README.md

---
tags:
- unsloth
- sentence-transformers
- sentence-similarity
- feature-extraction
- dense
- generated_from_trainer
- dataset_size:10000
- loss:MultipleNegativesRankingLoss
base_model: unsloth/embeddinggemma-300m
widget:
- source_sentence: 'What is the most successful treatment for lung SFTs?

    '
  sentences:
  - "Recent progress in radioimmunoassay (RIA) technology has shown that thyroglobulin\
    \ (Tg) is a protein normally secreted by the thyroid gland (Van Herle et al.,\
    \ 1979) and can be detected in the serum of virtually all normal subjects (Roitt\
    \ and Torrigiani, 1967; Van Herle et al., 1973; Pezzino et al., 1977; Bodlaender\
    \ et al., 1978; Roti et al., 1981) . The clinical usefulness of measuring serum\
    \ Tg levels in thyroidal and nonthyroidal disorders has been pointed out by many\
    \ workers. For example, high levels of serum Tg have been reported in patients\
    \ with Graves' disease (Van Herle et al., 1973; Izumi and Larsen, 1978; Gardner\
    \ et al., 1979; Pacini et al., 1980) , subacute thyroiditis (Van Herle et al.,\
    \ 1973; Izumi and Larsen, 1978; Gardner et al., 1979; Pacini et al., 1980) , and\
    \ differentiated thyroid carcinoma (Van Herle and Uller, 1975; Shlossberg et al.,\
    \ 1979; Pacini et al., 1980) , whereas the suppression of serum Tg levels in thyrotoxicosis\
    \ factitia has been reported (Mariotti et al., 1982) .\n\n Elevated levels of\
    \ serum Tg have also been reported in normal pregnant women at the third trimester\
    \ (Torrigiani et al., 1969) and at delivery (Van Herle et al., 1973; Pacini et\
    \ al., 1980; Roti et al., 1981) . However, there has been little information concerning\
    \ the level of serum Tg in each trimester of normal pregnancy. Therefore, it is\
    \ not clear whether the levels of serum Tg in pregnant women can be used in the\
    \ assessment of the clinical states of thyroidal disorders. subjects showed an\
    \ approximately normal distribution in the logarithmic scale (Van Herle et al.,\
    \ 1976; Nakamura et al., 1984) . The Mann and Whitney U test was per formed using\
    \ the native values for Tg (Pezzino et. al., 1977; Nakamura et al., 1984) . Differences\
    \ were considered to be significant if p was less than 0.05. Mean values in the\
    \ results were calculated from the levels of log Tg.\n\n Results Figure 1 shows\
    \ the concentrations of serum Tg obtained from 52 pregnant and 15 nonpregnant\
    \ females. Table 1 shows the mean logarithms for serum Tg and the range. The mean\
    \ serum Tg concentration calculated from the logarithms for serum Tg of nonpregnant\
    \ control females was 6.0ng/ml with a range of 1.5 to 23.6ng/ml.\n\n For pregnant\
    \ women, the mean serum Tg levels at the first, second, early third, and the late\
    \ third trimesters were 8.4 (range 1.3-18.0), 9.2 (1.7-25.6), 10.1 (1.8-22.8),\
    \ and 12.1ng/ml (5.3-25.2), respectively. The variation of log Tg levels in the\
    \ control group was not significantly different from that of the 4 pregnant groups.\n\
    \n The mean value at the late third trimester was significantly higher (p<0.05\
    \ in both statistical analyses) than that of the controls. On the other hand,\
    \ each mean value at the first, second, and early third \n\n Virtually all aspects\
    \ of thyroid hormone economy are affected by pregnancy. For example, it is well\
    \ known that T3 and T4 steadily increase during the first trimester and remain\
    \ at high levels thereafter (Chan et al., 1975; Yamamoto et al., 1979; Skjoldebrand\
    \ et al., 1982) .\n\n Concerning the values for serum Tg in normal pregnant women,\
    \ only a few reports have been published.\n\n An earlier report by Hjort and Pedersen\
    \ (1962) using a semiquantitative hemagglutination-inhibition technique showed\
    \ that serum Tg was not detected in nonpregnant women but was detected in 3, 11,\
    \ and 50% of pregnant women at the end of the first trimester, at six weeks before\
    \ delivery, and at delivery, respectively. Torrigiani et al. (1969) , using RIA,\
    \ compared the serum Tg levels of nonpregnant women with those of pregnant women\
    \ at the first and third trimesters."
  - "Les patients et familles qui ne sont pas en faveur de l'aide à mourir et ne comprennent\
    \ pas en quoi cette approche diffère de l'abstention et l'interruption des traitements\
    \ de maintien de la vie pourraient être réfractaires à l'idée d'interrompre un\
    \ traitement de maintien de la vie lorsque cela est médicalement adapté. Ils pourraient\
    \ avoir peur ou accuser les professionnels de la santé et les hôpitaux d'avoir\
    \ pour but premier d'accélérer la mort, ne comprenant pas que les recommandations\
    \ visant à limiter ou interrompre certaines interventions se fondent sur l'absence\
    \ de bienfaits du traitement. D'autres paramètres contextuels, tels que la demande\
    \ pour les services de l'USI et le nombre de lits, pourraient accentuer le manque\
    \ de confiance. Alors que l'accélération intentionnelle du processus de mourir\
    \ est illégale sauf dans le contexte très spécifique de l'aide à mourir, dans\
    \ certains pays, des médecins 6 et infirmières ont rapporté cette pratique. 7\
    \ La Société belge de soins intensifs et de médecine d'urgence (SIZ) a récemment\
    \ publié une déclaration soutenant l'utilisation de médicaments en l'absence d'inconfort\
    \ du patient afin « d'améliorer la qualité de la mort », raccourcissant ainsi\
    \ le processus de décès.\n\n 8 L'exposé de principe de la SCSI servira de fondement\
    \ pour lancer la conversation concernant les pratiques actuelles d'abstention\
    \ et d'interruption des traitements de maintien de la vie dans les USI canadiennes\
    \ et la façon dont les recommandations pourront être appliquées dans la pratique\
    \ afin de faciliter des soins de fin de vie transparents respectant les valeurs\
    \ et préférences des patients tout en tenant compte des expériences des personnes\
    \ prenant soin d'eux.\n\n Alors que les progrès en médecine et en chirurgie permettent\
    \ aux patients atteints de maladie grave de vivre plus longtemps que jamais, les\
    \ conversations portant sur les soins de fin de vie et les décisions concernant\
    \ l'abstention et l'interruption des traitements de maintien de la vie vont devenir\
    \ de plus en plus fréquentes. Dans le contexte d'un cadre clinique en évolution,\
    \ les questions éthiques entourant l'abstention et l'interruption des traitements\
    \ de maintien de la vie devront constamment être réévaluées. D'un point de vue\
    \ très personnel, la mort d'un proche fait partie de l'intimité d'une relation.\
    \ En tant que professionnels de la santé, nous avons le privilège d'être invités\
    \ dans cette relation. Ce privilège s'accompagne d'une lourde responsabilité.\
    \ L'intégrité, la compassion, et une approche interprofessionnelle fondée sur\
    \ les principes face aux défis que comportent les conversations concernant l'abstention\
    \ et l'interruption des traitements de maintien de la vie permettront que les\
    \ soins, qu'il s'agisse de ceux jusqu'à ou entourant la fin de vie, soient personnalisés\
    \ selon les besoins dynamiques et contextuels de nos patients et de leurs familles.\n\
    \n Editorial responsibility This submission was handled by Dr. Hilary P. Grocott,\
    \ Editor-in-Chief, Canadian Journal of Anesthesia.\n\n Financial support None.\n\
    \n Responsabilité éditoriale Cet article a été traité par Dr Hilary P. Grocott,\
    \ rédacteur en chef, Journal canadien d'anesthésie.\n\n Soutien financier Aucun."
  - "2 The differential diagnosis of a lung SFT includes numerous malignant and benign\
    \ tumors, including hemangiopericytoma, mesothelioma, monophasic synovial sarcoma,\
    \ sarcomatoid renal cell carcinoma, spindle cell lipoma, fibrosarcoma, leiomyosarcoma\
    \ and neurogenic tumors, including schwan-noma and malignant peripheral nerve\
    \ sheath tumors. 6 Immunohistochemistry is significant for differentiating between\
    \ these tumors. For example, leiomyosarcomas are CD34-negative and positive for\
    \ SMA and desmin. Thus, the presence of different markers in leiomyosarcoma distinguishes\
    \ it from an SFT.\n\n The most successful treatment for SFTs is surgery. In the\
    \ present case, two surgical approaches were prepared depending on the intraoperative\
    \ frozen section. If the tumor was benign, a total tumor excision was to be performed.\
    \ A lower left lung lobe resection was to be performed for a malignant tumor,\
    \ as well as a lymph node dissection involving radical dissection of the mediastinum.\
    \ In the present case, the tumor was identified as benign. The efficacy of surgery\
    \ depends on the entirety of the tumor resection. 8 Previous studies have reported\
    \ the use of adjuvant radiotherapy or chemotherapy for malignant SFTs; however,\
    \ the effectiveness of such treatment has yet to be elucidated. 3 Metastases are\
    \ usually blood-borne and have been identified in the liver, bone, brain, lungs\
    \ and muscles. 2 Chen et al. 9 reported the case of a 78-year-old male who presented\
    \ with a left gluteal soft tissue mass with a twomonth history of a newly-diagnosed\
    \ metastatic lung adenocarcinoma. H&E staining of the mass revealed an SFT containing\
    \ metastases from the adenocarcinoma. 9 Furthermore, Schirosi et al. 10 reported\
    \ that high p53 expression in SFTs may be significantly correlated with a poor\
    \ prognosis. Due to the potential for metastasis and recurrence, long-term follow-up\
    \ for several years is required. Watanabe et al. 11 described the case of a 57-year\
    \ old female who was diagnosed with adenocarcinoma of the right, middle lung lobe\
    \ and malignant visceral pleura SFT of the left, upper lung lobe. The patient\
    \ received a median sternotomy. The study illustrated the importance of the diagnosis\
    \ and treatment of two coexisting primary malignancies.\n\n In conclusion, the\
    \ present study described a rare case of an SFT arising from the lung in a male\
    \ patient. A tumor resection was successfully performed and the diagnosis of an\
    \ SFT was determined based on the immunohistochemical findings. Long-term follow-up\
    \ with radiological imaging is required to monitor the recurrence and metastasis\
    \ of this type of tumor."
- source_sentence: 'What are the limitations and challenges associated with body powered
    prosthetics, and how do they differ from myoelectric prosthetics?

