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Kidnapped But Not Kids: A Case Series of Three Octogenarian Hostages Held in Captivity by Hamas. 被绑架的不是孩子:哈马斯囚禁三名八旬老人人质的案例系列。
IF 1.4 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-28 DOI: 10.5041/RMMJ.10534
A Mark Clarfield, Hagai Levine

On 7 October, 2023 Israel was attacked over the Gaza border by Hamas terrorists. Mostly civilians, approximately 1,200 people were killed, with an additional 251 taken hostage (in addition to 4 abducted before October 7 for a total of 255 hostages), many of whom have since died. Of the total abducted, 13% were older than 65, a third of whom were octogenarians. Brief case histories of three abductees over 80 years of age are presented: two released and one still in captivity. The extreme "pre-morbid" vulnerability of these older hostages is described along with the additional data on their clinical situation and the extreme stresses to which they are being subjected. The situation described constitutes one of the most severe examples of elder abuse documented in the modern era.

2023 年 10 月 7 日,以色列在加沙边境遭到哈马斯恐怖分子的袭击。大部分是平民,约有 1 200 人丧生,另有 251 人被劫持为人质(加上 10 月 7 日之前被劫持的 4 人,人质总数为 255 人),其中许多人已经死亡。在所有被绑架者中,13%的人年龄超过 65 岁,其中三分之一是八旬老人。本文介绍了三位 80 岁以上被绑架者的简要病史:两位已获释,一位仍被关押。报告描述了这些老年人质 "病前 "的极端脆弱性,以及他们的临床状况和所承受的极端压力的补充数据。所描述的情况是现代记录在案的最严重的虐待老人事件之一。
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引用次数: 0
IgG4-related Breast Disease: Review of the Literature. IgG4 相关乳腺疾病:文献综述
IF 1.4 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-28 DOI: 10.5041/RMMJ.10532
Helana Jeries, Yolanda Braun-Moscovici, Alexandra Balbir-Gurman

IgG4-related disease (IgG4-RD) is a rare illness with inflammatory and fibrotic changes in affected organs such as pancreas, thyroid, salivary or lacrimal glands, and retroperitoneal space; rarely other organs may be involved. IgG4-related breast disease (IgG4-BD) is very rare and generally presents as a lump or mastitis. IgG4-BD as a presenting feature of IgG4-RD is extremely rare. Hence, this paper reviews the known (n=48) IgG-BD cases reported in the literature to date. The majority of cases were diagnosed on routine mammography or during assessment for other clinically significant features. The absence of a lump border, and especially the absence of calcifications on ultrasonography, mammography, or computed tomography, is typical for IgG4-BD. Characteristic IgG4-BD pathological findings were dense lymphoplasmacytic infiltration with stromal fibrosis, and more than 10% IgG4+ plasma cells/high-power field (HPF); the mean percentage of IgG4+/IgG+ plasma cells was 54.2%, and only one-third of the patients had all "classical" signs of IgG4-BD including storiform fibrosis and obliterative phlebitis. Most of the cases had a benign course and responded to surgical excision with or without steroid therapy.

IgG4 相关疾病(IgG4-RD)是一种罕见的疾病,受累器官(如胰腺、甲状腺、唾液腺或泪腺以及腹膜后间隙)会出现炎症和纤维化病变;很少有其他器官会受累。IgG4相关性乳腺疾病(IgG4-BD)非常罕见,一般表现为肿块或乳腺炎。IgG4-BD作为IgG4-RD的表现特征极为罕见。因此,本文回顾了迄今为止文献报道的已知 IgG-BD 病例(48 例)。大多数病例是在常规乳腺 X 射线检查或评估其他临床重要特征时确诊的。IgG4-BD的典型特征是没有肿块边界,尤其是在超声波、乳腺X线摄影或计算机断层扫描中没有钙化。IgG4-BD的特征性病理结果是致密的淋巴浆细胞浸润伴基质纤维化,IgG4+浆细胞/高倍视野(HPF)超过10%;IgG4+/IgG+浆细胞的平均比例为54.2%,只有三分之一的患者具有IgG4-BD的所有 "经典 "体征,包括基质纤维化和闭塞性静脉炎。大多数病例的病程为良性,并对手术切除加或不加类固醇治疗有反应。
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引用次数: 0
The Medical Professional Elimination Program and the Ideology and Motivation of Nazi Physicians. 医学专业人员淘汰计划与纳粹医生的意识形态和动机》(The Medical Professional Elimination Program and the Ideology and Motivation of Nazi Physicians)。
IF 1.4 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-28 DOI: 10.5041/RMMJ.10533
George M Weisz, Deborah E-S Hemstreet

