Hasil untuk "Internal medicine"

Pankaj Garg, Mostafa Ali, Mohammad Alomari et al.

Abstract Cardiac benign metastatic leiomyoma (BML) is a rare cardiac tumor that is usually asymptomatic, frequently misdiagnosed and may result in serious complications, including embolization, heart failure and death. This review highlights the importance of considering cardiac BML in the differential diagnosis of cardiac masses, especially in women with a history of uterine leiomyomas. This review summarizes the current knowledge about cardiac BML, including its demographics, clinical presentation, etio-pathogenesis, diagnosis, and management. The authors discuss the challenges associated with diagnosing cardiac BML and emphasize the importance of a thorough history, physical examination, and imaging studies. They also review the different treatment options for cardiac BML, including surgical resection and role of medical and surgical castration. Early diagnosis and management of cardiac BML is crucial to prevent complications. This review provides valuable insights for clinicians who may encounter this rare condition. By raising awareness of cardiac BML and its management strategies, this review can improve patient care and outcomes.

Huipeng Meng PhD, Yanlong Zhang PhD, Jinghao Duan PhD et al.

Objective To systematically investigate the impact of adjusting the relative weight of the built-in Stereotactic Radiosurgery Normal Tissue Objective (SRS-NTO) on dosimetric quality, plan complexity, and delivery efficiency in HyperArc™ stereotactic radiosurgery (SRS) for brain oligometastases. Methods In this retrospective planning study, a cohort of 20 patients with 1-3 brain oligometastases was analyzed. For each case, six distinct HyperArc plans were designed and optimized using the Varian Eclipse™ Treatment Planning System. To precisely isolate its impact, the relative weight of the SRS-NTO to the PTV objective was systematically varied across six levels—50%, 75%, 100% (default), 125%, 150%, and 200%—while all other planning parameters were held constant. A comprehensive comparative evaluation was then performed to assess the plans across four key domains: (i) dosimetric quality, evaluated by metrics including the Paddick Conformity Index (CI), Gradient Index (GI), and dose to Organs at Risk (OARs); (ii) plan complexity, characterized by various modulation and aperture-based indices; (iii) delivery efficiency, primarily quantified by the total Monitor Units (MUs); and (iv) physical deliverability, verified via Gamma analysis. Results Increasing NTO weight did not significantly alter dosimetric quality; key metrics for CI, GI, and OAR sparing remained statistically equivalent (p > .05). Conversely, higher NTO weights prompted a significant reduction in total MUs (p < .001) that reached an optimum at the 150% setting, and enhanced plan deliverability, evidenced by significantly higher Gamma passing rates under stricter verification criteria. An inflection point was observed beyond the 150% setting, with higher weights leading to degraded plan complexity and efficiency. Strategies within the 125% to 150% range demonstrated a superior balance, achieving optimal dosimetric trends while maximizing gains in efficiency and precision. Conclusion In HyperArc SRS for brain oligometastases, moderately increasing the SRS-NTO weight from the default 100% into the 125% to 150% range is a superior clinical strategy. This adjustment significantly enhances treatment efficiency and delivery precision by reducing plan complexity, without compromising dosimetric quality, thereby achieving a superior overall performance.

Kira DiClemente-Bosco, Caroline Kuo, Goodman Sibeko et al.

Background In South Africa, rates of HIV and alcohol use are among the highest globally, with a detrimental synergistic relationship. Screening, Brief Intervention, and Referral to Treatment (SBIRT) is an evidence-based, cost-effective approach to identifying people at risk of alcohol-related problems to deliver early intervention. We developed and deployed a cascading train-the-trainer model to promote SBIRT implementation in a large nongovernmental organization offering HIV services across South Africa. Method Between 2021 and 2022, we completed preparatory activities including designing scalable training resources prior to rolling out the train-the-trainer model across two South African provinces. We conducted a comprehensive assessment of outcomes at the trainer- (knowledge, fidelity), provider- (attitudes, confidence, perceived implementation potential, adoption), and client-encounter (reach) levels over approximately one year. Results We trained 12 novice trainers who then trained 206 providers to implement SBIRT. Trainer SBIRT knowledge increased pre- to posttraining, and fidelity of training delivery was high (99.0% of elements covered across sessions). Provider attitudes, confidence, and perceived implementation potential increased over time, and 64% of providers adopted SBIRT. Reach of the model varied by component, with 41,793 clients screened by trained providers. Of those screening positive for risky alcohol use, 86% received brief intervention (BI) and 53% received referral to treatment (RT). Additionally, 15,353 clients who did not screen as having risky alcohol use received BI and 1,122 received RT. Conclusion Results indicated that the cascading training model was delivered with high fidelity, associated with improvements in all provider outcomes, and reached high numbers of clients for the screening component of the model. Rates of BI and RT delivery were moderate to high, though data suggested over-application of these elements with some clients, highlighting the tension between reach and fidelity. Lessons learned will inform future scale-out of this model in HIV service settings in low- and middle-income countries.

