query: Foxcatcher was nominated for Best Director.

pos: Foxcatcher Foxcatcher is a 2014 American biographical sports true crime drama film produced and directed by Bennett Miller . Written by E. Max Frye and Dan Futterman , the film stars Steve Carell , Channing Tatum , and Mark Ruffalo . The film 's plot is loosely based on the events surrounding multimillionaire E.I. du Pont family heir and wrestling enthusiast John E. du Pont 's 1986 recruitment of 1984 U.S. Olympic gold medalist wrestlers Mark Schultz and his older brother Dave to help coach U.S. wrestlers for participation in national , world , and Olympic competition , and the subsequent murder of Dave by du Pont in January 1996 . Although the film 's action is largely set at du Pont 's now-broken-up 800-acre suburban Philadelphia estate Foxcatcher Farm , the majority of the movie was filmed in the Pittsburgh metropolitan area .   Foxcatcher received critical acclaim for the performances of Carell , Tatum , and Ruffalo , as well as Miller 's direction and the film 's visual style and tone . It was nominated for the Palme d'Or in the main competition section at the 2014 Cannes Film Festival , where Miller won the Best Director Award . The film had three Golden Globe Award nominations , including Best Picture . The film was nominated for five Oscars at the 2015 Academy Awards , including a Best Actor nomination for Carell , Best Supporting Actor for Ruffalo and Best Director for Miller . It became the first film to be nominated for Best Director but not Best Picture since 2008 , when Julian Schnabel was nominated for The Diving Bell and the Butterfly , two years before the Academy extended its maximum number of Best Picture nominees to 10 films .

neg: The Curious Case of Benjamin Button (film) The Curious Case of Benjamin Button is a 2008 American romantic fantasy drama film directed by David Fincher . The storyline by Eric Roth and Robin Swicord is loosely based on the 1922 short story of the same name by F. Scott Fitzgerald . The film stars Brad Pitt as a man who ages in reverse and Cate Blanchett as the love interest throughout his life .   The film was released in North America on December 25 , 2008 to positive reviews . The film went on to receive thirteen Academy Award nominations , including Best Picture , Best Director for Fincher , Best Actor for Pitt and Best Supporting Actress for Taraji P. Henson , and won three , for Best Art Direction , Best Makeup , and Best Visual Effects .

neg: Lynne Ramsay Lynne Ramsay ( born 5 December 1969 ) is a Scottish film director , writer , producer , and cinematographer best known for the feature films Ratcatcher , Morvern Callar , We Need to Talk about Kevin and You Were Never Really Here .   Lynne Ramsay 's films are marked by a fascination with children and young people and the recurring themes of grief , guilt and death and its aftermath . They are low on dialogue and explicit story exposition , and instead use images , vivid details , music and sound design to create their worlds . In April 2013 she was selected as a member of the main competition jury at the 2013 Cannes Film Festival . In 2015 , she was named as a member of the Jury for the Main Competition at the 2015 Venice Film Festival .

neg: BAFTA Award for Best Film The BAFTA Award for Best Film is given annually by the British Academy of Film and Television Arts and presented at the British Academy Film Awards . It has been given since the 1st BAFTA Awards , representing the best films of 1947 , but until 1969 it was called the BAFTA Award for Best Film From Any Source . It is possible for films from any country to be nominated , although British films are also recognised in the category BAFTA Award for Best British Film and ( since 1983 ) foreign-language films in BAFTA Award for Best Film Not in the English Language . As such , there have been multiple occasions of a film being nominated in two of these categories .   There has been one tie for the Best Film award when , in 1962 , Ballad of a Soldier tied with The Hustler for Best Film from any Source . Until 1981 , the award was given to the director , except in 1976 and 1977 , when it was given to the producers . From 1981 to 1985 , it was given solely to the producers , and then in 1986 , it was shared between the Director and Producer . In 1998 , it was once again given to only the producers .   In the following lists , the titles and names in bold with a dark grey background are the winners and recipients respectively ; those not in bold are the nominees . The years given are those in which the films under consideration were released , not the year of the ceremony , which always takes place the following year .

neg: A Star Is Burns `` A Star Is Burns '' is the eighteenth episode of The Simpsons ' sixth season . It first aired on the Fox network in the United States on March 5 , 1995 . In the episode , Springfield decides to hold a film festival , and famed critic Jay Sherman is invited to be a judge .   The story involves a crossover with the short-lived animated series The Critic . Jay Sherman was the main character on the show . The Critic was created by Al Jean and Mike Reiss , who had previously written for The Simpsons but left following the fourth season , and produced by James L. Brooks , who was also a producer for The Simpsons . The show had premiered on the American Broadcasting Company ( ABC ) network in January 1994 but was canceled despite positive critical reception . The series was switched over to Fox , and put in the timeslot directly after The Simpsons . Brooks pitched a crossover episode as a way to promote The Critic and decided that a film festival would be a good way to introduce Sherman .   Matt Groening , creator of The Simpsons , reacted negatively when he heard about this episode , feeling that it was just an advertisement for The Critic , and that people would incorrectly associate the show with him . When he was unsuccessful in getting the program pulled , he had his name removed from the credits and went public with his concerns , openly criticizing James L. Brooks .   The episode was directed by Susie Dietter and was the first episode to be written by Ken Keeler . Jon Lovitz , the star of The Critic , guest stars as Jay Sherman , while Maurice LaMarche ( who was also a regular on The Critic ) has a few minor roles . The episode received mixed reviews from critics , many of whom felt the crossover was out of place on the show , although Barney 's film festival entry was well received .

neg: California Film Awards The California Film Awards is a film awards ceremony that offers awards in the categories of Best Picture , Actor , Actress , Cinematography , Directing , First-Time Directors , Editing , Screenplay , Animation , Art Design , Music Videos , Short Films , Experimental Films , Student Films , California Films , Foreign Films , Documentaries and Feature Narratives . Only independent films are eligible .

neg: Film director A film director is a person who directs the making of a film . Generally , a film director controls a film 's artistic and dramatic aspects and visualizes the screenplay ( or script ) while guiding the technical crew and actors in the fulfillment of that vision . The director has a key role in choosing the cast members , production design , and the creative aspects of filmmaking . Under European Union law , the director is viewed as the author of the film .   The film director gives direction to the cast and crew and creates an overall vision through which a film eventually becomes realized , or noticed . Directors need to be able to mediate differences in creative visions and stay within the boundaries of the film 's budget . There are many pathways to becoming a film director . Some film directors started as screenwriters , cinematographers , film editors or actors . Other film directors have attended a film school . Directors use different approaches . Some outline a general plotline and let the actors improvise dialogue , while others control every aspect , and demand that the actors and crew follow instructions precisely . Some directors also write their own screenplays or collaborate on screenplays with long-standing writing partners . Some directors edit or appear in their films , or compose the music score for their films .

neg: 78th Academy Awards The 78th Academy Awards ceremony , presented by the Academy of Motion Picture Arts and Sciences ( AMPAS ) , took place on March 5 , 2006 , at the Kodak Theatre in Hollywood , Los Angeles beginning at 5:00 p.m. PST / 8:00 p.m. EST. . The ceremony was scheduled one week later than usual to avoid conflicting with the 2006 Winter Olympics . During the ceremony , AMPAS presented Academy Awards ( commonly referred to as Oscars ) in 24 categories honoring films released in 2005 . The ceremony , televised in the United States by ABC , was produced by Gil Cates and directed by Louis J. Horvitz . Actor Jon Stewart hosted the show for the first time . Two weeks earlier in a ceremony at The Beverly Hilton in Beverly Hills , California held on February 18 , the Academy Awards for Technical Achievement were presented by host Rachel McAdams .   Crash won three awards including Academy Award for Best Picture . Other winners included Brokeback Mountain , King Kong , and Memoirs of a Geisha also with three awards apiece , and Capote , The Chronicles of Narnia : The Lion , the Witch and the Wardrobe , The Constant Gardener , Hustle and Flow , March of the Penguins , The Moon and the Son : An Imagined Conversation , A Note of Triumph : The Golden Age of Norman Corwin , Six Shooter , Syriana , Tsotsi , Walk the Line , and Wallace & Gromit : The Curse of the Were-Rabbit with one each . The telecast garnered nearly 39 million viewers in the United States .

