches to treat and prevent, not only central nervous system injury and dysfunction in sleep apnea, but also the cardiovascular and potentially metabolic conditions associated with this prevalent, disabling disorder.", "evidence_relation": "supporting" }, { "cited_pmid": "20425226", "evidence_support": "The progress in elucidating mechanisms of neural injury is palpable, and it now seems we indeed are closer to developing therapies to prevent and treat neural injury in obstructive sleep apnea", "evidence_relation": "supporting" } ] } ] }, "webis-2": { "answer": "The question asks for natural ways to prevent or treat sleep apnea, but the context does not provide any information about natural ways to prevent or treat sleep apnea.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The question asks for natural ways to prevent or treat sleep apnea, but the context does not provide any information about natural ways to prevent or treat sleep apnea.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-3": { "answer": "There is no natural way to prevent sleep apnea. Treatment options for sleep apnea in children include adenotonsillectomy, which is the first line treatment, but improvement in objectively documented outcomes is often inadequate and a substantial number of children have residual disease [28052557]. A multidisciplinary approach is required as most of them have additional risk factors for sleep apnea and comorbidities [28052557]. Different diagnostic modalities are available to evaluate the sites of persistent upper airway obstruction and currently available treatment options are discussed in the literature [28052557].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "There is no natural way to prevent sleep apnea.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Treatment options for sleep apnea in children include adenotonsillectomy, which is the first line treatment, but improvement in objectively documented outcomes is often inadequate and a substantial number of children have residual disease [28052557].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "28052557", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "A multidisciplinary approach is required as most of them have additional risk factors for sleep apnea and comorbidities [28052557].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "28052557", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Different diagnostic modalities are available to evaluate the sites of persistent upper airway obstruction and currently available treatment options are discussed in the literature [28052557].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "28052557", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-5": { "answer": "There is no natural way to prevent sleep apnea. Treatment options for sleep apnea in children include adenotonsillectomy, which is the first line treatment, but improvement in objectively documented outcomes is often inadequate and a substantial number of children have residual disease [28052557]. A multidisciplinary approach is required as most of them have additional risk factors for sleep apnea and comorbidities [28052557]. Different diagnostic modalities are available to evaluate the sites of persistent upper airway obstruction and currently available treatment options are discussed in the literature [28052557].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "There is no natural way to prevent sleep apnea.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Treatment options for sleep apnea in children include adenotonsillectomy, which is the first line treatment, but improvement in objectively documented outcomes is often inadequate and a substantial number of children have residual disease [28052557].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28052557", "evidence_support": "Although adenotonsillectomy is the first line treatment for children with obstructive sleep apnea syndrome (0SAS),1 improvement in objectively documented outcomes is often inadequate and a substantial number of children have residual disease.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "A multidisciplinary approach is required as most of them have additional risk factors for sleep apnea and comorbidities [28052557].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28052557", "evidence_support": "The management of these children is frequently complex and a multidisciplinary approach is required as most of them have additional risk factors for OSAS and comorbidities.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Different diagnostic modalities are available to evaluate the sites of persistent upper airway obstruction and currently available treatment options are discussed in the literature [28052557].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "28052557", "evidence_support": "Thereafter, we discuss different diagnostic modalities to evaluate the sites of persistent upper airway obstruction and the currently available treatment options.", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-1": { "answer": "There are several natural approaches to prevent and treat sleep apnea, including maintaining a healthy weight, avoiding alcohol and sedatives, sleeping on one's side, and practicing good sleep hygiene. Additionally, certain exercises, such as those that strengthen the throat muscles, may help reduce the severity of sleep apnea symptoms. However, it is important to consult a healthcare professional for personalized advice and treatment options.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "There are several natural approaches to prevent and treat sleep apnea, including maintaining a healthy weight, avoiding alcohol and sedatives, sleeping on one's side, and practicing good sleep hygiene.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, certain exercises, such as those that strengthen the throat muscles, may help reduce the severity of sleep apnea symptoms.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "However, it is important to consult a healthcare professional for personalized advice and treatment options.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "Question: Are there ways to prevent sleep apnea or treat it naturally?", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Question: Are there ways to prevent sleep apnea or treat it naturally?", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-gpt-6": { "answer": "There is no specific context provided regarding natural prevention or treatment methods for sleep apnea. However, general approaches to manage sleep apnea may include lifestyle changes such as weight loss, regular exercise, avoiding alcohol and sedatives, and sleeping on one's side. These strategies can help reduce the severity of sleep apnea symptoms.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "There is no specific context provided regarding natural prevention or treatment methods for sleep apnea.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "However, general approaches to manage sleep apnea may include lifestyle changes such as weight loss, regular exercise, avoiding alcohol and sedatives, and sleeping on one's side.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "These strategies can help reduce the severity of sleep apnea symptoms.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "zero-shot-gemini-flash": { "answer": "Natural remedies for sleep apnea often focus on lifestyle modifications [33659106, 37532368]. Weight loss is a cornerstone of treatment, with a 7-11% reduction significantly improving sleep apnea [30709529]. This can be achieved through dietary changes and physical activity [30709529, 32334866]. Quitting smoking and alcohol consumption can also be beneficial [33659106]. Position modification, such as avoiding sleeping on your back, may also help [19412478]. While these interventions are highly recommended, they may not be sufficient for all patients [33318366]. In cases where conservative measures fail, continuous positive airway pressure (CPAP) is the preferred treatment [14694548]. Surgical interventions are considered only after non-surgical options have been exhausted [14694548]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Natural remedies for sleep apnea often focus on lifestyle modifications [33659106, 37532368].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33659106", "evidence_support": "Although several therapeutic modalities are available for curing OSA, behavioral therapies are also utilized for a positive outcome", "evidence_relation": "supporting" }, { "cited_pmid": "37532368", "evidence_support": "With rising obesity rates, weight loss and lifestyle programs seem to be the most favorable integrative methods to combine with conventional OSA therapies", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Weight loss is a cornerstone of treatment, with a 7-11% reduction significantly improving sleep apnea [30709529].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30709529", "evidence_support": "Weight loss of 7% to 11% significantly improves OSA with remission seen with greater weight loss.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This can be achieved through dietary changes and physical activity [30709529, 32334866].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30709529", "evidence_support": "This article discusses specific weight loss interventions effective in improving OSA, including lifestyle interventions with dietary modification and physical activity, pharmacotherapy, and bariatric surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "32334866", "evidence_support": "Lifestyle interventions are cornerstones of weight management. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Quitting smoking and alcohol consumption can also be beneficial [33659106].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33659106", "evidence_support": "Reducing weight, quitting alcohol and smoking, eating a nutritional diet, and exercising are the modifications to benefit people.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Position modification, such as avoiding sleeping on your back, may also help [19412478].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19412478", "evidence_support": "There is some evidence for the use of conservative interventions such as weight loss and position modification. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "While these interventions are highly recommended, they may not be sufficient for all patients [33318366].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "33318366", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "In cases where conservative measures fail, continuous positive airway pressure (CPAP) is the preferred treatment [14694548].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "14694548", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Surgical interventions are considered only after non-surgical options have been exhausted [14694548].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "14694548", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "To prevent and treat sleep apnea naturally, weight loss and lifestyle modifications are highly recommended, especially for obese individuals [35460431, 24061345]. Patients should also avoid sleep deprivation, sedatives, and alcohol [12973373, 15162258]. Mandibular advancement devices (MAD) and positional therapy are promising alternative therapies, particularly for those with positional obstructive sleep apnea [35460431, 32386700]. Additionally, sleeping on one's side can help in mild cases [15162258]. While various nonprescription therapies exist, such as nasal dilators and dietary supplements, their effectiveness remains unproven [15162258]. Recent technological advances have also enhanced interest in positional therapy, offering new devices for better management [30709524, 30709526]. Overall, a combination of weight management and alternative therapies may provide effective natural treatment options for sleep apnea.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "To prevent and treat sleep apnea naturally, weight loss and lifestyle modifications are highly recommended, especially for obese individuals [35460431, 24061345].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35460431", "evidence_support": "Weight loss and lifestyle modifications are highly recommended in all obese or overweight patients.", "evidence_relation": "supporting" }, { "cited_pmid": "24061345", "evidence_support": "ACP recommends that all overweight and obese patients diagnosed with OSA should be encouraged to lose weight. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Patients should also avoid sleep deprivation, sedatives, and alcohol [12973373, 15162258].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15162258", "evidence_support": "Weight-loss recommendation, no alcohol and no sedatives are the first therapeutic approaches for patients with the obstructive sleep apne syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "12973373", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Mandibular advancement devices (MAD) and positional therapy are promising alternative therapies, particularly for those with positional obstructive sleep apnea [35460431, 32386700].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35460431", "evidence_support": "Mandibular advancement devices (MAD), positional therapy (PT) and hypoglossal nerve stimulation (HSN) are recent and personalized alternative therapies on which there is promising and encouraging data but with still little strong scientific evidence.", "evidence_relation": "supporting" }, { "cited_pmid": "32386700", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, sleeping on one's side can help in mild cases [15162258].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15162258", "evidence_support": "If there is a postural component in mild cases sleeping on the side can help.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "While various nonprescription therapies exist, such as nasal dilators and dietary supplements, their effectiveness remains unproven [15162258].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "15162258", "evidence_support": "Different nonprescription therapies are available (internal and external nasal dilators, nasal and oral lubricants, dietary supplements, magnetic pillows and matresses) but their usefulness for the treatment has not been demonstrated.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Recent technological advances have also enhanced interest in positional therapy, offering new devices for better management [30709524, 30709526].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30709524", "evidence_support": "The future of OSA management lies in identifying patients at risk of developing OSA and developing strategy to prevent OSA from taking root. ", "evidence_relation": "neutral" }, { "cited_pmid": "30709526", "evidence_support": "Positional therapy appears to be an attractive strategy for many patients with positional obstructive sleep apnea (OSA).", "evidence_relation": "supporting" }, { "cited_pmid": "30709526", "evidence_support": "Recent technological advances have renewed interest in positional therapy, with the invention of new sophisticated vibratory positional therapy devices. These devices have shown great promise with efficacy, markedly improved patient tolerance, and long-term adherence.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Overall, a combination of weight management and alternative therapies may provide effective natural treatment options for sleep apnea.", "answer_sentence_relevance": "required", "citation_assessment": null } ] } } }, { "question_id": "117", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Chromosome 22q11.2 deletion syndrome, which is the most common microdeletion syndrome in humans, highlights the complexity of genetic influences on the immune system. Mutations or deletions in regions like RUNX2 lead to various developmental issues, such as thymic hypoplasia, which limits T cell production and contributes to a Th2 polarization, increasing the risk of atopic conditions in adulthood. These genetic changes also elevate the risk of autoimmunity due to low regulatory T cell levels [30565249]. Genetic variants related to immune dysregulation have been observed in other conditions like familial Mediterranean fever (FMF), emphasizing the intricate interaction between genetics and environment. Similarly, in euryhaline teleost fish, stress response and hormone regulation in osmoregulatory organs showcase how genetic expression adapts to environmental stress, providing parallels to how RUNX2 mutations impact human development [36982391].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Chromosome 22q11.2 deletion syndrome, which is the most common microdeletion syndrome in humans, highlights the complexity of genetic influences on the immune system.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Mutations or deletions in regions like RUNX2 lead to various developmental issues, such as thymic hypoplasia, which limits T cell production and contributes to a Th2 polarization, increasing the risk of atopic conditions in adulthood.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "These genetic changes also elevate the risk of autoimmunity due to low regulatory T cell levels [30565249].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30565249", "evidence_support": "Thymic hypoplasia also contributes to low regulatory T cells and this may be part of the overall increased risk of autoimmunity.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Genetic variants related to immune dysregulation have been observed in other conditions like familial Mediterranean fever (FMF), emphasizing the intricate interaction between genetics and environment.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Similarly, in euryhaline teleost fish, stress response and hormone regulation in osmoregulatory organs showcase how genetic expression adapts to environmental stress, providing parallels to how RUNX2 mutations impact human development [36982391].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36982391", "evidence_support": "In euryhaline teleost black porgy, Acanthopagrus schlegelii, the glucocorticoid receptor (gr), growth hormone receptor (ghr), prolactin (prl)-receptor (prlr), and sodium-potassium ATPase alpha subunit (\u03b1-nka) play essential physiological roles in the osmoregulatory organs, including the gill, kidney, and intestine, during osmotic stress.", "evidence_relation": "neutral" } ] } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "A mutation in the RUNX2 gene will significantly impact future bone and teeth development, leading to cleidocranial dysplasia (CCD) [37500953, 27509906, 29947791]. This mutation will cause delayed closure of cranial sutures and result in hypoplastic or aplastic clavicles, contributing to short stature [27509906, 16244783, 15099800]. Dental anomalies, including delayed eruption of permanent teeth and the presence of supernumerary teeth, will also occur [27509906, 29947791, 30391791]. The mutation will disrupt both endochondral and intramembranous bone formation, reducing calvarial bone volume [37500953, 25079226, 24222232]. It will affect osteoblast differentiation, compromising osteogenic potential and reducing the expression of bone marker genes [37500953, 29947791, 25079226]. Additionally, the mineralized capacity of dental follicle cells will be affected, leading to unique dental phenotypes [27509906, 29947791, 36175952]. The transcriptional activity of the RUNX2 gene will be altered, causing mislocalization and reduced stability of the RUNX2 protein [37500953, 20872798, 23659235]. Consequently, the overall bone formation and mineralization processes will be impaired, significantly affecting skeletal integrity and dental health [37500953, 27509906, 25079226].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A mutation in the RUNX2 gene will significantly impact future bone and teeth development, leading to cleidocranial dysplasia (CCD) [37500953, 27509906, 29947791].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37500953", "evidence_support": "Cleidocranial dysplasia (CCD) is a genetic disorder caused by mutations in the RUNX2 gene, affecting bone and teeth development.", "evidence_relation": "supporting" }, { "cited_pmid": "27509906", "evidence_support": "Heterozygous mutation of RUNX2 can cause cleidocranial dysplasia (CCD), a systemic disease with extensive skeletal dysplasia and abnormality of tooth growth.", "evidence_relation": "supporting" }, { "cited_pmid": "29947791", "evidence_support": "Disturbed permanent tooth eruption is common in cleidocranial dysplasia (CCD), a skeletal disorder caused by heterozygous mutation of RUNX2, but the mechanism underlying is still unclear.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This mutation will cause delayed closure of cranial sutures and result in hypoplastic or aplastic clavicles, contributing to short stature [27509906, 16244783, 15099800].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15099800", "evidence_support": "Genetic studies have recently identified a mutation of one allele of runt-related gene 2 (RUNX2/CBFA1) as the cause for an autosomal-dominant skeletal disorder, cleidocranial dysplasia (CCD), which is characterised by hypoplasia of the clavicles and calvariae and widened sutures and fontanelles.", "evidence_relation": "supporting" }, { "cited_pmid": "27509906", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16244783", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Dental anomalies, including delayed eruption of permanent teeth and the presence of supernumerary teeth, will also occur [27509906, 29947791, 30391791].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27509906", "evidence_support": "These effects may contribute in part to the pathological manifestations of retention of primary teeth and delayed eruption of permanent teeth in patients with CCD.", "evidence_relation": "supporting" }, { "cited_pmid": "29947791", "evidence_support": "As it is well known that dental follicle cells (DFCs) play a critical role in tooth eruption, the changed biological characteristics of DFCs might give rise to disturbance of permanent tooth eruption in CCD patients. ", "evidence_relation": "supporting" }, { "cited_pmid": "29947791", "evidence_support": "This effect may provide valuable explanations and implications for the mechanism of delayed permanent tooth eruption in CCD patients.", "evidence_relation": "neutral" }, { "cited_pmid": "30391791", "evidence_support": "Cleidocranial dysplasia (CCD), mainly caused by RUNX2 mutation, is a dominantly inherited skeletal disorder with many dental abnormalities, characterized by delayed permanent tooth eruption.", "evidence_relation": "supporting" }, { "cited_pmid": "30391791", "evidence_support": "These effects may be partly responsible for the defects in permanent tooth eruption of CCD patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The mutation will disrupt both endochondral and intramembranous bone formation, reducing calvarial bone volume [37500953, 25079226, 24222232].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24222232", "evidence_support": "The runt-related transcription factor 2 gene (RUNX2), which is also known as CBFA1, is a master regulatory gene in bone formation.", "evidence_relation": "neutral" }, { "cited_pmid": "37500953", "evidence_support": "Mislocalization of RUNX2 and reduced expression of downstream genes were observed in MSCs from a CCD patient with the p.Ser247Valfs*3 mutation, leading to compromised osteogenic potential.", "evidence_relation": "neutral" }, { "cited_pmid": "25079226", "evidence_support": "Consequently, Runx2 mutant bones exhibited decreased stiffness and structural integrity. By 3 months of age, bone acquisition in mutant mice was roughly half that of wild-type littermates.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It will affect osteoblast differentiation, compromising osteogenic potential and reducing the expression of bone marker genes [37500953, 29947791, 25079226].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37500953", "evidence_support": "Mislocalization of RUNX2 and reduced expression of downstream genes were observed in MSCs from a CCD patient with the p.Ser247Valfs*3 mutation, leading to compromised osteogenic potential.", "evidence_relation": "supporting" }, { "cited_pmid": "29947791", "evidence_support": "fter osteogenic induction, we found that the mineralised capacity of DFCs and the expression of osteoblast-related genes, including RUNX2, ALP, OSX, OCN and Col I\u03b11, in DFCs was severely interfered by the RUNX2 mutation found in CCD patients", "evidence_relation": "supporting" }, { "cited_pmid": "25079226", "evidence_support": "The Runx2 transcription factor is critical for commitment to the osteoblast lineage", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Additionally, the mineralized capacity of dental follicle cells will be affected, leading to unique dental phenotypes [27509906, 29947791, 36175952].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29947791", "evidence_support": "After osteogenic induction, we found that the mineralised capacity of DFCs and the expression of osteoblast-related genes, including RUNX2, ALP, OSX, OCN and Col I\u03b11, in DFCs was severely interfered by the RUNX2 mutation found in CCD patients.", "evidence_relation": "supporting" }, { "cited_pmid": "36175952", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "27509906", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "The transcriptional activity of the RUNX2 gene will be altered, causing mislocalization and reduced stability of the RUNX2 protein [37500953, 20872798, 23659235].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23659235", "evidence_support": "The RUNX2 mutations identified were assessed for their effect on the subcellular localization of the mutant RUNX2 proteins because of previously reported inconsistent findings", "evidence_relation": "supporting" }, { "cited_pmid": "37500953", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "20872798", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Consequently, the overall bone formation and mineralization processes will be impaired, significantly affecting skeletal integrity and dental health [37500953, 27509906, 25079226].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37500953", "evidence_support": "Cleidocranial dysplasia (CCD) is a genetic disorder caused by mutations in the RUNX2 gene, affecting bone and teeth development", "evidence_relation": "supporting" }, { "cited_pmid": "27509906", "evidence_support": "Heterozygous mutation of RUNX2 can cause cleidocranial dysplasia (CCD), a systemic disease with extensive skeletal dysplasia and abnormality of tooth growth", "evidence_relation": "supporting" }, { "cited_pmid": "27509906", "evidence_support": "These outcomes indicate that the RUNX2 mutation disturbs the modulatory effects of DFCs and PDLCs on the differentiation of osteoclasts and osteoblasts, thereby interfering with bone remodelling. ", "evidence_relation": "supporting" }, { "cited_pmid": "25079226", "evidence_support": ". Runx2 mutants showed progressive retardation in postnatal growth and exhibited significantly low bone mass by 1 month of age", "evidence_relation": "supporting" }, { "cited_pmid": "25079226", "evidence_support": "Decreased bone formation was associated with decreased gene expression of osteoblast markers and impaired collagen assembly in the extracellular matri", "evidence_relation": "supporting" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Mutations in the RUNX2 gene, which are responsible for cleidocranial dysplasia (CCD), significantly impact bone and dental development by disrupting osteoblast differentiation and bone remodeling processes.These mutations lead to mislocalization of the RUNX2 protein, reduced expression of osteoblast-related genes, and impaired osteogenic potential, as observed in mesenchymal stem cells and dental follicle cells from CCD patients [37500953, 27509906, 29947791]. Additionally, RUNX2 mutations interfere with osteoclastogenesis by altering the RANKL/OPG signaling pathway, further contributing to delayed tooth eruption and bone resorption deficiencies [27068678, 32008052]. The severity of phenotypic manifestations can vary, potentially due to differences in the degree of nuclear localization impairment and other factors such as nonsense-mediated mRNA decay [23659235]. Overall, RUNX2 mutations compromise the regulatory functions essential for normal skeletal and dental development, leading to the characteristic features of CCD.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in the RUNX2 gene, which are responsible for cleidocranial dysplasia (CCD), significantly impact bone and dental development by disrupting osteoblast differentiation and bone remodeling processes.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "These mutations lead to mislocalization of the RUNX2 protein, reduced expression of osteoblast-related genes, and impaired osteogenic potential, as observed in mesenchymal stem cells and dental follicle cells from CCD patients [37500953, 27509906, 29947791].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37500953", "evidence_support": "This study provides insight into the functional consequences of C-terminal mutations in RUNX2, including reduced expression, mislocalization, and aberrant transactivation of downstream genes, contributing to the compromised osteogenic potential observed in CCD.", "evidence_relation": "supporting" }, { "cited_pmid": "27509906", "evidence_support": "These outcomes indicate that the RUNX2 mutation disturbs the modulatory effects of DFCs and PDLCs on the differentiation of osteoclasts and osteoblasts, thereby interfering with bone remodelling", "evidence_relation": "supporting" }, { "cited_pmid": "29947791", "evidence_support": "As it is well known that dental follicle cells (DFCs) play a critical role in tooth eruption, the changed biological characteristics of DFCs might give rise to disturbance of permanent tooth eruption in CCD patients.", "evidence_relation": "supporting" }, { "cited_pmid": "29947791", "evidence_support": "After osteogenic induction, we found that the mineralised capacity of DFCs and the expression of osteoblast-related genes, including RUNX2, ALP, OSX, OCN and Col I\u03b11, in DFCs was severely interfered by the RUNX2 mutation found in CCD patients.", "evidence_relation": "supporting" }, { "cited_pmid": "29947791", "evidence_support": "All these findings indicate that RUNX2 mutation can reduce the osteogenic capacity of DFCs through inhibiting osteoblast-associated genes, thereby disturbing alveolar bone formation, which serves as a motive force for tooth eruption.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, RUNX2 mutations interfere with osteoclastogenesis by altering the RANKL/OPG signaling pathway, further contributing to delayed tooth eruption and bone resorption deficiencies [27068678, 32008052].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27068678", "evidence_support": "Cleidocranial dysplasia (CCD), a skeletal disorder characterized by delayed permanent tooth eruption and other dental abnormalities, is caused by heterozygous RUNX2 mutations.", "evidence_relation": "supporting" }, { "cited_pmid": "32008052", "evidence_support": "Mutant RUNX2 lost the function of regulating osteoclast differentiation and bone remodeling, resulting in the defective formation of the tooth eruption pathway and impaction of permanent teeth in cleidocranial dysplasia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The severity of phenotypic manifestations can vary, potentially due to differences in the degree of nuclear localization impairment and other factors such as nonsense-mediated mRNA decay [23659235].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "23659235", "evidence_support": "However, because the correlation between the severity of the phenotype and the degree of mutational impairment of RUNX2 is not consistent, other factors, such as nonsense-mediated mRNA decay and negative dominant effects, may also play a role.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Overall, RUNX2 mutations compromise the regulatory functions essential for normal skeletal and dental development, leading to the characteristic features of CCD.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Mutations in the RUNX2 gene will likely affect bone formation and remodeling, leading to impaired osteogenesis and osteoclastogenesis [37500953, 27509906, 29947791]. This can result in delayed tooth eruption, dental abnormalities, and skeletal dysplasia, characteristic of cleidocranial dysplasia (CCD) [27509906, 29947791, 20225274]. The mutations can also impact the expression of osteoblast-related genes, such as ALP, OSX, OCN, and Col I\u03b11, leading to compromised osteogenic potential [29947791, 30391791]. Furthermore, RUNX2 mutations can affect the regulation of osteoclast differentiation and bone resorption through the AKT/NFATc1/CTSK axis [32008052]. The severity of the phenotype may not always correlate with the degree of mutational impairment of RUNX2, suggesting that other factors, such as nonsense-mediated mRNA decay and negative dominant effects, may also play a role [23659235]. Overall, RUNX2 mutations can have significant effects on bone and tooth development, leading to a range of skeletal and dental abnormalities.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in the RUNX2 gene will likely affect bone formation and remodeling, leading to impaired osteogenesis and osteoclastogenesis [37500953, 27509906, 29947791].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37500953", "evidence_support": "This study provides insight into the functional consequences of C-terminal mutations in RUNX2, including reduced expression, mislocalization, and aberrant transactivation of downstream genes, contributing to the compromised osteogenic potential observed in CCD.", "evidence_relation": "neutral" }, { "cited_pmid": "27509906", "evidence_support": "RUNX2 is an important osteo-specific factor with crucial functions in bone formation and remodelling as well as resorption of teeth. Heterozygous mutation of RUNX2 can cause cleidocranial dysplasia (CCD), a systemic disease with extensive skeletal dysplasia and abnormality of tooth growth.", "evidence_relation": "supporting" }, { "cited_pmid": "29947791", "evidence_support": "All these findings indicate that RUNX2 mutation can reduce the osteogenic capacity of DFCs through inhibiting osteoblast-associated genes, thereby disturbing alveolar bone formation, which serves as a motive force for tooth eruption.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This can result in delayed tooth eruption, dental abnormalities, and skeletal dysplasia, characteristic of cleidocranial dysplasia (CCD) [27509906, 29947791, 20225274].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27509906", "evidence_support": "Heterozygous mutation of RUNX2 can cause cleidocranial dysplasia (CCD), a systemic disease with extensive skeletal dysplasia and abnormality of tooth growth.", "evidence_relation": "supporting" }, { "cited_pmid": "27509906", "evidence_support": "These effects may contribute in part to the pathological manifestations of retention of primary teeth and delayed eruption of permanent teeth in patients with CCD.", "evidence_relation": "supporting" }, { "cited_pmid": "29947791", "evidence_support": "Disturbed permanent tooth eruption is common in cleidocranial dysplasia (CCD), a skeletal disorder caused by heterozygous mutation of RUNX2, but the mechanism underlying is still unclear.", "evidence_relation": "supporting" }, { "cited_pmid": "29947791", "evidence_support": "This effect may provide valuable explanations and implications for the mechanism of delayed permanent tooth eruption in CCD patients.", "evidence_relation": "supporting" }, { "cited_pmid": "20225274", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The mutations can also impact the expression of osteoblast-related genes, such as ALP, OSX, OCN, and Col I\u03b11, leading to compromised osteogenic potential [29947791, 30391791].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29947791", "evidence_support": "After osteogenic induction, we found that the mineralised capacity of DFCs and the expression of osteoblast-related genes, including RUNX2, ALP, OSX, OCN and Col I\u03b11, in DFCs was severely interfered by the RUNX2 mutation found in CCD patients.", "evidence_relation": "supporting" }, { "cited_pmid": "30391791", "evidence_support": "ALP activity, ALP staining and alizarin red staining results indicated that mutant RUNX2 decreased the mineralization ability of DFCs. In addition, mutant RUNX2 significantly down-regulated the expression of osteoblast-associated genes.", "evidence_relation": "supporting" }, { "cited_pmid": "30391791", "evidence_support": "RUNX2 mutation can reduce the osteogenic capacity of DFCs by inhibiting osteoblast-associated genes and then affecting bone formation, which participates in bone remodeling during tooth eruption.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, RUNX2 mutations can affect the regulation of osteoclast differentiation and bone resorption through the AKT/NFATc1/CTSK axis [32008052].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32008052", "evidence_support": "Wild-type RUNX2 promoted osteoclast differentiation, formation of F-actin ring, and bone resorption, while mutant RUNX2 attenuated the positive differentiation effect.", "evidence_relation": "supporting" }, { "cited_pmid": "32008052", "evidence_support": "The present study suggested that RUNX2 promotes osteoclastogenesis and bone resorption through the AKT/NFATc1/CTSK axis. Mutant RUNX2 lost the function of regulating osteoclast differentiation and bone remodeling, resulting in the defective formation of the tooth eruption pathway and impaction of permanent teeth in cleidocranial dysplasia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The severity of the phenotype may not always correlate with the degree of mutational impairment of RUNX2, suggesting that other factors, such as nonsense-mediated mRNA decay and negative dominant effects, may also play a role [23659235].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23659235", "evidence_support": "Cleidocranial dysplasia (CCD) is a skeletal disorder caused by heterozygous mutations in the runt-related transcription factor 2 (RUNX2) gene", "evidence_relation": "neutral" }, { "cited_pmid": "23659235", "evidence_support": "However, because the correlation between the severity of the phenotype and the degree of mutational impairment of RUNX2 is not consistent, other factors, such as nonsense-mediated mRNA decay and negative dominant effects, may also play a role.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, RUNX2 mutations can have significant effects on bone and tooth development, leading to a range of skeletal and dental abnormalities.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "Mutations in the RUNX2 gene can lead to cleidocranial dysplasia (CCD), a genetic disorder that affects bone and teeth development [28703881, 14688224, 20648631]. The mutations can result in a range of skeletal and dental abnormalities, including delayed closure of fontanels, hypoplastic or aplastic clavicles, and dental anomalies such as supernumerary teeth and delayed eruption [28703881, 37500953, 23376464]. The mutations can also affect the osteogenic potential of mesenchymal stem cells, leading to compromised bone formation [30391791, 28703881, 23376464]. In some cases, the mutations can result in a gain-of-function effect, leading to increased expression of RUNX2 and altered subcellular localization of the protein [37500953, 32360898]. The mutations can also affect the expression of downstream genes involved in osteoblast differentiation and bone formation [19767586, 28738062, 23376464]. Overall, the mutations in the RUNX2 gene can have significant effects on bone and teeth development, leading to a range of clinical features associated with CCD [34638677, 29058294, 28703881]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in the RUNX2 gene can lead to cleidocranial dysplasia (CCD), a genetic disorder that affects bone and teeth development [28703881, 14688224, 20648631].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28703881", "evidence_support": "To identify a novel mutation of Runx2 gene in Cleidocranial Dysplasia (CCD) patients and to characterize the functional consequences of this mutation.", "evidence_relation": "neutral" }, { "cited_pmid": "14688224", "evidence_support": "Heterozygous mutations in Runx2 cause cleidocranial dysplasia (CCD), an inherited disorder in humans and mice characterized by skeletal defects, supernumerary teeth, and delayed eruption.", "evidence_relation": "supporting" }, { "cited_pmid": "20648631", "evidence_support": "Mutations in RUNX2 cause CCD, but are not identified in all CCD patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The mutations can result in a range of skeletal and dental abnormalities, including delayed closure of fontanels, hypoplastic or aplastic clavicles, and dental anomalies such as supernumerary teeth and delayed eruption [28703881, 37500953, 23376464].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28703881", "evidence_support": "The G462X mutation might reduce the Runx2 transacting activity, lower the protein stability, downgrade the expression of bone marker genes, and eventually diminish osteoblast differentiation in CCD patients.", "evidence_relation": "supporting" }, { "cited_pmid": "37500953", "evidence_support": "Cleidocranial dysplasia (CCD) is a genetic disorder caused by mutations in the RUNX2 gene, affecting bone and teeth development. ", "evidence_relation": "supporting" }, { "cited_pmid": "37500953", "evidence_support": "This study provides insight into the functional consequences of C-terminal mutations in RUNX2, including reduced expression, mislocalization, and aberrant transactivation of downstream genes, contributing to the compromised osteogenic potential observed in CCD.", "evidence_relation": "neutral" }, { "cited_pmid": "23376464", "evidence_support": "We found that the mutation is localized at c. 1116_1119insC, p. Q374fsX384 and the proliferative ability and osteogenic potential of the MSCs isolated from the bone marrow and dental pulp of the patient (RUNX2(+/m)) were decreased compared to normal individuals (RUNX2(+/+)).", "evidence_relation": "neutral" }, { "cited_pmid": "23376464", "evidence_support": "The reduced ability of MSCs to differentiate into osteoblasts might provide an explanation for the defects of bone and teeth in the CCD patient", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The mutations can also affect the osteogenic potential of mesenchymal stem cells, leading to compromised bone formation [30391791, 28703881, 23376464].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30391791", "evidence_support": "RUNX2 mutation can reduce the osteogenic capacity of DFCs by inhibiting osteoblast-associated genes and then affecting bone formation, which participates in bone remodeling during tooth eruption.", "evidence_relation": "supporting" }, { "cited_pmid": "23376464", "evidence_support": "Bone extracellular matrix deposition or bone formation by differentiated osteoblasts begins at late stage during bone formation and lasts throughout life.", "evidence_relation": "neutral" }, { "cited_pmid": "23376464", "evidence_support": "We found that the mutation is localized at c. 1116_1119insC, p. Q374fsX384 and the proliferative ability and osteogenic potential of the MSCs isolated from the bone marrow and dental pulp of the patient (RUNX2(+/m)) were decreased compared to normal individuals (RUNX2(+/+))", "evidence_relation": "supporting" }, { "cited_pmid": "23376464", "evidence_support": "The reduced ability of MSCs to differentiate into osteoblasts might provide an explanation for the defects of bone and teeth in the CCD patient", "evidence_relation": "supporting" }, { "cited_pmid": "28703881", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In some cases, the mutations can result in a gain-of-function effect, leading to increased expression of RUNX2 and altered subcellular localization of the protein [37500953, 32360898].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32360898", "evidence_support": "Dual-luciferase assays showed that three of four tested RUNX2 variants conferred a gain-of-function effect on RUNX2, further suggesting their putative pathogenicity in the tested NCS cases.", "evidence_relation": "supporting" }, { "cited_pmid": "37500953", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The mutations can also affect the expression of downstream genes involved in osteoblast differentiation and bone formation [19767586, 28738062, 23376464].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19767586", "evidence_support": "The reporter gene assays revealed that all the mutants exhibited significantly reduced transactivation activities on the osteocalcin promoter.", "evidence_relation": "neutral" }, { "cited_pmid": "28738062", "evidence_support": "This disease is mainly caused by heterozygous mutations in RUNX2, a gene that encodes an osteoblast-specific transcription factor", "evidence_relation": "supporting" }, { "cited_pmid": "23376464", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, the mutations in the RUNX2 gene can have significant effects on bone and teeth development, leading to a range of clinical features associated with CCD [34638677, 29058294, 28703881].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34638677", "evidence_support": "Our findings demonstrated for the first time that, in addition to the alteration of downstream gene expression, RUNX2 mutations impair p53 expression affecting osteogenic maturation.", "evidence_relation": "neutral" }, { "cited_pmid": "29058294", "evidence_support": "Haploinsufficiency of the runt-related transcription factor 2 (Runx2) gene is widely known to be responsible for cleidocranial dysplasia (CCD).", "evidence_relation": "supporting" }, { "cited_pmid": "28703881", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Mutations in RUNX2 can cause cleidocranial dysplasia, a skeletal disorder characterized by the absence or underdevelopment of the collarbone and other skeletal abnormalities [19830829, 17290219]. RUNX2 mutations can also lead to a predisposition to cancer, particularly osteosarcoma [19830829, 37108164, 17290219]. In addition, RUNX2 mutations have been associated with an increased risk of developing other types of cancer, including breast, lung, and colon cancer [19830829, 37108164, 17290219]. The mutations can also affect the development of the hematopoietic system, leading to an increased risk of blood disorders such as leukemia [31964134, 15061191, 17290219]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in RUNX2 can cause cleidocranial dysplasia, a skeletal disorder characterized by the absence or underdevelopment of the collarbone and other skeletal abnormalities [19830829, 17290219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19830829", "evidence_support": "RUNX2 mutations cause cleidocranial dysplasia; most are of the missense type and commonly occur in the Runt domain. RUNX3 is a tumor suppressor gene with hemizygous deletion of one allele and hypermethylation of the other, resulting in gastric adenocarcinoma.\n", "evidence_relation": "supporting" }, { "cited_pmid": "17290219", "evidence_support": "Mutations in RUNX2 cause the inherited skeletal disorder cleidocranial dysplasia (CCD). ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "RUNX2 mutations can also lead to a predisposition to cancer, particularly osteosarcoma [19830829, 37108164, 17290219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37108164", "evidence_support": "Many discoveries have illustrated the indirect and direct biological functions of RUNX2 in orchestrating cancer stemness, cancer metastasis, angiogenesis, proliferation, and chemoresistance to anticancer compounds, warranting further exploration of the associated mechanisms to support the development of a novel therapeutic strategy.", "evidence_relation": "neutral" }, { "cited_pmid": "17290219", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "19830829", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In addition, RUNX2 mutations have been associated with an increased risk of developing other types of cancer, including breast, lung, and colon cancer [19830829, 37108164, 17290219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37108164", "evidence_support": "Many discoveries have illustrated the indirect and direct biological functions of RUNX2 in orchestrating cancer stemness, cancer metastasis, angiogenesis, proliferation, and chemoresistance to anticancer compounds, warranting further exploration of the associated mechanisms to support the development of a novel therapeutic strategy.", "evidence_relation": "neutral" }, { "cited_pmid": "17290219", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "19830829", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The mutations can also affect the development of the hematopoietic system, leading to an increased risk of blood disorders such as leukemia [31964134, 15061191, 17290219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31964134", "evidence_support": "RUNX1 mutations are frequently found and have been intensively studied in hematological malignancies.", "evidence_relation": "supporting" }, { "cited_pmid": "15061191", "evidence_support": "Many of those affected, usually by point mutations in one allele, are predisposed to the development of acute myeloid leukemia (AML) in adult life.", "evidence_relation": "supporting" }, { "cited_pmid": "17290219", "evidence_support": "Monoallelic RUNX1 mutations cause familial platelet disorder with predisposition for acute myelogenous leukemia (FPD/AML).", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Mutations in RUNX2 can cause cleidocranial dysplasia (CCD), a skeletal disorder characterized by delayed closure of fontanels, dental abnormalities, and hypoplastic clavicles [29058294, 20225274, 17290219]. RUNX2 mutations can also be associated with an increased risk of cancer, particularly in the development of osteosarcoma [37108164]. Additionally, further research on RUNX2 mutations may provide insights into the molecular mechanisms underlying the development of cancer and the role of RUNX2 in regulating cell growth and differentiation [37108164]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in RUNX2 can cause cleidocranial dysplasia (CCD), a skeletal disorder characterized by delayed closure of fontanels, dental abnormalities, and hypoplastic clavicles [29058294, 20225274, 17290219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29058294", "evidence_support": "Haploinsufficiency of the runt-related transcription factor 2 (Runx2) gene is widely known to be responsible for cleidocranial dysplasia (CCD).", "evidence_relation": "supporting" }, { "cited_pmid": "20225274", "evidence_support": "Cleidocranial dysplasia (CCD) is caused by haploinsufficiency in RUNX2 function.", "evidence_relation": "supporting" }, { "cited_pmid": "17290219", "evidence_support": "Mutations in RUNX2 cause the inherited skeletal disorder cleidocranial dysplasia (CCD).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "RUNX2 mutations can also be associated with an increased risk of cancer, particularly in the development of osteosarcoma [37108164].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37108164", "evidence_support": "Recently discovered RUNX2 somatic mutations, expressional signatures of RUNX2 in normal tissues and tumors, and the prognostic and clinical significance of RUNX2 in many types of cancer have attracted attention and led RUNX2 to be considered a biomarker for cancer.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, further research on RUNX2 mutations may provide insights into the molecular mechanisms underlying the development of cancer and the role of RUNX2 in regulating cell growth and differentiation [37108164].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37108164", "evidence_support": "Recently discovered RUNX2 somatic mutations, expressional signatures of RUNX2 in normal tissues and tumors, and the prognostic and clinical significance of RUNX2 in many types of cancer have attracted attention and led RUNX2 to be considered a biomarker for cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "37108164", "evidence_support": "Many discoveries have illustrated the indirect and direct biological functions of RUNX2 in orchestrating cancer stemness, cancer metastasis, angiogenesis, proliferation, and chemoresistance to anticancer compounds, warranting further exploration of the associated mechanisms to support the development of a novel therapeutic strategy.", "evidence_relation": "supporting" }, { "cited_pmid": "37108164", "evidence_support": "In this review, we focus mainly on critical and recent research developments, including RUNX2's oncogenic activities, by summarizing and integrating the findings on somatic mutations of RUNX2, transcriptomic studies, clinical information, and discoveries about how the RUNX2-induced signaling pathway modulates malignant progression in cancer. We also comprehensively discuss RUNX2 RNA expression in a pancancer panel and in specific normal cell types at the single-cell level to indicate the potential cell types and sites for tumorigenesis", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Mutations in RUNX2 can cause cleidocranial dysplasia (CCD), a skeletal disorder characterized by delayed closure of fontanels, dental abnormalities, and hypoplastic clavicles [27177937, 21274329, 27272193]. RUNX2 mutations can also be associated with an increased risk of cancer, particularly in the development of osteosarcoma [37108164, 25738872, 37663774]. In the future, RUNX2 mutations may lead to the development of novel therapeutic strategies for the treatment of CCD and other related disorders [35235174]. Additionally, further research on RUNX2 mutations may provide insights into the molecular mechanisms underlying the development of cancer and the role of RUNX2 in regulating cell growth and differentiation [37108164, 28299665, 31395086]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in RUNX2 can cause cleidocranial dysplasia (CCD), a skeletal disorder characterized by delayed closure of fontanels, dental abnormalities, and hypoplastic clavicles [27177937, 21274329, 27272193].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27177937", "evidence_support": "Cleidocranial dysplasia (CCD) is a rare genetic disorder of bone, characterised by hypoplastic/aplastic clavicles, delayed closure of fontanelles and sutures of the cranium and dental abnormalities", "evidence_relation": "supporting" }, { "cited_pmid": "27177937", "evidence_support": "ctor 2 (RUNX2) gene-that adds to the spectrum of mutations in this gene", "evidence_relation": "neutral" }, { "cited_pmid": "21274329", "evidence_support": "CCD is caused by mutation in the gene on 6p21 encoding transcription factor CBFA1, i.e. runt-related transcription factor 2(RUNX2). The disease is characterized by a persistently open anterior fontanelle and skull sutures, hypoplastic or aplastic clavicles, dental abnormalities, short stature, a wide pubic symphysis, and a variety of other skeletal changes. A major finding of CCD is hypoplasia or aplasia of clavicular bones resulting in the ability of the patient to approximate the shoulders. Delayed closure of the anterior fontanelle and of metopic sutures causes frontal bossing", "evidence_relation": "supporting" }, { "cited_pmid": "27272193", "evidence_support": "Mutations within RUNX2 are linked to Cleidocranial dysplasia syndrome (CCD) in humans. CCD is an autosomal skeletal disorder characterized by several features such as delayed closure of fontanels, dental abnormalities and hypoplastic clavicles", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "RUNX2 mutations can also be associated with an increased risk of cancer, particularly in the development of osteosarcoma [37108164, 25738872, 37663774].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37108164", "evidence_support": "Recently discovered RUNX2 somatic mutations, expressional signatures of RUNX2 in normal tissues and tumors, and the prognostic and clinical significance of RUNX2 in many types of cancer have attracted attention and led RUNX2 to be considered a biomarker for cancer. ", "evidence_relation": "supporting" }, { "cited_pmid": "25738872", "evidence_support": "Previous studies have suggested the importance of osteoblast activity in OS tumorigenesis and metastasis, as OS is characterized by abnormal bone formation, while osteoblast is the predominant cell type both in OS and in metastatic tumor tissues. RUNX2 is a known essential transcription factor for osteoblast differentiation. RUNX2 has also been linked to many human cancers, including bone cancers and cancer metastasis in bone", "evidence_relation": "supporting" }, { "cited_pmid": "25738872", "evidence_support": " RUNX2 may be involved in OS pathogenesis by regulating cell cycle controlling of (pre)-osteoblasts, which subsequently convert to OS cells. ", "evidence_relation": "supporting" }, { "cited_pmid": "37663774", "evidence_support": "Osteosarcoma is the most common primary malignant bone tumor with a high risk of metastasis and recurrence", "evidence_relation": "neutral" }, { "cited_pmid": "37663774", "evidence_support": "RUNX2 is an important transcription factor for osteoblastic differentiation, and aberrant expression of the gene contributes to the development and progression of osteosarcoma.", "evidence_relation": "supporting" }, { "cited_pmid": "37663774", "evidence_support": "The datasets can be used by researchers to identify novel targets of RUNX2 and elucidate the role and underlying mechanism of RUNX2 in osteosarcoma pathogenesis and metabolic reprogramming.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In the future, RUNX2 mutations may lead to the development of novel therapeutic strategies for the treatment of CCD and other related disorders [35235174].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35235174", "evidence_support": "We explored a novel RUNX2 deletion/frameshift mutation in a sporadic CCD patient. This finding suggests that the VWRPY domain may play a key role in RUNX2 transactivation ability.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, further research on RUNX2 mutations may provide insights into the molecular mechanisms underlying the development of cancer and the role of RUNX2 in regulating cell growth and differentiation [37108164, 28299665, 31395086].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37108164", "evidence_support": "We expect this review to shed light on the recent mechanistical findings and modulatory role of RUNX2 in cancer progression and provide biological information that can guide new research in this field.", "evidence_relation": "supporting" }, { "cited_pmid": "28299665", "evidence_support": "Understanding how RUNX dysregulation in cancer impinges on normal biological processes is important for identifying the molecular mechanisms that lead to malignancy", "evidence_relation": "supporting" }, { "cited_pmid": "28299665", "evidence_support": "With the recent advances in RUNX research, it is time to revisit the many mechanisms/pathways that RUNX engage to regulate cell fate and decide whether cells proliferate, differentiate or die.", "evidence_relation": "supporting" }, { "cited_pmid": "31395086", "evidence_support": "Consistent evidence indicates that RUNX2 expression is aberrantly reactivated in cancer and supports tumor progression.", "evidence_relation": "supporting" }, { "cited_pmid": "31395086", "evidence_support": "Overall, our data provide new insights into the molecular mechanisms controlling RUNX2 in cancer and consolidate the rationale for the use of HDACi as potential pharmacological strategy to counteract the pro-oncogenic program controlled by RUNX2 in cancer cells.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Mutations in RUNX2 can cause cleidocranial dysplasia (CCD), a skeletal disorder characterized by delayed closure of fontanels, dental abnormalities, and hypoplastic clavicles [21274329, 27177937, 27272193]. RUNX2 mutations can also be associated with an increased risk of cancer, particularly in the development of osteosarcoma [37663774, 37108164, 25738872]. In the future, RUNX2 mutations may lead to the development of novel therapeutic strategies for the treatment of CCD and other related disorders [17290219, 35235174]. Additionally, further research on RUNX2 mutations may provide insights into the molecular mechanisms underlying the development of cancer and the role of RUNX2 in regulating cell growth and differentiation [31395086, 37108164, 28299665]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in RUNX2 can cause cleidocranial dysplasia (CCD), a skeletal disorder characterized by delayed closure of fontanels, dental abnormalities, and hypoplastic clavicles [21274329, 27177937, 27272193].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21274329", "evidence_support": "Cleidocranial dysplasia (CCD) is a rare autosomal dominant skeletal disease. CCD is caused by mutation in the gene on 6p21 encoding transcription factor CBFA1, i.e. runt-related transcription factor 2(RUNX2). The disease is characterized by a persistently open anterior fontanelle and skull sutures, hypoplastic or aplastic clavicles, dental abnormalities, short stature, a wide pubic symphysis, and a variety of other skeletal changes.", "evidence_relation": "supporting" }, { "cited_pmid": "27177937", "evidence_support": "Cleidocranial dysplasia (CCD) is a rare genetic disorder of bone, characterised by hypoplastic/aplastic clavicles, delayed closure of fontanelles and sutures of the cranium and dental abnormalities.", "evidence_relation": "supporting" }, { "cited_pmid": "27272193", "evidence_support": "Mutations within RUNX2 are linked to Cleidocranial dysplasia syndrome (CCD) in humans. CCD is an autosomal skeletal disorder characterized by several features such as delayed closure of fontanels, dental abnormalities and hypoplastic clavicles.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "RUNX2 mutations can also be associated with an increased risk of cancer, particularly in the development of osteosarcoma [37663774, 37108164, 25738872].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37663774", "evidence_support": "RUNX2 is an important transcription factor for osteoblastic differentiation, and aberrant expression of the gene contributes to the development and progression of osteosarcoma.", "evidence_relation": "supporting" }, { "cited_pmid": "37663774", "evidence_support": "The datasets can be used by researchers to identify novel targets of RUNX2 and elucidate the role and underlying mechanism of RUNX2 in osteosarcoma pathogenesis and metabolic reprogramming.", "evidence_relation": "supporting" }, { "cited_pmid": "37108164", "evidence_support": "Recently discovered RUNX2 somatic mutations, expressional signatures of RUNX2 in normal tissues and tumors, and the prognostic and clinical significance of RUNX2 in many types of cancer have attracted attention and led RUNX2 to be considered a biomarker for cancer. ", "evidence_relation": "supporting" }, { "cited_pmid": "25738872", "evidence_support": "RUNX2 is a known essential transcription factor for osteoblast differentiation. RUNX2 has also been linked to many human cancers, including bone cancers and cancer metastasis in bone.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In the future, RUNX2 mutations may lead to the development of novel therapeutic strategies for the treatment of CCD and other related disorders [17290219, 35235174].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17290219", "evidence_support": "Mutations in RUNX2 cause the inherited skeletal disorder cleidocranial dysplasia (CCD).", "evidence_relation": "supporting" }, { "cited_pmid": "35235174", "evidence_support": "Several studies have revealed that CCD development is strongly linked with different mutations in runt-related transcription factor 2 (RUNX2) gene", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, further research on RUNX2 mutations may provide insights into the molecular mechanisms underlying the development of cancer and the role of RUNX2 in regulating cell growth and differentiation [31395086, 37108164, 28299665].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "31395086", "evidence_support": "Consistent evidence indicates that RUNX2 expression is aberrantly reactivated in cancer and supports tumor progression. The mechanisms leading to RUNX2 expression in cancer has only recently began to emerge. Previously, we showed that suppressing the activity of the epigenetic regulators HDACs significantly represses RUNX2 expression highlighting a role for these enzymes in RUNX2 reactivation in cancer. However, the molecular mechanisms by which HDACs control RUNX2 are still largely unexplored. Here, to fill this gap, we investigated the role of different HDACs in RUNX2 expression regulation in breast and thyroid cancer, tumors that majorly rely on RUNX2 for their development and progression.\nMETHODS: Proliferation assays and evaluation of RUNX2 mRNA levels by qRT-PCR were used to evaluate the effect of several HDACi and specific siRNAs on a panel of cancer cell lines. ", "evidence_relation": "supporting" }, { "cited_pmid": "31395086", "evidence_support": "Overall, our data provide new insights into the molecular mechanisms controlling RUNX2 in cancer and consolidate the rationale for the use of HDACi as potential pharmacological strategy to counteract the pro-oncogenic program controlled by RUNX2 in cancer cells.", "evidence_relation": "supporting" }, { "cited_pmid": "37108164", "evidence_support": "Runt-related transcription factor 2 (RUNX2) is critical for the modulation of chondrocyte osteoblast differentiation and hypertrophy. Recently discovered RUNX2 somatic mutations, expressional signatures of RUNX2 in normal tissues and tumors, and the prognostic and clinical significance of RUNX2 in many types of cancer have attracted attention and led RUNX2 to be considered a biomarker for cancer. Many discoveries have illustrated the indirect and direct biological functions of RUNX2 in orchestrating cancer stemness, cancer metastasis, angiogenesis, proliferation, and chemoresistance to anticancer compounds, warranting further exploration of the associated mechanisms to support the development of a novel therapeutic strategy.", "evidence_relation": "supporting" }, { "cited_pmid": "37108164", "evidence_support": "We expect this review to shed light on the recent mechanistical findings and modulatory role of RUNX2 in cancer progression and provide biological information that can guide new research in this field.", "evidence_relation": "supporting" }, { "cited_pmid": "28299665", "evidence_support": "A regulatory function for RUNX in tissue stem cells points sharply to a causal effect in tumorigenesis. Understanding how RUNX dysregulation in cancer impinges on normal biological processes is important for identifying the molecular mechanisms that lead to malignancy. It will also indicate whether restoration of proper RUNX function to redirect cell fate is a feasible treatment for cancer. With the recent advances in RUNX research, it is time to revisit the many mechanisms/pathways that RUNX engage to regulate cell fate and decide whether cells proliferate, differentiate or die.", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Mutations in RUNX2 can cause cleidocranial dysplasia (CCD), a skeletal disorder characterized by delayed closure of fontanels, dental abnormalities, and hypoplastic clavicles [27177937, 27272193, 21274329]. RUNX2 mutations can also be associated with an increased risk of cancer, particularly in the development of osteosarcoma [25738872, 37663774, 37108164]. In the future, RUNX2 mutations may lead to the development of novel therapeutic strategies for the treatment of CCD and other related disorders [17290219]. Additionally, further research on RUNX2 mutations may provide insights into the molecular mechanisms underlying the development of cancer and the role of RUNX2 in regulating cell growth and differentiation [37108164, 31395086, 28299665]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in RUNX2 can cause cleidocranial dysplasia (CCD), a skeletal disorder characterized by delayed closure of fontanels, dental abnormalities, and hypoplastic clavicles [27177937, 27272193, 21274329].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27177937", "evidence_support": "Cleidocranial dysplasia (CCD) is a rare genetic disorder of bone, characterised by hypoplastic/aplastic clavicles, delayed closure of fontanelles and sutures of the cranium and dental abnormalities.", "evidence_relation": "supporting" }, { "cited_pmid": "27272193", "evidence_support": "Mutations within RUNX2 are linked to Cleidocranial dysplasia syndrome (CCD) in humans. CCD is an autosomal skeletal disorder characterized by several features such as delayed closure of fontanels, dental abnormalities and hypoplastic clavicles.", "evidence_relation": "supporting" }, { "cited_pmid": "21274329", "evidence_support": "Cleidocranial dysplasia (CCD) is a rare autosomal dominant skeletal disease. CCD is caused by mutation in the gene on 6p21 encoding transcription factor CBFA1, i.e. runt-related transcription factor 2(RUNX2). The disease is characterized by a persistently open anterior fontanelle and skull sutures, hypoplastic or aplastic clavicles, dental abnormalities, short stature, a wide pubic symphysis, and a variety of other skeletal changes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "RUNX2 mutations can also be associated with an increased risk of cancer, particularly in the development of osteosarcoma [25738872, 37663774, 37108164].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25738872", "evidence_support": "RUNX2 is a known essential transcription factor for osteoblast differentiation. RUNX2 has also been linked to many human cancers, including bone cancers and cancer metastasis in bone.", "evidence_relation": "supporting" }, { "cited_pmid": "37663774", "evidence_support": "RUNX2 is an important transcription factor for osteoblastic differentiation, and aberrant expression of the gene contributes to the development and progression of osteosarcoma.", "evidence_relation": "supporting" }, { "cited_pmid": "37108164", "evidence_support": "Recently discovered RUNX2 somatic mutations, expressional signatures of RUNX2 in normal tissues and tumors, and the prognostic and clinical significance of RUNX2 in many types of cancer have attracted attention and led RUNX2 to be considered a biomarker for cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "37108164", "evidence_support": "We expect this review to shed light on the recent mechanistical findings and modulatory role of RUNX2 in cancer progression and provide biological information that can guide new research in this field.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In the future, RUNX2 mutations may lead to the development of novel therapeutic strategies for the treatment of CCD and other related disorders [17290219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17290219", "evidence_support": "Mutations in RUNX2 cause the inherited skeletal disorder cleidocranial dysplasia (CCD)", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, further research on RUNX2 mutations may provide insights into the molecular mechanisms underlying the development of cancer and the role of RUNX2 in regulating cell growth and differentiation [37108164, 31395086, 28299665].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37108164", "evidence_support": "Recently discovered RUNX2 somatic mutations, expressional signatures of RUNX2 in normal tissues and tumors, and the prognostic and clinical significance of RUNX2 in many types of cancer have attracted attention and led RUNX2 to be considered a biomarker for cancer. Many discoveries have illustrated the indirect and direct biological functions of RUNX2 in orchestrating cancer stemness, cancer metastasis, angiogenesis, proliferation, and chemoresistance to anticancer compounds, warranting further exploration of the associated mechanisms to support the development of a novel therapeutic strategy. ", "evidence_relation": "supporting" }, { "cited_pmid": "37108164", "evidence_support": "We expect this review to shed light on the recent mechanistical findings and modulatory role of RUNX2 in cancer progression and provide biological information that can guide new research in this field.", "evidence_relation": "supporting" }, { "cited_pmid": "31395086", "evidence_support": "Consistent evidence indicates that RUNX2 expression is aberrantly reactivated in cancer and supports tumor progression. The mechanisms leading to RUNX2 expression in cancer has only recently began to emerge", "evidence_relation": "supporting" }, { "cited_pmid": "28299665", "evidence_support": "With the recent advances in RUNX research, it is time to revisit the many mechanisms/pathways that RUNX engage to regulate cell fate and decide whether cells proliferate, differentiate or die", "evidence_relation": "supporting" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Mutations in RUNX2 can cause cleidocranial dysplasia (CCD), a skeletal disorder characterized by delayed closure of fontanels, dental abnormalities, and hypoplastic clavicles [29087131, 27500518, 20931042]. RUNX2 mutations can also be associated with an increased risk of cancer, particularly in the development of osteosarcoma [25738872, 19688969, 21197465]. In the future, RUNX2 mutations may lead to the development of novel therapeutic strategies for the treatment of CCD and other related disorders [17290219]. Additionally, further research on RUNX2 mutations may provide insights into the molecular mechanisms underlying the development of cancer and the role of RUNX2 in regulating cell growth and differentiation [20580290, 37108164, 30374602]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in RUNX2 can cause cleidocranial dysplasia (CCD), a skeletal disorder characterized by delayed closure of fontanels, dental abnormalities, and hypoplastic clavicles [29087131, 27500518, 20931042].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29087131", "evidence_support": "Cleidocranial dysplasia is an uncommon bone dysplasia with an autosomal dominant inheritance pattern characterized by short stature, large fontanels, midface hypoplasia, absence or hypoplasia of clavicles and orodental alterations.", "evidence_relation": "supporting" }, { "cited_pmid": "29087131", "evidence_support": "We report two male adolescents (cousins), with cleidocranial dysplasia who presented a heterozygous missense mutation (c.674G> A, p.R225Q) in the RUNX2 gene, characterized by severe phenotype, such as absent clavicles, but with variation in the delayed fontanel closure, dental abnormalities (anomalies in shape and number) and scoliosis, thus demonstrating intrafamilial variation in these patients with the same genotype.", "evidence_relation": "supporting" }, { "cited_pmid": "27500518", "evidence_support": "Cleidocranial dysplasia syndrome, a rare genetic disorder, documented to have an autosomal dominant inheritance pattern and caused by caused by mutations of the transcription factor RUNX2", "evidence_relation": "supporting" }, { "cited_pmid": "20931042", "evidence_support": "Cleidocranial dysplasia is a rare autosomal dominant condition with generalized dysplasia of bone, characterized by delayed closer of cranial sutures, hypoplastic or aplastic clavicles, short stature, dental abnormalities and a variety of other skeletal abnormalities", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "RUNX2 mutations can also be associated with an increased risk of cancer, particularly in the development of osteosarcoma [25738872, 19688969, 21197465].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25738872", "evidence_support": "RUNX2 has also been linked to many human cancers, including bone cancers and cancer metastasis in bone.", "evidence_relation": "supporting" }, { "cited_pmid": "25738872", "evidence_support": "RUNX2 may be involved in OS pathogenesis by regulating cell cycle controlling of (pre)-osteoblasts, which subsequently convert to OS cells", "evidence_relation": "supporting" }, { "cited_pmid": "19688969", "evidence_support": "Runx2, Indian hedgehog (IHH), and Sox9 are proteins that play major roles in bone formation and tumorigenesis.", "evidence_relation": "supporting" }, { "cited_pmid": "19688969", "evidence_support": "High expression of Runx2 was significantly related to tumor metastasis in osteosarcoma. Our results suggest that overexpression of Runx2 might be a useful prognostic marker in osteosarcoma cases.", "evidence_relation": "supporting" }, { "cited_pmid": "21197465", "evidence_support": "In recent years, an important role has emerged for the RUNX2 \"platform protein\" in osteosarcoma oncogenesis.", "evidence_relation": "supporting" }, { "cited_pmid": "21197465", "evidence_support": "Studies of osteosarcoma tumours have revealed that the RUNX2 DNA copy number together with RNA and protein levels are highly elevated in osteosarcoma tumors. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In the future, RUNX2 mutations may lead to the development of novel therapeutic strategies for the treatment of CCD and other related disorders [17290219].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "17290219", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, further research on RUNX2 mutations may provide insights into the molecular mechanisms underlying the development of cancer and the role of RUNX2 in regulating cell growth and differentiation [20580290, 37108164, 30374602].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "20580290", "evidence_support": "Furthermore, we review the evidence that RUNX2 promotes neoplastic development in haematopoietic lineages and in advanced mammary and prostate cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "37108164", "evidence_support": "Runt-related transcription factor 2 (RUNX2) is critical for the modulation of chondrocyte osteoblast differentiation and hypertrophy.", "evidence_relation": "supporting" }, { "cited_pmid": "30374602", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Mutations in RUNX2 can cause cleidocranial dysplasia (CCD), a skeletal disorder characterized by delayed closure of fontanels, dental abnormalities, and hypoplastic clavicles [26538892, 25937737, 19769274]. RUNX2 mutations can also be associated with an increased risk of various cancers, including their potential role in orchestrating cancer stemness, cancer metastasis, angiogenesis, proliferation, and chemoresistance [25738872, 37663774, 37108164]. The relationship between RUNX2 and cancer is complex and warrants further exploration [25738872, 37663774, 37108164]. In the future, RUNX2 mutations may lead to the development of novel therapeutic strategies for the treatment of CCD and other related disorders [22194205]. Additionally, further research on RUNX2 mutations may provide insights into the molecular mechanisms underlying the development of cancer and the role of RUNX2 in regulating cell growth and differentiation [30374602, 20580290, 37108164]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in RUNX2 can cause cleidocranial dysplasia (CCD), a skeletal disorder characterized by delayed closure of fontanels, dental abnormalities, and hypoplastic clavicles [26538892, 25937737, 19769274].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26538892", "evidence_support": "Cleidocranial dysplasia (CCD) is a rare autosomal dominant condition with generalized dysplasia of bone characterized by delayed closure of cranial sutures, hypoplastic or aplastic clavicles, short stature, dental abnormalities and a variety of other skeletal abnormalities.", "evidence_relation": "supporting" }, { "cited_pmid": "25937737", "evidence_support": "Cleidocranial dysplasia (CCD) is an autosomal dominant disorder resulting in the skeletal and dental abnormalities due to the disturbance in ossification of the bones. Clavicle is the most commonly affected bone.", "evidence_relation": "supporting" }, { "cited_pmid": "19769274", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "RUNX2 mutations can also be associated with an increased risk of various cancers, including their potential role in orchestrating cancer stemness, cancer metastasis, angiogenesis, proliferation, and chemoresistance [25738872, 37663774, 37108164].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25738872", "evidence_support": "RUNX2 has also been linked to many human cancers, including bone cancers and cancer metastasis in bone.", "evidence_relation": "supporting" }, { "cited_pmid": "25738872", "evidence_support": "RUNX2 may be involved in OS pathogenesis by regulating cell cycle controlling of (pre)-osteoblasts, which subsequently convert to OS cells. The roles and mechanisms of RUNX2 during OS metastasis and bone metastasis in target cancers (herein prostate and breast cancers), were as described. ", "evidence_relation": "supporting" }, { "cited_pmid": "37108164", "evidence_support": "Many discoveries have illustrated the indirect and direct biological functions of RUNX2 in orchestrating cancer stemness, cancer metastasis, angiogenesis, proliferation, and chemoresistance to anticancer compounds, warranting further exploration of the associated mechanisms to support the development of a novel therapeutic strategy", "evidence_relation": "supporting" }, { "cited_pmid": "37663774", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The relationship between RUNX2 and cancer is complex and warrants further exploration [25738872, 37663774, 37108164].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "25738872", "evidence_support": "RUNX2 has also been linked to many human cancers, including bone cancers and cancer metastasis in bone", "evidence_relation": "supporting" }, { "cited_pmid": "25738872", "evidence_support": "However, the view of RUNX2 during OS tumorigenesis has not been unanimous", "evidence_relation": "supporting" }, { "cited_pmid": "37663774", "evidence_support": "RUNX2 is an important transcription factor for osteoblastic differentiation, and aberrant expression of the gene contributes to the development and progression of osteosarcoma", "evidence_relation": "contradicting" }, { "cited_pmid": "37108164", "evidence_support": "Recently discovered RUNX2 somatic mutations, expressional signatures of RUNX2 in normal tissues and tumors, and the prognostic and clinical significance of RUNX2 in many types of cancer have attracted attention and led RUNX2 to be considered a biomarker for cancer", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In the future, RUNX2 mutations may lead to the development of novel therapeutic strategies for the treatment of CCD and other related disorders [22194205].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "22194205", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, further research on RUNX2 mutations may provide insights into the molecular mechanisms underlying the development of cancer and the role of RUNX2 in regulating cell growth and differentiation [30374602, 20580290, 37108164].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20580290", "evidence_support": "Furthermore, we review the evidence that RUNX2 promotes neoplastic development in haematopoietic lineages and in advanced mammary and prostate cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "37108164", "evidence_support": "Recently discovered RUNX2 somatic mutations, expressional signatures of RUNX2 in normal tissues and tumors, and the prognostic and clinical significance of RUNX2 in many types of cancer have attracted attention and led RUNX2 to be considered a biomarker for cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "30374602", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Mutations in RUNX2 can cause cleidocranial dysplasia (CCD), a skeletal disorder characterized by delayed closure of fontanels, dental abnormalities, and hypoplastic clavicles [19515746, 25937737, 17290219]. RUNX2 mutations can also be associated with an increased risk of various types of cancer, including but not limited to osteosarcoma, as RUNX2 plays a role in modulating cancer stemness, metastasis, angiogenesis, proliferation, and chemoresistance [37108164, 35522574]. In the future, RUNX2 mutations may lead to the development of novel therapeutic strategies for the treatment of various types of cancer [37108164]. Additionally, further research on RUNX2 mutations may provide insights into the molecular mechanisms underlying the development of cancer and the role of RUNX2 in regulating cell growth and differentiation [30374602, 23073173, 37108164]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in RUNX2 can cause cleidocranial dysplasia (CCD), a skeletal disorder characterized by delayed closure of fontanels, dental abnormalities, and hypoplastic clavicles [19515746, 25937737, 17290219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19515746", "evidence_support": "Cleidocranial dysplasia (CCD) is an autosomal dominant bone disease in humans caused by haploinsufficiency of the RUNX2 gene", "evidence_relation": "supporting" }, { "cited_pmid": "25937737", "evidence_support": "Cleidocranial dysplasia (CCD) is an autosomal dominant disorder resulting in the skeletal and dental abnormalities due to the disturbance in ossification of the bones.", "evidence_relation": "supporting" }, { "cited_pmid": "17290219", "evidence_support": "Mutations in RUNX2 cause the inherited skeletal disorder cleidocranial dysplasia (CCD)", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "RUNX2 mutations can also be associated with an increased risk of various types of cancer, including but not limited to osteosarcoma, as RUNX2 plays a role in modulating cancer stemness, metastasis, angiogenesis, proliferation, and chemoresistance [37108164, 35522574].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37108164", "evidence_support": "Many discoveries have illustrated the indirect and direct biological functions of RUNX2 in orchestrating cancer stemness, cancer metastasis, angiogenesis, proliferation, and chemoresistance to anticancer compounds, warranting further exploration of the associated mechanisms to support the development of a novel therapeutic strategy.", "evidence_relation": "supporting" }, { "cited_pmid": "35522574", "evidence_support": "RUNX gene family gene expression was related to prognosis in several cancers.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In the future, RUNX2 mutations may lead to the development of novel therapeutic strategies for the treatment of various types of cancer [37108164].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37108164", "evidence_support": "Recently discovered RUNX2 somatic mutations, expressional signatures of RUNX2 in normal tissues and tumors, and the prognostic and clinical significance of RUNX2 in many types of cancer have attracted attention and led RUNX2 to be considered a biomarker for cancer", "evidence_relation": "supporting" }, { "cited_pmid": "37108164", "evidence_support": "Many discoveries have illustrated the indirect and direct biological functions of RUNX2 in orchestrating cancer stemness, cancer metastasis, angiogenesis, proliferation, and chemoresistance to anticancer compounds, warranting further exploration of the associated mechanisms to support the development of a novel therapeutic strategy.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, further research on RUNX2 mutations may provide insights into the molecular mechanisms underlying the development of cancer and the role of RUNX2 in regulating cell growth and differentiation [30374602, 23073173, 37108164].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30374602", "evidence_support": "It also plays major roles in chondrocyte maturation, mesenchymal stem cell differentiation, cleidocranial dysplasia, and the growth and metastasis of tumors.", "evidence_relation": "neutral" }, { "cited_pmid": "23073173", "evidence_support": "This study establishes a contributing mechanism for progression of prostate cancer cells to a more apoptosis-resistant and thus malignant phenotype, whereby increased expression of RUNX2 modulates the expression of apoptosis-associated factors, specifically Bcl-2.", "evidence_relation": "supporting" }, { "cited_pmid": "37108164", "evidence_support": "Many discoveries have illustrated the indirect and direct biological functions of RUNX2 in orchestrating cancer stemness, cancer metastasis, angiogenesis, proliferation, and chemoresistance to anticancer compounds, warranting further exploration of the associated mechanisms to support the development of a novel therapeutic strategy.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Mutations in RUNX2 can cause cleidocranial dysplasia (CCD), a skeletal disorder characterized by abnormal clavicles, patent sutures and fontanelles, supernumerary teeth, short stature, and dental abnormalities [31984822]. RUNX2 mutations can also be associated with an increased risk of cancer, including various types, as RUNX2 plays a role in modulating cancer stemness, metastasis, angiogenesis, proliferation, and chemoresistance [31395086, 37108164]. Additionally, further research on RUNX2 mutations may provide insights into the molecular mechanisms underlying the development of cancer and the role of RUNX2 in regulating cell growth and differentiation [20580290, 30374602, 37108164]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in RUNX2 can cause cleidocranial dysplasia (CCD), a skeletal disorder characterized by abnormal clavicles, patent sutures and fontanelles, supernumerary teeth, short stature, and dental abnormalities [31984822].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31984822", "evidence_support": "Cleidocranial dysplasia (CCD) is a genetic disorder with an autosomal dominant inheritance pattern. CCD characterized by abnormal clavicles, patent sutures and fontenelles, supernumerary teeth and short stature. Approximately 60-70% of CCD patients have mutations in the RUNX2 gene.", "evidence_relation": "supporting" }, { "cited_pmid": "31984822", "evidence_support": "Runx2 regulates mesenchymal cell proliferation in sutures and suture closure by inducing the signaling pathways of the genes of Fgf, Pthlh, hedgehog and Wnt.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "RUNX2 mutations can also be associated with an increased risk of cancer, including various types, as RUNX2 plays a role in modulating cancer stemness, metastasis, angiogenesis, proliferation, and chemoresistance [31395086, 37108164].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31395086", "evidence_support": "Consistent evidence indicates that RUNX2 expression is aberrantly reactivated in cancer and supports tumor progression.", "evidence_relation": "supporting" }, { "cited_pmid": "37108164", "evidence_support": "Recently discovered RUNX2 somatic mutations, expressional signatures of RUNX2 in normal tissues and tumors, and the prognostic and clinical significance of RUNX2 in many types of cancer have attracted attention and led RUNX2 to be considered a biomarker for cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "37108164", "evidence_support": "Many discoveries have illustrated the indirect and direct biological functions of RUNX2 in orchestrating cancer stemness, cancer metastasis, angiogenesis, proliferation, and chemoresistance to anticancer compounds, warranting further exploration of the associated mechanisms to support the development of a novel therapeutic strategy.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, further research on RUNX2 mutations may provide insights into the molecular mechanisms underlying the development of cancer and the role of RUNX2 in regulating cell growth and differentiation [20580290, 30374602, 37108164].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20580290", "evidence_support": "Runx1 and its binding partner, CBFbeta, are frequently targeted in acute leukaemia but evidence is accumulating that all three Runx genes may have a role to play in a wider range of cancers, either as tumour promoters or tumour suppressors.", "evidence_relation": "neutral" }, { "cited_pmid": "20580290", "evidence_support": "Furthermore, we review the evidence that RUNX2 promotes neoplastic development in haematopoietic lineages and in advanced mammary and prostate cancer.\n", "evidence_relation": "supporting" }, { "cited_pmid": "30374602", "evidence_support": "multifunctional transcription factor essential for osteoblast differentiation. It also plays major roles in chondrocyte maturation, mesenchymal stem cell differentiation, cleidocranial dysplasia, and the growth and metastasis of tumors. The present study was performed to investigate the functions of Runx2 in the differentiation and migration of Schwann cells and outgrowth of neurites after peripheral nervous system injury.", "evidence_relation": "supporting" }, { "cited_pmid": "37108164", "evidence_support": "Recently discovered RUNX2 somatic mutations, expressional signatures of RUNX2 in normal tissues and tumors, and the prognostic and clinical significance of RUNX2 in many types of cancer have attracted attention and led RUNX2 to be considered a biomarker for cancer.", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Mutations in the RUNX2 gene, which are responsible for cleidocranial dysplasia (CCD), will continue to impact bone and dental development by disrupting osteogenic differentiation and bone remodeling processes.These mutations lead to mislocalization of the RUNX2 protein, reduced expression of osteoblast-related genes, and impaired osteogenic potential in mesenchymal stem cells and dental follicle cells [37500953, 29947791]. Additionally, RUNX2 mutations interfere with osteoclastogenesis and bone resorption, further complicating bone remodeling [32008052, 27068678]. The altered RUNX2 function also affects the expression of downstream genes critical for bone and tooth formation, contributing to delayed tooth eruption and skeletal abnormalities [27509906, 15099800]. These disruptions are not easily reversible, as evidenced by the inability to fully rescue osteogenic deficiencies even with overexpression of wild-type RUNX2 [29947791]. Consequently, future impacts include persistent skeletal and dental anomalies, necessitating ongoing research into therapeutic interventions.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in the RUNX2 gene, which are responsible for cleidocranial dysplasia (CCD), will continue to impact bone and dental development by disrupting osteogenic differentiation and bone remodeling processes.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "These mutations lead to mislocalization of the RUNX2 protein, reduced expression of osteoblast-related genes, and impaired osteogenic potential in mesenchymal stem cells and dental follicle cells [37500953, 29947791].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37500953", "evidence_support": "This study provides insight into the functional consequences of C-terminal mutations in RUNX2, including reduced expression, mislocalization, and aberrant transactivation of downstream genes, contributing to the compromised osteogenic potential observed in CCD.", "evidence_relation": "supporting" }, { "cited_pmid": "29947791", "evidence_support": "All these findings indicate that RUNX2 mutation can reduce the osteogenic capacity of DFCs through inhibiting osteoblast-associated genes, thereby disturbing alveolar bone formation, which serves as a motive force for tooth eruption", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, RUNX2 mutations interfere with osteoclastogenesis and bone resorption, further complicating bone remodeling [32008052, 27068678].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32008052", "evidence_support": "The present study suggested that RUNX2 promotes osteoclastogenesis and bone resorption through the AKT/NFATc1/CTSK axis.", "evidence_relation": "supporting" }, { "cited_pmid": "27068678", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The altered RUNX2 function also affects the expression of downstream genes critical for bone and tooth formation, contributing to delayed tooth eruption and skeletal abnormalities [27509906, 15099800].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27509906", "evidence_support": "Heterozygous mutation of RUNX2 can cause cleidocranial dysplasia (CCD), a systemic disease with extensive skeletal dysplasia and abnormality of tooth growth.", "evidence_relation": "supporting" }, { "cited_pmid": "15099800", "evidence_support": "Genetic studies have recently identified a mutation of one allele of runt-related gene 2 (RUNX2/CBFA1) as the cause for an autosomal-dominant skeletal disorder, cleidocranial dysplasia (CCD), which is characterised by hypoplasia of the clavicles and calvariae and widened sutures and fontanelles. In addition, CCD is frequently affected with multiple supernumerary teeth and the impaction and delayed eruption of teeth, the causes of all these dental abnormalities are still unknown.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "These disruptions are not easily reversible, as evidenced by the inability to fully rescue osteogenic deficiencies even with overexpression of wild-type RUNX2 [29947791].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29947791", "evidence_support": "After osteogenic induction, we found that the mineralised capacity of DFCs and the expression of osteoblast-related genes, including RUNX2, ALP, OSX, OCN and Col I\u03b11, in DFCs was severely interfered by the RUNX2 mutation found in CCD patients.", "evidence_relation": "neutral" }, { "cited_pmid": "29947791", "evidence_support": "Surprisingly, the osteogenic deficiency and the abnormal expression of osteoblast-associated genes in DFCs from the CCD patient were almost rescued by overexpression of wild-type RUNX2 using lentivirus.", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Consequently, future impacts include persistent skeletal and dental anomalies, necessitating ongoing research into therapeutic interventions.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "A mutation in the RUNX2 gene, which encodes a transcription factor critical for osteoblast differentiation and skeletal development, can lead to significant future impacts on bone formation and maintenance.Clinically, such mutations are associated with cleidocranial dysplasia, characterized by delayed closure of cranial sutures, hypoplastic or absent clavicles, and dental anomalies.The mutation disrupts normal osteoblast function, leading to impaired bone mineralization and skeletal abnormalities.Long-term consequences may include increased susceptibility to fractures, dental issues, and potential complications in skeletal growth and development.Understanding the specific mutation's nature can help predict the severity and range of phenotypic manifestations, guiding clinical management and genetic counseling.Further research into RUNX2 mutations may reveal additional roles in bone biology and potential therapeutic targets for skeletal dysplasias.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A mutation in the RUNX2 gene, which encodes a transcription factor critical for osteoblast differentiation and skeletal development, can lead to significant future impacts on bone formation and maintenance.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Clinically, such mutations are associated with cleidocranial dysplasia, characterized by delayed closure of cranial sutures, hypoplastic or absent clavicles, and dental anomalies.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "The mutation disrupts normal osteoblast function, leading to impaired bone mineralization and skeletal abnormalities.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Long-term consequences may include increased susceptibility to fractures, dental issues, and potential complications in skeletal growth and development.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Understanding the specific mutation's nature can help predict the severity and range of phenotypic manifestations, guiding clinical management and genetic counseling.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Further research into RUNX2 mutations may reveal additional roles in bone biology and potential therapeutic targets for skeletal dysplasias.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Mutations in the RUNX2 gene, such as those found in cleidocranial dysplasia (CCD), can affect various aspects of bone and tooth development [37500953, 29947791, 27509906]. Specifically, RUNX2 mutations can impair osteogenic differentiation of dental follicle cells, leading to delayed permanent tooth eruption [29947791, 30391791]. Additionally, RUNX2 mutations can disrupt the regulation of osteoclastogenesis, affecting bone resorption and remodeling [27509906, 32008052]. Furthermore, RUNX2 mutations can also impact the expression of genes involved in bone formation, such as osteocalcin, and affect the mineralization of bone and teeth [23376464, 20872798]. Overall, mutations in RUNX2 can have significant effects on the development and maintenance of the skeletal and dental systems, leading to various abnormalities and complications [37500953, 29947791, 27509906]. These effects can be observed in both human patients with CCD and in animal models with RUNX2 mutations [14688224, 25079226].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in the RUNX2 gene, such as those found in cleidocranial dysplasia (CCD), can affect various aspects of bone and tooth development [37500953, 29947791, 27509906].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37500953", "evidence_support": "Cleidocranial dysplasia (CCD) is a genetic disorder caused by mutations in the RUNX2 gene, affecting bone and teeth development.", "evidence_relation": "supporting" }, { "cited_pmid": "29947791", "evidence_support": "Disturbed permanent tooth eruption is common in cleidocranial dysplasia (CCD), a skeletal disorder caused by heterozygous mutation of RUNX2, but the mechanism underlying is still unclear.", "evidence_relation": "supporting" }, { "cited_pmid": "27509906", "evidence_support": "RUNX2 is an important osteo-specific factor with crucial functions in bone formation and remodelling as well as resorption of teeth.", "evidence_relation": "supporting" }, { "cited_pmid": "27509906", "evidence_support": "Heterozygous mutation of RUNX2 can cause cleidocranial dysplasia (CCD), a systemic disease with extensive skeletal dysplasia and abnormality of tooth growth.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Specifically, RUNX2 mutations can impair osteogenic differentiation of dental follicle cells, leading to delayed permanent tooth eruption [29947791, 30391791].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29947791", "evidence_support": "All these findings indicate that RUNX2 mutation can reduce the osteogenic capacity of DFCs through inhibiting osteoblast-associated genes, thereby disturbing alveolar bone formation, which serves as a motive force for tooth eruption", "evidence_relation": "supporting" }, { "cited_pmid": "30391791", "evidence_support": "RUNX2 mutation can reduce the osteogenic capacity of DFCs by inhibiting osteoblast-associated genes and then affecting bone formation, which participates in bone remodeling during tooth eruption", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, RUNX2 mutations can disrupt the regulation of osteoclastogenesis, affecting bone resorption and remodeling [27509906, 32008052].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27509906", "evidence_support": "These outcomes indicate that the RUNX2 mutation disturbs the modulatory effects of DFCs and PDLCs on the differentiation of osteoclasts and osteoblasts, thereby interfering with bone remodelling. ", "evidence_relation": "supporting" }, { "cited_pmid": "32008052", "evidence_support": "This study, for the first time, verifies the effect of RUNX2 on osteoclast differentiation and bone resorption ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, RUNX2 mutations can also impact the expression of genes involved in bone formation, such as osteocalcin, and affect the mineralization of bone and teeth [23376464, 20872798].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23376464", "evidence_support": "We found that the mutation is localized at c. 1116_1119insC, p. Q374fsX384 and the proliferative ability and osteogenic potential of the MSCs isolated from the bone marrow and dental pulp of the patient (RUNX2(+/m)) were decreased compared to normal individuals (RUNX2(+/+))", "evidence_relation": "supporting" }, { "cited_pmid": "20872798", "evidence_support": "This study suggests that the truncated RUNX2 mutant protein may be responsible for the alterations of RUNX2(+/m) DPCs, and RUNX2 gene may be involved in dental development by affecting the cell growth and differentiation, which provides new insights into understanding of dental abnormalities in CCD patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Overall, mutations in RUNX2 can have significant effects on the development and maintenance of the skeletal and dental systems, leading to various abnormalities and complications [37500953, 29947791, 27509906].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37500953", "evidence_support": "Cleidocranial dysplasia (CCD) is a genetic disorder caused by mutations in the RUNX2 gene, affecting bone and teeth development.", "evidence_relation": "supporting" }, { "cited_pmid": "29947791", "evidence_support": "All these findings indicate that RUNX2 mutation can reduce the osteogenic capacity of DFCs through inhibiting osteoblast-associated genes, thereby disturbing alveolar bone formation, which serves as a motive force for tooth eruption.", "evidence_relation": "supporting" }, { "cited_pmid": "27509906", "evidence_support": "Heterozygous mutation of RUNX2 can cause cleidocranial dysplasia (CCD), a systemic disease with extensive skeletal dysplasia and abnormality of tooth growth.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "These effects can be observed in both human patients with CCD and in animal models with RUNX2 mutations [14688224, 25079226].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "14688224", "evidence_support": "Genetic and molecular studies in humans and mice indicate that Runx2 (Cbfa1) is a critical transcriptional regulator of bone and tooth formation. Heterozygous mutations in Runx2 cause cleidocranial dysplasia (CCD), an inherited disorder in humans and mice characterized by skeletal defects, supernumerary teeth, and delayed eruption.", "evidence_relation": "supporting" }, { "cited_pmid": "25079226", "evidence_support": "In addition to impaired osteoblast function, mutant mice showed markedly decreased osteoclast number and postnatal bone resorption. Taken together, functional deficiency of Runx2 in osteoblasts does not result in failed embryonic skeletogenesis but disrupts postnatal bone formation.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash": { "answer": "Mutations in RUNX2, the gene encoding the Runt-related transcription factor 2, are associated with Cleidocranial Dysplasia (CCD), a rare autosomal dominant skeletal disorder [28964668, 38068903, 33987976]. CCD is characterized by delayed ossification of midline structures, particularly affecting the skull and clavicles [21131390, 27272193, 31347140]. This leads to a distinctive facial appearance and shoulder abnormalities [21131390]. Dental problems, including eruption difficulties, are often the first sign of CCD [21131390]. RUNX2 is crucial for osteoblast and skeletal development, and its deficiency can cause extra- and intra-oral malformations requiring orthodontic treatment [38068903, 28056872]. While the classic CCD phenotype is consistently observed, the severity of the disorder can vary widely [11857736, 12196916].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in RUNX2, the gene encoding the Runt-related transcription factor 2, are associated with Cleidocranial Dysplasia (CCD), a rare autosomal dominant skeletal disorder [28964668, 38068903, 33987976].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28964668", "evidence_support": "Cleidocranial dysplasia is a hereditary congenital disorder that results in delayed ossification of midline structures, and is caused by mutations in the RunX2 (runt-related transcription factor 2) gene located on the short arm of chromosome 6.", "evidence_relation": "supporting" }, { "cited_pmid": "38068903", "evidence_support": "Cleidocranial dysplasia (CCD) is a rare genetic defect caused by a heterozygous mutation of runt-related transcription factor 2 (RUNX2), which is important for osteoblast and skeletal development.", "evidence_relation": "supporting" }, { "cited_pmid": "33987976", "evidence_support": "Loss or decrease of function in runt-related transcription factor 2 encoded by RUNX2 is known to cause a rare autosomal-dominant skeletal disorder, cleidocranial dysplasia (CCD).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "CCD is characterized by delayed ossification of midline structures, particularly affecting the skull and clavicles [21131390, 27272193, 31347140].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21131390", "evidence_support": "Although it involves the whole skeletal system, the main clinical manifestations of CCD are malformations of the skull and clavicles, which lead to a typical appearance of the face and shoulders.", "evidence_relation": "supporting" }, { "cited_pmid": "27272193", "evidence_support": "CCD is an autosomal skeletal disorder characterized by several features such as delayed closure of fontanels, dental abnormalities and hypoplastic clavicles", "evidence_relation": "supporting" }, { "cited_pmid": "31347140", "evidence_support": "Pathogenic variants in RUNX2 have been linked to the Cleidocranial dysplasia (CCD), which is characterized by hypoplasia or aplasia of clavicles, delayed fontanelle closure, and dental anomalies.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This leads to a distinctive facial appearance and shoulder abnormalities [21131390].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21131390", "evidence_support": "Although it involves the whole skeletal system, the main clinical manifestations of CCD are malformations of the skull and clavicles, which lead to a typical appearance of the face and shoulders. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Dental problems, including eruption difficulties, are often the first sign of CCD [21131390].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21131390", "evidence_support": "Dental aspects are particularly evident and often eruption difficulties are the first indication for the patient, who does not present any other problem. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "RUNX2 is crucial for osteoblast and skeletal development, and its deficiency can cause extra- and intra-oral malformations requiring orthodontic treatment [38068903, 28056872].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "38068903", "evidence_support": "Cleidocranial dysplasia (CCD) is a rare genetic defect caused by a heterozygous mutation of runt-related transcription factor 2 (RUNX2), which is important for osteoblast and skeletal development. RUNX2-deficiency causes extra- and intra-oral malformations that often require orthodontic treatment. ", "evidence_relation": "supporting" }, { "cited_pmid": "28056872", "evidence_support": "As RUNX2 is mainly expressed in osteoblasts, CCD typically affects the skeletal and dental systems.", "evidence_relation": "supporting" }, { "cited_pmid": "28056872", "evidence_support": "dysmorphic face, including hypertelorism, midface hypoplasia, and chin protrusion. At a young age, he had received orthodontic surgery, due to dental abnormalities. ", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "While the classic CCD phenotype is consistently observed, the severity of the disorder can vary widely [11857736, 12196916].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "11857736", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "12196916", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Mutations in RUNX2, a gene crucial for bone and cartilage development, can lead to Cleidocranial Dysplasia (CCD) [34217160, 27272193, 31347140]. CCD is a rare genetic disorder characterized by hypoplasia or aplasia of clavicles, delayed fontanelle closure, and dental anomalies [31347140, 35235174, 37500953]. RUNX2 is a master regulator of osteoblast differentiation, cartilage, and bone development [31347140, 29852250, 17343269]. Most RUNX2 mutations result in loss-of-function mutations, leading to CCD, an autosomal dominant disorder [29852250, 33647526, 20872798]. CCD is characterized by multiple craniofacial and dental anomalies, including hypoplastic or aplastic clavicles, midface hypoplasia, delayed closure of cranial sutures, short stature, delayed eruption of permanent teeth, and supernumerary teeth [30798031, 26220009, 16143022].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in RUNX2, a gene crucial for bone and cartilage development, can lead to Cleidocranial Dysplasia (CCD) [34217160, 27272193, 31347140].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34217160", "evidence_support": "Pathogenic variants of RUNX2, a gene that encodes an osteoblast-specific transcription factor, have been shown as the cause of Cleidocranial dysplasia (CCD), which is a rare hereditary skeletal and dental disorder with dominant mode of inheritance and a broad range of clinical variability.", "evidence_relation": "supporting" }, { "cited_pmid": "27272193", "evidence_support": "Mutations within RUNX2 are linked to Cleidocranial dysplasia syndrome (CCD) in humans. ", "evidence_relation": "supporting" }, { "cited_pmid": "31347140", "evidence_support": "RUNX2 (Runt-related transcription factor 2) is a master regulator of osteoblast differentiation, cartilage and bone development. Pathogenic variants in RUNX2 have been linked to the Cleidocranial dysplasia (CCD), which is characterized by hypoplasia or aplasia of clavicles, delayed fontanelle closure, and dental anomalies.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "CCD is a rare genetic disorder characterized by hypoplasia or aplasia of clavicles, delayed fontanelle closure, and dental anomalies [31347140, 35235174, 37500953].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31347140", "evidence_support": "Pathogenic variants in RUNX2 have been linked to the Cleidocranial dysplasia (CCD), which is characterized by hypoplasia or aplasia of clavicles, delayed fontanelle closure, and dental anomalies.", "evidence_relation": "supporting" }, { "cited_pmid": "35235174", "evidence_support": "Cleidocranial dysplasia (CCD) is a rare genetic disorder affecting bone and cartilage development. Clinical features of CCD comprise short stature, delayed ossification of craniofacial structures with numerous Wormian bones, underdeveloped or aplastic clavicles and multiple dental anomalies. Several studies have revealed that CCD development is strongly linked with different mutations in runt-related transcription factor 2 (RUNX2) gene.", "evidence_relation": "supporting" }, { "cited_pmid": "37500953", "evidence_support": "Cleidocranial dysplasia (CCD) is a genetic disorder caused by mutations in the RUNX2 gene, affecting bone and teeth development.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "RUNX2 is a master regulator of osteoblast differentiation, cartilage, and bone development [31347140, 29852250, 17343269].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31347140", "evidence_support": "RUNX2 (Runt-related transcription factor 2) is a master regulator of osteoblast differentiation, cartilage and bone development.", "evidence_relation": "supporting" }, { "cited_pmid": "29852250", "evidence_support": "Runt-related transcription factor 2 (RUNX2) is well-known for its role in bone development and tooth morphogenesis.", "evidence_relation": "supporting" }, { "cited_pmid": "17343269", "evidence_support": "RUNX2 is the principal master switch for osteogenesis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Most RUNX2 mutations result in loss-of-function mutations, leading to CCD, an autosomal dominant disorder [29852250, 33647526, 20872798].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29852250", "evidence_support": "Most RUNX2 mutations described in the literature result in loss-of-function mutations of RUNX2 responsible for cleidocranial dysplasia, an autosomal dominant disorder.", "evidence_relation": "supporting" }, { "cited_pmid": "33647526", "evidence_support": "Cleidocranial dysplasia is a dominantly inherited skeletal dysplasia resulting from inherited or spontaneous mutations of Runt-related transcription factor 2 gene (RUNX2)", "evidence_relation": "supporting" }, { "cited_pmid": "20872798", "evidence_support": "Cleidocranial dysplasia (CCD) is an autosomal-dominant disorder caused by a lack of function of one or more alleles of the RUNX2 gene.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "CCD is characterized by multiple craniofacial and dental anomalies, including hypoplastic or aplastic clavicles, midface hypoplasia, delayed closure of cranial sutures, short stature, delayed eruption of permanent teeth, and supernumerary teeth [30798031, 26220009, 16143022].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30798031", "evidence_support": "Cleidocranial dysplasia (CCD) is a congenital autosomal dominant skeletal disease characterized by multiple craniofacial and dental anomali", "evidence_relation": "supporting" }, { "cited_pmid": "30798031", "evidence_support": "These results suggested that the newly identified splice-site mutation (c.581-9 T\u2009>\u2009G) in RUNX2 was responsible for CCD in this family through its alteration of RUNX2 activity and upregulated IBSP levels. These findings extend the mutational spectrum of the RUNX2 gene and might contribute to genetic diagnosis and counseling of families with CCD.", "evidence_relation": "neutral" }, { "cited_pmid": "26220009", "evidence_support": "Cleidocranial dysplasia (CCD; MIM 119600) is an autosomal dominant skeletal dysplasia characterised by hypopalstic and/or aplastic clavicles, midface hypoplasia, absent or delayed closure of cranial sutures, moderately short stature, delayed eruption of permanent dentition and supernumerary teeth", "evidence_relation": "supporting" }, { "cited_pmid": "16143022", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Mutations in the RUNX2 gene are primarily associated with cleidocranial dysplasia (CCD), a genetic disorder that affects bone and teeth development [27272193, 38068903]. This condition is characterized by features such as delayed ossification of midline structures, hypoplastic or aplastic clavicles, supernumerary teeth, and delayed eruption of permanent teeth [28964668, 26220009]. RUNX2 is considered a master regulator of bone development, and its mutations can lead to impaired osteoblast differentiation and bone remodeling [16222673, 32008052]. As a result, individuals with RUNX2 mutations may experience skeletal defects, growth retardation, and dental abnormalities, which can necessitate orthodontic treatment [14688224, 38068903]. Long-term effects may include ongoing dental issues and skeletal malformations that require medical management [32008052, 38068903].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in the RUNX2 gene are primarily associated with cleidocranial dysplasia (CCD), a genetic disorder that affects bone and teeth development [27272193, 38068903].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27272193", "evidence_support": "Mutations within RUNX2 are linked to Cleidocranial dysplasia syndrome (CCD) in humans.", "evidence_relation": "supporting" }, { "cited_pmid": "38068903", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This condition is characterized by features such as delayed ossification of midline structures, hypoplastic or aplastic clavicles, supernumerary teeth, and delayed eruption of permanent teeth [28964668, 26220009].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28964668", "evidence_support": "Cleidocranial dysplasia is a hereditary congenital disorder that results in delayed ossification of midline structures, and is caused by mutations in the RunX2 (runt-related transcription factor 2) gene located on the short arm of chromosome 6.", "evidence_relation": "supporting" }, { "cited_pmid": "26220009", "evidence_support": "Cleidocranial dysplasia (CCD; MIM 119600) is an autosomal dominant skeletal dysplasia characterised by hypopalstic and/or aplastic clavicles, midface hypoplasia, absent or delayed closure of cranial sutures, moderately short stature, delayed eruption of permanent dentition and supernumerary teeth", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "RUNX2 is considered a master regulator of bone development, and its mutations can lead to impaired osteoblast differentiation and bone remodeling [16222673, 32008052].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16222673", "evidence_support": "RUNX2 (OMIM 600211), the responsible gene for CCD, is considered to be a master gene for bone development and bone homeostasis.", "evidence_relation": "supporting" }, { "cited_pmid": "32008052", "evidence_support": "The present study suggested that RUNX2 promotes osteoclastogenesis and bone resorption through the AKT/NFATc1/CTSK axis. Mutant RUNX2 lost the function of regulating osteoclast differentiation and bone remodeling, resulting in the defective formation of the tooth eruption pathway and impaction of permanent teeth in cleidocranial dysplasia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "As a result, individuals with RUNX2 mutations may experience skeletal defects, growth retardation, and dental abnormalities, which can necessitate orthodontic treatment [14688224, 38068903].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14688224", "evidence_support": "Heterozygous mutations in Runx2 cause cleidocranial dysplasia (CCD), an inherited disorder in humans and mice characterized by skeletal defects, supernumerary teeth, and delayed eruption.", "evidence_relation": "supporting" }, { "cited_pmid": "38068903", "evidence_support": "Cleidocranial dysplasia (CCD) is a rare genetic defect caused by a heterozygous mutation of runt-related transcription factor 2 (RUNX2), which is important for osteoblast and skeletal development", "evidence_relation": "supporting" }, { "cited_pmid": "38068903", "evidence_support": "RUNX2-deficiency causes extra- and intra-oral malformations that often require orthodontic treatment", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Long-term effects may include ongoing dental issues and skeletal malformations that require medical management [32008052, 38068903].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32008052", "evidence_support": "Mutant RUNX2 lost the function of regulating osteoclast differentiation and bone remodeling, resulting in the defective formation of the tooth eruption pathway and impaction of permanent teeth in cleidocranial dysplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "38068903", "evidence_support": "RUNX2-deficiency causes extra- and intra-oral malformations that often require orthodontic treatment.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Mutations in the RUNX2 gene are primarily associated with cleidocranial dysplasia (CCD), a genetic disorder that affects skeletal development [17656144, 19767586]. Individuals with CCD often experience hypoplasia or absence of clavicles, delayed closure of fontanelles, and dental anomalies such as late tooth eruption and impacted teeth [31347140, 20082269]. These mutations impair osteoblast differentiation and bone remodeling, leading to various skeletal abnormalities [32008052, 36175952]. Additionally, RUNX2 mutations can result in broader skeletal issues, affecting both membranous and endochondral bone formation [27500518]. The clinical manifestations of CCD can vary significantly among individuals, influenced by genetic and environmental factors [20702542, 24228240]. Overall, RUNX2 mutations can lead to long-term developmental challenges and may require ongoing medical management [38068903].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in the RUNX2 gene are primarily associated with cleidocranial dysplasia (CCD), a genetic disorder that affects skeletal development [17656144, 19767586].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17656144", "evidence_support": "Mutations of the runx2 gene in humans cause cleidocranial dysplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "19767586", "evidence_support": "Cleidocranial dysplasia (CCD) is an inherited autosomal-dominant skeletal disease caused by heterozygous mutations in the osteoblast-specific transcription factor, RUNX2.", "evidence_relation": "supporting" }, { "cited_pmid": "19767586", "evidence_support": "Our results provide new genetic evidence that mutations involved in RUNX2 contribute to CCD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Individuals with CCD often experience hypoplasia or absence of clavicles, delayed closure of fontanelles, and dental anomalies such as late tooth eruption and impacted teeth [31347140, 20082269].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31347140", "evidence_support": "Pathogenic variants in RUNX2 have been linked to the Cleidocranial dysplasia (CCD), which is characterized by hypoplasia or aplasia of clavicles, delayed fontanelle closure, and dental anomalies.", "evidence_relation": "supporting" }, { "cited_pmid": "20082269", "evidence_support": "We studied a Chinese family that included three affected individuals with CCD phenotypes; the clinical features of patients with CCD include delayed closure of fontanelles, frontal bossing, dysplasia of clavicles, late tooth eruption, and other skeletal anomalies. X-ray analysis showed aplasia of the clavicles.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "These mutations impair osteoblast differentiation and bone remodeling, leading to various skeletal abnormalities [32008052, 36175952].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32008052", "evidence_support": "Wild-type RUNX2 promoted osteoclast differentiation, formation of F-actin ring, and bone resorption, while mutant RUNX2 attenuated the positive differentiation effect.", "evidence_relation": "supporting" }, { "cited_pmid": "32008052", "evidence_support": "This study, for the first time, verifies the effect of RUNX2 on osteoclast differentiation and bone resorption and provides new insight for the explanation of cleidocranial dysplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "36175952", "evidence_support": "Mutation of Runx2 causing cleidocranial dysplasia negatively affects osteogenesis and the osteoclastic ability of dental follicles, resulting in tooth eruption difficulties. Among a variety of cells and molecules, Nel-like molecule type 1 (Nell-1) plays an important role in neural crest-derived tissues and is strongly expressed in dental follicles. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, RUNX2 mutations can result in broader skeletal issues, affecting both membranous and endochondral bone formation [27500518].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27500518", "evidence_support": "Cleidocranial dysplasia syndrome, a rare genetic disorder, documented to have an autosomal dominant inheritance pattern and caused by caused by mutations of the transcription factor RUNX2", "evidence_relation": "neutral" }, { "cited_pmid": "27500518", "evidence_support": "The mutation of the RUNX2 gene results in cleidocranial dysplasia syndrome", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The clinical manifestations of CCD can vary significantly among individuals, influenced by genetic and environmental factors [20702542, 24228240].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "20702542", "evidence_support": "The occurrence of intrafamilial clinical variability raises the view that hypomorphic effects and genetic modifiers may alter the clinical expressivity of these mutations.", "evidence_relation": "supporting" }, { "cited_pmid": "24228240", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, RUNX2 mutations can lead to long-term developmental challenges and may require ongoing medical management [38068903].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "38068903", "evidence_support": "RUNX2-deficiency causes extra- and intra-oral malformations that often require orthodontic treatment.", "evidence_relation": "supporting" } ] } ] }, "webis-1": { "answer": "Mutation in runx2 may affect the future development of cleidocranial dysplasia (CCD) [28173761,20702542,29058294,19767586].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutation in runx2 may affect the future development of cleidocranial dysplasia (CCD) [28173761,20702542,29058294,19767586].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28173761", "evidence_support": "Haploinsufficiency of the runt-related transcription factor 2 (RUNX2) gene is known to cause cleidocranial dysplasia (CCD).", "evidence_relation": "supporting" }, { "cited_pmid": "28173761", "evidence_support": "RUNX2 haploinsufficiency was associated with CCD pathogenesis.", "evidence_relation": "supporting" }, { "cited_pmid": "20702542", "evidence_support": "Cleidocranial dysplasia (CCD) is a dominantly inherited skeletal dysplasia caused by mutations in the osteoblast-specific transcription factor-encoding gene, RUNX2", "evidence_relation": "supporting" }, { "cited_pmid": "20702542", "evidence_support": "Our results provide new genetic evidence that mutations involved in RUNX2 contribute to CCD.", "evidence_relation": "supporting" }, { "cited_pmid": "29058294", "evidence_support": "Haploinsufficiency of the runt-related transcription factor 2 (Runx2) gene is widely known to be responsible for cleidocranial dysplasia (CCD).", "evidence_relation": "supporting" }, { "cited_pmid": "29058294", "evidence_support": "Our finding may further extend the known mutation spectrum of the RUNX2 gene, and facilitate prenatal genetic diagnosis of CCD in the future.", "evidence_relation": "neutral" }, { "cited_pmid": "19767586", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "webis-2": { "answer": "Mutation in Runx2 will likely lead to cleidocranial dysplasia (CCD) [29058294].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutation in Runx2 will likely lead to cleidocranial dysplasia (CCD) [29058294].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29058294", "evidence_support": "Haploinsufficiency of the runt-related transcription factor 2 (Runx2) gene is widely known to be responsible for cleidocranial dysplasia (CCD).", "evidence_relation": "supporting" }, { "cited_pmid": "29058294", "evidence_support": "To date, more than 190 mutations in Runx2 gene have been reported to be related to CCD. ", "evidence_relation": "supporting" } ] } ] }, "webis-3": { "answer": "Mutation in runx2 will affect bone formation, particularly in cranial sutures, clavicle formation, and dental development, leading to cleidocranial dysplasia, a rare autosomal dominant skeletal dysplasia characterized by delayed closure of cranial sutures, aplastic or hypoplastic clavicle formation, short stature, and dental anomalies, including malocclusion, supernumerary teeth, and delayed eruption of permanent teeth [24222232,20225274].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutation in runx2 will affect bone formation, particularly in cranial sutures, clavicle formation, and dental development, leading to cleidocranial dysplasia, a rare autosomal dominant skeletal dysplasia characterized by delayed closure of cranial sutures, aplastic or hypoplastic clavicle formation, short stature, and dental anomalies, including malocclusion, supernumerary teeth, and delayed eruption of permanent teeth [24222232,20225274].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24222232", "evidence_support": "Mutations in RUNX2 have been identified in cleidocranial dysplasia (CCD) patients.", "evidence_relation": "supporting" }, { "cited_pmid": "20225274", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-5": { "answer": "Mutation in runx2 will affect bone formation, particularly in cranial sutures, clavicle formation, and dental development, leading to cleidocranial dysplasia, a rare autosomal dominant skeletal dysplasia characterized by delayed closure of cranial sutures, aplastic or hypoplastic clavicle formation, short stature, and dental anomalies, including malocclusion, supernumerary teeth, and delayed eruption of permanent teeth [24222232,20225274].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutation in runx2 will affect bone formation, particularly in cranial sutures, clavicle formation, and dental development, leading to cleidocranial dysplasia, a rare autosomal dominant skeletal dysplasia characterized by delayed closure of cranial sutures, aplastic or hypoplastic clavicle formation, short stature, and dental anomalies, including malocclusion, supernumerary teeth, and delayed eruption of permanent teeth [24222232,20225274].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24222232", "evidence_support": "Mutations in RUNX2 have been identified in cleidocranial dysplasia (CCD) patients. CCD is a rare autosomal dominant skeletal dysplasia that is characterized by delayed closure of cranial sutures, aplastic or hypoplastic clavicle formation, short stature, and dental anomalies, including malocclusion, supernumerary teeth, and delayed eruption of permanent teeth.", "evidence_relation": "supporting" }, { "cited_pmid": "20225274", "evidence_support": "Cleidocranial dysplasia (CCD) is caused by haploinsufficiency in RUNX2 function", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-1": { "answer": "A mutation in the RUNX2 gene is likely to affect bone development and mineralization in the future. RUNX2 is a critical transcription factor for osteoblast differentiation, and mutations can lead to skeletal disorders such as cleidocranial dysplasia, characterized by impaired bone formation and dental anomalies.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A mutation in the RUNX2 gene is likely to affect bone development and mineralization in the future.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "RUNX2 is a critical transcription factor for osteoblast differentiation, and mutations can lead to skeletal disorders such as cleidocranial dysplasia, characterized by impaired bone formation and dental anomalies.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "Mutation in the RUNX2 gene will likely lead to cleidocranial dysplasia (CCD), a condition characterized by skeletal abnormalities, particularly affecting the development of bones and teeth. This is due to the haploinsufficiency of the RUNX2 gene, which is known to be responsible for CCD [29058294]. Additionally, specific mutations such as insertions and deletions in the RUNX2 gene can further complicate the phenotype associated with this condition [29089101].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutation in the RUNX2 gene will likely lead to cleidocranial dysplasia (CCD), a condition characterized by skeletal abnormalities, particularly affecting the development of bones and teeth.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This is due to the haploinsufficiency of the RUNX2 gene, which is known to be responsible for CCD [29058294].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29058294", "evidence_support": "Haploinsufficiency of the runt-related transcription factor 2 (Runx2) gene is widely known to be responsible for cleidocranial dysplasia (CCD).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, specific mutations such as insertions and deletions in the RUNX2 gene can further complicate the phenotype associated with this condition [29089101].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29089101", "evidence_support": "Our findings demonstrated that the novel c.243-260delGGCGGCTGCGGCGGCGGC mutation resulted in CCD. These results extend the spectrum of RUNX2 mutations in CCD patients and suggest a functional role of the novel mutation in CCD.", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-6": { "answer": "Mutation in the RUNX2 gene, such as the R131G or R225Q mutations, can lead to cleidocranial dysplasia, a condition characterized by skeletal abnormalities including underdeveloped or absent clavicles and dental anomalies [20225274,24634175,18166138]. These mutations disrupt the protein's ability to bind to DNA, which is crucial for normal bone and cartilage development, potentially resulting in long-term skeletal and dental issues [20225274,24634175,18166138].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutation in the RUNX2 gene, such as the R131G or R225Q mutations, can lead to cleidocranial dysplasia, a condition characterized by skeletal abnormalities including underdeveloped or absent clavicles and dental anomalies [20225274,24634175,18166138].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20225274", "evidence_support": "We have previously identified a series of RUNX2 mutations in Korean CCD patients, including a novel R131G missense mutation in the Runt-homology domain.", "evidence_relation": "supporting" }, { "cited_pmid": "24634175", "evidence_support": "Cleidocranial dysplasia (CCD; MIM 119600) is an autosomal dominant hereditary disorder of skeletal features whose characteristic clinical symptoms are caused by mutations in the RUNX2 gene. Varying degrees of clavicular hypoplasia and dental abnormalities are the most prominent features of this disorder.", "evidence_relation": "supporting" }, { "cited_pmid": "24634175", "evidence_support": "In this study, we presented a Chinese family that included 4 individuals with a p.R225Q mutation in the RUNX2 gene and characteristic CCD phenotypes", "evidence_relation": "neutral" }, { "cited_pmid": "24634175", "evidence_support": "On the basis of the structural analysis, this study further demonstrated that the p.R225Q mutation abolished DNA binding by RUNX2 and its results also suggested that other genetic and/or environmental factors could affect the CCD phenotypes", "evidence_relation": "supporting" }, { "cited_pmid": "18166138", "evidence_support": "Cleidocranial dysplasia (CCD) is a dominantly inherited disease characterized by hypoplastic or absent clavicles, large fontanels, dental dysplasia, and delayed skeletal development.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These mutations disrupt the protein's ability to bind to DNA, which is crucial for normal bone and cartilage development, potentially resulting in long-term skeletal and dental issues [20225274,24634175,18166138].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20225274", "evidence_support": "Here, we examine the functional consequences of the RUNX2(R131G) mutation, which could potentially affect DNA binding, nuclear localization signal, and/or heterodimerization with core-binding factor-beta (CBF-beta). ", "evidence_relation": "supporting" }, { "cited_pmid": "20225274", "evidence_support": "We conclude that loss of DNA binding, but not nuclear localization or CBF-beta heterodimerization, causes RUNX2 haploinsufficiency in patients with the RUNX2(R131G) mutation.", "evidence_relation": "neutral" }, { "cited_pmid": "24634175", "evidence_support": "Cleidocranial dysplasia (CCD; MIM 119600) is an autosomal dominant hereditary disorder of skeletal features whose characteristic clinical symptoms are caused by mutations in the RUNX2 gene. Varying degrees of clavicular hypoplasia and dental abnormalities are the most prominent features of this disorder.", "evidence_relation": "supporting" }, { "cited_pmid": "24634175", "evidence_support": "On the basis of the structural analysis, this study further demonstrated that the p.R225Q mutation abolished DNA binding by RUNX2 and its results also suggested that other genetic and/or environmental factors could affect the CCD phenotypes.", "evidence_relation": "supporting" }, { "cited_pmid": "18166138", "evidence_support": "Based on the crystal structure, we predict this novel missense mutation is likely to disrupt DNA binding by RUNX2, and at least locally affect the Runt domain structure.", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gemini-flash": { "answer": "Mutations in RUNX2 can lead to Cleidocranial Dysplasia (CCD), a skeletal disorder characterized by underdeveloped clavicles and skull, widened sutures and fontanelles, and dental abnormalities [15099800]. CCD patients often have multiple supernumerary teeth, impacted teeth, and delayed tooth eruption [15099800]. The delayed tooth eruption in CCD is caused by impaired recruitment of osteoclasts, which are responsible for bone resorption during tooth eruption [15099800]. While RUNX2 mutations do not affect femoral bone remodeling, they are insufficient for the active alveolar bone resorption needed for timely tooth eruption [15099800]. RUNX2 also plays a role in myogenic development, which warrants further investigation [28056872]. Additionally, RUNX2 levels are correlated with advanced stages of prostate and breast cancer, and its depletion inhibits cell migration and invasion, preventing metastatic bone disease [20561908]. This suggests that RUNX2 plays a role in tumor cell activation and bone metastasis [20561908]. The impaired function of RUNX2 could explain the unique phenotype of CCD [24984680]. Alterations in the WWOX gene, which interacts with RUNX2, are associated with metabolic abnormalities [36271927]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in RUNX2 can lead to Cleidocranial Dysplasia (CCD), a skeletal disorder characterized by underdeveloped clavicles and skull, widened sutures and fontanelles, and dental abnormalities [15099800].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15099800", "evidence_support": "Genetic studies have recently identified a mutation of one allele of runt-related gene 2 (RUNX2/CBFA1) as the cause for an autosomal-dominant skeletal disorder, cleidocranial dysplasia (CCD), which is characterised by hypoplasia of the clavicles and calvariae and widened sutures and fontanelles. In addition, CCD is frequently affected with multiple supernumerary teeth and the impaction and delayed eruption of teeth", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "CCD patients often have multiple supernumerary teeth, impacted teeth, and delayed tooth eruption [15099800].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15099800", "evidence_support": "In addition, CCD is frequently affected with multiple supernumerary teeth and the impaction and delayed eruption of teeth, the causes of all these dental abnormalities are still unknown.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The delayed tooth eruption in CCD is caused by impaired recruitment of osteoclasts, which are responsible for bone resorption during tooth eruption [15099800].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15099800", "evidence_support": "These results also suggest the possibility that impaired recruitment of osteoclasts is one of the cellular mechanisms of delayed tooth eruption in CCD patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While RUNX2 mutations do not affect femoral bone remodeling, they are insufficient for the active alveolar bone resorption needed for timely tooth eruption [15099800].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15099800", "evidence_support": "Genetic studies have recently identified a mutation of one allele of runt-related gene 2 (RUNX2/CBFA1) as the cause for an autosomal-dominant skeletal disorder, cleidocranial dysplasia (CCD), which is characterised by hypoplasia of the clavicles and calvariae and widened sutures and fontanelles. In addition, CCD is frequently affected with multiple supernumerary teeth and the impaction and delayed eruption of teeth, the causes of all these dental abnormalities are still unknown. To clarify the cellular mechanism of the delayed tooth eruption in CCD, the process of tooth eruption was examined in heterozygous Runx2/Cbfa1 (mouse homolog of RUNX2/CBFA1) knockout mice, known to mimic most of the bone abnormalities of CCD. The timing of the appearance of maxillary and mandibular teeth into the oral cavity was significantly delayed in heterozygous mutant mice compared with wild-type mice. From postnatal days 8 to 10, an active alveolar bone resorption and a marked increase of the osteoclast surfaces was observed in the eruption pathway of both genotypes, but this increase was significantly suppressed in the mutant mice. In contrast, the osteoclast surfaces did not show a significant difference between the two genotypes in the future cortical area of femora. These results suggest that haploinsufficiency of Runx2/Cbfa1 does not effect the femoral bone remodelling but is insufficient for the active alveolar bone resorption essential for the prompt timing of tooth eruption. These results also suggest the possibility that impaired recruitment of osteoclasts is one of the cellular mechanisms of delayed tooth eruption in CCD patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "RUNX2 also plays a role in myogenic development, which warrants further investigation [28056872].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28056872", "evidence_support": "We described limb-girdle myopathy in a patient with CCD that carried a heterozygous RUNX2 missense mutation. This uncommon phenotype expanded the phenotypic spectrum of the RUNX2 p.R225Q mutation.", "evidence_relation": "supporting" }, { "cited_pmid": "28056872", "evidence_support": "The role of RUNX2 in myogenic development merits future studies. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Additionally, RUNX2 levels are correlated with advanced stages of prostate and breast cancer, and its depletion inhibits cell migration and invasion, preventing metastatic bone disease [20561908].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20561908", "evidence_support": "Recent evidence has identified a correlation of Runx2 levels in advanced stages of prostate and breast cancer and demonstrated that effective depletion of Runx2 by RNA interference inhibits migration and invasive properties of the cells prevents metastatic bone disease. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "This suggests that RUNX2 plays a role in tumor cell activation and bone metastasis [20561908].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20561908", "evidence_support": "These are the master transcription factors of the Runx family of genes, the focus of this review, with emphasis placed on Runx2 that is abnormally expressed at very high levels in cancer cell lines that are metastatic to bone.", "evidence_relation": "supporting" }, { "cited_pmid": "20561908", "evidence_support": "Recent evidence has identified a correlation of Runx2 levels in advanced stages of prostate and breast cancer and demonstrated that effective depletion of Runx2 by RNA interference inhibits migration and invasive properties of the cells prevents metastatic bone disease", "evidence_relation": "supporting" }, { "cited_pmid": "20561908", "evidence_support": "This striking effect is consistent with the broad spectrum of Runx2 properties in activating many genes in tumor cells that have already been established as indicators of bone metastasis in poor prognosis. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "The impaired function of RUNX2 could explain the unique phenotype of CCD [24984680].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24984680", "evidence_support": "The described mutation, c.391C>T (p.R131C) appears to influence both structure and function of the protein by hampering the interaction of RUNX2 with DNA. The impaired function could explain the peculiar reported CCD phenotype. The dental condition of our patient has largely improved after treatment.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "9", "answer_sentence": "Alterations in the WWOX gene, which interacts with RUNX2, are associated with metabolic abnormalities [36271927].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "36271927", "evidence_support": "Because WWOX binds to some transcription factors, it is a modulator of many cellular processes, including metabolic processes.", "evidence_relation": "supporting" }, { "cited_pmid": "36271927", "evidence_support": "The WW domain of WWOX is directly engaged in the control of the activity of transcription factors such as HIF1\u03b1 and RUNX2; therefore, WWOX gene alterations are associated with some metabolic abnormalities.", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "Mutations in the RUNX2 gene can lead to cleidocranial dysplasia (CCD), a genetic disorder characterized by skeletal defects, supernumerary teeth, and delayed eruption of teeth [14688224, 38068903]. This condition arises from heterozygous loss-of-function mutations, which impair RUNX2's role in osteoblast and skeletal development [28056872, 38068903]. Individuals with CCD often exhibit aplastic or hypoplastic clavicles and may require orthodontic treatment due to dental anomalies [23289840, 38068903]. Furthermore, RUNX2 mutations can disrupt normal bone and tooth development, potentially leading to severe malformations [14688224, 24984680]. In severe cases, complete absence of bone can occur, as seen in mice lacking RUNX2 [12902164]. Thus, future implications of RUNX2 mutations include ongoing skeletal and dental issues that may necessitate medical and dental interventions [23289840, 38068903].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in the RUNX2 gene can lead to cleidocranial dysplasia (CCD), a genetic disorder characterized by skeletal defects, supernumerary teeth, and delayed eruption of teeth [14688224, 38068903].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14688224", "evidence_support": "Heterozygous mutations in Runx2 cause cleidocranial dysplasia (CCD), an inherited disorder in humans and mice characterized by skeletal defects, supernumerary teeth, and delayed eruption.", "evidence_relation": "supporting" }, { "cited_pmid": "38068903", "evidence_support": "Cleidocranial dysplasia (CCD) is a rare genetic defect caused by a heterozygous mutation of runt-related transcription factor 2 (RUNX2), which is important for osteoblast and skeletal development. RUNX2-deficiency causes extra- and intra-oral malformations that often require orthodontic treatment.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This condition arises from heterozygous loss-of-function mutations, which impair RUNX2's role in osteoblast and skeletal development [28056872, 38068903].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28056872", "evidence_support": "Cleidocranial dysplasia (CCD) is a rare hereditary disorder that arises from heterozygous loss of function mutations in the runt-related transcription factor 2 (RUNX2) gene. As RUNX2 is mainly expressed in osteoblasts, CCD typically affects the skeletal and dental systems.", "evidence_relation": "supporting" }, { "cited_pmid": "38068903", "evidence_support": "Cleidocranial dysplasia (CCD) is a rare genetic defect caused by a heterozygous mutation of runt-related transcription factor 2 (RUNX2), which is important for osteoblast and skeletal development. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Individuals with CCD often exhibit aplastic or hypoplastic clavicles and may require orthodontic treatment due to dental anomalies [23289840, 38068903].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23289840", "evidence_support": "The most prevalent features associated with CCD are aplastic or hypoplastic clavicles, supernumerary teeth, failed eruption of permanent teeth, and a hypoplastic maxilla.", "evidence_relation": "supporting" }, { "cited_pmid": "23289840", "evidence_support": "CCD is of clinical importance in dentistry and medicine because it affects the bones and teeth and is characterized by many changes in skeletal patterning and growth", "evidence_relation": "supporting" }, { "cited_pmid": "38068903", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, RUNX2 mutations can disrupt normal bone and tooth development, potentially leading to severe malformations [14688224, 24984680].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14688224", "evidence_support": "Heterozygous mutations in Runx2 cause cleidocranial dysplasia (CCD), an inherited disorder in humans and mice characterized by skeletal defects, supernumerary teeth, and delayed eruption.", "evidence_relation": "supporting" }, { "cited_pmid": "14688224", "evidence_support": "Mice lacking the Runx2 gene die at birth and lack bone and tooth development.", "evidence_relation": "supporting" }, { "cited_pmid": "14688224", "evidence_support": "These data support the hypothesis that Runx2 is one of the key mesenchymal factors that influences tooth morphogenesis and the subsequent differentiation of ameloblasts and odontoblasts.", "evidence_relation": "supporting" }, { "cited_pmid": "24984680", "evidence_support": "This report deals with a case of Cleidocranial Dysplasia (CCD) associated to a rare mutation of the RUNX2 gene and a peculiar dental phenotype, namely no supernumerary teeth.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In severe cases, complete absence of bone can occur, as seen in mice lacking RUNX2 [12902164].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "12902164", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Thus, future implications of RUNX2 mutations include ongoing skeletal and dental issues that may necessitate medical and dental interventions [23289840, 38068903].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23289840", "evidence_support": "Cleidocranial dysplasia (CCD) is a rare congenital autosomal dominant skeletal disorder", "evidence_relation": "neutral" }, { "cited_pmid": "23289840", "evidence_support": "CCD is of clinical importance in dentistry and medicine because it affects the bones and teeth and is characterized by many changes in skeletal patterning and growth. ", "evidence_relation": "supporting" }, { "cited_pmid": "38068903", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] } } }, { "question_id": "118", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Healing times for corneal injuries can vary based on the severity and underlying health conditions. Minor corneal injuries, such as superficial abrasions, typically heal within a few days to a week without medical intervention, assuming no complications arise. It's important to monitor the injury closely, as symptoms like persistent pain, redness, or vision changes may indicate complications that require medical attention. In cases where the patient experiences repeated injuries or has a pre-existing condition that affects healing, such as an autoimmune disorder, the healing process may be delayed, and medical consultation is recommended [31568017].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Healing times for corneal injuries can vary based on the severity and underlying health conditions.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Minor corneal injuries, such as superficial abrasions, typically heal within a few days to a week without medical intervention, assuming no complications arise.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "It's important to monitor the injury closely, as symptoms like persistent pain, redness, or vision changes may indicate complications that require medical attention.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "In cases where the patient experiences repeated injuries or has a pre-existing condition that affects healing, such as an autoimmune disorder, the healing process may be delayed, and medical consultation is recommended [31568017].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "31568017", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Most minor corneal abrasions typically heal within 24 to 72 hours, with superficial corneal wounds often recovering within days [15259527, 31436261, 23587556]. The corneal epithelium usually re-epithelializes promptly after trauma, facilitating rapid healing [30059040, 29355667, 23587556]. Studies in animal models, such as rats, show almost complete healing by 36 hours, while porcine models indicate wound closure within 5-7 days [19420767, 21330660, 36077171]. Small, uncomplicated corneal abrasions may not necessitate follow-up due to their quick recovery [23317075, 29355667, 33200044]. In rabbits, corneal re-epithelialization is observed within 5 days, and tear protein profiles correlate with wound closure in a similar timeframe [19335555, 33662355, 22816086]. CAP37-treated corneal wounds demonstrate accelerated healing within 48 hours, highlighting the potential for faster recovery with specific treatments [30542656]. Overall, minor corneal injuries generally heal efficiently without medical intervention, although the exact duration can vary slightly depending on the specific circumstances and model studied [31436261, 33200044, 16701650].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Most minor corneal abrasions typically heal within 24 to 72 hours, with superficial corneal wounds often recovering within days [15259527, 31436261, 23587556].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15259527", "evidence_support": "Most corneal abrasions heal in 24 to 72 hours and rarely progress to corneal erosion or infection.", "evidence_relation": "supporting" }, { "cited_pmid": "23587556", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "31436261", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The corneal epithelium usually re-epithelializes promptly after trauma, facilitating rapid healing [30059040, 29355667, 23587556].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29355667", "evidence_support": "After trauma, the cornea typically re-epithelializes promptly thereby minimizing the risk of infection, opacification or perforation. ", "evidence_relation": "supporting" }, { "cited_pmid": "30059040", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "23587556", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Studies in animal models, such as rats, show almost complete healing by 36 hours, while porcine models indicate wound closure within 5-7 days [19420767, 21330660, 36077171].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "19420767", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "21330660", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "36077171", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Small, uncomplicated corneal abrasions may not necessitate follow-up due to their quick recovery [23317075, 29355667, 33200044].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "23317075", "evidence_support": "Follow-up may not be necessary for patients with small (4 mm or less), uncomplicated abrasions; normal vision; and resolving symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "33200044", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "29355667", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In rabbits, corneal re-epithelialization is observed within 5 days, and tear protein profiles correlate with wound closure in a similar timeframe [19335555, 33662355, 22816086].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "33662355", "evidence_support": "Grading of rabbit eyes post-alkali burn had shown complete conjunctivalization in 80% (n\u00a0=\u00a012/15) of the rabbits with the alkali burn grade score of 3.88\u00a0\u00b1\u00a00.29 in three months and remained stable at four months (4.12\u00a0\u00b1\u00a00.24). However, ocular surface showed self-healing in 20% (n\u00a0=\u00a03/15) of the rabbits with a score of 1.67\u00a0\u00b1\u00a00.34 in four months irrespective of similar alkali injury. These self-healing corneas exhibited decreased opacity score from 2.51\u00a0\u00b1\u00a00.39 to 0.66\u00a0\u00b1\u00a00.22 (p\u00a0=\u00a00.002) and regressed vascularity from 1.66\u00a0\u00b1\u00a00.41 to 0.66\u00a0\u00b1\u00a00.33 in one to nine months, respectively. ", "evidence_relation": "contradicting" }, { "cited_pmid": "19335555", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "22816086", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "CAP37-treated corneal wounds demonstrate accelerated healing within 48 hours, highlighting the potential for faster recovery with specific treatments [30542656].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30542656", "evidence_support": "The cationic antimicrobial protein of 37 kDa (CAP37) mediates proliferation, migration, and adhesion of human corneal epithelial cells and promotes corneal re-epithelialization in mouse.", "evidence_relation": "supporting" }, { "cited_pmid": "30542656", "evidence_support": "The corneal epithelium in mouse eyes was removed and wounds were treated with a saline vehicle or human recombinant CAP37. Wounds were visualized with fluoresce in staining at 0, 16, 24 and 48 h.", "evidence_relation": "supporting" }, { "cited_pmid": "30542656", "evidence_support": "Mouse corneas were excised at 0, 6, 16, 24 and 48 h post corneal abrasion", "evidence_relation": "supporting" }, { "cited_pmid": "30542656", "evidence_support": "Results corroborating previous studies showed accelerated wound closure in corneas treated with CAP37 compared to those treated with the saline vehicle. ", "evidence_relation": "supporting" }, { "cited_pmid": "30542656", "evidence_support": "By 48 h post-wounding, histological analysis revealed more staining for neutrophils than the staining observed in the controls", "evidence_relation": "supporting" }, { "cited_pmid": "30542656", "evidence_support": "In general, CAP37 appeared to decrease pro-inflammatory cytokines at 24 h and increase them at 48 h when compared to the control group.", "evidence_relation": "supporting" }, { "cited_pmid": "30542656", "evidence_support": "These data demonstrate that CAP37 modulates the production of cytokines in the cornea and suggest that limiting the number of neutrophils recruited during the early inflammatory phase may support corneal re-epithelialization.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Overall, minor corneal injuries generally heal efficiently without medical intervention, although the exact duration can vary slightly depending on the specific circumstances and model studied [31436261, 33200044, 16701650].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31436261", "evidence_support": "For example, a superficial skin or corneal wound may recover within days; however, more severe injuries can last up to several months and may leave scarring", "evidence_relation": "supporting" }, { "cited_pmid": "33200044", "evidence_support": "Corneal injury activates a carefully orchestrated series of repair processes capable of resolving minor lesions over time, but it often fails to overcome the menace of moderate, severe, and chronic injuries and secondary pathophysiologies that permanently impair vision.", "evidence_relation": "supporting" }, { "cited_pmid": "16701650", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Minor corneal injuries, such as superficial abrasions, typically heal within 24 to 72 hours without medical intervention, as the corneal epithelium rapidly regenerates to restore the protective barrier [15259527, 23317075]. The healing process involves epithelial cell migration and proliferation, which are usually sufficient to close small defects and prevent complications [15259527, 30059040]. However, the healing rate can be influenced by factors such as the size and depth of the abrasion, patient age, and the presence of underlying conditions [15259527, 35602595]. While most minor abrasions resolve quickly, it is crucial to monitor for signs of infection or delayed healing, which may necessitate medical evaluation [23317075, 31598519]. Protective measures, such as avoiding eye rubbing and using artificial tears, can support the natural healing process [15259527, 23317075].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Minor corneal injuries, such as superficial abrasions, typically heal within 24 to 72 hours without medical intervention, as the corneal epithelium rapidly regenerates to restore the protective barrier [15259527, 23317075].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15259527", "evidence_support": "Most corneal abrasions heal in 24 to 72 hours and rarely progress to corneal erosion or infection.", "evidence_relation": "supporting" }, { "cited_pmid": "23317075", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The healing process involves epithelial cell migration and proliferation, which are usually sufficient to close small defects and prevent complications [15259527, 30059040].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "30059040", "evidence_support": "The epithelial abrasion model of corneal injury is ideal for studies on epithelial cell proliferation, migration and re-epithelialization of the corneal layers.", "evidence_relation": "supporting" }, { "cited_pmid": "15259527", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, the healing rate can be influenced by factors such as the size and depth of the abrasion, patient age, and the presence of underlying conditions [15259527, 35602595].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35602595", "evidence_support": "Together, these findings suggest that there are several significant differences in the stiffness and signaling that underlie the decreased wound healing efficacy of the cornea in older mice.", "evidence_relation": "supporting" }, { "cited_pmid": "15259527", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While most minor abrasions resolve quickly, it is crucial to monitor for signs of infection or delayed healing, which may necessitate medical evaluation [23317075, 31598519].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "23317075", "evidence_support": "The goals of treatment include pain control, prevention of infection, and healing.", "evidence_relation": "neutral" }, { "cited_pmid": "23317075", "evidence_support": "Referral is indicated for any patient with symptoms that do not improve or that worsen, a corneal infiltrate or ulcer, significant vision loss, or a penetrating eye injury.", "evidence_relation": "supporting" }, { "cited_pmid": "31598519", "evidence_support": "Disruptions in the protective epithelial and stromal layers of the cornea can render the eye susceptible to infection, stromal ulceration, perforation, scarring, and significant vision loss.", "evidence_relation": "neutral" }, { "cited_pmid": "31598519", "evidence_support": "It is important to treat the underlying causative condition, which may include an infection, limbal stem cell deficiency, or diabetes, in order to facilitate wound healing.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Protective measures, such as avoiding eye rubbing and using artificial tears, can support the natural healing process [15259527, 23317075].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "15259527", "evidence_support": "Symptoms can be worsened by exposure to light, blinking, and rubbing the injured surface against the inside of the eyelid.", "evidence_relation": "supporting" }, { "cited_pmid": "23317075", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "A minor corneal injury, such as a corneal abrasion, typically heals on its own without medical attention within 24 to 72 hours [15259527, 23317075]. The healing process involves the regeneration of the corneal epithelium, which can be facilitated by the expression of certain proteins, such as thrombospondin-1 [14985101]. In some cases, the healing process may be accelerated by the use of certain substances, such as sericin or verbascoside [19420767, 25165705]. However, it is essential to note that some corneal injuries may not heal properly without medical attention, leading to complications such as persistent epithelial defects [31598519]. In general, the healing time for a minor corneal injury can vary depending on the severity of the injury and individual factors, such as age [35602595]. In most cases, the cornea is fully healed within 24 hours [30059040, 35602595]. If symptoms persist or worsen, medical attention is necessary to prevent further complications.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A minor corneal injury, such as a corneal abrasion, typically heals on its own without medical attention within 24 to 72 hours [15259527, 23317075].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15259527", "evidence_support": "Most corneal abrasions heal in 24 to 72 hours and rarely progress to corneal erosion or infection.", "evidence_relation": "supporting" }, { "cited_pmid": "23317075", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The healing process involves the regeneration of the corneal epithelium, which can be facilitated by the expression of certain proteins, such as thrombospondin-1 [14985101].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "14985101", "evidence_support": "These findings suggest the possibility that epithelial defects in the corneas stimulate the expression of TSP-1 in the wound area, resulting in the accelerated re-epithelialization of the cornea", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In some cases, the healing process may be accelerated by the use of certain substances, such as sericin or verbascoside [19420767, 25165705].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "19420767", "evidence_support": "The present study demonstrates that the instillation of sericin solution has a potent effect in promoting wound healing and wound-size reduction in rats, probably caused by increasing cell movement and proliferation.", "evidence_relation": "supporting" }, { "cited_pmid": "25165705", "evidence_support": "Thus, the topical administration of verbascoside appears to reduce the action time of cells, as verified by histochemical and immunofluorescence assays.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, it is essential to note that some corneal injuries may not heal properly without medical attention, leading to complications such as persistent epithelial defects [31598519].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "31598519", "evidence_support": "Persistent corneal epithelial defects (PEDs or PCEDs) result from the failure of rapid re-epithelialization and closure within 10-14 days after a corneal injury, even with standard supportive treatment.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In general, the healing time for a minor corneal injury can vary depending on the severity of the injury and individual factors, such as age [35602595].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35602595", "evidence_support": "Together, these findings suggest that there are several significant differences in the stiffness and signaling that underlie the decreased wound healing efficacy of the cornea in older mice.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "In most cases, the cornea is fully healed within 24 hours [30059040, 35602595].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30059040", "evidence_support": "Then, we follow the timeline of wound healing 0, 18, and 72 h after abrasion, until the wound is re-epithelialized.", "evidence_relation": "neutral" }, { "cited_pmid": "35602595", "evidence_support": "Corneas from 9-week mice were fully healed within 24\u00a0h.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "If symptoms persist or worsen, medical attention is necessary to prevent further complications.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "Most corneal abrasions heal in 24 to 72 hours and rarely progress to corneal erosion or infection [27457359, 26472608, 27119941]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Most corneal abrasions heal in 24 to 72 hours and rarely progress to corneal erosion or infection [27457359, 26472608, 27119941].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27457359", "evidence_support": "The primary outcome was healing at 24, 48 and 72 hours while secondary outcomes included measures of pain, quality of life and adverse effects.", "evidence_relation": "supporting" }, { "cited_pmid": "26472608", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "27119941", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [27119941, 25140844, 15259527]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [27119941, 25140844, 15259527].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27119941", "evidence_support": "Pain improves significantly after 24 hours and should be resolved by 48 hours.", "evidence_relation": "supporting" }, { "cited_pmid": "25140844", "evidence_support": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage.", "evidence_relation": "supporting" }, { "cited_pmid": "15259527", "evidence_support": "Most corneal abrasions heal in 24 to 72 hours and rarely progress to corneal erosion or infection.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [25140844, 15259527, 29217021]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [25140844, 15259527, 29217021].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25140844", "evidence_support": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage.", "evidence_relation": "supporting" }, { "cited_pmid": "15259527", "evidence_support": "Most corneal abrasions heal in 24 to 72 hours and rarely progress to corneal erosion or infection.", "evidence_relation": "supporting" }, { "cited_pmid": "29217021", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [15259527, 25140844, 22859636]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [15259527, 25140844, 22859636].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15259527", "evidence_support": "Most corneal abrasions heal in 24 to 72 hours and rarely progress to corneal erosion or infection.", "evidence_relation": "contradicting" }, { "cited_pmid": "25140844", "evidence_support": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage.", "evidence_relation": "neutral" }, { "cited_pmid": "22859636", "evidence_support": "Children with corneal abrasions should have follow-up appointments within 24 to 48 hours to assess healing, complications, and side effects of treatment, particularly if they are using topical NSAIDs", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [22859636, 15259527, 25140844]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [22859636, 15259527, 25140844].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25140844", "evidence_support": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage.", "evidence_relation": "neutral" }, { "cited_pmid": "22859636", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15259527", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [15259527, 25140844, 22859636]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [15259527, 25140844, 22859636].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15259527", "evidence_support": "Most corneal abrasions heal in 24 to 72 hours and rarely progress to corneal erosion or infection.", "evidence_relation": "contradicting" }, { "cited_pmid": "25140844", "evidence_support": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage.", "evidence_relation": "neutral" }, { "cited_pmid": "22859636", "evidence_support": "Children with corneal abrasions should have follow-up appointments within 24 to 48 hours to assess healing, complications, and side effects of treatment, particularly if they are using topical NSAIDs", "evidence_relation": "supporting" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [22859636, 15259527, 25140844]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [22859636, 15259527, 25140844].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25140844", "evidence_support": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage.", "evidence_relation": "neutral" }, { "cited_pmid": "22859636", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15259527", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [22859636, 25140844]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [22859636, 25140844].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25140844", "evidence_support": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage.", "evidence_relation": "supporting" }, { "cited_pmid": "22859636", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [22859636, 15259527, 25140844]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [22859636, 15259527, 25140844].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25140844", "evidence_support": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage.", "evidence_relation": "neutral" }, { "cited_pmid": "22859636", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15259527", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [25140844, 22859636, 15259527]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage [25140844, 22859636, 15259527].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25140844", "evidence_support": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage.", "evidence_relation": "supporting" }, { "cited_pmid": "22859636", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15259527", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Minor corneal injuries, such as small abrasions, typically heal within 24 to 72 hours without medical intervention, as the corneal epithelium rapidly regenerates [15259527, 23317075]. The healing process involves re-epithelialization, where epithelial cells migrate to cover the defect, often completing within 24 hours in young, healthy individuals [30059040, 35602595]. However, factors such as age, underlying health conditions, and the presence of foreign bodies can influence healing time [35602595, 31598519]. While most minor abrasions resolve quickly, complications like infection or persistent epithelial defects can occur if the injury is not properly managed [15259527, 23317075]. Therefore, while minor injuries generally heal swiftly, monitoring for signs of complications is crucial to ensure complete recovery and prevent long-term damage [15259527, 23317075].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Minor corneal injuries, such as small abrasions, typically heal within 24 to 72 hours without medical intervention, as the corneal epithelium rapidly regenerates [15259527, 23317075].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15259527", "evidence_support": "Most corneal abrasions heal in 24 to 72 hours and rarely progress to corneal erosion or infection.", "evidence_relation": "supporting" }, { "cited_pmid": "23317075", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The healing process involves re-epithelialization, where epithelial cells migrate to cover the defect, often completing within 24 hours in young, healthy individuals [30059040, 35602595].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30059040", "evidence_support": "Then, we follow the timeline of wound healing 0, 18, and 72 h after abrasion, until the wound is re-epithelialized. The epithelial abrasion model of corneal injury is ideal for studies on epithelial cell proliferation, migration and re-epithelialization of the corneal layers.", "evidence_relation": "supporting" }, { "cited_pmid": "35602595", "evidence_support": "Corneas from 9-week mice were fully healed within 24\u00a0h. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, factors such as age, underlying health conditions, and the presence of foreign bodies can influence healing time [35602595, 31598519].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35602595", "evidence_support": "We hypothesized that changes in tissue stiffness of the cornea with age may alter calcium signaling between cells after injury, and the downstream effects of this signaling on cellular motility and wound healing.", "evidence_relation": "supporting" }, { "cited_pmid": "31598519", "evidence_support": "It is important to treat the underlying causative condition, which may include an infection, limbal stem cell deficiency, or diabetes, in order to facilitate wound healing.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While most minor abrasions resolve quickly, complications like infection or persistent epithelial defects can occur if the injury is not properly managed [15259527, 23317075].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "15259527", "evidence_support": "Most corneal abrasions heal in 24 to 72 hours and rarely progress to corneal erosion or infection.", "evidence_relation": "supporting" }, { "cited_pmid": "23317075", "evidence_support": "Follow-up may not be necessary for patients with small (4 mm or less), uncomplicated abrasions; normal vision; and resolving symptoms.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Therefore, while minor injuries generally heal swiftly, monitoring for signs of complications is crucial to ensure complete recovery and prevent long-term damage [15259527, 23317075].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15259527", "evidence_support": "Most corneal abrasions heal in 24 to 72 hours and rarely progress to corneal erosion or infection.", "evidence_relation": "supporting" }, { "cited_pmid": "23317075", "evidence_support": "Referral is indicated for any patient with symptoms that do not improve or that worsen, a corneal infiltrate or ulcer, significant vision loss, or a penetrating eye injury.", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "A minor corneal injury, such as a superficial abrasion, typically heals within 24 to 48 hours without medical intervention, due to the cornea's high regenerative capacity.However, the healing process can be influenced by factors such as the extent of the injury, the presence of any foreign bodies, and the individual's overall health and immune status.Symptoms like pain, redness, tearing, and sensitivity to light usually improve as the cornea heals.It is crucial to monitor for signs of infection or complications, such as worsening pain, vision changes, or persistent redness, which may necessitate medical evaluation.While minor injuries often resolve quickly, ensuring the eye is protected from further trauma and avoiding contact lens use during healing can aid recovery.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A minor corneal injury, such as a superficial abrasion, typically heals within 24 to 48 hours without medical intervention, due to the cornea's high regenerative capacity.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "However, the healing process can be influenced by factors such as the extent of the injury, the presence of any foreign bodies, and the individual's overall health and immune status.", "answer_sentence_relevance": "borderline", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Symptoms like pain, redness, tearing, and sensitivity to light usually improve as the cornea heals.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "It is crucial to monitor for signs of infection or complications, such as worsening pain, vision changes, or persistent redness, which may necessitate medical evaluation.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "While minor injuries often resolve quickly, ensuring the eye is protected from further trauma and avoiding contact lens use during healing can aid recovery.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "A minor corneal injury, such as a corneal abrasion, typically heals on its own within 24 to 72 hours without medical attention [15259527, 23317075]. The healing process involves the regeneration of the corneal epithelium, which can be facilitated by the body's natural wound healing mechanisms [30059040]. In some cases, minor corneal injuries may take longer to heal, but most will resolve within a few days [25165705]. It is essential to note that while minor corneal injuries can heal without medical attention, more severe injuries or those that do not improve within a few days may require medical evaluation and treatment to prevent complications [19420767]. Additionally, certain factors, such as age, can affect the healing rate of corneal injuries, with older individuals potentially experiencing delayed healing [35602595]. Overall, minor corneal injuries can heal quickly without medical attention, but it is crucial to monitor the injury and seek medical attention if symptoms persist or worsen.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A minor corneal injury, such as a corneal abrasion, typically heals on its own within 24 to 72 hours without medical attention [15259527, 23317075].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15259527", "evidence_support": "Most corneal abrasions heal in 24 to 72 hours and rarely progress to corneal erosion or infection.", "evidence_relation": "supporting" }, { "cited_pmid": "23317075", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The healing process involves the regeneration of the corneal epithelium, which can be facilitated by the body's natural wound healing mechanisms [30059040].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30059040", "evidence_support": "The epithelial abrasion model of corneal injury is ideal for studies on epithelial cell proliferation, migration and re-epithelialization of the corneal layers.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In some cases, minor corneal injuries may take longer to heal, but most will resolve within a few days [25165705].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25165705", "evidence_support": "The results indicate a latency time of only three hours and furthermore the corneal epithelium heals in 48 hours.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It is essential to note that while minor corneal injuries can heal without medical attention, more severe injuries or those that do not improve within a few days may require medical evaluation and treatment to prevent complications [19420767].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19420767", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, certain factors, such as age, can affect the healing rate of corneal injuries, with older individuals potentially experiencing delayed healing [35602595].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35602595", "evidence_support": "Together, these findings suggest that there are several significant differences in the stiffness and signaling that underlie the decreased wound healing efficacy of the cornea in older mice.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, minor corneal injuries can heal quickly without medical attention, but it is crucial to monitor the injury and seek medical attention if symptoms persist or worsen.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "ten-shot-gemini-flash": { "answer": "Minor corneal abrasions typically heal within 48 hours without complications or eye damage [25140844]. These minor injuries tend to heal quickly and without sequela [33456682]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Minor corneal abrasions typically heal within 48 hours without complications or eye damage [25140844].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25140844", "evidence_support": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These minor injuries tend to heal quickly and without sequela [33456682].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33456682", "evidence_support": "Minor ophthalmic injuries, including chemosis and subconjunctival bleeding, are more frequently associated with midface trauma. These minor injuries tend to heal quickly and without sequela. ", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Minor corneal abrasions typically heal within 48 hours without complications [25140844, 33456682]. These injuries tend to heal quickly and without long-term consequences [33456682]. While some corneal injuries may take longer to heal, with an average epithelial healing time of 24.6 days [11862088], minor abrasions usually resolve within a shorter timeframe. However, it is important to note that severe corneal injuries may require medical attention to prevent complications [31741043]. \n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Minor corneal abrasions typically heal within 48 hours without complications [25140844, 33456682].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25140844", "evidence_support": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage.", "evidence_relation": "supporting" }, { "cited_pmid": "33456682", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These injuries tend to heal quickly and without long-term consequences [33456682].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33456682", "evidence_support": "Minor ophthalmic injuries, including chemosis and subconjunctival bleeding, are more frequently associated with midface trauma.", "evidence_relation": "neutral" }, { "cited_pmid": "33456682", "evidence_support": "These minor injuries tend to heal quickly and without sequela. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "While some corneal injuries may take longer to heal, with an average epithelial healing time of 24.6 days [11862088], minor abrasions usually resolve within a shorter timeframe.", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "11862088", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, it is important to note that severe corneal injuries may require medical attention to prevent complications [31741043].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "31741043", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "A minor corneal injury typically heals within 10 to 14 days without medical intervention. However, if the corneal epithelial defect persists beyond this period, it may indicate a failure of re-epithelialization, which could lead to complications [31598519]. It is recommended that any persistent defects be treated within 7 to 10 days to prevent secondary issues [31598519]. While some injuries may show a tendency to self-heal, timely assessment is crucial to ensure proper recovery and avoid complications [33662355]. Therefore, if symptoms persist or worsen, seeking medical attention is advisable.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A minor corneal injury typically heals within 10 to 14 days without medical intervention.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "However, if the corneal epithelial defect persists beyond this period, it may indicate a failure of re-epithelialization, which could lead to complications [31598519].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31598519", "evidence_support": "Persistent corneal epithelial defects (PEDs or PCEDs) result from the failure of rapid re-epithelialization and closure within 10-14 days after a corneal injury, even with standard supportive treatment.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "It is recommended that any persistent defects be treated within 7 to 10 days to prevent secondary issues [31598519].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31598519", "evidence_support": "Recently-developed medical treatments can target the re-epithelialization process by facilitating access to growth factors and anti-inflammatory agents, and novel surgical techniques can provide re-innervation to the cornea. PEDs should be treated within 7-10 days to avoid secondary complications. These interventions, along with a step-wise approach to management, can be useful in patients with PEDs that are refractory to standard medical treatment.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While some injuries may show a tendency to self-heal, timely assessment is crucial to ensure proper recovery and avoid complications [33662355].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "33662355", "evidence_support": "However, ocular surface showed self-healing in 20% (n\u00a0=\u00a03/15) of the rabbits with a score of 1.67\u00a0\u00b1\u00a00.34 in four months irrespective of similar alkali injury.", "evidence_relation": "neutral" }, { "cited_pmid": "33662355", "evidence_support": "Our study shows the essentiality to consider the time required for surgical intervention after the corneal alkali injury in rabbit models as evident from their tendency to self-heal and restore corneal phenotype without therapy.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Therefore, if symptoms persist or worsen, seeking medical attention is advisable.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "A minor corneal injury, such as a corneal abrasion, typically heals within a few days without medical intervention. Most corneal abrasions heal within 48 hours, although complete epithelial healing may take up to 7 days [36065127, 23652196]. In general, epithelial closure is achieved after approximately 2.4 days, with normalization of the epithelium occurring around 3.6 days [347160]. While many patients recover well without complications, it is advisable to seek medical attention if symptoms persist or worsen, as this could indicate a more serious issue [29217021]. Regular monitoring is recommended to ensure proper healing and prevent complications [29217021].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A minor corneal injury, such as a corneal abrasion, typically heals within a few days without medical intervention.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Most corneal abrasions heal within 48 hours, although complete epithelial healing may take up to 7 days [36065127, 23652196].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36065127", "evidence_support": "The findings indicate that patients who sustain a perioperative corneal abrasion can be reassured that in many cases it will heal within 48 hours, but they should seek earlier review if symptoms persist or deteriorate.", "evidence_relation": "supporting" }, { "cited_pmid": "23652196", "evidence_support": "The epithelium was healed in all patients at day 7.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In general, epithelial closure is achieved after approximately 2.4 days, with normalization of the epithelium occurring around 3.6 days [347160].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "347160", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While many patients recover well without complications, it is advisable to seek medical attention if symptoms persist or worsen, as this could indicate a more serious issue [29217021].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "29217021", "evidence_support": "Although the vast majority of patients do very well and likely would heal on their own without ophthalmology referral, it seems reasonable that patients with corneal abrasions are assessed once by an ophthalmologist immediately or possibly up to 1-2 days after the initial emergency visit, depending on the individual patient circumstances.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Regular monitoring is recommended to ensure proper healing and prevent complications [29217021].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "29217021", "evidence_support": "Although the vast majority of patients do very well and likely would heal on their own without ophthalmology referral, it seems reasonable that patients with corneal abrasions are assessed once by an ophthalmologist immediately or possibly up to 1-2 days after the initial emergency visit, depending on the individual patient circumstances", "evidence_relation": "supporting" } ] } ] }, "webis-1": { "answer": "A minor cornea injury usually heals within a few weeks with conservative treatment [24163517]. However, severe injuries can lead to partial and/or permanent loss of corneal functions [36696947].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A minor cornea injury usually heals within a few weeks with conservative treatment [24163517].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24163517", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "However, severe injuries can lead to partial and/or permanent loss of corneal functions [36696947].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "36696947", "evidence_support": "If the chemical injury is mild, the cornea will heal with normal clarity, but severe injuries can lead to partial and/or permanent loss of corneal functions.", "evidence_relation": "supporting" } ] } ] }, "webis-2": { "answer": "The context does not provide information about the healing time of a minor cornea injury.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The context does not provide information about the healing time of a minor cornea injury.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-3": { "answer": "The given context does not provide information about the healing time of a minor cornea injury without medical attention.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The given context does not provide information about the healing time of a minor cornea injury without medical attention.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-5": { "answer": "The given context does not provide information about the healing time of a minor cornea injury without medical attention.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The given context does not provide information about the healing time of a minor cornea injury without medical attention.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-gpt-1": { "answer": "A minor cornea injury typically takes about 1 to 3 days to heal without medical attention, depending on the severity of the injury and individual healing factors. However, it is advisable to seek medical attention to ensure proper healing and to prevent complications.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A minor cornea injury typically takes about 1 to 3 days to heal without medical attention, depending on the severity of the injury and individual healing factors.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "However, it is advisable to seek medical attention to ensure proper healing and to prevent complications.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "Minor corneal injuries typically heal within 48 hours without complications or the need for medical attention [25140844]. This rapid healing process is common for minor corneal abrasions, indicating that most individuals can expect a full recovery in a short timeframe.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Minor corneal injuries typically heal within 48 hours without complications or the need for medical attention [25140844].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25140844", "evidence_support": "Minor corneal abrasions usually heal within 48 hours without complications or eye damage.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This rapid healing process is common for minor corneal abrasions, indicating that most individuals can expect a full recovery in a short timeframe.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-6": { "answer": "The context provided does not contain specific information regarding the healing time for a minor cornea injury without medical attention. Generally, minor corneal abrasions can heal within 1 to 3 days, but this can vary based on individual circumstances and the extent of the injury. It is advisable to seek medical attention for proper evaluation and management.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The context provided does not contain specific information regarding the healing time for a minor cornea injury without medical attention.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Generally, minor corneal abrasions can heal within 1 to 3 days, but this can vary based on individual circumstances and the extent of the injury.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "It is advisable to seek medical attention for proper evaluation and management.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "zero-shot-gemini-flash": { "answer": "Unfortunately, I cannot provide a definitive answer to your question based on the provided snippets. The snippets you provided do not contain information about the healing time of minor cornea injuries without medical attention. \n\nIt is crucial to understand that corneal injuries, even minor ones, can be serious and require prompt medical evaluation. [PMID: 29987534] The cornea is a delicate structure that protects the eye, and any damage can lead to complications like infection, scarring, and vision loss. [PMID: 29987534] \n\nTherefore, it is strongly advised to seek immediate medical attention for any corneal injury, regardless of its perceived severity. [PMID: 29987534] A qualified healthcare professional can assess the injury, provide appropriate treatment, and advise on the expected healing time. \n", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Unfortunately, I cannot provide a definitive answer to your question based on the provided snippets.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "The snippets you provided do not contain information about the healing time of minor cornea injuries without medical attention.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "It is crucial to understand that corneal injuries, even minor ones, can be serious and require prompt medical evaluation.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "[PMID: 29987534]", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "The cornea is a delicate structure that protects the eye, and any damage can lead to complications like infection, scarring, and vision loss.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "[PMID: 29987534]", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "Therefore, it is strongly advised to seek immediate medical attention for any corneal injury, regardless of its perceived severity.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "8", "answer_sentence": "[PMID: 29987534]", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "9", "answer_sentence": "A qualified healthcare professional can assess the injury, provide appropriate treatment, and advise on the expected healing time.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "zero-shot-gpt4o-mini": { "answer": "A minor corneal injury typically heals on its own within a few days. Most patients experience significant healing, with 98.5% of abrasions resolving without complications [16916874]. Healing times can vary, but many corneal abrasions heal within 48 hours [36065127]. In studies, epithelial closure was achieved on average after about 2.4 days, with complete normalization occurring around 3.6 days [347160]. Additionally, some patients in specific treatment groups showed healing times of approximately 4.3 to 7.1 days [16876497]. Overall, while many minor injuries can heal without medical intervention, monitoring for complications is advisable, especially if symptoms persist beyond a few days [29945490].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A minor corneal injury typically heals on its own within a few days.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Most patients experience significant healing, with 98.5% of abrasions resolving without complications [16916874].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16916874", "evidence_support": "Of these, 368 (98.5%) abrasions healed without complications.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Healing times can vary, but many corneal abrasions heal within 48 hours [36065127].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36065127", "evidence_support": "The findings indicate that patients who sustain a perioperative corneal abrasion can be reassured that in many cases it will heal within 48 hours, but they should seek earlier review if symptoms persist or deteriorate. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In studies, epithelial closure was achieved on average after about 2.4 days, with complete normalization occurring around 3.6 days [347160].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "347160", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, some patients in specific treatment groups showed healing times of approximately 4.3 to 7.1 days [16876497].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16876497", "evidence_support": "Mean epithelialization time was 7.1 days in the hyaluronic acid group. In the autologous serum group, epithelium healed after a mean of 4.3 days. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, while many minor injuries can heal without medical intervention, monitoring for complications is advisable, especially if symptoms persist beyond a few days [29945490].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "29945490", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] } } }, { "question_id": "119", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "In the treatment of stage 4 Chronic Obstructive Pulmonary Disease (COPD), a common and effective approach often involves the use of combination therapies that include bronchodilators, corticosteroids, and phosphodiesterase-4 inhibitors. While specific drug names are not detailed in the provided references, the general strategy focuses on managing symptoms, improving lung function, and reducing exacerbations. It is important to tailor the treatment plan to the individual patient's needs, often requiring a combination of long-acting muscarinic antagonists (LAMAs), long-acting beta-agonists (LABAs), and inhaled corticosteroids (ICS) to achieve optimal results.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In the treatment of stage 4 Chronic Obstructive Pulmonary Disease (COPD), a common and effective approach often involves the use of combination therapies that include bronchodilators, corticosteroids, and phosphodiesterase-4 inhibitors.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "While specific drug names are not detailed in the provided references, the general strategy focuses on managing symptoms, improving lung function, and reducing exacerbations.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "It is important to tailor the treatment plan to the individual patient's needs, often requiring a combination of long-acting muscarinic antagonists (LAMAs), long-acting beta-agonists (LABAs), and inhaled corticosteroids (ICS) to achieve optimal results.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "For treating stage 4 COPD, LABA/LAMA combinations and triple therapy are most popular [30153695, 32777289, 21334553]. LABA/LAMA combinations, such as indacaterol/glycopyrronium, umeclidinium/vilanterol, and aclidinium/formoterol, are recommended when symptoms are not improved with a single agent [20496301, 15902378, 27223863]. These combinations improve lung function, patient-reported outcomes, and are effective in preventing COPD exacerbations [15902378, 24802656, 27223863]. Triple therapy, which includes an inhaled corticosteroid (ICS), a long-acting beta-agonist (LABA), and a long-acting muscarinic antagonist (LAMA), is recommended for patients with severe COPD and frequent exacerbations [30153695, 30463457, 21334553]. This therapy is beneficial for patients uncontrolled by dual bronchodilator combinations, reducing exacerbations, improving lung function, and enhancing quality of life [32777289, 21334553, 33302284]. Triple therapy is particularly recommended for COPD patients with persistent symptoms, moderate to severe COPD, and clinically significant symptoms and exacerbations [34351996, 33302284, 27576232]. Additionally, roflumilast is an add-on option for severe COPD [21509737, 23767419, 23592218]. Overall, LABA/LAMA and triple therapy are central to managing stage 4 COPD [30153695, 32777289, 29115881].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For treating stage 4 COPD, LABA/LAMA combinations and triple therapy are most popular [30153695, 32777289, 21334553].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30153695", "evidence_support": "Long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA) in fixed-dose combination inhalers are the pillars of modern COPD therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "32777289", "evidence_support": "The use of triple therapy with inhaled corticosteroids, long-acting beta-agonist and long-acting antimuscarinics has been shown to be beneficial in COPD patients who continue to have symptoms and exacerbations, despite receiving dual bronchodilator combinations.", "evidence_relation": "supporting" }, { "cited_pmid": "21334553", "evidence_support": "Bronchodilators, especially prolonged-action bronchodilators, are the most potent and there are two groups: beta-2 mimetics and anticholinergics.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "LABA/LAMA combinations, such as indacaterol/glycopyrronium, umeclidinium/vilanterol, and aclidinium/formoterol, are recommended when symptoms are not improved with a single agent [20496301, 15902378, 27223863].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20496301", "evidence_support": "Current guidelines highlight that for COPD patients uncontrolled by bronchodilator monotherapy, combination therapy is recommended. These include LABA/ICS and LAMA/LABA combinations.", "evidence_relation": "supporting" }, { "cited_pmid": "15902378", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "27223863", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "These combinations improve lung function, patient-reported outcomes, and are effective in preventing COPD exacerbations [15902378, 24802656, 27223863].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15902378", "evidence_support": "Bronchodilators form the foundation of the pharmacotherapy of patients with chronic obstructive pulmonary disease (COPD). Scores of information from numerous large-scale clinical trials, mechanistic differences between classes of bronchodilators, and anti-inflammatory/bronchodilator fixed combinations make the decision what compound primarily to prefer in COPD treatment a challenge. In this review of large, double-blind, clinical trials with anticholinergic drugs, long- and short-acting beta(2)-agonists, xanthines and different application forms and combination of these compounds will be examined for clinical efficacy. The following practical objectives were accepted to define effective disease management: improvement of lung function, physical parameters such as 6-min walking distance, reduction of exacerbation rate and severity, improvement of quality of life and dyspnea score. Based on this review, inhalation therapy with a long-acting bronchodilator such as tiotropium, formoterol or salmeterol is proposed for early treatment algorithm. The combination of an anticholinergic compound and a long-acting bronchodilator may have an additive effect on bronchodilatation. The addition of inhaled corticosteroids is only recommended in stages III and IV. Besides, pharmacotherapy of COPD should always be flanked by smoking prevention programs, and supportive ", "evidence_relation": "supporting" }, { "cited_pmid": "24802656", "evidence_support": "Combinations of two long-acting bronchodilators and long-acting bronchodilators with inhaled corticosteroids (ICS) are recommended therapies in the management of chronic obstructive pulmonary disease (COPD). Three fixed-dose combination products have recently been approved for the treatment of COPD (the long-acting \u03b22-agonist plus long-acting muscarinic antagonist [LABA/LAMA] combinations glycopyrronium/indacaterol [QVA149] and umeclidinium/vilanterol, and the LABA/ICS fluticasone furoate/vilanterol), with others currently in late-stage development. LABA/LAMA and LABA/ICS combination therapies demonstrate positive effects on both lung function and patient-reported outcomes, with significant improvements observed with LABA/LAMA combinations compared with placebo, each component alone and other comparators in current use. No new safety concerns have been observed with combinations of long-acting bronchodilators. Combinations of two long-acting bronchodilators represent a new and convenient treatment option in COPD. This review summarizes published efficacy and safety data from clinical trials of both LABA/LAMA and novel LABA/ICS combinations in patients with COPD.", "evidence_relation": "supporting" }, { "cited_pmid": "27223863", "evidence_support": "Long-acting \u03b22-agonists [LABAs] and long-acting muscarinic antagonists [LAMAs]) are primary therapies for chronic obstructive pulmonary disease (COPD). Despite improvements in lung function and patient-reported outcomes (PROs) with these therapies, there is room to optimize outcomes further. Combined use of LABAs and LAMAs is recommended when symptoms are not improved with a single agent, and LABA/LAMA fixed-dose combinations (FDCs) are at the forefront of drug development in COPD.\nAREAS COVERED: This review focusses on the three LABA/LAMA FDCs (indacaterol/glycopyrrolate(1) [IND/GLY] 27.5/15.6\u00a0\u00b5g twice daily, umeclidinium/vilanterol [UMEC/VI] 62.5/25\u00a0\u00b5g once daily and tiotropium/olodaterol [Tio/Olo] 5/5\u00a0\u00b5g once daily approved in the US. Phase III clinical trials have shown benefits in lung function, dyspnea and health status with FDCs of IND/GLY, UMEC/VI and Tio/Olo versus placebo and monotherapies. Expert commentary: Data from recent studies of three LABA/LAMA combinations, reviewed here, indicate that dual bronchodilation may be beneficial above and beyond both the monotherapies and LABA/ICS combinations, in providing improvements in lung function and PROs for patients with COPD, which may encourage a shift away from the use of ICS in COPD management, in particular for non-exacerbating patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Triple therapy, which includes an inhaled corticosteroid (ICS), a long-acting beta-agonist (LABA), and a long-acting muscarinic antagonist (LAMA), is recommended for patients with severe COPD and frequent exacerbations [30153695, 30463457, 21334553].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30153695", "evidence_support": "Long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA) in fixed-dose combination inhalers are the pillars of modern COPD therapy. LABA/inhaled corticosteroids (ICS) inhalers have been proved to be particularly efficient in patients with \u2265\u200a2 exacerbations per year", "evidence_relation": "supporting" }, { "cited_pmid": "30463457", "evidence_support": "The triple therapy term covers the combination of inhaled corticosteroid (ICS), long-acting \u03b2-receptor agonist (LABA) and long-acting anticholinergic drug (LAMA) in one or in separate inhalers.", "evidence_relation": "supporting" }, { "cited_pmid": "21334553", "evidence_support": "Inhaled corticosteroids are the main anti-inflammatory drugs but have modest efficacy and their use is reserved for patients with severe disease and frequent exacerbations and/or asthma traits", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "This therapy is beneficial for patients uncontrolled by dual bronchodilator combinations, reducing exacerbations, improving lung function, and enhancing quality of life [32777289, 21334553, 33302284].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "32777289", "evidence_support": "In this real world, multicentre study in India, TFC significantly improved lung function, symptoms and quality of life among all patients with COPD, but the effect was more pronounced among non-smoker COPD patients.", "evidence_relation": "supporting" }, { "cited_pmid": "21334553", "evidence_support": "Associating these three drugs can improve symptom control, improve quality of life and reduce the number of exacerbations.", "evidence_relation": "supporting" }, { "cited_pmid": "33302284", "evidence_support": "In conclusion, our real-life results suggest that triple inhaled therapy with FF/UMEC/VI, when given to COPD patients with frequent exacerbations, is able to positively impact on dyspnea and global health status as well as to significantly decrease COPD exacerbations and improve airflow limitation and lung hyperinflation.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Triple therapy is particularly recommended for COPD patients with persistent symptoms, moderate to severe COPD, and clinically significant symptoms and exacerbations [34351996, 33302284, 27576232].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34351996", "evidence_support": "Reports recommends that patients with clinically significant symptoms and exacerbations of chronic obstructive pulmonary disease (COPD) should escalate to triple therapy, a combined use of inhaled corticosteroids (ICS), long-acting muscarinic antagonists (LAMA) and long-acting b2-agonists (LABA)(ICS/LAMA/LABA).", "evidence_relation": "supporting" }, { "cited_pmid": "33302284", "evidence_support": "Triple therapy consisting of a drug association including an inhaled corticosteroid, a long-acting muscarinic receptor antagonist and a long-acting \u03b22-adrenergic agonist, delivered via a single device, can be a valuable treatment for chronic obstructive pulmonary disease (COPD) patients experiencing frequent disease exacerbations.", "evidence_relation": "supporting" }, { "cited_pmid": "33302284", "evidence_support": "In conclusion, our real-life results suggest that triple inhaled therapy with FF/UMEC/VI, when given to COPD patients with frequent exacerbations, is able to positively impact on dyspnea and global health status as well as to significantly decrease COPD exacerbations and improve airflow limitation and lung hyperinflation.", "evidence_relation": "supporting" }, { "cited_pmid": "27576232", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Additionally, roflumilast is an add-on option for severe COPD [21509737, 23767419, 23592218].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "21509737", "evidence_support": "The addition of PDE4 inhibitor (roflumilast) to LABA or LAMA in patients with severe COPD, improves lung function and reduces exacerbation frequency.", "evidence_relation": "supporting" }, { "cited_pmid": "23767419", "evidence_support": "Roflumilast, an oral selective inhibitor of phosphodiesterase 4, is used to manage moderate to severe COPD.", "evidence_relation": "supporting" }, { "cited_pmid": "23592218", "evidence_support": "Roflumilast is an add-on option for patients with severe COPD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Overall, LABA/LAMA and triple therapy are central to managing stage 4 COPD [30153695, 32777289, 29115881].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30153695", "evidence_support": "Long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA) in fixed-dose combination inhalers are the pillars of modern COPD therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "32777289", "evidence_support": "The use of triple therapy with inhaled corticosteroids, long-acting beta-agonist and long-acting antimuscarinics has been shown to be beneficial in COPD patients who continue to have symptoms and exacerbations, despite receiving dual bronchodilator combinations.", "evidence_relation": "supporting" }, { "cited_pmid": "29115881", "evidence_support": "The current GOLD (Global Initiative for Chronic Obstructive Lung Disease) recommendations suggest using long acting \u03b22 agonists (LABA) and long acting muscarinic antagonists (LAMA) in combination for group B COPD patients with persistent symptoms, group C COPD patients with further exacerbations on LAMA therapy alone and for group D COPD patients with or without combination with inhaled corticosteroids (ICS)", "evidence_relation": "supporting" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "For treating stage 4 COPD, the most popular drug combination is inhaled corticosteroids (ICS) with long-acting beta-agonists (LABA) and long-acting muscarinic antagonists (LAMA) in a triple therapy regimen.This combination has been shown to significantly reduce exacerbation rates, improve lung function, and enhance quality of life in patients with severe COPD [30153695, 18666664, 30463457]. Specifically, fixed-dose combinations such as fluticasone furoate/umeclidinium/vilanterol and beclometasone/formoterol/glycopyrronium have demonstrated superior efficacy compared to dual therapies or monotherapies [30153695, 30463457]. These triple therapies are particularly beneficial for patients with frequent exacerbations and persistent symptoms despite dual bronchodilator therapy [30153695, 30463457, 34351996]. Additionally, long-acting bronchodilators like tiotropium are essential in managing symptoms and reducing exacerbation rates in severe COPD [20496301, 15902378]. Overall, the combination of ICS, LABA, and LAMA remains the cornerstone of pharmacological management for stage 4 COPD.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For treating stage 4 COPD, the most popular drug combination is inhaled corticosteroids (ICS) with long-acting beta-agonists (LABA) and long-acting muscarinic antagonists (LAMA) in a triple therapy regimen.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This combination has been shown to significantly reduce exacerbation rates, improve lung function, and enhance quality of life in patients with severe COPD [30153695, 18666664, 30463457].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30153695", "evidence_support": "Recent trials with fixed-dose combination inhalers containing fluticasonfuroate/vilanterol/umeclidinium or beclometasone/formoterol/glycopyrronium significantly reduced exacerbation rates and dyspnea scores and improved lung function as well as quality of life better than the LABA/ICS, LABA/LAMA comparators or the single compounds in selected COPD trial patients.", "evidence_relation": "supporting" }, { "cited_pmid": "30463457", "evidence_support": "A 20% reduction in the risk of moderate or severe exacerbation was found in patients receiving triple therapy compared to the ICS/LABA combination and LAMA monotherapy. Triple therapy reduces the number of exacerbations in comparison with double bronchodilatation (LABA/LAMA), thus representing an interesting therapeutic option in the management of COPD.", "evidence_relation": "supporting" }, { "cited_pmid": "18666664", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Specifically, fixed-dose combinations such as fluticasone furoate/umeclidinium/vilanterol and beclometasone/formoterol/glycopyrronium have demonstrated superior efficacy compared to dual therapies or monotherapies [30153695, 30463457].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30153695", "evidence_support": "Long-acting beta-agonist (LABA) and long-acting muscarinic antagonist (LAMA) in fixed-dose combination inhalers are the pillars of modern COPD therapy. ", "evidence_relation": "supporting" }, { "cited_pmid": "30153695", "evidence_support": "Recent trials with fixed-dose combination inhalers containing fluticasonfuroate/vilanterol/umeclidinium or beclometasone/formoterol/glycopyrronium significantly reduced exacerbation rates and dyspnea scores and improved lung function as well as quality of life better than the LABA/ICS, LABA/LAMA comparators or the single compounds in selected COPD trial patients. ", "evidence_relation": "supporting" }, { "cited_pmid": "30463457", "evidence_support": "The triple therapy term covers the combination of inhaled corticosteroid (ICS), long-acting \u03b2-receptor agonist (LABA) and long-acting anticholinergic drug (LAMA) in one or in separate inhalers", "evidence_relation": "supporting" }, { "cited_pmid": "30463457", "evidence_support": "The latest GOLD 2018 (Global Initiative for Chronic Obstructive Disease) guidelines recommend the triple therapy in the management of chronic obstructive pulmonary disease (COPD) in patients of group D who despite the combination of two drugs: LAMA/LABA or ICS/LABA continue to have persistent symptoms or suffer from further frequent exacerbations.", "evidence_relation": "supporting" }, { "cited_pmid": "30463457", "evidence_support": "The first triple fixed-dose combination of extrafine beclomethasone/formoterol/glycopyrronium in one pMDI type inhaler intended for the treatment of COPD has been registered in Europe in 2017.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "These triple therapies are particularly beneficial for patients with frequent exacerbations and persistent symptoms despite dual bronchodilator therapy [30153695, 30463457, 34351996].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30153695", "evidence_support": "LABA/inhaled corticosteroids (ICS) inhalers have been proved to be particularly efficient in patients with \u2265\u200a2 exacerbations per year", "evidence_relation": "supporting" }, { "cited_pmid": "30153695", "evidence_support": "Recent trials with fixed-dose combination inhalers containing fluticasonfuroate/vilanterol/umeclidinium or beclometasone/formoterol/glycopyrronium significantly reduced exacerbation rates and dyspnea scores and improved lung function as well as quality of life better than the LABA/ICS, LABA/LAMA comparators or the single compounds in selected COPD trial patients.", "evidence_relation": "supporting" }, { "cited_pmid": "30463457", "evidence_support": "The latest GOLD 2018 (Global Initiative for Chronic Obstructive Disease) guidelines recommend the triple therapy in the management of chronic obstructive pulmonary disease (COPD) in patients of group D who despite the combination of two drugs: LAMA/LABA or ICS/LABA continue to have persistent symptoms or suffer from further frequent exacerbations.", "evidence_relation": "supporting" }, { "cited_pmid": "34351996", "evidence_support": "2021 Global Initiative for Chronic Obstructive Lung Disease (GOLD) Reports recommends that patients with clinically significant symptoms and exacerbations of chronic obstructive pulmonary disease (COPD) should escalate to triple therapy, a combined use of inhaled corticosteroids (ICS), long-acting muscarinic antagonists (LAMA) and long-acting b2-agonists (LABA)(ICS/LAMA/LABA).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, long-acting bronchodilators like tiotropium are essential in managing symptoms and reducing exacerbation rates in severe COPD [20496301, 15902378].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20496301", "evidence_support": "The use of tiotropium results in improved health status, dyspnea, and exercise capacity, and reduced hyperinflation and COPD exacerbation rate in patients with moderate to severe COPD.", "evidence_relation": "supporting" }, { "cited_pmid": "15902378", "evidence_support": "Based on this review, inhalation therapy with a long-acting bronchodilator such as tiotropium, formoterol or salmeterol is proposed for early treatment algorithm", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, the combination of ICS, LABA, and LAMA remains the cornerstone of pharmacological management for stage 4 COPD.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "For stage 4 COPD, the most popular treatment combination is a long-acting bronchodilator, such as a long-acting beta-2 agonist (LABA) or a long-acting muscarinic antagonist (LAMA), in combination with an inhaled corticosteroid (ICS) [16900364, 18666664, 18398787]. This combination has been shown to improve lung function, reduce exacerbations, and improve quality of life [30153695, 20496301, 30463457]. Specifically, the combination of a LABA and an ICS, such as salmeterol and fluticasone, is commonly used [23898819]. Additionally, the combination of a LAMA and a LABA, such as tiotropium and formoterol, has also been shown to be effective [19863370]. However, it's worth noting that the use of ICS is generally recommended for patients with severe or very severe COPD, and should be used in combination with a bronchodilator [16900364, 18666664].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For stage 4 COPD, the most popular treatment combination is a long-acting bronchodilator, such as a long-acting beta-2 agonist (LABA) or a long-acting muscarinic antagonist (LAMA), in combination with an inhaled corticosteroid (ICS) [16900364, 18666664, 18398787].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16900364", "evidence_support": "Patients with stages III and IV should usually be put on long-term corticosteroid inhalation, preferably in combination with long-acting bronchodilators.", "evidence_relation": "supporting" }, { "cited_pmid": "18666664", "evidence_support": "A combination of ICS with long-acting beta-2-adrenoceptor agonists (LABA) is prescribed in patients with GOLD stage III-IV with at least 2 exacerbations in the past year, a deterioration of the quality of life and with symptoms, if treatment with a LABA alone or an ICS alone results in insufficient improvement.", "evidence_relation": "supporting" }, { "cited_pmid": "18398787", "evidence_support": "Because ICS therapy is recommended only in conjunction with a bronchodilator, fixed ICS/LABA combinations are a logical consequence for COPD long-term therapy.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This combination has been shown to improve lung function, reduce exacerbations, and improve quality of life [30153695, 20496301, 30463457].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "30153695", "evidence_support": "Recent trials with fixed-dose combination inhalers containing fluticasonfuroate/vilanterol/umeclidinium or beclometasone/formoterol/glycopyrronium significantly reduced exacerbation rates and dyspnea scores and improved lung function as well as quality of life better than the LABA/ICS, LABA/LAMA comparators or the single compounds in selected COPD trial patients", "evidence_relation": "supporting" }, { "cited_pmid": "20496301", "evidence_support": "LABAs-salmeterol and formoterol-have been shown to significantly improve lung function, health status, and symptom reduction, compared with ipratropium.", "evidence_relation": "supporting" }, { "cited_pmid": "30463457", "evidence_support": "Triple therapy reduces the number of exacerbations in comparison with double bronchodilatation (LABA/LAMA), thus representing an interesting therapeutic option in the management of COPD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Specifically, the combination of a LABA and an ICS, such as salmeterol and fluticasone, is commonly used [23898819].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23898819", "evidence_support": "Inhaled corticosteroids (ICS), in conjunction with long-acting beta-agonists (LABA), are routinely considered at severe and very severe stages of COPD when patients lack adequate response to single-therapy with LABAs", "evidence_relation": "supporting" }, { "cited_pmid": "23898819", "evidence_support": "Until new forms of drug combinations are made available, the use of dual-therapy containing a LABA and ICS remain as the most logical and appropriate approach for the treatment of patients suffering from severe and very severe COPD with repeated exacerbations.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, the combination of a LAMA and a LABA, such as tiotropium and formoterol, has also been shown to be effective [19863370].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19863370", "evidence_support": "Currently, there is no documentation that tiotropium is superior to formoterol or the contrary, but a combination of tiotropium and formoterol is more effective than single drugs alone in inducing bronchodilation and a bronchodilator-mediated symptom benefit in patients suffering from COPD. Once-daily or twice-daily formoterol, added to tiotropium, are both better than tiotropium alone, but the published evidence suggests twice-daily formoterol is the best add-on option.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "However, it's worth noting that the use of ICS is generally recommended for patients with severe or very severe COPD, and should be used in combination with a bronchodilator [16900364, 18666664].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16900364", "evidence_support": "Patients with stages III and IV should usually be put on long-term corticosteroid inhalation, preferably in combination with long-acting bronchodilators.", "evidence_relation": "supporting" }, { "cited_pmid": "18666664", "evidence_support": "Inhaled corticosteroids (ICS) reduce the exacerbation frequency in patients with moderate to severe or very severe COPD (GOLD stage II-IV) and recurrent exacerbations. A combination of ICS with long-acting beta-2-adrenoceptor agonists (LABA) is prescribed in patients with GOLD stage III-IV with at least 2 exacerbations in the past year, a deterioration of the quality of life and with symptoms, if treatment with a LABA alone or an ICS alone results in insufficient improvement.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "The most popular and effective medications for treating stage 4 COPD include combination therapies such as long-acting bronchodilators (LABDs), inhaled corticosteroids (ICS), and phosphodiesterase-4 inhibitors [15970187, 23648908, 24802656]. Specifically, combinations of long-acting beta-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) or LABAs and ICS are recommended for patients with severe COPD [26814721, 29305841, 16267348]. Additionally, triple therapy with LABA/LAMA/ICS may be required for patients with repeated exacerbations [21509737]. Roflumilast, a phosphodiesterase-4 inhibitor, has also been shown to reduce exacerbations in patients with severe COPD [21509737, 15929966, 25269184]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The most popular and effective medications for treating stage 4 COPD include combination therapies such as long-acting bronchodilators (LABDs), inhaled corticosteroids (ICS), and phosphodiesterase-4 inhibitors [15970187, 23648908, 24802656].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23648908", "evidence_support": "Pharmacologic interventions discussed include inhaled corticosteroids, long-acting \u03b2-agonists, long-acting antimuscarinic agents, macrolide antibiotics, and phosphodiesterase-4 inhibitors.", "evidence_relation": "supporting" }, { "cited_pmid": "24802656", "evidence_support": "Three fixed-dose combination products have recently been approved for the treatment of COPD (the long-acting \u03b22-agonist plus long-acting muscarinic antagonist [LABA/LAMA] combinations glycopyrronium/indacaterol [QVA149] and umeclidinium/vilanterol, and the LABA/ICS fluticasone furoate/vilanterol), with others currently in late-stage development. LABA/LAMA and LABA/ICS combination therapies demonstrate positive effects on both lung function and patient-reported outcomes, with significant improvements observed with LABA/LAMA combinations compared with placebo, each component alone and other comparators in current use. No new safety concerns have been observed with combinations of long-acting bronchodilators. ", "evidence_relation": "supporting" }, { "cited_pmid": "15970187", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Specifically, combinations of long-acting beta-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs) or LABAs and ICS are recommended for patients with severe COPD [26814721, 29305841, 16267348].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29305841", "evidence_support": "Long-acting bronchodilator therapy is the cornerstone treatment for patients with COPD; combinations of bronchodilators of different pharmacological classes have shown improved efficacy vs monotherapy", "evidence_relation": "supporting" }, { "cited_pmid": "16267348", "evidence_support": "The combination of a short-acting anticholinergic with a long-acting beta-agonist, or the combination of a long-acting anticholinergic with a short- or long-acting beta-agonist, has been shown in most studies to improve lung function versus monotherapy with the individual components.", "evidence_relation": "supporting" }, { "cited_pmid": "26814721", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, triple therapy with LABA/LAMA/ICS may be required for patients with repeated exacerbations [21509737].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21509737", "evidence_support": "As COPD progresses and patient has repeated exacerbations triple therapy LABA/LAMA/ICS may be required.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Roflumilast, a phosphodiesterase-4 inhibitor, has also been shown to reduce exacerbations in patients with severe COPD [21509737, 15929966, 25269184].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21509737", "evidence_support": "The addition of PDE4 inhibitor (roflumilast) to LABA or LAMA in patients with severe COPD, improves lung function and reduces exacerbation frequency", "evidence_relation": "supporting" }, { "cited_pmid": "25269184", "evidence_support": "Generally speaking, roflumilast therapy appears justified for patients with symptoms of chronic bronchitis, severe or very severe bronchial obstruction (forced expiratory volume below 50%) and/or frequent exacerbations of the disease (= > 2/12 mo).", "evidence_relation": "supporting" }, { "cited_pmid": "15929966", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "The most popular and effective treatment for stage 4 COPD is a combination of long-acting bronchodilators, such as long-acting beta-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs), often in combination with inhaled corticosteroids (ICS) [16900364, 21509737, 26636171]. This combination is recommended for patients with severe COPD and frequent exacerbations, as it has been shown to improve lung function, reduce symptoms, and decrease the risk of exacerbations [16900364, 21509737, 26636171]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The most popular and effective treatment for stage 4 COPD is a combination of long-acting bronchodilators, such as long-acting beta-agonists (LABAs) and long-acting muscarinic antagonists (LAMAs), often in combination with inhaled corticosteroids (ICS) [16900364, 21509737, 26636171].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16900364", "evidence_support": "Patients with stages III and IV should usually be put on long-term corticosteroid inhalation, preferably in combination with long-acting bronchodilators.", "evidence_relation": "supporting" }, { "cited_pmid": "21509737", "evidence_support": "For patients with moderate to severe COPD combining bronchodilators from different classes long acting beta(2)-agonists or long acting muscarinic antagonists (LABA/LAMA) are recommended.", "evidence_relation": "supporting" }, { "cited_pmid": "26636171", "evidence_support": "Short-acting bronchodilators are used as rescue medication, while long-acting bronchodilators or/and long-actingmuscarinic agents are the treatment of choice for patients in groups B, C and D. Inhaled corticosteroids are only recommended for groups Cand D", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This combination is recommended for patients with severe COPD and frequent exacerbations, as it has been shown to improve lung function, reduce symptoms, and decrease the risk of exacerbations [16900364, 21509737, 26636171].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21509737", "evidence_support": "Inhaled bronchodilators such as beta(2)-agonists and muscarinic antagonists help to prevent and control symptoms in COPD patients, reduce the frequency and severity of exacerbations, improve health status and exercise tolerance and have an acceptable safety profile.", "evidence_relation": "supporting" }, { "cited_pmid": "21509737", "evidence_support": "The addition of PDE4 inhibitor (roflumilast) to LABA or LAMA in patients with severe COPD, improves lung function and reduces exacerbation frequency", "evidence_relation": "supporting" }, { "cited_pmid": "26636171", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16900364", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "For stage 4 COPD, the most popular treatment is a combination of long-acting bronchodilators, such as long-acting beta-agonists and long-acting antimuscarinic drugs, and inhaled corticosteroids [17703625, 15745384, 28220381]. Roflumilast, a phosphodiesterase-4 inhibitor, is also used as an add-on option for patients with severe COPD [16239101, 23651802, 23592218]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For stage 4 COPD, the most popular treatment is a combination of long-acting bronchodilators, such as long-acting beta-agonists and long-acting antimuscarinic drugs, and inhaled corticosteroids [17703625, 15745384, 28220381].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17703625", "evidence_support": "The principal bronchodilator treatments are beta2-agonists, anticholinergics, theophylline, and a combination of these drugs", "evidence_relation": "supporting" }, { "cited_pmid": "28220381", "evidence_support": "Acute exacerbations become more frequent and more severe as the disease reaches end-stage. Inhaled corticosteroids in combination with long-acting bronchodilators can reduce the frequency of exacerbations, and supported self-management aims to facilitate timely treatment of deterioration", "evidence_relation": "supporting" }, { "cited_pmid": "15745384", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Roflumilast, a phosphodiesterase-4 inhibitor, is also used as an add-on option for patients with severe COPD [16239101, 23651802, 23592218].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "16239101", "evidence_support": "A new generation of pharmacotherapeutic agents, most notably phosphodiesterase-4 inhibitors, which are already in the advanced stages of clinical development, and leukotriene B4 inhibitors (in early clinical development), may shape future treatment as further insight is gained into the pathological mechanisms underlying COPD.", "evidence_relation": "supporting" }, { "cited_pmid": "23651802", "evidence_support": "Inhaled corticosteroids can be added for reducing exacerbations where also roflumilast has proven efficacy", "evidence_relation": "supporting" }, { "cited_pmid": "23592218", "evidence_support": "Roflumilast is an add-on option for patients with severe COPD", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "For stage 4 COPD, the most popular treatment is a combination of long-acting bronchodilators, such as long-acting beta-agonists and long-acting antimuscarinic drugs, and inhaled corticosteroids [16900364, 17678942, 28220381]. Roflumilast, a phosphodiesterase-4 inhibitor, is also used as an add-on option for patients with severe COPD [22833385, 21468165, 20689641]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For stage 4 COPD, the most popular treatment is a combination of long-acting bronchodilators, such as long-acting beta-agonists and long-acting antimuscarinic drugs, and inhaled corticosteroids [16900364, 17678942, 28220381].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16900364", "evidence_support": "Patients with stages III and IV should usually be put on long-term corticosteroid inhalation, preferably in combination with long-acting bronchodilators.", "evidence_relation": "supporting" }, { "cited_pmid": "17678942", "evidence_support": "Inhaled corticosteroids reduce the frequency of acute exacerbations and are recommended for patients with severe COPD and frequent exacerbations.", "evidence_relation": "supporting" }, { "cited_pmid": "28220381", "evidence_support": "As breathlessness increases, treatment is stepped up from short-acting to long-acting bronchodilators supplemented by non-pharmacological interventions such as pulmonary rehabilitation", "evidence_relation": "supporting" }, { "cited_pmid": "28220381", "evidence_support": "Inhaled corticosteroids in combination with long-acting bronchodilators can reduce the frequency of exacerbations, and supported self-management aims to facilitate timely treatment of deterioration.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Roflumilast, a phosphodiesterase-4 inhibitor, is also used as an add-on option for patients with severe COPD [22833385, 21468165, 20689641].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22833385", "evidence_support": "Roflumilast is a selective phosphodiesterase 4 inhibitor which has been licensed in the European Union since 2010 and in Switzerland since November 2011 as an add-on treatment for patients with chronic obstructive pulmonary disease (COPD) in GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages 3 and 4 (FEV(1) <50% predicted after bronchodilatation) and frequent exacerbations despite correctly-dosed therapy with a long-acting bronchodilator.", "evidence_relation": "supporting" }, { "cited_pmid": "20689641", "evidence_support": "In April 2010, the European Medicines Agency Committee for Medicinal Products for Human Use recommended approval of roflumilast, a selective phosphodiesterase 4 inhibitor, for the \"maintenance treatment of severe chronic obstructive pulmonary disease (COPD, FEV(1) postbronchodilator less than 50% predicted) associated with chronic bronchitis in adult patients with a history of frequent exacerbations as add-on to bronchodilator treatment\". ", "evidence_relation": "supporting" }, { "cited_pmid": "20689641", "evidence_support": "Roflumilast is the first selective phosphodiesterase 4 inhibitor and will offer physicians another treatment option for patients with more severe COPD.", "evidence_relation": "supporting" }, { "cited_pmid": "21468165", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "For stage 4 COPD, the most popular treatment is a combination of long-acting bronchodilators, such as long-acting beta-agonists and long-acting antimuscarinic drugs, and inhaled corticosteroids [28220381, 16900364, 17678942]. Roflumilast, a phosphodiesterase-4 inhibitor, is also used as an add-on option for patients with severe COPD [22833385, 20689641, 21468165]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For stage 4 COPD, the most popular treatment is a combination of long-acting bronchodilators, such as long-acting beta-agonists and long-acting antimuscarinic drugs, and inhaled corticosteroids [28220381, 16900364, 17678942].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28220381", "evidence_support": "Inhaled corticosteroids in combination with long-acting bronchodilators can reduce the frequency of exacerbations, and supported self-management aims to facilitate timely treatment of deterioration.", "evidence_relation": "supporting" }, { "cited_pmid": "16900364", "evidence_support": "Patients with stages III and IV should usually be put on long-term corticosteroid inhalation, preferably in combination with long-acting bronchodilators.", "evidence_relation": "supporting" }, { "cited_pmid": "17678942", "evidence_support": "Long-acting anticholinergic agents can provide similar prolonged improvement in lung function with once-daily dosing.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Roflumilast, a phosphodiesterase-4 inhibitor, is also used as an add-on option for patients with severe COPD [22833385, 20689641, 21468165].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22833385", "evidence_support": "Roflumilast is a selective phosphodiesterase 4 inhibitor which has been licensed in the European Union since 2010 and in Switzerland since November 2011 as an add-on treatment for patients with chronic obstructive pulmonary disease (COPD) in GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages 3 and 4 (FEV(1) <50% predicted after bronchodilatation) and frequent exacerbations despite correctly-dosed therapy with a long-acting bronchodilator", "evidence_relation": "supporting" }, { "cited_pmid": "20689641", "evidence_support": "In April 2010, the European Medicines Agency Committee for Medicinal Products for Human Use recommended approval of roflumilast, a selective phosphodiesterase 4 inhibitor, for the \"maintenance treatment of severe chronic obstructive pulmonary disease (COPD, FEV(1) postbronchodilator less than 50% predicted) associated with chronic bronchitis in adult patients with a history of frequent exacerbations as add-on to bronchodilator treatment\".", "evidence_relation": "supporting" }, { "cited_pmid": "21468165", "evidence_support": "rious PDE4 inhibitors have been evaluated as potential therapies in asthma or COPD but among these only roflumilast have been authorized in Europe to be used in patients with severe COPD as an add-on to the bronchodilator therapy.", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "For stage 4 COPD, the most popular treatment is a combination of long-acting bronchodilators, such as long-acting beta-agonists and long-acting antimuscarinic drugs, and inhaled corticosteroids [16900364, 17678942, 28220381]. Roflumilast, a phosphodiesterase-4 inhibitor, is also used as an add-on option for patients with severe COPD [21468165, 22833385, 20689641]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For stage 4 COPD, the most popular treatment is a combination of long-acting bronchodilators, such as long-acting beta-agonists and long-acting antimuscarinic drugs, and inhaled corticosteroids [16900364, 17678942, 28220381].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16900364", "evidence_support": "Patients with stages III and IV should usually be put on long-term corticosteroid inhalation, preferably in combination with long-acting bronchodilators.", "evidence_relation": "supporting" }, { "cited_pmid": "17678942", "evidence_support": "Combining different classes of bronchodilators or combining a bronchodilator with a corticosteroid provides greater improvements in lung function and symptoms than the individual agents given alone.", "evidence_relation": "supporting" }, { "cited_pmid": "28220381", "evidence_support": "Inhaled corticosteroids in combination with long-acting bronchodilators can reduce the frequency of exacerbations, and supported self-management aims to facilitate timely treatment of deterioration.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Roflumilast, a phosphodiesterase-4 inhibitor, is also used as an add-on option for patients with severe COPD [21468165, 22833385, 20689641].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21468165", "evidence_support": "Various PDE4 inhibitors have been evaluated as potential therapies in asthma or COPD but among these only roflumilast have been authorized in Europe to be used in patients with severe COPD as an add-on to the bronchodilator therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "22833385", "evidence_support": "Roflumilast is a selective phosphodiesterase 4 inhibitor which has been licensed in the European Union since 2010 and in Switzerland since November 2011 as an add-on treatment for patients with chronic obstructive pulmonary disease (COPD) in GOLD (Global Initiative for Chronic Obstructive Lung Disease) stages 3 and 4 (FEV(1) <50% predicted after bronchodilatation) and frequent exacerbations despite correctly-dosed therapy with a long-acting bronchodilator.", "evidence_relation": "supporting" }, { "cited_pmid": "20689641", "evidence_support": "In April 2010, the European Medicines Agency Committee for Medicinal Products for Human Use recommended approval of roflumilast, a selective phosphodiesterase 4 inhibitor, for the \"maintenance treatment of severe chronic obstructive pulmonary disease (COPD, FEV(1) postbronchodilator less than 50% predicted) associated with chronic bronchitis in adult patients with a history of frequent exacerbations as add-on to bronchodilator treatment\".", "evidence_relation": "supporting" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "For stage 4 COPD, the most popular treatment is a combination of long-acting bronchodilators, such as long-acting beta-agonists and long-acting antimuscarinic drugs, and inhaled corticosteroids [16239101, 16900364]. Roflumilast, a phosphodiesterase-4 inhibitor, is also used as an add-on option for patients with severe COPD [16389409, 37709133, 16126838]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For stage 4 COPD, the most popular treatment is a combination of long-acting bronchodilators, such as long-acting beta-agonists and long-acting antimuscarinic drugs, and inhaled corticosteroids [16239101, 16900364].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16239101", "evidence_support": "Bronchodilators are the mainstay of COPD treatment and can be combined with inhaled corticosteroids for greater efficacy and fewer side effects.", "evidence_relation": "supporting" }, { "cited_pmid": "16900364", "evidence_support": "Patients with stages III and IV should usually be put on long-term corticosteroid inhalation, preferably in combination with long-acting bronchodilators.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Roflumilast, a phosphodiesterase-4 inhibitor, is also used as an add-on option for patients with severe COPD [16389409, 37709133, 16126838].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16389409", "evidence_support": "Roflumilast is a selective phosphodiesterase (PDE) 4 inhibitor with a range of anti-inflammatory properties and potential for treatment of inflammatory disease.", "evidence_relation": "supporting" }, { "cited_pmid": "16389409", "evidence_support": "In chronic obstructive pulmonary disease, roflumilast taken as a once-daily oral dose of 500 ug has been shown to reduce the frequency of exacerbations with small effects on improving lung function. ", "evidence_relation": "supporting" }, { "cited_pmid": "37709133", "evidence_support": "Oral roflumilast is a phosphodiesterase-4 inhibitor approved for the prevention of exacerbations of chronic obstructive pulmonary disease and chronic bronchitis. ", "evidence_relation": "supporting" }, { "cited_pmid": "16126838", "evidence_support": "Roflumilast, a potent and selective phosphodiesterase 4 (PDE4) inhibitor, has been demonstrated to be an effective anti-inflammatory agent in airway inflammatory diseases. ", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "For stage 4 COPD, the most popular treatment is a combination of long-acting bronchodilators, such as long-acting beta-agonists and long-acting antimuscarinic drugs, and inhaled corticosteroids [16239101, 16900364]. Roflumilast, a phosphodiesterase-4 inhibitor, is also used as an add-on option for patients with severe COPD [37709133, 19356389]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For stage 4 COPD, the most popular treatment is a combination of long-acting bronchodilators, such as long-acting beta-agonists and long-acting antimuscarinic drugs, and inhaled corticosteroids [16239101, 16900364].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16900364", "evidence_support": "Patients with stages III and IV should usually be put on long-term corticosteroid inhalation, preferably in combination with long-acting bronchodilators.", "evidence_relation": "supporting" }, { "cited_pmid": "16239101", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Roflumilast, a phosphodiesterase-4 inhibitor, is also used as an add-on option for patients with severe COPD [37709133, 19356389].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37709133", "evidence_support": "Oral roflumilast is a phosphodiesterase-4 inhibitor approved for the prevention of exacerbations of chronic obstructive pulmonary disease and chronic bronchitis.", "evidence_relation": "supporting" }, { "cited_pmid": "19356389", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "For stage 4 COPD, the most popular treatment is a combination of long-acting bronchodilators, such as long-acting beta-agonists and long-acting antimuscarinic drugs, and inhaled corticosteroids [16900364, 16239101]. Roflumilast, a phosphodiesterase-4 inhibitor, is also used as an add-on option for patients with severe COPD [16126838, 16389409, 37709133]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For stage 4 COPD, the most popular treatment is a combination of long-acting bronchodilators, such as long-acting beta-agonists and long-acting antimuscarinic drugs, and inhaled corticosteroids [16900364, 16239101].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16900364", "evidence_support": "Patients with stages III and IV should usually be put on long-term corticosteroid inhalation, preferably in combination with long-acting bronchodilators.", "evidence_relation": "supporting" }, { "cited_pmid": "16239101", "evidence_support": "Bronchodilators are the mainstay of COPD treatment and can be combined with inhaled corticosteroids for greater efficacy and fewer side effects.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Roflumilast, a phosphodiesterase-4 inhibitor, is also used as an add-on option for patients with severe COPD [16126838, 16389409, 37709133].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16126838", "evidence_support": "Roflumilast, a potent and selective phosphodiesterase 4 (PDE4) inhibitor, has been demonstrated to be an effective anti-inflammatory agent in airway inflammatory diseases.", "evidence_relation": "supporting" }, { "cited_pmid": "16389409", "evidence_support": "In chronic obstructive pulmonary disease, roflumilast taken as a once-daily oral dose of 500 ug has been shown to reduce the frequency of exacerbations with small effects on improving lung function.", "evidence_relation": "supporting" }, { "cited_pmid": "37709133", "evidence_support": "Oral roflumilast is a phosphodiesterase-4 inhibitor approved for the prevention of exacerbations of chronic obstructive pulmonary disease and chronic bronchitis. ", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "For stage 4 COPD, the most popular treatment is a combination of long-acting bronchodilators, such as long-acting beta-agonists and long-acting muscarinic antagonists, and long-term corticosteroid inhalation [29258327, 16900364, 19462352]. Roflumilast, a phosphodiesterase-4 inhibitor, is also used as an add-on option for patients with severe COPD [16389409, 37069030, 24249758]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For stage 4 COPD, the most popular treatment is a combination of long-acting bronchodilators, such as long-acting beta-agonists and long-acting muscarinic antagonists, and long-term corticosteroid inhalation [29258327, 16900364, 19462352].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29258327", "evidence_support": "Although numerous treatment options are available, management of COPD remains a clinical challenge. Long-acting bronchodilators represent a significant class of medications that have the potential to reduce exacerbations and related hospitalizations and improve overall health outcomes.", "evidence_relation": "neutral" }, { "cited_pmid": "16900364", "evidence_support": "Patients with stages III and IV should usually be put on long-term corticosteroid inhalation, preferably in combination with long-acting bronchodilators.", "evidence_relation": "supporting" }, { "cited_pmid": "19462352", "evidence_support": "The most effective treatments for dyspnoea are bronchodilators, although also opiates may improve dyspnoea.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Roflumilast, a phosphodiesterase-4 inhibitor, is also used as an add-on option for patients with severe COPD [16389409, 37069030, 24249758].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24249758", "evidence_support": "Roflumilast (Daliresp, Forest Pharmaceuticals) is an oral phosphodiesterase-4 (PDE-4) inhibitor that targets inflammatory cells involved in triggering COPD exacerbations", "evidence_relation": "supporting" }, { "cited_pmid": "16389409", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "37069030", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "For treating stage 4 COPD, the most popular drug combination is triple therapy, which includes inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), and long-acting muscarinic antagonists (LAMA) [30463457, 30153695]. This combination is recommended for patients with severe symptoms and frequent exacerbations despite dual therapy [30463457, 30153695]. Triple therapy has been shown to significantly reduce exacerbation rates, improve lung function, and enhance quality of life compared to dual therapy or monotherapy [30463457, 30153695, 21334553]. Fixed-dose combinations such as beclomethasone/formoterol/glycopyrronium and fluticasone furoate/umeclidinium/vilanterol are among the first approved for this purpose and have demonstrated efficacy in clinical trials [30153695, 21334553]. These combinations leverage the synergistic effects of bronchodilation and anti-inflammatory action to manage severe COPD effectively [30463457, 30153695, 21334553].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For treating stage 4 COPD, the most popular drug combination is triple therapy, which includes inhaled corticosteroids (ICS), long-acting beta-agonists (LABA), and long-acting muscarinic antagonists (LAMA) [30463457, 30153695].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30463457", "evidence_support": "The triple therapy term covers the combination of inhaled corticosteroid (ICS), long-acting \u03b2-receptor agonist (LABA) and long-acting anticholinergic drug (LAMA) in one or in separate inhalers", "evidence_relation": "supporting" }, { "cited_pmid": "30463457", "evidence_support": "The latest GOLD 2018 (Global Initiative for Chronic Obstructive Disease) guidelines recommend the triple therapy in the management of chronic obstructive pulmonary disease (COPD) in patients of group D who despite the combination of two drugs: LAMA/LABA or ICS/LABA continue to have persistent symptoms or suffer from further frequent exacerbations.", "evidence_relation": "supporting" }, { "cited_pmid": "30153695", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This combination is recommended for patients with severe symptoms and frequent exacerbations despite dual therapy [30463457, 30153695].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30463457", "evidence_support": "The latest GOLD 2018 (Global Initiative for Chronic Obstructive Disease) guidelines recommend the triple therapy in the management of chronic obstructive pulmonary disease (COPD) in patients of group D who despite the combination of two drugs: LAMA/LABA or ICS/LABA continue to have persistent symptoms or suffer from further frequent exacerbations.", "evidence_relation": "supporting" }, { "cited_pmid": "30463457", "evidence_support": "A 20% reduction in the risk of moderate or severe exacerbation was found in patients receiving triple therapy compared to the ICS/LABA combination and LAMA monotherapy.", "evidence_relation": "supporting" }, { "cited_pmid": "30153695", "evidence_support": "Until recently, although recommended in guidelines for severe and unstable COPD patients, the clinical usefulness of the LABA/LAMA/ICS combination was a matter of debate. Recent trials with fixed-dose combination inhalers containing fluticasonfuroate/vilanterol/umeclidinium or beclometasone/formoterol/glycopyrronium significantly reduced exacerbation rates and dyspnea scores and improved lung function as well as quality of life better than the LABA/ICS, LABA/LAMA comparators or the single compounds in selected COPD trial patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Triple therapy has been shown to significantly reduce exacerbation rates, improve lung function, and enhance quality of life compared to dual therapy or monotherapy [30463457, 30153695, 21334553].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30463457", "evidence_support": "Expert commentary: A 20% reduction in the risk of moderate or severe exacerbation was found in patients receiving triple therapy compared to the ICS/LABA combination and LAMA monotherapy. Triple therapy reduces the number of exacerbations in comparison with double bronchodilatation (LABA/LAMA), thus representing an interesting therapeutic option in the management of COPD", "evidence_relation": "supporting" }, { "cited_pmid": "21334553", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "30153695", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Fixed-dose combinations such as beclomethasone/formoterol/glycopyrronium and fluticasone furoate/umeclidinium/vilanterol are among the first approved for this purpose and have demonstrated efficacy in clinical trials [30153695, 21334553].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30153695", "evidence_support": "Recent trials with fixed-dose combination inhalers containing fluticasonfuroate/vilanterol/umeclidinium or beclometasone/formoterol/glycopyrronium significantly reduced exacerbation rates and dyspnea scores and improved lung function as well as quality of life better than the LABA/ICS, LABA/LAMA comparators or the single compounds in selected COPD trial patients. Beclometasone/formoterol/glycolpyrronium and fluticasonfuroate/umeclidinium/vilanterol are the first triple combination therapies approved in a fixed-dose inhaler for COPD patients. ", "evidence_relation": "supporting" }, { "cited_pmid": "21334553", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "These combinations leverage the synergistic effects of bronchodilation and anti-inflammatory action to manage severe COPD effectively [30463457, 30153695, 21334553].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "30463457", "evidence_support": " triple therapy term covers the combination of inhaled corticosteroid (ICS), long-acting \u03b2-receptor agonist (LABA) and long-acting anticholinergic drug (LAMA) in one or in separate inhalers", "evidence_relation": "supporting" }, { "cited_pmid": "21334553", "evidence_support": "Bronchodilators, especially prolonged-action bronchodilators, are the most potent and there are two groups: beta-2 mimetics and anticholinergics.", "evidence_relation": "supporting" }, { "cited_pmid": "30153695", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "For treating stage 4 COPD, the most popular drug regimen typically includes a combination of long-acting bronchodilators, inhaled corticosteroids, and phosphodiesterase-4 inhibitors.Long-acting beta-agonists (LABAs) such as salmeterol or formoterol, and long-acting muscarinic antagonists (LAMAs) like tiotropium or umeclidinium, are often used together to improve lung function and reduce exacerbations.Inhaled corticosteroids (ICS) like fluticasone or budesonide are added to reduce inflammation.Phosphodiesterase-4 inhibitors such as roflumilast may be used to further decrease exacerbation frequency in patients with chronic bronchitis.Additionally, supplemental oxygen therapy is crucial for patients with severe hypoxemia.This combination aims to optimize lung function, reduce symptoms, and prevent exacerbations, thereby improving the quality of life for patients with advanced COPD.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For treating stage 4 COPD, the most popular drug regimen typically includes a combination of long-acting bronchodilators, inhaled corticosteroids, and phosphodiesterase-4 inhibitors.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Long-acting beta-agonists (LABAs) such as salmeterol or formoterol, and long-acting muscarinic antagonists (LAMAs) like tiotropium or umeclidinium, are often used together to improve lung function and reduce exacerbations.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Inhaled corticosteroids (ICS) like fluticasone or budesonide are added to reduce inflammation.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Phosphodiesterase-4 inhibitors such as roflumilast may be used to further decrease exacerbation frequency in patients with chronic bronchitis.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, supplemental oxygen therapy is crucial for patients with severe hypoxemia.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "This combination aims to optimize lung function, reduce symptoms, and prevent exacerbations, thereby improving the quality of life for patients with advanced COPD.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "For stage 4 COPD, a combination of inhaled corticosteroids (ICS) and long-acting bronchodilators, such as long-acting beta-2-adrenoceptor agonists (LABA) and long-acting muscarinic antagonists (LAMA), is commonly used [16900364, 20496301, 18666664]. Specifically, a triple therapy consisting of ICS, LABA, and LAMA has been shown to improve symptom control, quality of life, and reduce exacerbations in patients with severe COPD [30463457, 30153695, 21334553]. This combination is recommended for patients with stage III and IV COPD who have a history of exacerbations and persistent symptoms despite treatment with a single bronchodilator [16900364, 18666664]. The use of triple therapy has been associated with a 20% reduction in the risk of moderate or severe exacerbations compared to ICS/LABA combination and LAMA monotherapy [30463457]. However, the choice of specific medications and combinations should be individualized based on patient characteristics and response to treatment.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For stage 4 COPD, a combination of inhaled corticosteroids (ICS) and long-acting bronchodilators, such as long-acting beta-2-adrenoceptor agonists (LABA) and long-acting muscarinic antagonists (LAMA), is commonly used [16900364, 20496301, 18666664].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16900364", "evidence_support": "Patients with stages III and IV should usually be put on long-term corticosteroid inhalation, preferably in combination with long-acting bronchodilators.", "evidence_relation": "supporting" }, { "cited_pmid": "20496301", "evidence_support": "Current guidelines highlight that for COPD patients uncontrolled by bronchodilator monotherapy, combination therapy is recommended. These include LABA/ICS and LAMA/LABA combinations", "evidence_relation": "supporting" }, { "cited_pmid": "18666664", "evidence_support": "In patients with severe or very severe COPD (stage III-IV of the criteria of the Global Initiative for Obstructive Lung Disease (GOLD) or with cardiac comorbidity, there is a slight preference for the long-acting anticholinergic tiotropium. Inhaled corticosteroids (ICS) reduce the exacerbation frequency in patients with moderate to severe or very severe COPD (GOLD stage II-IV) and recurrent exacerbations. A combination of ICS with long-acting beta-2-adrenoceptor agonists (LABA) is prescribed in patients with GOLD stage III-IV with at least 2 exacerbations in the past year, a deterioration of the quality of life and with symptoms, if treatment with a LABA alone or an ICS alone results in insufficient improvement.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Specifically, a triple therapy consisting of ICS, LABA, and LAMA has been shown to improve symptom control, quality of life, and reduce exacerbations in patients with severe COPD [30463457, 30153695, 21334553].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30463457", "evidence_support": "The latest GOLD 2018 (Global Initiative for Chronic Obstructive Disease) guidelines recommend the triple therapy in the management of chronic obstructive pulmonary disease (COPD) in patients of group D who despite the combination of two drugs: LAMA/LABA or ICS/LABA continue to have persistent symptoms or suffer from further frequent exacerbations.", "evidence_relation": "supporting" }, { "cited_pmid": "30463457", "evidence_support": "Triple therapy reduces the number of exacerbations in comparison with double bronchodilatation (LABA/LAMA), thus representing an interesting therapeutic option in the management of COPD.", "evidence_relation": "supporting" }, { "cited_pmid": "30153695", "evidence_support": "Recent trials with fixed-dose combination inhalers containing fluticasonfuroate/vilanterol/umeclidinium or beclometasone/formoterol/glycopyrronium significantly reduced exacerbation rates and dyspnea scores and improved lung function as well as quality of life better than the LABA/ICS, LABA/LAMA comparators or the single compounds in selected COPD trial patients.", "evidence_relation": "supporting" }, { "cited_pmid": "21334553", "evidence_support": "Associating these three drugs can improve symptom control, improve quality of life and reduce the number of exacerbations.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This combination is recommended for patients with stage III and IV COPD who have a history of exacerbations and persistent symptoms despite treatment with a single bronchodilator [16900364, 18666664].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16900364", "evidence_support": "Patients with stages III and IV should usually be put on long-term corticosteroid inhalation, preferably in combination with long-acting bronchodilators. ", "evidence_relation": "supporting" }, { "cited_pmid": "18666664", "evidence_support": "A combination of ICS with long-acting beta-2-adrenoceptor agonists (LABA) is prescribed in patients with GOLD stage III-IV with at least 2 exacerbations in the past year, a deterioration of the quality of life and with symptoms, if treatment with a LABA alone or an ICS alone results in insufficient improvement. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The use of triple therapy has been associated with a 20% reduction in the risk of moderate or severe exacerbations compared to ICS/LABA combination and LAMA monotherapy [30463457].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30463457", "evidence_support": "The latest GOLD 2018 (Global Initiative for Chronic Obstructive Disease) guidelines recommend the triple therapy in the management of chronic obstructive pulmonary disease (COPD) in patients of group D who despite the combination of two drugs: LAMA/LABA or ICS/LABA continue to have persistent symptoms or suffer from further frequent exacerbations.", "evidence_relation": "supporting" }, { "cited_pmid": "30463457", "evidence_support": "A 20% reduction in the risk of moderate or severe exacerbation was found in patients receiving triple therapy compared to the ICS/LABA combination and LAMA monotherapy.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "However, the choice of specific medications and combinations should be individualized based on patient characteristics and response to treatment.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "ten-shot-gemini-flash": { "answer": "The most popular treatment for stage 4 COPD involves a combination of inhaled medications targeting multiple disease processes [26417965, 34428673]. The most common combination is triple therapy, which includes a long-acting beta-agonist (LABA), a long-acting muscarinic antagonist (LAMA), and an inhaled corticosteroid (ICS) [26417965]. This combination is often preferred over dual therapy, which may include LABA + ICS or LAMA + LABA [23767419]. While the effectiveness of triple therapy compared to dual therapy is still under investigation, it is considered a common approach for managing advanced COPD [23767419, 17310045]. \n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The most popular treatment for stage 4 COPD involves a combination of inhaled medications targeting multiple disease processes [26417965, 34428673].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "34428673", "evidence_support": "Combination treatments, targeting multiple disease processes, benefit subjects with acute exacerbation of chronic obstructive pulmonary disease (AECOPD)", "evidence_relation": "neutral" }, { "cited_pmid": "26417965", "evidence_support": "The most common maintenance treatment was inhaled corticoids (ICS) (80.9%) followed by long-acting beta-agonists (LABA) (75.4%). The most common combination was triple therapy (LABA+ LAMA+ICS) (56.2%) followed by LABA+ICS dual therapy (18.2%) regardless of the severity of COPD.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The most common combination is triple therapy, which includes a long-acting beta-agonist (LABA), a long-acting muscarinic antagonist (LAMA), and an inhaled corticosteroid (ICS) [26417965].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26417965", "evidence_support": "The most common combination was triple therapy (LABA+ LAMA+ICS) (56.2%) followed by LABA+ICS dual therapy (18.2%) regardless of the severity of COPD. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This combination is often preferred over dual therapy, which may include LABA + ICS or LAMA + LABA [23767419].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23767419", "evidence_support": "If patients remain symptomatic despite monotherapy, dual therapy with a long-acting anticholinergic and a LABA, or a LABA and an ICS, may be beneficial.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While the effectiveness of triple therapy compared to dual therapy is still under investigation, it is considered a common approach for managing advanced COPD [23767419, 17310045].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23767419", "evidence_support": "Triple therapy (ie, a long-acting anticholinergic, a LABA, and an ICS) also is used, but it is unclear if triple therapy is superior to dual therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "17310045", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "For stage 4 COPD, the most popular and effective treatment is a combination of inhaled long-acting bronchodilators and inhaled corticosteroids (ICS) [23367674, 11404867]. The most common combination is triple therapy, which includes a long-acting beta-agonist (LABA), a long-acting muscarinic antagonist (LAMA), and ICS [26417965]. However, for patients with severe COPD and frequent exacerbations, roflumilast, a selective phosphodiesterase-4 (PDE-4) inhibitor, is also a popular option [24249758, 25429225, 22433610]. Roflumilast has been shown to reduce exacerbations and improve lung function, particularly in patients with chronic bronchitis [24249758, 26338438, 22433610]. In very severe cases, oxygen therapy may be used to prolong survival [23367674].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For stage 4 COPD, the most popular and effective treatment is a combination of inhaled long-acting bronchodilators and inhaled corticosteroids (ICS) [23367674, 11404867].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23367674", "evidence_support": "For patients with severe COPD and repeated exacerbations, the standard treatment remains an inhaled bronchodilator combined with an inhaled corticosteroid, or oxygen therapy in some cases.", "evidence_relation": "supporting" }, { "cited_pmid": "11404867", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The most common combination is triple therapy, which includes a long-acting beta-agonist (LABA), a long-acting muscarinic antagonist (LAMA), and ICS [26417965].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26417965", "evidence_support": "The most common combination was triple therapy (LABA+ LAMA+ICS) (56.2%) followed by LABA+ICS dual therapy (18.2%) regardless of the severity of COPD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, for patients with severe COPD and frequent exacerbations, roflumilast, a selective phosphodiesterase-4 (PDE-4) inhibitor, is also a popular option [24249758, 25429225, 22433610].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24249758", "evidence_support": "Roflumilast (Daliresp, Forest Pharmaceuticals) is an oral phosphodiesterase-4 (PDE-4) inhibitor that targets inflammatory cells involved in triggering COPD exacerbations.", "evidence_relation": "supporting" }, { "cited_pmid": "24249758", "evidence_support": "In six placebo-controlled trials involving nearly 4500 patients with COPD of varying severity, the use of roflumilast was associated with reduced COPD exacerbations and improved lung function, as determined by spirometry, with the greatest benefits observed in patients with severe COPD who had chronic bronchitis and a history of frequent exacerbations; clinical efficacy was demonstrated in patients receiving roflumilast alone as well as those receiving concomitant inhaled long-acting \u03b22-agonist (LABA) therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "24249758", "evidence_support": "Roflumilast is a safe and effective option for controlling COPD exacerbations in a defined subset of patients for whom the available treatment alternatives are very limited.", "evidence_relation": "supporting" }, { "cited_pmid": "25429225", "evidence_support": "Roflumilast is a selective phosphodiesterase-4 (PDE-4) inhibitor that was approved by the US Food and Drug Administration in February 2011 for the management of chronic obstructive pulmonary disease (COPD).", "evidence_relation": "supporting" }, { "cited_pmid": "25429225", "evidence_support": "Roflumilast appears to be useful in vulnerable patients who are at high risk for exacerbations.", "evidence_relation": "supporting" }, { "cited_pmid": "25429225", "evidence_support": "Patients with severe-to-very severe COPD, chronic bronchitis, and frequent history of exacerbations derived the greatest benefit with roflumilast", "evidence_relation": "supporting" }, { "cited_pmid": "22433610", "evidence_support": "The greatest benefit seen with roflumilast was among patients with moderate-to-severe COPD associated with chronic bronchitis along with a recent history of exacerbations", "evidence_relation": "supporting" }, { "cited_pmid": "22433610", "evidence_support": "Despite its only modest benefits in improving lung function and reducing exacerbation rates, roflumilast serves as a safe and effective option in the treatment of COPD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Roflumilast has been shown to reduce exacerbations and improve lung function, particularly in patients with chronic bronchitis [24249758, 26338438, 22433610].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24249758", "evidence_support": "Roflumilast (Daliresp, Forest Pharmaceuticals) is an oral phosphodiesterase-4 (PDE-4) inhibitor that targets inflammatory cells involved in triggering COPD exacerbations", "evidence_relation": "supporting" }, { "cited_pmid": "24249758", "evidence_support": "In six placebo-controlled trials involving nearly 4500 patients with COPD of varying severity, the use of roflumilast was associated with reduced COPD exacerbations and improved lung function, as determined by spirometry, with the greatest benefits observed in patients with severe COPD who had chronic bronchitis and a history of frequent exacerbations; clinical efficacy was demonstrated in patients receiving roflumilast alone as well as those receiving concomitant inhaled long-acting \u03b22-agonist (LABA) therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "24249758", "evidence_support": "Roflumilast is a safe and effective option for controlling COPD exacerbations in a defined subset of patients for whom the available treatment alternatives are very limite", "evidence_relation": "supporting" }, { "cited_pmid": "26338438", "evidence_support": "Roflumilast (Daliresp\u00ae, Daxas\u00ae) is a selective phosphodiesterase 4 (PDE4) inhibitor that decreases systemic and pulmonary inflammation and improves disease symptoms in patients with severe chronic obstructive pulmonary disease (COP", "evidence_relation": "supporting" }, { "cited_pmid": "26338438", "evidence_support": "Roflumilast is an effective treatment in patients with moderate to severe COPD; it improves lung function and is generally associated with a lower risk of exacerbation, particularly in patients with more severe disease and/or chronic bronchitis, cough and sputum.", "evidence_relation": "supporting" }, { "cited_pmid": "22433610", "evidence_support": "Despite its only modest benefits in improving lung function and reducing exacerbation rates, roflumilast serves as a safe and effective option in the treatment of COPD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In very severe cases, oxygen therapy may be used to prolong survival [23367674].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "23367674", "evidence_support": "Oxygen therapy prolongs survival in very severe disease.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "For treating stage 4 Chronic Obstructive Pulmonary Disease (COPD), the most popular and effective medications include long-acting bronchodilators, specifically long-acting muscarinic antagonists (LAMAs) and long-acting beta-agonists (LABAs) [23592218, 28409477]. Tiotropium, a LAMA, is often recommended as a first-line treatment due to its ability to improve quality of life and reduce exacerbations [18957624, 16030078]. Combination therapies, such as a LABA with a LAMA or an inhaled corticosteroid (ICS), are also effective for patients who remain symptomatic despite monotherapy [23767419, 17878465]. Roflumilast, an add-on therapy, may be beneficial for patients with severe COPD [23592218]. Overall, current guidelines advocate for the use of these combinations to enhance treatment outcomes in advanced COPD [23243635, 21512392].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For treating stage 4 Chronic Obstructive Pulmonary Disease (COPD), the most popular and effective medications include long-acting bronchodilators, specifically long-acting muscarinic antagonists (LAMAs) and long-acting beta-agonists (LABAs) [23592218, 28409477].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23592218", "evidence_support": "Bronchodilators, namely long-acting antimuscarinic drugs and long-acting beta-agonists, form the mainstay of treatment in COPD.", "evidence_relation": "supporting" }, { "cited_pmid": "28409477", "evidence_support": "Long-acting bronchodilators (LABDs) are recommended as a first-line maintenance therapy in patients with moderate or severe chronic obstructive pulmonary disease (COPD)", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Tiotropium, a LAMA, is often recommended as a first-line treatment due to its ability to improve quality of life and reduce exacerbations [18957624, 16030078].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18957624", "evidence_support": "Tiotropium appears to be the best option as a first-line drug for patients with moderate-to-severe COPD because of its ability to sustain bronchodilator effect, improve quality of life, reduce COPD exacerbations, and reduce health resource usage.", "evidence_relation": "supporting" }, { "cited_pmid": "16030078", "evidence_support": "Tiotropium is an effective inhaled anticholinergic agent that is recommended among preferred long-acting bronchodilators for the chronic management of moderate to very severe COPD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Combination therapies, such as a LABA with a LAMA or an inhaled corticosteroid (ICS), are also effective for patients who remain symptomatic despite monotherapy [23767419, 17878465].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23767419", "evidence_support": "If patients remain symptomatic despite monotherapy, dual therapy with a long-acting anticholinergic and a LABA, or a LABA and an ICS, may be beneficial.", "evidence_relation": "supporting" }, { "cited_pmid": "17878465", "evidence_support": "Combining a long-acting beta2-adrenoceptor agonist with an inhaled corticosteroid has also been shown to be more effective than the use of either agent alone.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Roflumilast, an add-on therapy, may be beneficial for patients with severe COPD [23592218].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23592218", "evidence_support": "Roflumilast is an add-on option for patients with severe COPD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Overall, current guidelines advocate for the use of these combinations to enhance treatment outcomes in advanced COPD [23243635, 21512392].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23243635", "evidence_support": "Current guidelines for the management of chronic obstructive pulmonary disease (COPD) recommend the use of inhaled long-acting bronchodilators, inhaled corticosteroids (ICSs) and their combinations for maintenance treatment of moderate to severe COPD.", "evidence_relation": "supporting" }, { "cited_pmid": "21512392", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "For treating stage 4 Chronic Obstructive Pulmonary Disease (COPD), the most popular and effective medications include a combination of long-acting bronchodilators and inhaled corticosteroids (ICS). Specifically, the combination of a long-acting beta2-agonist (LABA) and a long-acting muscarinic antagonist (LAMA) is highly recommended to reduce exacerbations [30521694, 18044689]. Triple therapy, which includes a LABA, LAMA, and ICS, is also used, although its superiority over dual therapy remains uncertain [23767419]. Roflumilast, a selective phosphodiesterase-4 inhibitor, is an additional option for patients with severe COPD [27844172]. Overall, dual bronchodilator therapy is preferred for patients with moderate to very severe COPD, especially those experiencing frequent exacerbations [28594587, 37343975].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For treating stage 4 Chronic Obstructive Pulmonary Disease (COPD), the most popular and effective medications include a combination of long-acting bronchodilators and inhaled corticosteroids (ICS).", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Specifically, the combination of a long-acting beta2-agonist (LABA) and a long-acting muscarinic antagonist (LAMA) is highly recommended to reduce exacerbations [30521694, 18044689].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30521694", "evidence_support": "Long-acting bronchodilators such as long-acting \u03b2-agonist (LABA), long-acting muscarinic antagonist (LAMA), and LABA/inhaled corticosteroid (ICS) combinations have been used in people with moderate to severe chronic obstructive pulmonary disease (COPD) to control symptoms such as dyspnoea and cough, and prevent exacerbations", "evidence_relation": "supporting" }, { "cited_pmid": "30521694", "evidence_support": "There is evidence that the LABA/LAMA combination decreases moderate to severe exacerbations compared to LABA/ICS combination, LAMA, and LABA in the high-risk population", "evidence_relation": "supporting" }, { "cited_pmid": "30521694", "evidence_support": "There is evidence that the LABA/LAMA combination reduces severe exacerbations compared to LABA/ICS combination and LABA in the high-risk population (network HR 0.78 (95% CrI 0.64 to 0.93) and 0.64 (95% CrI 0.51 to 0.81), respectively)", "evidence_relation": "supporting" }, { "cited_pmid": "30521694", "evidence_support": "The LABA/LAMA combination was the highest ranked treatment group to reduce COPD exacerbations although there was some uncertainty in the results.", "evidence_relation": "supporting" }, { "cited_pmid": "18044689", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Triple therapy, which includes a LABA, LAMA, and ICS, is also used, although its superiority over dual therapy remains uncertain [23767419].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23767419", "evidence_support": "Triple therapy (ie, a long-acting anticholinergic, a LABA, and an ICS) also is used, but it is unclear if triple therapy is superior to dual therapy", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Roflumilast, a selective phosphodiesterase-4 inhibitor, is an additional option for patients with severe COPD [27844172].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27844172", "evidence_support": "More recently the orally active selective PDE4 inhibitor, roflumilast, has been introduced into clinical practice for the treatment of severe COPD on top of gold standard treatment.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Overall, dual bronchodilator therapy is preferred for patients with moderate to very severe COPD, especially those experiencing frequent exacerbations [28594587, 37343975].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28594587", "evidence_support": "Nevertheless, the benefits observed with IND/GLY confirm dual bronchodilator as the preferred therapy in patients with moderate-to-very-severe COPD regardless of sex.", "evidence_relation": "supporting" }, { "cited_pmid": "37343975", "evidence_support": "Single-inhaler dual bronchodilators are now recommended as initial treatment of COPD for patients with multiple exacerbations or with moderate or severe dyspnoea.", "evidence_relation": "supporting" } ] } ] }, "webis-1": { "answer": "The question does not provide enough context to determine the most popular drug or combination of drugs for treating stage 4 COPD. However, it is mentioned that according to GOLD guidelines, patients with very severe COPD may be treated with a drug like tiotropium [20102307]. Additionally, it is mentioned that there are new medications in Phase III clinical trials, such as olodaterol and glycopyrronium maleate [24185438].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The question does not provide enough context to determine the most popular drug or combination of drugs for treating stage 4 COPD.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "However, it is mentioned that according to GOLD guidelines, patients with very severe COPD may be treated with a drug like tiotropium [20102307].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "20102307", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, it is mentioned that there are new medications in Phase III clinical trials, such as olodaterol and glycopyrronium maleate [24185438].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24185438", "evidence_support": "An extensive COPD pipeline consists of many oral and inhaled medications, including olodaterol and glycopyrronium maleate, which are in Phase III clinical trials.", "evidence_relation": "supporting" } ] } ] }, "webis-2": { "answer": "The most popular drugs for treating stage 4 COPD are likely to be bronchodilators, such as \u03b22-agonists and anticholinergics, and their combination with inhaled corticosteroids [24802511,24185438].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The most popular drugs for treating stage 4 COPD are likely to be bronchodilators, such as \u03b22-agonists and anticholinergics, and their combination with inhaled corticosteroids [24802511,24185438].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24185438", "evidence_support": "Studies also have been conducted to determine which inhaled agents are preferred for use when long-acting bronchodilators are needed as mono- and combination therapy.", "evidence_relation": "neutral" }, { "cited_pmid": "24802511", "evidence_support": "A review of use of the pMDI device in patients with COPD with different available and prescribed medications (bronchodilators-\u03b22-agonists and anticholinergics, and their combination with inhaled corticosteroids) is discussed.", "evidence_relation": "neutral" } ] } ] }, "webis-3": { "answer": "Inhaled corticosteroid/long-acting \u03b2-2 agonists (ICS/LABA) combination inhalers are popular for treating stage 4 COPD [30983423].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Inhaled corticosteroid/long-acting \u03b2-2", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "agonists (ICS/LABA) combination inhalers are popular for treating stage 4 COPD [30983423].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "30983423", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-5": { "answer": "Inhaled corticosteroid/long-acting \u03b2-2 agonists (ICS/LABA) combination inhalers are popular for treating stage 4 COPD [30983423].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Inhaled corticosteroid/long-acting \u03b2-2", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "agonists (ICS/LABA) combination inhalers are popular for treating stage 4 COPD [30983423].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30983423", "evidence_support": "Inhaled corticosteroid/long-acting \u03b2-2 agonists (ICS/LABA) combination inhalers have been a lifeline for a generation of chronic obstructive pulmonary disease (COPD) and asthma patients.", "evidence_relation": "supporting" }, { "cited_pmid": "30983423", "evidence_support": "FF/VI will likely remain a popular ICS/LBA combination to treat COPD, as a once-daily inhaled therapy delivered via the Ellipta device popular with COPD patients, with extensive clinical trial and real-world data to support its use.", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-1": { "answer": "The most popular drug for treating stage 4 COPD is a combination of long-acting bronchodilators, such as a long-acting beta-agonist (LABA) and a long-acting muscarinic antagonist (LAMA), often used alongside inhaled corticosteroids (ICS) for patients with frequent exacerbations. This combination helps improve lung function, reduce symptoms, and decrease the frequency of exacerbations in advanced COPD.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The most popular drug for treating stage 4 COPD is a combination of long-acting bronchodilators, such as a long-acting beta-agonist (LABA) and a long-acting muscarinic antagonist (LAMA), often used alongside inhaled corticosteroids (ICS) for patients with frequent exacerbations.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This combination helps improve lung function, reduce symptoms, and decrease the frequency of exacerbations in advanced COPD.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "The most popular drug combination for treating stage 4 COPD is fluticasone furoate and vilanterol (FF/VI), which is a once-daily inhaled corticosteroid and long-acting beta-agonist combination. This combination has extensive clinical trial and real-world data supporting its efficacy in managing COPD symptoms [30983423]. Other medications, such as olodaterol and glycopyrronium maleate, are also in development but are not as established in practice [24185438].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The most popular drug combination for treating stage 4 COPD is fluticasone furoate and vilanterol (FF/VI), which is a once-daily inhaled corticosteroid and long-acting beta-agonist combination.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This combination has extensive clinical trial and real-world data supporting its efficacy in managing COPD symptoms [30983423].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30983423", "evidence_support": "Fluticasone furoate and Vilanterol (FF/VI) as a once-daily ICS/LABA combination have an extensive clinical trial and real-world data to support its use in COPD patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Other medications, such as olodaterol and glycopyrronium maleate, are also in development but are not as established in practice [24185438].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24185438", "evidence_support": "An extensive COPD pipeline consists of many oral and inhaled medications, including olodaterol and glycopyrronium maleate, which are in Phase III clinical trials.", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-6": { "answer": "The context provided does not specify a particular drug or combination of drugs that is most popular for treating stage 4 COPD. However, standard treatment for advanced COPD typically includes long-acting bronchodilators, such as beta-agonists (e.g., salmeterol) and anticholinergics, along with inhaled corticosteroids. The snippets mention salmeterol, but do not provide enough information to determine its popularity or effectiveness in stage 4 COPD specifically [35853985,27799757,37154390].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The context provided does not specify a particular drug or combination of drugs that is most popular for treating stage 4 COPD.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "However, standard treatment for advanced COPD typically includes long-acting bronchodilators, such as beta-agonists (e.g., salmeterol) and anticholinergics, along with inhaled corticosteroids.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "The snippets mention salmeterol, but do not provide enough information to determine its popularity or effectiveness in stage 4 COPD specifically [35853985,27799757,37154390].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "35853985", "evidence_support": "The most classic treatment recommended in the current chronic obstructive pulmonary disease (COPD) guidelines is glucocorticoid and \u03b22 receptor agonist combination, such as salmeterol xinafoate and fluticasone propionate (Sal/Flu), causing many adverse reactions due to hormones.", "evidence_relation": "contradicting" }, { "cited_pmid": "27799757", "evidence_support": "Bronchodilators (\u03b22-agonists and antimuscarinics) are the mainstay of pharmacologic therapy in patients with COPD, with long-acting agents recommended for patients with moderate to severe symptoms or those who are at a higher risk for COPD exacerbations.", "evidence_relation": "neutral" }, { "cited_pmid": "37154390", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "zero-shot-gemini-flash": { "answer": "The most common combination of drugs for stage 4 COPD is triple therapy, which includes a long-acting beta-agonist (LABA), a long-acting muscarinic antagonist (LAMA), and an inhaled corticosteroid (ICS) [26417965]. This combination is followed by LABA and ICS dual therapy [26417965]. Inhaled corticosteroids are the most common maintenance treatment for COPD, followed by LABAs [26417965]. For patients with severe COPD and frequent exacerbations, the standard treatment is an inhaled bronchodilator combined with an inhaled corticosteroid, or oxygen therapy in some cases [23367674]. Roflumilast, a phosphodiesterase-4 inhibitor, has shown modest improvements in lung function and reduced rates of exacerbations in patients with moderate-to-severe COPD [22433610]. The greatest benefit of roflumilast was seen in patients with chronic bronchitis and a history of exacerbations [22433610]. Roflumilast can be used as monotherapy or in combination with LABAs or anticholinergic agents [22433610]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The most common combination of drugs for stage 4 COPD is triple therapy, which includes a long-acting beta-agonist (LABA), a long-acting muscarinic antagonist (LAMA), and an inhaled corticosteroid (ICS) [26417965].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26417965", "evidence_support": "The most common combination was triple therapy (LABA+ LAMA+ICS) (56.2%) followed by LABA+ICS dual therapy (18.2%) regardless of the severity of COPD. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This combination is followed by LABA and ICS dual therapy [26417965].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "26417965", "evidence_support": "The most common combination was triple therapy (LABA+ LAMA+ICS) (56.2%) followed by LABA+ICS dual therapy (18.2%) regardless of the severity of COPD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Inhaled corticosteroids are the most common maintenance treatment for COPD, followed by LABAs [26417965].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26417965", "evidence_support": "The most common maintenance treatment was inhaled corticoids (ICS) (80.9%) followed by long-acting beta-agonists (LABA) (75.4%).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "For patients with severe COPD and frequent exacerbations, the standard treatment is an inhaled bronchodilator combined with an inhaled corticosteroid, or oxygen therapy in some cases [23367674].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23367674", "evidence_support": "Drugs have only a modest, purely symptomatic effect; a bronchodilator is combined with an inhaled corticosteroid when exacerbations are frequent.", "evidence_relation": "supporting" }, { "cited_pmid": "23367674", "evidence_support": "For patients with severe COPD and repeated exacerbations, the standard treatment remains an inhaled bronchodilator combined with an inhaled corticosteroid, or oxygen therapy in some cases.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Roflumilast, a phosphodiesterase-4 inhibitor, has shown modest improvements in lung function and reduced rates of exacerbations in patients with moderate-to-severe COPD [22433610].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22433610", "evidence_support": "In 6 published Phase 3 trials to date, roflumilast 500 \u03bcg daily exhibited modest improvements in lung function, measured by pre- and postbronchodilator forced expiratory volume in 1 second, and reduced rates of moderate and severe exacerbations", "evidence_relation": "supporting" }, { "cited_pmid": "22433610", "evidence_support": "Despite its only modest benefits in improving lung function and reducing exacerbation rates, roflumilast serves as a safe and effective option in the treatment of COPD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "The greatest benefit of roflumilast was seen in patients with chronic bronchitis and a history of exacerbations [22433610].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22433610", "evidence_support": "The greatest benefit seen with roflumilast was among patients with moderate-to-severe COPD associated with chronic bronchitis along with a recent history of exacerbations.", "evidence_relation": "supporting" }, { "cited_pmid": "22433610", "evidence_support": "Despite its only modest benefits in improving lung function and reducing exacerbation rates, roflumilast serves as a safe and effective option in the treatment of COPD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Roflumilast can be used as monotherapy or in combination with LABAs or anticholinergic agents [22433610].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22433610", "evidence_support": "The benefits were demonstrated with monotherapy and in combination with long-acting \u03b2(2)-agonists or anticholinergic agents.", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "For stage 4 Chronic Obstructive Pulmonary Disease (COPD), the most popular treatment is triple therapy, which combines a long-acting muscarinic antagonist (LAMA), a long-acting beta2 agonist (LABA), and an inhaled corticosteroid (ICS) [30463457, 37327161]. This combination is recommended for patients who continue to experience symptoms or frequent exacerbations despite dual therapy with either LAMA/LABA or ICS/LABA [30463457]. Triple therapy has been shown to reduce exacerbations more effectively than double bronchodilation [30463457, 37327161]. Additionally, for patients at high risk of exacerbations, the use of a fixed combination of an ICS and LABA, such as budesonide-formoterol, is also recommended [25515181, 23898819]. Roflumilast, a PDE4 inhibitor, can be added to enhance treatment outcomes in severe cases [25684586, 21509737].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For stage 4 Chronic Obstructive Pulmonary Disease (COPD), the most popular treatment is triple therapy, which combines a long-acting muscarinic antagonist (LAMA), a long-acting beta2 agonist (LABA), and an inhaled corticosteroid (ICS) [30463457, 37327161].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30463457", "evidence_support": "The triple therapy term covers the combination of inhaled corticosteroid (ICS), long-acting \u03b2-receptor agonist (LABA) and long-acting anticholinergic drug (LAMA) in one or in separate inhalers. The latest GOLD 2018 (Global Initiative for Chronic Obstructive Disease) guidelines recommend the triple therapy in the management of chronic obstructive pulmonary disease (COPD) in patients of group D who despite the combination of two drugs: LAMA/LABA or ICS/LABA continue to have persistent symptoms or suffer from further frequent exacerbations.", "evidence_relation": "supporting" }, { "cited_pmid": "30463457", "evidence_support": "Triple therapy reduces the number of exacerbations in comparison with double bronchodilatation (LABA/LAMA), thus representing an interesting therapeutic option in the management of COPD. ", "evidence_relation": "supporting" }, { "cited_pmid": "37327161", "evidence_support": "Triple therapy with a long-acting muscarinic antagonist/long-acting beta2 agonist/inhaled corticosteroid combination improves symptoms and lung function more than dual therapy but increases pneumonia risk.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This combination is recommended for patients who continue to experience symptoms or frequent exacerbations despite dual therapy with either LAMA/LABA or ICS/LABA [30463457].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30463457", "evidence_support": "The latest GOLD 2018 (Global Initiative for Chronic Obstructive Disease) guidelines recommend the triple therapy in the management of chronic obstructive pulmonary disease (COPD) in patients of group D who despite the combination of two drugs: LAMA/LABA or ICS/LABA continue to have persistent symptoms or suffer from further frequent exacerbations.", "evidence_relation": "supporting" }, { "cited_pmid": "30463457", "evidence_support": "A 20% reduction in the risk of moderate or severe exacerbation was found in patients receiving triple therapy compared to the ICS/LABA combination and LAMA monotherapy.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Triple therapy has been shown to reduce exacerbations more effectively than double bronchodilation [30463457, 37327161].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30463457", "evidence_support": "Triple therapy reduces the number of exacerbations in comparison with double bronchodilatation (LABA/LAMA), thus representing an interesting therapeutic option in the management of COPD.", "evidence_relation": "supporting" }, { "cited_pmid": "37327161", "evidence_support": "Triple therapy with a long-acting muscarinic antagonist/long-acting beta2 agonist/inhaled corticosteroid combination improves symptoms and lung function more than dual therapy but increases pneumonia risk", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, for patients at high risk of exacerbations, the use of a fixed combination of an ICS and LABA, such as budesonide-formoterol, is also recommended [25515181, 23898819].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25515181", "evidence_support": "For the high exacerbation risk phenotype, pharmacotherapy with a long-acting anticholinergic or a fixed combination of an inhaled glucocorticoid and a long-acting \u03b22 -agonist (budesonide-formoterol, beclomethasone dipropionate-formoterol, fluticasone propionate-salmeterol or fluticasone furoate-vilanterol) is recommended as a first choice.", "evidence_relation": "supporting" }, { "cited_pmid": "23898819", "evidence_support": "Inhaled corticosteroids (ICS), in conjunction with long-acting beta-agonists (LABA), are routinely considered at severe and very severe stages of COPD when patients lack adequate response to single-therapy with LABAs.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Roflumilast, a PDE4 inhibitor, can be added to enhance treatment outcomes in severe cases [25684586, 21509737].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25684586", "evidence_support": "We postulated that roflumilast would reduce exacerbations in patients with severe chronic obstructive pulmonary disease at risk for exacerbations, even in combination with inhaled corticosteroid and longacting \u03b22 agonist treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "25684586", "evidence_support": "Our findings suggest that roflumilast reduces exacerbations and hospital admissions in patients with severe chronic obstructive pulmonary disease and chronic bronchitis who are at risk of frequent and severe exacerbations despite inhaled corticosteroid and longacting \u03b22 agonist therapy, even in combination with tiotropium.", "evidence_relation": "supporting" }, { "cited_pmid": "21509737", "evidence_support": "The addition of PDE4 inhibitor (roflumilast) to LABA or LAMA in patients with severe COPD, improves lung function and reduces exacerbation frequency.", "evidence_relation": "supporting" }, { "cited_pmid": "21509737", "evidence_support": "PDE4 inhibitors have been shown to play a role in severe COPD and they are effective particularly in combination with other pharmacological agents.", "evidence_relation": "supporting" } ] } ] } } }, { "question_id": "120", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Left-sided facial numbness can have various underlying causes, some of which may require medical attention. For instance, a stroke involving the cerebellar peduncles, as reported in a case where an 83-year-old woman experienced a bilateral middle cerebellar peduncles stroke, could result in numbness or other neurological symptoms due to the involvement of the vertebral arteries [33160128]. Additionally, rare conditions such as cauda equina arteriovenous malformation (AVM), although primarily affecting the lower body, indicate the complexity of vascular malformations that can lead to neurological symptoms depending on the location of the AVM [34653704]. Given the range of potential causes, it is advisable for the patient to seek medical evaluation to rule out serious conditions.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can have various underlying causes, some of which may require medical attention.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "For instance, a stroke involving the cerebellar peduncles, as reported in a case where an 83-year-old woman experienced a bilateral middle cerebellar peduncles stroke, could result in numbness or other neurological symptoms due to the involvement of the vertebral arteries [33160128].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33160128", "evidence_support": "We present the case of an 83-year-old woman with an isolated bilateral middle cerebellar peduncles stroke caused by complete occlusion of the right vertebral artery and focal occlusion of the left vertebral artery due to giant cell arteritis. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, rare conditions such as cauda equina arteriovenous malformation (AVM), although primarily affecting the lower body, indicate the complexity of vascular malformations that can lead to neurological symptoms depending on the location of the AVM [34653704].", "answer_sentence_relevance": "inappropriate", "citation_assessment": [ { "cited_pmid": "34653704", "evidence_support": "Cauda equina AVM with bilateral arterial feeders is extremely rare.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Given the range of potential causes, it is advisable for the patient to seek medical evaluation to rule out serious conditions.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Left-sided facial numbness can result from various conditions, each with distinct etiologies [21614764, 30456043, 16940363]. Tick infestation may lead to this symptom through neurotoxic effects [17408447, 21531525, 36109088]. Kawasaki Disease, although primarily affecting children, can also cause left-sided facial numbness due to its vasculitic nature [23423832]. Bal\u00f3's concentric sclerosis, a rare demyelinating disease, can manifest with facial numbness [17549061]. Leprosy, an infectious disease caused by Mycobacterium leprae, can damage peripheral nerves, leading to numbness [22669019]. Guillain-Barr\u00e9 syndrome, an autoimmune disorder, can cause facial numbness as part of its broader neurological impact [28966341, 35719795, 26823357]. Melkersson-Rosenthal syndrome, characterized by recurrent facial swelling, can also present with numbness [16096940]. Cephalic tetanus, a rare form of tetanus, can affect cranial nerves, resulting in facial numbness [28108438, 34898510]. Temporal bone fractures may cause numbness due to direct trauma to facial nerves [17041546, 32086330]. Lastly, cerebellopontine angle lipoma, a benign tumor, can compress cranial nerves, leading to facial numbness [30456043, 33377403, 20066061].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can result from various conditions, each with distinct etiologies [21614764, 30456043, 16940363].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21614764", "evidence_support": "Magnetic resonance imaging revealed a 20 mm-sized aneurysm of the left vertebral artery leading to compression of the trigeminal nerve.", "evidence_relation": "neutral" }, { "cited_pmid": "30456043", "evidence_support": "Magnetic resonance imaging (MRI) revealed a large homogenously enhancing lesion arising from the inferior surface of the tentorium toward the left cerebellopontine angle causing significant brainstem compression ( Fig. 1A and 1B ).", "evidence_relation": "neutral" }, { "cited_pmid": "16940363", "evidence_support": "We report a case of congenital absence of the left internal carotid artery (ICA) that presented with left-sided facial numbness.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "10", "answer_sentence": "Lastly, cerebellopontine angle lipoma, a benign tumor, can compress cranial nerves, leading to facial numbness [30456043, 33377403, 20066061].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30456043", "evidence_support": "Magnetic resonance imaging (MRI) revealed a large homogenously enhancing lesion arising from the inferior surface of the tentorium toward the left cerebellopontine angle causing significant brainstem compression ( Fig. 1A and 1B ).", "evidence_relation": "supporting" }, { "cited_pmid": "33377403", "evidence_support": "We report a case of cholesteatoma that caused left facial pain with facial numbness. The tumour was located in the left cerebellopontine angle (CPA) and Meckel's cave.", "evidence_relation": "neutral" }, { "cited_pmid": "20066061", "evidence_support": "Magnetic resonance imaging showed left cerebellopontine angle (CPA) mass suggestive of an epidermoid involving the Vth nerve and Gasserian ganglion and extending into the middle cranial fossa.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Tick infestation may lead to this symptom through neurotoxic effects [17408447, 21531525, 36109088].", "answer_sentence_relevance": "inappropriate", "citation_assessment": [ { "cited_pmid": "17408447", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "21531525", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "36109088", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Kawasaki Disease, although primarily affecting children, can also cause left-sided facial numbness due to its vasculitic nature [23423832].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23423832", "evidence_support": "Herein, the authors report an 8-mo-old infant who had left sided facial nerve palsy and multiple coronary aneurysms associated with KD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Bal\u00f3's concentric sclerosis, a rare demyelinating disease, can manifest with facial numbness [17549061].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17549061", "evidence_support": "A 37-year-old woman without important previous medical history presented to an emergency room with acute onset of left-sided weakness and numbness.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Leprosy, an infectious disease caused by Mycobacterium leprae, can damage peripheral nerves, leading to numbness [22669019].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22669019", "evidence_support": "Leprosy is an important cause of cranial nerve palsy in endemic areas where it may be seen in upto 17.6% patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Guillain-Barr\u00e9 syndrome, an autoimmune disorder, can cause facial numbness as part of its broader neurological impact [28966341, 35719795, 26823357].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28966341", "evidence_support": "A rare variant of Guillain-Barr\u00e9 syndrome (GBS) consists of facial diplegia and paresthesia, but an even more rare association is with facial hemiplegia, similar to Bell's palsy.", "evidence_relation": "supporting" }, { "cited_pmid": "35719795", "evidence_support": "The etiology of facial nerve palsy is diverse and includes herpes zoster virus, Guillain-Barre syndrome (GBS), otitis media, Lyme disease, sarcoidosis, human immunodeficiency virus, etc", "evidence_relation": "supporting" }, { "cited_pmid": "26823357", "evidence_support": "Unilateral facial nerve palsy is rarely encountered in Guillain-Barr\u00e9 syndrome (GBS).", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Melkersson-Rosenthal syndrome, characterized by recurrent facial swelling, can also present with numbness [16096940].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16096940", "evidence_support": "Melkersson-Rosenthal syndrome is a rare cause of recurrent facial nerve palsy.", "evidence_relation": "supporting" }, { "cited_pmid": "16096940", "evidence_support": "The syndrome is classically characterized by a triad of signs consisting of facial edema, recurrent peripheral facial nerve paralysis, and congenital fissured tongue, although it may also present in a mono- or oligosymptomatic form", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Cephalic tetanus, a rare form of tetanus, can affect cranial nerves, resulting in facial numbness [28108438, 34898510].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28108438", "evidence_support": "Cephalic tetanus is defined as a combination of trismus and paralysis of one or more cranial nerves", "evidence_relation": "supporting" }, { "cited_pmid": "28108438", "evidence_support": "Since it is a rare cause of facial nerve palsy, it is often overlooked as a differential diagnosis", "evidence_relation": "supporting" }, { "cited_pmid": "28108438", "evidence_support": "We present the case of a 75-year-old man admitted to our emergency department with left facial nerve palsy, left ptosis and dysphagia 2\u2005weeks after a head laceration", "evidence_relation": "neutral" }, { "cited_pmid": "34898510", "evidence_support": "Cephalic tetanus is a rare clinical form of tetanus, clinically characterized by trismus and cranial nerve palsy involving one or more cranial nerves, facial nerve being the most common", "evidence_relation": "supporting" }, { "cited_pmid": "34898510", "evidence_support": "We report a case of cephalic tetanus with left-sided lower motor facial nerve palsy in a 66-year-old non-immunized patient after an untreated laceration injury", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "9", "answer_sentence": "Temporal bone fractures may cause numbness due to direct trauma to facial nerves [17041546, 32086330].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17041546", "evidence_support": "The neurological and CT scan examination revealed fracture of the left temporal bone with total facial expression muscles paralysis. ", "evidence_relation": "supporting" }, { "cited_pmid": "32086330", "evidence_support": "Facial paralysis is a potentially disabling complication of temporal bone fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "32086330", "evidence_support": "CT of skull showed bilateral longitudinal temporal bone fractures. Bilateral facial palsy was confirmed by clinical and topodiagnostic tests.", "evidence_relation": "supporting" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Left-sided facial numbness can result from various etiologies, including vascular, neoplastic, congenital, infectious, and neurological causes.Vascular causes include aneurysms and vertebral artery dissections, which can compress the trigeminal nerve or brainstem, leading to sensory deficits [21614764, 24777086]. Neoplastic causes such as meningiomas, adenoid cystic carcinoma, and metastatic tumors can also compress cranial nerves or brain structures, resulting in facial numbness [30456043, 30005538, 31723507]. Congenital absence of the internal carotid artery can present similarly due to altered cerebral blood flow [16940363]. Infectious etiologies like herpes simplex virus and varicella-zoster virus reactivation can cause facial nerve inflammation and subsequent numbness [26991053, 21924743]. Neurological disorders such as CADASIL and Fahr's disease involve genetic mutations leading to cerebral infarcts or calcifications, respectively, which can manifest as facial numbness [37731412, 37927774]. Each of these conditions requires specific diagnostic and therapeutic approaches based on the underlying cause.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can result from various etiologies, including vascular, neoplastic, congenital, infectious, and neurological causes.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Vascular causes include aneurysms and vertebral artery dissections, which can compress the trigeminal nerve or brainstem, leading to sensory deficits [21614764, 24777086].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21614764", "evidence_support": "A 58-year-old female admitted herself to the emergency department with progressive left-sided facial hypoesthesia. Magnetic resonance imaging revealed a 20 mm-sized aneurysm of the left vertebral artery leading to compression of the trigeminal nerve.", "evidence_relation": "supporting" }, { "cited_pmid": "24777086", "evidence_support": "Third patient, presented with sudden onset of left facial numbness and right upper limb weakness; 1 day after, right arm and leg hypoesthesia with hoarseness. MRA revealed dissection of left distal vertebral artery and MRI showed infarction in lower medulla oblongata", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Neoplastic causes such as meningiomas, adenoid cystic carcinoma, and metastatic tumors can also compress cranial nerves or brain structures, resulting in facial numbness [30456043, 30005538, 31723507].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30456043", "evidence_support": "Magnetic resonance imaging (MRI) revealed a large homogenously enhancing lesion arising from the inferior surface of the tentorium toward the left cerebellopontine angle causing significant brainstem compression ( Fig. 1A and 1B ). The differential diagnoses for this lesion included meningioma and trigeminal nerve schwannoma.", "evidence_relation": "neutral" }, { "cited_pmid": "30005538", "evidence_support": "Our patient presented with left-sided facial numbness without other symptoms.", "evidence_relation": "neutral" }, { "cited_pmid": "30005538", "evidence_support": "Magnetic resonance imaging (MRI) of the brain revealed an enhancing lesion involving the left maxillary sinus with orbital invasion and posterior extension into the cavernous sinus", "evidence_relation": "neutral" }, { "cited_pmid": "31723507", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Congenital absence of the internal carotid artery can present similarly due to altered cerebral blood flow [16940363].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16940363", "evidence_support": "We report a case of congenital absence of the left internal carotid artery (ICA) that presented with left-sided facial numbness.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Infectious etiologies like herpes simplex virus and varicella-zoster virus reactivation can cause facial nerve inflammation and subsequent numbness [26991053, 21924743].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26991053", "evidence_support": "To our knowledge, this is the first ever reported documentation of relapsing-remitting facial and brachial plexus neuritis caused by HSV-1.", "evidence_relation": "supporting" }, { "cited_pmid": "21924743", "evidence_support": "Simultaneous reactivation of two alphaherpesviruses (HSV-1 and VZV) in our immunosuppressed patient underscores the need to consider opportunistic infection as a cause of facial weakness.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Neurological disorders such as CADASIL and Fahr's disease involve genetic mutations leading to cerebral infarcts or calcifications, respectively, which can manifest as facial numbness [37731412, 37927774].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37731412", "evidence_support": "Fahr's disease is a rare hereditary neurological disorder characterized by idiopathic basal ganglia and cerebral cortex calcifications. It presents a wide range of neurological manifestations, including motor dysfunction, sensory deficits, seizures, headaches, visual disturbances, and movement disorders. We present a case report of a 42-year-old female who presented to the accident and emergency department with a stroke alert. Her main symptom was left facial numbness", "evidence_relation": "supporting" }, { "cited_pmid": "37927774", "evidence_support": "CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is a hereditary cerebral arteriopathy caused by a neurogenic locus notch homolog protein 3 (NOTCH3) gene mutation. This article describes the case of a man in his early 40s who experienced sudden onset temporary left-sided weakness and facial numbness that resolved in two hours, along with residual weakness in the upper and lower limbs", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Each of these conditions requires specific diagnostic and therapeutic approaches based on the underlying cause.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Left-sided facial numbness can be caused by various conditions, including aneurysms of the vertebral artery cerebellopontine angle meningiomas congenital absence of the internal carotid artery and adenoid cystic carcinoma of the maxillary sinus [21614764, 30456043, 16940363]. It can also be a symptom of trigeminal neuralgia caused by compressive cervical radiculopathy cholesteatoma in the cerebellopontine angle-Meckel's cave and epidermoid tumors in the cerebellopontine angle [31274646, 33377403, 20066061]. Additionally, left-sided facial numbness can be a manifestation of rare conditions such as Fahr's disease cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and facial-onset sensory and motor neuronopathy (FOSMN) . Other possible causes include hydroxychloroquine overdose lung carcinoma metastasis and vertebral artery dissection [37731412, 37927774, 33504750].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by various conditions, including aneurysms of the vertebral artery cerebellopontine angle meningiomas congenital absence of the internal carotid artery and adenoid cystic carcinoma of the maxillary sinus [21614764, 30456043, 16940363].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21614764", "evidence_support": "Magnetic resonance imaging revealed a 20 mm-sized aneurysm of the left vertebral artery leading to compression of the trigeminal nerve.", "evidence_relation": "neutral" }, { "cited_pmid": "30456043", "evidence_support": "Magnetic resonance imaging (MRI) revealed a large homogenously enhancing lesion arising from the inferior surface of the tentorium toward the left cerebellopontine angle causing significant brainstem compression", "evidence_relation": "supporting" }, { "cited_pmid": "16940363", "evidence_support": "We report a case of congenital absence of the left internal carotid artery (ICA) that presented with left-sided facial numbness.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can also be a symptom of trigeminal neuralgia caused by compressive cervical radiculopathy cholesteatoma in the cerebellopontine angle-Meckel's cave and epidermoid tumors in the cerebellopontine angle [31274646, 33377403, 20066061].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31274646", "evidence_support": "We report 3 patients with classic trigeminal neuropathy (TN) findings, which were due to compressive cervical radiculopathy, and provide a brief anatomic explanation for this association", "evidence_relation": "supporting" }, { "cited_pmid": "33377403", "evidence_support": "We report a case of cholesteatoma that caused left facial pain with facial numbness. The tumour was located in the left cerebellopontine angle (CPA) and Meckel's cave", "evidence_relation": "supporting" }, { "cited_pmid": "20066061", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, left-sided facial numbness can be a manifestation of rare conditions such as Fahr's disease cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and facial-onset sensory and motor neuronopathy (FOSMN) .", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Other possible causes include hydroxychloroquine overdose lung carcinoma metastasis and vertebral artery dissection [37731412, 37927774, 33504750].", "answer_sentence_relevance": "inappropriate", "citation_assessment": [ { "cited_pmid": "37731412", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "37927774", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "33504750", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "Left-sided facial numbness can be caused by various factors, including idiopathic peripheral facial palsy, also known as Bell's palsy, which is the most common cause of facial nerve palsy [32445717, 24053080, 37079301]. Other causes include systemic viral infections, trauma, surgery, diabetes, local infections, tumors, immune disorders, and degenerative diseases of the central nervous system [33025045, 24053080, 22190798]. Additionally, facial nerve palsy can be caused by reactivation of Varicella Zoster Virus, Lyme disease, otogenic factors, and post-surgery complications [23891413, 20052641, 33025045]. In some cases, facial numbness can be a symptom of a more serious condition, such as a stroke, intracranial hemorrhage, subarachnoid hemorrhage, brain tumor, central nervous system infection, Guillain-Barr\u00e9 syndrome, or Lyme disease [23891413, 33025045]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by various factors, including idiopathic peripheral facial palsy, also known as Bell's palsy, which is the most common cause of facial nerve palsy [32445717, 24053080, 37079301].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32445717", "evidence_support": "Facial paralysis is the most common cranial nerve paralysis and the majority of these are idiopathic. Idiopathic facial nerve paralysis, or Bell palsy, typically presents acutely, affects the entire face, may be associated with hyperacusis, a decrease in lacrimation, salivation, or dysgeusia, and typically resolves spontaneously.", "evidence_relation": "supporting" }, { "cited_pmid": "24053080", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "37079301", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Other causes include systemic viral infections, trauma, surgery, diabetes, local infections, tumors, immune disorders, and degenerative diseases of the central nervous system [33025045, 24053080, 22190798].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33025045", "evidence_support": "The most frequent reason for a non-idiopathic peripheral FP was a reactivation of Varicella Zoster Virus (VZV; 36.4%). Traumatic origin had a higher proportion of complete FP (52.9%).", "evidence_relation": "supporting" }, { "cited_pmid": "33025045", "evidence_support": "Infectious causes for non-idiopathic FP like VZV reactivation and Lyme disease had best probability for complete recovery. Post-surgery FP had a worse prognosis.", "evidence_relation": "neutral" }, { "cited_pmid": "24053080", "evidence_support": "The most frequent causes of secondary peripheral facial weakness are systemic viral infections, trauma, surgery, diabetes, local infections, tumor, immune disorders, drugs, degenerative diseases of the central nervous system, etc. ", "evidence_relation": "supporting" }, { "cited_pmid": "22190798", "evidence_support": "Possible factors that are involved in the pathogenesis include disturbance of fat metabolism, trauma, viral infections, heredity, endocrine disturbances and auto-immunity.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, facial nerve palsy can be caused by reactivation of Varicella Zoster Virus, Lyme disease, otogenic factors, and post-surgery complications [23891413, 20052641, 33025045].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20052641", "evidence_support": "Ramsay Hunt syndrome (RHS) is defined as a peripheral facial nerve palsy accompanied by an erythematous vesicular rash on the ear (zoster oticus) and hard palate. It is known that varicella zoster virus (VZV) causes RHS.", "evidence_relation": "supporting" }, { "cited_pmid": "33025045", "evidence_support": "The most frequent reason for a non-idiopathic peripheral FP was a reactivation of Varicella Zoster Virus (VZV; 36.4%).", "evidence_relation": "supporting" }, { "cited_pmid": "33025045", "evidence_support": "Infectious causes for non-idiopathic FP like VZV reactivation and Lyme disease had best probability for complete recovery. Post-surgery FP had a worse prognosis.", "evidence_relation": "neutral" }, { "cited_pmid": "23891413", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In some cases, facial numbness can be a symptom of a more serious condition, such as a stroke, intracranial hemorrhage, subarachnoid hemorrhage, brain tumor, central nervous system infection, Guillain-Barr\u00e9 syndrome, or Lyme disease [23891413, 33025045].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23891413", "evidence_support": "Our outcome was one of the following diagnoses made within 90 days of the index ED visit: stroke, intracranial hemorrhage, subarachnoid hemorrhage, brain tumor, central nervous system infection, Guillain-Barr\u00e9 syndrome, Lyme disease, otitis media/mastoiditis, or herpes zoster.", "evidence_relation": "supporting" }, { "cited_pmid": "33025045", "evidence_support": "Infectious causes for non-idiopathic FP like VZV reactivation and Lyme disease had best probability for complete recovery. Post-surgery FP had a worse prognosis", "evidence_relation": "neutral" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Left-sided facial numbness can be caused by various conditions, including a 1.6 cm irregular enhancing mass in the left middle cerebellar peduncle, compressive cervical radiculopathy, Bell's palsy, lateral medullary syndrome, thalamic infarction, multiple sclerosis, metastatic disease, and aneurysm of the vertebral artery [16264857, 31274646, 36268328]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by various conditions, including a 1.6 cm irregular enhancing mass in the left middle cerebellar peduncle, compressive cervical radiculopathy, Bell's palsy, lateral medullary syndrome, thalamic infarction, multiple sclerosis, metastatic disease, and aneurysm of the vertebral artery [16264857, 31274646, 36268328].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16264857", "evidence_support": "Cranial MRI revealed a 1.6 cm irregular enhancing mass in the left middle cerebellar peduncle. Neurologic examination was significant for diminished sensation over the left face to pinprick, left-sided dysmetria, and mild lateral instability of the trunk while walking.", "evidence_relation": "supporting" }, { "cited_pmid": "36268328", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "31274646", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Left-sided facial numbness can be caused by various conditions, including neoplastic pathology, infection, and compression of the trigeminal nerve [21628435, 16264857, 18280947]. It can also be a symptom of a more serious underlying condition such as multiple sclerosis, malignancy, or a stroke [18280947, 36268328, 31783736]. Additionally, it can be a manifestation of lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by a stroke in the lateral part of the medulla oblongata [16400410, 26350694, 36268328]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by various conditions, including neoplastic pathology, infection, and compression of the trigeminal nerve [21628435, 16264857, 18280947].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21628435", "evidence_support": "The appearance of numbness, even when pain continues to be the most pressing complaint, necessitates clinical assessment of the integrity of all aspects of the trigeminal pathways, which may also include neurophysiologic, radiographic, and laboratory evaluation.", "evidence_relation": "supporting" }, { "cited_pmid": "18280947", "evidence_support": "It may be a nonmetastatic neurological manifestation of malignancy, often with no clinically visible pathology. ", "evidence_relation": "neutral" }, { "cited_pmid": "16264857", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can also be a symptom of a more serious underlying condition such as multiple sclerosis, malignancy, or a stroke [18280947, 36268328, 31783736].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18280947", "evidence_support": "It may be a nonmetastatic neurological manifestation of malignancy, often with no clinically visible pathology.", "evidence_relation": "supporting" }, { "cited_pmid": "31783736", "evidence_support": "Benign and malignant diseases are known to cause this circumscribed symptom, which can easily be overlooked or misdiagnosed.", "evidence_relation": "supporting" }, { "cited_pmid": "31783736", "evidence_support": "Various diseases may be responsible for NCS, including malignancies or even central neurological disorders such as multiple sclerosis.", "evidence_relation": "supporting" }, { "cited_pmid": "36268328", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, it can be a manifestation of lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by a stroke in the lateral part of the medulla oblongata [16400410, 26350694, 36268328].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16400410", "evidence_support": "In cases with exclusive ipsilateral facial sensory abnormalities, infarcts affected lateral and posterior bulbar portions, with slight or no medial extension", "evidence_relation": "neutral" }, { "cited_pmid": "16400410", "evidence_support": "The only patient who presented bilateral facial symptoms had an infarct that covered both medial and lateral, in addition to the posterior region of the medulla", "evidence_relation": "supporting" }, { "cited_pmid": "26350694", "evidence_support": "Various sensory impairments have been reported in patients with lateral medullary syndrome, also known as Wallenberg syndrome. The typical sensory impairments experienced by patients with this condition are ipsilateral facial and contralateral trunk and limb thermal hypesthesia and hypoalgesia. Tactile (light touch) sensation is not generally diminis", "evidence_relation": "supporting" }, { "cited_pmid": "36268328", "evidence_support": "Lateral medullary syndrome (LMS) is the most common and severe neurological syndrome associated with atherothrombotic occlusion of the intracranial vertebral artery, followed by posterior inferior cerebellar artery and medullary artery occlusion.", "evidence_relation": "supporting" }, { "cited_pmid": "36268328", "evidence_support": "In LMS, the upper motor neuron facial palsy is caused by the involvement of aberrant supranuclear fibers of the facial nerv", "evidence_relation": "neutral" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Left-sided facial numbness can be caused by various conditions, including neoplastic pathology, infection, and compression of the trigeminal nerve [21628435, 17305614, 34156205]. It can also be a symptom of a more serious underlying condition such as multiple sclerosis, malignancy, or a stroke [19800798, 36186832, 23917097]. In some cases, it can be caused by a lacunar infarction, which is a common cause of the Cheiro-Oral Syndrome [16720226]. Additionally, it can be a manifestation of lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by a stroke in the lateral part of the medulla oblongata [35698705, 16400410, 16133717]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by various conditions, including neoplastic pathology, infection, and compression of the trigeminal nerve [21628435, 17305614, 34156205].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21628435", "evidence_support": "Facial or intraoral numbness, the hallmark of trigeminal neuropathy, may represent the earliest symptomology of malignancy or autoimmune connective tissue disease as sensory neurons are destroyed. Such numbness, especially if progressive, necessitates periodic evaluation and vigilance even years after presentation if no diagnosis can be made.", "evidence_relation": "supporting" }, { "cited_pmid": "21628435", "evidence_support": "In the routine evaluation of patients with facial pain, the clinician will inevitably be confronted with secondary pathology of the trigeminal nerves and nuclei. The appearance of numbness, even when pain continues to be the most pressing complaint, necessitates clinical assessment of the integrity of all aspects of the trigeminal pathways, which may also include neurophysiologic, radiographic, and laboratory evaluation.", "evidence_relation": "supporting" }, { "cited_pmid": "34156205", "evidence_support": "Tumor-induced brainstem and trigeminal nerve compression was found in 115 cases. Sixty-four of these patients had trigeminal radiculopathy symptoms. Degree of brainstem compression was significantly higher in trigeminal radiculopathy group. Facial hypoesthesia was found in 61patients, trigeminal neuralgia - in 5 cases, neuropathic pain - in 3 patients. Thirty-seven patients without brainstem compression had no trigeminal nerve involvement. ", "evidence_relation": "supporting" }, { "cited_pmid": "34156205", "evidence_support": "Trigeminal radiculopathy is caused by severe brainstem compression following vestibular schwannomas and usually results sensory disturbances and rarely facial pain. ", "evidence_relation": "supporting" }, { "cited_pmid": "17305614", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can also be a symptom of a more serious underlying condition such as multiple sclerosis, malignancy, or a stroke [19800798, 36186832, 23917097].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "19800798", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "36186832", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "23917097", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In some cases, it can be caused by a lacunar infarction, which is a common cause of the Cheiro-Oral Syndrome [16720226].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16720226", "evidence_support": "Cheiro-oral-pedal syndrome is characterized by specific sensory disturbance around the corner of the mouth, in the hand and in the foot on the same side.", "evidence_relation": "supporting" }, { "cited_pmid": "16720226", "evidence_support": "Cheiro-oral-pedal syndrome is caused by lacunar infarction in majority of the cases", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, it can be a manifestation of lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by a stroke in the lateral part of the medulla oblongata [35698705, 16400410, 16133717].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35698705", "evidence_support": "Lateral medullary syndrome (LMS), also known as Wallenberg syndrome, is a cerebrovascular event following ischemia of the lateral part of the medulla oblongata.", "evidence_relation": "supporting" }, { "cited_pmid": "16133717", "evidence_support": "The dorso-lateral medullary syndrome (Wallenberg's syndrome) is produced by infarction of a wedge of lateral medulla posterior to the inferior olivary nucleus and is usually caused by vertebral artery occlusion.", "evidence_relation": "supporting" }, { "cited_pmid": "16400410", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Left-sided facial numbness can be caused by various conditions, including neoplastic pathology, infection, and compression of the trigeminal nerve [21628435, 34156205, 17305614]. It can also be a symptom of a more serious underlying condition such as multiple sclerosis, malignancy, or a stroke [31783736, 18280947, 19800798]. Additionally, it can be a manifestation of lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by a stroke in the lateral part of the medulla oblongata [16133717, 29404361, 35698705]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by various conditions, including neoplastic pathology, infection, and compression of the trigeminal nerve [21628435, 34156205, 17305614].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21628435", "evidence_support": "The appearance of numbness, even when pain continues to be the most pressing complaint, necessitates clinical assessment of the integrity of all aspects of the trigeminal pathways, which may also include neurophysiologic, radiographic, and laboratory evaluation.", "evidence_relation": "supporting" }, { "cited_pmid": "34156205", "evidence_support": "Trigeminal radiculopathy is caused by severe brainstem compression following vestibular schwannomas and usually results sensory disturbances and rarely facial pain.", "evidence_relation": "neutral" }, { "cited_pmid": "17305614", "evidence_support": "TNs always pose differential location difficulties as multiple diseases are capable of producing them: they can be the result of traumatism, tumors, or diseases of the connective tissue, infectious or demyelinating diseases, or may be of idiopathic origin.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can also be a symptom of a more serious underlying condition such as multiple sclerosis, malignancy, or a stroke [31783736, 18280947, 19800798].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31783736", "evidence_support": "Benign and malignant diseases are known to cause this circumscribed symptom, which can easily be overlooked or misdiagnosed.", "evidence_relation": "supporting" }, { "cited_pmid": "31783736", "evidence_support": "In this case report we introduce a patient who clinically shows an NCS. Various diseases may be responsible for NCS, including malignancies or even central neurological disorders such as multiple sclerosis. ", "evidence_relation": "supporting" }, { "cited_pmid": "18280947", "evidence_support": "Numb chin syndrome, sometimes called numb lip syndrome, is an uncommon but well-recognized symptom in medical oncolog", "evidence_relation": "neutral" }, { "cited_pmid": "18280947", "evidence_support": "It may be a nonmetastatic neurological manifestation of malignancy, often with no clinically visible pathology.", "evidence_relation": "neutral" }, { "cited_pmid": "19800798", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, it can be a manifestation of lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by a stroke in the lateral part of the medulla oblongata [16133717, 29404361, 35698705].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16133717", "evidence_support": "The dorso-lateral medullary syndrome (Wallenberg's syndrome) is produced by infarction of a wedge of lateral medulla posterior to the inferior olivary nucleus and is usually caused by vertebral artery occlusion.", "evidence_relation": "supporting" }, { "cited_pmid": "29404361", "evidence_support": "Lateral medullary syndrome (LMS), also known as Wallenberg's syndrome, PICA syndrome, results from occlusion of the posterior inferior cerebellar artery, with associated infarction of parts of medulla oblongata, and cerebellum on the ipsilateral side.", "evidence_relation": "supporting" }, { "cited_pmid": "35698705", "evidence_support": "Lateral medullary syndrome (LMS), also known as Wallenberg syndrome, is a cerebrovascular event following ischemia of the lateral part of the medulla oblongata. ", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Left-sided facial numbness can be caused by various conditions, including neoplastic pathology, infection, and compression of the trigeminal nerve [34156205, 21628435, 17305614]. It can also be a symptom of a more serious underlying condition such as multiple sclerosis, malignancy, or a stroke [18280947, 19800798, 31783736]. In some cases, it can be caused by a lacunar thalamic infarction, which is a rare variant of the Cheiro-Oral Syndrome [31417832]. Additionally, it can be a manifestation of lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by a stroke in the lateral part of the medulla oblongata [16400410, 29404361, 16133717]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by various conditions, including neoplastic pathology, infection, and compression of the trigeminal nerve [34156205, 21628435, 17305614].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21628435", "evidence_support": "Facial or intraoral numbness, the hallmark of trigeminal neuropathy, may represent the earliest symptomology of malignancy or autoimmune connective tissue disease as sensory neurons are destroyed", "evidence_relation": "supporting" }, { "cited_pmid": "17305614", "evidence_support": "Facial numbness indicates trigeminal sensory alteration affecting the trigeminal system", "evidence_relation": "supporting" }, { "cited_pmid": "34156205", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can also be a symptom of a more serious underlying condition such as multiple sclerosis, malignancy, or a stroke [18280947, 19800798, 31783736].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "31783736", "evidence_support": "Various diseases may be responsible for NCS, including malignancies or even central neurological disorders such as multiple sclerosis. A lacunar thalamic ischemia as a cause of NCS is very rare and to our knowledge described in the literature only in the contex of a COS in three cases. ", "evidence_relation": "neutral" }, { "cited_pmid": "18280947", "evidence_support": "We urge all general dentists, oral medicine specialists, and oral and maxillofacial surgeons to consider metastatic cancer in patients with unexplained facial hypoesthesia.", "evidence_relation": "neutral" }, { "cited_pmid": "19800798", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In some cases, it can be caused by a lacunar thalamic infarction, which is a rare variant of the Cheiro-Oral Syndrome [31417832].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31417832", "evidence_support": "We report a patient who presented with cheiro-oral syndrome (COS) with\u00a0left sided perioral,\u00a0thumb, and\u00a0thenar\u00a0numbness\u00a0after an acute lacunar infarct of the right thalamus.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, it can be a manifestation of lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by a stroke in the lateral part of the medulla oblongata [16400410, 29404361, 16133717].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29404361", "evidence_support": "Lateral medullary syndrome (LMS), also known as Wallenberg's syndrome, PICA syndrome, results from occlusion of the posterior inferior cerebellar artery, with associated infarction of parts of medulla oblongata, and cerebellum on the ipsilateral side.", "evidence_relation": "supporting" }, { "cited_pmid": "16400410", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16133717", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Left-sided facial numbness can be caused by various conditions, including neoplastic pathology, infection, and compression of the trigeminal nerve [31471563, 16264857]. It can also be a symptom of a more serious underlying condition such as multiple sclerosis, malignancy, or a stroke [35957787]. In some cases, it can be caused by a lacunar thalamic infarction, which is a rare variant of the Cheiro-Oral Syndrome [16521819, 28490287]. Additionally, it can be a manifestation of lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by a stroke in the lateral part of the medulla oblongata [24626124]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by various conditions, including neoplastic pathology, infection, and compression of the trigeminal nerve [31471563, 16264857].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31471563", "evidence_support": "The most common cause was neoplastic pathology (n\u2009=\u200910, 71%), with perineural spread from squamous cell carcinoma being the most common (five cases, 36%). The remaining cases were related to infection (n\u2009=\u20094, 29%).", "evidence_relation": "supporting" }, { "cited_pmid": "16264857", "evidence_support": " A 37-year-old Brazilian man was admitted to Massachusetts General Hospital for evaluation of left-sided facial numbness, left-sided ataxia, dizziness, and vertigo. Seven weeks prior to admission, he reported numbness of the left oral cavity and tongue after a dental procedure. Three weeks prior to presentation, he developed left-sided incoordination with dizziness and vertigo.", "evidence_relation": "supporting" }, { "cited_pmid": "16264857", "evidence_support": "A CT scan without contrast revealed no abnormalities and he was discharged home.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can also be a symptom of a more serious underlying condition such as multiple sclerosis, malignancy, or a stroke [35957787].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35957787", "evidence_support": "Multiple sclerosis is a disease that affects the central nervous system, resulting in various symptoms such as vision, physical activity, and stability", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In some cases, it can be caused by a lacunar thalamic infarction, which is a rare variant of the Cheiro-Oral Syndrome [16521819, 28490287].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28490287", "evidence_support": "Neuroimaging showed an acute right thalamic lacunar infarct consistent with the diagnosis of cheiro-oral syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "16521819", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, it can be a manifestation of lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by a stroke in the lateral part of the medulla oblongata [24626124].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24626124", "evidence_support": "Patients with lateral medullary syndrome classically present with crossed hemisensory disturbance, ipsilateral Horner syndrome, and cerebellar signs, all of which are attributable to infarction of the lateral medulla.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Left-sided facial numbness can be caused by various conditions, including neoplastic pathology, infection, and compression of the trigeminal nerve [31471563]. It can also be a symptom of a more serious underlying condition such as arteriovenous malformations, carotid stenosis, dissection or aneurysm, brain infarctions, meningioma, and various intra-axial tumors [34254302]. In some cases, it can be caused by a lacunar thalamic infarction, which is a rare variant of the Cheiro-Oral Syndrome [33039224]. Additionally, it can be a manifestation of lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by an infarct in the territory of the posterior inferior cerebellar artery [32539005]. This is a result of a stroke in that area [32539005]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by various conditions, including neoplastic pathology, infection, and compression of the trigeminal nerve [31471563].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31471563", "evidence_support": "The most common cause was neoplastic pathology (n\u2009=\u200910, 71%), with perineural spread from squamous cell carcinoma being the most common (five cases, 36%). The remaining cases were related to infection (n\u2009=\u20094, 29%).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can also be a symptom of a more serious underlying condition such as arteriovenous malformations, carotid stenosis, dissection or aneurysm, brain infarctions, meningioma, and various intra-axial tumors [34254302].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "34254302", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In some cases, it can be caused by a lacunar thalamic infarction, which is a rare variant of the Cheiro-Oral Syndrome [33039224].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33039224", "evidence_support": "The Cheiro-Oral (COS) Syndrome is a rare neurologic condition characterized by sensory disturbances involving the peri-oral area and the upper extremity, typically isolated to the hand or fingers.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, it can be a manifestation of lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by an infarct in the territory of the posterior inferior cerebellar artery [32539005].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32539005", "evidence_support": "Wallenberg syndrome, or lateral medullar syndrome, is the clinical presentation of the infarct in the territory of posterior inferior cerebellar artery.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "This is a result of a stroke in that area [32539005].", "answer_sentence_relevance": "inappropriate", "citation_assessment": [ { "cited_pmid": "32539005", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Left-sided facial numbness can be caused by various conditions, including neoplastic pathology, infection, and compression of the trigeminal nerve [16264857, 31471563, 18280947]. It can also be a symptom of a more serious underlying condition such as multiple sclerosis, malignancy, stroke, cervical artery dissection, rupture of a normal spleen, or other conditions that can cause cough-induced complications affecting various systems of the body [32007456, 30963343]. In some cases, Cheiro-Oral Syndrome can be caused by a lacunar thalamic infarction [33039224, 23269103]. Additionally, it can be a manifestation of lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by a stroke in the lateral part of the medulla oblongata [24626124, 35925455, 36923779]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by various conditions, including neoplastic pathology, infection, and compression of the trigeminal nerve [16264857, 31471563, 18280947].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31471563", "evidence_support": "The most common cause was neoplastic pathology (n\u2009=\u200910, 71%), with perineural spread from squamous cell carcinoma being the most common (five cases, 36%). The remaining cases were related to infection (n\u2009=\u20094, 29%).", "evidence_relation": "supporting" }, { "cited_pmid": "31471563", "evidence_support": "Given the poor prognosis of the patients in our case series, numbness of the face may be a portentous sign and therefore warrants a thorough examination with close follow up.", "evidence_relation": "neutral" }, { "cited_pmid": "16264857", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18280947", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can also be a symptom of a more serious underlying condition such as multiple sclerosis, malignancy, stroke, cervical artery dissection, rupture of a normal spleen, or other conditions that can cause cough-induced complications affecting various systems of the body [32007456, 30963343].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32007456", "evidence_support": "An exhaustive systematic review of the English literature revealed an exceedingly large and varied spectrum of cough-induced complications affecting many systems, including upper airways, chest wall and thorax, abdominal wall, heart and aorta, central nervous system, eye, gastrointestinal tract, urogenital system, and emotional and psychological harm.", "evidence_relation": "supporting" }, { "cited_pmid": "32007456", "evidence_support": "Reported cough-induced pathology ranges from rare (the majority) to common and from trivial (eg, lightheadedness, subconjunctival hemorrhage) to severe and life-threatening (eg, cervical artery dissection, rupture of a normal spleen).", "evidence_relation": "supporting" }, { "cited_pmid": "30963343", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In some cases, Cheiro-Oral Syndrome can be caused by a lacunar thalamic infarction [33039224, 23269103].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "33039224", "evidence_support": "The Cheiro-Oral (COS) Syndrome is a rare neurologic condition characterized by sensory disturbances involving the peri-oral area and the upper extremity, typically isolated to the hand or fingers. The thalamus contralateral to the symptomatic side is the brain region most commonly involved. Most cases are caused by ischemic or hemorrhagic strokes, although other structural lesions have been implicate", "evidence_relation": "supporting" }, { "cited_pmid": "23269103", "evidence_support": "Here we report a case of a 55-year-old man presenting with the clinical findings of Cheiro-Oral syndrome, a pure sensory thalamic lacunar syndrome that clinically presents with contralateral sensory deficits of the fingers and hemimouth.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, it can be a manifestation of lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by a stroke in the lateral part of the medulla oblongata [24626124, 35925455, 36923779].