    '
  sentences:
  - "n consideration of the constant evolution of issues related to MRI safety and\
    \ the need to update and revise existing guidelines and policies and procedures,\
    \ there is an ongoing challenge to be aware of the latest developments associated\
    \ with this topic. Notably, comprehensive reviews and textbooks have been written\
    \ on the subject of MRI safety and there are Websites with content that is updated\
    \ on a regular basis [1] [2] [3] [4] [5] [6] [7] [8] [9] [10] [11] [12] [13] [14]\
    \ [15] . Therefore, the reader is referred to those important resources. The goal\
    \ of this article is to provide an MRI safety update that covers selected topics\
    \ including those that are \"new\" (e.g., MRI contrast agents and nephrogenic\
    \ systemic fibrosis [NSF] ), subjects that should be reassessed because of recent\
    \ changes (e.g., screening patients and individuals), topics that deserve emphasis\
    \ because of controversy or confusion (e.g., certain policies and procedures),\
    \ and information that should be considered in light of new findings (e.g., MRI\
    \ test results for implants and devices, including items evaluated at 3 T).\n\n\
    \ The implementation of appropriate policies and procedures to screen a patient\
    \ for an MRI examination or an individual before permitting entry into the MRI\
    \ environment (i.e., the MR system room) is a vital aspect of a facility's MRI\
    \ safety program that, when conducted properly, prevents problems, separate screening\
    \ form was created specifically for individuals who need to enter the MRI environment\
    \ or MR system room. All nonpatient individuals (e.g., MRI technologist, physician,\
    \ relative, visitor, allied health professional, maintenance worker, custodial\
    \ worker, fire fighter, security officer) are required to undergo screening before\
    \ being permitted in the MRI environment. Once the form has been completed, the\
    \ MRI safetytrained health care worker must review the information and perform\
    \ a verbal interview to verify the form's content and to allow discussion of any\
    \ questions or concerns [1, 12, 14, [15] [16] [17] . If the individual undergoing\
    \ screening needs to enter the bore of the MR system and, thus, becomes exposed\
    \ to the MRI-related electromagnetic fields, this person must be screened using\
    \ the same form and criteria applied to patients [12, 14] .\n\n For patient screening,\
    \ the process may be initiated when scheduling the examination, although this\
    \ may not be possible in certain cases; at that time, it may be possible to determine\
    \ whether the patient has an implant that may be potentially contraindicated or\
    \ that requires special attention for the MRI procedure (e.g., a ferromagnetic\
    \ aneurysm clip, pacemaker, neurostimulation system) or if the patient has an\
    \ underlying condition that needs further consideration (e.g., the patient is\
    \ pregnant, has a disability, has a history of renal failure, has a metallic foreign\
    \ body). Preliminary screening helps to prevent scheduling patients who may be\
    \ inappropriate candidates for MRI.\n\n At the MRI center, the patient must undergo\
    \ comprehensive screening in preparation for the MRI examination. This preparation\
    \ entails the use of the screening form to facilitate and to document the procedure,\
    \ a review of the information on the screening form, and a verbal interview to\
    \ verify the information and allow discussion of any questions or concerns that\
    \ the patient may have. The MRI safety-trained health care worker must conduct\
    \ these critical aspects of patient screening. Additional detailed instructions\
    \ for patient screening have been described previously [1, 2, [7] [8] [9] [11]\
    \ [12] [13] [14] [15] [16] [17] .\n\n Importantly, both the screening form designed\
    \ for the patient and the one for other individuals have the following statement\
    \ to emphasize the need to prevent the introduction of unwanted items into the\
    \ MR system room:\n\n Remove This reminder along with standard policies and procedures\
    \ to control access to the MRI system room and to inspect the patient or individual\
    \ as well as all items intended for use in the scanner room will serve to prevent\
    \ accidents and injuries [1, 2, [7] [8] [9] [11] [12] [13] [14] [15] [16] [17]\
    \ .\n\n An important feature of MRI safety entails the identification of implants\
    \ and devices and careful consideration of the associated risks [1, [11] [12]\
    \ [13] [14] [15] [16] [17] . Currently, more than 1,800 objects have been tested\
    \ relative to the use of MRI, with over 600 items evaluated at 3 T or higher [12,\
    \ 14] . MRI test findings at 3 T are particularly important for patient management\
    \ given the large increase in clinical applications and growing use of this high-field-strength\
    \ MR system [18, 19] ."
  - "Assimilation of the atlas is the most frequent form of bone fusion. We recently\
    \ evaluated 510 cases of group A basilar invagina- tion. 22 The fusion of the\
    \ occipital condyle with the facet of atlas determined the presence (or absence)\
    \ of assimilation of the atlas. Two hundred and fifty patients (49%) had assimilation\
    \ of atlas, of which 238 had bilateral and 12 had unilateral atlas assimilation.\
    \ Unilateral assimilation of the atlas has been only infrequently reported in\
    \ the literature. Unilateral assimilation was always associated with torticollis\
    \ of the neck. C2-3 fusion was identified in 234 patients (45.8%). In 201 of these\
    \ patients there was assimilation of the atlas. Out of the 75 cases with group\
    \ B basilar invagination evaluated by us 18 occipitalised atlas was seen in 31\
    \ cases and C2-3 fusion was seen in 19 cases. Both occipitalized atlas and C2-3\
    \ fusion was seen in 15 cases.\n\n Out of the 510 cases with group A basilar invagination\
    \ evaluated by us, 22 subaxial vertebral bone fusions were identified in 28 cases\
    \ (5.5%). Such bone fusions have been named as Klippel-Feil abnormalities. 5 Out\
    \ of the 75 cases with Group B basilar invagination, 2 patients had Klippel-Feil\
    \ abnormality.\n\n \n\n Our observations of cases with both group A and group\
    \ B basilar invagination suggest that both neck size and the posterior fossa height\
    \ were smaller than the values seen in the normal population. 18, 22 Essentially,\
    \ it appears that both the posterior fossa or clival height and the neck size\
    \ were reduced simultaneously and proportionately. The bone fusions were most\
    \ often either above (assimilation of the atlas) or below (C2-3 fusion) the tip\
    \ of the odontoid process. Our observations suggest that the decrease in posterior\
    \ cranial fossa/clival height and shortening of the neck in the presence of normal\
    \ cord and brain stem length result in relaxation of the neural structures and\
    \ allow a stretch-free traverse over the tip of the odontoid process. The craniocervical\
    \ cord is \"humped\" over, but not significantly compressed or indented by the\
    \ odontoid process. This idea was confirmed by the measurements of brain-stem\
    \ girth opposite the tip of the odontoid process. It appears that shortening of\
    \ the neck and a decrease in posterior fossa height could be naturally occurring\
    \ protective measures that allow critical neural structures to traverse stretchfree\
    \ over the tip of the odontoid process.\n\n We recently reported our experience\
    \ with 4 patients with severe shortening of the neck and torticollis since early\
    \ childhood who presented with complaint of pain in the nape of neck as the primary\
    \ symptom. 23 ( Figs. 1-3 ) We recently treated one more similar case who also\
    \ presented with short neck, torticollis and neck pain. The ages of the 5 patients\
    \ were 4, 5, 14, 16, and 27 years. There were 1 male and 4 females. All 5 patients\
    \ had relatively well preserved neurological functions. One patient had vertical\
    \ mobile and reducible atlantoaxial dislocation, and 4 patients had anteroposterior\
    \ mobile and reducible dislocation. There was assimilation of atlas in 1 patient.\
    \ The arch of atlas was bifid in 3 patients and absent in 1 patient. Three patients\
    \ underwent atlantoaxial fixation. All the 3 patients were relieved of neck pain\
    \ after their surgery. The potential surgical difficulties due to the presence\
    \ of severe shortening of neck height and marginal presenting symptoms favored\
    \ conservative observation in the other 2 patients. Follow-up ranged from 6 to\
    \ 84 months. All patients are functionally and socially active. One of our patients\
    \ had vertical mobile and reducible atlantoaxial instability. Such instability\
    \ is a result of incompetence of facets and laxity of ligaments. In 4 patients,\
    \ there was additional presence of bifid/absent posterior arch of atlas. Our atlantoaxial\
    \ fixation procedure involved lateral mass fixation on each side. However, considering\
    \ that there is a potential for 2 fixed segments on each side to move relative\
    \ to each other in a horizontal perspective, a cross clamp fixation may possibly\
    \ be the option. 15 However, such a procedure was not adopted. All 5 cases had\
    \ relatively well-preserved neurological state despite evidence of instability\
    \ at the atlantoaxial joint, marked shortening of the neck and torticollis. Moreover,\
    \ envisaging the potential difficulties in exposure of the atlantoaxial joint\
    \ due to severe shortening of the neck, surgery was avoided in cases 1 and 2,\
    \ despite the presence of neck pain as a significant symptom in both patients\
    \ and episodic dyspnea in 1 patient. However, relatively significant neck pain\
    \ and torticollis forced the other 3 patients to undergo surgical treatment. The\
    \ atlantoaxial joint was identified to be markedly unstable in these 3 cases.\n\
    \n Spinal fusions are natural protective maneuvering in presence of atlantoaxial\
    \ instability. Spinal fusions result in shortening of neck size and are a long-term\
    \ effect of neck spasm related to atlantoaxial instability. Atlantoaxial fixation\
    \ is the treatment."
  - "In 2005, a total of 1.6 million individuals in the United States were living\
    \ with a loss of limb and it has been projected that by 2050 this number will\
    \ rise to 3.6 million 1 . With an expected increase in amputees, the need for\
    \ prosthetic development also increases. It has been reported 2-5 that 30 to 50%\
    \ of amputees are unsatisfied with the comfort or functionality of their prosthetic.\
    \ The majority of prosthetics are body powered or myoelectric. Body powered prosthetics\
    \ rely on a series of cables and harnesses attached to non-affected joints to\
    \ move the prosthesis through joint manipulation of the unaffected limb. It has\
    \ been reported 6 that body powered prostheses require high levels of force to\
    \ actuate which may result in greater fatigue or difficulty of use, especially\
    \ for children 7 . In addition, many amputees reported 2, 5 discontinuing the\
    \ use of body powered prosthetics due to their lack of comfort, aesthetic appeal,\
    \ and functionality.\n\n Recently, the development of myoelectric prosthetics\
    \ aimed to address the issues related to aesthetics, difficultly of use, comfort,\
    \ and functionality posed by body powered prosthetics. Myoelectric prosthetics\
    \ use the electromyographic (EMG) signal from muscles of the affected limb to\
    \ control the movements of an externally powered prosthetic. The EMG signal consists\
    \ of motor unit action potentials which reflect the neural signal sent from the\
    \ spinal cord to the muscles 8 . Thus, through decomposition methods the EMG signal\
    \ could be used to interpret the intensity and desired movement which can then\
    \ be used to control myoelectric prosthetics. The decomposition of the EMG signal\
    \ can be performed a number of ways including: wavelet analysis, auto-regression,\
    \ shortterm or fast Fourier transform, Fuzzy logic system, artificial intelligence,\
    \ or higher order statistics 9 . Many prosthetics utilize only one decomposition\
    \ method, however, it is likely that a combination of many methodologies will\
    \ be required to address the current issues with myoelectric prosthetics. Specifically,\
    \ in a recent study by Farina et al 8 , they examined current myoelectric controlled\
    \ upper-limb prostheses and identified specific issues that need to be further\
    \ developed which included: more intuitive, closed-loop, adaptive, robust real-time\
    \ controls (<200 ms), minimal number of recording electrodes, limited complexity,\
    \ and low power consumption 8 . Based on the reports of amputees [2] [3] [4] [5]\
    \ and the findings of Farina et al 8 , there is a need for decomposition algorithms\
    \ that can create more intuitive and robust real-time myoelectric prosthetics\
    \ (<200 ms). Previous studies [10] [11] [12] [13] [14] have reported myoelectric\
    \ prosthetic grasp times from 400 to 5,000 ms, however, there are currently no\
    \ standardized measurements for reporting these grasp times 15 (i.e. inclusion\
    \ of signal onset, decomposition time, etc. in grasp time measurement). The grasp\
    \ times ranging from 400 to 5,000 ms are well beyond what is considered a real-time\
    \ control (<200 ms) defined by Farina et al 8 . Therefore, further examination\
    \ and development of new signal acquisition techniques and decomposition algorithms\
    \ are needed to create a more robust real-time myoelectric prosthetic.\n\n It\
    \ has been reported [16] [17] [18] that many myoelectric prosthetics require extensive\
    \ training to become proficient enough to improve the performance of activities\
    \ of daily living (ADL). In addition, the greater the number of hours of training\
