The American journal of the medical sciences最新文献

Background: Nonspecific symptoms and variability in radiographic reporting patterns contribute to a diagnostic delay of the diagnosis of pulmonary fibrosis. An attractive solution is the use of machine-learning algorithms to screen for radiographic features suggestive of pulmonary fibrosis. Thus, we developed and validated a machine learning classifier algorithm (ScreenDx) to screen computed tomography imaging and identify incidental cases of pulmonary fibrosis.

Methods: ScreenDx is a deep learning convolutional neural network that was developed from a multi-source dataset (cohort A) of 3,658 cases of normal and abnormal CT's, including CT's from patients with COPD, emphysema, and community-acquired pneumonia. Cohort B, a US-based cohort (n=381) was used for tuning the algorithm, and external validation was performed on cohort C (n=683), a separate international dataset.

Results: At the optimal threshold, the sensitivity and specificity for detection of pulmonary fibrosis in cohort B was 0.91 (95% CI 88-94%) and 0.95 (95% CI 93-97%), respectively, with AUC 0.98. In the external validation dataset (cohort C), the sensitivity and specificity were 1.0 (95% 99.9-100.0) and 0.98 (95% CI 97.9-99.6), respectively, with AUC 0.997. There were no significant differences in the ability of ScreenDx to identify pulmonary fibrosis based on CT manufacturer (Phillips, Toshiba, GE Healthcare, or Siemens) or slice thickness (2 mm vs 2-4 mm vs 4 mm).

Conclusion: Regardless of CT manufacturer or slice thickness, ScreenDx demonstrated high performance across two, multi-site datasets for identifying incidental cases of pulmonary fibrosis. This suggest that the algorithm may be generalizable across patient populations and different healthcare systems.

A bronchobiliary fistula (BBF) is a rare condition that occurs from an abnormal communication between the biliary tree and bronchial airway. Historically, BBFs resulted as complications from certain traumas, malignancy, or infection; however, iatrogenic etiology is becoming more common in the setting of advancing therapeutics. We present two such cases of patients with bronchobiliary fistulas and subsequent treatment that arose after medical treatment for underlying malignancies. Due to there being no current guidelines on the treatment approach for bronchobiliary fistulas, a literature review spanning over forty years was performed to identify treatment modalities and etiologies documented in the past. The review showed that regardless of the underlying cause of the BBF, a dual therapy approach or multi-modal therapy approach had a higher rate of success than a single intervention approach.

Background: Uric acid (UA) has been associated with an increased incidence of psoriasis (PsO) and psoriatic arthritis (PsA). Clinical evidence shows that patients with PsO often have elevated serum UA levels, contributing to HUA and gout. This study investigated the bidirectional relationships among hyperuricemia (HUA), gout, PsO, and PsA through a systematic review and meta-analysis.

Objectives: To evaluate the associations between PsO, PsA, and the risks of HUA and gout.

Materials and methods: PubMed, Embase, CNKI, and Wanfang databases were searched for relevant literature published from databases inception until February 2024.Quality was assessed using the Newcastle-Ottawa Scale (NOS).

Results: A total of 8 studies were included. Eligible studies included case-control, cohort, and cross-sectional studies.The meta-analysis showed that patients with PsO had a 2.56-fold higher risk of HUA [OR = 2.56, 95% CI (1.82-3.59)] while PsA patients had a 3.56-fold higher risk of HUA [OR = 3.56, 95% CI (2.04-6.20)]. The risk of gout was 4.95 times higher in PsA [OR = 4.95, 95% CI (2.72-9.01)] and 1.95 times higher in PsO [OR = 1.95, 95% CI (1.02-3.75)].

Conclusion: This study demonstrated an bidirectional relationship between psoriasis, psoriatic arthritis and gout or hyperuricemia, highlighting the need for clinicians to consider these conditions in managing the studied diseases.

Introduction: The best timing for evaluation of anemia is not well defined and the clinical yield of performing workup during non-anemia-related hospitalization is unclear. We aimed to evaluate the prognostic value of inpatient laboratory anemia evaluation.