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24626124", "evidence_support": "Patients with lateral medullary syndrome classically present with crossed hemisensory disturbance, ipsilateral Horner syndrome, and cerebellar signs, all of which are attributable to infarction of the lateral medulla.", "evidence_relation": "supporting" }, { "cited_pmid": "35925455", "evidence_support": "Lateral medullary syndrome (LMS) is an ischemic stroke of the medulla oblongata that involves the territory of the posterior inferior cerebellar artery.", "evidence_relation": "supporting" }, { "cited_pmid": "36923779", "evidence_support": "LMS (Wallenberg syndrome) is one of the brainstem stroke syndromes caused by occlusion of PICA. ", "evidence_relation": "neutral" }, { "cited_pmid": "36923779", "evidence_support": "LMS is a rare form of brainstem stroke and carries a favorable prognosis if early hospitalization and treatment is applied.", "evidence_relation": "neutral" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Left-sided facial numbness can be caused by various conditions, including neoplastic pathology, infection, and compression of the trigeminal nerve [27657317, 31471563, 16264857]. It can also be a symptom of a more serious underlying condition such as respiratory diseases, heart diseases, anxiety, depression, or obesity [34610625]. In some cases, Cheiro-Oral Syndrome can be caused by a lacunar infarction in the posterior limb of the internal capsule adjacent to and minimally involving thalamus [23269103, 30636764, 28490287, 16521819]. Additionally, it can be a manifestation of lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by a stroke in the lateral part of the medulla oblongata [24626124]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by various conditions, including neoplastic pathology, infection, and compression of the trigeminal nerve [27657317, 31471563, 16264857].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27657317", "evidence_support": "We conclude that gradual-onset facial paralysis or twitching may occur as a result of a neoplastic invasion of the facial nerve along its course from the cerebellopontine angle to the parotid gland.", "evidence_relation": "supporting" }, { "cited_pmid": "31471563", "evidence_support": "The most common cause was neoplastic pathology (n\u2009=\u200910, 71%), with perineural spread from squamous cell carcinoma being the most common (five cases, 36%). The remaining cases were related to infection (n\u2009=\u20094, 29%).", "evidence_relation": "supporting" }, { "cited_pmid": "16264857", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can also be a symptom of a more serious underlying condition such as respiratory diseases, heart diseases, anxiety, depression, or obesity [34610625].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "34610625", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In some cases, Cheiro-Oral Syndrome can be caused by a lacunar infarction in the posterior limb of the internal capsule adjacent to and minimally involving thalamus [23269103, 30636764, 28490287, 16521819].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23269103", "evidence_support": "Here we report a case of a 55-year-old man presenting with the clinical findings of Cheiro-Oral syndrome, a pure sensory thalamic lacunar syndrome that clinically presents with contralateral sensory deficits of the fingers and hemimouth", "evidence_relation": "supporting" }, { "cited_pmid": "30636764", "evidence_support": "MRI revealed subacute infarct in the posterior limb of right internal capsule adjacent to and minimally involving thalamus. He was diagnosed as CheiroOral Syndrome as a result of ischemic stroke and managed.", "evidence_relation": "supporting" }, { "cited_pmid": "28490287", "evidence_support": "Neuroimaging showed an acute right thalamic lacunar infarct consistent with the diagnosis of cheiro-oral syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "16521819", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, it can be a manifestation of lateral medullary syndrome, also known as Wallenberg syndrome, which is caused by a stroke in the lateral part of the medulla oblongata [24626124].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24626124", "evidence_support": "Patients with lateral medullary syndrome classically present with crossed hemisensory disturbance, ipsilateral Horner syndrome, and cerebellar signs, all of which are attributable to infarction of the lateral medulla", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Left-sided facial numbness can result from various etiologies, including neoplastic, vascular, infectious, and congenital causes.Neoplastic conditions such as cerebellopontine angle meningiomas and metastatic adenocarcinomas can compress cranial nerves, leading to facial numbness [30456043, 31723507]. Vascular causes include aneurysms of the vertebral artery compressing the trigeminal nerve and CADASIL, a hereditary arteriopathy causing subcortical infarcts [21614764, 37927774]. Infectious etiologies like herpes simplex virus (HSV) and varicella-zoster virus (VZV) reactivation can cause facial nerve inflammation and numbness [26991053, 21924743]. Congenital absence of the internal carotid artery can also present with facial numbness due to altered cerebral hemodynamics [16940363]. Additionally, systemic conditions such as Fahr's disease, characterized by basal ganglia calcifications, and autoimmune diseases like systemic lupus erythematosus can manifest with facial sensory deficits [37731412, 23978499]. Each of these conditions requires specific diagnostic and therapeutic approaches based on the underlying pathology.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can result from various etiologies, including neoplastic, vascular, infectious, and congenital causes.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Neoplastic conditions such as cerebellopontine angle meningiomas and metastatic adenocarcinomas can compress cranial nerves, leading to facial numbness [30456043, 31723507].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30456043", "evidence_support": "This video depicts the case of an 81-year-old man who presented with a 3-month history of left-sided facial numbness and gait imbalance", "evidence_relation": "neutral" }, { "cited_pmid": "30456043", "evidence_support": "On examination, he had gait ataxia and decreased left facial sensation in the V2 and V3 distribution", "evidence_relation": "neutral" }, { "cited_pmid": "30456043", "evidence_support": "Magnetic resonance imaging (MRI) revealed a large homogenously enhancing lesion arising from the inferior surface of the tentorium toward the left cerebellopontine angle causing significant brainstem compression ( Fig. 1A and 1B ). The differential diagnoses for this lesion included meningioma and trigeminal nerve schwannoma.", "evidence_relation": "supporting" }, { "cited_pmid": "30456043", "evidence_support": "Histopathological examination of the lesion revealed a World Health Organization (WHO) grade I meningioma", "evidence_relation": "neutral" }, { "cited_pmid": "31723507", "evidence_support": "In 2017, the patient came in with facial neuropathy, shooting pains, sinus headaches, eyelid concerns, and active tumoral activity was detected in the middle cranial fossa, involving parotid glands and the vertebral column", "evidence_relation": "neutral" }, { "cited_pmid": "31723507", "evidence_support": "Craniotomy revealed a metastatic poorly differentiated adenocarcinoma that extended through foramen ovale and rotundum to the infratemporal fossa and caused left-sided facial paralysis, hearing loss and numbness in CN V2 - V3 distribution.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Vascular causes include aneurysms of the vertebral artery compressing the trigeminal nerve and CADASIL, a hereditary arteriopathy causing subcortical infarcts [21614764, 37927774].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21614764", "evidence_support": "Magnetic resonance imaging revealed a 20 mm-sized aneurysm of the left vertebral artery leading to compression of the trigeminal nerve.", "evidence_relation": "supporting" }, { "cited_pmid": "37927774", "evidence_support": "CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is a hereditary cerebral arteriopathy caused by a neurogenic locus notch homolog protein 3 (NOTCH3) gene mutation.", "evidence_relation": "supporting" }, { "cited_pmid": "37927774", "evidence_support": "Based on his clinical presentation, strong family history, and brain MRI findings, a diagnosis of CADASIL was suspected.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Infectious etiologies like herpes simplex virus (HSV) and varicella-zoster virus (VZV) reactivation can cause facial nerve inflammation and numbness [26991053, 21924743].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26991053", "evidence_support": "To our knowledge, this is the first ever reported documentation of relapsing-remitting facial and brachial plexus neuritis caused by HSV-1.", "evidence_relation": "supporting" }, { "cited_pmid": "21924743", "evidence_support": "Simultaneous reactivation of two alphaherpesviruses (HSV-1 and VZV) in our immunosuppressed patient underscores the need to consider opportunistic infection as a cause of facial weakness.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Congenital absence of the internal carotid artery can also present with facial numbness due to altered cerebral hemodynamics [16940363].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16940363", "evidence_support": "We report a case of congenital absence of the left internal carotid artery (ICA) that presented with left-sided facial numbness.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Additionally, systemic conditions such as Fahr's disease, characterized by basal ganglia calcifications, and autoimmune diseases like systemic lupus erythematosus can manifest with facial sensory deficits [37731412, 23978499].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37731412", "evidence_support": "Fahr's disease is a rare hereditary neurological disorder characterized by idiopathic basal ganglia and cerebral cortex calcifications. It presents a wide range of neurological manifestations, including motor dysfunction, sensory deficits, seizures, headaches, visual disturbances, and movement disorders.", "evidence_relation": "supporting" }, { "cited_pmid": "23978499", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Each of these conditions requires specific diagnostic and therapeutic approaches based on the underlying pathology.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Left-sided facial numbness can result from various etiologies, including neurological, vascular, and infectious causes.Common neurological causes include trigeminal neuralgia, multiple sclerosis, and Bell's palsy, which can affect the facial nerve or its central connections.Vascular events such as transient ischemic attacks (TIAs) or strokes can also lead to unilateral facial numbness, often accompanied by other neurological deficits.Infections like herpes zoster (shingles) can cause numbness if the trigeminal nerve is involved.Additionally, structural lesions such as tumors or cysts in the brain or along the nerve pathways can compress neural structures, leading to sensory disturbances.Less commonly, systemic conditions like diabetes or vitamin deficiencies can contribute to neuropathy, manifesting as facial numbness.Accurate diagnosis typically requires a thorough clinical evaluation, including imaging and laboratory tests, to identify the underlying cause and guide appropriate treatment.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can result from various etiologies, including neurological, vascular, and infectious causes.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Common neurological causes include trigeminal neuralgia, multiple sclerosis, and Bell's palsy, which can affect the facial nerve or its central connections.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Vascular events such as transient ischemic attacks (TIAs) or strokes can also lead to unilateral facial numbness, often accompanied by other neurological deficits.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Infections like herpes zoster (shingles) can cause numbness if the trigeminal nerve is involved.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, structural lesions such as tumors or cysts in the brain or along the nerve pathways can compress neural structures, leading to sensory disturbances.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Less commonly, systemic conditions like diabetes or vitamin deficiencies can contribute to neuropathy, manifesting as facial numbness.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "Accurate diagnosis typically requires a thorough clinical evaluation, including imaging and laboratory tests, to identify the underlying cause and guide appropriate treatment.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Left-sided facial numbness can be caused by various conditions, including cerebellopontine angle tumors, such as meningiomas or epidermoids which can compress the trigeminal nerve, leading to numbness in the face [30456043, 20066061]. Other possible causes include aneurysms of the vertebral artery congenital absence of the internal carotid artery and metastatic disease, such as breast cancer [21614764, 16940363]. Additionally, facial numbness can be a symptom of neurological disorders, such as Fahr's disease cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and multiple sclerosis [37731412, 37927774]. In some cases, facial numbness can also be caused by viral infections, such as herpes simplex virus (HSV) or varicella zoster virus [21924743].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by various conditions, including cerebellopontine angle tumors, such as meningiomas or epidermoids which can compress the trigeminal nerve, leading to numbness in the face [30456043, 20066061].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30456043", "evidence_support": "This video depicts the case of an 81-year-old man who presented with a 3-month history of left-sided facial numbness and gait imbalance. On examination, he had gait ataxia and decreased left facial sensation in the V2 and V3 distribution. Magnetic resonance imaging (MRI) revealed a large homogenously enhancing lesion arising from the inferior surface of the tentorium toward the left cerebellopontine angle causing significant brainstem compression ( Fig. 1A and 1B ). The differential diagnoses for this lesion included meningioma and trigeminal nerve schwannoma", "evidence_relation": "supporting" }, { "cited_pmid": "20066061", "evidence_support": "Magnetic resonance imaging showed left cerebellopontine angle (CPA) mass suggestive of an epidermoid involving the Vth nerve and Gasserian ganglion and extending into the middle cranial fossa.", "evidence_relation": "supporting" }, { "cited_pmid": "20066061", "evidence_support": "TN caused by cerebellopontine angle epidermoids is uncommon and should be kept in view in all cases presenting with TN. ", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Other possible causes include aneurysms of the vertebral artery congenital absence of the internal carotid artery and metastatic disease, such as breast cancer [21614764, 16940363].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21614764", "evidence_support": "Magnetic resonance imaging revealed a 20 mm-sized aneurysm of the left vertebral artery leading to compression of the trigeminal nerve.", "evidence_relation": "supporting" }, { "cited_pmid": "16940363", "evidence_support": "We report a case of congenital absence of the left internal carotid artery (ICA) that presented with left-sided facial numbness", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, facial numbness can be a symptom of neurological disorders, such as Fahr's disease cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy (CADASIL) and multiple sclerosis [37731412, 37927774].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37731412", "evidence_support": "Fahr's disease is a rare hereditary neurological disorder characterized by idiopathic basal ganglia and cerebral cortex calcifications", "evidence_relation": "supporting" }, { "cited_pmid": "37731412", "evidence_support": "Her main symptom was left facial numbness.", "evidence_relation": "neutral" }, { "cited_pmid": "37927774", "evidence_support": "CADASIL (cerebral autosomal dominant arteriopathy with subcortical infarcts and leukoencephalopathy) is a hereditary cerebral arteriopathy caused by a neurogenic locus notch homolog protein 3 (NOTCH3) gene mutation", "evidence_relation": "neutral" }, { "cited_pmid": "37927774", "evidence_support": "This article describes the case of a man in his early 40s who experienced sudden onset temporary left-sided weakness and facial numbness that resolved in two hours, along with residual weakness in the upper and lower limbs", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In some cases, facial numbness can also be caused by viral infections, such as herpes simplex virus (HSV) or varicella zoster virus [21924743].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21924743", "evidence_support": "Brain magnetic resonance imaging (MRI) revealed enhancement in the left geniculate ganglion and in the intracanalicular and tympanic segments of the facial nerve.", "evidence_relation": "neutral" }, { "cited_pmid": "21924743", "evidence_support": "Analysis of cerebrospinal fluid (CSF) and serum revealed intrathecal synthesis of anti-varicella zoster virus (VZV) IgG antibody. ", "evidence_relation": "neutral" }, { "cited_pmid": "21924743", "evidence_support": "In addition, herpes simplex virus (HSV)-1 DNA was found in saliva of the patient on 3 consecutive days. Simultaneous reactivation of two alphaherpesviruses (HSV-1 and VZV) in our immunosuppressed patient underscores the need to consider opportunistic infection as a cause of facial weakness.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash": { "answer": "Left-sided facial numbness can be a symptom of various neurological conditions. It can occur alongside other symptoms like double vision, tremors, weakness, and pain in the limbs [31192054]. It can also be associated with a sudden onset of facial weakness and severe headache, potentially triggered by medication changes [9825082]. Additionally, left-sided facial numbness can be a symptom of more complex neurological conditions like ataxia, ptosis, and sensory loss [36741224]. It is crucial to seek medical attention to determine the underlying cause of left-sided facial numbness, as it can be a sign of a serious medical condition. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be a symptom of various neurological conditions.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "It can occur alongside other symptoms like double vision, tremors, weakness, and pain in the limbs [31192054].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "31192054", "evidence_support": "Postoperative day 2, she began to experience multiple symptoms, including double-vision, left-sided facial numbness, tremors, pain, and weakness in her left fingers, arm, and leg.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "It can also be associated with a sudden onset of facial weakness and severe headache, potentially triggered by medication changes [9825082].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "9825082", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, left-sided facial numbness can be a symptom of more complex neurological conditions like ataxia, ptosis, and sensory loss [36741224].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36741224", "evidence_support": "A 55-year-old man was admitted to the university hospital with symptoms including ataxia, left ptosis, decreased sensation of pain and temperature on the right side, left facial numbness, and dizziness. Brain magnetic resonance imaging revealed an infarction in the left dorsolateral medulla. Therefore, he was diagnosed with Wallenberg syndrome.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is crucial to seek medical attention to determine the underlying cause of left-sided facial numbness, as it can be a sign of a serious medical condition.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Left-sided facial numbness can be caused by various conditions, some of which require medical attention. It can be a symptom of a maxillary sinus tumor, particularly an aggressive form known as an aggressive sinonasal carcinoma (ASC) [30005538]. This type of tumor can invade the orbit and surrounding structures, leading to facial numbness without other symptoms [30005538]. Facial numbness can also be a sign of neurological issues, such as a lesion affecting the trigeminothalamic tract, which can cause numbness on the left side of the face [22735243]. Additionally, delayed cranial neuropathy, a complication of neurosurgical interventions, can manifest as facial numbness and is often associated with herpes simplex virus (HSV) reactivation [15993188]. Therefore, it is crucial to seek medical evaluation to determine the underlying cause of left-sided facial numbness, especially if it is accompanied by other symptoms [30005538].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by various conditions, some of which require medical attention.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "It can be a symptom of a maxillary sinus tumor, particularly an aggressive form known as an aggressive sinonasal carcinoma (ASC) [30005538].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30005538", "evidence_support": "Magnetic resonance imaging (MRI) of the brain revealed an enhancing lesion involving the left maxillary sinus with orbital invasion and posterior extension into the cavernous sinus. Transnasal endoscopic exploration with tissue removal revealed ACC.", "evidence_relation": "neutral" }, { "cited_pmid": "30005538", "evidence_support": "This case displays a unique presentation of an advanced ACC of the maxillary sinus manifesting as isolated unilateral trigeminal anesthesia without sinonasal symptoms. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This type of tumor can invade the orbit and surrounding structures, leading to facial numbness without other symptoms [30005538].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "30005538", "evidence_support": "This case displays a unique presentation of an advanced ACC of the maxillary sinus manifesting as isolated unilateral trigeminal anesthesia without sinonasal symptoms.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Facial numbness can also be a sign of neurological issues, such as a lesion affecting the trigeminothalamic tract, which can cause numbness on the left side of the face [22735243].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22735243", "evidence_support": "The neighboring lesions include the right ventral trigeminothalamic tract causing left facial numbness, right trigeminal motor nucleus leading to right lateral pterygoid muscle weakness, right anterolateral tract resulting in a left hemisensory syndrome, and the right superior cerebellar peduncle decussation causing left limb ataxia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, delayed cranial neuropathy, a complication of neurosurgical interventions, can manifest as facial numbness and is often associated with herpes simplex virus (HSV) reactivation [15993188].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15993188", "evidence_support": "Delayed cranial neuropathy is an uncommon complication of neurosurgical interventions of which the exact etiology is uncertain.", "evidence_relation": "contradicting" }, { "cited_pmid": "15993188", "evidence_support": "Nine days postoperatively, he developed severe facial weakness on the ipsilateral side. The polymerase chain reaction for herpes simplex virus (HSV) was positive in the cerebrospinal fluid (CSF).", "evidence_relation": "supporting" }, { "cited_pmid": "15993188", "evidence_support": "The second patient developed left-sided facial numbness 20 days after microvascular decompression of the left facial nerve. The polymerase chain reaction for HSV was positive in the CSF.", "evidence_relation": "supporting" }, { "cited_pmid": "15993188", "evidence_support": "Three months postoperatively, she developed multiple cranial neuropathies (involving cranial nerves V, VI, VIII, and XII). This was accompanied by serologic evidence of HSV reactivation and a positive polymerase chain reaction for HSV in the CSF.", "evidence_relation": "supporting" }, { "cited_pmid": "15993188", "evidence_support": "The 3 reported cases provide evidence that delayed postoperative cranial neuropathy can be caused by HSV reactivation and can involve multiple cranial nerves.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Therefore, it is crucial to seek medical evaluation to determine the underlying cause of left-sided facial numbness, especially if it is accompanied by other symptoms [30005538].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "30005538", "evidence_support": "It also reinforces the need for clinical diligence with the workup of new onset neuropathic symptoms in the maxillary distribution of the trigeminal nerve.", "evidence_relation": "neutral" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Left-sided facial numbness can result from various medical conditions, often indicating underlying neurological issues. Common causes include nerve compression or damage, such as from a tumor or vascular malformation affecting the trigeminal nerve [24282445, 37421424]. It may also be associated with conditions like multiple sclerosis, which can cause demyelination of nerves [28042016]. In some cases, facial numbness can occur after surgical procedures, such as microvascular decompression of the facial nerve [15993188]. Other potential causes include migraines, infections, or even transient ischemic attacks [31504852, 33859915]. Given the range of possible causes, it is advisable to seek medical attention to determine the underlying issue and appropriate treatment [29381971, 36741224].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can result from various medical conditions, often indicating underlying neurological issues.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Common causes include nerve compression or damage, such as from a tumor or vascular malformation affecting the trigeminal nerve [24282445, 37421424].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24282445", "evidence_support": "Moreover, this particular suspicion should be raised when patients with known malignancy experience concomitant trigeminal (V) and facial (VII) nerve dysfunctions.", "evidence_relation": "neutral" }, { "cited_pmid": "37421424", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "It may also be associated with conditions like multiple sclerosis, which can cause demyelination of nerves [28042016].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "28042016", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In some cases, facial numbness can occur after surgical procedures, such as microvascular decompression of the facial nerve [15993188].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15993188", "evidence_support": "The first patient underwent microvascular decompression of the left facial nerve because of hemifacial spasm. Nine days postoperatively, he developed severe facial weakness on the ipsilateral side", "evidence_relation": "supporting" }, { "cited_pmid": "15993188", "evidence_support": "The second patient developed left-sided facial numbness 20 days after microvascular decompression of the left facial nerve.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Other potential causes include migraines, infections, or even transient ischemic attacks [31504852, 33859915].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31504852", "evidence_support": "A 33-yr-old man without medical history presented with left-sided headache and mild left-sided facial numbness and weakness. Admission MR imaging revealed a nonenhancing mass, which was hyperintense on T1-weighted MR images, compressing the brainstem anteriorly.", "evidence_relation": "neutral" }, { "cited_pmid": "33859915", "evidence_support": "A high degree of suspicion in young females with worsening headache and neurologic signs and symptoms will help with timely diagnosis and management avoiding serious consequences.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Given the range of possible causes, it is advisable to seek medical attention to determine the underlying issue and appropriate treatment [29381971, 36741224].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36741224", "evidence_support": "A 55-year-old man was admitted to the university hospital with symptoms including ataxia, left ptosis, decreased sensation of pain and temperature on the right side, left facial numbness, and dizziness. Brain magnetic resonance imaging revealed an infarction in the left dorsolateral medulla.", "evidence_relation": "neutral" }, { "cited_pmid": "29381971", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Left-sided facial numbness can be caused by several conditions, with Bell's palsy being the most common. Bell's palsy, also known as idiopathic facial paralysis, accounts for over 50% of facial paralysis cases and typically results from inflammation of the facial nerve (cranial nerve VII) [31097197, 37016644, 12516381]. The exact cause of Bell's palsy is often unknown, but it may be associated with viral infections, particularly reactivation of herpes viruses [22684016, 8509941]. Other potential causes of facial numbness include tumors, trauma, and strokes, which should be considered, especially if there are additional neurological symptoms [37003859, 33133816]. If the numbness persists or is accompanied by other concerning symptoms, it is advisable to seek medical attention for further evaluation [3809265].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by several conditions, with Bell's palsy being the most common.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Bell's palsy, also known as idiopathic facial paralysis, accounts for over 50% of facial paralysis cases and typically results from inflammation of the facial nerve (cranial nerve VII) [31097197, 37016644, 12516381].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31097197", "evidence_support": "Bell's palsy is the most common diagnosis associated with facial nerve weakness or paralysis.", "evidence_relation": "supporting" }, { "cited_pmid": "37016644", "evidence_support": "Bell's palsy is an acute, ipsilateral facial paralysis secondary to inflammation of cranial nerve VII.", "evidence_relation": "supporting" }, { "cited_pmid": "12516381", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The exact cause of Bell's palsy is often unknown, but it may be associated with viral infections, particularly reactivation of herpes viruses [22684016, 8509941].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22684016", "evidence_support": "The aetiology of Bell's palsy is unknown but viral infection or autoimmune disease has been postulated as possible pathomechanisms. Bell's palsy may be caused when latent herpes viruses (herpes simplex, herpes zoster) are reactivated from cranial nerve ganglia.", "evidence_relation": "supporting" }, { "cited_pmid": "8509941", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Other potential causes of facial numbness include tumors, trauma, and strokes, which should be considered, especially if there are additional neurological symptoms [37003859, 33133816].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37003859", "evidence_support": "The most common cause of facial paralysis is Bell's palsy, followed by malignant or benign tumors, iatrogenic insults, trauma, virus-associated paralysis, and congenital etiologies.", "evidence_relation": "supporting" }, { "cited_pmid": "33133816", "evidence_support": "Brainstem infarction typically presents with vague symptoms, including headache, nausea, vomiting, and vertigo. Rarely do patients present with complete unilateral facial paralysis, mimicking Bell's palsy.", "evidence_relation": "supporting" }, { "cited_pmid": "33133816", "evidence_support": "Stroke and other clinically emergent etiologies should be considered high on the differential diagnosis when patients have neurological signs and symptoms in addition to facial nerve palsy.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "If the numbness persists or is accompanied by other concerning symptoms, it is advisable to seek medical attention for further evaluation [3809265].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "3809265", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "webis-1": { "answer": "Left sided facial numbness can be caused by various conditions such as hemifacial spasm, endocarditis, and dental issues [30851047,22865392,30567250,25547947,20495395].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left sided facial numbness can be caused by various conditions such as hemifacial spasm, endocarditis, and dental issues [30851047,22865392,30567250,25547947,20495395].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30851047", "evidence_support": "On examination, he had left-sided facial numbness along the V3 distribution to pinprick and light touch.", "evidence_relation": "neutral" }, { "cited_pmid": "30851047", "evidence_support": "The patient underwent a left temporal craniotomy for biopsy of the lesion, formalizing the diagnosis of a MPNST of the left trigeminal nerve.", "evidence_relation": "neutral" }, { "cited_pmid": "22865392", "evidence_support": "We present a case of community-acquired left-sided Pseudomonas aeruginosa endocarditis in a person without intravenous drug use. The patient presented with facial numbness and did not have any predisposing condition for endocarditis.", "evidence_relation": "supporting" }, { "cited_pmid": "30567250", "evidence_support": "A 48-year-old man presented with acute onset of left facial numbness, ataxic gait and double vision.", "evidence_relation": "neutral" }, { "cited_pmid": "30567250", "evidence_support": "Neuroimaging showed evidence of acute stroke in the cerebellum and brainstem, for which he was treated with thrombolytics", "evidence_relation": "neutral" }, { "cited_pmid": "25547947", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "20495395", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "webis-2": { "answer": "The left sided facial numbness is likely caused by a lesion or damage to the left trigeminal nerve (V3 distribution) [30851047].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The left sided facial numbness is likely caused by a lesion or damage to the left trigeminal nerve (V3 distribution) [30851047].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30851047", "evidence_support": "On examination, he had left-sided facial numbness along the V3 distribution to pinprick and light touch. Magnetic resonance imaging (MRI) revealed an enhancing left V3 lesion extending from Meckel's cave to the angle of the mandible.", "evidence_relation": "supporting" } ] } ] }, "webis-3": { "answer": "The patient presented with facial numbness due to community-acquired left-sided Pseudomonas aeruginosa endocarditis [22865392].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The patient presented with facial numbness due to community-acquired left-sided Pseudomonas aeruginosa endocarditis [22865392].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "22865392", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-5": { "answer": "The patient presented with facial numbness due to community-acquired left-sided Pseudomonas aeruginosa endocarditis. . [22865392].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The patient presented with facial numbness due to community-acquired left-sided Pseudomonas aeruginosa endocarditis. .", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-1": { "answer": "Left sided facial numbness can be caused by various conditions, including stroke, multiple sclerosis, nerve compression, or migraines. It may also result from trauma or infections affecting the facial nerves. A thorough medical evaluation is necessary to determine the underlying cause.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left sided facial numbness can be caused by various conditions, including stroke, multiple sclerosis, nerve compression, or migraines.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "It may also result from trauma or infections affecting the facial nerves.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "A thorough medical evaluation is necessary to determine the underlying cause.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "Left-sided facial numbness can be caused by various conditions, including viral infections like varicella-zoster virus reactivation, which can lead to facial pain, swelling, and rash [24799517]. Additionally, neurological issues such as stroke or other central nervous system events may also result in left-sided facial numbness, as indicated by cases involving ataxia and hemiparesis [30798276].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by various conditions, including viral infections like varicella-zoster virus reactivation, which can lead to facial pain, swelling, and rash [24799517].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24799517", "evidence_support": "A 57-year-old man developed 3 days of left facial pain and swelling with left-sided hearing loss followed by a painful, unilateral, erythematous, and vesicular rash on the left anterior two-thirds of the tongue, external auditory canal, lip, and face typical of varicella-zoster virus reactivation (figure).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, neurological issues such as stroke or other central nervous system events may also result in left-sided facial numbness, as indicated by cases involving ataxia and hemiparesis [30798276].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "30798276", "evidence_support": "This 37-year-old man presented with left sided facial warmth and numbness associated with new sudden-onset right hemiparesis.", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-6": { "answer": "Left-sided facial numbness can be caused by various conditions, including focal brain lesions such as a pontine infarct, which may lead to unilateral facial nerve paralysis [33133816]. Additionally, infections like endocarditis or the presence of masses in the body could also contribute to neurological symptoms, including facial numbness [22865392,16264857]. It is important to evaluate the underlying cause through appropriate medical assessment.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by various conditions, including focal brain lesions such as a pontine infarct, which may lead to unilateral facial nerve paralysis [33133816].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33133816", "evidence_support": "Brainstem infarction typically presents with vague symptoms, including headache, nausea, vomiting, and vertigo.", "evidence_relation": "neutral" }, { "cited_pmid": "33133816", "evidence_support": "Here we report the case of a 40-year-old\u00a0woman who presented to the emergency department with intractable nausea, vomiting, and vertigo upon waking along with left-sided upper and lower extremity numbness and right-sided facial paralysis. Her atypical presentation of unilateral facial nerve paralysis in the context of nausea, vomiting, and vertigo prompted neurological studies, which were significant for a small punctate infarct in the pons involving the right facial colliculus. \u200b", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, infections like endocarditis or the presence of masses in the body could also contribute to neurological symptoms, including facial numbness [22865392,16264857].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22865392", "evidence_support": "We present a case of community-acquired left-sided Pseudomonas aeruginosa endocarditis in a person without intravenous drug use. The patient presented with facial numbness and did not have any predisposing condition for endocarditis. He was treated successfully with valvular surgery, along with combination antibiotics", "evidence_relation": "supporting" }, { "cited_pmid": "16264857", "evidence_support": "Cranial MRI revealed a 1.6 cm irregular enhancing mass in the left middle cerebellar peduncle. Neurologic examination was significant for diminished sensation over the left face to pinprick, left-sided dysmetria, and mild lateral instability of the trunk while walking.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "It is important to evaluate the underlying cause through appropriate medical assessment.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "zero-shot-gemini-flash": { "answer": "Left-sided facial numbness can be caused by a variety of conditions, including nerve damage, tumors, and infections [22739563, 26459945, 31192054]. For example, a herniated disc in the neck can compress nerves, leading to numbness in the face, arm, and leg [31274646]. Numbness in the left cheek, nose, and upper lip can also be a symptom of a tumor in the skull base [30005538]. Additionally, a rare disorder called numb chin syndrome, often associated with cancer, can cause numbness on the left side of the lower lip and chin [1067543, 22739563]. If you experience left-sided facial numbness, it is important to see a doctor to determine the underlying cause and receive appropriate treatment [22739563]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can be caused by a variety of conditions, including nerve damage, tumors, and infections [22739563, 26459945, 31192054].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22739563", "evidence_support": "In this study, the authors suggest an initial diagnostic workup that includes a computed tomography scan of the mandible and a magnetic resonance imaging of the skull base searching for malignancy in patients with isolated numb chin syndrome, a rare disorder often associated with cancer, especially breast cancer and lymphoma, with mandibular metastases, leptomeningeal seeding and metastases of the base of the skull explaining the origin of the syndrome in most cases.", "evidence_relation": "neutral" }, { "cited_pmid": "26459945", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "31192054", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "For example, a herniated disc in the neck can compress nerves, leading to numbness in the face, arm, and leg [31274646].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31274646", "evidence_support": "In each case, left-sided disk herniation between the C5 and C7 levels caused TN and classic (dermatome appropriate) cervical radicular findings, all of which resolved with anterior cervical decompression and fusion (ACDF).", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Numbness in the left cheek, nose, and upper lip can also be a symptom of a tumor in the skull base [30005538].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30005538", "evidence_support": "Adenoid cystic carcinoma (ACC) is a rare malignant secretory gland tumor. ", "evidence_relation": "neutral" }, { "cited_pmid": "30005538", "evidence_support": "It often presents at an advanced stage with perineural spread (PNS).", "evidence_relation": "neutral" }, { "cited_pmid": "30005538", "evidence_support": "Our patient presented with left-sided facial numbness without other symptoms", "evidence_relation": "supporting" }, { "cited_pmid": "30005538", "evidence_support": " The numbness was localized to the left cheek, left side of nose, and left upper lip.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, a rare disorder called numb chin syndrome, often associated with cancer, can cause numbness on the left side of the lower lip and chin [1067543, 22739563].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22739563", "evidence_support": "In this study, the authors suggest an initial diagnostic workup that includes a computed tomography scan of the mandible and a magnetic resonance imaging of the skull base searching for malignancy in patients with isolated numb chin syndrome, a rare disorder often associated with cancer, especially breast cancer and lymphoma, with mandibular metastases, leptomeningeal seeding and metastases of the base of the skull explaining the origin of the syndrome in most cases", "evidence_relation": "supporting" }, { "cited_pmid": "1067543", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "If you experience left-sided facial numbness, it is important to see a doctor to determine the underlying cause and receive appropriate treatment [22739563].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "22739563", "evidence_support": "Magnetic resonance imaging of the skull base revealed a tumoral infiltration of the left side of Meckel's cave, involvement of the clivus with extension into the cavernous sinus and signs of focal leptomeningeal infiltration. The patient was eventually diagnosed with generalized Burkitt's lymphoma.", "evidence_relation": "neutral" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "Left-sided facial numbness can arise from various causes, including nerve dysfunctions, particularly involving the trigeminal (V) and facial (VII) nerves [24282445]. Conditions such as migraines or multiple sclerosis may also lead to facial numbness and paresthesias without facial weakness [24194991, 32833816]. In some cases, it can be associated with cranial nerve deficits, which may include hearing loss [29381971]. Additionally, tumors or infections can cause perineural spread affecting facial nerves, leading to numbness [24282445]. If the numbness persists or is accompanied by other symptoms like weakness or pain, it is advisable to seek medical attention to rule out serious underlying conditions [36932004, 28042016].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Left-sided facial numbness can arise from various causes, including nerve dysfunctions, particularly involving the trigeminal (V) and facial (VII) nerves [24282445].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24282445", "evidence_support": " Moreover, this particular suspicion should be raised when patients with known malignancy experience concomitant trigeminal (V) and facial (VII) nerve dysfunctions.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Conditions such as migraines or multiple sclerosis may also lead to facial numbness and paresthesias without facial weakness [24194991, 32833816].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32833816", "evidence_support": "A 24-year-old male patient presented with left-sided intermitted headache and facial numbness. Radiographic imaging showed a 3 cm \u00d7 2.3\u200acm mass with heterogeneous density in the sphenoid region.", "evidence_relation": "neutral" }, { "cited_pmid": "24194991", "evidence_support": "This patient presented 5 years after the removal of a lentigo maligna melanoma from her left cheek with left sided facial numbness and paresthesias with no reported facial weakness. Initial MRI revealed a mass on the left trigeminal nerve that appeared to be a trigeminal schwannoma.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In some cases, it can be associated with cranial nerve deficits, which may include hearing loss [29381971].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29381971", "evidence_support": "Cranial nerve deficits, including left facial paralysis, left facial numbness and left hearing loss, were evident on examination.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, tumors or infections can cause perineural spread affecting facial nerves, leading to numbness [24282445].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24282445", "evidence_support": "Adenoid cystic carcinomas (ACCs) are relatively rare tumours, notorious for wide local infiltration and perineural spread. Perineural extension commonly occurs along branches of the trigeminal and facial nerves, and its presence represents a poor prognostic factor with implications for treatment approach.", "evidence_relation": "supporting" }, { "cited_pmid": "24282445", "evidence_support": "The auriculotemporal nerve may serve as a route for tumour spread, particularly in the setting of head and neck malignancy", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "If the numbness persists or is accompanied by other symptoms like weakness or pain, it is advisable to seek medical attention to rule out serious underlying conditions [36932004, 28042016].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36932004", "evidence_support": "A 72-year-old woman presented to the Emergency\u00a0Department (ED)\u00a0with altered mental status, 4 days of left-sided facial numbness and weakness, and sudden facial pain, swelling, and erythema.", "evidence_relation": "neutral" }, { "cited_pmid": "28042016", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] } } }, { "question_id": "121", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "To lower cortisol levels, it is important to focus on stress management techniques, as chronic stress is a major contributor to elevated cortisol. Practices such as regular exercise, adequate sleep, mindfulness meditation, and healthy dietary habits can be effective. Additionally, managing emotions and psychological well-being, such as through therapy or cognitive behavioral strategies, can play a significant role in regulating cortisol levels [23327297]. It is also important to avoid overtraining, as intense and prolonged physical activity without adequate recovery can lead to increased cortisol levels, which might negatively impact athletic performance and overall health [27157507].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "To lower cortisol levels, it is important to focus on stress management techniques, as chronic stress is a major contributor to elevated cortisol.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Practices such as regular exercise, adequate sleep, mindfulness meditation, and healthy dietary habits can be effective.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, managing emotions and psychological well-being, such as through therapy or cognitive behavioral strategies, can play a significant role in regulating cortisol levels [23327297].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23327297", "evidence_support": "empathy and emotion regulation are highlighted which provide further insights on how these processes might relate. Finally, possible directions for future research are presented.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It is also important to avoid overtraining, as intense and prolonged physical activity without adequate recovery can lead to increased cortisol levels, which might negatively impact athletic performance and overall health [27157507].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27157507", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Exercise and mindfulness-based programs can help lower cortisol levels by reducing stress [26912245, 36497535, 18312945]. Adequate sleep is crucial, as lower evening cortisol is associated with earlier sleep onset and longer nighttime sleep duration [34387342, 31156717, 17462555]. In children, lower evening cortisol correlates with more nighttime sleep minutes and higher sleep efficiency, and parental involvement at bedtime can further reduce evening cortisol levels [36282747, 18309767, 21812811]. Early sleep onset in infants predicts lower hair cortisol [33870573, 18309767, 21812811]. Prolonged activation of the HPA axis can lead to hypercortisolemia or hypocortisolemia, indicating the importance of managing stress to prevent these conditions [30764034, 21812811]. Critical illness-related corticosteroid insufficiency involves insufficient circulating cortisol and impaired cellular utilization of cortisol, highlighting the need for careful monitoring in critically ill patients [30764034, 21812811]. Overall, managing sleep, stress, and exercise are key strategies for lowering cortisol levels effectively [36497535, 18312945, 20048467].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Exercise and mindfulness-based programs can help lower cortisol levels by reducing stress [26912245, 36497535, 18312945].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26912245", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "36497535", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18312945", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Adequate sleep is crucial, as lower evening cortisol is associated with earlier sleep onset and longer nighttime sleep duration [34387342, 31156717, 17462555].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34387342", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "31156717", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "17462555", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In children, lower evening cortisol correlates with more nighttime sleep minutes and higher sleep efficiency, and parental involvement at bedtime can further reduce evening cortisol levels [36282747, 18309767, 21812811].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36282747", "evidence_support": "The present study examined 3- to 6-year-old children's evening cortisol levels as a pathway linking parental involvement at bedtime to children's nighttime sleep duration and quality.", "evidence_relation": "supporting" }, { "cited_pmid": "36282747", "evidence_support": "Path analyses controlling for child and family demographics provided support for three significant indirect effects: lower child evening cortisol acted as a pathway linking greater parental presence at bedtime to more child nighttime sleep minutes and higher sleep efficiency, and lower child evening cortisol also linked greater parental contact at bedtime to higher sleep efficiency.", "evidence_relation": "supporting" }, { "cited_pmid": "21812811", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18309767", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Early sleep onset in infants predicts lower hair cortisol [33870573, 18309767, 21812811].", "answer_sentence_relevance": "inappropriate", "citation_assessment": [ { "cited_pmid": "33870573", "evidence_support": "Overall, early sleep onset predicted lower hair cortisol above and beyond sleep duration, family income and chaos experienced at home.", "evidence_relation": "supporting" }, { "cited_pmid": "21812811", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18309767", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Prolonged activation of the HPA axis can lead to hypercortisolemia or hypocortisolemia, indicating the importance of managing stress to prevent these conditions [30764034, 21812811].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30764034", "evidence_support": "Prolonged activation of the hypothalamic-pituitary-adrenal (HPA) axis can result in hypercortisolemia or hypocortisolemia; both can be detrimental to recovery from critical illness.", "evidence_relation": "supporting" }, { "cited_pmid": "21812811", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Critical illness-related corticosteroid insufficiency involves insufficient circulating cortisol and impaired cellular utilization of cortisol, highlighting the need for careful monitoring in critically ill patients [30764034, 21812811].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "30764034", "evidence_support": "Primary and secondary adrenal insufficiency, relative adrenal insufficiency, tissue resistance to glucocorticoids, adrenocorticotrophic hormone deficiency and immune-mediated inhibition of the HPA axis can be the cause of the impairment of the secretion or action of cortisol in critically ill patients.", "evidence_relation": "supporting" }, { "cited_pmid": "30764034", "evidence_support": "Patients with critical illness-related corticosteroid insufficiency not only have insufficient circulating cortisol but also have impaired cellular utilization of cortisol.", "evidence_relation": "supporting" }, { "cited_pmid": "21812811", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Overall, managing sleep, stress, and exercise are key strategies for lowering cortisol levels effectively [36497535, 18312945, 20048467].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36497535", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18312945", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "20048467", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Lowering cortisol levels can be achieved through various behavioral and environmental modifications.Adequate and consistent sleep is crucial, as shorter sleep durations and greater variability in sleep patterns are associated with lower waking cortisol levels and flatter diurnal slopes [26963376]. Parental involvement at bedtime can reduce evening cortisol levels in children, suggesting that stress reduction techniques before sleep may be beneficial [36282747]. Additionally, maintaining a regular eating schedule and avoiding late-night meals can support a healthy cortisol rhythm, as irregular eating patterns are linked to disrupted cortisol levels during pregnancy [36687684]. Engaging in mindfulness and relaxation practices, such as meditation, can also help manage stress and lower cortisol levels by enhancing attentiveness and reducing self-criticism [26912245]. Overall, consistent sleep, regular meal timing, and stress management techniques are effective strategies for lowering cortisol levels.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Lowering cortisol levels can be achieved through various behavioral and environmental modifications.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Adequate and consistent sleep is crucial, as shorter sleep durations and greater variability in sleep patterns are associated with lower waking cortisol levels and flatter diurnal slopes [26963376].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26963376", "evidence_support": "Between-person results revealed that shorter average objective sleep duration and greater sleep duration variability were related to lower levels of waking cortisol and flatter diurnal slopes across the day. Within-person results revealed that on nights when individuals slept for shorter durations than usual they also had lower levels of waking cortisol the next day.", "evidence_relation": "supporting" }, { "cited_pmid": "26963376", "evidence_support": "Overall, this study provides a greater understanding of how multiple components of sleep, measured in naturalistic environments, are related to cortisol and sAA diurnal rhythms, and how day-to-day, within-person changes in sleep duration contribute to daily variations in cortisol.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Parental involvement at bedtime can reduce evening cortisol levels in children, suggesting that stress reduction techniques before sleep may be beneficial [36282747].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36282747", "evidence_support": "Path analyses controlling for child and family demographics provided support for three significant indirect effects: lower child evening cortisol acted as a pathway linking greater parental presence at bedtime to more child nighttime sleep minutes and higher sleep efficiency, and lower child evening cortisol also linked greater parental contact at bedtime to higher sleep efficiency. Among this low-risk sample, the findings suggest that encouraging parental involvement in young children's bedtime routine may promote healthy sleep by way of reduced child physiological arousal.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, maintaining a regular eating schedule and avoiding late-night meals can support a healthy cortisol rhythm, as irregular eating patterns are linked to disrupted cortisol levels during pregnancy [36687684].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36687684", "evidence_support": "Findings suggest that certain chrononutrition components, particularly eating window and breakfast skipping have a significant influence on maternal melatonin and cortisol rhythm.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Engaging in mindfulness and relaxation practices, such as meditation, can also help manage stress and lower cortisol levels by enhancing attentiveness and reducing self-criticism [26912245].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26912245", "evidence_support": "After considering the way meditation cultivates heightened attentiveness, refines sensory clarity, lessens self-criticism, and increases affect tolerance, thereby deepening psychoanalytic listening, I'll examine how psychoanalytic perspectives on unconscious communication and meaning illuminate and transform the nearsightedness of meditation, aiding therapists and clients in understanding troubling thoughts, feelings, and behavior.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, consistent sleep, regular meal timing, and stress management techniques are effective strategies for lowering cortisol levels.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Lowering cortisol levels can be achieved through various methods, including exercise, mindfulness, and stress management techniques.Research has shown that exercise, such as endurance mountain runs, can help reduce cortisol levels and improve overall health [18312945]. Additionally, mindfulness-based programs, such as mindfulness-based family psychoeducation, can also help reduce caregiver burden and improve cortisol regulation [36497535]. Furthermore, getting enough sleep and maintaining a consistent sleep schedule can also help regulate cortisol levels, as sleep deprivation can lead to increased cortisol production [26963376, 33870573]. It is also important to note that a healthy diet and lifestyle, including a balanced eating window and avoiding skipping breakfast, can also help regulate cortisol levels [36687684]. Overall, a combination of these methods can help lower cortisol levels and improve overall health and wellbeing.are cited in this response.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Lowering cortisol levels can be achieved through various methods, including exercise, mindfulness, and stress management techniques.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Research has shown that exercise, such as endurance mountain runs, can help reduce cortisol levels and improve overall health [18312945].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18312945", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, mindfulness-based programs, such as mindfulness-based family psychoeducation, can also help reduce caregiver burden and improve cortisol regulation [36497535].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36497535", "evidence_support": "Photovoice is a participatory action research method of fostering dialogues about personal experiences by sharing and discussing photographs that may improve our understanding about how a mindfulness-based family psychoeducation program (MBFPE) can reduce the caregiver burden and improve their caregiving experience", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, getting enough sleep and maintaining a consistent sleep schedule can also help regulate cortisol levels, as sleep deprivation can lead to increased cortisol production [26963376, 33870573].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26963376", "evidence_support": "Overall, this study provides a greater understanding of how multiple components of sleep, measured in naturalistic environments, are related to cortisol and sAA diurnal rhythms, and how day-to-day, within-person changes in sleep duration contribute to daily variations in cortisol.", "evidence_relation": "supporting" }, { "cited_pmid": "33870573", "evidence_support": "Findings suggest that in early development, the day-to-day relation between sleep and cortisol is not bidirectional, but more driven by diurnal cortisol.", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is also important to note that a healthy diet and lifestyle, including a balanced eating window and avoiding skipping breakfast, can also help regulate cortisol levels [36687684].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36687684", "evidence_support": "During both trimesters, a lower awakening cortisol level was observed in pregnant women who skipped breakfast (\u03b2 = -0.33, p = 0.029; \u03b2 = -0.29, p = 0.044).", "evidence_relation": "contradicting" }, { "cited_pmid": "36687684", "evidence_support": "Findings suggest that certain chrononutrition components, particularly eating window and breakfast skipping have a significant influence on maternal melatonin and cortisol rhythm.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, a combination of these methods can help lower cortisol levels and improve overall health and wellbeing.are cited in this response.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "To lower cortisol levels, several strategies can be employed [33495978, 26246040, 29278839]. Engaging in stress management techniques, such as guided relaxation, can help reduce cortisol levels after acute stress [33495978, 26246040]. Additionally, practicing mindfulness and meditation can also help mitigate the effects of stress and lower cortisol levels [33495978, 26246040]. Optimizing expectations and distraction can also lead to lower cortisol levels after acute stress [29278839]. Moreover, spending time in nature, such as visiting urban parks, can also help reduce cortisol levels and improve overall well-being [34879780]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "To lower cortisol levels, several strategies can be employed [33495978, 26246040, 29278839].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "26246040", "evidence_support": "The effect of guided relaxation on cortisol and affect: Stress reactivity as a moderator.", "evidence_relation": "neutral" }, { "cited_pmid": "33495978", "evidence_support": "Participants in SM showed lower levels of total cortisol and a smaller CAR compared with those in EX, NUT, or EX+NUT from baseline to 4 months post-intervention.", "evidence_relation": "neutral" }, { "cited_pmid": "29278839", "evidence_support": "Optimizing expectations and distraction leads to lower cortisol levels after acute stress.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Engaging in stress management techniques, such as guided relaxation, can help reduce cortisol levels after acute stress [33495978, 26246040].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33495978", "evidence_support": "Participants in SM showed lower levels of total cortisol and a smaller CAR compared with those in EX, NUT, or EX+NUT from baseline to 4 months post-intervention.", "evidence_relation": "supporting" }, { "cited_pmid": "26246040", "evidence_support": "Results indicate that a single guided relaxation intervention improves positive affect among individuals high in stress reactivity.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, practicing mindfulness and meditation can also help mitigate the effects of stress and lower cortisol levels [33495978, 26246040].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33495978", "evidence_support": "Participants in SM showed lower levels of total cortisol and a smaller CAR compared with those in EX, NUT, or EX+NUT from baseline to 4 months post-intervention", "evidence_relation": "supporting" }, { "cited_pmid": "33495978", "evidence_support": "These findings provide support for the efficacy of telephone-based, health behavior interventions in improving different stress outcomes among chronically stressed midlife and older adults and suggest the need to test the longer-term effects of these interventions for improving health outcomes in this population.", "evidence_relation": "neutral" }, { "cited_pmid": "26246040", "evidence_support": "Results indicate that a single guided relaxation intervention improves positive affect among individuals high in stress reactivity.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Optimizing expectations and distraction can also lead to lower cortisol levels after acute stress [29278839].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29278839", "evidence_support": "Brief psychological interventions aiming to optimize expectations or distraction prior to stress reduce the cortisol response in healthy participants after an acute stressor.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Moreover, spending time in nature, such as visiting urban parks, can also help reduce cortisol levels and improve overall well-being [34879780].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34879780", "evidence_support": "The duration of park visit was identified as a key variable significantly associated with cortisol reduction, and changes in SWB scores after the park visit were significantly associated with changes in cortisol level.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "To lower cortisol levels, consider engaging in stress management interventions such as mindfulness, meditation, or relaxation techniques [32204833, 23696104, 37879237]. These interventions have been shown to reduce cortisol levels in various studies, with mindfulness and meditation being the most effective [16183205, 23696104, 37879237]. A systematic review of 58 studies found that stress management interventions outperformed control conditions with a medium positive effect size, and that mindfulness and meditation interventions were most effective at changing cortisol levels [32635830, 23696104, 37879237]. Additionally, a meta-analysis of 10 studies found that meditation interventions had a significant, medium effect on cortisol levels in at-risk samples, such as patients with somatic illnesses [32635830, 23696104, 37879237]. Exercise, particularly physical activity, has also been shown to reduce cortisol levels, with a study finding that 12 weeks of exercise reduced salivary morning cortisol levels in patients with depression [16330155, 30815455, 32204833]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "To lower cortisol levels, consider engaging in stress management interventions such as mindfulness, meditation, or relaxation techniques [32204833, 23696104, 37879237].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32204833", "evidence_support": "Stress leads to ill-health and disease, and with today's fast-pace western society, engaging in strategies to relieve stress is crucial for good health across the life-course. Activities such as focusing on positive characteristics, art/music therapies, mindfulness, yoga and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being. It is thought that patterns of cortisol secretion, which are regulated by the brain, are a key mediator of stress-disease and well-being-health links. ", "evidence_relation": "supporting" }, { "cited_pmid": "23696104", "evidence_support": "The basal cortisol level decreased significantly in the IBMT but not in relaxation group after 2 and 4\u2009weeks of training. An additional IBMT practice session immediately after acute stress produced significantly lower cortisol release for the IBMT group in comparison with relaxation at weeks 2 and 4.", "evidence_relation": "contradicting" }, { "cited_pmid": "37879237", "evidence_support": "Mindfulness and meditation (g = 0. 345) and relaxation (g = 0. 347) interventions were most effective at changing cortisol levels, while mind body therapies (g = 0. 129) and talking therapies (g = 0.107) were shown to have smaller and non-significant effect sizes.", "evidence_relation": "supporting" }, { "cited_pmid": "37879237", "evidence_support": "Overall, the current findings confirm that stress management interventions can positively influence cortisol levels. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These interventions have been shown to reduce cortisol levels in various studies, with mindfulness and meditation being the most effective [16183205, 23696104, 37879237].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16183205", "evidence_support": "Subjects in the CBSM group showed significantly reduced cortisol stress responses. With regard to gender, this effect was observed in both men and women. However, the magnitude of the CBSM effect on cortisol responses was smaller in women than in men.", "evidence_relation": "supporting" }, { "cited_pmid": "23696104", "evidence_support": "The basal cortisol level decreased significantly in the IBMT but not in relaxation group after 2 and 4\u2009weeks of training.", "evidence_relation": "contradicting" }, { "cited_pmid": "37879237", "evidence_support": "Mindfulness and meditation (g = 0. 345) and relaxation (g = 0. 347) interventions were most effective at changing cortisol levels, while mind body therapies (g = 0. 129) and talking therapies (g = 0.107) were shown to have smaller and non-significant effect sizes.", "evidence_relation": "supporting" }, { "cited_pmid": "37879237", "evidence_support": "Overall, the current findings confirm that stress management interventions can positively influence cortisol levels.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "A systematic review of 58 studies found that stress management interventions outperformed control conditions with a medium positive effect size, and that mindfulness and meditation interventions were most effective at changing cortisol levels [32635830, 23696104, 37879237].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37879237", "evidence_support": "Six databases (Medline, PsychInfo, Embase, CINAHL, Cochrane and Web of Science) were searched (1171 studies identified) with 58 studies (combined N\u00a0=\u00a03508) included in the meta-analysis.", "evidence_relation": "neutral" }, { "cited_pmid": "37879237", "evidence_support": "A random effects meta-analysis on cortisol as measured in blood, saliva or hair found that stress management interventions outperformed pooled control conditions with a medium positive effect size (g = 0.282). ", "evidence_relation": "supporting" }, { "cited_pmid": "37879237", "evidence_support": "Mindfulness and meditation (g = 0. 345) and relaxation (g = 0. 347) interventions were most effective at changing cortisol levels, while mind body therapies (g = 0. 129) and talking therapies (g = 0.107) were shown to have smaller and non-significant effect sizes.", "evidence_relation": "supporting" }, { "cited_pmid": "37879237", "evidence_support": "Overall, the current findings confirm that stress management interventions can positively influence cortisol levels.", "evidence_relation": "supporting" }, { "cited_pmid": "23696104", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "32635830", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, a meta-analysis of 10 studies found that meditation interventions had a significant, medium effect on cortisol levels in at-risk samples, such as patients with somatic illnesses [32635830, 23696104, 37879237].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32635830", "evidence_support": "Based on 10 studies using blood samples meditation interventions had a significant, medium effect from pre-to post-test compared to the control group. Upon closer inspection, this effect was only present for at-risk samples, that is, patients with a somatic illness.", "evidence_relation": "supporting" }, { "cited_pmid": "23696104", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "37879237", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Exercise, particularly physical activity, has also been shown to reduce cortisol levels, with a study finding that 12 weeks of exercise reduced salivary morning cortisol levels in patients with depression [16330155, 30815455, 32204833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30815455", "evidence_support": "We found a marked flattening of the diurnal cortisol slope (p = 0.004) and a reduced cortisol level at awakening (p = 0.017) after 12 weeks of PE treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "30815455", "evidence_support": "PE reduced the rate of cortisol level decline across the day in depressed adults.", "evidence_relation": "supporting" }, { "cited_pmid": "32204833", "evidence_support": "Activities such as focusing on positive characteristics, art/music therapies, mindfulness, yoga and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being.", "evidence_relation": "supporting" }, { "cited_pmid": "16330155", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Mindfulness-based stress reduction, meditation, and yoga can help lower cortisol levels [23218058, 23527522, 20129404]. Studies have shown that regular contemplative mental training, mindfulness meditation, and cognitive-behavioral stress management can reduce cortisol levels [37879237, 23527522, 20129404]. Additionally, activities such as focusing on positive characteristics, art/music therapies, and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being [32204833]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mindfulness-based stress reduction, meditation, and yoga can help lower cortisol levels [23218058, 23527522, 20129404].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23218058", "evidence_support": "The results suggest an adjustment of cortisol levels as a result of MBSR.", "evidence_relation": "supporting" }, { "cited_pmid": "23527522", "evidence_support": "Mindfulness increased from pre- to post-retreat, F(1, 56) = 36.20, p < .001. Cortisol did not significantly change.", "evidence_relation": "contradicting" }, { "cited_pmid": "20129404", "evidence_support": "In the current manuscript, we review the available literature on the role of cortisol as a physiological marker for improvement with regards to mindfulness practice, and make recommendations for future study designs", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Studies have shown that regular contemplative mental training, mindfulness meditation, and cognitive-behavioral stress management can reduce cortisol levels [37879237, 23527522, 20129404].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37879237", "evidence_support": "Overall, the current findings confirm that stress management interventions can positively influence cortisol levels.", "evidence_relation": "supporting" }, { "cited_pmid": "23527522", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "20129404", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, activities such as focusing on positive characteristics, art/music therapies, and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being [32204833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32204833", "evidence_support": "Activities such as focusing on positive characteristics, art/music therapies, mindfulness, yoga and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being. ", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Mindfulness-based stress reduction, meditation, and yoga can help lower cortisol levels [20129404, 34259441, 32635830]. Studies have shown that regular contemplative mental training, mindfulness meditation, and cognitive-behavioral stress management can reduce cortisol levels [32204833, 34259441, 37879237]. Additionally, activities such as focusing on positive characteristics, art/music therapies, and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being [32204833, 21749556, 34566791]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mindfulness-based stress reduction, meditation, and yoga can help lower cortisol levels [20129404, 34259441, 32635830].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20129404", "evidence_support": "In the current manuscript, we review the available literature on the role of cortisol as a physiological marker for improvement with regards to mindfulness practice, and make recommendations for future study designs.", "evidence_relation": "supporting" }, { "cited_pmid": "34259441", "evidence_support": "Our results point to the reduction of long-term cortisol exposure as a mechanism through which meditation-based mental training may exert positive effects on practitioners' health.", "evidence_relation": "supporting" }, { "cited_pmid": "32635830", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Studies have shown that regular contemplative mental training, mindfulness meditation, and cognitive-behavioral stress management can reduce cortisol levels [32204833, 34259441, 37879237].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32204833", "evidence_support": "Activities such as focusing on positive characteristics, art/music therapies, mindfulness, yoga and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being.", "evidence_relation": "supporting" }, { "cited_pmid": "32204833", "evidence_support": "It is thought that patterns of cortisol secretion, which are regulated by the brain, are a key mediator of stress-disease and well-being-health links.", "evidence_relation": "supporting" }, { "cited_pmid": "34259441", "evidence_support": "Our results point to the reduction of long-term cortisol exposure as a mechanism through which meditation-based mental training may exert positive effects on practitioners' health.", "evidence_relation": "supporting" }, { "cited_pmid": "37879237", "evidence_support": "Mindfulness and meditation (g = 0. 345) and relaxation (g = 0. 347) interventions were most effective at changing cortisol levels, while mind body therapies (g = 0. 129) and talking therapies (g = 0.107) were shown to have smaller and non-significant effect sizes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, activities such as focusing on positive characteristics, art/music therapies, and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being [32204833, 21749556, 34566791].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32204833", "evidence_support": "Activities such as focusing on positive characteristics, art/music therapies, mindfulness, yoga and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being.", "evidence_relation": "supporting" }, { "cited_pmid": "21749556", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "34566791", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Mindfulness-based stress reduction, meditation, and yoga can help lower cortisol levels [34259441, 32635830, 23527522]. Studies have shown that regular contemplative mental training, mindfulness meditation, and cognitive-behavioral stress management can reduce cortisol levels [34259441, 37879237, 20129404]. Additionally, activities such as focusing on positive characteristics, art/music therapies, and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being [21749556, 34566791, 32204833]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mindfulness-based stress reduction, meditation, and yoga can help lower cortisol levels [34259441, 32635830, 23527522].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34259441", "evidence_support": "Our results point to the reduction of long-term cortisol exposure as a mechanism through which meditation-based mental training may exert positive effects on practitioners' health.", "evidence_relation": "supporting" }, { "cited_pmid": "32635830", "evidence_support": "Previous meta-analytic results showed beneficial effects of meditation interventions for cortisol levels.", "evidence_relation": "supporting" }, { "cited_pmid": "23527522", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Studies have shown that regular contemplative mental training, mindfulness meditation, and cognitive-behavioral stress management can reduce cortisol levels [34259441, 37879237, 20129404].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34259441", "evidence_support": "Our results point to the reduction of long-term cortisol exposure as a mechanism through which meditation-based mental training may exert positive effects on practitioners' health", "evidence_relation": "supporting" }, { "cited_pmid": "37879237", "evidence_support": "Overall, the current findings confirm that stress management interventions can positively influence cortisol levels.", "evidence_relation": "supporting" }, { "cited_pmid": "20129404", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, activities such as focusing on positive characteristics, art/music therapies, and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being [21749556, 34566791, 32204833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21749556", "evidence_support": "The evidence suggests that creative activities can have a healing and protective effect on mental well-being.", "evidence_relation": "supporting" }, { "cited_pmid": "34566791", "evidence_support": "Diverse music activities were considered: receptive and intentional music listening; sharing music; instrument playing; group singing; lyrics and rapping; movement and dance; and songwriting, composition, and improvisation.", "evidence_relation": "supporting" }, { "cited_pmid": "32204833", "evidence_support": "Stress leads to ill-health and disease, and with today's fast-pace western society, engaging in strategies to relieve stress is crucial for good health across the life-course. Activities such as focusing on positive characteristics, art/music therapies, mindfulness, yoga and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being.", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Mindfulness-based stress reduction, meditation, and yoga can help lower cortisol levels [32635830, 34259441, 20129404]. Studies have shown that regular contemplative mental training, mindfulness meditation, and cognitive-behavioral stress management can reduce cortisol levels [34259441, 37879237, 32204833]. Additionally, activities such as focusing on positive characteristics, art/music therapies, and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being [34566791, 21749556, 32204833]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mindfulness-based stress reduction, meditation, and yoga can help lower cortisol levels [32635830, 34259441, 20129404].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32635830", "evidence_support": "Previous meta-analytic results showed beneficial effects of meditation interventions for cortisol levels.", "evidence_relation": "supporting" }, { "cited_pmid": "32635830", "evidence_support": "This pattern may suggest that that meditation interventions are most beneficial for at-risk populations. These interventions might provide people with strategies of stress management that can contribute to well-being.", "evidence_relation": "supporting" }, { "cited_pmid": "34259441", "evidence_support": "Our results point to the reduction of long-term cortisol exposure as a mechanism through which meditation-based mental training may exert positive effects on practitioners' health.", "evidence_relation": "supporting" }, { "cited_pmid": "20129404", "evidence_support": "Cortisol is the major stress hormone in the human organism and as such is a promising candidate measure in the study of the effects of Mindfulness-Based Stress Reduction programs.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Studies have shown that regular contemplative mental training, mindfulness meditation, and cognitive-behavioral stress management can reduce cortisol levels [34259441, 37879237, 32204833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34259441", "evidence_support": "Our results point to the reduction of long-term cortisol exposure as a mechanism through which meditation-based mental training may exert positive effects on practitioners' health.", "evidence_relation": "supporting" }, { "cited_pmid": "37879237", "evidence_support": "Mindfulness and meditation (g = 0. 345) and relaxation (g = 0. 347) interventions were most effective at changing cortisol levels, while mind body therapies (g = 0. 129) and talking therapies (g = 0.107) were shown to have smaller and non-significant effect sizes.", "evidence_relation": "supporting" }, { "cited_pmid": "32204833", "evidence_support": "Activities such as focusing on positive characteristics, art/music therapies, mindfulness, yoga and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, activities such as focusing on positive characteristics, art/music therapies, and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being [34566791, 21749556, 32204833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21749556", "evidence_support": "However, the evidence to support these claims is weak and assumptions were made that lacked reliability and validity. Establishing the benefit of participating in creative arts is difficult because of a lack of consistency of a clear definition, but it is important to identify the potential of creative arts as a therapeutic and transformational tools and not an intervention for therapeutic diversion.", "evidence_relation": "contradicting" }, { "cited_pmid": "32204833", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "34566791", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Mindfulness-based stress reduction, meditation, and yoga can help lower cortisol levels [20129404, 37879237, 23527522]. Studies have shown that regular contemplative mental training, mindfulness meditation, and cognitive-behavioral stress management can reduce cortisol levels [20129404, 23724462, 37879237]. Additionally, activities such as focusing on positive characteristics, art/music therapies, and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being [28840638, 26111942, 26286974]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mindfulness-based stress reduction, meditation, and yoga can help lower cortisol levels [20129404, 37879237, 23527522].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37879237", "evidence_support": "Mindfulness and meditation (g = 0. 345) and relaxation (g = 0. 347) interventions were most effective at changing cortisol levels, while mind body therapies (g = 0. 129) and talking therapies (g = 0.107) were shown to have smaller and non-significant effect sizes.", "evidence_relation": "supporting" }, { "cited_pmid": "23527522", "evidence_support": "These data suggest a relation between self-reported mindfulness and resting output of the hypothalamic-pituitary-adrenal system", "evidence_relation": "neutral" }, { "cited_pmid": "20129404", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Studies have shown that regular contemplative mental training, mindfulness meditation, and cognitive-behavioral stress management can reduce cortisol levels [20129404, 23724462, 37879237].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23724462", "evidence_support": "Mindfulness meditation is a method to relax the mind that decreases stress, which otherwise would increase serum cortisol. So, mindfulness meditation should decrease serum cortisol.", "evidence_relation": "supporting" }, { "cited_pmid": "23724462", "evidence_support": "Mindfulness meditation lowers the cortisol levels in the blood suggesting that it can lower stress and may decrease the risk of diseases that arise from stress such as psychiatric disorder, peptic ulcer and migraine.", "evidence_relation": "supporting" }, { "cited_pmid": "37879237", "evidence_support": "Overall, the current findings confirm that stress management interventions can positively influence cortisol levels.", "evidence_relation": "supporting" }, { "cited_pmid": "20129404", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, activities such as focusing on positive characteristics, art/music therapies, and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being [28840638, 26111942, 26286974].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28840638", "evidence_support": "Both physical activity and relaxation have stress-relieving potential.", "evidence_relation": "supporting" }, { "cited_pmid": "28840638", "evidence_support": "In a randomized cross-over trial, 81 healthy adults completed 4 types of short-term interventions for stress reduction, each lasting for 1\u00a0hr: (1) physical activity (walking) combined with resting, (2) walking combined with balneotherapy, (3) combined resting and balneotherapy, and (4) resting only.", "evidence_relation": "supporting" }, { "cited_pmid": "26111942", "evidence_support": "Results indicated an overall beneficial effect consisting of reduced stress, anxiety and depressive symptoms, and improved psychological well-being and sleep quality.", "evidence_relation": "supporting" }, { "cited_pmid": "26286974", "evidence_support": "Collectively these findings indicate that increased engagement in health-enhancing physical activity represents one factor associated with greater well-being.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Mindfulness-based stress reduction, meditation, and possibly mindfulness, can help lower cortisol levels [25673371, 24049209, 32635830, 26790919]. However, the association of cortisol and mindfulness has yet to be rigorously evaluated, and findings are inconclusive [25673371, 24049209, 32635830, 26790919]. Studies have shown that regular contemplative mental training, mindfulness meditation, and cognitive-behavioral stress management can reduce cortisol levels [16183205, 16330155, 34259441]. Additionally, activities such as focusing on positive characteristics, art/music therapies, and engaging with nature have been shown to reduce stress and enhance well-being [15900809, 33066853]. Engaging in physical activity is also widely recommended and has proven physical, mental, and social benefits, although the direct connection to well-being is still being researched [15900809, 33066853]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mindfulness-based stress reduction, meditation, and possibly mindfulness, can help lower cortisol levels [25673371, 24049209, 32635830, 26790919].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25673371", "evidence_support": "Cortisol is increasingly included in examinations of mindfulness intervention effects as an indicator of efficacy; however, the association of cortisol and mindfulness has yet to be rigorously evaluated.", "evidence_relation": "contradicting" }, { "cited_pmid": "25673371", "evidence_support": "Mindfulness may influence cortisol, but findings are inconclusive.", "evidence_relation": "neutral" }, { "cited_pmid": "24049209", "evidence_support": "More patients in the yoga groups had a drop in cortisol levels as compared to drug-only group.", "evidence_relation": "supporting" }, { "cited_pmid": "32635830", "evidence_support": "Previous meta-analytic results showed beneficial effects of meditation interventions for cortisol levels.", "evidence_relation": "supporting" }, { "cited_pmid": "32635830", "evidence_support": "This pattern may suggest that that meditation interventions are most beneficial for at-risk populations.", "evidence_relation": "supporting" }, { "cited_pmid": "26790919", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "However, the association of cortisol and mindfulness has yet to be rigorously evaluated, and findings are inconclusive [25673371, 24049209, 32635830, 26790919].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "25673371", "evidence_support": "Inconsistent results were found for mindfulness effects on cortisol.", "evidence_relation": "supporting" }, { "cited_pmid": "25673371", "evidence_support": "Mindfulness may influence cortisol, but findings are inconclusive.", "evidence_relation": "supporting" }, { "cited_pmid": "24049209", "evidence_support": "The findings support that yoga may act at the level of the hypothalamus by its 'anti-stress' effects (reducing the cortisol), to bring about relief in depression", "evidence_relation": "contradicting" }, { "cited_pmid": "32635830", "evidence_support": "Previous meta-analytic results showed beneficial effects of meditation interventions for cortisol levels.", "evidence_relation": "contradicting" }, { "cited_pmid": "32635830", "evidence_support": "This pattern may suggest that that meditation interventions are most beneficial for at-risk populations.", "evidence_relation": "neutral" }, { "cited_pmid": "26790919", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Studies have shown that regular contemplative mental training, mindfulness meditation, and cognitive-behavioral stress management can reduce cortisol levels [16183205, 16330155, 34259441].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16183205", "evidence_support": "Subjects in the CBSM group showed significantly reduced cortisol stress responses", "evidence_relation": "supporting" }, { "cited_pmid": "16330155", "evidence_support": "Cognitive-behavioral stress management (CBSM) has repeatedly been shown to effectively reduce cortisol responses to acute psychosocial stress.", "evidence_relation": "supporting" }, { "cited_pmid": "34259441", "evidence_support": "Our results point to the reduction of long-term cortisol exposure as a mechanism through which meditation-based mental training may exert positive effects on practitioners' health.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, activities such as focusing on positive characteristics, art/music therapies, and engaging with nature have been shown to reduce stress and enhance well-being [15900809, 33066853].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33066853", "evidence_support": "Nature exposure has been widely shown to have a positive effect in reducing stress, both perceived and physiologic.", "evidence_relation": "supporting" }, { "cited_pmid": "15900809", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Engaging in physical activity is also widely recommended and has proven physical, mental, and social benefits, although the direct connection to well-being is still being researched [15900809, 33066853].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15900809", "evidence_support": "Many researchers have set a clear path between physical exercise and feeling better or the connection of reduced physical activity and diminished health. Nevertheless the allusive subjective psychological construct of well-being has not been directly connected to physical activity.", "evidence_relation": "supporting" }, { "cited_pmid": "15900809", "evidence_support": "Despite abundance of technical evidence that supports notions of correlations between physical exercise and well-being, the scientific proof is not within our reach yet", "evidence_relation": "supporting" }, { "cited_pmid": "15900809", "evidence_support": "Until an actual research based connection will be found between physical exercise and well-being, the authors strongly recommend physical activity as part of everyone's leisure time, since there are enough proven physical mental, and social benefits to physical activity besides well-being.", "evidence_relation": "supporting" }, { "cited_pmid": "33066853", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Meditation interventions have been shown to efficiently reduce cortisol levels, particularly in at-risk populations, such as those with somatic illnesses or living in stressful life situations [25673371, 32635830]. The evidence suggests that mindfulness-based stress reduction can be an effective strategy for stress management and contributing to overall well-being [25673371, 32635830]. Studies have shown that regular contemplative mental training, mindfulness meditation, and cognitive-behavioral stress management can reduce cortisol levels [23724462, 32204833, 37879237]. Additionally, activities such as focusing on positive characteristics, art/music therapies, and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being [33176590, 29604546, 33066853]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Meditation interventions have been shown to efficiently reduce cortisol levels, particularly in at-risk populations, such as those with somatic illnesses or living in stressful life situations [25673371, 32635830].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25673371", "evidence_support": "Mindfulness may influence cortisol, but findings are inconclusive. ", "evidence_relation": "contradicting" }, { "cited_pmid": "32635830", "evidence_support": "Previous meta-analytic results showed beneficial effects of meditation interventions for cortisol levels.", "evidence_relation": "supporting" }, { "cited_pmid": "32635830", "evidence_support": "This pattern may suggest that that meditation interventions are most beneficial for at-risk populations.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The evidence suggests that mindfulness-based stress reduction can be an effective strategy for stress management and contributing to overall well-being [25673371, 32635830].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "25673371", "evidence_support": "Mindfulness may influence cortisol, but findings are inconclusive", "evidence_relation": "neutral" }, { "cited_pmid": "32635830", "evidence_support": "These interventions might provide people with strategies of stress management that can contribute to well-being. Preliminary results suggest that benefits of meditation interventions might not fade with time.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Studies have shown that regular contemplative mental training, mindfulness meditation, and cognitive-behavioral stress management can reduce cortisol levels [23724462, 32204833, 37879237].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23724462", "evidence_support": "Mindfulness meditation is a method to relax the mind that decreases stress, which otherwise would increase serum cortisol. So, mindfulness meditation should decrease serum cortisol.", "evidence_relation": "supporting" }, { "cited_pmid": "23724462", "evidence_support": "Mindfulness meditation lowers the cortisol levels in the blood suggesting that it can lower stress and may decrease the risk of diseases that arise from stress such as psychiatric disorder, peptic ulcer and migraine.", "evidence_relation": "supporting" }, { "cited_pmid": "32204833", "evidence_support": "Activities such as focusing on positive characteristics, art/music therapies, mindfulness, yoga and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being.", "evidence_relation": "supporting" }, { "cited_pmid": "37879237", "evidence_support": "Mindfulness and meditation (g = 0. 345) and relaxation (g = 0. 347) interventions were most effective at changing cortisol levels,", "evidence_relation": "supporting" }, { "cited_pmid": "37879237", "evidence_support": "Overall, the current findings confirm that stress management interventions can positively influence cortisol levels.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, activities such as focusing on positive characteristics, art/music therapies, and engaging with nature and/or physical activity have been shown to reduce stress and enhance well-being [33176590, 29604546, 33066853].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33176590", "evidence_support": "Music therapy is increasingly being used as an intervention for stress reduction in both medical and mental healthcare settings.", "evidence_relation": "supporting" }, { "cited_pmid": "29604546", "evidence_support": "Heart rate, blood pressure, and self-report measures provide the most convincing evidence that spending time in outdoor environments, particularly those with green space, may reduce the experience of stress, and ultimately improve health.", "evidence_relation": "supporting" }, { "cited_pmid": "33066853", "evidence_support": "Nature exposure has been widely shown to have a positive effect in reducing stress, both perceived and physiologic.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Research on the effects of mindfulness-based stress reduction on cortisol levels shows significant changes, with a medium positive effect size, indicating that mindfulness and meditation interventions can positively influence cortisol levels [37879237, 25673371, 23724462, 26790919, 24049209]. Studies have shown that regular contemplative mental training, mindfulness meditation, and cognitive-behavioral stress management can reduce cortisol levels [37879237, 23724462]. Activities that focus on cultivating a high frequency of positive states of mind have been shown to enhance well-being [19592515, 25566365, 33192785, 20522440]. However, nature engagement, which can cultivate positive states of mind, was not found to be correlated with reduced stress levels in one study [19592515, 25566365, 33192785, 20522440]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Research on the effects of mindfulness-based stress reduction on cortisol levels shows significant changes, with a medium positive effect size, indicating that mindfulness and meditation interventions can positively influence cortisol levels [37879237, 25673371, 23724462, 26790919, 24049209].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37879237", "evidence_support": "Overall, the current findings confirm that stress management interventions can positively influence cortisol levels", "evidence_relation": "supporting" }, { "cited_pmid": "25673371", "evidence_support": "Mindfulness may influence cortisol, but findings are inconclusive.", "evidence_relation": "contradicting" }, { "cited_pmid": "23724462", "evidence_support": "Mindfulness meditation lowers the cortisol levels in the blood suggesting that it can lower stress and may decrease the risk of diseases that arise from stress such as psychiatric disorder, peptic ulcer and migraine.", "evidence_relation": "supporting" }, { "cited_pmid": "26790919", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "24049209", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Studies have shown that regular contemplative mental training, mindfulness meditation, and cognitive-behavioral stress management can reduce cortisol levels [37879237, 23724462].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37879237", "evidence_support": "Overall, the current findings confirm that stress management interventions can positively influence cortisol levels", "evidence_relation": "supporting" }, { "cited_pmid": "23724462", "evidence_support": "Mindfulness meditation is a method to relax the mind that decreases stress, which otherwise would increase serum cortisol. So, mindfulness meditation should decrease serum cortisol.", "evidence_relation": "supporting" }, { "cited_pmid": "23724462", "evidence_support": "Mindfulness meditation lowers the cortisol levels in the blood suggesting that it can lower stress and may decrease the risk of diseases that arise from stress such as psychiatric disorder, peptic ulcer and migraine.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Activities that focus on cultivating a high frequency of positive states of mind have been shown to enhance well-being [19592515, 25566365, 33192785, 20522440].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "19592515", "evidence_support": "Enjoyable leisure activities, taken in the aggregate, are associated with psychosocial and physical measures relevant for health and well-being.", "evidence_relation": "supporting" }, { "cited_pmid": "25566365", "evidence_support": "Among people experiencing a high frequency of positive states of mind, perceived stress seems to have a low correspondence with depression, anxiety, and perceived health.", "evidence_relation": "supporting" }, { "cited_pmid": "33192785", "evidence_support": "Our results suggest that it is important for people to have positive experiences with nature in childhood, both for continued NE and to inculcate PEAs in adulthood.", "evidence_relation": "neutral" }, { "cited_pmid": "20522440", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, nature engagement, which can cultivate positive states of mind, was not found to be correlated with reduced stress levels in one study [19592515, 25566365, 33192785, 20522440].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19592515", "evidence_support": "The PEAT was correlated with higher levels of positive psychosocial states and lower levels of depression and negative affect.", "evidence_relation": "contradicting" }, { "cited_pmid": "25566365", "evidence_support": "Among people experiencing a high frequency of positive states of mind, perceived stress seems to have a low correspondence with depression, anxiety, and perceived health.", "evidence_relation": "contradicting" }, { "cited_pmid": "33192785", "evidence_support": "Contrary to other studies and to our hypothesis, we did not find a correlation between undergraduate NE and reduced stress levels.", "evidence_relation": "supporting" }, { "cited_pmid": "20522440", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Lowering cortisol levels can be achieved through various behavioral and environmental modifications.Adequate sleep is crucial, as shorter sleep durations and greater variability in sleep patterns are associated with lower waking cortisol levels and flatter diurnal slopesParental involvement at bedtime can reduce evening cortisol levels in children, suggesting that stress reduction techniques before sleep may be beneficial [36282747]. Additionally, maintaining a consistent sleep schedule and ensuring sufficient sleep duration can help regulate cortisol rhythms [26963376, 33870573]. High ambient temperatures can increase cortisol levels, so managing environmental stressors such as heat exposure may also be effective [33292975]. Finally, engaging in stress-reducing activities like meditation and psychoanalysis can help lower cortisol by improving emotional regulation and reducing physiological arousal [26912245]. These strategies collectively support the regulation of cortisol levels through improved sleep, reduced stress, and controlled environmental factors.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Lowering cortisol levels can be achieved through various behavioral and environmental modifications.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Adequate sleep is crucial, as shorter sleep durations and greater variability in sleep patterns are associated with lower waking cortisol levels and flatter diurnal slopesParental involvement at bedtime can reduce evening cortisol levels in children, suggesting that stress reduction techniques before sleep may be beneficial [36282747].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36282747", "evidence_support": "Path analyses controlling for child and family demographics provided support for three significant indirect effects: lower child evening cortisol acted as a pathway linking greater parental presence at bedtime to more child nighttime sleep minutes and higher sleep efficiency, and lower child evening cortisol also linked greater parental contact at bedtime to higher sleep efficiency. Among this low-risk sample, the findings suggest that encouraging parental involvement in young children's bedtime routine may promote healthy sleep by way of reduced child physiological arousal.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, maintaining a consistent sleep schedule and ensuring sufficient sleep duration can help regulate cortisol rhythms [26963376, 33870573].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26963376", "evidence_support": "Overall, this study provides a greater understanding of how multiple components of sleep, measured in naturalistic environments, are related to cortisol and sAA diurnal rhythms, and how day-to-day, within-person changes in sleep duration contribute to daily variations in cortisol.", "evidence_relation": "supporting" }, { "cited_pmid": "33870573", "evidence_support": "Overall, early sleep onset predicted lower hair cortisol above and beyond sleep duration, family income and chaos experienced at home.", "evidence_relation": "supporting" }, { "cited_pmid": "33870573", "evidence_support": "Findings suggest that in early development, the day-to-day relation between sleep and cortisol is not bidirectional, but more driven by diurnal cortisol.", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "High ambient temperatures can increase cortisol levels, so managing environmental stressors such as heat exposure may also be effective [33292975].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33292975", "evidence_support": "Although goats in the summer maintained rectal temperature and plasma cortisol levels similar to those observed in the winter, the higher respiratory rate and lower feed intake and milk yield (MY) from the goats in the summer indicated that the goats in the summer were exposed to a higher degree of HTa.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Finally, engaging in stress-reducing activities like meditation and psychoanalysis can help lower cortisol by improving emotional regulation and reducing physiological arousal [26912245].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26912245", "evidence_support": "Psychoanalysis and meditation not only compensate for the other's blind spots, but also, when practiced together, can provide a richer experience than either discipline pursued alone.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "These strategies collectively support the regulation of cortisol levels through improved sleep, reduced stress, and controlled environmental factors.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "To lower cortisol levels, focus on stress reduction techniques such as regular physical exercise, which can decrease cortisol production and improve mood.Mindfulness practices, including meditation and yoga, have been shown to reduce cortisol by promoting relaxation and reducing perceived stress.Adequate sleep is crucial, as sleep deprivation can elevate cortisol levels; aim for 7-9 hours of quality sleep per night.A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help regulate cortisol, while avoiding excessive caffeine and sugar is advisable.Social support and engaging in enjoyable activities can also mitigate stress and lower cortisol.Additionally, cognitive-behavioral therapy (CBT) can be effective in managing stress and reducing cortisol levels.If cortisol levels remain high despite these interventions, further evaluation for underlying conditions such as Cushing's syndrome may be warranted.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "To lower cortisol levels, focus on stress reduction techniques such as regular physical exercise, which can decrease cortisol production and improve mood.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Mindfulness practices, including meditation and yoga, have been shown to reduce cortisol by promoting relaxation and reducing perceived stress.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Adequate sleep is crucial, as sleep deprivation can elevate cortisol levels; aim for 7-9 hours of quality sleep per night.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "A balanced diet rich in fruits, vegetables, whole grains, and lean proteins can help regulate cortisol, while avoiding excessive caffeine and sugar is advisable.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Social support and engaging in enjoyable activities can also mitigate stress and lower cortisol.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Additionally, cognitive-behavioral therapy (CBT) can be effective in managing stress and reducing cortisol levels.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "If cortisol levels remain high despite these interventions, further evaluation for underlying conditions such as Cushing's syndrome may be warranted.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Lowering cortisol levels can be achieved through various methods, including establishing a consistent sleep schedule and creating a relaxing bedtime routine, as parental involvement at bedtime has been shown to reduce child evening cortisol levels, which may also apply to adults [36282747]. Additionally, practicing stress-reducing techniques such as meditation and deep breathing exercises can help decrease cortisol levels [26912245]. Furthermore, maintaining a healthy diet and lifestyle, including regular exercise and a balanced eating window, can also contribute to lower cortisol levels [36687684]. It is essential to note that individual results may vary, and what works for one person may not work for another.Moreover, certain medical conditions, such as Cushing's syndrome, may require medical treatment to lower cortisol levels [30764034]. Consultation with a healthcare professional is necessary to determine the best approach for individual cases.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Lowering cortisol levels can be achieved through various methods, including establishing a consistent sleep schedule and creating a relaxing bedtime routine, as parental involvement at bedtime has been shown to reduce child evening cortisol levels, which may also apply to adults [36282747].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36282747", "evidence_support": "Path analyses controlling for child and family demographics provided support for three significant indirect effects: lower child evening cortisol acted as a pathway linking greater parental presence at bedtime to more child nighttime sleep minutes and higher sleep efficiency, and lower child evening cortisol also linked greater parental contact at bedtime to higher sleep efficiency. Among this low-risk sample, the findings suggest that encouraging parental involvement in young children's bedtime routine may promote healthy sleep by way of reduced child physiological arousal.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, practicing stress-reducing techniques such as meditation and deep breathing exercises can help decrease cortisol levels [26912245].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26912245", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Furthermore, maintaining a healthy diet and lifestyle, including regular exercise and a balanced eating window, can also contribute to lower cortisol levels [36687684].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36687684", "evidence_support": "Findings suggest that certain chrononutrition components, particularly eating window and breakfast skipping have a significant influence on maternal melatonin and cortisol rhythm. Dietary intervention targeting these characteristics may be useful in maintaining maternal circadian rhythm.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It is essential to note that individual results may vary, and what works for one person may not work for another.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Moreover, certain medical conditions, such as Cushing's syndrome, may require medical treatment to lower cortisol levels [30764034].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30764034", "evidence_support": "In this article, how adrenal dysfunction presents in critical illness and how appropriate diagnosis and management can be achieved in the critical care setting will be discussed.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Consultation with a healthcare professional is necessary to determine the best approach for individual cases.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gemini-flash": { "answer": "Several methods can help lower cortisol levels. Mindfulness meditation has been shown to decrease stress and reduce cortisol levels in the blood [23724462]. This practice can be used in combination with standard treatments for stress-related conditions [23724462]. Yoga has also been found to significantly reduce salivary cortisol levels [27094980]. Meditation, particularly guided imagery, has been shown to effectively reduce cortisol levels [23715264]. Physical exercise, including tai chi, has been associated with decreased cortisol levels [29262731, 33495978]. Additionally, virtual reality-based relaxation techniques have been shown to reduce salivary cortisol levels [34946455]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Several methods can help lower cortisol levels.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Mindfulness meditation has been shown to decrease stress and reduce cortisol levels in the blood [23724462].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23724462", "evidence_support": "Mindfulness meditation is a method to relax the mind that decreases stress, which otherwise would increase serum cortisol. So, mindfulness meditation should decrease serum cortisol.", "evidence_relation": "supporting" }, { "cited_pmid": "23724462", "evidence_support": "To study the effect of mindfulness meditation on mental health by using Thai GHQ28 questionaire and study the effect of mindfulness meditation on stress by using serum cortisol.", "evidence_relation": "neutral" }, { "cited_pmid": "23724462", "evidence_support": "The average serum cortisol levels before mindfulness meditation was 381.93 nmol/L (SD 97.74) becoming significantly lower after mindfulness meditation 306.38 nmol/L (SD 90.95)", "evidence_relation": "supporting" }, { "cited_pmid": "23724462", "evidence_support": "Mindfulness meditation lowers the cortisol levels in the blood suggesting that it can lower stress and may decrease the risk of diseases that arise from stress such as psychiatric disorder, peptic ulcer and migraine.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This practice can be used in combination with standard treatments for stress-related conditions [23724462].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23724462", "evidence_support": "Then, mindfulness meditation should be used in combination with standard treatment.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Yoga has also been found to significantly reduce salivary cortisol levels [27094980].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27094980", "evidence_support": "Salivary cortisol and alpha-amylase concentration were measured before and after yoga classes at time 1 (27-32 gestational weeks) and time 2 (34-37 gestational weeks)", "evidence_relation": "supporting" }, { "cited_pmid": "27094980", "evidence_support": "The mean salivary cortisol concentration declined significantly after each yoga class ", "evidence_relation": "supporting" }, { "cited_pmid": "27094980", "evidence_support": "This study indicated the immediate stress reduction effects of yoga during pregnancy.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Meditation, particularly guided imagery, has been shown to effectively reduce cortisol levels [23715264].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23715264", "evidence_support": "Guided imagery was effective in reducing cortisol in the group condition (t = 3.90, P < .001)", "evidence_relation": "supporting" }, { "cited_pmid": "23715264", "evidence_support": "Results suggest that specific relaxation techniques may be partially responsible for cortisol decreases associated with relaxation and CBSM", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Physical exercise, including tai chi, has been associated with decreased cortisol levels [29262731, 33495978].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29262731", "evidence_support": "Decreased levels of cortisol, epinephrine and norepinephrine (stress-related hormones) were associated to interventions like yoga, meditation, tai chi, acupuncture, mindfulness, religious/spiritual practices, cognitive behavior therapy, coping and physical exercises. ", "evidence_relation": "supporting" }, { "cited_pmid": "33495978", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Additionally, virtual reality-based relaxation techniques have been shown to reduce salivary cortisol levels [34946455].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34946455", "evidence_support": "All VR-based relaxation techniques reduced salivary steroid hormone (i.e., cortisol, cortisone, and total glucocorticoid) levels and increased galvanic skin response values.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Lowering cortisol levels can be achieved through various stress management techniques. Mindfulness-based stress reduction (MBSR) programs have been shown to significantly reduce cortisol levels in both patients and caregivers [22442202, 32635830]. Relaxation techniques, such as listening to music for relaxation, have also been associated with lower cortisol concentrations [26142566]. Massage therapy has been shown to reduce stress and anxiety, leading to lower cortisol levels [16864390]. Additionally, interventions like cognitive-behavioral stress management (CBSM) have been proven effective in reducing cortisol responses to stress [16330155]. These interventions may provide strategies for stress management, contributing to overall well-being [32635830].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Lowering cortisol levels can be achieved through various stress management techniques.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Mindfulness-based stress reduction (MBSR) programs have been shown to significantly reduce cortisol levels in both patients and caregivers [22442202, 32635830].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22442202", "evidence_support": "MBSR-C may be a beneficial intervention for reducing stress, anxiety, cortisol levels, and symptoms in advanced-stage cancer patients and may also benefit caregivers.", "evidence_relation": "supporting" }, { "cited_pmid": "32635830", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Relaxation techniques, such as listening to music for relaxation, have also been associated with lower cortisol concentrations [26142566].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26142566", "evidence_support": "The relation between music listening and stress is inconsistently reported across studies, with the major part of studies being set in experimental settings. Furthermore, the psychobiological mechanisms for a potential stress-reducing effect remain unclear. We examined the potential stress-reducing effect of music listening in everyday life using both subjective and objective indicators of stress. Fifty-five healthy university students were examined in an ambulatory assessment study, both during a regular term week (five days) and during an examination week (five days). Participants rated their current music-listening behavior and perceived stress levels four times per day, and a sub-sample (n = 25) additionally provided saliva samples for the later analysis of cortisol and alpha-amylase on two consecutive days during both weeks. Results revealed that mere music listening was effective in reducing subjective stress levels (p = 0.010). The most profound effects were found when 'relaxation' was stated as the reason for music listening, with subsequent decreases in subjective stress levels (p \u2264 0.001) and lower cortisol concentrations (p \u2264 0.001). Alpha-amylase varied as a function of the arousal of the selected music, with energizing music increasing and relaxing music decreasing alpha-amylase activity (p = 0.025). These findings suggest that music listening can be considered a means of stress reduction in daily life, especially if it is listened to for the reason of relaxation. Furthermore, these results shed light on the physiological mechanisms underlying the stress-reducing effect of music, with music listening differentially affecting the physiological stress systems.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Massage therapy has been shown to reduce stress and anxiety, leading to lower cortisol levels [16864390].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16864390", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, interventions like cognitive-behavioral stress management (CBSM) have been proven effective in reducing cortisol responses to stress [16330155].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16330155", "evidence_support": "Cognitive-behavioral stress management (CBSM) has repeatedly been shown to effectively reduce cortisol responses to acute psychosocial stress.", "evidence_relation": "supporting" }, { "cited_pmid": "16330155", "evidence_support": "The results show that CBSM reduces psychological and somatic symptoms and influences the ability to show a cortisol response corresponding to subjectively perceived stress.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "These interventions may provide strategies for stress management, contributing to overall well-being [32635830].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32635830", "evidence_support": "Previous meta-analytic results showed beneficial effects of meditation interventions for cortisol levels.", "evidence_relation": "supporting" }, { "cited_pmid": "32635830", "evidence_support": "These interventions might provide people with strategies of stress management that can contribute to well-being.", "evidence_relation": "supporting" }, { "cited_pmid": "32635830", "evidence_support": "Preliminary results suggest that benefits of meditation interventions might not fade with time.", "evidence_relation": "neutral" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "To lower cortisol levels, several effective strategies can be employed. Regular aerobic exercise has been shown to significantly reduce cortisol levels and improve physical health [27540967, 18956514]. Cognitive-behavioral stress management (CBSM) techniques can also effectively decrease cortisol responses to stress [16330155, 23715264]. Additionally, practices such as meditation and relaxation techniques have been linked to lower cortisol levels [32635830, 24406660]. Engaging in nature and physical activity can further enhance stress reduction and promote overall well-being [26684708]. Lastly, maintaining a balanced diet with controlled sugar intake may help modulate cortisol responses to stress [36615866]. Implementing these methods can contribute to better stress management and lower cortisol levels.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "To lower cortisol levels, several effective strategies can be employed.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Regular aerobic exercise has been shown to significantly reduce cortisol levels and improve physical health [27540967, 18956514].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27540967", "evidence_support": "Aerobic exercise (AE) and cognitive training (CT) can reduce cortisol levels.", "evidence_relation": "supporting" }, { "cited_pmid": "18956514", "evidence_support": "Exercise is an effective stress-management tool and is important for physical health.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Cognitive-behavioral stress management (CBSM) techniques can also effectively decrease cortisol responses to stress [16330155, 23715264].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16330155", "evidence_support": "Cognitive-behavioral stress management (CBSM) has repeatedly been shown to effectively reduce cortisol responses to acute psychosocial stress.", "evidence_relation": "supporting" }, { "cited_pmid": "23715264", "evidence_support": "Results suggest that specific relaxation techniques may be partially responsible for cortisol decreases associated with relaxation and CBSM.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, practices such as meditation and relaxation techniques have been linked to lower cortisol levels [32635830, 24406660].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32635830", "evidence_support": "Previous meta-analytic results showed beneficial effects of meditation interventions for cortisol levels.", "evidence_relation": "supporting" }, { "cited_pmid": "24406660", "evidence_support": "Our findings showed that these practices reduced cortisol levels and increased social connectedness. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Engaging in nature and physical activity can further enhance stress reduction and promote overall well-being [26684708].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26684708", "evidence_support": "Physical activity is widely used as a stress-management intervention for employees. Moreover, experiences in contact with nature have been shown to provide stress-reduction and restoration from mental fatigue.", "evidence_relation": "supporting" }, { "cited_pmid": "26684708", "evidence_support": "Green-exercise at the workplace could be a profitable way to manage stress and induce restoration among employees.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Lastly, maintaining a balanced diet with controlled sugar intake may help modulate cortisol responses to stress [36615866].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36615866", "evidence_support": "Cross-species evidence shows that conditions of chronic and acute stress increase the intake of, and preference for, caloric-dense palatable foods, a phenomenon thought to be explained by the mitigating effects of comfort foods on the activity of the stress-response network", "evidence_relation": "neutral" }, { "cited_pmid": "36615866", "evidence_support": "As the consumption of sugar rose individuals had lower post-stressor cortisol levels, a smaller rate of increase in cortisol 20 and 35 min after the CPT, a lower cortisol peak, and an overall weaker quadratic effect", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Implementing these methods can contribute to better stress management and lower cortisol levels.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "To lower cortisol levels, engaging in regular physical activity is highly effective. Exercise has been shown to reduce cortisol levels significantly, with aerobic exercise leading to a reduction of about 26% in cortisol after interventions [27540967]. Additionally, cognitive-behavioral stress management techniques can effectively decrease cortisol responses to stress [16330155]. Simple relaxation techniques, such as diaphragmatic breathing and progressive muscle relaxation, are also beneficial in lowering cortisol levels [24959794]. Furthermore, spending time in nature has been associated with stress reduction and lower cortisol levels [26684708, 34566548]. Incorporating these strategies into your routine can help manage stress and improve overall well-being [37879237, 32635830].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "To lower cortisol levels, engaging in regular physical activity is highly effective.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Exercise has been shown to reduce cortisol levels significantly, with aerobic exercise leading to a reduction of about 26% in cortisol after interventions [27540967].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27540967", "evidence_support": "Aerobic exercise (AE) and cognitive training (CT) can reduce cortisol levels.", "evidence_relation": "supporting" }, { "cited_pmid": "27540967", "evidence_support": "After interventions, cortisol levels were reduced in AE and AE+CT by \u223c26%.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, cognitive-behavioral stress management techniques can effectively decrease cortisol responses to stress [16330155].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16330155", "evidence_support": "Cognitive-behavioral stress management (CBSM) has repeatedly been shown to effectively reduce cortisol responses to acute psychosocial stress.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Simple relaxation techniques, such as diaphragmatic breathing and progressive muscle relaxation, are also beneficial in lowering cortisol levels [24959794].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24959794", "evidence_support": "Specific stress-related symptoms, psychological job demands and cortisol levels were found to be significantly decreased after 8-weeks in the intervention group.", "evidence_relation": "supporting" }, { "cited_pmid": "24959794", "evidence_support": "Simple relaxation training (diaphragmatic breathing and progressive muscle relaxation) could benefit employees and it is strongly proposed that these and other similar techniques should be tested in various labour settings.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, spending time in nature has been associated with stress reduction and lower cortisol levels [26684708, 34566548].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26684708", "evidence_support": "Moreover, experiences in contact with nature have been shown to provide stress-reduction and restoration from mental fatigue.", "evidence_relation": "supporting" }, { "cited_pmid": "26684708", "evidence_support": "Green-exercise at the workplace could be a profitable way to manage stress and induce restoration among employees. Further studies on larger samples are needed in order to improve the generalizability of the results.", "evidence_relation": "supporting" }, { "cited_pmid": "34566548", "evidence_support": "Being amongst trees may also help to alleviate stress and anxiety, lowering cortisol levels and consequently helping the proper functioning of the immune system.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Incorporating these strategies into your routine can help manage stress and improve overall well-being [37879237, 32635830].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32635830", "evidence_support": "These interventions might provide people with strategies of stress management that can contribute to well-being. Preliminary results suggest that benefits of meditation interventions might not fade with time.", "evidence_relation": "supporting" }, { "cited_pmid": "37879237", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-1": { "answer": "The given context does not provide information on how to lower cortisol level. However, it is important to note that high cortisol levels can be associated with Cushing's syndrome, which can be treated by surgical removal of the tumor causing the syndrome [32843452]. Additionally, dexamethasone suppression test (DST) is a diagnostic test for Cushing's syndrome, but it is not a treatment for high cortisol levels [37908989].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The given context does not provide information on how to lower cortisol level.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "However, it is important to note that high cortisol levels can be associated with Cushing's syndrome, which can be treated by surgical removal of the tumor causing the syndrome [32843452].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "32843452", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, dexamethasone suppression test (DST) is a diagnostic test for Cushing's syndrome, but it is not a treatment for high cortisol levels [37908989].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "37908989", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-2": { "answer": "It is difficult to lower the cortisol level in this case as the patient might have a pituitary or adrenal gland disorder or primary aldosteronism [16791399]. The patient should consult a doctor for further evaluation and treatment.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "It is difficult to lower the cortisol level in this case as the patient might have a pituitary or adrenal gland disorder or primary aldosteronism [16791399].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "16791399", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The patient should consult a doctor for further evaluation and treatment.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-3": { "answer": "The text does not provide information on how to lower cortisol levels.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The text does not provide information on how to lower cortisol levels.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-5": { "answer": "The text does not provide information on how to lower cortisol levels.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The text does not provide information on how to lower cortisol levels.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-gpt-1": { "answer": "To lower cortisol levels, consider adopting stress-reduction techniques such as regular exercise, mindfulness meditation, and adequate sleep. Additionally, maintaining a balanced diet rich in whole foods, reducing caffeine and sugar intake, and engaging in relaxation practices can also help manage cortisol levels effectively.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "To lower cortisol levels, consider adopting stress-reduction techniques such as regular exercise, mindfulness meditation, and adequate sleep.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, maintaining a balanced diet rich in whole foods, reducing caffeine and sugar intake, and engaging in relaxation practices can also help manage cortisol levels effectively.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "To lower cortisol levels, consider implementing stress-reduction techniques such as mindfulness, regular physical activity, and adequate sleep, as these practices can help manage stress and potentially reduce cortisol production. While the context discusses cortisol levels in athletes and their stress responses, it does not provide specific interventions for lowering cortisol, so general stress management strategies are recommended.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "To lower cortisol levels, consider implementing stress-reduction techniques such as mindfulness, regular physical activity, and adequate sleep, as these practices can help manage stress and potentially reduce cortisol production.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "While the context discusses cortisol levels in athletes and their stress responses, it does not provide specific interventions for lowering cortisol, so general stress management strategies are recommended.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-gpt-6": { "answer": "Answer: The provided context does not contain relevant information regarding methods to lower cortisol levels. Therefore, I cannot provide an answer based on the given snippets. Generally, lifestyle changes such as regular exercise, adequate sleep, stress management techniques, and a balanced diet can help lower cortisol levels.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Answer: The provided context does not contain relevant information regarding methods to lower cortisol levels.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Therefore, I cannot provide an answer based on the given snippets.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Generally, lifestyle changes such as regular exercise, adequate sleep, stress management techniques, and a balanced diet can help lower cortisol levels.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "zero-shot-gemini-flash": { "answer": "Mindfulness meditation has been shown to effectively lower cortisol levels [23724462, 32635830, 37342644]. Studies have demonstrated a significant decrease in serum cortisol levels after mindfulness meditation sessions [23724462, 37342644]. This reduction in cortisol is attributed to the stress-reducing effects of mindfulness meditation [23724462, 32635830]. Other meditation techniques, such as Osho dynamic meditation and Rajyoga meditation, have also been shown to reduce cortisol levels [28050359, 28393774]. Additionally, aerobic exercise and cognitive training have been found to lower cortisol levels [27540967]. These interventions can provide individuals with strategies for stress management, contributing to overall well-being [32635830]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mindfulness meditation has been shown to effectively lower cortisol levels [23724462, 32635830, 37342644].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23724462", "evidence_support": "Mindfulness meditation lowers the cortisol levels in the blood suggesting that it can lower stress and may decrease the risk of diseases that arise from stress such as psychiatric disorder, peptic ulcer and migraine.", "evidence_relation": "supporting" }, { "cited_pmid": "32635830", "evidence_support": "Previous meta-analytic results showed beneficial effects of meditation interventions for cortisol levels", "evidence_relation": "supporting" }, { "cited_pmid": "37342644", "evidence_support": "Additionally, telomere length is shown to be affected by cortisol levels, and this meditation practice can also help to increase telomere length, and thereby slow down cellular aging.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Studies have demonstrated a significant decrease in serum cortisol levels after mindfulness meditation sessions [23724462, 37342644].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23724462", "evidence_support": "Mindfulness meditation is a method to relax the mind that decreases stress, which otherwise would increase serum cortisol", "evidence_relation": "supporting" }, { "cited_pmid": "23724462", "evidence_support": "So, mindfulness meditation should decrease serum cortisol", "evidence_relation": "supporting" }, { "cited_pmid": "23724462", "evidence_support": "Mindfulness meditation lowers the cortisol levels in the blood suggesting that it can lower stress and may decrease the risk of diseases that arise from stress such as psychiatric disorder, peptic ulcer and migraine.", "evidence_relation": "supporting" }, { "cited_pmid": "37342644", "evidence_support": "Additionally, telomere length is shown to be affected by cortisol levels, and this meditation practice can also help to increase telomere length, and thereby slow down cellular aging.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This reduction in cortisol is attributed to the stress-reducing effects of mindfulness meditation [23724462, 32635830].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23724462", "evidence_support": "Mindfulness meditation is a method to relax the mind that decreases stress, which otherwise would increase serum cortisol.", "evidence_relation": "supporting" }, { "cited_pmid": "23724462", "evidence_support": "Mindfulness meditation lowers the cortisol levels in the blood suggesting that it can lower stress and may decrease the risk of diseases that arise from stress such as psychiatric disorder, peptic ulcer and migraine.", "evidence_relation": "supporting" }, { "cited_pmid": "32635830", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Other meditation techniques, such as Osho dynamic meditation and Rajyoga meditation, have also been shown to reduce cortisol levels [28050359, 28393774].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28050359", "evidence_support": "The results of the study showed a significant reduction in plasma cortisol levels when the participants were tested after 21 days of meditation; it can be concluded that the Osho dynamic meditation produces anti-stress effects. ", "evidence_relation": "supporting" }, { "cited_pmid": "28393774", "evidence_support": "The practice of Rajyoga meditation can have beneficial effects on modulating anxiety and cortisol level in patients undergoing major cardiac surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "28393774", "evidence_support": "The serum cortisol level was also favorably modulated by the practice of Rajyoga meditation.", "evidence_relation": "supporting" }, { "cited_pmid": "28393774", "evidence_support": "Mindbody intervention is found to effective in reducing the anxiety of the patients and modulating the cortisol level in patients undergoing wellknown stressful surgery like coronary artery bypass surgery.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, aerobic exercise and cognitive training have been found to lower cortisol levels [27540967].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27540967", "evidence_support": "Aerobic exercise (AE) and cognitive training (CT) can reduce cortisol levels.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "These interventions can provide individuals with strategies for stress management, contributing to overall well-being [32635830].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32635830", "evidence_support": "These interventions might provide people with strategies of stress management that can contribute to well-being.", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "To lower cortisol levels, consider several effective strategies. Engaging in massage therapy has been shown to reduce stress and anxiety, leading to lower cortisol levels [16864390]. Additionally, aromatherapy with lavender and rosemary can also decrease cortisol [17291597]. Regular physical activity can help; a study indicated significant reductions in cortisol levels after a preparation phase of exercise [25732317]. Furthermore, skin-to-skin contact, which promotes oxytocin release, can help lower cortisol secretion [35850037]. Lastly, even a single session of mud therapy has been reported to significantly decrease cortisol levels [11236389]. Implementing these methods may help improve your performance and overall health.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "To lower cortisol levels, consider several effective strategies.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Engaging in massage therapy has been shown to reduce stress and anxiety, leading to lower cortisol levels [16864390].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16864390", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, aromatherapy with lavender and rosemary can also decrease cortisol [17291597].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17291597", "evidence_support": "In contrast, both lavender and rosemary stimulations decreased cortisol levels. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Regular physical activity can help; a study indicated significant reductions in cortisol levels after a preparation phase of exercise [25732317].", "answer_sentence_relevance": "inappropriate", "citation_assessment": [ { "cited_pmid": "25732317", "evidence_support": "There were significant decrements of cortisol plasma levels (at rest 33.4%; after test 27.46%), with insignificant changes of ACTH plasma levels, after 6 weeks of preparation phase and after finishing of half season, at rest and after maximal treadmill test.", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, skin-to-skin contact, which promotes oxytocin release, can help lower cortisol secretion [35850037].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35850037", "evidence_support": "There was a decrease in salivary cortisol levels to 0.157 [0.088; 0.351]\u00a0\u03bcg/dl compared to baseline (p\u00a0\u02c2\u00a00.001) with a simultaneous increase of the urinary oxytocin level -73.59 [45.18; 108.8]\u00a0pg/ml (p\u2009=\u20090.028) in response to SSC.", "evidence_relation": "neutral" }, { "cited_pmid": "35850037", "evidence_support": "Skin-to-skin contact helps to ameliorate the hormonal stress in preterm infants by activating the oxytocin release with simultaneous reduction of cortisol secretion.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Lastly, even a single session of mud therapy has been reported to significantly decrease cortisol levels [11236389].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "11236389", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Implementing these methods may help improve your performance and overall health.", "answer_sentence_relevance": "required", "citation_assessment": null } ] } } }, { "question_id": "122", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "T wave abnormalities on an ECG can indicate a variety of cardiac issues, ranging from benign variations to more serious conditions such as ischemia, electrolyte imbalances, or myocardial infarction. The T wave represents the repolarization of the ventricles, and abnormalities in its shape, size, or direction can suggest underlying heart problems. For instance, inverted T waves can be a sign of myocardial ischemia, while tall, peaked T waves might indicate hyperkalemia. Given the potential implications, it is important for the patient to consult with a healthcare provider to interpret the results in the context of their overall health and any symptoms they may be experiencing.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "T wave abnormalities on an ECG can indicate a variety of cardiac issues, ranging from benign variations to more serious conditions such as ischemia, electrolyte imbalances, or myocardial infarction.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "The T wave represents the repolarization of the ventricles, and abnormalities in its shape, size, or direction can suggest underlying heart problems.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "For instance, inverted T waves can be a sign of myocardial ischemia, while tall, peaked T waves might indicate hyperkalemia.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Given the potential implications, it is important for the patient to consult with a healthcare provider to interpret the results in the context of their overall health and any symptoms they may be experiencing.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "T-wave abnormalities indicate abnormal ventricular repolarization and are sensitive markers of repolarization abnormalities [33420509, 26391699, 25465868]. T-wave inversion is common in myocardial infarction and can be a sign of silent myocardial ischemia [22179535, 18606329, 25970951]. These abnormalities are prevalent in non-ST-segment elevation acute coronary syndromes and are linked to sudden cardiac death risk [29432131, 15618066, 17897130]. Deeply inverted T-waves in Wellens' syndrome indicate critical LAD stenosis, while T-wave alternans predict potentially fatal arrhythmias [21140289, 26603327, 23870659]. T-wave abnormalities can result from noncardiac pathophysiology and are associated with subclinical atherosclerosis [33420509, 18606329, 16308114]. They predict future cardiovascular events and cardiovascular mortality, with NSSTTAs being independent risk markers for cardiovascular disease, increased cardiovascular mortality, all-cause mortality, and stroke risk [15842426, 23764245, 26523363]. T-wave oversensing can cause inappropriate ICD shocks, and T-wave changes can occur after accessory pathway ablation [18616439, 18709008, 28353570]. T-wave inversion is also common in hypertrophic cardiomyopathy and T-wave reversal in lead aVR is linked to sudden death risk [22179535, 21632912, 36942750].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "T-wave abnormalities indicate abnormal ventricular repolarization and are sensitive markers of repolarization abnormalities [33420509, 26391699, 25465868].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33420509", "evidence_support": "T-wave abnormalities (TWA) are often found on ECG and signify abnormal ventricular repolarisation.", "evidence_relation": "supporting" }, { "cited_pmid": "26391699", "evidence_support": "Several benign and pathological conditions can induce changes in repolarization detected as alteration of the ST segment or T wave", "evidence_relation": "supporting" }, { "cited_pmid": "26391699", "evidence_support": "Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population", "evidence_relation": "supporting" }, { "cited_pmid": "25465868", "evidence_support": "T-wave morphology has been shown to be more sensitive than QT and QTc interval to describe repolarization abnormalities.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "T-wave inversion is common in myocardial infarction and can be a sign of silent myocardial ischemia [22179535, 18606329, 25970951].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18606329", "evidence_support": "T-wave inversions produced by myocardial infarction (MI) are classically narrow and symmetric.", "evidence_relation": "neutral" }, { "cited_pmid": "25970951", "evidence_support": "ST segment depression and T waves inversion are electrocardiographic (ECG) repolarization abnormalities often encountered in clinical medical practice that have been proved to predict future cardiovascular events.", "evidence_relation": "neutral" }, { "cited_pmid": "22179535", "evidence_support": "T-wave inversion on a 12-lead ECG is usually dismissed in young people as normal persistence of the juvenile pattern of repolarization. However, T-wave inversion is a common ECG abnormality of cardiomyopathies such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy, which are leading causes of sudden cardiac death in athletes.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "These abnormalities are prevalent in non-ST-segment elevation acute coronary syndromes and are linked to sudden cardiac death risk [29432131, 15618066, 17897130].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities in the setting of non-ST-segment elevation acute coronary syndromes are related to the presence of myocardial edema.", "evidence_relation": "supporting" }, { "cited_pmid": "15618066", "evidence_support": "Although ST-segment changes are considered the most important ECG feature in NSTE-ACS, T-wave abnormalities are the most common ECG finding", "evidence_relation": "neutral" }, { "cited_pmid": "17897130", "evidence_support": "Abnormal microvolt T-wave alternans (TWA) predicts the risk of ventricular arrhythmias and sudden cardiac death.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Deeply inverted T-waves in Wellens' syndrome indicate critical LAD stenosis, while T-wave alternans predict potentially fatal arrhythmias [21140289, 26603327, 23870659].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21140289", "evidence_support": "T-wave abnormalities are gaining significance in the realm of electrocardiogram diagnostics. In particular, T-wave alternans are proving to be powerful predictive indicators of potentially fatal arrhythmias. T-wave morphology monitoring and analysis are the means by which alternans and other abnormalities are detected.", "evidence_relation": "supporting" }, { "cited_pmid": "26603327", "evidence_support": "Increased T wave alternans (TWA) represents ventricular depolarization heterogeneity and is a non-invasive marker of sudden cardiac death.", "evidence_relation": "supporting" }, { "cited_pmid": "23870659", "evidence_support": "TWA is an attractive marker as it is closely linked to ECG heterogeneity and abnormalities in calcium handling, key factors in arrhythmogenesis", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "T-wave abnormalities can result from noncardiac pathophysiology and are associated with subclinical atherosclerosis [33420509, 18606329, 16308114].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18606329", "evidence_support": "Electrocardiography T-wave changes including low-amplitude and abnormally inverted T waves may be the result of noncardiac path physiology. ", "evidence_relation": "supporting" }, { "cited_pmid": "16308114", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "33420509", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "They predict future cardiovascular events and cardiovascular mortality, with NSSTTAs being independent risk markers for cardiovascular disease, increased cardiovascular mortality, all-cause mortality, and stroke risk [15842426, 23764245, 26523363].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15842426", "evidence_support": "T-wave abnormalities appear to be greater predictors of cardiovascular mortality", "evidence_relation": "supporting" }, { "cited_pmid": "26523363", "evidence_support": "In middle-age men, INTW is associated with a 2 to 3-fold higher risk of death, myocardial infarction and angina pectoris.", "evidence_relation": "supporting" }, { "cited_pmid": "23764245", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "T-wave oversensing can cause inappropriate ICD shocks, and T-wave changes can occur after accessory pathway ablation [18616439, 18709008, 28353570].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18616439", "evidence_support": "In patients with potential ACS presenting to the ED, T-wave abnormalities are associated with higher rates of 30-day cardiovascular events.", "evidence_relation": "supporting" }, { "cited_pmid": "18709008", "evidence_support": "T-wave inversion in leads II, III and aVF with the disappearance of the delta wave after ablation of the accessory pathway in patients with Wolff-Parkinson-White syndrome (accessory pathway in the right posteroseptal region of the heart), is the most powerful marker of successful ablation.", "evidence_relation": "supporting" }, { "cited_pmid": "28353570", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "8", "answer_sentence": "T-wave inversion is also common in hypertrophic cardiomyopathy and T-wave reversal in lead aVR is linked to sudden death risk [22179535, 21632912, 36942750].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22179535", "evidence_support": "However, T-wave inversion is a common ECG abnormality of cardiomyopathies such as hypertrophic cardiomyopathy and arrhythmogenic right ventricular cardiomyopathy, which are leading causes of sudden cardiac death in athletes.", "evidence_relation": "supporting" }, { "cited_pmid": "22179535", "evidence_support": "The prevalence of T-wave inversion decreases significantly after puberty. Echocardiographic investigation of children with postpubertal persistence of T-wave inversion at preparticipation screening is warranted because it may lead to presymptomatic diagnosis of a cardiomyopathy that could lead to sudden cardiac death during sports.", "evidence_relation": "supporting" }, { "cited_pmid": "36942750", "evidence_support": "T wave inversion (TWI) on ECG may suggest an undiagnosed cardiomyopathy.", "evidence_relation": "supporting" }, { "cited_pmid": "36942750", "evidence_support": "Cardiomyopathy diagnoses were more strongly associated with certain patterns of abnormal TWI.", "evidence_relation": "supporting" }, { "cited_pmid": "21632912", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "T-wave abnormalities on electrocardiograms (ECGs) indicate disruptions in ventricular repolarization and can be associated with various cardiac conditions, including myocardial edema in non-ST-elevation acute coronary syndromes subclinical atherosclerosis, and increased cardiovascular mortality [29432131, 33420509, 15842426]. These abnormalities, such as T-wave inversions or alternans, are significant predictors of potentially fatal arrhythmias and sudden cardiac death [21140289, 26391699]. In patients with diabetes, T-wave abnormalities are linked to major cardiovascular events and structural myocardial changes [33420509, 26603327]. Additionally, T-wave axis deviations are prevalent in metabolic syndrome and can independently predict cardiovascular risk [23102027]. Monitoring T-wave morphology is crucial for early detection and risk stratification in clinical settings [21140289, 23870659]. Understanding the specific etiology of T-wave abnormalities requires comprehensive clinical evaluation and targeted cardiac investigations [24276094].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "T-wave abnormalities on electrocardiograms (ECGs) indicate disruptions in ventricular repolarization and can be associated with various cardiac conditions, including myocardial edema in non-ST-elevation acute coronary syndromes subclinical atherosclerosis, and increased cardiovascular mortality [29432131, 33420509, 15842426].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities in the setting of non-ST-segment elevation acute coronary syndromes are related to the presence of myocardial edema. ", "evidence_relation": "supporting" }, { "cited_pmid": "33420509", "evidence_support": "The presence and magnitude of TWA are associated with increased risk of clinical cardiovascular events and mortality in individuals with diabetes and may have value in refining risk, particularly in those with prevalent CVD.", "evidence_relation": "supporting" }, { "cited_pmid": "15842426", "evidence_support": "While both ST segment depression and abnormal T-wave amplitude are clinically important, T-wave abnormalities appear to be greater predictors of cardiovascular mortality.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These abnormalities, such as T-wave inversions or alternans, are significant predictors of potentially fatal arrhythmias and sudden cardiac death [21140289, 26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21140289", "evidence_support": "In particular, T-wave alternans are proving to be powerful predictive indicators of potentially fatal arrhythmias.", "evidence_relation": "supporting" }, { "cited_pmid": "26391699", "evidence_support": "In this review, we will discuss the current knowledge of the SCD risk with standard 12-lead ECG T wave abnormalities in the general population, and possible T wave changes in various cardiac conditions predisposing to SCD.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In patients with diabetes, T-wave abnormalities are linked to major cardiovascular events and structural myocardial changes [33420509, 26603327].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33420509", "evidence_support": "The presence and magnitude of TWA are associated with increased risk of clinical cardiovascular events and mortality in individuals with diabetes and may have value in refining risk, particularly in those with prevalent CVD.", "evidence_relation": "supporting" }, { "cited_pmid": "26603327", "evidence_support": "Our results demonstrated that calibrated IBS, GLS, and LV diastolic dysfunction are independent predictors for high TWA in T2DM patients. These findings suggest that subclinical myocardial structural and functional abnormalities may contribute to high TWA in T2DM patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, T-wave axis deviations are prevalent in metabolic syndrome and can independently predict cardiovascular risk [23102027].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "23102027", "evidence_support": "T wave axis abnormality is associated with an increased risk of cardiovascular mortality, independently of other risk factors and can be associated with the presence of the metabolic syndrome (MetS).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Monitoring T-wave morphology is crucial for early detection and risk stratification in clinical settings [21140289, 23870659].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "21140289", "evidence_support": "T-wave morphology monitoring and analysis are the means by which alternans and other abnormalities are detected.", "evidence_relation": "supporting" }, { "cited_pmid": "21140289", "evidence_support": "Current design of the T-wave monitor, once improved, can find use in the screening, diagnosis, and early detection of T-wave abnormalities in clinical settings.", "evidence_relation": "supporting" }, { "cited_pmid": "23870659", "evidence_support": "TWA in risk stratification and to discuss its current and potential applications in guiding device and medical therapy.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Understanding the specific etiology of T-wave abnormalities requires comprehensive clinical evaluation and targeted cardiac investigations [24276094].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24276094", "evidence_support": "The causes of abnormal T waves on electrocardiography are multiple and varied. Careful clinical history taking and physical examination are necessary for accurate identification of the cause of such abnormalities. Subsequent targeted specialised cardiac investigations, such as echocardiography or coronary angiography, may be of importance in the diagnosis of the underlying cardiac pathology.", "evidence_relation": "supporting" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "A T-wave abnormality refers to an irregularity in the T-wave component of an electrocardiogram (ECG), which can be indicative of various cardiac conditions [24276094, 29432131]. T-wave abnormalities can manifest as changes in the T-wave axis, morphology, or amplitude, and may be associated with myocardial edema, ischemia, or other cardiac pathologies [29432131, 21140289]. In some cases, T-wave abnormalities may be a marker of increased risk for sudden cardiac death, particularly in individuals with underlying cardiovascular disease [33420509, 15842426]. T-wave alternans, a specific type of T-wave abnormality, has been linked to repolarization heterogeneity and arrhythmogenesis [26391699, 23102027]. The clinical significance of T-wave abnormalities can vary depending on the context, and careful interpretation of the ECG in conjunction with clinical history and physical examination is necessary for accurate diagnosis [24276094, 18616439]. T-wave abnormalities can also be seen in healthy individuals, particularly athletes, and may not always be indicative of underlying pathology [29538783, 16893703].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T-wave abnormality refers to an irregularity in the T-wave component of an electrocardiogram (ECG), which can be indicative of various cardiac conditions [24276094, 29432131].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities are common during the acute phase of non-ST-segment elevation acute coronary syndromes, but mechanisms underlying their occurrence are unclear.", "evidence_relation": "supporting" }, { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities in the setting of non-ST-segment elevation acute coronary syndromes are related to the presence of myocardial edema.", "evidence_relation": "supporting" }, { "cited_pmid": "24276094", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "T-wave abnormalities can manifest as changes in the T-wave axis, morphology, or amplitude, and may be associated with myocardial edema, ischemia, or other cardiac pathologies [29432131, 21140289].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities in the setting of non-ST-segment elevation acute coronary syndromes are related to the presence of myocardial edema.", "evidence_relation": "supporting" }, { "cited_pmid": "21140289", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In some cases, T-wave abnormalities may be a marker of increased risk for sudden cardiac death, particularly in individuals with underlying cardiovascular disease [33420509, 15842426].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33420509", "evidence_support": "The presence and magnitude of TWA are associated with increased risk of clinical cardiovascular events and mortality in individuals with diabetes and may have value in refining risk, particularly in those with prevalent CVD. Graphical abstract.", "evidence_relation": "supporting" }, { "cited_pmid": "15842426", "evidence_support": "While both ST segment depression and abnormal T-wave amplitude are clinically important, T-wave abnormalities appear to be greater predictors of cardiovascular mortality.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "T-wave alternans, a specific type of T-wave abnormality, has been linked to repolarization heterogeneity and arrhythmogenesis [26391699, 23102027].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26391699", "evidence_support": "Several benign and pathological conditions can induce changes in repolarization detected as alteration of the ST segment or T wave", "evidence_relation": "supporting" }, { "cited_pmid": "23102027", "evidence_support": "T wave axis abnormality is associated with an increased risk of cardiovascular mortality, independently of other risk factors and can be associated with the presence of the metabolic syndrome (MetS)", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The clinical significance of T-wave abnormalities can vary depending on the context, and careful interpretation of the ECG in conjunction with clinical history and physical examination is necessary for accurate diagnosis [24276094, 18616439].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24276094", "evidence_support": "The causes of abnormal T waves on electrocardiography are multiple and varied. Careful clinical history taking and physical examination are necessary for accurate identification of the cause of such abnormalities.", "evidence_relation": "supporting" }, { "cited_pmid": "18616439", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "T-wave abnormalities can also be seen in healthy individuals, particularly athletes, and may not always be indicative of underlying pathology [29538783, 16893703].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16893703", "evidence_support": "The potential importance of T-wave assessment in the fetus with cardiac arrhythmia was evidenced by the high incidence of marked QT prolongation and T-wave alternans in the fetuses with suboptimal outcomes.", "evidence_relation": "neutral" }, { "cited_pmid": "29538783", "evidence_support": "Many forms of CVD that predispose to sudden cardiac death are associated with T-wave abnormalities in childhood", "evidence_relation": "neutral" } ] } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG) that can indicate various heart conditions, including myocardial infarction, ventricular hypertrophy, and bundle branch block [22819483, 15914943, 33183921]. T wave abnormalities can be classified into different types, such as T wave inversion, T wave flattening, and T wave alternans [22819483, 16216613, 33183921]. T wave inversion is a common abnormality that can be seen in various conditions, including myocardial infarction, coronary artery disease, and cardiomyopathy [34397499, 33183921, 21671953]. T wave alternans is a specific type of abnormality that can indicate an increased risk of arrhythmias and sudden cardiac death [19479631, 20555232, 16602577]. The presence and type of T wave abnormality can provide important information about the underlying heart condition and can be used to guide diagnosis and treatment [26718348]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG) that can indicate various heart conditions, including myocardial infarction, ventricular hypertrophy, and bundle branch block [22819483, 15914943, 33183921].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15914943", "evidence_support": "T-wave morphology analysis (TMA) quantifies irregularities of ventricular repolarization based on singular value decomposition of the 12-lead electrocardiogram (ECG).", "evidence_relation": "supporting" }, { "cited_pmid": "33183921", "evidence_support": "Although T-wave inversions are nonspecific, in the appropriate clinical setting, the pattern of negative biphasic T-waves or T-wave inversion in V2-V3 can indicate critical stenosis of the left anterior descending coronary artery (i.e. \"anterior Wellens sign\").", "evidence_relation": "supporting" }, { "cited_pmid": "33183921", "evidence_support": "New, focal T-wave inversions in an anatomic distribution may be an early warning sign of impending myocardial infarction.", "evidence_relation": "supporting" }, { "cited_pmid": "22819483", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "T wave abnormalities can be classified into different types, such as T wave inversion, T wave flattening, and T wave alternans [22819483, 16216613, 33183921].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33183921", "evidence_support": "In this case, T-wave inversions in the inferior leads, along with a tall T-wave in V2-V3, were seen prior to the development of an inferior-posterior STEMI.", "evidence_relation": "neutral" }, { "cited_pmid": "22819483", "evidence_support": "T-wave inversion is associated with increased odds of DD in patients with ECG-LVH with preserved systolic function. The reversal of the normal sequence of repolarization manifested on the 12-lead ECG as TWI may be a factor to DD.", "evidence_relation": "neutral" }, { "cited_pmid": "16216613", "evidence_support": "However, recent studies suggest that inverted T waves in the precordial leads are the most frequent ECG sign of massive PE (Chest 1997;11:537).", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "T wave inversion is a common abnormality that can be seen in various conditions, including myocardial infarction, coronary artery disease, and cardiomyopathy [34397499, 33183921, 21671953].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34397499", "evidence_support": "The ECG showed T-wave morphology known to be consistent with myocardial infarction. Although the ECG is a crucial diagnostic tool to recognize myocardial ischemia and infarction promptly, it must be understood that T-wave abnormalities can represent noncardiac pathology", "evidence_relation": "supporting" }, { "cited_pmid": "33183921", "evidence_support": "Although T-wave inversions are nonspecific, in the appropriate clinical setting, the pattern of negative biphasic T-waves or T-wave inversion in V2-V3 can indicate critical stenosis of the left anterior descending coronary artery (i.e. \"anterior Wellens sign\"). ", "evidence_relation": "supporting" }, { "cited_pmid": "21671953", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "T wave alternans is a specific type of abnormality that can indicate an increased risk of arrhythmias and sudden cardiac death [19479631, 20555232, 16602577].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19479631", "evidence_support": "Abnormal T-wave morphology and TWA seem to reflect the heart disease rather than specifically vulnerability to VT/VF.", "evidence_relation": "supporting" }, { "cited_pmid": "20555232", "evidence_support": "Over the course of more than a century, visible T-wave alternans (TWA), defined as a beat-to-beat alternation in the morphology and amplitude of the ST segment or T wave, has been observed to occur in close association with life-threatening arrhythmias in patients with acute myocardial ischemia and infarction, heart failure, Prinzmetal's angina, and channelopathies, including Brugada and long QT syndromes", "evidence_relation": "supporting" }, { "cited_pmid": "16602577", "evidence_support": "T-wave alternans (TWA) has been linked to increased vulnerability to ventricular fibrillation in different settings including myocardial ischemia", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The presence and type of T wave abnormality can provide important information about the underlying heart condition and can be used to guide diagnosis and treatment [26718348].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "26718348", "evidence_support": "T wave amplitude in V2-V6 \u22650.6mV, and T wave amplitude in lead 1+V6 \u22640mV detected a lateral infarction (sensitivity 33 and 44%, specificity 83 and 80%). T wave amplitude in lead 1+V6 \u22640mV was the only independent predictor of infarction or LCx occlusion (AUC 0.72 and 0.74).", "evidence_relation": "neutral" }, { "cited_pmid": "26718348", "evidence_support": " T wave abnormalities identify previous lateral infarction and LCx disease", "evidence_relation": "neutral" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "A T wave abnormality is a change in the shape or amplitude of the T wave on an electrocardiogram (ECG) [26718348, 29538783, 26391699]. The T wave represents the repolarization of the ventricles in the heart [30969986, 29538783, 15618066]. T wave abnormalities can be caused by various factors, including myocardial ischemia, infarction, and repolarization disorders [26718348, 30969986, 26391699]. They can also be associated with underlying cardiac conditions, such as coronary artery disease, heart failure, and cardiomyopathy [26718348, 30969986, 26391699]. T wave abnormalities can be classified into different types, including T wave inversion, flattening, and biphasic T waves [26718348, 30969986, 26391699]. The presence of T wave abnormalities on an ECG can indicate a higher risk of cardiovascular events, including myocardial infarction, heart failure, and sudden cardiac death [30969986, 26391699, 18616439]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T wave abnormality is a change in the shape or amplitude of the T wave on an electrocardiogram (ECG) [26718348, 29538783, 26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26718348", "evidence_support": "T wave amplitude in V2-V6 \u22650.6mV, and T wave amplitude in lead 1+V6 \u22640mV detected a lateral infarction (sensitivity 33 and 44%, specificity 83 and 80%). T wave amplitude in lead 1+V6 \u22640mV was the only independent predictor of infarction or LCx occlusion (AUC 0.72 and 0.74).", "evidence_relation": "neutral" }, { "cited_pmid": "26391699", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "29538783", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The T wave represents the repolarization of the ventricles in the heart [30969986, 29538783, 15618066].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29538783", "evidence_support": "The T-wave is generated during ventricular repolarization.", "evidence_relation": "supporting" }, { "cited_pmid": "30969986", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15618066", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "T wave abnormalities can be caused by various factors, including myocardial ischemia, infarction, and repolarization disorders [26718348, 30969986, 26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26718348", "evidence_support": " T wave abnormalities identify previous lateral infarction and LCx disease.", "evidence_relation": "supporting" }, { "cited_pmid": "30969986", "evidence_support": "T wave alternans (TWA) is an electrocardiographic marker of heightened sudden death risk from ventricular tachyarrhythmias in patients with cardiomyopathy. ", "evidence_relation": "supporting" }, { "cited_pmid": "26391699", "evidence_support": "Several benign and pathological conditions can induce changes in repolarization detected as alteration of the ST segment or T wave. Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "They can also be associated with underlying cardiac conditions, such as coronary artery disease, heart failure, and cardiomyopathy [26718348, 30969986, 26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26718348", "evidence_support": "T wave abnormalities identify previous lateral infarction and LCx disease.", "evidence_relation": "neutral" }, { "cited_pmid": "30969986", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "26391699", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "T wave abnormalities can be classified into different types, including T wave inversion, flattening, and biphasic T waves [26718348, 30969986, 26391699].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "30969986", "evidence_support": "T wave alternans (TWA) is an electrocardiographic marker of heightened sudden death risk from ventricular tachyarrhythmias in patients with cardiomyopathy.", "evidence_relation": "neutral" }, { "cited_pmid": "26391699", "evidence_support": "Several benign and pathological conditions can induce changes in repolarization detected as alteration of the ST segment or T wave.", "evidence_relation": "neutral" }, { "cited_pmid": "26718348", "evidence_support": "T wave abnormalities identify previous lateral infarction and LCx disease.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "The presence of T wave abnormalities on an ECG can indicate a higher risk of cardiovascular events, including myocardial infarction, heart failure, and sudden cardiac death [30969986, 26391699, 18616439].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30969986", "evidence_support": "T wave alternans (TWA) is an electrocardiographic marker of heightened sudden death risk from ventricular tachyarrhythmias in patients with cardiomyopathy.", "evidence_relation": "supporting" }, { "cited_pmid": "26391699", "evidence_support": "Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population.", "evidence_relation": "supporting" }, { "cited_pmid": "18616439", "evidence_support": "In patients with potential ACS presenting to the ED, T-wave abnormalities are associated with higher rates of 30-day cardiovascular events.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG), which is a test that measures the electrical activity of the heart [15842426, 36863333, 26336523]. The T wave represents the repolarization of the ventricles, and abnormalities in this wave can indicate various heart conditions, such as myocardial infarction, coronary artery disease, or other cardiac problems [21140289, 15842426, 26273449]. T wave abnormalities can manifest as changes in the shape, size, or direction of the T wave, and can be associated with an increased risk of cardiovascular mortality, sudden cardiac death, or other adverse outcomes [21140289, 36863333, 18616439]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG), which is a test that measures the electrical activity of the heart [15842426, 36863333, 26336523].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15842426", "evidence_support": "Electrocardiograms were classified using Minnesota code according to the degree of ST depression and T-wave abnormality, and the nine possible combinations of ST segment and T-wave abnormalities were recoded for analysis.", "evidence_relation": "supporting" }, { "cited_pmid": "36863333", "evidence_support": "This study aimed to observe the incidence of MACE in hypertensive patients and the correlation between the electrocardiogram (ECG) T-wave abnormalities and echocardiographic changes", "evidence_relation": "neutral" }, { "cited_pmid": "26336523", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The T wave represents the repolarization of the ventricles, and abnormalities in this wave can indicate various heart conditions, such as myocardial infarction, coronary artery disease, or other cardiac problems [21140289, 15842426, 26273449].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21140289", "evidence_support": "In particular, T-wave alternans are proving to be powerful predictive indicators of potentially fatal arrhythmias.", "evidence_relation": "supporting" }, { "cited_pmid": "15842426", "evidence_support": "ST depression and T-wave amplitude abnormalities are known to be independent predictors of cardiovascular (CV) death, but a direct comparison between them has not been described.", "evidence_relation": "supporting" }, { "cited_pmid": "15842426", "evidence_support": "While both ST segment depression and abnormal T-wave amplitude are clinically important, T-wave abnormalities appear to be greater predictors of cardiovascular mortality.", "evidence_relation": "supporting" }, { "cited_pmid": "26273449", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "T wave abnormalities can manifest as changes in the shape, size, or direction of the T wave, and can be associated with an increased risk of cardiovascular mortality, sudden cardiac death, or other adverse outcomes [21140289, 36863333, 18616439].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21140289", "evidence_support": "In particular, T-wave alternans are proving to be powerful predictive indicators of potentially fatal arrhythmias.", "evidence_relation": "supporting" }, { "cited_pmid": "36863333", "evidence_support": "Hypertensive patients with abnormal T-wave show a higher incidence of adverse cardiovascular events. The values of cardiac structural markers were significantly higher in the group with abnormal T-wave.", "evidence_relation": "supporting" }, { "cited_pmid": "18616439", "evidence_support": "In patients with potential ACS presenting to the ED, T-wave abnormalities are associated with higher rates of 30-day cardiovascular events.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG), which is a test that measures the electrical activity of the heart [26336523, 17870490, 24276094]. The T wave represents the repolarization of the ventricles, and abnormalities in this wave can indicate various heart conditions, such as myocardial infarction, coronary artery disease, or other cardiac problems [26718348, 37449521, 26391699]. T wave abnormalities can manifest as changes in the shape, size, or direction of the T wave, and can be associated with an increased risk of cardiovascular mortality, sudden cardiac death, or other adverse outcomes [29538783, 15842426, 26391699]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG), which is a test that measures the electrical activity of the heart [26336523, 17870490, 24276094].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24276094", "evidence_support": "The causes of abnormal T waves on electrocardiography are multiple and varied.", "evidence_relation": "neutral" }, { "cited_pmid": "17870490", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "26336523", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The T wave represents the repolarization of the ventricles, and abnormalities in this wave can indicate various heart conditions, such as myocardial infarction, coronary artery disease, or other cardiac problems [26718348, 37449521, 26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26718348", "evidence_support": "T wave abnormalities identify previous lateral infarction and LCx disease.", "evidence_relation": "supporting" }, { "cited_pmid": "37449521", "evidence_support": "Prolonged QTc, atrial fibrillation (AF)\u00a0and ECG changes indicative of ischemic heart disease, such as Q waves, ST depression, and T wave inversion, were the most prevalent changes. ", "evidence_relation": "supporting" }, { "cited_pmid": "26391699", "evidence_support": "Several benign and pathological conditions can induce changes in repolarization detected as alteration of the ST segment or T wave", "evidence_relation": "supporting" }, { "cited_pmid": "26391699", "evidence_support": "Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "T wave abnormalities can manifest as changes in the shape, size, or direction of the T wave, and can be associated with an increased risk of cardiovascular mortality, sudden cardiac death, or other adverse outcomes [29538783, 15842426, 26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29538783", "evidence_support": "Many forms of CVD that predispose to sudden cardiac death are associated with T-wave abnormalities in childhood", "evidence_relation": "supporting" }, { "cited_pmid": "15842426", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "26391699", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG), which is a test that measures the electrical activity of the heart [17870490, 24276094, 15842426]. The T wave represents the repolarization of the ventricles, and abnormalities in this wave can indicate various heart conditions, such as myocardial infarction, coronary artery disease, or other cardiac problems [37449521, 26718348, 26391699]. T wave abnormalities can manifest as changes in the shape, size, or direction of the T wave, and can be associated with an increased risk of cardiovascular mortality, sudden cardiac death, or other adverse outcomes [15842426, 29538783, 26391699]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG), which is a test that measures the electrical activity of the heart [17870490, 24276094, 15842426].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24276094", "evidence_support": "The causes of abnormal T waves on electrocardiography are multiple and varied.", "evidence_relation": "neutral" }, { "cited_pmid": "15842426", "evidence_support": "Electrocardiograms were classified using Minnesota code according to the degree of ST depression and T-wave abnormality, and the nine possible combinations of ST segment and T-wave abnormalities were recoded for analysis.", "evidence_relation": "neutral" }, { "cited_pmid": "17870490", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The T wave represents the repolarization of the ventricles, and abnormalities in this wave can indicate various heart conditions, such as myocardial infarction, coronary artery disease, or other cardiac problems [37449521, 26718348, 26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37449521", "evidence_support": "Prolonged QTc, atrial fibrillation (AF)\u00a0and ECG changes indicative of ischemic heart disease, such as Q waves, ST depression, and T wave inversion, were the most prevalent changes.", "evidence_relation": "supporting" }, { "cited_pmid": "26718348", "evidence_support": "T wave amplitude in V2-V6 \u22650.6mV, and T wave amplitude in lead 1+V6 \u22640mV detected a lateral infarction (sensitivity 33 and 44%, specificity 83 and 80%). T wave amplitude in lead 1+V6 \u22640mV was the only independent predictor of infarction or LCx occlusion (AUC 0.72 and 0.74).", "evidence_relation": "neutral" }, { "cited_pmid": "26391699", "evidence_support": "Several benign and pathological conditions can induce changes in repolarization detected as alteration of the ST segment or T wave. Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "T wave abnormalities can manifest as changes in the shape, size, or direction of the T wave, and can be associated with an increased risk of cardiovascular mortality, sudden cardiac death, or other adverse outcomes [15842426, 29538783, 26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15842426", "evidence_support": "While both ST segment depression and abnormal T-wave amplitude are clinically important, T-wave abnormalities appear to be greater predictors of cardiovascular mortality.", "evidence_relation": "supporting" }, { "cited_pmid": "29538783", "evidence_support": "Many forms of CVD that predispose to sudden cardiac death are associated with T-wave abnormalities in childhood.", "evidence_relation": "supporting" }, { "cited_pmid": "26391699", "evidence_support": "Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population.", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG), which is a test that measures the electrical activity of the heart [24276094, 17870490, 36863333]. The T wave represents the repolarization of the ventricles, and abnormalities in this wave can indicate various heart conditions, such as myocardial infarction, coronary artery disease, or other cardiac problems [37449521, 26718348, 26391699]. T wave abnormalities can manifest as changes in the shape, size, or direction of the T wave, and can be associated with an increased risk of cardiovascular mortality, sudden cardiac death, or other adverse outcomes [15842426, 29538783, 26391699]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG), which is a test that measures the electrical activity of the heart [24276094, 17870490, 36863333].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36863333", "evidence_support": "This study aimed to observe the incidence of MACE in hypertensive patients and the correlation between the electrocardiogram (ECG) T-wave abnormalities and echocardiographic changes", "evidence_relation": "neutral" }, { "cited_pmid": "24276094", "evidence_support": "The causes of abnormal T waves on electrocardiography are multiple and varied.", "evidence_relation": "neutral" }, { "cited_pmid": "17870490", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The T wave represents the repolarization of the ventricles, and abnormalities in this wave can indicate various heart conditions, such as myocardial infarction, coronary artery disease, or other cardiac problems [37449521, 26718348, 26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37449521", "evidence_support": "Prolonged QTc, atrial fibrillation (AF)\u00a0and ECG changes indicative of ischemic heart disease, such as Q waves, ST depression, and T wave inversion, were the most prevalent changes.", "evidence_relation": "supporting" }, { "cited_pmid": "26391699", "evidence_support": "Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population.", "evidence_relation": "supporting" }, { "cited_pmid": "26718348", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "T wave abnormalities can manifest as changes in the shape, size, or direction of the T wave, and can be associated with an increased risk of cardiovascular mortality, sudden cardiac death, or other adverse outcomes [15842426, 29538783, 26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15842426", "evidence_support": "T-wave abnormalities appear to be greater predictors of cardiovascular mortality", "evidence_relation": "supporting" }, { "cited_pmid": "29538783", "evidence_support": "Many forms of CVD that predispose to sudden cardiac death are associated with T-wave abnormalities in childhood.", "evidence_relation": "supporting" }, { "cited_pmid": "26391699", "evidence_support": "Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population", "evidence_relation": "supporting" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG), which is a test that measures the electrical activity of the heart [21140289, 16613182, 24276094]. The T wave represents the repolarization of the ventricles, and abnormalities in this wave can indicate various heart conditions, such as myocardial infarction, coronary artery disease, or other cardiac problems [15842434, 26718348, 34130049]. T wave abnormalities can manifest as changes in the shape, size, or direction of the T wave, and can be associated with an increased risk of cardiovascular mortality, sudden cardiac death, or other adverse outcomes [26718348, 26391699, 16613182]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG), which is a test that measures the electrical activity of the heart [21140289, 16613182, 24276094].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16613182", "evidence_support": "As important electrocardiographic findings of myocardial ischemia, there are ST elevation or depression, increase high T wave (hyperacute T wave), negative T wave and negative U wave, but it is particularly important to compare those findings and manifestation.", "evidence_relation": "neutral" }, { "cited_pmid": "21140289", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "24276094", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The T wave represents the repolarization of the ventricles, and abnormalities in this wave can indicate various heart conditions, such as myocardial infarction, coronary artery disease, or other cardiac problems [15842434, 26718348, 34130049].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15842434", "evidence_support": "The T wave marks the final phase of ventricular repolarization and is a symbol of transmural dispersion of repolarization (TDR) in the ventricles.", "evidence_relation": "supporting" }, { "cited_pmid": "34130049", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "26718348", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "T wave abnormalities can manifest as changes in the shape, size, or direction of the T wave, and can be associated with an increased risk of cardiovascular mortality, sudden cardiac death, or other adverse outcomes [26718348, 26391699, 16613182].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26391699", "evidence_support": "Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population.", "evidence_relation": "supporting" }, { "cited_pmid": "16613182", "evidence_support": "there are ST elevation or depression, increase high T wave (hyperacute T wave), negative T wave and negative U wave, but it is particularly important to compare those findings and manifestation.", "evidence_relation": "supporting" }, { "cited_pmid": "26718348", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG), which is a test that measures the electrical activity of the heart [21140289]. The T wave represents the repolarization of the ventricles, and abnormalities in this wave can indicate various heart conditions, such as myocardial infarction, coronary artery disease, or other cardiac problems [15842426, 34130049]. T wave abnormalities can manifest as changes in the shape, size, or direction of the T wave, and can be associated with previous lateral wall myocardial infarction and circumflex artery disease [26718348, 26391699]. These changes can be early markers of an underlying cardiovascular disease [26718348, 26391699]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG), which is a test that measures the electrical activity of the heart [21140289].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21140289", "evidence_support": "T-wave morphology monitoring and analysis are the means by which alternans and other abnormalities are detected.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The T wave represents the repolarization of the ventricles, and abnormalities in this wave can indicate various heart conditions, such as myocardial infarction, coronary artery disease, or other cardiac problems [15842426, 34130049].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15842426", "evidence_support": "ST depression and T-wave amplitude abnormalities are known to be independent predictors of cardiovascular (CV) death, but a direct comparison between them has not been described.", "evidence_relation": "supporting" }, { "cited_pmid": "15842426", "evidence_support": "While both ST segment depression and abnormal T-wave amplitude are clinically important, T-wave abnormalities appear to be greater predictors of cardiovascular mortality.", "evidence_relation": "supporting" }, { "cited_pmid": "34130049", "evidence_support": "Although upright T wave in lead V1 can be a normal variant, it has been linked in a few studies and observations to cardiovascular disease, especially myocardial ischemia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "T wave abnormalities can manifest as changes in the shape, size, or direction of the T wave, and can be associated with previous lateral wall myocardial infarction and circumflex artery disease [26718348, 26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26718348", "evidence_support": "T wave abnormalities identify previous lateral infarction and LCx disease.", "evidence_relation": "supporting" }, { "cited_pmid": "26391699", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "These changes can be early markers of an underlying cardiovascular disease [26718348, 26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26718348", "evidence_support": "wave abnormalities identify previous lateral infarction and LCx disease.", "evidence_relation": "supporting" }, { "cited_pmid": "26391699", "evidence_support": "Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG), which is a test that measures the electrical activity of the heart [24276094, 16613182, 21140289]. The T wave represents the repolarization of the ventricles, and abnormalities in this wave can indicate various heart conditions, such as myocardial infarction, coronary artery disease, or other cardiac problems [34130049, 15842434, 26391699]. T wave abnormalities can manifest as changes in the shape, size, or direction of the T wave, and can be associated with an increased risk of cardiovascular mortality, sudden cardiac death, or other adverse outcomes [15842426, 29432131, 29538783]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG), which is a test that measures the electrical activity of the heart [24276094, 16613182, 21140289].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16613182", "evidence_support": "As important electrocardiographic findings of myocardial ischemia, there are ST elevation or depression, increase high T wave (hyperacute T wave), negative T wave and negative U wave, but it is particularly important to compare those findings and manifestation", "evidence_relation": "supporting" }, { "cited_pmid": "21140289", "evidence_support": "T-wave abnormalities are gaining significance in the realm of electrocardiogram diagnostics.", "evidence_relation": "neutral" }, { "cited_pmid": "21140289", "evidence_support": "In particular, T-wave alternans are proving to be powerful predictive indicators of potentially fatal arrhythmias", "evidence_relation": "neutral" }, { "cited_pmid": "21140289", "evidence_support": "Current design of the T-wave monitor, once improved, can find use in the screening, diagnosis, and early detection of T-wave abnormalities in clinical settings", "evidence_relation": "supporting" }, { "cited_pmid": "24276094", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The T wave represents the repolarization of the ventricles, and abnormalities in this wave can indicate various heart conditions, such as myocardial infarction, coronary artery disease, or other cardiac problems [34130049, 15842434, 26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34130049", "evidence_support": "Although upright T wave in lead V1 can be a normal variant, it has been linked in a few studies and observations to cardiovascular disease, especially myocardial ischemia", "evidence_relation": "supporting" }, { "cited_pmid": "15842434", "evidence_support": "The T wave marks the final phase of ventricular repolarization and is a symbol of transmural dispersion of repolarization (TDR) in the ventricles.", "evidence_relation": "supporting" }, { "cited_pmid": "26391699", "evidence_support": "Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "T wave abnormalities can manifest as changes in the shape, size, or direction of the T wave, and can be associated with an increased risk of cardiovascular mortality, sudden cardiac death, or other adverse outcomes [15842426, 29432131, 29538783].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15842426", "evidence_support": "While both ST segment depression and abnormal T-wave amplitude are clinically important, T-wave abnormalities appear to be greater predictors of cardiovascular mortality.", "evidence_relation": "supporting" }, { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities are common during the acute phase of non-ST-segment elevation acute coronary syndromes, but mechanisms underlying their occurrence are unclear.", "evidence_relation": "supporting" }, { "cited_pmid": "29538783", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG), which is a test that measures the electrical activity of the heart [24276094, 21140289, 16084669]. The T wave represents the repolarization of the ventricles, and abnormalities in this wave can indicate various heart conditions, such as myocardial infarction, coronary artery disease, or other cardiac problems [26718348, 15842434, 34130049]. T wave abnormalities can manifest as changes in the shape, size, or direction of the T wave, and can be associated with the presence of myocardial edema, and an increased risk of cardiovascular mortality, sudden cardiac death, or other adverse outcomes [26391699, 29538783, 29432131]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T wave abnormality is an irregularity in the T wave of an electrocardiogram (ECG), which is a test that measures the electrical activity of the heart [24276094, 21140289, 16084669].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21140289", "evidence_support": "T-wave morphology monitoring and analysis are the means by which alternans and other abnormalities are detected.", "evidence_relation": "neutral" }, { "cited_pmid": "16084669", "evidence_support": "The T-wave of the electrocardiogram (ECG) is generated both from the left and the right ventricles of the heart.", "evidence_relation": "neutral" }, { "cited_pmid": "24276094", "evidence_support": "The causes of abnormal T waves on electrocardiography are multiple and varied.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The T wave represents the repolarization of the ventricles, and abnormalities in this wave can indicate various heart conditions, such as myocardial infarction, coronary artery disease, or other cardiac problems [26718348, 15842434, 34130049].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26718348", "evidence_support": "T wave abnormalities identify previous lateral infarction and LCx disease.", "evidence_relation": "supporting" }, { "cited_pmid": "15842434", "evidence_support": "The T wave marks the final phase of ventricular repolarization and is a symbol of transmural dispersion of repolarization (TDR) in the ventricles.", "evidence_relation": "supporting" }, { "cited_pmid": "34130049", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "T wave abnormalities can manifest as changes in the shape, size, or direction of the T wave, and can be associated with the presence of myocardial edema, and an increased risk of cardiovascular mortality, sudden cardiac death, or other adverse outcomes [26391699, 29538783, 29432131].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29538783", "evidence_support": "Many forms of CVD that predispose to sudden cardiac death are associated with T-wave abnormalities in childhood. The T-wave is generated during ventricular repolarization. T-waves on an electrocardiogram typically undergo maturational changes throughout childhood and adolescence. A pediatric practitioner's ability to understand these changes is required to understand abnormal T-waves and recognize potentially life-threatening types of CVD", "evidence_relation": "supporting" }, { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities are common during the acute phase of non-ST-segment elevation acute coronary syndromes, but mechanisms underlying their occurrence are unclear. We hypothesized that T-wave abnormalities in the presentation of non-ST-segment elevation acute coronary syndromes correspond to the presence of myocardial edema.", "evidence_relation": "supporting" }, { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities in the setting of non-ST-segment elevation acute coronary syndromes are related to the presence of myocardial edema. High specificity of this ECG alteration identifies a change in ischemic myocardium associated with worse outcomes that is potentially reversible.", "evidence_relation": "supporting" }, { "cited_pmid": "26391699", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "T-wave abnormalities on an electrocardiogram (ECG) signify disruptions in ventricular repolarization and can indicate various cardiac pathologies, including myocardial edema in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) increased cardiovascular mortality risk and potential for sudden cardiac death (SCD) [29432131, 23102027, 26391699]. These abnormalities can manifest as T-wave inversions, alternans, or axis deviations, each associated with different clinical implications.For instance, T-wave alternans are predictive of fatal arrhythmias while T-wave axis deviations are linked to metabolic syndrome and increased cardiovascular risk [21140289, 23102027]. In patients with diabetes, T-wave abnormalities correlate with major cardiovascular events [33420509]. Additionally, T-wave changes can be early markers of underlying cardiovascular diseases, even in asymptomatic individuals, and are crucial for risk stratification and early intervention [26391699]. Understanding and monitoring T-wave abnormalities are essential for diagnosing and managing various cardiac conditions effectively.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "T-wave abnormalities on an electrocardiogram (ECG) signify disruptions in ventricular repolarization and can indicate various cardiac pathologies, including myocardial edema in non-ST-segment elevation acute coronary syndromes (NSTE-ACS) increased cardiovascular mortality risk and potential for sudden cardiac death (SCD) [29432131, 23102027, 26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities are common during the acute phase of non-ST-segment elevation acute coronary syndromes, but mechanisms underlying their occurrence are unclear. We hypothesized that T-wave abnormalities in the presentation of non-ST-segment elevation acute coronary syndromes correspond to the presence of myocardial edema.", "evidence_relation": "supporting" }, { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities in the setting of non-ST-segment elevation acute coronary syndromes are related to the presence of myocardial edema. High specificity of this ECG alteration identifies a change in ischemic myocardium associated with worse outcomes that is potentially reversible.", "evidence_relation": "supporting" }, { "cited_pmid": "23102027", "evidence_support": "T wave axis abnormality is associated with an increased risk of cardiovascular mortality, independently of other risk factors and can be associated with the presence of the metabolic syndrome (MetS).", "evidence_relation": "supporting" }, { "cited_pmid": "26391699", "evidence_support": "Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These abnormalities can manifest as T-wave inversions, alternans, or axis deviations, each associated with different clinical implications.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "For instance, T-wave alternans are predictive of fatal arrhythmias while T-wave axis deviations are linked to metabolic syndrome and increased cardiovascular risk [21140289, 23102027].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21140289", "evidence_support": "In particular, T-wave alternans are proving to be powerful predictive indicators of potentially fatal arrhythmias. T-wave morphology monitoring and analysis are the means by which alternans and other abnormalities are detected.", "evidence_relation": "supporting" }, { "cited_pmid": "23102027", "evidence_support": "T wave axis abnormality is associated with an increased risk of cardiovascular mortality, independently of other risk factors and can be associated with the presence of the metabolic syndrome (MetS).", "evidence_relation": "supporting" }, { "cited_pmid": "23102027", "evidence_support": "T wave axis deviation is associated with MetS and its individual components.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In patients with diabetes, T-wave abnormalities correlate with major cardiovascular events [33420509].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33420509", "evidence_support": "The presence and magnitude of TWA are associated with increased risk of clinical cardiovascular events and mortality in individuals with diabetes and may have value in refining risk, particularly in those with prevalent CVD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, T-wave changes can be early markers of underlying cardiovascular diseases, even in asymptomatic individuals, and are crucial for risk stratification and early intervention [26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26391699", "evidence_support": "Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Understanding and monitoring T-wave abnormalities are essential for diagnosing and managing various cardiac conditions effectively.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "A T wave abnormality on an electrocardiogram (ECG) can indicate various cardiac conditions, including ischemia, electrolyte imbalances, or structural heart disease.T wave inversion or flattening may suggest myocardial ischemia or infarction, particularly if seen in contiguous leads.Hyperkalemia typically presents with peaked T waves, while hypokalemia can cause flattened or inverted T waves.Additionally, T wave abnormalities can be associated with conditions like left ventricular hypertrophy, pericarditis, or the effects of medications such as digitalis.It is crucial to interpret T wave changes in the context of the patient's clinical presentation and other ECG findings to determine their significance accurately.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T wave abnormality on an electrocardiogram (ECG) can indicate various cardiac conditions, including ischemia, electrolyte imbalances, or structural heart disease.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "T wave inversion or flattening may suggest myocardial ischemia or infarction, particularly if seen in contiguous leads.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Hyperkalemia typically presents with peaked T waves, while hypokalemia can cause flattened or inverted T waves.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, T wave abnormalities can be associated with conditions like left ventricular hypertrophy, pericarditis, or the effects of medications such as digitalis.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "It is crucial to interpret T wave changes in the context of the patient's clinical presentation and other ECG findings to determine their significance accurately.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "A T-wave abnormality refers to an irregularity in the T-wave component of an electrocardiogram (ECG), which can be indicative of various cardiac conditions [24276094, 29432131]. T-wave abnormalities can manifest as changes in the T-wave morphology, amplitude, or axis, and can be associated with myocardial edema, ischemia, or other cardiac pathologies [29432131, 21140289]. In some cases, T-wave abnormalities can be a predictor of cardiovascular mortality, particularly in patients with diabetes or metabolic syndrome [23102027, 33420509]. T-wave alternans, a specific type of T-wave abnormality, has been linked to an increased risk of sudden cardiac death and can be detected using specialized ECG monitoring [15842426, 23870659]. The clinical significance of T-wave abnormalities can vary depending on the context and underlying cardiac condition, and therefore, careful interpretation by a healthcare professional is necessary [24276094, 26391699]. Early recognition and diagnosis of T-wave abnormalities can aid in the identification of patients at increased cardiovascular risk [23102027, 18616439].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T-wave abnormality refers to an irregularity in the T-wave component of an electrocardiogram (ECG), which can be indicative of various cardiac conditions [24276094, 29432131].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities in the setting of non-ST-segment elevation acute coronary syndromes are related to the presence of myocardial edema. High specificity of this ECG alteration identifies a change in ischemic myocardium associated with worse outcomes that is potentially reversible.", "evidence_relation": "supporting" }, { "cited_pmid": "24276094", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "T-wave abnormalities can manifest as changes in the T-wave morphology, amplitude, or axis, and can be associated with myocardial edema, ischemia, or other cardiac pathologies [29432131, 21140289].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities are common during the acute phase of non-ST-segment elevation acute coronary syndromes, but mechanisms underlying their occurrence are unclear.", "evidence_relation": "supporting" }, { "cited_pmid": "29432131", "evidence_support": "We hypothesized that T-wave abnormalities in the presentation of non-ST-segment elevation acute coronary syndromes correspond to the presence of myocardial edema.", "evidence_relation": "supporting" }, { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities in the setting of non-ST-segment elevation acute coronary syndromes are related to the presence of myocardial edema. High specificity of this ECG alteration identifies a change in ischemic myocardium associated with worse outcomes that is potentially reversible.", "evidence_relation": "supporting" }, { "cited_pmid": "21140289", "evidence_support": "T-wave abnormalities are gaining significance in the realm of electrocardiogram diagnostics. In particular, T-wave alternans are proving to be powerful predictive indicators of potentially fatal arrhythmias.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In some cases, T-wave abnormalities can be a predictor of cardiovascular mortality, particularly in patients with diabetes or metabolic syndrome [23102027, 33420509].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23102027", "evidence_support": "T wave axis abnormality is associated with an increased risk of cardiovascular mortality, independently of other risk factors and can be associated with the presence of the metabolic syndrome (MetS).", "evidence_relation": "supporting" }, { "cited_pmid": "23102027", "evidence_support": "T wave axis deviation is associated with MetS and its individual components.", "evidence_relation": "supporting" }, { "cited_pmid": "33420509", "evidence_support": "The presence and magnitude of TWA are associated with increased risk of clinical cardiovascular events and mortality in individuals with diabetes and may have value in refining risk, particularly in those with prevalent CVD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "T-wave alternans, a specific type of T-wave abnormality, has been linked to an increased risk of sudden cardiac death and can be detected using specialized ECG monitoring [15842426, 23870659].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15842426", "evidence_support": "ST depression and T-wave amplitude abnormalities are known to be independent predictors of cardiovascular (CV) death, but a direct comparison between them has not been described.", "evidence_relation": "neutral" }, { "cited_pmid": "15842426", "evidence_support": "While both ST segment depression and abnormal T-wave amplitude are clinically important, T-wave abnormalities appear to be greater predictors of cardiovascular mortality.", "evidence_relation": "supporting" }, { "cited_pmid": "23870659", "evidence_support": "Analytical methods to measure T-wave alternans (TWA), a beat-to-beat fluctuation in the morphology of the ST-segment and T wave in the electrocardiogram (ECG), have been developed to address the unmet challenge of identifying individuals at increased risk for sudden cardiac death.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The clinical significance of T-wave abnormalities can vary depending on the context and underlying cardiac condition, and therefore, careful interpretation by a healthcare professional is necessary [24276094, 26391699].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "24276094", "evidence_support": "The causes of abnormal T waves on electrocardiography are multiple and varied. Careful clinical history taking and physical examination are necessary for accurate identification of the cause of such abnormalities. Subsequent targeted specialised cardiac investigations, such as echocardiography or coronary angiography, may be of importance in the diagnosis of the underlying cardiac pathology.", "evidence_relation": "supporting" }, { "cited_pmid": "26391699", "evidence_support": "Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Early recognition and diagnosis of T-wave abnormalities can aid in the identification of patients at increased cardiovascular risk [23102027, 18616439].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "18616439", "evidence_support": "In patients with potential ACS presenting to the ED, T-wave abnormalities are associated with higher rates of 30-day cardiovascular events.", "evidence_relation": "supporting" }, { "cited_pmid": "23102027", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gemini-flash": { "answer": "T-wave abnormalities (TWAs) are changes in the T-wave segment of an electrocardiogram (ECG) that indicate abnormal ventricular repolarization [30061136]. These changes can be caused by various factors, including acute myocardial ischemia, left ventricular hypertrophy, digitalis glycosides, and ischemic heart disease [30061136, 4054634]. TWAs can also be a result of noncardiac conditions, such as neurogenic or functional abnormalities [18606329]. TWAs can be persistent and may remain for hours to weeks, even in patients without symptoms [12442245]. They can also be associated with Wellens' syndrome, a pattern of T-wave changes linked to critical stenosis of the left anterior descending artery [12442245]. The significance of TWAs in the absence of chest pain or other signs of ischemia is not fully understood [2069777]. Interpretation of TWAs should be done in conjunction with other clinical and laboratory information to avoid misinterpretations [4054634].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "T-wave abnormalities (TWAs) are changes in the T-wave segment of an electrocardiogram (ECG) that indicate abnormal ventricular repolarization [30061136].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30061136", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These changes can be caused by various factors, including acute myocardial ischemia, left ventricular hypertrophy, digitalis glycosides, and ischemic heart disease [30061136, 4054634].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30061136", "evidence_support": "T wave inversion (TWI) has many differential diagnoses with acute myocardial ischaemia being the highest on the list of potential causes.", "evidence_relation": "supporting" }, { "cited_pmid": "4054634", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "TWAs can also be a result of noncardiac conditions, such as neurogenic or functional abnormalities [18606329].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18606329", "evidence_support": "Electrocardiography T-wave changes including low-amplitude and abnormally inverted T waves may be the result of noncardiac path physiology.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "TWAs can be persistent and may remain for hours to weeks, even in patients without symptoms [12442245].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "12442245", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "They can also be associated with Wellens' syndrome, a pattern of T-wave changes linked to critical stenosis of the left anterior descending artery [12442245].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "12442245", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "The significance of TWAs in the absence of chest pain or other signs of ischemia is not fully understood [2069777].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "2069777", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Interpretation of TWAs should be done in conjunction with other clinical and laboratory information to avoid misinterpretations [4054634].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "4054634", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "T-wave abnormalities on an electrocardiogram (ECG) reflect changes in the T-wave segment, which is generated during ventricular repolarization [29538783]. These abnormalities can be caused by various conditions, both benign and pathological, that affect the repolarization process [26391699]. While they are common, their significance in predicting cardiovascular outcomes is still being studied [18616439]. T-wave abnormalities can be early indicators of underlying cardiovascular disease, and even minor changes can predict reduced survival and increased risk of sudden cardiac death [26391699]. They can also be associated with prolonged QT intervals, nonspecific ST-T changes, and other ECG abnormalities [33787068, 6491645].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "T-wave abnormalities on an electrocardiogram (ECG) reflect changes in the T-wave segment, which is generated during ventricular repolarization [29538783].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29538783", "evidence_support": "The T-wave is generated during ventricular repolarization.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These abnormalities can be caused by various conditions, both benign and pathological, that affect the repolarization process [26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26391699", "evidence_support": "Several benign and pathological conditions can induce changes in repolarization detected as alteration of the ST segment or T wave.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "While they are common, their significance in predicting cardiovascular outcomes is still being studied [18616439].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "18616439", "evidence_support": "T-wave abnormalities on electrocardiograms (ECGs) are common, but their ability to predict 30-day cardiovascular outcomes at the time of emergency department (ED) presentation is unknown.", "evidence_relation": "supporting" }, { "cited_pmid": "18616439", "evidence_support": "The authors determined the association between T-wave abnormalities on the presenting ECG and cardiovascular outcomes within 30 days of presentation in patients with potential acute coronary syndromes (ACSs).", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "T-wave abnormalities can be early indicators of underlying cardiovascular disease, and even minor changes can predict reduced survival and increased risk of sudden cardiac death [26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26391699", "evidence_support": "Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "They can also be associated with prolonged QT intervals, nonspecific ST-T changes, and other ECG abnormalities [33787068, 6491645].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "33787068", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "6491645", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "T-wave abnormalities are changes in the T-wave segment of an electrocardiogram (ECG) and are among the most common ECG abnormalities [4054634]. These changes can serve as early markers of underlying cardiovascular diseases and are associated with reduced survival and increased risk of sudden cardiac death [26391699]. T-wave abnormalities are particularly significant in patients with non-ST-segment elevation acute coronary syndromes and are considered greater predictors of cardiovascular mortality compared to other ECG changes [11728347, 15842426]. They may indicate conditions such as left ventricular hypertrophy or systolic dysfunction, although distinguishing between these conditions can be challenging with conventional ECG [2148032]. Overall, T-wave abnormalities are gaining importance in ECG diagnostics and warrant further evaluation [21140289].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "T-wave abnormalities are changes in the T-wave segment of an electrocardiogram (ECG) and are among the most common ECG abnormalities [4054634].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "4054634", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These changes can serve as early markers of underlying cardiovascular diseases and are associated with reduced survival and increased risk of sudden cardiac death [26391699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26391699", "evidence_support": "Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "T-wave abnormalities are particularly significant in patients with non-ST-segment elevation acute coronary syndromes and are considered greater predictors of cardiovascular mortality compared to other ECG changes [11728347, 15842426].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15842426", "evidence_support": "While both ST segment depression and abnormal T-wave amplitude are clinically important, T-wave abnormalities appear to be greater predictors of cardiovascular mortality.", "evidence_relation": "supporting" }, { "cited_pmid": "11728347", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "They may indicate conditions such as left ventricular hypertrophy or systolic dysfunction, although distinguishing between these conditions can be challenging with conventional ECG [2148032].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "2148032", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Overall, T-wave abnormalities are gaining importance in ECG diagnostics and warrant further evaluation [21140289].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21140289", "evidence_support": "T-wave abnormalities are gaining significance in the realm of electrocardiogram diagnostics. In particular, T-wave alternans are proving to be powerful predictive indicators of potentially fatal arrhythmias.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "T-wave abnormalities are changes in the T-wave segment of an electrocardiogram (ECG) that can indicate underlying cardiovascular issues. These abnormalities may include tall, upright, or deeply inverted T-waves, as well as flattened T-waves and ST segment changes [3756602, 8881540]. T-wave abnormalities are often non-specific but can serve as early markers for cardiovascular disease, predicting reduced survival and increased risk of sudden cardiac death (SCD) [26391699, 15842426]. Specifically, inverted T-waves have been associated with coronary heart disease and higher mortality rates [32975832]. The significance of T-wave abnormalities in ECG diagnostics is increasing, as they are recognized as important predictors of cardiovascular mortality [21140289, 6209083].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "T-wave abnormalities are changes in the T-wave segment of an electrocardiogram (ECG) that can indicate underlying cardiovascular issues.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "These abnormalities may include tall, upright, or deeply inverted T-waves, as well as flattened T-waves and ST segment changes [3756602, 8881540].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "3756602", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "8881540", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "T-wave abnormalities are often non-specific but can serve as early markers for cardiovascular disease, predicting reduced survival and increased risk of sudden cardiac death (SCD) [26391699, 15842426].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26391699", "evidence_support": "Changes in the ST segment and T waves can be early markers of an underlying cardiovascular disease, and even minor ST-T abnormalities have predicted reduced survival and increased risk of SCD in the adult population.", "evidence_relation": "supporting" }, { "cited_pmid": "15842426", "evidence_support": "ST depression and T-wave amplitude abnormalities are known to be independent predictors of cardiovascular (CV) death, but a direct comparison between them has not been described.", "evidence_relation": "supporting" }, { "cited_pmid": "15842426", "evidence_support": "While both ST segment depression and abnormal T-wave amplitude are clinically important, T-wave abnormalities appear to be greater predictors of cardiovascular mortality.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Specifically, inverted T-waves have been associated with coronary heart disease and higher mortality rates [32975832].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32975832", "evidence_support": "Inverted T waves in the electrocardiogram (ECG) have been associated with coronary heart disease (CHD) and mortality.", "evidence_relation": "supporting" }, { "cited_pmid": "32975832", "evidence_support": "In multivariate-adjusted models, anterior and lateral (but not inferior) T-wave inversions associated with increased risk of CHD (HR: 2.37 [95% confidence interval 1.20-4.68] and 1.65 [1.27-2.15], respectively). In multivariable analyses, only lateral T-wave inversions associated with increased risk of mortality in the entire study population (HR 1.51 [1.26-1.81]) as well as among individuals with no CHD at baseline (HR 1.59 [1.29-1.96]).", "evidence_relation": "supporting" }, { "cited_pmid": "32975832", "evidence_support": "T-wave inversion in the anterior and lateral lead groups is independently associated with the risk of CHD, and lateral T-wave inversion is also associated with increased risk of mortality.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The significance of T-wave abnormalities in ECG diagnostics is increasing, as they are recognized as important predictors of cardiovascular mortality [21140289, 6209083].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21140289", "evidence_support": "T-wave abnormalities are gaining significance in the realm of electrocardiogram diagnostics. In particular, T-wave alternans are proving to be powerful predictive indicators of potentially fatal arrhythmias.", "evidence_relation": "supporting" }, { "cited_pmid": "6209083", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "webis-1": { "answer": "A t wave abnormality is an ECG finding that can be seen in various forms, such as T wave inversion in inferiorly directed frontal plane leads, T wave inversion in both inferiorly directed frontal plane leads and precordial leads, and other categories of T-wave abnormalities [32610845,15618066,18616439,29432131]. These abnormalities can be associated with adverse outcomes, such as myocardial edema [29432131].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A t wave abnormality is an ECG finding that can be seen in various forms, such as T wave inversion in inferiorly directed frontal plane leads, T wave inversion in both inferiorly directed frontal plane leads and precordial leads, and other categories of T-wave abnormalities [32610845,15618066,18616439,29432131].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32610845", "evidence_support": "Most common ECG abnormality was T wave inversion in inferiorly directed frontal plane leads seen in 16 (29.6%) subjects followed by T wave inversion in both inferiorly directed frontal plane leads and precordial leads noted in 13 (24%) subjects. Next most common ECG abnormality was T wave inversion in the precordial leads seen in 10 (18.5%) subjects", "evidence_relation": "supporting" }, { "cited_pmid": "15618066", "evidence_support": "New quantitative T-wave analysis of the admission ECG gives additional predictive information concerning clinical outcome and identifies patients who benefit from early coronary angiography.", "evidence_relation": "supporting" }, { "cited_pmid": "18616439", "evidence_support": "In patients with potential ACS presenting to the ED, T-wave abnormalities are associated with higher rates of 30-day cardiovascular events.", "evidence_relation": "supporting" }, { "cited_pmid": "29432131", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These abnormalities can be associated with adverse outcomes, such as myocardial edema [29432131].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities in the setting of non-ST-segment elevation acute coronary syndromes are related to the presence of myocardial edema.", "evidence_relation": "supporting" } ] } ] }, "webis-2": { "answer": "A T wave abnormality is an ECG finding characterized by a change in the shape or amplitude of the T wave, which is a part of the electrocardiogram (ECG) that represents the repolarization of the ventricles [29432131]. In the context of non-ST-segment elevation acute coronary syndromes, a.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T wave abnormality is an ECG finding characterized by a change in the shape or amplitude of the T wave, which is a part of the electrocardiogram (ECG) that represents the repolarization of the ventricles [29432131].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29432131", "evidence_support": "ECGs were classified dichotomously (ie, ischemic versus normal/nonischemic) and nominally according to patterns of presentation: no ST- or T-wave abnormalities, isolated T-wave abnormality, isolated ST depression, ST depression+T-wave abnormality.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In the context of non-ST-segment elevation acute coronary syndromes, a.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-3": { "answer": "A T wave abnormality is an electrocardiographic signature of myocardial edema in non-ST-elevation acute coronary syndromes [29432131].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T wave abnormality is an electrocardiographic signature of myocardial edema in non-ST-elevation acute coronary syndromes [29432131].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities are common during the acute phase of non-ST-segment elevation acute coronary syndromes, but mechanisms underlying their occurrence are unclear.", "evidence_relation": "supporting" }, { "cited_pmid": "29432131", "evidence_support": "We hypothesized that T-wave abnormalities in the presentation of non-ST-segment elevation acute coronary syndromes correspond to the presence of myocardial edema.", "evidence_relation": "supporting" }, { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities in the setting of non-ST-segment elevation acute coronary syndromes are related to the presence of myocardial edema. ", "evidence_relation": "supporting" } ] } ] }, "webis-5": { "answer": "A T wave abnormality is an electrocardiographic signature of myocardial edema in non-ST-elevation acute coronary syndromes [29432131].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T wave abnormality is an electrocardiographic signature of myocardial edema in non-ST-elevation acute coronary syndromes [29432131].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities are common during the acute phase of non-ST-segment elevation acute coronary syndromes, but mechanisms underlying their occurrence are unclear.", "evidence_relation": "supporting" }, { "cited_pmid": "29432131", "evidence_support": "We hypothesized that T-wave abnormalities in the presentation of non-ST-segment elevation acute coronary syndromes correspond to the presence of myocardial edema.", "evidence_relation": "supporting" }, { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities in the setting of non-ST-segment elevation acute coronary syndromes are related to the presence of myocardial edema.", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-1": { "answer": "A T wave abnormality refers to any deviation from the normal shape or duration of the T wave on an electrocardiogram (ECG). This can indicate various cardiac conditions, such as ischemia, electrolyte imbalances, or other heart diseases, and is often assessed in conjunction with other ECG findings to determine the underlying cause.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T wave abnormality refers to any deviation from the normal shape or duration of the T wave on an electrocardiogram (ECG).", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This can indicate various cardiac conditions, such as ischemia, electrolyte imbalances, or other heart diseases, and is often assessed in conjunction with other ECG findings to determine the underlying cause.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "A T-wave abnormality refers to changes in the T-wave portion of an electrocardiogram (ECG) that can indicate underlying cardiac issues. In the context of non-ST-segment elevation acute coronary syndromes, these abnormalities are commonly observed and are thought to be associated with myocardial edema, which suggests that they may reflect underlying myocardial injury or stress [29432131].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T-wave abnormality refers to changes in the T-wave portion of an electrocardiogram (ECG) that can indicate underlying cardiac issues.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "In the context of non-ST-segment elevation acute coronary syndromes, these abnormalities are commonly observed and are thought to be associated with myocardial edema, which suggests that they may reflect underlying myocardial injury or stress [29432131].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "29432131", "evidence_support": ": T-wave abnormalities in the setting of non-ST-segment elevation acute coronary syndromes are related to the presence of myocardial edema. High specificity of this ECG alteration identifies a change in ischemic myocardium associated with worse outcomes that is potentially reversible.", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-6": { "answer": "A T wave abnormality refers to any deviation from the normal T wave morphology on an electrocardiogram (ECG), which can indicate various cardiac conditions. These abnormalities can manifest as inverted T waves, peaked T waves, or other changes, and may be associated with conditions such as myocardial edema or electrolyte imbalances [29432131,23879281,19419407]. The specific nature of the T wave abnormality can provide important diagnostic information regarding underlying heart issues.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A T wave abnormality refers to any deviation from the normal T wave morphology on an electrocardiogram (ECG), which can indicate various cardiac conditions.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "These abnormalities can manifest as inverted T waves, peaked T waves, or other changes, and may be associated with conditions such as myocardial edema or electrolyte imbalances [29432131,23879281,19419407].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29432131", "evidence_support": "T-wave abnormalities in the setting of non-ST-segment elevation acute coronary syndromes are related to the presence of myocardial edema.", "evidence_relation": "supporting" }, { "cited_pmid": "23879281", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "19419407", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The specific nature of the T wave abnormality can provide important diagnostic information regarding underlying heart issues.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "zero-shot-gemini-flash": { "answer": "T-wave abnormalities are changes in the shape or amplitude of the T wave on an electrocardiogram (ECG) [11781965, 21140289]. These abnormalities can be caused by a variety of factors, including heart disease, medication use, and neurological disorders [4054634, 3756602]. While some t-wave abnormalities are non-specific, others can be indicative of serious conditions such as myocardial infarction (MI) [3756602, 18606329]. For example, Wellens' syndrome, characterized by specific t-wave changes, is associated with critical stenosis of the left anterior descending (LAD) coronary artery [12442245]. T-wave abnormalities are gaining significance in ECG diagnostics, particularly t-wave alternans, which are strong predictors of potentially fatal arrhythmias [21140289]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "T-wave abnormalities are changes in the shape or amplitude of the T wave on an electrocardiogram (ECG) [11781965, 21140289].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21140289", "evidence_support": "T-wave abnormalities are gaining significance in the realm of electrocardiogram diagnostics. In particular, T-wave alternans are proving to be powerful predictive indicators of potentially fatal arrhythmias.", "evidence_relation": "supporting" }, { "cited_pmid": "11781965", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These abnormalities can be caused by a variety of factors, including heart disease, medication use, and neurological disorders [4054634, 3756602].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "4054634", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "3756602", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "While some t-wave abnormalities are non-specific, others can be indicative of serious conditions such as myocardial infarction (MI) [3756602, 18606329].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18606329", "evidence_support": "T-wave inversions produced by myocardial infarction (MI) are classically narrow and symmetric. Electrocardiography T-wave changes including low-amplitude and abnormally inverted T waves may be the result of noncardiac path physiology.", "evidence_relation": "supporting" }, { "cited_pmid": "18606329", "evidence_support": "The first case involved a 64-year-old woman who presented to the emergency department with diffuse splayed T-wave inversions and was found to have an MI in the context of an acute cerebrovascular accident.", "evidence_relation": "supporting" }, { "cited_pmid": "3756602", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "For example, Wellens' syndrome, characterized by specific t-wave changes, is associated with critical stenosis of the left anterior descending (LAD) coronary artery [12442245].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "12442245", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "T-wave abnormalities are gaining significance in ECG diagnostics, particularly t-wave alternans, which are strong predictors of potentially fatal arrhythmias [21140289].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21140289", "evidence_support": "T-wave abnormalities are gaining significance in the realm of electrocardiogram diagnostics. In particular, T-wave alternans are proving to be powerful predictive indicators of potentially fatal arrhythmias.", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "T wave abnormalities are common electrocardiogram (ECG) changes that indicate abnormal ventricular repolarization [4054634, 33420509]. These abnormalities can manifest as various forms, including notched, bifid, flat, or inverted T waves [4054634, 18606329]. They are often nonspecific but can be associated with conditions such as left ventricular hypertrophy, ischemic heart disease, and other cardiac or non-cardiac issues [4054634, 2184809]. T wave changes may persist for hours to weeks and can serve as indicators of underlying heart problems, including myocardial infarction [12442245, 12359290]. Clinicians often monitor these changes to assess cardiac health and potential risks, as significant T wave abnormalities can correlate with adverse outcomes, including sudden cardiac events [28008355, 15842426].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "T wave abnormalities are common electrocardiogram (ECG) changes that indicate abnormal ventricular repolarization [4054634, 33420509].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33420509", "evidence_support": "T-wave abnormalities (TWA) are often found on ECG and signify abnormal ventricular repolarisation.", "evidence_relation": "supporting" }, { "cited_pmid": "4054634", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These abnormalities can manifest as various forms, including notched, bifid, flat, or inverted T waves [4054634, 18606329].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "18606329", "evidence_support": "Electrocardiography T-wave changes including low-amplitude and abnormally inverted T waves may be the result of noncardiac path physiology.", "evidence_relation": "neutral" }, { "cited_pmid": "4054634", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "They are often nonspecific but can be associated with conditions such as left ventricular hypertrophy, ischemic heart disease, and other cardiac or non-cardiac issues [4054634, 2184809].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "4054634", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "2184809", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "T wave changes may persist for hours to weeks and can serve as indicators of underlying heart problems, including myocardial infarction [12442245, 12359290].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "12442245", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "12359290", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Clinicians often monitor these changes to assess cardiac health and potential risks, as significant T wave abnormalities can correlate with adverse outcomes, including sudden cardiac events [28008355, 15842426].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "28008355", "evidence_support": "T-wave changes were the main abnormalities associated with a high risk of sudden death.", "evidence_relation": "supporting" }, { "cited_pmid": "28008355", "evidence_support": "In a group of men who had not previously experienced major episodes of CHD but who subsequently died from it, there was strong evidence that high-risk ECG changes, mainly T-wave abnormalities, differentiated between those who later died sudden deaths and those who survived for >24\u2005hours.", "evidence_relation": "supporting" }, { "cited_pmid": "15842426", "evidence_support": "While both ST segment depression and abnormal T-wave amplitude are clinically important, T-wave abnormalities appear to be greater predictors of cardiovascular mortality.", "evidence_relation": "supporting" } ] } ] } } }, { "question_id": "123", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "A mutation in the FBN1 gene, which encodes the protein fibrillin-1, is most commonly associated with Marfan syndrome, a connective tissue disorder that affects many parts of the body, including the heart, blood vessels, eyes, and bones. The FBN1 gene provides instructions for making fibrillin-1, a protein that is essential for the formation of elastic fibers found in connective tissue. Mutations in this gene can lead to weakened connective tissues, resulting in a range of symptoms such as aortic enlargement, dislocated lenses in the eyes, and skeletal abnormalities like long limbs and fingers [30565249]. Additionally, mutations in genes like FBN1 can have variable effects depending on the specific mutation and other genetic factors, which may influence the severity and range of symptoms [37994127].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A mutation in the FBN1 gene, which encodes the protein fibrillin-1, is most commonly associated with Marfan syndrome, a connective tissue disorder that affects many parts of the body, including the heart, blood vessels, eyes, and bones.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "The FBN1 gene provides instructions for making fibrillin-1, a protein that is essential for the formation of elastic fibers found in connective tissue.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Mutations in this gene can lead to weakened connective tissues, resulting in a range of symptoms such as aortic enlargement, dislocated lenses in the eyes, and skeletal abnormalities like long limbs and fingers [30565249].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "30565249", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, mutations in genes like FBN1 can have variable effects depending on the specific mutation and other genetic factors, which may influence the severity and range of symptoms [37994127].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "37994127", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "FBN1 mutations are genetic alterations that can lead to a variety of disorders, most notably Marfan syndrome, which is characterized by cardiovascular, skeletal, and ocular manifestations [27437668, 16930007, 18435798]. These mutations can also cause thoracic aortic aneurysm and dissection, ectopia lentis, and aortic root aneurysm and dilatation [27437668, 27558095, 23897642]. FBN1 mutations can be frameshift, missense, nonsense, splice site, deletions, or duplications, and they can lead to structural protein alterations and premature termination codons [18435798, 16220557, 14695540]. Severe Marfan syndrome is often associated with mutations in exons 24-32, while mutations in exons 41 and 42 can also cause Marfan syndrome [24668922, 21683322, 19002209]. Additionally, FBN1 mutations can result in Weill-Marchesani syndrome, acromelic dysplasias, short stature, brachydactyly, and neonatal Marfan syndrome [27437668, 24668922, 21683322]. These mutations can cause severe cardiovascular complications, including fragmentation of aortic elastic lamellae and endoplasmic reticulum stress in aortic aneurysm [31730815, 27558095, 27724990]. FBN1 mutations can be identified by next-generation sequencing or Sanger sequencing [36292727, 31163209, 27558095].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "FBN1 mutations are genetic alterations that can lead to a variety of disorders, most notably Marfan syndrome, which is characterized by cardiovascular, skeletal, and ocular manifestations [27437668, 16930007, 18435798].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27437668", "evidence_support": "FBN1 is the causative gene for Marfan syndrome, an inherited disorder of connective tissue whose major features include tall stature and arachnodactyly, ectopia lentis, and thoracic aortic aneurysm and dissection.", "evidence_relation": "supporting" }, { "cited_pmid": "16930007", "evidence_support": "Marfan syndrome is an autosomal-dominant connective tissue disorder characterized by pleiotropic manifestations involving the skeletal, ocular, and cardiovascular systems and resulting from mutations in the gene for fibrillin, FBN1.", "evidence_relation": "supporting" }, { "cited_pmid": "18435798", "evidence_support": "Fibrillin-1 gene (FBN1) mutations cause Marfan syndrome (MFS), an inherited connective tissue disorder with autosomal dominant transmission. Major clinical manifestations affect cardiovascular and skeletal apparatuses and ocular and central nervous systems.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These mutations can also cause thoracic aortic aneurysm and dissection, ectopia lentis, and aortic root aneurysm and dilatation [27437668, 27558095, 23897642].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27437668", "evidence_support": "FBN1 is the causative gene for Marfan syndrome, an inherited disorder of connective tissue whose major features include tall stature and arachnodactyly, ectopia lentis, and thoracic aortic aneurysm and dissection.", "evidence_relation": "supporting" }, { "cited_pmid": "27558095", "evidence_support": "Two patients with thoracic aortic aneurysms and dissections were diagnosed as MFS according to the revised Ghent criteria", "evidence_relation": "supporting" }, { "cited_pmid": "27558095", "evidence_support": "They showed cardiovascular phenotype thoracic aortic aneurysms and dissections, a life-threatening vascular disease, and atrial septal defect respectively.", "evidence_relation": "supporting" }, { "cited_pmid": "27558095", "evidence_support": "One de novo missense mutation in exon 50 of FBN1 was identified only in the patient-2, showing aortic root aneurysm and aortic root dilatation", "evidence_relation": "supporting" }, { "cited_pmid": "23897642", "evidence_support": "Mutations in FBN1 cause a range of overlapping but distinct conditions including Marfan syndrome (MFS), Weill-Marchesani syndrome (WMS), familial thoracic aortic aneurysms/dissections (FTAAD), acromicric dysplasia (AD), and geleophysic dysplasia (GD)", "evidence_relation": "supporting" }, { "cited_pmid": "23897642", "evidence_support": "The proband with WMS has ectopia lentis, short stature, thickened pinnae, tight skin, striae atrophicae, reduced extension of the elbows, contractures of the fingers and toes, and brachydactyly and has a missense mutation in exon 42 of FBN1 (c.5242T>C; p.C1748R).", "evidence_relation": "supporting" }, { "cited_pmid": "23897642", "evidence_support": "The second proband displays classic characteristics of MFS, including ectopia lentis, skeletal features, and aortic root dilatation, and has a missense mutation in exon 41 of FBN1 (c.5084G>A; p.C1695Y)", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "FBN1 mutations can be frameshift, missense, nonsense, splice site, deletions, or duplications, and they can lead to structural protein alterations and premature termination codons [18435798, 16220557, 14695540].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18435798", "evidence_support": "Fibrillin-1 gene (FBN1) mutations cause Marfan syndrome (MFS), an inherited connective tissue disorder with autosomal dominant transmission.", "evidence_relation": "neutral" }, { "cited_pmid": "18435798", "evidence_support": "Among the 77 different mutational events, 46 had not been previously reported. They are represented by 49 missense (61%), 1 silent (1%), 13 nonsense (16%), 6 donor splice site mutations (8%), 8 small deletions (10%), and 3 small duplications (4%). ", "evidence_relation": "supporting" }, { "cited_pmid": "18435798", "evidence_support": "We found preferential associations between The Cys-missense mutations and ectopia lentis and premature termination codon mutations and skeletal manifestations.", "evidence_relation": "supporting" }, { "cited_pmid": "16220557", "evidence_support": "Marfan syndrome (MFS) is an autosomal-dominant disorder of the fibrous connective tissue that is typically caused by mutations in the gene coding for fibrillin-1 (FBN1), a major component of extracellular microfibrils", "evidence_relation": "neutral" }, { "cited_pmid": "16220557", "evidence_support": "Twenty-nine novel and nine recurrent mutations were identified in 38 of the analyzed patients. The mutations comprised 18 missense (47%), eight nonsense (21%), and five splice site (13%) mutations. Seven further mutations (18%) resulted from deletion, insertion, or duplication events, six of which led to a frameshift and subsequent premature termination. ", "evidence_relation": "supporting" }, { "cited_pmid": "14695540", "evidence_support": "We screened 57 unrelated patients with MFS or a Marfan-like phenotype using a combination of SSCP and/or DHPLC. We detected 49 different FBN1 mutations, 30 (62%) of which were novel. The mutations comprised 38 substitutions (78%), 10 deletions (20%), and one duplication (2%). There were 28 missense (57%), nine frameshift (18%), eight splice site (16%), and four nonsense mutations (8 %). ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Severe Marfan syndrome is often associated with mutations in exons 24-32, while mutations in exons 41 and 42 can also cause Marfan syndrome [24668922, 21683322, 19002209].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24668922", "evidence_support": "Subsequent in vitro splicing analysis showed this mutation led to exon 35 skipping, presumably resulting in a deletion of 42 amino acids (p.Leu1405_Asp1446del). Interestingly, this mutation is localized outside the region of exons 24-32, whose mutation is responsible for the substantial majority of cases of neonatal MFS.", "evidence_relation": "supporting" }, { "cited_pmid": "21683322", "evidence_support": "We identified 16 heterozygous FBN1 mutations that are all located in exons 41 and 42 and encode TGF\u03b2-binding protein-like domain 5 (TB5) of FBN1 in 29 GD and AD cases.", "evidence_relation": "supporting" }, { "cited_pmid": "19002209", "evidence_support": "The severe end of the spectrum is represented by neonatal MFS, the vast majority of probands carrying a mutation within exons 24-32. We previously showed that a mutation in exons 24-32 is predictive of a severe cardiovascular phenotype even in non-neonatal cases, and that mutations leading to premature truncation codons are under-represented in this region.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, FBN1 mutations can result in Weill-Marchesani syndrome, acromelic dysplasias, short stature, brachydactyly, and neonatal Marfan syndrome [27437668, 24668922, 21683322].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "27437668", "evidence_support": "FBN1 is the causative gene for Marfan syndrome, an inherited disorder of connective tissue whose major features include tall stature and arachnodactyly, ectopia lentis, and thoracic aortic aneurysm and dissection.", "evidence_relation": "supporting" }, { "cited_pmid": "24668922", "evidence_support": "Marfan syndrome (MFS) is an autosomal dominant disorder caused by mutations in the fibrillin 1 gene (FBN1)", "evidence_relation": "supporting" }, { "cited_pmid": "21683322", "evidence_support": "After exome sequencing in GD and AD cases, we selected fibrillin 1 (FBN1) as a candidate gene, even though mutations in this gene have been described in Marfan syndrome, which is characterized by tall stature and arachnodactyly.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "These mutations can cause severe cardiovascular complications, including fragmentation of aortic elastic lamellae and endoplasmic reticulum stress in aortic aneurysm [31730815, 27558095, 27724990].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27558095", "evidence_support": "They showed cardiovascular phenotype thoracic aortic aneurysms and dissections, a life-threatening vascular disease, and atrial septal defect respectively.", "evidence_relation": "neutral" }, { "cited_pmid": "27558095", "evidence_support": "One de novo missense mutation in exon 50 of FBN1 was identified only in the patient-2, showing aortic root aneurysm and aortic root dilatation.", "evidence_relation": "supporting" }, { "cited_pmid": "27724990", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "31730815", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "FBN1 mutations can be identified by next-generation sequencing or Sanger sequencing [36292727, 31163209, 27558095].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36292727", "evidence_support": "Whole exome sequencing and Sanger sequencing were performed to identify the pathogenic mutation.", "evidence_relation": "supporting" }, { "cited_pmid": "31163209", "evidence_support": "FBN1 gene sequencing was performed by next generation sequencing and Sanger sequencing methods.", "evidence_relation": "supporting" }, { "cited_pmid": "27558095", "evidence_support": "According to the next-generation sequencing results, the mutations in FBN1 were confirmed by direct sequencing.", "evidence_relation": "supporting" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "FBN1 mutations are genetic alterations in the fibrillin-1 gene, which encodes a crucial structural component of connective tissue microfibrils.These mutations are primarily associated with Marfan syndrome (MFS), an autosomal dominant disorder characterized by cardiovascular, skeletal, and ocular abnormalities, including aortic aneurysms, tall stature, and ectopia lentis [27437668, 16930007, 18435798]. Over 2700 distinct FBN1 mutations have been identified, with no specific mutation hotspots, complicating genotype-phenotype correlations [16930007, 31730815]. These mutations can include missense, nonsense, splice site alterations, and small deletions or duplications, often affecting calcium-binding epidermal growth factor-like domains [18435798, 16220557]. Certain mutations, such as those leading to premature termination codons, are linked to specific phenotypic manifestations like skeletal abnormalities, while cysteine substitutions are frequently associated with ectopia lentis . Molecular analysis of FBN1 is crucial for diagnosing MFS and related disorders, especially in cases with ambiguous clinical presentations [18435798, 16220557, 14695540].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "FBN1 mutations are genetic alterations in the fibrillin-1 gene, which encodes a crucial structural component of connective tissue microfibrils.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "These mutations are primarily associated with Marfan syndrome (MFS), an autosomal dominant disorder characterized by cardiovascular, skeletal, and ocular abnormalities, including aortic aneurysms, tall stature, and ectopia lentis [27437668, 16930007, 18435798].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27437668", "evidence_support": "FBN1 is the causative gene for Marfan syndrome, an inherited disorder of connective tissue whose major features include tall stature and arachnodactyly, ectopia lentis, and thoracic aortic aneurysm and dissection.", "evidence_relation": "supporting" }, { "cited_pmid": "16930007", "evidence_support": "Marfan syndrome is an autosomal-dominant connective tissue disorder characterized by pleiotropic manifestations involving the skeletal, ocular, and cardiovascular systems and resulting from mutations in the gene for fibrillin, FBN1.", "evidence_relation": "supporting" }, { "cited_pmid": "18435798", "evidence_support": "Fibrillin-1 gene (FBN1) mutations cause Marfan syndrome (MFS), an inherited connective tissue disorder with autosomal dominant transmission. Major clinical manifestations affect cardiovascular and skeletal apparatuses and ocular and central nervous systems.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Over 2700 distinct FBN1 mutations have been identified, with no specific mutation hotspots, complicating genotype-phenotype correlations [16930007, 31730815].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16930007", "evidence_support": "Mutations are spread over the entire FBNJ gene and there are no particular hot spots.", "evidence_relation": "supporting" }, { "cited_pmid": "31730815", "evidence_support": "To date, more than 2700 FBN1 mutations are known.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "These mutations can include missense, nonsense, splice site alterations, and small deletions or duplications, often affecting calcium-binding epidermal growth factor-like domains [18435798, 16220557].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "18435798", "evidence_support": "They are represented by 49 missense (61%), 1 silent (1%), 13 nonsense (16%), 6 donor splice site mutations (8%), 8 small deletions (10%), and 3 small duplications (4%). The majority of missense mutations were within the calcium-binding epidermal growth factor-like domains.", "evidence_relation": "supporting" }, { "cited_pmid": "16220557", "evidence_support": "The mutations comprised 18 missense (47%), eight nonsense (21%), and five splice site (13%) mutations. Seven further mutations (18%) resulted from deletion, insertion, or duplication events, six of which led to a frameshift and subsequent premature termination.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Certain mutations, such as those leading to premature termination codons, are linked to specific phenotypic manifestations like skeletal abnormalities, while cysteine substitutions are frequently associated with ectopia lentis .", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Molecular analysis of FBN1 is crucial for diagnosing MFS and related disorders, especially in cases with ambiguous clinical presentations [18435798, 16220557, 14695540].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "18435798", "evidence_support": "Fibrillin-1 gene (FBN1) mutations cause Marfan syndrome (MFS), an inherited connective tissue disorder with autosomal dominant transmission. ", "evidence_relation": "supporting" }, { "cited_pmid": "18435798", "evidence_support": "In conclusion, we were able to detect FBN1 mutations in 88% of patients with MFS and in 36% of patients with other fibrillinopathies type I, confirming that FBN1 mutations are good predictors of classic MFS.", "evidence_relation": "supporting" }, { "cited_pmid": "16220557", "evidence_support": "On the basis of the data presented here and in a previous study, we were able to establish highly significant correlations between the FBN1 mutation type and the MFS phenotype in a group of 76 mutation-positive patients for whom comprehensive clinical data were available. ", "evidence_relation": "supporting" }, { "cited_pmid": "14695540", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "FBN1 mutation refers to a genetic alteration in the FBN1 gene, which encodes the protein fibrillin-1, a crucial component of extracellular microfibrils [27437668, 16930007]. These mutations can lead to Marfan syndrome, a disorder of connective tissue characterized by pleiotropic manifestations involving the skeletal, ocular, and cardiovascular systems [16930007, 18435798]. The mutations can be diverse, including missense, nonsense, frameshift, and splice site mutations, and are often spread throughout the entire FBN1 gene [16930007, 18435798, 31730815]. The identification of FBN1 mutations is crucial for the diagnosis of Marfan syndrome, and molecular analysis of the FBN1 gene can reduce diagnostic uncertainty in patients with suspected Marfan syndrome or related disorders [16930007, 31730815]. The detection rate of FBN1 mutations can vary depending on the methodology used, but denaturing high-performance liquid chromatography (DHPLC) has been shown to be a sensitive technique with a mutation detection rate of approximately 95% [16930007].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "FBN1 mutation refers to a genetic alteration in the FBN1 gene, which encodes the protein fibrillin-1, a crucial component of extracellular microfibrils [27437668, 16930007].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27437668", "evidence_support": "FBN1 encodes the gene for fibrillin-1, a structural macromolecule that polymerizes into microfibrils.", "evidence_relation": "supporting" }, { "cited_pmid": "27437668", "evidence_support": " is the causative gene for Marfan syndrome, an inherited disorder of connective tissue whose major features include tall stature and arachnodactyly, ectopia lentis, and thoracic aortic aneurysm and dissection", "evidence_relation": "neutral" }, { "cited_pmid": "16930007", "evidence_support": "Marfan syndrome is an autosomal-dominant connective tissue disorder characterized by pleiotropic manifestations involving the skeletal, ocular, and cardiovascular systems and resulting from mutations in the gene for fibrillin, FBN1.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These mutations can lead to Marfan syndrome, a disorder of connective tissue characterized by pleiotropic manifestations involving the skeletal, ocular, and cardiovascular systems [16930007, 18435798].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16930007", "evidence_support": "Marfan syndrome is an autosomal-dominant connective tissue disorder characterized by pleiotropic manifestations involving the skeletal, ocular, and cardiovascular systems and resulting from mutations in the gene for fibrillin, FBN1.", "evidence_relation": "supporting" }, { "cited_pmid": "18435798", "evidence_support": "Fibrillin-1 gene (FBN1) mutations cause Marfan syndrome (MFS), an inherited connective tissue disorder with autosomal dominant transmission. Major clinical manifestations affect cardiovascular and skeletal apparatuses and ocular and central nervous systems.", "evidence_relation": "supporting" }, { "cited_pmid": "18435798", "evidence_support": " In conclusion, we were able to detect FBN1 mutations in 88% of patients with MFS and in 36% of patients with other fibrillinopathies type I, confirming that FBN1 mutations are good predictors of classic MFS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The mutations can be diverse, including missense, nonsense, frameshift, and splice site mutations, and are often spread throughout the entire FBN1 gene [16930007, 18435798, 31730815].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18435798", "evidence_support": "They are represented by 49 missense (61%), 1 silent (1%), 13 nonsense (16%), 6 donor splice site mutations (8%), 8 small deletions (10%), and 3 small duplications (4%).", "evidence_relation": "supporting" }, { "cited_pmid": "31730815", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16930007", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The identification of FBN1 mutations is crucial for the diagnosis of Marfan syndrome, and molecular analysis of the FBN1 gene can reduce diagnostic uncertainty in patients with suspected Marfan syndrome or related disorders [16930007, 31730815].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16930007", "evidence_support": "Marfan syndrome is an autosomal-dominant connective tissue disorder characterized by pleiotropic manifestations involving the skeletal, ocular, and cardiovascular systems and resulting from mutations in the gene for fibrillin, FBN1.", "evidence_relation": "supporting" }, { "cited_pmid": "31730815", "evidence_support": "Molecular analysis of the FBN1 gene reduces diagnostic uncertainty in patients with suspected MFS or MFS-related disorders (MFS-RD)", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The detection rate of FBN1 mutations can vary depending on the methodology used, but denaturing high-performance liquid chromatography (DHPLC) has been shown to be a sensitive technique with a mutation detection rate of approximately 95% [16930007].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16930007", "evidence_support": "In those instances, molecular analysis of the FBN1 gene is helpful to identify at-risk individuals. Mutations are spread over the entire FBNJ gene and there are no particular hot spots.", "evidence_relation": "neutral" }, { "cited_pmid": "16930007", "evidence_support": "Different standard methodologies are available to identify these mutations, however, one of the most sensitive techniques is denaturing high-performance liquid chromatography. This approach allows the performance of the analysis in a semi-automated manner and has a mutation detection rate of approx 95%.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "FBN1 mutation refers to a mutation in the gene that encodes fibrillin-1, a protein crucial for the formation of elastic fibers found in connective tissue [33030311, 19839986, 15598221]. This mutation can lead to various health problems, including Marfan syndrome, a genetic disorder that affects the body's connective tissue, and other fibrillinopathies [24940037, 19839986, 15598221]. The mutation can result in a range of symptoms, from mild to severe, including tall stature, arachnodactyly, ectopia lentis, and thoracic aortic aneurysm and dissection [21976953, 31774634, 16220557]. The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [16222657, 36096698, 16220557]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "FBN1 mutation refers to a mutation in the gene that encodes fibrillin-1, a protein crucial for the formation of elastic fibers found in connective tissue [33030311, 19839986, 15598221].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19839986", "evidence_support": "The aim of this study was to establish a national database of mutations in the fibrillin-1 (FBN1) gene that cause Marfan syndrome (MFS) in the Taiwanese population.", "evidence_relation": "neutral" }, { "cited_pmid": "33030311", "evidence_support": "Mutations in the transforming growth factor \u03b2-binding protein-like domain 5 (TB5) region of FBN1 can lead to autosomal acromelic dysplasia and Marfan syndrome, which are two diseases with apparently opposite phenotypes.", "evidence_relation": "neutral" }, { "cited_pmid": "15598221", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This mutation can lead to various health problems, including Marfan syndrome, a genetic disorder that affects the body's connective tissue, and other fibrillinopathies [24940037, 19839986, 15598221].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24940037", "evidence_support": "FBN1-associated fibrillinopathies are a group of diseases with dynamic phenotype changes. Novel mutation p.1310G>S was first reported to cause Marfan syndrome (MFS).", "evidence_relation": "supporting" }, { "cited_pmid": "19839986", "evidence_support": "The aim of this study was to establish a national database of mutations in the fibrillin-1 (FBN1) gene that cause Marfan syndrome (MFS) in the Taiwanese population", "evidence_relation": "supporting" }, { "cited_pmid": "15598221", "evidence_support": "The R2726W mutation in the fibrillin 1 (FBN1, Marfan syndrome) gene segregates with isolated skeletal features of Marfan syndrome and/or high stature. ", "evidence_relation": "supporting" }, { "cited_pmid": "15598221", "evidence_support": "The FBN1 R2776W mutation, which is associated with skeletal features of Marfan syndrome, appears incompletely penetrant.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The mutation can result in a range of symptoms, from mild to severe, including tall stature, arachnodactyly, ectopia lentis, and thoracic aortic aneurysm and dissection [21976953, 31774634, 16220557].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16220557", "evidence_support": "Marfan syndrome (MFS) is an autosomal-dominant disorder of the fibrous connective tissue that is typically caused by mutations in the gene coding for fibrillin-1 (FBN1), a major component of extracellular microfibrils. The clinical spectrum of MFS is highly variable and includes involvement of the cardiovascular, skeletal, ocular, and other organ systems; however, the genotype-phenotype correlations have not been well developed.", "evidence_relation": "supporting" }, { "cited_pmid": "21976953", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "31774634", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [16222657, 36096698, 16220557].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16222657", "evidence_support": "Marfan Syndrome (MFS) is an autosomal dominant disorder of the connective tissue due to mutations of Fibrillin-1 gene (FBN1) in more than 90% of cases and Transforming Growth Factor-Beta-Receptor2 gene (TGFB2R) in a minority of cases.", "evidence_relation": "supporting" }, { "cited_pmid": "36096698", "evidence_support": "Mutations in fibrillin-1 (FBN1) were detected in an autosomal dominant Marfan syndrome (MFS) pedigree.", "evidence_relation": "supporting" }, { "cited_pmid": "16220557", "evidence_support": "Marfan syndrome (MFS) is an autosomal-dominant disorder of the fibrous connective tissue that is typically caused by mutations in the gene coding for fibrillin-1 (FBN1), a major component of extracellular microfibrils.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "A mutation in the FBN1 gene is a change in the DNA sequence of the gene that encodes the protein fibrillin-1 [27437668, 20538085, 17984934]. Fibrillin-1 is a structural protein that plays a crucial role in the formation of microfibrils, which are essential components of connective tissue [19161152, 27437668, 28944857]. Mutations in the FBN1 gene can lead to various disorders, including Marfan syndrome, a condition characterized by tall stature, arachnodactyly, ectopia lentis, and aortic aneurysm and dissection [27437668, 21976953, 28944857]. The FBN1 gene mutations can be missense, nonsense, frameshift, or splice site mutations, and they can occur in different regions of the gene, including the calcium-binding epidermal growth factor-like domains [30534251, 16220557, 18435798]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A mutation in the FBN1 gene is a change in the DNA sequence of the gene that encodes the protein fibrillin-1 [27437668, 20538085, 17984934].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27437668", "evidence_support": "FBN1 encodes the gene for fibrillin-1, a structural macromolecule that polymerizes into microfibrils.", "evidence_relation": "supporting" }, { "cited_pmid": "20538085", "evidence_support": "The Fibrillin-1 gene (FBN1; chromosome 15q21.1) encodes a major glycoprotein component of the extracellular matrix", "evidence_relation": "supporting" }, { "cited_pmid": "17984934", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Fibrillin-1 is a structural protein that plays a crucial role in the formation of microfibrils, which are essential components of connective tissue [19161152, 27437668, 28944857].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27437668", "evidence_support": "FBN1 encodes the gene for fibrillin-1, a structural macromolecule that polymerizes into microfibrils.", "evidence_relation": "supporting" }, { "cited_pmid": "19161152", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "28944857", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Mutations in the FBN1 gene can lead to various disorders, including Marfan syndrome, a condition characterized by tall stature, arachnodactyly, ectopia lentis, and aortic aneurysm and dissection [27437668, 21976953, 28944857].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27437668", "evidence_support": "FBN1 is the causative gene for Marfan syndrome, an inherited disorder of connective tissue whose major features include tall stature and arachnodactyly, ectopia lentis, and thoracic aortic aneurysm and dissection. ", "evidence_relation": "supporting" }, { "cited_pmid": "21976953", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "28944857", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The FBN1 gene mutations can be missense, nonsense, frameshift, or splice site mutations, and they can occur in different regions of the gene, including the calcium-binding epidermal growth factor-like domains [30534251, 16220557, 18435798].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16220557", "evidence_support": "The mutations comprised 18 missense (47%), eight nonsense (21%), and five splice site (13%) mutations. Seven further mutations (18%) resulted from deletion, insertion, or duplication events, six of which led to a frameshift and subsequent premature termination.", "evidence_relation": "supporting" }, { "cited_pmid": "18435798", "evidence_support": "They are represented by 49 missense (61%), 1 silent (1%), 13 nonsense (16%), 6 donor splice site mutations (8%), 8 small deletions (10%), and 3 small duplications (4%). The majority of missense mutations were within the calcium-binding epidermal growth factor-like domains.", "evidence_relation": "supporting" }, { "cited_pmid": "30534251", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "FBN1 mutation refers to a change in the fibrillin-1 gene, which encodes a protein essential for the formation of elastic fibers found in connective tissue [15598221, 31471346, 31163209]. This mutation can lead to Marfan syndrome, a genetic disorder that affects the body's connective tissue, and other related disorders [15598221, 31163209, 17679947]. The mutation can result in a range of symptoms, including tall stature, long limbs and fingers, heart problems, and eye issues [18435798, 21976953, 16220557]. The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [31163209, 16220557, 30534251]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "FBN1 mutation refers to a change in the fibrillin-1 gene, which encodes a protein essential for the formation of elastic fibers found in connective tissue [15598221, 31471346, 31163209].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15598221", "evidence_support": "The R2726W mutation in the fibrillin 1 (FBN1, Marfan syndrome) gene segregates with isolated skeletal features of Marfan syndrome and/or high stature.", "evidence_relation": "supporting" }, { "cited_pmid": "15598221", "evidence_support": "The FBN1 R2776W mutation, which is associated with skeletal features of Marfan syndrome, appears incompletely penetrant.", "evidence_relation": "supporting" }, { "cited_pmid": "31163209", "evidence_support": "FBN1 gene mutations lead to MFS and related connective tissue disorders.", "evidence_relation": "supporting" }, { "cited_pmid": "31471346", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This mutation can lead to Marfan syndrome, a genetic disorder that affects the body's connective tissue, and other related disorders [15598221, 31163209, 17679947].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15598221", "evidence_support": "The R2726W mutation in the fibrillin 1 (FBN1, Marfan syndrome) gene segregates with isolated skeletal features of Marfan syndrome and/or high stature.", "evidence_relation": "supporting" }, { "cited_pmid": "31163209", "evidence_support": "Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder mainly affecting the cardiovascular, ocular and musculo-skeletal systems", "evidence_relation": "supporting" }, { "cited_pmid": "17679947", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The mutation can result in a range of symptoms, including tall stature, long limbs and fingers, heart problems, and eye issues [18435798, 21976953, 16220557].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18435798", "evidence_support": "Fibrillin-1 gene (FBN1) mutations cause Marfan syndrome (MFS), an inherited connective tissue disorder with autosomal dominant transmission. Major clinical manifestations affect cardiovascular and skeletal apparatuses and ocular and central nervous systems.", "evidence_relation": "supporting" }, { "cited_pmid": "16220557", "evidence_support": "Marfan syndrome (MFS) is an autosomal-dominant disorder of the fibrous connective tissue that is typically caused by mutations in the gene coding for fibrillin-1 (FBN1), a major component of extracellular microfibrils.", "evidence_relation": "supporting" }, { "cited_pmid": "16220557", "evidence_support": "The clinical spectrum of MFS is highly variable and includes involvement of the cardiovascular, skeletal, ocular, and other organ systems", "evidence_relation": "supporting" }, { "cited_pmid": "21976953", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [31163209, 16220557, 30534251].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31163209", "evidence_support": "Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder mainly affecting the cardiovascular, ocular and musculo-skeletal systems. FBN1 gene mutations lead to MFS and related connective tissue disorders.", "evidence_relation": "supporting" }, { "cited_pmid": "16220557", "evidence_support": "Marfan syndrome (MFS) is an autosomal-dominant disorder of the fibrous connective tissue that is typically caused by mutations in the gene coding for fibrillin-1 (FBN1), a major component of extracellular microfibrils.", "evidence_relation": "supporting" }, { "cited_pmid": "30534251", "evidence_support": "Marfan syndrome (MFS) is a multisystem autosomal dominant heritable disorder and, although there are over 1700 mutations that have been identified in the fibrillin-1 (FBN1) gene associated with it, there are many variants that remain unknown.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "FBN1 mutation refers to a change in the fibrillin-1 gene, which encodes a protein essential for the formation of elastic fibers found in connective tissue [15598221, 27386756, 27437668]. This mutation can lead to Marfan syndrome, a genetic disorder that affects the body's connective tissue, and other related disorders [19554831, 23121584, 16571647]. The mutation can result in a range of symptoms, including tall stature, long limbs and fingers, heart problems, and eye issues [18435798, 16220557, 28442527]. The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [31163209, 31588525, 30534251]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "FBN1 mutation refers to a change in the fibrillin-1 gene, which encodes a protein essential for the formation of elastic fibers found in connective tissue [15598221, 27386756, 27437668].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27386756", "evidence_support": "Fibrillin-1 is a large glycoprotein encoded by the FBN1 gene in humans. It provides strength and elasticity to connective tissues and is involved in regulating the bioavailability of the growth factor TGF\u03b2. Mutations in FBN1 may be associated with depleted or abnormal adipose tissue, seen in some patients with Marfan syndrome and lipodystrophies. ", "evidence_relation": "supporting" }, { "cited_pmid": "27437668", "evidence_support": "FBN1 encodes the gene for fibrillin-1, a structural macromolecule that polymerizes into microfibrils. Fibrillin microfibrils are morphologically distinctive fibrils, present in all connective tissues and assembled into tissue-specific architectural frameworks. ", "evidence_relation": "supporting" }, { "cited_pmid": "15598221", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This mutation can lead to Marfan syndrome, a genetic disorder that affects the body's connective tissue, and other related disorders [19554831, 23121584, 16571647].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19554831", "evidence_support": "The Marfan syndrome is an inherited disorder of the connective tissue which is mainly caused by a mutation in the fibrillin-1 gene.", "evidence_relation": "supporting" }, { "cited_pmid": "23121584", "evidence_support": "Marfan syndrome is a multisystem disorder of connective tissue that is inherited in an autosomal dominant fashion, and results from mutation of the FBN1 gene on human chromosome 15.", "evidence_relation": "supporting" }, { "cited_pmid": "16571647", "evidence_support": "Marfan syndrome (MFS), a relatively common autosomal dominant hereditary disorder of connective tissue with prominent manifestations in the skeletal, ocular, and cardiovascular systems, is caused by mutations in the gene for fibrillin-1 (FBN1)", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The mutation can result in a range of symptoms, including tall stature, long limbs and fingers, heart problems, and eye issues [18435798, 16220557, 28442527].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18435798", "evidence_support": "Major clinical manifestations affect cardiovascular and skeletal apparatuses and ocular and central nervous systems", "evidence_relation": "supporting" }, { "cited_pmid": "16220557", "evidence_support": "The clinical spectrum of MFS is highly variable and includes involvement of the cardiovascular, skeletal, ocular, and other organ systems; however, the genotype-phenotype correlations have not been well developed.", "evidence_relation": "supporting" }, { "cited_pmid": "28442527", "evidence_support": "A nine-year-old girl was referred to our pediatric endocrinology clinic for tall stature. Physical examination revealed a lens dislocation with strabismus, high palate, positive wrist and thumb signs, joint hypermobility, and pes planus. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [31163209, 31588525, 30534251].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "31163209", "evidence_support": "Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder mainly affecting the cardiovascular, ocular and musculo-skeletal systems. FBN1 gene mutations lead to MFS and related connective tissue disorders.", "evidence_relation": "supporting" }, { "cited_pmid": "30534251", "evidence_support": "Marfan syndrome (MFS) is a multisystem autosomal dominant heritable disorder and, although there are over 1700 mutations that have been identified in the fibrillin-1 (FBN1) gene associated with it, there are many variants that remain unknown.", "evidence_relation": "supporting" }, { "cited_pmid": "31588525", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "FBN1 mutation refers to a change in the fibrillin-1 gene, which encodes a protein essential for the formation of elastic fibers found in connective tissue [27386756, 27437668, 15598221]. This mutation can lead to Marfan syndrome, a genetic disorder that affects the body's connective tissue, and other related disorders [19554831, 16571647, 23121584]. The mutation can result in a range of symptoms, including tall stature, long limbs and fingers, heart problems, and eye issues [16220557, 30565850, 28442527]. The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [30534251, 31163209, 16220557]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "FBN1 mutation refers to a change in the fibrillin-1 gene, which encodes a protein essential for the formation of elastic fibers found in connective tissue [27386756, 27437668, 15598221].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27386756", "evidence_support": "Fibrillin-1 is a large glycoprotein encoded by the FBN1 gene in humans", "evidence_relation": "supporting" }, { "cited_pmid": "27386756", "evidence_support": "It provides strength and elasticity to connective tissues and is involved in regulating the bioavailability of the growth factor TGF\u03b2", "evidence_relation": "supporting" }, { "cited_pmid": "27386756", "evidence_support": "Mutations in FBN1 ", "evidence_relation": "neutral" }, { "cited_pmid": "27437668", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15598221", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This mutation can lead to Marfan syndrome, a genetic disorder that affects the body's connective tissue, and other related disorders [19554831, 16571647, 23121584].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19554831", "evidence_support": "The Marfan syndrome is an inherited disorder of the connective tissue which is mainly caused by a mutation in the fibrillin-1 gene.", "evidence_relation": "supporting" }, { "cited_pmid": "16571647", "evidence_support": "Marfan syndrome (MFS), a relatively common autosomal dominant hereditary disorder of connective tissue with prominent manifestations in the skeletal, ocular, and cardiovascular systems, is caused by mutations in the gene for fibrillin-1 (FBN1).", "evidence_relation": "supporting" }, { "cited_pmid": "23121584", "evidence_support": "Marfan syndrome is a multisystem disorder of connective tissue that is inherited in an autosomal dominant fashion, and results from mutation of the FBN1 gene on human chromosome 15.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The mutation can result in a range of symptoms, including tall stature, long limbs and fingers, heart problems, and eye issues [16220557, 30565850, 28442527].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30565850", "evidence_support": "Accordingly, in previously published patients with LTBP2-related eye disease, additional extraocular findings have been occasionally reported and include, among others, high-arched palate, tall stature, and variable cardiac involvement.", "evidence_relation": "supporting" }, { "cited_pmid": "30565850", "evidence_support": "Here, we report two unrelated Roma/Gypsy patients first ascertained for a multisystem disorder mainly characterized by primary congenital glaucoma, complex congenital heart defect, tall stature, long fingers, skin striae and dystrophic scarring, and resembling Marfan syndrome. Heart involvement was severe with polyvalvular heart dysplasia in one, and transposition of great arteries, thoracic arterial tortuosity, polyvalvular heart dysplasia, and neo-aortic root dilatation in the other", "evidence_relation": "supporting" }, { "cited_pmid": "16220557", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "28442527", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [30534251, 31163209, 16220557].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30534251", "evidence_support": "Marfan syndrome (MFS) is a multisystem autosomal dominant heritable disorder and, although there are over 1700 mutations that have been identified in the fibrillin-1 (FBN1) gene associated with it, there are many variants that remain unknown.", "evidence_relation": "supporting" }, { "cited_pmid": "31163209", "evidence_support": "Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder mainly affecting the cardiovascular, ocular and musculo-skeletal systems. FBN1 gene mutations lead to MFS and related connective tissue disorders.", "evidence_relation": "supporting" }, { "cited_pmid": "16220557", "evidence_support": "Marfan syndrome (MFS) is an autosomal-dominant disorder of the fibrous connective tissue that is typically caused by mutations in the gene coding for fibrillin-1 (FBN1), a major component of extracellular microfibrils.", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "FBN1 mutation refers to a change in the fibrillin-1 gene, which encodes a protein essential for the formation of elastic fibers found in connective tissue [15598221, 27386756, 31163209]. This mutation can lead to Marfan syndrome, a genetic disorder that affects the body's connective tissue, and other related disorders [23121584, 16571647, 19554831]. The mutation can result in a range of symptoms, including tall stature, long limbs and fingers, heart problems, and eye issues [16220557, 30565850, 28442527]. The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [31163209, 30534251, 16220557]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "FBN1 mutation refers to a change in the fibrillin-1 gene, which encodes a protein essential for the formation of elastic fibers found in connective tissue [15598221, 27386756, 31163209].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27386756", "evidence_support": "Fibrillin-1 is a large glycoprotein encoded by the FBN1 gene in humans. It provides strength and elasticity to connective tissues and is involved in regulating the bioavailability of the growth factor TGF\u03b2. Mutations in FBN1 may be associated with depleted or abnormal adipose tissue, seen in some patients with Marfan syndrome and lipodystrophies.", "evidence_relation": "supporting" }, { "cited_pmid": "31163209", "evidence_support": "FBN1 gene mutations lead to MFS and related connective tissue disorders", "evidence_relation": "supporting" }, { "cited_pmid": "15598221", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This mutation can lead to Marfan syndrome, a genetic disorder that affects the body's connective tissue, and other related disorders [23121584, 16571647, 19554831].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23121584", "evidence_support": "Marfan syndrome is a multisystem disorder of connective tissue that is inherited in an autosomal dominant fashion, and results from mutation of the FBN1 gene on human chromosome 15. ", "evidence_relation": "supporting" }, { "cited_pmid": "16571647", "evidence_support": "Marfan syndrome (MFS), a relatively common autosomal dominant hereditary disorder of connective tissue with prominent manifestations in the skeletal, ocular, and cardiovascular systems, is caused by mutations in the gene for fibrillin-1 (FBN1).", "evidence_relation": "supporting" }, { "cited_pmid": "19554831", "evidence_support": "The Marfan syndrome is an inherited disorder of the connective tissue which is mainly caused by a mutation in the fibrillin-1 gene.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The mutation can result in a range of symptoms, including tall stature, long limbs and fingers, heart problems, and eye issues [16220557, 30565850, 28442527].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28442527", "evidence_support": "To our knowledge, this sequence variant has been reported as a polymorphism (rs113602180), but it is the first report identifying it as the genetic cause of Marfan syndrome. We hypothesize that this de novo novel missense FBN1 mutation disrupts fibrillin-1 function and is probably involved in the development of Marfan syndrome in this patient.", "evidence_relation": "neutral" }, { "cited_pmid": "30565850", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16220557", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [31163209, 30534251, 16220557].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "31163209", "evidence_support": "Marfan syndrome (MFS) is an autosomal dominant connective tissue disorder mainly affecting the cardiovascular, ocular and musculo-skeletal systems.", "evidence_relation": "supporting" }, { "cited_pmid": "30534251", "evidence_support": "Marfan syndrome (MFS) is a multisystem autosomal dominant heritable disorder and, although there are over 1700 mutations that have been identified in the fibrillin-1 (FBN1) gene associated with it, there are many variants that remain unknown.", "evidence_relation": "supporting" }, { "cited_pmid": "16220557", "evidence_support": "Marfan syndrome (MFS) is an autosomal-dominant disorder of the fibrous connective tissue that is typically caused by mutations in the gene coding for fibrillin-1 (FBN1), a major component of extracellular microfibrils.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "FBN1 mutation refers to a change in the fibrillin-1 gene, which encodes a protein essential for the formation of elastic fibers found in connective tissue [22921888, 22262941, 27386756]. This mutation can lead to Marfan syndrome, a genetic disorder that affects the body's connective tissue, and other related disorders [16181034, 24555249, 21387612]. The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [20704907, 32120431, 25304133]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "FBN1 mutation refers to a change in the fibrillin-1 gene, which encodes a protein essential for the formation of elastic fibers found in connective tissue [22921888, 22262941, 27386756].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22262941", "evidence_support": "It has been reported that FBN1 mutations account for approximately 90% of Autosomal Dominant MFS.", "evidence_relation": "neutral" }, { "cited_pmid": "27386756", "evidence_support": "Mutations in FBN1 may be associated with depleted or abnormal adipose tissue, seen in some patients with Marfan syndrome and lipodystrophies. ", "evidence_relation": "supporting" }, { "cited_pmid": "22921888", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This mutation can lead to Marfan syndrome, a genetic disorder that affects the body's connective tissue, and other related disorders [16181034, 24555249, 21387612].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16181034", "evidence_support": "MFS is caused by mutations in the fibrillin gene, located on chromosome 15 at locus 15q21. ", "evidence_relation": "supporting" }, { "cited_pmid": "16181034", "evidence_support": "Fibrillin abnormalities reduce the structural integrity of different body systems, primarily involving the heart valves, blood vessels, lungs, bones, tendons, ligaments, cartilages, eyes, skin, spinal dura and the CNS.", "evidence_relation": "supporting" }, { "cited_pmid": "24555249", "evidence_support": "Marfan syndrome is a genetic disorder of the connective tissue caused by mutations in FBN1 gene. ", "evidence_relation": "supporting" }, { "cited_pmid": "21387612", "evidence_support": "Marfan syndrome is an inherited connective tissue disorder with ocular, skeletal and cardiovascular systems and often causes acute aortic dissection.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [20704907, 32120431, 25304133].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20704907", "evidence_support": "A single inherited mutant gene usually is enough to confer a high risk of cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "20704907", "evidence_support": "Therefore, when an inherited mutation is identified in one member of a family, the rest of the family members can be screened for the presence of this mutation.", "evidence_relation": "neutral" }, { "cited_pmid": "25304133", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "32120431", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "FBN1 mutation refers to a change in the fibrillin-1 gene, which encodes a protein essential for the formation of elastic fibers found in connective tissue [29286095, 19293843]. This mutation can lead to impaired biomechanical tissue properties, altered cell-matrix interactions, uncontrolled growth factor or cytokine activation, and the development of fibrillinopathies and associated severe complications in multiple organs [29286095, 19293843]. The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [28383543, 32094424]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "FBN1 mutation refers to a change in the fibrillin-1 gene, which encodes a protein essential for the formation of elastic fibers found in connective tissue [29286095, 19293843].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29286095", "evidence_support": "Fibrillins (FBNs) are key relay molecules that form the backbone of microfibrils in elastic and non\u2011elastic tissues.", "evidence_relation": "supporting" }, { "cited_pmid": "19293843", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This mutation can lead to impaired biomechanical tissue properties, altered cell-matrix interactions, uncontrolled growth factor or cytokine activation, and the development of fibrillinopathies and associated severe complications in multiple organs [29286095, 19293843].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29286095", "evidence_support": "Consequently, mutations affecting the structure, assembly and stability of FBN microfibrils have been associated with impaired biomechanical tissue properties, altered cell\u2011matrix interactions, uncontrolled growth factor or cytokine activation, and the development of fibrillinopathies and associated severe complications in multiple organs.", "evidence_relation": "supporting" }, { "cited_pmid": "19293843", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [28383543, 32094424].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "28383543", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "32094424", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "FBN1 mutation refers to a change in the fibrillin-1 gene, which encodes a protein essential for the formation of elastic fibers found in connective tissue [19293843, 31055806, 27437668]. This mutation can lead to Marfan syndrome, a genetic disorder that affects the body's connective tissue, and other related disorders [17242442, 34475413, 20351703]. The mutation can result in a range of mild and unspecific symptoms, which may include neurological, neuromuscular, hematological, and pulmonary issues [37628614]. These symptoms are typically milder and occur later in life compared to those with biallelic variants [37628614]. The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [31588525]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "FBN1 mutation refers to a change in the fibrillin-1 gene, which encodes a protein essential for the formation of elastic fibers found in connective tissue [19293843, 31055806, 27437668].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19293843", "evidence_support": "However, FBN1 gene mutations are found in an ill-defined group of diseases termed 'type I fibrillinopathies', which are associated with an increased risk of aortic dilatation and dissection", "evidence_relation": "supporting" }, { "cited_pmid": "19293843", "evidence_support": "This recommendation should help clinicians and biologists in identifying probands with a high probability of carrying a FBN1 gene mutation, and thus optimize biological resources", "evidence_relation": "neutral" }, { "cited_pmid": "31055806", "evidence_support": "By bioinformatic analysis, the mutations may affect the structure and function of the FBN1 protein.", "evidence_relation": "supporting" }, { "cited_pmid": "31055806", "evidence_support": "The c.1879C>T and c.2584T>C mutations of the FBN1 gene probably account for the disease in the two pedigrees, respectively. Identification of the c.2584T>C has enriched the spectrum of FBN1 gene mutations.", "evidence_relation": "supporting" }, { "cited_pmid": "27437668", "evidence_support": "FBN1 encodes the gene for fibrillin-1, a structural macromolecule that polymerizes into microfibrils. Fibrillin microfibrils are morphologically distinctive fibrils, present in all connective tissues and assembled into tissue-specific architectural frameworks", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This mutation can lead to Marfan syndrome, a genetic disorder that affects the body's connective tissue, and other related disorders [17242442, 34475413, 20351703].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17242442", "evidence_support": "Marfan syndrome is a heritable disorder of the connective tissue that affects the cardiovascular, skeletal and ocular systems, and often involves the skin, nervous system and lungs.", "evidence_relation": "supporting" }, { "cited_pmid": "34475413", "evidence_support": "Marfan syndrome (MFS) is an autosomal dominant, age-related but highly penetrant condition with substantial intrafamilial and interfamilial variability. MFS is caused by pathogenetic variants in FBN1, which encodes fibrillin-1, a major structural component of the extracellular matrix that provides support to connective tissues, particularly in arteries, the pericondrium and structures in the eye.", "evidence_relation": "supporting" }, { "cited_pmid": "20351703", "evidence_support": "Marfan syndrome is a connective-tissue disease inherited in an autosomal dominant manner and caused mainly by mutations in the gene FBN1.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The mutation can result in a range of mild and unspecific symptoms, which may include neurological, neuromuscular, hematological, and pulmonary issues [37628614].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37628614", "evidence_support": "However, in recent years, an increasing number of case reports have suggested that mild and unspecific symptoms can occur in some heterozygotes, as symptomatic heterozygotes have been identified across different disease types, including neurological, neuromuscular, hematological, and pulmonary diseases.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "These symptoms are typically milder and occur later in life compared to those with biallelic variants [37628614].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "37628614", "evidence_support": "The symptoms are usually milder in heterozygotes than in biallelic variants and occur \"later in life\".", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [31588525].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31588525", "evidence_support": "This chapter will briefly summarize classical inheritance patterns. Most of the heritable human diseases are transmitted in an autosomal recessive way, but others, i.e., inherited tumor syndromes, follow the autosomal dominant pattern. ", "evidence_relation": "neutral" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "FBN1 mutation refers to a change in the fibrillin-1 gene, which encodes a protein essential for the formation of elastic fibers found in connective tissue [21034599, 22921888, 31163209]. This mutation can lead to Marfan syndrome, a genetic disorder that affects the body's connective tissue, and other related disorders [24555249, 16325700, 16181034]. The mutation can result in a range of mild and unspecific symptoms in some heterozygotes, which are usually milder and occur later in life [37628614]. The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [26277931, 23893571, 31588525]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "FBN1 mutation refers to a change in the fibrillin-1 gene, which encodes a protein essential for the formation of elastic fibers found in connective tissue [21034599, 22921888, 31163209].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21034599", "evidence_support": "These results expand the mutation spectrum of fibrillin-1 gene and help in the study of the molecular pathogenesis of Marfan syndrome, indicating that mutations occurring in the 3' end of fibrillin-1 gene may play an independent functional role in the pathogenesis of Marfan syndrome", "evidence_relation": "supporting" }, { "cited_pmid": "22921888", "evidence_support": "Fibrillins and latent transforming growth factor \u03b2 binding proteins (LTBPs) are components of the extracellular matrix of connective tissue. While fibrillins are integral to the 10nm microfibrils, and often associated with elastin, all family members are likely to have an additional role in regulating the bioavailability of transforming growth factor \u03b2 (TGB\u03b2)", "evidence_relation": "supporting" }, { "cited_pmid": "22921888", "evidence_support": "Mutation of fibrillin genes results in connective tissue phenotypes which reflect both the increased level of active TGB\u03b2 and the structural failure of the extracellular matrix due to the absence or abnormality of fibrillin protein. Fibrillinopathies include Marfan syndrome, familial ectopia lentis, familial thoracic aneurysm (mutations of FBN1) and congenital contractural arachnodactyly (mutation of FBN2).", "evidence_relation": "supporting" }, { "cited_pmid": "31163209", "evidence_support": "FBN1 gene mutations lead to MFS and related connective tissue disorders. In this work we described clinical and molecular data of 26 unrelated individuals with suspected MFS who were referred for FBN1 mutation analysis", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This mutation can lead to Marfan syndrome, a genetic disorder that affects the body's connective tissue, and other related disorders [24555249, 16325700, 16181034].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24555249", "evidence_support": "Marfan syndrome is a genetic disorder of the connective tissue caused by mutations in FBN1 gene. ", "evidence_relation": "supporting" }, { "cited_pmid": "16325700", "evidence_support": "Marfan's syndrome is a systemic disorder of connective tissue caused by mutations in the extracellular matrix protein fibrillin 1. Cardinal manifestations include proximal aortic aneurysm, dislocation of the ocular lens, and long-bone overgrowth. Important advances have been made in the diagnosis and medical and surgical care of affected individuals, yet substantial morbidity and premature mortality remain", "evidence_relation": "supporting" }, { "cited_pmid": "16181034", "evidence_support": "Marfan syndrome (MFS) is one of the most frequent connective tissue disorders, showing striking pleiotropism and clinical variability. ", "evidence_relation": "supporting" }, { "cited_pmid": "16181034", "evidence_support": "MFS is caused by mutations in the fibrillin gene, located on chromosome 15 at locus 15q21.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The mutation can result in a range of mild and unspecific symptoms in some heterozygotes, which are usually milder and occur later in life [37628614].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "37628614", "evidence_support": "However, in recent years, an increasing number of case reports have suggested that mild and unspecific symptoms can occur in some heterozygotes, as symptomatic heterozygotes have been identified across different disease types, including neurological, neuromuscular, hematological, and pulmonary diseases. The symptoms are usually milder in heterozygotes than in biallelic variants and occur \"later in life\".", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The mutation can be inherited in an autosomal dominant pattern, meaning a single copy of the mutated gene is enough to cause the condition [26277931, 23893571, 31588525].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26277931", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "23893571", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "31588525", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "FBN1 mutations are genetic alterations in the fibrillin-1 gene, which encodes a crucial component of extracellular microfibrils, leading to Marfan syndrome (MFS) and related connective tissue disorders [27437668, 16930007]. These mutations, which include missense, nonsense, splice site mutations, and small deletions or duplications, disrupt the structural integrity and function of fibrillin-1, resulting in a wide range of phenotypic manifestations, particularly affecting the cardiovascular, skeletal, and ocular systems [18435798, 16220557]. The clinical presentation of MFS is highly variable, with common features including aortic aneurysms, ectopia lentis, and skeletal abnormalities such as tall stature and arachnodactyly [27437668, 16930007]. Genotype-phenotype correlations are complex, but certain mutations, such as those involving cysteine residues, are more frequently associated with specific manifestations like ectopia lentis . Molecular analysis of FBN1 is essential for confirming the diagnosis and guiding clinical management [18435798, 14695540, 16930007].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "FBN1 mutations are genetic alterations in the fibrillin-1 gene, which encodes a crucial component of extracellular microfibrils, leading to Marfan syndrome (MFS) and related connective tissue disorders [27437668, 16930007].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27437668", "evidence_support": "FBN1 is the causative gene for Marfan syndrome, an inherited disorder of connective tissue whose major features include tall stature and arachnodactyly, ectopia lentis, and thoracic aortic aneurysm and dissection.", "evidence_relation": "supporting" }, { "cited_pmid": "16930007", "evidence_support": "Marfan syndrome is an autosomal-dominant connective tissue disorder characterized by pleiotropic manifestations involving the skeletal, ocular, and cardiovascular systems and resulting from mutations in the gene for fibrillin, FBN1.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These mutations, which include missense, nonsense, splice site mutations, and small deletions or duplications, disrupt the structural integrity and function of fibrillin-1, resulting in a wide range of phenotypic manifestations, particularly affecting the cardiovascular, skeletal, and ocular systems [18435798, 16220557].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18435798", "evidence_support": "Fibrillin-1 gene (FBN1) mutations cause Marfan syndrome (MFS), an inherited connective tissue disorder with autosomal dominant transmission. Major clinical manifestations affect cardiovascular and skeletal apparatuses and ocular and central nervous systems.", "evidence_relation": "supporting" }, { "cited_pmid": "18435798", "evidence_support": "We found preferential associations between The Cys-missense mutations and ectopia lentis and premature termination codon mutations and skeletal manifestations.", "evidence_relation": "supporting" }, { "cited_pmid": "16220557", "evidence_support": "Marfan syndrome (MFS) is an autosomal-dominant disorder of the fibrous connective tissue that is typically caused by mutations in the gene coding for fibrillin-1 (FBN1), a major component of extracellular microfibrils. The clinical spectrum of MFS is highly variable and includes involvement of the cardiovascular, skeletal, ocular, and other organ systems; however, the genotype-phenotype correlations have not been well developed.", "evidence_relation": "supporting" }, { "cited_pmid": "16220557", "evidence_support": "The mutations comprised 18 missense (47%), eight nonsense (21%), and five splice site (13%) mutations.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The clinical presentation of MFS is highly variable, with common features including aortic aneurysms, ectopia lentis, and skeletal abnormalities such as tall stature and arachnodactyly [27437668, 16930007].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "27437668", "evidence_support": "FBN1 is the causative gene for Marfan syndrome, an inherited disorder of connective tissue whose major features include tall stature and arachnodactyly, ectopia lentis, and thoracic aortic aneurysm and dissection. More than one thousand individual mutations in FBN1 are associated with Mar", "evidence_relation": "supporting" }, { "cited_pmid": "16930007", "evidence_support": "Marfan syndrome is an autosomal-dominant connective tissue disorder characterized by pleiotropic manifestations involving the skeletal, ocular, and cardiovascular systems and resulting from mutations in the gene for fibrillin, FBN1", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Genotype-phenotype correlations are complex, but certain mutations, such as those involving cysteine residues, are more frequently associated with specific manifestations like ectopia lentis .", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Molecular analysis of FBN1 is essential for confirming the diagnosis and guiding clinical management [18435798, 14695540, 16930007].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "18435798", "evidence_support": "In conclusion, we were able to detect FBN1 mutations in 88% of patients with MFS and in 36% of patients with other fibrillinopathies type I, confirming that FBN1 mutations are good predictors of classic MFS.", "evidence_relation": "supporting" }, { "cited_pmid": "14695540", "evidence_support": "Further analysis of detailed clinical information and mutation data may help to anticipate the clinical consequences of specific FBN1 mutations", "evidence_relation": "supporting" }, { "cited_pmid": "16930007", "evidence_support": "Nevertheless, the age-related nature of some clinical manifestations and the variable phenotypic expression of the disorder may hamper the diagnosis. In those instances, molecular analysis of the FBN1 gene is helpful to identify at-risk individuals. ", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "The FBN1 mutation refers to genetic alterations in the FBN1 gene, which encodes fibrillin-1, a crucial glycoprotein for the formation of elastic fibers in connective tissue.Mutations in FBN1 are primarily associated with Marfan syndrome, an autosomal dominant disorder characterized by cardiovascular, ocular, and skeletal abnormalities, including aortic aneurysms, lens dislocation, and long bone overgrowth.These mutations can lead to defective microfibril formation, resulting in weakened connective tissue integrity.Over 1,000 different FBN1 mutations have been identified, with varying phenotypic expressions and severity.Genetic testing for FBN1 mutations is essential for diagnosing Marfan syndrome and related connective tissue disorders, guiding clinical management, and informing family planning decisions.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The FBN1 mutation refers to genetic alterations in the FBN1 gene, which encodes fibrillin-1, a crucial glycoprotein for the formation of elastic fibers in connective tissue.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Mutations in FBN1 are primarily associated with Marfan syndrome, an autosomal dominant disorder characterized by cardiovascular, ocular, and skeletal abnormalities, including aortic aneurysms, lens dislocation, and long bone overgrowth.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "These mutations can lead to defective microfibril formation, resulting in weakened connective tissue integrity.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Over 1,000 different FBN1 mutations have been identified, with varying phenotypic expressions and severity.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Genetic testing for FBN1 mutations is essential for diagnosing Marfan syndrome and related connective tissue disorders, guiding clinical management, and informing family planning decisions.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "A mutation in the FBN1 gene, which encodes the protein fibrillin-1, is the primary cause of Marfan syndrome (MFS), a genetic disorder that affects the connective tissue in various parts of the body [27437668, 16930007, 18435798]. FBN1 mutations can result in a wide range of clinical manifestations, including tall stature, arachnodactyly, ectopia lentis, and thoracic aortic aneurysm and dissection [27437668, 16220557]. The mutations can be missense, nonsense, frameshift, or splice site mutations, and are often located in the calcium-binding epidermal growth factor-like domains of the FBN1 gene [18435798, 14695540]. The identification of FBN1 mutations is crucial for the diagnosis of MFS, and molecular analysis of the gene can help reduce diagnostic uncertainty in patients with suspected MFS or related disorders [16930007, 31730815]. Over 2700 FBN1 mutations have been identified to date, and the mutation detection rate can be as high as 95% using techniques such as denaturing high-performance liquid chromatography [16930007, 31730815].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A mutation in the FBN1 gene, which encodes the protein fibrillin-1, is the primary cause of Marfan syndrome (MFS), a genetic disorder that affects the connective tissue in various parts of the body [27437668, 16930007, 18435798].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27437668", "evidence_support": "FBN1 encodes the gene for fibrillin-1, a structural macromolecule that polymerizes into microfibrils. Fibrillin microfibrils are morphologically distinctive fibrils, present in all connective tissues and assembled into tissue-specific architectural frameworks. FBN1 is the causative gene for Marfan syndrome, an inherited disorder of connective tissue whose major features include tall stature and arachnodactyly, ectopia lentis, and thoracic aortic aneurysm and dissection.", "evidence_relation": "supporting" }, { "cited_pmid": "16930007", "evidence_support": "Marfan syndrome is an autosomal-dominant connective tissue disorder characterized by pleiotropic manifestations involving the skeletal, ocular, and cardiovascular systems and resulting from mutations in the gene for fibrillin, FBN1. ", "evidence_relation": "supporting" }, { "cited_pmid": "18435798", "evidence_support": "Fibrillin-1 gene (FBN1) mutations cause Marfan syndrome (MFS), an inherited connective tissue disorder with autosomal dominant transmission. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "FBN1 mutations can result in a wide range of clinical manifestations, including tall stature, arachnodactyly, ectopia lentis, and thoracic aortic aneurysm and dissection [27437668, 16220557].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27437668", "evidence_support": "FBN1 is the causative gene for Marfan syndrome, an inherited disorder of connective tissue whose major features include tall stature and arachnodactyly, ectopia lentis, and thoracic aortic aneurysm and dissection. ", "evidence_relation": "supporting" }, { "cited_pmid": "16220557", "evidence_support": "The clinical spectrum of MFS is highly variable and includes involvement of the cardiovascular, skeletal, ocular, and other organ systems; however, the genotype-phenotype correlations have not been well developed.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The mutations can be missense, nonsense, frameshift, or splice site mutations, and are often located in the calcium-binding epidermal growth factor-like domains of the FBN1 gene [18435798, 14695540].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18435798", "evidence_support": "They are represented by 49 missense (61%), 1 silent (1%), 13 nonsense (16%), 6 donor splice site mutations (8%), 8 small deletions (10%), and 3 small duplications (4%). The majority of missense mutations were within the calcium-binding epidermal growth factor-like domains. ", "evidence_relation": "supporting" }, { "cited_pmid": "14695540", "evidence_support": "The mutations comprised 38 substitutions (78%), 10 deletions (20%), and one duplication (2%). There were 28 missense (57%), nine frameshift (18%), eight splice site (16%), and four nonsense mutations (8 %).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The identification of FBN1 mutations is crucial for the diagnosis of MFS, and molecular analysis of the gene can help reduce diagnostic uncertainty in patients with suspected MFS or related disorders [16930007, 31730815].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16930007", "evidence_support": "In those instances, molecular analysis of the FBN1 gene is helpful to identify at-risk individuals. Mutations are spread over the entire FBNJ gene and there are no particular hot spots.", "evidence_relation": "supporting" }, { "cited_pmid": "31730815", "evidence_support": "Molecular analysis of the FBN1 gene reduces diagnostic uncertainty in patients with suspected MFS or MFS-related disorders (MFS-RD).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Over 2700 FBN1 mutations have been identified to date, and the mutation detection rate can be as high as 95% using techniques such as denaturing high-performance liquid chromatography [16930007, 31730815].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16930007", "evidence_support": "Different standard methodologies are available to identify these mutations, however, one of the most sensitive techniques is denaturing high-performance liquid chromatography. This approach allows the performance of the analysis in a semi-automated manner and has a mutation detection rate of approx 95%.", "evidence_relation": "supporting" }, { "cited_pmid": "31730815", "evidence_support": "To date, more than 2700 FBN1 mutations are known.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash": { "answer": "An FBN1 mutation refers to a change in the gene that codes for fibrillin-1, a protein crucial for connective tissue development [10633129, 9401003, 12723256]. These mutations are the primary cause of Marfan syndrome, an autosomal dominant disorder affecting connective tissues throughout the body [12413333, 36035136, 33739008]. Marfan syndrome primarily affects the cardiovascular, skeletal, and ocular systems [10633129, 33739008, 10442675]. The mutations can lead to a range of symptoms, including aortic aneurysms, lens dislocation, and skeletal abnormalities [25337071, 17467262, 27956365]. FBN1 mutations can also cause other connective tissue disorders, collectively known as fibrillinopathies [12723256, 12651868, 16061422].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "An FBN1 mutation refers to a change in the gene that codes for fibrillin-1, a protein crucial for connective tissue development [10633129, 9401003, 12723256].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "10633129", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "9401003", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "12723256", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These mutations are the primary cause of Marfan syndrome, an autosomal dominant disorder affecting connective tissues throughout the body [12413333, 36035136, 33739008].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36035136", "evidence_support": "Marfan syndrome, an autosomal dominant disorder of connective tissue, is primarily caused by mutations in the fibrillin-1 (FBN1) gene, which encodes the protein fibrillin-1.", "evidence_relation": "supporting" }, { "cited_pmid": "33739008", "evidence_support": "Marfan syndrome is an autosomal dominant disorder of the connective tissue caused by mutations of the fibrillin-1 gene (FBN1) that primarly involves the cardiovascular, skeletal and ocular systems.", "evidence_relation": "supporting" }, { "cited_pmid": "12413333", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Marfan syndrome primarily affects the cardiovascular, skeletal, and ocular systems [10633129, 33739008, 10442675].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "33739008", "evidence_support": "Marfan syndrome is an autosomal dominant disorder of the connective tissue caused by mutations of the fibrillin-1 gene (FBN1) that primarly involves the cardiovascular, skeletal and ocular systems.", "evidence_relation": "supporting" }, { "cited_pmid": "10633129", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "10442675", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The mutations can lead to a range of symptoms, including aortic aneurysms, lens dislocation, and skeletal abnormalities [25337071, 17467262, 27956365].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "25337071", "evidence_support": "Marfan syndrome is an autosomal dominant disorder of the connective tissue, characterized by early development of thoracic aortic aneurysms and/or dissections, accompanied by ocular and/or skeletal involvement, and is caused by mutations in the fibrillin 1 (FBN1) gene.", "evidence_relation": "supporting" }, { "cited_pmid": "17467262", "evidence_support": "Marfan syndrome is a connective tissue disorder with ocular, musculoskeletal and cardiovascular manifestations that are caused by mutations in fibrillin-1, the major constituent of extracellular microfibrils.", "evidence_relation": "supporting" }, { "cited_pmid": "27956365", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "FBN1 mutations can also cause other connective tissue disorders, collectively known as fibrillinopathies [12723256, 12651868, 16061422].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "12723256", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "12651868", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "16061422", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "An FBN1 mutation refers to a change in the gene that codes for fibrillin-1, a protein crucial for the structure and function of connective tissue [9401003, 17467262, 36035136]. These mutations are most commonly associated with Marfan syndrome, an autosomal dominant disorder characterized by a range of skeletal, ocular, and cardiovascular abnormalities [9401003, 17467262, 36035136]. Marfan syndrome is caused by a deficiency of fibrillin-1, leading to defects in the microfibrillar protein architecture within the cardiovascular, musculoskeletal, ocular, and dermal systems [27956365, 28098115]. FBN1 mutations can also cause other connective tissue disorders, collectively known as fibrillinopathies [12723256, 31163209].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "An FBN1 mutation refers to a change in the gene that codes for fibrillin-1, a protein crucial for the structure and function of connective tissue [9401003, 17467262, 36035136].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17467262", "evidence_support": "Marfan syndrome is a connective tissue disorder with ocular, musculoskeletal and cardiovascular manifestations that are caused by mutations in fibrillin-1, the major constituent of extracellular microfibrils. ", "evidence_relation": "supporting" }, { "cited_pmid": "36035136", "evidence_support": "Marfan syndrome, an autosomal dominant disorder of connective tissue, is primarily caused by mutations in the fibrillin-1 (FBN1) gene, which encodes the protein fibrillin-1. ", "evidence_relation": "supporting" }, { "cited_pmid": "9401003", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These mutations are most commonly associated with Marfan syndrome, an autosomal dominant disorder characterized by a range of skeletal, ocular, and cardiovascular abnormalities [9401003, 17467262, 36035136].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17467262", "evidence_support": "Marfan syndrome is a connective tissue disorder with ocular, musculoskeletal and cardiovascular manifestations that are caused by mutations in fibrillin-1, the major constituent of extracellular microfibrils", "evidence_relation": "supporting" }, { "cited_pmid": "36035136", "evidence_support": "Marfan syndrome, an autosomal dominant disorder of connective tissue, is primarily caused by mutations in the fibrillin-1 (FBN1) gene, which encodes the protein fibrillin-1", "evidence_relation": "supporting" }, { "cited_pmid": "9401003", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Marfan syndrome is caused by a deficiency of fibrillin-1, leading to defects in the microfibrillar protein architecture within the cardiovascular, musculoskeletal, ocular, and dermal systems [27956365, 28098115].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "27956365", "evidence_support": "Fibrillin microfibrils and elastic fibers are critical determinants of elastic tissues where they define as tissue-specific architectures vital mechanical properties such as pliability and elastic recoil.", "evidence_relation": "neutral" }, { "cited_pmid": "27956365", "evidence_support": "Mutations in fibrillin-1 (FBN1) are causative for the Marfan syndrome, a congenital multisystem disorder characterized by progressive deterioration of the fibrillin microfibril/ elastic fiber architecture in the cardiovascular, musculoskeletal, ocular, and dermal system.", "evidence_relation": "supporting" }, { "cited_pmid": "28098115", "evidence_support": "Marfan syndrome (MFS), the founding member of connective tissue disorder, is an autosomal dominant disease; it is caused by a deficiency of the microfibrillar protein fibrillin-1 (FBN1) and characterized by involvement of three main systems; skeletal, ocular, and cardiovascular.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "FBN1 mutations can also cause other connective tissue disorders, collectively known as fibrillinopathies [12723256, 31163209].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31163209", "evidence_support": "FBN1 gene mutations lead to MFS and related connective tissue disorders.", "evidence_relation": "supporting" }, { "cited_pmid": "12723256", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Mutations in the fibrillin-1 gene (FBN1) are primarily responsible for Marfan syndrome (MFS), an autosomal dominant connective tissue disorder [10633129, 8941093]. This condition is characterized by a range of symptoms affecting the skeletal, ocular, and cardiovascular systems, including tall stature, aortic aneurysms, and lens dislocation (ectopia lentis) [25979247, 21858451]. Over 3,000 mutations in the FBN1 gene have been identified, with no specific hotspots, indicating that mutations can occur throughout the gene [30219651, 10633129]. Additionally, FBN1 mutations can lead to related connective tissue disorders, such as isolated ectopia lentis and familial aortic aneurysm, which may not meet the full criteria for Marfan syndrome [10633129, 12651868]. Overall, FBN1 mutations significantly impact connective tissue integrity and function.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in the fibrillin-1 gene (FBN1) are primarily responsible for Marfan syndrome (MFS), an autosomal dominant connective tissue disorder [10633129, 8941093].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "10633129", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "8941093", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This condition is characterized by a range of symptoms affecting the skeletal, ocular, and cardiovascular systems, including tall stature, aortic aneurysms, and lens dislocation (ectopia lentis) [25979247, 21858451].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25979247", "evidence_support": "The majority of mutations affecting the human fibrillin-1 gene, FBN1, result in Marfan syndrome (MFS), a common connective tissue disorder characterised by tall stature, ocular and cardiovascular defects.", "evidence_relation": "supporting" }, { "cited_pmid": "21858451", "evidence_support": "FBN1 mutations typically cause the Marfan syndrome, an autosomal dominant disorder manifesting with skeletal overgrowth, aortic aneurysm, and lens dislocation (ectopia lentis).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Over 3,000 mutations in the FBN1 gene have been identified, with no specific hotspots, indicating that mutations can occur throughout the gene [30219651, 10633129].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30219651", "evidence_support": "Most of the more than 3000 mutations known today in FBN1 cause the Marfan syndrome", "evidence_relation": "neutral" }, { "cited_pmid": "30219651", "evidence_support": "Marfan mutations can occur in any of the 56 domains that compose fibrillin-1. ", "evidence_relation": "supporting" }, { "cited_pmid": "10633129", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, FBN1 mutations can lead to related connective tissue disorders, such as isolated ectopia lentis and familial aortic aneurysm, which may not meet the full criteria for Marfan syndrome [10633129, 12651868].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "10633129", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "12651868", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Overall, FBN1 mutations significantly impact connective tissue integrity and function.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Mutations in the fibrillin-1 gene (FBN1) are primarily responsible for Marfan syndrome, an autosomal dominant disorder characterized by skeletal overgrowth, aortic aneurysms, and lens dislocation known as ectopia lentis [21858451, 27437668]. Individuals with Marfan syndrome often exhibit tall stature and arachnodactyly, along with cardiovascular, ocular, and musculoskeletal abnormalities [9401003, 16342915]. In addition to Marfan syndrome, FBN1 mutations can infrequently cause other conditions such as Weill-Marchesani syndrome, isolated ectopia lentis, and geleophysic dysplasia [21858451]. These mutations affect the extracellular glycoprotein fibrillin-1, which is crucial for connective tissue integrity [10647894, 12402346]. Therefore, individuals with FBN1 mutations may face a range of health issues related to connective tissue disorders.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Mutations in the fibrillin-1 gene (FBN1) are primarily responsible for Marfan syndrome, an autosomal dominant disorder characterized by skeletal overgrowth, aortic aneurysms, and lens dislocation known as ectopia lentis [21858451, 27437668].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21858451", "evidence_support": "FBN1 mutations typically cause the Marfan syndrome, an autosomal dominant disorder manifesting with skeletal overgrowth, aortic aneurysm, and lens dislocation (ectopia lentis).", "evidence_relation": "supporting" }, { "cited_pmid": "27437668", "evidence_support": "FBN1 is the causative gene for Marfan syndrome, an inherited disorder of connective tissue whose major features include tall stature and arachnodactyly, ectopia lentis, and thoracic aortic aneurysm and dissection.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Individuals with Marfan syndrome often exhibit tall stature and arachnodactyly, along with cardiovascular, ocular, and musculoskeletal abnormalities [9401003, 16342915].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "16342915", "evidence_support": "Marfan syndrome (MFS) is an autosomal dominant inherited connective tissue disorder caused by mutations in the fibrillin-1 (FBN1) gene with variable clinical manifestations in the cardiovascular, musculoskeletal and ocular systems.", "evidence_relation": "supporting" }, { "cited_pmid": "16342915", "evidence_support": "The highest correlation was found between FBN1 missense mutations, which manifested as ectopia lentis, skeletal major and skin minor criteria, and two out of four clustered phenotypes.", "evidence_relation": "neutral" }, { "cited_pmid": "9401003", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In addition to Marfan syndrome, FBN1 mutations can infrequently cause other conditions such as Weill-Marchesani syndrome, isolated ectopia lentis, and geleophysic dysplasia [21858451].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21858451", "evidence_support": "Infrequently, FBN1 mutations cause dominantly inherited Weill-Marchesani syndrome (WMS), isolated ectopia lentis (IEL), or the fibrotic condition, geleophysic dysplasia (GD). ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "These mutations affect the extracellular glycoprotein fibrillin-1, which is crucial for connective tissue integrity [10647894, 12402346].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "10647894", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "12402346", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Therefore, individuals with FBN1 mutations may face a range of health issues related to connective tissue disorders.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-1": { "answer": "fbn1 mutation refers to a genetic mutation in the fibrillin 1 (FBN1) gene, which can cause Marfan syndrome or isolated skeletal features of Marfan syndrome and/or high stature [15598221,26558191,22876116,24610719].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "fbn1 mutation refers to a genetic mutation in the fibrillin 1 (FBN1) gene, which can cause Marfan syndrome or isolated skeletal features of Marfan syndrome and/or high stature [15598221,26558191,22876116,24610719].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15598221", "evidence_support": "The R2726W mutation in the fibrillin 1 (FBN1, Marfan syndrome) gene segregates with isolated skeletal features of Marfan syndrome and/or high stature.", "evidence_relation": "supporting" }, { "cited_pmid": "26558191", "evidence_support": "In the first epidermal growth factor-like module, we identified a novel FBN1 mutation (p.C102Y), which caused ELS in the family.", "evidence_relation": "neutral" }, { "cited_pmid": "22876116", "evidence_support": "This is a first report of a mutation in FBN1 in MFS patients of Pakistani origin. The identification of a FBN1 mutation in this family confirms the diagnosis of MFS patients and expands the worldwide spectrum of FBN1 mutations.", "evidence_relation": "supporting" }, { "cited_pmid": "24610719", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "webis-2": { "answer": "The R2726W mutation in the fibrillin 1 (FBN1) gene is a fbn1 mutation [24610719,15598221].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The R2726W mutation in the fibrillin 1 (FBN1) gene is a fbn1 mutation [24610719,15598221].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "24610719", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15598221", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-3": { "answer": "The R2726W mutation in the fibrillin 1 (FBN1) gene is associated with isolated skeletal features of Marfan syndrome and/or high stature [15598221,22876116].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The R2726W mutation in the fibrillin 1 (FBN1) gene is associated with isolated skeletal features of Marfan syndrome and/or high stature [15598221,22876116].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15598221", "evidence_support": "The R2726W mutation in the fibrillin 1 (FBN1, Marfan syndrome) gene segregates with isolated skeletal features of Marfan syndrome and/or high stature.", "evidence_relation": "supporting" }, { "cited_pmid": "22876116", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-5": { "answer": "The R2726W mutation in the fibrillin 1 (FBN1) gene is associated with isolated skeletal features of Marfan syndrome and/or high stature [15598221,22876116].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The R2726W mutation in the fibrillin 1 (FBN1) gene is associated with isolated skeletal features of Marfan syndrome and/or high stature [15598221,22876116].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15598221", "evidence_support": "The R2726W mutation in the fibrillin 1 (FBN1, Marfan syndrome) gene segregates with isolated skeletal features of Marfan syndrome and/or high stature.", "evidence_relation": "supporting" }, { "cited_pmid": "22876116", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-gpt-1": { "answer": "Fbn1 mutation refers to a genetic alteration in the FBN1 gene, which encodes the protein fibrillin-1, a key component of connective tissue. Mutations in this gene are associated with Marfan syndrome and other connective tissue disorders, leading to symptoms such as cardiovascular issues, skeletal abnormalities, and ocular problems. These mutations can affect the structure and function of fibrillin-1, resulting in a range of clinical manifestations.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Fbn1 mutation refers to a genetic alteration in the FBN1 gene, which encodes the protein fibrillin-1, a key component of connective tissue.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Mutations in this gene are associated with Marfan syndrome and other connective tissue disorders, leading to symptoms such as cardiovascular issues, skeletal abnormalities, and ocular problems.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "These mutations can affect the structure and function of fibrillin-1, resulting in a range of clinical manifestations.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "A fbn1 mutation refers to a change in the fibrillin-1 gene (FBN1), which is associated with Marfan syndrome, a genetic disorder affecting connective tissue. The R2726W mutation is one specific example that has been linked to isolated skeletal features and high stature in individuals with Marfan syndrome [15598221]. This mutation can be inherited in an autosomal dominant manner, as seen in families affected by the condition [22876116].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A fbn1 mutation refers to a change in the fibrillin-1 gene (FBN1), which is associated with Marfan syndrome, a genetic disorder affecting connective tissue.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "The R2726W mutation is one specific example that has been linked to isolated skeletal features and high stature in individuals with Marfan syndrome [15598221].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15598221", "evidence_support": "The R2726W mutation in the fibrillin 1 (FBN1, Marfan syndrome) gene segregates with isolated skeletal features of Marfan syndrome and/or high stature.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This mutation can be inherited in an autosomal dominant manner, as seen in families affected by the condition [22876116].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22876116", "evidence_support": "To describe a novel mutation in the fibrillin-1 (FBN1) gene in a large Pakistani family with autosomal dominant Marfan syndrome (MFS)", "evidence_relation": "neutral" } ] } ] }, "webis-gpt-6": { "answer": "FBN1 mutations refer to genetic alterations in the FBN1 gene, which encodes the connective protein fibrillin-1. These mutations can lead to various conditions, including Marfan syndrome and ectopia lentis, with specific mutations like R2726W being noted for their incomplete penetrance and the novel p.G1344E. mutation being directly associated with ectopia lentis [15598221,32404357,22876116]. The presence of these mutations can significantly impact connective tissue integrity and function.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "FBN1 mutations refer to genetic alterations in the FBN1 gene, which encodes the connective protein fibrillin-1.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "These mutations can lead to various conditions, including Marfan syndrome and ectopia lentis, with specific mutations like R2726W being noted for their incomplete penetrance and the novel p.G1344E. mutation being directly associated with ectopia lentis [15598221,32404357,22876116].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15598221", "evidence_support": "The R2726W mutation in the fibrillin 1 (FBN1, Marfan syndrome) gene segregates with isolated skeletal features of Marfan syndrome and/or high stature.", "evidence_relation": "supporting" }, { "cited_pmid": "15598221", "evidence_support": "The FBN1 R2776W mutation, which is associated with skeletal features of Marfan syndrome, appears incompletely penetrant.", "evidence_relation": "supporting" }, { "cited_pmid": "22876116", "evidence_support": "The identification of a FBN1 mutation in this family confirms the diagnosis of MFS patients and expands the worldwide spectrum of FBN1 mutations.", "evidence_relation": "neutral" }, { "cited_pmid": "32404357", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The presence of these mutations can significantly impact connective tissue integrity and function.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "zero-shot-gemini-flash": { "answer": "A mutation in the FBN1 gene, which encodes fibrillin-1, is the cause of Marfan syndrome [9649943, 33739008, 33450697]. Fibrillin-1 is a protein found in the extracellular matrix, which is the material that surrounds cells [9649943]. Marfan syndrome is an autosomal dominant disorder, meaning that a person only needs to inherit one copy of the mutated gene from either parent to develop the condition [25337071, 33739008, 10633129]. The disorder primarily affects the cardiovascular, skeletal, and ocular systems [25337071, 10633129, 33739008]. Marfan syndrome is characterized by a range of symptoms, including aortic aneurysms, skeletal abnormalities, and eye problems [25337071, 10633129, 33739008]. The severity of Marfan syndrome can vary widely from person to person [23444230]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A mutation in the FBN1 gene, which encodes fibrillin-1, is the cause of Marfan syndrome [9649943, 33739008, 33450697].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33739008", "evidence_support": "Marfan syndrome is an autosomal dominant disorder of the connective tissue caused by mutations of the fibrillin-1 gene (FBN1) that primarly involves the cardiovascular, skeletal and ocular systems.", "evidence_relation": "supporting" }, { "cited_pmid": "33450697", "evidence_support": "Marfan syndrome (MFS) is a connective-tissue disorder caused mainly by heterozygous mutations in the FBN1 gene that encodes fibrillin-1.", "evidence_relation": "supporting" }, { "cited_pmid": "9649943", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Fibrillin-1 is a protein found in the extracellular matrix, which is the material that surrounds cells [9649943].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "9649943", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Marfan syndrome is an autosomal dominant disorder, meaning that a person only needs to inherit one copy of the mutated gene from either parent to develop the condition [25337071, 33739008, 10633129].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25337071", "evidence_support": "Marfan syndrome is an autosomal dominant disorder of the connective tissue, characterized by early development of thoracic aortic aneurysms and/or dissections, accompanied by ocular and/or skeletal involvement, and is caused by mutations in the fibrillin 1 (FBN1) gene.", "evidence_relation": "supporting" }, { "cited_pmid": "33739008", "evidence_support": "Marfan syndrome is an autosomal dominant disorder of the connective tissue caused by mutations of the fibrillin-1 gene (FBN1) that primarly involves the cardiovascular, skeletal and ocular systems.", "evidence_relation": "supporting" }, { "cited_pmid": "10633129", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The disorder primarily affects the cardiovascular, skeletal, and ocular systems [25337071, 10633129, 33739008].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25337071", "evidence_support": "Marfan syndrome is an autosomal dominant disorder of the connective tissue, characterized by early development of thoracic aortic aneurysms and/or dissections, accompanied by ocular and/or skeletal involvement, and is caused by mutations in the fibrillin 1 (FBN1) gene.", "evidence_relation": "supporting" }, { "cited_pmid": "33739008", "evidence_support": "Marfan syndrome is an autosomal dominant disorder of the connective tissue caused by mutations of the fibrillin-1 gene (FBN1) that primarly involves the cardiovascular, skeletal and ocular systems.", "evidence_relation": "supporting" }, { "cited_pmid": "10633129", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Marfan syndrome is characterized by a range of symptoms, including aortic aneurysms, skeletal abnormalities, and eye problems [25337071, 10633129, 33739008].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25337071", "evidence_support": "Marfan syndrome is an autosomal dominant disorder of the connective tissue, characterized by early development of thoracic aortic aneurysms and/or dissections, accompanied by ocular and/or skeletal involvement, and is caused by mutations in the fibrillin 1 (FBN1) gene.", "evidence_relation": "supporting" }, { "cited_pmid": "33739008", "evidence_support": "Marfan syndrome is an autosomal dominant disorder of the connective tissue caused by mutations of the fibrillin-1 gene (FBN1) that primarly involves the cardiovascular, skeletal and ocular systems.", "evidence_relation": "supporting" }, { "cited_pmid": "10633129", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "The severity of Marfan syndrome can vary widely from person to person [23444230].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23444230", "evidence_support": "Mutations in fibrillin-1 (FBN1) cause a wide spectrum of disorders, including Marfan syndrome, which have in common defects in fibrillin-1 microfibrils.", "evidence_relation": "neutral" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "Fibrillin-1 (FBN1) mutations are genetic alterations in the FBN1 gene, which encodes a crucial extracellular matrix protein involved in connective tissue structure. These mutations primarily cause Marfan syndrome, an autosomal dominant disorder characterized by diverse manifestations affecting the ocular, skeletal, and cardiovascular systems, including aortic aneurysms and lens dislocation [10633129, 25979247, 37108724]. Additionally, FBN1 mutations can lead to related connective tissue disorders, such as isolated ectopia lentis and stiff skin syndrome, which exhibit overlapping phenotypes [10633129, 25979247, 21858451]. The pathogenic mechanism often involves a dominant negative effect, where mutant fibrillin-1 disrupts normal microfibril function [12651868, 27956365]. Over 3,000 distinct mutations in the FBN1 gene have been identified, contributing to the clinical variability seen in affected individuals [30219651, 30534251].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Fibrillin-1 (FBN1) mutations are genetic alterations in the FBN1 gene, which encodes a crucial extracellular matrix protein involved in connective tissue structure.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "These mutations primarily cause Marfan syndrome, an autosomal dominant disorder characterized by diverse manifestations affecting the ocular, skeletal, and cardiovascular systems, including aortic aneurysms and lens dislocation [10633129, 25979247, 37108724].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25979247", "evidence_support": "The majority of mutations affecting the human fibrillin-1 gene, FBN1, result in Marfan syndrome (MFS), a common connective tissue disorder characterised by tall stature, ocular and cardiovascular defects.", "evidence_relation": "supporting" }, { "cited_pmid": "37108724", "evidence_support": "Mutations in the fibrillin-1 gene (FBN1) are linked to Marfan syndrome (MFS), a systemic connective tissue disorder that, besides other heterogeneous symptoms, usually manifests in life-threatening aortic complications.", "evidence_relation": "supporting" }, { "cited_pmid": "10633129", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, FBN1 mutations can lead to related connective tissue disorders, such as isolated ectopia lentis and stiff skin syndrome, which exhibit overlapping phenotypes [10633129, 25979247, 21858451].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25979247", "evidence_support": "Recently, stiff skin syndrome (SSS) and a group of syndromes known collectively as the acromelic dysplasias, which typically result in short stature, skin thickening and joint stiffness, have been linked to FBN1 mutations that affect specific domains of the fibrillin-1 protein.", "evidence_relation": "supporting" }, { "cited_pmid": "21858451", "evidence_support": "FBN1 mutations typically cause the Marfan syndrome, an autosomal dominant disorder manifesting with skeletal overgrowth, aortic aneurysm, and lens dislocation (ectopia lentis). Infrequently, FBN1 mutations cause dominantly inherited Weill-Marchesani syndrome (WMS), isolated ectopia lentis (IEL), or the fibrotic condition, geleophysic dysplasia (GD).", "evidence_relation": "supporting" }, { "cited_pmid": "10633129", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The pathogenic mechanism often involves a dominant negative effect, where mutant fibrillin-1 disrupts normal microfibril function [12651868, 27956365].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27956365", "evidence_support": "Mutations in fibrillin-1 (FBN1) are causative for the Marfan syndrome, a congenital multisystem disorder characterized by progressive deterioration of the fibrillin microfibril/ elastic fiber architecture in the cardiovascular, musculoskeletal, ocular, and dermal system", "evidence_relation": "supporting" }, { "cited_pmid": "12651868", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Over 3,000 distinct mutations in the FBN1 gene have been identified, contributing to the clinical variability seen in affected individuals [30219651, 30534251].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30219651", "evidence_support": "Most of the more than 3000 mutations known today in FBN1 cause the Marfan syndrome", "evidence_relation": "supporting" }, { "cited_pmid": "30534251", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] } } }, { "question_id": "124", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Coronary artery disease (CAD) without angina refers to the presence of atherosclerosis or narrowing of the coronary arteries without the typical symptom of chest pain or discomfort known as angina pectoris. This condition can be concerning because even in the absence of angina, the reduced blood flow to the heart muscle can still increase the risk of a heart attack or other cardiovascular complications. It's important for patients to manage risk factors such as high blood pressure, cholesterol, and diabetes, and to follow their doctor's recommendations for treatment and lifestyle changes [27552940].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina refers to the presence of atherosclerosis or narrowing of the coronary arteries without the typical symptom of chest pain or discomfort known as angina pectoris.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This condition can be concerning because even in the absence of angina, the reduced blood flow to the heart muscle can still increase the risk of a heart attack or other cardiovascular complications.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "It's important for patients to manage risk factors such as high blood pressure, cholesterol, and diabetes, and to follow their doctor's recommendations for treatment and lifestyle changes [27552940].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "27552940", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "CAD without angina refers to the presence of coronary artery disease without the typical chest pain [21526712, 36685161, 31228187]. These patients may experience other symptoms such as dyspnea and fatigue [21526712, 34902504, 36423427]. Despite the absence of chest pain, they are at increased risk for adverse cardiovascular outcomes and events [36035733, 31168187, 34902504]. Often, these patients remain undiagnosed and untreated, leading to poor physical functioning and quality of life [34796207, 36035733, 31168187]. They may also incur high healthcare costs due to repeat testing [36035733, 34902504, 25361793]. Although they have a similar risk of cardiovascular hospitalization as those with angina, their all-cause mortality is generally lower [28395884, 23410541, 29521447]. Chronic pain in areas like the neck and arm can also be present [21526712]. Therefore, it's crucial to recognize and manage CAD without angina to mitigate these risks and improve patient outcomes [34796207, 36035733, 31168187].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "CAD without angina refers to the presence of coronary artery disease without the typical chest pain [21526712, 36685161, 31228187].