Pulmonary tuberculosis with hypercalcemia

An 80-year-old man was referred to our hospital for further examination of fever, cough and left pleural effusion. The laboratory findings showed acute inflammation, and the elevation of albumin-corrected serum calcium and 1,25-dihydroxyvitamin D3. A chest CT revealed centrilobular particulate opacity in the bilateral lung fields and left pleural effusion, indicating acute hypercalcemia and hypervitaminosis D associated with pulmonary tuberculosis. By the confirmation of Mycobacterium tuberculosis on polymerase chain reaction and cultures of the sputum and pleural effusion, a diagnosis of pulmonary tuberculosis was made. The patient successfully completed a 9-month course of the anti-tuberculosis treatment, and bilateral infiltrative shadows and left pleural effusion in chest X-ray disappeared. Symptoms progressively improved and serum level of albumin-corrected calcium and 1,25-dihydroxyvitamin D3 eventually normalized. While pulmonary tuberculosis is an infrequent cause of hypercalcemia, it should be considered in patients with hypercalcemia and elevated serum level of 1,25-dihydroxyvitamin D3

Enhancing the Driver's Comprehension of ADS's System Limitations: An HMI for Providing Request-to-Intervene Trigger Information

Level 3 automated driving systems (ADS) have attracted significant attention and are being commercialized. A Level 3 ADS prompts the driver to take control by requesting to intervene (RtI) when its operational design domain (ODD) or system limitations are exceeded. However, complex traffic situations may lead drivers to perceive multiple potential triggers of RtI simultaneously, causing hesitation or confusion during take-over. Therefore, drivers must clearly understand the ADS's system limitations to understand the triggers of RtI and ensure safe take-over. In this study, we propose a voice-based HMI for providing RtI trigger cues to help drivers understand ADS's system limitations. The results of a between-group experiment using a driving simulator showed that incorporating effective trigger cues into the RtI enabled drivers to comprehend the ADS's system limitations better and reduce collisions. It also improved the subjective evaluations of drivers, such as the comprehensibility of system limitations, hesitation in response to RtI, and acceptance of ADS behaviors when encountering RtI while using the ADS. Therefore, enhanced comprehension resulting from trigger cues is essential for promoting a safer and better user experience using ADS during RtI

Hydrogen-enhanced creep deformation of SUY-1 pure iron

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Liver Sarcoidosis with Unique MRI Images Using Gadolinium Ethoxybenzyl Diethylenetriamine Pentaacetic Acid

Sarcoidosis is a systemic disease characterized by the formation of non-caseating granulomas in multiple organs. In the diagnosis of sarcoidosis, imaging modalities such as ultrasonography, computed tomography (CT) and magnetic resonance imaging (MRI) are useful;however, there are few reports of MRI imaging using gadolinium ethoxybenzyl diethylenetriamine pentaacetic acid (Gd-EOB) MRI. A 46-year-old Japanese female with suspected pulmonary sarcoidosis was admitted to our hospital because low-density mottles in the liver were observed incidentally by chest CT. The low-density mottles were not enhanced at the arterial phase or portal phase by abdominal CT and MRI, and decreased uptake was observed in the hepatobiliary phase of Gd-EOB MRI. No hematological disorder was observed except for a slight increase of biliary enzymes. The lesion was diagnosed as liver sarcoidosis by the liver biopsy. Since the patient refused steroid therapy, we prescribed ursodeoxycholic acid (UDCA). 600mg/day. The serum levels of biliary enzymes were normalized and the abdominal CT findings gradually improved after the initiation of UDCA medication. Gd-EOB MRI showed unique hypointense areas in the liver at the hepatobiliary phase, which might be useful in the diagnosis of liver sarcoidosis

Safety and Efficacy of Radiofrequency Ablation with Artificial Ascites for Hepatocellular Carcinoma

The artificial ascites technique is often used during radiofrequency ablation (RFA) for hepatocellular carcinoma (HCC) treatment because it prevents visceral damage and improves visualization by minimizing interference of the lungs and mesentery. This study determined the efficacy and safety of RFA using the artificial ascites technique in HCC patients. We examined 188 HCC patients who were treated by RFA and fulfilled the Milan criteria. Treatment outcomes (complete ablation rate, local recurrence rate, complication rate, liver function including total bilirubin level, alanine aminotransferase level, albumin level, and prothrombin time) were compared among patients divided into 3 groups based on the volume of artificial ascites injected:GroupⅠ (n＝86), no artificial ascites injected;GroupⅡ (n＝35), ＜1,000ml artificial ascites injected;and Group Ⅲ (n＝67), ＞1,000ml artificial ascites injected. No significant difference was observed in complete ablation or local recurrence rates among the 3 groups, or in the extent of liver function damage after RFA. Artificial ascites disappeared within 7 days; additional diuretics were needed only in 5 (all from Group Ⅲ) of 102 patients. No serious complications such as intestinal perforation or intraperitoneal bleeding were observed. Thus, we found that artificial ascites injection during RFA is effective and safe, and can be used to prevent major procedural complications

