Hasil untuk "Internal medicine"

T. Fitzpatrick

Introduction biology and pathophysiology of skin disorders presenting in the skin and mucous membranes dermatology and internal medicine diseases due to microbial agents therapeutics paediatric and geriatric dermatology.

J. Mccauley, D. Kern, K. Kolodner et al.

Dhruv R. Seshadri, Ryan T. Li, J. Voos et al.

The convergence of semiconductor technology, physiology, and predictive health analytics from wearable devices has advanced its clinical and translational utility for sports. The detection and subsequent application of metrics pertinent to and indicative of the physical performance, physiological status, biochemical composition, and mental alertness of the athlete has been shown to reduce the risk of injuries and improve performance and has enabled the development of athlete-centered protocols and treatment plans by team physicians and trainers. Our discussions in this review include commercially available devices, as well as those described in scientific literature to provide an understanding of wearable sensors for sports medicine. The primary objective of this paper is to provide a comprehensive review of the applications of wearable technology for assessing the biomechanical and physiological parameters of the athlete. A secondary objective of this paper is to identify collaborative research opportunities among academic research groups, sports medicine health clinics, and sports team performance programs to further the utility of this technology to assist in the return-to-play for athletes across various sporting domains. A companion paper discusses the use of wearables to monitor the biochemical profile and mental acuity of the athlete.

Joana Marques‐Antunes, Egon Rodrigues, Marta Guimarães et al.

PurposeRepairing complex abdominal wall hernias is challenging, often requiring component separation techniques (CST) for tension-free closure. Adjuvant therapies, such as botulinum toxin type A (BTA), preoperative progressive pneumoperitoneum (PPP), and intraoperative fascial traction (IFT), may reduce the need for CST by improving abdominal wall compliance and reduce the complexity of the hernia. There is limited knowledge about the effects of their combined use. Our aim is to evaluate the rate of CST in abdominal wall reconstruction for complex midline hernias after adjuvant therapies.MethodsA cross-sectional study was conducted on patients who underwent surgery for correction of midline complex abdominal hernias between June 2020 and June 2024. Patients submitted to BTA, PPP, or/and IFT were included. Exclusion criteria were non-midline hernias, non eletive surgeries and less than 3 months of follow-up.ResultsAmong the 44 patients studied, 61.4% underwent abdominal wall reconstruction without requiring CST. Traditional predictors like component separation index and rectus/defect ratio were not associated with a higher rate of CST after adjuvant therapies. 45.5% of patients underwent a combination of adjuvant techniques (BTA + PPP or BTA + IFT). The early and late complication rates were 20.5% and 9.1%. A recurrence rate of 4.5% was reported after a median follow-up of 13 months.ConclusionThis study suggests that adjuvant therapies may influence the surgical approach to abdominal wall reconstruction. The synchronous application of adjuvant therapies, both preoperatively and intraoperatively, could enhance their effect and contribute to the use of less disruptive techniques.

Guillaume Barbalat, Ariane Guilbert, Lucie Adelaïde et al.

Abstract Background A number of negative developmental outcomes in response to extreme temperature have been documented. Yet, to our knowledge, environmental research has left the question of the effect of temperature on human neurodevelopment largely unexplored. Here, we aimed to investigate the effect of ambient temperature on linguistic development at the age of 2 years-old. Methods We used data from the prospective national French birth cohort ELFE (N = 12,163) and highly-resolved exposure models with daily temporal resolution and 200 m to 1 km spatial resolution. We investigated the effect of weekly averages of overall, daytime and night-time temperature in the prenatal (first 30 weeks of gestation) and postnatal (91 weeks after birth) period on vocabulary production scores from the MacArthur-Bates Communicative Development Inventories (MB-CDI) at 2 years-old. Exposure-response and lag-response relationships were modeled with confounder-adjusted distributed lag non-linear models. Results Scores at the MB-CDI decreased by 3.2% (relative risk (RR) 0.968, 95% confidence interval (CI): 0.939–0.998) following exposure to severe night-time heat of 15.6 °C (95th percentile) vs. 8.3 °C (median) throughout gestational weeks 14 to 19. In the postnatal period, scores at the MB-CDI decreased by 14.8% (RR 0.852; 95% CI: [0.756–0.96]) for severe overall heat of 21.9 °C (95th percentile) vs. 11.5 °C (median) throughout weeks 1 to 28. Consistent results were found for daytime and night-time heat. We observed positive effects of overall and night-time heat in the first few weeks of pregnancy. Night-time cold in the pre-natal period also resulted in improved scores at the MB-CDI. Adjusting our models for air pollutants (PM2.5, PM10 and NO2) tended to confirm these observations. Finally, there were no significant differences in temperature effects between boys and girls. Conclusion In this large cohort study, we showed a negative impact of hot temperatures during pregnancy and after birth on language acquisition. Positive associations observed in the first few weeks of pregnancy are likely the results of methodological artifacts. Positive associations with night-time cold during the prenatal period are likely truly protective, as colder temperatures may encourage staying indoors at a comfortable temperature. Policymakers should consider neurodevelopment impairments as a deleterious effect of climate change.

