Hasil untuk "Internal medicine"

Bjørn Hofmann

Antonina Drzewiecka, Artur Drzewiecki, Oliwia Maciaszek et al.

Introduction and Purpose: Vascular access devices (VADs) are essential for modern inpatient care, yet optimal device selection remains complex due to heterogeneous data on dwell time, indications, and complications. Peripheral options such as midline catheters (MCs) and long peripheral catheters (LPCs) are increasingly proposed as alternatives to peripherally inserted central catheters (PICCs) and central venous catheters (CVCs), particularly for intermediate-duration therapy and in patients with difficult intravenous access (DIVA). The aim of this narrative review is to synthesize current evidence on peripheral and central vascular access, focusing on peripheral intravenous catheters (PIVCs), MCs, LPCs, PICCs, and CVCs, with respect to dwell time, therapeutic indications, and complication rates, including catheter-related bloodstream infections (CRBSI) and thrombosis. State of Knowledge: PIVCs, although most commonly used, have short dwell times and high failure rates, often complicated by phlebitis, infiltration, and occlusion. Midline catheters provide longer dwell times and reduce repeated cannulation but are associated with minor mechanical complications such as superficial thrombophlebitis and occlusion. PICCs and CVCs enable prolonged delivery of vesicant and hyperosmolar therapies but carry higher risks of bloodstream infection and venous thromboembolism. Comparative studies suggest midlines may reduce CRBSI and CLABSI-reportable events relative to PICCs, at the cost of more frequent minor complications. Conclusion: No single VAD is universally optimal. Device choice should integrate therapy duration, infusate characteristics, vascular anatomy, and the balance of infectious, thrombotic, and mechanical risks. MCs and LPCs appear promising for intermediate-duration, peripherally compatible therapies; however, high-quality randomized studies are needed to refine vascular access algorithms and confirm safety signals.

Diego-Martin Lombardo, Christian F Beckmann

The mechanism of neurocognitive failure in Alzheimer's disease remains obscure. While the mainstream hypothesis in the field posits that brain tau pathology is the only process that drives cognitive decline in AD, other complementary mechanisms link vascular brain lesions with beta-amyloid pathology as an important factor leading to neurodegeneration. Recently, it was also proposed that the brain's network's functional imbalance could primarily drive cognitive decline in neurodegenerative diseases. Here, we investigated whether the anticorrelation between the default mode (DMN) and dorsal attention networks (DAN) reveals different pathology burdens in the AD spectrum. We grouped individuals based on their PET amyloid and cognitive status. Using cross-validated regression models, we investigated whether cognitive impairment can be predicted based on rs-fMRI DMN-DAN anticorrelation. We found that the DMN-DAN anticorrelation differentiates between pathology burdens in AD, as quantified by PET amyloid imaging and cognitive performance. We found that an attenuated DMN-DAN anticorrelation predicted cognitive decline, which was controlled by sex, age, education, and brain tau pathology. Education level, measuring cognitive reserve, did not modulate the association between DMN-DAN anticorrelation and cognitive decline. We demonstrate that the attenuation of the anticorrelation between DMN and DAN is associated with a mechanism of cognitive dysfunction independent of tau pathology and proxies of resilience to cognitive decline or cognitive reserve. Our results also suggest the existence of an alternative mechanism of neurocognitive breakdown independent of advanced medial temporal cortex pathology and protective factors of cognitive decline, such as cognitive reserve.

Kholoud Alqasem, Sakhr Alshwayyat, Salsabeel Aljawabrah et al.

