Hasil untuk "Specialties of internal medicine"

W. P. Thomas, C. Gaber, G. Jacobs et al.

Jihoon Jeong

Small language models (SLMs) in the 100M-10B parameter range increasingly power production systems, yet whether they possess the internal emotion representations recently discovered in frontier models remains unknown. We present the first comparative analysis of emotion vector extraction methods for SLMs, evaluating 9 models across 5 architectural families (GPT-2, Gemma, Qwen, Llama, Mistral) using 20 emotions and two extraction methods (generation-based and comprehension-based). Generation-based extraction produces statistically superior emotion separation (Mann-Whitney p = 0.007; Cohen's d = -107.5), with the advantage modulated by instruction tuning and architecture. Emotion representations localize at middle transformer layers (~50% depth), following a U-shaped curve that is architecture-invariant from 124M to 3B parameters. We validate these findings against representational anisotropy baselines across 4 models and confirm causal behavioral effects through steering experiments, independently verified by an external emotion classifier (92% success rate, 37/40 scenarios). Steering reveals three regimes -- surgical (coherent text transformation), repetitive collapse, and explosive (text degradation) -- quantified by perplexity ratios and separated by model architecture rather than scale. We document cross-lingual emotion entanglement in Qwen, where steering activates semantically aligned Chinese tokens that RLHF does not suppress, raising safety concerns for multilingual deployment. This work provides methodological guidelines for emotion research on open-weight models and contributes to the Model Medicine series by bridging external behavioral profiling with internal representational analysis.

Sascha Hatahet, Sorin Popescu, Charlotte Eitel et al.

BackgroundA novel balloon-in-basket pulsed field ablation (BiB-PFA) catheter enables efficient pulmonary vein isolation (PVI) and allows posterior wall isolation (PWI) within the same procedure. The incremental biological effect of PWI compared to PVI alone remains uncertain, particularly regarding inflammation, myocardial injury, and hemolysis.MethodsIn this prospective, single-center study, consecutive patients with atrial fibrillation underwent first-time BiB-PFA, either PVI only or PVI plus PWI. Venous blood samples were collected before and one day after ablation. Biomarkers included leukocytes, platelets, hemoglobin, C-reactive protein (CRP), haptoglobin, bilirubin, lactate dehydrogenase (LDH), creatinine, estimated glomerular filtration rate (GFR), myoglobin, creatine kinase (CK), and troponin T.ResultsA total of 60 patients were enrolled (PVI only n = 30, PVI + PWI n = 30). Baseline characteristics were comparable. PVI + PWI required more applications (19 vs. 16; p < 0.001) but had similar procedure time. Both groups showed significant increases in inflammatory (CRP, leukocytes), myocardial (troponin T, CK, LDH, myoglobin), and hemolysis markers (bilirubin, LDH, haptoglobin changes; all p < 0.001). However, the magnitude of biomarker release did not differ between PVI only and PVI + PWI: Δ troponin T (1,154 vs. 1,029 ng/L, p = 0.694), Δ CK (217 vs. 197 U/L, p = 0.652), Δ CRP (2.7 vs. 3.4 mg/L, p = 0.475), Δ bilirubin (2.4 vs. 2.8 µmol/L, p = 0.842), Δ creatinine (3.3 vs. 9.0 µmol/L, p = 0.085).ConclusionBiB-PFA PVI provokes systemic responses involving inflammation, myocardial injury, and hemolysis. Adjunctive PWI increases application number but does not further increase biomarker release, supporting the biological safety of PWI.

Xinyue Wang, Liming Li, Michael Roman et al.