neg: 25th Academy Awards The 25th Academy Awards ceremony was held on March 19 , 1953 . It took place at the RKO Pantages Theatre in Hollywood , California , and the NBC International Theatre in New York City .   It was the first Academy Awards ceremony to be televised , and the first ceremony to be held in Hollywood and New York City simultaneously . It was also the only year that the New York ceremonies were to be held in the NBC International Theatre on Columbus Circle , which was shortly thereafter demolished and replaced by the New York Coliseum convention center .   A major upset occurred in the category of Best Picture . The heavily favored High Noon lost to Cecil B. DeMille 's The Greatest Show on Earth , eventually considered among the worst films to have won the Academy Award for Best Picture . The American film magazine Premiere placed the movie on its list of the 10 worst Oscar winners and the British film magazine Empire rated it # 3 on their list of the 10 worst Oscar winners . It has the lowest spot on Rotten Tomatoes ' list of the 81 films to win Best Picture . Of all the films nominated for the Oscar this year , only High Noon and Singin ' in the Rain would show up 46 years later on the American Film Institute list of the greatest American films of the 20th Century . For a film that only received two nominations , Singin ' in the Rain went on to be named as the greatest American musical film of all time and in the 2007 American Film Institute updated list as the fifth greatest American film of all time , while High Noon was ranked twenty-seventh on the same 2007 list , as well .   The Bad and the Beautiful won five awards , the most wins ever for a film not nominated for Best Picture . It was also the second Academy Awards in which a film not nominated for Best Picture received the most awards of the evening , excluding years where there were ties for the most wins . The only other film to do this was The Thief of Bagdad at the 13th Academy Awards ; as of the 87th Academy Awards , it has not happened since .   Until Spotlight won only Best Picture and Best Original Screenplay at the 88th Academy Awards , this was the last year in which the Best Picture winner won just two Oscars . It was also the second of three years to date in which two films not nominated for Best Picture received more nominations than the winner ( The Bad and the Beautiful and Hans Christian Andersen , both with six ) . This occurred again at the 79th Academy Awards .   Shirley Booth also became the last person to win an Oscar in a Leading Role to be born in the 19th century . She also holds the distinction of being the first woman in her 50s to win the award , at the age of 54 ( the second woman in her 50s to win , Julianne Moore , was 54 when awarded at the 87th Academy Awards ) .   John Ford 's fourth win for Best Director set a record for the most wins in this category that remains unmatched to this day .   For the first time since the introduction of Supporting Actor and Actress awards in 1936 , Best Picture , Best Director , and all four acting Oscars went to six different films . This has happened only three times since , at the 29th Academy Awards for 1956 , the 78th for 2005 , and the 85th for 2012 .

neg: Goodfellas Goodfellas ( stylized as GoodFellas ) is a 1990 American crime film directed by Martin Scorsese . It is an adaptation of the 1986 non-fiction book Wiseguy by Nicholas Pileggi , who co-wrote the screenplay with Scorsese . The film narrates the rise and fall of mob associate Henry Hill and his friends over a period from 1955 to 1980 .   Scorsese initially named the film Wise Guy and postponed making it ; later , he and Pileggi changed the name to Goodfellas . To prepare for their roles in the film , Robert De Niro , Joe Pesci , and Ray Liotta often spoke with Pileggi , who shared research material left over from writing the book . According to Pesci , improvisation and ad-libbing came out of rehearsals wherein Scorsese gave the actors freedom to do whatever they wanted . The director made transcripts of these sessions , took the lines he liked best , and put them into a revised script , which the cast worked from during principal photography .   Made on a budget of $ 25 million , Goodfellas grossed $ 46.8 million . It received positive reviews from critics and was nominated for six Academy Awards , including Best Picture and Best Director , with Pesci winning Best Actor in a Supporting Role . The film won five awards from the British Academy of Film and Television Arts , including Best Film and Best Director . Additionally , Goodfellas was named the year 's best film by various critics ' groups .   Goodfellas is widely regarded as one of the greatest films in the crime genre . In 2000 , it was deemed `` culturally , historically , and aesthetically significant '' and selected for preservation in the National Film Registry by the United States Library of Congress . Its content and style have been emulated in numerous other films and television shows .

neg: Joe Roth Joseph E. `` Joe '' Roth ( born 1948 ) is an American film executive , producer and film director . He co-founded Morgan Creek Productions in 1987 and was chairman of 20th Century Fox ( 1989 -- 93 ) , Caravan Pictures ( 1993 -- 94 ) , and Walt Disney Studios ( 1994 -- 2000 ) before founding Revolution Studios in 2000 .

neg: Eytan Fox Eytan Fox ( born on August 21 , 1964 ) is an Israeli film director .

neg: F. Emasculata `` F. Emasculata '' is the twenty-second episode of the second season of the American science fiction television series The X-Files . It first premiered on the Fox network in the United States on . It was written by series creator Chris Carter and staff writer Howard Gordon , and directed by Rob Bowman . The episode is a `` Monster-of-the-Week '' story , unconnected to the series ' wider mythology . `` F. Emasculata '' received a Nielsen rating of 8.9 and was watched by 8.5 million households . The episode received mixed reviews from television critics .   The show centers on FBI special agents Fox Mulder ( David Duchovny ) and Dana Scully ( Gillian Anderson ) who work on cases linked to the paranormal , called X-Files . Mulder is a believer in the paranormal , while the skeptical Scully has been assigned to debunk his work . In this episode , Scully tries to discover the cause of a mysterious illness after several men in a prison die . Meanwhile , Mulder attempts to find two escapees who could potentially spread the disease .   `` F. Emasculata '' was based on the actual practice of pharmaceutical companies sending scientists all over the world looking for plants and animals that could have medicinal use . The X-Files director Frank Spotnitz felt that the episode 's exploding pustules were ridiculous because of their over-the-top nature . The Costa Rican forest at the opening was shot at the Seymour Demonstration Forest in Northern Vancouver .

neg: The Simpsons Movie The Simpsons Movie is a 2007 American animated comedy film based on the Fox television series The Simpsons . The film was directed by David Silverman , and stars the regular television cast of Dan Castellaneta , Julie Kavner , Nancy Cartwright , Yeardley Smith , Hank Azaria , Harry Shearer , Tress MacNeille , Pamela Hayden , Marcia Wallace , and Russi Taylor with guest appearances by Tom Hanks , Green Day , and Albert Brooks . The film follows Homer Simpson , whose irresponsibility gets the better of him when he pollutes the lake in Springfield after the town has cleaned it up following receipt of a warning from the Environmental Protection Agency . As the townspeople exile him and eventually his family abandons him , Homer works to redeem his folly by stopping Russ Cargill , the fictional head of the EPA , when he intends to destroy Springfield .   Previous attempts to create a The Simpsons film failed due to the lack of a script of appropriate length and production crew members . Eventually , producers James L. Brooks , Matt Groening , Al Jean , Richard Sakai , and Mike Scully began development of the film in 2001 . A writing team consisting of Brooks , Groening , Jean , Scully , Ian Maxtone-Graham , George Meyer , David Mirkin , Mike Reiss , Matt Selman , John Swartzwelder , and Jon Vitti was assembled . They conceived numerous plot ideas , with Groening 's being the one developed into a film . The script was re-written over a hundred times , and this creativity continued after the animation had begun in 2006 . This meant hours of finished material was cut , which included cameo roles from Erin Brockovich , Minnie Driver , Isla Fisher , Kelsey Grammer , and Edward Norton . Hanks and Green Day appeared in the final cut as themselves .   Tie-in promotions were made with several companies , including Burger King and 7-Eleven , the latter which transformed selected stores into Kwik-E-Marts . The film premiered in Springfield , Vermont , which had won the right to hold it through a competition organized by Fox . The film was a critical and commercial success , grossing over $ 527 million worldwide .