    \ required to become proficient enough to utilize a prosthetic are related to\
    \ greater amputee drop-out rates. Therefore, as new signal acquisition techniques\
    \ and decomposition algorithms are developed, consideration to the intuitive nature\
    \ of the device should be given to increase amputee-prosthetic retention and usability\
    \ of the prosthetic.\n\n The primary method for controlling myoelectric prosthetics\
    \ currently utilizes the EMG signal, however, some recent studies have proposed\
    \ the use of the mechanomyographic (MMG) signal. The MMG signal measures the lateral\
    \ oscillations of the activated muscle and occurs after the onset of the EMG signal\
    \ 19, 20 . The use of the MMG signal for prosthetic controls is relatively new\
    \ compared to body powered or EMG based prosthetics and have primarily been proposed\
    \ in research laboratories and not commercially available prosthetics. For example,\
    \ Silva et al 21 , reported using the root mean square (RMS) amplitude of the\
    \ MMG signal to identify extension and flexion movements from the forearm, however,\
    \ there were incorrect movements reported due to artifact or unconscious movements.\
    \ In addition, Al-Mulla and Sepulveda 22 proposed a wavelet decomposition process\
    \ for the MMG signal to control extension and flexion movements, but was only\
    \ able reach 70% accuracy."
- source_sentence: What is the recommended approach for managing spontaneous rupture
    of the esophagus?
  sentences:
  - "Tables I and II show our experience with instrumental oesophageal perforations.\n\
    \n Spontaneous rupture of the lower oesophagus is rare and usually presents as\
    \ an acute abdomen. It should always be considered when a patient who has the\
    \ signs and symptoms of an acute abdomen is operated upon and no lesion is found\
    \ in the abdomen to account for the symptoms. The abdomen should not be closed\
    \ until a perforated oesophagus has been excluded. The diagnosis can often be\
    \ made at this stage by the anaesthetist, because he will almost certainly have\
    \ inflated the patient's lungs with oxygen prior to intubation, and much of the\
    \ gas will pass down the oesophagus through the perforation and rise up the mediastinum\
    \ to the supraclavicular fossae to be palpated there as crepitus.\n\n Spontaneous\
    \ rupture of the oesophagus may occur in the healthy oesophagus, in one weakened\
    \ by inflammation, or as a terminal event in the chronically ill patient.\n\n\
    \ Rupture is almost always abrupt in onset, with no symptoms previously referable\
    \ to the oesophagus, but it may also occur insidiously in debilitated and chronically\
    \ ill patients, especially if there is a fungus infection of the oesophagus. The\
    \ rupture usually occurs at the lower end of the oesophagus and the tear is linear\
    \ and in the longitudinal axis. Two main factors operate to cause spontaneous\
    \ rupture of the oesophagus: (1) increased intraluminal pressure in the oesophagus;\
    \ (2) (Table IV) . What one strives for is to get an oesophago-cutaneous fistula\
    \ as soon as possible by adequate and efficient drainage of the pleural cavity\
    \ and mediastinum, at the same time ensuring that the lung remains fully expanded\
    \ so that a track can form along the drainage tubes to the skin. In the very ill,\
    \ shocked patient this will, in the first instance, mean the rapid insertion of\
    \ an intercostal drainage tube into the right or left pleural cavity. Suction\
    \ is applied to this tube through an underwater seal (closed drainage). The oesophagus\
    \ is intubated, and gentle, continuous suction is applied to keep the oesophagus\
    \ empty. Intensive antibiotic cover is started (see below). It will be necessary,\
    \ once the acute phase of shock is over, and in the less acutely ill patient,\
    \ to ensure better drainage. Through a small right or left thoracotomy, the pleural\
    \ cavity is cleared of fluid and fibrin, and a large-bore drainage tube is accurately\
    \ positioned next to the perforation. At this time it is often difficult to find\
    \ the actual perforation because of fibrin and granulation tissue. One way to\
    \ demonstrate the perforation is to cover the posterior mediastinum with saline,\
    \ then to ask the anaesthetist to blow down an indwelling oesophageal tube; the\
    \ bubbles that ensue localize the perforation (Fig. 2) . At this operation two\
    \ gastrostomies are done (Fig. 3) . One is used to keep the stomach empty. The\
    \ reason the stomach is kept as empty as possible is because the negative pressure\
    \ in the affected pleural cavity tends to suck gastric juice up the oesophagus\
    \ through the perforation and so into the pleural cavity. This is especially true\
    \ in infants with oesophageal atresias, in whom the anastomosis has broken down,\
    \ and in adults where the perforation is in the lower two-thirds of the oesophagus.\
    \ A second tube is threaded out into the jejunum and used for feeding.\n\n Adequate\
    \ intravenous replacement of fluid, calories, and protein must be given. For two\
    \ to eight weeks these patients will lose a large quantity of protein and electrolyte-rich\
    \ fluid and at the (Dawes, 1964"
  - "98 However, resistance to fosfomycin due to overexpression of enolpyruvyl transferase\
    \ has been also observed.\n\n Several modifying enzymes have been described, sometimes\
    \ in species that could produce this antibiotic, 99 but also in strains that harbor\
    \ plasmidic or chromosomal resistance. In all cases, they lead to the formation\
    \ of inactive adducts:\n\n • FosA is a metalloenzyme. It opens the epoxide ring\
    \ of fosfomycin and forms a covalent bond between the sulfhydryl residue of the\
    \ cysteine in glutathione and the C-1 of fosfomycin. [100] [101] [102] This type\
    \ of resistance has been found in some Gram-negative strains (Enterobacteriaceae,\
    \ Pseudomonas spp, and Acinetobacter spp), 103 where it is either encoded by plasmids\
    \ or by the chromosome. 104 It is worth underlining the important similarities\
    \ between the DNA of these genes and those of several strains of Streptomyces\
    \ spp.\n\n • FosB allows the formation of L-cysteinefosfomycin. This type of resistance\
    \ has been found in Gram-positive species only, either encoded by plasmids in\
    \ Staphylococcus spp, 103, 105, 106 or by the chromosome in Bacillus subtilis.\
    \ 107 Because the amino acid sequence of FosB is 48% identical to that of FosA,\
    \ a common origin is likely. 106, 107 • FosC allows fosfomycin phosphorylation\
    \ with ATP as a cosubstrate. It has been described in P. syringae, a species that\
    \ naturally produces fosfomycin.\n\n A similar mechanism has been described with\
    \ fomA and fomB in Streptomyces wedmorensis, 108 and with rare strains of P. aeruginosa.\n\
    \n • FosX leads to a water adduct. It has been described in Mesorhizobium loti\
    \ and Listeria monocytogenes. [110] [111] [112] Mutations in transport systems\
    \ (glpT or uhpT) are easily observed in laboratory studies, and lead to a decrease\
    \ in uptake of the drug, and thus resistance to fosfomycin. 85, 86, 113, 114 They\
    \ may be associated with mutations in their regulatory genes, such as uhpA (encoding\
    \ a regulator protein required for activation of the uhpT promoter), or ptsI and\
    \ cyaA, the products of which are involved in the synthesis of cyclic AMP and\
    \ therefore regulate the level of glycerophosphate transport.\n\n Although many\
    \ mechanisms of resistance to fosfomycin have been described since its discovery,\
    \ mutations of fecal E. coli strains during treatment of uncomplicated acute cystitis\
    \ do not appear to be clinically relevant, which sets them apart from the fluoroquinolones.\
    \ 117 For some authors, the observation that fosfomycin resistance does not increase\
    \ with the passage of time could be due to the fact that mutations in murA and\
    \ in transport systems have a biological cost which is not compatible with their\
    \ persistence in the community. 114, 118, 119 But another concern about the lack\
    \ of development of fosfomycin resistance must be considered, ie, that it has\
    \ been little used in the past, either in human or animal therapies.\n\n Considering\
    \ the present status of its susceptibility, fosfomycin often appears to be an\
    \ interesting therapeutic option for the treatment of multidrug-resistant Enterobacteriaceae,\
    \ 9 in vitro susceptibility testing and interpretative standards Susceptibility\
    \ testing for fosfomycin may be performed by the agar disk diffusion method, the\
    \ gradient diffusion method (Etest ® , AB Biodisk, Solna, Sweden), the agar or\
    \ broth dilution method, or by the break point dilution method. Unfortunately,\
    \ for many reasons, fosfomycin susceptibility results were not reported in many\
    \ of the publications dealing with multidrug-resistant bacteria.\n\n The results\
    \ of in vitro susceptibility testing may be influenced by many factors. In particular,\
    \ phosphate ions are able to inhibit the glycerophosphate transport system, while\
    \ a high concentration of dextrose represses the hexose phosphate uptake system,\
    \ therefore false resistant results may be reported if the medium does not include\
    \ an inducer for the hexose phosphate uptake system. 86, 93, 133 In correct for\
    \ this, the practice of adding glucose-6-phosphate to Mueller Hinton medium was\
    \ generally adopted."
  - "Multiple myeloma (MM), also known as plasma cell myeloma, is characterized by\
    \ excess bone marrow plasma cells, monoclonal paraproteins, bone lytic lesions,\
    \ renal disease and immunodeficiency [1] . Around the world, MM is the second\
    \ most frequent hematologic malignancy after non-Hodgkin lymphoma [2] .\n\n Interferon\
    \ regulatory factor (IRF) belongs to the nuclear transcription factors, named\
    \ by its regulation of interferon [3] . IRF families, including more than 10 members,\
    \ are identified to have recognition of domain amino terminal of DNA with specific\
    \ sequences and binding function. Functionally, IRF not only regulates cell response\
    \ to interferon, but also plays a pivotal role in cell proliferation, apoptosis,\
    \ oncogenic conversion susceptibility and T cell immune responses [3] . Multiple\
    \ myeloma oncogene 1 (MUM1) / Interferon regulatory factor 4 (IRF4) is one of\
    \ interferon regulatory factors, which has been shown to be an important transcription\
    \ factor and is involved in the negative regulation of Th17 cells differentiation\
    \ and the production of Th17-related cytokines, including IL-17, IL-21 and IL-22\
    \ [4, 5] . Mechanically, IRF4 may play a key role in the IL-21-mediated Th17 cells\
    \ differentiation by influencing the balance of RORα, RORγ and Foxp3 [6] . In\
    \ plasma cells, IRF4 is also known to be an important modulator for their differentiation\
    \ [7] . Moreover, IL-1 drives the early differentiation of Th17 cells by regulating\
    \ the expressions of IRF4 and RORγt [8] . Therefore, mounting evidence support\
    \ that IRF4 plays a role in the differentiation of Th17 cells.\n\n Th17 cells\
    \ are recently identified to participate in bacterial infections, and numerous\
    \ immunologic diseases [9] . The emblematic Th-1 or Th-2 lineages secrete IL-17\
    \ rather than IL-4 or IFN-γ [10] . A recent study indicated that IL-17 plays a\
    \ critical role in the control of the phenotype switch from Th-1 to Th-17, and\
    \ leads to lytic bone disease in MM [11] .\n\n Immunotherapy has emerged as a\
    \ promising approach for MM treatment recently, but it still lacks targeted specifically\
    \ and optimized drugs [12] . It is generally accepted that Th17 cells and its\
    \ relevant cytokines are critical components in the autoimmunity. IRF4 is recognized\
    \ as an important modulator for the differentiation of Th17 cells. Therefore,\
    \ defining the relationship between IRF4 and Th17 cells may shed a light for the\
    \ treatment of MM.\n\n \n\n To evaluate the expression of IRF4 in MM patients,\
    \ we analyzed public gene expression data of purified plasma cells from MM patients\
    \ (n = 351) compared with normal plasma cells (NPC) (n = 22) or monoclonal gammopathy\
    \ of undetermined significance (MGUS) cells (n = 44). Statistical comparison of\
    \ the IRF4 expression levels in the graph showed that significant up-regulation\
    \ of IRF4 is obvious in 351 MM patients compared with NPC and MGUS (p < 0.001,\
    \ Figure 1A ). Moreover, we investigated the correlation between IRF4 expression\
    \ and survival. Survival months were longer in patients with low IRF4 expression\
    \ than in those with high IRF4 expression (p < 0.05, Figure 1B ). Next, we measured\
    \ the IRF4 expression in bone marrow tissues of 58 MM patients and healthy donors\
    \ by immunohistochemistry. The results showed that 38 cases of MM patients exhibited\
    \ a distinct increase of IRF4 expression (+~+ + + +), the positive rate was 65.5%\
    \ (38/58), including 12 cases (+), 15 cases (+ +), 6 cases (+ + +), 5 cases (+\
    \ + + +). IRF4 is found to be expressed in MM cell nucleus, and not observed in\
    \ lymphocytes, macrophages, and neutrophils ( Figure 1C ). We then analyzed the\
    \ correlations between the expression of IRF4 and the clinical parameters. No\
    \ association was found between the expression of IRF4 and the clinical parameters,\
    \ such as gender, age, proportion of plasma cells, blood sedimentation (ESR),\
    \ hemoglobin (Hb), C-reactive protein (CRP), lactate dehydrogenase (LDH), serum\
    \ creatinine (sCr) and serum albumin (ALB Figure 1D ; ISS stage: p = 0.002, Figure\
    \ 1E )."
- source_sentence: 'What is the relationship between the times of HR and HL and the
    times of right and left ventricular ejection?