Min Ji Jeon, Eun Sang Yu, Dae Sik Kim et al.

Abstract High-dose melphalan at 200 mg/m2 (MEL-200) is the standard conditioning regimen before autologous stem cell transplantation (ASCT) in patients with multiple myeloma (MM). Busulfan (BU) and cyclophosphamide (CY) can be used as alternatives when MEL is unavailable. However, most studies on BU/CY conditioning regimens were conducted before proteasome inhibitors (PIs) and immunomodulatory drugs (IMIDs) were available. This non-interventional comparative cohort study compared progression-free survival (PFS) between the MEL-200 and BU/CY in patients with MM treated with PIs and/or IMIDs. A total of 137 patients were analyzed (MEL-200,113 patients; BU/CY, 24 patients). The BU/CY group had a higher rate of PI and/or IMID use and very good partial response (VGPR) or complete remission (CR) at ASCT and post-ASCT maintenance. Median PFS was 29.7 and 46.8 months in the MEL-200 and BU/CY groups, respectively. In the multivariate analysis, PFS was significantly better in the BU/CY group. International Staging System Stage I and VGPR or CR at ASCT were significantly associated with longer PFS. No treatment-related mortality was observed in either group by day 100. The BU/CY conditioning regimen may be a viable alternative to the MEL-200 regimen in patients with MM who undergo ASCT after treatment with PIs and/or IMIDs.

Rezvan Elahifar, Mohammad Mahdi Parvizi, Hossein Fatemian et al.

Abstract Background Evidence-based medicine is defined as searching for medical information, reviewing and comparing it to each patient’s situation, and then judging the optimal decision. We aimed to measure the psychometric properties of the Evidence-Based Performance Profile (EBP2) Questionnaire among the students of health-related fields at Shiraz University of Medical Sciences. Methods This cross-sectional study was conducted in 2021. The EBP2 questionnaire, which includes 74 five-Likert-scale items, was translated into the Persian language using the forward-backward translation method. A panel of five experts approved the face, content, and structural validity of the questionnaire. The Cronbach’s alpha and McDonald’s Omega coefficients were utilized to assess the questionnaire’s internal consistency. Furthermore, both confirmatory and exploratory factor analyses were used to assess the questionnaire’s construct validity. SPSS software version 25 and LISREL software version 8.8 were used for statistical analysis. Results Overall, 339 students participated in this study. The cultural adaptability, linguistic equivalence, and content validity of the Persian version of the EBP2 questionnaire were approved by a five-member team of medical experts. In addition, the results showed excellent internal consistency of the Persian version of the EBP2 questionnaire (Cronbach’s alpha = 0.962, McDonald’s Omega (ML) = 0.963). Moreover, all domains had acceptable reliability (> 0.7), except the Practice domain which had a marginally acceptable Cronbach’s alpha coefficient equal to 0.686. Exploratory factor analysis discovered six domains for the questionnaire. Moreover, the confirmatory factor analysis demonstrated that all indices except the comparative fit index (CFI) and adjusted goodness of fit (AGFI) confirmed the validity of the EBP2 questionnaire. Conclusion The study’s findings indicate that the Persian translated of the EBP2 questionnaire exhibited satisfactory validity and reliability for assessing students’ evidence-based performance in health-related fields.

