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Diagnostics (Basel, Switzerland) Jun 2024The Expanded Disability Status Scale (EDSS) is the most popular method to assess disease progression and treatment effectiveness in patients with multiple sclerosis...
The Expanded Disability Status Scale (EDSS) is the most popular method to assess disease progression and treatment effectiveness in patients with multiple sclerosis (PwMS). One of the main problems with the EDSS method is that different results can be determined by different physicians for the same patient. In this case, it is necessary to produce autonomous solutions that will increase the reliability of the EDSS, which has a decision-making role. This study proposes a machine learning approach to predict EDSS scores using aerobic capacity data from PwMS. The primary goal is to reduce potential complications resulting from incorrect scoring procedures. Cardiovascular and aerobic capacity parameters of individuals, including aerobic capacity, ventilation, respiratory frequency, heart rate, average oxygen density, load, and energy expenditure, were evaluated. These parameters were given as input to CatBoost, gradient boosting (GBM), extreme gradient boosting (XGBoost), and decision tree (DT) machine learning methods. The most significant EDSS results were determined with the XGBoost algorithm. Mean absolute error, root mean square error, mean square error, mean absolute percent error, and R square values were obtained as 0.26, 0.4, 0.26, 16, and 0.68, respectively. The XGBoost based machine learning technique was shown to be effective in predicting EDSS based on aerobic capacity and cardiovascular data in PwMS.
PubMed: 38928664
DOI: 10.3390/diagnostics14121249 -
Brain Sciences Jun 2024Intracerebral hemorrhage (ICH) is a critical condition characterized by a high prevalence, substantial mortality rates, and unpredictable clinical outcomes, which...
Intracerebral hemorrhage (ICH) is a critical condition characterized by a high prevalence, substantial mortality rates, and unpredictable clinical outcomes, which results in a serious threat to human health. Improving the timeliness and accuracy of prognosis assessment is crucial to minimizing mortality and long-term disability associated with ICH. Due to the complexity of ICH, the diagnosis of ICH in clinical practice heavily relies on the professional expertise and clinical experience of physicians. Traditional prognostic methods largely depend on the specialized knowledge and subjective judgment of healthcare professionals. Meanwhile, existing artificial intelligence (AI) methodologies, which predominantly utilize features derived from computed tomography (CT) scans, fall short of capturing the multifaceted nature of ICH. Although existing methods are capable of integrating clinical information and CT images for prognosis, the effectiveness of this fusion process still requires improvement. To surmount these limitations, the present study introduces a novel AI framework, termed the ICH Network (ICH-Net), which employs a joint-attention cross-modal network to synergize clinical textual data with CT imaging features. The architecture of ICH-Net consists of three integral components: the Feature Extraction Module, which processes and abstracts salient characteristics from the clinical and imaging data, the Feature Fusion Module, which amalgamates the diverse data streams, and the Classification Module, which interprets the fused features to deliver prognostic predictions. Our evaluation, conducted through a rigorous five-fold cross-validation process, demonstrates that ICH-Net achieves a commendable accuracy of up to 87.77%, outperforming other state-of-the-art methods detailed within our research. This evidence underscores the potential of ICH-Net as a formidable tool in prognosticating ICH, promising a significant advancement in clinical decision-making and patient care.
PubMed: 38928618
DOI: 10.3390/brainsci14060618 -
Brain Sciences Jun 2024People seeking asylum are susceptible to head injury (HI) due to exposure to various forms of violence including war, torture, or interpersonal violence. Yet, the...