    '
  sentences:
  - "The precautionary principle, first applied to the field of environmental safety,\
    \ states that, in the face of uncertain risk and incomplete data, policy-makers\
    \ should err on the side of restraint. The corollary of the principle states the\
    \ prominence of health over all other considerations, especially economic.\n\n\
    \ In Malaysia, after the Nipah vims had been recognised as a new entity, control\
    \ measures were implemented which included restrictions on the importation and\
    \ movement of pigs, culling of pigs in affected areas, minimising contact between\
    \ humans and potentially infected animals, Wearing protective clothing and hygiene\
    \ measures for humans in contact with pigs, and active surveillance for human\
    \ cases. High-level government commitment was essential in enacting control measures.\
    \ Co-ordination between veterinary and human public health services was reinforced\
    \ and co-operation is now ongoing.\n\n Although the outbreak has been controlled\
    \ successfully, various problems were identified, including co-ordination between\
    \ human and veterinary public health services and the other government departments\
    \ involved, co-ordination of international inputs, and response to the media.\
    \ The need for an effective intersectoral group dealing with zoonotic diseases\
    \ is one of the lessons that has been learnt during the Nipah virus outbreak (27)\
    \ .\n\n The occurrence of a significant number of outbreaks of new and emerging\
    \ zoonotic diseases over the past few years is a matter of concern. Similar occurrences\
    \ can be expected in the future as the continuous alteration of the environment\
    \ and the establishment of human settlements in formerly uninhabited areas, particularly\
    \ in the tropics, are factors that favour the emergence of diseases, the agents\
    \ of which may have remained undiscovered in nature for centuries. To these problems\
    \ are added the ever-increasing demand for animal protein foods, the acceleration\
    \ of international trade, especially of food products and livestock, and the increasing\
    \ number of people who are potentially more susceptible to opportunistic infection\
    \ by agents of animal origin. Apart from the direct impact on human health through\
    \ sickness and death, these new, emerging zoonoses can have other important consequences,\
    \ such as the following:\n\n -to serve as a reminder of the existence of infectious\
    \ diseases and the capacity of these diseases to occur very unexpectedly in new\
    \ locations and new animal species -to stress the need for stronger international\
    \ co-operation, better local, regional and global networks for communicable disease\
    \ surveillance and pandemic planning -to contribute to the definition of new paradigms,\
    \ especially relating to food safety policies and more generally to the protection\
    \ of public health -to reinforce the importance of intersectorial collaboration\
    \ for disease containment in addition to that of independence of sectorial interests\
    \ and transparency when managing certain health risks.\n\n The challenge to public\
    \ health posed by effective surveillance, prevention and control of zoonotic diseases\
    \ can be met. The recent response to a number of outbreaks, for example, human\
    \ monkeypox in central Africa, avian influenza in Hong Kong, RVF in Kenya and\
    \ Somalia, and Nipah virus in Malaysia, has shown the types of partnership required.\n\
    \n The role of the WHO in this increasingly important area of public health is\
    \ to strengthen the capacity of countries and the international community to prevent\
    \ such dangers from developing, and to minimise the impact of outbreaks on public\
    \ health. To achieve this, the WHO works in partnership with other organisations,\
    \ within a global framework, to reshape and strengthen the network for communicable\
    \ disease surveillance and control. The aim is to detect and contain the spread\
    \ of viral, bacterial and zoonotic diseases where and when they occur.\n\n Les\
    \ zoonoses émergentes et leurs conséquences sur la santé publique \n\n Nombre\
    \ de maladies nouvelles, émergentes et réémergentes chez l'homme sont provoquées\
    \ par des agents pathogènes transmis par des animaux ou des produits d'origine\
    \ animale. De nombreuses espèces animales, domestiques et sauvages, servent de\
    \ réservoir à ces agents, virus, bactéries ou parasites. Compte tenu de la diversité\
    \ des espèces animales concernées, la surveillance et la prophylaxie efficaces\
    \ des zoonoses constituent un véritable défi. Les auteurs décrivent les conséquences\
    \ directes et indirectes des zoonoses émergentes sur la santé publique. Les conséquences\
    \ directes sont celles qui se définissent en termes de morbidité et de mortalité.\
    \ Les conséquences indirectes concernent l'incidence des maladies émergentes sur\
    \ deux catégories de personnes : les professionnels de la santé et la population\
    \ dans son ensemble. L'évaluation par les professionnels de l'importance de ces\
    \ maladies détermine les pratiques et l'organisation en matière de santé publique,\
    \ la définition de thèmes de recherche et l'affectation des ressources aux niveaux\
    \ national et international."
  - "Haemangioma is a common type of vascular tumour in paediatric age group [1] .\
    \ Most of them are benign and non-life threatening [1] . Kasabach Merritt syndrome\
    \ (KMS) is a combination of giant haemangioma, thrombocytopenia and consumptive\
    \ coagulopathy [1] [2] [3] [4] [5] . It presents with diverse clinical presentation\
    \ and may be a part of other recognized syndrome [1, 2] . KMS is a well-recognized\
    \ but rare clinical entity that may be life threatening [1] [2] [3] [4] and bears\
    \ considerable anesthetic implications [3] [4] [5] .\n\n Here, we would like to\
    \ report a case of an 11-year-old boy, after obtaining a written permission from\
    \ parents, who came to us for preoperative evaluation with a haemangioma (15.7×13.3\
    \ cm in maximum dimension) involving the left forearm [Table/ Fig-1] . It began\
    \ to appear as a small lesion without causing any associated problem at the age\
    \ of three years. Though the patient have attended various medical services, he\
    \ was not provided with any conclusive diagnosis nor there any improvement in\
    \ his symptomology. During the last eight years it enlarged many folds with destruction\
    \ of radius, erosion & remodeling of ulna [Table/ Fig-2 ]. As there was profound\
    \ bonny destruction, an above elbow amputation was planned by his surgical team.\
    \ His bed side physical examination did not reveal any other significant abnormality.\
    \ All preoperative lab parameters were normal except for a platelet count of 72,000/µL.\
    \ A subsequent coagulation profile revealed a prothombin time prolonged by five\
    \ seconds and international normalized ratio (INR) of 1.52. Considering the possibility\
    \ of KMS, he was referred to haematology service. He was diagnosed with KMS by\
    \ the haematology service and no preoperative transfusion was advised. The possibility\
    \ of massive blood loss and institution of massive blood transfusion protocol\
    \ was discussed and planned accordingly. He was provided general anaesthesia with\
    \ endotracheal intubation and mechanical ventilation during the surgery. Total\
    \ anaesthesia time was 90 min and trachea was extubated at the end of surgery.\
    \ We did not encounter any reduction of platelet count or deterioration of coagulation\
    \ profile during the intraoperative period and there was no need of A practice\
    \ derived consensus statement discussing diagnostic workup, surgical and non-surgical\
    \ treatment modalities of KMS has been published very recently [2] . Apart from\
    \ the problems associated with anatomic locations of the tumour [1, 3] and haematological\
    \ abnormalities [1] [2] [3] [4] [5] , cardiac derangement from high-volume arterio-venous\
    \ shunting is also a concern [2] [3] [4] . The anaesthetic implications of pharmacological\
    \ measures used during the treatment of KMS should also be addressed with assiduity\
    \ [1] [2] [3] . Anaesthesia and surgery may possibly trigger disseminated intravascular\
    \ coagulation and induce severe bleeding [3] . Although KMS is associated with\
    \ mortality and morbidity [1, 2] , case reports of successful perioperative outcome\
    \ is also available in literature [3, 5] . Recently, survival benefit has been\
    \ documented in patients with traumatic hemorrhage that were managed with hemostatic\
    \ therapy guided by viscoelastic point-of-care coagulation devices (thromboelastography)\
    \ [6] . Thromboelastography is also increasingly being used in hemorrhage of non-traumatic\
    \ origin [7] . In a patient with KMS, FloTrac/Vigileo system was used successfully\
    \ to guide appropriate resuscitative measures that ensured stable perioperative\
    \ hemodynamics [5] . Thus, the authors believe that the impact of use of viscoelastic\
    \ point-of-care coagulation and noninvasive cardiac output monitoring devices\
    \ on mortality and morbidity of patients with KMS should be evaluated.\n\n Haemangioma\
    \ is a common condition in pediatric age group [1, 2] , thus anaesthesiologists\
    \ are expected to encounter patients with hemangioma frequently. KMS is a rare\
    \ clinical manifestation in patients with haemangioma, moreover its clinical features\
    \ are diverse [1] [2] [3] [4] [5] [6] [7] . Although this particular case did\
    \ not pose much challenge in the perioperative period, this discussion should\
    \ serve to remind anesthesiologists of the possible complications and management\
    \ issues that may be encountered with KMS.\n\n [Table/ Fig-1] : Haemangioma involving\
    \ the left forearm [Table/ Fig-2 ]: X-ray of the left forearm showing a large\
    \ expansile soft tissue density (arrow mark) lesion in the mid and distal forearm\
    \ causing profound bone erosion and deformity, especially involving the radius\
    \ and also the ulna"
  - "In addition, measurements from the onset of the QRS complex to the first major\
    \ deflection of the first heart sound, the carotid upstroke, the carotid shoulder,\
    \ the beginning of the second heart sound, and the beginning of the second component\
    \ of the second heart sound are included. found to correlate with the initial\
    \ positive acceleration peak of the carotid pressure rise in a few subjects from\
    \ whom these data were obtained by graphic differentiation of the carotid pressure\
    \ pulse (figure 3). Furthermore, previous work from this laboratory has already\
    \ established the time of this acceleration peak obtained from carotid pressure\
    \ pulses in 10 normal subjects as occurring at .14 second after the Q.' Figure\
    \ 3 shows a comparison of the ballistocardiograph, the carotid pulse, and the\
    \ graph- was found to be almost synchronous with the anacrotic shoulder of the\
    \ carotid pulse (carotid shoulder). The carotid shoulder was taken as the point\
    \ of maximal deceleration of the carotid pulse pressure rise, and could be selected\
    \ with fair accuracy from simple inspection of the carotid pulse curve. Figure\
    \ 3 clarifies the relationship of the carotid shoulder and the point of maximal\
    \ deceleration of the carotid pulse. A temporal relationship between the shoulder\
    \ of the carotid pulse and one of the high frequency J peaks has been noted by\
    \ Rappaport.9 Similarly, the JD point may be related to slope changes of the carotid\
    \ pulse in late systole. This slope change is visible in figure 8 . The subscript\
    \ D indicates the delayed J wave. The K point has not been shown to be related\
    \ to the physiologic events as measured. The 2 L peaks, LL and LR, have a close\
    \ relationship to the first and second components of the second heart sound. LL\
    \ occurs during the rapid downstroke of the carotid incisura, at the time of the\
    \ first component, and LR occurs slightly later with the second component of the\
    \ second sound.\n\n A striking correlation was found between the times of HR and\
    \ HL and the reported times of right and left ventricular ejection, respectively.\
    \ In 10 subjects studied by cardiac catheterization, Braunwald, Fishman, and Cournand10\
    \ found the interval between the onset of the Q wave of the electrocardiogram\
    \ and right ventricular ejection to be .080 ±t .0079 second. This is to be compared\
    \ to a Q to HR time of .085 + .010 second in the present study. Braunwald fig.\
    \ 4) . A similar early presystolic force has been described by others, using high\
    \ frequency technics.\", 12 It has been observed to be present with atrial fibrillation,\
    \ showing its independence from atrial systole.\n\n Following the F-G wave, there\
    \ is a headward deflection or force having its onset at approximately .05 second\
    \ after Q. The time of onset correlates with the first major vibration of the\
    \ first heart sound, and this upstroke (the G-H wave) has been observed to be\
    \ exaggerated in patients with mitral stenosis, and other conditions causing pulmonary\
    \ hypertension (fig. 4) . It is postulated that the initial event at the onset\
    \ of right ventricular contraction is an acceleration of an impulse or \"bolus\"\
    \ of blood toward the base of the heart.* This headward acceleration of blood\
    \ would result in a footward force on the body (the F-G downstroke). The subsequent\
    \ deceleration (footward acceleration) resulting from the impact of this \"bolus\"\
    \ against the closed A-V and semilunar valves would result in a headward acceleration\
    \ of the body. When the impact force on the pulmonic valve has become sufficiently\
    \ great to open the valve, there is a sharp headward acceleration of the now unimpeded\
    \ pulse wave as it flows into the pulmonary artery. This is reflected by a footward\
    \ acceleration of the body in reaction, causing the downstroke following the HR\
    \ point. Meanwhile, an analogous headward force has begun on the left side of\
    \ the heart because of impact on the aortic valve, and terminates when the aortic\
    \ valve opens, normally somewhat later than the opening of the pulmonic valve.\
    \ This impact -produces a visible headward deflection in the force ballistocardiogram\
    \ terminating at the HL point. The pulse wave then is accelerated headward in\
    \ the aorta, producing a footward reaction on the body, the HW-IL downstroke.\n\
    \n Ejection Systole. The HL point occurs at the time of left ventricular ejection,\
    \ as measured by Braunwald10 and as may be predicted from the time of the upstroke\
    \ in the carotid pulse. The subsequent footward force on the body would be the\
    \ anticipated reaction to the headward acceleration of blood in the aorta."
- source_sentence: What are the systemic manifestations of Fournier's syndrome?
  sentences:
  - "Fournier's syndrome is defined as a suppurative bacterial infection of the perineal,\
    \ genital, or perianal regions. Those conditions often lead to thrombosis of subcutaneous\
    \ vessels and with infection, resulting in the development of gangrene of the\
    \ overlying skin and subcutaneous tissue [1] . This rare syndrome is a rapidly\
    \ progressive and potentially lethal necrotizing fasciitis caused by invasive\
    \ infections of the lower part of the genitourinary tract, anorectal soft tissue,\
    \ and genital skin [1, 2] . The devastating rapidity is typical, as evidenced\
    \ by the fact that the mean duration of symptoms to become the target of emergency\
    \ operation is just a few days, and a majority of patients are seriously ill at\
    \ the time of admission. Anesthetic management of patients with this syndrome\
    \ is often difficult, due to its devastating nature as well as significant comorbid\
    \ diseases. However, because of the infrequency of the syndrome, there is limited\
    \ information regarding the anesthetic management of this disease. We recently\
    \ encountered the anesthetic management in three cases of patients with Fournier's\
    \ syndrome. There were three initial emergency and six additional elective operations\