Alexander Moog

Internal migration is an essential aspect to study labor mobility. I exploit the German statutory minimum wage introduction in 2015 to estimate its push and pull effects on internal migration using a 2% sample of administrative data. In a conditional fixed effects Poisson difference-in-differences framework with a continuous treatment, I find that the minimum wage introduction leads to an increase in the out-migration of low-skilled workers with migrant background by 25% with an increasing tendency over time from districts where a high share of workers are subject to the minimum wage (high-bite districts). In contrast the migration decision of native-born low-skilled workers is not affected by the policy. However, both native-born low-skilled workers and those with a migrant background do relocate across establishments, leaving high-bite districts as their workplace. In addition, I find an increase for unemployed individuals with a migrant background in out-migrating from high-bite districts. These results emphasize the importance of considering the effects on geographical labor mobility when implementing and analyzing policies that affect the determinants of internal migration.

Wilmer Stalin Sanango Reinoso, Jorge Oswaldo Herrera Ordoñez , Soraya Puertas Azanza et al.

Introducción: El control de la tensión arterial (TA), es un objetivo fundamental, en los pacientes con enfermedad renal crónica estadio 5D, ya que la hipertensión y la hipotensión causan efectos adversos en la calidad de vida del paciente y predisponen al aumento del riesgo cardiovascular. El objetivo del presente estudio fue realizar un análisis económico de la prescripción de antihipertensivos en un grupo de pacientes en terapia sustitutuva de la función renal. Métodos: Se trata de un estudio transversal, realizado en el servicio de hemodiálisis del hospital “José Carrasco Arteaga”. Las variables fueron: tipo de diálisis, sexo, uso de antihipertensivos, tipo de antihipertensivos y costo. La muestra fue no probabilística. Resultados: Se analizan 174 pacientes, 73 (41.95%) en programa de hemodiálisis (HD), 80 (45.98%) en programa de diálisis peritoneal manual (DP) y 21 (12.07%) en diálisis peritoneal automatizada (DPA). Fueron 74% de hombres en HD, 39 casos (48.7%) en DP, 12 casos (57.14%) en DPA. El uso de antihipertensivos en HD fue del 84%, en DP fue del 86% y en DPA fue del 86%. El costo de antihipertensivos fue en  HD 12.5 ± 8.7 USD, en DP 15.7 ± 22.4 y en DPCA  16.4 ± 18.6 USD P>0.05. Conclusión: el uso de antipertensivos en este grupo de estudio fue en mas del 84% en las diferentes modalidades de diálisis, sin diferencia estadítica en el análisis de costo.

Hanan El-Mazahy, Jaidaa Mekky, Noha Elshaer

Abstract Background The COVID-19 pandemic has impacted medical professionals’ job satisfaction and was a call to adopt telemedicine. Finding out how far medical professionals are satisfied and ready to use telemedicine would be important to improve medical practice. Methods Data was collected from 959 medical professionals from both the governmental and private health sectors in Egypt in 2021 using a specifically designed online questionnaire, to evaluate job satisfaction, perception of telemedicine, and propose solutions to improve medical practice. Results The study revealed low to moderate job satisfaction at governmental (27.2%) and private (58.7%) sectors. Underpayment was the most reported challenge at both sectors (37.8% and 28.3%, respectively). Dissatisfaction with government salary was independently predicted by working at the Ministry of Health and Population (OR = 5.54, 95%CI = 2.39,12.8; p < 0.001). Wage increase (46.10%), medical training of professionals (18.1%), and management of non-human resources (14.4%) were the most proposed solutions to improve medical practice in Egypt. During the COVID-19 pandemic, 90.7% of medical professionals had practiced telemedicine with moderate level of perception of its benefits (56%). Conclusions During the COVID-19 pandemic, medical professionals reported low to moderate job satisfaction and a moderate level of perception of telemedicine. It is recommended to analyze the healthcare financing system and provide continuous training of medical professionals to improve medical practice in Egypt.

Roopali Sehrawat, Nalini Bansal, Ajitabh Srivastava et al.

Basidiobolus ranarum is known to cause subcutaneous mycoses; however, rare cases of hepatic and gastrointestinal involvement by basidiobolomycosis have been reported. Hepatic basidiobolomycosis may be confused with a carcinoma on imaging, and histological examination and fungal culture can help distinguish between these two. We report a rare case of basidiobolomycosis in a 16-year-old male with liver and gastrointestinal involvement.