The appointment of a new chancellor in 1933 marked the beginning of the Third Reich in Germany. The ideology of the Nazi Party focused on establishing a pure Aryan state characterized by nationalism and racial superiority. Their goals would be achieved through a totalitarian form of government that enforced the subjugation, exclusion, and elimination of those they defined as inferior minorities, particularly Jews, who were depicted as non-human. Implementation of the Nazi ideology required the exclusion of Jewish people and other dissenters, particularly Jewish physicians, from their professions. The exclusion of Jewish physicians, referred to herein as a "Medical Professional Elimination Program," was gradually imposed on other Jewish professions in nations absorbed by the Third Reich, and particularly enforced by incorporated Austria. Why did German and Austrian doctors support the Nazi racial ideology, the removal of Jewish physicians from every possible sphere of influence, and subsequently participate in criminal medical research and experimentation, as well as euthanasia of perceived non-contributors to society, and become involved in refining the effectiveness of the death camps? Was the Medical Professional Elimination Program an opportunistic political concept, or was it part of an entrenched ideology? With these questions in mind, the lives of four key Nazi physicians and two institutions are examined.

1933 年新总理的任命标志着德国第三帝国的开始。纳粹党的意识形态侧重于建立一个以民族主义和种族优越为特征的纯雅利安国家。他们的目标将通过极权主义的政府形式来实现,这种政府强制征服、排斥和消灭那些他们定义为劣等的少数民族,尤其是被视为非人类的犹太人。纳粹意识形态的实施要求将犹太人和其他持不同政见者,尤其是犹太医生,排除在他们的职业之外。对犹太医生的排斥在本文中被称为 "医疗职业淘汰计划",在被第三帝国吞并的国家中,尤其是在合并后的奥地利,该计划逐渐被强加于其他犹太职业。为什么德国和奥地利的医生支持纳粹的种族意识形态,支持将犹太医生排除在一切可能的影响范围之外,并随后参与犯罪医学研究和实验,以及对被认为对社会无贡献者实施安乐死,并参与改进死亡集中营的有效性?医疗专业人员淘汰计划是一个机会主义的政治概念,还是根深蒂固的意识形态的一部分?带着这些问题,我们对四位重要的纳粹医生和两个机构的生平进行了研究。
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引用次数: 0
Myxedema Coma-associated Pancytopenia: A Case Report. 肌水肿昏迷相关全血细胞减少症:病例报告。
IF 1.4 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-28 DOI: 10.5041/RMMJ.10535
David A Stein, Orit Twito, Yoav Geva, Nadav Sarid

Pancytopenia is defined as a reduction in red blood cells, white blood cells, and platelets, and can pose as a diagnostic challenge due to the multitude of causes. Myxedema coma is the manifestation of severe untreated hypothyroidism. This case report presents a rare instance of myxedema coma-associated pancytopenia in a 53-year-old man with a history of untreated hypothyroidism. The patient presented with altered mental status and vital instability, and on further workup was found to have pancytopenia. During his hospital stay his symptomatic hypothyroidism was identified, and he was treated with intravenous levothyroxine, hydrocortisone, and supportive care. The patient's clinical status improved gradually, with normalized blood counts upon discharge. This case underscores the significance of considering myxedema coma in the differential diagnosis of pancytopenia, especially in older patients with limited healthcare access. Increased awareness of this association can aid clinicians in timely diagnosis and management, preventing potential complications associated with untreated hypothyroidism.

