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Purpose: Given AI's recent success in computer vision applications, majority of pathologists anticipate that it will be able to assist them with a variety of digital pathology activities. Massive improvements in deep learning have enabled a synergy between Artificial Intelligence (AI) and deep learning, enabling image-based diagnosis against the backdrop of digital pathology. AI-based solutions are being developed to eliminate errors and save pathologists time., Aims: In this paper, we will discuss the components that went into the use of Artificial Intelligence in Pathology, its use in the medical profession, the obstacles and constraints that it encounters, and the future possibilities of AI in the medical field., Conclusions: Based on these factors, we elaborate upon the use of AI in medical pathology and provide future recommendations for its successful implementation in this field., (© 2023. The Author(s), under exclusive licence to Royal Academy of Medicine in Ireland.)

Here we describe the LifeTime Initiative, which aims to track, understand and target human cells during the onset and progression of complex diseases, and to analyse their response to therapy at single-cell resolution. This mission will be implemented through the development, integration and application of single-cell multi-omics and imaging, artificial intelligence and patient-derived experimental disease models during the progression from health to disease. The analysis of large molecular and clinical datasets will identify molecular mechanisms, create predictive computational models of disease progression, and reveal new drug targets and therapies. The timely detection and interception of disease embedded in an ethical and patient-centred vision will be achieved through interactions across academia, hospitals, patient associations, health data management systems and industry. The application of this strategy to key medical challenges in cancer, neurological and neuropsychiatric disorders, and infectious, chronic inflammatory and cardiovascular diseases at the single-cell level will usher in cell-based interceptive medicine in Europe over the next decade.

Contemporary medicine is characterized by an increasing subspecialization and the acquisition of a greater knowledge about the interaction among the different body structures (biosemiotics), both in health and disease. This article proposes a new conceptualization of the body based on considering it as a biological space (cells, tissues, and organs) and a biosemiotic space (exchange of signs among them). Its development would lead to a new subspecialty focused on the study and interference of disease biosemiotics (biosemiotic medicine), which would trigger a processbased medicine centered on early diagnosis and management of disease., Competing Interests: None, (Sociedad Argentina de Pediatría.)

The aim of this article is to make a contribution to the regional reflection with regard to autism spectrum disorders (ASDs) at a key moment in which the authorities are requested by the users, professionals in the fields of health, pedagogy and education to put forward a structured answer to a multitude of expressed needs. The question for the creation of a competence pole of an academic tertiary level is posed in order to advise in the best possible way the families who do not know how to orient themselves in the maze and contradictions of the proposed solutions and to help the professionals who are submerged by an ever increasing demand of services exceeding the means of the existing institutions and who cannot justify their choices among the various existing theoretical and scientific models.

Collagen-vascular diseases could be defined as 'chronic', 'inflammatory', 'multiorgan diseases' 'with immunological derangement'. It is important to know that these diseases frequently involve locomotorium, skin, and vessels, of which symptoms or signs are easily sensed by patient herself or observed by herself or a doctor from her body surface. Even among routine laboratory findings, cytopenia, lymphocytopenia, inflammatory reactant level increase, serum total protein level increase could be indicative of these diseases. When considering a substantial number of patients with these diseases or with their subclinical status, routine medical check for rheumatoid factor or anti-nuclear antibody would be better recommended. In case that differential diagnosis is difficult or a strong intervention may be necessary, visiting a rheumatologist at least once would be a choice for early diagnosis or to avoid iatrogenic adverse events induced by irrelevant steroid, disease-modifying anti-rheumatic drug or immunosuppressant. Socio-economically, the early diagnosis and early treatment for these diseases would be very effective showing a good cost-performance.

The use of operations, visits to doctors and early diagnostic tests for children are examples of different services selected from the whole spectrum of preventative and therapeutic health service provisions in childhood and adolescence. In the German Health Interview and Examination Survey for Children and Adolescents (KiGGS), which is representative for Germany, 17,641 children and adolescents aged 0-17 or their parents were questioned on subjects such as their use of medical services. The use made of individual early diagnostic tests for children remains above the 90 % limit until the U7 test and drops to 89.0 % at U8, falling to 86.4 % at U9. 81 % of children took part in all the early diagnostic tests provided until age 6 (U3 to U9). Another 16 % only took advantage of some parts of this service and 3 % of the children never went to one of these check-ups. As was to be expected, the annual rate of visits to paediatricians drops as children get older from 95.1 % for 0-2-year-olds to 25.4 % of the 14-17-year-olds, while the rate of visits to general practitioners rises from 11.8 % to 53.1 %. If one tracks the rate of visits to specialist doctors all the way across childhood and adolescence, different paths emerge: while children aged 3-6 most often visit the ear, nose and throat doctor, at primary school age they mainly see opticians, and 14-17-year-olds most often visit doctors of internal medicine, dermatologists and surgeons. 37.1 % of the 0-17-year-old children and adolescents had undergone an operation. In order of declining frequency, the operations named were adenoidectomy (15.2 %), tonsillectomy (5.9 %), herniotomy (3.6 %) and appendectomy (2.4 %). Circumcisions had been carried out on 10.9 % of the boys. The different way medical services are used in different subgroups may not only depend on medical factors but also on social factors, medical attitudes and the availability of services provided.

