Hasil untuk "Specialties of internal medicine"

Jumpei Ohashi, Tatsuya Hayashi, Shingo Yamamoto et al.

Abstract Background In pulmonary vein isolation (PVI) for atrial fibrillation (AF), intraoperative defibrillation is often required. Intracardiac defibrillation catheters (ICDCs) are most effective when positioned to enclose the heart between the coronary sinus (CS) and right atrium (RA) (CS/RA configuration). However, achieving this positioning via the inferior vena cava (IVC) can be challenging, and alternative configurations remain underexplored. Methods This study included patients with paroxysmal or persistent AF who underwent cryoballoon ablation followed by intracardiac cardioversion using an ICDC via the IVC. The catheter was initially positioned with distal electrodes in the CS and proximal electrodes in the IVC (CS‐only configuration). If cardioversion failed, the catheter was repositioned to place distal electrodes in the superior vena cava (SVC configuration). A maximum of 30 J of energy was used for all cardioversion attempts. Results A total of 81 patients were included. Cardioversion in the CS‐only configuration restored sinus rhythm in 11% (9/81) of patients. Repositioning to the SVC configuration achieved successful cardioversion in 93.1% (67/72) of the remaining cases without complications. Patients requiring the SVC configuration had a significantly higher prevalence of persistent AF (33.3% vs. 80.6%; p = 0.045). No adverse events were observed following cardioversion in the SVC configuration. Conclusions While the CS‐only configuration offers ease of placement, its efficacy is limited. Repositioning to the SVC configuration significantly enhances cardioversion success and represents a safer, more effective alternative for ICDC use during AF ablation.

J. Dunne, D. Foo, J. Jancey et al.

Short interpregnancy intervals (IPIs) of <6–18 months are associated with adverse maternal and child outcomes. This study aimed to identify the individual, relationship, community, and societal factors that influence short IPIs in high-income countries. A comprehensive search was undertaken in CINAHL Plus, Ovid/EMBASE, Ovid/MEDLINE, Ovid/PsycINFO, ProQuest, PubMed, Scopus, Web of Science, and Google Scholar for articles published in English from 1st January 1990 to 26th October 2023. Studies were included if they reported an effect estimate of at least one determinant of pregnancy spacing in a high-income country. The quality of the included studies was assessed using the Johanna Briggs Institute Critical Appraisal Tool and Cochrane Risk Assessment Tool. Multi-level factors at the individual, relationship, community, and societal level were systematically identified through the socio-ecological model. This study is registered with PROSPERO (CRD42020176311). Of 2005 unique articles, 220 were identified for full-text review, and 55 met the inclusion criteria representing a total of 27,103,055 women from 13 high-income countries. All the included studies were deemed to be of moderate to high quality. Most of the studies reported determinants of short IPI at the individual level, with non-use of contraception the most common reported factor. Peer influence was a factor at the relationship level, and access to health care and reproductive services were impactful at the community and societal levels, respectively. Future research and efforts should support the development and implementation of policies and practices that support optimum pregnancy spacing from a comprehensive socio-ecological position.

Anbang Du, Michael Head, Markus Brede

Interdisciplinary research, a process of knowledge integration, is vital for scientific advancements. It remains unclear whether prestigious journals that are highly impactful lead in disseminating interdisciplinary knowledge. In this paper, by constructing topic-level correlation networks based on publications, we evaluated the interdisciplinarity of more and less prestigious journals in medicine. We found research from prestigious medical journals tends to be less interdisciplinary than research from other medical journals. We also established that cancer-related research is the main driver of interdisciplinarity in medical science. Our results indicate a weak tendency for differences in topic correlations between more and less prestigious journals to be co-located. Accordingly, we identified that interdisciplinarity in prestigious journals mainly differs from interdisciplinarity in other journals in areas such as infections, nervous system diseases and cancer. Overall, our results suggest that interdisciplinarity in science could benefit from prestigious journals easing rigid disciplinary boundaries.

Shayan Vassef, Soorya Ram Shimegekar, Abhay Goyal et al.