    \ under general anesthesia, except one spinal anesthesia in an elective case.\
    \ Therefore, we report these cases and review the relevant literatures.\n\n Immediate\
    \ and, if required, repetitive operation is important for saving lives in patients\
    \ with this syndrome [1] [2] [3] . Fournier's syndrome is frequently associated\
    \ with certain diseases and conditions. Diabetes mellitus is probably the most\
    \ common comorbid disease, as evidenced by our cases [1] . Even when the patient\
    \ has diabetes, as in our two patients, Fournier's syndrome might be the first\
    \ clinical disease to be detected. The second common condition is alcoholism,\
    \ such as in all our patients, because any disorder that compromises the immunity\
    \ enhances development of a severe infection [1, 2] . The other associated clinical\
    \ features are malnutrition, prolonged hospitalization, radiation therapy, chemotherapy,\
    \ neurologic deficits, cirrhosis, leukemia, renal failure, organic heart disease,\
    \ vasculitis, intravenous drug abuse, lupus, cirrhosis, AIDS and steroid medications.\
    \ In obstetric anesthesia, cervical or pudendal nerve block can induce the syndrome\
    \ as well [1] .\n\n Abnormal laboratory results include hyperglycemia, hypocalcemia,\
    \ anemia, leukocytosis and thrombocytopenia, as evidenced by our patients [1]\
    \ . Most of those abnormalities are due to sepsis. The systemic manifestations\
    \ include fever, tachycardia, and volume depletion similar to those of severe\
    \ peritonitis [1] . All our patients also had sepsis in terms of the preoperative\
    \ definition. Two patients looked to be in late distributive shock and the other\
    \ patient in early distributive shock, respectively. In the case of no active\
    \ bleeding, delayed or inadequate volume resuscitation is a significant error\
    \ that would have detrimental effects on the patients's outcome in septic shock.\
    \ If initial crystalloid fluid resuscitation is insufficient to raise the mean\
    \ arterial pressure to 65 mmHg and the CVP to 8 to 12 mmHg, then vasopressors\
    \ and inotropes are needed as the second step in the guidelines of early goal-directed\
    \ therapy [4] . It is rational to use a blood transfusion when the hematocrit\
    \ is below 30% when invasive monitoring might be indicated [4] . Among two patients\
    \ in late septic shock, one patient fortunately responded to our initial fluid\
    \ resuscitation, whereas the other patient needed dopamine for hypotension. In\
    \ another patient, early shock occurred, and a blood transfusion and dopamine\
    \ and norepinephrine were required to achieve an adequate cardiac output and oxygen\
    \ delivery to maintain vital organ function were needed, because his affected\
    \ area including www.ekja.org\n\n Vol. 61, No. 2, August 2011 lower extremity\
    \ was wide and bleeding was ongoing. His septic manifestations reoccurred sporadically\
    \ over four months of hospitalization and progressed into cardiorespiratory collapse\
    \ and death after five debridements under general anesthesia. The preanesthetic\
    \ investigation of the extent of the lesion is also important, because the ambiguity\
    \ of the region involved could influence the choice of the anesthetic technique.\
    \ Koitabashi and colleagues [5] suggested the avoidance of spinal anesthesia in\
    \ the presence of lumbar subcutaneous gas. Sato and associates [3] recommended\
    \ that using general anesthesia is preferable for controlling physiologic homeostasis.\
    \ Fournier's syndrome in particular originateed in anorectal disease, which is\
    \ the usual subject of regional anesthetic procedures, is known to be aggressive,\
    \ produces marked systemic toxicity and myonecrosis as in our mortal case, and\
    \ can be connected with higher mortality [1] . Hence, particular attention should\
    \ be necessary for the choice of the anesthetic procedures. The reason we performed\
    \ spinal anesthesia at the secondary wound closure one month after initial debridement\
    \ in one patient was that he underwent computer tomography to depict the accurate\
    \ extent of the lesion. Among gravely ill patients it seems wise to not waste\
    \ precious time doing a lot of investigation to perform regional anesthesia.\n\
    \n The degree of debridement for Fournier's syndrome is variable from simple incision\
    \ to wide excision with massive bleeding [2] . Many surviving patients require\
    \ secondary wound closure, skin graft or a reconstructive flap procedure. In spite\
    \ of appropriate therapy, the mortality rate in Fournier's syndrome is reported\
    \ to exceed 40% in many studies [1] [2] [3] . Prolonged sepsis manifested by fever\
    \ or hypotension and lasting for more than 48 hours was experienced among about\
    \ 40% of patients, as in our expired patient [2] . Some reports have associated\
    \ older age, female gender, anorectal causes, delayed admission, the presence\
    \ of debilitating conditions such as renal failure and hepatic dysfunction with\
    \ high mortality. Laboratory parameters on admission statistically related to\
    \ fatality include low hematocrit, calcium, albumin, and cholesterol, and high\
    \ BUN and alkaline phosphatase levels. The syndrome could rapidly progress into\
    \ prolonged sepsis, DIC, pneumonia, respiratory failure, diabetic ketoacidosis,\
    \ renal failure, and heart failure.\n\n In conclusion, our experiences emphasize\
    \ that Fournier's syndrome has a fatal potential, so optimal conduct of anesthesia\
    \ requires forethought and sound management as well as an understanding of the\
    \ pathophysiology of this syndrome for successful anesthesia."
  - "tissue infiltration of polymorphonuclear neutrophils (PMN). In response to bacterial\
    \ infection, neutrophil activation in the lungs leads to ALI (53) and PMN infiltration\
    \ represents a primary mechanism for sepsis-induced pulmonary dysfunction and\
    \ injury (10) .\n\n In the normal lung, continuous fluid clearance by the lung\
    \ lymphatics is essential for the maintenance of dry alveolar surfaces (60) .\
    \ Ion pumps and channels positioned on alveolar epithelial cell surfaces generate\
    \ transepithelial osmotic gradients that drive water movement from the alveolar\
    \ space into the lung interstitium. The key pumps and channels involved in alveolar\
    \ fluid transport include aquaporin 5 (Aqp5), cystic fibrosis transmembrane conductance\
    \ regulator (CFTR), epithelial sodium channel (ENaC), and Na ϩ -K ϩ -ATPase (37)\
    \ . In ALI, the lung endothelial barrier is damaged, resulting in abnormal capillary\
    \ permeability and pulmonary edema as the lymphatic clearance is overwhelmed (60)\
    \ . In contrast to the endothelium, the alveolar epithelium is often spared in\
    \ sepsisinduced ALI, and therefore active ion and fluid clearance is preserved\
    \ (56) . Recent reports, however, suggest that ion pump and channel functions\
    \ are affected early during sepsis (37) .\n\n To maintain a \"dry\" alveolar space\
    \ and normal lung function, it is essential that the milieu within the alveolar\
    \ space remain distinct from that of the subepithelial compartment (30) . The\
    \ maintenance mechanism depends on the formation and proper functioning of specialized\
    \ molecular structures between adjacent cells comprising the epithelial sheet,\
    \ the so-called tight junctions (TJ). The alveolar epithelial TJ is a complex\
    \ of integral membrane proteins that firmly interact with the epithelial cytoskeleton\
    \ (27) . TJs serve as a regulated semipermeable barrier that limits passive diffusion\
    \ of solutes across paracellular pathways between adjacent cells (1). Han et al.\
    \ (30) recently showed that ALI was associated with diminished expression and\
    \ function of TJ proteins in lung epithelium.\n\n Emerging evidence indicates\
    \ that inflammation and coagulation are connected (34) . This is especially important\
    \ in sepsis as inflammatory cytokines activate the coagulation cascade and inhibit\
    \ fibrinolysis, thereby shifting normal hemostasis toward a prothrombotic state.\
    \ Sepsis-driven coagulation induces consumption of coagulation factors leading\
    \ to disseminated intravascular coagulation (DIC), a phenomenon frequently associated\
    \ with sepsis-induced ALI. Indeed, impairment of capillary blood flow during sepsis\
    \ has been observed in human tissues by orthogonal polarization spectral imaging\
    \ and sidestream dark-field imaging (17) . It is currently estimated that as many\
    \ as 50% of all sepsis patients develop DIC (25) . Bastarache et al. (6) have\
    \ recently reported that in ALI, the alveolar compartment contains high levels\
    \ of tissue factor (TF) procoagulant activity that favor fibrin deposition in\
    \ the air spaces. TF activation results in thrombin formation, which augments\
    \ permeability and enhances inflammation (14) .\n\n Vitamin C is a small, water-soluble\
    \ molecule that readily acts as a one-or two-electron reducing agent for many\
    \ radicals and oxidants. Vitamin C is bioavailable equally as either dehydro-L-ascorbic\
    \ acid (DHA) or L-ascorbic acid (AscA). Specialized cells can take up reduced\
    \ vitamin C (AscA) through Na ϩ -dependent ascorbate cotransporters (SVCT1 and\
    \ SVCT2). Most other cells take up vitamin C in its oxidized form (DHA) via facilitative\
    \ glucose transporters (48) . Sepsis lowers plasma AscA concentrations (57) and,\
    \ importantly, low vitamin C levels correlate inversely with multiple organ failure\
    \ and directly with survival (9) . Studies using animal models show that vitamin\
    \ C prevents endotoxin-induced hypotension and improves arteriolar responsiveness,\
    \ arterial blood pressure, capillary blood flow, liver function, and survival\
    \ in experimental sepsis (4, 59) .\n\n We recently showed that vitamin C, administered\
    \ after the onset of endotoxemia, attenuates proinflammatory and procoagulant\
    \ states that induce lung vascular injury and improved survival in an animal model\
    \ of sepsis (23) . In the present study we show that vitamin C attenuates sepsis-induced\
    \ ALI by enhancing alveolar epithelial barrier integrity. Furthermore, vitamin\
    \ C induced the expression of ion channels and pumps, which play critical roles\
    \ in improving alveolar fluid clearance. In addition, we also observed marked\
    \ changes in the viscoelastic clot properties of septic mice blood."
  - "Nucleotides can be synthesized de novo or recycled through a salvage pathway\
    \ in vivo. In the salvage pathway, nucleotides are synthesized from extracellular\
    \ nucleosides and/or nucleobases. The plasma membrane transport of nucleosides\
    \ is concerned with both the physiology and pharmacology of mammalian cells. Most\
    \ mammalian cells simultaneously express several nucleoside transporters (NTs)\
    \ in the plasma membrane. NTs possess certain differences in Na + -dependency,\
    \ permeation selectivity, and inhibitor sensitivity. NTs can be divided into two\
    \ major classes: concentrative Na + -dependent nucleoside transporters (CNTs)\
    \ and equilibrative Na + -independent nucleoside transporters (ENTs). CNTs are\
    \ nucleoside/Na + symporters that transport nucleosides against their concentration\
    \ * To whom correspondence should be addressed: Laboratory of Chemical Toxicology\
    \ and Environmental Health, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen,\
    \ Machida, Tokyo 194-8543, Japan. Tel. & Fax: +81-42-721-1563; E-mail: ogra@ac.shoyaku.ac.jp\
    \ gradients. In contrast, ENTs transport nucleosides by facilitated diffusion.\
    \ ENTs can be further divided into two subclasses depending on their sensitivity\
    \ to nitrobenzylthioinosine (NBTI). NBTI-sensitive and NBTI-insensitive forms\
    \ are coded by ENT1 and ENT2 genes, respectively. ENT1 and ENT2 are inhibited\
    \ by dipyridamole and dilazep. 1) On the other hand, CNTs can be divided into\
    \ three forms. No specific pharmacological inhibitors have been identified for\
    \ any CNTs so far. It was reported that dipyridamole, a classic NT inhibitor,\
    \ was useful in enhancing the effectiveness of cancer chemotherapeutic agents,\
    \ in particular, antimetabolites, based upon the inhibition of the nucleoside\
    \ salvage pathway. 2, 3) Hence, the combination of NT inhibitors and antimetabolites\
    \ is expected to provide more effective and safer cancer chemotherapy in the clinical\
    \ setting.\n\n Cimicifugoside, a triterpenoid originating from the rhizomes of\
    \ Cimicifuga simplex (C. simplex), has been used in traditional Chinese medicine\
    \ as the so-called Cimicifugae rhizoma (Fig. 1) . The medicine is prescribed because\
    \ of its anti-C 2011 The Pharmaceutical Society of Japan inflammatory, analgesic,\
    \ and anti-pyretic effects. 4) In addition, it has been reported that cimicifugoside\
    \ selectively inhibits the uptake of nucleosides into phytohematoagglutinin-stimulated\
    \ human lymphocytes and several malignant cell lines. 5, 6) Indeed, the uptake\
    \ of nucleosides, such as uridine, thymidine, and adenosine, but not nucleobases\
    \ was inhibited by cimicifugoside and its analogs, such as cimicifugenin and bugbanosides\
    \ A and B, in a leukemia cell line. 7) As the mechanism underlying the inhibition\
    \ of nucleoside transport by cimicifugoside, it is speculated that cimicifugoside\
    \ has weak affinity for the binding site of NBTI in ENTs, although the detailed\
    \ inhibitory mechanism is still unclear. Furthermore, cimicifugoside and its analogs\
    \ potentiated the cytotoxicity of methotrexate, a folic acid antimetabolite. In\
    \ our previous study, we demonstrated that the synergic effect of methotrexate\
    \ and cimicifugoside. 7) In this study, we intended to clarify the mechanisms\
    \ underlying the cell-specific synergic effect of cimicifugoside on the cytotoxicity\
    \ of methotrexate. We focused on the involvement of NT expression and activity\
    \ in the cell lines. Cell Culture --The human promonocytic leukemia cell line\
    \ U937 and the chronic myelogenetic leukemia cell line K562 were provided by the\
    \ Cell Resource Center for Biomedical Research (Institute of Development, Aging\
    \ and Cancer, Tohoku University, Sendai, Japan). Cells were cultured in RPMI 1640\
    \ medium supplemented with 5% (v/v) heat-inactivated fetal bovine serum (FBS),\
    \ 60 µg/ml kanamycin and 2 mM L-glutamine (culture medium) at 37 • C in a humidified\
    \ atmosphere of 5% CO 2 and 95% air."
pipeline_tag: sentence-similarity
library_name: sentence-transformers
metrics:
- cosine_accuracy@1
- cosine_accuracy@3
- cosine_accuracy@5
- cosine_accuracy@10
- cosine_precision@1
- cosine_precision@3
- cosine_precision@5
- cosine_precision@10
- cosine_recall@1
- cosine_recall@3
- cosine_recall@5
- cosine_recall@10
- cosine_ndcg@10
- cosine_mrr@10
- cosine_map@100
model-index:
- name: SentenceTransformer based on unsloth/embeddinggemma-300m
  results:
  - task:
      type: information-retrieval
      name: Information Retrieval
    dataset:
      name: Unknown
      type: unknown
    metrics:
    - type: cosine_accuracy@1
      value: 0.7885
      name: Cosine Accuracy@1
    - type: cosine_accuracy@3
      value: 0.9075
      name: Cosine Accuracy@3
    - type: cosine_accuracy@5
      value: 0.9325
      name: Cosine Accuracy@5
    - type: cosine_accuracy@10
      value: 0.9555
      name: Cosine Accuracy@10
    - type: cosine_precision@1
      value: 0.7885
      name: Cosine Precision@1
    - type: cosine_precision@3
      value: 0.3025
      name: Cosine Precision@3
    - type: cosine_precision@5
      value: 0.18650000000000003
      name: Cosine Precision@5
    - type: cosine_precision@10
      value: 0.09555000000000001
      name: Cosine Precision@10
    - type: cosine_recall@1
      value: 0.7885
      name: Cosine Recall@1
    - type: cosine_recall@3
      value: 0.9075
      name: Cosine Recall@3
    - type: cosine_recall@5
      value: 0.9325
      name: Cosine Recall@5
    - type: cosine_recall@10
      value: 0.9555
      name: Cosine Recall@10
    - type: cosine_ndcg@10
      value: 0.877036735014105
      name: Cosine Ndcg@10
    - type: cosine_mrr@10
      value: 0.8513523809523807
      name: Cosine Mrr@10
    - type: cosine_map@100
      value: 0.8529621389766024
      name: Cosine Map@100
---

