Hasil untuk "Internal medicine"

T. Virgilio, K. Chahine, H. Bansal et al.

Abstract Background L19IL2 is a clinical-stage antibody-cytokine fusion protein that has been investigated for the treatment of various cancer types. Despite its promising antitumor activity, the precise mechanism of action is still not fully understood. Methods In this work, we employed a myc-driven B-cell lymphoma murine model to demonstrate that systemic administration of L19IL2 induced a robust CD8⁺ T cell-dependent tumor regression across multiple organs without expansion of regulatory T cells. Results Following L19IL2 administration, intratumoral CD8+ T cells proliferated and acquired effector and memory phenotypes, associated with private clonal expansion and enhanced killing. Moreover, the spatial behavior of peritumoral CD8+ T cells studied by intravital microscopy demonstrated a rapid increase in tumor-directed motility and infiltration following L19IL2 administration. Conclusions These findings described the detailed mechanism of action of L19IL2 against B cell lymphoma and revealed for the first time the dynamic responses of peritumoral CD8+ T cells to targeted IL2 stimulation, supporting the use of L19IL2 for patients with aggressive B cell lymphoma.

Thomas B. Mieling

The coupling between internal degrees of freedom of quantum systems and their overall motion in an external gravitational field plays a central role in multiple extensions of Einstein's equivalence principle to quantum physics. While previous models of such effects were predominantly restricted to linearized gravity and often required quantum particles to follow prescribed world-lines, this letter shows how such phenomena can be understood using generally covariant semi-classical approximations in the framework of quantum field theory in curved space-times. This method provides a unification and generalization of previously established results, but also predicts new effects such as an influence of internal energies on field amplitudes, as well as correction terms to the internal Schrödinger equation that give rise to Berry phases.

Yu Li, Yu Chen, Gansheng Xie et al.

BackgroundComputed tomography (CT) Hounsfield units (HUs) of pathologically confirmed metastatic inguinal lymph nodes (ILNs) were proved to be higher than negative ones. We designed this study to explore the clinical value of CT HU for diagnosing palpable ILN metastasis in patients with penile cancer.MethodsA total of 32 patients with penile cancer, including 84 palpable ILNs, were recruited in this study. They all performed 5-mm layer pelvic contrast-enhanced CT (CE-CT) before treatment. The palpable ILNs were matched with CT image. By using radiologic software PACS, the layer with a maximum cross-sectional area of target lymph node was selected, and the short axis was defined as diameter. We outlined the edge of target lymph nodes, and the software automatically calculated its area, maximum CT HU, and average CT HU. All target ILNs were biopsied by surgery to confirm the presence of metastasis.ResultsCompared with non-metastatic ILNs, metastatic ILNs had larger diameter, area, maximum non-contrast CT (NC-CT) HU, maximum arterial-phase CE-CT (ACE-CT) HU, average NC-CT HU, and average ACE-CT HU, with statistically significant differences (P < 0.05). Receiver operating characteristic analysis showed the all six parameters (maximum NC-CT HU, maximum ACE-CT HU, average NC-CT HU, average ACE-CT HU, diameter, and area) had significant diagnostic value for ILN metastasis, with an area under the curve of 0.847, 0.853, 0.900, 0.919, 0.809, and 0.789, respectively. The average ACE-CT HU (cutoff: 40.5) had the highest accuracy as 0.857, and maximum NC-CT HU (cutoff: 51.5) had the highest sensitivity of 0.897.ConclusionILN CT HU was clinically valuable for the diagnosis of palpable ILN metastasis in patients with newly diagnosed penile cancer.