Clinical ML workflows are often fragmented and inefficient: triage, task selection, and model deployment are handled by a patchwork of task-specific networks. These pipelines are rarely aligned with data-science practice, reducing efficiency and increasing operational cost. They also lack data-driven model identification (from imaging/tabular inputs) and standardized delivery of model outputs. We present a framework that employs a single vision-language model (VLM) in two complementary, modular roles. First (Solution 1): the VLM acts as an aware model-card matcher that routes an incoming image to the appropriate specialist model via a three-stage workflow (modality -> primary abnormality -> model-card ID). Reliability is improved by (i) stage-wise prompts enabling early termination via "None"/"Other" and (ii) a calibrated top-2 answer selector with a stage-wise cutoff. This raises routing accuracy by +9 and +11 percentage points on the training and held-out splits, respectively, compared with a baseline router, and improves held-out calibration (lower Expected Calibration Error, ECE). Second (Solution 2): we fine-tune the same VLM on specialty-specific datasets so that one model per specialty covers multiple downstream tasks, simplifying deployment while maintaining performance. Across gastroenterology, hematology, ophthalmology, pathology, and radiology, this single-model deployment matches or approaches specialized baselines. Together, these solutions reduce data-science effort through more accurate selection, simplify monitoring and maintenance by consolidating task-specific models, and increase transparency via per-stage justifications and calibrated thresholds. Each solution stands alone, and in combination they offer a practical, modular path from triage to deployment.

Menghua Xia, Reimund Bayerlein, Yanis Chemli et al.

Artificial intelligence-generated content (AIGC) has shown remarkable performance in nuclear medicine imaging (NMI), offering cost-effective software solutions for tasks such as image enhancement, motion correction, and attenuation correction. However, these advancements come with the risk of hallucinations, generating realistic yet factually incorrect content. Hallucinations can misrepresent anatomical and functional information, compromising diagnostic accuracy and clinical trust. This paper presents a comprehensive perspective of hallucination-related challenges in AIGC for NMI, introducing the DREAM report, which covers recommendations for definition, representative examples, detection and evaluation metrics, underlying causes, and mitigation strategies. This position statement paper aims to initiate a common understanding for discussions and future research toward enhancing AIGC applications in NMI, thereby supporting their safe and effective deployment in clinical practice.

Zahra Akbari Khanaposhtani, Hossein Rajabi

Objective: Research on eye lens dosimetry for radiation workers has increased after the 2012 ICRP118 update on eye lens dose limits. However, corneal dosimetry remains underexplored due to historical focus and measurement challenges. This study uses a high-resolution digital eye phantom in Monte Carlo simulations to estimate corneal and lens doses for nuclear medicine staff, with and without lead glasses. Method: The Monte Carlo code GATE (version 9.0) based on GEANT4 (version 10.6) was used to estimate and compare doses in a digital eye phantom, accounting for primary and scattered radiation from common radionuclides (F18, I131, Tc99m) with varying lead glass shielding (0 to 0.75 mm). Results: Across all radionuclides, the dose to the cornea was consistently higher than the dose to the lens. Notably, the ratio of corneal to lens dose increased with thicker lead glasses, indicating a greater dose reduction to the lens compared to the cornea. Conclusion: The findings show that corneal doses from all studied radionuclides exceeded lens doses. Although increasing lead glass thickness reduced both, the reduction was more significant for the lens, raising the cornea-to-lens dose ratio. This trend suggests that while thicker lead glasses enhance lens protection, their practicality may be limited due to diminishing returns and potential discomfort. Keywords: Corneal Dosimetry, Lens Dosimetry, Monte Carlo, GATE, Nuclear Medicine, Simulation

Qingchao Wang, Dahai Yang, Linlin Zhang et al.

Rahul Tiwari, Awnish Kumar, Vishal Kumar Singh et al.