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21526712", "evidence_support": "Absence of chest pain with chronic left arm and neck pain is more unusual but demonstrates the heterogeneity of presentation.", "evidence_relation": "neutral" }, { "cited_pmid": "36685161", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "31228187", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These patients may experience other symptoms such as dyspnea and fatigue [21526712, 34902504, 36423427].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "21526712", "evidence_support": "Anginal equivalents such as dyspnoea and fatigue, or radiation of pain to the neck, jaw and arm, are also well described.", "evidence_relation": "supporting" }, { "cited_pmid": "36423427", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "34902504", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Despite the absence of chest pain, they are at increased risk for adverse cardiovascular outcomes and events [36035733, 31168187, 34902504].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36035733", "evidence_support": "Despite the absence of obstructive CAD, those with INOCA have an increased risk of all-cause mortality and adverse outcomes, including recurrent angina and cardiovascular events.", "evidence_relation": "supporting" }, { "cited_pmid": "34902504", "evidence_support": "Based on current evidence, these patients are at increased risk of adverse cardiovascular events, even though they have no obstructive CAD.", "evidence_relation": "supporting" }, { "cited_pmid": "31168187", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Often, these patients remain undiagnosed and untreated, leading to poor physical functioning and quality of life [34796207, 36035733, 31168187].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "34796207", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "36035733", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "31168187", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "They may also incur high healthcare costs due to repeat testing [36035733, 34902504, 25361793].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36035733", "evidence_support": "These patients often undergo repeat testing, including cardiac catheterization, resulting in lifetime healthcare costs that rival those for obstructive CAD.", "evidence_relation": "supporting" }, { "cited_pmid": "34902504", "evidence_support": "Importantly, INOCA is associated with recurrent clinical presentations with chest pain, impaired functional capacity, reduced health-related quality of life, and high healthcare costs", "evidence_relation": "supporting" }, { "cited_pmid": "25361793", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Although they have a similar risk of cardiovascular hospitalization as those with angina, their all-cause mortality is generally lower [28395884, 23410541, 29521447].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28395884", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "23410541", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "29521447", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Chronic pain in areas like the neck and arm can also be present [21526712].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21526712", "evidence_support": "Anginal equivalents such as dyspnoea and fatigue, or radiation of pain to the neck, jaw and arm, are also well described. Absence of chest pain with chronic left arm and neck pain is more unusual but demonstrates the heterogeneity of presentation.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Therefore, it's crucial to recognize and manage CAD without angina to mitigate these risks and improve patient outcomes [34796207, 36035733, 31168187].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "34796207", "evidence_support": "But adequate diagnosis is vital, so that treatment can be started to reduce symptoms, reduce healthcare costs and improve quality of life and cardiovascular prognosis.", "evidence_relation": "supporting" }, { "cited_pmid": "31168187", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "36035733", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Coronary artery disease (CAD) without angina refers to the presence of atherosclerotic plaque in the coronary arteries without the typical chest pain symptoms associated with angina pectoris.This condition can be asymptomatic or present with atypical symptoms such as dyspnea or fatigue, which may lead to underdiagnosis and undertreatment [21526712, 28395884]. Despite the absence of angina, patients with CAD are at increased risk for adverse cardiovascular events, including myocardial infarction and mortality, similar to those with symptomatic CAD [28395884, 20494653]. The absence of angina does not necessarily indicate a benign prognosis; in fact, asymptomatic CAD patients may have a higher mortality rate compared to those with angina, possibly due to delayed diagnosis and treatment [20494653]. Therefore, it is crucial to identify and manage CAD in patients without angina to mitigate the risk of severe cardiovascular outcomes [28395884, 20494653].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina refers to the presence of atherosclerotic plaque in the coronary arteries without the typical chest pain symptoms associated with angina pectoris.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This condition can be asymptomatic or present with atypical symptoms such as dyspnea or fatigue, which may lead to underdiagnosis and undertreatment [21526712, 28395884].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "21526712", "evidence_support": "Frequently patients with coronary artery disease (CAD) present with chest pain. Anginal equivalents such as dyspnoea and fatigue, or radiation of pain to the neck, jaw and arm, are also well described. Absence of chest pain with chronic left arm and neck pain is more unusual but demonstrates the heterogeneity of presentation", "evidence_relation": "supporting" }, { "cited_pmid": "21526712", "evidence_support": "CAD should be considered in those anginal equivalents in the absence of 'strangling and anxiety of the breast'", "evidence_relation": "supporting" }, { "cited_pmid": "28395884", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Despite the absence of angina, patients with CAD are at increased risk for adverse cardiovascular events, including myocardial infarction and mortality, similar to those with symptomatic CAD [28395884, 20494653].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28395884", "evidence_support": "In conclusion, in patients with CAD, AP was associated with similar risk for CV hospitalization and revascularization and lower all-cause mortality compared with patients without AP regardless of DM status.", "evidence_relation": "supporting" }, { "cited_pmid": "20494653", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The absence of angina does not necessarily indicate a benign prognosis; in fact, asymptomatic CAD patients may have a higher mortality rate compared to those with angina, possibly due to delayed diagnosis and treatment [20494653].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20494653", "evidence_support": "In conclusion, in patients with stable CAD undergoing elective PCI, the absence of symptoms was associated with an increase in 1-year mortality.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Therefore, it is crucial to identify and manage CAD in patients without angina to mitigate the risk of severe cardiovascular outcomes [28395884, 20494653].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "28395884", "evidence_support": "patients with CAD, AP was associated with similar risk for CV hospitalization and revascularization and lower all-cause mortality compared with patients without AP regardless of DM status", "evidence_relation": "supporting" }, { "cited_pmid": "20494653", "evidence_support": "On multivariate analysis, the absence of symptoms was a strong independent predictor of 1-year mortality (p = 0.017). In conclusion, in patients with stable CAD undergoing elective PCI, the absence of symptoms was associated with an increase in 1-year mortality.", "evidence_relation": "supporting" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "CAD without angina refers to the presence of coronary artery disease (CAD) without symptoms of angina pectoris [28395884]. This phenomenon is observed in patients who undergo coronary angiography and are found to have obstructive CAD, but do not experience typical angina symptoms [28395884]. The absence of angina in patients with CAD is associated with an increased risk of adverse outcomes, including cardiovascular events and mortality [20494653]. In fact, a study found that asymptomatic patients with CAD had a higher 1-year mortality rate compared to those with symptomatic CAD [20494653]. The underlying mechanisms for this association are not fully understood, but it is thought that the absence of angina may be related to altered pain perception or neuropathy, particularly in patients with diabetes [28395884]. Further research is needed to elucidate the relationship between CAD and angina symptoms.provides additional context on the pathophysiology of CAD and angina [31168187].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "CAD without angina refers to the presence of coronary artery disease (CAD) without symptoms of angina pectoris [28395884].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28395884", "evidence_support": "Angina pectoris (AP) has different prognostic implications in various populations. Patients with diabetes mellitus (DM) may experience neuropathy such that AP may not be perceived in the setting of coronary artery disease (CAD).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This phenomenon is observed in patients who undergo coronary angiography and are found to have obstructive CAD, but do not experience typical angina symptoms [28395884].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28395884", "evidence_support": "Patients with diabetes mellitus (DM) may experience neuropathy such that AP may not be perceived in the setting of coronary artery disease (CAD).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The absence of angina in patients with CAD is associated with an increased risk of adverse outcomes, including cardiovascular events and mortality [20494653].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20494653", "evidence_support": "The 1-year mortality rate was greater in the asymptomatic patients (43 [4.1%] vs 16 [1.8%], p = 0.003).", "evidence_relation": "neutral" }, { "cited_pmid": "20494653", "evidence_support": "On multivariate analysis, the absence of symptoms was a strong independent predictor of 1-year mortality (p = 0.017).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In fact, a study found that asymptomatic patients with CAD had a higher 1-year mortality rate compared to those with symptomatic CAD [20494653].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "20494653", "evidence_support": "In conclusion, in patients with stable CAD undergoing elective PCI, the absence of symptoms was associated with an increase in 1-year mortality", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The underlying mechanisms for this association are not fully understood, but it is thought that the absence of angina may be related to altered pain perception or neuropathy, particularly in patients with diabetes [28395884].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28395884", "evidence_support": "Angina pectoris (AP) has different prognostic implications in various populations. Patients with diabetes mellitus (DM) may experience neuropathy such that AP may not be perceived in the setting of coronary artery disease (CAD).", "evidence_relation": "supporting" }, { "cited_pmid": "28395884", "evidence_support": "The relation between AP status and clinical outcomes was not dependent on DM status (all interaction p >0.10). In conclusion, in patients with CAD, AP was associated with similar risk for CV hospitalization and revascularization and lower all-cause mortality compared with patients without AP regardless of DM status. ", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Further research is needed to elucidate the relationship between CAD and angina symptoms.provides additional context on the pathophysiology of CAD and angina [31168187].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31168187", "evidence_support": "This review encompasses a broader spectrum of pathophysiological mechanisms of non-CAD, and proposes a new way of classification based on the major disorder involved: type I (ischemic mechanisms) and type II (non-ischemic mechanisms), depending on which mechanism predominates. Hopefully, this would provide new insights in the understanding of this disorder, thus leading to accurate and early diagnosis and successful treatment, especially considering the increased mortality risk in these patients.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "CAD without angina can be detected through various diagnostic tests, including coronary angiography, computed tomography angiography (CTA), and cardiac magnetic resonance imaging (MRI) [27318576, 24076080, 19625270]. ", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "CAD without angina can be detected through various diagnostic tests, including coronary angiography, computed tomography angiography (CTA), and cardiac magnetic resonance imaging (MRI) [27318576, 24076080, 19625270].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "27318576", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "24076080", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "19625270", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Angina pectoris without obstructive coronary artery disease (CAD) occurs when patients experience chest pain or discomfort due to various non-obstructive causes, such as microvascular dysfunction, vasospastic angina, or non-coronary disease [15754152, 32617474, 34487597]. In some cases, patients with angina without obstructive CAD may have a higher risk of future heart diseases, including myocardial infarction, and may require a comprehensive invasive assessment to identify the underlying cause of their symptoms [15754152, 32617474, 34487597]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Angina pectoris without obstructive coronary artery disease (CAD) occurs when patients experience chest pain or discomfort due to various non-obstructive causes, such as microvascular dysfunction, vasospastic angina, or non-coronary disease [15754152, 32617474, 34487597].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15754152", "evidence_support": "Angina in the setting of a normal angiogram (NOCAD) occurs in 20-30% of patients undergoing coronary angiography.", "evidence_relation": "neutral" }, { "cited_pmid": "15754152", "evidence_support": "The etiologies of NOCAD can be anatomically classified into three groups: epicardial disease, coronary microvascular dysfunction, and noncoronary disease.", "evidence_relation": "supporting" }, { "cited_pmid": "15754152", "evidence_support": "Microvascular dysfunction may be secondary to hypertension, cardiomyopathy, infiltrative disease, valvular disease, or idiopathic.", "evidence_relation": "supporting" }, { "cited_pmid": "32617474", "evidence_support": "Patients with angina and no obstructive CAD classified by computed tomography coronary angiography may have myocardial ischaemia due to microvascular angina, vasospastic angina, or both.", "evidence_relation": "supporting" }, { "cited_pmid": "34487597", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In some cases, patients with angina without obstructive CAD may have a higher risk of future heart diseases, including myocardial infarction, and may require a comprehensive invasive assessment to identify the underlying cause of their symptoms [15754152, 32617474, 34487597].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32617474", "evidence_support": "Even in those without obstructive coronary artery disease (CAD), women with angina continue to have increased mortality.", "evidence_relation": "supporting" }, { "cited_pmid": "32617474", "evidence_support": "Coronary function testing, in the form of diagnostic guidewire-based tests and adjunctive acetylcholine provocation, has proven to be critical in the accurate diagnoses and appropriate management of these patients.", "evidence_relation": "supporting" }, { "cited_pmid": "15754152", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "34487597", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Coronary artery disease (CAD) without angina refers to a condition where a person has CAD, but does not experience angina pectoris, which is chest pain or discomfort caused by reduced blood flow to the heart muscle [30001355, 26067854]. CAD without angina is often diagnosed through medical imaging tests such as coronary angiography, which shows the presence of plaque buildup in the coronary arteries, but the patient does not experience typical angina symptoms [30001355]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina refers to a condition where a person has CAD, but does not experience angina pectoris, which is chest pain or discomfort caused by reduced blood flow to the heart muscle [30001355, 26067854].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30001355", "evidence_support": "Current management and treatment of stable CAD patients with angina is still suboptimal and different compared to those without angina.", "evidence_relation": "neutral" }, { "cited_pmid": "26067854", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "CAD without angina is often diagnosed through medical imaging tests such as coronary angiography, which shows the presence of plaque buildup in the coronary arteries, but the patient does not experience typical angina symptoms [30001355].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30001355", "evidence_support": "Patients with angina underwent more frequently coronary angiography (92.7% vs 84.9%; p<0.0001) and other diagnostic imaging procedures compared to those without angina", "evidence_relation": "neutral" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Coronary artery disease (CAD) without angina refers to a condition where a person has CAD, but does not experience angina pectoris, which is chest pain or discomfort caused by reduced blood flow to the heart muscle [26067854, 21526712, 30001355]. CAD without angina is often diagnosed through medical imaging tests such as coronary angiography, which shows the presence of plaque buildup in the coronary arteries, but the patient does not experience typical angina symptoms [30001355]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina refers to a condition where a person has CAD, but does not experience angina pectoris, which is chest pain or discomfort caused by reduced blood flow to the heart muscle [26067854, 21526712, 30001355].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21526712", "evidence_support": "CAD should be considered in those anginal equivalents in the absence of 'strangling and anxiety of the breast'.", "evidence_relation": "supporting" }, { "cited_pmid": "30001355", "evidence_support": "Among the 5070 consecutive stable CAD patients enrolled in 183 participating centers over a 3-month period, 3714 (73.2%) had no angina and 1356 (26.8%) presented with angina.", "evidence_relation": "neutral" }, { "cited_pmid": "26067854", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "CAD without angina is often diagnosed through medical imaging tests such as coronary angiography, which shows the presence of plaque buildup in the coronary arteries, but the patient does not experience typical angina symptoms [30001355].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "30001355", "evidence_support": "Current management and treatment of stable CAD patients with angina is still suboptimal and different compared to those without angina.", "evidence_relation": "neutral" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Coronary artery disease (CAD) without angina refers to a condition where a person has CAD, but does not experience angina pectoris, which is chest pain or discomfort caused by reduced blood flow to the heart muscle [21526712, 26067854, 30001355]. CAD without angina is often diagnosed through medical imaging tests such as coronary angiography, which shows the presence of plaque buildup in the coronary arteries, but the patient does not experience typical angina symptoms [29890282, 30001355]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina refers to a condition where a person has CAD, but does not experience angina pectoris, which is chest pain or discomfort caused by reduced blood flow to the heart muscle [21526712, 26067854, 30001355].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30001355", "evidence_support": "Current management and treatment of stable CAD patients with angina is still suboptimal and different compared to those without angina.", "evidence_relation": "neutral" }, { "cited_pmid": "21526712", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "26067854", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "CAD without angina is often diagnosed through medical imaging tests such as coronary angiography, which shows the presence of plaque buildup in the coronary arteries, but the patient does not experience typical angina symptoms [29890282, 30001355].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "30001355", "evidence_support": "Current management and treatment of stable CAD patients with angina is still suboptimal and different compared to those without angina.", "evidence_relation": "neutral" }, { "cited_pmid": "29890282", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Coronary artery disease (CAD) without angina refers to a condition where a person has CAD, but does not experience angina pectoris, which is chest pain or discomfort caused by reduced blood flow to the heart muscle [30001355]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina refers to a condition where a person has CAD, but does not experience angina pectoris, which is chest pain or discomfort caused by reduced blood flow to the heart muscle [30001355].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30001355", "evidence_support": "Current management and treatment of stable CAD patients with angina is still suboptimal and different compared to those without angina.", "evidence_relation": "neutral" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Coronary artery disease (CAD) without angina refers to a condition where a person has CAD, but does not experience angina pectoris, which is chest pain or discomfort caused by reduced blood flow to the heart muscle [15603242, 32246442, 28196437]. CAD without angina is often diagnosed through medical imaging tests such as coronary angiography, which shows the presence of plaque buildup in the coronary arteries, but the patient does not experience typical angina symptoms [14963655]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina refers to a condition where a person has CAD, but does not experience angina pectoris, which is chest pain or discomfort caused by reduced blood flow to the heart muscle [15603242, 32246442, 28196437].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28196437", "evidence_support": "Angina pectoris is defined as substernal chest pain, pressure, or discomfort that is typically exacerbated by exertion and/or emotional stress, lasts greater than 30 to 60 seconds, and is relieved by rest and nitroglycerin.", "evidence_relation": "neutral" }, { "cited_pmid": "32246442", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15603242", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "CAD without angina is often diagnosed through medical imaging tests such as coronary angiography, which shows the presence of plaque buildup in the coronary arteries, but the patient does not experience typical angina symptoms [14963655].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "14963655", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Coronary artery disease (CAD) without angina refers to a condition where a person has CAD, but does not experience angina pectoris, which is chest pain or discomfort caused by reduced blood flow to the heart muscle [32246442, 22050067]. CAD without angina symptoms is often diagnosed through non-invasive tests, such as stress tests, to detect stress-induced myocardial ischemia [15912431, 34487597, 19774513]. The clinical context and pre-test probability for significant CAD are crucial in determining the usefulness of a test [15912431, 34487597, 19774513]. Non-invasive tests are typically used in patients with intermediate pre-test probability, and in patients with high pre-test probability, they are helpful for risk stratification [15912431, 34487597, 19774513]. In asymptomatic patients, there is no established indication for any tests apart from calculation of a global cardiovascular risk based on traditional risk factors and initiation of primary preventive measures if appropriate [15912431, 34487597, 19774513]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina refers to a condition where a person has CAD, but does not experience angina pectoris, which is chest pain or discomfort caused by reduced blood flow to the heart muscle [32246442, 22050067].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32246442", "evidence_support": "Angina pectoris is caused by myocardial ischemia in the main expression of pain in the chest or adjoining area, which is usually a result of exertion and related to myocardial function disorder.", "evidence_relation": "neutral" }, { "cited_pmid": "22050067", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "CAD without angina symptoms is often diagnosed through non-invasive tests, such as stress tests, to detect stress-induced myocardial ischemia [15912431, 34487597, 19774513].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15912431", "evidence_support": "Clinically, coronary artery disease (CAD) presents either as stable angina pectoris or as an acute coronary syndrome.", "evidence_relation": "neutral" }, { "cited_pmid": "15912431", "evidence_support": "In order to detect hemodynamically significant coronary artery stenoses, exercise stress tests or noninvasive stress imaging are usually implemented in the diagnostic workup", "evidence_relation": "supporting" }, { "cited_pmid": "15912431", "evidence_support": "Consecutively, patients without high-risk features need a thorough noninvasive evaluation for the presence of significant CAD which is comparable to patients presenting with chronic stable angina pectoris.", "evidence_relation": "supporting" }, { "cited_pmid": "19774513", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "34487597", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The clinical context and pre-test probability for significant CAD are crucial in determining the usefulness of a test [15912431, 34487597, 19774513].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "19774513", "evidence_support": "Tests for the diagnosis of coronary artery disease (CAD) rely on two main diagnostic principles, that is direct visualisation of coronary anatomy or detection of stress-induced myocardial ischaemia. Whether a given test is useful for the patient's management critically depends on the clinical context, that is pre-test probability for significant CAD. ", "evidence_relation": "supporting" }, { "cited_pmid": "34487597", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15912431", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Non-invasive tests are typically used in patients with intermediate pre-test probability, and in patients with high pre-test probability, they are helpful for risk stratification [15912431, 34487597, 19774513].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "19774513", "evidence_support": "Non-invasive tests have the highest diagnostic yield in patients with chest pain and intermediate pre-test probability.", "evidence_relation": "supporting" }, { "cited_pmid": "19774513", "evidence_support": "In patients with low or high pre-test probability, non-invasive tests provide hardly any added diagnostic information. However, in patients with high pre-test probability of CAD, non-invasive tests are helpful for risk stratification. ", "evidence_relation": "supporting" }, { "cited_pmid": "34487597", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15912431", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In asymptomatic patients, there is no established indication for any tests apart from calculation of a global cardiovascular risk based on traditional risk factors and initiation of primary preventive measures if appropriate [15912431, 34487597, 19774513].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "19774513", "evidence_support": "In asymptomatic patients, there is no established indication for any tests apart from calculation of a global cardiovascular risk based on traditional risk factors and initiation of primary preventive measures if appropriate.", "evidence_relation": "supporting" }, { "cited_pmid": "34487597", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15912431", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Coronary artery disease (CAD) without angina refers to a condition where a person has CAD, but does not experience angina pectoris, which is chest pain or discomfort caused by reduced blood flow to the heart muscle [32246442, 15603242, 28196437]. CAD without angina is often diagnosed through medical imaging tests such as multidetector computed tomographic (MDCT) angiography, cardiac magnetic resonance (MR) imaging, and cardiac CT [15912431, 20066140]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina refers to a condition where a person has CAD, but does not experience angina pectoris, which is chest pain or discomfort caused by reduced blood flow to the heart muscle [32246442, 15603242, 28196437].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32246442", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15603242", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "28196437", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "CAD without angina is often diagnosed through medical imaging tests such as multidetector computed tomographic (MDCT) angiography, cardiac magnetic resonance (MR) imaging, and cardiac CT [15912431, 20066140].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "20066140", "evidence_support": "A single MDCT scan in the emergency department is valuable in ruling out both cardiac and noncardiac causes of acute chest pain. Cardiac magnetic resonance (MR) currently lacks the spatial resolution of MDCT limiting its assessment of the coronary vasculature, but the proximal coronary arteries can be evaluated along with myocardial function and viability without exposure to contrast dye or ionizing radiation", "evidence_relation": "supporting" }, { "cited_pmid": "20066140", "evidence_support": "In addition, MR imaging also has great potential for characterizing coronary plaques, as well as following their progression and regression.", "evidence_relation": "supporting" }, { "cited_pmid": "15912431", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Coronary artery disease (CAD) without angina refers to a condition where a person has CAD, but does not experience angina pectoris, which is chest pain or discomfort caused by reduced blood flow to the heart muscle [21911339, 18642769]. CAD without angina is often diagnosed through medical imaging tests such as stress electrocardiography, stress echocardiography, single-photon emission computed tomography myocardial perfusion imaging, positron emission tomography, coronary computed tomography (CT) angiography, and magnetic resonance imaging, which show the presence of plaque buildup in the coronary arteries, but the patient does not experience typical angina symptoms [28870377, 32617474]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina refers to a condition where a person has CAD, but does not experience angina pectoris, which is chest pain or discomfort caused by reduced blood flow to the heart muscle [21911339, 18642769].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21911339", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18642769", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "CAD without angina is often diagnosed through medical imaging tests such as stress electrocardiography, stress echocardiography, single-photon emission computed tomography myocardial perfusion imaging, positron emission tomography, coronary computed tomography (CT) angiography, and magnetic resonance imaging, which show the presence of plaque buildup in the coronary arteries, but the patient does not experience typical angina symptoms [28870377, 32617474].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "28870377", "evidence_support": "Multiple imaging modalities are available to evaluate patients suspected of having coronary ischemia, such as stress electrocardiography, stress echocardiography, single-photon emission computed tomography myocardial perfusion imaging, positron emission tomography, coronary computed tomography (CT) angiography, and magnetic resonance imaging", "evidence_relation": "supporting" }, { "cited_pmid": "28870377", "evidence_support": "These imaging modalities can variably provide functional and anatomical delineation of coronary stenoses and help guide appropriate therapy. ", "evidence_relation": "supporting" }, { "cited_pmid": "28870377", "evidence_support": "We also discuss newer technologies such as CT fractional flow reserve, CT angiography with perfusion, whole-heart coronary magnetic resonance angiography with perfusion, which can provide both anatomical as well as functional information in the same test, thus obviating the need for multiple diagnostic tests to obtain a comprehensive assessment of both, plaque burden and downstream ischemia.", "evidence_relation": "supporting" }, { "cited_pmid": "32617474", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Coronary artery disease (CAD) without angina refers to the presence of atherosclerotic plaques in the coronary arteries without the clinical manifestation of chest pain or anginal symptoms.This condition can still pose significant risks, as subclinical atherosclerosis may progress to obstructive CAD or lead to adverse cardiovascular events such as myocardial infarction or heart failure [31168187, 34902504]. Patients with CAD without angina might not experience symptoms due to the absence of significant obstruction or due to well-developed collateral circulation that compensates for reduced blood flow [31168187, 34902504]. Despite the lack of symptoms, these patients require careful monitoring and management of cardiovascular risk factors to prevent disease progression and complications [31168187, 34902504]. The absence of angina does not equate to a benign prognosis, as underlying coronary pathology can still result in significant morbidity and mortality [31168187, 34902504].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina refers to the presence of atherosclerotic plaques in the coronary arteries without the clinical manifestation of chest pain or anginal symptoms.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This condition can still pose significant risks, as subclinical atherosclerosis may progress to obstructive CAD or lead to adverse cardiovascular events such as myocardial infarction or heart failure [31168187, 34902504].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34902504", "evidence_support": "Based on current evidence, these patients are at increased risk of adverse cardiovascular events, even though they have no obstructive CAD. ", "evidence_relation": "supporting" }, { "cited_pmid": "31168187", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Patients with CAD without angina might not experience symptoms due to the absence of significant obstruction or due to well-developed collateral circulation that compensates for reduced blood flow [31168187, 34902504].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "31168187", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "34902504", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Despite the lack of symptoms, these patients require careful monitoring and management of cardiovascular risk factors to prevent disease progression and complications [31168187, 34902504].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "31168187", "evidence_support": "New data gathered from large clinical trials indicate that nonobstructive coronary artery disease (non-CAD) is a clinical entity that should not be ignored.", "evidence_relation": "neutral" }, { "cited_pmid": "31168187", "evidence_support": "Furthermore, considering the increased mortality risk established recently, a prognosis of non-CAD is not benign as previously thought.", "evidence_relation": "neutral" }, { "cited_pmid": "34902504", "evidence_support": "Based on current evidence, these patients are at increased risk of adverse cardiovascular events, even though they have no obstructive CAD. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The absence of angina does not equate to a benign prognosis, as underlying coronary pathology can still result in significant morbidity and mortality [31168187, 34902504].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31168187", "evidence_support": "Furthermore, considering the increased mortality risk established recently, a prognosis of non-CAD is not benign as previously thought", "evidence_relation": "supporting" }, { "cited_pmid": "34902504", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Coronary artery disease (CAD) without angina refers to the presence of atherosclerotic plaques in the coronary arteries without the symptomatic chest pain typically associated with angina pectoris.This condition indicates that while there is a significant narrowing or blockage in the coronary arteries, it has not yet resulted in the ischemic pain that characterizes angina.Patients with CAD without angina may still be at risk for adverse cardiovascular events such as myocardial infarction or sudden cardiac death.Diagnosis often involves imaging studies like coronary angiography or non-invasive tests such as CT angiography.Management focuses on lifestyle modifications, pharmacotherapy to control risk factors like hypertension, hyperlipidemia, and diabetes, and possibly antiplatelet therapy to prevent thrombotic events.Regular monitoring and follow-up are crucial to detect any progression to symptomatic disease.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina refers to the presence of atherosclerotic plaques in the coronary arteries without the symptomatic chest pain typically associated with angina pectoris.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This condition indicates that while there is a significant narrowing or blockage in the coronary arteries, it has not yet resulted in the ischemic pain that characterizes angina.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Patients with CAD without angina may still be at risk for adverse cardiovascular events such as myocardial infarction or sudden cardiac death.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Diagnosis often involves imaging studies like coronary angiography or non-invasive tests such as CT angiography.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Management focuses on lifestyle modifications, pharmacotherapy to control risk factors like hypertension, hyperlipidemia, and diabetes, and possibly antiplatelet therapy to prevent thrombotic events.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Regular monitoring and follow-up are crucial to detect any progression to symptomatic disease.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "CAD without angina refers to the presence of coronary artery disease (CAD) without symptoms of angina pectoris [31168187, 21526712]. This condition is often detected incidentally during coronary angiography performed for other reasons, such as evaluation of chest pain or shortness of breath [31168187]. The absence of angina in patients with CAD may be due to various factors, including the presence of non-obstructive CAD, which is estimated to occur in 50% of female patients undergoing coronary angiography [31168187]. Additionally, some patients with CAD may not experience angina due to the presence of collateral circulation or other compensatory mechanisms [21526712]. However, the absence of angina does not necessarily imply a benign prognosis, as patients with CAD without angina are still at risk of adverse cardiovascular events [36035733, 21911339]. Further evaluation and management of these patients are necessary to reduce cardiovascular risk and prevent complications.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "CAD without angina refers to the presence of coronary artery disease (CAD) without symptoms of angina pectoris [31168187, 21526712].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21526712", "evidence_support": "Absence of chest pain with chronic left arm and neck pain is more unusual but demonstrates the heterogeneity of presentation. CAD should be considered in those anginal equivalents in the absence of 'strangling and anxiety of the breast'.", "evidence_relation": "supporting" }, { "cited_pmid": "31168187", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This condition is often detected incidentally during coronary angiography performed for other reasons, such as evaluation of chest pain or shortness of breath [31168187].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "31168187", "evidence_support": "It is estimated that 50% of female population undergoing coronarography are diagnosed with non-CAD. There is also an increase in the prevalence of non-CAD in both genders, which is probably due to gradual expanding of clinical indications for angiography in patients with angina.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The absence of angina in patients with CAD may be due to various factors, including the presence of non-obstructive CAD, which is estimated to occur in 50% of female patients undergoing coronary angiography [31168187].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31168187", "evidence_support": "It is estimated that 50% of female population undergoing coronarography are diagnosed with non-CAD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, some patients with CAD may not experience angina due to the presence of collateral circulation or other compensatory mechanisms [21526712].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "21526712", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "However, the absence of angina does not necessarily imply a benign prognosis, as patients with CAD without angina are still at risk of adverse cardiovascular events [36035733, 21911339].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36035733", "evidence_support": "Despite the absence of obstructive CAD, those with INOCA have an increased risk of all-cause mortality and adverse outcomes, including recurrent angina and cardiovascular events.", "evidence_relation": "supporting" }, { "cited_pmid": "21911339", "evidence_support": "Patients with stable angina and normal coronary arteries or diffuse non-obstructive CAD have elevated risks of MACE and all-cause mortality compared with a reference population without ischaemic heart disease.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Further evaluation and management of these patients are necessary to reduce cardiovascular risk and prevent complications.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gemini-flash": { "answer": "Coronary artery disease (CAD) without angina pectoris, also known as silent myocardial ischemia, refers to the presence of significant blockages in the coronary arteries without the typical chest pain associated with angina [32320779, 3536094]. This condition can be detected through diagnostic tests like angiography or stress tests, even in the absence of symptoms [32320779]. Silent ischemia is associated with an adverse prognosis and can be a treatment target in obstructive CAD [32320779]. Patients with silent ischemia often have more extensive coronary artery disease compared to those without ischemia [8444500]. Silent ischemia is also associated with an increased risk of future coronary events [8444500].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina pectoris, also known as silent myocardial ischemia, refers to the presence of significant blockages in the coronary arteries without the typical chest pain associated with angina [32320779, 3536094].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32320779", "evidence_support": "Up to two-thirds of patients with obstructive coronary artery disease (CAD) have silent ischemia (SI), which predicts an adverse prognosis and can be a treatment target in obstructive CAD.", "evidence_relation": "supporting" }, { "cited_pmid": "32320779", "evidence_support": "Ambulatory ischemia is prevalent in women with CMD, with a majority being SI, while most reported symptoms were not accompanied by ambulatory ischemia. ", "evidence_relation": "neutral" }, { "cited_pmid": "3536094", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This condition can be detected through diagnostic tests like angiography or stress tests, even in the absence of symptoms [32320779].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "32320779", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Silent ischemia is associated with an adverse prognosis and can be a treatment target in obstructive CAD [32320779].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32320779", "evidence_support": "Up to two-thirds of patients with obstructive coronary artery disease (CAD) have silent ischemia (SI), which predicts an adverse prognosis and can be a treatment target in obstructive CAD. Over 50% of women with ischemia and no obstructive CAD have coronary microvascular dysfunction (CMD), which is associated with adverse cardiovascular outcomes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Patients with silent ischemia often have more extensive coronary artery disease compared to those without ischemia [8444500].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "8444500", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Silent ischemia is also associated with an increased risk of future coronary events [8444500].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "8444500", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Coronary artery disease (CAD) without angina, also known as silent CAD, is a common occurrence in individuals with type 2 diabetes mellitus (T2DM) [16442369, 33305706, 37292080]. This means that individuals with T2DM may have significant blockages in their coronary arteries without experiencing the typical chest pain associated with angina [16442369, 33305706, 37292080]. Silent CAD is often undetected in T2DM patients and pre-diabetes, making early detection and intervention challenging [33305706, 25567211]. The prevalence of silent CAD in T2DM is high, and it is often diagnosed in advanced stages with extensive atherosclerosis and poor outcomes [16386666, 37292080]. This highlights the importance of screening for CAD in diabetic populations to ensure timely diagnosis and treatment [17491661, 25567211].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina, also known as silent CAD, is a common occurrence in individuals with type 2 diabetes mellitus (T2DM) [16442369, 33305706, 37292080].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16442369", "evidence_support": "In diabetic patients, CAD is often silent", "evidence_relation": "supporting" }, { "cited_pmid": "33305706", "evidence_support": "Silent coronary heart disease is frequently undetected in type 2 diabetes mellitus (DM2) and pre-diabetes determined by glucose intolerance (GI).", "evidence_relation": "supporting" }, { "cited_pmid": "37292080", "evidence_support": "To conclude, there is a high prevalence of silent CAD in T2DM.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This means that individuals with T2DM may have significant blockages in their coronary arteries without experiencing the typical chest pain associated with angina [16442369, 33305706, 37292080].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16442369", "evidence_support": "In diabetic patients, CAD is often silent.", "evidence_relation": "supporting" }, { "cited_pmid": "37292080", "evidence_support": "To conclude, there is a high prevalence of silent CAD in T2DM.", "evidence_relation": "supporting" }, { "cited_pmid": "33305706", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Silent CAD is often undetected in T2DM patients and pre-diabetes, making early detection and intervention challenging [33305706, 25567211].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "33305706", "evidence_support": "Silent coronary heart disease is frequently undetected in type 2 diabetes mellitus (DM2) and pre-diabetes determined by glucose intolerance (GI).", "evidence_relation": "supporting" }, { "cited_pmid": "25567211", "evidence_support": "In that sense, silent CAD in diabetics has long been a matter of concern, leading both to continued attempts at its diagnosis as well as to the persisting challenge of defining if screening for CAD in the diabetic population is useful and/or warranted.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The prevalence of silent CAD in T2DM is high, and it is often diagnosed in advanced stages with extensive atherosclerosis and poor outcomes [16386666, 37292080].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16386666", "evidence_support": "In type 2 diabetes mellitus (DM2) patients, coronary artery disease (CAD) generally is detected in an advanced stage, whereas an asymptomatic stage is commonly missed.", "evidence_relation": "supporting" }, { "cited_pmid": "16386666", "evidence_support": "In DM2 patients, CAD generally is detected in an advanced stage with an extensive atherosclerosis and poor outcome, whereas CAD in an asymptomatic stage is commonly missed.", "evidence_relation": "supporting" }, { "cited_pmid": "37292080", "evidence_support": "To conclude, there is a high prevalence of silent CAD in T2DM.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "This highlights the importance of screening for CAD in diabetic populations to ensure timely diagnosis and treatment [17491661, 25567211].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "17491661", "evidence_support": "Because the clinical signs of coronary artery disease (CAD) in diabetic patients are hard to detect and routine screening is costly, it would be of great benefit to try to either prevent CAD from occurring or to detect it early and provide optimal care.", "evidence_relation": "supporting" }, { "cited_pmid": "25567211", "evidence_support": "The most frequent and stronger point in favor of screening rests on the assumption that early diagnosis of CAD may lead to early treatment and therefore improved outcomes. Nonetheless, screening for CAD in diabetics is a controversial issue, since studies have not yielded evidence supporting better outcomes in diabetics screened for CAD compared to nonscreened diabetics. For several reasons, current tests that detect inducible ischemia or assess atherosclerotic burden may not be able to identify those patients at increased risk. Therefore a cautious look should be taken (once more) at that question.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Coronary artery disease (CAD) without angina means that a patient has significant coronary artery blockages but does not experience the typical chest pain associated with angina pectoris. In fact, many patients with CAD do not report angina; studies show that only about 57% of patients with CAD experience angina symptoms [6883830]. The absence of angina does not exclude the presence of significant CAD, as patients can undergo periods of reversible myocardial ischemia without any anginal pain [3984868, 3661392]. This condition can still lead to serious complications, including heart dysfunction, even in the absence of symptoms [89388]. Therefore, it is crucial for patients diagnosed with CAD without angina to be monitored closely for potential heart issues.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina means that a patient has significant coronary artery blockages but does not experience the typical chest pain associated with angina pectoris.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "In fact, many patients with CAD do not report angina; studies show that only about 57% of patients with CAD experience angina symptoms [6883830].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "6883830", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The absence of angina does not exclude the presence of significant CAD, as patients can undergo periods of reversible myocardial ischemia without any anginal pain [3984868, 3661392].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "3984868", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "3661392", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "This condition can still lead to serious complications, including heart dysfunction, even in the absence of symptoms [89388].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "89388", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Therefore, it is crucial for patients diagnosed with CAD without angina to be monitored closely for potential heart issues.", "answer_sentence_relevance": "borderline", "citation_assessment": null } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Coronary artery disease (CAD) without angina means that a patient has significant coronary artery blockages or myocardial ischemia without experiencing the typical chest pain associated with angina pectoris. This condition is often referred to as silent myocardial ischemia, which can occur even in the absence of symptoms [2815772, 1604922]. Notably, the absence of angina does not exclude the presence of significant CAD; studies show that a substantial percentage of patients with CAD do not report angina [6883830, 3984868]. In fact, silent ischemia can indicate a higher risk of myocardial infarction and death, emphasizing that prognosis is determined more by the severity of ischemia than by the presence of pain [1604922, 3443122]. Therefore, regular monitoring and assessment are crucial for patients diagnosed with CAD without angina.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina means that a patient has significant coronary artery blockages or myocardial ischemia without experiencing the typical chest pain associated with angina pectoris.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This condition is often referred to as silent myocardial ischemia, which can occur even in the absence of symptoms [2815772, 1604922].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "2815772", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "1604922", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Notably, the absence of angina does not exclude the presence of significant CAD; studies show that a substantial percentage of patients with CAD do not report angina [6883830, 3984868].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "6883830", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "3984868", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In fact, silent ischemia can indicate a higher risk of myocardial infarction and death, emphasizing that prognosis is determined more by the severity of ischemia than by the presence of pain [1604922, 3443122].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "1604922", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "3443122", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Therefore, regular monitoring and assessment are crucial for patients diagnosed with CAD without angina.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-1": { "answer": "In the given context, CAD without angina means Coronary Artery Disease without angina pectoris (chest pain).", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In the given context, CAD without angina means Coronary Artery Disease without angina pectoris (chest pain).", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-2": { "answer": "\"CAD without angina\" refers to the presence of Coronary Artery Disease (CAD) without symptoms of angina pectoris [17873528]. In other words, it is a condition where CAD is present but the patient does not experience chest pain or discomfort due to reduced blood flow to the heart muscle [17873528]. This condition is.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "\"CAD without angina\" refers to the presence of Coronary Artery Disease (CAD) without symptoms of angina pectoris [17873528].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17873528", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In other words, it is a condition where CAD is present but the patient does not experience chest pain or discomfort due to reduced blood flow to the heart muscle [17873528].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17873528", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This condition is.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-3": { "answer": "In the given context, \"cad without angina\" refers to Coronary Artery Disease (CAD) without angina pectoris, which is a condition where there is no typical chest pain associated with CAD [17873528].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In the given context, \"cad without angina\" refers to Coronary Artery Disease (CAD) without angina pectoris, which is a condition where there is no typical chest pain associated with CAD [17873528].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17873528", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-5": { "answer": "In the given context, \"cad without angina\" refers to Coronary Artery Disease (CAD) without angina pectoris, which is a condition where there is no typical chest pain associated with CAD [17873528].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In the given context, \"cad without angina\" refers to Coronary Artery Disease (CAD) without angina pectoris, which is a condition where there is no typical chest pain associated with CAD [17873528].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17873528", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-gpt-1": { "answer": "CAD without angina refers to coronary artery disease where the patient does not experience chest pain or discomfort typically associated with angina. This condition can still lead to significant heart issues, as the absence of angina does not indicate the absence of underlying heart problems or reduced blood flow to the heart muscle. It is important for individuals with CAD to be monitored for other symptoms and risk factors, even if they do not experience angina.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "CAD without angina refers to coronary artery disease where the patient does not experience chest pain or discomfort typically associated with angina.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This condition can still lead to significant heart issues, as the absence of angina does not indicate the absence of underlying heart problems or reduced blood flow to the heart muscle.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "It is important for individuals with CAD to be monitored for other symptoms and risk factors, even if they do not experience angina.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "Cad without angina refers to a condition where a patient has coronary artery disease (CAD) but does not experience angina, which is chest pain or discomfort typically associated with heart problems. In the context provided, patients with coronary vasospastic angina may have symptoms without significant CAD, defined as having less than 50% stenosis, indicating that they can experience angina-like symptoms without the presence of significant blockages in the coronary arteries [17873528].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cad without angina refers to a condition where a patient has coronary artery disease (CAD) but does not experience angina, which is chest pain or discomfort typically associated with heart problems.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "In the context provided, patients with coronary vasospastic angina may have symptoms without significant CAD, defined as having less than 50% stenosis, indicating that they can experience angina-like symptoms without the presence of significant blockages in the coronary arteries [17873528].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "17873528", "evidence_support": "Limited information is available comparing the clinical characteristics and prognosis for patients with coronary vasospastic angina in the absence of hemodynamically significant coronary artery disease (CAD) (defined as >50% stenosis) versus patients with significant fixed CAD presenting with either stable angina pectoris (SAP) or acute coronary syndromes (ACS).", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-6": { "answer": "Cad without angina refers to coronary artery disease (CAD) in patients who do not experience angina, which is chest pain or discomfort due to reduced blood flow to the heart. This condition can occur even in the presence of microvascular dysfunction or other cardiac issues, as indicated by studies showing that some patients with CAD may have impaired microvascular function without the typical symptoms of angina [37899519,23682790]. Understanding this distinction is important for diagnosing and managing heart disease, particularly in patients who may not present with classic symptoms [26541919].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cad without angina refers to coronary artery disease (CAD) in patients who do not experience angina, which is chest pain or discomfort due to reduced blood flow to the heart.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This condition can occur even in the presence of microvascular dysfunction or other cardiac issues, as indicated by studies showing that some patients with CAD may have impaired microvascular function without the typical symptoms of angina [37899519,23682790].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23682790", "evidence_support": "Microvascular function does not correlate with atherosclerosis, but is impaired in individuals with refractory angina. Microvascular dysfunction may play a role in the symptomatology of angina.", "evidence_relation": "supporting" }, { "cited_pmid": "37899519", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Understanding this distinction is important for diagnosing and managing heart disease, particularly in patients who may not present with classic symptoms [26541919].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "26541919", "evidence_support": "Angina does not predict all-cause mortality in medically treated patients with LV systolic dysfunction and CAD, nor does it identify patients who have a greater survival benefit from CABG. However, CABG does improve angina to a greater extent than medical therapy alone.", "evidence_relation": "neutral" } ] } ] }, "zero-shot-gemini-flash": { "answer": "Coronary heart disease (CHD) without angina pectoris means that the patient has blockages in their coronary arteries, but they do not experience chest pain [12103256]. Angina is a common symptom of CHD, but it is not always present [36273723]. This condition is often under-recognized, and it is unclear if referral patterns for chest pain diagnosis have changed over time [36273723]. While the prevalence of patients diagnosed with angina with no obstructive coronary artery disease (ANOCA) by means of coronary angiography has been studied, it is still unclear if the referral patterns for chest pain diagnosis have changed [36273723]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary heart disease (CHD) without angina pectoris means that the patient has blockages in their coronary arteries, but they do not experience chest pain [12103256].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "12103256", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Angina is a common symptom of CHD, but it is not always present [36273723].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36273723", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This condition is often under-recognized, and it is unclear if referral patterns for chest pain diagnosis have changed over time [36273723].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36273723", "evidence_support": "There is still under-recognition of this condition, but it is unclear if the referral patterns for chest pain diagnosis have changed. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While the prevalence of patients diagnosed with angina with no obstructive coronary artery disease (ANOCA) by means of coronary angiography has been studied, it is still unclear if the referral patterns for chest pain diagnosis have changed [36273723].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36273723", "evidence_support": "Angina with no obstructive coronary artery disease (ANOCA) is a common entity. There is still under-recognition of this condition, but it is unclear if the referral patterns for chest pain diagnosis have changed. ", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "Coronary artery disease (CAD) without angina pectoris means that a patient has significant coronary artery disease but does not experience the typical chest pain associated with it. This condition can occur because many patients with CAD may not exhibit angina, as studies show that only about 57% of CAD patients report this symptom [6883830]. The absence of angina does not rule out significant CAD, as silent myocardial ischemia can occur, indicating true ischemia without the typical pain [2815772, 9420727]. Furthermore, significant coronary artery stenosis can be present even in patients without angina [3617869, 3381731]. Therefore, CAD can be diagnosed through imaging techniques, regardless of the presence of angina symptoms [3984868, 12056739].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coronary artery disease (CAD) without angina pectoris means that a patient has significant coronary artery disease but does not experience the typical chest pain associated with it.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This condition can occur because many patients with CAD may not exhibit angina, as studies show that only about 57% of CAD patients report this symptom [6883830].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "6883830", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The absence of angina does not rule out significant CAD, as silent myocardial ischemia can occur, indicating true ischemia without the typical pain [2815772, 9420727].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "2815772", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "9420727", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, significant coronary artery stenosis can be present even in patients without angina [3617869, 3381731].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "3617869", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "3381731", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Therefore, CAD can be diagnosed through imaging techniques, regardless of the presence of angina symptoms [3984868, 12056739].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "3984868", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "12056739", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] } } }, { "question_id": "125", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Tamsulosin is primarily used to treat the symptoms of an enlarged prostate (benign prostatic hyperplasia or BPH). It works by relaxing the muscles in the prostate and bladder neck, making it easier to urinate. This medication helps relieve symptoms such as difficulty in beginning the flow of urine, weak stream, and the need to urinate frequently or urgently, including during the middle of the night [35392762]. Additionally, tamsulosin is sometimes used in the management of kidney stones to help pass them more easily [22699418].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is primarily used to treat the symptoms of an enlarged prostate (benign prostatic hyperplasia or BPH).", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "It works by relaxing the muscles in the prostate and bladder neck, making it easier to urinate.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "This medication helps relieve symptoms such as difficulty in beginning the flow of urine, weak stream, and the need to urinate frequently or urgently, including during the middle of the night [35392762].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35392762", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, tamsulosin is sometimes used in the management of kidney stones to help pass them more easily [22699418].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22699418", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Tamsulosin is primarily used for treating benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) [18345957, 21888698, 14680444]. It is also used off-label for the management of distal ureteral stones, promoting the spontaneous passage of ureteral calculi [19051800, 27639296, 22690465]. Tamsulosin is effective in medical expulsive therapy for ureteral stones, particularly those less than 10 mm in size, and improves stone clearance after lithotripsy [24852587, 30694932, 27639296]. By reducing muscle spasm in the ureteric wall and decreasing peristalsis below the stone while raising pressure above it, tamsulosin facilitates stone expulsion [27639296, 24719805, 36812907]. This reduces the pain associated with stone passage and can shorten hospital stays for patients with ureteral stones [27639296, 16317534, 17609936]. Additionally, tamsulosin is used in combination with extracorporeal physical vibrational lithecbole for managing distal ureteral calculi [17609936, 25363178, 17445639]. Overall, tamsulosin plays a significant role in both BPH management and the treatment of distal ureteral stones [18345957, 20170206, 28721281].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is primarily used for treating benign prostatic hyperplasia (BPH) and associated lower urinary tract symptoms (LUTS) [18345957, 21888698, 14680444].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18345957", "evidence_support": "Although tamsulosin is mainly used to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia, with better understanding of functional anatomy and distribution of alpha(1) receptors, it is also indicated in other conditions of genito-urinary tract in both men and women.", "evidence_relation": "supporting" }, { "cited_pmid": "21888698", "evidence_support": "Tamsulosin, a superselective subtype alpha 1a and 1d blocker, is used for the treatment of male lower urinary tract symptoms (LUTS) commonly caused by benign prostatic hyperplasia (BPH).", "evidence_relation": "supporting" }, { "cited_pmid": "14680444", "evidence_support": "Both placebo-controlled and comparative studies with other agents have demonstrated tamsulosin to be an effective treatment for patients with lower urinary symptoms suggestive of benign prostatic hyperplasia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also used off-label for the management of distal ureteral stones, promoting the spontaneous passage of ureteral calculi [19051800, 27639296, 22690465].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19051800", "evidence_support": "They are also used off-label in patients with a distal ureteral stone to enhance passage of the stone.", "evidence_relation": "supporting" }, { "cited_pmid": "27639296", "evidence_support": "Tamsulosin, an alpha-1-adrenocepter blocking agent, is thought to induce spontaneous stone passage by relaxing ureteral smooth muscle tone", "evidence_relation": "supporting" }, { "cited_pmid": "22690465", "evidence_support": "Urologists are using tamsulosin (Flomax) off-label as an aid for passing ureteral stones.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Tamsulosin is effective in medical expulsive therapy for ureteral stones, particularly those less than 10 mm in size, and improves stone clearance after lithotripsy [24852587, 30694932, 27639296].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24852587", "evidence_support": "Tamsulosin, an \u03b1-antagonist, has been used as therapy to facilitate the expulsion of lithiasis.", "evidence_relation": "supporting" }, { "cited_pmid": "24852587", "evidence_support": "All randomized controlled trials (RCTs) comparing tamsulosin to standard therapy or placebo for the treatment of a single distal ureterolithiasis \u2264 10 mm in adult patients with renal colic confirmed by radiographic imaging were included.", "evidence_relation": "supporting" }, { "cited_pmid": "24852587", "evidence_support": "Tamsulosin increases the rate of spontaneous passage of distal ureterolithiasis (\u2264 10 mm).", "evidence_relation": "supporting" }, { "cited_pmid": "30694932", "evidence_support": "Tamsulosin is widely administered as a medical expulsive therapy to facilitate stone passage in patients with ureteral calculi.", "evidence_relation": "supporting" }, { "cited_pmid": "30694932", "evidence_support": "Our current meta-analysis results indicate that tamsulosin is effective and relatively safe in patients with ureteral stone as a medical expulsive therapy to facilitate stone passage. It is suggested to administer it selectively in patients with 5 to 10 mm ureteral stones.", "evidence_relation": "supporting" }, { "cited_pmid": "27639296", "evidence_support": "Tamsulosin, an alpha-1-adrenocepter blocking agent, is thought to induce spontaneous stone passage by relaxing ureteral smooth muscle tone.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "By reducing muscle spasm in the ureteric wall and decreasing peristalsis below the stone while raising pressure above it, tamsulosin facilitates stone expulsion [27639296, 24719805, 36812907].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27639296", "evidence_support": "Tamsulosin, an alpha-1-adrenocepter blocking agent, is thought to induce spontaneous stone passage by relaxing ureteral smooth muscle tone", "evidence_relation": "supporting" }, { "cited_pmid": "24719805", "evidence_support": "Tamsulosin is an \u03b1-1A-specific blocker which induces selective relaxation of ureteral smooth muscle with subsequent inhibition of ureteral spasms and dilatation of the ureteral lumen and facilitates stone expelling.", "evidence_relation": "supporting" }, { "cited_pmid": "36812907", "evidence_support": "Tamsulosin, as an \u03b1-receptor blocker, has the function of relaxing ureteral muscles, and can help stones to be discharged from ureteral orifice.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "This reduces the pain associated with stone passage and can shorten hospital stays for patients with ureteral stones [27639296, 16317534, 17609936].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27639296", "evidence_support": "A relatively recent treatment strategy for urolithiasis involves using medical expulsive therapy (MET) to increase the likelihood of spontaneous passage of ureteral stones. ", "evidence_relation": "supporting" }, { "cited_pmid": "27639296", "evidence_support": "Tamsulosin, an alpha-1-adrenocepter blocking agent, is thought to induce spontaneous stone passage by relaxing ureteral smooth muscle tone.", "evidence_relation": "supporting" }, { "cited_pmid": "27639296", "evidence_support": "This has led to tamsulosin being frequently prescribed from the emergency department (ED) for off-label use without the support of high-quality evidence.", "evidence_relation": "neutral" }, { "cited_pmid": "27639296", "evidence_support": "The number of procedures, length of hospital stay, and health care costs after the initial ED visit could potentially be reduced. Tamsulosin may also increase patient satisfaction by reducing the invasive treatment and decreasing the time to stone passage.", "evidence_relation": "supporting" }, { "cited_pmid": "16317534", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "17609936", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Additionally, tamsulosin is used in combination with extracorporeal physical vibrational lithecbole for managing distal ureteral calculi [17609936, 25363178, 17445639].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17609936", "evidence_support": "Despite the relatively small number of patients, our data indicate that the use of tamsulosin after ESWL in this specific subgroup of patients does not result in improved success and stone-free rate and expulsion time.", "evidence_relation": "contradicting" }, { "cited_pmid": "25363178", "evidence_support": "In this study, although the addition of tamsulosin to conservative treatment of distal ureteral stones in the distal ureteral stone expulsion showed no significant difference between the two groups, but the reduction in the duration of expulsion, reduce pain and reduce the need for analgesic has been beneficial.", "evidence_relation": "supporting" }, { "cited_pmid": "17445639", "evidence_support": " In our study, the use of tamsulosin for the expulsion of distal ureteral stones was effective; however, the use of tolterodine provided no additional advantages", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Overall, tamsulosin plays a significant role in both BPH management and the treatment of distal ureteral stones [18345957, 20170206, 28721281].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18345957", "evidence_support": "Although tamsulosin is mainly used to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia, with better understanding of functional anatomy and distribution of alpha(1) receptors, it is also indicated in other conditions of genito-urinary tract in both men and women.", "evidence_relation": "supporting" }, { "cited_pmid": "20170206", "evidence_support": "Tamsulosin is an alpha(1)-adrenoceptor antagonist used for the treatment of lower urinary tract symptoms that are suggestive of benign prostatic hyperplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "28721281", "evidence_support": "Currently alpha1-adrenoceptor blockers (AB) are widely used as first-line therapy to improve lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH).", "evidence_relation": "supporting" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Tamsulosin is primarily used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) by selectively blocking alpha(1A)- and alpha(1D)-adrenoceptors, which results in the relaxation of prostatic and bladder neck smooth muscles, thereby improving urine flow and reducing symptoms [14680444, 22822617, 16684433]. It is available in modified-release (MR) and oral controlled absorption system (OCAS) formulations, with the latter offering food-independent absorption and potentially fewer cardiovascular side effects [20170206]. Tamsulosin is also effective in reducing the risk of acute urinary retention (AUR) postoperatively and in patients with neurogenic bladder due to spinal cord injury, although rare severe adverse effects like hypotension and priapism have been reported [36157672, 37850293, 26099320]. Additionally, it has been used off-label for treating LUTS in women, demonstrating significant symptom improvement in clinical trials [18345957, 28424499].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is primarily used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) by selectively blocking alpha(1A)- and alpha(1D)-adrenoceptors, which results in the relaxation of prostatic and bladder neck smooth muscles, thereby improving urine flow and reducing symptoms [14680444, 22822617, 16684433].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14680444", "evidence_support": "The alpha(1)-adrenoceptor antagonist, tamsulosin, is selective for alpha(1A)- and alpha(1D)- over alpha(1B)-adrenoceptors. Both placebo-controlled and comparative studies with other agents have demonstrated tamsulosin to be an effective treatment for patients with lower urinary symptoms suggestive of benign prostatic hyperplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "22822617", "evidence_support": "The alpha-adrenergic receptor antagonists represent the most frequently prescribed first line treatment for benign prostatic hyperplasia. Tamsulosin is a uroselective alpha1A/alpha1D adrenergic receptor antagonist.", "evidence_relation": "supporting" }, { "cited_pmid": "16684433", "evidence_support": "This study evaluated the efficacy and safety of the alpha(1A)/alpha(1D) subtype-selective blocker tamsulosin for the increasingly common treatment of benign prostatic hyperplasia (BPH) in the primary care setting.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is available in modified-release (MR) and oral controlled absorption system (OCAS) formulations, with the latter offering food-independent absorption and potentially fewer cardiovascular side effects [20170206].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "20170206", "evidence_support": "It is mostly used in a modified-release (MR) formulation, but an oral controlled absorption system (OCAS) and a 'without-water' tablet formulation are also available in some countries", "evidence_relation": "supporting" }, { "cited_pmid": "20170206", "evidence_support": "Whereas absorption from the MR formulation is affected by concomitant food intake, that of the OCAS formulation is food independent", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Tamsulosin is also effective in reducing the risk of acute urinary retention (AUR) postoperatively and in patients with neurogenic bladder due to spinal cord injury, although rare severe adverse effects like hypotension and priapism have been reported [36157672, 37850293, 26099320].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36157672", "evidence_support": "Tamsulosin, a selective \u03b11-adrenergic receptor antagonist, is commonly used for treating neurogenic bladder in patients with spinal cord injury (SCI).", "evidence_relation": "supporting" }, { "cited_pmid": "37850293", "evidence_support": "Tamsulosin is the most often prescribed drug; there are a lot of studies devoted to its use in different patient subgroups.", "evidence_relation": "neutral" }, { "cited_pmid": "26099320", "evidence_support": "Tamsulosin is an alpha blocker that works by relaxing bladder neck muscles. It is used to treat benign prostatic hypertrophy and retention.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, it has been used off-label for treating LUTS in women, demonstrating significant symptom improvement in clinical trials [18345957, 28424499].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28424499", "evidence_support": "Tamsulosin has been used for the off-label treatment of lower urinary tract symptoms (LUTS) in women. ", "evidence_relation": "supporting" }, { "cited_pmid": "28424499", "evidence_support": "On the basis of the present evidence, tamsulosin is an effective treatment for the relief of LUTS in women when compared with placebo.", "evidence_relation": "supporting" }, { "cited_pmid": "18345957", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Tamsulosin is primarily used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) in men [18345957, 21888698, 14680444]. It is a selective alpha-1 adrenergic receptor antagonist that relaxes the smooth muscles in the prostate and bladder neck, improving urine flow and reducing symptoms [14680444, 22822617]. Tamsulosin has also been used off-label to treat LUTS in women, with studies showing its efficacy in reducing symptoms and improving quality of life [28424499]. Additionally, tamsulosin has been used to prevent acute urinary retention in the perioperative period in patients undergoing surgical procedures [37850293, 26099320]. It is available in various formulations, including modified-release and oral controlled absorption system, which have similar efficacy but differ in their pharmacokinetic profiles [20170206]. Overall, tamsulosin is a widely used and effective treatment for LUTS associated with BPH and other conditions.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is primarily used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) in men [18345957, 21888698, 14680444].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18345957", "evidence_support": "Although tamsulosin is mainly used to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia, with better understanding of functional anatomy and distribution of alpha(1) receptors, it is also indicated in other conditions of genito-urinary tract in both men and women.", "evidence_relation": "supporting" }, { "cited_pmid": "21888698", "evidence_support": "Tamsulosin, a superselective subtype alpha 1a and 1d blocker, is used for the treatment of male lower urinary tract symptoms (LUTS) commonly caused by benign prostatic hyperplasia (BPH).", "evidence_relation": "supporting" }, { "cited_pmid": "14680444", "evidence_support": "Both placebo-controlled and comparative studies with other agents have demonstrated tamsulosin to be an effective treatment for patients with lower urinary symptoms suggestive of benign prostatic hyperplasia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is a selective alpha-1 adrenergic receptor antagonist that relaxes the smooth muscles in the prostate and bladder neck, improving urine flow and reducing symptoms [14680444, 22822617].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14680444", "evidence_support": "The alpha(1)-adrenoceptor antagonist, tamsulosin, is selective for alpha(1A)- and alpha(1D)- over alpha(1B)-adrenoceptors. Both placebo-controlled and comparative studies with other agents have demonstrated tamsulosin to be an effective treatment for patients with lower urinary symptoms suggestive of benign prostatic hyperplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "22822617", "evidence_support": "Tamsulosin is a uroselective alpha1A/alpha1D adrenergic receptor antagonist.", "evidence_relation": "supporting" }, { "cited_pmid": "22822617", "evidence_support": "Clinical response to a 12-week tamsulosin treatment improved during the course of treatment, reflected in a reduction in all of the lower urinary tract symptoms, with rare and insignificant side effects", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Tamsulosin has also been used off-label to treat LUTS in women, with studies showing its efficacy in reducing symptoms and improving quality of life [28424499].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28424499", "evidence_support": "Tamsulosin has been used for the off-label treatment of lower urinary tract symptoms (LUTS) in women. Over the past few years, several randomized controlled trials (RCTs) have reported the clinical effectiveness and safety of tamsulosin for LUTS in women.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, tamsulosin has been used to prevent acute urinary retention in the perioperative period in patients undergoing surgical procedures [37850293, 26099320].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37850293", "evidence_support": "The perioperative management of patients involves multiple aspects. Acute urinary retention (AUR) is one of the possible postoperative complications. Alpha-adrenoblockers are commonly used for treatment and prevention of AUR. Tamsulosin is the most often prescribed drug; there are a lot of studies devoted to its use in different patient subgroups.", "evidence_relation": "supporting" }, { "cited_pmid": "37850293", "evidence_support": "According to the results, tamsulosin results in a significant reduction in the risk of postoperative AUR. ", "evidence_relation": "supporting" }, { "cited_pmid": "26099320", "evidence_support": "Urinary retention is a common complication of pelvic surgery, leading to urinary tract infection and prolonged hospital stays. Tamsulosin is an alpha blocker that works by relaxing bladder neck muscles.", "evidence_relation": "supporting" }, { "cited_pmid": "26099320", "evidence_support": "Preemptive perioperative use of tamsulosin may significantly decrease the incidence of urinary retention in men undergoing pelvic surgery. This may play a role in avoidance of urinary retention, particularly in patients with distal rectal cancer.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is available in various formulations, including modified-release and oral controlled absorption system, which have similar efficacy but differ in their pharmacokinetic profiles [20170206].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "20170206", "evidence_support": "It is mostly used in a modified-release (MR) formulation, but an oral controlled absorption system (OCAS) and a 'without-water' tablet formulation are also available in some countries. The oral bioavailability of the MR formulation in the fasted state is close to 100%. Whereas absorption from the MR formulation is affected by concomitant food intake, that of the OCAS formulation is food independent.", "evidence_relation": "supporting" }, { "cited_pmid": "20170206", "evidence_support": "Clinical studies have indicated that despite its lower bioavailability, the OCAS formulation has the same treatment efficacy as the MR formulation but causes somewhat fewer cardiovascular adverse effects.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, tamsulosin is a widely used and effective treatment for LUTS associated with BPH and other conditions.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH), a condition where the prostate gland is enlarged, causing urinary problems [18345957, 19051800, 31555556]. It is also used off-label to treat women with LUTS, particularly those with voiding dysfunction [22983886, 28424499]. Additionally, tamsulosin is used to help pass kidney stones by relaxing the muscles in the ureter [19051800]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) in men with benign prostatic hyperplasia (BPH), a condition where the prostate gland is enlarged, causing urinary problems [18345957, 19051800, 31555556].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18345957", "evidence_support": "Although tamsulosin is mainly used to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia, with better understanding of functional anatomy and distribution of alpha(1) receptors, it is also indicated in other conditions of genito-urinary tract in both men and women.", "evidence_relation": "supporting" }, { "cited_pmid": "19051800", "evidence_support": "Selective postsynaptic alpha1-adrenergic blocking agents such as tamsulosin are mainly used for treating micturition symptoms due to prostatic hyperplasia", "evidence_relation": "supporting" }, { "cited_pmid": "31555556", "evidence_support": "Tamsulosin remains the single most popular uroselective alpha adrenoceptor antagonist approved for the treatment of lower urinary tract symptoms (LUTS) attributable to benign prostatic hyperplasia (BPH).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also used off-label to treat women with LUTS, particularly those with voiding dysfunction [22983886, 28424499].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "22983886", "evidence_support": "Consistent positive findings across multiple clinical studies suggest that in women with LUTS, particularly those with voiding dysfunction, tamsulosin may be an effective and safe treatment option", "evidence_relation": "supporting" }, { "cited_pmid": "28424499", "evidence_support": "Tamsulosin has been used for the off-label treatment of lower urinary tract symptoms (LUTS) in women.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, tamsulosin is used to help pass kidney stones by relaxing the muscles in the ureter [19051800].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19051800", "evidence_support": "They are also used off-label in patients with a distal ureteral stone to enhance passage of the stone.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Tamsulosin is primarily used to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia [16986050, 22550968, 14680444]. It is also indicated in other conditions of the genitourinary tract in both men and women [18345957, 22550968, 14680444]. Tamsulosin is a potent, third-generation selective alpha(1A) adrenoceptor-blocking agent [14680444, 22983886, 18345957]. It is effective in improving lower urinary tract symptoms associated with benign prostatic hyperplasia and has a better side effect profile than earlier alpha-adrenergic-receptor antagonists [16986050, 22550968, 14680444]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is primarily used to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia [16986050, 22550968, 14680444].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16986050", "evidence_support": "Tamsulosin, a uroselective alpha(1A)-adrenergic-receptor antagonist, has been shown to improve lower urinary tract symptoms associated with benign prostatic hyperplasia. ", "evidence_relation": "supporting" }, { "cited_pmid": "22550968", "evidence_support": "The 5\u03b1-reductase inhibitor dutasteride and the \u03b1(1)-adrenergic receptor antagonist tamsulosin are available as a fixed-dose combination for use in men with symptomatic benign prostatic hyperplasia (BPH) and an enlarged prostate.", "evidence_relation": "supporting" }, { "cited_pmid": "14680444", "evidence_support": "The alpha(1)-adrenoceptor antagonist, tamsulosin, is selective for alpha(1A)- and alpha(1D)- over alpha(1B)-adrenoceptors. Both placebo-controlled and comparative studies with other agents have demonstrated tamsulosin to be an effective treatment for patients with lower urinary symptoms suggestive of benign prostatic hyperplasia. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also indicated in other conditions of the genitourinary tract in both men and women [18345957, 22550968, 14680444].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18345957", "evidence_support": "Although tamsulosin is mainly used to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia, with better understanding of functional anatomy and distribution of alpha(1) receptors, it is also indicated in other conditions of genito-urinary tract in both men and women.", "evidence_relation": "supporting" }, { "cited_pmid": "22550968", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "14680444", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Tamsulosin is a potent, third-generation selective alpha(1A) adrenoceptor-blocking agent [14680444, 22983886, 18345957].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "14680444", "evidence_support": "The alpha(1)-adrenoceptor antagonist, tamsulosin, is selective for alpha(1A)- and alpha(1D)- over alpha(1B)-adrenoceptors.", "evidence_relation": "supporting" }, { "cited_pmid": "18345957", "evidence_support": "Tamsulosin is a potent, third-generation selective alpha(1A) adrenoceptor-blocking agent.", "evidence_relation": "supporting" }, { "cited_pmid": "22983886", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It is effective in improving lower urinary tract symptoms associated with benign prostatic hyperplasia and has a better side effect profile than earlier alpha-adrenergic-receptor antagonists [16986050, 22550968, 14680444].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "16986050", "evidence_support": "Tamsulosin, a uroselective alpha(1A)-adrenergic-receptor antagonist, has been shown to improve lower urinary tract symptoms associated with benign prostatic hyperplasia. It has a better side effect profile than earlier alpha-adrenergic-receptor antagonists, which were initially developed as antihypertensive agents.", "evidence_relation": "supporting" }, { "cited_pmid": "22550968", "evidence_support": "The 5\u03b1-reductase inhibitor dutasteride and the \u03b1(1)-adrenergic receptor antagonist tamsulosin are available as a fixed-dose combination for use in men with symptomatic benign prostatic hyperplasia (BPH) and an enlarged prostate", "evidence_relation": "supporting" }, { "cited_pmid": "14680444", "evidence_support": "Both placebo-controlled and comparative studies with other agents have demonstrated tamsulosin to be an effective treatment for patients with lower urinary symptoms suggestive of benign prostatic hyperplasia", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate [31555556, 19051800, 15369425]. It is also used off-label in patients with a distal ureteral stone to enhance passage of the stone [19051800, 16158745]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate [31555556, 19051800, 15369425].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31555556", "evidence_support": "Tamsulosin remains the single most popular uroselective alpha adrenoceptor antagonist approved for the treatment of lower urinary tract symptoms (LUTS) attributable to benign prostatic hyperplasia (BPH).", "evidence_relation": "supporting" }, { "cited_pmid": "19051800", "evidence_support": "Selective postsynaptic alpha1-adrenergic blocking agents such as tamsulosin are mainly used for treating micturition symptoms due to prostatic hyperplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "15369425", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also used off-label in patients with a distal ureteral stone to enhance passage of the stone [19051800, 16158745].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19051800", "evidence_support": "Selective postsynaptic alpha1-adrenergic blocking agents such as tamsulosin are mainly used for treating micturition symptoms due to prostatic hyperplasia. They are also used off-label in patients with a distal ureteral stone to enhance passage of the stone.", "evidence_relation": "supporting" }, { "cited_pmid": "16158745", "evidence_support": "Use of tamsulosin 0.4 mg daily in patients with distal ureteric stones is pathogenetically validated, is highly clinically and cost effective", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate [15883586, 21901681, 16986050]. It is also used off-label in patients with a distal ureteral stone to enhance passage of the stone [17216000, 25684798, 19051800]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate [15883586, 21901681, 16986050].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21901681", "evidence_support": "Tamsulosin provided a small to moderate improvement in urinary symptoms and flow compared to men receiving placebo in men with BPH.", "evidence_relation": "supporting" }, { "cited_pmid": "16986050", "evidence_support": "Tamsulosin, a uroselective alpha(1A)-adrenergic-receptor antagonist, has been shown to improve lower urinary tract symptoms associated with benign prostatic hyperplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "15883586", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also used off-label in patients with a distal ureteral stone to enhance passage of the stone [17216000, 25684798, 19051800].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17216000", "evidence_support": "Alpha-blockers have been demonstrated to increase expulsion rates of distal ureteral stones, decrease time to expulsion, and decrease need for analgesia during stone passage.", "evidence_relation": "supporting" }, { "cited_pmid": "19051800", "evidence_support": "They are also used off-label in patients with a distal ureteral stone to enhance passage of the stone.", "evidence_relation": "supporting" }, { "cited_pmid": "25684798", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate [21901681, 16986050, 15883586]. It is also used off-label in patients with a distal ureteral stone to enhance passage of the stone [19051800, 25684798, 17216000]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate [21901681, 16986050, 15883586].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21901681", "evidence_support": "Tamsulosin improved symptoms and peak urine flow relative to placebo.", "evidence_relation": "supporting" }, { "cited_pmid": "21901681", "evidence_support": "Tamsulosin provided a small to moderate improvement in urinary symptoms and flow compared to men receiving placebo in men with BPH. ", "evidence_relation": "supporting" }, { "cited_pmid": "16986050", "evidence_support": "Tamsulosin, a uroselective alpha(1A)-adrenergic-receptor antagonist, has been shown to improve lower urinary tract symptoms associated with benign prostatic hyperplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "15883586", "evidence_support": "The switch to tamsulosin 0.4 mg o.d. improves LUTS and related quality of life.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also used off-label in patients with a distal ureteral stone to enhance passage of the stone [19051800, 25684798, 17216000].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19051800", "evidence_support": "They are also used off-label in patients with a distal ureteral stone to enhance passage of the stone.", "evidence_relation": "supporting" }, { "cited_pmid": "17216000", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "25684798", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate [16986050, 21901681, 15883586]. It is also used off-label in patients with a distal ureteral stone to enhance passage of the stone [19051800, 25684798, 17216000]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate [16986050, 21901681, 15883586].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16986050", "evidence_support": "Tamsulosin, a uroselective alpha(1A)-adrenergic-receptor antagonist, has been shown to improve lower urinary tract symptoms associated with benign prostatic hyperplasia. ", "evidence_relation": "supporting" }, { "cited_pmid": "21901681", "evidence_support": "This systematic review assessed the effects of tamsulosin in the treatment of lower urinary tract symptoms (LUTS) compatible with BPH.", "evidence_relation": "supporting" }, { "cited_pmid": "21901681", "evidence_support": "Tamsulosin improved symptoms and peak urine flow relative to placebo.", "evidence_relation": "neutral" }, { "cited_pmid": "21901681", "evidence_support": "Tamsulosin provided a small to moderate improvement in urinary symptoms and flow compared to men receiving placebo in men with BPH.", "evidence_relation": "supporting" }, { "cited_pmid": "15883586", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also used off-label in patients with a distal ureteral stone to enhance passage of the stone [19051800, 25684798, 17216000].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19051800", "evidence_support": "They are also used off-label in patients with a distal ureteral stone to enhance passage of the stone.", "evidence_relation": "supporting" }, { "cited_pmid": "17216000", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "25684798", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate [21592295, 30549500, 18345957]. It is also used off-label in patients with a distal ureteral stone to enhance passage of the stone [19116093, 17681643, 17011944]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate [21592295, 30549500, 18345957].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18345957", "evidence_support": "Although tamsulosin is mainly used to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia, with better understanding of functional anatomy and distribution of alpha(1) receptors, it is also indicated in other conditions of genito-urinary tract in both men and women.", "evidence_relation": "supporting" }, { "cited_pmid": "30549500", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "21592295", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also used off-label in patients with a distal ureteral stone to enhance passage of the stone [19116093, 17681643, 17011944].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19116093", "evidence_support": "All have proven to be efficacious. In addition, intake of citrate-rich juices, such as lemonade, may help to reduce urinary stone formation. More recently, there has been increasing interest in and use of medical therapy to aide in the passage of ureteral stones. Medical expulsive therapy (MET) has been shown to be cost effective compared with observation followed by treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "19116093", "evidence_support": "Alpha-adrenergic receptor blockers are most commonly prescribed to promote passage of ureteral stones. They are able to facilitate stone passage, reduce time to passage, and decrease pain.", "evidence_relation": "supporting" }, { "cited_pmid": "17681643", "evidence_support": "Recently, medical expulsive therapy using alpha-antagonists or calcium channel blockers has been shown to augment stone passage rates of moderately sized, distal, ureteral stones.", "evidence_relation": "supporting" }, { "cited_pmid": "17681643", "evidence_support": "Our results suggest that \"medical expulsive therapy,\" using either alpha-antagonists or calcium channel blockers, augments the stone expulsion rate compared to standard therapy for moderately sized distal ureteral stones.", "evidence_relation": "supporting" }, { "cited_pmid": "17011944", "evidence_support": "Medical therapies to ease urinary-stone passage have been reported, but are not generally used. If effective, such therapies would increase the options for treatment of urinary stones. To assess efficacy, we sought to identify and summarise all randomised controlled trials in which calcium-channel blockers or alpha blockers were used to treat urinary stone disease.", "evidence_relation": "supporting" }, { "cited_pmid": "17011944", "evidence_support": "Patients given calcium-channel blockers or alpha blockers had a 65% (absolute risk reduction=0.31 95% CI 0.25-0.38) greater likelihood of stone passage than those not given such treatment (pooled risk ratio 1.65; 95% CI 1.45-1.88)", "evidence_relation": "supporting" }, { "cited_pmid": "17011944", "evidence_support": "our findings suggest that medical therapy is an option for facilitation of urinary-stone passage for patients amenable to conservative management, potentially obviating the need for surgery.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate [16986050, 21592295, 18345957]. It is also used off-label in patients with a distal ureteral stone to enhance passage of the stone, specifically with Tamsulosin [25684798, 33363827]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate [16986050, 21592295, 18345957].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16986050", "evidence_support": "Tamsulosin, a uroselective alpha(1A)-adrenergic-receptor antagonist, has been shown to improve lower urinary tract symptoms associated with benign prostatic hyperplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "21592295", "evidence_support": "Silodosin administered by 4 mg twice daily is as effective as tamsulosin 0.2 mg daily in treating patients with LUTS associated with BPH.", "evidence_relation": "neutral" }, { "cited_pmid": "21592295", "evidence_support": "The trial shows the non-inferiority of silodosin 4 mg twice daily to tamsulosin 0.2 mg once daily in patients with symptoms of BPH.", "evidence_relation": "neutral" }, { "cited_pmid": "18345957", "evidence_support": "Although tamsulosin is mainly used to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia, with better understanding of functional anatomy and distribution of alpha(1) receptors, it is also indicated in other conditions of genito-urinary tract in both men and women.", "evidence_relation": "supporting" }, { "cited_pmid": "18345957", "evidence_support": "The management of benign prostatic hyperplasia was transurethral resection of prostate until simpler and alternative treatments were tried in the last two decades, particularly alpha(1) adrenoceptor-blocking agents. Tamsulosin is a potent, third-generation selective alpha(1A) adrenoceptor-blocking agent.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also used off-label in patients with a distal ureteral stone to enhance passage of the stone, specifically with Tamsulosin [25684798, 33363827].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25684798", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "33363827", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate [14680444, 22822617, 15906783]. It is also used off-label in patients with a distal ureteral stone to enhance passage of the stone [20109697, 25684798, 19051800]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate [14680444, 22822617, 15906783].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14680444", "evidence_support": "Both placebo-controlled and comparative studies with other agents have demonstrated tamsulosin to be an effective treatment for patients with lower urinary symptoms suggestive of benign prostatic hyperplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "22822617", "evidence_support": "Clinical response to a 12-week tamsulosin treatment improved during the course of treatment, reflected in a reduction in all of the lower urinary tract symptoms, with rare and insignificant side effects.", "evidence_relation": "supporting" }, { "cited_pmid": "15906783", "evidence_support": "Tamsulosin is effective and well tolerated", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also used off-label in patients with a distal ureteral stone to enhance passage of the stone [20109697, 25684798, 19051800].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20109697", "evidence_support": "Tamsulosin is a safe and effective drug that enhances spontaneous passage of distal ureteral stones sized 10 mm or smaller.", "evidence_relation": "supporting" }, { "cited_pmid": "19051800", "evidence_support": "Selective postsynaptic alpha1-adrenergic blocking agents such as tamsulosin are mainly used for treating micturition symptoms due to prostatic hyperplasia. They are also used off-label in patients with a distal ureteral stone to enhance passage of the stone.", "evidence_relation": "supporting" }, { "cited_pmid": "25684798", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate [16986050, 14680444, 30549500]. It is also used off-label in patients with a distal ureteral stone to enhance passage of the stone [22690465, 16317534, 19051800]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH), a nonmalignant enlargement of the prostate [16986050, 14680444, 30549500].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16986050", "evidence_support": "Tamsulosin, a uroselective alpha(1A)-adrenergic-receptor antagonist, has been shown to improve lower urinary tract symptoms associated with benign prostatic hyperplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "14680444", "evidence_support": "The alpha(1)-adrenoceptor antagonist, tamsulosin, is selective for alpha(1A)- and alpha(1D)- over alpha(1B)-adrenoceptors. Both placebo-controlled and comparative studies with other agents have demonstrated tamsulosin to be an effective treatment for patients with lower urinary symptoms suggestive of benign prostatic hyperplasia. Its effectiveness appears to be maintained over many years. Tamsulosin may also effectively reduce lower urinary tract symptoms in other urological diseases. ", "evidence_relation": "supporting" }, { "cited_pmid": "30549500", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also used off-label in patients with a distal ureteral stone to enhance passage of the stone [22690465, 16317534, 19051800].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22690465", "evidence_support": "Urologists are using tamsulosin (Flomax) off-label as an aid for passing ureteral stones. ", "evidence_relation": "supporting" }, { "cited_pmid": "16317534", "evidence_support": "It has recently been demonstrated that specific adrenoceptors subtypes (alpha(1A)/alpha(1D)) are prevalent in the distal part of the ureter, a finding supporting the interesting results obtained by different groups with the use of tamsulosin in the treatment of distal ureteral calculi.", "evidence_relation": "supporting" }, { "cited_pmid": "16317534", "evidence_support": "This selective alpha-blocker should therefore be included in the pharmacological regimen of patients when a conservative approach is considered in the treatment of ureteral lithiasis.", "evidence_relation": "supporting" }, { "cited_pmid": "19051800", "evidence_support": "They are also used off-label in patients with a distal ureteral stone to enhance passage of the stone. ", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Tamsulosin is primarily used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) by selectively blocking alpha(1A)- and alpha(1D)-adrenergic receptors, leading to smooth muscle relaxation in the prostate and bladder neck, thereby improving urine flow and reducing symptoms [21888698, 14680444, 22822617]. It is available in modified-release (MR) and oral controlled absorption system (OCAS) formulations, with the latter offering improved pharmacokinetics and food-independent absorption [18345957, 20170206]. Tamsulosin has demonstrated high efficacy and tolerability, with a side effect profile comparable to placebo, making it suitable even for patients with cardiovascular comorbidities [14680444, 16684433]. Additionally, tamsulosin is used off-label for conditions such as distal ureteral stones due to its smooth muscle relaxant properties [18345957, 19051800]. Rare but serious adverse effects, such as priapism and hypotension, have been reported, necessitating patient awareness and monitoring [32698265, 36157672].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is primarily used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) by selectively blocking alpha(1A)- and alpha(1D)-adrenergic receptors, leading to smooth muscle relaxation in the prostate and bladder neck, thereby improving urine flow and reducing symptoms [21888698, 14680444, 22822617].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21888698", "evidence_support": "Tamsulosin, a superselective subtype alpha 1a and 1d blocker, is used for the treatment of male lower urinary tract symptoms (LUTS) commonly caused by benign prostatic hyperplasia (BPH).", "evidence_relation": "supporting" }, { "cited_pmid": "14680444", "evidence_support": "The alpha(1)-adrenoceptor antagonist, tamsulosin, is selective for alpha(1A)- and alpha(1D)- over alpha(1B)-adrenoceptors. Both placebo-controlled and comparative studies with other agents have demonstrated tamsulosin to be an effective treatment for patients with lower urinary symptoms suggestive of benign prostatic hyperplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "22822617", "evidence_support": "The alpha-adrenergic receptor antagonists represent the most frequently prescribed first line treatment for benign prostatic hyperplasia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is available in modified-release (MR) and oral controlled absorption system (OCAS) formulations, with the latter offering improved pharmacokinetics and food-independent absorption [18345957, 20170206].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20170206", "evidence_support": "It is mostly used in a modified-release (MR) formulation, but an oral controlled absorption system (OCAS) and a 'without-water' tablet formulation are also available in some countries.", "evidence_relation": "supporting" }, { "cited_pmid": "18345957", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Tamsulosin has demonstrated high efficacy and tolerability, with a side effect profile comparable to placebo, making it suitable even for patients with cardiovascular comorbidities [14680444, 16684433].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "14680444", "evidence_support": "Both placebo-controlled and comparative studies with other agents have demonstrated tamsulosin to be an effective treatment for patients with lower urinary symptoms suggestive of benign prostatic hyperplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "14680444", "evidence_support": " A dose of tamsulosin 0.4 mg/day has a tolerability close to that of placebo and has little, if any, blood pressure lowering effects. Tolerability and lack of blood pressure lowering are maintained even in high-risk patients such as those with cardiovascular comorbidity and/or comedication.", "evidence_relation": "supporting" }, { "cited_pmid": "16684433", "evidence_support": "Overall, patients treated with tamsulosin in a primary care setting experienced rapid, significant improvement in their signs and symptoms of BPH, based upon the change in the AUA Symptom Score. Tamsulosin was well tolerated; no new safety concerns were observed. Tamsulosin was not associated with significant effects on blood pressure or first-dose hypotension.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, tamsulosin is used off-label for conditions such as distal ureteral stones due to its smooth muscle relaxant properties [18345957, 19051800].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18345957", "evidence_support": "Although tamsulosin is mainly used to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia, with better understanding of functional anatomy and distribution of alpha(1) receptors, it is also indicated in other conditions of genito-urinary tract in both men and women.", "evidence_relation": "supporting" }, { "cited_pmid": "19051800", "evidence_support": "They are also used off-label in patients with a distal ureteral stone to enhance passage of the stone. This application is based on the smooth muscle relaxant effect of alpha1-receptor blockade.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Rare but serious adverse effects, such as priapism and hypotension, have been reported, necessitating patient awareness and monitoring [32698265, 36157672].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "32698265", "evidence_support": "Priapism has been reported as a rare side effect through direct inhibition of the sympathetic input necessary for detumesence", "evidence_relation": "supporting" }, { "cited_pmid": "32698265", "evidence_support": "However, its use may be associated on rare occasions with priapism, hence Health-care professionals should be aware in order to advice all patients taking such medications about this rare but serious adverse effect and to seek help as soon as possible.", "evidence_relation": "supporting" }, { "cited_pmid": "36157672", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Tamsulosin is primarily used to treat benign prostatic hyperplasia (BPH), a condition characterized by an enlarged prostate gland that can cause urinary difficulties in men.It is an alpha-1 adrenergic receptor antagonist that works by relaxing the muscles in the prostate and bladder neck, thereby improving urine flow and reducing symptoms such as difficulty starting urination, weak stream, and the need to urinate frequently or urgently.Tamsulosin is specifically selective for alpha-1A receptors, which are predominantly found in the prostate, minimizing systemic side effects.It is typically administered once daily and is well-tolerated, though potential side effects include dizziness, headache, and orthostatic hypotension.Tamsulosin is not indicated for the treatment of hypertension or for use in women or children.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is primarily used to treat benign prostatic hyperplasia (BPH), a condition characterized by an enlarged prostate gland that can cause urinary difficulties in men.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "It is an alpha-1 adrenergic receptor antagonist that works by relaxing the muscles in the prostate and bladder neck, thereby improving urine flow and reducing symptoms such as difficulty starting urination, weak stream, and the need to urinate frequently or urgently.", "answer_sentence_relevance": "borderline", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Tamsulosin is specifically selective for alpha-1A receptors, which are predominantly found in the prostate, minimizing systemic side effects.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "It is typically administered once daily and is well-tolerated, though potential side effects include dizziness, headache, and orthostatic hypotension.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Tamsulosin is not indicated for the treatment of hypertension or for use in women or children.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Tamsulosin is primarily used to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) [18345957, 21888698, 16986050]. It is a uroselective alpha(1A)-adrenergic-receptor antagonist that relaxes the smooth muscles in the prostate and bladder neck, improving urine flow and reducing symptoms [16986050, 14680444]. Additionally, tamsulosin has been used to treat other genitourinary conditions, including distal ureteral stones, and has been used off-label for this purpose [19051800]. It is also used in the treatment of neurogenic bladder in patients with spinal cord injury [36157672]. Tamsulosin is available in various formulations, including modified-release (MR) and oral controlled absorption system (OCAS) [18611117, 20170206]. The standard dose is 0.4 mg/day, which has been shown to be effective and well-tolerated in clinical trials [14680444, 22822617].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is primarily used to treat lower urinary tract symptoms (LUTS) secondary to benign prostatic hyperplasia (BPH) [18345957, 21888698, 16986050].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21888698", "evidence_support": "Tamsulosin, a superselective subtype alpha 1a and 1d blocker, is used for the treatment of male lower urinary tract symptoms (LUTS) commonly caused by benign prostatic hyperplasia (BPH).", "evidence_relation": "supporting" }, { "cited_pmid": "21888698", "evidence_support": "Tamsulosin OCAS\u00ae treatment led to significant improvements in LUTS, HUS and QoL in Thai patients with bladder outlet obstruction from BPH with few side effects.", "evidence_relation": "supporting" }, { "cited_pmid": "16986050", "evidence_support": "Tamsulosin, a uroselective alpha(1A)-adrenergic-receptor antagonist, has been shown to improve lower urinary tract symptoms associated with benign prostatic hyperplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "18345957", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is a uroselective alpha(1A)-adrenergic-receptor antagonist that relaxes the smooth muscles in the prostate and bladder neck, improving urine flow and reducing symptoms [16986050, 14680444].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16986050", "evidence_support": "Tamsulosin, a uroselective alpha(1A)-adrenergic-receptor antagonist, has been shown to improve lower urinary tract symptoms associated with benign prostatic hyperplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "14680444", "evidence_support": "The alpha(1)-adrenoceptor antagonist, tamsulosin, is selective for alpha(1A)- and alpha(1D)- over alpha(1B)-adrenoceptors. Both placebo-controlled and comparative studies with other agents have demonstrated tamsulosin to be an effective treatment for patients with lower urinary symptoms suggestive of benign prostatic hyperplasia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, tamsulosin has been used to treat other genitourinary conditions, including distal ureteral stones, and has been used off-label for this purpose [19051800].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "19051800", "evidence_support": "They are also used off-label in patients with a distal ureteral stone to enhance passage of the stone. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It is also used in the treatment of neurogenic bladder in patients with spinal cord injury [36157672].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36157672", "evidence_support": "Tamsulosin, a selective \u03b11-adrenergic receptor antagonist, is commonly used for treating neurogenic bladder in patients with spinal cord injury (SCI).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Tamsulosin is available in various formulations, including modified-release (MR) and oral controlled absorption system (OCAS) [18611117, 20170206].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18611117", "evidence_support": "Tamsulosin MR has been on the market for the treatment of lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) for many years. Recently, tamsulosin OCAS was introduced, which has improved pharmacokinetics.", "evidence_relation": "supporting" }, { "cited_pmid": "20170206", "evidence_support": "It is mostly used in a modified-release (MR) formulation, but an oral controlled absorption system (OCAS) and a 'without-water' tablet formulation are also available in some countries.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "The standard dose is 0.4 mg/day, which has been shown to be effective and well-tolerated in clinical trials [14680444, 22822617].", "answer_sentence_relevance": "inappropriate", "citation_assessment": [ { "cited_pmid": "14680444", "evidence_support": "A dose of tamsulosin 0.4 mg/day has a tolerability close to that of placebo and has little, if any, blood pressure lowering effects.", "evidence_relation": "supporting" }, { "cited_pmid": "22822617", "evidence_support": "Clinical response to a 12-week tamsulosin treatment improved during the course of treatment, reflected in a reduction in all of the lower urinary tract symptoms, with rare and insignificant side effects.", "evidence_relation": "neutral" } ] } ] }, "ten-shot-gemini-flash": { "answer": "Tamsulosin is primarily used to treat lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) [18345957, 19051800, 26739177]. It is an alpha-1 blocker that relaxes bladder neck muscles, improving urinary flow and reducing symptoms like frequent urination, difficulty starting urination, and weak urine stream [26099320, 12957198]. Tamsulosin is also used to treat urinary retention associated with BPH [26099320]. While primarily used for BPH, tamsulosin may also be beneficial for other genito-urinary conditions in both men and women [18345957]. It has been shown to be effective in promoting the passage of distal ureteral stones and reducing pain associated with stone expulsion [19493392].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is primarily used to treat lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH) [18345957, 19051800, 26739177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18345957", "evidence_support": "Although tamsulosin is mainly used to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia, with better understanding of functional anatomy and distribution of alpha(1) receptors, it is also indicated in other conditions of genito-urinary tract in both men and women.", "evidence_relation": "supporting" }, { "cited_pmid": "19051800", "evidence_support": "Selective postsynaptic alpha1-adrenergic blocking agents such as tamsulosin are mainly used for treating micturition symptoms due to prostatic hyperplasia.", "evidence_relation": "supporting" }, { "cited_pmid": "26739177", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is an alpha-1 blocker that relaxes bladder neck muscles, improving urinary flow and reducing symptoms like frequent urination, difficulty starting urination, and weak urine stream [26099320, 12957198].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26099320", "evidence_support": "Tamsulosin is an alpha blocker that works by relaxing bladder neck muscles. It is used to treat benign prostatic hypertrophy and retention.", "evidence_relation": "supporting" }, { "cited_pmid": "12957198", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Tamsulosin is also used to treat urinary retention associated with BPH [26099320].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26099320", "evidence_support": "Tamsulosin is an alpha blocker that works by relaxing bladder neck muscles", "evidence_relation": "supporting" }, { "cited_pmid": "26099320", "evidence_support": "It is used to treat benign prostatic hypertrophy and retention", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While primarily used for BPH, tamsulosin may also be beneficial for other genito-urinary conditions in both men and women [18345957].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18345957", "evidence_support": "Although tamsulosin is mainly used to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia, with better understanding of functional anatomy and distribution of alpha(1) receptors, it is also indicated in other conditions of genito-urinary tract in both men and women.", "evidence_relation": "supporting" }, { "cited_pmid": "18345957", "evidence_support": "The management of benign prostatic hyperplasia was transurethral resection of prostate until simpler and alternative treatments were tried in the last two decades, particularly alpha(1) adrenoceptor-blocking agents. Tamsulosin is a potent, third-generation selective alpha(1A) adrenoceptor-blocking agent.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It has been shown to be effective in promoting the passage of distal ureteral stones and reducing pain associated with stone expulsion [19493392].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19493392", "evidence_support": "Tamsulosin, an alpha-1 receptor antagonist, has been demonstrated effective in promoting distal ureteral stone passage and in reducing pain associated with stone expulsion.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Tamsulosin, also known as Flomax, is a commonly prescribed medication for benign prostatic hyperplasia (BPH) [35812583, 20642551, 20926447]. It is an alpha-1 blocker that helps relax the muscles in the prostate and bladder neck, improving urine flow and reducing symptoms like frequent urination, difficulty starting urination, and weak urine stream [8936627, 11471862, 11829730]. Tamsulosin is also used off-label to aid in passing ureteral stones [22690465]. While primarily used for BPH, its use has expanded to other genitourinary conditions in both men and women [18345957]. Tamsulosin's effectiveness has been demonstrated in numerous studies, showing improvement in urinary flow rate and symptom relief [9789483, 15812214, 23662493].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin, also known as Flomax, is a commonly prescribed medication for benign prostatic hyperplasia (BPH) [35812583, 20642551, 20926447].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35812583", "evidence_support": "Tamsulosin, sold under the brand name Flomax, is a commonly prescribed medication for benign prostatic hypertrophy (BPH).", "evidence_relation": "supporting" }, { "cited_pmid": "20642551", "evidence_support": "Tamsulosin is available on prescription as a modified release capsule in the US (Flomax), and in most European countries for the treatment of the signs and symptoms of benign prostatic hyperplasia (BPH).", "evidence_relation": "supporting" }, { "cited_pmid": "20926447", "evidence_support": "Earlier this year, tamsulosin, an alpha blocker previously only available on prescription, became available for sale by pharmacists as a treatment for functional symptoms of benign prostatic hyperplasia (BPH) in men aged 45-75 years (Flomax Relief MR - Boehringer Ingelheim).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is an alpha-1 blocker that helps relax the muscles in the prostate and bladder neck, improving urine flow and reducing symptoms like frequent urination, difficulty starting urination, and weak urine stream [8936627, 11471862, 11829730].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "8936627", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "11471862", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "11829730", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Tamsulosin is also used off-label to aid in passing ureteral stones [22690465].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22690465", "evidence_support": "Urologists are using tamsulosin (Flomax) off-label as an aid for passing ureteral stones. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While primarily used for BPH, its use has expanded to other genitourinary conditions in both men and women [18345957].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18345957", "evidence_support": "BACKGROUND: Although tamsulosin is mainly used to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia, with better understanding of functional anatomy and distribution of alpha(1) receptors, it is also indicated in other conditions of genito-urinary tract in both men and women.\nOBJECTIVE: To detail the therapeutic use and clinical effects of tamsulosin.\nMETHODS: The scope of the review was related to tamsulosin and its therapeutic application in conditions of genitourinary tract. Publications were searched from Pubmed and Medline from 1975 to 2007 using the search words tamsulosin, lower urinary tract symptoms, alpha receptors and blockers.\nCONCLUSIONS: The management of benign prostatic hyperplasia was transurethral resection of prostate until simpler and alternative treatments were tried in the last two decades, particularly alpha(1) adrenoceptor-blocking agents. Tamsulosin is a potent, third-generation selective alpha(1A) adrenoceptor-blocking ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Tamsulosin's effectiveness has been demonstrated in numerous studies, showing improvement in urinary flow rate and symptom relief [9789483, 15812214, 23662493].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15812214", "evidence_support": "We administered tamsulosin, an alpha1A/alpha1D-selective adrenergic antagonist, in women with functional bladder neck obstruction to evaluate its potential therapeutic effects.", "evidence_relation": "supporting" }, { "cited_pmid": "15812214", "evidence_support": "The use of alpha1-blockers may be an initial treatment option for female functional bladder neck obstruction, as this therapeutic option proved to be effective in more than 50% of our patients suffering from this voiding dysfunction.", "evidence_relation": "supporting" }, { "cited_pmid": "23662493", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "9789483", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Tamsulosin is primarily used to treat benign prostatic hyperplasia (BPH), a condition characterized by an enlarged prostate that causes urinary symptoms [23151678, 20642551]. It is an alpha-1 adrenoreceptor antagonist that helps alleviate lower urinary tract symptoms associated with BPH, such as difficulty urinating and bladder outlet obstruction [18614430, 33425801]. Tamsulosin is available as a prescription medication, commonly known by the brand name Flomax, and is used to improve urinary flow and reduce discomfort related to urinary disturbances caused by BPH [20642551, 17258532]. Overall, it is considered a primary option for the medical management of this condition [33425801].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is primarily used to treat benign prostatic hyperplasia (BPH), a condition characterized by an enlarged prostate that causes urinary symptoms [23151678, 20642551].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23151678", "evidence_support": "Tamsulosin hydrochloride is one of the most potent drugs for treatment of benign prostatic hyperplasia (BPH), however, the efficacy of tamsulosin hydrochloride varies among individuals. ", "evidence_relation": "supporting" }, { "cited_pmid": "20642551", "evidence_support": "Tamsulosin is available on prescription as a modified release capsule in the US (Flomax), and in most European countries for the treatment of the signs and symptoms of benign prostatic hyperplasia (BPH). ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is an alpha-1 adrenoreceptor antagonist that helps alleviate lower urinary tract symptoms associated with BPH, such as difficulty urinating and bladder outlet obstruction [18614430, 33425801].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18614430", "evidence_support": "Tamsulosin hydrochloride is used to treat the symptoms of an enlarged prostate, a condition technically known as benign prostatic hyperplasia or BPH. ", "evidence_relation": "supporting" }, { "cited_pmid": "33425801", "evidence_support": "Tamsulosin, an alpha-1 adrenoreceptor antagonist, has been used as a primary option for medical treatment of benign prostate hyperplasia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Tamsulosin is available as a prescription medication, commonly known by the brand name Flomax, and is used to improve urinary flow and reduce discomfort related to urinary disturbances caused by BPH [20642551, 17258532].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20642551", "evidence_support": "Tamsulosin is available on prescription as a modified release capsule in the US (Flomax), and in most European countries for the treatment of the signs and symptoms of benign prostatic hyperplasia (BPH).", "evidence_relation": "supporting" }, { "cited_pmid": "17258532", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Overall, it is considered a primary option for the medical management of this condition [33425801].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "33425801", "evidence_support": "Tamsulosin, an alpha-1 adrenoreceptor antagonist, has been used as a primary option for medical treatment of benign prostate hyperplasia. ", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Tamsulosin is an alpha-1 blocker primarily used to manage benign prostatic hyperplasia (BPH), a common condition in older men that significantly impacts their daily lives [32891534, 8647139]. It works by relaxing the muscles in the prostate and bladder neck, which helps improve urinary flow and reduce symptoms associated with BPH [12535426, 11074198]. Tamsulosin is often the first-line medical therapy for BPH, with surgical options considered when medical treatment is ineffective or complications arise [19499750, 18231614]. It has been shown to significantly improve both peak urinary flow and the severity of BPH-related symptoms in clinical trials [11299113, 23089343].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is an alpha-1 blocker primarily used to manage benign prostatic hyperplasia (BPH), a common condition in older men that significantly impacts their daily lives [32891534, 8647139].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32891534", "evidence_support": "Tamsulosin is the most widely used alpha-1 blocker medication for managing benign prostatic hyperplasia (BPH) as indicated in the current practice guideline.", "evidence_relation": "supporting" }, { "cited_pmid": "32891534", "evidence_support": "Older adults with BPH who encountered higher medical expenses had substantially higher medical costs when treated with tamsulosin than other common alpha blockers", "evidence_relation": "supporting" }, { "cited_pmid": "8647139", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It works by relaxing the muscles in the prostate and bladder neck, which helps improve urinary flow and reduce symptoms associated with BPH [12535426, 11074198].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "12535426", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "11074198", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Tamsulosin is often the first-line medical therapy for BPH, with surgical options considered when medical treatment is ineffective or complications arise [19499750, 18231614].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19499750", "evidence_support": "Medical therapy is the first and the most frequently used treatment for BPH; surgical treatments represent a second-line option when medical therapy is non effective or when complications are associated.", "evidence_relation": "supporting" }, { "cited_pmid": "18231614", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It has been shown to significantly improve both peak urinary flow and the severity of BPH-related symptoms in clinical trials [11299113, 23089343].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23089343", "evidence_support": "Initial management for BPH includes lifestyle modification, and smooth muscle relaxant alpha blocker therapy. Alpha blockers usually take effect quickly within 3-5 days, and have minimal side effects. Current commonly used alpha blockers include the selective alpha blockers tamsulosin (Flomax), alfusosin (Xatral), and silodosin (Rapaflo).", "evidence_relation": "neutral" }, { "cited_pmid": "11299113", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "webis-1": { "answer": "Tamsulosin is used for the treatment of benign prostatic hyperplasia (BPH) [15369425,31469636,33235880,21745239].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is used for the treatment of benign prostatic hyperplasia (BPH) [15369425,31469636,33235880,21745239].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31469636", "evidence_support": "We described baseline demographic and clinical characteristics of men currently not using prescription medications for benign prostatic hyperplasia (BPH) but interested in self-directed use of over-the-counter (OTC) tamsulosin and who had participated in OTC tamsulosin-simulated studies.", "evidence_relation": "supporting" }, { "cited_pmid": "33235880", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15369425", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "21745239", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "webis-2": { "answer": "Tamsulosin is used for the treatment of benign prostatic hyperplasia (BPH) [31469636].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is used for the treatment of benign prostatic hyperplasia (BPH) [31469636].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31469636", "evidence_support": "We described baseline demographic and clinical characteristics of men currently not using prescription medications for benign prostatic hyperplasia (BPH) but interested in self-directed use of over-the-counter (OTC) tamsulosin and who had participated in OTC tamsulosin-simulated studies.", "evidence_relation": "supporting" }, { "cited_pmid": "31469636", "evidence_support": "Disease characteristics of men not using BPH prescription medication and interested in using OTC tamsulosin were similar to those using BPH medication or diagnosed with BPH.", "evidence_relation": "neutral" } ] } ] }, "webis-3": { "answer": "Tamsulosin is used for the treatment of benign prostatic hyperplasia (BPH) [31469636].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is used for the treatment of benign prostatic hyperplasia (BPH) [31469636].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31469636", "evidence_support": "We described baseline demographic and clinical characteristics of men currently not using prescription medications for benign prostatic hyperplasia (BPH) but interested in self-directed use of over-the-counter (OTC) tamsulosin and who had participated in OTC tamsulosin-simulated studies.", "evidence_relation": "supporting" }, { "cited_pmid": "31469636", "evidence_support": "Disease characteristics of men not using BPH prescription medication and interested in using OTC tamsulosin were similar to those using BPH medication or diagnosed with BPH.", "evidence_relation": "neutral" } ] } ] }, "webis-5": { "answer": "Tamsulosin is used for the treatment of benign prostatic hyperplasia (BPH). . [31469636].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is used for the treatment of benign prostatic hyperplasia (BPH). .", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-1": { "answer": "Tamsulosin is primarily used to treat benign prostatic hyperplasia (BPH), a condition characterized by an enlarged prostate that can cause urinary difficulties. It works by relaxing the muscles in the prostate and bladder neck, improving urine flow and reducing symptoms associated with BPH.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is primarily used to treat benign prostatic hyperplasia (BPH), a condition characterized by an enlarged prostate that can cause urinary difficulties.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "It works by relaxing the muscles in the prostate and bladder neck, improving urine flow and reducing symptoms associated with BPH.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "Tamsulosin is primarily used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) as it is the most popular uroselective alpha adrenoceptor antagonist for this condition [31555556]. However, it has also been prescribed for both potentially appropriate and inappropriate indications in some cases [15369425].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is primarily used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) as it is the most popular uroselective alpha adrenoceptor antagonist for this condition [31555556].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31555556", "evidence_support": "Tamsulosin remains the single most popular uroselective alpha adrenoceptor antagonist approved for the treatment of lower urinary tract symptoms (LUTS) attributable to benign prostatic hyperplasia (BPH). ", "evidence_relation": "supporting" }, { "cited_pmid": "31555556", "evidence_support": "Tamsulosin was prescribed in patients without a recorded diagnosis of BPH and in women. ", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "However, it has also been prescribed for both potentially appropriate and inappropriate indications in some cases [15369425].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15369425", "evidence_support": "Tamsulosin was prescribed for appropriate indications in 66% of patients, potentially appropriate indications in 4% of patients, and inappropriate indications in 30% of patients", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-6": { "answer": "Tamsulosin is primarily used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) [20854184,21592295]. It works by relaxing the muscles in the prostate and bladder neck, which helps improve urine flow and reduce symptoms related to BPH [20854184,21592295]. Additionally, tamsulosin has been studied in pediatric patients with bladder issues, indicating its broader application in managing urinary symptoms [20642551].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is primarily used to treat lower urinary tract symptoms (LUTS) associated with benign prostatic hyperplasia (BPH) [20854184,21592295].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20854184", "evidence_support": "Selective \u03b1-blockers (tamsulosin) and dual 5\u03b1-reductase inhibitors (dutasteride) have an important role in the medical treatment of symptomatic BPH.", "evidence_relation": "neutral" }, { "cited_pmid": "21592295", "evidence_support": "The trial shows the non-inferiority of silodosin 4 mg twice daily to tamsulosin 0.2 mg once daily in patients with symptoms of BPH.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It works by relaxing the muscles in the prostate and bladder neck, which helps improve urine flow and reduce symptoms related to BPH [20854184,21592295].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "20854184", "evidence_support": "Selective \u03b1-blockers (tamsulosin) and dual 5\u03b1-reductase inhibitors (dutasteride) have an important role in the medical treatment of symptomatic BPH.", "evidence_relation": "neutral" }, { "cited_pmid": "21592295", "evidence_support": "The trial shows the non-inferiority of silodosin 4 mg twice daily to tamsulosin 0.2 mg once daily in patients with symptoms of BPH.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, tamsulosin has been studied in pediatric patients with bladder issues, indicating its broader application in managing urinary symptoms [20642551].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20642551", "evidence_support": "The pharmacokinetics of tamsulosin hydrochloride (HCl) have been extensively studied in adults, but no pharmacokinetic data for paediatrics have been published to date.", "evidence_relation": "contradicting" } ] } ] }, "zero-shot-gemini-flash": { "answer": "Tamsulosin is a medication primarily used to treat lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH), also known as an enlarged prostate [10676828, 18345957]. It works by relaxing the smooth muscle in the prostate and bladder neck, which helps to improve bladder emptying [10676828]. Tamsulosin is a selective alpha1a-adrenergic receptor antagonist, meaning it specifically targets certain receptors in the prostate and bladder [10676828, 11872327]. This targeted action makes it more effective than other alpha-adrenergic antagonists for managing BPH symptoms [10676828]. Additionally, tamsulosin has been shown to be effective in promoting the passage of distal ureteral stones and reducing pain associated with stone expulsion [16317534, 19493392]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin is a medication primarily used to treat lower urinary tract symptoms (LUTS) caused by benign prostatic hyperplasia (BPH), also known as an enlarged prostate [10676828, 18345957].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18345957", "evidence_support": ": Although tamsulosin is mainly used to treat lower urinary tract symptoms secondary to benign prostatic hyperplasia, with better understanding of functional anatomy and distribution of alpha(1) receptors, it is also indicated in other conditions of genito-urinary tract in both men and women.", "evidence_relation": "supporting" }, { "cited_pmid": "10676828", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It works by relaxing the smooth muscle in the prostate and bladder neck, which helps to improve bladder emptying [10676828].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "10676828", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Tamsulosin is a selective alpha1a-adrenergic receptor antagonist, meaning it specifically targets certain receptors in the prostate and bladder [10676828, 11872327].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "10676828", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "11872327", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "This targeted action makes it more effective than other alpha-adrenergic antagonists for managing BPH symptoms [10676828].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "10676828", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, tamsulosin has been shown to be effective in promoting the passage of distal ureteral stones and reducing pain associated with stone expulsion [16317534, 19493392].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16317534", "evidence_support": "Our data confirm the efficacy of tamsulosin in the treatment of distal ureteral stones up to 1 cm.", "evidence_relation": "supporting" }, { "cited_pmid": "19493392", "evidence_support": "Tamsulosin, an alpha-1 receptor antagonist, has been demonstrated effective in promoting distal ureteral stone passage and in reducing pain associated with stone expulsion.", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "Tamsulosin, commonly known as Flomax, is primarily used to treat benign prostatic hyperplasia (BPH), a condition that causes urinary symptoms in men, such as difficulty urinating and increased frequency [25338730, 32891534]. It is an alpha-1 adrenergic antagonist that helps relax the muscles in the prostate and bladder neck, improving urine flow and reducing symptoms associated with BPH [17258532, 11433602]. Additionally, tamsulosin is used off-label to facilitate the passage of ureteral stones by relaxing the smooth muscles in the urinary tract, which can help alleviate pain and improve stone clearance [22690465, 19819530]. Overall, tamsulosin is a well-tolerated medication that effectively addresses lower urinary tract symptoms related to BPH and aids in managing ureteral stones [10559631, 20642551].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Tamsulosin, commonly known as Flomax, is primarily used to treat benign prostatic hyperplasia (BPH), a condition that causes urinary symptoms in men, such as difficulty urinating and increased frequency [25338730, 32891534].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25338730", "evidence_support": "The purpose of this study was to determine the impact of sequential DTCA campaigns for two drugs used to treat benign prostatic hyperplasia (BPH): one newer agent, dutasteride (Avodart(\u00ae)), and one older first-line agent, tamsulosin (Flomax(\u00ae)).", "evidence_relation": "neutral" }, { "cited_pmid": "32891534", "evidence_support": "Tamsulosin is the most widely used alpha-1 blocker medication for managing benign prostatic hyperplasia (BPH) as indicated in the current practice guideline.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is an alpha-1 adrenergic antagonist that helps relax the muscles in the prostate and bladder neck, improving urine flow and reducing symptoms associated with BPH [17258532, 11433602].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17258532", "evidence_support": "To report choroidal detachment following tamsulosin (Flomax, an alpha(1A)-adrenoceptor antagonist) treatment of benign prostatic hyperplasia (BPH).", "evidence_relation": "supporting" }, { "cited_pmid": "11433602", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, tamsulosin is used off-label to facilitate the passage of ureteral stones by relaxing the smooth muscles in the urinary tract, which can help alleviate pain and improve stone clearance [22690465, 19819530].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22690465", "evidence_support": "Urologists are using tamsulosin (Flomax) off-label as an aid for passing ureteral stones.", "evidence_relation": "supporting" }, { "cited_pmid": "19819530", "evidence_support": "The presence of alpha-1A adrenoceptor in the distal ureteral smooth muscle prompted the use of tamsulosin, a selective alpha-1 blocker, to promote spontaneous passage of distal ureteral and juxtavesical calculi. Tamsulosin also improves stone clearance after shock wave lithotripsy.", "evidence_relation": "supporting" }, { "cited_pmid": "19819530", "evidence_support": "Treatment with tamsulosin improves the stone free rate and reduces the occurrence of colic episodes, after ureteroscopic laser lithotripsy of large renal and ureteric calculi.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Overall, tamsulosin is a well-tolerated medication that effectively addresses lower urinary tract symptoms related to BPH and aids in managing ureteral stones [10559631, 20642551].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20642551", "evidence_support": "Tamsulosin is available on prescription as a modified release capsule in the US (Flomax), and in most European countries for the treatment of the signs and symptoms of benign prostatic hyperplasia (BPH). ", "evidence_relation": "supporting" }, { "cited_pmid": "10559631", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] } } }, { "question_id": "126", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Nondisjunction is a type of error during cell division, where chromosomes fail to separate properly. This can occur during either meiosis or mitosis. In meiosis, nondisjunction can lead to gametes (sperm or egg cells) with an abnormal number of chromosomes, which, if fertilized, can result in conditions such as Down syndrome, Turner syndrome, or Klinefelter syndrome. The causes of nondisjunction are not entirely understood but may involve age-related changes in the spindle apparatus that helps separate chromosomes, errors in chromosome pairing or recombination, or environmental factors. It's more common in older women due to the prolonged arrest of eggs in meiosis.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a type of error during cell division, where chromosomes fail to separate properly.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This can occur during either meiosis or mitosis.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "In meiosis, nondisjunction can lead to gametes (sperm or egg cells) with an abnormal number of chromosomes, which, if fertilized, can result in conditions such as Down syndrome, Turner syndrome, or Klinefelter syndrome.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "The causes of nondisjunction are not entirely understood but may involve age-related changes in the spindle apparatus that helps separate chromosomes, errors in chromosome pairing or recombination, or environmental factors.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "It's more common in older women due to the prolonged arrest of eggs in meiosis.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Nondisjunction is a chromosome distribution error during cell division that results in daughter cells with abnormal chromosome numbers, potentially leading to conditions like Down syndrome [16915240, 18369452, 19533770]. This error can occur during meiosis I or II and is more common in maternal meiosis [18369452, 16192701, 19533770]. Causes include loss of cohesion in oocytes, reduced recombination, aberrant meiotic recombination, and mutations in cell cycle regulators or spindle proteins [16192701, 19008956, 16222248]. Chromosome malorientation, premature chromatid separation, and structural chromosome abnormalities also contribute to nondisjunction [17314397, 19533770, 24926858]. Maternal regulation of recombination and oocyte-specific dysregulation play significant roles [16192701, 19533770, 24926858]. Age-induced oxidative damage and genetic polymorphisms further influence the likelihood of nondisjunction [19008956, 19533770, 24926858]. The absence of recombination is particularly associated with this error, which can result in trisomy or monosomy [16192701, 19533770, 24926858].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a chromosome distribution error during cell division that results in daughter cells with abnormal chromosome numbers, potentially leading to conditions like Down syndrome [16915240, 18369452, 19533770].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16915240", "evidence_support": "One simple, widely accepted mechanism for generating an aberrant chromosome number, or aneuploidy, is through nondisjunction--a chromosome distribution error that occurs during mitosis when both copies of a duplicated chromosome are deposited into one daughter cell and none into the other. ", "evidence_relation": "supporting" }, { "cited_pmid": "16915240", "evidence_support": "Here we show that the direct result of chromosome nondisjunction is gain or loss of a single chromosome, which results in near-diploid aneuploidy, not tetraploidy.", "evidence_relation": "neutral" }, { "cited_pmid": "18369452", "evidence_support": "Nondisjunction of chromosome 21 is the leading cause of Down syndrome. ", "evidence_relation": "supporting" }, { "cited_pmid": "19533770", "evidence_support": "Down syndrome caused by meiotic nondisjunction of chromosome 21 in humans, is well known to be associated with advanced maternal age, but success in identifying and understanding other risk factors has been limited. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This error can occur during meiosis I or II and is more common in maternal meiosis [18369452, 16192701, 19533770].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16192701", "evidence_support": "Within the last decade, aberrant meiotic recombination has been confirmed as a molecular risk factor for chromosome nondisjunction in humans.", "evidence_relation": "supporting" }, { "cited_pmid": "16192701", "evidence_support": "Significant alterations in recombination have been found for all meiosis I-derived trisomies studied to date and a subset of so called \"meiosis II\" trisomy.", "evidence_relation": "supporting" }, { "cited_pmid": "19533770", "evidence_support": "Our sample contains 107 maternal meiosis I errors and 31 maternal meiosis II errors and we subsequently stratified them with respect to maternal age and the number of detectable crossover events.", "evidence_relation": "supporting" }, { "cited_pmid": "18369452", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Causes include loss of cohesion in oocytes, reduced recombination, aberrant meiotic recombination, and mutations in cell cycle regulators or spindle proteins [16192701, 19008956, 16222248].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16192701", "evidence_support": "Within the last decade, aberrant meiotic recombination has been confirmed as a molecular risk factor for chromosome nondisjunction in humans.", "evidence_relation": "supporting" }, { "cited_pmid": "16192701", "evidence_support": "Among cases of maternal meiosis I-derived trisomy 21, increasing maternal age is associated with a decreasing frequency of recombination in the susceptible pericentromeric and telomeric regions. ", "evidence_relation": "supporting" }, { "cited_pmid": "19008956", "evidence_support": "One attractive hypothesis to explain age-dependent nondisjunction (NDJ) is that loss of cohesion over time causes recombinant homologues to dissociate prematurely and segregate randomly during the first meiotic division. Using Drosophila as a model system, we have tested this hypothesis and observe a significant increase in meiosis I NDJ in experimentally aged Drosophila oocytes when the cohesin protein SMC1 is reduced. ", "evidence_relation": "supporting" }, { "cited_pmid": "19008956", "evidence_support": "Our findings that recombinant chromosomes are at highest risk for loss of chiasmata during diplotene argue that human oocytes are most vulnerable to age-induced loss of meiotic cohesion at the stage at which they remain arrested for several years.", "evidence_relation": "supporting" }, { "cited_pmid": "16222248", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Chromosome malorientation, premature chromatid separation, and structural chromosome abnormalities also contribute to nondisjunction [17314397, 19533770, 24926858].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17314397", "evidence_support": "Live-cell liquid crystal polarized light microscope imaging showed nondisjunction was caused by chromosome malorientation.", "evidence_relation": "supporting" }, { "cited_pmid": "19533770", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "24926858", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Maternal regulation of recombination and oocyte-specific dysregulation play significant roles [16192701, 19533770, 24926858].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16192701", "evidence_support": "Among cases of maternal meiosis I-derived trisomy 21, increasing maternal age is associated with a decreasing frequency of recombination in the susceptible pericentromeric and telomeric regions.", "evidence_relation": "supporting" }, { "cited_pmid": "19533770", "evidence_support": "Overall reduction of recombination irrespective of maternal age is also evident in meiosis I cases.", "evidence_relation": "supporting" }, { "cited_pmid": "24926858", "evidence_support": "Collectively, these findings suggest that factors that affect the accessibility of a specific chromosome region to recombination may be altered in at least a proportion of oocytes with MI and MII errors.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Age-induced oxidative damage and genetic polymorphisms further influence the likelihood of nondisjunction [19008956, 19533770, 24926858].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19008956", "evidence_support": "One attractive hypothesis to explain age-dependent nondisjunction (NDJ) is that loss of cohesion over time causes recombinant homologues to dissociate prematurely and segregate randomly during the first meiotic division.", "evidence_relation": "neutral" }, { "cited_pmid": "19008956", "evidence_support": "Our finding that missegregation of recombinant homologues increases with age supports the model that chiasmata are destabilized by gradual loss of cohesion over time.", "evidence_relation": "neutral" }, { "cited_pmid": "19533770", "evidence_support": "Overall reduction of recombination irrespective of maternal age is also evident in meiosis I cases.", "evidence_relation": "neutral" }, { "cited_pmid": "24926858", "evidence_support": "For errors in the oocyte, increased maternal age and altered patterns of recombination are highly associated with nondisjunction.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "The absence of recombination is particularly associated with this error, which can result in trisomy or monosomy [16192701, 19533770, 24926858].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16192701", "evidence_support": "Within the last decade, aberrant meiotic recombination has been confirmed as a molecular risk factor for chromosome nondisjunction in humans.", "evidence_relation": "supporting" }, { "cited_pmid": "16192701", "evidence_support": "Recombination tethers homologous chromosomes, linking and guiding them through proper segregation at meiosis I. In model organisms, mutations that disturb the recombination pathway increase the frequency of chromosome malsegregation and alterations in both the amount and placement of meiotic recombination are associated with nondisjunction. ", "evidence_relation": "neutral" }, { "cited_pmid": "24926858", "evidence_support": "For errors in the oocyte, increased maternal age and altered patterns of recombination are highly associated with nondisjunction.", "evidence_relation": "neutral" }, { "cited_pmid": "19533770", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Nondisjunction is the failure of chromosomes to segregate properly during cell division, leading to aneuploidy, where cells have an abnormal number of chromosomes.This error can occur during meiosis or mitosis and is influenced by several factors.In meiosis, nondisjunction is often associated with altered recombination patterns, such as reduced or improperly placed exchanges, particularly near centromeres or telomeres, which disrupts chromosome tethering and segregation [16192701, 19533770]. Increased maternal age is a significant risk factor, likely due to age-related deterioration of cohesion proteins that maintain chromosome structure [19008956, 26407969]. Additionally, transcriptional activity of ribosomal RNA genes and genetic variants affecting meiotic processes can contribute to nondisjunction [16769819, 31830031]. Environmental factors and genetic predispositions also play roles, as evidenced by studies linking specific gene polymorphisms to increased nondisjunction risk [36447056]. These multifactorial influences underscore the complexity of nondisjunction and its significant impact on conditions like Down syndrome [18369452, 16192705].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is the failure of chromosomes to segregate properly during cell division, leading to aneuploidy, where cells have an abnormal number of chromosomes.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This error can occur during meiosis or mitosis and is influenced by several factors.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "In meiosis, nondisjunction is often associated with altered recombination patterns, such as reduced or improperly placed exchanges, particularly near centromeres or telomeres, which disrupts chromosome tethering and segregation [16192701, 19533770].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16192701", "evidence_support": "Within the last decade, aberrant meiotic recombination has been confirmed as a molecular risk factor for chromosome nondisjunction in humans.", "evidence_relation": "supporting" }, { "cited_pmid": "16192701", "evidence_support": "In model organisms, mutations that disturb the recombination pathway increase the frequency of chromosome malsegregation and alterations in both the amount and placement of meiotic recombination are associated with nondisjunction.", "evidence_relation": "supporting" }, { "cited_pmid": "16192701", "evidence_support": "For other trisomies, the placement of meiotic recombination has been altered. It appears that recombination too near the centromere or too far from the centromere imparts an increased risk for nondisjunction.", "evidence_relation": "supporting" }, { "cited_pmid": "19533770", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Increased maternal age is a significant risk factor, likely due to age-related deterioration of cohesion proteins that maintain chromosome structure [19008956, 26407969].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19008956", "evidence_support": "In humans, meiotic chromosome segregation errors increase dramatically as women age, but the molecular defects responsible are largely unknown", "evidence_relation": "contradicting" }, { "cited_pmid": "19008956", "evidence_support": "Our data provide the first demonstration in any organism that, when meiotic cohesion begins intact, the aging process can weaken it sufficiently and cause missegregation of recombinant chromosomes.", "evidence_relation": "supporting" }, { "cited_pmid": "26407969", "evidence_support": "This specific type of error is estimated to account for over 90 % of live births with DS, with maternal age being the best known risk factor for chromosome 21 nondisjunction. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, transcriptional activity of ribosomal RNA genes and genetic variants affecting meiotic processes can contribute to nondisjunction [16769819, 31830031].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31830031", "evidence_support": "Several candidate genes showed strong associations with maternal nondisjunction of chromosome 21, demonstrating that genetic variants associated with normal variation in meiotic processes can be risk factors for nondisjunction", "evidence_relation": "supporting" }, { "cited_pmid": "16769819", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Environmental factors and genetic predispositions also play roles, as evidenced by studies linking specific gene polymorphisms to increased nondisjunction risk [36447056].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36447056", "evidence_support": "These findings from the largest population sample tested ever revealed that mutations/polymorphisms of the genes DNMT3B and RFC1 impair recombination that leads to chromosome 21 nondisjunction in the oocyte at meiosis II stage and bring us a significant step closer towards understanding the aetiology of chromosome 21 nondisjunction and birth of a child with Down syndrome to women at any age.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "These multifactorial influences underscore the complexity of nondisjunction and its significant impact on conditions like Down syndrome [18369452, 16192705].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18369452", "evidence_support": "Our results emphasize the fact that human nondisjunction is a multifactorial trait that must be dissected into its component parts to identify specific associated risk factors.", "evidence_relation": "supporting" }, { "cited_pmid": "16192705", "evidence_support": "Although progress has been made to understand the mechanisms and risk factors that underlie nondisjunction, considerably more research needs to be conducted to dissect this multifactorial trait, one that has a considerable impact on our species.", "evidence_relation": "neutral" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Nondisjunction is a type of chromosome segregation error that occurs during cell division, resulting in an abnormal number of chromosomes in daughter cells [17314397, 16769819]. This error can occur during meiosis or mitosis and can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes [18369452, 16192701]. Nondisjunction can be caused by various factors, including errors in meiotic recombination, centromere dysfunction, and spindle formation abnormalities [16192705, 19008956]. In oocytes, nondisjunction is often associated with advanced maternal age and altered recombination patterns [16222248, 31830031]. Additionally, genetic variants in certain genes, such as DNMT3B and RFC1, have been linked to an increased risk of nondisjunction [36447056]. The mechanisms underlying nondisjunction are complex and multifactorial, and further research is needed to fully understand the causes and consequences of this error [16915240, 26407969]. Understanding nondisjunction is crucial for elucidating the etiology of aneuploidy and developing strategies for prevention and treatment.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a type of chromosome segregation error that occurs during cell division, resulting in an abnormal number of chromosomes in daughter cells [17314397, 16769819].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17314397", "evidence_support": "Live-cell liquid crystal polarized light microscope imaging showed nondisjunction was caused by chromosome malorientation.", "evidence_relation": "neutral" }, { "cited_pmid": "16769819", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This error can occur during meiosis or mitosis and can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes [18369452, 16192701].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16192701", "evidence_support": "Within the last decade, aberrant meiotic recombination has been confirmed as a molecular risk factor for chromosome nondisjunction in humans.", "evidence_relation": "neutral" }, { "cited_pmid": "18369452", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Nondisjunction can be caused by various factors, including errors in meiotic recombination, centromere dysfunction, and spindle formation abnormalities [16192705, 19008956].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19008956", "evidence_support": "One attractive hypothesis to explain age-dependent nondisjunction (NDJ) is that loss of cohesion over time causes recombinant homologues to dissociate prematurely and segregate randomly during the first meiotic division", "evidence_relation": "supporting" }, { "cited_pmid": "16192705", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In oocytes, nondisjunction is often associated with advanced maternal age and altered recombination patterns [16222248, 31830031].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16222248", "evidence_support": "Although mutations in cell cycle regulators or spindle proteins can perturb chromosome segregation, the causes and consequences of spontaneous mitotic chromosome nondisjunction in human cells are not well understood.", "evidence_relation": "neutral" }, { "cited_pmid": "31830031", "evidence_support": "Several candidate genes showed strong associations with maternal nondisjunction of chromosome 21, demonstrating that genetic variants associated with normal variation in meiotic processes can be risk factors for nondisjunction.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, genetic variants in certain genes, such as DNMT3B and RFC1, have been linked to an increased risk of nondisjunction [36447056].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36447056", "evidence_support": "We hypothesize that the risk variants and mutations of DNMT3B and RFC1 genes may cause reduction in two or more recombination events and also cause peri-centromeric single exchange that increases the risk of nondisjunction at any age of women.", "evidence_relation": "supporting" }, { "cited_pmid": "36447056", "evidence_support": "These findings from the largest population sample tested ever revealed that mutations/polymorphisms of the genes DNMT3B and RFC1 impair recombination that leads to chromosome 21 nondisjunction in the oocyte at meiosis II stage and bring us a significant step closer towards understanding the aetiology of chromosome 21 nondisjunction and birth of a child with Down syndrome to women at any age.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "The mechanisms underlying nondisjunction are complex and multifactorial, and further research is needed to fully understand the causes and consequences of this error [16915240, 26407969].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16915240", "evidence_support": "One simple, widely accepted mechanism for generating an aberrant chromosome number, or aneuploidy, is through nondisjunction--a chromosome distribution error that occurs during mitosis when both copies of a duplicated chromosome are deposited into one daughter cell and none into the other.", "evidence_relation": "neutral" }, { "cited_pmid": "26407969", "evidence_support": "This specific type of error is estimated to account for over 90 % of live births with DS, with maternal age being the best known risk factor for chromosome 21 nondisjunction.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Understanding nondisjunction is crucial for elucidating the etiology of aneuploidy and developing strategies for prevention and treatment.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [14742700, 29037558, 19828553]. This can occur during meiosis, the process by which gametes (sperm or egg cells) are formed, or during mitosis, the process by which somatic cells divide [14742700, 25547535, 26491874]. Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause genetic disorders such as Down syndrome [14742700, 19828553, 30390610]. The causes of nondisjunction are not fully understood, but it is thought to be related to errors in the process of chromosome separation, such as a failure of the chromosomes to properly align or a failure of the spindle fibers to properly separate the chromosomes [15329821, 19828553, 18270181]. Additionally, advanced maternal age is a known risk factor for nondisjunction, as the risk of aneuploidy increases with age [22317970, 22195772, 22705668]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [14742700, 29037558, 19828553].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19828553", "evidence_support": "It is known that most aneuploidies are due to non-disjunction events occurring in the maternal germ line. Linkage studies have associated abnormal patterns of meiotic recombination to the origin of the non-disjunction event in many aneuploid conditions.", "evidence_relation": "supporting" }, { "cited_pmid": "14742700", "evidence_support": "To investigate the different timings and nature of chromosomal mosaicism, we developed single cell multiplex fluorescent (FL)-PCR to distinguish meiotic and mitotic cell division errors.", "evidence_relation": "neutral" }, { "cited_pmid": "29037558", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This can occur during meiosis, the process by which gametes (sperm or egg cells) are formed, or during mitosis, the process by which somatic cells divide [14742700, 25547535, 26491874].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14742700", "evidence_support": "Of these, 13 (52%) comprised cells with concordant DNA fingerprints indicative of meiotic non-disjunction errors.", "evidence_relation": "neutral" }, { "cited_pmid": "14742700", "evidence_support": "Errors at all stages including metaphase (MI) (12%) and first (38%), second (31%) and third (19%) mitotic cleavage divisions were identified from the types and proportion of different allelic profiles.", "evidence_relation": "neutral" }, { "cited_pmid": "26491874", "evidence_support": "While these errors frequently arise in oocyte meiosis, many such whole-chromosome abnormalities affecting cleavage-stage embryos are the result of chromosome missegregation occurring during the initial mitotic cell divisions.", "evidence_relation": "supporting" }, { "cited_pmid": "25547535", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause genetic disorders such as Down syndrome [14742700, 19828553, 30390610].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14742700", "evidence_support": "Chromosome 21 was investigated as the model chromosome as trisomy 21 (Down's syndrome) represents the most common chromosomal aneuploidy that reaches live birth.", "evidence_relation": "supporting" }, { "cited_pmid": "19828553", "evidence_support": "It is known that most aneuploidies are due to non-disjunction events occurring in the maternal germ line.", "evidence_relation": "supporting" }, { "cited_pmid": "30390610", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The causes of nondisjunction are not fully understood, but it is thought to be related to errors in the process of chromosome separation, such as a failure of the chromosomes to properly align or a failure of the spindle fibers to properly separate the chromosomes [15329821, 19828553, 18270181].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15329821", "evidence_support": "A positive relationship was found between maternal age and these two types of nondisjunction, but the most significant correlation was observed with chromatid separation resulting in the presence of free chromatid in metaphase II oocyte. These data revealed that chromatid separation was an essential factor in the age-dependent occurrence of aneuploidy. This finding provided new insights into the mechanism of nondisjunction in female meiosis since disturbance in molecular chromatid cohesion by cohesins might be a causal mechanism predisposing to nondisjunction and involved in the maternal age effect.", "evidence_relation": "supporting" }, { "cited_pmid": "19828553", "evidence_support": "The aneuploidy frequency found in MII oocytes was 12.6%, and both whole-chromosome non-disjunction (1.94%) and premature separation of sister chromatids (PSSC) (12.6%) have been found. ", "evidence_relation": "neutral" }, { "cited_pmid": "19828553", "evidence_support": "In addition, we report vulnerable patterns of meiotic recombination in chromosome 16 that may be at risk of leading to a non-disjunction event.", "evidence_relation": "supporting" }, { "cited_pmid": "18270181", "evidence_support": "The results indicate high increase of 21 and XY disomies, as well as diploidy in both spermatocytes at MII and spermatozoa (P < 0.0001). Achiasmate segregation of sex chromosomes was found in 3.4% of spermatocytes II, preceded by early-dissociated XY bivalent at MI (41.5% of cells). We also detected premature separation of sister chromatids (PSSC) in 4.6% of MII.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, advanced maternal age is a known risk factor for nondisjunction, as the risk of aneuploidy increases with age [22317970, 22195772, 22705668].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22317970", "evidence_support": "Chromosome aneuploidy is a major cause of pregnancy loss, abnormal pregnancy and live births following both natural conception and in vitro fertilisation (IVF) and increases exponentially with maternal age in the decade preceding the menopause.", "evidence_relation": "supporting" }, { "cited_pmid": "22195772", "evidence_support": "All types of aneuploidy that rose with increasing maternal age can be attributed to disjunction errors during meiosis of the oocyte.", "evidence_relation": "supporting" }, { "cited_pmid": "22705668", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Nondisjunction is a type of chromosome error that occurs during cell division, resulting in an abnormal number of chromosomes in the daughter cells [17911163, 16222248, 18369452]. It is a leading cause of aneuploidy, which is the presence of an abnormal number of chromosomes in a cell [17911163, 31830031, 18369452]. Nondisjunction can occur in both mitosis and meiosis, but it is more common in meiosis, particularly in the formation of gametes [19828553, 17911163, 17705154]. The primary risk factors for nondisjunction are maternal age and altered recombination, with maternal age being the most significant risk factor [19828553, 16192705, 17911163]. As women age, the likelihood of nondisjunction increases, particularly in the first meiotic division [19828553, 17911163, 19050929]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a type of chromosome error that occurs during cell division, resulting in an abnormal number of chromosomes in the daughter cells [17911163, 16222248, 18369452].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16222248", "evidence_support": "Nondisjunction occurred with high frequency in cells that became binucleated by furrow regression, but not in cells that completed cytokinesis to form two mononucleated cells. Our findings indicate that nondisjunction does not directly yield aneuploid cells, but rather tetraploid cells that may subsequently become aneuploid through further division.", "evidence_relation": "neutral" }, { "cited_pmid": "17911163", "evidence_support": "We know that most aneuploidy derives from errors in maternal meiosis I, that maternal age is a risk factor for most, if not all, human trisomies, and that alterations in recombination are an important contributor to meiotic non-disjunction.", "evidence_relation": "neutral" }, { "cited_pmid": "18369452", "evidence_support": "Nondisjunction of chromosome 21 is the leading cause of Down syndrome. Two risk factors for maternal nondisjunction of chromosome 21 are increased maternal age and altered recombination.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is a leading cause of aneuploidy, which is the presence of an abnormal number of chromosomes in a cell [17911163, 31830031, 18369452].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17911163", "evidence_support": "Aneuploidy is the most common chromosome abnormality in humans, and is the leading genetic cause of miscarriage and congenital birth defects.", "evidence_relation": "supporting" }, { "cited_pmid": "18369452", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "31830031", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Nondisjunction can occur in both mitosis and meiosis, but it is more common in meiosis, particularly in the formation of gametes [19828553, 17911163, 17705154].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "19828553", "evidence_support": "In the present study, we report the finding of a considerable frequency of aneuploidy in oocytes from young donors, with the frequency of PSSC being higher than the frequency of whole-chromosome non-disjunction.", "evidence_relation": "neutral" }, { "cited_pmid": "17911163", "evidence_support": "We know that most aneuploidy derives from errors in maternal meiosis I, that maternal age is a risk factor for most, if not all, human trisomies, and that alterations in recombination are an important contributor to meiotic non-disjunction.", "evidence_relation": "supporting" }, { "cited_pmid": "17705154", "evidence_support": "Our results indicate that the majority of trisomy 22 errors (>96%) arise during oogenesis with most of these errors ( approximately 90%) occurring during the first meiotic division", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The primary risk factors for nondisjunction are maternal age and altered recombination, with maternal age being the most significant risk factor [19828553, 16192705, 17911163].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19828553", "evidence_support": "In the present study, we report the finding of a considerable frequency of aneuploidy in oocytes from young donors, with the frequency of PSSC being higher than the frequency of whole-chromosome non-disjunction", "evidence_relation": "neutral" }, { "cited_pmid": "16192705", "evidence_support": "For errors occurring in oocytes, the primary risk factors are maternal age and altered recombination.", "evidence_relation": "supporting" }, { "cited_pmid": "17911163", "evidence_support": "We know that most aneuploidy derives from errors in maternal meiosis I, that maternal age is a risk factor for most, if not all, human trisomies, and that alterations in recombination are an important contributor to meiotic non-disjunction.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "As women age, the likelihood of nondisjunction increases, particularly in the first meiotic division [19828553, 17911163, 19050929].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "17911163", "evidence_support": "We know that most aneuploidy derives from errors in maternal meiosis I, that maternal age is a risk factor for most, if not all, human trisomies, and that alterations in recombination are an important contributor to meiotic non-disjunction.", "evidence_relation": "supporting" }, { "cited_pmid": "19050929", "evidence_support": "First, the significant association between advanced maternal age and chromosome 21 nondisjunction was restricted to meiotic errors in the egg; the association was not observed in sperm or in post-zygotic mitotic errors", "evidence_relation": "supporting" }, { "cited_pmid": "19050929", "evidence_support": "Second, advanced maternal age was significantly associated with both meiosis I (MI) and meiosis II (MII)", "evidence_relation": "supporting" }, { "cited_pmid": "19828553", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [19050929, 16518691, 16222248]. This can occur during meiosis, the process by which gametes (sperm or egg cells) are formed, or during mitosis, the process by which somatic cells divide [16192699, 16518691, 16222248]. Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause various health problems, including birth defects and cancer [16915240, 36428993, 16518691]. The causes of nondisjunction are not fully understood, but research suggests that it can be influenced by various factors, including advanced maternal age, altered recombination patterns, and genetic mutations [17584770, 31830031, 16192701]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [19050929, 16518691, 16222248].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16518691", "evidence_support": "Aneuploidy results from nondisjunction of chromosomes in meiosis and is the leading cause of developmental disabilities and mental retardation in humans.", "evidence_relation": "supporting" }, { "cited_pmid": "16222248", "evidence_support": "It has been assumed that nondisjunction of a chromosome during mitosis will yield two aneuploid daughter cells.", "evidence_relation": "supporting" }, { "cited_pmid": "16222248", "evidence_support": "Here we show that chromosome nondisjunction is tightly coupled to regulation of cytokinesis in human cell lines, such that nondisjunction results in the formation of tetraploid rather than aneuploid cells.", "evidence_relation": "supporting" }, { "cited_pmid": "19050929", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This can occur during meiosis, the process by which gametes (sperm or egg cells) are formed, or during mitosis, the process by which somatic cells divide [16192699, 16518691, 16222248].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16192699", "evidence_support": "The mechanisms of aneuploidy induction in human oogenesis mainly involve nondisjunction arising during the first and second meiotic divisions.", "evidence_relation": "supporting" }, { "cited_pmid": "16518691", "evidence_support": "Aneuploidy results from nondisjunction of chromosomes in meiosis and is the leading cause of developmental disabilities and mental retardation in humans.", "evidence_relation": "supporting" }, { "cited_pmid": "16222248", "evidence_support": "It has been assumed that nondisjunction of a chromosome during mitosis will yield two aneuploid daughter cells.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause various health problems, including birth defects and cancer [16915240, 36428993, 16518691].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16915240", "evidence_support": "One simple, widely accepted mechanism for generating an aberrant chromosome number, or aneuploidy, is through nondisjunction--a chromosome distribution error that occurs during mitosis when both copies of a duplicated chromosome are deposited into one daughter cell and none into the other.", "evidence_relation": "supporting" }, { "cited_pmid": "36428993", "evidence_support": "Aneuploidy is a hallmark of cancer and a major cause of miscarriages in humans.", "evidence_relation": "supporting" }, { "cited_pmid": "36428993", "evidence_support": "It is caused by chromosome segregation errors during cell divisions.", "evidence_relation": "neutral" }, { "cited_pmid": "16518691", "evidence_support": "Aneuploidy results from nondisjunction of chromosomes in meiosis and is the leading cause of developmental disabilities and mental retardation in humans.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The causes of nondisjunction are not fully understood, but research suggests that it can be influenced by various factors, including advanced maternal age, altered recombination patterns, and genetic mutations [17584770, 31830031, 16192701].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17584770", "evidence_support": "Maternal and paternal ages were elevated in cases with paternal meiotic origin.", "evidence_relation": "neutral" }, { "cited_pmid": "17584770", "evidence_support": "This study supports the evidence for subtle chromosome-specific influences on the mechanisms that determine non-disjunction of human chromosomes, consistent with the diversity of findings for other trisomies.", "evidence_relation": "neutral" }, { "cited_pmid": "31830031", "evidence_support": ". Several candidate genes showed strong associations with maternal nondisjunction of chromosome 21, demonstrating that genetic variants associated with normal variation in meiotic processes can be risk factors for nondisjunction.", "evidence_relation": "supporting" }, { "cited_pmid": "16192701", "evidence_support": "Within the last decade, aberrant meiotic recombination has been confirmed as a molecular risk factor for chromosome nondisjunction in humans.", "evidence_relation": "contradicting" }, { "cited_pmid": "16192701", "evidence_support": "regions. It is likely that multiple risk factors lead to nondisjunction, some age dependent and others age independent, some that act globally and others that are chromosome specific.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [19050929, 16915240, 28208750]. This can occur during meiosis, the process by which gametes (sperm or egg cells) are formed, or during mitosis, the process by which somatic cells divide [36428993, 16222248, 16192699]. Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause various health problems, including birth defects and cancer [28087838, 20810265, 17911163]. The causes of nondisjunction are not fully understood, but research suggests that it can be influenced by various factors, including advanced maternal age, altered recombination patterns, and genetic mutations [18369452, 16192705, 15551222]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [19050929, 16915240, 28208750].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16915240", "evidence_support": "One simple, widely accepted mechanism for generating an aberrant chromosome number, or aneuploidy, is through nondisjunction--a chromosome distribution error that occurs during mitosis when both copies of a duplicated chromosome are deposited into one daughter cell and none into the other.", "evidence_relation": "supporting" }, { "cited_pmid": "19050929", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "28208750", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This can occur during meiosis, the process by which gametes (sperm or egg cells) are formed, or during mitosis, the process by which somatic cells divide [36428993, 16222248, 16192699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16222248", "evidence_support": "It has been assumed that nondisjunction of a chromosome during mitosis will yield two aneuploid daughter cell", "evidence_relation": "supporting" }, { "cited_pmid": "16192699", "evidence_support": "The mechanisms of aneuploidy induction in human oogenesis mainly involve nondisjunction arising during the first and second meiotic divisions.", "evidence_relation": "supporting" }, { "cited_pmid": "16192699", "evidence_support": "Aneuploid mosaics most commonly arise by chromosome loss, followed by chromosome gain and least frequently by mitotic nondisjunction.", "evidence_relation": "neutral" }, { "cited_pmid": "36428993", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause various health problems, including birth defects and cancer [28087838, 20810265, 17911163].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28087838", "evidence_support": "Aneuploidy can result from chromosome loss or nondisjunction due to chromosome mis-segregation at anaphase", "evidence_relation": "supporting" }, { "cited_pmid": "20810265", "evidence_support": "Aneuploidy reduces fecundity and is a frequent cause of inherited birth defects. In addition, aneuploidy is very common in solid tumors where it is associated with poor patient prognosis", "evidence_relation": "supporting" }, { "cited_pmid": "17911163", "evidence_support": "Aneuploidy is the most common chromosome abnormality in humans, and is the leading genetic cause of miscarriage and congenital birth defects.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The causes of nondisjunction are not fully understood, but research suggests that it can be influenced by various factors, including advanced maternal age, altered recombination patterns, and genetic mutations [18369452, 16192705, 15551222].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18369452", "evidence_support": "Two risk factors for maternal nondisjunction of chromosome 21 are increased maternal age and altered recombination.", "evidence_relation": "supporting" }, { "cited_pmid": "16192705", "evidence_support": "For errors occurring in oocytes, the primary risk factors are maternal age and altered recombination.", "evidence_relation": "supporting" }, { "cited_pmid": "15551222", "evidence_support": "We hypothesize that environmental and age-related insults accumulate in the ovary as a woman ages, leading to malsegregation of oocytes with stable exchange patterns. It is this risk, due to recombination-independent factors, that would be most influenced by increasing age, leading to the observed maternal age effect.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [16915240, 19050929, 16518691]. This can occur during meiosis, the process by which gametes (sperm or egg cells) are formed, or during mitosis, the process by which somatic cells divide [36428993, 16192699, 16222248]. Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause various health problems, including birth defects and cancer [17911163, 20810265, 28087838]. The causes of nondisjunction are not fully understood, but research suggests that it can be influenced by various factors, including advanced maternal age, altered recombination patterns, and genetic mutations [15551222, 18369452, 16192705]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [16915240, 19050929, 16518691].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16915240", "evidence_support": "One simple, widely accepted mechanism for generating an aberrant chromosome number, or aneuploidy, is through nondisjunction--a chromosome distribution error that occurs during mitosis when both copies of a duplicated chromosome are deposited into one daughter cell and none into the other.", "evidence_relation": "supporting" }, { "cited_pmid": "16518691", "evidence_support": "Aneuploidy results from nondisjunction of chromosomes in meiosis and is the leading cause of developmental disabilities and mental retardation in humans.", "evidence_relation": "supporting" }, { "cited_pmid": "19050929", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This can occur during meiosis, the process by which gametes (sperm or egg cells) are formed, or during mitosis, the process by which somatic cells divide [36428993, 16192699, 16222248].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16192699", "evidence_support": "The mechanisms of aneuploidy induction in human oogenesis mainly involve nondisjunction arising during the first and second meiotic divisions.", "evidence_relation": "supporting" }, { "cited_pmid": "16222248", "evidence_support": "It has been assumed that nondisjunction of a chromosome during mitosis will yield two aneuploid daughter cells", "evidence_relation": "supporting" }, { "cited_pmid": "36428993", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause various health problems, including birth defects and cancer [17911163, 20810265, 28087838].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17911163", "evidence_support": "Aneuploidy is the most common chromosome abnormality in humans, and is the leading genetic cause of miscarriage and congenital birth defects.", "evidence_relation": "supporting" }, { "cited_pmid": "20810265", "evidence_support": "Aneuploidy reduces fecundity and is a frequent cause of inherited birth defects.", "evidence_relation": "supporting" }, { "cited_pmid": "28087838", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The causes of nondisjunction are not fully understood, but research suggests that it can be influenced by various factors, including advanced maternal age, altered recombination patterns, and genetic mutations [15551222, 18369452, 16192705].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15551222", "evidence_support": "Altered genetic recombination has been identified as the first molecular correlate of chromosome nondisjunction in both humans and model organisms. Little evidence has emerged to link maternal age--long recognized as the primary risk factor for nondisjunction--with altered recombination, although some studies have provided hints of such a relationship.", "evidence_relation": "supporting" }, { "cited_pmid": "15551222", "evidence_support": "These results suggest that the greatest risk factor for nondisjunction among younger women is the presence of a susceptible exchange pattern.", "evidence_relation": "supporting" }, { "cited_pmid": "15551222", "evidence_support": ". It is this risk, due to recombination-independent factors, that would be most influenced by increasing age, leading to the observed maternal age effect.", "evidence_relation": "supporting" }, { "cited_pmid": "18369452", "evidence_support": "Two risk factors for maternal nondisjunction of chromosome 21 are increased maternal age and altered recombination.", "evidence_relation": "supporting" }, { "cited_pmid": "16192705", "evidence_support": "For errors occurring in oocytes, the primary risk factors are maternal age and altered recombination.", "evidence_relation": "supporting" }, { "cited_pmid": "16192705", "evidence_support": "Although the studies of paternal nondisjunction are limited due to the relatively small proportion of errors of this type, we review the potential influence of paternal age, recombination and other environmental and genetic factors on susceptibility.", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [16915240, 16518691, 19050929]. This can occur during meiosis, the process by which gametes (sperm or egg cells) are formed, or during mitosis, the process by which somatic cells divide [16192699, 15573136, 28600780]. Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause various health problems, including birth defects and cancer [20810265, 28087838, 17911163]. The causes of nondisjunction are not fully understood, but research suggests that it can be influenced by various factors, including advanced maternal age, altered recombination patterns, and genetic mutations [15551222, 18369452, 16192705]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [16915240, 16518691, 19050929].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16915240", "evidence_support": "One simple, widely accepted mechanism for generating an aberrant chromosome number, or aneuploidy, is through nondisjunction--a chromosome distribution error that occurs during mitosis when both copies of a duplicated chromosome are deposited into one daughter cell and none into the other.", "evidence_relation": "supporting" }, { "cited_pmid": "16915240", "evidence_support": "Here we show that the direct result of chromosome nondisjunction is gain or loss of a single chromosome, which results in near-diploid aneuploidy, not tetraploidy", "evidence_relation": "neutral" }, { "cited_pmid": "19050929", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16518691", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This can occur during meiosis, the process by which gametes (sperm or egg cells) are formed, or during mitosis, the process by which somatic cells divide [16192699, 15573136, 28600780].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16192699", "evidence_support": "The mechanisms of aneuploidy induction in human oogenesis mainly involve nondisjunction arising during the first and second meiotic divisions.", "evidence_relation": "supporting" }, { "cited_pmid": "15573136", "evidence_support": "Meiosis is the type of cell division that gives rise to eggs and sperm. Errors in the execution of this process can result in the generation of aneuploid gametes, which are associated with birth defects and infertility in humans.", "evidence_relation": "supporting" }, { "cited_pmid": "28600780", "evidence_support": "Accurate execution of the meiotic cell division to generate a female and a male gamete is required for the generation of healthy offspring harboring the correct number of chromosomes. Unfortunately, meiosis is error prone.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause various health problems, including birth defects and cancer [20810265, 28087838, 17911163].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20810265", "evidence_support": "Errors in chromosome segregation are irreversible and lead to a state of aneuploidy where the number of chromosomes in a cell or organism is not a multiple of the haploid number of chromosomes. Aneuploidy reduces fecundity and is a frequent cause of inherited birth defects. In addition, aneuploidy is very common in solid tumors where it is associated with poor patient prognosis. Recent work has revealed the most common pathways by ", "evidence_relation": "supporting" }, { "cited_pmid": "28087838", "evidence_support": "Aneuploidy can result from chromosome loss or nondisjunction due to chromosome mis-segregation at anaphase.", "evidence_relation": "supporting" }, { "cited_pmid": "28087838", "evidence_support": "uploidy. To investigate whether chromosome distribution analysis, specifically of nondisjunction, using chromosome-specific centromeric probes provides a more sensitive assay for aneugen detection, six reference aneugens with differing modes of action were tested on human lymphoblastoid TK6 cells. The results show that chromosome loss is a substantial part of the process leading to aneuploidy in TK6 cells. This differs from previous studies on human lymphocytes where nondisjunction has been described as the major mechanism of aneugenicity. However, in the current study more cells and types of aneugenic damage were analyzed. Although compound specific effects on nondisjunction were identified, chromosome distribution analysis did not", "evidence_relation": "supporting" }, { "cited_pmid": "17911163", "evidence_support": "Aneuploidy is the most common chromosome abnormality in humans, and is the leading genetic cause of miscarriage and congenital birth defects. Since the identification of the first human aneuploid conditions nearly a half-century ago, a great deal of information has accrued on its origin and etiology. We know that most aneuploidy derives from errors in maternal meiosis I, that maternal age is a risk factor for most, if not all, human trisomies, and that alterations in recombination are an important contributor to meiotic non-disjunction. In this review, we summarize some of the data that have led to these conclusions, and discuss some of the approaches now being used to address the underlying causes of meiotic non-disjunction in humans", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The causes of nondisjunction are not fully understood, but research suggests that it can be influenced by various factors, including advanced maternal age, altered recombination patterns, and genetic mutations [15551222, 18369452, 16192705].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15551222", "evidence_support": "Altered genetic recombination has been identified as the first molecular correlate of chromosome nondisjunction in both humans and model organisms. Little evidence has emerged to link maternal age--long recognized as the primary risk factor for nondisjunction--with altered recombination, although some studies have provided hints of such a relationship", "evidence_relation": "supporting" }, { "cited_pmid": "18369452", "evidence_support": "Two risk factors for maternal nondisjunction of chromosome 21 are increased maternal age and altered recombination", "evidence_relation": "supporting" }, { "cited_pmid": "16192705", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [16915240, 21617258, 29159670]. This can occur during meiosis, the process by which gametes (sperm or egg cells) are formed, or during mitosis, the process by which somatic cells divide [18413063, 18693127, 25605710]. Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause various health problems, including birth defects and cancer [16192705, 21289044, 18558649]. The causes of nondisjunction are not fully understood, but research suggests that it can be influenced by various factors, including advanced maternal age, altered recombination patterns, and genetic mutations [16192705, 18369452, 17911163]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [16915240, 21617258, 29159670].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16915240", "evidence_support": "One simple, widely accepted mechanism for generating an aberrant chromosome number, or aneuploidy, is through nondisjunction--a chromosome distribution error that occurs during mitosis when both copies of a duplicated chromosome are deposited into one daughter cell and none into the other.", "evidence_relation": "supporting" }, { "cited_pmid": "21617258", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "29159670", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This can occur during meiosis, the process by which gametes (sperm or egg cells) are formed, or during mitosis, the process by which somatic cells divide [18413063, 18693127, 25605710].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "18413063", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18693127", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "25605710", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause various health problems, including birth defects and cancer [16192705, 21289044, 18558649].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21289044", "evidence_support": "Aneuploidy refers to karyotypic abnormalities characterized by gain or loss of individual chromosomes. ", "evidence_relation": "supporting" }, { "cited_pmid": "18558649", "evidence_support": "change in chromosome number that is not the exact multiple of the haploid karyotype is known as aneuploidy.", "evidence_relation": "supporting" }, { "cited_pmid": "16192705", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The causes of nondisjunction are not fully understood, but research suggests that it can be influenced by various factors, including advanced maternal age, altered recombination patterns, and genetic mutations [16192705, 18369452, 17911163].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16192705", "evidence_support": "For errors occurring in oocytes, the primary risk factors are maternal age and altered recombination.", "evidence_relation": "supporting" }, { "cited_pmid": "16192705", "evidence_support": "the potential influence of paternal age, recombination and other environmental and genetic factors on susceptibility.", "evidence_relation": "contradicting" }, { "cited_pmid": "18369452", "evidence_support": "Nondisjunction of chromosome 21 is the leading cause of Down syndrome. Two risk factors for maternal nondisjunction of chromosome 21 are increased maternal age and altered recombination.", "evidence_relation": "supporting" }, { "cited_pmid": "17911163", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in a gain or loss of a single chromosome in the daughter cells, leading to near-diploid aneuploidy [16915240]. Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause various health problems, including birth defects and cancer [28208750]. Nondisjunction is a type of chromosome error where a pair of chromosomes fails to separate properly during cell division, resulting in an abnormal number of chromosomes [18369452, 16192705]. The leading cause of Down syndrome (DS) is nondisjunction of chromosome 21 occurring during the formation of gametes [18369452, 16192705]. The primary risk factors for nondisjunction, particularly in oocytes, are maternal age and altered recombination [18369452, 16192705]. Other potential risk factors include genetic mutations and altered recombination patterns [18369452, 16192705]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in a gain or loss of a single chromosome in the daughter cells, leading to near-diploid aneuploidy [16915240].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16915240", "evidence_support": "One simple, widely accepted mechanism for generating an aberrant chromosome number, or aneuploidy, is through nondisjunction--a chromosome distribution error that occurs during mitosis when both copies of a duplicated chromosome are deposited into one daughter cell and none into the other.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause various health problems, including birth defects and cancer [28208750].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28208750", "evidence_support": "Most often, these novel chromosome distributions are detrimental to the health and survival of the organism.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Nondisjunction is a type of chromosome error where a pair of chromosomes fails to separate properly during cell division, resulting in an abnormal number of chromosomes [18369452, 16192705].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16192705", "evidence_support": "Although the studies of paternal nondisjunction are limited due to the relatively small proportion of errors of this type, we review the potential influence of paternal age, recombination and other environmental and genetic factors on susceptibility.", "evidence_relation": "neutral" }, { "cited_pmid": "18369452", "evidence_support": "a pericentromeric exchange protects the bivalent against age-related risk factors allowing proper segregation of homologues at meiosis I, but not segregation of sisters at meiosis II.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The leading cause of Down syndrome (DS) is nondisjunction of chromosome 21 occurring during the formation of gametes [18369452, 16192705].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18369452", "evidence_support": "Nondisjunction of chromosome 21 is the leading cause of Down syndrome. Two risk factors for maternal nondisjunction of chromosome 21 are increased maternal age and altered recombination.", "evidence_relation": "supporting" }, { "cited_pmid": "16192705", "evidence_support": "The leading cause of Down syndrome (DS) is nondisjunction of chromosome 21 occurring during the formation of gametes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The primary risk factors for nondisjunction, particularly in oocytes, are maternal age and altered recombination [18369452, 16192705].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18369452", "evidence_support": "Two risk factors for maternal nondisjunction of chromosome 21 are increased maternal age and altered recombination.", "evidence_relation": "supporting" }, { "cited_pmid": "16192705", "evidence_support": "For errors occurring in oocytes, the primary risk factors are maternal age and altered recombination.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Other potential risk factors include genetic mutations and altered recombination patterns [18369452, 16192705].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18369452", "evidence_support": "Two risk factors for maternal nondisjunction of chromosome 21 are increased maternal age and altered recombination.", "evidence_relation": "supporting" }, { "cited_pmid": "16192705", "evidence_support": "For errors occurring in oocytes, the primary risk factors are maternal age and altered recombination.", "evidence_relation": "supporting" }, { "cited_pmid": "16192705", "evidence_support": "recombination and other environmental and genetic factors on susceptibility.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [16915240, 29159670]. This can occur during meiosis, the process by which gametes (sperm or egg cells) are formed, or during mitosis, the process by which somatic cells divide [28208750, 19549496, 15573136]. Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause various health problems, including birth defects and cancer [31830031, 18558649, 21289044]. The causes of nondisjunction are not fully understood, but research suggests that it can be influenced by various factors, including advanced maternal age, altered recombination patterns, and genetic mutations [18369452, 16192705, 17911163]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [16915240, 29159670].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16915240", "evidence_support": "One simple, widely accepted mechanism for generating an aberrant chromosome number, or aneuploidy, is through nondisjunction--a chromosome distribution error that occurs during mitosis when both copies of a duplicated chromosome are deposited into one daughter cell and none into the other.", "evidence_relation": "supporting" }, { "cited_pmid": "29159670", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This can occur during meiosis, the process by which gametes (sperm or egg cells) are formed, or during mitosis, the process by which somatic cells divide [28208750, 19549496, 15573136].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28208750", "evidence_support": "Polyploid cells may then undergo abnormal division to generate aneuploid cells. Chromosome segregation errors may also involve fragments of whole chromosomes. A major consequence of segregation defects is change in the relative dosage of products from genes located on the missegregated chromosomes. ", "evidence_relation": "neutral" }, { "cited_pmid": "28208750", "evidence_support": "Lastly, chromosome segregation errors during gamete formation in meiosis are a primary cause of human birth defects and infertility", "evidence_relation": "neutral" }, { "cited_pmid": "15573136", "evidence_support": "Meiosis is the type of cell division that gives rise to eggs and sperm. Errors in the execution of this process can result in the generation of aneuploid gametes, which are associated with birth defects and infertility in humans", "evidence_relation": "supporting" }, { "cited_pmid": "19549496", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause various health problems, including birth defects and cancer [31830031, 18558649, 21289044].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31830031", "evidence_support": "Human nondisjunction errors in oocytes are the leading cause of pregnancy loss, and for pregnancies that continue to term, the leading cause of intellectual disabilities and birth defects", "evidence_relation": "supporting" }, { "cited_pmid": "18558649", "evidence_support": "A change in chromosome number that is not the exact multiple of the haploid karyotype is known as aneuploidy.", "evidence_relation": "supporting" }, { "cited_pmid": "21289044", "evidence_support": "Aneuploidy refers to karyotypic abnormalities characterized by gain or loss of individual chromosomes. This condition is associated with disease and death in all organisms in which it has been studied.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The causes of nondisjunction are not fully understood, but research suggests that it can be influenced by various factors, including advanced maternal age, altered recombination patterns, and genetic mutations [18369452, 16192705, 17911163].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18369452", "evidence_support": "Two risk factors for maternal nondisjunction of chromosome 21 are increased maternal age and altered recombination.", "evidence_relation": "supporting" }, { "cited_pmid": "18369452", "evidence_support": "Our results emphasize the fact that human nondisjunction is a multifactorial trait that must be dissected into its component parts to identify specific associated risk factors.", "evidence_relation": "supporting" }, { "cited_pmid": "16192705", "evidence_support": "For errors occurring in oocytes, the primary risk factors are maternal age and altered recombination. ", "evidence_relation": "supporting" }, { "cited_pmid": "16192705", "evidence_support": "Although the studies of paternal nondisjunction are limited due to the relatively small proportion of errors of this type, we review the potential influence of paternal age, recombination and other environmental and genetic factors on susceptibility.", "evidence_relation": "supporting" }, { "cited_pmid": "17911163", "evidence_support": "We know that most aneuploidy derives from errors in maternal meiosis I, that maternal age is a risk factor for most, if not all, human trisomies, and that alterations in recombination are an important contributor to meiotic non-disjunction.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [16915240, 29159670]. This can occur during meiosis, the process by which gametes (sperm or egg cells) are formed, or during mitosis, the process by which somatic cells divide [23644379, 17168547, 15525526]. Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause various health problems, including birth defects and cancer [21289044, 17911163, 19549887]. The causes of nondisjunction are not fully understood, but research suggests that it can be influenced by various factors, including advanced maternal age, altered recombination patterns, and genetic mutations [16192705, 17911163]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a type of error that occurs during cell division, where a pair of chromosomes fails to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [16915240, 29159670].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16915240", "evidence_support": "One simple, widely accepted mechanism for generating an aberrant chromosome number, or aneuploidy, is through nondisjunction--a chromosome distribution error that occurs during mitosis when both copies of a duplicated chromosome are deposited into one daughter cell and none into the other.", "evidence_relation": "supporting" }, { "cited_pmid": "29159670", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This can occur during meiosis, the process by which gametes (sperm or egg cells) are formed, or during mitosis, the process by which somatic cells divide [23644379, 17168547, 15525526].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23644379", "evidence_support": "Mitosis is the process of one cell dividing into two daughters, such that each inherits a single and complete copy of the genome of their mother. This is achieved through the equal segregation of the sister chromatids between the daughter cells", "evidence_relation": "neutral" }, { "cited_pmid": "17168547", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15525526", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Nondisjunction can lead to aneuploidy, a condition where a cell has an abnormal number of chromosomes, which can cause various health problems, including birth defects and cancer [21289044, 17911163, 19549887].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21289044", "evidence_support": "Aneuploidy refers to karyotypic abnormalities characterized by gain or loss of individual chromosomes. This condition is associated with disease and death in all organisms in which it has been studied.", "evidence_relation": "supporting" }, { "cited_pmid": "17911163", "evidence_support": "Aneuploidy is the most common chromosome abnormality in humans, and is the leading genetic cause of miscarriage and congenital birth defects.", "evidence_relation": "supporting" }, { "cited_pmid": "19549887", "evidence_support": "Aneuploidy is a characteristic of cancer, with greater than 90% of all solid tumors in humans carrying an aberrant karyotype. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The causes of nondisjunction are not fully understood, but research suggests that it can be influenced by various factors, including advanced maternal age, altered recombination patterns, and genetic mutations [16192705, 17911163].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16192705", "evidence_support": "For errors occurring in oocytes, the primary risk factors are maternal age and altered recombination.", "evidence_relation": "supporting" }, { "cited_pmid": "17911163", "evidence_support": "We know that most aneuploidy derives from errors in maternal meiosis I, that maternal age is a risk factor for most, if not all, human trisomies, and that alterations in recombination are an important contributor to meiotic non-disjunction.", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Nondisjunction is the failure of chromosomes to segregate properly during cell division, leading to aneuploidy, where cells have an abnormal number of chromosomes.This can occur during meiosis or mitosis and is a primary cause of conditions such as Down syndrome [18369452, 16192705]. Key factors contributing to nondisjunction include advanced maternal age, which affects chromosomal cohesion and recombination patterns [18369452, 19008956, 19533770]. Altered recombination, particularly near centromeres or telomeres, increases the risk of nondisjunction by disrupting proper chromosomal segregation [16192701, 22160426]. Additionally, genetic mutations in cohesion proteins and folate regulator genes can impair chromosomal stability and segregation [19008956, 36447056]. Environmental factors and high transcription rates of certain genes also contribute to nondisjunction by interfering with chromosomal dynamics and segregation mechanisms [16769819, 15576240]. Understanding these multifactorial causes is crucial for elucidating the mechanisms underlying chromosomal nondisjunction and its associated disorders.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is the failure of chromosomes to segregate properly during cell division, leading to aneuploidy, where cells have an abnormal number of chromosomes.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This can occur during meiosis or mitosis and is a primary cause of conditions such as Down syndrome [18369452, 16192705].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "16192705", "evidence_support": "The leading cause of Down syndrome (DS) is nondisjunction of chromosome 21 occurring during the formation of gametes", "evidence_relation": "supporting" }, { "cited_pmid": "18369452", "evidence_support": "Nondisjunction of chromosome 21 is the leading cause of Down syndrome.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Key factors contributing to nondisjunction include advanced maternal age, which affects chromosomal cohesion and recombination patterns [18369452, 19008956, 19533770].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18369452", "evidence_support": "Two risk factors for maternal nondisjunction of chromosome 21 are increased maternal age and altered recombination.", "evidence_relation": "supporting" }, { "cited_pmid": "19008956", "evidence_support": "One attractive hypothesis to explain age-dependent nondisjunction (NDJ) is that loss of cohesion over time causes recombinant homologues to dissociate prematurely and segregate randomly during the first meiotic division.", "evidence_relation": "supporting" }, { "cited_pmid": "19533770", "evidence_support": "Down syndrome caused by meiotic nondisjunction of chromosome 21 in humans, is well known to be associated with advanced maternal age, but success in identifying and understanding other risk factors has been limited.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Altered recombination, particularly near centromeres or telomeres, increases the risk of nondisjunction by disrupting proper chromosomal segregation [16192701, 22160426].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16192701", "evidence_support": "Within the last decade, aberrant meiotic recombination has been confirmed as a molecular risk factor for chromosome nondisjunction in humans.", "evidence_relation": "supporting" }, { "cited_pmid": "16192701", "evidence_support": "In model organisms, mutations that disturb the recombination pathway increase the frequency of chromosome malsegregation and alterations in both the amount and placement of meiotic recombination are associated with nondisjunction.", "evidence_relation": "supporting" }, { "cited_pmid": "16192701", "evidence_support": "It appears that recombination too near the centromere or too far from the centromere imparts an increased risk for nondisjunction.", "evidence_relation": "supporting" }, { "cited_pmid": "22160426", "evidence_support": "We have previously examined characteristics of maternal chromosomes 21 that exhibited a single recombination on 21q and proposed that certain recombination configurations are risk factors for either meiosis I (MI) or meiosis II (MII) nondisjunction", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, genetic mutations in cohesion proteins and folate regulator genes can impair chromosomal stability and segregation [19008956, 36447056].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36447056", "evidence_support": "The aim of the present work was to explore the intriguing association of maternal folate regulator gene polymorphisms and mutations with the incidence of chromosome 21 nondisjunction and Down syndrome birth", "evidence_relation": "supporting" }, { "cited_pmid": "19008956", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Environmental factors and high transcription rates of certain genes also contribute to nondisjunction by interfering with chromosomal dynamics and segregation mechanisms [16769819, 15576240].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16769819", "evidence_support": "These findings demonstrate that highly transcribed loci can cause chromosome nondisjunction.", "evidence_relation": "supporting" }, { "cited_pmid": "15576240", "evidence_support": "Two methods were used to explore etoposide effects on chromosome segregation: a genetic experiment capable of detecting sex-chromosome nondisjunction in living progeny; and the use of FISH (fluorescence in situ hybridization) technology to score numbers of Chromosomes X, Y, and 8 in spermatozoa.", "evidence_relation": "neutral" }, { "cited_pmid": "15576240", "evidence_support": "Taken together these two approaches indicated that etoposide exposure of pachytene spermatocytes induces malsegregation, and that the findings of the genetic experiment probably yielded a marked underestimate of nondisjunction.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Understanding these multifactorial causes is crucial for elucidating the mechanisms underlying chromosomal nondisjunction and its associated disorders.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Nondisjunction is a chromosomal anomaly that occurs when homologous chromosomes or sister chromatids fail to separate properly during meiosis or mitosis, leading to an abnormal distribution of chromosomes in the daughter cells.This can result in aneuploidy, where cells have an abnormal number of chromosomes, such as trisomy 21, which causes Down syndrome.The causes of nondisjunction are multifactorial and can include advanced maternal age, errors in the meiotic spindle apparatus, and defects in the cohesion of sister chromatids.Additionally, environmental factors and genetic predispositions may contribute to the likelihood of nondisjunction events.Understanding the precise mechanisms remains an area of active research, with implications for genetic counseling and reproductive health.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a chromosomal anomaly that occurs when homologous chromosomes or sister chromatids fail to separate properly during meiosis or mitosis, leading to an abnormal distribution of chromosomes in the daughter cells.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This can result in aneuploidy, where cells have an abnormal number of chromosomes, such as trisomy 21, which causes Down syndrome.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "The causes of nondisjunction are multifactorial and can include advanced maternal age, errors in the meiotic spindle apparatus, and defects in the cohesion of sister chromatids.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, environmental factors and genetic predispositions may contribute to the likelihood of nondisjunction events.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Understanding the precise mechanisms remains an area of active research, with implications for genetic counseling and reproductive health.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Nondisjunction is a type of chromosome error that occurs during cell division, where a pair of homologous chromosomes or sister chromatids fail to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [17314397, 18369452, 16769819]. This can occur during meiosis, leading to aneuploidy in gametes, or during mitosis, resulting in somatic mosaicism [16192701, 19008956]. The causes of nondisjunction are multifactorial and include errors in meiotic recombination, centromere function, and spindle formation [36447056, 16192705, 31830031]. Additionally, advanced maternal age, altered recombination patterns, and environmental exposures have been identified as risk factors for nondisjunction [19533770, 29702247, 24014426]. In some cases, nondisjunction can be caused by genetic mutations or epigenetic alterations that affect chromosome segregation [22160426, 16222248]. Understanding the mechanisms and risk factors underlying nondisjunction is crucial for the prevention and diagnosis of aneuploidy-related disorders, such as Down syndrome.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a type of chromosome error that occurs during cell division, where a pair of homologous chromosomes or sister chromatids fail to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [17314397, 18369452, 16769819].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16769819", "evidence_support": "Transcription of ribosomal genes can cause nondisjunction.", "evidence_relation": "neutral" }, { "cited_pmid": "18369452", "evidence_support": "a pericentromeric exchange protects the bivalent against age-related risk factors allowing proper segregation of homologues at meiosis I, but not segregation of sisters at meiosis II.", "evidence_relation": "neutral" }, { "cited_pmid": "17314397", "evidence_support": "Cold arrest induced a fraction of meiosis II crane fly spermatocytes to form (n + 1) and (n - 1) daughters during recovery.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This can occur during meiosis, leading to aneuploidy in gametes, or during mitosis, resulting in somatic mosaicism [16192701, 19008956].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19008956", "evidence_support": "Our data provide the first demonstration in any organism that, when meiotic cohesion begins intact, the aging process can weaken it sufficiently and cause missegregation of recombinant chromosomes.", "evidence_relation": "neutral" }, { "cited_pmid": "16192701", "evidence_support": "In model organisms, mutations that disturb the recombination pathway increase the frequency of chromosome malsegregation and alterations in both the amount and placement of meiotic recombination are associated with nondisjunction.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The causes of nondisjunction are multifactorial and include errors in meiotic recombination, centromere function, and spindle formation [36447056, 16192705, 31830031].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36447056", "evidence_support": "These findings from the largest population sample tested ever revealed that mutations/polymorphisms of the genes DNMT3B and RFC1 impair recombination that leads to chromosome 21 nondisjunction in the oocyte at meiosis II stage and bring us a significant step closer towards understanding the aetiology of chromosome 21 nondisjunction and birth of a child with Down syndrome to women at any age.", "evidence_relation": "neutral" }, { "cited_pmid": "16192705", "evidence_support": "Although the studies of paternal nondisjunction are limited due to the relatively small proportion of errors of this type, we review the potential influence of paternal age, recombination and other environmental and genetic factors on susceptibility.", "evidence_relation": "neutral" }, { "cited_pmid": "31830031", "evidence_support": "Several candidate genes showed strong associations with maternal nondisjunction of chromosome 21, demonstrating that genetic variants associated with normal variation in meiotic processes can be risk factors for nondisjunction.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, advanced maternal age, altered recombination patterns, and environmental exposures have been identified as risk factors for nondisjunction [19533770, 29702247, 24014426].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19533770", "evidence_support": "Down syndrome caused by meiotic nondisjunction of chromosome 21 in humans, is well known to be associated with advanced maternal age, but success in identifying and understanding other risk factors has been limited.", "evidence_relation": "supporting" }, { "cited_pmid": "24014426", "evidence_support": "These results suggest that regulation at the maternal level predisposes MI error oocytes to reduced levels of recombination, but additional oocyte-specific dysregulation contributes to the nondisjunction event.", "evidence_relation": "supporting" }, { "cited_pmid": "29702247", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In some cases, nondisjunction can be caused by genetic mutations or epigenetic alterations that affect chromosome segregation [22160426, 16222248].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22160426", "evidence_support": "Our analyses included 785 maternal MI errors, 87 of which exhibited two recombinations on 21q, and 283 maternal MII errors, 81 of which exhibited two recombinations on 21q. Among MI cases, the average location of the distal recombination was proximal to that of normally segregating chromosomes 21 (35.28 vs. 38.86 Mb), a different pattern than that seen for single events and one that suggests an association with genomic features. For MII errors, the most proximal recombination was closer to the centromere than that on normally segregating chromosomes 21 and this proximity was associated with increasing maternal age", "evidence_relation": "supporting" }, { "cited_pmid": "16222248", "evidence_support": "Although mutations in cell cycle regulators or spindle proteins can perturb chromosome segregation,", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Understanding the mechanisms and risk factors underlying nondisjunction is crucial for the prevention and diagnosis of aneuploidy-related disorders, such as Down syndrome.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gemini-flash": { "answer": "Nondisjunction is a chromosomal error that occurs during cell division, specifically mitosis or meiosis, where chromosomes fail to separate properly, resulting in daughter cells with an abnormal number of chromosomes [16915240]. This error is a major cause of aneuploidy, which is a change in the normal number of chromosomes in a cell [26178843]. Aneuploidy is a leading cause of pregnancy loss and cognitive impairment in humans [30390610, 12646133]. The most common cause of nondisjunction is maternal age, with advanced maternal age being a significant risk factor [15329821, 12646133]. This age-related risk is particularly associated with errors during meiosis I, the first stage of egg cell formation [2316522, 6452581]. While maternal age is a major factor, other risk factors, both age-dependent and age-independent, may also contribute to nondisjunction [16192701].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a chromosomal error that occurs during cell division, specifically mitosis or meiosis, where chromosomes fail to separate properly, resulting in daughter cells with an abnormal number of chromosomes [16915240].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16915240", "evidence_support": "One simple, widely accepted mechanism for generating an aberrant chromosome number, or aneuploidy, is through nondisjunction--a chromosome distribution error that occurs during mitosis when both copies of a duplicated chromosome are deposited into one daughter cell and none into the other. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This error is a major cause of aneuploidy, which is a change in the normal number of chromosomes in a cell [26178843].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26178843", "evidence_support": "Chromosome aneuploidy refers to changes in the chromosome complement of a genome and can include gain or loss of genetic material.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Aneuploidy is a leading cause of pregnancy loss and cognitive impairment in humans [30390610, 12646133].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "30390610", "evidence_support": "The leading cause of pregnancy loss and cognitive impairment in humans is chromosome aneuploidy.", "evidence_relation": "supporting" }, { "cited_pmid": "12646133", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The most common cause of nondisjunction is maternal age, with advanced maternal age being a significant risk factor [15329821, 12646133].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15329821", "evidence_support": "A positive relationship was found between maternal age and these two types of nondisjunction, but the most significant correlation was observed with chromatid separation resulting in the presence of free chromatid in metaphase II oocyte.", "evidence_relation": "supporting" }, { "cited_pmid": "12646133", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "This age-related risk is particularly associated with errors during meiosis I, the first stage of egg cell formation [2316522, 6452581].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "2316522", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "6452581", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "While maternal age is a major factor, other risk factors, both age-dependent and age-independent, may also contribute to nondisjunction [16192701].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16192701", "evidence_support": "Within the last decade, aberrant meiotic recombination has been confirmed as a molecular risk factor for chromosome nondisjunction in humans. Recombination tethers homologous chromosomes, linking and guiding them through proper segregation at meiosis I. In model organisms, mutations that disturb the recombination pathway increase the frequency of chromosome malsegregation and alterations in both the amount and placement of meiotic recombination are associated with nondisjunction. This association has been established for humans as well. Significant alterations in recombination have been found for all meiosis I-derived trisomies studied to date and a subset of so called \"meiosis II\" trisomy. Often exchange levels are reduced in a subset of cases where the nondisjoining chromosome fails to undergo recombination. For other trisomies, the placement of meiotic recombination has been altered. It appears that recombination too near the centromere or too far from the centromere imparts an increased risk for nondisjunction. Recent evidence from trisomy 21 also suggests an association may exist between recombination and maternal age, the most widely identified risk factor for aneuploidy. Among cases of maternal meiosis I-derived trisomy 21, increasing maternal age is associated with a decreasing frequency of recombination in the susceptible pericentromeric and telomeric regions. It is likely that multiple risk factors lead to nondisjunction, some age dependent and others age independent, some that act globally and others that are chromosome specific. Future studies are expected to shed new light on the timing and placement of recombination, providing additional clues to the link between altered recombination and chromosome ", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Nondisjunction is an error during cell division (mitosis or meiosis) where chromosomes fail to separate properly, resulting in daughter cells with an abnormal number of chromosomes [16915240]. This is a common cause of aneuploidy, which is an abnormal number of chromosomes in a cell [16915240]. A major cause of nondisjunction is advanced maternal age, particularly during oogenesis [26407969, 15329821]. This age-related risk is more pronounced in oogenesis than spermatogenesis [6452581]. Research suggests that the loss of cohesion, a mechanism that keeps chromosomes together during meiosis, weakens with age, leading to missegregation of chromosomes [19008956]. This loss of cohesion is particularly vulnerable during the diplotene stage, where human oocytes remain arrested for several years [19008956].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is an error during cell division (mitosis or meiosis) where chromosomes fail to separate properly, resulting in daughter cells with an abnormal number of chromosomes [16915240].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16915240", "evidence_support": "One simple, widely accepted mechanism for generating an aberrant chromosome number, or aneuploidy, is through nondisjunction--a chromosome distribution error that occurs during mitosis when both copies of a duplicated chromosome are deposited into one daughter cell and none into the other.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This is a common cause of aneuploidy, which is an abnormal number of chromosomes in a cell [16915240].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16915240", "evidence_support": "One simple, widely accepted mechanism for generating an aberrant chromosome number, or aneuploidy, is through nondisjunction--a chromosome distribution error that occurs during mitosis when both copies of a duplicated chromosome are deposited into one daughter cell and none into the other. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "A major cause of nondisjunction is advanced maternal age, particularly during oogenesis [26407969, 15329821].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26407969", "evidence_support": "Chromosome 21 nondisjunction in oocytes is the most common cause of trisomy 21, the primary chromosomal abnormality responsible for Down syndrome (DS).", "evidence_relation": "neutral" }, { "cited_pmid": "15329821", "evidence_support": "Maternal ageing is the only etiological factor unequivocally associated with the occurrence of aneuploid conceptuses.", "evidence_relation": "supporting" }, { "cited_pmid": "15329821", "evidence_support": "A positive relationship was found between maternal age and these two types of nondisjunction, but the most significant correlation was observed with chromatid separation resulting in the presence of free chromatid in metaphase II oocyte.", "evidence_relation": "supporting" }, { "cited_pmid": "15329821", "evidence_support": "This finding provided new insights into the mechanism of nondisjunction in female meiosis since disturbance in molecular chromatid cohesion by cohesins might be a causal mechanism predisposing to nondisjunction and involved in the maternal age effect.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "This age-related risk is more pronounced in oogenesis than spermatogenesis [6452581].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "6452581", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Research suggests that the loss of cohesion, a mechanism that keeps chromosomes together during meiosis, weakens with age, leading to missegregation of chromosomes [19008956].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19008956", "evidence_support": "One attractive hypothesis to explain age-dependent nondisjunction (NDJ) is that loss of cohesion over time causes recombinant homologues to dissociate prematurely and segregate randomly during the first meiotic division", "evidence_relation": "supporting" }, { "cited_pmid": "19008956", "evidence_support": "Our finding that missegregation of recombinant homologues increases with age supports the model that chiasmata are destabilized by gradual loss of cohesion over time.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "This loss of cohesion is particularly vulnerable during the diplotene stage, where human oocytes remain arrested for several years [19008956].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "19008956", "evidence_support": "Moreover, the stage at which Drosophila oocytes are most vulnerable to age-related defects is analogous to that at which human oocytes remain arrested for decades. ", "evidence_relation": "supporting" }, { "cited_pmid": "19008956", "evidence_support": "Our findings that recombinant chromosomes are at highest risk for loss of chiasmata during diplotene argue that human oocytes are most vulnerable to age-induced loss of meiotic cohesion at the stage at which they remain arrested for several years.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Nondisjunction is a chromosomal error that occurs when chromosomes fail to separate properly during cell division, leading to an abnormal number of chromosomes in the resulting cells, a condition known as aneuploidy [17911163, 26407969]. This error is most commonly associated with maternal age, as older mothers have a higher risk of nondisjunction, particularly during meiosis I [8768496, 15329821]. In fact, maternal age is the best-known risk factor for conditions like Down syndrome, which is primarily caused by nondisjunction of chromosome 21 [26407969, 17546231]. Other factors, including alterations in recombination patterns, may also contribute to nondisjunction, indicating that multiple age-dependent and independent factors can play a role [16192701, 2316522].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a chromosomal error that occurs when chromosomes fail to separate properly during cell division, leading to an abnormal number of chromosomes in the resulting cells, a condition known as aneuploidy [17911163, 26407969].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26407969", "evidence_support": "The results of our study support the hypothesis that young mothers of DS babies are \"biologically older\" than mothers of euploid babies in the same age group and supports telomere length as a biomarker of age and hence risk for chromosome nondisjunction.", "evidence_relation": "neutral" }, { "cited_pmid": "17911163", "evidence_support": "We know that most aneuploidy derives from errors in maternal meiosis I, that maternal age is a risk factor for most, if not all, human trisomies, and that alterations in recombination are an important contributor to meiotic non-disjunction.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This error is most commonly associated with maternal age, as older mothers have a higher risk of nondisjunction, particularly during meiosis I [8768496, 15329821].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15329821", "evidence_support": "A positive relationship was found between maternal age and these two types of nondisjunction, but the most significant correlation was observed with chromatid separation resulting in the presence of free chromatid in metaphase II oocyte.", "evidence_relation": "supporting" }, { "cited_pmid": "15329821", "evidence_support": "This finding provided new insights into the mechanism of nondisjunction in female meiosis since disturbance in molecular chromatid cohesion by cohesins might be a causal mechanism predisposing to nondisjunction and involved in the maternal age effect.", "evidence_relation": "supporting" }, { "cited_pmid": "8768496", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In fact, maternal age is the best-known risk factor for conditions like Down syndrome, which is primarily caused by nondisjunction of chromosome 21 [26407969, 17546231].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26407969", "evidence_support": "This specific type of error is estimated to account for over 90 % of live births with DS, with maternal age being the best known risk factor for chromosome 21 nondisjunction.", "evidence_relation": "supporting" }, { "cited_pmid": "17546231", "evidence_support": "Advanced maternal age and susceptible recombination patterns are recognized risk factors associated to Down syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "17546231", "evidence_support": "Maternal origin of trisomy occurs in approximately 90% of cases", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Other factors, including alterations in recombination patterns, may also contribute to nondisjunction, indicating that multiple age-dependent and independent factors can play a role [16192701, 2316522].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16192701", "evidence_support": "It is likely that multiple risk factors lead to nondisjunction, some age dependent and others age independent, some that act globally and others that are chromosome specific.", "evidence_relation": "supporting" }, { "cited_pmid": "2316522", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Nondisjunction is a chromosomal error that occurs during cell division, specifically when homologous chromosomes fail to separate properly during meiosis, leading to an abnormal number of chromosomes in gametes, known as aneuploidy [16915240, 26747203]. This error is a significant contributor to birth defects and spontaneous abortions [26747203]. The most common cause of nondisjunction is advancing maternal age, which increases the likelihood of errors during oogenesis, particularly during meiosis I [8768496, 15329821]. Factors such as altered recombination and deficiencies in chromatid cohesion also play a role in this process [18369452, 15329821]. Nondisjunction of chromosome 21 is specifically linked to Down syndrome, highlighting the impact of maternal age and other risk factors on genetic outcomes [18369452, 19533770].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a chromosomal error that occurs during cell division, specifically when homologous chromosomes fail to separate properly during meiosis, leading to an abnormal number of chromosomes in gametes, known as aneuploidy [16915240, 26747203].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16915240", "evidence_support": "nondisjunction--a chromosome distribution error that occurs during mitosis when both copies of a duplicated chromosome are deposited into one daughter cell and none into the other", "evidence_relation": "supporting" }, { "cited_pmid": "26747203", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This error is a significant contributor to birth defects and spontaneous abortions [26747203].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26747203", "evidence_support": "Errors segregating homologous chromosomes during meiosis result in aneuploid gametes and are the largest contributing factor to birth defects and spontaneous abortions in humans.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The most common cause of nondisjunction is advancing maternal age, which increases the likelihood of errors during oogenesis, particularly during meiosis I [8768496, 15329821].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15329821", "evidence_support": "Maternal ageing is the only etiological factor unequivocally associated with the occurrence of aneuploid conceptuses.", "evidence_relation": "neutral" }, { "cited_pmid": "15329821", "evidence_support": "A positive relationship was found between maternal age and these two types of nondisjunction, but the most significant correlation was observed with chromatid separation resulting in the presence of free chromatid in metaphase II oocyte.", "evidence_relation": "supporting" }, { "cited_pmid": "8768496", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Factors such as altered recombination and deficiencies in chromatid cohesion also play a role in this process [18369452, 15329821].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18369452", "evidence_support": "Two risk factors for maternal nondisjunction of chromosome 21 are increased maternal age and altered recombination.", "evidence_relation": "supporting" }, { "cited_pmid": "15329821", "evidence_support": "This finding provided new insights into the mechanism of nondisjunction in female meiosis since disturbance in molecular chromatid cohesion by cohesins might be a causal mechanism predisposing to nondisjunction and involved in the maternal age effect.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Nondisjunction of chromosome 21 is specifically linked to Down syndrome, highlighting the impact of maternal age and other risk factors on genetic outcomes [18369452, 19533770].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18369452", "evidence_support": "Nondisjunction of chromosome 21 is the leading cause of Down syndrome. Two risk factors for maternal nondisjunction of chromosome 21 are increased maternal age and altered recombination.", "evidence_relation": "supporting" }, { "cited_pmid": "19533770", "evidence_support": "Down syndrome caused by meiotic nondisjunction of chromosome 21 in humans, is well known to be associated with advanced maternal age, but success in identifying and understanding other risk factors has been limited.", "evidence_relation": "supporting" } ] } ] }, "webis-1": { "answer": "Nondisjunction is a type of abnormality in which chromosomes fail to separate during cell division, resulting in an abnormal number of chromosomes in the daughter cells [16222248,18664148,22345986,28087838,15126399]. Nondisjunction can be caused by errors in the spindle checkpoint, which is a mechanism that ensures that chromosomes are properly aligned and separated during cell division [16222248,18664148,22345986,28087838,15126399]. Nondisjunction can also be caused by errors in the cytokinesis process, which is the division of the cell cytoplasm and.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a type of abnormality in which chromosomes fail to separate during cell division, resulting in an abnormal number of chromosomes in the daughter cells [16222248,18664148,22345986,28087838,15126399].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16222248", "evidence_support": "It has been assumed that nondisjunction of a chromosome during mitosis will yield two aneuploid daughter cells.", "evidence_relation": "supporting" }, { "cited_pmid": "18664148", "evidence_support": "In cases when these females additionally contained inversion in one of chromosomes X, a tendency toward the appearance of nondisjunction events was observed in individuals containing mutation in the heterozygote.", "evidence_relation": "neutral" }, { "cited_pmid": "22345986", "evidence_support": "Down syndrome (DS) is the most common chromosomal disorder.", "evidence_relation": "neutral" }, { "cited_pmid": "22345986", "evidence_support": "Nondisjunction was the most common type of abnormality, followed by translocation and lastly mosaic: 96.1, 3.1, and 0.8%, respectively.", "evidence_relation": "neutral" }, { "cited_pmid": "28087838", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "15126399", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Nondisjunction can be caused by errors in the spindle checkpoint, which is a mechanism that ensures that chromosomes are properly aligned and separated during cell division [16222248,18664148,22345986,28087838,15126399].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16222248", "evidence_support": "Although mutations in cell cycle regulators or spindle proteins can perturb chromosome segregation, the causes and consequences of spontaneous mitotic chromosome nondisjunction in human cells are not well understood.", "evidence_relation": "contradicting" }, { "cited_pmid": "22345986", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18664148", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "28087838", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "15126399", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Nondisjunction can also be caused by errors in the cytokinesis process, which is the division of the cell cytoplasm and.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-2": { "answer": "Nondisjunction is a type of error during cell division where the chromosomes fail to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [33484483]. In females, this error occurs during meiosis I (MI) division, where homologous chromosomes should separate but do not due to improper t.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a type of error during cell division where the chromosomes fail to separate properly, resulting in an abnormal number of chromosomes in the daughter cells [33484483].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33484483", "evidence_support": "Data from studies in humans and mice demonstrate that placement of recombination sites during fetal development influences the likelihood of an MI nondisjunction event that results in the production of an aneuploid egg.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In females, this error occurs during meiosis I (MI) division, where homologous chromosomes should separate but do not due to improper t.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-3": { "answer": "Nondisjunction is not mentioned in the given context. However, the question \"What is it?\" can be interpreted as asking for the name or function of an object. In the given context, it seems that children are more interested in the function of an object when they ask \"What is it?\" [15147491].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is not mentioned in the given context.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "However, the question \"What is it?\" can be interpreted as asking for the name or function of an object.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "In the given context, it seems that children are more interested in the function of an object when they ask \"What is it?\"", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-5": { "answer": "Nondisjunction is not mentioned in the given context. However, the question \"What is it?\" can be interpreted as asking for the name or function of an object. In the given context, it seems that children are more interested in the function of an object when they ask \"What is it?\". . [15147491].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is not mentioned in the given context.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "However, the question \"What is it?\" can be interpreted as asking for the name or function of an object.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "In the given context, it seems that children are more interested in the function of an object when they ask \"What is it?\". .", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-gpt-1": { "answer": "Nondisjunction is the failure of homologous chromosomes or sister chromatids to separate properly during cell division, leading to an abnormal number of chromosomes in the daughter cells. It can occur during meiosis or mitosis and is often caused by errors in the spindle assembly checkpoint, which fails to ensure that all chromosomes are correctly attached to the spindle apparatus before separation. This can result in conditions such as Down syndrome, Turner syndrome, or Klinefelter syndrome, depending on which chromosomes are affected.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is the failure of homologous chromosomes or sister chromatids to separate properly during cell division, leading to an abnormal number of chromosomes in the daughter cells.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "It can occur during meiosis or mitosis and is often caused by errors in the spindle assembly checkpoint, which fails to ensure that all chromosomes are correctly attached to the spindle apparatus before separation.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "This can result in conditions such as Down syndrome, Turner syndrome, or Klinefelter syndrome, depending on which chromosomes are affected.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "Nondisjunction is the failure of homologous chromosomes or sister chromatids to separate properly during cell division, leading to the formation of cells with an abnormal number of chromosomes. It is often associated with errors in cytokinesis, where improper regulation can result in tetraploid cells, which may later become aneuploid through further divisions [16222248]. Specifically, nondisjunction is more likely to occur in cells that become binucleated due to furrow regression, rather than in those that complete cytokinesis normally [16222248].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is the failure of homologous chromosomes or sister chromatids to separate properly during cell division, leading to the formation of cells with an abnormal number of chromosomes.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "It is often associated with errors in cytokinesis, where improper regulation can result in tetraploid cells, which may later become aneuploid through further divisions [16222248].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16222248", "evidence_support": "It has been assumed that nondisjunction of a chromosome during mitosis will yield two aneuploid daughter cells. Here we show that chromosome nondisjunction is tightly coupled to regulation of cytokinesis in human cell lines, such that nondisjunction results in the formation of tetraploid rather than aneuploid cells.", "evidence_relation": "supporting" }, { "cited_pmid": "16222248", "evidence_support": "Our findings indicate that nondisjunction does not directly yield aneuploid cells, but rather tetraploid cells that may subsequently become aneuploid through further division.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Specifically, nondisjunction is more likely to occur in cells that become binucleated due to furrow regression, rather than in those that complete cytokinesis normally [16222248].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16222248", "evidence_support": "Nondisjunction occurred with high frequency in cells that became binucleated by furrow regression, but not in cells that completed cytokinesis to form two mononucleated cells.", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-6": { "answer": "Nondisjunction is the failure of homologous chromosomes or sister chromatids to separate properly during cell division, leading to an abnormal number of chromosomes in the resulting cells. It can occur during meiosis or mitosis and is often caused by errors in the spindle assembly checkpoint or other regulatory mechanisms during cell division. While the context provided does not directly address the causes of nondisjunction, it is a well-established phenomenon in genetics.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is the failure of homologous chromosomes or sister chromatids to separate properly during cell division, leading to an abnormal number of chromosomes in the resulting cells.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "It can occur during meiosis or mitosis and is often caused by errors in the spindle assembly checkpoint or other regulatory mechanisms during cell division.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "While the context provided does not directly address the causes of nondisjunction, it is a well-established phenomenon in genetics.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "zero-shot-gemini-flash": { "answer": "Nondisjunction is the failure of chromosomes to separate properly during cell division, resulting in daughter cells with an abnormal number of chromosomes [16915240, 30260330]. This can occur during meiosis, the process of cell division that produces gametes (sperm and egg cells), or during mitosis, the process of cell division that produces all other cells in the body [16915240]. Nondisjunction during meiosis can lead to aneuploidy, a condition in which an individual has an abnormal number of chromosomes [30260330]. The causes of nondisjunction are complex and can include factors such as maternal age [1279409, 19008956], altered recombination [1981474, 18369452], and defects in the spindle apparatus [23222652, 3219919]. [PMID16915240, PMID30260330, PMID1279409, PMID19008956, PMID1981474, PMID18369452, PMID23222652, PMID3219919] \n", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is the failure of chromosomes to separate properly during cell division, resulting in daughter cells with an abnormal number of chromosomes [16915240, 30260330].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "16915240", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "30260330", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This can occur during meiosis, the process of cell division that produces gametes (sperm and egg cells), or during mitosis, the process of cell division that produces all other cells in the body [16915240].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "16915240", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Nondisjunction during meiosis can lead to aneuploidy, a condition in which an individual has an abnormal number of chromosomes [30260330].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "30260330", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The causes of nondisjunction are complex and can include factors such as maternal age [1279409, 19008956], altered recombination [1981474, 18369452], and defects in the spindle apparatus [23222652, 3219919].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "23222652", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "3219919", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "1981474", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "18369452", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "1279409", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "19008956", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "[PMID16915240, PMID30260330, PMID1279409, PMID19008956, PMID1981474, PMID18369452, PMID23222652, PMID3219919]", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "zero-shot-gpt4o-mini": { "answer": "Nondisjunction is a chromosomal error that occurs when chromosomes fail to separate properly during cell division, leading to an abnormal number of chromosomes in daughter cells, a condition known as aneuploidy [16915240, 26407969]. This phenomenon is most commonly associated with conditions like Down syndrome, which is primarily caused by nondisjunction of chromosome 21 during oogenesis [12486916, 26017139]. \n\nThe causes of nondisjunction include advanced maternal age, which significantly increases the risk, particularly during the first meiotic division [2316522, 12522562]. Other factors may include genetic predispositions and environmental influences, although the exact mechanisms remain poorly understood [9801867, 17236610]. Errors can occur in both maternal and paternal meiosis, but maternal errors are more prevalent [155033, 17236610].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nondisjunction is a chromosomal error that occurs when chromosomes fail to separate properly during cell division, leading to an abnormal number of chromosomes in daughter cells, a condition known as aneuploidy [16915240, 26407969].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26407969", "evidence_support": "Chromosome 21 nondisjunction in oocytes is the most common cause of trisomy 21, the primary chromosomal abnormality responsible for Down syndrome (DS).", "evidence_relation": "neutral" }, { "cited_pmid": "16915240", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This phenomenon is most commonly associated with conditions like Down syndrome, which is primarily caused by nondisjunction of chromosome 21 during oogenesis [12486916, 26017139].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "26017139", "evidence_support": "Down syndrome (DS, also known as trisomy 21) most often results from chromosomal nondisjunction during oogenesis.", "evidence_relation": "supporting" }, { "cited_pmid": "12486916", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The causes of nondisjunction include advanced maternal age, which significantly increases the risk, particularly during the first meiotic division [2316522, 12522562].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "2316522", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "12522562", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Other factors may include genetic predispositions and environmental influences, although the exact mechanisms remain poorly understood [9801867, 17236610].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "17236610", "evidence_support": "The National Down Syndrome Project (NDSP), based at Emory University in Atlanta, Georgia, represents a multi-site, population-based, case-control study with two major aims: (1) to identify molecular and epidemiological factors contributing to chromosome nondisjunction and the consequent packaging of an extra chromosome into an egg or sperm, and (2) to identify risk factors for Down syndrome-associated birth defects.", "evidence_relation": "neutral" }, { "cited_pmid": "9801867", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Errors can occur in both maternal and paternal meiosis, but maternal errors are more prevalent [155033, 17236610].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17236610", "evidence_support": "Nondisjunction during oogenesis accounted for 93.2% of the cases. Errors in spermatogenesis were found in 4.1%, and 2.7% were post-zygotic errors.", "evidence_relation": "supporting" }, { "cited_pmid": "155033", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] } } }, { "question_id": "127", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Gene therapy can have various effects on the body depending on the specific genetic condition being targeted and the method used. For instance, in Neurofibromatosis type 1 (NF1), gene therapy involving nonsense suppression and NMD inhibition shows potential in restoring neurofibromin protein expression, which may help reduce tumor formation in patients [37520682]. Additionally, gene therapy can impact the immune system, as seen in treatments aimed at enhancing the body\u2019s response to infections or reducing inflammation, such as in transplant arteriosclerosis, where mobilization of bone marrow-derived vascular progenitor cells prevented coronary intimal proliferation [16701171]. These examples illustrate the diverse and significant effects gene therapy may have on an organism.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy can have various effects on the body depending on the specific genetic condition being targeted and the method used.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "For instance, in Neurofibromatosis type 1 (NF1), gene therapy involving nonsense suppression and NMD inhibition shows potential in restoring neurofibromin protein expression, which may help reduce tumor formation in patients [37520682].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37520682", "evidence_support": "Nonsense suppression in combination with NMD inhibition restored neurofibromin protein expression in primary NF1-/- Schwann cells isolated from minipig neurofibromas.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, gene therapy can impact the immune system, as seen in treatments aimed at enhancing the body\u2019s response to infections or reducing inflammation, such as in transplant arteriosclerosis, where mobilization of bone marrow-derived vascular progenitor cells prevented coronary intimal proliferation [16701171].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16701171", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "These examples illustrate the diverse and significant effects gene therapy may have on an organism.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Gene therapy has significant effects on an organism, offering treatment for a variety of conditions [15553101, 31845133, 15827576]. It can treat cancer, including glioblastoma multiforme, by inducing cell suicide in cancer cells and selectively targeting tumor cells [15827576, 29297925, 33165431]. It also addresses cardiovascular diseases, arthritis, and rare genetic disorders [15553101, 20027718, 17900991]. In the realm of genetic diseases, gene therapy can restore dystrophin expression in Duchenne muscular dystrophy and treat hemophilia [31845133, 29297925, 37210312]. It is effective in treating retinal disorders such as age-related macular degeneration and diabetic retinopathy [15553101, 26279067, 26502313]. Gene therapy can improve gene delivery efficiency and enhance transgene expression, which is crucial for therapeutic effectiveness [15553101, 25227756, 36986717]. It can inhibit cellular proliferation and migration, contributing to its anti-cancer properties [15827576, 21450400, 18294288]. Additionally, gene therapy can induce immune tolerance and has anti-thrombotic effects, which are beneficial in various medical conditions [15553101, 16136161, 26909355]. It also improves the survival of transplanted stem cells, enhancing the outcomes of regenerative therapies [15553101, 36986717, 32926348].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy has significant effects on an organism, offering treatment for a variety of conditions [15553101, 31845133, 15827576].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15553101", "evidence_support": "It is a promising new biomedical discipline that could potentially lead to new treatments for hereditary diseases, cardiovascular and neurologic disorders, cancer, diabetes and even infectious diseases.", "evidence_relation": "supporting" }, { "cited_pmid": "31845133", "evidence_support": "Gene therapy as a novel study in molecular medicine will have a significant impact on human health in the near future.", "evidence_relation": "supporting" }, { "cited_pmid": "15827576", "evidence_support": "Gene therapy has developed as a method of approach to the treatment of human diseases based on the transfer of genetic material to the cells of an individual.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can treat cancer, including glioblastoma multiforme, by inducing cell suicide in cancer cells and selectively targeting tumor cells [15827576, 29297925, 33165431].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15827576", "evidence_support": "Thus, the different gene therapy strategies are based on the combination of three key elements: the genetic material to be transferred, the method of transfer and the cellular type that will incorporate this genetic material. Attention was initially centred on the treatment of monogenic hereditary diseases, but subsequently the majority of clinical trials (over four hundred) have concerned the treatment of cancer.", "evidence_relation": "neutral" }, { "cited_pmid": "29297925", "evidence_support": "In some cases, gene therapy consists of genetically modified cells, such as when chimeric antigen receptors are stably introduced into T lymphocytes, and used as tumor therapy, mainly for leukemias..", "evidence_relation": "neutral" }, { "cited_pmid": "33165431", "evidence_support": "Gene therapy is an experimental technique to treat genetic diseases. It is based on the introduction of nucleic acid with the help of a vector, into a diseased cell or tissue, to correct the gene expression and thus prevent, halt, or reverse a pathological process. It is a promising treatment approach for genetic diseases, inherited diseases, vaccination, cancer, immunomodulation, as well as healing of some refractory ulcers.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "It also addresses cardiovascular diseases, arthritis, and rare genetic disorders [15553101, 20027718, 17900991].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15553101", "evidence_support": "It is a promising new biomedical discipline that could potentially lead to new treatments for hereditary diseases, cardiovascular and neurologic disorders, cancer, diabetes and even infectious diseases.", "evidence_relation": "supporting" }, { "cited_pmid": "20027718", "evidence_support": "Most trials focus on acquired disorders such as cancer and cardiovascular disease;", "evidence_relation": "supporting" }, { "cited_pmid": "17900991", "evidence_support": "A wide range of diseases - including cancer, vascular and neurodegenerative disorders and inherited genetic diseases - are being considered as targets for this therapy in adults.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In the realm of genetic diseases, gene therapy can restore dystrophin expression in Duchenne muscular dystrophy and treat hemophilia [31845133, 29297925, 37210312].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31845133", "evidence_support": "Therefore, gene therapy advances are being applied to correct inherited genetic disorders such as hemophilia, cystic fibrosis, and familial hypercholesterolemia as well as acquired diseases like cancer, AIDS, Alzheimer's disease, Parkinson's disease, and infectious diseases like HIV.", "evidence_relation": "supporting" }, { "cited_pmid": "37210312", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "29297925", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is effective in treating retinal disorders such as age-related macular degeneration and diabetic retinopathy [15553101, 26279067, 26502313].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26502313", "evidence_support": "In other disease states, such as neovascular age-related macular degeneration, the delivered gene product modulates existing proteins within a cell, such as vascular endothelial growth factor, for a desired therapeutic effect. This latter approach may have broader applications in other diseases such as diabetes and other retinal vascular diseases that are as yet unrealized.", "evidence_relation": "supporting" }, { "cited_pmid": "26279067", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15553101", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Gene therapy can improve gene delivery efficiency and enhance transgene expression, which is crucial for therapeutic effectiveness [15553101, 25227756, 36986717].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15553101", "evidence_support": "Gene therapy is defined as the introduction of genetic material in a patient's cells with resulting therapeutic benefit.", "evidence_relation": "supporting" }, { "cited_pmid": "36986717", "evidence_support": "The aims of gene therapy include utilising cells to produce a suitable protein, silencing over-producing proteins, and genetically modifying and repairing cell functions that may affect disease conditions.", "evidence_relation": "supporting" }, { "cited_pmid": "25227756", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "It can inhibit cellular proliferation and migration, contributing to its anti-cancer properties [15827576, 21450400, 18294288].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15827576", "evidence_support": "Gene therapy has developed as a method of approach to the treatment of human diseases based on the transfer of genetic material to the cells of an individual. Normally, the aim of this transfer of genetic material is to re-establish a cellular function that has been abolished or is defective, to introduce a new function or to interfere with an existing function.", "evidence_relation": "neutral" }, { "cited_pmid": "18294288", "evidence_support": "Cancer gene therapy, in which pharmacologically active compounds are administered to cancer patients in a genetic form, has been examined not only in animals but also in cancer patients.", "evidence_relation": "neutral" }, { "cited_pmid": "21450400", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Additionally, gene therapy can induce immune tolerance and has anti-thrombotic effects, which are beneficial in various medical conditions [15553101, 16136161, 26909355].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15553101", "evidence_support": "Furthermore, therapeutic effects have been obtained in several phase I/II gene therapy clinical trials for hemophilia, severe combined immune deficiency (SCID) and cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "16136161", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "26909355", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "9", "answer_sentence": "It also improves the survival of transplanted stem cells, enhancing the outcomes of regenerative therapies [15553101, 36986717, 32926348].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "32926348", "evidence_support": "However, it remains to be decided whether genetic modification of mesenchymal stem cells by vectors carrying reporter or therapeutic genes leads to adverse effects on morphology, phenotypic profiles, and viability of transplanted cells. ", "evidence_relation": "neutral" }, { "cited_pmid": "36986717", "evidence_support": "The aims of gene therapy include utilising cells to produce a suitable protein, silencing over-producing proteins, and genetically modifying and repairing cell functions that may affect disease conditions.", "evidence_relation": "neutral" }, { "cited_pmid": "15553101", "evidence_support": "Preclinical studies in animal models have shown that therapeutic effects can be achieved after gene therapy for genetic, acquired and complex disorders. Furthermore, therapeutic effects have been obtained in several phase I/II gene therapy clinical trials for hemophilia, severe combined immune deficiency (SCID) and cancer.", "evidence_relation": "neutral" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Gene therapy introduces genetic material into an organism's cells to correct or modify gene expression, offering potential treatments for a variety of genetic and acquired diseases [15553101, 15827576]. It has shown therapeutic benefits in preclinical models and clinical trials for conditions such as hemophilia, severe combined immune deficiency (SCID), and certain cancers [15553101, 15827576]. However, gene therapy can also pose risks, including immune reactions, insertional mutagenesis, and oncogenicity, as seen in some SCID patients who developed leukemia [15827576, 16988659]. Advances in vector technology have improved safety and efficacy, but challenges remain, such as achieving sustained gene expression and managing immune responses [15553101, 20027718]. Despite these hurdles, gene therapy continues to evolve, with promising applications in treating hereditary diseases, cancer, and other complex disorders [15553101, 31845133, 25227756].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy introduces genetic material into an organism's cells to correct or modify gene expression, offering potential treatments for a variety of genetic and acquired diseases [15553101, 15827576].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15553101", "evidence_support": "Gene therapy is defined as the introduction of genetic material in a patient's cells with resulting therapeutic benefit. It is a promising new biomedical discipline that could potentially lead to new treatments for hereditary diseases, cardiovascular and neurologic disorders, cancer, diabetes and even infectious diseases.", "evidence_relation": "supporting" }, { "cited_pmid": "15827576", "evidence_support": "Gene therapy has developed as a method of approach to the treatment of human diseases based on the transfer of genetic material to the cells of an individual. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It has shown therapeutic benefits in preclinical models and clinical trials for conditions such as hemophilia, severe combined immune deficiency (SCID), and certain cancers [15553101, 15827576].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15553101", "evidence_support": "Preclinical studies in animal models have shown that therapeutic effects can be achieved after gene therapy for genetic, acquired and complex disorders. Furthermore, therapeutic effects have been obtained in several phase I/II gene therapy clinical trials for hemophilia, severe combined immune deficiency (SCID) and cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "15827576", "evidence_support": "Attention was initially centred on the treatment of monogenic hereditary diseases, but subsequently the majority of clinical trials (over four hundred) have concerned the treatment of cancer.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, gene therapy can also pose risks, including immune reactions, insertional mutagenesis, and oncogenicity, as seen in some SCID patients who developed leukemia [15827576, 16988659].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15827576", "evidence_support": "And, in the late 1990s, a group of children with severe combined immunodeficiency were successfully treated through the ex vivo transfer of the correct version of the altered gene to their bone marrow, although some of these children later developed lymphoproliferative syndromes due to the activation of an oncogen in the corrected cells.", "evidence_relation": "supporting" }, { "cited_pmid": "16988659", "evidence_support": "Gene therapy has been remarkably effective for the immunological reconstitution of patients with severe combined immune deficiency, but the occurrence of leukaemia in a few patients has stimulated debate about the safety of the procedure and the mechanisms of leukaemogenesis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Advances in vector technology have improved safety and efficacy, but challenges remain, such as achieving sustained gene expression and managing immune responses [15553101, 20027718].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "15553101", "evidence_support": "Gene transfer technology has improved significantly over the past few years and has led to the development of vectors which have fewer side-effects without compromising their efficacy, at least partly due the development of cell-type specific targetable vectors. ", "evidence_relation": "supporting" }, { "cited_pmid": "20027718", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Despite these hurdles, gene therapy continues to evolve, with promising applications in treating hereditary diseases, cancer, and other complex disorders [15553101, 31845133, 25227756].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15553101", "evidence_support": "Gene therapy is defined as the introduction of genetic material in a patient's cells with resulting therapeutic benefit. It is a promising new biomedical discipline that could potentially lead to new treatments for hereditary diseases, cardiovascular and neurologic disorders, cancer, diabetes and even infectious diseases.", "evidence_relation": "supporting" }, { "cited_pmid": "31845133", "evidence_support": "Therefore, gene therapy advances are being applied to correct inherited genetic disorders such as hemophilia, cystic fibrosis, and familial hypercholesterolemia as well as acquired diseases like cancer, AIDS, Alzheimer's disease, Parkinson's disease, and infectious diseases like HIV. ", "evidence_relation": "supporting" }, { "cited_pmid": "25227756", "evidence_support": "To help readers to grasp the essence and to better organize the diverse applications, we categorize them under four gene therapy strategies: (1) gene replacement therapy for monogenic diseases, (2) gene addition for complex disorders and infectious diseases, (3) gene expression alteration targeting RNA, and (4) gene editing to introduce targeted changes in host genome.", "evidence_relation": "supporting" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Gene therapy can have various effects on an organism, including therapeutic benefits, such as correcting genetic disorders, treating diseases, and preventing the development of severe manifestations of early-onset disease [15553101, 31845133, 32020561]. It can also induce tolerance against the therapeutic transgenic protein, allowing for repeated treatment after birth if necessary [17900991]. However, gene therapy can also have adverse effects, such as infusion reactions, liver damage, and adverse effects from immune suppressants or steroids [37210312]. Additionally, there is a risk of insertional mutagenesis, although this concern may be less relevant for future trials [28854824]. Furthermore, gene therapy can also have long-term effects, such as the development of liver tumors, as seen in some animal studies [16136161]. Overall, the effects of gene therapy on an organism can be significant, and careful consideration of the potential benefits and risks is necessary.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy can have various effects on an organism, including therapeutic benefits, such as correcting genetic disorders, treating diseases, and preventing the development of severe manifestations of early-onset disease [15553101, 31845133, 32020561].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15553101", "evidence_support": "Gene therapy is defined as the introduction of genetic material in a patient's cells with resulting therapeutic benefit. It is a promising new biomedical discipline that could potentially lead to new treatments for hereditary diseases, cardiovascular and neurologic disorders, cancer, diabetes and even infectious diseases.", "evidence_relation": "supporting" }, { "cited_pmid": "31845133", "evidence_support": "Therefore, gene therapy advances are being applied to correct inherited genetic disorders such as hemophilia, cystic fibrosis, and familial hypercholesterolemia as well as acquired diseases like cancer, AIDS, Alzheimer's disease, Parkinson's disease, and infectious diseases like HIV.", "evidence_relation": "supporting" }, { "cited_pmid": "32020561", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can also induce tolerance against the therapeutic transgenic protein, allowing for repeated treatment after birth if necessary [17900991].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17900991", "evidence_support": "Research shows that gene transfer to the developing fetus targets rapidly expanding populations of stem cells, which are inaccessible after birth, and indicates that the use of integrating vector systems results in permanent gene transfer.", "evidence_relation": "neutral" }, { "cited_pmid": "17900991", "evidence_support": "In animal models of congenital disease such as haemophilia, studies show that the functionally immature fetal immune system does not respond to the product of the introduced gene, and therefore immune tolerance can be induced. This means that treatment could be repeated after birth, if that was necessary to continue to correct the disease.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, gene therapy can also have adverse effects, such as infusion reactions, liver damage, and adverse effects from immune suppressants or steroids [37210312].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37210312", "evidence_support": "Possible safety concerns include infusion reactions, liver damage, and adverse effects from immune suppressants or steroids.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, there is a risk of insertional mutagenesis, although this concern may be less relevant for future trials [28854824].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28854824", "evidence_support": "The field has also learned from previous shortcomings, although some of the major concerns of the past, specifically insertional mutagenesis, may not be of relevance for future trials.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, gene therapy can also have long-term effects, such as the development of liver tumors, as seen in some animal studies [16136161].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16136161", "evidence_support": "However, recently we have also observed a high incidence of liver tumours after in utero application of an early form of third-generation equine infectious anaemia virus vectors with SIN configuration.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, the effects of gene therapy on an organism can be significant, and careful consideration of the potential benefits and risks is necessary.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "Gene therapy has the potential to treat or cure diseases by transferring genetic material into cells, tissues, or organs [26469046, 35778331, 17577203]. It can be used to repair or replace faulty genes, introduce new genes to fight disease, or modify existing genes to prevent disease [18337227, 32696132, 15952901]. Gene therapy can be used to treat a wide range of diseases, including genetic disorders, cancer, and acquired diseases such as cardiovascular disease and AIDS [15546456, 32696132, 15952901]. The effects of gene therapy on an organism can be significant, including improved health outcomes, increased quality of life, and potentially even a cure for certain diseases [15549408, 27260498, 32696132]. However, gene therapy is still a relatively new and developing field, and there are many challenges and risks associated with it, including the potential for adverse reactions, unintended consequences, and the need for careful regulation and oversight [18535928, 17009872, 18337227]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy has the potential to treat or cure diseases by transferring genetic material into cells, tissues, or organs [26469046, 35778331, 17577203].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26469046", "evidence_support": "They provide evidence for the long-sought promise of gene therapy to deliver 'cures' for some otherwise terminal or severely disabling conditions. Behind these advances lie improved vector designs that enable the safe delivery of therapeutic genes to specific cells.", "evidence_relation": "supporting" }, { "cited_pmid": "35778331", "evidence_support": "This includes viral vector-mediated gene therapy to supply or bypass a missing/defective gene, gene editing enabled by programmable nucleases to create sequence-specific alterations in the genome, and gene silencing to reduce the expression of a gene or genes.", "evidence_relation": "supporting" }, { "cited_pmid": "17577203", "evidence_support": "The disease targets for gene therapy are multiple, but the most promising data have come from monogenic disorders. As the number of potential targets for gene therapy continues to increase, and a substantial number of trials continue with both the standard and the later generation vector systems, it is hoped that a therapeutic niche for gene therapy will emerge in the coming decades", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can be used to repair or replace faulty genes, introduce new genes to fight disease, or modify existing genes to prevent disease [18337227, 32696132, 15952901].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15952901", "evidence_support": "Broadly defined, the concept of gene therapy involves the transfer of genetic material into a cell, tissue, or whole organ, with the goal of curing a disease or at least improving the clinical status of a patient.", "evidence_relation": "supporting" }, { "cited_pmid": "18337227", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "32696132", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Gene therapy can be used to treat a wide range of diseases, including genetic disorders, cancer, and acquired diseases such as cardiovascular disease and AIDS [15546456, 32696132, 15952901].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15546456", "evidence_support": "Gene therapy was originally conceived as an approach to the treatment of genetic disease, to repair or replace a faulty gene. Subsequently, gene therapy clinical trials have been undertaken for a wide range of conditions, particularly cancer and AIDS.", "evidence_relation": "supporting" }, { "cited_pmid": "15952901", "evidence_support": "Their performance and pathogenicity has been evaluated in animal models, and encouraging results form the basis for clinical trials to treat genetic disorders and acquired diseases.", "evidence_relation": "neutral" }, { "cited_pmid": "32696132", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The effects of gene therapy on an organism can be significant, including improved health outcomes, increased quality of life, and potentially even a cure for certain diseases [15549408, 27260498, 32696132].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15549408", "evidence_support": "The expanding knowledge of the genetic and cellular mechanisms of human diseases in the post-genomic era coupled with the development of different vector systems to efficiently transfer genes to a variety of cell types and organs in vivo gave rise to the concept of gene therapy as a promising therapeutic option for genetic and acquired diseases. ", "evidence_relation": "supporting" }, { "cited_pmid": "15549408", "evidence_support": "Overall, gene therapy remains promising for the correction of genetic as well as acquired disorders, where permanent or transient expression of a gene product will be therapeutic.", "evidence_relation": "supporting" }, { "cited_pmid": "27260498", "evidence_support": "Clinical benefit has been achieved over the last 17years in a limited number of medical conditions for which pathophysiological studies determined that they were favorable settings.", "evidence_relation": "supporting" }, { "cited_pmid": "32696132", "evidence_support": "In the recent several years, gene therapy has experienced rapid progress and achieved huge success", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "However, gene therapy is still a relatively new and developing field, and there are many challenges and risks associated with it, including the potential for adverse reactions, unintended consequences, and the need for careful regulation and oversight [18535928, 17009872, 18337227].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "18535928", "evidence_support": "The practicability of gene-addition-type gene therapy protocols has been demonstrated in several successful clinical trials, but the risk of insertional mutagenesis remains a major obstacle.", "evidence_relation": "supporting" }, { "cited_pmid": "17009872", "evidence_support": "In this review, which focuses on monogenic diseases, we discuss the problem of insertional oncogenesis and identify areas for future research, such as developing more quantitative assays for risk and efficacy, and ways of minimizing the genotoxic effects of gene therapy protocols, which will be important if gene therapy is to fulfill its conceptual promise", "evidence_relation": "supporting" }, { "cited_pmid": "18337227", "evidence_support": "Although gene therapy is still at a fairly primitive stage, it is firmly science based", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Gene therapy involves the transfer of genetic material into a cell, tissue, or whole organ to cure a disease or improve a patient's clinical status [23682464, 21897331, 15952901]. The goal of gene therapy is to introduce a corrected copy of a gene to the somatic cells of an individual to treat or alleviate the underlying disease [23682464, 15553101, 21897331]. Gene therapy has been used to treat a wide range of conditions, including inherited diseases, cancers, and acquired disorders [23682464, 27260498, 15881698]. The main challenge in gene therapy is finding an appropriate vector that is both effective and safe, as most currently available vectors confer only weak and transient therapeutic gene expression [15553101, 20027718, 15952901]. Gene therapy has made significant progress, including tangible success, although much slower than was initially predicted [23682464, 27260498, 18337227]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy involves the transfer of genetic material into a cell, tissue, or whole organ to cure a disease or improve a patient's clinical status [23682464, 21897331, 15952901].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23682464", "evidence_support": "Gene therapy is a form of molecular medicine based on the addition of a corrected copy of a gene to the somatic cells of an individual in order to cure or to alleviate the underlying disease.", "evidence_relation": "supporting" }, { "cited_pmid": "21897331", "evidence_support": "This review discusses gene therapy as a new treatment paradigm where genetic material is introduced into cells for therapeutic benefit.", "evidence_relation": "supporting" }, { "cited_pmid": "21897331", "evidence_support": "The genetic material is the 'drug'. It can have a transient or ongoing effect depending on whether or not the introduced genetic material becomes part of the host cell DNA", "evidence_relation": "supporting" }, { "cited_pmid": "15952901", "evidence_support": "Broadly defined, the concept of gene therapy involves the transfer of genetic material into a cell, tissue, or whole organ, with the goal of curing a disease or at least improving the clinical status of a patient. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The goal of gene therapy is to introduce a corrected copy of a gene to the somatic cells of an individual to treat or alleviate the underlying disease [23682464, 15553101, 21897331].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23682464", "evidence_support": "Gene therapy is a form of molecular medicine based on the addition of a corrected copy of a gene to the somatic cells of an individual in order to cure or to alleviate the underlying disease. This approach provides new targeted therapies for an increasing number of acquired or inherited diseases", "evidence_relation": "supporting" }, { "cited_pmid": "15553101", "evidence_support": "Gene therapy is defined as the introduction of genetic material in a patient's cells with resulting therapeutic benefit.", "evidence_relation": "supporting" }, { "cited_pmid": "21897331", "evidence_support": "This review discusses gene therapy as a new treatment paradigm where genetic material is introduced into cells for therapeutic benefit. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Gene therapy has been used to treat a wide range of conditions, including inherited diseases, cancers, and acquired disorders [23682464, 27260498, 15881698].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23682464", "evidence_support": "This approach provides new targeted therapies for an increasing number of acquired or inherited diseases.", "evidence_relation": "supporting" }, { "cited_pmid": "23682464", "evidence_support": "Recently, significant clinical benefits have been reported for several inherited diseases of the hematopoietic system but also of the retina and some cancers, widening its application provided that severe adverse events can be efficiently and stably prevented.", "evidence_relation": "supporting" }, { "cited_pmid": "27260498", "evidence_support": "They include inherited disorders of the immune system, leukodystrophies, possibly hemoglobinopathies, hemophilia B, and retinal dystrophies. Advances in the treatment of B-cell leukemias and lymphomas have also been achieved.", "evidence_relation": "supporting" }, { "cited_pmid": "15881698", "evidence_support": "Although originally considered only as a treatment for inherited single-gene defects, gene therapy has also found applications in acquired illness, such as cardiovascular diseases", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The main challenge in gene therapy is finding an appropriate vector that is both effective and safe, as most currently available vectors confer only weak and transient therapeutic gene expression [15553101, 20027718, 15952901].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15553101", "evidence_support": "The introduction of genetic material into somatic cells requires gene delivery vectors.", "evidence_relation": "neutral" }, { "cited_pmid": "15553101", "evidence_support": "Nevertheless, the success of gene therapy is still very much depending upon the continuous development of improved vector technologies which would hopefully and ultimately cure diseases which are refractory to current treatment paradigms.", "evidence_relation": "supporting" }, { "cited_pmid": "20027718", "evidence_support": "1) Gene therapy consists of inserting foreign genetic material into a patient's cells to correct a health disorder; (2) Only a fraction of gene therapy trials involve hereditary single-gene disorders. Most trials focus on acquired disorders such as cancer and cardiovascular disease", "evidence_relation": "neutral" }, { "cited_pmid": "20027718", "evidence_support": "One of the main problems with gene therapy is finding an appropriate vector (viral or non-viral) that is both effective and safe. Most currently available vectors confer only weak and transient therapeutic gene expression.", "evidence_relation": "supporting" }, { "cited_pmid": "15952901", "evidence_support": "A key factor in the success of gene therapy is the development of delivery systems that are capable of efficient gene transfer in a variety of tissues, without causing any associated pathogenic effects.", "evidence_relation": "supporting" }, { "cited_pmid": "15952901", "evidence_support": "Despite some initial success in these trials, vector development remains a seminal concern for improved gene therapy technologies.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Gene therapy has made significant progress, including tangible success, although much slower than was initially predicted [23682464, 27260498, 18337227].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23682464", "evidence_support": "Since its very first beginning in the 90's essentially for cancer treatment, this therapeutical approach has met unpredicted obstacles as well as true success.", "evidence_relation": "supporting" }, { "cited_pmid": "27260498", "evidence_support": "Gene therapy has become a reality, although still a fragile one. 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Over the next decade, the relevance of gene therapy to medical practices will increase and it will become important for physicians to understand the basic principles and strategies that underlie the therapeutic intervention.", "evidence_relation": "supporting" }, { "cited_pmid": "27358116", "evidence_support": "The principal concept of gene therapy is an experimental technique that uses genes to treat or prevent disease.", "evidence_relation": "neutral" }, { "cited_pmid": "27358116", "evidence_support": "The conclusion is that, with increased pathobiological understanding and biotechnological improvements, gene therapy will become a standard part of clinical practice.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Gene therapy has the potential to revolutionize medicine by treating the causes of disease rather than the symptoms [23682464, 15466989, 20027718]. 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", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy has the potential to revolutionize medicine by treating the causes of disease rather than the symptoms [23682464, 15466989, 20027718].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23682464", "evidence_support": "Gene therapy is a form of molecular medicine based on the addition of a corrected copy of a gene to the somatic cells of an individual in order to cure or to alleviate the underlying disease.", "evidence_relation": "supporting" }, { "cited_pmid": "15466989", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "20027718", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It involves the transfer of genetic material into a cell, tissue, or whole organ to cure or alleviate a disease [23682464, 15881698, 20027718].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23682464", "evidence_support": "Gene therapy is a form of molecular medicine based on the addition of a corrected copy of a gene to the somatic cells of an individual in order to cure or to alleviate the underlying disease.", "evidence_relation": "supporting" }, { "cited_pmid": "20027718", "evidence_support": "(1) Gene therapy consists of inserting foreign genetic material into a patient's cells to correct a health disorder", "evidence_relation": "supporting" }, { "cited_pmid": "15881698", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Gene therapy can be used to repair or replace a faulty gene, introduce a new function, or interfere with an existing function [23682464, 15827576, 36096566].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23682464", "evidence_support": "Gene therapy is a form of molecular medicine based on the addition of a corrected copy of a gene to the somatic cells of an individual in order to cure or to alleviate the underlying disease.", "evidence_relation": "supporting" }, { "cited_pmid": "15827576", "evidence_support": "Gene therapy has developed as a method of approach to the treatment of human diseases based on the transfer of genetic material to the cells of an individual. Normally, the aim of this transfer of genetic material is to re-establish a cellular function that has been abolished or is defective, to introduce a new function or to interfere with an existing function. ", "evidence_relation": "supporting" }, { "cited_pmid": "36096566", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Gene therapy can be delivered directly into the target organ or the general circulation, or alternatively into cells that are first isolated from the patient and then reinjected [15952901, 26702034, 26611602].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15952901", "evidence_support": "Broadly defined, the concept of gene therapy involves the transfer of genetic material into a cell, tissue, or whole organ, with the goal of curing a disease or at least improving the clinical status of a patient.", "evidence_relation": "supporting" }, { "cited_pmid": "26702034", "evidence_support": "Patients with some inherited single-gene defects can now be treated with their own bone marrow stem cells that have been engineered with a viral vector carrying the missing gene.", "evidence_relation": "supporting" }, { "cited_pmid": "26611602", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The goal of gene therapy is to provide a therapeutic benefit, and it has the potential to become a standard part of clinical practice in the future [23682464, 24621283, 15466989].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23682464", "evidence_support": "Recently, significant clinical benefits have been reported for several inherited diseases of the hematopoietic system but also of the retina and some cancers, widening its application provided that severe adverse events can be efficiently and stably prevented.", "evidence_relation": "supporting" }, { "cited_pmid": "24621283", "evidence_support": "Gene therapy offers the possibility of accurately and specifically targeting particular genetic abnormalities through gene correction, addition or replacement. It represents a compelling idea that adds a new dimension to our portfolio of credible therapeutic choices.", "evidence_relation": "supporting" }, { "cited_pmid": "15466989", "evidence_support": "Over the next decade, the relevance of gene therapy to medical practices will increase and it will become important for physicians to understand the basic principles and strategies that underlie the therapeutic intervention", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Gene therapy has the potential to revolutionize medicine by treating the causes of disease rather than the symptoms [15466989]. It involves the transfer of genetic material into a cell, tissue, or whole organ to cure or alleviate a disease [30536225, 23682464]. Gene therapy is a form of molecular medicine based on the addition of a corrected copy of a gene to the somatic cells of an individual in order to cure or to alleviate the underlying disease [23682464]. This approach provides new targeted therapies for an inherited or acquired diseases [23682464]. Gene therapy can be delivered directly into the target organ or the general circulation, or alternatively into cells that are first isolated from the patient and then reinjected [26702034].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy has the potential to revolutionize medicine by treating the causes of disease rather than the symptoms [15466989].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15466989", "evidence_support": "Interest in this therapeutic modality is based on the potential for treatment and cure of some of the most malignant and devastating diseases affecting humans.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It involves the transfer of genetic material into a cell, tissue, or whole organ to cure or alleviate a disease [30536225, 23682464].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30536225", "evidence_support": "Gene therapy is the delivery of nucleic acid for the expression of a therapeutic product in order to treat diseases on a genetic level.", "evidence_relation": "supporting" }, { "cited_pmid": "23682464", "evidence_support": "Gene therapy is a form of molecular medicine based on the addition of a corrected copy of a gene to the somatic cells of an individual in order to cure or to alleviate the underlying disease.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Gene therapy is a form of molecular medicine based on the addition of a corrected copy of a gene to the somatic cells of an individual in order to cure or to alleviate the underlying disease [23682464].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23682464", "evidence_support": "Gene therapy is a form of molecular medicine based on the addition of a corrected copy of a gene to the somatic cells of an individual in order to cure or to alleviate the underlying disease.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "This approach provides new targeted therapies for an inherited or acquired diseases [23682464].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23682464", "evidence_support": "This approach provides new targeted therapies for an increasing number of acquired or inherited diseases.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Gene therapy can be delivered directly into the target organ or the general circulation, or alternatively into cells that are first isolated from the patient and then reinjected [26702034].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "26702034", "evidence_support": "The first clinical gene delivery, which involved insertion of a marker gene into lymphocytes from cancer patients, was published 25 years ago.", "evidence_relation": "supporting" }, { "cited_pmid": "26702034", "evidence_support": "Patients with some inherited single-gene defects can now be treated with their own bone marrow stem cells that have been engineered with a viral vector carrying the missing gene.", "evidence_relation": "supporting" }, { "cited_pmid": "26702034", "evidence_support": "Patients with inherited retinopathies and haemophilia B can also be treated by local or systemic injection of viral vectors.", "evidence_relation": "neutral" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Gene therapy has the potential to revolutionize medicine by treating the causes of disease rather than the symptoms [33834479, 23682464, 15881698]. It involves the transfer of genetic material into a cell, tissue, or whole organ to cure or alleviate a disease [30536225, 15827576, 15881698]. Gene therapy can be used to repair or replace a faulty gene, introduce a new function, or interfere with an existing function [23905156, 23682464, 15881698]. It has been used to treat various diseases, including infectious diseases such as Kawasaki disease, toxic epidermolysis, Stevens-Johnson syndrome, infections caused by parvovirus B19, hemophagocytic syndrome, and severe toxemia caused by Clostridium difficile, Streptococcus pyogenes, and Staphylococcus aureus [21751556]. Gene therapy can be delivered directly into the target organ or the general circulation, or alternatively into cells that are first isolated from the patient and then reinjected [26611602, 15952901].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy has the potential to revolutionize medicine by treating the causes of disease rather than the symptoms [33834479, 23682464, 15881698].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15881698", "evidence_support": "Gene therapy revolutionizes medicine by treating the causes of disease rather than the symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "23682464", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "33834479", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It involves the transfer of genetic material into a cell, tissue, or whole organ to cure or alleviate a disease [30536225, 15827576, 15881698].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30536225", "evidence_support": "Gene therapy is the delivery of nucleic acid for the expression of a therapeutic product in order to treat diseases on a genetic level.", "evidence_relation": "supporting" }, { "cited_pmid": "15827576", "evidence_support": "Gene therapy has developed as a method of approach to the treatment of human diseases based on the transfer of genetic material to the cells of an individual.", "evidence_relation": "supporting" }, { "cited_pmid": "15881698", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Gene therapy can be used to repair or replace a faulty gene, introduce a new function, or interfere with an existing function [23905156, 23682464, 15881698].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23905156", "evidence_support": "Gene therapy aims at the insertion of a functional gene into the cells of a patient for the correction of an inborn error of metabolism, to alter or repair an acquired genetic abnormality, and to provide new function to the cell.", "evidence_relation": "supporting" }, { "cited_pmid": "23682464", "evidence_support": "Gene therapy is a form of molecular medicine based on the addition of a corrected copy of a gene to the somatic cells of an individual in order to cure or to alleviate the underlying disease", "evidence_relation": "supporting" }, { "cited_pmid": "15881698", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It has been used to treat various diseases, including infectious diseases such as Kawasaki disease, toxic epidermolysis, Stevens-Johnson syndrome, infections caused by parvovirus B19, hemophagocytic syndrome, and severe toxemia caused by Clostridium difficile, Streptococcus pyogenes, and Staphylococcus aureus [21751556].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "21751556", "evidence_support": "In practice of the infectious ward IVIG are used as a drug of choice in the treatment of Kawasaki disease, in toxic epidermolysis and Stevens-Johnson syndrome. As adjunctive therapy IVIG are used in the infection with parvovirus B19, in hemophagocytic syndrome, for treatment of infections presenting with a severe toxemia caused by Clostridium difficile, Streptococcus pyogenes and Staphylococcus aureus.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Gene therapy can be delivered directly into the target organ or the general circulation, or alternatively into cells that are first isolated from the patient and then reinjected [26611602, 15952901].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15952901", "evidence_support": "Broadly defined, the concept of gene therapy involves the transfer of genetic material into a cell, tissue, or whole organ, with the goal of curing a disease or at least improving the clinical status of a patient.", "evidence_relation": "supporting" }, { "cited_pmid": "26611602", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Gene therapy has the potential to revolutionize medicine by treating the causes of disease rather than the symptoms [15466989, 37264658, 23682464]. It involves the transfer of genetic material into a cell, tissue, or whole organ to cure or alleviate a disease [20027718, 15881698, 30536225]. Gene therapy can be used to repair or replace a faulty gene, introduce a new function, or interfere with an existing function [15827576, 15546456, 23682464]. It has been used to treat various diseases, including infectious diseases such as Kawasaki disease, toxic epidermolysis, Stevens-Johnson syndrome, and infections caused by certain bacteria and viruses [21751556]. Gene therapy can be delivered through various methods, including viral vectors (such as retroviruses, lentiviruses, adenoviruses, and adeno-associated viruses) [15952901, 35123997]. The goal of gene therapy is to provide a therapeutic benefit, and it has the potential to become a standard part of clinical practice in the future [16782218, 16320132, 23682464]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy has the potential to revolutionize medicine by treating the causes of disease rather than the symptoms [15466989, 37264658, 23682464].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15466989", "evidence_support": "Interest in this therapeutic modality is based on the potential for treatment and cure of some of the most malignant and devastating diseases affecting humans. ", "evidence_relation": "supporting" }, { "cited_pmid": "37264658", "evidence_support": "Gene therapy would allow the expression of a functional protein, provided that the cellular machinery in the diseased cell could correctly fold and traffic the protein to the cell membrane.", "evidence_relation": "supporting" }, { "cited_pmid": "23682464", "evidence_support": "Gene therapy is a form of molecular medicine based on the addition of a corrected copy of a gene to the somatic cells of an individual in order to cure or to alleviate the underlying disease. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It involves the transfer of genetic material into a cell, tissue, or whole organ to cure or alleviate a disease [20027718, 15881698, 30536225].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20027718", "evidence_support": "Gene therapy consists of inserting foreign genetic material into a patient's cells to correct a health disorder; ", "evidence_relation": "supporting" }, { "cited_pmid": "15881698", "evidence_support": "Gene therapy revolutionizes medicine by treating the causes of disease rather than the symptoms.", "evidence_relation": "neutral" }, { "cited_pmid": "15881698", "evidence_support": "This type of medicine would involve a therapeutic gene administered and a delivery system adapted to the targeted pharmaceutical objective.", "evidence_relation": "supporting" }, { "cited_pmid": "30536225", "evidence_support": "Gene therapy is the delivery of nucleic acid for the expression of a therapeutic product in order to treat diseases on a genetic level.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Gene therapy can be used to repair or replace a faulty gene, introduce a new function, or interfere with an existing function [15827576, 15546456, 23682464].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15827576", "evidence_support": "Normally, the aim of this transfer of genetic material is to re-establish a cellular function that has been abolished or is defective, to introduce a new function or to interfere with an existing function", "evidence_relation": "supporting" }, { "cited_pmid": "15546456", "evidence_support": "Gene therapy was originally conceived as an approach to the treatment of genetic disease, to repair or replace a faulty gene.", "evidence_relation": "supporting" }, { "cited_pmid": "23682464", "evidence_support": "Gene therapy is a form of molecular medicine based on the addition of a corrected copy of a gene to the somatic cells of an individual in order to cure or to alleviate the underlying disease", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It has been used to treat various diseases, including infectious diseases such as Kawasaki disease, toxic epidermolysis, Stevens-Johnson syndrome, and infections caused by certain bacteria and viruses [21751556].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21751556", "evidence_support": "In practice of the infectious ward IVIG are used as a drug of choice in the treatment of Kawasaki disease, in toxic epidermolysis and Stevens-Johnson syndrome. As adjunctive therapy IVIG are used in the infection with parvovirus B19, in hemophagocytic syndrome, for treatment of infections presenting with a severe toxemia caused by Clostridium difficile, Streptococcus pyogenes and Staphylococcus aureus.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Gene therapy can be delivered through various methods, including viral vectors (such as retroviruses, lentiviruses, adenoviruses, and adeno-associated viruses) [15952901, 35123997].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15952901", "evidence_support": "Vectors based upon many different viral systems, including retroviruses, lentiviruses, adenoviruses, and adeno-associated viruses, currently offer the best choice for efficient gene delivery.", "evidence_relation": "supporting" }, { "cited_pmid": "35123997", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "The goal of gene therapy is to provide a therapeutic benefit, and it has the potential to become a standard part of clinical practice in the future [16782218, 16320132, 23682464].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16782218", "evidence_support": "Gene therapy encompasses a spectrum of therapeutic strategies, ranging from the compelling concept of using wild type copies of genes to correct the root cause of recessive genetic disorders through to using genes to mediate powerful and selective toxicity to cancer cells.", "evidence_relation": "supporting" }, { "cited_pmid": "16320132", "evidence_support": "Gene therapy is a promising technique for treating disease through the modification of gene expression", "evidence_relation": "supporting" }, { "cited_pmid": "23682464", "evidence_support": "Recently, significant clinical benefits have been reported for several inherited diseases of the hematopoietic system but also of the retina and some cancers, widening its application provided that severe adverse events can be efficiently and stably prevented.", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Gene therapy introduces genetic material into an organism's cells to correct or modify gene expression, offering therapeutic benefits for various genetic and acquired diseases [15553101, 15827576]. It has shown promise in treating hereditary conditions like hemophilia and severe combined immunodeficiency (SCID), as well as acquired disorders such as cancer and cardiovascular diseases [15553101, 15827576, 31845133]. The therapeutic effects can be achieved through direct in vivo administration or ex vivo modification of cells, which are then reintroduced into the patient [20027718, 15549408]. However, challenges such as immune responses, transient gene expression, and potential oncogenicity remain significant hurdles [20027718, 15549408, 20858588]. Despite these issues, advancements in vector technology and gene editing have improved safety and efficacy, making gene therapy a viable option for previously untreatable conditions [15553101, 29297925, 25227756]. Nonetheless, long-term effects and the risk of adverse events, such as insertional mutagenesis, necessitate careful monitoring and ongoing research [15549408, 28854824, 16988659].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy introduces genetic material into an organism's cells to correct or modify gene expression, offering therapeutic benefits for various genetic and acquired diseases [15553101, 15827576].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15553101", "evidence_support": "Gene therapy is defined as the introduction of genetic material in a patient's cells with resulting therapeutic benefit.", "evidence_relation": "supporting" }, { "cited_pmid": "15827576", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It has shown promise in treating hereditary conditions like hemophilia and severe combined immunodeficiency (SCID), as well as acquired disorders such as cancer and cardiovascular diseases [15553101, 15827576, 31845133].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15553101", "evidence_support": "It is a promising new biomedical discipline that could potentially lead to new treatments for hereditary diseases, cardiovascular and neurologic disorders, cancer, diabetes and even infectious diseases.", "evidence_relation": "supporting" }, { "cited_pmid": "15553101", "evidence_support": "Furthermore, therapeutic effects have been obtained in several phase I/II gene therapy clinical trials for hemophilia, severe combined immune deficiency (SCID) and cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "15827576", "evidence_support": "Attention was initially centred on the treatment of monogenic hereditary diseases, but subsequently the majority of clinical trials (over four hundred) have concerned the treatment of cancer.", "evidence_relation": "neutral" }, { "cited_pmid": "31845133", "evidence_support": "Therefore, gene therapy advances are being applied to correct inherited genetic disorders such as hemophilia, cystic fibrosis, and familial hypercholesterolemia as well as acquired diseases like cancer, AIDS, Alzheimer's disease, Parkinson's disease, and infectious diseases like HIV.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The therapeutic effects can be achieved through direct in vivo administration or ex vivo modification of cells, which are then reintroduced into the patient [20027718, 15549408].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20027718", "evidence_support": "The therapeutic gene can be delivered directly into the target organ or the general circulation, or alternatively into cells that are first isolated from the patient and then reinjected", "evidence_relation": "supporting" }, { "cited_pmid": "15549408", "evidence_support": "Correction of the genetic defect can be attempted by either in vivo administration to directly target a diseased organ or by administration of ex vivo genetically modified cells, e.g., bone marrow stem cells", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, challenges such as immune responses, transient gene expression, and potential oncogenicity remain significant hurdles [20027718, 15549408, 20858588].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "20027718", "evidence_support": "In addition, many carry major risks such as immunological disorders and oncogenicity;", "evidence_relation": "supporting" }, { "cited_pmid": "15549408", "evidence_support": "However, a number of hurdles must still be overcome to make gene therapy safe and applicable for human diseases.", "evidence_relation": "supporting" }, { "cited_pmid": "20858588", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Despite these issues, advancements in vector technology and gene editing have improved safety and efficacy, making gene therapy a viable option for previously untreatable conditions [15553101, 29297925, 25227756].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "15553101", "evidence_support": "Gene transfer technology has improved significantly over the past few years and has led to the development of vectors which have fewer side-effects without compromising their efficacy, at least partly due the development of cell-type specific targetable vectors.", "evidence_relation": "supporting" }, { "cited_pmid": "15553101", "evidence_support": "Nevertheless, the success of gene therapy is still very much depending upon the continuous development of improved vector technologies which would hopefully and ultimately cure diseases which are refractory to current treatment paradigms.", "evidence_relation": "supporting" }, { "cited_pmid": "25227756", "evidence_support": "In Part I of this Review (Wang and Gao, 2014), we introduced recent advances in gene delivery technologies and explained how they have powered some of the current human gene therapy applications.", "evidence_relation": "supporting" }, { "cited_pmid": "29297925", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Nonetheless, long-term effects and the risk of adverse events, such as insertional mutagenesis, necessitate careful monitoring and ongoing research [15549408, 28854824, 16988659].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "28854824", "evidence_support": "Gene therapy promises to cure the disease \"at the root\" and is therefore exceptional in its potential, but also formidable in its challenges, as long-term side effects are hard to predict and clinical experience remains limited.", "evidence_relation": "neutral" }, { "cited_pmid": "28854824", "evidence_support": "although some of the major concerns of the past, specifically insertional mutagenesis, may not be of relevance for future trials.", "evidence_relation": "contradicting" }, { "cited_pmid": "15549408", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16988659", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Gene therapy involves the introduction, removal, or alteration of genetic material within an organism's cells to treat or prevent disease.Its effects can be profound, potentially correcting genetic disorders by restoring normal function to defective genes, thereby alleviating symptoms or halting disease progression.For example, gene therapy has shown promise in treating inherited retinal diseases, certain types of cancer, and hemophilia.However, it can also pose risks, such as immune reactions, insertional mutagenesis leading to cancer, and off-target effects where unintended genes are altered.The long-term efficacy and safety of gene therapy are still under investigation, necessitating careful patient selection and monitoring.Despite these challenges, advancements in vector design and delivery methods continue to enhance its therapeutic potential, making gene therapy a promising frontier in personalized medicine.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy involves the introduction, removal, or alteration of genetic material within an organism's cells to treat or prevent disease.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Its effects can be profound, potentially correcting genetic disorders by restoring normal function to defective genes, thereby alleviating symptoms or halting disease progression.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "For example, gene therapy has shown promise in treating inherited retinal diseases, certain types of cancer, and hemophilia.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "However, it can also pose risks, such as immune reactions, insertional mutagenesis leading to cancer, and off-target effects where unintended genes are altered.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "The long-term efficacy and safety of gene therapy are still under investigation, necessitating careful patient selection and monitoring.", "answer_sentence_relevance": "borderline", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Despite these challenges, advancements in vector design and delivery methods continue to enhance its therapeutic potential, making gene therapy a promising frontier in personalized medicine.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Gene therapy can have various effects on an organism, including the correction of genetic disorders, introduction of new functions, and interference with existing functions [15827576]. It has been shown to be effective in treating genetic diseases, such as severe combined immunodeficiency (SCID) and hemophilia, by introducing a functional copy of the faulty gene [15553101, 29297925]. Gene therapy can also be used to treat acquired diseases, such as cancer, by introducing genes that inhibit tumor growth or stimulate the immune system [15827576, 15549408]. However, gene therapy can also have adverse effects, such as the development of leukemia in some patients with SCID [16988659]. Additionally, the use of viral vectors can cause immune responses and other safety concerns [20027718, 20858588]. Overall, the effects of gene therapy on an organism depend on the specific disease being treated, the type of vector used, and the individual's response to the therapy [31845133, 25227756].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy can have various effects on an organism, including the correction of genetic disorders, introduction of new functions, and interference with existing functions [15827576].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15827576", "evidence_support": "Normally, the aim of this transfer of genetic material is to re-establish a cellular function that has been abolished or is defective, to introduce a new function or to interfere with an existing function", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It has been shown to be effective in treating genetic diseases, such as severe combined immunodeficiency (SCID) and hemophilia, by introducing a functional copy of the faulty gene [15553101, 29297925].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15553101", "evidence_support": "Furthermore, therapeutic effects have been obtained in several phase I/II gene therapy clinical trials for hemophilia, severe combined immune deficiency (SCID) and cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "29297925", "evidence_support": "Examples of successfully treated disorders are primary immunodeficiencies and hemophilias.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Gene therapy can also be used to treat acquired diseases, such as cancer, by introducing genes that inhibit tumor growth or stimulate the immune system [15827576, 15549408].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15827576", "evidence_support": "Gene therapy has developed as a method of approach to the treatment of human diseases based on the transfer of genetic material to the cells of an individual", "evidence_relation": "supporting" }, { "cited_pmid": "15827576", "evidence_support": "Attention was initially centred on the treatment of monogenic hereditary diseases, but subsequently the majority of clinical trials (over four hundred) have concerned the treatment of cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "15827576", "evidence_support": "And, in the late 1990s, a group of children with severe combined immunodeficiency were successfully treated through the ex vivo transfer of the correct version of the altered gene to their bone marrow,", "evidence_relation": "supporting" }, { "cited_pmid": "15549408", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, gene therapy can also have adverse effects, such as the development of leukemia in some patients with SCID [16988659].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16988659", "evidence_support": "Gene therapy has been remarkably effective for the immunological reconstitution of patients with severe combined immune deficiency, but the occurrence of leukaemia in a few patients has stimulated debate about the safety of the procedure and the mechanisms of leukaemogenesis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, the use of viral vectors can cause immune responses and other safety concerns [20027718, 20858588].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20027718", "evidence_support": "One of the main problems with gene therapy is finding an appropriate vector (viral or non-viral) that is both effective and safe. ", "evidence_relation": "supporting" }, { "cited_pmid": "20858588", "evidence_support": "Viruses, in this context, can cause adverse events such as toxicity, immune and inflammatory responses, as well as gene control and targeting issues. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, the effects of gene therapy on an organism depend on the specific disease being treated, the type of vector used, and the individual's response to the therapy [31845133, 25227756].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "25227756", "evidence_support": "To help readers to grasp the essence and to better organize the diverse applications, we categorize them under four gene therapy strategies: (1) gene replacement therapy for monogenic diseases, (2) gene addition for complex disorders and infectious diseases, (3) gene expression alteration targeting RNA, and (4) gene editing to introduce targeted changes in host genome.", "evidence_relation": "neutral" }, { "cited_pmid": "31845133", "evidence_support": "Accordingly, many types of diseases are now being studied and treated in clinical trials through various gene delivery vectors.", "evidence_relation": "neutral" } ] } ] }, "ten-shot-gemini-flash": { "answer": "Gene therapy aims to treat, cure, or prevent diseases by altering gene expression [11706603, 34790341]. It can correct genetic defects or enhance the expression of beneficial proteins [11470139]. Gene therapy has shown potential in treating various diseases, including cancer, infectious diseases, and vascular conditions [11706603, 9814826]. It can also regulate immune responses in vivo, as demonstrated by studies using cytokine genes [8506293]. Gene therapy can be delivered safely and effectively to multiple organs, providing long-lasting benefits without significant side effects [35537048]. However, the long-term effects of gene therapy are not fully understood, which is an important consideration for patients [37800996].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy aims to treat, cure, or prevent diseases by altering gene expression [11706603, 34790341].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34790341", "evidence_support": "Gene therapies can treat, prevent, or cure a disease by changing the expression of a person's genes.", "evidence_relation": "supporting" }, { "cited_pmid": "11706603", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can correct genetic defects or enhance the expression of beneficial proteins [11470139].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "11470139", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Gene therapy has shown potential in treating various diseases, including cancer, infectious diseases, and vascular conditions [11706603, 9814826].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "11706603", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "9814826", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It can also regulate immune responses in vivo, as demonstrated by studies using cytokine genes [8506293].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "8506293", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Gene therapy can be delivered safely and effectively to multiple organs, providing long-lasting benefits without significant side effects [35537048].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35537048", "evidence_support": "Further, telomere shortening associated with aging was ameliorated by TERT and mitochondrial structure deterioration was halted in both treatments. Intranasal and injectable preparations performed equally well in safely and efficiently delivering gene therapy to multiple organs, with long-lasting benefits and without carcinogenicity or unwanted side effects. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "However, the long-term effects of gene therapy are not fully understood, which is an important consideration for patients [37800996].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "37800996", "evidence_support": "however, the long-term effects of curative strategies remain to be fully established and have significant implications in a patient's decision to seek therapy.", "evidence_relation": "neutral" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Gene therapy is a novel approach that aims to treat, cure, or prevent diseases by altering the expression of a person's genes [11706603, 34790341]. It involves transferring nucleic acids to somatic cells, which can correct genetic defects or enhance the expression of beneficial proteins, leading to therapeutic effects [11470139]. Gene therapy has shown potential in addressing complex diseases such as cancer, heart disease, and neurodegenerative syndromes [8561476]. Recent advancements have made gene therapy a viable first-line treatment for some fatal diseases [32718206]. It can be delivered safely and effectively to multiple organs, providing long-lasting benefits without significant side effects [35537048]. However, while gene therapy can stabilize or improve disease symptoms, the long-term effects are not fully understood, which is an important consideration for patients [37800996].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy is a novel approach that aims to treat, cure, or prevent diseases by altering the expression of a person's genes [11706603, 34790341].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34790341", "evidence_support": "Gene therapies can treat, prevent, or cure a disease by changing the expression of a person's genes.", "evidence_relation": "supporting" }, { "cited_pmid": "11706603", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It involves transferring nucleic acids to somatic cells, which can correct genetic defects or enhance the expression of beneficial proteins, leading to therapeutic effects [11470139].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "11470139", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Gene therapy has shown potential in addressing complex diseases such as cancer, heart disease, and neurodegenerative syndromes [8561476].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "8561476", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Recent advancements have made gene therapy a viable first-line treatment for some fatal diseases [32718206].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "32718206", "evidence_support": "The promise of genetic therapies has turned into reality in recent years, with new first-line treatments for fatal diseases now available to patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It can be delivered safely and effectively to multiple organs, providing long-lasting benefits without significant side effects [35537048].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35537048", "evidence_support": "Specifically, this treatment significantly improved glucose tolerance, physical performance, as well as preventing body mass loss and alopecia", "evidence_relation": "neutral" }, { "cited_pmid": "35537048", "evidence_support": "Intranasal and injectable preparations performed equally well in safely and efficiently delivering gene therapy to multiple organs, with long-lasting benefits and without carcinogenicity or unwanted side effects.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "However, while gene therapy can stabilize or improve disease symptoms, the long-term effects are not fully understood, which is an important consideration for patients [37800996].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37800996", "evidence_support": "Alternative donor sources, including haploidentical donor and autologous with gene therapy, expand donor options but are limited by inferior outcomes, limited data, and/or shorter follow-up and therefore remain experimental.", "evidence_relation": "neutral" }, { "cited_pmid": "37800996", "evidence_support": "Patients with stable donor engraftment do not experience SCD-related symptoms and have stabilization or improvement of end-organ pathology; however, the long-term effects of curative strategies remain to be fully established and have significant implications in a patient's decision to seek therapy.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Gene therapy involves the transfer of nucleic acids to a patient's somatic cells, aiming to correct genetic defects or enhance the expression of beneficial proteins, leading to therapeutic effects [11470139, 11995408]. This innovative treatment has shown promise in addressing various conditions, including cancer, genetic disorders, and severe hemophilia, potentially improving disease outcomes and quality of life [34464044, 34288447]. Gene therapy can provide significant benefits after a single administration, offering a transformative approach for previously incurable diseases [37674905, 32718206]. However, challenges remain regarding safety, efficacy, and the long-term effects of these therapies, which are still under investigation [34462265, 37800996]. Overall, gene therapy represents a significant advancement in medical treatment, with the potential to change the course of many serious health conditions [36111754, 37032509].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy involves the transfer of nucleic acids to a patient's somatic cells, aiming to correct genetic defects or enhance the expression of beneficial proteins, leading to therapeutic effects [11470139, 11995408].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "11470139", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "11995408", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This innovative treatment has shown promise in addressing various conditions, including cancer, genetic disorders, and severe hemophilia, potentially improving disease outcomes and quality of life [34464044, 34288447].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34464044", "evidence_support": "In the next 60 years, numerous tools for gene delivery have been developed and applied for clinical research, culminating in the registration of several genetic therapies in Europe and the USA. Some of these strategies, aimed to treat severe combined immunodeficiencies, inherited forms of blindness, spinal muscular atrophy, some cancers, and genetic anemias, are the real hope for patients suffering from previously incurable diseases or the ones whose treatment was not effective. ", "evidence_relation": "supporting" }, { "cited_pmid": "34288447", "evidence_support": "Since the cloning and characterization of the factor VIII (FVIII) and factor IX genes in the mid-1980s, gene therapy has been perceived as having significant potential for the treatment of severe hemophilia.", "evidence_relation": "supporting" }, { "cited_pmid": "34288447", "evidence_support": "Adeno-associated viral vector-mediated gene therapy for hemophilia A and B has been extensively investigated in preclinical models over the past 20\u00a0years, and since 2011, there has been increasing evidence in early phase clinical trials that this therapeutic strategy can provide safe and effective rescue of the hemostatic phenotype in severe hemophilia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Gene therapy can provide significant benefits after a single administration, offering a transformative approach for previously incurable diseases [37674905, 32718206].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37674905", "evidence_support": "Gene therapies have potential to improve outcomes of severe diseases after only a single administration.", "evidence_relation": "supporting" }, { "cited_pmid": "32718206", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, challenges remain regarding safety, efficacy, and the long-term effects of these therapies, which are still under investigation [34462265, 37800996].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "34462265", "evidence_support": "The potential for gene therapy, gene editing and genetic therapies to ameliorate the course of these conditions is extraordinarily exciting, but there are significant challenges associated with their use, particularly with respect to safety, efficacy, cost and equity.", "evidence_relation": "supporting" }, { "cited_pmid": "37800996", "evidence_support": "Patients with stable donor engraftment do not experience SCD-related symptoms and have stabilization or improvement of end-organ pathology; however, the long-term effects of curative strategies remain to be fully established and have significant implications in a patient's decision to seek therapy.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Overall, gene therapy represents a significant advancement in medical treatment, with the potential to change the course of many serious health conditions [36111754, 37032509].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36111754", "evidence_support": "Gene therapy offers the possibility of a clinically relevant improvement in disease phenotype and transformational improvement in quality of life, including an opportunity to engage in physical activities more confidently.", "evidence_relation": "supporting" }, { "cited_pmid": "37032509", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Gene therapy is a novel treatment approach that modifies or adds new biochemical properties to a patient's cells by altering gene expression [11706603, 11995408]. It has the potential to treat, cure, or prevent diseases, including genetic disorders and cancer, by correcting genetic defects or overexpressing beneficial proteins [11470139, 11706603]. This therapy can provide long-lasting effects, potentially improving the quality of life for patients with conditions like thalassemia and sickle cell disease [33496753, 37800996]. However, the introduction of new genetic material can have complex consequences, and the long-term safety and efficacy of gene therapy are still under investigation [37181114, 32205585]. Overall, gene therapy represents a promising advancement in medical treatment, offering hope for previously intractable diseases [15790317, 29803277].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy is a novel treatment approach that modifies or adds new biochemical properties to a patient's cells by altering gene expression [11706603, 11995408].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "11706603", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "11995408", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It has the potential to treat, cure, or prevent diseases, including genetic disorders and cancer, by correcting genetic defects or overexpressing beneficial proteins [11470139, 11706603].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "11470139", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "11706603", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This therapy can provide long-lasting effects, potentially improving the quality of life for patients with conditions like thalassemia and sickle cell disease [33496753, 37800996].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33496753", "evidence_support": "In thalassemia, HSCT was frequently associated with large positive effects in physical and emotional HRQOL domains (median d = 0.79 and d = 0.57, respectively). In SCD, HSCT was associated with large positive effects in all HRQOL domains.", "evidence_relation": "supporting" }, { "cited_pmid": "33496753", "evidence_support": "Emerging data suggest improvement in HRQOL outcomes across different domains following gene therapy in thalassemia and SCD.", "evidence_relation": "supporting" }, { "cited_pmid": "37800996", "evidence_support": "HSCT, both allogeneic and autologous gene therapy, in the SCD population reverses the sickle phenotype, prevents further organ damage, can resolve prior organ dysfunction in both pediatric and adult patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, the introduction of new genetic material can have complex consequences, and the long-term safety and efficacy of gene therapy are still under investigation [37181114, 32205585].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37181114", "evidence_support": "Nevertheless, the consequences of introducing new genetic material are not trivial.", "evidence_relation": "supporting" }, { "cited_pmid": "32205585", "evidence_support": "Early short-term therapeutic benefit has been reported for some of the ongoing clinical trials, but confirmation of long-term safety and efficacy remains to be shown. Future therapies aiming at the targeted correction of specific disease-causing DNA mutations are emerging and will likely enter clinical testing in the near future.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Overall, gene therapy represents a promising advancement in medical treatment, offering hope for previously intractable diseases [15790317, 29803277].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15790317", "evidence_support": "Airway disease in cystic fibrosis (CF) is the major cause of death and is presently inadequately treatable, but genetic therapies offer the hope that such life-long disease will be curable, or at least satisfactorily treated.", "evidence_relation": "supporting" }, { "cited_pmid": "29803277", "evidence_support": "Gene therapy has curative potential, whereby autologous hematopoietic stem cells are genetically modified and transplanted, which would not be limited by matched donors, resulting in 1-time, life-long correction devoid of immune side effects.", "evidence_relation": "supporting" } ] } ] }, "webis-1": { "answer": "Gene therapy can have therapeutic effects on an organism, particularly in cancer therapy [29334764,16768302,16143811,26783511]. However, there has been no significant breakthrough in these two forms of therapy [16467873,16143811]. Gene therapy may become an important part of anticancer therapy and is expected to improve the therapeutic effect of head and neck cancers in the near future [29334764]. In addition to cancer gene therapy, there are many other diseases and disorders where gene therapy holds exciting and promising opportunities [16768302].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy can have therapeutic effects on an organism, particularly in cancer therapy [29334764,16768302,16143811,26783511].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29334764", "evidence_support": "Gene therapy is a rapidly evolving field in cancer therapy that has been shown to improve the efficacy of antitumor treatment", "evidence_relation": "supporting" }, { "cited_pmid": "29334764", "evidence_support": "Thus, gene therapy may become an important part of anticancer therapy and is expected to improve the therapeutic effect of head and neck cancers in the near future.", "evidence_relation": "supporting" }, { "cited_pmid": "16768302", "evidence_support": "Gene therapy, especially of cancer, has created exciting and elusive areas of therapeutic research in the past decade.", "evidence_relation": "supporting" }, { "cited_pmid": "16143811", "evidence_support": "Gene therapy and viral therapy for cancer have therapeutic effects, but there has been no significant breakthrough in these two forms of therapy.", "evidence_relation": "contradicting" }, { "cited_pmid": "26783511", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "However, there has been no significant breakthrough in these two forms of therapy [16467873,16143811].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16467873", "evidence_support": "Gene therapy and viral therapy for cancer have got some therapeutic effects, but both have no great breakthrough. Therefore, we worked out a new strategy called Targeting Gene-Virotherapy of Cancer which is a combination of the advantage of gene therapy and virotherapy. ", "evidence_relation": "supporting" }, { "cited_pmid": "16143811", "evidence_support": "Gene therapy and viral therapy for cancer have therapeutic effects, but there has been no significant breakthrough in these two forms of therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "16143811", "evidence_support": "This new therapy has stronger antitumor effects than either gene therapy or viral therapy. A tumor-specific replicative adenovirus vector ZD55 (E1B55KD deleted Adv.) was constructed and various single therapeutic genes were inserted into ZD55 to form ZD55-gene. ", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Gene therapy may become an important part of anticancer therapy and is expected to improve the therapeutic effect of head and neck cancers in the near future [29334764].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29334764", "evidence_support": "Gene therapy is a rapidly evolving field in cancer therapy that has been shown to improve the efficacy of antitumor treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "29334764", "evidence_support": "Thus, gene therapy may become an important part of anticancer therapy and is expected to improve the therapeutic effect of head and neck cancers in the near future.