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Gan H, Ren X, Zou Y, Li L, Ding J, Peng L, Xiong Y, Li X, Xiao W. Rheumatoid arthritis complicated with cervical actinomycosis and ureteral obstruction: A case report and literature review. ZHONG NAN DA XUE XUE BAO. YI XUE BAN = JOURNAL OF CENTRAL SOUTH UNIVERSITY. MEDICAL SCIENCES 2024; 49:818-824. [PMID: 39174896 PMCID: PMC11341218 DOI: 10.11817/j.issn.1672-7347.2024.230501] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Indexed: 08/24/2024]
Abstract
Actinomycosis is a rare chronic granulomatous disease characterized by granuloma formation and tissue fibrosis with sinus tracts, often misdiagnosed due to its similarity to many infectious and non-infectious diseases. This report presents a case of a 60-year-old female with more than 10 years history of rheumatoid arthritis who developed actinomycosis infection after long-term treatment with immunosuppressants and biologics, including methotrexate, leflunomide, and infliximab, leading to recurrent joint pain, poorly controlled rheumatoid arthritis activity, and persistent elevation of white blood cell counts. Abdominal CT revealed a pelvic mass and right ureteral dilation. Pathological examination of cervical tissue showed significant neutrophil infiltration and sulfur granules, indicating actinomycosis. The patient received 18 months of doxycycline treatment for the infection and continued rheumatoid arthritis therapy with leflunomide, hydroxychloroquine sulfate, and tofacitinib, resulting in improved joint symptoms and normalized white blood cell counts. After 2 years of follow-up, the patient remained stable with no recurrence. This case highlights the importance of clinicians being vigilant for infections, particularly chronic, occult infections from rare pathogens, in rheumatoid arthritis patients on potent immunosuppressants and biologics, advocating for early screening and diagnosis.
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Affiliation(s)
- Haina Gan
- Department of Rheumatology and Immunology, Changde Hospital Affiliated to Xiangya School of Medicine, Central South University & First People's Hospital of Changde City, Changde Hunan 415003, China.
| | - Xiang Ren
- Department of Rheumatology and Immunology, Changde Hospital Affiliated to Xiangya School of Medicine, Central South University & First People's Hospital of Changde City, Changde Hunan 415003, China
| | - Yao Zou
- Department of Rheumatology and Immunology, Changde Hospital Affiliated to Xiangya School of Medicine, Central South University & First People's Hospital of Changde City, Changde Hunan 415003, China
| | - Lihua Li
- Department of Rheumatology and Immunology, Changde Hospital Affiliated to Xiangya School of Medicine, Central South University & First People's Hospital of Changde City, Changde Hunan 415003, China
| | - Jingtao Ding
- Department of Rheumatology and Immunology, Changde Hospital Affiliated to Xiangya School of Medicine, Central South University & First People's Hospital of Changde City, Changde Hunan 415003, China
| | - Lijuan Peng
- Department of Rheumatology and Immunology, Changde Hospital Affiliated to Xiangya School of Medicine, Central South University & First People's Hospital of Changde City, Changde Hunan 415003, China
| | - Ying Xiong
- Department of Rheumatology and Immunology, Changde Hospital Affiliated to Xiangya School of Medicine, Central South University & First People's Hospital of Changde City, Changde Hunan 415003, China
| | - Xianyao Li
- Department of Rheumatology and Immunology, Changde Hospital Affiliated to Xiangya School of Medicine, Central South University & First People's Hospital of Changde City, Changde Hunan 415003, China
| | - Wei Xiao
- Department of Rheumatology and Immunology, Changde Hospital Affiliated to Xiangya School of Medicine, Central South University & First People's Hospital of Changde City, Changde Hunan 415003, China.
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Fraioli F, Albert N, Boellaard R, Galazzo IB, Brendel M, Buvat I, Castellaro M, Cecchin D, Fernandez PA, Guedj E, Hammers A, Kaplar Z, Morbelli S, Papp L, Shi K, Tolboom N, Traub-Weidinger T, Verger A, Van Weehaeghe D, Yakushev I, Barthel H. Perspectives of the European Association of Nuclear Medicine on the role of artificial intelligence (AI) in molecular brain imaging. Eur J Nucl Med Mol Imaging 2024; 51:1007-1011. [PMID: 38097746 DOI: 10.1007/s00259-023-06553-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/22/2024]
Affiliation(s)
- Francesco Fraioli
- Institute of Nuclear Medicine, University College London Hospitals, 5Th Floor UCH, 235 Euston Rd, London, NW1 2BU, UK.