Background: The Two-Week Rule (TWR) was introduced to ensure that all patients with a suspected colorectal cancer (CRC) saw a hospital specialist within 14 days of an urgent GP referral. Guidelines were available to GPs to facilitate the appropriate TWR referral of patients exhibiting high-risk CRC symptoms., Methods: We aimed to evaluate the TWR and its CRC detection rate on NHS CRC diagnostic services by performing a literature search and critically appraising the peer-reviewed studies. Only 12 studies were eligible for inclusion. Data was collected and overall results were given as weighted averages., Results: The studies identified indicated that only 10.3% of patients referred by the TWR were eventually diagnosed with CRC. When examining the referral origin of all CRC patients diagnosed during the time of the studies, 24% had been referred using the TWR, 24.1% were referred as emergency cases, and 52.4% were referred using alternative routes. No evidence was found to indicate that the TWR had resulted in identifying CRC patients at an earlier, more treatable stage of their disease., Conclusion: The TWR referral system needs to be improved to increase the number of CRC patients referred using this fast track method as they present to their GP. The TWR and new NICE Guidelines for the referral of patients with suspected cancer should be independently evaluated.

Abstract Purpose Hepatocellular carcinoma (HCC) associated with Hepatitis B Virus (HBV) is one of the most severe malignancies in East Asia, where early diagnosis is crucial for improving patient prognosis. So we aim to identify effective early diagnostic model for HCC. Design and methods We enrolled 108 early-stage HCC patients and 102 non-HCC individuals underlying HBV infection, collecting plasma exosomal miRNAs (exo-miRNAs) from all participants. These patients were randomly assigned to sequencing, screening, training, and validation group. After preliminary screening of candidate exo-miRNAs by next-generation high-throughput sequencing, qPCR data from the screening group were utilized in conjunction with the random forest machine learning algorithm to identify candidate exo-miRNAs with diagnostic potential. Subsequently, logistic regression diagnostic model was constructed using the relative expression levels of candidate exo-miRNAs, alpha-fetoprotein (AFP) levels and clinical parameters of gender and the presence of cirrhosis from the training group. The diagnostic accuracy of diagnostic model was subsequently validated in the validation group. Results Firstly, we identified miR-212-5p, miR-1248, and miR-1250-5p as candidate exo-miRNAs with potential diagnostic value. The exo-miRNAs panel, which consisted of miR-212-5p, miR-1248, miR-1250-5p, along with clinical parameters of gender and cirrhosis, achieved an AUC of 0.8634 (95% CI: 0.8027–0.9241), demonstrating diagnostic performance non-inferior to AFP in the independent dataset. Subsequently, by combining exo-miRNAs, AFP level and clinical parameter of gender, we enhanced the diagnostic panel, miRAGe, which exhibited an AUC of 0.9499 (95% CI: 0.9192–0.9806), sensitivity of 0.8900, and specificity of 0.9468. Conclusion Our study indicates that the miRAGe panel has low rate of both missed diagnosis and misdiagnosis rates, potentially serving as a useful diagnostic tool for HBV-related HCC in early stage, which may subsequently contribute to improve the prognosis.

Introduction A shift in policy has occurred with the introduction of molecular diagnostic tools for the upfront diagnosis of all cases of tuberculosis, including drug-resistant tuberculosis. The impact of this shift in policy on severity of disease was studied, and comparisons were drawn between the year 2015 and 2020. Study Type and Design This was an observational study conducted between 2020 and 2021. Seventy patients of MDR-TB with or without additional drug resistance, hospitalized in the year 2015 and 2020, were studied. Results The study reveals a substantial reduction in the median time from the onset of symptoms to diagnosis between 2015 and 2020. Specifically, the median duration decreased from 12 weeks in 2015 to 8 weeks in 2020. Moreover, we found that in 2015, all cases under study had a history of tuberculosis in comparison to 2020. Additionally, there was a higher incidence of anemia in 2015 compared to 2020. In the radiological examination, it was observed that in 2015, a higher frequency of cases exhibited cavitations, bronchiectasis, and fibrosis on chest X-rays compared to the findings in 2020. The mean cavity size in 2015 measured 6.73 cm, while in 2020, it averaged 4.06 cm. Additionally, we noticed a higher occurrence of significantly advanced cases in 2015 in contrast to 2020. Conclusion The implementation of the new policy of upfront DST was noted to decrease the time required for diagnosis and bacterial load as ascertained from degree of sputum smear positivity, radiological lesions, and severity of anemia.