Abstract Background Small cell carcinoma (SCC) is a neuroendocrine tumor that usually originates in the lungs but can also arise from extrapulmonary sites. Extrapulmonary small cell carcinomas (EPSCCs) are aggressive and rare, with limited data guiding their management. This case report contributes to the literature by presenting the diagnosis and treatment of primary peritoneal SCC. Case presentation This case describes a 69-year-old man who presented with abdominal distension and pain, raising concerns for metastasis. He had a history of prostate cancer treated with radical prostatectomy and pelvic lymph node dissection. Biopsy and imaging revealed metastatic SCC involving the peritoneum and omentum. A diagnosis of primary peritoneal SCC or SCC of unknown primary origin was made due to the absence of a detectable primary tumor in typical sites. The patient underwent three separate courses of carboplatin/etoposide chemotherapy (6 cycles each), with each course resulting in significant disease regression and symptom relief. Recurrence was managed effectively with repeated chemotherapy cycles, but long-term follow-up showed the need for continued treatment to maintain disease control and quality of life. Conclusion This case underscores the importance of a multidisciplinary approach and patient-centered care in managing rare cancers like primary peritoneal SCC. Further research is essential to clarify its molecular characteristics and improve therapeutic options. Graphical abstract

Soichiro Migita, Kyotaro Uehata, Tomohiro I

A Straight-Line Program (SLP) for a string $T$ is a context-free grammar in Chomsky normal form that derives $T$ only, which can be seen as a compressed form of $T$. Kida et al.\ introduced collage systems [Theor. Comput. Sci., 2003] to generalize SLPs by adding repetition rules and truncation rules. The smallest size $c(T)$ of collage systems for $T$ has gained attention to see how these generalized rules improve the compression ability of SLPs. Navarro et al. [IEEE Trans. Inf. Theory, 2021] showed that $c(T) \in O(z(T))$ and there is a string family with $c(T) \in Ω(b(T) \log |T|)$, where $z(T)$ is the number of phrases in the Lempel-Ziv parsing of $T$ and $b(T)$ is the smallest size of bidirectional schemes for $T$. They also introduced a subclass of collage systems, called internal collage systems, and proved that its smallest size $\hat{c}(T)$ for $T$ is at least $b(T)$. While $c(T) \le \hat{c}(T)$ is obvious, it is unknown how large $\hat{c}(T)$ is compared to $c(T)$. In this paper, we prove that $\hat{c}(T) = Θ(c(T))$ by showing that any collage system of size $m$ can be transformed into an internal collage system of size $O(m)$ in $O(m^2)$ time. Thanks to this result, we can focus on internal collage systems to study the asymptotic behavior of $c(T)$, which helps to suppress excess use of truncation rules. As a direct application, we get $b(T) = O(c(T))$, which answers an open question posed in [Navarro et al., IEEE Trans. Inf. Theory, 2021]. We also give a MAX-SAT formulation to compute $\hat{c}(T)$ for a given $T$.

Reilly Haskins, Benjamin Adams

Knowledge distillation compresses a larger neural model (teacher) into smaller, faster student models by training them to match teacher outputs. However, the internal computational transformations that occur during this process remain poorly understood. We apply techniques from mechanistic interpretability to analyze how internal circuits, representations, and activation patterns differ between teachers and students. Focusing on GPT2 and its distilled counterpart DistilGPT2, and generalizing our findings to both bidirectional architectures and larger model pairs, we find that student models can reorganize, compress, and discard teacher components, often resulting in a stronger reliance on fewer individual components. To quantify functional alignment beyond output similarity, we introduce an alignment metric based on influence-weighted component similarity, validated across multiple tasks. Our findings reveal that while knowledge distillation preserves broad functional behaviors, it also causes significant shifts in internal computation, with important implications for the robustness and generalization capacity of distilled models.

V. Druskin, S. Moskow, M. Zaslavsky

We consider the computation of internal solutions for a time domain plasma wave equation with unknown coefficients from the data obtained by sampling its transfer function at the boundary. The computation is performed by transforming known background snapshots using the Cholesky decomposition of the data-driven Gramian. We show that this approximation is asymptotically close to the projection of the true internal solution onto the subspace of background snapshots. This allows us to derive a generally applicable bound for the error in the approximation of internal fields from boundary data for a time domain plasma wave equation with an unknown potential $q$. For general $q\in L^\infty$, we prove convergence of these data generated internal fields in one dimension for two examples. The first is for piecewise constant initial data and sampling $τ$ equal to the pulse width. The second is piecewise linear initial data and sampling at half the pulse width. We show that in both cases the data generated solutions converge in $L^2$ at order $\sqrtτ$. We present numerical experiments validating the result and the sharpness of this convergence rate.