Choon Chiat Oh, Boon Yee Lim, Elizabeth Chun Yong Lee et al.

ABSTRACT Background Cutaneous squamous cell carcinoma (cSCC) remains poorly understood at the molecular level, both in the immunocompetent and immunosuppressed population with skin of colour. Data on the diversity of viruses found in cSCC is also lacking. Objectives We aimed to characterise the immunological and molecular profiles of cSCC in organ transplant recipients (OTR) and non‐transplant recipients in an Asian cohort (n = 53) and explore the diversity of viruses detected. Methods Gene expression analysis was performed on snap‐frozen cSCC tissues using the NanoString PanCancer IO360 panel. Viral detection was performed using the Twist Comprehensive Viral Research Panel. Results cSCC presented dysregulation of immune response pathways and tumour microenvironment remodelling compared to adjacent normal skin tissue. Cell‐type profiling based on gene expression profiles showed higher levels of exhausted CD8 cells, neutrophils, and cytotoxic cells in tumour cells. Furthermore, three distinct clusters of cSCC gene signatures could be observed, where Cluster 3 with the highest Tumour inflammation signature (TIS) scores displayed distinct upregulation of most pathways suggesting a more inflamed or “hot” tumour phenotype. cSCC of OTR exhibited greater expression of tumour markers (AQP9, SERPINA1) and reduced expression of T‐cell cytokines (CXCL10, CXCL11). Viruses were particularly enriched in tumour tissue, as compared with normal skin. In addition, there was an enrichment of detectable viruses in transplant‐associated cSCC, with several tumours harbouring multiple viruses (HPV, EBV, MCV, and TTV). Conclusions cSCC is marked by a pro‐tumorigenic immune environment with altered immune cell populations. These findings support the potential for stratified, immune‐tailored treatment approaches for cSCC, especially in OTR who have a higher disease burden. Future studies on the possible oncogenic role of the detected viruses can be undertaken.

Felix E Y Aggor, Martinna Bertolini, Bianca M Coleman et al.

Oropharyngeal candidiasis (OPC) is the most common human fungal infection, arising typically from T cell immune impairments. IL-17 and IL-22 contribute individually to OPC responses, but here we demonstrate that the combined actions of both cytokines are essential for resistance to OPC. Mice lacking IL-17RA and IL-22RA1 exhibited high fungal loads in esophagus- and intestinal tract, severe weight loss, and symptoms of colitis. Ultimately, mice succumbed to infection. Dual loss of IL-17RA and IL-22RA impaired expression of small proline rich proteins (SPRRs), a class of antimicrobial effectors not previously linked to fungal immunity. Sprr2a1 exhibited direct candidacidal activity in vitro, and Sprr1-3a-/- mice were susceptible to OPC. Thus, cooperative actions of Type 17 cytokines mediate oral mucosal anti-Candida defenses and reveal a role for SPRRs.