Background: Ectopic pregnancy is defined as pregnancy that occurs outside normal uterine cavity that occurs due to implantation of fertilized ovum in an aberrant site which is conducive to its growth and development. In developing countries like India, late presentations with tubal rupture and hemodynamic instability, late presentations with tubal rupture causes first trimester maternal morbidity and mortality. For early diagnosis, a clinician should be well aware about the various presentations of ectopic pregnancy. Aims and Objectives: (a) To estimate the incidence, risk factors, clinical manifestations and outcome following different management protocol. (b) To estimate the morbidity and mortality with respect to different types of presentation and management. (c) To understand the need for clinical assessment in order to diagnose early and provide urgent intervention and also to lean toward the possibility of conservative approach in order to preserve fertility. Materials and Methods: The current study was a time bound, Observational descriptive study with Longitudinal design. It was conducted in the Department of Obstetrics and Gynecology, R. G. Kar Medical College and Hospital, between March 2021 and August 2022. One hundred and thirty-eight participants, suspected to have ectopic pregnancy were enrolled for the study. Data collection was done by detailed history taking and physical examination. The basic investigations including hemoglobin, ABO and Rhesus typing, urine pregnancy test, and ultrasound (USG) examination were done. All data were collected on a structural data form and analyzed for descriptive statistics. Post-operative histopathological examination (HPE) reports were collected and final diagnosis was made. Results: About 63.8% of the study population belonged to 21–30 years of age. About 63.7% patients presented with >5–8 weeks of amenorrhea. About 18.1% of the study population were sterilized and the duration between the sterilization and the occurrence of ectopic was 4–10 years in 64% patients. The most common risk factor was h/o Previous C-section (31.8%). The most common clinical symptom was abdominal pain present in 131 (94.9%), 44 (31.9%) participants had all the three classical symptoms with 100% specificity. On examination, forniceal fullness/tenderness was the most specific finding. The most common USG finding was Adnexal mass with empty Uterine cavity with Free fluid (49.2%). Most of the patients were managed with Partial Salpingectomy (30.4%). The final diagnosis of ectopic was made in 129 patients, which was confirmed by HPE reports in 124 patients. Five patients underwent medical treatment. Conclusion: Early diagnosis before rupture and referral are the key factor in reducing the maternal morbidity and mortality.

Prediabetes is a condition characterized by impaired fasting glucose, impaired glucose tolerance, or a combination of both, which is classified under the category of "Pi Dan" in Traditional Chinese Medicine (TCM). With the changes in modern lifestyles, the prevalence of prediabetes is continuously rising, carrying a risk comparable to diabetes prognosis. Therefore, timely diagnosis and early intervention are crucial. This article reviewed the origins and definitions of prediabetes from both TCM and modern medical perspectives, revealing that TCM had already recognized "Pi Dan" as early as the composition of the "SuWen". With the development of evidence-based medicine and the implementation of standardized clinical research, China has gradually established the standardized clinical practice guidelines for prediabetes with TCM characteristics. Regarding diagnosis, diagnostic indicators and thresholds for monitoring blood glucose levels, various non-invasive integrated TCM and modern medical diagnostic methods, including TCM syndrome diagnosis, integrated TCM and Western medicine diagnostic models, disease risk scoring models, biomarkers, and wearable devices, have been continuously improved. However, its primary focus lies in diabetes prevention rather than the early detection and screening of prediabetes. Besides, 1-hour plasma glucose may be a new outcome for prediabetes diagnosis or identifying high-risk diabetes populations in the future. However, further research is required to validate its broader application. Addressing the challenges of dynamic diagnostic standards, complex screening processes, atypical clinical symptoms, and low disease awareness during early prediabetes diagnosis, it is imperative to continuously update and refine diagnostic standards. The integration of digital health management and wearable devices should be promoted to fully capitalize on TCM strengths in constructingt disease diagnostic models that combine TCM macro manifestations and omics microdata for prediabetes. Simplified and expedited integrated TCM and modern medical screening methods can facilitate early screening, early diagnosis, early intervention, and early recovery for prediabetes.

Aim – to study the organizational features of detection of secondary metachronous primary multiple CRC in patients with primary extracolorectal malignancies. Material and methods. The medical documentation of 163 oncological patients with extracolorectal malignancies and secondary metachronous CRC was analyzed. The patients were divided into subgroups according to the profile of dispensary observation. Results. In 66% (108) of cases, patients were diagnosed with malignancies of four subgroups: skin, breast, urological and gynecological spheres, the number of cases of malignancies’ localization correlated with the number of accumulated contingent. CRC at stage 1 was detected in 24% of cases. The right parts of the colon were affected in 22.1% (36) of cases, the left – in 38.7% (63), the rectum – in 33.1% (54), tumors of several departments – in 4.9% (8), anal cancer – in 1.2% (2) of cases. CRC was detected in the period from 7 to 678 months after extracolorectal malignancies. Earlier, CRC was diagnosed in cases with skin and urological tumors, later, in the group with breast cancer and oncogynecological profile. Conclusion. The majority of the subjects were women (60.7%), the average age was 69 years. Patients with oncodermatological (22%), oncourological (15.3%), oncomammological (15.3%), oncogynecological (13.5%) profiles, lesions of the left colon (38.7%) and rectum (33.1%) predominated. The time interval between the detection of the primary tumor and the detection of secondary CRC depends on the localization of the primary malignancies (p=0).Screening of CRC is necessary not only among the healthy population, but also in the group of patients with extracolorectal malignancies, it is possible to use an immunochemical quantitative stool test for hidden blood at the stage of providing specialized medical care in the "oncology" profile.

Abstract The diagnosis of fibrodysplasia ossificans progressiva is missed or delayed because of its insidious precursors, especially in uncharacteristic cases. Fibrodysplasia ossificans progressiva, which mostly displayed the mutation c.617G > A, p.R206H, is characterized by congenital malformation of the great toe and progressive extra-skeletal ossification of ligaments, tendons and muscles. The mutation c.774G > C, p.R258S (HGVS: NC_000002.11:g.158626896 C > G) in activin A receptor type I is an infrequent etiology of fibrodysplasia ossificans progressiva and can present different clinical features. Awareness of these multiple clinical features will help endocrinologists in the early diagnosis of fibrodysplasia ossificans progressiva. We report a case of fibrodysplasia ossificans progressiva with the activin A receptor type I mutation c.774G > C, p.R258S, which was diagnosed before its ossifying period.