People seeking asylum are susceptible to head injury (HI) due to exposure to various forms of violence including war, torture, or interpersonal violence. Yet, the extents to which clinicians assess HI, and if so, what the associated characteristics are, are not well known. We analyzed 200 U.S.-based medico-legal affidavits using descriptive, multivariate regression, and thematic analysis. Head injury was documented in 38% of affidavits. Those who experienced physical violence were eight times likelier to experience HI than those who did not experience physical violence. Five themes emerged: (1) HI occurred commonly in the context of interpersonal violence (44%), followed by militarized violence (33%); (2) mechanisms of HI included direct blows to the head and asphyxiation, suggesting potential for both traumatic brain injury and brain injury from oxygen deprivation; (3) HI was often recurrent and concurrent with other physical injuries; (4) co-morbid psychiatric and post-concussive symptoms made it challenging to assess neurological and psychiatric etiologies; and (5) overall, there was a paucity of assessments and documentation of HI and sequelae. Among individuals assessed for asylum claims, HI is common, often recurrent, occurring in the context of interpersonal violence, and concurrent with psychological and other physical trauma. Physical violence is an important risk factor for HI, which should be assessed when physical violence is reported.
PubMed: 38928599
DOI: 10.3390/brainsci14060599 -
International Journal of Molecular... Jun 2024Thyroid cancer diagnosis primarily relies on imaging techniques and cytological analyses. In cases where the diagnosis is uncertain, the quantification of molecular... (Review)
Review
Thyroid cancer diagnosis primarily relies on imaging techniques and cytological analyses. In cases where the diagnosis is uncertain, the quantification of molecular markers has been incorporated after cytological examination. This approach helps physicians to make surgical decisions, estimate cancer aggressiveness, and monitor the response to treatments. Despite the availability of commercial molecular tests, their widespread use has been hindered in our experience due to cost constraints and variability between them. Thus, numerous groups are currently evaluating new molecular markers that ultimately will lead to improved diagnostic certainty, as well as better classification of prognosis and recurrence. In this review, we start reviewing the current preoperative testing methodologies, followed by a comprehensive review of emerging molecular markers. We focus on micro RNAs, long non-coding RNAs, and mitochondrial (mt) signatures, including mtDNA genes and circulating cell-free mtDNA. We envision that a robust set of molecular markers will complement the national and international clinical guides for proper assessment of the disease.
Topics: Humans; Biomarkers, Tumor; Thyroid Neoplasms; DNA, Mitochondrial; Mitochondria; RNA, Untranslated; RNA, Long Noncoding; MicroRNAs; Prognosis
PubMed: 38928426
DOI: 10.3390/ijms25126719 -
International Journal of Molecular... Jun 2024While urinary polymerase chain reaction (PCR) testing is effective in organism identification in patients with complex urinary tract infections (cUTI), limited data...
While urinary polymerase chain reaction (PCR) testing is effective in organism identification in patients with complex urinary tract infections (cUTI), limited data exists on the clinical usefulness of this test. We serially surveyed physicians treating symptomatic patients with cUTI both at presentation and after PCR, and urine culture (UC) results were available to ascertain how the test results modified the therapy. A total of 96 unique surveys completed by 21 providers were included in the data analysis. The mean age for female and male patients was 69.4 ± 15.5 and 71.6 ± 12.7 years, respectively. The test positivity and line-item concordance for UC and PCR were consistent with prior reports. The PCR results modified or confirmed treatment in 59/96 (61.5%) and 25/96 (26.0%) of the cases, respectively, with 12/29 (41.4%) and 47/67 (70.1%) having negative and positive PCR results, respectively, resulting in treatment change (difference 28.7%, < 0.01). Of these, 55/59 (57.3%) were alterations in the antibiotic regimen. PCR use to modify treatment was similar across providers and not statistically different when stratified by patient age, gender, or prior empiric therapy. In 31/59 (52.5%) of the cases, the PCR results modified the treatment where UC would not; conversely, UC would have modified the treatment in 3/37 (8.1%) of the cases where PCR did not (difference 44.4%, < 0.01). We find that PCR test results are used by clinicians in managing cUTI, and use of this test provides an opportunity to improve antibiotic stewardship in this difficult-to-treat subset of patients.
