Hasil untuk "Internal medicine"

Piotr Górka, Julia Frączek, Karolina Borówka et al.

Background: Hamstring muscle injuries (HMI) remain the most prevalent non-contact injury in high-speed sports, particularly football and athletics. Despite sports medicine advancements, HMI is characterised by high recurrence rates (12–33%), causing significant time loss and performance decrements. Aim: This paper provides a comprehensive literature review regarding the functional anatomy, risk factors, diagnostic classification, and evidence-based treatment strategies for HMI. Material and methods: A narrative literature review was conducted using PubMed and MEDLINE. We focused on high-quality studies (systematic reviews, randomised controlled trials, clinical guidelines) published between 2010 and 2025, covering conservative and surgical management. Results: The biceps femoris long head's bi-articular architecture and dual innervation predispose it to eccentric strain during sprinting. Diagnosis has evolved with the British Athletics Muscle Injury Classification (BAMIC), which identifies intratendinous involvement as predicting prolonged recovery. Conservative management remains the gold standard for mid-substance injuries; L-protocol (lengthening) and eccentric strengthening show superior outcomes over concentric training. Surgery is indicated for complete proximal avulsions or high-grade partial tears with retraction (>2 cm); acute repair yields better outcomes than chronic reconstruction. Conclusions: Effective HMI management requires a multimodal approach. While conservative care resolves most injuries, precise MRI diagnosis is crucial to identify surgical candidates early. Return to play must be criteria-based, prioritising restored eccentric strength, fascicle length, and sprint mechanics over time-based protocols or imaging clearance.

Shitong Zhou, Shitong Zhou, Yu Jiang et al.

IntroductionHead and neck squamous cell carcinoma (HNSCC) is a highly heterogeneous malignancy with poor overall prognosis. Recent studies have suggested that propionate metabolism-related genes (PMRGs) may play key roles in tumor progression and immune regulation, yet their functions in HNSCC remain unclear.MethodsTranscriptomic data from 502 HNSCC tumor samples and 44 normal tissue samples were obtained from the UCSC Xena database as the training set. Two independent datasets (GSE41613 and GSE6631) from the GEO database were used for validation. Differentially expressed genes (DEGs), key module genes identified via weighted gene co-expression network analysis (WGCNA), and PMRGs were intersected to identify candidate genes. A prognostic model was constructed using Cox regression and LASSO analysis. Immune infiltration, somatic mutations, and drug sensitivity were compared between high- and low-risk groups. Gene expression was further validated by RT-qPCR using clinical samples.ResultsA total of 42 intersecting genes were identified, and four feature genes (PRKAA2, SLC7A5, GRIP2, CHGB) were selected to build the prognostic model. The model effectively stratified patients into high- and low-risk groups with significant survival differences in both the training and validation cohorts. The high-risk group exhibited marked differences in immune cell infiltration, immune checkpoint expression, and cancer immune cycle activity. Mutation burden and drug sensitivity also varied significantly between risk groups. A nomogram combining risk score and pathological N stage showed strong predictive performance.DiscussionThis study highlights the potential role of PMRGs in immune regulation and tumor progression in HNSCC. The proposed four-gene signature provides a novel tool for prognosis prediction and offers new insights for risk stratification and individualized therapy. Further multicenter validation and mechanistic studies are warranted.

Taishiro Kamasaki, Hiroshi Otao, Mizuki Hachiya et al.

Background This study investigates factors influencing cane use among older adults and identifies most significant determinants. Methods This study is a cross-sectional study. A total of 160 community-dwelling older adults (mean age, 79±7 years) were included in the analysis. Binomial logistic regression analysis was conducted using the presence or absence of cane use as the dependent variable, and the associated factors were investigated. Results There were 108 participants (mean age, 77±7 years) in the cane-non-using group and 52 (mean age, 83±6 years) in the cane-using group. Factors associated with the presence or absence of cane use were open-eyed one-leg standing time (odds ratio [OR]=0.81; 95% confidence interval [CI], 0.70–0.93; p=0.003) and depressed mood (OR=2.78; 95% CI, 1.31–5.91; p=0.008). Conclusion Older adults with reduced balance ability and depressive mood need to use a cane. This highlights the need to assess balance ability and depressed mood in prescribing a cane to older adults. Appropriate prescription of canes has the potential to enrich the lives of older adults by contributing to their safe range of activities.