Abstract Circulating genetically abnormal cells (CACs) have emerged as a promising biomarker for the early diagnosis of lung cancer, particularly in patients with pulmonary nodules. However, their performance may be suboptimal in certain patient populations. This study aimed to refine patient selection to improve the detection of CACs in pulmonary nodules. A retrospective analysis was conducted on 241 patients with pulmonary nodules who had undergone pathological diagnosis through surgical tissue specimens. Utilizing consensus clustering analysis, the patients were categorized into three distinct clusters. Cluster 1 was characterized by older age, larger nodule size, and a higher prevalence of hypertension and diabetes. Notably, the diagnostic efficacy of CACs in Cluster 1 surpassed that of the overall patient population (AUC: 0.855 vs. 0.689, P = 0.044). Moreover, for Cluster 1, an integrated diagnostic model was developed, incorporating CACs, sex, maximum nodule type, and maximum nodule size, resulting in a further improved AUC of 0.925 (95% CI 0.846–1.000). In conclusion, our study demonstrates that CACs detection shows better diagnostic performance in aiding the differentiation between benign and malignant nodules in older patients with larger pulmonary nodules and comorbidities such as diabetes and hypertension. Further research and validation are needed to explore how to better integrate CACs detection into clinical practice.

Abstract Plant diseases can inflict varying degrees of damage on agricultural production. Therefore, identifying a rapid, non-destructive early diagnostic method is crucial for safeguarding plants. Cladosporium fulvum (C. fulvum) is one of the major diseases in tomato growth. This work presents a method of data fusion using two hyperspectral imaging systems of visible/near-infrared (VIS/NIR) and near-infrared (NIR) spectroscopy for the early diagnosis of C. fulvum in greenhouse tomatoes. First, hyperspectral images of samples at health and different times of infection were collected. The average spectral data of the image regions of interest were extracted and preprocessed for subsequent spectral datasets. Then different classification models were established for VIS/NIR and NIR data, optimized through various variable selection and data fusion methods. The principal component analysis-radial basis function neural network (PCA-RBF) model established using low-level data fusion achieved optimal results, achieving accuracies of 100% and 99.3% for calibration and prediction, respectively. Moreover, both the macro-averaged F1 (Macro-F1) values reached 1, and the geometric mean (G-mean) values reached 1 and 1, respectively. The results indicated that it was feasible to establish a PCA-RBF model by using the hyperspectral technique with low-level data fusion for the early detection of C. fulvum in greenhouse tomatoes.

Objective To investigate the value of ultrasound micro-flow imaging (MFI) combined with serum inflammatory factors in the early diagnosis of diabetic kidney disease (DKD). Methods A total of 92 patients with DKD who were admitted to The Affiliated Hospital of Qingdao University from June 1, 2022 to June 30, 2023 were enrolled as DKD group, and 64 patients with type 2 diabetes mellitus (T2DM) who were admitted to our hospital during the same period of time were enrolled as T2DM group. Related data were collected for the two groups, including clinical indicators, ultrasound blood flow parameters, and serum inflammatory factors. Ultrasound blood flow parameters included MFI-value, left renal interlobar artery resistance index (RI1), right renal interlobar artery resistance index (RI2), left renal interlobar arterial peak velocity (PSV1), and right renal interlobar arterial peak velocity (PSV2). The Spearman method was used to investigate the correlation of MFI-value with clinical indicators and serum inflammatory factors; the forward conditional approach in binary logistic regression was used to analyze the impact of DKD; the receiver operating characteristic (ROC) curve was used to analyze the value of MFI-value and serum inflammatory factors in predicting DKD. Results Compared with the DKD group, the T2DM group had significantly lower RI1 and serum levels of C-reactive protein, interleukin-6 (IL-6), and interleukin-18 (Z=-6.73--3.20,P

Abstract Hepatocellular carcinoma (HCC) is the most common liver cancer and is among the leading causes of cancer-related death worldwide. There is no reliable biomarker for the early diagnosis of HCC. Circulating microRNAs (miRNAs) have attracted attention as potential biomarkers of disease. By small-RNA next-generation sequencing, the analysis of serum miRNAs led to the identification of molecular signatures able to discriminate advanced HCC from early HCC (n = 246); advanced HCC from CIRRHOSIS (n = 299); advanced HCC from HEALTHY (n = 320); HEALTHY from early HCC (n = 343); and HEALTHY from CIRRHOSIS (n = 414). Cirrhotic patients and early HCC patients exhibited similar serum miRNA profiles, yet a small number of miRNAs (n = 57) were able to distinguish these two classes of patients. A second objective of the study was to identify serum miRNAs capable of predicting the response to therapy in patients with advanced HCC. All patients were treated with sorafenib as first-line therapy: 24 were nonresponsive and 24 responsive. Analysis of circulating miRNAs revealed a 54 miRNAs signature able to separate the two subgroups. This study suggested that circulating miRNAs could be useful biomarkers for monitoring patients with liver diseases ranging from cirrhosis to advanced HCC and possibly predicting susceptibility to first-line treatment based on sorafenib.