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In addition to cancer gene therapy, there are many other diseases and disorders where gene therapy holds exciting and promising opportunities [16768302].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16768302", "evidence_support": "Gene therapy, especially of cancer, has created exciting and elusive areas of therapeutic research in the past decade.", "evidence_relation": "supporting" }, { "cited_pmid": "16768302", "evidence_support": "In addition to cancer gene therapy there are many other diseases and disorders where gene therapy holds exciting and promising opportunities.", "evidence_relation": "supporting" } ] } ] }, "webis-2": { "answer": "Gene therapy can have effects such as improving the efficacy of antitumor treatment and potentially being a safe and effective anticancer treatment [29334764].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy can have effects such as improving the efficacy of antitumor treatment and potentially being a safe and effective anticancer treatment [29334764].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29334764", "evidence_support": "Gene therapy is a rapidly evolving field in cancer therapy that has been shown to improve the efficacy of antitumor treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "29334764", "evidence_support": "With current innovations in tumor biology and knowledge, gene therapy has great potential as a safe and effective anticancer treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "29334764", "evidence_support": "Thus, gene therapy may become an important part of anticancer therapy and is expected to improve the therapeutic effect of head and neck cancers in the near future.", "evidence_relation": "supporting" } ] } ] }, "webis-3": { "answer": "Gene therapy has been used in more than 1700 clinical trials for various diseases, including cancer [24520527]. It offers innovative approaches for cancer treatment [36096566]. However, it has also been associated with drawbacks and successes [24520527]. The surgeon plays a pivotal role in the diagnosis and treatment of cancer, and understanding gene therapy is essential for managing patients with neoplastic disease [36096566].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy has been used in more than 1700 clinical trials for various diseases, including cancer [24520527].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24520527", "evidence_support": "More than 1700 clinical trials have been conducted where gene therapy is used as a means for therapy.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It offers innovative approaches for cancer treatment [36096566].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36096566", "evidence_support": "The broad field of gene therapy offers numerous innovative approaches for cancer treatment.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, it has also been associated with drawbacks and successes [24520527].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24520527", "evidence_support": "We have experienced drawbacks and successes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The surgeon plays a pivotal role in the diagnosis and treatment of cancer, and understanding gene therapy is essential for managing patients with neoplastic disease [36096566].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36096566", "evidence_support": "This review focuses on what the clinical surgeon needs to know to optimize the benefit of gene therapy for patients with cancer.", "evidence_relation": "supporting" } ] } ] }, "webis-5": { "answer": "Gene therapy has been used in more than 1700 clinical trials for various diseases, including cancer [24520527]. It offers innovative approaches for cancer treatment. . [36096566]. However, it has also been associated with drawbacks and successes [24520527]. The surgeon plays a pivotal role in the diagnosis and treatment of cancer, and understanding gene therapy is essential for managing patients with neoplastic disease. . [36096566].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy has been used in more than 1700 clinical trials for various diseases, including cancer [24520527].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "24520527", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It offers innovative approaches for cancer treatment. .", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "However, it has also been associated with drawbacks and successes [24520527].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "24520527", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The surgeon plays a pivotal role in the diagnosis and treatment of cancer, and understanding gene therapy is essential for managing patients with neoplastic disease. .", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-gpt-1": { "answer": "Gene therapy can have various effects on an organism, including the potential to correct genetic disorders, enhance immune responses, or provide therapeutic benefits for diseases such as cancer. By introducing, removing, or altering genetic material within a patient's cells, gene therapy aims to treat or prevent disease at the molecular level, leading to improved health outcomes. However, the specific effects can vary widely depending on the target condition, the method of delivery, and the genes involved.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy can have various effects on an organism, including the potential to correct genetic disorders, enhance immune responses, or provide therapeutic benefits for diseases such as cancer.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "By introducing, removing, or altering genetic material within a patient's cells, gene therapy aims to treat or prevent disease at the molecular level, leading to improved health outcomes.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "However, the specific effects can vary widely depending on the target condition, the method of delivery, and the genes involved.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "Gene therapy can enhance the effectiveness of cancer treatments by directly targeting the genetic material of somatic cells within the organism, leading to improved therapeutic outcomes, particularly in conditions like head and neck cancers [29334764]. This approach represents a significant advancement in cancer therapy, potentially increasing the efficacy of existing treatments.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy can enhance the effectiveness of cancer treatments by directly targeting the genetic material of somatic cells within the organism, leading to improved therapeutic outcomes, particularly in conditions like head and neck cancers [29334764].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29334764", "evidence_support": " Thus, gene therapy may become an important part of anticancer therapy and is expected to improve the therapeutic effect of head and neck cancers in the near future.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This approach represents a significant advancement in cancer therapy, potentially increasing the efficacy of existing treatments.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-6": { "answer": "Gene therapy can have various effects on an organism, primarily aimed at correcting genetic disorders by introducing, removing, or altering genetic material within a patient's cells. While the provided context does not specifically address the effects of gene therapy, it is generally understood that successful gene therapy can lead to the restoration of normal function in affected cells, potentially improving health outcomes and quality of life for individuals with genetic conditions.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy can have various effects on an organism, primarily aimed at correcting genetic disorders by introducing, removing, or altering genetic material within a patient's cells.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "While the provided context does not specifically address the effects of gene therapy, it is generally understood that successful gene therapy can lead to the restoration of normal function in affected cells, potentially improving health outcomes and quality of life for individuals with genetic conditions.", "answer_sentence_relevance": "borderline", "citation_assessment": null } ] }, "zero-shot-gemini-flash": { "answer": "Gene therapy aims to deliver nucleic acids to cells to achieve a therapeutic effect [33949931]. The goal is to deliver the gene construct to the target cell, achieve stable transduction, and produce a therapeutic effect [30781363]. Gene therapy could permanently correct or improve the clinical manifestations of many genetic diseases [17979686]. Gene transfer systems can be used to study cell function, and overexpression of a transgene can restore or improve protein function [11735335]. This can positively influence cell function and counterbalance cellular pathophysiology [11735335]. Gene therapy can quickly affect the production of biologic response modifiers in a highly compartmentalized fashion [11735335]. However, immune responses to the therapeutic protein pose a significant hurdle for successful gene therapy [17979686]. Problematic immune responses can include the development of a cytotoxic T lymphocyte (CTL) response that destroys genetically-modified cells or the formation of antibodies against the therapeutic protein [17979686]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy aims to deliver nucleic acids to cells to achieve a therapeutic effect [33949931].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33949931", "evidence_support": "Gene therapy is a technique that aims at the delivery of nucleic acids to cells, to obtain a therapeutic effect.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The goal is to deliver the gene construct to the target cell, achieve stable transduction, and produce a therapeutic effect [30781363].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30781363", "evidence_support": "The main objective of gene therapy is to deliver an adequate amount of gene construct to the intended target cell, achieve stable transduction in target cells, and to produce a clinically therapeutic effect.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Gene therapy could permanently correct or improve the clinical manifestations of many genetic diseases [17979686].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17979686", "evidence_support": "Gene therapy could result in the permanent correction or amelioration of the clinical manifestations of many genetic diseases.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Gene transfer systems can be used to study cell function, and overexpression of a transgene can restore or improve protein function [11735335].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "11735335", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "This can positively influence cell function and counterbalance cellular pathophysiology [11735335].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "11735335", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Gene therapy can quickly affect the production of biologic response modifiers in a highly compartmentalized fashion [11735335].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "11735335", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "7", "answer_sentence": "However, immune responses to the therapeutic protein pose a significant hurdle for successful gene therapy [17979686].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17979686", "evidence_support": "However, immune responses to the therapeutic protein pose a significant hurdle for successful gene therapy. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Problematic immune responses can include the development of a cytotoxic T lymphocyte (CTL) response that destroys genetically-modified cells or the formation of antibodies against the therapeutic protein [17979686].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "17979686", "evidence_support": "Problematic immune responses can include the development of a cytotoxic T lymphocyte (CTL) response that results in the destruction of genetically-modified cells and/or the formation of antibodies directed against the therapeutic protein.", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "Gene therapy is a promising approach that modifies gene expression to treat, cure, or prevent diseases, particularly in cancer and genetic disorders [11706603, 34790341]. It typically involves using vectors, often viruses, to deliver therapeutic genes to target cells [11706603]. This technique can lead to significant effects, such as reversing disease phenotypes, enhancing immune responses, and improving organ function [37800996, 8561476]. For instance, gene therapy has shown potential in treating conditions like hemophilia and cystic fibrosis by correcting genetic defects [11470139, 7485213]. Additionally, advancements in gene delivery systems have improved the safety and efficacy of these therapies, allowing for long-term expression of beneficial genes [31972133, 18391581]. Overall, gene therapy holds the potential to transform treatment options across various diseases, offering hope for previously intractable conditions [32718206, 11382597].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Gene therapy is a promising approach that modifies gene expression to treat, cure, or prevent diseases, particularly in cancer and genetic disorders [11706603, 34790341].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34790341", "evidence_support": "Gene therapies can treat, prevent, or cure a disease by changing the expression of a person's genes. ", "evidence_relation": "supporting" }, { "cited_pmid": "11706603", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It typically involves using vectors, often viruses, to deliver therapeutic genes to target cells [11706603].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "11706603", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This technique can lead to significant effects, such as reversing disease phenotypes, enhancing immune responses, and improving organ function [37800996, 8561476].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37800996", "evidence_support": "Hematopoietic stem cell transplant (HSCT) is the only readily available curative option for sickle cell disease (SCD).", "evidence_relation": "neutral" }, { "cited_pmid": "37800996", "evidence_support": "HSCT, both allogeneic and autologous gene therapy, in the SCD population reverses the sickle phenotype, prevents further organ damage, can resolve prior organ dysfunction in both pediatric and adult patients. ", "evidence_relation": "supporting" }, { "cited_pmid": "8561476", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "For instance, gene therapy has shown potential in treating conditions like hemophilia and cystic fibrosis by correcting genetic defects [11470139, 7485213].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "11470139", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "7485213", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, advancements in gene delivery systems have improved the safety and efficacy of these therapies, allowing for long-term expression of beneficial genes [31972133, 18391581].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "31972133", "evidence_support": "Gene therapy with adeno-associated virus (AAV) vectors has demonstrated safety and long-term efficacy in a number of trials across target organs, including eye, liver, skeletal muscle, and the central nervous system.", "evidence_relation": "supporting" }, { "cited_pmid": "18391581", "evidence_support": "Techniques have employed viral and nonviral vectors to deliver gene modulating compounds directly into the cell.", "evidence_relation": "neutral" }, { "cited_pmid": "18391581", "evidence_support": "While continued research and clinical trials are needed to identify a robust system of gene delivery, gene therapy techniques have great potential to treat kidney disease at the cellular level and improve patient quality of life.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, gene therapy holds the potential to transform treatment options across various diseases, offering hope for previously intractable conditions [32718206, 11382597].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "32718206", "evidence_support": "The promise of genetic therapies has turned into reality in recent years, with new first-line treatments for fatal diseases now available to patients.", "evidence_relation": "supporting" }, { "cited_pmid": "11382597", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] } } }, { "question_id": "128", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "The effects of CBD on liver enzymes and overall liver function have been studied in various contexts, though conclusive evidence on long-term damage is still emerging. CBD has been associated with changes in liver enzyme levels, particularly in the context of its interaction with other substances. For example, studies have shown that certain dietary patterns and supplements can influence liver enzyme levels, suggesting that the liver's response to CBD may vary based on additional factors like diet and concurrent medication use [26749006]. Additionally, while some medications and substances may elevate liver enzyme levels, their long-term impact on liver health depends on dosage and individual patient factors.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The effects of CBD on liver enzymes and overall liver function have been studied in various contexts, though conclusive evidence on long-term damage is still emerging.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "CBD has been associated with changes in liver enzyme levels, particularly in the context of its interaction with other substances.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "For example, studies have shown that certain dietary patterns and supplements can influence liver enzyme levels, suggesting that the liver's response to CBD may vary based on additional factors like diet and concurrent medication use [26749006].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "26749006", "evidence_support": "This study provides the first evidence for a diet-calibre relationship in children and adolescents with type 1 diabetes.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, while some medications and substances may elevate liver enzyme levels, their long-term impact on liver health depends on dosage and individual patient factors.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "CBD can cause elevations in serum ALT levels and hypertransaminasemia (ALT/AST) in some users, indicating potential liver enzyme disruption [33022751, 37458709, 36863504]. It inhibits cytochrome P450 enzymes, including CYP2C19, CYP3A, CYP2C9, and CYP2D6, affecting liver metabolism and drug interactions [23318708, 21356216, 22166891]. The inhibition of CYP2C19 and CYP2D6 by CBD is concentration-dependent, with CYP2D6 inhibition being stronger than other cannabinoids and involving its structural components [23318708, 21821735, 24160757]. CBD's inhibition of CYP2D6 is competitive, not metabolism-dependent, and occurs with K(i) values of 1.16 to 2.69 \u03bcM [21821735, 34491040, 22129319]. This inhibition can significantly impact drug metabolism [24160757, 34491040, 22129319]. CBD can produce reactive oxygen species, leading to hepatotoxicity, which is influenced by individual susceptibility and genetic factors [18929579, 37088127, 35631293]. Despite these risks, CBD can also prevent liver steatosis, alleviate liver inflammation via NF-\u03baB and NLRP3 pathways, and reduce oxidative stress [28935932, 21362471, 34630100]. Due to these varied effects, dose modification may be necessary in cases of hepatic impairment [30921490, 31288397, 36972999].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "CBD can cause elevations in serum ALT levels and hypertransaminasemia (ALT/AST) in some users, indicating potential liver enzyme disruption [33022751, 37458709, 36863504].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury.", "evidence_relation": "supporting" }, { "cited_pmid": "37458709", "evidence_support": "We conclude that the marked increased incidence of CBD-associated ALT elevations in patients already receiving VPA is unlikely to involve the three major mechanisms of direct hepatotoxicity.", "evidence_relation": "contradicting" }, { "cited_pmid": "36863504", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It inhibits cytochrome P450 enzymes, including CYP2C19, CYP3A, CYP2C9, and CYP2D6, affecting liver metabolism and drug interactions [23318708, 21356216, 22166891].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23318708", "evidence_support": "These results indicate that CBD caused potent CYP2C19 inhibition, in which one free phenolic hydroxyl group and the pentyl side chain of CBD may play important roles.", "evidence_relation": "supporting" }, { "cited_pmid": "21356216", "evidence_support": "This study indicated that CBD most potently inhibited catalytic activity of human CYP3A enzymes, especially CYP3A4 and CYP3A5.", "evidence_relation": "supporting" }, { "cited_pmid": "22166891", "evidence_support": "These results indicated that the three major phytocannabinoids but not PAHs contained in marijuana smoke potently inhibited CYP2C9 activity and that these cannabinoids can be characterized as direct inhibitors for CYP2C9.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The inhibition of CYP2C19 and CYP2D6 by CBD is concentration-dependent, with CYP2D6 inhibition being stronger than other cannabinoids and involving its structural components [23318708, 21821735, 24160757].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23318708", "evidence_support": "These results indicate that CBD caused potent CYP2C19 inhibition, in which one free phenolic hydroxyl group and the pentyl side chain of CBD may play important roles.\n", "evidence_relation": "supporting" }, { "cited_pmid": "21821735", "evidence_support": "These results indicated that CBD caused potent direct CYP2D6 inhibition, in which two phenolic hydroxyl groups and the pentyl side chain of CBD may play important roles.\n", "evidence_relation": "supporting" }, { "cited_pmid": "24160757", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "CBD's inhibition of CYP2D6 is competitive, not metabolism-dependent, and occurs with K(i) values of 1.16 to 2.69 \u03bcM [21821735, 34491040, 22129319].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "21821735", "evidence_support": "CBD competitively inhibited the CYP2D6 activities with the apparent K(i) values of 1.16 to 2.69 \u03bcM.", "evidence_relation": "supporting" }, { "cited_pmid": "34491040", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "22129319", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "This inhibition can significantly impact drug metabolism [24160757, 34491040, 22129319].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24160757", "evidence_support": "Studies of THC, CBD, and CBN inhibition and induction of major human CYP-450 isoforms generally reflect a low risk of clinically significant drug interactions with most use, but specific human data are lacking.", "evidence_relation": "neutral" }, { "cited_pmid": "34491040", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "22129319", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "CBD can produce reactive oxygen species, leading to hepatotoxicity, which is influenced by individual susceptibility and genetic factors [18929579, 37088127, 35631293].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18929579", "evidence_support": "The present results suggest that CBDHQ formed during hepatic microsomal metabolism of CBD is capable of generating ROS and inducing cell toxicity.\n", "evidence_relation": "supporting" }, { "cited_pmid": "35631293", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "37088127", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Despite these risks, CBD can also prevent liver steatosis, alleviate liver inflammation via NF-\u03baB and NLRP3 pathways, and reduce oxidative stress [28935932, 21362471, 34630100].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28935932", "evidence_support": "Furthermore, CBD improved alcohol-induced hepatic metabolic dysregulation and steatosis by restoring changes in hepatic mRNA or protein expression of ACC-1, FASN, PPAR\u03b1, MCAD, ADIPOR-1, and mCPT-1. Thus, CBD may have therapeutic potential in the treatment of alcoholic liver diseases associated with inflammation, oxidative stress and steatosis, which deserves exploration in human trials.", "evidence_relation": "supporting" }, { "cited_pmid": "21362471", "evidence_support": "CBD significantly reduced the extent of liver inflammation, oxidative/nitrative stress, and cell death and also attenuated the bacterial endotoxin-triggered NF-\u03baB activation and TNF-\u03b1 production in isolated Kupffer cells, ", "evidence_relation": "supporting" }, { "cited_pmid": "34630100", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Due to these varied effects, dose modification may be necessary in cases of hepatic impairment [30921490, 31288397, 36972999].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "30921490", "evidence_support": "These findings indicate that dose modification is necessary in patients with moderate and severe hepatic impairment, and a lower starting dose and slower titration are necessary based on benefit-risk.", "evidence_relation": "supporting" }, { "cited_pmid": "31288397", "evidence_support": "General clinical recommendations of reducing substrate doses, monitoring for ADEs, and finding alternative therapy should be considered, especially in medically complex patients.", "evidence_relation": "supporting" }, { "cited_pmid": "36972999", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Cannabidiol (CBD) can significantly impact liver enzymes, particularly alanine aminotransferase (ALT).In a phase I clinical trial, 44% of healthy adults taking 1,500 mg/day of CBD experienced ALT elevations above the upper limit of normal (ULN), with 31% exceeding 5\u00d7 ULN, meeting criteria for drug-induced liver injury [33022751]. The mechanism involves reactive oxygen species (ROS) production during CBD metabolism, contributing to hepatotoxicity [37458709, 18929579]. Additionally, CBD inhibits several cytochrome P450 enzymes, including CYP1A2, CYP2C19, and CYP3A4, which can alter the metabolism of other drugs and potentially exacerbate liver enzyme elevations [20117100, 23318708, 21356216]. These effects are dose-dependent and can be influenced by co-administration with other hepatotoxic drugs, such as valproate, which increases the risk of liver enzyme elevations . Therefore, monitoring liver function is crucial when administering high doses of CBD, especially in patients with pre-existing liver conditions or those taking other medications metabolized by CYP enzymes [37458709].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) can significantly impact liver enzymes, particularly alanine aminotransferase (ALT).In a phase I clinical trial, 44% of healthy adults taking 1,500 mg/day of CBD experienced ALT elevations above the upper limit of normal (ULN), with 31% exceeding 5\u00d7 ULN, meeting criteria for drug-induced liver injury [33022751].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "Seven (44%) participants experienced peak serum alanine aminotransferase (ALT) values greater than the upper limit of normal (ULN). For five (31%) participants, the value exceeded\u00a05\u00a0\u00d7\u00a0ULN, therefore meeting the international consensus criteria for drug-induced liver injury.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The mechanism involves reactive oxygen species (ROS) production during CBD metabolism, contributing to hepatotoxicity [37458709, 18929579].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "37458709", "evidence_support": "We gathered in vitro data assessing the potential for CBD, the two major CBD metabolites, and VPA to cause hepatotoxicity via inhibition of bile acid transporters, mitochondrial dysfunction, and production of reactive oxygen species (ROS).", "evidence_relation": "supporting" }, { "cited_pmid": "18929579", "evidence_support": "The present results suggest that CBDHQ formed during hepatic microsomal metabolism of CBD is capable of generating ROS and inducing cell toxicity.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, CBD inhibits several cytochrome P450 enzymes, including CYP1A2, CYP2C19, and CYP3A4, which can alter the metabolism of other drugs and potentially exacerbate liver enzyme elevations [20117100, 23318708, 21356216].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23318708", "evidence_support": "These results indicate that CBD caused potent CYP2C19 inhibition, in which one free phenolic hydroxyl group and the pentyl side chain of CBD may play important roles.", "evidence_relation": "supporting" }, { "cited_pmid": "21356216", "evidence_support": "This study indicated that CBD most potently inhibited catalytic activity of human CYP3A enzymes, especially CYP3A4 and CYP3A5.", "evidence_relation": "supporting" }, { "cited_pmid": "20117100", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "These effects are dose-dependent and can be influenced by co-administration with other hepatotoxic drugs, such as valproate, which increases the risk of liver enzyme elevations .", "answer_sentence_relevance": "borderline", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Therefore, monitoring liver function is crucial when administering high doses of CBD, especially in patients with pre-existing liver conditions or those taking other medications metabolized by CYP enzymes [37458709].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "37458709", "evidence_support": "We conclude that the marked increased incidence of CBD-associated ALT elevations in patients already receiving VPA is unlikely to involve the three major mechanisms of direct hepatotoxicity.", "evidence_relation": "contradicting" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Cannabidiol (CBD) has been shown to inhibit various liver enzymes, including cytochrome P450 (CYP) enzymes, which play a crucial role in the metabolism of many drugs [20117100, 23318708, 21821735]. Specifically, CBD has been found to inhibit CYP1A1, CYP1A2, CYP2C9, CYP2C19, CYP2D6, and CYP3A4 [20117100, 23318708, 21821735]. This inhibition can lead to increased levels of certain drugs in the body, potentially increasing the risk of adverse effects [31288397, 37541924]. Additionally, CBD has been shown to induce CYP2C19 and CYP3A4, which can lead to decreased levels of certain drugs [37313955]. The mechanisms of CBD-mediated inhibition of liver enzymes are not fully understood, but may involve disruption of critical metabolic pathways and liver enzyme functions [37088127]. Overall, the effects of CBD on liver enzymes highlight the potential for drug-drug interactions and the need for careful consideration when using CBD in conjunction with other medications.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) has been shown to inhibit various liver enzymes, including cytochrome P450 (CYP) enzymes, which play a crucial role in the metabolism of many drugs [20117100, 23318708, 21821735].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20117100", "evidence_support": "Inhibitory effects of Delta(9)-tetrahydrocannabinol (Delta(9)-THC), cannabidiol (CBD), and cannabinol (CBN), the three major constituents in marijuana, on catalytic activities of human cytochrome P450 (CYP) 1 enzymes were investigated.", "evidence_relation": "supporting" }, { "cited_pmid": "20117100", "evidence_support": "CBD most potently inhibited the CYP1A1 activity; the apparent K(i) value (0.155microM) was at least one-seventeenth of the values for other CYP1 isoforms.", "evidence_relation": "supporting" }, { "cited_pmid": "23318708", "evidence_support": "The present study investigated the inhibitory effect of cannabidiol (CBD), a major constituent of marijuana, on the catalytic activity of cytochrome P450 2C19 (CYP2C19).", "evidence_relation": "supporting" }, { "cited_pmid": "23318708", "evidence_support": "These results indicate that CBD caused potent CYP2C19 inhibition, in which one free phenolic hydroxyl group and the pentyl side chain of CBD may play important roles.", "evidence_relation": "supporting" }, { "cited_pmid": "21821735", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Specifically, CBD has been found to inhibit CYP1A1, CYP1A2, CYP2C9, CYP2C19, CYP2D6, and CYP3A4 [20117100, 23318708, 21821735].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "23318708", "evidence_support": "These results indicate that CBD caused potent CYP2C19 inhibition, in which one free phenolic hydroxyl group and the pentyl side chain of CBD may play important roles", "evidence_relation": "supporting" }, { "cited_pmid": "20117100", "evidence_support": "These results indicated that CBD and CBN showed CYP1 isoform-selective direct inhibition and that CBD was characterized as a potent mechanism-based inhibitor of human CYP1 enzymes, especially CYP1A1.", "evidence_relation": "supporting" }, { "cited_pmid": "21821735", "evidence_support": "These results indicated that CBD caused potent direct CYP2D6 inhibition, in which two phenolic hydroxyl groups and the pentyl side chain of CBD may play important roles.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This inhibition can lead to increased levels of certain drugs in the body, potentially increasing the risk of adverse effects [31288397, 37541924].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37541924", "evidence_support": "The relevance of CBD-drug interactions is largely unknown.", "evidence_relation": "contradicting" }, { "cited_pmid": "31288397", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, CBD has been shown to induce CYP2C19 and CYP3A4, which can lead to decreased levels of certain drugs [37313955].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37313955", "evidence_support": "Cannabidiol (CBD) and \u0394-9-tetrahydrocannabinol (\u03949-THC), the most abundant phytocannabinoids, are in vitro reversible and time-dependent (CBD only) inhibitors of several cytochrome P450 (CYP) enzymes. ", "evidence_relation": "supporting" }, { "cited_pmid": "37313955", "evidence_support": "The CBD\u2009+\u2009\u03949-THC brownie inhibited CYP2C19\u2009>\u2009CYP2C9\u2009>\u2009CYP3A\u2009>\u2009CYP1A2 (but not CYP2D6) activity, as evidenced by an increase in the geometric mean ratio of probe drug area under the plasma concentration-time curve (AUC) relative to placebo (AUCGMR ) of omeprazole, losartan, midazolam, and caffeine by 207%, 77%, 56%, and 39%, respectively. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The mechanisms of CBD-mediated inhibition of liver enzymes are not fully understood, but may involve disruption of critical metabolic pathways and liver enzyme functions [37088127].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37088127", "evidence_support": "The mechanisms of CBD-mediated toxicity are not fully understood, but they may involve disruption of critical metabolic pathways and liver enzyme functions, receptor-specific binding activity, disruption of testosterone steroidogenesis, inhibition of reuptake and degradation of endocannabinoids, and the triggering of oxidative stress", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, the effects of CBD on liver enzymes highlight the potential for drug-drug interactions and the need for careful consideration when using CBD in conjunction with other medications.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "Cannabidiol (CBD) may cause liver damage in some individuals, as evidenced by elevated liver enzymes, particularly alanine aminotransferase (ALT) and aspartate aminotransferase (AST) [31052254, 33022751]. In a study of healthy adults, 44% of participants experienced peak serum ALT values greater than the upper limit of normal, and 31% had values exceeding 5 times the upper limit of normal, indicating potential liver injury [33022751]. However, other studies suggest that CBD may have protective effects on the liver, such as reducing inflammation and oxidative stress, and promoting liver regeneration [19086956, 20597071, 17652447]. The effects of CBD on liver enzymes may vary depending on the individual, the dose and duration of CBD use, and the presence of underlying liver disease [33022751]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) may cause liver damage in some individuals, as evidenced by elevated liver enzymes, particularly alanine aminotransferase (ALT) and aspartate aminotransferase (AST) [31052254, 33022751].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31052254", "evidence_support": "As in the acute phase, 615 mg/kg CBD increased LBW ratios, ALT, AST, and total bilirubin.", "evidence_relation": "supporting" }, { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In a study of healthy adults, 44% of participants experienced peak serum ALT values greater than the upper limit of normal, and 31% had values exceeding 5 times the upper limit of normal, indicating potential liver injury [33022751].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "Seven (44%) participants experienced peak serum alanine aminotransferase (ALT) values greater than the upper limit of normal (ULN). For five (31%) participants, the value exceeded\u00a05\u00a0\u00d7\u00a0ULN, therefore meeting the international consensus criteria for drug-induced liver injury", "evidence_relation": "supporting" }, { "cited_pmid": "33022751", "evidence_support": "healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, other studies suggest that CBD may have protective effects on the liver, such as reducing inflammation and oxidative stress, and promoting liver regeneration [19086956, 20597071, 17652447].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19086956", "evidence_support": "The similar pattern found between the effect of cannabinoids and their antagonists on brain and liver indicated that the therapeutic effect might be directed by the improvement in both organs through CB2 receptors and/or TRPV1 receptors.", "evidence_relation": "supporting" }, { "cited_pmid": "20597071", "evidence_support": "CB2 receptors reduce liver injury and promote liver regeneration following acute insult, via distinct paracrine mechanisms involving hepatic myofibroblasts. These results suggest that CB2 agonists display potent hepatoprotective properties, in addition to their antifibrogenic effects.", "evidence_relation": "supporting" }, { "cited_pmid": "17652447", "evidence_support": "These findings suggest that selective CB(2) receptor agonists may represent a novel, protective strategy against I/R injury by attenuating oxidative stress, inflammatory response, and apoptosis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The effects of CBD on liver enzymes may vary depending on the individual, the dose and duration of CBD use, and the presence of underlying liver disease [33022751].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury. Given the demonstrated interindividual variation in susceptibility, clinicians should be alert to this potential effect from CBD, which is increasingly available in various nonprescription forms and doses to consumers.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Cannabidiol (CBD) may cause liver enzyme elevations in some individuals, which can be a sign of liver injury [36912195, 33022751, 31052254]. Studies have shown that CBD can cause elevations in serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in healthy adults, and in some cases, these elevations can be severe enough to meet the criteria for drug-induced liver injury [34918948, 36912195, 33022751]. The risk of liver enzyme elevations appears to be higher in individuals taking high doses of CBD, and the incidence is also increased in individuals taking CBD in combination with other medications [34918948, 36912195, 33022751]. The exact mechanisms by which CBD causes liver enzyme elevations are not fully understood, but it is thought to be related to its effects on the liver's metabolism and its ability to induce oxidative stress [35631293, 34918948, 21704641]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) may cause liver enzyme elevations in some individuals, which can be a sign of liver injury [36912195, 33022751, 31052254].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36912195", "evidence_support": "Findings of liver enzyme elevations in recent cannabidiol studies have raised concerns over liver safety.", "evidence_relation": "supporting" }, { "cited_pmid": "36912195", "evidence_support": "Cannabidiol use was associated with an increased probability of liver enzyme elevation (N\u00a0=\u00a012 trials, n\u00a0=\u00a01229; OR\u00a0=\u00a05.85 95% CI\u00a0=\u00a03.84-8.92, p\u00a0<\u00a00.001) and DILI (N\u00a0=\u00a012 trials, n\u00a0=\u00a01229; OR\u00a0=\u00a04.82 95% CI\u00a0=\u00a02.46-9.45, p\u00a0<\u00a00.001) compared to placebo controls", "evidence_relation": "supporting" }, { "cited_pmid": "36912195", "evidence_support": "Cannabidiol-associated liver enzyme elevations and DILI meet the criteria of common adverse drug events.", "evidence_relation": "supporting" }, { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury.", "evidence_relation": "supporting" }, { "cited_pmid": "31052254", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Studies have shown that CBD can cause elevations in serum alanine aminotransferase (ALT) and aspartate aminotransferase (AST) in healthy adults, and in some cases, these elevations can be severe enough to meet the criteria for drug-induced liver injury [34918948, 36912195, 33022751].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34918948", "evidence_support": "Previous studies have suggested that prescribed cannabidiol (CBD) products may cause elevations in liver tests (LT).", "evidence_relation": "supporting" }, { "cited_pmid": "34918948", "evidence_support": "At the end of 30 days, LTs were obtained. Follow-up LTs were offered to all individuals with elevated alanine transaminase (ALT) values. Results: A total of 28,121 individuals were invited to participate in this study, 1475 enrolled, and 839 (female: 65.3%, male: 34.7%) completed the study. Full-spectrum hemp oil was used by 55.7%, CBD-isolate by 40.5%, and broad spectrum by 3.8%. The mean\u00b1SD daily dose of CBD was 50.3+40.7\u2009mg. The prevalence of elevated ALT was 9.1%, aspartate aminotransferase (AST) 4.0%, alkaline phosphatase 1.9%, total bilirubin 1.7%, with 85.5% of the ALT elevations <2\u00d7the upper limit of normal (ULN) with only 0.3% having ALT levels >3\u00d7 ULN. The prevalence of ALT and AST elevations (9.1% and 4.0%) were not significantly different from known adult general population prevalences (8.9% and 4.9%)", "evidence_relation": "supporting" }, { "cited_pmid": "34918948", "evidence_support": "There was no significant association between CBD dosage and LT values", "evidence_relation": "contradicting" }, { "cited_pmid": "34918948", "evidence_support": "Self-medication of CBD does not appear to be associated with an increased prevalence of LT elevation and most of the LT elevations are likely due to the conditions/medications for which the individuals are taking CBD.", "evidence_relation": "contradicting" }, { "cited_pmid": "36912195", "evidence_support": "Findings of liver enzyme elevations in recent cannabidiol studies have raised concerns over liver safety", "evidence_relation": "supporting" }, { "cited_pmid": "36912195", "evidence_support": "Cannabidiol use was associated with an increased probability of liver enzyme elevation (N\u00a0=\u00a012 trials, n\u00a0=\u00a01229; OR\u00a0=\u00a05.85 95% CI\u00a0=\u00a03.84-8.92, p\u00a0<\u00a00.001) and DILI (N\u00a0=\u00a012 trials, n\u00a0=\u00a01229; OR\u00a0=\u00a04.82 95% CI\u00a0=\u00a02.46-9.45, p\u00a0<\u00a00.001) compared to placebo controls", "evidence_relation": "supporting" }, { "cited_pmid": "36912195", "evidence_support": "Cannabidiol-associated liver enzyme elevations and DILI meet the criteria of common adverse drug events", "evidence_relation": "supporting" }, { "cited_pmid": "33022751", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The risk of liver enzyme elevations appears to be higher in individuals taking high doses of CBD, and the incidence is also increased in individuals taking CBD in combination with other medications [34918948, 36912195, 33022751].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34918948", "evidence_support": "The prevalence of ALT and AST elevations (9.1% and 4.0%) were not significantly different from known adult general population prevalences (8.9% and 4.9%). There was no significant association between CBD dosage and LT values.", "evidence_relation": "contradicting" }, { "cited_pmid": "36912195", "evidence_support": "In participants taking cannabidiol (N\u00a0=\u00a028 trials, n\u00a0=\u00a01533), the pooled proportion of liver enzyme elevations was 0.074 (95% CI 0.0448-0.1212),", "evidence_relation": "supporting" }, { "cited_pmid": "36912195", "evidence_support": "High-dose CBD (\u22651000\u00a0mg/day or \u226520\u00a0mg/kg/day) and concomitant antiepileptic drug use were identified as risk factors.", "evidence_relation": "supporting" }, { "cited_pmid": "33022751", "evidence_support": "Seven (44%) participants experienced peak serum alanine aminotransferase (ALT) values greater than the upper limit of normal (ULN). For five (31%) participants, the value exceeded\u00a05\u00a0\u00d7\u00a0ULN, therefore meeting the international consensus criteria for drug-induced liver injury.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The exact mechanisms by which CBD causes liver enzyme elevations are not fully understood, but it is thought to be related to its effects on the liver's metabolism and its ability to induce oxidative stress [35631293, 34918948, 21704641].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "21704641", "evidence_support": "Cannabidiol (CBD), one of the major constituents in marijuana, has been shown to be extensively metabolized by experimental animals and humans. However, human hepatic enzymes responsible for the CBD metabolism remain to be elucidated.", "evidence_relation": "neutral" }, { "cited_pmid": "34918948", "evidence_support": "Previous studies have suggested that prescribed cannabidiol (CBD) products may cause elevations in liver tests (LT).", "evidence_relation": "neutral" }, { "cited_pmid": "35631293", "evidence_support": "Collectively, these data suggest that consumers should be aware of the appreciable pharmacokinetic differences between commercial CBD formulations, CBD is unlikely to influence the caloric cost of eating but may prove to be of some benefit to initial metabolic responses, consuming CBD with food alters the dynamics of CBD metabolism and increases systemic availability, and low-dose CBD probably does not represent a risk to normal liver function.", "evidence_relation": "neutral" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Cannabidiol (CBD) may cause elevations in liver tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in some individuals, particularly at high doses [36863504, 34918948, 31052254]. However, the prevalence of elevated liver enzymes in adults taking CBD is not significantly different from the general adult population [34918948, 35631293]. CBD may also affect liver function by regulating the NF-\u03baB and NLRP3 inflammasome pathways, and may have a protective effect against liver inflammation and oxidative stress [31032942, 34630100]. The mechanisms of CBD-mediated liver effects are not fully understood, but may involve disruption of critical metabolic pathways and liver enzyme functions [20117100, 37458709, 31052254]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) may cause elevations in liver tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in some individuals, particularly at high doses [36863504, 34918948, 31052254].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36863504", "evidence_support": "In double-blinded, placebo-controlled clinical trials, elevated ALT levels were observed in some patients, but these findings could not be uncoupled from the confounds of potential drug-drug interactions with co-administration of valproate and clobazam.", "evidence_relation": "contradicting" }, { "cited_pmid": "34918948", "evidence_support": "Previous studies have suggested that prescribed cannabidiol (CBD) products may cause elevations in liver tests (LT). This study compared the prevalence of elevated LT in an adult population self-administering CBD with the normal and general adult population prevalences.", "evidence_relation": "supporting" }, { "cited_pmid": "34918948", "evidence_support": "Self-medication of CBD does not appear to be associated with an increased prevalence of LT elevation and most of the LT elevations are likely due to the conditions/medications for which the individuals are taking CBD.", "evidence_relation": "contradicting" }, { "cited_pmid": "31052254", "evidence_support": "In the acute study, significant increases in liver-to-body weight (LBW) ratios, plasma ALT, AST, and total bilirubin were observed for the 2460 mg/kg dose.", "evidence_relation": "supporting" }, { "cited_pmid": "31052254", "evidence_support": ". In conclusion, CBD exhibited clear signs of hepatotoxicity, possibly of a cholestatic nature.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "However, the prevalence of elevated liver enzymes in adults taking CBD is not significantly different from the general adult population [34918948, 35631293].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34918948", "evidence_support": "Self-medication of CBD does not appear to be associated with an increased prevalence of LT elevation and most of the LT elevations are likely due to the conditions/medications for which the individuals are taking CBD.", "evidence_relation": "supporting" }, { "cited_pmid": "35631293", "evidence_support": "Finally, CBD did not evoke physiologically relevant changes in markers of liver function.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "CBD may also affect liver function by regulating the NF-\u03baB and NLRP3 inflammasome pathways, and may have a protective effect against liver inflammation and oxidative stress [31032942, 34630100].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31032942", "evidence_support": "In conclusion, the suppression of the activation of NLRP3 inflammasome through deactivation of NF-\u03baB in macrophages by CBD might be one mechanism of its anti-inflammatory function in the liver.", "evidence_relation": "supporting" }, { "cited_pmid": "34630100", "evidence_support": "CBD treatment inhibited macrophage recruitment and suppressed activation of NF\u03baB-NLRP3-pyroptosis pathway in mice livers. The hepatoprotective property of CBD in the current model might be a result of inhibition of inflammation via alleviating activation of the hepatic NF\u03baB-NLRP3 inflammasome-pyroptosis pathway by CBD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The mechanisms of CBD-mediated liver effects are not fully understood, but may involve disruption of critical metabolic pathways and liver enzyme functions [20117100, 37458709, 31052254].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20117100", "evidence_support": "These results indicated that CBD and CBN showed CYP1 isoform-selective direct inhibition and that CBD was characterized as a potent mechanism-based inhibitor of human CYP1 enzymes, especially CYP1A1.", "evidence_relation": "supporting" }, { "cited_pmid": "31052254", "evidence_support": "In conclusion, CBD exhibited clear signs of hepatotoxicity, possibly of a cholestatic nature.", "evidence_relation": "supporting" }, { "cited_pmid": "31052254", "evidence_support": "The involvement of numerous pathways associated with lipid and xenobiotic metabolism raises serious concerns about potential drug interactions as well as the safety of CBD.", "evidence_relation": "supporting" }, { "cited_pmid": "37458709", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Cannabidiol (CBD) may cause elevations in liver tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in some individuals, particularly at high doses [36863504, 31052254, 33022751]. However, the prevalence of elevated liver enzymes in adults taking CBD is not significantly different from the general adult population [35631293, 36968131, 34918948]. CBD may also affect liver function by regulating the NF-\u03baB and NLRP3 inflammasome pathways, and may have a protective effect against liver inflammation and oxidative stress [34630100, 31032942]. The mechanisms of CBD-mediated liver effects are not fully understood, but may involve disruption of critical metabolic pathways and liver enzyme functions [37088127, 20117100, 36912195]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) may cause elevations in liver tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in some individuals, particularly at high doses [36863504, 31052254, 33022751].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36863504", "evidence_support": "In double-blinded, placebo-controlled clinical trials, elevated ALT levels were observed in some patients, but these findings could not be uncoupled from the confounds of potential drug-drug interactions with co-administration of valproate and clobazam.", "evidence_relation": "contradicting" }, { "cited_pmid": "31052254", "evidence_support": "In the acute study, significant increases in liver-to-body weight (LBW) ratios, plasma ALT, AST, and total bilirubin were observed for the 2460 mg/kg dose.", "evidence_relation": "supporting" }, { "cited_pmid": "31052254", "evidence_support": "As in the acute phase, 615 mg/kg CBD increased LBW ratios, ALT, AST, and total bilirubin", "evidence_relation": "supporting" }, { "cited_pmid": "33022751", "evidence_support": "Seven (44%) participants experienced peak serum alanine aminotransferase (ALT) values greater than the upper limit of normal (ULN). For five (31%) participants, the value exceeded\u00a05\u00a0\u00d7\u00a0ULN, therefore meeting the international consensus criteria for drug-induced liver injury.", "evidence_relation": "supporting" }, { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "However, the prevalence of elevated liver enzymes in adults taking CBD is not significantly different from the general adult population [35631293, 36968131, 34918948].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "35631293", "evidence_support": "Finally, CBD did not evoke physiologically relevant changes in markers of liver function. ", "evidence_relation": "supporting" }, { "cited_pmid": "36968131", "evidence_support": "The prevalences of elevations in ALT and aspartate aminotransferase were not significantly different from those of the general adult population, and the prevalences of elevated levels of alkaline phosphatase and bilirubin were less than those of a healthy adult population.", "evidence_relation": "supporting" }, { "cited_pmid": "34918948", "evidence_support": "The prevalence of ALT and AST elevations (9.1% and 4.0%) were not significantly different from known adult general population prevalences (8.9% and 4.9%).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "CBD may also affect liver function by regulating the NF-\u03baB and NLRP3 inflammasome pathways, and may have a protective effect against liver inflammation and oxidative stress [34630100, 31032942].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34630100", "evidence_support": "CBD treatment inhibited macrophage recruitment and suppressed activation of NF\u03baB-NLRP3-pyroptosis pathway in mice livers. The hepatoprotective property of CBD in the current model might be a result of inhibition of inflammation via alleviating activation of the hepatic NF\u03baB-NLRP3 inflammasome-pyroptosis pathway by CBD.", "evidence_relation": "supporting" }, { "cited_pmid": "31032942", "evidence_support": "CBD significantly inhibited the nuclear factor-\u03baappa B (NF-\u03baB) p65 nuclear translocation and the activation of nucleotide-binding domain like receptor protein 3 (NLRP3) inflammasome both in vivo and in vitro studies, which lead to the reduction of the expression of inflammation-related factors in our studies.", "evidence_relation": "supporting" }, { "cited_pmid": "31032942", "evidence_support": "In conclusion, the suppression of the activation of NLRP3 inflammasome through deactivation of NF-\u03baB in macrophages by CBD might be one mechanism of its anti-inflammatory function in the liver.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The mechanisms of CBD-mediated liver effects are not fully understood, but may involve disruption of critical metabolic pathways and liver enzyme functions [37088127, 20117100, 36912195].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37088127", "evidence_support": "The mechanisms of CBD-mediated toxicity are not fully understood, but they may involve disruption of critical metabolic pathways and liver enzyme functions, receptor-specific binding activity, disruption of testosterone steroidogenesis, inhibition of reuptake and degradation of endocannabinoids, and the triggering of oxidative stress.", "evidence_relation": "supporting" }, { "cited_pmid": "36912195", "evidence_support": "Cannabidiol-associated liver enzyme elevations and DILI meet the criteria of common adverse drug events. Clinicians are encouraged to screen for cannabidiol use and monitor liver function in patients at increased risk.", "evidence_relation": "supporting" }, { "cited_pmid": "20117100", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Cannabidiol (CBD) may cause elevations in liver tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in some individuals, particularly at high doses [33022751, 31052254, 36863504]. However, the prevalence of elevated liver enzymes in adults taking CBD is not significantly different from the general adult population [36968131, 34918948, 35631293]. CBD may also affect liver function by regulating the NF-\u03baB and NLRP3 inflammasome pathways, and may have a protective effect against liver inflammation and oxidative stress [31032942, 34630100]. The mechanisms of CBD-mediated liver effects are not fully understood, but may involve disruption of critical metabolic pathways and liver enzyme functions [33022751, 36912195, 37088127]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) may cause elevations in liver tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in some individuals, particularly at high doses [33022751, 31052254, 36863504].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury.", "evidence_relation": "supporting" }, { "cited_pmid": "31052254", "evidence_support": "In the acute study, significant increases in liver-to-body weight (LBW) ratios, plasma ALT, AST, and total bilirubin were observed for the 2460 mg/kg dose.", "evidence_relation": "supporting" }, { "cited_pmid": "36863504", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "However, the prevalence of elevated liver enzymes in adults taking CBD is not significantly different from the general adult population [36968131, 34918948, 35631293].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36968131", "evidence_support": "cannabidiol (CBD) may result in low levels of male total testosterone (TT), elevations in liver tests (LTs), and daytime drowsiness (DD).", "evidence_relation": "neutral" }, { "cited_pmid": "36968131", "evidence_support": "We investigated the prevalences of TT and LT in a large adult sample self-administering CBD and determined the effect self-dosing of CBD has on the severity of DD.", "evidence_relation": "neutral" }, { "cited_pmid": "36968131", "evidence_support": "CBD was not associated with an increased prevalence of elevation of LT or low levels of TT in men. Furthermore, CBD administration decreased DD and was associated with a lower prevalence of low testosterone levels in older men as compared to age-adjusted population norms.", "evidence_relation": "supporting" }, { "cited_pmid": "34918948", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "35631293", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "CBD may also affect liver function by regulating the NF-\u03baB and NLRP3 inflammasome pathways, and may have a protective effect against liver inflammation and oxidative stress [31032942, 34630100].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31032942", "evidence_support": "CBD significantly inhibited the nuclear factor-\u03baappa B (NF-\u03baB) p65 nuclear translocation and the activation of nucleotide-binding domain like receptor protein 3 (NLRP3) inflammasome both in vivo and in vitro studies, which lead to the reduction of the expression of inflammation-related factors in our studies.", "evidence_relation": "supporting" }, { "cited_pmid": "31032942", "evidence_support": "In conclusion, the suppression of the activation of NLRP3 inflammasome through deactivation of NF-\u03baB in macrophages by CBD might be one mechanism of its anti-inflammatory function in the liver.", "evidence_relation": "supporting" }, { "cited_pmid": "34630100", "evidence_support": "CBD treatment inhibited macrophage recruitment and suppressed activation of NF\u03baB-NLRP3-pyroptosis pathway in mice livers. The hepatoprotective property of CBD in the current model might be a result of inhibition of inflammation via alleviating activation of the hepatic NF\u03baB-NLRP3 inflammasome-pyroptosis pathway by CBD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The mechanisms of CBD-mediated liver effects are not fully understood, but may involve disruption of critical metabolic pathways and liver enzyme functions [33022751, 36912195, 37088127].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury. ", "evidence_relation": "supporting" }, { "cited_pmid": "36912195", "evidence_support": "Cannabidiol-associated liver enzyme elevations and DILI meet the criteria of common adverse drug events. ", "evidence_relation": "neutral" }, { "cited_pmid": "37088127", "evidence_support": "The mechanisms of CBD-mediated toxicity are not fully understood, but they may involve disruption of critical metabolic pathways and liver enzyme functions, receptor-specific binding activity, disruption of testosterone steroidogenesis, inhibition of reuptake and degradation of endocannabinoids, and the triggering of oxidative stress. ", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Cannabidiol (CBD) may cause elevations in liver tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in some individuals, particularly at high doses [33022751, 31052254, 36863504]. However, the prevalence of elevated liver enzymes in adults taking CBD is not significantly different from the general adult population [34918948, 35631293, 36968131]. CBD may also affect liver function by regulating the NF-\u03baB and NLRP3 inflammasome pathways, and may have a protective effect against liver inflammation and oxidative stress [34630100, 31032942]. The mechanisms of CBD-mediated liver effects are not fully understood, but may involve disruption of critical metabolic pathways and liver enzyme functions [37088127, 36912195, 20117100]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) may cause elevations in liver tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in some individuals, particularly at high doses [33022751, 31052254, 36863504].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury.", "evidence_relation": "supporting" }, { "cited_pmid": "31052254", "evidence_support": "As in the acute phase, 615 mg/kg CBD increased LBW ratios, ALT, AST, and total bilirubin", "evidence_relation": "supporting" }, { "cited_pmid": "36863504", "evidence_support": "In double-blinded, placebo-controlled clinical trials, elevated ALT levels were observed in some patients, but these findings could not be uncoupled from the confounds of potential drug-drug interactions with co-administration of valproate and clobazam", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "However, the prevalence of elevated liver enzymes in adults taking CBD is not significantly different from the general adult population [34918948, 35631293, 36968131].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34918948", "evidence_support": "Self-medication of CBD does not appear to be associated with an increased prevalence of LT elevation and most of the LT elevations are likely due to the conditions/medications for which the individuals are taking CBD.", "evidence_relation": "supporting" }, { "cited_pmid": "36968131", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "35631293", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "CBD may also affect liver function by regulating the NF-\u03baB and NLRP3 inflammasome pathways, and may have a protective effect against liver inflammation and oxidative stress [34630100, 31032942].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34630100", "evidence_support": "The hepatoprotective property of CBD in the current model might be a result of inhibition of inflammation via alleviating activation of the hepatic NF\u03baB-NLRP3 inflammasome-pyroptosis pathway by CBD", "evidence_relation": "supporting" }, { "cited_pmid": "31032942", "evidence_support": "In conclusion, the suppression of the activation of NLRP3 inflammasome through deactivation of NF-\u03baB in macrophages by CBD might be one mechanism of its anti-inflammatory function in the liver.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The mechanisms of CBD-mediated liver effects are not fully understood, but may involve disruption of critical metabolic pathways and liver enzyme functions [37088127, 36912195, 20117100].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "37088127", "evidence_support": "The mechanisms of CBD-mediated toxicity are not fully understood, but they may involve disruption of critical metabolic pathways and liver enzyme functions, receptor-specific binding activity, disruption of testosterone steroidogenesis, inhibition of reuptake and degradation of endocannabinoids, and the triggering of oxidative stress.", "evidence_relation": "supporting" }, { "cited_pmid": "36912195", "evidence_support": "Cannabidiol-associated liver enzyme elevations and DILI meet the criteria of common adverse drug events. Clinicians are encouraged to screen for cannabidiol use and monitor liver function in patients at increased risk.", "evidence_relation": "neutral" }, { "cited_pmid": "20117100", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Cannabidiol (CBD) may cause elevations in liver tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in some individuals, particularly at high doses [36912195, 36916524, 34918948]. However, the prevalence of elevated liver enzymes in adults taking CBD is not significantly different from the general adult population [36968131, 34918948]. CBD may also affect liver function by regulating the NF-\u03baB and NLRP3 inflammasome pathways, and may have a protective effect against liver inflammation and oxidative stress [34630100, 21930120, 22739983]. The mechanisms of CBD-mediated liver effects are not fully understood, but may involve disruption of critical metabolic pathways and liver enzyme functions [33022751, 31052254]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) may cause elevations in liver tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in some individuals, particularly at high doses [36912195, 36916524, 34918948].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36912195", "evidence_support": "Cannabidiol-associated liver enzyme elevations and DILI meet the criteria of common adverse drug events.", "evidence_relation": "supporting" }, { "cited_pmid": "34918948", "evidence_support": "Self-medication of CBD does not appear to be associated with an increased prevalence of LT elevation and most of the LT elevations are likely due to the conditions/medications for which the individuals are taking CBD", "evidence_relation": "contradicting" }, { "cited_pmid": "36916524", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "However, the prevalence of elevated liver enzymes in adults taking CBD is not significantly different from the general adult population [36968131, 34918948].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36968131", "evidence_support": "The prevalences of elevations in ALT and aspartate aminotransferase were not significantly different from those of the general adult population, and the prevalences of elevated levels of alkaline phosphatase and bilirubin were less than those of a healthy adult population. There was no relationship between LT and CBD dose.", "evidence_relation": "supporting" }, { "cited_pmid": "36968131", "evidence_support": "In this large-sample study, self-dosing CBD was not associated with an increased prevalence of elevation of LT or low levels of TT in men.", "evidence_relation": "supporting" }, { "cited_pmid": "34918948", "evidence_support": "The prevalence of ALT and AST elevations (9.1% and 4.0%) were not significantly different from known adult general population prevalences (8.9% and 4.9%).", "evidence_relation": "supporting" }, { "cited_pmid": "34918948", "evidence_support": "There was no significant association between CBD dosage and LT values.", "evidence_relation": "supporting" }, { "cited_pmid": "34918948", "evidence_support": "Self-medication of CBD does not appear to be associated with an increased prevalence of LT elevation and most of the LT elevations are likely due to the conditions/medications for which the individuals are taking CBD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "CBD may also affect liver function by regulating the NF-\u03baB and NLRP3 inflammasome pathways, and may have a protective effect against liver inflammation and oxidative stress [34630100, 21930120, 22739983].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34630100", "evidence_support": "CBD treatment inhibited macrophage recruitment and suppressed activation of NF\u03baB-NLRP3-pyroptosis pathway in mice livers. The hepatoprotective property of CBD in the current model might be a result of inhibition of inflammation via alleviating activation of the hepatic NF\u03baB-NLRP3 inflammasome-pyroptosis pathway by CBD.", "evidence_relation": "supporting" }, { "cited_pmid": "21930120", "evidence_support": "Immunohistochemical analysis revealed that cannabidiol significantly reduced the expression of inducible nitric oxide synthase, cyclooxygenase-2, nuclear factor-\u03baB, Fas ligand and caspase-3, and increased the expression of survivin protein in ischemic/reperfused liver tissue.", "evidence_relation": "supporting" }, { "cited_pmid": "22739983", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The mechanisms of CBD-mediated liver effects are not fully understood, but may involve disruption of critical metabolic pathways and liver enzyme functions [33022751, 31052254].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "All ALT elevations above the ULN began within 2-4\u00a0weeks of initial exposure to CBD.", "evidence_relation": "neutral" }, { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury.", "evidence_relation": "supporting" }, { "cited_pmid": "31052254", "evidence_support": "In conclusion, CBD exhibited clear signs of hepatotoxicity, possibly of a cholestatic nature.", "evidence_relation": "supporting" }, { "cited_pmid": "31052254", "evidence_support": "The involvement of numerous pathways associated with lipid and xenobiotic metabolism raises serious concerns about potential drug interactions as well as the safety of CBD.", "evidence_relation": "neutral" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Cannabidiol (CBD) may cause elevations in liver tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in some individuals, particularly at high doses [36912195, 37458709, 33022751]. However, the prevalence of elevated liver enzymes in adults taking CBD is significantly different from the general adult population, with a potential risk of drug-induced liver injury [33022751]. CBD may also affect liver function by regulating the NF-\u03baB and NLRP3 inflammasome pathways [32374168, 34918948, 35563697, 31032942]. However, the current evidence suggests that long-term consumption of oral cannabidiol may not have a protective effect against liver inflammation and oxidative stress, and may even cause elevations in liver tests in some individuals [32374168, 34918948, 35563697, 31032942]. The mechanisms of CBD-mediated liver effects are not fully understood, but may involve disruption of critical metabolic pathways and liver enzyme functions [31052254, 37088127]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) may cause elevations in liver tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in some individuals, particularly at high doses [36912195, 37458709, 33022751].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36912195", "evidence_support": "Cannabidiol use was associated with an increased probability of liver enzyme elevation (N\u00a0=\u00a012 trials, n\u00a0=\u00a01229; OR\u00a0=\u00a05.85 95% CI\u00a0=\u00a03.84-8.92, p\u00a0<\u00a00.001) and DILI (N\u00a0=\u00a012 trials, n\u00a0=\u00a01229; OR\u00a0=\u00a04.82 95% CI\u00a0=\u00a02.46-9.45, p\u00a0<\u00a00.001) compared to placebo controls.", "evidence_relation": "supporting" }, { "cited_pmid": "36912195", "evidence_support": "Cannabidiol-associated liver enzyme elevations and DILI meet the criteria of common adverse drug events.", "evidence_relation": "supporting" }, { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury", "evidence_relation": "supporting" }, { "cited_pmid": "37458709", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "However, the prevalence of elevated liver enzymes in adults taking CBD is significantly different from the general adult population, with a potential risk of drug-induced liver injury [33022751].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "CBD may also affect liver function by regulating the NF-\u03baB and NLRP3 inflammasome pathways [32374168, 34918948, 35563697, 31032942].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32374168", "evidence_support": "CBD inhibitory effects on the NLRP3 inflammasome may contribute to the overall anti-inflammatory effects reported for this phytocannabinoid.", "evidence_relation": "supporting" }, { "cited_pmid": "34918948", "evidence_support": "Self-medication of CBD does not appear to be associated with an increased prevalence of LT elevation and most of the LT elevations are likely due to the conditions/medications for which the individuals are taking CBD.", "evidence_relation": "contradicting" }, { "cited_pmid": "35563697", "evidence_support": "Overall, CBD and THC were found to be effective in alleviating the LPS-induced cytokine storm in human macrophages and primary HBECs, at least via modulation of NLRP3 inflammasome and STAT3 signaling pathways.", "evidence_relation": "supporting" }, { "cited_pmid": "31032942", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, the current evidence suggests that long-term consumption of oral cannabidiol may not have a protective effect against liver inflammation and oxidative stress, and may even cause elevations in liver tests in some individuals [32374168, 34918948, 35563697, 31032942].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34918948", "evidence_support": "Self-medication of CBD does not appear to be associated with an increased prevalence of LT elevation and most of the LT elevations are likely due to the conditions/medications for which the individuals are taking CBD.", "evidence_relation": "contradicting" }, { "cited_pmid": "35563697", "evidence_support": "Therefore, we hypothesized that CBD and THC reduce the levels of pro-inflammatory cytokines by inhibiting key inflammatory signaling pathways.", "evidence_relation": "contradicting" }, { "cited_pmid": "32374168", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "31032942", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The mechanisms of CBD-mediated liver effects are not fully understood, but may involve disruption of critical metabolic pathways and liver enzyme functions [31052254, 37088127].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31052254", "evidence_support": "CBD exhibited clear signs of hepatotoxicity, possibly of a cholestatic nature", "evidence_relation": "neutral" }, { "cited_pmid": "37088127", "evidence_support": "The mechanisms of CBD-mediated toxicity are not fully understood, but they may involve disruption of critical metabolic pathways and liver enzyme functions, receptor-specific binding activity, disruption of testosterone steroidogenesis, inhibition of reuptake and degradation of endocannabinoids, and the triggering of oxidative stress.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Cannabidiol (CBD) may cause elevations in liver tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in some individuals, particularly at high doses [34918948, 33022751, 31120211]. Cannabidiol (CBD) consumption may be associated with elevated liver enzymes in healthy adults, with a study showing that 44% of participants experienced peak serum alanine aminotransferase (ALT) values greater than the upper limit of normal (ULN), and 31% exceeded 5 \u00d7 ULN, meeting the international consensus criteria for drug-induced liver injury [33022751]. CBD may have a positive effect on liver function, as it has been found to alleviate liver injuries, prevent fatty liver, and inhibit inflammation via alleviating activation of the hepatic NF\u03baB-NLRP3 inflammasome-pyroptosis pathway [31032942, 21362471, 33022751, 34630100]. The mechanisms of CBD-mediated liver effects are not fully understood, but may involve disruption of critical metabolic pathways and liver enzyme functions [36912195, 31052254, 33022751]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) may cause elevations in liver tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in some individuals, particularly at high doses [34918948, 33022751, 31120211].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34918948", "evidence_support": "Previous studies have suggested that prescribed cannabidiol (CBD) products may cause elevations in liver tests (LT). ", "evidence_relation": "supporting" }, { "cited_pmid": "34918948", "evidence_support": "There was no significant association between CBD dosage and LT values.", "evidence_relation": "contradicting" }, { "cited_pmid": "33022751", "evidence_support": "Seven (44%) participants experienced peak serum alanine aminotransferase (ALT) values greater than the upper limit of normal (ULN).", "evidence_relation": "supporting" }, { "cited_pmid": "33022751", "evidence_support": "There was no correlation between transaminase elevations and baseline characteristics, CYP2C19 genotype, or CBD plasma concentrations. ", "evidence_relation": "contradicting" }, { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury.", "evidence_relation": "supporting" }, { "cited_pmid": "31120211", "evidence_support": ". Known side-effects are vomiting, diarrhoea, fever, sleepiness, and abnormal liver function test results.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Cannabidiol (CBD) consumption may be associated with elevated liver enzymes in healthy adults, with a study showing that 44% of participants experienced peak serum alanine aminotransferase (ALT) values greater than the upper limit of normal (ULN), and 31% exceeded 5 \u00d7 ULN, meeting the international consensus criteria for drug-induced liver injury [33022751].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "Seven (44%) participants experienced peak serum alanine aminotransferase (ALT) values greater than the upper limit of normal (ULN).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "CBD may have a positive effect on liver function, as it has been found to alleviate liver injuries, prevent fatty liver, and inhibit inflammation via alleviating activation of the hepatic NF\u03baB-NLRP3 inflammasome-pyroptosis pathway [31032942, 21362471, 33022751, 34630100].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31032942", "evidence_support": "In addition, Inhibitor of activation of NF-\u03baB partly suppressed the NLRP3 inflammasome activation, while adding CBD further inhibited NF-\u03baB activation and correspondingly suppressed the NLRP3 inflammasome activation in macrophages. In conclusion, the suppression of the activation of NLRP3 inflammasome through deactivation of NF-\u03baB in macrophages by CBD might be one mechanism of its anti-inflammatory function in the liver.", "evidence_relation": "supporting" }, { "cited_pmid": "21362471", "evidence_support": "I/R triggered time-dependent increases/changes in markers of liver injury (serum transaminases), hepatic oxidative/nitrative stress (4-hydroxy-2-nonenal, nitrotyrosine content/staining, and gp91phox and inducible nitric oxide synthase mRNA), mitochondrial dysfunction (decreased complex I activity), inflammation (tumor necrosis factor \u03b1 (TNF-\u03b1), cyclooxygenase 2, macrophage inflammatory protein-1\u03b1/2, intercellular adhesion molecule 1 mRNA levels; tissue neutrophil infiltration; nuclear factor \u03baB (NF-\u03baB) activation), stress signaling (p38MAPK and JNK), and cell death (DNA fragmentation, PARP activity, and TUNEL).", "evidence_relation": "neutral" }, { "cited_pmid": "21362471", "evidence_support": "Thus, CBD may represent a novel, protective strategy against I/R injury by attenuating key inflammatory pathways and oxidative/nitrative tissue injury, independent of classical CB1/2 receptors.", "evidence_relation": "supporting" }, { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury. G", "evidence_relation": "supporting" }, { "cited_pmid": "34630100", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The mechanisms of CBD-mediated liver effects are not fully understood, but may involve disruption of critical metabolic pathways and liver enzyme functions [36912195, 31052254, 33022751].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36912195", "evidence_support": "Cannabidiol-associated liver enzyme elevations and DILI meet the criteria of common adverse drug events.", "evidence_relation": "neutral" }, { "cited_pmid": "31052254", "evidence_support": "In conclusion, CBD exhibited clear signs of hepatotoxicity, possibly of a cholestatic nature.", "evidence_relation": "supporting" }, { "cited_pmid": "31052254", "evidence_support": "The involvement of numerous pathways associated with lipid and xenobiotic metabolism raises serious concerns about potential drug interactions as well as the safety of CBD.", "evidence_relation": "neutral" }, { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Cannabidiol (CBD) may cause elevations in liver tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in some individuals, particularly at high doses [33022751, 31120211, 34918948]. The prevalence of elevated liver enzymes in adults taking CBD is significantly different from the general adult population, with some studies showing that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury [36968131, 33022751, 34918948]. CBD may have a protective effect on liver function and may alleviate liver inflammation and oxidative stress in some individuals [33022751, 34630100]. The mechanisms of CBD-mediated liver effects are not fully understood, but may involve the suppression of the activation of NLRP3 inflammasome through deactivation of NF-\u03baB in macrophages [33022751, 31032942]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) may cause elevations in liver tests, including alanine aminotransferase (ALT) and aspartate aminotransferase (AST), in some individuals, particularly at high doses [33022751, 31120211, 34918948].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "Seven (44%) participants experienced peak serum alanine aminotransferase (ALT) values greater than the upper limit of normal (ULN).", "evidence_relation": "supporting" }, { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury.", "evidence_relation": "supporting" }, { "cited_pmid": "34918948", "evidence_support": "Previous studies have suggested that prescribed cannabidiol (CBD) products may cause elevations in liver tests (LT).", "evidence_relation": "supporting" }, { "cited_pmid": "31120211", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The prevalence of elevated liver enzymes in adults taking CBD is significantly different from the general adult population, with some studies showing that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury [36968131, 33022751, 34918948].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36968131", "evidence_support": "In this large-sample study, self-dosing CBD was not associated with an increased prevalence of elevation of LT or low levels of TT in men.", "evidence_relation": "contradicting" }, { "cited_pmid": "33022751", "evidence_support": "conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury", "evidence_relation": "supporting" }, { "cited_pmid": "34918948", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "CBD may have a protective effect on liver function and may alleviate liver inflammation and oxidative stress in some individuals [33022751, 34630100].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34630100", "evidence_support": "We found that CBD prevented liver steatosis and oxidative stress induced by EHFD.", "evidence_relation": "supporting" }, { "cited_pmid": "34630100", "evidence_support": "The hepatoprotective property of CBD in the current model might be a result of inhibition of inflammation via alleviating activation of the hepatic NF\u03baB-NLRP3 inflammasome-pyroptosis pathway by CBD.", "evidence_relation": "supporting" }, { "cited_pmid": "33022751", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The mechanisms of CBD-mediated liver effects are not fully understood, but may involve the suppression of the activation of NLRP3 inflammasome through deactivation of NF-\u03baB in macrophages [33022751, 31032942].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31032942", "evidence_support": "CBD significantly inhibited the nuclear factor-\u03baappa B (NF-\u03baB) p65 nuclear translocation and the activation of nucleotide-binding domain like receptor protein 3 (NLRP3) inflammasome both in vivo and in vitro studies, which lead to the reduction of the expression of inflammation-related factors in our studies.", "evidence_relation": "supporting" }, { "cited_pmid": "31032942", "evidence_support": "In addition, Inhibitor of activation of NF-\u03baB partly suppressed the NLRP3 inflammasome activation, while adding CBD further inhibited NF-\u03baB activation and correspondingly suppressed the NLRP3 inflammasome activation in macrophages. In conclusion, the suppression of the activation of NLRP3 inflammasome through deactivation of NF-\u03baB in macrophages by CBD might be one mechanism of its anti-inflammatory function in the liver.", "evidence_relation": "supporting" }, { "cited_pmid": "33022751", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Cannabidiol (CBD) can significantly impact liver enzymes, particularly cytochrome P450 (CYP) enzymes, leading to potential drug-drug interactions and hepatotoxicity.In healthy adults, therapeutic doses of CBD (1,500 mg/day) have been associated with elevated serum alanine aminotransferase (ALT) levels, meeting criteria for drug-induced liver injury in some cases [33022751]. CBD inhibits several CYP enzymes, including CYP1A1, CYP2C19, and CYP3A4, through competitive and mechanism-based inhibition, which can alter the metabolism of co-administered drugs [20117100, 23318708, 34330718]. Additionally, CBD metabolism generates reactive oxygen species (ROS), contributing to oxidative stress and potential liver damage [18929579]. The hepatotoxic effects of CBD are dose-dependent and can be exacerbated when combined with other hepatotoxic drugs, such as valproate [37458709]. These findings underscore the importance of monitoring liver function and potential drug interactions in patients using CBD.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) can significantly impact liver enzymes, particularly cytochrome P450 (CYP) enzymes, leading to potential drug-drug interactions and hepatotoxicity.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "In healthy adults, therapeutic doses of CBD (1,500 mg/day) have been associated with elevated serum alanine aminotransferase (ALT) levels, meeting criteria for drug-induced liver injury in some cases [33022751].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "Sixteen healthy adults were enrolled in a phase I, open-label, fixed single-sequence drug-drug interaction trial to investigate the effect of repeated dose administration of CBD (1,500\u00a0mg/day) on cytochrome P450 (CYP) 1A2 activity. Seven (44%) participants experienced peak serum alanine aminotransferase (ALT) values greater than the upper limit of normal (ULN). For five (31%) participants, the value exceeded\u00a05\u00a0\u00d7\u00a0ULN, therefore meeting the international consensus criteria for drug-induced liver injury.", "evidence_relation": "supporting" }, { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "CBD inhibits several CYP enzymes, including CYP1A1, CYP2C19, and CYP3A4, through competitive and mechanism-based inhibition, which can alter the metabolism of co-administered drugs [20117100, 23318708, 34330718].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20117100", "evidence_support": "These cannabinoids inhibited 7-ethoxyresorufin O-deethylase activity of recombinant CYP1A1, CYP1A2, and CYP1B1 in a competitive manner.", "evidence_relation": "supporting" }, { "cited_pmid": "20117100", "evidence_support": "CBD most potently inhibited the CYP1A1 activity; the apparent K(i) value (0.155microM) was at least one-seventeenth of the values for other CYP1 isoforms.", "evidence_relation": "supporting" }, { "cited_pmid": "20117100", "evidence_support": "The preincubation of CBD resulted in a time- and concentration-dependent decrease in catalytic activity of all the recombinant CYP1 enzymes and human liver microsomes.", "evidence_relation": "supporting" }, { "cited_pmid": "20117100", "evidence_support": "These results indicated that CBD and CBN showed CYP1 isoform-selective direct inhibition and that CBD was characterized as a potent mechanism-based inhibitor of human CYP1 enzymes, especially CYP1A1.", "evidence_relation": "supporting" }, { "cited_pmid": "23318708", "evidence_support": " (S)-Mephenytoin 4'-hydroxylase activities of human liver microsomes (HLMs) and recombinant CYP2C19 were inhibited by CBD in a concentration-dependent manner (IC\u2085\u2080 = 8.70 and 2.51 \u00b5M, respectively). ", "evidence_relation": "supporting" }, { "cited_pmid": "23318708", "evidence_support": "These results indicate that CBD caused potent CYP2C19 inhibition, in which one free phenolic hydroxyl group and the pentyl side chain of CBD may play important roles.", "evidence_relation": "supporting" }, { "cited_pmid": "34330718", "evidence_support": "CBD was previously reported to be metabolized primarily by CYP2C19 and CYP3A4, with minor contributions from UDP-glucuronosyltransferases", "evidence_relation": "supporting" }, { "cited_pmid": "34330718", "evidence_support": "These findings have implications for patients taking CBD who may be at risk for clinically important cytochrome P450-mediated drug interactions.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, CBD metabolism generates reactive oxygen species (ROS), contributing to oxidative stress and potential liver damage [18929579].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18929579", "evidence_support": "We investigated whether cannabidiol (CBD) and cannabidiol hydroxy-quinone (CBDHQ) generate reactive oxygen species (ROS) during metabolism with mouse hepatic microsomes. CBD and CBDHQ (91.5 microM) significantly suppressed lipid peroxidation in the mouse hepatic microsomes", "evidence_relation": "supporting" }, { "cited_pmid": "18929579", "evidence_support": "The present results suggest that CBDHQ formed during hepatic microsomal metabolism of CBD is capable of generating ROS and inducing cell toxicity.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The hepatotoxic effects of CBD are dose-dependent and can be exacerbated when combined with other hepatotoxic drugs, such as valproate [37458709].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37458709", "evidence_support": "the marked increased incidence of CBD-associated ALT elevations in patients already receiving VPA is unlikely to involve the three major mechanisms of direct hepatotoxicity.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "These findings underscore the importance of monitoring liver function and potential drug interactions in patients using CBD.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Cannabidiol (CBD) can affect liver enzymes, particularly cytochrome P450 enzymes, which play a crucial role in drug metabolism.CBD has been shown to inhibit these enzymes, potentially leading to altered metabolism of concomitant medications, which may increase the risk of adverse effects or toxicity.Elevated liver enzymes, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), have been observed in some patients using CBD, indicating potential liver stress or damage.The risk appears to be dose-dependent, with higher doses more likely to cause significant enzyme elevation.However, the clinical significance of these changes remains under investigation, and individual responses can vary.Monitoring liver function tests is advisable when initiating or adjusting CBD therapy, especially in patients with pre-existing liver conditions or those taking other hepatotoxic medications.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) can affect liver enzymes, particularly cytochrome P450 enzymes, which play a crucial role in drug metabolism.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "CBD has been shown to inhibit these enzymes, potentially leading to altered metabolism of concomitant medications, which may increase the risk of adverse effects or toxicity.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Elevated liver enzymes, such as alanine aminotransferase (ALT) and aspartate aminotransferase (AST), have been observed in some patients using CBD, indicating potential liver stress or damage.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "The risk appears to be dose-dependent, with higher doses more likely to cause significant enzyme elevation.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "However, the clinical significance of these changes remains under investigation, and individual responses can vary.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Monitoring liver function tests is advisable when initiating or adjusting CBD therapy, especially in patients with pre-existing liver conditions or those taking other hepatotoxic medications.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Cannabidiol (CBD) has been shown to affect liver enzymes, particularly cytochrome P450 (CYP) enzymes, which play a crucial role in metabolizing various drugs [33022751, 20117100, 23318708]. CBD is a potent inhibitor of CYP1A1, CYP2C19, and CYP3A4, with IC50 values ranging from 0.155 to 8.70 \u03bcM [20117100, 23318708, 24160757]. Additionally, CBD has been found to inhibit CYP2C9 and CYP2D6, although with lower potency [22166891, 21821735]. The inhibition of these enzymes by CBD may lead to increased levels of co-administered drugs, potentially resulting in adverse effects [24160757, 36704740]. Furthermore, CBD has been shown to induce liver injury in some individuals, as evidenced by elevated serum transaminase levels [33022751, 37458709]. However, the mechanisms underlying CBD-induced liver injury are not fully understood and may involve the disruption of critical metabolic pathways and liver enzyme functions [37088127].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) has been shown to affect liver enzymes, particularly cytochrome P450 (CYP) enzymes, which play a crucial role in metabolizing various drugs [33022751, 20117100, 23318708].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20117100", "evidence_support": "These results indicated that CBD and CBN showed CYP1 isoform-selective direct inhibition and that CBD was characterized as a potent mechanism-based inhibitor of human CYP1 enzymes, especially CYP1A1.", "evidence_relation": "supporting" }, { "cited_pmid": "23318708", "evidence_support": "These results indicate that CBD caused potent CYP2C19 inhibition, in which one free phenolic hydroxyl group and the pentyl side chain of CBD may play important roles.", "evidence_relation": "supporting" }, { "cited_pmid": "33022751", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "CBD is a potent inhibitor of CYP1A1, CYP2C19, and CYP3A4, with IC50 values ranging from 0.155 to 8.70 \u03bcM [20117100, 23318708, 24160757].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20117100", "evidence_support": "CBD most potently inhibited the CYP1A1 activity; the apparent K(i) value (0.155microM) was at least one-seventeenth of the values for other CYP1 isoforms.", "evidence_relation": "supporting" }, { "cited_pmid": "23318708", "evidence_support": "These results indicate that CBD caused potent CYP2C19 inhibition, in which one free phenolic hydroxyl group and the pentyl side chain of CBD may play important roles.", "evidence_relation": "supporting" }, { "cited_pmid": "24160757", "evidence_support": "In vitro data were identified that characterize cytochrome P-450 (CYP-450) enzymes as potential significant contributors to the primary metabolism of several exogenous cannabinoids: tetrahydrocannabinol (THC; CYPs 2C9, 3A4); cannabidiol (CBD; CYPs 2C19, 3A4); cannabinol (CBN; CYPs 2C9, 3A4); JWH-018 (CYPs 1A2, 2C9); and AM2201 (CYPs 1A2, 2C9).", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, CBD has been found to inhibit CYP2C9 and CYP2D6, although with lower potency [22166891, 21821735].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21821735", "evidence_support": "These results indicated that CBD caused potent direct CYP2D6 inhibition, in which two phenolic hydroxyl groups and the pentyl side chain of CBD may play important roles.", "evidence_relation": "supporting" }, { "cited_pmid": "22166891", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The inhibition of these enzymes by CBD may lead to increased levels of co-administered drugs, potentially resulting in adverse effects [24160757, 36704740].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36704740", "evidence_support": "CBD and other cannabinoids are metabolized extensively by the CYP450 system, and also inhibit many of these enzymes, potentially leading to variable serum levels of other medications, as well as variable levels of cannabinoids when other medications modify the system", "evidence_relation": "supporting" }, { "cited_pmid": "24160757", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, CBD has been shown to induce liver injury in some individuals, as evidenced by elevated serum transaminase levels [33022751, 37458709].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury.", "evidence_relation": "supporting" }, { "cited_pmid": "37458709", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "However, the mechanisms underlying CBD-induced liver injury are not fully understood and may involve the disruption of critical metabolic pathways and liver enzyme functions [37088127].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "37088127", "evidence_support": "The mechanisms of CBD-mediated toxicity are not fully understood, but they may involve disruption of critical metabolic pathways and liver enzyme functions, receptor-specific binding activity, disruption of testosterone steroidogenesis, inhibition of reuptake and degradation of endocannabinoids, and the triggering of oxidative stress.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash": { "answer": "CBD has been shown to increase liver enzymes, which are indicators of liver function [30730563, 33450016, 37889215]. This effect has been observed in both human and animal studies [33450016, 34391060, 35307550]. While these elevations are often considered benign and may improve with continued CBD use or dose reduction [30443449, 35307550], it is important to monitor liver enzymes, especially when CBD is used in high doses or with other medications like valproate [31053391, 36551926, 28782097]. Regular liver function tests are recommended to detect any potential liver damage early [36551926, 31120211].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "CBD has been shown to increase liver enzymes, which are indicators of liver function [30730563, 33450016, 37889215].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30730563", "evidence_support": "CBD is not risk free, with adverse events (primarily somnolence and gastrointestinal in nature) and drug interactions. CBD has been shown to increase liver function tests and needs further study to assess its impact on suicidal ideation.", "evidence_relation": "supporting" }, { "cited_pmid": "33450016", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "37889215", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This effect has been observed in both human and animal studies [33450016, 34391060, 35307550].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "33450016", "evidence_support": "Twenty-three client-owned dogs with naturally occurring osteoarthritis of appendicular joints completed this prospective, double-blinded, crossover, placebo-controlled study.", "evidence_relation": "neutral" }, { "cited_pmid": "33450016", "evidence_support": "Adverse events associated with CBD administration included elevation in liver enzymes (n = 14)", "evidence_relation": "neutral" }, { "cited_pmid": "34391060", "evidence_support": "Upon oral supplementation of CBD, elevation in liver enzymes was observed for both dogs and cats, and pharmacokinetics of CBD are different in the two species.", "evidence_relation": "supporting" }, { "cited_pmid": "35307550", "evidence_support": "Mild hypocalcemia was seen in all horses and elevated liver enzymes were observed in 8/12 horses, but these changes improved or normalized within 10 days after the final CBD dose.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "While these elevations are often considered benign and may improve with continued CBD use or dose reduction [30443449, 35307550], it is important to monitor liver enzymes, especially when CBD is used in high doses or with other medications like valproate [31053391, 36551926, 28782097].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "30443449", "evidence_support": "Adverse effects of CBD overall appear to be benign, while more concerning adverse effects (e.g., elevated liver enzymes) improve with continued CBD use or dose reduction.", "evidence_relation": "supporting" }, { "cited_pmid": "35307550", "evidence_support": "Mild hypocalcemia was seen in all horses and elevated liver enzymes were observed in 8/12 horses, but these changes improved or normalized within 10 days after the final CBD dose.", "evidence_relation": "supporting" }, { "cited_pmid": "31053391", "evidence_support": "Cannabidiol can cause liver enzyme elevation, especially when co-administered with valproate.", "evidence_relation": "supporting" }, { "cited_pmid": "31053391", "evidence_support": "Rather than spontaneous treatment without medical supervision, adequate medical oversight is indicated to monitor and manage the proper dose, side effects, validity of the product, and drug-drug interactions.", "evidence_relation": "supporting" }, { "cited_pmid": "36551926", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "28782097", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Regular liver function tests are recommended to detect any potential liver damage early [36551926, 31120211].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36551926", "evidence_support": "Screening for occult liver pathology should be performed and hepatic enzymes monitored, especially with high CBD doses.", "evidence_relation": "supporting" }, { "cited_pmid": "31120211", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "CBD has been shown to increase liver enzymes, which are indicators of liver function [30730563, 33450016, 34391060]. This effect has been observed in both human and animal studies [34391060, 35307550]. While CBD's overall adverse effects are generally considered benign, elevated liver enzymes are a more concerning side effect [30443449]. These elevations may improve with continued CBD use or dose reduction [30443449, 35307550]. It is crucial to monitor liver enzymes, especially when CBD is used in high doses or alongside medications like valproate, which can exacerbate this effect [31053391, 36551926]. \n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "CBD has been shown to increase liver enzymes, which are indicators of liver function [30730563, 33450016, 34391060].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30730563", "evidence_support": "CBD has been shown to increase liver function tests and needs further study to assess its impact on suicidal ideation.\n", "evidence_relation": "supporting" }, { "cited_pmid": "33450016", "evidence_support": "Adverse events associated with CBD administration included elevation in liver enzymes (n = 14) and vomiting (n = 2).\n", "evidence_relation": "supporting" }, { "cited_pmid": "34391060", "evidence_support": "Upon oral supplementation of CBD, elevation in liver enzymes was observed for both dogs and cats, and pharmacokinetics of CBD are different in the two species.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This effect has been observed in both human and animal studies [34391060, 35307550].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "34391060", "evidence_support": "Upon oral supplementation of CBD, elevation in liver enzymes was observed for both dogs and cats, and pharmacokinetics of CBD are different in the two species.", "evidence_relation": "supporting" }, { "cited_pmid": "35307550", "evidence_support": "Mild hypocalcemia was seen in all horses and elevated liver enzymes were observed in 8/12 horses, but these changes improved or normalized within 10 days after the final CBD dose.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "While CBD's overall adverse effects are generally considered benign, elevated liver enzymes are a more concerning side effect [30443449].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30443449", "evidence_support": "Adverse effects of CBD overall appear to be benign, while more concerning adverse effects (e.g., elevated liver enzymes) improve with continued CBD use or dose reduction.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "These elevations may improve with continued CBD use or dose reduction [30443449, 35307550].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "30443449", "evidence_support": "Adverse effects of CBD overall appear to be benign, while more concerning adverse effects (e.g., elevated liver enzymes) improve with continued CBD use or dose reduction.", "evidence_relation": "supporting" }, { "cited_pmid": "35307550", "evidence_support": "Mild hypocalcemia was seen in all horses and elevated liver enzymes were observed in 8/12 horses, but these changes improved or normalized within 10 days after the final CBD dose", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is crucial to monitor liver enzymes, especially when CBD is used in high doses or alongside medications like valproate, which can exacerbate this effect [31053391, 36551926].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "31053391", "evidence_support": "The exact antiepileptic mechanism of cannabidiol is currently not known, but it modulates a number of endogenous systems and may have a novel anticonvulsant effect. However, it has broad drug-drug interactions with several agents, including inducer and inhibitor of CYP3A4 or CYP2C19. Cannabidiol can cause liver enzyme elevation, especially when co-administered with valproate. The US Food and Drug Administration (FDA) has approved pharmaceutical-grade cannabidiol oil for two childhood-onset catastrophic epilepsies: Dravet syndrome and Lennox-Gastaut syndrome. The Drug Enforcement Agency also reclassified this product as a schedule V agent.", "evidence_relation": "supporting" }, { "cited_pmid": "36551926", "evidence_support": "With anti-inflammatory properties, cannabinoids may be a potential strategy to reduce immune activation in people living with HIV (PLWH) but more information on their safety and tolerability is needed.", "evidence_relation": "neutral" }, { "cited_pmid": "36551926", "evidence_support": "Out of ten individuals, eight completed the study. Two from the CBD-only arm were withdrawn for safety concerns: phlebotomy aggravating pre-existing anemia and severe hepatitis on 800 mg CBD with newly discovered pancreatic adenocarcinoma, respectively. Seven did not have any significant toxicity. Cannabinoids did not alter hematology/biochemistry profiles. CD4 count, CD4/CD8 ratio, and HIV suppression remained stable. Most adverse effects were mild-moderate.", "evidence_relation": "neutral" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Cannabidiol (CBD) can lead to elevations in liver enzymes, particularly alanine aminotransferase (ALT) and aspartate aminotransferase (AST), which may indicate potential liver injury [33022751, 36559092]. In clinical studies, some participants experienced ALT levels exceeding the upper limit of normal, with a subset meeting criteria for drug-induced liver injury [33022751]. However, the prevalence of elevated liver enzymes in CBD users is not significantly different from that in the general population [36968131]. While adverse effects are generally mild, monitoring liver function tests is recommended, especially at higher doses of CBD [36551926, 30443449]. In some cases, liver enzyme levels may improve with continued use or dose reduction [30443449]. Overall, further research is needed to fully understand the long-term effects of CBD on liver health [30730563].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) can lead to elevations in liver enzymes, particularly alanine aminotransferase (ALT) and aspartate aminotransferase (AST), which may indicate potential liver injury [33022751, 36559092].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "Seven (44%) participants experienced peak serum alanine aminotransferase (ALT) values greater than the upper limit of normal (ULN). For five (31%) participants, the value exceeded\u00a05\u00a0\u00d7\u00a0ULN, therefore meeting the international consensus criteria for drug-induced liver injury.", "evidence_relation": "supporting" }, { "cited_pmid": "36559092", "evidence_support": "Serious adverse effects include mainly hypertransaminasemia with serum levels elevations greater than three times the upper limit of the normal (6.4%),", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In clinical studies, some participants experienced ALT levels exceeding the upper limit of normal, with a subset meeting criteria for drug-induced liver injury [33022751].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, the prevalence of elevated liver enzymes in CBD users is not significantly different from that in the general population [36968131].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36968131", "evidence_support": "The prevalences of elevations in ALT and aspartate aminotransferase were not significantly different from those of the general adult population, and the prevalences of elevated levels of alkaline phosphatase and bilirubin were less than those of a healthy adult population.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While adverse effects are generally mild, monitoring liver function tests is recommended, especially at higher doses of CBD [36551926, 30443449].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "36551926", "evidence_support": "In PLWH, cannabinoids seem generally safe and well-tolerated, though larger studies are needed. Screening for occult liver pathology should be performed and hepatic enzymes monitored, especially with high CBD doses.", "evidence_relation": "supporting" }, { "cited_pmid": "30443449", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In some cases, liver enzyme levels may improve with continued use or dose reduction [30443449].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30443449", "evidence_support": "Adverse effects of CBD overall appear to be benign, while more concerning adverse effects (e.g., elevated liver enzymes) improve with continued CBD use or dose reduction.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, further research is needed to fully understand the long-term effects of CBD on liver health [30730563].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "30730563", "evidence_support": "CBD has been shown to increase liver function tests and needs further study to assess its impact on suicidal ideation.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Cannabidiol (CBD) can lead to elevations in liver enzymes, specifically alanine aminotransferase (ALT) and aspartate aminotransferase (AST) [30194563, 33022751]. Clinical trials have shown that a significant percentage of participants experienced ALT levels exceeding the upper limit of normal, with some meeting criteria for drug-induced liver injury [33022751, 37458709]. The incidence of liver enzyme elevation is notably higher in patients taking CBD alongside other medications, such as valproate [37458709, 36863504]. While these elevations are concerning, they may improve with continued use or dose reduction of CBD [30443449]. Overall, monitoring liver function tests is recommended for individuals using CBD, especially at higher doses or in combination with other drugs [36912195, 36559092].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) can lead to elevations in liver enzymes, specifically alanine aminotransferase (ALT) and aspartate aminotransferase (AST) [30194563, 33022751].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury.", "evidence_relation": "supporting" }, { "cited_pmid": "30194563", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Clinical trials have shown that a significant percentage of participants experienced ALT levels exceeding the upper limit of normal, with some meeting criteria for drug-induced liver injury [33022751, 37458709].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33022751", "evidence_support": "Seven (44%) participants experienced peak serum alanine aminotransferase (ALT) values greater than the upper limit of normal (ULN). For five (31%) participants, the value exceeded\u00a05\u00a0\u00d7\u00a0ULN, therefore meeting the international consensus criteria for drug-induced liver injury.", "evidence_relation": "supporting" }, { "cited_pmid": "33022751", "evidence_support": "We conclude that healthy adults consuming CBD may experience elevations in serum ALT consistent with drug-induced liver injury.", "evidence_relation": "supporting" }, { "cited_pmid": "37458709", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The incidence of liver enzyme elevation is notably higher in patients taking CBD alongside other medications, such as valproate [37458709, 36863504].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37458709", "evidence_support": "In clinical trials of cannabidiol (CBD) for the treatment of seizures in patients with Dravet syndrome, Lennox-Gastaut syndrome, and tuberous sclerosis complex, elevations in serum alanine aminotransferase (ALT) >\u20093\u00d7 the upper limit of normal were observed in some patents, but the incidence was much greater in patients who were receiving treatment with valproate (VPA) before starting CBD.", "evidence_relation": "supporting" }, { "cited_pmid": "36863504", "evidence_support": "In double-blinded, placebo-controlled clinical trials, elevated ALT levels were observed in some patients, but these findings could not be uncoupled from the confounds of potential drug-drug interactions with co-administration of valproate and clobazam", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While these elevations are concerning, they may improve with continued use or dose reduction of CBD [30443449].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "30443449", "evidence_support": "In contrast, more recent studies that have included over 100 participants showed that CBD use resulted in a significant reduction in seizure frequency. Adverse effects of CBD overall appear to be benign, while more concerning adverse effects (e.g., elevated liver enzymes) improve with continued CBD use or dose reduction.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Overall, monitoring liver function tests is recommended for individuals using CBD, especially at higher doses or in combination with other drugs [36912195, 36559092].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36912195", "evidence_support": "Clinicians are encouraged to screen for cannabidiol use and monitor liver function in patients at increased risk.", "evidence_relation": "supporting" }, { "cited_pmid": "36559092", "evidence_support": "However, it can potentially interact with other drugs and its use should be monitored, especially at the beginning of treatment.", "evidence_relation": "supporting" } ] } ] }, "webis-1": { "answer": "CBD is metabolized into decarbonylated cannabidiol, 7-hydroxy-cannabidiol and cannabidiol-glucuronide in the liver [34439405]. The metabolism of CBD is largely dependent on cytosolic NAD+-dependent enzymes, with lesser contributions from NADPH-dependent microsomal enzymes [37197460]. 7-OH-CBD formation is positively correlated with CYP2C19 activity but was not associated with CYP2C19 genotype, and CYP2C9 was found to contribute significantly to 7-OH-CBD generation [34330718].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "CBD is metabolized into decarbonylated cannabidiol, 7-hydroxy-cannabidiol and cannabidiol-glucuronide in the liver [34439405].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34439405", "evidence_support": "The results of this study indicate that CBD reaches the rat liver where it is then metabolized into decarbonylated cannabidiol, 7-hydroxy-cannabidiol and cannabidiol-glucuronide.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The metabolism of CBD is largely dependent on cytosolic NAD+-dependent enzymes, with lesser contributions from NADPH-dependent microsomal enzymes [37197460].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37197460", "evidence_support": "Cofactor dependence experiments with human liver subcellular fractions revealed that 7-carboxy-CBD and 11-carboxy-THC formation is largely dependent on cytosolic NAD+-dependent enzymes, with lesser contributions from NADPH-dependent microsomal enzymes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "7-OH-CBD formation is positively correlated with CYP2C19 activity but was not associated with CYP2C19 genotype, and CYP2C9 was found to contribute significantly to 7-OH-CBD generation [34330718].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "34330718", "evidence_support": "genotyped human liver microsomes, 7-OH-CBD formation was positively correlated with CYP2C19 activity but was not associated with CYP2C19 genotype.", "evidence_relation": "supporting" }, { "cited_pmid": "34330718", "evidence_support": " 7-OH-CBD formation was associated with human liver microsomal CYP2C19 activity, but not CYP2C19 genotype, and CYP2C9 was found to contribute significantly to 7-OH-CBD generation.", "evidence_relation": "supporting" } ] } ] }, "webis-2": { "answer": "CBD is metabolized in the liver [34439405]. The topical application of CBD prevents ROS- and enzyme-dependent phospholipid metabolism in the liver of UV-irradiated rats, suggesting that it may protect the liver [34439405]. However, the specific effect of CBD on liver enzymes is not directly mentioned.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "CBD is metabolized in the liver [34439405].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "34439405", "evidence_support": "The results of this study indicate that CBD reaches the rat liver where it is then metabolized into decarbonylated cannabidiol, 7-hydroxy-cannabidiol and cannabidiol-glucuronide. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The topical application of CBD prevents ROS- and enzyme-dependent phospholipid metabolism in the liver of UV-irradiated rats, suggesting that it may protect the liver [34439405].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34439405", "evidence_support": "These data show that CBD applied to the skin prevents ROS- and enzyme-dependent phospholipid metabolism in the liver of UV-irradiated rats, suggesting that it may be used as an internal organ protector.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, the specific effect of CBD on liver enzymes is not directly mentioned.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-3": { "answer": "CBD accumulation in mammalian tissues has the potential to influence receptor binding and metabolism [35631242]. The rise in tissue CBD was closely related to specific pharmacokinetic parameters, and adipose tissue levels were ~10 to ~100 fold greater than liver or muscle [35631242]. CBD accumulation in gastrocnemius muscle, liver and adipose tissue in adult rats following oral gavage was investigated [35631242].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "CBD accumulation in mammalian tissues has the potential to influence receptor binding and metabolism [35631242].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "35631242", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The rise in tissue CBD was closely related to specific pharmacokinetic parameters, and adipose tissue levels were ~10 to ~100 fold greater than liver or muscle [35631242].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "35631242", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "CBD accumulation in gastrocnemius muscle, liver and adipose tissue in adult rats following oral gavage was investigated [35631242].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "35631242", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-5": { "answer": "CBD accumulation in mammalian tissues has the potential to influence receptor binding and metabolism [35631242]. The rise in tissue CBD was closely related to specific pharmacokinetic parameters, and adipose tissue levels were ~10 to ~100 fold greater than liver or muscle. . [35631242]. CBD accumulation in gastrocnemius muscle, liver and adipose tissue in adult rats following oral gavage was investigated [35631242].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "CBD accumulation in mammalian tissues has the potential to influence receptor binding and metabolism [35631242].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "35631242", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The rise in tissue CBD was closely related to specific pharmacokinetic parameters, and adipose tissue levels were ~10 to ~100 fold greater than liver or muscle. .", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "CBD accumulation in gastrocnemius muscle, liver and adipose tissue in adult rats following oral gavage was investigated [35631242].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "35631242", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-gpt-1": { "answer": "The effect of CBD on liver enzymes is not well established without specific context. However, some studies suggest that CBD may influence liver enzyme activity, potentially leading to alterations in drug metabolism. It is important to monitor liver function in patients using CBD, especially those on other medications that are metabolized by the liver.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The effect of CBD on liver enzymes is not well established without specific context.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "However, some studies suggest that CBD may influence liver enzyme activity, potentially leading to alterations in drug metabolism.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "It is important to monitor liver function in patients using CBD, especially those on other medications that are metabolized by the liver.", "answer_sentence_relevance": "borderline", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "CBD appears to have a protective effect on liver enzymes, particularly in the context of liver injuries induced by ethanol and a high-fat, high-cholesterol diet. The studies suggest that CBD may help alleviate liver damage and reduce inflammation, which could be beneficial for liver enzyme regulation [31032942]. However, the specific effects of CBD on liver enzyme levels were not detailed in the provided context.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "CBD appears to have a protective effect on liver enzymes, particularly in the context of liver injuries induced by ethanol and a high-fat, high-cholesterol diet.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "The studies suggest that CBD may help alleviate liver damage and reduce inflammation, which could be beneficial for liver enzyme regulation [31032942].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31032942", "evidence_support": "We found that CBD alleviated liver inflammation induced by HFC diet", "evidence_relation": "supporting" }, { "cited_pmid": "31032942", "evidence_support": "suppression of the activation of NLRP3 inflammasome through deactivation of NF-\u03baB in macrophages by CBD might be one mechanism of its anti-inflammatory function in the liver.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, the specific effects of CBD on liver enzyme levels were not detailed in the provided context.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-gpt-6": { "answer": "Cannabidiol (CBD) affects liver enzymes primarily through its interaction with the cytochrome P450 enzyme system, where it can inhibit certain isoforms, particularly CYP1 enzymes [34330718,20117100]. This inhibition can alter the metabolism of other drugs processed by these enzymes, potentially leading to increased drug levels and effects [20117100]. Additionally, CBD is metabolized by liver enzymes to produce active metabolites, which may also influence liver enzyme activity [37197460,34330718].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) affects liver enzymes primarily through its interaction with the cytochrome P450 enzyme system, where it can inhibit certain isoforms, particularly CYP1 enzymes [34330718,20117100].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34330718", "evidence_support": "The results from reaction phenotyping experiments with recombinant cytochrome P450 enzymes and cytochrome P450-selective chemical inhibitors indicated that both CYP2C19 and CYP2C9 are capable of CBD metabolism to 7-OH-CBD.", "evidence_relation": "supporting" }, { "cited_pmid": "34330718", "evidence_support": "This study demonstrates that both CYP2C19 and CYP2C9 are involved in CBD metabolism to the active metabolite 7-OH-CBD and that CYP3A4 is a major contributor to CBD metabolism through pathways other than 7-hydroxylation. 7-OH-CBD formation was associated with human liver microsomal CYP2C19 activity, but not CYP2C19 genotype, and CYP2C9 was found to contribute significantly to 7-OH-CBD generation. These findings have implications for patients taking CBD who may be at risk for clinically important cytochrome P450-mediated drug interactions.", "evidence_relation": "supporting" }, { "cited_pmid": "20117100", "evidence_support": "Inhibitory effects of Delta(9)-tetrahydrocannabinol (Delta(9)-THC), cannabidiol (CBD), and cannabinol (CBN), the three major constituents in marijuana, on catalytic activities of human cytochrome P450 (CYP) 1 enzymes were investigated. These cannabinoids inhibited 7-ethoxyresorufin O-deethylase activity of recombinant CYP1A1, CYP1A2, and CYP1B1 in a competitive manner. CBD most potently inhibited the CYP1A1 activity; the apparent K(i) value (0.155microM) was at least one-seventeenth of the values for other CYP1 isoforms.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This inhibition can alter the metabolism of other drugs processed by these enzymes, potentially leading to increased drug levels and effects [20117100].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20117100", "evidence_support": "These results indicated that CBD and CBN showed CYP1 isoform-selective direct inhibition and that CBD was characterized as a potent mechanism-based inhibitor of human CYP1 enzymes, especially CYP1A1.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, CBD is metabolized by liver enzymes to produce active metabolites, which may also influence liver enzyme activity [37197460,34330718].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37197460", "evidence_support": "The cannabinoids cannabidiol (CBD) and delta-9-tetrahydrocannabinol (THC) undergo extensive oxidative metabolism in the liver. Although cytochromes P450 form the primary, pharmacologically active, hydroxylated metabolites of CBD and THC,", "evidence_relation": "supporting" }, { "cited_pmid": "34330718", "evidence_support": "The objectives of this study were to further characterize the roles of cytochrome P450 enzymes in CBD metabolism, specifically to the active metabolite 7-OH-CBD, and to investigate the impact of CYP2C19 polymorphism on CBD metabolism in genotyped human liver microsomes.", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gemini-flash": { "answer": "CBD has been shown to increase liver function tests in both humans and animals [30730563, 34391060, 37889215]. This effect has been observed in both dogs and cats [34391060], and liver enzymes should be monitored during CBD administration in dogs [37889215]. In humans, CBD has been associated with an increased likelihood of withdrawal due to adverse events, including serious adverse events related to abnormal liver function tests [32268347]. However, in some cases, elevated liver enzymes have improved or normalized with continued CBD use or dose reduction [30443449, 35307550]. It is important to note that CBD can interact with other medications, and it is essential to consult with a healthcare professional before taking CBD [35658956]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "CBD has been shown to increase liver function tests in both humans and animals [30730563, 34391060, 37889215].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30730563", "evidence_support": "CBD has been shown to increase liver function tests and needs further study to assess its impact on suicidal ideation.\n", "evidence_relation": "supporting" }, { "cited_pmid": "34391060", "evidence_support": "Upon oral supplementation of CBD, elevation in liver enzymes was observed for both dogs and cats, and pharmacokinetics of CBD are different in the two species.", "evidence_relation": "supporting" }, { "cited_pmid": "37889215", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This effect has been observed in both dogs and cats [34391060], and liver enzymes should be monitored during CBD administration in dogs [37889215].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "34391060", "evidence_support": "Upon oral supplementation of CBD, elevation in liver enzymes was observed for both dogs and cats, and pharmacokinetics of CBD are different in the two species.", "evidence_relation": "supporting" }, { "cited_pmid": "37889215", "evidence_support": "Liver enzymes should be monitored with administration of CBD in dogs", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In humans, CBD has been associated with an increased likelihood of withdrawal due to adverse events, including serious adverse events related to abnormal liver function tests [32268347].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32268347", "evidence_support": "Compared with placebo, CBD was associated with an increased likelihood of withdrawal for any reason (OR 2.61, 95% CI: 1.38-4.96) or due to adverse events (OR 2.65, 95% CI: 1.04-6.80), any serious adverse event (OR 2.30, 95% CI: 1.18-4.48), serious adverse events related to abnormal liver function tests (OR 11.19, 95% CI: 2.09-60.02) or pneumonia (OR 5.37, 95% CI: 1.17-24.65), any adverse event (OR 1.55, 95% CI: 1.03-2.33), adverse events due to decreased appetite (OR 3.56, 95% CI: 1.94-6.53), diarrhoea (OR 2.61, 95% CI: 1.46-4.67), somnolence (OR 2.23, 95% CI: 1.07-4.64) and sedation (OR 4.21, 95% CI: 1.18-15.01). ", "evidence_relation": "supporting" }, { "cited_pmid": "32268347", "evidence_support": "In summary, the available data from clinical trials suggest that CBD is well tolerated and has relatively few serious adverse effects, however interactions with other medications should be monitored carefully.", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, in some cases, elevated liver enzymes have improved or normalized with continued CBD use or dose reduction [30443449, 35307550].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30443449", "evidence_support": "Adverse effects of CBD overall appear to be benign, while more concerning adverse effects (e.g., elevated liver enzymes) improve with continued CBD use or dose reduction. ", "evidence_relation": "supporting" }, { "cited_pmid": "35307550", "evidence_support": "Mild hypocalcemia was seen in all horses and elevated liver enzymes were observed in 8/12 horses, but these changes improved or normalized within 10 days after the final CBD dose.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is important to note that CBD can interact with other medications, and it is essential to consult with a healthcare professional before taking CBD [35658956].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "35658956", "evidence_support": "Consumers and practitioners should remain cautious of unregulated and often-mislabeled CBD products due to the risks of taking too much CBD (e.g., drug-drug interactions, liver enzyme elevations, increased side effects) and the consequences of taking too little (e.g., no clinical benefits due to underdosing)", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "Cannabidiol (CBD) can lead to elevated liver enzymes, indicating potential liver damage. Studies have shown that CBD administration is associated with increased liver function tests, particularly when combined with other medications like valproate [30730563, 31053391]. Adverse events, including elevated liver enzymes, have been reported in several cases [33450016, 37331197]. While some patients experience mild elevations, these can improve with continued use or dose reduction [30443449]. Monitoring liver enzymes is recommended, especially at higher doses of CBD [36551926]. Overall, while CBD may cause liver enzyme elevation, the effects can vary, and further research is needed to fully understand its impact on liver health [30730563, 32268347].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Cannabidiol (CBD) can lead to elevated liver enzymes, indicating potential liver damage.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Studies have shown that CBD administration is associated with increased liver function tests, particularly when combined with other medications like valproate [30730563, 31053391].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30730563", "evidence_support": "CBD has been shown to increase liver function tests", "evidence_relation": "supporting" }, { "cited_pmid": "31053391", "evidence_support": "Cannabidiol can cause liver enzyme elevation, especially when co-administered with valproate.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Adverse events, including elevated liver enzymes, have been reported in several cases [33450016, 37331197].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33450016", "evidence_support": "Adverse events associated with CBD administration included elevation in liver enzymes (n = 14) and vomiting (n = 2).", "evidence_relation": "supporting" }, { "cited_pmid": "37331197", "evidence_support": "Adverse event (AE) incidence was 31%, most commonly somnolence, seizure, diarrhea, and decreased appetite. Two patients discontinued CBD owing to AEs, and four patients with LGS experienced elevated liver enzymes.\n", "evidence_relation": "supporting" }, { "cited_pmid": "37331197", "evidence_support": "Results support favorable effectiveness and retention of CBD without concomitant clobazam for up to 12 months in clinical practice.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While some patients experience mild elevations, these can improve with continued use or dose reduction [30443449].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30443449", "evidence_support": "In contrast, more recent studies that have included over 100 participants showed that CBD use resulted in a significant reduction in seizure frequency. Adverse effects of CBD overall appear to be benign, while more concerning adverse effects (e.g., elevated liver enzymes) improve with continued CBD use or dose reduction.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Monitoring liver enzymes is recommended, especially at higher doses of CBD [36551926].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36551926", "evidence_support": "Screening for occult liver pathology should be performed and hepatic enzymes monitored, especially with high CBD doses.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, while CBD may cause liver enzyme elevation, the effects can vary, and further research is needed to fully understand its impact on liver health [30730563, 32268347].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "30730563", "evidence_support": "CBD has been shown to increase liver function tests and needs further study to assess its impact on suicidal ideation.", "evidence_relation": "supporting" }, { "cited_pmid": "32268347", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] } } }, { "question_id": "129", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Abrupt cessation of metoprolol, a beta-blocker used to manage high blood pressure, can lead to several potential side effects due to the sudden lack of its effects on the heart and blood vessels. One significant risk is a rebound effect, where the symptoms being treated, such as high blood pressure or chest pain, may return more severely. Additionally, sudden withdrawal can lead to other cardiovascular issues, including a rapid increase in heart rate and an elevated risk of heart attack, particularly in individuals with pre-existing heart conditions [23384631]. It's crucial to consult a healthcare provider before stopping metoprolol to avoid these potentially serious complications [22907738].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Abrupt cessation of metoprolol, a beta-blocker used to manage high blood pressure, can lead to several potential side effects due to the sudden lack of its effects on the heart and blood vessels.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "One significant risk is a rebound effect, where the symptoms being treated, such as high blood pressure or chest pain, may return more severely.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, sudden withdrawal can lead to other cardiovascular issues, including a rapid increase in heart rate and an elevated risk of heart attack, particularly in individuals with pre-existing heart conditions [23384631].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23384631", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It's crucial to consult a healthcare provider before stopping metoprolol to avoid these potentially serious complications [22907738].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "22907738", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Abrupt withdrawal of metoprolol can lead to several serious side effects [17949833, 15660353, 28182127]. It can cause variant angina, heart failure, and symptomatic bradycardia [15660353, 16513452, 23983956]. Patients may experience severe headaches, dizziness, and vivid dreams or nightmares [32582495, 20146183, 21112460]. Sudden cessation can also result in visual hallucinations, acute delirium, and sleep disturbances [16223079, 32582495, 20146183]. There is a risk of dyspnea, bronchospasm, and cold extremities [27840760, 21180298, 20571874]. Metoprolol withdrawal can cause metabolic disturbances and postural hypotension [30410801, 16198657, 21180298]. Additionally, patients might suffer from severe bradycardia and sexual dysfunction [35475060, 18452693, 16513452]. Tiredness and severe headaches are also common [16967357, 15646732, 15592325]. These effects highlight the importance of gradual tapering under medical supervision [28182127, 28930747, 18828349].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Abrupt withdrawal of metoprolol can lead to several serious side effects [17949833, 15660353, 28182127].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": "We are describing a case of TLVABS developing after abrupt withdrawal of metoprolol", "evidence_relation": "supporting" }, { "cited_pmid": "15660353", "evidence_support": "We describe a patient with nonsignificant coronary artery disease who experienced variant angina after beta -blockade withdrawal", "evidence_relation": "neutral" }, { "cited_pmid": "28182127", "evidence_support": "Metoprolol treatment worsens the depressive and high burnout symptoms, but affords anxiolytic benefits independent of HR reduction in CHF patients with clinical mental disorders", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can cause variant angina, heart failure, and symptomatic bradycardia [15660353, 16513452, 23983956].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15660353", "evidence_support": "We describe a patient with nonsignificant coronary artery disease who experienced variant angina after beta -blockade withdrawal.", "evidence_relation": "supporting" }, { "cited_pmid": "16513452", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "23983956", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Patients may experience severe headaches, dizziness, and vivid dreams or nightmares [32582495, 20146183, 21112460].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32582495", "evidence_support": "We present the case of an 84-year-old male presented to the clinic complaining of increased confusion, fatigue, lightheadedness, nightmares, sleep disturbance, and gait problems for four weeks.", "evidence_relation": "supporting" }, { "cited_pmid": "32582495", "evidence_support": "The most common symptoms are psychiatric conditions, bizarre and vivid dreams, sleep disturbances, delirium, psychosis, and visual hallucinations.", "evidence_relation": "supporting" }, { "cited_pmid": "20146183", "evidence_support": "A 71-year-old man had had visual hallucinations and vivid dreams for two years after starting to take metoprolol.", "evidence_relation": "supporting" }, { "cited_pmid": "21112460", "evidence_support": "We describe an 81-year-old man who developed sleep disorders, nightmares, depression and anxiety as probable adverse effect of low-dose metoprolol (25 mg/day).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Sudden cessation can also result in visual hallucinations, acute delirium, and sleep disturbances [16223079, 32582495, 20146183].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32582495", "evidence_support": "The most common symptoms are psychiatric conditions, bizarre and vivid dreams, sleep disturbances, delirium, psychosis, and visual hallucinations.", "evidence_relation": "supporting" }, { "cited_pmid": "20146183", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16223079", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "There is a risk of dyspnea, bronchospasm, and cold extremities [27840760, 21180298, 20571874].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21180298", "evidence_support": "Thus non-selective (e.g. propranolol) or modestly beta-1 selective (e.g. metoprolol, atenolol) are associated with metabolic disturbance, bronchospasm, epinephrine/hypertensive interaction (with cigarette-smoking or insulin-induced hypoglycaemia)", "evidence_relation": "supporting" }, { "cited_pmid": "27840760", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "20571874", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Metoprolol withdrawal can cause metabolic disturbances and postural hypotension [30410801, 16198657, 21180298].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30410801", "evidence_support": "The potassium level rose to 5.6-5.7\u2009mEq/L with metoprolol and normalized when the agent was discontinued. ", "evidence_relation": "neutral" }, { "cited_pmid": "21180298", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16198657", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Additionally, patients might suffer from severe bradycardia and sexual dysfunction [35475060, 18452693, 16513452].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35475060", "evidence_support": "Bradycardia, renal failure, atrioventricular (AV) blockade, shock, and hyperkalemia (BRASH) syndrome is an uncommon and relatively new entity that results from synergy between AV\u00a0nodal blockade and renal failure leading to a vicious cycle of hypotension, profound bradycardia, and hyperkalemia.", "evidence_relation": "supporting" }, { "cited_pmid": "18452693", "evidence_support": "To our knowledge, we report the first case of complete atrioventricular block associated with coadministration of paroxetine and metoprolol. Increasing physicians' awareness of drug-induced severe bradyarrhythmia might prevent unnecessary implantation of permanent pacemakers.", "evidence_relation": "supporting" }, { "cited_pmid": "16513452", "evidence_support": "We report a case of this inhibition manifested by life-threatening bradycardia in a patient receiving a CYP2D6 substrate, metoprolol.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Tiredness and severe headaches are also common [16967357, 15646732, 15592325].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16967357", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15646732", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15592325", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "9", "answer_sentence": "These effects highlight the importance of gradual tapering under medical supervision [28182127, 28930747, 18828349].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "28182127", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "28930747", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18828349", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Abrupt discontinuation of metoprolol can lead to significant adverse effects, including transient left ventricular apical ballooning syndrome (TLVABS), which is a stress-induced cardiomyopathy characterized by temporary weakening of the heart's apex [17949833]. Additionally, sudden withdrawal may exacerbate underlying conditions such as variant angina due to autonomic imbalance, where the protective effect of beta-blockade against sympathetic surges is lost [15660353]. Patients may also experience a rebound increase in heart rate and blood pressure, potentially leading to arrhythmias or myocardial infarction.These effects underscore the importance of gradual tapering rather than abrupt cessation of metoprolol to mitigate these risks [17949833, 15660353].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Abrupt discontinuation of metoprolol can lead to significant adverse effects, including transient left ventricular apical ballooning syndrome (TLVABS), which is a stress-induced cardiomyopathy characterized by temporary weakening of the heart's apex [17949833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": "Transient Left Ventricular Apical Ballooning Syndrome (TLVABS) has been described to occur in response to number of stressful events, drug effects or drug withdrawal. Withdrawal of beta blockade has not been described to precipitate TLVABS. We are describing a case of TLVABS developing after abrupt withdrawal of metoprolol.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, sudden withdrawal may exacerbate underlying conditions such as variant angina due to autonomic imbalance, where the protective effect of beta-blockade against sympathetic surges is lost [15660353].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15660353", "evidence_support": "We describe a patient with nonsignificant coronary artery disease who experienced variant angina after beta -blockade withdrawal. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Patients may also experience a rebound increase in heart rate and blood pressure, potentially leading to arrhythmias or myocardial infarction.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "These effects underscore the importance of gradual tapering rather than abrupt cessation of metoprolol to mitigate these risks [17949833, 15660353].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15660353", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Sudden cessation of metoprolol can lead to withdrawal symptoms, including transient left ventricular apical ballooning syndrome (TLVABS) [17949833]. This condition is characterized by a reversible left ventricular dysfunction, often precipitated by stressful events or drug withdrawal.Additionally, abrupt discontinuation of metoprolol may also lead to rebound hypertension, tachycardia, and angina [17949833]. Furthermore, patients with coronary artery disease may experience an increased risk of myocardial infarction or sudden death due to the loss of beta-blockade [17949833]. It is essential to taper metoprolol gradually to avoid these withdrawal symptoms and ensure a smooth transition to alternative treatments.The exact mechanisms underlying these withdrawal symptoms are not fully understood, but they are thought to be related to the sudden loss of beta-adrenergic blockade [17949833]. Clinicians should be aware of these potential risks and take necessary precautions when discontinuing metoprolol therapy.is the primary source for this information [17949833].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Sudden cessation of metoprolol can lead to withdrawal symptoms, including transient left ventricular apical ballooning syndrome (TLVABS) [17949833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": "Transient Left Ventricular Apical Ballooning Syndrome (TLVABS) has been described to occur in response to number of stressful events, drug effects or drug withdrawal.", "evidence_relation": "supporting" }, { "cited_pmid": "17949833", "evidence_support": "We are describing a case of TLVABS developing after abrupt withdrawal of metoprolol.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This condition is characterized by a reversible left ventricular dysfunction, often precipitated by stressful events or drug withdrawal.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, abrupt discontinuation of metoprolol may also lead to rebound hypertension, tachycardia, and angina [17949833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": "Transient Left Ventricular Apical Ballooning Syndrome (TLVABS) has been described to occur in response to number of stressful events, drug effects or drug withdrawal. Withdrawal of beta blockade has not been described to precipitate TLVABS. We are describing a case of TLVABS developing after abrupt withdrawal of metoprolol.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, patients with coronary artery disease may experience an increased risk of myocardial infarction or sudden death due to the loss of beta-blockade [17949833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is essential to taper metoprolol gradually to avoid these withdrawal symptoms and ensure a smooth transition to alternative treatments.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "The exact mechanisms underlying these withdrawal symptoms are not fully understood, but they are thought to be related to the sudden loss of beta-adrenergic blockade [17949833].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Clinicians should be aware of these potential risks and take necessary precautions when discontinuing metoprolol therapy.is the primary source for this information [17949833].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "No answer was found for this question; however, here are some documents related to this topic: ['17323786', '25921410', '31806613'].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "No answer was found for this question; however, here are some documents related to this topic:", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "['17323786', '25921410', '31806613'].", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Abrupt cessation of metoprolol can cause various side effects, including central nervous system complications such as confusion, fatigue, lightheadedness, nightmares, sleep disturbance, and gait problems [16223079, 29381909, 32582495]. It can also lead to psychiatric conditions, bizarre and vivid dreams, sleep disturbances, delirium, psychosis, and visual hallucinations [16223079, 32582495, 22336000]. Additionally, metoprolol withdrawal can cause a withdrawal syndrome, which includes nervousness, tachycardia, headache, agitation, and nausea [29381909, 15857353, 32582495]. In some cases, it can also lead to a rapid increase in blood pressure to pre-treatment levels or above, or both, and/or myocardial ischemia [25908023, 29381909, 28539824]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Abrupt cessation of metoprolol can cause various side effects, including central nervous system complications such as confusion, fatigue, lightheadedness, nightmares, sleep disturbance, and gait problems [16223079, 29381909, 32582495].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16223079", "evidence_support": "The relationship between stopping metoprolol and the disappearance of the psychosis appeared to be a causal one and this is supported by the limited literature available on this subject.", "evidence_relation": "contradicting" }, { "cited_pmid": "32582495", "evidence_support": "The most common symptoms are psychiatric conditions, bizarre and vivid dreams, sleep disturbances, delirium, psychosis, and visual hallucinations.", "evidence_relation": "neutral" }, { "cited_pmid": "29381909", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can also lead to psychiatric conditions, bizarre and vivid dreams, sleep disturbances, delirium, psychosis, and visual hallucinations [16223079, 32582495, 22336000].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32582495", "evidence_support": "The most common symptoms are psychiatric conditions, bizarre and vivid dreams, sleep disturbances, delirium, psychosis, and visual hallucinations.", "evidence_relation": "supporting" }, { "cited_pmid": "22336000", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16223079", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, metoprolol withdrawal can cause a withdrawal syndrome, which includes nervousness, tachycardia, headache, agitation, and nausea [29381909, 15857353, 32582495].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15857353", "evidence_support": "Abrupt withdrawal of these drugs can produce a syndrome of sympathetic overactivity that includes nervousness, tachycardia, headache, agitation and nausea 36-72 h after cessation of the drug.", "evidence_relation": "supporting" }, { "cited_pmid": "29381909", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "32582495", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In some cases, it can also lead to a rapid increase in blood pressure to pre-treatment levels or above, or both, and/or myocardial ischemia [25908023, 29381909, 28539824].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25908023", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "29381909", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "28539824", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Abrupt cessation of metoprolol can lead to withdrawal syndrome, which includes symptoms such as nervousness, tachycardia, headache, agitation, and nausea [15857353]. In some cases, it can also cause a rapid increase in blood pressure to pre-treatment levels or above, or myocardial ischemia [17949833, 15857353]. Furthermore, transient left ventricular apical ballooning syndrome has been reported in a case of abrupt metoprolol withdrawal [17949833]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Abrupt cessation of metoprolol can lead to withdrawal syndrome, which includes symptoms such as nervousness, tachycardia, headache, agitation, and nausea [15857353].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15857353", "evidence_support": "Abrupt withdrawal of these drugs can produce a syndrome of sympathetic overactivity that includes nervousness, tachycardia, headache, agitation and nausea 36-72 h after cessation of the drug.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In some cases, it can also cause a rapid increase in blood pressure to pre-treatment levels or above, or myocardial ischemia [17949833, 15857353].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15857353", "evidence_support": "A withdrawal syndrome may occur after discontinuation of almost all types of antihypertensive drugs, but mostly occurs with clonidine, beta-blockers, methyldopa and guanabenz. Less commonly can produce a rapid increase of the blood pressure to pre-treatment levels or above, or both and/or myocardial ischaemia. Although the exact incidence of the syndrome is not known, it appears to be rare, at least in patients receiving standard doses of the above antihypertensive drugs", "evidence_relation": "supporting" }, { "cited_pmid": "17949833", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Furthermore, transient left ventricular apical ballooning syndrome has been reported in a case of abrupt metoprolol withdrawal [17949833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": "Transient Left Ventricular Apical Ballooning Syndrome (TLVABS) has been described to occur in response to number of stressful events, drug effects or drug withdrawal. ", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Abrupt cessation of metoprolol can lead to withdrawal syndrome, which includes symptoms such as nervousness, tachycardia, headache, agitation, and nausea [15857353]. In some cases, it can also cause a rapid increase in blood pressure to pre-treatment levels or above, or myocardial ischemia [15857353]. The article does not provide information about the effects of suddenly stopping metoprolol [23968902]. However, it does compare the risk of emergent bradycardia when initiating metoprolol versus carvedilol [23968902]. Furthermore, transient left ventricular apical ballooning syndrome has been reported in a case of abrupt metoprolol withdrawal [17949833]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Abrupt cessation of metoprolol can lead to withdrawal syndrome, which includes symptoms such as nervousness, tachycardia, headache, agitation, and nausea [15857353].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15857353", "evidence_support": "Abrupt withdrawal of these drugs can produce a syndrome of sympathetic overactivity that includes nervousness, tachycardia, headache, agitation and nausea 36-72 h after cessation of the drug.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In some cases, it can also cause a rapid increase in blood pressure to pre-treatment levels or above, or myocardial ischemia [15857353].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15857353", "evidence_support": "Less commonly can produce a rapid increase of the blood pressure to pre-treatment levels or above, or both and/or myocardial ischaemia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The article does not provide information about the effects of suddenly stopping metoprolol [23968902].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23968902", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, it does compare the risk of emergent bradycardia when initiating metoprolol versus carvedilol [23968902].", "answer_sentence_relevance": "inappropriate", "citation_assessment": [ { "cited_pmid": "23968902", "evidence_support": "Large randomized trials have reported mixed results regarding the risk of bradycardia between metoprolol and carvedilol. ", "evidence_relation": "supporting" }, { "cited_pmid": "23968902", "evidence_support": "Initiation of metoprolol is associated with an increased risk of emergent bradycardia compared with carvedilol, although the overall incidence of emergent bradycardia is low in routine clinical practice.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, transient left ventricular apical ballooning syndrome has been reported in a case of abrupt metoprolol withdrawal [17949833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": "Transient Left Ventricular Apical Ballooning Syndrome (TLVABS) has been described to occur in response to number of stressful events, drug effects or drug withdrawal. ", "evidence_relation": "supporting" }, { "cited_pmid": "17949833", "evidence_support": "We are describing a case of TLVABS developing after abrupt withdrawal of metoprolol.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Abrupt cessation of metoprolol can lead to withdrawal syndrome, which includes symptoms such as nervousness, tachycardia, headache, agitation, and nausea [15857353]. In some cases, it can also cause a rapid increase in blood pressure to pre-treatment levels or above, or myocardial ischemia [15857353]. Furthermore, transient left ventricular apical ballooning syndrome has been reported in a case of abrupt metoprolol withdrawal [17949833]. ", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Abrupt cessation of metoprolol can lead to withdrawal syndrome, which includes symptoms such as nervousness, tachycardia, headache, agitation, and nausea [15857353].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "15857353", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In some cases, it can also cause a rapid increase in blood pressure to pre-treatment levels or above, or myocardial ischemia [15857353].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "15857353", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Furthermore, transient left ventricular apical ballooning syndrome has been reported in a case of abrupt metoprolol withdrawal [17949833].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Abrupt cessation of metoprolol can lead to withdrawal syndrome, which includes symptoms such as nervousness, tachycardia, headache, agitation, and nausea [15857353]. In some cases, it can also cause a rapid increase in blood pressure to pre-treatment levels or above, or myocardial ischemia [15857353]. Furthermore, transient left ventricular apical ballooning syndrome has been reported in a case of abrupt metoprolol withdrawal [17949833]. ", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Abrupt cessation of metoprolol can lead to withdrawal syndrome, which includes symptoms such as nervousness, tachycardia, headache, agitation, and nausea [15857353].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "15857353", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In some cases, it can also cause a rapid increase in blood pressure to pre-treatment levels or above, or myocardial ischemia [15857353].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "15857353", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Furthermore, transient left ventricular apical ballooning syndrome has been reported in a case of abrupt metoprolol withdrawal [17949833].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Abrupt cessation of metoprolol can lead to withdrawal syndrome, which includes symptoms such as nervousness, tachycardia, headache, agitation, and nausea [15857353]. Additionally, stopping metoprolol abruptly can lead to emergent bradycardia, particularly with the immediate-release formulation [23813768]. Furthermore, transient left ventricular apical ballooning syndrome has been reported in a case of abrupt metoprolol withdrawal [17949833]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Abrupt cessation of metoprolol can lead to withdrawal syndrome, which includes symptoms such as nervousness, tachycardia, headache, agitation, and nausea [15857353].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15857353", "evidence_support": "Abrupt withdrawal of these drugs can produce a syndrome of sympathetic overactivity that includes nervousness, tachycardia, headache, agitation and nausea 36-72 h after cessation of the drug.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, stopping metoprolol abruptly can lead to emergent bradycardia, particularly with the immediate-release formulation [23813768].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23813768", "evidence_support": "The risk of emergent bradycardia associated with metoprolol initiation was higher with the IR formulation than the SR formulation, although the absolute risk was low.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Furthermore, transient left ventricular apical ballooning syndrome has been reported in a case of abrupt metoprolol withdrawal [17949833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": "Transient Left Ventricular Apical Ballooning Syndrome (TLVABS) has been described to occur in response to number of stressful events, drug effects or drug withdrawal. Withdrawal of beta blockade has not been described to precipitate TLVABS. We are describing a case of TLVABS developing after abrupt withdrawal of metoprolol.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Abrupt cessation of metoprolol can lead to withdrawal syndrome, which includes symptoms such as nervousness, tachycardia, headache, agitation, and nausea [15857353]. In some cases, it can also cause a rapid increase in blood pressure to pre-treatment levels or above, or increase the risk of hypertension [20524092]. Additionally, stopping metoprolol abruptly can lead to emergent bradycardia, particularly with metoprolol being associated with an increased risk of emergent bradycardia compared to carvedilol [23968902, 23813768]. Furthermore, transient left ventricular apical ballooning syndrome has been reported [16270223]. Here we present (to our knowledge) the first case of this syndrome in a negroid patient [16270223]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Abrupt cessation of metoprolol can lead to withdrawal syndrome, which includes symptoms such as nervousness, tachycardia, headache, agitation, and nausea [15857353].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15857353", "evidence_support": "Abrupt withdrawal of these drugs can produce a syndrome of sympathetic overactivity that includes nervousness, tachycardia, headache, agitation and nausea 36-72 h after cessation of the drug.", "evidence_relation": "supporting" }, { "cited_pmid": "15857353", "evidence_support": "In this study regarding the withdrawal syndrome that follows cessation of antihypertensive drugs therapy, a reference to the abrupt discontinuation of the main categories of antihypertensive drugs is also attempted.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In some cases, it can also cause a rapid increase in blood pressure to pre-treatment levels or above, or increase the risk of hypertension [20524092].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20524092", "evidence_support": "Regardless of its effect on blood pressure, low-dose aspirin effectively prevents cardiovascular events in patients with and without hypertension, but its benefits should be carefully weighed against a potential increase in the risk of adverse effects such as gastric bleeding and hemorrhagic stroke, as well as a small increase in the risk of hypertension.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, stopping metoprolol abruptly can lead to emergent bradycardia, particularly with metoprolol being associated with an increased risk of emergent bradycardia compared to carvedilol [23968902, 23813768].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23968902", "evidence_support": "CONCLUSIONS: Initiation of metoprolol is associated with an increased risk of emergent bradycardia compared with carvedilol, although the overall incidence of emergent bradycardia is low in routine clinical practice.", "evidence_relation": "supporting" }, { "cited_pmid": "23813768", "evidence_support": "The risk of emergent bradycardia associated with metoprolol initiation was higher with the IR formulation than the SR formulation, although the absolute risk was low", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, transient left ventricular apical ballooning syndrome has been reported [16270223].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16270223", "evidence_support": "Transient left ventricular apical ballooning is an acute cardiac syndrome characterised by an abrupt onset of chest pain and is usually associated with anterior electrocardiographic changes.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Here we present (to our knowledge) the first case of this syndrome in a negroid patient [16270223].", "answer_sentence_relevance": "inappropriate", "citation_assessment": [ { "cited_pmid": "16270223", "evidence_support": "Here we present (to our knowledge) the first case of this syndrome in a negroid patient.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Abrupt cessation of metoprolol can lead to withdrawal syndrome, which includes symptoms such as nervousness, tachycardia, headache, agitation, and nausea [15857353]. In some cases, abruptly stopping certain medications or treatments can cause rebound effects such as anxiety, restlessness, heart palpitations, nausea, sweating, urinary urgency, dry mouth, constipation, blurred vision, activation, insomnia, and mild anticholinergic withdrawal syndrome [20506969]. Stopping metoprolol abruptly is not particularly associated with emergent bradycardia [23813768, 34854616]. Instead, the risk of emergent bradycardia is higher when initiating metoprolol, particularly with the immediate-release formulation [23813768, 34854616]. Furthermore, transient left ventricular apical ballooning syndrome has been reported in a case of prolonged electrophysiology procedure [17226085, 17949833]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Abrupt cessation of metoprolol can lead to withdrawal syndrome, which includes symptoms such as nervousness, tachycardia, headache, agitation, and nausea [15857353].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15857353", "evidence_support": "Abrupt withdrawal of these drugs can produce a syndrome of sympathetic overactivity that includes nervousness, tachycardia, headache, agitation and nausea 36-72 h after cessation of the drug.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In some cases, abruptly stopping certain medications or treatments can cause rebound effects such as anxiety, restlessness, heart palpitations, nausea, sweating, urinary urgency, dry mouth, constipation, blurred vision, activation, insomnia, and mild anticholinergic withdrawal syndrome [20506969].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20506969", "evidence_support": "After chronic use, abruptly stopping adrenergic receptor drugs can cause rebound anxiety, restlessness, and heart palpitations.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Stopping metoprolol abruptly is not particularly associated with emergent bradycardia [23813768, 34854616].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "34854616", "evidence_support": "Not all drugs can be stopped abruptly, since this can result in a rebound-effect or withdrawal symptoms", "evidence_relation": "neutral" }, { "cited_pmid": "34854616", "evidence_support": "In addition, beta-blockers, corticosteroids and proton-pump inhibitors cause symptoms when stopped without tapering.", "evidence_relation": "contradicting" }, { "cited_pmid": "23813768", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Instead, the risk of emergent bradycardia is higher when initiating metoprolol, particularly with the immediate-release formulation [23813768, 34854616].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23813768", "evidence_support": "To estimate and compare the risk of emergent bradycardia associated with starting immediate-release (IR) and slow-release (SR) formulations of metoprolol", "evidence_relation": "supporting" }, { "cited_pmid": "23813768", "evidence_support": "The risk of emergent bradycardia associated with metoprolol initiation was higher with the IR formulation than the SR formulation, although the absolute risk was low.", "evidence_relation": "supporting" }, { "cited_pmid": "34854616", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, transient left ventricular apical ballooning syndrome has been reported in a case of prolonged electrophysiology procedure [17226085, 17949833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17226085", "evidence_support": "The authors report a case of transient left ventricular apical ballooning after a prolonged electrophysiology procedure.", "evidence_relation": "supporting" }, { "cited_pmid": "17949833", "evidence_support": "Transient Left Ventricular Apical Ballooning Syndrome (TLVABS) has been described to occur in response to number of stressful events, drug effects or drug withdrawal", "evidence_relation": "neutral" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Abrupt cessation of metoprolol can lead to withdrawal syndrome, which includes symptoms such as nervousness, tachycardia, headache, agitation, and nausea [15857353]. In some cases, it can also cause a rapid increase in blood pressure to pre-treatment levels or above, or myocardial ischemia [34854616]. Additionally, stopping metoprolol abruptly can lead to emergent bradycardia, particularly with the immediate-release formulation [34854616]. Furthermore, transient left ventricular apical ballooning syndrome has been reported in a case of abrupt metoprolol withdrawal [17949833]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Abrupt cessation of metoprolol can lead to withdrawal syndrome, which includes symptoms such as nervousness, tachycardia, headache, agitation, and nausea [15857353].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15857353", "evidence_support": "Abrupt withdrawal of these drugs can produce a syndrome of sympathetic overactivity that includes nervousness, tachycardia, headache, agitation and nausea 36-72 h after cessation of the drug.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In some cases, it can also cause a rapid increase in blood pressure to pre-treatment levels or above, or myocardial ischemia [34854616].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34854616", "evidence_support": "Not all drugs can be stopped abruptly, since this can result in a rebound-effect", "evidence_relation": "supporting" }, { "cited_pmid": "34854616", "evidence_support": "In addition, beta-blockers, corticosteroids and proton-pump inhibitors cause symptoms when stopped without tapering.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, stopping metoprolol abruptly can lead to emergent bradycardia, particularly with the immediate-release formulation [34854616].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34854616", "evidence_support": "In addition, beta-blockers, corticosteroids and proton-pump inhibitors cause symptoms when stopped without tapering.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, transient left ventricular apical ballooning syndrome has been reported in a case of abrupt metoprolol withdrawal [17949833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": "Transient Left Ventricular Apical Ballooning Syndrome (TLVABS) has been described to occur in response to number of stressful events, drug effects or drug withdrawal.", "evidence_relation": "supporting" }, { "cited_pmid": "17949833", "evidence_support": "Withdrawal of beta blockade has not been described to precipitate TLVABS", "evidence_relation": "contradicting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Abrupt discontinuation of metoprolol can lead to significant adverse effects, including the development of Transient Left Ventricular Apical Ballooning Syndrome (TLVABS), characterized by acute heart failure and myocardial stunning, as reported in a case following sudden metoprolol withdrawal [17949833]. Additionally, sudden cessation may precipitate severe psychiatric symptoms such as delirium, with complex visual and auditory hallucinations resolving rapidly upon stopping the drug [16223079]. Furthermore, abrupt withdrawal can exacerbate underlying conditions, potentially leading to severe bradycardia and hypotension, especially in patients with concurrent renal insufficiency or those taking other AV nodal blocking agents, as seen in BRASH syndrome [35475060]. These findings underscore the importance of gradual tapering rather than sudden discontinuation to mitigate these risks.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Abrupt discontinuation of metoprolol can lead to significant adverse effects, including the development of Transient Left Ventricular Apical Ballooning Syndrome (TLVABS), characterized by acute heart failure and myocardial stunning, as reported in a case following sudden metoprolol withdrawal [17949833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": "Transient Left Ventricular Apical Ballooning Syndrome (TLVABS) has been described to occur in response to number of stressful events, drug effects or drug withdrawal.", "evidence_relation": "supporting" }, { "cited_pmid": "17949833", "evidence_support": "We are describing a case of TLVABS developing after abrupt withdrawal of metoprolol.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, sudden cessation may precipitate severe psychiatric symptoms such as delirium, with complex visual and auditory hallucinations resolving rapidly upon stopping the drug [16223079].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16223079", "evidence_support": "The relationship between stopping metoprolol and the disappearance of the psychosis appeared to be a causal one", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Furthermore, abrupt withdrawal can exacerbate underlying conditions, potentially leading to severe bradycardia and hypotension, especially in patients with concurrent renal insufficiency or those taking other AV nodal blocking agents, as seen in BRASH syndrome [35475060].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35475060", "evidence_support": "Bradycardia, renal failure, atrioventricular (AV) blockade, shock, and hyperkalemia (BRASH) syndrome is an uncommon and relatively new entity that results from synergy between AV\u00a0nodal blockade and renal failure leading to a vicious cycle of hypotension, profound bradycardia, and hyperkalemia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "These findings underscore the importance of gradual tapering rather than sudden discontinuation to mitigate these risks.", "answer_sentence_relevance": "borderline", "citation_assessment": null } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Abrupt discontinuation of metoprolol, a beta-blocker, can lead to significant adverse effects, including rebound hypertension, tachycardia, and exacerbation of angina.In patients with coronary artery disease, sudden withdrawal may precipitate acute myocardial infarction or severe arrhythmias.Additionally, symptoms such as palpitations, anxiety, and increased sweating may occur due to sympathetic overactivity.The risk of these effects is heightened in individuals with preexisting cardiovascular conditions.Gradual tapering of the dose is recommended to mitigate these risks and allow the autonomic nervous system to adjust.If discontinuation is necessary, close monitoring for signs of cardiovascular instability is crucial.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Abrupt discontinuation of metoprolol, a beta-blocker, can lead to significant adverse effects, including rebound hypertension, tachycardia, and exacerbation of angina.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "In patients with coronary artery disease, sudden withdrawal may precipitate acute myocardial infarction or severe arrhythmias.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, symptoms such as palpitations, anxiety, and increased sweating may occur due to sympathetic overactivity.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "The risk of these effects is heightened in individuals with preexisting cardiovascular conditions.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Gradual tapering of the dose is recommended to mitigate these risks and allow the autonomic nervous system to adjust.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "If discontinuation is necessary, close monitoring for signs of cardiovascular instability is crucial.", "answer_sentence_relevance": "borderline", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Sudden withdrawal of metoprolol can lead to rebound hypertension, which may be severe and potentially life-threatening [17949833]. Additionally, abrupt discontinuation of metoprolol can cause transient left ventricular apical ballooning syndrome (TLVABS), a condition characterized by reversible left ventricular dysfunction [17949833]. Furthermore, stopping metoprolol suddenly may also lead to a withdrawal syndrome, which can manifest as delirium, psychosis, or hallucinations, particularly in elderly patients [16223079, 22516214]. It is essential to taper metoprolol gradually to avoid these adverse effects.The exact mechanisms underlying these phenomena are not fully understood, but it is thought that the sudden loss of beta-blockade can lead to a rebound increase in sympathetic activity, causing these symptoms [17949833, 16223079]. Clinicians should be aware of these potential risks and take necessary precautions when discontinuing metoprolol therapy.are the primary sources supporting this information [17949833, 16223079, 22516214].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Sudden withdrawal of metoprolol can lead to rebound hypertension, which may be severe and potentially life-threatening [17949833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, abrupt discontinuation of metoprolol can cause transient left ventricular apical ballooning syndrome (TLVABS), a condition characterized by reversible left ventricular dysfunction [17949833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": "Transient Left Ventricular Apical Ballooning Syndrome (TLVABS) has been described to occur in response to number of stressful events, drug effects or drug withdrawal. Withdrawal of beta blockade has not been described to precipitate TLVABS. We are describing a case of TLVABS developing after abrupt withdrawal of metoprolol.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Furthermore, stopping metoprolol suddenly may also lead to a withdrawal syndrome, which can manifest as delirium, psychosis, or hallucinations, particularly in elderly patients [16223079, 22516214].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16223079", "evidence_support": "During admission the patient appeared to be suffering from a delirium with complex visual and auditory hallucinations, for which he was given haloperidol.", "evidence_relation": "supporting" }, { "cited_pmid": "22516214", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It is essential to taper metoprolol gradually to avoid these adverse effects.", "answer_sentence_relevance": "borderline", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "The exact mechanisms underlying these phenomena are not fully understood, but it is thought that the sudden loss of beta-blockade can lead to a rebound increase in sympathetic activity, causing these symptoms [17949833, 16223079].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16223079", "evidence_support": "The relationship between stopping metoprolol and the disappearance of the psychosis appeared to be a causal one and this is supported by the limited literature available on this subject.", "evidence_relation": "neutral" }, { "cited_pmid": "17949833", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Clinicians should be aware of these potential risks and take necessary precautions when discontinuing metoprolol therapy.are the primary sources supporting this information [17949833, 16223079, 22516214].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "17949833", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16223079", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "22516214", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gemini-flash": { "answer": "Abruptly stopping metoprolol can lead to several adverse effects, including tachycardia, hypertension, and cardiac ischemia [27320095]. This sudden withdrawal can also cause a rebound increase in cardiac sensitivity to isoprenaline, which can persist for up to 14 days [6125187]. In patients with dilated cardiomyopathy (DCM) who benefit from beta-blocker therapy, withdrawal can even lead to death [10467195]. Additionally, abrupt metoprolol withdrawal can result in a marked rebound in resting heart rate [6125187]. These withdrawal phenomena can be largely prevented by gradually reducing the dose of metoprolol over a prolonged period [6125187].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Abruptly stopping metoprolol can lead to several adverse effects, including tachycardia, hypertension, and cardiac ischemia [27320095].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27320095", "evidence_support": "Sudden withdrawal of beta blockers may result in tachycardia, hypertension and cardiac ischaemia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This sudden withdrawal can also cause a rebound increase in cardiac sensitivity to isoprenaline, which can persist for up to 14 days [6125187].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "6125187", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In patients with dilated cardiomyopathy (DCM) who benefit from beta-blocker therapy, withdrawal can even lead to death [10467195].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "10467195", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, abrupt metoprolol withdrawal can result in a marked rebound in resting heart rate [6125187].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "6125187", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "These withdrawal phenomena can be largely prevented by gradually reducing the dose of metoprolol over a prolonged period [6125187].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "6125187", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Abruptly stopping metoprolol can lead to several side effects, including general malaise, palpitations, headache, sweating, and tremor [793849]. These symptoms are more pronounced in the standing position and usually disappear upon resuming beta-blocker therapy or gradually over 5-7 days with placebo [793849]. Abrupt withdrawal can also cause a rebound increase in cardiac sensitivity to isoproterenol, leading to a rise in resting heart rate [7053309, 6125187]. This rebound effect can persist for up to 14 days after stopping propranolol [6125187]. In some cases, abrupt metoprolol withdrawal has been associated with severe chest pain during exercise, potentially due to uncontrolled hypertension or a specific response to the beta-blocker [8261479]. While these withdrawal phenomena can be prevented by gradual withdrawal, caution is advised when discontinuing any beta-blocker due to the unpredictable nature of adverse cardiac events [6125187, 5].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Abruptly stopping metoprolol can lead to several side effects, including general malaise, palpitations, headache, sweating, and tremor [793849].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "793849", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These symptoms are more pronounced in the standing position and usually disappear upon resuming beta-blocker therapy or gradually over 5-7 days with placebo [793849].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "793849", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Abrupt withdrawal can also cause a rebound increase in cardiac sensitivity to isoproterenol, leading to a rise in resting heart rate [7053309, 6125187].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "7053309", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "6125187", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "This rebound effect can persist for up to 14 days after stopping propranolol [6125187].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "6125187", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In some cases, abrupt metoprolol withdrawal has been associated with severe chest pain during exercise, potentially due to uncontrolled hypertension or a specific response to the beta-blocker [8261479].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "8261479", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "While these withdrawal phenomena can be prevented by gradual withdrawal, caution is advised when discontinuing any beta-blocker due to the unpredictable nature of adverse cardiac events [6125187, 5].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "6125187", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "5", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Suddenly stopping metoprolol can lead to serious side effects, including an acute hypertensive crisis, which is a rapid increase in blood pressure that can be life-threatening [3813760]. Withdrawal from beta-blockers like metoprolol may also result in severe complications, including death; studies have shown that some patients deteriorated or died suddenly after discontinuation [10467195]. Additionally, patients with ischemic heart disease may experience post-beta blockade hypersensitivity, which can exacerbate their condition if the medication is abruptly stopped [2427833]. Therefore, it is crucial to consult a healthcare provider before making any changes to medication regimens, including skipping doses.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Suddenly stopping metoprolol can lead to serious side effects, including an acute hypertensive crisis, which is a rapid increase in blood pressure that can be life-threatening [3813760].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "3813760", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Withdrawal from beta-blockers like metoprolol may also result in severe complications, including death; studies have shown that some patients deteriorated or died suddenly after discontinuation [10467195].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "10467195", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, patients with ischemic heart disease may experience post-beta blockade hypersensitivity, which can exacerbate their condition if the medication is abruptly stopped [2427833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "2427833", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Therefore, it is crucial to consult a healthcare provider before making any changes to medication regimens, including skipping doses.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Suddenly stopping metoprolol, a beta-blocker, can lead to several adverse effects. Withdrawal may cause tachycardia (increased heart rate), hypertension (high blood pressure), and even cardiac ischemia (reduced blood flow to the heart) [27320095]. These effects occur because the body has adapted to the presence of the medication, and abrupt cessation can lead to a rebound effect, worsening the underlying condition it was treating. It is generally recommended to taper off beta-blockers gradually under medical supervision rather than stopping suddenly to minimize these risks [27320095]. If you are experiencing side effects like swollen ankles, it is important to consult your healthcare provider for guidance rather than skipping doses on your own.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Suddenly stopping metoprolol, a beta-blocker, can lead to several adverse effects.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Withdrawal may cause tachycardia (increased heart rate), hypertension (high blood pressure), and even cardiac ischemia (reduced blood flow to the heart) [27320095].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27320095", "evidence_support": "Sudden withdrawal of beta blockers may result in tachycardia, hypertension and cardiac ischaemia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "These effects occur because the body has adapted to the presence of the medication, and abrupt cessation can lead to a rebound effect, worsening the underlying condition it was treating.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "It is generally recommended to taper off beta-blockers gradually under medical supervision rather than stopping suddenly to minimize these risks [27320095].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27320095", "evidence_support": "Sudden withdrawal of beta blockers may result in tachycardia, hypertension and cardiac ischaemia. The loss of the blockade around the time of surgery may predispose the patient to a myocardial infarction.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "If you are experiencing side effects like swollen ankles, it is important to consult your healthcare provider for guidance rather than skipping doses on your own.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-1": { "answer": "Sudden discontinuation of metoprolol can cause reversible dysosmia (loss of smell) and hypogeusia (loss of taste) [22336000,30024498].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Sudden discontinuation of metoprolol can cause reversible dysosmia (loss of smell) and hypogeusia (loss of taste) [22336000,30024498].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30024498", "evidence_support": "At the third week of metoprolol treatment, the patient noticed a qualitative change in her ability to smell, also called dysosmia.", "evidence_relation": "supporting" }, { "cited_pmid": "22336000", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-2": { "answer": "The question cannot be answered based on the given context.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The question cannot be answered based on the given context.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-3": { "answer": "The given context does not provide information about the side effects for suddenly stopping metoprolol.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The given context does not provide information about the side effects for suddenly stopping metoprolol.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-5": { "answer": "The given context does not provide information about the side effects for suddenly stopping metoprolol.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The given context does not provide information about the side effects for suddenly stopping metoprolol.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-gpt-1": { "answer": "Suddenly stopping metoprolol can lead to withdrawal symptoms, including increased heart rate, elevated blood pressure, and the potential for angina or myocardial infarction in patients with coronary artery disease. It is generally recommended to taper the dosage gradually under medical supervision to minimize these risks.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Suddenly stopping metoprolol can lead to withdrawal symptoms, including increased heart rate, elevated blood pressure, and the potential for angina or myocardial infarction in patients with coronary artery disease.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "It is generally recommended to taper the dosage gradually under medical supervision to minimize these risks.", "answer_sentence_relevance": "borderline", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "Question: What are side effects for suddenly stopping metoprolol?", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Question: What are side effects for suddenly stopping metoprolol?", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-gpt-6": { "answer": "The context provided does not contain relevant information regarding the side effects of suddenly stopping metoprolol. Therefore, based on general medical knowledge, abruptly discontinuing metoprolol can lead to rebound hypertension, increased heart rate, and potential exacerbation of angina or heart failure symptoms. It is generally recommended to taper the dosage gradually under medical supervision to avoid these adverse effects.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The context provided does not contain relevant information regarding the side effects of suddenly stopping metoprolol.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Therefore, based on general medical knowledge, abruptly discontinuing metoprolol can lead to rebound hypertension, increased heart rate, and potential exacerbation of angina or heart failure symptoms.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "It is generally recommended to taper the dosage gradually under medical supervision to avoid these adverse effects.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "zero-shot-gemini-flash": { "answer": "Suddenly stopping metoprolol can lead to serious side effects, including a rapid increase in blood pressure [PMID: 28408428]. This can cause chest pain, shortness of breath, and even heart attack [PMID: 28408428]. Additionally, stopping metoprolol abruptly can trigger rebound hypertension, where blood pressure rises even higher than before starting the medication [PMID: 28408428]. This can be dangerous, especially for individuals with pre-existing heart conditions. It is crucial to consult with a healthcare professional before making any changes to your medication regimen [PMID: 28408428]. \n", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Suddenly stopping metoprolol can lead to serious side effects, including a rapid increase in blood pressure", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "[PMID: 28408428].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "This can cause chest pain, shortness of breath, and even heart attack [PMID: 28408428].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, stopping metoprolol abruptly can trigger rebound hypertension, where blood pressure rises even higher than before starting the medication", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "[PMID: 28408428].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "This can be dangerous, especially for individuals with pre-existing heart conditions.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "It is crucial to consult with a healthcare professional before making any changes to your medication regimen", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "8", "answer_sentence": "[PMID: 28408428].", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "zero-shot-gpt4o-mini": { "answer": "Suddenly stopping metoprolol can lead to several adverse effects, primarily due to the abrupt withdrawal of beta-blockade. Patients may experience rebound hypertension, which is a significant increase in blood pressure that can occur after discontinuation [PMID1]. Additionally, there is a risk of exacerbating angina or even triggering myocardial infarction, particularly in individuals with underlying heart conditions [PMID2]. Other potential withdrawal symptoms include increased heart rate and anxiety [PMID3]. It is generally recommended to taper the dosage gradually under medical supervision to minimize these risks [PMID4]. Therefore, skipping a dose without consulting a healthcare provider could lead to these complications, and it is advisable to seek medical advice before making any changes to medication.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Suddenly stopping metoprolol can lead to several adverse effects, primarily due to the abrupt withdrawal of beta-blockade.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Patients may experience rebound hypertension, which is a significant increase in blood pressure that can occur after discontinuation [PMID1].", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, there is a risk of exacerbating angina or even triggering myocardial infarction, particularly in individuals with underlying heart conditions [PMID2].", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Other potential withdrawal symptoms include increased heart rate and anxiety [PMID3].", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "It is generally recommended to taper the dosage gradually under medical supervision to minimize these risks [PMID4].", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Therefore, skipping a dose without consulting a healthcare provider could lead to these complications, and it is advisable to seek medical advice before making any changes to medication.", "answer_sentence_relevance": "required", "citation_assessment": null } ] } } }, { "question_id": "130", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Polycystic ovary syndrome (PCOS) has been linked to oxidative stress, which can exacerbate the condition by affecting mitochondrial function and insulin resistance. Oxidative stress can lead to the overproduction of reactive oxygen species (ROS), which negatively impact cellular functions and contribute to insulin resistance. For example, in diabetes, oxidative stress is known to impair mitochondrial function in pancreatic \u03b2-cells, and similar mechanisms could be involved in PCOS, where oxidative stress may worsen insulin resistance and exacerbate symptoms [34455488]. Additionally, oxidative stress is implicated in various metabolic disorders and could contribute to the pathophysiology of PCOS by affecting insulin signaling pathways, increasing the risk of metabolic complications associated with the condition [35140289].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Polycystic ovary syndrome (PCOS) has been linked to oxidative stress, which can exacerbate the condition by affecting mitochondrial function and insulin resistance.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Oxidative stress can lead to the overproduction of reactive oxygen species (ROS), which negatively impact cellular functions and contribute to insulin resistance.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "For example, in diabetes, oxidative stress is known to impair mitochondrial function in pancreatic \u03b2-cells, and similar mechanisms could be involved in PCOS, where oxidative stress may worsen insulin resistance and exacerbate symptoms [34455488].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34455488", "evidence_support": "Diabetes mellitus (DM) is a metabolic syndrome, caused by insufficient insulin secretion or insulin resistance (IR)", "evidence_relation": "neutral" }, { "cited_pmid": "34455488", "evidence_support": "DM enhances oxidative stress and induces mitochondrial function in different kinds of cell types, including pancreatic \u03b2-cells.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, oxidative stress is implicated in various metabolic disorders and could contribute to the pathophysiology of PCOS by affecting insulin signaling pathways, increasing the risk of metabolic complications associated with the condition [35140289].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35140289", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "PCOS is linked to increased oxidative stress levels and plays a central role in its pathophysiology [31198521, 23303572, 26770659]. Women with PCOS exhibit higher serum oxidative stress markers and increased reactive oxygen species production [30568513, 23303572, 27007571]. This condition is associated with decreased antioxidant status, leading to abnormal oxidative stress biomarkers [25911850, 30450993, 24002405]. Elevated malondialdehyde (MDA) levels and total oxidant status (TOS), along with lower total antioxidant capacity (TAC), are observed in PCOS women [25911850, 23303572, 35207512]. Oxidative stress may contribute to insulin resistance and is correlated with insulin parameters in PCOS [36232686, 31235121, 30450993]. Hyperandrogenism in PCOS promotes oxidative stress, which is also linked to cardiovascular risk and inflammation [37762427, 26770659, 36386912]. Additionally, oxidative stress is associated with ovulation disorders and potential DNA damage in PCOS [37762427, 36386912, 37448805]. These factors collectively suggest that oxidative stress is a significant contributor to the pathogenesis and complications of PCOS [36279177, 26770659, 26066290].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "PCOS is linked to increased oxidative stress levels and plays a central role in its pathophysiology [31198521, 23303572, 26770659].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31198521", "evidence_support": "Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "23303572", "evidence_support": "Oxidative stress might be associated with polycystic ovary syndrome (PCOS), but relatively small studies published to date do not permit reaching a definitive conclusion.", "evidence_relation": "contradicting" }, { "cited_pmid": "26770659", "evidence_support": "OS is considered as a potential inducing factor in the pathogenesis of PCOS, which is one of the most common complex endocrine disorders and a leading cause of female infertility, affecting 4%-12% of women in the world, as OS has close interactions with PCOS characteristics, just as insulin resistance (IR), hyperandrogenemia, and chronic inflammation.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Women with PCOS exhibit higher serum oxidative stress markers and increased reactive oxygen species production [30568513, 23303572, 27007571].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30568513", "evidence_support": "Literature emerging from Western countries has reported increased levels of serum oxidative stress markers among polycystic ovarian syndrome (PCOS) women.", "evidence_relation": "supporting" }, { "cited_pmid": "30568513", "evidence_support": "This study provides supportive evidence that oxidative stress might play a role in the pathogenesis of PCOS and, hence, oxidative stress parameters could be suggested as diagnostic markers for early diagnosis of high-risk groups.", "evidence_relation": "supporting" }, { "cited_pmid": "27007571", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "23303572", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This condition is associated with decreased antioxidant status, leading to abnormal oxidative stress biomarkers [25911850, 30450993, 24002405].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25911850", "evidence_support": "However, over the past decade emerging evidence has shown that increased Oxidative Stress (OS) and decreased antioxidant status were often linked with PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "30450993", "evidence_support": "Evidences have shown that Oxidative Stress and decreased antioxidant status are often linked with PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "30450993", "evidence_support": "Our study suggests that women with PCOS have oxidative stress and elevated CRP irrespective of obesity.", "evidence_relation": "supporting" }, { "cited_pmid": "24002405", "evidence_support": "An increased cardiovascular risk has to be anticipated in PCOS as it is a metabolically unstable condition.", "evidence_relation": "neutral" }, { "cited_pmid": "24002405", "evidence_support": "PCOS is associated with oxidative stress, namely increased production of free radicals followed by decreased serum antioxidant levels and antioxidant enzyme activity.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Elevated malondialdehyde (MDA) levels and total oxidant status (TOS), along with lower total antioxidant capacity (TAC), are observed in PCOS women [25911850, 23303572, 35207512].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25911850", "evidence_support": "Therefore, MN assay and serum MDA levels may serve together or individually as biomarkers of OS in PCOS women.", "evidence_relation": "supporting" }, { "cited_pmid": "23303572", "evidence_support": "Compared with control women, patients with PCOS presented higher circulating concentrations of homocysteine (23% increase, SMD 0.6, 95CI, 0.4-0.8), malondialdehyde (47% increase, SMD 1.9, 95CI 1.2-2.6) and asymmetric dimethylarginine (36% increase, SMD 1.1, 95CI 0.6-1.6), and increased superoxide dismutase activity (34% increase, SMD 1.0, 95CI 0.5-1.4) and decreased glutathione levels (50% decrease, SMD -3.7, 95CI -6.2 to -1.2) and paraoxonase-1 activity (32% decrease, SMD -0.9, 95CI -1.3 to -0.4).", "evidence_relation": "supporting" }, { "cited_pmid": "23303572", "evidence_support": "Circulating markers of oxidative stress are abnormal in women with PCOS independent of weight excess. T", "evidence_relation": "supporting" }, { "cited_pmid": "35207512", "evidence_support": "Studies have shown an increase in the concentration and activity of oxidative stress (OS) markers in patients with PCOS, compared to that in unaffected women.", "evidence_relation": "supporting" }, { "cited_pmid": "35207512", "evidence_support": "Then, we compared malonodialdehyde (MDA), superoxide dismutase (SOD), catalase (CAT), and glutathione peroxidase (GPx), including overweight and obesity, hyperandrogenemia, and IR in the PCOS group.", "evidence_relation": "supporting" }, { "cited_pmid": "35207512", "evidence_support": "MDA levels and CAT activity differed significantly between the groups.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Oxidative stress may contribute to insulin resistance and is correlated with insulin parameters in PCOS [36232686, 31235121, 30450993].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36232686", "evidence_support": "Circulating markers of oxidative stress are abnormal in women with PCOS.", "evidence_relation": "neutral" }, { "cited_pmid": "36232686", "evidence_support": "There is a close relationship between oxidative stress and insulin resistance (IR).", "evidence_relation": "supporting" }, { "cited_pmid": "36232686", "evidence_support": "We discovered that oxidative stress contributed to skeletal muscle IR in PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "We designed prospective study aimed to explore the association of PCOS and oxidative stress and examine the relationship of oxidative stress biomarkers with insulin parameters.", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "At the same time insulin levels were found to be significantly high and a positive correlation between oxidative stress and insulin parameters was observed in PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "30450993", "evidence_support": "Evidences have shown that Oxidative Stress and decreased antioxidant status are often linked with PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "30450993", "evidence_support": "Insulin Resistance in PCOS patients ranges from 50% to 70% and may encourage OS by production of reactive oxygen species.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Hyperandrogenism in PCOS promotes oxidative stress, which is also linked to cardiovascular risk and inflammation [37762427, 26770659, 36386912].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "Hyperandrogenism promotes inflammation and IR, both of which can increase the production of ROS and lead to OS", "evidence_relation": "supporting" }, { "cited_pmid": "26770659", "evidence_support": "Oxidative stress (OS) has received extensive attention in the last two decades, because of the discovery that abnormal oxidation status was related to patients with chronic diseases, such as diabetes, cardiovascular, polycystic ovary syndrome (PCOS), cancer, and neurological diseases", "evidence_relation": "supporting" }, { "cited_pmid": "36386912", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Additionally, oxidative stress is associated with ovulation disorders and potential DNA damage in PCOS [37762427, 36386912, 37448805].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "Oxidative stress (OS) is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them. It can play a role in a variety of reproductive system conditions, including polycystic ovary syndrome (PCOS), endometriosis, preeclampsia, and infertility", "evidence_relation": "supporting" }, { "cited_pmid": "36386912", "evidence_support": "Recent studies have shown that OS may be closely related to ovulation disorders in PCOS, and antioxidants can improve the oxidative stress state of PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "37448805", "evidence_support": "Significantly higher levels of OS markers and abnormal mitochondrial function in GCs have been found in patients with PCOS compared to healthy subjects, suggesting that increased OS is associated with PCOS progression", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "These factors collectively suggest that oxidative stress is a significant contributor to the pathogenesis and complications of PCOS [36279177, 26770659, 26066290].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" }, { "cited_pmid": "26770659", "evidence_support": "OS is considered as a potential inducing factor in the pathogenesis of PCOS, which is one of the most common complex endocrine disorders and a leading cause of female infertility, affecting 4%-12% of women in the world, as OS has close interactions with PCOS characteristics, just as insulin resistance (IR), hyperandrogenemia, and chronic inflammation.", "evidence_relation": "supporting" }, { "cited_pmid": "26066290", "evidence_support": "Thus, it is evident that OS regulates several cellular mechanisms in PCOS.", "evidence_relation": "supporting" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Polycystic ovary syndrome (PCOS) is strongly linked to oxidative stress (OS), with numerous studies indicating elevated levels of oxidative biomarkers in affected women [23303572, 36279177, 35207512]. OS in PCOS is characterized by an imbalance between reactive oxygen species (ROS) production and antioxidant defenses, contributing to metabolic and reproductive dysfunctions [37762427, 26770659]. Elevated markers such as malondialdehyde (MDA) and decreased antioxidant levels like glutathione are commonly observed in PCOS patients, independent of obesity [23303572, 25911850]. Hyperandrogenism and insulin resistance (IR), prevalent in PCOS, exacerbate OS by promoting ROS production and impairing mitochondrial function [37762427, 30450993]. This oxidative imbalance can damage ovarian follicles, impairing oocyte quality and fertility [37762427, 33216309]. Furthermore, OS is implicated in the increased cardiovascular risk and metabolic complications seen in PCOS, highlighting its significant role in the syndrome's pathophysiology [26066290, 35207512].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Polycystic ovary syndrome (PCOS) is strongly linked to oxidative stress (OS), with numerous studies indicating elevated levels of oxidative biomarkers in affected women [23303572, 36279177, 35207512].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23303572", "evidence_support": "Oxidative stress might be associated with polycystic ovary syndrome (PCOS), but relatively small studies published to date do not permit reaching a definitive conclusion.", "evidence_relation": "contradicting" }, { "cited_pmid": "23303572", "evidence_support": "Circulating markers of oxidative stress are abnormal in women with PCOS independent of weight excess. This finding suggests that oxidative stress may participate in the pathophysiology of this common disorder.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "This review summarizes and discusses the role of OS in the pathogenesis of PCOS syndrome, focusing on metabolic, reproductive, and cancer complications.", "evidence_relation": "neutral" }, { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS). PCOS is described mainly as a disproportion of reproductive hormones, leading to chronic anovulation and infertility in women. Interestingly, OS in PCOS may be associated with many disorders and diseases.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Interestingly, in patients with PCOS, an increase in oxidative status and insufficient compensation of the increase in antioxidant status before any cardiovascular complications are observed.", "evidence_relation": "supporting" }, { "cited_pmid": "35207512", "evidence_support": "Studies have shown an increase in the concentration and activity of oxidative stress (OS) markers in patients with PCOS, compared to that in unaffected women.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "OS in PCOS is characterized by an imbalance between reactive oxygen species (ROS) production and antioxidant defenses, contributing to metabolic and reproductive dysfunctions [37762427, 26770659].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "Oxidative stress (OS) is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them. ", "evidence_relation": "supporting" }, { "cited_pmid": "37762427", "evidence_support": "It can play a role in a variety of reproductive system conditions, including polycystic ovary syndrome (PCOS), endometriosis, preeclampsia, and infertility.", "evidence_relation": "supporting" }, { "cited_pmid": "37762427", "evidence_support": "In this review, we briefly discuss the links between oxidative stress and PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "26770659", "evidence_support": "OS is considered as a potential inducing factor in the pathogenesis of PCOS, which is one of the most common complex endocrine disorders and a leading cause of female infertility, affecting 4%-12% of women in the world, as OS has close interactions with PCOS characteristics, just as insulin resistance (IR), hyperandrogenemia, and chronic inflammation.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Elevated markers such as malondialdehyde (MDA) and decreased antioxidant levels like glutathione are commonly observed in PCOS patients, independent of obesity [23303572, 25911850].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23303572", "evidence_support": "Meta-analysis calculated standardized mean differences (SMDs) and 95% confidence intervals (95CI). RESULTS From 1633 potential studies identified electronically, 68 studies, including 4933 PCOS patients and 3671 controls, were selected. ", "evidence_relation": "neutral" }, { "cited_pmid": "23303572", "evidence_support": "Compared with control women, patients with PCOS presented higher circulating concentrations of homocysteine (23% increase, SMD 0.6, 95CI, 0.4-0.8), malondialdehyde (47% increase, SMD 1.9, 95CI 1.2-2.6) and asymmetric dimethylarginine (36% increase, SMD 1.1, 95CI 0.6-1.6), and increased superoxide dismutase activity (34% increase, SMD 1.0, 95CI 0.5-1.4) and decreased glutathione levels (50% decrease, SMD -3.7, 95CI -6.2 to -1.2) and paraoxonase-1 activity (32% decrease, SMD -0.9, 95CI -1.3 to -0.4).", "evidence_relation": "supporting" }, { "cited_pmid": "25911850", "evidence_support": "The frequency of MN cells (5.89 \u00b1 4.86 vs. 2.24 \u00b1 2.01) and mean serum MDA (360.84 \u00b1 87.08 vs. 301.70 \u00b1 82.82) levels were considerably higher in patients than controls (p = < 0.0001), furthermore, a positive correlation was observed between MNC and MDA levels in patients (r = 0.349, p = 0.0008) and not in controls (r = 0.104, p = 0.37), suggest high OS in PCOS women.", "evidence_relation": "supporting" }, { "cited_pmid": "25911850", "evidence_support": "Therefore, MN assay and serum MDA levels may serve together or individually as biomarkers of OS in PCOS women.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Hyperandrogenism and insulin resistance (IR), prevalent in PCOS, exacerbate OS by promoting ROS production and impairing mitochondrial function [37762427, 30450993].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "Hyperandrogenism promotes inflammation and IR, both of which can increase the production of ROS and lead to OS.", "evidence_relation": "supporting" }, { "cited_pmid": "30450993", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "This oxidative imbalance can damage ovarian follicles, impairing oocyte quality and fertility [37762427, 33216309].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "Oxidative stress (OS) is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them", "evidence_relation": "neutral" }, { "cited_pmid": "37762427", "evidence_support": "Excessive ROS may damage oocytes and granulosa cells within the follicles, impairing their quality and compromising fertility.", "evidence_relation": "supporting" }, { "cited_pmid": "33216309", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Furthermore, OS is implicated in the increased cardiovascular risk and metabolic complications seen in PCOS, highlighting its significant role in the syndrome's pathophysiology [26066290, 35207512].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26066290", "evidence_support": "Polycystic ovarian syndrome (PCOS) is a complex endocrine condition which is associated with metabolic and cardiovascular complications.", "evidence_relation": "supporting" }, { "cited_pmid": "26066290", "evidence_support": "Fact is that, in PCOS women, the circulating biomarkers of OS are in abnormal levels that are independent of overweight, which depicts the participation of OS in the pathophysiology of this common derangement.", "evidence_relation": "supporting" }, { "cited_pmid": "35207512", "evidence_support": "In women with PCOS, metabolic disorders such as insulin resistance (IR), hyperinsulinemia, obesity, diabetes mellitus, and other elements of metabolic syndrome are likely to occur", "evidence_relation": "supporting" }, { "cited_pmid": "35207512", "evidence_support": "Studies have shown an increase in the concentration and activity of oxidative stress (OS) markers in patients with PCOS, compared to that in unaffected women.", "evidence_relation": "supporting" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress, as evidenced by increased levels of circulating markers of oxidative stress in women with PCOS [23303572, 25911850, 36232686]. Oxidative stress is thought to play a central role in the pathophysiology of PCOS, contributing to metabolic and hormonal dysregulation [31198521, 37762427]. Studies have shown that oxidative stress is associated with insulin resistance, hyperandrogenism, and chronic inflammation in PCOS [37762427, 26770659, 30450993]. Furthermore, oxidative stress has been linked to ovulation disorders and decreased embryo quality in women with PCOS [36386912, 33216309]. The exact mechanisms underlying the relationship between PCOS and oxidative stress are not fully understood, but it is thought to involve an imbalance between the production of reactive oxygen species and the body's antioxidant defenses [31198521, 37762427]. Overall, the evidence suggests that oxidative stress is a key component of the pathophysiology of PCOS.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress, as evidenced by increased levels of circulating markers of oxidative stress in women with PCOS [23303572, 25911850, 36232686].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23303572", "evidence_support": "This finding suggests that oxidative stress may participate in the pathophysiology of this common disorder.", "evidence_relation": "supporting" }, { "cited_pmid": "25911850", "evidence_support": "However, over the past decade emerging evidence has shown that increased Oxidative Stress (OS) and decreased antioxidant status were often linked with PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "36232686", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Oxidative stress is thought to play a central role in the pathophysiology of PCOS, contributing to metabolic and hormonal dysregulation [31198521, 37762427].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31198521", "evidence_support": "Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "37762427", "evidence_support": "These functional consequences may contribute to the metabolic and hormonal dysregulation observed in PCOS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Studies have shown that oxidative stress is associated with insulin resistance, hyperandrogenism, and chronic inflammation in PCOS [37762427, 26770659, 30450993].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "It can play a role in a variety of reproductive system conditions, including polycystic ovary syndrome (PCOS), endometriosis, preeclampsia, and infertility.", "evidence_relation": "supporting" }, { "cited_pmid": "37762427", "evidence_support": "Impaired OXPHOS and mitochondrial dysfunction may contribute to insulin resistance (IR) by disrupting insulin signaling pathways and impairing glucose metabolism.", "evidence_relation": "supporting" }, { "cited_pmid": "26770659", "evidence_support": "OS is considered as a potential inducing factor in the pathogenesis of PCOS, which is one of the most common complex endocrine disorders and a leading cause of female infertility, affecting 4%-12% of women in the world, as OS has close interactions with PCOS characteristics, just as insulin resistance (IR), hyperandrogenemia, and chronic inflammation.", "evidence_relation": "supporting" }, { "cited_pmid": "30450993", "evidence_support": "Evidences have shown that Oxidative Stress and decreased antioxidant status are often linked with PCOS. Insulin Resistance in PCOS patients ranges from 50% to 70% and may encourage OS by production of reactive oxygen species.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, oxidative stress has been linked to ovulation disorders and decreased embryo quality in women with PCOS [36386912, 33216309].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36386912", "evidence_support": "Recent studies have shown that OS may be closely related to ovulation disorders in PCOS, and antioxidants can improve the oxidative stress state of PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "33216309", "evidence_support": "Even though serum oxidative stress was severe, the study suggested that FF oxidative stress contributed more to embryo quality, to which we should give more attention in the future", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The exact mechanisms underlying the relationship between PCOS and oxidative stress are not fully understood, but it is thought to involve an imbalance between the production of reactive oxygen species and the body's antioxidant defenses [31198521, 37762427].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31198521", "evidence_support": "Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS. Although intracellular reactive oxygen species (ROS) production and propagation are controlled by highly complex antioxidant enzymatic and non-enzymatic systems, understanding of mechanisms that oxidative stress is important to develop strategies for prevention and therapy of PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "37762427", "evidence_support": "Oxidative stress (OS) is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them. It can play a role in a variety of reproductive system conditions, including polycystic ovary syndrome (PCOS), endometriosis, preeclampsia, and infertility.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, the evidence suggests that oxidative stress is a key component of the pathophysiology of PCOS.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "Polycystic ovary syndrome (PCOS) is associated with oxidative stress, which is an imbalance between oxidants and antioxidants in cells [24585089, 22940766, 35125733]. Oxidative stress may play a central role in the pathophysiology of PCOS, contributing to its development and progression [30450993, 27489079, 23303572]. Studies have shown that women with PCOS have higher levels of oxidative stress markers, such as malondialdehyde (MDA), and lower levels of antioxidants, such as superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) [27799629, 32877771, 31304805]. Oxidative stress in PCOS may be related to insulin resistance, hyperandrogenism, and inflammation, which are common features of the syndrome [27489079, 30450993, 37996893]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Polycystic ovary syndrome (PCOS) is associated with oxidative stress, which is an imbalance between oxidants and antioxidants in cells [24585089, 22940766, 35125733].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24585089", "evidence_support": "Compared with controls, women with PCOS were found to have significantly increased insulin resistance (IR), oxidative stress (OS) and inflammation levels, creating a vicious circle of effects in the pathophysiology of PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "35125733", "evidence_support": "Several biomarkers involved in oxidative stress may influence polycystic ovary syndrome (PCOS). Superoxide dismutase (SOD) has been commonly identified as dismutase enzyme catalyzes the conversion of superoxide to hydrogen peroxide and elemental oxygen, and could serve as an important biomarker in this direction. The objective of the present study to determine the precise role of SOD levels in women with PCOS using a meta-analysis approach. The electronic databases like PubMed, Google Scholar, Web of Sciences, Clinical trial.gov, Cochrane Database of Systematic Review were searched for obtaining relevant studies on the association of SOD level in women with PCOS. Pooled standardized mean difference with 95% CI was computed using the DerSimonian and Liard method. A total of 267 articles were screened, out of which 12 articles fulfilled the inclusion criteria of the present meta-analysis involving 558 cases and 529 controls. Analysis including overall studies observed a higher SOD level (statistically non-significant) in women with PCOS compared to controls (SMD 0.35, 95% Cl -0.91 to 1.62, P\u2009=\u20090.58), however, statistically significant higher SOD levels were noted\u00a0in studies using serum as a source of sample (SMD 1.53, 95% CI 0.25 to 2.81, P\u2009=\u20090.019). In conclusion, women with PCOS exhibited increased SOD levels compared to controls suggesting that the byproduct of oxidative damage is expected to be increased in women with PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "22940766", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Oxidative stress may play a central role in the pathophysiology of PCOS, contributing to its development and progression [30450993, 27489079, 23303572].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30450993", "evidence_support": "Evidences have shown that Oxidative Stress and decreased antioxidant status are often linked with PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "27489079", "evidence_support": "Patients with PCOS with HA have higher oxidative stress levels compared with those without HA.", "evidence_relation": "supporting" }, { "cited_pmid": "23303572", "evidence_support": "Circulating markers of oxidative stress are abnormal in women with PCOS independent of weight excess. This finding suggests that oxidative stress may participate in the pathophysiology of this common disorder.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Studies have shown that women with PCOS have higher levels of oxidative stress markers, such as malondialdehyde (MDA), and lower levels of antioxidants, such as superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px) [27799629, 32877771, 31304805].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27799629", "evidence_support": "The objective of this study was to investigate the presence of systemic OS in non-stimulated cycles and to determine OS markers (malondialdehyde [MDA], advanced oxidation protein products [AOPP], hydroperoxides [FOX], glutathione [GSH], and vitamin E) during COS in non-obese infertile women with and without PCOS who were subjected to ARTs.", "evidence_relation": "neutral" }, { "cited_pmid": "27799629", "evidence_support": "Intergroup analysis showed that serum MDA concentrations were higher in the PCOS group at D3 (P=0.048) and D4 (P=0.002).", "evidence_relation": "supporting" }, { "cited_pmid": "32877771", "evidence_support": "After conventional ovarian stimulation, the patients with PCOS had higher serum MDA and GPx concentrations (P < 0.03) and lower serum SOD levels (P < 0.03) on the hCG trigger day than the controls. Further, the serum MDA and GPx levels on the trigger day were also positively correlated with the number of good quality embryos (R = 0.26, P = 0.01; R = 0.21, P = 0.04; respectively).", "evidence_relation": "supporting" }, { "cited_pmid": "32877771", "evidence_support": "The data suggest that moderate systemic oxidative stress on the hCG trigger day had no detrimental effects on live birth rate in young and non-obese patients with PCOS after IVF/ICSI treatment.", "evidence_relation": "contradicting" }, { "cited_pmid": "31304805", "evidence_support": "The aim of the present study was to compare the level of dietary antioxidants and oxidative stress markers including TAC, MDA and abdominal obesity prevalence in PCOS patients with healthy individuals", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Oxidative stress in PCOS may be related to insulin resistance, hyperandrogenism, and inflammation, which are common features of the syndrome [27489079, 30450993, 37996893].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27489079", "evidence_support": "Patients with PCOS with HA have higher oxidative stress levels compared with those without HA. ", "evidence_relation": "supporting" }, { "cited_pmid": "30450993", "evidence_support": "Evidences have shown that Oxidative Stress and decreased antioxidant status are often linked with PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "30450993", "evidence_support": "Insulin Resistance in PCOS patients ranges from 50% to 70% and may encourage OS by production of reactive oxygen species.", "evidence_relation": "supporting" }, { "cited_pmid": "37996893", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Oxidative stress is linked to polycystic ovary syndrome (PCOS) [26330853, 31235121, 26770659]. Studies have shown that women with PCOS have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione peroxidase, compared to women without PCOS [26330853, 36386912, 31235121]. Oxidative stress is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are common characteristics of PCOS [26330853, 31235121, 26770659]. The relationship between oxidative stress and PCOS is bidirectional, with oxidative stress contributing to the development of PCOS and PCOS exacerbating oxidative stress [26330853, 36386912, 26770659]. Oxidative stress can damage ovarian follicles and disrupt normal follicular development and maturation, leading to infertility [26330853, 25177558, 26770659]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Oxidative stress is linked to polycystic ovary syndrome (PCOS) [26330853, 31235121, 26770659].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26330853", "evidence_support": "PCOS is also associated with oxidative stress changes.", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "Low levels of antioxidants and increased oxidative stress with insulin resistance along with the observed correlation between these parameters suggest that women with PCOS are under oxidative stress which supports the concept that oxidative stress is involved in PCOS pathophysiology.", "evidence_relation": "supporting" }, { "cited_pmid": "26770659", "evidence_support": "Oxidative stress (OS) has received extensive attention in the last two decades, because of the discovery that abnormal oxidation status was related to patients with chronic diseases, such as diabetes, cardiovascular, polycystic ovary syndrome (PCOS), cancer, and neurological diseases.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Studies have shown that women with PCOS have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione peroxidase, compared to women without PCOS [26330853, 36386912, 31235121].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26330853", "evidence_support": "These changes show that oxidative stress contributes to PCOS and the decrease of antioxidants leads to increase of oxidation products contributing to PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "36386912", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "31235121", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Oxidative stress is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are common characteristics of PCOS [26330853, 31235121, 26770659].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26330853", "evidence_support": "PCOS is also associated with oxidative stress changes", "evidence_relation": "supporting" }, { "cited_pmid": "26330853", "evidence_support": "These changes show that oxidative stress contributes to PCOS and the decrease of antioxidants leads to increase of oxidation products contributing to PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "26770659", "evidence_support": "OS is considered as a potential inducing factor in the pathogenesis of PCOS, which is one of the most common complex endocrine disorders and a leading cause of female infertility, affecting 4%-12% of women in the world, as OS has close interactions with PCOS characteristics, just as insulin resistance (IR), hyperandrogenemia, and chronic inflammation", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The relationship between oxidative stress and PCOS is bidirectional, with oxidative stress contributing to the development of PCOS and PCOS exacerbating oxidative stress [26330853, 36386912, 26770659].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26330853", "evidence_support": "These changes show that oxidative stress contributes to PCOS and the decrease of antioxidants leads to increase of oxidation products contributing to PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "26770659", "evidence_support": "OS is considered as a potential inducing factor in the pathogenesis of PCOS, which is one of the most common complex endocrine disorders and a leading cause of female infertility, affecting 4%-12% of women in the world, as OS has close interactions with PCOS characteristics, just as insulin resistance (IR), hyperandrogenemia, and chronic inflammation.", "evidence_relation": "supporting" }, { "cited_pmid": "36386912", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Oxidative stress can damage ovarian follicles and disrupt normal follicular development and maturation, leading to infertility [26330853, 25177558, 26770659].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26330853", "evidence_support": "Polycystic ovary syndrome (PCOS) is a common disorder of infertility which affects more than 100 million women. It is characterized by chronic anovulation, hyper androgenism and obesity. PCOS is also associated with oxidative stress changes.", "evidence_relation": "supporting" }, { "cited_pmid": "26770659", "evidence_support": "OS is considered as a potential inducing factor in the pathogenesis of PCOS, which is one of the most common complex endocrine disorders and a leading cause of female infertility, affecting 4%-12% of women in the world, as OS has close interactions with PCOS characteristics, just as insulin resistance (IR), hyperandrogenemia, and chronic inflammation.", "evidence_relation": "supporting" }, { "cited_pmid": "25177558", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress [21557696, 37762427, 31198521]. Oxidative stress is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them [37762427]. PCOS patients have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione, compared to healthy women [30568513, 31235121, 21667435]. Oxidative stress in PCOS is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are all characteristics of the syndrome [27489079, 27958630, 26330853]. The increased oxidative stress in PCOS may contribute to the development of metabolic and cardiovascular complications, as well as infertility [23539878, 31235121, 21667435]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress [21557696, 37762427, 31198521].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21557696", "evidence_support": "This study showed that oxidative stress is increased in PCOS even in the absence of MetS or IR", "evidence_relation": "supporting" }, { "cited_pmid": "37762427", "evidence_support": "Oxidative stress (OS) is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them.", "evidence_relation": "supporting" }, { "cited_pmid": "37762427", "evidence_support": "It can play a role in a variety of reproductive system conditions, including polycystic ovary syndrome (PCOS), endometriosis, preeclampsia, and infertility.", "evidence_relation": "supporting" }, { "cited_pmid": "31198521", "evidence_support": "Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Oxidative stress is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them [37762427].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "Oxidative stress (OS) is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "PCOS patients have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione, compared to healthy women [30568513, 31235121, 21667435].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30568513", "evidence_support": "Literature emerging from Western countries has reported increased levels of serum oxidative stress markers among polycystic ovarian syndrome (PCOS) women.", "evidence_relation": "supporting" }, { "cited_pmid": "30568513", "evidence_support": "PCOS women had lower GSH and TAC levels compared to controls with a statistically significant difference observed for GSH levels (P=0.006). ", "evidence_relation": "supporting" }, { "cited_pmid": "30568513", "evidence_support": "This study provides supportive evidence that oxidative stress might play a role in the pathogenesis of PCOS and, hence, oxidative stress parameters could be suggested as diagnostic markers for early diagnosis of high-risk groups. ", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "Subjects with PCOS had poor antioxidant status as reflected by significantly low levels of glutathione, vitamin C & E and considerably increased activities of antioxidant enzymes like glutathione peroxidase, glutathione reductase and glutathione transferase as compared to those without PCOS", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "Low levels of antioxidants and increased oxidative stress with insulin resistance along with the observed correlation between these parameters suggest that women with PCOS are under oxidative stress which supports the concept that oxidative stress is involved in PCOS pathophysiology", "evidence_relation": "supporting" }, { "cited_pmid": "21667435", "evidence_support": "Plasma nitrotyrosine and MDA were increased, but only nitrotyrosine was significantly higher (p < 0.05) in PCOS women compared to controls", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Oxidative stress in PCOS is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are all characteristics of the syndrome [27489079, 27958630, 26330853].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27489079", "evidence_support": "The increased oxidative stress in PCOS is related to HA status, increased plasma glucose, TG, HDL-C and E2 levels, decreased apoA1 concentrations and a relative shortage of antioxidant capacity.", "evidence_relation": "supporting" }, { "cited_pmid": "27958630", "evidence_support": "The patients with PCOS are under oxidative stress and this oxidative stress seems to be the highest in patients with IR and with infertility", "evidence_relation": "neutral" }, { "cited_pmid": "26330853", "evidence_support": "The levels of serum insulin, C-reactive protein, advanced oxidation protein productswere significantly increased in women with PCOS compared with healthy women but there was a decrease in level of total antioxidants status in PCOS women.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The increased oxidative stress in PCOS may contribute to the development of metabolic and cardiovascular complications, as well as infertility [23539878, 31235121, 21667435].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23539878", "evidence_support": "These results suggest that PCOS independently influenced oxidative stress. Overall, the presence of PCOS may increase cardiovascular risk.", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "Thus oxidative stress could be a contributory factor to future cardiovascular disease risk in these women in addition to known features like dyslipidemia, central obesity, etc.", "evidence_relation": "supporting" }, { "cited_pmid": "21667435", "evidence_support": "Hence, presence of insulin resistance, hyperinsulinemia and oxidative damage are likely to accelerate slow development of cardiovascular disease in PCOS.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress [26881435, 31198521, 36279177]. Oxidative stress is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them [38005277, 18069575, 37762427]. PCOS patients have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione, compared to healthy women [21667435, 23303572, 31235121]. Oxidative stress in PCOS is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are all characteristics of the syndrome [36386912, 16337616, 36279177]. The increased oxidative stress in PCOS may contribute to the development of metabolic and cardiovascular complications, as well as infertility [37371662, 26066290, 36279177]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress [26881435, 31198521, 36279177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26881435", "evidence_support": "Apart from hormonal derangements, insulin signaling defects and adipose tissue dysfunction, oxidative stress, defined as an imbalance derived from excessive formation of oxidants in the presence of limited antioxidants defenses, has been actively implicated in the etiology of the syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "26881435", "evidence_support": "Although underlying mechanisms have not been fully elucidated yet, it becomes evident that oxidative stress holds a respectable share in the pathogenesis of PCOS. In fact, PCOS can be considered as a purely oxidative state, where the body antioxidants cannot outweigh the excessive production of free radicals.", "evidence_relation": "supporting" }, { "cited_pmid": "26881435", "evidence_support": "Oxidative stress, in conjunction with the rest etiologic mechanisms of PCOS and the cardinal contribution of environmental factors, leads to an adverse redox status that stigmatizes the natural process of the syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "31198521", "evidence_support": "Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS. Although intracellular reactive oxygen species (ROS) production and propagation are controlled by highly complex antioxidant enzymatic and non-enzymatic systems, understanding of mechanisms that oxidative stress is important to develop strategies for prevention and therapy of PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "A genetic, epigenetic, and environmental association exists between oxidative stress (OS) and polycystic ovary syndrome (PCOS), expressed in a multifaceted clinical profile.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Oxidative stress is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them [38005277, 18069575, 37762427].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "38005277", "evidence_support": "Oxidative stress is a condition that occurs when there is an imbalance between the production of reactive oxygen species (ROS) and the body's ability to neutralize them [...]", "evidence_relation": "supporting" }, { "cited_pmid": "18069575", "evidence_support": "Oxidative stress is defined as an imbalance between the production of reactive oxygen species (ROS) and the antioxidant network, in favour of the former.", "evidence_relation": "supporting" }, { "cited_pmid": "37762427", "evidence_support": "Oxidative stress (OS) is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "PCOS patients have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione, compared to healthy women [21667435, 23303572, 31235121].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21667435", "evidence_support": "Plasma nitrotyrosine and malondialdehyde (MDA), representative byproducts of protein and lipid oxidative damage, were determined by enzyme immunoassa", "evidence_relation": "neutral" }, { "cited_pmid": "21667435", "evidence_support": "Plasma nitrotyrosine and MDA were increased, but only nitrotyrosine was significantly higher (p < 0.05) in PCOS women compared to controls.", "evidence_relation": "contradicting" }, { "cited_pmid": "21667435", "evidence_support": "Indices of insulin resistance (insulin and HOMAIR) were significantly higher in PCOS group and positively correlated with level of MDA (r = 0.397 and r = 0.523, respectively; p < 0.05) as well as GPX activity (r = 0.531 and r = 0.358, respectively; p < 0.05).", "evidence_relation": "supporting" }, { "cited_pmid": "23303572", "evidence_support": "Compared with control women, patients with PCOS presented higher circulating concentrations of homocysteine (23% increase, SMD 0.6, 95CI, 0.4-0.8), malondialdehyde (47% increase, SMD 1.9, 95CI 1.2-2.6) and asymmetric dimethylarginine (36% increase, SMD 1.1, 95CI 0.6-1.6), and increased superoxide dismutase activity (34% increase, SMD 1.0, 95CI 0.5-1.4) and decreased glutathione levels (50% decrease, SMD -3.7, 95CI -6.2 to -1.2) and paraoxonase-1 activity (32% decrease, SMD -0.9, 95CI -1.3 to -0.4).", "evidence_relation": "supporting" }, { "cited_pmid": "23303572", "evidence_support": "Circulating markers of oxidative stress are abnormal in women with PCOS independent of weight excess.", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "Subjects with PCOS had poor antioxidant status as reflected by significantly low levels of glutathione, vitamin C & E and considerably increased activities of antioxidant enzymes like glutathione peroxidase, glutathione reductase and glutathione transferase as compared to those without PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "Low levels of antioxidants and increased oxidative stress with insulin resistance along with the observed correlation between these parameters suggest that women with PCOS are under oxidative stress which supports the concept that oxidative stress is involved in PCOS pathophysiology.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Oxidative stress in PCOS is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are all characteristics of the syndrome [36386912, 16337616, 36279177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36386912", "evidence_support": "This article reviews the interaction between OS and hyperandrogenism, insulin resistance and overweight/obesity; the effects of OS, hyperandrogenism, insulin resistance and overweight/obesity on ovulation disorders in PCOS; and the application of antioxidants in PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "16337616", "evidence_support": "the association of hyperandrogenism, insulin resistance and chronic inflammation raised the possibility of an increase risk of cardiovascular disease in women suffering from PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "This review focuses on characteristic markers of OS in PCOS and the relationship between OS and PCOS related to insulin resistance (IR), hyperandrogenemia, obesity, chronic inflammation, cardiovascular diseases, and cancer.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The increased oxidative stress in PCOS may contribute to the development of metabolic and cardiovascular complications, as well as infertility [37371662, 26066290, 36279177].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "37371662", "evidence_support": "One of the most common causes of infertility is polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" }, { "cited_pmid": "37371662", "evidence_support": "The systemic immune response, in particular the inflammatory response, in conjunction with metabolic disorders, insulin resistance (IR), hyperadrenalism, insufficient secretion of progesterone, and oxidative stress lead not only to cardiovascular diseases, cancer, autoimmunity, and lipid metabolism disorders but also to infertility.", "evidence_relation": "supporting" }, { "cited_pmid": "26066290", "evidence_support": "Polycystic ovarian syndrome (PCOS) is a complex endocrine condition which is associated with metabolic and cardiovascular complications.", "evidence_relation": "supporting" }, { "cited_pmid": "26066290", "evidence_support": "This article concentrates on the recent developments in the regulation of oxidative stress (OS) in PCOS and on the association between PCOS and CVD outcomes. The prognostic events that define the severity of PCOS and involvement of cardiovascular risk in PCOS include endothelial dysfunction (ED) and impaired cardiac structure.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "PCOS is described mainly as a disproportion of reproductive hormones, leading to chronic anovulation and infertility in women.", "evidence_relation": "neutral" }, { "cited_pmid": "36279177", "evidence_support": "Interestingly, in patients with PCOS, an increase in oxidative status and insufficient compensation of the increase in antioxidant status before any cardiovascular complications are observed.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress [36279177, 31198521, 26881435]. Oxidative stress is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them [22301329, 38005277, 18069575]. PCOS patients have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione, compared to healthy women [21667435, 31235121, 23303572]. Oxidative stress in PCOS is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are all characteristics of the syndrome [36386912, 16337616, 36279177]. The increased oxidative stress in PCOS may contribute to the development of metabolic and cardiovascular complications, as well as infertility [26066290, 37371662, 36279177]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress [36279177, 31198521, 26881435].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" }, { "cited_pmid": "31198521", "evidence_support": "Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "26881435", "evidence_support": "Oxidative stress, in conjunction with the rest etiologic mechanisms of PCOS and the cardinal contribution of environmental factors, leads to an adverse redox status that stigmatizes the natural process of the syndrome.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Oxidative stress is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them [22301329, 38005277, 18069575].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "22301329", "evidence_support": "Oxidative stress is defined by an imbalance between increased levels of reactive oxygen species (ROS) and a low activity of antioxidant mechanisms. ", "evidence_relation": "supporting" }, { "cited_pmid": "38005277", "evidence_support": "Oxidative stress is a condition that occurs when there is an imbalance between the production of reactive oxygen species (ROS) and the body's ability to neutralize them [...].", "evidence_relation": "supporting" }, { "cited_pmid": "18069575", "evidence_support": "Oxidative stress is defined as an imbalance between the production of reactive oxygen species (ROS) and the antioxidant network, in favour of the former.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "PCOS patients have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione, compared to healthy women [21667435, 31235121, 23303572].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21667435", "evidence_support": "Plasma nitrotyrosine and malondialdehyde (MDA), representative byproducts of protein and lipid oxidative damage, were determined by enzyme immunoassay.", "evidence_relation": "neutral" }, { "cited_pmid": "21667435", "evidence_support": "Plasma nitrotyrosine and MDA were increased, but only nitrotyrosine was significantly higher (p < 0.05) in PCOS women compared to controls.", "evidence_relation": "neutral" }, { "cited_pmid": "21667435", "evidence_support": "Uric acid (surrogate marker of \u00d7 antine oxidase) was also significantly elevated in PCOS (p < 0.05). Both plasma SOD and GPX activity showed no statistically significant difference between PCOS and controls.", "evidence_relation": "contradicting" }, { "cited_pmid": "31235121", "evidence_support": "Polycystic ovary syndrome (PCOS) is a composite heterogeneous condition with multifactorial etiology like genetic, environmental factors and oxidative stress", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "Subjects with PCOS had poor antioxidant status as reflected by significantly low levels of glutathione, vitamin C & E and considerably increased activities of antioxidant enzymes like glutathione peroxidase, glutathione reductase and glutathione transferase as compared to those without PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "23303572", "evidence_support": "Compared with control women, patients with PCOS presented higher circulating concentrations of homocysteine (23% increase, SMD 0.6, 95CI, 0.4-0.8), malondialdehyde (47% increase, SMD 1.9, 95CI 1.2-2.6) and asymmetric dimethylarginine (36% increase, SMD 1.1, 95CI 0.6-1.6), and increased superoxide dismutase activity (34% increase, SMD 1.0, 95CI 0.5-1.4) and decreased glutathione levels (50% decrease, SMD -3.7, 95CI -6.2 to -1.2) and paraoxonase-1 activity (32% decrease, SMD -0.9, 95CI -1.3 to -0.4).", "evidence_relation": "supporting" }, { "cited_pmid": "23303572", "evidence_support": "Circulating markers of oxidative stress are abnormal in women with PCOS independent of weight excess.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Oxidative stress in PCOS is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are all characteristics of the syndrome [36386912, 16337616, 36279177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36386912", "evidence_support": "Polycystic ovary syndrome (PCOS) is a common reproductive endocrine disease that is characterized by oligo-ovulation or anovulation, hyperandrogenism, and polycystic ovaries observed using ultrasound with high clinical heterogeneity.", "evidence_relation": "supporting" }, { "cited_pmid": "36386912", "evidence_support": "This article reviews the interaction between OS and hyperandrogenism, insulin resistance and overweight/obesity; the effects of OS, hyperandrogenism, insulin resistance and overweight/obesity on ovulation disorders in PCOS; and the application of antioxidants in PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "16337616", "evidence_support": "The polycystic ovary syndrome (PCOS) is a common disorder in premenopausal women, characterized by the presence, among other traits, of hyperandrogenism, insulin resistance, and hyperinsulinism.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "A genetic, epigenetic, and environmental association exists between oxidative stress (OS) and polycystic ovary syndrome (PCOS), expressed in a multifaceted clinical profile", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS)", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Interestingly", "evidence_relation": "neutral" }, { "cited_pmid": "36279177", "evidence_support": "OS in PCOS may be associated with many disorders and diseases. This review focuses on characteristic markers of OS in PCOS and the relationship between OS and PCOS related to insulin resistance (IR), hyperandrogenemia, obesity, chronic inflammation, cardiovascular diseases, and cancer. Interestingly, in patients with PCOS, an increase in oxidative status and insufficient compensation of the increase in antioxidant status before any cardiovascular complications are observe", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The increased oxidative stress in PCOS may contribute to the development of metabolic and cardiovascular complications, as well as infertility [26066290, 37371662, 36279177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26066290", "evidence_support": "Polycystic ovarian syndrome (PCOS) is a complex endocrine condition which is associated with metabolic and cardiovascular complications", "evidence_relation": "supporting" }, { "cited_pmid": "37371662", "evidence_support": "The systemic immune response, in particular the inflammatory response, in conjunction with metabolic disorders, insulin resistance (IR), hyperadrenalism, insufficient secretion of progesterone, and oxidative stress lead not only to cardiovascular diseases, cancer, autoimmunity, and lipid metabolism disorders but also to infertility.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "This review focuses on characteristic markers of OS in PCOS and the relationship between OS and PCOS related to insulin resistance (IR), hyperandrogenemia, obesity, chronic inflammation, cardiovascular diseases, and cancer", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress [26881435, 31198521, 36279177]. Oxidative stress is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them [22301329, 38005277, 18069575]. PCOS patients have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione, compared to healthy women [31235121, 23303572, 21667435]. Oxidative stress in PCOS is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are all characteristics of the syndrome [36386912, 16337616, 36279177]. The increased oxidative stress in PCOS may contribute to the development of metabolic and cardiovascular complications, as well as infertility [26066290, 36279177, 37371662]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress [26881435, 31198521, 36279177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26881435", "evidence_support": "Apart from hormonal derangements, insulin signaling defects and adipose tissue dysfunction, oxidative stress, defined as an imbalance derived from excessive formation of oxidants in the presence of limited antioxidants defenses, has been actively implicated in the etiology of the syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "26881435", "evidence_support": "Oxidative stress, in conjunction with the rest etiologic mechanisms of PCOS and the cardinal contribution of environmental factors, leads to an adverse redox status that stigmatizes the natural process of the syndrome.\n", "evidence_relation": "supporting" }, { "cited_pmid": "31198521", "evidence_support": "Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "A genetic, epigenetic, and environmental association exists between oxidative stress (OS) and polycystic ovary syndrome (PCOS), expressed in a multifaceted clinical profile.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Oxidative stress is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them [22301329, 38005277, 18069575].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "22301329", "evidence_support": "Oxidative stress is defined by an imbalance between increased levels of reactive oxygen species (ROS) and a low activity of antioxidant mechanisms.", "evidence_relation": "supporting" }, { "cited_pmid": "38005277", "evidence_support": "Oxidative stress is a condition that occurs when there is an imbalance between the production of reactive oxygen species (ROS) and the body's ability to neutralize them ", "evidence_relation": "supporting" }, { "cited_pmid": "18069575", "evidence_support": "Oxidative stress is defined as an imbalance between the production of reactive oxygen species (ROS) and the antioxidant network, in favour of the former.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "PCOS patients have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione, compared to healthy women [31235121, 23303572, 21667435].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31235121", "evidence_support": "Subjects with PCOS had poor antioxidant status as reflected by significantly low levels of glutathione, vitamin C & E and considerably increased activities of antioxidant enzymes like glutathione peroxidase, glutathione reductase and glutathione transferase as compared to those without PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "21667435", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "23303572", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Oxidative stress in PCOS is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are all characteristics of the syndrome [36386912, 16337616, 36279177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36386912", "evidence_support": "This article reviews the interaction between OS and hyperandrogenism, insulin resistance and overweight/obesity; the effects of OS, hyperandrogenism, insulin resistance and overweight/obesity on ovulation disorders in PCOS; and the application of antioxidants in PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "16337616", "evidence_support": "Moreover, the association of hyperandrogenism, insulin resistance and chronic inflammation raised the possibility of an increase risk of cardiovascular disease in women suffering from PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Interestingly, OS in PCOS may be associated with many disorders and diseases. This review focuses on characteristic markers of OS in PCOS and the relationship between OS and PCOS related to insulin resistance (IR), hyperandrogenemia, obesity, chronic inflammation, cardiovascular diseases, and cancer. Interestingly, in patients with PCOS, an increase in oxidative status and insufficient compensation of the increase in antioxidant status before any cardiovascular complications are observed.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The increased oxidative stress in PCOS may contribute to the development of metabolic and cardiovascular complications, as well as infertility [26066290, 36279177, 37371662].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "26066290", "evidence_support": "Polycystic ovarian syndrome (PCOS) is a complex endocrine condition which is associated with metabolic and cardiovascular complications. It is elevated to a metabolic disorder with significant long term health ramification due to the high prevalence of insulin resistance (IR), impaired glucose tolerance, type 2 diabetes (T2D), dyslipidemia and numerous cardiovascular risk factors in PCOS women", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "genetic, epigenetic, and environmental association exists between oxidative stress (OS) and polycystic ovary syndrome (PCOS), expressed in a multifaceted clinical profile.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "This review focuses on characteristic markers of OS in PCOS and the relationship between OS and PCOS related to insulin resistance (IR), hyperandrogenemia, obesity, chronic inflammation, cardiovascular diseases, and cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Interestingly, in patients with PCOS, an increase in oxidative status and insufficient compensation of the increase in antioxidant status before any cardiovascular complications are observed.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Moreover, free radicals promote carcinogenesis in PCOS patients. However, despite these data, it has not been established whether oxygen stress influences PCOS development or a secondary disorder resulting from hyperglycemia, IR, and cardiovascular and cancer complicat", "evidence_relation": "contradicting" }, { "cited_pmid": "37371662", "evidence_support": "One of the most common causes of infertility is polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress [26881435, 32131660, 36279177]. Oxidative stress is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them [22301329, 18924487, 35892633]. PCOS patients have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione, compared to healthy women [23303572, 31235121]. Oxidative stress in PCOS is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are all characteristics of the syndrome [36279177]. The increased oxidative stress in PCOS may contribute to the development of metabolic and cardiovascular complications, as well as infertility [26881435, 31803965, 34689247]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress [26881435, 32131660, 36279177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26881435", "evidence_support": "Although underlying mechanisms have not been fully elucidated yet, it becomes evident that oxidative stress holds a respectable share in the pathogenesis of PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "32131660", "evidence_support": "This study aimed to examine the possible association between the oxidative stress parameters and clomiphene citrate resistance in polycystic ovary syndrome.", "evidence_relation": "neutral" }, { "cited_pmid": "32131660", "evidence_support": "In this study, the antioxidants catalase and ferroxidase were found to be lower in PCOS women compared to non-PCOS; however, they were the lowest in clomiphene citrate-resistant PCOS women. Interestingly, myeloperoxidase, which is a part of oxidative stress, was also found to be higher in the non-PCOS group.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS)", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Oxidative stress is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them [22301329, 18924487, 35892633].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "22301329", "evidence_support": "Oxidative stress is defined by an imbalance between increased levels of reactive oxygen species (ROS) and a low activity of antioxidant mechanisms.", "evidence_relation": "supporting" }, { "cited_pmid": "35892633", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18924487", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "PCOS patients have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione, compared to healthy women [23303572, 31235121].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23303572", "evidence_support": "Compared with control women, patients with PCOS presented higher circulating concentrations of homocysteine (23% increase, SMD 0.6, 95CI, 0.4-0.8), malondialdehyde (47% increase, SMD 1.9, 95CI 1.2-2.6) and asymmetric dimethylarginine (36% increase, SMD 1.1, 95CI 0.6-1.6), and increased superoxide dismutase activity (34% increase, SMD 1.0, 95CI 0.5-1.4) and decreased glutathione levels (50% decrease, SMD -3.7, 95CI -6.2 to -1.2) and paraoxonase-1 activity (32% decrease, SMD -0.9, 95CI -1.3 to -0.4).", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "Subjects with PCOS had poor antioxidant status as reflected by significantly low levels of glutathione, vitamin C & E and considerably increased activities of antioxidant enzymes like glutathione peroxidase, glutathione reductase and glutathione transferase as compared to those without PCOS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Oxidative stress in PCOS is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are all characteristics of the syndrome [36279177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36279177", "evidence_support": "This review focuses on characteristic markers of OS in PCOS and the relationship between OS and PCOS related to insulin resistance (IR), hyperandrogenemia, obesity, chronic inflammation, cardiovascular diseases, and cancer", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The increased oxidative stress in PCOS may contribute to the development of metabolic and cardiovascular complications, as well as infertility [26881435, 31803965, 34689247].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26881435", "evidence_support": "This review focuses on understanding the putative role of oxidative stress in the pathophysiology of PCOS and analyzing its interconnection with the rest etiologic parameters and its contribution to the reproductive and metabolic manifestations of the syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "26881435", "evidence_support": "Although underlying mechanisms have not been fully elucidated yet, it becomes evident that oxidative stress holds a respectable share in the pathogenesis of PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "31803965", "evidence_support": "Collectively, HSYA exerted beneficial effects on PCOS mice by restoring hormone secretion and alleviating oxidative stress.", "evidence_relation": "neutral" }, { "cited_pmid": "34689247", "evidence_support": "Different hormonal and inflammatory cross-talks may play in the appearance of its eventual complications as a leading cause of infertility.", "evidence_relation": "neutral" }, { "cited_pmid": "34689247", "evidence_support": "There is preparatory evidence of the effectiveness of antioxidant interventions in ameliorating some of the PCOS complications, including metabolic and hormonal disorders", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress [36279177, 26881435, 30568513]. Oxidative stress is a condition that occurs as a result of an imbalance between the body's ability to detoxify and neutralize reactive oxygen species (ROS), and the production of ROS [22301329, 30477143]. ROS are needed for adequate cell function, including the production of energy by the mitochondria [22301329, 30477143]. PCOS patients have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione, compared to healthy women [23303572, 31235121, 31304805]. Oxidative stress in PCOS is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are all characteristics of the syndrome [18073681, 36279177, 29995717]. The increased oxidative stress in PCOS may contribute to the development of metabolic and cardiovascular complications, as well as infertility [36279177, 31235121, 26881435]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress [36279177, 26881435, 30568513].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36279177", "evidence_support": "A genetic, epigenetic, and environmental association exists between oxidative stress (OS) and polycystic ovary syndrome (PCOS), expressed in a multifaceted clinical profile.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Interestingly, in patients with PCOS, an increase in oxidative status and insufficient compensation of the increase in antioxidant status before any cardiovascular complications are observed.", "evidence_relation": "supporting" }, { "cited_pmid": "26881435", "evidence_support": "Although underlying mechanisms have not been fully elucidated yet, it becomes evident that oxidative stress holds a respectable share in the pathogenesis of PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "30568513", "evidence_support": "Literature emerging from Western countries has reported increased levels of serum oxidative stress markers among polycystic ovarian syndrome (PCOS) women.", "evidence_relation": "supporting" }, { "cited_pmid": "30568513", "evidence_support": "This study provides supportive evidence that oxidative stress might play a role in the pathogenesis of PCOS and, hence, oxidative stress parameters could be suggested as diagnostic markers for early diagnosis of high-risk groups.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Oxidative stress is a condition that occurs as a result of an imbalance between the body's ability to detoxify and neutralize reactive oxygen species (ROS), and the production of ROS [22301329, 30477143].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22301329", "evidence_support": "Oxidative stress is defined by an imbalance between increased levels of reactive oxygen species (ROS) and a low activity of antioxidant mechanisms.", "evidence_relation": "supporting" }, { "cited_pmid": "30477143", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "ROS are needed for adequate cell function, including the production of energy by the mitochondria [22301329, 30477143].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "22301329", "evidence_support": "However, ROS are needed for adequate cell function, including the production of energy by the mitochondria. ", "evidence_relation": "supporting" }, { "cited_pmid": "30477143", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "PCOS patients have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione, compared to healthy women [23303572, 31235121, 31304805].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23303572", "evidence_support": "Compared with control women, patients with PCOS presented higher circulating concentrations of homocysteine (23% increase, SMD 0.6, 95CI, 0.4-0.8), malondialdehyde (47% increase, SMD 1.9, 95CI 1.2-2.6) and asymmetric dimethylarginine (36% increase, SMD 1.1, 95CI 0.6-1.6), and increased superoxide dismutase activity (34% increase, SMD 1.0, 95CI 0.5-1.4) and decreased glutathione levels (50% decrease, SMD -3.7, 95CI -6.2 to -1.2) and paraoxonase-1 activity (32% decrease, SMD -0.9, 95CI -1.3 to -0.4).", "evidence_relation": "supporting" }, { "cited_pmid": "23303572", "evidence_support": "Circulating markers of oxidative stress are abnormal in women with PCOS independent of weight excess. ", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "Subjects with PCOS had poor antioxidant status as reflected by significantly low levels of glutathione, vitamin C & E and considerably increased activities of antioxidant enzymes like glutathione peroxidase, glutathione reductase and glutathione transferase as compared to those without PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "Low levels of antioxidants and increased oxidative stress with insulin resistance along with the observed correlation between these parameters suggest that women with PCOS are under oxidative stress which supports the concept that oxidative stress is involved in PCOS pathophysiology. ", "evidence_relation": "supporting" }, { "cited_pmid": "31304805", "evidence_support": "However, a statistically significant difference was found between the two groups in terms of malondialdehyde (MDA) and some dietary antioxidants levels (mean in case group: vit C\u2009=\u200934/2\u2009mg, vit E\u2009=\u20097/7\u2009mg, Se = 84/6\u00a0\u00b5g, Zn = 7/5\u2009mg, beta-carotene = 762/8\u00a0\u00b5g, mean in control group: vit C\u2009=\u200972/5\u2009mg, vit E\u2009=\u200910/6\u2009mg, Se = 91/0\u00a0\u00b5g, Zn = 10/6\u2009mg, beta-carotene = 1609/5\u00a0\u00b5g).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Oxidative stress in PCOS is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are all characteristics of the syndrome [18073681, 36279177, 29995717].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36279177", "evidence_support": "This review focuses on characteristic markers of OS in PCOS and the relationship between OS and PCOS related to insulin resistance (IR), hyperandrogenemia, obesity, chronic inflammation, cardiovascular diseases, and cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "18073681", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "29995717", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "The increased oxidative stress in PCOS may contribute to the development of metabolic and cardiovascular complications, as well as infertility [36279177, 31235121, 26881435].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36279177", "evidence_support": "This review summarizes and discusses the role of OS in the pathogenesis of PCOS syndrome, focusing on metabolic, reproductive, and cancer complications.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Interestingly, in patients with PCOS, an increase in oxidative status and insufficient compensation of the increase in antioxidant status before any cardiovascular complications are observed.", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "Thus oxidative stress could be a contributory factor to future cardiovascular disease risk in these women in addition to known features like dyslipidemia, central obesity, etc.", "evidence_relation": "supporting" }, { "cited_pmid": "26881435", "evidence_support": "This review focuses on understanding the putative role of oxidative stress in the pathophysiology of PCOS and analyzing its interconnection with the rest etiologic parameters and its contribution to the reproductive and metabolic manifestations of the syndrome.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress [26881435, 36279177, 31198521]. Oxidative stress is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them [35892633, 22301329, 18924487]. PCOS patients have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione, compared to healthy women [30202741, 31235121, 23303572]. Oxidative stress in PCOS is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are all characteristics of the syndrome [29995717, 36279177]. The increased oxidative stress in PCOS may contribute to the development of metabolic and cardiovascular complications, as well as infertility [26881435, 36279177, 28711514]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress [26881435, 36279177, 31198521].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26881435", "evidence_support": "Oxidative stress, in conjunction with the rest etiologic mechanisms of PCOS and the cardinal contribution of environmental factors, leads to an adverse redox status that stigmatizes the natural process of the syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "A genetic, epigenetic, and environmental association exists between oxidative stress (OS) and polycystic ovary syndrome (PCOS), expressed in a multifaceted clinical profile.", "evidence_relation": "supporting" }, { "cited_pmid": "31198521", "evidence_support": "Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Oxidative stress is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them [35892633, 22301329, 18924487].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22301329", "evidence_support": "Oxidative stress is defined by an imbalance between increased levels of reactive oxygen species (ROS) and a low activity of antioxidant mechanisms.", "evidence_relation": "supporting" }, { "cited_pmid": "35892633", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18924487", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "PCOS patients have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione, compared to healthy women [30202741, 31235121, 23303572].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31235121", "evidence_support": "Subjects with PCOS had poor antioxidant status as reflected by significantly low levels of glutathione, vitamin C & E and considerably increased activities of antioxidant enzymes like glutathione peroxidase, glutathione reductase and glutathione transferase as compared to those without PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "Low levels of antioxidants and increased oxidative stress with insulin resistance along with the observed correlation between these parameters suggest that women with PCOS are under oxidative stress which supports the concept that oxidative stress is involved in PCOS pathophysiology.", "evidence_relation": "supporting" }, { "cited_pmid": "23303572", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "30202741", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Oxidative stress in PCOS is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are all characteristics of the syndrome [29995717, 36279177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36279177", "evidence_support": "This review focuses on characteristic markers of OS in PCOS and the relationship between OS and PCOS related to insulin resistance (IR), hyperandrogenemia, obesity, chronic inflammation, cardiovascular diseases, and cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "29995717", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The increased oxidative stress in PCOS may contribute to the development of metabolic and cardiovascular complications, as well as infertility [26881435, 36279177, 28711514].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26881435", "evidence_support": "Although underlying mechanisms have not been fully elucidated yet, it becomes evident that oxidative stress holds a respectable share in the pathogenesis of PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "26881435", "evidence_support": "Oxidative stress, in conjunction with the rest etiologic mechanisms of PCOS and the cardinal contribution of environmental factors, leads to an adverse redox status that stigmatizes the natural process of the syndrome.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "PCOS is described mainly as a disproportion of reproductive hormones, leading to chronic anovulation and infertility in women.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "This review focuses on characteristic markers of OS in PCOS and the relationship between OS and PCOS related to insulin resistance (IR), hyperandrogenemia, obesity, chronic inflammation, cardiovascular diseases, and cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Interestingly, in patients with PCOS, an increase in oxidative status and insufficient compensation of the increase in antioxidant status before any cardiovascular complications are observed. Moreover, free radicals promote carcinogenesis in PCOS patients.", "evidence_relation": "supporting" }, { "cited_pmid": "28711514", "evidence_support": "The probable reason suggested for elevated CVRF in PCOS is oxidative stress (OS), which is an integral factor in cardiometabolic complications (CMC) seen in PCOS women.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress [36279177, 31198521, 26881435]. Oxidative stress is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them [22301329, 18924487]. PCOS patients have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione, compared to healthy women [23303572, 31803965, 31235121]. Oxidative stress in PCOS is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are all characteristics of the syndrome [16249279, 36279177]. The increased oxidative stress in PCOS may contribute to the development of metabolic and cardiovascular complications, as well as infertility [36279177, 26330853, 31803965]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Polycystic ovary syndrome (PCOS) is linked to oxidative stress [36279177, 31198521, 26881435].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36279177", "evidence_support": "A genetic, epigenetic, and environmental association exists between oxidative stress (OS) and polycystic ovary syndrome (PCOS), expressed in a multifaceted clinical profile.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" }, { "cited_pmid": "31198521", "evidence_support": "Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "26881435", "evidence_support": "Although underlying mechanisms have not been fully elucidated yet, it becomes evident that oxidative stress holds a respectable share in the pathogenesis of PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "26881435", "evidence_support": "Oxidative stress, in conjunction with the rest etiologic mechanisms of PCOS and the cardinal contribution of environmental factors, leads to an adverse redox status that stigmatizes the natural process of the syndrome.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Oxidative stress is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them [22301329, 18924487].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "22301329", "evidence_support": "Oxidative stress is defined by an imbalance between increased levels of reactive oxygen species (ROS) and a low activity of antioxidant mechanisms.", "evidence_relation": "supporting" }, { "cited_pmid": "18924487", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "PCOS patients have higher levels of oxidative stress markers, such as malondialdehyde, and lower levels of antioxidants, such as glutathione, compared to healthy women [23303572, 31803965, 31235121].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23303572", "evidence_support": "Compared with control women, patients with PCOS presented higher circulating concentrations of homocysteine (23% increase, SMD 0.6, 95CI, 0.4-0.8), malondialdehyde (47% increase, SMD 1.9, 95CI 1.2-2.6) and asymmetric dimethylarginine (36% increase, SMD 1.1, 95CI 0.6-1.6), and increased superoxide dismutase activity (34% increase, SMD 1.0, 95CI 0.5-1.4) and decreased glutathione levels (50% decrease, SMD -3.7, 95CI -6.2 to -1.2) and paraoxonase-1 activity (32% decrease, SMD -0.9, 95CI -1.3 to -0.4).", "evidence_relation": "supporting" }, { "cited_pmid": "23303572", "evidence_support": "Circulating markers of oxidative stress are abnormal in women with PCOS independent of weight excess.", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "Polycystic ovary syndrome (PCOS) is a composite heterogeneous condition with multifactorial etiology like genetic, environmental factors and oxidative stress", "evidence_relation": "neutral" }, { "cited_pmid": "31803965", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Oxidative stress in PCOS is associated with insulin resistance, hyperandrogenism, and chronic inflammation, which are all characteristics of the syndrome [16249279, 36279177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16249279", "evidence_support": "Insulin resistance and chronic low level inflammation are often present in women with polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" }, { "cited_pmid": "16249279", "evidence_support": "The resultant oxidative stress may contribute to a proinflammatory state that induces insulin resistance and hyperandrogenism in women with this disorder.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The increased oxidative stress in PCOS may contribute to the development of metabolic and cardiovascular complications, as well as infertility [36279177, 26330853, 31803965].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "This review focuses on characteristic markers of OS in PCOS and the relationship between OS and PCOS related to insulin resistance (IR), hyperandrogenemia, obesity, chronic inflammation, cardiovascular diseases, and cancer.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Interestingly, in patients with PCOS, an increase in oxidative status and insufficient compensation of the increase in antioxidant status before any cardiovascular complications are observed. ", "evidence_relation": "supporting" }, { "cited_pmid": "31803965", "evidence_support": "Polycystic ovary syndrome (PCOS) is the most common endocrine disease resulting in female infertility.", "evidence_relation": "supporting" }, { "cited_pmid": "26330853", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Polycystic ovary syndrome (PCOS) is strongly linked to oxidative stress (OS), with numerous studies indicating elevated levels of oxidative biomarkers in affected women [23303572, 26770659]. OS in PCOS is characterized by an imbalance between reactive oxygen species (ROS) production and antioxidant defenses, contributing to metabolic and reproductive dysfunctions [37762427, 36279177]. Elevated markers such as malondialdehyde and decreased antioxidant levels like glutathione are consistently observed in PCOS patients, independent of obesity [23303572, 25911850]. Hyperandrogenism and insulin resistance, common in PCOS, exacerbate OS by promoting ROS production and mitochondrial dysfunction [37762427, 36232686]. This oxidative imbalance can impair follicular development, oocyte quality, and overall fertility [37762427, 33216309]. Furthermore, OS is implicated in the increased cardiovascular risk and chronic inflammation seen in PCOS, highlighting its central role in the syndrome's pathophysiology [26770659, 24002405].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Polycystic ovary syndrome (PCOS) is strongly linked to oxidative stress (OS), with numerous studies indicating elevated levels of oxidative biomarkers in affected women [23303572, 26770659].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23303572", "evidence_support": "Oxidative stress might be associated with polycystic ovary syndrome (PCOS)", "evidence_relation": "supporting" }, { "cited_pmid": "23303572", "evidence_support": "Circulating markers of oxidative stress are abnormal in women with PCOS independent of weight excess", "evidence_relation": "supporting" }, { "cited_pmid": "26770659", "evidence_support": "OS is considered as a potential inducing factor in the pathogenesis of PCOS, which is one of the most common complex endocrine disorders and a leading cause of female infertility, affecting 4%-12% of women in the world, as OS has close interactions with PCOS characteristics, just as insulin resistance (IR), hyperandrogenemia, and chronic inflammation.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "OS in PCOS is characterized by an imbalance between reactive oxygen species (ROS) production and antioxidant defenses, contributing to metabolic and reproductive dysfunctions [37762427, 36279177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "Oxidative stress (OS) is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Elevated markers such as malondialdehyde and decreased antioxidant levels like glutathione are consistently observed in PCOS patients, independent of obesity [23303572, 25911850].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23303572", "evidence_support": "Circulating markers of oxidative stress are abnormal in women with PCOS independent of weight excess", "evidence_relation": "supporting" }, { "cited_pmid": "25911850", "evidence_support": "However, over the past decade emerging evidence has shown that increased Oxidative Stress (OS) and decreased antioxidant status were often linked with PCOS", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Hyperandrogenism and insulin resistance, common in PCOS, exacerbate OS by promoting ROS production and mitochondrial dysfunction [37762427, 36232686].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "Oxidative stress (OS) is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them.", "evidence_relation": "supporting" }, { "cited_pmid": "37762427", "evidence_support": "It can play a role in a variety of reproductive system conditions, including polycystic ovary syndrome (PCOS), endometriosis, preeclampsia, and infertility. In this review, we briefly discuss the links between oxidative stress and PCOS. Mitochondrial mutations may lead to impaired oxidative phosphorylation (OXPHOS), decreased adenosine triphosphate (ATP) production, and an increased production of ROS. These functional consequences may contribute to the metabolic and hormonal dysregulation observed in PCOS. Studies have shown that OS negatively affects ovarian follicles and disrupts normal follicular development and maturation. Excessive ROS may damage oocytes and granulosa cells within the follicles, impairing their quality and compromising fertility. Impaired OXPHOS and mitochondrial dysfunction may contribute to insulin resistance (IR) by disrupting insulin signaling pathways and impairing glucose metabolism. Due to dysfunctional OXPHOS, reduced ATP production, may hinder insulin-stimulated glucose uptake, leading to IR. Hyperandrogenism promotes inflammation and IR, both of which can increase the production of ROS and lead to OS. A detrimental feedback loop ensues as IR escalates, causing elevated insulin levels that exacerbate OS", "evidence_relation": "supporting" }, { "cited_pmid": "36232686", "evidence_support": "Polycystic ovarian syndrome (PCOS) is a reproductive, endocrine, and metabolic disorder. Circulating markers of oxidative stress are abnormal in women with PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "36232686", "evidence_support": "We discovered increased oxidative biomarkers, increased ROS production, and damaged insulin sensitivity in the skeletal muscles of mice with PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "36232686", "evidence_support": "Hyperandrogenism caused mitochondrial dysfunction and redox imbalance in the skeletal muscles of mice with PCOS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "This oxidative imbalance can impair follicular development, oocyte quality, and overall fertility [37762427, 33216309].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "Studies have shown that OS negatively affects ovarian follicles and disrupts normal follicular development and maturation. Excessive ROS may damage oocytes and granulosa cells within the follicles, impairing their quality and compromising fertility. I", "evidence_relation": "supporting" }, { "cited_pmid": "33216309", "evidence_support": "PURPOSE: Elevated oxidative stress has been proposed as an important factor in the pathogenesis of polycystic ovary syndrome (PCOS)-related infertility. Our study was aimed at simultaneously exploring local and systemic oxidative stress in PCOS individuals and its relationship with embryo quality.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Furthermore, OS is implicated in the increased cardiovascular risk and chronic inflammation seen in PCOS, highlighting its central role in the syndrome's pathophysiology [26770659, 24002405].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26770659", "evidence_support": "OS is considered as a potential inducing factor in the pathogenesis of PCOS, which is one of the most common complex endocrine disorders and a leading cause of female infertility, affecting 4%-12% of women in the world, as OS has close interactions with PCOS characteristics, just as insulin resistance (IR), hyperandrogenemia, and chronic inflammation.", "evidence_relation": "supporting" }, { "cited_pmid": "24002405", "evidence_support": "PCOS is associated with oxidative stress, namely increased production of free radicals followed by decreased serum antioxidant levels and antioxidant enzyme activity. Broad range of endocrine and metabolic disturbances like obesity, hyperinsulinemia as well as dyslipidemia might be responsible for PCOS-associated oxidative stress.", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Polycystic ovary syndrome (PCOS) is indeed linked to oxidative stress, which is characterized by an imbalance between reactive oxygen species (ROS) and antioxidant defenses.Elevated oxidative stress in PCOS patients is associated with insulin resistance, hyperandrogenism, and chronic inflammation, contributing to the pathophysiology of the syndrome.Studies have shown increased levels of oxidative markers such as malondialdehyde and decreased antioxidant levels like superoxide dismutase and glutathione in women with PCOS.This oxidative imbalance may exacerbate metabolic and reproductive abnormalities, including anovulation and cardiovascular risks.Addressing oxidative stress through lifestyle modifications, dietary antioxidants, and pharmacological interventions may offer therapeutic benefits in managing PCOS symptoms and associated complications.However, further research is needed to fully elucidate the mechanisms and develop targeted treatments.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Polycystic ovary syndrome (PCOS) is indeed linked to oxidative stress, which is characterized by an imbalance between reactive oxygen species (ROS) and antioxidant defenses.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Elevated oxidative stress in PCOS patients is associated with insulin resistance, hyperandrogenism, and chronic inflammation, contributing to the pathophysiology of the syndrome.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Studies have shown increased levels of oxidative markers such as malondialdehyde and decreased antioxidant levels like superoxide dismutase and glutathione in women with PCOS.This oxidative imbalance may exacerbate metabolic and reproductive abnormalities, including anovulation and cardiovascular risks.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Addressing oxidative stress through lifestyle modifications, dietary antioxidants, and pharmacological interventions may offer therapeutic benefits in managing PCOS symptoms and associated complications.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "However, further research is needed to fully elucidate the mechanisms and develop targeted treatments.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Polycystic ovary syndrome (PCOS) is indeed linked to oxidative stress, as evidenced by multiple studies [37337194, 30568513, 31198521]. Oxidative stress is a condition characterized by an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them [37762427]. In PCOS, oxidative stress is thought to play a central role in the pathophysiology of the disorder, contributing to metabolic and hormonal dysregulation [37762427, 23303572]. Elevated levels of oxidative stress markers, such as malondialdehyde and homocysteine, have been consistently observed in women with PCOS compared to controls [23303572, 26770659]. Furthermore, oxidative stress has been linked to insulin resistance, a common feature of PCOS, and may contribute to the development of cardiovascular disease and other metabolic complications [36279177, 25911850]. Overall, the evidence suggests that oxidative stress is a key component of the PCOS pathophysiology.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Polycystic ovary syndrome (PCOS) is indeed linked to oxidative stress, as evidenced by multiple studies [37337194, 30568513, 31198521].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37337194", "evidence_support": "This study showed for the first time that there was no causal relationship between PCOS and OS.", "evidence_relation": "contradicting" }, { "cited_pmid": "30568513", "evidence_support": "This study provides supportive evidence that oxidative stress might play a role in the pathogenesis of PCOS and, hence, oxidative stress parameters could be suggested as diagnostic markers for early diagnosis of high-risk groups", "evidence_relation": "supporting" }, { "cited_pmid": "31198521", "evidence_support": "Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Oxidative stress is a condition characterized by an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them [37762427].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "Oxidative stress (OS) is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In PCOS, oxidative stress is thought to play a central role in the pathophysiology of the disorder, contributing to metabolic and hormonal dysregulation [37762427, 23303572].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "These functional consequences may contribute to the metabolic and hormonal dysregulation observed in PCOS.", "evidence_relation": "neutral" }, { "cited_pmid": "37762427", "evidence_support": "Exploring the relations between OS and PCOS is crucial to fully understand the role of OS in the pathophysiology of PCOS and to develop effective treatment strategies to improve the quality of life of women affected by this condition.", "evidence_relation": "supporting" }, { "cited_pmid": "23303572", "evidence_support": "Circulating markers of oxidative stress are abnormal in women with PCOS independent of weight excess. This finding suggests that oxidative stress may participate in the pathophysiology of this common disorder.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Elevated levels of oxidative stress markers, such as malondialdehyde and homocysteine, have been consistently observed in women with PCOS compared to controls [23303572, 26770659].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23303572", "evidence_support": "Compared with control women, patients with PCOS presented higher circulating concentrations of homocysteine (23% increase, SMD 0.6, 95CI, 0.4-0.8), malondialdehyde (47% increase, SMD 1.9, 95CI 1.2-2.6) and asymmetric dimethylarginine (36% increase, SMD 1.1, 95CI 0.6-1.6), and increased superoxide dismutase activity (34% increase, SMD 1.0, 95CI 0.5-1.4) and decreased glutathione levels (50% decrease, SMD -3.7, 95CI -6.2 to -1.2) and paraoxonase-1 activity (32% decrease, SMD -0.9, 95CI -1.3 to -0.4).", "evidence_relation": "supporting" }, { "cited_pmid": "26770659", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, oxidative stress has been linked to insulin resistance, a common feature of PCOS, and may contribute to the development of cardiovascular disease and other metabolic complications [36279177, 25911850].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "However, despite these data, it has not been established whether oxygen stress influences PCOS development or a secondary disorder resulting from hyperglycemia, IR, and cardiovascular and cancer complications in women.", "evidence_relation": "contradicting" }, { "cited_pmid": "25911850", "evidence_support": "However, over the past decade emerging evidence has shown that increased Oxidative Stress (OS) and decreased antioxidant status were often linked with PCOS. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, the evidence suggests that oxidative stress is a key component of the PCOS pathophysiology.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "ten-shot-gemini-flash": { "answer": "Yes, polycystic ovary syndrome (PCOS) is strongly linked to oxidative stress [36279177, 30450993, 31198521]. Oxidative stress, an imbalance between oxidants and antioxidants, plays a central role in the development and progression of PCOS [31198521, 31435584]. This imbalance is often associated with increased production of free radicals and decreased antioxidant levels and enzyme activity [24002405, 34689247]. Oxidative stress contributes to a proinflammatory state that can induce insulin resistance and hyperandrogenism, key features of PCOS [16249279, 36856088]. This oxidative stress is also linked to mitochondrial dysfunction, which further contributes to the complications of PCOS [31420039].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yes, polycystic ovary syndrome (PCOS) is strongly linked to oxidative stress [36279177, 30450993, 31198521].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36279177", "evidence_support": "A genetic, epigenetic, and environmental association exists between oxidative stress (OS) and polycystic ovary syndrome (PCOS), expressed in a multifaceted clinical profile.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" }, { "cited_pmid": "30450993", "evidence_support": "Evidences have shown that Oxidative Stress and decreased antioxidant status are often linked with PCOS. ", "evidence_relation": "supporting" }, { "cited_pmid": "31198521", "evidence_support": "Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Oxidative stress, an imbalance between oxidants and antioxidants, plays a central role in the development and progression of PCOS [31198521, 31435584].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31198521", "evidence_support": "Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "31435584", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This imbalance is often associated with increased production of free radicals and decreased antioxidant levels and enzyme activity [24002405, 34689247].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24002405", "evidence_support": "PCOS is associated with oxidative stress, namely increased production of free radicals followed by decreased serum antioxidant levels and antioxidant enzyme activity", "evidence_relation": "supporting" }, { "cited_pmid": "34689247", "evidence_support": "Excessive production of reactive oxygen species over the power of the antioxidant system as oxidative stress is known to contribute to a variety of diseases like PCOS", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Oxidative stress contributes to a proinflammatory state that can induce insulin resistance and hyperandrogenism, key features of PCOS [16249279, 36856088].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16249279", "evidence_support": "The resultant oxidative stress may contribute to a proinflammatory state that induces insulin resistance and hyperandrogenism in women with this disorder.", "evidence_relation": "supporting" }, { "cited_pmid": "36856088", "evidence_support": "Polycystic ovary syndrome (PCOS) is a condition that affects approximately 13% of reproductive age women and is characterized by androgen excess, menstrual irregularity and altered ovarian morphology.", "evidence_relation": "neutral" }, { "cited_pmid": "36856088", "evidence_support": "A panel of PCOS biomarkers should include, besides ovarian products, markers of adipose tissue function, insulin resistance, vascular health, and low-grade chronic inflammation. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "This oxidative stress is also linked to mitochondrial dysfunction, which further contributes to the complications of PCOS [31420039].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31420039", "evidence_support": "Mitochondria play a key role in energy production, and mitochondrial dysfunction at the cellular level can affect systemic metabolic balance. The recent wide acceptance of functional mitochondrial disorders as a correlated factor of numerous diseases has led to the presupposition that abnormal mitochondrial metabolic markers are associated with PCOS. Studies conducted in the past few years have confirmed that increased oxidative stress is associated with the progression and related complications of PCOS and have proven the relationship between other mitochondrial dysfunctions and PCOS.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Yes, Polycystic Ovary Syndrome (PCOS) is strongly linked to oxidative stress [30450993, 36279177, 31198521]. Oxidative stress occurs when there is an imbalance between the production of reactive oxygen species (ROS) and the body's ability to neutralize them [37762427]. This imbalance can contribute to various reproductive system conditions, including PCOS [37762427]. In PCOS patients, oxidative stress arises from an imbalance between free radicals and antioxidants in follicular fluid, leading to abnormal follicle development and defects in oocytes [35057828]. Circulating markers of oxidative stress are also abnormal in women with PCOS [36232686]. This oxidative stress is closely related to insulin resistance (IR) [36232686, 22223702], a common feature of PCOS [29604466, 36661246].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yes, Polycystic Ovary Syndrome (PCOS) is strongly linked to oxidative stress [30450993, 36279177, 31198521].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30450993", "evidence_support": "Evidences have shown that Oxidative Stress and decreased antioxidant status are often linked with PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "A genetic, epigenetic, and environmental association exists between oxidative stress (OS) and polycystic ovary syndrome (PCOS), expressed in a multifaceted clinical profile", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS)", "evidence_relation": "supporting" }, { "cited_pmid": "31198521", "evidence_support": "Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Oxidative stress occurs when there is an imbalance between the production of reactive oxygen species (ROS) and the body's ability to neutralize them [37762427].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "Oxidative stress (OS) is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This imbalance can contribute to various reproductive system conditions, including PCOS [37762427].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "It can play a role in a variety of reproductive system conditions, including polycystic ovary syndrome (PCOS), endometriosis, preeclampsia, and infertility.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In PCOS patients, oxidative stress arises from an imbalance between free radicals and antioxidants in follicular fluid, leading to abnormal follicle development and defects in oocytes [35057828].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35057828", "evidence_support": "In polycystic ovary syndrome (PCOS) patients, an imbalance between free radicals and antioxidants in follicular fluid leads to oxidative stress, aberrant folliculogenesis, and intrinsic defects in PCOS oocytes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Circulating markers of oxidative stress are also abnormal in women with PCOS [36232686].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36232686", "evidence_support": "Circulating markers of oxidative stress are abnormal in women with PCOS. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "This oxidative stress is closely related to insulin resistance (IR) [36232686, 22223702], a common feature of PCOS [29604466, 36661246].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36232686", "evidence_support": "There is a close relationship between oxidative stress and insulin resistance (IR).", "evidence_relation": "supporting" }, { "cited_pmid": "22223702", "evidence_support": "Possibly due to a deficiency of insulin mediators, polycystic ovary syndrome (PCOS) is often associated with insulin resistance (IR) and hyperinsulinemia, likely responsible for an elevated production of reactive oxygen species.", "evidence_relation": "supporting" }, { "cited_pmid": "29604466", "evidence_support": "Polycystic ovary syndrome is a common endocrinopathy characterized by anovulatory infertility, hyperandrogenism, insulin resistance and oxidative stress, which predisposes affected women to reproductive and cardiometabolic complications in later life.", "evidence_relation": "supporting" }, { "cited_pmid": "36661246", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Yes, polycystic ovary syndrome (PCOS) is linked to oxidative stress. Research indicates that oxidative stress and chronic inflammation are involved in the pathogenesis of PCOS [35961097]. Women with PCOS often exhibit increased levels of reactive oxygen species (ROS), which can impair ovarian function and disrupt normal follicular development [37762427, 35882072]. Additionally, oxidative stress is associated with insulin resistance, a common feature in PCOS, further complicating the condition [31298704, 25064406]. Abnormal circulating markers of oxidative stress have been observed in women with PCOS, independent of body weight, highlighting its role in the disorder's pathophysiology [26066290, 36232686]. Overall, oxidative stress contributes to metabolic and reproductive complications in PCOS [16249279, 37585035].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yes, polycystic ovary syndrome (PCOS) is linked to oxidative stress.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Research indicates that oxidative stress and chronic inflammation are involved in the pathogenesis of PCOS [35961097].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35961097", "evidence_support": "It has been reported that oxidative stress and chronic inflammation may be involved in the pathogenesis of polycystic ovary syndrome (PCOS)", "evidence_relation": "supporting" }, { "cited_pmid": "35961097", "evidence_support": "In conclusion, our results suggest that OGG1 might be involved in the pathogenesis of PCOS by regulating the secretion of IL-6 through NF-\u03baB signaling pathway, and there might be a balance between the inhibition of oxidative stress and the promotion of chronic inflammation by OGG1 on KGN cells", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Women with PCOS often exhibit increased levels of reactive oxygen species (ROS), which can impair ovarian function and disrupt normal follicular development [37762427, 35882072].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "Studies have shown that OS negatively affects ovarian follicles and disrupts normal follicular development and maturation. Excessive ROS may damage oocytes and granulosa cells within the follicles, impairing their quality and compromising fertility.", "evidence_relation": "supporting" }, { "cited_pmid": "35882072", "evidence_support": "Excessive production of reactive oxygen species (ROS) in granulosa cells (GCs) plays a role in pathogenesis of polycystic ovarian syndrome (PCOS) by developing oxidative stress (OS).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, oxidative stress is associated with insulin resistance, a common feature in PCOS, further complicating the condition [31298704, 25064406].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31298704", "evidence_support": "Oxidative stress and insulin resistance are often present in polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" }, { "cited_pmid": "25064406", "evidence_support": "To study the expression of insulin signaling-related genes and oxidative stress markers in the visceral adipose tissue obtained from polycystic ovary syndrome (PCOS) patients and healthy control subjects and to investigate the relationships among abdominal obesity, insulin resistance, and oxidative stress at the tissue level.", "evidence_relation": "neutral" }, { "cited_pmid": "25064406", "evidence_support": "The strong correlation of insulin resistance with oxidative stress at the VAT level suggests that local oxidative stress and abnormalities of insulin signaling in adipose tissue play critical roles in the pathogenesis of PCOS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Abnormal circulating markers of oxidative stress have been observed in women with PCOS, independent of body weight, highlighting its role in the disorder's pathophysiology [26066290, 36232686].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26066290", "evidence_support": "Fact is that, in PCOS women, the circulating biomarkers of OS are in abnormal levels that are independent of overweight, which depicts the participation of OS in the pathophysiology of this common derangement.", "evidence_relation": "supporting" }, { "cited_pmid": "36232686", "evidence_support": "Circulating markers of oxidative stress are abnormal in women with PCOS. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, oxidative stress contributes to metabolic and reproductive complications in PCOS [16249279, 37585035].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16249279", "evidence_support": "The resultant oxidative stress may contribute to a proinflammatory state that induces insulin resistance and hyperandrogenism in women with this disorder.", "evidence_relation": "supporting" }, { "cited_pmid": "37585035", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Yes, polycystic ovary syndrome (PCOS) is linked to oxidative stress (OS). Research indicates that oxidative stress and chronic inflammation may play a significant role in the pathogenesis of PCOS [35961097]. Women with PCOS often exhibit abnormal levels of circulating biomarkers for oxidative stress, independent of body weight, highlighting its involvement in the condition's pathophysiology [26066290]. Additionally, oxidative stress is associated with insulin resistance, hyperandrogenism, and mitochondrial dysfunction, which are common features of PCOS [31298704, 34787028]. Elevated oxidative stress negatively affects ovarian follicles, disrupting normal follicular development and maturation [37762427]. Overall, oxidative stress contributes to the metabolic disorders frequently observed in women with PCOS [37585035, 16249279].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yes, polycystic ovary syndrome (PCOS) is linked to oxidative stress (OS).", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Research indicates that oxidative stress and chronic inflammation may play a significant role in the pathogenesis of PCOS [35961097].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35961097", "evidence_support": "It has been reported that oxidative stress and chronic inflammation may be involved in the pathogenesis of polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Women with PCOS often exhibit abnormal levels of circulating biomarkers for oxidative stress, independent of body weight, highlighting its involvement in the condition's pathophysiology [26066290].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26066290", "evidence_support": "Fact is that, in PCOS women, the circulating biomarkers of OS are in abnormal levels that are independent of overweight, which depicts the participation of OS in the pathophysiology of this common derangement.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, oxidative stress is associated with insulin resistance, hyperandrogenism, and mitochondrial dysfunction, which are common features of PCOS [31298704, 34787028].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31298704", "evidence_support": "Oxidative stress and insulin resistance are often present in polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" }, { "cited_pmid": "34787028", "evidence_support": "Polycystic ovary syndrome (PCOS) is a disease whose diagnosis is based on the detection of hyperandrogenism (HA) and ovulatory dysfunction.", "evidence_relation": "supporting" }, { "cited_pmid": "34787028", "evidence_support": "Women with PCOS frequently develop insulin resistance (IR), which generates a metabolic condition that involves a decrease in the action of insulin at the cellular level and is linked to compensatory hyperinsulinemia (HI). ", "evidence_relation": "supporting" }, { "cited_pmid": "34787028", "evidence_support": "Additionally, it has been observed that the main effect of insulin in the ovary is the stimulation of androgen synthesis, resulting in HA, one of the fundamental characteristics of the PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "34787028", "evidence_support": "Moreover, mitochondrial dysfunction is present in PCOS patients and is a common feature in both IR and HA.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Elevated oxidative stress negatively affects ovarian follicles, disrupting normal follicular development and maturation [37762427].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "Studies have shown that OS negatively affects ovarian follicles and disrupts normal follicular development and maturation. Excessive ROS may damage oocytes and granulosa cells within the follicles, impairing their quality and compromising fertility.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, oxidative stress contributes to the metabolic disorders frequently observed in women with PCOS [37585035, 16249279].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37585035", "evidence_support": "In contrast, in women with PCOS who have normal insulin levels, it is likely that genetics, inflammation, oxidative stress and possible interaction with environmental factors are present that link these women to metabolic disorder", "evidence_relation": "supporting" }, { "cited_pmid": "16249279", "evidence_support": "The resultant oxidative stress may contribute to a proinflammatory state that induces insulin resistance and hyperandrogenism in women with this disorder.", "evidence_relation": "supporting" } ] } ] }, "webis-1": { "answer": "Yes, oxidative stress is linked to polycystic ovary syndrome (PCOS) [36279177,34578816,31235121,37647682,26386695].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yes, oxidative stress is linked to polycystic ovary syndrome (PCOS) [36279177,34578816,31235121,37647682,26386695].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36279177", "evidence_support": "However, despite these data, it has not been established whether oxygen stress influences PCOS development or a secondary disorder resulting from hyperglycemia, IR, and cardiovascular and cancer complications in women.", "evidence_relation": "contradicting" }, { "cited_pmid": "34578816", "evidence_support": "This article reviews oxidative stress, its markers, nutritional supplementation and clinical studies.", "evidence_relation": "neutral" }, { "cited_pmid": "31235121", "evidence_support": "Low levels of antioxidants and increased oxidative stress with insulin resistance along with the observed correlation between these parameters suggest that women with PCOS are under oxidative stress which supports the concept that oxidative stress is involved in PCOS pathophysiology.", "evidence_relation": "supporting" }, { "cited_pmid": "37647682", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "26386695", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "webis-2": { "answer": "Yes, PCOS is linked to oxidative stress [31235121].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yes, PCOS is linked to oxidative stress [31235121].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31235121", "evidence_support": "Polycystic ovary syndrome (PCOS) is a composite heterogeneous condition with multifactorial etiology like genetic, environmental factors and oxidative stress. ", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "Low levels of antioxidants and increased oxidative stress with insulin resistance along with the observed correlation between these parameters suggest that women with PCOS are under oxidative stress which supports the concept that oxidative stress is involved in PCOS pathophysiology.", "evidence_relation": "supporting" } ] } ] }, "webis-3": { "answer": "Yes, oxidative stress (OS) is one of the factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS) [36279177].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yes, oxidative stress (OS) is one of the factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS) [36279177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" } ] } ] }, "webis-5": { "answer": "Yes, oxidative stress (OS) is one of the factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS). . [36279177].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yes, oxidative stress (OS) is one of the factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS). .", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-1": { "answer": "Polycystic ovary syndrome (PCOS) is indeed linked to oxidative stress. Research indicates that women with PCOS often exhibit increased oxidative stress levels, which may contribute to the pathophysiology of the condition, including insulin resistance and inflammation. This relationship highlights the importance of managing oxidative stress in the treatment of PCOS.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Polycystic ovary syndrome (PCOS) is indeed linked to oxidative stress.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Research indicates that women with PCOS often exhibit increased oxidative stress levels, which may contribute to the pathophysiology of the condition, including insulin resistance and inflammation.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "This relationship highlights the importance of managing oxidative stress in the treatment of PCOS.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "Yes, PCOS is linked to oxidative stress. Oxidative stress is identified as a significant factor in the pathogenesis of polycystic ovary syndrome, indicating that an imbalance between oxidants and antioxidants plays a role in this condition [36279177]. Additionally, the multifactorial etiology of PCOS includes oxidative stress as one of the contributing factors [31235121].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yes, PCOS is linked to oxidative stress.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Oxidative stress is identified as a significant factor in the pathogenesis of polycystic ovary syndrome, indicating that an imbalance between oxidants and antioxidants plays a role in this condition [36279177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, the multifactorial etiology of PCOS includes oxidative stress as one of the contributing factors [31235121].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31235121", "evidence_support": "Polycystic ovary syndrome (PCOS) is a composite heterogeneous condition with multifactorial etiology like genetic, environmental factors and oxidative stress.", "evidence_relation": "supporting" }, { "cited_pmid": "31235121", "evidence_support": "Low levels of antioxidants and increased oxidative stress with insulin resistance along with the observed correlation between these parameters suggest that women with PCOS are under oxidative stress which supports the concept that oxidative stress is involved in PCOS pathophysiology.", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-6": { "answer": "Yes, polycystic ovary syndrome (PCOS) is linked to increased oxidative stress, as indicated by studies showing a correlation between PCOS and elevated oxidative stress levels in specific populations, such as Omani women [30568513]. Additionally, the evaluation of pro-oxidant-antioxidant balance in PCOS suggests that oxidative stress plays a significant role in the condition [28868943].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yes, polycystic ovary syndrome (PCOS) is linked to increased oxidative stress, as indicated by studies showing a correlation between PCOS and elevated oxidative stress levels in specific populations, such as Omani women [30568513].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30568513", "evidence_support": "oxidative stress might play a role in the pathogenesis of PCOS and, hence, oxidative stress parameters could be suggested as diagnostic markers for early diagnosis of high-risk groups. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, the evaluation of pro-oxidant-antioxidant balance in PCOS suggests that oxidative stress plays a significant role in the condition [28868943].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28868943", "evidence_support": "Increased oxidative stress in PCOS is associated with inflammation which is closely linked", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gemini-flash": { "answer": "Yes, polycystic ovary syndrome (PCOS) is linked to oxidative stress [30450993, 31198521, 36279177]. Oxidative stress is an imbalance between oxidants and antioxidants in cells [37762427]. It is recognized as a key factor in the development of PCOS [31198521, 36279177]. PCOS can be considered a purely oxidative state where the body's antioxidants cannot overcome the excessive production of free radicals [26881435]. This imbalance leads to increased reactive oxygen species (ROS) levels and decreased antioxidant capacity in PCOS patients [35392500]. This can damage ovarian tissues and contribute to metabolic disorders [35392500]. The excessive production of ROS overpowers the antioxidant system, contributing to PCOS [34689247]. Oxidative stress is also linked to insulin resistance and hyperinsulinemia, which are often present in PCOS [22223702, 31298704]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yes, polycystic ovary syndrome (PCOS) is linked to oxidative stress [30450993, 31198521, 36279177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30450993", "evidence_support": "Evidences have shown that Oxidative Stress and decreased antioxidant status are often linked with PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "31198521", "evidence_support": "Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Oxidative stress is an imbalance between oxidants and antioxidants in cells [37762427].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37762427", "evidence_support": "Oxidative stress (OS) is a condition that occurs as a result of an imbalance between the production of reactive oxygen species (ROS) and the body's ability to detoxify and neutralize them.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "It is recognized as a key factor in the development of PCOS [31198521, 36279177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31198521", "evidence_support": "Oxidative stress is now recognized to play a central role in the pathophysiology of many different disorders, including PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "A genetic, epigenetic, and environmental association exists between oxidative stress (OS) and polycystic ovary syndrome (PCOS), expressed in a multifaceted clinical profile.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "PCOS can be considered a purely oxidative state where the body's antioxidants cannot overcome the excessive production of free radicals [26881435].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26881435", "evidence_support": "In fact, PCOS can be considered as a purely oxidative state, where the body antioxidants cannot outweigh the excessive production of free radicals.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "This imbalance leads to increased reactive oxygen species (ROS) levels and decreased antioxidant capacity in PCOS patients [35392500].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35392500", "evidence_support": "Increased reactive oxygen species levels and decreased antioxidant capacity in PCOS patients can lead to metabolic disorders and damage the ovarian tissues, resulting in the occurrence of related symptoms.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "This can damage ovarian tissues and contribute to metabolic disorders [35392500].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35392500", "evidence_support": "Polycystic ovary syndrome (PCOS) is the most common cause of infertility in reproductive-age women. Increased reactive oxygen species levels and decreased antioxidant capacity in PCOS patients can lead to metabolic disorders and damage the ovarian tissues, resulting in the occurrence of related symptoms.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "The excessive production of ROS overpowers the antioxidant system, contributing to PCOS [34689247].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34689247", "evidence_support": "Excessive production of reactive oxygen species over the power of the antioxidant system as oxidative stress is known to contribute to a variety of diseases like PCOS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Oxidative stress is also linked to insulin resistance and hyperinsulinemia, which are often present in PCOS [22223702, 31298704].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "22223702", "evidence_support": "Possibly due to a deficiency of insulin mediators, polycystic ovary syndrome (PCOS) is often associated with insulin resistance (IR) and hyperinsulinemia, likely responsible for an elevated production of reactive oxygen species.", "evidence_relation": "supporting" }, { "cited_pmid": "31298704", "evidence_support": "Oxidative stress and insulin resistance are often present in polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "Yes, polycystic ovary syndrome (PCOS) is linked to oxidative stress (OS). Research indicates that women with PCOS often exhibit increased levels of oxidative stress, which is characterized by an imbalance between oxidants and antioxidants in the body [30450993, 35558291, 36279177]. This condition is associated with various metabolic disorders, and oxidative stress plays a significant role in its pathogenesis [23232537, 37448805]. Elevated oxidative stress markers have been found in PCOS patients, independent of body weight, suggesting its involvement in the disease's development [26066290, 37448805]. Furthermore, oxidative stress negatively impacts ovarian function, leading to issues such as abnormal follicular development and ovulation disorders [36786429, 37762427]. Overall, oxidative stress is a critical factor in the pathophysiology of PCOS and its related complications [37530952, 33920227].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yes, polycystic ovary syndrome (PCOS) is linked to oxidative stress (OS).", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Research indicates that women with PCOS often exhibit increased levels of oxidative stress, which is characterized by an imbalance between oxidants and antioxidants in the body [30450993, 35558291, 36279177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30450993", "evidence_support": "Evidences have shown that Oxidative Stress and decreased antioxidant status are often linked with PCOS.", "evidence_relation": "supporting" }, { "cited_pmid": "35558291", "evidence_support": "Increasing evidence reveals that PCOS may be associated with an increased level of oxidative stress.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "A genetic, epigenetic, and environmental association exists between oxidative stress (OS) and polycystic ovary syndrome (PCOS), expressed in a multifaceted clinical profile.", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Oxidative stress (OS), an imbalance between oxidants and antioxidants in cells, is one of many factors playing essential roles in the pathogenesis of polycystic ovary syndrome (PCOS)", "evidence_relation": "supporting" }, { "cited_pmid": "36279177", "evidence_support": "Interestingly, in patients with PCOS, an increase in oxidative status and insufficient compensation of the increase in antioxidant status before any cardiovascular complications are observed.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This condition is associated with various metabolic disorders, and oxidative stress plays a significant role in its pathogenesis [23232537, 37448805].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23232537", "evidence_support": "Polycystic ovary syndrome (PCOS) has recently been associated with increased oxidative stress, often put in relation to the syndrome's typical metabolic disorder. ", "evidence_relation": "supporting" }, { "cited_pmid": "23232537", "evidence_support": "These results suggest that in PCOS women there is an increase of the oxidation of thiol groups of proteins follicular, correlated to a progressive increase of the oxidative stress and that the administration of D-chiro-inositol in patients with this disease seems to reduce the oxidation of thiol groups.", "evidence_relation": "supporting" }, { "cited_pmid": "37448805", "evidence_support": "PCOS has diverse etiologies and oxidative stress (OS) plays an important role.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Elevated oxidative stress markers have been found in PCOS patients, independent of body weight, suggesting its involvement in the disease's development [26066290, 37448805].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26066290", "evidence_support": "Fact is that, in PCOS women, the circulating biomarkers of OS are in abnormal levels that are independent of overweight, which depicts the participation of OS in the pathophysiology of this common derangement.", "evidence_relation": "supporting" }, { "cited_pmid": "37448805", "evidence_support": "PCOS has diverse etiologies and oxidative stress (OS) plays an important role.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, oxidative stress negatively impacts ovarian function, leading to issues such as abnormal follicular development and ovulation disorders [36786429, 37762427].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36786429", "evidence_support": "Excessive oxidative stress and apoptosis of ovarian granulosa cells lead to abnormal follicular development and ovulation disorders in polycystic ovary syndrome (PCOS).", "evidence_relation": "supporting" }, { "cited_pmid": "37762427", "evidence_support": "Studies have shown that OS negatively affects ovarian follicles and disrupts normal follicular development and maturation", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, oxidative stress is a critical factor in the pathophysiology of PCOS and its related complications [37530952, 33920227].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37530952", "evidence_support": "Increasing the intake of dietary polyphenols might reduce oxidative stress and inflammation and thus alleviate the risk of metabolic, endothelial, and cardiovascular disorders. Nowadays, there are an increasing number of studies related to the effects of dietary polyphenols on PCOS and its accompanying cardio-metabolic disturbances.", "evidence_relation": "supporting" }, { "cited_pmid": "33920227", "evidence_support": "This review intends to emphasise the key role of oxidative stress and chronic inflammation in PCOS pathogenesis; however, the exact molecular mechanism is mostly unknown and requires further investigation.", "evidence_relation": "supporting" } ] } ] } } }, { "question_id": "131", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Formoterol, a long-acting beta-agonist used to manage asthma, is associated with several potential side effects. Common side effects include tremors, headaches, and nervousness, which are linked to its mechanism of action that stimulates beta-2 adrenergic receptors [22669289]. Additionally, in rare cases, the use of formoterol can lead to more serious cardiovascular effects, such as palpitations, tachycardia, and arrhythmias, particularly in patients with underlying heart conditions [24317129]. Patients may also experience muscle cramps or gastrointestinal disturbances, though these are less common [23384631]. It is essential for patients to be aware of these potential side effects and to consult with their healthcare provider if they experience any concerning symptoms.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Formoterol, a long-acting beta-agonist used to manage asthma, is associated with several potential side effects.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Common side effects include tremors, headaches, and nervousness, which are linked to its mechanism of action that stimulates beta-2 adrenergic receptors [22669289].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22669289", "evidence_support": "G-protein-coupled receptor 40 (GPR40), highly expressed in pancreatic \u03b2-cells, mediates free fatty acid (FFA)-induced insulin secretion. This phase I, double-blind, randomized study investigated the safety, tolerability, pharmacokinetics (PK), and pharmacodynamics (PD) of a novel, glucose-lowering GPR40 agonist, TAK-875 (q.d., orally \u00d7 14 days), in type 2 diabetics (placebo, n = 14; at 25, 50, 100, 200, or 400 mg, n = 45). Approximately dose-proportional increases in AUC(0-24) and C(max) occurred. TAK-875 showed good tolerability with no dose-limiting side effects. Two subjects (on TAK-875) had mild hypoglycemia, probably related to prolonged fasting after oral glucose tolerance tests (OGTTs). TAK-875 showed reductions from baseline in fasting (2 to -93 mg/dl) and post-OGTT glucose (26 to -172 mg/dl), with an apparent dose-dependent increase in post-OGTT C-peptide over 14 days. Consistent with preclinical data, TAK-875 apparently acts as a glucose-dependent insulinotropic agent with low hypoglycemic risk. Its PK is suitable for once-daily oral administration.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, in rare cases, the use of formoterol can lead to more serious cardiovascular effects, such as palpitations, tachycardia, and arrhythmias, particularly in patients with underlying heart conditions [24317129].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24317129", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Patients may also experience muscle cramps or gastrointestinal disturbances, though these are less common [23384631].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23384631", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is essential for patients to be aware of these potential side effects and to consult with their healthcare provider if they experience any concerning symptoms.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Formoterol can cause a range of side effects, including tremor, headache, and palpitations [16226024, 15350154, 18023995]. It may also lead to muscle cramps, myalgia, and muscle weakness [15145339, 27245339, 16432501]. Some patients experience paradoxical bronchospasm and dysrhythmias, which can be severe [15350154, 17458051, 29332144]. Life-threatening asthma episodes are a serious risk associated with formoterol use [23722615, 19797669, 17458051]. Additionally, it can cause increased heart rate and elevated QTc interval [15707858, 16226024, 16303295]. Oral candidiasis and pharyngolaryngeal pain are notable localized side effects [18694544]. Insomnia and agitation are potential central nervous system effects [22489078, 18632258]. Formoterol can also result in elevated creatine kinase levels and decreased plasma potassium [15145339, 15707858, 16303295]. Increased serum glucose is another metabolic side effect [15707858, 16303295, 18632258]. Impaired bronchoprotection is a critical concern for patients using formoterol [15350154, 29332144, 18686730]. These side effects highlight the need for careful monitoring and consideration when prescribing formoterol to patients [15350154, 23722615].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Formoterol can cause a range of side effects, including tremor, headache, and palpitations [16226024, 15350154, 18023995].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16226024", "evidence_support": "The occurrence of adverse events was dose-related, the most common events being tremor, hypokalaemia, headache and palpitation.", "evidence_relation": "supporting" }, { "cited_pmid": "15350154", "evidence_support": "The long-acting beta2-agonists cause predictable adverse effects including headache, tremor, palpitations, muscle cramps and a fall in serum potassium concentration.", "evidence_relation": "supporting" }, { "cited_pmid": "18023995", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "10", "answer_sentence": "Impaired bronchoprotection is a critical concern for patients using formoterol [15350154, 29332144, 18686730].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15350154", "evidence_support": "In patients with asthma, salmeterol and formoterol increase lung function, reduce asthmatic symptoms and improve quality of life when compared with placebo.", "evidence_relation": "contradicting" }, { "cited_pmid": "15350154", "evidence_support": "Tolerance to the bronchodilator effects of formoterol has also been seen, although this is small and most of the beneficial effects are maintained long-term.", "evidence_relation": "supporting" }, { "cited_pmid": "29332144", "evidence_support": "There are also concerns with regard to the effects of LABAs on bronchial hyperresponsiveness (BHR), where long-term use is associated with increased BHR and loss of bronchoprotection.", "evidence_relation": "supporting" }, { "cited_pmid": "18686730", "evidence_support": "Significant research has been performed to investigate the efficacy, safety and tolerability of formoterol in the therapeutic field of COPD.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "11", "answer_sentence": "These side effects highlight the need for careful monitoring and consideration when prescribing formoterol to patients [15350154, 23722615].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15350154", "evidence_support": "The long-acting beta2-agonists cause predictable adverse effects including headache, tremor, palpitations, muscle cramps and a fall in serum potassium concentration.", "evidence_relation": "supporting" }, { "cited_pmid": "23722615", "evidence_support": "Nonfatal asthma-related serious adverse events were significantly reduced with formoterol (relative risk 0.63, 95% CI 0.53-0.75), as were discontinuations due to adverse events.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It may also lead to muscle cramps, myalgia, and muscle weakness [15145339, 27245339, 16432501].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15145339", "evidence_support": "A patient is presented who developed myalgia and muscle weakness, associated with an elevation of creatine kinase (CK) during treatment with formoterol.", "evidence_relation": "supporting" }, { "cited_pmid": "27245339", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16432501", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Some patients experience paradoxical bronchospasm and dysrhythmias, which can be severe [15350154, 17458051, 29332144].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15350154", "evidence_support": "Salmeterol can also cause paradoxical bronchospasm. There is some evidence that serious adverse events including dysrhythmias and life-threatening asthma episodes can occur; however, the incidence of such events is very low but may be increased in patients not taking an inhaled corticosteroid.", "evidence_relation": "supporting" }, { "cited_pmid": "29332144", "evidence_support": "Unexplained paradoxical asthma exacerbations and deaths have been associated with LABAs, particularly when used without ICS.", "evidence_relation": "supporting" }, { "cited_pmid": "17458051", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Life-threatening asthma episodes are a serious risk associated with formoterol use [23722615, 19797669, 17458051].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23722615", "evidence_support": "Nonfatal asthma-related serious adverse events were significantly reduced with formoterol ", "evidence_relation": "contradicting" }, { "cited_pmid": "19797669", "evidence_support": "We conclude that there was insufficient power to determine whether formoterol increases the risk of mortality.", "evidence_relation": "contradicting" }, { "cited_pmid": "17458051", "evidence_support": "Three smaller trials showed an increase in severe asthma attacks in patients using formoterol without a steroid", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, it can cause increased heart rate and elevated QTc interval [15707858, 16226024, 16303295].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15707858", "evidence_support": "Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001).", "evidence_relation": "supporting" }, { "cited_pmid": "16303295", "evidence_support": "Both agents were associated with decreased plasma potassium (mean minimum values: 3.4 and 3.3 mmol/l for formoterol and salbutamol, respectively; P=0.914), increased serum glucose (mean maximum values: 9.0 and 8.7 mmol/l, respectively; P=0.373), and small increases in mean QTc interval (mean maximum 439 ms with both treatments; P=0.813).", "evidence_relation": "supporting" }, { "cited_pmid": "16226024", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Oral candidiasis and pharyngolaryngeal pain are notable localized side effects [18694544].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18694544", "evidence_support": "Drug-related AEs (>or=2% overall) were oral candidiasis, tremor, and pharyngolaryngeal pain.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Insomnia and agitation are potential central nervous system effects [22489078, 18632258].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22489078", "evidence_support": "insomnia, pressured speech, agitation, and suicidal ideation within the 1st month after initiating formoterol + budesonide", "evidence_relation": "supporting" }, { "cited_pmid": "18632258", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Formoterol can also result in elevated creatine kinase levels and decreased plasma potassium [15145339, 15707858, 16303295].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15145339", "evidence_support": "A patient is presented who developed myalgia and muscle weakness, associated with an elevation of creatine kinase (CK) during treatment with formoterol", "evidence_relation": "supporting" }, { "cited_pmid": "15145339", "evidence_support": "Subsequent muscle biopsy demonstrated atrophic fibres lacking cytochrome C-oxidase and succinate dehydrogenase, suggestive of mitochondrial dysfunctio", "evidence_relation": "neutral" }, { "cited_pmid": "15707858", "evidence_support": "Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001). ", "evidence_relation": "supporting" }, { "cited_pmid": "15707858", "evidence_support": "Both treatments increased FEV1 to a mean maximum of 4.6 L (P=0.613), but the mean FEV1 AUC(0-72)h for formoterol was significantly greater than for salbutamol (302.2 L h, vs. 277.4 L h; P<0.001)", "evidence_relation": "neutral" }, { "cited_pmid": "16303295", "evidence_support": "Both agents were associated with decreased plasma potassium (mean minimum values: 3.4 and 3.3 mmol/l for formoterol and salbutamol, respectively; P=0.914), increased serum glucose (mean maximum values: 9.0 and 8.7 mmol/l, respectively; P=0.373), and small increases in mean QTc interval (mean maximum 439 ms with both treatments; P=0.813)", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "9", "answer_sentence": "Increased serum glucose is another metabolic side effect [15707858, 16303295, 18632258].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15707858", "evidence_support": "Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001). ", "evidence_relation": "supporting" }, { "cited_pmid": "16303295", "evidence_support": "Both agents were associated with decreased plasma potassium (mean minimum values: 3.4 and 3.3 mmol/l for formoterol and salbutamol, respectively; P=0.914), increased serum glucose (mean maximum values: 9.0 and 8.7 mmol/l, respectively; P=0.373), and small increases in mean QTc interval (mean maximum 439 ms with both treatments; P=0.813).", "evidence_relation": "supporting" }, { "cited_pmid": "18632258", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Formoterol, a long-acting beta2-agonist (LABA), is associated with several side effects, including muscle cramps, tremor, headache, palpitations, and hypokalemia [15350154, 16226024]. High doses can lead to systemic effects such as decreased plasma potassium and increased serum glucose levels, although these changes are generally not clinically significant [15707858, 16303295]. There are rare but serious adverse events, including dysrhythmias and life-threatening asthma episodes, particularly in patients not using inhaled corticosteroids [15350154]. Additionally, formoterol has been linked to psychiatric symptoms such as insomnia, agitation, and suicidal ideation in children [22489078]. Mitochondrial dysfunction and muscle weakness have also been reported, with symptoms resolving upon discontinuation [15145339]. While formoterol is generally well-tolerated, its safety profile necessitates careful monitoring, especially at higher doses or in vulnerable populations [16303295, 18321744].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Formoterol, a long-acting beta2-agonist (LABA), is associated with several side effects, including muscle cramps, tremor, headache, palpitations, and hypokalemia [15350154, 16226024].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15350154", "evidence_support": "The long-acting beta2-agonists cause predictable adverse effects including headache, tremor, palpitations, muscle cramps and a fall in serum potassium concentration.", "evidence_relation": "supporting" }, { "cited_pmid": "16226024", "evidence_support": "The occurrence of adverse events was dose-related, the most common events being tremor, hypokalaemia, headache and palpitation. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "High doses can lead to systemic effects such as decreased plasma potassium and increased serum glucose levels, although these changes are generally not clinically significant [15707858, 16303295].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15707858", "evidence_support": "Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001). However, none of these effects was clinically significant.", "evidence_relation": "supporting" }, { "cited_pmid": "16303295", "evidence_support": "Both agents were associated with decreased plasma potassium (mean minimum values: 3.4 and 3.3 mmol/l for formoterol and salbutamol, respectively; P=0.914), increased serum glucose (mean maximum values: 9.0 and 8.7 mmol/l, respectively; P=0.373), and small increases in mean QTc interval (mean maximum 439 ms with both treatments; P=0.813). No clinically relevant between-treatment differences in adverse events or laboratory values occurred.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "There are rare but serious adverse events, including dysrhythmias and life-threatening asthma episodes, particularly in patients not using inhaled corticosteroids [15350154].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15350154", "evidence_support": "There is some evidence that serious adverse events including dysrhythmias and life-threatening asthma episodes can occur; however, the incidence of such events is very low but may be increased in patients not taking an inhaled corticosteroid. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, formoterol has been linked to psychiatric symptoms such as insomnia, agitation, and suicidal ideation in children [22489078].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22489078", "evidence_support": "Herein is reported a case of a 9-year-old boy who developed insomnia, pressured speech, agitation, and suicidal ideation within the 1st month after initiating formoterol + budesonide. He had not received oral glucocorticoids for >90 days. All symptoms resolved within 48 hr upon discontinuing formoterol while continuing budesonide", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Mitochondrial dysfunction and muscle weakness have also been reported, with symptoms resolving upon discontinuation [15145339].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15145339", "evidence_support": "A patient is presented who developed myalgia and muscle weakness, associated with an elevation of creatine kinase (CK) during treatment with formoterol. Subsequent muscle biopsy demonstrated atrophic fibres lacking cytochrome C-oxidase and succinate dehydrogenase, suggestive of mitochondrial dysfunction. There were no inflammatory changes. Immunocytochemical analysis using antibodies to alpha-actinin-2 and alpha-actinin-3 demonstrated positive staining of 'rod-like' bodies in atrophic fibres. Clinical and biochemical improvement occurred following withdrawal of formoterol.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "While formoterol is generally well-tolerated, its safety profile necessitates careful monitoring, especially at higher doses or in vulnerable populations [16303295, 18321744].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "16303295", "evidence_support": "To evaluate the safety and tolerability of high-dose formoterol and salbutamol in patients with chronic obstructive pulmonary disease (COPD).", "evidence_relation": "neutral" }, { "cited_pmid": "16303295", "evidence_support": "Treatment with high-dose formoterol and salbutamol was equally well tolerated, with no reports of serious adverse events. ", "evidence_relation": "contradicting" }, { "cited_pmid": "18321744", "evidence_support": "The BDP/formoterol combination was well tolerated, and exhibited a safety profile generally similar to formoterol alone when administered in high doses to stable asthmatic patients.", "evidence_relation": "supporting" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Formoterol, a long-acting beta2-adrenergic receptor agonist, has been associated with various side effects, including decreased plasma potassium levels , increased serum glucose , and small increases in mean QTc interval [15707858, 16226024, 18321744]. Additionally, formoterol has been linked to muscle weakness, myalgia, and mitochondrial dysfunction [15145339]. In some cases, formoterol has been associated with more severe side effects, such as suicidal ideation and thought disorder in children and delirium in elderly patients, particularly when combined with inhaled corticosteroids [22489078, 24097913]. Furthermore, formoterol has been reported to cause tremor, palpitations, and muscle cramps [15350154]. It is essential to note that the safety profile of formoterol may vary depending on the population, dosage, and combination with other medications.Overall, while formoterol is generally well-tolerated, it is crucial to monitor patients for potential side effects and adjust treatment accordingly.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Formoterol, a long-acting beta2-adrenergic receptor agonist, has been associated with various side effects, including decreased plasma potassium levels , increased serum glucose , and small increases in mean QTc interval [15707858, 16226024, 18321744].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15707858", "evidence_support": "FEV1 was measured 15 min pre-dose and 2 h post-dose. Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001). ", "evidence_relation": "supporting" }, { "cited_pmid": "18321744", "evidence_support": "Formoterol caused a significantly greater decrease in serum potassium than BDP/formoterol or placebo (difference in mean minimum concentrations", "evidence_relation": "supporting" }, { "cited_pmid": "16226024", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, formoterol has been linked to muscle weakness, myalgia, and mitochondrial dysfunction [15145339].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15145339", "evidence_support": " A patient is presented who developed myalgia and muscle weakness, associated with an elevation of creatine kinase (CK) during treatment with formoterol. Subsequent muscle biopsy demonstrated atrophic fibres lacking cytochrome C-oxidase and succinate dehydrogenase, suggestive of mitochondrial dysfunction.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In some cases, formoterol has been associated with more severe side effects, such as suicidal ideation and thought disorder in children and delirium in elderly patients, particularly when combined with inhaled corticosteroids [22489078, 24097913].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22489078", "evidence_support": "Herein is reported a case of a 9-year-old boy who developed insomnia, pressured speech, agitation, and suicidal ideation within the 1st month after initiating formoterol + budesonide. ", "evidence_relation": "supporting" }, { "cited_pmid": "22489078", "evidence_support": "To our knowledge, this is the first report of childhood suicidal ideation strongly associated with use of a combination inhaled corticosteroid/LABA.", "evidence_relation": "contradicting" }, { "cited_pmid": "24097913", "evidence_support": "An elderly male described confusion and hallucinations within 1 week after initiation of budesonide/formoterol for chronic obstructive pulmonary disease.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, formoterol has been reported to cause tremor, palpitations, and muscle cramps [15350154].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15350154", "evidence_support": "In patients with asthma, salmeterol and formoterol increase lung function, reduce asthmatic symptoms and improve quality of life when compared with placebo.", "evidence_relation": "neutral" }, { "cited_pmid": "15350154", "evidence_support": "The long-acting beta2-agonists cause predictable adverse effects including headache, tremor, palpitations, muscle cramps and a fall in serum potassium concentration.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is essential to note that the safety profile of formoterol may vary depending on the population, dosage, and combination with other medications.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Overall, while formoterol is generally well-tolerated, it is crucial to monitor patients for potential side effects and adjust treatment accordingly.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "Common side effects of formoterol include muscle cramps, muscle twisting, tremor, and heart rate increase [18394012, 19136239, 35115339]. Other potential side effects include sore throat, dry throat, and cough [29061968, 19136239]. In rare cases, formoterol may cause suicidal ideation, thought disorder, and psychiatric disorders [29061968, 22489078]. Long-term use of formoterol may lead to tolerance to its bronchodilating effect [15350154, 16169761]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Common side effects of formoterol include muscle cramps, muscle twisting, tremor, and heart rate increase [18394012, 19136239, 35115339].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18394012", "evidence_support": "Systemic effects were modest", "evidence_relation": "neutral" }, { "cited_pmid": "18394012", "evidence_support": "FEV(1)[area under the time-response curve (AUC)] and satisfaction scores increased with all formoterol doses compared with placebo, as did AUC tremor with the 24- and 48-microg doses and AUC heart rate with the 48-microg dose.", "evidence_relation": "neutral" }, { "cited_pmid": "19136239", "evidence_support": "A total of 114 (72%) patients reported potential side effects to long-acting-beta-agonists.", "evidence_relation": "neutral" }, { "cited_pmid": "19136239", "evidence_support": "The most frequent were muscle cramps (62%) and muscle twisting (39%).", "evidence_relation": "supporting" }, { "cited_pmid": "35115339", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Other potential side effects include sore throat, dry throat, and cough [29061968, 19136239].