A. Morano, O. Santillán

The present work studies the gravitational radiation of a non abelian vortex with a non compact internal moduli describing its excitations. This situation may be realised by semi-local supersymmetric vortices \cite{novedad1}-\cite{reviewshifman}, although supersymmetry is not necessary for this to happen. In the situation considered along this work, the internal space has infinite volume, and a largely energetic perturbation propagates along the object, even though the vortex line may not be moving. A specific configuration is presented, in which the internal space is the resolved conifold with its Ricci flat metric. The curious feature about it is that it corresponds to a static vortex, that is, the perturbation is only due to the internal modes. Even being static, the emission of gravitational radiation is in the present case of considerable order. This suggest that the presence of slowly moving objects that can emit a large amount of gravitational radiation is a hint of non abelianity.

Tiago Sepúlveda Santos, Rita Marçal, Oana Moldovan et al.

Type IV Ehlers-Danlos syndrome (vascular) is a rare connective tissue disease caused by COL3A1 gene mutation on type III collagen. Clinical presentation is related to vascular fragility and risk of rupture of the arterial wall. Definite diagnosis is given by genetic study and the approach to these patients requires a multidisciplinary team and effective blood pressure control. There is currently only one medication with potential benefit in prevention of cardiovascular events: celiprolol. This article describes the case of a 41-year-old female patient, diagnosed with vascular Ehlers-Danlos syndrome after multiple major cardiovascular events: aortic, coronary and carotid dissections and venous and arterial thrombosis. These required multiple surgical interventions and long-term admission in intensive care units leading to complete functional recovery. This case report seeks to stress the need for an early diagnosis to prevent the severe cardiovascular complications of this rare syndrome. Resumo: A síndrome de Ehlers-Danlos tipo IV (vascular) é uma doença rara do tecido conjuntivo, caracterizada por uma mutação no gene COL3A1 do colagénio tipo III. A apresentação clínica cursa com fragilidade vascular e risco de rutura da parede arterial em idades jovens. O diagnóstico definitivo é estabelecido pelo estudo genético e a abordagem destes doentes assenta numa equipa multidisciplinar e num eficaz controlo da pressão arterial, existindo atualmente um único fármaco com aparente benefício na prevenção de eventos vasculares, o celiprolol. Este artigo descreve o caso de uma doente, cujo diagnóstico de síndrome de Ehlers-Danlos vascular foi feito aos 41 anos, na sequência múltiplos eventos cardiovasculares major, a saber: dissecção aórtica, coronária, carotídea, tromboses arteriais e venosas, que implicaram múltiplas intervenções cirúrgicas e internamento prolongado em Unidade de Cuidados Intensivos, com total recuperação funcional. Pretende-se, com este caso, salientar a gravidade das manifestações cardiovasculares desta síndrome e a necessidade do diagnóstico precoce, com o objectivo de prevenção das mesmas.

Xiaoxue Xie, Caiping Chen, Wenting Chen et al.

B7 family members and their receptors play key roles in regulating T cell responses, and constitute very attractive targets for developing immunotherapeutic drugs. V-Set and Immunoglobulin domain containing 3 (VSIG3), a ligand for the novel B7 family immune checkpoint V-domain immunoglobulin suppressor of T cell activation (VISTA), can significantly inhibit T cell functions. Inhibitors targeting the VISTA/VSIG3 pathway are of great significance in tumor immunology. Here, we show the crystal structure of the extracellular domain (ECD) of the human VSIG3 protein at 2.64 angstrom resolution, and we produce recombinant human VSIG-3 ECD in both CHO cells and E. coli. Furthermore, we demonstrated the interaction of VISTA and VSIG3 by coimmunoprecipitation (Co-IP). Based on protein-protein docking for VISTA and VSIG3, we report a small molecule inhibitor of VSIG3 K284-3046 and evaluate its biological activities in vitro. This study was the first to reveal the crystal structure of VSIG3, and provides the structural basis for designing antibodies or compounds for the unique VSIG3/VISTA coinhibitory pathway in the treatment of cancers, autoimmune diseases and may be beneficial of designing vaccines.

Jason Z. S. Hu

In this note, we review a construction of category with families (CwF) in a presheaf category. When the base category of a presheaf category is a CwF, we internalize this CwF structure in the CwF of the presheaf category. This note assumes working knowledge on category theory.

Shigeru Fujisaki, Motoi Takashina, Ken-ichi Sakurai et al.