neg: Tower Heist Tower Heist is a 2011 American heist comedy film directed by Brett Ratner and written by Ted Griffin and Jeff Nathanson , based on a story by Bill Collage , Adam Cooper and Griffin . The plot follows Josh Kovaks ( Ben Stiller ) , Charlie Gibbs ( Casey Affleck ) and Enrique Dev ` reaux ( Michael Peña ) , employees of an exclusive apartment building who lose their pensions in the Ponzi scheme of Wall Street businessman Arthur Shaw ( Alan Alda ) . The group enlist the aid of criminal Slide ( Eddie Murphy ) , bankrupt businessman Mr. Fitzhugh ( Matthew Broderick ) and another employee of the apartment building , Odessa ( Gabourey Sidibe ) , to break into Shaw 's apartment and steal back their money while avoiding the FBI agent in charge of his case , Claire Denham ( Téa Leoni ) .   Tower Heist began development as early as 2005 , based on an idea by Murphy that would star himself and an all-black cast of comedians as a heist group who rob Trump International Hotel and Tower . As the script developed and changed into an Ocean 's Eleven -- style caper , Murphy left the project . Ratner continued to develop the idea into what would eventually become Tower Heist , with Murphy later rejoining the production . Filming took place entirely in New York City on a budget of $ 75 million ( after tax rebates ) , with several buildings provided by Donald Trump used to represent the eponymous tower . The film score was composed by Christophe Beck and released commercially on November 1 , 2011 .   The film received mixed reviews with much of the praise going to the cast , including Broderick , Leoni and Stiller . However , Murphy was repeatedly singled out by critics as the star of the film , with critics feeling that he displayed a welcome return to the comedic style of his early career . Much of the criticism received by the film was focused on the plot , which was considered `` formulaic , '' `` rushed , '' `` dull '' and `` laborious . '' The film was released on November 4 , 2011 and earned $ 152 million worldwide .   Prior to release , the film was involved in a controversy over plans by Universal Pictures to release it for home viewing on video on demand to 500,000 Comcast customers , only three weeks after its theatrical debut . Concern over the implementation 's harming ticket sales and inspiring further films to follow suit resulted in several theater chains ' refusal to show the film at all if the plan went ahead , forcing Universal to abandon the idea .

neg: Joel Schumacher Joel T. Schumacher ( born August 29 , 1939 ) is an American film director , screenwriter , and producer .   Schumacher rose to fame after directing hit films of his decade St. Elmo 's Fire ( 1985 ) , The Lost Boys ( 1987 ) and Flatliners ( 1990 ) . He later went on to direct John Grisham adaptations The Client ( 1994 ) and A Time to Kill ( 1996 ) . His films Falling Down ( 1993 ) and 8mm ( 1999 ) were competed for Palme d'Or and Golden Bear respectively .   In 1993 , he signed on to direct the next installments of Batman film series . Schumacher-directed Batman films Batman Forever ( 1995 ) and particularly Batman & Robin ( 1997 ) received negative reactions from both public and critics . After Batman films , Schumacher pulled back from blockbusters and returned to making minimalist films such as Tigerland ( 2000 ) and Phone Booth ( 2002 ) , both earning positive reviews . He also directed The Phantom of the Opera ( 2004 ) , The Number 23 ( 2007 ) and several episodes of House of Cards .   Known for casting young actors , Schumacher helped actors like Colin Farrell , Kiefer Sutherland , and Matthew McConaughey to launch careers .

neg: Fergal Reilly Fergal Reilly is an Irish animator , storyboard artist , and film director , best known for directing the animated film The Angry Birds Movie .

neg: Never Again (The X-Files) `` Never Again '' is the thirteenth episode of the fourth season of the American science fiction television series The X-Files . It was written by producers Glen Morgan and James Wong , and directed by Rob Bowman . The episode aired in the United States on February 2 , 1997 on the Fox network and in the United Kingdom on BBC One on December 3 , 1997 . The episode is a `` Monster-of-the-Week '' story , a stand-alone plot which is unconnected to the series ' wider mythology . The episode received a Nielsen rating of 13 and was viewed by 21.36 million viewers . It received mostly positive reviews from television critics .   The show centers on FBI special agents Fox Mulder ( David Duchovny ) and Dana Scully ( Gillian Anderson ) who work on cases linked to the paranormal , called X-Files . Mulder is a believer in the paranormal , while the skeptical Scully has been assigned to debunk his work . In this episode , Scully leaves town -- and Mulder -- for a solo assignment . She soon meets Ed Jerse , a man who is being mentally controlled by a drug-related side effect of his tattoo . His tattoo , affectionately named Betty , does not want to share him , especially not with Scully .   Although `` Never Again '' was directed by Bowman , it was originally scheduled to be directed by noted movie director Quentin Tarantino . Tarantino was unable to direct the entry due to a dispute with the Directors Guild of America . Gillian Anderson was particularly pleased with the episode showing a different side of Scully ; she had specifically asked Morgan and Wong to write an episode that explored Scully 's dark side . Several cast members from Morgan and Wong 's series Space : Above and Beyond were cast in the episode .

neg: Academy Award for Best Animated Feature The Academy Awards are given each year by the Academy of Motion Picture Arts and Sciences ( AMPAS or the Academy ) for the best films and achievements of the previous year . The Academy Award for Best Animated Feature is given each year for animated films . An animated feature is defined by the Academy as a film with a running time of more than 40 minutes in which characters ' performances are created using a frame-by-frame technique , a significant number of the major characters are animated , and animation figures in no less than 75 percent of the running time . The Academy Award for Best Animated Feature was first given for films made in 2001 .   Through the 89th Academy Awards , presented in 2017 , Academy Award nominations in this category were made by the Academy 's animation section ; effective with the 2018 awards , all Academy members will be eligible to vote on nominations . The entire AMPAS membership has been eligible to choose the winner since the award 's inception . If there are sixteen or more films submitted for the category , the winner is voted from a shortlist of five films , which has happened six times , otherwise there will only be three films on the shortlist . Additionally , eight eligible animated features must have been theatrically released in Los Angeles County within the calendar year for this category to be activated .   Animated films can be nominated for other categories , but have rarely been so ; Beauty and the Beast ( 1991 ) was the first animated film ever nominated for Best Picture . Up ( 2009 ) and Toy Story 3 ( 2010 ) also received Best Picture nominations after the Academy expanded the number of nominees .   Waltz with Bashir ( 2008 ) is the only animated film ever nominated for Best Foreign Language Film ( though it did not receive a nomination for Best Animated Feature ) . The Nightmare Before Christmas ( 1993 ) and Kubo and the Two Strings ( 2016 ) are the only two animated films to ever be nominated for Best Visual Effects .

neg: Dallas–Fort Worth Film Critics Association Awards 2014 The 20th Dallas -- Fort Worth Film Critics Association Awards honoring the best in film for 2014 were announced on December 15 , 2014 . These awards `` recognizing extraordinary accomplishment in film '' are presented annually by the Dallas -- Fort Worth Film Critics Association ( DFWFCA ) , based in the Dallas -- Fort Worth metroplex region of Texas . The organization , founded in 1990 , includes 30 film critics for print , radio , television , and internet publications based in north Texas . The Dallas -- Fort Worth Film Critics Association began presenting its annual awards list in 1993 .   Birdman was the DFWFCA 's most awarded film of 2014 , taking five top honors . Birdman won in Best Picture , Best Actor ( Michael Keaton ) , Best Director ( Alejandro G. Iñárritu ) , Best Cinematography ( Emmanuel Lubezki ) , and Best Screenplay ( Alejandro G. Iñárritu , Nicolás Giacobone , Alexander Dinelaris Jr. , and Armando Bo ) .   Another film , Boyhood , earned multiple 2014 honors from the DFWFCA . The coming-of-age tale received top honors in the Best Supporting Actress ( Patricia Arquette ) as well as being presented the Russell Smith Award as the `` best low-budget or cutting-edge independent film '' of the year . The award is named in honor of late Dallas Morning News film critic Russell Smith . Reese Witherspoon was named Best Actress for her role as Cheryl Strayed in Wild . The other films earning honors were Sweden 's Force Majeure for Best Foreign Language Film , Citizenfour as Best Documentary Film , and The Lego Movie for Best Animated Film .

