Hasil untuk "Internal medicine"

Filomena Gomes, P. Schuetz, L. Bounoure et al.

Patrick Minges, Martina Diaz McDermott, Jazmyn Shaw

Case Presentation: A 30-year-old female with a history of alcoholic cirrhosis and esophageal varices presented with massive hematemesis. A gastric balloon tamponade device was subsequently placed to temporize variceal hemorrhage, and point-of-care ultrasound (POCUS) was used to confirm the appropriate placement of the gastric balloon before complete inflation. We describe a novel use of ultrasound for use in severely ill patients with gastrointestinal (GI) bleeding. Discussion: A fluid-filled and distended stomach has long been recognized as a cause of a false-positive focused assessment with sonography in trauma exam but may also be a vital piece of information in the scenario of a patient with suspected upper GI hemorrhage. There is very little description in the literature of using POCUS to confirm the appropriate placement of a gastric tamponade balloon with none by emergency physicians.. Ultrasound may offer advantages over plain radiography in this application given its speed and safety; thus, its utility for this task is worth further investigation.

Fulya Memis, Meryem Yalvac Kandefer, Sonay Aydin et al.

<b>Background:</b> Interleukin-10 (IL-10) and vascular endothelial growth factor (VEGF) are believed to possess a role in the pathophysiology of multiple myeloma (MM). We aimed to assess the significance of these parameters in the diagnosis, monitoring, and prognosis of the disease by examining them in patients at diagnosis and post-treatment and comparing the findings with those of healthy individuals. <b>Methods:</b> We conducted blood sampling from 35 patients diagnosed with MM at the time of diagnosis and from 15 of these patients post-treatment. We additionally assessed similar serum markers in a control group of 15 healthy individuals. Furthermore, we documented laboratory results, organ involvement, comorbidities, and CD27-CD81 levels assessed using flow cytometry in the bone marrow, along with treatments and patient responses. We also examined the quantity of cells collected during mobilization in patients who had autologous stem cell transplantation. <b>Results:</b> We found a positive correlation (<i>p</i> = 0.028/<i>p</i> = 0.035) between IL-10 and VEGF with the international staging score. In patients with renal involvement, IL-10 levels were higher and VEGF levels were lower than those without renal involvement (<i>p</i> = 0.011/<i>p</i> = 0.012). We showed that VEGF levels decreased significantly with treatment (<i>p</i> = 0.001). We found no statistically significant correlation between treatment responses and IL-10 and VEGF. The number of CD34 cells collected by mobilization showed a negative correlation with CD27 and a positive correlation with VEGF (<i>p</i> = 0.007/<i>p</i> = 0.032). <b>Conclusions:</b> Serum IL-10 level is associated with ISS and renal involvement in MM patients. There is a positive correlation between serum VEGF levels and the number of stem cells collected during mobilization. As CD27 expression increases, the number of stem cells collected in mobilization decreases.

Lilla Bűdi, Dániel Hammer, Rita Varga et al.

ObjectivesSpingosine-1-phosphate (S1P) and ceramides are bioactive sphingolipids that influence cancer cell fate. Anti-ceramide antibodies might inhibit the effects of ceramide. The aim of this study was to assess the potential role of circulating S1P and anti-ceramide antibody as biomarkers in non-small cell lung cancer (NSCLC).MethodsWe recruited 66 subjects (34 controls and 32 patients with NSCLC). Patient history and clinical variables were taken from all participants. Venous blood samples were collected to evaluate plasma biomarkers. If bronchoscopy was performed, bronchial washing fluid (BWF) was also analyzed. We measured the levels of S1P and anti-ceramide antibody with ELISA.ResultsS1P levels were significantly higher in the NSCLC group (3770.99 ± 762.29 ng/mL vs. 366.53 ± 249.38 ng/mL, patients with NSCLC vs. controls, respectively, p &lt; 0.001). Anti-ceramide antibody levels were significantly elevated in the NSCLC group (278.70 ± 19.26 ng/mL vs. 178.60 ± 18 ng/mL, patients with NSCLC vs. controls, respectively, p = 0.007). Age or BMI had no significant effect on anti-ceramide antibody or S1P levels. BWF samples had higher levels of anti-ceramide antibody (155.29 ± 27.58 ng/mL vs. 105.87 ± 9.99 ng/mL, patients with NSCLC vs. controls, respectively, p &lt; 0.001). Overall survival (OS) was 13.36 months. OS was not affected by anti-ceramide antibody or S1P levels.ConclusionHigher levels of S1P and anti-ceramide antibody were associated with active cancer. These results suggest that sphingolipid alterations might be important features of NSCLC.

Qingwei Wu, Zhifa Ge, Chengyu Lv et al.