J. Dunne, D. Foo, J. Jancey et al.

Short interpregnancy intervals (IPIs) of <6–18 months are associated with adverse maternal and child outcomes. This study aimed to identify the individual, relationship, community, and societal factors that influence short IPIs in high-income countries. A comprehensive search was undertaken in CINAHL Plus, Ovid/EMBASE, Ovid/MEDLINE, Ovid/PsycINFO, ProQuest, PubMed, Scopus, Web of Science, and Google Scholar for articles published in English from 1st January 1990 to 26th October 2023. Studies were included if they reported an effect estimate of at least one determinant of pregnancy spacing in a high-income country. The quality of the included studies was assessed using the Johanna Briggs Institute Critical Appraisal Tool and Cochrane Risk Assessment Tool. Multi-level factors at the individual, relationship, community, and societal level were systematically identified through the socio-ecological model. This study is registered with PROSPERO (CRD42020176311). Of 2005 unique articles, 220 were identified for full-text review, and 55 met the inclusion criteria representing a total of 27,103,055 women from 13 high-income countries. All the included studies were deemed to be of moderate to high quality. Most of the studies reported determinants of short IPI at the individual level, with non-use of contraception the most common reported factor. Peer influence was a factor at the relationship level, and access to health care and reproductive services were impactful at the community and societal levels, respectively. Future research and efforts should support the development and implementation of policies and practices that support optimum pregnancy spacing from a comprehensive socio-ecological position.

Jun Wei, Jun Wei, Jun Wei et al.

Lactylation, a recently identified epigenetic modification derived from lactate metabolism, has emerged as a key regulator linking cellular metabolic states to chromatin remodeling and gene transcription. Acting through histone and non-histone protein lactylation (for example, Histone H3 Lysine 9 Lactylation [H3K9la], Histone H3 Lysine 18 Lactylation [H3K18la]), this modification reshapes chromatin accessibility and activates transcriptional programs, thereby driving tumor progression, metabolic reprogramming, immune evasion, and chemoresistance in digestive system malignancies. This review comprehensively summarizes the latest advances in lactylation across esophageal cancer (EC), gastric cancer (GC), colorectal cancer (CRC), hepatocellular carcinoma (HCC), pancreatic cancer (PC), and gallbladder cancer (GBC), emphasizing its role in epigenetic regulation of oncogenic signaling and metabolic–epigenetic crosstalk. Moreover, we discuss potential biomarkers, therapeutic targets, and pharmacologic strategies aimed at modulating lactylation. Despite promising translational potential, key challenges remain in standardizing detection methods and validating clinical efficacy. The intricate mechanisms of lactylation not only deepen our understanding of digestive tumor biology but also unveil a rich landscape of novel therapeutic targets. Future investigations should focus on deciphering lactylation-mediated epigenetic mechanisms in tumor immunotherapy and precision medicine, providing new directions for research and clinical insights for the early diagnosis and tailored treatment of digestive system tumors.

Saara H. Huoponen, Katrin Sisa, Tom Saari et al.

ABSTRACT Aim The aim of the study was to survey the observed incidence of adverse effects (AEs) related to electroconvulsive therapy (ECT) in Finnish neuromodulation units, as well as to explore what medical interventions are used to prevent and treat them in those units. Methods An electronic survey was conducted among Finnish neuromodulation units at the end of 2022. The survey included 35 questions related to AEs and their prevention and/or treatment in the responding units’ ECT patient populations. Results Our survey reached 19 out of 26 units in Finland, with 17 units completing the full questionnaire. Headache, myalgia and postictal confusion (PIC) emerged as the most frequently reported AEs. Nausea and high blood pressure were reported less often. Only a few units reported AEs known to be rare, such as accidental awareness during general anesthesia and the aspiration of gastric contents. However, there was considerable variation in the recognition and treatment of those ECT‐related AEs the diagnosis of which depends more on patients’ self‐reporting, including headache, myalgia or nausea. Five units (29%) reported frequent or occasional headache or myalgia and four units (24%) reported occasional nausea experienced by their patients, but these AEs were addressed pharmacologically in those units neither by prophylaxis nor by treatment. This raises concern about whether these AEs are perceived as an insignificant issue in delivering ECT treatment, thus requiring no intervention, or if those AEs should be better recognized and and managed more actively. Conclusions AEs related to ECT treatment are common, but some still appear poorly recognized and treated. Regarding treatment adherence, minimizing potential AEs whenever feasible can be considered important. A thorough preoperative assessment of patients is required to identify possible risk factors for AEs. An objective and structured evaluation tool for recognizing adverse effects in patients undergoing ECT treatment would be useful.

