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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.

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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.

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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.

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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: Aqueous humor levels of syndecan-1 and syndecan-4 associated with OCTA metrics in diabetic retinopathy

Date Published: 2025-11-20

Abstract:
Attenuated endothelium glycocalyx had been shown to be related to vascular damage during diabetic retinopathy (DR). Syndecans were pivotal components of retinal glycocalyx, which could be released from the endothelial surface by a highly regulated proteolytic cleavage. Thus, in the present study, we tested for the associations between diabetic retinal vascular injuries, as evidenced by optical coherence tomography angiography (OCTA) metrics, and levels of syndecan-1 and syndecan-4 in the aqueous humor of diabetic patients. A prospectively designed cross-sectional study. The study enrolled 14 patients (16 eyes) with DR, 8 patients (10 eyes) with diabetes mellitus (DM) but no DR (NDR), and 16 patients (20 eyes) without DM (NDM). All participants underwent an OCTA scan with a 3?×?3?mm pattern. The images were meticulously binarized for quantification. OCTA metrics of perfusion density (PD) were calculated after large vessels were separated from capillaries by a rigorous automatic algorithm. All vessels PD (PD all ), large vessels PD (PD large ), and capillaries PD (PD cap ) were calculated, respectively. Additionally, the concentrations of syndecans were measured using the highly sensitive Luminex Multiplex Immunoassay, ensuring the accuracy and reliability of the results. The aqueous humor level of syndecan-1 in DR (298.500?±?106.900?pg./mL) group was significantly higher than that in NDR (193.800?±?51.920?pg./mL) and NDM (181.900?±?42.580?pg./mL) group (both p <?0.05). For syndecan-4, the level in aqueous humor in DR (83.270?±?19.180?pg./mL) group was significantly lower than that in NDR (110.300?±?13.720?pg./mL) and NDM (116.900?±?40.570?pg./mL) group (both p <?0.05). But the differences of syndecan-1 and syndecan-4 had no statistical significance between NDM and NDR group (both p >?0.05). About the OCTA metrics, the PD all in DR (37.840?±?3.552) group was significantly lower than that in NDR (42.760?±?2.633) and NDM (46.460?±?2.201) group (both p <?0.05). For the PD large , the value in DR (15.940?±?4.094) group was significantly higher than that in NDR (12.600?±?3.179) and NDM (11.850?±?2.565) group (both p <?0.05). And the PD cap in DR (21.900?±?4.581) group was significantly lower than that in NDR (30.150?±?2.521) and NDM (31.820?±?2.535) group (both p <?0.05). But the differences of PD all , PD large , and PD cap had no statistical significance between NDM and NDR group (both p >?0.05). The results showed that syndecan-1 level in aqueous humor was negatively correlated with PD all ( r =??0.5499, p <?0.0001), PD cap ( r =??0.4938, p =?0.0005). However, syndecan-4 level in aqueous humor was positively correlated with PD all ( r =?0.3149, p =?0.0330), PD cap ( r =?0.3470, p =?0.0181). There were no correlation between syndecan-1 and syndecan-4 with PD large (both p >?0.05). ROC analysis showed that syndecan-1 (AUC?=?0.8188, p =?0.0072), syndecan-4 (AUC?=?0.8750, p =?0.0016), PD all (AUC?=?0.8563, p =?0.0027), PD large (AUC?=?0.7625, p =?0.0269), and PD cap (AUC?=?0.9375, p =?0.0002) all demonstrated good diagnostic performance for DR. The combination of all indicators for diagnosing DR achieved an AUC of 0.9750, p <?0.0001. The differential expression of syndecan-1 and syndecan-4 was observed in the aqueous humor of DR patients, with syndecan-1 being up-regulated and syndecan-4 down-regulated. As DR progresses, retinal large vessel PD showed an increasing trend, while capillaries PD decreased. Moreover, both syndecan-1 and syndecan-4 exhibited correlations with retinal capillaries PD. Syndecan-1, syndecan-4 and OCTA parameters had demonstrated excellent diagnostic efficacy for DR. These results not only expanded the range of potential biomarkers for detecting DR but also provide support for the future development of novel therapeutic targets for this condition.

Introduction:
Diabetic retinopathy (DR) is one of the common microvascular complications of diabetes mellitus (DM) and the main cause of preventable blindness in the working-age population ( 1 , 2 ). The International Diabetes Federation estimates that by 2045, the number of DM patients worldwide will reach 700 million and the number of DR patients will increase to 160.5 million ( 3 ). More and more evidence indicates that inflammation and angiogenesis are important factors in the occurrence and development of DR, and retinal…

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