Autoimmune hepatitis (AIH) is a progressive liver inflammatory disease mediated by an autoimmune response, with an increasing incidence rate. In severe cases, AIH will rapidly progress to liver cirrhosis and liver failure and even lead to death. The gut microbiota is a complex ecosystem that significantly regulates physiological and pathological processes among various digestive system diseases. It is widely acknowledged that there is a critical correlation between AIH and the gut microbiota. Numerous studies have demonstrated that the composition of gut microbiota in individuals with AIH differs markedly from that of healthy subjects. Immune cells, especially T cells, are pivotal in the development of AIH, closely interacting with the gut microbiota. In this review, we discuss the regulatory role of the gut microbiota in T cell-mediated development of AIH, as well as the effect of T cells on the composition of the gut microbiota in AIH. By modulating gut microbiota or immunity pathways, novel opportunities are provided to regulate the balance of the immune-microbial microenvironment, targeting the dual factor for autoimmune hepatitis therapies.

Mohammad Hossein Imani, Amir Hossein Imani, Amirhossein Saem et al.

Abstract Background Falls are a leading cause of injury, hospitalization, and mortality among older adults. Sedative-hypnotic medications, especially benzodiazepines and Z-drugs, have been implicated as potential contributors to fall risk and fracture. This study investigated the prevalence of sedative-hypnotic drug use in elderly patients with falls and its association with fracture outcomes. Methods A cross-sectional study was conducted on 200 patients aged ≥ 60 years presenting with falls to Rasool Akram Hospital, Tehran (2023–2024). Demographics, comorbidities, and medication history were extracted from medical records. Sedative-hypnotic use was recorded, and outcomes included fracture occurrence confirmed by imaging. Statistical analyses included chi-square tests and multivariate logistic regression. Results Among 200 patients (mean age 73 ± 8 years; 65.5% female), 55.5% sustained a fracture. Sedative-hypnotic use was identified in 15.5% (n = 31). Fracture prevalence was higher in sedative users compared to non-users (74% vs. 52%), but the difference was not statistically significant (p = 0.08). Benzodiazepines were the most commonly used class (15.5%). Losartan use was more frequent in fracture patients (29.7% vs. 12.4%) and showed a significant association in logistic regression (OR 3.28; 95% CI: 1.48–7.26; p = 0.003). Conclusions Sedative-hypnotic use was common among elderly patients presenting with falls; although fracture risk was higher in users, the association did not reach statistical significance, likely due to limited sample size. The observed link between losartan and fractures should be interpreted cautiously and warrants further investigation. Medication review remains a critical component of fall-prevention strategies in geriatric care.

Xingyu Zhou, Qifan Li, Xiaobin Hu et al.

The diffusion model presents a powerful ability to capture the entire (conditional) data distribution. However, due to the lack of sufficient training and data to learn to cover low-probability areas, the model will be penalized for failing to generate high-quality images corresponding to these areas. To achieve better generation quality, guidance strategies such as classifier free guidance (CFG) can guide the samples to the high-probability areas during the sampling stage. However, the standard CFG often leads to over-simplified or distorted samples. On the other hand, the alternative line of guiding diffusion model with its bad version is limited by carefully designed degradation strategies, extra training and additional sampling steps. In this paper, we proposed a simple yet effective strategy Internal Guidance (IG), which introduces an auxiliary supervision on the intermediate layer during training process and extrapolates the intermediate and deep layer's outputs to obtain generative results during sampling process. This simple strategy yields significant improvements in both training efficiency and generation quality on various baselines. On ImageNet 256x256, SiT-XL/2+IG achieves FID=5.31 and FID=1.75 at 80 and 800 epochs. More impressively, LightningDiT-XL/1+IG achieves FID=1.34 which achieves a large margin between all of these methods. Combined with CFG, LightningDiT-XL/1+IG achieves the current state-of-the-art FID of 1.19.

J. Files, Anita P. Mayer, M. Ko et al.

Ali Qorbani, Mohammad Khalili, Saeidreza Nourollahifard et al.