全血细胞减少症是指红细胞、白细胞和血小板减少,由于病因繁多,在诊断上可能是一个难题。肌水肿昏迷是严重的甲状腺功能减退症未经治疗的表现。本病例报告了一例罕见的肌水肿性昏迷相关的全血细胞减少症,患者是一名 53 岁的男性,有未经治疗的甲状腺功能减退症病史。患者出现精神状态改变和生命体征不稳定,进一步检查发现他患有全血细胞减少症。住院期间,他的无症状甲状腺功能减退症得到了确认,并接受了静脉注射左甲状腺素、氢化可的松和支持性治疗。患者的临床状况逐渐好转,出院时血细胞计数恢复正常。本病例强调,在全血细胞减少症的鉴别诊断中考虑肌水肿性昏迷非常重要,尤其是对于医疗条件有限的老年患者。提高对这一关联的认识有助于临床医生及时诊断和处理,防止出现与未经治疗的甲状腺功能减退症相关的潜在并发症。
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引用次数: 0
Inpatient Rehabilitation is Effective for Severe Daily Activity Deficits Related to Chronic Low Back Pain. 住院康复治疗对与慢性腰痛相关的严重日常活动障碍有效。
IF 1.4 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-28 DOI: 10.5041/RMMJ.10530
Elena Aidinoff, Sharona Yosef Ayalon, Dianne Michaeli, Ilana Gelernter, Amiram Catz, Vadim Bluvshtein

Background and objective: Chronic low back pain disability (CLBPD) is a syndrome that includes pain, disability, emotional impairments, and social problems. The study was conducted to examine the effect of an inpatient rehabilitation program on the performance of everyday life tasks (daily activities), and report on pain in CLBPD patients with primary activities of daily living (ADL) deficits.

Methods: In a retrospective cohort study, demographic and clinical data were retrieved from records of inpatients admitted consecutively to the program. Scores of the Spinal Pain Independence Measure (SPIM) and of changes in reported pain levels were used to assess improvement in the performance of daily activities and pain reduction. T-tests were used to assess the significance of score changes. Spearman's correlations and analysis of variance were used to assess relationships of SPIM gain and affecting factors.

Results: Ninety-nine patients were included. Daily task performance improved in 71 patients (71.7%). The SPIM score increased from 48.7 (SD 16.3) at admission to the rehabilitation program to 57.8 (SD 12.5) at discharge (P<0.001). The SPIM score at admission negatively affected SPIM gain (P<0.001). The SPIM gain was significant for admission SPIM scores of 50 or lower (P<0.05), but differences in SPIM scores were not as noticeable for patients with admission SPIM scores above 50. Relief in pain was reported in 59 patients (59.6%) and was not associated with function.

Conclusions: The multidisciplinary rehabilitation program, which improved function and provided limited pain relief in inpatients with CLBPD primary ADL deficits, can be effective for the most severe CLBPD cases.

