1,721,020 research outputs found
New perspectives on the use of artificial intelligence in the ultrasound evaluation of lung diseases
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Aspirin, platelets, and cancer: The point of view of the internist.
No full textGrowing evidence suggests the beneficial effect of aspirin against some types of cancer, particularly of the gastrointestinal tract, and it has been provided for an effect both in cancer prevention as well as in survival improvement of cancer patients. Aspirin benefits increase with duration of treatment, especially after 10years of treatment. The inhibition of platelet activation at sites of gastrointestinal mucosal lesions could be the primary mechanism of action of low-dose aspirin. Indeed, the formation of tumor cell-induced platelet aggregates may favor immune evasion, by releasing angiogenic and growth factors, and also by promoting cancer cell dissemination. Moreover, platelets may contribute to aberrant COX-2 expression in colon carcinoma cells, thereby contributing to downregulation of oncosuppressor genes and upregulation of oncogenes, such as cyclin B1. Platelet adhesion to cancer cells leads also to an increased expression of genes involved in the EMT, such as the EMT-inducing transcription factors ZEB1 and TWIST1 and the mesenchymal marker vimentin. The aspirin-mediated inactivation of platelets may restore antitumor reactivity by blocking the release of paracrine lipid and protein mediators that induce COX-2 expression in adjacent nucleated cells at sites of mucosal injury. Thus, recent findings suggest interesting perspectives on "old" aspirin and NSAID treatment and/or "new" specific drugs to target the "evil" interactions between platelets and cancer for chemoprevention
Coagulation at the crossroads of the communicable/non-communicable disease dyad: The case of pneumonia
No full textUltrasound, contrast-enhanced ultrasound and pyelonephritis: A narrative review
Full text linkAcute pyelonephritis (APN) is a bacterial infection resulting in kidney inflam-mation, typically arising as a complication of an ascending urinary tract infection that ascends from the bladder to the kidneys. Clinical diagnosis is generally based on clinical and laboratory findings. Recent guidelines recommend not performing diagnostic imaging unless a complicated APN is suspected or the infection affects high-risk patients such as the elderly, immunocompromised individuals, or diabetics. Contrast-enhanced ultrasound (CEUS) is a valuable tool in both the diagnosis and follow-up of APN. It aids in distinguishing small simple nephritic involvement from abscess complications and monitoring their evolution over time during antibiotic therapy. Given its lack of ionizing radiation and nephrotoxicity, CEUS is a valid diagnostic modality for approaching and monitoring pyelo-nephritis, improving early identification and characterization of inflammatory lesions. This review aims to summarize the main evidence on the use of ultrasound and CEUS in the diagnosis of APN and its follow-up
Predictive role of microvesicles in cirrhotic patients: A promised land or a land of confusion? A narrative review
Full text linkMammalian cells release several membrane-enclosed vesicles called extracellular vesicles. Those vesicles can contain several molecules such as proteins, DNA and various RNA. Therefore, extracellular vesicles can act as a target delivery system and exert multiple biological effects. Several works demonstrated that extracellular vesicles are increased or dysregulated in patients with cirrhosis, and they can be predictive of disease progression, complications and mortality. This review aims to summarize and highlight the role of extracellular vesicles in the cirrhotic patient and how they correlate with the degree of disease and with complications, particularly with the development of portal thrombosis and hepatocellular carcinoma
Ultrasound-guided small-bore chest drain placement: a retrospective analysis of feasibility, safety and clinical implications in internal medicine ward
Full text linkPurpose: Massive and complex pleural effusions represent a frequent challenge for internists, particularly when patients present with significant symptoms and the hospital setting lacks dedicated thoracic surgery or interventional pneumology services. Methods: This retrospective study evaluates the effectiveness and feasibility of ultrasound-guided small-bore chest drain placement performed by internal medicine physicians with interventional ultrasound experience. We analyze procedural success rates, complication profiles, and subsequent clinical management in a cohort of patients managed in a single internal medicine ultrasound ward. Results: In our series of ten patients, ultrasound-guided drain placement was successful in all cases. No immediate major complications were encountered, and subsequent complications were minimal and manageable. Conclusion: Ultrasound-guided small-bore chest drain placement is a feasible, safe, and effective alternative to surgical chest tube insertion in selected patients in internal medicine wards, potentially avoiding the need for hospitalization or transfer to specialized thoracic surgery services
The importance of ultrasound-guided biopsy: lesson from a case of liver metastasis from uveal melanoma
Full text linkMelanoma is an extremely aggressive malignant neoplasm. Uveal melanoma is the most common primary intraocular malignancy in adults, representing 3–5% of all melanomas. Liver metastases can be clinically detected in 10–20% of patients with metastatic disease from cutaneous melanoma. However, while liver is typically not the first site of disease spread in cutaneous melanoma, ocular melanoma has been showed to primarily metastasize from the eye to the liver; indeed, liver metastases are detected in approximately 87% of patients with metastatic uveal melanoma. Therefore, liver metastasis can be challenging to identify in early stages, thus being essentially asymptomatic until the disease has advanced. Here we report the case of a patient who came to our ultrasound unit reporting a large liver mass. Both contrast-enhanced abdominal computed tomography and magnetic resonance imaging did not establish a definitive diagnosis. The final diagnosis was made only through an ultrasound-guided biopsy of the mass, thus revealing a uveal melanoma metastasis. This is followed by a review of the literature on imaging follow-up of patients with melanoma
The Coxib case: Are EP receptors really guilty?
No full textThe effects of nonsteroidal anti-inflammatory drugs (NSAIDs) originate from the inhibition of cyclooxygenase (COX), which converts arachidonic acid (AA) to prostaglandin H-2 (PGH(2)). COX consists of two isoforms, called COX-1 and COX-2. Increasing drug selectivity for COX-2 is associated with higher CV risk. Indeed, Coxibs are shown to favour a prothrombotic state, predisposing patients to myocardial infarction (MI) or thrombotic stroke, and to counter the effects of antihypertensive drugs. Indeed, Coxibs affect kidneys, by dysregulating glomerular filtration and salt/water homeostasis. Eventually, recent data associate Coxibs to "amazing" side effects such as acute hepatitis, hyperkalemia and atrial fibrillation or flutter. The circulating concentrations reached in vivo regulate the selectivity towards one of the two COX isozymes. Thus, both tNSAIDs and Coxibs seem to be able to interfere with COX-2 activity, but the interaction depends on the concentration at which each drug may inhibit PGs synthetase in different tissues. PG synthesis inhibition leads to a multiplicity of effects which can be due to the activation of four E-type prostanoid (EP) receptors, which show differential patterns of tissue distribution. Moreover, nitric oxide (NO) bioavailability and its relation with the endogenous nitric oxide synthase (NOS) inhibitors asymmetric dimethylarginine (ADMA) and l-NG-monomethylarginine (l-NMMA), renin release by juxtaglomerular cells and aldosterone pathway, seem to determine NSAID safety also. These changes may powerfully synergize with NSAID-induced prostaglandin (PG) modifications, thus regulating vascular side effects. (C) 2016 Elsevier Ireland Ltd. All rights reserved
Oxidative Stress Modulation Through Habitual Physical Activity
No full textOxidative stress is involved in different pathophysiological states, such as aging, inflammatory, cardiovascular and neurodegenerative diseases, by damaging several cellular and tissue components including proteins, DNA and lipids. On the other hand, free radicals generated during physical activity are important modulators of muscle contraction, antioxidant protection, and oxidative damage repair. Indeed, ROS, generated during physical activity, are likely main mediators of antioxidant molecules upregulation, as reflected by increased glutathione reductase levels after exercise training
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