Jingpu Zhao, Yongfeng Xu

PITX1, also known as the pituitary homeobox 1 gene, has emerged as a key regulator in animal growth and development, attracting significant research attention. Recent investigations have revealed the implication of dysregulated PITX1 expression in tumorigenesis, highlighting its involvement in cancer development. Notably, PITX1 interacts with p53 and exerts control over crucial cellular processes including cell cycle progression, apoptosis, and chemotherapy resistance. Its influence extends to various tumors, such as esophageal, colorectal, gastric, and liver cancer, contributing to tumor progression and metastasis. Despite its significance, a comprehensive review examining PITX1’s role in oncology remains lacking. This review aims to address this gap by providing a comprehensive overview of PITX1 in different cancer types, with a particular focus on its clinicopathological significance.

Chamali Akter Shykat, Saiful Islam, Foyez Ahmed et al.

Epidemiological information and proper identification of Fasciola species present in Bangladesh are important for control. This study was aimed at determining the prevalence of liver fluke infection of goats in Sylhet, Bangladesh, and identifying those using integrated morphometric and molecular techniques. A total of 260 slaughtered goats (Capra hircus) were examined, and flukes were collected from infected liver using sterilized forceps. Fasciolosis prevalence in goats was 35.38% (92/260) across all age and sex categories. Female goats were found more infected (37.14%, 65/175) than male goats (31.76%, 27/85), while infection rate was found higher in young animals (37.91%, 69/182) compared to adults (29.48% 23/78). Infection rate was observed higher in rainy season (52.96%, 45/85), followed by winter (27.38%, 26/95) and summer (26.25%, 21/80). Collected flukes were examined by light microscopy after being stained with Semichon’s acetocarmine, and sequences of mtDNA Cox1 genes were obtained. Ten adult flukes were measured, 38.72±3.37 mm in length and 11.8±1.9 mm in width. Based on morphometric features especially branching of the testis and body length/body width ratios (3.28±0.42), the flukes were primarily identified as Fasciola gigantica. Amplicon sequences were compared by BLAST and the cox1 sequences showed 97.1-99.3% similarity with the reference sequences (F. gigantica and Fasciola sp.) from GenBank. In this study, we found a considerable prevalence of fascioliasis in goats, and F. gigantica was solely identified with variation. To control these parasites and prevent potential public health risks, appropriate control techniques must be developed.

Johannes Leiner, Vincent Pellissier, Sebastian König et al.

Abstract Background Severe acute respiratory infections (SARI) are the most common infectious causes of death. Previous work regarding mortality prediction models for SARI using machine learning (ML) algorithms that can be useful for both individual risk stratification and quality of care assessment is scarce. We aimed to develop reliable models for mortality prediction in SARI patients utilizing ML algorithms and compare its performances with a classic regression analysis approach. Methods Administrative data (dataset randomly split 75%/25% for model training/testing) from years 2016–2019 of 86 German Helios hospitals was retrospectively analyzed. Inpatient SARI cases were defined by ICD-codes J09-J22. Three ML algorithms were evaluated and its performance compared to generalized linear models (GLM) by computing receiver operating characteristic area under the curve (AUC) and area under the precision-recall curve (AUPRC). Results The dataset contained 241,988 inpatient SARI cases (75 years or older: 49%; male 56.2%). In-hospital mortality was 11.6%. AUC and AUPRC in the testing dataset were 0.83 and 0.372 for GLM, 0.831 and 0.384 for random forest (RF), 0.834 and 0.382 for single layer neural network (NNET) and 0.834 and 0.389 for extreme gradient boosting (XGBoost). Statistical comparison of ROC AUCs revealed a better performance of NNET and XGBoost as compared to GLM. Conclusion ML algorithms for predicting in-hospital mortality were trained and tested on a large real-world administrative dataset of SARI patients and showed good discriminatory performances. Broad application of our models in clinical routine practice can contribute to patients’ risk assessment and quality management.

K. Xenou, C. Sotiropoulou, P. Karousi et al.

Stéphanie Watier-Grillot, Damien Costa, Cédric Petit et al.

