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Machine learning applications in stroke medicine:advancements,challenges,and future prospectives

Neural Regeneration Research 2024年第4期19卷 769-773页

作者： Mario Daidone Sergio Ferrantelli Antonino Tuttolomondo internal medicine and stroke care Ward Department of Health PromotionMother and Child CareInternal Medicine and Medical SpecialtiesUniversity of Palermo Molecular and Clinical medicine PhD Program University of Palermo

stroke is a leading cause of disability and mortality worldwide,necessitating the development of advanced technologies to improve its diagnosis,treatment,and patient *** recent years,machine learning techniques have emerged as promising tools in stroke medicine,enabling efficient analysis of large-scale datasets and facilitating personalized and precision medicine *** abstract provides a comprehensive overview of machine learning’s applications,challenges,and future directions in stroke *** introduced machine learning algorithms have been extensively employed in all the fields of stroke *** learning models have demonstrated remarkable accuracy in imaging analysis,diagnosing stroke subtypes,risk stratifications,guiding medical treatment,and predicting patient *** the tremendous potential of machine learning in stroke medicine,several challenges must be *** include the need for standardized and interoperable data collection,robust model validation and generalization,and the ethical considerations surrounding privacy and *** addition,integrating machine learning models into clinical workflows and establishing regulatory frameworks are critical for ensuring their widespread adoption and impact in routine stroke *** learning promises to revolutionize stroke medicine by enabling precise diagnosis,tailored treatment selection,and improved *** research and collaboration among clinicians,researchers,and technologists are essential for overcoming challenges and realizing the full potential of machine learning in stroke care,ultimately leading to enhanced patient outcomes and quality of *** review aims to summarize all the current implications of machine learning in stroke diagnosis,treatment,and prognostic *** the same time,another purpose of this paper is to explore all the future perspectives these techniques can provide in combating this disabling dis

关键词： cerebrovascular disease deep learning machine learning reinforcement learning stroke stroke therapy supervised learning unsupervised learning

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A retrospective analysis of carbapenem-resistant Acinetobacter baumannii infections in critically ill patients:Experience at a tertiary-care teaching hospital ICU

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Journal of Intensive medicine 2024年第2期4卷 181-186页

作者： Leyla Ferlicolak Neriman Defne Altintas Fugen Yoruk Department of internal medicine Division of Intensive care unit Ankara University Faculty of MedicineAnkaraTurkey Department of Infectious Diseases and Clinical Microbiology Ankara University Faculty of MedicineAnkaraTurkey

Background Acinetobacter baumannii is a clinically significant pathogen with a high incidence of multidrug resistance that is associated with life-threatening nosocomial ***,we aimed to provide an insight into the clinical characteristics and outcomes of a unique group of *** infections in which the isolates were resistant to carbapenems and most other antibiotic groups in a tertiary-care intensive care unit(ICU).Methods We performed a retrospective observational study in which records of patients hospitalized in the ICU between June 1,2021 and June 1,2023 were *** checked the clinical,laboratory,and microbiological records of all adult patients who had carbapenem-resistant ***(CRAB)*** antibiotic treatments and definitive antibiotic treatments after culture positivity and susceptibility test results were recorded.C-reactive protein(CRP)and procalcitonin levels and leukocyte counts were *** of ICU stay and 30-day mortality were defined as the outcome *** During the study period,57 patients were diagnosed with CRAB *** respiratory tract was the leading infection site(80.7%).In non-survivors,bloodstream infections(21.9%vs.4.0%P=0.05)and colistin-resistant(col-R)CRAB infections(43.8%vs.24.0%,P=0.12)were more common than in survivors,but these parameters were not statistically *** length of ICU stay was not different between survivors and ***,the rate of col-R among CRAB clinical isolates was 35.1%.The 30-day mortality in all patients with CRAB infection was 56.1%.Mortality in col-R CRAB and colistin-susceptible(col-S)CRAB infections was 70.0%and 48.6%,respectively(P=0.12).Prior carbapenem use was 56.1%.Prior colistin use before col-R and col-S CRAB infections was not significant(35.0%vs.27.0%,P=0.53).Conclusions Our study provides real-world data on highly resistant *** infections and shares the characteristics of infections with such resistant stra

关键词： Mortality Colistin-resi stant Gram-negative bacteria MDR Intensive care unit

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Importance of timely and adequate source control in sepsis and septic shock

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Journal of Intensive medicine 2024年第3期4卷 281-286页