# SentenceTransformer

This model was finetuned with [Unsloth](https://github.com/unslothai/unsloth).

[<img src="https://raw.githubusercontent.com/unslothai/unsloth/main/images/unsloth%20made%20with%20love.png" width="200"/>](https://github.com/unslothai/unsloth)
 based on unsloth/embeddinggemma-300m

This is a [sentence-transformers](https://www.SBERT.net) model finetuned from [unsloth/embeddinggemma-300m](https://huggingface.co/unsloth/embeddinggemma-300m) on the generator dataset. It maps sentences & paragraphs to a 768-dimensional dense vector space and can be used for semantic textual similarity, semantic search, paraphrase mining, text classification, clustering, and more.

## Model Details

### Model Description
- **Model Type:** Sentence Transformer
- **Base model:** [unsloth/embeddinggemma-300m](https://huggingface.co/unsloth/embeddinggemma-300m) <!-- at revision bfa3c846ac738e62aa61806ef9112d34acb1dc5a -->
- **Maximum Sequence Length:** 1024 tokens
- **Output Dimensionality:** 768 dimensions
- **Similarity Function:** Cosine Similarity
- **Training Dataset:**
    - generator
<!-- - **Language:** Unknown -->
<!-- - **License:** Unknown -->

### Model Sources

- **Documentation:** [Sentence Transformers Documentation](https://sbert.net)
- **Repository:** [Sentence Transformers on GitHub](https://github.com/huggingface/sentence-transformers)
- **Hugging Face:** [Sentence Transformers on Hugging Face](https://huggingface.co/models?library=sentence-transformers)

### Full Model Architecture

```
SentenceTransformer(
  (0): Transformer({'max_seq_length': 1024, 'do_lower_case': False, 'architecture': 'PeftModelForFeatureExtraction'})
  (1): Pooling({'word_embedding_dimension': 768, 'pooling_mode_cls_token': False, 'pooling_mode_mean_tokens': True, 'pooling_mode_max_tokens': False, 'pooling_mode_mean_sqrt_len_tokens': False, 'pooling_mode_weightedmean_tokens': False, 'pooling_mode_lasttoken': False, 'include_prompt': True})
  (2): Dense({'in_features': 768, 'out_features': 3072, 'bias': False, 'activation_function': 'torch.nn.modules.linear.Identity'})
  (3): Dense({'in_features': 3072, 'out_features': 768, 'bias': False, 'activation_function': 'torch.nn.modules.linear.Identity'})
  (4): Normalize()
)
```

## Usage

### Direct Usage (Sentence Transformers)

First install the Sentence Transformers library:

```bash
pip install -U sentence-transformers
```