Topics: Humans; Urinary Tract Infections; Female; Male; Aged; Polymerase Chain Reaction; Clinical Decision-Making; Middle Aged; Aged, 80 and over; Anti-Bacterial Agents; Urinalysis
PubMed: 38928323
DOI: 10.3390/ijms25126616 -
International Journal of Molecular... Jun 2024The blood counts of α thalassemia carriers (α-thal) are similar to those of β thalassemia carriers, except for Hemoglobin A (Hb A), which is not elevated. The...
The blood counts of α thalassemia carriers (α-thal) are similar to those of β thalassemia carriers, except for Hemoglobin A (Hb A), which is not elevated. The objective of this study was to determine whether mathematical formulas are effective for detecting suspected α-thal. The data were obtained from the database of the prevention program for detecting couples at risk for having a child with hemoglobinopathy. Red Blood Cells (RBC) indices were analyzed using mathematical formulas, and the sensitivity and negative predictive value (NPV) were calculated. Among 1334 blood counts suspected of α-thal analyzed, only the Shine and Lal and the Support Vector Machine formulas revealed high sensitivity and NPV. Sensitivity was 85.54 and 99.33%, and NPV was 98.93 and 99.93%, respectively. Molecular defects were found in 291, and 81 had normal α genes. Molecular analysis was not performed in 962 of the samples. Based on these results, mathematical formulas incorporating one of these reliable formulas for detecting suspected α or β thalassemia carriers in the program of the automatic analyzers can flag these results, increase the awareness of the primary physicians about the carrier risk, and send an alert with a recommendation for further testing.
Topics: Humans; Support Vector Machine; alpha-Thalassemia; Heterozygote; Female; Male; Erythrocyte Indices; beta-Thalassemia; Genetic Carrier Screening
PubMed: 38928152
DOI: 10.3390/ijms25126446 -
Cancers Jun 2024(1) Background: Currently, an increasing number of women postpone pregnancy beyond the age of 35. Gynecological cancers affect a significant proportion of women of... (Review)
Review
(1) Background: Currently, an increasing number of women postpone pregnancy beyond the age of 35. Gynecological cancers affect a significant proportion of women of reproductive age, necessitating the development of fertility preservation methods to fulfill family planning. Consequently, providing treatment options that preserve fertility in women diagnosed with gynecological cancers has become a crucial component of care for survivors. (2) Methods: We conducted an extensive search of relevant scientific publications in PubMed and Embase databases and performed a narrative review, including high-quality peer-reviewed research on fertility after being treated for gynecologic cancers, reporting pregnancy rates, birth rates, and pregnancy outcomes in cancer survivors as well as therapeutic options which partially preserve fertility and methods for obtaining a pregnancy in survivors. (3) Discussion: The medicine practiced today is focused on both treating the neoplasm and preserving the quality of life of the patients, with fertility preservation being an important element of this quality. This leads to an improved quality of life, allowing these women to become mothers even in the seemingly adverse circumstances posed by such a pathology. However, although there are guidelines on female fertility preservation in the context of neoplasms, an analysis shows that physicians do not routinely consider it and do not discuss these options with their patients. (4) Conclusions: Advancements in medicine have led to a better understanding and management of gynecological neoplasms, resulting in increased survival rates. Once the battle against these neoplasms is won, the issue of preserving the quality of life for these women arises, with fertility preservation being an important aspect for women who have not yet fulfilled their family planning desires at the time of diagnosis. It is important for patients to be informed about the available options for fertility preservation and to be encouraged to make informed decisions in collaboration with their medical team. Standardized recommendations for onco-fertility into guidelines should be taken into consideration in the future.