Asif Naveed Ahmed, Lettie E. Rawlins, Niamat Khan et al.

Abstract Background Hereditary motor and sensory neuropathy (HMSN) refers to a group of inherited progressive peripheral neuropathies characterized by reduced nerve conduction velocity with chronic segmental demyelination and/or axonal degeneration. HMSN is highly clinically and genetically heterogeneous with multiple inheritance patterns and phenotypic overlap with other inherited neuropathies and neurodegenerative diseases. Due to this high complexity and genetic heterogeneity, this study aimed to elucidate the genetic causes of HMSN in Pakistani families using Whole Exome Sequencing (WES) for variant identification and Sanger sequencing for validation and segregation analysis, facilitating accurate clinical diagnosis. Methods Families from Khyber Pakhtunkhwa with at least two members showing HMSN symptoms, who had not previously undergone genetic analysis, were included. Referrals for genetic investigations were based on clinical features suggestive of HMSN by local neurologists. WES was performed on affected individuals from each family, with Sanger sequencing used to validate and analyze the segregation of identified variants among family members. Clinical data including age of onset were assessed for variability among affected individuals, and the success rate of genetic diagnosis was compared with existing literature using proportional differences and Cohen’s h. Results WES identified homozygous pathogenic variants in GDAP1 (c.310 + 4 A > G, p.?), SETX (c.5948_5949del, p.(Asn1984Profs*30), IGHMBP2 (c.1591 C > A, p.(Pro531Thr) and NARS1 (c.1633 C > T, p.(Arg545Cys) as causative for HMSN in five out of nine families, consistent with an autosomal recessive inheritance pattern. Additionally, in families with HMSN, a SETX variant was found to cause cerebellar ataxia, while a NARS1 variant was linked to intellectual disability. Based on American College of Medical Genetics and Genomics criteria, the GDAP1 variant is classified as a variant of uncertain significance, while variants in SETX and IGHMBP2 are classified as pathogenic, and the NARS1 variant is classified as likely pathogenic. The age of onset ranged from 1 to 15 years (Mean = 5.13, SD = 3.61), and a genetic diagnosis was achieved in 55.56% of families with HMSN, with small effect sizes compared to previous studies. Conclusions This study expands the molecular genetic spectrum of HMSN and HMSN plus type neuropathies in Pakistan and facilitates accurate diagnosis, genetic counseling, and clinical management for affected families.

Wenjie Wang, Jiaxin Yang, Kexin Wang et al.

Abstract Objective The purpose of this study was to investigate the combined effect of self-reported sleep durations and physical activity (PA) on all cause and cardiovascular diseases mortality. Methods Twenty-nine thousand fifty-eight participants (48.5% male, median age 49 years) from the National Health and Nutrition Examination Survey cycles 2007 to 2016 were included. We classified sleep duration into five categories (< 5.5 h/d,5.5–6.5 h/d,6.5–7.5 h/d,7.5–8.5 h/d, ≥ 8.5 h/d) and classified PA levels into three groups (high, medium and low). PA information and self-reported sleep duration were obtained by questionnaire. We derived 15 PA–sleep duration combinations. The primary endpoint was all-cause mortality, and the major secondary endpoint was cardiovascular diseases (CVD) mortality as of December 2022. Results Median follow-up was 91 months. Compared with standard sleep duration (6.5–7.5 h/d), both shorter (< 5.5 h/d) and longer (≥ 8.5 h/d) sleep durations increased risks of all-cause mortality and CVD mortality in low PA. The deleterious associations of sleep duration with all outcomes was amplified by lower PA. There was no significant reduction in CVD mortality risk associated with increased physical activity during short sleep duration (< 6.5 h/d). During standard sleep, low PA significantly increased CVD mortality risk. At medium physical activity, both short and long sleep increased cardiovascular mortality. It was also found that sleep duration (≥ 8.5 h/d) was associated with a increase in all-cause and cardiovascular mortality at both low and high PA levels. Conclusions This study suggested that low PA significantly increased the association of self-reported long and short sleep durations with all-cause and CVD mortality. All cause mortality appears to benefit from medium physical activity, while medium PA did not. Physical activity did not significantly reduce the risk of CVD mortality.