neg: Buffalo '66 Buffalo '66 is a 1998 comedy-drama film that is writer-director Vincent Gallo 's full-length motion picture debut . Vincent Gallo and Christina Ricci star in the lead roles and the supporting cast includes Mickey Rourke , Rosanna Arquette , Ben Gazzara , and Anjelica Huston . Gallo also composed and performed much of the music for the film .   The film received critical acclaim and Empire listed it as the 36th-greatest independent film ever made . It was filmed in and around Gallo 's native Buffalo , New York in winter . The film uses British progressive rock music in its soundtrack , notably King Crimson and Yes .   The title refers to the Buffalo Bills football team , with the number referring to the statement , `` They have n't won a championship since 1966 . '' This is critical to the plot which focuses on the Super Bowl in which the Bills , in the early 1990s , came very close to winning , but the game was blown with a missed field goal .


query: A treatment for peripheral artery disease is bypass grafting.

pos: Peripheral artery disease Peripheral artery disease ( PAD ) is a narrowing of the arteries other than those that supply the heart or the brain . When narrowing occurs in the heart , it is called coronary artery disease , while , in the brain , it is called cerebrovascular disease . Peripheral artery disease most commonly affects the legs , but other arteries may also be involved . The classic symptom is leg pain when walking which resolves with rest , known as intermittent claudication . Other symptoms including skin ulcers , bluish skin , cold skin , or poor nail and hair growth may occur in the affected leg . Complications may include an infection or tissue death which may require amputation ; coronary artery disease , or stroke . Up to 50 % of cases of PAD are without symptoms .   The main risk factor is cigarette smoking . Other risk factors include diabetes , high blood pressure , and high blood cholesterol . The underlying mechanism is usually atherosclerosis . Other causes include artery spasm . PAD is typically diagnosed by finding an ankle-brachial index ( ABI ) less than 0.90 , which is the systolic blood pressure at the ankle divided by the systolic blood pressure of the arm . Duplex ultrasonography and angiography may also be used . Angiography is more accurate and allows for treatment at the same time ; however , it is associated with greater risks .   It is unclear if screening for disease is useful as it has not been properly studied . In those with intermittent claudication from PAD , stopping smoking and supervised exercise therapy improves outcomes . Medications , including statins , ACE inhibitors , and cilostazol also may help . Aspirin does not appear to help those with mild disease but is usually recommended in those with more significant disease . Anticoagulants such as warfarin are not typically of benefit . Procedures used to treat the disease include bypass grafting , angioplasty , and atherectomy .   In 2015 about 155 million people had PAD worldwide . In the developed world it affects about 5.3 % of 45 to 50 years olds and 18.6 % of 85 - to 90-year-olds . In the developing world it affects 4.6 % of people between the ages of 45 to 50 and 15 % of people between the ages of 85 to 90 . In the developed world PAD is equally common among men and women while in the developing world women are more commonly affected . In 2015 PAD resulted in about 52,500 deaths up from 16,000 deaths in 1990 .

neg: Hyperfibrinolysis The fibrinolysis system is responsible for removing blood clots . Hyperfibrinolysis describes a situation with markedly enhanced fibrinolytic activity , resulting in increased , sometimes catastrophic bleeding . Hyperfibrinolysis can be caused by acquired or congenital reasons . Among the congenital conditions for hyperfibrinolysis , deficiency of alpha-2-antiplasmin ( alpha-2-plasmin inhibitor ) or plasminogen activator inhibitor type 1 ( PAI-1 ) are very rare . The affected individuals show a hemophilia-like bleeding phenotype . Acquired hyperfibrinolysis is found in liver disease , in patients with severe trauma , during major surgical procedures , and other conditions . A special situation with temporarily enhanced fibrinolysis is thrombolytic therapy with drugs which activate plasminogen , e.g. for use in acute ischemic events or in patients with stroke . In patients with severe trauma , hyperfibrinolysis is associated with poor outcome . Moreover , hyperfibrinolysis may be associated with blood brain barrier impairment , a plasmin-dependent effect due to an increased generation of bradykinin .   Bleeding is caused by the generation of fibrinogen degradation products which interfere with regular fibrin polymerization and inhibit platelet aggregation . Moreover , plasmin which is formed in excess in hyperfibrinolysis can proteolytically activate or inactivate many plasmatic or cellular proteins involved in hemostasis . Especially the degradation of fibrinogen , an essential protein for platelet aggregation and clot stability , may be a major cause for clinical bleeding .

neg: Diabetes mellitus Diabetes mellitus ( DM ) , commonly referred to as diabetes , is a group of metabolic diseases in which there are high blood sugar levels over a prolonged period . Symptoms of high blood sugar include frequent urination , increased thirst , and increased hunger . If left untreated , diabetes can cause many complications . Acute complications can include diabetic ketoacidosis , nonketotic hyperosmolar coma , or death . Serious long-term complications include heart disease , stroke , chronic kidney failure , foot ulcers , and damage to the eyes .   Diabetes is due to either the pancreas not producing enough insulin or the cells of the body not responding properly to the insulin produced . There are three main types of diabetes mellitus :  Type 1 DM results from the pancreas 's failure to produce enough insulin . This form was previously referred to as `` insulin-dependent diabetes mellitus '' ( IDDM ) or `` juvenile diabetes '' . The cause is unknown .  Type 2 DM begins with insulin resistance , a condition in which cells fail to respond to insulin properly . As the disease progresses a lack of insulin may also develop . This form was previously referred to as `` non insulin-dependent diabetes mellitus '' ( NIDDM ) or `` adult-onset diabetes '' . The most common cause is excessive body weight and not enough exercise .  Gestational diabetes is the third main form and occurs when pregnant women without a previous history of diabetes develop high blood sugar levels .   Prevention and treatment involve maintaining a healthy diet , regular physical exercise , a normal body weight , and avoiding use of tobacco . Control of blood pressure and maintaining proper foot care are important for people with the disease . Type 1 DM must be managed with insulin injections . Type 2 DM may be treated with medications with or without insulin . Insulin and some oral medications can cause low blood sugar . Weight loss surgery in those with obesity is sometimes an effective measure in those with type 2 DM . Gestational diabetes usually resolves after the birth of the baby .   , an estimated 415 million people had diabetes worldwide , with type 2 DM making up about 90 % of the cases . This represents 8.3 % of the adult population , with equal rates in both women and men . , trends suggested the rate would continue to rise . Diabetes at least doubles a person 's risk of early death . From 2012 to 2015 , approximately 1.5 to 5.0 million deaths each year resulted from diabetes . The global economic cost of diabetes in 2014 was estimated to be billion . In the United States , diabetes cost $ 245 billion in 2012 .

neg: Acute limb ischaemia Acute limb ischaemia ( ALI ) occurs when there is a sudden lack of blood flow to a limb .   Acute limb ischaemia is caused by embolism or thrombosis , or rarely by dissection or trauma . Thrombosis is usually caused by peripheral vascular disease ( atherosclerotic disease that leads to blood vessel blockage ) , while an embolism is usually of cardiac origin . In the United States , ALI is estimated to occur in 14 out of every 100,000 people per year . With proper surgical care , acute limb ischaemia is a highly treatable condition ; however , delayed treatment ( beyond 6 to 12 hours ) can result in permanent disability , amputation , and/or death .   The New Latin term ischaemia as written , is a British version of the word ischemia , and stems from the Greek terms ischein ` to hold ' ; and haima ` blood ' . In this sense , ischaemia refers to the inhibition of blood flow to/through the limb .

neg: Telehealth Telehealth involves the distribution of health-related services and information . Distribution is via electronic information and telecommunication technologies . It allows long distance patient/clinician contact and care , advice , reminders , education , intervention , monitoring and remote admissions . As well as provider distance-learning ; meetings , supervision , and presentations between practitioners ; online information and health data management and healthcare system integration . Telehealth could include two clinicians discussing a case over video conference ; a robotic surgery occurring through remote access ; physical therapy done via digital monitoring instruments , live feed and application combinations ; tests being forwarded between facilities for interpretation by a higher specialist ; home monitoring through continuous sending of patient health data ; client to practitioner online conference ; or even videophone interpretation during a consult .   As the population grows and ages , and medical advances are made which prolong life , demands increase on the healthcare system . Healthcare providers are also being asked to do more , with no increase in funding , or are encouraged to move to new models of funding and care such as patient-centred or outcomes based , rather than fee-for-service . Some specific health professions already have a shortage ( i.e. Speech-language pathologists ) . When rural settings , lack of transport , lack of mobility ( i.e. . In the elderly or disabled ) , decreased funding or lack of staffing restrict access to care , telehealth can bridge the gap .