With its extreme axial tilt, radiant energy budget and internal heat of Uranus remain among the most intriguing mysteries of our Solar System. Here, we present the global radiant energy budget spanning a complete orbital period, revealing significant seasonal variations driven primarily by the highly variable solar flux. Despite these fluctuations, emitted thermal power consistently exceeds absorbed solar power, indicating a net energy loss and ongoing global cooling. Based on the seasonal variations of radiant energy budget, we determine a statistically significant internal heat flux. This finding resolves a long-standing debate over whether Uranus possesses internal heat. We also examine the energy budget of the weather layer by combining the internal heat with the radiant energies, revealing significant energy imbalances at both global and hemispheric scales. These global and hemispheric imbalances should be considered in theoretical and numerical models. The Uranus flagship mission, as recommended by the recent survey, will provide crucial observations to address more unresolved questions and advance our understanding of this enigmatic ice giant.

Enrique Morales, Maria Galindo

Agathe Yvinou, Romain Alain

Abstract Gender and sex disparities persist in orthopaedic and traumatology surgery, making it one of the least diverse medical specialties worldwide. Despite growing women representation in medical education, women continue to be significantly underrepresented in orthopaedics, occupying only 6–8% of surgical roles. This underrepresentation extends to academic leadership, research, and public speaking opportunities, ultimately limiting innovation and the quality of patient care. Systemic barriers—such as gender bias, lack of mentorship, and misperceptions about physical demands—discourage women from entering and advancing in the field. This manuscript explores the current landscape of gender inequality in orthopaedics and identifies strategic interventions to promote equity. Solutions include enhancing recruitment through early exposure, fostering inclusive institutional cultures, expanding mentorship and sponsorship opportunities, and implementing supportive policies for work-life integration. In patient care, disparities in diagnosis, pain management, surgical decision-making, and rehabilitation access disproportionately impact women. We advocate for the development of gender-inclusive clinical guidelines, equitable research funding, and standardized assessment tools. Additionally, the role of public awareness is examined, emphasizing the need to highlight success stories, engage male allies, and conduct outreach through educational and community initiatives. Programs such as the Perry Initiative, Nth Dimensions, and campaigns like HeForShe are shown to play pivotal roles in shifting perceptions and increasing diversity. Addressing these disparities is not only a matter of justice but also essential to achieving excellence in clinical outcomes. This article offers a comprehensive framework for fostering gender and sex equality in orthopaedic and traumatology surgery through systemic, cultural, and policy-level change.

Jiashuang Xu, Lin Zhang, Qiqi Ji et al.

Abstract Background Nursing is one of the critically important disciplines in healthcare. Due to its complexity and specificity, nursing students often face additional higher education-related stress. However, there is less research on higher education-related stress among nursing students. Therefore, the purpose of this study was to investigate the effects of emotional empathy and emotional intelligence on the dimensions of higher education-related stress among nursing students. Methods This study utilized a multi-stage sampling design and was completed within the March-June 2023 period. A total of 1126 nursing students were recruited to complete the questionnaire. The self-administered questionnaire included the basic characteristics of the subjects, an emotional empathy scale, an emotional intelligence scale, and a higher education-related stress scale. One-way ANOVA/t-tests, correlation coefficients, and hierarchical linear regression analyses were used to explore the factors affecting higher education-related stress and the relationship between emotional empathy and emotional intelligence with the dimensions of higher education-related stress. Results The mean (SD) scores of challenges and dissatisfaction dimensions of higher education-related stress among nursing students were 30.052 (7.466) and 8.270 (2.205), respectively. Emotional empathy was significantly and positively related to the challenges and dissatisfaction dimensions of higher education-related stress. Emotional intelligence was negatively correlated with the challenges dimension of higher education-related stress and positively correlated with the dissatisfaction dimension. Stratified multiple regression analyses revealed that nursing students' emotional empathy and emotional intelligence were significant predictors of the dimensions of higher education-related stress. Conclusion Overall, emotional empathy and emotional intelligence were significantly correlated with all dimensions of higher education-related stress. Consequently, in future interventions, the Chinese government and education sector can develop nursing students' ability to use emotional empathy and emotional intelligence rationally through emotional regulation strategies and emotional intelligence courses, to reduce the higher education-related stress they experience.

Chaoyi Wu, Pengcheng Qiu, Jinxin Liu et al.