Abstract Background Fabry disease (FD), an X-linked lysosomal storage disorder, is caused by mutations in the gene encoding α-galactosidase A, resulting in lysosomal accumulation of globotriaosylceramide and other glycosphingolipids. Early detection of FD is challenging, accounting for delayed diagnosis and treatment initiation. This study aimed to develop an algorithm using a logistic regression model to facilitate early identification of patients based on ICD-10-GM coding using a German Sickness Fund Database. Methods The logistic regression model was fitted on a binary outcome variable based on either a treated FD cohort or a control cohort (without FD). Comorbidities specific to the involved organs were used as covariates to identify potential FD patients with ICD-10-GM E75.2 diagnosis but without any FD-specific medication. Specificity and sensitivity of the model were optimized to determine a likely threshold. The cut-point with the largest values for the Youden index and concordance probability method and the lowest value for closest to (0,1) was identified as 0.08 for each respective value. The sensitivity and specificity for this cut-point were 80.4% and 79.8%, respectively. Additionally, a sensitivity analysis of the potential FD patients with at least two codes of E75.2 diagnoses was performed. Results A total of 284 patients were identified in the potential FD cohort using the logistic regression model. Most potential FD patients were

With Japan's economic growth, its life expectancy increased from 1965, and since 1980, Japan has become one of the longest-lived countries in the world. Strong government-led initiatives such as low-cost health insurance, widely distributed health screenings, a new law to prevent non-communicable diseases established in 1956, Shokuiku (Japanese culinary education), and stress-measuring systems in the workplace contributed to the population's longevity. In addition to these public initiatives, Japan has benefited from evolving lifestyle practices over its long history. These include Washoku (Japanese traditional food), which utilizes the complex interaction of individual nutrients unique to Japan as well as numerous metabolically active compounds, the interrelation of Japan's population levels with its plant-dominant diet, a mindful culture connected with nature, and the principle of hara-hachi-bu (Confucianism-based caloric restriction habit; "eat until 80% full"), and so on. In 2002, Japan took the remarkable action of stipulating by law that citizens must deepen their interest in and understanding of the importance of healthy lifestyle habits, be aware of their own health status, and strive to improve their health throughout their lives. Today, to protect its future, Japan must face a new challenge: a population that is declining and is the world's fastest-aging. [ABSTRACT FROM AUTHOR]

AbstractBurkholderia cepacia complex (Bcc) is a bacterial group with ‘natural’ multi-antimicrobial resistance. This complex has generated epidemic outbreaks across the world. In people with cystic fibrosis (CF), Bcc can cause severe lung infections that lead to accelerated lung damage, which can be complicated by necrotizing pneumonia accompanied by high fevers, leucocytosis, and bacteraemia, which commonly causes fatal outcomes. Specifically, infection by Burkholderia cenocepacia is considered an exclusion criterion for lung transplantation. The species of Bcc exhibit both genetic and phenotypic hypervariability that complicate their accurate microbiological identification. Automated methods such as MALDI-TOF can err in the determination of species. Their slow growth even in selective agars and the absence of international consensuses on the optimal conditions for their isolation make early diagnosis a difficult challenge to overcome. The absence of correlations between antibiograms and clinical results has resulted in the absence of standardized cut-off values of antimicrobial susceptibility, a fact that brings a latent risk since incorrect antibiotic therapy can induce the selection of more aggressive variants that worsen the clinical picture of the host, added to the absence of a clear therapeutic guide for the eradication of pulmonary infections by Bcc in patients with CF, resulting in frequently ineffective treatments. There is an urgent need to standardize methods and diagnostic tools that would allow an early and accurate diagnosis, as well as to perform clinical studies of the effectiveness of available antibiotics to eradicate Bcc infections, which would allow us to establish standardized therapeutic schemes for Bcc-infected patients.

Summary: Background: Large language models (LLMs) have shown promising performance in various healthcare domains, but their effectiveness in identifying specific clinical conditions in real medical records is less explored. This study evaluates LLMs for detecting signs of cognitive decline in real electronic health record (EHR) clinical notes, comparing their error profiles with traditional models. The insights gained will inform strategies for performance enhancement. Methods: This study, conducted at Mass General Brigham in Boston, MA, analysed clinical notes from the four years prior to a 2019 diagnosis of mild cognitive impairment in patients aged 50 and older. We developed prompts for two LLMs, Llama 2 and GPT-4, on Health Insurance Portability and Accountability Act (HIPAA)-compliant cloud-computing platforms using multiple approaches (e.g., hard prompting, retrieval augmented generation, and error analysis-based instructions) to select the optimal LLM-based method. Baseline models included a hierarchical attention-based neural network and XGBoost. Subsequently, we constructed an ensemble of the three models using a majority vote approach. Confusion-matrix-based scores were used for model evaluation. Findings: We used a randomly annotated sample of 4949 note sections from 1969 patients (women: 1046 [53.1%]; age: mean, 76.0 [SD, 13.3] years), filtered with keywords related to cognitive functions, for model development. For testing, a random annotated sample of 1996 note sections from 1161 patients (women: 619 [53.3%]; age: mean, 76.5 [SD, 10.2] years) without keyword filtering was utilised. GPT-4 demonstrated superior accuracy and efficiency compared to Llama 2, but did not outperform traditional models. The ensemble model outperformed the individual models in terms of all evaluation metrics with statistical significance (p