A. Hwong, Y. Li, R. Morin et al.

Introduction Older adults with schizophrenia often have multiple chronic conditions, or multimorbidity, yet most prior research has focused on single medical conditions. Objectives To characterize multimorbidity patterns and utilization among older adults with schizophrenia to understand how multimorbidity affects this population and their clinical service needs. Methods This retrospective cohort study included veterans aged 50 years and older with schizophrenia and followed their comorbid diagnoses and utilization (outpatient, inpatient, and emergency) from 2012 to 2019. Comorbid diagnoses included myocardial infarction, congestive heart failure, stroke, chronic obstructive pulmonary disease (COPD), cancer, dementia, traumatic brain injury, hepatitis C, osteoarthritis, renal disease, chronic pain, sleep disorder, depression, dysthymia, posttraumatic stress disorder (PTSD), general anxiety disorder, alcohol use disorder, other substance use disorder, and tobacco use disorder. Latent class analysis was used to identify latent profiles of psychiatric and medical comorbidity. Chi-square and F-tests were used to assess differences in demographics, comorbidities, and utilization across the latent classes. Results The cohort included 82,495 adults with schizophrenia. Three distinct multimorbidity classes were identified: Minimal Comorbidity (67.0% of the cohort), High Comorbidity (17.6%) and Substance Use Disorders and Related Conditions (SUDRC) (15.4%). The Minimal Comorbidity class had <10% prevalence of all comorbid diagnoses. The High Comorbidity class had >20% prevalence of congestive heart failure, COPD, dementia, renal disease, sleep disorder, and depression. The SUDRC class had >70% prevalence of alcohol and drug use disorders and >20% prevalence of COPD, hepatitis C, depression, and PTSD. Although the High Comorbidity class had the highest rates of chronic medical conditions, the SUDRC class had the highest rates of emergency and inpatient medical care and emergency, inpatient, and outpatient mental health care utilization. Comparing across classes, all p-values were <.001 for utilization. Conclusions Older adults with schizophrenia are a heterogeneous group with distinct multimorbidity classes and different patterns of utilization. Those with high prevalence of substance use disorders had the highest rates of emergency and inpatient medical and overall mental health care utilization. Tailoring integrated care services to target specific clinical needs could improve outcomes for this population. Disclosure of Interest None Declared

Yan W, Wu J, Wang S et al.