Abstract Background Hilar biliary stricture caused by isolated fungal infections in immunocompetent patients are considered to be extremely rare and difficult to the diagnose from the outset. Case presentation We report a unique case of granulomatous cholangitis based on isolated biliary fungal infection manifesting as obstructive jaundice and mimicking hilar cholangiocarcinoma in an immunocompetent woman. A 67-year-old Japanese woman was referred to our hospital for obstructive jaundice. She had been followed up for hypochondroplasia by the referring physician. Her total bilirubin level was 5.4 mg/dL. Viral hepatitis screening was found to be negative, and serum IgG4 was within normal limits; however, her CA19-9 level was high. Abdominal computed tomography revealed dilatation of the intrahepatic bile ducts. Abdominal echogram detected a solid mass in the hilar bile duct. Her magnetic resonance cholangiopancreatography has also revealed an abrupt stenosis of the primary biliary confluence with upstream dilatation of the intrahepatic bile ducts. Endoscopic nasobiliary drainage was then performed to improve the obstructive jaundice. Although biliary cytology did not reveal malignant findings, the bile duct in the hilum showed severe stenosis, and hilar cholangiocarcinoma could not be completely excluded. The patient had a developmental disorder based on chondrodystrophy. To avoid excessive surgical stress, such as hepatic lobectomy, we performed resection of the extrahepatic bile duct and Roux-en-Y hepaticojejunostomy reconstruction. Intraoperative frozen sections of the resection margins were determined to be negative for tumor. The resected specimen showed multiple strictures inside the common bile duct, numerous calculi in the lumen, and little free space. The final pathological diagnosis was granulomatous cholangitis due to fungal infection. The patient’s postoperative course was deemed uneventful. She was discharged from our hospital 23 days after surgery without antifungal treatment. Conclusions For a unique case of granulomatous cholangitis based on isolated biliary fungal infection mimicking hilar cholangiocarcinoma, we were able to avoid excessive invasion and performed appropriate surgical management.

Michel Gondran, Alexandre Gondran

We propose an interpretative framework for quantum mechanics corresponding to the specifications of Louis de Broglie's double-solution theory. The principle is to decompose the evolution of a quantum system into two wave functions: an external wave function corresponding to the evolution of its center of mass and an internal wave function corresponding to the evolution of its internal variables in the center-of-mass system. Mathematical decomposition is only possible in certain cases because there are many interactions linking these two parts. In addition, these two wave functions will have different meanings and interpretations. The external wave function "pilots" the center of mass of the quantum system: it corresponds to the Broglie pilot wave. When the Planck constant tends to zero, it results mathematically from the convergence of the square of the module and the phase of the external wave function to a density and a classical action verifying the Hamilton-Jacobi statistical equations. This interpretation explains all the measurement results, namely those yielded by interference, spin measurement (Stern and Gerlach) and non-locality (EPR-B) experiments. For the internal wave function, several interpretations are possible : the one of the pilot wave can be applied in cascade to the internal wave function. However, the interpretation proposed by Erwin Schr{ö}dinger at the Solvay Congress in 1927 and restricted to the internal wave function is also possible. For Schr{ö}dinger, the particles are extended and the square of the module of the (internal) wave function of an electron corresponds to the density of its charge in space. We present many arguments in favour of this interpretation, which like the pilot wave interpretation is realistic and deterministic. Finally, we will see that this double interpretation serves as a frame of reference by which to better understand the debates on the interpretation of quantum mechanics and to review the relationships between gravity and quantum mechanics.

Rui Wang, Yuta Hozumi, Changchuan Yin et al.

Tremendous effort has been given to the development of diagnostic tests, preventive vaccines, and therapeutic medicines for coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Much of this development has been based on the reference genome collected on January 5, 2020. Based on the genotyping of 6156 genome samples collected up to April 24, 2020, we report that SARS-CoV-2 has had 4459 alarmingly mutations which can be clustered into five subtypes. We introduce mutation ratio and mutation $h$-index to characterize the protein conservativeness and unveil that SARS-CoV-2 envelope protein, main protease, and endoribonuclease protein are relatively conservative, while SARS-CoV-2 nucleocapsid protein, spike protein, and papain-like protease are relatively non-conservative. In particular, the nucleocapsid protein has more than half its genes changed in the past few months, signaling devastating impacts on the ongoing development of COVID-19 diagnosis, vaccines, and drugs.