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29061968", "evidence_support": "Exposure-adjusted incidence rates of cardiac AEs (arrhythmia and myocardial ischaemia) and cough were numerically lower in the olodaterol group than the formoterol group, while nasopharyngitis, throat irritation, metabolism and psychiatric disorders were numerically higher in the olodaterol group.", "evidence_relation": "supporting" }, { "cited_pmid": "19136239", "evidence_support": "The most frequent were sore (54%) and dry (52%) throat.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In rare cases, formoterol may cause suicidal ideation, thought disorder, and psychiatric disorders [29061968, 22489078].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22489078", "evidence_support": "Herein is reported a case of a 9-year-old boy who developed insomnia, pressured speech, agitation, and suicidal ideation within the 1st month after initiating formoterol + budesonide.", "evidence_relation": "supporting" }, { "cited_pmid": "22489078", "evidence_support": "To our knowledge, this is the first report of childhood suicidal ideation strongly associated with use of a combination inhaled corticosteroid/LABA.", "evidence_relation": "supporting" }, { "cited_pmid": "29061968", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Long-term use of formoterol may lead to tolerance to its bronchodilating effect [15350154, 16169761].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15350154", "evidence_support": "The two inhaled long-acting beta2-adrenoceptor agonists, salmeterol and formoterol, have been studied extensively since their introduction in the early 1990s.", "evidence_relation": "neutral" }, { "cited_pmid": "15350154", "evidence_support": "Tolerance to the bronchodilator effects of formoterol has also been seen, although this is small and most of the beneficial effects are maintained long-term.", "evidence_relation": "supporting" }, { "cited_pmid": "16169761", "evidence_support": "Formoterol decreases the bronchodilator response to salbutamol following MPT", "evidence_relation": "neutral" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Common side effects of formoterol include decreased plasma potassium levels, increased serum glucose levels, and small increases in mean QTc interval [18023995, 16303295, 15707858]. Some patients may experience systemic effects such as palpitations and tremors, but these are generally not clinically significant [18023995, 14982610, 18023335]. High doses of formoterol can cause a decrease in plasma potassium levels, increased serum glucose levels, and small increases in mean QTc interval [18023995, 16303295, 15707858]. However, these effects are not clinically significant [18023995, 15649853, 15707858]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Common side effects of formoterol include decreased plasma potassium levels, increased serum glucose levels, and small increases in mean QTc interval [18023995, 16303295, 15707858].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16303295", "evidence_support": "Both agents were associated with decreased plasma potassium (mean minimum values: 3.4 and 3.3 mmol/l for formoterol and salbutamol, respectively; P=0.914), increased serum glucose (mean maximum values: 9.0 and 8.7 mmol/l, respectively; P=0.373), and small increases in mean QTc interval (mean maximum 439 ms with both treatments; P=0.813).", "evidence_relation": "supporting" }, { "cited_pmid": "15707858", "evidence_support": "Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001).", "evidence_relation": "supporting" }, { "cited_pmid": "18023995", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Some patients may experience systemic effects such as palpitations and tremors, but these are generally not clinically significant [18023995, 14982610, 18023335].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14982610", "evidence_support": "One patient developed ventricular trigeminy after both formoterol and salbutamol.", "evidence_relation": "neutral" }, { "cited_pmid": "18023995", "evidence_support": "In clinical studies, formoterol was well tolerated and had an adverse-event profile similar to that of other beta2-adrenergic receptor agonists.", "evidence_relation": "neutral" }, { "cited_pmid": "18023335", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "High doses of formoterol can cause a decrease in plasma potassium levels, increased serum glucose levels, and small increases in mean QTc interval [18023995, 16303295, 15707858].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16303295", "evidence_support": "Both agents were associated with decreased plasma potassium (mean minimum values: 3.4 and 3.3 mmol/l for formoterol and salbutamol, respectively; P=0.914), increased serum glucose (mean maximum values: 9.0 and 8.7 mmol/l, respectively; P=0.373), and small increases in mean QTc interval ", "evidence_relation": "supporting" }, { "cited_pmid": "16303295", "evidence_support": "mean maximum 439 ms with both treatments; P=0.813", "evidence_relation": "neutral" }, { "cited_pmid": "15707858", "evidence_support": "Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001).", "evidence_relation": "supporting" }, { "cited_pmid": "18023995", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, these effects are not clinically significant [18023995, 15649853, 15707858].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15649853", "evidence_support": "No significant differences in effects were observed between rac- and (R;R)-formoterol.", "evidence_relation": "supporting" }, { "cited_pmid": "15649853", "evidence_support": "This study does not indicate a clinically important advantage of (R;R)-formoterol as acute bronchodilator compared to the racemate.", "evidence_relation": "neutral" }, { "cited_pmid": "15707858", "evidence_support": "Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001). However, none of these effects was clinically significant.", "evidence_relation": "supporting" }, { "cited_pmid": "15707858", "evidence_support": "High-dose formoterol via Aerolizer did not produce any clinically significant systemic effects in patients with mild/moderate asthma.", "evidence_relation": "supporting" }, { "cited_pmid": "18023995", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Common side effects of formoterol include tremors, palpitations, and increased heart rate [18023335, 15763453, 20477219]. High doses of formoterol may cause systemic effects such as decreased plasma potassium, increased serum glucose, and small increases in mean QTc interval [15707858, 16303295]. However, these effects are generally not clinically significant [15763453, 16303295, 14982610]. In some cases, formoterol may cause ventricular trigeminy, and one death per 1000 people on formoterol or on short-acting beta(2)-agonists has been reported [20824877, 14982610]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Common side effects of formoterol include tremors, palpitations, and increased heart rate [18023335, 15763453, 20477219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18023335", "evidence_support": "Maximum bronchodilation and systemic effects were similar after formoterol and salbutamol, except for statistically significantly larger maximum heart rate and palpitation and tremor scores after salbutamol.", "evidence_relation": "supporting" }, { "cited_pmid": "15763453", "evidence_support": "Formoterol 4.5 microg used as needed was at least as effective and safe as terbutaline 0.5 mg used as needed in intermittent and mild persistent asthma, and was associated with less systemic effects when administered as high single doses.", "evidence_relation": "neutral" }, { "cited_pmid": "20477219", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "High doses of formoterol may cause systemic effects such as decreased plasma potassium, increased serum glucose, and small increases in mean QTc interval [15707858, 16303295].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15707858", "evidence_support": "Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001).", "evidence_relation": "supporting" }, { "cited_pmid": "16303295", "evidence_support": "Treatment with high-dose formoterol and salbutamol was equally well tolerated, with no reports of serious adverse events. Both agents were associated with decreased plasma potassium (mean minimum values: 3.4 and 3.3 mmol/l for formoterol and salbutamol, respectively; P=0.914), increased serum glucose (mean maximum values: 9.0 and 8.7 mmol/l, respectively; P=0.373), and small increases in mean QTc interval (mean maximum 439 ms with both treatments; P=0.813).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, these effects are generally not clinically significant [15763453, 16303295, 14982610].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "14982610", "evidence_support": "There were no clinically important or statistically significant changes in heart rate, QTc, T-wave height, plasma potassium, oxygen saturation, or systolic and diastolic blood pressures with formoterol or salbutamol.", "evidence_relation": "supporting" }, { "cited_pmid": "15763453", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16303295", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In some cases, formoterol may cause ventricular trigeminy, and one death per 1000 people on formoterol or on short-acting beta(2)-agonists has been reported [20824877, 14982610].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20824877", "evidence_support": "There was one death per 1000 people on formoterol or on short-acting beta(2)-agonists.", "evidence_relation": "supporting" }, { "cited_pmid": "14982610", "evidence_support": "One patient developed ventricular trigeminy after both formoterol and salbutamol.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Common side effects of formoterol include tremors, palpitations, and increased heart rate [18394012]. High doses of formoterol may cause systemic effects such as decreased plasma potassium, increased serum glucose, and small increases in mean QTc interval [15707858, 16303295, 18321744]. However, these effects are generally not clinically significant [16303295, 15763453, 14982610]. In some cases, formoterol may cause ventricular trigeminy, and one death per 1000 people on formoterol or on short-acting beta(2)-agonists has been reported [20824877, 14982610]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Common side effects of formoterol include tremors, palpitations, and increased heart rate [18394012].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18394012", "evidence_support": "FEV(1)[area under the time-response curve (AUC)] and satisfaction scores increased with all formoterol doses compared with placebo, as did AUC tremor with the 24- and 48-microg doses and AUC heart rate with the 48-microg dose. A dose-response relationship was seen with FEV(1) and tremor,", "evidence_relation": "supporting" }, { "cited_pmid": "18394012", "evidence_support": "Since the systemic effects from a relatively high dose were minimal,", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "High doses of formoterol may cause systemic effects such as decreased plasma potassium, increased serum glucose, and small increases in mean QTc interval [15707858, 16303295, 18321744].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15707858", "evidence_support": "Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001).", "evidence_relation": "supporting" }, { "cited_pmid": "16303295", "evidence_support": "Both agents were associated with decreased plasma potassium (mean minimum values: 3.4 and 3.3 mmol/l for formoterol and salbutamol, respectively; P=0.914), increased serum glucose (mean maximum values: 9.0 and 8.7 mmol/l, respectively; P=0.373), and small increases in mean QTc interval (mean maximum 439 ms with both treatments; P=0.813).", "evidence_relation": "supporting" }, { "cited_pmid": "18321744", "evidence_support": "Formoterol caused a significantly greater decrease in serum potassium than BDP/formoterol or placebo (difference in mean minimum concentrations; 0.11 and -0.15 mmol/l, respectively, p<0.05 for both comparisons).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, these effects are generally not clinically significant [16303295, 15763453, 14982610].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "16303295", "evidence_support": "Treatment with high-dose formoterol and salbutamol was equally well tolerated, with no reports of serious adverse events.", "evidence_relation": "supporting" }, { "cited_pmid": "14982610", "evidence_support": "There were no clinically important or statistically significant changes in heart rate, QTc, T-wave height, plasma potassium, oxygen saturation, or systolic and diastolic blood pressures with formoterol or salbutamol. ", "evidence_relation": "supporting" }, { "cited_pmid": "15763453", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In some cases, formoterol may cause ventricular trigeminy, and one death per 1000 people on formoterol or on short-acting beta(2)-agonists has been reported [20824877, 14982610].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20824877", "evidence_support": "There was one death per 1000 people on formoterol or on short-acting beta(2)-agonists.", "evidence_relation": "supporting" }, { "cited_pmid": "14982610", "evidence_support": "One patient developed ventricular trigeminy after both formoterol and salbutamol", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Common side effects of formoterol include tremors, palpitations, and increased heart rate [18394012]. High doses of formoterol may cause systemic effects such as decreased plasma potassium, increased serum glucose, and small increases in mean QTc interval [18321744, 16303295, 15707858]. However, these effects are generally not clinically significant [16303295, 14982610, 15763453]. In some cases, formoterol may cause ventricular trigeminy, and one death per 1000 people on formoterol or on short-acting beta(2)-agonists has been reported [14982610, 20824877]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Common side effects of formoterol include tremors, palpitations, and increased heart rate [18394012].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18394012", "evidence_support": "as did AUC tremor with the 24- and 48-microg doses and AUC heart rate with the 48-microg dose. A dose-response relationship was seen with FEV(1) and tremor,", "evidence_relation": "supporting" }, { "cited_pmid": "18394012", "evidence_support": "the systemic effects from a relatively high dose were minimal", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "High doses of formoterol may cause systemic effects such as decreased plasma potassium, increased serum glucose, and small increases in mean QTc interval [18321744, 16303295, 15707858].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18321744", "evidence_support": "Formoterol caused a significantly greater decrease in serum potassium than BDP/formoterol or placebo (difference in mean minimum concentrations; 0.11 and -0.15 mmol/l, respectively, p<0.05 for both comparisons).", "evidence_relation": "supporting" }, { "cited_pmid": "18321744", "evidence_support": "High doses of BDP/formoterol did not significantly reduce serum potassium, while formoterol alone did to a greater extent. The BDP/formoterol combination was well tolerated, and exhibited a safety profile generally similar to formoterol alone when administered in high doses to stable asthmatic patients.", "evidence_relation": "contradicting" }, { "cited_pmid": "16303295", "evidence_support": "Treatment with high-dose formoterol and salbutamol was equally well tolerated, with no reports of serious adverse events. Both agents were associated with decreased plasma potassium (mean minimum values: 3.4 and 3.3 mmol/l for formoterol and salbutamol, respectively; P=0.914), increased serum glucose (mean maximum values: 9.0 and 8.7 mmol/l, respectively; P=0.373), and small increases in mean QTc interval (mean maximum 439 ms with both treatments; P=0.813).", "evidence_relation": "supporting" }, { "cited_pmid": "15707858", "evidence_support": "Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, these effects are generally not clinically significant [16303295, 14982610, 15763453].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "14982610", "evidence_support": "There were no clinically important or statistically significant changes in heart rate, QTc, T-wave height, plasma potassium, oxygen saturation, or systolic and diastolic blood pressures with formoterol or salbutamol.", "evidence_relation": "supporting" }, { "cited_pmid": "15763453", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16303295", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In some cases, formoterol may cause ventricular trigeminy, and one death per 1000 people on formoterol or on short-acting beta(2)-agonists has been reported [14982610, 20824877].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14982610", "evidence_support": "One patient developed ventricular trigeminy after both formoterol and salbutamol.", "evidence_relation": "supporting" }, { "cited_pmid": "20824877", "evidence_support": "There was one death per 1000 people on formoterol or on short-acting beta(2)-agonists.", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Common side effects of formoterol include tremors, palpitations, and increased heart rate [18394012]. High doses of formoterol may cause systemic effects such as decreased plasma potassium, increased serum glucose, and small increases in mean QTc interval [16303295, 15707858, 18321744]. However, these effects are generally not clinically significant [16303295, 15763453, 14982610]. In some cases, formoterol may cause ventricular trigeminy, and one death per 1000 people on formoterol or on short-acting beta(2)-agonists has been reported [14982610, 20824877]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Common side effects of formoterol include tremors, palpitations, and increased heart rate [18394012].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18394012", "evidence_support": "Systemic effects were modest, however, and high doses did not appear to reduce patient satisfaction.", "evidence_relation": "contradicting" }, { "cited_pmid": "18394012", "evidence_support": "FEV(1)[area under the time-response curve (AUC)] and satisfaction scores increased with all formoterol doses compared with placebo, as did AUC tremor with the 24- and 48-microg doses and AUC heart rate with the 48-microg dose. A dose-response relationship was seen with FEV(1) and tremor, but not with satisfaction scores.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "High doses of formoterol may cause systemic effects such as decreased plasma potassium, increased serum glucose, and small increases in mean QTc interval [16303295, 15707858, 18321744].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16303295", "evidence_support": "Treatment with high-dose formoterol and salbutamol was equally well tolerated, with no reports of serious adverse event", "evidence_relation": "contradicting" }, { "cited_pmid": "16303295", "evidence_support": "Both agents were associated with decreased plasma potassium (mean minimum values: 3.4 and 3.3 mmol/l for formoterol and salbutamol, respectively; P=0.914), increased serum glucose (mean maximum values: 9.0 and 8.7 mmol/l, respectively; P=0.373), and small increases in mean QTc interval (mean maximum 439 ms with both treatments; P=0.813).", "evidence_relation": "supporting" }, { "cited_pmid": "15707858", "evidence_support": "Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001). ", "evidence_relation": "supporting" }, { "cited_pmid": "18321744", "evidence_support": "The corticosteroid beclomethasone dipropionate (BDP) has been formulated with the long acting beta agonist formoterol (BDP/formoterol 100 microg/6 microg, Foster) in a single inhaler using Modulite technolo", "evidence_relation": "neutral" }, { "cited_pmid": "18321744", "evidence_support": "Formoterol caused a significantly greater decrease in serum potassium than BDP/formoterol or placebo (difference in mean minimum concentrations; 0.11 and -0.15 mmol/l, respectively, p<0.05 for both comparisons).", "evidence_relation": "supporting" }, { "cited_pmid": "18321744", "evidence_support": "High doses of BDP/formoterol did not significantly reduce serum potassium, while formoterol alone did to a greater extent.", "evidence_relation": "contradicting" }, { "cited_pmid": "18321744", "evidence_support": "The BDP/formoterol combination was well tolerated, and exhibited a safety profile generally similar to formoterol alone when administered in high doses to stable asthmatic patie", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, these effects are generally not clinically significant [16303295, 15763453, 14982610].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "14982610", "evidence_support": "There were no clinically important or statistically significant changes in heart rate, QTc, T-wave height, plasma potassium, oxygen saturation, or systolic and diastolic blood pressures with formoterol or salbutamol", "evidence_relation": "supporting" }, { "cited_pmid": "15763453", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16303295", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In some cases, formoterol may cause ventricular trigeminy, and one death per 1000 people on formoterol or on short-acting beta(2)-agonists has been reported [14982610, 20824877].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14982610", "evidence_support": "One patient developed ventricular trigeminy after both formoterol and salbutamol. She had had ventricular ectopics on her screening electrocardiogram.", "evidence_relation": "supporting" }, { "cited_pmid": "20824877", "evidence_support": "There was one death per 1000 people on formoterol or on short-acting beta(2)-agonists.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Common side effects of formoterol include tremors, palpitations, and increased heart rate [15649853]. High doses of formoterol may cause systemic effects such as decreased plasma potassium, increased serum glucose, and small increases in mean QTc interval [15373934, 18321744, 15707858]. However, these effects are generally not clinically significant [16892777, 33273813]. In some cases, formoterol may cause ventricular trigeminy, and one death per 1000 people on formoterol or on short-acting beta(2)-agonists has been reported [14982610, 20824877]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Common side effects of formoterol include tremors, palpitations, and increased heart rate [15649853].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15649853", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "High doses of formoterol may cause systemic effects such as decreased plasma potassium, increased serum glucose, and small increases in mean QTc interval [15373934, 18321744, 15707858].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15373934", "evidence_support": "Thus, mean minimum plasma potassium, was suppressed from 3.56 (95% confidence interval, CI: 3.48-3.65) mmol l(-1) on the day of no treatment to 2.98 (CI: 2.90-3.08) after 10 x F4.5 and 2.70 (CI: 2.61-2.78) mmol l(-1) after 10 x T500, and maximum Q-Tc (heart rate corrected Q-T interval [Bazett's formula]) was prolonged from 429 (CI: 422-435) ms on the day of no treatment, to 455 (CI: 448-462) ms after 10 x F4.5 and 470 (CI: 463-476) ms after 10 x T500.", "evidence_relation": "supporting" }, { "cited_pmid": "18321744", "evidence_support": "Formoterol caused a significantly greater decrease in serum potassium than BDP/formoterol or placebo (difference in mean minimum concentrations; 0.11 and -0.15 mmol/l, respectively, p<0.05 for both comparisons). ", "evidence_relation": "supporting" }, { "cited_pmid": "18321744", "evidence_support": "For glucose, the mean maximum increase after formoterol treatment was 0.4 mmol/l (p<0.01 compared to placebo), while BDP/formoterol treatment caused a maximum increase of 0.7 mmol/l (p<0.01 compared to formoterol and placebo).", "evidence_relation": "supporting" }, { "cited_pmid": "15707858", "evidence_support": "Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, these effects are generally not clinically significant [16892777, 33273813].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16892777", "evidence_support": "Clinical data also demonstrate that formoterol is safe and well tolerated even in high doses, with an adverse event profile similar to that of SABAs.", "evidence_relation": "supporting" }, { "cited_pmid": "33273813", "evidence_support": "The adverse event profile of inhaled formoterol is similar to that of placebo, with few adverse cardiovascular events.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In some cases, formoterol may cause ventricular trigeminy, and one death per 1000 people on formoterol or on short-acting beta(2)-agonists has been reported [14982610, 20824877].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14982610", "evidence_support": "One patient developed ventricular trigeminy after both formoterol and salbutamol.", "evidence_relation": "supporting" }, { "cited_pmid": "20824877", "evidence_support": "There was one death per 1000 people on formoterol or on short-acting beta(2)-agonists.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Common side effects of formoterol include tremors, palpitations, and increased heart rate [15649853]. High doses of formoterol may cause systemic effects such as increased heart rate, but no information was found about the effects on plasma potassium and serum glucose [15649853]. However, these effects are generally not clinically significant [34414631]. In some cases, formoterol may cause dysrhythmia events [16911869]. Some evidence suggests an increased risk of myocardial infarction associated with beta(2)-agonist use in patients with chronic obstructive pulmonary disease (COPD) [16911869]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Common side effects of formoterol include tremors, palpitations, and increased heart rate [15649853].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15649853", "evidence_support": "(R;R)- and rac-formoterol were still effective 22-24 h after single high doses, but this was associated with some systemic side effect (increased heart rate) initially.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "High doses of formoterol may cause systemic effects such as increased heart rate, but no information was found about the effects on plasma potassium and serum glucose [15649853].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15649853", "evidence_support": "(R;R)- and rac-formoterol were still effective 22-24 h after single high doses, but this was associated with some systemic side effect (increased heart rate) initially.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, these effects are generally not clinically significant [34414631].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "34414631", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In some cases, formoterol may cause dysrhythmia events [16911869].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16911869", "evidence_support": "Some evidence suggests an increased risk of myocardial infarction and dysrhythmia events associated with beta(2)-agonist use in patients with chronic obstructive pulmonary disease (COPD)", "evidence_relation": "supporting" }, { "cited_pmid": "16911869", "evidence_support": "Holter monitoring data were variable but showed no clinically meaningful differences between the formoterol and placebo groups, respectively, for variables such as (mean+/-SD at end of treatment): heart rate (80+/-8.6 vs. 80+/-10.6 bpm), number and rate of ventricular premature beats (total 732+/-2685.4 vs. 650+/-2090.6; rate 35+/-131.0 vs. 30+/-101.3 per h), ventricular tachycardia events (total 0.4+/-1.70 vs. 1.0+/-9.23; rate 0.02+/-0.082 vs. 0.05+/-0.479 per h), and supraventricular premature beats (total 504+/-1844.1 vs. 823+/-2961.8; rate 22+/-80.6 vs. 37+/-129.6 per h).", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Some evidence suggests an increased risk of myocardial infarction associated with beta(2)-agonist use in patients with chronic obstructive pulmonary disease (COPD) [16911869].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16911869", "evidence_support": "Some evidence suggests an increased risk of myocardial infarction and dysrhythmia events associated with beta(2)-agonist use in patients with chronic obstructive pulmonary disease (COPD).", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Common side effects of formoterol include tremors, palpitations, and increased heart rate [15649853]. High doses of formoterol may cause systemic effects such as decreased plasma potassium, increased serum glucose, and small increases in mean QTc interval [15373934, 16303295, 15707858]. Actually the text does not mention that the side effects are not significant [16892777]. The text states that formoterol is safe and well tolerated even in high doses, with an adverse event profile similar to that of SABAs [16892777]. Formoterol may have a higher risk of asthma mortality compared to non-LABA treatments [19797669, 33273813]. Although the evidence is not conclusive, the point estimates suggest a 2.0- to 3.2-fold increased risk of asthma death associated with Formoterol use [19797669, 33273813]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Common side effects of formoterol include tremors, palpitations, and increased heart rate [15649853].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15649853", "evidence_support": "(R;R)- and rac-formoterol were still effective 22-24 h after single high doses, but this was associated with some systemic side effect (increased heart rate) initially", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "High doses of formoterol may cause systemic effects such as decreased plasma potassium, increased serum glucose, and small increases in mean QTc interval [15373934, 16303295, 15707858].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15373934", "evidence_support": "Thus, mean minimum plasma potassium, was suppressed from 3.56 (95% confidence interval, CI: 3.48-3.65) mmol l(-1) on the day of no treatment to 2.98 (CI: 2.90-3.08) after 10 x F4.5 and 2.70 (CI: 2.61-2.78) mmol l(-1) after 10 x T500, and maximum Q-Tc (heart rate corrected Q-T interval [Bazett's formula]) was prolonged from 429 (CI: 422-435) ms on the day of no treatment, to 455 (CI: 448-462) ms after 10 x F4.5 and 470 (CI: 463-476) ms after 10 x T500.", "evidence_relation": "supporting" }, { "cited_pmid": "16303295", "evidence_support": "Both agents were associated with decreased plasma potassium (mean minimum values: 3.4 and 3.3 mmol/l for formoterol and salbutamol, respectively; P=0.914), increased serum glucose (mean maximum values: 9.0 and 8.7 mmol/l, respectively; P=0.373), and small increases in mean QTc interval (mean maximum 439 ms with both treatments; P=0.813).", "evidence_relation": "supporting" }, { "cited_pmid": "15707858", "evidence_support": "Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Actually the text does not mention that the side effects are not significant [16892777].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16892777", "evidence_support": "Clinical data also demonstrate that formoterol is safe and well tolerated even in high doses, with an adverse event profile similar to that of SABAs.", "evidence_relation": "contradicting" }, { "cited_pmid": "16892777", "evidence_support": "Overall, formoterol is safe and effective as adjunct controller therapy for moderate and severe persistent asthma and as monotherapy for EIB.", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The text states that formoterol is safe and well tolerated even in high doses, with an adverse event profile similar to that of SABAs [16892777].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16892777", "evidence_support": "Clinical data also demonstrate that formoterol is safe and well tolerated even in high doses, with an adverse event profile similar to that of SABAs.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Formoterol may have a higher risk of asthma mortality compared to non-LABA treatments [19797669, 33273813].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19797669", "evidence_support": "Randomised controlled clinical trials of duration > or = 4 weeks that compared formoterol with a non-LABA comparator treatment in asthma were included in a meta-analysis of the risk of all-cause mortality and asthma death.", "evidence_relation": "neutral" }, { "cited_pmid": "33273813", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Although the evidence is not conclusive, the point estimates suggest a 2.0- to 3.2-fold increased risk of asthma death associated with Formoterol use [19797669, 33273813].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19797669", "evidence_support": "The simple contingency table odds ratio for risk of all-cause mortality with formoterol was 1.1 (95% CI 0.6-2.2) and for asthma death was 2.7 (95% CI 0.5-26.7).", "evidence_relation": "supporting" }, { "cited_pmid": "19797669", "evidence_support": "We conclude that there was insufficient power to determine whether formoterol increases the risk of mortality. However, the point estimates of a 2.0- to 3.2-fold increased risk of asthma death are not reassuring and add weight to evidence that LABA use in certain circumstances may increase the risk of asthma mortality.", "evidence_relation": "supporting" }, { "cited_pmid": "33273813", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Common side effects of formoterol are not explicitly stated in the provided text, but it is mentioned that the adverse event profile of inhaled formoterol is similar to that of placebo, with few adverse cardiovascular events [33273813]. High doses of formoterol may cause systemic effects such as decreased plasma potassium, increased serum glucose, and small increases in mean QTc interval [15707858, 15373934]. However, these effects are generally not clinically significant [16892777]. Regular formoterol treatment may increase the risk of serious adverse events, including asthma-related events, with one extra serious adverse event occurring over 16 weeks for every 149 people treated with regular formoterol [22513944]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Common side effects of formoterol are not explicitly stated in the provided text, but it is mentioned that the adverse event profile of inhaled formoterol is similar to that of placebo, with few adverse cardiovascular events [33273813].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33273813", "evidence_support": "The adverse event profile of inhaled formoterol is similar to that of placebo, with few adverse cardiovascular events.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "High doses of formoterol may cause systemic effects such as decreased plasma potassium, increased serum glucose, and small increases in mean QTc interval [15707858, 15373934].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15707858", "evidence_support": "Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001).", "evidence_relation": "supporting" }, { "cited_pmid": "15373934", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, these effects are generally not clinically significant [16892777].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16892777", "evidence_support": "Clinical data also demonstrate that formoterol is safe and well tolerated even in high doses", "evidence_relation": "contradicting" }, { "cited_pmid": "16892777", "evidence_support": "Overall, formoterol is safe and effective as adjunct controller therapy for moderate and severe persistent asthma and as monotherapy for EIB.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Regular formoterol treatment may increase the risk of serious adverse events, including asthma-related events, with one extra serious adverse event occurring over 16 weeks for every 149 people treated with regular formoterol [22513944].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22513944", "evidence_support": "Non-fatal serious adverse events were significantly increased when regular formoterol was compared with placebo (Peto odds ratio (OR) 1.57; 95% CI 1.06 to 2.31). One extra serious adverse event occurred over 16 weeks for every 149 people treated with regular formoterol (95% CI 66 to 1407 people).", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Formoterol, a long-acting beta2-agonist (LABA), is generally well-tolerated but can cause several side effects.Common adverse effects include headache, tremor, palpitations, muscle cramps, and hypokalemia [15350154, 15707858, 16303295]. High doses of formoterol can lead to systemic effects such as increased serum glucose and small increases in the QTc interval, although these changes are typically not clinically significant [15707858, 16303295, 18321744]. Rare but serious side effects include myalgia, muscle weakness, and mitochondrial dysfunction, as evidenced by elevated creatine kinase and muscle biopsy findings [15145339]. Additionally, there have been isolated reports of psychiatric symptoms, including insomnia, agitation, and suicidal ideation, particularly in pediatric patients [22489078]. Despite these potential risks, large clinical trials have not shown a significant increase in asthma-related deaths or serious adverse events when formoterol is used in combination with inhaled corticosteroids [23722615, 18768573, 19140566].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Formoterol, a long-acting beta2-agonist (LABA), is generally well-tolerated but can cause several side effects.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Common adverse effects include headache, tremor, palpitations, muscle cramps, and hypokalemia [15350154, 15707858, 16303295].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15350154", "evidence_support": "The long-acting beta2-agonists cause predictable adverse effects including headache, tremor, palpitations, muscle cramps and a fall in serum potassium concentration.", "evidence_relation": "supporting" }, { "cited_pmid": "15707858", "evidence_support": "High-dose formoterol via Aerolizer did not produce any clinically significant systemic effects in patients with mild/moderate asthma.", "evidence_relation": "contradicting" }, { "cited_pmid": "16303295", "evidence_support": "Treatment with high-dose formoterol and salbutamol was equally well tolerated, with no reports of serious adverse events.", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "High doses of formoterol can lead to systemic effects such as increased serum glucose and small increases in the QTc interval, although these changes are typically not clinically significant [15707858, 16303295, 18321744].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15707858", "evidence_support": "Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001). ", "evidence_relation": "supporting" }, { "cited_pmid": "16303295", "evidence_support": "Treatment with high-dose formoterol and salbutamol was equally well tolerated, with no reports of serious adverse events. Both agents were associated with decreased plasma potassium (mean minimum values: 3.4 and 3.3 mmol/l for formoterol and salbutamol, respectively; P=0.914), increased serum glucose (mean maximum values: 9.0 and 8.7 mmol/l, respectively; P=0.373), and small increases in mean QTc interval (mean maximum 439 ms with both treatments; P=0.813).", "evidence_relation": "supporting" }, { "cited_pmid": "18321744", "evidence_support": "QTc, plasma lactate and vital signs values observed with the combination were not statistically different from those with formoterol alone. For glucose, the mean maximum increase after formoterol treatment was 0.4 mmol/l (p<0.01 compared to placebo), while BDP/formoterol treatment caused a maximum increase of 0.7 mmol/l (p<0.01 compared to formoterol and placebo).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Rare but serious side effects include myalgia, muscle weakness, and mitochondrial dysfunction, as evidenced by elevated creatine kinase and muscle biopsy findings [15145339].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15145339", "evidence_support": "A patient is presented who developed myalgia and muscle weakness, associated with an elevation of creatine kinase (CK) during treatment with formoterol. Subsequent muscle biopsy demonstrated atrophic fibres lacking cytochrome C-oxidase and succinate dehydrogenase, suggestive of mitochondrial dysfunction.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, there have been isolated reports of psychiatric symptoms, including insomnia, agitation, and suicidal ideation, particularly in pediatric patients [22489078].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22489078", "evidence_support": "Herein is reported a case of a 9-year-old boy who developed insomnia, pressured speech, agitation, and suicidal ideation within the 1st month after initiating formoterol + budesonide.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Despite these potential risks, large clinical trials have not shown a significant increase in asthma-related deaths or serious adverse events when formoterol is used in combination with inhaled corticosteroids [23722615, 18768573, 19140566].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "23722615", "evidence_support": "We conclude that this enlarged dataset indicates no increased risk of asthma-related deaths among patients exposed to formoterol compared with non-LABA treatments, although the wide confidence interval precludes certainty.", "evidence_relation": "supporting" }, { "cited_pmid": "18768573", "evidence_support": "However, despite data on >68,000 patients, the power was insufficient to conclude that there was no increased mortality with formoterol. Cardiac-related serious adverse events were not increased, and asthma-related serious adverse events were significantly reduced with formoterol.", "evidence_relation": "supporting" }, { "cited_pmid": "19140566", "evidence_support": "In patients with asthma using inhaled corticosteroids formoterol decreased the risk of asthma-related hospitalizations. There were too few asthma-related deaths and intubations to establish formoterol's relative impact on these outcomes.", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Formoterol, a long-acting beta-agonist (LABA) used in asthma and COPD management, can cause several side effects.Common adverse effects include tremor, headache, and palpitations due to its sympathomimetic activity.Patients may also experience muscle cramps, insomnia, and nervousness.Serious but less frequent side effects include paradoxical bronchospasm, hypokalemia, and hyperglycemia.Cardiovascular effects such as tachycardia, hypertension, and arrhythmias are particularly concerning in patients with preexisting heart conditions.Long-term use of LABAs without concomitant inhaled corticosteroids can increase the risk of asthma-related death, hence they should not be used as monotherapy in asthma.Monitoring for these side effects is crucial, especially in patients with comorbid conditions.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Formoterol, a long-acting beta-agonist (LABA) used in asthma and COPD management, can cause several side effects.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Common adverse effects include tremor, headache, and palpitations due to its sympathomimetic activity.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Patients may also experience muscle cramps, insomnia, and nervousness.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Serious but less frequent side effects include paradoxical bronchospasm, hypokalemia, and hyperglycemia.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Cardiovascular effects such as tachycardia, hypertension, and arrhythmias are particularly concerning in patients with preexisting heart conditions.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Long-term use of LABAs without concomitant inhaled corticosteroids can increase the risk of asthma-related death, hence they should not be used as monotherapy in asthma.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "Monitoring for these side effects is crucial, especially in patients with comorbid conditions.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Formoterol, a long-acting beta2-adrenergic receptor agonist, is generally well-tolerated, but can cause side effects such as tremor, palpitations, muscle cramps, and a fall in serum potassium concentration [15350154]. High doses of formoterol can lead to decreased plasma potassium, increased serum glucose, and small increases in mean QTc interval [15707858, 16303295, 18321744]. In rare cases, formoterol has been associated with serious adverse events, including dysrhythmias and life-threatening asthma episodes, particularly in patients not taking an inhaled corticosteroid [15350154]. Additionally, formoterol has been linked to mitochondrial dysfunction and rod-like lesions in muscle fibers [15145339]. However, the overall safety profile of formoterol is comparable to that of other beta2-adrenergic receptor agonists, and it is considered effective and safe for the treatment of asthma and chronic obstructive pulmonary disease (COPD) [18023995, 18768573].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Formoterol, a long-acting beta2-adrenergic receptor agonist, is generally well-tolerated, but can cause side effects such as tremor, palpitations, muscle cramps, and a fall in serum potassium concentration [15350154].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15350154", "evidence_support": "The long-acting beta2-agonists cause predictable adverse effects including headache, tremor, palpitations, muscle cramps and a fall in serum potassium concentration.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "High doses of formoterol can lead to decreased plasma potassium, increased serum glucose, and small increases in mean QTc interval [15707858, 16303295, 18321744].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15707858", "evidence_support": "Both formoterol and salbutamol were associated with decreased plasma potassium (mean of minimum values: 3.4 and 3.6 mmol/L, respectively; P<0.001), increased serum glucose (mean of maximum values: 8.3 and 7.9 mmol/L, respectively; P=0.021), and small increases in mean QTc interval (mean of maximum values: 428.8 and 417.4 ms, respectively; P<0.001).", "evidence_relation": "supporting" }, { "cited_pmid": "16303295", "evidence_support": "Both agents were associated with decreased plasma potassium (mean minimum values: 3.4 and 3.3 mmol/l for formoterol and salbutamol, respectively; P=0.914), increased serum glucose (mean maximum values: 9.0 and 8.7 mmol/l, respectively; P=0.373), and small increases in mean QTc interval (mean maximum 439 ms with both treatments; P=0.813).", "evidence_relation": "supporting" }, { "cited_pmid": "18321744", "evidence_support": "Formoterol caused a significantly greater decrease in serum potassium than BDP/formoterol or placebo (difference in mean minimum concentrations; 0.11 and -0.15 mmol/l, respectively, p<0.05 for both comparisons).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In rare cases, formoterol has been associated with serious adverse events, including dysrhythmias and life-threatening asthma episodes, particularly in patients not taking an inhaled corticosteroid [15350154].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15350154", "evidence_support": "There is some evidence that serious adverse events including dysrhythmias and life-threatening asthma episodes can occur; however, the incidence of such events is very low but may be increased in patients not taking an inhaled corticosteroid.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, formoterol has been linked to mitochondrial dysfunction and rod-like lesions in muscle fibers [15145339].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15145339", "evidence_support": "Subsequent muscle biopsy demonstrated atrophic fibres lacking cytochrome C-oxidase and succinate dehydrogenase, suggestive of mitochondrial dysfunction. ", "evidence_relation": "supporting" }, { "cited_pmid": "15145339", "evidence_support": "Immunocytochemical analysis using antibodies to alpha-actinin-2 and alpha-actinin-3 demonstrated positive staining of 'rod-like' bodies in atrophic fibres.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "However, the overall safety profile of formoterol is comparable to that of other beta2-adrenergic receptor agonists, and it is considered effective and safe for the treatment of asthma and chronic obstructive pulmonary disease (COPD) [18023995, 18768573].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "18023995", "evidence_support": "Formoterol is a selective long-acting beta2-adrenergic receptor agonist (LABA) that provides significant and sustained bronchodilatory effect for up to 12h following a single dose.", "evidence_relation": "supporting" }, { "cited_pmid": "18023995", "evidence_support": "In clinical studies, formoterol was well tolerated and had an adverse-event profile similar to that of other beta2-adrenergic receptor agonists. Formoterol is a rapidly acting, well-tolerated, effective beta2-adrenergic receptor agonist that can be regularly used as a long-acting bronchodilator for patients with moderate to severe COPD, as per recommendations of the current treatment guidelines.", "evidence_relation": "supporting" }, { "cited_pmid": "18768573", "evidence_support": "However, despite data on >68,000 patients, the power was insufficient to conclude that there was no increased mortality with formoterol.", "evidence_relation": "contradicting" } ] } ] }, "ten-shot-gemini-flash": { "answer": "Formoterol, a long-acting beta2-agonist, can cause various side effects, including hoarseness, dry mouth, headache, and dizziness [22779932]. Less common side effects include increased urination and cough [22779932]. Studies have shown an increased risk of serious adverse events with regular formoterol compared to placebo, even in patients taking inhaled corticosteroids [18843738, 22513944]. This increase was more pronounced in children than adults, but the difference was not statistically significant [22513944]. While formoterol has shown benefits in managing asthma symptoms, clinical decisions should consider the balance between its benefits and potential risks [31553802].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Formoterol, a long-acting beta2-agonist, can cause various side effects, including hoarseness, dry mouth, headache, and dizziness [22779932].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22779932", "evidence_support": "The most of the adverse events were associated with fixed inhaled formoterol-budesonide combination and inhaled tiotropium. The most frequently reported reactions were hoarseness, xerostomia, headache and dizziness. Poliuri and cough were less frequently reported reactions.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Less common side effects include increased urination and cough [22779932].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22779932", "evidence_support": "Poliuri and cough were less frequently reported reactions.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Studies have shown an increased risk of serious adverse events with regular formoterol compared to placebo, even in patients taking inhaled corticosteroids [18843738, 22513944].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "18843738", "evidence_support": "Non-fatal serious adverse events were significantly increased when regular formoterol was compared with placebo (Odds Ratio 1.57 [95% CI: 1.05 to 2.37]).", "evidence_relation": "supporting" }, { "cited_pmid": "18843738", "evidence_support": "In comparison with placebo, we have found an increased risk of serious adverse events with regular formoterol, and this does not appear to be abolished in patients taking inhaled corticosteroids.", "evidence_relation": "supporting" }, { "cited_pmid": "22513944", "evidence_support": "Non-fatal serious adverse events were significantly increased when regular formoterol was compared with placebo (Peto odds ratio (OR) 1.57; 95% CI 1.06 to 2.31).", "evidence_relation": "supporting" }, { "cited_pmid": "18843738", "evidence_support": "In comparison with placebo, we have found an increased risk of serious adverse events with regular formoterol, and this does not appear to be abolished in patients taking inhaled corticosteroids.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "This increase was more pronounced in children than adults, but the difference was not statistically significant [22513944].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "22513944", "evidence_support": "The effect on serious adverse events of regular formoterol in children was greater than the effect in adults, but the difference between age groups was not significant", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "While formoterol has shown benefits in managing asthma symptoms, clinical decisions should consider the balance between its benefits and potential risks [31553802].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31553802", "evidence_support": "Clinical decisions and information provided to patients regarding regular use of formoterol and ICS need to take into account the balance between known symptomatic benefits of formoterol and ICS versus the remaining degree of uncertainty associated with its potential harmful effects.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Formoterol is generally well-tolerated, with side effects similar to other beta2-adrenergic receptor agonists [18023995, 14720051, 9506248]. Common side effects include tremor, palpitations, hoarseness, dry mouth, headache, and dizziness [22779932, 9506248]. Less frequent side effects include cough, polyuria, peripheral edema, tachycardia, and dyspepsia [22779932, 24389826]. While systemic effects are expected with this class of drugs, formoterol has been shown to have less impact on serum potassium, pulse, blood pressure, heart rate, and QT interval compared to terbutaline [11534893]. The duration of systemic cardiovascular or metabolic side effects of formoterol is similar to those of salbutamol [12214578]. However, higher doses of formoterol, both oral and inhaled, are associated with more adverse events [9506248].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Formoterol is generally well-tolerated, with side effects similar to other beta2-adrenergic receptor agonists [18023995, 14720051, 9506248].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18023995", "evidence_support": "In clinical studies, formoterol was well tolerated and had an adverse-event profile similar to that of other beta2-adrenergic receptor agonists. Formoterol is a rapidly acting, well-tolerated, effective beta2-adrenergic receptor agonist that can be regularly used as a long-acting bronchodilator for patients with moderate to severe COPD, as per recommendations of the current treatment guidelines.", "evidence_relation": "supporting" }, { "cited_pmid": "14720051", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "9506248", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Common side effects include tremor, palpitations, hoarseness, dry mouth, headache, and dizziness [22779932, 9506248].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22779932", "evidence_support": "The most of the adverse events were associated with fixed inhaled formoterol-budesonide combination and inhaled tiotropium. The most frequently reported reactions were hoarseness, xerostomia, headache and dizziness. Poliuri and cough were less frequently reported reactions.", "evidence_relation": "supporting" }, { "cited_pmid": "9506248", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Less frequent side effects include cough, polyuria, peripheral edema, tachycardia, and dyspepsia [22779932, 24389826].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22779932", "evidence_support": " The most of the adverse events were associated with fixed inhaled formoterol-budesonide combination and inhaled tiotropium. The most frequently reported reactions were hoarseness, xerostomia, headache and dizziness. Poliuri and cough were less frequently reported reactions.", "evidence_relation": "supporting" }, { "cited_pmid": "24389826", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While systemic effects are expected with this class of drugs, formoterol has been shown to have less impact on serum potassium, pulse, blood pressure, heart rate, and QT interval compared to terbutaline [11534893].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "11534893", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The duration of systemic cardiovascular or metabolic side effects of formoterol is similar to those of salbutamol [12214578].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "12214578", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "However, higher doses of formoterol, both oral and inhaled, are associated with more adverse events [9506248].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "9506248", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Formoterol, a long-acting beta-2 agonist used for asthma, can cause several side effects. Common adverse events include tremors, which are more pronounced at higher doses [15031566], as well as headache (9.5%), nasopharyngitis (6.9%), and cough (1.1%) [22541245, 30232933]. Other reported side effects include asthma exacerbation (2.0%) and dysphonia (1.8%) [30232933]. While formoterol is generally well tolerated and has a good safety profile, some patients may experience cardiovascular and metabolic effects, particularly at higher doses [14693296, 12564654]. Overall, the incidence of significant adverse effects is low, and formoterol is considered safe for both maintenance and rescue treatment in asthma management [22082160, 25328383]. Regular monitoring is advisable to manage any potential side effects effectively.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Formoterol, a long-acting beta-2 agonist used for asthma, can cause several side effects.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Common adverse events include tremors, which are more pronounced at higher doses [15031566], as well as headache (9.5%), nasopharyngitis (6.9%), and cough (1.1%) [22541245, 30232933].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15031566", "evidence_support": "Tremor was the most common adverse event and was more pronounced at high doses. ", "evidence_relation": "supporting" }, { "cited_pmid": "22541245", "evidence_support": "Asthma exacerbation incidence and rate (per patient-treatment year) were lower with budesonide/formoterol versus budesonide (incidence, 7.7% vs 14.0% [P= .006]; rate ratio, 0.615 [P= .002]). Time to first asthma exacerbation was longer (P= .018) with budesonide/formoterol versus budesonide. The most common adverse events, regardless of study drug relationship, were headache (9.5% and 7.7%), nasopharyngitis (6.9% and 8.0%), sinusitis (4.0% and 6.3%), and viral upper respiratory tract infection (5.8% and 4.4%) for budesonide/formoterol and budesonide, respectively.", "evidence_relation": "supporting" }, { "cited_pmid": "30232933", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Other reported side effects include asthma exacerbation (2.0%) and dysphonia (1.8%) [30232933].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30232933", "evidence_support": "Adverse events (AEs) occurred in 60.0% patients, and 10.2% had AEs considered possibly related to fluticasone/formoterol [most commonly asthma exacerbation (2.0% patients), dysphonia (1.8%) and cough (1.1%)].", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While formoterol is generally well tolerated and has a good safety profile, some patients may experience cardiovascular and metabolic effects, particularly at higher doses [14693296, 12564654].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14693296", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "12564654", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Overall, the incidence of significant adverse effects is low, and formoterol is considered safe for both maintenance and rescue treatment in asthma management [22082160, 25328383].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22082160", "evidence_support": "Clinical safety studies lasting up to 1 year have found that MF/F has a low incidence of local and systemic side effects.", "evidence_relation": "supporting" }, { "cited_pmid": "25328383", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Regular monitoring is advisable to manage any potential side effects effectively.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Formoterol, a long-acting beta-2 agonist (LABA), can cause several side effects. Common adverse effects include palpitations, tremors, and increased heart rate, which may limit the tolerable dose [21034447, 23348973]. There is also a risk of paradoxical asthma exacerbations and even deaths, particularly when used without inhaled corticosteroids (ICS) [29332144, 23392793]. Long-term use of LABAs like formoterol may lead to tolerance of their bronchodilator effects and increased bronchial hyperresponsiveness [29332144]. Other reported side effects include insomnia, agitation, and pressured speech, which can occur shortly after starting treatment [22489078]. It is recommended to use formoterol in combination with ICS to minimize these risks [23392793].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Formoterol, a long-acting beta-2 agonist (LABA), can cause several side effects.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Common adverse effects include palpitations, tremors, and increased heart rate, which may limit the tolerable dose [21034447, 23348973].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21034447", "evidence_support": "In addition, LABAs have an acceptable safety profile, and are not associated with an increased risk of respiratory mortality, although adverse effects such as palpitations and tremor may limit the dose that can be tolerated.", "evidence_relation": "supporting" }, { "cited_pmid": "23348973", "evidence_support": "In any case, they can induce adverse effects, such as increased heart rate, palpitations, transient decrease in PaO2, and tremor. D", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "There is also a risk of paradoxical asthma exacerbations and even deaths, particularly when used without inhaled corticosteroids (ICS) [29332144, 23392793].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29332144", "evidence_support": "Unexplained paradoxical asthma exacerbations and deaths have been associated with LABAs, particularly when used without ICS.", "evidence_relation": "supporting" }, { "cited_pmid": "23392793", "evidence_support": "In asthma, it is recommended that long-acting \u03b22-agonists (LABAs) not be used as monotherapy, but, be used with inhaled corticosteroids (ICS) to minimize the risk of serious adverse events", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Long-term use of LABAs like formoterol may lead to tolerance of their bronchodilator effects and increased bronchial hyperresponsiveness [29332144].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29332144", "evidence_support": "LABAs clearly demonstrate effective bronchodilatation and steroid-sparing activity, but long-term treatment can lead to tolerance of their bronchodilator effects", "evidence_relation": "supporting" }, { "cited_pmid": "29332144", "evidence_support": "There are also concerns with regard to the effects of LABAs on bronchial hyperresponsiveness (BHR), where long-term use is associated with increased BHR and loss of bronchoprotection.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Other reported side effects include insomnia, agitation, and pressured speech, which can occur shortly after starting treatment [22489078].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22489078", "evidence_support": "Herein is reported a case of a 9-year-old boy who developed insomnia, pressured speech, agitation, and suicidal ideation within the 1st month after initiating formoterol + budesonide. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "It is recommended to use formoterol in combination with ICS to minimize these risks [23392793].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23392793", "evidence_support": "In asthma, it is recommended that long-acting \u03b22-agonists (LABAs) not be used as monotherapy, but, be used with inhaled corticosteroids (ICS) to minimize the risk of serious adverse events.", "evidence_relation": "supporting" } ] } ] }, "webis-1": { "answer": "The long-acting inhaled beta(2)-agonist formoterol has systemic effects when taken in high doses [18394012]. The systemic side effects of formoterol include [18394012]:", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The long-acting inhaled beta(2)-agonist formoterol has systemic effects when taken in high doses [18394012].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "18394012", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The systemic side effects of formoterol include [18394012]:", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "18394012", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-2": { "answer": "The given context does not provide information about the side effects of using formoterol [31298593].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The given context does not provide information about the side effects of using formoterol [31298593].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "31298593", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-3": { "answer": "In patients taking maintenance ICS-salmeterol, but not ICS-formoterol, significantly more non-asthma-related and nonserious DAEs occurred with as-needed formoterol versus as-needed salbutamol [37054881].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In patients taking maintenance ICS-salmeterol, but not ICS-formoterol, significantly more non-asthma-related and nonserious DAEs occurred with as-needed formoterol versus as-needed salbutamol [37054881].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "37054881", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-5": { "answer": "In patients taking maintenance ICS-salmeterol, but not ICS-formoterol, significantly more non-asthma-related and nonserious DAEs occurred with as-needed formoterol versus as-needed salbutamol [37054881].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In patients taking maintenance ICS-salmeterol, but not ICS-formoterol, significantly more non-asthma-related and nonserious DAEs occurred with as-needed formoterol versus as-needed salbutamol [37054881].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "37054881", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-gpt-1": { "answer": "Formoterol, a long-acting beta-agonist used for asthma and chronic obstructive pulmonary disease, can cause side effects such as tremors, palpitations, headache, and increased heart rate. Additionally, it may lead to potential cardiovascular effects and, in some cases, paradoxical bronchospasm. It is important for patients to be monitored for these side effects, especially when starting treatment or adjusting dosages.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Formoterol, a long-acting beta-agonist used for asthma and chronic obstructive pulmonary disease, can cause side effects such as tremors, palpitations, headache, and increased heart rate.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, it may lead to potential cardiovascular effects and, in some cases, paradoxical bronchospasm.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "It is important for patients to be monitored for these side effects, especially when starting treatment or adjusting dosages.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "The side effects of using formoterol include an increased number of asthma-related events in children, although this finding was not statistically significant [23744625]. In adults, while there were no significant differences in all-cause non-fatal serious adverse events with regular formoterol combined with inhaled corticosteroids, there was a significant reduction in asthma-related serious adverse events compared to inhaled corticosteroids alone [23744625]. Overall, the evidence suggests that while formoterol may have some associated risks, it can also lead to fewer asthma-related serious events in adults when used with inhaled corticosteroids.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The side effects of using formoterol include an increased number of asthma-related events in children, although this finding was not statistically significant [23744625].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23744625", "evidence_support": "Epidemiological evidence has suggested a link between beta2-agonists and increases in asthma mortality.", "evidence_relation": "contradicting" }, { "cited_pmid": "23744625", "evidence_support": "taking regular formoterol with inhaled corticosteroids, and one in a participant administered regular inhaled corticosteroids alone.", "evidence_relation": "neutral" }, { "cited_pmid": "23744625", "evidence_support": "In contrast with all-cause serious adverse events, the addition of new trial data means that asthma-related serious adverse events associated with formoterol are now significantly fewer in adults taking regular formoterol with inhaled corticosteroids (Peto OR 0.49, 95% CI 0.28 to 0.88, moderate-quality evidence). Although a greater number of asthma-related events were reported in children receiving regular formoterol, this finding was not statistically significant (Peto OR 1.49, 95% CI 0.48 to 4.61, low-quality evidence).", "evidence_relation": "supporting" }, { "cited_pmid": "23744625", "evidence_support": "From the evidence in this review, it is not possible to reassure people with asthma that regular use of inhaled corticosteroids with formoterol carries no risk of increasing mortality in comparison with use of inhaled corticosteroids alone. On the other hand, we have found no conclusive evidence of serious harm, and only one asthma-related death was registered during more than 4200 patient-years of observation with formoterol.In adults, no significant difference in all-cause non-fatal serious adverse events was noted with regular formoterol with inhaled corticosteroids, but a significant reduction in asthma-related serious adverse events was observed in comparison with inhaled corticosteroids alone.", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In adults, while there were no significant differences in all-cause non-fatal serious adverse events with regular formoterol combined with inhaled corticosteroids, there was a significant reduction in asthma-related serious adverse events compared to inhaled corticosteroids alone [23744625].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23744625", "evidence_support": "In contrast with all-cause serious adverse events, the addition of new trial data means that asthma-related serious adverse events associated with formoterol are now significantly fewer in adults taking regular formoterol with inhaled corticosteroids (Peto OR 0.49, 95% CI 0.28 to 0.88, moderate-quality evidence).", "evidence_relation": "supporting" }, { "cited_pmid": "23744625", "evidence_support": "In adults, no significant difference in all-cause non-fatal serious adverse events was noted with regular formoterol with inhaled corticosteroids, but a significant reduction in asthma-related serious adverse events was observed in comparison with inhaled corticosteroids alone.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Overall, the evidence suggests that while formoterol may have some associated risks, it can also lead to fewer asthma-related serious events in adults when used with inhaled corticosteroids.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-6": { "answer": "Formoterol, a long-acting \u03b2\u2082-adrenoceptor agonist, can have several side effects, including potential pro-inflammatory actions in the bronchial epithelium [37413911]. Additionally, while it is primarily used for bronchodilation in asthma management, its systemic effects may also lead to adverse reactions, although specific side effects are not detailed in the provided context [23907810,15649853]. Overall, monitoring for both local and systemic side effects is important when using formoterol.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Formoterol, a long-acting \u03b2\u2082-adrenoceptor agonist, can have several side effects, including potential pro-inflammatory actions in the bronchial epithelium [37413911].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37413911", "evidence_support": "Despite the wide usage of \u03b22-adrenoceptor agonists in asthma treatment, they do have side effects such as aggravating inflammation", "evidence_relation": "supporting" }, { "cited_pmid": "37413911", "evidence_support": "In this study, we investigated formoterol, a more specific \u03b22-adrenoceptor agonist, -mediated signaling pathways involved in the production of IL-6 and IL-8 in 16HBE14o- human bronchial epithelia. The effects of formoterol were detected in the presence of PKA, exchange protein directly activated by cAMP (EPAC), cystic fibrosis transmembrane conductance regulator (CFTR), extracellular signal-regulated protein kinase (ERK)1/2 and Src inhibitors.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, while it is primarily used for bronchodilation in asthma management, its systemic effects may also lead to adverse reactions, although specific side effects are not detailed in the provided context [23907810,15649853].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23907810", "evidence_support": "Pharmacologically mediated bronchodilation is important in the management of asthma, and is primarily achieved with \u03b2\u2082-agonists.", "evidence_relation": "supporting" }, { "cited_pmid": "23907810", "evidence_support": "At comparable peak bronchodilator effect, AZD3199 was associated with a lower level of systemic side effects than formoterol.", "evidence_relation": "supporting" }, { "cited_pmid": "15649853", "evidence_support": "(R;R)- and rac-formoterol were still effective 22-24 h after single high doses, but this was associated with some systemic side effect (increased heart rate) initially.", "evidence_relation": "supporting" }, { "cited_pmid": "15649853", "evidence_support": "Thus, the single dose bronchodilatating effect of formoterol resides in (R;R)-formoterol.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Overall, monitoring for both local and systemic side effects is important when using formoterol.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "zero-shot-gemini-flash": { "answer": "The most common side effects of formoterol are tremor and palpitations [9506248, 1718682]. These are typical side effects associated with beta 2-agonists [9506248]. Other reported side effects include hoarseness, xerostomia, headache, and dizziness [22779932]. Formoterol can also cause post-inhalation cough, hyperglycemia, respiratory tract infections, and possibly cardiac disorders [21954512]. The incidence of adverse events is dose-dependent, with higher doses associated with more side effects [1718682, 9506248]. While formoterol has systemic effects at high doses [18394012], the duration of these effects seems similar to those of salbutamol [12214578]. However, the magnitude of systemic side effects may be less pronounced with formoterol compared to salbutamol [12214578]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The most common side effects of formoterol are tremor and palpitations [9506248, 1718682].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "9506248", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "1718682", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These are typical side effects associated with beta 2-agonists [9506248].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "9506248", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Other reported side effects include hoarseness, xerostomia, headache, and dizziness [22779932].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22779932", "evidence_support": "The most of the adverse events were associated with fixed inhaled formoterol-budesonide combination and inhaled tiotropium. The most frequently reported reactions were hoarseness, xerostomia, headache and dizziness", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Formoterol can also cause post-inhalation cough, hyperglycemia, respiratory tract infections, and possibly cardiac disorders [21954512].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21954512", "evidence_support": "Some adverse effects seem to be more frequent than with other long-acting bronchodilators, including post-inhalation cough, hyperglycaemia, respiratory tract infections, and possibly cardiac disorders.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The incidence of adverse events is dose-dependent, with higher doses associated with more side effects [1718682, 9506248].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "1718682", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "9506248", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "While formoterol has systemic effects at high doses [18394012], the duration of these effects seems similar to those of salbutamol [12214578].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "18394012", "evidence_support": "The long-acting inhaled beta(2)-agonist formoterol has systemic effects when taken in high doses.", "evidence_relation": "supporting" }, { "cited_pmid": "18394012", "evidence_support": "Among subjects with COPD, high-dose inhaled formoterol produced a dose-related increase in forced expiratory volume in 1 s without a corresponding reduction in dyspnoea or increase in walk distance.", "evidence_relation": "neutral" }, { "cited_pmid": "18394012", "evidence_support": "Our results show that in patients with COPD rac-formoterol improves FEV(1) and patient satisfaction without a corresponding reduction in dyspnoea.", "evidence_relation": "neutral" }, { "cited_pmid": "12214578", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "7", "answer_sentence": "However, the magnitude of systemic side effects may be less pronounced with formoterol compared to salbutamol [12214578].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "12214578", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "Formoterol, a long-acting bronchodilator, can cause several side effects. The most common adverse event reported is tremor, particularly at higher doses [15031566]. Other drug-related adverse effects occurring in more than 1% of patients include dry mouth, nausea, and insomnia [18363201]. Mild and transient nervousness has also been noted in some individuals [10335908]. While formoterol generally has a good safety profile, with low incidence of local and systemic side effects [22082160, 12564654], it can still affect heart rate and potassium levels, although these changes are typically small and without significant clinical consequences [10335908]. Overall, formoterol is well tolerated, especially when used as a maintenance treatment [12564654, 1360774].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Formoterol, a long-acting bronchodilator, can cause several side effects.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "The most common adverse event reported is tremor, particularly at higher doses [15031566].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15031566", "evidence_support": "Tremor was the most common adverse event and was more pronounced at high doses.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Other drug-related adverse effects occurring in more than 1% of patients include dry mouth, nausea, and insomnia [18363201].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18363201", "evidence_support": "Drug related AEs in the FFIS arm with a frequency > or = 1% and exceeding placebo were dry mouth, nausea, and insomnia. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Mild and transient nervousness has also been noted in some individuals [10335908].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "10335908", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "While formoterol generally has a good safety profile, with low incidence of local and systemic side effects [22082160, 12564654], it can still affect heart rate and potassium levels, although these changes are typically small and without significant clinical consequences [10335908].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22082160", "evidence_support": "Clinical safety studies lasting up to 1 year have found that MF/F has a low incidence of local and systemic side effects.", "evidence_relation": "supporting" }, { "cited_pmid": "10335908", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "12564654", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, formoterol is well tolerated, especially when used as a maintenance treatment [12564654, 1360774].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "12564654", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "1360774", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] } } }, { "question_id": "132", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Vitamin D plays a crucial role in various bodily functions, and its deficiency can have several adverse effects. Low vitamin D levels are associated with decreased immune function, potentially increasing the risk of infections. Additionally, a deficiency in vitamin D can lead to metabolic and structural issues, such as the degradation of erythrocytes, which may affect overall blood health and increase the risk of cardiovascular problems. Furthermore, inadequate vitamin D can impair calcium absorption, leading to weakened bones and a higher likelihood of fractures over time.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Vitamin D plays a crucial role in various bodily functions, and its deficiency can have several adverse effects.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Low vitamin D levels are associated with decreased immune function, potentially increasing the risk of infections.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, a deficiency in vitamin D can lead to metabolic and structural issues, such as the degradation of erythrocytes, which may affect overall blood health and increase the risk of cardiovascular problems.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, inadequate vitamin D can impair calcium absorption, leading to weakened bones and a higher likelihood of fractures over time.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Low vitamin D has significant health implications, including an increased risk of cardiovascular disease, fractures, and osteoporosis [21824858, 23609564, 24622671]. It leads to bone loss or osteomalacia and can cause muscle weakness [18852718, 21824858, 18020534]. In children, low vitamin D can result in growth retardation, skeletal deformities, and rickets [21824858, 20511052, 26203122]. It is associated with cognitive impairment, autoimmune diseases, metabolic syndrome, and insulin resistance [21824858, 22254030, 24622671]. Low vitamin D exacerbates osteopenia and osteoporosis, increasing the risk of hip fractures [21824858, 18020534, 16907998]. It also causes a decline in calcium absorption, triggering parathyroid hormone release [18852718, 24020640, 21984863]. Additionally, low vitamin D is linked to obesity, hypertension, diabetes, and inflammation [23609564, 22254030, 23566943]. These effects collectively highlight the critical role of vitamin D in maintaining overall health and preventing various chronic conditions [19897699, 30341848, 23306192].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D has significant health implications, including an increased risk of cardiovascular disease, fractures, and osteoporosis [21824858, 23609564, 24622671].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21824858", "evidence_support": "In utero and during childhood, vitamin D deficiency can cause growth retardation and skeletal deformities and may increase the risk of hip fracture later in life. Vitamin D deficiency in adults can exacerbate osteopenia and osteoporosis, cause osteomalacia and muscle weakness, and increase the risk of fracture.", "evidence_relation": "supporting" }, { "cited_pmid": "21824858", "evidence_support": "Of great interest is its role in decreasing the risk of many chronic illnesses, including common cancers, autoimmune diseases, infectious diseases, and cardiovascular disease.", "evidence_relation": "supporting" }, { "cited_pmid": "23609564", "evidence_support": "Vitamin D deficiency is associated with substantial increases in the incidence of hypertension, hyperlipidaemia, myocardial infarction and stroke, as well as in diseases such as chronic kidney disease and type 2 diabetes.", "evidence_relation": "supporting" }, { "cited_pmid": "23609564", "evidence_support": "Some evidence suggests that vitamin D status is a biomarker of lifestyle, since unhealthy and sedentary lifestyles are associated with vitamin D insufficiency or deficiency and are also risk factors for cardiovascular complications.", "evidence_relation": "supporting" }, { "cited_pmid": "24622671", "evidence_support": "Investigators of most prospective studies reported moderate to strong inverse associations between 25(OH)D concentrations and cardiovascular diseases, serum lipid concentrations, inflammation, glucose metabolism disorders, weight gain, infectious diseases, multiple sclerosis, mood disorders, declining cognitive function, impaired physical functioning, and all-cause mortality.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It leads to bone loss or osteomalacia and can cause muscle weakness [18852718, 21824858, 18020534].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18852718", "evidence_support": "Low serum vitamin D levels are common in the general population and cause a decline in calcium absorption, leading to low serum levels of ionized calcium, which in turn trigger the release of parathyroid hormone, promoting skeletal resorption and, eventually, bone loss or osteomalacia.", "evidence_relation": "supporting" }, { "cited_pmid": "21824858", "evidence_support": "Vitamin D deficiency in adults can exacerbate osteopenia and osteoporosis, cause osteomalacia and muscle weakness, and increase the risk of fracture.", "evidence_relation": "supporting" }, { "cited_pmid": "18020534", "evidence_support": "Vitamin D deficiency causes osteopenia, osteoporosis and osteomalacia, increasing the risk of fracture.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In children, low vitamin D can result in growth retardation, skeletal deformities, and rickets [21824858, 20511052, 26203122].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21824858", "evidence_support": "In utero and during childhood, vitamin D deficiency can cause growth retardation and skeletal deformities and may increase the risk of hip fracture later in life.", "evidence_relation": "supporting" }, { "cited_pmid": "20511052", "evidence_support": "Low vitamin D status classically has skeletal consequences such as osteomalacia/rickets.", "evidence_relation": "supporting" }, { "cited_pmid": "26203122", "evidence_support": "The classical clinical consequence of vitamin D deficiency is osteomalacia, presenting as rickets in children.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It is associated with cognitive impairment, autoimmune diseases, metabolic syndrome, and insulin resistance [21824858, 22254030, 24622671].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21824858", "evidence_support": "More recently, associations between low vitamin D status and increased risk for various non-skeletal morbidities have been recognized; whether all of these associations are causally related to low vitamin D status remains to be determined", "evidence_relation": "neutral" }, { "cited_pmid": "21824858", "evidence_support": "Of great interest is its role in decreasing the risk of many chronic illnesses, including common cancers, autoimmune diseases, infectious diseases, and cardiovascular disease.", "evidence_relation": "supporting" }, { "cited_pmid": "22254030", "evidence_support": "Vitamin D deficiency/insufficiency has been associated with muscle weakness and a high incidence of various chronic diseases such as cardiovascular disease, cancer, multiple sclerosis, and type 1 and 2 diabetes", "evidence_relation": "supporting" }, { "cited_pmid": "24622671", "evidence_support": "Investigators of most prospective studies reported moderate to strong inverse associations between 25(OH)D concentrations and cardiovascular diseases, serum lipid concentrations, inflammation, glucose metabolism disorders, weight gain, infectious diseases, multiple sclerosis, mood disorders, declining cognitive function, impaired physical functioning, and all-cause mortality.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Low vitamin D exacerbates osteopenia and osteoporosis, increasing the risk of hip fractures [21824858, 18020534, 16907998].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21824858", "evidence_support": "vitamin D deficiency can cause growth retardation and skeletal deformities and may increase the risk of hip fracture later in life. Vitamin D deficiency in adults can exacerbate osteopenia and osteoporosis, cause osteomalacia and muscle weakness, and increase the risk of fracture.", "evidence_relation": "supporting" }, { "cited_pmid": "18020534", "evidence_support": "Vitamin D deficiency causes osteopenia, osteoporosis and osteomalacia, increasing the risk of fracture.", "evidence_relation": "supporting" }, { "cited_pmid": "16907998", "evidence_support": "Vitamin D deficiency causes osteopenia, precipitates and exacerbates osteoporosis, causes the painful bone disease osteomalacia, and increases muscle weakness, which worsens the risk of falls and fractures", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "It also causes a decline in calcium absorption, triggering parathyroid hormone release [18852718, 24020640, 21984863].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18852718", "evidence_support": " Low serum vitamin D levels are common in the general population and cause a decline in calcium absorption, leading to low serum levels of ionized calcium, which in turn trigger the release of parathyroid hormone, promoting skeletal resorption and, eventually, bone loss or osteomalacia.", "evidence_relation": "supporting" }, { "cited_pmid": "24020640", "evidence_support": "Epidemiological studies show that low vitamin D status is associated with a variety of negative skeletal consequences in older adults including osteomalacia, reduced bone mineral density, impaired Ca absorption and secondary hyperparathyroidism.", "evidence_relation": "supporting" }, { "cited_pmid": "21984863", "evidence_support": "Secondary hyperparathyroidism can develop in patients with chronic kidney disease as a result of low 25-hydroxyvitamin D levels or impaired conversion to 1,25-dihydroxyvitamin D.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Additionally, low vitamin D is linked to obesity, hypertension, diabetes, and inflammation [23609564, 22254030, 23566943].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23609564", "evidence_support": "Vitamin D deficiency is associated with substantial increases in the incidence of hypertension, hyperlipidaemia, myocardial infarction and stroke, as well as in diseases such as chronic kidney disease and type 2 diabetes. Low vitamin D levels also upregulate the renin-angiotensin-aldosterone system, increase inflammation and cause endothelial dysfunction. ", "evidence_relation": "supporting" }, { "cited_pmid": "22254030", "evidence_support": "Vitamin D deficiency/insufficiency has been associated with muscle weakness and a high incidence of various chronic diseases such as cardiovascular disease, cancer, multiple sclerosis, and type 1 and 2 diabetes.", "evidence_relation": "supporting" }, { "cited_pmid": "23566943", "evidence_support": "Low plasma 25-hydroxy-vitamin D (25OHD) is associated with obesity. Vitamin D (VD) may be implicated in obesity and its complications such as insulin resistance, hypertension, and low-grade inflammation. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "These effects collectively highlight the critical role of vitamin D in maintaining overall health and preventing various chronic conditions [19897699, 30341848, 23306192].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19897699", "evidence_support": "Vitamin D is a fat-soluble vitamin that plays an important role in bone metabolism and seems to have some anti-inflammatory and immune-modulating properties", "evidence_relation": "supporting" }, { "cited_pmid": "30341848", "evidence_support": "Vitamin D is essential for the maintenance of calcium and phosphorus homeostasis, skeletal growth and various other metabolic processes", "evidence_relation": "supporting" }, { "cited_pmid": "23306192", "evidence_support": "Vitamin D plays a crucial role in the development and maintenance of a healthy skeleton throughout life.", "evidence_relation": "supporting" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Low vitamin D levels are associated with a range of adverse health outcomes, particularly affecting musculoskeletal and non-skeletal systems.Deficiency in vitamin D impairs calcium absorption, leading to conditions such as osteomalacia, osteoporosis, and increased fracture risk due to weakened bones and muscle weakness [18852718, 21824858, 18020534]. It also exacerbates muscle weakness, increasing the risk of falls, particularly in older adults [16907998, 31766576]. Beyond skeletal health, low vitamin D status has been linked to increased risks of cardiovascular diseases, type 2 diabetes, and various infections, although causal relationships remain debated [23609564, 22254030, 24622671]. Vitamin D deficiency is prevalent globally, with significant impacts on bone mineral density and muscle strength, particularly in populations with limited sun exposure or dietary intake [22525842, 19321588, 17604580]. Supplementation with vitamin D, often in combination with calcium, is recommended to mitigate these risks and improve overall health outcomes [18852718, 18020534, 24020640].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D levels are associated with a range of adverse health outcomes, particularly affecting musculoskeletal and non-skeletal systems.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Deficiency in vitamin D impairs calcium absorption, leading to conditions such as osteomalacia, osteoporosis, and increased fracture risk due to weakened bones and muscle weakness [18852718, 21824858, 18020534].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18852718", "evidence_support": "Low serum vitamin D levels are common in the general population and cause a decline in calcium absorption, leading to low serum levels of ionized calcium, which in turn trigger the release of parathyroid hormone, promoting skeletal resorption and, eventually, bone loss or osteomalacia.", "evidence_relation": "supporting" }, { "cited_pmid": "21824858", "evidence_support": "Vitamin D deficiency in adults can exacerbate osteopenia and osteoporosis, cause osteomalacia and muscle weakness, and increase the risk of fracture.", "evidence_relation": "supporting" }, { "cited_pmid": "18020534", "evidence_support": "Vitamin D(3) (cholecalciferol) sufficiency is essential for maximising bone health. Vitamin D enhances intestinal absorption of calcium and phosphorus.", "evidence_relation": "supporting" }, { "cited_pmid": "18020534", "evidence_support": "Vitamin D deficiency [as defined by a serum 25(OH)D level of <50 nmol/L (<20 ng/mL)] is pandemic. This deficiency is very prevalent in osteoporotic patients. Vitamin D deficiency causes osteopenia, osteoporosis and osteomalacia, increasing the risk of fracture. ", "evidence_relation": "supporting" }, { "cited_pmid": "18020534", "evidence_support": "Vitamin D deficiency causes muscle weakness, increasing the risk of falls and fractures, and should be aggressively treated with pharmacological doses of vitamin D. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "It also exacerbates muscle weakness, increasing the risk of falls, particularly in older adults [16907998, 31766576].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16907998", "evidence_support": "Vitamin D inadequacy is pandemic in adults. Vitamin D deficiency causes osteopenia, precipitates and exacerbates osteoporosis, causes the painful bone disease osteomalacia, and increases muscle weakness, which worsens the risk of falls and fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "31766576", "evidence_support": "Therefore, older people with vitamin D deficiency might be at risk of sarcopenia, a geriatric syndrome characterized by the progressive loss of skeletal muscle mass and strength often complicated by adverse events, such as falls, disability hospitalization and death.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Beyond skeletal health, low vitamin D status has been linked to increased risks of cardiovascular diseases, type 2 diabetes, and various infections, although causal relationships remain debated [23609564, 22254030, 24622671].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23609564", "evidence_support": "Epidemiological studies suggest an association between low vitamin D levels and risk factors for cardiovascular disease, but a causal relationship has not been established, and clinical trials and meta-analyses have not demonstrated convincing evidence that vitamin D therapy improves cardiovascular outcomes.", "evidence_relation": "supporting" }, { "cited_pmid": "22254030", "evidence_support": "Besides its well-known effects on calcium/phosphate homeostasis, vitamin D influences muscle function, cardiovascular homeostasis, nervous function, and the immune response. Vitamin D deficiency/insufficiency has been associated with muscle weakness and a high incidence of various chronic diseases such as cardiovascular disease, cancer, multiple sclerosis, and type 1 and 2 diabetes.", "evidence_relation": "supporting" }, { "cited_pmid": "24622671", "evidence_support": "The discrepancy between observational and intervention studies suggests that low 25(OH)D is a marker of ill health. Inflammatory processes involved in disease occurrence and clinical course would reduce 25(OH)D, which would explain why low vitamin D status is reported in a wide range of disorders.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Vitamin D deficiency is prevalent globally, with significant impacts on bone mineral density and muscle strength, particularly in populations with limited sun exposure or dietary intake [22525842, 19321588, 17604580].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22525842", "evidence_support": "Low vitamin D status is extremely common worldwide due to low dietary intake and low skin production.", "evidence_relation": "supporting" }, { "cited_pmid": "17604580", "evidence_support": "Vitamin D deficiency causes osteopenia, precipitates and exacerbates osteoporosis, causes a painful disease, osteomalacia, and increases muscle weakness, which worsens the risk of falls and fractures. ", "evidence_relation": "supporting" }, { "cited_pmid": "17604580", "evidence_support": "Factors contributing to low vitamin D levels include low sunlight exposure, decreased skin synthesis and intestinal absorption, and inadequate diet", "evidence_relation": "supporting" }, { "cited_pmid": "19321588", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Supplementation with vitamin D, often in combination with calcium, is recommended to mitigate these risks and improve overall health outcomes [18852718, 18020534, 24020640].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "18852718", "evidence_support": "Three recent meta-analyses concluded that vitamin D must be administered in combination with calcium in order to substantially reduce the risk of nonvertebral fracture in adults over the age of 50 years.", "evidence_relation": "supporting" }, { "cited_pmid": "18020534", "evidence_support": "Patients being treated for osteoporosis should be adequately supplemented with calcium and vitamin D to maximise the benefit of treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "24020640", "evidence_support": "However, it is generally accepted that vitamin D (17\u00b75 \u03bcg/d) in combination with Ca (1200 mg/d) reduces bone loss among older white subjects. ", "evidence_relation": "supporting" }, { "cited_pmid": "24020640", "evidence_support": "n conclusion, it is generally accepted that vitamin D in combination with Ca reduces the risk of non-vertebral fractures particularly those in institutional care.", "evidence_relation": "supporting" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Low vitamin D levels have been associated with various adverse health outcomes, including osteopenia, osteoporosis, osteomalacia, and muscle weakness, which can increase the risk of falls and fractures [18852718, 21824858, 18020534]. Vitamin D deficiency has also been linked to an increased risk of cardiovascular disease, hypertension, and stroke, as well as diseases such as chronic kidney disease and type 2 diabetes [23609564]. Additionally, low vitamin D levels have been associated with impaired bone mineralization, reduced bone density, and secondary hyperparathyroidism [18852718, 22525842, 24020640]. Furthermore, vitamin D deficiency has been linked to sarcopenia, a geriatric syndrome characterized by the progressive loss of skeletal muscle mass and strength [31766576, 33920130]. Overall, maintaining adequate vitamin D levels is crucial for optimal bone health and preventing various non-skeletal morbidities.Vitamin D supplementation has been shown to reduce the risk of fractures and falls in older adults [18852718, 22525842, 24020640].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D levels have been associated with various adverse health outcomes, including osteopenia, osteoporosis, osteomalacia, and muscle weakness, which can increase the risk of falls and fractures [18852718, 21824858, 18020534].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18852718", "evidence_support": "Low serum vitamin D levels are common in the general population and cause a decline in calcium absorption, leading to low serum levels of ionized calcium, which in turn trigger the release of parathyroid hormone, promoting skeletal resorption and, eventually, bone loss or osteomalacia.", "evidence_relation": "supporting" }, { "cited_pmid": "21824858", "evidence_support": "Vitamin D deficiency in adults can exacerbate osteopenia and osteoporosis, cause osteomalacia and muscle weakness, and increase the risk of fracture.", "evidence_relation": "supporting" }, { "cited_pmid": "18020534", "evidence_support": "Vitamin D deficiency causes osteopenia, osteoporosis and osteomalacia, increasing the risk of fracture.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Vitamin D deficiency has also been linked to an increased risk of cardiovascular disease, hypertension, and stroke, as well as diseases such as chronic kidney disease and type 2 diabetes [23609564].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23609564", "evidence_support": "Vitamin D deficiency is associated with substantial increases in the incidence of hypertension, hyperlipidaemia, myocardial infarction and stroke, as well as in diseases such as chronic kidney disease and type 2 diabetes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, low vitamin D levels have been associated with impaired bone mineralization, reduced bone density, and secondary hyperparathyroidism [18852718, 22525842, 24020640].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18852718", "evidence_support": "Low serum vitamin D levels are common in the general population and cause a decline in calcium absorption, leading to low serum levels of ionized calcium, which in turn trigger the release of parathyroid hormone, promoting skeletal resorption and, eventually, bone loss or osteomalacia. ", "evidence_relation": "supporting" }, { "cited_pmid": "18852718", "evidence_support": "In addition to disordered calcium homeostasis, low vitamin D levels might have effects on cell proliferation and differentiation and immune function", "evidence_relation": "supporting" }, { "cited_pmid": "24020640", "evidence_support": "Epidemiological studies show that low vitamin D status is associated with a variety of negative skeletal consequences in older adults including osteomalacia, reduced bone mineral density, impaired Ca absorption and secondary hyperparathyroidism.", "evidence_relation": "supporting" }, { "cited_pmid": "22525842", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, vitamin D deficiency has been linked to sarcopenia, a geriatric syndrome characterized by the progressive loss of skeletal muscle mass and strength [31766576, 33920130].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31766576", "evidence_support": "Therefore, older people with vitamin D deficiency might be at risk of sarcopenia, a geriatric syndrome characterized by the progressive loss of skeletal muscle mass and strength often complicated by adverse events, such as falls, disability hospitalization and death.", "evidence_relation": "supporting" }, { "cited_pmid": "33920130", "evidence_support": "this group, low vitamin D plasma concentration is related to osteoporosis, osteomalacia, sarcopenia and myalgia.", "evidence_relation": "supporting" }, { "cited_pmid": "33920130", "evidence_support": "Osteoporosis and sarcopenia (generalized and progressive decrease of skeletal muscle mass and strength) are some of the musculoskeletal consequences of hypovitaminosis D.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Overall, maintaining adequate vitamin D levels is crucial for optimal bone health and preventing various non-skeletal morbidities.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Vitamin D supplementation has been shown to reduce the risk of fractures and falls in older adults [18852718, 22525842, 24020640].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "18852718", "evidence_support": "Three recent meta-analyses concluded that vitamin D must be administered in combination with calcium in order to substantially reduce the risk of nonvertebral fracture in adults over the age of 50 years.", "evidence_relation": "supporting" }, { "cited_pmid": "22525842", "evidence_support": "Suboptimal vitamin D status contributes to many conditions, including osteomalacia/rickets, osteoporosis, falls, and fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "24020640", "evidence_support": "However, it is generally accepted that vitamin D (17\u00b75 \u03bcg/d) in combination with Ca (1200 mg/d) reduces bone loss among older white subjects.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "Low vitamin D status has been associated with various health consequences, including increased risk of osteoporosis, fractures, falls, and mortality [19491061, 20511052, 20795934]. It has also been linked to a higher risk of chronic diseases such as cardiovascular disease, type 2 diabetes, certain types of cancer, and autoimmune diseases [21605301, 18400738, 20795934]. Additionally, vitamin D deficiency has been associated with musculoskeletal pain, muscle weakness, and impaired immune function [18020534, 20498201, 28774221]. Furthermore, low vitamin D levels have been linked to an increased risk of respiratory infections, adverse pregnancy outcomes, and cognitive decline [30225965]. Overall, maintaining adequate vitamin D levels is essential for overall health and well-being [23542507, 18801384]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D status has been associated with various health consequences, including increased risk of osteoporosis, fractures, falls, and mortality [19491061, 20511052, 20795934].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19491061", "evidence_support": "More recently, the contribution of low vitamin D status to increased falls and fracture risk has become appreciated. Additionally, nonclassic effects of vitamin D inadequacy are being recognized, and low vitamin D status is being potentially associated with a multitude of conditions (including Alzheimer disease, osteoarthritis, multiple sclerosis, and hypertension) and higher overall mortality.", "evidence_relation": "supporting" }, { "cited_pmid": "20795934", "evidence_support": "Recent studies also suggest a role for vitamin D deficiency in multifactorial disorders, including progressive renal function loss and cardiovascular disease; it is also a risk factor for frailty", "evidence_relation": "supporting" }, { "cited_pmid": "20511052", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It has also been linked to a higher risk of chronic diseases such as cardiovascular disease, type 2 diabetes, certain types of cancer, and autoimmune diseases [21605301, 18400738, 20795934].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18400738", "evidence_support": "Vitamin D deficiency has been associated with increased risk of common cancers, autoimmune diseases, hypertension, and infectious diseases. ", "evidence_relation": "supporting" }, { "cited_pmid": "21605301", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "20795934", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, vitamin D deficiency has been associated with musculoskeletal pain, muscle weakness, and impaired immune function [18020534, 20498201, 28774221].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18020534", "evidence_support": "Vitamin D deficiency causes osteopenia, osteoporosis and osteomalacia, increasing the risk of fracture. ", "evidence_relation": "supporting" }, { "cited_pmid": "18020534", "evidence_support": "Vitamin D deficiency causes muscle weakness, increasing the risk of falls and fractures, and should be aggressively treated with pharmacological doses of vitamin D", "evidence_relation": "supporting" }, { "cited_pmid": "28774221", "evidence_support": "It may lead to osteomalacia with severe musculoskeletal pain.", "evidence_relation": "supporting" }, { "cited_pmid": "28774221", "evidence_support": "A moderate dose of vitamin D normalized l vitamin D levels, improved muscular strength and reduced pain in this group of vitamin D deficient immigrant women.", "evidence_relation": "supporting" }, { "cited_pmid": "20498201", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, low vitamin D levels have been linked to an increased risk of respiratory infections, adverse pregnancy outcomes, and cognitive decline [30225965].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30225965", "evidence_support": "Vitamin D is an essential nutrient for bone health and may influence the risks of respiratory illness, adverse pregnancy outcomes, and chronic diseases of adulthood.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Overall, maintaining adequate vitamin D levels is essential for overall health and well-being [23542507, 18801384].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23542507", "evidence_support": "Adequate vitamin D status seems to be protective against musculoskeletal disorders (muscle weakness, falls, fractures), infectious diseases, autoimmune diseases, cardiovascular disease, type 1 and type 2 diabetes mellitus, several types of cancer, neurocognitive dysfunction and mental illness, and other diseases, as well as infertility and adverse pregnancy and birth outcomes.", "evidence_relation": "supporting" }, { "cited_pmid": "18801384", "evidence_support": "Over the past two decades, it is now recognized that vitamin D not only is important for calcium metabolism and maintenance of bone health throughout life, but also plays an important role in reducing risk of many chronic diseases including type I diabetes, multiple sclerosis, rheumatoid arthritis, deadly cancers, heart disease and infectious diseases", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Low vitamin D status is associated with a decline in calcium absorption, leading to low serum levels of ionized calcium, which triggers the release of parathyroid hormone, promoting skeletal resorption and eventually bone loss or osteomalacia [21824858, 18852718, 20511052]. Low vitamin D levels can also have effects on cell proliferation and differentiation and immune function [18852718, 22123633, 22254030]. Additionally, low vitamin D status is linked to increased risk for various nonskeletal morbidities, including cardiovascular disease, cancer, multiple sclerosis, and type 1 and 2 diabetes [20511052, 22123633, 22254030]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D status is associated with a decline in calcium absorption, leading to low serum levels of ionized calcium, which triggers the release of parathyroid hormone, promoting skeletal resorption and eventually bone loss or osteomalacia [21824858, 18852718, 20511052].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18852718", "evidence_support": "Low serum vitamin D levels are common in the general population and cause a decline in calcium absorption, leading to low serum levels of ionized calcium, which in turn trigger the release of parathyroid hormone, promoting skeletal resorption and, eventually, bone loss or osteomalacia.", "evidence_relation": "supporting" }, { "cited_pmid": "21824858", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "20511052", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Low vitamin D levels can also have effects on cell proliferation and differentiation and immune function [18852718, 22123633, 22254030].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18852718", "evidence_support": "Low serum vitamin D levels are common in the general population and cause a decline in calcium absorption, leading to low serum levels of ionized calcium, which in turn trigger the release of parathyroid hormone, promoting skeletal resorption and, eventually, bone loss or osteomalacia.", "evidence_relation": "supporting" }, { "cited_pmid": "18852718", "evidence_support": "In addition to disordered calcium homeostasis, low vitamin D levels might have effects on cell proliferation and differentiation and immune function.", "evidence_relation": "supporting" }, { "cited_pmid": "22123633", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "22254030", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, low vitamin D status is linked to increased risk for various nonskeletal morbidities, including cardiovascular disease, cancer, multiple sclerosis, and type 1 and 2 diabetes [20511052, 22123633, 22254030].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20511052", "evidence_support": "More recently, associations between low vitamin D status and increased risk for various nonskeletal morbidities have been recognized; whether all of these associations are causally related to low vitamin D status remains to be determined.", "evidence_relation": "supporting" }, { "cited_pmid": "22123633", "evidence_support": "Regular sunlight exposure and vitamin D supplementation in early childhood may offer protection against the development of type 1 diabetes. Epidemiological evidence supports the importance of adequate vitamin D levels for the prevention of a number of cancers, mainly breast and colorectal ones. There seems to be an inverse relation between 25(OH)D serum concentrations and cardiovascular diseases, some components of the metabolic syndrome, and physical fitness.", "evidence_relation": "supporting" }, { "cited_pmid": "22254030", "evidence_support": " Vitamin D deficiency/insufficiency has been associated with muscle weakness and a high incidence of various chronic diseases such as cardiovascular disease, cancer, multiple sclerosis, and type 1 and 2 diabetes. ", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Low vitamin D status is associated with various health consequences, including musculoskeletal disorders, such as osteomalacia, rickets, osteoporosis, falls, and fractures [21193656, 24846318, 23542507]. It is also linked to increased risk of cardiovascular disease, type 1 and type 2 diabetes mellitus, certain types of cancer, neurocognitive dysfunction, mental illness, and other diseases [23306192, 23085014, 27037388]. Additionally, vitamin D deficiency is associated with all-cause mortality [22123633, 23085014, 26204630]. Furthermore, low vitamin D status can cause muscle weakness, increasing the risk of falling and fractures, and is also related to depression and impaired cognitive function [16174483, 21824858, 26204630]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D status is associated with various health consequences, including musculoskeletal disorders, such as osteomalacia, rickets, osteoporosis, falls, and fractures [21193656, 24846318, 23542507].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21193656", "evidence_support": "Vitamin D deficiency, which classically manifests as bone disease (either rickets or osteomalacia), is characterized by impaired bone mineralization. More recently, the term vitamin D insufficiency has been used to describe low levels of serum 25-hydroxyvitamin D that may be associated with other disease outcomes.", "evidence_relation": "supporting" }, { "cited_pmid": "24846318", "evidence_support": "The vitamin D endocrine system is critical for the maintenance of circulating calcium concentrations, but recently, there has been advocacy for the widespread use of vitamin D supplements to improve skeletal and nonskeletal health.", "evidence_relation": "supporting" }, { "cited_pmid": "23542507", "evidence_support": "Adequate vitamin D status seems to be protective against musculoskeletal disorders (muscle weakness, falls, fractures), infectious diseases, autoimmune diseases, cardiovascular disease, type 1 and type 2 diabetes mellitus, several types of cancer, neurocognitive dysfunction and mental illness, and other diseases, as well as infertility and adverse pregnancy and birth outcomes. Vitamin D deficiency/insufficiency is associated with all-cause mortality.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also linked to increased risk of cardiovascular disease, type 1 and type 2 diabetes mellitus, certain types of cancer, neurocognitive dysfunction, mental illness, and other diseases [23306192, 23085014, 27037388].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23306192", "evidence_support": "Vitamin D, the sunshine vitamin, has received a lot of attention recently as a result of a meteoric rise in the number of publications showing that vitamin D plays a crucial role in a plethora of physiological functions and associating vitamin D deficiency with many acute and chronic illnesses including disorders of calcium metabolism, autoimmune diseases, some cancers, type 2 diabetes mellitus, cardiovascular disease and infectious diseases. ", "evidence_relation": "supporting" }, { "cited_pmid": "23085014", "evidence_support": "Adequate vitamin D status has been linked to decreased risks of developing specific cancers, including cancers of the esophagus, stomach, colon, rectum, gallbladder, pancreas, lung, breast, uterus, ovary, prostate, urinary bladder, kidney, skin, thyroid, and hematopoietic system (e.g., Hodgkin's lymphoma, non-Hodgkin's lymphoma, multiple myeloma); bacterial infections; rheumatoid arthritis; Crohn's disease; periodontal disease; multiple sclerosis; asthma; type 2 diabetes; cardiovascular disease; stroke; peripheral artery disease; hypertension; chronic kidney disease; muscle weakness; cognitive impairment; Alzheimer's disease; clinical depression; and premature death. On the other hand, inadequate vitamin D status during human pregnancy may be associated with increased risk for the development of type 1 diabetes in the offspring. ", "evidence_relation": "supporting" }, { "cited_pmid": "27037388", "evidence_support": "Vitamin D deficiency is a public health concern. Mediated by classical endocrine effects, vitamin D deficiency is causally linked with bone and calcium disorders. ", "evidence_relation": "neutral" }, { "cited_pmid": "27037388", "evidence_support": "Supported by large volumes of observational studies linking low circulating vitamin D with negative outcomes for many common disease states, there is growing interest that vitamin D may be central to the pathology and outcomes of many common diseases, including cardiovascular, cancer and autoimmune conditions", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, vitamin D deficiency is associated with all-cause mortality [22123633, 23085014, 26204630].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22123633", "evidence_support": "Low vitamin D concentrations seem to be significantly associated with all-cause mortality.", "evidence_relation": "supporting" }, { "cited_pmid": "23085014", "evidence_support": "Adequate vitamin D status has been linked to decreased risks of developing specific cancers, including cancers of the esophagus, stomach, colon, rectum, gallbladder, pancreas, lung, breast, uterus, ovary, prostate, urinary bladder, kidney, skin, thyroid, and hematopoietic system (e.g., Hodgkin's lymphoma, non-Hodgkin's lymphoma, multiple myeloma); bacterial infections; rheumatoid arthritis; Crohn's disease; periodontal disease; multiple sclerosis; asthma; type 2 diabetes; cardiovascular disease; stroke; peripheral artery disease; hypertension; chronic kidney disease; muscle weakness; cognitive impairment; Alzheimer's disease; clinical depression; and premature death.", "evidence_relation": "supporting" }, { "cited_pmid": "26204630", "evidence_support": "Hypovitaminosis D is associated with cardiovascular disease, the metabolic syndrome, type 2 diabetes mellitus, cancer as well as with increased mortality", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, low vitamin D status can cause muscle weakness, increasing the risk of falling and fractures, and is also related to depression and impaired cognitive function [16174483, 21824858, 26204630].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16174483", "evidence_support": "Clinical consequences related to low vitamin D levels include not only osteomalacia, osteoporosis, and rickets, but also neuro-muscular dysfunction and fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "21824858", "evidence_support": "Vitamin D deficiency in adults can exacerbate osteopenia and osteoporosis, cause osteomalacia and muscle weakness, and increase the risk of fracture.", "evidence_relation": "supporting" }, { "cited_pmid": "26204630", "evidence_support": "Further, Vitamin D deficiency is related to depression and impaired cognitive function", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Low vitamin D status is associated with various health consequences, including musculoskeletal disorders, such as osteomalacia, rickets, osteoporosis, falls, and fractures [21939984, 29074835, 29074833]. It is also linked to increased risk of cardiovascular disease, type 1 and type 2 diabetes mellitus, certain types of cancer, neurocognitive dysfunction, mental illness, and other diseases [27037388, 23085014, 23306192]. Additionally, vitamin D deficiency is associated with all-cause mortality [32371900, 30700025, 37275650]. Furthermore, low vitamin D status can cause muscle weakness, increasing the risk of falling and fractures, and is also related to depression and impaired cognitive function [29963601, 25326374, 22536766]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D status is associated with various health consequences, including musculoskeletal disorders, such as osteomalacia, rickets, osteoporosis, falls, and fractures [21939984, 29074835, 29074833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21939984", "evidence_support": "Rickets, osteomalacia, osteoporosis and myopathy are among the better known consequences of a low to very low vitamin D status.", "evidence_relation": "supporting" }, { "cited_pmid": "29074835", "evidence_support": "Severe vitamin D deficiency causes osteomalacia/rickets. Even milder vitamin D insufficiency could still be harmful for bone health via secondary hyperparathyroidism and bone loss, and could also lead to increased risk of falling.", "evidence_relation": "supporting" }, { "cited_pmid": "29074833", "evidence_support": "The lower the serum 25(OH)D level is, the higher the risks are, of secondary hyperparathyroidism, low bone mineral density, fall, fracture, rickets/osteomalacia, and hypocalcemia, as well as lower response to anti-osteoporosis medications.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also linked to increased risk of cardiovascular disease, type 1 and type 2 diabetes mellitus, certain types of cancer, neurocognitive dysfunction, mental illness, and other diseases [27037388, 23085014, 23306192].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27037388", "evidence_support": "Supported by large volumes of observational studies linking low circulating vitamin D with negative outcomes for many common disease states, there is growing interest that vitamin D may be central to the pathology and outcomes of many common diseases, including cardiovascular, cancer and autoimmune conditions", "evidence_relation": "supporting" }, { "cited_pmid": "23085014", "evidence_support": "Adequate vitamin D status has been linked to decreased risks of developing specific cancers, including cancers of the esophagus, stomach, colon, rectum, gallbladder, pancreas, lung, breast, uterus, ovary, prostate, urinary bladder, kidney, skin, thyroid, and hematopoietic system (e.g., Hodgkin's lymphoma, non-Hodgkin's lymphoma, multiple myeloma); bacterial infections; rheumatoid arthritis; Crohn's disease; periodontal disease; multiple sclerosis; asthma; type 2 diabetes; cardiovascular disease; stroke; peripheral artery disease; hypertension; chronic kidney disease; muscle weakness; cognitive impairment; Alzheimer's disease; clinical depression; and premature death.", "evidence_relation": "supporting" }, { "cited_pmid": "23306192", "evidence_support": "Vitamin D, the sunshine vitamin, has received a lot of attention recently as a result of a meteoric rise in the number of publications showing that vitamin D plays a crucial role in a plethora of physiological functions and associating vitamin D deficiency with many acute and chronic illnesses including disorders of calcium metabolism, autoimmune diseases, some cancers, type 2 diabetes mellitus, cardiovascular disease and infectious diseases. Vitamin D deficiency is now recognized as a global pandemic", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, vitamin D deficiency is associated with all-cause mortality [32371900, 30700025, 37275650].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32371900", "evidence_support": "We additionally revealed that vitamin D deficiency was an independent predicator for all-cause mortality in higher CTR hemodialysis patients.", "evidence_relation": "supporting" }, { "cited_pmid": "30700025", "evidence_support": "The vast majority of studies reported inverse associations between 25(OH)D concentration and all-cause mortality.", "evidence_relation": "supporting" }, { "cited_pmid": "37275650", "evidence_support": "The crude analysis showed that vitamin D deficiency, but not vitamin D insufficiency, correlated to higher all-cause mortality risk. The association remained similar after adjusting for potential confounders, showing that vitamin D deficiency (HR: 1.38, 95% CI 1.15-1.66), but not vitamin D insufficiency (HR: 1.03, 95% CI 0.88-1.20), correlated to higher all-cause mortality risk.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, low vitamin D status can cause muscle weakness, increasing the risk of falling and fractures, and is also related to depression and impaired cognitive function [29963601, 25326374, 22536766].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29963601", "evidence_support": "Vitamin D is increasingly recognised to play an important role in normal muscle function. Low vitamin D status is associated with an increased risk of falls and proximal weakness.", "evidence_relation": "supporting" }, { "cited_pmid": "25326374", "evidence_support": "Recently, numerous extra osseous effects of vitamin D have been described, amongst them a positive effect on neuromuscular and cognitive functions.", "evidence_relation": "supporting" }, { "cited_pmid": "25326374", "evidence_support": "Several lines of evidence suggest that the beneficial effects of vitamin D on fall and fracture risk can be explained more by its action on the neuromuscular and cognitive functions than by its direct effect on bone metabolism.", "evidence_relation": "supporting" }, { "cited_pmid": "25326374", "evidence_support": "In this review, we first report on the relationships between vitamin D and osteoporotic fracture risk. Then, we present the data from the literature regarding the effects of vitamin D on risk factors such as fall risk and reduction in BMD, physical performance, and cognitive performance. Specific emphasis is put on the latter because there is evidence of a relationship between low concentration of serum 25-hydroxyvitamin D (the primary indicator of vitamin D status) and low cognitive abilities which have been shown to be a risk factor for falling. ", "evidence_relation": "supporting" }, { "cited_pmid": "22536766", "evidence_support": "Patients with low calcium intake and a low vitamin D status are at risk to develop secondary hyperparathyroidism, increased bone resorbtion, osteopenia and fractures.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Low vitamin D status is associated with various health consequences, including musculoskeletal disorders, such as osteomalacia, rickets, osteoporosis, falls, and fractures [21939984, 29074835, 29074833]. It is also linked to increased risk of cardiovascular disease, type 1 and type 2 diabetes mellitus, certain types of cancer, neurocognitive dysfunction, mental illness, and other diseases [26204630, 23306192, 23085014]. Additionally, vitamin D deficiency is associated with all-cause mortality [32371900, 30700025, 37275650]. Furthermore, low vitamin D status can cause muscle weakness, increasing the risk of falling and fractures, and is also related to depression and impaired cognitive function [26204630, 25326374, 21824858]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D status is associated with various health consequences, including musculoskeletal disorders, such as osteomalacia, rickets, osteoporosis, falls, and fractures [21939984, 29074835, 29074833].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21939984", "evidence_support": "Rickets, osteomalacia, osteoporosis and myopathy are among the better known consequences of a low to very low vitamin D status.", "evidence_relation": "supporting" }, { "cited_pmid": "29074835", "evidence_support": "Severe vitamin D deficiency causes osteomalacia/rickets. Even milder vitamin D insufficiency could still be harmful for bone health via secondary hyperparathyroidism and bone loss, and could also lead to increased risk of falling. ", "evidence_relation": "supporting" }, { "cited_pmid": "29074833", "evidence_support": "The lower the serum 25(OH)D level is, the higher the risks are, of secondary hyperparathyroidism, low bone mineral density, fall, fracture, rickets/osteomalacia, and hypocalcemia, as well as lower response to anti-osteoporosis medications", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also linked to increased risk of cardiovascular disease, type 1 and type 2 diabetes mellitus, certain types of cancer, neurocognitive dysfunction, mental illness, and other diseases [26204630, 23306192, 23085014].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26204630", "evidence_support": "Hypovitaminosis D is associated with cardiovascular disease, the metabolic syndrome, type 2 diabetes mellitus, cancer as well as with increased mortality. Further, Vitamin D deficiency is related to depression and impaired cognitive function", "evidence_relation": "supporting" }, { "cited_pmid": "23306192", "evidence_support": "Vitamin D, the sunshine vitamin, has received a lot of attention recently as a result of a meteoric rise in the number of publications showing that vitamin D plays a crucial role in a plethora of physiological functions and associating vitamin D deficiency with many acute and chronic illnesses including disorders of calcium metabolism, autoimmune diseases, some cancers, type 2 diabetes mellitus, cardiovascular disease and infectious diseases.", "evidence_relation": "supporting" }, { "cited_pmid": "23085014", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, vitamin D deficiency is associated with all-cause mortality [32371900, 30700025, 37275650].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32371900", "evidence_support": "Hemodialysis patients with vitamin D deficiency {plasma levels of 25-hydroxyvitamin D [25(OH)D] below 20\u2009ng/mL} are associated with even higher mortality rates", "evidence_relation": "supporting" }, { "cited_pmid": "30700025", "evidence_support": "There is moderate evidence that vitamin D status is inversely associated with cancer mortality and death due to respiratory diseases, while for cardiovascular mortality, there is weak evidence of an association in observational studies, which is not supported by the data from intervention or Mendelian randomization studies", "evidence_relation": "contradicting" }, { "cited_pmid": "37275650", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, low vitamin D status can cause muscle weakness, increasing the risk of falling and fractures, and is also related to depression and impaired cognitive function [26204630, 25326374, 21824858].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26204630", "evidence_support": "Further, Vitamin D deficiency is related to depression and impaired cognitive function.", "evidence_relation": "supporting" }, { "cited_pmid": "25326374", "evidence_support": "decreases the risk of fracture", "evidence_relation": "neutral" }, { "cited_pmid": "25326374", "evidence_support": "positive effect on neuromuscular and cognitive functions.", "evidence_relation": "neutral" }, { "cited_pmid": "25326374", "evidence_support": "Several lines of evidence suggest that the beneficial effects of vitamin D on fall and fracture risk can be explained more by its action on the neuromuscular and cognitive functions than by its direct effect on bone metabolism.", "evidence_relation": "supporting" }, { "cited_pmid": "21824858", "evidence_support": "In utero and during childhood, vitamin D deficiency can cause growth retardation and skeletal deformities and may increase the risk of hip fracture later in life. Vitamin D deficiency in adults can exacerbate osteopenia and osteoporosis, cause osteomalacia and muscle weakness, and increase the risk of fracture.", "evidence_relation": "supporting" }, { "cited_pmid": "21824858", "evidence_support": "More recently, associations between low vitamin D status and increased risk for various non-skeletal morbidities have been recognized", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Low vitamin D status is associated with various health consequences, including musculoskeletal disorders, such as osteomalacia, rickets, osteoporosis, falls, and fractures [29074833, 21939984, 29074835]. It is also linked to increased risk of cardiovascular disease, type 1 and type 2 diabetes mellitus, certain types of cancer, neurocognitive dysfunction, mental illness, and other diseases [23085014, 23306192, 27037388]. Additionally, vitamin D deficiency is associated with all-cause mortality [32371900, 30700025, 37275650]. Furthermore, low vitamin D status can cause muscle weakness, increasing the risk of falling and fractures, and is also related to depression and impaired cognitive function [25326374, 22536766, 29963601]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D status is associated with various health consequences, including musculoskeletal disorders, such as osteomalacia, rickets, osteoporosis, falls, and fractures [29074833, 21939984, 29074835].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29074833", "evidence_support": "The lower the serum 25(OH)D level is, the higher the risks are, of secondary hyperparathyroidism, low bone mineral density, fall, fracture, rickets/osteomalacia, and hypocalcemia, as well as lower response to anti-osteoporosis medications.", "evidence_relation": "supporting" }, { "cited_pmid": "21939984", "evidence_support": "Rickets, osteomalacia, osteoporosis and myopathy are among the better known consequences of a low to very low vitamin D status.", "evidence_relation": "supporting" }, { "cited_pmid": "29074835", "evidence_support": "Severe vitamin D deficiency causes osteomalacia/rickets. Even milder vitamin D insufficiency could still be harmful for bone health via secondary hyperparathyroidism and bone loss, and could also lead to increased risk of falling. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also linked to increased risk of cardiovascular disease, type 1 and type 2 diabetes mellitus, certain types of cancer, neurocognitive dysfunction, mental illness, and other diseases [23085014, 23306192, 27037388].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23085014", "evidence_support": "Adequate vitamin D status has been linked to decreased risks of developing specific cancers, including cancers of the esophagus, stomach, colon, rectum, gallbladder, pancreas, lung, breast, uterus, ovary, prostate, urinary bladder, kidney, skin, thyroid, and hematopoietic system (e.g., Hodgkin's lymphoma, non-Hodgkin's lymphoma, multiple myeloma); bacterial infections; rheumatoid arthritis; Crohn's disease; periodontal disease; multiple sclerosis; asthma; type 2 diabetes; cardiovascular disease; stroke; peripheral artery disease; hypertension; chronic kidney disease; muscle weakness; cognitive impairment; Alzheimer's disease; clinical depression; and premature death. On the other hand, inadequate vitamin D status during human pregnancy may be associated with increased risk for the development of type 1 diabetes in the offspring.", "evidence_relation": "supporting" }, { "cited_pmid": "23306192", "evidence_support": "Vitamin D, the sunshine vitamin, has received a lot of attention recently as a result of a meteoric rise in the number of publications showing that vitamin D plays a crucial role in a plethora of physiological functions and associating vitamin D deficiency with many acute and chronic illnesses including disorders of calcium metabolism, autoimmune diseases, some cancers, type 2 diabetes mellitus, cardiovascular disease and infectious diseases. ", "evidence_relation": "supporting" }, { "cited_pmid": "27037388", "evidence_support": "Supported by large volumes of observational studies linking low circulating vitamin D with negative outcomes for many common disease states, there is growing interest that vitamin D may be central to the pathology and outcomes of many common diseases, including cardiovascular, cancer and autoimmune conditions.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, vitamin D deficiency is associated with all-cause mortality [32371900, 30700025, 37275650].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32371900", "evidence_support": "Hemodialysis patients with vitamin D deficiency {plasma levels of 25-hydroxyvitamin D [25(OH)D] below 20\u2009ng/mL} are associated with even higher mortality rates.", "evidence_relation": "supporting" }, { "cited_pmid": "32371900", "evidence_support": "Additionally, vitamin D deficiency was associated with all-cause mortality in patients with higher CTR after adjustment in hierarchical regression models", "evidence_relation": "supporting" }, { "cited_pmid": "37275650", "evidence_support": "summary, among middle-aged and older adults in the United States, nearly 20% were vitamin D deficient. Vitamin D deficiency, but not vitamin D insufficiency, correlated to increased mortality risk.", "evidence_relation": "supporting" }, { "cited_pmid": "30700025", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, low vitamin D status can cause muscle weakness, increasing the risk of falling and fractures, and is also related to depression and impaired cognitive function [25326374, 22536766, 29963601].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25326374", "evidence_support": "we present the data from the literature regarding the effects of vitamin D on risk factors such as fall risk and reduction in BMD, physical performance, and cognitive performance", "evidence_relation": "supporting" }, { "cited_pmid": "25326374", "evidence_support": "Specific emphasis is put on the latter because there is evidence of a relationship between low concentration of serum 25-hydroxyvitamin D (the primary indicator of vitamin D status) and low cognitive abilities which have been shown to be a risk factor for falling.", "evidence_relation": "supporting" }, { "cited_pmid": "25326374", "evidence_support": "Future studies are nonetheless needed to elucidate the associations between vitamin D and different risk factors, in particular the link between vitamin D and various cognitive functions.", "evidence_relation": "neutral" }, { "cited_pmid": "22536766", "evidence_support": "Patients with low calcium intake and a low vitamin D status are at risk to develop secondary hyperparathyroidism, increased bone resorbtion, osteopenia and fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "29963601", "evidence_support": "Low vitamin D status is associated with an increased risk of falls and proximal weakness.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Low vitamin D status is associated with various health consequences, including musculoskeletal disorders, such as osteomalacia, rickets, osteoporosis, falls, and fractures [18237070, 22525842]. It is also linked to increased risk of cardiovascular disease, type 1 and type 2 diabetes mellitus, certain types of cancer, neurocognitive dysfunction, mental illness, and other diseases [19940414, 26545282, 15751909]. Additionally, vitamin D deficiency is associated with all-cause mortality [23883271, 37340242, 30700025]. Furthermore, low vitamin D status can cause muscle weakness, increasing the risk of falling and fractures, and is also related to depression and impaired cognitive function [21824858, 29963601, 18237070]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D status is associated with various health consequences, including musculoskeletal disorders, such as osteomalacia, rickets, osteoporosis, falls, and fractures [18237070, 22525842].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18237070", "evidence_support": " low vitamin D status underlies multiple deleterious health consequences including skeletal fragility, muscle weakness, and a potential multitude of non-skeletal morbidities", "evidence_relation": "supporting" }, { "cited_pmid": "22525842", "evidence_support": "Suboptimal vitamin D status contributes to many conditions, including osteomalacia/rickets, osteoporosis, falls, and fractures.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also linked to increased risk of cardiovascular disease, type 1 and type 2 diabetes mellitus, certain types of cancer, neurocognitive dysfunction, mental illness, and other diseases [19940414, 26545282, 15751909].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19940414", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "26545282", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15751909", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, vitamin D deficiency is associated with all-cause mortality [23883271, 37340242, 30700025].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23883271", "evidence_support": "We investigated a hypothesis that low vitamin D in this population may be associated with premature mortality via a systematic review and meta-analysis", "evidence_relation": "supporting" }, { "cited_pmid": "23883271", "evidence_support": "Low vitamin D status is inversely associated with all-cause mortality but the risk is higher amongst older individuals and the relationship is prone to residual confounding.", "evidence_relation": "supporting" }, { "cited_pmid": "37340242", "evidence_support": "Vitamin D deficiency and all biomarkers of SIR were significantly associated with all-cause mortality and mortality from cancer, cardiovascular and respiratory disease.", "evidence_relation": "supporting" }, { "cited_pmid": "30700025", "evidence_support": "Epidemiological evidence suggests that vitamin D deficiency is associated with increased mortality", "evidence_relation": "supporting" }, { "cited_pmid": "30700025", "evidence_support": "The vast majority of studies reported inverse associations between 25(OH)D concentration and all-cause mortality.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, low vitamin D status can cause muscle weakness, increasing the risk of falling and fractures, and is also related to depression and impaired cognitive function [21824858, 29963601, 18237070].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21824858", "evidence_support": "Vitamin D deficiency in adults can exacerbate osteopenia and osteoporosis, cause osteomalacia and muscle weakness, and increase the risk of fracture.", "evidence_relation": "supporting" }, { "cited_pmid": "21824858", "evidence_support": "More recently, associations between low vitamin D status and increased risk for various non-skeletal morbidities have been recognized; whether all of these associations are causally related to low vitamin D status remains to be determine", "evidence_relation": "supporting" }, { "cited_pmid": "29963601", "evidence_support": "Low vitamin D status is associated with an increased risk of falls and proximal weakness.", "evidence_relation": "supporting" }, { "cited_pmid": "18237070", "evidence_support": "Only recently, the medical community has begun to appreciate that low vitamin D status underlies multiple deleterious health consequences including skeletal fragility, muscle weakness, and a potential multitude of non-skeletal morbidities.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Low vitamin D status is associated with various health consequences, including musculoskeletal disorders, such as osteomalacia, rickets, osteoporosis, falls, and fractures [22525842]. It is also linked to increased risk of cardiovascular disease, type 1 and type 2 diabetes mellitus, certain types of cancer, neurocognitive dysfunction, mental illness, and other diseases [15751909, 19940414]. Additionally, vitamin D deficiency is associated with all-cause mortality [23883271, 36337642, 19710612]. Furthermore, low vitamin D status can cause muscle weakness, increasing the risk of falling and fractures, and is also related to depression and impaired cognitive function [21939984, 17138809, 35362398]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D status is associated with various health consequences, including musculoskeletal disorders, such as osteomalacia, rickets, osteoporosis, falls, and fractures [22525842].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22525842", "evidence_support": "Suboptimal vitamin D status contributes to many conditions, including osteomalacia/rickets, osteoporosis, falls, and fractures.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also linked to increased risk of cardiovascular disease, type 1 and type 2 diabetes mellitus, certain types of cancer, neurocognitive dysfunction, mental illness, and other diseases [15751909, 19940414].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15751909", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "19940414", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, vitamin D deficiency is associated with all-cause mortality [23883271, 36337642, 19710612].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23883271", "evidence_support": "Low vitamin D status is inversely associated with all-cause mortality but the risk is higher amongst older individuals and the relationship is prone to residual confounding.", "evidence_relation": "supporting" }, { "cited_pmid": "19710612", "evidence_support": "Accumulating evidence suggests that vitamin D deficiency is linked to excess mortality.", "evidence_relation": "supporting" }, { "cited_pmid": "36337642", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, low vitamin D status can cause muscle weakness, increasing the risk of falling and fractures, and is also related to depression and impaired cognitive function [21939984, 17138809, 35362398].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21939984", "evidence_support": "Rickets, osteomalacia, osteoporosis and myopathy are among the better known consequences of a low to very low vitamin D status.", "evidence_relation": "supporting" }, { "cited_pmid": "17138809", "evidence_support": "Vitamin D deficiency is common in older adults and has been implicated in psychiatric and neurologic disorders.", "evidence_relation": "supporting" }, { "cited_pmid": "17138809", "evidence_support": "After adjusting for age, race, gender, and season of vitamin D determination, vitamin D deficiency was associated with presence of an active mood disorder (odds ratio: 11.69, 95% confidence interval: 2.04-66.86; Wald chi(2) = 7.66, df = 2, p = 0.022). Using the same covariates in a linear regression model, vitamin D deficiency was associated with worse performance on the SBT (F = 5.22, df = [2, 77], p = 0.044) and higher CDR Sum of Box scores (F = 3.20, df = [2, 77], p = 0.047) in the vitamin D-deficient group. ", "evidence_relation": "supporting" }, { "cited_pmid": "17138809", "evidence_support": "In a cross-section of older adults, vitamin D deficiency was associated with low mood and with impairment on two of four measures of cognitive performance.", "evidence_relation": "supporting" }, { "cited_pmid": "35362398", "evidence_support": "Vitamin D is engaged in various neural processes, with low vitamin D linked to depression and cognitive dysfunction.", "evidence_relation": "supporting" }, { "cited_pmid": "35362398", "evidence_support": "Apart from providing insights into the neural mechanisms by which low vitamin D contributes to cognitive impairment in MDD in a gender-dependent manner, these findings might have clinical implications for assignment of female patients with MDD and cognitive dysfunction to adjuvant vitamin D supplementation therapy, which may ultimately advance a precision approach to personalized antidepressant choice.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Low vitamin D status is associated with various health consequences, including musculoskeletal disorders, such as osteomalacia, rickets, osteoporosis, falls, fractures, and musculoskeletal pain [22525842, 20498201]. It is also linked to increased risk of cardiovascular disease, type 1 and type 2 diabetes mellitus, certain types of cancer, neurocognitive dysfunction, mental illness, and other diseases [15751909, 19940414]. Additionally, vitamin D deficiency is associated with all-cause mortality [23883271, 30700025, 37340242]. Furthermore, low vitamin D status can cause muscle weakness, increasing the risk of falling and fractures, and is also related to depression and impaired cognitive function [23377209, 29963601, 19373764]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D status is associated with various health consequences, including musculoskeletal disorders, such as osteomalacia, rickets, osteoporosis, falls, fractures, and musculoskeletal pain [22525842, 20498201].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22525842", "evidence_support": "Suboptimal vitamin D status contributes to many conditions, including osteomalacia/rickets, osteoporosis, falls, and fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "20498201", "evidence_support": "After adjusting for age, having 'other pain' was associated with a 30% increase in the odds of having low 25-(OH)D while CWP was associated with a 50% increase.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also linked to increased risk of cardiovascular disease, type 1 and type 2 diabetes mellitus, certain types of cancer, neurocognitive dysfunction, mental illness, and other diseases [15751909, 19940414].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15751909", "evidence_support": "Diabetes, gallbladder stones, high blood pressure, liver disease, coronary artery disease, cerebrovascular disease, certain types of cancers, and infertility can all be traced in part to the increased secretion of inflammatory and coagulation molecules from fat cells.", "evidence_relation": "supporting" }, { "cited_pmid": "19940414", "evidence_support": "Obesity is a significant risk factor for and contributor to increased morbidity and mortality, most importantly from cardiovascular disease (CVD) and diabetes, but also from cancer and chronic diseases, including osteoarthritis, liver and kidney disease, sleep apnea, and depression.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, vitamin D deficiency is associated with all-cause mortality [23883271, 30700025, 37340242].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23883271", "evidence_support": "The pooled hazard ratio for low compared to high vitamin D demonstrated a significant inverse association (HR 1.19, 95% CI 1.12-1.27) between vitamin D levels and all-cause mortality after adjustment for available confounders. In an age-stratified meta-analysis, the hazard ratio for older participants was 1.25 (95% CI 1.14-1.36) and for younger participants 1.12 (95% CI 1.01-1.24).", "evidence_relation": "supporting" }, { "cited_pmid": "30700025", "evidence_support": "There is moderate evidence that vitamin D status is inversely associated with cancer mortality and death due to respiratory diseases, while for cardiovascular mortality, there is weak evidence of an association in observational studies, which is not supported by the data from intervention or Mendelian randomization studies.", "evidence_relation": "contradicting" }, { "cited_pmid": "37340242", "evidence_support": "Vitamin D deficiency and systemic inflammation were independently and strongly associated with mortality.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, low vitamin D status can cause muscle weakness, increasing the risk of falling and fractures, and is also related to depression and impaired cognitive function [23377209, 29963601, 19373764].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23377209", "evidence_support": "Lower vitamin D levels were found in people with depression compared with controls (SMD = 0.60, 95% CI 0.23-0.97) and there was an increased odds ratio of depression for the lowest v. highest vitamin D categories in the cross-sectional studies ", "evidence_relation": "supporting" }, { "cited_pmid": "23377209", "evidence_support": "Our analyses are consistent with the hypothesis that low vitamin D concentration is associated with depression, and highlight the need for randomised controlled trials of vitamin D for the prevention and treatment of depression to determine whether this association is causal.", "evidence_relation": "supporting" }, { "cited_pmid": "29963601", "evidence_support": "Low vitamin D status is associated with an increased risk of falls and proximal weakness. ", "evidence_relation": "supporting" }, { "cited_pmid": "19373764", "evidence_support": "This case demonstrates that severe vitamin D-deficiency may be associated with musculoskeletal pain and weakness.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Low vitamin D status is associated with various health consequences, including musculoskeletal disorders, such as osteomalacia, rickets, osteoporosis, falls, and fractures [21824858, 33669918]. It is also linked to increased risk of cardiovascular disease, including coronary heart disease, heart failure, hypertension, stroke, atrial fibrillation, and sudden cardiac death, type 1 and type 2 diabetes mellitus, certain types of cancer, neurocognitive dysfunction, mental illness, insulin resistance, hyperglycemia, dyslipidemia, and other diseases [15751909, 19940414, 26087341]. Additionally, vitamin D deficiency is associated with all-cause mortality [23883271, 37340242, 30700025]. Furthermore, low vitamin D status can cause muscle weakness, increasing the risk of falling and fractures, and is also related to an increased risk of depression [23727408, 31909749, 20683115, 21939984]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D status is associated with various health consequences, including musculoskeletal disorders, such as osteomalacia, rickets, osteoporosis, falls, and fractures [21824858, 33669918].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21824858", "evidence_support": "However, rickets can be considered the tip of the vitamin D deficiency iceberg.", "evidence_relation": "supporting" }, { "cited_pmid": "21824858", "evidence_support": "vitamin D deficiency can cause growth retardation and skeletal deformities and may increase the risk of hip fracture later in life. Vitamin D deficiency in adults can exacerbate osteopenia and osteoporosis, cause osteomalacia and muscle weakness, and increase the risk of fracture.", "evidence_relation": "supporting" }, { "cited_pmid": "33669918", "evidence_support": "This review summarizes the metabolism of vitamin D, the research regarding the possible risk factors leading to vitamin D deficiency, and the relationships between vitamin D deficiency and numerous illnesses, including rickets, osteoporosis and osteomalacia, muscle weakness and falls, autoimmune disorders, infectious diseases, cardiovascular diseases (CVDs), cancers, and neurological disorders.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is also linked to increased risk of cardiovascular disease, including coronary heart disease, heart failure, hypertension, stroke, atrial fibrillation, and sudden cardiac death, type 1 and type 2 diabetes mellitus, certain types of cancer, neurocognitive dysfunction, mental illness, insulin resistance, hyperglycemia, dyslipidemia, and other diseases [15751909, 19940414, 26087341].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15751909", "evidence_support": "Diabetes, gallbladder stones, high blood pressure, liver disease, coronary artery disease, cerebrovascular disease, certain types of cancers, and infertility can all be traced in part to the increased secretion of inflammatory and coagulation molecules from fat cells.", "evidence_relation": "supporting" }, { "cited_pmid": "19940414", "evidence_support": "Obesity is a significant risk factor for and contributor to increased morbidity and mortality, most importantly from cardiovascular disease (CVD) and diabetes, but also from cancer and chronic diseases, including osteoarthritis, liver and kidney disease, sleep apnea, and depression.", "evidence_relation": "supporting" }, { "cited_pmid": "26087341", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, vitamin D deficiency is associated with all-cause mortality [23883271, 37340242, 30700025].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23883271", "evidence_support": "The pooled hazard ratio for low compared to high vitamin D demonstrated a significant inverse association (HR 1.19, 95% CI 1.12-1.27) between vitamin D levels and all-cause mortality after adjustment for available confounders.", "evidence_relation": "supporting" }, { "cited_pmid": "23883271", "evidence_support": "Low vitamin D status is inversely associated with all-cause mortality but the risk is higher amongst older individuals and the relationship is prone to residual confounding.", "evidence_relation": "supporting" }, { "cited_pmid": "37340242", "evidence_support": "Vitamin D deficiency and all biomarkers of SIR were significantly associated with all-cause mortality and mortality from cancer, cardiovascular and respiratory disease", "evidence_relation": "supporting" }, { "cited_pmid": "37340242", "evidence_support": "Vitamin D deficiency and systemic inflammation were independently and strongly associated with mortality.", "evidence_relation": "supporting" }, { "cited_pmid": "30700025", "evidence_support": "Epidemiological evidence suggests that vitamin D deficiency is associated with increased mortality, but it is unclear whether this is explained by reverse causation, and if there are specific causes of death for which vitamin D might be important. ", "evidence_relation": "supporting" }, { "cited_pmid": "30700025", "evidence_support": "The vast majority of studies reported inverse associations between 25(OH)D concentration and all-cause mortality.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, low vitamin D status can cause muscle weakness, increasing the risk of falling and fractures, and is also related to an increased risk of depression [23727408, 31909749, 20683115, 21939984].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31909749", "evidence_support": "Studies have suggested a relationship between low circulating levels of Vitamin D and depression.", "evidence_relation": "supporting" }, { "cited_pmid": "20683115", "evidence_support": "Serum 25(OH) vitamin D was low (5 ng/mL) and serum parathyroid hormone level was high. After administration of oral vitamin D, muscle weakness improved and vitamin D level increased to 39.11 ng/mL.", "evidence_relation": "supporting" }, { "cited_pmid": "23727408", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "21939984", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Low vitamin D levels are associated with a range of adverse health outcomes, primarily affecting bone and muscle health.Deficiency in vitamin D impairs calcium absorption, leading to conditions such as osteomalacia, osteoporosis, and increased fracture risk due to weakened bones and muscle weakness [18852718, 22525842, 18020534]. In older adults, low vitamin D exacerbates osteopenia and osteoporosis, increasing the likelihood of falls and fractures [21824858, 16907998]. Beyond skeletal effects, low vitamin D status has been linked to various non-skeletal morbidities, including cardiovascular diseases, diabetes, and certain cancers, although the causal relationships remain uncertain [23609564, 22254030, 19897699]. Vitamin D deficiency is also prevalent among older adults, contributing to sarcopenia, characterized by the progressive loss of muscle mass and strength, which heightens the risk of falls and disability [31766576, 29963601]. Adequate vitamin D levels are crucial for maintaining bone density and muscle function, and supplementation is often necessary to achieve optimal health outcomes [22525842, 16907998, 17604580].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D levels are associated with a range of adverse health outcomes, primarily affecting bone and muscle health.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Deficiency in vitamin D impairs calcium absorption, leading to conditions such as osteomalacia, osteoporosis, and increased fracture risk due to weakened bones and muscle weakness [18852718, 22525842, 18020534].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18852718", "evidence_support": "Low serum vitamin D levels are common in the general population and cause a decline in calcium absorption, leading to low serum levels of ionized calcium, which in turn trigger the release of parathyroid hormone, promoting skeletal resorption and, eventually, bone loss or osteomalacia.", "evidence_relation": "supporting" }, { "cited_pmid": "22525842", "evidence_support": "Suboptimal vitamin D status contributes to many conditions, including osteomalacia/rickets, osteoporosis, falls, and fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "18020534", "evidence_support": "Vitamin D deficiency causes osteopenia, osteoporosis and osteomalacia, increasing the risk of fracture.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In older adults, low vitamin D exacerbates osteopenia and osteoporosis, increasing the likelihood of falls and fractures [21824858, 16907998].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21824858", "evidence_support": "vitamin D deficiency can cause growth retardation and skeletal deformities and may increase the risk of hip fracture later in life. Vitamin D deficiency in adults can exacerbate osteopenia and osteoporosis, cause osteomalacia and muscle weakness, and increase the risk of fracture. ", "evidence_relation": "supporting" }, { "cited_pmid": "16907998", "evidence_support": "Vitamin D deficiency causes osteopenia, precipitates and exacerbates osteoporosis, causes the painful bone disease osteomalacia, and increases muscle weakness, which worsens the risk of falls and fractures.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Beyond skeletal effects, low vitamin D status has been linked to various non-skeletal morbidities, including cardiovascular diseases, diabetes, and certain cancers, although the causal relationships remain uncertain [23609564, 22254030, 19897699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23609564", "evidence_support": "Vitamin D deficiency is associated with substantial increases in the incidence of hypertension, hyperlipidaemia, myocardial infarction and stroke, as well as in diseases such as chronic kidney disease and type 2 diabetes. ", "evidence_relation": "supporting" }, { "cited_pmid": "23609564", "evidence_support": "However, the role of vitamin D deficiency in cardiovascular morbidity and mortality is an emerging and hotly debated topic.", "evidence_relation": "supporting" }, { "cited_pmid": "22254030", "evidence_support": "Vitamin D deficiency/insufficiency has been associated with muscle weakness and a high incidence of various chronic diseases such as cardiovascular disease, cancer, multiple sclerosis, and type 1 and 2 diabetes. Most importantly, low vitamin D status has been found to be an independent predictor of all-cause mortality. ", "evidence_relation": "supporting" }, { "cited_pmid": "19897699", "evidence_support": "Low vitamin D levels are associated with increased overall and cardiovascular mortality, cancer incidence and mortality, and autoimmune diseases such as multiple sclerosis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Vitamin D deficiency is also prevalent among older adults, contributing to sarcopenia, characterized by the progressive loss of muscle mass and strength, which heightens the risk of falls and disability [31766576, 29963601].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31766576", "evidence_support": "Therefore, older people with vitamin D deficiency might be at risk of sarcopenia, a geriatric syndrome characterized by the progressive loss of skeletal muscle mass and strength often complicated by adverse events, such as falls, disability hospitalization and death. ", "evidence_relation": "supporting" }, { "cited_pmid": "29963601", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Adequate vitamin D levels are crucial for maintaining bone density and muscle function, and supplementation is often necessary to achieve optimal health outcomes [22525842, 16907998, 17604580].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "22525842", "evidence_support": "Low vitamin D status is extremely common worldwide due to low dietary intake and low skin production. Suboptimal vitamin D status contributes to many conditions, including osteomalacia/rickets, osteoporosis, falls, and fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "16907998", "evidence_support": "Vitamin D deficiency causes osteopenia, precipitates and exacerbates osteoporosis, causes the painful bone disease osteomalacia, and increases muscle weakness, which worsens the risk of falls and fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "17604580", "evidence_support": "Vitamin D deficiency causes osteopenia, precipitates and exacerbates osteoporosis, causes a painful disease, osteomalacia, and increases muscle weakness, which worsens the risk of falls and fractures", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Low vitamin D levels can lead to a range of health issues, primarily affecting bone health due to impaired calcium absorption.This deficiency can result in rickets in children, characterized by bone deformities, and osteomalacia in adults, leading to bone pain and muscle weakness.Additionally, low vitamin D is associated with an increased risk of osteoporosis, which heightens fracture risk.Beyond skeletal effects, vitamin D deficiency has been linked to a higher susceptibility to infections, autoimmune diseases, cardiovascular diseases, and certain cancers.It may also contribute to mood disorders such as depression.While the exact mechanisms are not fully understood, vitamin D's role in immune modulation and cellular growth regulation is critical.Monitoring and managing vitamin D levels through diet, supplementation, and sensible sun exposure are essential for overall health.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D levels can lead to a range of health issues, primarily affecting bone health due to impaired calcium absorption.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This deficiency can result in rickets in children, characterized by bone deformities, and osteomalacia in adults, leading to bone pain and muscle weakness.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, low vitamin D is associated with an increased risk of osteoporosis, which heightens fracture risk.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Beyond skeletal effects, vitamin D deficiency has been linked to a higher susceptibility to infections, autoimmune diseases, cardiovascular diseases, and certain cancers.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "It may also contribute to mood disorders such as depression.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "While the exact mechanisms are not fully understood, vitamin D's role in immune modulation and cellular growth regulation is critical.", "answer_sentence_relevance": "borderline", "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "Monitoring and managing vitamin D levels through diet, supplementation, and sensible sun exposure are essential for overall health.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Low vitamin D levels have been associated with various adverse health outcomes, including osteomalacia, osteoporosis, and increased risk of fractures [18852718, 22525842, 18020534]. Vitamin D deficiency can also lead to muscle weakness, increasing the risk of falls and fractures [18852718, 18020534, 17604580]. Furthermore, low vitamin D status has been linked to an increased risk of cardiovascular disease, hypertension, and type 2 diabetes [23609564, 22254030]. Additionally, vitamin D deficiency has been associated with impaired bone mineralization, reduced bone density, and secondary hyperparathyroidism [18852718, 24020640, 20511052]. It is essential to note that the definition of vitamin D deficiency and insufficiency is still a topic of debate, and more research is needed to establish a clear consensus [18852718, 22525842, 20511052]. Overall, maintaining adequate vitamin D levels is crucial for overall health, particularly for bone and muscle health.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D levels have been associated with various adverse health outcomes, including osteomalacia, osteoporosis, and increased risk of fractures [18852718, 22525842, 18020534].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18852718", "evidence_support": "Low serum vitamin D levels are common in the general population and cause a decline in calcium absorption, leading to low serum levels of ionized calcium, which in turn trigger the release of parathyroid hormone, promoting skeletal resorption and, eventually, bone loss or osteomalacia.", "evidence_relation": "supporting" }, { "cited_pmid": "22525842", "evidence_support": "Low vitamin D status is extremely common worldwide due to low dietary intake and low skin production. Suboptimal vitamin D status contributes to many conditions, including osteomalacia/rickets, osteoporosis, falls, and fractures. It is possible or even likely that low vitamin D status increases risk for a multitude of other conditions.", "evidence_relation": "supporting" }, { "cited_pmid": "18020534", "evidence_support": "Vitamin D deficiency causes osteopenia, osteoporosis and osteomalacia, increasing the risk of fracture.", "evidence_relation": "supporting" }, { "cited_pmid": "18020534", "evidence_support": "Vitamin D deficiency causes muscle weakness, increasing the risk of falls and fractures, and should be aggressively treated with pharmacological doses of vitamin D.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Vitamin D deficiency can also lead to muscle weakness, increasing the risk of falls and fractures [18852718, 18020534, 17604580].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18852718", "evidence_support": "Vitamin D is critical for calcium homeostasis. Following cutaneous synthesis or ingestion, vitamin D is metabolized to 25(OH)D and then to the active form 1,25(OH)2D. Low serum vitamin D levels are common in the general population and cause a decline in calcium absorption, leading to low serum levels of ionized calcium, which in turn trigger the release of parathyroid hormone, promoting skeletal resorption and, eventually, bone loss or osteomalacia. Vitamin D deficiency is generally defined as a serum 25(OH)D concentration <25-37 nmol/l (<10-15 ng/ml), but the definition of the milder state of vitamin D insufficiency is controversial. Three recent meta-analyses concluded that vitamin D must be administered in combination with calcium in order to substantially reduce the risk of nonvertebral fracture in adults over the age of 50 years. Fracture protection is optimal when patient adherence to medication exceeds 80% and vitamin D doses exceed 700 IU/day. In addition to disordered calcium homeostasis, low vitamin D levels might have effects on cell proliferation and differentiation and immune function.", "evidence_relation": "supporting" }, { "cited_pmid": "18020534", "evidence_support": "Vitamin D(3) (cholecalciferol) sufficiency is essential for maximising bone health. Vitamin D enhances intestinal absorption of calcium and phosphorus. The major source of vitamin D for both children and adults is exposure of the skin to sunlight. Season, latitude, skin pigmentation, sunscreen use, clothing and aging can dramatically influence the synthesis of vitamin D in the skin. Very few foods naturally contain vitamin D or are fortified with vitamin D. Serum 25-hydroxyvitamin D [25(OH)D; calcifediol] is the best measure of vitamin D status. Vitamin D deficiency [as defined by a serum 25(OH)D level of <50 nmol/L (<20 ng/mL)] is pandemic. This deficiency is very prevalent in osteoporotic patients. Vitamin D deficiency causes osteopenia, osteoporosis and osteomalacia, increasing the risk of fracture. Unlike osteoporosis, which is a painless disease, osteomalacia causes aching bone pain that is often misdiagnosed as fibromyalgia or chronic pain syndrome or is simply dismissed as depression. Vitamin D deficiency causes muscle weakness, increasing the risk of falls and fractures, and should be aggressively treated with pharmacological doses of vitamin D. Vitamin D sufficiency can be sustained by sensible sun exposure or ingesting at least 800-1000 IU of vitamin D(3) daily. Patients being treated for osteoporosis should be adequately supplemented with calcium and vitamin D to maximise the benefit of treatmen", "evidence_relation": "supporting" }, { "cited_pmid": "17604580", "evidence_support": "m and neuromuscular function. Vitamin D synthesis is a process in which the skin, liver, and kidney are sequentially involved. The vitamin D pool is completed by the amount taken with food and supplements. Vitamin D deficiency causes osteopenia, precipitates and exacerbates osteoporosis, causes a painful disease, osteomalacia, and increases muscle weakness, which worsens the risk of falls and fractures. A high prevalence of vitamin D insufficiency exists in the apparently healthy population, osteoporotic patients, and patients with prior fractures. Factors contributing to low vitamin D levels include low sunlight exposure, decreased skin synthesis and intestinal absorption, and inadequate diet. The simplest way to correct hypovitaminosis is adequate nutrition and supplements. However, few patients with osteoporosis and/or fractures, receive adequate supplements. Vitamin D insufficiency may alter the regulatory mechanisms of parathyroid hormone and may induce a secondary hyperparathyroidism that increases the risk of osteoporosis and fractures, although the necessary degree of this is not established. Monitoring of serum 25-hydroxyvitamin D levels is the only way to assess vitamin D status. The ideal healthy blood levels of 25-hydroxyvitamin D are controversial, although a range from 30 to 60ng/mL is widely accepted. The role of vitamin D supplementation is to provide humans with the nutrient in an amount closer to the biological norm for our species. This amount of vitamin D results in optimal function of many aspects of health, including balance", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Furthermore, low vitamin D status has been linked to an increased risk of cardiovascular disease, hypertension, and type 2 diabetes [23609564, 22254030].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23609564", "evidence_support": "Vitamin D deficiency is associated with substantial increases in the incidence of hypertension, hyperlipidaemia, myocardial infarction and stroke, as well as in diseases such as chronic kidney disease and type 2 diabetes.", "evidence_relation": "supporting" }, { "cited_pmid": "22254030", "evidence_support": "Vitamin D deficiency/insufficiency has been associated with muscle weakness and a high incidence of various chronic diseases such as cardiovascular disease, cancer, multiple sclerosis, and type 1 and 2 diabetes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, vitamin D deficiency has been associated with impaired bone mineralization, reduced bone density, and secondary hyperparathyroidism [18852718, 24020640, 20511052].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18852718", "evidence_support": "Low serum vitamin D levels are common in the general population and cause a decline in calcium absorption, leading to low serum levels of ionized calcium, which in turn trigger the release of parathyroid hormone, promoting skeletal resorption and, eventually, bone loss or osteomalacia.", "evidence_relation": "supporting" }, { "cited_pmid": "24020640", "evidence_support": "Epidemiological studies show that low vitamin D status is associated with a variety of negative skeletal consequences in older adults including osteomalacia, reduced bone mineral density, impaired Ca absorption and secondary hyperparathyroidism.", "evidence_relation": "supporting" }, { "cited_pmid": "20511052", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is essential to note that the definition of vitamin D deficiency and insufficiency is still a topic of debate, and more research is needed to establish a clear consensus [18852718, 22525842, 20511052].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "18852718", "evidence_support": "Vitamin D is critical for calcium homeostas", "evidence_relation": "neutral" }, { "cited_pmid": "18852718", "evidence_support": "Low serum vitamin D levels are common in the general population and cause a decline in calcium absorption, leading to low serum levels of ionized calcium, which in turn trigger the release of parathyroid hormone, promoting skeletal resorption and, eventually, bone loss or osteomalac", "evidence_relation": "neutral" }, { "cited_pmid": "18852718", "evidence_support": "Vitamin D deficiency is generally defined as a serum 25(OH)D concentration <25-37 nmol/l (<10-15 ng/ml), but the definition of the milder state of vitamin D insufficiency is controversial.", "evidence_relation": "supporting" }, { "cited_pmid": "20511052", "evidence_support": "Although controversy surrounds the definition of low vitamin D status, there is increasing agreement that the optimal circulating 25(OH)D level should be approximately 30 to 32 ng/mL or above.", "evidence_relation": "supporting" }, { "cited_pmid": "22525842", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, maintaining adequate vitamin D levels is crucial for overall health, particularly for bone and muscle health.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gemini-flash": { "answer": "Low vitamin D levels, also known as vitamin D deficiency, can have significant negative effects on overall health and well-being [16251641]. It can lead to various musculoskeletal problems, including rickets in children, osteopenia, osteoporosis, and fractures in adults [18400738, 11493580, 16251641]. Vitamin D deficiency also causes secondary hyperparathyroidism, which contributes to bone loss and mineralization defects [11493580, 16251641]. Additionally, low vitamin D levels can cause muscle weakness, increasing the risk of falls and fractures [16251641, 26529933]. Furthermore, vitamin D deficiency has been linked to an increased risk of various health issues, including type 1 diabetes, multiple sclerosis, rheumatoid arthritis, hypertension, cardiovascular heart disease, and certain cancers [16251641, 18400738]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D levels, also known as vitamin D deficiency, can have significant negative effects on overall health and well-being [16251641].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "16251641", "evidence_support": "In adults, vitamin D deficiency induces secondary hyperparathyroidism, which causes a loss of matrix and minerals, thus increasing the risk of osteoporosis and fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "16251641", "evidence_support": "Vitamin D deficiency also has other serious consequences on overall health and well-being.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can lead to various musculoskeletal problems, including rickets in children, osteopenia, osteoporosis, and fractures in adults [18400738, 11493580, 16251641].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18400738", "evidence_support": "Vitamin D deficiency causes rickets in children and will precipitate and exacerbate osteopenia, osteoporosis, and fractures in adults. ", "evidence_relation": "supporting" }, { "cited_pmid": "16251641", "evidence_support": "Vitamin D deficiency causes poor mineralization of the collagen matrix in young children's bones leading to growth retardation and bone deformities known as rickets. In adults, vitamin D deficiency induces secondary hyperparathyroidism, which causes a loss of matrix and minerals, thus increasing the risk of osteoporosis and fractures", "evidence_relation": "supporting" }, { "cited_pmid": "16251641", "evidence_support": "Vitamin D deficiency causes muscle weakness, increasing the risk of falling and fractures", "evidence_relation": "supporting" }, { "cited_pmid": "11493580", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Vitamin D deficiency also causes secondary hyperparathyroidism, which contributes to bone loss and mineralization defects [11493580, 16251641].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16251641", "evidence_support": "Vitamin D deficiency causes poor mineralization of the collagen matrix in young children's bones leading to growth retardation and bone deformities known as rickets", "evidence_relation": "supporting" }, { "cited_pmid": "16251641", "evidence_support": " In adults, vitamin D deficiency induces secondary hyperparathyroidism, which causes a loss of matrix and minerals, thus increasing the risk of osteoporosis and fractures. ", "evidence_relation": "supporting" }, { "cited_pmid": "11493580", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, low vitamin D levels can cause muscle weakness, increasing the risk of falls and fractures [16251641, 26529933].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16251641", "evidence_support": "Vitamin D deficiency causes muscle weakness, increasing the risk of falling and fractures. ", "evidence_relation": "supporting" }, { "cited_pmid": "26529933", "evidence_support": "Vitamin D insufficiency is related to low muscle strength, increasing body sway, falls in the elderly.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, vitamin D deficiency has been linked to an increased risk of various health issues, including type 1 diabetes, multiple sclerosis, rheumatoid arthritis, hypertension, cardiovascular heart disease, and certain cancers [16251641, 18400738].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16251641", "evidence_support": "Vitamin D deficiency also has other serious consequences on overall health and well-being. There is mounting scientific evidence that implicates vitamin D deficiency with an increased risk of type I diabetes, multiple sclerosis, rheumatoid arthritis, hypertension, cardiovascular heart disease, and many common deadly cancers. ", "evidence_relation": "supporting" }, { "cited_pmid": "18400738", "evidence_support": "Vitamin D deficiency has been associated with increased risk of common cancers, autoimmune diseases, hypertension, and infectious diseases.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Low vitamin D levels, also known as vitamin D deficiency, can have significant effects on various aspects of health [17117289, 20136908, 31906679]. In children, it can lead to rickets, a condition characterized by bone softening and deformities [17117289, 25247796]. In adults, vitamin D deficiency can contribute to osteoporosis, osteomalacia, and increased risk of fractures [17117289, 25247796, 11493580]. It also plays a crucial role in calcium homeostasis, affecting calcium absorption in the gut [20429045, 17682795, 33897181]. Vitamin D is essential for bone mineralization, muscle function, and coordination [20429045, 17682795]. Additionally, vitamin D deficiency can impact the immune system, muscle function, and renal health [22672742, 32925179, 26851346]. \n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D levels, also known as vitamin D deficiency, can have significant effects on various aspects of health [17117289, 20136908, 31906679].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17117289", "evidence_support": "Vitamin D deficiency not only causes rickets among children but also precipitates and exacerbates osteoporosis among adults and causes the painful bone disease osteomalacia", "evidence_relation": "supporting" }, { "cited_pmid": "17117289", "evidence_support": "Vitamin D deficiency has been associated with increased risk for other morbidities such as cardiovascular disease, type 1 and type 2 diabetes mellitus and cancer, especially of the colon and prostate.", "evidence_relation": "supporting" }, { "cited_pmid": "31906679", "evidence_support": "Its deficit is widespread in the human population worldwide and has a\u00a0significant impact on the prevalence of metabolic bone diseases. Its deficiency may support the dysfunction of many other body systems.", "evidence_relation": "supporting" }, { "cited_pmid": "20136908", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In children, it can lead to rickets, a condition characterized by bone softening and deformities [17117289, 25247796].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17117289", "evidence_support": "Vitamin D deficiency not only causes rickets among children but also precipitates and exacerbates osteoporosis among adults and causes the painful bone disease osteomalacia.", "evidence_relation": "supporting" }, { "cited_pmid": "25247796", "evidence_support": "Vitamin D deficiency may result in bone diseases, such as rickets in children and osteomalacia and osteoporosis in adults.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In adults, vitamin D deficiency can contribute to osteoporosis, osteomalacia, and increased risk of fractures [17117289, 25247796, 11493580].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17117289", "evidence_support": "Vitamin D deficiency not only causes rickets among children but also precipitates and exacerbates osteoporosis among adults and causes the painful bone disease osteomalacia.", "evidence_relation": "supporting" }, { "cited_pmid": "25247796", "evidence_support": "Vitamin D deficiency may result in bone diseases, such as rickets in children and osteomalacia and osteoporosis in adults.", "evidence_relation": "supporting" }, { "cited_pmid": "11493580", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It also plays a crucial role in calcium homeostasis, affecting calcium absorption in the gut [20429045, 17682795, 33897181].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20429045", "evidence_support": "The main role for vitamin D is calcium homeostasis, and low levels of vitamin D result in lower gastrointestinal absorption of calcium. ", "evidence_relation": "supporting" }, { "cited_pmid": "17682795", "evidence_support": "Vitamin D is essential for intestinal calcium absorption, bone mineralisation and plays an important role in neuromuscular functions. ", "evidence_relation": "supporting" }, { "cited_pmid": "33897181", "evidence_support": "Vitamin D has been shown to play a vital role in bone mineral homeostasis by stimulating the intestinal absorption of calcium and phosphate. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Vitamin D is essential for bone mineralization, muscle function, and coordination [20429045, 17682795].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "20429045", "evidence_support": " Vitamin D is also critical for mineralization of bone tissue, muscle function, and coordination. ", "evidence_relation": "supporting" }, { "cited_pmid": "17682795", "evidence_support": "Vitamin D is essential for intestinal calcium absorption, bone mineralisation and plays an important role in neuromuscular functions.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Additionally, vitamin D deficiency can impact the immune system, muscle function, and renal health [22672742, 32925179, 26851346].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "22672742", "evidence_support": "Vitamin D has important roles both in the autoimmune response and in skeletal muscles.", "evidence_relation": "supporting" }, { "cited_pmid": "22672742", "evidence_support": "As vitamin D has beneficial effects on the autoimmune response and on fatigue score in patients with MG, we suggest monitoring this parameter in patients with MG and supplementation with vitamin D3 when 25(OH)D levels are low.", "evidence_relation": "supporting" }, { "cited_pmid": "26851346", "evidence_support": "Vitamin D plays an important role in renal (patho)physiology.", "evidence_relation": "neutral" }, { "cited_pmid": "26851346", "evidence_support": "This study demonstrates that 1,25-vitamin D3 deficiency directly leads to renal injury in rodents.", "evidence_relation": "supporting" }, { "cited_pmid": "32925179", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Low vitamin D levels can significantly impact health, leading to various conditions. It is associated with an increased risk of hypertension, cardiovascular diseases, and metabolic disorders such as type 2 diabetes [23609564, 25400681]. Additionally, vitamin D deficiency can exacerbate bone health issues, causing osteopenia, osteoporosis, and osteomalacia, which increases the risk of fractures [21824858, 22870413]. Beyond skeletal health, low vitamin D levels may contribute to immune dysfunction and have been linked to autoimmune diseases and psychiatric conditions, including depression and Alzheimer's disease [28786260, 22796576]. Furthermore, it can lead to muscle weakness and has been implicated in respiratory issues like asthma [21824858, 24729717]. 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Vitamin D deficiency in adults can exacerbate osteopenia and osteoporosis, cause osteomalacia and muscle weakness, and increase the risk of fracture.", "evidence_relation": "supporting" }, { "cited_pmid": "22870413", "evidence_support": "The deficiency of vitamin D can lead to rickets in children and osteomalacia in adults", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Beyond skeletal health, low vitamin D levels may contribute to immune dysfunction and have been linked to autoimmune diseases and psychiatric conditions, including depression and Alzheimer's disease [28786260, 22796576].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28786260", "evidence_support": "It should not be underestimated, not only due to the well-known consequences vitamin D deficiency has on bone health, but primarily because recent studies have shown how the biologically active form of vitamin D - 1,25(OH)2D - is involved in many biological processes, including immune system modulation.", "evidence_relation": "supporting" }, { "cited_pmid": "28786260", "evidence_support": "This finding led to a proposed link between vitamin D deficiency and autoimmune diseases.", "evidence_relation": "supporting" }, { "cited_pmid": "22796576", "evidence_support": "Increasingly vitamin D deficiency is being associated with a number of psychiatric conditions.", "evidence_relation": "supporting" }, { "cited_pmid": "22796576", "evidence_support": "More recently epidemiological associations have been made between low vitamin D and psychiatric disorders not typically associated with abnormalities in brain development such as depression and Alzheimer's disease.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, it can lead to muscle weakness and has been implicated in respiratory issues like asthma [21824858, 24729717].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21824858", "evidence_support": "Vitamin D deficiency in adults can exacerbate osteopenia and osteoporosis, cause osteomalacia and muscle weakness, and increase the risk of fracture.", "evidence_relation": "supporting" }, { "cited_pmid": "24729717", "evidence_support": "In the last decade, many epidemiologic studies have investigated the link between vitamin D deficiency and asthma. Most studies have shown that vitamin D deficiency increases the risk of asthma and allergies. Low levels of vitamin D have been associated with asthma severity and loss of control, together with recurrent exacerbations.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, maintaining adequate vitamin D levels is crucial for both bone and overall health.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Low vitamin D levels can significantly impact health, leading to various bone-related diseases. In adults, vitamin D deficiency can exacerbate osteopenia and osteoporosis, cause osteomalacia, and increase the risk of fractures and muscle weakness [21824858, 16907998]. In children, it can result in growth retardation and skeletal deformities, increasing the risk of hip fractures later in life [21824858]. Additionally, low vitamin D is associated with a higher risk of falls, cardiovascular diseases, diabetes mellitus, and autoimmune disorders [30341848, 15585788]. Overall, vitamin D deficiency not only affects bone health but is also linked to serious health conditions, including certain cancers and multiple sclerosis [16251641, 15585788]. Therefore, maintaining adequate vitamin D levels is crucial for overall health and well-being.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D levels can significantly impact health, leading to various bone-related diseases.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "In adults, vitamin D deficiency can exacerbate osteopenia and osteoporosis, cause osteomalacia, and increase the risk of fractures and muscle weakness [21824858, 16907998].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21824858", "evidence_support": "Vitamin D deficiency in adults can exacerbate osteopenia and osteoporosis, cause osteomalacia and muscle weakness, and increase the risk of fracture.", "evidence_relation": "supporting" }, { "cited_pmid": "16907998", "evidence_support": "Vitamin D deficiency causes osteopenia, precipitates and exacerbates osteoporosis, causes the painful bone disease osteomalacia, and increases muscle weakness, which worsens the risk of falls and fractures.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In children, it can result in growth retardation and skeletal deformities, increasing the risk of hip fractures later in life [21824858].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21824858", "evidence_support": "In utero and during childhood, vitamin D deficiency can cause growth retardation and skeletal deformities and may increase the risk of hip fracture later in life.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, low vitamin D is associated with a higher risk of falls, cardiovascular diseases, diabetes mellitus, and autoimmune disorders [30341848, 15585788].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30341848", "evidence_support": "Literature evidences show that low vitamin D levels are also related with increased risk of falls, fractures, muscle pain, muscle weakness, cardiovascular risk, diabetes mellitus, polycystic ovary syndrome (PCOS), infections, and autoimmune disorders also. Adequate intake of vitamin D is necessary for all individuals of any age group. Sunlight exposure, food fortification and routine supplementation can only fulfill the deficiency of vitamin D. This review article emphasizes on the prevalence of vitamin D deficiency, potential implications, and effect of supplementation on cardiovascular disease, diabetes mellitus, polycystic ovary syndrome (PCOS), autoimmune disorders, sleep disturbance and pain.", "evidence_relation": "supporting" }, { "cited_pmid": "15585788", "evidence_support": "Vitamin D deficiency not only causes rickets among children but also precipitates and exacerbates osteoporosis among adults and causes the painful bone disease osteomalacia. Vitamin D deficiency has been associated with increased risks of deadly cancers, cardiovascular disease, multiple sclerosis, rheumatoid arthritis, and type 1 diabetes mellitus.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Overall, vitamin D deficiency not only affects bone health but is also linked to serious health conditions, including certain cancers and multiple sclerosis [16251641, 15585788].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16251641", "evidence_support": "Vitamin D deficiency causes muscle weakness, increasing the risk of falling and fractures. Vitamin D deficiency also has other serious consequences on overall health and well-being.", "evidence_relation": "supporting" }, { "cited_pmid": "16251641", "evidence_support": "There is mounting scientific evidence that implicates vitamin D deficiency with an increased risk of type I diabetes, multiple sclerosis, rheumatoid arthritis, hypertension, cardiovascular heart disease, and many common deadly cancers.", "evidence_relation": "supporting" }, { "cited_pmid": "15585788", "evidence_support": "Vitamin D deficiency not only causes rickets among children but also precipitates and exacerbates osteoporosis among adults and causes the painful bone disease osteomalacia. Vitamin D deficiency has been associated with increased risks of deadly cancers, cardiovascular disease, multiple sclerosis, rheumatoid arthritis, and type 1 diabetes mellitus.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Therefore, maintaining adequate vitamin D levels is crucial for overall health and well-being.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-1": { "answer": "Vitamin D deficiency affects musculoskeletal health and is associated with osteoporosis, obesity, hypertension, diabetes, and cardiovascular disease (CVD) [19142273,37233176,31708871,21432355,23776856,28724169].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Vitamin D deficiency affects musculoskeletal health and is associated with osteoporosis, obesity, hypertension, diabetes, and cardiovascular disease (CVD) [19142273,37233176,31708871,21432355,23776856,28724169].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19142273", "evidence_support": "Vitamin D status affects musculoskeletal health.", "evidence_relation": "supporting" }, { "cited_pmid": "19142273", "evidence_support": "More recently, the nonmusculoskeletal actions of vitamin D have become increasingly documented including endocrine effect on kidneys and intestine, local autocrine effects on cell differentiation, proliferation and immune modulation, and cell membrane effects including promotion of the intestinal absorption of calcium and the secretion of insulin.", "evidence_relation": "supporting" }, { "cited_pmid": "37233176", "evidence_support": "Vitamin D deficiency in metabolic disorders has primary effects on osteoporosis, obesity, hypertension, diabetes, and cardiovascular disease (CVD).", "evidence_relation": "supporting" }, { "cited_pmid": "31708871", "evidence_support": "Vitamin D has a long-established role in bone health. In the last two decades, there has been a dramatic resurgence in research interest in vitamin D due to studies that have shown its possible benefits for non-skeletal health.", "evidence_relation": "supporting" }, { "cited_pmid": "21432355", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "23776856", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "28724169", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "webis-2": { "answer": "Vitamin D deficiency can lead to various health problems, such as osteoporosis, obesity, hypertension, diabetes, and cardiovascular disease (CVD) [37233176]. It also affects musculoskeletal health [19142273].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Vitamin D deficiency can lead to various health problems, such as osteoporosis, obesity, hypertension, diabetes, and cardiovascular disease (CVD) [37233176].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37233176", "evidence_support": "Vitamin D deficiency in metabolic disorders has primary effects on osteoporosis, obesity, hypertension, diabetes, and cardiovascular disease (CVD).", "evidence_relation": "supporting" }, { "cited_pmid": "37233176", "evidence_support": "Vitamin D insufficiency increases the risk of diabetes because it lowers insulin sensitivity, and also raises the risk of obesity and CVD because of its effect on the body's lipid profile, particularly in terms of the prevalence of dangerously high levels of low-density lipoproteins (LDL).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It also affects musculoskeletal health [19142273].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19142273", "evidence_support": "Vitamin D status affects musculoskeletal health. ", "evidence_relation": "supporting" } ] } ] }, "webis-3": { "answer": "Vitamin D deficiency is a major public health problem worldwide in all age groups, even in those residing in countries with low latitude [24239505]. It can affect various physiological systems beyond bone remodeling [20948470]. However, most countries are still lacking data, particularly population representative data, with very limited information in infants, children, adolescents, and pregnant women [24239505].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Vitamin D deficiency is a major public health problem worldwide in all age groups, even in those residing in countries with low latitude [24239505].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24239505", "evidence_support": "Vitamin D deficiency is a major public health problem worldwide in all age groups, even in those residing in countries with low latitude, where it was generally assumed that UV radiation was adequate enough to prevent this deficiency, and in industrialized countries, where vitamin D fortification has been implemented now for years.", "evidence_relation": "supporting" }, { "cited_pmid": "24239505", "evidence_support": "In conclusion, vitamin D deficiency is a global public health problem in all age groups, particularly in those from the Middle East.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can affect various physiological systems beyond bone remodeling [20948470].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20948470", "evidence_support": "Also considered are which physiological systems vitamin D affects in addition to bone remodelling, as well as the latest findings as to how this vitamin can benefit the body.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, most countries are still lacking data, particularly population representative data, with very limited information in infants, children, adolescents, and pregnant women [24239505].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24239505", "evidence_support": " However, most countries are still lacking data, particularly population representative data, with very limited information in infants, children, adolescents and pregnant women. ", "evidence_relation": "supporting" }, { "cited_pmid": "24239505", "evidence_support": "There is striking lack of data in infants, children and adolescents worldwide", "evidence_relation": "supporting" } ] } ] }, "webis-5": { "answer": "Vitamin D deficiency is a major public health problem worldwide in all age groups, even in those residing in countries with low latitude [24239505]. It can affect various physiological systems beyond bone remodeling [20948470]. However, most countries are still lacking data, particularly population representative data, with very limited information in infants, children, adolescents, and pregnant women [24239505].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Vitamin D deficiency is a major public health problem worldwide in all age groups, even in those residing in countries with low latitude [24239505].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "24239505", "evidence_support": "Vitamin D deficiency is a major public health problem worldwide in all age groups, even in those residing in countries with low latitude, where it was generally assumed that UV radiation was adequate enough to prevent this deficiency, and in industrialized countries, where vitamin D fortification has been implemented now for years. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can affect various physiological systems beyond bone remodeling [20948470].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20948470", "evidence_support": "Also considered are which physiological systems vitamin D affects in addition to bone remodelling, as well as the latest findings as to how this vitamin can benefit the body.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, most countries are still lacking data, particularly population representative data, with very limited information in infants, children, adolescents, and pregnant women [24239505].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24239505", "evidence_support": "However, most countries are still lacking data, particularly population representative data, with very limited information in infants, children, adolescents and pregnant women.", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-1": { "answer": "Low vitamin D levels can lead to a variety of health issues, including weakened bones due to decreased calcium absorption, increased risk of fractures, and potential development of conditions such as osteoporosis. Additionally, low vitamin D may be associated with immune dysfunction, increased risk of chronic diseases, and mood disorders.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D levels can lead to a variety of health issues, including weakened bones due to decreased calcium absorption, increased risk of fractures, and potential development of conditions such as osteoporosis.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, low vitamin D may be associated with immune dysfunction, increased risk of chronic diseases, and mood disorders.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "Low vitamin D levels can lead to several adverse health effects, including increased risk of diabetes due to lowered insulin sensitivity, obesity, and cardiovascular disease due to negative impacts on lipid profiles, particularly elevated LDL levels [37233176]. Additionally, vitamin D deficiency is associated with metabolic disorders such as osteoporosis, hypertension, and may also heighten the risk of infections and autoimmune diseases [22525442].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D levels can lead to several adverse health effects, including increased risk of diabetes due to lowered insulin sensitivity, obesity, and cardiovascular disease due to negative impacts on lipid profiles, particularly elevated LDL levels [37233176].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37233176", "evidence_support": "Vitamin D deficiency in metabolic disorders has primary effects on osteoporosis, obesity, hypertension, diabetes, and cardiovascular disease (CVD).", "evidence_relation": "supporting" }, { "cited_pmid": "37233176", "evidence_support": "Vitamin D insufficiency increases the risk of diabetes because it lowers insulin sensitivity, and also raises the risk of obesity and CVD because of its effect on the body's lipid profile, particularly in terms of the prevalence of dangerously high levels of low-density lipoproteins (LDL).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, vitamin D deficiency is associated with metabolic disorders such as osteoporosis, hypertension, and may also heighten the risk of infections and autoimmune diseases [22525442].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22525442", "evidence_support": "Recent data support the theory that vitamin D deficiency in adults and children may increase the risk of infections and auto-immune diseases.", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-6": { "answer": "Low vitamin D levels can negatively impact various health parameters, including reproductive health and neonatal growth. Specifically, low vitamin D may affect endometrial thickness and follicle growth in infertile women, as well as influence neonatal growth parameters and the prevalence of vitamin D deficiency in newborns, which is associated with maternal vitamin D status [29526131,25800497,30027298].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D levels can negatively impact various health parameters, including reproductive health and neonatal growth.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Specifically, low vitamin D may affect endometrial thickness and follicle growth in infertile women, as well as influence neonatal growth parameters and the prevalence of vitamin D deficiency in newborns, which is associated with maternal vitamin D status [29526131,25800497,30027298].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29526131", "evidence_support": "The results showed that a correlation exists between endometrial thickness as well as the number of antral follicles and replete level of Vitamin D.", "evidence_relation": "supporting" }, { "cited_pmid": "25800497", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "30027298", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "zero-shot-gemini-flash": { "answer": "Low vitamin D levels can have a significant impact on your health. [25247796, 25207384] Vitamin D deficiency can lead to bone diseases such as rickets in children and osteomalacia and osteoporosis in adults. [25247796] Osteoporosis is characterized by a loss of bone mass, weakened bone structure, and increased risk of fractures. [25247796] It can also cause secondary hyperparathyroidism, high bone turnover, bone loss, and mineralization defects. [11493580] Low vitamin D levels are associated with low muscle strength, increased body sway, and falls in the elderly. [26529933] Other less certain consequences include myopathy and falls. [11493580] Vitamin D deficiency can also cause musculoskeletal symptoms such as low back pain, muscle weakness, muscle aches, and bone pain. [19835345, 27221206] In addition to its effects on bones and muscles, vitamin D deficiency can also affect other body systems. [31906679] It has been linked to increased morbidity and mortality in the general population and in critically ill patients. [23134762] \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D levels can have a significant impact on your health.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "[25247796, 25207384] Vitamin D deficiency can lead to bone diseases such as rickets in children and osteomalacia and osteoporosis in adults.", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25247796", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "25207384", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Osteoporosis is characterized by a loss of bone mass, weakened bone structure, and increased risk of fractures.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "It can also cause secondary hyperparathyroidism, high bone turnover, bone loss, and mineralization defects.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Low vitamin D levels are associated with low muscle strength, increased body sway, and falls in the elderly.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Other less certain consequences include myopathy and falls.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "[11493580] Vitamin D deficiency can also cause musculoskeletal symptoms such as low back pain, muscle weakness, muscle aches, and bone pain.", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "11493580", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "8", "answer_sentence": "In addition to its effects on bones and muscles, vitamin D deficiency can also affect other body systems.", "answer_sentence_relevance": "borderline", "citation_assessment": null }, { "answer_sentence_id": "9", "answer_sentence": "It has been linked to increased morbidity and mortality in the general population and in critically ill patients.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "zero-shot-gpt4o-mini": { "answer": "Low vitamin D levels can lead to a range of serious health issues. In children, it causes rickets, while in adults, it can precipitate osteomalacia and exacerbate osteoporosis, increasing the risk of fractures [18400738, 25247796]. Vitamin D deficiency is also linked to various non-skeletal morbidities, including cardiovascular diseases, autoimmune disorders, and certain cancers, particularly of the colon and prostate [17117289, 30560516]. Additionally, it can result in muscle weakness, which raises the risk of falls and further injuries [16251641, 18237070]. The widespread nature of vitamin D deficiency poses significant public health concerns due to its negative impact on both musculoskeletal and extra-skeletal health [32486496, 37242420]. Addressing this deficiency through supplementation can help mitigate these risks [26529933].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Low vitamin D levels can lead to a range of serious health issues.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "In children, it causes rickets, while in adults, it can precipitate osteomalacia and exacerbate osteoporosis, increasing the risk of fractures [18400738, 25247796].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18400738", "evidence_support": "Vitamin D deficiency causes rickets in children and will precipitate and exacerbate osteopenia, osteoporosis, and fractures in adults.", "evidence_relation": "supporting" }, { "cited_pmid": "25247796", "evidence_support": "Vitamin D deficiency may result in bone diseases, such as rickets in children and osteomalacia and osteoporosis in adults.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Vitamin D deficiency is also linked to various non-skeletal morbidities, including cardiovascular diseases, autoimmune disorders, and certain cancers, particularly of the colon and prostate [17117289, 30560516].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17117289", "evidence_support": "osteomalacia. Vitamin D deficiency has been associated with increased risk for other morbidities such as cardiovascular disease, type 1 and type 2 diabetes mellitus and cancer, especially of the colon and prostate.", "evidence_relation": "supporting" }, { "cited_pmid": "30560516", "evidence_support": "Deficiency of vitamin D is a global concern affecting a huge number of human populations. This deficiency has a serious impact on human health not only affecting bone mineral density but also becoming the reason for cardiovascular disorders, infectious diseases, autoimmune diseases and cancers.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, it can result in muscle weakness, which raises the risk of falls and further injuries [16251641, 18237070].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16251641", "evidence_support": "Vitamin D deficiency causes muscle weakness, increasing the risk of falling and fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "18237070", "evidence_support": "Only recently, the medical community has begun to appreciate that low vitamin D status underlies multiple deleterious health consequences including skeletal fragility, muscle weakness, and a potential multitude of non-skeletal morbidities.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The widespread nature of vitamin D deficiency poses significant public health concerns due to its negative impact on both musculoskeletal and extra-skeletal health [32486496, 37242420].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32486496", "evidence_support": "Vitamin D deficiency is a global health problem due to its high prevalence and its negative consequences on musculoskeletal and extra-skeletal health.", "evidence_relation": "supporting" }, { "cited_pmid": "37242420", "evidence_support": "Vitamin D deficiency is a constantly growing health problem worldwide. Adults affected with hypovitaminosis D could experience negative consequences on their musculoskeletal system and extra-skeletal health.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Addressing this deficiency through supplementation can help mitigate these risks [26529933].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "26529933", "evidence_support": "Supplementation with vitamin D reduces risk of osteoporotic fracture, and improves muscle strength and postural balance to prevent the elderly from fall.", "evidence_relation": "supporting" } ] } ] } } }, { "question_id": "133", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Ovarian cyst surgery can have varying short and long-term effects, particularly concerning fertility. Women with polycystic ovary syndrome (PCOS), who may undergo surgery for ovarian cysts, are at an increased risk of developing metabolic abnormalities, such as hypertension, dyslipidaemia, and obesity, which are associated with a higher risk of cardiovascular disease over the long term. These factors need to be carefully managed post-surgery to mitigate further health risks [15380148]. Moreover, the mental state and anxiety levels of patients can also be affected by the surgery and its aftermath, especially when patients are isolated for recovery. Anxiety and agitation may increase, particularly in patients with a history of mental illness, although most patients do not find the isolation rituals disconcerting.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Ovarian cyst surgery can have varying short and long-term effects, particularly concerning fertility.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Women with polycystic ovary syndrome (PCOS), who may undergo surgery for ovarian cysts, are at an increased risk of developing metabolic abnormalities, such as hypertension, dyslipidaemia, and obesity, which are associated with a higher risk of cardiovascular disease over the long term.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "These factors need to be carefully managed post-surgery to mitigate further health risks [15380148].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "15380148", "evidence_support": "An increased prevalence of hypertension, dyslipidaemia, obesity and hyperinsulinaemia, as well as changes in coagulation and blood vessel function, provide an explanation as to why women with PCOS are at an increased risk of developing cardiovascular disease over the long term.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Moreover, the mental state and anxiety levels of patients can also be affected by the surgery and its aftermath, especially when patients are isolated for recovery.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Anxiety and agitation may increase, particularly in patients with a history of mental illness, although most patients do not find the isolation rituals disconcerting.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Ovarian cystectomy can reduce ovarian reserve both short-term and long-term, with Anti-M\u00fcllerian hormone (AMH) levels decreasing post-surgery [28089684, 29806554, 23368705]. Although ovarian reserve shows some recovery six months after surgery, the reduction in markers of ovarian reserve can persist [31824636, 30906458, 24678485]. Laparoscopic stripping cystectomy is preferable for managing endometriomas due to lower recurrence and improved fertility outcomes [34693862, 27436368, 19249702]. However, endometrioma surgery by stripping can reduce ovarian reserve immediately and over time, and multiple surgeries increase the risk of ovarian insufficiency [23768623, 31824636, 19249702]. Patients should be counseled on the risks to reproductive potential, and surgical management should be individualized based on symptoms and reproductive goals [28089684, 34693862, 24858999]. Monitoring ovarian reserve long-term is crucial post-surgery, as ovarian insufficiency can onset long after cystectomy [26420658, 23768623, 24858999]. While AMH reduction post-surgery does not significantly affect pregnancy rates, pre-operative assessment of ovarian reserve is useful [27436368, 27028572, 29724140]. Sclerotherapy and plasma vaporization are alternatives that preserve ovarian parenchyma, and mucinous cyst resection does not damage ovarian reserve [34693862, 24559614, 24902013].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Ovarian cystectomy can reduce ovarian reserve both short-term and long-term, with Anti-M\u00fcllerian hormone (AMH) levels decreasing post-surgery [28089684, 29806554, 23368705].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28089684", "evidence_support": "There has been an emerging concern about the effect of ovarian cystectomy on ovarian reserve with some evidence of short-term and long-term reduction in ovarian reserve.", "evidence_relation": "supporting" }, { "cited_pmid": "28089684", "evidence_support": "The impact of surgery on ovarian reserve can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, and limited use of electrosurgery.", "evidence_relation": "supporting" }, { "cited_pmid": "29806554", "evidence_support": "Our data showed a significant decrease in anti-M\u00fcllerian hormone levels after surgery on the ovaries. If this results in a long-term reduced ovarian reserve or is merely a short-term reaction to the procedure needs to be clarified.", "evidence_relation": "supporting" }, { "cited_pmid": "23368705", "evidence_support": "We found a nonstatistically significant decreases in serum AMH levels after surgical excision of the cysts. Our results suggest that an appropriate surgical technique, without the use of the bipolar coagulation of ovarian border, does not determine a significant reduction of ovarian reserve.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Although ovarian reserve shows some recovery six months after surgery, the reduction in markers of ovarian reserve can persist [31824636, 30906458, 24678485].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31824636", "evidence_support": "Multiple well-designed studies consistently demonstrate that surgical excision of endometrioma is associated with a decline in the ovarian reserve. Recent studies with long term follow up suggest some recovery in the markers of ovarian reserve, but they almost never reach preoperative levels.", "evidence_relation": "supporting" }, { "cited_pmid": "30906458", "evidence_support": "In terms of postoperative ovarian reserve, the levels of E2 and AMH slightly decreased while the FSH level slightly increased in the suture group at both 1 and 6 months after surgery.", "evidence_relation": "neutral" }, { "cited_pmid": "30906458", "evidence_support": "In the electrocoagulation group, however, the levels of E2 and AMH decreased significantly while the FSH level increased significantly at 1 month after surgery. Six months after surgery, these levels all returned slightly showing some recovery of ovarian reserve.", "evidence_relation": "supporting" }, { "cited_pmid": "24678485", "evidence_support": "Median level of serum AMH was significantly decreased", "evidence_relation": "neutral" }, { "cited_pmid": "24678485", "evidence_support": "On the other hand, no significant differences in FSH, E2, AFC and ovarian volumes were found between the preoperative and three months postoperative levels.", "evidence_relation": "contradicting" }, { "cited_pmid": "24678485", "evidence_support": "Serum AMH levels were significantly decreased after laparoscopic cystectomy without any changes of other ovarian reserve tests.", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Laparoscopic stripping cystectomy is preferable for managing endometriomas due to lower recurrence and improved fertility outcomes [34693862, 27436368, 19249702].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "34693862", "evidence_support": "Evidence suggests that laparoscopic ovarian cystectomy via stripping is the preferable surgical technique for management of endometrioma, compared with excisional/ablative techniques, in the fields of pain improvement, spontaneous pregnancy rates, and ovarian cyst recurrences.", "evidence_relation": "supporting" }, { "cited_pmid": "27436368", "evidence_support": "The aim of the present study was to determine the long-term effects of different laparoscopic hemostatic techniques on ovarian reserve after ovarian cystectomy.", "evidence_relation": "supporting" }, { "cited_pmid": "19249702", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, endometrioma surgery by stripping can reduce ovarian reserve immediately and over time, and multiple surgeries increase the risk of ovarian insufficiency [23768623, 31824636, 19249702].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23768623", "evidence_support": "Endometrioma surgery by stripping the cyst capsule has been associated with a reduction in ovarian reserve.", "evidence_relation": "supporting" }, { "cited_pmid": "23768623", "evidence_support": "Endometrioma surgery by stripping of the cyst capsule is associated with a significant reduction in ovarian reserve. The reduction is immediate and sustained over time.", "evidence_relation": "supporting" }, { "cited_pmid": "31824636", "evidence_support": "Multiple well-designed studies consistently demonstrate that surgical excision of endometrioma is associated with a decline in the ovarian reserve.", "evidence_relation": "supporting" }, { "cited_pmid": "19249702", "evidence_support": "In fact, an increase in premature ovarian failure rate was reported when both the ovaries are involved in surgery.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Patients should be counseled on the risks to reproductive potential, and surgical management should be individualized based on symptoms and reproductive goals [28089684, 34693862, 24858999].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28089684", "evidence_support": "Patients should be counseled on the risks of surgery on reproductive potential, and the management plan should be individualized to the patient's symptoms and reproductive goals.", "evidence_relation": "supporting" }, { "cited_pmid": "34693862", "evidence_support": "Patients should be counselled about the risks of surgery and the management plan should be individualised to patient's symptoms and reproductive goals.", "evidence_relation": "supporting" }, { "cited_pmid": "24858999", "evidence_support": "It is particularly important to monitor ovarian reserve long-term for patients who wish to conceive in the future and to suggest a variety of infertility treatments appropriate for their ovarian reserve.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Monitoring ovarian reserve long-term is crucial post-surgery, as ovarian insufficiency can onset long after cystectomy [26420658, 23768623, 24858999].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "26420658", "evidence_support": "AMH levels temporarily decreased after laparoscopic cystectomy for ovarian endometriomas, with complete recovery of preoperative AMH values at 12\u2009months postoperatively.", "evidence_relation": "supporting" }, { "cited_pmid": "26420658", "evidence_support": "Patients with bilateral cysts have higher rates of decline of AMH levels compared to patients with unilateral affection.", "evidence_relation": "neutral" }, { "cited_pmid": "23768623", "evidence_support": "Endometrioma surgery by stripping of the cyst capsule is associated with a significant reduction in ovarian reserve.", "evidence_relation": "supporting" }, { "cited_pmid": "23768623", "evidence_support": "The reduction is immediate and sustained over time.", "evidence_relation": "neutral" }, { "cited_pmid": "24858999", "evidence_support": "We found that cystectomy of endometriotic cysts is the potential risk factor for ovarian insufficiency after surgery, at times, the onset of ovarian insufficiency long after cystectomy. Therefore, it is important to monitor ovarian reserve for an extended period of time after ovarian surgery.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "While AMH reduction post-surgery does not significantly affect pregnancy rates, pre-operative assessment of ovarian reserve is useful [27436368, 27028572, 29724140].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27436368", "evidence_support": "Serum levels of anti-M\u00fcllerian hormone (AMH) were determined preoperatively and postoperatively at 1, 3, and 12 months, and patients were evaluated for residual ovarian volume, antral follicle count, and pregnancy.", "evidence_relation": "neutral" }, { "cited_pmid": "27436368", "evidence_support": "In addition, in the hemostatic suture group, there was no statistically significant difference between preoperative and postoperative AMH levels ( P = .165) and between the postoperative antral follicle count ( P = .779) and the residual ovarian volume ( P = .248), whereas in the bipolar electrocoagulation group, postoperative AMH levels were lower than preoperative levels ( P = .028) and postoperative residual ovarian volumes at 3 and 12 months were lower than those at 1 month ( P = .001). Nonetheless, pregnancy rates were not significantly different ( P = .546). ", "evidence_relation": "supporting" }, { "cited_pmid": "27028572", "evidence_support": "Data reported herein demonstrate that the AMH reduction following ovarian cyst surgery is maintained two years after surgery; however, the postoperative AMH decrease that follows ovarian cyst surgery might not reduce the chances to achieve pregnancy.", "evidence_relation": "supporting" }, { "cited_pmid": "29724140", "evidence_support": "There was no statistically significant difference in AMH serum levels between pregnant and non-pregnant women, neither before nor after surgery. AMH did not appear to have a predictive role on reproductive outcome.", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Sclerotherapy and plasma vaporization are alternatives that preserve ovarian parenchyma, and mucinous cyst resection does not damage ovarian reserve [34693862, 24559614, 24902013].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24559614", "evidence_support": "Besides excision, sclerotherapy and plasma vaporization are promising, offering a greater preservation of the ovarian parenchyma, especially in endometriomas.", "evidence_relation": "supporting" }, { "cited_pmid": "24902013", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "34693862", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Surgical intervention for ovarian cysts, particularly cystectomy, can significantly impact ovarian reserve both short and long term.Postoperative reductions in anti-M\u00fcllerian hormone (AMH) levels indicate a decline in ovarian reserve, with larger cysts and endometriomas showing more pronounced effects [29806554, 31824636]. The choice of hemostatic method during surgery is crucial; bipolar electrocoagulation is associated with greater ovarian damage compared to suturing, leading to more significant declines in AMH and antral follicle count (AFC) [30906458, 27436368]. While some recovery in ovarian reserve markers may occur over time, they rarely return to preoperative levels [31824636, 30906458]. The complexity of the surgery, including the extent of cyst removal and the use of electrosurgery, further influences these outcomes, necessitating careful surgical planning and individualized patient counseling to balance the benefits of symptom relief and fertility preservation [28089684, 34693862, 28186620].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgical intervention for ovarian cysts, particularly cystectomy, can significantly impact ovarian reserve both short and long term.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Postoperative reductions in anti-M\u00fcllerian hormone (AMH) levels indicate a decline in ovarian reserve, with larger cysts and endometriomas showing more pronounced effects [29806554, 31824636].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29806554", "evidence_support": "There was a statistically significant decrease in anti-M\u00fcllerian hormone from 3.94\u2009\u00b1\u20093.18 to 3.14\u2009\u00b1\u20092.57\u2009ng/mL (p\u2009=\u20090.001). In 80.8%, the cysts were unilateral, and in over 90.4%, a complete cyst extirpation was performed.", "evidence_relation": "supporting" }, { "cited_pmid": "29806554", "evidence_support": "Our data showed a significant decrease in anti-M\u00fcllerian hormone levels after surgery on the ovaries.", "evidence_relation": "supporting" }, { "cited_pmid": "31824636", "evidence_support": "The ovarian reserve is decreased in women with endometriomas, as compared to similarly aged healthy women or women with other benign ovarian cysts. Some data suggest women with endometrioma experience a faster decline in AMH than age matched healthy women.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The choice of hemostatic method during surgery is crucial; bipolar electrocoagulation is associated with greater ovarian damage compared to suturing, leading to more significant declines in AMH and antral follicle count (AFC) [30906458, 27436368].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30906458", "evidence_support": "In the electrocoagulation group, however, the levels of E2 and AMH decreased significantly while the FSH level increased significantly at 1 month after surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "30906458", "evidence_support": "In laparoscopic ovarian cystectomy, hemostatic electrocoagulation had a more negative impact on ovarian reserve than hemostatic suture.", "evidence_relation": "supporting" }, { "cited_pmid": "27436368", "evidence_support": "Bipolar electrocoagulation is more destructive compared with hemostatic suture.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While some recovery in ovarian reserve markers may occur over time, they rarely return to preoperative levels [31824636, 30906458].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "31824636", "evidence_support": "Multiple well-designed studies consistently demonstrate that surgical excision of endometrioma is associated with a decline in the ovarian reserve. Recent studies with long term follow up suggest some recovery in the markers of ovarian reserve, but they almost never reach preoperative levels. ", "evidence_relation": "supporting" }, { "cited_pmid": "30906458", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The complexity of the surgery, including the extent of cyst removal and the use of electrosurgery, further influences these outcomes, necessitating careful surgical planning and individualized patient counseling to balance the benefits of symptom relief and fertility preservation [28089684, 34693862, 28186620].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28089684", "evidence_support": "The impact of surgery on ovarian reserve can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, and limited use of electrosurgery. Patients should be counseled on the risks of surgery on reproductive potential, and the management plan should be individualized to the patient's symptoms and reproductive goals.", "evidence_relation": "supporting" }, { "cited_pmid": "34693862", "evidence_support": "Patients should be counselled about the risks of surgery and the management plan should be individualised to patient's symptoms and reproductive goals.", "evidence_relation": "supporting" }, { "cited_pmid": "28186620", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Surgery for ovarian cysts can have both short-term and long-term effects on ovarian reserve and fertility.Short-term effects include a significant decrease in anti-M\u00fcllerian hormone (AMH) levels, which can indicate a reduction in ovarian reserve [29806554, 30906458, 23768623]. The extent of the damage depends on the surgical technique, with bipolar electrocoagulation being the most damaging [30906458, 27436368]. Long-term effects are less clear, with some studies suggesting a sustained reduction in ovarian reserve , while others indicate some recovery over time [23768623, 24858999, 26420658]. The complexity of the surgery, such as the use of electrocautery, can also impact ovarian reserve [30906458, 19249702]. Additionally, the presence of endometriotic cysts may further compromise ovarian reserve [31824636, 28186620]. It is essential to consider these factors when counseling patients and individualizing their management plan [28089684, 34693862]. The impact of surgery on ovarian reserve can be minimized by selecting the appropriate technique and being mindful of the patient's reproductive goals.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgery for ovarian cysts can have both short-term and long-term effects on ovarian reserve and fertility.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Short-term effects include a significant decrease in anti-M\u00fcllerian hormone (AMH) levels, which can indicate a reduction in ovarian reserve [29806554, 30906458, 23768623].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29806554", "evidence_support": "Previous publications suggest a reduction in the ovarian reserve following ovarian surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "29806554", "evidence_support": "Also, the size of the cysts had an influence on the ovarian reserve, only larger ovarian cysts with a diameter of 5\u2009cm or more showed a statistically significant reduction in anti-M\u00fcllerian hormone.", "evidence_relation": "supporting" }, { "cited_pmid": "29806554", "evidence_support": "Our data showed a significant decrease in anti-M\u00fcllerian hormone levels after surgery on the ovaries.", "evidence_relation": "supporting" }, { "cited_pmid": "30906458", "evidence_support": "In terms of postoperative ovarian reserve, the levels of E2 and AMH slightly decreased while the FSH level slightly increased in the suture group at both 1 and 6 months after surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "23768623", "evidence_support": "There was a significant decrease both in AMH concentration (24%) and in AFC (11%) 1 month following surgery (P<0.01).", "evidence_relation": "supporting" }, { "cited_pmid": "23768623", "evidence_support": "Endometrioma surgery by stripping of the cyst capsule is associated with a significant reduction in ovarian reserve.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The extent of the damage depends on the surgical technique, with bipolar electrocoagulation being the most damaging [30906458, 27436368].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "30906458", "evidence_support": "In laparoscopic ovarian cystectomy, hemostatic electrocoagulation had a more negative impact on ovarian reserve than hemostatic suture.", "evidence_relation": "supporting" }, { "cited_pmid": "27436368", "evidence_support": "Bipolar electrocoagulation is more destructive compared with hemostatic suture.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Long-term effects are less clear, with some studies suggesting a sustained reduction in ovarian reserve , while others indicate some recovery over time [23768623, 24858999, 26420658].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23768623", "evidence_support": "It is still not clear whether the inflicted damage is immediate, sustained over time or associated with the use of electrocautery, nor which marker is more accurately reflects the post-operative reduction in ovarian reserve.", "evidence_relation": "contradicting" }, { "cited_pmid": "23768623", "evidence_support": "Endometrioma surgery by stripping of the cyst capsule is associated with a significant reduction in ovarian reserve. The reduction is immediate and sustained over time.", "evidence_relation": "supporting" }, { "cited_pmid": "24858999", "evidence_support": "We found that cystectomy of endometriotic cysts is the potential risk factor for ovarian insufficiency after surgery, at times, the onset of ovarian insufficiency long after cystectomy. Therefore, it is important to monitor ovarian reserve for an extended period of time after ovarian surgery. It is particularly important to monitor ovarian reserve long-term for patients who wish to conceive in the future and to suggest a variety of infertility treatments appropriate for their ovarian reserve.", "evidence_relation": "supporting" }, { "cited_pmid": "26420658", "evidence_support": "AMH levels temporarily decreased after laparoscopic cystectomy for ovarian endometriomas, with complete recovery of preoperative AMH values at 12\u2009months postoperatively", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The complexity of the surgery, such as the use of electrocautery, can also impact ovarian reserve [30906458, 19249702].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30906458", "evidence_support": "In laparoscopic ovarian cystectomy, hemostatic electrocoagulation had a more negative impact on ovarian reserve than hemostatic suture.", "evidence_relation": "supporting" }, { "cited_pmid": "19249702", "evidence_support": "Currently, no definitive data clarify whether the damage to the ovarian reserve, observed in patient with endometrioma, is related to the surgical procedure, to the previous presence of the cyst, or both.", "evidence_relation": "contradicting" }, { "cited_pmid": "19249702", "evidence_support": "Electrosurgial coagulation during hemostasis could play an important role in terms of damage to ovarian stroma and vascularization.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Additionally, the presence of endometriotic cysts may further compromise ovarian reserve [31824636, 28186620].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "31824636", "evidence_support": "The ovarian reserve is decreased in women with endometriomas, as compared to similarly aged healthy women or women with other benign ovarian cysts.", "evidence_relation": "supporting" }, { "cited_pmid": "28186620", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "It is essential to consider these factors when counseling patients and individualizing their management plan [28089684, 34693862].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "28089684", "evidence_support": "Patients should be counseled on the risks of surgery on reproductive potential, and the management plan should be individualized to the patient's symptoms and reproductive goals.", "evidence_relation": "supporting" }, { "cited_pmid": "34693862", "evidence_support": "Patients should be counselled about the risks of surgery and the management plan should be individualised to patient's symptoms and reproductive goals.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "The impact of surgery on ovarian reserve can be minimized by selecting the appropriate technique and being mindful of the patient's reproductive goals.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "The short-term effects of surgery for ovarian cysts include a risk of complications such as bleeding, infection, and damage to surrounding organs [17949797, 34802687, 22791381]. The risk of complications is higher for women with a higher body mass index, a greater number of previous open abdominal surgeries, or severe adhesions [30308307]. The long-term effects of surgery for ovarian cysts include a potential impact on fertility, with some studies suggesting that ovarian reserve may be decreased after surgery, particularly for women who undergo laparoscopic ovarian cystectomy for endometriomas [16054961, 36971598, 27030496]. Laparoscopic surgery is generally considered to be a safe and effective treatment for ovarian cysts, with a lower risk of complications and a faster recovery time compared to open surgery [19249702, 24922340, 18254304]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The short-term effects of surgery for ovarian cysts include a risk of complications such as bleeding, infection, and damage to surrounding organs [17949797, 34802687, 22791381].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34802687", "evidence_support": "To evaluate the perioperative outcomes of premenopausal women undergoing cystectomy or oophorectomy for ovarian endometriomas (OMAs) and other benign neoplasms.", "evidence_relation": "neutral" }, { "cited_pmid": "22791381", "evidence_support": "To assess the feasibility and short-term surgical outcome of laparoscopic surgery among women with large ovarian cysts.", "evidence_relation": "neutral" }, { "cited_pmid": "22791381", "evidence_support": "The mean (range) operative time, estimated blood loss (EBL) and hospital stay were 107.6 (55-250 min), 226.9 (10-1300 mL) and 6.1 (4-15 days), respectively.", "evidence_relation": "neutral" }, { "cited_pmid": "22791381", "evidence_support": "One patient had postoperative bleeding and one had minor complications associated with wound oozing at the umbilical port site.", "evidence_relation": "supporting" }, { "cited_pmid": "17949797", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The risk of complications is higher for women with a higher body mass index, a greater number of previous open abdominal surgeries, or severe adhesions [30308307].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30308307", "evidence_support": "Patients at greater risk of intraoperative complications were those with a higher BMI, a greater number of previous open abdominal surgeries, or severe adhesions noted at the time of procedure.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The long-term effects of surgery for ovarian cysts include a potential impact on fertility, with some studies suggesting that ovarian reserve may be decreased after surgery, particularly for women who undergo laparoscopic ovarian cystectomy for endometriomas [16054961, 36971598, 27030496].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16054961", "evidence_support": "Our results suggest that careful attention should be given to preventing post-operative adhesion in the diseased and surgically managed ovary in cases that undergo cystectomy.", "evidence_relation": "neutral" }, { "cited_pmid": "36971598", "evidence_support": "There is a growing body of evidence that ovarian cystectomy may negatively impact ovarian reserve.", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "Those with a history of ovarian cyst surgery were more likely to report having a history of infertility compared with age-matched women who reported no history of cyst surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "It is possible that both ovarian surgery to remove cysts and the conditions that lead women to develop cysts requiring surgery may affect subsequent successful conception.", "evidence_relation": "supporting" }, { "cited_pmid": "27030496", "evidence_support": "Ovarian reserve declines after the cystectomy for ovarian benign cysts and the cystectomy has a negative impact on IVF/ICSI-ET cycle, resulting in a decrease of the number of retrieved oocytes and the number of embryo cryopreserved, but do not influence clinical pregnancy outcome. Ovarian reserve is impaired more seriously by cystectomy for ovarian endometriosis cyst than other ovarian benign cyst.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Laparoscopic surgery is generally considered to be a safe and effective treatment for ovarian cysts, with a lower risk of complications and a faster recovery time compared to open surgery [19249702, 24922340, 18254304].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "19249702", "evidence_support": "Laparoscopic cyst excision is considered the best treatment in terms of lower recurrence and improved fertility. ", "evidence_relation": "supporting" }, { "cited_pmid": "24922340", "evidence_support": "Laparoscopic surgery is the preferred approach in women with ovarian cysts and a low risk of malignancy, and the aim in young women should be to preserve the ovary.", "evidence_relation": "supporting" }, { "cited_pmid": "18254304", "evidence_support": "Laparoscopic management of carefully selected ovarian cysts is an appropriate alternative for exploratory laparotomy even in elderly patients with or without underlying diseases", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Women who undergo surgery for ovarian cysts may experience short-term and long-term effects, including reduced ovarian reserve, which can impact fertility [36971598, 28089684, 32518685]. Studies have shown that ovarian cystectomy, a surgical procedure to remove the cyst, may negatively impact ovarian reserve, increasing the risk of infertility [36971598, 28089684, 32518685]. The risk of infertility after surgery is higher for women who undergo cystectomy compared to those who do not undergo surgery [36971598, 28089684, 32518685]. The estimated geometric mean AMH levels of those who reported a history of ovarian cyst surgery were 1.08 times those of women who reported no history of surgery [36971598, 28089684, 30686836]. Women who undergo surgery for ovarian cysts may also experience short-term complications, such as postoperative pain, fever, and hospital stay, but these complications are generally not severe [33279627, 28089684, 31586249]. However, major postoperative complications, such as sepsis, thromboembolic events, cardiac events, and reoperation, can occur in up to 22.4% of patients [33279627, 28282907, 35568582].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Women who undergo surgery for ovarian cysts may experience short-term and long-term effects, including reduced ovarian reserve, which can impact fertility [36971598, 28089684, 32518685].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36971598", "evidence_support": "Those with a history of ovarian cyst surgery were more likely to report having a history of infertility compared with age-matched women who reported no history of cyst surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "28089684", "evidence_support": "There has been an emerging concern about the effect of ovarian cystectomy on ovarian reserve with some evidence of short-term and long-term reduction in ovarian reserve. Certain cyst characteristics (endometrioma pathology, large cyst size, bilateral presentation) are associated with a greater decline in ovarian reserve after cystectomy.", "evidence_relation": "supporting" }, { "cited_pmid": "32518685", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Studies have shown that ovarian cystectomy, a surgical procedure to remove the cyst, may negatively impact ovarian reserve, increasing the risk of infertility [36971598, 28089684, 32518685].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36971598", "evidence_support": "There is a growing body of evidence that ovarian cystectomy may negatively impact ovarian reserve", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "Infertility after surgery was more common for women reporting cyst surgery than those without surgery after adjusting for age, race, body mass index, cancer history, parity before assigned surgery age, history of infertility before surgery age, and endometriosis (median-adjusted hazard ratio 2.41, 95% simulation interval 1.03-6.78)", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "Those with a history of ovarian cyst surgery were more likely to report having a history of infertility compared with age-matched women who reported no history of cyst surgery", "evidence_relation": "supporting" }, { "cited_pmid": "28089684", "evidence_support": "There has been an emerging concern about the effect of ovarian cystectomy on ovarian reserve with some evidence of short-term and long-term reduction in ovarian reserve", "evidence_relation": "supporting" }, { "cited_pmid": "32518685", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The risk of infertility after surgery is higher for women who undergo cystectomy compared to those who do not undergo surgery [36971598, 28089684, 32518685].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36971598", "evidence_support": "Infertility after surgery was more common for women reporting cyst surgery than those without surgery after adjusting for age, race, body mass index, cancer history, parity before assigned surgery age, history of infertility before surgery age, and endometriosis (median-adjusted hazard ratio 2.41, 95% simulation interval 1.03-6.78).", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "Those with a history of ovarian cyst surgery were more likely to report having a history of infertility compared with age-matched women who reported no history of cyst surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "28089684", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "32518685", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The estimated geometric mean AMH levels of those who reported a history of ovarian cyst surgery were 1.08 times those of women who reported no history of surgery [36971598, 28089684, 30686836].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36971598", "evidence_support": "The estimated geometric mean (95% confidence interval [CI]) AMH levels of those who reported a history of ovarian cyst surgery were 1.08 (95% CI: 0.57-2.05) times those of women who reported no history of surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "30686836", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "28089684", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Women who undergo surgery for ovarian cysts may also experience short-term complications, such as postoperative pain, fever, and hospital stay, but these complications are generally not severe [33279627, 28089684, 31586249].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33279627", "evidence_support": "Intraoperative ovarian cyst spillage of a benign cyst is associated with limited adverse clinical outcomes", "evidence_relation": "supporting" }, { "cited_pmid": "31586249", "evidence_support": "IOCS during laparoscopic cystectomy is associated with larger cyst diameter and intraperitoneal adhesions, but not with adverse short- or long-term outcomes nor with recurrence rates.", "evidence_relation": "contradicting" }, { "cited_pmid": "28089684", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "However, major postoperative complications, such as sepsis, thromboembolic events, cardiac events, and reoperation, can occur in up to 22.4% of patients [33279627, 28282907, 35568582].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28282907", "evidence_support": "Three of 4 patients with Grade IV complications had malignancy (p < 0.0004", "evidence_relation": "neutral" }, { "cited_pmid": "33279627", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "35568582", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Surgery for ovarian cysts can have both short-term and long-term effects on women's fertility [24559614, 30686836, 16213426]. Short-term effects include damage to the ovarian reserve, which can lead to a decrease in the number of eggs available for fertilization [24858999, 30686836, 36971598]. Long-term effects can include a higher risk of infertility, as well as a lower success rate for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments [24858999, 24559614, 36971598]. However, the impact of surgery on fertility can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, and limited use of electrosurgery [28089684, 24559614]. Laparoscopic surgery is generally considered a safe and effective treatment for ovarian cysts, with a lower risk of complications and a faster recovery time compared to open surgery [28089684, 30686836, 17022919].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgery for ovarian cysts can have both short-term and long-term effects on women's fertility [24559614, 30686836, 16213426].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24559614", "evidence_support": "Analysis of the epidemiologic data, drawn mainly from comparative studies and cohorts, shows that the role of cysts in infertility is controversial and that the effects of surgical treatment are often more harmful than the cyst itself to the ovarian reserve", "evidence_relation": "supporting" }, { "cited_pmid": "24559614", "evidence_support": "Surgery does not seem to improve pregnancy rates", "evidence_relation": "contradicting" }, { "cited_pmid": "30686836", "evidence_support": "Ovarian cystectomy did not negatively impact the pregnancy rate or the live birth rate compared to controls", "evidence_relation": "contradicting" }, { "cited_pmid": "16213426", "evidence_support": "Laparoscopic excision of ovarian cysts is associated with damage to ovarian reserve, at least immediately after surgery", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Short-term effects include damage to the ovarian reserve, which can lead to a decrease in the number of eggs available for fertilization [24858999, 30686836, 36971598].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24858999", "evidence_support": "We found that cystectomy of endometriotic cysts is the potential risk factor for ovarian insufficiency after surgery", "evidence_relation": "supporting" }, { "cited_pmid": "30686836", "evidence_support": "Patients after surgical cyst removal had a significant lower number of oocytes retrieved (MNOR) in comparison to the control group", "evidence_relation": "supporting" }, { "cited_pmid": "30686836", "evidence_support": "Conclusions Ovarian cystectomy did not negatively impact the pregnancy rate or the live birth rate compared to controls.", "evidence_relation": "contradicting" }, { "cited_pmid": "36971598", "evidence_support": "There is a growing body of evidence that ovarian cystectomy may negatively impact ovarian reserve.", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "Those with a history of ovarian cyst surgery were more likely to report having a history of infertility compared with age-matched women who reported no history of cyst surgery. It is possible that both ovarian surgery to remove cysts and the conditions that lead women to develop cysts requiring surgery may affect subsequent successful conception.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Long-term effects can include a higher risk of infertility, as well as a lower success rate for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments [24858999, 24559614, 36971598].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24858999", "evidence_support": "We found that cystectomy of endometriotic cysts is the potential risk factor for ovarian insufficiency after surgery, at times, the onset of ovarian insufficiency long after cystectomy.", "evidence_relation": "supporting" }, { "cited_pmid": "24559614", "evidence_support": "Analysis of the epidemiologic data, drawn mainly from comparative studies and cohorts, shows that the role of cysts in infertility is controversial and that the effects of surgical treatment are often more harmful than the cyst itself to the ovarian reserve. Surgery does not seem to improve pregnancy rates.", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "Infertility after surgery was more common for women reporting cyst surgery than those without surgery after adjusting for age, race, body mass index, cancer history, parity before assigned surgery age, history of infertility before surgery age, and endometriosis", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "Those with a history of ovarian cyst surgery were more likely to report having a history of infertility compared with age-matched women who reported no history of cyst surgery.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, the impact of surgery on fertility can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, and limited use of electrosurgery [28089684, 24559614].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28089684", "evidence_support": "The impact of surgery on ovarian reserve can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, and limited use of electrosurgery.", "evidence_relation": "supporting" }, { "cited_pmid": "24559614", "evidence_support": "Analysis of the epidemiologic data, drawn mainly from comparative studies and cohorts, shows that the role of cysts in infertility is controversial and that the effects of surgical treatment are often more harmful than the cyst itself to the ovarian reserve.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Laparoscopic surgery is generally considered a safe and effective treatment for ovarian cysts, with a lower risk of complications and a faster recovery time compared to open surgery [28089684, 30686836, 17022919].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28089684", "evidence_support": "Laparoscopic cystectomy is the first-line treatment for these cysts and is associated with better pain control and less recurrence than drainage or cyst ablation procedures.", "evidence_relation": "supporting" }, { "cited_pmid": "17022919", "evidence_support": "Ovarian cystectomy performed by laparoscopy is associated with a higher incidence of intra-abdominal spillage than laparotomy, but this not associated with any increase in morbidity. Laparoscopic treatment results in a shorter hospital stay and less intraoperative blood loss than laparotomy, but it is associated with a significantly higher risk of recurrence.", "evidence_relation": "contradicting" }, { "cited_pmid": "30686836", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Surgery for ovarian cysts can have both short-term and long-term effects on women's fertility [16213426, 28089684, 36971598]. Short-term effects include damage to the ovarian reserve, which can lead to a decrease in the number of eggs available for fertilization [30686836, 28089684, 24559614]. Long-term effects can include a higher risk of infertility, as well as a lower success rate for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments [36971598]. However, the impact of surgery on fertility can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, and limited use of electrosurgery [28089684]. Laparoscopic surgery is generally considered a safe and effective treatment for ovarian cysts, with a lower risk of complications and a faster recovery time compared to open surgery [23761838, 15450319, 16960678].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgery for ovarian cysts can have both short-term and long-term effects on women's fertility [16213426, 28089684, 36971598].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28089684", "evidence_support": "There has been an emerging concern about the effect of ovarian cystectomy on ovarian reserve with some evidence of short-term and long-term reduction in ovarian reserve.", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "Those with a history of ovarian cyst surgery were more likely to report having a history of infertility compared with age-matched women who reported no history of cyst surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "16213426", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Short-term effects include damage to the ovarian reserve, which can lead to a decrease in the number of eggs available for fertilization [30686836, 28089684, 24559614].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30686836", "evidence_support": "Patients after surgical cyst removal had a significant lower number of oocytes retrieved (MNOR) in comparison to the control group (8.2\u2009\u00b1\u20095.0 vs. 9.5\u2009\u00b1\u20095.4) (p\u2009=\u20090.00).", "evidence_relation": "supporting" }, { "cited_pmid": "30686836", "evidence_support": "Conclusions Ovarian cystectomy did not negatively impact the pregnancy rate or the live birth rate compared to controls.", "evidence_relation": "contradicting" }, { "cited_pmid": "28089684", "evidence_support": "There has been an emerging concern about the effect of ovarian cystectomy on ovarian reserve with some evidence of short-term and long-term reduction in ovarian reserve.", "evidence_relation": "supporting" }, { "cited_pmid": "28089684", "evidence_support": "Certain cyst characteristics (endometrioma pathology, large cyst size, bilateral presentation) are associated with a greater decline in ovarian reserve after cystectomy.", "evidence_relation": "supporting" }, { "cited_pmid": "24559614", "evidence_support": "Analysis of the epidemiologic data, drawn mainly from comparative studies and cohorts, shows that the role of cysts in infertility is controversial and that the effects of surgical treatment are often more harmful than the cyst itself to the ovarian reserve. Surgery does not seem to improve pregnancy rates.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Long-term effects can include a higher risk of infertility, as well as a lower success rate for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments [36971598].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36971598", "evidence_support": "Infertility after surgery was more common for women reporting cyst surgery than those without surgery after adjusting for age, race, body mass index, cancer history, parity before assigned surgery age, history of infertility before surgery age, and endometriosis (median-adjusted hazard ratio 2.41, 95% simulation interval 1.03-6.78).", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "Those with a history of ovarian cyst surgery were more likely to report having a history of infertility compared with age-matched women who reported no history of cyst surgery. It is possible that both ovarian surgery to remove cysts and the conditions that lead women to develop cysts requiring surgery may affect subsequent successful conception.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, the impact of surgery on fertility can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, and limited use of electrosurgery [28089684].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "28089684", "evidence_support": "The impact of surgery on ovarian reserve can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, and limited use of electrosurgery.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Laparoscopic surgery is generally considered a safe and effective treatment for ovarian cysts, with a lower risk of complications and a faster recovery time compared to open surgery [23761838, 15450319, 16960678].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23761838", "evidence_support": "Laparoscopy is becoming more important in the early diagnosis and treatment of adnexal cyst torsion due to its advantages, such as its minimally invasive nature, reduced acute stress reaction and facilitation of direct observation of intra-abdominal lesions.", "evidence_relation": "supporting" }, { "cited_pmid": "23761838", "evidence_support": "Detorsion while retaining ovarian function did not increase the risk of thromboembolism and laparoscopic surgery was minimally invasive with faster recovery times and minimal impact on fertility.", "evidence_relation": "supporting" }, { "cited_pmid": "15450319", "evidence_support": "The role of operative laparoscopy in the management of patients with adnexal masses is expanding, offering distinct advantages of lower morbidity, improved postoperative recovery, and reduced cost.", "evidence_relation": "supporting" }, { "cited_pmid": "16960678", "evidence_support": "This approach has the advantages of minimising the risk of spillage of cyst fluid, a smaller incision compared to laparotomy, as well as faster recovery.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Surgery for ovarian cysts can have both short-term and long-term effects on women's fertility [24559614, 16213426, 36971598]. Short-term effects include damage to the ovarian reserve, which can lead to a decrease in the number of eggs available for fertilization [30686836, 28089684, 24559614]. Long-term effects can include a higher risk of infertility, as well as a lower success rate for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments [24858999]. However, the impact of surgery on fertility can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, and limited use of electrosurgery [28089684]. Laparoscopic surgery is generally considered a safe and effective treatment for ovarian cysts, with a lower risk of complications and a faster recovery time compared to open surgery [23761838, 15450319, 22791381].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgery for ovarian cysts can have both short-term and long-term effects on women's fertility [24559614, 16213426, 36971598].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16213426", "evidence_support": "Laparoscopic excision of ovarian cysts is associated with damage to ovarian reserve, at least immediately after surgery. ", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "24559614", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Short-term effects include damage to the ovarian reserve, which can lead to a decrease in the number of eggs available for fertilization [30686836, 28089684, 24559614].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30686836", "evidence_support": "Ovarian cystectomy did not negatively impact the pregnancy rate or the live birth rate compared to controls", "evidence_relation": "contradicting" }, { "cited_pmid": "28089684", "evidence_support": "There has been an emerging concern about the effect of ovarian cystectomy on ovarian reserve with some evidence of short-term and long-term reduction in ovarian reserve. Certain cyst characteristics (endometrioma pathology, large cyst size, bilateral presentation) are associated with a greater decline in ovarian reserve after cystectomy.", "evidence_relation": "supporting" }, { "cited_pmid": "24559614", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Long-term effects can include a higher risk of infertility, as well as a lower success rate for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments [24858999].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24858999", "evidence_support": "The mean age of the patients at the time of surgery was 27.8\u00b15.5 years-old, and the mean period of onset of ovarian insufficiency was 5.8\u00b13.8 years.", "evidence_relation": "neutral" }, { "cited_pmid": "24858999", "evidence_support": "We found that cystectomy of endometriotic cysts is the potential risk factor for ovarian insufficiency after surgery, at times, the onset of ovarian insufficiency long after cystectomy.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, the impact of surgery on fertility can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, and limited use of electrosurgery [28089684].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "28089684", "evidence_support": "The impact of surgery on ovarian reserve can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, and limited use of electrosurgery.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Laparoscopic surgery is generally considered a safe and effective treatment for ovarian cysts, with a lower risk of complications and a faster recovery time compared to open surgery [23761838, 15450319, 22791381].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "23761838", "evidence_support": "Laparoscopy is becoming more important in the early diagnosis and treatment of adnexal cyst torsion due to its advantages, such as its minimally invasive nature, reduced acute stress reaction and facilitation of direct observation of intra-abdominal lesions.", "evidence_relation": "supporting" }, { "cited_pmid": "15450319", "evidence_support": "The role of operative laparoscopy in the management of patients with adnexal masses is expanding, offering distinct advantages of lower morbidity, improved postoperative recovery, and reduced cost.", "evidence_relation": "supporting" }, { "cited_pmid": "22791381", "evidence_support": "With proper patient selection, laparoscopy is a feasible and safe treatment for women with large ovarian cysts and tumor size did not have effect on laparoscopic management.", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Surgery for ovarian cysts can have both short-term and long-term effects on women's fertility [36776004, 24559614, 36971598]. Short-term effects include damage to the ovarian reserve, which can lead to a decrease in the number of eggs available for fertilization [30686836, 36971598, 24559614]. Long-term effects can include a higher risk of infertility, as well as a lower success rate for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments [24858999, 36971598]. However, the impact of surgery on fertility can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, and limited use of electrosurgery [28089684]. Laparoscopic surgery is generally considered a safe and effective treatment for ovarian cysts, with a lower risk of complications and a faster recovery time compared to open surgery [15450319, 16960678, 23761838].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgery for ovarian cysts can have both short-term and long-term effects on women's fertility [36776004, 24559614, 36971598].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36776004", "evidence_support": "In short term laparoscopic ovarian cystectomy has no significant effect on ovarian reserve. But with long-term follow-up ovarian reserve, ovarian response to gonadotropin stimulation and pregnancy rate are decreased", "evidence_relation": "contradicting" }, { "cited_pmid": "36971598", "evidence_support": "Those with a history of ovarian cyst surgery were more likely to report having a history of infertility compared with age-matched women who reported no history of cyst surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "24559614", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Short-term effects include damage to the ovarian reserve, which can lead to a decrease in the number of eggs available for fertilization [30686836, 36971598, 24559614].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30686836", "evidence_support": "Ovarian cystectomy did not negatively impact the pregnancy rate or the live birth rate compared to controls.", "evidence_relation": "contradicting" }, { "cited_pmid": "36971598", "evidence_support": "There is a growing body of evidence that ovarian cystectomy may negatively impact ovarian reserve.", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "It is possible that both ovarian surgery to remove cysts and the conditions that lead women to develop cysts requiring surgery may affect subsequent successful conception.", "evidence_relation": "supporting" }, { "cited_pmid": "24559614", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Long-term effects can include a higher risk of infertility, as well as a lower success rate for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments [24858999, 36971598].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24858999", "evidence_support": "We found that cystectomy of endometriotic cysts is the potential risk factor for ovarian insufficiency after surgery, at times, the onset of ovarian insufficiency long after cystectomy. Therefore, it is important to monitor ovarian reserve for an extended period of time after ovarian surgery. It is particularly important to monitor ovarian reserve long-term for patients who wish to conceive in the future and to suggest a variety of infertility treatments appropriate for their ovarian reserve.", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "There is a growing body of evidence that ovarian cystectomy may negatively impact ovarian reserve. However, it is unclear whether ovarian cyst surgery puts women at risk of future infertility.", "evidence_relation": "contradicting" }, { "cited_pmid": "36971598", "evidence_support": "Infertility after surgery was more common for women reporting cyst surgery than those without surgery after adjusting for age, race, body mass index, cancer history, parity before assigned surgery age, history of infertility before surgery age, and endometriosis (median-adjusted hazard ratio 2.41, 95% simulation interval 1.03-6.78).", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "Those with a history of ovarian cyst surgery were more likely to report having a history of infertility compared with age-matched women who reported no history of cyst surgery. It is possible that both ovarian surgery to remove cysts and the conditions that lead women to develop cysts requiring surgery may affect subsequent successful conception.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, the impact of surgery on fertility can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, and limited use of electrosurgery [28089684].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "28089684", "evidence_support": "The impact of surgery on ovarian reserve can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, and limited use of electrosurgery.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Laparoscopic surgery is generally considered a safe and effective treatment for ovarian cysts, with a lower risk of complications and a faster recovery time compared to open surgery [15450319, 16960678, 23761838].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "15450319", "evidence_support": "The role of operative laparoscopy in the management of patients with adnexal masses is expanding, offering distinct advantages of lower morbidity, improved postoperative recovery, and reduced cost.", "evidence_relation": "supporting" }, { "cited_pmid": "15450319", "evidence_support": "Advanced operative laparoscopy for management of ovarian cysts, when performed by experienced endoscopic surgeons, is as safe and effective as open techniques.", "evidence_relation": "supporting" }, { "cited_pmid": "16960678", "evidence_support": "Laparoscopy has become an accepted method of management for ovarian cysts.", "evidence_relation": "supporting" }, { "cited_pmid": "16960678", "evidence_support": "Laparoscopic guided aspiration was performed, followed by extra-abdominal excision of the cyst. This approach has the advantages of minimising the risk of spillage of cyst fluid, a smaller incision compared to laparotomy, as well as faster recovery.", "evidence_relation": "supporting" }, { "cited_pmid": "23761838", "evidence_support": "Laparoscopy is becoming more important in the early diagnosis and treatment of adnexal cyst torsion due to its advantages, such as its minimally invasive nature, reduced acute stress reaction and facilitation of direct observation of intra-abdominal lesions. ", "evidence_relation": "supporting" }, { "cited_pmid": "23761838", "evidence_support": "laparoscopic surgery was minimally invasive with faster recovery times and minimal impact on fertility. Furthermore, the study showed that the laparoscopic management of pedicle torsion of adnexal cysts is safe and reliable with the retention of ovarian endocrine and reproductive function.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Surgery for ovarian cysts can have both short-term and long-term effects on women's fertility [36971598]. Short-term effects include damage to the ovarian reserve, which can lead to a decrease in the number of eggs available for fertilization [27402553, 29962184, 36499748]. Laparoscopic surgery is generally considered a safe and effective treatment for ovarian cysts, with a lower risk of complications and a faster recovery time compared to open surgery [17949797, 16034946, 24738121]. Nevertheless, the decision to undergo surgery should be made on a case-by-case basis, taking into account the individual patient's symptoms, reproductive goals, and overall health [37669016]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgery for ovarian cysts can have both short-term and long-term effects on women's fertility [36971598].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36971598", "evidence_support": "There is a growing body of evidence that ovarian cystectomy may negatively impact ovarian reserve.", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "Infertility after surgery was more common for women reporting cyst surgery than those without surgery after adjusting for age, race, body mass index, cancer history, parity before assigned surgery age, history of infertility before surgery age, and endometriosis (median-adjusted hazard ratio 2.41, 95% simulation interval 1.03-6.78).", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "Those with a history of ovarian cyst surgery were more likely to report having a history of infertility compared with age-matched women who reported no history of cyst surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "It is possible that both ovarian surgery to remove cysts and the conditions that lead women to develop cysts requiring surgery may affect subsequent successful conception.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Short-term effects include damage to the ovarian reserve, which can lead to a decrease in the number of eggs available for fertilization [27402553, 29962184, 36499748].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27402553", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "29962184", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "36499748", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Laparoscopic surgery is generally considered a safe and effective treatment for ovarian cysts, with a lower risk of complications and a faster recovery time compared to open surgery [17949797, 16034946, 24738121].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17949797", "evidence_support": "METHODS: We conducted a prospective study applying laparoscopic surgery among women with ovarian cysts whose maximum diameter was > or = 10 cm and radiologic and laboratory features suggestive of benign disease. Patients' demographics, clinical and ultrasound features, CA-125 values, surgical procedures, operative and post-operative complications, estimated amount of blood loss (EBL), operative time, conversion to laparotomy and the pathologic findings were recorded.", "evidence_relation": "neutral" }, { "cited_pmid": "17949797", "evidence_support": "patients underwent laparoscopic surgery over 7 years. The mean (range) age and body mass index were 45.2 (17-73 years) and 30 (21-42), respectively. Laparoscopic surgery was successful in 31 (93.9%) patients. The procedure was converted to laparotomy in 2 patients secondary to adhesions. There were no operative or post-operative complications. The mean (range) operative time, EBL and hospital stay were 82 (45-125 min), 89 (20-250 mL) and 0.94 (0-4 days), respectively. Twenty-three (70%) patients were discharged home the day of the surgery. ", "evidence_relation": "supporting" }, { "cited_pmid": "17949797", "evidence_support": "Laparoscopy is feasible and safe for women with large ovarian cysts with benign features and results in a short hospital stay.", "evidence_relation": "supporting" }, { "cited_pmid": "16034946", "evidence_support": "Over the last ten years laparoscopy has become an increasingly common approach for the surgical removal of benign ovarian tumours. ", "evidence_relation": "supporting" }, { "cited_pmid": "16034946", "evidence_support": "The pooled estimate for febrile morbidity decreased for laparoscopy compared to laparotomy (Peto OR 0.34; 95% CI 0.13 to 0.88). The odds of any adverse effect of surgery (total number of complications - surgical injury and/or post operative complications) were decreased after laparoscopic procedures (Peto OR 0.26; 95% CI 0.12 to 0.55). ", "evidence_relation": "supporting" }, { "cited_pmid": "16034946", "evidence_support": "Mean length of hospital stay was shorter in the laparoscopy group with reduction 2.79 days (95% CI -2.95 to -2.62) compared to laparotomy. ", "evidence_relation": "supporting" }, { "cited_pmid": "16034946", "evidence_support": "In women undergoing surgery for benign ovarian tumours, laparoscopy is associated with a reduction in the following; febrile morbidity, urinary tract infection, post operative complications, post operative pain, days in hospital and total cost. ", "evidence_relation": "supporting" }, { "cited_pmid": "24738121", "evidence_support": "was to evaluate the surgical and obstetric results of laparoscopy versus laparotomy in the management of ovarian cyst during pregnancy.\nMATERIAL AND METHODS: Sixty-nine eligible patients who met our criteria were randomly divided into the laparoscopy group (n\u2009=\u200933) and the laparotomy group (n\u2009=\u200936). The two groups were compared for their surgical and obstetric outcomes and the extent of pelvic adhesion discovered in later cesarean section (CS).\nRESULTS: The laparoscopy group had less blood loss (43\u2009\u00b1\u200915 vs 51\u2009\u00b1\u200913\u2009mL, P\u2009=\u20090.02), shorter postoperative hospital stay (2.9\u2009\u00b1\u20090.5 vs 5.8\u2009\u00b1\u20090.6 days, P\u2009<\u20090.001), and lower postoperative pain score (2.7\u2009\u00b1\u20091.2 vs 5.9\u2009\u00b1\u20091.5, P\u2009<\u20090.001) compared with the laparotomy group. The operative time, neonates' Apgar scores and birthweights between the two groups showed no significant differences (P\u2009>\u20090.05). Sixteen patients in the laparoscopy group, and 15 patients in the laparotomy group underwent cesarean section. The filmy and dense type adhesion rate was significantly different between the laparoscopy group and the laparotomy group (6.25% vs 53.3%, and 0% vs 20%, respectively).\nCONCLUSIONS: The present results suggest that laparoscopy is a better choice than laparotomy for ovarian cyst during pregnancy, with less blood loss, less postoperative pain and less postoperative hospital stay. It offers a faster recovery, results in less pelvic adhesion and does not affect the fetus; however, studies encompassing larger numbers of cases are needed.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Nevertheless, the decision to undergo surgery should be made on a case-by-case basis, taking into account the individual patient's symptoms, reproductive goals, and overall health [37669016].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "37669016", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Surgery for ovarian cysts can have both short-term and long-term effects on women's fertility [36971598]. Short-term effects of chemotherapy include damage to the ovarian reserve, which can lead to a decrease in the number of eggs available for fertilization, as well as other effects such as bone loss, weight gain, neurotoxicity, and neurocognitive changes [23714443]. Long-term effects of male smoking can include a higher risk of infertility, as well as a lower success rate for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments [32953410]. However, the impact of surgery on fertility can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, limited use of electrosurgery, and employing microsurgical techniques with advanced laparoscopic or robotic surgery, which can simplify complex minimally invasive fertility-sparing procedures [24569400, 37900072].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgery for ovarian cysts can have both short-term and long-term effects on women's fertility [36971598].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36971598", "evidence_support": "However, it is unclear whether ovarian cyst surgery puts women at risk of future infertility. This study investigates whether surgery for benign ovarian cysts is associated with long-term infertility risk.", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Short-term effects of chemotherapy include damage to the ovarian reserve, which can lead to a decrease in the number of eggs available for fertilization, as well as other effects such as bone loss, weight gain, neurotoxicity, and neurocognitive changes [23714443].", "answer_sentence_relevance": "inappropriate", "citation_assessment": [ { "cited_pmid": "23714443", "evidence_support": "Exposure to chemotherapy can lead to a variety of early and late long-term toxicities, including ovarian failure (with resultant infertility and sexual dysfunction), bone loss, weight gain, neurotoxicity, neurocognitive changes, cardiac toxicity and secondary malignancy.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Long-term effects of male smoking can include a higher risk of infertility, as well as a lower success rate for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments [32953410].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32953410", "evidence_support": "This study monitors the effect of male smoking and age of the woman on the success of the intracytoplasmic sperm injection (ICSI) fertilization process as part of the assisted reproduction technique (ART). A total of 703 couples in the in vitro fertilization (IVF) program were included", "evidence_relation": "neutral" }, { "cited_pmid": "32953410", "evidence_support": "The results from the study showed that interaction of male smoking and women's age (>35 years) have significant negative impact on ongoing pregnancy rate and live birth rate.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, the impact of surgery on fertility can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, limited use of electrosurgery, and employing microsurgical techniques with advanced laparoscopic or robotic surgery, which can simplify complex minimally invasive fertility-sparing procedures [24569400, 37900072].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24569400", "evidence_support": "With this comes the promise of simplifying complex minimally invasive fertility-sparing procedures so that they can be performed in a safe and reproducible manner by reproductive specialists.", "evidence_relation": "supporting" }, { "cited_pmid": "37900072", "evidence_support": "This is done using standard laparoscopic surgery or robotic surgery (computer-assisted laparoscopy), a method increasingly used and accessible to all specialists who want to maintain the fertility of their patients with various oncological diseases.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Surgery for ovarian cysts can have both short-term and long-term effects on women's fertility [36971598, 24210233]. Short-term effects include damage to the ovarian reserve, which can lead to a decrease in the number of eggs available for fertilization [35100616, 30870184, 29962184]. Long-term effects can include a higher risk of infertility [19548080, 35639653]. The success rate of intracytoplasmic sperm injection (ICSI) treatments does not appear to be affected by the cause of infertility or a family history of potential genetic disorders [19548080, 35639653]. The impact of surgery on fertility can be minimized by adopting a fertility-sparing focus in pelvic surgery, integrating this focus into structured gynaecological surgical training, and being mindful of the patient's age and existing risk factors for subfertility [27909567]. Laparoscopic surgery is generally considered a safe and effective treatment for ovarian cysts, with a lower risk of complications and a faster recovery time compared to open surgery [16034946, 17949797, 24738121].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgery for ovarian cysts can have both short-term and long-term effects on women's fertility [36971598, 24210233].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36971598", "evidence_support": "Infertility after surgery was more common for women reporting cyst surgery than those without surgery after adjusting for age, race, body mass index, cancer history, parity before assigned surgery age, history of infertility before surgery age, and endometriosis (median-adjusted hazard ratio 2.41, 95% simulation interval 1.03-6.78).", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "Those with a history of ovarian cyst surgery were more likely to report having a history of infertility compared with age-matched women who reported no history of cyst surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "24210233", "evidence_support": "It appears that more than the histologic nature of the ovarian cysts, it is the surgical treatment of the cyst which may decrease fertility.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Short-term effects include damage to the ovarian reserve, which can lead to a decrease in the number of eggs available for fertilization [35100616, 30870184, 29962184].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35100616", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "30870184", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "29962184", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Long-term effects can include a higher risk of infertility [19548080, 35639653].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19548080", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "35639653", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The success rate of intracytoplasmic sperm injection (ICSI) treatments does not appear to be affected by the cause of infertility or a family history of potential genetic disorders [19548080, 35639653].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "19548080", "evidence_support": "Our results suggest that the success rate of ICSI treatment is not related to the cause of infertility or a family history positive for potential genetic disorders.", "evidence_relation": "supporting" }, { "cited_pmid": "35639653", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The impact of surgery on fertility can be minimized by adopting a fertility-sparing focus in pelvic surgery, integrating this focus into structured gynaecological surgical training, and being mindful of the patient's age and existing risk factors for subfertility [27909567].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27909567", "evidence_support": "A fertility-sparing focus on all pelvic surgery is likely to prevent further decline in ovarian reserve for women who are already at higher risk.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Laparoscopic surgery is generally considered a safe and effective treatment for ovarian cysts, with a lower risk of complications and a faster recovery time compared to open surgery [16034946, 17949797, 24738121].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16034946", "evidence_support": "The pooled estimate for febrile morbidity decreased for laparoscopy compared to laparotomy (Peto OR 0.34; 95% CI 0.13 to 0.88)", "evidence_relation": "supporting" }, { "cited_pmid": "16034946", "evidence_support": "The odds of any adverse effect of surgery (total number of complications - surgical injury and/or post operative complications) were decreased after laparoscopic procedures (Peto OR 0.26; 95% CI 0.12 to 0.55). Short-term recovery: VAS pain scores favoured laparoscopy (WMD -2.36; 95% CI -2.07 to -2.03) andt he odds of being pain free were significantly greater for the laparoscopy group compared to laparotomy (Peto OR 7.35; 95% CI 4.3 to 12.56)", "evidence_relation": "supporting" }, { "cited_pmid": "16034946", "evidence_support": "Mean length of hospital stay was shorter in the laparoscopy group with reduction 2.79 days (95% CI -2.95 to -2.62) compared to laparotomy. ", "evidence_relation": "supporting" }, { "cited_pmid": "16034946", "evidence_support": "In women undergoing surgery for benign ovarian tumours, laparoscopy is associated with a reduction in the following; febrile morbidity, urinary tract infection, post operative complications, post operative pain, days in hospital and total cost. ", "evidence_relation": "supporting" }, { "cited_pmid": "17949797", "evidence_support": "Laparoscopy is feasible and safe for women with large ovarian cysts with benign features and results in a short hospital stay.", "evidence_relation": "supporting" }, { "cited_pmid": "24738121", "evidence_support": "The laparoscopy group had less blood loss (43\u2009\u00b1\u200915 vs 51\u2009\u00b1\u200913\u2009mL, P\u2009=\u20090.02), shorter postoperative hospital stay (2.9\u2009\u00b1\u20090.5 vs 5.8\u2009\u00b1\u20090.6 days, P\u2009<\u20090.001), and lower postoperative pain score (2.7\u2009\u00b1\u20091.2 vs 5.9\u2009\u00b1\u20091.5, P\u2009<\u20090.001) compared with the laparotomy group.", "evidence_relation": "supporting" }, { "cited_pmid": "24738121", "evidence_support": "The present results suggest that laparoscopy is a better choice than laparotomy for ovarian cyst during pregnancy, with less blood loss, less postoperative pain and less postoperative hospital stay. It offers a faster recovery, results in less pelvic adhesion and does not affect the fetus; however, studies encompassing larger numbers of cases are needed.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Surgery for ovarian cysts can have both short-term and long-term effects on women's fertility [36971598]. Short-term effects include damage to the ovarian reserve, which can lead to a decrease in the number of eggs available for fertilization [28089684]. Long-term effects can include a higher risk of infertility, as well as a lower success rate for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments [19330609]. However, the impact of surgery on fertility can be minimized by integrating a fertility-sparing focus into surgical training and practice, particularly for women of advanced reproductive age, and being aware of the potential risks of pelvic surgery on ovarian reserve [27909567]. Laparoscopic surgery is generally considered a safe and effective treatment for ovarian cysts, with a lower risk of complications and a faster recovery time compared to open surgery [24427377, 16034946, 17949797].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgery for ovarian cysts can have both short-term and long-term effects on women's fertility [36971598].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36971598", "evidence_support": "Those with a history of ovarian cyst surgery were more likely to report having a history of infertility compared with age-matched women who reported no history of cyst surgery.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Short-term effects include damage to the ovarian reserve, which can lead to a decrease in the number of eggs available for fertilization [28089684].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28089684", "evidence_support": "There has been an emerging concern about the effect of ovarian cystectomy on ovarian reserve with some evidence of short-term and long-term reduction in ovarian reserve. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Long-term effects can include a higher risk of infertility, as well as a lower success rate for in vitro fertilization (IVF) and intracytoplasmic sperm injection (ICSI) treatments [19330609].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19330609", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, the impact of surgery on fertility can be minimized by integrating a fertility-sparing focus into surgical training and practice, particularly for women of advanced reproductive age, and being aware of the potential risks of pelvic surgery on ovarian reserve [27909567].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27909567", "evidence_support": "A fertility-sparing focus on all pelvic surgery is likely to prevent further decline in ovarian reserve for women who are already at higher risk. Such focus seems to be currently lacking. It is proposed that integrating fertility-sparing focus to structured gynaecological surgical training will benefit women.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Laparoscopic surgery is generally considered a safe and effective treatment for ovarian cysts, with a lower risk of complications and a faster recovery time compared to open surgery [24427377, 16034946, 17949797].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "24427377", "evidence_support": "In addition to the well-known advantages of laparoscopic surgery (e.g., decreased postoperative pain, length of hospital stay, and wound infection), perfect cosmetic results are particularly important for young women. The pure laparoscopic management of giant ovarian cysts is safe and feasible.", "evidence_relation": "supporting" }, { "cited_pmid": "16034946", "evidence_support": "In women undergoing surgery for benign ovarian tumours, laparoscopy is associated with a reduction in the following; febrile morbidity, urinary tract infection, post operative complications, post operative pain, days in hospital and total cost.", "evidence_relation": "supporting" }, { "cited_pmid": "17949797", "evidence_support": "Laparoscopy is feasible and safe for women with large ovarian cysts with benign features and results in a short hospital stay.", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Surgical intervention for ovarian cysts, particularly laparoscopic cystectomy, can significantly impact ovarian reserve both short-term and long-term.Postoperative declines in anti-M\u00fcllerian hormone (AMH) levels are commonly observed, with larger cysts and endometriomas showing more pronounced reductions [28089684, 29806554]. The choice of hemostatic method during surgery is crucial; bipolar electrocoagulation is associated with greater ovarian reserve damage compared to suturing [27436368, 30906458]. While some recovery in ovarian reserve markers may occur over time, they rarely return to preoperative levels [31824636]. Surgical complexity, including the extent of cyst removal and the use of energy modalities, further influences outcomes, with more conservative techniques like plasma energy ablation causing less harm [31824636, 23368705]. Patients should be counseled on these risks, and surgical approaches should be tailored to minimize ovarian damage while addressing the cyst pathology effectively [28089684, 34693862].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgical intervention for ovarian cysts, particularly laparoscopic cystectomy, can significantly impact ovarian reserve both short-term and long-term.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Postoperative declines in anti-M\u00fcllerian hormone (AMH) levels are commonly observed, with larger cysts and endometriomas showing more pronounced reductions [28089684, 29806554].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28089684", "evidence_support": "Certain cyst characteristics (endometrioma pathology, large cyst size, bilateral presentation) are associated with a greater decline in ovarian reserve after cystectomy.", "evidence_relation": "supporting" }, { "cited_pmid": "29806554", "evidence_support": "There was a statistically significant decrease in anti-M\u00fcllerian hormone from 3.94\u2009\u00b1\u20093.18 to 3.14\u2009\u00b1\u20092.57\u2009ng/mL (p\u2009=\u20090.001). In 80.8%, the cysts were unilateral, and in over 90.4%, a complete cyst extirpation was performed. A statistically significant reduction was seen in follicular cysts (4.72\u2009\u00b1\u20093.84 to 3.76\u2009\u00b1\u20092.91\u2009ng/mL; p\u2009=\u20090.039) and endometriosis cysts (2.55\u2009\u00b1\u20091.87 to 1.72\u2009\u00b1\u20091.39\u2009ng/mL; p\u2009=\u20090.024). Also, the size of the cysts had an influence on the ovarian reserve, only larger ovarian cysts with a diameter of 5\u2009cm or more showed a statistically significant reduction in anti-M\u00fcllerian hormone. Our data showed a significant decrease in anti-M\u00fcllerian hormone levels after surgery on the ovaries.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The choice of hemostatic method during surgery is crucial; bipolar electrocoagulation is associated with greater ovarian reserve damage compared to suturing [27436368, 30906458].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27436368", "evidence_support": "Bipolar electrocoagulation is more destructive compared with hemostatic suture. However, the ovarian reserve does not decrease further during the follow-up period.", "evidence_relation": "contradicting" }, { "cited_pmid": "30906458", "evidence_support": "In laparoscopic ovarian cystectomy, hemostatic electrocoagulation had a more negative impact on ovarian reserve than hemostatic suture. The use of electrocoagulation for hemostasis should be minimized during the operation, and the suture method should be adopted for hemostasis and shaping of the ovarian wound.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While some recovery in ovarian reserve markers may occur over time, they rarely return to preoperative levels [31824636].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31824636", "evidence_support": "Recent studies with long term follow up suggest some recovery in the markers of ovarian reserve, but they almost never reach preoperative levels", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Surgical complexity, including the extent of cyst removal and the use of energy modalities, further influences outcomes, with more conservative techniques like plasma energy ablation causing less harm [31824636, 23368705].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31824636", "evidence_support": "Limited data suggest ablation of the cyst wall with plasma energy is associated with less harm to reserve with similar recurrence rates as compared with excision and bipolar coagulation.", "evidence_relation": "supporting" }, { "cited_pmid": "23368705", "evidence_support": "Excisional surgery is the best technique to prevent recurrences and improve symptoms but it may result in ovarian reserve damage due to the removal of healthy ovarian cortex. ", "evidence_relation": "supporting" }, { "cited_pmid": "23368705", "evidence_support": "an appropriate surgical technique, without the use of the bipolar coagulation of ovarian border, does not determine a significant reduction of ovarian reserve", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Patients should be counseled on these risks, and surgical approaches should be tailored to minimize ovarian damage while addressing the cyst pathology effectively [28089684, 34693862].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "28089684", "evidence_support": "Patients should be counseled on the risks of surgery on reproductive potential, and the management plan should be individualized to the patient's symptoms and reproductive goals.", "evidence_relation": "supporting" }, { "cited_pmid": "34693862", "evidence_support": "Patients should be counselled about the risks of surgery and the management plan should be individualised to patient's symptoms and reproductive goals", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Surgery for ovarian cysts, such as cystectomy or oophorectomy, can have both short and long-term effects.Short-term effects include pain, bleeding, infection, and potential damage to surrounding organs, which are generally manageable with appropriate perioperative care.Long-term effects depend on the complexity of the surgery and the extent of ovarian tissue removed.Women may experience hormonal imbalances, early menopause, or infertility if significant ovarian tissue is excised.Complex surgeries, particularly those involving malignancy, may necessitate additional treatments like chemotherapy, impacting overall health and quality of life.Psychological effects, including anxiety and depression, can also occur due to concerns about fertility and cancer risk.Close monitoring and follow-up care are essential to manage these outcomes effectively.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgery for ovarian cysts, such as cystectomy or oophorectomy, can have both short and long-term effects.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Short-term effects include pain, bleeding, infection, and potential damage to surrounding organs, which are generally manageable with appropriate perioperative care.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Long-term effects depend on the complexity of the surgery and the extent of ovarian tissue removed.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Women may experience hormonal imbalances, early menopause, or infertility if significant ovarian tissue is excised.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Complex surgeries, particularly those involving malignancy, may necessitate additional treatments like chemotherapy, impacting overall health and quality of life.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Psychological effects, including anxiety and depression, can also occur due to concerns about fertility and cancer risk.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "Close monitoring and follow-up care are essential to manage these outcomes effectively.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Surgery for ovarian cysts can have both short-term and long-term effects on ovarian reserve.Short-term effects include a decrease in anti-M\u00fcllerian hormone (AMH) levels, which can be seen as early as 24 hours after surgery and can persist for up to 6 months [23368705, 30906458]. The extent of the decrease in AMH levels can vary depending on the surgical technique used, with bipolar electrocoagulation being more destructive to ovarian reserve compared to hemostatic suture [27436368, 30906458]. Long-term effects of surgery on ovarian reserve are less clear, with some studies suggesting that ovarian reserve may recover over time , while others suggest that the damage may be permanent [34693862]. The complexity of the surgery, including the use of advanced techniques such as single-port access laparoscopy, may also impact ovarian reserve [26213861]. Overall, the impact of surgery on ovarian reserve is a complex issue that requires careful consideration and individualized management [28089684, 29806554].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgery for ovarian cysts can have both short-term and long-term effects on ovarian reserve.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Short-term effects include a decrease in anti-M\u00fcllerian hormone (AMH) levels, which can be seen as early as 24 hours after surgery and can persist for up to 6 months [23368705, 30906458].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23368705", "evidence_support": "The aim of this study was to investigate the extent of the ovarian reserve damage after stripping technique of unilateral endometriomas, by dosing the Anti-M\u00fcllerian Hormone (AMH).", "evidence_relation": "neutral" }, { "cited_pmid": "23368705", "evidence_support": "The AMH serum levels were estimated in the early proliferative phase of the cycle, before surgery (time 0), 24 h after surgery (time 1), the first menstrual cycle after surgery (time 2) and the third menstrual cycle after surgery (time 3). We found a nonstatistically significant decreases in serum AMH levels after surgical excision of the cysts.", "evidence_relation": "supporting" }, { "cited_pmid": "30906458", "evidence_support": "Blood samples were drawn from all patients at roughly three time points: Before the surgery, 1 month and 6 months after the surgery.", "evidence_relation": "neutral" }, { "cited_pmid": "30906458", "evidence_support": " In terms of postoperative ovarian reserve, the levels of E2 and AMH slightly decreased while the FSH level slightly increased in the suture group at both 1 and 6 months after surgery. ", "evidence_relation": "supporting" }, { "cited_pmid": "30906458", "evidence_support": "the levels of E2 and AMH decreased significantly while the FSH level increased significantly at 1 month after surgery. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The extent of the decrease in AMH levels can vary depending on the surgical technique used, with bipolar electrocoagulation being more destructive to ovarian reserve compared to hemostatic suture [27436368, 30906458].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27436368", "evidence_support": "Bipolar electrocoagulation is more destructive compared with hemostatic suture.", "evidence_relation": "supporting" }, { "cited_pmid": "30906458", "evidence_support": "In laparoscopic ovarian cystectomy, hemostatic electrocoagulation had a more negative impact on ovarian reserve than hemostatic suture.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Long-term effects of surgery on ovarian reserve are less clear, with some studies suggesting that ovarian reserve may recover over time , while others suggest that the damage may be permanent [34693862].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34693862", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The complexity of the surgery, including the use of advanced techniques such as single-port access laparoscopy, may also impact ovarian reserve [26213861].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26213861", "evidence_support": "The aim of this study was to evaluate whether the single-port surgery affects the ovarian reserve whilst performing laparoscopic ovarian cystectomy for unilateral endometrioma", "evidence_relation": "supporting" }, { "cited_pmid": "26213861", "evidence_support": "In conclusion, our results suggest that SPAL cystectomy should not be recommended to patients undergoing surgery for endometrioma excision who want to preserve their fertility.", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, the impact of surgery on ovarian reserve is a complex issue that requires careful consideration and individualized management [28089684, 29806554].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28089684", "evidence_support": "The impact of surgery on ovarian reserve can be minimized by selecting the appropriate surgery for the patient, careful tissue handling, and limited use of electrosurgery. Patients should be counseled on the risks of surgery on reproductive potential, and the management plan should be individualized to the patient's symptoms and reproductive goals.", "evidence_relation": "supporting" }, { "cited_pmid": "29806554", "evidence_support": "The aim of this study was to investigate the influence of an ovarian operation on the ovarian reserve, based on the anti-M\u00fcllerian hormone levels", "evidence_relation": "neutral" }, { "cited_pmid": "29806554", "evidence_support": "However, concerning young women, the indication of surgery should be given cautiously as-at least temporarily-a reduction in the ovarian reserve can occur.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash": { "answer": "Surgery for ovarian cysts can have both short-term and long-term effects on fertility [24559614, 24210233]. While surgery aims to prevent complications like rupture or malignancy [24559614], it may negatively impact ovarian reserve and fertility [24559614, 24210233]. The surgical approach significantly influences fertility outcomes [24210233, 24559614]. Laparoscopic procedures are generally preferred for their minimally invasive nature and faster recovery times, minimizing impact on fertility [23761838, 24559614]. However, even minimally invasive techniques can affect ovarian reserve [35835531]. Cystectomy, which involves removing the cyst while preserving ovarian tissue, is considered a fertility-sparing option [24210233, 11535985]. However, the extent of damage to ovarian reserve can vary depending on the type of cyst and the surgical technique used [19249702, 27882760]. In cases of bilateral cysts, the risk of premature ovarian failure increases [19249702]. Therefore, a comprehensive assessment of ovarian reserve and a joint decision between surgeons and reproductive specialists are crucial for managing ovarian cysts in women desiring future fertility [24210233, 24559614].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgery for ovarian cysts can have both short-term and long-term effects on fertility [24559614, 24210233].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24559614", "evidence_support": "Analysis of the epidemiologic data, drawn mainly from comparative studies and cohorts, shows that the role of cysts in infertility is controversial and that the effects of surgical treatment are often more harmful than the cyst itself to the ovarian reserve.", "evidence_relation": "supporting" }, { "cited_pmid": "24210233", "evidence_support": "It appears that more than the histologic nature of the ovarian cysts, it is the surgical treatment of the cyst which may decrease fertility.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "While surgery aims to prevent complications like rupture or malignancy [24559614], it may negatively impact ovarian reserve and fertility [24559614, 24210233].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24559614", "evidence_support": "For a long time it was hoped that surgical treatment could prevent potential complications (such as rupture or malignancy).", "evidence_relation": "supporting" }, { "cited_pmid": "24210233", "evidence_support": "It appears that more than the histologic nature of the ovarian cysts, it is the surgical treatment of the cyst which may decrease fertility.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The surgical approach significantly influences fertility outcomes [24210233, 24559614].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24210233", "evidence_support": "It appears that more than the histologic nature of the ovarian cysts, it is the surgical treatment of the cyst which may decrease fertility. Some good practice of surgical procedures must be kept in mind when one manages a benign ovarian tumor in a young patient wishing to preserve her fertility: surgery should be avoided as much as possible; kystectomy is better than oophorectomy; no radical surgery should be done without pathological certitudes; electrocoagulation must be avoided on the cyst walls. In some situations, fertility is specially endangered: bilateral ovarian cysts, recurrence or strong probability of recurrence (endometriomas), poor ovarian reserve (previous chemo- or radiotherapy, age>35, premature ovarian failure). In these situations, a pre-operative assessment of the ovarian reserve could be useful.", "evidence_relation": "supporting" }, { "cited_pmid": "24559614", "evidence_support": "Analysis of the epidemiologic data, drawn mainly from comparative studies and cohorts, shows that the role of cysts in infertility is controversial and that the effects of surgical treatment are often more harmful than the cyst itself to the ovarian reserve.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Laparoscopic procedures are generally preferred for their minimally invasive nature and faster recovery times, minimizing impact on fertility [23761838, 24559614].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23761838", "evidence_support": "Laparoscopy is becoming more important in the early diagnosis and treatment of adnexal cyst torsion due to its advantages, such as its minimally invasive nature, reduced acute stress reaction and facilitation of direct observation of intra-abdominal lesions.", "evidence_relation": "supporting" }, { "cited_pmid": "23761838", "evidence_support": "Detorsion while retaining ovarian function did not increase the risk of thromboembolism and laparoscopic surgery was minimally invasive with faster recovery times and minimal impact on fertility.", "evidence_relation": "supporting" }, { "cited_pmid": "24559614", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "However, even minimally invasive techniques can affect ovarian reserve [35835531].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35835531", "evidence_support": "Despite minimally invasive surgical techniques, evidence suggests a number of healthy ovarian follicles and tissues are resected intraoperatively, resulting in subsequent decline of ovarian reserve", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Cystectomy, which involves removing the cyst while preserving ovarian tissue, is considered a fertility-sparing option [24210233, 11535985].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24210233", "evidence_support": "It appears that more than the histologic nature of the ovarian cysts, it is the surgical treatment of the cyst which may decrease fertility.", "evidence_relation": "neutral" }, { "cited_pmid": "24210233", "evidence_support": "In some situations, fertility is specially endangered: bilateral ovarian cysts, recurrence or strong probability of recurrence (endometriomas), poor ovarian reserve (previous chemo- or radiotherapy, age>35, premature ovarian failure).", "evidence_relation": "neutral" }, { "cited_pmid": "11535985", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "7", "answer_sentence": "However, the extent of damage to ovarian reserve can vary depending on the type of cyst and the surgical technique used [19249702, 27882760].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "19249702", "evidence_support": "Even if a consistent amount of ovarian tissue is unintentionally removed together with the capsule of the cyst, resulting in does not show the follicular pattern observed in working ovaries. Currently, no definitive data clarify whether the damage to the ovarian reserve, observed in patient with endometrioma, is related to the surgical procedure, to the previous presence of the cyst, or both. ", "evidence_relation": "contradicting" }, { "cited_pmid": "27882760", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "8", "answer_sentence": "In cases of bilateral cysts, the risk of premature ovarian failure increases [19249702].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19249702", "evidence_support": "In fact, an increase in premature ovarian failure rate was reported when both the ovaries are involved in surgery.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "9", "answer_sentence": "Therefore, a comprehensive assessment of ovarian reserve and a joint decision between surgeons and reproductive specialists are crucial for managing ovarian cysts in women desiring future fertility [24210233, 24559614].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24559614", "evidence_support": " For presumed benign ovarian tumors, fertility sparing should be the main concern", "evidence_relation": "neutral" }, { "cited_pmid": "24559614", "evidence_support": "The context of the infertility is essential, and surgeons and specialists in reproductive medicine should decide management jointly.", "evidence_relation": "supporting" }, { "cited_pmid": "24210233", "evidence_support": "The global management of benign ovarian tumors in young patients should be decided between surgeons and specialists in reproductive biology.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "The effects of surgery for ovarian cysts on fertility depend on the type of surgery and the complexity of the procedure. Laparoscopic surgery, a minimally invasive approach, is generally considered less disruptive to fertility compared to open surgery [PMID1, PMID2]. Laparoscopic cystectomy, the removal of the cyst, is often the preferred method for benign cysts, as it preserves ovarian tissue and minimizes the risk of adhesions [PMID3]. However, more complex procedures, such as oophorectomy (ovary removal) or extensive adhesions, can have a greater impact on fertility [PMID4]. Long-term effects may include scarring, adhesions, and reduced ovarian reserve, which can affect future pregnancies [PMID5]. It is crucial to discuss the specific risks and benefits of each procedure with a qualified healthcare professional to make informed decisions about fertility preservation. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The effects of surgery for ovarian cysts on fertility depend on the type of surgery and the complexity of the procedure.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Laparoscopic surgery, a minimally invasive approach, is generally considered less disruptive to fertility compared to open surgery [PMID1, PMID2].", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Laparoscopic cystectomy, the removal of the cyst, is often the preferred method for benign cysts, as it preserves ovarian tissue and minimizes the risk of adhesions [PMID3].", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "However, more complex procedures, such as oophorectomy (ovary removal) or extensive adhesions, can have a greater impact on fertility [PMID4].", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Long-term effects may include scarring, adhesions, and reduced ovarian reserve, which can affect future pregnancies [PMID5].", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "It is crucial to discuss the specific risks and benefits of each procedure with a qualified healthcare professional to make informed decisions about fertility preservation.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gpt4o-mini": { "answer": "Surgery for ovarian cysts can have both short- and long-term effects on fertility. While cystectomy, particularly for endometriomas, has been a standard treatment providing pain relief and reducing recurrence rates, it may also impact ovarian function [31344251]. However, careful excision aimed at preserving ovarian tissue can lead to better long-term outcomes and fertility preservation [31344251]. Interventional radiology offers alternatives that can minimize the need for surgery, thereby reducing morbidity and preserving fertility potential [22236906]. For asymptomatic patients with small, stable cysts, expectant management may be beneficial, showing no harm and potentially avoiding surgery altogether [31344251]. Ultimately, the choice of procedure should be guided by a trained surgeon to optimize outcomes and maintain fertility.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgery for ovarian cysts can have both short- and long-term effects on fertility.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "While cystectomy, particularly for endometriomas, has been a standard treatment providing pain relief and reducing recurrence rates, it may also impact ovarian function [31344251].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31344251", "evidence_support": "Cystectomy of ovarian endometriomas has been the first-line treatment for management for many years because it provides improved pain relief, reduces recurrence rates, and was thought to be favorable in in vitro fertilization.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, careful excision aimed at preserving ovarian tissue can lead to better long-term outcomes and fertility preservation [31344251].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "31344251", "evidence_support": "When surgical intervention is appropriate, careful ovarian cyst excision with goal of ovarian tissue preservation and treatment of additional endometriosis by a trained surgeon can provide the patient the best long-term outcome and preservation of ovarian tissue and function.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Interventional radiology offers alternatives that can minimize the need for surgery, thereby reducing morbidity and preserving fertility potential [22236906].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "22236906", "evidence_support": "Interventional radiology offers therapeutic options that obviate surgery, thereby minimizing morbidity and mortality and maximizing the potential for fertility preservation.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "For asymptomatic patients with small, stable cysts, expectant management may be beneficial, showing no harm and potentially avoiding surgery altogether [31344251].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31344251", "evidence_support": "However, a growing body of evidence is demonstrating benefit, or at least no harm, in expectant management for asymptomatic patients with small, stable endometriomas", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Ultimately, the choice of procedure should be guided by a trained surgeon to optimize outcomes and maintain fertility.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Surgery for ovarian cysts can have both short- and long-term effects on fertility. Short-term complications may include infection, bleeding, and damage to surrounding organs [PMID1]. The complexity of the procedure, such as whether it is laparoscopic or open surgery, can influence recovery time and potential complications [PMID2]. Long-term effects may involve changes in ovarian function, especially if ovarian tissue is removed or damaged during surgery [PMID3]. Laparoscopic surgery is generally associated with less tissue damage and quicker recovery, making it a preferred option for preserving fertility [PMID4]. However, the specific impact on fertility can vary based on individual circumstances, including the type and size of the cyst and the surgical technique used [PMID5]. It is essential to discuss these factors with a healthcare provider to understand the best approach for preserving fertility.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgery for ovarian cysts can have both short- and long-term effects on fertility.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Short-term complications may include infection, bleeding, and damage to surrounding organs", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "[PMID1].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "The complexity of the procedure, such as whether it is laparoscopic or open surgery, can influence recovery time and potential complications [PMID2].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Long-term effects may involve changes in ovarian function, especially if ovarian tissue is removed or damaged during surgery", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "[PMID3].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "Laparoscopic surgery is generally associated with less tissue damage and quicker recovery, making it a preferred option for preserving fertility [PMID4].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "8", "answer_sentence": "However, the specific impact on fertility can vary based on individual circumstances, including the type and size of the cyst and the surgical technique used [PMID5].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "9", "answer_sentence": "It is essential to discuss these factors with a healthcare provider to understand the best approach for preserving fertility.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-1": { "answer": "The short-term effect of surgery for ovarian cysts is the removal of the cyst, but it may also affect future fertility in younger women [36971598,24683475]. The long-term effect of surgery for ovarian cysts is not well understood, but it may be associated with a higher risk of infertility [36971598]. The complexity of the surgery may also affect the long-term outcome, with larger cysts being associated with poorer feto-maternal outcomes [30376010]. Hypothyroidism should be considered in the differential diagnosis of adult females presenting with multicystic ovarian tumors to avoid unnecessary ovarian surgery.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The short-term effect of surgery for ovarian cysts is the removal of the cyst, but it may also affect future fertility in younger women [36971598,24683475].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "36971598", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "24683475", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The long-term effect of surgery for ovarian cysts is not well understood, but it may be associated with a higher risk of infertility [36971598].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "36971598", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The complexity of the surgery may also affect the long-term outcome, with larger cysts being associated with poorer feto-maternal outcomes [30376010].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "30376010", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Hypothyroidism should be considered in the differential diagnosis of adult females presenting with multicystic ovarian tumors to avoid unnecessary ovarian surgery.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-2": { "answer": "The short-term effects of laparoscopic ovarian cystectomy include pain, bleeding, infection, and reaction to anesthesia. The long-term effects depend on the complexity of the surgery and the patient's health status, but they are not mentioned in the context [19830152].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The short-term effects of laparoscopic ovarian cystectomy include pain, bleeding, infection, and reaction to anesthesia.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "The long-term effects depend on the complexity of the surgery and the patient's health status, but they are not mentioned in the context [19830152].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "19830152", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-3": { "answer": "The short term effect of surgery for women with ovarian cyst is the resolution of the cyst, while the long term effect and complexity of surgery depends on the patient's age and fertility goals. In younger women, it is desirable to avoid unnecessary surgery to not compromise fertility in the future [24683475]. However, in some cases, such as large ovarian cysts, surgery may be necessary [24683475]. Surgical excision should be considered only when adequate thyroid replacement therapy fails to resolve ovarian enlargement [24683475]. In this case, the patient was started on thyroxine replacement therapy, and within a period of 4 months, the size of the cyst regressed significantly.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The short term effect of surgery for women with ovarian cyst is the resolution of the cyst, while the long term effect and complexity of surgery depends on the patient's age and fertility goals.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "In younger women, it is desirable to avoid unnecessary surgery to not compromise fertility in the future [24683475].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24683475", "evidence_support": "In younger women with ovarian cysts, it is also desirable to avoid unnecessary surgery so as to not compromise fertility in the future.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, in some cases, such as large ovarian cysts, surgery may be necessary [24683475].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "24683475", "evidence_support": "In view of the large ovarian cyst, she was advised to undergo elective laparotomy in the gynaecology department", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Surgical excision should be considered only when adequate thyroid replacement therapy fails to resolve ovarian enlargement [24683475].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24683475", "evidence_support": "Surgical excision should be considered only when adequate thyroid replacement therapy fails to resolve ovarian enlargement.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In this case, the patient was started on thyroxine replacement therapy, and within a period of 4 months, the size of the cyst regressed significantly.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-5": { "answer": "The short term effect of surgery for women with ovarian cyst is the resolution of the cyst, while the long term effect and complexity of surgery depends on the patient's age and fertility goals. In younger women, it is desirable to avoid unnecessary surgery to not compromise fertility in the future [24683475]. However, in some cases, such as large ovarian cysts, surgery may be necessary [24683475]. Surgical excision should be considered only when adequate thyroid replacement therapy fails to resolve ovarian enlargement [24683475]. In this case, the patient was started on thyroxine replacement therapy, and within a period of 4 months, the size of the cyst regressed significantly.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The short term effect of surgery for women with ovarian cyst is the resolution of the cyst, while the long term effect and complexity of surgery depends on the patient's age and fertility goals.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "In younger women, it is desirable to avoid unnecessary surgery to not compromise fertility in the future [24683475].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24683475", "evidence_support": "In younger women with ovarian cysts, it is also desirable to avoid unnecessary surgery so as to not compromise fertility in the future.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, in some cases, such as large ovarian cysts, surgery may be necessary [24683475].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24683475", "evidence_support": "Surgical excision should be considered only when adequate thyroid replacement therapy fails to resolve ovarian enlargement.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Surgical excision should be considered only when adequate thyroid replacement therapy fails to resolve ovarian enlargement [24683475].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24683475", "evidence_support": "Hypothyroidism should be considered in the differential diagnosis of adult females presenting with multicystic ovarian tumours.", "evidence_relation": "neutral" }, { "cited_pmid": "24683475", "evidence_support": "Surgical excision should be considered only when adequate thyroid replacement therapy fails to resolve ovarian enlargement.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In this case, the patient was started on thyroxine replacement therapy, and within a period of 4 months, the size of the cyst regressed significantly.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-gpt-1": { "answer": "The short-term effects of surgery for ovarian cysts may include pain, bleeding, infection, and complications related to anesthesia. Long-term effects can involve changes in menstrual cycles, potential impacts on fertility, and the risk of recurrence of cysts. The complexity of the surgery, such as whether it is laparoscopic or open surgery, can influence recovery time and the likelihood of these effects.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The short-term effects of surgery for ovarian cysts may include pain, bleeding, infection, and complications related to anesthesia.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Long-term effects can involve changes in menstrual cycles, potential impacts on fertility, and the risk of recurrence of cysts.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "The complexity of the surgery, such as whether it is laparoscopic or open surgery, can influence recovery time and the likelihood of these effects.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "The short-term effects of surgery for ovarian cysts may include immediate recovery challenges and potential complications, while long-term effects can include an increased risk of infertility. Studies indicate that women who undergo surgery for benign ovarian cysts have a higher likelihood of experiencing infertility compared to those who do not have surgery, with a median-adjusted hazard ratio of 2.41 indicating a significant association [36971598]. Additionally, the underlying conditions leading to cyst formation may also impact future conception success [36971598].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The short-term effects of surgery for ovarian cysts may include immediate recovery challenges and potential complications, while long-term effects can include an increased risk of infertility.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Studies indicate that women who undergo surgery for benign ovarian cysts have a higher likelihood of experiencing infertility compared to those who do not have surgery, with a median-adjusted hazard ratio of 2.41 indicating a significant association [36971598].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36971598", "evidence_support": "Infertility after surgery was more common for women reporting cyst surgery than those without surgery after adjusting for age, race, body mass index, cancer history, parity before assigned surgery age, history of infertility before surgery age, and endometriosis (median-adjusted hazard ratio 2.41, 95% simulation interval 1.03-6.78)", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, the underlying conditions leading to cyst formation may also impact future conception success [36971598].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36971598", "evidence_support": "It is possible that both ovarian surgery to remove cysts and the conditions that lead women to develop cysts requiring surgery may affect subsequent successful conception.", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-6": { "answer": "The short and long term effects of surgery for women with ovarian cysts can vary based on factors such as the type of cyst, the surgical approach, and individual patient characteristics. Short-term complications may include infection, bleeding, and pain, while long-term effects can involve changes in ovarian reserve, which is influenced by the histology and size of the cyst as well as the complexity of the surgical procedure [33279627,36971598,29806554]. Additionally, there is a risk of infertility associated with surgery for benign ovarian cysts, highlighting the importance of careful surgical planning and consideration of the patient's reproductive goals [36971598,29806554].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The short and long term effects of surgery for women with ovarian cysts can vary based on factors such as the type of cyst, the surgical approach, and individual patient characteristics.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Short-term complications may include infection, bleeding, and pain, while long-term effects can involve changes in ovarian reserve, which is influenced by the histology and size of the cyst as well as the complexity of the surgical procedure [33279627,36971598,29806554].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36971598", "evidence_support": "Results: Approximately 6.1% of women reported cyst surgery. Infertility after surgery was more common for women reporting cyst surgery than those without surgery after adjusting for age, race, body mass index, cancer history, parity before assigned surgery age, history of infertility before surgery age, and endometriosis (median-adjusted hazard ratio 2.41, 95% simulation interval 1.03-6.78). The estimated geometric mean (95% co", "evidence_relation": "supporting" }, { "cited_pmid": "29806554", "evidence_support": "Previous publications suggest a reduction in the ovarian reserve following ovarian surgery. The influence of the underlying disease, histology, size of the ovarian cyst and type of procedure remains unclear. The aim of this study was to investigate the influence of an ovarian operation on the ovarian reserve, based on the anti-M\u00fcllerian hormone levels. The anti-M\u00fcllerian hormone values were determined by means of a standardized enzyme-linked immunosorbent assay. In total, 52 patients with one or more ovarian cysts of different histologic entities treated at the Department of Women's Health at the Women's University Hospital in T\u00fcbingen were included in the study. Anti-M\u00fcllerian hormone was determined before and after surgery. The patients were 28 (range\u2009=\u200918-40) years old on average. There was a statistically significant decrease in anti-M\u00fcllerian hormone from 3.94\u2009\u00b1\u20093.18 to 3.14\u2009\u00b1\u20092.57\u2009ng/mL (p\u2009=\u20090.001). In 80.8%, the cysts were unilateral, and in over 90.4%, a complete cyst extirpation was performed. A statistically significant reduction was seen in follicular cysts (4.72\u2009\u00b1\u20093.84 to 3.76\u2009\u00b1\u20092.91\u2009ng/mL; p\u2009=\u20090.039) and endometriosis cysts (2.55\u2009\u00b1\u20091.87 to 1.72\u2009\u00b1\u20091.39\u2009ng/mL; p\u2009=\u20090.024). Also, the size of the cysts had an influence on the ovarian reserve, only larger ovarian cysts with a diameter of 5\u2009cm or more showed a statistically significant reduction in anti-M\u00fcllerian hormone. Our data showed a significant decrease in anti-M\u00fcllerian hormone levels after surgery on the ovaries. If this results in a long-term reduced ovarian reserve or is merely a short-term reaction to the procedure needs to be clarified. However, concerning young women, the indication of surgery should be given cautiously as-at least temporarily-a reduction in the ovarian reserve can occur.", "evidence_relation": "supporting" }, { "cited_pmid": "33279627", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, there is a risk of infertility associated with surgery for benign ovarian cysts, highlighting the importance of careful surgical planning and consideration of the patient's reproductive goals [36971598,29806554].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36971598", "evidence_support": "Infertility after surgery was more common for women reporting cyst surgery than those without surgery after adjusting for age, race, body mass index, cancer history, parity before assigned surgery age, history of infertility before surgery age, and endometriosis (median-adjusted hazard ratio 2.41, 95% simulation interval 1.03-6.78).", "evidence_relation": "supporting" }, { "cited_pmid": "36971598", "evidence_support": "Those with a history of ovarian cyst surgery were more likely to report having a history of infertility compared with age-matched women who reported no history of cyst surgery. It is possible that both ovarian surgery to remove cysts and the conditions that lead women to develop cysts requiring surgery may affect subsequent successful conception", "evidence_relation": "supporting" }, { "cited_pmid": "29806554", "evidence_support": "Our data showed a significant decrease in anti-M\u00fcllerian hormone levels after surgery on the ovaries", "evidence_relation": "supporting" }, { "cited_pmid": "29806554", "evidence_support": "If this results in a long-term reduced ovarian reserve or is merely a short-term reaction to the procedure needs to be clarified", "evidence_relation": "supporting" }, { "cited_pmid": "29806554", "evidence_support": "However, concerning young women, the indication of surgery should be given cautiously as-at least temporarily-a reduction in the ovarian reserve can occur", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gemini-flash": { "answer": "Surgery for ovarian cysts can have both short and long-term effects on fertility [24559614, 27857046]. While conservative laparoscopic approaches are preferred to minimize damage to ovarian tissue [24559614], surgery can still negatively impact ovarian reserve [27030496, 35835531]. This can lead to a decrease in the number of retrieved oocytes and embryos cryopreserved during IVF/ICSI-ET cycles [27030496]. The impact on fertility is more severe with cystectomy for endometriosis cysts compared to other benign cysts [27030496]. While surgery does not seem to improve pregnancy rates [24559614], fertility-sparing surgery for borderline ovarian tumors is feasible and effective [16491337]. However, the recurrence rate after cystectomy is higher compared to other surgical options [16491337]. The decision to proceed with surgery should be made jointly by surgeons and specialists in reproductive medicine, considering the individual patient's fertility goals and the potential risks and benefits of different surgical approaches [24559614]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Surgery for ovarian cysts can have both short and long-term effects on fertility [24559614, 27857046].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24559614", "evidence_support": "Analysis of the epidemiologic data, drawn mainly from comparative studies and cohorts, shows that the role of cysts in infertility is controversial and that the effects of surgical treatment are often more harmful than the cyst itself to the ovarian reserve", "evidence_relation": "supporting" }, { "cited_pmid": "24559614", "evidence_support": "Surgery does not seem to improve pregnancy rates.", "evidence_relation": "supporting" }, { "cited_pmid": "27857046", "evidence_support": "There is a low pregnancy rate after laparoscopic cystectomy of benign OT. Moreover, pregnancy rate after cystectomy of endometrioma is significantly lower and the percentage of reccurence of endometrioma is significantly higher.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "While conservative laparoscopic approaches are preferred to minimize damage to ovarian tissue [24559614], surgery can still negatively impact ovarian reserve [27030496, 35835531].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24559614", "evidence_support": "Analysis of the epidemiologic data, drawn mainly from comparative studies and cohorts, shows that the role of cysts in infertility is controversial and that the effects of surgical treatment are often more harmful than the cyst itself to the ovarian reserve.", "evidence_relation": "neutral" }, { "cited_pmid": "24559614", "evidence_support": "When a surgical option is nonetheless chosen, a conservative laparoscopic approach is more suitable.", "evidence_relation": "supporting" }, { "cited_pmid": "27030496", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "35835531", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This can lead to a decrease in the number of retrieved oocytes and embryos cryopreserved during IVF/ICSI-ET cycles [27030496].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27030496", "evidence_support": "The influence of different types of ovarian cysts on ovarian reserve and pregnancy outcome in IVF/ICSI-ET cycles were also studied, ovarian endometriosis cyst was studied as Group A, and Group B consisted of benign ovarian teratomas, simple ovarian cyst and mucinous cystadenoma.", "evidence_relation": "supporting" }, { "cited_pmid": "27030496", "evidence_support": "Ovarian reserve declines after the cystectomy for ovarian benign cysts and the cystectomy has a negative impact on IVF/ICSI-ET cycle, resulting in a decrease of the number of retrieved oocytes and the number of embryo cryopreserved, but do not influence clinical pregnancy outcome.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The impact on fertility is more severe with cystectomy for endometriosis cysts compared to other benign cysts [27030496].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27030496", "evidence_support": "To investigate the impact of previous cystectomy for ovary benign cyst on ovarian reserve and pregnancy outcome in in vitro fertilization/intracytoplasmic sperm injection-embryo transfer (IVF/ICSI-ET) cycles.", "evidence_relation": "neutral" }, { "cited_pmid": "27030496", "evidence_support": "Ovarian reserve is impaired more seriously by cystectomy for ovarian endometriosis cyst than other ovarian benign cyst.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "While surgery does not seem to improve pregnancy rates [24559614], fertility-sparing surgery for borderline ovarian tumors is feasible and effective [16491337].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24559614", "evidence_support": "Surgery does not seem to improve pregnancy rates. ", "evidence_relation": "supporting" }, { "cited_pmid": "16491337", "evidence_support": "Fertility-sparing surgery for borderline ovarian tumors (BOT) is feasible and effective and does not seem to have a negative effect on survival", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "However, the recurrence rate after cystectomy is higher compared to other surgical options [16491337].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16491337", "evidence_support": "Recurrences were more frequent after cystectomy than after USO (P=.0001) and BSO (P=.0001) and when intraoperative cyst rupture occurred (P=.04).", "evidence_relation": "supporting" }, { "cited_pmid": "16491337", "evidence_support": "These results suggest that cystectomy for BOT is associated with a high risk of intraoperative cyst rupture and of recurrence compared with USO or BSO.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "The decision to proceed with surgery should be made jointly by surgeons and specialists in reproductive medicine, considering the individual patient's fertility goals and the potential risks and benefits of different surgical approaches [24559614].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24559614", "evidence_support": "The context of the infertility is essential, and surgeons and specialists in reproductive medicine should decide management jointly.", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "Laparoscopic surgery is often recommended for women with ovarian cysts due to its advantages, including shorter hospital stays, fewer adverse effects, and improved quality of life compared to traditional methods [25762854]. This minimally invasive approach also provides better visualization during surgery, which can enhance outcomes [25762854]. \n\nIn terms of long-term effects, prophylactic surgeries, such as hysterectomy with or without bilateral salpingo-oophorectomy, can significantly reduce cancer risk but may lead to complications like premature menopause if performed before childbearing is complete [26177554]. Therefore, it is crucial to balance the benefits of reducing cancer incidence with the potential long-term impacts on fertility and hormonal health [26177554]. Overall, the complexity of the procedure and its implications for fertility should be carefully considered when planning surgery for ovarian cysts.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Laparoscopic surgery is often recommended for women with ovarian cysts due to its advantages, including shorter hospital stays, fewer adverse effects, and improved quality of life compared to traditional methods [25762854].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25762854", "evidence_support": "Laparoscopic surgery seems to offer significant advantages such as reduced hospital stay, less adverse effects, better quality of life, and superior vision especially on surgical treatment of cases like endometriosis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This minimally invasive approach also provides better visualization during surgery, which can enhance outcomes [25762854].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25762854", "evidence_support": "Laparoscopic surgery seems to offer significant advantages such as reduced hospital stay, less adverse effects, better quality of life, and superior vision especially on surgical treatment of cases like endometriosis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In terms of long-term effects, prophylactic surgeries, such as hysterectomy with or without bilateral salpingo-oophorectomy, can significantly reduce cancer risk but may lead to complications like premature menopause if performed before childbearing is complete [26177554].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26177554", "evidence_support": "Prophylactic hysterectomy with or without bilateral salpingo-oophorectomy reduces the cancer incidence", "evidence_relation": "supporting" }, { "cited_pmid": "26177554", "evidence_support": "Prophylactic surgery could be performed at a suitable age after childbearing to obtain a balance between reducing the risk of cancer and minimizing long-term complications from premature menopause.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Therefore, it is crucial to balance the benefits of reducing cancer incidence with the potential long-term impacts on fertility and hormonal health [26177554].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26177554", "evidence_support": "Prophylactic surgery could be performed at a suitable age after childbearing to obtain a balance between reducing the risk of cancer and minimizing long-term complications from premature menopause.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Overall, the complexity of the procedure and its implications for fertility should be carefully considered when planning surgery for ovarian cysts.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] } } }, { "question_id": "134", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "The symptoms of irritable bowel syndrome (IBS) can vary but often include abdominal pain, bloating, gas, and changes in bowel habits such as diarrhea or constipation. Treatment options for IBS typically focus on managing these symptoms and may involve dietary adjustments, stress management techniques, and medications aimed at relieving specific symptoms [29105313]. Additionally, it's important to consider the patient's overall health and any potential comorbidities when selecting the most appropriate treatment plan. For example, sublingual immunotherapy has shown promise in managing symptoms related to allergies, which could be relevant for some IBS patients with concurrent allergic conditions [29105313].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The symptoms of irritable bowel syndrome (IBS) can vary but often include abdominal pain, bloating, gas, and changes in bowel habits such as diarrhea or constipation.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Treatment options for IBS typically focus on managing these symptoms and may involve dietary adjustments, stress management techniques, and medications aimed at relieving specific symptoms [29105313].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29105313", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, it's important to consider the patient's overall health and any potential comorbidities when selecting the most appropriate treatment plan.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "For example, sublingual immunotherapy has shown promise in managing symptoms related to allergies, which could be relevant for some IBS patients with concurrent allergic conditions [29105313].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29105313", "evidence_support": "Sublingual immunotherapy using peach extract enriched in Pru p 3 (Pru p 3-enriched-SLIT) brings a new perspective to treating patients with allergy to lipid transfer proteins", "evidence_relation": "supporting" } ] } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "IBS symptoms include abdominal pain, diarrhea, constipation, bloating, and flatulence [26491416, 21927652, 15324713]. Treatments vary based on symptom predominance [21180545, 31820883, 28403981]. For diarrhea-predominant IBS (IBS-D), loperamide, serotonin 5-HT3 antagonists, rifaximin, and eluxadoline are effective [26491416, 30466670, 15467518]. Antidiarrheals can also be used [31820883, 16498278, 20074154]. Constipation-predominant IBS (IBS-C) can be treated with dietary fiber, lubiprostone, linaclotide, polyethylene glycol, tegaserod, and plecanatide [26491416, 30466670, 16836950]. Antispasmodics and peppermint oil can relieve general IBS pain [16836950, 21616041, 21694813]. Antidepressants and neuromodulators help manage pain and other symptoms [21616041, 15467518, 21694813]. Cognitive behavioral techniques and hypnotherapy can alleviate symptoms by addressing psychological factors [30466670, 31820883, 28403981]. Low-FODMAP diets and probiotics may reduce overall IBS symptoms [26491416, 30466670, 33315591]. Each treatment should be tailored to the patient's specific symptom profile for optimal management [21180545, 28403981, 20890316].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "IBS symptoms include abdominal pain, diarrhea, constipation, bloating, and flatulence [26491416, 21927652, 15324713].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26491416", "evidence_support": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with abdominal pain, diarrhea, constipation, or a mix of symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "21927652", "evidence_support": "Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by episodic abdominal pain or discomfort in association with altered bowel habits (diarrhea and/or constipation). Other gastrointestinal symptoms, such as bloating and flatulence, are also common.", "evidence_relation": "supporting" }, { "cited_pmid": "15324713", "evidence_support": "The irritable bowel syndrome (IBS) is part of the spectrum of functional bowel disorders characterised by a diverse consortium of abdominal symptoms including abdominal pain, altered bowel function (bowel frequency and/or constipation), bloating, abdominal distension, the sensation of incomplete evacuation and the increased passage of mucus.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "10", "answer_sentence": "Each treatment should be tailored to the patient's specific symptom profile for optimal management [21180545, 28403981, 20890316].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "28403981", "evidence_support": "Finally, the key to successful treatment of patients with IBS is a good physician-patient relationship and use of person-centred care principles.", "evidence_relation": "supporting" }, { "cited_pmid": "20890316", "evidence_support": "Patient-centered care is recommended, in which management is focused on the patient's most bothersome and impactful symptoms, their preferences and previous experiences with treatment, and addressing factors associated with the onset and exacerbation of symptoms. ", "evidence_relation": "supporting" }, { "cited_pmid": "21180545", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Treatments vary based on symptom predominance [21180545, 31820883, 28403981].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21180545", "evidence_support": "Although all patients with IBS have symptoms of abdominal pain and disordered defecation, treatment needs to be individualized and should focus on the predominant symptom.", "evidence_relation": "supporting" }, { "cited_pmid": "28403981", "evidence_support": "In these patients, use of pharmacotherapy on the basis of the predominant symptom (constipation, diarrhoea, pain, or bloating) or combination of symptoms is the next step", "evidence_relation": "supporting" }, { "cited_pmid": "31820883", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "For diarrhea-predominant IBS (IBS-D), loperamide, serotonin 5-HT3 antagonists, rifaximin, and eluxadoline are effective [26491416, 30466670, 15467518].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26491416", "evidence_support": "For patients with diarrhea-predominant IBS, treatment options include the synthetic peripheral \u03bc-opioid receptor agonist loperamide, antispasmodic agents, antidepressants, serotonin 5-HT3 antagonists, and the gut-specific antibiotic rifaximin.", "evidence_relation": "supporting" }, { "cited_pmid": "15467518", "evidence_support": "In diarrhea-predominant IBS, opioids (e.g. loperamide) and the 5-HT(3) receptor antagonist alosetron are efficacious.", "evidence_relation": "supporting" }, { "cited_pmid": "30466670", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Antidiarrheals can also be used [31820883, 16498278, 20074154].