作者： Jan J.De Waele Department of Intensive care medicine Ghent University HospitalGhentBelgium Department of internal medicine and Pediatrics Faculty of Medicine and Health SciencesGhent UniversityGhentBelgium

Source control is defined as the physical measures undertaken to eliminate the source of infection and control ongoing contamination, as well as restore anatomy and function at the site of infection. It is a key component of the management of patients with sepsis and septic shock and one of the main determinants of the outcome of infections that require source control. While not all infections may require source control, it should be considered in every patient presenting with sepsis;it is applicable and necessary in numerous infections, not only those occurring in the abdominal cavity. Although the biological rationale is clear, several aspects of source control remain under debate. The timing of source control may impact outcome;early source control is particularly relevant for patients with abdominal infections or necrotizing skin and soft tissue infections, as well as for those with more severe disease. Percutaneous procedures are increasingly used for source control;nevertheless, surgery—tailored to the patient and infection—remains a valid option for source control. For outcome optimization, adequate source control is more important than the strategy used. It should be acknowledged that source control interventions may often fail, posing a challenge in this setting. Thus, an individualized, multidisciplinary approach tailored to the infection and patient is preferable.

关键词： Sepsis Septic shock Source control Drainage Debridement

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Reporting quality evaluation of clinical practice guidelines for pulmonary nodules with the RIGHT checklist

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Chinese Medical Journal 2024年第5期137卷 625-627页

作者： Xuan Wu Wenqiang Wang Quncheng Zhang Ya Sun Nan Wei Li Yang Yuanjian Yang Huizhen Yang Haiyang Liu Xiaoju Zhang Department of Respiratory and Critical care medicine Zhengzhou University People’s HospitalHenan Provincial People’s HospitalZhengzhouHenan 450003China Department of internal medicine Academy of Medical ScienceZhengzhou UniversityZhengzhouHenan 450001China Department of internal medicine Xinxiang Medical UniversityXinxiangHenan 453003China

To the Editor:Pulmonary nodules are defined as localized opacities of up to 30 mm in diameter,surrounded by pulmonary parenchyma or located adjacent to the pleura.^([1])The ideal management for pulmonary nodules is to diagnose and treat malignant nodules as early as possible and minimize radiation exposures,based on the general *** practice guidelines(CPGs)always provide efficient recommendations based on systematic reviews of high-quality evidence and reporting to optimize patient care.^([2])Accumulating evidence shows that adherence to the guidelines improves patient outcomes.^([3])However,the reporting quality of CPGs seems poor.^([4])Several instruments have been generated to evaluate the quality of CPGs.

关键词： pulmonary Clinical clinical

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Glucagon-like peptide 1 agonists are potentially useful drugs for treating metabolic dysfunction-associated steatotic liver disease

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World Journal of Gastroenterology 2024年第30期30卷 3541-3547页

作者： Maurizio Soresi Lydia Giannitrapani Department of Health Promotion Sciences Maternal and Infant CareInternal Medicine and Medical Specialties(PROMISE)University of PalermoPalermo 90127Italy

In this editorial,we comment on Yin et al’s recently published Letter to the *** particular,we focus on the potential use of glucagon-like peptide 1 receptor agonists(GLP-1RAs)alone,but even more so in combination therapy,as one of the most promising therapies in metabolic dysfunction-associated steatotic liver disease(MASLD),the new definition of an old condition,non-alcoholic fatty liver disease,which aims to better define the spectrum of steatotic *** is well known that GLP-1RAs,having shown outstanding performance in fat loss,weight loss,and improvement of insulin resistance,could play a role in protecting the liver from progressive *** clinical trials have shown that,among GLP-1RAs,semaglutide is a safe,well-studied therapeutic choice for MASLD patients;however,most studies demonstrate that,while semaglutide can reduce steatosis,including steatohepatitis histological signs(in terms of inflammatory cell infiltration and hepatocyte ballooning),it does not improve *** of therapies with different but complementary mechanisms of action are considered the best way to improve efficiency and slow disease progression due to the complex pathophysiology of the *** particular,GLP-1RAs associated with antifibrotic drug therapy,dual glucose-dependent insulinotropic polypeptide(GIP)/GLP-1RA or GLP-1 and glucagon RAs have promoted greater improvement in hepatic steatosis,liver biochemistry,and non-invasive fibrosis tests than ***,although to date there are no definitive indications from international drug agencies,there is the hope that soon the therapeutic lines in the most advanced phase of study will be able to provide a therapy for MASLD,one that will certainly include the use of GLP-1RAs as combination therapy.