In this study, we present MedS-Bench, a comprehensive benchmark designed to evaluate the performance of large language models (LLMs) in clinical contexts. Unlike existing benchmarks that focus on multiple-choice question answering, MedS-Bench spans 11 high-level clinical tasks, including clinical report summarization, treatment recommendations, diagnosis, named entity recognition, and medical concept explanation, among others. We evaluated six leading LLMs, e.g., MEDITRON, Mistral, InternLM 2, Llama 3, GPT-4, and Claude-3.5 using few-shot prompting, and found that even the most sophisticated models struggle with these complex tasks. To address these limitations, we developed MedS-Ins, a large-scale instruction tuning dataset for medicine. MedS-Ins comprises 58 medically oriented language corpora, totaling 13.5 million samples across 122 tasks. To demonstrate the dataset's utility, we conducted a proof-of-concept experiment by performing instruction tuning on a lightweight, open-source medical language model. The resulting model, MMedIns-Llama 3, significantly outperformed existing models across nearly all clinical tasks. To promote further advancements in the application of LLMs to clinical challenges, we have made the MedS-Ins dataset fully accessible and invite the research community to contribute to its expansion.Additionally, we have launched a dynamic leaderboard for MedS-Bench, which we plan to regularly update the test set to track progress and enhance the adaptation of general LLMs to the medical domain. Leaderboard: https://henrychur.github.io/MedS-Bench/. Github: https://github.com/MAGIC-AI4Med/MedS-Ins.

Qasam M. Ghulam, Jens P. Goetze, Nikolaj Eldrup et al.

Introduction: Abdominal aortic aneurysms (AAAs) with intraluminal thrombus (ILT) are suggested to be more prone to rupture than AAAs without. Prior studies indicate that the von Willebrand factor (vWf) plays a role in the formation of ILT since a positive correlation between ILT volume and vWf has been shown. vWf mediates the tethering of platelets at sites of endothelial injury, and the protease ADAMTS-13 cleaves larger forms of vWf, thus counteracting the thrombosis cascade and maintaining haemostatic balance. When investigating the largest quantifiable thrombus in the human body, it was hypothesised that circulating ADAMTS-13 activity may be associated with ILT size in patients with AAA and the aim was to explore this potential relationship using 3D contrast enhanced ultrasound (3D-CEUS) for ILT volume determination. Report: In this retrospective, exploratory study, 60 patients with AAA were evaluated, and the association between ILT volume and thickness and ADAMTS-13 was estimated using 3D-CEUS. ADAMTS-13 activity was measured in plasma samples obtained the same day. No association between ILT volume (r = −0.03, p = 0.84) or ILT thickness (r = 0.02, p = 0.87) and ADAMTS-13 activity was found. Likewise, when subdividing the group into lowest and highest 50% of ADAMTS-13 activity, the half with the lowest ADAMTS-13 activity (mean ILT volume ±standard deviation [SD]: 32 ± 34 mL) did not differ from the half with the highest ADAMTS-13 activity (43 ± 24 mL) when comparing ILT volume (p = 0.172, F = 2.95) and thickness (p = 0.070). Discussion: After evaluating the largest quantifiable intraluminal thrombus in the vasculature, it was concluded that, surprisingly, circulating ADAMTS-13 activity seems unrelated to ILT formation in AAA.

Dafna D. Gladman, Peter Nash, Philip J. Mease et al.

