Hasil untuk "Internal medicine"

J. Wennberg

Hyun Jung Lee, Uri Ladabaum

Colonoscopy plays a pivotal role in colorectal cancer (CRC) screening and reduces CRC incidence and mortality. Its effectiveness depends on colonoscopist performance, which can vary. Missed lesions during colonoscopy can lead to post-colonoscopy CRC (PCCRC), making high-quality colonoscopy essential for maximizing the preventive benefit of CRC screening. This review highlights the significance of colonoscopy quality indicators and practices for improvement. Bowel preparation, cecal intubation, and withdrawal time are key process indicators for procedure quality and are closely associated with the adenoma detection rate (ADR) and PCCRC risk. Given the role of colonoscopy in preventing CRC through the removal of precancerous lesions, the ADR serves as the core quality metric and the most reliable predictor of PCCRC. Serrated polyps have gained attention in colonoscopy quality research, as 15% to 30% of CRCs arise from serrated lesions, with an increased detection rate inversely associated with PCCRC risk. This emphasizes the critical need for continuous efforts by colonoscopists to enhance performance quality. Systemic interventions, audits and feedback during endoscopist education, basic and enhanced withdrawal and inspection techniques, and technologies such as mucosal exposure devices and computer-aided detection have demonstrated efficacy in increasing the ADR. While artificial intelligence has shown promise in increasing the ADR, inconsistent outcomes in real-world studies underscore the continued importance of the fundamental aspects of high-quality colonoscopy techniques, including complete mucosal exposure. Understanding quality indicators and ensuring high-performance quality in daily practice will ultimately lead to better CRC prevention outcomes.

Michael A. Bekos, Giordano Da Lozzo, Fabrizio Frati et al.

A well-known result by Kant [Algorithmica, 1996] implies that n-vertex outerplane graphs admit embedding-preserving planar straight-line grid drawings where the internal faces are convex polygons in $O(n^2)$ area. In this paper, we present an algorithm to compute such drawings in $O(n^{1.5})$ area. We also consider outerplanar drawings in which the internal faces are required to be strictly-convex polygons. In this setting, we consider outerplanar graphs whose weak dual is a path and give a drawing algorithm that achieves $Θ(nk^2)$ area, where $k$ is the maximum size of an internal facial cycle.

Pengyu Shi, Éric Climent, Dominique Legendre

Direct numerical simulations of a uniform flow past a fixed spherical droplet are performed to determine the parameter range within which the axisymmetric flow becomes unstable. The problem is governed by three dimensionless parameters: the drop-to-fluid dynamic viscosity ratio, $μ^\ast$, and the external and internal Reynolds numbers, $\Rey^e$ and $\Rey^i$, which are defined using the kinematic viscosities of the external and internal fluids, respectively. The present study confirms the existence of a regime at low-to-moderate viscosity ratio where the axisymmetric flow breaks down due to an internal flow instability. In the initial stages of this bifurcation, the external flow remains axisymmetric, while the asymmetry is generated and grows only inside the droplet. As the disturbance propagates outward, the entire flow first transits to a biplanar symmetric flow, characterised by two pairs of counter-rotating streamwise vortices in the wake. A detailed examination of the flow field reveals that the vorticity on the internal side of the droplet interface is driving the flow instability. Specifically, the bifurcation sets in once the maximum internal vorticity exceeds a critical value that decreases with increasing $\Rey^i$. For sufficiently large $\Rey^i$, internal flow bifurcation may occur at viscosity ratios of $μ^\ast = O(10)$, an order of magnitude higher than previously reported values. Finally, we demonstrate that the internal flow bifurcation in the configuration of a fixed droplet in a uniform fluid stream is closely related to the first path instability experienced by a buoyant, deformable droplet of low-to-moderate $μ^\ast$ freely rising in a stagnant liquid.

Mengzhou Sun, Sendong Zhao, Jianyu Chen et al.

