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Draft a comprehensive differential diagnosis for acute substernal chest pain in a 45-year-old male with hypertension and hyperlipidemia, diaphoresis, exertional onset, and normal initial ECG/troponin; include life-threatening causes first, key distinguishing features, and immediate diagnostic next steps.

Draft a detailed differential diagnosis for new-onset unilateral throbbing headache with visual aura and brief monocular vision loss in a 32-year-old female on oral contraceptives; include red-flag symptoms, stroke/TIA considerations, and recommended initial workup.

Draft an assessment and plan for stage-2 hypertension (BP 162/98) in an obese 52-year-old with suspected obstructive sleep apnea; include ASCVD risk estimate, lifestyle prescriptions, first-line pharmacotherapy with drug/dose/targets, baseline labs/monitoring, and 4–6 week follow-up.

Draft an assessment and plan for type 2 diabetes follow-up with A1c 9.2% on metformin 1,000 mg BID and eGFR 65; compare adding a GLP-1 receptor agonist vs an SGLT2 inhibitor, address weight loss goals, hypoglycemia education, vaccinations, and micro/macrovascular screening.

Draft a history and physical for a patient presenting with chest pain, including HPI using OLDCARTS, pertinent ROS, PMH/meds/allergies, FH/SH, focused cardiac/pulmonary exam, initial labs and imaging orders, prioritized differential, HEART score risk stratification, and early management.

Draft a history and physical for a new patient with progressive exertional dyspnea, orthopnea, and bilateral leg edema; include differential (heart failure, COPD, PE, anemia, renal disease), targeted exam maneuvers, and first-line diagnostics and management.

Draft a progress note for COPD follow-up two weeks after an acute exacerbation treated with prednisone and antibiotics; include symptom trajectory, CAT score (if available), inhaler technique/adherence, oxygen needs, spirometry plan, smoking cessation counseling, and return precautions.

Draft a progress note for post-operative day 2 after total knee arthroplasty; include pain control strategy, DVT prophylaxis, PT/OT milestones, wound status, bowel/urinary function, labs/vitals review, complications screening, and discharge readiness.

Draft a discharge summary for community-acquired pneumonia admission; include admission/discharge dates, presenting symptoms, radiology/labs, pathogen if identified, inpatient therapies and response, discharge medications with durations, pending tests, follow-up appointments, and return precautions.

Draft a discharge summary for myocardial infarction managed with PCI and drug-eluting stent placement; include cath findings, complications, inpatient course, discharge medications (DAPT, statin, beta-blocker, ACEi/ARB), cardiac rehab referral, and follow-up plan.

Draft discharge instructions for a patient hospitalized with acute decompensated heart failure; include daily weights, sodium and fluid restriction amounts, medication list with dosing, signs of worsening heart failure, follow-up appointments, and lab monitoring plan.

Draft discharge instructions for an asthma exacerbation; include controller and reliever regimen, steroid taper schedule, spacer technique, trigger avoidance, a written asthma action plan, return precautions, and follow-up timing.

Draft a patient handout on managing high blood pressure in plain language; explain what BP numbers mean, key lifestyle steps (DASH diet, sodium limits, alcohol moderation), home BP monitoring instructions, medication adherence tips, and when to call the doctor.

Draft a patient handout for type 2 diabetes education in plain language; cover A1c goals, the plate method, physical activity targets, self-monitoring of blood glucose, hypoglycemia signs and the 15-15 rule, foot care basics, and a vaccination checklist.

Draft a summary of the latest CDC and WHO guidelines for managing community-acquired pneumonia in adults, including empiric antibiotic choices, duration of therapy, and follow-up recommendations.

Draft a plain-language overview of the ADA and AACE guidelines for diabetes management, focusing on A1c goals, weight management, and the use of GLP-1 receptor agonists and SGLT2 inhibitors.

Draft a summary of the 2024 USPSTF breast cancer screening recommendations, including updated screening intervals, risk-based approaches, and the role of MRI for high-risk patients.

Draft a concise summary of NCCN guidelines for melanoma management, including staging, surgical margins, adjuvant therapy, and checkpoint inhibitor recommendations.

Draft treatment alternatives for community-acquired MRSA skin infections in patients allergic to sulfa drugs; include oral and IV options, dosing, and duration.

Draft treatment alternatives for patients with type 2 diabetes who are unable to tolerate GLP-1 receptor agonists due to nausea; include medication substitutions and lifestyle recommendations.

Draft a summary of options for treating refractory depression, comparing ketamine infusions, transcranial magnetic stimulation (TMS), and electroconvulsive therapy (ECT).