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31820883", "evidence_support": "Laxatives or prokinetics and antidiarrheals are used to treat constipation and diarrhea respectively, but have little effect on abdominal pain.", "evidence_relation": "supporting" }, { "cited_pmid": "20074154", "evidence_support": "The mainstay of intervention is pharmacological treatment with antispasmodics and antidiarrheals for diarrhea, prokinetics and high-fiber diets for constipation, and supportive therapy with low-dose antidepressants to normalize gastrointestinal motility.", "evidence_relation": "supporting" }, { "cited_pmid": "16498278", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Constipation-predominant IBS (IBS-C) can be treated with dietary fiber, lubiprostone, linaclotide, polyethylene glycol, tegaserod, and plecanatide [26491416, 30466670, 16836950].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26491416", "evidence_support": "For patients with diarrhea-predominant IBS, treatment options include the synthetic peripheral \u03bc-opioid receptor agonist loperamide, antispasmodic agents, antidepressants, serotonin 5-HT3 antagonists, and the gut-specific antibiotic rifaximin.", "evidence_relation": "contradicting" }, { "cited_pmid": "26491416", "evidence_support": "For patients with constipation-predominant IBS, therapeutic strategies may include dietary fiber, laxatives, and the prosecretory agents lubiprostone and linaclotide.", "evidence_relation": "supporting" }, { "cited_pmid": "30466670", "evidence_support": "Newer treatments for IBS-D, such as eluxadoline, and IBS-C, with linaclotide, lubiprostone, plecanatide, also can provide durable relief.", "evidence_relation": "supporting" }, { "cited_pmid": "16836950", "evidence_support": "For constipation-predominant (C-IBS) symptoms, current treatment options include fiber supplementation, polyethylene glycol, and tegaserod.", "evidence_relation": "supporting" }, { "cited_pmid": "16836950", "evidence_support": "Additional agents under investigation for C-IBS include the ClC(2) chloride channel opener lubiprostone, mu-opioid receptor antagonist alvimopan, and 5-HT(4) agonist renzapride. For diarrhea-predominant (D-IBS) symptoms, available therapies include loperamide, alosetron, and clonidine.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Antispasmodics and peppermint oil can relieve general IBS pain [16836950, 21616041, 21694813].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16836950", "evidence_support": "Pharmacologic agents used to treat IBS-associated pain include myorelaxants, peppermint oil, and peripherally acting opiates.", "evidence_relation": "supporting" }, { "cited_pmid": "21616041", "evidence_support": "Fiber, peppermint oil, or antispasmodic agents are beneficial as first-line therapies in some patients. ", "evidence_relation": "supporting" }, { "cited_pmid": "21694813", "evidence_support": "Medical therapy for this condition has traditionally been directed towards symptom relief, using fiber or antispasmodic agents", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Antidepressants and neuromodulators help manage pain and other symptoms [21616041, 15467518, 21694813].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21616041", "evidence_support": "Fiber, peppermint oil, or antispasmodic agents are beneficial as first-line therapies in some patients. Where these fail, emerging data have confirmed the efficacy of antidepressants, drugs acting on the 5-hydroxytryptamine receptor, and probiotics in the short-term treatment of IBS.", "evidence_relation": "supporting" }, { "cited_pmid": "15467518", "evidence_support": "In patients with IBS and abdominal pain, antispasmodics and antidepressants can be used, with the best evidence supporting the prescription of tricyclic antidepressants.", "evidence_relation": "supporting" }, { "cited_pmid": "21694813", "evidence_support": "Medical therapy for this condition has traditionally been directed towards symptom relief, using fiber or antispasmodic agents. In recent years, emerging data have confirmed the efficacy of antidepressants, psychological therapies, 5-HT(3) antagonists, 5-HT(4) agonists, and probiotics in the short-term treatment of IBS, although whether these therapies influence the long-term course of the disease is unknown.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Cognitive behavioral techniques and hypnotherapy can alleviate symptoms by addressing psychological factors [30466670, 31820883, 28403981].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30466670", "evidence_support": "Low-FODMAP diets have been helpful in providing symptom relief, as have cognitive behavioral and mind-body techniques that help patients manage symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "31820883", "evidence_support": "Due to the heterogeneity of the disorder, finding the correct treatment option is often challenging.", "evidence_relation": "neutral" }, { "cited_pmid": "31820883", "evidence_support": "Refractory IBS symptoms can be treated with probiotics, antibiotics, histamine-receptor antagonists or alternative therapy, including psychotherapy, hypnotherapy, acupuncture or phytomedicines. H", "evidence_relation": "supporting" }, { "cited_pmid": "28403981", "evidence_support": "For patients with symptoms that are refractory to these initial treatment options and those who have comorbid conditions or psychological symptoms, a combination of therapies should be used, and the use of psychotropic drugs and psychological treatment alternatives is often effective.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "9", "answer_sentence": "Low-FODMAP diets and probiotics may reduce overall IBS symptoms [26491416, 30466670, 33315591].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26491416", "evidence_support": "Recent data suggest that a gluten-free diet and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may benefit some patients.", "evidence_relation": "supporting" }, { "cited_pmid": "26491416", "evidence_support": "Ongoing research is evaluating the use of probiotics. For patients with constipation-predominant IBS, therapeutic strategies may include dietary fiber, laxatives, and the prosecretory agents lubiprostone and linaclotide.", "evidence_relation": "neutral" }, { "cited_pmid": "30466670", "evidence_support": "Low-FODMAP diets have been helpful in providing symptom relief, as have cognitive behavioral and mind-body techniques that help patients manage symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "33315591", "evidence_support": "We recommend a limited trial of a low fermentable oligosaccharides, disacchardies, monosaccharides, polyols (FODMAP) diet in patients with IBS to improve global symptoms.", "evidence_relation": "supporting" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Irritable bowel syndrome (IBS) is characterized by chronic or recurrent abdominal pain associated with altered bowel habits, including diarrhea, constipation, or a mix of both, often accompanied by bloating and flatulence [26491416, 21927652]. The pathophysiology involves factors such as altered bowel motility, visceral hypersensitivity, psychosocial stressors, and gut microbiome alterations [26491416, 21927652]. Diagnosis is clinical, using criteria like Rome IV, and excludes organic diseases [21616041, 24124703]. Treatment is symptom-focused: for diarrhea-predominant IBS (IBS-D), options include loperamide, rifaximin, and 5-HT3 antagonists like alosetron ; for constipation-predominant IBS (IBS-C), treatments include fiber, laxatives, lubiprostone, and linaclotide [26491416, 15467518, 26491416]. Antispasmodics and antidepressants can alleviate abdominal pain, though evidence varies [16836950, 15467518]. Dietary modifications, such as low-FODMAP diets, and psychological therapies, including cognitive behavioral therapy, are also beneficial [30466670, 31820883]. Emerging therapies and probiotics show promise but require further validation [26491416, 21927652].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is characterized by chronic or recurrent abdominal pain associated with altered bowel habits, including diarrhea, constipation, or a mix of both, often accompanied by bloating and flatulence [26491416, 21927652].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26491416", "evidence_support": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with abdominal pain, diarrhea, constipation, or a mix of symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "21927652", "evidence_support": "Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by episodic abdominal pain or discomfort in association with altered bowel habits (diarrhea and/or constipation). Other gastrointestinal symptoms, such as bloating and flatulence, are also common.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The pathophysiology involves factors such as altered bowel motility, visceral hypersensitivity, psychosocial stressors, and gut microbiome alterations [26491416, 21927652].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "26491416", "evidence_support": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with abdominal pain, diarrhea, constipation, or a mix of symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "26491416", "evidence_support": "The pathophysiology of IBS is not completely understood but appears to involve genetics, the gut microbiome, immune activation, altered intestinal permeability, and brain-gut interactions.", "evidence_relation": "supporting" }, { "cited_pmid": "21927652", "evidence_support": "Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by episodic abdominal pain or discomfort in association with altered bowel habits (diarrhea and/or constipation). Other gastrointestinal symptoms, such as bloating and flatulence, are also common.", "evidence_relation": "supporting" }, { "cited_pmid": "21927652", "evidence_support": "A variety of factors are believed to play a role in the development of IBS symptoms, including altered bowel motility, visceral hypersensitivity, psychosocial stressors, altered brain-gut interactions, immune activation/low grade inflammation, alterations in the gut microbiome, and genetic factors.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Diagnosis is clinical, using criteria like Rome IV, and excludes organic diseases [21616041, 24124703].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "21616041", "evidence_support": "The diagnosis should be made on clinical grounds, using symptom-based criteria such as the Manning or Rome criteria, unless symptoms are thought to be atypical.", "evidence_relation": "supporting" }, { "cited_pmid": "24124703", "evidence_support": "The diagnosis of irritable bowel syndrome (IBS) should be considered when patients have had abdominal pain/discomfort, bloating, and change in bowel habits for 6 month", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Treatment is symptom-focused: for diarrhea-predominant IBS (IBS-D), options include loperamide, rifaximin, and 5-HT3 antagonists like alosetron ; for constipation-predominant IBS (IBS-C), treatments include fiber, laxatives, lubiprostone, and linaclotide [26491416, 15467518, 26491416].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26491416", "evidence_support": "For patients with diarrhea-predominant IBS, treatment options include the synthetic peripheral \u03bc-opioid receptor agonist loperamide, antispasmodic agents, antidepressants, serotonin 5-HT3 antagonists, and the gut-specific antibiotic rifaximin.", "evidence_relation": "supporting" }, { "cited_pmid": "26491416", "evidence_support": "For patients with constipation-predominant IBS, therapeutic strategies may include dietary fiber, laxatives, and the prosecretory agents lubiprostone and linaclotide.", "evidence_relation": "supporting" }, { "cited_pmid": "15467518", "evidence_support": "Treatment strategies for IBS are currently directed at the predominant symptoms. In diarrhea-predominant IBS, opioids (e.g. loperamide) and the 5-HT(3) receptor antagonist alosetron are efficacious. In constipation-predominant IBS, fiber and bulk laxatives are traditionally used, but their efficacy is variable and may worsen symptoms.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Antispasmodics and antidepressants can alleviate abdominal pain, though evidence varies [16836950, 15467518].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15467518", "evidence_support": "In patients with IBS and abdominal pain, antispasmodics and antidepressants can be used, with the best evidence supporting the prescription of tricyclic antidepressants.", "evidence_relation": "supporting" }, { "cited_pmid": "16836950", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Dietary modifications, such as low-FODMAP diets, and psychological therapies, including cognitive behavioral therapy, are also beneficial [30466670, 31820883].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30466670", "evidence_support": "Low-FODMAP diets have been helpful in providing symptom relief, as have cognitive behavioral and mind-body techniques that help patients manage symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "31820883", "evidence_support": "In general, lifestyle and dietary changes, including the low-FODMAP of gluten-free diet, are the first-in-line treatment for all patients. Issues with dietary changes are the strict elimination of multiple food products and hence difficult compliance to the diet.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Emerging therapies and probiotics show promise but require further validation [26491416, 21927652].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26491416", "evidence_support": "Recent data suggest that a gluten-free diet and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may benefit some patients.", "evidence_relation": "neutral" }, { "cited_pmid": "21927652", "evidence_support": "Finally, several emerging therapies with novel mechanisms of action are in development. Complementary and alternative medicine therapies including probiotics, herbal therapies and acupuncture are gaining popularity among IBS sufferers, although concerns regarding manufacturing standards and the paucity of high quality efficacy and safety data remain.", "evidence_relation": "supporting" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by chronic abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [26491416, 30466670, 16836950]. The symptoms can vary among patients and change over time, making treatment challenging [24944467]. Treatment strategies are focused on specific symptoms, and a stepwise management approach is advocated, starting with general management principles, including dietary and lifestyle advice [28403981]. Pharmacotherapy is typically targeted against the predominant symptom, such as antispasmodics and antidepressants for abdominal pain, and laxatives or prokinetics for constipation [21180545, 31820883, 21616041]. Emerging data have confirmed the efficacy of antidepressants, psychological therapies, 5-HT(3) antagonists, 5-HT(4) agonists, and probiotics in the short-term treatment of IBS [21694813, 20011349]. A low fermentable oligosaccharides, disaccharides, monosaccharides, polyols (FODMAP) diet may also improve global symptoms [33315591].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by chronic abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [26491416, 30466670, 16836950].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26491416", "evidence_support": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with abdominal pain, diarrhea, constipation, or a mix of symptoms. ", "evidence_relation": "supporting" }, { "cited_pmid": "26491416", "evidence_support": "Recent data suggest that a gluten-free diet and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may benefit some patients.", "evidence_relation": "neutral" }, { "cited_pmid": "30466670", "evidence_support": "Irritable bowel syndrome (IBS) is present in patients with symptoms of chronic abdominal pain and altered bowel habits but no identifiable organic etiology.", "evidence_relation": "supporting" }, { "cited_pmid": "30466670", "evidence_support": "Low-FODMAP diets have been helpful in providing symptom relief, as have cognitive behavioral and mind-body techniques that help patients manage symptoms. Targeted symptomatic relief for the patient's predominant symptoms provides relief in addition to effective older medications that are inexpensive and reliable. ", "evidence_relation": "neutral" }, { "cited_pmid": "16836950", "evidence_support": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that can present with a wide array of symptoms that make treatment difficult. Current therapies are directed at relieving symptoms of abdominal pain or discomfort, bloating, constipation, and diarrhea.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The symptoms can vary among patients and change over time, making treatment challenging [24944467].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "24944467", "evidence_support": "IBS is a clinical diagnosis and presents as one of the three predominant subtypes: (1) IBS with constipation (IBS-C); (2) IBS with diarrhea (IBS-D); and (3) mixed IBS (IBS-M); former ROME definitions refer to IBS-M as alternating IBS (IBS-A).", "evidence_relation": "neutral" }, { "cited_pmid": "24944467", "evidence_support": "Across the IBS subtypes, the presentation of symptoms may vary among patients and change over time. Patients report the most distressing symptoms to be abdominal pain, straining, myalgias, urgency, bloating and feelings of serious illness. The complexity and diversity of IBS presentation makes treatment difficult.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Treatment strategies are focused on specific symptoms, and a stepwise management approach is advocated, starting with general management principles, including dietary and lifestyle advice [28403981].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28403981", "evidence_support": "A stepwise management approach is advocated for patients with IBS. For a substantial proportion of patients with mild symptoms, general management principles, including making a confident diagnosis and offering explanation, reassurance, and dietary and lifestyle advice, are sufficient.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Pharmacotherapy is typically targeted against the predominant symptom, such as antispasmodics and antidepressants for abdominal pain, and laxatives or prokinetics for constipation [21180545, 31820883, 21616041].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21180545", "evidence_support": "Although all patients with IBS have symptoms of abdominal pain and disordered defecation, treatment needs to be individualized and should focus on the predominant symptom", "evidence_relation": "supporting" }, { "cited_pmid": "21180545", "evidence_support": "This paper will review therapeutic options for the treatment of IBS using a tailored approach based on the predominant symptom. Abdominal pain, bloating, constipation and diarrhea are the four main symptoms that can be addressed using a combination of dietary interventions and medications. Treatment options include probiotics, antibiotics, tricyclic antidepressants, selective serotonin reuptake inhibitors and agents that modulate chloride channels and serotonin.", "evidence_relation": "supporting" }, { "cited_pmid": "31820883", "evidence_support": "Laxatives or prokinetics and antidiarrheals are used to treat constipation and diarrhea respectively, but have little effect on abdominal pain. To treat gastro-intestinal (GI) symptoms, antispasmodics can be attributed.", "evidence_relation": "supporting" }, { "cited_pmid": "21616041", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Emerging data have confirmed the efficacy of antidepressants, psychological therapies, 5-HT(3) antagonists, 5-HT(4) agonists, and probiotics in the short-term treatment of IBS [21694813, 20011349].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21694813", "evidence_support": "In recent years, emerging data have confirmed the efficacy of antidepressants, psychological therapies, 5-HT(3) antagonists, 5-HT(4) agonists, and probiotics in the short-term treatment of IBS, although whether these therapies influence the long-term course of the disease is unknown.", "evidence_relation": "supporting" }, { "cited_pmid": "20011349", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "A low fermentable oligosaccharides, disaccharides, monosaccharides, polyols (FODMAP) diet may also improve global symptoms [33315591].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33315591", "evidence_support": "We recommend a limited trial of a low fermentable oligosaccharides, disacchardies, monosaccharides, polyols (FODMAP) diet in patients with IBS to improve global symptoms. ", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract characterized by abdominal pain and altered bowel habits, including diarrhea, constipation, or alternating diarrhea and constipation [21180545, 16370407, 15324713]. Other common symptoms include bloating, abdominal distension, the sensation of incomplete evacuation, and the increased passage of mucus [15324713, 15767561]. The goals of treatment are symptom relief and improved quality of life [20074154, 27592867, 16368443]. Treatment options include lifestyle and dietary changes, such as a low-FODMAP diet, fiber supplements, antispasmodic agents, antidepressants, and probiotics [30466670, 33049223, 30817479]. Pharmacological treatments include antidiarrheal agents, laxatives, and medications that modulate the effects of serotonin [17597676, 16370407, 16368443]. Alternative therapies, such as cognitive behavioral therapy, hypnotherapy, and acupuncture, may also be effective in managing symptoms [30466670, 33049223, 15861740]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract characterized by abdominal pain and altered bowel habits, including diarrhea, constipation, or alternating diarrhea and constipation [21180545, 16370407, 15324713].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21180545", "evidence_support": "Irritable bowel syndrome (IBS) is a highly prevalent functional bowel disorder routinely encountered by healthcare providers.", "evidence_relation": "supporting" }, { "cited_pmid": "21180545", "evidence_support": "Although all patients with IBS have symptoms of abdominal pain and disordered defecation, treatment needs to be individualized and should focus on the predominant symptom", "evidence_relation": "supporting" }, { "cited_pmid": "16370407", "evidence_support": "Irritable bowel syndrome affects 10 to 15 percent of the U.S. population to some degree. This condition is defined as abdominal pain and discomfort with altered bowel habits in the absence of any other mechanical, inflammatory, or biochemical explanation for these symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "15324713", "evidence_support": "The irritable bowel syndrome (IBS) is part of the spectrum of functional bowel disorders characterised by a diverse consortium of abdominal symptoms including abdominal pain, altered bowel function (bowel frequency and/or constipation), bloating, abdominal distension, the sensation of incomplete evacuation and the increased passage of mucus.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Other common symptoms include bloating, abdominal distension, the sensation of incomplete evacuation, and the increased passage of mucus [15324713, 15767561].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15324713", "evidence_support": "The irritable bowel syndrome (IBS) is part of the spectrum of functional bowel disorders characterised by a diverse consortium of abdominal symptoms including abdominal pain, altered bowel function (bowel frequency and/or constipation), bloating, abdominal distension, the sensation of incomplete evacuation and the increased passage of mucus.", "evidence_relation": "supporting" }, { "cited_pmid": "15767561", "evidence_support": "It is characterized by chronic abdominal pain or discomfort associated with disordered bowel habit and visceral hypersensitivity.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The goals of treatment are symptom relief and improved quality of life [20074154, 27592867, 16368443].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "20074154", "evidence_support": "Because the pathophysiology and causes of IBS are poorly understood, treatment approaches are mainly focused on symptom management to maintain everyday functioning and improve quality of life for persons with IBS. ", "evidence_relation": "supporting" }, { "cited_pmid": "27592867", "evidence_support": "Treatment is recommended on a symptom-based approach targeting the dominating symptom/symptoms. If symptoms are reduced, the quality of life is considerably improved.", "evidence_relation": "supporting" }, { "cited_pmid": "16368443", "evidence_support": "Irritable bowel syndrome (IBS) is associated with a substantial burden on individual patients, health care systems, and society as a whole.", "evidence_relation": "neutral" }, { "cited_pmid": "16368443", "evidence_support": "Symptoms of IBS vary with each patient and disease episode. Although improvement in individual IBS symptoms is desirable, the overall goal in managing patients with IBS is to achieve global symptom improvement. Traditional IBS therapies (ie, psychotherapy/behavioral therapy, bulking agents, antidiarrheals, antispasmodics, and tricyclic antidepressants) have lacked demonstrable efficacy in randomized controlled trials. ", "evidence_relation": "supporting" }, { "cited_pmid": "16368443", "evidence_support": "IBS-specific agents offer an opportunity for patients with IBS to achieve global symptom improvement. However, when weighing the costs and potential risks against the potential benefits, clinicians should consider the nature and severity of the patient's symptoms, the degree of functional impairment, and the presence of psychosocial comorbidities.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Treatment options include lifestyle and dietary changes, such as a low-FODMAP diet, fiber supplements, antispasmodic agents, antidepressants, and probiotics [30466670, 33049223, 30817479].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30466670", "evidence_support": "Low-FODMAP diets have been helpful in providing symptom relief, as have cognitive behavioral and mind-body techniques that help patients manage symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "33049223", "evidence_support": "The mainstays of treatment include patient education about the condition, dietary changes, soluble fibre, and antispasmodic drugs.", "evidence_relation": "supporting" }, { "cited_pmid": "30817479", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Pharmacological treatments include antidiarrheal agents, laxatives, and medications that modulate the effects of serotonin [17597676, 16370407, 16368443].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17597676", "evidence_support": "One of the major advancements in the treatment of patients with IBS has been the development of US Food and Drug Administration--approved serotonergic therapeutics that specifically target the underlying causes of IBS and provide multisymptom relief by improving gastrointestinal function.", "evidence_relation": "supporting" }, { "cited_pmid": "16370407", "evidence_support": "Antispasmodic agents may be used as needed, but anticholinergic and other side effects limit their use in some patients. Loperamide is an option for treatment of moderately severe diarrhea. Antidepressants have been shown to relieve pain and may be effective in low doses.", "evidence_relation": "supporting" }, { "cited_pmid": "16370407", "evidence_support": "Tegaserod has an advantage over placebo in constipation-predominant irritable bowel syndrome; it is indicated for up to 12 weeks of treatment in women.", "evidence_relation": "neutral" }, { "cited_pmid": "16368443", "evidence_support": "Traditional IBS therapies (ie, psychotherapy/behavioral therapy, bulking agents, antidiarrheals, antispasmodics, and tricyclic antidepressants) have lacked demonstrable efficacy in randomized controlled trials.", "evidence_relation": "neutral" }, { "cited_pmid": "16368443", "evidence_support": "In clinical trials, IBS-specific treatments (ie, agents that affect serotonergic pathways) have been associated with significant improvements in global symptoms.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Alternative therapies, such as cognitive behavioral therapy, hypnotherapy, and acupuncture, may also be effective in managing symptoms [30466670, 33049223, 15861740].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30466670", "evidence_support": "Low-FODMAP diets have been helpful in providing symptom relief, as have cognitive behavioral and mind-body techniques that help patients manage symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "33049223", "evidence_support": "Other treatments tend to be reserved for people with severe symptoms and include central neuromodulators, intestinal secretagogues, drugs acting on opioid or 5-HT receptors, or minimally absorbed antibiotics (all of which are selected according to predominant bowel habit), as well as psychological therapies.", "evidence_relation": "supporting" }, { "cited_pmid": "15861740", "evidence_support": "However, diet, bulking agents, antispasmodics and a variety of alternative therapies including herbs, probiotics, and psychological intervention are important in individual patients.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "The symptoms of irritable bowel syndrome (IBS) include abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [28224836, 15324713, 15335409]. The condition affects between 5% and 10% of otherwise healthy individuals at any one point in time and, in most people, runs a relapsing and remitting course [28224836, 24124703, 17597676]. The best described risk factor is acute enteric infection, but IBS is also more common in people with psychological comorbidity and in young adult women than in the rest of the general population [24124703, 22963061, 17597676]. The pathophysiology of IBS is incompletely understood, but it is well established that there is disordered communication between the gut and the brain, leading to motility disturbances, visceral hypersensitivity, and altered CNS processing [24124703, 17597676, 21180545]. Treatment options for IBS include patient education about the condition, dietary changes, soluble fiber, and antispasmodic drugs [28403981, 15605117, 15335409].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The symptoms of irritable bowel syndrome (IBS) include abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [28224836, 15324713, 15335409].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28224836", "evidence_support": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder.", "evidence_relation": "neutral" }, { "cited_pmid": "15324713", "evidence_support": "The irritable bowel syndrome (IBS) is part of the spectrum of functional bowel disorders characterised by a diverse consortium of abdominal symptoms including abdominal pain, altered bowel function (bowel frequency and/or constipation), bloating, abdominal distension, the sensation of incomplete evacuation and the increased passage of mucus.", "evidence_relation": "supporting" }, { "cited_pmid": "15335409", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The condition affects between 5% and 10% of otherwise healthy individuals at any one point in time and, in most people, runs a relapsing and remitting course [28224836, 24124703, 17597676].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "28224836", "evidence_support": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder.", "evidence_relation": "neutral" }, { "cited_pmid": "17597676", "evidence_support": "Irritable bowel syndrome (IBS) is a difficult disease to treat because of its ill-defined triggers, variable clinical course, and unpredictable myriad of symptoms of varying severity.", "evidence_relation": "neutral" }, { "cited_pmid": "24124703", "evidence_support": "The diagnosis of irritable bowel syndrome (IBS) should be considered when patients have had abdominal pain/discomfort, bloating, and change in bowel habits for 6 months. Patients may experience variation between periods of constipation and diarrhea.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The best described risk factor is acute enteric infection, but IBS is also more common in people with psychological comorbidity and in young adult women than in the rest of the general population [24124703, 22963061, 17597676].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "17597676", "evidence_support": "Irritable bowel syndrome (IBS) is a difficult disease to treat because of its ill-defined triggers, variable clinical course, and unpredictable myriad of symptoms of varying severity.", "evidence_relation": "neutral" }, { "cited_pmid": "22963061", "evidence_support": "In North America, the prevalence of irritable bowel syndrome is 5 to 10 percent with peak prevalence from 20 to 39 years of age.", "evidence_relation": "neutral" }, { "cited_pmid": "24124703", "evidence_support": "When evaluating patients with IBS, physicians should be alert for red flag symptoms, such as rectal bleeding, anemia, nighttime pain, and weight loss.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The pathophysiology of IBS is incompletely understood, but it is well established that there is disordered communication between the gut and the brain, leading to motility disturbances, visceral hypersensitivity, and altered CNS processing [24124703, 17597676, 21180545].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24124703", "evidence_support": "Various etiologic mechanisms have been proposed for IBS, including abnormal bowel motility, inflammation, altered mucosal permeability, genetic predisposition, and visceral hypersensitivity.", "evidence_relation": "supporting" }, { "cited_pmid": "21180545", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "17597676", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Treatment options for IBS include patient education about the condition, dietary changes, soluble fiber, and antispasmodic drugs [28403981, 15605117, 15335409].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28403981", "evidence_support": "For a substantial proportion of patients with mild symptoms, general management principles, including making a confident diagnosis and offering explanation, reassurance, and dietary and lifestyle advice, are sufficient.", "evidence_relation": "supporting" }, { "cited_pmid": "15605117", "evidence_support": "Current therapeutic treatments include the use of fiber supplements, antidiarrheal agents, laxatives, antispasmodics, tricyclic antidepressants and serotonergic agents", "evidence_relation": "supporting" }, { "cited_pmid": "15335409", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder characterized by multiple symptoms, including abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [31700231, 17597676, 24379577]. The exact cause is unknown, but it is believed to be related to a combination of factors, including genetic predisposition, sensomotoric dysfunction, altered enteric inflammation, and immune activation, as well as disturbance of the brain-gut interaction [25734736, 17663206]. Diagnosis is typically made on clinical grounds, using symptom-based criteria such as the Rome criteria, and excluding organic disease [22963061, 34128613, 16042907]. Treatment options are varied and often focused on symptom relief, including lifestyle modifications, dietary changes, fiber supplements, antispasmodics, antidiarrheals, laxatives, and probiotics [33651094, 25734736, 28403981]. In some cases, antidepressants, psychological therapies, and alternative treatments such as acupuncture and hypnotherapy may also be effective [33049223, 21616041, 15717250]. A stepwise management approach is often advocated, starting with general management principles and progressing to pharmacotherapy and combination therapies as needed [33049223, 20074154, 21616041]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder characterized by multiple symptoms, including abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [31700231, 17597676, 24379577].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31700231", "evidence_support": "These include diarrhea-predominant and constipation-predominant IBS, as well as the mixed type, a combination of the two", "evidence_relation": "neutral" }, { "cited_pmid": "24379577", "evidence_support": "Its management accounts for up to 25% of a gastroenterologist's workload in the outpatient department, and the main symptoms are abdominal pain, bloating, and altered bowel habits.", "evidence_relation": "supporting" }, { "cited_pmid": "17597676", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The exact cause is unknown, but it is believed to be related to a combination of factors, including genetic predisposition, sensomotoric dysfunction, altered enteric inflammation, and immune activation, as well as disturbance of the brain-gut interaction [25734736, 17663206].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "25734736", "evidence_support": "Factors important to the development of IBS include alterations in the gut microbiome, intestinal permeability, gut immune function, motility, visceral sensation, brain-gut interactions, and psychosocial status", "evidence_relation": "supporting" }, { "cited_pmid": "17663206", "evidence_support": "Genetic predisposition, sensomotoric dysfunction, altered enteric inflammation and immune activation and disturbance of the brain-gut interaction are the most important pathogenetic factors.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Diagnosis is typically made on clinical grounds, using symptom-based criteria such as the Rome criteria, and excluding organic disease [22963061, 34128613, 16042907].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "22963061", "evidence_support": "Irritable bowel syndrome is defined as abdominal discomfort or pain associated with altered bowel habits for at least three days per month in the previous three months, with the absence of organic disease.", "evidence_relation": "neutral" }, { "cited_pmid": "34128613", "evidence_support": "Patients who meet symptom-based criteria and have no alarm features may be confidently diagnosed with few, if any, additional tests. ", "evidence_relation": "supporting" }, { "cited_pmid": "16042907", "evidence_support": "Symptom-based criteria and a limited medical evaluation are used for diagnosis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Treatment options are varied and often focused on symptom relief, including lifestyle modifications, dietary changes, fiber supplements, antispasmodics, antidiarrheals, laxatives, and probiotics [33651094, 25734736, 28403981].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33651094", "evidence_support": "The initial treatment plan should include patient education, reassurance, and first-line treatments such as fiber and osmotic laxatives for constipation, opioids for diarrhea, antispasmodics for pain and for management of associated psychological disorders", "evidence_relation": "supporting" }, { "cited_pmid": "25734736", "evidence_support": "Various dietary, lifestyle, medical, and behavioral interventions have proven effective in randomized clinical trials.", "evidence_relation": "supporting" }, { "cited_pmid": "28403981", "evidence_support": "In these patients, use of pharmacotherapy on the basis of the predominant symptom (constipation, diarrhoea, pain, or bloating) or combination of symptoms is the next step.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In some cases, antidepressants, psychological therapies, and alternative treatments such as acupuncture and hypnotherapy may also be effective [33049223, 21616041, 15717250].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33049223", "evidence_support": "Other treatments tend to be reserved for people with severe symptoms and include central neuromodulators, intestinal secretagogues, drugs acting on opioid or 5-HT receptors, or minimally absorbed antibiotics (all of which are selected according to predominant bowel habit), as well as psychological therapies.", "evidence_relation": "supporting" }, { "cited_pmid": "21616041", "evidence_support": "Where these fail, emerging data have confirmed the efficacy of antidepressants, drugs acting on the 5-hydroxytryptamine receptor, and probiotics in the short-term treatment of IBS.", "evidence_relation": "supporting" }, { "cited_pmid": "15717250", "evidence_support": "Regarding treatment, life style advice such as avoidance of specific nutrients that precipitate or aggravate or the \"little psychotherapy\" (addressing patients concerns and anxiety regarding the symptoms) are considered essential.", "evidence_relation": "supporting" }, { "cited_pmid": "15717250", "evidence_support": "Evidence-based pharmacological interventions include herbal preparations, spasmolytics, low dose tricyclic antidepressants and 5-HT-3-receptor antagonists and 5-HT-4-receptor agonists.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "A stepwise management approach is often advocated, starting with general management principles and progressing to pharmacotherapy and combination therapies as needed [33049223, 20074154, 21616041].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33049223", "evidence_support": "The mainstays of treatment include patient education about the condition, dietary changes, soluble fibre, and antispasmodic drugs.", "evidence_relation": "supporting" }, { "cited_pmid": "33049223", "evidence_support": "Other treatments tend to be reserved for people with severe symptoms and include central neuromodulators, intestinal secretagogues, drugs acting on opioid or 5-HT receptors, or minimally absorbed antibiotics (all of which are selected according to predominant bowel habit), as well as psychological therapies", "evidence_relation": "supporting" }, { "cited_pmid": "20074154", "evidence_support": "The mainstay of intervention is pharmacological treatment with antispasmodics and antidiarrheals for diarrhea, prokinetics and high-fiber diets for constipation, and supportive therapy with low-dose antidepressants to normalize gastrointestinal motility. Other interventions include lifestyle and dietary changes, psychotherapy, herbal therapies and acupuncture.", "evidence_relation": "contradicting" }, { "cited_pmid": "21616041", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder characterized by multiple symptoms, including abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [16042907, 27159638, 34238582]. The exact cause is unknown, but it is believed to be related to a combination of factors, including genetic predisposition, sensomotoric dysfunction, altered enteric inflammation, and immune activation, as well as disturbance of the brain-gut interaction [17663206, 28404070]. Diagnosis is typically made on clinical grounds, using symptom-based criteria such as the Rome criteria, and excluding organic disease [21616041, 16042907, 34128613]. Treatment options are varied and often focused on symptom relief, including lifestyle modifications, dietary changes, fiber supplements, antispasmodics, antidiarrheals, laxatives, and probiotics [31820883, 33651094, 15324713]. In some cases, antidepressants, psychological therapies, and alternative treatments such as acupuncture and hypnotherapy may also be effective [20074154, 28403981]. A stepwise management approach is often advocated, starting with general management principles and progressing to pharmacotherapy and combination therapies as needed [21616041, 28403981]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder characterized by multiple symptoms, including abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [16042907, 27159638, 34238582].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16042907", "evidence_support": "Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with a wide variety of presentations that may include abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits.", "evidence_relation": "supporting" }, { "cited_pmid": "27159638", "evidence_support": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high population prevalence.", "evidence_relation": "neutral" }, { "cited_pmid": "27159638", "evidence_support": "Clinical symptoms of IBS include abdominal pain or discomfort, stool irregularities and bloating, as well as other somatic, visceral and psychiatric comorbidities.", "evidence_relation": "supporting" }, { "cited_pmid": "34238582", "evidence_support": "Irritable bowel syndrome is one of the most common functional bowel disorders, and has a substantial impact on patients' daily lives, as well as a big economic impact on society. It is characterised by abdominal pain, bloating and abdominal distention and altered bowel movements, with a predominance of diarrhoea, constipation, or alternation of these signs, which cannot be explained by a structural or biochemical abnormality. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The exact cause is unknown, but it is believed to be related to a combination of factors, including genetic predisposition, sensomotoric dysfunction, altered enteric inflammation, and immune activation, as well as disturbance of the brain-gut interaction [17663206, 28404070].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17663206", "evidence_support": "Genetic predisposition, sensomotoric dysfunction, altered enteric inflammation and immune activation and disturbance of the brain-gut interaction are the most important pathogenetic factors.", "evidence_relation": "supporting" }, { "cited_pmid": "28404070", "evidence_support": "Underlying mechanisms that could lead to irritable bowel syndrome include genetic factors (most notably an identified mutation of SCN5A); post-infectious changes, chronic infections and disturbances in the intestinal microbiota; low-grade mucosal inflammation, immune activation, and altered intestinal permeability; disordered bile salt metabolism (in 10-20% of cases with diarrhoea); abnormalities in serotonin metabolism; and alterations in brain function, which could be primary or secondary factors.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Diagnosis is typically made on clinical grounds, using symptom-based criteria such as the Rome criteria, and excluding organic disease [21616041, 16042907, 34128613].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "21616041", "evidence_support": "The diagnosis should be made on clinical grounds, using symptom-based criteria such as the Manning or Rome criteria, unless symptoms are thought to be atypical.", "evidence_relation": "supporting" }, { "cited_pmid": "16042907", "evidence_support": "Symptom-based criteria and a limited medical evaluation are used for diagnosis.", "evidence_relation": "supporting" }, { "cited_pmid": "34128613", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Treatment options are varied and often focused on symptom relief, including lifestyle modifications, dietary changes, fiber supplements, antispasmodics, antidiarrheals, laxatives, and probiotics [31820883, 33651094, 15324713].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31820883", "evidence_support": "Due to the heterogeneity of the disorder, finding the correct treatment option is often challenging. In general, lifestyle and dietary changes, including the low-FODMAP of gluten-free diet, are the first-in-line treatment for all patients. Issues with dietary changes are the strict elimination of multiple food products and hence difficult compliance to the diet. When lifestyle changes do not lead to adequate symptom relief, patients should be treated according to their predominant bowel habits and most prominent symptoms. Laxatives or prokinetics and antidiarrheals are used to treat constipation and diarrhea respectively, but have little effect on abdominal pain. To treat gastro-intestinal (GI) symptoms, antispasmodics can be attributed. Low doses of neuromodulators can help gain control over GI and central symptoms, but are also prone to more severe side effects, restricting their widespread use. Refractory IBS symptoms can be treated with probiotics, antibiotics, histamine-receptor antagonists or alternative therapy, including psychotherapy, hypnotherapy, acupuncture or phytomedicines. ", "evidence_relation": "supporting" }, { "cited_pmid": "33651094", "evidence_support": "Traditionally, the diagnosis of IBS has been based on the positive identification of symptoms that correlate with several different syndromes associated with disorders such as IBS diarrhea, IBS constipation, functional diarrhea, functional constipation, chronic functional abdominal pain, or bloating.", "evidence_relation": "neutral" }, { "cited_pmid": "33651094", "evidence_support": "The initial treatment plan should include patient education, reassurance, and first-line treatments such as fiber and osmotic laxatives for constipation, opioids for diarrhea, antispasmodics for pain and for management of associated psychological disorders.", "evidence_relation": "supporting" }, { "cited_pmid": "15324713", "evidence_support": "Standard therapy generally involves a symptom-directed approach; anti-diarrhoeal agents for bowel frequency, soluble fibre or laxatives for constipation and smooth muscle relaxants and anti-spasmodics for pain.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In some cases, antidepressants, psychological therapies, and alternative treatments such as acupuncture and hypnotherapy may also be effective [20074154, 28403981].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20074154", "evidence_support": "IBS is characterized by a symptom complex of abdominal pain and abnormal bowel habits that present as diarrhea or constipation, and general physical weakness in the absence of abnormal morphological, histological or inflammatory markers.", "evidence_relation": "neutral" }, { "cited_pmid": "20074154", "evidence_support": "Other interventions include lifestyle and dietary changes, psychotherapy, herbal therapies and acupuncture.", "evidence_relation": "supporting" }, { "cited_pmid": "28403981", "evidence_support": "For patients with symptoms that are refractory to these initial treatment options and those who have comorbid conditions or psychological symptoms, a combination of therapies should be used, and the use of psychotropic drugs and psychological treatment alternatives is often effective.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "A stepwise management approach is often advocated, starting with general management principles and progressing to pharmacotherapy and combination therapies as needed [21616041, 28403981].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28403981", "evidence_support": "Irritable bowel syndrome (IBS) is one of the most common functional gastrointestinal disorders. A stepwise management approach is advocated for patients with IBS. For a substantial proportion of patients with mild symptoms, general management principles, including making a confident diagnosis and offering explanation, reassurance, and dietary and lifestyle advice, are sufficient.", "evidence_relation": "supporting" }, { "cited_pmid": "28403981", "evidence_support": "In these patients, use of pharmacotherapy on the basis of the predominant symptom (constipation, diarrhoea, pain, or bloating) or combination of symptoms is the next step.", "evidence_relation": "supporting" }, { "cited_pmid": "21616041", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder characterized by multiple symptoms, including abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [27159638, 34238582, 16042907]. The exact cause is unknown, but it is believed to be related to a combination of factors, including genetic predisposition, sensomotoric dysfunction, altered enteric inflammation, and immune activation, as well as disturbance of the brain-gut interaction [18952527, 28404070, 25734736]. Diagnosis is typically made on clinical grounds, using symptom-based criteria such as the Rome criteria, and excluding organic disease [34128613, 21616041, 16042907]. Treatment options are varied and often focused on symptom relief, including lifestyle modifications, dietary changes, fiber supplements, antispasmodics, antidiarrheals, laxatives, and probiotics [33651094, 15324713, 31820883]. In some cases, antidepressants, psychological therapies, and alternative treatments such as acupuncture and hypnotherapy may also be effective [22963061, 28403981, 21616041]. A stepwise management approach is often advocated, starting with general management principles and progressing to pharmacotherapy and combination therapies as needed [28403981, 21616041, 20074154]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder characterized by multiple symptoms, including abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [27159638, 34238582, 16042907].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27159638", "evidence_support": "Clinical symptoms of IBS include abdominal pain or discomfort, stool irregularities and bloating, as well as other somatic, visceral and psychiatric comorbidities. ", "evidence_relation": "supporting" }, { "cited_pmid": "34238582", "evidence_support": "Irritable bowel syndrome is one of the most common functional bowel disorders, and has a substantial impact on patients' daily lives, as well as a big economic impact on society. It is characterised by abdominal pain, bloating and abdominal distention and altered bowel movements, with a predominance of diarrhoea, constipation, or alternation of these signs, which cannot be explained by a structural or biochemical abnormality.", "evidence_relation": "supporting" }, { "cited_pmid": "16042907", "evidence_support": "Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with a wide variety of presentations that may include abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The exact cause is unknown, but it is believed to be related to a combination of factors, including genetic predisposition, sensomotoric dysfunction, altered enteric inflammation, and immune activation, as well as disturbance of the brain-gut interaction [18952527, 28404070, 25734736].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "28404070", "evidence_support": "Underlying mechanisms that could lead to irritable bowel syndrome include genetic factors (most notably an identified mutation of SCN5A); post-infectious changes, chronic infections and disturbances in the intestinal microbiota; low-grade mucosal inflammation, immune activation, and altered intestinal permeability; disordered bile salt metabolism (in 10-20% of cases with diarrhoea); abnormalities in serotonin metabolism; and alterations in brain function, which could be primary or secondary factors.", "evidence_relation": "supporting" }, { "cited_pmid": "25734736", "evidence_support": "Factors important to the development of IBS include alterations in the gut microbiome, intestinal permeability, gut immune function, motility, visceral sensation, brain-gut interactions, and psychosocial status.", "evidence_relation": "supporting" }, { "cited_pmid": "18952527", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Diagnosis is typically made on clinical grounds, using symptom-based criteria such as the Rome criteria, and excluding organic disease [34128613, 21616041, 16042907].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34128613", "evidence_support": "Patients who meet symptom-based criteria and have no alarm features may be confidently diagnosed with few, if any, additional tests.", "evidence_relation": "supporting" }, { "cited_pmid": "21616041", "evidence_support": "The diagnosis should be made on clinical grounds, using symptom-based criteria such as the Manning or Rome criteria, unless symptoms are thought to be atypical. Excluding celiac disease in all patients consulting with symptoms suggestive of IBS is worthwhile, but evidence for performing other investigations to exclude organic disease is not convincing.", "evidence_relation": "supporting" }, { "cited_pmid": "16042907", "evidence_support": "Symptom-based criteria and a limited medical evaluation are used for diagnosis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Treatment options are varied and often focused on symptom relief, including lifestyle modifications, dietary changes, fiber supplements, antispasmodics, antidiarrheals, laxatives, and probiotics [33651094, 15324713, 31820883].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33651094", "evidence_support": "The initial treatment plan should include patient education, reassurance, and first-line treatments such as fiber and osmotic laxatives for constipation, opioids for diarrhea, antispasmodics for pain and for management of associated psychological disorders.", "evidence_relation": "supporting" }, { "cited_pmid": "15324713", "evidence_support": "There is currently no universally effective therapy for IBS. Standard therapy generally involves a symptom-directed approach; anti-diarrhoeal agents for bowel frequency, soluble fibre or laxatives for constipation and smooth muscle relaxants and anti-spasmodics for pain.", "evidence_relation": "supporting" }, { "cited_pmid": "31820883", "evidence_support": "When lifestyle changes do not lead to adequate symptom relief, patients should be treated according to their predominant bowel habits and most prominent symptoms. Laxatives or prokinetics and antidiarrheals are used to treat constipation and diarrhea respectively,", "evidence_relation": "supporting" }, { "cited_pmid": "31820883", "evidence_support": "Refractory IBS symptoms can be treated with probiotics,", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In some cases, antidepressants, psychological therapies, and alternative treatments such as acupuncture and hypnotherapy may also be effective [22963061, 28403981, 21616041].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22963061", "evidence_support": "Treatment with antidepressants and psychological therapies are also effective for improving symptoms compared with usual care.", "evidence_relation": "supporting" }, { "cited_pmid": "28403981", "evidence_support": "For patients with symptoms that are refractory to these initial treatment options and those who have comorbid conditions or psychological symptoms, a combination of therapies should be used, and the use of psychotropic drugs and psychological treatment alternatives is often effective.", "evidence_relation": "supporting" }, { "cited_pmid": "21616041", "evidence_support": "Where these fail, emerging data have confirmed the efficacy of antidepressants, drugs acting on the 5-hydroxytryptamine receptor, and probiotics in the short-term treatment of IBS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "A stepwise management approach is often advocated, starting with general management principles and progressing to pharmacotherapy and combination therapies as needed [28403981, 21616041, 20074154].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28403981", "evidence_support": "A stepwise management approach is advocated for patients with IBS. For a substantial proportion of patients with mild symptoms, general management principles, including making a confident diagnosis and offering explanation, reassurance, and dietary and lifestyle advice, are sufficient. However, many patients continue to have moderate-to-severe symptoms and are not satisfied solely with this approach. In these patients, use of pharmacotherapy on the basis of the predominant symptom (constipation, diarrhoea, pain, or bloating) or combination of symptoms is the next step.", "evidence_relation": "supporting" }, { "cited_pmid": "21616041", "evidence_support": "The aim should be to improve the predominant symptom reported by the patient. Fiber, peppermint oil, or antispasmodic agents are beneficial as first-line therapies in some patients. Where these fail, emerging data have confirmed the efficacy of antidepressants, drugs acting on the 5-hydroxytryptamine receptor, and probiotics in the short-term treatment of IBS. There are a number of novel therapies under development that show promise, including non-absorbable antibiotics, lubiprostone, and linaclotide.", "evidence_relation": "supporting" }, { "cited_pmid": "20074154", "evidence_support": "The mainstay of intervention is pharmacological treatment with antispasmodics and antidiarrheals for diarrhea, prokinetics and high-fiber diets for constipation, and supportive therapy with low-dose antidepressants to normalize gastrointestinal motility.", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder characterized by multiple symptoms, including abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [34238582, 27159638, 16042907]. The exact cause is unknown, but it is believed to be related to a combination of factors, including genetic predisposition, sensomotoric dysfunction, altered enteric inflammation, and immune activation, as well as disturbance of the brain-gut interaction [17663206, 25734736, 28404070]. Diagnosis is typically made on clinical grounds, using symptom-based criteria such as the Rome criteria, and excluding organic disease [21616041, 34128613, 16042907]. Treatment options are varied and often focused on symptom relief, including lifestyle modifications, dietary changes, fiber supplements, antispasmodics, antidiarrheals, laxatives, and probiotics [15324713, 33651094, 31820883]. In some cases, antidepressants, psychological therapies, and alternative treatments such as acupuncture and hypnotherapy may also be effective [24379577, 21616041, 15717250]. A stepwise management approach is often advocated, starting with general management principles and progressing to pharmacotherapy and combination therapies as needed [28403981, 20074154]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder characterized by multiple symptoms, including abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [34238582, 27159638, 16042907].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34238582", "evidence_support": "Irritable bowel syndrome is one of the most common functional bowel disorders, and has a substantial impact on patients' daily lives, as well as a big economic impact on society. It is characterised by abdominal pain, bloating and abdominal distention and altered bowel movements, with a predominance of diarrhoea, constipation, or alternation of these signs, which cannot be explained by a structural or biochemical abnormality.", "evidence_relation": "supporting" }, { "cited_pmid": "27159638", "evidence_support": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disease with a high population prevalence.", "evidence_relation": "neutral" }, { "cited_pmid": "27159638", "evidence_support": "Clinical symptoms of IBS include abdominal pain or discomfort, stool irregularities and bloating, as well as other somatic, visceral and psychiatric comorbidities.", "evidence_relation": "supporting" }, { "cited_pmid": "16042907", "evidence_support": "Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with a wide variety of presentations that may include abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The exact cause is unknown, but it is believed to be related to a combination of factors, including genetic predisposition, sensomotoric dysfunction, altered enteric inflammation, and immune activation, as well as disturbance of the brain-gut interaction [17663206, 25734736, 28404070].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "17663206", "evidence_support": "Genetic predisposition, sensomotoric dysfunction, altered enteric inflammation and immune activation and disturbance of the brain-gut interaction are the most important pathogenetic factors", "evidence_relation": "supporting" }, { "cited_pmid": "25734736", "evidence_support": "Factors important to the development of IBS include alterations in the gut microbiome, intestinal permeability, gut immune function, motility, visceral sensation, brain-gut interactions, and psychosocial status.", "evidence_relation": "supporting" }, { "cited_pmid": "28404070", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Diagnosis is typically made on clinical grounds, using symptom-based criteria such as the Rome criteria, and excluding organic disease [21616041, 34128613, 16042907].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21616041", "evidence_support": "The diagnosis should be made on clinical grounds, using symptom-based criteria such as the Manning or Rome criteria, unless symptoms are thought to be atypical.", "evidence_relation": "supporting" }, { "cited_pmid": "34128613", "evidence_support": "Patients who meet symptom-based criteria and have no alarm features may be confidently diagnosed with few, if any, additional tests. ", "evidence_relation": "contradicting" }, { "cited_pmid": "16042907", "evidence_support": "Symptom-based criteria and a limited medical evaluation are used for diagnosis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Treatment options are varied and often focused on symptom relief, including lifestyle modifications, dietary changes, fiber supplements, antispasmodics, antidiarrheals, laxatives, and probiotics [15324713, 33651094, 31820883].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15324713", "evidence_support": "Standard therapy generally involves a symptom-directed approach; anti-diarrhoeal agents for bowel frequency, soluble fibre or laxatives for constipation and smooth muscle relaxants and anti-spasmodics for pain.", "evidence_relation": "supporting" }, { "cited_pmid": "15324713", "evidence_support": "More speculative new therapeutic approaches include anti-inflammatory agents, antibiotics, probiotics, antagonists of CCK1 receptors, tachykinins and other novel neuronal receptors", "evidence_relation": "supporting" }, { "cited_pmid": "33651094", "evidence_support": "The initial treatment plan should include patient education, reassurance, and first-line treatments such as fiber and osmotic laxatives for constipation, opioids for diarrhea, antispasmodics for pain and for management of associated psychological disorders. ", "evidence_relation": "supporting" }, { "cited_pmid": "31820883", "evidence_support": "In general, lifestyle and dietary changes, including the low-FODMAP of gluten-free diet, are the first-in-line treatment for all patients. Issues with dietary changes are the strict elimination of multiple food products and hence difficult compliance to the diet. When lifestyle changes do not lead to adequate symptom relief, patients should be treated according to their predominant bowel habits and most prominent symptoms. Laxatives or prokinetics and antidiarrheals are used to treat constipation and diarrhea respectively, but have little effect on abdominal pain. To treat gastro-intestinal (GI) symptoms, antispasmodics can be attributed. Low doses of neuromodulators can help gain control over GI and central symptoms, but are also prone to more severe side effects, restricting their widespread use.", "evidence_relation": "supporting" }, { "cited_pmid": "31820883", "evidence_support": "Refractory IBS symptoms can be treated with probiotics, antibiotics, histamine-receptor antagonists or alternative therapy, including psychotherapy, hypnotherapy, acupuncture or phytomedicines", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In some cases, antidepressants, psychological therapies, and alternative treatments such as acupuncture and hypnotherapy may also be effective [24379577, 21616041, 15717250].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24379577", "evidence_support": "In recent years, there has been increasing evidence to suggest that psychological treatments, in particular cognitive-behavioral therapy (CBT), are effective for the management of IBS.", "evidence_relation": "supporting" }, { "cited_pmid": "21616041", "evidence_support": "emerging data have confirmed the efficacy of antidepressants, drugs acting on the 5-hydroxytryptamine receptor, and probiotics in the short-term treatment of IBS.", "evidence_relation": "supporting" }, { "cited_pmid": "15717250", "evidence_support": "\"little psychotherapy\" (addressing patients concerns and anxiety regarding the symptoms) are considered essential.", "evidence_relation": "supporting" }, { "cited_pmid": "15717250", "evidence_support": "Evidence-based pharmacological interventions include herbal preparations, spasmolytics, low dose tricyclic antidepressants and 5-HT-3-receptor antagonists and 5-HT-4-receptor agonists.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "A stepwise management approach is often advocated, starting with general management principles and progressing to pharmacotherapy and combination therapies as needed [28403981, 20074154].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28403981", "evidence_support": "A stepwise management approach is advocated for patients with IBS.", "evidence_relation": "supporting" }, { "cited_pmid": "28403981", "evidence_support": "For patients with symptoms that are refractory to these initial treatment options and those who have comorbid conditions or psychological symptoms, a combination of therapies should be used, and the use of psychotropic drugs and psychological treatment alternatives is often effective.", "evidence_relation": "supporting" }, { "cited_pmid": "20074154", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder characterized by multiple symptoms, including abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [33049223, 28541989, 16898604]. Treatment options are varied and often focused on symptom relief, including lifestyle modifications, dietary changes, fiber supplements, antispasmodics, antidiarrheals, laxatives, and probiotics [15324713]. In some cases, antidepressants, psychological therapies, and alternative treatments such as acupuncture and hypnotherapy may also be effective [35168522, 17365072]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder characterized by multiple symptoms, including abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [33049223, 28541989, 16898604].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33049223", "evidence_support": "Irritable bowel syndrome is a functional gastrointestinal disorder with symptoms including abdominal pain associated with a change in stool form or frequency.", "evidence_relation": "supporting" }, { "cited_pmid": "28541989", "evidence_support": "Irritable bowel syndrome (IBS) is a common, chronic gastrointestinal (GI) condition characterized by disturbances in bowel habits and abdominal pain in the absence of known organic pathology.", "evidence_relation": "supporting" }, { "cited_pmid": "16898604", "evidence_support": "Irritable bowel syndrome (IBS) is a disease entity characterized by recurrent abdominal pain or discomfort associated with altered bowel movement, in which no obvious pathogenetic lesion is identified to explain the symptoms.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Treatment options are varied and often focused on symptom relief, including lifestyle modifications, dietary changes, fiber supplements, antispasmodics, antidiarrheals, laxatives, and probiotics [15324713].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15324713", "evidence_support": "Standard therapy generally involves a symptom-directed approach; anti-diarrhoeal agents for bowel frequency, soluble fibre or laxatives for constipation and smooth muscle relaxants and anti-spasmodics for pain.", "evidence_relation": "supporting" }, { "cited_pmid": "15324713", "evidence_support": "More speculative new therapeutic approaches include anti-inflammatory agents, antibiotics, probiotics, antagonists of CCK1 receptors, tachykinins and other novel neuronal receptors.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In some cases, antidepressants, psychological therapies, and alternative treatments such as acupuncture and hypnotherapy may also be effective [35168522, 17365072].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35168522", "evidence_support": "It was emphasized that acupuncture combined with antidepressant pharmacological treatment not only enhanced the improvement of primary and secondary depressive symptoms but also reduced the side effects of the medical treatment, which is the main cause for high dropout rates with drug treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "17365072", "evidence_support": "This study represents the first controlled comparison of hypnotherapy with a well-established psychotherapy for depression, meeting the APA criteria for a \"probably efficacious\" treatment for depression.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder characterized by recurrent abdominal pain or discomfort associated with altered bowel movement [16898604, 26455114, 27159638]. The diagnostic criteria for IBS are entirely based on the subjective symptoms of the patients, which can include abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [16898604, 26455114, 27159638]. Postulated pathogenesis for IBS include motility disorder, visceral sensation abnormalities, complex relationship between brain and gut, relationship to personality, and post-infectious abnormalities in the colonic mucosa [16898604, 26455114, 27159638]. The exact cause is unknown, but it is believed to be related to a combination of factors, including genetic predisposition, sensomotoric dysfunction, altered enteric inflammation, and immune activation, as well as disturbance of the brain-gut interaction [24997032]. Diagnosis is typically made on clinical grounds, using symptom-based criteria such as the Rome criteria, and excluding organic disease [29072609].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder characterized by recurrent abdominal pain or discomfort associated with altered bowel movement [16898604, 26455114, 27159638].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16898604", "evidence_support": "Irritable bowel syndrome (IBS) is a disease entity characterized by recurrent abdominal pain or discomfort associated with altered bowel movement, in which no obvious pathogenetic lesion is identified to explain the symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "26455114", "evidence_support": "The classic symptoms of irritable bowel syndrome (IBS) are abdominal pain, bloating and some form of bowel dysfunction.", "evidence_relation": "supporting" }, { "cited_pmid": "27159638", "evidence_support": "Clinical symptoms of IBS include abdominal pain or discomfort, stool irregularities and bloating, as well as other somatic, visceral and psychiatric comorbidities.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The diagnostic criteria for IBS are entirely based on the subjective symptoms of the patients, which can include abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [16898604, 26455114, 27159638].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16898604", "evidence_support": "Though many possibilities are presented, diagnostic criteria for IBS are entirely based on the subjective symptoms of the patients", "evidence_relation": "supporting" }, { "cited_pmid": "26455114", "evidence_support": "The classic symptoms of irritable bowel syndrome (IBS) are abdominal pain, bloating and some form of bowel dysfunction.", "evidence_relation": "supporting" }, { "cited_pmid": "27159638", "evidence_support": "Clinical symptoms of IBS include abdominal pain or discomfort, stool irregularities and bloating, as well as other somatic, visceral and psychiatric comorbidities. Currently, the diagnosis of IBS is based on symptoms and the exclusion of other organic diseases", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Postulated pathogenesis for IBS include motility disorder, visceral sensation abnormalities, complex relationship between brain and gut, relationship to personality, and post-infectious abnormalities in the colonic mucosa [16898604, 26455114, 27159638].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16898604", "evidence_support": "Postulated pathogenesis for IBS are; motility disorder, visceral sensation abnormalities, complex relationship between brain and gut, relationship to personality, and post-infectious abnormalities in the colonic mucosa.", "evidence_relation": "supporting" }, { "cited_pmid": "27159638", "evidence_support": "Although the underlying pathogenesis is far from understood, aetiological factors include increased epithelial hyperpermeability, dysbiosis, inflammation, visceral hypersensitivity, epigenetics and genetics, and altered brain-gut interactions.", "evidence_relation": "supporting" }, { "cited_pmid": "26455114", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The exact cause is unknown, but it is believed to be related to a combination of factors, including genetic predisposition, sensomotoric dysfunction, altered enteric inflammation, and immune activation, as well as disturbance of the brain-gut interaction [24997032].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24997032", "evidence_support": "The interaction between the brain and the gut has been recognized for many centuries.", "evidence_relation": "neutral" }, { "cited_pmid": "24997032", "evidence_support": "perturbations in normal signalling have been associated with a multitude of disorders, including inflammatory and functional gastrointestinal disorders", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Diagnosis is typically made on clinical grounds, using symptom-based criteria such as the Rome criteria, and excluding organic disease [29072609].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "29072609", "evidence_support": "The diagnosis of IBS can be made by performing a careful review of the patient's symptoms, taking a thoughtful history (e.g., diet, medication, medical, surgical, and psychological history), evaluating the patient for the presence of warning signs (e.g., \"red flags\" of anemia, hematochezia, unintentional weight loss, or a family history of colorectal cancer or inflammatory bowel disease), performing a guided physical examination, and using the Rome IV criteria", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder characterized by multiple symptoms, including abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [33049223, 28541989, 27159638]. The exact cause is unknown, but it is believed to be related to a combination of factors, including genetic/social learning factors, diet, intestinal microbiota, intestinal low-grade inflammation, abnormal gastrointestinal endocrine cells, and possibly obesity as a comorbidity [18806702, 26167065, 27159638]. Diagnosis is typically made through a multi-phase process, including observation, problem determination, hypotheses generation, hypothesis control through laboratory and imaging tests, working diagnosis, therapeutic/caring decisions, and final diagnosis, followed by follow-up [20589362]. Treatment options are varied and often focused on symptom relief, including lifestyle modifications, dietary changes, fiber supplements, antispasmodics, antidiarrheals, laxatives, and probiotics [30817479]. In some cases, antidepressants, psychological therapies, and alternative treatments such as acupuncture and hypnotherapy may also be effective [23700366, 30152732, 24215924].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder characterized by multiple symptoms, including abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [33049223, 28541989, 27159638].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33049223", "evidence_support": "Irritable bowel syndrome is a functional gastrointestinal disorder with symptoms including abdominal pain associated with a change in stool form or frequency.", "evidence_relation": "supporting" }, { "cited_pmid": "28541989", "evidence_support": "Irritable bowel syndrome (IBS) is a common, chronic gastrointestinal (GI) condition characterized by disturbances in bowel habits and abdominal pain in the absence of known organic pathology.", "evidence_relation": "supporting" }, { "cited_pmid": "27159638", "evidence_support": "Clinical symptoms of IBS include abdominal pain or discomfort, stool irregularities and bloating, as well as other somatic, visceral and psychiatric comorbidities.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The exact cause is unknown, but it is believed to be related to a combination of factors, including genetic/social learning factors, diet, intestinal microbiota, intestinal low-grade inflammation, abnormal gastrointestinal endocrine cells, and possibly obesity as a comorbidity [18806702, 26167065, 27159638].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "26167065", "evidence_support": "Irritable bowel syndrome (IBS) is a common gastrointestinal disorder, the pathophysiology of which is not completely known, although it has been shown that genetic/social learning factors, diet, intestinal microbiota, intestinal low-grade inflammation, and abnormal gastrointestinal endocrine cells play a major role.", "evidence_relation": "supporting" }, { "cited_pmid": "27159638", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18806702", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Diagnosis is typically made through a multi-phase process, including observation, problem determination, hypotheses generation, hypothesis control through laboratory and imaging tests, working diagnosis, therapeutic/caring decisions, and final diagnosis, followed by follow-up [20589362].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20589362", "evidence_support": "It is the process of identifying a disease by its signs, symptoms and results of various diagnostic (laboratory or imaging) procedures. D. is part of clinical reasoning. It includes the following phases: 1. observation (anamnesis, medical examination); 2. problem determination; 3. hypotheses generation; 4. hypothesis control (through laboratory and imaging tests); 5. working D.; 6. therapeutic/caring decisions; 7. final D., 8. follow-up.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Treatment options are varied and often focused on symptom relief, including lifestyle modifications, dietary changes, fiber supplements, antispasmodics, antidiarrheals, laxatives, and probiotics [30817479].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30817479", "evidence_support": "Risk factors are multifactorial and treatment typically consists of antimotility or stimulant laxatives and antidepressants.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In some cases, antidepressants, psychological therapies, and alternative treatments such as acupuncture and hypnotherapy may also be effective [23700366, 30152732, 24215924].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23700366", "evidence_support": "Evidence-based data suggest that light therapy, St John's wort, Rhodiola rosea, omega-3 fatty acids, yoga, acupuncture, mindfulness therapies, exercise, sleep deprivation, and S-adenosylmethionine are effective in the treatment of mood disorders.", "evidence_relation": "supporting" }, { "cited_pmid": "30152732", "evidence_support": "Acupuncture and hypnotherapy can be developed as treatment options alone as an equivalent to conventional treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "24215924", "evidence_support": "Acupuncture has traditionally been used for problems including anxiety, insomnia, stress, and depression in China and other East Asian countries.", "evidence_relation": "neutral" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder characterized by multiple symptoms, including abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [26455114, 33049223]. The exact cause is unknown, but it is believed to be related to a combination of factors, including genetic/social learning factors, diet, intestinal microbiota, intestinal low-grade inflammation, and abnormal gastrointestinal endocrine cells [26167065]. Diagnosis is typically made on clinical grounds, using symptom-based criteria such as the Rome criteria, and excluding organic disease [29072609, 33733289]. Treatment options are varied and often focused on symptom relief, including lifestyle modifications, dietary changes, fiber supplements, antispasmodics, antidiarrheals, laxatives, and probiotics [21545610, 15324713, 24992947]. In some cases, acupuncture may also be effective [24935275, 30152732, 20192908]. A stepwise management approach is often advocated, starting with general management principles and progressing to more intensive treatment as needed [22480585, 34032534]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a complex functional bowel disorder characterized by multiple symptoms, including abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits [26455114, 33049223].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26455114", "evidence_support": "The classic symptoms of irritable bowel syndrome (IBS) are abdominal pain, bloating and some form of bowel dysfunction. ", "evidence_relation": "supporting" }, { "cited_pmid": "26455114", "evidence_support": "Traditionally IBS is divided into diarrhoea, constipation or alternating subtypes", "evidence_relation": "supporting" }, { "cited_pmid": "26455114", "evidence_support": "IBS patients frequently complain of one or more non-colonic symptoms, these include constant lethargy, low backache, nausea, bladder symptoms suggestive of an irritable bladder, chest pain and dyspareunia in women.", "evidence_relation": "contradicting" }, { "cited_pmid": "33049223", "evidence_support": "Irritable bowel syndrome is a functional gastrointestinal disorder with symptoms including abdominal pain associated with a change in stool form or frequency. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The exact cause is unknown, but it is believed to be related to a combination of factors, including genetic/social learning factors, diet, intestinal microbiota, intestinal low-grade inflammation, and abnormal gastrointestinal endocrine cells [26167065].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "26167065", "evidence_support": "Irritable bowel syndrome (IBS) is a common gastrointestinal disorder, the pathophysiology of which is not completely known, although it has been shown that genetic/social learning factors, diet, intestinal microbiota, intestinal low-grade inflammation, and abnormal gastrointestinal endocrine cells play a major role.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Diagnosis is typically made on clinical grounds, using symptom-based criteria such as the Rome criteria, and excluding organic disease [29072609, 33733289].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29072609", "evidence_support": "The diagnosis of IBS can be made by performing a careful review of the patient's symptoms, taking a thoughtful history (e.g., diet, medication, medical, surgical, and psychological history), evaluating the patient for the presence of warning signs (e.g., \"red flags\" of anemia, hematochezia, unintentional weight loss, or a family history of colorectal cancer or inflammatory bowel disease), performing a guided physical examination, and using the Rome IV criteria.", "evidence_relation": "supporting" }, { "cited_pmid": "29072609", "evidence_support": "This monograph provides a brief overview on the development of the Rome criteria, discusses the utility of the Rome IV criteria, and reviews how the criteria can be applied clinically to diagnose IBS.", "evidence_relation": "supporting" }, { "cited_pmid": "33733289", "evidence_support": "We found a minimal agreement between Rome III and Rome IV FGID diagnosis, especially in the diagnoses of functional constipation, irritable bowel syndrome, and functional dyspepsia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Treatment options are varied and often focused on symptom relief, including lifestyle modifications, dietary changes, fiber supplements, antispasmodics, antidiarrheals, laxatives, and probiotics [21545610, 15324713, 24992947].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21545610", "evidence_support": "The available studies suggest improvement in various IBS symptoms with loperamide, fibre supplements, lubiprostone, tricyclic antidepressants (TCAs), selective serotonin receptor inhibitors (SSRIs), antispasmotics, rifaximin, pregabalin, gabapentin, clonidine, octreotide and probiotic treatments.", "evidence_relation": "supporting" }, { "cited_pmid": "15324713", "evidence_support": "Standard therapy generally involves a symptom-directed approach; anti-diarrhoeal agents for bowel frequency, soluble fibre or laxatives for constipation and smooth muscle relaxants and anti-spasmodics for pain. ", "evidence_relation": "supporting" }, { "cited_pmid": "24992947", "evidence_support": "Currently, there is evidence to support improvements in specific IBS symptoms following treatment with loperamide, psyllium, bran, lubiprostone, linaclotide, amitriptyline, trimipramine, desipramine, citalopram, fluoxetine, paroxetine, dicyclomine, peppermint oil, rifaximin, ketotifen, pregabalin, gabapentin and octreotide and there are many new medications being investigated for the treatment of IBS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In some cases, acupuncture may also be effective [24935275, 30152732, 20192908].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "24935275", "evidence_support": "Antidepressants and some psychological therapies are effective treatments for IBS.", "evidence_relation": "neutral" }, { "cited_pmid": "20192908", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "30152732", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "A stepwise management approach is often advocated, starting with general management principles and progressing to more intensive treatment as needed [22480585, 34032534].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "22480585", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "34032534", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, and altered bowel habits, including diarrhea (IBS-D), constipation (IBS-C), or a mix of both [30466670, 26491416, 16042907]. The pathophysiology involves factors like altered gut motility, visceral hypersensitivity, immune activation, and brain-gut interactions [26491416, 21927652]. Diagnosis is clinical, based on symptom criteria like the Rome IV, and typically excludes organic diseases [21180545, 21616041]. Treatment is symptom-focused, with dietary modifications such as low-FODMAP diets and gluten-free diets showing efficacy [30466670, 26491416, 33315591]. Pharmacologic options include loperamide and rifaximin for IBS-D, and lubiprostone and linaclotide for IBS-C [30466670, 26491416, 31820883]. Antispasmodics, antidepressants, and probiotics may also provide relief for abdominal pain and bloating [16836950, 21616041, 21927652]. Emerging therapies and a combination of pharmacologic and non-pharmacologic approaches are often necessary due to the heterogeneous nature of IBS symptoms [21180545, 31820883, 21927652].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by symptoms such as abdominal pain, bloating, and altered bowel habits, including diarrhea (IBS-D), constipation (IBS-C), or a mix of both [30466670, 26491416, 16042907].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30466670", "evidence_support": "Irritable bowel syndrome (IBS) is present in patients with symptoms of chronic abdominal pain and altered bowel habits but no identifiable organic etiology.", "evidence_relation": "supporting" }, { "cited_pmid": "26491416", "evidence_support": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with abdominal pain, diarrhea, constipation, or a mix of symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "16042907", "evidence_support": "Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder with a wide variety of presentations that may include abdominal pain, bloating, diarrhea, constipation, or alternating bowel habits.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The pathophysiology involves factors like altered gut motility, visceral hypersensitivity, immune activation, and brain-gut interactions [26491416, 21927652].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26491416", "evidence_support": "The pathophysiology of IBS is not completely understood but appears to involve genetics, the gut microbiome, immune activation, altered intestinal permeability, and brain-gut interactions.", "evidence_relation": "supporting" }, { "cited_pmid": "21927652", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Diagnosis is clinical, based on symptom criteria like the Rome IV, and typically excludes organic diseases [21180545, 21616041].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "21180545", "evidence_support": "Rather, IBS should be confidently diagnosed in the clinic at the time of the first visit using the Rome III criteria and a careful history and physical examination.", "evidence_relation": "supporting" }, { "cited_pmid": "21616041", "evidence_support": "The diagnosis should be made on clinical grounds, using symptom-based criteria such as the Manning or Rome criteria, unless symptoms are thought to be atypical.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Treatment is symptom-focused, with dietary modifications such as low-FODMAP diets and gluten-free diets showing efficacy [30466670, 26491416, 33315591].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30466670", "evidence_support": "Low-FODMAP diets have been helpful in providing symptom relief, as have cognitive behavioral and mind-body techniques that help patients manage symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "26491416", "evidence_support": "Recent data suggest that a gluten-free diet and a diet low in fermentable oligosaccharides, disaccharides, monosaccharides, and polyols (FODMAPs) may benefit some patients.", "evidence_relation": "supporting" }, { "cited_pmid": "33315591", "evidence_support": "We recommend a limited trial of a low fermentable oligosaccharides, disacchardies, monosaccharides, polyols (FODMAP) diet in patients with IBS to improve global symptoms.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Pharmacologic options include loperamide and rifaximin for IBS-D, and lubiprostone and linaclotide for IBS-C [30466670, 26491416, 31820883].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30466670", "evidence_support": "Newer treatments for IBS-D, such as eluxadoline, and IBS-C, with linaclotide, lubiprostone, plecanatide, also can provide durable relief.", "evidence_relation": "supporting" }, { "cited_pmid": "26491416", "evidence_support": "For patients with diarrhea-predominant IBS, treatment options include the synthetic peripheral \u03bc-opioid receptor agonist loperamide, antispasmodic agents, antidepressants, serotonin 5-HT3 antagonists, and the gut-specific antibiotic rifaximin.", "evidence_relation": "supporting" }, { "cited_pmid": "26491416", "evidence_support": "For patients with constipation-predominant IBS, therapeutic strategies may include dietary fiber, laxatives, and the prosecretory agents lubiprostone and linaclotide. ", "evidence_relation": "supporting" }, { "cited_pmid": "31820883", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Antispasmodics, antidepressants, and probiotics may also provide relief for abdominal pain and bloating [16836950, 21616041, 21927652].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21616041", "evidence_support": "Where these fail, emerging data have confirmed the efficacy of antidepressants, drugs acting on the 5-hydroxytryptamine receptor, and probiotics in the short-term treatment of IBS.", "evidence_relation": "supporting" }, { "cited_pmid": "21927652", "evidence_support": "Evidence based therapies for the global symptoms of constipation predominant IBS (IBS-C) include lubiprostone and tegaserod; evidence based therapies for the global symptoms of diarrhea predominant IBS (IBS-D) include the probiotic Bifidobacter infantis, the nonabsorbable antibiotic rifaximin, and alosetron", "evidence_relation": "supporting" }, { "cited_pmid": "21927652", "evidence_support": "Additionally, there is persuasive evidence to suggest that selected antispasmodics and antidepressants are of benefit for the treatment of abdominal pain in IBS patients", "evidence_relation": "supporting" }, { "cited_pmid": "16836950", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Emerging therapies and a combination of pharmacologic and non-pharmacologic approaches are often necessary due to the heterogeneous nature of IBS symptoms [21180545, 31820883, 21927652].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21180545", "evidence_support": "Treatment options for IBS have increased in number in the past decade and clinicians should not be limited to using only fiber supplements and smooth muscle relaxants.", "evidence_relation": "supporting" }, { "cited_pmid": "21180545", "evidence_support": "This paper will review therapeutic options for the treatment of IBS using a tailored approach based on the predominant symptom. Abdominal pain, bloating, constipation and diarrhea are the four main symptoms that can be addressed using a combination of dietary interventions and medications. Treatment options include probiotics, antibiotics, tricyclic antidepressants, selective serotonin reuptake inhibitors and agents that modulate chloride channels and serotonin. ", "evidence_relation": "supporting" }, { "cited_pmid": "31820883", "evidence_support": ". In general, lifestyle and dietary changes, including the low-FODMAP of gluten-free diet, are the first-in-line treatment for all patients.", "evidence_relation": "neutral" }, { "cited_pmid": "31820883", "evidence_support": "When lifestyle changes do not lead to adequate symptom relief, patients should be treated according to their predominant bowel habits and most prominent symptoms. Laxatives or prokinetics and antidiarrheals are used to treat constipation and diarrhea respectively, but have little effect on abdominal pain. To treat gastro-intestinal (GI) symptoms, antispasmodics can be attributed. Low doses of neuromodulators can help gain control over GI and central symptoms, but are also prone to more severe side effects, restricting their widespread use. Refractory IBS symptoms can be treated with probiotics, antibiotics, histamine-receptor antagonists or alternative therapy, including psychotherapy, hypnotherapy, acupuncture or phytomedicines.", "evidence_relation": "supporting" }, { "cited_pmid": "21927652", "evidence_support": "In the absence of biomarkers that can distinguish between IBS subgroups on the basis of pathophysiology, treatment of this condition is predicated upon a patient's most bothersome symptoms", "evidence_relation": "neutral" }, { "cited_pmid": "21927652", "evidence_support": "Evidence based therapies for the global symptoms of constipation predominant IBS (IBS-C) include lubiprostone and tegaserod; evidence based therapies for the global symptoms of diarrhea predominant IBS (IBS-D) include the probiotic Bifidobacter infantis, the nonabsorbable antibiotic rifaximin, and alosetron. Additionally, there is persuasive evidence to suggest that selected antispasmodics and antidepressants are of benefit for the treatment of abdominal pain in IBS patients. Finally, several emerging therapies with novel mechanisms of action are in development. Complementary and alternative medicine therapies including probiotics, herbal therapies and acupuncture are gaining popularity among IBS sufferers, although concerns regarding manufacturing standards and the paucity of high quality efficacy and safety data remain.", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Irritable Bowel Syndrome (IBS) manifests with symptoms such as abdominal pain, bloating, and altered bowel habits, including diarrhea, constipation, or a combination of both.The exact etiology is unclear, but it involves gut-brain axis dysregulation, visceral hypersensitivity, and altered gastrointestinal motility.Treatment is multifaceted, focusing on symptom management and improving quality of life.Dietary modifications, such as a low FODMAP diet, can be beneficial.Pharmacological treatments include antispasmodics, laxatives, antidiarrheals, and low-dose antidepressants for pain modulation.Psychological therapies, including cognitive-behavioral therapy and gut-directed hypnotherapy, may also be effective.Probiotics and fiber supplements are sometimes recommended, though their efficacy varies.Regular follow-up is essential to tailor treatment to individual patient responses and symptom fluctuations.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable Bowel Syndrome (IBS) manifests with symptoms such as abdominal pain, bloating, and altered bowel habits, including diarrhea, constipation, or a combination of both.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "The exact etiology is unclear, but it involves gut-brain axis dysregulation, visceral hypersensitivity, and altered gastrointestinal motility.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Treatment is multifaceted, focusing on symptom management and improving quality of life.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Dietary modifications, such as a low FODMAP diet, can be beneficial.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Pharmacological treatments include antispasmodics, laxatives, antidiarrheals, and low-dose antidepressants for pain modulation.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Psychological therapies, including cognitive-behavioral therapy and gut-directed hypnotherapy, may also be effective.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "Probiotics and fiber supplements are sometimes recommended, though their efficacy varies.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "8", "answer_sentence": "Regular follow-up is essential to tailor treatment to individual patient responses and symptom fluctuations.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits, including diarrhea, constipation, or a mix of symptoms [30466670, 26491416, 21616041]. The symptoms can vary among patients and change over time, making treatment challenging [24944467]. Treatment strategies are focused on specific symptoms, and a stepwise management approach is advocated, starting with general management principles, including dietary and lifestyle advice, and then using pharmacotherapy based on the predominant symptom [28403981, 20890316]. Pharmacologic agents used to treat IBS-associated symptoms include myorelaxants, peppermint oil, and peripherally acting opiates for abdominal pain, and fiber, laxatives, and prosecretory agents for constipation [16836950, 15324713]. Emerging data have confirmed the efficacy of antidepressants, 5-HT(3) antagonists, 5-HT(4) agonists, and probiotics in the short-term treatment of IBS [21180545, 21616041, 21694813].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits, including diarrhea, constipation, or a mix of symptoms [30466670, 26491416, 21616041].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30466670", "evidence_support": "Irritable bowel syndrome (IBS) is present in patients with symptoms of chronic abdominal pain and altered bowel habits but no identifiable organic etiology.", "evidence_relation": "supporting" }, { "cited_pmid": "26491416", "evidence_support": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with abdominal pain, diarrhea, constipation, or a mix of symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "21616041", "evidence_support": "Irritable bowel syndrome (IBS) is a chronic functional disorder of the gastrointestinal tract.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The symptoms can vary among patients and change over time, making treatment challenging [24944467].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "24944467", "evidence_support": "Across the IBS subtypes, the presentation of symptoms may vary among patients and change over time.", "evidence_relation": "supporting" }, { "cited_pmid": "24944467", "evidence_support": "Patients report the most distressing symptoms to be abdominal pain, straining, myalgias, urgency, bloating and feelings of serious illness. The complexity and diversity of IBS presentation makes treatment difficult.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Treatment strategies are focused on specific symptoms, and a stepwise management approach is advocated, starting with general management principles, including dietary and lifestyle advice, and then using pharmacotherapy based on the predominant symptom [28403981, 20890316].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28403981", "evidence_support": "A stepwise management approach is advocated for patients with IBS. For a substantial proportion of patients with mild symptoms, general management principles, including making a confident diagnosis and offering explanation, reassurance, and dietary and lifestyle advice, are sufficient. However, many patients continue to have moderate-to-severe symptoms and are not satisfied solely with this approach. In these patients, use of pharmacotherapy on the basis of the predominant symptom (constipation, diarrhoea, pain, or bloating) or combination of symptoms is the next step.", "evidence_relation": "supporting" }, { "cited_pmid": "20890316", "evidence_support": "Patient-centered care is recommended, in which management is focused on the patient's most bothersome and impactful symptoms, their preferences and previous experiences with treatment, and addressing factors associated with the onset and exacerbation of symptoms. Pharmacotherapy is typically targeted against the predominant symptom", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Pharmacologic agents used to treat IBS-associated symptoms include myorelaxants, peppermint oil, and peripherally acting opiates for abdominal pain, and fiber, laxatives, and prosecretory agents for constipation [16836950, 15324713].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16836950", "evidence_support": "Pharmacologic agents used to treat IBS-associated pain include myorelaxants, peppermint oil, and peripherally acting opiates. ", "evidence_relation": "supporting" }, { "cited_pmid": "16836950", "evidence_support": "Soluble fibers (ispaghula, calcium polycarbophil, psyllium) are more effective than insoluble fibers (wheat bran, corn fiber) in alleviating global symptoms and relieving constipation, although fiber in general has marginal benefit in treatment of overall IBS symptoms", "evidence_relation": "supporting" }, { "cited_pmid": "15324713", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Emerging data have confirmed the efficacy of antidepressants, 5-HT(3) antagonists, 5-HT(4) agonists, and probiotics in the short-term treatment of IBS [21180545, 21616041, 21694813].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21180545", "evidence_support": "Treatment options include probiotics, antibiotics, tricyclic antidepressants, selective serotonin reuptake inhibitors and agents that modulate chloride channels and serotonin", "evidence_relation": "supporting" }, { "cited_pmid": "21616041", "evidence_support": "Where these fail, emerging data have confirmed the efficacy of antidepressants, drugs acting on the 5-hydroxytryptamine receptor, and probiotics in the short-term treatment of IBS", "evidence_relation": "supporting" }, { "cited_pmid": "21694813", "evidence_support": "In recent years, emerging data have confirmed the efficacy of antidepressants, psychological therapies, 5-HT(3) antagonists, 5-HT(4) agonists, and probiotics in the short-term treatment of IBS, although whether these therapies influence the long-term course of the disease is unknown.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash": { "answer": "Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits [23764698, 28445436, 35266839]. The most common symptom is abdominal pain, often described as cramping [22963061]. Other common symptoms include diarrhea, constipation, or alternating diarrhea and constipation [22963061]. IBS is diagnosed based on symptoms that correlate with different syndromes associated with the disorder [33651094]. Treatment for IBS is individualized and focuses on managing the most bothersome symptoms [16498278, 12095474]. This may involve dietary changes, stress management techniques, and medications to address specific symptoms like diarrhea or constipation [20718649, 21350320].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by chronic abdominal pain and altered bowel habits [23764698, 28445436, 35266839].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23764698", "evidence_support": "Irritable bowel syndrome (IBS), characterized by abdominal pain or discomfort associated with a change in bowel patterns, is one of the most common functional gastrointestinal disorders.", "evidence_relation": "supporting" }, { "cited_pmid": "28445436", "evidence_support": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is characterized by symptoms of chronic abdominal pain and altered bowel habits in the absence of an overtly identifiable cause. It is the most commonly diagnosed functional gastrointestinal disorder, accounting for about one third of gastroenterology visits.", "evidence_relation": "supporting" }, { "cited_pmid": "35266839", "evidence_support": "Irritable bowel syndrome (IBS) is a symptom-based disorder of chronic abdominal pain and altered bowel habits.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The most common symptom is abdominal pain, often described as cramping [22963061].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22963061", "evidence_support": "Abdominal pain is the most common symptom and often is described as a cramping sensation.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Other common symptoms include diarrhea, constipation, or alternating diarrhea and constipation [22963061].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22963061", "evidence_support": "Other common symptoms include diarrhea, constipation, or alternating diarrhea and constipation.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "IBS is diagnosed based on symptoms that correlate with different syndromes associated with the disorder [33651094].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "33651094", "evidence_support": "Traditionally, the diagnosis of IBS has been based on the positive identification of symptoms that correlate with several different syndromes associated with disorders such as IBS diarrhea, IBS constipation, functional diarrhea, functional constipation, chronic functional abdominal pain, or bloating. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Treatment for IBS is individualized and focuses on managing the most bothersome symptoms [16498278, 12095474].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16498278", "evidence_support": "Treatment of IBS needs to be individualized, focusing on patients' predominant symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "12095474", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "This may involve dietary changes, stress management techniques, and medications to address specific symptoms like diarrhea or constipation [20718649, 21350320].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21350320", "evidence_support": "Combinations of drugs to target bothersome symptoms are suggested as the first-line pharmacologic treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "21350320", "evidence_support": "Exclusion diets have modest efficacy in improving symptoms in some IBS patients.", "evidence_relation": "supporting" }, { "cited_pmid": "21350320", "evidence_support": "Symptom-based therapies with dietary fiber, bulking agents, laxatives, antispasmodics and laxatives are effective in the improvement of some individual symptoms,", "evidence_relation": "supporting" }, { "cited_pmid": "20718649", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by chronic abdominal pain, discomfort, and altered bowel habits [35266839, 26783972, 28932272]. The exact cause of IBS is unknown, but it is believed to be multifactorial, involving factors like altered gut motility, bacterial overgrowth, microscopic inflammation, and visceral hypersensitivity [20567539, 19624083]. IBS is a prevalent condition affecting 5-20% of the general population [24379577, 25734736]. Treatment for IBS focuses on managing symptoms and improving quality of life [35561102]. This may involve dietary modifications, stress management techniques, and medications to address specific symptoms like pain, diarrhea, or constipation [3286362]. \n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by chronic abdominal pain, discomfort, and altered bowel habits [35266839, 26783972, 28932272].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35266839", "evidence_support": "Irritable bowel syndrome (IBS) is a symptom-based disorder of chronic abdominal pain and altered bowel habits. ", "evidence_relation": "supporting" }, { "cited_pmid": "26783972", "evidence_support": "Irritable bowel syndrome (IBS) is a prevalent gastrointestinal disorder characterized by abdominal pain or discomfort and altered bowel habits.", "evidence_relation": "supporting" }, { "cited_pmid": "28932272", "evidence_support": "Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by abdominal pain associated with defecation with altered stool frequency or stool form. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The exact cause of IBS is unknown, but it is believed to be multifactorial, involving factors like altered gut motility, bacterial overgrowth, microscopic inflammation, and visceral hypersensitivity [20567539, 19624083].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "20567539", "evidence_support": "The etiology of irritable bowel syndrome (IBS) is thought to be multifactorial, with several factors (including alterations in gut motility, small-bowel bacterial overgrowth, microscopic inflammation, and visceral hypersensitivity) potentially playing a role. Recent studies have suggested that probiotics may be useful in the treatment of IBS. Although the exact mechanism for how probiotics may aid in the reduction of symptoms commonly found in IBS is unknown, the effects of probiotics on alterations in gut bacteria appear to play a part. This review focuses on recent studies examining the role of probiotics in the treatment of IBS.", "evidence_relation": "supporting" }, { "cited_pmid": "19624083", "evidence_support": "The exact cause of irritable bowel syndrome (IBS) is not known. Multiple factors, like genetic, gut motility, visceral hypersensitivity, psychosocial factors and immune-mediated factors, are thought to contribute to the symptom complex of IBS.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "IBS is a prevalent condition affecting 5-20% of the general population [24379577, 25734736].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24379577", "evidence_support": "Irritable bowel syndrome (IBS) is a common disorder, reported to be found in 5%-20% of the general population.", "evidence_relation": "supporting" }, { "cited_pmid": "25734736", "evidence_support": "Irritable bowel syndrome (IBS) affects 7% to 21% of the general population.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Treatment for IBS focuses on managing symptoms and improving quality of life [35561102].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35561102", "evidence_support": "Irritable bowel syndrome (IBS) is the most commonly diagnosed gastrointestinal disorder and negatively impacts individuals' quality of life.", "evidence_relation": "neutral" }, { "cited_pmid": "35561102", "evidence_support": "Cognitive behavioral therapy appears effective for reducing symptoms in many irritable bowel syndrome patients.", "evidence_relation": "neutral" }, { "cited_pmid": "35561102", "evidence_support": "However, it is difficult to compare the effectiveness of these randomized clinical trials due to the various cognitive behavioral therapy protocols, combined routes of therapy delivery, and different outcome measures used.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "This may involve dietary modifications, stress management techniques, and medications to address specific symptoms like pain, diarrhea, or constipation [3286362].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "3286362", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by abdominal pain or discomfort and altered bowel habits, including chronic diarrhea, constipation, or both [32425821, 22306725]. Patients often experience symptoms such as bloating, straining, urgency, and incomplete evacuation, which can significantly impact their quality of life [27134665, 32425821]. \n\nTreatment typically involves a multifactorial approach, starting with lifestyle changes and dietary modifications, followed by pharmacotherapy [14502115, 28110300]. Effective medications include rifaximin, linaclotide, and peppermint oil, which have shown reliable evidence for symptom improvement [24992947, 27134665]. Additionally, psychological interventions may be beneficial, addressing stress and anxiety related to IBS [27134665, 32425821]. Overall, a personalized treatment plan that encompasses both gastrointestinal and psychological aspects is essential for managing IBS effectively [27134665, 33241185].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a common gastrointestinal disorder characterized by abdominal pain or discomfort and altered bowel habits, including chronic diarrhea, constipation, or both [32425821, 22306725].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32425821", "evidence_support": "Irritable bowel syndrome (IBS) is a frequent functional gastrointestinal disorder. The patients complain about various symptoms like change in bowel habits, constipation or diarrhea, abdominal pain, and meteorism leading to a great reduction in quality of life. ", "evidence_relation": "supporting" }, { "cited_pmid": "22306725", "evidence_support": "Irritable bowel syndrome (IBS) is a common disorder characterized by abdominal pain or discomfort and altered bowel habit (chronic or recurrent diarrhea, constipation, or both) that occurs more frequently in women than in men.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Patients often experience symptoms such as bloating, straining, urgency, and incomplete evacuation, which can significantly impact their quality of life [27134665, 32425821].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27134665", "evidence_support": "Irritable bowel syndrome is a functional bowel disorder with gastrointestinal symptoms (e.g. abdominal pain, straining, urgency, incomplete evacuation, nausea, and bloating) that occur alongside bowel function alterations (i.e. constipation, diarrhea, or both).", "evidence_relation": "supporting" }, { "cited_pmid": "32425821", "evidence_support": "The patients complain about various symptoms like change in bowel habits, constipation or diarrhea, abdominal pain, and meteorism leading to a great reduction in quality of life.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Treatment typically involves a multifactorial approach, starting with lifestyle changes and dietary modifications, followed by pharmacotherapy [14502115, 28110300].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28110300", "evidence_support": "The most common therapeutic approaches for IBS include education and reassurance, lifestyles (especially nutrition-based interventions), peripherally acting medications (which typically target motility), centrally acting medications (which target visceral hypersensitivity and pain) and psychological interventions (which aim to reduce the effects of stress or symptom-specific anxiety).", "evidence_relation": "supporting" }, { "cited_pmid": "14502115", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Effective medications include rifaximin, linaclotide, and peppermint oil, which have shown reliable evidence for symptom improvement [24992947, 27134665].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24992947", "evidence_support": "Of the medications with demonstrated improvements for IBS symptoms, rifaximin, lubiprostone, linaclotide, fiber supplementation and peppermint oil have the most reliable evidence supporting their use for the treatment of IBS", "evidence_relation": "supporting" }, { "cited_pmid": "27134665", "evidence_support": "A number of therapies have emerged in recent years with clinical trial data demonstrating efficacy and safety for patients with irritable bowel syndrome, including agents that target gastrointestinal motility (i.e. linaclotide), gastrointestinal opioid receptors (i.e. asimadoline, eluxadoline), and gut microbiota (i.e. rifaximin)", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, psychological interventions may be beneficial, addressing stress and anxiety related to IBS [27134665, 32425821].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27134665", "evidence_support": " Patients with irritable bowel syndrome may also experience comorbid anxiety and depression. Irritable bowel syndrome is common, with a prevalence estimated between 3% and 28%, affecting patient health and quality of life. ", "evidence_relation": "neutral" }, { "cited_pmid": "27134665", "evidence_support": "Management of irritable bowel syndrome can include lifestyle changes, dietary interventions, counseling, psychologic medication, and agents that affect gastrointestinal motility", "evidence_relation": "supporting" }, { "cited_pmid": "27134665", "evidence_support": "Management that encompasses all aspects of irritable bowel syndrome (gastrointestinal symptoms) and comorbid psychologic symptoms (e.g. anxiety or depression) is important for improving overall patient health and well-being.", "evidence_relation": "supporting" }, { "cited_pmid": "32425821", "evidence_support": "However, also psychotherapy is an important treatment option for patients with IBS and should not be restricted to those with psychiatric comorbidities. Several evidence-based psychotherapeutic treatment options exist such as psychoeducation, self-help, cognitive behavioral therapy, psychodynamic psychotherapy, hypnotherapy, mindfulness-based therapy, and relaxation therapy which will be discussed in the present review.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, a personalized treatment plan that encompasses both gastrointestinal and psychological aspects is essential for managing IBS effectively [27134665, 33241185].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27134665", "evidence_support": "The pathophysiology of irritable bowel syndrome is multifactorial (i.e. genetics, immune components, changes in the gut microbiota, disturbances in physiologic stress response systems, and psychosocial factors). Management of irritable bowel syndrome can include lifestyle changes, dietary interventions, counseling, psychologic medication, and agents that affect gastrointestinal motility.", "evidence_relation": "supporting" }, { "cited_pmid": "27134665", "evidence_support": "Management that encompasses all aspects of irritable bowel syndrome (gastrointestinal symptoms) and comorbid psychologic symptoms (e.g. anxiety or depression) is important for improving overall patient health and well-being.", "evidence_relation": "supporting" }, { "cited_pmid": "33241185", "evidence_support": "Patients may benefit from a multipronged, individualized approach, including dietary modifications, and psychological and pharmacological therapies.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by episodic abdominal pain or discomfort, often associated with altered bowel habits, including diarrhea, constipation, or a combination of both [21927652, 26491416]. Other symptoms may include bloating, gas, and flatulence [21927652, 31820883]. \n\nTreatment options for IBS typically start with lifestyle and dietary changes, particularly the low-FODMAP diet, which has been shown to alleviate symptoms [28617710, 31820883]. Additional therapies may include antispasmodics, antidepressants, probiotics, and specific medications like rifaximin for diarrhea-predominant IBS [29528206, 21927652]. Evidence suggests that these treatments can effectively improve overall symptom scores and abdominal pain in IBS patients [30935559, 21927652].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a common functional gastrointestinal disorder characterized by episodic abdominal pain or discomfort, often associated with altered bowel habits, including diarrhea, constipation, or a combination of both [21927652, 26491416].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21927652", "evidence_support": "Irritable bowel syndrome (IBS) is a chronic functional gastrointestinal disorder characterized by episodic abdominal pain or discomfort in association with altered bowel habits (diarrhea and/or constipation).", "evidence_relation": "supporting" }, { "cited_pmid": "26491416", "evidence_support": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder associated with abdominal pain, diarrhea, constipation, or a mix of symptoms.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Other symptoms may include bloating, gas, and flatulence [21927652, 31820883].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21927652", "evidence_support": "Other gastrointestinal symptoms, such as bloating and flatulence, are also common. ", "evidence_relation": "supporting" }, { "cited_pmid": "31820883", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Treatment options for IBS typically start with lifestyle and dietary changes, particularly the low-FODMAP diet, which has been shown to alleviate symptoms [28617710, 31820883].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28617710", "evidence_support": "The low FODMAP diet is now recognized as first-line therapy for treatment of irritable bowel syndrome (IBS) symptoms including abdominal pain, gas, bloating, diarrhea and or constipation.", "evidence_relation": "supporting" }, { "cited_pmid": "28617710", "evidence_support": "Applying the low FODMAP diet in IBS can greatly improve health and quality of life outcomes by alleviating or significantly improves symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "31820883", "evidence_support": "In general, lifestyle and dietary changes, including the low-FODMAP of gluten-free diet, are the first-in-line treatment for all patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additional therapies may include antispasmodics, antidepressants, probiotics, and specific medications like rifaximin for diarrhea-predominant IBS [29528206, 21927652].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29528206", "evidence_support": "Depending on the IBS subtype and its likely etiology, patients may benefit from treatment with antispasmodics, antidepressants, guanylate cyclase-C agonists, chloride channel activators, antidiarrheal agents, probiotics, and/or antibiotics.", "evidence_relation": "supporting" }, { "cited_pmid": "29528206", "evidence_support": "The management of functional fecal incontinence includes behavioral therapy, relief of constipation (disimpaction, bulking agents), and antidiarrheal drugs. Functional anorectal pain management has not been well studied, but patient symptoms may improve with physical therapy, antispasmodics, nerve block, or onabotulinumtoxinA injection.", "evidence_relation": "supporting" }, { "cited_pmid": "21927652", "evidence_support": "Evidence based therapies for the global symptoms of constipation predominant IBS (IBS-C) include lubiprostone and tegaserod; evidence based therapies for the global symptoms of diarrhea predominant IBS (IBS-D) include the probiotic Bifidobacter infantis, the nonabsorbable antibiotic rifaximin, and alosetron. Additionally, there is persuasive evidence to suggest that selected antispasmodics and antidepressants are of benefit for the treatment of abdominal pain in IBS patients. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Evidence suggests that these treatments can effectively improve overall symptom scores and abdominal pain in IBS patients [30935559, 21927652].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "30935559", "evidence_support": "Probiotics, prebiotics, and low FODMAP diet are therapeutic means associated with modification of the gut microbiome for the alleviation of IBS symptoms", "evidence_relation": "supporting" }, { "cited_pmid": "30935559", "evidence_support": "There is a general agreement in the 11 included systematic reviews and meta-analyses that probiotic therapy is safe and can be effective in improving overall IBS symptom scores and abdominal pain in the general IBS population", "evidence_relation": "supporting" }, { "cited_pmid": "21927652", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-1": { "answer": "Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by symptoms including abdominal pain and altered bowel function [28094313,35869354]. The pathophysiology of IBS includes disordered gut motility, alterations in gut microbiota, neural-hormonal system abnormalities, immune reactivity, and visceral hypersensitivity [35869354]. Treatment options include dietary approaches, psychological.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by symptoms including abdominal pain and altered bowel function [28094313,35869354].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28094313", "evidence_support": "Irritable bowel syndrome (IBS) is a functional bowel disorder characterized by symptoms including abdominal pain and altered bowel function.", "evidence_relation": "supporting" }, { "cited_pmid": "35869354", "evidence_support": "Irritable bowel syndrome with diarrhea (IBS-D) is a chronic disorder of gut-brain interaction, characterized by recurrent abdominal pain in association with more frequent, loose stools.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The pathophysiology of IBS includes disordered gut motility, alterations in gut microbiota, neural-hormonal system abnormalities, immune reactivity, and visceral hypersensitivity [35869354].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35869354", "evidence_support": "The pathophysiology of irritable bowel syndrome (IBS) includes disordered gut motility, alterations in gut microbiota, neural-hormonal system abnormalities, immune reactivity, and visceral hypersensitivity.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Treatment options include dietary approaches, psychological.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-2": { "answer": "The symptoms of IBS-D include recurrent abdominal pain in association with more frequent, loose stools [35869354]. The pathophysiology of IBS includes disordered gut motility, alterations in gut microbiota, neural-hormonal system abnormalities, immune reactivity, and visceral hypersensitivity [35869354].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The symptoms of IBS-D include recurrent abdominal pain in association with more frequent, loose stools [35869354].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35869354", "evidence_support": "Irritable bowel syndrome with diarrhea (IBS-D) is a chronic disorder of gut-brain interaction, characterized by recurrent abdominal pain in association with more frequent, loose stools.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The pathophysiology of IBS includes disordered gut motility, alterations in gut microbiota, neural-hormonal system abnormalities, immune reactivity, and visceral hypersensitivity [35869354].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35869354", "evidence_support": "The pathophysiology of irritable bowel syndrome (IBS) includes disordered gut motility, alterations in gut microbiota, neural-hormonal system abnormalities, immune reactivity, and visceral hypersensitivity. ", "evidence_relation": "supporting" } ] } ] }, "webis-3": { "answer": "The symptoms of IBS include abdominal pain, bloating, and changes in bowel habits. The treatment for IBS includes dietary modifications, stress management, and medications such as antispasmodics, antidepressants, and antibiotics [32469130].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The symptoms of IBS include abdominal pain, bloating, and changes in bowel habits.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "The treatment for IBS includes dietary modifications, stress management, and medications such as antispasmodics, antidepressants, and antibiotics [32469130].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32469130", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-5": { "answer": "The symptoms of IBS include abdominal pain, bloating, and changes in bowel habits. The treatment for IBS includes dietary modifications, stress management, and medications such as antispasmodics, antidepressants, and antibiotics. . [32469130].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The symptoms of IBS include abdominal pain, bloating, and changes in bowel habits.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "The treatment for IBS includes dietary modifications, stress management, and medications such as antispasmodics, antidepressants, and antibiotics. .", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-1": { "answer": "Irritable Bowel Syndrome (IBS) is characterized by symptoms such as abdominal pain, bloating, gas, diarrhea, and constipation. Treatments typically include dietary changes, such as increasing fiber intake or following a low FODMAP diet, medications to manage symptoms (like antispasmodics or laxatives), and psychological therapies such as cognitive behavioral therapy to address stress and anxiety.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable Bowel Syndrome (IBS) is characterized by symptoms such as abdominal pain, bloating, gas, diarrhea, and constipation.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Treatments typically include dietary changes, such as increasing fiber intake or following a low FODMAP diet, medications to manage symptoms (like antispasmodics or laxatives), and psychological therapies such as cognitive behavioral therapy to address stress and anxiety.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "The symptoms of Irritable Bowel Syndrome (IBS) include abdominal pain, altered bowel habits, and bloating. Treatment options for IBS encompass both nonpharmacologic approaches, such as cognitive behavioral therapy which has been shown to effectively reduce bowel symptoms, and pharmacologic options that target individual symptoms [27689201].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The symptoms of Irritable Bowel Syndrome (IBS) include abdominal pain, altered bowel habits, and bloating.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Treatment options for IBS encompass both nonpharmacologic approaches, such as cognitive behavioral therapy which has been shown to effectively reduce bowel symptoms, and pharmacologic options that target individual symptoms [27689201].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27689201", "evidence_support": "In this context we analysed the data regarding the efficacy of two psychological treatments in IBS: cognitive behavioral therapy and hypnosis.", "evidence_relation": "supporting" }, { "cited_pmid": "27689201", "evidence_support": "Several studies showed that cognitive behavioral therapy is effective in reducing bowel symptoms in IBS, both post-treatment and short-term follow-up. ", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-6": { "answer": "Irritable bowel syndrome (IBS) is characterized by symptoms such as abdominal pain, bloating, and altered bowel habits, including diarrhea and constipation [21545610]. Treatment typically involves dietary modifications, lifestyle changes, and medications aimed at alleviating specific symptoms, although no definitive cure exists [29508539,24992947]. Management strategies may include antispasmodics, laxatives, or medications targeting specific symptoms like diarrhea or constipation [24992947].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is characterized by symptoms such as abdominal pain, bloating, and altered bowel habits, including diarrhea and constipation [21545610].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21545610", "evidence_support": "The efficacy of each medication for the symptoms of abdominal pain, bloating, stool form, mucus, urgency, feeling of incomplete evacuation, flatulence, frequency, or borborgymi and overall symptoms are reported by IBS subtype.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Treatment typically involves dietary modifications, lifestyle changes, and medications aimed at alleviating specific symptoms, although no definitive cure exists [29508539,24992947].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29508539", "evidence_support": "Treatments were appraised for their effects on symptoms and quality of life while also considering, but rarely prioritizing, other aspects including convenience of the regimen itself, whether it addressed the perceived root causes of IBS, perceived side-effects, and cost.", "evidence_relation": "neutral" }, { "cited_pmid": "29508539", "evidence_support": "Treatment seeking in IBS can be challenging for patients. Supportive discussions with health care professionals about illness perceptions, treatment beliefs, and goals could improve patients' experiences.", "evidence_relation": "neutral" }, { "cited_pmid": "29508539", "evidence_support": "Studies show few treatment modalities provide complete symptom relief. IBS is associated with emotional and physical distress, and negatively impacts personal, social, and professional aspects of quality of life.", "evidence_relation": "supporting" }, { "cited_pmid": "24992947", "evidence_support": "Of the medications with demonstrated improvements for IBS symptoms, rifaximin, lubiprostone, linaclotide, fiber supplementation and peppermint oil have the most reliable evidence supporting their use for the treatment of IBS.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Management strategies may include antispasmodics, laxatives, or medications targeting specific symptoms like diarrhea or constipation [24992947].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24992947", "evidence_support": "Currently, there is evidence to support improvements in specific IBS symptoms following treatment with loperamide, psyllium, bran, lubiprostone, linaclotide, amitriptyline, trimipramine, desipramine, citalopram, fluoxetine, paroxetine, dicyclomine, peppermint oil, rifaximin, ketotifen, pregabalin, gabapentin and octreotide and there are many new medications being investigated for the treatment of IBS. ", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gemini-flash": { "answer": "Irritable bowel syndrome (IBS) is a common disorder characterized by chronic abdominal pain and altered bowel habits [35266839, 28445436]. IBS is diagnosed based on symptoms using the Rome criteria [31820883]. The most distressing symptom is chronic, visceral pain, which significantly impacts quality of life [29957084]. Treatment options for IBS include lifestyle and dietary changes, such as a low-FODMAP or gluten-free diet [31820883]. If these changes are ineffective, treatment is tailored to the predominant bowel habits and symptoms [31820883]. Laxatives or prokinetics are used for constipation, while antidiarrheals are used for diarrhea, but these have little effect on abdominal pain [31820883]. Antispasmodics can be used to treat gastrointestinal symptoms [31820883]. Neuromodulators can help control gastrointestinal and central symptoms, but their use is limited due to potential side effects [31820883]. Refractory IBS symptoms may be treated with probiotics, antibiotics, histamine-receptor antagonists, or alternative therapies such as psychotherapy, hypnotherapy, acupuncture, or phytomedicines [31820883]. However, evidence for many of these options is sparse, and high-quality research is often lacking [31820883]. It is important to note that most treatment options only provide symptom relief for a subset of patients [31820883]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is a common disorder characterized by chronic abdominal pain and altered bowel habits [35266839, 28445436].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35266839", "evidence_support": "Irritable bowel syndrome (IBS) is a symptom-based disorder of chronic abdominal pain and altered bowel habits. ", "evidence_relation": "supporting" }, { "cited_pmid": "28445436", "evidence_support": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is characterized by symptoms of chronic abdominal pain and altered bowel habits in the absence of an overtly identifiable cause.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "10", "answer_sentence": "However, evidence for many of these options is sparse, and high-quality research is often lacking [31820883].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31820883", "evidence_support": "However, for many of these options, scientific evidence is sparse and high-quality research is often lacking, leading to inconclusive results.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "11", "answer_sentence": "It is important to note that most treatment options only provide symptom relief for a subset of patients [31820883].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31820883", "evidence_support": "In general, all of the available treatment options only provide symptom relief for a subset of patients. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "IBS is diagnosed based on symptoms using the Rome criteria [31820883].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "31820883", "evidence_support": "In the absence of an accurate biomarker for the disorder, IBS is mainly diagnosed based symptomology using the Rome criteria. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The most distressing symptom is chronic, visceral pain, which significantly impacts quality of life [29957084].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29957084", "evidence_support": " One of the two major symptoms of the disease is chronic, visceral pain. The patients report pain as the most distressing symptom with the greatest impact on quality of life, challenging both to patients and healthcare providers. ", "evidence_relation": "supporting" }, { "cited_pmid": "29957084", "evidence_support": "Pain is the main contributor to severity in IBS. Seeking pain alleviation is the most common reason that IBS sufferers consult with their physicians", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Treatment options for IBS include lifestyle and dietary changes, such as a low-FODMAP or gluten-free diet [31820883].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31820883", "evidence_support": "In general, lifestyle and dietary changes, including the low-FODMAP of gluten-free diet, are the first-in-line treatment for all patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "If these changes are ineffective, treatment is tailored to the predominant bowel habits and symptoms [31820883].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31820883", "evidence_support": "When lifestyle changes do not lead to adequate symptom relief, patients should be treated according to their predominant bowel habits and most prominent symptoms.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Laxatives or prokinetics are used for constipation, while antidiarrheals are used for diarrhea, but these have little effect on abdominal pain [31820883].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "31820883", "evidence_support": "Laxatives or prokinetics and antidiarrheals are used to treat constipation and diarrhea respectively, but have little effect on abdominal pain.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Antispasmodics can be used to treat gastrointestinal symptoms [31820883].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31820883", "evidence_support": "To treat gastro-intestinal (GI) symptoms, antispasmodics can be attributed.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Neuromodulators can help control gastrointestinal and central symptoms, but their use is limited due to potential side effects [31820883].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31820883", "evidence_support": "In general, lifestyle and dietary changes, including the low-FODMAP of gluten-free diet, are the first-in-line treatment for all patients. Issues with dietary changes are the strict elimination of multiple food products and hence difficult compliance to the diet. ", "evidence_relation": "neutral" }, { "cited_pmid": "31820883", "evidence_support": "Low doses of neuromodulators can help gain control over GI and central symptoms, but are also prone to more severe side effects, restricting their widespread use. Refractory IBS symptoms can be treated with probiotics, antibiotics, histamine-receptor antagonists or alternative therapy, including psychotherapy, hypnotherapy, acupuncture or phytomedicines.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "9", "answer_sentence": "Refractory IBS symptoms may be treated with probiotics, antibiotics, histamine-receptor antagonists, or alternative therapies such as psychotherapy, hypnotherapy, acupuncture, or phytomedicines [31820883].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31820883", "evidence_support": "Refractory IBS symptoms can be treated with probiotics, antibiotics, histamine-receptor antagonists or alternative therapy, including psychotherapy, hypnotherapy, acupuncture or phytomedicines.", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "Irritable bowel syndrome (IBS) is characterized by symptoms such as abdominal pain, bloating, diarrhea, and constipation, often without any identifiable organic cause [718552, 31468816, 28445436]. Abdominal pain is the most common symptom, typically described as cramping [22963061]. Treatment for IBS aims to relieve symptoms and improve quality of life, employing a multidisciplinary approach [22963061, 12095474]. Common therapeutic options include dietary modifications, psychological interventions, exercise, and medications such as antispasmodics, antibiotics, and antidepressants [34941040, 28110300]. Education and reassurance are also crucial components of effective management [12095474, 28445436]. Given the complexity of IBS, a tailored approach based on individual symptoms is often necessary [28445436, 34790245].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Irritable bowel syndrome (IBS) is characterized by symptoms such as abdominal pain, bloating, diarrhea, and constipation, often without any identifiable organic cause [718552, 31468816, 28445436].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31468816", "evidence_support": "Irritable bowel syndrome (IBS) is an umbrella term for a common range of symptoms such as abdominal pain, distension (bloating), diarrhoea and constipation.", "evidence_relation": "supporting" }, { "cited_pmid": "28445436", "evidence_support": "Irritable bowel syndrome (IBS) is a functional gastrointestinal disorder that is characterized by symptoms of chronic abdominal pain and altered bowel habits in the absence of an overtly identifiable cause.", "evidence_relation": "supporting" }, { "cited_pmid": "718552", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Abdominal pain is the most common symptom, typically described as cramping [22963061].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22963061", "evidence_support": "Abdominal pain is the most common symptom and often is described as a cramping sensation. The absence of abdominal pain essentially excludes irritable bowel syndrome", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Treatment for IBS aims to relieve symptoms and improve quality of life, employing a multidisciplinary approach [22963061, 12095474].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22963061", "evidence_support": "The goals of treatment are symptom relief and improved quality of life.", "evidence_relation": "supporting" }, { "cited_pmid": "22963061", "evidence_support": "Exercise, antibiotics, antispasmodics, peppermint oil, and probiotics appear to improve symptoms. Over-the-counter laxatives and antidiarrheals may improve stool frequency but not pain. Treatment with antidepressants and psychological therapies are also effective for improving symptoms compared with usual care. Lubiprostone is effective for the treatment of constipation-predominant irritable bowel syndrome, and alosetron (restrictions for use apply in the United States) and tegaserod (available only for emergency use in the United States) are approved for patients with severe symptoms in whom conventional therapy has been ineffective.", "evidence_relation": "supporting" }, { "cited_pmid": "12095474", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Common therapeutic options include dietary modifications, psychological interventions, exercise, and medications such as antispasmodics, antibiotics, and antidepressants [34941040, 28110300].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34941040", "evidence_support": "Therapeutic interventions range from dietary modification, psychological interventions, exercise, to the use of antispasmodics, antibiotics, and antidepressants.", "evidence_relation": "supporting" }, { "cited_pmid": "28110300", "evidence_support": "The most common therapeutic approaches for IBS include education and reassurance, lifestyles (especially nutrition-based interventions), peripherally acting medications (which typically target motility), centrally acting medications (which target visceral hypersensitivity and pain) and psychological interventions (which aim to reduce the effects of stress or symptom-specific anxiety).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Education and reassurance are also crucial components of effective management [12095474, 28445436].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "28445436", "evidence_support": "The treatment options for IBS are challenging and varied.", "evidence_relation": "neutral" }, { "cited_pmid": "12095474", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Given the complexity of IBS, a tailored approach based on individual symptoms is often necessary [28445436, 34790245].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "28445436", "evidence_support": "The treatment options for IBS are challenging and varied.", "evidence_relation": "supporting" }, { "cited_pmid": "28445436", "evidence_support": "existing drug therapies are administered based on the predominant symptoms and IBS-subtype.", "evidence_relation": "neutral" }, { "cited_pmid": "34790245", "evidence_support": "Given the complexity of the therapeutic management of irritable bowel syndrome (IBS), alternative non-pharmacological therapies are frequently offered to patients.", "evidence_relation": "supporting" }, { "cited_pmid": "34790245", "evidence_support": "Although body-directed therapies such as acupuncture and osteopathic medicine may be beneficial for overall IBS symptoms, higher-quality RCTs are needed to establish the clinical benefit of non-pharmacological interventions for IBS.", "evidence_relation": "neutral" } ] } ] } } }, { "question_id": "135", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "If a patient is prescribed thyroid medications but chooses not to take them, several health complications may arise depending on the type of thyroid disorder. For example, untreated hypothyroidism can lead to symptoms such as fatigue, weight gain, depression, and more severe complications like heart problems. Similarly, hyperthyroidism that is left untreated may result in severe cardiovascular issues, bone loss, and in extreme cases, a life-threatening condition known as thyroid storm. It is important to follow the prescribed treatment plan to avoid these potential risks [31728507].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If a patient is prescribed thyroid medications but chooses not to take them, several health complications may arise depending on the type of thyroid disorder.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "For example, untreated hypothyroidism can lead to symptoms such as fatigue, weight gain, depression, and more severe complications like heart problems.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Similarly, hyperthyroidism that is left untreated may result in severe cardiovascular issues, bone loss, and in extreme cases, a life-threatening condition known as thyroid storm.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "It is important to follow the prescribed treatment plan to avoid these potential risks [31728507].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "31728507", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Not taking prescribed thyroid medications can lead to worsening symptoms and a range of health issues [28441949, 15210253, 27741701]. Untreated thyroid conditions can cause fatigue, weight gain, and depression [29431508, 21652518]. Patients may experience hair loss, dry skin, and constipation [29431508, 21652518]. Muscle weakness and joint pain are also common [29431508, 21652518]. High cholesterol and a slow heart rate can develop, increasing the risk of heart disease [29431508, 21652518]. Memory problems and nerve damage may occur [29431508, 21652518]. Goiter and hoarseness can result from untreated thyroid issues [29431508, 21652518]. Infertility and irregular menstrual cycles are potential consequences [29431508, 21652518]. Increased sensitivity to cold and swelling in the neck are additional symptoms [29431508, 21652518]. Therefore, adherence to thyroid medication is crucial to avoid these complications [23688368, 28441949, 15210253].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Not taking prescribed thyroid medications can lead to worsening symptoms and a range of health issues [28441949, 15210253, 27741701].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28441949", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15210253", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "27741701", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "10", "answer_sentence": "Therefore, adherence to thyroid medication is crucial to avoid these complications [23688368, 28441949, 15210253].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23688368", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "28441949", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15210253", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Untreated thyroid conditions can cause fatigue, weight gain, and depression [29431508, 21652518].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29431508", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "21652518", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Patients may experience hair loss, dry skin, and constipation [29431508, 21652518].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29431508", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "21652518", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Muscle weakness and joint pain are also common [29431508, 21652518].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29431508", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "21652518", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "High cholesterol and a slow heart rate can develop, increasing the risk of heart disease [29431508, 21652518].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29431508", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "21652518", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Memory problems and nerve damage may occur [29431508, 21652518].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29431508", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "21652518", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Goiter and hoarseness can result from untreated thyroid issues [29431508, 21652518].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29431508", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "21652518", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Infertility and irregular menstrual cycles are potential consequences [29431508, 21652518].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29431508", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "21652518", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "9", "answer_sentence": "Increased sensitivity to cold and swelling in the neck are additional symptoms [29431508, 21652518].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "29431508", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "21652518", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Failure to adhere to prescribed thyroid medication can lead to significant health complications.For patients with hypothyroidism, nonadherence can result in persistent symptoms such as fatigue, weight gain, and depression, and may exacerbate cardiovascular issues due to elevated cholesterol levels [23688368, 15101664]. In severe cases, untreated hypothyroidism can progress to myxedema coma, a life-threatening condition characterized by extreme hypothyroidism, hypothermia, and altered mental status [21877479]. Conversely, for hyperthyroid patients, skipping medication can lead to uncontrolled symptoms like weight loss, anxiety, and palpitations, potentially escalating to thyroid storm, a critical state with high fever, tachycardia, and delirium [21877479, 15101664]. Both scenarios underscore the importance of consistent medication adherence to manage thyroid function and prevent severe outcomes [23688368, 15101664].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Failure to adhere to prescribed thyroid medication can lead to significant health complications.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "For patients with hypothyroidism, nonadherence can result in persistent symptoms such as fatigue, weight gain, and depression, and may exacerbate cardiovascular issues due to elevated cholesterol levels [23688368, 15101664].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23688368", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15101664", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In severe cases, untreated hypothyroidism can progress to myxedema coma, a life-threatening condition characterized by extreme hypothyroidism, hypothermia, and altered mental status [21877479].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21877479", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Conversely, for hyperthyroid patients, skipping medication can lead to uncontrolled symptoms like weight loss, anxiety, and palpitations, potentially escalating to thyroid storm, a critical state with high fever, tachycardia, and delirium [21877479, 15101664].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21877479", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15101664", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Both scenarios underscore the importance of consistent medication adherence to manage thyroid function and prevent severe outcomes [23688368, 15101664].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23688368", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15101664", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "If a patient is prescribed thyroid medication but does not take it, they may experience a range of negative consequences, including worsening of symptoms, such as fatigue, weight gain, and dry skin [27741701]. Non-adherence to thyroid medication can also lead to decreased quality of life and increased risk of complications, such as cardiovascular disease and osteoporosis [15101664]. Furthermore, intentional non-adherence, such as stopping medication when feeling better, can be particularly problematic, as it may lead to undertreatment and poor disease control [23688368]. It is essential for clinicians to educate patients about the importance of adherence and to address any concerns or misconceptions they may have about their medication [26499336]. By doing so, clinicians can help patients understand the benefits of treatment and improve their overall health outcomes.Additionally, clinicians should be aware of the potential for medication errors, such as incorrect dosing or administration, which can also impact treatment efficacy [26448665, 28515501].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If a patient is prescribed thyroid medication but does not take it, they may experience a range of negative consequences, including worsening of symptoms, such as fatigue, weight gain, and dry skin [27741701].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27741701", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Non-adherence to thyroid medication can also lead to decreased quality of life and increased risk of complications, such as cardiovascular disease and osteoporosis [15101664].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15101664", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Furthermore, intentional non-adherence, such as stopping medication when feeling better, can be particularly problematic, as it may lead to undertreatment and poor disease control [23688368].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23688368", "evidence_support": "Stopping taking analgesics when feeling better was the most commonly reported nonadherence behavior (74%); those reporting \"intentional\" nonadherence when feeling better were more likely to report not using analgesics in the index week (100% vs. 67.7%; p = .029) and agree that pain medication can keep you from knowing what is going on in your body (p = .029) and were less likely to need stronger pain medication (33.3% vs. 81.5%; p = .003). \"Unintentional\" nonadherence, i.e., forgetfulness/carelessness, though associated with many analgesic beliefs, was not associated with measures of analgesic use in the index period.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It is essential for clinicians to educate patients about the importance of adherence and to address any concerns or misconceptions they may have about their medication [26499336].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "26499336", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "By doing so, clinicians can help patients understand the benefits of treatment and improve their overall health outcomes.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Additionally, clinicians should be aware of the potential for medication errors, such as incorrect dosing or administration, which can also impact treatment efficacy [26448665, 28515501].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "26448665", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "28515501", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "If you are prescribed thyroid medications but don't take them, you may experience poor clinical outcomes, increased health care costs, and a higher risk of cardiovascular disease and neurocognitive impairment [29865926, 27126268]. Non-adherence to thyroid hormone replacement therapy can lead to uncontrolled hypothyroidism, which may cause symptoms such as fatigue, weight gain, and dry skin [30636753]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you are prescribed thyroid medications but don't take them, you may experience poor clinical outcomes, increased health care costs, and a higher risk of cardiovascular disease and neurocognitive impairment [29865926, 27126268].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29865926", "evidence_support": "Patients who were adherent used significantly fewer resources and had significantly lower all-cause ($14,136 vs. $14,926; p\u2009<\u2009.0001) and hypothyroidism-related ($1672 vs. $1709; p\u2009<\u2009.0001) total costs, although the costs of drugs were higher in the adherent group. Furthermore, adherent patients, compared to nonadherent patients, were significantly less likely to be diagnosed with comorbid Addison's disease, bipolar disorder, chronic kidney disease, depression, migraine, obesity, type 1 diabetes or type 2 diabetes during the follow-up period.", "evidence_relation": "supporting" }, { "cited_pmid": "29865926", "evidence_support": "Compared to nonadherence, adherence to LT4 among patients with hypothyroidism was associated with a significant reduction in all-cause and hypothyroidism-related costs and resource utilization as well as significantly lower rates of many comorbid diagnoses.\n", "evidence_relation": "supporting" }, { "cited_pmid": "27126268", "evidence_support": "Patients with uncorrected disease suffer significant morbidity and have an increased risk of cardiovascular disease and neurocognitive impairment", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Non-adherence to thyroid hormone replacement therapy can lead to uncontrolled hypothyroidism, which may cause symptoms such as fatigue, weight gain, and dry skin [30636753].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30636753", "evidence_support": "Non-adherence to medication in hypothyroid patients leads to poor clinical outcome and increased health care costs.", "evidence_relation": "neutral" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Untreated thyroid problems can lead to various complications, including poor growth and development in children and adolescents, compromised brain and physical functioning in young to middle-aged adults, and increased risk of cardiovascular disease, obesity, hypertension, and poor quality of life [32175200, 37556077, 31011539]. In young women of fertile age, undertreatment can result in subnormal fertility, recurrent pregnancy loss, preeclampsia, and compromised fetal growth and neurocognitive development [37556077, 31485975, 31011539]. In the elderly population, undertreatment can lead to confusion between physiological age adaptation and a requirement for thyroid hormone treatment [31054225, 31011539, 23045326]. If left untreated, thyroid problems can cause or exacerbate numerous symptoms, and can eventually lead to death [32175200, 37556077, 23045326]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated thyroid problems can lead to various complications, including poor growth and development in children and adolescents, compromised brain and physical functioning in young to middle-aged adults, and increased risk of cardiovascular disease, obesity, hypertension, and poor quality of life [32175200, 37556077, 31011539].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37556077", "evidence_support": "Lack of early treatment in congenital hypothyroidism can lead to permanent damage of brain function. In young to middle-aged adults, consequences are often overlooked, and treatment delayed by many years. The resulting consequences are also at this age group compromised brain and physical functioning but less severe and partly reversible with treatment. The undertreated condition often results in a higher risk of several secondary devastating diseases such as increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, poor quality of life.", "evidence_relation": "supporting" }, { "cited_pmid": "31011539", "evidence_support": "Cross-sectional studies have reported that TSH above or close to the upper normal limit correlates with unfavorable metabolic and cardiovascular outcomes.", "evidence_relation": "supporting" }, { "cited_pmid": "32175200", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In young women of fertile age, undertreatment can result in subnormal fertility, recurrent pregnancy loss, preeclampsia, and compromised fetal growth and neurocognitive development [37556077, 31485975, 31011539].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37556077", "evidence_support": "In young women of fertile age the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, preeclampsia, compromised fetal growth and neurocognitive development.", "evidence_relation": "supporting" }, { "cited_pmid": "31011539", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "31485975", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In the elderly population, undertreatment can lead to confusion between physiological age adaptation and a requirement for thyroid hormone treatment [31054225, 31011539, 23045326].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23045326", "evidence_support": "Thyroid dysfunction is a common problem in the elderly and is often masked by comorbid conditions and medications.", "evidence_relation": "supporting" }, { "cited_pmid": "31054225", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "31011539", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "If left untreated, thyroid problems can cause or exacerbate numerous symptoms, and can eventually lead to death [32175200, 37556077, 23045326].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23045326", "evidence_support": "Left untreated, thyroid dysfunction can cause or exacerbate numerous symptoms, and can eventually lead to death.", "evidence_relation": "supporting" }, { "cited_pmid": "32175200", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "37556077", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "If you are prescribed thyroid medications but don't take them, you may experience a range of negative consequences, including poor growth and development, compromised brain and physical function, increased risk of cardiovascular disease, obesity, hypertension, poor physical capacity, and poor quality of life [38015369, 37556077]. In young women, undertreatment can lead to subnormal fertility, recurrent pregnancy loss, preeclampsia, and compromised fetal growth and neurocognitive development [38015369, 37556077]. In the elderly, undertreatment can lead to increased mortality [37556077]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you are prescribed thyroid medications but don't take them, you may experience a range of negative consequences, including poor growth and development, compromised brain and physical function, increased risk of cardiovascular disease, obesity, hypertension, poor physical capacity, and poor quality of life [38015369, 37556077].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "38015369", "evidence_support": "In children and adolescents, the most devastating consequences of undertreatment with levothyroxine (LT4) are poor growth and development. Delayed treatment in congenital hypothyroidism can lead to permanent brain damage.", "evidence_relation": "supporting" }, { "cited_pmid": "38015369", "evidence_support": "The under-treated condition often results in a higher risk of, e.g., increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, and poor quality of life. ", "evidence_relation": "supporting" }, { "cited_pmid": "37556077", "evidence_support": "In children and adolescents, the most devastating consequences of undertreatment are poor growth and development. Lack of early treatment in congenital hypothyroidism can lead to permanent damage of brain function. ", "evidence_relation": "supporting" }, { "cited_pmid": "37556077", "evidence_support": "The undertreated condition often results in a higher risk of several secondary devastating diseases such as increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, poor quality of life.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In young women, undertreatment can lead to subnormal fertility, recurrent pregnancy loss, preeclampsia, and compromised fetal growth and neurocognitive development [38015369, 37556077].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "38015369", "evidence_support": "In young fertile women, the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, compromised fetal growth, and neurocognitive development.", "evidence_relation": "supporting" }, { "cited_pmid": "37556077", "evidence_support": "In young women of fertile age the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, preeclampsia, compromised fetal growth and neurocognitive development.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In the elderly, undertreatment can lead to increased mortality [37556077].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37556077", "evidence_support": "The undertreated condition often results in a higher risk of several secondary devastating diseases such as increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, poor quality of life.", "evidence_relation": "supporting" }, { "cited_pmid": "37556077", "evidence_support": "In the elderly population care must be given to avoid confusing a slightly high serum TSH as result of physiological age adaptation with a requirement for LT4 treatment in a truly hypothyroid patient.", "evidence_relation": "neutral" }, { "cited_pmid": "37556077", "evidence_support": "Undertreatment of the preventable non-communicable disease hypothyroidism requires more focus both from caretakers in the healthcare system, but also from the global political systems in order to prevent the personally devastating and socioeconomically challenging consequences.", "evidence_relation": "neutral" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "If you are prescribed thyroid medications but don't take them, you may experience a range of negative consequences, including poor growth and development, compromised brain and physical function, increased risk of cardiovascular disease, obesity, hypertension, poor physical capacity, and poor quality of life [37556077, 38015369]. In young women, undertreatment can lead to subnormal fertility, recurrent pregnancy loss, preeclampsia, and compromised fetal growth and neurocognitive development [37556077]. In the elderly, undertreatment can lead to increased mortality [16915315, 16749288]. I do not have the correct information to provide a fix, the article did not provide symptoms for not taking thyroid medication [25377611]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you are prescribed thyroid medications but don't take them, you may experience a range of negative consequences, including poor growth and development, compromised brain and physical function, increased risk of cardiovascular disease, obesity, hypertension, poor physical capacity, and poor quality of life [37556077, 38015369].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37556077", "evidence_support": "The undertreated condition often results in a higher risk of several secondary devastating diseases such as increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, poor quality of life.", "evidence_relation": "supporting" }, { "cited_pmid": "38015369", "evidence_support": "The under-treated condition often results in a higher risk of, e.g., increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, and poor quality of life.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In young women, undertreatment can lead to subnormal fertility, recurrent pregnancy loss, preeclampsia, and compromised fetal growth and neurocognitive development [37556077].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37556077", "evidence_support": "In young women of fertile age the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, preeclampsia, compromised fetal growth and neurocognitive development.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In the elderly, undertreatment can lead to increased mortality [16915315, 16749288].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16915315", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16749288", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "I do not have the correct information to provide a fix, the article did not provide symptoms for not taking thyroid medication [25377611].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "25377611", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "If you are prescribed thyroid medications but don't take them, you may experience a range of negative consequences, including poor growth and development, compromised brain and physical function, increased risk of cardiovascular disease, obesity, hypertension, poor physical capacity, and poor quality of life [38015369, 37556077]. In young women, undertreatment can lead to subnormal fertility, recurrent pregnancy loss, preeclampsia, and compromised fetal growth and neurocognitive development [38015369, 37556077]. In the elderly, undertreatment can lead to increased mortality [16915315]. Additionally, nonadherence to medication can lead to a range of symptoms, including tremors, and others [25377611]. However, symptoms like lethargy, body temperature dysregulation, orthostatic hypotension, and diarrhea are not mentioned in this article [25377611]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you are prescribed thyroid medications but don't take them, you may experience a range of negative consequences, including poor growth and development, compromised brain and physical function, increased risk of cardiovascular disease, obesity, hypertension, poor physical capacity, and poor quality of life [38015369, 37556077].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "38015369", "evidence_support": "The under-treated condition often results in a higher risk of, e.g., increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, and poor quality of life.", "evidence_relation": "supporting" }, { "cited_pmid": "37556077", "evidence_support": "The undertreated condition often results in a higher risk of several secondary devastating diseases such as increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, poor quality of life.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In young women, undertreatment can lead to subnormal fertility, recurrent pregnancy loss, preeclampsia, and compromised fetal growth and neurocognitive development [38015369, 37556077].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "38015369", "evidence_support": "In young fertile women, the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, compromised fetal growth, and neurocognitive development", "evidence_relation": "supporting" }, { "cited_pmid": "37556077", "evidence_support": "In young women of fertile age the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, preeclampsia, compromised fetal growth and neurocognitive development.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In the elderly, undertreatment can lead to increased mortality [16915315].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16915315", "evidence_support": "Elderly patients represent a large proportion of patients with acute myocardial infarction, but they receive less medical therapy than younger patients.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, nonadherence to medication can lead to a range of symptoms, including tremors, and others [25377611].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25377611", "evidence_support": "Nonadherence to medications is common and associated with poor or limited clinical outcomes in the treatment of bipolar disorder.", "evidence_relation": "supporting" }, { "cited_pmid": "25377611", "evidence_support": "Weight gain, perceived cognitive impairment, tremors, and sedation are the adverse effects most likely to lead to nonadherence.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "However, symptoms like lethargy, body temperature dysregulation, orthostatic hypotension, and diarrhea are not mentioned in this article [25377611].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "25377611", "evidence_support": "Weight gain, perceived cognitive impairment, tremors, and sedation are the adverse effects most likely to lead to nonadherence.", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "If you are prescribed thyroid medications but don't take them, you may experience a range of negative consequences, including poor growth and development, compromised brain and physical function, increased risk of cardiovascular disease, obesity, hypertension, poor physical capacity, and poor quality of life [37556077, 38015369]. In young women, undertreatment can lead to subnormal fertility, recurrent pregnancy loss, preeclampsia, and compromised fetal growth and neurocognitive development [37556077]. In the elderly, undertreatment can lead to increased mortality [16915315, 16749288]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you are prescribed thyroid medications but don't take them, you may experience a range of negative consequences, including poor growth and development, compromised brain and physical function, increased risk of cardiovascular disease, obesity, hypertension, poor physical capacity, and poor quality of life [37556077, 38015369].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37556077", "evidence_support": "The resulting consequences are also at this age group compromised brain and physical functioning but less severe and partly reversible with treatment. 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In young women, undertreatment can lead to subnormal fertility, recurrent pregnancy loss, preeclampsia, and compromised fetal growth and neurocognitive development [37556077]. In the elderly, undertreatment can lead to increased mortality [16915315, 15063816]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you are prescribed thyroid medications but don't take them, you may experience a range of negative consequences, including poor growth and development, compromised brain and physical function, increased risk of cardiovascular disease, obesity, hypertension, poor physical capacity, and poor quality of life [38015369, 37556077].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "38015369", "evidence_support": "The under-treated condition often results in a higher risk of, e.g., increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, and poor quality of life. ", "evidence_relation": "supporting" }, { "cited_pmid": "37556077", "evidence_support": "In children and adolescents, the most devastating consequences of undertreatment are poor growth and development.", "evidence_relation": "supporting" }, { "cited_pmid": "37556077", "evidence_support": "The undertreated condition often results in a higher risk of several secondary devastating diseases such as increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, poor quality of life.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In young women, undertreatment can lead to subnormal fertility, recurrent pregnancy loss, preeclampsia, and compromised fetal growth and neurocognitive development [37556077].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37556077", "evidence_support": "Lack of early treatment in congenital hypothyroidism can lead to permanent damage of brain function.", "evidence_relation": "neutral" }, { "cited_pmid": "37556077", "evidence_support": "In young women of fertile age the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, preeclampsia, compromised fetal growth and neurocognitive development.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In the elderly, undertreatment can lead to increased mortality [16915315, 15063816].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "16915315", "evidence_support": "26,4% of the patients older than 75 years died in the hospital.", "evidence_relation": "neutral" }, { "cited_pmid": "16915315", "evidence_support": "Elderly patients represent a large proportion of patients with acute myocardial infarction, but they receive less medical therapy than younger patients.", "evidence_relation": "neutral" }, { "cited_pmid": "15063816", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "If you are prescribed thyroid medications but don't take them, you may experience a range of negative consequences, including poor growth and development, compromised brain and physical function, increased risk of cardiovascular disease, obesity, hypertension, poor physical capacity, and poor quality of life [37556077, 38015369]. In young women, undertreatment can lead to subnormal fertility, recurrent pregnancy loss, preeclampsia, and compromised fetal growth and neurocognitive development [37556077]. In the elderly, undertreatment can lead to increased mortality [16915315]. Additionally, nonadherence to medication can lead to a return of psychotic symptoms, including those associated with schizophrenia [21205805]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you are prescribed thyroid medications but don't take them, you may experience a range of negative consequences, including poor growth and development, compromised brain and physical function, increased risk of cardiovascular disease, obesity, hypertension, poor physical capacity, and poor quality of life [37556077, 38015369].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37556077", "evidence_support": "The undertreated condition often results in a higher risk of several secondary devastating diseases such as increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, poor quality of life.", "evidence_relation": "supporting" }, { "cited_pmid": "38015369", "evidence_support": "The under-treated condition often results in a higher risk of, e.g., increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, and poor quality of life.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In young women, undertreatment can lead to subnormal fertility, recurrent pregnancy loss, preeclampsia, and compromised fetal growth and neurocognitive development [37556077].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37556077", "evidence_support": ". In young women of fertile age the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, preeclampsia, compromised fetal growth and neurocognitive development.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In the elderly, undertreatment can lead to increased mortality [16915315].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16915315", "evidence_support": "Patients older than 75 years represented 43% of all patients with acute myocardial infarction. 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Patients in the early phase of schizophrenia should be cautioned about the possible consequences of partial or relatively brief periods of antipsychotic medication nonadherence.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "If you are prescribed thyroid medications but don't take them, you may experience a range of negative consequences, including poor growth and development, compromised brain and physical function, increased risk of cardiovascular disease, obesity, hypertension, poor physical capacity, and poor quality of life [37556077, 38015369]. In young women, undertreatment can lead to subnormal fertility, recurrent pregnancy loss, preeclampsia, and compromised fetal growth and neurocognitive development [37556077]. In the elderly, undertreatment can lead to increased mortality [22642781, 16915315, 33709336]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you are prescribed thyroid medications but don't take them, you may experience a range of negative consequences, including poor growth and development, compromised brain and physical function, increased risk of cardiovascular disease, obesity, hypertension, poor physical capacity, and poor quality of life [37556077, 38015369].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37556077", "evidence_support": "The undertreated condition often results in a higher risk of several secondary devastating diseases such as increased cardiovascular disease burden, obesity, hypertension, poor physical capacity, poor quality of life.", "evidence_relation": "supporting" }, { "cited_pmid": "38015369", "evidence_support": "In children and adolescents, the most devastating consequences of undertreatment with levothyroxine (LT4) are poor growth and development.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In young women, undertreatment can lead to subnormal fertility, recurrent pregnancy loss, preeclampsia, and compromised fetal growth and neurocognitive development [37556077].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37556077", "evidence_support": "In young women of fertile age the consequences of undertreatment with LT4 are subnormal fertility, recurrent pregnancy loss, preeclampsia, compromised fetal growth and neurocognitive development. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In the elderly, undertreatment can lead to increased mortality [22642781, 16915315, 33709336].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22642781", "evidence_support": "Underprescription of potentially useful drugs is widespread among older people and may herald several adverse outcomes.", "evidence_relation": "supporting" }, { "cited_pmid": "33709336", "evidence_support": "Under-prescription is associated with negative consequences, such as higher risk of cardiovascular events, worsening disability, hospitalization and death.", "evidence_relation": "supporting" }, { "cited_pmid": "16915315", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Failure to adhere to prescribed thyroid medication can lead to significant health complications.Thyroid hormones are crucial for regulating metabolism, and insufficient levels can result in hypothyroidism, characterized by symptoms such as fatigue, weight gain, and depression [32467550]. Nonadherence can exacerbate these symptoms and potentially lead to severe outcomes like myxedema coma, a life-threatening condition [32467550]. Additionally, untreated hypothyroidism can increase the risk of cardiovascular diseases due to elevated cholesterol levels and hypertension [32467550]. Patients often struggle with medication adherence due to misconceptions about the necessity of continuous treatment, especially if they feel asymptomatic [28441949]. Understanding the critical role of thyroid hormones and the risks associated with nonadherence is essential for effective patient management and preventing adverse health outcomes [28441949].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Failure to adhere to prescribed thyroid medication can lead to significant health complications.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Thyroid hormones are crucial for regulating metabolism, and insufficient levels can result in hypothyroidism, characterized by symptoms such as fatigue, weight gain, and depression [32467550].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32467550", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Nonadherence can exacerbate these symptoms and potentially lead to severe outcomes like myxedema coma, a life-threatening condition [32467550].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32467550", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, untreated hypothyroidism can increase the risk of cardiovascular diseases due to elevated cholesterol levels and hypertension [32467550].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32467550", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Patients often struggle with medication adherence due to misconceptions about the necessity of continuous treatment, especially if they feel asymptomatic [28441949].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "28441949", "evidence_support": "Many patients find it difficult to adhere to prescribed medication for various reasons, some of which may link to the way they conceptualise medicines and understand their illness and treatment. ", "evidence_relation": "supporting" }, { "cited_pmid": "28441949", "evidence_support": "Participants provided insights into their understanding of what constitutes a medicine and what substances can be added to a prescribed regimen, which impacted on adherence. Importantly, the majority of participants demonstrated poor understanding of their illness, medications, regimens and dosage instructions", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Understanding the critical role of thyroid hormones and the risks associated with nonadherence is essential for effective patient management and preventing adverse health outcomes [28441949].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28441949", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "If a patient is prescribed thyroid medication but does not take it, they risk exacerbating their underlying thyroid condition, which can lead to significant health complications.For hypothyroidism, untreated cases can result in severe symptoms such as profound fatigue, weight gain, depression, and myxedema coma, a life-threatening condition.For hyperthyroidism, failure to take prescribed medication can lead to symptoms like weight loss, anxiety, palpitations, and potentially life-threatening thyroid storm.Both conditions can also contribute to cardiovascular issues, including arrhythmias and heart failure.Non-adherence to thyroid medication can impair metabolic processes, cognitive function, and overall quality of life, necessitating close monitoring and management to prevent these adverse outcomes.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If a patient is prescribed thyroid medication but does not take it, they risk exacerbating their underlying thyroid condition, which can lead to significant health complications.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "For hypothyroidism, untreated cases can result in severe symptoms such as profound fatigue, weight gain, depression, and myxedema coma, a life-threatening condition.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "For hyperthyroidism, failure to take prescribed medication can lead to symptoms like weight loss, anxiety, palpitations, and potentially life-threatening thyroid storm.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Both conditions can also contribute to cardiovascular issues, including arrhythmias and heart failure.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Non-adherence to thyroid medication can impair metabolic processes, cognitive function, and overall quality of life, necessitating close monitoring and management to prevent these adverse outcomes.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "If a patient is prescribed thyroid medication but does not take it, they may experience a range of negative consequences, including worsening of symptoms, such as fatigue, weight gain, and dry skin [32467550]. Untreated hypothyroidism can also lead to more severe complications, such as increased risk of cardiovascular disease, osteoporosis, and infertility [21877479]. Furthermore, non-adherence to thyroid medication can result in decreased quality of life, as patients may experience persistent symptoms that impact their daily functioning and overall well-being [28441949]. It is essential for patients to work closely with their healthcare provider to manage their thyroid condition and adhere to their prescribed medication regimen to prevent these negative outcomes [23688368]. Clinicians should also be aware of the potential for non-adherence and take steps to educate patients about the importance of taking their medication as prescribed [31787647].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If a patient is prescribed thyroid medication but does not take it, they may experience a range of negative consequences, including worsening of symptoms, such as fatigue, weight gain, and dry skin [32467550].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32467550", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Untreated hypothyroidism can also lead to more severe complications, such as increased risk of cardiovascular disease, osteoporosis, and infertility [21877479].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21877479", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Furthermore, non-adherence to thyroid medication can result in decreased quality of life, as patients may experience persistent symptoms that impact their daily functioning and overall well-being [28441949].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28441949", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It is essential for patients to work closely with their healthcare provider to manage their thyroid condition and adhere to their prescribed medication regimen to prevent these negative outcomes [23688368].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23688368", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Clinicians should also be aware of the potential for non-adherence and take steps to educate patients about the importance of taking their medication as prescribed [31787647].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "31787647", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gemini-flash": { "answer": "Not taking prescribed thyroid medication can lead to serious consequences due to untreated hypothyroidism [35186597, 35651456]. Hypothyroidism can cause a dangerous hypometabolic state, potentially leading to myxedema crisis, a life-threatening condition with a high mortality rate, even with aggressive treatment [35186597]. Myxedema coma, a fatal emergency, is an extreme manifestation of hypothyroidism [24402022]. Untreated hypothyroidism can also negatively impact renal function, leading to a greater decline in estimated glomerular filtration rate (eGFR) compared to those receiving thyroid hormone therapy [22723335]. Therefore, discontinuing thyroid medication can have severe health implications and should be discussed with a healthcare professional. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Not taking prescribed thyroid medication can lead to serious consequences due to untreated hypothyroidism [35186597, 35651456].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35186597", "evidence_support": "Severe, uncorrected hypothyroidism can result in a dangerous hypometabolic state leading to myxedema crisis, a rare but life-threatening illness.", "evidence_relation": "supporting" }, { "cited_pmid": "35651456", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Hypothyroidism can cause a dangerous hypometabolic state, potentially leading to myxedema crisis, a life-threatening condition with a high mortality rate, even with aggressive treatment [35186597].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35186597", "evidence_support": "Severe, uncorrected hypothyroidism can result in a dangerous hypometabolic state leading to myxedema crisis, a rare but life-threatening illness.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Myxedema coma, a fatal emergency, is an extreme manifestation of hypothyroidism [24402022].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24402022", "evidence_support": "Myxedema coma, a rare but fatal emergency, is an extreme expression of hypothyroidism.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Untreated hypothyroidism can also negatively impact renal function, leading to a greater decline in estimated glomerular filtration rate (eGFR) compared to those receiving thyroid hormone therapy [22723335].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22723335", "evidence_support": "Thyroid hormone therapy not only preserved renal function better, but was also an independent predictor of renal outcome in chronic kidney disease patients with subclinical hypothyroidism.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Therefore, discontinuing thyroid medication can have severe health implications and should be discussed with a healthcare professional.", "answer_sentence_relevance": "borderline", "citation_assessment": null } ] }, "ten-shot-gemini-flash-wiki": { "answer": "I am sorry, but I cannot answer this question. The provided snippets do not contain any information about the safety of not taking prescribed medications for thyroid conditions. It is crucial to consult with a healthcare professional for personalized advice regarding medication management. Self-treating thyroid conditions can have serious consequences and may lead to complications. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "I am sorry, but I cannot answer this question.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "The provided snippets do not contain any information about the safety of not taking prescribed medications for thyroid conditions.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "It is crucial to consult with a healthcare professional for personalized advice regarding medication management.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Self-treating thyroid conditions can have serious consequences and may lead to complications.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "ten-shot-gpt4o-mini": { "answer": "If you are prescribed thyroid medications but do not take them, you may experience significant health risks. Hypothyroidism requires lifelong treatment with levothyroxine to maintain normal thyroid hormone levels [36818804]. Not taking these medications can lead to untreated hypothyroidism, which is associated with adverse effects on both maternal and fetal health during pregnancy [26573046, 26403562]. Additionally, inadequate treatment can result in complications such as reduced bone mineral density, heart failure, and atrial fibrillation [33320453, 9625507]. In some cases, stopping levothyroxine can lead to elevated thyroid-stimulating hormone (TSH) levels, increasing the risk of cardiovascular issues [24125493, 30400044]. Therefore, it is crucial to discuss any concerns about medication with your healthcare provider to ensure safe management of your thyroid condition.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you are prescribed thyroid medications but do not take them, you may experience significant health risks.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Hypothyroidism requires lifelong treatment with levothyroxine to maintain normal thyroid hormone levels [36818804].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36818804", "evidence_support": "Hypothyroidism requires lifelong thyroid hormone replacement with levothyroxine.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Not taking these medications can lead to untreated hypothyroidism, which is associated with adverse effects on both maternal and fetal health during pregnancy [26573046, 26403562].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26573046", "evidence_support": "Untreated maternal hypothyroidism can have adverse effects on both the mother and fetus, but it can potentially be prevented by adequate levothyroxine replacement.", "evidence_relation": "supporting" }, { "cited_pmid": "26403562", "evidence_support": "Inadequately treated maternal hypothyroidism is associated with numerous adverse fetal and maternal outcomes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, inadequate treatment can result in complications such as reduced bone mineral density, heart failure, and atrial fibrillation [33320453, 9625507].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33320453", "evidence_support": "The decision-making process needs to take into account the risk of levothyroxine overtreatment and the resulting adverse consequences, such as reduction of bone mineral density, heart failure, and atrial fibrillation.", "evidence_relation": "supporting" }, { "cited_pmid": "9625507", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In some cases, stopping levothyroxine can lead to elevated thyroid-stimulating hormone (TSH) levels, increasing the risk of cardiovascular issues [24125493, 30400044].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30400044", "evidence_support": "The risk for CHD and ischemic stroke was higher in thyroid cancer patients who received thyroidectomy, and the dosage of levothyroxine administered appears to play a major role.", "evidence_relation": "neutral" }, { "cited_pmid": "24125493", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Therefore, it is crucial to discuss any concerns about medication with your healthcare provider to ensure safe management of your thyroid condition.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Not taking prescribed thyroid medications can lead to significant health risks. Patients with untreated hypothyroidism may experience symptoms such as fatigue, weight gain, and decreased mood [29863229]. Additionally, there is an increased risk of serious complications, including cardiovascular disease and neurocognitive impairment [27126268, 31149148]. In severe cases, untreated hypothyroidism can progress to myxedema coma, a life-threatening condition [10332556]. Furthermore, subclinical hypothyroidism can lead to adverse pregnancy outcomes and infertility [21841481]. Overall, failing to adhere to thyroid medication can exacerbate existing health issues and increase the risk of developing more severe conditions [17448261, 16026106]. Regular monitoring and treatment are essential to mitigate these risks.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Not taking prescribed thyroid medications can lead to significant health risks.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Patients with untreated hypothyroidism may experience symptoms such as fatigue, weight gain, and decreased mood [29863229].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29863229", "evidence_support": "Hypothyroidism results in decreased mood and neurocognition, weight gain, fatigue, and many other undesirable symptoms.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, there is an increased risk of serious complications, including cardiovascular disease and neurocognitive impairment [27126268, 31149148].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27126268", "evidence_support": "Patients with uncorrected disease suffer significant morbidity and have an increased risk of cardiovascular disease and neurocognitive impairment.", "evidence_relation": "supporting" }, { "cited_pmid": "31149148", "evidence_support": "Hypothyroidism is a chronic inflammatory disease that has a high risk of developing cardiovascular disease.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In severe cases, untreated hypothyroidism can progress to myxedema coma, a life-threatening condition [10332556].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "10332556", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, subclinical hypothyroidism can lead to adverse pregnancy outcomes and infertility [21841481].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "21841481", "evidence_support": "Subclinical hypothyroidism is associated with an increasing number of adverse effects including infertility, miscarriage, preterm delivery, and breech presentation at birth.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, failing to adhere to thyroid medication can exacerbate existing health issues and increase the risk of developing more severe conditions [17448261, 16026106].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17448261", "evidence_support": "Postmenopausal women are at increased risk of both osteoporosis and cardiovascular disease, and untreated thyroid disease may exacerbate these risks.", "evidence_relation": "supporting" }, { "cited_pmid": "16026106", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Regular monitoring and treatment are essential to mitigate these risks.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-1": { "answer": "If you are prescribed thyroid meds but don't take them, it can lead to misleading increases in thyroid function tests, potentially leading to a false diagnosis of hyperthyroidism [31363424,21041167]. Additionally, not taking prescribed antihypertensive medications can lead to persistently high blood pressure [21041167].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you are prescribed thyroid meds but don't take them, it can lead to misleading increases in thyroid function tests, potentially leading to a false diagnosis of hyperthyroidism [31363424,21041167].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "31363424", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "21041167", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, not taking prescribed antihypertensive medications can lead to persistently high blood pressure [21041167].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "21041167", "evidence_support": "A diagnosis of nonadherence to treatment (pseudomalabsorption of levothyroxine) was made. After reduction of her levothyroxine dosage to 100 \u03bcg daily, results of thyroid function tests showed improvement. The doses of her antihypertensive medications were likewise altered.", "evidence_relation": "neutral" } ] } ] }, "webis-2": { "answer": "The question cannot be answered based on the given context.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The question cannot be answered based on the given context.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-3": { "answer": "If you are prescribed thyroid meds but don't take them, it may lead to poor clinical outcomes in patients with SLE .", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you are prescribed thyroid meds but don't take them, it may lead to poor clinical outcomes in patients with SLE .", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-5": { "answer": "If you are prescribed thyroid meds but don't take them, it may lead to poor clinical outcomes in patients with SLE .", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you are prescribed thyroid meds but don't take them, it may lead to poor clinical outcomes in patients with SLE .", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-gpt-1": { "answer": "If you are prescribed thyroid medications but do not take them, you may experience symptoms of hypothyroidism, which can include fatigue, weight gain, depression, and sensitivity to cold. Long-term untreated hypothyroidism can lead to more severe complications, such as heart problems, myxedema coma, and impaired mental function. It is important to follow your healthcare provider's instructions regarding thyroid medication to maintain proper hormone levels and overall health.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you are prescribed thyroid medications but do not take them, you may experience symptoms of hypothyroidism, which can include fatigue, weight gain, depression, and sensitivity to cold.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Long-term untreated hypothyroidism can lead to more severe complications, such as heart problems, myxedema coma, and impaired mental function.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "It is important to follow your healthcare provider's instructions regarding thyroid medication to maintain proper hormone levels and overall health.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "If you are prescribed thyroid medications and do not take them, you may experience symptoms of hypothyroidism, such as fatigue, weight gain, and depression, due to insufficient thyroid hormone levels in your body. The context indicates a significant increase in thyroid hormone prescriptions, suggesting that many individuals rely on these medications for proper thyroid function [19432950].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you are prescribed thyroid medications and do not take them, you may experience symptoms of hypothyroidism, such as fatigue, weight gain, and depression, due to insufficient thyroid hormone levels in your body.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "The context indicates a significant increase in thyroid hormone prescriptions, suggesting that many individuals rely on these medications for proper thyroid function [19432950].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "19432950", "evidence_support": "Thyroid hormone replacement is one of the most commonly prescribed and cost effective treatments for a chronic disease. ", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-6": { "answer": "Question: What can happen if you are prescribed thyroid meds but don't take them?", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Question: What can happen if you are prescribed thyroid meds but don't take them?", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "zero-shot-gemini-flash": { "answer": "I am sorry, but I cannot answer the question without any relevant snippets. Please provide the relevant snippets from scientific papers so I can provide a comprehensive and accurate answer. \n", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "I am sorry, but I cannot answer the question without any relevant snippets.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Please provide the relevant snippets from scientific papers so I can provide a comprehensive and accurate answer.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "zero-shot-gpt4o-mini": { "answer": "If you are prescribed thyroid medications but choose not to take them, several outcomes may occur. In some cases, patients may remain euthyroid, meaning their thyroid hormone levels are normal without medication [33786164]. However, if the underlying thyroid condition requires hormone replacement and it is not taken, the patient could experience symptoms of hypothyroidism, which can lead to fatigue, weight gain, and other health issues [33786164]. In certain situations, such as with large multinodular goiters, a surgical option like hemi-thyroidectomy may be recommended to avoid the need for hormone replacement, particularly if the patient refuses medication [33786164]. Therefore, it is crucial to discuss any concerns about medication with a healthcare provider to understand the potential risks and benefits of not taking prescribed thyroid medications.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you are prescribed thyroid medications but choose not to take them, several outcomes may occur.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "In some cases, patients may remain euthyroid, meaning their thyroid hormone levels are normal without medication [33786164].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33786164", "evidence_support": "Thirty-two of them (84%) had their symptoms resolve completely and did not need a completion surgery. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, if the underlying thyroid condition requires hormone replacement and it is not taken, the patient could experience symptoms of hypothyroidism, which can lead to fatigue, weight gain, and other health issues [33786164].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33786164", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In certain situations, such as with large multinodular goiters, a surgical option like hemi-thyroidectomy may be recommended to avoid the need for hormone replacement, particularly if the patient refuses medication [33786164].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "33786164", "evidence_support": "Hemi thyroidectomy was chosen to avoid the risk of hormone replacement,", "evidence_relation": "supporting" }, { "cited_pmid": "33786164", "evidence_support": "We would recommend hemi thyroidectomy for cases of large multi nodular goiter due to its positive implication on patient outcome particularly if the patient refuse hormonal replacement.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Therefore, it is crucial to discuss any concerns about medication with a healthcare provider to understand the potential risks and benefits of not taking prescribed thyroid medications.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] } } }, { "question_id": "136", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Severe elbow pain, especially following activities like playing tennis, could be a sign of conditions such as tennis elbow or other forms of tendinitis. If over-the-counter medications like Aleve do not provide relief, there are several other treatment options available. Sublingual immunotherapy using specific extracts has shown promise in modulating the immune response and could potentially reduce inflammation, though this is typically applied in the context of allergies [29105313]. Another innovative approach to managing inflammation involves the use of mesenchymal stem cells (MSCs), which have shown potential in treating various musculoskeletal issues by promoting tissue regeneration and reducing inflammation [18464503]. In severe cases, it may also be beneficial to consult with a specialist to explore physical therapy or other interventional treatments.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Severe elbow pain, especially following activities like playing tennis, could be a sign of conditions such as tennis elbow or other forms of tendinitis.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "If over-the-counter medications like Aleve do not provide relief, there are several other treatment options available.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Sublingual immunotherapy using specific extracts has shown promise in modulating the immune response and could potentially reduce inflammation, though this is typically applied in the context of allergies [29105313].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "29105313", "evidence_support": "Sublingual immunotherapy using peach extract enriched in Pru p 3 (Pru p 3-enriched-SLIT) brings a new perspective to treating patients with allergy to lipid transfer proteins", "evidence_relation": "supporting" }, { "cited_pmid": "29105313", "evidence_support": "Successful Pru p 3-enriched-SLIT is linked to an important immunosuppression of allergen-specific effector T cells, potentially due to an increase of allergen-specific Treg cells.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Another innovative approach to managing inflammation involves the use of mesenchymal stem cells (MSCs), which have shown potential in treating various musculoskeletal issues by promoting tissue regeneration and reducing inflammation [18464503].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18464503", "evidence_support": "Mesenchymal stem cells (MSCs) are a potential cellular source for stem cell-based therapy, since they have the ability to proliferate and differentiate into mesodermal tissues.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In severe cases, it may also be beneficial to consult with a specialist to explore physical therapy or other interventional treatments.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "For severe elbow pain, treatments vary based on the cause and severity [17539763, 36759236, 18590859]. NSAIDs and corticosteroid injections provide pain relief, while physical therapy, including splinting and proprioceptive retraining, improves function [17539763, 36759236, 33004169]. Rest, ice, cryotherapy, and heat therapy are effective conservative treatments [18180389, 19345885, 24565822]. Advanced conditions may require total elbow arthroplasty or prosthetic replacement to reduce pain and restore function [17539763, 18590859, 34099969]. Arthroscopic surgery can address elbow stiffness by removing loose bodies and osteophytes [17539763, 35123712, 23391361]. Lateral collateral ligament reconstruction is for elbow instability, and a hinged external fixator stabilizes severe injuries [23380013, 34169008, 31070573]. High-intensity laser therapy, bracing, and kinesio taping help with lateral elbow tendinopathy, while hyaluronic acid injections enhance muscle strength [33004169, 33636381, 35022075]. Cetylated fatty acid cream with menthol and transcutaneous electrical nerve stimulation can alleviate pain in conditions like tennis elbow [20003341, 23999980, 15903393].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, treatments vary based on the cause and severity [17539763, 36759236, 18590859].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17539763", "evidence_support": "Nonoperative management consisting of oral analgesics, intra-articular steroid injections, physical therapy, and splinting may provide symptomatic relief in the majority of patients", "evidence_relation": "neutral" }, { "cited_pmid": "36759236", "evidence_support": "Surgical treatment depends on the underlying etiology, chief complaint, patient age, and functional demand. ", "evidence_relation": "supporting" }, { "cited_pmid": "18590859", "evidence_support": "Surgical treatment is based on disease etiology, severity of degeneration, and patient age", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "NSAIDs and corticosteroid injections provide pain relief, while physical therapy, including splinting and proprioceptive retraining, improves function [17539763, 36759236, 33004169].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17539763", "evidence_support": "Nonoperative management consisting of oral analgesics, intra-articular steroid injections, physical therapy, and splinting may provide symptomatic relief in the majority of patients. ", "evidence_relation": "supporting" }, { "cited_pmid": "36759236", "evidence_support": "Treatment begins with nonsurgical modalities, including activity modification, anti-inflammatories, hand therapy, and corticosteroids. ", "evidence_relation": "supporting" }, { "cited_pmid": "33004169", "evidence_support": "Steroid injections, NSAIDs, topical creams, platelet-rich plasma, physical therapy, and kinesiotaping are considered conservative treatments, while surgical options are last-resort treatments reserved for refractory LE. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Rest, ice, cryotherapy, and heat therapy are effective conservative treatments [18180389, 19345885, 24565822].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18180389", "evidence_support": "Nonsurgical treatment, the mainstay of management, involves a myriad of options, including rest, nonsteroidal anti-inflammatory drugs, physical therapy, cortisone, blood and botulinum toxin injections, supportive forearm bracing, and local modalities", "evidence_relation": "supporting" }, { "cited_pmid": "19345885", "evidence_support": "Nonoperative management may provide symptomatic relief in the early stages of the disease process for most patients.", "evidence_relation": "supporting" }, { "cited_pmid": "24565822", "evidence_support": "In most cases, the treatment given to patients is conservative and involves rest, ice, non-steroidal anti-inflammatory drugs for pain, and an appropriate physical therapy regimen with a progressive return to play when symptoms have resolved", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Advanced conditions may require total elbow arthroplasty or prosthetic replacement to reduce pain and restore function [17539763, 18590859, 34099969].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17539763", "evidence_support": "Total elbow arthroplasty can provide satisfactory results in the majority of patients with significant degeneration of the elbow.", "evidence_relation": "supporting" }, { "cited_pmid": "18590859", "evidence_support": "Rheumatoid, low-demand, and elderly patients are candidates for total elbow replacement; posttraumatic and osteoarthritic elbows in younger patients with considerable functional demands are treated with interpositional arthroplasty.", "evidence_relation": "supporting" }, { "cited_pmid": "34099969", "evidence_support": "Total elbow arthroplasty is very successful in terms of pain relief and function, but it is reserved for patients with end-stage osteoarthritis who are relatively older and have failed joint preserving procedures.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Arthroscopic surgery can address elbow stiffness by removing loose bodies and osteophytes [17539763, 35123712, 23391361].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17539763", "evidence_support": "Total elbow arthroplasty can provide satisfactory results in the majority of patients with significant degeneration of the elbow.", "evidence_relation": "supporting" }, { "cited_pmid": "35123712", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "23391361", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Lateral collateral ligament reconstruction is for elbow instability, and a hinged external fixator stabilizes severe injuries [23380013, 34169008, 31070573].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23380013", "evidence_support": "A stiff elbow with distal humeral nonunion can be treated successfully using a unilateral hinged external fixator to supplement the open reduction and internal fixation. A hinged external fixator was an effective rehabilitation method for improving range of motion and maintaining joint stability.", "evidence_relation": "supporting" }, { "cited_pmid": "31070573", "evidence_support": "Hinged external fixation of the elbow provides the advantages of static fixation with the benefits of continued motion of the joint.", "evidence_relation": "supporting" }, { "cited_pmid": "34169008", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "High-intensity laser therapy, bracing, and kinesio taping help with lateral elbow tendinopathy, while hyaluronic acid injections enhance muscle strength [33004169, 33636381, 35022075].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33004169", "evidence_support": "Steroid injections, NSAIDs, topical creams, platelet-rich plasma, physical therapy, and kinesiotaping are considered conservative treatments, while surgical options are last-resort treatments reserved for refractory LE.", "evidence_relation": "supporting" }, { "cited_pmid": "33636381", "evidence_support": "We therefore recommend considering non-invasive techniques such as ESWT treatment prior to surgery in tennis elbow.", "evidence_relation": "neutral" }, { "cited_pmid": "35022075", "evidence_support": "HA injections yielded significant success in pain relief by three months.", "evidence_relation": "neutral" }, { "cited_pmid": "35022075", "evidence_support": "This study indicates that patients with chronic lateral epicondylitis may benefit from receiving injections of hyaluronic acid rather than having to undergo surgery.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Cetylated fatty acid cream with menthol and transcutaneous electrical nerve stimulation can alleviate pain in conditions like tennis elbow [20003341, 23999980, 15903393].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20003341", "evidence_support": "Transcutaneous electrical nerve stimulation (TENS) is an inexpensive, non-invasive, non-pharmacological form of analgesia that is commonly used in the treatment of pain. ", "evidence_relation": "supporting" }, { "cited_pmid": "23999980", "evidence_support": "To investigate the effectiveness of supplementing information and advice on analgesia and exercise from a general practitioner with transcutaneous electrical nerve stimulation (TENS) as a non-drug form of analgesia to reduce pain intensity in patients with tennis elbow.", "evidence_relation": "neutral" }, { "cited_pmid": "23999980", "evidence_support": "This trial does not provide evidence for additional benefit of TENS as an adjunct to primary care management of tennis elbow.", "evidence_relation": "contradicting" }, { "cited_pmid": "15903393", "evidence_support": "This investigation was an extension of a previous study conducted in our laboratory in which we showed that 1 month of treatment with a topical cream (Celadrin) consisting of cetylated fatty acids was effective for reducing pain and improving functional performance in individuals with osteoarthritis (OA) of the knee (Kraemer et al., Journal of Rheumatology, 2004). ", "evidence_relation": "supporting" }, { "cited_pmid": "15903393", "evidence_support": "One week of treatment with a topical cream consisting of cetylated fatty acids and menthol was similarly effective for reducing pain and improving functional performance in individuals with arthritis of the knee, elbow, and wrist. ", "evidence_relation": "supporting" }, { "cited_pmid": "15903393", "evidence_support": "Nevertheless, our data support the use of a topical cream consisting of cetylated fatty acids (with or without menthol) for enhancing the potential for exercise training in this population.", "evidence_relation": "supporting" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Severe elbow pain, often due to conditions like rheumatoid arthritis, posttraumatic arthritis, or primary osteoarthritis, can be managed initially with nonoperative treatments such as oral analgesics, intra-articular steroid injections, physical therapy, and activity modification [17539763, 36759236]. When these measures fail, surgical options are considered based on the underlying etiology, disease severity, and patient factors such as age and activity level [17539763, 18590859]. Arthroscopic debridement and synovectomy are effective for mild to moderate rheumatoid arthritis, while capsular release and ulnohumeral arthroplasty are suitable for early posttraumatic arthritis and osteoarthritis [18590859]. For severe cases, total elbow arthroplasty is reserved for elderly or low-demand patients due to concerns about prosthesis longevity, whereas interpositional arthroplasty is preferred for younger, active patients [17539763, 18590859, 21501790]. Advances in arthroscopic techniques have improved outcomes, offering substantial pain relief and functional restoration [36759236, 34099969].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Severe elbow pain, often due to conditions like rheumatoid arthritis, posttraumatic arthritis, or primary osteoarthritis, can be managed initially with nonoperative treatments such as oral analgesics, intra-articular steroid injections, physical therapy, and activity modification [17539763, 36759236].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17539763", "evidence_support": "Rheumatoid arthritis is the most common cause of elbow arthritis, followed by posttraumatic arthritis and primary osteoarthritis. Nonoperative management consisting of oral analgesics, intra-articular steroid injections, physical therapy, and splinting may provide symptomatic relief in the majority of patients.", "evidence_relation": "supporting" }, { "cited_pmid": "36759236", "evidence_support": "The most common etiologies include rheumatoid arthritis, posttraumatic arthritis, and primary osteoarthritis. Treatment begins with nonsurgical modalities, including activity modification, anti-inflammatories, hand therapy, and corticosteroids.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "When these measures fail, surgical options are considered based on the underlying etiology, disease severity, and patient factors such as age and activity level [17539763, 18590859].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17539763", "evidence_support": "If these modalities fail, operative treatment is guided by the severity of disease as well as several patient-related factors such as age, activity level, and expectations", "evidence_relation": "supporting" }, { "cited_pmid": "18590859", "evidence_support": "Surgical treatment is based on disease etiology, severity of degeneration, and patient age", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Arthroscopic debridement and synovectomy are effective for mild to moderate rheumatoid arthritis, while capsular release and ulnohumeral arthroplasty are suitable for early posttraumatic arthritis and osteoarthritis [18590859].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18590859", "evidence_support": "Rheumatoid elbows with mild to moderate disease benefit from arthroscopic debridement and synovectomy, whereas capsular release and ulnohumeral arthroplasty can relieve painful elbows with early posttraumatic arthritis and osteoarthritis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "For severe cases, total elbow arthroplasty is reserved for elderly or low-demand patients due to concerns about prosthesis longevity, whereas interpositional arthroplasty is preferred for younger, active patients [17539763, 18590859, 21501790].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17539763", "evidence_support": "If these modalities fail, operative treatment is guided by the severity of disease as well as several patient-related factors such as age, activity level, and expectations. Total elbow arthroplasty can provide satisfactory results in the majority of patients with significant degeneration of the elbow. However, due to issues regarding prosthesis longevity, this procedure is generally avoided in young active patients.", "evidence_relation": "supporting" }, { "cited_pmid": "18590859", "evidence_support": "Rheumatoid, low-demand, and elderly patients are candidates for total elbow replacement; posttraumatic and osteoarthritic elbows in younger patients with considerable functional demands are treated with interpositional arthroplasty.", "evidence_relation": "supporting" }, { "cited_pmid": "21501790", "evidence_support": "End-stage elbow arthritis in young, active patients presents a challenging problem to the upper extremity surgeon. Total elbow arthroplasty is not a viable option in this population because of functional restrictions, limited implant survivorship, and the lack of an adequate salvage option.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Advances in arthroscopic techniques have improved outcomes, offering substantial pain relief and functional restoration [36759236, 34099969].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36759236", "evidence_support": "Advances in technology, especially arthroscopic techniques, have expanded the treatment options available to surgeons. The goals of treatment include pain relief and restoration of functional range of motion.", "evidence_relation": "supporting" }, { "cited_pmid": "34099969", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Severe elbow pain can be managed through various treatment options, depending on the underlying cause and severity of the condition.For patients with lateral epicondylitis, also known as tennis elbow, nonoperative modalities such as physical therapy, nonsteroidal anti-inflammatory drugs, and corticosteroid injections may provide relief [22759604, 33004169, 18180389]. However, in refractory cases, arthroscopic release with debridement is a good surgical option [21469624, 36462778]. For patients with elbow arthritis, arthroscopic or open synovectomy, debridement arthroplasty, and interposition arthroplasty are generally recommended for the young and active patient population, whereas total elbow arthroplasty is considered a more suitable option for low-demand and elderly patients with end-stage painful arthritis [17539763, 18590859, 23391361]. In cases of severe elbow stiffness with distal humeral nonunion, a hinged external fixator and open surgery may be necessary [23380013].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Severe elbow pain can be managed through various treatment options, depending on the underlying cause and severity of the condition.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "For patients with lateral epicondylitis, also known as tennis elbow, nonoperative modalities such as physical therapy, nonsteroidal anti-inflammatory drugs, and corticosteroid injections may provide relief [22759604, 33004169, 18180389].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22759604", "evidence_support": "A \"watch-and-wait\" approach can be an appropriate treatment option, although physical therapy has been shown to be an effective first-line therapy. Corticosteroids, while providing relief of pain in the acute setting, may be detrimental to recovery in the long term.", "evidence_relation": "supporting" }, { "cited_pmid": "33004169", "evidence_support": "Steroid injections, NSAIDs, topical creams, platelet-rich plasma, physical therapy, and kinesiotaping are considered conservative treatments, while surgical options are last-resort treatments reserved for refractory LE.", "evidence_relation": "supporting" }, { "cited_pmid": "18180389", "evidence_support": "Nonsurgical treatment, the mainstay of management, involves a myriad of options, including rest, nonsteroidal anti-inflammatory drugs, physical therapy, cortisone, blood and botulinum toxin injections, supportive forearm bracing, and local modalities.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, in refractory cases, arthroscopic release with debridement is a good surgical option [21469624, 36462778].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21469624", "evidence_support": "Chronic lateral epicondylitis is a common painful condition affecting the elbow. Many treatments have been proposed to alleviate the pain. Surgical treatment options include open, arthroscopic, and percutaneous debridement techniques, while nonoperative modalities have traditionally included physical therapy, bracing, and cortisone injections. Platelet-rich plasma injections have recently gained popularity as an additional treatment option, with early reports of success in elite athletes.", "evidence_relation": "supporting" }, { "cited_pmid": "21469624", "evidence_support": "This article presents a case of a 55-year-old right-hand-dominant woman with bilateral lateral epicondylitis refractory to multiple corticosteroid injections and physical therapy, treated with platelet-rich plasma injection in the right elbow and concomitant arthroscopic extensor carpi radialis brevis tendon release and debridement in the left elbow", "evidence_relation": "supporting" }, { "cited_pmid": "36462778", "evidence_support": "In refractory cases, arthroscopic release with debridement is a good surgical option but is not superior to open or percutaneous techniques.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "For patients with elbow arthritis, arthroscopic or open synovectomy, debridement arthroplasty, and interposition arthroplasty are generally recommended for the young and active patient population, whereas total elbow arthroplasty is considered a more suitable option for low-demand and elderly patients with end-stage painful arthritis [17539763, 18590859, 23391361].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17539763", "evidence_support": "Patients with elbow arthritis typically present with complaints of pain and stiffness. Rheumatoid arthritis is the most common cause of elbow arthritis, followed by posttraumatic arthritis and primary osteoarthritis.", "evidence_relation": "neutral" }, { "cited_pmid": "17539763", "evidence_support": "Total elbow arthroplasty can provide satisfactory results in the majority of patients with significant degeneration of the elbow. However, due to issues regarding prosthesis longevity, this procedure is generally avoided in young active patients. Other operative treatment options for such patients include arthroscopic or open synovectomy, debridement arthroplasty, and interpositional arthroplasty.", "evidence_relation": "supporting" }, { "cited_pmid": "18590859", "evidence_support": "Rheumatoid elbows with mild to moderate disease benefit from arthroscopic debridement and synovectomy, whereas capsular release and ulnohumeral arthroplasty can relieve painful elbows with early posttraumatic arthritis and osteoarthritis.", "evidence_relation": "supporting" }, { "cited_pmid": "18590859", "evidence_support": "Rheumatoid, low-demand, and elderly patients are candidates for total elbow replacement; posttraumatic and osteoarthritic elbows in younger patients with considerable functional demands are treated with interpositional arthroplasty.", "evidence_relation": "supporting" }, { "cited_pmid": "23391361", "evidence_support": "Arthroscopic or open synovectomy, debridement arthroplasty, and interposition arthroplasty are generally recommended for the young and active patient population, whereas for low-demand and elderly patients with end-stage painful arthritis, total elbow arthroplasty is considered a more suitable surgical option.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In cases of severe elbow stiffness with distal humeral nonunion, a hinged external fixator and open surgery may be necessary [23380013].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23380013", "evidence_support": "To improve treatment outcomes, the authors applied a hinged external fixator after performing open reduction and internal fixation and evaluated the clinical outcome. Between 2005 and 2011, eleven patients with elbow stiffness and distal humeral nonunion underwent open arthrolysis, surgical reduction, internal fixation, hinged external fixation, and selective bone grafting. The ulnar nerve was anteriorly transposed in all patients. Elbow range of motion, Mayo Elbow Performance Score, and radiographs were assessed pre- and postoperatively. All patients achieved solid union in an average of 5.6 months. Preoperatively, mean flexion was 86.8\u00b0, mean extension was 45.5\u00b0, and mean total range of motion was 41.3\u00b0. Postoperatively, mean flexion was 125.9\u00b0, mean extension was 11.8\u00b0, and mean total range of motion was 114.1\u00b0. Mean Mayo Elbow Performance Score also significantly improved from 59 points", "evidence_relation": "supporting" }, { "cited_pmid": "23380013", "evidence_support": "A stiff elbow with distal humeral nonunion can be treated successfully using a unilateral hinged external fixator to supplement the open reduction and internal fixation.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "For severe elbow pain, treatment options include conservative measures such as physical therapy, counterforce bracing, and corticosteroid injections [19243730, 17910298, 24584568]. Topical nonsteroidal anti-inflammatory drugs, ultrasonography, and iontophoresis with nonsteroidal anti-inflammatory drugs may also provide short-term benefits [21157658, 17910298, 21708051]. Progressive resistance exercises may confer modest intermediate-term results [17910298]. In some cases, surgery may be necessary, such as arthroscopic debridement, capsular release, and ulnohumeral arthroplasty [22418944, 31558411, 18590859]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, treatment options include conservative measures such as physical therapy, counterforce bracing, and corticosteroid injections [19243730, 17910298, 24584568].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17910298", "evidence_support": "Topical nonsteroidal anti-inflammatory drugs, corticosteroid injections, ultrasonography, and iontophoresis with nonsteroidal anti-inflammatory drugs appear to provide short-term benefits. Use of an inelastic, nonarticular, proximal forearm strap (tennis elbow brace) may improve function during daily activities.", "evidence_relation": "supporting" }, { "cited_pmid": "24584568", "evidence_support": "Different treatment modalities have been described, including the use of orthotics, non-steroidal anti-inflammatory drugs, steroid injections, topical glyceryl trinitrate, exercise therapy, manual therapy, ultrasound therapy, laser therapy, extracorporeal shockwave therapy, acupuncture, taping, platelet-rich plasma injections, hyaluronan gel injections, botulinum toxin injections, and surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "19243730", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Topical nonsteroidal anti-inflammatory drugs, ultrasonography, and iontophoresis with nonsteroidal anti-inflammatory drugs may also provide short-term benefits [21157658, 17910298, 21708051].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21157658", "evidence_support": "During the acute phase topical NSAIR, steroid injections, ultrasound and acupuncture are helpful.", "evidence_relation": "supporting" }, { "cited_pmid": "17910298", "evidence_support": "Topical nonsteroidal anti-inflammatory drugs, corticosteroid injections, ultrasonography, and iontophoresis with nonsteroidal anti-inflammatory drugs appear to provide short-term benefits.", "evidence_relation": "supporting" }, { "cited_pmid": "21708051", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Progressive resistance exercises may confer modest intermediate-term results [17910298].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17910298", "evidence_support": "Progressive resistance exercises may confer modest intermediate-term results.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In some cases, surgery may be necessary, such as arthroscopic debridement, capsular release, and ulnohumeral arthroplasty [22418944, 31558411, 18590859].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22418944", "evidence_support": "If this is not the case or if the conservative treatment does not succeed, arthroscopic techniques, ligament reconstruction or nerve decompression are the major alternatives.", "evidence_relation": "supporting" }, { "cited_pmid": "31558411", "evidence_support": "Arthroscopic debridement for primary elbow osteoarthritis reliably produces pain relief, motion range gains, and good functional outcomes", "evidence_relation": "supporting" }, { "cited_pmid": "31558411", "evidence_support": "Total elbow arthroplasty, in contrast, is considered a salvage option in this patient population, as activities must be restricted to protect the implant.", "evidence_relation": "supporting" }, { "cited_pmid": "18590859", "evidence_support": "Rheumatoid elbows with mild to moderate disease benefit from arthroscopic debridement and synovectomy, whereas capsular release and ulnohumeral arthroplasty can relieve painful elbows with early posttraumatic arthritis and osteoarthritis.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "For severe elbow pain, the initial treatment should be conservative, including rest, nonsteroidal anti-inflammatory drugs, physical therapy, cortisone injections, and local modalities [18686818, 18180389, 35876779]. If nonoperative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted [16713868, 18180389, 35876779]. Surgical treatments are dictated based on the severity of the pathology, involvement of soft tissues, and concomitant pathology [18686818, 18180389, 35876779]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, the initial treatment should be conservative, including rest, nonsteroidal anti-inflammatory drugs, physical therapy, cortisone injections, and local modalities [18686818, 18180389, 35876779].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18686818", "evidence_support": "Initial treatment should be conservative and is successful in up to 90% of cases. Modalities such as patient education, physiotherapy, use of splints, anti-inflammatory medication, complementary medicine and eventually local injections are all acceptable treatment methods.", "evidence_relation": "supporting" }, { "cited_pmid": "18180389", "evidence_support": "Nonsurgical treatment, the mainstay of management, involves a myriad of options, including rest, nonsteroidal anti-inflammatory drugs, physical therapy, cortisone, blood and botulinum toxin injections, supportive forearm bracing, and local modalities.", "evidence_relation": "supporting" }, { "cited_pmid": "35876779", "evidence_support": "Mainstay treatment is nonoperative modalities such as stretching, rest, activity modification, therapy, and injections.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If nonoperative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted [16713868, 18180389, 35876779].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35876779", "evidence_support": "If nonoperative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted.", "evidence_relation": "supporting" }, { "cited_pmid": "16713868", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18180389", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Surgical treatments are dictated based on the severity of the pathology, involvement of soft tissues, and concomitant pathology [18686818, 18180389, 35876779].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35876779", "evidence_support": "Surgical treatments are dictated based on the severity of the pathology, involvement of soft tissues, and concomitant pathology.", "evidence_relation": "supporting" }, { "cited_pmid": "18686818", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18180389", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "For severe elbow pain, initial treatment should be conservative and may include rest, nonsteroidal anti-inflammatory drugs, physical therapy, and the occasional intraarticular corticosteroid injection [18686818, 16464123, 23016111]. If conservative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted [35876779]. Surgical treatment may be necessary in some cases, and options include arthroscopic release, open debridement, and total elbow arthroplasty [18686818, 18180389, 17536516]. It is also important to address any underlying conditions, such as ulnar nerve symptoms or contracture of the posterior oblique ligament of the medial collateral ligament, through mini-open ulnar nerve neurolysis and release of the posterior oblique ligament [30945150]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, initial treatment should be conservative and may include rest, nonsteroidal anti-inflammatory drugs, physical therapy, and the occasional intraarticular corticosteroid injection [18686818, 16464123, 23016111].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18686818", "evidence_support": "Initial treatment should be conservative and is successful in up to 90% of cases. Modalities such as patient education, physiotherapy, use of splints, anti-inflammatory medication, complementary medicine and eventually local injections are all acceptable treatment methods. ", "evidence_relation": "supporting" }, { "cited_pmid": "16464123", "evidence_support": "Corticosteroids and elbow straps are often used for treatment; however, there is only very limited prospective clinical or experimental evidence for their effectiveness. The most effective modalities of treatment are probably rest (the absence of painful activity) combined with cryotherapy in the acute stage then NSAIDs and heat in its various modalities including ultrasound. Cortisone injections may be used to create a pain-free window of opportunity to optimise the athletes' rehabilitation exercises. ", "evidence_relation": "supporting" }, { "cited_pmid": "23016111", "evidence_support": "Nonsteroidal anti-inflammatory drugs and localized corticosteroid injections yield moderate symptomatic relief in short term but do not demonstrate benefit on long-term follow-up.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If conservative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted [35876779].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35876779", "evidence_support": "If nonoperative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Surgical treatment may be necessary in some cases, and options include arthroscopic release, open debridement, and total elbow arthroplasty [18686818, 18180389, 17536516].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18686818", "evidence_support": "Surgical treatment of tennis elbow should be used only as a last resort. Both open and arthroscopic methods are acceptable and their results are considered to be excellent.", "evidence_relation": "supporting" }, { "cited_pmid": "18180389", "evidence_support": "For patients with recalcitrant disease, the traditional open d\u00e9bridement technique has been modified by multiple surgeons, with others relying on arthroscopic or even percutaneous procedures.", "evidence_relation": "supporting" }, { "cited_pmid": "17536516", "evidence_support": "Surgery is reserved for patients with recalcitrant elbow pain unresponsive to nonsurgical management.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It is also important to address any underlying conditions, such as ulnar nerve symptoms or contracture of the posterior oblique ligament of the medial collateral ligament, through mini-open ulnar nerve neurolysis and release of the posterior oblique ligament [30945150].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30945150", "evidence_support": "For four patients with preoperative ulnar nerve symptoms or contracture of the posterior oblique ligament of the medial collateral ligament, mini-open ulnar nerve neurolysis and release of the posterior oblique ligament were performed", "evidence_relation": "supporting" }, { "cited_pmid": "30945150", "evidence_support": "Arthroscopic release for the severely stiff elbow could improve range of motion.", "evidence_relation": "neutral" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "For severe elbow pain, initial treatment should be conservative and may include rest, nonsteroidal anti-inflammatory drugs, physical therapy, and the occasional intraarticular corticosteroid injection [33004169, 23016111, 16464123]. If conservative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted [24198540, 35876779]. Surgical treatment may be necessary in some cases, and options include arthroscopic release, open debridement, and total elbow arthroplasty [30945150, 31558411, 17536516]. It is also important to address any underlying conditions, such as ulnar nerve symptoms or contracture of the posterior oblique ligament of the medial collateral ligament, through mini-open ulnar nerve neurolysis and release of the posterior oblique ligament [30945150]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, initial treatment should be conservative and may include rest, nonsteroidal anti-inflammatory drugs, physical therapy, and the occasional intraarticular corticosteroid injection [33004169, 23016111, 16464123].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33004169", "evidence_support": "Steroid injections, NSAIDs, topical creams, platelet-rich plasma, physical therapy, and kinesiotaping are considered conservative treatments, while surgical options are last-resort treatments reserved for refractory LE. ", "evidence_relation": "supporting" }, { "cited_pmid": "23016111", "evidence_support": "Nonsteroidal anti-inflammatory drugs and localized corticosteroid injections yield moderate symptomatic relief in short term but do not demonstrate benefit on long-term follow-up.", "evidence_relation": "supporting" }, { "cited_pmid": "16464123", "evidence_support": "The most effective modalities of treatment are probably rest (the absence of painful activity) combined with cryotherapy in the acute stage then NSAIDs and heat in its various modalities including ultrasound. Cortisone injections may be used to create a pain-free window of opportunity to optimise the athletes' rehabilitation exercises. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If conservative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted [24198540, 35876779].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24198540", "evidence_support": "In this review we report the new options for the management of tendinopathy, including eccentric exercises, extracorporeal shockwave therapy, injections (intratendinous injections of corticosteroids, aprotinin, polidocanol platelet-rich plasma, autologous blood injection, high-volume injections) and surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "35876779", "evidence_support": "If nonoperative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Surgical treatment may be necessary in some cases, and options include arthroscopic release, open debridement, and total elbow arthroplasty [30945150, 31558411, 17536516].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30945150", "evidence_support": "Arthroscopic release for the severely stiff elbow could improve range of motion.", "evidence_relation": "supporting" }, { "cited_pmid": "31558411", "evidence_support": "Arthroscopic debridement for primary elbow osteoarthritis reliably produces pain relief, motion range gains, and good functional outcomes. Total elbow arthroplasty, in contrast, is considered a salvage option in this patient population, as activities must be restricted to protect the implant.", "evidence_relation": "supporting" }, { "cited_pmid": "17536516", "evidence_support": "Surgery is reserved for patients with recalcitrant elbow pain unresponsive to nonsurgical management.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It is also important to address any underlying conditions, such as ulnar nerve symptoms or contracture of the posterior oblique ligament of the medial collateral ligament, through mini-open ulnar nerve neurolysis and release of the posterior oblique ligament [30945150].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30945150", "evidence_support": "For four patients with preoperative ulnar nerve symptoms or contracture of the posterior oblique ligament of the medial collateral ligament, mini-open ulnar nerve neurolysis and release of the posterior oblique ligament were performed.", "evidence_relation": "supporting" }, { "cited_pmid": "30945150", "evidence_support": "Arthroscopic release for the severely stiff elbow could improve range of motion.", "evidence_relation": "neutral" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "For severe elbow pain, initial treatment should be conservative and may include rest, nonsteroidal anti-inflammatory drugs, physical therapy, and the occasional intraarticular corticosteroid injection [23016111, 16464123, 18686818]. If conservative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted [24198540, 35876779]. Surgical treatment may be necessary in some cases, and options include arthroscopic release, open debridement, and total elbow arthroplasty [23391361, 31558411, 17536516]. It is also important to address any underlying conditions, such as ulnar nerve symptoms or contracture of the posterior oblique ligament of the medial collateral ligament, through mini-open ulnar nerve neurolysis and release of the posterior oblique ligament [30945150]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, initial treatment should be conservative and may include rest, nonsteroidal anti-inflammatory drugs, physical therapy, and the occasional intraarticular corticosteroid injection [23016111, 16464123, 18686818].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23016111", "evidence_support": "Their etiology is degenerative and related to repetitive overuse and underlying tendinopathy. Nonsteroidal anti-inflammatory drugs and localized corticosteroid injections yield moderate symptomatic relief in short term but do not demonstrate benefit on long-term follow-up", "evidence_relation": "neutral" }, { "cited_pmid": "23016111", "evidence_support": "Platelet-rich plasma injections may be advantageous in cases of chronic lateral epicondylitis", "evidence_relation": "neutral" }, { "cited_pmid": "16464123", "evidence_support": "Corticosteroids and elbow straps are often used for treatment; however, there is only very limited prospective clinical or experimental evidence for their effectiveness", "evidence_relation": "contradicting" }, { "cited_pmid": "16464123", "evidence_support": "The most effective modalities of treatment are probably rest (the absence of painful activity) combined with cryotherapy in the acute stage then NSAIDs and heat in its various modalities including ultrasound", "evidence_relation": "supporting" }, { "cited_pmid": "16464123", "evidence_support": "Cortisone injections may be used to create a pain-free window of opportunity to optimise the athletes' rehabilitation exercis", "evidence_relation": "supporting" }, { "cited_pmid": "18686818", "evidence_support": "Initial treatment should be conservative and is successful in up to 90% of cases", "evidence_relation": "supporting" }, { "cited_pmid": "18686818", "evidence_support": "Modalities such as patient education, physiotherapy, use of splints, anti-inflammatory medication, complementary medicine and eventually local injections are all acceptable treatment methods", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If conservative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted [24198540, 35876779].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24198540", "evidence_support": "In this review we report the new options for the management of tendinopathy, including eccentric exercises, extracorporeal shockwave therapy, injections (intratendinous injections of corticosteroids, aprotinin, polidocanol platelet-rich plasma, autologous blood injection, high-volume injections) and surgery", "evidence_relation": "supporting" }, { "cited_pmid": "35876779", "evidence_support": "If nonoperative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Surgical treatment may be necessary in some cases, and options include arthroscopic release, open debridement, and total elbow arthroplasty [23391361, 31558411, 17536516].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23391361", "evidence_support": "Arthroscopic or open synovectomy, debridement arthroplasty, and interposition arthroplasty are generally recommended for the young and active patient population, whereas for low-demand and elderly patients with end-stage painful arthritis, total elbow arthroplasty is considered a more suitable surgical option. ", "evidence_relation": "supporting" }, { "cited_pmid": "31558411", "evidence_support": "Arthroscopic debridement for primary elbow osteoarthritis reliably produces pain relief, motion range gains, and good functional outcomes. Total elbow arthroplasty, in contrast, is considered a salvage option in this patient population, as activities must be restricted to protect the implant.", "evidence_relation": "supporting" }, { "cited_pmid": "31558411", "evidence_support": "Complex regional pain syndrome developed in 3 patients. Ulnar nerve transposition was required secondarily in 1 patient and another patient had persistent dysesthesia after ulnar nerve release. This minimally invasive technique provides good short-term outcomes in primary elbow osteoarthritis and is associated with a low complication rate.", "evidence_relation": "supporting" }, { "cited_pmid": "17536516", "evidence_support": "Surgery is reserved for patients with recalcitrant elbow pain unresponsive to nonsurgical management.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It is also important to address any underlying conditions, such as ulnar nerve symptoms or contracture of the posterior oblique ligament of the medial collateral ligament, through mini-open ulnar nerve neurolysis and release of the posterior oblique ligament [30945150].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30945150", "evidence_support": "Arthroscopic release for the stiff elbow has been widely used, but there are no reports limited to severe stiffness.", "evidence_relation": "neutral" }, { "cited_pmid": "30945150", "evidence_support": "For four patients with preoperative ulnar nerve symptoms or contracture of the posterior oblique ligament of the medial collateral ligament, mini-open ulnar nerve neurolysis and release of the posterior oblique ligament were performed.", "evidence_relation": "supporting" }, { "cited_pmid": "30945150", "evidence_support": "Arthroscopic release could be performed without any intraoperative complications. Range of motion for the elbow significantly improved from 95\u00b0 of flexion and -\u200955\u00b0 of extension to 109\u00b0 of flexion and -\u200932\u00b0 of extension. The Mayo Elbow Performance Score also improved from 56 points to 80 points. Two patients underw", "evidence_relation": "neutral" }, { "cited_pmid": "30945150", "evidence_support": "Arthroscopic release for the severely stiff elbow could improve range of motion. Careful attention should be given during surgery to avoid complications such as intramuscular bleeding or nerve damage.", "evidence_relation": "neutral" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "For severe elbow pain, initial treatment should be conservative and may include rest, nonsteroidal anti-inflammatory drugs, physical therapy, and the occasional intraarticular corticosteroid injection [16464123, 23016111, 33004169]. If conservative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted [24198540, 35876779]. Surgical treatment may be necessary in some cases, and options include arthroscopic release, open debridement, and total elbow arthroplasty [30945150, 17536516, 31558411]. It is also important to address any underlying conditions, such as ulnar nerve symptoms or contracture of the posterior oblique ligament of the medial collateral ligament, through mini-open ulnar nerve neurolysis and release of the posterior oblique ligament [30945150]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, initial treatment should be conservative and may include rest, nonsteroidal anti-inflammatory drugs, physical therapy, and the occasional intraarticular corticosteroid injection [16464123, 23016111, 33004169].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16464123", "evidence_support": "The most effective modalities of treatment are probably rest (the absence of painful activity) combined with cryotherapy in the acute stage then NSAIDs and heat in its various modalities including ultrasound. Cortisone injections may be used to create a pain-free window of opportunity to optimise the athletes' rehabilitation exercises.", "evidence_relation": "supporting" }, { "cited_pmid": "23016111", "evidence_support": "Nonsteroidal anti-inflammatory drugs and localized corticosteroid injections yield moderate symptomatic relief in short term but do not demonstrate benefit on long-term follow-up.", "evidence_relation": "neutral" }, { "cited_pmid": "33004169", "evidence_support": "Steroid injections, NSAIDs, topical creams, platelet-rich plasma, physical therapy, and kinesiotaping are considered conservative treatments, while surgical options are last-resort treatments reserved for refractory LE.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If conservative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted [24198540, 35876779].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24198540", "evidence_support": "In this review we report the new options for the management of tendinopathy, including eccentric exercises, extracorporeal shockwave therapy, injections (intratendinous injections of corticosteroids, aprotinin, polidocanol platelet-rich plasma, autologous blood injection, high-volume injections) and surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "35876779", "evidence_support": "If nonoperative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Surgical treatment may be necessary in some cases, and options include arthroscopic release, open debridement, and total elbow arthroplasty [30945150, 17536516, 31558411].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30945150", "evidence_support": "Arthroscopic release for the severely stiff elbow could improve range of motion.", "evidence_relation": "supporting" }, { "cited_pmid": "17536516", "evidence_support": "Surgery is reserved for patients with recalcitrant elbow pain unresponsive to nonsurgical management. This article reviews the technique of arthroscopic tennis elbow release surgery, including indications, contraindications, complications, postoperative rehabilitation, and outcome.", "evidence_relation": "supporting" }, { "cited_pmid": "31558411", "evidence_support": "Arthroscopic debridement for primary elbow osteoarthritis reliably produces pain relief, motion range gains, and good functional outcomes. Total elbow arthroplasty, in contrast, is considered a salvage option in this patient population, as activities must be restricted to protect the implant", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It is also important to address any underlying conditions, such as ulnar nerve symptoms or contracture of the posterior oblique ligament of the medial collateral ligament, through mini-open ulnar nerve neurolysis and release of the posterior oblique ligament [30945150].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30945150", "evidence_support": "For four patients with preoperative ulnar nerve symptoms or contracture of the posterior oblique ligament of the medial collateral ligament, mini-open ulnar nerve neurolysis and release of the posterior oblique ligament were performed.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "For severe elbow pain, initial treatment should be conservative and may include rest, nonsteroidal anti-inflammatory drugs, physical therapy, and the occasional intraarticular corticosteroid injection [18686818, 33004169]. If conservative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted [34618635, 19468902, 23487341]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, initial treatment should be conservative and may include rest, nonsteroidal anti-inflammatory drugs, physical therapy, and the occasional intraarticular corticosteroid injection [18686818, 33004169].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18686818", "evidence_support": "Initial treatment should be conservative and is successful in up to 90% of cases. Modalities such as patient education, physiotherapy, use of splints, anti-inflammatory medication, complementary medicine and eventually local injections are all acceptable treatment methods.", "evidence_relation": "supporting" }, { "cited_pmid": "33004169", "evidence_support": "Steroid injections, NSAIDs, topical creams, platelet-rich plasma, physical therapy, and kinesiotaping are considered conservative treatments, while surgical options are last-resort treatments reserved for refractory LE.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If conservative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted [34618635, 19468902, 23487341].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19468902", "evidence_support": "Recently, there is emerging literature on the beneficial effects of PRP for chronic non-healing tendon injuries including lateral epicondylitis and plantar fasciitis and cartilage degeneration (Mishra and Pavelko, The American Journal of Sports Medicine 10(10):1-5, 2006; Barrett and Erredge, Podiatry Today 17:37-42, 2004).", "evidence_relation": "neutral" }, { "cited_pmid": "23487341", "evidence_support": "Platelet-rich plasma injection is an emerging alternative treatment method for common musculoskeletal tendon injuries.", "evidence_relation": "supporting" }, { "cited_pmid": "34618635", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "For severe elbow pain, initial treatment should be conservative and may include rest, nonsteroidal anti-inflammatory drugs, physical therapy, and the occasional intraarticular corticosteroid injection [35876779]. If conservative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted for chronic, recalcitrant tendinopathy [21872551]. Surgical treatment may be necessary in some cases, and options include arthroscopic release, open debridement, and total elbow arthroplasty [33438926]. It is also important to address any underlying conditions, such as medial collateral ligament injuries or contracture of the posterior oblique ligament, through appropriate treatment such as bracing, delayed reconstruction, or surgical reconstruction techniques using free tendon grafts [28461925, 26231962]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, initial treatment should be conservative and may include rest, nonsteroidal anti-inflammatory drugs, physical therapy, and the occasional intraarticular corticosteroid injection [35876779].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35876779", "evidence_support": "Medial elbow pain is a common presentation that can be a challenge to appropriately treat for the orthopedic surgeon", "evidence_relation": "neutral" }, { "cited_pmid": "35876779", "evidence_support": "Causes include medial epicondylitis, ulnar neuritis, ulnar collateral ligament injury, flexor pronator strain, or snapping medial triceps", "evidence_relation": "supporting" }, { "cited_pmid": "35876779", "evidence_support": "A good outcome is typically achieved with adequate treatment of tendon degeneration at the common flexor tendon origin", "evidence_relation": "neutral" }, { "cited_pmid": "35876779", "evidence_support": "Mainstay treatment is nonoperative modalities such as stretching, rest, activity modification, therapy, and injections.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If conservative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted for chronic, recalcitrant tendinopathy [21872551].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21872551", "evidence_support": "To determine whether ultrasound (US)-guided percutaneous needle tenotomy followed by a platelet-rich plasma (PRP) injection would result in pain reduction, functional improvement, or structural alterations in patients with chronic, recalcitrant tendinopathy.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Surgical treatment may be necessary in some cases, and options include arthroscopic release, open debridement, and total elbow arthroplasty [33438926].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33438926", "evidence_support": "It is important to be aware of the epidemiology, presenting symptoms, and indications for nonsurgical and surgical treatment options for osteochondritis dissecans of the knee, elbow, and ankle.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It is also important to address any underlying conditions, such as medial collateral ligament injuries or contracture of the posterior oblique ligament, through appropriate treatment such as bracing, delayed reconstruction, or surgical reconstruction techniques using free tendon grafts [28461925, 26231962].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26231962", "evidence_support": "Treatment may be conservative or surgical, but optimal management remains controversial. Surgery should include exploration of the ulnar nerve throughout its course around the elbow and release of all compressive structures.", "evidence_relation": "neutral" }, { "cited_pmid": "28461925", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "For severe elbow pain, initial treatment should be conservative and may include rest, nonsteroidal anti-inflammatory drugs, physical therapy, and the occasional intraarticular corticosteroid injection [33004169, 18686818]. If conservative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted [36410881]. Surgical treatment may be necessary in some cases, and options include arthroscopic debridement and synovectomy, capsular release, ulnohumeral arthroplasty, interpositional arthroplasty, and total elbow arthroplasty or replacement [30881733, 18590859, 31788158]. Ulnar nerve symptoms can be caused by mechanical forces that produce traction or ischemia to the nerve, often due to compression at the elbow [26231962]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, initial treatment should be conservative and may include rest, nonsteroidal anti-inflammatory drugs, physical therapy, and the occasional intraarticular corticosteroid injection [33004169, 18686818].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33004169", "evidence_support": "Steroid injections, NSAIDs, topical creams, platelet-rich plasma, physical therapy, and kinesiotaping are considered conservative treatments, while surgical options are last-resort treatments reserved for refractory LE.", "evidence_relation": "supporting" }, { "cited_pmid": "18686818", "evidence_support": "Initial treatment should be conservative and is successful in up to 90% of cases. Modalities such as patient education, physiotherapy, use of splints, anti-inflammatory medication, complementary medicine and eventually local injections are all acceptable treatment methods.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If conservative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted [36410881].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36410881", "evidence_support": "Prolotherapy is a nonsurgical regenerative technique that allows small amounts of irritant solution to be injected into the site of painful tendon and ligament insertions to promote the growth of healthy cells and tissues.", "evidence_relation": "neutral" }, { "cited_pmid": "36410881", "evidence_support": "Prolotherapy is beneficial in a variety of different musculoskeletal conditions, including, but not limited to, lateral epicondylosis,", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Surgical treatment may be necessary in some cases, and options include arthroscopic debridement and synovectomy, capsular release, ulnohumeral arthroplasty, interpositional arthroplasty, and total elbow arthroplasty or replacement [30881733, 18590859, 31788158].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18590859", "evidence_support": "Surgical treatment is based on disease etiology, severity of degeneration, and patient age. Rheumatoid elbows with mild to moderate disease benefit from arthroscopic debridement and synovectomy, whereas capsular release and ulnohumeral arthroplasty can relieve painful elbows with early posttraumatic arthritis and osteoarthritis.", "evidence_relation": "supporting" }, { "cited_pmid": "18590859", "evidence_support": "Rheumatoid, low-demand, and elderly patients are candidates for total elbow replacement; posttraumatic and osteoarthritic elbows in younger patients with considerable functional demands are treated with interpositional arthroplasty.", "evidence_relation": "supporting" }, { "cited_pmid": "31788158", "evidence_support": "Total elbow arthroplasty is a common surgical procedure used in the management of advanced rheumatoid arthritis, posttraumatic arthritis, osteoarthritis, and unfixable fracture in elderly patients.", "evidence_relation": "supporting" }, { "cited_pmid": "30881733", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Ulnar nerve symptoms can be caused by mechanical forces that produce traction or ischemia to the nerve, often due to compression at the elbow [26231962].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "26231962", "evidence_support": "Ulnar neuropathy at the elbow (UNE) is the second most common entrapment neuropathy after carpal tunnel syndrome and occurs most commonly at the elbow due to mechanical forces that produce traction or ischemia to the nerve.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "For severe elbow pain, initial treatment should be conservative and may include rest, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, use of splints, and local injections [33004169, 21063499, 18656765, 27672692, 18686818]. Surgical treatment may be necessary in some cases, and options include arthroscopic debridement and synovectomy, capsular release, ulnohumeral arthroplasty, interpositional arthroplasty, total elbow replacement, total elbow allografts, and elbow arthrodeses [30925627, 16756798, 18590859]. It is also important to address any underlying conditions, such as ulnar nerve symptoms or adhesive ulnar neuropathy, through surgical treatment such as ulnar nerve neurolysis [25088214]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, initial treatment should be conservative and may include rest, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, use of splints, and local injections [33004169, 21063499, 18656765, 27672692, 18686818].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33004169", "evidence_support": "Steroid injections, NSAIDs, topical creams, platelet-rich plasma, physical therapy, and kinesiotaping are considered conservative treatments, while surgical options are last-resort treatments reserved for refractory LE.", "evidence_relation": "supporting" }, { "cited_pmid": "21063499", "evidence_support": "Corticosteroid injection is one of the most common interventions for lateral epicondylitis or tennis elbow.", "evidence_relation": "supporting" }, { "cited_pmid": "18656765", "evidence_support": "Corticosteroid injection did not affect the apparently self-limited course of lateral elbow pain. In secondary analyses in a subset of patients, perceived disability associated with lateral elbow pain correlated with depression and ineffective coping skills.", "evidence_relation": "contradicting" }, { "cited_pmid": "27672692", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "18686818", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Surgical treatment may be necessary in some cases, and options include arthroscopic debridement and synovectomy, capsular release, ulnohumeral arthroplasty, interpositional arthroplasty, total elbow replacement, total elbow allografts, and elbow arthrodeses [30925627, 16756798, 18590859].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30925627", "evidence_support": "Total elbow arthroplasty is currently an established surgical treatment for several pathologies of the elbow.", "evidence_relation": "supporting" }, { "cited_pmid": "16756798", "evidence_support": "Each year, about 80 elbow arthroplasties are performed in Denmark. Approximately two thirds are done due to rheumatoid arthritis, the others due to comminuted fractures of the elbow, especially in elderly patients.", "evidence_relation": "supporting" }, { "cited_pmid": "18590859", "evidence_support": "Rheumatoid elbows with mild to moderate disease benefit from arthroscopic debridement and synovectomy, whereas capsular release and ulnohumeral arthroplasty can relieve painful elbows with early posttraumatic arthritis and osteoarthritis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "It is also important to address any underlying conditions, such as ulnar nerve symptoms or adhesive ulnar neuropathy, through surgical treatment such as ulnar nerve neurolysis [25088214].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25088214", "evidence_support": "The patient obtained a good clinical outcome by surgical neurolysis of the ulnar nerve combined with a brachial artery perforator-based propeller flap to cover the soft tissue defect after resection of the scar tissue and to prevent readhesion of the ulnar nerve", "evidence_relation": "neutral" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Severe elbow pain, often due to conditions like osteoarthritis or lateral epicondylitis, can be managed through a combination of nonoperative and surgical interventions.Initial treatment typically includes activity modification, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and corticosteroid injections, which can provide symptomatic relief [34099969, 17539763]. For patients unresponsive to conservative measures, surgical options such as arthroscopic debridement, synovectomy, or interpositional arthroplasty may be considered, depending on the underlying etiology and patient factors like age and activity level [17539763, 18590859, 36759236]. Total elbow arthroplasty is reserved for older patients with end-stage arthritis due to concerns about prosthesis longevity [34099969, 18590859]. In younger, active patients, interpositional arthroplasty can relieve severe pain while preserving bone stock and future reconstructive options [21501790]. For chronic lateral epicondylitis, surgical release of the common extensor origin, either arthroscopic or open, is effective when conservative treatments fail [21469624, 21253755].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Severe elbow pain, often due to conditions like osteoarthritis or lateral epicondylitis, can be managed through a combination of nonoperative and surgical interventions.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Initial treatment typically includes activity modification, nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy, and corticosteroid injections, which can provide symptomatic relief [34099969, 17539763].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34099969", "evidence_support": "Conservative treatment, including activity modifications, nonsteroidal anti-inflammatory drugs and the occasional intraarticular corticosteroid injection, may provide adequate pain relief in earlier stages .", "evidence_relation": "supporting" }, { "cited_pmid": "17539763", "evidence_support": "Nonoperative management consisting of oral analgesics, intra-articular steroid injections, physical therapy, and splinting may provide symptomatic relief in the majority of patients", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "For patients unresponsive to conservative measures, surgical options such as arthroscopic debridement, synovectomy, or interpositional arthroplasty may be considered, depending on the underlying etiology and patient factors like age and activity level [17539763, 18590859, 36759236].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17539763", "evidence_support": "Other operative treatment options for such patients include arthroscopic or open synovectomy, debridement arthroplasty, and interpositional arthroplasty.", "evidence_relation": "supporting" }, { "cited_pmid": "18590859", "evidence_support": "Rheumatoid elbows with mild to moderate disease benefit from arthroscopic debridement and synovectomy, whereas capsular release and ulnohumeral arthroplasty can relieve painful elbows with early posttraumatic arthritis and osteoarthritis.", "evidence_relation": "supporting" }, { "cited_pmid": "36759236", "evidence_support": "Operative intervention may be considered once nonsurgical management has failed.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Total elbow arthroplasty is reserved for older patients with end-stage arthritis due to concerns about prosthesis longevity [34099969, 18590859].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34099969", "evidence_support": "Total elbow arthroplasty is very successful in terms of pain relief and function, but it is reserved for patients with end-stage osteoarthritis who are relatively older and have failed joint preserving procedures.", "evidence_relation": "supporting" }, { "cited_pmid": "18590859", "evidence_support": "Rheumatoid, low-demand, and elderly patients are candidates for total elbow replacement;", "evidence_relation": "supporting" }, { "cited_pmid": "18590859", "evidence_support": "Total elbow allografts and elbow arthrodeses are considered only in salvage situations.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In younger, active patients, interpositional arthroplasty can relieve severe pain while preserving bone stock and future reconstructive options [21501790].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21501790", "evidence_support": "With the appropriate surgical indication, interposition arthroplasty can relieve severe pain, affording a functional elbow without severely proscribing permitted activities.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "For chronic lateral epicondylitis, surgical release of the common extensor origin, either arthroscopic or open, is effective when conservative treatments fail [21469624, 21253755].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21469624", "evidence_support": "Surgical treatment options include open, arthroscopic, and percutaneous debridement techniques, while nonoperative modalities have traditionally included physical therapy, bracing, and cortisone injections", "evidence_relation": "supporting" }, { "cited_pmid": "21253755", "evidence_support": "Both arthroscopic and percutaneous release of the common extensor origin can be effective in treatment of lateral epicondylitis.", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "For severe elbow pain, initial management should include rest, ice application, and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain.If the pain persists, a thorough clinical evaluation is necessary to identify underlying causes such as tendinitis, bursitis, or fractures.Imaging studies like X-rays or MRI may be warranted for accurate diagnosis.Physical therapy can be beneficial for improving range of motion and strengthening surrounding muscles.In cases of refractory pain or specific conditions like lateral epicondylitis, corticosteroid injections or platelet-rich plasma (PRP) therapy might be considered.Surgical intervention is reserved for cases where conservative treatments fail, such as severe tendon tears or joint instability.It is crucial to tailor the treatment plan based on the specific diagnosis and patient needs, ensuring a multidisciplinary approach for optimal outcomes.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, initial management should include rest, ice application, and nonsteroidal anti-inflammatory drugs (NSAIDs) to reduce inflammation and pain.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "If the pain persists, a thorough clinical evaluation is necessary to identify underlying causes such as tendinitis, bursitis, or fractures.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Imaging studies like X-rays or MRI may be warranted for accurate diagnosis.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Physical therapy can be beneficial for improving range of motion and strengthening surrounding muscles.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "In cases of refractory pain or specific conditions like lateral epicondylitis, corticosteroid injections or platelet-rich plasma (PRP) therapy might be considered.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Surgical intervention is reserved for cases where conservative treatments fail, such as severe tendon tears or joint instability.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "It is crucial to tailor the treatment plan based on the specific diagnosis and patient needs, ensuring a multidisciplinary approach for optimal outcomes.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Severe elbow pain can be addressed through various treatment options, depending on the underlying cause and severity of the condition.For patients with lateral epicondylitis, also known as tennis elbow, nonoperative measures such as rest, nonsteroidal anti-inflammatory medication, and physical therapy are often effective [18180389, 17536516, 18686818]. However, in refractory cases, surgical interventions like arthroscopic release with debridement or percutaneous release of the common extensor origin may be necessary [21253755]. Additionally, platelet-rich plasma injections have shown promise in reducing pain and improving function in patients with recalcitrant epicondylitis [21323296, 28577784]. For patients with severe elbow arthritis, total elbow arthroplasty may be considered, although this is typically reserved for older patients with end-stage osteoarthritis who have failed joint-preserving procedures [34099969, 17539763, 18590859]. A thorough preoperative evaluation is essential in choosing the suitable surgical procedure for each individual patient [17539763, 18590859].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Severe elbow pain can be addressed through various treatment options, depending on the underlying cause and severity of the condition.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "For patients with lateral epicondylitis, also known as tennis elbow, nonoperative measures such as rest, nonsteroidal anti-inflammatory medication, and physical therapy are often effective [18180389, 17536516, 18686818].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18180389", "evidence_support": "Nonsurgical treatment, the mainstay of management, involves a myriad of options, including rest, nonsteroidal anti-inflammatory drugs, physical therapy, cortisone, blood and botulinum toxin injections, supportive forearm bracing, and local modalities.", "evidence_relation": "supporting" }, { "cited_pmid": "17536516", "evidence_support": "Conservative treatment measures will lead to symptom resolution in most cases.", "evidence_relation": "supporting" }, { "cited_pmid": "18686818", "evidence_support": "Modalities such as patient education, physiotherapy, use of splints, anti-inflammatory medication, complementary medicine and eventually local injections are all acceptable treatment methods", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, in refractory cases, surgical interventions like arthroscopic release with debridement or percutaneous release of the common extensor origin may be necessary [21253755].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21253755", "evidence_support": "Rest, activity modification, and conservative therapies are generally efficacious in relieving symptoms in the majority of patients; however, a small percentage of people will experience refractory pain and require surgical intervention to alleviate their discomfort. Surgical release of the common extensor origin can be done through an open, percutaneous, or arthroscopic approach.", "evidence_relation": "supporting" }, { "cited_pmid": "21253755", "evidence_support": "Both arthroscopic and percutaneous release of the common extensor origin can be effective in treatment of lateral epicondylitis. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, platelet-rich plasma injections have shown promise in reducing pain and improving function in patients with recalcitrant epicondylitis [21323296, 28577784].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21323296", "evidence_support": "Results suggest that a single platelet-rich plasma injection can improve pain and function scores, thus avoiding surgery.", "evidence_relation": "supporting" }, { "cited_pmid": "28577784", "evidence_support": "Autologous blood injections and platelet-rich plasma injections are the two most frequently used orthobiologic techniques in the treatment of lateral epicondylitis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "For patients with severe elbow arthritis, total elbow arthroplasty may be considered, although this is typically reserved for older patients with end-stage osteoarthritis who have failed joint-preserving procedures [34099969, 17539763, 18590859].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34099969", "evidence_support": "Total elbow arthroplasty is very successful in terms of pain relief and function, but it is reserved for patients with end-stage osteoarthritis who are relatively older and have failed joint preserving procedures.", "evidence_relation": "supporting" }, { "cited_pmid": "17539763", "evidence_support": "If these modalities fail, operative treatment is guided by the severity of disease as well as several patient-related factors such as age, activity level, and expectations. Total elbow arthroplasty can provide satisfactory results in the majority of patients with significant degeneration of the elbow. However, due to issues regarding prosthesis longevity, this procedure is generally avoided in young active patients.", "evidence_relation": "supporting" }, { "cited_pmid": "18590859", "evidence_support": "Rheumatoid, low-demand, and elderly patients are candidates for total elbow replacement;", "evidence_relation": "supporting" }, { "cited_pmid": "18590859", "evidence_support": "Total elbow allografts and elbow arthrodeses are considered only in salvage situations.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "A thorough preoperative evaluation is essential in choosing the suitable surgical procedure for each individual patient [17539763, 18590859].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "17539763", "evidence_support": "As all of these operations may provide a satisfactory outcome for the appropriate patient, a thorough preoperative evaluation is essential in choosing the suitable surgical procedure for each individual patient.", "evidence_relation": "supporting" }, { "cited_pmid": "18590859", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gemini-flash": { "answer": "Severe elbow pain, often associated with lateral epicondylitis (tennis elbow), can be challenging to manage [35022075, 33088394]. While the condition is often self-limiting, persistent pain may require more aggressive interventions [35031850, 23997125]. If conservative treatments like rest, NSAIDs, and physical therapy fail, corticosteroid injections can provide short-term pain relief, but they carry a risk of recurrence [1419555, 20003341]. Hyaluronic acid injections have shown promise in reducing pain from chronic tennis elbow, with sustained improvement over a year [35022075]. Botulinum toxin A injections have also demonstrated effectiveness in treating chronic tennis elbow [15614651]. In refractory cases, surgical options range from minimally invasive procedures to extensive joint denervation [10543604, 15011112].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Severe elbow pain, often associated with lateral epicondylitis (tennis elbow), can be challenging to manage [35022075, 33088394].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "35022075", "evidence_support": "For those with persistent and painful TE, nonsurgical treatment options are limited. Thousands of studies have tried to find effective treatments for TE but have usually failed.", "evidence_relation": "supporting" }, { "cited_pmid": "33088394", "evidence_support": "lateral epicondylitis is a common cause of elbow pain. Its management in physical medicine is based on medical treatment and appropriate functional rehabilitation. However no therapeutic option seems clearly superior to the other.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "While the condition is often self-limiting, persistent pain may require more aggressive interventions [35031850, 23997125].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35031850", "evidence_support": "Lateral epicondylitis is a self-limiting condition, with operative management only recommended in severe, recalcitrant cases.", "evidence_relation": "supporting" }, { "cited_pmid": "23997125", "evidence_support": "It is generally self-limiting, but in some patients it may continue to cause persistent symptoms, which can be refractory to treatment.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "If conservative treatments like rest, NSAIDs, and physical therapy fail, corticosteroid injections can provide short-term pain relief, but they carry a risk of recurrence [1419555, 20003341].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20003341", "evidence_support": "Whilst corticosteroid injections offer short term pain relief, this treatment is unpleasant and is used with caution due to an associated high risk of pain recurrence in the long term. ", "evidence_relation": "supporting" }, { "cited_pmid": "1419555", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Hyaluronic acid injections have shown promise in reducing pain from chronic tennis elbow, with sustained improvement over a year [35022075].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35022075", "evidence_support": "HA injections yielded significant success in pain relief by three months. Patients continued to improve for the 12-month duration of the study. This study indicates that patients with chronic lateral epicondylitis may benefit from receiving injections of hyaluronic acid rather than having to undergo surgery.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Botulinum toxin A injections have also demonstrated effectiveness in treating chronic tennis elbow [15614651].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15614651", "evidence_support": "A single injection of Btx A was effective as therapy for chronic tennis elbow. It can be carried out in an out-patient setting, and allows the patient to continue working.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "In refractory cases, surgical options range from minimally invasive procedures to extensive joint denervation [10543604, 15011112].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "15011112", "evidence_support": "In refractory cases operation is indicated after conservative treatment.", "evidence_relation": "neutral" }, { "cited_pmid": "10543604", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Severe elbow pain, often associated with lateral epicondylitis (tennis elbow), can be managed with a variety of non-operative treatments [18180389, 28577784, 33123709]. These include rest, nonsteroidal anti-inflammatory drugs (NSAIDs), bracing, and physical therapy [18180389, 28577784, 36800442]. Other conservative options include steroid injections, topical creams, platelet-rich plasma, kinesiotaping, and shock wave therapy [33004169, 20188266]. While lateral epicondylitis is often self-limiting, surgical intervention may be considered for chronic, recalcitrant cases unresponsive to non-operative management [25077751, 17536516, 20188266]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Severe elbow pain, often associated with lateral epicondylitis (tennis elbow), can be managed with a variety of non-operative treatments [18180389, 28577784, 33123709].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "18180389", "evidence_support": "Nonsurgical treatment, the mainstay of management, involves a myriad of options, including rest, nonsteroidal anti-inflammatory drugs, physical therapy, cortisone, blood and botulinum toxin injections, supportive forearm bracing, and local modalities.", "evidence_relation": "supporting" }, { "cited_pmid": "28577784", "evidence_support": "Lateral epicondylitis (tennis elbow) is a frequent cause of elbow pain; most patients (80%-90%) are successfully treated with standard nonoperative methods (rest, nonsteroidal anti-inflammatory drugs, bracing, and physical therapy). ", "evidence_relation": "supporting" }, { "cited_pmid": "33123709", "evidence_support": "The available evidence supports the use of non-operative treatment modalities in managing this condition.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These include rest, nonsteroidal anti-inflammatory drugs (NSAIDs), bracing, and physical therapy [18180389, 28577784, 36800442].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18180389", "evidence_support": "Nonsurgical treatment, the mainstay of management, involves a myriad of options, including rest, nonsteroidal anti-inflammatory drugs, physical therapy, cortisone, blood and botulinum toxin injections, supportive forearm bracing, and local modalities.", "evidence_relation": "supporting" }, { "cited_pmid": "28577784", "evidence_support": "Lateral epicondylitis (tennis elbow) is a frequent cause of elbow pain; most patients (80%-90%) are successfully treated with standard nonoperative methods (rest, nonsteroidal anti-inflammatory drugs, bracing, and physical therapy).", "evidence_relation": "supporting" }, { "cited_pmid": "36800442", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Other conservative options include steroid injections, topical creams, platelet-rich plasma, kinesiotaping, and shock wave therapy [33004169, 20188266].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33004169", "evidence_support": "Steroid injections, NSAIDs, topical creams, platelet-rich plasma, physical therapy, and kinesiotaping are considered conservative treatments, while surgical options are last-resort treatments reserved for refractory LE.", "evidence_relation": "supporting" }, { "cited_pmid": "20188266", "evidence_support": "Nonoperative management includes medication, bracing, physical therapy, corticosteroid injections, shock wave therapy, platelet-rich plasma, and low-dose thermal ablation devices. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While lateral epicondylitis is often self-limiting, surgical intervention may be considered for chronic, recalcitrant cases unresponsive to non-operative management [25077751, 17536516, 20188266].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "25077751", "evidence_support": "Although it is typically a self-limiting process, there are many nonsurgical and surgical treatment options available if lateral epicondylitis becomes chronic and continues to cause pain.", "evidence_relation": "supporting" }, { "cited_pmid": "17536516", "evidence_support": "Surgery is reserved for patients with recalcitrant elbow pain unresponsive to nonsurgical management", "evidence_relation": "supporting" }, { "cited_pmid": "20188266", "evidence_support": "When these are unsuccessful, however, surgical measures may be performed with a high rate of success.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "For severe elbow pain, especially after activities like tennis, initial management typically includes nonoperative treatments such as rest, activity modification, stretching, and physical therapy [35876779, 16464123]. If these methods fail, intermediate interventions like platelet-rich plasma injections, extracorporeal shockwave therapy, or ultrasound-guided procedures may be considered [35876779]. Cortisone injections can also provide temporary pain relief, allowing for rehabilitation exercises [16464123]. In cases where nonsurgical management is ineffective, surgical options such as open or arthroscopic synovectomy, or even total elbow arthroplasty, may be necessary, particularly for patients with significant joint damage [12670136, 1408372]. Regular monitoring and adjustments to the treatment plan are essential for optimal recovery [19345885].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, especially after activities like tennis, initial management typically includes nonoperative treatments such as rest, activity modification, stretching, and physical therapy [35876779, 16464123].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35876779", "evidence_support": "Mainstay treatment is nonoperative modalities such as stretching, rest, activity modification, therapy, and injections.", "evidence_relation": "supporting" }, { "cited_pmid": "16464123", "evidence_support": "The most effective modalities of treatment are probably rest (the absence of painful activity) combined with cryotherapy in the acute stage then NSAIDs and heat in its various modalities including ultrasound.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If these methods fail, intermediate interventions like platelet-rich plasma injections, extracorporeal shockwave therapy, or ultrasound-guided procedures may be considered [35876779].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35876779", "evidence_support": "If nonoperative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Cortisone injections can also provide temporary pain relief, allowing for rehabilitation exercises [16464123].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16464123", "evidence_support": "Cortisone injections may be used to create a pain-free window of opportunity to optimise the athletes' rehabilitation exercises.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In cases where nonsurgical management is ineffective, surgical options such as open or arthroscopic synovectomy, or even total elbow arthroplasty, may be necessary, particularly for patients with significant joint damage [12670136, 1408372].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "12670136", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "1408372", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Regular monitoring and adjustments to the treatment plan are essential for optimal recovery [19345885].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "19345885", "evidence_support": " Nonoperative management may provide symptomatic relief in the early stages of the disease process for most patients. Surgical treatment is guided by disease etiology and severity, patient age, and functional demands.", "evidence_relation": "neutral" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "For severe elbow pain, especially after activities like tennis, several conservative treatment options are available. Nonsteroidal anti-inflammatory drugs (NSAIDs) can provide short-term relief, but if they are ineffective, other methods should be considered [30464656, 23016111]. Physical therapy is crucial for rehabilitation and pain management, and using a tennis-elbow band can help alleviate symptoms [8342481, 36462778]. Additionally, extracorporeal shock wave therapy and corticosteroid injections may offer relief [36462778, 30464656]. If conservative treatments fail after 6 to 12 months, surgical options such as arthroscopic release or open surgery may be necessary [23016111, 33330224]. It's essential to start with conservative measures before progressing to more invasive treatments [2180031].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, especially after activities like tennis, several conservative treatment options are available.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs) can provide short-term relief, but if they are ineffective, other methods should be considered [30464656, 23016111].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30464656", "evidence_support": "The data demonstrate that NSAIDs, PT, bracing, and shockwave therapy provide limited benefit for treating LE", "evidence_relation": "supporting" }, { "cited_pmid": "23016111", "evidence_support": "Nonsteroidal anti-inflammatory drugs and localized corticosteroid injections yield moderate symptomatic relief in short term but do not demonstrate benefit on long-term follow-up.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Physical therapy is crucial for rehabilitation and pain management, and using a tennis-elbow band can help alleviate symptoms [8342481, 36462778].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36462778", "evidence_support": "The initial treatment should be nonoperative and include physical therapy, nonsteroidal anti-inflammatory medication, rest, bracing, extracorporeal shock wave therapy, and injection therapy with various agents such as autologous blood, dextrose, corticosteroids, or platelet-rich plasma.", "evidence_relation": "supporting" }, { "cited_pmid": "8342481", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, extracorporeal shock wave therapy and corticosteroid injections may offer relief [36462778, 30464656].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36462778", "evidence_support": "The initial treatment should be nonoperative and include physical therapy, nonsteroidal anti-inflammatory medication, rest, bracing, extracorporeal shock wave therapy, and injection therapy with various agents such as autologous blood, dextrose, corticosteroids, or platelet-rich plasma.", "evidence_relation": "supporting" }, { "cited_pmid": "30464656", "evidence_support": "Nonsteroidal anti-inflammatory drugs (NSAIDs), physical therapy (PT), shockwave therapy, and injections with corticosteroids or biologics are all conservative treatment options for LE. For refractory cases, surgical options include open, arthroscopic, and percutaneous techniques.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "If conservative treatments fail after 6 to 12 months, surgical options such as arthroscopic release or open surgery may be necessary [23016111, 33330224].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23016111", "evidence_support": "If 6 to 12 months of nonoperative treatment fails, then surgical intervention can be undertaken.", "evidence_relation": "supporting" }, { "cited_pmid": "33330224", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "It's essential to start with conservative measures before progressing to more invasive treatments [2180031].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "2180031", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "webis-1": { "answer": "The guidelines suggest that rehabilitation clinicians can use transcutaneous electrical nerve stimulation (TENS) as a patient-controlled adjunct to primary care management for tennis elbow to provide superior pain relief [25213605]. Other treatments include ultrasound-guided PRP injection, and exercises to strengthen the muscles in the wrist and forearm [36975037].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The guidelines suggest that rehabilitation clinicians can use transcutaneous electrical nerve stimulation (TENS) as a patient-controlled adjunct to primary care management for tennis elbow to provide superior pain relief [25213605].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25213605", "evidence_support": "TENS conferred no additional clinical benefit over primary care management consisting of information and advice on analgesia and exercise for patients with tennis elbow, probably partly owing to poor adherence to treatment recommendations.", "evidence_relation": "contradicting" }, { "cited_pmid": "25213605", "evidence_support": "TENS as an adjunct to primary care management failed to show any additional pain relief compared with primary care management alone.", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Other treatments include ultrasound-guided PRP injection, and exercises to strengthen the muscles in the wrist and forearm [36975037].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36975037", "evidence_support": "Here, we explain what the guidelines say about how to diagnose tennis elbow (sometimes called lateral elbow pain or lateral elbow tendinopathy), the specific treatments your physical therapist might offer you to help manage pain and improve the mobility of your elbow, and the types of exercises you could do to strengthen the muscles in your wrist and forearm.", "evidence_relation": "neutral" } ] } ] }, "webis-2": { "answer": "The guidelines suggest that physical therapy can help manage pain and improve the mobility of the elbow for people with tennis elbow [36975037]. This may include specific exercises to strengthen the muscles in the wrist and forearm [36975037]. It is important to consult with a healthcare professional for a proper diagnosis and treatment plan.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The guidelines suggest that physical therapy can help manage pain and improve the mobility of the elbow for people with tennis elbow [36975037].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36975037", "evidence_support": "You do not have to play tennis to get tennis elbow-a very common problem for people who do lots of repetitive movements of the wrist, forearm and elbow, such as carpentry, painting or racquet sports. Most people with tennis elbow feel pain on the outside of their elbow and upper forearm. Experts in managing elbow pain developed a guideline for rehabilitation clinicians to use to help you understand more about tennis elbow. Here, we explain what the guidelines say about how to diagnose tennis elbow (sometimes called lateral elbow pain or lateral elbow tendinopathy), the specific treatments your physical therapist might offer you to help manage pain and improve the mobility of your elbow, and the types of exercises you could do to strengthen the muscles in your wrist and forearm.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This may include specific exercises to strengthen the muscles in the wrist and forearm [36975037].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36975037", "evidence_support": "the specific treatments your physical therapist might offer you to help manage pain and improve the mobility of your elbow, and the types of exercises you could do to strengthen the", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "It is important to consult with a healthcare professional for a proper diagnosis and treatment plan.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-3": { "answer": "The guideline for rehabilitation clinicians suggests specific treatments for tennis elbow, such as exercises to strengthen the muscles in the wrist and forearm, and the Posterolateral Rotatory Apprehension Test for diagnosis [36975037,27276837].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The guideline for rehabilitation clinicians suggests specific treatments for tennis elbow, such as exercises to strengthen the muscles in the wrist and forearm, and the Posterolateral Rotatory Apprehension Test for diagnosis [36975037,27276837].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27276837", "evidence_support": "Posterolateral rotatory apprehension test was proposed for diagnosis of posterolateral rotatory instability of elbow. However, no review literatures that studied about posterolateral rotatory apprehensions test in tennis elbow.", "evidence_relation": "contradicting" }, { "cited_pmid": "27276837", "evidence_support": "A result from posterolateral rotatory apprehension test should be negative in general tennis elbow patients. If this test is used in a tennis elbow patients who are suspected with hidden instability and the result is positive, further evaluation is strongly suggested.", "evidence_relation": "supporting" }, { "cited_pmid": "36975037", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-5": { "answer": "The guideline for rehabilitation clinicians suggests specific treatments for tennis elbow, such as exercises to strengthen the muscles in the wrist and forearm, and the Posterolateral Rotatory Apprehension Test for diagnosis [36975037,27276837].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The guideline for rehabilitation clinicians suggests specific treatments for tennis elbow, such as exercises to strengthen the muscles in the wrist and forearm, and the Posterolateral Rotatory Apprehension Test for diagnosis [36975037,27276837].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36975037", "evidence_support": "Here, we explain what the guidelines say about how to diagnose tennis elbow (sometimes called lateral elbow pain or lateral elbow tendinopathy), the specific treatments your physical therapist might offer you to help manage pain and improve the mobility of your elbow, and the types of exercises you could do to strengthen the muscles in your wrist and forearm.", "evidence_relation": "supporting" }, { "cited_pmid": "27276837", "evidence_support": "Posterolateral rotatory apprehension test was proposed for diagnosis of posterolateral rotatory instability of elbow.", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-1": { "answer": "For severe elbow pain, it is important to first identify the underlying cause, which may involve a physical examination and imaging studies. Treatment options may include rest, ice application, nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief, physical therapy, and in some cases, corticosteroid injections or surgery if conservative measures fail. Consulting a healthcare professional for a tailored treatment plan is recommended.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, it is important to first identify the underlying cause, which may involve a physical examination and imaging studies.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Treatment options may include rest, ice application, nonsteroidal anti-inflammatory drugs (NSAIDs) for pain relief, physical therapy, and in some cases, corticosteroid injections or surgery if conservative measures fail.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Consulting a healthcare professional for a tailored treatment plan is recommended.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "For severe elbow pain, particularly in cases like tennis elbow, treatment options include open surgery release or leucocyte-rich platelet-rich plasma (L-PRP) therapy. Both interventions have shown to result in clinically meaningful improvements in pain intensity and function over time [30658050].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, particularly in cases like tennis elbow, treatment options include open surgery release or leucocyte-rich platelet-rich plasma (L-PRP) therapy.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Both interventions have shown to result in clinically meaningful improvements in pain intensity and function over time [30658050].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "30658050", "evidence_support": "Once radial nerve trunk sensitivity was identified and the intervention, consisting of ultrasound-guided percutaneous electrical nerve stimulation targeting the radial nerve combined with a low-load exercise program, was applied, a full resolution of pain and function occurred rapidly.", "evidence_relation": "neutral" } ] } ] }, "webis-gpt-6": { "answer": "Severe elbow pain can be addressed through various therapeutic strategies, including evaluation for potential underlying causes such as arthritis or injury [24784124]. In cases where conservative treatments are ineffective, surgical options like elbow arthroplasty may be considered [16756798]. Additionally, specific interventions may be necessary for conditions like elbow ankylosis due to heterotopic ossification, particularly in patients with severe burns [32158828].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Severe elbow pain can be addressed through various therapeutic strategies, including evaluation for potential underlying causes such as arthritis or injury [24784124].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24784124", "evidence_support": "Ulnar collateral ligament injuries occur in athletes participating in sports that involve overhead throwing.", "evidence_relation": "neutral" }, { "cited_pmid": "24784124", "evidence_support": "Plain radiography is the initial choice for the evaluation of acute injuries and is best for showing bony injuries, soft tissue swelling, and joint effusions.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In cases where conservative treatments are ineffective, surgical options like elbow arthroplasty may be considered [16756798].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16756798", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, specific interventions may be necessary for conditions like elbow ankylosis due to heterotopic ossification, particularly in patients with severe burns [32158828].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "32158828", "evidence_support": "To date, however, no effective standard treatment has been reported, and therefore treatment methods vary between different facilities.", "evidence_relation": "contradicting" }, { "cited_pmid": "32158828", "evidence_support": "Based on past reports, we examined our cases and recommend effective therapeutic strategies. We posed the following three questions: (1) Is the surgical intervention effective or detrimental for elbow ankylosis due to HO? (2) What is the best timing for the intervention? (3) What is the most effective postoperative rehabilitation plan?", "evidence_relation": "neutral" }, { "cited_pmid": "32158828", "evidence_support": "Surgical resection is beneficial for elbow ankylosis due to HO after burn injury.", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gemini-flash": { "answer": "Severe elbow pain, often associated with tennis elbow (lateral epicondylitis), can be managed with a variety of non-operative treatments [28577784, 36800442, 33004169]. These include rest, nonsteroidal anti-inflammatory drugs (NSAIDs), bracing, and physical therapy [28577784, 36800442, 33004169]. Physical therapy plays a key role in managing acute symptoms and preventing recurrence [8342481]. Other options include corticosteroid injections, shock wave therapy, platelet-rich plasma, and low-dose thermal ablation devices [20188266]. These treatments aim to relieve pain, reduce inflammation, promote healing, and rehabilitate the injured arm [2180031, 37018622]. Surgery is a last resort for refractory cases [33004169]. It is important to start with simple and conservative therapies before progressing to more complex and invasive treatments [2180031]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Severe elbow pain, often associated with tennis elbow (lateral epicondylitis), can be managed with a variety of non-operative treatments [28577784, 36800442, 33004169].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28577784", "evidence_support": "Lateral epicondylitis (tennis elbow) is a frequent cause of elbow pain; most patients (80%-90%) are successfully treated with standard nonoperative methods (rest, nonsteroidal anti-inflammatory drugs, bracing, and physical therapy).", "evidence_relation": "supporting" }, { "cited_pmid": "33004169", "evidence_support": "Steroid injections, NSAIDs, topical creams, platelet-rich plasma, physical therapy, and kinesiotaping are considered conservative treatments, while surgical options are last-resort treatments reserved for refractory LE.", "evidence_relation": "supporting" }, { "cited_pmid": "36800442", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These include rest, nonsteroidal anti-inflammatory drugs (NSAIDs), bracing, and physical therapy [28577784, 36800442, 33004169].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28577784", "evidence_support": "Lateral epicondylitis (tennis elbow) is a frequent cause of elbow pain; most patients (80%-90%) are successfully treated with standard nonoperative methods (rest, nonsteroidal anti-inflammatory drugs, bracing, and physical therapy).", "evidence_relation": "supporting" }, { "cited_pmid": "33004169", "evidence_support": "Steroid injections, NSAIDs, topical creams, platelet-rich plasma, physical therapy, and kinesiotaping are considered conservative treatments, while surgical options are last-resort treatments reserved for refractory LE.", "evidence_relation": "supporting" }, { "cited_pmid": "36800442", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Physical therapy plays a key role in managing acute symptoms and preventing recurrence [8342481].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "8342481", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Other options include corticosteroid injections, shock wave therapy, platelet-rich plasma, and low-dose thermal ablation devices [20188266].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20188266", "evidence_support": "Nonoperative management includes medication, bracing, physical therapy, corticosteroid injections, shock wave therapy, platelet-rich plasma, and low-dose thermal ablation devices. When these are unsuccessful, however, surgical measures may be performed with a high rate of success.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "These treatments aim to relieve pain, reduce inflammation, promote healing, and rehabilitate the injured arm [2180031, 37018622].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "37018622", "evidence_support": "Management of LE symptoms should be directed to the management of pain, protection of movement, and improvement of arm performance.", "evidence_relation": "supporting" }, { "cited_pmid": "2180031", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Surgery is a last resort for refractory cases [33004169].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33004169", "evidence_support": "Steroid injections, NSAIDs, topical creams, platelet-rich plasma, physical therapy, and kinesiotaping are considered conservative treatments, while surgical options are last-resort treatments reserved for refractory LE.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "It is important to start with simple and conservative therapies before progressing to more complex and invasive treatments [2180031].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "2180031", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "For severe elbow pain, particularly from conditions like tennis elbow, nonoperative treatments are typically the first line of management. These include rest, activity modification, physical therapy, and possibly corticosteroid injections for short-term relief [35876779, 24565822]. If these conservative measures fail, options such as extracorporeal shockwave therapy, platelet-rich plasma injections, or ultrasound-guided tenotomy may be considered [35876779, 31471243]. Additionally, transcutaneous electrical nerve stimulation (TENS) can provide non-pharmacological pain relief [20003341, 23999980]. In cases where pain persists despite these interventions, surgical options like debridement or joint replacement may be necessary [1408372, 34706389]. Overall, a combination of patient education and supportive care is crucial for effective management and prevention of recurrence [8342481].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For severe elbow pain, particularly from conditions like tennis elbow, nonoperative treatments are typically the first line of management.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "These include rest, activity modification, physical therapy, and possibly corticosteroid injections for short-term relief [35876779, 24565822].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35876779", "evidence_support": "Mainstay treatment is nonoperative modalities such as stretching, rest, activity modification, therapy, and injections.", "evidence_relation": "supporting" }, { "cited_pmid": "24565822", "evidence_support": "In most cases, the treatment given to patients is conservative and involves rest, ice, non-steroidal anti-inflammatory drugs for pain, and an appropriate physical therapy regimen with a progressive return to play when symptoms have resolved.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "If these conservative measures fail, options such as extracorporeal shockwave therapy, platelet-rich plasma injections, or ultrasound-guided tenotomy may be considered [35876779, 31471243].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35876779", "evidence_support": "If nonoperative management fails, intermediate interventions such as extracorporeal shockwave therapy, platelet-rich plasma injections, prolotherapy, and ultrasound-guided percutaneous tenotomy can be attempted.", "evidence_relation": "supporting" }, { "cited_pmid": "31471243", "evidence_support": "Ultrasound-guided tenotomy (USGT) is a minimally invasive treatment option for cases recalcitrant to conservative management.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, transcutaneous electrical nerve stimulation (TENS) can provide non-pharmacological pain relief [20003341, 23999980].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20003341", "evidence_support": "Transcutaneous electrical nerve stimulation (TENS) is an inexpensive, non-invasive, non-pharmacological form of analgesia that is commonly used in the treatment of pain.", "evidence_relation": "supporting" }, { "cited_pmid": "23999980", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In cases where pain persists despite these interventions, surgical options like debridement or joint replacement may be necessary [1408372, 34706389].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34706389", "evidence_support": "Surgical debridement and repair are typically performed in refractory cases, resulting in good to excellent outcomes in most cases.", "evidence_relation": "supporting" }, { "cited_pmid": "1408372", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, a combination of patient education and supportive care is crucial for effective management and prevention of recurrence [8342481].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "8342481", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] } } }, { "question_id": "137", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "When considering the management of type 2 diabetes, both metformin and dietary approaches like the ketogenic diet can influence A1C levels. Metformin is a well-established medication that has been widely used to effectively lower A1C levels by improving insulin sensitivity and reducing glucose production in the liver. On the other hand, dietary patterns, although not specifically ketogenic diets, have been shown to impact metabolic health. For instance, Canada's Food Guide (CFG) promotes a diet rich in grains, fruits, and vegetables, which aligns with the principles of healthy eating for diabetes management [18461106]. However, while dietary approaches can have beneficial effects, metformin's role in directly lowering A1C levels is more robustly supported by clinical evidence [18461106].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "When considering the management of type 2 diabetes, both metformin and dietary approaches like the ketogenic diet can influence A1C levels.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Metformin is a well-established medication that has been widely used to effectively lower A1C levels by improving insulin sensitivity and reducing glucose production in the liver.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "On the other hand, dietary patterns, although not specifically ketogenic diets, have been shown to impact metabolic health.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "For instance, Canada's Food Guide (CFG) promotes a diet rich in grains, fruits, and vegetables, which aligns with the principles of healthy eating for diabetes management [18461106].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "18461106", "evidence_support": "Although the two guides differ in their recommendations for red wine, fats, and meat and meat alternatives, they both promote a diet rich in grains, fruits, and vegetables.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "However, while dietary approaches can have beneficial effects, metformin's role in directly lowering A1C levels is more robustly supported by clinical evidence [18461106].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18461106", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "In an adult with type 2 diabetes, both metformin and a ketogenic diet can effectively lower HbA1c levels, but each has distinct advantages and challenges [34448957, 33163300, 36012064]. Metformin lowers HbA1c by around 1.32%, is well tolerated, and does not cause weight gain or significant hypoglycemia [26132124, 33970588, 23690375]. It is also effective when combined with other agents, including insulin, to improve HbA1c levels [26132124, 33970588, 18630062]. On the other hand, a ketogenic diet significantly reduces HbA1c and improves glycemic control, potentially reducing the need for pharmacotherapy [34448957, 32641437, 33163300]. However, adherence to a ketogenic diet can be challenging for many patients [34448957, 32640608, 37709770]. While metformin offers a reliable and well-tolerated pharmacological approach, the ketogenic diet provides a non-pharmacological option that may enhance glycemic control but requires sustained dietary commitment [34448957, 33163300, 36012064]. Therefore, the choice between metformin and a ketogenic diet should consider patient preferences, potential adherence, and overall treatment goals [22122222].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In an adult with type 2 diabetes, both metformin and a ketogenic diet can effectively lower HbA1c levels, but each has distinct advantages and challenges [34448957, 33163300, 36012064].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34448957", "evidence_support": "Despite the documented decrease in HbA1, a definitive causal effect of KD remains to be proven.", "evidence_relation": "supporting" }, { "cited_pmid": "33163300", "evidence_support": "This review concludes that the ketogenic diet is superior to controls in terms of glycemic control and lipid profile improvements, and the results are significant enough to recommend it as an adjunctive treatment for type two diabetes.", "evidence_relation": "supporting" }, { "cited_pmid": "36012064", "evidence_support": "Overall, these results suggest that a ketogenic diet may be an effective dietary intervention for body weight and glycemic control, as well as improved lipid profiles in overweight patients with T2DM.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Metformin lowers HbA1c by around 1.32%, is well tolerated, and does not cause weight gain or significant hypoglycemia [26132124, 33970588, 23690375].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33970588", "evidence_support": "Metformin should be used as a first-line treatment in all patients with type 2 diabetes unless contraindicated.", "evidence_relation": "neutral" }, { "cited_pmid": "26132124", "evidence_support": "Patients should be treated initially with metformin because it is the only medication shown in randomized controlled trials to reduce mortality and complications.", "evidence_relation": "neutral" }, { "cited_pmid": "23690375", "evidence_support": "The incretin mimetic exenatide, a high-cost injectable drug, is similar to metformin for reduction of A1c and body mass index.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "It is also effective when combined with other agents, including insulin, to improve HbA1c levels [26132124, 33970588, 18630062].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33970588", "evidence_support": "Metformin should be used as a first-line treatment in all patients with type 2 diabetes unless contraindicated. Add-on treatment with a sodium-dependent glucose cotransporter 2 inhibitor or glucagon-like peptide 1 receptor agonist should be considered in patients who have or are at high risk of cardiovascular disease and in patients with kidney disease.", "evidence_relation": "neutral" }, { "cited_pmid": "26132124", "evidence_support": "Patients should be treated initially with metformin because it is the only medication shown in randomized controlled trials to reduce mortality and complications. Additional medications such as sulfonylureas, dipeptidyl-peptidase-4 inhibitors, thiazolidinediones, and glucagon-like peptide-1 receptor agonists should be added as needed in a patient-centered fashion.", "evidence_relation": "supporting" }, { "cited_pmid": "18630062", "evidence_support": "In addition, metformin can be associated with any other antidiabetic agent.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "On the other hand, a ketogenic diet significantly reduces HbA1c and improves glycemic control, potentially reducing the need for pharmacotherapy [34448957, 32641437, 33163300].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34448957", "evidence_support": "KD results in improved HbA1c already after 3 weeks, and the effect seems to persist for at least 1 year. This is associated with a reduction in glucose-lowering medications.", "evidence_relation": "supporting" }, { "cited_pmid": "32641437", "evidence_support": "Within 4 months of transitioning to KD, combined with IF, she achieved glycaemic control off pharmacotherapy, with HbA1c of 6.4.", "evidence_relation": "supporting" }, { "cited_pmid": "33163300", "evidence_support": "The findings of this review show a significant effect of the ketogenic diet as compared to controls in terms of weight reduction, glycemic control, and improved lipid profile. A noticeable improvement was seen in glycated hemoglobin (HbA1c) and in high-density lipoprotein (HDL), favoring the ketogenic diet as compared to control.", "evidence_relation": "supporting" }, { "cited_pmid": "33163300", "evidence_support": "This review concludes that the ketogenic diet is superior to controls in terms of glycemic control and lipid profile improvements, and the results are significant enough to recommend it as an adjunctive treatment for type two diabetes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "However, adherence to a ketogenic diet can be challenging for many patients [34448957, 32640608, 37709770].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "37709770", "evidence_support": "Despite the evidence supporting the efficacy of the ketogenic diet (KD) on weight and type 2 diabetes (T2D) management, adherence to the KD is challenging.", "evidence_relation": "supporting" }, { "cited_pmid": "32640608", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "34448957", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "While metformin offers a reliable and well-tolerated pharmacological approach, the ketogenic diet provides a non-pharmacological option that may enhance glycemic control but requires sustained dietary commitment [34448957, 33163300, 36012064].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34448957", "evidence_support": "KD results in improved HbA1c already after 3 weeks, and the effect seems to persist for at least 1 year. This is associated with a reduction in glucose-lowering medications.", "evidence_relation": "supporting" }, { "cited_pmid": "33163300", "evidence_support": "Results The findings of this review show a significant effect of the ketogenic diet as compared to controls in terms of weight reduction, glycemic control, and improved lipid profile.", "evidence_relation": "supporting" }, { "cited_pmid": "36012064", "evidence_support": "Overall, these results suggest that a ketogenic diet may be an effective dietary intervention for body weight and glycemic control, as well as improved lipid profiles in overweight patients with T2DM. Hence, a ketogenic diet can be recommended for the therapeutic intervention of overweight patients with T2DM.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Therefore, the choice between metformin and a ketogenic diet should consider patient preferences, potential adherence, and overall treatment goals [22122222].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "22122222", "evidence_support": "The majority of patients with type 2 diabetes mellitus will eventually require combination therapy involving two or more agents to achieve their glycemic target as their disease progresses. ", "evidence_relation": "neutral" }, { "cited_pmid": "22122222", "evidence_support": "Both treatment guidelines emphasize that treatment selection for patients with type 2 diabetes should be guided by the goal of lowering hemoglobin A(1c) (A1C) level and individualizing therapy to each patient based on clinical factors and comorbidities.", "evidence_relation": "supporting" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "In adults with type 2 diabetes, both metformin and a ketogenic diet (KD) have been shown to effectively lower HbA1c levels, but the KD may offer superior glycemic control.Metformin is widely recommended as a first-line treatment and has been proven to reduce HbA1c levels and improve insulin sensitivity [33970588]. However, multiple studies indicate that a KD can lead to more significant reductions in HbA1c compared to standard diets or even low-carbohydrate diets, with effects observed as early as three weeks and sustained for up to a year [34448957, 35800806, 33163300]. Additionally, a KD has been associated with reduced need for glucose-lowering medications and significant weight loss, which further aids in glycemic control [34448957, 35800806]. Despite these benefits, the KD requires strict adherence and medical supervision to ensure safety and effectiveness [34448957, 33163300]. Therefore, while both options are effective, the KD may offer enhanced glycemic control but with greater demands on patient compliance and monitoring.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In adults with type 2 diabetes, both metformin and a ketogenic diet (KD) have been shown to effectively lower HbA1c levels, but the KD may offer superior glycemic control.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Metformin is widely recommended as a first-line treatment and has been proven to reduce HbA1c levels and improve insulin sensitivity [33970588].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33970588", "evidence_support": "Metformin should be used as a first-line treatment in all patients with type 2 diabetes unless contraindicated.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, multiple studies indicate that a KD can lead to more significant reductions in HbA1c compared to standard diets or even low-carbohydrate diets, with effects observed as early as three weeks and sustained for up to a year [34448957, 35800806, 33163300].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34448957", "evidence_support": "KD results in improved HbA1c already after 3 weeks, and the effect seems to persist for at least 1 year.", "evidence_relation": "supporting" }, { "cited_pmid": "35800806", "evidence_support": "Similarly, a significant decrease in HbA1c percentage was recorded in patients that consumed KDs compared to those who consumed the control diets (SMD: -1.45%; 95% CI; -2.73%, -0.17%: P < 0.00001", "evidence_relation": "supporting" }, { "cited_pmid": "35800806", "evidence_support": "The results also show that the KD significantly impacts weight loss than control diets. The results show that the KD is more effective in reducing glycated haemoglobin and body weight (BW) than a low-carbohydrate diet.", "evidence_relation": "supporting" }, { "cited_pmid": "33163300", "evidence_support": "A noticeable improvement was seen in glycated hemoglobin (HbA1c) and in high-density lipoprotein (HDL), favoring the ketogenic diet as compared to control", "evidence_relation": "supporting" }, { "cited_pmid": "33163300", "evidence_support": "This review concludes that the ketogenic diet is superior to controls in terms of glycemic control and lipid profile improvements, and the results are significant enough to recommend it as an adjunctive treatment for type two diabetes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, a KD has been associated with reduced need for glucose-lowering medications and significant weight loss, which further aids in glycemic control [34448957, 35800806].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34448957", "evidence_support": "KD results in improved HbA1c already after 3 weeks, and the effect seems to persist for at least 1 year. This is associated with a reduction in glucose-lowering medications. The weight loss observed after a short time period seems to be maintained with a long-term diet. ", "evidence_relation": "supporting" }, { "cited_pmid": "35800806", "evidence_support": "Different measures, such as dietary therapies and physical training, have been used to manage type 2 diabetes through weight and glycemic control. ", "evidence_relation": "supporting" }, { "cited_pmid": "35800806", "evidence_support": "Similarly, a significant decrease in HbA1c percentage was recorded in patients that consumed KDs compared to those who consumed the control diets (SMD: -1.45%; 95% CI; -2.73%, -0.17%: P < 0.00001). The results also show that the KD significantly impacts weight loss than control diets.", "evidence_relation": "supporting" }, { "cited_pmid": "35800806", "evidence_support": "The results show that the KD is more effective in reducing glycated haemoglobin and body weight (BW) than a low-carbohydrate diet. Therefore, we can summarize that the KD is a more effective dietary therapy. However, there is a need to balance the weight loss and glycemic control benefits obtained from the KD with the increased cardiovascular risks for patients with type 2 diabetes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Despite these benefits, the KD requires strict adherence and medical supervision to ensure safety and effectiveness [34448957, 33163300].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34448957", "evidence_support": "Adequate support (supportive psychological counseling, enhancing positive affectivity, reinforcing mindful eating) is necessary to achieve a benefit and to assure adherence.", "evidence_relation": "supporting" }, { "cited_pmid": "34448957", "evidence_support": "Despite the documented decrease in HbA1, a definitive causal effect of KD remains to be proven. KD should be performed under strict medical supervision.", "evidence_relation": "supporting" }, { "cited_pmid": "33163300", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Therefore, while both options are effective, the KD may offer enhanced glycemic control but with greater demands on patient compliance and monitoring.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "In adults with type 2 diabetes, a ketogenic diet may be more effective than metformin for lowering A1c levels [34448957, 35800806, 33163300]. Studies show ketogenic diets significantly reduce HbA1c, with a systematic review demonstrating greater reductions compared to low-carb diets [35800806]. A meta-analysis found ketogenic diets improved glycemic control and weight loss in type 2 diabetes patients [33163300]. Metformin, typically a first-line treatment, may have limited effectiveness in lowering A1c for some patients [26132124, 33970588]. However, ketogenic diets should be performed under strict medical supervision, with long-term cardiovascular risks carefully monitored [34448957]. A combination of metformin and ketogenic diet may be considered, but further research is needed to determine the optimal approach [22673594].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In adults with type 2 diabetes, a ketogenic diet may be more effective than metformin for lowering A1c levels [34448957, 35800806, 33163300].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34448957", "evidence_support": "KD results in improved HbA1c already after 3 weeks, and the effect seems to persist for at least 1 year.", "evidence_relation": "neutral" }, { "cited_pmid": "35800806", "evidence_support": "Similarly, a significant decrease in HbA1c percentage was recorded in patients that consumed KDs compared to those who consumed the control diets (SMD: -1.45%; 95% CI; -2.73%, -0.17%: P < 0.00001)", "evidence_relation": "supporting" }, { "cited_pmid": "33163300", "evidence_support": "This review concludes that the ketogenic diet is superior to controls in terms of glycemic control and lipid profile improvements, and the results are significant enough to recommend it as an adjunctive treatment for type two diabetes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Studies show ketogenic diets significantly reduce HbA1c, with a systematic review demonstrating greater reductions compared to low-carb diets [35800806].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35800806", "evidence_support": "The results show that the KD is more effective in reducing glycated haemoglobin and body weight (BW) than a low-carbohydrate diet. Therefore, we can summarize that the KD is a more effective dietary therapy.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "A meta-analysis found ketogenic diets improved glycemic control and weight loss in type 2 diabetes patients [33163300].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33163300", "evidence_support": "Today, it is used by many to help in weight loss", "evidence_relation": "supporting" }, { "cited_pmid": "33163300", "evidence_support": " The findings of this review show a significant effect of the ketogenic diet as compared to controls in terms of weight reduction, glycemic control, and improved lipid profile", "evidence_relation": "supporting" }, { "cited_pmid": "33163300", "evidence_support": "This review concludes that the ketogenic diet is superior to controls in terms of glycemic control and lipid profile improvements, and the results are significant enough to recommend it as an adjunctive treatment for type two diabetes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Metformin, typically a first-line treatment, may have limited effectiveness in lowering A1c for some patients [26132124, 33970588].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26132124", "evidence_support": "Patients should be treated initially with metformin because it is the only medication shown in randomized controlled trials to reduce mortality and complications", "evidence_relation": "neutral" }, { "cited_pmid": "33970588", "evidence_support": "Metformin should be used as a first-line treatment in all patients with type 2 diabetes unless contraindicated.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "However, ketogenic diets should be performed under strict medical supervision, with long-term cardiovascular risks carefully monitored [34448957].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "34448957", "evidence_support": "KD should be performed under strict medical supervision.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "A combination of metformin and ketogenic diet may be considered, but further research is needed to determine the optimal approach [22673594].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22673594", "evidence_support": "Three hundred and sixty-three overweight and obese participants were recruited from the Al-Shaab Clinic for a 24-wk diet intervention trial; 102 of them had type 2 diabetes. The participants were advised to choose LCD or LDKD, depending on their preference. Body weight, body mass index, changes in waist circumference, blood glucose level, changes in hemoglobin and glycosylated hemoglobin, total cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, triglycerides, uric acid, urea and creatinine were determined before and at 4, 8, 12, 16, 20, and 24 wk after the administration of the LCD or LCKD. The initial dose of some antidiabetic medications was decreased to half and some were discontinued at the beginning of the dietary program in the LCKD group. Dietary counseling and further medication adjustment were done on a biweekly basis.", "evidence_relation": "neutral" }, { "cited_pmid": "22673594", "evidence_support": "Therefore, diabetic patients on a ketogenic diet should be under strict medical supervision because the LCKD can significantly lower blood glucose levels.", "evidence_relation": "neutral" } ] } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "A ketogenic diet is more effective than metformin in lowering A1c levels in adults with type 2 diabetes [33652834, 27643725, 36297044]. Studies have shown that a ketogenic diet can lead to significant improvements in glycemic control, weight loss, and lipid profiles, and can even reduce the need for diabetes medications [27643725, 31611148, 35537861]. In contrast, metformin is a medication that is commonly used to treat type 2 diabetes, but it may not be as effective in lowering A1c levels as a ketogenic diet [23680948, 37904380, 22673594]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A ketogenic diet is more effective than metformin in lowering A1c levels in adults with type 2 diabetes [33652834, 27643725, 36297044].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33652834", "evidence_support": "At the end of the study, in the VLCKD group 26.6% of patients had stopped all antidiabetic medications, and 73.3% were taking only metformin, whereas 46.6% of LCD patients had to increase antidiabetic medications.", "evidence_relation": "contradicting" }, { "cited_pmid": "36297044", "evidence_support": "Among gluco-metabolic parameters, only the very-low-calorie ketogenic Mediterranean diet group showed a significant decrease in fasting blood glucose and HbA1c, insulin, C-peptide total cholesterol, LDL, and triglycerides.", "evidence_relation": "neutral" }, { "cited_pmid": "27643725", "evidence_support": "The interventional weight loss program based on a VLCK diet is most effective in reducing body weight and improvement of glycemic control than a standard hypocaloric diet with safety and good tolerance for T2DM patients.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Studies have shown that a ketogenic diet can lead to significant improvements in glycemic control, weight loss, and lipid profiles, and can even reduce the need for diabetes medications [27643725, 31611148, 35537861].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35537861", "evidence_support": "Carbohydrate restriction can exert a significant and important reduction on levels of cardiometabolic risk factors in patients with type 2 diabetes. Levels of most cardiometabolic outcomes decreased linearly with the decrease in carbohydrate intake.", "evidence_relation": "supporting" }, { "cited_pmid": "31611148", "evidence_support": "Based on the evidence reviewed, low-CHO and very-low-CHO diets are not superior to other dietary approaches for weight loss. These diets may have advantages related to appetite control, triglyceride reduction, and reduction in the use of medication in T2D management.", "evidence_relation": "neutral" }, { "cited_pmid": "27643725", "evidence_support": "The interventional weight loss program based on a VLCK diet is most effective in reducing body weight and improvement of glycemic control than a standard hypocaloric diet with safety and good tolerance for T2DM patients.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In contrast, metformin is a medication that is commonly used to treat type 2 diabetes, but it may not be as effective in lowering A1c levels as a ketogenic diet [23680948, 37904380, 22673594].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23680948", "evidence_support": "However, limiting both protein and carbohydrates as in a classic ketogenic diet remarkably reduces blood glucose in animal models of type 1 and type 2 diabetes and reverses diabetic nephropathy", "evidence_relation": "neutral" }, { "cited_pmid": "37904380", "evidence_support": "The 2-meals-a-day KD can significantly improve weight, blood glucose, and lipid control in newly diagnosed obese patients with type 2 diabetes mellitus", "evidence_relation": "neutral" }, { "cited_pmid": "22673594", "evidence_support": "This study shows the beneficial effects of a ketogenic diet over the conventional LCD in obese diabetic subjects. The ketogenic diet appears to improve glycemic control", "evidence_relation": "neutral" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "A ketogenic diet is more effective than metformin in lowering A1c levels in adults with type 2 diabetes [30881073, 32640608, 36012064]. Studies have shown that a ketogenic diet can improve glycemic control, reduce medication use, and promote weight loss in patients with type 2 diabetes [30881073, 32640608, 36012064]. A meta-analysis of 15 studies found that a ketogenic diet resulted in a greater reduction in HbA1c levels compared to a low-carbohydrate diet [30881073, 32640608, 36012064]. Additionally, a ketogenic diet has been shown to improve lipid profiles, including a decrease in triglycerides and an increase in high-density lipoprotein (HDL) cholesterol [24717684, 32640608, 36012064]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A ketogenic diet is more effective than metformin in lowering A1c levels in adults with type 2 diabetes [30881073, 32640608, 36012064].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30881073", "evidence_support": "A growing body of evidence suggests that a low-carbohydrate, high-fat, ketogenic diet (KD) may be a more effective nutritional strategy for improving glycemic control.", "evidence_relation": "supporting" }, { "cited_pmid": "32640608", "evidence_support": "Our study findings confirmed that ketogenic diets were more effective in improving metabolic parameters associated with glycemic, weight, and lipid controls in patients with overweight or obesity, especially those with preexisting diabetes, as compared to low-fat diets.", "evidence_relation": "supporting" }, { "cited_pmid": "36012064", "evidence_support": "these results suggest that a ketogenic diet may be an effective dietary intervention for body weight and glycemic control, as well as improved lipid profiles in overweight patients with T2DM.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Studies have shown that a ketogenic diet can improve glycemic control, reduce medication use, and promote weight loss in patients with type 2 diabetes [30881073, 32640608, 36012064].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30881073", "evidence_support": "These cases demonstrate the efficacy of KDs in terms of improving glycemic control in DM2 patients and lend support to the increased use of KDs in this population cohort.\n", "evidence_relation": "supporting" }, { "cited_pmid": "32640608", "evidence_support": "Our study findings confirmed that ketogenic diets were more effective in improving metabolic parameters associated with glycemic, weight, and lipid controls in patients with overweight or obesity, especially those with preexisting diabetes, as compared to low-fat diets.", "evidence_relation": "supporting" }, { "cited_pmid": "36012064", "evidence_support": "Overall, these results suggest that a ketogenic diet may be an effective dietary intervention for body weight and glycemic control, as well as improved lipid profiles in overweight patients with T2DM.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "A meta-analysis of 15 studies found that a ketogenic diet resulted in a greater reduction in HbA1c levels compared to a low-carbohydrate diet [30881073, 32640608, 36012064].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30881073", "evidence_support": "A growing body of evidence suggests that a low-carbohydrate, high-fat, ketogenic diet (KD) may be a more effective nutritional strategy for improving glycemic control. ", "evidence_relation": "supporting" }, { "cited_pmid": "30881073", "evidence_support": "These cases demonstrate the efficacy of KDs in terms of improving glycemic control in DM2 patients and lend support to the increased use of KDs in this population cohort.", "evidence_relation": "supporting" }, { "cited_pmid": "32640608", "evidence_support": "The effects of ketogenic diets on glycemic control were greater for diabetic patients relative to those of low-fat diets, indicated by lower glycated hemoglobin (SMD, -0.62; p < 0.001) and homeostatic model assessment index (SMD, -0.29; p = 0.02), while comparable effects were observed for nondiabetic patients.", "evidence_relation": "supporting" }, { "cited_pmid": "32640608", "evidence_support": "Our study findings confirmed that ketogenic diets were more effective in improving metabolic parameters associated with glycemic, weight, and lipid controls in patients with overweight or obesity, especially those with preexisting diabetes, as compared to low-fat diets. ", "evidence_relation": "supporting" }, { "cited_pmid": "36012064", "evidence_support": "Overall, these results suggest that a ketogenic diet may be an effective dietary intervention for body weight and glycemic control, as well as improved lipid profiles in overweight patients with T2DM. Hence, a ketogenic diet can be recommended for the therapeutic intervention of overweight patients with T2DM.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, a ketogenic diet has been shown to improve lipid profiles, including a decrease in triglycerides and an increase in high-density lipoprotein (HDL) cholesterol [24717684, 32640608, 36012064].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32640608", "evidence_support": "Ketogenic diets led to substantial weight reduction (SMD, -0.46; p = 0.04) irrespective of patients' diabetes status at baseline and improved lipid profiles in terms of lower triglyceride (SMD, -0.45; p = 0.01) and greater high-density lipoprotein (SMD, 0.31; p = 0.005) for diabetic patients.", "evidence_relation": "supporting" }, { "cited_pmid": "32640608", "evidence_support": "Our study findings confirmed that ketogenic diets were more effective in improving metabolic parameters associated with glycemic, weight, and lipid controls in patients with overweight or obesity, especially those with preexisting diabetes, as compared to low-fat diets", "evidence_relation": "supporting" }, { "cited_pmid": "36012064", "evidence_support": "The results show that a ketogenic diet had significantly beneficial effects on the loss of body weight (SMD, -5.63, p = 0.008), the reduction of waist circumference (SMD, -2.32, p = 0.04), lowering glycated hemoglobin (SMD, -0.38, p = 0.0008) and triglycerides (SMD, -0.36, p = 0.0001), and increasing high-density lipoproteins (SMD, 0.28, p = 0.003). ", "evidence_relation": "supporting" }, { "cited_pmid": "24717684", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "A ketogenic diet is more effective than metformin in lowering A1c levels in adults with type 2 diabetes [32641437, 36583214, 32640608]. The ketogenic diet has been shown to improve glycemic control, reduce body weight, and decrease the need for antidiabetic medications [22673594, 32641437, 36064937]. Studies have consistently demonstrated that a ketogenic diet can lead to significant reductions in HbA1c levels, with some studies showing decreases of up to 1.5% in just 24 weeks [35469570, 22673594, 29269731]. Additionally, the ketogenic diet has been shown to improve lipid profiles, reduce blood pressure, and increase insulin sensitivity, all of which can contribute to better overall health outcomes for individuals with type 2 diabetes [35469570, 32641437, 29269731]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A ketogenic diet is more effective than metformin in lowering A1c levels in adults with type 2 diabetes [32641437, 36583214, 32640608].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32641437", "evidence_support": "A 57-year-old woman with type 2 diabetes treated with metformin and strict adherence to a standard diabetic diet presented with a haemoglobin A1c (HbA1c) of 9.3%. Within 4 months of transitioning to KD, combined with IF, she achieved glycaemic control off pharmacotherapy, with HbA1c of 6.4", "evidence_relation": "supporting" }, { "cited_pmid": "36583214", "evidence_support": "Low-carbohydrate ketogenic diets effectively improved cardiovascular risk factors (blood glucose, weight, and lipids) in obese/ overweight patients, especially those with T2DM when compared with non-ketogenic diets", "evidence_relation": "supporting" }, { "cited_pmid": "32640608", "evidence_support": "Our study findings confirmed that ketogenic diets were more effective in improving metabolic parameters associated with glycemic, weight, and lipid controls in patients with overweight or obesity, especially those with preexisting diabetes, as compared to low-fat diets.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The ketogenic diet has been shown to improve glycemic control, reduce body weight, and decrease the need for antidiabetic medications [22673594, 32641437, 36064937].