Yu-Ming Shen, Pao-Hwa Chen

Abstract Background Simultaneous bilateral percutaneous nephrolithotomy (PCNL) offers the advantage of treating stones in both kidneys, thereby reducing the need for multiple surgeries. Due to the limited number of cases, simultaneous PCNL has unwarranted safety and efficacy concerns. This study aimed to evaluate the complications and stone-free rates of simultaneous bilateral PCNL in the treatment of bilateral large complex stones and to compare different access methods. Method Between January 2012 and December 2022, 36 consecutive patients who underwent simultaneous bilateral PCNL for large complex renal stones were enrolled. Guy’s stone score (GSS) was used to assess the complexity of stone. The preoperative, intraoperative, and post-operative parameters were assessed. The patients were first categorized based on channel size (conventional vs. mini-PCNL), and then further sub-grouped according to specific combinations of tract size and dilation method for comparative analysis. Results Thirty-six consecutive patients (72 renal units) underwent simultaneous bilateral PCNL. The median stone burden was 602.43 mm2 (interquartile range: 225–1332.72 mm2), mean surgical duration was 70.9 ± 29.6 minutes for each renal unit (range, 30–140 minutes), and the mean hematocrit reduction was 6.8±8.4%. The mean length of stay was four days, and the stone-free rate was 81.9%. Notably, eGFR (estimated Glomerular filtration rate) values showed significant improvement at one-year follow-up (p < 0.001), with 29.4% of patients showing clinical downstaging. The overall complication rate was 16.7%, with the majority of complications being transient fever. Mini-PCNL had a shorter length of stay (p < 0.05). The complication rates for Amplatz, balloon, and mini-PCNL were 13.3%, 23.1%, and 12.5%, respectively. The post-operative radiographic stone-free rate (SFR) for 72 renal units was 81.9%, with the highest rate in the mini-PCNL group (93.7%). Conclusions There was no increase in the rate of complications compared to unilateral PCNL. This study provides valuable insights into surgical outcomes using different access methods.

Jacob E. Aronoff, Benjamin C. Trumble

The rise in chronic diseases over the last century presents a significant health and economic burden globally. Here we apply evolutionary medicine and life history theory to better understand their development. We highlight an imbalanced metabolic axis of growth and proliferation (anabolic) versus maintenance and dormancy (catabolic), focusing on major mechanisms including IGF-1, mTOR, AMPK, and Klotho. We also relate this axis to the hyperfunction theory of aging, which similarly implicates anabolic mechanisms like mTOR in aging and disease. Next, we highlight the Brain-Body Energy Conservation model, which connects the hyperfunction theory with energetic trade-offs that induce hypofunction and catabolic health risks like impaired immunity. Finally, we discuss how modern environmental mismatches exacerbate this process. Following our review, we discuss future research directions to better understand health risk. This includes studying IGF-1, mTOR, AMPK, and Klotho and how they relate to health and aging in human subsistence populations, including with lifestyle shifts. It also includes understanding their role in the developmental origins of health and disease as well as the social determinants of health disparities. Further, we discuss the need for future studies on exceptionally long-lived species to understand potentially underappreciated trade-offs and costs that come with their longevity. We close with considering possible implications for therapeutics, including (1) compensatory pathways counteracting treatments, (2) a Goldilocks zone, in which suppressing anabolic metabolism too far introduces catabolic health risks, and (3) species constraints, in which therapeutics tested in shorter lived species with greater anabolic imbalance will be less effective in humans.

D. Ntotsikas, K. N. Gourgouliatos

This work presents a global solution for the internal and the external field of an axisymmetric rotating neutron star. It is shown that the twist of the internal field affects the external field, by increasing the number of open field lines and eventually the spin-down rate of the star. This effect is far more drastic if the toroidal field, and consequently the poloidal current flowing within the star, is allowed to populate the closed field lines of the magnetosphere, rather than if it remains confined in the star. We further remark that the internal field structure depends on the presence of a twisted magnetosphere: if the twist current is not allowed to flow in the magnetosphere it only occupied a narrow toroid at the interior of the star, whereas if the twist currents are allowed to flow in the magnetosphere the internal toroidal field may occupy a significant volume of the stellar interior. Strong magnetospheric currents may also impact the emission mechanisms, and lead to fluctuations in magnetar spin-down rates, moding and nulling of pulsars, a correlation between angular shear and twist, and the general morphology of the pulsar magnetic field leading to various observational manifestations. The magnetospheric toroidal fields may possibly dissipate, thus the system may switch from global twist to internal twist and consequently exhibit transient behavior.

Mao-Qiang Man, Mao-Qiang Man, Mao-Qiang Man et al.

Autism spectrum disorder (ASD) is a common neurological disorder. Although the etiologies of ASD have been widely speculated, evidence also supports the pathogenic role of cutaneous inflammation in autism. The prevalence of ASD is higher in individuals with inflammatory dermatoses than in those without inflammatory diseases. Anti-inflammation therapy alleviates symptoms of ASD. Recent studies suggest a link between epidermal dysfunction and ASD. In the murine model, mice with ASD display epidermal dysfunction, accompanied by increased expression levels of proinflammatory cytokines in both the skin and the brain. Children with ASD, which develops in their early lifetime, also exhibit altered epidermal function. Interestingly, improvement in epidermal function alleviates some symptoms of ASD. This line of evidence suggests a pathogenic role of cutaneous dysfunction in ASD. Either an improvement in epidermal function or effective treatment of inflammatory dermatoses can be an alternative approach to the management of ASD. We summarize here the current evidence of the association between the skin and ASD.