Then you can load this model and run inference.
```python
from sentence_transformers import SentenceTransformer

# Download from the 🤗 Hub
model = SentenceTransformer("sentence_transformers_model_id")
# Run inference
queries = [
    "What are the systemic manifestations of Fournier\u0027s syndrome?",
]
documents = [
    "Fournier's syndrome is defined as a suppurative bacterial infection of the perineal, genital, or perianal regions. Those conditions often lead to thrombosis of subcutaneous vessels and with infection, resulting in the development of gangrene of the overlying skin and subcutaneous tissue [1] . This rare syndrome is a rapidly progressive and potentially lethal necrotizing fasciitis caused by invasive infections of the lower part of the genitourinary tract, anorectal soft tissue, and genital skin [1, 2] . The devastating rapidity is typical, as evidenced by the fact that the mean duration of symptoms to become the target of emergency operation is just a few days, and a majority of patients are seriously ill at the time of admission. Anesthetic management of patients with this syndrome is often difficult, due to its devastating nature as well as significant comorbid diseases. However, because of the infrequency of the syndrome, there is limited information regarding the anesthetic management of this disease. We recently encountered the anesthetic management in three cases of patients with Fournier's syndrome. There were three initial emergency and six additional elective operations under general anesthesia, except one spinal anesthesia in an elective case. Therefore, we report these cases and review the relevant literatures.\n\n Immediate and, if required, repetitive operation is important for saving lives in patients with this syndrome [1] [2] [3] . Fournier's syndrome is frequently associated with certain diseases and conditions. Diabetes mellitus is probably the most common comorbid disease, as evidenced by our cases [1] . Even when the patient has diabetes, as in our two patients, Fournier's syndrome might be the first clinical disease to be detected. The second common condition is alcoholism, such as in all our patients, because any disorder that compromises the immunity enhances development of a severe infection [1, 2] . The other associated clinical features are malnutrition, prolonged hospitalization, radiation therapy, chemotherapy, neurologic deficits, cirrhosis, leukemia, renal failure, organic heart disease, vasculitis, intravenous drug abuse, lupus, cirrhosis, AIDS and steroid medications. In obstetric anesthesia, cervical or pudendal nerve block can induce the syndrome as well [1] .\n\n Abnormal laboratory results include hyperglycemia, hypocalcemia, anemia, leukocytosis and thrombocytopenia, as evidenced by our patients [1] . Most of those abnormalities are due to sepsis. The systemic manifestations include fever, tachycardia, and volume depletion similar to those of severe peritonitis [1] . All our patients also had sepsis in terms of the preoperative definition. Two patients looked to be in late distributive shock and the other patient in early distributive shock, respectively. In the case of no active bleeding, delayed or inadequate volume resuscitation is a significant error that would have detrimental effects on the patients's outcome in septic shock. If initial crystalloid fluid resuscitation is insufficient to raise the mean arterial pressure to 65 mmHg and the CVP to 8 to 12 mmHg, then vasopressors and inotropes are needed as the second step in the guidelines of early goal-directed therapy [4] . It is rational to use a blood transfusion when the hematocrit is below 30% when invasive monitoring might be indicated [4] . Among two patients in late septic shock, one patient fortunately responded to our initial fluid resuscitation, whereas the other patient needed dopamine for hypotension. In another patient, early shock occurred, and a blood transfusion and dopamine and norepinephrine were required to achieve an adequate cardiac output and oxygen delivery to maintain vital organ function were needed, because his affected area including www.ekja.org\n\n Vol. 61, No. 2, August 2011 lower extremity was wide and bleeding was ongoing. His septic manifestations reoccurred sporadically over four months of hospitalization and progressed into cardiorespiratory collapse and death after five debridements under general anesthesia. The preanesthetic investigation of the extent of the lesion is also important, because the ambiguity of the region involved could influence the choice of the anesthetic technique. Koitabashi and colleagues [5] suggested the avoidance of spinal anesthesia in the presence of lumbar subcutaneous gas. Sato and associates [3] recommended that using general anesthesia is preferable for controlling physiologic homeostasis. Fournier's syndrome in particular originateed in anorectal disease, which is the usual subject of regional anesthetic procedures, is known to be aggressive, produces marked systemic toxicity and myonecrosis as in our mortal case, and can be connected with higher mortality [1] . Hence, particular attention should be necessary for the choice of the anesthetic procedures. The reason we performed spinal anesthesia at the secondary wound closure one month after initial debridement in one patient was that he underwent computer tomography to depict the accurate extent of the lesion. Among gravely ill patients it seems wise to not waste precious time doing a lot of investigation to perform regional anesthesia.\n\n The degree of debridement for Fournier's syndrome is variable from simple incision to wide excision with massive bleeding [2] . Many surviving patients require secondary wound closure, skin graft or a reconstructive flap procedure. In spite of appropriate therapy, the mortality rate in Fournier's syndrome is reported to exceed 40% in many studies [1] [2] [3] . Prolonged sepsis manifested by fever or hypotension and lasting for more than 48 hours was experienced among about 40% of patients, as in our expired patient [2] . Some reports have associated older age, female gender, anorectal causes, delayed admission, the presence of debilitating conditions such as renal failure and hepatic dysfunction with high mortality. Laboratory parameters on admission statistically related to fatality include low hematocrit, calcium, albumin, and cholesterol, and high BUN and alkaline phosphatase levels. The syndrome could rapidly progress into prolonged sepsis, DIC, pneumonia, respiratory failure, diabetic ketoacidosis, renal failure, and heart failure.\n\n In conclusion, our experiences emphasize that Fournier's syndrome has a fatal potential, so optimal conduct of anesthesia requires forethought and sound management as well as an understanding of the pathophysiology of this syndrome for successful anesthesia.",
    'Nucleotides can be synthesized de novo or recycled through a salvage pathway in vivo. In the salvage pathway, nucleotides are synthesized from extracellular nucleosides and/or nucleobases. The plasma membrane transport of nucleosides is concerned with both the physiology and pharmacology of mammalian cells. Most mammalian cells simultaneously express several nucleoside transporters (NTs) in the plasma membrane. NTs possess certain differences in Na + -dependency, permeation selectivity, and inhibitor sensitivity. NTs can be divided into two major classes: concentrative Na + -dependent nucleoside transporters (CNTs) and equilibrative Na + -independent nucleoside transporters (ENTs). CNTs are nucleoside/Na + symporters that transport nucleosides against their concentration * To whom correspondence should be addressed: Laboratory of Chemical Toxicology and Environmental Health, Showa Pharmaceutical University, 3-3165 Higashi-Tamagawagakuen, Machida, Tokyo 194-8543, Japan. Tel. & Fax: +81-42-721-1563; E-mail: ogra@ac.shoyaku.ac.jp gradients. In contrast, ENTs transport nucleosides by facilitated diffusion. ENTs can be further divided into two subclasses depending on their sensitivity to nitrobenzylthioinosine (NBTI). NBTI-sensitive and NBTI-insensitive forms are coded by ENT1 and ENT2 genes, respectively. ENT1 and ENT2 are inhibited by dipyridamole and dilazep. 1) On the other hand, CNTs can be divided into three forms. No specific pharmacological inhibitors have been identified for any CNTs so far. It was reported that dipyridamole, a classic NT inhibitor, was useful in enhancing the effectiveness of cancer chemotherapeutic agents, in particular, antimetabolites, based upon the inhibition of the nucleoside salvage pathway. 2, 3) Hence, the combination of NT inhibitors and antimetabolites is expected to provide more effective and safer cancer chemotherapy in the clinical setting.\n\n Cimicifugoside, a triterpenoid originating from the rhizomes of Cimicifuga simplex (C. simplex), has been used in traditional Chinese medicine as the so-called Cimicifugae rhizoma (Fig. 1) . The medicine is prescribed because of its anti-C 2011 The Pharmaceutical Society of Japan inflammatory, analgesic, and anti-pyretic effects. 4) In addition, it has been reported that cimicifugoside selectively inhibits the uptake of nucleosides into phytohematoagglutinin-stimulated human lymphocytes and several malignant cell lines. 5, 6) Indeed, the uptake of nucleosides, such as uridine, thymidine, and adenosine, but not nucleobases was inhibited by cimicifugoside and its analogs, such as cimicifugenin and bugbanosides A and B, in a leukemia cell line. 7) As the mechanism underlying the inhibition of nucleoside transport by cimicifugoside, it is speculated that cimicifugoside has weak affinity for the binding site of NBTI in ENTs, although the detailed inhibitory mechanism is still unclear. Furthermore, cimicifugoside and its analogs potentiated the cytotoxicity of methotrexate, a folic acid antimetabolite. In our previous study, we demonstrated that the synergic effect of methotrexate and cimicifugoside. 7) In this study, we intended to clarify the mechanisms underlying the cell-specific synergic effect of cimicifugoside on the cytotoxicity of methotrexate. We focused on the involvement of NT expression and activity in the cell lines. Cell Culture --The human promonocytic leukemia cell line U937 and the chronic myelogenetic leukemia cell line K562 were provided by the Cell Resource Center for Biomedical Research (Institute of Development, Aging and Cancer, Tohoku University, Sendai, Japan). Cells were cultured in RPMI 1640 medium supplemented with 5% (v/v) heat-inactivated fetal bovine serum (FBS), 60 µg/ml kanamycin and 2 mM L-glutamine (culture medium) at 37 • C in a humidified atmosphere of 5% CO 2 and 95% air.',
    'tissue infiltration of polymorphonuclear neutrophils (PMN). In response to bacterial infection, neutrophil activation in the lungs leads to ALI (53) and PMN infiltration represents a primary mechanism for sepsis-induced pulmonary dysfunction and injury (10) .\n\n In the normal lung, continuous fluid clearance by the lung lymphatics is essential for the maintenance of dry alveolar surfaces (60) . Ion pumps and channels positioned on alveolar epithelial cell surfaces generate transepithelial osmotic gradients that drive water movement from the alveolar space into the lung interstitium. The key pumps and channels involved in alveolar fluid transport include aquaporin 5 (Aqp5), cystic fibrosis transmembrane conductance regulator (CFTR), epithelial sodium channel (ENaC), and Na ϩ -K ϩ -ATPase (37) . In ALI, the lung endothelial barrier is damaged, resulting in abnormal capillary permeability and pulmonary edema as the lymphatic clearance is overwhelmed (60) . In contrast to the endothelium, the alveolar epithelium is often spared in sepsisinduced ALI, and therefore active ion and fluid clearance is preserved (56) . Recent reports, however, suggest that ion pump and channel functions are affected early during sepsis (37) .\n\n To maintain a "dry" alveolar space and normal lung function, it is essential that the milieu within the alveolar space remain distinct from that of the subepithelial compartment (30) . The maintenance mechanism depends on the formation and proper functioning of specialized molecular structures between adjacent cells comprising the epithelial sheet, the so-called tight junctions (TJ). The alveolar epithelial TJ is a complex of integral membrane proteins that firmly interact with the epithelial cytoskeleton (27) . TJs serve as a regulated semipermeable barrier that limits passive diffusion of solutes across paracellular pathways between adjacent cells (1). Han et al. (30) recently showed that ALI was associated with diminished expression and function of TJ proteins in lung epithelium.\n\n Emerging evidence indicates that inflammation and coagulation are connected (34) . This is especially important in sepsis as inflammatory cytokines activate the coagulation cascade and inhibit fibrinolysis, thereby shifting normal hemostasis toward a prothrombotic state. Sepsis-driven coagulation induces consumption of coagulation factors leading to disseminated intravascular coagulation (DIC), a phenomenon frequently associated with sepsis-induced ALI. Indeed, impairment of capillary blood flow during sepsis has been observed in human tissues by orthogonal polarization spectral imaging and sidestream dark-field imaging (17) . It is currently estimated that as many as 50% of all sepsis patients develop DIC (25) . Bastarache et al. (6) have recently reported that in ALI, the alveolar compartment contains high levels of tissue factor (TF) procoagulant activity that favor fibrin deposition in the air spaces. TF activation results in thrombin formation, which augments permeability and enhances inflammation (14) .\n\n Vitamin C is a small, water-soluble molecule that readily acts as a one-or two-electron reducing agent for many radicals and oxidants. Vitamin C is bioavailable equally as either dehydro-L-ascorbic acid (DHA) or L-ascorbic acid (AscA). Specialized cells can take up reduced vitamin C (AscA) through Na ϩ -dependent ascorbate cotransporters (SVCT1 and SVCT2). Most other cells take up vitamin C in its oxidized form (DHA) via facilitative glucose transporters (48) . Sepsis lowers plasma AscA concentrations (57) and, importantly, low vitamin C levels correlate inversely with multiple organ failure and directly with survival (9) . Studies using animal models show that vitamin C prevents endotoxin-induced hypotension and improves arteriolar responsiveness, arterial blood pressure, capillary blood flow, liver function, and survival in experimental sepsis (4, 59) .\n\n We recently showed that vitamin C, administered after the onset of endotoxemia, attenuates proinflammatory and procoagulant states that induce lung vascular injury and improved survival in an animal model of sepsis (23) . In the present study we show that vitamin C attenuates sepsis-induced ALI by enhancing alveolar epithelial barrier integrity. Furthermore, vitamin C induced the expression of ion channels and pumps, which play critical roles in improving alveolar fluid clearance. In addition, we also observed marked changes in the viscoelastic clot properties of septic mice blood.',
]
query_embeddings = model.encode_query(queries)
document_embeddings = model.encode_document(documents)
print(query_embeddings.shape, document_embeddings.shape)
# [1, 768] [3, 768]

# Get the similarity scores for the embeddings
similarities = model.similarity(query_embeddings, document_embeddings)
print(similarities)
# tensor([[0.5232, 0.0169, 0.1165]])
```

<!--
### Direct Usage (Transformers)

<details><summary>Click to see the direct usage in Transformers</summary>

</details>
-->

<!--
### Downstream Usage (Sentence Transformers)

You can finetune this model on your own dataset.

<details><summary>Click to expand</summary>

</details>
-->

<!--
### Out-of-Scope Use

*List how the model may foreseeably be misused and address what users ought not to do with the model.*
-->

## Evaluation

### Metrics

#### Information Retrieval

* Evaluated with [<code>InformationRetrievalEvaluator</code>](https://sbert.net/docs/package_reference/sentence_transformer/evaluation.html#sentence_transformers.evaluation.InformationRetrievalEvaluator)

| Metric              | Value     |
|:--------------------|:----------|
| cosine_accuracy@1   | 0.7885    |
| cosine_accuracy@3   | 0.9075    |
| cosine_accuracy@5   | 0.9325    |
| cosine_accuracy@10  | 0.9555    |
| cosine_precision@1  | 0.7885    |
| cosine_precision@3  | 0.3025    |
| cosine_precision@5  | 0.1865    |
| cosine_precision@10 | 0.0956    |
| cosine_recall@1     | 0.7885    |
| cosine_recall@3     | 0.9075    |
| cosine_recall@5     | 0.9325    |
| cosine_recall@10    | 0.9555    |
| **cosine_ndcg@10**  | **0.877** |
| cosine_mrr@10       | 0.8514    |
| cosine_map@100      | 0.853     |

<!--
## Bias, Risks and Limitations

*What are the known or foreseeable issues stemming from this model? You could also flag here known failure cases or weaknesses of the model.*
-->

<!--
### Recommendations

*What are recommendations with respect to the foreseeable issues? For example, filtering explicit content.*
-->

## Training Details

### Training Dataset

#### generator

* Dataset: generator
* Size: 10,000 training samples
* Columns: <code>question</code> and <code>passage_text</code>
* Approximate statistics based on the first 1000 samples:
  |         | question                                                                          | passage_text                                                                          |
  |:--------|:----------------------------------------------------------------------------------|:--------------------------------------------------------------------------------------|
  | type    | string                                                                            | string                                                                                |
  | details | <ul><li>min: 7 tokens</li><li>mean: 20.79 tokens</li><li>max: 60 tokens</li></ul> | <ul><li>min: 481 tokens</li><li>mean: 945.6 tokens</li><li>max: 1024 tokens</li></ul> |
* Samples:
  | question                                                                                                                                                                                              | passage_text                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                             |
  |:------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|:---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
  | <code>What factors may contribute to increased pulmonary conduit durability in patients who undergo the Ross operation compared to those with right ventricular outflow tract obstruction?<br></code> | <code>I n 1966, Ross and Somerville 1 reported the first use of an aortic homograft to establish right ventricle-to-pulmonary artery continuity in a patient with tetralogy of Fallot and pulmonary atresia. Since that time, pulmonary position homografts have been used in a variety of right-sided congenital heart lesions. Actuarial 5-year homograft survivals for cryopreserved homografts are reported to range between 55% and 94%, with the shortest durability noted in patients less than 2 years of age. 4 Pulmonary position homografts also are used to replace pulmonary autografts explanted to repair left-sided outflow disease (the Ross operation). Several factors may be likely to favor increased pulmonary conduit durability in Ross patients compared with those with right ventricular outflow tract obstruction, including later age at operation (allowing for larger homografts), more normal pulmonary artery architecture, absence of severe right ventricular hypertrophy, and more natural positioning of ...</code> |
  | <code>How does MCAM expression in hMSC affect the growth and maintenance of hematopoietic progenitors?</code>                                                                                         | <code>After culture in a 3-dimensional hydrogel-based matrix, which constitutes hypoxic conditions, MCAM expression is lost. Concordantly, Tormin et al. demonstrated that MCAM is down-regulated under hypoxic conditions. 10 Furthermore, it was shown by others and our group that oxygen tension causes selective modification of hematopoietic cell and mesenchymal stromal cell interactions in co-culture systems as well as influence HSPC metabolism. [44] [45] [46] Thus, the observed differences between Sharma et al. and our data in HSPC supporting capacity of hMSC are likely due to the different culture conditions used. Further studies are required to clarify the influence of hypoxia in our model system. Altogether these findings provide further evidence for the importance of MCAM in supporting HSPC. Furthermore, previous reports have shown that MCAM is down-regulated in MSC after several passages as well as during aging and differentiation. 19, 47 Interestingly, MCAM overexpression in hMSC enhance...</code> |
  | <code>What is the relationship between Fanconi anemia and breast and ovarian cancer susceptibility genes?<br></code>                                                                                  | <code>( 31 ) , of which 5% -10 % may be caused by genetic factors ( 32 ) , up to half a million of these patients may be at risk of secondary hereditary neoplasms. The historic observation of twofold to fi vefold increased risks of cancers of the ovary, thyroid, and connective tissue after breast cancer ( 33 ) presaged the later syndromic association of these tumors with inherited mutations of BRCA1, BRCA2, PTEN, and p53 ( 16 ) . By far the largest cumulative risk of a secondary cancer in BRCA mutation carriers is associated with cancer in the contralateral breast, which may reach a risk of 29.5% at 10 years ( 34 ) . The Breast Cancer Linkage Consortium ( 35 , 36 ) also documented threefold to fi vefold increased risks of subsequent cancers of prostate, pancreas, gallbladder, stomach, skin (melanoma), and uterus in BRCA2 mutation carriers and twofold increased risks of prostate and pancreas cancer in BRCA1 mutation carriers; these results are based largely on self-reported family history inf...</code> |
* Loss: [<code>MultipleNegativesRankingLoss</code>](https://sbert.net/docs/package_reference/sentence_transformer/losses.html#multiplenegativesrankingloss) with these parameters:
  ```json
  {
      "scale": 20.0,
      "similarity_fct": "cos_sim",
      "gather_across_devices": false
  }
  ```