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22673594", "evidence_support": "Previous studies from our laboratory have shown the beneficial effects of a low-carbohydrate ketogenic diet (LCKD) in patients with type 2 diabetes after its long term administration.", "evidence_relation": "supporting" }, { "cited_pmid": "22673594", "evidence_support": "The ketogenic diet appears to improve glycemic control.", "evidence_relation": "supporting" }, { "cited_pmid": "32641437", "evidence_support": "This case demonstrates the effective and sustainable use of intermittent fasting (IF) and ketogenic diet (KD) in a normal weight patient with type 2 diabetes, who did not attain glycaemic control with a standard care approach.", "evidence_relation": "supporting" }, { "cited_pmid": "36064937", "evidence_support": "A VLC/KD may cause reductions in HbA1c and triglycerides in those with pre-diabetes or T2D but evidence of an advantage over other strategies is limited. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Studies have consistently demonstrated that a ketogenic diet can lead to significant reductions in HbA1c levels, with some studies showing decreases of up to 1.5% in just 24 weeks [35469570, 22673594, 29269731].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35469570", "evidence_support": "A ketogenic diet consistently demonstrates improved glycemic control in Type 2 Diabetics, and in those at risk of Type 2 Diabetes.", "evidence_relation": "supporting" }, { "cited_pmid": "22673594", "evidence_support": "This study shows the beneficial effects of a ketogenic diet over the conventional LCD in obese diabetic subjects. The ketogenic diet appears to improve glycemic control. Therefore, diabetic patients on a ketogenic diet should be under strict medical supervision because the LCKD can significantly lower blood glucose levels.", "evidence_relation": "supporting" }, { "cited_pmid": "29269731", "evidence_support": "In a 12-month trial, adults with elevated HbA1c and body weight assigned to an LCK diet had greater reductions in HbA1c, lost more weight, and reduced more medications than those instructed to follow an MCCR diet.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, the ketogenic diet has been shown to improve lipid profiles, reduce blood pressure, and increase insulin sensitivity, all of which can contribute to better overall health outcomes for individuals with type 2 diabetes [35469570, 32641437, 29269731].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35469570", "evidence_support": "It was hypothesized that a ketogenic diet is effective in improving insulin sensitivity in individuals with Type 2 Diabetes, with the greatest effect resulting from a ketogenic diet paired with exercise", "evidence_relation": "supporting" }, { "cited_pmid": "35469570", "evidence_support": "A ketogenic diet consistently demonstrates improved glycemic control in Type 2 Diabetics, and in those at risk of Type 2 Diabetes. However, the studies are limited in their lack of exploration of the effects of a long-term ketogenic diet on the liver, with only one study including this data. Randomized trials looking at the effect of a ketogenic diet on the liver are needed.", "evidence_relation": "supporting" }, { "cited_pmid": "32641437", "evidence_support": "This case demonstrates the effective and sustainable use of intermittent fasting (IF) and ketogenic diet (KD) in a normal weight patient with type 2 diabetes, who did not attain glycaemic control with a standard care approach.", "evidence_relation": "supporting" }, { "cited_pmid": "29269731", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "A ketogenic diet is more effective than metformin in lowering A1c levels in adults with type 2 diabetes [30881073, 32641437]. The ketogenic diet has been shown to improve glycemic control, reduce body weight, and decrease the need for antidiabetic medications [22673594, 19490828, 16318637]. Studies have consistently demonstrated that a ketogenic diet can lead to significant reductions in HbA1c levels, with some studies showing decreases of up to 1.5% in just 24 weeks [19099589, 14747212]. In contrast, metformin typically reduces HbA1c levels by 1-2% over a period of several months [32316649, 22275444]. Additionally, the ketogenic diet has been shown to improve lipid profiles, reduce blood pressure, and increase insulin sensitivity, all of which can contribute to better overall health outcomes for individuals with type 2 diabetes [31485454, 35469570, 32641437]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A ketogenic diet is more effective than metformin in lowering A1c levels in adults with type 2 diabetes [30881073, 32641437].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30881073", "evidence_support": "These cases demonstrate the efficacy of KDs in terms of improving glycemic control in DM2 patients and lend support to the increased use of KDs in this population cohort.", "evidence_relation": "supporting" }, { "cited_pmid": "32641437", "evidence_support": "This case demonstrates the effective and sustainable use of intermittent fasting (IF) and ketogenic diet (KD) in a normal weight patient with type 2 diabetes, who did not attain glycaemic control with a standard care approach. A 57-year-old woman with type 2 diabetes treated with metformin and strict adherence to a standard diabetic diet presented with a haemoglobin A1c (HbA1c) of 9.3%. Within 4 months of transitioning to KD, combined with IF, she achieved glycaemic control off pharmacotherapy, with HbA1c of 6.4.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The ketogenic diet has been shown to improve glycemic control, reduce body weight, and decrease the need for antidiabetic medications [22673594, 19490828, 16318637].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22673594", "evidence_support": "These studies have indicated that, in addition to decreasing body weight and improving glycemia, LCKD can be effective in decreasing antidiabetic medication dosage. Similar to the LCKD, the conventional low-calorie, high nutritional value diet is also used for weight loss.", "evidence_relation": "supporting" }, { "cited_pmid": "22673594", "evidence_support": " The ketogenic diet appears to improve glycemic control. Therefore, diabetic patients on a ketogenic diet should be under strict medical supervision because the LCKD can significantly lower blood glucose levels.", "evidence_relation": "supporting" }, { "cited_pmid": "16318637", "evidence_support": "The low-carbohydrate, ketogenic diet (LCKD) may be effective for improving glycemia and reducing medications in patients with type 2 diabetes.", "evidence_relation": "supporting" }, { "cited_pmid": "16318637", "evidence_support": "The LCKD improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants. Because the LCKD can be very effective at lowering blood glucose, patients on diabetes medication who use this diet should be under close medical supervision or capable of adjusting their medication.", "evidence_relation": "supporting" }, { "cited_pmid": "19490828", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Studies have consistently demonstrated that a ketogenic diet can lead to significant reductions in HbA1c levels, with some studies showing decreases of up to 1.5% in just 24 weeks [19099589, 14747212].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19099589", "evidence_support": "The LCKD group had greater improvements in hemoglobin A1c (-1.5% vs. -0.5%, p = 0.03), body weight (-11.1 kg vs. -6.9 kg, p = 0.008), and high density lipoprotein cholesterol (+5.6 mg/dL vs. 0 mg/dL, p < 0.001) compared to the LGID group.", "evidence_relation": "supporting" }, { "cited_pmid": "14747212", "evidence_support": "The ketogenic VLCD is an effective short-term, and possibly long-term, therapy for pediatric patients with type 2 diabetes.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In contrast, metformin typically reduces HbA1c levels by 1-2% over a period of several months [32316649, 22275444].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22275444", "evidence_support": "Metformin monotherapy lowered HbA(1c) by 1.12% (95% CI 0.92-1.32; I(2) = 80%) versus placebo,", "evidence_relation": "supporting" }, { "cited_pmid": "32316649", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, the ketogenic diet has been shown to improve lipid profiles, reduce blood pressure, and increase insulin sensitivity, all of which can contribute to better overall health outcomes for individuals with type 2 diabetes [31485454, 35469570, 32641437].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31485454", "evidence_support": "Because low-carbohydrate diets are effective strategies to improve insulin resistance, the hallmark of type 2 diabetes, the purpose of reporting these clinical cases was to reveal the meaningful changes observed in 90 days of low-carbohydrate (LC) ketogenic dietary intervention in female type 2 diabetics aged 18-45.", "evidence_relation": "supporting" }, { "cited_pmid": "35469570", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "32641437", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "A ketogenic diet is more effective than metformin in lowering A1c levels in adults with type 2 diabetes [32641437, 30881073]. The ketogenic diet has been shown to improve glycemic control, reduce body weight, and decrease the need for antidiabetic medications [19490828, 16318637, 22673594]. Studies have consistently demonstrated that a ketogenic diet can lead to significant reductions in HbA1c levels, with some studies showing decreases of up to 1.5% in just 24 weeks [14747212, 19099589]. In contrast, metformin typically reduces HbA1c levels by 1-2% over a period of several months [32316649, 22275444]. Additionally, the ketogenic diet has been shown to improve lipid profiles, reduce blood pressure, and increase insulin sensitivity, all of which can contribute to better overall health outcomes for individuals with type 2 diabetes [31485454, 35469570, 32641437]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A ketogenic diet is more effective than metformin in lowering A1c levels in adults with type 2 diabetes [32641437, 30881073].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32641437", "evidence_support": "Within 4 months of transitioning to KD, combined with IF, she achieved glycaemic control off pharmacotherapy, with HbA1c of 6.4.", "evidence_relation": "supporting" }, { "cited_pmid": "30881073", "evidence_support": "A growing body of evidence suggests that a low-carbohydrate, high-fat, ketogenic diet (KD) may be a more effective nutritional strategy for improving glycemic control.", "evidence_relation": "supporting" }, { "cited_pmid": "30881073", "evidence_support": "These cases demonstrate the efficacy of KDs in terms of improving glycemic control in DM2 patients and lend support to the increased use of KDs in this population cohort.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The ketogenic diet has been shown to improve glycemic control, reduce body weight, and decrease the need for antidiabetic medications [19490828, 16318637, 22673594].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16318637", "evidence_support": "The low-carbohydrate, ketogenic diet (LCKD) may be effective for improving glycemia and reducing medications in patients with type 2 diabetes.", "evidence_relation": "supporting" }, { "cited_pmid": "16318637", "evidence_support": "The LCKD improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants. ", "evidence_relation": "supporting" }, { "cited_pmid": "22673594", "evidence_support": "These studies have indicated that, in addition to decreasing body weight and improving glycemia, LCKD can be effective in decreasing antidiabetic medication dosage.", "evidence_relation": "supporting" }, { "cited_pmid": "22673594", "evidence_support": "The ketogenic diet appears to improve glycemic control.", "evidence_relation": "supporting" }, { "cited_pmid": "19490828", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Studies have consistently demonstrated that a ketogenic diet can lead to significant reductions in HbA1c levels, with some studies showing decreases of up to 1.5% in just 24 weeks [14747212, 19099589].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14747212", "evidence_support": "HbA(1c) dropped from 8.8 +/- 0.6 to 7.4 +/- 0.6% (P < 0.005) as the diet was continued for a mean of 60 +/- 8 days (range 4-130 days)", "evidence_relation": "supporting" }, { "cited_pmid": "14747212", "evidence_support": "The ketogenic VLCD is an effective short-term, and possibly long-term, therapy for pediatric patients with type 2 diabetes. Blood glucose control and BMI improve", "evidence_relation": "supporting" }, { "cited_pmid": "19099589", "evidence_support": "The LCKD group had greater improvements in hemoglobin A1c (-1.5% vs. -0.5%, p = 0.03)", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In contrast, metformin typically reduces HbA1c levels by 1-2% over a period of several months [32316649, 22275444].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32316649", "evidence_support": "Over 90% of patients with type 2 diabetes and failure of metformin reached their HbA1c goal with additional basal insulin at bedtime over several year", "evidence_relation": "contradicting" }, { "cited_pmid": "22275444", "evidence_support": "Metformin monotherapy lowered HbA(1c) by 1.12% (95% CI 0.92-1.32; I(2) = 80%) versus placebo, metformin added to oral therapy lowered HbA(1c) by 0.95% (0.77-1.13; I(2) = 77%) versus placebo added to oral therapy, and metformin added to insulin therapy lowered HbA(1c) by 0.60% (0.30-0.91; I(2) = 79.8%) versus insulin onl", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, the ketogenic diet has been shown to improve lipid profiles, reduce blood pressure, and increase insulin sensitivity, all of which can contribute to better overall health outcomes for individuals with type 2 diabetes [31485454, 35469570, 32641437].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35469570", "evidence_support": "It was hypothesized that a ketogenic diet is effective in improving insulin sensitivity in individuals with Type 2 Diabetes, with the greatest effect resulting from a ketogenic diet paired with exercise.", "evidence_relation": "supporting" }, { "cited_pmid": "35469570", "evidence_support": "A ketogenic diet consistently demonstrates improved glycemic control in Type 2 Diabetics, and in those at risk of Type 2 Diabetes.", "evidence_relation": "supporting" }, { "cited_pmid": "32641437", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "31485454", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "A ketogenic diet is more effective than metformin in lowering A1c levels in adults with type 2 diabetes [30881073, 32641437]. The ketogenic diet has been shown to improve glycemic control, reduce body weight, and decrease the need for antidiabetic medications [16318637, 19490828, 22673594]. Studies have consistently demonstrated that a ketogenic diet can lead to significant reductions in HbA1c levels, with some studies showing decreases of up to 1.5% in just 24 weeks [19099589, 14747212]. In contrast, metformin typically reduces HbA1c levels by 1-2% over a period of several months [32316649, 22275444]. Additionally, the ketogenic diet has been shown to improve lipid profiles, reduce blood pressure, and increase insulin sensitivity, all of which can contribute to better overall health outcomes for individuals with type 2 diabetes [31485454, 35469570, 32641437]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A ketogenic diet is more effective than metformin in lowering A1c levels in adults with type 2 diabetes [30881073, 32641437].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30881073", "evidence_support": "A growing body of evidence suggests that a low-carbohydrate, high-fat, ketogenic diet (KD) may be a more effective nutritional strategy for improving glycemic control.", "evidence_relation": "supporting" }, { "cited_pmid": "32641437", "evidence_support": "This case demonstrates the effective and sustainable use of intermittent fasting (IF) and ketogenic diet (KD) in a normal weight patient with type 2 diabetes, who did not attain glycaemic control with a standard care approach.", "evidence_relation": "supporting" }, { "cited_pmid": "32641437", "evidence_support": "Within 4 months of transitioning to KD, combined with IF, she achieved glycaemic control off pharmacotherapy, with HbA1c of 6.4.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The ketogenic diet has been shown to improve glycemic control, reduce body weight, and decrease the need for antidiabetic medications [16318637, 19490828, 22673594].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16318637", "evidence_support": "The LCKD improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants", "evidence_relation": "supporting" }, { "cited_pmid": "22673594", "evidence_support": "These studies have indicated that, in addition to decreasing body weight and improving glycemia, LCKD can be effective in decreasing antidiabetic medication dosage", "evidence_relation": "supporting" }, { "cited_pmid": "19490828", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Studies have consistently demonstrated that a ketogenic diet can lead to significant reductions in HbA1c levels, with some studies showing decreases of up to 1.5% in just 24 weeks [19099589, 14747212].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19099589", "evidence_support": "The LCKD group had greater improvements in hemoglobin A1c (-1.5% vs. -0.5%, p = 0.03), body weight (-11.1 kg vs. -6.9 kg, p = 0.008), and high density lipoprotein cholesterol (+5.6 mg/dL vs. 0 mg/dL, p < 0.001) compared to the LGID group.", "evidence_relation": "supporting" }, { "cited_pmid": "14747212", "evidence_support": "The ketogenic VLCD is an effective short-term, and possibly long-term, therapy for pediatric patients with type 2 diabetes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In contrast, metformin typically reduces HbA1c levels by 1-2% over a period of several months [32316649, 22275444].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32316649", "evidence_support": "HbA1c decreased by -1.2% and bodyweight by -1.7 kg after a duration of 31.7 \u00b1 29.1 (range 2-133) months.", "evidence_relation": "supporting" }, { "cited_pmid": "22275444", "evidence_support": "Metformin monotherapy lowered HbA(1c) by 1.12%", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, the ketogenic diet has been shown to improve lipid profiles, reduce blood pressure, and increase insulin sensitivity, all of which can contribute to better overall health outcomes for individuals with type 2 diabetes [31485454, 35469570, 32641437].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31485454", "evidence_support": "The volunteers lost significant weight (85.7 \u00b1 3.2\u2009kg to 76.7 \u00b1 2.8\u2009kg) and lowered systolic (134.0 \u00b1 1.6 to 123.3 \u00b1 1.1\u2009mmHg) and diastolic (89.9 \u00b1 1.3 to 82.6 \u00b1 1.0\u2009mmHg) blood pressure. HbA1c dropped to 5.6%. Most blood lipids were significantly altered, including HDL cholesterol (43.1 \u00b1 4.4 to 52.3 \u00b1 3.3\u2009mg/dl), triglycerides (177.0 \u00b1 19.8 to 92.1 \u00b1 8.7\u2009mg/dl), and the TG\u2009:\u2009HDL ratio (4.7 \u00b1 0.8 to 1.9 \u00b1 0.2).", "evidence_relation": "supporting" }, { "cited_pmid": "35469570", "evidence_support": "It was hypothesized that a ketogenic diet is effective in improving insulin sensitivity in individuals with Type 2 Diabetes, with the greatest effect resulting from a ketogenic diet paired with exercise.", "evidence_relation": "supporting" }, { "cited_pmid": "35469570", "evidence_support": "Every trial utilizing a ketogenic diet showed marked improvement in glycemic control among participants in support of the hypothesi", "evidence_relation": "supporting" }, { "cited_pmid": "35469570", "evidence_support": "One study noted that while a ketogenic diet greatly improved glycemic control, it created problems with lipid metabolism and the liver.", "evidence_relation": "contradicting" }, { "cited_pmid": "35469570", "evidence_support": "A ketogenic diet consistently demonstrates improved glycemic control in Type 2 Diabetics, and in those at risk of Type 2 Diabetes", "evidence_relation": "supporting" }, { "cited_pmid": "32641437", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "The ketogenic diet has been shown to improve glycemic control, reduce body weight, and decrease the need for antidiabetic medications [34448957, 33257645, 19099589]. Studies have consistently demonstrated that a ketogenic diet can lead to significant reductions in HbA1c levels, with some studies showing decreases of up to 1.5% in just 24 weeks [31185843]. In contrast, metformin typically reduces HbA1c levels by 1-2% over a period of several months [36786075]. Additionally, the ketogenic diet has been shown to improve lipid profiles, reduce blood pressure, and increase insulin sensitivity, all of which can contribute to better overall health outcomes for individuals with type 2 diabetes [36800966, 19368291]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The ketogenic diet has been shown to improve glycemic control, reduce body weight, and decrease the need for antidiabetic medications [34448957, 33257645, 19099589].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34448957", "evidence_support": "To assess the pleiotropic effects of ketogenic diets (KD) on glucose control, changes in medication, and weight loss in individuals with type 2 diabetes, and to evaluate its practical feasibility", "evidence_relation": "supporting" }, { "cited_pmid": "34448957", "evidence_support": "KD results in improved HbA1c already after 3 weeks, and the effect seems to persist for at least 1 year", "evidence_relation": "supporting" }, { "cited_pmid": "34448957", "evidence_support": "This is associated with a reduction in glucose-lowering medications", "evidence_relation": "supporting" }, { "cited_pmid": "34448957", "evidence_support": "The weight loss observed after a short time period seems to be maintained with a long-term diet", "evidence_relation": "neutral" }, { "cited_pmid": "33257645", "evidence_support": "At present, the beneficial effect of the ketogenic diet (KD) on weight loss in obese patients is generally recognized", "evidence_relation": "supporting" }, { "cited_pmid": "33257645", "evidence_support": "KD not only has a therapeutic effect on glycemic and lipid control among patients with T2DM but also significantly contributes to their weight loss.", "evidence_relation": "supporting" }, { "cited_pmid": "19099589", "evidence_support": "The diet lower in carbohydrate led to greater improvements in glycemic control, and more frequent medication reduction/elimination than the low glycemic index diet.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Studies have consistently demonstrated that a ketogenic diet can lead to significant reductions in HbA1c levels, with some studies showing decreases of up to 1.5% in just 24 weeks [31185843].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31185843", "evidence_support": "In half of the comparative studies with T2DM, the KD lead to signifiantly greater reductions in HbA1c-levels (HbA1c difference: -0.5 to -1.5 %) compared to reference diets (HbA1c difference: +0.2 to -0.5 %).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In contrast, metformin typically reduces HbA1c levels by 1-2% over a period of several months [36786075].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36786075", "evidence_support": "HbA1c levels were reduced by at least 1% after 6\u00a0months of metformin treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "36786075", "evidence_support": "After 6\u2009months of metformin treatment, serum levels of HbA1C in responders were reduced significantly in both groups (T/T and T/C\u2009+\u2009C/C), (p-value\u00a0=\u00a0<.0001). ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, the ketogenic diet has been shown to improve lipid profiles, reduce blood pressure, and increase insulin sensitivity, all of which can contribute to better overall health outcomes for individuals with type 2 diabetes [36800966, 19368291].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36800966", "evidence_support": "After VLCKD all the women experienced a significant reduction in body weight and an overall improvement of body composition parameters", "evidence_relation": "supporting" }, { "cited_pmid": "36800966", "evidence_support": "VLCKD reduces BP in women with of obesity and hypertension in a safely manner.", "evidence_relation": "neutral" }, { "cited_pmid": "19368291", "evidence_support": "It is also necessary to emphasize that as well as the weight loss, ketogenic diets are healthier because they promote a non-atherogenic lipid profile, lower blood pressure and diminish resistance to insulin with an improvement in blood levels of glucose and insulin.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "The study found that the ketogenic diet significantly contributed to glycemic control, but it does not directly compare its effectiveness to metformin in lowering A1c levels [33257645]. A more accurate statement would be: A ketogenic diet has a therapeutic effect on glycemic control among patients with type 2 diabetes [33257645]. The ketogenic diet has been shown to improve glycemic control, reduce body weight, and decrease the need for antidiabetic medications [19368291, 34448957, 16318637]. Studies have consistently demonstrated that a ketogenic diet can lead to significant reductions in HbA1c levels, with some studies showing decreases of up to 1.5% in just 24 weeks [31185843]. In contrast, metformin typically reduces HbA1c levels by approximately 0.95-1.12% over a period of several months [22275444]. Additionally, the ketogenic diet has been shown to reduce blood pressure and increase insulin sensitivity, all of which can contribute to better overall health outcomes for individuals with type 2 diabetes [34448957, 35969209].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The study found that the ketogenic diet significantly contributed to glycemic control, but it does not directly compare its effectiveness to metformin in lowering A1c levels [33257645].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33257645", "evidence_support": "KD not only has a therapeutic effect on glycemic and lipid control among patients with T2DM but also significantly contributes to their weight loss.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "A more accurate statement would be: A ketogenic diet has a therapeutic effect on glycemic control among patients with type 2 diabetes [33257645].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33257645", "evidence_support": "KD not only has a therapeutic effect on glycemic and lipid control among patients with T2DM but also significantly contributes to their weight loss.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The ketogenic diet has been shown to improve glycemic control, reduce body weight, and decrease the need for antidiabetic medications [19368291, 34448957, 16318637].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19368291", "evidence_support": "It is also necessary to emphasize that as well as the weight loss, ketogenic diets are healthier because they promote a non-atherogenic lipid profile, lower blood pressure and diminish resistance to insulin with an improvement in blood levels of glucose and insulin", "evidence_relation": "supporting" }, { "cited_pmid": "34448957", "evidence_support": "KD results in improved HbA1c already after 3 weeks, and the effect seems to persist for at least 1 year.", "evidence_relation": "supporting" }, { "cited_pmid": "16318637", "evidence_support": "The low-carbohydrate, ketogenic diet (LCKD) may be effective for improving glycemia and reducing medications in patients with type 2 diabetes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Studies have consistently demonstrated that a ketogenic diet can lead to significant reductions in HbA1c levels, with some studies showing decreases of up to 1.5% in just 24 weeks [31185843].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31185843", "evidence_support": "In many analysed studies, KD led to significant weight loss and had beneficial effects on lipoprotein profile and insulin resistance. In half of the comparative studies with T2DM, the KD lead to signifiantly greater reductions in HbA1c-levels (HbA1c difference: -0.5 to -1.5 %) compared to reference diets (HbA1c difference: +0.2 to -0.5 %).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In contrast, metformin typically reduces HbA1c levels by approximately 0.95-1.12% over a period of several months [22275444].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22275444", "evidence_support": "Metformin monotherapy lowered HbA(1c) by 1.12% (95% CI 0.92-1.32; I(2) = 80%) versus placebo, metformin added to oral therapy lowered HbA(1c) by 0.95% (0.77-1.13; I(2) = 77%) versus placebo added to oral therapy, and metformin added to insulin therapy lowered HbA(1c) by 0.60% (0.30-0.91; I(2) = 79.8%) versus insulin only.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Additionally, the ketogenic diet has been shown to reduce blood pressure and increase insulin sensitivity, all of which can contribute to better overall health outcomes for individuals with type 2 diabetes [34448957, 35969209].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34448957", "evidence_support": "KD results in improved HbA1c already after 3 weeks, and the effect seems to persist for at least 1 year.", "evidence_relation": "supporting" }, { "cited_pmid": "35969209", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "The ketogenic diet may improve lipid profiles but showed no additional benefits for glycaemic control or weight loss compared to control diets in type 2 diabetes patients [38006799]. The ketogenic diet has been shown to improve glycemic control, reduce body weight, and decrease the need for antidiabetic medications [16685046, 33443451, 34448957]. Studies have consistently demonstrated that a ketogenic diet can lead to significant reductions in HbA1c levels, with some studies showing decreases in just 90 days [36064937, 31485454]. In contrast, metformin typically reduces HbA1c levels by approximately 0.6-1.12% over a period of several months [24604630, 22275444, 36786075]. Additionally, the ketogenic diet has been shown to improve lipid profiles, reduce blood pressure, improve glucose homeostasis and increase insulin sensitivity, all of which can contribute to overall health benefits for individuals with type 2 diabetes [19368291, 38006799, 20427477]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The ketogenic diet may improve lipid profiles but showed no additional benefits for glycaemic control or weight loss compared to control diets in type 2 diabetes patients [38006799].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "38006799", "evidence_support": "The ketogenic diet may improve lipid profiles but showed no additional benefits for glycaemic control or weight loss compared to control diets in type 2 diabetes patients over two years.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The ketogenic diet has been shown to improve glycemic control, reduce body weight, and decrease the need for antidiabetic medications [16685046, 33443451, 34448957].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16685046", "evidence_support": "Low-carbohydrate diets may promote greater weight loss than does the conventional low-fat, high-carbohydrate diet.", "evidence_relation": "supporting" }, { "cited_pmid": "16685046", "evidence_support": "KLC and NLC diets were equally effective in reducing body weight and insulin resistance, but the KLC diet was associated with several adverse metabolic and emotional effects.", "evidence_relation": "supporting" }, { "cited_pmid": "33443451", "evidence_support": "Taken together, the data suggest that KD has beneficial effects on BW, BMI, FM, FFM, LBM, WC, VAT, and PBF.", "evidence_relation": "supporting" }, { "cited_pmid": "34448957", "evidence_support": "KD results in improved HbA1c already after 3 weeks, and the effect seems to persist for at least 1 year. This is associated with a reduction in glucose-lowering medications.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Studies have consistently demonstrated that a ketogenic diet can lead to significant reductions in HbA1c levels, with some studies showing decreases in just 90 days [36064937, 31485454].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36064937", "evidence_support": "A VLC/KD may cause reductions in HbA1c and triglycerides in those with pre-diabetes or T2D but evidence of an advantage over other strategies is limited.", "evidence_relation": "supporting" }, { "cited_pmid": "31485454", "evidence_support": "Because low-carbohydrate diets are effective strategies to improve insulin resistance, the hallmark of type 2 diabetes, the purpose of reporting these clinical cases was to reveal the meaningful changes observed in 90 days of low-carbohydrate (LC) ketogenic dietary intervention in female type 2 diabetics aged 18-45.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In contrast, metformin typically reduces HbA1c levels by approximately 0.6-1.12% over a period of several months [24604630, 22275444, 36786075].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24604630", "evidence_support": "Metformin decreased the GA/HbA1c ratio in patients with newly diagnosed type 2 diabetes.", "evidence_relation": "supporting" }, { "cited_pmid": "22275444", "evidence_support": "Evidence supports the effectiveness of metformin therapy in a clinically important lowering of HbA(1c) used as monotherapy and in combination with other therapeutic agents.", "evidence_relation": "supporting" }, { "cited_pmid": "36786075", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, the ketogenic diet has been shown to improve lipid profiles, reduce blood pressure, improve glucose homeostasis and increase insulin sensitivity, all of which can contribute to overall health benefits for individuals with type 2 diabetes [19368291, 38006799, 20427477].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19368291", "evidence_support": "It is also necessary to emphasize that as well as the weight loss, ketogenic diets are healthier because they promote a non-atherogenic lipid profile, lower blood pressure and diminish resistance to insulin with an improvement in blood levels of glucose and insulin.", "evidence_relation": "supporting" }, { "cited_pmid": "38006799", "evidence_support": "The ketogenic diet may improve lipid profiles but showed no additional benefits for glycaemic control or weight loss compared to control diets in type 2 diabetes patients over two years.", "evidence_relation": "contradicting" }, { "cited_pmid": "20427477", "evidence_support": "are frequently implemented in efforts to reduce or maintain body weight, although the metabolic effects of long-term exposure to this type of diet remain controversial. This study assessed the responsivity to peripheral and central insulin, glucose tolerance, and meal-induced effects of consuming a KD in the rat. After 8 wk of consuming chow or KD, caloric intake after peripheral or central insulin and insulin and glucose levels after a glucose challenge were assessed. In a separate group of rats, glucose and insulin responses to either a low- or high-carbohydrate test meal w", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "A VLC/KD may cause reductions in HbA1c and triglycerides in those with pre-diabetes or T2D but evidence of an advantage over other strategies is limited [36064937]. The ketogenic diet has been shown to improve glycemic control, reduce body weight, and decrease the need for antidiabetic medications [33163300, 34448957, 33257645]. Studies have consistently demonstrated that a ketogenic diet can lead to significant reductions in HbA1c levels, with some studies showing decreases in just 90 days [31485454, 31185843]. In contrast, metformin typically reduces HbA1c levels by 1-2% over a period of several months [28332301, 24604630, 36786075]. Additionally, the ketogenic diet has been shown to improve lipid profiles, reduce blood pressure, and increase insulin sensitivity, all of which can contribute to better overall health outcomes for individuals with type 2 diabetes [35794438, 38006799]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A VLC/KD may cause reductions in HbA1c and triglycerides in those with pre-diabetes or T2D but evidence of an advantage over other strategies is limited [36064937].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36064937", "evidence_support": "Very low carbohydrate/ketogenic diets (VLC/KDs) are popular but their role in managing pre-diabetes and type 2 diabetes (T2D) is uncertain.", "evidence_relation": "supporting" }, { "cited_pmid": "36064937", "evidence_support": "A VLC/KD may cause reductions in HbA1c and triglycerides in those with pre-diabetes or T2D but evidence of an advantage over other strategies is limited. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The ketogenic diet has been shown to improve glycemic control, reduce body weight, and decrease the need for antidiabetic medications [33163300, 34448957, 33257645].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33163300", "evidence_support": "The findings of this review show a significant effect of the ketogenic diet as compared to controls in terms of weight reduction, glycemic control, and improved lipid profile.", "evidence_relation": "supporting" }, { "cited_pmid": "34448957", "evidence_support": "KD results in improved HbA1c already after 3 weeks, and the effect seems to persist for at least 1 year. This is associated with a reduction in glucose-lowering medications. The weight loss observed after a short time period seems to be maintained with a long-term diet", "evidence_relation": "supporting" }, { "cited_pmid": "33257645", "evidence_support": "KD not only has a therapeutic effect on glycemic and lipid control among patients with T2DM but also significantly contributes to their weight loss.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Studies have consistently demonstrated that a ketogenic diet can lead to significant reductions in HbA1c levels, with some studies showing decreases in just 90 days [31485454, 31185843].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31185843", "evidence_support": "In half of the comparative studies with T2DM, the KD lead to signifiantly greater reductions in HbA1c-levels (HbA1c difference: -0.5 to -1.5 %) compared to reference diets (HbA1c difference: +0.2 to -0.5 %)", "evidence_relation": "supporting" }, { "cited_pmid": "31485454", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In contrast, metformin typically reduces HbA1c levels by 1-2% over a period of several months [28332301, 24604630, 36786075].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28332301", "evidence_support": "However, HbA1c levels were lower in the liraglutide- and metformin-treated groups than in the gliclazide-treated group, and reductions in IHF content were greater with liraglutide than with gliclazide", "evidence_relation": "supporting" }, { "cited_pmid": "24604630", "evidence_support": "HbA1c decreased significantly from 9.0 \u00b1 2.1% at baseline to 6.5 \u00b1 0.9% at week 24,", "evidence_relation": "supporting" }, { "cited_pmid": "24604630", "evidence_support": "Metformin decreased the GA/HbA1c ratio in patients with newly diagnosed type 2 diabetes. This suggests that metformin improves postprandial hyperglycaemia in patients with newly diagnosed type 2 diabetes", "evidence_relation": "supporting" }, { "cited_pmid": "36786075", "evidence_support": "According to their glycosylated haemoglobin (HbA1c) levels, the patients were divided into two groups: responders (HbA1c levels were reduced by at least 1% after 6\u00a0months of metformin treatment.) and non-responders.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, the ketogenic diet has been shown to improve lipid profiles, reduce blood pressure, and increase insulin sensitivity, all of which can contribute to better overall health outcomes for individuals with type 2 diabetes [35794438, 38006799].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35794438", "evidence_support": "VLC/KDs contribute to greater weight loss in the short term (<\u20096\u00a0months) compared to higher carbohydrate diets, but there is typically no difference between the diets by 12\u00a0months. Triglyceride and high-density lipoprotein cholesterol levels generally improve, but there is a variable response in low-density lipoprotein cholesterol levels, with some individuals experiencing a dramatic increase, particularly those with latent genetic dyslipidemias.", "evidence_relation": "supporting" }, { "cited_pmid": "38006799", "evidence_support": "The ketogenic diet may improve lipid profiles but showed no additional benefits for glycaemic control or weight loss compared to control diets in type 2 diabetes patients over two years.", "evidence_relation": "contradicting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "In adults with type 2 diabetes, both metformin and a ketogenic diet (KD) have been shown to effectively lower HbA1c levels, but their mechanisms and additional benefits differ.Metformin is widely recommended as the first-line treatment due to its efficacy, safety profile, and ability to reduce mortality and complications [33970588, 23690375]. It typically lowers HbA1c by approximately 1% [23690375]. Conversely, a KD has demonstrated significant reductions in HbA1c, often greater than those achieved with standard diets, and can also lead to substantial weight loss and improved lipid profiles [34448957, 35800806, 33163300]. For instance, a systematic review found that KD significantly reduced HbA1c and body weight compared to control diets [35800806]. However, KD requires strict adherence and medical supervision to ensure safety and effectiveness [34448957]. While both options are effective, the choice may depend on patient-specific factors, including the ability to adhere to dietary restrictions and the presence of comorbidities.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In adults with type 2 diabetes, both metformin and a ketogenic diet (KD) have been shown to effectively lower HbA1c levels, but their mechanisms and additional benefits differ.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Metformin is widely recommended as the first-line treatment due to its efficacy, safety profile, and ability to reduce mortality and complications [33970588, 23690375].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33970588", "evidence_support": "Metformin should be used as a first-line treatment in all patients with type 2 diabetes unless contraindicated.", "evidence_relation": "supporting" }, { "cited_pmid": "23690375", "evidence_support": "Metformin is the first-line treatment for patients with diabetes because it reduces mortality rates.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "It typically lowers HbA1c by approximately 1% [23690375].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23690375", "evidence_support": "These drugs are equally effective for glucose control, lowering A1c by approximately 1%.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Conversely, a KD has demonstrated significant reductions in HbA1c, often greater than those achieved with standard diets, and can also lead to substantial weight loss and improved lipid profiles [34448957, 35800806, 33163300].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34448957", "evidence_support": "KD results in improved HbA1c already after 3 weeks, and the effect seems to persist for at least 1 year.", "evidence_relation": "supporting" }, { "cited_pmid": "35800806", "evidence_support": "he results obtained by conducting a meta-analysis showed that low-carbohydrates had a greater reduction in the HbA1c than other diets (standardized mean difference [SMD]: -0.27%; 95% CI; -0.60%, 0.07%: P = 0.008, I2 = 66%). Similarly, a significant decrease in HbA1c percentage was recorded in patients that consumed KDs compared to those who consumed the control diets (SMD: -1.45%; 95% CI; -2.73%, -0.17%: P < 0.00001).", "evidence_relation": "supporting" }, { "cited_pmid": "33163300", "evidence_support": "Results The findings of this review show a significant effect of the ketogenic diet as compared to controls in terms of weight reduction, glycemic control, and improved lipid profile. A noticeable improvement was seen in glycated hemoglobin (HbA1c) and in high-density lipoprotein (HDL), favoring the ketogenic diet as compared to control.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "For instance, a systematic review found that KD significantly reduced HbA1c and body weight compared to control diets [35800806].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35800806", "evidence_support": "Therefore, we can summarize that the KD is a more effective dietary therapy", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "However, KD requires strict adherence and medical supervision to ensure safety and effectiveness [34448957].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34448957", "evidence_support": "Adequate support (supportive psychological counseling, enhancing positive affectivity, reinforcing mindful eating) is necessary to achieve a benefit and to assure adherence.", "evidence_relation": "supporting" }, { "cited_pmid": "34448957", "evidence_support": "KD should be performed under strict medical supervision.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "While both options are effective, the choice may depend on patient-specific factors, including the ability to adhere to dietary restrictions and the presence of comorbidities.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "In adults with type 2 diabetes, both metformin and a ketogenic diet can effectively lower HbA1c levels, but their mechanisms and suitability vary.Metformin, a first-line pharmacological treatment, primarily reduces hepatic glucose production and improves insulin sensitivity, typically lowering HbA1c by 1-2%.It is well-studied, generally safe, and has cardiovascular benefits.A ketogenic diet, characterized by very low carbohydrate intake, can also significantly reduce HbA1c by promoting weight loss and improving insulin sensitivity, with some studies showing reductions comparable to or greater than metformin.However, adherence to a ketogenic diet can be challenging, and long-term safety data are limited.The choice between metformin and a ketogenic diet should consider patient preferences, potential side effects, comorbidities, and the ability to maintain dietary changes.Combining both approaches may offer synergistic benefits, but this requires careful monitoring and individualized patient management.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In adults with type 2 diabetes, both metformin and a ketogenic diet can effectively lower HbA1c levels, but their mechanisms and suitability vary.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Metformin, a first-line pharmacological treatment, primarily reduces hepatic glucose production and improves insulin sensitivity, typically lowering HbA1c by 1-2%.It is well-studied, generally safe, and has cardiovascular benefits.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "A ketogenic diet, characterized by very low carbohydrate intake, can also significantly reduce HbA1c by promoting weight loss and improving insulin sensitivity, with some studies showing reductions comparable to or greater than metformin.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "However, adherence to a ketogenic diet can be challenging, and long-term safety data are limited.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "The choice between metformin and a ketogenic diet should consider patient preferences, potential side effects, comorbidities, and the ability to maintain dietary changes.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Combining both approaches may offer synergistic benefits, but this requires careful monitoring and individualized patient management.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "For an adult with type 2 diabetes, a ketogenic diet may be a more effective option to lower A1c levels compared to metformin, as it has been shown to improve glycemic control and reduce A1c levels in several studies [32641437, 34448957, 35800806]. A systematic review and meta-analysis of randomized controlled trials found that a ketogenic diet resulted in a significant reduction in A1c levels, with a mean difference of -1.45% compared to control diets [35800806]. Additionally, a meta-analysis of clinical trials found that a ketogenic diet was superior to controls in terms of glycemic control and lipid profile improvements [33163300]. In contrast, metformin is typically associated with a reduction in A1c levels of approximately 1% [33970588, 23690375]. However, it is essential to note that metformin is generally recommended as a first-line treatment for type 2 diabetes due to its efficacy, safety profile, and cost-effectiveness [26132124, 18630062].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "For an adult with type 2 diabetes, a ketogenic diet may be a more effective option to lower A1c levels compared to metformin, as it has been shown to improve glycemic control and reduce A1c levels in several studies [32641437, 34448957, 35800806].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32641437", "evidence_support": "Within 4 months of transitioning to KD, combined with IF, she achieved glycaemic control off pharmacotherapy, with HbA1c of 6.4.", "evidence_relation": "supporting" }, { "cited_pmid": "34448957", "evidence_support": "KD results in improved HbA1c already after 3 weeks, and the effect seems to persist for at least 1 year.", "evidence_relation": "supporting" }, { "cited_pmid": "35800806", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "A systematic review and meta-analysis of randomized controlled trials found that a ketogenic diet resulted in a significant reduction in A1c levels, with a mean difference of -1.45% compared to control diets [35800806].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35800806", "evidence_support": "The results obtained by conducting a meta-analysis showed that low-carbohydrates had a greater reduction in the HbA1c than other diets (standardized mean difference [SMD]: -0.27%; 95% CI; -0.60%, 0.07%: P = 0.008, I2 = 66%). Similarly, a significant decrease in HbA1c percentage was recorded in patients that consumed KDs compared to those who consumed the control diets (SMD: -1.45%; 95% CI; -2.73%, -0.17%: P < 0.00001).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, a meta-analysis of clinical trials found that a ketogenic diet was superior to controls in terms of glycemic control and lipid profile improvements [33163300].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33163300", "evidence_support": "This review concludes that the ketogenic diet is superior to controls in terms of glycemic control and lipid profile improvements, and the results are significant enough to recommend it as an adjunctive treatment for type two diabetes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In contrast, metformin is typically associated with a reduction in A1c levels of approximately 1% [33970588, 23690375].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23690375", "evidence_support": "These drugs are equally effective for glucose control, lowering A1c by approximately 1%.", "evidence_relation": "supporting" }, { "cited_pmid": "33970588", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "However, it is essential to note that metformin is generally recommended as a first-line treatment for type 2 diabetes due to its efficacy, safety profile, and cost-effectiveness [26132124, 18630062].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26132124", "evidence_support": "Patients should be treated initially with metformin because it is the only medication shown in randomized controlled trials to reduce mortality and complications", "evidence_relation": "supporting" }, { "cited_pmid": "18630062", "evidence_support": "Metformin is the best first option at present due to its efficacy, its neutral effect on weight, its security profile and its cost. In addition, metformin can be ass", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash": { "answer": "Both metformin and ketogenic diets have shown promise in managing type 2 diabetes and lowering HbA1c levels. Metformin is a commonly prescribed medication for type 2 diabetes, and its effectiveness in lowering HbA1c levels is well-established [32641437]. Ketogenic diets, which involve a high-fat, low-carbohydrate intake, have also been shown to improve glycemic control in individuals with type 2 diabetes [32641437]. However, the optimal approach for an individual with type 2 diabetes depends on various factors, including their overall health, lifestyle, and preferences. It is crucial to consult with a healthcare professional to determine the most appropriate treatment plan, which may involve a combination of medication, dietary modifications, and lifestyle changes. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Both metformin and ketogenic diets have shown promise in managing type 2 diabetes and lowering HbA1c levels.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Metformin is a commonly prescribed medication for type 2 diabetes, and its effectiveness in lowering HbA1c levels is well-established [32641437].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32641437", "evidence_support": "This case demonstrates the effective and sustainable use of intermittent fasting (IF) and ketogenic diet (KD) in a normal weight patient with type 2 diabetes, who did not attain glycaemic control with a standard care approach.", "evidence_relation": "neutral" }, { "cited_pmid": "32641437", "evidence_support": "A 57-year-old woman with type 2 diabetes treated with metformin and strict adherence to a standard diabetic diet presented with a haemoglobin A1c (HbA1c) of 9.3%.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Ketogenic diets, which involve a high-fat, low-carbohydrate intake, have also been shown to improve glycemic control in individuals with type 2 diabetes [32641437].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32641437", "evidence_support": "This case demonstrates the effective and sustainable use of intermittent fasting (IF) and ketogenic diet (KD) in a normal weight patient with type 2 diabetes, who did not attain glycaemic control with a standard care approach.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, the optimal approach for an individual with type 2 diabetes depends on various factors, including their overall health, lifestyle, and preferences.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "It is crucial to consult with a healthcare professional to determine the most appropriate treatment plan, which may involve a combination of medication, dietary modifications, and lifestyle changes.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Both metformin and the ketogenic diet have shown effectiveness in managing blood glucose levels in individuals with type 2 diabetes. Metformin, a commonly prescribed medication, works by reducing glucose production in the liver and improving insulin sensitivity [PMID1, PMID2]. The ketogenic diet, a high-fat, low-carbohydrate diet, promotes ketosis, a metabolic state where the body primarily uses fat for energy, leading to reduced blood glucose levels [PMID3, PMID4]. The optimal approach for managing blood glucose levels in type 2 diabetes depends on individual factors, such as severity of the condition, presence of other health issues, and personal preferences. Consulting with a healthcare professional is crucial to determine the most appropriate treatment plan. \n", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Both metformin and the ketogenic diet have shown effectiveness in managing blood glucose levels in individuals with type 2 diabetes.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Metformin, a commonly prescribed medication, works by reducing glucose production in the liver and improving insulin sensitivity", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "[PMID1, PMID2].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "The ketogenic diet, a high-fat, low-carbohydrate diet, promotes ketosis, a metabolic state where the body primarily uses fat for energy, leading to reduced blood glucose levels [PMID3, PMID4].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "The optimal approach for managing blood glucose levels in type 2 diabetes depends on individual factors, such as severity of the condition, presence of other health issues, and personal preferences.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Consulting with a healthcare professional is crucial to determine the most appropriate treatment plan.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "ten-shot-gpt4o-mini": { "answer": "In adults with type 2 diabetes, both metformin and a ketogenic diet (KD) can effectively lower HbA1c levels, but their effectiveness may vary based on individual circumstances. Metformin is a common first-line medication that can help reduce HbA1c levels; however, some patients may not achieve optimal control with it alone, as seen in a case where a patient had an HbA1c of 9.3% while on metformin [32641437]. On the other hand, a ketogenic diet has shown promising results, with individuals achieving significant glycemic control and reductions in HbA1c, such as a patient reaching an HbA1c of 6.4% after transitioning to a KD [32641437]. Additionally, structured low-carbohydrate diets can facilitate weight loss and improve glycemic control, particularly in those with higher baseline HbA1c levels [36297093]. Therefore, the choice between metformin and a ketogenic diet should be personalized based on individual health parameters and preferences.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In adults with type 2 diabetes, both metformin and a ketogenic diet (KD) can effectively lower HbA1c levels, but their effectiveness may vary based on individual circumstances.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Metformin is a common first-line medication that can help reduce HbA1c levels; however, some patients may not achieve optimal control with it alone, as seen in a case where a patient had an HbA1c of 9.3% while on metformin [32641437].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32641437", "evidence_support": "A 57-year-old woman with type 2 diabetes treated with metformin and strict adherence to a standard diabetic diet presented with a haemoglobin A1c (HbA1c) of 9.3%.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "On the other hand, a ketogenic diet has shown promising results, with individuals achieving significant glycemic control and reductions in HbA1c, such as a patient reaching an HbA1c of 6.4% after transitioning to a KD [32641437].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32641437", "evidence_support": "This case demonstrates the effective and sustainable use of intermittent fasting (IF) and ketogenic diet (KD) in a normal weight patient with type 2 diabetes, who did not attain glycaemic control with a standard care approach. A 57-year-old woman with type 2 diabetes treated with metformin and strict adherence to a standard diabetic diet presented with a haemoglobin A1c (HbA1c) of 9.3%. Within 4 months of transitioning to KD, combined with IF, she achieved glycaemic control off pharmacotherapy, with HbA1c of 6.4", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, structured low-carbohydrate diets can facilitate weight loss and improve glycemic control, particularly in those with higher baseline HbA1c levels [36297093].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36297093", "evidence_support": "A health care professional delivered low-carbohydrate diet program can facilitate weight loss and improve glycaemic control with greatest improvements and clinical relevance in individuals with worse baseline parameters.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Therefore, the choice between metformin and a ketogenic diet should be personalized based on individual health parameters and preferences.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "In adults with type 2 diabetes, a ketogenic diet (KD) may be more effective than metformin for lowering hemoglobin A1c (HbA1c) levels. One study reported that a patient transitioning to a KD achieved significant glycemic control, reducing her HbA1c from 9.3% to 6.4% within four months without pharmacotherapy [32641437]. Additionally, a low-carbohydrate diet program has been shown to facilitate weight loss and improve glycemic control, particularly in individuals with higher baseline HbA1c levels [36297093]. In contrast, while metformin is effective, its impact on HbA1c may not be as pronounced as that of a KD, especially for those with more severe diabetes [36297093]. Therefore, for better HbA1c management, a ketogenic diet could be a superior option for some patients.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In adults with type 2 diabetes, a ketogenic diet (KD) may be more effective than metformin for lowering hemoglobin A1c (HbA1c) levels.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "One study reported that a patient transitioning to a KD achieved significant glycemic control, reducing her HbA1c from 9.3% to 6.4% within four months without pharmacotherapy [32641437].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "32641437", "evidence_support": "Within 4 months of transitioning to KD, combined with IF, she achieved glycaemic control off pharmacotherapy, with HbA1c of 6.4.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, a low-carbohydrate diet program has been shown to facilitate weight loss and improve glycemic control, particularly in individuals with higher baseline HbA1c levels [36297093].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36297093", "evidence_support": "A health care professional delivered low-carbohydrate diet program can facilitate weight loss and improve glycaemic control with greatest improvements and clinical relevance in individuals with worse baseline parameters.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In contrast, while metformin is effective, its impact on HbA1c may not be as pronounced as that of a KD, especially for those with more severe diabetes [36297093].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36297093", "evidence_support": "HbA1c reduced from 6.0 \u00b1 1.2 to 5.6 \u00b1 0.7% (n = 212, p < 0.001). For members with a commencing HbA1c of <5.7% (n = 110), 5.7\u22126.4% (n = 55), and \u22656.5% (n = 48), HbA1c reduced \u22120.1 \u00b1 0.2%, \u22120.3 \u00b1 0.3%, and \u22121.4 \u00b1 1.3%, respectively. For members with a commencing HbA1c \u22656.5%, 90% experienced a HbA1c reduction and 54% achieved a final HbA1c < 6.5%.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Therefore, for better HbA1c management, a ketogenic diet could be a superior option for some patients.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-1": { "answer": "The context does not provide a direct comparison between metformin and ketogenic diet in an adult with type 2 diabetes. However, it is mentioned that both low-carbohydrate and ketogenic diets can reduce blood glucose and improve glucose tolerance and insulin sensitivity [33838492].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The context does not provide a direct comparison between metformin and ketogenic diet in an adult with type 2 diabetes.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "However, it is mentioned that both low-carbohydrate and ketogenic diets can reduce blood glucose and improve glucose tolerance and insulin sensitivity [33838492].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "33838492", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-2": { "answer": "The context does not provide information about the effectiveness of metformin or ketogenic diet in adults with type 2 diabetes to lower a1c levels [14747212].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The context does not provide information about the effectiveness of metformin or ketogenic diet in adults with type 2 diabetes to lower a1c levels [14747212].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "14747212", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-3": { "answer": "The given context does not provide enough information to compare the effectiveness of metformin and a ketogenic diet in lowering A1C levels in an adult with type 2 diabetes. The context only discusses the effectiveness of a ketogenic diet in improving insulin sensitivity in individuals with Type 2 Diabetes, but it does not provide.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The given context does not provide enough information to compare the effectiveness of metformin and a ketogenic diet in lowering A1C levels in an adult with type 2 diabetes.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "The context only discusses the effectiveness of a ketogenic diet in improving insulin sensitivity in individuals with Type 2 Diabetes, but it does not provide.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-5": { "answer": "The given context does not provide enough information to compare the effectiveness of metformin and a ketogenic diet in lowering A1C levels in an adult with type 2 diabetes. The context only discusses the effectiveness of a ketogenic diet in improving insulin sensitivity in individuals with Type 2 Diabetes, but it does not provide.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The given context does not provide enough information to compare the effectiveness of metformin and a ketogenic diet in lowering A1C levels in an adult with type 2 diabetes.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "The context only discusses the effectiveness of a ketogenic diet in improving insulin sensitivity in individuals with Type 2 Diabetes, but it does not provide.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-gpt-1": { "answer": "In an adult with type 2 diabetes, metformin is generally considered the first-line medication for lowering A1C levels due to its established efficacy and safety profile. While a ketogenic diet may also help some individuals achieve lower A1C levels through weight loss and improved insulin sensitivity, metformin is typically more effective for most patients in managing blood glucose levels. Therefore, metformin would likely be the most effective option.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In an adult with type 2 diabetes, metformin is generally considered the first-line medication for lowering A1C levels due to its established efficacy and safety profile.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "While a ketogenic diet may also help some individuals achieve lower A1C levels through weight loss and improved insulin sensitivity, metformin is typically more effective for most patients in managing blood glucose levels.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Therefore, metformin would likely be the most effective option.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "In adults with type 2 diabetes, a ketogenic diet may be more effective than metformin for lowering A1c levels, particularly for those who do not achieve glycemic control with standard care. Evidence suggests that a ketogenic diet can improve insulin sensitivity and may provide sustainable results when combined with exercise [35469570]. However, individual responses can vary, and it is essential to consider personalized treatment plans.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In adults with type 2 diabetes, a ketogenic diet may be more effective than metformin for lowering A1c levels, particularly for those who do not achieve glycemic control with standard care.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Evidence suggests that a ketogenic diet can improve insulin sensitivity and may provide sustainable results when combined with exercise [35469570].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35469570", "evidence_support": "It was hypothesized that a ketogenic diet is effective in improving insulin sensitivity in individuals with Type 2 Diabetes, with the greatest effect resulting from a ketogenic diet paired with exercise.", "evidence_relation": "supporting" }, { "cited_pmid": "35469570", "evidence_support": "Every trial utilizing a ketogenic diet showed marked improvement in glycemic control among participants in support of the hypothesis.", "evidence_relation": "supporting" }, { "cited_pmid": "35469570", "evidence_support": "ketogenic diet consistently demonstrates improved glycemic control in Type 2 Diabetics, and in those at risk of Type 2 Diabetes.", "evidence_relation": "supporting" }, { "cited_pmid": "35469570", "evidence_support": "In addition, there were very few studies found when researching that paired a ketogenic diet with exercise to study both the effect on glycemic control, as well as avoiding potential hepatic steatosis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, individual responses can vary, and it is essential to consider personalized treatment plans.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-gpt-6": { "answer": "In adults with type 2 diabetes, a ketogenic diet may be an effective option for improving insulin sensitivity and lowering A1C levels [35469570,16318637]. While metformin is a standard first-line medication for managing blood glucose levels, the ketogenic diet has shown promise as a low-carbohydrate approach that can also aid in glycemic control [35469570,16318637,32641437]. Therefore, both options can be beneficial, but the ketogenic diet may provide additional metabolic advantages in certain individuals.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In adults with type 2 diabetes, a ketogenic diet may be an effective option for improving insulin sensitivity and lowering A1C levels [35469570,16318637].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35469570", "evidence_support": "It was hypothesized that a ketogenic diet is effective in improving insulin sensitivity in individuals with Type 2 Diabetes, with the greatest effect resulting from a ketogenic diet paired with exercise.", "evidence_relation": "supporting" }, { "cited_pmid": "16318637", "evidence_support": "The LCKD improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "While metformin is a standard first-line medication for managing blood glucose levels, the ketogenic diet has shown promise as a low-carbohydrate approach that can also aid in glycemic control [35469570,16318637,32641437].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35469570", "evidence_support": "A ketogenic diet consistently demonstrates improved glycemic control in Type 2 Diabetics, and in those at risk of Type 2 Diabetes", "evidence_relation": "supporting" }, { "cited_pmid": "16318637", "evidence_support": "The LCKD improved glycemic control in patients with type 2 diabetes such that diabetes medications were discontinued or reduced in most participants", "evidence_relation": "supporting" }, { "cited_pmid": "32641437", "evidence_support": "This case demonstrates the effective and sustainable use of intermittent fasting (IF) and ketogenic diet (KD) in a normal weight patient with type 2 diabetes, who did not attain glycaemic control with a standard care approach.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Therefore, both options can be beneficial, but the ketogenic diet may provide additional metabolic advantages in certain individuals.", "answer_sentence_relevance": "borderline", "citation_assessment": null } ] }, "zero-shot-gemini-flash": { "answer": "Metformin and ketogenic diets have both been shown to be effective in lowering A1c levels in patients with type 2 diabetes. [16318637, 10566564, 12915642] Metformin is often the first-line treatment for type 2 diabetes due to its effectiveness in reducing mortality rates and improving cardiovascular outcomes. [23690375, 17065668] Ketogenic diets (LCKD) have also been shown to improve glycemic control in patients with type 2 diabetes, leading to medication discontinuation or reduction in most participants. [16318637] However, due to the potential for significant blood glucose lowering, patients on diabetes medication who use LCKD should be under close medical supervision. [16318637] Ultimately, the most effective option for lowering A1c levels will depend on the individual patient's needs and preferences, and should be determined in consultation with a healthcare professional. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Metformin and ketogenic diets have both been shown to be effective in lowering A1c levels in patients with type 2 diabetes.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "[16318637, 10566564, 12915642] Metformin is often the first-line treatment for type 2 diabetes due to its effectiveness in reducing mortality rates and improving cardiovascular outcomes.", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16318637", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "10566564", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "12915642", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "[23690375, 17065668] Ketogenic diets (LCKD) have also been shown to improve glycemic control in patients with type 2 diabetes, leading to medication discontinuation or reduction in most participants.", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23690375", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "17065668", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "[16318637] However, due to the potential for significant blood glucose lowering, patients on diabetes medication who use LCKD should be under close medical supervision.", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "16318637", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Ultimately, the most effective option for lowering A1c levels will depend on the individual patient's needs and preferences, and should be determined in consultation with a healthcare professional.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "zero-shot-gpt4o-mini": { "answer": "In adults with type 2 diabetes, both metformin and a ketogenic diet (KD) can effectively lower HbA1c levels, but their efficacy may vary. A ketogenic diet has shown significant results; for instance, one patient achieved an HbA1c of 6.4% after transitioning to a KD without pharmacotherapy [32641437]. Another study reported a woman reducing her HbA1c from 8.9% to 5.4% after adopting a low-carbohydrate diet combined with metformin and exercise [18309535]. Additionally, a low-carbohydrate diet can lead to substantial improvements in glycemic control, especially in individuals with higher baseline HbA1c levels [36297093]. While metformin is effective, the KD may provide more pronounced benefits in some cases, particularly when combined with lifestyle changes [34017786, 18309535]. Thus, the choice between metformin and a ketogenic diet may depend on individual circumstances and preferences.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "In adults with type 2 diabetes, both metformin and a ketogenic diet (KD) can effectively lower HbA1c levels, but their efficacy may vary.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "A ketogenic diet has shown significant results; for instance, one patient achieved an HbA1c of 6.4% after transitioning to a KD without pharmacotherapy [32641437].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32641437", "evidence_support": "Within 4 months of transitioning to KD, combined with IF, she achieved glycaemic control off pharmacotherapy, with HbA1c of 6.4. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Another study reported a woman reducing her HbA1c from 8.9% to 5.4% after adopting a low-carbohydrate diet combined with metformin and exercise [18309535].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18309535", "evidence_support": "Her low carbohydrate diet was continued, endurance exercise was included, medication with metformin was started and during 8 months she was off insulin and showed much lower blood sugar values than before.", "evidence_relation": "supporting" }, { "cited_pmid": "18309535", "evidence_support": "Her HbA1c value has been reduced from 8.9 to 5.4% and her total/HDL cholesterol ratio has been reduced from 5.4 to 1.7. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, a low-carbohydrate diet can lead to substantial improvements in glycemic control, especially in individuals with higher baseline HbA1c levels [36297093].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36297093", "evidence_support": "A health care professional delivered low-carbohydrate diet program can facilitate weight loss and improve glycaemic control with greatest improvements and clinical relevance in individuals with worse baseline parameters.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "While metformin is effective, the KD may provide more pronounced benefits in some cases, particularly when combined with lifestyle changes [34017786, 18309535].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34017786", "evidence_support": "Fifty-six years old male type 2 diabetes patient with fasting blood sugar (FBS) 414 mg/d and hemoglobin A1c (HbA1c) 10.7% tried low carbohydrate diet (LCD) 30 days. After the diet, his FBS decreased to 174 mg/d and HbA1c was 7.7%.", "evidence_relation": "supporting" }, { "cited_pmid": "18309535", "evidence_support": "With a low carbohydrate diet and exercise this woman no longer has diabetes or severe overweight. It is our opinion that many patients with type 2 diabetes can manage without medication (especially insulin) by reducing the intake of carbohydrates considerably.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Thus, the choice between metformin and a ketogenic diet may depend on individual circumstances and preferences.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] } } }, { "question_id": "138", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "The safety of using Sudafed after Afrin for nasal congestion primarily depends on understanding the potential interactions between these medications. While both medications are used to relieve nasal congestion, they work through different mechanisms. Afrin (oxymetazoline) is a topical nasal decongestant that works by constricting blood vessels in the nasal passages, while Sudafed (pseudoephedrine) is an oral decongestant that reduces swelling and congestion by shrinking blood vessels throughout the body. However, combining them could increase the risk of side effects such as increased blood pressure, anxiety, or heart palpitations, especially in patients with underlying cardiovascular conditions. Therefore, it is advisable to consult a healthcare provider before using both medications together [15376472].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The safety of using Sudafed after Afrin for nasal congestion primarily depends on understanding the potential interactions between these medications.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "While both medications are used to relieve nasal congestion, they work through different mechanisms.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Afrin (oxymetazoline) is a topical nasal decongestant that works by constricting blood vessels in the nasal passages, while Sudafed (pseudoephedrine) is an oral decongestant that reduces swelling and congestion by shrinking blood vessels throughout the body.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "However, combining them could increase the risk of side effects such as increased blood pressure, anxiety, or heart palpitations, especially in patients with underlying cardiovascular conditions.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Therefore, it is advisable to consult a healthcare provider before using both medications together [15376472].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15376472", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "You can use Sudafed after using Afrin for nasal congestion, but caution is advised [34607935, 20463825]. Sudafed contains pseudoephedrine, an oral decongestant, while Afrin contains oxymetazoline, a topical nasal decongestant [15236629, 34607935, 16218514]. Overuse of nasal decongestants like oxymetazoline can cause rhinitis medicamentosa, which is rebound nasal congestion [16784007, 23375990, 32628388]. Therefore, oxymetazoline should be limited to 3-7 days of use [32628388, 17323712, 35712651]. Combining pseudoephedrine and oxymetazoline can increase side effects, including cardiovascular and neurological risks associated with pseudoephedrine [34607935, 25532441, 25024716]. Oxymetazoline is effective for short-term relief, but prolonged use can lead to complications [32242436, 34607935, 17323712]. Consulting a doctor before combining these medications is essential to manage potential risks [34607935]. Using both medications together may provide relief but requires careful monitoring to avoid adverse effects [34607935, 20463825].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "You can use Sudafed after using Afrin for nasal congestion, but caution is advised [34607935, 20463825].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20463825", "evidence_support": "Topical decongestants reduce congestion associated with allergic rhinitis, but local adverse effects make them unsuitable for long-term use. Oral decongestants show some efficacy against congestion in allergic rhinitis and the common cold, and can be combined with oral antihistamines.", "evidence_relation": "neutral" }, { "cited_pmid": "34607935", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Sudafed contains pseudoephedrine, an oral decongestant, while Afrin contains oxymetazoline, a topical nasal decongestant [15236629, 34607935, 16218514].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15236629", "evidence_support": "In a double-blind, randomized, placebo-controlled design, 48 adults with acute coryza received a single oral dose of 60 mg pseudoephedrine (Sudafed; Pfizer Consumer HealthCare Group, Caringbah, NSW, Australia) or matching placebo", "evidence_relation": "neutral" }, { "cited_pmid": "15236629", "evidence_support": "Pseudoephedrine produced a significant decrease in NAR (P = 0.005; 95% confidence interval (CI) 0.073, 0.383). Nasal volume increased, but this did not reach significance (P = 0.07; 95% CI -0.842, 0.034). There was no change in MCA and symptoms. 4. In conclusion, pseudoephedrine has a moderate effect in decreasing objective measures of nasal congestion in coryza", "evidence_relation": "neutral" }, { "cited_pmid": "34607935", "evidence_support": "The over-the-counter nasal decongestant oxymetazoline (eg, Afrin) is used in the pediatric population for a variety of conditions in the operating room setting", "evidence_relation": "neutral" }, { "cited_pmid": "16218514", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Overuse of nasal decongestants like oxymetazoline can cause rhinitis medicamentosa, which is rebound nasal congestion [16784007, 23375990, 32628388].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16784007", "evidence_support": "Rhinitis medicamentosa (RM) is a condition induced by overuse of nasal decongestants.", "evidence_relation": "supporting" }, { "cited_pmid": "23375990", "evidence_support": "The review of the literature conducted by the task force studied in detail the concepts of \"rebound congestion\" and \"rhinitis medicamentosa\" often reported in a context of misuse, particularly of topical nasal decongestants.", "evidence_relation": "supporting" }, { "cited_pmid": "32628388", "evidence_support": "The most common rebound nasal congestion associated with the use of topical decongestants.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Therefore, oxymetazoline should be limited to 3-7 days of use [32628388, 17323712, 35712651].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "32628388", "evidence_support": "In most cases, the duration of the use of vasoconstrictor drugs should be limited to 5-7 days, according to Patient information leaflets for the drugs", "evidence_relation": "supporting" }, { "cited_pmid": "32628388", "evidence_support": "However, in patients who have had a history of episodes of rebound nasal congestion, which develops including the previously indicated periods, the duration of decongestant therapy should be limited to 3 days", "evidence_relation": "supporting" }, { "cited_pmid": "17323712", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "35712651", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Combining pseudoephedrine and oxymetazoline can increase side effects, including cardiovascular and neurological risks associated with pseudoephedrine [34607935, 25532441, 25024716].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34607935", "evidence_support": "Given its vasoconstrictive properties, it can have cardiovascular adverse effects when systemically absorbed. There have been several reports of cardiac and respiratory complications related to use of oxymetazoline in the pediatric population.", "evidence_relation": "supporting" }, { "cited_pmid": "25532441", "evidence_support": "Furthermore, due to unpredictable severe cardiovascular and neurological adverse events that may occur even at low dose and in the absence of any pre-existing pathology, they should not be prescribed for the common cold, and ENT physicians must carefully weigh the risk/benefit ratio in patients with allergic rhinitis", "evidence_relation": "neutral" }, { "cited_pmid": "25024716", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Oxymetazoline is effective for short-term relief, but prolonged use can lead to complications [32242436, 34607935, 17323712].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "34607935", "evidence_support": "Given its vasoconstrictive properties, it can have cardiovascular adverse effects when systemically absorbed. There have been several reports of cardiac and respiratory complications related to use of oxymetazoline in the pediatric population", "evidence_relation": "supporting" }, { "cited_pmid": "34607935", "evidence_support": "Current US Food and Drug Administration approval for oxymetazoline is for patients \u22656 years of age, but medical professionals may elect to use it short-term and off label for younger children in particular clinical scenarios in which the potential benefit may outweigh risks (eg, active bleeding, acute respiratory distress from nasal obstruction, acute complicated sinusitis, improved surgical visualization, nasal decongestion for scope examination, other conditions, etc)", "evidence_relation": "supporting" }, { "cited_pmid": "17323712", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "32242436", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Consulting a doctor before combining these medications is essential to manage potential risks [34607935].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34607935", "evidence_support": "Current US Food and Drug Administration approval for oxymetazoline is for patients \u22656 years of age, but medical professionals may elect to use it short-term and off label for younger children in particular clinical scenarios in which the potential benefit may outweigh risks (eg, active bleeding, acute respiratory distress from nasal obstruction, acute complicated sinusitis, improved surgical visualization, nasal decongestion for scope examination, other conditions, etc).", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Using both medications together may provide relief but requires careful monitoring to avoid adverse effects [34607935, 20463825].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "20463825", "evidence_support": "Topical decongestants reduce congestion associated with allergic rhinitis, but local adverse effects make them unsuitable for long-term use. Oral decongestants show some efficacy against congestion in allergic rhinitis and the common cold, and can be combined with oral antihistamines.", "evidence_relation": "supporting" }, { "cited_pmid": "34607935", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Using Sudafed (pseudoephedrine) after Afrin (oxymetazoline) for nasal congestion can be considered, but caution is advised due to the risk of rhinitis medicamentosa (RM) from overuse of nasal decongestants [16784007, 32628388]. Afrin, a topical decongestant, provides rapid relief but should not be used for more than 3-7 days to avoid rebound congestion [32628388, 29785414]. Sudafed, an oral decongestant, can be used as an alternative to avoid the local adverse effects associated with prolonged use of topical agents [20463825, 17323712]. However, combining these medications should be done under medical supervision to manage potential systemic side effects and avoid exacerbating RM [16784007, 23375990]. If nasal congestion persists, intranasal corticosteroids may be considered for long-term management [20463825]. Always ensure that the cumulative dose and duration of decongestant use are within safe limits to prevent adverse effects [16784007, 32628388].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Using Sudafed (pseudoephedrine) after Afrin (oxymetazoline) for nasal congestion can be considered, but caution is advised due to the risk of rhinitis medicamentosa (RM) from overuse of nasal decongestants [16784007, 32628388].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16784007", "evidence_support": "The term RM, also called rebound or chemical rhinitis, is also used to describe the adverse nasal congestion that develops after using medications other than topical decongestants.", "evidence_relation": "supporting" }, { "cited_pmid": "32628388", "evidence_support": "The most common rebound nasal congestion associated with the use of topical decongestants.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Afrin, a topical decongestant, provides rapid relief but should not be used for more than 3-7 days to avoid rebound congestion [32628388, 29785414].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32628388", "evidence_support": "To prevent the development of rebound nasal congestion caused by topical decongestants, it is important to limit the frequency of their use. In most cases, the duration of the use of vasoconstrictor drugs should be limited to 5-7 days, according to Patient information leaflets for the drugs", "evidence_relation": "supporting" }, { "cited_pmid": "29785414", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Sudafed, an oral decongestant, can be used as an alternative to avoid the local adverse effects associated with prolonged use of topical agents [20463825, 17323712].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20463825", "evidence_support": "Topical decongestants reduce congestion associated with allergic rhinitis, but local adverse effects make them unsuitable for long-term use. Oral decongestants show some efficacy against congestion in allergic rhinitis and the common cold, and can be combined with oral antihistamines.", "evidence_relation": "supporting" }, { "cited_pmid": "17323712", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, combining these medications should be done under medical supervision to manage potential systemic side effects and avoid exacerbating RM [16784007, 23375990].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16784007", "evidence_support": "The term RM, also called rebound or chemical rhinitis, is also used to describe the adverse nasal congestion that develops after using medications other than topical decongestants", "evidence_relation": "neutral" }, { "cited_pmid": "16784007", "evidence_support": "Since the cumulative dose of nasal decongestants or time period needed to initiate RM has not been conclusively determined, these medications should only be used for the shortest period necessary", "evidence_relation": "supporting" }, { "cited_pmid": "23375990", "evidence_support": "These products, very effective to rapidly improve nasal congestion, are sometimes available over the counter and can be the subject of misuse, which is difficult to control. The Soci\u00e9t\u00e9 Fran\u00e7aise d'ORL has recently issued guidelines concerning the use of these decongestants in the doctor's office and the operating room", "evidence_relation": "supporting" }, { "cited_pmid": "23375990", "evidence_support": "The review of the literature conducted by the task force studied in detail the concepts of \"rebound congestion\" and \"rhinitis medicamentosa\" often reported in a context of misuse, particularly of topical nasal decongestants.", "evidence_relation": "neutral" }, { "cited_pmid": "23375990", "evidence_support": "The task force explained the rebound congestion observed after stopping nasal decongestant treatment by return of the nasal congestion induced by rhinosinusitis and rejected the concept of rhinitis medicamentosa in the absence of scientific evidence from patients with rhinosinusitis.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "If nasal congestion persists, intranasal corticosteroids may be considered for long-term management [20463825].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20463825", "evidence_support": "Intranasal corticosteroids have broad anti-inflammatory activities, are the most potent long-term pharmacologic treatment of congestion associated with allergic rhinitis, and show some congestion relief in rhinosinusitis and nasal polyposis. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Always ensure that the cumulative dose and duration of decongestant use are within safe limits to prevent adverse effects [16784007, 32628388].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16784007", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "32628388", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Using Sudafed after Afrin for nasal congestion is not recommended due to the risk of rebound congestion, also known as rhinitis medicamentosa [16784007, 23375990, 32628388]. Afrin, which contains oxymetazoline, is a topical nasal decongestant that can cause rebound congestion with prolonged use [16784007, 32628388]. Sudafed, which contains pseudoephedrine, is an oral decongestant that can also contribute to rebound congestion [16784007, 23375990]. The combination of both medications may increase the risk of developing rhinitis medicamentosa, a condition characterized by chronic nasal congestion and inflammation [16784007, 32628388]. It is recommended to limit the use of topical nasal decongestants like Afrin to 3-5 days and to avoid using oral decongestants like Sudafed after using Afrin to minimize the risk of rebound congestion [16784007, 32628388]. If nasal congestion persists, alternative treatments such as intranasal corticosteroids or antihistamines may be considered [20463825].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Using Sudafed after Afrin for nasal congestion is not recommended due to the risk of rebound congestion, also known as rhinitis medicamentosa [16784007, 23375990, 32628388].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16784007", "evidence_support": "Rhinitis medicamentosa (RM) is a condition induced by overuse of nasal decongestants. The term RM, also called rebound or chemical rhinitis, is also used to describe the adverse nasal congestion that develops after using medications other than topical decongestants.", "evidence_relation": "supporting" }, { "cited_pmid": "23375990", "evidence_support": "The task force explained the rebound congestion observed after stopping nasal decongestant treatment by return of the nasal congestion induced by rhinosinusitis and rejected the concept of rhinitis medicamentosa in the absence of scientific evidence from patients with rhinosinusitis.", "evidence_relation": "contradicting" }, { "cited_pmid": "32628388", "evidence_support": "The most common rebound nasal congestion associated with the use of topical decongestants. Excessive use of intranasal decongestants leads to a decrease in the number of alpha-adrenoreceptors on the surface of cell membranes and uncoupling their connection with the G-protein and the development of tachyphylaxis. To prevent the development of rebound nasal congestion caused by topical decongestants, it is important to limit the frequency of their use", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Afrin, which contains oxymetazoline, is a topical nasal decongestant that can cause rebound congestion with prolonged use [16784007, 32628388].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16784007", "evidence_support": "Rhinitis medicamentosa (RM) is a condition induced by overuse of nasal decongestants. The term RM, also called rebound or chemical rhinitis, is also used to describe the adverse nasal congestion that develops after using medications other than topical decongestants.", "evidence_relation": "neutral" }, { "cited_pmid": "32628388", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Sudafed, which contains pseudoephedrine, is an oral decongestant that can also contribute to rebound congestion [16784007, 23375990].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23375990", "evidence_support": "The task force explained the rebound congestion observed after stopping nasal decongestant treatment by return of the nasal congestion induced by rhinosinusitis and rejected the concept of rhinitis medicamentosa in the absence of scientific evidence from patients with rhinosinusitis.", "evidence_relation": "supporting" }, { "cited_pmid": "16784007", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The combination of both medications may increase the risk of developing rhinitis medicamentosa, a condition characterized by chronic nasal congestion and inflammation [16784007, 32628388].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16784007", "evidence_support": "Rhinitis medicamentosa (RM) is a condition induced by overuse of nasal decongestants. The term RM, also called rebound or chemical rhinitis, is also used to describe the adverse nasal congestion that develops after using medications other than topical decongestants.", "evidence_relation": "supporting" }, { "cited_pmid": "32628388", "evidence_support": "The most common rebound nasal congestion associated with the use of topical decongestants.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is recommended to limit the use of topical nasal decongestants like Afrin to 3-5 days and to avoid using oral decongestants like Sudafed after using Afrin to minimize the risk of rebound congestion [16784007, 32628388].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16784007", "evidence_support": "Since the cumulative dose of nasal decongestants or time period needed to initiate RM has not been conclusively determined, these medications should only be used for the shortest period necessary.", "evidence_relation": "supporting" }, { "cited_pmid": "32628388", "evidence_support": "In most cases, the duration of the use of vasoconstrictor drugs should be limited to 5-7 days, according to Patient information leaflets for the drugs. However, in patients who have had a history of episodes of rebound nasal congestion, which develops including the previously indicated periods, the duration of decongestant therapy should be limited to 3 days.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "If nasal congestion persists, alternative treatments such as intranasal corticosteroids or antihistamines may be considered [20463825].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "20463825", "evidence_support": "Intranasal corticosteroids have broad anti-inflammatory activities, are the most potent long-term pharmacologic treatment of congestion associated with allergic rhinitis, and show some congestion relief in rhinosinusitis and nasal polyposis", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "No answer was found for this question; however, here are some documents related to this topic: ['23375990', '15794071', '17253470'].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "No answer was found for this question; however, here are some documents related to this topic:", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "['23375990', '15794071', '17253470'].", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Taking Sudafed after using Afrin for nasal congestion is generally safe, but it's essential to be cautious due to the potential for rebound congestion [23375990, 17044805, 32628388]. Prolonged use of Afrin can lead to rebound congestion, a condition where the nasal passages become dependent on the medication to stay open [23375990, 32628388, 17044805]. Sudafed, which contains pseudoephedrine, can help relieve nasal congestion, but using it in combination with Afrin may increase the risk of rebound congestion [23375990, 32628388, 17044805]. To minimize this risk, it's recommended to limit the use of Afrin to 3-5 days and use Sudafed only as needed [15794071, 17044805, 32628388]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Taking Sudafed after using Afrin for nasal congestion is generally safe, but it's essential to be cautious due to the potential for rebound congestion [23375990, 17044805, 32628388].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23375990", "evidence_support": "The task force explained the rebound congestion observed after stopping nasal decongestant treatment by return of the nasal congestion induced by rhinosinusitis and rejected the concept of rhinitis medicamentosa in the absence of scientific evidence from patients with rhinosinusitis.", "evidence_relation": "supporting" }, { "cited_pmid": "32628388", "evidence_support": "One type of non-allergic non-infectious rhinitis is represented by a heterogeneous group of rhinitis medicamentosa, which can be divided into several pathogenetic types. The most common rebound nasal congestion associated with the use of topical decongestants.", "evidence_relation": "supporting" }, { "cited_pmid": "17044805", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Prolonged use of Afrin can lead to rebound congestion, a condition where the nasal passages become dependent on the medication to stay open [23375990, 32628388, 17044805].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23375990", "evidence_support": "No study has been able to distinguish between inflammatory lesions induced by chronic rhinosinusitis and lesions possibly related to the use of nasal decongestants.", "evidence_relation": "contradicting" }, { "cited_pmid": "23375990", "evidence_support": "The task force explained the rebound congestion observed after stopping nasal decongestant treatment by return of the nasal congestion induced by rhinosinusitis and rejected the concept of rhinitis medicamentosa in the absence of scientific evidence from patients with rhinosinusitis.", "evidence_relation": "contradicting" }, { "cited_pmid": "32628388", "evidence_support": "The most common rebound nasal congestion associated with the use of topical decongestants.", "evidence_relation": "supporting" }, { "cited_pmid": "17044805", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Sudafed, which contains pseudoephedrine, can help relieve nasal congestion, but using it in combination with Afrin may increase the risk of rebound congestion [23375990, 32628388, 17044805].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23375990", "evidence_support": "The task force explained the rebound congestion observed after stopping nasal decongestant treatment by return of the nasal congestion induced by rhinosinusitis and rejected the concept of rhinitis medicamentosa in the absence of scientific evidence from patients with rhinosinusitis", "evidence_relation": "contradicting" }, { "cited_pmid": "32628388", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "17044805", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "To minimize this risk, it's recommended to limit the use of Afrin to 3-5 days and use Sudafed only as needed [15794071, 17044805, 32628388].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32628388", "evidence_support": "To prevent the development of rebound nasal congestion caused by topical decongestants, it is important to limit the frequency of their use.", "evidence_relation": "supporting" }, { "cited_pmid": "32628388", "evidence_support": "However, in patients who have had a history of episodes of rebound nasal congestion, which develops including the previously indicated periods, the duration of decongestant therapy should be limited to 3 days.", "evidence_relation": "supporting" }, { "cited_pmid": "17044805", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15794071", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "No answer was found for this question; however, here are some documents related to this topic: ['15236629', '23375990', '15794071'].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "No answer was found for this question; however, here are some documents related to this topic:", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "['15236629', '23375990', '15794071'].", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "No answer was found for this question; however, here are some documents related to this topic: ['15236629', '23375990', '15794071'].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "No answer was found for this question; however, here are some documents related to this topic:", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "['15236629', '23375990', '15794071'].", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "No answer was found for this question; however, here are some documents related to this topic: ['15236629', '23375990', '15794071'].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "No answer was found for this question; however, here are some documents related to this topic:", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "['15236629', '23375990', '15794071'].", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "No answer was found for this question; however, here are some documents related to this topic: ['15236629', '23375990', '15794071'].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "No answer was found for this question; however, here are some documents related to this topic:", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "['15236629', '23375990', '15794071'].", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Afrin is a topical nasal decongestant that can cause rebound congestion with prolonged use, while Sudafed is an oral decongestant that can interact with other medications and have side effects such as insomnia [32628388, 24608651]. ", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Afrin is a topical nasal decongestant that can cause rebound congestion with prolonged use, while Sudafed is an oral decongestant that can interact with other medications and have side effects such as insomnia [32628388, 24608651].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "32628388", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "24608651", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "However, it is essential to follow the recommended dosage and usage guidelines for both medications to minimize potential side effects and interactions [19458202]. ", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "However, it is essential to follow the recommended dosage and usage guidelines for both medications to minimize potential side effects and interactions [19458202].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "19458202", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Afrin is a topical nasal decongestant that can cause rebound congestion with prolonged use, while Sudafed is an oral decongestant that can interact with other medications and have side effects such as insomnia [24608651, 32628388]. ", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Afrin is a topical nasal decongestant that can cause rebound congestion with prolonged use, while Sudafed is an oral decongestant that can interact with other medications and have side effects such as insomnia [24608651, 32628388].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "24608651", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "32628388", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Afrin is a topical nasal decongestant that can cause rebound congestion with prolonged use, while Sudafed is an oral decongestant that can interact with other medications and have side effects such as insomnia [37787170, 32628388]. ", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Afrin is a topical nasal decongestant that can cause rebound congestion with prolonged use, while Sudafed is an oral decongestant that can interact with other medications and have side effects such as insomnia [37787170, 32628388].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "37787170", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "32628388", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Using Sudafed (pseudoephedrine) after Afrin (oxymetazoline) for nasal congestion can be considered, but caution is advised due to potential adverse effects and the risk of rhinitis medicamentosa (RM).Afrin, a topical decongestant, provides rapid relief but should not be used for more than 3-7 days to avoid rebound congestion [32628388]. Sudafed, an oral decongestant, can be effective for nasal congestion but has variable efficacy and potential cardiovascular and neurological side effects [16218514, 25532441]. Combining these medications may enhance decongestive effects but increases the risk of adverse events, particularly in patients with cardiovascular conditions [25532441]. Therefore, it is crucial to limit the duration of Afrin use and monitor for any adverse reactions when transitioning to Sudafed [16218514, 32628388]. If symptoms persist, alternative treatments such as intranasal corticosteroids or antihistamine-decongestant combinations may be considered [20463825, 16450574].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Using Sudafed (pseudoephedrine) after Afrin (oxymetazoline) for nasal congestion can be considered, but caution is advised due to potential adverse effects and the risk of rhinitis medicamentosa (RM).Afrin, a topical decongestant, provides rapid relief but should not be used for more than 3-7 days to avoid rebound congestion [32628388].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32628388", "evidence_support": "To prevent the development of rebound nasal congestion caused by topical decongestants, it is important to limit the frequency of their use. In most cases, the duration of the use of vasoconstrictor drugs should be limited to 5-7 days, according to Patient information leaflets for the drugs.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Sudafed, an oral decongestant, can be effective for nasal congestion but has variable efficacy and potential cardiovascular and neurological side effects [16218514, 25532441].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "25532441", "evidence_support": "Furthermore, due to unpredictable severe cardiovascular and neurological adverse events that may occur even at low dose and in the absence of any pre-existing pathology, they should not be prescribed for the common cold, and ENT physicians must carefully weigh the risk/benefit ratio in patients with allergic rhinitis. ", "evidence_relation": "supporting" }, { "cited_pmid": "16218514", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Combining these medications may enhance decongestive effects but increases the risk of adverse events, particularly in patients with cardiovascular conditions [25532441].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25532441", "evidence_support": "Furthermore, due to unpredictable severe cardiovascular and neurological adverse events that may occur even at low dose and in the absence of any pre-existing pathology, they should not be prescribed for the common cold, and ENT physicians must carefully weigh the risk/benefit ratio in patients with allergic rhinitis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Therefore, it is crucial to limit the duration of Afrin use and monitor for any adverse reactions when transitioning to Sudafed [16218514, 32628388].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32628388", "evidence_support": "To prevent the development of rebound nasal congestion caused by topical decongestants, it is important to limit the frequency of their use.", "evidence_relation": "supporting" }, { "cited_pmid": "16218514", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "If symptoms persist, alternative treatments such as intranasal corticosteroids or antihistamine-decongestant combinations may be considered [20463825, 16450574].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "20463825", "evidence_support": "Intranasal corticosteroids have broad anti-inflammatory activities, are the most potent long-term pharmacologic treatment of congestion associated with allergic rhinitis, and show some congestion relief in rhinosinusitis and nasal polyposis.", "evidence_relation": "supporting" }, { "cited_pmid": "16450574", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Yes, Sudafed (pseudoephedrine) can be used after Afrin (oxymetazoline) for nasal congestion, but caution is advised.Afrin is a topical nasal decongestant that provides quick relief by constricting blood vessels in the nasal passages, but it should not be used for more than three consecutive days due to the risk of rebound congestion.Sudafed is an oral decongestant that works systemically to reduce nasal congestion.Using both can provide complementary relief, but combining them may increase the risk of side effects such as elevated blood pressure, increased heart rate, and potential central nervous system stimulation.It is crucial to monitor for these side effects, especially in patients with cardiovascular conditions.Always consider individual patient factors and consult clinical guidelines or a healthcare provider if uncertain.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yes, Sudafed (pseudoephedrine) can be used after Afrin (oxymetazoline) for nasal congestion, but caution is advised.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Afrin is a topical nasal decongestant that provides quick relief by constricting blood vessels in the nasal passages, but it should not be used for more than three consecutive days due to the risk of rebound congestion.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Sudafed is an oral decongestant that works systemically to reduce nasal congestion.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Using both can provide complementary relief, but combining them may increase the risk of side effects such as elevated blood pressure, increased heart rate, and potential central nervous system stimulation.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "It is crucial to monitor for these side effects, especially in patients with cardiovascular conditions.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Always consider individual patient factors and consult clinical guidelines or a healthcare provider if uncertain.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Using Sudafed after Afrin for nasal congestion may not be the most effective approach, as Sudafed's decongestant effect may be limited in comparison to Afrin [16218514]. Afrin, which contains oxymetazoline, is a potent topical decongestant that can provide rapid relief from nasal congestion [32242436]. However, its use should be limited to 3-5 days to avoid rebound congestion [32628388]. Sudafed, on the other hand, contains pseudoephedrine, which has been shown to have a less pronounced decongestant effect compared to xylometazoline [16218514]. Additionally, pseudoephedrine may not be as effective in relieving nasal congestion in patients with chronic sinusitis [16218514]. Therefore, if Afrin is used initially, it may be more effective to continue its use for a short period rather than switching to Sudafed [32242436]. However, it is essential to follow the recommended duration of use for Afrin to avoid rebound congestion [32628388].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Using Sudafed after Afrin for nasal congestion may not be the most effective approach, as Sudafed's decongestant effect may be limited in comparison to Afrin [16218514].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16218514", "evidence_support": "MRI clearly shows a clear cut superiority of xylometazoline over pseudoephedrine concerning decongestion of the nasal mucosa. However, there was no decongestive effect whatsoever on the mucosa of the sinuses with either sympathicomimetic", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Afrin, which contains oxymetazoline, is a potent topical decongestant that can provide rapid relief from nasal congestion [32242436].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "32242436", "evidence_support": "Because topical nasal decongestants provide rapid and dramatic relief from these symptoms, especially nasal congestion, they are frequently used and abused by patients", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, its use should be limited to 3-5 days to avoid rebound congestion [32628388].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32628388", "evidence_support": "To prevent the development of rebound nasal congestion caused by topical decongestants, it is important to limit the frequency of their use. In most cases, the duration of the use of vasoconstrictor drugs should be limited to 5-7 days", "evidence_relation": "contradicting" }, { "cited_pmid": "32628388", "evidence_support": "However, in patients who have had a history of episodes of rebound nasal congestion, which develops including the previously indicated periods, the duration of decongestant therapy should be limited to 3 days.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Sudafed, on the other hand, contains pseudoephedrine, which has been shown to have a less pronounced decongestant effect compared to xylometazoline [16218514].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "16218514", "evidence_support": "MRI clearly shows a clear cut superiority of xylometazoline over pseudoephedrine concerning decongestion of the nasal mucosa. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, pseudoephedrine may not be as effective in relieving nasal congestion in patients with chronic sinusitis [16218514].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16218514", "evidence_support": "Pseudoephedrine does not show a clear and long lasting decongestive effect on the turbinates.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Therefore, if Afrin is used initially, it may be more effective to continue its use for a short period rather than switching to Sudafed [32242436].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32242436", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "However, it is essential to follow the recommended duration of use for Afrin to avoid rebound congestion [32628388].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32628388", "evidence_support": "To prevent the development of rebound nasal congestion caused by topical decongestants, it is important to limit the frequency of their use. In most cases, the duration of the use of vasoconstrictor drugs should be limited to 5-7 days, according to Patient information leaflets for the drugs.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash": { "answer": "It is generally not recommended to use Sudafed (pseudoephedrine) after using Afrin (oxymetazoline) for nasal congestion. Afrin is a nasal decongestant that works by constricting blood vessels in the nose, reducing swelling and congestion [PMID1]. However, prolonged use of Afrin can lead to rebound congestion, where the nasal passages become even more congested when the medication wears off [PMID2]. This rebound congestion can be worsened by using Sudafed, which also constricts blood vessels [PMID3]. Therefore, it is best to consult a doctor or pharmacist before using Sudafed after Afrin to avoid potential complications.\n\n[PMID1, PMID2, PMID3] \n", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "It is generally not recommended to use Sudafed (pseudoephedrine) after using Afrin (oxymetazoline) for nasal congestion.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Afrin is a nasal decongestant that works by constricting blood vessels in the nose, reducing swelling and congestion [PMID1].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "However, prolonged use of Afrin can lead to rebound congestion, where the nasal passages become even more congested when the medication wears off [PMID2].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "This rebound congestion can be worsened by using Sudafed, which also constricts blood vessels", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "[PMID3].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Therefore, it is best to consult a doctor or pharmacist before using Sudafed after Afrin to avoid potential complications.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "[PMID1, PMID2, PMID3]", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "ten-shot-gemini-flash-wiki": { "answer": "It is generally not recommended to use Sudafed (pseudoephedrine) after using Afrin (oxymetazoline) for nasal congestion. Afrin is a nasal decongestant that works by constricting blood vessels in the nose, reducing swelling and improving airflow [PMID1, PMID2]. However, prolonged use of Afrin can lead to rebound congestion, where the nasal passages become even more congested when the medication wears off [PMID3]. This rebound congestion can be worsened by using Sudafed, which also constricts blood vessels [PMID4]. Therefore, it is best to avoid using Sudafed after using Afrin to prevent worsening rebound congestion.\n\n[PMID1, PMID2, PMID3, PMID4] \n", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "It is generally not recommended to use Sudafed (pseudoephedrine) after using Afrin (oxymetazoline) for nasal congestion.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Afrin is a nasal decongestant that works by constricting blood vessels in the nose, reducing swelling and improving airflow", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "[PMID1, PMID2].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "However, prolonged use of Afrin can lead to rebound congestion, where the nasal passages become even more congested when the medication wears off [PMID3].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "This rebound congestion can be worsened by using Sudafed, which also constricts blood vessels [PMID4].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Therefore, it is best to avoid using Sudafed after using Afrin to prevent worsening rebound congestion.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "[PMID1, PMID2, PMID3, PMID4]", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "ten-shot-gpt4o-mini": { "answer": "Using Sudafed (pseudoephedrine) after Afrin (oxymetazoline) can be safe, but caution is advised. Afrin is a topical decongestant that can cause rebound congestion if used for more than three consecutive days [PMID1]. Sudafed, an oral decongestant, works differently by constricting blood vessels to reduce swelling in the nasal passages [PMID2]. While there are no direct contraindications for using these medications together, it is essential to monitor for potential side effects such as increased blood pressure or heart rate, especially in individuals with pre-existing conditions [PMID3]. Always consult with a healthcare provider before combining medications to ensure safety and effectiveness tailored to your specific health needs.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Using Sudafed (pseudoephedrine) after Afrin (oxymetazoline) can be safe, but caution is advised.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Afrin is a topical decongestant that can cause rebound congestion if used for more than three consecutive days [PMID1].", "answer_sentence_relevance": "borderline", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Sudafed, an oral decongestant, works differently by constricting blood vessels to reduce swelling in the nasal passages [PMID2].", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "While there are no direct contraindications for using these medications together, it is essential to monitor for potential side effects such as increased blood pressure or heart rate, especially in individuals with pre-existing conditions [PMID3].", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Always consult with a healthcare provider before combining medications to ensure safety and effectiveness tailored to your specific health needs.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Using Sudafed (pseudoephedrine) after Afrin (oxymetazoline) can be safe, but caution is advised. Afrin is a topical decongestant that can cause rebound congestion if used for more than three consecutive days [PMID1]. Sudafed, an oral decongestant, works differently by reducing nasal swelling and congestion [PMID2]. However, combining these medications may increase the risk of side effects such as increased heart rate or blood pressure, especially in sensitive individuals [PMID3]. It is recommended to wait at least 12 hours after using Afrin before taking Sudafed to minimize potential interactions and side effects. Always consult with a healthcare provider for personalized advice based on your health status and medication history.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Using Sudafed (pseudoephedrine) after Afrin (oxymetazoline) can be safe, but caution is advised.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Afrin is a topical decongestant that can cause rebound congestion if used for more than three consecutive days [PMID1].", "answer_sentence_relevance": "borderline", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Sudafed, an oral decongestant, works differently by reducing nasal swelling and congestion [PMID2].", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "However, combining these medications may increase the risk of side effects such as increased heart rate or blood pressure, especially in sensitive individuals [PMID3].", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "It is recommended to wait at least 12 hours after using Afrin before taking Sudafed to minimize potential interactions and side effects.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Always consult with a healthcare provider for personalized advice based on your health status and medication history.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-1": { "answer": "The given context does not provide information about using Sudafed after using Afrin for nasal congestion. However, it is generally recommended to consult a healthcare professional before combining over-the-counter medications for nasal congestion.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The given context does not provide information about using Sudafed after using Afrin for nasal congestion.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "However, it is generally recommended to consult a healthcare professional before combining over-the-counter medications for nasal congestion.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-2": { "answer": "It is not recommended to use Sudafed after using Afrin for nasal congestion, as it can potentially lead to an overdose of decongestants and harmful effects [15236629].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "It is not recommended to use Sudafed after using Afrin for nasal congestion, as it can potentially lead to an overdose of decongestants and harmful effects [15236629].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15236629", "evidence_support": "In conclusion, pseudoephedrine has a moderate effect in decreasing objective measures of nasal congestion in coryza.", "evidence_relation": "neutral" } ] } ] }, "webis-3": { "answer": "It is not recommended to use Sudafed after using Afrin for nasal congestion as it can lead to rebound congestion .", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "It is not recommended to use Sudafed after using Afrin for nasal congestion as it can lead to rebound congestion .", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-5": { "answer": "It is not recommended to use Sudafed after using Afrin for nasal congestion as it can lead to rebound congestion .", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "It is not recommended to use Sudafed after using Afrin for nasal congestion as it can lead to rebound congestion .", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-1": { "answer": "It is generally advised to avoid using Sudafed (pseudoephedrine) immediately after using Afrin (oxymetazoline) for nasal congestion. Afrin is a topical decongestant that can cause rebound congestion if used for more than three consecutive days, while Sudafed is an oral decongestant that can increase blood pressure and may have interactions with other medications. It is best to consult a healthcare provider for personalized advice based on your specific situation.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "It is generally advised to avoid using Sudafed (pseudoephedrine) immediately after using Afrin (oxymetazoline) for nasal congestion.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Afrin is a topical decongestant that can cause rebound congestion if used for more than three consecutive days, while Sudafed is an oral decongestant that can increase blood pressure and may have interactions with other medications.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "It is best to consult a healthcare provider for personalized advice based on your specific situation.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "Yes, you can use Sudafed (pseudoephedrine) after using Afrin (oxymetazoline) for nasal congestion, but it is important to be cautious. Afrin is a topical decongestant that should not be used for more than three consecutive days to avoid rebound congestion, while Sudafed is an oral decongestant that can help alleviate nasal congestion symptoms. Combining these medications may provide additional relief, especially for patients with moderate-to-severe nasal congestion [20477610]. However, always consult with a healthcare provider before combining medications to ensure safety and efficacy.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yes, you can use Sudafed (pseudoephedrine) after using Afrin (oxymetazoline) for nasal congestion, but it is important to be cautious.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Afrin is a topical decongestant that should not be used for more than three consecutive days to avoid rebound congestion, while Sudafed is an oral decongestant that can help alleviate nasal congestion symptoms.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Combining these medications may provide additional relief, especially for patients with moderate-to-severe nasal congestion [20477610].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20477610", "evidence_support": "Administering desloratadine in combination with the decongestant pseudoephedrine may offer allergic rhinitis patients with moderate-to-severe nasal congestion the benefits of desloratadine's effectiveness for alleviating histamine-mediated symptoms plus pseudoephedrine's relief from nasal congestion.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "However, always consult with a healthcare provider before combining medications to ensure safety and efficacy.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-gpt-6": { "answer": "Using Sudafed after Afrin for nasal congestion is generally not recommended without a break in between. Afrin, a topical decongestant, can lead to rebound congestion if used for more than a few days, while Sudafed is an oral decongestant that may not effectively address the rebound effect caused by Afrin [23375990]. It is advisable to consult a healthcare provider for personalized recommendations based on your specific situation [23375990].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Using Sudafed after Afrin for nasal congestion is generally not recommended without a break in between.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Afrin, a topical decongestant, can lead to rebound congestion if used for more than a few days, while Sudafed is an oral decongestant that may not effectively address the rebound effect caused by Afrin [23375990].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23375990", "evidence_support": "The task force explained the rebound congestion observed after stopping nasal decongestant treatment by return of the nasal congestion induced by rhinosinusitis and rejected the concept of rhinitis medicamentosa in the absence of scientific evidence from patients with rhinosinusitis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "It is advisable to consult a healthcare provider for personalized recommendations based on your specific situation [23375990].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23375990", "evidence_support": "Systemic and topical nasal decongestants are widely used in otorhinolaryngology and general practice for the management of acute rhinosinusitis and as an adjuvant in certain forms of chronic rhinosinusitis.", "evidence_relation": "neutral" } ] } ] }, "zero-shot-gemini-flash": { "answer": "It is generally not recommended to use Sudafed after using Afrin for nasal congestion. Afrin is a nasal decongestant that works by constricting blood vessels in the nose, reducing swelling and congestion. However, prolonged use of Afrin can lead to rebound congestion, where the nasal passages become even more congested when the medication wears off. [PMID: 28408424] This rebound congestion can be worse than the original congestion and can make it difficult to breathe. [PMID: 28408424] Sudafed is also a nasal decongestant, and using it after Afrin could worsen the rebound congestion. [PMID: 28408424] It is important to consult with a healthcare professional before using any medications, especially if you are already taking other medications. [PMID: 28408424] \n", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "It is generally not recommended to use Sudafed after using Afrin for nasal congestion.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "10", "answer_sentence": "[PMID: 28408424]", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Afrin is a nasal decongestant that works by constricting blood vessels in the nose, reducing swelling and congestion.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "However, prolonged use of Afrin can lead to rebound congestion, where the nasal passages become even more congested when the medication wears off.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "[PMID: 28408424]", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "This rebound congestion can be worse than the original congestion and can make it difficult to breathe.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "[PMID: 28408424]", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "Sudafed is also a nasal decongestant, and using it after Afrin could worsen the rebound congestion.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "8", "answer_sentence": "[PMID: 28408424]", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "9", "answer_sentence": "It is important to consult with a healthcare professional before using any medications, especially if you are already taking other medications.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "zero-shot-gpt4o-mini": { "answer": "Using Sudafed (pseudoephedrine) after Afrin (oxymetazoline) can be safe, but caution is advised. Afrin is a topical decongestant that can lead to rebound congestion if used for more than three consecutive days [PMID1]. Sudafed, an oral decongestant, works differently by constricting blood vessels in the nasal passages [PMID2]. While there are no direct contraindications for using these medications together, it is essential to monitor for potential side effects, such as increased blood pressure or heart rate, especially in individuals with pre-existing conditions [PMID3]. Always consult a healthcare provider before combining medications to ensure safety and efficacy tailored to your specific health needs.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Using Sudafed (pseudoephedrine) after Afrin (oxymetazoline) can be safe, but caution is advised.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Afrin is a topical decongestant that can lead to rebound congestion if used for more than three consecutive days [PMID1].", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Sudafed, an oral decongestant, works differently by constricting blood vessels in the nasal passages [PMID2].", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "While there are no direct contraindications for using these medications together, it is essential to monitor for potential side effects, such as increased blood pressure or heart rate, especially in individuals with pre-existing conditions [PMID3].", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Always consult a healthcare provider before combining medications to ensure safety and efficacy tailored to your specific health needs.", "answer_sentence_relevance": "required", "citation_assessment": null } ] } } }, { "question_id": "139", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Untreated anorexia can lead to severe long-term consequences, including chronic malnutrition, osteoporosis, cardiovascular problems, reproductive issues like amenorrhea, and severe mental health challenges such as depression and anxiety. The physical and psychological effects of untreated anorexia can be life-threatening and significantly impair quality of life over time.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia can lead to severe long-term consequences, including chronic malnutrition, osteoporosis, cardiovascular problems, reproductive issues like amenorrhea, and severe mental health challenges such as depression and anxiety.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "The physical and psychological effects of untreated anorexia can be life-threatening and significantly impair quality of life over time.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Untreated anorexia nervosa significantly increases the risk of death and is associated with high mortality rates [23706279, 28581532, 19014869]. It can lead to severe medical complications, including cardiac issues, renal failure, and end-stage renal disease [23329707, 26138740, 23842978]. Osteoporosis and myocardial mass modification are common long-term outcomes, along with chronic undernutrition and long-term nutritional deficiencies [23706279, 18361276, 21360368]. Adolescents may experience short stature and severe developmental complications [18361276, 18574227, 31041816]. The disorder is linked to a high suicide rate and substantial social and psychological suffering, resulting in poor quality of life and severe disability [19014869, 26138740, 29105700]. Persistent illness and high relapse rates are frequent, even with treatment attempts [28581532, 19014869, 34777061]. Psychosocial complications and family burden are also notable consequences [31074662, 31041816, 36141668]. Overall, untreated anorexia nervosa leads to severe and multifaceted health issues, emphasizing the critical need for timely and effective intervention [23706279, 26138740, 29105700].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia nervosa significantly increases the risk of death and is associated with high mortality rates [23706279, 28581532, 19014869].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "Untreated AN is associated with a significant increase in the risk of death.", "evidence_relation": "supporting" }, { "cited_pmid": "28581532", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "19014869", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can lead to severe medical complications, including cardiac issues, renal failure, and end-stage renal disease [23329707, 26138740, 23842978].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23329707", "evidence_support": "Anorexia nervosa may be associated with several medical complications of varying severity, including dysfunction of the renal system.", "evidence_relation": "supporting" }, { "cited_pmid": "23842978", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "26138740", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Osteoporosis and myocardial mass modification are common long-term outcomes, along with chronic undernutrition and long-term nutritional deficiencies [23706279, 18361276, 21360368].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "The obsessive fear of weight gain, critically limited food intake and neuroendocrine aberrations characteristic of AN have both short- and long-term consequences for the reproductive, cardiovascular, gastrointestinal and skeletal systems.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "AN is related to a decrease in bone mass density, which can lead to osteopenia and osteoporosis and a significant increase in fracture risk in later life.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "It is reported that 80% of AN patients are affected by a cardiac complications such as sinus bradycardia, a prolonged QT interval on electrocardiography, arrythmias, myocardial mass modification and hypotension.", "evidence_relation": "supporting" }, { "cited_pmid": "18361276", "evidence_support": "Chronic undernutrition leads to main long-term medical complications of eating disorders: linear growth in adolescents with anorexia nervosa, infertility, and osteoporosis.", "evidence_relation": "supporting" }, { "cited_pmid": "21360368", "evidence_support": "Osteoporosis is common in anorexia nervosa. It places these patients at increased lifetime risk for fractures. Bone loss may never recover completely even once weight is restored.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Adolescents may experience short stature and severe developmental complications [18361276, 18574227, 31041816].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18361276", "evidence_support": "Chronic undernutrition leads to main long-term medical complications of eating disorders: linear growth in adolescents with anorexia nervosa, infertility, and osteoporosis.", "evidence_relation": "supporting" }, { "cited_pmid": "18574227", "evidence_support": "A second possible skeletal effect of teenage-onset anorexia nervosa is short stature. ", "evidence_relation": "supporting" }, { "cited_pmid": "18574227", "evidence_support": "Adolescent boys with anorexia nervosa are more likely than adolescent girls to have short stature, possibly because growth potential persists for two years longer in boys than in girls.", "evidence_relation": "supporting" }, { "cited_pmid": "31041816", "evidence_support": "The long-term prognosis is often poor, with severe developmental, medical and psychosocial complications, high rates of relapse and mortality. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The disorder is linked to a high suicide rate and substantial social and psychological suffering, resulting in poor quality of life and severe disability [19014869, 26138740, 29105700].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19014869", "evidence_support": "In AN, there are an almost 18-fold increase in mortality including a high suicide rate, chronic courses in approximately 20 per cent of the cases, and more than half of the patients showing either a complete or a partial eating disorder in combination with another psychiatric disorder or another psychiatric disorder without an eating disorder.", "evidence_relation": "supporting" }, { "cited_pmid": "26138740", "evidence_support": "Anorexia nervosa has the highest mortality rate of any psychiatric disorder.", "evidence_relation": "supporting" }, { "cited_pmid": "29105700", "evidence_support": "Eating disorders (and especially anorexia nervosa) are associated with severe disability, poor quality of life and high mortality rate.", "evidence_relation": "supporting" }, { "cited_pmid": "29105700", "evidence_support": "Anorexia nervosa ranks among the main causes of death among young women. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Persistent illness and high relapse rates are frequent, even with treatment attempts [28581532, 19014869, 34777061].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34777061", "evidence_support": "A minority will become chronic despite extensive treatment. These patients are treatment-resistant and may not necessarily benefit from usual treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "28581532", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "19014869", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Psychosocial complications and family burden are also notable consequences [31074662, 31041816, 36141668].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31074662", "evidence_support": "For many sufferers of anorexia nervosa, the time course is long, and the prospect of disability and family burden great.", "evidence_relation": "supporting" }, { "cited_pmid": "31041816", "evidence_support": "The long-term prognosis is often poor, with severe developmental, medical and psychosocial complications, high rates of relapse and mortality.", "evidence_relation": "supporting" }, { "cited_pmid": "36141668", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Overall, untreated anorexia nervosa leads to severe and multifaceted health issues, emphasizing the critical need for timely and effective intervention [23706279, 26138740, 29105700].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "The obsessive fear of weight gain, critically limited food intake and neuroendocrine aberrations characteristic of AN have both short- and long-term consequences for the reproductive, cardiovascular, gastrointestinal and skeletal systems.", "evidence_relation": "supporting" }, { "cited_pmid": "26138740", "evidence_support": "Every body system may be adversely affected by anorexia nervosa. Yet, remarkably, most of the medical complications of anorexia nervosa are treatable and reversible with optimal medical care, as part of a multidisciplinary team who are often involved in the care of these patients.", "evidence_relation": "supporting" }, { "cited_pmid": "29105700", "evidence_support": "Some patients with anorexia nervosa refuse treatments though presenting severe medical complications and having a high mortality risk. Hence the need to evaluate when it could be appropriate to prescribe a compulsory treatment in the more complex cases who refuse interventions, deemed necessary for them.", "evidence_relation": "supporting" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Untreated anorexia nervosa (AN) can lead to severe long-term outcomes, including a significantly increased risk of mortality, with an almost 18-fold increase in death rates, often due to medical complications and suicide [19014869]. Chronic undernutrition from AN results in critical medical issues such as osteoporosis, leading to a three- to seven-fold increased risk of fractures, particularly in the spine and femur [23706279, 37578122, 21360368]. Cardiovascular complications, including sinus bradycardia, prolonged QT interval, and hypotension, affect up to 80% of patients [23706279]. Additionally, untreated AN can cause persistent infertility, impaired growth in adolescents, and renal failure, sometimes necessitating dialysis [18361276, 23329707]. Psychiatric comorbidities, such as anxiety, depression, and substance abuse disorders, are prevalent and can persist even after partial recovery [28581532, 19014869]. Early detection and intervention are crucial to mitigate these severe long-term consequences [23706279, 21360368].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia nervosa (AN) can lead to severe long-term outcomes, including a significantly increased risk of mortality, with an almost 18-fold increase in death rates, often due to medical complications and suicide [19014869].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19014869", "evidence_support": "In AN, there are an almost 18-fold increase in mortality including a high suicide rate, chronic courses in approximately 20 per cent of the cases, and more than half of the patients showing either a complete or a partial eating disorder in combination with another psychiatric disorder or another psychiatric disorder without an eating disorder. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Chronic undernutrition from AN results in critical medical issues such as osteoporosis, leading to a three- to seven-fold increased risk of fractures, particularly in the spine and femur [23706279, 37578122, 21360368].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "AN is related to a decrease in bone mass density, which can lead to osteopenia and osteoporosis and a significant increase in fracture risk in later life.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "Reduced BMD may subsequently lead to a three- to seven-fold increased risk of spontaneous fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "37578122", "evidence_support": "We found no overall increased risk in males, but in both sexes we found a particularly high site-specific fracture risk in the spine and femur.", "evidence_relation": "supporting" }, { "cited_pmid": "21360368", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Cardiovascular complications, including sinus bradycardia, prolonged QT interval, and hypotension, affect up to 80% of patients [23706279].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "It is reported that 80% of AN patients are affected by a cardiac complications such as sinus bradycardia, a prolonged QT interval on electrocardiography, arrythmias, myocardial mass modification and hypotension.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, untreated AN can cause persistent infertility, impaired growth in adolescents, and renal failure, sometimes necessitating dialysis [18361276, 23329707].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18361276", "evidence_support": "Chronic undernutrition leads to main long-term medical complications of eating disorders: linear growth in adolescents with anorexia nervosa, infertility, and osteoporosis.", "evidence_relation": "supporting" }, { "cited_pmid": "23329707", "evidence_support": "Anorexia nervosa may be associated with several medical complications of varying severity, including dysfunction of the renal system. Though there are some reports of renal failure in patients with anorexia nervosa, few reports are available concerning patients who required maintenance dialysis.", "evidence_relation": "supporting" }, { "cited_pmid": "23329707", "evidence_support": "We report a case of a patient with long-term untreated anorexia nervosa-binge eating/purging type who started psychiatric treatment when in a life-threatening situation (renal failure requiring dialysis), with unsuccessful weight recovery while on dialysis and died of septicaemia. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Psychiatric comorbidities, such as anxiety, depression, and substance abuse disorders, are prevalent and can persist even after partial recovery [28581532, 19014869].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28581532", "evidence_support": "AN is associated with high risk of developing other psychiatric disorders during the patients' lifetime, even after recovery from AN (mainly: affective disorders, anxiety disorders, obsessive-compulsive disorders, substance abuse disorders).", "evidence_relation": "supporting" }, { "cited_pmid": "19014869", "evidence_support": "In AN, there are an almost 18-fold increase in mortality including a high suicide rate, chronic courses in approximately 20 per cent of the cases, and more than half of the patients showing either a complete or a partial eating disorder in combination with another psychiatric disorder or another psychiatric disorder without an eating disorder.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Early detection and intervention are crucial to mitigate these severe long-term consequences [23706279, 21360368].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "Better detection and sophisticated therapy should prevent the long-term consequences of this disorder. The aims of treatment are not only recovery but also prophylaxis and relief of the long-term effects of this disorder. Further investigations of the long-term disease risk are needed.", "evidence_relation": "supporting" }, { "cited_pmid": "21360368", "evidence_support": "Early diagnosis and treatment of anorexia nervosa are paramount to prevent initial weight loss and subsequent loss of bone.", "evidence_relation": "supporting" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Untreated anorexia nervosa can lead to severe long-term consequences, including a significant increase in the risk of death [23706279]. Chronic undernutrition can result in linear growth deficits in adolescents, infertility, and osteoporosis [18361276]. Additionally, anorexia nervosa is associated with a high risk of cardiac complications, such as sinus bradycardia, arrhythmias, and hypotension, which can be life-threatening [23706279]. Furthermore, bone loss may never recover completely even after weight restoration, leading to a three- to seven-fold increased risk of spontaneous fractures [23706279, 21360368]. The risk of fractures, particularly in the spine and femur, can persist even after recovery, with a 46% increased risk of any fracture up to 40 years after diagnosis [37578122]. Overall, the long-term outcomes of untreated anorexia nervosa are severe and can have a significant impact on an individual's quality of life and mortality risk.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia nervosa can lead to severe long-term consequences, including a significant increase in the risk of death [23706279].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "The obsessive fear of weight gain, critically limited food intake and neuroendocrine aberrations characteristic of AN have both short- and long-term consequences for the reproductive, cardiovascular, gastrointestinal and skeletal systems.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "Untreated AN is associated with a significant increase in the risk of death.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Chronic undernutrition can result in linear growth deficits in adolescents, infertility, and osteoporosis [18361276].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18361276", "evidence_support": "Chronic undernutrition leads to main long-term medical complications of eating disorders: linear growth in adolescents with anorexia nervosa, infertility, and osteoporosis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, anorexia nervosa is associated with a high risk of cardiac complications, such as sinus bradycardia, arrhythmias, and hypotension, which can be life-threatening [23706279].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "It is reported that 80% of AN patients are affected by a cardiac complications such as sinus bradycardia, a prolonged QT interval on electrocardiography, arrythmias, myocardial mass modification and hypotension.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, bone loss may never recover completely even after weight restoration, leading to a three- to seven-fold increased risk of spontaneous fractures [23706279, 21360368].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "A decrease in bone mineral density (BMD) is one of the most important medical consequences of AN. Reduced BMD may subsequently lead to a three- to seven-fold increased risk of spontaneous fractures. ", "evidence_relation": "supporting" }, { "cited_pmid": "21360368", "evidence_support": "Osteoporosis is common in anorexia nervosa. It places these patients at increased lifetime risk for fractures. Bone loss may never recover completely even once weight is restored. T", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The risk of fractures, particularly in the spine and femur, can persist even after recovery, with a 46% increased risk of any fracture up to 40 years after diagnosis [37578122].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37578122", "evidence_support": "In conclusion, we found that AN was associated with a 46% increased risk of any fracture up to 40\u2009years after diagnosis. We found no overall increased risk in males, but in both sexes we found a particularly high site-specific fracture risk in the spine and femur.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, the long-term outcomes of untreated anorexia nervosa are severe and can have a significant impact on an individual's quality of life and mortality risk.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "Untreated anorexia can lead to severe and long-lasting physical and psychological problems, including a high risk of mortality [26059633, 16885933, 22300749]. Some individuals may experience persistent negative effects on bone health, even after weight recovery [30819332]. A substantial proportion of individuals with anorexia nervosa may continue to suffer from eating disorders over time, and the risk of suicide is particularly pronounced [16885933, 23329707, 16231345]. In some cases, anorexia nervosa may be associated with severe medical complications, including dysfunction of the renal system, and may require maintenance dialysis [23329707]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia can lead to severe and long-lasting physical and psychological problems, including a high risk of mortality [26059633, 16885933, 22300749].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16885933", "evidence_support": "Finally, considering AN demographic characteristics, that is young female subjects in Westernized societies, mortality rate is confirmed to be dramatically high.", "evidence_relation": "supporting" }, { "cited_pmid": "22300749", "evidence_support": "Anorexia nervosa is a severe psychosomatic disease with somatic complications in the long-term course and a high mortality rate.", "evidence_relation": "supporting" }, { "cited_pmid": "26059633", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Some individuals may experience persistent negative effects on bone health, even after weight recovery [30819332].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30819332", "evidence_support": "We hypothesized that the long-term impact on bone health may persist even after normalization of body weight.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "A substantial proportion of individuals with anorexia nervosa may continue to suffer from eating disorders over time, and the risk of suicide is particularly pronounced [16885933, 23329707, 16231345].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16885933", "evidence_support": "Deaths due to suicide, AN-related and AN-unrelated diseases were 1.20, 3.07 and 0.98%, respectively.", "evidence_relation": "supporting" }, { "cited_pmid": "16231345", "evidence_support": "At the 12-year follow-up 19.0% had AN, 9.5% had bulimia nervosa-purging type (BN-P), 19.0% were classified as eating disorder not otherwise specified (EDNOS).", "evidence_relation": "neutral" }, { "cited_pmid": "23329707", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In some cases, anorexia nervosa may be associated with severe medical complications, including dysfunction of the renal system, and may require maintenance dialysis [23329707].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23329707", "evidence_support": "Anorexia nervosa may be associated with several medical complications of varying severity, including dysfunction of the renal system. Though there are some reports of renal failure in patients with anorexia nervosa, few reports are available concerning patients who required maintenance dialysis.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Untreated anorexia nervosa can lead to a range of long-term outcomes, including a significant increase in the risk of death, with a standardized mortality ratio of 4.37 for lifetime anorexia nervosa [23706279, 23771148, 28581532]. The condition can also lead to a range of physical complications, including osteoporosis, infertility, and heart problems, as well as psychiatric comorbidities such as depression and anxiety disorders [23706279, 18361276, 28581532]. In addition, untreated anorexia nervosa can result in a decrease in bone mass density, which can lead to a three- to seven-fold increased risk of spontaneous fractures [23706279, 30819332, 18361276]. Furthermore, the condition can also lead to a range of social and psychological problems, including difficulties in relationships, education, and employment [23706279, 18361276, 30764636]. In some cases, anorexia nervosa can also lead to a persistent eating disorder, with up to 20% of cases following an unremitting course despite many attempts at symptom-based treatments [23706279, 34777061, 35582333]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia nervosa can lead to a range of long-term outcomes, including a significant increase in the risk of death, with a standardized mortality ratio of 4.37 for lifetime anorexia nervosa [23706279, 23771148, 28581532].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "Untreated AN is associated with a significant increase in the risk of death.", "evidence_relation": "supporting" }, { "cited_pmid": "23771148", "evidence_support": "The standardized mortality ratio was 4.37 (95% CI=2.4-7.3) for lifetime anorexia nervosa and 2.33 (95% CI=0.3-8.4) for bulimia nervosa with no history of anorexia nervosa.", "evidence_relation": "supporting" }, { "cited_pmid": "28581532", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The condition can also lead to a range of physical complications, including osteoporosis, infertility, and heart problems, as well as psychiatric comorbidities such as depression and anxiety disorders [23706279, 18361276, 28581532].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "AN is related to a decrease in bone mass density, which can lead to osteopenia and osteoporosis and a significant increase in fracture risk in later life. ", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "The condition is associated with fertility problems, unplanned pregnancies and generally negative attitudes to pregnancy.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "It is reported that 80% of AN patients are affected by a cardiac complications such as sinus bradycardia, a prolonged QT interval on electrocardiography, arrythmias, myocardial mass modification and hypotension", "evidence_relation": "supporting" }, { "cited_pmid": "18361276", "evidence_support": "Chronic undernutrition leads to main long-term medical complications of eating disorders: linear growth in adolescents with anorexia nervosa, infertility, and osteop", "evidence_relation": "supporting" }, { "cited_pmid": "28581532", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In addition, untreated anorexia nervosa can result in a decrease in bone mass density, which can lead to a three- to seven-fold increased risk of spontaneous fractures [23706279, 30819332, 18361276].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "A decrease in bone mineral density (BMD) is one of the most important medical consequences of AN. Reduced BMD may subsequently lead to a three- to seven-fold increased risk of spontaneous fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "18361276", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "30819332", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, the condition can also lead to a range of social and psychological problems, including difficulties in relationships, education, and employment [23706279, 18361276, 30764636].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18361276", "evidence_support": "Eating disorders long-term evolution is good in 50% of cases, middle in 25% (recovery from eating disorders, but still psychological suffering) and bad in 25% of cases, with chronic eating disorders, anxious or depressive comorbid disorder, and bad consequences in social patients' life.", "evidence_relation": "neutral" }, { "cited_pmid": "30764636", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "23706279", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In some cases, anorexia nervosa can also lead to a persistent eating disorder, with up to 20% of cases following an unremitting course despite many attempts at symptom-based treatments [23706279, 34777061, 35582333].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34777061", "evidence_support": "Anorexia Nervosa (AN) is a severe eating disorder which typically develops in younger females. Many studies focus on this specific population, a majority of which will eventually partially or fully recover. A minority will become chronic despite extensive treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "35582333", "evidence_support": "Treatment failure and relapse are common after completing treatment, and a substantial proportion of patients develop severe and enduring AN.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Untreated anorexia can lead to severe long-term consequences, including osteoporosis, infertility, and increased risk of fractures [18361276, 23706279, 23760852]. Women with anorexia may experience complications during pregnancy, such as hyperemesis gravidarum, anemia, and obstetric complications [23706279]. Anorexia can also lead to cardiac complications, including sinus bradycardia, prolonged QT interval, arrhythmias, and hypotension [23706279]. In addition, anorexia can cause neuroendocrine changes, including impairment of gonadotropin-releasing hormone pulsatile secretion and changes in neuropeptide activity [23706279]. Untreated anorexia is associated with a significant increase in the risk of death [16231345, 15257758, 28581532]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia can lead to severe long-term consequences, including osteoporosis, infertility, and increased risk of fractures [18361276, 23706279, 23760852].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18361276", "evidence_support": "Chronic undernutrition leads to main long-term medical complications of eating disorders: linear growth in adolescents with anorexia nervosa, infertility, and osteoporosis. ", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "AN is related to a decrease in bone mass density, which can lead to osteopenia and osteoporosis and a significant increase in fracture risk in later life.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "The condition is associated with fertility problems, unplanned pregnancies and generally negative attitudes to pregnancy.", "evidence_relation": "neutral" }, { "cited_pmid": "23706279", "evidence_support": "A decrease in bone mineral density (BMD) is one of the most important medical consequences of AN. Reduced BMD may subsequently lead to a three- to seven-fold increased risk of spontaneous fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "Untreated AN is associated with a significant increase in the risk of death.", "evidence_relation": "supporting" }, { "cited_pmid": "23760852", "evidence_support": "Osteoporosis commonly occurs in patients with anorexia nervosa (AN) and is often irreversible even after weight restoration.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Women with anorexia may experience complications during pregnancy, such as hyperemesis gravidarum, anemia, and obstetric complications [23706279].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "During pregnancy, women with the condition have higher rates of hyperemesis gravidarum, anaemia and obstetric complications, as well as impaired weight gain and compromised intrauterine foetal growth.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Anorexia can also lead to cardiac complications, including sinus bradycardia, prolonged QT interval, arrhythmias, and hypotension [23706279].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "It is reported that 80% of AN patients are affected by a cardiac complications such as sinus bradycardia, a prolonged QT interval on electrocardiography, arrythmias, myocardial mass modification and hypotension.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In addition, anorexia can cause neuroendocrine changes, including impairment of gonadotropin-releasing hormone pulsatile secretion and changes in neuropeptide activity [23706279].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "Neuroendocrine changes include impairment of gonadotropin releasing-hormone (GnRH) pulsatile secretion and changes in neuropeptide activity at the hypothalamic level, which cause profound hypoestrogenism.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Untreated anorexia is associated with a significant increase in the risk of death [16231345, 15257758, 28581532].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16231345", "evidence_support": "Mortality was high and symptomatic recovery protracted.", "evidence_relation": "supporting" }, { "cited_pmid": "15257758", "evidence_support": "Among psychiatric disorders, anorexia nervosa has the highest mortality rate.", "evidence_relation": "supporting" }, { "cited_pmid": "28581532", "evidence_support": "The condition is associated with a high risk of chronic course and poor prognosis in terms of treatment and the risk of death.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Untreated anorexia can lead to severe long-term consequences, including osteoporosis, infertility, and increased risk of fractures [37578122, 23706279, 36109301]. Women with anorexia may experience complications during pregnancy, such as hyperemesis gravidarum, anemia, and obstetric complications [23706279, 35172902]. Anorexia can also lead to cardiac complications, including sinus bradycardia, prolonged QT interval, arrhythmias, and hypotension [23706279, 19646241, 21739848]. In addition, anorexia can cause neuroendocrine changes, including impairment of gonadotropin-releasing hormone pulsatile secretion and changes in neuropeptide activity [27811940, 23706279, 31662110]. Untreated anorexia is associated with a significant increase in the risk of death [15478133, 36566253, 23771148]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia can lead to severe long-term consequences, including osteoporosis, infertility, and increased risk of fractures [37578122, 23706279, 36109301].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37578122", "evidence_support": "In conclusion, we found that AN was associated with a 46% increased risk of any fracture up to 40\u2009years after diagnosis", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "AN is related to a decrease in bone mass density, which can lead to osteopenia and osteoporosis and a significant increase in fracture risk in later life.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "Untreated AN is associated with a significant increase in the risk of death", "evidence_relation": "supporting" }, { "cited_pmid": "36109301", "evidence_support": "Several factors, such as long-term high-dose steroids, chronic inflammation, malnutrition, immobility, lack of sex steroids, and medication can reduce bone density and increase the risk for fragility fractures when left untreated.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Women with anorexia may experience complications during pregnancy, such as hyperemesis gravidarum, anemia, and obstetric complications [23706279, 35172902].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "Rates of birth complications and low birth weight may be higher in women with previous AN", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "During pregnancy, women with the condition have higher rates of hyperemesis gravidarum, anaemia and obstetric complications, as well as impaired weight gain and compromised intrauterine foetal growth.", "evidence_relation": "supporting" }, { "cited_pmid": "35172902", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Anorexia can also lead to cardiac complications, including sinus bradycardia, prolonged QT interval, arrhythmias, and hypotension [23706279, 19646241, 21739848].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "It is reported that 80% of AN patients are affected by a cardiac complications such as sinus bradycardia, a prolonged QT interval on electrocardiography, arrythmias, myocardial mass modification and hypotension.", "evidence_relation": "supporting" }, { "cited_pmid": "19646241", "evidence_support": "But the commonest complications are rhythm variations, typically bradycardia with a prolonged QT interval in up to a 40% of the cases, which altogether elevates ventricular tachycardia and sudden death risk.", "evidence_relation": "supporting" }, { "cited_pmid": "19646241", "evidence_support": "We present the case of a male who was diagnosed with anorexia nervosa and developed asthenia, a long QT interval and also a severe both hypokalaemia and hypomagnesaemia.", "evidence_relation": "supporting" }, { "cited_pmid": "21739848", "evidence_support": "Sinus bradycardia is the most common cardiovascular physical finding and the most common arrhythmia in patients with anorexia nervosa. It is important to appreciate the significance of sinus bradycardia in this clinical setting because it may be associated with sudden death, especially in the presence of other arrhythmias or EKG abnormalities, such as prolongation of the QTc interval.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In addition, anorexia can cause neuroendocrine changes, including impairment of gonadotropin-releasing hormone pulsatile secretion and changes in neuropeptide activity [27811940, 23706279, 31662110].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27811940", "evidence_support": "Dysfunction of the hypothalamic-pituitary axis includes hypogonadotropic hypogonadism with relative oestrogen and androgen deficiency, growth hormone resistance, hypercortisolaemia, non-thyroidal illness syndrome, hyponatraemia and hypooxytocinaemia", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "The obsessive fear of weight gain, critically limited food intake and neuroendocrine aberrations characteristic of AN have both short- and long-term consequences for the reproductive, cardiovascular, gastrointestinal and skeletal systems", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "Neuroendocrine changes include impairment of gonadotropin releasing-hormone (GnRH) pulsatile secretion and changes in neuropeptide activity at the hypothalamic level, which cause profound hypoestrogenism.", "evidence_relation": "supporting" }, { "cited_pmid": "31662110", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Untreated anorexia is associated with a significant increase in the risk of death [15478133, 36566253, 23771148].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15478133", "evidence_support": "Anorexia nervosa is associated with an increased mortality rate.", "evidence_relation": "supporting" }, { "cited_pmid": "36566253", "evidence_support": "AN is associated with a substantial risk of death from many medical causes.", "evidence_relation": "supporting" }, { "cited_pmid": "23771148", "evidence_support": "These findings highlight the need for early identification and intervention and suggest that a long duration of illness, substance abuse, low weight, and poor psychosocial functioning raise the risk for mortality in anorexia nervosa.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Untreated anorexia can lead to severe long-term consequences, including osteoporosis, infertility, and increased risk of fractures [23760852, 23706279, 37578122]. Women with anorexia may experience complications during pregnancy, such as hyperemesis gravidarum, anemia, and obstetric complications [30737323, 23706279, 35172902]. Anorexia can also lead to cardiac complications, including sinus bradycardia, prolonged QT interval, arrhythmias, and hypotension [21739848, 23706279, 19646241]. In addition, anorexia can cause neuroendocrine changes, including impairment of gonadotropin-releasing hormone pulsatile secretion and changes in neuropeptide activity [23706279, 18224538, 27811940]. Untreated anorexia is associated with a significant increase in the risk of death [36566253, 15478133, 23771148]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia can lead to severe long-term consequences, including osteoporosis, infertility, and increased risk of fractures [23760852, 23706279, 37578122].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23760852", "evidence_support": "Osteoporosis commonly occurs in patients with anorexia nervosa (AN) and is often irreversible even after weight restoration.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "The obsessive fear of weight gain, critically limited food intake and neuroendocrine aberrations characteristic of AN have both short- and long-term consequences for the reproductive, cardiovascular, gastrointestinal and skeletal systems.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "AN is related to a decrease in bone mass density, which can lead to osteopenia and osteoporosis and a significant increase in fracture risk in later life. Rates of birth complications and low birth weight may be higher in women with previous AN. The condition is associated with fertility problems, unplanned pregnancies and generally negative attitudes to pregnancy.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "Untreated AN is associated with a significant increase in the risk of death. ", "evidence_relation": "neutral" }, { "cited_pmid": "37578122", "evidence_support": "Researchers have reported increased fracture risk in patients with anorexia nervosa (AN), but more knowledge on the long-term risk and the effects of age, male sex, and time-related changes is still needed.", "evidence_relation": "supporting" }, { "cited_pmid": "37578122", "evidence_support": "In conclusion, we found that AN was associated with a 46% increased risk of any fracture up to 40\u2009years after diagnosis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Women with anorexia may experience complications during pregnancy, such as hyperemesis gravidarum, anemia, and obstetric complications [30737323, 23706279, 35172902].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "Neuroendocrine changes include impairment of gonadotropin releasing-hormone (GnRH) pulsatile secretion and changes in neuropeptide activity at the hypothalamic level, which cause profound hypoestrogenism. AN is related to a decrease in bone mass density, which can lead to osteopenia and osteoporosis and a significant increase in fracture risk in later life. Rates of birth complications and low birth weight may be higher in women with previous AN. The condition is associated with fertility problems, unplanned pregnancies and generally negative attitudes to pregnancy. During pregnancy, women with the condition have higher rates of hyperemesis gravidarum, anaemia and obstetric complications, as well as impaired weight gain and compromised intrauterine foetal growth. ", "evidence_relation": "supporting" }, { "cited_pmid": "35172902", "evidence_support": "It is a common misconception that women with active anorexia nervosa (AN) are less likely to conceive. Pregnancies in women with AN are considered high risk. The purpose of this systematic review was to explore pregnancy complications in women with active AN, including maternal, fetal, and neonatal complications.", "evidence_relation": "supporting" }, { "cited_pmid": "35172902", "evidence_support": "Women with active AN have a different profile of pregnancy complications comparing to malnourished women and women in starvation. We recommend early discussion with women diagnosed with AN regarding their fertility and pregnancy complications. We recommend clinicians to aim to improve physical and psychological symptoms of AN as well as correction of any nutritional deficiency ideally prior to conception.", "evidence_relation": "supporting" }, { "cited_pmid": "30737323", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Anorexia can also lead to cardiac complications, including sinus bradycardia, prolonged QT interval, arrhythmias, and hypotension [21739848, 23706279, 19646241].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21739848", "evidence_support": "Cardiovascular complications are common in patients with anorexia nervosa, an eating disorder resulting in severe malnutrition that affects multiple organ systems.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "It is reported that 80% of AN patients are affected by a cardiac complications such as sinus bradycardia, a prolonged QT interval on electrocardiography, arrythmias, myocardial mass modification and hypotension.", "evidence_relation": "supporting" }, { "cited_pmid": "19646241", "evidence_support": "Cardiac co-morbility is common and we can find sometimes a mass loss from the left ventricle, which can be seen by echocardiography.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In addition, anorexia can cause neuroendocrine changes, including impairment of gonadotropin-releasing hormone pulsatile secretion and changes in neuropeptide activity [23706279, 18224538, 27811940].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "The obsessive fear of weight gain, critically limited food intake and neuroendocrine aberrations characteristic of AN have both short- and long-term consequences for the reproductive, cardiovascular, gastrointestinal and skeletal systems. Neuroendocrine changes include impairment of gonadotropin releasing-hormone (GnRH) pulsatile secretion and changes in neuropeptide activity at the hypothalamic level, which cause profound hypoestrogenism.", "evidence_relation": "supporting" }, { "cited_pmid": "18224538", "evidence_support": "Functional hypothalamic amenorrhea (FHA) is defined as a non-organic and reversible disorder in which the impairment of gonadotropin-releasing hormone (GnRH) pulsatile secretion plays a key role. There are main three types of FHA: stress-related amenorrhea, weight loss", "evidence_relation": "supporting" }, { "cited_pmid": "27811940", "evidence_support": "Anorexia nervosa is a psychiatric disorder characterized by altered body image, persistent food restriction and low body weight, and is associated with global endocrine dysregulation in both adolescent girls and women. Dysfunction of the hypothalamic-pituitary axis includes hypogonadotropic hypogonadism with relative oestrogen and androgen deficiency, growth hormone resistance, hypercortisolaemia, non-thyroidal illness syndrome, hyponatraemia and hypooxytocinaemia.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Untreated anorexia is associated with a significant increase in the risk of death [36566253, 15478133, 23771148].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36566253", "evidence_support": "AN is associated with a substantial risk of death from many medical causes.", "evidence_relation": "supporting" }, { "cited_pmid": "15478133", "evidence_support": "Anorexia nervosa is associated with an increased mortality rate.", "evidence_relation": "supporting" }, { "cited_pmid": "15478133", "evidence_support": "It seems likely that the association of deaths with anorexia nervosa is systematically underreported.", "evidence_relation": "neutral" }, { "cited_pmid": "23771148", "evidence_support": "Risk of premature death among patients with lifetime anorexia nervosa peaked within the first 10 years of follow-up, resulting in a standardized mortality ratio of 7.7 (95% CI=3.7-14.2)", "evidence_relation": "supporting" }, { "cited_pmid": "23771148", "evidence_support": "These findings highlight the need for early identification and intervention and suggest that a long duration of illness, substance abuse, low weight, and poor psychosocial functioning raise the risk for mortality in anorexia nervosa.", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Untreated anorexia can lead to severe long-term consequences, including osteoporosis, infertility, and increased risk of fractures [23760852, 23706279, 37578122]. Women with anorexia may experience complications during pregnancy, such as hyperemesis gravidarum, anemia, and obstetric complications [35172902, 23706279, 30737323]. Anorexia can also lead to cardiac complications, including sinus bradycardia, prolonged QT interval, arrhythmias, and hypotension [19646241, 23706279, 21739848]. In addition, anorexia can cause neuroendocrine changes, including impairment of gonadotropin-releasing hormone pulsatile secretion and changes in neuropeptide activity [31662110, 27811940, 18224538]. Untreated anorexia is associated with a significant increase in the risk of death [36566253, 15478133, 23771148]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia can lead to severe long-term consequences, including osteoporosis, infertility, and increased risk of fractures [23760852, 23706279, 37578122].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23760852", "evidence_support": "Osteoporosis commonly occurs in patients with anorexia nervosa (AN) and is often irreversible even after weight restoration.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "The obsessive fear of weight gain, critically limited food intake and neuroendocrine aberrations characteristic of AN have both short- and long-term consequences for the reproductive, cardiovascular, gastrointestinal and skeletal systems.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "AN is related to a decrease in bone mass density, which can lead to osteopenia and osteoporosis and a significant increase in fracture risk in later life.", "evidence_relation": "supporting" }, { "cited_pmid": "37578122", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Women with anorexia may experience complications during pregnancy, such as hyperemesis gravidarum, anemia, and obstetric complications [35172902, 23706279, 30737323].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35172902", "evidence_support": "Anaemia, caesarean section, concurrent recreational substance use, intrauterine growth restriction, preterm birth, small-for-gestation (SGA) birth, and low birth weight were the most reported pregnancy complications in women with active AN, while the rates of gestational diabetes and postpartum haemorrhage were lower.", "evidence_relation": "supporting" }, { "cited_pmid": "35172902", "evidence_support": "Women with active AN have a different profile of pregnancy complications comparing to malnourished women and women in starvation.", "evidence_relation": "neutral" }, { "cited_pmid": "23706279", "evidence_support": "The obsessive fear of weight gain, critically limited food intake and neuroendocrine aberrations characteristic of AN have both short- and long-term consequences for the reproductive, cardiovascular, gastrointestinal and skeletal systems. Neuroendocrine changes include impairment of gonadotropin releasing-hormone (GnRH) pulsatile secretion and changes in neuropeptide activity at the hypothalamic level, which cause profound hypoestrogenism. AN is related to a decrease in bone mass density, which can lead to osteopenia and osteoporosis and a significant increase in fracture risk in later life. Rates of birth complications and low birth weight may be higher in women with previous AN.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "During pregnancy, women with the condition have higher rates of hyperemesis gravidarum, anaemia and obstetric complications, as well as impaired weight gain and compromised intrauterine foetal growth.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "It is reported that 80% of AN patients are affected by a cardiac complications such as sinus bradycardia, a prolonged QT interval on electrocardiography, arrythmias, myocardial mass modification and hypotension. A decrease in bone mineral density (BMD) is one of the most important medical consequences of AN. Reduced BMD may subsequently lead to a three- to seven-fold increased risk of spontaneous fractures. Untreated AN is associated with a significant increase in the risk of death.", "evidence_relation": "neutral" }, { "cited_pmid": "30737323", "evidence_support": "We report a case of WE complicating a case of triplet pregnancy with hyperemesis gravidarum, which highlights the importance of early recognition and treatment, resulting in complete recovery as in the index case.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Anorexia can also lead to cardiac complications, including sinus bradycardia, prolonged QT interval, arrhythmias, and hypotension [19646241, 23706279, 21739848].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19646241", "evidence_support": "But the commonest complications are rhythm variations, typically bradycardia with a prolonged QT interval in up to a 40% of the cases, which altogether elevates ventricular tachycardia and sudden death risk.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "It is reported that 80% of AN patients are affected by a cardiac complications such as sinus bradycardia, a prolonged QT interval on electrocardiography, arrythmias, myocardial mass modification and hypotension.", "evidence_relation": "supporting" }, { "cited_pmid": "21739848", "evidence_support": "It is important to appreciate the significance of sinus bradycardia in this clinical setting because it may be associated with sudden death, especially in the presence of other arrhythmias or EKG abnormalities, such as prolongation of the QTc interval.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In addition, anorexia can cause neuroendocrine changes, including impairment of gonadotropin-releasing hormone pulsatile secretion and changes in neuropeptide activity [31662110, 27811940, 18224538].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31662110", "evidence_support": "Anorexia nervosa is a perilous disease of unknown etiology that causes a variety of endocrine effects.", "evidence_relation": "supporting" }, { "cited_pmid": "27811940", "evidence_support": "Dysfunction of the hypothalamic-pituitary axis includes hypogonadotropic hypogonadism with relative oestrogen and androgen deficiency, growth hormone resistance, hypercortisolaemia, non-thyroidal illness syndrome, hyponatraemia and hypooxytocinaemia.", "evidence_relation": "supporting" }, { "cited_pmid": "18224538", "evidence_support": "Functional hypothalamic amenorrhea (FHA) is defined as a non-organic and reversible disorder in which the impairment of gonadotropin-releasing hormone (GnRH) pulsatile secretion plays a key role. There are main three types of FHA: stress-related amenorrhea, weight loss-related amenorrhea and exercise-related amenorrhea.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Untreated anorexia is associated with a significant increase in the risk of death [36566253, 15478133, 23771148].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36566253", "evidence_support": "AN is associated with a substantial risk of death from many medical causes.", "evidence_relation": "supporting" }, { "cited_pmid": "15478133", "evidence_support": "Anorexia nervosa is associated with an increased mortality rate", "evidence_relation": "supporting" }, { "cited_pmid": "23771148", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Untreated anorexia can lead to severe long-term consequences, including osteoporosis, infertility, and increased risk of fractures [31719982, 23547526, 23706279]. Women with anorexia may experience complications during pregnancy, such as hyperemesis gravidarum, anemia, and obstetric complications [35172902, 27582794]. Anorexia can also lead to cardiac complications, including sinus bradycardia, prolonged QT interval, arrhythmias, and hypotension [26710932, 19646241, 15048952]. In addition, anorexia can cause neuroendocrine changes, including impairment of gonadotropin-releasing hormone pulsatile secretion and changes in neuropeptide activity [15208511, 26123258, 18227633]. Untreated anorexia is associated with a significant increase in the risk of death [15800149, 23706279, 15478133]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia can lead to severe long-term consequences, including osteoporosis, infertility, and increased risk of fractures [31719982, 23547526, 23706279].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31719982", "evidence_support": "Osteoporosis represents a common and severe complication in patients with anorexia nervosa (AN) that normally persists despite weight restoration and the resumption of regular menses.", "evidence_relation": "supporting" }, { "cited_pmid": "23547526", "evidence_support": "Anorexia nervosa-related metabolic disturbances lead to disminished bone resistance and increased risk of fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "AN is related to a decrease in bone mass density, which can lead to osteopenia and osteoporosis and a significant increase in fracture risk in later life", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "Untreated AN is associated with a significant increase in the risk of death.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Women with anorexia may experience complications during pregnancy, such as hyperemesis gravidarum, anemia, and obstetric complications [35172902, 27582794].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35172902", "evidence_support": "Pregnancies in women with AN are considered high risk. The purpose of this systematic review was to explore pregnancy complications in women with active AN, including maternal, fetal, and neonatal complications.", "evidence_relation": "supporting" }, { "cited_pmid": "35172902", "evidence_support": "Anaemia, caesarean section, concurrent recreational substance use, intrauterine growth restriction, preterm birth, small-for-gestation (SGA) birth, and low birth weight were the most reported pregnancy complications in women with active AN, while the rates of gestational diabetes and postpartum haemorrhage were lower.", "evidence_relation": "supporting" }, { "cited_pmid": "27582794", "evidence_support": "Pregnant women with anorexia nervosa may have a higher risk of hypertension, miscarriage, difficult labour, premature delivery and intrauterine growth restriction.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Anorexia can also lead to cardiac complications, including sinus bradycardia, prolonged QT interval, arrhythmias, and hypotension [26710932, 19646241, 15048952].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26710932", "evidence_support": "A number of cardiac abnormalities associated with anorexia nervosa have been described in the literature, including pericardial and valvular pathology, changes in left ventricular mass and function, conduction abnormalities, bradycardia, hypotension, and dysregulation in peripheral vascular contractility. ", "evidence_relation": "supporting" }, { "cited_pmid": "19646241", "evidence_support": "But the commonest complications are rhythm variations, typically bradycardia with a prolonged QT interval in up to a 40% of the cases, which altogether elevates ventricular tachycardia and sudden death risk.", "evidence_relation": "supporting" }, { "cited_pmid": "15048952", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In addition, anorexia can cause neuroendocrine changes, including impairment of gonadotropin-releasing hormone pulsatile secretion and changes in neuropeptide activity [15208511, 26123258, 18227633].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15208511", "evidence_support": "Studies of the orexigenic peptides neuropeptide Y and the opioid peptides have shown state-related abnormalities in patients with eating disorders.", "evidence_relation": "supporting" }, { "cited_pmid": "18227633", "evidence_support": "Our study demonstrates dissociation in the secretion of gonadotropins after hypothalamic stimulation in anorexic patients.", "evidence_relation": "supporting" }, { "cited_pmid": "26123258", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Untreated anorexia is associated with a significant increase in the risk of death [15800149, 23706279, 15478133].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15800149", "evidence_support": "Anorexia nervosa is associated with increased risk of premature death.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "Untreated AN is associated with a significant increase in the risk of death.", "evidence_relation": "supporting" }, { "cited_pmid": "15478133", "evidence_support": "Anorexia nervosa is associated with an increased mortality rate. ", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Untreated anorexia can lead to severe long-term consequences, including osteoporosis, infertility, and increased risk of fractures [23706279]. Women with anorexia may experience complications during pregnancy, such as hyperemesis gravidarum, anemia, and obstetric complications [35172902]. Anorexia can also lead to cardiac complications, including sinus bradycardia, prolonged QT interval, arrhythmias, and a common complication is rhythm variations, typically bradycardia with a prolonged QT interval in up to a 40% of the cases, which altogether elevates ventricular tachycardia and sudden death risk [30173377, 21739848, 26885932, 19646241]. Additionally, severe hypokalaemia and hypomagnesaemia can also occur [30173377, 21739848, 26885932, 19646241]. In addition, anorexia can cause neuroendocrine changes, including impairment of gonadotropin-releasing hormone pulsatile secretion and changes in neuropeptide activity [18227633, 15050983]. Untreated anorexia is associated with a significant increase in the risk of death [21727255, 23706279, 16134111]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia can lead to severe long-term consequences, including osteoporosis, infertility, and increased risk of fractures [23706279].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "The obsessive fear of weight gain, critically limited food intake and neuroendocrine aberrations characteristic of AN have both short- and long-term consequences for the reproductive, cardiovascular, gastrointestinal and skeletal systems.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "AN is related to a decrease in bone mass density, which can lead to osteopenia and osteoporosis and a significant increase in fracture risk in later life.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Women with anorexia may experience complications during pregnancy, such as hyperemesis gravidarum, anemia, and obstetric complications [35172902].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35172902", "evidence_support": "Anaemia, caesarean section, concurrent recreational substance use, intrauterine growth restriction, preterm birth, small-for-gestation (SGA) birth, and low birth weight were the most reported pregnancy complications in women with active AN, while the rates of gestational diabetes and postpartum haemorrhage were lower.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Anorexia can also lead to cardiac complications, including sinus bradycardia, prolonged QT interval, arrhythmias, and a common complication is rhythm variations, typically bradycardia with a prolonged QT interval in up to a 40% of the cases, which altogether elevates ventricular tachycardia and sudden death risk [30173377, 21739848, 26885932, 19646241].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30173377", "evidence_support": "This review demonstrated that the most common cardiac abnormalities in AN are bradycardia and QT interval prolongation, which may occasionally degenerate into ventricular arrhythmias such as Torsades des Pointes or ventricular fibrillation. As these arrhythmias may be the substrate of sudden cardiac death (SCD), they require cardiac monitoring in hospital.", "evidence_relation": "supporting" }, { "cited_pmid": "21739848", "evidence_support": "It is important to appreciate the significance of sinus bradycardia in this clinical setting because it may be associated with sudden death, especially in the presence of other arrhythmias or EKG abnormalities, such as prolongation of the QTc interval.", "evidence_relation": "supporting" }, { "cited_pmid": "26885932", "evidence_support": "We report a case of sinus bradycardia in an anorexia patient with the clinical manifestations, laboratory exams, auxiliary exams, therapeutic methods, and her prognosis, who was admitted to Peking University Third Hospital recently.", "evidence_relation": "supporting" }, { "cited_pmid": "19646241", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, severe hypokalaemia and hypomagnesaemia can also occur [30173377, 21739848, 26885932, 19646241].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30173377", "evidence_support": "Finally, refeeding syndrome (RFS), which occurs during the first days of refeeding, may engender a critically increased risk of acute, life-threatening cardiac complications.", "evidence_relation": "neutral" }, { "cited_pmid": "21739848", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "26885932", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "19646241", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "In addition, anorexia can cause neuroendocrine changes, including impairment of gonadotropin-releasing hormone pulsatile secretion and changes in neuropeptide activity [18227633, 15050983].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18227633", "evidence_support": "Anorexia nervosa negatively affects multiple body systems including the reproductive system.", "evidence_relation": "neutral" }, { "cited_pmid": "18227633", "evidence_support": "Basal levels of luteinizing hormone (LH) and follicle-stimulating hormone (FSH) were significantly lower in the patients. The responses of LH to GnRH were diminished, but those of FSH were exaggerated", "evidence_relation": "supporting" }, { "cited_pmid": "18227633", "evidence_support": "Our study demonstrates dissociation in the secretion of gonadotropins after hypothalamic stimulation in anorexic patients.", "evidence_relation": "supporting" }, { "cited_pmid": "15050983", "evidence_support": "The neuroendocrine changes associated with menstrual abnormalities in underweight and weight recovered anorexia nervosa, recent research on osteopenia, and treatment recommendations are addressed", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Untreated anorexia is associated with a significant increase in the risk of death [21727255, 23706279, 16134111].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21727255", "evidence_support": "Individuals with eating disorders have significantly elevated mortality rates, with the highest rates occurring in those with AN", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "Untreated AN is associated with a significant increase in the risk of death", "evidence_relation": "supporting" }, { "cited_pmid": "16134111", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Untreated anorexia can lead to severe long-term consequences, including osteoporosis, infertility, and increased risk of fractures [23706279, 21365578, 22161979]. Women with anorexia may experience complications during pregnancy, such as hyperemesis gravidarum, anemia, and obstetric complications [35172902, 37873998]. Anorexia can also lead to cardiac complications, including sinus bradycardia, prolonged QT interval, arrhythmias, and hypotension [30173377, 15048952, 26710932]. In addition, anorexia can cause neuroendocrine changes, including impairment of gonadotropin-releasing hormone pulsatile secretion and changes in neuropeptide activity [18542109, 18227633]. Untreated anorexia is associated with a significant increase in the risk of death [21727255, 16134111, 23771148]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia can lead to severe long-term consequences, including osteoporosis, infertility, and increased risk of fractures [23706279, 21365578, 22161979].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "The obsessive fear of weight gain, critically limited food intake and neuroendocrine aberrations characteristic of AN have both short- and long-term consequences for the reproductive, cardiovascular, gastrointestinal and skeletal systems. ", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "AN is related to a decrease in bone mass density, which can lead to osteopenia and osteoporosis and a significant increase in fracture risk in later life. Rates of birth complications and low birth weight may be higher in women with previous AN. The condition is associated with fertility problems, unplanned pregnancies and generally negative attitudes to pregnancy.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": "A decrease in bone mineral density (BMD) is one of the most important medical consequences of AN. Reduced BMD may subsequently lead to a three- to seven-fold increased risk of spontaneous fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "21365578", "evidence_support": "AN is a risk factor for secondary osteoporosis. AN-related metabolic disturbances lead to diminished bone quality and increased risk of fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "21365578", "evidence_support": "AN is a risk factor for secondary osteoporosis. AN-related metabolic disturbances lead to diminished bone quality and increased risk of fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "22161979", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Women with anorexia may experience complications during pregnancy, such as hyperemesis gravidarum, anemia, and obstetric complications [35172902, 37873998].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35172902", "evidence_support": "Anaemia, caesarean section, concurrent recreational substance use, intrauterine growth restriction, preterm birth, small-for-gestation (SGA) birth, and low birth weight were the most reported pregnancy complications in women with active AN, while the rates of gestational diabetes and postpartum haemorrhage were lower.", "evidence_relation": "supporting" }, { "cited_pmid": "37873998", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Anorexia can also lead to cardiac complications, including sinus bradycardia, prolonged QT interval, arrhythmias, and hypotension [30173377, 15048952, 26710932].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30173377", "evidence_support": "This review demonstrated that the most common cardiac abnormalities in AN are bradycardia and QT interval prolongation, which may occasionally degenerate into ventricular arrhythmias such as Torsades des Pointes or ventricular fibrillation.", "evidence_relation": "supporting" }, { "cited_pmid": "15048952", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "26710932", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In addition, anorexia can cause neuroendocrine changes, including impairment of gonadotropin-releasing hormone pulsatile secretion and changes in neuropeptide activity [18542109, 18227633].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18542109", "evidence_support": "Anorexia nervosa (AN) is a psychiatric disease associated with notable medical complications and increased mortality. Endocrine abnormalities, including hypogonadotropic hypogonadism, hypercortisolemia, growth hormone resistance and sick euthyroid syndrome, mediate the clinical manifestations of this disease.", "evidence_relation": "supporting" }, { "cited_pmid": "18227633", "evidence_support": "Our study demonstrates dissociation in the secretion of gonadotropins after hypothalamic stimulation in anorexic patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Untreated anorexia is associated with a significant increase in the risk of death [21727255, 16134111, 23771148].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21727255", "evidence_support": "Individuals with eating disorders have significantly elevated mortality rates, with the highest rates occurring in those with AN. The mortality rates for BN and EDNOS are similar. The study found age at assessment to be a significant predictor of mortality for patients with AN.", "evidence_relation": "supporting" }, { "cited_pmid": "16134111", "evidence_support": "Contrary to some reports in the literature, our study confirms a high mortality rate within the AN population.", "evidence_relation": "supporting" }, { "cited_pmid": "23771148", "evidence_support": "Sixteen deaths (6.5%) were recorded (lifetime anorexia nervosa, N=14; bulimia nervosa with no history of anorexia nervosa, N=2). The standardized mortality ratio was 4.37 (95% CI=2.4-7.3) for lifetime anorexia nervosa and 2.33 (95% CI=0.3-8.4) for bulimia nervosa with no history of anorexia nervosa.", "evidence_relation": "supporting" }, { "cited_pmid": "23771148", "evidence_support": "Risk of premature death among patients with lifetime anorexia nervosa peaked within the first 10 years of follow-up, resulting in a standardized mortality ratio of 7.7 (95% CI=3.7-14.2).", "evidence_relation": "supporting" }, { "cited_pmid": "23771148", "evidence_support": "These findings highlight the need for early identification and intervention and suggest that a long duration of illness, substance abuse, low weight, and poor psychosocial functioning raise the risk for mortality in anorexia nervosa.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Untreated anorexia can lead to severe long-term consequences, including osteoporosis, infertility, and increased risk of fractures [23706279, 17607972, 30764024]. Women with anorexia may experience complications during pregnancy, such as hyperemesis gravidarum, anemia, and obstetric complications [35172902, 37873998]. Anorexia can also lead to cardiac complications, including sinus bradycardia, prolonged QT interval, arrhythmias, and hypotension [26710932, 15048952, 21739848]. In addition, anorexia can cause neuroendocrine changes, including impairment of gonadotropin-releasing hormone pulsatile secretion and changes in neuropeptide activity [18227633, 18542109]. Untreated anorexia is associated with a significant increase in the risk of death [15478133, 23706279, 36566253]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia can lead to severe long-term consequences, including osteoporosis, infertility, and increased risk of fractures [23706279, 17607972, 30764024].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "AN is related to a decrease in bone mass density, which can lead to osteopenia and osteoporosis and a significant increase in fracture risk in later life.", "evidence_relation": "supporting" }, { "cited_pmid": "30764024", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "17607972", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Women with anorexia may experience complications during pregnancy, such as hyperemesis gravidarum, anemia, and obstetric complications [35172902, 37873998].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35172902", "evidence_support": "Anaemia, caesarean section, concurrent recreational substance use, intrauterine growth restriction, preterm birth, small-for-gestation (SGA) birth, and low birth weight were the most reported pregnancy complications in women with active AN, while the rates of gestational diabetes and postpartum haemorrhage were lower.", "evidence_relation": "supporting" }, { "cited_pmid": "37873998", "evidence_support": "Women with ED were more likely to have HG in their first pregnancy compared with women with no history of EDs (adjusted odds ratio [AOR] 9.4, 95% CI 6.52-13.66, p\u2009<\u2009.0001)", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Anorexia can also lead to cardiac complications, including sinus bradycardia, prolonged QT interval, arrhythmias, and hypotension [26710932, 15048952, 21739848].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26710932", "evidence_support": "Recent studies suggest that adverse myocardial structural changes occur in this condition, which could underlie the increased mortality.", "evidence_relation": "supporting" }, { "cited_pmid": "26710932", "evidence_support": "We sought to elucidate the impact of anorexia nervosa in four cardiovascular domains: structural, repolarization/conduction, hemodynamic, and peripheral vascular.", "evidence_relation": "supporting" }, { "cited_pmid": "26710932", "evidence_support": "A number of cardiac abnormalities associated with anorexia nervosa have been described in the literature, including pericardial and valvular pathology, changes in left ventricular mass and function, conduction abnormalities, bradycardia, hypotension, and dysregulation in peripheral vascular contractility.", "evidence_relation": "supporting" }, { "cited_pmid": "26710932", "evidence_support": "Admission to an inpatient unit with telemetry monitoring is recommended for patients with severe sinus bradycardia or junction rhythm, marked prolongation of the corrected QT interval, or syncope.", "evidence_relation": "supporting" }, { "cited_pmid": "15048952", "evidence_support": "Syncope is a potentially dangerous symptom of anorexia nervosa that is usually attributed to bradycardia, dehydration, or hypoglycemia.", "evidence_relation": "supporting" }, { "cited_pmid": "21739848", "evidence_support": "Cardiovascular complications are common in patients with anorexia nervosa, an eating disorder resulting in severe malnutrition that affects multiple organ systems", "evidence_relation": "supporting" }, { "cited_pmid": "21739848", "evidence_support": "Sinus bradycardia is the most common cardiovascular physical finding and the most common arrhythmia in patients with anorexia nervosa", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In addition, anorexia can cause neuroendocrine changes, including impairment of gonadotropin-releasing hormone pulsatile secretion and changes in neuropeptide activity [18227633, 18542109].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18227633", "evidence_support": "Anorexia nervosa negatively affects multiple body systems including the reproductive system", "evidence_relation": "supporting" }, { "cited_pmid": "18227633", "evidence_support": "Our study demonstrates dissociation in the secretion of gonadotropins after hypothalamic stimulation in anorexic patients.", "evidence_relation": "supporting" }, { "cited_pmid": "18542109", "evidence_support": "Anorexia nervosa (AN) is a psychiatric disease associated with notable medical complications and increased mortality.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Untreated anorexia is associated with a significant increase in the risk of death [15478133, 23706279, 36566253].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15478133", "evidence_support": "Anorexia nervosa is associated with an increased mortality rate.", "evidence_relation": "supporting" }, { "cited_pmid": "15478133", "evidence_support": " An audit of the quality of information and diagnosis was conducted on death certificates in which anorexia nervosa was mentioned.", "evidence_relation": "supporting" }, { "cited_pmid": "15478133", "evidence_support": "National mortality statistics derived from death certificates are a flawed source of information on deaths from anorexia nervosa when taken at face value. ", "evidence_relation": "neutral" }, { "cited_pmid": "36566253", "evidence_support": "AN is associated with a substantial risk of death from many medical causes.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Untreated anorexia nervosa (AN) can lead to severe long-term outcomes, including a significantly increased risk of mortality, with an almost 18-fold increase in death rates, often due to cardiac complications and suicide [23706279, 19014869]. Chronic undernutrition associated with AN results in substantial medical complications such as osteoporosis, leading to a three- to seven-fold increased risk of fractures, and impaired linear growth in adolescents [23706279, 18361276, 37578122]. Fertility issues, including infertility and obstetric complications, are also prevalent [23706279, 18361276]. Psychiatric comorbidities, such as anxiety, depression, and substance abuse disorders, frequently persist even after recovery from AN [28581532, 19014869]. Additionally, untreated AN can result in long-term deficits in bone mineral density, which may not fully recover even with weight restoration, increasing the risk of fractures and osteoporosis [21360368, 16972186, 16242373]. Early detection and intervention are crucial to mitigate these severe outcomes [23706279, 28581532].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia nervosa (AN) can lead to severe long-term outcomes, including a significantly increased risk of mortality, with an almost 18-fold increase in death rates, often due to cardiac complications and suicide [23706279, 19014869].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "Untreated AN is associated with a significant increase in the risk of death.", "evidence_relation": "supporting" }, { "cited_pmid": "19014869", "evidence_support": "In AN, there are an almost 18-fold increase in mortality including a high suicide rate, chronic courses in approximately 20 per cent of the cases, and more than half of the patients showing either a complete or a partial eating disorder in combination with another psychiatric disorder or another psychiatric disorder without an eating disorder.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Chronic undernutrition associated with AN results in substantial medical complications such as osteoporosis, leading to a three- to seven-fold increased risk of fractures, and impaired linear growth in adolescents [23706279, 18361276, 37578122].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "A decrease in bone mineral density (BMD) is one of the most important medical consequences of AN. Reduced BMD may subsequently lead to a three- to seven-fold increased risk of spontaneous fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "18361276", "evidence_support": "Chronic undernutrition leads to main long-term medical complications of eating disorders: linear growth in adolescents with anorexia nervosa, infertility, and osteoporosis.", "evidence_relation": "supporting" }, { "cited_pmid": "37578122", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Fertility issues, including infertility and obstetric complications, are also prevalent [23706279, 18361276].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "Rates of birth complications and low birth weight may be higher in women with previous AN. The condition is associated with fertility problems, unplanned pregnancies and generally negative attitudes to pregnancy. During pregnancy, women with the condition have higher rates of hyperemesis gravidarum, anaemia and obstetric complications, as well as impaired weight gain and compromised intrauterine foetal growth.", "evidence_relation": "supporting" }, { "cited_pmid": "18361276", "evidence_support": "Chronic undernutrition leads to main long-term medical complications of eating disorders: linear growth in adolescents with anorexia nervosa, infertility, and osteoporosis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Psychiatric comorbidities, such as anxiety, depression, and substance abuse disorders, frequently persist even after recovery from AN [28581532, 19014869].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28581532", "evidence_support": "However, the recovery can take several years and AN is associated with high risk of developing other psychiatric disorders during the patients' lifetime, even after recovery from AN (mainly: affective disorders, anxiety disorders, obsessive-compulsive disorders, substance abuse disorders).", "evidence_relation": "supporting" }, { "cited_pmid": "19014869", "evidence_support": "In AN, there are an almost 18-fold increase in mortality including a high suicide rate, chronic courses in approximately 20 per cent of the cases, and more than half of the patients showing either a complete or a partial eating disorder in combination with another psychiatric disorder or another psychiatric disorder without an eating disorder.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, untreated AN can result in long-term deficits in bone mineral density, which may not fully recover even with weight restoration, increasing the risk of fractures and osteoporosis [21360368, 16972186, 16242373].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21360368", "evidence_support": "Osteoporosis is common in anorexia nervosa. It places these patients at increased lifetime risk for fractures. Bone loss may never recover completely even once weight is restored.", "evidence_relation": "supporting" }, { "cited_pmid": "21360368", "evidence_support": "Loss of bone density can occur rapidly and very early in the course of anorexia nervosa", "evidence_relation": "supporting" }, { "cited_pmid": "16972186", "evidence_support": "Anorexia nervosa (AN), a condition of severe undernutrition, is associated with low bone mineral density (BMD) in adults and adolescents.", "evidence_relation": "supporting" }, { "cited_pmid": "16242373", "evidence_support": "However, in contrast to postmenopausal osteoporosis, bone loss associated with anorexia nervosa is related mainly to inadequate bone formation, with only a slight increase in bone resorption", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Early detection and intervention are crucial to mitigate these severe outcomes [23706279, 28581532].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "Better detection and sophisticated therapy should prevent the long-term consequences of this disorder. The aims of treatment are not only recovery but also prophylaxis and relief of the long-term effects of this disorder.", "evidence_relation": "supporting" }, { "cited_pmid": "28581532", "evidence_support": "The condition is associated with a high risk of chronic course and poor prognosis in terms of treatment and the risk of death.", "evidence_relation": "neutral" }, { "cited_pmid": "28581532", "evidence_support": "Better knowledge of the course of anorexia can contribute to more realistic expectations of the pace of symptomatic improvement, as well as to a creation of therapeutic programs which are better adapted to the needs of the patients.", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Untreated anorexia nervosa can lead to severe long-term outcomes, including chronic malnutrition, cardiovascular complications such as bradycardia and heart failure, and significant bone density loss resulting in osteoporosis.Endocrine disruptions can cause amenorrhea and infertility in women, while gastrointestinal issues like gastroparesis and severe constipation are common.Neurological effects include cognitive impairment and peripheral neuropathy.Psychiatric comorbidities, including depression and anxiety, often worsen, increasing the risk of suicide.Chronic anorexia can also lead to multi-organ failure and has one of the highest mortality rates among psychiatric disorders.Early and comprehensive treatment is crucial to mitigate these risks and improve prognosis.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia nervosa can lead to severe long-term outcomes, including chronic malnutrition, cardiovascular complications such as bradycardia and heart failure, and significant bone density loss resulting in osteoporosis.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Endocrine disruptions can cause amenorrhea and infertility in women, while gastrointestinal issues like gastroparesis and severe constipation are common.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Neurological effects include cognitive impairment and peripheral neuropathy.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Psychiatric comorbidities, including depression and anxiety, often worsen, increasing the risk of suicide.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Chronic anorexia can also lead to multi-organ failure and has one of the highest mortality rates among psychiatric disorders.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Early and comprehensive treatment is crucial to mitigate these risks and improve prognosis.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Untreated anorexia nervosa can lead to severe long-term consequences, including a significant increase in the risk of deathChronic undernutrition can result in linear growth impairment in adolescents, infertility, and osteoporosis [18361276]. Osteoporosis is a common complication, placing individuals at increased lifetime risk for fractures, with bone loss potentially never recovering completely even after weight restoration [21360368]. Additionally, anorexia nervosa can lead to cardiac complications, such as sinus bradycardia, arrhythmias, and hypotension, affecting up to 80% of patients [23706279]. Furthermore, untreated anorexia nervosa can result in a chronic course, with approximately 20% of cases experiencing a poor prognosis, including a high risk of developing other psychiatric disorders, such as affective disorders, anxiety disorders, and substance abuse disorders [28581532]. Early detection and treatment are crucial to prevent these long-term consequences.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia nervosa can lead to severe long-term consequences, including a significant increase in the risk of deathChronic undernutrition can result in linear growth impairment in adolescents, infertility, and osteoporosis [18361276].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18361276", "evidence_support": "Chronic undernutrition leads to main long-term medical complications of eating disorders: linear growth in adolescents with anorexia nervosa, infertility, and osteoporosis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Osteoporosis is a common complication, placing individuals at increased lifetime risk for fractures, with bone loss potentially never recovering completely even after weight restoration [21360368].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21360368", "evidence_support": "Osteoporosis is common in anorexia nervosa. It places these patients at increased lifetime risk for fractures. Bone loss may never recover completely even once weight is restored.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, anorexia nervosa can lead to cardiac complications, such as sinus bradycardia, arrhythmias, and hypotension, affecting up to 80% of patients [23706279].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "It is reported that 80% of AN patients are affected by a cardiac complications such as sinus bradycardia, a prolonged QT interval on electrocardiography, arrythmias, myocardial mass modification and hypotension.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, untreated anorexia nervosa can result in a chronic course, with approximately 20% of cases experiencing a poor prognosis, including a high risk of developing other psychiatric disorders, such as affective disorders, anxiety disorders, and substance abuse disorders [28581532].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28581532", "evidence_support": "AN is associated with high risk of developing other psychiatric disorders during the patients' lifetime, even after recovery from AN (mainly: affective disorders, anxiety disorders, obsessive-compulsive disorders, substance abuse disorders).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Early detection and treatment are crucial to prevent these long-term consequences.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gemini-flash": { "answer": "Untreated anorexia nervosa can have severe long-term consequences, including significant mortality risk [25238849, 15985966]. The most common cause of death in anorexia nervosa is suicide [10773895, 17056416]. Long-term effects can include organ failure, disability, and even death in extreme cases [32368866]. While some patients with severe anorexia recover, many experience long-term negative consequences, such as osteoporosis [28644530, 15918539]. Anorexia can also have long-term effects on overall and reproductive health [28700663]. Early diagnosis and intervention are crucial for effective treatment and prevention of these undesirable long-term health consequences [35635472].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia nervosa can have severe long-term consequences, including significant mortality risk [25238849, 15985966].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25238849", "evidence_support": "Anorexia nervosa is an eating disorder that often causes malnutrition and carries high mortality risk.", "evidence_relation": "supporting" }, { "cited_pmid": "15985966", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The most common cause of death in anorexia nervosa is suicide [10773895, 17056416].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17056416", "evidence_support": "Suicide in anorexia nervosa and bulimia nervosa is a major cause of death.", "evidence_relation": "supporting" }, { "cited_pmid": "10773895", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Long-term effects can include organ failure, disability, and even death in extreme cases [32368866].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32368866", "evidence_support": "Anorexia nervosa is a multifactorial eating disorder that manifests with self-starvation, extreme anxiety, hyperactivity, and amenorrhea. Long-term effects include organ failure, disability, and in extreme cases, even death.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "While some patients with severe anorexia recover, many experience long-term negative consequences, such as osteoporosis [28644530, 15918539].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15918539", "evidence_support": "Both disorders have a high somatic and psychiatric comorbidity; the most severe complication at long term follow-up is osteoporosis.", "evidence_relation": "supporting" }, { "cited_pmid": "28644530", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Anorexia can also have long-term effects on overall and reproductive health [28700663].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28700663", "evidence_support": "Anorexia and bulimia nervosa may have long-term effects on overall and reproductive health.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Early diagnosis and intervention are crucial for effective treatment and prevention of these undesirable long-term health consequences [35635472].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "35635472", "evidence_support": "Early diagnosis, which is important for effective treatment and prevention of undesirable long-term health consequences, imposes problems among non-specialist clinicians unfamiliar with these patients, such as those working in primary care. Early, accurate diagnosis, particularly in primary care, allows expert interventions early enough in the disorder to facilitate positive treatment outcomes.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Untreated anorexia nervosa can have severe and long-term consequences for an individual's health and well-being [15139557, 20413695]. It is associated with a significantly increased risk of death, with nearly 5% of individuals dying from the disorder [23329707, 23706279]. About 20% of individuals with anorexia nervosa remain chronically ill, often experiencing somatic complications [35173158, 16941399]. Anorexia nervosa ranks among the main causes of death among young women [29105700]. Furthermore, untreated anorexia can lead to reduced quality of life, increased healthcare costs, and lower earnings [32796186]. It can also impact reproductive health, increasing the risk of infertility, adverse pregnancy outcomes, and miscarriage [16647671, 28700663]. No body system is spared from the adverse effects of anorexia nervosa, especially as the disorder becomes more severe and chronic [26169883].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia nervosa can have severe and long-term consequences for an individual's health and well-being [15139557, 20413695].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15139557", "evidence_support": "Anorexia nervosa is a common problem in young adults that may present with a variety of metabolic and hematologic abnormalities, as well as weight loss and psychological disturbances", "evidence_relation": "supporting" }, { "cited_pmid": "20413695", "evidence_support": "In addition, the 2 primary eating disorders, anorexia nervosa and bulimia nervosa, may have acute, life-threatening consequences", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is associated with a significantly increased risk of death, with nearly 5% of individuals dying from the disorder [23329707, 23706279].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23329707", "evidence_support": "Nearly 5% of affected individuals die of this disease and 20% develop a chronic eating disorder.", "evidence_relation": "supporting" }, { "cited_pmid": "23706279", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "About 20% of individuals with anorexia nervosa remain chronically ill, often experiencing somatic complications [35173158, 16941399].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35173158", "evidence_support": "About 20% of individuals with anorexia nervosa (AN) remain chronically ill", "evidence_relation": "supporting" }, { "cited_pmid": "16941399", "evidence_support": "Three-quarters of the patients are healed or improve their condition long-term; one-quarter has a chronic course frequently including somatic complications and death. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Anorexia nervosa ranks among the main causes of death among young women [29105700].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29105700", "evidence_support": "Anorexia nervosa ranks among the main causes of death among young women. 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It has the highest mortality rate among psychiatric disorders, highlighting its severity [30700054]. Patients may experience significant morbidity, including low bone mineral density, severe osteoporosis, and electrolyte disturbances, which can increase the risk of fractures and cardiac arrhythmias [28520584, 11862200]. Additionally, prolonged anorexia can result in extreme muscle wasting and cachexia, further complicating recovery [30700054, 2376327]. The risk of suicide is also elevated in individuals with anorexia, making early intervention crucial to improve long-term outcomes [27662598, 37315981]. Without appropriate treatment, the prognosis can worsen, leading to longstanding symptoms and serious medical complications [25049202, 1739320].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia nervosa can lead to severe long-term health consequences, including organ failure, disability, and even death [27262009, 32368866].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27262009", "evidence_support": "Early diagnosis and treatment are associated with improved outcomes, whereas the consequences of untreated eating disorders, particularly anorexia nervosa, can be devastating, including death.", "evidence_relation": "supporting" }, { "cited_pmid": "32368866", "evidence_support": "Long-term effects include organ failure, disability, and in extreme cases, even death.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It has the highest mortality rate among psychiatric disorders, highlighting its severity [30700054].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30700054", "evidence_support": "Anorexia nervosa is the most severe eating disorder; it has a protracted course of illness and the highest mortality rate among all psychiatric illnesses. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Patients may experience significant morbidity, including low bone mineral density, severe osteoporosis, and electrolyte disturbances, which can increase the risk of fractures and cardiac arrhythmias [28520584, 11862200].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28520584", "evidence_support": "Eating Disorders are psychiatric disorders associated with a high risk for low bone mineral density (BMD) and fractures. Low BMD is a consequence of undernutrition, changes in body composition, and hormonal alterations.", "evidence_relation": "supporting" }, { "cited_pmid": "11862200", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, prolonged anorexia can result in extreme muscle wasting and cachexia, further complicating recovery [30700054, 2376327].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30700054", "evidence_support": "It is characterised by a restriction of energy intake followed by substantial weight loss, which can culminate in cachexia and related medical consequences.", "evidence_relation": "supporting" }, { "cited_pmid": "2376327", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The risk of suicide is also elevated in individuals with anorexia, making early intervention crucial to improve long-term outcomes [27662598, 37315981].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27662598", "evidence_support": "The risk of suicide is elevated.", "evidence_relation": "supporting" }, { "cited_pmid": "37315981", "evidence_support": "Anorexia nervosa and atypical anorexia nervosa are serious, potentially life-threatening illnesses that are best addressed through early detection and treatment", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Without appropriate treatment, the prognosis can worsen, leading to longstanding symptoms and serious medical complications [25049202, 1739320].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "25049202", "evidence_support": "Because eating disorders in adolescents who have history of overweight take longer to be identified, they consequently may have a poorer prognosis", "evidence_relation": "supporting" }, { "cited_pmid": "1739320", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Untreated anorexia nervosa can lead to severe long-term health consequences, including a high risk of mortality, with nearly 5% of affected individuals dying from the disorder [23329707, 27262009]. It is associated with the highest mortality rate of any psychiatric disorder, primarily due to medical complications such as cardiac issues, electrolyte imbalances, and organ failure [30883398, 15561639]. Additionally, individuals may experience significant decreases in bone mineral density, leading to osteopenia and osteoporosis, which increases fracture risk [23706279]. Other complications include severe malnutrition, which negatively impacts physical, mental, and social health [26261037]. The risk of chronic eating disorders also rises, with 20% of individuals developing long-term issues [23329707]. Early detection and treatment are crucial to mitigate these risks and improve outcomes [37315981].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Untreated anorexia nervosa can lead to severe long-term health consequences, including a high risk of mortality, with nearly 5% of affected individuals dying from the disorder [23329707, 27262009].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23329707", "evidence_support": "Anorexia nervosa remains challenging to treat and difficult to prevent. Nearly 5% of affected individuals die of this disease and 20% develop a chronic eating disorder.", "evidence_relation": "supporting" }, { "cited_pmid": "27262009", "evidence_support": "whereas the consequences of untreated eating disorders, particularly anorexia nervosa, can be devastating, including death.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is associated with the highest mortality rate of any psychiatric disorder, primarily due to medical complications such as cardiac issues, electrolyte imbalances, and organ failure [30883398, 15561639].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30883398", "evidence_support": "The diagnosis of anorexia nervosa is associated with the highest mortality rate of any psychiatric disorder, mainly caused by medical complications.", "evidence_relation": "supporting" }, { "cited_pmid": "15561639", "evidence_support": "Anorexia nervosa is a very serious eating disorder that is associated with severe medical complications.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, individuals may experience significant decreases in bone mineral density, leading to osteopenia and osteoporosis, which increases fracture risk [23706279].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23706279", "evidence_support": "AN is related to a decrease in bone mass density, which can lead to osteopenia and osteoporosis and a significant increase in fracture risk in later life.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Other complications include severe malnutrition, which negatively impacts physical, mental, and social health [26261037].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26261037", "evidence_support": "The weight loss and malnutrition resulting from EDs have widespread negative consequences for physical, mental and social health.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The risk of chronic eating disorders also rises, with 20% of individuals developing long-term issues [23329707].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23329707", "evidence_support": "Nearly 5% of affected individuals die of this disease and 20% develop a chronic eating disorder.", "evidence_relation": "supporting" }, { "cited_pmid": "23329707", "evidence_support": "We report a case of a patient with long-term untreated anorexia nervosa-binge eating/purging type who started psychiatric treatment when in a life-threatening situation (renal failure requiring dialysis), with unsuccessful weight recovery while on dialysis and died of septicaemia.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Early detection and treatment are crucial to mitigate these risks and improve outcomes [37315981].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "37315981", "evidence_support": "Early intervention is of utmost importance for avoiding long-term health consequences.", "evidence_relation": "supporting" } ] } ] }, "webis-1": { "answer": "Possible long-term outcomes of not treating anorexia include poor outcomes or ineffective weight recovery, potential complications of surgery, and life-threatening weight loss [34193279].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Possible long-term outcomes of not treating anorexia include poor outcomes or ineffective weight recovery, potential complications of surgery, and life-threatening weight loss [34193279].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34193279", "evidence_support": "Although several reports have proposed surgery for SMA syndrome associated with anorexia nervosa, these have shown poor outcomes or did not reveal the long-term weight course.", "evidence_relation": "supporting" } ] } ] }, "webis-2": { "answer": "Possible long-term outcomes of not treating anorexia nervosa include poor weight gain, malnutrition, osteoporosis, cardiovascular problems, and even death [34193279]. In severe cases, it can also lead to the development of secondary medical conditions such as anemia, electrolyte imbalances, and gastrointestinal.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Possible long-term outcomes of not treating anorexia nervosa include poor weight gain, malnutrition, osteoporosis, cardiovascular problems, and even death [34193279].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34193279", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In severe cases, it can also lead to the development of secondary medical conditions such as anemia, electrolyte imbalances, and gastrointestinal.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-3": { "answer": "Long-term outcomes of not treating anorexia nervosa in a patient with lipedema may include persistent disproportionate subcutaneous tissue accumulation on the lower half of the body despite weight loss [34121088]. This can lead to decreased body image acceptance [34121088].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Long-term outcomes of not treating anorexia nervosa in a patient with lipedema may include persistent disproportionate subcutaneous tissue accumulation on the lower half of the body despite weight loss [34121088].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34121088", "evidence_support": "After a decade-long struggle, her eating disorder resolved, and she maintained a healthy weight and BMI of 21.5 kg/m\u00b2 but disproportionate fat remained in her lower body", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This can lead to decreased body image acceptance [34121088].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34121088", "evidence_support": "Poor awareness and limited diagnosis of lipedema contribute to the confusion of lipedema with obesity and can lead to decreased body image acceptance.", "evidence_relation": "supporting" }, { "cited_pmid": "34121088", "evidence_support": "A young woman with disproportionate fat accumulation on the lower half of her body self-identified as having obesity.", "evidence_relation": "neutral" } ] } ] }, "webis-5": { "answer": "Long-term outcomes of not treating anorexia nervosa in a patient with lipedema may include persistent disproportionate subcutaneous tissue accumulation on the lower half of the body despite weight loss. . [34121088]. This can lead to decreased body image acceptance [34121088].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Long-term outcomes of not treating anorexia nervosa in a patient with lipedema may include persistent disproportionate subcutaneous tissue accumulation on the lower half of the body despite weight loss. .", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "This can lead to decreased body image acceptance [34121088].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34121088", "evidence_support": "Poor awareness and limited diagnosis of lipedema contribute to the confusion of lipedema with obesity and can lead to decreased body image acceptance", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-1": { "answer": "Possible long-term outcomes of not treating anorexia include severe physical health complications such as heart problems, bone density loss, and organ failure, as well as psychological issues like chronic anxiety, depression, and social withdrawal. Additionally, untreated anorexia can lead to a significantly increased risk of mortality due to the combination of malnutrition and associated health risks. Early intervention is crucial to improve recovery chances and long-term health.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Possible long-term outcomes of not treating anorexia include severe physical health complications such as heart problems, bone density loss, and organ failure, as well as psychological issues like chronic anxiety, depression, and social withdrawal.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, untreated anorexia can lead to a significantly increased risk of mortality due to the combination of malnutrition and associated health risks.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Early intervention is crucial to improve recovery chances and long-term health.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "Question: What are possible long-term outcomes of not treating anorexia?", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Question: What are possible long-term outcomes of not treating anorexia?", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-gpt-6": { "answer": "Long-term outcomes of not treating anorexia can include a high rate of relapse, with studies indicating that individuals may experience a return to symptoms within two to four years after initial treatment [25440306]. Additionally, untreated anorexia can lead to severe physical and psychological complications, including malnutrition, osteoporosis, and increased risk of other mental health disorders [28927864,31074662]. The chronic nature of the illness can also result in enduring health issues and a diminished quality of life [31074662].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Long-term outcomes of not treating anorexia can include a high rate of relapse, with studies indicating that individuals may experience a return to symptoms within two to four years after initial treatment [25440306].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "25440306", "evidence_support": "Two participants (6.1%) relapsed (FBT: n\u00a0= 1, 4.5%; AFT: n\u00a0= 1, 9.1%), on average 1.98 years (SD\u00a0= 0.14 years) after remission was achieved at 1-year follow-up.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, untreated anorexia can lead to severe physical and psychological complications, including malnutrition, osteoporosis, and increased risk of other mental health disorders [28927864,31074662].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31074662", "evidence_support": "Managing the years of illness so as to have the best outcome physically and psychologically, even where full weight recovery does not occur, or has not yet occurred, is the topic of this article.", "evidence_relation": "neutral" }, { "cited_pmid": "28927864", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The chronic nature of the illness can also result in enduring health issues and a diminished quality of life [31074662].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31074662", "evidence_support": "For many sufferers of anorexia nervosa, the time course is long, and the prospect of disability and family burden great. This is all too often the case, even with early diagnosis and treatment. The term severe and enduring anorexia nervosa has been applied to these survivors. Yet, a majority of patients do eventually recover and, even where this is not the case, adaptive medical stability and function can be maintained despite alarming dilapidation.", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gemini-flash": { "answer": "Anorexia nervosa is a serious mental illness with potentially devastating long-term consequences [15379177, 8191175]. It can lead to death [8191175] and has one of the highest mortality rates of any mental illness [15379177]. Untreated anorexia can have long-term effects on bone health [15379177, 35937789], reproductive health [28700663, 35937789], and overall health [28700663]. The adolescent years are particularly vulnerable, as they are a time of neurological changes that impact cognitive function [35937789]. Untreated anorexia can also lead to persistent psychiatric health problems [17077433], such as anxiety and depression [28341321], which often persist after the eating disorder symptoms are resolved [28341321]. Early detection and intervention are crucial for achieving good long-term outcomes [14988957]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Anorexia nervosa is a serious mental illness with potentially devastating long-term consequences [15379177, 8191175].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15379177", "evidence_support": "This devastating illness and related eating disorders may have long-term effects on bone health", "evidence_relation": "supporting" }, { "cited_pmid": "8191175", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It can lead to death [8191175] and has one of the highest mortality rates of any mental illness [15379177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15379177", "evidence_support": "Anorexia nervosa has one of the highest mortality rates of any mental illness.", "evidence_relation": "supporting" }, { "cited_pmid": "8191175", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Untreated anorexia can have long-term effects on bone health [15379177, 35937789], reproductive health [28700663, 35937789], and overall health [28700663].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15379177", "evidence_support": "This devastating illness and related eating disorders may have long-term effects on bone health.", "evidence_relation": "supporting" }, { "cited_pmid": "28700663", "evidence_support": "Anorexia and bulimia nervosa may have long-term effects on overall and reproductive health.", "evidence_relation": "supporting" }, { "cited_pmid": "35937789", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The adolescent years are particularly vulnerable, as they are a time of neurological changes that impact cognitive function [35937789].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "35937789", "evidence_support": "The adolescent years are also a time of neurological changes that impact cognitive function, and anxiety and depression present more frequently during this time.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Untreated anorexia can also lead to persistent psychiatric health problems [17077433], such as anxiety and depression [28341321], which often persist after the eating disorder symptoms are resolved [28341321, 15379177].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17077433", "evidence_support": "At follow-up 9-14 years after hospital admission, 8.7% of patients with anorexia nervosa had persistent psychiatric health problems demanding hospital care and 21.4% were dependent on society for their main income; the stratified relative risks were 5.8 (95% CI 4.7-7.6) and 2.6 (2.3-3.0) respectively, compared with the general female population.", "evidence_relation": "supporting" }, { "cited_pmid": "28341321", "evidence_support": "Anorexia nervosa (AN) typically presents in adolescence and is highly comorbid with anxiety and depression, which often persist after elimination of AN symptomology. ", "evidence_relation": "supporting" }, { "cited_pmid": "15379177", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Early detection and intervention are crucial for achieving good long-term outcomes [15379177, 14988957].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15379177", "evidence_support": "Anorexia nervosa has one of the highest mortality rates of any mental illnes", "evidence_relation": "neutral" }, { "cited_pmid": "14988957", "evidence_support": "Early detection and early intervention are key elements in achieving good, long term outcomes.", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "Not treating anorexia nervosa can lead to severe long-term health consequences, including significant medical complications and a high risk of premature death, which is the highest among mental health disorders [14658557, 17108872]. Chronic malnutrition can result in irreversible effects on growth, bone health, and cardiovascular function, increasing the risk of fractures and cardiovascular issues later in life [19445758, 36792652]. Additionally, the psychological impacts can lead to chronic eating disorders in about 20% of individuals [21481284]. Early intervention is crucial to mitigate these risks and improve long-term outcomes, as untreated anorexia can cause devastating effects on both physical and mental health [37315981, 26261037].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Not treating anorexia nervosa can lead to severe long-term health consequences, including significant medical complications and a high risk of premature death, which is the highest among mental health disorders [14658557, 17108872].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17108872", "evidence_support": "Although classified as mental health disorders, they may lead to serious medical consequences and have the highest rate of premature death of any mental health diagnosis.", "evidence_relation": "supporting" }, { "cited_pmid": "14658557", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Chronic malnutrition can result in irreversible effects on growth, bone health, and cardiovascular function, increasing the risk of fractures and cardiovascular issues later in life [19445758, 36792652].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19445758", "evidence_support": "Estimated prevalence is highest in teenage girls, and up to 0.7% of this age group may be affected. While most people with anorexia nervosa recover completely or partially, about 5% die of the condition, and 20% develop a chronic eating disorder. Young women with anorexia nervosa are at increased risk of bone fractures later in life.", "evidence_relation": "supporting" }, { "cited_pmid": "36792652", "evidence_support": "Cardiovascular complications are common in patients with anorexia nervosa (AN) and population studies have revealed that developmental adaptations in response to undernutrition have long-term consequences for cardiovascular health", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, the psychological impacts can lead to chronic eating disorders in about 20% of individuals [21481284].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21481284", "evidence_support": "While most people with anorexia nervosa recover completely or partially, about 5% die of the condition, and 20% develop a chronic eating disorder.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Early intervention is crucial to mitigate these risks and improve long-term outcomes, as untreated anorexia can cause devastating effects on both physical and mental health [37315981, 26261037].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37315981", "evidence_support": "Early intervention is of utmost importance for avoiding long-term health consequences.", "evidence_relation": "supporting" }, { "cited_pmid": "37315981", "evidence_support": "Anorexia nervosa and atypical anorexia nervosa are serious, potentially life-threatening illnesses that are best addressed through early detection and treatment. ", "evidence_relation": "supporting" }, { "cited_pmid": "26261037", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] } } }, { "question_id": "140", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Spontaneous fractures, especially in the absence of direct trauma or injury, can be associated with underlying conditions that weaken bone integrity. Vigorous exercise can sometimes trigger stress fractures, particularly if there is an underlying condition such as osteoporosis, metabolic bone disease, or even nutritional deficiencies that might predispose bones to fracture under stress [27508891]. Additionally, other systemic factors, such as vascular conditions or hormonal imbalances, could contribute to the weakening of bone structures, leading to spontaneous fractures [20728663]. It is important for patients experiencing unexplained fractures to undergo a thorough medical evaluation to rule out these potential underlying causes.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Spontaneous fractures, especially in the absence of direct trauma or injury, can be associated with underlying conditions that weaken bone integrity.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Vigorous exercise can sometimes trigger stress fractures, particularly if there is an underlying condition such as osteoporosis, metabolic bone disease, or even nutritional deficiencies that might predispose bones to fracture under stress [27508891].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27508891", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, other systemic factors, such as vascular conditions or hormonal imbalances, could contribute to the weakening of bone structures, leading to spontaneous fractures [20728663].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20728663", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It is important for patients experiencing unexplained fractures to undergo a thorough medical evaluation to rule out these potential underlying causes.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Acute fractures in both hands without direct injury or trauma can result from several underlying conditions [19292188, 28164049, 21409500]. Convulsive seizures and electric shocks can cause fractures through severe muscle contractions [35140076, 19920290, 29725569]. Osteoporosis significantly increases susceptibility to low-trauma fractures due to decreased bone density [28164049]. Avascular necrosis, which can be induced by chronic steroid use or chemotherapy, weakens bones and predisposes them to fractures [19292188, 21409500]. Antiepileptic therapy and vitamin D disorders also contribute to reduced bone density, increasing fracture risk [33686840, 33999242]. Hypoglycemia and alcohol withdrawal can trigger convulsions, leading to fractures from excessive muscle contractions [35140076, 19920290, 29725569]. Acute reflex muscle contractions can cause stress fractures even in the absence of direct trauma [25379353]. Thus, a comprehensive evaluation of the patient's medical history and current medications is crucial to identify the underlying cause of acute fractures in both hands [19292188, 28164049, 21409500].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without direct injury or trauma can result from several underlying conditions [19292188, 28164049, 21409500].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21409500", "evidence_support": "Preiser's disease is a rare entity and is commonly associated with avascular necrosis of the scaphoid without fracture or trauma. A case of bilateral idiopathic avascular necrosis of the scaphoid is reported", "evidence_relation": "neutral" }, { "cited_pmid": "28164049", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "19292188", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Convulsive seizures and electric shocks can cause fractures through severe muscle contractions [35140076, 19920290, 29725569].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "19920290", "evidence_support": "Bilateral posterior fracture-dislocations of the shoulders are a rare injury that usually occurs secondary to a tonic-clonic seizure, electrocution or a high energy trauma.", "evidence_relation": "neutral" }, { "cited_pmid": "35140076", "evidence_support": "Bilateral posterior shoulder fracture dislocation is a debilitating injury and is quite rare. This injury pattern has been described in the literature as either secondary to seizure, electrocution or major trauma. We present a case of an elderly man who appears to have sustained the injury after an episode of retching and vomiting.", "evidence_relation": "neutral" }, { "cited_pmid": "29725569", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Osteoporosis significantly increases susceptibility to low-trauma fractures due to decreased bone density [28164049].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28164049", "evidence_support": "Osteoporosis is a significant health-care problem characterized by excessive skeletal fragility, susceptibility to low-trauma fractures in men as well as women. Any abnormality of the bone that reduces the strength of the bone predisposes it to mechanical failure during normal activity or with minimum trauma.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Avascular necrosis, which can be induced by chronic steroid use or chemotherapy, weakens bones and predisposes them to fractures [19292188, 21409500].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19292188", "evidence_support": "Chronic steroid use may severely decrease bone strength, thus increasing the risk for such an injury. ", "evidence_relation": "supporting" }, { "cited_pmid": "21409500", "evidence_support": "Avascular necrosis of bone may affect specific areas of the body where the blood supply to the bone or part of the bone is vulnerable to injury or disease.", "evidence_relation": "supporting" }, { "cited_pmid": "21409500", "evidence_support": "In the carpal scaphoid, it can find this entity consequent a trauma, microtrauma, or fractures, especially in the proximal pole (Preiser in Fortschr Geb Roentgenstr 15:189-197, 1910), associated with a systemic disease, steroid ingestion (Ferlic and Morin in J Hand Surg-A 14:13-16, 1989), chemotherapy (Green in Hand Clinic 3:163-168, 1987) or a hypoplastic scaphoid (Gunal et al., in J Hand Surg-B 20(6):736-740, 1995)", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Antiepileptic therapy and vitamin D disorders also contribute to reduced bone density, increasing fracture risk [33686840, 33999242].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33686840", "evidence_support": "Epileptic seizures might be associated with an increased risk of fractures, either as a result of trauma after a fall or as a result of excessive muscle contraction. In the pediatric population, excessive muscle contraction is a more significant risk factor for fractures, due to the lack of maturity in the musculoskeletal system, while antiepileptic therapy itself can lead to a reduction of bone density.", "evidence_relation": "supporting" }, { "cited_pmid": "33999242", "evidence_support": "Additionally, because of the high prevalence of pediatric vitamin D insufficiency, it is commonly identified in young children with fractures", "evidence_relation": "supporting" }, { "cited_pmid": "33999242", "evidence_support": "Despite the scientific evidence, among disorders of mineralization, non-rachitic disorders of vitamin D have become a popular non-scientific theory to explain the fractures identified in abused children.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Hypoglycemia and alcohol withdrawal can trigger convulsions, leading to fractures from excessive muscle contractions [35140076, 19920290, 29725569].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19920290", "evidence_support": "Bilateral posterior fracture-dislocations of the shoulders are a rare injury that usually occurs secondary to a tonic-clonic seizure, electrocution or a high energy trauma.", "evidence_relation": "neutral" }, { "cited_pmid": "29725569", "evidence_support": "We report a 71-years-old man who sustained a left acetabular fracture secondary to generalized seizure after clipping of an unruptured aneurysm without trauma and any risk for fracture.", "evidence_relation": "neutral" }, { "cited_pmid": "35140076", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Acute reflex muscle contractions can cause stress fractures even in the absence of direct trauma [25379353].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25379353", "evidence_support": "We report a case of right subcondylar and coronoid fractures without any evidence of direct trauma to the zygomatic area or an indirect trauma to the mandibular corpus or sypmheseal region.", "evidence_relation": "supporting" }, { "cited_pmid": "25379353", "evidence_support": "The possible cause was identified as acute reflex contraction of the temporalis muscles leading to coronoid and condylar stress fractures.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Thus, a comprehensive evaluation of the patient's medical history and current medications is crucial to identify the underlying cause of acute fractures in both hands [19292188, 28164049, 21409500].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "19292188", "evidence_support": "Awareness of the detrimental effect of chronic steroid consumption on bone morphology, and familiarity with treatment alternatives to improve bone mass is important to prevent such a severe injury.", "evidence_relation": "neutral" }, { "cited_pmid": "28164049", "evidence_support": "In people taking long-term bisphoshponate therapy, symptomatic cortical stress reactions accompanied by evidence of a stress line across the cortical thickening suggest an increased risk of a complete stress fracture.", "evidence_relation": "neutral" }, { "cited_pmid": "21409500", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Acute fractures in both hands without apparent injury or trauma can be attributed to underlying conditions such as osteoporosis or chronic steroid use, which significantly weaken bone integrity.Osteoporosis, characterized by reduced bone strength, predisposes individuals to fractures from minimal trauma or even normal activities [28164049]. Chronic steroid use, particularly in conditions like systemic lupus erythematosus or chronic lung disease, can severely impair bone metabolism, leading to fractures without significant trauma [19292188]. Additionally, avascular necrosis, often associated with steroid use or systemic diseases, can compromise bone vascularity and strength, resulting in fractures [21409500]. These conditions highlight the importance of considering metabolic bone diseases and medication history in patients presenting with unexplained bilateral hand fractures.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without apparent injury or trauma can be attributed to underlying conditions such as osteoporosis or chronic steroid use, which significantly weaken bone integrity.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Osteoporosis, characterized by reduced bone strength, predisposes individuals to fractures from minimal trauma or even normal activities [28164049].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28164049", "evidence_support": "Osteoporosis is a significant health-care problem characterized by excessive skeletal fragility, susceptibility to low-trauma fractures in men as well as women. Any abnormality of the bone that reduces the strength of the bone predisposes it to mechanical failure during normal activity or with minimum trauma.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Chronic steroid use, particularly in conditions like systemic lupus erythematosus or chronic lung disease, can severely impair bone metabolism, leading to fractures without significant trauma [19292188].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19292188", "evidence_support": "Patients with chronic lung disease and chronic inflammatory conditions are frequently treated with steroids such as prednisone at doses that may exceed 2.5 mg a day for long durations. Fractures at vulnerable sites such as the femoral ne", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, avascular necrosis, often associated with steroid use or systemic diseases, can compromise bone vascularity and strength, resulting in fractures [21409500].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21409500", "evidence_support": "Avascular necrosis of bone may affect specific areas of the body where the blood supply to the bone or part of the bone is vulnerable to injury or disease.", "evidence_relation": "supporting" }, { "cited_pmid": "21409500", "evidence_support": "In the carpal scaphoid, it can find this entity consequent a trauma, microtrauma, or fractures, especially in the proximal pole (Preiser in Fortschr Geb Roentgenstr 15:189-197, 1910), associated with a systemic disease, steroid ingestion (Ferlic and Morin in J Hand Surg-A 14:13-16, 1989),", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "These conditions highlight the importance of considering metabolic bone diseases and medication history in patients presenting with unexplained bilateral hand fractures.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Acute fractures in both hands without injury or trauma can be caused by various factors, including osteoporosis, which can lead to pathological fractures [28164049]. Certain medications, such as bisphosphonates, can also increase the risk of fractures, even with minimal trauma [28164049]. Additionally, conditions like avascular necrosis, which can be caused by steroid ingestion or other factors, can lead to fractures without trauma [21409500]. In rare cases, fractures can occur due to electrically-induced tetanic muscle contractions caused by electric shocks, even at low voltages [24733506]. Furthermore, repetitive stress and overuse, such as in gymnasts, can lead to chronic progression of separation of the distal humeral epiphyses, resulting in bilateral fractures [25438108]. It is essential to investigate the underlying cause of such fractures to provide proper treatment and prevent further complications.are relevant studies that support this information [28164049, 21409500, 24733506].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without injury or trauma can be caused by various factors, including osteoporosis, which can lead to pathological fractures [28164049].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28164049", "evidence_support": "Osteoporosis is a significant health-care problem characterized by excessive skeletal fragility, susceptibility to low-trauma fractures in men as well as women. Any abnormality of the bone that reduces the strength of the bone predisposes it to mechanical failure during normal activity or with minimum trauma. The mechanical failure manifests itself as a fracture, and this fracture must be recognized as a pathological fracture if the patient is to be treated properly.", "evidence_relation": "supporting" }, { "cited_pmid": "28164049", "evidence_support": "Osteoporosis is one of the leading causes of such pathological fractures and accounts for 1.5 million fractures annually", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Certain medications, such as bisphosphonates, can also increase the risk of fractures, even with minimal trauma [28164049].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28164049", "evidence_support": "In the following case report, we present a 56-year-old postmenopausal female patient with bilateral pathological subtrochanteric fracture femurii due to intake of bisphosponates for 4 years for osteoporosis", "evidence_relation": "supporting" }, { "cited_pmid": "28164049", "evidence_support": "In people taking long-term bisphoshponate therapy, symptomatic cortical stress reactions accompanied by evidence of a stress line across the cortical thickening suggest an increased risk of a complete stress fracture. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, conditions like avascular necrosis, which can be caused by steroid ingestion or other factors, can lead to fractures without trauma [21409500].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21409500", "evidence_support": "Avascular necrosis of bone may affect specific areas of the body where the blood supply to the bone or part of the bone is vulnerable to injury or disease", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In rare cases, fractures can occur due to electrically-induced tetanic muscle contractions caused by electric shocks, even at low voltages [24733506].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24733506", "evidence_support": "Few cases of fractures after electric shocks at low-voltages (with no direct blunt trauma) are reported in the literature. They result from electrically-induced tetanic muscle contractions.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, repetitive stress and overuse, such as in gymnasts, can lead to chronic progression of separation of the distal humeral epiphyses, resulting in bilateral fractures [25438108].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25438108", "evidence_support": "We report a case of an 11-year-old male patient who sustained separation of the distal humeral epiphyses bilaterally after 2 years of gymnastics, without a clear mechanism of injury.", "evidence_relation": "supporting" }, { "cited_pmid": "25438108", "evidence_support": "Consequently, this type of repeated stress induces injury to the epiphyseal cartilages bilaterally, resulting in chronic progression of separation of the distal humeral epiphyses.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "It is essential to investigate the underlying cause of such fractures to provide proper treatment and prevent further complications.are relevant studies that support this information [28164049, 21409500, 24733506].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "28164049", "evidence_support": "Any abnormality of the bone that reduces the strength of the bone predisposes it to mechanical failure during normal activity or with minimum trauma.", "evidence_relation": "neutral" }, { "cited_pmid": "24733506", "evidence_support": "Only four cases of radius fractures resulting from accidental electric shocks at low voltages have been previously reported in the literature. All of them involved pediatric patients, suggesting that a child's vulnerability to this kind of fracture may exist.", "evidence_relation": "neutral" }, { "cited_pmid": "21409500", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "Stress fractures can occur in the hands without any injury or trauma, especially in athletes who participate in sports that involve repetitive stress on the hands and wrists, such as tennis, gymnastics, and rock climbing [14977672, 20212101, 27848072]. These fractures can be caused by repetitive strain on the bones, leading to small cracks or breaks [32978679, 20212101, 25959203]. In some cases, stress fractures can also be caused by underlying conditions such as osteoporosis or bone disease [19858462]. Additionally, certain medications, such as bisphosphonates, can increase the risk of stress fractures [25227921, 20189757]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Stress fractures can occur in the hands without any injury or trauma, especially in athletes who participate in sports that involve repetitive stress on the hands and wrists, such as tennis, gymnastics, and rock climbing [14977672, 20212101, 27848072].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14977672", "evidence_support": "Overall, by location, the hand contributed the greatest number of total fractures. By sport, the incidence rate was highest in basketball (0.081) for male athletes and in gymnastics (0.069) for female athletes. ", "evidence_relation": "supporting" }, { "cited_pmid": "14977672", "evidence_support": "Female athletes sustained significantly more stress fractures.", "evidence_relation": "neutral" }, { "cited_pmid": "20212101", "evidence_support": "Stress fractures of the second metacarpal are characteristic of adolescent tennis players and are associated with an increased intensity of tennis play and may be associated with use of the semi-Western or Western grip.", "evidence_relation": "supporting" }, { "cited_pmid": "27848072", "evidence_support": "These fractures occur frequently in individuals participating in sports activities involving racquets, bats, or clubs.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These fractures can be caused by repetitive strain on the bones, leading to small cracks or breaks [32978679, 20212101, 25959203].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25959203", "evidence_support": "Stress fractures of the upper limbs are uncommon, and are most often reported as individual cases or small series.", "evidence_relation": "supporting" }, { "cited_pmid": "20212101", "evidence_support": "here are 12 reported cases of metacarpal stress fractures in athletes, with only 4 of them involving the second metacarpal.", "evidence_relation": "supporting" }, { "cited_pmid": "32978679", "evidence_support": "Stress fractures of the upper extremities in athletes are important injuries for radiologists to appreciate despite being far less common than stress fractures\u00a0of the lower extremities.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In some cases, stress fractures can also be caused by underlying conditions such as osteoporosis or bone disease [19858462].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19858462", "evidence_support": "Osteoporosis is an important risk factor for fragility fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "19858462", "evidence_support": "In 2007, 9,346 NARCOMS participants reported fractures and clinical risk factors for fractures including history of osteoporosis or osteopenia (low bone mass), sedentary level of physical activity, falls in the last year, current smoking status, family history of osteoporosis, and impaired mobility.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, certain medications, such as bisphosphonates, can increase the risk of stress fractures [25227921, 20189757].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25227921", "evidence_support": "Long-term bisphosphonate use has been suggested to result in decreased bone remodelling and increased risk of atypical fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "25227921", "evidence_support": "Ulnar fractures in patients with bisphosphonate therapy demonstrate features similar to those described for atypical femoral fractures, suggesting that these fractures could also possibly be due to bisphosphonate use. ", "evidence_relation": "supporting" }, { "cited_pmid": "20189757", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Primary hyperparathyroidism can cause spontaneous fractures in young patients, including finger fractures, due to osteoporosis and decreased bone strength [15856364, 27196476, 19275452]. Osteogenesis imperfecta, a heritable disorder of bone, can also lead to spontaneous fractures after trivial trauma, as seen in a 27-year-old woman who experienced multiple fractures in her left hand after a fall while dancing [27196476, 37278060, 19275452]. In some cases, spontaneous fractures can occur without any apparent cause, as seen in a healthy young man who experienced concurrent bilateral nontraumatic fractures of the clavicle [27196476, 16741479, 31215795]. Additionally, acute calcific tendinitis of the finger can cause spontaneous fractures, and spontaneous fractures can also occur in patients with rheumatoid arthritis due to osteopenic bone [21597994, 15856364, 27196476]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Primary hyperparathyroidism can cause spontaneous fractures in young patients, including finger fractures, due to osteoporosis and decreased bone strength [15856364, 27196476, 19275452].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27196476", "evidence_support": "Osteoporosis and osteoporotic fractures represent a substantial health burden, and predominantly affect the elderly. Younger generations may also develop these conditions because of various predisposing conditions, including primary hyperparathyroidism", "evidence_relation": "supporting" }, { "cited_pmid": "19275452", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15856364", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Osteogenesis imperfecta, a heritable disorder of bone, can also lead to spontaneous fractures after trivial trauma, as seen in a 27-year-old woman who experienced multiple fractures in her left hand after a fall while dancing [27196476, 37278060, 19275452].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37278060", "evidence_support": "Children with osteogenesis imperfecta (OI) frequently present with fractures;", "evidence_relation": "supporting" }, { "cited_pmid": "19275452", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "27196476", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In some cases, spontaneous fractures can occur without any apparent cause, as seen in a healthy young man who experienced concurrent bilateral nontraumatic fractures of the clavicle [27196476, 16741479, 31215795].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16741479", "evidence_support": "We report a case of concurrent bilateral nontraumatic fractures of the clavicle occurring in a healthy young man in the absence of repetitive trauma.", "evidence_relation": "supporting" }, { "cited_pmid": "31215795", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "27196476", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, acute calcific tendinitis of the finger can cause spontaneous fractures, and spontaneous fractures can also occur in patients with rheumatoid arthritis due to osteopenic bone [21597994, 15856364, 27196476].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21597994", "evidence_support": "Patients with rheumatoid arthritis have osteopenic bone secondary to a variety of causes. We report a case of bilateral stress fractures of the ulna in an elderly patient with rheumatoid arthritis, and literature on this condition is reviewed.", "evidence_relation": "supporting" }, { "cited_pmid": "15856364", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "27196476", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Acute fractures in both hands without injury or trauma can be caused by various conditions, including osteogenesis imperfecta, primary hyperparathyroidism, and non-traumatic fractures following seizures [27196476, 20205769, 15856364]. Osteogenesis imperfecta is a heritable disorder of bone that predisposes patients to fractures after trivial trauma [19646378]. Primary hyperparathyroidism can cause osteoporosis and osteoporotic fractures, even in young patients [27196476]. Non-traumatic fractures can also occur due to metabolic conditions such as hypercorticism and diabetic chronic renal failure, which can lead to a decrease in bone mineral density [27196476, 20205769]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without injury or trauma can be caused by various conditions, including osteogenesis imperfecta, primary hyperparathyroidism, and non-traumatic fractures following seizures [27196476, 20205769, 15856364].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27196476", "evidence_support": "Younger generations may also develop these conditions because of various predisposing conditions, including primary hyperparathyroidism.", "evidence_relation": "neutral" }, { "cited_pmid": "27196476", "evidence_support": "Clinicians should be aware that finger fractures may be an early skeletal manifestation of primary hyperparathyroidism that can help achieve a prompt diagnosis of the condition, especially when they occur in young adults in the absence of major trauma.", "evidence_relation": "supporting" }, { "cited_pmid": "20205769", "evidence_support": "Seizures with or without trauma may cause fractures that occur commonly in epileptic seizures.", "evidence_relation": "supporting" }, { "cited_pmid": "15856364", "evidence_support": "In a 51-year-old woman with a history of fractures and dislocations after low intensity trauma in childhood, intensive blue sclera, short stature, and hearing loss, the diagnosis of osteogenesis imperfecta (OI) was suspected.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Osteogenesis imperfecta is a heritable disorder of bone that predisposes patients to fractures after trivial trauma [19646378].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19646378", "evidence_support": "Osteogenesis imperfecta is a heritable disorder of bone, which predisposes patients to fractures after trivial trauma, as was demonstrated in this case.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Primary hyperparathyroidism can cause osteoporosis and osteoporotic fractures, even in young patients [27196476].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27196476", "evidence_support": "Osteoporosis and osteoporotic fractures represent a substantial health burden, and predominantly affect the elderly. Younger generations may also develop these conditions because of various predisposing conditions, including primary hyperparathyroidism.", "evidence_relation": "supporting" }, { "cited_pmid": "27196476", "evidence_support": "Clinicians should be aware that finger fractures may be an early skeletal manifestation of primary hyperparathyroidism that can help achieve a prompt diagnosis of the condition, especially when they occur in young adults in the absence of major trauma.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Non-traumatic fractures can also occur due to metabolic conditions such as hypercorticism and diabetic chronic renal failure, which can lead to a decrease in bone mineral density [27196476, 20205769].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20205769", "evidence_support": "Some metabolic conditions leading to a decrease in bone mineral density may cause fractures secondary to non-epileptic seizure", "evidence_relation": "supporting" }, { "cited_pmid": "20205769", "evidence_support": "They occurred in two male patients, 18 and 48 years old suffering respectively from hypercorticism and poorly controlled diabetes mellitus", "evidence_relation": "supporting" }, { "cited_pmid": "20205769", "evidence_support": "Fracture was promoted by a decrease in mineral bone density caused respectively by hypercorticism and diabetic chronic renal failure.", "evidence_relation": "supporting" }, { "cited_pmid": "27196476", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Acute fractures in both hands without injury or trauma can be caused by various conditions, including osteogenesis imperfecta, primary hyperparathyroidism, and non-traumatic fractures following seizures [27196476]. Osteogenesis imperfecta is a heritable disorder of bone that predisposes patients to fractures after trivial trauma [25439022, 18328983, 19646378]. Primary hyperparathyroidism can cause osteoporosis and osteoporotic fractures, even in young patients [36173907, 27196476]. Non-traumatic fractures can also occur due to metabolic conditions such as hypercorticism and diabetic chronic renal failure, which can lead to a decrease in bone mineral density [20205769, 18988699, 20808045]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without injury or trauma can be caused by various conditions, including osteogenesis imperfecta, primary hyperparathyroidism, and non-traumatic fractures following seizures [27196476].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27196476", "evidence_support": "Younger generations may also develop these conditions because of various predisposing conditions, including primary hyperparathyroidism.", "evidence_relation": "supporting" }, { "cited_pmid": "27196476", "evidence_support": "Clinicians should be aware that finger fractures may be an early skeletal manifestation of primary hyperparathyroidism that can help achieve a prompt diagnosis of the condition, especially when they occur in young adults in the absence of major trauma.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Osteogenesis imperfecta is a heritable disorder of bone that predisposes patients to fractures after trivial trauma [25439022, 18328983, 19646378].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25439022", "evidence_support": "Osteogenesis imperfecta (OI) is a heritable bone fragility disorder that presents with a wide clinical phenotype spectrum: from perinatal lethality and severe deformities to very mild forms without fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "18328983", "evidence_support": "Osteogenesis Imperfecta is a heritable disorder characterized by bone fragility and low bone mass, with a wide spectrum of clinical expression.", "evidence_relation": "supporting" }, { "cited_pmid": "19646378", "evidence_support": "Osteogenesis imperfecta is a heritable disorder of bone, which predisposes patients to fractures after trivial trauma, as was demonstrated in this case.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Primary hyperparathyroidism can cause osteoporosis and osteoporotic fractures, even in young patients [36173907, 27196476].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36173907", "evidence_support": "PHPT is usually caused by an adenoma and its presentation is often asymptomatic, though it can negatively impact the skeleton via osteoporosis mostly affecting cortical bone and fracture", "evidence_relation": "supporting" }, { "cited_pmid": "27196476", "evidence_support": "Osteoporosis and osteoporotic fractures represent a substantial health burden, and predominantly affect the elderly. Younger generations may also develop these conditions because of various predisposing conditions, including primary hyperparathyroidism.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Non-traumatic fractures can also occur due to metabolic conditions such as hypercorticism and diabetic chronic renal failure, which can lead to a decrease in bone mineral density [20205769, 18988699, 20808045].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20205769", "evidence_support": "Some metabolic conditions leading to a decrease in bone mineral density may cause fractures secondary to non-epileptic seizure", "evidence_relation": "supporting" }, { "cited_pmid": "20205769", "evidence_support": "Fracture was promoted by a decrease in mineral bone density caused respectively by hypercorticism and diabetic chronic renal failure.", "evidence_relation": "supporting" }, { "cited_pmid": "20205769", "evidence_support": "These observations emphasize that fracture prevention among patients with decreased mineral bone density should include the avoidance of metabolic causes of seizure.", "evidence_relation": "supporting" }, { "cited_pmid": "18988699", "evidence_support": "However, osteoporosis in stage 4 to 5 chronic kidney disease cannot be diagnosed on the basis of bone mineral density criteria established by the World Health Organization or the presence of fragility fractures because patients with all forms of renal bone disease can demonstrate low bone mineral density and fragility fractures.", "evidence_relation": "neutral" }, { "cited_pmid": "20808045", "evidence_support": "In DM, either type 1 or type 2, fracture risk is elevated probably due to deteriorated bone quality and increased frequency of falls, because the risk is much higher than that expected by bone density. In CKD, especially in patients undergoing dialysis therapy, high risks of fractures in younger people and of mortality after fractures are striking. Even mild to moderate renal dysfunction has recently been reported to elevate fracture risk.", "evidence_relation": "supporting" }, { "cited_pmid": "20808045", "evidence_support": "In GIO, we reviewed some papers in terms of relationship between doses and duration of corticosteroids and fracture ris", "evidence_relation": "neutral" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Acute fractures in both hands without injury or trauma can be caused by various conditions, including osteogenesis imperfecta, primary hyperparathyroidism, and non-traumatic fractures following seizures [15856364]. Osteogenesis imperfecta is a heritable disorder of bone that predisposes patients to fractures after trivial trauma [25439022, 18328983, 19646378]. Primary hyperparathyroidism can cause osteoporosis and osteoporotic fractures, even in young patients [36173907, 27196476]. Non-traumatic fractures can also occur due to metabolic conditions such as hypercorticism and diabetic chronic renal failure, which can lead to a decrease in bone mineral density [20205769, 20808045, 18988699]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without injury or trauma can be caused by various conditions, including osteogenesis imperfecta, primary hyperparathyroidism, and non-traumatic fractures following seizures [15856364].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15856364", "evidence_support": "She had radiographic evidence of healed fractures of the left fibula, the third metacarpal, and the fourth and fifth middle phalanges of the right hand. OI, affecting the type I collagen tissue of the sclera, skin, ligaments, and skeleton, presenting with ligament laxity resulting in subluxations and hand deformities may be misdiagnosed as hand deformities of rheumatoid arthritis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Osteogenesis imperfecta is a heritable disorder of bone that predisposes patients to fractures after trivial trauma [25439022, 18328983, 19646378].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25439022", "evidence_support": "Osteogenesis imperfecta (OI) is a heritable bone fragility disorder that presents with a wide clinical phenotype spectrum: from perinatal lethality and severe deformities to very mild forms without fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "18328983", "evidence_support": "Osteogenesis Imperfecta is a heritable disorder characterized by bone fragility and low bone mass, with a wide spectrum of clinical expression. ", "evidence_relation": "supporting" }, { "cited_pmid": "19646378", "evidence_support": "Osteogenesis imperfecta is a heritable disorder of bone, which predisposes patients to fractures after trivial trauma, as was demonstrated in this case.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Primary hyperparathyroidism can cause osteoporosis and osteoporotic fractures, even in young patients [36173907, 27196476].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36173907", "evidence_support": "PHPT is usually caused by an adenoma and its presentation is often asymptomatic, though it can negatively impact the skeleton via osteoporosis mostly affecting cortical bone and fracture.", "evidence_relation": "supporting" }, { "cited_pmid": "27196476", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Non-traumatic fractures can also occur due to metabolic conditions such as hypercorticism and diabetic chronic renal failure, which can lead to a decrease in bone mineral density [20205769, 20808045, 18988699].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20205769", "evidence_support": "Some metabolic conditions leading to a decrease in bone mineral density may cause fractures secondary to non-epileptic seizure.", "evidence_relation": "neutral" }, { "cited_pmid": "20205769", "evidence_support": "They occurred in two male patients, 18 and 48 years old suffering respectively from hypercorticism and poorly controlled diabetes mellitus", "evidence_relation": "supporting" }, { "cited_pmid": "20808045", "evidence_support": "In this review, we focused on diabetes mellitus (DM) , chronic kidney disease (CKD) , and glucocorticoid-induced osteoporosis (GIO) , which frequently occurred in the clinical settings, to discuss hip fracture risk.", "evidence_relation": "supporting" }, { "cited_pmid": "18988699", "evidence_support": "However, osteoporosis in stage 4 to 5 chronic kidney disease cannot be diagnosed on the basis of bone mineral density criteria established by the World Health Organization or the presence of fragility fractures because patients with all forms of renal bone disease can demonstrate low bone mineral density and fragility fractures", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Osteogenesis imperfecta is a heritable disorder of bone that predisposes patients to fractures after trivial trauma [19646378, 25439022, 18328983]. Primary hyperparathyroidism can cause osteoporosis and osteoporotic fractures, even in young patients [36173907, 27196476]. Non-traumatic fractures can also occur due to metabolic conditions such as hypercorticism and diabetic chronic renal failure, which can lead to a decrease in bone mineral density [20808045, 18988699, 20205769]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Osteogenesis imperfecta is a heritable disorder of bone that predisposes patients to fractures after trivial trauma [19646378, 25439022, 18328983].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19646378", "evidence_support": "Osteogenesis imperfecta is a heritable disorder of bone, which predisposes patients to fractures after trivial trauma, as was demonstrated in this case.", "evidence_relation": "supporting" }, { "cited_pmid": "25439022", "evidence_support": "Osteogenesis imperfecta (OI) is a heritable bone fragility disorder that presents with a wide clinical phenotype spectrum: from perinatal lethality and severe deformities to very mild forms without fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "18328983", "evidence_support": "Osteogenesis Imperfecta is a heritable disorder characterized by bone fragility and low bone mass, with a wide spectrum of clinical expression.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Primary hyperparathyroidism can cause osteoporosis and osteoporotic fractures, even in young patients [36173907, 27196476].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36173907", "evidence_support": "PHPT is usually caused by an adenoma and its presentation is often asymptomatic, though it can negatively impact the skeleton via osteoporosis mostly affecting cortical bone and fracture.", "evidence_relation": "supporting" }, { "cited_pmid": "36173907", "evidence_support": "Limited data exist on NPHPT's effects on the skeleton, though current evidence suggests a positive correlation between the disorder and the presence of osteoporotic fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "27196476", "evidence_support": "Osteoporosis and osteoporotic fractures represent a substantial health burden, and predominantly affect the elderly. Younger generations may also develop these conditions because of various predisposing conditions, including primary hyperparathyroidism.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Non-traumatic fractures can also occur due to metabolic conditions such as hypercorticism and diabetic chronic renal failure, which can lead to a decrease in bone mineral density [20808045, 18988699, 20205769].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20808045", "evidence_support": "In DM, either type 1 or type 2, fracture risk is elevated probably due to deteriorated bone quality and increased frequency of falls, because the risk is much higher than that expected by bone density. In CKD, especially in patients undergoing dialysis therapy, high risks of fractures in younger people and of mortality after fractures are striking. Even mild to moderate renal dysfunction has recently been reported to elevate fracture risk.", "evidence_relation": "supporting" }, { "cited_pmid": "20205769", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18988699", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Acute fractures in both hands without injury or trauma can be caused by various conditions, including osteogenesis imperfecta, primary hyperparathyroidism, and non-traumatic fractures following seizures [27196476, 15856364, 19646378]. Osteogenesis imperfecta is a heritable disorder of bone that predisposes patients to fractures after trivial trauma [19014167, 30838070, 17560761]. Primary hyperparathyroidism can cause osteoporosis and osteoporotic fractures, even in young patients [27196476, 15841948, 16799210]. Non-traumatic fractures can also occur due to metabolic conditions such as hypercorticism and diabetic chronic renal failure, which can lead to a decrease in bone mineral density [28851260, 19275452, 35843715]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without injury or trauma can be caused by various conditions, including osteogenesis imperfecta, primary hyperparathyroidism, and non-traumatic fractures following seizures [27196476, 15856364, 19646378].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27196476", "evidence_support": "Younger generations may also develop these conditions because of various predisposing conditions, including primary hyperparathyroidism.", "evidence_relation": "supporting" }, { "cited_pmid": "27196476", "evidence_support": "Clinicians should be aware that finger fractures may be an early skeletal manifestation of primary hyperparathyroidism that can help achieve a prompt diagnosis of the condition, especially when they occur in young adults in the absence of major trauma.", "evidence_relation": "supporting" }, { "cited_pmid": "15856364", "evidence_support": "In a 51-year-old woman with a history of fractures and dislocations after low intensity trauma in childhood, intensive blue sclera, short stature, and hearing loss, the diagnosis of osteogenesis imperfecta (OI) was suspected.", "evidence_relation": "supporting" }, { "cited_pmid": "15856364", "evidence_support": "Bone mineral density evaluated by dual-energy X-ray absorptiometry (DEXA) showed severe osteoporosis of the femur and lumbar vertebrae.", "evidence_relation": "neutral" }, { "cited_pmid": "19646378", "evidence_support": "Osteogenesis imperfecta is a heritable disorder of bone, which predisposes patients to fractures after trivial trauma, as was demonstrated in this case.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Osteogenesis imperfecta is a heritable disorder of bone that predisposes patients to fractures after trivial trauma [19014167, 30838070, 17560761].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19014167", "evidence_support": "In osteogenesis imperfecta bone is osteoporotic.", "evidence_relation": "supporting" }, { "cited_pmid": "30838070", "evidence_support": "The overall bone biomechanics result in a relatively weak and brittle structure.", "evidence_relation": "neutral" }, { "cited_pmid": "17560761", "evidence_support": "Osteogenesis imperfecta is a genetic disorder that causes increased bone fragility and low bone mass.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Primary hyperparathyroidism can cause osteoporosis and osteoporotic fractures, even in young patients [27196476, 15841948, 16799210].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27196476", "evidence_support": "Osteoporosis and osteoporotic fractures represent a substantial health burden, and predominantly affect the elderly. Younger generations may also develop these conditions because of various predisposing conditions, including primary hyperparathyroidism.", "evidence_relation": "supporting" }, { "cited_pmid": "16799210", "evidence_support": "Secondary osteoporosis is the result of an underlying disease such as an endocrine abnormality, and an example of such is primary hyperparathyroidism", "evidence_relation": "supporting" }, { "cited_pmid": "15841948", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Non-traumatic fractures can also occur due to metabolic conditions such as hypercorticism and diabetic chronic renal failure, which can lead to a decrease in bone mineral density [28851260, 19275452, 35843715].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28851260", "evidence_support": "The lumbar spine and femoral neck BMD were significantly lower in the ACS and CD groups than in the control group.", "evidence_relation": "supporting" }, { "cited_pmid": "19275452", "evidence_support": "Among the most common causes of spontaneous fracture are", "evidence_relation": "neutral" }, { "cited_pmid": "19275452", "evidence_support": "osteodystrophy because of chronic renal failure", "evidence_relation": "neutral" }, { "cited_pmid": "35843715", "evidence_support": "Impaired bone mineralization in patients with PAI is correlated with HC dose. A daily HC dose \u226512 mg/m2/day was associated with an increased risk of osteopenia and osteoporosis in these patients", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Acute fractures in both hands without injury or trauma can be caused by various conditions, including osteogenesis imperfecta and primary hyperparathyroidism [19646378]. Osteogenesis imperfecta is a heritable disorder of bone, which predisposes patients to fractures after trivial trauma [19646378]. Osteogenesis imperfecta is a heritable disorder of bone that predisposes patients to fractures after trivial trauma [24964776, 28820180, 17560761]. Primary hyperparathyroidism can cause osteoporosis and osteoporotic fractures, even in young patients [15262513, 28131138, 18167138]. Non-traumatic fractures can also occur due to metabolic conditions such as metabolic syndrome, type 2 diabetes, and dysmobility syndrome, which can lead to a decrease in bone mineral density [15920858, 34905879, 34638624]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without injury or trauma can be caused by various conditions, including osteogenesis imperfecta and primary hyperparathyroidism [19646378].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19646378", "evidence_support": "Osteogenesis imperfecta is a heritable disorder of bone, which predisposes patients to fractures after trivial trauma, as was demonstrated in this case.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Osteogenesis imperfecta is a heritable disorder of bone, which predisposes patients to fractures after trivial trauma [19646378].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19646378", "evidence_support": "Osteogenesis imperfecta is a heritable disorder of bone, which predisposes patients to fractures after trivial trauma, as was demonstrated in this case.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Osteogenesis imperfecta is a heritable disorder of bone that predisposes patients to fractures after trivial trauma [24964776, 28820180, 17560761].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24964776", "evidence_support": "Osteogenesis imperfecta (OI) is a genetic bone fragility disorder characterized by low bone mass, skeletal deformity, and variable short stature", "evidence_relation": "supporting" }, { "cited_pmid": "28820180", "evidence_support": "Skeletal deformity and bone fragility are the hallmarks of the brittle bone dysplasia osteogenesis imperfecta.", "evidence_relation": "supporting" }, { "cited_pmid": "17560761", "evidence_support": "Osteogenesis imperfecta is a genetic disorder that causes increased bone fragility and low bone mass.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Primary hyperparathyroidism can cause osteoporosis and osteoporotic fractures, even in young patients [15262513, 28131138, 18167138].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15262513", "evidence_support": "Primary HPT is associated with increased fracture risk both at the cancellous bone-enriched spine and the cortical bone-enriched distal one third of the radius.", "evidence_relation": "supporting" }, { "cited_pmid": "28131138", "evidence_support": "Diminished bone mineral density and nephrolithiasis are the major current clinical sequelae", "evidence_relation": "neutral" }, { "cited_pmid": "18167138", "evidence_support": "Epidemiological studies have shown that the relative risk of spine and nonspine fractures is increased in untreated PHPT starting up to 10 years before the diagnosis is made", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Non-traumatic fractures can also occur due to metabolic conditions such as metabolic syndrome, type 2 diabetes, and dysmobility syndrome, which can lead to a decrease in bone mineral density [15920858, 34905879, 34638624].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34905879", "evidence_support": "Animal and human studies suggest metabolic and dysmobility syndromes negatively impact on the risk for fragility fracture, contributing to increase the associated mortality rate", "evidence_relation": "supporting" }, { "cited_pmid": "34905879", "evidence_support": "In recent years, strong correlation between type 2 diabetes, a frequent constitutive part of metabolic syndrome and fragility fracture risk has been reported, but the possible molecular mechanisms by which it can occur are still to be defined.", "evidence_relation": "supporting" }, { "cited_pmid": "34638624", "evidence_support": "However, bone fragility can manifest at any age, within the context of a wide spectrum of congenital rare bone metabolic diseases in which the inherited genetic defect alters correct bone modeling and remodeling at different points and aspects of bone synthesis and/or bone resorption, leading to defective bone tissue highly prone to long bone bowing, stress fractures and pseudofractures, and/or fragility fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "15920858", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Acute fractures in both hands without injury or trauma can be caused by various conditions, including osteogenesis imperfecta, primary hyperparathyroidism, and non-traumatic fractures following seizures [37278060, 28820180, 26531771]. Osteogenesis imperfecta is a heritable disorder of bone that predisposes patients to fractures after trivial trauma [28820180, 17560761, 24964776]. Primary hyperparathyroidism can cause osteoporosis and osteoporotic fractures, even in young patients [15841948, 30665547, 33484857]. Non-traumatic fractures can also occur due to metabolic conditions such as hypercorticism and diabetic chronic renal failure, which can lead to a decrease in bone mineral density [22715262, 20205769]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without injury or trauma can be caused by various conditions, including osteogenesis imperfecta, primary hyperparathyroidism, and non-traumatic fractures following seizures [37278060, 28820180, 26531771].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37278060", "evidence_support": "Children with osteogenesis imperfecta (OI) frequently present with fractures; however, hand and wrist fractures (HWFs), those distal to the radial and ulnar diaphysis, are seldom observed.", "evidence_relation": "contradicting" }, { "cited_pmid": "37278060", "evidence_support": "OI HWFs are uncommon (3.8%, 18/469) but specific HWF morphologies and locations are more common in patients with OI; however, these are not pathognomonic.", "evidence_relation": "neutral" }, { "cited_pmid": "28820180", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "26531771", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Osteogenesis imperfecta is a heritable disorder of bone that predisposes patients to fractures after trivial trauma [28820180, 17560761, 24964776].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28820180", "evidence_support": "Skeletal deformity and bone fragility are the hallmarks of the brittle bone dysplasia osteogenesis imperfecta. The diagnosis of osteogenesis imperfecta usually depends on family history and clinical presentation characterized by a fracture (or fractures) during the prenatal period, at birth or in early childhood; genetic tests can confirm diagnosis.", "evidence_relation": "supporting" }, { "cited_pmid": "17560761", "evidence_support": "Osteogenesis imperfecta is a genetic disorder that causes increased bone fragility and low bone mass.", "evidence_relation": "supporting" }, { "cited_pmid": "24964776", "evidence_support": "Osteogenesis imperfecta (OI) is a genetic bone fragility disorder characterized by low bone mass, skeletal deformity, and variable short stature.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Primary hyperparathyroidism can cause osteoporosis and osteoporotic fractures, even in young patients [15841948, 30665547, 33484857].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15841948", "evidence_support": "Parathyroid hormone assays are being increasingly performed as part of the routine evaluation of osteoporosis.", "evidence_relation": "neutral" }, { "cited_pmid": "30665547", "evidence_support": "Traditionally, classical complications of primary hyperparathyroidism are mainly represented by skeletal, kidney and gastrointestinal involvement", "evidence_relation": "supporting" }, { "cited_pmid": "33484857", "evidence_support": "It is usually diagnosed incidentally in case of hypercalcemia, osteoporosis or, more rarely, renal involvement such as lithiasis. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Non-traumatic fractures can also occur due to metabolic conditions such as hypercorticism and diabetic chronic renal failure, which can lead to a decrease in bone mineral density [22715262, 20205769].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20205769", "evidence_support": "Some metabolic conditions leading to a decrease in bone mineral density may cause fractures secondary to non-epileptic seizure.", "evidence_relation": "supporting" }, { "cited_pmid": "20205769", "evidence_support": "They occurred in two male patients, 18 and 48 years old suffering respectively from hypercorticism and poorly controlled diabetes mellitus", "evidence_relation": "supporting" }, { "cited_pmid": "20205769", "evidence_support": "Fracture was promoted by a decrease in mineral bone density caused respectively by hypercorticism and diabetic chronic renal failure.", "evidence_relation": "supporting" }, { "cited_pmid": "20205769", "evidence_support": "These observations emphasize that fracture prevention among patients with decreased mineral bone density should include the avoidance of metabolic causes of seizure.", "evidence_relation": "supporting" }, { "cited_pmid": "22715262", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Acute fractures in both hands without injury or trauma can be caused by various conditions, including osteogenesis imperfecta, primary hyperparathyroidism, and non-traumatic fractures following seizures [19646378]. Osteogenesis imperfecta is a heritable disorder of bone that predisposes patients to fractures after trivial trauma [15110498, 17560761, 24964776]. Primary hyperparathyroidism can cause osteoporosis and osteoporotic fractures, even in young patients [30665547, 33484857, 18167138]. Non-traumatic fractures can also occur due to metabolic conditions such as hypercorticism and diabetic chronic renal failure, which can lead to a decrease in bone mineral density [24554936, 19275452, 18401211]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without injury or trauma can be caused by various conditions, including osteogenesis imperfecta, primary hyperparathyroidism, and non-traumatic fractures following seizures [19646378].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19646378", "evidence_support": "Osteogenesis imperfecta is a heritable disorder of bone, which predisposes patients to fractures after trivial trauma, as was demonstrated in this case.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Osteogenesis imperfecta is a heritable disorder of bone that predisposes patients to fractures after trivial trauma [15110498, 17560761, 24964776].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15110498", "evidence_support": "Osteogenesis imperfecta is a genetic disorder of increased bone fragility, low bone mass, and other connective-tissue manifestations.", "evidence_relation": "supporting" }, { "cited_pmid": "17560761", "evidence_support": "Osteogenesis imperfecta is a genetic disorder that causes increased bone fragility and low bone mass.", "evidence_relation": "supporting" }, { "cited_pmid": "24964776", "evidence_support": "Osteogenesis imperfecta (OI) is a genetic bone fragility disorder characterized by low bone mass, skeletal deformity, and variable short stature.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Primary hyperparathyroidism can cause osteoporosis and osteoporotic fractures, even in young patients [30665547, 33484857, 18167138].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33484857", "evidence_support": "Primary hyperparathyroidism (PHPT) is a disease caused by excessive and inappropriate secretion of parathyroid hormone resulting in hypercalcemia", "evidence_relation": "neutral" }, { "cited_pmid": "33484857", "evidence_support": "It is usually diagnosed incidentally in case of hypercalcemia, osteoporosis or, more rarely, renal involvement such as lithiasis.", "evidence_relation": "supporting" }, { "cited_pmid": "18167138", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "30665547", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Non-traumatic fractures can also occur due to metabolic conditions such as hypercorticism and diabetic chronic renal failure, which can lead to a decrease in bone mineral density [24554936, 19275452, 18401211].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24554936", "evidence_support": "This case illustrates that hypercortisolism may cause bone fragility in the absence of marked changes in areal bone mineral density.", "evidence_relation": "supporting" }, { "cited_pmid": "19275452", "evidence_support": "Among the most common causes of spontaneous fracture are osteoporosis (calcium deficiency and corticosteroid-induced), malignancy, overexposure to vitamin A, periprosthetic weakening, Brucellosis, cerebral palsy (especially in children), and osteodystrophy because of chronic renal failure.", "evidence_relation": "supporting" }, { "cited_pmid": "18401211", "evidence_support": "Overt endogenous glucocorticoid excess is a well-recognized cause of bone loss and osteoporotic fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "18401211", "evidence_support": "Subclinical hypercortisolism, a condition of impaired hypothalamic- adrenal-axis homeostasis without the classical signs and symptoms of glucocorticoid excess, is a recently defined entity, which has been shown to be associated to increased bone resorption, bone loss, and high prevalence of vertebral fractures regardless of gonadal status.", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Acute fractures in both hands without apparent injury or trauma can be attributed to underlying conditions that weaken bone integrity, such as osteoporosis or chronic steroid use.Osteoporosis significantly increases skeletal fragility, making bones susceptible to fractures from minimal trauma [28164049]. Chronic steroid use, particularly in conditions like systemic lupus erythematosus or chronic lung disease, can severely decrease bone strength, leading to fractures even without severe trauma [19292188]. Additionally, avascular necrosis, which can be induced by steroid use or systemic diseases, may also contribute to spontaneous fractures [21409500]. These conditions compromise bone metabolism and structural integrity, predisposing individuals to fractures under low-impact or seemingly trivial circumstances.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without apparent injury or trauma can be attributed to underlying conditions that weaken bone integrity, such as osteoporosis or chronic steroid use.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Osteoporosis significantly increases skeletal fragility, making bones susceptible to fractures from minimal trauma [28164049].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28164049", "evidence_support": "Osteoporosis is a significant health-care problem characterized by excessive skeletal fragility, susceptibility to low-trauma fractures in men as well as women. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Chronic steroid use, particularly in conditions like systemic lupus erythematosus or chronic lung disease, can severely decrease bone strength, leading to fractures even without severe trauma [19292188].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19292188", "evidence_support": "Chronic steroid use may severely decrease bone strength, thus increasing the risk for such an injury.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, avascular necrosis, which can be induced by steroid use or systemic diseases, may also contribute to spontaneous fractures [21409500].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21409500", "evidence_support": "Avascular necrosis of bone may affect specific areas of the body where the blood supply to the bone or part of the bone is vulnerable to injury or disease.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "These conditions compromise bone metabolism and structural integrity, predisposing individuals to fractures under low-impact or seemingly trivial circumstances.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Acute fractures in both hands without a history of injury or trauma could be indicative of underlying pathological conditions such as osteoporosis, metabolic bone diseases like osteomalacia, or endocrine disorders such as hyperparathyroidism.Additionally, malignancies such as multiple myeloma or metastatic bone disease can weaken bone structure, making spontaneous fractures more likely.Rheumatologic conditions like rheumatoid arthritis can also compromise bone integrity.Less commonly, genetic disorders such as osteogenesis imperfecta or conditions leading to chronic steroid use can predispose individuals to fractures.A comprehensive evaluation including detailed medical history, physical examination, and diagnostic imaging, along with laboratory tests to assess bone metabolism and potential malignancies, is essential to determine the underlying cause.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without a history of injury or trauma could be indicative of underlying pathological conditions such as osteoporosis, metabolic bone diseases like osteomalacia, or endocrine disorders such as hyperparathyroidism.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, malignancies such as multiple myeloma or metastatic bone disease can weaken bone structure, making spontaneous fractures more likely.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Rheumatologic conditions like rheumatoid arthritis can also compromise bone integrity.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Less commonly, genetic disorders such as osteogenesis imperfecta or conditions leading to chronic steroid use can predispose individuals to fractures.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "A comprehensive evaluation including detailed medical history, physical examination, and diagnostic imaging, along with laboratory tests to assess bone metabolism and potential malignancies, is essential to determine the underlying cause.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Acute fractures in both hands without injury or trauma can be caused by various factors, including osteoporosis, which can lead to fractures with minimal or no trauma [28164049]. Certain medications, such as bisphosphonates, can also increase the risk of fractures, including bilateral subtrochanteric fractures [28164049]. Additionally, conditions like Preiser's disease, a rare entity characterized by avascular necrosis of the scaphoid, can cause bilateral fractures without trauma [21409500]. Furthermore, systemic diseases, such as systemic lupus erythematosus, and chronic steroid use can also contribute to impaired bone metabolism, increasing the risk of fractures [19292188]. It is essential to consider these factors when evaluating patients with acute fractures in both hands without a clear history of trauma.A thorough medical history and diagnostic workup are necessary to determine the underlying cause of the fractures.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without injury or trauma can be caused by various factors, including osteoporosis, which can lead to fractures with minimal or no trauma [28164049].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28164049", "evidence_support": "Osteoporosis is a significant health-care problem characterized by excessive skeletal fragility, susceptibility to low-trauma fractures in men as well as women.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Certain medications, such as bisphosphonates, can also increase the risk of fractures, including bilateral subtrochanteric fractures [28164049].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28164049", "evidence_support": "In people taking long-term bisphoshponate therapy, symptomatic cortical stress reactions accompanied by evidence of a stress line across the cortical thickening suggest an increased risk of a complete stress fracture.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, conditions like Preiser's disease, a rare entity characterized by avascular necrosis of the scaphoid, can cause bilateral fractures without trauma [21409500].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21409500", "evidence_support": "Preiser's disease is a rare entity and is commonly associated with avascular necrosis of the scaphoid without fracture or trauma. A case of bilateral idiopathic avascular necrosis of the scaphoid is reported.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Furthermore, systemic diseases, such as systemic lupus erythematosus, and chronic steroid use can also contribute to impaired bone metabolism, increasing the risk of fractures [19292188].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19292188", "evidence_support": "Chronic steroid use may severely decrease bone strength, thus increasing the risk for such an injury.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is essential to consider these factors when evaluating patients with acute fractures in both hands without a clear history of trauma.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "A thorough medical history and diagnostic workup are necessary to determine the underlying cause of the fractures.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gemini-flash": { "answer": "Acute fractures in both hands without a history of injury or trauma can be caused by underlying medical conditions. One possibility is severe gout, where uric acid crystals accumulate in the joints, leading to inflammation and potential bone damage [35039366]. This can manifest as late-stage gouty tophi, affecting both hands [35039366]. Another cause could be acute poliomyelitis, a viral infection that affects the nervous system and can lead to muscle weakness and paralysis, potentially causing fractures due to weakened muscles [19977355]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without a history of injury or trauma can be caused by underlying medical conditions.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "One possibility is severe gout, where uric acid crystals accumulate in the joints, leading to inflammation and potential bone damage [35039366].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35039366", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This can manifest as late-stage gouty tophi, affecting both hands [35039366].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35039366", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Another cause could be acute poliomyelitis, a viral infection that affects the nervous system and can lead to muscle weakness and paralysis, potentially causing fractures due to weakened muscles [19977355].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19977355", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Acute fractures in both hands without a clear injury or trauma can be caused by various factors. One possibility is underlying medical conditions like diabetes, which can weaken bones and increase fracture risk, especially in the upper extremities [26074321]. Another cause could be overuse or repetitive stress, particularly in athletes, leading to increased fracture risk in the hands and upper arms [14606509]. Additionally, certain types of fractures, like those involving the trapezoid bone, can occur due to excessive flexion stress on the wrist joint [10783105]. While the exact mechanism is unknown, it is theorized that the force applied to the trapezoid bone through the second metacarpal bone can lead to a fracture [10783105]. It is important to note that fractures can also occur due to underlying bone diseases or conditions, which may require further investigation [12755160].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without a clear injury or trauma can be caused by various factors.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "One possibility is underlying medical conditions like diabetes, which can weaken bones and increase fracture risk, especially in the upper extremities [26074321].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26074321", "evidence_support": "It is unclear whether fracture risk is increased in newly diagnosed type 2 diabetes patients. In addition, fracture risk of various sites (hip, spine, upper extremity) was analysed.", "evidence_relation": "contradicting" }, { "cited_pmid": "26074321", "evidence_support": "Already few years after diabetes diagnosis, type 2 diabetes patients more frequently experienced overall, hip, spine, and upper extremity fractures, respectively.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Another cause could be overuse or repetitive stress, particularly in athletes, leading to increased fracture risk in the hands and upper arms [14606509].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14606509", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, certain types of fractures, like those involving the trapezoid bone, can occur due to excessive flexion stress on the wrist joint [10783105].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "10783105", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "While the exact mechanism is unknown, it is theorized that the force applied to the trapezoid bone through the second metacarpal bone can lead to a fracture [10783105].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "10783105", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "It is important to note that fractures can also occur due to underlying bone diseases or conditions, which may require further investigation [12755160].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "12755160", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Acute fractures in both hands without apparent injury can occur due to several underlying conditions. Spontaneous fractures may arise from osteoporosis, which can be caused by calcium deficiency or corticosteroid use [19275452]. Other potential causes include malignancy, overexposure to vitamin A, and metabolic disorders such as hypophosphatemia or diabetes mellitus [19275452, 15361379]. Additionally, acute reflex contractions of the temporalis muscles during vigorous activity may lead to bilateral stress fractures [27882276]. Non-traumatic fractures have been documented in patients with conditions like cancer, where they are often pathological due to bone metastases [28807072]. Therefore, it is essential to investigate bone metabolism disorders if fractures occur without significant trauma [26454499].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without apparent injury can occur due to several underlying conditions.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Spontaneous fractures may arise from osteoporosis, which can be caused by calcium deficiency or corticosteroid use [19275452].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19275452", "evidence_support": "Among the most common causes of spontaneous fracture are osteoporosis (calcium deficiency and corticosteroid-induced), malignancy, overexposure to vitamin A, periprosthetic weakening, Brucellosis, cerebral palsy (especially in children), and osteodystrophy because of chronic renal failure.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Other potential causes include malignancy, overexposure to vitamin A, and metabolic disorders such as hypophosphatemia or diabetes mellitus [19275452, 15361379].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19275452", "evidence_support": "Among the most common causes of spontaneous fracture are osteoporosis (calcium deficiency and corticosteroid-induced), malignancy, overexposure to vitamin A, periprosthetic weakening, Brucellosis, cerebral palsy (especially in children), and osteodystrophy because of chronic renal failure.", "evidence_relation": "supporting" }, { "cited_pmid": "15361379", "evidence_support": "Less often they are associated with metabolic disorders such as osteoporosis, hypophosphataemia, and diabetes mellitus.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, acute reflex contractions of the temporalis muscles during vigorous activity may lead to bilateral stress fractures [27882276].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27882276", "evidence_support": "The definite etiology of this case is unknown, but possible causes or contributing factors may include acute reflex contraction of the patient's temporalis muscles leading to bilateral stress fractures, coronoid process hyperplasia, or the patient's long-term use of omeprazole.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Non-traumatic fractures have been documented in patients with conditions like cancer, where they are often pathological due to bone metastases [28807072].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28807072", "evidence_support": "Non-traumatic bone fractures in cancer patients are usually pathological fractures due to bone metastases.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Therefore, it is essential to investigate bone metabolism disorders if fractures occur without significant trauma [26454499].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "26454499", "evidence_support": "Joint and bone pain without any trauma should be investigated and bone metabolism disorders should be kept in mind.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Acute fractures in both hands without prior injury may be caused by underlying conditions that weaken bone structure, such as osteoporosis. Osteoporosis is characterized by low bone mass and deterioration of bone architecture, leading to increased fragility and low-trauma fractures [22461252, 25061487]. Factors contributing to osteoporosis include long-term steroid use, chronic inflammation, malnutrition, and vitamin D deficiency [36109301, 29869038]. Additionally, conditions like chronic kidney disease can significantly elevate the risk of fragility fractures [34319515, 37227976]. Other potential causes include genetic disorders, such as osteogenesis imperfecta, and systemic issues like hyponatremia, which can lead to instability and increased fracture risk [36109301, 30746503]. It is essential to evaluate these factors to understand the cause of the fractures.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without prior injury may be caused by underlying conditions that weaken bone structure, such as osteoporosis.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Osteoporosis is characterized by low bone mass and deterioration of bone architecture, leading to increased fragility and low-trauma fractures [22461252, 25061487].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22461252", "evidence_support": "Bone fragility is a silent condition that increases bone fracture risk, enhanced by low bone mass and microarchitecture deterioration of bone tissue that lead to osteoporosis. Fragility fractures are the major clinical manifestation of osteoporosis.", "evidence_relation": "supporting" }, { "cited_pmid": "25061487", "evidence_support": "Osteoporosis is a metabolic bone disease associated with a reduction in bone mass and deterioration of bone architecture, leading to increased fragility and subsequent low-trauma fractures in the vertebral column, hip, forearm and other bones. In literature, metabolic bone diseases such as osteoporosis and osteomalacia have been recognised as a complication of chronic liver disease, although the mechanisms of this association remain unclear", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Factors contributing to osteoporosis include long-term steroid use, chronic inflammation, malnutrition, and vitamin D deficiency [36109301, 29869038].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36109301", "evidence_support": "Several factors, such as long-term high-dose steroids, chronic inflammation, malnutrition, immobility, lack of sex steroids, and medication can reduce bone density and increase the risk for fragility fractures when left untreated. ", "evidence_relation": "supporting" }, { "cited_pmid": "29869038", "evidence_support": "Dual-energy x-ray absorptiometry (DXA) prior to FLS consult was confirmed in 30% (67/223). Vitamin D deficiency (25-hydroxy vitamin D <\u200920\u00a0ng/ml) in 41.9% (78/186) including undetectable levels in 16.6% (31/186) and secondary hyperparathyroidism in 43.3% (78/180) were the most common laboratory confirmed secondary etiologies for bone loss.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, conditions like chronic kidney disease can significantly elevate the risk of fragility fractures [34319515, 37227976].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34319515", "evidence_support": "People with chronic kidney disease (CKD) are at high risk of bone fractures.", "evidence_relation": "supporting" }, { "cited_pmid": "34319515", "evidence_support": "Patients with CKD are at increased risk of fragility fractures and associated consequences.", "evidence_relation": "supporting" }, { "cited_pmid": "37227976", "evidence_support": "The risk of bone fracture is high in patients with chronic kidney disease (CKD), and aggressive treatment to reduce fragility fracture risk is the major strategy. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Other potential causes include genetic disorders, such as osteogenesis imperfecta, and systemic issues like hyponatremia, which can lead to instability and increased fracture risk [36109301, 30746503].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36109301", "evidence_support": "Also, genetic conditions can predispose to primary bone fragility disorders, with osteogenesis imperfecta being the most common.", "evidence_relation": "supporting" }, { "cited_pmid": "30746503", "evidence_support": "Hyponatremia is associated with gait instability, osteoporosis, and increased falls and bone fractures, and studies suggest that compromised bone quality with hyponatremia may be independent of plasma osmolality.", "evidence_relation": "supporting" }, { "cited_pmid": "30746503", "evidence_support": "Our analyses support the hypothesis that hyponatremia is an additional risk factor for osteoporosis and fragility fracture among patients with diabetes mellitus.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "It is essential to evaluate these factors to understand the cause of the fractures.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-1": { "answer": "Acute bilateral radial shaft fractures can be caused by a low-caliber gunshot injury [19440576].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute bilateral radial shaft fractures can be caused by a low-caliber gunshot injury [19440576].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "19440576", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-2": { "answer": "The cause of acute fractures in both hands when there hasn\u2019t been injury or trauma in this case is not definitively stated in the context. However, it is possible that the patient may have gripped the control tightly during high-G exposure, which could have caused stress fractures in the hands [33253389]. This is a plausible explanation, but it.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The cause of acute fractures in both hands when there hasn\u2019t been injury or trauma in this case is not definitively stated in the context.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "However, it is possible that the patient may have gripped the control tightly during high-G exposure, which could have caused stress fractures in the hands [33253389].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33253389", "evidence_support": "There are several injuries potentially related to high-G exposure, including neck and back pain, spinal fractures, and pneumomediastinum", "evidence_relation": "supporting" }, { "cited_pmid": "33253389", "evidence_support": "To our knowledge, consecutive rib fractures related to high-G exposure have never been documented. ", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This is a plausible explanation, but it.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-3": { "answer": "Acute fractures in both of your hands can be caused by high-G exposure during centrifuge training [33253389].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both of your hands can be caused by high-G exposure during centrifuge training [33253389].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33253389", "evidence_support": "There are several injuries potentially related to high-G exposure, including neck and back pain, spinal fractures, and pneumomediastinum.", "evidence_relation": "supporting" }, { "cited_pmid": "33253389", "evidence_support": "We present a young military pilot diagnosed with isolated fractures of the right 9th and 10th ribs via X-ray after high-G exposure (maximum G level: 9G).", "evidence_relation": "supporting" }, { "cited_pmid": "33253389", "evidence_support": "The potential explanations for the multiple rib fractures are repetitive stress from the anti-G straining maneuver and anti-G suit compression of the abdominal bladder", "evidence_relation": "supporting" }, { "cited_pmid": "33253389", "evidence_support": "This report may increase the awareness of flight surgeons and training units regarding the risk of chest wall injuries during high-G exposure and encourage them to use multiple diagnostic tools to determine the correct diagnosis.", "evidence_relation": "supporting" } ] } ] }, "webis-5": { "answer": "Acute fractures in both of your hands can be caused by high-G exposure during centrifuge training [33253389].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both of your hands can be caused by high-G exposure during centrifuge training [33253389].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33253389", "evidence_support": "We present a young military pilot diagnosed with isolated fractures of the right 9th and 10th ribs via X-ray after high-G exposure (maximum G level: 9G).", "evidence_relation": "supporting" }, { "cited_pmid": "33253389", "evidence_support": "He also denied having previously experienced trauma of the rib cage or participated in any strenuous military training program or exercise before centrifuge training. ", "evidence_relation": "neutral" } ] } ] }, "webis-gpt-1": { "answer": "Acute fractures in both hands without any injury or trauma can be caused by several factors, including underlying medical conditions such as osteoporosis, which weakens bones, or conditions that affect bone density and strength. Additionally, certain metabolic disorders, overuse injuries, or even stress fractures from repetitive activities could lead to such fractures. It is important to consult a healthcare professional for a thorough evaluation and diagnosis.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without any injury or trauma can be caused by several factors, including underlying medical conditions such as osteoporosis, which weakens bones, or conditions that affect bone density and strength.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, certain metabolic disorders, overuse injuries, or even stress fractures from repetitive activities could lead to such fractures.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "It is important to consult a healthcare professional for a thorough evaluation and diagnosis.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "Question: What can cause acute fractures in both of your hands when there hasn\u2019t been injury or trauma?", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Question: What can cause acute fractures in both of your hands when there hasn\u2019t been injury or trauma?", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-gpt-6": { "answer": "Acute fractures in both hands without any injury or trauma could be indicative of underlying conditions such as osteoporosis or other metabolic bone diseases that weaken bone structure. While the provided context does not directly address causes of acute fractures, it is important to consider that fractures can occur due to pathological conditions rather than external trauma.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without any injury or trauma could be indicative of underlying conditions such as osteoporosis or other metabolic bone diseases that weaken bone structure.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "While the provided context does not directly address causes of acute fractures, it is important to consider that fractures can occur due to pathological conditions rather than external trauma.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "zero-shot-gemini-flash": { "answer": "While it's unusual to experience acute fractures in both hands without a clear injury, there are a few possibilities. One is **osteoporosis**, a condition where bones become weak and brittle, making them more susceptible to fractures [PMID1, PMID2]. This can occur due to various factors like age, hormonal imbalances, or certain medications [PMID3]. Another possibility is **osteogenesis imperfecta**, a genetic disorder characterized by weak bones that break easily [PMID4]. Finally, **underlying medical conditions** like cancer or certain metabolic disorders can also weaken bones and increase fracture risk [PMID5]. It's crucial to consult a doctor for a proper diagnosis and treatment plan. \n", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "While it's unusual to experience acute fractures in both hands without a clear injury, there are a few possibilities.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "One is **osteoporosis**, a condition where bones become weak and brittle, making them more susceptible to fractures [PMID1, PMID2].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "This can occur due to various factors like age, hormonal imbalances, or certain medications", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "[PMID3].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Another possibility is **osteogenesis imperfecta**, a genetic disorder characterized by weak bones that break easily [PMID4].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Finally, **underlying medical conditions** like cancer or certain metabolic disorders can also weaken bones and increase fracture risk [PMID5].", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "It's crucial to consult a doctor for a proper diagnosis and treatment plan.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "zero-shot-gpt4o-mini": { "answer": "Acute fractures in both hands without prior injury or trauma can be caused by several underlying conditions. One common cause is osteoporosis, a condition characterized by weakened bones that are more susceptible to fractures, even with minimal stress [PMID1]. Additionally, certain metabolic disorders, such as hyperparathyroidism, can lead to bone fragility and increase fracture risk [PMID2]. In some cases, overuse or repetitive stress from vigorous exercise can also contribute to stress fractures, particularly if the bones are already compromised [PMID3]. Lastly, conditions like rheumatoid arthritis can weaken bones and lead to fractures without direct trauma [PMID4]. It is essential for the patient to consult a healthcare professional for a thorough evaluation to determine the specific cause of the fractures.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Acute fractures in both hands without prior injury or trauma can be caused by several underlying conditions.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "One common cause is osteoporosis, a condition characterized by weakened bones that are more susceptible to fractures, even with minimal stress [PMID1].", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, certain metabolic disorders, such as hyperparathyroidism, can lead to bone fragility and increase fracture risk [PMID2].", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "In some cases, overuse or repetitive stress from vigorous exercise can also contribute to stress fractures, particularly if the bones are already compromised [PMID3].", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Lastly, conditions like rheumatoid arthritis can weaken bones and lead to fractures without direct trauma [PMID4].", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "It is essential for the patient to consult a healthcare professional for a thorough evaluation to determine the specific cause of the fractures.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] } } }, { "question_id": "141", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Yellow fever can lead to a range of complications, especially if the infection is severe. Complications may include acute kidney injury, which can progress to kidney failure, as noted in studies where certain viral infections have been linked to hypertension and damage to the cardiovascular system. Additionally, yellow fever can cause hepatic failure, which may lead to jaundice, bleeding disorders, and multiple organ failure. In severe cases, these complications can be life-threatening and require immediate medical attention. The disease's impact on the immune system can also increase the risk of secondary infections and other related complications [30562093].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yellow fever can lead to a range of complications, especially if the infection is severe.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Complications may include acute kidney injury, which can progress to kidney failure, as noted in studies where certain viral infections have been linked to hypertension and damage to the cardiovascular system.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, yellow fever can cause hepatic failure, which may lead to jaundice, bleeding disorders, and multiple organ failure.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "In severe cases, these complications can be life-threatening and require immediate medical attention.", "answer_sentence_relevance": "borderline", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "The disease's impact on the immune system can also increase the risk of secondary infections and other related complications [30562093].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30562093", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Yellow fever can lead to severe complications, including acute kidney injury and renal failure, which may progress to multiple organ failure [31340247, 18061688, 18620963]. The disease often causes severe hepatitis, resulting in hepatic failure, liver necrosis, and hepatocyte apoptosis [18061688, 16219382, 15829426]. Patients may develop jaundice and hepatic encephalopathy due to extensive liver damage [16498293, 15829426, 28333617]. Hemorrhage and coagulopathy are common, potentially leading to gastrointestinal bleeding and disseminated intravascular coagulation [33268494, 18061688, 37711029]. Cardiovascular shock and neurological impairment are also significant concerns [31155206, 16117712, 32965473]. Additionally, yellow fever can cause bleeding episodes and midzonal liver injury [29641667, 16219382, 16650626]. Ascites and disseminated mycosis are further complications that may arise [30123781, 33014700]. The combination of these severe conditions can lead to shock and a high mortality rate if not promptly treated [18061688, 16117712, 27406389].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yellow fever can lead to severe complications, including acute kidney injury and renal failure, which may progress to multiple organ failure [31340247, 18061688, 18620963].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31340247", "evidence_support": "Yellow fever is one of the most important mosquito-borne diseases, which still affects a significant number of people every year, mainly in tropical countries.", "evidence_relation": "neutral" }, { "cited_pmid": "31340247", "evidence_support": "Mortality can be high, even with intensive treatment due to multiple organ failure, including acute kidney injury (AKI).", "evidence_relation": "supporting" }, { "cited_pmid": "18061688", "evidence_support": "Yellow fever (YF) is a life-threatening mosquito-borne flaviviral hemorrhagic fever (VHF) characterized by severe hepatitis, renal failure, hemorrhage, and rapid terminal events with shock and multi-organ failure.", "evidence_relation": "supporting" }, { "cited_pmid": "18620963", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The disease often causes severe hepatitis, resulting in hepatic failure, liver necrosis, and hepatocyte apoptosis [18061688, 16219382, 15829426].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18061688", "evidence_support": "Yellow fever (YF) is a life-threatening mosquito-borne flaviviral hemorrhagic fever (VHF) characterized by severe hepatitis, renal failure, hemorrhage, and rapid terminal events with shock and multi-organ failure.", "evidence_relation": "supporting" }, { "cited_pmid": "16219382", "evidence_support": "Infection with the yellow fever virus can progress with lesions in the heart, kidneys, central nervous system, and liver. In the liver, the histopathological picture is characterized by necrosis, steatosis and hepatocyte apoptosis, with a preferential midzone distribution.", "evidence_relation": "supporting" }, { "cited_pmid": "15829426", "evidence_support": "It causes severe disease involving especially the liver, with lesions characterized by midzonal steatosis, apoptosis and lytic necrosis of the hepatocytes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Patients may develop jaundice and hepatic encephalopathy due to extensive liver damage [16498293, 15829426, 28333617].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16498293", "evidence_support": "Encephalopathy appeared on day 7 and death occurred on day 8 due to massive gastrointestinal bleeding.", "evidence_relation": "neutral" }, { "cited_pmid": "15829426", "evidence_support": "It causes severe disease involving especially the liver, with lesions characterized by midzonal steatosis, apoptosis and lytic necrosis of the hepatocytes. ", "evidence_relation": "supporting" }, { "cited_pmid": "15829426", "evidence_support": "Hepatic damage in yellow fever resulted mainly from a massive death of hepatocytes due to apoptosis and to a lesser extent due to lytic necrosis.", "evidence_relation": "supporting" }, { "cited_pmid": "28333617", "evidence_support": "During hospital stay, the patient's condition deteriorated and she developed hepatic encephalopathy requiring transfer to the intensive care.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Hemorrhage and coagulopathy are common, potentially leading to gastrointestinal bleeding and disseminated intravascular coagulation [33268494, 18061688, 37711029].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33268494", "evidence_support": "In its most severe form, YF manifests as a hemorrhagic fever that causes severe damage to visceral organs", "evidence_relation": "supporting" }, { "cited_pmid": "33268494", "evidence_support": "Although coagulopathy is a defining feature of severe YF in humans, the mechanism by which it develops remains uncertain. Hepatocytes are a major target of yellow fever virus (YFV) infection, and the coagulopathy in severe YF has long been attributed to massive hepatocyte infection and destruction that results in a defect in clotting factor synthesis.", "evidence_relation": "supporting" }, { "cited_pmid": "33268494", "evidence_support": "These findings expand our understanding of viral hemorrhagic disease and associated coagulopathy and suggest directions for clinical management of severe YF cases.", "evidence_relation": "supporting" }, { "cited_pmid": "18061688", "evidence_support": "Yellow fever (YF) is a life-threatening mosquito-borne flaviviral hemorrhagic fever (VHF) characterized by severe hepatitis, renal failure, hemorrhage, and rapid terminal events with shock and multi-organ failure.", "evidence_relation": "supporting" }, { "cited_pmid": "37711029", "evidence_support": "Yellow fever virus can cause, among other symptoms, hemorrhage and disseminated intravascular coagulation, indicating a role for endothelial cells in disease pathogenesis. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Cardiovascular shock and neurological impairment are also significant concerns [31155206, 16117712, 32965473].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31155206", "evidence_support": "Approximately half of those infected will be asymptomatic, while 15% will develop the severe/malignant form of the disease that includes renal and hepatic failure, bleeding, and neurological impairment as the principal symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "16117712", "evidence_support": "Approximately one in seven people who become infected develop a rapidly progressive illness, with hepatitis, renal failure, hemorrhage and cardiovascular shock, with a case fatality rate of 20-50%.", "evidence_relation": "supporting" }, { "cited_pmid": "32965473", "evidence_support": "Yellow fever (YF) causes high fever, liver dysfunction, renal failure, hypercoagulopathy and platelet dysfunction and can lead to shock and death with a case-fatality ratio of 20-50%.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Additionally, yellow fever can cause bleeding episodes and midzonal liver injury [29641667, 16219382, 16650626].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29641667", "evidence_support": "These forms lead to renal, hepatic and neurological impairment, and bleeding episodes.", "evidence_relation": "supporting" }, { "cited_pmid": "16219382", "evidence_support": "Infection with the yellow fever virus can progress with lesions in the heart, kidneys, central nervous system, and liver", "evidence_relation": "supporting" }, { "cited_pmid": "16650626", "evidence_support": "In the liver, one of the main targets of the virus, the infection induces a characteristic midzonal injury characterized by hepatocyte necrosis, apoptosis and steatosis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Ascites and disseminated mycosis are further complications that may arise [30123781, 33014700].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30123781", "evidence_support": "Disseminated mycosis (DM)-with cardiac involvement and shock-is an unexpected and severe opportunistic infection in patients with yellow fever.", "evidence_relation": "supporting" }, { "cited_pmid": "30123781", "evidence_support": "During hospitalization, the patient developed hepatic encephalopathy, ascending leukocytosis, and ascites, with signs consistent with peritonitis.", "evidence_relation": "supporting" }, { "cited_pmid": "30123781", "evidence_support": "At autopsy, angioinvasive mycosis was evidenced mainly in the heart, lungs, kidneys, and adrenals.", "evidence_relation": "supporting" }, { "cited_pmid": "33014700", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "8", "answer_sentence": "The combination of these severe conditions can lead to shock and a high mortality rate if not promptly treated [18061688, 16117712, 27406389].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18061688", "evidence_support": "Yellow fever (YF) is a life-threatening mosquito-borne flaviviral hemorrhagic fever (VHF) characterized by severe hepatitis, renal failure, hemorrhage, and rapid terminal events with shock and multi-organ failure.", "evidence_relation": "neutral" }, { "cited_pmid": "27406389", "evidence_support": "The patient presented with hemorrhagic fever, jaundice and oliguria at day 3 after onset, which rapidly progressed to multisystem organ failure with extremely elevated liver, pancreatic and myocardial enzymes. The patient died despite the intensive supportive treatments that were performed.", "evidence_relation": "neutral" }, { "cited_pmid": "16117712", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Yellow fever can lead to severe complications, including acute kidney injury (AKI), hepatic failure, hemorrhage, and neurological impairment, with a high mortality rate in severe cases [31340247, 18061688, 31155206]. AKI is a significant contributor to mortality, though its pathophysiology remains incompletely understood [31340247]. Hepatic involvement often results in jaundice, coagulopathy, and liver necrosis, which can progress to acute liver failure, sometimes necessitating liver transplantationHemorrhagic manifestations and disseminated intravascular coagulation are common, driven by endothelial damage and consumptive coagulopathy [33268494, 37711029]. Neurological complications, including encephalopathy and neurotropic disease, can also occur, particularly in severe cases [31155206, 32965473]. Opportunistic infections, such as disseminated mycosis and invasive aspergillosis, may complicate the clinical course, mimicking bacterial sepsis and exacerbating systemic inflammatory responses [30123781, 33014700]. These complications underscore the critical need for early diagnosis and intensive supportive care to improve outcomes in yellow fever patients.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yellow fever can lead to severe complications, including acute kidney injury (AKI), hepatic failure, hemorrhage, and neurological impairment, with a high mortality rate in severe cases [31340247, 18061688, 31155206].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31340247", "evidence_support": "Mortality can be high, even with intensive treatment due to multiple organ failure, including acute kidney injury (AKI).", "evidence_relation": "supporting" }, { "cited_pmid": "18061688", "evidence_support": "Yellow fever (YF) is a life-threatening mosquito-borne flaviviral hemorrhagic fever (VHF) characterized by severe hepatitis, renal failure, hemorrhage, and rapid terminal events with shock and multi-organ failure.", "evidence_relation": "supporting" }, { "cited_pmid": "31155206", "evidence_support": "Approximately half of those infected will be asymptomatic, while 15% will develop the severe/malignant form of the disease that includes renal and hepatic failure, bleeding, and neurological impairment as the principal symptoms.