Methods: This was a retrospective propensity-matched cohort study between the years 2013-2022 in Rabin Medical Center Israel. We included all patients admitted for non-anemia-related reasons and were found to be anemic. Patients were divided into groups based on basic laboratory anemia evaluation. Outcomes were cancer diagnosis, colonoscopy rate, duration of admission, and all-cause mortality. Multivariable analysis with competing risk of death was performed and a p-value of 5% was considered significant.

Results: Following matching, 4,238 patients were included in the evaluation group compared to 7,680 in the no-evaluation group. In-patient laboratory anemia evaluation was associated with gastrointestinal cancer and any cancer diagnosis - HR of 1.53 (95% CI, 1.15- 2.05) and HR of 1.23 (95% CI, 1.11-1.37) respectively. The rate of colonoscopy was higher, and anemia prevalence was lower in the evaluation group after 1-year follow-up. Intravenous iron treatment was more prevalent in the evaluation group. The laboratory anemia evaluation prolonged the admission (5 vs 4 days). There was no difference in the all-cause mortality across the 10-year follow-up.

Conclusion: Inpatient anemia evaluation with basic laboratory tests was found to be associated with an increase in outpatient gastrointestinal cancer diagnosis and showed clinical and diagnostic advantages. For patients who can benefit from early gastrointestinal cancer diagnosis, admission holds a valid opportunity to initiate the evaluation.

Objectives: To determine the epidemiology and prognosis of sepsis in cancer patients and the influence of sepsis on the mortality of cancer patients.

Methods: In this multicenter, prospective, observational study, cancer patients hospitalized without sepsis followed up until discharge or a maximum of 90 days were included. The incidence of sepsis in the follow-up period, risk factors for sepsis, risk factors for 28-day mortality in patients with sepsis and 90-day mortality in the entire group were determined.

Results: During the study, 790 cancer patients were included. Sepsis developed in 72 patients (9.1%) during the follow-up. Older age, hospitalization due to any infection, graft versus host diseases (GVHD), the presence of a urethral catheter, and previous bacterial infection in the last three months were risk factors of sepsis. Among all cancer patients, sepsis was found to be the most important factor influencing 90-day mortality (OR 13.42(1.79-6.83)). Mortality among the sepsis cohort was independently associated with an infection with a carbapenem-resistant bacterium (OR 15.47(1.45-64.17)), appropriateness of empirical treatment (OR 5.02 (0.17-7.61) and having a clinical improvement on the fifth day of the treatment (OR 10.58(0.39-28.25).

Conclusions: Sepsis was documented in one out of 11 hospitalized cancer patients and the mortality rate increases 13-fold when sepsis develops. Invasive devices, GVHD, and previous bacterial infections were related to sepsis and antibiotic resistance were the most important driver for mortality. Antimicrobial stewardship, rational use of catheters (if necessary, in accordance with asepsis/antisepsis, short-term use) is important to save lives in cancer patients.

Background: In end-stage renal disease (ESRD), reduced renal function affects medication response and clearance, increasing risk of adverse drug reactions. Renal disease is a risk factor for poor prognosis in severe cutaneous adverse reactions (SCARs). The effects of SCARs in ESRD patients are less understood.

Methods: This retrospective analysis of the United States Renal Data System (USRDS) evaluated whether SCARs are an independent risk factor for mortality in ESRD patients, controlling for demographic and clinical factors, including malnutrition, sepsis, pneumonia, secondary autoimmune conditions and Charlson Comorbidity Index (CCI). We examined whether Stevens-Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) or drug reaction with eosinophilia and systemic symptoms (DRESS) was associated with all-cause mortality in subjects enrolled in the USRDS from 2005-2018.