Yves Colin de Verdière, Zhenhao Li

We study a model of internal waves in an effectively 2D aquarium under periodic forcing. In the case when the underlying classical dynamics has sufficiently irrational rotation number, we prove that the energy of the internal waves remains bounded. This involves studying the spectrum of a related 0-th order pseudodifferential operator at spectral parameters corresponding to such dynamics. For the special cases of rectangular and elliptic domains, we give an explicit spectral description of that operator.

A. Lobo, M. Pérez-Echeverría, J. Artal

P. Hsu, Feng-Woei Tsay, J. Kao et al.

1Division of Gastroenterology and Hepatology, Department of Internal Medicine, An Nan Hospital, China Medical University, Tainan, Taiwan 2Kaohsiung Veterans General Hospital and National YangMing University, Kaohsiung, Taiwan 3Division of Gastroenterology, Department of Internal Medicine, Michigan Medicine, University of Michigan, Ann Arbor, Michigan, USA 4Department of Nuclear Medicine, Taipei Veterans General Hospital and National YangMing University, Taipei, Taiwan 5Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung, Taiwan 6Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Municipal Siaogang Hospital, Kaohsiung, Taiwan 7Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan

W J Bom, F B M Joosten, M M G J van Borren et al.

Objective: Radiofrequency ablation (RFA) is increasingly considered the prime option for treating symptomatic, benign, non-functioning thyroid nodules (NFTN). However, little is known about the degree of operator experience required to achieve optimal results. This study describes the RFA learning curve of a single-center team. Methods: A retrospective cohort study of the first 103 patients receivin g RFA treatment for a single, symptomatic, and benign NFTN, with a follow-up of at least 1 year. The primary outcome measure was technique efficacy, defined as the per centage of patients with a 6-month nodal volume reduction ratio (VRR) >50% after si ngle-session RFA. Optimal treatment efficacy was defined as a 6-month VRR >50% achie ved in at least 75% of patients. Secondary outcomes were complications of RFA and indications of secondary interventions. Results: Median nodal volume at baseline was 12.0 mL (range 2.0–58.0 mL ). A 6-month VRR >50% was achieved in 45% of the first 20 patients, 75% of th e next 20, and 79% of the following 63 patients. Complications included minor bleeding (N = 4), transient hyperthyroidism (N = 4), and transient loss of voice (N = 1). Poor volume reduction or nodular regrowth led to diagnostic lobectomy in 11 patients and a second RFA in 5. Lobectomy revealed a follicular carcinoma (T2N0M0) in 2 patient s. In 1 patient, nodule regrowth was caused by an intranodular solitary B-cell lymphoma. Conclusion: About 40 procedures are required to achieve a 6-month VRR >50% in the majority of patients. Appropriate follow-up with re-evaluation is recommended for all patients with a VRR <50% and in those with regrowth to exclude underlying malignancy.

Chunling Wang, Xiaozhun Huang, Xiaofeng Lan et al.

BackgroundSpontaneously ruptured hepatocellular carcinoma (rHCC) with hemorrhage is characterized by rapid onset and progression. The aim of this systematic review was to explore the current studies on rHCC with hemorrhage and determine the optimum treatment strategy.MethodThe PubMed, Web of Science, Embase, and the Cochrane Library databases were searched for studies reporting survival outcomes with comparison between emergency resection (ER) and transarterial embolization following staged hepatectomy (SH) were included by inclusion and exclusion criteria, the perioperative and survival data were statistically summarized using Review Manager 5.3 software.ResultA total of 8 retrospective studies were included, with a total sample size of 556, including 285 (51.3%) in the ER group and 271 (48.7%) in the SH group. The perioperative blood loss and blood transfusion volume in the SH group were less than those in the ER group, and there were no significant differences in the operative time, incidence of complications, mortality and recurrence rate of tumors between the two groups. The 1-, 2-, 3-year overall survival and 1-, 2-, 3-, 5-year disease-free survival of the ER group were not significantly different from those of the SH group, and the 5-year overall survival rate of ER group was lower than that of the SH group (hazard ratios=1.52; 95% confidence intervals: 1.14-2.03, P=0.005).ConclusionThere was no significant difference in the short-term efficacy of ER or SH in the treatment of ruptured HCC, and SH was superior to ER in the long-term survival.

