Hasil untuk "Internal medicine"

R. Wachter, L. Goldman

Stéphane Potvin, Stéphane Potvin, Yasser Khazaal et al.

D.Alan Herbst, MD, Banafsheh Shakibajahromi, MD, Michael V. Genuardi, MD et al.

Advanced heart failure is associated with accelerated brain atrophy, largely related to chronic cerebral malperfusion. Both heart transplantation (HT) and left ventricular assist device (LVAD) implantation improve vital organ perfusion, but the comparative effect on brain atrophy remains unclear. Given the MR incompatibility of LVADs, we leveraged serial CT imaging in patients who underwent either HT or LVAD implantation. 58 patients were included in this single-center retrospective cohort (23 LVAD; 35 HT). LVAD patients experienced greater brain atrophy (median: 7.1 mL/year; IQR: 0.9–15.7) than transplant patients (median: 0.4 mL/year; IQR: −6.7–13.9), but this difference was non-significant (p=0.09). Temporal atrophy (expansion of the Sylvian fissure) was greater in LVAD patients (median: 0.91 mm/year; IQR: 0.14–2.27) than HT patients (median: 0.10 mm/year; IQR: 0.02–0.55), p=0.005. These observations reveal a need for future work to prospectively quantify brain atrophy after LVAD implantation and HT, while comparing with that of advanced heart failure.

Yanling Xiao, Lixia Liu, Xiaoying Peng et al.

Abstract Background Gastrointestinal bleeding (GIB) is associated with high mortality rates among critically ill patients. The hemoglobin-to-red blood cell distribution width ratio (HRR) has recently emerged as a potential prognostic marker in various clinical settings. However, the association between HRR and prognosis in critically ill patients with GIB is unclear. Methods We conducted a retrospective cohort study using the MIMIC-IV database (version 2.2). Patients diagnosed with GIB were included based on predefined criteria. The HRR was calculated as the ratio of hemoglobin to red blood cell distribution width. Kaplan-Meier curves and multivariate Cox regression models assessed the association between HRR and 180-day mortality. Restricted cubic spline curves were employed to evaluate the nonlinear relationship between HRR and mortality. Additionally, a segmented regression model was constructed to determine the threshold effect in nonlinearity. Subgroup analyses were performed to assess the consistency of the relationship between HRR and 180-day mortality across different patient populations. Results A total of 2,346 patients met the inclusion criteria. Higher HRR was independently associated with reduced 180-day all-cause mortality (adjusted HR, 0.15; 95% CI, 0.07–0.31; P < 0.001). Non-linear associations were observed using restricted cubic splines (P for overall < 0.001, P for non-linearity = 0.002). When HRR was less than 0.81, each unit increase in HRR was associated with a 90% reduction in 180-day mortality among patients with GIB (HR, 0.10; 95% CI, 0.04–0.24; P < 0.001). Subgroup analyses demonstrated that the association between HRR and 180-day mortality was consistent across all subgroups. Conclusion HRR exhibits a significant nonlinear negative association with 180-day mortality in critically ill patients with GIB. This association was consistent across multiple subgroups, suggesting that HRR may serve as a simple and effective prognostic biomarker in patients with GIB.

Peter S Andrus, Claire J Standley, J Russell Stothard et al.

Lake Victoria is a well-known hot spot for intestinal schistosomiasis, caused by infection with the trematode Schistosoma mansoni. The snail intermediate hosts of this parasite are Biomphalaria snails, with Biomphalaria choanomphala being the predominant intermediate host within Lake Victoria. The prevalence of S. mansoni infection within snail populations is influenced by both biotic and abiotic factors, including the physical and chemical characteristics of their environment, the incidence of infection in human populations (and reservoir hosts) and the level of genetic compatibility between the parasite and the host. Using molecular xenomonitoring, we measured the prevalence of S. mansoni infection within B. choanomphala populations along the Kenyan, Tanzanian and Ugandan shorelines of Lake Victoria and related this to the abiotic (habitat type, water depth, turbulence, temperature, conductivity, total dissolved solids, salinity, pH level) and biotic (B. choanomphala abundance, genetic diversity of host snail populations) factors of the lake. The overall mean prevalence of S. mansoni infection at Lake Victoria was 9.3%, with the highest prevalence of infection occurring on the Tanzanian shoreline (13.1%), followed by the Ugandan (8.2%) and Kenyan (4.7%) shorelines. There was a significant difference in B. choanomphala abundance, water temperature, conductivity, salinity, total dissolved solids and major anion/cation concentrations between the Kenyan, Tanzanian and Ugandan shorelines of Lake Victoria. A Spearman's rank analysis found that the prevalence of S. mansoni infection had a significant, positive relationship with higher levels of B. choanomphala abundance, water acidity, and cation (Ca2+, Mg2+) concentrations. Additionally, we observed that sites with S. mansoni infection correlated with B. choanomphala populations with a higher mean haplotype diversity score compared to sites found without infection, though there was no significant relationship between the prevalence of infection and B. choanomphala haplotype diversity scores. Although our analysis is based upon an archival and unique collection of Biomphalaria snails, the abiotic and biotic relationships uncovered are useful for eco-epidemiological comparisons of intestinal schistosomiasis across Lake Victoria in future.