Dominik Trnka

We present a Markl-style definition of operads colored by a small category. In the presence of a unit these are equivalent to substitudes of Day and Street. We show that operads colored by a category are internal algebras of a certain categorical operad of functors. We describe a groupoid-colored quadratic binary operad, whose algebras are non-unital Markl operads in the context of operadic categories. As a by-product we describe the free internal operad construction.

Zhengyong Wang, Liquan Shen, Yihan Yu et al.

Underwater image enhancement (UIE) is a meaningful but challenging task, and many learning-based UIE methods have been proposed in recent years. Although much progress has been made, these methods still exist two issues: (1) There exists a significant region-wise quality difference in a single underwater image due to the underwater imaging process, especially in regions with different scene depths. However, existing methods neglect this internal characteristic of underwater images, resulting in inferior performance; (2) Due to the uniqueness of the acquisition approach, underwater image acquisition tools usually capture multiple images in the same or similar scenes. Thus, the underwater images to be enhanced in practical usage are highly correlated. However, when processing a single image, existing methods do not consider the rich external information provided by the related images. There is still room for improvement in their performance. Motivated by these two aspects, we propose a novel internal-external representation learning (UIERL) network to better perform UIE tasks with internal and external information, simultaneously. In the internal representation learning stage, a new depth-based region feature guidance network is designed, including a region segmentation based on scene depth to sense regions with different quality levels, followed by a region-wise space encoder module. With performing region-wise feature learning for regions with different quality separately, the network provides an effective guidance for global features and thus guides intra-image differentiated enhancement. In the external representation learning stage, we first propose an external information extraction network to mine the rich external information in the related images. Then, internal and external features interact with each other via the proposed external-assist-internal module and internal-assist-e

Xinyu Cheng, Yi Zhang, Di Zhao et al.

Suicidality in patients with major depressive disorder (MDD) has been an urgent affair during the COVID-19 pandemic. It is well-established that impulsivity and trait anxiety are two risk factors for suicidal ideation. However, literature is still insufficient on the relationships among impulsivity, (state/trait) anxiety and suicidal ideation in individuals with MDD. The present study aims to explore the relationships of these three variables in MDD patients during the COVID-19 pandemic through three scales, including Barrett Impulsivity Scale (BIS), State-Trait Anxiety Scale (STAI) and Self-rating Idea of Suicide Scale (SIOSS). Sixty-three MDD patients (low SIOSS group and high SIOSS group, which were split by the mean score of SIOSS) and twenty-seven well-matched healthy controls were analyzed. Our results showed that the high SIOSS group had higher trait anxiety (p &lt; 0.001, 95% CI = [−19.29, −5.02]) but there was no difference in state anxiety (p = 0.171, 95% CI = [−10.60, 1.25]), compared with the low SIOSS group. And the correlation between impulsivity and suicidal ideation was significant in MDD patients (r = 0.389, p = 0.002), yet it was not significant in healthy controls (r = 0.285, p = 0.167). Further, mediation analysis showed that trait anxiety significantly mediate impulsivity and suicidal ideation in patients with depression (total effect: β = 0.304, p = 0.002, 95% CI = [0.120, 0.489]; direct effect: β = 0.154, p = 0.076, 95% CI = [−0.169, 0.325]), indicating impulsivity influenced suicidal ideation through trait anxiety in MDD patients. In conclusion, our results suggested that trait anxiety might mediate the association of impulsivity and suicidal ideation in MDD patients. Clinicians may use symptoms of trait anxiety and impulsivity for screening when actively evaluating suicidal ideation in MDD patients, especially in the setting of COVID-19 pandemic.