| | - Nathalie Albert
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Ronald Boellaard
- Department of Radiology and Nuclear Medicine, Amsterdam UMC, Location VUmc, Amsterdam, The Netherlands
| | | | - Matthias Brendel
- Department of Nuclear Medicine, Ludwig-Maximilians-University of Munich, Munich, Germany
| | - Irene Buvat
- Institut Curie - Inserm Laboratory of Translational Imaging in Oncology, Paris, France
| | - Marco Castellaro
- Department of Information Engineering, University-Hospital of Padova, Padua, Italy
| | - Diego Cecchin
- Nuclear Medicine Unit, Department of Medicine - DIMED, University-Hospital of Padova, Padua, Italy
| | - Pablo Aguiar Fernandez
- CIMUS, Universidade Santiago de Compostela & Nuclear Medicine Dept, Univ. Hospital IDIS, Santiago de Compostela, Spain
| | - Eric Guedj
- Département de Médecine Nucléaire, Aix Marseille Univ, APHM, CNRS, Centrale Marseille, Institut Fresnel, Hôpital de La Timone, CERIMED, Marseille, France
| | - Alexander Hammers
- School of Biomedical Engineering and Imaging Sciences, King's College London St Thomas' Hospital, London, SE1 7EH, UK
| | - Zoltan Kaplar
- Institute of Nuclear Medicine, University College London Hospitals, 5Th Floor UCH, 235 Euston Rd, London, NW1 2BU, UK
| | - Silvia Morbelli
- Nuclear Medicine Unit, AOU Città Della Salute E Della Scienza Di Torino, University of Turin, Turin, Italy
| | - Laszlo Papp
- Center for Medical Physics and Biomedical Engineering, Medical University of Vienna, Vienna, Austria
| | - Kuangyu Shi
- Lab for Artificial Intelligence and Translational Theranostic, Dept. of Nuclear Medicine, University of Bern, Bern, Switzerland
| | - Nelleke Tolboom
- Department of Radiology and Nuclear Medicine, Utrecht University Medical Center, Utrecht, The Netherlands
| | - Tatjana Traub-Weidinger
- Division of Nuclear Medicine, Department of Biomedical Imaging and Image-Guided Therapy, Medical University of Vienna, Vienna, Austria
| | - Antoine Verger
- Department of Nuclear Medicine and Nancyclotep Imaging Platform, CHRU Nancy, Université de Lorraine, IADI, INSERM U1254, Nancy, France
| | - Donatienne Van Weehaeghe
- Department of Radiology and Nuclear Medicine, Ghent University Hospital, C. Heymanslaan 10, 9000, Ghent, Belgium
| | - Igor Yakushev
- Department of Nuclear Medicine, School of Medicine, Technical University of Munich, Munich, Germany
| | - Henryk Barthel
- Department of Nuclear Medicine, Leipzig University Medical Centre, Leipzig, Germany
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Kerr WT, McFarlane KN. Machine Learning and Artificial Intelligence Applications to Epilepsy: a Review for the Practicing Epileptologist. Curr Neurol Neurosci Rep 2023; 23:869-879. [PMID: 38060133 DOI: 10.1007/s11910-023-01318-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/24/2023] [Indexed: 12/08/2023]
Abstract
PURPOSE OF REVIEW Machine Learning (ML) and Artificial Intelligence (AI) are data-driven techniques to translate raw data into applicable and interpretable insights that can assist in clinical decision making. Some of these tools have extremely promising initial results, earning both great excitement and creating hype. This non-technical article reviews recent developments in ML/AI in epilepsy to assist the current practicing epileptologist in understanding both the benefits and limitations of integrating ML/AI tools into their clinical practice. RECENT FINDINGS ML/AI tools have been developed to assist clinicians in almost every clinical decision including (1) predicting future epilepsy in people at risk, (2) detecting and monitoring for seizures, (3) differentiating epilepsy from mimics, (4) using data to improve neuroanatomic localization and lateralization, and (5) tracking and predicting response to medical and surgical treatments. We also discuss practical, ethical, and equity considerations in the development and application of ML/AI tools including chatbots based on Large Language Models (e.g., ChatGPT). ML/AI tools will change how clinical medicine is practiced, but, with rare exceptions, the transferability to other centers, effectiveness, and safety of these approaches have not yet been established rigorously. In the future, ML/AI will not replace epileptologists, but epileptologists with ML/AI will replace epileptologists without ML/AI.