Wenjuan Yan,1,&ast; Jiaojiao Wu,2,&ast; Shanmei Wang,1 Qi Zhang,1 Youhua Yuan,1 Nan Jing,1 Jiangfeng Zhang,1 Hangchan He,3 Yi Li1 1Department of Clinical Microbiology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, People’s Republic of China; 2Department of Clinical Microbiology, Xiayi People’s Hospital, Shangqiu, Henan, People’s Republic of China; 3Department of Clinical Laboratory, Baofeng Traditional Chinese Medicine Hospital, Pingdingshan, Henan, People’s Republic of China&ast;These authors contributed equally to this workCorrespondence: Yi Li, Department of Clinical Microbiology, Henan Provincial People’s Hospital, People’s Hospital of Zhengzhou University, People’s Hospital of Henan University, Zhengzhou, Henan, People’s Republic of China, Tel +8615939039006, Email liyilabmed@henu.edu.cnPurpose: To analyze the risk factors and clinical outcomes of patients isolated with polymyxin B-resistant (PR) Enterobacterales from various clinical specimens to prevent and control the spread of these strains.Methods: This retrospective case-control study included 72 PR Enterobacterales-positive cases and 144 polymyxin B-susceptible (PS) Enterobacterales controls from 2018 to 2022. Patients with PR Enterobacterales isolated in various clinical cultures were defined as cases. Patients with PS Enterobacterales cultures at similar anatomic sites during the same period were randomly selected as controls. Data were collected from clinical and laboratory test records. Bivariable logistic regression and Pearson’s chi-square tests were used to assess risk factors.Results: PR strains were predominantly Klebsiella pneumoniae (72.2%) and Salmonella enteritidis (8.3%). Of the patients, 66.04% were admitted to an intensive care unit (ICU). Risk factors for isolation with PR strains included chronic heart disease (P = 0.012; odds ratio [OR] 1.15; 95% confidence interval [CI] 1.03– 1.28), immunosuppressant use (P = 0.016; OR 1.04 [1.0– 1.07), drainage tube [head] (P = 0.006; OR 1.1 [1.0– 1.1]), and polymyxin B exposure (P = 0.007; OR 1.03 [1.0– 1.06]. With respect to outcomes, admission to an ICU (P = 0.003; OR 7.1 [1.9– 25.4]), hypertension (P = 0.035; OR 1.4 [1.02– 1.83]), and drainage tube [head] (P = 0.044; OR 1.1 [1.0– 1.15]) were associated with treatment failure. Additionally, treatment failure was more frequent in patients (45.83%) than in controls (14.58%).Conclusion: The major risk factors for isolation with PR strains were chronic heart disease, exposure to immunosuppressants, use of drainage tubes, and polymyxin B exposure. The isolation of PR strains in patients was a predictor of unfavorable outcomes. These findings provide a basis for monitoring the spread of PR Enterobacterales.Keywords: polymyxin B resistance, treatment failure, Klebsiella pneumoniae, Salmonella enteritidis

Dalia D. Hadi, Mohammed Dheyaa Marsool Marsool, Ali Dheyaa Marsool Marsool et al.

Abstract Background Idiopathic pulmonary fibrosis (IPF) is a progressive and debilitating lung disease characterized by irreversible scarring of the lungs. The cause of IPF is unknown, but it is thought to involve a combination of genetic and environmental factors. There is no cure for IPF, and treatment is focused on slowing disease progression and relieving symptoms. Aims We aimed in this review to investigate and provide the latest insights into IPF management modalities, including the potential of Saracatinibas a substitute for current IPF drugs. We also investigated the therapeutic potential of Sotatercept in addressing pulmonary hypertension associated with IPF. Materials and Methods We conducted a comprehensive literature review of relevant studies on IPF management. We searched electronic databases, including PubMed, Scopus, Embase, and Web of science. Results The two Food and Drug Administration‐approved drugs for IPF, Pirfenidone, and Nintedanib, have been pivotal in slowing disease progression, yet experimental evidence suggests that Saracatinib surpasses their efficacy. Preclinical trials investigating the potential of Saracatinib, a tyrosine kinase inhibitor, have shown to be more effective than current IPF drugs in slowing disease progression in preclinical studies. Also, Sotatercept,a fusion protein, has been shown to reduce pulmonary vascular resistance and improve exercise tolerance in patients with PH associated with IPF in clinical trials. Conclusions The advancements discussed in this review hold the promise of improving the quality of life for IPF patients and enhancing our understanding of this condition. There remains a need for further research to confirm the efficacy and safety of new IPF treatments and to develop more effective strategies for managing exacerbations.

SJ Byrne, D Chang, GG Adams et al.