Understanding the development and maintenance of immunological memory is important for efforts to eliminate parasitic diseases like leishmaniasis. Leishmaniasis encompasses a range of pathologies, resulting from infection with protozoan parasites belonging to the subgenera Leishmania and Viannia of the genus Leishmania. A striking feature of these infections is that natural or drug-mediated cure of infection generally confers life-long protection against disease. The generation of protective T cell responses are necessary to control Leishmania infections. CD4+ T helper (Th) cells orchestrate immune responses in leishmaniasis and IFNγ+ Tbet+ CD4+ T (Th1) cells are required for the activation of phagocytes to kill captured or resident parasites, while other Th cell subset, including FoxP3+ natural regulatory T cells and Th2 cells can promote disease progression by suppressing the activities of Th1 cells. Upon resolution of a primary Leishmania infection, different subsets of CD4+ T cells, including tissue-resident memory T cells, effector memory T cells, central memory T cells, and short-lived effector T cells, help to confer resistance against reinfection. To maintain long-term protective Leishmania-specific CD4+ T cells responses, it is believed that persistent parasites or re-exposure to parasites at regular intervals is required (concomitant immunity). Despite the advances in our understanding about the immune responses during leishmaniasis, the generation of long-lasting protective immunity via vaccination has yet to be achieved. In this review, we summarize our current understanding about the formation and maintenance of immunological memory and control of leishmaniasis at the individual and population level. We will focus on Indian visceral leishmaniasis and discuss T cell responses that contribute to susceptibility to leishmaniasis, parasite persistence in populations and the environment, as well as describing advances in the development of leishmaniasis vaccines aimed at inducing protective CD4+ T cell responses.

Elham Alipoor, Shiva Salehi, Sahar Dehghani et al.

Abstract Introduction Asymmetric dimethylarginine (ADMA), a cardiovascular risk factor, increases in renal failure. The aim of this study was to investigate ADMA levels in normal weight and obese patients on hemodialysis. Methods In this cross-sectional study, 43 normal weight and 43 obese patients on regular hemodialysis were examined. Malnutrition-inflammation score (MIS), anthropometry, circulating ADMA, lipid profiles including triglycerides (TG), total cholesterol (TC), low-density lipoprotein (LDL), high-density lipoprotein (HDL) and lipid ratios, glucose homeostasis parameters, blood pressure, and high-sensitivity C-reactive protein (hs-CRP) were assessed. Results Serum levels of ADMA were significantly lower in the obese compared to the normal weight patients (10268.2 ± 10092.4 vs. 13765.2 ± 9951.3 ng/l, P = 0.03). At the same time MIS score (6.1 ± 2.4 vs. 10.7 ± 3.2, P < 0.001), systolic blood pressure (119 ± 26.8 vs. 134.2 ± 24.7 mmHg, P = 0.018) and mean arterial pressure (91.3 ± 18.6 vs. 100.9 ± 15.9 mmHg, P = 0.028) were significantly lower in the obese than the normal weight group. Fasting blood glucose (P = 0.045), TG/HDL (P = 0.03), TC/HDL (P = 0.019), and LDL/HDL (P = 0.005) ratios, and hs-CRP (P = 0.015) levels were significantly higher in the obese than in the normal weight group. Conclusion Circulating ADMA was significantly lower in obese than in normal weight patients on hemodialysis, which was concomitant with lower MIS, indicating a better nutritional inflammatory status, and lower blood pressure.

Ken Zhao, Sam Y. Son, Debkumar Sarkar et al.

Abstract Sinistral portal hypertension, also known as left-sided portal hypertension, is a rare cause of gastric variceal bleeding which occurs secondary to occlusion of the splenic vein. We present a case of venous occlusion and sinistral portal hypertension secondary to distal pancreatic cancer requiring treatment of gastric variceal bleeding. After failing conservative management, transvenous intervention was attempted, but a venous communication with the gastric varices was unable to be identified on multiple venograms. A percutaneous trans-splenic approach using a 21-G needle and ultrasound guidance was successful in directly accessing an intraparenchymal vein feeding the gastric varices, and glue embolization was performed directly through the access needle with excellent results.

Aaron L. Sarvet, Mats J. Stensrud

In our original article (Sarvet & Stensrud, 2024), we examine twin definitions of "harm" in personalized medicine: one based on predictions of individuals' unmeasurable response types (counterfactual harm), and another based solely on the observations of experiments (interventionist harm). In their commentary, Mueller & Pearl (2024) (MP) read our review as an argument that "counterfactual logic should [...] be purged from consideration of harm and benefit" and "strongly object [...] that a rational decision maker may well apply the interventional perspective to the exclusion of counterfactual considerations." Here we show that this objection is misguided. We analyze MP's examples and derive a general result, showing that determinations of harm through interventionist and counterfactual analyses will always concur. Therefore, individuals who embrace counterfactual formulations and those who object to their use will make equivalent decisions in uncontroversial settings.