### Evaluation Dataset

#### generator

* Dataset: generator
* Size: 2,000 evaluation samples
* Columns: <code>question</code> and <code>passage_text</code>
* Approximate statistics based on the first 1000 samples:
  |         | question                                                                          | passage_text                                                                          |
  |:--------|:----------------------------------------------------------------------------------|:--------------------------------------------------------------------------------------|
  | type    | string                                                                            | string                                                                                |
  | details | <ul><li>min: 7 tokens</li><li>mean: 20.91 tokens</li><li>max: 61 tokens</li></ul> | <ul><li>min: 465 tokens</li><li>mean: 943.1 tokens</li><li>max: 1024 tokens</li></ul> |
* Samples:
  | question                                                                                                                                                                                  | passage_text                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                   |
  |:------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|:---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------|
  | <code>What are some hereditary cancer syndromes that can result in various forms of cancer?<br></code>                                                                                    | <code>Hereditary Cancer Syndromes, including Hereditary Breast and Ovarian Cancer (HBOC) and Lynch Syndrome (LS), can result in various forms of cancer due to germline mutations in cancer predisposition genes. While the major contributory genes for these syndromes have been identified and well-studied (BRCA1/ BRCA2 for HBOC and MSH2/MSH6/MLH1/PMS2/ EPCAM for LS), there remains a large percentage of associated cancer cases that are negative for germline mutations in these genes, including 80% of women with a personal or family history of breast cancer who are negative for BRCA1/2 mutations [1] . Similarly, between 30 and 50% of families fulfill stringent criteria for LS and test negative for germline mismatch repair gene mutations [2] . Adding complexity to these disorders is the significant overlap in the spectrum of cancers observed between various hereditary cancer syndromes, including many cancer susceptibility syndromes. Some that contribute to elevated breast cancer risk include Li-Frau...</code>       |
  | <code>How do MAK-4 and MAK-5 exert their antioxidant properties?<br></code>                                                                                                               | <code>Hybrid F1 mice were injected with urethane (300 mg/kg) at 8 days of age. A group was then put on a MAK-supplemented diet, another group was fed a standard pellet diet. At 36 weeks of age the mice were sacrificed and the livers examined for the presence of tumors mouse (Panel A) and for the number of nodules per mouse (Panel B) (* p < 0.05, ** P < 0.001). Statistical analysis was performed by Two Way ANOVA Test followed by Post Hoc Bonferroni analysis. <br><br> We than measured the influence of the MAK-4+5 combination on the expression of the three liver-specific connexins (cx26, cx32, and cx43). The level of cx26 expression was similar in all the groups of mice treated with the MAK-supplemented diet and in the control (Figure 4, Panel A) . A significant, time-dependent increase in cx32 was observed in the liver of all the groups of MAK treated mice compared to the normal diet-fed controls. Cx32 expression increased 2-fold after 1 week of treatment, and 3-to 4-fold at 3 months (Figure 4, Pane...</code> |
  | <code>What are the primary indications for a decompressive craniectomy, and what role does neurocritical care play in determining the suitability of a patient for this procedure?</code> | <code>Decompressive craniectomy is a valid neurosurgical strategy now a day as an alternative to control an elevated intracranial pressure (ICP) and controlling the risk of uncal and/or subfalcine herniation, in refractory cases to the postural, ventilator, and pharmacological measures to control it. The neurocritical care and the ICP monitorization are key determinants to identify and postulate the inclusion criteria to consider a patient as candidate to this procedure, as it is always considered a rescue surgical technique. Head trauma and ischemic or hemorrhagic cerebrovascular disease with progressive deterioration due to mass effect are some of the cases that may require a decompressive craniectomy with its different variants. However, this procedure per se can have complications described in the postcraniectomy syndrome and may occur in short, medium, or even long term.<br><br> 1,2 The paradoxical herniation is a condition in which there is a deviation of the midline with mass effect, even t...</code> |
* Loss: [<code>MultipleNegativesRankingLoss</code>](https://sbert.net/docs/package_reference/sentence_transformer/losses.html#multiplenegativesrankingloss) with these parameters:
  ```json
  {
      "scale": 20.0,
      "similarity_fct": "cos_sim",
      "gather_across_devices": false
  }
  ```

### Training Hyperparameters
#### Non-Default Hyperparameters

- `eval_strategy`: steps
- `per_device_train_batch_size`: 64
- `per_device_eval_batch_size`: 64
- `gradient_accumulation_steps`: 2
- `learning_rate`: 2e-05
- `max_steps`: 30
- `warmup_ratio`: 0.03
- `bf16`: True
- `prompts`: {'question': '', 'passage_text': ''}
- `batch_sampler`: no_duplicates

#### All Hyperparameters
<details><summary>Click to expand</summary>

- `overwrite_output_dir`: False
- `do_predict`: False
- `eval_strategy`: steps
- `prediction_loss_only`: True
- `per_device_train_batch_size`: 64
- `per_device_eval_batch_size`: 64
- `per_gpu_train_batch_size`: None
- `per_gpu_eval_batch_size`: None
- `gradient_accumulation_steps`: 2
- `eval_accumulation_steps`: None
- `torch_empty_cache_steps`: None
- `learning_rate`: 2e-05
- `weight_decay`: 0.0
- `adam_beta1`: 0.9
- `adam_beta2`: 0.999
- `adam_epsilon`: 1e-08
- `max_grad_norm`: 1.0
- `num_train_epochs`: 3.0
- `max_steps`: 30
- `lr_scheduler_type`: linear
- `lr_scheduler_kwargs`: {}
- `warmup_ratio`: 0.03
- `warmup_steps`: 0
- `log_level`: passive
- `log_level_replica`: warning
- `log_on_each_node`: True
- `logging_nan_inf_filter`: True
- `save_safetensors`: True
- `save_on_each_node`: False
- `save_only_model`: False
- `restore_callback_states_from_checkpoint`: False
- `no_cuda`: False
- `use_cpu`: False
- `use_mps_device`: False
- `seed`: 42
- `data_seed`: None
- `jit_mode_eval`: False
- `use_ipex`: False
- `bf16`: True
- `fp16`: False
- `fp16_opt_level`: O1
- `half_precision_backend`: auto
- `bf16_full_eval`: False
- `fp16_full_eval`: False
- `tf32`: None
- `local_rank`: 0
- `ddp_backend`: None
- `tpu_num_cores`: None
- `tpu_metrics_debug`: False
- `debug`: []
- `dataloader_drop_last`: False
- `dataloader_num_workers`: 0
- `dataloader_prefetch_factor`: None
- `past_index`: -1
- `disable_tqdm`: False
- `remove_unused_columns`: True
- `label_names`: None
- `load_best_model_at_end`: False
- `ignore_data_skip`: False
- `fsdp`: []
- `fsdp_min_num_params`: 0
- `fsdp_config`: {'min_num_params': 0, 'xla': False, 'xla_fsdp_v2': False, 'xla_fsdp_grad_ckpt': False}
- `fsdp_transformer_layer_cls_to_wrap`: None
- `accelerator_config`: {'split_batches': False, 'dispatch_batches': None, 'even_batches': True, 'use_seedable_sampler': True, 'non_blocking': False, 'gradient_accumulation_kwargs': None}
- `parallelism_config`: None
- `deepspeed`: None
- `label_smoothing_factor`: 0.0
- `optim`: adamw_torch_fused
- `optim_args`: None
- `adafactor`: False
- `group_by_length`: False
- `length_column_name`: length
- `ddp_find_unused_parameters`: None
- `ddp_bucket_cap_mb`: None
- `ddp_broadcast_buffers`: False
- `dataloader_pin_memory`: True
- `dataloader_persistent_workers`: False
- `skip_memory_metrics`: True
- `use_legacy_prediction_loop`: False
- `push_to_hub`: False
- `resume_from_checkpoint`: None
- `hub_model_id`: None
- `hub_strategy`: every_save
- `hub_private_repo`: None
- `hub_always_push`: False
- `hub_revision`: None
- `gradient_checkpointing`: False
- `gradient_checkpointing_kwargs`: None
- `include_inputs_for_metrics`: False
- `include_for_metrics`: []
- `eval_do_concat_batches`: True
- `fp16_backend`: auto
- `push_to_hub_model_id`: None
- `push_to_hub_organization`: None
- `mp_parameters`: 
- `auto_find_batch_size`: False
- `full_determinism`: False
- `torchdynamo`: None
- `ray_scope`: last
- `ddp_timeout`: 1800
- `torch_compile`: False
- `torch_compile_backend`: None
- `torch_compile_mode`: None
- `include_tokens_per_second`: False
- `include_num_input_tokens_seen`: False
- `neftune_noise_alpha`: None
- `optim_target_modules`: None
- `batch_eval_metrics`: False
- `eval_on_start`: False
- `use_liger_kernel`: False
- `liger_kernel_config`: None
- `eval_use_gather_object`: False
- `average_tokens_across_devices`: False
- `prompts`: {'question': '', 'passage_text': ''}
- `batch_sampler`: no_duplicates
- `multi_dataset_batch_sampler`: proportional
- `router_mapping`: {}
- `learning_rate_mapping`: {}

</details>

### Training Logs
| Epoch  | Step | Training Loss | Validation Loss | cosine_ndcg@10 |
|:------:|:----:|:-------------:|:---------------:|:--------------:|
| -1     | -1   | -             | -               | 0.4316         |
| 0.0637 | 5    | 1.0146        | 0.4369          | 0.7671         |
| 0.1274 | 10   | 0.355         | 0.2226          | 0.8450         |
| 0.1911 | 15   | 0.1585        | 0.1685          | 0.8626         |
| 0.2548 | 20   | 0.1369        | 0.1467          | 0.8700         |
| 0.3185 | 25   | 0.1559        | 0.1369          | 0.8748         |
| 0.3822 | 30   | 0.1456        | 0.1347          | 0.8773         |
| -1     | -1   | -             | -               | 0.8770         |


### Framework Versions
- Python: 3.11.7
- Sentence Transformers: 5.2.2
- Transformers: 4.56.2
- PyTorch: 2.10.0+cu128
- Accelerate: 1.12.0
- Datasets: 4.3.0
- Tokenizers: 0.22.2

## Citation

### BibTeX

#### Sentence Transformers
```bibtex
@inproceedings{reimers-2019-sentence-bert,
    title = "Sentence-BERT: Sentence Embeddings using Siamese BERT-Networks",
    author = "Reimers, Nils and Gurevych, Iryna",
    booktitle = "Proceedings of the 2019 Conference on Empirical Methods in Natural Language Processing",
    month = "11",
    year = "2019",
    publisher = "Association for Computational Linguistics",
    url = "https://arxiv.org/abs/1908.10084",
}
```

#### MultipleNegativesRankingLoss
```bibtex
@misc{henderson2017efficient,
    title={Efficient Natural Language Response Suggestion for Smart Reply},
    author={Matthew Henderson and Rami Al-Rfou and Brian Strope and Yun-hsuan Sung and Laszlo Lukacs and Ruiqi Guo and Sanjiv Kumar and Balint Miklos and Ray Kurzweil},
    year={2017},
    eprint={1705.00652},
    archivePrefix={arXiv},
    primaryClass={cs.CL}
}
```

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