Evidence-based medicine (EBM) holds a crucial role in clinical application. Given suitable medical articles, doctors effectively reduce the incidence of misdiagnoses. Researchers find it efficient to use large language models (LLMs) techniques like RAG for EBM tasks. However, the EBM maintains stringent requirements for evidence, and RAG applications in EBM struggle to efficiently distinguish high-quality evidence. Therefore, inspired by the meta-analysis used in EBM, we provide a new method to re-rank and filter the medical evidence. This method presents multiple principles to filter the best evidence for LLMs to diagnose. We employ a combination of several EBM methods to emulate the meta-analysis, which includes reliability analysis, heterogeneity analysis, and extrapolation analysis. These processes allow the users to retrieve the best medical evidence for the LLMs. Ultimately, we evaluate these high-quality articles and show an accuracy improvement of up to 11.4% in our experiments and results. Our method successfully enables RAG to extract higher-quality and more reliable evidence from the PubMed dataset. This work can reduce the infusion of incorrect knowledge into responses and help users receive more effective replies.

Jiacheng Xie, Shuai Zeng, Yang Yu et al.

Traditional Chinese Medicine (TCM) presents a rich and structurally unique knowledge system that challenges conventional applications of large language models (LLMs). Although previous TCM-specific LLMs have shown progress through supervised fine-tuning, they often face limitations in alignment, data quality, and evaluation consistency. In this study, we introduce Ladder-base, the first TCM-focused LLM trained with Group Relative Policy Optimization (GRPO), a reinforcement learning method that improves reasoning and factual consistency by optimizing response selection based on intra-group comparisons. Ladder-base is built upon the Qwen2.5-7B-Instruct foundation model and trained exclusively on the textual subset of the TCM-Ladder benchmark, using 80 percent of the data for training and the remaining 20 percent split evenly between validation and test sets. Through standardized evaluation, Ladder-base demonstrates superior performance across multiple reasoning metrics when compared to both state-of-the-art general-purpose LLMs such as GPT-4, Gemini 2.5, Claude 3, and Qwen3 and domain-specific TCM models including BenTsao, HuatuoGPT2, and Zhongjing. These findings suggest that GRPO provides an effective and efficient strategy for aligning LLMs with expert-level reasoning in traditional medical domains and supports the development of trustworthy and clinically grounded TCM artificial intelligence systems.

Arfan Ghani

Epileptic seizures arise from abnormally synchronised neural activity and remain a major global health challenge, affecting more than 50 million people worldwide. Despite advances in pharmacological interventions, a significant proportion of patients continue to experience uncontrolled seizures, underscoring the need for alternative neuromodulation strategies. Rhythmic neural entrainment has recently emerged as a promising mechanism for disrupting pathological synchrony, but most existing systems rely on complex analogue electronics or high-power stimulation hardware. This study investigates a minimal digital custom-designed chip that generates a stable 6 Hz oscillation capable of entraining epileptic seizure activity. Using a publicly available EEG seizure dataset, we extracted and averaged analogue seizure waveforms, digitised them to emulate neural front-ends, and directly interfaced the digitised signals with digital output recordings acquired from the chip using a Saleae Logic analyser. The chip pulse train was resampled and low-pass-reconstructed to produce an analogue 6 Hz waveform, allowing direct comparison between seizure morphology, its digitised representation, and the entrained output. Frequency-domain and time-domain analyses demonstrate that the chip imposes a narrow-band 6 Hz rhythm that overrides the broadband spectral profile of seizure activity. These results provide a proof-of-concept for low-power digital custom-designed entrainment as a potential pathway toward simplified, wearable seizure-interruption devices for precision medicine and future healthcare devices.

Haiping Huang, Xinyi Su, Yuqian Zhang et al.