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "AKI is a significant contributor to mortality, though its pathophysiology remains incompletely understood [31340247].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31340247", "evidence_support": "Mortality can be high, even with intensive treatment due to multiple organ failure, including acute kidney injury (AKI).", "evidence_relation": "supporting" }, { "cited_pmid": "31340247", "evidence_support": "The pathophysiology of yellow fever-induced acute kidney injury (AKI) is still to be completely understood, and the best clinical approach has not yet been determined. This manuscript presents the most recent scientific evidence of kidney involvement in yellow fever, since AKI plays an important role in the mortality rate.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Hepatic involvement often results in jaundice, coagulopathy, and liver necrosis, which can progress to acute liver failure, sometimes necessitating liver transplantationHemorrhagic manifestations and disseminated intravascular coagulation are common, driven by endothelial damage and consumptive coagulopathy [33268494, 37711029].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33268494", "evidence_support": "These findings expand our understanding of viral hemorrhagic disease and associated coagulopathy and suggest directions for clinical management of severe YF cases.", "evidence_relation": "supporting" }, { "cited_pmid": "37711029", "evidence_support": "Yellow fever virus can cause, among other symptoms, hemorrhage and disseminated intravascular coagulation, indicating a role for endothelial cells in disease pathogenesis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Neurological complications, including encephalopathy and neurotropic disease, can also occur, particularly in severe cases [31155206, 32965473].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31155206", "evidence_support": "Approximately half of those infected will be asymptomatic, while 15% will develop the severe/malignant form of the disease that includes renal and hepatic failure, bleeding, and neurological impairment as the principal symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "32965473", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Opportunistic infections, such as disseminated mycosis and invasive aspergillosis, may complicate the clinical course, mimicking bacterial sepsis and exacerbating systemic inflammatory responses [30123781, 33014700].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30123781", "evidence_support": "DM can mimic bacterial sepsis and should be considered in the differential diagnosis of causes of systemic inflammatory response syndrome in this group of patients, especially in areas where an outbreak of yellow fever is ongoing", "evidence_relation": "supporting" }, { "cited_pmid": "33014700", "evidence_support": "We report an unusual fatal case of disseminated IA in a non-immunocompromised patient following yellow fever vaccine-associated viscerotropic disease", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "These complications underscore the critical need for early diagnosis and intensive supportive care to improve outcomes in yellow fever patients.", "answer_sentence_relevance": "borderline", "citation_assessment": null } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Yellow fever can lead to severe complications, including acute kidney injury (AKI) liver failure , and hemorrhage [31340247]. In severe cases, the disease can progress to multi-organ failure, resulting in high mortality rates [18061688, 15487593]. Additionally, patients with yellow fever are at risk of developing consumptive coagulopathy, characterized by high concentrations of plasma D-dimer, a fibrin split product [33268494]. Disseminated mycosis, a severe opportunistic infection, can also occur in patients with yellow fever, particularly in areas where outbreaks are ongoing [30123781]. Furthermore, yellow fever can cause neurological impairment, including encephalopathy and meningoencephalitis [16498293, 32965473, 35309283]. In rare cases, the disease can lead to fatal multiorgan failure due to yellow fever vaccine-associated viscerotropic disease [18023511]. These complications highlight the importance of prompt diagnosis and treatment of yellow fever.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yellow fever can lead to severe complications, including acute kidney injury (AKI) liver failure , and hemorrhage [31340247].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31340247", "evidence_support": "Yellow fever is one of the most important mosquito-borne diseases, which still affects a significant number of people every year, mainly in tropical countries. Mortality can be high, even with intensive treatment due to multiple organ failure, including acute kidney injury (AKI). This disease can also be a burden on the health care system in developing countries, without mentioning the number of lives that could be ", "evidence_relation": "supporting" }, { "cited_pmid": "31340247", "evidence_support": "injury (AKI) is still to be completely understood, and the best clinical approach has not yet been determined. This manuscript presents the most recent scientific evidence of kidney involvement in yellow fever, since AKI plays an important role in the mortality rate. Recent outbreaks have occurred in Brazil and further studies are required to provide a better clinical control for patients with yellow fever.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In severe cases, the disease can progress to multi-organ failure, resulting in high mortality rates [18061688, 15487593].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18061688", "evidence_support": "Yellow fever (YF) is a life-threatening mosquito-borne flaviviral hemorrhagic fever (VHF) characterized by severe hepatitis, renal failure, hemorrhage, and rapid terminal events with shock and multi-organ failure.", "evidence_relation": "supporting" }, { "cited_pmid": "15487593", "evidence_support": "The case fatality rate of severe yellow fever is 50% or higher", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, patients with yellow fever are at risk of developing consumptive coagulopathy, characterized by high concentrations of plasma D-dimer, a fibrin split product [33268494].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33268494", "evidence_support": "However, when we analyzed blood from Brazilian patients with severe YF, we found high concentrations of plasma D-dimer, a fibrin split product, suggestive of a concurrent consumptive process.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Disseminated mycosis, a severe opportunistic infection, can also occur in patients with yellow fever, particularly in areas where outbreaks are ongoing [30123781].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30123781", "evidence_support": "Disseminated mycosis (DM)-with cardiac involvement and shock-is an unexpected and severe opportunistic infection in patients with yellow fever. ", "evidence_relation": "supporting" }, { "cited_pmid": "30123781", "evidence_support": "At autopsy, angioinvasive mycosis was evidenced mainly in the heart, lungs, kidneys, and adrenals.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, yellow fever can cause neurological impairment, including encephalopathy and meningoencephalitis [16498293, 32965473, 35309283].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16498293", "evidence_support": "Encephalopathy appeared on day 7 and death occurred on day 8 due to massive gastrointestinal bleeding.", "evidence_relation": "supporting" }, { "cited_pmid": "35309283", "evidence_support": "Cases of YEL-AND have presented as acute inflammatory demyelinating polyneuropathy, acute disseminated encephalomyelitis, and meningoencephalitis.", "evidence_relation": "supporting" }, { "cited_pmid": "32965473", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "In rare cases, the disease can lead to fatal multiorgan failure due to yellow fever vaccine-associated viscerotropic disease [18023511].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18023511", "evidence_support": "Yellow fever vaccine-associated viscerotropic disease (YEL-AVD) is a rare complication of yellow fever (YF) vaccination.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "These complications highlight the importance of prompt diagnosis and treatment of yellow fever.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "Possible complications for a person with yellow fever include multi-organ failure, hemorrhagic events, fulminant liver failure, pancreatitis, and neurological complications such as hemorrhage, encephalitis, myelitis, acute disseminated encephalomyelitis, Guillain-Barr\u00e9 syndrome, and congenital malformations [35247791]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Possible complications for a person with yellow fever include multi-organ failure, hemorrhagic events, fulminant liver failure, pancreatitis, and neurological complications such as hemorrhage, encephalitis, myelitis, acute disseminated encephalomyelitis, Guillain-Barr\u00e9 syndrome, and congenital malformations [35247791].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35247791", "evidence_support": "Although not commonly, these infections are associated with neurological complications, characterized mainly by hemorrhage, encephalitis, myelitis, acute disseminated encephalomyelitis, Guillain-Barr\u00e9 syndrome, and/or congenital malformations.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "Yellow fever can cause various complications, including severe liver dysfunction, coagulopathy, and bleeding episodes [29641667, 15487593, 32386609]. In severe cases, the disease can lead to renal, hepatic, and neurological impairment, with a high lethality rate [29641667, 15487593, 20513550]. The disease can also cause jaundice, bleeding diathesis, and hepatorenal involvement [16967591, 29641667, 15487593]. The case fatality rate of severe yellow fever is 50% or higher [15487593, 32386609, 20513550]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yellow fever can cause various complications, including severe liver dysfunction, coagulopathy, and bleeding episodes [29641667, 15487593, 32386609].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29641667", "evidence_support": "These forms lead to renal, hepatic and neurological impairment, and bleeding episodes. ", "evidence_relation": "supporting" }, { "cited_pmid": "15487593", "evidence_support": "In severe cases, jaundice, bleeding diathesis, with hepatorenal involvement are common. ", "evidence_relation": "supporting" }, { "cited_pmid": "32386609", "evidence_support": "When symptomatic, yellow fever infection causes severe liver dysfunction and coagulopathy with elevated mortality rates.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In severe cases, the disease can lead to renal, hepatic, and neurological impairment, with a high lethality rate [29641667, 15487593, 20513550].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29641667", "evidence_support": "The most serious forms occur in around 15% of those infected, with high lethality rates. These forms lead to renal, hepatic and neurological impairment, and bleeding episodes. 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In severe cases, the disease can be fatal, with a case fatality rate of 50% or higher [37992431, 25193630]. 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Of the four ebolaviruses, Zaire virus was the most lethal (CFR = 66.6%, 95% CI 55.9-76.8), then Sudan virus (CFR=48.5%, 95% CI 38.6-58.4), Bundibugyo virus (CFR=32.8%, 95% CI 25.8-40.2) and Tai Forest virus (CFR= 0%, 95% CI 0.0-97.5). ", "evidence_relation": "supporting" }, { "cited_pmid": "25193630", "evidence_support": "Twenty outbreaks, including the current one, were studied. The estimated case fatality rate was 65.4% (CI 95% [54.6%; 75.5%]) and varied among the outbreaks", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Possible complications for a person with yellow fever include severe liver dysfunction, coagulopathy, jaundice, bleeding diathesis, renal impairment, neurological impairment, and multiorgan failure [15487593]. In severe cases, the disease can be fatal, with a case fatality rate of 65.4% or higher, specifically for the Zaire species of the Ebola virus disease [25193630]. 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The pathophysiology involves direct viral cytopathic effects, immune-mediated hepatocyte apoptosis, and cytokine storms, leading to extensive liver damage characterized by midzonal necrosis, steatosis, and apoptosis [16219382, 15829426, 16650626]. Renal involvement is common, manifesting as AKI, which exacerbates the disease's severity and mortality [31340247, 18620963]. Coagulopathy, marked by high plasma D-dimer levels, indicates a consumptive process contributing to hemorrhagic complications [33268494]. Additionally, severe cases may present with disseminated intravascular coagulation and endothelial damage, further complicating the clinical picture [37711029]. Opportunistic infections, such as disseminated mycosis, can occur, mimicking bacterial sepsis and complicating the diagnosis and management [30123781]. These complications underscore the critical need for early diagnosis and intensive supportive care in managing yellow fever.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yellow fever can lead to severe complications, including acute kidney injury (AKI), hepatic failure, hemorrhage, and multi-organ failure, which significantly contribute to its high mortality rate [31340247, 18061688].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31340247", "evidence_support": "Mortality can be high, even with intensive treatment due to multiple organ failure, including acute kidney injury (AKI)", "evidence_relation": "supporting" }, { "cited_pmid": "18061688", "evidence_support": "Yellow fever (YF) is a life-threatening mosquito-borne flaviviral hemorrhagic fever (VHF) characterized by severe hepatitis, renal failure, hemorrhage, and rapid terminal events with shock and multi-organ failure", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The pathophysiology involves direct viral cytopathic effects, immune-mediated hepatocyte apoptosis, and cytokine storms, leading to extensive liver damage characterized by midzonal necrosis, steatosis, and apoptosis [16219382, 15829426, 16650626].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16219382", "evidence_support": "In the liver, the histopathological picture is characterized by necrosis, steatosis and hepatocyte apoptosis, with a preferential midzone distribution.", "evidence_relation": "supporting" }, { "cited_pmid": "16219382", "evidence_support": "The histopathological pattern was characterized by steatosis, lytic necrosis and hepatocyte apoptosis associated with a moderate mononuclear inflammatory infiltrate.", "evidence_relation": "supporting" }, { "cited_pmid": "15829426", "evidence_support": "It causes severe disease involving especially the liver, with lesions characterized by midzonal steatosis, apoptosis and lytic necrosis of the hepatocytes. Quantitative histological and immunohistochemical analysis of 53 human hepatic samples demonstrated apoptosis, steatosis and lytic necrosis of hepatocytes with midzonal pattern.", "evidence_relation": "supporting" }, { "cited_pmid": "16650626", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Renal involvement is common, manifesting as AKI, which exacerbates the disease's severity and mortality [31340247, 18620963].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31340247", "evidence_support": "Mortality can be high, even with intensive treatment due to multiple organ failure, including acute kidney injury (AKI).", "evidence_relation": "supporting" }, { "cited_pmid": "18620963", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Coagulopathy, marked by high plasma D-dimer levels, indicates a consumptive process contributing to hemorrhagic complications [33268494].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33268494", "evidence_support": "However, when we analyzed blood from Brazilian patients with severe YF, we found high concentrations of plasma D-dimer, a fibrin split product, suggestive of a concurrent consumptive process.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, severe cases may present with disseminated intravascular coagulation and endothelial damage, further complicating the clinical picture [37711029].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37711029", "evidence_support": "Yellow fever virus can cause, among other symptoms, hemorrhage and disseminated intravascular coagulation, indicating a role for endothelial cells in disease pathogenesis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Opportunistic infections, such as disseminated mycosis, can occur, mimicking bacterial sepsis and complicating the diagnosis and management [30123781].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30123781", "evidence_support": "DM can mimic bacterial sepsis and should be considered in the differential diagnosis of causes of systemic inflammatory response syndrome in this group of patients, especially in areas where an outbreak of yellow fever is ongoing.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "These complications underscore the critical need for early diagnosis and intensive supportive care in managing yellow fever.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Yellow fever can lead to severe complications, particularly in its toxic phase, which occurs in approximately 15% of cases.These complications include jaundice, hemorrhagic manifestations such as bleeding from the nose, mouth, and gastrointestinal tract, and multi-organ failure affecting the liver, kidneys, and heart.Hepatic dysfunction can result in coagulopathy and encephalopathy, while renal failure may necessitate dialysis.Cardiovascular complications can include myocarditis and arrhythmias.Secondary bacterial infections are also a risk due to immune system impairment.The case-fatality rate for severe yellow fever can be as high as 20-50%, underscoring the importance of early recognition and supportive care.Vaccination remains the most effective preventive measure against yellow fever.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yellow fever can lead to severe complications, particularly in its toxic phase, which occurs in approximately 15% of cases.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "These complications include jaundice, hemorrhagic manifestations such as bleeding from the nose, mouth, and gastrointestinal tract, and multi-organ failure affecting the liver, kidneys, and heart.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Hepatic dysfunction can result in coagulopathy and encephalopathy, while renal failure may necessitate dialysis.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Cardiovascular complications can include myocarditis and arrhythmias.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Secondary bacterial infections are also a risk due to immune system impairment.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "The case-fatality rate for severe yellow fever can be as high as 20-50%, underscoring the importance of early recognition and supportive care.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "Vaccination remains the most effective preventive measure against yellow fever.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Yellow fever can lead to severe complications, including acute kidney injury (AKI) liver failure and hemorrhagic fever [31340247, 31155206, 18061688]. In severe cases, patients may experience jaundice, bleeding diathesis, and hepatorenal involvement [15487593]. Additionally, disseminated mycosis, a severe opportunistic infection, can occur in patients with yellow fever, particularly in areas where an outbreak is ongoing [30123781]. Consumptive coagulopathy, characterized by high concentrations of plasma D-dimer, can also develop, indicating a concurrent consumptive process [33268494]. Furthermore, liver transplantation may be necessary in cases of acute liver failure due to yellow fever [31155206]. In rare cases, yellow fever vaccine-associated neurotropic disease (YEL-AND) can occur, presenting as acute inflammatory demyelinating polyneuropathy, acute disseminated encephalomyelitis, or meningoencephalitis [32965473, 35309283]. These complications highlight the severity of yellow fever and the need for prompt medical attention.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yellow fever can lead to severe complications, including acute kidney injury (AKI) liver failure and hemorrhagic fever [31340247, 31155206, 18061688].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31340247", "evidence_support": "Mortality can be high, even with intensive treatment due to multiple organ failure, including acute kidney injury (AKI).", "evidence_relation": "supporting" }, { "cited_pmid": "18061688", "evidence_support": "Yellow fever (YF) is a life-threatening mosquito-borne flaviviral hemorrhagic fever (VHF) characterized by severe hepatitis, renal failure, hemorrhage, and rapid terminal events with shock and multi-organ failure.", "evidence_relation": "supporting" }, { "cited_pmid": "31155206", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "In severe cases, patients may experience jaundice, bleeding diathesis, and hepatorenal involvement [15487593].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15487593", "evidence_support": "In severe cases, jaundice, bleeding diathesis, with hepatorenal involvement are common.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, disseminated mycosis, a severe opportunistic infection, can occur in patients with yellow fever, particularly in areas where an outbreak is ongoing [30123781].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30123781", "evidence_support": "Disseminated mycosis (DM)-with cardiac involvement and shock-is an unexpected and severe opportunistic infection in patients with yellow fever. DM can mimic bacterial sepsis and should be considered in the differential diagnosis of causes of systemic inflammatory response syndrome in this group of patients, especially in areas where an outbreak of yellow fever is ongoing.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Consumptive coagulopathy, characterized by high concentrations of plasma D-dimer, can also develop, indicating a concurrent consumptive process [33268494].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33268494", "evidence_support": "However, when we analyzed blood from Brazilian patients with severe YF, we found high concentrations of plasma D-dimer, a fibrin split product, suggestive of a concurrent consumptive process.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, liver transplantation may be necessary in cases of acute liver failure due to yellow fever [31155206].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "31155206", "evidence_support": "The objective of this study was to report on the case of a patient who was transferred to the hepatobiliary unit of our service due to acute liver failure due to yellow fever. He was treated with liver transplantation. The patient progressed satisfactorily, being discharged from the intensive care unit in 10 days and discharged from the hospital within 19 days after transplantation", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "In rare cases, yellow fever vaccine-associated neurotropic disease (YEL-AND) can occur, presenting as acute inflammatory demyelinating polyneuropathy, acute disseminated encephalomyelitis, or meningoencephalitis [32965473, 35309283].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32965473", "evidence_support": "Serious adverse events (SAEs), such as YF vaccine-associated neurotropic disease (YEL-AND) are rare.", "evidence_relation": "supporting" }, { "cited_pmid": "35309283", "evidence_support": "Yellow fever vaccine-associated neurotropic disease (YEL-AND) is a rare and serious complication following vaccination with the 17D live attenuated yellow fever vaccine. Cases of YEL-AND have presented as acute inflammatory demyelinating polyneuropathy, acute disseminated encephalomyelitis, and meningoencephalitis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "These complications highlight the severity of yellow fever and the need for prompt medical attention.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "ten-shot-gemini-flash": { "answer": "Yellow fever (YF) can be a serious illness with a mortality rate reaching 50% [22093046]. The most severe forms of YF, occurring in about 15% of infected individuals, are associated with high lethality rates [29641667]. These severe forms manifest as hemorrhagic fever, causing significant damage to internal organs [33268494]. This can lead to renal, hepatic, and neurological impairment, as well as bleeding episodes [29641667]. While half of patients in the toxic phase die within 10-14 days, the rest recover without significant organ damage [24056028]. \n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yellow fever (YF) can be a serious illness with a mortality rate reaching 50% [22093046].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22093046", "evidence_support": "Yellow fever (YF) may be very serious, with mortality reaching 50%.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The most severe forms of YF, occurring in about 15% of infected individuals, are associated with high lethality rates [29641667].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29641667", "evidence_support": "The most serious forms occur in around 15% of those infected, with high lethality rates.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "These severe forms manifest as hemorrhagic fever, causing significant damage to internal organs [33268494].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33268494", "evidence_support": "In its most severe form, YF manifests as a hemorrhagic fever that causes severe damage to visceral organs.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "This can lead to renal, hepatic, and neurological impairment, as well as bleeding episodes [29641667].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29641667", "evidence_support": "These forms lead to renal, hepatic and neurological impairment, and bleeding episodes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "While half of patients in the toxic phase die within 10-14 days, the rest recover without significant organ damage [24056028].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24056028", "evidence_support": "Half of the patients who enter the toxic phase die within 10-14 d, while the rest recover without significant organ damage. ", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Yellow fever (YF) can lead to serious complications, including liver dysfunction, renal failure, and neurological impairment [29641667, 33268494]. YF can also cause hypercoagulopathy and platelet dysfunction, leading to bleeding episodes [32965473, 29641667]. In its most severe form, YF manifests as a hemorrhagic fever, causing significant damage to visceral organs [33268494]. The toxic phase of YF can be fatal, with a mortality rate of 20-50% [32965473, 24056028]. While some patients recover without significant organ damage, others may require intensive care support, liver transplantation, or may die within 60 days [24056028, 31772079]. \n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yellow fever (YF) can lead to serious complications, including liver dysfunction, renal failure, and neurological impairment [29641667, 33268494].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29641667", "evidence_support": "These forms lead to renal, hepatic and neurological impairment, and bleeding episodes.", "evidence_relation": "supporting" }, { "cited_pmid": "33268494", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "YF can also cause hypercoagulopathy and platelet dysfunction, leading to bleeding episodes [32965473, 29641667].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32965473", "evidence_support": "Yellow fever (YF) causes high fever, liver dysfunction, renal failure, hypercoagulopathy and platelet dysfunction and can lead to shock and death with a case-fatality ratio of 20-50%.", "evidence_relation": "supporting" }, { "cited_pmid": "29641667", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In its most severe form, YF manifests as a hemorrhagic fever, causing significant damage to visceral organs [33268494].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33268494", "evidence_support": "In its most severe form, YF manifests as a hemorrhagic fever that causes severe damage to visceral organs.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The toxic phase of YF can be fatal, with a mortality rate of 20-50% [32965473, 24056028].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32965473", "evidence_support": "Yellow fever (YF) causes high fever, liver dysfunction, renal failure, hypercoagulopathy and platelet dysfunction and can lead to shock and death with a case-fatality ratio of 20-50%. YF vaccination results in long-lasting protective immunity.", "evidence_relation": "supporting" }, { "cited_pmid": "24056028", "evidence_support": "Up to 50% of severely affected persons from YF die without treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "24056028", "evidence_support": "YF usually causes fever, muscle pain with prominent backache, headache, shivers, loss of appetite, and nausea or vomiting.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "While some patients recover without significant organ damage, others may require intensive care support, liver transplantation, or may die within 60 days [24056028, 31772079].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24056028", "evidence_support": "Most patients improve, and their symptoms disappear after 3 to 4 d. Half of the patients who enter the toxic phase die within 10-14 d, while the rest recover without significant organ damage. ", "evidence_relation": "supporting" }, { "cited_pmid": "31772079", "evidence_support": "Clinical outcomes include severity meeting criteria for intensive care support, liver transplantation, in-hospital mortality and mortality within 60 days.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Yellow fever (YF) can lead to severe complications, including high mortality rates, with case-fatality ratios ranging from 20% to 50% [22093046, 32965473]. Complications may involve multiorgan failure, affecting the liver, kidneys, and other systems, which can result in shock and death [31967265, 37242350]. Liver dysfunction is particularly significant, often leading to fulminant liver failure and hemorrhagic events [31116245, 31116245]. Acute kidney injury (AKI) is also common, with a high association with mortality [35257072]. Neurological symptoms can occur, especially in severe cases, although YF is not classified as a neurotropic virus [36707912, 32041533]. Overall, the disease can culminate in multiple organ dysfunction, emphasizing the need for careful monitoring and management [37242350].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yellow fever (YF) can lead to severe complications, including high mortality rates, with case-fatality ratios ranging from 20% to 50% [22093046, 32965473].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22093046", "evidence_support": "Yellow fever (YF) may be very serious, with mortality reaching 50%.", "evidence_relation": "supporting" }, { "cited_pmid": "32965473", "evidence_support": "Yellow fever (YF) causes high fever, liver dysfunction, renal failure, hypercoagulopathy and platelet dysfunction and can lead to shock and death with a case-fatality ratio of 20-50%. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Complications may involve multiorgan failure, affecting the liver, kidneys, and other systems, which can result in shock and death [31967265, 37242350].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31967265", "evidence_support": "We report the case of a 20-year-old male from the department of Amazonas who presented with nine days of disease characterized by multiorgan failure (neurological, renal, hepatic, respiratory, and hematological involvement).", "evidence_relation": "supporting" }, { "cited_pmid": "37242350", "evidence_support": "Arboviruses, such as yellow fever virus (YFV), dengue virus (DENV), and chikungunya virus (CHIKV), present wide global dissemination and a pathogenic profile developed in infected individuals, from non-specific clinical conditions to severe forms, characterised by the promotion of significant lesions in different organs of the harbourer, culminating in multiple organ dysfunction. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Liver dysfunction is particularly significant, often leading to fulminant liver failure and hemorrhagic events [31116245, 31116245].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31116245", "evidence_support": "YF acute severe cases show a generalised involvement of different organs (liver, spleen, heart, kidneys, intestines and pancreas), and different parameters were related to outcome. Factor V and lipase are independent variables associated with death, reinforcing the importance of hemorrhagic events due to fulminant liver failure and pointing to pancreatitis as a relevant event in the outcome of the disease.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Acute kidney injury (AKI) is also common, with a high association with mortality [35257072].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35257072", "evidence_support": "INTRODUCTION: There have been few studies investigating acute kidney injury (AKI) in patients with yellow fever (YF). The objective of this study was to identify the risk factors for AKI and death in such patients.\nMETHODS: We evaluated 95 consecutive critically ill adult patients with the sylvatic form of YF, as confirmed by reverse-transcriptase polymerase chain reaction, in Brazil. The outcome measures were AKI (as defined by Kidney Disease: Improving Global Outcomes [KDIGO] criteria) and in-hospital death.\nRESULTS: Of the 95 patients, 73 (76.8%) had AKI and 59 (62.1%) died from it. A total of 70 patients (73.7%) required dialysis because of AKI. After adjusting for age, sex, and the Simplified Acute Physiology Score 3 (SAPS 3), we found that elevated fractional excretion of sodium and requiring dialysis were independent risk factors for in-hospital mortality and that proteinuria correlated with AKI-associated mortality.\nCONCLUSION: Our findings indicate that, in patients with sylvatic YF, AKI is common and is associated with significant mortality. The data presented here could prove useful for improving understanding of the pathogenesis of AKI in YF and informing decisions regarding the care of the affected patients.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Neurological symptoms can occur, especially in severe cases, although YF is not classified as a neurotropic virus [36707912, 32041533].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36707912", "evidence_support": "Even though it is not a proven neurotropic virus, neurological symptoms in more severe clinical forms are frequent. ", "evidence_relation": "supporting" }, { "cited_pmid": "36707912", "evidence_support": "The neuropathological findings are sufficient to justify the multiple clinical neurologic disturbances detected in the YF cases. ", "evidence_relation": "supporting" }, { "cited_pmid": "32041533", "evidence_support": "However, in rare cases it can produce serious neurotropic and viscerotropic complications.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Overall, the disease can culminate in multiple organ dysfunction, emphasizing the need for careful monitoring and management [37242350].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37242350", "evidence_support": "Arboviruses, such as yellow fever virus (YFV), dengue virus (DENV), and chikungunya virus (CHIKV), present wide global dissemination and a pathogenic profile developed in infected individuals, from non-specific clinical conditions to severe forms, characterised by the promotion of significant lesions in different organs of the harbourer, culminating in multiple organ dysfunction.", "evidence_relation": "supporting" }, { "cited_pmid": "37242350", "evidence_support": "Among the alterations evaluated, cell swelling, microvesicular steatosis, and apoptosis were classified according to the degree of tissue damage from severe to very severe", "evidence_relation": "neutral" }, { "cited_pmid": "37242350", "evidence_support": "Pathological abnormalities associated with YFV, DENV, and CHIKV infections showed a predominance of changes in the midzonal area. We also noted that, among the arboviruses studied, liver involvement in cases of YFV infection was more intense.", "evidence_relation": "neutral" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Yellow fever can lead to several serious complications. The disease typically causes fever, and in severe cases, it can result in liver and renal failure, which may present with hemorrhagic signs [24630625]. These complications can be life-threatening, and the risk of mortality increases significantly in patients who develop severe forms of the disease. Additionally, yellow fever can lead to multi-organ dysfunction, which complicates recovery and may require intensive medical care [24630625]. Early recognition and supportive treatment are crucial to managing the disease and mitigating potential complications.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yellow fever can lead to several serious complications.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "The disease typically causes fever, and in severe cases, it can result in liver and renal failure, which may present with hemorrhagic signs [24630625].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24630625", "evidence_support": "It causes fever and possibly liver and renal failure with hemorrhagic signs, which may be fatal.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "These complications can be life-threatening, and the risk of mortality increases significantly in patients who develop severe forms of the disease.", "answer_sentence_relevance": "borderline", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, yellow fever can lead to multi-organ dysfunction, which complicates recovery and may require intensive medical care [24630625].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24630625", "evidence_support": "The yellow-fever vaccine-associated autoimmune disease with central nervous system involvement (such as acute disseminated encephalomyelitis) associates fever and headaches, neurologic dysfunction, seizures, cerebrospinal fluid (CSF) pleocytosis, and elevated protein, with neuroimaging consistent with multifocal areas of demyelization.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Early recognition and supportive treatment are crucial to managing the disease and mitigating potential complications.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-1": { "answer": "Possible complications for a person that has yellow fever include hemorrhagic viral disease, neurotropic disease, corneal graft rejection, and adverse events such as prolonged detection of yellow fever RNA in blood and urine [29308400,22594140,23856798,20348528,28254833,32041533,33507830].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Possible complications for a person that has yellow fever include hemorrhagic viral disease, neurotropic disease, corneal graft rejection, and adverse events such as prolonged detection of yellow fever RNA in blood and urine [29308400,22594140,23856798,20348528,28254833,32041533,33507830].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22594140", "evidence_support": "Yellow fever is a mosquito-transmitted hemorrhagic viral disease that is endemic to tropical regions in South America and Africa.", "evidence_relation": "neutral" }, { "cited_pmid": "29308400", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "23856798", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "20348528", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "28254833", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "32041533", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "33507830", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "webis-2": { "answer": "The yellow fever vaccine can have serious adverse effects, but the context does not provide information about the possible complications for a person that has yellow fever itself [32041533].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The yellow fever vaccine can have serious adverse effects, but the context does not provide information about the possible complications for a person that has yellow fever itself [32041533].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "32041533", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-3": { "answer": "Possible complications for a person that has yellow fever include severe fever, jaundice, liver damage, kidney failure, and even death [29308400,23856798].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Possible complications for a person that has yellow fever include severe fever, jaundice, liver damage, kidney failure, and even death [29308400,23856798].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29308400", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "23856798", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-5": { "answer": "Possible complications for a person that has yellow fever include severe fever, jaundice, liver damage, kidney failure, and even death. . [29308400,23856798].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Possible complications for a person that has yellow fever include severe fever, jaundice, liver damage, kidney failure, and even death. .", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-1": { "answer": "Possible complications for a person with yellow fever include liver damage, kidney failure, bleeding disorders, and shock. Severe cases can lead to multi-organ failure and death, particularly in individuals with pre-existing health conditions or those who are not vaccinated. Yellow fever can also cause a relapse of symptoms after an initial improvement, known as the \"toxic phase,\" which can be life-threatening.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Possible complications for a person with yellow fever include liver damage, kidney failure, bleeding disorders, and shock.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Severe cases can lead to multi-organ failure and death, particularly in individuals with pre-existing health conditions or those who are not vaccinated.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Yellow fever can also cause a relapse of symptoms after an initial improvement, known as the \"toxic phase,\" which can be life-threatening.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "The possible complications for a person who has yellow fever vaccination include severe adverse reactions such as yellow fever vaccine-associated viscerotropic disease and acute uveitis, as noted in a case study of a 37-year-old man who experienced these complications after vaccination [32041533]. Additionally, there are potentially fatal complications associated with the yellow fever vaccine itself, which should be considered when deciding to vaccinate in non-endemic areas [20348528].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The possible complications for a person who has yellow fever vaccination include severe adverse reactions such as yellow fever vaccine-associated viscerotropic disease and acute uveitis, as noted in a case study of a 37-year-old man who experienced these complications after vaccination [32041533].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32041533", "evidence_support": "We describe the case of a 37\u2009years old man who developed after the yellow fever vaccination a yellow fever vaccine-associated viscerotropic disease followed by acute uveitis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, there are potentially fatal complications associated with the yellow fever vaccine itself, which should be considered when deciding to vaccinate in non-endemic areas [20348528].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20348528", "evidence_support": "Knowledge of potentially fatal complications of yellow fever vaccine should temper decisions to vaccinate populations where the disease is not endemic.", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-6": { "answer": "The possible complications for a person that has yellow fever include viscerotropic disease, which can lead to severe systemic illness, and acute uveitis, which is inflammation of the uveal tract of the eye [32041533,22594140]. Additionally, there may be cases of corneal graft rejection associated with the yellow fever vaccine, indicating potential ocular complications [33507830]. These complications highlight the importance of monitoring and managing adverse effects following vaccination or infection.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The possible complications for a person that has yellow fever include viscerotropic disease, which can lead to severe systemic illness, and acute uveitis, which is inflammation of the uveal tract of the eye [32041533,22594140].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32041533", "evidence_support": "However, in rare cases it can produce serious neurotropic and viscerotropic complications", "evidence_relation": "supporting" }, { "cited_pmid": "32041533", "evidence_support": "We describe the case of a 37\u2009years old man who developed after the yellow fever vaccination a yellow fever vaccine-associated viscerotropic disease followed by acute uveitis", "evidence_relation": "supporting" }, { "cited_pmid": "22594140", "evidence_support": "Herein, we report a mild case of yellow fever vaccine-associated viscerotropic disease 4 days after administration of the vaccine", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Additionally, there may be cases of corneal graft rejection associated with the yellow fever vaccine, indicating potential ocular complications [33507830].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33507830", "evidence_support": "This is the first case report of corneal transplant rejection temporally associated with yellow fever vaccination. Although the yellow fever vaccine is a very safe and efficacious vaccine, the occurrence of vaccine-related rejection may be more frequent than reported. Both patients and ophthalmologists should be aware of possible vaccine-related complications which may be potentially sight-threatening.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "These complications highlight the importance of monitoring and managing adverse effects following vaccination or infection.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "zero-shot-gemini-flash": { "answer": "Yellow fever (YF) can be a serious illness with a high mortality rate, reaching 50% in some cases [22093046, 32965473]. While most infections are mild or asymptomatic, 10% progress to a severe clinical picture with a 50% case-fatality rate [12806465]. YF can cause high fever, liver dysfunction, renal failure, hypercoagulopathy, and platelet dysfunction, leading to shock and death [32965473]. In rare cases, YF can also produce serious neurotropic and viscerotropic complications [32041533]. Hepatic involvement in YF cases shows intense histopathological changes, including cell swelling, microvesicular steatosis, and apoptosis [37242350]. These changes can range from severe to very severe, indicating the potential for significant liver damage [37242350]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yellow fever (YF) can be a serious illness with a high mortality rate, reaching 50% in some cases [22093046, 32965473].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22093046", "evidence_support": "Yellow fever (YF) may be very serious, with mortality reaching 50%.", "evidence_relation": "supporting" }, { "cited_pmid": "32965473", "evidence_support": "Yellow fever (YF) causes high fever, liver dysfunction, renal failure, hypercoagulopathy and platelet dysfunction and can lead to shock and death with a case-fatality ratio of 20-50%.", "evidence_relation": "supporting" }, { "cited_pmid": "32965473", "evidence_support": "We applied the Brighton Collaboration diagnostic criteria to assess the diagnostic accuracy of the clinical diagnoses and found meningoencephalitis in 38 reported YEL-AND cases, Guillain Barr\u00e9 Syndrome (GBS) in seven, Acute Disseminated Encephalomyelitis (ADEM) in six and myelitis in five.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "While most infections are mild or asymptomatic, 10% progress to a severe clinical picture with a 50% case-fatality rate [12806465].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "12806465", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "YF can cause high fever, liver dysfunction, renal failure, hypercoagulopathy, and platelet dysfunction, leading to shock and death [32965473].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32965473", "evidence_support": "Yellow fever (YF) causes high fever, liver dysfunction, renal failure, hypercoagulopathy and platelet dysfunction and can lead to shock and death with a case-fatality ratio of 20-50%. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In rare cases, YF can also produce serious neurotropic and viscerotropic complications [32041533].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32041533", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Hepatic involvement in YF cases shows intense histopathological changes, including cell swelling, microvesicular steatosis, and apoptosis [37242350].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37242350", "evidence_support": "Hepatic involvement in cases of YF showed a greater intensity of histopathological changes. Among the alterations evaluated, cell swelling, microvesicular steatosis, and apoptosis were classified according to the degree of tissue damage from severe to very severe. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "These changes can range from severe to very severe, indicating the potential for significant liver damage [37242350].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37242350", "evidence_support": "among the arboviruses studied, liver involvement in cases of YFV infection was more intense.", "evidence_relation": "neutral" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "Yellow fever can lead to severe complications in about 10% of cases, with a high case-fatality rate of 50% among those who develop severe symptoms [12806465]. The disease is characterized by fever, liver failure, renal failure, and hemorrhagic signs, which can be fatal [24630625]. The virus primarily targets the liver, causing significant damage, including hepatocyte necrosis and apoptosis [16650626]. Patients may also experience icterus (jaundice) and hemorrhagic diathesis, which can lead to death within days of severe illness onset [11463409]. While most infections are mild or asymptomatic, the potential for rapid deterioration underscores the importance of monitoring and managing complications effectively [12806465, 3490922].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Yellow fever can lead to severe complications in about 10% of cases, with a high case-fatality rate of 50% among those who develop severe symptoms [12806465].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "12806465", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "The disease is characterized by fever, liver failure, renal failure, and hemorrhagic signs, which can be fatal [24630625].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24630625", "evidence_support": "It causes fever and possibly liver and renal failure with hemorrhagic signs, which may be fatal.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The virus primarily targets the liver, causing significant damage, including hepatocyte necrosis and apoptosis [16650626].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16650626", "evidence_support": "In the liver, one of the main targets of the virus, the infection induces a characteristic midzonal injury characterized by hepatocyte necrosis, apoptosis and steatosis.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Patients may also experience icterus (jaundice) and hemorrhagic diathesis, which can lead to death within days of severe illness onset [11463409].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "11463409", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "While most infections are mild or asymptomatic, the potential for rapid deterioration underscores the importance of monitoring and managing complications effectively [12806465, 3490922].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "12806465", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "3490922", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] } } }, { "question_id": "142", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Medications that raise blood pressure can interact with antihypertensive drugs, potentially diminishing their effectiveness and increasing the risk of hypertension-related complications. For instance, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are known to raise blood pressure by causing sodium retention and decreasing kidney function, which can counteract the effects of antihypertensive medications [15778253]. Similarly, certain antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), have been associated with increased blood pressure, making it essential for patients on antihypertensive therapy to consult their healthcare provider before starting or adjusting any medication.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Medications that raise blood pressure can interact with antihypertensive drugs, potentially diminishing their effectiveness and increasing the risk of hypertension-related complications.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "For instance, nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen and naproxen are known to raise blood pressure by causing sodium retention and decreasing kidney function, which can counteract the effects of antihypertensive medications [15778253].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15778253", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Similarly, certain antidepressants, particularly selective serotonin reuptake inhibitors (SSRIs), have been associated with increased blood pressure, making it essential for patients on antihypertensive therapy to consult their healthcare provider before starting or adjusting any medication.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Several medications can interact with high blood pressure [17028488, 29291681, 18607141]. NSAIDs interfere with antihypertensives and increase blood pressure in hypertensive patients [24755117, 21646872, 20203454]. Some antidepressants, steroids, and glucocorticoids can also raise blood pressure [17028488, 29291681, 34414219]. Phenylpropanolamines, sibutramine, decongestants, and oral contraceptives are known to increase blood pressure [17028488, 29291681, 18607141]. Calcineurin inhibitors and erythropoietin affect blood pressure as well [17028488, 18607141, 26096556]. Cocaine and opioids can alter blood pressure, with cocaine typically causing an increase [17028488, 20203454, 18607141]. Methylphenidate is another drug that affects blood pressure [17028488, 18607141, 26096556]. Rifampin interacts with antihypertensive drugs, potentially altering their effectiveness [32100890, 32918434]. Tedizolid may increase blood pressure, and protease inhibitors, along with non-nucleoside reverse transcriptase inhibitors, can affect antihypertensive drug levels [32064090, 34784859]. Beta-blockers and calcium channel blockers are least affected by NSAIDs [24755117, 25618128, 21646872]. These interactions highlight the importance of monitoring blood pressure in patients taking these medications [24042856, 18607141, 26096556].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Several medications can interact with high blood pressure [17028488, 29291681, 18607141].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17028488", "evidence_support": "Many antihypertensive drugs have important interactions with drugs used for different purposes; when these are used concomitantly, adverse effects on blood pressure can result.", "evidence_relation": "supporting" }, { "cited_pmid": "29291681", "evidence_support": "One of the main causes of secondary hypertension, frequently ignored, is represented by certain categories of drugs, that can induce hypertension, increase the blood pressure values in previously controlled hypertension, decrease the effects of antihypertensive medication or induce a hypertensive emergency.", "evidence_relation": "supporting" }, { "cited_pmid": "18607141", "evidence_support": "A variety of therapeutic agents or chemical substances can induce either a transient or persistent increase in blood pressure or interfere with the blood pressure-lowering effects of antihypertensive drugs.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "10", "answer_sentence": "Beta-blockers and calcium channel blockers are least affected by NSAIDs [24755117, 25618128, 21646872].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24755117", "evidence_support": "The calcium channel blockers and \u03b2-blockers seem to be least affected by the concomitant use of NSAIDs.", "evidence_relation": "supporting" }, { "cited_pmid": "25618128", "evidence_support": "Not all groups of antihypertensive drugs are affected to the same degree; some are more affected, and others, such as calcium channel blockers, are not affected at all ", "evidence_relation": "neutral" }, { "cited_pmid": "21646872", "evidence_support": "Most antihypertensive medications seem to have decreased effects with concomitant NSAID administration, with the exception of calcium channel blockers.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "11", "answer_sentence": "These interactions highlight the importance of monitoring blood pressure in patients taking these medications [24042856, 18607141, 26096556].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "24042856", "evidence_support": "Management guidelines for NSAID-antihypertensive drug-drug interactions should advise SBP monitoring before and after initiation of an NSAID or intensification of NSAID therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "18607141", "evidence_support": "Careful evaluation of a patient's drug regimen may identify chemically induced hypertension and obviate unnecessary evaluation and direct to the optimal antihypertensive therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "26096556", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "NSAIDs interfere with antihypertensives and increase blood pressure in hypertensive patients [24755117, 21646872, 20203454].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24755117", "evidence_support": "Nonsteroidal anti-inflammatory drugs (NSAIDs) are widely available as over-the-counter medications, despite their numerous side effects and drug interactions.", "evidence_relation": "neutral" }, { "cited_pmid": "24755117", "evidence_support": "The aim of this article is to increase awareness of the hypertensive potential of NSAIDs and their interference with antihypertensives.", "evidence_relation": "supporting" }, { "cited_pmid": "21646872", "evidence_support": "Nonsteroidal anti-inflammatory drugs (NSAIDs) are ubiquitous medications used by a wide range of people from otherwise healthy normotensive patients to hypertensive patients with many significant comorbidities.", "evidence_relation": "supporting" }, { "cited_pmid": "20203454", "evidence_support": "Common substances that can interfere with BP control include nonsteroidal anti-inflammatory drugs (NSAIDs), oral contraceptives, glucocorticoids, antidepressants, decongestants, alcohol, or other stimulants like cocaine and methamphetamines.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Some antidepressants, steroids, and glucocorticoids can also raise blood pressure [17028488, 29291681, 34414219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17028488", "evidence_support": "The most important prescription drugs that affect blood pressure are the nonsteroidal anti-inflammatory drugs (including selective inhibitors of the second isoform of cyclooxygenase) and steroids.", "evidence_relation": "supporting" }, { "cited_pmid": "17028488", "evidence_support": "Phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them. ", "evidence_relation": "supporting" }, { "cited_pmid": "29291681", "evidence_support": "The most frequently incriminated drugs are steroids, nonsteroidal anti-inflammatory drugs, sympathomimetic agents, central nervous system stimulants (alcohol, amphetamine), dietary supplements (ginseng, natural liquorice etc), other therapeutic agents (sibutramine, antiemetic agents, oral physostigmine, L-dopa, leflunomide, growth hormone, thyroid hormone, recombinant human erythropoietin), antidepressants, immunosuppressants, antiangiogenic drugs, anaesthetics, heavy metals and toxins.", "evidence_relation": "supporting" }, { "cited_pmid": "34414219", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Phenylpropanolamines, sibutramine, decongestants, and oral contraceptives are known to increase blood pressure [17028488, 29291681, 18607141].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17028488", "evidence_support": "Phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them", "evidence_relation": "supporting" }, { "cited_pmid": "29291681", "evidence_support": "One of the main causes of secondary hypertension, frequently ignored, is represented by certain categories of drugs, that can induce hypertension, increase the blood pressure values in previously controlled hypertension, decrease the effects of antihypertensive medication or induce a hypertensive emergency. These drugs may be over-the-counter medications, illicit drugs or prescription drugs used for the treatment of acute or chronic conditions. The most frequently incriminated drugs are steroids, nonsteroidal anti-inflammatory drugs, sympathomimetic agents, central nervous system stimulants (alcohol, amphetamine), dietary supplements (ginseng, natural liquorice etc), other therapeutic agents (sibutramine, antiemetic agents, oral physostigmine, L-dopa, leflunomide, growth hormone, thyroid hormone, recombinant human erythropoietin), antidepressants, immunosuppressants, antiangiogenic drugs, anaesthetics, heavy metals and toxins", "evidence_relation": "supporting" }, { "cited_pmid": "18607141", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Calcineurin inhibitors and erythropoietin affect blood pressure as well [17028488, 18607141, 26096556].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17028488", "evidence_support": "Many antihypertensive drugs have important interactions with drugs used for different purposes; when these are used concomitantly, adverse effects on blood pressure can result.", "evidence_relation": "neutral" }, { "cited_pmid": "17028488", "evidence_support": "Phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them. Conversely, the hypertensive effects of calcineurin inhibitors and erythropoietin are most commonly overcome by increasing the intensity of antihypertensive drug treatment, since these drugs are essentially unavoidable in most patients who receive them.", "evidence_relation": "supporting" }, { "cited_pmid": "26096556", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18607141", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Cocaine and opioids can alter blood pressure, with cocaine typically causing an increase [17028488, 20203454, 18607141].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17028488", "evidence_support": "Physicians who work in emergency departments are more familiar with illicit or unregulated drugs that affect blood pressure; chief among these are cocaine and other opioids, and methylphenidate and its congeners.", "evidence_relation": "supporting" }, { "cited_pmid": "20203454", "evidence_support": "Common substances that can interfere with BP control include nonsteroidal anti-inflammatory drugs (NSAIDs), oral contraceptives, glucocorticoids, antidepressants, decongestants, alcohol, or other stimulants like cocaine and methamphetamines", "evidence_relation": "supporting" }, { "cited_pmid": "18607141", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Methylphenidate is another drug that affects blood pressure [17028488, 18607141, 26096556].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17028488", "evidence_support": "Physicians who work in emergency departments are more familiar with illicit or unregulated drugs that affect blood pressure; chief among these are cocaine and other opioids, and methylphenidate and its congeners.", "evidence_relation": "supporting" }, { "cited_pmid": "26096556", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18607141", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Rifampin interacts with antihypertensive drugs, potentially altering their effectiveness [32100890, 32918434].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32100890", "evidence_support": "Lack of blood pressure control is often seen in hypertensive patients concomitantly taking antituberculosis medications due to the complex drug-drug interactions between rifampin and antihypertensive drugs.", "evidence_relation": "supporting" }, { "cited_pmid": "32100890", "evidence_support": "Application of the BDDCS to predict interactions between rifampin and antihypertensive drugs for patients with both tuberculosis and hypertension was found to be reliable.", "evidence_relation": "supporting" }, { "cited_pmid": "32918434", "evidence_support": "We postulate that rifampicin has attenuated the therapeutic effect of amlodipine via potent induction of hepatic CYP3A4 but the failure to control the blood pressure even with medications unrelated to cytochrome P450 pathways raises the spectre of an additional interaction.", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "9", "answer_sentence": "Tedizolid may increase blood pressure, and protease inhibitors, along with non-nucleoside reverse transcriptase inhibitors, can affect antihypertensive drug levels [32064090, 34784859].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32064090", "evidence_support": "Thiscase report concerns a 34-year-old male with a hip prosthesis infection, under treatment with antidepressant and antihypertensive drugs, who presented with an increase in blood pressure after four days of treatment with oral tedizolid. ", "evidence_relation": "supporting" }, { "cited_pmid": "34784859", "evidence_support": "Serum levels of any kind of antihypertensive drugs may be influenced by the coadministration of protease inhibitors, non-nucleoside reverse transcriptase inhibitor, or other antiretroviral. ", "evidence_relation": "supporting" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to interact with antihypertensive medications, potentially increasing blood pressure through mechanisms such as sodium retention and vasoconstriction [21646872, 21612106]. This interaction is particularly significant in hypertensive patients, where NSAIDs can attenuate the efficacy of antihypertensive agents, especially those other than calcium channel blockers [24755117, 25618128]. The hypertensive effect of NSAIDs can range from minor to substantial, with increases in systolic blood pressure up to 14.3 mm Hg reported in some studies [21646872]. Additionally, other medications such as steroids, certain antidepressants, and calcineurin inhibitors can also elevate blood pressure or reduce the effectiveness of antihypertensive treatments [17028488, 29291681]. Given the widespread use of these drugs, careful monitoring and management are essential to mitigate adverse cardiovascular outcomes in patients with hypertension [20203454, 22195528].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to interact with antihypertensive medications, potentially increasing blood pressure through mechanisms such as sodium retention and vasoconstriction [21646872, 21612106].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21646872", "evidence_support": "Nonsteroidal anti-inflammatory drugs (NSAIDs) are ubiquitous medications used by a wide range of people from otherwise healthy normotensive patients to hypertensive patients with many significant comorbidities.", "evidence_relation": "supporting" }, { "cited_pmid": "21646872", "evidence_support": "Through a variety of mechanisms related to prostaglandin inhibition, including sodium retention and vasoconstriction, these agents may increase blood pressure.", "evidence_relation": "supporting" }, { "cited_pmid": "21612106", "evidence_support": "These drugs, the older group, nonselective ciclooxigenase inibitors (inhibitors of COX-1 and COX-2), may increase blood pressure and cardiovascular risk.", "evidence_relation": "supporting" }, { "cited_pmid": "21612106", "evidence_support": "The main mechanism of the increased blood pressure by NSAID is blockage of prostaglandin synthesis", "evidence_relation": "supporting" }, { "cited_pmid": "21612106", "evidence_support": "The results of blockage of prostaglandin synthesis are sodium and fluid retention", "evidence_relation": "supporting" }, { "cited_pmid": "21612106", "evidence_support": "Indomethacin, naproxen, and other NSAID increase the blood pressure in patients treated with beta-blockers, diuretics, metildopa, ACE-inhibitors and combination of various antihipertensive drugs, but there is no increase of blood pressure in patients treated with calcium blockers. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This interaction is particularly significant in hypertensive patients, where NSAIDs can attenuate the efficacy of antihypertensive agents, especially those other than calcium channel blockers [24755117, 25618128].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24755117", "evidence_support": "Patients with hypertension appear to be more susceptible than normotensive individuals to the blood pressure-increasing effect of NSAIDs.", "evidence_relation": "supporting" }, { "cited_pmid": "24755117", "evidence_support": "The calcium channel blockers and \u03b2-blockers seem to be least affected by the concomitant use of NSAIDs.", "evidence_relation": "supporting" }, { "cited_pmid": "25618128", "evidence_support": "The present article focusses on the mechanism and the degree of influence on the blood pressure of particular types of antihypertensive agents used in combination with NSAID.", "evidence_relation": "supporting" }, { "cited_pmid": "25618128", "evidence_support": "Not all groups of antihypertensive drugs are affected to the same degree; some are more affected, and others, such as calcium channel blockers, are not affected at all.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The hypertensive effect of NSAIDs can range from minor to substantial, with increases in systolic blood pressure up to 14.3 mm", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Hg reported in some studies [21646872].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "21646872", "evidence_support": "There is evidence of small blood pressure increases in normotensive patients taking NSAIDs approximating +1.1 mm Hg. Patients with treated hypertension show variable increases with NSAID treatment, ranging up to +14.3 mm Hg for systolic pressure and +2.3 mm Hg for diastolic blood pressure.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, other medications such as steroids, certain antidepressants, and calcineurin inhibitors can also elevate blood pressure or reduce the effectiveness of antihypertensive treatments [17028488, 29291681].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17028488", "evidence_support": "The most important prescription drugs that affect blood pressure are the nonsteroidal anti-inflammatory drugs (including selective inhibitors of the second isoform of cyclooxygenase) and steroids. Phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them. Conversely, the hypertensive effects of calcineurin inhibitors and erythropoietin are most commonly overcome by increasing the intensity of antihypertensive drug treatment, since these drugs are essentially unavoidable in most patients who receive them.", "evidence_relation": "supporting" }, { "cited_pmid": "29291681", "evidence_support": "The most frequently incriminated drugs are steroids, nonsteroidal anti-inflammatory drugs, sympathomimetic agents, central nervous system stimulants (alcohol, amphetamine), dietary supplements (ginseng, natural liquorice etc), other therapeutic agents (sibutramine, antiemetic agents, oral physostigmine, L-dopa, leflunomide, growth hormone, thyroid hormone, recombinant human erythropoietin), antidepressants, immunosuppressants, antiangiogenic drugs, anaesthetics, heavy metals and toxins. ", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Given the widespread use of these drugs, careful monitoring and management are essential to mitigate adverse cardiovascular outcomes in patients with hypertension [20203454, 22195528].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "20203454", "evidence_support": "Patients who demonstrate a deterioration in BP control should be questioned about adherence, recent changes to diet and lifestyle, signs and symptoms of secondary causes of hypertension, and use of any concomitant medications or other substances that may be known to increase BP or interfere with antihypertensive therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "20203454", "evidence_support": "clinicians must actively investigate potential contributing factors and appropriately increase or adjust antihypertensive therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "22195528", "evidence_support": "Careful evaluation of a patient's drug regimen may identify chemically induced hypertension and obviate unnecessary evaluation and facilitate antihypertensive therapy.", "evidence_relation": "supporting" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Nonsteroidal anti-inflammatory drugs (NSAIDs) have a significant drug interaction with high blood pressure, as they can increase blood pressure in patients with hypertension [24755117, 25618128, 21646872]. This is due to the inhibition of prostaglandin synthesis, leading to sodium and fluid retention [21612106]. Additionally, certain antidepressants, such as serotonin-norepinephrine reuptake inhibitors, particularly venlafaxine, can also increase blood pressure [34414219]. Other medications that can interact with high blood pressure include steroids, sympathomimetic agents, and certain antihypertensive drugs, such as calcineurin inhibitors and erythropoietin [17028488, 29291681]. Furthermore, some over-the-counter medications, such as decongestants and certain dietary supplements, can also increase blood pressure [29291681, 18257920]. It is essential for clinicians to be aware of these potential interactions to provide optimal treatment for patients with hypertension.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs) have a significant drug interaction with high blood pressure, as they can increase blood pressure in patients with hypertension [24755117, 25618128, 21646872].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "24755117", "evidence_support": "Patients with hypertension appear to be more susceptible than normotensive individuals to the blood pressure-increasing effect of NSAIDs.", "evidence_relation": "supporting" }, { "cited_pmid": "24755117", "evidence_support": "Most studies have found that short-term use of NSAIDs does not pose a major risk for hypertension or increase in cardiovascular disease in healthy individuals. The calcium channel blockers and \u03b2-blockers seem to be least affected by the concomitant use of NSAIDs. A dentist must weigh the benefits and disadvantages of using NSAIDs in patients taking antihypertensive drugs. ", "evidence_relation": "contradicting" }, { "cited_pmid": "25618128", "evidence_support": "This could well explain the commonly encountered experience of drug interaction between NSAIDs and antihypertensive drugs, which is very common in clinical practice. The severity of this drug interaction is classified as class C, with a\u00a0recommendation to monitor therapy. However, even a\u00a0minor long-term increase in blood pressure can significantly increase the risk of cardiovascular mortality, while mortality rates can possibly be reduced by sufficiently effective treatment of hypertension.", "evidence_relation": "supporting" }, { "cited_pmid": "21646872", "evidence_support": "Through a variety of mechanisms related to prostaglandin inhibition, including sodium retention and vasoconstriction, these agents may increase blood pressure.", "evidence_relation": "supporting" }, { "cited_pmid": "21646872", "evidence_support": "Given the current literature, it appears that NSAIDs increase blood pressure in patients with controlled-hypertension, but the quantity of this increase is variable. If possible, patients who have hypertension should avoid taking NSAIDs", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This is due to the inhibition of prostaglandin synthesis, leading to sodium and fluid retention [21612106].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "21612106", "evidence_support": "The main mechanism of the increased blood pressure by NSAID is blockage of prostaglandin synthesis. The results of blockage of prostaglandin synthesis are sodium and fluid retention.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, certain antidepressants, such as serotonin-norepinephrine reuptake inhibitors, particularly venlafaxine, can also increase blood pressure [34414219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34414219", "evidence_support": "Serotonin-norepinephrine reuptake inhibitors, particularly venlafaxine, carry a greater risk of hypertension, possibly related to greater effects on the sympathetic nervous system.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Other medications that can interact with high blood pressure include steroids, sympathomimetic agents, and certain antihypertensive drugs, such as calcineurin inhibitors and erythropoietin [17028488, 29291681].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17028488", "evidence_support": "The most important prescription drugs that affect blood pressure are the nonsteroidal anti-inflammatory drugs (including selective inhibitors of the second isoform of cyclooxygenase) and steroids. Phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them. Conversely, the hypertensive effects of calcineurin inhibitors and erythropoietin are most commonly overcome by increasing the intensity of antihypertensive drug treatment, since these drugs are essentially unavoidable in most patients who receive them.", "evidence_relation": "supporting" }, { "cited_pmid": "29291681", "evidence_support": "The most frequently incriminated drugs are steroids, nonsteroidal anti-inflammatory drugs, sympathomimetic agents, central nervous system stimulants (alcohol, amphetamine), dietary supplements (ginseng, natural liquorice etc), other therapeutic agents (sibutramine, antiemetic agents, oral physostigmine, L-dopa, leflunomide, growth hormone, thyroid hormone, recombinant human erythropoietin), antidepressants, immunosuppressants, antiangiogenic drugs, anaesthetics, heavy metals and toxins.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, some over-the-counter medications, such as decongestants and certain dietary supplements, can also increase blood pressure [29291681, 18257920].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29291681", "evidence_support": "These drugs may be over-the-counter medications, illicit drugs or prescription drugs used for the treatment of acute or chronic conditions.", "evidence_relation": "supporting" }, { "cited_pmid": "18257920", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "It is essential for clinicians to be aware of these potential interactions to provide optimal treatment for patients with hypertension.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, oestroprogestinic agents, immunosuppressants, erythropoietin, inhibitors of angiogenesis, anti-HIV agents, and some high-density lipoprotein-raising agents can cause hypertension and/or blunt the effect of antihypertensive treatment [30052747, 25618128, 24042856]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, oestroprogestinic agents, immunosuppressants, erythropoietin, inhibitors of angiogenesis, anti-HIV agents, and some high-density lipoprotein-raising agents can cause hypertension and/or blunt the effect of antihypertensive treatment [30052747, 25618128, 24042856].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30052747", "evidence_support": "The most prevalent BP-interfering prescription medications were nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophens, and hormones. ", "evidence_relation": "supporting" }, { "cited_pmid": "30052747", "evidence_support": "The use of prescription BP-interfering medications, especially NSAIDs, is prevalent among patients requiring intensification of their antihypertensive regimen.", "evidence_relation": "supporting" }, { "cited_pmid": "25618128", "evidence_support": "Not all groups of antihypertensive drugs are affected to the same degree; some are more affected, and others, such as calcium channel blockers, are not affected at all. Similarly, not every NSAID increases blood pressure", "evidence_relation": "contradicting" }, { "cited_pmid": "24042856", "evidence_support": "A newly initiated NSAID has an immediate clinically relevant effect on SBP in some users of antihypertensives", "evidence_relation": "supporting" }, { "cited_pmid": "24042856", "evidence_support": "Management guidelines for NSAID-antihypertensive drug-drug interactions should advise SBP monitoring before and after initiation of an NSAID or intensification of NSAID therapy.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "The medication that has a drug interaction with high blood pressure is rifampicin, which can attenuate the therapeutic effect of amlodipine via potent induction of hepatic CYP3A4 [35841932, 32918434, 36311309]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The medication that has a drug interaction with high blood pressure is rifampicin, which can attenuate the therapeutic effect of amlodipine via potent induction of hepatic CYP3A4 [35841932, 32918434, 36311309].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "32918434", "evidence_support": "We postulate that rifampicin has attenuated the therapeutic effect of amlodipine via potent induction of hepatic CYP3A4 but the failure to control the blood pressure even with medications unrelated to cytochrome P450 pathways raises the spectre of an additional interaction.", "evidence_relation": "supporting" }, { "cited_pmid": "35841932", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "36311309", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them [30052747, 17120715, 18953082]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them [30052747, 17120715, 18953082].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30052747", "evidence_support": "The most prevalent BP-interfering prescription medications were nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophens, and hormones.", "evidence_relation": "supporting" }, { "cited_pmid": "17120715", "evidence_support": "A review of the main interacting drug regimens will complete this paper, attesting that drugs as various as NSAID, corticosteroids, erythropoietin, cyclosporine, antidepressants, beta blockers, carbamazepine, sympathomimetics, antihistamines, tramadol and (...) can induce arterial hypertension.", "evidence_relation": "supporting" }, { "cited_pmid": "18953082", "evidence_support": "Non-steroidal anti-inflammatory drugs (NSAIDs) may increase blood pressure (BP) and blunt the effects of many antihypertensives.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them [21646872, 30052747, 17028488]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them [21646872, 30052747, 17028488].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21646872", "evidence_support": "Through a variety of mechanisms related to prostaglandin inhibition, including sodium retention and vasoconstriction, these agents may increase blood pressure.", "evidence_relation": "contradicting" }, { "cited_pmid": "21646872", "evidence_support": "Given the current literature, it appears that NSAIDs increase blood pressure in patients with controlled-hypertension, but the quantity of this increase is variable.", "evidence_relation": "neutral" }, { "cited_pmid": "30052747", "evidence_support": "Withdrawing medications that interfere with blood pressure (BP) is recommended in patients with uncontrolled BP, yet real-world use of such agents is not well characterized among individuals with hypertension.", "evidence_relation": "neutral" }, { "cited_pmid": "30052747", "evidence_support": "The most prevalent BP-interfering prescription medications were nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophens, and hormones.", "evidence_relation": "contradicting" }, { "cited_pmid": "30052747", "evidence_support": "The use of prescription BP-interfering medications, especially NSAIDs, is prevalent among patients requiring intensification of their antihypertensive regimen.", "evidence_relation": "contradicting" }, { "cited_pmid": "17028488", "evidence_support": "The most important prescription drugs that affect blood pressure are the nonsteroidal anti-inflammatory drugs (including selective inhibitors of the second isoform of cyclooxygenase) and steroids. Phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them [21646872, 30052747, 17028488]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them [21646872, 30052747, 17028488].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21646872", "evidence_support": "Through a variety of mechanisms related to prostaglandin inhibition, including sodium retention and vasoconstriction, these agents may increase blood pressure.", "evidence_relation": "contradicting" }, { "cited_pmid": "21646872", "evidence_support": "Given the current literature, it appears that NSAIDs increase blood pressure in patients with controlled-hypertension, but the quantity of this increase is variable.", "evidence_relation": "neutral" }, { "cited_pmid": "30052747", "evidence_support": "Withdrawing medications that interfere with blood pressure (BP) is recommended in patients with uncontrolled BP, yet real-world use of such agents is not well characterized among individuals with hypertension.", "evidence_relation": "neutral" }, { "cited_pmid": "30052747", "evidence_support": "The most prevalent BP-interfering prescription medications were nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophens, and hormones.", "evidence_relation": "contradicting" }, { "cited_pmid": "30052747", "evidence_support": "The use of prescription BP-interfering medications, especially NSAIDs, is prevalent among patients requiring intensification of their antihypertensive regimen.", "evidence_relation": "contradicting" }, { "cited_pmid": "17028488", "evidence_support": "The most important prescription drugs that affect blood pressure are the nonsteroidal anti-inflammatory drugs (including selective inhibitors of the second isoform of cyclooxygenase) and steroids. Phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them.", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them [30052747, 21646872, 17028488]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them [30052747, 21646872, 17028488].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30052747", "evidence_support": "The most prevalent BP-interfering prescription medications were nonsteroidal anti-inflammatory drugs (NSAIDs), acetaminophens, and hormones.", "evidence_relation": "supporting" }, { "cited_pmid": "21646872", "evidence_support": "patients who have hypertension should avoid taking NSAIDs.", "evidence_relation": "supporting" }, { "cited_pmid": "17028488", "evidence_support": "The most important prescription drugs that affect blood pressure are the nonsteroidal anti-inflammatory drugs (including selective inhibitors of the second isoform of cyclooxygenase) and steroids. Phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them [15013931]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them [15013931].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15013931", "evidence_support": "However, it does have a consistent effect of increasing blood pressure and pulse", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them [17028488]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them [17028488].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17028488", "evidence_support": "The most important prescription drugs that affect blood pressure are the nonsteroidal anti-inflammatory drugs (including selective inhibitors of the second isoform of cyclooxygenase) and steroids. Phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, phenylpropanolamines, and some antidepressants can often be avoided, as they raise blood pressure in a significant proportion of those who take them [15685250, 17028488, 16579768, 15066944]. Sibutramine is unlikely to cause a critical increase in blood pressure, but blood pressure and heart rate should be monitored closely [15685250, 17028488, 16579768, 15066944]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs), steroids, phenylpropanolamines, and some antidepressants can often be avoided, as they raise blood pressure in a significant proportion of those who take them [15685250, 17028488, 16579768, 15066944].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15685250", "evidence_support": "There have been concerns that norepinephrine reuptake inhibition with sibutramine could exacerbate arterial hypertension", "evidence_relation": "neutral" }, { "cited_pmid": "17028488", "evidence_support": "The most important prescription drugs that affect blood pressure are the nonsteroidal anti-inflammatory drugs (including selective inhibitors of the second isoform of cyclooxygenase) and steroids. Phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them.", "evidence_relation": "supporting" }, { "cited_pmid": "16579768", "evidence_support": "Dogs with concurrent cardiovascular disease should be monitored for blood pressure while receiving alpha-adrenergic agents because of the effects on diastolic and mean arterial pressure", "evidence_relation": "neutral" }, { "cited_pmid": "15066944", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Sibutramine is unlikely to cause a critical increase in blood pressure, but blood pressure and heart rate should be monitored closely [15685250, 17028488, 16579768, 15066944].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "15685250", "evidence_support": "Sibutramine treatment is unlikely to elicit a critical increase in blood pressure even in hypertensive patients. However, blood pressure and HR should be monitored closely.", "evidence_relation": "supporting" }, { "cited_pmid": "17028488", "evidence_support": "sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them.", "evidence_relation": "contradicting" }, { "cited_pmid": "16579768", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "15066944", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Nonsteroidal anti-inflammatory drugs (NSAIDs), phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them [15013931, 34414219, 25978108]. Steroids, such as synthetic glucocorticoids, may be associated with a slight increase in systolic blood pressure in some patients, but the effect is generally clinically nonsignificant [15013931, 34414219, 25978108]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs), phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them [15013931, 34414219, 25978108].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15013931", "evidence_support": "However, it does have a consistent effect of increasing blood pressure and pulse. Thus, blood pressure and heart rate should be monitored in patients using sibutramine and it may not be applicable in obese patients with significant cardiovascular disease.", "evidence_relation": "supporting" }, { "cited_pmid": "34414219", "evidence_support": "This phenomenon may depend, at least in part, on the use of antidepressant drugs, which may influence blood pressure through different effects on adrenergic and serotoninergic pathways, as well as on histaminergic, dopaminergic, and cholinergic systems.", "evidence_relation": "neutral" }, { "cited_pmid": "34414219", "evidence_support": "Agomelatine, the only melatonergic antidepressant drug, may also have limited effects on blood pressure. Tricyclic antidepressants have been associated with increases in blood pressure, as well as orthostatic hypotension, particularly imipramine.", "evidence_relation": "supporting" }, { "cited_pmid": "34414219", "evidence_support": "Clinicians treating depressive patients should carefully consider their blood pressure status and cardiovascular comorbidities because of the effects of antidepressant drugs on blood pressure profiles and potential interactions with antihypertensive treatments.", "evidence_relation": "supporting" }, { "cited_pmid": "25978108", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Steroids, such as synthetic glucocorticoids, may be associated with a slight increase in systolic blood pressure in some patients, but the effect is generally clinically nonsignificant [15013931, 34414219, 25978108].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25978108", "evidence_support": "We did not find any evidence of the effects of glucocorticoids on blood pressure in these patients.", "evidence_relation": "contradicting" }, { "cited_pmid": "25978108", "evidence_support": "In this group of patients, glucocorticoid exposure was associated with a slight (<1 mm Hg; P = .03) increase of systolic but not diastolic (P = .52) blood pressure. However, in 4% of people or fewer, extreme increases or decreases (ie, \u226530 mm Hg for systolic blood pressure) in blood pressure were observed after glucocorticoid initiation.", "evidence_relation": "supporting" }, { "cited_pmid": "25978108", "evidence_support": "Contrary to what is usually thought, the increase of blood pressure during the first months of exposure to synthetic glucocorticoids seems clinically nonsignificant.", "evidence_relation": "supporting" }, { "cited_pmid": "15013931", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "34414219", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to interact with antihypertensive medications, potentially increasing blood pressure through mechanisms such as sodium retention and vasoconstriction [21646872, 21612106]. This interaction is particularly significant in hypertensive patients, where NSAIDs can diminish the efficacy of antihypertensive agents, except for calcium channel blockers, which are less affected [25618128, 24755117]. Other medications, including certain antidepressants like serotonin-norepinephrine reuptake inhibitors, can also elevate blood pressure by enhancing sympathetic nervous system activity [34414219]. Additionally, steroids and calcineurin inhibitors are notable for their hypertensive effects, often necessitating intensified antihypertensive therapy [17028488, 29291681]. The impact of these interactions underscores the importance of careful medication management and monitoring in patients with hypertension to prevent adverse cardiovascular outcomes [22195528, 20203454].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs) are known to interact with antihypertensive medications, potentially increasing blood pressure through mechanisms such as sodium retention and vasoconstriction [21646872, 21612106].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21646872", "evidence_support": "Nonsteroidal anti-inflammatory drugs (NSAIDs) are ubiquitous medications used by a wide range of people from otherwise healthy normotensive patients to hypertensive patients with many significant comorbidities. Through a variety of mechanisms related to prostaglandin inhibition, including sodium retention and vasoconstriction, these agents may increase blood pressure", "evidence_relation": "supporting" }, { "cited_pmid": "21612106", "evidence_support": "The main mechanism of the increased blood pressure by NSAID is blockage of prostaglandin synthesis. The results of blockage of prostaglandin synthesis are sodium and fluid retention.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This interaction is particularly significant in hypertensive patients, where NSAIDs can diminish the efficacy of antihypertensive agents, except for calcium channel blockers, which are less affected [25618128, 24755117].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25618128", "evidence_support": "Their consumption is high among older people, who are much more sensitive to the side effects, and who are often also taking other drugs which can interact with them. Moreover, the majority of the older population is suffering from hypertension. This could well explain the commonly encountered experience of drug interaction between NSAIDs and antihypertensive drugs, which is very common in clinical practice. The severity of this drug interaction is classified as class C, with a\u00a0recommendation to monitor therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "25618128", "evidence_support": "Therefore, in clinical practice, this type of interaction should not be overlooked as a\u00a0major cause of failure of hypertension treatment in older patients, as well in many cases in general. ", "evidence_relation": "neutral" }, { "cited_pmid": "25618128", "evidence_support": "Not all groups of antihypertensive drugs are affected to the same degree; some are more affected, and others, such as calcium channel blockers, are not affected at all. Similarly, not every NSAID increases blood pressure. Many studies, some of which are analyzed in this article, present evidence of the degree of the influence NSAIDs have on blood pressure.", "evidence_relation": "contradicting" }, { "cited_pmid": "24755117", "evidence_support": "The aim of this article is to increase awareness of the hypertensive potential of NSAIDs and their interference with antihypertensives. Patients with hypertension appear to be more susceptible than normotensive individuals to the blood pressure-increasing effect of NSAIDs", "evidence_relation": "supporting" }, { "cited_pmid": "24755117", "evidence_support": "The calcium channel blockers and \u03b2-blockers seem to be least affected by the concomitant use of NSAIDs.", "evidence_relation": "supporting" }, { "cited_pmid": "24755117", "evidence_support": "For those who may be at greater risk, such as patients with hypertension and the elderly, careful selection of the class of NSAID and close monitoring are appropriate measures, especially if long-term use is anticipated.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Other medications, including certain antidepressants like serotonin-norepinephrine reuptake inhibitors, can also elevate blood pressure by enhancing sympathetic nervous system activity [34414219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34414219", "evidence_support": "Serotonin-norepinephrine reuptake inhibitors, particularly venlafaxine, carry a greater risk of hypertension, possibly related to greater effects on the sympathetic nervous system.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, steroids and calcineurin inhibitors are notable for their hypertensive effects, often necessitating intensified antihypertensive therapy [17028488, 29291681].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17028488", "evidence_support": "Conversely, the hypertensive effects of calcineurin inhibitors and erythropoietin are most commonly overcome by increasing the intensity of antihypertensive drug treatment, since these drugs are essentially unavoidable in most patients who receive them.", "evidence_relation": "supporting" }, { "cited_pmid": "29291681", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "The impact of these interactions underscores the importance of careful medication management and monitoring in patients with hypertension to prevent adverse cardiovascular outcomes [22195528, 20203454].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "22195528", "evidence_support": "Careful evaluation of a patient's drug regimen may identify chemically induced hypertension and obviate unnecessary evaluation and facilitate antihypertensive therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "20203454", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Several medications can interact with antihypertensive drugs, potentially affecting blood pressure control.Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can reduce the efficacy of antihypertensives by causing sodium and water retention.Certain antidepressants, particularly monoamine oxidase inhibitors (MAOIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), can elevate blood pressure.Decongestants containing pseudoephedrine or phenylephrine can also increase blood pressure and counteract antihypertensive treatment.Additionally, corticosteroids can lead to fluid retention and hypertension.Some herbal supplements, such as licorice root, can exacerbate high blood pressure.It is crucial to monitor blood pressure closely and adjust medications as needed when these interactions are present.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Several medications can interact with antihypertensive drugs, potentially affecting blood pressure control.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs) like ibuprofen can reduce the efficacy of antihypertensives by causing sodium and water retention.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Certain antidepressants, particularly monoamine oxidase inhibitors (MAOIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs), can elevate blood pressure.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Decongestants containing pseudoephedrine or phenylephrine can also increase blood pressure and counteract antihypertensive treatment.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, corticosteroids can lead to fluid retention and hypertension.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Some herbal supplements, such as licorice root, can exacerbate high blood pressure.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "It is crucial to monitor blood pressure closely and adjust medications as needed when these interactions are present.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Nonsteroidal anti-inflammatory drugs (NSAIDs) have a significant drug interaction with high blood pressure, as they can increase blood pressure in patients with hypertension [25618128, 24755117, 21646872]. This is due to the inhibition of prostaglandin synthesis, leading to sodium and fluid retention [21612106]. Additionally, certain antidepressants, such as serotonin-norepinephrine reuptake inhibitors, particularly venlafaxine, can also increase blood pressure [34414219]. Other medications that can interact with high blood pressure include steroids, sympathomimetic agents, and certain antiretroviral drugs [29291681, 30822569, 34784859]. Furthermore, some over-the-counter medications, such as decongestants and certain analgesics, can also increase blood pressure [16675317, 18257920]. It is essential for clinicians to be aware of these potential interactions and monitor blood pressure in patients taking these medications [20203454, 24042856]. Careful evaluation of a patient's drug regimen can help identify chemically induced hypertension and guide optimal antihypertensive therapy [22195528, 18607141].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs) have a significant drug interaction with high blood pressure, as they can increase blood pressure in patients with hypertension [25618128, 24755117, 21646872].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25618128", "evidence_support": "This could well explain the commonly encountered experience of drug interaction between NSAIDs and antihypertensive drugs, which is very common in clinical practice.", "evidence_relation": "supporting" }, { "cited_pmid": "24755117", "evidence_support": "Patients with hypertension appear to be more susceptible than normotensive individuals to the blood pressure-increasing effect of NSAIDs.", "evidence_relation": "supporting" }, { "cited_pmid": "21646872", "evidence_support": "Given the current literature, it appears that NSAIDs increase blood pressure in patients with controlled-hypertension, but the quantity of this increase is variable.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This is due to the inhibition of prostaglandin synthesis, leading to sodium and fluid retention [21612106].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "21612106", "evidence_support": "The main mechanism of the increased blood pressure by NSAID is blockage of prostaglandin synthesis. The results of blockage of prostaglandin synthesis are sodium and fluid retention.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, certain antidepressants, such as serotonin-norepinephrine reuptake inhibitors, particularly venlafaxine, can also increase blood pressure [34414219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34414219", "evidence_support": "Serotonin-norepinephrine reuptake inhibitors, particularly venlafaxine, carry a greater risk of hypertension, possibly related to greater effects on the sympathetic nervous system.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Other medications that can interact with high blood pressure include steroids, sympathomimetic agents, and certain antiretroviral drugs [29291681, 30822569, 34784859].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29291681", "evidence_support": "The most frequently incriminated drugs are steroids, nonsteroidal anti-inflammatory drugs, sympathomimetic agents, central nervous system stimulants (alcohol, amphetamine), dietary supplements (ginseng, natural liquorice etc), other therapeutic agents (sibutramine, antiemetic agents, oral physostigmine, L-dopa, leflunomide, growth hormone, thyroid hormone, recombinant human erythropoietin), antidepressants, immunosuppressants, antiangiogenic drugs, anaesthetics, heavy metals and toxins. ", "evidence_relation": "supporting" }, { "cited_pmid": "30822569", "evidence_support": " Excessive water and sodium retention, direct vasoconstriction or sympathomimetic activation are major mechanisms of action of such substances. ", "evidence_relation": "neutral" }, { "cited_pmid": "34784859", "evidence_support": "Serum levels of any kind of antihypertensive drugs may be influenced by the coadministration of protease inhibitors, non-nucleoside reverse transcriptase inhibitor, or other antiretroviral", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, some over-the-counter medications, such as decongestants and certain analgesics, can also increase blood pressure [16675317, 18257920].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16675317", "evidence_support": "In 2004, individuals in the United States spent >$2.5 billion on over-the-counter (OTC) nonsteroidal anti-inflammatory drugs (NSAIDs) and filled >100 million NSAID prescriptions.", "evidence_relation": "neutral" }, { "cited_pmid": "16675317", "evidence_support": "Nonnarcotic analgesics are generally considered safe when used as directed but do have the potential to increase blood pressure in patients with hypertension treated with antihypertensives.", "evidence_relation": "supporting" }, { "cited_pmid": "16675317", "evidence_support": "Small increases in blood pressure in patients with hypertension also have been shown to increase cardiovascular morbidity and mortality.", "evidence_relation": "neutral" }, { "cited_pmid": "18257920", "evidence_support": "Some NSAIDs may also mitigate the antiplatelet benefits of aspirin and may increase blood pressure in patients with hypertension.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "It is essential for clinicians to be aware of these potential interactions and monitor blood pressure in patients taking these medications [20203454, 24042856].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "20203454", "evidence_support": "Patients who demonstrate a deterioration in BP control should be questioned about", "evidence_relation": "neutral" }, { "cited_pmid": "20203454", "evidence_support": "concomitant medications or other substances that may be known to increase BP or interfere with antihypertensive therapy", "evidence_relation": "neutral" }, { "cited_pmid": "24042856", "evidence_support": "Management guidelines for drug-drug interactions between non-steroidal anti-inflammatory drugs (NSAIDs) and antihypertensives recommend blood pressure monitoring in hypertensive patients", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Careful evaluation of a patient's drug regimen can help identify chemically induced hypertension and guide optimal antihypertensive therapy [22195528, 18607141].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "22195528", "evidence_support": "A myriad variety of therapeutic agents or chemical substances can induce either a transient or persistent increase in blood pressure, or interfere with the blood pressure-lowering effects of antihypertensive drugs.", "evidence_relation": "supporting" }, { "cited_pmid": "22195528", "evidence_support": "Careful evaluation of a patient's drug regimen may identify chemically induced hypertension and obviate unnecessary evaluation and facilitate antihypertensive therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "18607141", "evidence_support": "Careful evaluation of a patient's drug regimen may identify chemically induced hypertension and obviate unnecessary evaluation and direct to the optimal antihypertensive therapy.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash": { "answer": "Several medications can interact with antihypertensive drugs and potentially elevate blood pressure. Monoamine oxidase inhibitors (MAOIs) can cause hypertensive reactions when combined with sympathomimetic medications or tyramine-containing foods [8713690, 2190595]. Tricyclic antidepressants can increase the risk of hypertension when combined with yohimbine [10675182]. Non-steroidal anti-inflammatory drugs (NSAIDs) can lessen the antihypertensive effects of beta-blockers, diuretics, and ACE inhibitors [7667803]. Combining an alpha 1-blocking agent with a dihydropyridine can induce hypotension, which can be severe [7667803]. Calcium channel blockers (CCBs), particularly diltiazem and verapamil, are potent inhibitors of CYP3A4, leading to significant drug interactions with antihypertensives [33666764]. The interaction between CCBs and antihypertensives can vary depending on the specific CCB used [25280976].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Several medications can interact with antihypertensive drugs and potentially elevate blood pressure.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Monoamine oxidase inhibitors (MAOIs) can cause hypertensive reactions when combined with sympathomimetic medications or tyramine-containing foods [8713690, 2190595].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "8713690", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "2190595", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Tricyclic antidepressants can increase the risk of hypertension when combined with yohimbine [10675182].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "10675182", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Non-steroidal anti-inflammatory drugs (NSAIDs) can lessen the antihypertensive effects of beta-blockers, diuretics, and ACE inhibitors [7667803].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "7667803", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Combining an alpha 1-blocking agent with a dihydropyridine can induce hypotension, which can be severe [7667803].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "7667803", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Calcium channel blockers (CCBs), particularly diltiazem and verapamil, are potent inhibitors of CYP3A4, leading to significant drug interactions with antihypertensives [33666764].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33666764", "evidence_support": "Data has established the calcium channel blockers, namely, diltiazem and verapamil, as potent inhibitors of CYP3A4, and the majority of significant drug interactions involving antihypertensives are attributable to these two agents.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "The interaction between CCBs and antihypertensives can vary depending on the specific CCB used [25280976].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "25280976", "evidence_support": "Because lacidipine appears to have no effect on CsA exposure, it may be the best option among CCBs for treating high blood pressure caused by CsA in children", "evidence_relation": "neutral" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Many medications can interact with antihypertensive drugs, potentially affecting blood pressure control [17028488, 2182265, 33666764]. These interactions can lead to undesirable effects or even loss of blood pressure control [2182265]. For example, nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used and can interact with antihypertensive agents, particularly ACE inhibitors [25035720, 25618128]. Additionally, certain antihypertensive drugs, such as those metabolized by cytochrome P450 3A4, can have interactions with medications like rifampicin or antiepileptic drugs [10486655]. It is crucial to be aware of potential drug interactions, as they can significantly impact blood pressure management [12441214, 25584241, 26215211].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Many medications can interact with antihypertensive drugs, potentially affecting blood pressure control [17028488, 2182265, 33666764].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "17028488", "evidence_support": "Many antihypertensive drugs have important interactions with drugs used for different purposes; when these are used concomitantly, adverse effects on blood pressure can result.", "evidence_relation": "supporting" }, { "cited_pmid": "33666764", "evidence_support": "The pervasive use of antihypertensive medications combined with the presence of polypharmacy in many hypertensive patients results in significant risk of drug interactions.", "evidence_relation": "supporting" }, { "cited_pmid": "2182265", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "2", "answer_sentence": "These interactions can lead to undesirable effects or even loss of blood pressure control [2182265].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "2182265", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "For example, nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used and can interact with antihypertensive agents, particularly ACE inhibitors [25035720, 25618128].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25618128", "evidence_support": "This could well explain the commonly encountered experience of drug interaction between NSAIDs and antihypertensive drugs, which is very common in clinical practice", "evidence_relation": "supporting" }, { "cited_pmid": "25035720", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, certain antihypertensive drugs, such as those metabolized by cytochrome P450 3A4, can have interactions with medications like rifampicin or antiepileptic drugs [10486655].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "10486655", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is crucial to be aware of potential drug interactions, as they can significantly impact blood pressure management [12441214, 25584241, 26215211].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "25584241", "evidence_support": "We detected a significant number of drug drug interaction in hypertensive patients. These interactions were between antihypertensive agents or between hypertensive and drug for co-morbid condition", "evidence_relation": "neutral" }, { "cited_pmid": "26215211", "evidence_support": "Older adults are more likely to take more than two medications for medical conditions, and polypharmacy is associated with increased risk of adverse events (fall injury, hyperkalemia and hypokalemia, heart failure, and blood pressure exacerbation), polypharmacy mismanagement, drug-drug interaction, and increased costs. Knowledge of drugs that interact with known antihypertensive agents is paramount to avoiding or reducing adverse events, hospitalizations, and health care dollars.", "evidence_relation": "supporting" }, { "cited_pmid": "12441214", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Certain medications can interact with antihypertensive drugs and potentially elevate blood pressure. Non-steroidal anti-inflammatory drugs (NSAIDs) are known to reduce the effectiveness of beta-blockers, diuretics, and ACE inhibitors, which can lead to increased blood pressure [7667803, 18257920]. Additionally, sympathomimetic agents like phenylephrine and oxymetazoline can also raise blood pressure and should be avoided in patients taking antihypertensives [36425231]. Calcium channel blockers, particularly diltiazem and verapamil, are significant inhibitors of cytochrome P450 3A4, leading to potential drug interactions with various antihypertensives [33666764]. Furthermore, tricyclic antidepressants combined with yohimbine can increase hypertension risk [10675182]. Patients should be monitored for these interactions, especially when using over-the-counter products [12862505, 20489028].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Certain medications can interact with antihypertensive drugs and potentially elevate blood pressure.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Non-steroidal anti-inflammatory drugs (NSAIDs) are known to reduce the effectiveness of beta-blockers, diuretics, and ACE inhibitors, which can lead to increased blood pressure [7667803, 18257920].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18257920", "evidence_support": "Many patients are unaware that over-the-counter (OTC) analgesics can cause potentially serious adverse effects when used in combination with other common medications such as anticoagulants, corticosteroids, or antihypertensive agents", "evidence_relation": "supporting" }, { "cited_pmid": "7667803", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, sympathomimetic agents like phenylephrine and oxymetazoline can also raise blood pressure and should be avoided in patients taking antihypertensives [36425231].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36425231", "evidence_support": "Ranging from irreversible to reversible and selective to non-selective, these drugs target the monoamine oxidase (MAO) enzyme and prevent the oxidative deamination of various monoamines and catecholamines such as serotonin and dopamine, respectively. ", "evidence_relation": "neutral" }, { "cited_pmid": "36425231", "evidence_support": "In general, patients on a MAOI want to avoid two types of medications: those that can elevate blood pressure via sympathomimetic actions (e.g., phenylephrine and oxymetazoline) and those that can increase serotonin levels via 5-HT reuptake inhibition (e.g., dextromethorphan, chlorpheniramine, and brompheniramine)", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Calcium channel blockers, particularly diltiazem and verapamil, are significant inhibitors of cytochrome P450 3A4, leading to potential drug interactions with various antihypertensives [33666764].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33666764", "evidence_support": "Data has established the calcium channel blockers, namely, diltiazem and verapamil, as potent inhibitors of CYP3A4, and the majority of significant drug interactions involving antihypertensives are attributable to these two agents.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, tricyclic antidepressants combined with yohimbine can increase hypertension risk [10675182].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "10675182", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Patients should be monitored for these interactions, especially when using over-the-counter products [12862505, 20489028].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "12862505", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "20489028", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Several medications can interact with antihypertensive drugs and potentially elevate blood pressure. Nonsteroidal anti-inflammatory drugs (NSAIDs) are particularly notable, as they can diminish the effectiveness of antihypertensive medications like beta-blockers, diuretics, and ACE inhibitors, leading to increased blood pressure [17028488, 7667803]. Additionally, sympathomimetic agents such as phenylephrine and oxymetazoline can raise blood pressure due to their stimulating effects [36425231]. Certain antidepressants and medications like sibutramine may also significantly increase blood pressure in some patients [17028488]. Furthermore, monoamine oxidase inhibitors (MAOIs) can cause hypertensive reactions when interacting with sympathomimetic drugs or tyramine-containing foods [8713690, 22951238]. It is essential for patients to discuss their medications with healthcare providers to manage these potential interactions effectively.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Several medications can interact with antihypertensive drugs and potentially elevate blood pressure.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs) are particularly notable, as they can diminish the effectiveness of antihypertensive medications like beta-blockers, diuretics, and ACE inhibitors, leading to increased blood pressure [17028488, 7667803].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17028488", "evidence_support": "The most important prescription drugs that affect blood pressure are the nonsteroidal anti-inflammatory drugs (including selective inhibitors of the second isoform of cyclooxygenase) and steroids.", "evidence_relation": "supporting" }, { "cited_pmid": "7667803", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, sympathomimetic agents such as phenylephrine and oxymetazoline can raise blood pressure due to their stimulating effects [36425231].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36425231", "evidence_support": "In general, patients on a MAOI want to avoid two types of medications: those that can elevate blood pressure via sympathomimetic actions (e.g., phenylephrine and oxymetazoline)", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Certain antidepressants and medications like sibutramine may also significantly increase blood pressure in some patients [17028488].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17028488", "evidence_support": "The most important prescription drugs that affect blood pressure are the nonsteroidal anti-inflammatory drugs (including selective inhibitors of the second isoform of cyclooxygenase) and steroids", "evidence_relation": "supporting" }, { "cited_pmid": "17028488", "evidence_support": "Phenylpropanolamines, some antidepressants, and sibutramine can often be avoided, as they raise blood pressure in a significant proportion of those who take them", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Furthermore, monoamine oxidase inhibitors (MAOIs) can cause hypertensive reactions when interacting with sympathomimetic drugs or tyramine-containing foods [8713690, 22951238].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22951238", "evidence_support": "Hypertensive crisis and serotonin syndrome can occur in rare cases due to interactions between MAOIs and foods containing tyramine as well as interactions with serotonergic and sympathomimetic agents.", "evidence_relation": "supporting" }, { "cited_pmid": "8713690", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "It is essential for patients to discuss their medications with healthcare providers to manage these potential interactions effectively.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-1": { "answer": "The context does not provide information about a specific medication that has a drug interaction with high blood pressure. However, it is mentioned that antihypertensive medications are used to control blood pressure [22522073,37600544,16785330].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The context does not provide information about a specific medication that has a drug interaction with high blood pressure.", "answer_sentence_relevance": null, "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "However, it is mentioned that antihypertensive medications are used to control blood pressure [22522073,37600544,16785330].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "22522073", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "37600544", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16785330", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-2": { "answer": "The context does not provide information about specific medications that have a drug interaction with high blood pressure.", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The context does not provide information about specific medications that have a drug interaction with high blood pressure.", "answer_sentence_relevance": null, "citation_assessment": null } ] }, "webis-3": { "answer": "Peripheral vasodilators, specifically alpha-adrenoceptor antagonists and nondihydropyridine calcium channel antagonists, can exacerbate postural blood pressure changes and lead to orthostatic hypotension [15663349].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Peripheral vasodilators, specifically alpha-adrenoceptor antagonists and nondihydropyridine calcium channel antagonists, can exacerbate postural blood pressure changes and lead to orthostatic hypotension [15663349].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15663349", "evidence_support": "In addition, prospective randomised trials have demonstrated an improvement in postural blood pressure (PBP) changes with antihypertensive medications. When considering the individual classes, peripheral vasodilators, specifically alpha-adrenoceptor antagonists and nondihydropyridine calcium channel antagonists, can exacerbate PBP changes and lead to OH.", "evidence_relation": "supporting" } ] } ] }, "webis-5": { "answer": "Peripheral vasodilators, specifically alpha-adrenoceptor antagonists and nondihydropyridine calcium channel antagonists, can exacerbate postural blood pressure changes and lead to orthostatic hypotension [15663349].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Peripheral vasodilators, specifically alpha-adrenoceptor antagonists and nondihydropyridine calcium channel antagonists, can exacerbate postural blood pressure changes and lead to orthostatic hypotension [15663349].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15663349", "evidence_support": "When considering the individual classes, peripheral vasodilators, specifically alpha-adrenoceptor antagonists and nondihydropyridine calcium channel antagonists, can exacerbate PBP changes and lead to OH.", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-1": { "answer": "Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), decongestants, and some antidepressants, can interact with high blood pressure by potentially increasing blood pressure levels. It is important for individuals with hypertension to consult their healthcare provider before starting any new medication to avoid adverse interactions.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Certain medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs), decongestants, and some antidepressants, can interact with high blood pressure by potentially increasing blood pressure levels.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "It is important for individuals with hypertension to consult their healthcare provider before starting any new medication to avoid adverse interactions.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "Antihypertensive medications are commonly used to manage high blood pressure, but they can interact with other medications. For instance, certain non-steroidal anti-inflammatory drugs (NSAIDs) can reduce the effectiveness of antihypertensive medications, leading to uncontrolled blood pressure in some patients [37600544].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Antihypertensive medications are commonly used to manage high blood pressure, but they can interact with other medications.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "For instance, certain non-steroidal anti-inflammatory drugs (NSAIDs) can reduce the effectiveness of antihypertensive medications, leading to uncontrolled blood pressure in some patients [37600544].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37600544", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-gpt-6": { "answer": "The context provided does not specify a particular medication that has a drug interaction with high blood pressure. However, statins are mentioned in relation to their blood pressure-lowering effects, suggesting they may interact positively with high blood pressure management [19365283]. For specific drug interactions, it is essential to consult detailed pharmacological resources or guidelines.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "The context provided does not specify a particular medication that has a drug interaction with high blood pressure.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "However, statins are mentioned in relation to their blood pressure-lowering effects, suggesting they may interact positively with high blood pressure management [19365283].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19365283", "evidence_support": "Although statins had no significant effect among nonusers, it decreased systolic blood pressure by 3.3 mmHg among users of antihypertensive medication (interaction P = 0.02).", "evidence_relation": "supporting" }, { "cited_pmid": "19365283", "evidence_support": "Statins also lowered diastolic blood pressure by an average of 1.9 mmHg (P < 0.01), regardless of antihypertensive medication use.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "For specific drug interactions, it is essential to consult detailed pharmacological resources or guidelines.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "zero-shot-gemini-flash": { "answer": "Calcium channel blockers (CCBs) are commonly used to treat hypertension, but they can interact with other medications, including those used to treat conditions like cyclosporine-induced hypertension [25280976]. CCBs like nicardipine and amlodipine can increase the blood concentration of cyclosporine, potentially leading to adverse effects [25280976]. However, lacidipine, another CCB, does not appear to affect cyclosporine levels and may be a better option for treating hypertension in patients taking cyclosporine [25280976]. It's important to note that drug interactions can occur with various medications, including antihypertensives [25584241]. For example, amlodipine has been found to interact with atenolol and metoprolol, two common beta-blockers used for hypertension [25584241]. These interactions can lead to changes in blood pressure and other potential side effects [25584241]. Therefore, it's crucial to discuss all medications with your doctor to ensure safe and effective treatment [375859]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Calcium channel blockers (CCBs) are commonly used to treat hypertension, but they can interact with other medications, including those used to treat conditions like cyclosporine-induced hypertension [25280976].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25280976", "evidence_support": "Calcium channel blockers (CCBs) are considered to be the best treatment for CsA-induced hypertension, but they may alter the exposure and the effect of CsA by inhibiting the CYP3A4 pathway of CsA metabolism or P-gp.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "CCBs like nicardipine and amlodipine can increase the blood concentration of cyclosporine, potentially leading to adverse effects [25280976].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25280976", "evidence_support": "Calcium channel blockers (CCBs) are considered to be the best treatment for CsA-induced hypertension, but they may alter the exposure and the effect of CsA by inhibiting the CYP3A4 pathway of CsA metabolism or P-gp.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, lacidipine, another CCB, does not appear to affect cyclosporine levels and may be a better option for treating hypertension in patients taking cyclosporine [25280976].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "25280976", "evidence_support": "Dose-normalized CsA trough blood concentrations significantly increased in patients treated with nicardipine and amlodipine, whereas they remained stable in patients treated with lacidipine.", "evidence_relation": "supporting" }, { "cited_pmid": "25280976", "evidence_support": "Because lacidipine appears to have no effect on CsA exposure, it may be the best option among CCBs for treating high blood pressure caused by CsA in children.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It's important to note that drug interactions can occur with various medications, including antihypertensives [25584241].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25584241", "evidence_support": "We detected a significant number of drug drug interaction in hypertensive patients. These interactions were between antihypertensive agents or between hypertensive and drug for co-morbid condition.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "For example, amlodipine has been found to interact with atenolol and metoprolol, two common beta-blockers used for hypertension [25584241].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25584241", "evidence_support": "Drug drug interaction between atenolol & amlodipine was the most common DDI (136) followed by metoprolol and amlodine (88) in this study. Atenolol and amlodipine ( 25.92%) was the most common drugs to cause DDIs in our study.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "These interactions can lead to changes in blood pressure and other potential side effects [25584241].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "25584241", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Therefore, it's crucial to discuss all medications with your doctor to ensure safe and effective treatment [375859].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "375859", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "Certain medications can interact with antihypertensive drugs and elevate blood pressure. Nonsteroidal anti-inflammatory drugs (NSAIDs) are particularly notable, as they can increase blood pressure and reduce the effectiveness of various antihypertensive agents, including diuretics and beta-blockers [9397294]. Additionally, a wide range of therapeutic agents, such as corticosteroids, erythropoietin, and sympathomimetics, can also induce hypertension or interfere with blood pressure-lowering effects [17120715, 22195528]. Patients taking multiple medications for hypertension and other conditions are at increased risk for adverse drug interactions, which can lead to elevated blood pressure [15709894, 11863472]. Regular monitoring and careful review of a patient's medication regimen, including over-the-counter products, are essential to avoid chemically induced hypertension [375859, 12862505].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Certain medications can interact with antihypertensive drugs and elevate blood pressure.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Nonsteroidal anti-inflammatory drugs (NSAIDs) are particularly notable, as they can increase blood pressure and reduce the effectiveness of various antihypertensive agents, including diuretics and beta-blockers [9397294].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "9397294", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, a wide range of therapeutic agents, such as corticosteroids, erythropoietin, and sympathomimetics, can also induce hypertension or interfere with blood pressure-lowering effects [17120715, 22195528].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17120715", "evidence_support": "A review of the main interacting drug regimens will complete this paper, attesting that drugs as various as NSAID, corticosteroids, erythropoietin, cyclosporine, antidepressants, beta blockers, carbamazepine, sympathomimetics, antihistamines, tramadol and (...) can induce arterial hypertension.", "evidence_relation": "supporting" }, { "cited_pmid": "22195528", "evidence_support": "A myriad variety of therapeutic agents or chemical substances can induce either a transient or persistent increase in blood pressure, or interfere with the blood pressure-lowering effects of antihypertensive drugs. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Patients taking multiple medications for hypertension and other conditions are at increased risk for adverse drug interactions, which can lead to elevated blood pressure [15709894, 11863472].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "15709894", "evidence_support": "Many patients with high blood pressure receive multiple medications for hypertension and other conditions, placing them at risk for adverse drug interactions.", "evidence_relation": "supporting" }, { "cited_pmid": "11863472", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Regular monitoring and careful review of a patient's medication regimen, including over-the-counter products, are essential to avoid chemically induced hypertension [375859, 12862505].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "375859", "evidence_support": null, "evidence_relation": "invalid citation" }, { "cited_pmid": "12862505", "evidence_support": null, "evidence_relation": "invalid citation" } ] } ] } } }, { "question_id": "143", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "Coping with Huntington's disease involves both physical and mental preparedness. Like mountain climbers preparing for the challenges of high altitudes, patients with Huntington's disease must prepare for the physical and emotional challenges ahead. This may include gathering medical knowledge, engaging in physical activities to maintain strength, and seeking support from healthcare professionals [26948555]. Additionally, managing Huntington's disease shares similarities with coping strategies used in other progressive conditions, where patients may benefit from lifestyle adjustments and symptomatic treatments to improve their quality of life. Patients are encouraged to stay active, engage in activities that improve muscle strength, and seek supportive therapies to manage symptoms effectively.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Coping with Huntington's disease involves both physical and mental preparedness.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Like mountain climbers preparing for the challenges of high altitudes, patients with Huntington's disease must prepare for the physical and emotional challenges ahead.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "This may include gathering medical knowledge, engaging in physical activities to maintain strength, and seeking support from healthcare professionals [26948555].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26948555", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, managing Huntington's disease shares similarities with coping strategies used in other progressive conditions, where patients may benefit from lifestyle adjustments and symptomatic treatments to improve their quality of life.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Patients are encouraged to stay active, engage in activities that improve muscle strength, and seek supportive therapies to manage symptoms effectively.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Living with Huntington's disease (HD) involves managing a range of motor, cognitive, and psychiatric symptoms [15130098, 17352943, 28947115]. Symptom control is the primary focus of current treatments, which aim to improve quality of life [28947115, 38047100, 25063190]. Chorea significantly impacts daily functioning, while dysphagia becomes common in moderate-to-advanced stages [38047100, 24366610, 34413240]. Balance and gait impairments, along with sleep disturbances, are frequent issues [38047100, 27046737, 25494622]. Anxiety affects up to 71% of HD gene expansion carriers, and routine suicide assessment is recommended due to the high risk of depression and aggression predicting suicidal ideation [35055379, 20724050, 35570497]. Psychological and social support referrals are crucial, as HD disrupts family life and impacts family relations and well-being [15130098, 17352943, 25471490]. Support groups benefit caregivers, and positive appraisals, mastery, and spirituality correlate with better caregiver outcomes [15130098, 25471490, 15924027]. Advance directives are essential for end-of-life care planning [18619087, 17352944]. Guided self-help can assist in managing anxiety, and young people in HD families face multiple challenges [25063190, 30372686, 18347962].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease (HD) involves managing a range of motor, cognitive, and psychiatric symptoms [15130098, 17352943, 28947115].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "Huntington's disease is a genetic, neurological disorder characterized by mid-life onset, involuntary movements, cognitive decline, behavioral disturbance, and inexorable progression.", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "Huntington's disease is a slowly progressive neurodegenerative disorder with wide-ranging effects on affected individuals and their families.", "evidence_relation": "supporting" }, { "cited_pmid": "28947115", "evidence_support": "Multiple disease symptoms can remit or improve with currently available pharmacologic and behavioral interventions, even though barriers exist that interfere with access to treatment", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Symptom control is the primary focus of current treatments, which aim to improve quality of life [28947115, 38047100, 25063190].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25063190", "evidence_support": "The goal of the Patient Education Program for Huntington's disease is to improve quality of life for patients and caregivers, to educate and train them in order to develop coping strategies to deal with psychosocial stressors", "evidence_relation": "supporting" }, { "cited_pmid": "28947115", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "38047100", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Chorea significantly impacts daily functioning, while dysphagia becomes common in moderate-to-advanced stages [38047100, 24366610, 34413240].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "38047100", "evidence_support": "Huntington's disease (HD) is a neurodegenerative disease that has motor dysfunction, predominantly chorea, cognitive impairment, and psychiatric disturbances as symptoms.", "evidence_relation": "neutral" }, { "cited_pmid": "24366610", "evidence_support": "Huntington's disease (HD) is a dominantly inherited progressive neurological disease characterized by chorea, an involuntary brief movement that tends to flow between body regions.", "evidence_relation": "supporting" }, { "cited_pmid": "34413240", "evidence_support": "Huntington's disease (HD) is an inherited neurodegenerative disease characterised by neuropsychiatric symptoms, a movement disorder (most commonly choreiform) and progressive cognitive impairment.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Balance and gait impairments, along with sleep disturbances, are frequent issues [38047100, 27046737, 25494622].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "38047100", "evidence_support": "Mobility and balance evaluation and prevention strategies should be focused on for safety,", "evidence_relation": "neutral" }, { "cited_pmid": "27046737", "evidence_support": "This clinical report describes the integration of the evidence, clinical expertise, and patient values to develop and implement individualized, community-based exercise groups, aimed to improve balance, gait speed, and fatigue measures for persons with HD and those at-risk. ", "evidence_relation": "supporting" }, { "cited_pmid": "25494622", "evidence_support": "The benefits of regular physical activity for people with HD are widely recognized", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Anxiety affects up to 71% of HD gene expansion carriers, and routine suicide assessment is recommended due to the high risk of depression and aggression predicting suicidal ideation [35055379, 20724050, 35570497].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "35570497", "evidence_support": "Depression is a common neuropsychiatric syndrome in Huntington's disease (HD) and has debilitating consequences, including poorer sleep, exacerbation of cognitive and functional decline, and suicidality", "evidence_relation": "supporting" }, { "cited_pmid": "20724050", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "35055379", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Psychological and social support referrals are crucial, as HD disrupts family life and impacts family relations and well-being [15130098, 17352943, 25471490].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "The impact of Huntington's disease is devastating for individuals and their families as it is a disease with a long trajectory; many young people are aware that they may develop the illness for years before there are obvious symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "15130098", "evidence_support": "Our findings demonstrate that palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed.", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "Huntington's disease is a slowly progressive neurodegenerative disorder with wide-ranging effects on affected individuals and their families. Until a cure is found for the disease, patients and their families will continue to need care over years, even generations. The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers.", "evidence_relation": "supporting" }, { "cited_pmid": "25471490", "evidence_support": "Enduring caregiver burdens may lead to problems and caregivers are in need of social support and health services to deal with challenges. We wanted to explore coping strategies and behaviour patterns used by family caregivers to care for themselves, while caring for a family member with HD.", "evidence_relation": "supporting" }, { "cited_pmid": "25471490", "evidence_support": "In later stages of the disease, the need for care gradually overshadowed the caregivers' own activities, and they put their own life on hold", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Support groups benefit caregivers, and positive appraisals, mastery, and spirituality correlate with better caregiver outcomes [15130098, 25471490, 15924027].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "Our findings demonstrate that palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed.", "evidence_relation": "supporting" }, { "cited_pmid": "25471490", "evidence_support": "Health professionals and social workers should acknowledge that family caregivers balance their needs and considerations in coping with HD.", "evidence_relation": "supporting" }, { "cited_pmid": "15924027", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Advance directives are essential for end-of-life care planning [18619087, 17352944].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17352944", "evidence_support": "This paper describes one method for such management, which includes discussion about placement for care advance directives for feeding and treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "18619087", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "9", "answer_sentence": "Guided self-help can assist in managing anxiety, and young people in HD families face multiple challenges [25063190, 30372686, 18347962].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25063190", "evidence_support": "After program completion, significant improvement of behavioral symptoms and anxiety was found for manifest HD patients, and they used a less passive coping style and more social support", "evidence_relation": "supporting" }, { "cited_pmid": "30372686", "evidence_support": "For young people in families with Huntington's disease (HD) the challenge of having an affected family member (AFM) compounds challenges related to being at risk of HD themselves", "evidence_relation": "supporting" }, { "cited_pmid": "30372686", "evidence_support": "Young people in families with HD endure considerable emotional, social and practical burden secondary to having an AFM and being at risk themselves. Without increased support and services, the effects of being a young caregiver and living at risk are likely to have long ter", "evidence_relation": "supporting" }, { "cited_pmid": "18347962", "evidence_support": "Recognizing patterns of teen experiences may help health care providers develop strategies to support coping by teens in HD families", "evidence_relation": "supporting" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "Living with Huntington's disease (HD) requires a comprehensive, multidisciplinary approach to manage its progressive neurodegenerative effects and improve quality of life.Effective care involves a team led by a physician, including rehabilitation therapists, nurses, psychologists, genetic counselors, and social workers, aiming to maximize functional independence and anticipate future challenges [17352943, 28947115]. Psychological support is crucial, as HD patients often face significant emotional and cognitive burdens; tailored interventions can help manage these aspects [15130098, 35055379]. Rehabilitation strategies should be stage-specific, focusing on motor and cognitive training in early stages, task-specific rehabilitation in mid-stages, and safety and respiratory exercises in late stages [38047100, 26098083]. Engaging in community-based exercise programs can also improve physical function and reduce fatigue [27046737]. Additionally, patient education programs have shown to enhance coping strategies and reduce anxiety and psychosocial burdens for both patients and caregivers [25063190]. Overall, a well-coordinated, patient-centered care model is essential for managing HD effectively [34216010].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease (HD) requires a comprehensive, multidisciplinary approach to manage its progressive neurodegenerative effects and improve quality of life.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Effective care involves a team led by a physician, including rehabilitation therapists, nurses, psychologists, genetic counselors, and social workers, aiming to maximize functional independence and anticipate future challenges [17352943, 28947115].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers. The goals of care are to maximize the quality of life at all points through the course of the disease, in part by anticipating problems that are likely to arise at the next stage of the illness.", "evidence_relation": "supporting" }, { "cited_pmid": "28947115", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Psychological support is crucial, as HD patients often face significant emotional and cognitive burdens; tailored interventions can help manage these aspects [15130098, 35055379].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "The impact of Huntington's disease is devastating for individuals and their families as it is a disease with a long trajectory; many young people are aware that they may develop the illness for years before there are obvious symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "15130098", "evidence_support": "Our findings demonstrate that palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed.", "evidence_relation": "supporting" }, { "cited_pmid": "35055379", "evidence_support": "Huntington's disease (HD) is a rare and complex condition where affected individuals, family members, caregivers, and clinicians face a number of both long-term and fluctuating challenges.", "evidence_relation": "supporting" }, { "cited_pmid": "35055379", "evidence_support": "As a consequence, one of the most challenging aspects of the condition-psychological difficulties and their care-is often not given the emphasis it deserves in everyday clinical practice.", "evidence_relation": "neutral" }, { "cited_pmid": "35055379", "evidence_support": "As the search for a cure continues, we hope that this manifesto will create a new impetus towards refining the current approach to psychological difficulties in HD and ultimately improve the quality of life of the tens of thousands of families affected by HD worldwide.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Rehabilitation strategies should be stage-specific, focusing on motor and cognitive training in early stages, task-specific rehabilitation in mid-stages, and safety and respiratory exercises in late stages [38047100, 26098083].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "38047100", "evidence_support": "Programmed rehabilitation management based on the stage of the disease is effective for patients with HD", "evidence_relation": "supporting" }, { "cited_pmid": "26098083", "evidence_support": "Even at the early stage of the disease, HD patients suffer from motor and cognitive impairments. They are in need of physical, occupational and speech therapy or (inpatient) multidisciplinary rehabilitation", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Engaging in community-based exercise programs can also improve physical function and reduce fatigue [27046737].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27046737", "evidence_support": "Participants demonstrated improvement or maintenance of abilities in all measures with no adverse events.", "evidence_relation": "supporting" }, { "cited_pmid": "27046737", "evidence_support": "This clinical report describes the integration of the evidence, clinical expertise, and patient values to develop and implement individualized, community-based exercise groups, aimed to improve balance, gait speed, and fatigue measures for persons with HD and those at-risk.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Additionally, patient education programs have shown to enhance coping strategies and reduce anxiety and psychosocial burdens for both patients and caregivers [25063190].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25063190", "evidence_support": "The goal of the Patient Education Program for Huntington's disease is to improve quality of life for patients and caregivers, to educate and train them in order to develop coping strategies to deal with psychosocial stressors.", "evidence_relation": "supporting" }, { "cited_pmid": "25063190", "evidence_support": "After program completion, significant improvement of behavioral symptoms and anxiety was found for manifest HD patients, and they used a less passive coping style and more social support.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Overall, a well-coordinated, patient-centered care model is essential for managing HD effectively [34216010].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34216010", "evidence_support": "The findings of this review demonstrate that individuals who are gene-positive for or living with HD require support well beyond the disclosure of genetic testing and that it may be beneficial for healthcare providers to consider where along the life stage trajectory a person affected by HD may be to ensure the delivery of quality PCC", "evidence_relation": "supporting" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Living with Huntington's disease (HD) requires a multifaceted approach that addresses the physical, emotional, and social aspects of the disease [15130098, 17352943, 28947115]. Individuals with HD need to adjust to the impact of the illness, gather practical support from various sources, and bolster their spirit to cope with the disease [15130098]. A comprehensive care team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, and social workers, is essential to provide expert support and maximize quality of life [17352943, 28947115]. Physical therapy, occupational therapy, and speech therapy can help manage motor symptoms, cognitive decline, and behavioral changes [38047100, 26098083, 18467429]. Additionally, community-based exercise programs and rehabilitation management tailored to the stage of the disease can improve gait, balance, and fatigue [27046737, 25494622, 26098083]. A person-centered care approach, focusing on the individual's needs and preferences, is crucial to ensure a good quality of life and a comfortable approach to end-of-life care [34216010, 18619087].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease (HD) requires a multifaceted approach that addresses the physical, emotional, and social aspects of the disease [15130098, 17352943, 28947115].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "Our findings demonstrate that palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed.", "evidence_relation": "supporting" }, { "cited_pmid": "28947115", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "17352943", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Individuals with HD need to adjust to the impact of the illness, gather practical support from various sources, and bolster their spirit to cope with the disease [15130098].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "Themes were: (i). adjusting to the impact of the illness; (ii). surviving the search for essential information; (iii). gathering practical support from many sources; (iv). bolstering the spirit; (v). choreographing individual care and; (vi). fearing the future. Our findings demonstrate that palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "A comprehensive care team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, and social workers, is essential to provide expert support and maximize quality of life [17352943, 28947115].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers.", "evidence_relation": "supporting" }, { "cited_pmid": "28947115", "evidence_support": "Connecting expert multidisciplinary teams with community-based care, developing treatment guidelines, and involving the HD family community in quality improvements can achieve an integrated system of health care delivery.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Physical therapy, occupational therapy, and speech therapy can help manage motor symptoms, cognitive decline, and behavioral changes [38047100, 26098083, 18467429].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "38047100", "evidence_support": "Treatment in this period should focus on aerobic and resistance exercises, task-specific training, secondary prevention education, cognitive training, and psychological management.", "evidence_relation": "supporting" }, { "cited_pmid": "26098083", "evidence_support": "They are in need of physical, occupational and speech therapy or (inpatient) multidisciplinary rehabilitation.", "evidence_relation": "supporting" }, { "cited_pmid": "18467429", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, community-based exercise programs and rehabilitation management tailored to the stage of the disease can improve gait, balance, and fatigue [27046737, 25494622, 26098083].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27046737", "evidence_support": "This clinical report describes the integration of the evidence, clinical expertise, and patient values to develop and implement individualized, community-based exercise groups, aimed to improve balance, gait speed, and fatigue measures for persons with HD and those at-risk.", "evidence_relation": "supporting" }, { "cited_pmid": "25494622", "evidence_support": "The benefits of regular physical activity for people with HD are widely recognized. However, a number of factors can prohibit sustained exercise and activity. The purpose of this trial is to explore the feasibility, acceptability and effectiveness of a physical activity intervention program targeted for people with early- to mid-stage HD.", "evidence_relation": "neutral" }, { "cited_pmid": "26098083", "evidence_support": "There are four clinical randomized controlled trials (RCT) showing beneficial effects of physical therapy (standardized home-based training program).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "A person-centered care approach, focusing on the individual's needs and preferences, is crucial to ensure a good quality of life and a comfortable approach to end-of-life care [34216010, 18619087].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34216010", "evidence_support": "Person-centered care (PCC) is recognized as a key component of the delivery of quality healthcare and a model for healthcare systems worldwide", "evidence_relation": "supporting" }, { "cited_pmid": "18619087", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "Living with Huntington's disease requires a multifaceted approach to manage its impact on daily life [15130098, 19576265, 28947117]. Acceptance and emotional support are crucial for individuals with the disease, while their companions and caregivers benefit from planning, active coping, and seeking help [22278219, 15130098, 25471490]. Palliative care services can provide expert psychological and practical support, and be flexible and adequately planned to address the unique needs of each individual [15130098, 29089255]. A multidisciplinary care team, including neurologists, psychologists, occupational therapists, speech and language therapists, social workers, and nursing home doctors, can work together to provide comprehensive care [19576265, 29089255, 28947117]. Rehabilitation therapy, including exercise, physical activity, and motor training, can help manage functional loss and maximize quality of life [31588808, 17702702, 28947117]. Family caregivers play a vital role in supporting their loved ones, but they also need support and resources to cope with the challenges of caregiving [25471490, 23098031]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease requires a multifaceted approach to manage its impact on daily life [15130098, 19576265, 28947117].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "The impact of Huntington's disease is devastating for individuals and their families as it is a disease with a long trajectory; many young people are aware that they may develop the illness for years before there are obvious symptoms", "evidence_relation": "neutral" }, { "cited_pmid": "19576265", "evidence_support": "In the northern part of the Netherlands coordinated multidisciplinary care is offered to patients diagnosed with Huntington's disease.", "evidence_relation": "supporting" }, { "cited_pmid": "28947117", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Acceptance and emotional support are crucial for individuals with the disease, while their companions and caregivers benefit from planning, active coping, and seeking help [22278219, 15130098, 25471490].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "Our findings demonstrate that palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed.", "evidence_relation": "supporting" }, { "cited_pmid": "22278219", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "25471490", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Palliative care services can provide expert psychological and practical support, and be flexible and adequately planned to address the unique needs of each individual [15130098, 29089255].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed.", "evidence_relation": "supporting" }, { "cited_pmid": "29089255", "evidence_support": "Palliative care is an important concept in HD care focusing in quality of life, considering physical, psychosocial, and spiritual problems", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "A multidisciplinary care team, including neurologists, psychologists, occupational therapists, speech and language therapists, social workers, and nursing home doctors, can work together to provide comprehensive care [19576265, 29089255, 28947117].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19576265", "evidence_support": "In the northern part of the Netherlands coordinated multidisciplinary care is offered to patients diagnosed with Huntington's disease. A team of a neurologist, psychologist, occupational therapist, speech and language therapist, social worker and nursing home doctor monitors the patient and companion on a half-year basis and provide them with a plan of care.", "evidence_relation": "supporting" }, { "cited_pmid": "29089255", "evidence_support": "In HD, multispecialty care requires the active involvement of physicians, therapists, social workers and nutritionists.", "evidence_relation": "supporting" }, { "cited_pmid": "28947117", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Rehabilitation therapy, including exercise, physical activity, and motor training, can help manage functional loss and maximize quality of life [31588808, 17702702, 28947117].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31588808", "evidence_support": "Strategies such as using physical activity as a way of achieving control and adjusting expectations can help people with HD to continue to be active.", "evidence_relation": "supporting" }, { "cited_pmid": "17702702", "evidence_support": "The treatment programme included respiratory exercises and speech therapy, physical and occupational therapy and cognitive rehabilitation exercises.", "evidence_relation": "supporting" }, { "cited_pmid": "17702702", "evidence_support": "Each three-week period of treatment resulted in highly significant (P < 0.001) improvements of motor performance and daily life activities.", "evidence_relation": "supporting" }, { "cited_pmid": "17702702", "evidence_support": "Intensive rehabilitation treatments may positively influence the maintenance of functional and motor performance in patients with Huntington's disease.", "evidence_relation": "supporting" }, { "cited_pmid": "28947117", "evidence_support": "following: (1) provide comprehensive health records to an interdisciplinary care staff before admission to a more intense care setting (home health services, day program, assisted living, group home, long-term skilled nursing facility, palliative care); (2) consult with and refer to rehabilitation (occupational therapy, physical therapy, speech and language pathology), behavioral and psychiatric professionals for problem-solving strategies, which must be reviewed with direct care staff before implementation; (3) encourage and support qualitative and quantitative interdisciplinary research studies, and randomized controlled studies of nonpharmacologic interventions; and (4) assist in the development of meaningful measures to further document what works to provide a good quality of life for the patient and family and a comfortable thoughtful approach to a good death. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Family caregivers play a vital role in supporting their loved ones, but they also need support and resources to cope with the challenges of caregiving [25471490, 23098031].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "25471490", "evidence_support": "Family members in families with severe chronic disease play important roles in care-giving. In families affected by Huntington's disease (HD), caregivers encounter practical and emotional challenges and distress. Enduring caregiver burdens may lead to problems and caregivers are in need of social support and health services to deal with challenges.", "evidence_relation": "supporting" }, { "cited_pmid": "23098031", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "To live with Huntington's disease, it is essential to accept the condition and its progression, and to plan for the future [15130098, 25063190, 17352943]. People with HD and their families can benefit from expert psychological and practical support, flexible care, and advance care planning [15130098, 25063190, 17352943]. They should also be involved in decision-making regarding future care, while they are still able to make and express decisions by themselves [33852093, 25063190, 17352943]. Living with HD is a process that begins with acceptance or denial, growing awareness of the condition, and loss of autonomy and sense of self [15130098, 25063190, 35526033]. People with HD and their families can cope with the disease by using acceptance, emotional support, and planning, and by seeking help from healthcare professionals, family, and friends [15130098, 25063190, 17352943]. They can also benefit from counseling that emphasizes using active coping strategies for changes that can be compensated for and acceptance for changes that cannot [15130098, 25063190, 22278219]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "To live with Huntington's disease, it is essential to accept the condition and its progression, and to plan for the future [15130098, 25063190, 17352943].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "Our findings demonstrate that palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed.", "evidence_relation": "supporting" }, { "cited_pmid": "25063190", "evidence_support": "The goal of the Patient Education Program for Huntington's disease is to improve quality of life for patients and caregivers, to educate and train them in order to develop coping strategies to deal with psychosocial stressors.", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers. The goals of care are to maximize the quality of life at all points through the course of the disease, in part by anticipating problems that are likely to arise at the next stage of the illness", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "We describe below an approach to comprehensive care, and introduce the concept of the \"Huntington disease molecule\", in which the patient, in the center, is surrounded by a shell of immediate and extended family members, with bonds extended in multiple directions to provider who can give appropriate medical care, education, crisis management, research opportunities, address family issues, maximize function, and prepare for the future.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "People with HD and their families can benefit from expert psychological and practical support, flexible care, and advance care planning [15130098, 25063190, 17352943].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "Our findings demonstrate that palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed.", "evidence_relation": "supporting" }, { "cited_pmid": "25063190", "evidence_support": "This pilot study demonstrated the feasibility of the program in Huntington's disease, especially in the manifest stage of the disease.", "evidence_relation": "neutral" }, { "cited_pmid": "17352943", "evidence_support": "Until a cure is found for the disease, patients and their families will continue to need care over years, even generations. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "They should also be involved in decision-making regarding future care, while they are still able to make and express decisions by themselves [33852093, 25063190, 17352943].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33852093", "evidence_support": "Huntington Disease the patient will experience physical, cognitive and psychological issues, so that the patient won't be able to communicate or express his will in the end-of-life-phase of his disease. The problem is, after suffering a\u00a0while the patient often won't be able to eat by himself, so a\u00a0feeding tube must be implanted. In some cases a\u00a0tracheostomy tube is needed because of the respiratory insufficiency. ", "evidence_relation": "neutral" }, { "cited_pmid": "33852093", "evidence_support": "That's why it's most important when diagnosed with Huntington Disease to advance care planning to end-of-life care like life-sustaining measures that engages patients in decision-making regarding future care, while they are still able to make and express decisions by themselves.", "evidence_relation": "supporting" }, { "cited_pmid": "25063190", "evidence_support": "The goal of the Patient Education Program for Huntington's disease is to improve quality of life for patients and caregivers, to educate and train them in order to develop coping strategies to deal with psychosocial stressors. The program was derived from a standardized evidence-based program for Parkinson's disease. This pilot study assessed the feasibility of the program in Huntington's disease. Forty manifest patients with 28 caregivers and 19 premanifest carriers with 14 partners participated. ", "evidence_relation": "neutral" }, { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers. The goals of care are to maximize the quality of life at all points through the course of the disease, in part by anticipating problems that are likely to arise at the next stage of the illness. We describe below an approach to comprehensive care, and introduce the concept of the \"Huntington disease molecule\", in which the patient, in the center, is surrounded by a shell of immediate and extended family members, with bonds extended in multiple directions to provider who can give appropriate medical care, education, crisis management, research opportunities, address family issues, maximize function, and prepare for the future.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Living with HD is a process that begins with acceptance or denial, growing awareness of the condition, and loss of autonomy and sense of self [15130098, 25063190, 35526033].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "many young people are aware that they may develop the illness for years before there are obvious symptoms.", "evidence_relation": "neutral" }, { "cited_pmid": "15130098", "evidence_support": "Themes were: (i). adjusting to the impact of the illness; (ii). surviving the search for essential information; (iii). gathering practical support from many sources; (iv). bolstering the spirit; (v). choreographing individual care and; (vi). fearing the future.", "evidence_relation": "supporting" }, { "cited_pmid": "25063190", "evidence_support": "Assessments for depression and anxiety, psychosocial burden, need for help, quality of life, coping, behavioral, motor and cognitive status were performed.", "evidence_relation": "neutral" }, { "cited_pmid": "35526033", "evidence_support": "Living with HD is a process that begins with acceptance or denial that one is at risk for the disease or, growing awareness of the condition due to motor, behavioral, and cognitive changes, and, finally, loss of autonomy with physical dependence on another person, and loss of sense of self and family.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "People with HD and their families can cope with the disease by using acceptance, emotional support, and planning, and by seeking help from healthcare professionals, family, and friends [15130098, 25063190, 17352943].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "There is therefore ample opportunity to plan and choreograph the care and supportive services for people with Huntington's disease and their families.", "evidence_relation": "supporting" }, { "cited_pmid": "15130098", "evidence_support": "Our findings demonstrate that palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed.", "evidence_relation": "supporting" }, { "cited_pmid": "25063190", "evidence_support": "After program completion, significant improvement of behavioral symptoms and anxiety was found for manifest HD patients, and they used a less passive coping style and more social support", "evidence_relation": "supporting" }, { "cited_pmid": "25063190", "evidence_support": "Their caregivers reported less psychosocial burden. ", "evidence_relation": "neutral" }, { "cited_pmid": "17352943", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "They can also benefit from counseling that emphasizes using active coping strategies for changes that can be compensated for and acceptance for changes that cannot [15130098, 25063190, 22278219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25063190", "evidence_support": "The goal of the Patient Education Program for Huntington's disease is to improve quality of life for patients and caregivers, to educate and train them in order to develop coping strategies to deal with psychosocial stressors.", "evidence_relation": "supporting" }, { "cited_pmid": "25063190", "evidence_support": "After program completion, significant improvement of behavioral symptoms and anxiety was found for manifest HD patients, and they used a less passive coping style and more social support.", "evidence_relation": "supporting" }, { "cited_pmid": "22278219", "evidence_support": "Couples may benefit from counseling that emphasizes using active coping strategies for changes that can be compensated for and acceptance for changes that cannot in prodromal HD.", "evidence_relation": "supporting" }, { "cited_pmid": "15130098", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "Living with Huntington's disease requires a comprehensive approach to manage its effects on daily life [15130098, 18581443, 26444023]. It is essential to accept the condition and its progression, and to seek support from healthcare professionals, family, and caregivers [22278219, 17352943, 28947115]. A multidisciplinary care team, including rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other healthcare providers, can help individuals with Huntington's disease to maximize their quality of life [26444023, 28947115, 21171977]. Coping strategies, such as acceptance, emotional support, planning, and active coping, can be effective in managing the condition [25063190, 22278219]. It is also crucial to address mental health aspects, including depression, anxiety, and behavioral disturbances, through psychiatric medication and therapy [25139915, 26444023, 21171977]. Advance care planning, including discussions about end-of-life care and placement, can help individuals with Huntington's disease to make informed decisions about their care [33852093, 17352944, 18619087].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease requires a comprehensive approach to manage its effects on daily life [15130098, 18581443, 26444023].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "There is therefore ample opportunity to plan and choreograph the care and supportive services for people with Huntington's disease and their families", "evidence_relation": "neutral" }, { "cited_pmid": "26444023", "evidence_support": "HD requires specialist, expert, multidisciplinary care teams to manage it well.", "evidence_relation": "neutral" }, { "cited_pmid": "18581443", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is essential to accept the condition and its progression, and to seek support from healthcare professionals, family, and caregivers [22278219, 17352943, 28947115].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22278219", "evidence_support": "Participants with prodromal HD used acceptance, emotional support, and planning most frequently; companions used acceptance, planning, and active coping.", "evidence_relation": "supporting" }, { "cited_pmid": "22278219", "evidence_support": "Couples may benefit from counseling that emphasizes using active coping strategies for changes that can be compensated for and acceptance for changes that cannot in prodromal HD.", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "Until a cure is found for the disease, patients and their families will continue to need care over years, even generations.", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "We describe below an approach to comprehensive care, and introduce the concept of the \"Huntington disease molecule\", in which the patient, in the center, is surrounded by a shell of immediate and extended family members, with bonds extended in multiple directions to provider who can give appropriate medical care, education, crisis management, research opportunities, address family issues, maximize function, and prepare for the future.", "evidence_relation": "supporting" }, { "cited_pmid": "28947115", "evidence_support": "Connecting expert multidisciplinary teams with community-based care, developing treatment guidelines, and involving the HD family community in quality improvements can achieve an integrated system of health care delivery. Engaging people with HD in high-quality compassionate care will not only improve lives, it will also encourage participation in clinical trials that search for disease-modifying treatments that will reduce or bring the suffering of HD to an end.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "A multidisciplinary care team, including rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other healthcare providers, can help individuals with Huntington's disease to maximize their quality of life [26444023, 28947115, 21171977].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26444023", "evidence_support": "The most helpful factors for living with HD were identified as access to expert assessment and treatment for co-morbid mental health problems, integrated specialist multi-disciplinary HD expertise, and the provision of flexible care.", "evidence_relation": "supporting" }, { "cited_pmid": "26444023", "evidence_support": "HD requires specialist, expert, multidisciplinary care teams to manage it well. Specialists need to focus on the mental health aspects, and the provision must be flexible and responsive to current needs. Patients may have impaired insight into their abilities (e.g. driving) or the need for interventions, so carers' opinions should also be respected.", "evidence_relation": "supporting" }, { "cited_pmid": "28947115", "evidence_support": "Providing medical care for people and families affected by Huntington disease (HD) can be a rewarding effort when realistic goals of improved quality of life and optimized functional status are set", "evidence_relation": "neutral" }, { "cited_pmid": "28947115", "evidence_support": "Connecting expert multidisciplinary teams with community-based care, developing treatment guidelines, and involving the HD family community in quality improvements can achieve an integrated system of health care delivery. Engaging people with HD in high-quality compassionate care will not only improve lives, it will also encourage participation in clinical trials that search for disease-modifying treatments that will reduce or bring the suffering of HD to an end", "evidence_relation": "supporting" }, { "cited_pmid": "21171977", "evidence_support": "Management should be multidisciplinary and is based on treating symptoms with a view to improving quality of life", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Coping strategies, such as acceptance, emotional support, planning, and active coping, can be effective in managing the condition [25063190, 22278219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25063190", "evidence_support": "After program completion, significant improvement of behavioral symptoms and anxiety was found for manifest HD patients, and they used a less passive coping style and more social support", "evidence_relation": "supporting" }, { "cited_pmid": "25063190", "evidence_support": "This pilot study demonstrated the feasibility of the program in Huntington's disease, especially in the manifest stage of the disease.", "evidence_relation": "supporting" }, { "cited_pmid": "22278219", "evidence_support": "Many of the coping procedures were rated as effective, especially when changes were not severe. C", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is also crucial to address mental health aspects, including depression, anxiety, and behavioral disturbances, through psychiatric medication and therapy [25139915, 26444023, 21171977].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25139915", "evidence_support": "During the interview, the patient's family revealed that he had a previous diagnosis of Huntington's disease; there was also a family history of personality changes preceding Huntington's chorea. The patient was admitted to the psychiatric inpatient unit and started on low-dose risperidone. Consequently, there was marked improvement in his symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "26444023", "evidence_support": "Specialists need to focus on the mental health aspects, and the provision must be flexible and responsive to current needs.", "evidence_relation": "supporting" }, { "cited_pmid": "21171977", "evidence_support": "Medication and non-medical care for depression and aggressive behavior may be required.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Advance care planning, including discussions about end-of-life care and placement, can help individuals with Huntington's disease to make informed decisions about their care [33852093, 17352944, 18619087].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33852093", "evidence_support": "That's why it's most important when diagnosed with Huntington Disease to advance care planning to end-of-life care like life-sustaining measures that engages patients in decision-making regarding future care, while they are still able to make and express decisions by themselves.", "evidence_relation": "supporting" }, { "cited_pmid": "17352944", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18619087", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "Living with Huntington's disease requires a comprehensive approach to manage its effects on daily life [26444023, 15130098, 17352943]. It is essential to accept the condition and its progression, and to seek support from healthcare professionals, family, and caregivers [28947115, 17352943, 22278219]. A multidisciplinary care team, including rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other healthcare providers, can help individuals with Huntington's disease to maximize their quality of life [21171977, 17352943, 19576265]. Coping strategies, such as acceptance, emotional support, planning, and active coping, can be effective in managing the condition [22278219]. It is also crucial to address mental health aspects, including depression, anxiety, and behavioral disturbances, through psychiatric medication and therapy [26444023, 21171977, 25139915]. Advance care planning, including discussions about end-of-life care and placement, can help individuals with Huntington's disease to make informed decisions about their care [36970913, 17352944, 18619087].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease requires a comprehensive approach to manage its effects on daily life [26444023, 15130098, 17352943].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26444023", "evidence_support": "The most helpful factors for living with HD were identified as access to expert assessment and treatment for co-morbid mental health problems, integrated specialist multi-disciplinary HD expertise, and the provision of flexible care.", "evidence_relation": "supporting" }, { "cited_pmid": "26444023", "evidence_support": "HD requires specialist, expert, multidisciplinary care teams to manage it well. Specialists need to focus on the mental health aspects, and the provision must be flexible and responsive to current needs. Patients may have impaired insight into their abilities (e.g. driving) or the need for interventions, so carers' opinions should also be respected.", "evidence_relation": "supporting" }, { "cited_pmid": "15130098", "evidence_support": "The present study was conducted to explore the needs for palliative (supportive) care service provision of people with Huntington's disease and their families/informal carers.", "evidence_relation": "supporting" }, { "cited_pmid": "15130098", "evidence_support": "Our findings demonstrate that palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed.", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers.", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "We describe below an approach to comprehensive care, and introduce the concept of the \"Huntington disease molecule\", in which the patient, in the center, is surrounded by a shell of immediate and extended family members, with bonds extended in multiple directions to provider who can give appropriate medical care, education, crisis management, research opportunities, address family issues, maximize function, and prepare for the future.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is essential to accept the condition and its progression, and to seek support from healthcare professionals, family, and caregivers [28947115, 17352943, 22278219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28947115", "evidence_support": "Providing medical care for people and families affected by Huntington disease (HD) can be a rewarding effort when realistic goals of improved quality of life and optimized functional status are set", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "The goals of care are to maximize the quality of life at all points through the course of the disease, in part by anticipating problems that are likely to arise at the next stage of the illness", "evidence_relation": "supporting" }, { "cited_pmid": "22278219", "evidence_support": "Participants with prodromal HD used acceptance, emotional support, and planning most frequently; companions used acceptance, planning, and active coping.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "A multidisciplinary care team, including rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other healthcare providers, can help individuals with Huntington's disease to maximize their quality of life [21171977, 17352943, 19576265].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21171977", "evidence_support": "Management should be multidisciplinary and is based on treating symptoms with a view to improving quality of life.", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers. The goals of care are to maximize the quality of life at all points through the course of the disease, in part by anticipating problems that are likely to arise at the next stage of the illness. We describe below an approach to comprehensive care, and introduce the concept of the \"Huntington disease molecule\", in which the patient, in the center, is surrounded by a shell of immediate and extended family members, with bonds extended in multiple directions to provider who can give appropriate medical care, education, crisis management, research opportunities, address family issues, maximize function, and prepare for the future.", "evidence_relation": "supporting" }, { "cited_pmid": "19576265", "evidence_support": "In the northern part of the Netherlands coordinated multidisciplinary care is offered to patients diagnosed with Huntington's disease. A team of a neurologist, psychologist, occupational therapist, speech and language therapist, social worker and nursing home doctor monitors the patient and companion on a half-year basis and provide them with a plan of care.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Coping strategies, such as acceptance, emotional support, planning, and active coping, can be effective in managing the condition [22278219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22278219", "evidence_support": "Participants with prodromal HD used prescription medications, coping as a couple, hope, and self-monitoring; companions used hope and helping their partners. Many of the coping procedures were rated as effective, especially when changes were not severe.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is also crucial to address mental health aspects, including depression, anxiety, and behavioral disturbances, through psychiatric medication and therapy [26444023, 21171977, 25139915].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26444023", "evidence_support": "Specialists need to focus on the mental health aspects, and the provision must be flexible and responsive to current needs.", "evidence_relation": "supporting" }, { "cited_pmid": "21171977", "evidence_support": "Medication and non-medical care for depression and aggressive behavior may be required. ", "evidence_relation": "supporting" }, { "cited_pmid": "25139915", "evidence_support": "During the interview, the patient's family revealed that he had a previous diagnosis of Huntington's disease; there was also a family history of personality changes preceding Huntington's chorea. The patient was admitted to the psychiatric inpatient unit and started on low-dose risperidone.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Advance care planning, including discussions about end-of-life care and placement, can help individuals with Huntington's disease to make informed decisions about their care [36970913, 17352944, 18619087].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36970913", "evidence_support": "Early and timely consideration of ACP discussions is paramount in Huntington's disease (HD) given the potential challenges in ascertaining decision-making capacity in the advanced stages of the disease.", "evidence_relation": "supporting" }, { "cited_pmid": "17352944", "evidence_support": "This paper describes one method for such management, which includes discussion about placement for care advance directives for feeding and treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "18619087", "evidence_support": "The primary end-of-life considerations are advance directives decision-making and anticipating end-stage care needs.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Living with Huntington's disease requires a comprehensive approach to manage its effects on daily life [17352943, 15130098, 26444023]. It is essential to accept the condition and its progression, and to seek support from healthcare professionals, family, and caregivers [22278219, 17352943, 28947115]. A multidisciplinary care team, including rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other healthcare providers, can help individuals with Huntington's disease to maximize their quality of life [21171977, 17352943, 19576265]. Coping strategies, such as acceptance, emotional support, planning, and active coping, can be effective in managing the condition [31058309, 22278219, 25063190]. It is also crucial to address mental health aspects, including depression, anxiety, and behavioral disturbances, through psychiatric medication and therapy [21171977, 24564005, 26444023]. Advance care planning, including discussions about end-of-life care and placement, can help individuals with Huntington's disease to make informed decisions about their care [18619087, 17352944, 36970913].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease requires a comprehensive approach to manage its effects on daily life [17352943, 15130098, 26444023].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers. The goals of care are to maximize the quality of life at all points through the course of the disease, in part by anticipating problems that are likely to arise at the next stage of the illness.", "evidence_relation": "supporting" }, { "cited_pmid": "15130098", "evidence_support": "There is therefore ample opportunity to plan and choreograph the care and supportive services for people with Huntington's disease and their families", "evidence_relation": "supporting" }, { "cited_pmid": "26444023", "evidence_support": "HD requires specialist, expert, multidisciplinary care teams to manage it well. Specialists need to focus on the mental health aspects, and the provision must be flexible and responsive to current needs", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is essential to accept the condition and its progression, and to seek support from healthcare professionals, family, and caregivers [22278219, 17352943, 28947115].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22278219", "evidence_support": "Couples may benefit from counseling that emphasizes using active coping strategies for changes that can be compensated for and acceptance for changes that cannot in prodromal HD.", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "We describe below an approach to comprehensive care, and introduce the concept of the 'Huntington disease molecule,' in which the patient, in the center, is surrounded by a shell of immediate and extended family members, with bonds extended in multiple directions to provider who can give appropriate medical care, education, crisis management, research opportunities, address family issues, maximize function, and prepare for the future.", "evidence_relation": "supporting" }, { "cited_pmid": "28947115", "evidence_support": "Connecting expert multidisciplinary teams with community-based care, developing treatment guidelines, and involving the HD family community in quality improvements can achieve an integrated system of health care delivery.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "A multidisciplinary care team, including rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other healthcare providers, can help individuals with Huntington's disease to maximize their quality of life [21171977, 17352943, 19576265].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21171977", "evidence_support": "Management should be multidisciplinary and is based on treating symptoms with a view to improving quality of life. Chorea is treated with dopamine receptor blocking or depleting agents. Medication and non-medical care for depression and aggressive behavior may be required. The progression of the disease leads to a complete dependency in daily life, which results in patients requiring full-time care, and finally death. The most common cause of death is pneumonia, followed by suicide.", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers. The goals of care are to maximize the quality of life at all points through the course of the disease, in part by anticipating problems that are likely to arise at the next stage of the illness.", "evidence_relation": "supporting" }, { "cited_pmid": "19576265", "evidence_support": "A team of a neurologist, psychologist, occupational therapist, speech and language therapist, social worker and nursing home doctor monitors the patient and companion on a half-year basis and provide them with a plan of care.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Coping strategies, such as acceptance, emotional support, planning, and active coping, can be effective in managing the condition [31058309, 22278219, 25063190].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31058309", "evidence_support": "The most commonly used strategy was Acceptance, followed by Active Coping, Planning and Positive Re-interpretation and Growth.", "evidence_relation": "supporting" }, { "cited_pmid": "22278219", "evidence_support": "Participants with prodromal HD used acceptance, emotional support, and planning most frequently; companions used acceptance, planning, and active coping.", "evidence_relation": "supporting" }, { "cited_pmid": "25063190", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is also crucial to address mental health aspects, including depression, anxiety, and behavioral disturbances, through psychiatric medication and therapy [21171977, 24564005, 26444023].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "21171977", "evidence_support": "Medication and non-medical care for depression and aggressive behavior may be required.", "evidence_relation": "neutral" }, { "cited_pmid": "26444023", "evidence_support": "Specialists need to focus on the mental health aspects, and the provision must be flexible and responsive to current needs.", "evidence_relation": "supporting" }, { "cited_pmid": "24564005", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Advance care planning, including discussions about end-of-life care and placement, can help individuals with Huntington's disease to make informed decisions about their care [18619087, 17352944, 36970913].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18619087", "evidence_support": "The primary end-of-life considerations are advance directives decision-making and anticipating end-stage care needs.", "evidence_relation": "supporting" }, { "cited_pmid": "17352944", "evidence_support": "This paper describes one method for such management, which includes discussion about placement for care advance directives for feeding and treatment.", "evidence_relation": "neutral" }, { "cited_pmid": "36970913", "evidence_support": "Early and timely consideration of ACP discussions is paramount in Huntington's disease (HD) given the potential challenges in ascertaining decision-making capacity in the advanced stages of the disease. ACP helps to empower and extend patient autonomy, providing clinicians and surrogate decision makers with reassurance that management is consistent with a patient's expressed wishes", "evidence_relation": "supporting" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "Living with Huntington's disease requires a comprehensive approach to manage its effects on daily life [26444023, 17352943, 15130098]. It is essential to accept the condition and its progression, and to seek support from healthcare professionals, family, and caregivers [17352943, 22278219, 15130098]. A multidisciplinary care team, including rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other healthcare providers, can help individuals with Huntington's disease to maximize their quality of life [17352943, 19576265, 21171977]. Coping strategies, such as acceptance, emotional support, planning, and active coping, can be effective in managing the condition [35955039, 25063190, 22278219]. It is also crucial to address mental health aspects, including depression, anxiety, and behavioral disturbances, through psychiatric medication and therapy [26444023, 27222136, 24564005]. Advance care planning, including discussions about end-of-life care and placement, can help individuals with Huntington's disease to make informed decisions about their care [36970913, 17352944, 18619087].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease requires a comprehensive approach to manage its effects on daily life [26444023, 17352943, 15130098].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26444023", "evidence_support": "HD requires specialist, expert, multidisciplinary care teams to manage it well. Specialists need to focus on the mental health aspects, and the provision must be flexible and responsive to current needs.", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "We describe below an approach to comprehensive care, and introduce the concept of the \"Huntington disease molecule\", in which the patient, in the center, is surrounded by a shell of immediate and extended family members, with bonds extended in multiple directions to provider who can give appropriate medical care, education, crisis management, research opportunities, address family issues, maximize function, and prepare for the future.", "evidence_relation": "supporting" }, { "cited_pmid": "15130098", "evidence_support": "Our findings demonstrate that palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is essential to accept the condition and its progression, and to seek support from healthcare professionals, family, and caregivers [17352943, 22278219, 15130098].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22278219", "evidence_support": "Participants with prodromal HD used acceptance, emotional support, and planning most frequently; companions used acceptance, planning, and active coping.", "evidence_relation": "supporting" }, { "cited_pmid": "15130098", "evidence_support": "Our findings demonstrate that palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed.", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "A multidisciplinary care team, including rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other healthcare providers, can help individuals with Huntington's disease to maximize their quality of life [17352943, 19576265, 21171977].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers", "evidence_relation": "supporting" }, { "cited_pmid": "19576265", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "21171977", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Coping strategies, such as acceptance, emotional support, planning, and active coping, can be effective in managing the condition [35955039, 25063190, 22278219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35955039", "evidence_support": "The ability to cope with stress is one of the key competences for the course of neoplastic diseases and it can affect the treatment process.", "evidence_relation": "supporting" }, { "cited_pmid": "25063190", "evidence_support": "The goal of the Patient Education Program for Huntington's disease is to improve quality of life for patients and caregivers, to educate and train them in order to develop coping strategies to deal with psychosocial stressors.", "evidence_relation": "supporting" }, { "cited_pmid": "22278219", "evidence_support": "Participants with prodromal HD used acceptance, emotional support, and planning most frequently; companions used acceptance, planning, and active coping.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is also crucial to address mental health aspects, including depression, anxiety, and behavioral disturbances, through psychiatric medication and therapy [26444023, 27222136, 24564005].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "26444023", "evidence_support": "Specialists need to focus on the mental health aspects, and the provision must be flexible and responsive to current needs.", "evidence_relation": "supporting" }, { "cited_pmid": "27222136", "evidence_support": "Nonetheless the primary care provider remains the first line of defense against mental disorders, most commonly depression and anxiety that accompany and exacerbate common physical conditions.", "evidence_relation": "supporting" }, { "cited_pmid": "27222136", "evidence_support": "Psychotherapy can help overcome comorbidity depression however the most accessible intervention would be an antidepressant FDA approved for both anxiety and depressive disorders.", "evidence_relation": "neutral" }, { "cited_pmid": "24564005", "evidence_support": "This article seeks to illuminate psychosocial approaches for depression and anxiety that act additively or independently of pharmacotherapy and explain how physicians can utilize them", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Advance care planning, including discussions about end-of-life care and placement, can help individuals with Huntington's disease to make informed decisions about their care [36970913, 17352944, 18619087].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36970913", "evidence_support": "Early and timely consideration of ACP discussions is paramount in Huntington's disease (HD) given the potential challenges in ascertaining decision-making capacity in the advanced stages of the disease.", "evidence_relation": "supporting" }, { "cited_pmid": "17352944", "evidence_support": "There are unique issues to address in a disorder where patients are aware in advance that their ability to communicate, as well as their cognitive capacity, will become impaired.", "evidence_relation": "neutral" }, { "cited_pmid": "18619087", "evidence_support": "The primary end-of-life considerations are advance directives decision-making and anticipating end-stage care needs. ", "evidence_relation": "supporting" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "Living with Huntington's disease requires a comprehensive approach to manage its effects on daily life [18581443, 18414253, 15130098]. It is essential to accept the condition and its progression, and to seek support from healthcare professionals, family, and caregivers [35176640, 24791460]. A multidisciplinary care team, including rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other healthcare providers, can help individuals with Huntington's disease to maximize their quality of life [17352943, 36698999, 28947115]. Coping strategies, such as acceptance, emotional support, planning, and active coping, can be effective in managing the condition [35193564]. Advance care planning, including discussions about end-of-life care and placement, can help individuals with Huntington's disease to make informed decisions about their care [37586417, 36970913, 28428907]. A time-restricted ketogenic diet may also be beneficial in improving motor symptoms, activities of daily living, and quality of life [33922683, 35967897, 30062917]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease requires a comprehensive approach to manage its effects on daily life [18581443, 18414253, 15130098].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18581443", "evidence_support": "We review the pharmacological management of the various movement disorders associated with the disease, the cognitive decline and the commonly encountered behavioral disturbances. We discuss the nonclassical features of the disease, important in the management of these patients. Nonpharmacological support including genetic counseling and therapy and the importance of palliative care are also addressed.", "evidence_relation": "supporting" }, { "cited_pmid": "18414253", "evidence_support": "Finally, the combined role of the multidisciplinary team is highlighted in providing health and social care to people with Huntington's disease as it progresses and increasing professional support is required", "evidence_relation": "supporting" }, { "cited_pmid": "15130098", "evidence_support": "Our findings demonstrate that palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is essential to accept the condition and its progression, and to seek support from healthcare professionals, family, and caregivers [35176640, 24791460].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35176640", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "24791460", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "A multidisciplinary care team, including rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other healthcare providers, can help individuals with Huntington's disease to maximize their quality of life [17352943, 36698999, 28947115].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers. The goals of care are to maximize the quality of life at all points through the course of the disease, in part by anticipating problems that are likely to arise at the next stage of the illness.", "evidence_relation": "supporting" }, { "cited_pmid": "28947115", "evidence_support": "Connecting expert multidisciplinary teams with community-based care, developing treatment guidelines, and involving the HD family community in quality improvements can achieve an integrated system of health care delivery.", "evidence_relation": "supporting" }, { "cited_pmid": "28947115", "evidence_support": "Engaging people with HD in high-quality compassionate care will not only improve lives, it will also encourage participation in clinical trials that search for disease-modifying treatments that will reduce or bring the suffering of HD to an end.", "evidence_relation": "supporting" }, { "cited_pmid": "36698999", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Coping strategies, such as acceptance, emotional support, planning, and active coping, can be effective in managing the condition [35193564].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35193564", "evidence_support": "Coping denotes cognitive, emotional and behavioural struggles to tackle a troubled person-environment association. Therefore, coping strategies (CSs) are vital for mental well-being.", "evidence_relation": "supporting" }, { "cited_pmid": "35193564", "evidence_support": "The first identified theme (MHDs) had four subthemes: stress (55% of the articles), depression (30%), anxiety (25%) and burnout (15%). The second theme (CSs), on the other hand, had eight subthemes: support seeking (60%), active coping (40%), acceptance (40%), avoidance/denial (40%), substance abuse (35%), faith/religion (25%), sports (25%) and miscellaneous (40%).", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Advance care planning, including discussions about end-of-life care and placement, can help individuals with Huntington's disease to make informed decisions about their care [37586417, 36970913, 28428907].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37586417", "evidence_support": "HD patients are encouraged to engage in advance care planning (ACP)", "evidence_relation": "supporting" }, { "cited_pmid": "36970913", "evidence_support": "Advance care planning (ACP) is a useful tool that benefits adult patients, care providers, and surrogate decision makers, through providing opportunities for patients to consider, express, and formalize their beliefs, preferences, and wishes pertaining to decisions regarding future medical care at a time when they retain decision-making capacity.", "evidence_relation": "supporting" }, { "cited_pmid": "28428907", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "A time-restricted ketogenic diet may also be beneficial in improving motor symptoms, activities of daily living, and quality of life [33922683, 35967897, 30062917].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35967897", "evidence_support": "Metabolic strategies, such as fasting and ketogenic diets, theoretically enhance brain and muscle metabolism and mitochondria function, which may improve the clinical symptoms of HD.", "evidence_relation": "supporting" }, { "cited_pmid": "35967897", "evidence_support": "This case study is unique in that a patient with progressive, deteriorating HD was managed with a TRKD, with subsequent improvements in his motor symptoms, activities of daily living, cUHDRS score, most major HD-related behavior problems, and quality of life.", "evidence_relation": "supporting" }, { "cited_pmid": "30062917", "evidence_support": "Ketogenic diet treatment improves motor functions and daily living activities in children with epilepsy during the 12 months of treatment.", "evidence_relation": "supporting" }, { "cited_pmid": "33922683", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "A comprehensive approach to manage Huntington's disease involves understanding and coping with its complex effects on daily life, including movement disorders, cognitive decline, psychiatric disturbance, loss of autonomy, and loss of sense of self and family, as experienced by patients and their families [35526033, 18581443]. A multidisciplinary care team, including rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other healthcare providers, can help individuals with Huntington's disease to maximize their quality of life [18414253]. Coping strategies, such as acceptance, emotional support, planning, and active coping, can be effective in managing motor neuron disease MND, also known as amyotrophic lateral sclerosis ALS [31058309]. It is also crucial to address mental health aspects, including depression, anxiety, and behavioral disturbances, through therapy [17066756]. Cognitive-behavioral therapy and psychodynamic psychotherapy are the most frequently applied methods of psychotherapy in clinical practice [17066756].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "A comprehensive approach to manage Huntington's disease involves understanding and coping with its complex effects on daily life, including movement disorders, cognitive decline, psychiatric disturbance, loss of autonomy, and loss of sense of self and family, as experienced by patients and their families [35526033, 18581443].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35526033", "evidence_support": "Living with HD is a process that begins with acceptance or denial that one is at risk for the disease or, growing awareness of the condition due to motor, behavioral, and cognitive changes, and, finally, loss of autonomy with physical dependence on another person, and loss of sense of self and family.", "evidence_relation": "supporting" }, { "cited_pmid": "18581443", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "A multidisciplinary care team, including rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other healthcare providers, can help individuals with Huntington's disease to maximize their quality of life [18414253].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18414253", "evidence_support": "Finally, the combined role of the multidisciplinary team is highlighted in providing health and social care to people with Huntington's disease as it progresses and increasing professional support is required.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Coping strategies, such as acceptance, emotional support, planning, and active coping, can be effective in managing motor neuron disease MND, also known as amyotrophic lateral sclerosis ALS [31058309].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31058309", "evidence_support": "The most commonly used strategy was Acceptance, followed by Active Coping, Planning and Positive Re-interpretation and Growth. The least used strategies were Substance Use, Turning to Religion and Denial. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "It is also crucial to address mental health aspects, including depression, anxiety, and behavioral disturbances, through therapy [17066756].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17066756", "evidence_support": "Although there is substantial evidence for the efficacy of cognitive-behavioral therapy and some evidence for the efficacy of psychodynamic psychotherapy, further studies are required to improve the positive outcome rates of treatment responders in specific mental disorder", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Cognitive-behavioral therapy and psychodynamic psychotherapy are the most frequently applied methods of psychotherapy in clinical practice [17066756].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17066756", "evidence_support": "Cognitive-behavioral therapy and psychodynamic psychotherapy are the most frequently applied methods of psychotherapy in clinical practice.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "Living with Huntington's disease requires a comprehensive approach to manage its effects on daily life [18581443, 18414253]. It is essential to accept the condition and its progression, and to seek support from healthcare professionals, family, and caregivers [16539860, 24791460, 18293219]. A multidisciplinary care team, including rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other healthcare providers, can help individuals with Huntington's disease to maximize their quality of life [36717864, 17352943]. Coping strategies, such as acceptance, emotional support, planning, and active coping, can be effective in managing the condition [19786524]. It is also crucial to address mental health aspects by addressing the determinants of mental health in terms of protective and risk factors for both physical and mental conditions, promoting intersectorial cooperation, and implementing evidence-based mental health programmes that contribute to the well-being of populations [22946143, 17307955].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease requires a comprehensive approach to manage its effects on daily life [18581443, 18414253].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18414253", "evidence_support": "multidisciplinary team is highlighted in providing health and social care to people with Huntington's disease as it progresses and increasing professional support is required", "evidence_relation": "supporting" }, { "cited_pmid": "18581443", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is essential to accept the condition and its progression, and to seek support from healthcare professionals, family, and caregivers [16539860, 24791460, 18293219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16539860", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "24791460", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "18293219", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "A multidisciplinary care team, including rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other healthcare providers, can help individuals with Huntington's disease to maximize their quality of life [36717864, 17352943].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36717864", "evidence_support": "The long progressive complex nature of the disease demands multiple disciplines for treatment and care of patient and family.", "evidence_relation": "supporting" }, { "cited_pmid": "36717864", "evidence_support": "These health care providers need inter- and multidisciplinary collaboration to persevere and be efficacious in this devastating disease trajectory.", "evidence_relation": "supporting" }, { "cited_pmid": "36717864", "evidence_support": "The complex nature of Huntington's disease demands multidisciplinary treatment and care endorsed by international regulations and the lay association. ", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers. The goals of care are to maximize the quality of life at all points through the course of the disease, in part by anticipating problems that are likely to arise at the next stage of the illness.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Coping strategies, such as acceptance, emotional support, planning, and active coping, can be effective in managing the condition [19786524].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19786524", "evidence_support": "Coping strategies did not generally impact problems or emotions differently. Use of planning led to increased self-efficacy, which along with positive reinterpretation, predicted growth. ", "evidence_relation": "contradicting" }, { "cited_pmid": "19786524", "evidence_support": "Use of acceptance coping and seeking advice from others had both positive and negative effects on well-being.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is also crucial to address mental health aspects by addressing the determinants of mental health in terms of protective and risk factors for both physical and mental conditions, promoting intersectorial cooperation, and implementing evidence-based mental health programmes that contribute to the well-being of populations [22946143, 17307955].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22946143", "evidence_support": "Integration of mental health into primary care can be considered as the stepping stone in the way forward to tackle the barriers and problems in effective management of common mental disorders in the community.", "evidence_relation": "supporting" }, { "cited_pmid": "17307955", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "Living with Huntington's disease requires a comprehensive approach to manage its effects on daily life [35774908, 18581443]. It is essential to accept the condition and its progression, and to seek support from General Practitioners (GPs), who can provide support and encouragement throughout the coping process [17392931, 23795624]. A multidisciplinary care team, including rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other healthcare providers, can help individuals with Huntington's disease to maximize their quality of life [19576265, 36717864, 17352943]. Coping strategies, such as acceptance, emotional support, planning, and active coping, can be effective in managing the condition [35193564]. It is also crucial to address mental health aspects, including depression, anxiety, and behavioral disturbances, through lifestyle interventions such as diet, exercise, substance use, psychological well-being/stress, relationships, and sleep, in addition to psychiatric medication and therapy [35185421].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease requires a comprehensive approach to manage its effects on daily life [35774908, 18581443].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35774908", "evidence_support": "Currently, there is no definitive treatment for Huntington's disease. Thus, management is primarily focused on symptom management with the use of a variety of pharmaceutical agents.", "evidence_relation": "supporting" }, { "cited_pmid": "18581443", "evidence_support": "We review the pharmacological management of the various movement disorders associated with the disease, the cognitive decline and the commonly encountered behavioral disturbances. We discuss the nonclassical features of the disease, important in the management of these patients. Nonpharmacological support including genetic counseling and therapy and the importance of palliative care are also addressed.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "2", "answer_sentence": "It is essential to accept the condition and its progression, and to seek support from General Practitioners (GPs), who can provide support and encouragement throughout the coping process [17392931, 23795624].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17392931", "evidence_support": "When this change involves illness, the GP is well placed to provide support and practical assistance", "evidence_relation": "supporting" }, { "cited_pmid": "17392931", "evidence_support": "The GP can provide support and encouragement throughout this process.", "evidence_relation": "supporting" }, { "cited_pmid": "23795624", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "A multidisciplinary care team, including rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other healthcare providers, can help individuals with Huntington's disease to maximize their quality of life [19576265, 36717864, 17352943].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19576265", "evidence_support": "A team of a neurologist, psychologist, occupational therapist, speech and language therapist, social worker and nursing home doctor monitors the patient and companion on a half-year basis and provide them with a plan of care.", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers.", "evidence_relation": "supporting" }, { "cited_pmid": "36717864", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Coping strategies, such as acceptance, emotional support, planning, and active coping, can be effective in managing the condition [35193564].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35193564", "evidence_support": "Coping denotes cognitive, emotional and behavioural struggles to tackle a troubled person-environment association", "evidence_relation": "neutral" }, { "cited_pmid": "35193564", "evidence_support": "The second theme (CSs), on the other hand, had eight subthemes: support seeking (60%), active coping (40%), acceptance (40%), avoidance/denial (40%), substance abuse (35%), faith/religion (25%), sports (25%) and miscellaneous (40%)", "evidence_relation": "neutral" }, { "cited_pmid": "35193564", "evidence_support": "Among the most used CSs was support (social and emotional) seeking. Teaching medical students how to cope with challenging times is essential.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "It is also crucial to address mental health aspects, including depression, anxiety, and behavioral disturbances, through lifestyle interventions such as diet, exercise, substance use, psychological well-being/stress, relationships, and sleep, in addition to psychiatric medication and therapy [35185421].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "35185421", "evidence_support": "Thus, there is a critical opportunity for the field of lifestyle medicine to incorporate mental health into each of the foundational pillars (diet, exercise, substance use, psychological well-being/stress, relationships, sleep) while also specifically targeting lifestyle interventions for populations with mental disorders. ", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "Living with Huntington's disease (HD) requires a comprehensive, multidisciplinary approach to manage its progressive neurodegenerative effects on motor, cognitive, and psychiatric functions [17352943, 21907093]. Effective care involves a team led by a physician, including rehabilitation therapists, psychologists, genetic counselors, and social workers, aiming to maximize quality of life and anticipate future challenges [17352943, 28947115]. Rehabilitation tailored to disease stages, such as aerobic and resistance exercises in early stages and task-specific training in middle stages, can mitigate symptom severity and improve functional status [38047100, 26098083]. Psychological support is crucial, addressing the significant emotional and psychosocial stressors experienced by patients and caregivers [15130098, 35055379]. Community-based exercise programs and patient education initiatives can enhance coping strategies and social support, further improving quality of life [25063190, 27046737]. Engaging patients in high-quality, compassionate care not only alleviates symptoms but also encourages participation in clinical trials for potential disease-modifying treatments [28947115, 25494622].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease (HD) requires a comprehensive, multidisciplinary approach to manage its progressive neurodegenerative effects on motor, cognitive, and psychiatric functions [17352943, 21907093].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers.", "evidence_relation": "supporting" }, { "cited_pmid": "21907093", "evidence_support": "Huntington's disease (HD) is a devastating inherited neurodegenerative disease characterized primarily by progressive motor, cognitive, and psychiatric symptoms.", "evidence_relation": "supporting" }, { "cited_pmid": "21907093", "evidence_support": "We then give an overview of a suggested multidisciplinary approach to the management of HD, emphasizing the fact that it is a disease which impacts on entire families rather than affecting individuals in isolation.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Effective care involves a team led by a physician, including rehabilitation therapists, psychologists, genetic counselors, and social workers, aiming to maximize quality of life and anticipate future challenges [17352943, 28947115].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers. The goals of care are to maximize the quality of life at all points through the course of the disease, in part by anticipating problems that are likely to arise at the next stage of the illness.", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "We describe below an approach to comprehensive care, and introduce the concept of the \"Huntington disease molecule\", in which the patient, in the center, is surrounded by a shell of immediate and extended family members, with bonds extended in multiple directions to provider who can give appropriate medical care, education, crisis management, research opportunities, address family issues, maximize function, and prepare for the future.", "evidence_relation": "supporting" }, { "cited_pmid": "28947115", "evidence_support": "Connecting expert multidisciplinary teams with community-based care, developing treatment guidelines, and involving the HD family community in quality improvements can achieve an integrated system of health care delivery. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Rehabilitation tailored to disease stages, such as aerobic and resistance exercises in early stages and task-specific training in middle stages, can mitigate symptom severity and improve functional status [38047100, 26098083].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "38047100", "evidence_support": "Therefore, this review aimed to establish an effective rehabilitation approach for HD according to the stage of the disease. In the early stage of HD, the motor symptoms are mild, and psychological symptoms occur. Treatment in this period should focus on aerobic and resistance exercises, task-specific training, secondary prevention education, cognitive training, and psychological management. In the middle stage of HD, the motor symptoms are more severe. Task-specific rehabilitation approaches, education for the patient and caregiver, functional respiratory exercises, activities of daily living training, multidisciplinary and multimodal daycare rehabilitation are helpful to patients in this stage. At the late stage of HD, most patients need complete support for activity of daily living. Mobility and balance evaluation and prevention strategies should be focused on for safety, and respiratory exercises and physical exercise to prevent complications in patients with severely impaired mobility should be considered based on the patient's condition. Programmed rehabilitation management based on the stage of the disease is effective for patients with HD.", "evidence_relation": "supporting" }, { "cited_pmid": "26098083", "evidence_support": "They are in need of physical, occupational and speech therapy or (inpatient) multidisciplinary rehabilitation. This paper reviews the available evidence for the usefulness of these therapeutic interventions. Studies using HD animal models have shown that motor training per se or as part of an enriched environment setting may have a positive impact on disease onset and progression. There are four clinical randomized controlled trials (RCT) showing beneficial effects of physical therapy (standardized home-based training program). ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Psychological support is crucial, addressing the significant emotional and psychosocial stressors experienced by patients and caregivers [15130098, 35055379].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "Our findings demonstrate that palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed", "evidence_relation": "supporting" }, { "cited_pmid": "35055379", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Community-based exercise programs and patient education initiatives can enhance coping strategies and social support, further improving quality of life [25063190, 27046737].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25063190", "evidence_support": "The goal of the Patient Education Program for Huntington's disease is to improve quality of life for patients and caregivers, to educate and train them in order to develop coping strategies to deal with psychosocial stressors.", "evidence_relation": "supporting" }, { "cited_pmid": "27046737", "evidence_support": "This clinical report describes the integration of the evidence, clinical expertise, and patient values to develop and implement individualized, community-based exercise groups, aimed to improve balance, gait speed, and fatigue measures for persons with HD and those at-risk. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Engaging patients in high-quality, compassionate care not only alleviates symptoms but also encourages participation in clinical trials for potential disease-modifying treatments [28947115, 25494622].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28947115", "evidence_support": "Connecting expert multidisciplinary teams with community-based care, developing treatment guidelines, and involving the HD family community in quality improvements can achieve an integrated system of health care delivery.", "evidence_relation": "supporting" }, { "cited_pmid": "25494622", "evidence_support": "Huntington's disease (HD) is a complex, single-gene inherited neurodegenerative condition resulting in symptoms that occur across a wide range of neurological domains, including cognitive, behavioral and motor.", "evidence_relation": "neutral" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "Living with Huntington's disease involves a multidisciplinary approach to manage symptoms and maintain quality of life.Pharmacological treatments, such as tetrabenazine for chorea and antidepressants for mood disorders, can alleviate some symptoms.Physical therapy helps maintain mobility and reduce fall risk, while occupational therapy aids in adapting daily activities.Speech therapy can address communication and swallowing difficulties.Nutritional support is crucial due to increased caloric needs and swallowing issues.Psychological support, including counseling and support groups, is essential for both patients and caregivers to cope with emotional and cognitive challenges.Genetic counseling is recommended for family planning and understanding inheritance patterns.Regular follow-ups with a neurologist are necessary to monitor disease progression and adjust treatments.Research into disease-modifying therapies is ongoing, offering hope for future interventions.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease involves a multidisciplinary approach to manage symptoms and maintain quality of life.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Pharmacological treatments, such as tetrabenazine for chorea and antidepressants for mood disorders, can alleviate some symptoms.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Physical therapy helps maintain mobility and reduce fall risk, while occupational therapy aids in adapting daily activities.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Speech therapy can address communication and swallowing difficulties.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "Nutritional support is crucial due to increased caloric needs and swallowing issues.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "6", "answer_sentence": "Psychological support, including counseling and support groups, is essential for both patients and caregivers to cope with emotional and cognitive challenges.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "Genetic counseling is recommended for family planning and understanding inheritance patterns.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "8", "answer_sentence": "Regular follow-ups with a neurologist are necessary to monitor disease progression and adjust treatments.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "9", "answer_sentence": "Research into disease-modifying therapies is ongoing, offering hope for future interventions.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "rl31-70b_l31-70b_ragnarokv5biogen_top20": { "answer": "Living with Huntington's disease (HD) requires a multifaceted approach that addresses the physical, emotional, and social aspects of the condition [15130098, 17352943, 28947115]. Individuals with HD need to adapt to the impact of the illness, gather practical support from various sources, and bolster their spirit to cope with it [15130098]. A comprehensive care team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, and social workers, is essential for expert support and guidance [17352943]. The care team should focus on maximizing the quality of life, anticipating problems, and providing education, crisis management, and research opportunities [17352943, 28947115]. Individuals with HD can benefit from rehabilitation programs that include physical, occupational, speech therapy, and multidisciplinary rehabilitation [38047100, 26098083]. A patient-centered approach that acknowledges the individual's experiences, emotions, and needs is crucial for effective care [34216010, 35526033]. By adopting a holistic and supportive approach, individuals with HD can better manage their condition and improve their overall well-being.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease (HD) requires a multifaceted approach that addresses the physical, emotional, and social aspects of the condition [15130098, 17352943, 28947115].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "Our findings demonstrate that palliative care services for people with Huntington's disease and their informal carers need to provide expert psychological and practical support and perhaps most importantly, be flexible, adequately planned and choreographed.", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "We describe below an approach to comprehensive care, and introduce the concept of the \"Huntington disease molecule\", in which the patient, in the center, is surrounded by a shell of immediate and extended family members, with bonds extended in multiple directions to provider who can give appropriate medical care, education, crisis management, research opportunities, address family issues, maximize function, and prepare for the future.", "evidence_relation": "supporting" }, { "cited_pmid": "28947115", "evidence_support": "Connecting expert multidisciplinary teams with community-based care, developing treatment guidelines, and involving the HD family community in quality improvements can achieve an integrated system of health care delivery.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Individuals with HD need to adapt to the impact of the illness, gather practical support from various sources, and bolster their spirit to cope with it [15130098].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15130098", "evidence_support": "Themes were: (i). adjusting to the impact of the illness; (ii). surviving the search for essential information; (iii). gathering practical support from many sources; (iv). bolstering the spirit; (v). choreographing individual care and; (vi). fearing the future", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "A comprehensive care team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, and social workers, is essential for expert support and guidance [17352943].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The care team should focus on maximizing the quality of life, anticipating problems, and providing education, crisis management, and research opportunities [17352943, 28947115].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers. The goals of care are to maximize the quality of life at all points through the course of the disease, in part by anticipating problems that are likely to arise at the next stage of the illness.", "evidence_relation": "supporting" }, { "cited_pmid": "17352943", "evidence_support": "We describe below an approach to comprehensive care, and introduce the concept of the \"Huntington disease molecule\", in which the patient, in the center, is surrounded by a shell of immediate and extended family members, with bonds extended in multiple directions to provider who can give appropriate medical care, education, crisis management, research opportunities, address family issues, maximize function, and prepare for the future.", "evidence_relation": "supporting" }, { "cited_pmid": "28947115", "evidence_support": "Providing medical care for people and families affected by Huntington disease (HD) can be a rewarding effort when realistic goals of improved quality of life and optimized functional status are set", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Individuals with HD can benefit from rehabilitation programs that include physical, occupational, speech therapy, and multidisciplinary rehabilitation [38047100, 26098083].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "38047100", "evidence_support": "Task-specific rehabilitation approaches, education for the patient and caregiver, functional respiratory exercises, activities of daily living training, multidisciplinary and multimodal daycare rehabilitation are helpful to patients in this stage.", "evidence_relation": "supporting" }, { "cited_pmid": "26098083", "evidence_support": "They are in need of physical, occupational and speech therapy or (inpatient) multidisciplinary rehabilitation.", "evidence_relation": "supporting" }, { "cited_pmid": "26098083", "evidence_support": "Among the studies focusing on multidisciplinary rehabilitation, there is only one RCT.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "6", "answer_sentence": "A patient-centered approach that acknowledges the individual's experiences, emotions, and needs is crucial for effective care [34216010, 35526033].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34216010", "evidence_support": "The findings of this review demonstrate that individuals who are gene-positive for or living with HD require support well beyond the disclosure of genetic testing and that it may be beneficial for healthcare providers to consider where along the life stage trajectory a person affected by HD may be to ensure the delivery of quality PCC.", "evidence_relation": "supporting" }, { "cited_pmid": "35526033", "evidence_support": "To better serve these patients, our purpose is to understand, from the perspective of the patient and their families, how people with HD cope with their daily lives outside the clinical setting", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "By adopting a holistic and supportive approach, individuals with HD can better manage their condition and improve their overall well-being.", "answer_sentence_relevance": "borderline", "citation_assessment": null } ] }, "ten-shot-gemini-flash": { "answer": "Living with Huntington's disease (HD) requires proactive coping strategies to manage anxieties and accept an uncertain future [34374465]. Counseling can help develop these strategies [34374465]. It is important to remember that HD is a genetically caused disease with no known cure [30084274]. Lifestyle changes can improve quality of life and potentially delay disease progression [30084274]. Families can benefit from a multidisciplinary approach to education about the risks and benefits of testing, improving coping skills when a diagnosis is made [19808987]. Families may also need to balance considerations for protection and disclosure of information about the disease [25471490]. Caregivers may experience profound grief and loss, which can be associated with the ambiguous loss of their loved one [36198334].\n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease (HD) requires proactive coping strategies to manage anxieties and accept an uncertain future [34374465].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34374465", "evidence_support": "Individuals may benefit from counseling which supports them to develop proactive coping strategies to manage their anxieties and acceptance of an uncertain future.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Counseling can help develop these strategies [34374465].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34374465", "evidence_support": "Individuals may benefit from counseling which supports them to develop proactive coping strategies to manage their anxieties and acceptance of an uncertain future.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "It is important to remember that HD is a genetically caused disease with no known cure [30084274].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30084274", "evidence_support": "It is worth emphasizing that HD is a genetically caused disease with no known cure.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Lifestyle changes can improve quality of life and potentially delay disease progression [30084274].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30084274", "evidence_support": "Lifestyle changes that not only improve the quality of life but also delay disease progression for HD patients are greatly needed.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Families can benefit from a multidisciplinary approach to education about the risks and benefits of testing, improving coping skills when a diagnosis is made [19808987].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19808987", "evidence_support": "When testing is indicated, a multidisciplinary approach is essential to educate the family about the risks and benefits of testing and improve their coping skills when the final diagnosis is made.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Families may also need to balance considerations for protection and disclosure of information about the disease [25471490].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25471490", "evidence_support": "Health professionals and social workers should acknowledge that family caregivers balance their needs and considerations in coping with HD. They should, therefore, tailor healthcare services and social support to family caregivers' needs during the different stages of HD to improve caregivers' abilities to maintain some of their own activities, in balance with care-giving.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Caregivers may experience profound grief and loss, which can be associated with the ambiguous loss of their loved one [36198334].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36198334", "evidence_support": "HD caregivers experience profound grief/loss, expressed as disenfranchised grief that is associated with the ambiguous loss of their loved one, loss of family structure, social connectedness, and personal losses. ", "evidence_relation": "supporting" }, { "cited_pmid": "36198334", "evidence_support": "HD caregivers experience prolonged grief and other forms of spiritual suffering as they progressively lose their loved ones and disruption to their own lives.", "evidence_relation": "supporting" } ] } ] }, "ten-shot-gemini-flash-wiki": { "answer": "Living with Huntington's disease (HD) requires a multi-faceted approach focused on managing symptoms and improving quality of life [18394562, 30012004]. While there is no cure to halt the disease progression, symptomatic treatment can significantly improve quality of life [14586062, 18394562]. This includes medication for motor, psychiatric, and cognitive symptoms, tailored to individual needs [18394562, 22314929]. Physical therapy is crucial for managing mobility deficits and falls, especially in the early stages [18467429, 38047100]. Open communication, emotional support, and effective coping strategies are essential for adaptation and well-being [31653233, 34374465]. Advance care planning (ACP) is vital to ensure patient autonomy and consistent care as the disease progresses [36970913, 36698999]. \n\n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease (HD) requires a multi-faceted approach focused on managing symptoms and improving quality of life [18394562, 30012004].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18394562", "evidence_support": "Recently, surgical approaches including pallidotomy, deep brain stimulation, and fetal cell transplants have been used for the symptomatic treatment of HD. The selected therapy must be customized to the needs of each patient, minimizing the potential adverse effect", "evidence_relation": "supporting" }, { "cited_pmid": "18394562", "evidence_support": "The primary aim of this article is to review the role of the different therapies, both available and investigational, for the treatment of the motor, psychiatric, behavioral, and cognitive symptoms of HD, and to examine their impact on the patient's functionality and quality of life.\n", "evidence_relation": "supporting" }, { "cited_pmid": "30012004", "evidence_support": "HD is presently incurable, so the current goal is to allow affected individuals to live as well as possible with the illness, to maximise functional independence and quality of life for the person with HD, their carers and family members.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "While there is no cure to halt the disease progression, symptomatic treatment can significantly improve quality of life [14586062, 18394562].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18394562", "evidence_support": "Because there are no effective neuroprotective therapies that delay the progression of the disease, symptomatic treatment remains the cornerstone of medical management.", "evidence_relation": "supporting" }, { "cited_pmid": "18394562", "evidence_support": "The primary aim of this article is to review the role of the different therapies, both available and investigational, for the treatment of the motor, psychiatric, behavioral, and cognitive symptoms of HD, and to examine their impact on the patient's functionality and quality of life.", "evidence_relation": "neutral" }, { "cited_pmid": "14586062", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "3", "answer_sentence": "This includes medication for motor, psychiatric, and cognitive symptoms, tailored to individual needs [18394562, 22314929].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18394562", "evidence_support": "The primary aim of this article is to review the role of the different therapies, both available and investigational, for the treatment of the motor, psychiatric, behavioral, and cognitive symptoms of HD, and to examine their impact on the patient's functionality and quality of life.", "evidence_relation": "supporting" }, { "cited_pmid": "22314929", "evidence_support": " There is no specific treatment for Huntington's disease (HD). Its many symptoms of motor, psychiatric, and cognitive deterioration are managed with symptomatic relief, rehabilitation, and support.", "evidence_relation": "supporting" }, { "cited_pmid": "22314929", "evidence_support": "Psychiatric features, which have a significant impact on a patient's professional and personal life, often become the major focus of management.", "evidence_relation": "neutral" }, { "cited_pmid": "22314929", "evidence_support": "With HD's complexity, it is best managed with a multidisciplinary approach that includes a movement disorders specialist, a genetic counselor, a mental health professional, a physical therapist, and a social worker for support and coordination of services. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Physical therapy is crucial for managing mobility deficits and falls, especially in the early stages [18467429, 38047100].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "18467429", "evidence_support": "The main issues that emerged from the interviews were classified into 3 subthemes: (1) there is insufficient use of routine physical therapy-related outcome measures at different stages of HD, (2) there is underutilization of physical therapy services in managing HD (particularly in the early stages), and (3) the management of falls and mobility deficit progression is a key treatment aim for people with HD.", "evidence_relation": "supporting" }, { "cited_pmid": "38047100", "evidence_support": "At the late stage of HD, most patients need complete support for activity of daily living. Mobility and balance evaluation and prevention strategies should be focused on for safety", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Open communication, emotional support, and effective coping strategies are essential for adaptation and well-being [31653233, 34374465].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31653233", "evidence_support": "Open communication, emotional support, and support in selecting effective coping strategies can help patients adapt more readily to their disease, and improve their quality of life.", "evidence_relation": "supporting" }, { "cited_pmid": "34374465", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Advance care planning (ACP) is vital to ensure patient autonomy and consistent care as the disease progresses [36970913, 36698999].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36970913", "evidence_support": "Advance care planning (ACP) is a useful tool that benefits adult patients, care providers, and surrogate decision makers, through providing opportunities for patients to consider, express, and formalize their beliefs, preferences, and wishes pertaining to decisions regarding future medical care at a time when they retain decision-making capacity.", "evidence_relation": "supporting" }, { "cited_pmid": "36970913", "evidence_support": "ACP helps to empower and extend patient autonomy, providing clinicians and surrogate decision makers with reassurance that management is consistent with a patient's expressed wishes.", "evidence_relation": "supporting" }, { "cited_pmid": "36698999", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gpt4o-mini": { "answer": "Living with Huntington's disease (HD) involves adopting strategies to enhance quality of life and maintain functional independence. Engaging in counseling can help patients develop proactive coping strategies to manage anxiety and accept the uncertainties of the disease [34374465]. Seeking social support is crucial; studies show that both patients and their caregivers benefit from improved coping through social interactions [25063190, 28947115]. Physical activity can also play a significant role in maintaining control and adjusting expectations, helping individuals stay active [31588808]. Open communication and emotional support are essential for adapting to the disease and improving overall well-being [31653233]. Additionally, intensive neurorehabilitation may lessen disability and delay motor dysfunction progression, contributing positively to life quality [23480977]. Ultimately, setting realistic goals and fostering a supportive environment can significantly enhance the experience of living with HD [28947115, 37983776].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease (HD) involves adopting strategies to enhance quality of life and maintain functional independence.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Engaging in counseling can help patients develop proactive coping strategies to manage anxiety and accept the uncertainties of the disease [34374465].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34374465", "evidence_support": "Individuals may benefit from counseling which supports them to develop proactive coping strategies to manage their anxieties and acceptance of an uncertain future.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Seeking social support is crucial; studies show that both patients and their caregivers benefit from improved coping through social interactions [25063190, 28947115].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25063190", "evidence_support": "After program completion, significant improvement of behavioral symptoms and anxiety was found for manifest HD patients, and they used a less passive coping style and more social support. Their caregivers reported less psychosocial burden.", "evidence_relation": "supporting" }, { "cited_pmid": "28947115", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Physical activity can also play a significant role in maintaining control and adjusting expectations, helping individuals stay active [31588808].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31588808", "evidence_support": "Physical activity interventions are important components of comprehensive intervention strategies and may help alter the functional decline trajectory. ", "evidence_relation": "supporting" }, { "cited_pmid": "31588808", "evidence_support": "Strategies such as using physical activity as a way of achieving control and adjusting expectations can help people with HD to continue to be active.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Open communication and emotional support are essential for adapting to the disease and improving overall well-being [31653233].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31653233", "evidence_support": "Open communication, emotional support, and support in selecting effective coping strategies can help patients adapt more readily to their disease, and improve their quality of life.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Additionally, intensive neurorehabilitation may lessen disability and delay motor dysfunction progression, contributing positively to life quality [23480977].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "23480977", "evidence_support": "Studies validating the effectiveness of intensive neurorehabilitation such as a strategy to reducing functional impairments and to improving motor capacities in HD patients are limited and heterogeneous.", "evidence_relation": "supporting" }, { "cited_pmid": "23480977", "evidence_support": "Rehabilitative treatment in HD patients needs to be multifunctional and continuous to improve or maintain motor performances and functional independence.", "evidence_relation": "supporting" }, { "cited_pmid": "23480977", "evidence_support": "Despite Huntington's disease is a progressive and incurable disease intensive neurorehabilitation lessens patients' disability and improves their quality of life ameliorating autonomy and delaying the progression of motor dysfunction.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Ultimately, setting realistic goals and fostering a supportive environment can significantly enhance the experience of living with HD [28947115, 37983776].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28947115", "evidence_support": "Providing medical care for people and families affected by Huntington disease (HD) can be a rewarding effort when realistic goals of improved quality of life and optimized functional status are set.", "evidence_relation": "supporting" }, { "cited_pmid": "28947115", "evidence_support": "Engaging people with HD in high-quality compassionate care will not only improve lives, it will also encourage participation in clinical trials that search for disease-modifying treatments that will reduce or bring the suffering of HD to an end.", "evidence_relation": "supporting" }, { "cited_pmid": "37983776", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "ten-shot-gpt4o-mini-wiki": { "answer": "Living with Huntington's disease (HD) involves a multidisciplinary approach to enhance quality of life. Engaging in rehabilitation therapies, such as physical, occupational, and speech therapy, can help manage symptoms and improve functional capacity [28947117, 25642394]. Regular physical activity and exercise are beneficial for maintaining mobility and may slow disease progression [28947114, 35645302]. Palliative care is also crucial, addressing physical, psychosocial, and spiritual needs, which can improve overall well-being and delay nursing home placement [29089255, 24459605]. Additionally, ongoing assessment and support from healthcare professionals, including psychologists and social workers, are essential for addressing practical challenges faced by patients and caregivers [17352943, 11096752]. By focusing on these strategies, individuals with HD can better cope with their condition and maintain a higher quality of life.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease (HD) involves a multidisciplinary approach to enhance quality of life.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Engaging in rehabilitation therapies, such as physical, occupational, and speech therapy, can help manage symptoms and improve functional capacity [28947117, 25642394].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28947117", "evidence_support": "Neurologists' role in the care of people with advanced Huntington disease (HD) (total functional capacity <7), often limited by a lack of clinical research to support good practice, includes the following: (1) provide comprehensive health records to an interdisciplinary care staff before admission to a more intense care setting (home health services, day program, assisted living, group home, long-term skilled nursing facility, palliative care); (2) consult with and refer to rehabilitation (occupational therapy, physical therapy, speech and language pathology), behavioral and psychiatric professionals for problem-solving strategies, which must be reviewed with direct care staff before implementation; (3) encourage and support qualitative and quantitative interdisciplinary research studies, and randomized controlled studies of nonpharmacologic interventions; and (4) assist in the development of meaningful measures to further document what works to provide a good quality of life for the patient and family and a comfortable thoughtful approach to a good death.", "evidence_relation": "supporting" }, { "cited_pmid": "25642394", "evidence_support": "Multidisciplinary rehabilitation, comprising motor and cognitive intervention, has been shown to positively impact on functional capacity, depression, quality of life and some aspects of cognition in individuals with HD.", "evidence_relation": "supporting" }, { "cited_pmid": "25642394", "evidence_support": "This study provides preliminary evidence that multidisciplinary rehabilitation positively impacts on gray matter changes and cognitive functions relating to verbal learning and memory in individuals with manifest HD.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Regular physical activity and exercise are beneficial for maintaining mobility and may slow disease progression [28947114, 35645302].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28947114", "evidence_support": "Lifestyle factors, such as activity level and exercise, as well as specific motor training may be helpful in managing the functional sequelae of HD and possibly slowing disease progression.", "evidence_relation": "supporting" }, { "cited_pmid": "35645302", "evidence_support": "In order to mitigate impairments in motor function, physical exercise was integrated in HD rehabilitative interventions, showing to be a powerful tool to ameliorate the quality of life of HD-affected patients.", "evidence_relation": "supporting" }, { "cited_pmid": "35645302", "evidence_support": "Studies performed on mouse models showed a controversial role played by exercise, whereas in HD-affected patients, physical activity appeared to have positive effects on gait, motor function, UHDMRS scale, cognitive function, quality of life, postural stability, total body mass, fatty acid oxidative capacity, and VO2 max. Physical activity seems to be feasible, safe, and effective for HD patients. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Palliative care is also crucial, addressing physical, psychosocial, and spiritual needs, which can improve overall well-being and delay nursing home placement [29089255, 24459605].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "29089255", "evidence_support": "Palliative care is an important concept in HD care focusing in quality of life, considering physical, psychosocial, and spiritual problems. Palliative care may delay nursing home placement in advanced HD.", "evidence_relation": "supporting" }, { "cited_pmid": "24459605", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Additionally, ongoing assessment and support from healthcare professionals, including psychologists and social workers, are essential for addressing practical challenges faced by patients and caregivers [17352943, 11096752].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "17352943", "evidence_support": "The ideal care for HD is provided by a team, led by a physician, with input from rehabilitation therapists, nurses, psychologists, genetic counselors, social workers, and other health care providers. The goals of care are to maximize the quality of life at all points through the course of the disease, in part by anticipating problems that are likely to arise at the next stage of the illness.", "evidence_relation": "supporting" }, { "cited_pmid": "11096752", "evidence_support": null, "evidence_relation": "invalid citation" } ] }, { "answer_sentence_id": "6", "answer_sentence": "By focusing on these strategies, individuals with HD can better cope with their condition and maintain a higher quality of life.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null } ] }, "webis-1": { "answer": "Living with Huntington's disease involves managing motor disturbances, cognitive decline, and behavioral and psychological symptoms [27457568]. This can be achieved through patient education programs that aim to improve quality of life for patients and caregivers, and develop coping strategies to deal with psychosocial stressors [25063190].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease involves managing motor disturbances, cognitive decline, and behavioral and psychological symptoms [27457568].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27457568", "evidence_support": "Huntington's disease is a progressive, neurodegenerative disease with autosomal dominant inheritance, characterized by motor disturbances, cognitive decline and behavioral and psychological symptoms.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This can be achieved through patient education programs that aim to improve quality of life for patients and caregivers, and develop coping strategies to deal with psychosocial stressors [25063190].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25063190", "evidence_support": "The goal of the Patient Education Program for Huntington's disease is to improve quality of life for patients and caregivers, to educate and train them in order to develop coping strategies to deal with psychosocial stressors.", "evidence_relation": "supporting" }, { "cited_pmid": "25063190", "evidence_support": "After program completion, significant improvement of behavioral symptoms and anxiety was found for manifest HD patients, and they used a less passive coping style and more social support", "evidence_relation": "supporting" }, { "cited_pmid": "25063190", "evidence_support": "Their caregivers reported less psychosocial burden", "evidence_relation": "neutral" } ] } ] }, "webis-2": { "answer": "Living with Huntington's disease may require constant care and support from family or caregivers [37424016].", "is_answer_accurate": "no", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease may require constant care and support from family or caregivers [37424016].", "answer_sentence_relevance": null, "citation_assessment": [ { "cited_pmid": "37424016", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "webis-3": { "answer": "Living with Huntington's disease may require 24/7 care by family, management of muscle atrophy, and monitoring of creatine kinase levels to prevent rhabdomyolysis-induced acute kidney injury [37424016].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease may require 24/7 care by family, management of muscle atrophy, and monitoring of creatine kinase levels to prevent rhabdomyolysis-induced acute kidney injury [37424016].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37424016", "evidence_support": "Eventually, his kidney function recovered and he was discharged home with 24/7 care by his family for persistent impairments related to his Huntington's disease.", "evidence_relation": "supporting" }, { "cited_pmid": "37424016", "evidence_support": "This case report underscores the importance of promptly recognizing elevated creatine kinase levels in patients with Huntington's disease due to the risk of developing rhabdomyolysis-induced acute kidney injury.", "evidence_relation": "supporting" } ] } ] }, "webis-5": { "answer": "Living with Huntington's disease may require 24/7 care by family, management of muscle atrophy, and monitoring of creatine kinase levels to prevent rhabdomyolysis-induced acute kidney injury. . [37424016].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease may require 24/7 care by family, management of muscle atrophy, and monitoring of creatine kinase levels to prevent rhabdomyolysis-induced acute kidney injury. .", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-1": { "answer": "Living with Huntington's disease involves a combination of medical management, psychological support, and lifestyle adjustments. It is important to work closely with healthcare providers to manage symptoms and plan for future care needs. Engaging in physical activity, maintaining a healthy diet, and seeking support from family, friends, or support groups can also help improve quality of life.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease involves a combination of medical management, psychological support, and lifestyle adjustments.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "It is important to work closely with healthcare providers to manage symptoms and plan for future care needs.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Engaging in physical activity, maintaining a healthy diet, and seeking support from family, friends, or support groups can also help improve quality of life.", "answer_sentence_relevance": "required", "citation_assessment": null } ] }, "webis-gpt-4": { "answer": "To live with Huntington's disease, it is crucial to engage in advance care planning while the patient is still able to make decisions about their future care, including end-of-life preferences and life-sustaining measures [33852093]. This proactive approach helps address the physical, cognitive, and psychological challenges that arise as the disease progresses, ensuring that the patient's wishes are respected [16035633]. Additionally, support for both the patient and their family is essential to manage the significant impact on their social lives [16035633].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "To live with Huntington's disease, it is crucial to engage in advance care planning while the patient is still able to make decisions about their future care, including end-of-life preferences and life-sustaining measures [33852093].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "33852093", "evidence_support": "That's why it's most important when diagnosed with Huntington Disease to advance care planning to end-of-life care like life-sustaining measures that engages patients in decision-making regarding future care, while they are still able to make and express decisions by themselves.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "This proactive approach helps address the physical, cognitive, and psychological challenges that arise as the disease progresses, ensuring that the patient's wishes are respected [16035633].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16035633", "evidence_support": "Nurses play a vital role as health care providers and advocates for the patient with Huntington disease.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Additionally, support for both the patient and their family is essential to manage the significant impact on their social lives [16035633].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16035633", "evidence_support": "Huntington disease is a serious neurogenetic disease that affects the physical, cognitive, and psychiatric health of the patient, and has a significant impact on the social life of the family", "evidence_relation": "supporting" } ] } ] }, "webis-gpt-6": { "answer": "Living with Huntington's disease involves managing both the physical and emotional challenges associated with the condition. While the provided context does not directly address specific strategies for living with the disease, it highlights the importance of support systems, such as family and clinical trials, which can provide resources and community for those affected [29139332,37038822]. Engaging with healthcare professionals for symptom management and participating in support groups can also be beneficial for coping with the disease's progression [37038822].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease involves managing both the physical and emotional challenges associated with the condition.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "While the provided context does not directly address specific strategies for living with the disease, it highlights the importance of support systems, such as family and clinical trials, which can provide resources and community for those affected [29139332,37038822].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "29139332", "evidence_support": "The perspectives of those who live with Huntington's disease, especially given its extended effects within families, add significant clinical and theoretical insights.", "evidence_relation": "supporting" }, { "cited_pmid": "37038822", "evidence_support": "Huntington's disease (HD) community. Three clinical trials for HD, including the first Phase 3 trial of a potentially disease modifying genetic therapy for HD, were all brought to a halt in March of 2021.", "evidence_relation": "neutral" }, { "cited_pmid": "37038822", "evidence_support": "These conversations allowed HDSA to summarize how the HD community can be best supported through the clinical research process in three key areas: engagement, support, and education.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Engaging with healthcare professionals for symptom management and participating in support groups can also be beneficial for coping with the disease's progression [37038822].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37038822", "evidence_support": "These conversations allowed HDSA to summarize how the HD community can be best supported through the clinical research process in three key areas: engagement, support, and education.", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gemini-flash": { "answer": "Living with Huntington's disease (HD) requires a multifaceted approach to improve quality of life [25063190, 30012004]. Patients and caregivers can benefit from education and training programs that teach coping strategies for psychosocial stressors [25063190]. These programs can help patients develop less passive coping styles and utilize social support [25063190]. Counseling can also be beneficial, encouraging proactive coping strategies to manage anxieties and accept an uncertain future [34374465]. Couples may find counseling that emphasizes active coping for manageable changes and acceptance for those that cannot be altered helpful [22278219]. Open communication, emotional support, and guidance in selecting effective coping strategies can aid patients in adapting to their disease and improving their quality of life [31653233]. Family members should tailor healthcare services and social support to the needs of the patient during different stages of HD [25471490]. Healthcare professionals can play a crucial role in supporting suicidal HD mutation carriers by providing opportunities to discuss suicidality, offering psychoeducation on self-management, prescribing medication, and discussing end-of-life wishes [27258585]. \n", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease (HD) requires a multifaceted approach to improve quality of life [25063190, 30012004].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25063190", "evidence_support": "The goal of the Patient Education Program for Huntington's disease is to improve quality of life for patients and caregivers, to educate and train them in order to develop coping strategies to deal with psychosocial stressors.", "evidence_relation": "supporting" }, { "cited_pmid": "30012004", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "Patients and caregivers can benefit from education and training programs that teach coping strategies for psychosocial stressors [25063190].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25063190", "evidence_support": "The goal of the Patient Education Program for Huntington's disease is to improve quality of life for patients and caregivers, to educate and train them in order to develop coping strategies to deal with psychosocial stressors. ", "evidence_relation": "supporting" }, { "cited_pmid": "25063190", "evidence_support": "Their caregivers reported less psychosocial burden.", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "3", "answer_sentence": "These programs can help patients develop less passive coping styles and utilize social support [25063190].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25063190", "evidence_support": "The goal of the Patient Education Program for Huntington's disease is to improve quality of life for patients and caregivers, to educate and train them in order to develop coping strategies to deal with psychosocial stressors.", "evidence_relation": "supporting" }, { "cited_pmid": "25063190", "evidence_support": "After program completion, significant improvement of behavioral symptoms and anxiety was found for manifest HD patients, and they used a less passive coping style and more social support. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Counseling can also be beneficial, encouraging proactive coping strategies to manage anxieties and accept an uncertain future [34374465].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "34374465", "evidence_support": "Individuals may benefit from counseling which supports them to develop proactive coping strategies to manage their anxieties and acceptance of an uncertain future.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Couples may find counseling that emphasizes active coping for manageable changes and acceptance for those that cannot be altered helpful [22278219].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22278219", "evidence_support": "Couples may benefit from counseling that emphasizes using active coping strategies for changes that can be compensated for and acceptance for changes that cannot in prodromal HD. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Open communication, emotional support, and guidance in selecting effective coping strategies can aid patients in adapting to their disease and improving their quality of life [31653233].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31653233", "evidence_support": "It was determined that adequate information about patients' health status, and the use of coping strategies are related to their adaptation to their disease, and consequently, to their quality of life.", "evidence_relation": "supporting" }, { "cited_pmid": "31653233", "evidence_support": "Open communication, emotional support, and support in selecting effective coping strategies can help patients adapt more readily to their disease, and improve their quality of life.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "7", "answer_sentence": "Family members should tailor healthcare services and social support to the needs of the patient during different stages of HD [25471490].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25471490", "evidence_support": "They should, therefore, tailor healthcare services and social support to family caregivers' needs during the different stages of HD to improve caregivers' abilities to maintain some of their own activities, in balance with care-giving.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "8", "answer_sentence": "Healthcare professionals can play a crucial role in supporting suicidal HD mutation carriers by providing opportunities to discuss suicidality, offering psychoeducation on self-management, prescribing medication, and discussing end-of-life wishes [27258585].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27258585", "evidence_support": "HD study participants used four main strategies to cope with suicidality, including talking about suicidality, employing self-management activities, using medication, and discussing end-of-life wishes. Partners, relatives, and healthcare professionals can support suicidal HD mutation carriers in each of those four strategies.", "evidence_relation": "supporting" }, { "cited_pmid": "27258585", "evidence_support": "Despite the absence of a turnkey solution for suicidality in HD, healthcare professionals can play an important role in supporting suicidal HD mutation carriers by providing an opportunity to talk about suicidality, providing psychoeducation on self-management, prescribing medication, and discussing end-of-life wishes. ", "evidence_relation": "supporting" } ] } ] }, "zero-shot-gpt4o-mini": { "answer": "Living with Huntington's disease involves adopting coping strategies and lifestyle changes to enhance quality of life. Patient education programs aim to improve both patients' and caregivers' quality of life by teaching effective coping strategies to manage psychosocial stressors [25063190]. Open communication and emotional support are crucial, as they help patients adapt to their condition and improve their overall well-being [31653233]. Engaging in social support networks can also enhance coping mechanisms, leading to better adaptation and reduced anxiety [25063190, 22133668]. After participating in support programs, patients often report less behavioral symptoms and a shift towards more active coping styles [25063190]. Additionally, exploring alternative management strategies, such as counseling and therapist interventions, may further benefit patients' quality of life [22133668].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Living with Huntington's disease involves adopting coping strategies and lifestyle changes to enhance quality of life.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Patient education programs aim to improve both patients' and caregivers' quality of life by teaching effective coping strategies to manage psychosocial stressors [25063190].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25063190", "evidence_support": "The goal of the Patient Education Program for Huntington's disease is to improve quality of life for patients and caregivers, to educate and train them in order to develop coping strategies to deal with psychosocial stressors.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "Open communication and emotional support are crucial, as they help patients adapt to their condition and improve their overall well-being [31653233].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31653233", "evidence_support": "Open communication, emotional support, and support in selecting effective coping strategies can help patients adapt more readily to their disease, and improve their quality of life.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Engaging in social support networks can also enhance coping mechanisms, leading to better adaptation and reduced anxiety [25063190, 22133668].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25063190", "evidence_support": "After program completion, significant improvement of behavioral symptoms and anxiety was found for manifest HD patients, and they used a less passive coping style and more social support. Their caregivers reported less psychosocial burden. Premanifest carriers and their partners improved their coping by seeking social support more often.", "evidence_relation": "supporting" }, { "cited_pmid": "22133668", "evidence_support": "Further work is required to evaluate the impact of alternative management strategies, such as therapist intervention, counselling, and organisation support, on the patients' quality of life", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "5", "answer_sentence": "After participating in support programs, patients often report less behavioral symptoms and a shift towards more active coping styles [25063190].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "25063190", "evidence_support": "After program completion, significant improvement of behavioral symptoms and anxiety was found for manifest HD patients, and they used a less passive coping style and more social support.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Additionally, exploring alternative management strategies, such as counseling and therapist interventions, may further benefit patients' quality of life [22133668].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22133668", "evidence_support": "Further work is required to evaluate the impact of alternative management strategies, such as therapist intervention, counselling, and organisation support, on the patients' quality of life.", "evidence_relation": "supporting" } ] } ] } } }, { "question_id": "144", "machine_generated_answers": { "iiresearch_trec_bio2024_t5base_run": { "answer": "When considering the initiation of treatment for high blood pressure, especially in an otherwise healthy and fit individual, it's important to weigh the potential benefits and risks of starting treatment early. For example, while some patients may not require immediate medication, those with certain risk factors or who experience symptoms may benefit from early intervention. It's advisable to discuss with a healthcare provider to determine the best course of action, taking into account individual health status and potential lifestyle changes that could mitigate the need for medication. Additionally, patients undergoing treatment should be aware of any potential interactions with other medications or supplements, as these could impact the effectiveness of hypertension management [29547718].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "When considering the initiation of treatment for high blood pressure, especially in an otherwise healthy and fit individual, it's important to weigh the potential benefits and risks of starting treatment early.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "For example, while some patients may not require immediate medication, those with certain risk factors or who experience symptoms may benefit from early intervention.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "It's advisable to discuss with a healthcare provider to determine the best course of action, taking into account individual health status and potential lifestyle changes that could mitigate the need for medication.", "answer_sentence_relevance": "unnecessary", "citation_assessment": null }, { "answer_sentence_id": "4", "answer_sentence": "Additionally, patients undergoing treatment should be aware of any potential interactions with other medications or supplements, as these could impact the effectiveness of hypertension management [29547718].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "29547718", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_gpt-4o_arenuggetsallyouneed": { "answer": "Treatment for high blood pressure should be initiated if systolic BP is \u2265160 mmHg or diastolic BP is \u2265110 mmHg in pregnancy [28707234, 27456450, 27644446]. For high-risk cardiovascular patients, treatment should start if systolic BP is \u2265140 mmHg, and for hypertensive patients, the threshold is also \u2265140 mmHg [28707234, 22111320, 30093159]. In patients aged 75 or older, initiate treatment if systolic BP is \u2265160 mmHg [28707234, 27644446, 30402738]. For diabetics and those with chronic kidney disease (CKD), treatment is recommended for BP \u2265130/80 mmHg [28707234, 15834689, 22111320]. Patients with cardiovascular disease should be treated if BP is \u2265140/90 mmHg [28707234, 22111320, 25822270]. Combination therapy is advised for BP \u2265160/100 mmHg or if BP is >20/10 mmHg above the goal [31521481, 27456450, 20937445]. In severe asymptomatic hypertension, treat if BP is \u2265180/110 mmHg [28707234, 20148501, 14694280]. For community-dwelling patients aged 65 or older, target systolic BP <130 mmHg [31521481, 30431248, 29046992]. Lifestyle changes are recommended for all patients, and BP should be monitored with ambulatory or home devices for accuracy [37843942, 25822270, 30093159].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Treatment for high blood pressure should be initiated if systolic BP is \u2265160 mmHg or diastolic BP is \u2265110 mmHg in pregnancy [28707234, 27456450, 27644446].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27456450", "evidence_support": "For patients at low absolute cardiovascular disease risk with persistent blood pressure (BP) \u2265 160/100 mmHg, start antihypertensive therapy.", "evidence_relation": "supporting" }, { "cited_pmid": "28707234", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "27644446", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "For high-risk cardiovascular patients, treatment should start if systolic BP is \u2265140 mmHg, and for hypertensive patients, the threshold is also \u2265140 mmHg [28707234, 22111320, 30093159].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28707234", "evidence_support": "The historical threshold/target of 140/90\u00a0mmHg remains reasonable in most patients in identifying \"treatable\" risk, i.e., risk high enough to justify treatment and for which available treatment is effective enough to result in significant endpoint reduction.", "evidence_relation": "supporting" }, { "cited_pmid": "28707234", "evidence_support": "Above 140/90\u00a0mmHg, most low-to-moderate risk people should be treated and this target is also appropriate for the majority of high-risk individuals with diabetes, CKD, and/or CAD.", "evidence_relation": "supporting" }, { "cited_pmid": "22111320", "evidence_support": "Treatment is necessary for all patients with hypertension (blood pressure > or =140/ 90 mmHg) and for those with a blood pressure of 130/80 mmHg if they have diabetes, chronic kidney disease (CKD) or myocardial infarction.", "evidence_relation": "supporting" }, { "cited_pmid": "30093159", "evidence_support": "Individuals with an elevated 10-year risk of future cardiovascular disease events should receive drug therapies for blood pressures \u2265130/80 mmHg, whereas those at lower risk should receive antihypertensive medications for blood pressures \u2265140/90 mmHg.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "In patients aged 75 or older, initiate treatment if systolic BP is \u2265160 mmHg [28707234, 27644446, 30402738].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28707234", "evidence_support": "SBP >160\u00a0mmHg should, with rare exceptions, be treated. ", "evidence_relation": "supporting" }, { "cited_pmid": "27644446", "evidence_support": "In elderly hypertensives with SBP \u2265\u2009160\u2009mmHg there is solid evidence to recommend reducing SBP to between 140\u2009mmHg and 150\u2009mmHg.", "evidence_relation": "supporting" }, { "cited_pmid": "30402738", "evidence_support": "According to the current European guidelines the same values are recommended for those over the age of 80 years but treatment should start at a systolic blood pressure of \u2265160\u202fmm\u202fHg.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "For diabetics and those with chronic kidney disease (CKD), treatment is recommended for BP \u2265130/80 mmHg [28707234, 15834689, 22111320].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28707234", "evidence_support": "The Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) recommended a target of <140/90 for most patients and a target <130/80\u00a0mmHg for patients with diabetes or chronic kidney disease.", "evidence_relation": "supporting" }, { "cited_pmid": "22111320", "evidence_support": "Treatment is necessary for all patients with hypertension (blood pressure > or =140/ 90 mmHg) and for those with a blood pressure of 130/80 mmHg if they have diabetes, chronic kidney disease (CKD) or myocardial infarction.", "evidence_relation": "supporting" }, { "cited_pmid": "22111320", "evidence_support": "It should be < 130/80 mmHg in those with diabetes mellitus, CKD or myocardial infarction", "evidence_relation": "supporting" }, { "cited_pmid": "15834689", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Patients with cardiovascular disease should be treated if BP is \u2265140/90 mmHg [28707234, 22111320, 25822270].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28707234", "evidence_support": "Above 140/90\u00a0mmHg, most low-to-moderate risk people should be treated and this target is also appropriate for the majority of high-risk individuals with diabetes, CKD, and/or CAD.", "evidence_relation": "supporting" }, { "cited_pmid": "22111320", "evidence_support": "Treatment is necessary for all patients with hypertension (blood pressure > or =140/ 90 mmHg) and for those with a blood pressure of 130/80 mmHg if they have diabetes, chronic kidney disease (CKD) or myocardial infarction. ", "evidence_relation": "supporting" }, { "cited_pmid": "25822270", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "Combination therapy is advised for BP \u2265160/100 mmHg or if BP is >20/10 mmHg above the goal [31521481, 27456450, 20937445].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31521481", "evidence_support": "Treatment should be initiated with two drugs having complementary mechanisms of action when blood pressure is >20/10\u202fmm Hg above goal.", "evidence_relation": "supporting" }, { "cited_pmid": "27456450", "evidence_support": "A 2015 meta-analysis of patients with uncomplicated mild hypertension (systolic BP range, 140-169 mmHg) demonstrated that BP-lowering therapy is beneficial (reduced stroke, cardiovascular death and all-cause mortality).", "evidence_relation": "neutral" }, { "cited_pmid": "20937445", "evidence_support": "In most patients, 2 or more medications with complementary mechanisms of action should be used in combination", "evidence_relation": "neutral" } ] }, { "answer_sentence_id": "7", "answer_sentence": "In severe asymptomatic hypertension, treat if BP is \u2265180/110 mmHg [28707234, 20148501, 14694280].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20148501", "evidence_support": "When patients present with severely elevated blood pressure (i.e., systolic blood pressure of 180 mm Hg or greater, or diastolic blood pressure of 110 mm Hg or greater), physicians need to differentiate hypertensive emergency from severely elevated blood pressure without signs or symptoms of end-organ damage (severe asymptomatic hypertension).", "evidence_relation": "supporting" }, { "cited_pmid": "14694280", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "28707234", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "8", "answer_sentence": "For community-dwelling patients aged 65 or older, target systolic BP <130 mmHg [31521481, 30431248, 29046992].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31521481", "evidence_support": "Irrespective of blood pressure threshold for initiation of drug therapy, the target BP is minimally <130/80\u202fmm Hg in most. However, target BP is <130 systolic amongst those 65 and older as the committee made no recommendation for a DBP target.", "evidence_relation": "supporting" }, { "cited_pmid": "30431248", "evidence_support": "The blood pressure target should be inferior to 130/80 mmHg in people inferior to 65 years.", "evidence_relation": "supporting" }, { "cited_pmid": "29046992", "evidence_support": "We would treat these elderly patients with hypertension to a blood pressure goal of less than 130/80\u00a0mmHg", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "9", "answer_sentence": "Lifestyle changes are recommended for all patients, and BP should be monitored with ambulatory or home devices for accuracy [37843942, 25822270, 30093159].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "37843942", "evidence_support": "The use of ambulatory and home blood pressure monitoring improves diagnostic accuracy. ", "evidence_relation": "supporting" }, { "cited_pmid": "37843942", "evidence_support": "Physicians should counsel all patients with elevated blood pressure about effective lifestyle interventions, including the Dietary Approaches to Stop Hypertension (DASH) diet, dietary sodium restriction, potassium enrichment, regular exercise, weight loss, and moderation of alcohol consumption.", "evidence_relation": "supporting" }, { "cited_pmid": "25822270", "evidence_support": "Several lifestyle modifications are associated with improvements in blood pressure, including the Dietary Approaches to Stop Hypertension diet, sodium restriction, regular exercise, and moderate weight loss. ", "evidence_relation": "supporting" }, { "cited_pmid": "30093159", "evidence_support": "The guidelines emphasize non-drug strategies for blood pressure management, particularly healthy diet, several forms of physical activity, reduction in sodium intake, enhancement of potassium intake, reduction in alcohol use, and weight loss.", "evidence_relation": "supporting" } ] } ] }, "listgalore_gpt-4o_ragnarokv5biogen_top20": { "answer": "High blood pressure should be treated when systolic blood pressure (SBP) is \u2265140 mmHg or diastolic blood pressure (DBP) is \u226590 mmHg in most patients, including those with low-to-moderate cardiovascular risk [19381107, 28707234, 22111320]. For patients with diabetes, chronic kidney disease (CKD), or high cardiovascular risk, treatment should be initiated at BP levels of \u2265130/80 mmHg [19381107, 28707234, 22111320]. The target BP for most patients is <140/90 mmHg, but for those with diabetes or high cardiovascular risk, the goal is <130/80 mmHg [19381107, 28707234, 22111320]. In elderly patients, treatment is recommended for SBP \u2265160 mmHg, aiming to reduce it to 140-150 mmHg, and to <140 mmHg if well tolerated [27644446]. Despite some discrepancies in guidelines, the consensus supports initiating treatment at these thresholds to reduce cardiovascular morbidity and mortality [19381107, 28707234, 22111320].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "High blood pressure should be treated when systolic blood pressure (SBP) is \u2265140 mmHg or diastolic blood pressure (DBP) is \u226590 mmHg in most patients, including those with low-to-moderate cardiovascular risk [19381107, 28707234, 22111320].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19381107", "evidence_support": "The first recommendation is that of initiating antihypertensive drug treatment when systolic blood pressure is at least 140 or diastolic blood pressure at least 90 mmHg in patients with grade 1 hypertension and low or moderate total cardiovascular risk, and even when blood pressure is in the high normal range in patients with diabetes and previous cardiovascular disease.", "evidence_relation": "supporting" }, { "cited_pmid": "28707234", "evidence_support": "Above 140/90\u00a0mmHg, most low-to-moderate risk people should be treated and this target is also appropriate for the majority of high-risk individuals with diabetes, CKD, and/or CAD.", "evidence_relation": "supporting" }, { "cited_pmid": "22111320", "evidence_support": "Treatment is necessary for all patients with hypertension (blood pressure > or =140/ 90 mmHg) and for those with a blood pressure of 130/80 mmHg if they have diabetes, chronic kidney disease (CKD) or myocardial infarction.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "For patients with diabetes, chronic kidney disease (CKD), or high cardiovascular risk, treatment should be initiated at BP levels of \u2265130/80 mmHg [19381107, 28707234, 22111320].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19381107", "evidence_support": "The first recommendation is that of initiating antihypertensive drug treatment when systolic blood pressure is at least 140 or diastolic blood pressure at least 90 mmHg in patients with grade 1 hypertension and low or moderate total cardiovascular risk, and even when blood pressure is in the high normal range in patients with diabetes and previous cardiovascular disease.", "evidence_relation": "supporting" }, { "cited_pmid": "28707234", "evidence_support": "a target <130/80\u00a0mmHg for patients with diabetes or chronic kidney disease.", "evidence_relation": "supporting" }, { "cited_pmid": "22111320", "evidence_support": "Treatment is necessary for all patients with hypertension (blood pressure > or =140/ 90 mmHg) and for those with a blood pressure of 130/80 mmHg if they have diabetes, chronic kidney disease (CKD) or myocardial infarction.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The target BP for most patients is <140/90 mmHg, but for those with diabetes or high cardiovascular risk, the goal is <130/80 mmHg [19381107, 28707234, 22111320].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "19381107", "evidence_support": "The first recommendation is that of initiating antihypertensive drug treatment when systolic blood pressure is at least 140 or diastolic blood pressure at least 90 mmHg in patients with grade 1 hypertension and low or moderate total cardiovascular risk, and even when blood pressure is in the high normal range in patients with diabetes and previous cardiovascular disease. The second recommendation is that of achieving systolic blood pressure levels below 140 mmHg in all hypertensive patients, including the elderly, and values below 130 mmHg in patients having diabetes and high/very-high-risk patients.", "evidence_relation": "supporting" }, { "cited_pmid": "28707234", "evidence_support": "The Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) recommended a target of <140/90 for most patients and a target <130/80\u00a0mmHg for patients with diabetes or chronic kidney disease. Subsequently, meta-analyses, retrospective studies relating on-treatment BP to clinical outcomes and two large, randomized clinical trials (RCTs) have re-evaluated BP targets.", "evidence_relation": "supporting" }, { "cited_pmid": "22111320", "evidence_support": "It should be < 130/80 mmHg in those with diabetes mellitus, CKD or myocardial infarction and < 140/ 90 mmHg in elderly people and patients with cerebrovascular diseases. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "In elderly patients, treatment is recommended for SBP \u2265160 mmHg, aiming to reduce it to 140-150 mmHg, and to <140 mmHg if well tolerated [27644446].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "27644446", "evidence_support": "In fit elderly patients less than 80 years old treatment may be considered at SBP \u2265\u2009140\u2009mmHg with a target SBP <\u2009140\u2009mmHg if treatment is well tolerated.", "evidence_relation": "supporting" }, { "cited_pmid": "27644446", "evidence_support": " In fit individuals older than 80 years with an initial SBP \u2265\u2009160\u2009mmHg it is recommended to reduce SBP to between 150\u2009mmHg and 140\u2009mmHg.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Despite some discrepancies in guidelines, the consensus supports initiating treatment at these thresholds to reduce cardiovascular morbidity and mortality [19381107, 28707234, 22111320].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "28707234", "evidence_support": "The historical threshold/target of 140/90\u00a0mmHg remains reasonable in most patients in identifying \"treatable\" risk, i.e., risk high enough to justify treatment and for which available treatment is effective enough to result in significant endpoint reduction.", "evidence_relation": "supporting" }, { "cited_pmid": "22111320", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "19381107", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "listgalore_l31-70b_ragnarokv5biogen_top20": { "answer": "Treatment of high blood pressure should be initiated based on the patient's cardiovascular risk profile, rather than solely on blood pressure levels [19381107, 28707234, 31521481]. For patients with low to moderate cardiovascular risk, treatment is generally recommended when systolic blood pressure is \u2265140 mmHg or diastolic blood pressure is \u226590 mmHg [19381107, 28707234, 37843942]. However, for patients with high cardiovascular risk, diabetes, or chronic kidney disease, treatment may be initiated at lower blood pressure thresholds, such as \u2265130/80 mmHg [28707234, 31521481, 25822270]. The decision to treat should also consider the presence of end-organ damage and other comorbidities [15834689, 16810473]. Lifestyle modifications, such as dietary changes and exercise, should be recommended to all patients with elevated blood pressure, regardless of treatment decisions [37843942, 30093159]. The goal of treatment is to achieve a blood pressure target of <140/90 mmHg in most patients, and <130/80 mmHg in those with high cardiovascular risk or diabetes [28707234, 31521481, 16810473].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "Treatment of high blood pressure should be initiated based on the patient's cardiovascular risk profile, rather than solely on blood pressure levels [19381107, 28707234, 31521481].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19381107", "evidence_support": "The first recommendation is that of initiating antihypertensive drug treatment when systolic blood pressure is at least 140 or diastolic blood pressure at least 90 mmHg in patients with grade 1 hypertension and low or moderate total cardiovascular risk, and even when blood pressure is in the high normal range in patients with diabetes and previous cardiovascular disease. The second recommendation is that of achieving systolic blood pressure levels below 140 mmHg in all hypertensive patients, including the elderly, and values below 130 mmHg in patients having diabetes and high/very-high-risk patients.", "evidence_relation": "supporting" }, { "cited_pmid": "28707234", "evidence_support": "The historical threshold/target of 140/90\u00a0mmHg remains reasonable in most patients in identifying \"treatable\" risk, i.e., risk high enough to justify treatment and for which available treatment is effective enough to result in significant endpoint reduction. Above 140/90\u00a0mmHg, most low-to-moderate risk people should be treated and this target is also appropriate for the majority of high-risk individuals with diabetes, CKD, and/or CAD", "evidence_relation": "supporting" }, { "cited_pmid": "31521481", "evidence_support": "Absolute cardiovascular risk is utilized, for the first time, to determine high-risk status when BP 130-139/80-89\u202fmm Hg (Stage 1 hypertension) and high-risk patient characteristics/co-morbidities are absent including age 65 and older, diabetes, chronic kidney disease, known cardiovascular disease; high-risk individuals initiate drug therapy when BP\u00a0\u2265\u00a0130/80\u202fmm Hg.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "For patients with low to moderate cardiovascular risk, treatment is generally recommended when systolic blood pressure is \u2265140 mmHg or diastolic blood pressure is \u226590 mmHg [19381107, 28707234, 37843942].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19381107", "evidence_support": "The first recommendation is that of initiating antihypertensive drug treatment when systolic blood pressure is at least 140 or diastolic blood pressure at least 90 mmHg in patients with grade 1 hypertension and low or moderate total cardiovascular risk, and even when blood pressure is in the high normal range in patients with diabetes and previous cardiovascular disease.", "evidence_relation": "supporting" }, { "cited_pmid": "28707234", "evidence_support": "Above 140/90\u00a0mmHg, most low-to-moderate risk people should be treated and this target is also appropriate for the majority of high-risk individuals with diabetes, CKD, and/or CAD.", "evidence_relation": "supporting" }, { "cited_pmid": "37843942", "evidence_support": "Evidence strongly supports reducing blood pressure to less than 140/90 mm Hg to reduce the risk of all-cause and cardiovascular mortality in adults with hypertension.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "However, for patients with high cardiovascular risk, diabetes, or chronic kidney disease, treatment may be initiated at lower blood pressure thresholds, such as \u2265130/80 mmHg [28707234, 31521481, 25822270].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "28707234", "evidence_support": "The Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) recommended a target of <140/90 for most patients and a target <130/80\u00a0mmHg for patients with diabetes or chronic kidney disease.", "evidence_relation": "supporting" }, { "cited_pmid": "31521481", "evidence_support": "Absolute cardiovascular risk is utilized, for the first time, to determine high-risk status when BP 130-139/80-89\u202fmm Hg (Stage 1 hypertension) and high-risk patient characteristics/co-morbidities are absent including age 65 and older, diabetes, chronic kidney disease, known cardiovascular disease; high-risk individuals initiate drug therapy when BP\u00a0\u2265\u00a0130/80\u202fmm Hg.", "evidence_relation": "supporting" }, { "cited_pmid": "25822270", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The decision to treat should also consider the presence of end-organ damage and other comorbidities [15834689, 16810473].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "15834689", "evidence_support": "The targeted blood pressure levels are also defined by the extent of end-organ damage already present.", "evidence_relation": "supporting" }, { "cited_pmid": "16810473", "evidence_support": "Since risk factors cluster in hypertensive individuals, risk stratification should be made and decision about the management should not be based on blood pressure alone, but also according to the presence or absence of other risk factors, target organ damage, diabetes, and cardiovascular or renal damage, as well as on other aspects of the patient's personal, medical and social situation.", "evidence_relation": "supporting" }, { "cited_pmid": "16810473", "evidence_support": "The choice of drugs will be influenced by many factors, including previous experience of the patient with antihypertensive agents, cost of drugs, risk profile, presence or absence of target organ damage, clinical cardiovascular or renal disease or diabetes, patient's preference", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "5", "answer_sentence": "Lifestyle modifications, such as dietary changes and exercise, should be recommended to all patients with elevated blood pressure, regardless of treatment decisions [37843942, 30093159].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "37843942", "evidence_support": "Physicians should counsel all patients with elevated blood pressure about effective lifestyle interventions, including the Dietary Approaches to Stop Hypertension (DASH) diet, dietary sodium restriction, potassium enrichment, regular exercise, weight loss, and moderation of alcohol consumption. ", "evidence_relation": "supporting" }, { "cited_pmid": "30093159", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "6", "answer_sentence": "The goal of treatment is to achieve a blood pressure target of <140/90 mmHg in most patients, and <130/80 mmHg in those with high cardiovascular risk or diabetes [28707234, 31521481, 16810473].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "28707234", "evidence_support": "The Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) recommended a target of <140/90 for most patients and a target <130/80\u00a0mmHg for patients with diabetes or chronic kidney disease.", "evidence_relation": "supporting" }, { "cited_pmid": "31521481", "evidence_support": "Irrespective of blood pressure threshold for initiation of drug therapy, the target BP is minimally <130/80\u202fmm Hg in most.", "evidence_relation": "supporting" }, { "cited_pmid": "16810473", "evidence_support": "On the basis of current evidence from trials, it can be recommended that blood pressure, both systolic and diastolic, be intensively lowered at least below 140/90 mmHg and to definitely lower values, if tolerated, in all hypertensive patients, and below 130/80 mmHg in diabetics. ", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.boolena.llama3-70b_fixed": { "answer": "You should talk to your doctor about treatment options if your blood pressure is 130/80 mmHg or higher, or if you have diabetes, chronic kidney disease, or myocardial infarction [34620404, 22111320]. If you are at low cardiovascular risk, your doctor may recommend lifestyle changes before starting medication [14715040, 27872051]. If you are at high risk, your doctor may recommend starting medication immediately [14715040]. The goal of treatment is to lower your blood pressure to less than 130/80 mmHg, but this may vary depending on your individual risk factors and health status [34620404, 31958854, 23541376]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "You should talk to your doctor about treatment options if your blood pressure is 130/80 mmHg or higher, or if you have diabetes, chronic kidney disease, or myocardial infarction [34620404, 22111320].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "22111320", "evidence_support": "Treatment is necessary for all patients with hypertension (blood pressure > or =140/ 90 mmHg) and for those with a blood pressure of 130/80 mmHg if they have diabetes, chronic kidney disease (CKD) or myocardial infarction. ", "evidence_relation": "supporting" }, { "cited_pmid": "34620404", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If you are at low cardiovascular risk, your doctor may recommend lifestyle changes before starting medication [14715040, 27872051].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "14715040", "evidence_support": "Patients at low and medium risk should be followed up and given advice on nonpharmacological measures and treatment should only be initiated in cases of persistently elevated blood pressure.", "evidence_relation": "supporting" }, { "cited_pmid": "27872051", "evidence_support": "Lifestyle modifications for reducing blood pressure are appropriate for all patients and may be recommended while delaying drug treatment for those at lower absolute levels of cardiovascular disease risk.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "If you are at high risk, your doctor may recommend starting medication immediately [14715040].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "14715040", "evidence_support": "Guidelines recommend prompt initiation of antihypertensive treatment in patients at very high risk because of associated clinical conditions and this recommendation is strongly supported by the literature. Also patients at high risk must be treated without much delay, but it should be mentioned that the evidence is stronger for patients who are at high risk because of diabetes mellitus, than for patients at high risk because of left ventricular hypertrophy or the accumulation of >or = 3 other risk factors.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The goal of treatment is to lower your blood pressure to less than 130/80 mmHg, but this may vary depending on your individual risk factors and health status [34620404, 31958854, 23541376].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "34620404", "evidence_support": "An SBP of\u00a0<130\u00a0mm\u00a0Hg and DBP of\u00a0<80\u00a0mm\u00a0Hg were associated with the lowest risk for CVD events in cubic spline models", "evidence_relation": "neutral" }, { "cited_pmid": "34620404", "evidence_support": "In adults with hypertension and LVH, the risk for CVD events was the lowest at SBP <130\u00a0mm\u00a0Hg and DBP <80\u00a0mm\u00a0Hg", "evidence_relation": "supporting" }, { "cited_pmid": "31958854", "evidence_support": "Patients well below the age of 65 years with mild hypertension and low overall cardiovascular risk should be offered the option to adjust blood pressure even with systolic targets below 130\u200ammHg.", "evidence_relation": "supporting" }, { "cited_pmid": "23541376", "evidence_support": "In high-risk hypertensive patients, major cardiovascular events are significantly lower in those with systolic blood pressures<140 mm Hg and<130 mm Hg than in those with levels>140 mm Hg. There are stroke benefits at levels<120 mm Hg, but they are offset by increased coronary events. Renal function is best protected in the 130 to 139 mm Hg range.", "evidence_relation": "supporting" } ] } ] }, "norarr.llm_only_2.llama3-8b_fixed": { "answer": "You should treat high blood pressure when it is consistently 140/90 mmHg or higher, especially if you have diabetes, kidney disease, or cardiovascular disease [31521481, 36710087, 20845760]. However, if you have a high normal blood pressure (130-139/80-89 mmHg) and are at high risk for cardiovascular disease, your doctor may recommend treatment [31521481, 36346411, 16810473]. The goal of treatment is to lower your blood pressure to less than 130/80 mmHg, but this may not be necessary for everyone [31521481, 36710087, 26845164]. Your doctor will consider your individual risk factors and health status when deciding whether to start treatment and what target blood pressure to aim for [29536372, 26845164, 20845760]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "You should treat high blood pressure when it is consistently 140/90 mmHg or higher, especially if you have diabetes, kidney disease, or cardiovascular disease [31521481, 36710087, 20845760].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31521481", "evidence_support": "The exception amongst high-risk individuals is for secondary stroke prevention in drug na\u00efve individuals as drug therapy is initiated when blood pressure \u2265140/90\u202fmm Hg. Non-high risk individuals will initiate drug therapy when BP is \u2265140/90\u202fmm Hg.", "evidence_relation": "supporting" }, { "cited_pmid": "36710087", "evidence_support": "These treatments are associated with a significant reduction in morbidity and mortality in people with office BP\u00a0\u2265\u00a0140/90mmHg (self-measurements\u00a0\u2265\u00a0135/85mmHg).", "evidence_relation": "supporting" }, { "cited_pmid": "20845760", "evidence_support": "Diagnostic level for hypertension in clinic is > or = 140/90mmHg. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "However, if you have a high normal blood pressure (130-139/80-89 mmHg) and are at high risk for cardiovascular disease, your doctor may recommend treatment [31521481, 36346411, 16810473].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31521481", "evidence_support": "Absolute cardiovascular risk is utilized, for the first time, to determine high-risk status when BP 130-139/80-89\u202fmm Hg (Stage 1 hypertension) and high-risk patient characteristics/co-morbidities are absent including age 65 and older, diabetes, chronic kidney disease, known cardiovascular disease; high-risk individuals initiate drug therapy when BP\u00a0\u2265\u00a0130/80\u202fmm Hg.", "evidence_relation": "supporting" }, { "cited_pmid": "36346411", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "16810473", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The goal of treatment is to lower your blood pressure to less than 130/80 mmHg, but this may not be necessary for everyone [31521481, 36710087, 26845164].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31521481", "evidence_support": "Hypertension is diagnosed when blood pressure is consistently \u2265130 and/or \u226580\u202fmm Hg.", "evidence_relation": "neutral" }, { "cited_pmid": "31521481", "evidence_support": "Irrespective of blood pressure threshold for initiation of drug therapy, the target BP is minimally <130/80\u202fmm Hg in most. ", "evidence_relation": "supporting" }, { "cited_pmid": "26845164", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "36710087", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Your doctor will consider your individual risk factors and health status when deciding whether to start treatment and what target blood pressure to aim for [29536372, 26845164, 20845760].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "29536372", "evidence_support": "Lifestyle measures should be used to treat individuals with increased BP. Lifestyle measures plus BP-lowering drugs should be used for secondary prevention of recurrent cardiovascular events in individuals with clinical cardiovascular disease (coronary heart disease, congestive heart failure, or stroke) and an average SBP\u2009\u2265\u2009130\u00a0mmHg or an average DBP\u2009\u2265\u200980\u00a0mmHg. Lifestyle measures plus BP-lowering drugs should be used for primary prevention of cardiovascular disease in individuals with an estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD)\u2009\u2265\u200910% and an average SBP\u2009\u2265\u2009130\u00a0mmHg or an average DBP\u2009\u2265\u200980\u00a0mmHg. Lifestyle measures plus BP-lowering drugs should be used for primary prevention of cardiovascular disease in individuals with an estimated 10-year risk of ASCVD\u2009<\u200910% and an average SBP\u2009\u2265\u2009140\u00a0mmHg or an average DBP\u2009\u2265\u200990\u00a0mmHg.", "evidence_relation": "supporting" }, { "cited_pmid": "20845760", "evidence_support": "The treatment program should be prepared according to stratification of the risk; all patients must be guided to modify their lifestyle, and hypertensive medication should be started if necessary to achieve the target blood pressure level.", "evidence_relation": "supporting" }, { "cited_pmid": "26845164", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "norarr.llm_only_2.llama3-70b_fixed": { "answer": "If you have high blood pressure, your doctor may recommend lifestyle changes, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption [16810473, 36346411]. If your blood pressure is 130/80 mmHg or higher, your doctor may consider starting you on medication, especially if you have other risk factors for cardiovascular disease, such as diabetes, kidney disease, or a history of cardiovascular disease [36346411, 30612417, 31521481]. The goal of treatment is to lower your blood pressure to less than 130/80 mmHg [36710087, 31521481, 30612417]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you have high blood pressure, your doctor may recommend lifestyle changes, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption [16810473, 36346411].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36346411", "evidence_support": "First-line therapy for hypertension is lifestyle modification, including weight loss, healthy dietary pattern that includes low sodium and high potassium intake, physical activity, and moderation or elimination of alcohol consumption.", "evidence_relation": "supporting" }, { "cited_pmid": "36346411", "evidence_support": "First-line therapy for hypertension is lifestyle modification, consisting of weight loss, dietary sodium reduction and potassium supplementation, healthy dietary pattern, physical activity, and limited alcohol consumption.", "evidence_relation": "supporting" }, { "cited_pmid": "16810473", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If your blood pressure is 130/80 mmHg or higher, your doctor may consider starting you on medication, especially if you have other risk factors for cardiovascular disease, such as diabetes, kidney disease, or a history of cardiovascular disease [36346411, 30612417, 31521481].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36346411", "evidence_support": "The decision to initiate antihypertensive medication should be based on the level of BP and the presence of high atherosclerotic CVD risk. ", "evidence_relation": "supporting" }, { "cited_pmid": "30612417", "evidence_support": "The 2017 American College of Cardiology/American Heart Association/American Society of Hypertension guideline recommends an office visit blood pressure (BP) > 130/80 mmHg as the new threshold for diagnosis of hypertension, and states that the treatment goal for all hypertensive patients should be lowered to < 130/80 mmHg.", "evidence_relation": "supporting" }, { "cited_pmid": "30612417", "evidence_support": "However, despite their differences in thresholds for diagnosis of hypertension, both guidelines are in agreement that treatment should be considered in patients with BPs in the range of 130 to 139/80 to 89 mmHg if they have high cardiovascular risk.", "evidence_relation": "supporting" }, { "cited_pmid": "31521481", "evidence_support": " Absolute cardiovascular risk is utilized, for the first time, to determine high-risk status when BP 130-139/80-89\u202fmm Hg (Stage 1 hypertension) and high-risk patient characteristics/co-morbidities are absent including age 65 and older, diabetes, chronic kidney disease, known cardiovascular disease; high-risk individuals initiate drug therapy when BP\u00a0\u2265\u00a0130/80\u202fmm Hg.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The goal of treatment is to lower your blood pressure to less than 130/80 mmHg [36710087, 31521481, 30612417].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "36710087", "evidence_support": "The risk of cardiovascular events increases exponentially with the level of blood pressure (BP), starting from 115mmHg for systolic BP.", "evidence_relation": "neutral" }, { "cited_pmid": "31521481", "evidence_support": "Irrespective of blood pressure threshold for initiation of drug therapy, the target BP is minimally <130/80\u202fmm Hg in most.", "evidence_relation": "supporting" }, { "cited_pmid": "30612417", "evidence_support": "Hypertension guideline recommends an office visit blood pressure (BP) > 130/80 mmHg as the new threshold for diagnosis of hypertension, and states that the treatment goal for all hypertensive patients should be lowered to < 130/80 mmHg.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix.llm_only_2.llama3-70b_fixed": { "answer": "If you have high blood pressure, your doctor may recommend lifestyle changes, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption [27721223, 16810473, 25019019]. If your blood pressure is 130/80 mmHg or higher, your doctor may consider starting you on medication, especially if you have other risk factors for cardiovascular disease, such as diabetes, kidney disease, or a history of cardiovascular disease [36710087, 30612417]. The goal of treatment is to lower your blood pressure to less than 130/80 mmHg [21466632, 31521481, 30612417]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you have high blood pressure, your doctor may recommend lifestyle changes, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption [27721223, 16810473, 25019019].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "25019019", "evidence_support": "Lifestyle changes such as restriction of salt intake, exercise, restriction of alcohol intake, diet, and weight loss are included in all hypertension treatment guidelines.", "evidence_relation": "supporting" }, { "cited_pmid": "16810473", "evidence_support": null, "evidence_relation": "not relevant" }, { "cited_pmid": "27721223", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If your blood pressure is 130/80 mmHg or higher, your doctor may consider starting you on medication, especially if you have other risk factors for cardiovascular disease, such as diabetes, kidney disease, or a history of cardiovascular disease [36710087, 30612417].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36710087", "evidence_support": "For people at high cardiovascular risk, especially those with a history of cardiovascular disease, starting the treatment for an office BP\u00a0\u2265\u00a0130/80mmHg is also beneficial (self-measurements\u00a0\u2265\u00a0130/80mmHg as well).", "evidence_relation": "supporting" }, { "cited_pmid": "30612417", "evidence_support": "treatment should be considered in patients with BPs in the range of 130 to 139/80 to 89 mmHg if they have high cardiovascular risk. ", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The goal of treatment is to lower your blood pressure to less than 130/80 mmHg [21466632, 31521481, 30612417].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "21466632", "evidence_support": "While data extrapolated from many trials seemed to imply that lower blood pressures leads to more favorable cardiovascular outcomes, this paper reviews newer trials designed to treat to blood pressure targets below 130/80 mmHg in patients with long term established diabetes, which showed that this goal may prove more harmful than helpful.", "evidence_relation": "supporting" }, { "cited_pmid": "31521481", "evidence_support": "Non-high risk individuals will initiate drug therapy when BP is \u2265140/90\u202fmm Hg. Irrespective of blood pressure threshold for initiation of drug therapy, the target BP is minimally <130/80\u202fmm Hg in most. ", "evidence_relation": "supporting" }, { "cited_pmid": "30612417", "evidence_support": "The 2017 American College of Cardiology/American Heart Association/American Society of Hypertension guideline recommends an office visit blood pressure (BP) > 130/80 mmHg as the new threshold for diagnosis of hypertension, and states that the treatment goal for all hypertensive patients should be lowered to < 130/80 mmHg.", "evidence_relation": "supporting" } ] } ] }, "rarr_attrfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "If you have high blood pressure, your doctor may recommend lifestyle changes, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption [27721223, 16810473, 25019019]. If your blood pressure is 130/80 mmHg or higher, your doctor may consider starting you on medication, especially if you have other risk factors for cardiovascular disease, such as diabetes, kidney disease, or a history of cardiovascular disease [36710087, 30612417]. The goal of treatment is to lower your blood pressure to less than 130/80 mmHg [31521481, 30612417, 36346411]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you have high blood pressure, your doctor may recommend lifestyle changes, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption [27721223, 16810473, 25019019].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "27721223", "evidence_support": "Physicians are in an excellent position to help their patients stop smoking. Targeted weight loss interventions in population subgroups might be more effective for the prevention of hypertension than a general-population approach. A diet rich in high-potassium fruit and vegetables is strongly recommended", "evidence_relation": "supporting" }, { "cited_pmid": "27721223", "evidence_support": "Alcohol usage is a more frequent contributor to hypertension than is generally appreciated.", "evidence_relation": "neutral" }, { "cited_pmid": "16810473", "evidence_support": "This requires treatment of all the reversible factors identified, including smoking, dislipidemia, or diabetes, and the appropriate management of associated clinical conditions, as well as treatment of the raised blood pressure per se", "evidence_relation": "supporting" }, { "cited_pmid": "25019019", "evidence_support": "Lifestyle changes such as restriction of salt intake, exercise, restriction of alcohol intake, diet, and weight loss are included in all hypertension treatment guidelines", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If your blood pressure is 130/80 mmHg or higher, your doctor may consider starting you on medication, especially if you have other risk factors for cardiovascular disease, such as diabetes, kidney disease, or a history of cardiovascular disease [36710087, 30612417].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36710087", "evidence_support": "For people at high cardiovascular risk, especially those with a history of cardiovascular disease, starting the treatment for an office BP\u00a0\u2265\u00a0130/80mmHg is also beneficial (self-measurements\u00a0\u2265\u00a0130/80mmHg as well).", "evidence_relation": "supporting" }, { "cited_pmid": "30612417", "evidence_support": "The 2017 American College of Cardiology/American Heart Association/American Society of Hypertension guideline recommends an office visit blood pressure (BP) > 130/80 mmHg as the new threshold for diagnosis of hypertension, and states that the treatment goal for all hypertensive patients should be lowered to < 130/80 mmHg.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The goal of treatment is to lower your blood pressure to less than 130/80 mmHg [31521481, 30612417, 36346411].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "31521481", "evidence_support": "Irrespective of blood pressure threshold for initiation of drug therapy, the target BP is minimally <130/80\u202fmm Hg in most.", "evidence_relation": "supporting" }, { "cited_pmid": "30612417", "evidence_support": "The 2017 American College of Cardiology/American Heart Association/American Society of Hypertension guideline recommends an office visit blood pressure (BP) > 130/80 mmHg as the new threshold for diagnosis of hypertension, and states that the treatment goal for all hypertensive patients should be lowered to < 130/80 mmHg.", "evidence_relation": "supporting" }, { "cited_pmid": "36346411", "evidence_support": "Hypertension, defined as persistent systolic blood pressure (SBP) at least 130 mm Hg or diastolic BP (DBP) at least 80 mm Hg, affects approximately 116 million adults in the US and more than 1 billion adults worldwide.", "evidence_relation": "neutral" }, { "cited_pmid": "36346411", "evidence_support": "First-line therapy for hypertension is lifestyle modification, consisting of weight loss, dietary sodium reduction and potassium supplementation, healthy dietary pattern, physical activity, and limited alcohol consumption. When drug therapy is required, first-line therapies are thiazide or thiazidelike diuretics, angiotensin-converting enzyme inhibitor or angiotensin receptor blockers, and calcium channel blockers", "evidence_relation": "neutral" } ] } ] }, "rarr_attronly.llm_only_2.llama3-70b_fixed": { "answer": "If you have high blood pressure, your doctor may recommend lifestyle changes, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption [27721223, 25019019, 16810473]. If your blood pressure is 130/80 mmHg or higher, your doctor may consider starting you on medication, especially if you have other risk factors for cardiovascular disease, such as diabetes, kidney disease, or a history of cardiovascular disease [36710087, 30612417, 29536372]. The goal of treatment is to lower your blood pressure to less than 130/80 mmHg [31521481, 30612417, 29536372]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you have high blood pressure, your doctor may recommend lifestyle changes, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption [27721223, 25019019, 16810473].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "27721223", "evidence_support": "Physicians are in an excellent position to help their patients stop smoking. Targeted weight loss interventions in population subgroups might be more effective for the prevention of hypertension than a general-population approach. A diet rich in high-potassium fruit and vegetables is strongly recommended. Fresh products are best; normal potassium content is reduced when foods are canned or frozen.", "evidence_relation": "supporting" }, { "cited_pmid": "25019019", "evidence_support": "Lifestyle changes such as restriction of salt intake, exercise, restriction of alcohol intake, diet, and weight loss are included in all hypertension treatment guidelines.", "evidence_relation": "supporting" }, { "cited_pmid": "16810473", "evidence_support": "Lifestyle measures should be instituted whenever appropriate in all patients, including subjects with high normal blood pressure and patients who require drug treatment.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If your blood pressure is 130/80 mmHg or higher, your doctor may consider starting you on medication, especially if you have other risk factors for cardiovascular disease, such as diabetes, kidney disease, or a history of cardiovascular disease [36710087, 30612417, 29536372].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36710087", "evidence_support": "For people at high cardiovascular risk, especially those with a history of cardiovascular disease, starting the treatment for an office BP\u00a0\u2265\u00a0130/80mmHg is also beneficial (self-measurements\u00a0\u2265\u00a0130/80mmHg as well).", "evidence_relation": "supporting" }, { "cited_pmid": "30612417", "evidence_support": "However, despite their differences in thresholds for diagnosis of hypertension, both guidelines are in agreement that treatment should be considered in patients with BPs in the range of 130 to 139/80 to 89 mmHg if they have high cardiovascular risk.", "evidence_relation": "supporting" }, { "cited_pmid": "29536372", "evidence_support": "Lifestyle measures plus BP-lowering drugs should be used for primary prevention of cardiovascular disease in individuals with an estimated 10-year risk of atherosclerotic cardiovascular disease (ASCVD)\u2009\u2265\u200910% and an average SBP\u2009\u2265\u2009130\u00a0mmHg or an average DBP\u2009\u2265\u200980\u00a0mmHg.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The goal of treatment is to lower your blood pressure to less than 130/80 mmHg [31521481, 30612417, 29536372].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "31521481", "evidence_support": "Irrespective of blood pressure threshold for initiation of drug therapy, the target BP is minimally <130/80\u202fmm Hg in most.", "evidence_relation": "supporting" }, { "cited_pmid": "31521481", "evidence_support": "However, target BP is <130 systolic amongst those 65 and older as the committee made no recommendation for a DBP target", "evidence_relation": "supporting" }, { "cited_pmid": "30612417", "evidence_support": "The 2017 American College of Cardiology/American Heart Association/American Society of Hypertension guideline recommends an office visit blood pressure (BP) > 130/80 mmHg as the new threshold for diagnosis of hypertension, and states that the treatment goal for all hypertensive patients should be lowered to < 130/80 mmHg.", "evidence_relation": "supporting" }, { "cited_pmid": "29536372", "evidence_support": "BP should be lowered to\u2009<\u2009130/80\u00a0mmHg in patients with coronary heart disease, heart failure, or chronic kidney disease; after renal transplantation; for secondary stroke prevention; in lacunar stroke, peripheral arterial disease, and diabetes mellitus; and in ambulatory community-dwelling adults aged\u2009>\u200965\u00a0years.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgen.llm_only_2.llama3-70b_fixed": { "answer": "If you have high blood pressure, your doctor may recommend lifestyle changes, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption [37712135]. If your blood pressure is 130/80 mmHg or higher, your doctor may consider starting you on medication, especially if you have other risk factors for cardiovascular disease, such as diabetes, kidney disease, or a history of cardiovascular disease [30354757, 20845760]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you have high blood pressure, your doctor may recommend lifestyle changes, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption [37712135].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "37712135", "evidence_support": "An international panel of experts convened by the International Society of Hypertension College of Experts compiled lifestyle management recommendations as first-line strategy to prevent and control hypertension in adulthood. We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed. Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If your blood pressure is 130/80 mmHg or higher, your doctor may consider starting you on medication, especially if you have other risk factors for cardiovascular disease, such as diabetes, kidney disease, or a history of cardiovascular disease [30354757, 20845760].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "30354757", "evidence_support": "Using the new BP thresholds of \u2265130/80 mm\u2009Hg, \u224824 million new American adults would be diagnosed as having hypertension and 4.3 million would be recommended to start antihypertensive medications.", "evidence_relation": "supporting" }, { "cited_pmid": "20845760", "evidence_support": "Diagnostic level for hypertension in clinic is > or = 140/90mmHg", "evidence_relation": "contradicting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-8b_fixed": { "answer": "If you have high blood pressure, your doctor may recommend lifestyle changes, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption [37712135]. If your blood pressure is 140/90 mmHg or higher, your doctor may consider starting you on medication, especially if you have other risk factors for cardiovascular disease, such as diabetes, kidney disease, or a history of cardiovascular disease [20845760]. The goal of treatment is to lower your blood pressure to less than 140/90 mmHg [16061043, 29273294]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you have high blood pressure, your doctor may recommend lifestyle changes, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption [37712135].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "37712135", "evidence_support": "We also recommend that lifestyle changes be continued even when blood pressure-lowering medications are prescribed.", "evidence_relation": "supporting" }, { "cited_pmid": "37712135", "evidence_support": "Specific recommendations based on literature evidence are summarized with advice to start these measures early in life, including maintaining a healthy body weight, increased levels of different types of physical activity, healthy eating and drinking, avoidance and cessation of smoking and alcohol use, management of stress and sleep levels.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If your blood pressure is 140/90 mmHg or higher, your doctor may consider starting you on medication, especially if you have other risk factors for cardiovascular disease, such as diabetes, kidney disease, or a history of cardiovascular disease [20845760].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20845760", "evidence_support": "Diagnostic level for hypertension in clinic is > or = 140/90mmHg.", "evidence_relation": "supporting" }, { "cited_pmid": "20845760", "evidence_support": "Hypertensive patients are stratified into low-, moderate- and high-risk groups according to the presence or absence of risk factors other than blood pressure, hypertensive target organ damage and cardiovascular disease. In particular, the presence of diabetes mellitus and chronic kidney disease increases the risk. Attention to metabolic syndrome including a high-normal pressure as a component is also necessary. The treatment program should be prepared according to stratification of the risk; all patients must be guided to modify their lifestyle, and hypertensive medication should be started if necessary to achieve the target blood pressure level.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The goal of treatment is to lower your blood pressure to less than 140/90 mmHg [16061043, 29273294].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "16061043", "evidence_support": "Guidelines espouse a treatment goal of blood pressure reduction to <140 mm Hg for the systolic pressure and <90 mm Hg for the diastolic pressure in most hypertensive patients.", "evidence_relation": "supporting" }, { "cited_pmid": "29273294", "evidence_support": "The harmonized Canadian clinical practice guidelines for managing hypertension in people with diabetes provides health-behaviour advice and medical therapy recommendations for a threshold blood pressure of 130/80\u2009mmHg and above and to target blood pressure to below 130/80\u2009mmHg", "evidence_relation": "contradicting" } ] } ] }, "rarr_qgenfix.llm_only_2.llama3-70b_fixed": { "answer": "If you have high blood pressure, your doctor may recommend lifestyle changes, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption [27666380, 27721223, 16803935]. If your blood pressure is 140/90 mmHg or higher, your doctor may consider starting you on medication, especially if you have other risk factors for cardiovascular disease, such as smoking, high blood fats, obesity, lack of exercise, diabetes, hereditary features, environmental pollution, stress, irregularity in urine removal, or a history of cardiovascular disease [20845760, 24734330]. The goal of treatment is to lower your blood pressure to less than 140/90 mmHg [16061043]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you have high blood pressure, your doctor may recommend lifestyle changes, such as weight loss, healthy dietary pattern, physical activity, and moderation or elimination of alcohol consumption [27666380, 27721223, 16803935].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "27666380", "evidence_support": "A dietary pattern rich in nuts, seeds, fruit, and fish was inversely associated with blood pressure in this clinical sample.", "evidence_relation": "neutral" }, { "cited_pmid": "27721223", "evidence_support": "The foundation for a healthy blood pressure consists of a healthy diet, adequate exercise, stress reduction, and sufficient amounts of potassium and magnesium, but further investigations are required before making definitive therapeutic recommendations on magnesium use. Alcohol usage is a more frequent contributor to hypertension than is generally appreciated", "evidence_relation": "supporting" }, { "cited_pmid": "16803935", "evidence_support": "Interventions encouraging adoption of healthy diets and increased physical activity are needed to achieve national goals for preventing and treating hypertension, cardiovascular disease, diabetes, and other chronic diseases. ", "evidence_relation": "supporting" }, { "cited_pmid": "16803935", "evidence_support": "Both interventions implemented established national guidelines for blood pressure control (weight loss, reduced sodium and alcohol intake, and increased physical activity), and one intervention also included the Dietary Approaches to Stop Hypertension (DASH) diet.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If your blood pressure is 140/90 mmHg or higher, your doctor may consider starting you on medication, especially if you have other risk factors for cardiovascular disease, such as smoking, high blood fats, obesity, lack of exercise, diabetes, hereditary features, environmental pollution, stress, irregularity in urine removal, or a history of cardiovascular disease [20845760, 24734330].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "20845760", "evidence_support": "Diagnostic level for hypertension in clinic is > or = 140/90mmHg. ", "evidence_relation": "supporting" }, { "cited_pmid": "24734330", "evidence_support": "The factors significantly increasing risk the of cardiovascular disease are in addition to high blood pressure, smoking (also passive), high blood fats (cholesterol and its HDL, LDL fractions as well as triglyceride levels, obesity, lack of exercise, diabetes and hereditary features.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The goal of treatment is to lower your blood pressure to less than 140/90 mmHg [16061043].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "16061043", "evidence_support": "Guidelines espouse a treatment goal of blood pressure reduction to <140 mm Hg for the systolic pressure and <90 mm Hg for the diastolic pressure in most hypertensive patients.", "evidence_relation": "supporting" } ] } ] }, "rarr_qgenfix_custprompt.llm_only_3_v2.llama3-70b_fixed": { "answer": "If you have high blood pressure, your doctor may recommend lifestyle changes, such as weight loss, healthy dietary pattern, physical activity, and for people over 60 who drink heavily, reduction of alcohol intake to moderate levels, but not necessarily elimination [16208131, 26773016, 18785439]. If your blood pressure is 140/90 mmHg or higher, your doctor may consider starting you on medication, especially if you are non-high risk [36710087, 31521481]. If you are high-risk with blood pressure \u2265130/80 mmHg, or if you are high-risk for secondary stroke prevention with blood pressure \u2265140/90 mmHg, your doctor may consider starting you on medication [36710087, 31521481]. The goal of treatment is to lower your blood pressure to less than 140/90 mmHg [16061043]. ", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "If you have high blood pressure, your doctor may recommend lifestyle changes, such as weight loss, healthy dietary pattern, physical activity, and for people over 60 who drink heavily, reduction of alcohol intake to moderate levels, but not necessarily elimination [16208131, 26773016, 18785439].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16208131", "evidence_support": "reported. It is concluded that the hypertensive patient over the age of 60 who drinks over 16 drinks per week should be advised to reduce his or her alcohol intake but a daily drink may be advisable and the patient should not stop drinking entirely.", "evidence_relation": "supporting" }, { "cited_pmid": "26773016", "evidence_support": "To lower blood pressure (BP), several lifestyle changes are recommended such as weight loss, exercise, and following a healthy diet.", "evidence_relation": "supporting" }, { "cited_pmid": "26773016", "evidence_support": "Lifestyle factors such as exercise and weight loss in combination with dietary changes may also reduce BP.", "evidence_relation": "supporting" }, { "cited_pmid": "18785439", "evidence_support": "Physical activity is a primary lifestyle measure required to lower blood pressure in hypertensive patients, and the US Preventative Services Task force (USPSTF) recommends counseling by health care providers to promote regular physical activity.", "evidence_relation": "supporting" }, { "cited_pmid": "18785439", "evidence_support": "This study shows that fewer patients are receiving exercise counseling to help lower blood pressure and improve health outcomes.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "If your blood pressure is 140/90 mmHg or higher, your doctor may consider starting you on medication, especially if you are non-high risk [36710087, 31521481].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36710087", "evidence_support": "These treatments are associated with a significant reduction in morbidity and mortality in people with office BP\u00a0\u2265\u00a0140/90mmHg (self-measurements\u00a0\u2265\u00a0135/85mmHg).", "evidence_relation": "supporting" }, { "cited_pmid": "31521481", "evidence_support": "Non-high risk individuals will initiate drug therapy when BP is \u2265140/90\u202fmm Hg.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "3", "answer_sentence": "If you are high-risk with blood pressure \u2265130/80 mmHg, or if you are high-risk for secondary stroke prevention with blood pressure \u2265140/90 mmHg, your doctor may consider starting you on medication [36710087, 31521481].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "36710087", "evidence_support": "For people at high cardiovascular risk, especially those with a history of cardiovascular disease, starting the treatment for an office BP\u00a0\u2265\u00a0130/80mmHg is also beneficial (self-measurements\u00a0\u2265\u00a0130/80mmHg as well).", "evidence_relation": "supporting" }, { "cited_pmid": "31521481", "evidence_support": "Absolute cardiovascular risk is utilized, for the first time, to determine high-risk status when BP 130-139/80-89\u202fmm Hg (Stage 1 hypertension) and high-risk patient characteristics/co-morbidities are absent including age 65 and older, diabetes, chronic kidney disease, known cardiovascular disease; high-risk individuals initiate drug therapy when BP\u00a0\u2265\u00a0130/80\u202fmm Hg.", "evidence_relation": "supporting" }, { "cited_pmid": "31521481", "evidence_support": "as drug therapy is initiated when blood pressure \u2265140/90\u202fmm Hg", "evidence_relation": "supporting" }, { "cited_pmid": "31521481", "evidence_support": "Non-high risk individuals will initiate drug therapy when BP is \u2265140/90\u202fmm Hg", "evidence_relation": "contradicting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "The goal of treatment is to lower your blood pressure to less than 140/90 mmHg [16061043].", "answer_sentence_relevance": "borderline", "citation_assessment": [ { "cited_pmid": "16061043", "evidence_support": "Guidelines espouse a treatment goal of blood pressure reduction to <140 mm Hg for the systolic pressure and <90 mm Hg for the diastolic pressure in most hypertensive patients.", "evidence_relation": "supporting" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogen_top20": { "answer": "High blood pressure should be treated when systolic blood pressure (SBP) is \u2265140 mmHg or diastolic blood pressure (DBP) is \u226590 mmHg in most patients, as this threshold is associated with increased cardiovascular risk [19381107, 28707234, 16463797]. For patients with diabetes, chronic kidney disease (CKD), or high cardiovascular risk, treatment should be initiated at BP levels \u2265130/80 mmHg [31521481, 22111320, 37843942]. The target BP for most hypertensive patients is <140/90 mmHg, but for those with diabetes or high cardiovascular risk, the goal is <130/80 mmHg [19381107, 31521481, 22111320]. Intensive BP lowering below 120/70 mmHg is generally not recommended due to the risk of adverse events [30612417]. In elderly patients, particularly those over 80 years, treatment should aim for SBP between 140-150 mmHg if well tolerated . Combination therapy is often necessary to achieve target BP, especially in high-risk individuals [27644446, 16810473, 20937445].", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "High blood pressure should be treated when systolic blood pressure (SBP) is \u2265140 mmHg or diastolic blood pressure (DBP) is \u226590 mmHg in most patients, as this threshold is associated with increased cardiovascular risk [19381107, 28707234, 16463797].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19381107", "evidence_support": "The first recommendation is that of initiating antihypertensive drug treatment when systolic blood pressure is at least 140 or diastolic blood pressure at least 90 mmHg in patients with grade 1 hypertension and low or moderate total cardiovascular risk, and even when blood pressure is in the high normal range in patients with diabetes and previous cardiovascular disease.", "evidence_relation": "supporting" }, { "cited_pmid": "28707234", "evidence_support": "The Seventh Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure (JNC-7) recommended a target of <140/90 for most patients and a target <130/80\u00a0mmHg for patients with diabetes or chronic kidney disease.", "evidence_relation": "supporting" }, { "cited_pmid": "28707234", "evidence_support": "The historical threshold/target of 140/90\u00a0mmHg remains reasonable in most patients in identifying \"treatable\" risk, i.e., risk high enough to justify treatment and for which available treatment is effective enough to result in significant endpoint reduction. Above 140/90\u00a0mmHg, most low-to-moderate risk people should be treated and this target is also appropriate for the majority of high-risk individuals with diabetes, CKD, and/or CAD", "evidence_relation": "supporting" }, { "cited_pmid": "16463797", "evidence_support": "Having blood pressures 140/190 mmHg repeatedly at the doctor's office is associated with an increased cardiovascular risk and requires drug treatment if non-pharmacological measures do not allow blood pressure normalization.", "evidence_relation": "supporting" }, { "cited_pmid": "16463797", "evidence_support": "Antihypertensive therapy might already be required in patients exhibiting simultaneously blood pressure > or = 130/180 mmHg and diabetes and/or renal disease.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "2", "answer_sentence": "For patients with diabetes, chronic kidney disease (CKD), or high cardiovascular risk, treatment should be initiated at BP levels \u2265130/80 mmHg [31521481, 22111320, 37843942].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "31521481", "evidence_support": "Hypertension is diagnosed when blood pressure is consistently \u2265130 and/or \u226580\u202fmm Hg.", "evidence_relation": "supporting" }, { "cited_pmid": "31521481", "evidence_support": "Absolute cardiovascular risk is utilized, for the first time, to determine high-risk status when BP 130-139/80-89\u202fmm Hg (Stage 1 hypertension) and high-risk patient characteristics/co-morbidities are absent including age 65 and older, diabetes, chronic kidney disease, known cardiovascular disease; high-risk individuals initiate drug therapy when BP\u00a0\u2265\u00a0130/80\u202fmm Hg.", "evidence_relation": "supporting" }, { "cited_pmid": "22111320", "evidence_support": "Treatment is necessary for all patients with hypertension (blood pressure > or =140/ 90 mmHg) and for those with a blood pressure of 130/80 mmHg if they have diabetes, chronic kidney disease (CKD) or myocardial infarction.", "evidence_relation": "supporting" }, { "cited_pmid": "37843942", "evidence_support": null, "evidence_relation": "not relevant" } ] }, { "answer_sentence_id": "3", "answer_sentence": "The target BP for most hypertensive patients is <140/90 mmHg, but for those with diabetes or high cardiovascular risk, the goal is <130/80 mmHg [19381107, 31521481, 22111320].", "answer_sentence_relevance": "required", "citation_assessment": [ { "cited_pmid": "19381107", "evidence_support": "The second recommendation is that of achieving systolic blood pressure levels below 140 mmHg in all hypertensive patients, including the elderly, and values below 130 mmHg in patients having diabetes and high/very-high-risk patients", "evidence_relation": "supporting" }, { "cited_pmid": "31521481", "evidence_support": "Non-high risk individuals will initiate drug therapy when BP is \u2265140/90\u202fmm Hg. Irrespective of blood pressure threshold for initiation of drug therapy, the target BP is minimally <130/80\u202fmm Hg in most.", "evidence_relation": "supporting" }, { "cited_pmid": "22111320", "evidence_support": "The recommended target for blood pressure control is < 130/85 mmHg in young and middle-aged people. It should be < 130/80 mmHg in those with diabetes mellitus, CKD or myocardial infarction and < 140/ 90 mmHg in elderly people and patients with cerebrovascular diseases", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "4", "answer_sentence": "Intensive BP lowering below 120/70", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "5", "answer_sentence": "mmHg is generally not recommended due to the risk of adverse events [30612417].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "30612417", "evidence_support": "However, intensive BP lowering is associated with increased incidence of treatment-associated adverse events, and evidence suggests that BP lowering below 120/70 mmHg increases the risk of cardiovascular events.", "evidence_relation": "supporting" } ] }, { "answer_sentence_id": "6", "answer_sentence": "In elderly patients, particularly those over 80 years, treatment should aim for SBP between 140-150 mmHg if well tolerated .", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "7", "answer_sentence": "Combination therapy is often necessary to achieve target BP, especially in high-risk individuals [27644446, 16810473, 20937445].", "answer_sentence_relevance": "unnecessary", "citation_assessment": [ { "cited_pmid": "16810473", "evidence_support": "To reach target blood pressure, it is likely that a large proportion of patients will require combination therapy with more than one agent. ", "evidence_relation": "supporting" }, { "cited_pmid": "20937445", "evidence_support": "In most patients, 2 or more medications with complementary mechanisms of action should be used in combination. ", "evidence_relation": "supporting" }, { "cited_pmid": "27644446", "evidence_support": null, "evidence_relation": "not relevant" } ] } ] }, "rl31-70b_gpt-4o_ragnarokv5biogennc_top20": { "answer": "High blood pressure, or hypertension, should be treated when systolic blood pressure consistently exceeds 140 mmHg or diastolic pressure exceeds 90 mmHg, according to guidelines from the American College of Cardiology and the American Heart Association.Treatment is particularly urgent if the patient has additional cardiovascular risk factors such as diabetes, chronic kidney disease, or a history of cardiovascular events.Lifestyle modifications, including dietary changes, increased physical activity, and weight management, are first-line interventions.Pharmacologic treatment is recommended if lifestyle changes are insufficient to achieve target blood pressure levels or if initial readings are significantly elevated (e.g., systolic \u2265160 mmHg or diastolic \u2265100 mmHg).The goal is to reduce blood pressure to below 130/80 mmHg in most patients to minimize the risk of cardiovascular complications.Regular monitoring and individualized treatment plans are essential for effective management.", "is_answer_accurate": "yes", "answer_sentences": [ { "answer_sentence_id": "1", "answer_sentence": "High blood pressure, or hypertension, should be treated when systolic blood pressure consistently exceeds 140 mmHg or diastolic pressure exceeds 90 mmHg, according to guidelines from the American College of Cardiology and the American Heart Association.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "2", "answer_sentence": "Treatment is particularly urgent if the patient has additional cardiovascular risk factors such as diabetes, chronic kidney disease, or a history of cardiovascular events.", "answer_sentence_relevance": "required", "citation_assessment": null }, { "answer_sentence_id": "3", "answer_sentence": "Lifestyle modifications, including dietary changes, increased physical activity, and weight management, are first-line interventions.", "answer_sentence_relevance": "borderline", "citation_assessment": null },