Li Yizhen, Huang Shaohan, Qi Jiaxing et al.

No previous work has studied the performance of Large Language Models (LLMs) in the context of Traditional Chinese Medicine (TCM), an essential and distinct branch of medical knowledge with a rich history. To bridge this gap, we present a TCM question dataset named TCM-QA, which comprises three question types: single choice, multiple choice, and true or false, to examine the LLM's capacity for knowledge recall and comprehensive reasoning within the TCM domain. In our study, we evaluate two settings of the LLM, zero-shot and few-shot settings, while concurrently discussing the differences between English and Chinese prompts. Our results indicate that ChatGPT performs best in true or false questions, achieving the highest precision of 0.688 while scoring the lowest precision is 0.241 in multiple-choice questions. Furthermore, we observed that Chinese prompts outperformed English prompts in our evaluations. Additionally, we assess the quality of explanations generated by ChatGPT and their potential contribution to TCM knowledge comprehension. This paper offers valuable insights into the applicability of LLMs in specialized domains and paves the way for future research in leveraging these powerful models to advance TCM.

Arman Rahmim, Tyler J. Bradshaw, Guido Davidzon et al.

The 2nd SNMMI Artificial Intelligence (AI) Summit, organized by the SNMMI AI Task Force, took place in Bethesda, MD, on February 29 - March 1, 2024. Bringing together various community members and stakeholders, and following up on a prior successful 2022 AI Summit, the summit theme was: AI in Action. Six key topics included (i) an overview of prior and ongoing efforts by the AI task force, (ii) emerging needs and tools for computational nuclear oncology, (iii) new frontiers in large language and generative models, (iv) defining the value proposition for the use of AI in nuclear medicine, (v) open science including efforts for data and model repositories, and (vi) issues of reimbursement and funding. The primary efforts, findings, challenges, and next steps are summarized in this manuscript.

SC Weber, J Pallas, G Olson et al.

STARR (STAnford Research Repository) is a clinical research support ecosystem that supports basic science research, population health research and translational research at Stanford University. STARR consists of raw and analysis ready multi-modal data, and tools for cohort analysis and self service data access. STARR data is accessible on secure shared computing systems for ad hoc analysis. Also present is a suite of services on top of STARR, that allow researchers access to complex purpose built data cuts, common data models and software solutions. This manuscript is a research resource description and describes the evolution of STARR Tools that are used to offer self-service access to detailed clinical data for research purposes to researchers at Stanford Medicine, along with a framework used to ensure that data acquired via the self-service tools is handled in compliance with all applicable regulations and rules.

Aki Ronkainen, Imran Khan, Eva Krzyżewska-Dudek et al.

ABSTRACTFecal microbiota transplantation (FMT) is used routinely to treat recurrent Clostridioides difficile infection (rCDI) and investigated as a treatment for numerous conditions associated with gut microbiota alterations. Metagenomic analyses have indicated that recipient colonization by donor bacteria may be associated with favorable clinical outcomes. Bifidobacteria are abundant gut commensals associated with health. We have previously demonstrated that Bifidobacterium strains transferred in FMT can colonize recipients in long term, at least for a year, and recovered such strains by cultivation. This study addressed in vitro adhesion and pilus gene expression of long-term colonizing Bifidobacterium strains from FMT donors as well as in vivo colonization and capability to ameliorate antibiotic-induced microbiota disturbance. RNA-Seq differential gene expression analysis showed that the strongly adherent B. longum strains DY_pv11 and DX_pv23 expressed tight adherence and sortase-dependent pilus genes, respectively. Two B. longum strains, adherent DX_pv23 and poorly adhering DX_pv18, were selected to address in vivo colonization and efficacy to restore antibiotic-disturbed microbiota in C57BL/6 murine model. DX_pv23 colonized mice transiently with a rate comparable to that of the B. animalis BB-12 used as a reference. Although long-term colonization was not observed with any of the three strains, 16S rRNA gene profiling revealed that oral administration of DX_pv23 enhanced the recovery of antibiotic-disturbed microbiota to the original configuration significantly better than the other strains. The findings suggest that selected strains from FMT donors, such as DX_pv23 in this study, may have therapeutic potential by in vitro expression of colonization factors and boosting endogenous gut microbiota.