Abstract Background Stroke survivors often experience residual motor dysfunction in their limbs. Additional physical rehabilitation therapies may further improve patients’ functional outcomes. By combining direct interventions targeting the cerebral cortex or subcortical structures with indirect approaches that promote central nervous system reorganization, a closed-loop regulatory system can be established. This integrated approach may generate synergistic effects, thereby enhancing functional recovery outcomes. Methods This 3-week single-center randomized, single-masked study involved participants randomly assigned to either the electroacupuncture (EA) combined with robot-assisted gait training (RAGT) group (n = 22) or the RAGT alone group (n = 23). EA treatment was administered once daily for 30 min, 5 days per week, while RAGT treatment received the same duration of daily sessions. Baseline and endpoint assessments included the Fugl-Meyer lower extremity (FMA-LE) motor function assessment, functional ambulation category (FAC) scale, Berg Balance Scale (BBS) and electroencephalogram. Results After a 3-week intervention period, participants in both groups showed significant improvements in FMA-LE, FAC, and BBS scores compared to baseline levels. The EA combined RAGT group exhibited a reduction in the brain symmetry index within the alpha frequency band, along with enhanced coherence between the CZ electrode and the FCZ, FC2, and C1 electrodes. Furthermore, in the theta frequency band, a shortened average path length and improved global efficiency were observed. Conclusion Both interventions can safely and effectively improve lower limb motor function, and EA combined with RAGT combination therapy may have an advantage in promoting neuroplasticity, which may involve reversing pathological frequency spectrum imbalance after stroke, enhancing functional connections between sensorimotor-related brain regions, and optimizing the topological properties of brain functional networks. Trial registration Chinese Clinical Trial Registry (Registration No.: ChiCTR2500102382)

Gellan K. Ahmed, Gellan K. Ahmed, Ahmed A. Karim et al.

BackgroundAvoidant Restrictive Food Intake Disorder (ARFID) is a newly classified eating disorder that requires further understanding of its presentation. There is no previous report of ARFID in a child post-tonsillectomy. ARFID may be a potential negative outcome for children following oropharyngeal surgery.Case presentationA female child aged 10 years and 2 months presented with ARFID associated with depression, anxiety and nutritional deficiency following tonsillectomy. She had more difficulty in swallowing solids than fluids and had repeated vomiting and spitting food after chewing it. She became dehydrated and malnourished with a BMI of 10.5 and was misdiagnosed with myasthenic gravis.ConclusionsTo our knowledge, this is the first case report of ARFID in a child post-tonsillectomy. We discuss the pathophysiology of ARFID, which remains elusive, and recommend psychiatric assessment when evaluating children post operative tonsillectomy.

Wanying Zhao, Linlin Ye, Lei Cao et al.

BACKGROUND: Owing to the adverse effects of unilateral neglect (UN) on rehabilitation outcomes, fall risk, and activities of daily living, this field has gradually got considerable interest. Notwithstanding, there is presently an absence of efficient portrayals of the entire research field; hence, the motivation behind this study was to dissect and evaluate the literature published in the field of UN following stroke and other nonprogressive brain injuries to identify hotspots and trends for future research. MATERIALS AND METHODS: Original articles and reviews related to UN from 1970 to 2022 were retrieved from the Science Citation Index Expanded of the Web of Science Core Collection. CiteSpace, VOSviewer, and Bibliometrix software were used to observe publication fields, countries, and authors. RESULTS: A total of 1,202 publications were incorporated, consisting of 92% of original articles, with an overall fluctuating upward trend in the number of publications. Italy, the United Kingdom, and the United States made critical contributions, with Neuropsychologia being the most persuasive academic journal, and Bartolomeo P. ranked first in both the quantity of publications and co-citations. Keywords were divided into four clusters, and burst keyword detection demonstrated that networks and virtual reality might additionally emerge as frontiers of future development and warrant additional attention. CONCLUSIONS: UN is an emerging field, and this study presents the first bibliometric analysis to provide a comprehensive overview of research in the field. The insights and guidance garnered from our research on frontiers, trends, and popular topics could prove highly valuable in facilitating the rapid development of this field while informing future research directions.

Wei Liao, PhD, Meredith Ray, PhD, Carrie Fehnel, BBA et al.