Abstract Background Data on treatment switching directly from tumor necrosis factor inhibitors to tofacitinib in psoriatic arthritis (PsA) are limited. This post hoc analysis assessed efficacy and safety outcomes in patients with PsA who directly switched to tofacitinib in a long-term extension (LTE) study after receiving adalimumab (ADA) in a Phase 3 study, compared with those who continued to receive tofacitinib. Methods Patients with active PsA received tofacitinib 5 mg twice daily (BID) or ADA 40 mg once every 2 weeks in a 12-month, randomized, double-blind study (OPAL Broaden) and then continued or switched to tofacitinib 5 mg BID and maintained this dose in an open-label LTE study (OPAL Balance). Efficacy was assessed 3 months before the last visit and at the last visit in the Phase 3 study, and at month 3 (or month 6 for select outcomes) in the LTE study and included rates of ≥ 20/50/70% improvement in American College of Rheumatology response criteria, Psoriasis Area and Severity Index ≥ 75% improvement, Health Assessment Questionnaire-Disability Index (HAQ-DI) response (decrease from baseline ≥ 0.35 for patients with baseline HAQ-DI ≥ 0.35), Psoriatic Arthritis Disease Activity Score ≤ 3.2, and minimal disease activity; and change from baseline in Functional Assessment of Chronic Illness Therapy-Fatigue score. Safety was assessed at months 3 and 12 in both studies via incidence rates (patients with first events/100 patient-years). Results Overall, 180 patients were included (ADA→tofacitinib 5 mg BID: n = 91; continuing tofacitinib 5 mg BID: n = 89). At Phase 3 baseline, patients in the ADA→tofacitinib 5 mg BID group tended to be younger and have less active disease compared with those continuing tofacitinib. Efficacy was similar between groups in the Phase 3 study, and was maintained to month 3 or 6 in the LTE study. Treatment-emergent adverse events (AEs), serious AEs, and serious infections were generally similar in the Phase 3 and LTE studies, and between groups within each study. Conclusion Tofacitinib efficacy and safety were similar in patients with PsA who directly switched from ADA to tofacitinib and those who continued tofacitinib, suggesting that patients can be directly switched from ADA to tofacitinib without any washout period. Trial registration NCT01877668; NCT01976364

Chaoyi Wu, Weixiong Lin, Xiaoman Zhang et al.

Recently, Large Language Models (LLMs) have showcased remarkable capabilities in natural language understanding. While demonstrating proficiency in everyday conversations and question-answering situations, these models frequently struggle in domains that require precision, such as medical applications, due to their lack of domain-specific knowledge. In this paper, we describe the procedure for building a powerful, open-source language model specifically designed for medicine applications, termed as PMC-LLaMA. Our contributions are threefold: (i) we systematically investigate the process of adapting a general-purpose foundation language model towards medical domain, this involves data-centric knowledge injection through the integration of 4.8M biomedical academic papers and 30K medical textbooks, as well as comprehensive fine-tuning for alignment with domain-specific instructions; (ii) we contribute a large-scale, comprehensive dataset for instruction tuning. This dataset encompasses medical question-answering (QA), rationale for reasoning, and conversational dialogues, comprising a total of 202M tokens; (iii) we conduct thorough ablation studies to demonstrate the effectiveness of each proposed component. While evaluating on various public medical question-answering benchmarks, our lightweight PMCLLaMA, which consists of only 13 billion parameters, exhibits superior performance, even surpassing ChatGPT. All models, codes, datasets can be found in https://github.com/chaoyi-wu/PMC-LLaMA.

Leo Law, BingKan Xue

In varying environments it is beneficial for organisms to utilize available cues to infer the conditions they may encounter and express potentially favorable traits. However, external cues can be unreliable or too costly to use. We consider an alternative strategy where organisms exploit internal sources of information. Even without sensing environmental cues, their internal states may become correlated with the environment as a result of selection, which then form a memory that helps predict future conditions. To demonstrate the adaptive value of such internal memory in varying environments, we revisit the classic example of seed dormancy in annual plants. Previous studies have considered the germination fraction of seeds and its dependence on environmental cues. In contrast, we consider a model of germination fraction that depends on the seed age, which is an internal state that can serve as a memory. We show that, if the environmental variation has temporal structure, then age-dependent germination fractions will allow the population to have an increased long-term growth rate. The more organisms can remember through their internal states, the higher growth rate a population can potentially achieve. Our results suggest experimental ways to infer internal memory and its benefit for adaptation in varying environments.