Aim Periodontitis is a site-specific, chronic disease treated by non-surgical debridement of subgingival plaque. We aimed to determine the microbiome of sites that did not respond to this treatment (NR) compared with paired good responding (GR) sites before and after treatment.Materials and methods In a longitudinal cohort study, clinical parameters of disease and biological samples were taken prior to and 3 months after treatment. Twelve NR sites from six participants were paired with GR sites within the same participant. Subgingival plaque samples were subjected to bacterial community analysis using 16S rRNA gene sequencing.Results There were no significant differences in clinical parameters and microbial communities at baseline between GR and NR sites. Bacterial communities in deep pockets were dominated by a small number of species, notably Porphyromonas gingivalis and Treponema denticola. In NR sites three months after treatment there was no significant change in bacterial composition whilst there was a collapse in the abundance of pathobionts in GR sites.Conclusion NR sites were not identifiable prior to treatment by clinical or microbiological parameters. Treatment failed to disrupt pathogenic bacterial community in NR sites. Targeted suppression of particular species should be considered to initiate community collapse and aid disease resolution.

Noriaki Sunaga, Yasuhiko Koga, Yoshimasa Hachisu et al.

Sarcoidosis is a systemic granulomatous disease of unknown etiology. The diagnosis of sarcoidosis is based on clinicopathologic findings accompanied by the formation of granulomas in multiple organs, including the lung. Although angiotensin-converting enzyme (ACE) and soluble interleukin 2 receptor (sIL-2R) are traditionally used for the diagnosis of sarcoidosis, specific diagnostic markers remain to be determined. In the current study, we found that serum neuron-specific enolase (NSE) levels were elevated in patients with sarcoidosis. Serum NSE levels were positively correlated with serum ACE and sIL-2R levels. The sensitivity of NSE alone was modest, but its combination with sIL-2R and ACE had the highest sensitivity compared to those of each single marker. When comparing serum NSE and pro-gastrin-releasing peptide (ProGRP) levels in SCLC patients with those in patients with sarcoidosis and nonsarcoidotic benign diseases, serum NSE could be used to distinguish SCLC from sarcoidosis and nonsarcoidosis by setting at a cutoff value of 17.0 ng/ml with a sensitivity of 73.5% and a specificity of 90.2%, which were comparable to those of ProGRP. Serum NSE levels were associated with organ involvement and were higher in sarcoidosis patients who had been treated with oral corticosteroid (OCS) than in those who had never received OCS therapies; there was a positive association between elevated serum NSE levels and OCS use. Increased concentrations of serum NSE in patients at the nonremission phase decreased after spontaneous remission, whereas serum NSE levels fluctuated in accordance with serum ACE or sIL-2R levels during the follow-up period in patients with sarcoidosis. These findings suggest that NSE could be a marker for the diagnosis and monitoring of the clinical outcome of patients with sarcoidosis.

Haiyan Jin, Jie Zhang, Qiongyue Hu et al.

Purpose: Delirium is common in geriatric with Parkinson's disease (PD). Treatments for delirium have generally been neuroleptics; however, antipsychotics have potential effect to block striatal dopamine D2 receptors and worsen symptom of parkinsonism. We explored whether naloxone can alleviate delirium in PD and other forms of parkinsonism.Patients and Methods: Patients with parkinsonism who met the delirium criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) received naloxone infusions once or twice daily. Treatment effects were evaluated by the delirium rating scale–revised 98 (DRS-R98), including non-cognitive and cognitive subscales; the Richmond agitation–sedation scale (RASS); and the mini mental status examination (MMSE).Results: Two patients with primary parkinsonism, one with vascular PD were observed. The daily dose of naloxone was 2.08 ± 0.64 mg (range: 1–4 mg). Medication time last from 1 h to 7 days without side effects observed. Following with naloxone infusions, DRS-R98 scores decreased within 12 h and MMSE scores increased. The psychotic symptoms, disorientation, and attention deficits were alleviated significantly, while RASS scores decreased with naloxone treatment.Conclusion: Naloxone alleviated psychotic symptoms, improved cognitive dysfunction, and irritability in patients with delirium in the context of PD. The preliminary findings point out that the opioid system may be involved in the pathophysiology of delirium, which may be one of potential treat targets for delirium of PD.

Noritaka Fukunaga, Sho Sanami, Hiroya Kitasaka et al.