P. Carrasco Espí, M. Pellicer Ancos, B. Navarro León et al.

Edmond Nuellari, Maxim Llambro

Introduction: Abdominal aneurysm is considered a formidable pathological condition that requires prompt treatment. Its progressive increase leads to rupture and massive internal bleeding, which requires the most effective medical care. However, despite the improvement in medical equipment and postoperative care, mortality due to ruptured abdominal aneurysms is still close to 50%, which is primarily related to the severity of the pathology and open surgical intervention. Materials and Methods: 46 patients diagnosed with rupture of the abdominal aorta took part in the study. Selection criteria were a history of abdominal aortic rupture, conservative/operative treatment for the disease, and absence of other complications (acute renal failure, liver infarction) that could affect the results of the study. Results: Since January 2018, 46 cases of ruptured AAAs have been diagnosed. In all forty-six cases, surgical intervention was used: open surgery or endovascular technique. All 100% of patients had a previous history of diagnosed abdominal aortic aneurysm, for which they underwent periodic ultrasound examinations. As a result of the study, it was found that endovascular aortic aneurysm correction is the optimal method for both planned and emergency treatment of aortic aneurysm and its rupture. According to the Cochrane Specialized Register, it was established that endovascular repair is associated with a reduction in early morbidity and mortality after abdominal aneurysm, compared with other methods of surgical treatment. Furthermore, the study found that, unlike open surgery methods, endovascular techniques are associated with a lower risk of complications in the form of intestinal ischemia. Conclusions: Inferior quality studies and lack of information limit the conclusions of this review. From the statistical data shown in this paper, it can be concluded that there is a difference between endovascular and open methods of treatment of abdominal aortic aneurysm rupture. Mortality within the first 30 days after treatment and short-term complications are significantly lower in patients using EVAR. Systemic complications are also more prevalent in patients who were prescribed open surgical treatment.

Wei Liu, Yan Xu, Yi Wang et al.

Background Over 50% of patients with relapsed or refractory large B-cell lymphoma (r/r LBCL) receiving CD19-targeted chimeric antigen receptor (CAR19) T-cell therapy fail to achieve durable remission. Early identification of relapse or progression remains a significant challenge. In this study, we prospectively investigate the prognostic value of dynamic circulating tumor DNA (ctDNA) and track genetic evolution non-invasively, for the first time in an Asian population of r/r patients undergoing CAR19 T-cell therapy.Methods Longitudinal plasma samples were prospectively collected both before lymphodepletion and at multiple timepoints after CAR19 T-cell infusion. ctDNA was detected using a capture-based next-generation sequencing which has been validated in untreated LBCL.Results The study enrolled 23 patients with r/r LBCL and collected a total of 101 ctDNA samples. Higher pretreatment ctDNA levels were associated with inferior progression-free survival (PFS) (p=0.031) and overall survival (OS) (p=0.023). Patients with undetectable ctDNA negative (ctDNA–) at day 14 (D14) achieved an impressive 3-month complete response rate of 77.8% vs 22.2% (p=0.015) in patients with detectable ctDNA positive (ctDNA+), similar results observed for D28. CtDNA– at D28 predicted significantly longer 1-year PFS (90.9% vs 27.3%; p=0.004) and OS (90.9% vs 49.1%; p=0.003) compared with patients who remained ctDNA+. Notably, it is the first time to report that shorter ctDNA fragments (&lt;170 base pairs) were significantly associated with poorer PFS (p=0.031 for D14; p=0.002 for D28) and OS (p=0.013 for D14; p=0.008 for D28) in patients with LBCL receiving CAR T-cell therapy. Multiple mutated genes exhibited an elevated prevalence among patients with progressive disease, including TP53, IGLL5, PIM1, BTG1, CD79B, GNA13, and P2RY8. Notably, we observed a significant correlation between IGLL5 mutation and inferior PFS (p=0.008) and OS (p=0.014).Conclusions Our study highlights that dynamic ctDNA monitoring during CAR T-cell therapy can be a promising non-invasive method for early predicting treatment response and survival outcomes. Additionally, the ctDNA mutational profile provides novel insights into the mechanisms of tumor-intrinsic resistance to CAR19 T-cell therapy.