neg: Central venous catheter A central venous catheter ( CVC ) , also known as a central line , central venous line , or central venous access catheter , is a catheter placed into a large vein . Catheters can be placed in veins in the neck ( internal jugular vein ) , chest ( subclavian vein or axillary vein ) , groin ( femoral vein ) , or through veins in the arms ( also known as a PICC line , or peripherally inserted central catheters ) . It is used to administer medication or fluids that are unable to be taken by mouth or would harm a smaller peripheral vein , obtain blood tests ( specifically the `` central venous oxygen saturation '' ) , and measure central venous pressure .

neg: Heart block Heart block is a disease or inherited condition that causes a fault within the heart 's natural pacemaker due to some kind of obstruction ( or `` block '' ) in the electrical conduction system of the heart . Despite the severe-sounding name , heart block may often cause no symptoms at all in some cases , or occasional missed heartbeats in other cases ( which can cause lightheadedness , syncope ( fainting ) , and palpitations ) , or may require an artificial pacemaker to be implanted , depending upon exactly where in the heart conduction is being impaired and how significantly it is affected .   In severe cases where the heart 's ability to control and trigger heartbeats may be completely ineffective or unreliable , heart block can usually be treated by inserting an artificial pacemaker , a medical device that provides correct electrical impulses to trigger heart beats , compensating for the natural pacemaker 's unreliability . Therefore , heart block frequently has no effects , or mild and occasional effects , and is not life-threatening in the vast majority of cases , and is usually treatable in more serious cases .   The human heart uses electrical signals to maintain and initiate the regular heart beat in a living person ; incorrect conduction can lead to mild or serious symptoms depending upon the location of the blockage and how severely conduction is being blocked . Conduction is initiated by the sinoatrial node ( `` sinus node '' or `` SA node '' ) , and then travels to the atrioventricular node ( `` AV node '' ) which also contains a secondary `` pacemaker '' that acts as a backup for the SA nodes , then to the bundle of His and then via the bundle branches to the point of the apex of the fascicular branches ( shown in the diagram on the right ) . Blockages are therefore classified based on where the blockage occurs - namely the SA node ( `` Sinoatrial block '' ) , AV node ( `` AV block '' or AVB ) , and at or below the bundle of His ( `` Intra-Hisian '' or `` Infra-Hisian block '' respectively ) . Infra-Hisian blocks may occur at the left or right bundle branches ( `` bundle branch block '' ) or the fascicles of the left bundle branch ( `` fascicular block '' or `` Hemiblock '' ) . SA and AV node blocks are each divided into three degrees , with second degree blocks being divided into two types ( written either `` type I or II '' or `` type 1 or 2 '' ) . The term `` Wenckebach block '' is also used for second degree type 1 blocks of either the SA or AV node ; in addition second degree blocks type 1 and 2 are also sometimes known as `` Mobitz 1 '' and `` Mobitz 2 '' .   Clinically speaking , the blocks tend to have more serious potential the closer they are to the ` end ' of the electrical path ( the muscles of the heart regulated by the heartbeat ) , and less serious effects the closer they are to the ` start ' ( at the SA node ) , because the potential disruption becomes greater as more of the ` path ' is ` blocked ' from its ` end ' point . Therefore , most of the important heart blocks are AV nodal blocks and infra-Hisian blocks . SA blocks are usually of lesser clinical significance , since in the event of SA block , the AV node contains a secondary pacemaker which would still maintain a heart rate of around 40 - 60 beats per minute , sufficient for consciousness and much of daily life in the majority of individuals .

neg: Xenotransplantation Xenotransplantation ( xenos - from the Greek meaning `` foreign '' ) , is the transplantation of living cells , tissues or organs from one species to another . Such cells , tissues or organs are called xenografts or xenotransplants . It is contrasted with allotransplantation ( from other individual of same species ) , Syngeneic transplantation ( Grafts transplanted between two genetically identical individuals of the same species ) and Autotransplantation ( from one part of the body to another in the same person ) .   Xenotransplantation of human tumor cells into immunocompromised mice is a research technique frequently used in pre-clinical oncology research .   Human xenotransplantation offers a potential treatment for end-stage organ failure , a significant health problem in parts of the industrialized world . It also raises many novel medical , legal and ethical issues . A continuing concern is that many animals , such as pigs , have a shorter lifespan than humans , meaning that their tissues age at a quicker rate . Disease transmission ( xenozoonosis ) and permanent alteration to the genetic code of animals are also causes for concern . A few successful cases of xenotransplantation are published .   It is not uncommon for patients and physicians to use the term `` allograft '' imprecisely to refer to either allograft ( human-to-human ) or xenograft ( animal-to-human ) , but it is helpful scientifically ( for those searching or reading the scientific literature ) to maintain the more precise distinction in usage .

neg: Glaucoma Glaucoma is a group of eye diseases which result in damage to the optic nerve and vision loss . The most common type is open-angle glaucoma with less common types including closed-angle glaucoma and normal-tension glaucoma . Open-angle glaucoma develops slowly over time and there is no pain . Side vision may begin to decrease followed by central vision resulting in blindness if not treated . Closed-angle glaucoma can present gradually or suddenly . The sudden presentation may involve severe eye pain , blurred vision , mid-dilated pupil , redness of the eye , and nausea . Vision loss from glaucoma , once it has occurred , is permanent .   Risk factors for glaucoma include increased pressure in the eye , a family history of the condition , migraines , high blood pressure , and obesity . For eye pressures a value of greater than 21 mmHg is often used with higher pressures leading to a greater risk . However , some may have high eye pressure for years and never develop damage . Conversely , optic nerve damage may occur with normal pressure , known as normal-tension glaucoma . The mechanism of open-angle glaucoma is believed to be slow exit of aqueous humor through the trabecular meshwork while in closed-angle glaucoma the iris blocks the trabecular meshwork . Diagnosis is by a dilated eye examination . Often the optic nerve shows an abnormal amount of cupping .   If treated early it is possible to slow or stop the progression of disease with medication , laser treatment , or surgery . The goal of these treatments is to decrease eye pressure . A number of different classes of glaucoma medication are available . Laser treatments may be effective in both open-angle and closed-angle glaucoma . A number of types of glaucoma surgeries may be used in people who do not respond sufficiently to other measures . Treatment of closed-angle glaucoma is a medical emergency .   About 6 to 67 million people have glaucoma globally . The disease affects about 2 million people in the United States . It occurs more commonly among older people . Closed-angle glaucoma is more common in women . Glaucoma has been called the `` silent thief of sight '' because the loss of vision usually occurs slowly over a long period of time . Worldwide , glaucoma is the second-leading cause of blindness after cataracts . The word `` glaucoma '' is from ancient Greek glaukos which means blue , green , or gray . In English , the word was used as early as 1587 but did not become commonly used until after 1850 , when the development of the ophthalmoscope allowed people to see the optic nerve damage .

neg: Abbreviated New Drug Application An Abbreviated New Drug Application ( ANDA ) is an application for a U.S. generic drug approval for an existing licensed medication or approved drug .   The ANDA is submitted to FDA 's Center for Drug Evaluation and Research , Office of Generic Drugs , which provides for the review and ultimate approval of a generic drug product . Once approved , an applicant may manufacture and market the generic drug product to provide a safe , effective , low cost alternative to the American public . Electronic submissions of ANDAs have grown by 70 % since November 2008 . The Section IV challenge has been credited with suppressing new drug innovation .   A generic drug product is one that is comparable to an innovator drug product in dosage form , strength , route of administration , quality , performance characteristics and intended use . All approved products , both innovator and generic , are listed in FDA 's Approved Drug Products with Therapeutic Equivalence Evaluations ( Orange Book ) .   Generic drug applications are termed `` abbreviated '' because ( in comparison with a New Drug Application ) they are generally not required to include preclinical ( animal and in vitro ) and clinical ( human ) trial data to establish safety and effectiveness . Instead , generic applicants must scientifically demonstrate that their product is bioequivalent ( i.e. , performs in the same manner as the innovator drug ) . One way scientists demonstrate bioequivalence is to measure the time it takes the generic drug to reach the bloodstream in 24 to 36 healthy volunteers . This gives them the rate of absorption , or bioavailability , of the generic drug , which they can then compare to that of the innovator drug . The generic version must deliver the same amount of active ingredients into a patient 's bloodstream in the same amount of time as the innovator drug . In cases of topically active drugs , the bioequivalence of a drug can be demonstrated by comparing drugs dissolution or transdermal drug absorption is compared with the innovator drug . In cases of systemically active drugs , active drug blood concentration of that drug is compared with the innovator drug .   Using bioequivalence as the basis for approving generic copies of drug products was established by the Drug Price Competition and Patent Term Restoration Act of 1984 , also known as the Hatch-Waxman Act . This Act expedites the availability of less costly generic drugs by permitting FDA to approve applications to market generic versions of brand-name drugs without conducting costly and duplicative clinical trials . At the same time , the brand-name companies can apply for up to five additional years longer patent protection for the new medicines they developed to make up for time lost while their products were going through FDA 's approval process . Brand-name drugs are subject to the same bioequivalence tests as generics upon reformulation .