关键词： Non-alcoholic fatty liver disease Glucagon-like peptide 1 Semaglutide Liver fibrosis Therapy

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Reflections on COPD comorbidities

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Chinese Medical Journal 2024年第12期137卷 1504-1506页

作者： Zhenming He Yue Wang Lin Shan Yan Mou Yunhuan Liu Guanhua Ma Yanxu Wu Huili Zhu Jeffrey L.Curtis Shilei Cui Haiyan Ge Department of Pulmonary and Critical care medicine Huadong HospitalFudan UniversityShanghai 200040China Medical Service VA Ann Arbor Healthcare SystemAnn ArborMI 48105USA Pulmonary&Critical care medicine Division Department of Internal MedicineUniversity of MichiganAnn ArborMI 48109USA Graduate Program in Immunology University of MichiganAnn ArborMI 48109USA

To the Editor:Chronic obstructive pulmonary disease(COPD)is a common disease among the elderly,affecting over one-third of the elderly population *** progressive decline in lung function characteristic of COPD significantly impacts the quality of life and employability of affected individuals,resulting in a substantial direct and indirect socioeconomic *** frequently has comorbidities involving other organ *** all elderly COPD patients present with one or more comorbid conditions,collectively exacerbating health and economic *** viral and bacterial infections remain the most common triggers for COPD exacerbations(ECOPD).

关键词： morbid lung collective

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Sex and racial disparities in non-alcoholic fatty liver disease-related cardiovascular events: National inpatient sample analysis (2019)

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World Journal of Cardiology 2024年第3期16卷 137-148页

作者： Rupak Desai Ali Tariq Alvi Advait Vasavada Yashwitha Sai Pulakurthi Bhavin Patel Adil Sarvar Mohammed Shreyans Doshi Ikechukwu Ogbu Independent Researcher AtlantaGA 30079United States Department of internal medicine HCA Florida Westside HospitalPlantationFL 33324United States Department of internal medicine M.P.Shah Medical CollJamnagar 361008India Department of internal medicine Saint Michael Medical CenterNewarkNJ 07102United States Department of internal medicine Trinity Health Oakland HospitalPontiacMI 48341United States Department of internal medicine Central Michigan University College of MedicineSaginawMI 48602United States Department of internal medicine UCF College of Medicine HCA GME ConsortiumGainesvilleFL 32605United States Department of internal medicine Mountainview HospitalLas VegasNV 89108United States

BACKGROUND Non-alcoholic fatty liver disease(NAFLD)increases cardiovascular disease(CVD)risk irrespective of other risk ***,large-scale cardiovascular sex and race differences are poorly *** To investigate the relationship between NAFLD and major cardiovascular and cerebrovascular events(MACCE)in subgroups using a nationally representative united States inpatient *** We examined National Inpatient Sample(2019)to identify adult hospitalizations with NAFLD by age,sex,and race using ICD-10-CM *** and demographic characteristics,comorbidities,and MACCE-related mortality,acute myocardial infarction(AMI),cardiac arrest,and stroke were compared in NAFLD cohorts by sex and *** regression analyses were adjusted for sociodemographic characteristics,hospitalization features,and *** We examined 409130 hospitalizations[median 55(IQR 43-66)years]with *** was more common in females(1.2%),Hispanics(2%),and Native Americans(1.9%)than *** often reported non-elective admissions,Medicare enrolment,the median age of 55(IQR 42-67),and poor *** had higher obesity and uncomplicated diabetes but lower hypertension,hyperlipidemia,and complicated diabetes than *** had a median age of 48(IQR 37-60),were Medicaid enrollees,and had non-elective *** had greater diabetes and obesity rates than whites but lower hypertension and ***,all-cause mortality,AMI,cardiac arrest,and stroke were all greater in elderly individuals(Pcare.

关键词： Non-alcoholic fatty liver disease Cardiovascular disease Major cardiovascular and cerebrovascular events Sex/gender disparities Mortality

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Navigating the complex terrain of hepatitis B virus reactivation in the era of Bruton tyrosine kinase inhibitors

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World Journal of Gastroenterology 2024年第21期30卷 2748-2750页

作者： Wei-Nung Liu Ming-Shen Dai Felicia Lin Gen-Min Lin Department of medicine Tri-Service General HospitalTaipei 114Taiwan Division of Hematology/Oncology Department of Internal MedicineNational Defense Medical CenterTaipei 114Taiwan Community care Minnesota OncologyMinneapolisMN 55404United States Department of medicine Hualien Armed Forces General HospitalHualien City 970Taiwan

In this editorial,we offer a summary of the risk associated with hepatitis B reactivation(HBVr)in the setting of both solid and hematologic malignancies treated with Bruton tyrosine kinase(BTK)inhibitors,with insights derived from current ***,we emphasize the critical need for a framework regarding robust risk evaluation in patients undergoing such *** framework is essential for identifying those at increased risk of HBVr,enabling healthcare providers to implement proactive measures to prevent reactivation and ensure the safe administration of BTK inhibitor therapy.