<h4>Introduction</h4>Contaminated drinking and recreational waters account for most of the reported Cryptosporidium spp. exposures in high-income countries. In June 2017, two successive cryptosporidiosis outbreaks occurred among service members in a military training camp located in Southwest France. Several other gastroenteritis outbreaks were previously reported in this camp, all among trainees in the days following their arrival, without any causative pathogen identification. Epidemiological, microbiological and environmental investigations were carried out to explain theses outbreaks.<h4>Material and methods</h4>Syndromic diagnosis using multiplex PCR was used for stool testing. Water samples (100 L) were collected at 10 points of the drinking water installations and enumeration of Cryptosporidium oocysts performed. The identification of Cryptosporidium species was performed using real-time 18S SSU rRNA PCR and confirmed by GP60 sequencing.<h4>Results</h4>A total of 100 human cases were reported with a global attack rate of 27.8%. Cryptosporidium spp. was identified in 93% of stool samples with syndromic multiplex PCR. The entire drinking water network was contaminated with Cryptosporidium spp. The highest level of contamination was found in groundwater and in the water leaving the treatment plant, with >1,000 oocysts per 100 L. The same Cryptosporidium hominis isolate subtype IbA10G2 was identified in patients' stool and water samples. Several polluting activities were identified within the protection perimeters of the water resource. An additional ultrafiltration module was installed at the outlet of the water treatment plant. After several weeks, no Cryptosporidium oocysts were found in the public water supply.<h4>Conclusions</h4>After successive and unexplained gastroenteritis outbreaks, this investigation confirmed a waterborne outbreak due to Cryptosporidium hominis subtype IbA10G2. Our study demonstrates the value of syndromic diagnosis for gastroenteritis outbreak investigation. Our results also highlight the importance of better assessing the microbiological risk associated with raw water and the need for sensitive and easy-to-implement tools for parasite detection.

Kristina Rodionova, Martin Hindermann, Karl Hilgers et al.

Background: Angiotensin II (Ang II) and the renal sympathetic nervous system exert a strong influence on renal sodium and water excretion. We tested the hypothesis that already low doses of an Ang II inhibitor (candesartan) will result in similar effects on tubular sodium and water reabsorption in congestive heart failure (CHF) as seen after renal denervation (DNX). Methods: Measurement of arterial blood pressure, heart rate (HR), renal sympathetic nerve activity (RSNA), glomerular filtration rate (GFR), renal plasma flow (RPF), urine volume, and urinary sodium. To assess neural control of volume homeostasis, 21 days after the induction of CHF via myocardial infarction rats underwent volume expansion (0.9% NaCL; 10% body weight) to decrease RSNA. CHF rat and controls with or without DNX or pretreated with the Ang II type-1 receptor antagonist candesartan (0.5 ug i.v.) were studied. Results: CHF rats excreted only 68 + 10.2% of the volume load (10% body weight) in 90 min. CHF rats pretreated with candesartan or after DNX excreted from 92 to 103% like controls. Decreases of RSNA induced by volume expansion were impaired in CHF rats but unaffected by candesartan pointing to an intrarenal drug effect. GFR and RPF were not significantly different in controls or CHF. Conclusion: The prominent function of increased RSNA – retaining salt and water – could no longer be observed after renal Ang II receptor blockade in CHF rats.

S. Mamede, Tamara van Gog, K. van den Berge et al.

A. Nobili, G. Licata, F. Salerno et al.

Chantel L. Rabusin, Hylton B. Menz, Jodie A. McClelland et al.