背景和目的:慢性腰背痛残疾(CLBPD)是一种包括疼痛、残疾、情感障碍和社会问题的综合征。本研究旨在探讨住院康复计划对日常生活任务(日常活动)的影响,并报告有主要日常生活活动(ADL)障碍的慢性腰背痛残疾患者的疼痛情况:在一项回顾性队列研究中,研究人员从该项目连续收治的住院病人的记录中提取了人口统计学和临床数据。脊柱疼痛独立性量表(SPIM)的评分和报告疼痛程度的变化被用来评估日常活动能力的改善和疼痛的减轻。采用 T 检验来评估得分变化的显著性。斯皮尔曼相关性和方差分析用于评估 SPIM 增益与影响因素之间的关系:结果:共纳入 99 名患者。71名患者(71.7%)的日常工作表现有所改善。SPIM评分从入院时的48.7分(标准差为16.3分)上升到出院时的57.8分(标准差为12.5分)(结论:多学科康复计划的实施使患者的日常工作能力得到了改善:多学科康复计划改善了CLBPD住院患者的功能,并在一定程度上缓解了他们的疼痛,对最严重的CLBPD病例是有效的。
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引用次数: 0
The Role of Mesenchymal Stem Cells for Corneal Endothelial Regeneration: A Systematic Review. 间充质干细胞在角膜内皮再生中的作用:系统综述。
IF 1.4 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-10-28 DOI: 10.5041/RMMJ.10531
Siska Siska, I Gede Eka Wiratnaya, I Made Bakta, I Made Jawi, I Gde Raka Widiana, Putu Yuliawati, Made Ratna Saraswati, Heri Suroto

Objective: A single layer of tightly spaced cells, known as the endothelium, rests on the posterior side of the cornea. This endothelium regulates the stroma's relative dehydration, which is essential for corneal clarity. Cell therapy is an innovative method being used to repair various corneal abnormalities. Mesenchymal stem cells (MSCs) are now one of the most significant types of stem cells scientists have studied. This study aimed to evaluate the role of MSCs for corneal endothelial regeneration.

Methods: A systematic review was performed by searching for articles from reputable databases with many study-type references, including PubMed, Cochrane Library, Science Direct, and Google Scholar, up to January 2024. The resulting data were displayed using the 2020 PRISMA flowchart and evaluated using the PRISMA 2020 checklist. Most of the included studies were in vivo and used topical application and anterior chamber injection as the administration routes.

Results: Based on the findings of this review, MSCs increased corneal endothelial cell density, improved the defect area and corneal transparency, facilitated endothelial cell regeneration and wound healing, and decreased neovascularization and corneal pro-inflammatory cytokines as compared to controls.

Conclusion: Administration of MSCs into the anterior chamber could increase regeneration and proliferation of corneal endothelial tissue.

目的:角膜后侧有一层紧密排列的细胞,称为角膜内皮。角膜内皮可调节基质的相对脱水度,这对角膜的清晰度至关重要。细胞疗法是一种用于修复各种角膜异常的创新方法。间充质干细胞(MSCs)是目前科学家研究的最重要的干细胞类型之一。本研究旨在评估间充质干细胞在角膜内皮再生中的作用:方法:我们从PubMed、Cochrane Library、Science Direct和Google Scholar等知名数据库中搜索了截至2024年1月有大量研究类型参考文献的文章,进行了系统性综述。所得数据使用 2020 PRISMA 流程图显示,并使用 PRISMA 2020 核对表进行评估。纳入的大部分研究均为体内研究,并使用局部涂抹和前房注射作为给药途径:根据综述结果,与对照组相比,间充质干细胞可增加角膜内皮细胞密度,改善缺损面积和角膜透明度,促进内皮细胞再生和伤口愈合,减少新生血管生成和角膜促炎细胞因子:结论:在前房注射间充质干细胞可促进角膜内皮组织的再生和增殖。
{"title":"The Role of Mesenchymal Stem Cells for Corneal Endothelial Regeneration: A Systematic Review.","authors":"Siska Siska, I Gede Eka Wiratnaya, I Made Bakta, I Made Jawi, I Gde Raka Widiana, Putu Yuliawati, Made Ratna Saraswati, Heri Suroto","doi":"10.5041/RMMJ.10531","DOIUrl":"10.5041/RMMJ.10531","url":null,"abstract":"<p><strong>Objective: </strong>A single layer of tightly spaced cells, known as the endothelium, rests on the posterior side of the cornea. This endothelium regulates the stroma's relative dehydration, which is essential for corneal clarity. Cell therapy is an innovative method being used to repair various corneal abnormalities. Mesenchymal stem cells (MSCs) are now one of the most significant types of stem cells scientists have studied. This study aimed to evaluate the role of MSCs for corneal endothelial regeneration.</p><p><strong>Methods: </strong>A systematic review was performed by searching for articles from reputable databases with many study-type references, including PubMed, Cochrane Library, Science Direct, and Google Scholar, up to January 2024. The resulting data were displayed using the 2020 PRISMA flowchart and evaluated using the PRISMA 2020 checklist. Most of the included studies were in vivo and used topical application and anterior chamber injection as the administration routes.</p><p><strong>Results: </strong>Based on the findings of this review, MSCs increased corneal endothelial cell density, improved the defect area and corneal transparency, facilitated endothelial cell regeneration and wound healing, and decreased neovascularization and corneal pro-inflammatory cytokines as compared to controls.</p><p><strong>Conclusion: </strong>Administration of MSCs into the anterior chamber could increase regeneration and proliferation of corneal endothelial tissue.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"15 4","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11524423/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142584746","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Local Flap Reconstructions in Oral Cavity Defects: An Insight from 104 Cases. 口腔缺损的局部皮瓣重建:104 个病例的启示
IF 1.4 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-30 DOI: 10.5041/RMMJ.10526
Poonam Joshi, Manasi Bavaskar, Rathan Shetty, Arjun Singh, Sudhir Nair, Pankaj Chaturvedi