Srigiri Krishnapriya, Yepuganti Karuna

IntroductionBrain tumors are a common disease that affects millions of people worldwide. Considering the severity of brain tumors (BT), it is important to diagnose the disease in its early stages. With advancements in the diagnostic process, Magnetic Resonance Imaging (MRI) has been extensively used in disease detection. However, the accurate identification of BT is a complex task, and conventional techniques are not sufficiently robust to localize and extract tumors in MRI images. Therefore, in this study, we used a deep learning model combined with a segmentation algorithm to localize and extract tumors from MR images.MethodThis paper presents a Deep Learning (DL)-based You Look Only Once (YOLOv7) model in combination with the Grab Cut algorithm to extract the foreground of the tumor image to enhance the detection process. YOLOv7 is used to localize the tumor region, and the Grab Cut algorithm is used to extract the tumor from the localized region.ResultsThe performance of the YOLOv7 model with and without the Grab Cut algorithm is evaluated. The results show that the proposed approach outperforms other techniques, such as hybrid CNN-SVM, YOLOv5, and YOLOv6, in terms of accuracy, precision, recall, specificity, and F1 score.DiscussionOur results show that the proposed technique achieves a high dice score between tumor-extracted images and ground truth images. The findings show that the performance of the YOLOv7 model is improved by the inclusion of the Grab Cut algorithm compared to the performance of the model without the algorithm.

M. Plebani, P. Carraro

Julia R. Varshavsky, Swati D. G. Rayasam, Jennifer B. Sass et al.

Abstract A key element of risk assessment is accounting for the full range of variability in response to environmental exposures. Default dose-response methods typically assume a 10-fold difference in response to chemical exposures between average (healthy) and susceptible humans, despite evidence of wider variability. Experts and authoritative bodies support using advanced techniques to better account for human variability due to factors such as in utero or early life exposure and exposure to multiple environmental, social, and economic stressors. This review describes: 1) sources of human variability and susceptibility in dose-response assessment, 2) existing US frameworks for addressing response variability in risk assessment; 3) key scientific inadequacies necessitating updated methods; 4) improved approaches and opportunities for better use of science; and 5) specific and quantitative recommendations to address evidence and policy needs. Current default adjustment factors do not sufficiently capture human variability in dose-response and thus are inadequate to protect the entire population. Susceptible groups are not appropriately protected under current regulatory guidelines. Emerging tools and data sources that better account for human variability and susceptibility include probabilistic methods, genetically diverse in vivo and in vitro models, and the use of human data to capture underlying risk and/or assess combined effects from chemical and non-chemical stressors. We recommend using updated methods and data to improve consideration of human variability and susceptibility in risk assessment, including the use of increased default human variability factors and separate adjustment factors for capturing age/life stage of development and exposure to multiple chemical and non-chemical stressors. Updated methods would result in greater transparency and protection for susceptible groups, including children, infants, people who are pregnant or nursing, people with disabilities, and those burdened by additional environmental exposures and/or social factors such as poverty and racism.

Janine B. Kastelijn, Yorick L. van de Pavert, Marc G. Besselink et al.

Abstract Background Malignant gastric outlet obstruction (GOO) is a debilitating condition that frequently occurs in patients with malignancies of the distal stomach and (peri)ampullary region. The standard palliative treatment for patients with a reasonable life expectancy and adequate performance status is a laparoscopic surgical gastrojejunostomy (SGJ). Recently, endoscopic ultrasound-guided gastroenterostomy (EUS-GE) emerged as a promising alternative to the surgical approach. The present study aims to compare these treatment modalities in terms of efficacy, safety, and costs. Methods The ENDURO-study is a multicentre, open-label, parallel-group randomized controlled trial. In total, ninety-six patients with gastric outlet obstruction caused by an irresectable or metastasized malignancy will be 1:1 randomized to either SGJ or EUS-GE. The primary endpoint is time to tolerate at least soft solids. The co-primary endpoint is the proportion of patients with persisting or recurring symptoms of gastric outlet obstruction for which a reintervention is required. Secondary endpoints are technical and clinical success, quality of life, gastroenterostomy dysfunction, reinterventions, time to reintervention, adverse events, quality of life, time to start chemotherapy, length of hospital stay, readmissions, weight, survival, and costs. Discussion The ENDURO-study assesses whether EUS-GE, as compared to SGJ, results in a faster resumption of solid oral intake and is non-inferior regarding reinterventions for persistent or recurrent obstructive symptoms in patients with malignant GOO. This trial aims to guide future treatment strategies and to improve quality of life in a palliative setting. Trial registration International Clinical Trials Registry Platform (ICTRP): NL9592. Registered on 07 July 2021.