neg: Carbon nanotubes in medicine Carbon nanotubes ( CNTs ) are very prevalent in today 's world of medical research and are being highly researched in the fields of efficient drug delivery and biosensing methods for disease treatment and health monitoring . Carbon nanotube technology has shown to have the potential to alter drug delivery and biosensing methods for the better , and thus , carbon nanotubes have recently garnered interest in the field of medicine .   The use of CNTs in drug delivery and biosensing technology has the potential to revolutionalize medicine . Functionalization of single-walled nanotubes ( SWNTs ) has proven to enhance solubility and allow for efficient tumor targeting/drug delivery . It prevents SWNTs from being cytotoxic and altering the function of immune cells .   Cancer , a group of diseases in which cells grow and divide abnormally , is one of the primary diseases being looked at with regards to how it responds to CNT drug delivery . Current cancer therapy primarily involves surgery , radiation therapy , and chemotherapy . These methods of treatment are usually painful and kill normal cells in addition to producing adverse side effects . CNTs as drug delivery vehicles have shown potential in targeting specific cancer cells with a dosage lower than conventional drugs used , that is just as effective in killing the cells , however does not harm healthy cells and significantly reduces side effects . Current blood glucose monitoring methods by patients suffering from diabetes are normally invasive and often painful . For example , one method involves a continuous glucose sensor integrated into a small needle which must be inserted under the skin to monitor glucose levels every few days . Another method involves glucose monitoring strips to which blood must be applied . These methods are not only invasive but they can also yield inaccurate results . It was shown that 70 percent of glucose readings obtained by continuous glucose sensors differed by 10 percent or more and 7 percent differed by over 50 percent . The high electrochemically accessible surface area , high electrical conductivity and useful structural properties have demonstrated the potential use of single-walled nanotubes ( SWNTs ) and multi-walled nanotubes ( MWNTs ) in highly sensitive noninvasive glucose detectors .

neg: Surrogate endpoint In clinical trials , a surrogate endpoint ( or marker ) is a measure of effect of a specific treatment that may correlate with a real clinical endpoint but does not necessarily have a guaranteed relationship . The National Institutes of Health ( USA ) defines surrogate endpoint as `` a biomarker intended to substitute for a clinical endpoint '' .   Surrogate markers are used when the primary endpoint is undesired ( e.g. , death ) , or when the number of events is very small , thus making it impractical to conduct a clinical trial to gather a statistically significant number of endpoints . The FDA and other regulatory agencies will often accept evidence from clinical trials that show a direct clinical benefit to surrogate markers .   Surrogate endpoints can be obtained from different modalities , such as , behavioural or cognitive scores , or biomarkers from Electroencephalography ( qEEG ) , MRI , PET , or biochemical biomarkers .   A correlate does not make a surrogate . It is a common misconception that if an outcome is a correlate ( that is , correlated with the true clinical outcome ) it can be used as a valid surrogate end point ( that is , a replacement for the true clinical outcome ) . However , proper justification for such replacement requires that the effect of the intervention on the surrogate end point predicts the effect on the clinical outcome -- a much stronger condition than correlation .   The term `` surrogate '' should not be used in describing end points . Instead , descriptions of results and interpretations should be formulated in terms that designate the specific nature and category of variable assessed .   A surrogate endpoint of a clinical trial is a laboratory measurement or a physical sign used as a substitute for a clinically meaningful endpoint that measures directly how a patient feels , functions or survives . Changes induced by a therapy on a surrogate endpoint are expected to reflect changes in a clinically meaningful endpoint .   A commonly used example is cholesterol . While elevated cholesterol levels increase the likelihood for heart disease , the relationship is not linear - many people with normal cholesterol develop heart disease , and many with high cholesterol do not . `` Death from heart disease '' is the endpoint of interest , but `` cholesterol '' is the surrogate marker . A clinical trial may show that a particular drug ( for example , simvastatin ( Zocor ) ) is effective in reducing cholesterol , without showing directly that simvastatin prevents death . Proof of Zocor 's efficacy in reducing cardiovascular disease was only presented five years after its original introduction , and then only for secondary prevention . In another case , AstraZeneca has been accused of marketing rosuvastatin ( Crestor ) without providing hard endpoint data , relying instead on surrogate endpoints . The company counters that it had been tested on larger groups of patients than any other drug in the class , and that its effects should be comparable to the other statins .

neg: Cordectomy Cordectomy is the surgical removal of a cord . It usually refers to removal of the vocal cord , often for the purpose of treating Laryngeal Cancer . The word is derived from the Greek , combining `` Chorde '' and `` ektome '' meaning excision . It can be carried out by traditional surgical techniques or , increasingly , by Carbon Dioxide Laser . CO2 laser cordectomy has allowed the treatment of glottic carcinoma as a day case procedure . The procedure has also been carried out by vets to prevent incessant barking by dogs . In Human , this type of surgeries are usually done by the Otolaryngologists and Oral & Maxillofacial Surgeons .   Prior to surgery , the patient must be informed of serious , debilitating , and permanent consequences of surgery , most notably the loss of speaking capacity with severity correlating to the portion of vocal cords removed . A patient will be incapable of producing most vocal sounds following total cordectomy , although certain primal deep guttural screams may still be produced , with the patient almost always retaining the ability to speak in whispers . There is little no chance of a patient recovering their voice following a complete or near-complete cordectomy as the procedure literally removes the organs responsible for vocal utterances , and patients with a less-than-entire cordectomy will always lose some or most of their vocal range ( again corresponding to the section and amount of removed vocal cords ) . Doctors are encouraged to explore alternative communication technologies with patients ( such as voice-boxes , whisper-amplifying devices , and text = to-speak softwares ) prior to determining the acceptability of the procedure . Patients should be made to understand that the procedure is absolutely permanent and their vocal capacity ( with current technology ) will never recover to its range prior to the surgery , and patients with small percentages of cord removals will experience disproportionately severe loss of vocal range compared to the loss suffered by patients who have undergone a near-entire cordectomy procedure .   The indications being Carcinoma of Vocal cords and Early Glottic Carcinoma etc. .   According to the European Laryngeal Society , Cordectomy is classified into followings :   1 ) Type I : Subepithelial cordectomy  2 ) Type II : Subligamental cordectomy  3 ) Type III : Transmuscular cordectomy  4 ) Type IV : Total or Complete cordectomy   Category : Oral and maxillofacial surgery

neg: Mirror box A mirror box is a box with two mirrors in the center ( one facing each way ) , invented by Vilayanur S. Ramachandran to help alleviate phantom limb pain , in which patients feel they still have a limb after having it amputated . The wider use of mirrors in this way is known as mirror therapy .   In a mirror box the patient places the good limb into one side , and the residual limb into the other . The patient then looks into the mirror on the side with the good limb and makes `` mirror symmetric '' movements , as a symphony conductor might , or as we do when we clap our hands . Because the subject is seeing the reflected image of the good hand moving , it appears as if the phantom limb is also moving . Through the use of this artificial visual feedback it becomes possible for the patient to `` move '' the phantom limb , and to unclench it from potentially painful positions .   Based on the observation that phantom limb patients were much more likely to report paralyzed and painful phantoms if the actual limb had been paralyzed prior to amputation ( for example , due to a brachial plexus avulsion ) , Ramachandran and Rogers-Ramachandran proposed the `` learned paralysis '' hypothesis of painful phantom limbs . Their hypothesis was that every time the patient attempted to move the paralyzed limb , they received sensory feedback ( through vision and proprioception ) that the limb did not move . This feedback stamped itself into the brain circuitry through a process of Hebbian learning , so that , even when the limb was no longer present , the brain had learned that the limb ( and subsequent phantom ) was paralyzed .   Ramachandran 's theory was challenged by a 2010 research study conducted by Marian Michielsen of the University Medical Center , Rotterdam . Michielsen carried out research involving 22 stroke victims which suggests that mirror therapy works by enhancing the spatial coupling between limbs . Michielsen stated that `` The hypothesis that the mirror illusion enhances spatial coupling is supported by studies on healthy volunteers , showing that the mirror illusion increased the tendency of one limb to take on the spatial properties of the other limb .