Nelson Martins-Ferreira

Regardless of its environment, the category of internal groupoids is shown to be equivalent to the full subcategory of involutive-2-links that are unital and associative. The new notion of involutive-2-link originates from the study of triangulated surfaces and their application in additive manufacturing and 3d-printing. Thus, this result establishes a bridge between the structure of an internal groupoid and an abstract triangulated surface. An example is provided which can be thought of as a crossed-module of magmas rather than groups.

Daegwang Yoo, Minsun Kang, Jaehun Jung

Background Postpancreatectomy diabetes can be caused by resection of functioning pancreatic tissue and is associated with postoperative pancreatic islet cell mass loss and subsequent endocrine dysfunction. Diabetes is a well‐known risk factor for ischemic heart disease. However, no previous studies have investigated ischemic heart disease in patients with postpancreatectomy diabetes and pancreatic cancer. Methods and Results Rates of patients with diabetes diagnosed with pancreatic cancer who underwent pancreatectomy between 2002 and 2019 in South Korea were obtained from the Korean National Health Insurance Service database. Patient‐level propensity score matching was conducted to reduce the possibility of selection bias, and multivariate Cox proportional hazards models were used to determine the association between postpancreatectomy diabetes and ischemic heart disease. In total, 30 242 patients were initially enrolled in the study. After applying exclusion criteria and propensity score matching, 2952 patients were included in the comparative analysis between the postpancreatectomy group with diabetes and the group without diabetes. Patients in the postpancreatectomy group with diabetes had significantly higher rates of ischemic heart disease than those in the group without diabetes. In total, 3432 patients were included in the comparison between the postpancreatectomy and prepancreatectomy groups with diabetes. There was no significant difference in the risk of ischemic heart disease between the postpancreatectomy and prepancreatectomy groups with diabetes. Conclusions Patients who developed diabetes after pancreatectomy had a higher risk of ischemic heart disease than patients who did not develop diabetes after pancreatectomy, and the rate of ischemic heart disease in these patients was similar to that in patients preoperatively diagnosed with diabetes.

R. S. Akchurin, A. A. Shiryaev, V. P. Vasiliev et al.

Aim. To study the parameters of transit time flow measurement (TTFM) for coronary bypass grafts in patients with diffuse lesions with different diameter of target coronary arteries.Material and methods. The study included 150 patients with diffuse coronary artery disease. All patients underwent microscope-assisted coronary artery bypass grafting (CABG), during which the TTFM parameters were evaluated. Depending on the diameter of target coronary arteries, patients were divided into 3 groups: group 1 included grafts to arteries ≤1 mm (n=101), group 2 — 1-1,5 mm (n=138), group 3 — ≥1,5 mm (n=308). Comparative analysis of TTFM parameters was performed.Results. Mostly participants were male (76%); mean age was 62,9±7,6 years. During hospitalization, we recorded 1 death, 2 perioperative myocardial infarctions (1,3%) and 1 cerebrovascular accident (0,7%). TTFM analysis showed the worst hemodynamic parameters and a higher rate of suboptimal function in group 1; blood flow parameters were comparable in groups 2 and 3. The additional analysis in group 1 and combined groups 2 and 3 allows us to make an opinion about the negative impact of coronary artery diameter less than 1 mm on optimal blood flow through the grafts (odds ratio=2,1, 95% confidence interval, 1,2-3,8, p=0,011).Conclusion. Diffuse coronary atherosclerosis with a diameter of target coronary arteries less than 1 mm significantly increase the risk of suboptimal graft function that requires considering more aggressive secondary prevention. TTFM demonstrate high effectiveness of microscope-assisted CABG in target coronary artery diameter of 1-1,5 mm and higher.

Olapeju Daniyan, Obumneme Ezeanosike, Dorathy Obu et al.

We report a case of a newborn with persistent pulmonary hypertension (PPHN) due to meconium aspiration syndrome with associated lung collapse. Echocardiogram revealed features of persistent pulmonary hypertension. He was treated with compounded oral sildenafil. Oral sildenafil has proven to be effective and safe in the management of PPHN in neonates with persistent pulmonary hypertension. Therefore, in situations where inhaled nitric oxide is not available it may be used as an alternative therapy in PPHN. Further randomized controlled studies are needed to determine its efficacy and pharmacokinetics.