Introduction: Low-dose computed tomography screening (LDCT) and lung nodule programs (LNP) promote early lung cancer detection, improve survival; Multidisciplinary Care Programs (MDC) promote guideline-concordant care. The impact of such program-based care on “real-world” lung cancer survival is unquantified. We evaluated outcomes of lung cancer care delivered through structured programs in a community health care system. Methods: We conducted a cohort study linking institutional prospective observational LDCT, LNP and MDC databases with Tumor Registry of Baptist Cancer Center facilities. We categorized all patients diagnosed with lung cancer between 2011 and 2021 into program-based care versus non-program-based care cohorts. We compared patient characteristics, stage distribution, treatment modalities, survival and mortality in each pathway of care. Results: Of 12,148 patients, 237, 1,165, 1,140 and 9,606 were diagnosed through the LDCT, LNP, MDC or no program, respectively; non-program-based care sequentially diminished from 96.3% to 66.5%, diagnosis through LDCT increased from 0.5% to 7.1%, LNP from 3.5% to 20.8%; and MDC alone decreased from a high of 12.8% in 2014 to 5.6% in 2021. Program-based care was associated with earlier stage (p < 0.001), higher surgical resection rates (p < 0.001), greater use of adjuvant therapy (p < 0.001), better aggregate and stage-stratified survival (p < 0.001), and lower all-cause and lung cancer-specific mortality (p < 0.001). Recipients of non-program-based care were considerably less likely to receive lung cancer treatment; results remained consistent when patients receiving no treatment were excluded. Conclusions: Program-based care was associated with substantially better survival. Increasing access to program-based care should be explored as a matter of urgent public policy.

Michael B. Bonsall, Chris Huntingford, Thomas Rawson et al.

BackgroundBy March 2023, the COVID-19 illness had caused over 6.8 million deaths globally. Countries restricted disease spread through non-pharmaceutical interventions (NPIs; e.g. social distancing). More severe “lockdowns” were also required to manage disease spread. Although lockdowns effectively reduce virus transmission, they substantially disrupt economies and individual well-being. Fortunately, the availability of vaccines provides alternative approaches to manage disease spread. Yet, vaccination programs take several months to implement fully, require further time for individuals to develop immunity following inoculation, may not have complete coverage and/or may be imperfectly efficacious against the virus. Given these aspects of a vaccination programme, it is important to understand how NPIs (such as lockdowns) can be used in conjunction with vaccination to achieve public health goals.MethodsWe use mathematical methods to, investigate optimal approaches for vaccination under varying lockdown lengths and/or severities to prevent COVID-19-related deaths exceeding critical thresholds.ResultsWe find that increases in vaccination rate cause a disproportionate decrease in the length and severity lockdowns to keep mortality levels below a critical threshold. With vaccination, severe lockdowns can further reduce infections by up to 89%. Notably, we include simple demographics, modelling three groups: vulnerable, front-line workers, and non-vulnerable. We investigate the sequence of vaccination. One counter-intuitive finding is that even though the vulnerable group is high risk, demographically, this is a small group and critically, per person, vaccination therefore occurs more slowly. Hence vaccinating this group first achieves limited gains in overall disease control.DiscussionImportantly, we conclude that improved disease control may be best achieved by vaccinating the non-vulnerable group coupled with longer and/or more severe NPIs.

Yi‐Xian Liang, Yan‐Ping Xie, Huan‐Ming Yu et al.