Draft treatment options for advanced prostate cancer, including hormonal therapy, radiopharmaceuticals, and novel androgen receptor pathway inhibitors.

Draft a summary of recent research on mRNA vaccine technology beyond COVID-19, including applications in oncology and autoimmune disease prevention.

Draft an easy-to-understand overview of long COVID research, summarizing major symptoms, hypothesized mechanisms, and emerging treatment approaches.

Draft a summary of current research on Alzheimer’s disease biomarkers, including amyloid and tau imaging, and discuss how they influence diagnosis and trial design.

Draft an explanation of the interaction between warfarin and antibiotics such as ciprofloxacin or TMP-SMX, including INR effects and management recommendations.

Draft a summary evaluating drug interactions for patients taking Paxlovid and common cardiovascular drugs; include mechanism and recommended dose adjustments.

Draft a summary of the common and serious side effects of semaglutide, including GI intolerance, gallbladder disease, and thyroid-related warnings.

Draft an overview of potential side effects associated with long-term corticosteroid use, including osteoporosis, glucose intolerance, and adrenal suppression.

Draft a summary of essential lab tests to order in suspected acute pancreatitis, including amylase, lipase, liver enzymes, and metabolic panels, with interpretation guidance.

Draft laboratory workup recommendations for suspected hypothyroidism, including TSH, free T4, thyroid antibodies, and when to consider secondary causes.

Draft an explanation of which labs should be monitored in patients receiving methotrexate therapy, including CBC, LFTs, renal function, and frequency of monitoring.

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Research Article: Diagnostic lncRNA biomarkers and immune-related ceRNA networks for osteonecrosis of the femoral head in metabolic syndrome identified by plasma RNA sequencing and machine learning

Date Published: 2025-09-03

Abstract:
Osteonecrosis of the femoral head (ONFH) is a disabling orthopedic condition that remains challenging to diagnose at an early stage. Recent evidence suggests that immune dysregulation plays a central role in the development of both ONFH and metabolic syndrome (MetS), a cluster of metabolic abnormalities associated with increased ONFH risk. However, reliable noninvasive diagnostic biomarkers for ONFH, particularly in high-risk MetS populations, are still lacking. This study aimed to identify key diagnostic long non-coding RNAs (lncRNAs) in ONFH patients with MetS and to construct an immune-related competitive endogenous RNA (ceRNA) network. Plasma lncRNA and mRNA expression profiles from 9 ONFH patients and 6 healthy controls were analyzed to identify differentially expressed lncRNAs (DElncRNAs) and mRNAs (DEmRNAs), followed by ceRNA network construction. The MetS dataset from the Gene Expression Omnibus (GEO) was integrated, and weighted gene co-expression network analysis (WGCNA), functional enrichment, protein-protein interaction (PPI) network analysis, MCODE, CytoHubba-MCC, and random forest (RF) algorithms were employed to identify hub mRNAs and their associated lncRNAs. A nomogram model was developed, and diagnostic potential was evaluated using receiver operating characteristic (ROC) analysis and validation in an independent cohort (45 ONFH and 45 control samples). A total of 424 DElncRNAs and 1,431 DEmRNAs were identified, and a ceRNA network involving 7 lncRNAs, 24 miRNAs, and 683 mRNAs was constructed. Integration with the MetS dataset yielded 506 intersecting mRNAs, from which 11 hub mRNAs and 6 related lncRNAs were screened. Five key lncRNAs were selected by RF analysis to construct a diagnostic model with strong predictive performance (AUC > 0.7 in both RNA-seq and qRT-PCR validation). The immune-related ceRNA network also demonstrated significant associations with immune cell infiltration patterns. In conclusion, five candidate lncRNAs (MRPS30-DT, LINC01106, MIR100HG, WDR11-AS1, and PELATON) were identified as promising noninvasive diagnostic biomarkers for ONFH in MetS populations. These findings offer novel insights into immune-related regulatory mechanisms and may support early diagnosis using peripheral blood.

Introduction:
Osteonecrosis of the femoral head (ONFH) is pathologically characterized by localized death of bone cells (osteocytes, osteoblasts, osteoclasts, etc.) and bone marrow, which is primarily caused by disruption of the femoral head’s blood supply ( 1 , 2 ). As reparative processes fail to restore the necrotic area, structural deterioration and eventual collapse of the femoral head occur ( 3 ). According to epidemiological estimates, over 20,000 new ONFH cases are diagnosed annually in the United States, with a total…

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