Abstract Background and Aims The oral glucose tolerance test with 75 g glucose is commonly regarded as the gold standard (GS) for the detection of gestational diabetes mellitus (GDM). However, one limitation of this test is its administration in the late second trimester of pregnancy in some countries (e.g., Iran). This study aimed to evaluate the accuracy of pregnancy‐associated plasma protein‐A (PAPP‐A) for predicting GDM in the early first trimester of pregnancy using a novel statistical modeling technique. Methods The study population consisted of 344 pregnant women who participated in the first trimester screening program for GDM. Maternal serum PAPP‐A levels were measured between 11 and 13 gestational weeks for all participants. A Bayesian latent profile model (LPM) under the skew‐t (ST) distribution was employed to estimate the diagnostic accuracy measures of PAPP‐A in the absence of GS test outcomes. Results The mean (standard deviation) age of the participants was 28.87 ± 5.20 years. The median (interquartile range (IQR)) PAPP‐A MoM was 0.91 (0.69‐1.34). Utilizing the LPM under the ST distribution while adjusting for covariates, the sensitivity, specificity, and area under the receiver operating characteristic curve (AUC) of PAPP‐A were 92% (95% credible interval [CrI]: 0.89, 0.98), 81% (95% CrI: 0.76, 0.91), and 0.91 (95% CrI: 0.83, 0.97), respectively. Notably, the pregnant women with GDM had significantly lower PAPP‐A values ( β = −0.52, 95% CrI [−0.61, −0.46]). Conclusion Generally, our findings confirmed that PAPP‐A could serve as a potential screening tool for the identification of GDM in the early stages of pregnancy.

Lung adenocarcinoma is a primary type of lung cancer and is classified as a non small cell lung carcinoma. Headache is a rare presentation of lung carcinoma. This case report found that early diagnosis and proper treatment can improve disease outcomes. The case describes a 36-year-old woman presenting with a persistent left-sided headache and non radiating pain. Despite normal vital signs and laboratory results, an Magnetic Resonance Imaging (MRI) revealed multifocal abnormalities in the brain, suggesting neoplastic metastasis. Further investigations, including Computed Tomography (CT) scans and Positron Emission Tomography-Computed Tomography PET-CT scans, confirmed lung adenocarcinoma with metastases to the brain, bone, and liver. Histopathology revealed an invasive, moderately-differentiated adenocarcinoma. The patient was recommended palliative radiation therapy, and after compliance with treatment, she was discharged. The present case underscores the importance of thorough diagnostic evaluation in unexplained symptoms, leading to the identification of advanced-stage lung adenocarcinoma with multiple metastases.

The majority of esophageal squamous dysplasia (ESD) patients progress slowly, while a subset of patients can undergo recurrence rapidly or progress to invasive cancer even after proper treatment. However, the molecular mechanisms underlying these clinical observations are still largely unknown.

Statement of the Problem: It is essential to address caries risk at an early stage for the prevention of dental caries. Mobile application CaRisk is designed in a particular way to self-assess the dental caries risk by the individual’s themselves.Purpose: The current study aimed to assess the dental caries risk among age groups 5-6 and 35-44 using self-assessment caries risk mobile application CaRisk and compare it with the deft and DMFT values.Materials and Method: This cross-sectional study was conducted in Chennai, India; to evaluate the risk of dental caries in children aged 5 to 6 and adults aged 35 to 44. The scores of the mobile application CaRisk and the decayed- extracted- filled teeth (deft)/ decayed-missing-filled-teeth (DMFT) caries risk assessment were evaluated. Descriptive statistics were performed. The risk category was determined by frequency. Chi-square analysis was done to determine whether the DMFT scores and the CaRisk mobile app were associated. The correlation was performed between the CaRisk mobile application and DMFT scores.Results: Association was found between the caries risk assessment score of the mobile application CaRisk and the DMFT and deft scores of the adults and children for both the age groups 5-6 and 35-44 years respectively and it indicates that it was found to be statistically significant. Pearson’s correlation was performed to assess the strength of association and R-values obtained for the age group 5-6 and 35-44 years respectively, which was statistically significant (0.892 and 0.840).Conclusion: This CaRisk mobile application scores correlate with the deft and DMFT scores and it is an effective self-diagnosis tool for assessing dental caries risk assessment. Further, it is suggested that the mobile application CaRisk should be tested among a huge population.

Abstract Background Exosomes are nanosized vesicles released from all cells into surrounding biofluids, including cancer cells, and represent a very promising direction in terms of minimally invasive approaches to early disease detection. They carry tumor-specific biological contents such as DNA, RNA, proteins, lipids, and sugars, as well as surface molecules that are able to pinpoint the cellular source. By the above criteria, exosomes may be stratified according to the presence of tissue and disease-specific signatures and, due to their stability in such biofluids as plasma and serum, they represent an indispensable source of vital clinical insights from liquid biopsies, even at the earliest stages of cancer. Therefore, our work aimed to isolate and characterize LCa patients’ derived exosomes from serum by Flow Cytometry in order to define a specific epitope signature exploitable for early diagnosis. Methods Circulating exosomes were collected from serum collected from 30 LCa patients and 20 healthy volunteers by the use of antibody affinity method exploiting CD63 specific surface marker. Membrane epitopes were then characterized by Flow cytometry multiplex analysis and compared between LCa Patients and Healthy donors. Clinical data were also matched to obtain statistical correlation. Results A distinct overexpression of CD1c, CD2, CD3, CD4, CD11c, CD14, CD20, CD44, CD56, CD105, CD146, and CD209 was identified in LCa patients compared to healthy controls, correlating positively with tumor presence. Conversely, CD24, CD31, and CD40, though not overexpressed in tumor samples, showed a significant correlation with nodal involvement in LCa patients (p < 0.01). Conclusion This approach could allow us to set up a cost-effective and less invasive liquid biopsy protocol from a simple blood collection in order to early diagnose LCa and improve patients’ outcomes and quality of life. Graphical Abstract