B. Hygriv Rao, N.S. Rama Raju, C.S. Srinivasa Raju et al.

Objectives: In acute coronary syndrome (ACS) patients the focus is on major conventional risk factors - CRF [diabetes, hypertension, elevated low-density cholesterol (LDL-C) and smoking] whereas others - specific metabolic risk factors - MRF [high-density lipoprotein cholesterol (HDL-C), body-mass index (BMI), waist-hip ratio (WHR), and triglycerides, and HbA1c get less attention. Methods: This is a prospective case–control observational study from 15 tertiary care hospitals in India. CRF and MRF in patients presenting with first incidence of ACS (n = 2153) were compared with matched controls (n = 1210). Results: Propensity score matching (PSM) yielded 1193 cases and matched 1210 controls. Risk factor prevalence in cases vs. controls were CRF: hypertension - 39.4% vs 16.4% (p < 0.0001), diabetes - 42.6% vs 12.7% (p < 0.0001), smoking - 28.3% vs 9.3% (p < 0.0001) and elevated LDL-C - 70.2% vs 57.9% (p < 0.0001). MRF: High BMI - 54.7% vs 55.1% (p = 0.84), increased waist: hip ratio 79.5% vs 63.6% (p < 0.0001), high HbA1c - 37.8% vs 14.9% (p < 0.0001), low HDL-C - 56.2% vs 42.8% (p < 0.0001) and elevated triglycerides - 49.7% vs 44.2% (p = 0.007). Adjusted Odds ratios by multivariate analysis were CRF: hypertension - 2.3 (p < 0.001), diabetes - 4.7 (p < 0.001), high LDL-C - 3.3 (p < 0.001) and smoking- 6.3 (p < 0.001). MRF: High waist: hip ratio - 2.4 (p < 0.001) high HbA1c - 3.2 (p < 0.001), low HDL-C 2.2 (p < 0.001) and elevated triglycerides - 0.878 p = 0.17. Conclusion: In India, the risk of ACS conferred by specific metabolic risk factors (High waist: hip ratio, Low HDL-C and High HbA1c) is comparable to that caused by CRF.

Sheikh Shoib, Sheikh Mohammed Shariful Islam, Sheikh Mohd Saleem

Irandi Putra Pratomo, Dimas R. Noor, Kusmardi Kusmardi et al.

Xanthine oxidase (XO) is an enzyme that catalyzes the production of uric acid and superoxide radicals from purine bases: hypoxanthine and xanthine and is also expressed in respiratory epithelial cells. Uric acid, which is also considered a danger associated molecule pattern (DAMP), could trigger a series of inflammatory responses by activating the inflammasome complex path and NF-κB within the endothelial cells and by inducing proinflammatory cytokine release. Concurrently, XO also converts the superoxide radicals into hydroxyl radicals that further induce inflammatory responses. These conditions will ultimately sum up a hyperinflammation condition commonly dubbed as cytokine storm syndrome (CSS). The expression of proinflammatory cytokines and neutrophil chemokines may be reduced by XO inhibitor, as observed in human respiratory syncytial virus (HRSV)-infected A549 cells. Our review emphasizes that XO may have an essential role as an anti-inflammation therapy for respiratory viral infection, including coronavirus disease 2019 (COVID-19).

J. C. P. Leendertse, J. C. P. Leendertse, A. I. Wierdsma et al.

Background: Personal recovery (PR) is a subjective, multidimensional concept, and quantitative research using PR as an outcome is rapidly increasing. This systematic review is intended to support the design of interventions that contribute to PR in psychotic disorders, by providing an overview of associated factors and their weighted importance to PR: clinical factors, social factors, and socio-demographic characteristics are included, and factors related to the concept of PR (organized into CHIME dimensions).Methods: A systematic literature search was conducted from inception to March 2020. Quantitative studies that had used a validated questionnaire assessing the concept of PR were included. Mean effect sizes for the relationship between PR-scale total scores and related factors were calculated using meta-analyses. Sources of heterogeneity were examined using meta-regression tests.Results: Forty-six studies, that used (a total of) eight PR measures, showed that in clinical factors, affective symptoms had a medium negative association with PR-scale total scores (r = −0.44, 95%CI −0.50 to −0.37), while positive, negative and general symptoms had small negative correlations. No association was found with neuro-cognition. Social factors (support, work and housing, and functioning) showed small positive correlations. Gender and age differences had barely been researched. Large associations were found for PR-scale total scores with the CHIME dimensions hope (r = 0.56, 95%CI 0.48–0.63), meaning in life (r = 0.48, 95%CI 0.38–0.58) and empowerment (r = 0.53, 95%CI 0.42–0.63); while medium associations were found with connectedness (r = 0.34, 95%CI 0.43–0.65) and identity (r = 0.43, 95%CI 0.35–0.50). Levels of heterogeneity were high, sources included: the variety of PR measures, variations in sample characteristics, publication bias, variations in outcome measures, and cultural differences.Discussion: Most interventions in mental healthcare aim to reduce symptoms and improve functioning. With regard to stimulating PR, these interventions may benefit from also focusing on enhancing hope, empowerment, and meaning in life. The strength of these findings is limited by the challenges of comparing separate CHIME dimensions with questionnaires assessing the concept of PR, and by the high levels of heterogeneity observed. Future research should focus on the interaction between elements of PR and clinical and social factors over time.

