World journal of methodology最新文献

Background: Irritable bowel syndrome (IBS) is a prevalent functional gastrointestinal (FGITD) disorder, the diagnosis is based on Rome Criteria and other subjective tools. Because IBS overlaps with other FGITD and organic diseases, and the subjective tools do not apply to patients with cognitive decline, objective diagnostic tools are important in this category of patients.

Aim: To discuss the role of imaging in IBS diagnosis.

Methods: We systematically searched three databases for articles published in the English language with no limitation to a specific period. The literature search was conducted in June and July 2024. The keywords used are IBS and functional bowel disorders, computed tomography, Magnetic Resonance Imaging, functional brain magnetic resonance imaging (MRI), and static brain MRI, and were linked with the terms ^"AND" and ^"OR". Out of the 679 articles, 578 remained after duplication removal. However, 50 full texts were used in the review.

Results: Magnetic resonance imaging is superior due to its sensitivity, lack of radiation exposure, and lack of need for bowel preparation. Patients with IBS had smaller colonic and rectal volumes compared to healthy controls and functional constipation. Dynamic and static Magnetic Resonance Imaging of the brain showed increased activity, thinning, and increased volumes in specific areas of pain modulation. The above abnormalities are not uniform and vary significantly according to the type of IBS, the duration and intensity of symptoms, gender, and culture.

Conclusion: Magnetic resonance imaging shows smaller colonic and rectal volumes, and increased activity, thinning, and increased volumes in specific areas of pain modulation. Large trials incorporating all above limitations are needed.

In this article, artificial intelligence (AI) usage and its benefits in medicine are reviewed in the oncology, radiology, and cardiology fields. The relevant literature was searched in PubMed and Google Scholar using the words "Artificial Intelligence", "Artificial Intelligence in Medicine", "Artificial Intelligence in Cardiology", "Artificial Intelligence in Oncology", and "Artificial Intelligence in Radiology" for the last 10 years. This article covers the AI's current implications in daily practice, discussing its advantages and disadvantages based on the findings. AI's effect in medicine for reducing workload, diagnosis, time management, and drug dosing is going to be reviewed especially in radiology, oncology, and cardiology fields as well as general usage of AI in addition to important highlights. Lastly, this minireview evaluates the current challenges of AI technology in medicine and how clinicians should work with this emerging technology.

Background: Massive rotator cuff tears (RCTs) result in impaired shoulder function and quality of life. These tears lead to structural changes in the rotator cuff muscles, which compromise recovery after repair and increase re-tear rates.

Aim: To investigate the potential inhibitory effects of alpha-tocopherol (vitamin E) and OTR-4131 on muscle atrophy, fatty infiltration, and fibrosis in rotator cuff muscles following a massive RCT using a Wistar rat model, and establish a standardized methodology for evaluating potential therapeutic agents.

Methods: This protocol outlines a controlled animal study using 40 male Wistar rats, randomized into five groups. The experimental groups will receive either systemic administration of alpha-tocopherol or local administration of OTR-4131 via intramuscular injection into the supraspinatus and infraspinatus muscles. Two sham groups will receive systemic and local saline injections respectively, while a control group will undergo no intervention. The interventions will be administered after surgical transection of the supraspinatus and infraspinatus tendons. Outcomes will be assessed via wet muscle weight measurements, muscle fiber diameter, fatty infiltration percentage, and fibrosis evaluation using histological methods.

Results: The study anticipates that alpha-tocopherol and OTR-4131 will reduce muscle atrophy, fatty infiltration, and fibrosis compared to control and sham groups, supporting their potential protective role in rotator cuff muscle degeneration.

Conclusion: The results are expected to improve the understanding on the role of alpha-tocopherol and OTR-4131 in rotator cuff muscle protection after massive RCT and may serve as a foundation for further preclinical and clinical research aimed at improving rotator cuff repair outcomes.

Background: Autoimmune autonomic ganglionopathy (AAG), formerly known as acute pandysautonomia, is a rare, acquired, antibody-mediated, potentially curable autonomic disorder that presents with diffuse autonomic failure. High levels of anti-ganglionic nicotinic acetylcholine receptor (gAChR) serum antibodies are detected in approximately 50% of AAG cases, confirming the diagnosis.

Case summary: We present the case of a 68-year-old man who developed autonomic failure gradually over a 2-year period. Recently, the patient was unable to stand upright for more than a few seconds before fainting. Additionally, he presented with decreased sweating, dry mouth, urinary retention, early satiety, weight loss, bloating, constipation, and erectile dysfunction. Neurological examination revealed dilated pupils that were unresponsive to light. Deep tendon reflexes were absent or diminished. Serologic evaluation revealed the presence of gAChR autoantibodies. An orthostatic hypotension test yielded a positive result. The patient did not respond to symptomatic therapy, including midodrine, fludrocortisone and atomoxetine. Second-line therapy with immunoadsorption produced a noticeable clinical improvement; however, orthostatic hypotension persisted. Sequential rituximab infusion therapy successfully led to a significant improvement in symptoms.

Conclusion: Our case report supports the benefit of combined immunomodulatory therapy for refractory AAG cases that are unresponsive to single-agent treatment.

Background: Hyponatremia is the most common electrolyte imbalance, however the prognostic significance of hyponatremia in peripartum cardiomyopathy (PPCM) remains unclear.

Aim: To assess the prognostic significance of hyponatremia in PPCM patients.

Methods: We consecutively recruited patients with PPCM from 14 sites in Nigeria and followed them up for a median of 18 months. Serum sodium was measured at baseline, and patients with hyponatremia (< 135 mmol/L) were compared with those with normal sodium levels. Cox proportional hazards regression models were developed to identify factors associated with all-cause mortality.