Dalia D. Hadi, Mohammed Dheyaa Marsool Marsool, Ali Dheyaa Marsool Marsool et al.

Abstract Background Idiopathic pulmonary fibrosis (IPF) is a progressive and debilitating lung disease characterized by irreversible scarring of the lungs. The cause of IPF is unknown, but it is thought to involve a combination of genetic and environmental factors. There is no cure for IPF, and treatment is focused on slowing disease progression and relieving symptoms. Aims We aimed in this review to investigate and provide the latest insights into IPF management modalities, including the potential of Saracatinibas a substitute for current IPF drugs. We also investigated the therapeutic potential of Sotatercept in addressing pulmonary hypertension associated with IPF. Materials and Methods We conducted a comprehensive literature review of relevant studies on IPF management. We searched electronic databases, including PubMed, Scopus, Embase, and Web of science. Results The two Food and Drug Administration‐approved drugs for IPF, Pirfenidone, and Nintedanib, have been pivotal in slowing disease progression, yet experimental evidence suggests that Saracatinib surpasses their efficacy. Preclinical trials investigating the potential of Saracatinib, a tyrosine kinase inhibitor, have shown to be more effective than current IPF drugs in slowing disease progression in preclinical studies. Also, Sotatercept,a fusion protein, has been shown to reduce pulmonary vascular resistance and improve exercise tolerance in patients with PH associated with IPF in clinical trials. Conclusions The advancements discussed in this review hold the promise of improving the quality of life for IPF patients and enhancing our understanding of this condition. There remains a need for further research to confirm the efficacy and safety of new IPF treatments and to develop more effective strategies for managing exacerbations.

Martina Stojić

We introduce a natural generalization of the definition of a symmetric Hopf algebroid, internal to any symmetric monoidal category with coequalizers that commute with the monoidal product. Motivation for this is the study of Heisenberg doubles of countably dimensional Hopf algebras $A$ as internal Hopf algebroids over a (noncommutative) base $A$ in the category $\mathrm{indproVect}$ of filtered cofiltered vector spaces introduced by the author. One example of such Heisenberg double is internal Hopf algebroid $U(\mathfrak{g}) \sharp U(\mathfrak{g})^*$ over universal enveloping algebra $U(\mathfrak{g})$ of a finite-dimesional Lie algebra $\mathfrak{g}$ that is a properly internalized version of a completed Hopf algebroid previously studied as a Lie algebra type noncommutative phase space.

Jingjin Liu, Hankz Hankui Zhuo, Kebing Jin et al.

Traditional Chinese Medicine (TCM) has a rich history of utilizing natural herbs to treat a diversity of illnesses. In practice, TCM diagnosis and treatment are highly personalized and organically holistic, requiring comprehensive consideration of the patient's state and symptoms over time. However, existing TCM recommendation approaches overlook the changes in patient status and only explore potential patterns between symptoms and prescriptions. In this paper, we propose a novel Sequential Condition Evolved Interaction Knowledge Graph (SCEIKG), a framework that treats the model as a sequential prescription-making problem by considering the dynamics of the patient's condition across multiple visits. In addition, we incorporate an interaction knowledge graph to enhance the accuracy of recommendations by considering the interactions between different herbs and the patient's condition. Experimental results on a real-world dataset demonstrate that our approach outperforms existing TCM recommendation methods, achieving state-of-the-art performance.

Oguzhan Ekrem Turan, Resit Yigit Yilancioglu, Ahmet Anil Baskurt et al.

Upper venous system anatomic variations may cause difficulties during cardiac pacemaker implantation. Persistent left superior vena cava (PLSVC) and absent right superior vena cava could be an arrhythmogenic source of atrial arrhythmias and cardiac conduction disease. We represent dual-chamber pacemaker implantation in a patient with a very rare upper venous system anomaly, paroxysmal atrial fibrillation, sick sinus syndrome, that cause unusual fluoroscopic image.