Abstract Purpose To establish an automated pronuclei determination system by analysis using deep learning technology which is able to effectively learn with limited amount of supervised data. Methods An algorithm was developed by explicitly incorporating human observation where the outline around pronuclei is being observed in determining the number of pronuclei. Supervised data were selected from the time‐lapse images of 300 pronuclear stage embryos per class (total 900 embryos) clearly classified by embryologists as 0PN, 1PN, and 2PN. One‐hundred embryos per class (a total of 300 embryos) were used for verification data. The verification data were evaluated for the performance of detection in the number of pronuclei by regarding the results consistent with the judgment of the embryologists as correct answers. Results The sensitivity rates of 0PN, 1PN, and 2PN were 99%, 82%, and 99%, respectively, and the overlapping 2PN being difficult to determine by microscopic observation alone could also be appropriately assessed. Conclusions This study enabled the establishment of the automated pronuclei determination system with the precision almost equivalent to highly skilled embryologists.

L. Carlson, Anders Hamsten, A. Asplund

Sébastien Paquette, Hui C. Li, Sherryse L. Corrow et al.

Studies have shown subtle gray and white matter abnormalities in subjects with several developmental disorders including prosopagnosia, tone-deafness, and dyslexia. Correlational evidence suggests that tone-deafness and dyslexia tend to co-occur, suggesting a link between these two developmental disorders. However, it is not known whether tone-deafness can also be associated with other developmental disorders such as impaired face recognition or prosopagnosia. We addressed this question by assessing face perception abilities in a group of tone-deaf individuals and matched non-tone-deaf subjects. The Cambridge (CFMT) and the Warrington (WRMT) face memory tests were used to assess face processing in the combined group of 12, out of which six tested in the tone-deaf range. Only tone-deaf participants (two out of six) scored in the impaired range on the CFMT, one of whom was also impaired on the WRMT face memory test. Furthermore, the melodic composite score of all participants on the Montreal Battery of Evaluation of Amusia significantly correlated with their face recognition score on the CFMT. Our results suggest that in some cases tone-deafness might co-occur with face recognition impairments. It is implausible that both deficits are linked to a single cognitive dysfunction that spans different perceptual systems in different modalities. They are likely associated with a common pathogenetic mechanism of early development that leads to anomalies affecting the function of different brain systems or the connection between regions.

M. Linzer, A. Bitton, S. Tu et al.

P. Teirstein

Benjamin B. Clissold, Benjamin B. Clissold, Benjamin B. Clissold et al.

BackgroundEvidence of a decline in the incidence of stroke has emerged from population-based studies. These have included retrospective and prospective cohorts. However, in Australia and other countries, government bodies and stroke foundations predict a rise in the prevalence of stroke that is anticipated to increase the burden of stroke across the entire domain of care. This increase in prevalence must be viewed as different from the decline in incidence being observed, a measure of new stroke cases. In Victoria, all public emergency department visits and public and private hospital admissions are reported to the Department of Health and Human Services and include demographic, diagnostic, and procedural/treatment information.MethodsWe obtained data from financial years 1997/1998 to 2007/2008 inclusive, for all cases with a primary stroke diagnosis (ICD-10-AM categories) with associated data fields. Incident cases were established by using a 5-year clearance period.ResultsFrom 2003/2004 to 2007/2008 inclusive, there were 53,425 patients with a primary stroke or TIA diagnosis. The crude incident stroke rate for first ever stroke was 211 per 100,000 per year (95% CI 205–217) [females—205 per 100,000 per year (95% CI 196–214) and males—217 per 100,000 per year (95% CI 210–224)]. The overall stroke rates were seen to significantly decline over the period [males (per 100,000 per year) 227 in 2003/2004 to 202 in 2007/2008 (p = 0.0157) and females (per 100,000 per year) 214 in 2003/2004 to 188 in 2007/2008 (p = 0.0482)]. Ischemic stroke rates also appeared to decline; however, this change was not significant.ConclusionThese results demonstrate a significant decline in stroke incidence during the study period and may suggest evidence for effectiveness of primary and secondary prevention strategies in cerebrovascular risk factor management.

Mustafa Dohadwala, MD, Fayak Kamili, MD, NA Mark Estes, 3rd, MD, FHRS et al.

Stephen Devries, J. Dalen, D. Eisenberg et al.