Joy Onyinyechi Chionuma, Helen Onyeaka, Osmond C. Ekwebelem et al.

During pregnancy, women are at an increased risk of getting sick from respiratory viruses and when compared to non-pregnant women, pregnant women are more susceptible to severe illness from COVID-19. Owing to this fact and the emergence of a more infectious COVID-19 variants, pregnant women are currently classified as a vulnerable population, along with pediatric patients and older adults. While scientists are still learning more about the new variants, it is becoming clear that COVID-19 infected pregnant women are also at a real increased risk of poor pregnancy outcomes, as premature birth and babies born with lifelong health issues are possible if people become infected during pregnancy. Added to these facts, recommendation for COVID-19 has largely varied globally. The conspiracy-laden information on social media has led to pregnant women being hesitant about getting COVID-19 vaccine. Furthermore, as the transmissibility of COVID-19 is higher with this variant and the health system for maternal care in many countries regarded as “very bad” there is need to clearly highlight the impacts of the variants and for countries to speed up vaccination programme to reach all members of society.

Ji-Yeon Park, Kyungdo Han, Hun-Sung Kim et al.

Background Elevated γ-glutamyl transferase (γ-GTP) level is associated with metabolic syndrome, impaired glucose tolerance, and insulin resistance, which are risk factors for type 2 diabetes. We aimed to investigate the association of cumulative exposure to high γ-GTP level with risk of diabetes. Methods Using nationally representative data from the Korean National Health Insurance system, 346,206 people who were free of diabetes and who underwent 5 consecutive health examinations from 2005 to 2009 were followed to the end of 2018. High γ-GTP level was defined as those in the highest quartile, and the number of exposures to high γ-GTP level ranged from 0 to 5. Hazard ratio (HR) and 95% confidence interval (CI) for diabetes were analyzed using the multivariable Cox proportional-hazards model. Results The mean follow-up duration was 9.2±1.0 years, during which 15,183 (4.4%) patients developed diabetes. There was a linear increase in the incidence rate and the risk of diabetes with cumulative exposure to high γ-GTP level. After adjusting for possible confounders, the HR of diabetes in subjects with five consecutive high γ-GTP levels were 2.60 (95% CI, 2.47 to 2.73) in men and 3.05 (95% CI, 2.73 to 3.41) in women compared with those who never had a high γ-GTP level. Similar results were observed in various subgroup and sensitivity analyses. Conclusion There was a linear relationship between cumulative exposure to high γ-GTP level and risk of diabetes. Monitoring and lowering γ-GTP level should be considered for prevention of diabetes in the general population.

Lisa Göschl, Daniel Mrak, Katharina Grabmeier-Pfistershammer et al.

BackgroundPatients with inborn errors of immunity (IEI) are at increased risk for severe courses of SARS-CoV-2 infection. COVID-19 vaccination provides effective protection in healthy individuals. However, it remains unclear whether vaccination is efficient and safe in patients with constitutional dysfunctions of the immune system. Thus, we analyzed the humoral response, adverse reactions and assessed the disease activity of the underlying disease after COVID-19 vaccination in a cohort of patients suffering from IEIs or mannan-binding lectin deficiency (MBLdef).MethodsVaccination response was assessed after basic immunization using the Elecsys anti-SARS-CoV-2 S immunoassay and via Vero E6 cell based assay to detect neutralization capabilities. Phenotyping of lymphocytes was performed by flow cytometry. Patient charts were reviewed for disease activity, autoimmune phenomena as well as immunization status and reactogenicity of the vaccination. Activity of the underlying disease was assessed using a patient global numeric rating scale (NRS).ResultsOur cohort included 11 individuals with common variable immunodeficiency (CVID), one patient with warts hypogammaglobulinemia immunodeficiency myelokathexis (WHIM) syndrome, two patients with X-linked agammaglobulinemia (XLA), one patient with Muckle Wells syndrome, two patients with cryopyrin-associated periodic syndrome, one patient with Interferon-gamma (IFN-gamma) receptor defect, one patient with selective deficiency in pneumococcal antibody response combined with a low MBL level and seven patients with severe MBL deficiency. COVID-19 vaccination was generally well tolerated with little to no triggering of autoimmune phenomena. 20 out of 26 patients developed an adequate humoral vaccine response. 9 out of 11 patients developed a T cell response comparable to healthy control subjects. Tested immunoglobulin replacement therapy (IgRT) preparations contained Anti-SARS-CoV-2 S antibodies implicating additional protection through IgRT.SummaryIn summary the data support the efficacy and safety of a COVID-19 vaccination in patients with IEIs/MBLdef. We recommend evaluation of the humoral immune response and testing for virus neutralization after vaccination in this cohort.