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Affiliation(s)
- Wesley T Kerr
- Department of Neurology, University of Pittsburgh, 3471 Fifth Ave, Kaufmann 811.22, Pittsburgh, PA, 15213, USA.
- Department of Biomedical Informatics, University of Pittsburgh, 3471 Fifth Ave, Kaufmann 811.22, Pittsburgh, PA, 15213, USA.
- Department of Neurology, Michigan Medicine, University of Michigan, Ann Arbor, MI, USA.
| | - Katherine N McFarlane
- Department of Neurology, University of Pittsburgh, 3471 Fifth Ave, Kaufmann 811.22, Pittsburgh, PA, 15213, USA
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Jin SO, Mérida I, Stavropoulos I, Elwes RDC, Lam T, Guedj E, Girard N, Costes N, Hammers A. Characterisation of a novel [ 18F]FDG brain PET database and combination with a second database for optimising detection of focal abnormalities, using focal cortical dysplasia as an example. EJNMMI Res 2023; 13:98. [PMID: 37964137 PMCID: PMC10645721 DOI: 10.1186/s13550-023-01023-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2023] [Accepted: 07/26/2023] [Indexed: 11/16/2023] Open
Abstract
BACKGROUND Brain [18F]FDG PET is used clinically mainly in the presurgical evaluation for epilepsy surgery and in the differential diagnosis of neurodegenerative disorders. While scans are usually interpreted visually on an individual basis, comparison against normative cohorts allows statistical assessment of abnormalities and potentially higher sensitivity for detecting abnormalities. Little work has been done on out-of-sample databases (acquired differently to the patient data). Combination of different databases would potentially allow better power and discrimination. We fully characterised an unpublished healthy control brain [18F]FDG PET database (Marseille, n = 60, ages 21-78 years) and compared it to another publicly available database (MRXFDG, n = 37, ages 23-65 years). We measured and then harmonised spatial resolution and global values. A collection of patient scans (n = 34, 13-48 years) with histologically confirmed focal cortical dysplasias (FCDs) obtained on three generations of scanners was used to estimate abnormality detection rates using standard software (statistical parametric mapping, SPM12). RESULTS Regional SUVs showed similar patterns, but global values and resolutions were different as expected. Detection rates for the FCDs were 50% for comparison with the Marseille database and 53% for MRXFDG. Simply combining both databases worsened the detection rate to 41%. After harmonisation of spatial resolution, using a full factorial design matrix to accommodate global differences, and leaving out controls older than 60 years, we achieved detection rates of up to 71% for both databases combined. Detection rates were similar across the three scanner types used for patients, and high for patients whose MRI had been normal (n = 10/11). CONCLUSIONS As expected, global and regional data characteristics are database specific. However, our work shows the value of increasing database size and suggests ways in which database differences can be overcome. This may inform analysis via traditional statistics or machine learning, and clinical implementation.
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Affiliation(s)
- Sameer Omer Jin
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK
- King's College London & Guy's and St Thomas' PET Centre, London, UK
| | - Inés Mérida
- Centre d'Etude et de Recherche Multimodale et Pluridisciplinaire en Imagerie du Vivant (CERMEP), Lyon, France
| | - Ioannis Stavropoulos
- Department of Clinical Neurophysiology, King's College Hospital, London, UK
- Department of Basic and Clinical Neuroscience, Institute of Psychiatry, Psychology, and Neuroscience, King's College London, London, UK
| | - Robert D C Elwes
- Department of Clinical Neurophysiology, King's College Hospital, London, UK
| | - Tanya Lam
- Children's Neuroscience Centre, Evelina London Children's Hospital, Guy's and St Thomas' NHS Trust, London, UK
| | - Eric Guedj
- Nuclear Medicine Department, APHM, CNRS, Centrale Marseille, Institut Fresnel, Timone Hospital, CERIMED, Aix Marseille University, Marseille, France
| | - Nadine Girard
- Department of Neuroradiology, APHM, CRMBM, UMR CNRS 7339, Timone Hospital, Aix Marseille University, Marseille, France
| | - Nicolas Costes
- Centre d'Etude et de Recherche Multimodale et Pluridisciplinaire en Imagerie du Vivant (CERMEP), Lyon, France
| | - Alexander Hammers
- Faculty of Life Sciences and Medicine, School of Biomedical Engineering and Imaging Sciences, King's College London, London, UK.
- King's College London & Guy's and St Thomas' PET Centre, London, UK.
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