Background: Resection of oral cavity carcinoma often leads to complex defects causing functional and aesthetic morbidity. Providing optimum reconstruction with free flaps becomes challenging in a high-volume center setting with constrained resources. Hence, understanding the local flap technique for reconstructing oral cancer defects is prudent.

Materials and methods: This study is a retrospective analysis of prospectively operated cases of oral cavity resections which were subsequently reconstructed using local flaps from 2019 to 2022. Patients who underwent reconstruction with either melolabial flap, islanded facial artery myomucosal (FAMM) flap, submental flap, supraclavicular artery island flap, infrahyoid flap, or platysma myocutaneous flap (PMF) were included in this analysis. Eligible patients were followed up to evaluate functional outcomes like oral feeding and to analyze the Performance Status Scale for Head and Neck Cancer.

Results: The study included 104 patients. The tongue was the most common subsite, resulting in most hemiglossectomy defects, which were reconstructed using the melolabial flap procedure. Buccal mucosa defects in our series were reconstructed using the supraclavicular flap, whereas the submental flap procedure was the choice for lower lip-commissure defects. Complications such as partial and total flap loss, deep neck infection, and donor site complications like infection and gaping, oral cutaneous fistula, parotid fistula, and seroma were analyzed; the supraclavicular flap presented with a majority of complications.

Conclusion: Local flaps are an alternative to free flap reconstruction in select cases with optimum functional outcomes and minimal donor site morbidity. This article comprehensively reviews the surgical steps for various local flap procedures in oral cancer defects.