K. Hauer, S. Durning, W. Kernan et al.

Antoine Allioux, Eric Finster, Matthieu Sozeau

By extending type theory with a universe of definitionally associative and unital polynomial monads, we show how to arrive at a definition of opetopic type which is able to encode a number of fully coherent algebraic structures. In particular, our approach leads to a definition of $\infty$-groupoid internal to type theory and we prove that the type of such $\infty$-groupoids is equivalent to the universe of types. That is, every type admits the structure of an $\infty$-groupoid internally, and this structure is unique.

Seyed Vahid Moravvej, Abdolreza Mirzaei, Mehran Safayani

Text summarization in medicine can help doctors for reducing the time to access important information from countless documents. The paper offers a supervised extractive summarization method based on conditional generative adversarial networks using convolutional neural networks. Unlike previous models, which often use greedy methods to select sentences, we use a new approach for selecting sentences. Moreover, we provide a network for biomedical word embedding, which improves summarization. An essential contribution of the paper is introducing a new loss function for the discriminator, making the discriminator perform better. The proposed model achieves results comparable to the state-of-the-art approaches, as determined by the ROUGE metric. Experiments on the medical dataset show that the proposed method works on average 5% better than the competing models and is more similar to the reference summaries.

L. V. Kondratyeva, T. V. Popkova, M. V. Cherkasova et al.

Objective. To clarify the frequency of insulin resistance (IR) in patients with systemic lupus erythematosus (SLE), traditional and associated with rheumatic disease risk factors for its development, to assess the possibility of using the Finnish Type 2 Diabetes Risk Assessment Score (FINDRISC) questionnaire to detect IR.Material and methods. The cross-sectional study included 49 patients with SLE (46 women, 3 men) without diabetes mellitus and hyperglycemia, observed at the V.A. Nasonova Research Institute of Rheumatology in 2019–2020. The median age of the patients was 40 [33; 48] years, the duration of the disease was 3.0 [0.7; 8.0] years. Glucocorticoids (GC) were received by 41 (84%) patients, hydroxychloroquine – by 38 (78%), immunosuppressive drugs – by 10 (20%), biological agents – by 5 (10%). The glucose and fasting immunoreactive insulin levels were examined, and the Homeostasis Model Assessment of Insulin Resistance (HOMA-IR) index was calculated in all patients. HOMA-IR value ≥2.77 corresponded to IR. Traditional risk factors for type 2 diabetes and the risk of its development in the next 10 years in patients with SLE were assessed using the Russian version of the FINDRISC questionnaire.Results. The median HOMA-IR level in SLE patients was 1.7 [1.2; 2.5]. IR was detected in 10 (20%) of 49 patients with SLE. Patients with and without IR were comparable in terms of sex, age, duration and activity of SLE, therapy, and type 2 diabetes traditional risk factors. BMI, WC and insulin levels were higher in patients with IR. HOMA-IR correlated with body mass index (BMI) (r=0.6; p<0.001), waist circumference (WC) (r=0.5; p<0.001), risk categories for developing type 2 diabetes according to FINDRISС (r=0.3; p=0.03), SLEDAI-2K index (r=–0.4; p<0.01), C3 complement levels in serum (r=0.3; p=0.04) and the duration of GC therapy (r=0.3; p=0.03).Conclusion. IR was diagnosed in 20% of SLE patients without a history of diabetes and with normal fasting glucose in venous blood. The lower SLE activity, the longer GC intake in patient, the higher the HOMA-IR index was detected in him. However, the IR appearance was reliably associated only with an increasing BMI and WC. The use of the FINDRISC questionnaire, which allows to stratify respondents in the general population by the risk of developing type 2 diabetes mellitus, did not help to identify SLE patients with IR.