关键词： Hepatitis B virus reactivation Bruton tyrosine kinase inhibitors Hematologic malignancies Solid tumors Prophylaxis guidelines

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Extracorporeal organ support for critically ill patients:Overcoming the past,achieving the maximum at present,and redefining the future

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World Journal of Critical care medicine 2024年第2期13卷 19-28页

作者： Panagiotis Papamichalis Katerina G Oikonomou Maria Xanthoudaki Asimina Valsamaki Apostolia-Lemonia Skoura Sophia K Papathanasiou Achilleas Chovas Intensive care unit General Hospital of LarissaLarissa 41221Greece Department of Transfusion medicine University Hospital of LarissaLarissa 41110Greece Department of internal medicine General Hospital of LarissaLarissa 41221Greece

Extracorporeal organ support(ECOS)has made remarkable progress over the last few *** replacement therapy,introduced a few decades ago,was the first available application of *** subsequent evolution of ECOS enabled the enhanced support to many other organs,including the heart[veno-arterial extracorporeal membrane oxygenation(ECMO),slow continuous ultrafiltration],the lungs(veno-venous ECMO,extracorporeal carbon dioxide removal),and the liver(blood purification techniques for the detoxification of liver toxins).Moreover,additional indications of these methods,including the suppression of excessive inflammatory response occurring in severe disorders such as sepsis,coronavirus disease 2019,pancreatitis,and trauma(blood purification techniques for the removal of exotoxins,endotoxins,or cytokines),have *** organ support therapy is crucial since a vast majority of critically ill patients present not with a single but with multiple organ failure(MOF),whereas,traditional therapeutic approaches(mechanical ventilation for acute respiratory failure,antibiotics for sepsis,and inotropes for cardiac dysfunction)have reached the maximum efficacy and cannot be improved ***,several issues remain to be clarified,such as the complexity and cost of ECOS systems,standardization of indications,therapeutic protocols and initiation time,choice of the patients who will benefit most from these interventions,while evidence from randomized controlled trials supporting their use is still ***,these methods are currently a part of routine clinical practice in intensive care *** editorial presents the past,present,and future considerations,as well as perspectives regarding these *** better understanding of these methods,the pathophysiology of MOF,the crosstalk between native organs resulting in MOF,and the crosstalk between native organs and artificial organ support systems when applied sequentially or simultaneously,will lead t

关键词： Kidney-liver replacement therapy Heart-lung support Blood purification Native–artificial organ crosstalk Multiple organ support therapy Extracorporeal organ support

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Disease clearance in ulcerative colitis:A new therapeutic target for the future

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World Journal of Gastroenterology 2024年第13期30卷 1801-1809页

作者： Syed Adeel Hassan Neeraj Kapur Fahad Sheikh Anam Fahad Somia Jamal Division of Digestive Disease and Nutrition University of KentuckyLexingtonKY 40536United States Department of Pathology and Laboratory medicine Montefiore Medical CenterAlbert Einstein College of MedicineNew YorkNY 10461United States Division of Primary care Essen HealthcareNew YorkNY 10457United States Department of internal medicine Karachi Medical and Dental CollegeKarachi 74700SindhPakistan

Advancements in murine modeling systems for ulcerative colitis have diversified our understanding of the pathophysiological factors involved in disease onset and *** has fueled the identification of molecular targets,resulting in a rapidly expanding therapeutic ***,management strategies have evolved from symptomatic resolution to well-defined objective endpoints,including clinical remission,endoscopic remission and mucosal *** the incorporation of these assessment modalities has permitted targeted intervention in the context of a natural disease history and the prevention of complications,studies have consistently depicted discrepancies associated with ascertaining disease status through clinical and endoscopic *** recommendations lack consideration of histological *** simultaneous achievement of clinical,endoscopic,and histologic remission has not been fully *** has laid the groundwork for a novel therapeutic outcome termed disease clearance(DC).This article summarizes the concept of DC and its current evidence.

关键词： Inflammatory bowel disease Ulcerative colitis Clinical remission Endoscopic remission Histological remission Mucosal healing Disease clearance

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