ABSTRACT Introduction Lung adenocarcinoma (LUAD) is one of the major histopathological types of non‐small cell lung cancer (NSCLC), including solid, acinar, lepidic, papillary and micropapillary subtypes. Increasing evidence has shown that micropapillary LUAD is positively associated with a higher percentage of driver gene mutations, a higher incidence of metastasis and a poorer prognosis, while lepidic LUAD has a relatively better prognosis. However, the novel genetic change and its underlying mechanism in the progression of micropapillary LUAD have not been exactly determined. Methods A total of 181 patients with LUAD who underwent surgery at the First Affiliated Hospital of Huzhou University from January 2020 to December 2022 were enrolled. Three predominant lepidic and three predominant micropapillary LUAD tissue samples were carried out using whole‐exome sequencing. Comprehensive analysis of genomic variations and the difference between lepidic and micropapillary LUAD was performed. In addition, the TMEM229A Q200del mutation was verified using our cohort and TCGA‐LUAD datasets. The correlations between the TMEM229A Q200del mutation and the clinicopathological characteristics of patients with LUAD were further analyzed. The functions and mechanisms of TMEM229A Q200del on NSCLC cell proliferation and migration were also determined. Results The frequency of genomic changes in patients with micropapillary LUAD was higher than that in patients with lepidic LUAD. Mutations in EGFR, ATXN2, C14orf180, MUC12, NOTCH1, and PKD1L2 were concomitantly detected in three predominant micropapillary and three predominant lepidic LUAD cases. The TMEM229A Q200del mutation was only mutated in lepidic LUAD. Additionally, the TMEM229A Q200del mutation had occurred in 16 (8.8%) patients, and not found TMEM229A R76H and M346T mutations in our cohort, while TMEM229A mutations (R76H, M346T, and Q200del) occurred only in 1.0% of the TCGA‐LUAD cohort. Further correlation analysis between the TMEM229A Q200del mutation and clinicopathological characteristics suggested that a lower frequency of the Q200del mutation was significantly associated with positive lymph node metastasis, advanced TNM stage, positive cancer thrombus, and pathological features. Finally, overexpression of TMEM229A Q200del suppressed NSCLC cell proliferation and migration in vitro. Mechanistically, overexpression of TMEM229A and TMEM229A Q200del both reduced the expression level of phosphorylated (p)‐ERK and p‐AKT (Ser473), and the reduced protein level of p‐ERK in the TMEM229A Q200del group was more pronounced compared to the TMEM229A group. Conclusion Our results demonstrated that the TMEM229A Q200del mutant may play a protective role in the progression of LUAD via inactivating ERK pathway, providing a potential therapeutic target in LUAD.

Nicolas Lanchon, Pierre-Philippe Cortet

Starting from the classical formulation of the weak turbulence theory in a density stratified fluid, we derive a simplified version of the kinetic equation of internal gravity wave turbulence. This equation allows us to uncover scaling laws for the spatial and temporal energy spectra of internal wave turbulence which are consistent with typical scaling exponents observed in the oceans. The keystone of our description is the assumption that the energy transfers are dominated by a class of non-local resonant interactions, known as the ``induced diffusion'' triads, which conserve the ratio between the wave frequency and vertical wave number. Our analysis remarkably shows that the internal wave turbulence cascade is associated to an apparent constant flux of wave action.

Yan Gu, Chunhua Song, Sinisa Dovat et al.

Nicola Scichilone, Andrew Whittamore, Chris White et al.

Abstract Background Chronic obstructive pulmonary disease (COPD) is a common condition that causes irreversible airway obstruction. Fatigue and exertional dyspnoea, for example, have a detrimental impact on the patient’s daily life. Current research has revealed the need to empower the patient, which can result in not only educated and effective decision-making, but also a considerable improvement in patient satisfaction and treatment compliance. The current study aimed to investigate the perspectives and requirements of people living with COPD to possibly explore new ways to manage their disease. Methods Adults with COPD from 8 European countries were interviewed by human factor experts to evaluate their disease journey through the gathering of information on the age, performance, length, and impact of diagnosis, symptoms progression, and family and friends' reactions. The assessment of present symptoms, services, and challenges was performed through a 90-min semi-structured interview. To identify possible unmet needs of participants, a generic thematic method was used to explore patterns, themes, linkages, and sequences within the data collected. Flow charts and diagrams were created to communicate the primary findings. Following analysis, the data was consolidated into cohesive insights and conversation themes relevant to determining the patient's unmet needs. Results The 62, who voluntarily accepted to be interviewed, were patients (61% females, aged 32–70 years) with a COPD diagnosis for at least 6 months with stable symptoms of different severity. The main challenges expressed by the patients were the impact on their lifestyle, reduced physical activity, and issues with their mobility. About one-fourth had challenges with their symptoms or medication including difficulty in breathing. Beyond finding a cure for COPD was the primary goal for patients, their main needs were to receive adequate information on the disease and treatments, and to have adequate support to improve physical activity and mobility, helpful both for patients and their families. Conclusions These results could aid in the creation of new ideas and concepts to improve our patient’s quality of life, encouraging a holistic approach to people living with COPD and reinforcing the commitment to understanding their needs.