Results: Patients with DRESS were more often female (OR=1.37), with catheter (OR=1.08) or graft (OR=1.15) access and a higher CCI (OR=1.21). Those with SJS/TEN were more likely to be black (OR=2.43) or other race (OR=2.06) and female (OR=1.55), with catheter access (OR=1.36) and a higher CCI (OR=1.18). DRESS and SJS/TEN were associated with higher risk of malnutrition (OR=1.64, OR=2.61), sepsis (OR=1.93, OR=3.38), pneumonia (OR=1.82, OR=1.80), and secondary autoimmune conditions (OR=1.47, OR=1.47). Patients with DRESS (HR=2.05) or SJS/TEN (HR=3.12) had increased mortality across 12 months following diagnosis. Increasing age (HR=1.04), hemodialysis (HR=1.76), catheter (HR=2.58) or graft (HR=1.52) access, malnutrition (HR=1.07), and sepsis (HR=1.26) increased mortality risk.

Conclusion: ESRD patients' risk for SCARs varied by age, race, sex, comorbidities, and dialysis modality. Patients with a SCAR had increased mortality across 12 months following diagnosis.

William Osler, the founding Chair of Medicine at the Johns Hopkins College of Medicine, left for Oxford in 1905. He delivered a valedictory lecture February 1905 at Johns Hopkins in which he referred to a novel by Anthony Trollope called The Fixed Period. Osler stated that almost all important work was done prior to the age of 40 and the retirement age should be 60, at least for professors. In jest, he said that perhaps men should be euthanized by chloroform at age 60, which he recalled as the plot of the novel. The so-called Fixed Period address created a media controversy with numerous articles decrying Osler. Osler's reaction to the controversy has not been commonly documented. We examined an unpublished manuscript by Osler's student Francis Packard that contributes to the knowledge of Osler's feeling about The Fixed Period address and the reaction to it. In addition, for the first time we examine the extent and geography of newspaper articles about Olser's Fixed Period address.

Background: Empagliflozin was associated with a slower progression of kidney disease. We aimed to investigate the effect of empagliflozin on alleviating complement over-activation in DKD.

Methods: 100 patients with DKD were recruited, they were divided into three groups: group I, 50 patients type 2 diabetes mellitus (T2DM) with chronic kidney disease (CKD) stage I-II; group II, 50 patients T2DM with CKD stage III; and the control group, which included 50 healthy, age-matched volunteers. Groups I and II received empagliflozin, while Group III received a placebo. Before and after six months on empagliflozin, the patients in both groups underwent tests for serum creatinine, uric acid, fasting blood glucose (FBG), glycated hemoglobin (HbA1c) urine albumin/creatinine ratio, and blood levels of human complement fragment 4d (C4d).

Results: The optimal cut off value of C4d was ascertained to be 17.55 U/L with a sensitivity of about 68 % and specificity of about 68 %. There were statistically significant differences in Group I after empagliflozin treatment (p < 0.001): HbA1c (6.5 to 5.7), C4d (16 to 7U/l). Whereas serum creatinine (1.9 to 1.7mg/dl), HbA1c (9.9 to 6.7 %), urine albumin/creatinine ratio (115 to 49), and C4d (18 to 11U/l) were significantly improved in Group II after using empagliflozin (p < 0.001). There was a negative correlation between C4d levels and the percent change in uric acid (r -0.647-, p < 0.001).

Conclusion: Empagliflozin may have a beneficial effect on mitigating complement over-activation in DKD. Further research is needed to confirm our findings.

Esophageal squamous cell carcinoma (SCC) is a highly lethal malignancy with a low survival rate, often presenting at an advanced stage. Cutaneous metastasis from esophageal SCC is exceedingly rare, affecting less than 1 % of cases, and is associated with a poor prognosis. This review particularly focuses on facial metastasis and discusses the clinical presentation, diagnostic challenges, and management of cutaneous metastases. The variability in clinical presentation often leads to misdiagnosis, delaying appropriate treatment. Histopathological examination and immunohistochemical staining are crucial for accurate diagnosis. Management involves a combination of local and systemic therapies, tailored to the patient's overall health and disease extent. This topic emphasizes the need for vigilance and thorough diagnostic workups in patients with unusual skin lesions and highlights the importance of multidisciplinary care in optimizing treatment outcomes for patients with advanced esophageal cancer.