背景:口腔癌切除术通常会导致复杂的缺损,造成功能和美观方面的问题。在资源有限、手术量大的中心环境中,使用游离皮瓣进行最佳重建具有挑战性。因此,了解重建口腔癌缺损的局部皮瓣技术非常重要:本研究是对 2019 年至 2022 年期间前瞻性手术的口腔切除病例进行的回顾性分析,这些病例随后使用局部皮瓣进行了重建。本分析纳入了接受瓜唇皮瓣、岛状面动脉肌粘膜(FAMM)皮瓣、下颌骨皮瓣、锁骨上动脉岛状皮瓣、蝶骨下皮瓣或板肌肌皮瓣(PMF)重建的患者。对符合条件的患者进行随访,以评估口腔进食等功能性结果,并分析头颈部癌症患者的表现状态量表:研究共纳入 104 名患者。舌头是最常见的部位,导致了大多数半月板切除术后的缺损,这些缺损都采用了口唇皮瓣术进行重建。在我们的系列研究中,颊粘膜缺损采用锁骨上皮瓣重建,而下唇-颊粘膜缺损则选择下颌下皮瓣术。对部分和全部皮瓣脱落、颈部深部感染等并发症,以及感染和裂隙、口腔皮肤瘘、腮腺瘘和血清肿等供体部位并发症进行了分析;锁骨上皮瓣出现的并发症居多:结论:在特定病例中,局部皮瓣是游离皮瓣重建的替代选择,具有最佳的功能效果和最低的供体部位发病率。本文全面回顾了口腔癌缺损中各种局部皮瓣的手术步骤。
{"title":"Local Flap Reconstructions in Oral Cavity Defects: An Insight from 104 Cases.","authors":"Poonam Joshi, Manasi Bavaskar, Rathan Shetty, Arjun Singh, Sudhir Nair, Pankaj Chaturvedi","doi":"10.5041/RMMJ.10526","DOIUrl":"10.5041/RMMJ.10526","url":null,"abstract":"<p><strong>Background: </strong>Resection of oral cavity carcinoma often leads to complex defects causing functional and aesthetic morbidity. Providing optimum reconstruction with free flaps becomes challenging in a high-volume center setting with constrained resources. Hence, understanding the local flap technique for reconstructing oral cancer defects is prudent.</p><p><strong>Materials and methods: </strong>This study is a retrospective analysis of prospectively operated cases of oral cavity resections which were subsequently reconstructed using local flaps from 2019 to 2022. Patients who underwent reconstruction with either melolabial flap, islanded facial artery myomucosal (FAMM) flap, submental flap, supraclavicular artery island flap, infrahyoid flap, or platysma myocutaneous flap (PMF) were included in this analysis. Eligible patients were followed up to evaluate functional outcomes like oral feeding and to analyze the Performance Status Scale for Head and Neck Cancer.</p><p><strong>Results: </strong>The study included 104 patients. The tongue was the most common subsite, resulting in most hemiglossectomy defects, which were reconstructed using the melolabial flap procedure. Buccal mucosa defects in our series were reconstructed using the supraclavicular flap, whereas the submental flap procedure was the choice for lower lip-commissure defects. Complications such as partial and total flap loss, deep neck infection, and donor site complications like infection and gaping, oral cutaneous fistula, parotid fistula, and seroma were analyzed; the supraclavicular flap presented with a majority of complications.</p><p><strong>Conclusion: </strong>Local flaps are an alternative to free flap reconstruction in select cases with optimum functional outcomes and minimal donor site morbidity. This article comprehensively reviews the surgical steps for various local flap procedures in oral cancer defects.</p>","PeriodicalId":46408,"journal":{"name":"Rambam Maimonides Medical Journal","volume":"15 3","pages":""},"PeriodicalIF":1.4,"publicationDate":"2024-07-30","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11294683/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141876303","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Interpreting PPV and NPV of Diagnostic Tests with Uncertain Prevalence. 解读流行率不确定的诊断测试的 PPV 和 NPV。
IF 1.4 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-30 DOI: 10.5041/RMMJ.10527
Yakov Ben-Haim, Clifford C Dacso

Objective: Medical decision-making is often uncertain. The positive predictive value (PPV) and negative predictive value (NPV) are conditional probabilities characterizing diagnostic tests and assessing diagnostic interventions in clinical medicine and epidemiology. The PPV is the probability that a patient has a specified disease, given a positive test result for that disease. The NPV is the probability that a patient does not have the disease, given a negative test result for that disease. Both values depend on disease incidence or prevalence, which may be highly uncertain for unfamiliar diseases, epidemics, etc. Probability distributions for this uncertainty are usually unavailable. We develop a non-probabilistic method for interpreting PPV and NPV with uncertain prevalence.

Methods: Uncertainty in PPV and NPV is managed with the non-probabilistic concept of robustness in info-gap theory. Robustness of PPV or NPV estimates is the greatest uncertainty (in prevalence) at which the estimate's error is acceptable.