Clemence J. Belle, James M. Lonie, Sandra Brosda et al.

The poor treatment response of oesophageal adenocarcinoma (OAC) leads to low survival rates. Its increasing incidence makes finding more effective treatment a priority. Recent treatment improvements can be attributed to the inclusion of the tumour microenvironment (TME) and immune infiltrates in treatment decisions. OAC TME is largely immunosuppressed and reflects treatment resistance as patients with inflamed TME have better outcomes. Priming the tumour with the appropriate neoadjuvant chemoradiotherapy treatment could lead to higher immune infiltrations and higher expression of immune checkpoints, such as PD-1/PDL-1, CTLA4 or emerging new targets: LAG-3, TIM-3, TIGIT or ICOS. Multiple trials support the addition of immune checkpoint inhibitors to the current standard of care. However, results vary, supporting the need for better response biomarkers based on TME composition. This review explores what is known about OAC TME, the clinical significance of the various cell populations infiltrating it and the emerging therapeutical combination with a focus on immune checkpoints inhibitors.

Young-Hoon Kim, Shih‐Ann Chen, S. Ernst et al.

1Department of Internal Medicine, Arrhythmia Center, Korea University Medicine Anam Hospital, Seoul, Republic of Korea 2Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, ROC 3Department of Cardiology, Royal Brompton and Harefield Hospital, Imperial College London, London, UK 4Hospital Christus Muguerza Alta Especialidad, Monterrey, Mexico 5Division of Cardiology, Department of Internal Medicine, Keimyung University School of Medicine, Daegu, Republic of Korea 6Department of Cardiology, Medical University of Silesia, Katowice, Poland 7Cardiology Department, Arrhythmias and Electrophysiology Service, Clinica y Maternidad Suizo Argentina, Buenos Aires, Argentina 8Department of Cardiology, Faculty of Medicine, University of Tsukuba, Tsukuba, Japan 9Center for Atrial Fibrillation, Hospital Pro-Cardiaco, Rio de Janeiro, Brazil 10Division of Cardiology, Department of Medicine, QEII Health Sciences Centre, Dalhousie University, Halifax, NS, Canada 11Cardiology, University Hospital Basel, Basel, Switzerland 12Medical Clinic II (Department of Cardiology, Angiology and Intensive Care Medicine), University Hospital Schleswig-Holstein (UKSH) – Campus Luebeck, Luebeck, Germany 13Center for Arrhythmia Care, Pritzker School of Medicine, University of Chicago Medicine, Chicago, IL, USA 14Department of Cardiology, Waikato Hospital, Hamilton, New Zealand

Steven McDonald

M. Littman, B. Gerber, R. Goldstein et al.

An update of the 2006 American College of Veterinary Internal Medicine (ACVIM) Small Animal Consensus Statement on Lyme Disease in Dogs: Diagnosis, Treatment, and Prevention was presented at the 2016 ACVIM Forum in Denver, CO, followed by panel and audience discussion and a drafted consensus statement distributed online to diplomates for comment. The updated consensus statement is presented below. The consensus statement aims to provide guidance on the diagnosis, treatment, and prevention of Lyme borreliosis in dogs and cats.

Jinhua Chen, Zhenhua Yin, Wenping Song et al.

Accumulating evidence has showed that sushi-repeat-containing protein X-linked 2 (SRPX2) is an abnormal expression in a variety of cancers and involved in cancer carcinogenesis, chemosensitivity, and prognosis, which mainly promote cancer cell metastasis, invasion, and migration by regulating the uPAR/integrins/FAK signaling pathway, epithelial-mesenchymal transition (EMT), angiogenesis, and glycosylation. Inflammation has been regarded as a key role in regulating cancer initiation, progression, EMT, and therapeutics. Furthermore, SRPX2 exhibited excellent antifibrosis effect via the TGFβR1/SMAD3/SRPX2/AP1/SMAD7 signaling pathway. Therefore, this review provides compelling evidence that SRPX2 might be a therapeutic target for inflammation and cancer-related inflammation for future cancer therapeutics.

C. MacLean, E. Kerr, A. Qaseem

A. Matzdorff, O. Meyer, H. Ostermann et al.

A. Berruti, E. Baudin, H. Gelderblom et al.