Abstract Background Mid-portion Achilles tendinopathy is a common musculoskeletal condition characterised by degeneration of the Achilles tendon, which causes pain and disability. Multiple non-surgical treatments have been advocated for this condition including calf muscle eccentric exercise and in-shoe heel lifts. Although adherence is challenging, there is evidence to suggest that calf muscle eccentric exercise is effective in decreasing pain and improving function in people with Achilles tendinopathy. Heel lifts reduce ankle joint dorsiflexion and Achilles tendon strain, however their efficacy in the management of Achilles tendinopathy is unclear. This article describes the design of a parallel-group randomised trial comparing the efficacy of heel lifts to calf muscle eccentric exercise for Achilles tendinopathy. Methods Ninety-two participants with Achilles tendinopathy will be randomised to one of two groups: (i) a heel lift group that will receive pre-fabricated 12 mm in-shoe heel lifts (Clearly Adjustable®), or (ii) an exercise group that will be advised to carry out a calf muscle eccentric exercise program (twice a day, 7 days a week, for 12 weeks). Outcome measures will be obtained at baseline, 2, 6 and 12 weeks; the primary endpoint for assessing efficacy being 12 weeks. The primary outcome measure will be the total score of the Victorian Institute of Sport Assessment – Achilles (VISA–A) questionnaire. Secondary outcome measures will include thickness and integrity of the Achilles tendon (using ultrasound tissue characterisation [UTC]), participant perception of treatment effect on pain and function (using the 7-point Patient Global Impression of Change scale), severity of pain at the Achilles tendon (using a 100 mm visual analogue scale) in the previous week, health status (using the EuroQol-5D-5L™ questionnaire), physical activity levels (using the 7-day Recall Physical Activity Questionnaire) and calf muscle function (using the standing heel rise test). Data will be analysed using the intention to treat principle. Discussion The HEALTHY trial (Heel lifts versus calf muscle eccentric Exercise for AchiLles TendinopatHY) is the first randomised trial to compare the efficacy of heel lifts to calf muscle eccentric exercise in reducing pain and improving function in people with Achilles tendinopathy. A pragmatically designed trial was developed to ensure that if the interventions are found to be effective, the findings can be readily implemented in clinical practice. Trial registration Australian New Zealand Clinical Trials Registry: ACTRN12617001225303. Registered on August 22nd, 2017.

Moritsugu Kimura, Masao Toyoda, Nobumichi Saito et al.

Objective. Podocytes have highly differentiated functions and are extremely difficult to grow; thus, damage of podocytes is associated with glomerular dysfunction. Desquamated podocytes can be detected in urine of patients with severe renal impairment. Unlike the rapidly progressive glomerular damage in glomerulonephritis, only a few desquamated podocytes are usually detected in diabetic nephropathy (DN). It is not clear whether the low podocyte count in DN is due to limitation of the conventional method or true pathological feature. The aim of this study was to compare the conventional method with a newly modified method in detecting podocytes in morning urine samples of patients with DN. Materials and Methods. The study subjects were patients with type 2 diabetes. Urine samples from these patients were analyzed by the conventional method (Cytospin®) and the modified method (SurePath™). We determined the rate of detection of urinary podocytes and the number of detected cells. Results. The detection rate and podocyte count were significantly higher by the modified method than by the conventional method. The differences in the detection rates and numbers of podocytes were not significant between patients with normoalbuminuria and those with macroalbuminuria. However, they were significant in patients with microalbuminuria. The number of podocytes in the urine correlated significantly with the albumin-to-creatinine ratio, but not with the estimated glomerular filtration rate. Conclusions. The true number of urinary podocytes, as measured by the modified SurePath™-based method, in patients with DN is much higher than that estimated by the conventional method.

Mahdi Barzegar, Vahid Shaygannejad, Omid Mirmosayyeb et al.

Background: Multiple Sclerosis (MS) is a demyelinating disorder of the Central Nervous System (CNS). In addition to the role of immune mediated mechanisms, oxidative and nitrosative stress also play an important role in neuropathology of MS. Bilirubin as an endogenous antioxidant has neuroprotective effects; however few studies have assessed the association between serum bilirubin level and MS. Objectives: To evaluate serum level of bilirubin in MS patients. Materials and Methods: Serum samples were collected from participants who referred to Kashani MS clinic in Isfahan between July 2016 and July 2017. A total of 80 MS patients (67 females and 13 males) and 94 Healthy Control subjects (HCs) (62 female and 32 male) enrolled. Compression of bilirubin levels between MS patients and HCs was done with covariance analysis. Regression analysis was used to assess the relation between bilirubin concentration and EDSS. SPSS software version 17.0 for Windows (SPSS, Chicago, IL, USA) was used. Results: The level of Direct bilirubin (Dbil) was significantly lower in MS patients compared with HCs (P=0.02). Otherwise the serum concentration of Total bilirubin (Tbil) and in Direct bilirubin (Ibil) were higher in MS patients, but it was not statistically significant. There was a negative correlation between Extended Disability Status Scale (EDSS) and bilirubin levels (Tbil, Dbil and Ibil) but it was not significant.  Conclusion: Bilirubin level is lower in MS patients and deficit of its antioxidant level may play role in neuropathology of MS.