Results: Four properties are demonstrated. Zeroing: best estimates of PPV or NPV have no robustness to uncertain prevalence; best estimates are unreliable for interpreting diagnostic tests. Trade-off: robustness increases as error increases; this trade-off identifies robustly reliable error in PPV or NPV. Preference reversal: sometimes sub-optimal PPV or NPV estimates are more robust to uncertain incidence or prevalence than optimal estimates, motivating reversal of preference from the putative optimum to the sub-optimal estimate. Trade-off between specificity and robustness to uncertainty: the robustness increases as test-specificity decreases. These four properties underlie the interpretation of PPV and NPV.

Conclusions: The PPV and NPV assess diagnostic tests, but are sensitive to lack of knowledge that generates non-probabilistic uncertain prevalence and must be supplemented with robustness analysis. When uncertainties abound, as with unfamiliar diseases, assessing robustness is critical to avoiding erroneous decisions.

目的:医疗决策往往具有不确定性。在临床医学和流行病学中,阳性预测值(PPV)和阴性预测值(NPV)是诊断测试和评估诊断干预措施的条件概率。PPV 是指在特定疾病检测结果呈阳性的情况下,患者罹患该疾病的概率。NPV 是指在疾病检测结果为阴性的情况下,患者未患病的概率。这两个值都取决于疾病的发病率或流行率,而对于不熟悉的疾病、流行病等,发病率或流行率可能非常不确定。这种不确定性的概率分布通常是不可用的。我们开发了一种非概率方法,用于解释流行率不确定的 PPV 和 NPV:方法:PPV 和 NPV 的不确定性是通过信息差距理论中的非概率稳健性概念来处理的。PPV 或 NPV 估计值的稳健性是估计值误差可接受的最大不确定性(流行率):结果:证明了四个特性。归零:PPV 或 NPV 的最佳估计值对不确定的流行率没有稳健性;最佳估计值对诊断测试的解释不可靠。权衡:稳健性随着误差的增加而增加;这种权衡确定了 PPV 或 NPV 中稳健可靠的误差。偏好逆转:有时,次优 PPV 或 NPV 估计值比最优估计值更能应对不确定的发病率或流行率,从而促使偏好从推定的最优值逆转到次优估计值。特异性与对不确定性的稳健性之间的权衡:稳健性随着检测特异性的降低而增加。这四个特性是解释 PPV 和 NPV 的基础:PPV和NPV是对诊断测试的评估,但对产生非概率不确定流行率的知识缺乏很敏感,必须辅以稳健性分析。当不确定性因素大量存在时,如不熟悉的疾病,评估稳健性对于避免错误决策至关重要。
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引用次数: 0
Integration of Bite Mark Microbiome Analysis with Forensic DNA Profiling: Advancements, Challenges, and Synergistic Approaches. 将咬痕微生物组分析与法医 DNA 分析相结合:进展、挑战和协同方法。
IF 1.4 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-30 DOI: 10.5041/RMMJ.10528
Palash Arun Mehar, Lina Zamsingh Bhoyar, Archana Laxminarayan Mahakalkar

Bite mark analysis plays a pivotal role in forensic investigations, by helping to identify suspects and establish links between individuals and crime scenes. However, traditional bite mark methodologies face significant challenges due to issues with reliability and subjectivity. Recent advances in microbiome analysis, which involves identifying and characterizing the microbial communities found in bite marks, have led to the emergence of a promising tool for forensic investigations. The integration of microbiome analysis with conventional DNA profiling enables more accurate interpretation of bite mark evidence in forensic investigations. This review provides an in-depth look at the integration of bite mark microbiome analysis with forensic DNA profiling. It also addresses the challenges and strategies involved in microbiome-based bite mark analysis for forensic purposes.