Fan Liaw, Edward Gane, Nancy Leung et al.

Haoyin Zhou, Eva Gombos, Mehra Golshan et al.

Intraoperative observation of tissue internal structure is often difficult. Hence, real-time soft tissue deformation is essential for the localization of tumor and other internal structures. We propose a method to simulate the internal structural deformations in a soft tissue with surface profile variations. The deformation simulation utilizes virtual physical particles that receive interaction forces from the surface and other particles and adjust their positions accordingly. The proposed method involves two stages. In the initialization stage, the three-dimensional internal structure of the surface mesh is uniformly sampled using the particle expansion and attracting-repelling force models whilst simultaneously building the internal particle connections. In the simulation stage, under surface profile variations, we simulate the internal structural deformation based on a deformation force model that uses the internal particle connections. The main advantage of this method is that it greatly reduces the computational burden as it only involves simplified calculations and also does not require generating three-dimensional meshes. Preliminary experimental results show that the proposed method can handle up to 10,000 particles in 0.3s.

S. Yu. Martsevich, Yu. V. Lukina, N. P. Kutishenko et al.

Aim. To assess quality of life (QoL) and its dynamics during nicorandil treatment in patients with stable ischemic heart disease, to study the relationship of treatment adherence and QoL indicators when treated with nicorandil.Material and methods. Observational program NIKEA included 590 patients with angina pectoris. Seattle Angina Questionnaire (SAQ) was used to assess QoL. Patients completed SAQ at the visit of inclusion (V0) and at the visit after 3 months of observation (V3). Potential and actual adherence to therapy was assessed by medical interviews at visits V0, V1 (1 month of observation) and V3. During the visit V0 417 people (from 590 ones enrolled into the study) completed SAQ (71% response); after 3 months (V3) SAQ was filled in by 454 of 552 people who came to this visit (82% response). According to the results of medical interviews, potential adherence (visit V0) was determined in all 590 patients, actual adherence to nicorandil (visits V1 and V3) was assessed in 552 patients who came to these visits. In accordance with the degree of adherence, all patients were divided into 3 groups: (1) adherent to treatment (taking nicorandil for the first three months), (2) non-adherent (who refused to take nicorandil), and (3) partially non-adherent (who started nicorandil, but for various reasons stopped taking the drug).Results. In all patients, regardless of their adherence to the recommended drug, there was an increase in QoL according to all five scales of the SAQ after 3 months of follow-up. Statistically significant positive dynamics of all SAQ indicators was found only in adherent patients (p&lt;0.0001 for all aspects). Patients, who showed good adherence to nicorandil at V1, had more severe angina at the beginning of treatment (according to “Angina Stability” and “Angina Frequency” indicators). These patients also had lower QoL “Disease Perception” score and more confidence in the doctor (“Treatment Satisfaction” score) than non-adherent patients (p&lt;0.05). In non-adherent patients a mild degree of angina was determined 2 times more often according to “Angina Frequency” indicator (p=0.03).Conclusion. The results of the study confirm the interrelation and mutual influence of the QoL indicators and treatment adherence to nicorandil. Effective treatment with nicorandil in patients with lower health-related QoL indicators could increase treatment adherence. On the other hand, the mild degree of angina, the low level of confidence in the treating doctor, the side effects of the new drug reduce medication adherence of patients, which, as a result, negatively affects the QoL of these patients

Michelangelo Bin, Lorenzo Marconi

The paper deals with the problem of output regulation in a "non-equilibrium" context for a special class of multivariable nonlinear systems stabilizable by high-gain feedback. A post-processing internal model design suitable for the multivariable nature of the system, which might have more inputs than regulation errors, is proposed. Uncertainties in the system and exosystem are dealt with by assuming that the ideal steady state input belongs to a certain "class of signals" by which an appropriate model set for the internal model can be derived. The adaptation mechanism for the internal model is then cast as an identification problem and a least square solution is specifically developed. In line with recent developments in the field, the vision that emerges from the paper is that approximate, possibly asymptotic, regulation is the appropriate way of approaching the problem in a multivariable and uncertain context. New insights about the use of identification tools in the design of adaptive internal models are also presented.