Abstract Rickettsia occurs worldwide and rickettsiosis is recognized as an emerging infection in several parts of the world. Ticks are reservoir hosts for pathogenic Rickettsia species in humans and domestic animals. Most pathogenic Rickettsia species belong to the spotted Fever Group (SFG). This study aimed to identify and diagnose tick fauna and investigate the prevalence of Rickettsia spp. in ticks collected from domestic animals and dogs in the rural regions of Kerman Province, Southeast Iran. In this study, tick species (fauna) were identified and 2100 ticks (350 pooled samples) from two genera and species including Rhipicephalus linnaei (1128) and Hyalomma deteritum (972) were tested to detect Rickettsia genus using Real-time PCR. The presence of the Rickettsia genus was observed in 24.9% (95%CI 20.28–29.52) of the pooled samples. Sequencing and phylogenetic analyses revealed the presence of Rickettsia aeschlimannii (48.98%), Rickettsia conorii israelensis (28.57%), Rickettsia sibirica (20.41%), and Rickettsia helvetica (2.04%) in the positive samples. The results showed a significant association between county variables and the following variables: tick spp. (p < 0.001), Rickettsia genus infection in ticks (p < 0.001) and Rickettsia spp. (p < 0.001). In addition, there was a significant association between tick species and host animals (dogs and domestic animals) (p < 0.001), Rickettsia spp infection in ticks (p < 0.001), and Rickettsia spp. (p < 0.001). This study indicates a high prevalence of Rickettsia spp. (SFG) in ticks of domestic animals and dogs in rural areas of Kerman Province. The health system should be informed of the possibility of rickettsiosis and the circulating species of Rickettsia in these areas.

Ryunosuke Noda, Daisuke Ichikawa, Yugo Shibagaki

Abstract Minimal change disease (MCD) is a common cause of nephrotic syndrome. Due to its rapid progression, early detection is essential; however, definitive diagnosis requires invasive kidney biopsy. This study aims to develop non-invasive predictive models for diagnosing MCD by machine learning. We retrospectively collected data on demographic characteristics, blood tests, and urine tests from patients with nephrotic syndrome who underwent kidney biopsy. We applied four machine learning algorithms—TabPFN, LightGBM, Random Forest, and Artificial Neural Network—and logistic regression. We compared their performance using stratified 5-repeated 5-fold cross-validation for the area under the receiver operating characteristic curve (AUROC) and the area under the precision-recall curve (AUPRC). Variable importance was evaluated using the SHapley Additive exPlanations (SHAP) method. A total of 248 patients were included, with 82 cases (33%) were diagnosed with MCD. TabPFN demonstrated the best performance with an AUROC of 0.915 (95% CI 0.896–0.932) and an AUPRC of 0.840 (95% CI 0.807–0.872). The SHAP methods identified C3, total cholesterol, and urine red blood cells as key predictors for TabPFN, consistent with previous reports. Machine learning models could be valuable non-invasive diagnostic tools for MCD.

Qiao Jin, Fangyuan Chen, Yiliang Zhou et al.

Recent studies indicate that Generative Pre-trained Transformer 4 with Vision (GPT-4V) outperforms human physicians in medical challenge tasks. However, these evaluations primarily focused on the accuracy of multi-choice questions alone. Our study extends the current scope by conducting a comprehensive analysis of GPT-4V's rationales of image comprehension, recall of medical knowledge, and step-by-step multimodal reasoning when solving New England Journal of Medicine (NEJM) Image Challenges - an imaging quiz designed to test the knowledge and diagnostic capabilities of medical professionals. Evaluation results confirmed that GPT-4V performs comparatively to human physicians regarding multi-choice accuracy (81.6% vs. 77.8%). GPT-4V also performs well in cases where physicians incorrectly answer, with over 78% accuracy. However, we discovered that GPT-4V frequently presents flawed rationales in cases where it makes the correct final choices (35.5%), most prominent in image comprehension (27.2%). Regardless of GPT-4V's high accuracy in multi-choice questions, our findings emphasize the necessity for further in-depth evaluations of its rationales before integrating such multimodal AI models into clinical workflows.

Kathrin Krieger, Jan Egger, Jens Kleesiek et al.

3D data from high-resolution volumetric imaging is a central resource for diagnosis and treatment in modern medicine. While the fast development of AI enhances imaging and analysis, commonly used visualization methods lag far behind. Recent research used extended reality (XR) for perceiving 3D images with visual depth perception and touch but used restrictive haptic devices. While unrestricted touch benefits volumetric data examination, implementing natural haptic interaction with XR is challenging. The research question is whether a multisensory XR application with intuitive haptic interaction adds value and should be pursued. In a study, 24 experts for biomedical images in research and medicine explored 3D medical shapes with 3 applications: a multisensory virtual reality (VR) prototype using haptic gloves, a simple VR prototype using controllers, and a standard PC application. Results of standardized questionnaires showed no significant differences between all application types regarding usability and no significant difference between both VR applications regarding presence. Participants agreed to statements that VR visualizations provide better depth information, using the hands instead of controllers simplifies data exploration, the multisensory VR prototype allows intuitive data exploration, and it is beneficial over traditional data examination methods. While most participants mentioned manual interaction as best aspect, they also found it the most improvable. We conclude that a multisensory XR application with improved manual interaction adds value for volumetric biomedical data examination. We will proceed with our open-source research project ISH3DE (Intuitive Stereoptic Haptic 3D Data Exploration) to serve medical education, therapeutic decisions, surgery preparations, or research data analysis.