Honora Englander, K. Priest, H. Snyder et al.

1Division of Hospital Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; 2Section of Addiction Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon; 3School of Medicine, MD/PhD Program, Oregon Health & Science University, Portland, Oregon; 4School of Public Health, Oregon Health & Science University-Portland State University, Portland, Oregon; 5Department of Family Medicine, University of California, San Francisco, California; 6Division of Hospital Medicine, Zuckerberg San Francisco General Hospital and the Department of Medicine, University of California, San Francisco School of Medicine, San Francisco, California; 7University of Colorado, Department of Medicine, Division of General Internal Medicine and Division of Hospital Medicine, Denver, Colorado; 8Division of General Internal Medicine, Department of Medicine, Oregon Health & Science University, Portland, Oregon.

Yushu Lin, John Palmore

The current study uses numerical approaches to investigate the effect of droplet deformation and internal circulation on droplet dynamics. Although droplet drag is a classical area of study, there are still theoretical gaps in understanding the motion of large droplets. In applications like spray combustion, droplets of various sizes are generated and move with the flow. Large droplets tend to deform in the flow, and have complex interactions with the flow because of this deformation. To better model spray, the physical understanding of droplets need to be improved. Under spray conditions, droplets are subjected to a high temperature and pressure environment, and the coupling between liquid and gas is enhanced. Therefore, the deformation and internal circulation will affect droplet drag coefficient more significantly than in atmospheric conditions. To study the mechanism on how droplet shape and internal circulation influence droplet dynamics, we will use direct numerical simulation (DNS) to simulate a droplet falling at its terminal velocity in high pressure air. An in-house code developed for interface-capturing DNS of multiphase flows will be employed for the simulation. The drag coefficient is calculated, and the results are consistent with existing literature for slightly deformed droplets. The results show that the drag coefficient is directly related to the droplet deformation and droplet internal circulation. The paper also develops a theory to account the effect of Weber number and liquid/gas properties in droplet deformation.

Robin Ming Chen, Lili Fan, Samuel Walsh et al.

This paper studies the structural implications of constant vorticity for steady three-dimensional internal water waves. It is known that in many physical regimes, water waves beneath vacuum that have constant vorticity are necessarily two dimensional. The situation is more subtle for internal waves that traveling along the interface between two immiscible fluids. When the layers have the same density, there is a large class of explicit steady waves with constant vorticity that are three-dimensional in that the velocity field and pressure depend on one horizontal variable while the interface is an arbitrary function of the other. We prove the following rigidity result: every three-dimensional traveling internal wave with bounded velocity for which the vorticities in the upper and lower layers are nonzero, constant, and parallel must belong to this family. If the densities in each layer are distinct, then in fact the flow is fully two dimensional.

R. Kailasham, Rajarshi Chakrabarti, J. Ravi Prakash

An exact solution of coarse-grained polymer models with fluctuating internal friction and hydrodynamic interactions has not been proposed so far due to a one-to-all coupling between the connector vector velocities that precludes the formulation of the governing stochastic differential equations. A methodology for the removal of this coupling is presented, and the governing stochastic differential equations, obtained by attaching a kinetic interpretation to the Fokker-Planck equation for the system, are integrated numerically using Brownian dynamics simulations. The proposed computational route eliminates the calculation of the divergence of the diffusion tensor which appears in models with internal friction, and is about an order of magnitude faster than the recursion-based algorithm for the decoupling of connector-vector velocities previously developed [J. Rheol., 65, 903 (2021)] for the solution of freely draining models with internal friction. The effects of the interplay of various combinations of finite extensibility, internal friction and hydrodynamic interactions on the steady-shear-viscosity is examined. While finite extensibility leads solely to shear-thinning, both internal friction and hydrodynamic interactions result in shear-thinning followed by shear-thickening. The shear-thickening induced by internal friction effects are more pronounced than that due to hydrodynamic interactions.