咬痕分析在法医调查中起着至关重要的作用,它有助于识别犯罪嫌疑人并建立个人与犯罪现场之间的联系。然而,由于可靠性和主观性问题,传统的咬痕分析方法面临着巨大挑战。微生物组分析涉及对咬痕中发现的微生物群落进行鉴定和定性,微生物组分析的最新进展为法医调查带来了一种前景广阔的工具。微生物组分析与传统的 DNA 分析相结合,可在法医调查中更准确地解释咬痕证据。本综述深入探讨了咬痕微生物组分析与法医 DNA 图谱分析的整合。它还探讨了基于微生物组的法医咬痕分析所面临的挑战和策略。
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引用次数: 0
Navigating the Complexity of Alternating Hemiplegia in Childhood: A Comprehensive Review. 驾驭儿童交替性偏瘫的复杂性:全面回顾。
IF 1.4 Q2 MEDICINE, GENERAL & INTERNAL Pub Date : 2024-07-30 DOI: 10.5041/RMMJ.10529
Jamir Pitton Rissardo, Nilofar Murtaza Vora, Yogendra Singh, Sweta Kishore, Ana Letícia Fornari Caprara

Alternating hemiplegia of childhood (AHC) is a complex neurodevelopmental disorder characterized by paroxysmal and transient events of unilateral or bilateral paresis, usually occurring before 18 months of age. Mutations in the ATP1A3 gene, mainly p.Asp801Asn, p.Glu815Lys, and p.Gly947Arg at the protein level, are found in around 80% of the individuals with AHC. Interestingly, these mutations reflect the degree of severity of the neurological symptoms (p.Glu815Lys > p.Asp801Asn > p.Gly947Arg). Some channels involved in this disorder are N-type voltage-gated calcium channels, ATP-sensitive potassium channels, and the sodium/calcium exchanger. In this context, the management of AHC should be divided into the treatment of attacks, prophylactic treatment, and management of comorbidities commonly found in this group of individuals, including epilepsy, attention-deficit/hyperactivity disorder, aggressive behavior, cognitive impairment, movement disorders, and migraine. The importance of an integrated approach with a multidisciplinary team, such as neuropsychologists and dietitians, is worth mentioning, as well as the follow-up with a neurologist. In the present study, we propose new diagnostic criteria for AHC, dividing it into clinical, laboratory, supporting, and atypical features. Also, we review the location of the mutations in the ATP1A3 protein of individuals with AHC, rapid-onset dystonia-parkinsonism (RDP) variants, and early infantile epileptic encephalopathy (variants with hemiplegic attack). We also include a section about the animal models for ATP1A3 disorders.

儿童交替性偏瘫(AHC)是一种复杂的神经发育障碍,其特征是阵发性和短暂性的单侧或双侧瘫痪,通常发生在 18 个月之前。约 80% 的 AHC 患者体内存在 ATP1A3 基因突变,主要是蛋白水平的 p.Asp801Asn、p.Glu815Lys 和 p.Gly947Arg。有趣的是,这些突变反映了神经症状的严重程度(p.Glu815Lys > p.Asp801Asn > p.Gly947Arg)。这种疾病涉及的一些通道包括 N 型电压门控钙通道、ATP 敏感钾通道和钠/钙交换通道。在这种情况下,AHC 的治疗应分为发作治疗、预防治疗和这类患者常见的合并症治疗,包括癫痫、注意力缺陷/多动障碍、攻击行为、认知障碍、运动障碍和偏头痛。值得一提的是,与神经心理学家和营养学家等多学科团队合作的综合方法以及神经科医生的随访都非常重要。在本研究中,我们提出了新的 AHC 诊断标准,将其分为临床特征、实验室特征、辅助特征和非典型特征。此外,我们还回顾了 AHC 患者、速发型肌张力障碍-帕金森病(RDP)变异型和早期婴儿癫痫性脑病(偏瘫发作变异型)患者 ATP1A3 蛋白突变的位置。我们还加入了有关 ATP1A3 疾病动物模型的部分。
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引用次数: 0
期刊
Rambam Maimonides Medical Journal
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