High incidences of congenital syphilis have been reported in areas along the Pacific coast of Colombia. In this retrospective study, conducted during 2018–2022 at a public hospital in Buenaventura, Colombia, we analyzed data from 3,378 pregnant women. The opportunity to prevent congenital syphilis was missed in 53.1% of mothers because of the lack of syphilis screening. Characteristics of higher maternal social vulnerability and late access to prenatal care decreased the probability of having >1 syphilis screening test, thereby increasing the probability of having newborns with congenital syphilis. In addition, the opportunity to prevent congenital syphilis was missed in 41.5% of patients with syphilis because of the lack of treatment, which also increased the probability of having newborns with congenital syphilis. We demonstrate the urgent need to improve screening and treatment capabilities for maternal syphilis, particularly among pregnant women who are more socially vulnerable.

Background Hepatocellular carcinoma (HCC) is the main pathological type of primary liver cancer (PLC) and is closely associated with Hepatitis B virus (HBV) infection. HCC in its early stages often presents no significant symptoms and is usually discovered at an advanced stage with liver, portal vein, or other site metastases, leading to a poor prognosis. Regular screening and early diagnosis in high-risk populations in the early stages of the disease are of great significance for clinical treatment and prognosis. Objective To explore the application value of oligosaccharides and alpha-fetoprotein (AFP) in the risk population and patients of HBV-related HCC, providing a reference for clinical diagnosis. Methods The study included 165 chronic HBV infection patients treated at the First Affiliated Hospital of Soochow University from January to November 2022, comprising 123 non-HCC and 42 HCC patients. Patient data (age, gender, cirrhosis status), laboratory indices[total bilirubin (TB), albumin (ALB), platelet count (PLT), AFP]were collected through electronic medical records, and a liver cancer risk prediction model score for chronic liver disease patients (aMAP score) was calculated, along with oligosaccharide marker test results (G-Test). HCC patients were classified as the HCC group (42 cases), and non-HCC patients were divided based on aMAP scores into low-risk (60 points, 39 cases) groups. Receiver operating characteristic (ROC) curves were plotted to analyze the efficacy of AFP, G-Test, and their combined diagnosis of HCC, calculating the area under the ROC curve (AUC), and the DeLong test was used to compare the differences between combined and single indicator AUCs. Kappa consistency tests were used to analyze the consistency of AFP and G-Test with clinical diagnostic results. Results In patients with HCC, levels of AFP and G-Test were higher compared to those in the low-risk, medium-risk, and high-risk groups (P

Adaptive Optics (AO) has emerged as a revolutionary technology in ophthalmology, offering an unprecedented view into the eye's microstructures with high-resolution imaging capabilities. Originally developed for astronomy, AO technology has been adapted to correct the eye’s optical aberrations, enabling the visualization of individual cellular structures such as photoreceptors, retinal pigment epithelium cells, and capillaries within the retinal vasculature. This review provides a comprehensive overview of AO, discussing its historical background, technical principles, and incorporation into existing systems. We explore its transformative impact on ophthalmic research and clinical practice, highlighting its role in enhancing our understanding of ocular physiology, disease progression, and response to therapies. The clinical applications of AO, including early disease detection and monitoring, are examined alongside the patient experience and economic considerations. Despite its potential, AO's widespread adoption is currently limited by factors such as high costs, technical complexity, and patient cooperation challenges. We discuss these barriers and the innovative solutions emerging to overcome them, including system simplification, expanded fields of view, and advanced image analysis techniques. The article concludes by reflecting on the promising future of AO, with its evolving role in disease management, surgical planning, and systemic disease monitoring. As AO technology continues to advance, it promises to reshape the landscape of ophthalmic care, offering deeper insights into eye health and more precise patient care.

Objective: No standardised approach exists to provide advice after urgent suspected cancer (USC) referral when cancer is not found. This study aimed to assess preferences and acceptability of receiving advice after USC referral related to: 1) managing ongoing symptoms, 2) responding to early symptoms of other cancers, 3) cancer screening, 4) reducing risks of future cancer. Methods: 2,541 patients from two English NHS Trusts were mailed a survey 1–3 months after having no cancer found following urgent suspected gastrointestinal or head and neck cancer referral. Participants were asked about: willingness to receive advice; prospective acceptability; preferences related to mode, timing and who should provide advice; and previous advice receipt. Results: 406 patients responded (16.0%) with 397 in the final analyses. Few participants had previously received advice, yet most were willing to. Willingness varied by type of advice: fewer were willing to receive advice about early symptoms of other cancers (88.9%) than advice related to ongoing symptoms (94.3%). Acceptability was relatively high for all advice types. Reducing the risk of future cancer advice was more acceptable. Acceptability was lower in those from ethnic minority groups, and with lower levels of education. Most participants preferred to receive advice from a doctor; with results or soon after; either face to face or via the telephone. Conclusions: There is a potential unmet need for advice after USC referral when no cancer is found. Equitable intervention design should focus on increasing acceptability for people from ethnic minority groups and those with lower levels of education.