neg: Transplant surgeon A transplant surgeon is a surgeon who performs organ transplants . Among the many organs that can be transplanted are : kidneys . livers , hearts , lungs , the pancreas , the intestine ( especially the small intestine ) , and recently , faces , tracheal ( windpipe ) tissue , and penises . At the present time , some organs , notably the brain and its constituent lobes and subdivisions , can not be transplanted , and even if possible ( recently , research has been done into the subject ) , would be very controversial for many . However , more extensive research into the transplantation of individual neurons and supportive brain tissue , or groups thereof ( including glia , astrocytes , other neural connective tissue , and the surrounding meninges ) has been done , and may be more practical and somewhat less controversial . Substitution of whole genes or chromosomes , or large portions thereof , for the purpose of genetic therapy or engineering ( which is not actually transplantation , since these are not whole organs , or even tissues ) is generally not yet feasible . While the use of tissue grafts - which is much more common - is not transplantation , since an entire organ is not transferred , these two are closely related ( skin , hair , and subdermal tissue , connective tissue , musculoskeletal tissue , and corneas are commonly grafted ) .   Sometimes , the separation of conjoined individuals requires transplantation of an organ or organs , especially if complications develop . End-stage renal disease ( stages 5 and 6 ; either acute and non-reversible , or chronic ) , severe congestive or other heart failure or certain congenital cardiac structural defects ( where the blood can not be oxygenated or backflows , or where the ejection fraction or distribution of blood is insufficient ) ; and advanced chronic obstructive pulmonary disease , cystic fibrosis ( when the lungs are no longer able to function ) , or emphysema , are possible indicators for , respectively , renal ( kidney ) , cardiac ( heart ) , or pulmonary ( lung ) transplantation .   There are distinct parameters for who is eligible for transplantation of the different organs . Broadly speaking ( this is not meant to be exhaustive ) , these include : age , how long they have been on the waiting list , how urgently they need the organ ( which is often related to how long they 've been on the list , and whether they are actually in end-stage disease , which has its own laboratory and functional criteria per organ ) ; their prognosis ( how stable they are now - whether they can survive major invasive surgery and the anesthesia and post-op period , and how they have been , and how they likely will fare with and/or without the organ , versus with other therapies that are not transplantation - such as continued dialysis or getting an artificial heart or left ventricular assist device ) . Care must be taken when finding organs for the very young ( this requires special training , or at least knowledge of , pediatric and newborn transplantation procedures ) , or certain very elderly patients ( there may or may not be mandatory or preferred cut-off ages for receiving an organ or tissue , depending on the location , the institutions involved , the surgical team , whether the patient has any relevant co-morbidities and whether they are capable of caring for their new situation , how long and how well they might live , and the patient 's and family 's wishes ) . Transplantation rejection concerns , and the need to find willing donors or to have others give consent ( for the deceased , in a cadaveric procedure ) , and the need to match them and to screen the needed blood products and other materials and maintain sterility and asepsis , are all very relevant issues , as is how to proceed if rejection becomes an issue ( treatment , and if need be , removal ) , and how to deal with immune suppression post-transplant ( this has become somewhat easier in recent years ) . Those with diabetes ( particularly if it is advanced , and especially if it is not well-controlled ) , those who are culpably non-compliant with their medication and treatment plans , those who abuse substances ( any drugs , alcohol , or tobacco ) , those who are uncooperative , those whose diseases or prognoses are not amenable to transplantation ( or who may go on to need another of the same organ soon ) , those who have advanced and uncontrolled active liver or kidney disease , some prisoners , and those with advanced symptomatic AIDS or metastatic cancer with little chance of remediation are generally not candidates for transplantation ( or would be low on the priority list independently of any other factors ) , though in certain cases exceptions can , especially recently , with better technology and better knowledge and protocols , be made , per the discretion of the organ network , the institutions , and the patient 's doctor and surgical team .   Admission to the specialty , like many other surgical specialties , is very competitive . There is a shortage of organs and tissues available , and more donors and more surgeons and more locations capable of these procedures are needed , in both developed and developing countries . Because these patients are often somewhat unstable , on some form of life support and/or life-sustaining technologies ( cardiopulmonary bypass , respirator/ventilator or breathing tube , implantable cardioverter/defibrillator , some form of dialysis or other renal replacement therapy , artificial liver , parenteral nutrition , etc. ) , these procedures - especially if they involve the vital organs ( heart , lung , liver , pancreas ; kidney transplantation could be included here but is more common ) - usually only take place in Level I trauma centers that usually are academic medical centers ( teaching hospitals ) , or at least at a relatively large , well-staffed hospital with a 24-hour operating and emergency room service , 24-hour intensive and critical care available , a good hospital pharmacy , 24-hour advanced skilled nursing care available , access to the person 's GP and specialist , and 24-hour easy access to anesthesia practitioners , surgeons and physicians , and nurses with expertise in the transplanted organ and in emergency , operative , and intensive care . At smaller ( Level II or III ) institutions in smaller cities , it is still often possible to perform renal and corneal transplantation ( especially on adults ) , and do skin grafts ; the extent of their services varies with the personnel and the organ at stake ( hearts , livers , and lungs have extensive arterial , venous , and capillary vasculature , extensive connections to muscle , fascia , and connective tissue , connections to ligaments , tendons , and other body parts , and numerous small parts and nerves and nerve junctions , require a number of anastomoses , or joining of tissues , and are near other important structures ) . Training in the U.S. usually involves the four years of the undergraduate pre-medical track , four years of medical school , a rotating first year of residency ( the former internship year ) , and then four more residency years ( for a total of 5 ) in general surgery . At some point during those four years , a transplant surgeon would likely train to some extent in emergency surgical procedures , vascular surgical procedures , surgical procedures involving pediatric and/or geriatric cases , and a variety of surgical cases , featuring different conditions , degrees of urgency , and age groups , that require critical and/or intensive care . During their first residency rotational year , they are likely to focus on the surgical field , the emergency room , and critical/intensive care and post-operative/recovery care , as well as some time with immunology , anesthesia , pediatrics , and rehabilitation , and to spend some time with a paramedic or flight crew . During their residency , they will likely be exposed to a progressively increasing number of transplant cases , with more and more degrees of difficulty , and with less oversight over time . They can also complete another residency afterward in the specialty of the organ systems they most prefer to transplant ( cardiovascular , pulmonology , gastrointestinal/hepatic , nephrology/urology , etc. ) . Fellowships can be done in general transplant medicine or in certain areas of transplant medicine and surgery . Among the possible specialties are : transplantation rejection medicine/immunology , pediatric and/or neonatal transplantation of certain organs , sense organ transplantation ( primarily , corneas and research into future advances ) , transplantation research ( i.e. , into neural or brain region transplantation ) , obstetric transplantation ( of pregnant women ) , geriatric transplantation , trauma/burn transplantation surgery , emergency or critical care transplant surgery ( for unstable cases : emergency , septic , or acute degeneration cases needing transplants ) , post-transplantation rehabilitation , and oncologic or diabetic transplantation cases . It is a very stressful position demanding high accuracy in a very unforgiving surgical environment , requiring a very steady physical and motor presence and a calm , professional , and composed personality with a reasonably good bedside manner and the capacity for teamwork involving various personalities and multiple guidelines from multiple institutions , with not-uncommon failure and complication rates and with frequent transfers of patient care between facilities .