Results: Of the 191 PPCM patients recruited, 90 (47.1%) had hyponatremia at presentation. All-cause mortality among the hyponatremic patients (24/90; 26.7%) was significantly higher than among patients with normal serum sodium (7/101; 6.9%) (P-value < 0.001). In the Cox proportional hazards regression model, hyponatremia was independently associated with an increased risk of all-cause mortality [hazard ratio: 3.18 (95% confidence interval: 1.35-7.52; P = 0.008)], as were hypotension (systolic blood pressure < 100 mmHg) [2.22 (1.03-4.79); P = 0.043] and left ventricular ejection fraction (LVEF) < 25% [3.14 (1.47-6.73), P = 0.003].

Conclusion: Hyponatremia was common in our cohort of PPCM patients, and was independently associated with a threefold increased risk for all-cause mortality. Hypotension and a LVEF below 25% at presentation were also independent predictors of mortality.

Background: Atrial fibrillation (AF) remains the most common cardiac arrhythmia. The safety of endoscopic retrograde cholangiopancreatography (ERCP) in patients with AF remains largely unknown.

Aim: To analyze the effect of AF on hospital outcomes in patients undergoing ERCP.

Methods: We performed a retrospective cohort study using the Nationwide Inpatient Sample database. Adult patients with AF who underwent an inpatient ERCP were identified, then stratified by timing of ERCP, via international classification of diseases-10 codes. The primary outcome was all-cause in-hospital mortality. Secondary outcomes, including resource utilization, were assessed. Statistical analysis was performed using STATA software.

Results: Of the 433245 patients that underwent an ERCP, 49615 had a diagnosis of AF. Patients with AF had a significantly higher in-hospital mortality compared to those without AF [3.82% vs 1.13%, odds ratio (OR) = 1.93, P < 0.01]. AF was significantly associated with increased hospital stay (+1.71 days), hospital charges ($21210), shock (OR = 2.17), sepsis (OR = 1.34), intensive care unit admission (OR = 2.41), acute kidney injury (OR = 1.51), as well as a decreased likelihood of discharge to home (OR = 0.59), (all with P < 0.01). These results were consistent after propensity score matching. Upon subgroup analysis, patients with AF, whom underwent ERCP > 72 hours, had worse outcomes including higher in-hospital mortality (adjusted OR = 1.47, P < 0.01).

Conclusion: By way of this large, national analysis it appears AF is associated with significantly worse hospitalization outcomes, inducing increased mortality, in those undergoing ERCP. Further prospective investigation is warranted to potentially guide clinical recommendations for patients with AF undergoing ERCP in this setting.

During restorative dental procedures, complete control over the operative site is critical for patient comfort, safety, and the operator's access and visibility. The success of a fixed prosthesis depends on accurate impression making of the prepared finish lines on the abutment teeth. To optimise long-term outcomes for the fixed restoration, gingival retraction techniques should be used to decrease the marginal discrepancy among the restoration and the prepared abutment. Accurate marginal positioning of the restoration along the prepared finish line of the abutment is essential for therapeutic, preventive, and aesthetic purposes.

Artificial intelligence (AI), encompassing machine learning and deep learning, is being extensively used in medical sciences. It is slated to positively impact the diagnosis and prognostication of various diseases. Deep learning, a subset of AI, has been instrumental in diagnosing diabetic retinopathy (DR), diabetic macular edema, glaucoma, age-related macular degeneration, and numerous other ocular diseases. AI performs equally well in the early prediction of glaucoma and age-related macular degeneration. Integrating AI with telemedicine promises to improve healthcare delivery, although challenges persist in implementing AI algorithms, especially in developing countries. This review provides a comprehensive summary of AI, its applications in ophthalmology, particularly DR, the diverse algorithms utilized for different ocular conditions, and prospects for the future integration of AI in eye care.

Colorectal polyps remain a significant health concern because they can develop into cancer. Therefore, accurate assessment and diagnosis of polyps, along with appropriate treatment decisions, are crucial in preventing complications or malignant transformation. Some polyps are classified as complex polyps, which means they fail to elevate due to a scar from a previously removed polyp or can be determined by a scoring system like the size/morphology/site/access score, which considers factors like site, morphology, size, and access. Management of complex colorectal polyps involves various options, including endoscopic and surgical approaches. Endoscopic mucosal resection (EMR) may be challenging in scarred polyps, as inadequate lifting can result in incomplete resection or recurrence. As a more advanced alternative, endoscopic submucosal dissection (ESD) is suitable for larger lesions, enabling en-bloc resection even in complex cases with EMR. However, ESD requires expertise and is more time-consuming than EMR, often necessitating hospitalization due to its complexity. Endoscopic full-thickness resection could be a viable alternative for managing scarred polyps. Endoscopic powered resection, either alone or in combination with other modalities, can also be used to achieve less extensive resection. Managing complications during the procedure or post-procedurally is equally important, as bleeding or perforations can be fatal. Careful patient selection based on individual profiles and risk factors, along with the identification of any signs of malignancy, is crucial before treatment to avoid negative post-treatment outcomes.

The article by Chauhan et al highlights the transformative potential of magnification tools in improving precision and outcomes across various dental specialties. While the authors discuss the advantages of magnification, they do not address the potential integration of artificial intelligence (AI) with magnification devices to further enhance diagnostic and therapeutic efficiency. This letter explores the synergy of AI with magnification tools, emphasizing its applicability in image-guided diagnostics, workflow optimization, and personalized treatment planning. The integration of AI and magnification also paves the way for personalized, data-driven treatment strategies, marking a significant evolution in dental care. However, it is important to acknowledge the limitations and challenges associated with AI, such as data privacy concerns, algorithmic biases, and the need for robust validation before clinical implementation. This discussion underscores the need for interdisciplinary research to realize this potential.