Oversampling effect in pretraining for bidirectional encoder representations from transformers (BERT) to localize medical BERT and enhance biomedical BERT

Wada S., Takeda T., Okada K., et al. Oversampling effect in pretraining for bidirectional encoder representations from transformers (BERT) to localize medical BERT and enhance biomedical BERT. Artificial Intelligence in Medicine 153, 102889 (2024); https://doi.org/10.1016/j.artmed.2024.102889.Background: Pretraining large-scale neural language models on raw texts has made a significant contribution to improving transfer learning in natural language processing. With the introduction of transformer-based language models, such as bidirectional encoder representations from transformers (BERT), the performance of information extraction from free text has improved significantly in both the general and medical domains. However, it is difficult to train specific BERT models to perform well in domains for which few databases of a high quality and large size are publicly available. Objective: We hypothesized that this problem could be addressed by oversampling a domain-specific corpus and using it for pretraining with a larger corpus in a balanced manner. In the present study, we verified our hypothesis by developing pretraining models using our method and evaluating their performance. Methods: Our proposed method was based on the simultaneous pretraining of models with knowledge from distinct domains after oversampling. We conducted three experiments in which we generated (1) English biomedical BERT from a small biomedical corpus, (2) Japanese medical BERT from a small medical corpus, and (3) enhanced biomedical BERT pretrained with complete PubMed abstracts in a balanced manner. We then compared their performance with those of conventional models. Results: Our English BERT pretrained using both general and small medical domain corpora performed sufficiently well for practical use on the biomedical language understanding evaluation (BLUE) benchmark. Moreover, our proposed method was more effective than the conventional methods for each biomedical corpus of the same corpus size in the general domain. Our Japanese medical BERT outperformed the other BERT models built using a conventional method for almost all the medical tasks. The model demonstrated the same trend as that of the first experiment in English. Further, our enhanced biomedical BERT model, which was not pretrained on clinical notes, achieved superior clinical and biomedical scores on the BLUE benchmark with an increase of 0.3 points in the clinical score and 0.5 points in the biomedical score. These scores were above those of the models trained without our proposed method. Conclusions: Well-balanced pretraining using oversampling instances derived from a corpus appropriate for the target task allowed us to construct a high-performance BERT model

Stapler insertion angle toward the esophagus reduces the incidence of early postoperative Roux stasis syndrome after distal gastrectomy in minimally invasive surgery

Background Roux stasis syndrome (RSS) after Roux-en-Y (RY) reconstruction significantly prolongs the hospital stay and decreases the quality of life. The purpose of the present study was to evaluate the incidence of RSS in patients who underwent distal gastrectomy for gastric cancer and to identify the factors related to the development of RSS after mechanical RY reconstruction in minimally invasive surgery (MIS). Methods This study included 134 patients who underwent distal gastrectomy in MIS with mechanical RY anastomosis. RSS was defined as the presence of symptoms such as nausea, vomiting, or abdominal fullness, and the confirmation of delayed gastric emptying on imaging or gastrointestinal fiber testing. Clinical data were checked, including body mass index, operative procedure, age, sex, operative time, blood loss volume, extent of lymph node dissection, final stage, stapler insertion angle, method of entry hole closure. The relationship between the incidence of RSS and these factors was analyzed. Results RSS occurred in 24 of 134 patients (17.9%). RSS occurred significantly more frequently in patients with D2 lymphadenectomy than in patients with D1 + lymphadenectomy (p = 0.04). All patients underwent side-to-side anastomosis via the antecolic route. The incidence of RSS was significantly greater in patients with a stapler insertion angle toward the greater curvature (n = 20, 22.5%) versus the esophagus (n = 4, 8.9%) (p = 0.04). The multivariate logistic regression model revealed that the stapler insertion angle to the greater curvature is identified as independent risk factor for RSS (OR 3.23, 95%Cl 1.01–10.3, p = 0.04). Conclusion Stapler insertion angle toward the esophagus may reduce the incidence of early postoperative RSS rather than toward the greater curvature