Kasper

S. Desai, D. Asch, L. Bellini et al.

Gabriela Evers S, Héctor Adolfo Polania Liscano, Santiago Adolfo Polania Galindo

We describe a case of disseminated abdominal hydatid disease in a 21-year-old man who presented with clinical symptoms of persistent abdominal pain after abscess drainage post-appendectomy. The images showed multiple cystic lesions in the peritoneum, liver, and spleen. Due to pain exacerbation, the patient was taken to laparotomy. Multiple cystic lesions scattered throughout the abdominal cavity were observed, which were diagnosed by histopathology as multiple cystic lesions due to peritoneal and abdominal echinococcosis.

Jean-Jacques Rouby, Yinggang Zhu, Antoni Torres et al.

Rumeysa Eda Kanık Tezcan, Özden Yalçınkaya Alkar

Fibromyalgia is a musculoskeletal pain syndrome characterized with the presence of sensitive points and widespread chronic pain and restricts one's daily life activities and decreases the quality of life. The etiology of fibromyalgia is unclear, but there are numerous hypotheses regarding the emergence and progression of the disease. Among these, the biopsychosocial model offers a holistic framework in which biological, psychological and social mechanisms play a role in the development of fibromyalgia. Since the etiology of the disease is not yet understood, effective methods for its treatment have not been found, thus, interventions aim to reduce the effect of fibromyalgia and increase psychological and physiological functionality. This article aims to examine the psyhcological intervention areas and methods for fibromyalgia patients. In the literature, it is concluded that pain avoidance beliefs and behaviors, self-efficacy, physical activity, sleep quality, self-compassion, emotional skills, coping strategies, personality, comorbid psychopathology are the factors related with the emergence of the disease, severity of pain, and adherence to treatment in fibromyalgia patients. In this context, Cognitive-Behavioral Therapy (CBT), physical exercises, sleep management Acceptance and Commitment Therapy (ACT), compassion focused psychotherapies, mindfulness based psychotherapies, emotion expression and emotion regulation techniques, and biofeedback are recommended as effective methods which can be included in the treatment plans of fibromyalgia patients. Moreover, considering the psychosocial factors in the assessment processes was essential to establish individualized treatment plans. In addition, the importance of multidisciplinary approaches in the treatment processes of fibromyalgia has been discussed within the framework of the biopsychosocial model.

Edoardo Pozio

The main reservoir hosts of nematodes of the genus Trichinella are wild carnivores, although most human infections are caused by the consumption of pork. This group of zoonotic parasites completes the entire natural life cycle within the host organism. However, there is an important phase of the cycle that has only been highlighted in recent years and which concerns the permanence of the infecting larvae in the striated muscles of the host carcasses waiting to be ingested by a new host. To survive in this unique biological niche, Trichinella spp. larvae have developed an anaerobic metabolism for their survival in rotting carcasses and, for some species, a resistance to freezing for months or years in cold regions. Climate changes with increasingly temperatures and reduction of environmental humidity lower the survival time of larvae in host carcasses. In addition, environmental changes affect the biology and ecology of the main host species, reducing their number and age composition due to natural habitat fragmentation caused by increasing human settlements, extensive monocultures, increasing number of food animals, and reduction of trophic chains and biodiversity. All of these factors lead to a reduction in biological and environmental complexity that is the key to the natural host-parasite balance. In conclusion, Trichinella nematodes can be considered as an indicator of a health natural ecosystem.

B Hygriv Rao, NS Rama Raju, CS Srinivasa Raju et al.

J. Torres-Macho, T. Aro, I. Bruckner et al.

Point-of-care ultrasound (POCUS) is increasingly used to assess medical patients. It has many uses in daily clinical practice, including improved diagnostic timeliness and accuracy, and providing information about a patient's prognosis and follow-up. It has been integrated into numerous specialities, but remains relatively undefined in internal medicine training programs. Ultrasonography is a useful tool in the standard clinical practice of internists in numerous clinical scenarios (Emergency Department, hospital ward, general and specific consultations, and home care). Although POCUS has been recently included in the European curriculum of internal medicine, there are differences between European internists in its use, ranging from not at all to well structured educational programs. The use of POCUS needs to be widespread in internal medicine departments, and to accomplish this we must encourage structured training. This document details the consensus-based recommendations by the European Federation of Internal Medicine (EFIM) Ultrasound working group. We establish POCUS core competencies and clinical settings for internists in a symptom-based approach. We also propose training requirements, providing a framework for training programs at a national level.