Defeng Zou, Youjian Song, Omri Gat et al.

Optical soliton molecules in ultrafast lasers present striking analogies with their matter molecule counterparts, such as internal vibrations. However, the vibrations of soliton molecules are nonlinear, with frequencies that are sensitive to the system parameters, thus presenting an opportunity of control. Here, we experimentally demonstrate the synchronization of the internal vibrations of self-excited vibrating soliton molecules through a modulated optical injection. We show efficient sub-harmonic, fundamental and super-harmonic synchronization, forming a pattern of Arnold tongues with respect to the injection strength. Our observations are supported by numerical simulations.

Young Lee

Correspondence to Young Ho Lee, M.D., Ph.D. Division of Rheumatology, Department of Internal Medicine, Korea University Anam Hospital, Korea University College of Medicine, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Korea Tel: +82-2-920-5645, Fax: +82-2-922-5974, E-mail: lyhcgh@korea.ac.kr Copyrightc 2019 The Korean Association of Internal Medicine This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted noncommercial use, distribution, and reproduction in any medium, provided the original work is properly cited. What’s hot?

Yixiang Lu, Rui Wang, Qingwei Gao et al.

Multi-modal image fusion integrates different images of the same scene collected by different sensors into one image, making the fused image recognizable by the computer and perceived by human vision easily. The traditional tensor decomposition is an approximate decomposition method and has been applied to image fusion. In this way, the image details may be lost in the process of fusion image reconstruction. To preserve the fine information of the images, an image fusion method based on tensor matrix product decomposition is proposed to fuse multi-modal images in this article. First, each source image is initialized into a separate third-order tensor. Then, the tensor is decomposed into a matrix product form by using singular value decomposition (SVD), and the Sigmoid function is used to fuse the features extracted in the decomposition process. Finally, the fused image is reconstructed by multiplying all the fused tensor components. Since the algorithm is based on a series of singular value decomposition, a stable closed solution can be obtained and the calculation is also simple. The experimental results show that the fusion image quality obtained by this algorithm is superior to other algorithms in both objective evaluation metrics and subjective evaluation.

Mehmet Ak, Murat Gulsun

Trichotillomania (TM) is a rare psychiatric disorder, and recognized with its complications effecting functionality. A number of pharmacological agents and psychotherapy have been used in the treatment of TM. There are few publications of drug therapy for TM and no consensus has been established yet. This 16 year-old female patient with TM will be the second case in the literature treated by aripiprazole. Trikotilomani tedavisinde aripiprazol: Olgu sunumu Trikotilomani işlevselliği etkileyebilen nadir görülen psikiyatrik bozukluklardan biridir. Tedavisinde birçok farmakolojik ajan ve psikoterapi yöntemleri kullanılmaktadır. TM’nin ilaçla tedavisine ilişkin bir kaç yayın bulunmakla birlikte henüz görüş birliğine varılmamıştır. Bu makalede, 16 yaşında TM’li kadın olgu bir atipik antipsikotik olan aripiprazol ile tedavi edilmiş olup bu olgu, aripiprazole yanıt verdiği bildirilen literatürdeki ikinci TM olgusudur.

Felix P. Kemeth, Tom Bertalan, Nikolaos Evangelou et al.

We present an approach, based on learning an intrinsic data manifold, for the initialization of the internal state values of LSTM recurrent neural networks, ensuring consistency with the initial observed input data. Exploiting the generalized synchronization concept, we argue that the converged, "mature" internal states constitute a function on this learned manifold. The dimension of this manifold then dictates the length of observed input time series data required for consistent initialization. We illustrate our approach through a partially observed chemical model system, where initializing the internal LSTM states in this fashion yields visibly improved performance. Finally, we show that learning this data manifold enables the transformation of partially observed dynamics into fully observed ones, facilitating alternative identification paths for nonlinear dynamical systems.