PubMed: 38927920
DOI: 10.3390/cancers16122214 -
Bioengineering (Basel, Switzerland) Jun 2024In recent years, the use of smartphones and other wireless technology in medical care has developed rapidly. However, in some cases, especially for pediatric medical... (Review)
Review
In recent years, the use of smartphones and other wireless technology in medical care has developed rapidly. However, in some cases, especially for pediatric medical problems, the reliability of information accessed by mobile health technology remains debatable. The main aim of this paper is to evaluate the relevance of smartphone applications in the detection and diagnosis of pediatric medical conditions for which the greatest number of applications have been developed. This is the case of smartphone applications developed for the diagnosis of acute otitis media, otitis media with effusion, hearing impairment, obesity, amblyopia, and vision screening. In some cases, the information given by these applications has significantly improved the diagnostic ability of physicians. However, distinguishing between applications that can be effective and those that may lead to mistakes can be very difficult. This highlights the importance of a careful application selection before including smartphone-based artificial intelligence in everyday clinical practice.
PubMed: 38927864
DOI: 10.3390/bioengineering11060628 -
Bioengineering (Basel, Switzerland) Jun 2024The aim of this study was to assess the usefulness of an attachable video laryngoscope (AVL) by attaching a camera and a monitor to a conventional Macintosh laryngoscope...
The aim of this study was to assess the usefulness of an attachable video laryngoscope (AVL) by attaching a camera and a monitor to a conventional Macintosh laryngoscope (CML). Normal and tongue edema airway scenarios were simulated using a manikin. Twenty physicians performed tracheal intubations using CML, AVL, Pentax Airwayscope (AWS), and McGrath MAC (MAC) in each scenario. Ten physicians who had clinical experience in using tracheal intubation were designated as the skilled group, and another ten physicians who were affiliated with other departments and had little clinical experience using tracheal intubation were designated as the unskilled group. The time required for intubation and the success rate were recorded. The degree of difficulty of use and glottic view assessment were scored by participants. All 20 participants successfully completed the study. There was no difference in tracheal intubation success rate and intubation time in the normal airway scenario in both skilled and unskilled groups. In the experienced group, AWS had the highest success rate (100%) in the tongue edema airway scenario, followed by AVL (60%), MAC (60%), and CML (10%) ( = 0.001). The time required to intubate using AWS was significantly shorter than that with AVL (10.2 s vs. 19.2 s) or MAC (10.2 s vs. 20.4 s, = 0.007). The difficulty of using AVL was significantly lower than that of CML (7.8 vs. 2.8; < 0.001). For the experienced group, AVL was interpreted as being inferior to AWS but better than MAC. Similarly, in the unskilled group, AVL had a similar success rate and tracheal intubation time as MAC in the tongue edema scenario, but this was not statistically significant. The difficulty of using AVL was significantly lower than that of CML (8.8 vs. 3.3; < 0.001). AVL may be an alternative for VL.
PubMed: 38927806
DOI: 10.3390/bioengineering11060570 -
Biomedicines Jun 2024The use of immune checkpoint inhibitors (ICIs) for the treatment of various advanced and aggressive types of malignancy has significantly increased both survival and... (Review)
Review
The use of immune checkpoint inhibitors (ICIs) for the treatment of various advanced and aggressive types of malignancy has significantly increased both survival and long-term remission rates. ICIs block crucial inhibitory pathways of the immune system, in order to trigger an aggravated immune response against the tumor. However, this enhanced immune activation leads to the development of numerous immune-related adverse events (irAEs), which may affect any system. Although severe neurological irAEs are relatively rare, they carry a high disability burden, and they can be potentially life-threatening. Therefore, clinicians must be alert and act promptly when individuals receiving ICIs present with new-onset neurological symptoms. In this narrative review, we have collected all the currently available data regarding the epidemiology, pathogenesis, clinical manifestations, diagnosis, and treatment of post-ICI neurological irAEs. This review aims to raise physicians' awareness, enrich their knowledge regarding disease pathogenesis, and guide them through the diagnosis and management of post-ICI neurological irAEs.
PubMed: 38927526
DOI: 10.3390/biomedicines12061319