Keith J. Kincaid, Justin C. Kung, Alexander J. Senetar et al.

Novel coronavirus SARS-CoV-2 has created unprecedented healthcare challenges. Neurologic deficits are often an important presenting symptom. To date, the only reported post-infectious COVID-19 manifestations of neurologic disease include cognitive deficits and dysfunction of the peripheral nervous system. Here we report that seizure can also be a post-COVID-19 or “long-COVID” complication. We present a 71-year-old man with hypertension, diabetes mellitus, and COVID-19 diagnosed by RT-PCR who initially presented with posterior circulation stroke-like symptoms, which completely resolved after emergent thrombolysis. Six days later, the patient returned with seizure activity, supported by radiographic and electroencephalographic studies. Notably, he was negative for SARS-CoV-2, and no other provoking factor was uncovered after a comprehensive work-up. To our knowledge, this is the first report of post-infectious seizures after a case of COVID-19, highlighting the potential importance of monitoring for neurologic symptoms in COVID-19 patients, even after convalescence.

Rupak Desai, Tarang Parekh, Jilmil Raina et al.

Recent reports proposing a potential association of influenza virus infection with cardiovascular diseases like Takotsubo syndrome (TTS) warrant a literature review to elucidate the demographics, clinical presentation, and outcomes in these cases. A thorough literature search was performed until March 2020. We systematically discussed TTS cases reported following influenza infection or flu vaccination and related outcomes. Ten patients (7 women/3 men) were identified who displayed diagnostic and clinical signs of TTS after influenza infection or flu-like illness and influenza (flu) vaccination. Of 10 cases reviewed (mean age 77.0 ± 11.7 years), 7 (70%) were females, of whom 71.4% (n = 5) were above 60 years of age. Seven patients had influenza A, one patient had influenza B, and two patients had received a flu vaccination. Total 70% of cases reported the flu-like event as a triggering event for TTS and, all of them occurred within 5 days of symptoms onset or vaccination. The classical apical ballooning pattern, elevated cardiac enzymes, ST-segment/T-wave changes on electrocardiogram, and reduced left ventricular ejection fraction were present in a majority of the cases. Only one patient died during the course due to cardiac arrest whereas 6 cases (60%) reported at least one cardiopulmonary complication. Physicians should remain vigilant about an infrequent association of TTS and consequent cardiopulmonary complications in influenza virus infection especially in aged patients with prevalent cardiovascular risk factors. The overall prognosis of influenza-associated TTS while looks promising, there is a need for larger studies to find more conclusive evidence.

David Darrow

Internal DLA (IDLA) is an internal aggregation model in which particles perform random walks from the origin, in turn, and stop upon reaching an unoccupied site. Levine and Peres showed that, when particles start instead from fixed multiple-point distributions, the modified IDLA processes have deterministic scaling limits related to a certain obstacle problem. In this paper, we investigate the convergence rate of this "extended source" IDLA in the plane to its scaling limit. We show that, if $δ$ is the lattice size, fluctuations of the IDLA occupied set are at most of order $δ^{3/5}$ from its scaling limit, with probability at least $1-e^{-1/δ^{2/5}}$.