neg: Stroke in China Recent epidemiologic studies confirm that stroke is the most frequent cause of death in the People 's Republic of China , with an incidence more than fivefold that of myocardial infarction . Intracerebral hemorrhage causes about one third of all strokes , nearly three times the frequency in North American stroke registries . A marked regional variation in stroke incidence exists , with a threefold higher stroke incidence in northern than in southern Chinese cities , suggesting important environmental or dietary influences . Stroke treatment often involves a combination of modern and traditional herbal medicine ; the latter may modify platelet aggregation and blood viscosity . Stroke , particularly intracerebral hemorrhage , is the most frequent and important vascular disorder in China .   China reports more patients with stroke than anywhere else in the world . While there is still a great deal of unknown information , stroke research has been making great progress in recent years , such as in the areas of clinical research , population and genetic epidemiology , brain ischemia/reperfusion exploring , leukoencephalopathy ( CADASIL ) , neural stem cell and stroke , neuroprotective treatment for stroke , clinical therapy test in stroke , rehabilitation and prevention .   Cities and towns in China have integrated systems for registering and investigating strokes . Chinese researchers have followed closely the international level of stroke treatment with a forward position in neural stem cell . Traditional Chinese drugs have featured effects on neuroprotective treatment for stroke which has also been investigated . Chinese scientists have suggested a new way of dividing neuroprotectors in stroke . The clinical therapy test with urokinase and defibrase for cerebral infarction in China is effective and relatively safe , yet the original papers published by Chinese researchers and clinical effects for patient treatment still need to be improved and updated .

neg: Sensory stimulation therapy Sensory stimulation therapy ( SST ) is an experimental therapy that aims to utilize neural plasticity mechanisms to aid in the recovery of somatosensory function after stroke or cognitive ageing . Stroke and cognitive ageing are well known sources of cognitive loss , the former by neuronal death , the later by weakening of neural connections . As SS implies a patient will have a desired sense stimulated in a predetermined fashion at a known frequency . It has been found that this technique can be used to reduce as much as 30 years of cognitive ageing , and can both improve two point discrimination thresholds and also impair them .

neg: Hepatic artery embolization Hepatic artery embolization ( HAE ) , also known as trans-arterial embolization ( TAE ) , is one of the several therapeutic methods to treat primary liver tumors or metastases to the liver . The embolization therapy can reduce the size of the tumor , and decrease the tumor 's impact such its hormone production , effectively decreasing symptoms . The treatment was initially developed in the early 1970s . The several types of hepatic artery treatments are based on the observation that tumor cells get nearly all their nutrients from the hepatic artery , while the normal cells of the liver get about 70-80 percent of their nutrients and 50 % their oxygen supply from the portal vein , and thus can survive with the hepatic artery effectively blocked . In practice , hepatic artery embolization occludes the blood flow to the tumors , achieving significant tumor shrinkage in over 80 % of people . Shrinkage rates vary .

neg: Heart failure Heart failure ( HF ) , often referred to as congestive heart failure ( CHF ) , occurs when the heart is unable to pump sufficiently to maintain blood flow to meet the body 's needs . Signs and symptoms commonly include shortness of breath , excessive tiredness , and leg swelling . The shortness of breath is usually worse with exercise , while lying down , and may wake the person at night . A limited ability to exercise is also a common feature . Chest pain , including angina , does not typically occur due to heart failure .   Common causes of heart failure include coronary artery disease including a previous myocardial infarction ( heart attack ) , high blood pressure , atrial fibrillation , valvular heart disease , excess alcohol use , infection , and cardiomyopathy of an unknown cause . These cause heart failure by changing either the structure or the functioning of the heart . There are two main types of heart failure : heart failure due to left ventricular dysfunction and heart failure with normal ejection fraction depending on whether the ability of the left ventricle to contract is affected , or the heart 's ability to relax . The severity of disease is usually graded by the degree of problems with exercise . Heart failure is not the same as myocardial infarction ( in which part of the heart muscle dies ) or cardiac arrest ( in which blood flow stops altogether ) . Other diseases that may have symptoms similar to heart failure include obesity , kidney failure , liver problems , anemia , and thyroid disease .   The condition is diagnosed based on the history of the symptoms and a physical examination with confirmation by echocardiography . Blood tests , electrocardiography , and chest radiography may be useful to determine the underlying cause . Treatment depends on the severity and cause of the disease . In people with chronic stable mild heart failure , treatment commonly consists of lifestyle modifications such as stopping smoking , physical exercise , and dietary changes , as well as medications . In those with heart failure due to left ventricular dysfunction , angiotensin converting enzyme inhibitors or angiotensin receptor blockers along with beta blockers are recommended . For those with severe disease , aldosterone antagonists , or hydralazine with a nitrate may be used . Diuretics are useful for preventing fluid retention . Sometimes , depending on the cause , an implanted device such as a pacemaker or an implantable cardiac defibrillator may be recommended . In some moderate or severe cases cardiac resynchronization therapy ( CRT ) may be suggested or cardiac contractility modulation may be of benefit . A ventricular assist device or occasionally a heart transplant may be recommended in those with severe disease despite all other measures .   Heart failure is a common , costly , and potentially fatal condition . In 2015 it affected about 40 million people globally . In developed countries , around 2 % of adults have heart failure and in those over the age of 65 , this increases to 6 -- 10 % . In the year after diagnosis the risk of death is about 35 % after which it decreases to below 10 % each year . This is similar to the risks with a number of types of cancer . In the United Kingdom the disease is the reason for 5 % of emergency hospital admissions . Heart failure has been known since ancient times with the Ebers papyrus commenting on it around 1550 BCE .

neg: Electrodiagnostic medicine Electrodiagnosis ( EDX ) is a method of medical diagnosis that obtains information about diseases by passively recording the electrical activity of body parts ( that is , their natural electrophysiology ) or by measuring their response to external electrical stimuli ( evoked potentials ) . The most widely used methods of recording spontaneous electrical activity are various forms of electrodiagnostic testing ( electrography ) such as electrocardiography ( ECG ) , electroencephalography ( EEG ) , and electromyography ( EMG ) . Electrodiagnostic medicine ( also EDX ) is a medical subspecialty of neurology , clinical neurophysiology , cardiology , and physical medicine and rehabilitation . Electrodiagnostic physicians apply electrophysiologic techniques , including needle electromyography and nerve conduction studies to diagnose , evaluate , and treat people with impairments of the neurologic , neuromuscular , and/or muscular systems . The provision of a quality electrodiagnostic medical evaluation requires extensive scientific knowledge that includes anatomy and physiology of the peripheral nerves and muscles , the physics and biology of the electrical signals generated by muscle and nerve , the instrumentation used to process these signals , and techniques for clinical evaluation of diseases of the peripheral nerves and sensory pathways

neg: Erwin Payr Erwin Payr ( 17 February 1871 -- 6 April 1946 ) was an Austrian-German surgeon born in Innsbruck .   Following graduation in 1894 at Innsbruck , he worked as an assistant at the first pathological anatomy institute in Vienna . Afterwards he became an assistant to Carl Nicoladoni ( 1847-1902 ) at the University of Graz , where in 1899 he became habilitated for surgery .   In 1907 he became chief surgeon at the University of Greifswald , and in 1910 was appointed professor of surgery at the University of Königsberg . The following year he relocated to Leipzig , where he remained until his retirement in 1937 .   Payr was regarded as an excellent physician known for his expertise in all facets of surgery . He was the first surgeon to use ozone treatments in order to control and kill bacteria , a practice he learned from Swiss therapist E.A. Fisch . In 1935 he published Über Ozonbehandlung in der Chirurgie ( Ozone Treatment in Surgery ) . Also he introduced the use of absorbable magnesium sutures in vascular and nerve surgery .  He first reported animal experiments with readsorbable magnesium tubular device for vascular anastomosis elegantly realizing intima-to-intima facing , however just identifying in that first report its implicit mechanical limits  . He used elderberry stems for capillary drainage of brain abscesses .   Splenic-flexure syndrome or `` Payr 's disease '' is named after a condition he described . Payr 's disease is constipation due to kinking of an adhesion between the transverse and descending colon . Also a tool used in abdominal surgery called a `` Payr pylorus clamp '' is named after him , as is `` Payr 's sign '' , an indication of thrombophlebitis in which pain occurs when pressure is applied to the sole of the foot .