Chih‐Li Chen, Yu‐Shuen Tsai, Yen‐Hua Huang et al.

Lymphoid enhancer factor 1 (LEF1) activity is associated with progression of several types of cancers. The role of LEF1 in progression of hepatocellular carcinoma (HCC) remains poorly known. We investigated LEF1 expression in HCC and its interactions with epithelial‐mesenchymal transition (EMT) regulators (e.g., Snail, Slug, Twist) and stemness genes (e.g., octamer‐binding transcription factor 4 [Oct4], sex determining region Y‐box 2 [Sox2], Nanog homeobox [Nanog]). Microarray analysis was performed on resected tumor samples from patients with HCC with or without postoperative recurrence. LEF1 expression was associated with postoperative recurrence as validated by immunohistochemical staining in another HCC cohort. Among 74 patients, 44 displayed a relatively high percentage of LEF1 staining (>30% of HCC cells), which was associated with a reduced recurrence‐free interval (P < 0.001) and overall survival (P = 0.009). In multivariate analysis, a high percentage of LEF1 staining was significantly associated with low albumin level (P = 0.035), Twist overexpression (P = 0.018), Snail overexpression (P = 0.064), co‐expression of Twist and Snail (P = 0.054), and multinodular tumors (P = 0.025). Down‐regulation of LEF1 by short hairpin RNA decreased tumor sphere formation, soft agar colony formation, and transwell invasiveness of HCC cell lines Mahlavu and PLC. Xenotransplant and tail vein injection experiments revealed that LEF1 down‐regulation in Mahlavu reduced tumor size and metastasis. LEF1 up‐regulation in Huh7 increased sphere formation, soft agar colony formation, and transwell invasiveness. LEF1 was shown to physically interact with and transcriptionally activate promoter regions of Oct4, Snail, Slug, and Twist. Furthermore, Oct4, Snail, and Twist transactivated LEF1 to form a regulatory positive‐feedback loop. Conclusion: LEF1 plays a pivotal role in HCC progression through transcriptional regulation of Oct4 and EMT regulators.

George Dallas, Alexandros Mavvidis, Paschalis Kirialanis et al.

Background: It has been shown that whole body vibration training has an effect on strength and balance in athletes of various sports.Objective: The purpose of the study was to examine the effect of 8 weeks of Whole Body Vibration (WBV) training on static balance and explosive strength of the lower limbs, using two different training intensities vibration protocols.Methods: Eighty-three physical education students (age 19.39&#8239;&#177;&#8239;2.35&#8239;years) volunteered to participate in an 8-week WBV training. They were randomly divided into two groups with 30&#8239;sec and 60&#8239;sec duration of vibration exposure per exercise, total volume of exercise was the same for both groups. The explosive strength of the lower limbs was assessed by a squat jump and static balance by Balance Error Scoring System at the baseline (pre-test) and after 8 weeks of WBV training at 15&#8239;sec, 5, 10, and 15&#8239;min after the end of WBV exposure. A two-way ANOVA 2 × 5 (protocol × time) with repeated measures on both factors was used. Univariate analyses with simple contrasts across time were selected as post hoc tests.Results: Results showed a time × protocol interaction effect for static balance (p&#8239;&lt;&#8239;.001) but not for the squat jump (p&#8239;&gt;&#8239;.05). Furthermore, a time effect was found for the static balance and squat jump test. The 60&#8239;sec protocol had a greater percentage improvement compared to the 30&#8239;sec protocol in static balance (p =&#8239;.003), whereas the 30&#8239;sec protocol was superior to the 60&#8239;sec protocol in explosive strength. However, the differences between the two protocols were not significant.Conclusion: WBV training had positive effects on static balance and explosive strength in physical education students. Balance and jump performance may benefit from WBV training. Therefore, WBV may be an effective training method for the improvement of static balance and lower limb strength.