Objective To develop and validate a nomogram prediction model for the early diagnosis of active pulmonary tuberculosis (ATB) based on LASSO regression. Methods A total of 403 patients with ATB admitted to the Third People's Hospital of Kunming between March 2021 and March 2023 were used as the experimental group, and 175 cases of healthy physical examiners during the same period were selected as the control group. General information and laboratory test results of patients were collected, variables were screened using LASSO regression based on R software, and multivariable logistic regression was performed. A nomogram model of ATB was established based on the results of multivariable analysis, and internal validation was performed using receiver operating curve (ROC) and calibration curves, while clinical utility analysis using clinical decision curves. Results A total of 19 potential risk factors were screened by LASSO regression, namely C-reactive protein (CRP), haptoglobin (HAP), immunoglobulin G (IgG), absolute number of CD4+ lymphocytes (CD4+), ratio of CD4+ lymphocytes to CD8+ lymphocytes (CD4+/CD8+), interleukin (IL)-1β, IL-6, IL-8, IL-10, IL-17, lymphocyte percentage (LYM%), monocyte percentage (MON%), eosinophil percentage (EOS%), mean corpuscular hemoglobin concentration (MCHC), mean red blood cell volume (MCV), platelet count (PLT), red blood cell distribution width-standard deviation (RDW-SD), neutrophil to lymphocyte ratio (NLR) and platelet large cell ratio (PLCR). Multirariable analysis showed that CRP (OR=1.352, 95%CI: 1.134-1.612), IL-6 (OR=1.165, 95%CI: 1.032-1.315),IL-8 (OR=1.105, 95%CI: 1.019-1.198), IL-10 (OR=1.544, 95%CI: 1.066-2.235), EOS% (OR=1.386, 95%CI: 1.105-1.737), MCV (OR=1.154, 95%CI: 1.051-1.737), PLT (OR=1.025, 95%CI: 1.013-1.037), and MCHC (OR=0.899, 95%CI: 0.854-0.946) were the independent risk factors for ATB. According to the nomogram, the ROC was plotted and showed that AUC of ATB risk predicted by model was 0.982 (95%CI: 0.973-0.991), the calibration curve results showed that the predicting probability of ATB risk by the nomogram model was basically consistent with the actual probability, and the results of decision curve analysis showed that when the probability threshold of the nomogram model predicting the risk of ATB was more than 0.05, the net benefit value of the patients was greater than 0. Conclusion The risk of ATB increases with increasing levels of CRP, IL-6, IL-8, IL-10, EOS%, MCV, PLT and decreasing levels of MCHC. The nomogram prediction model based on the above factors can be used for the early diagnosis of ATB.

Sepsis is still one of the leading causes of maternal mortality and morbidity, being the third most common cause of maternal death, after hemorrhage and hypertensive disorders. Maternal sepsis may appear due to obstetric causes such as: chorioamnionitis, endometritis, abortion-related uterine infections, and wound infections. For non-obstetric causes of maternal sepsis, the most common are urinary tract infections and respiratory tract infections. This mini summary presents the challenges in early diagnosis and prompt management, caused by pregnancy physiological changes. Physiological alterations during pregnancy, like an increase in white cell count, heart rate, and respiratory rate, associated with a decrease in blood pressure are also known signs of infection, making the diagnosis of sepsis during pregnancy more difficult. The three pillars of sepsis treatment are early antibiotics, vital organ support and fluid therapy, the last one being controversial. A more restrictive approach for fluid resuscitation could be more suitable for pregnant women, considering the risk of fluid overload and pulmonary edema. Criteria for early recognition and appropriate management customized for maternal sepsis are mandatory.

Abstract Objective Intervertebral disc degeneration (IVDD) is a major cause of morbidity and disability. Our study aimed to investigate the potential of cartilage oligomeric matrix protein (COMP) and ADAMTS7 (A disintegrin and metalloproteinases with thrombospondin motifs 7) as biomarkers for IVDD together with their functional relationship. Methods IVD tissues and peripheral blood samples were collected from IVDD rabbit models over 1–4 weeks. Tissues and blood samples were also collected from clinical patients those were stratified into four equal groups according to Pfirrmann IVDD grading (I–V) with baseline data collected for each participant. COMP and ADAMTS7 expression were analyzed and biomarker characteristics were assessed using linear regression and receiver operating curve (ROC) analyses. Results COMP and ADAMTS7 expression increased in tissues and serum during IVDD progression. Serum COMP (sCOMP) and serum ADAMTS7 (sADAMTS7) levels increased in a time-dependent manner following IVD damage in the rabbit model while significant positive correlations were detected between sCOMP and sADAMTS7 and Pfirrmann grade in human subjects. ROC analysis showed that combining sCOMP and sADAMTS7 assay results produced an improved diagnostic measure for IVDD compared to individual sCOMP or sADAMTS7 tests. In vitro assays conducted on human cell isolates revealed that COMP prevented extracellular matrix degradation and antagonized ADAMTS7 expression although this protective role was uncoupled under microenvironmental conditions mimicking IVDD. Conclusions Increases in circulating COMP and ADAMTS7 correlate with IVDD progression and may play regulatory roles. Assays for sCOMP and/or sADAMTS7 levels can discriminate between healthy subjects and IVDD patients, warranting further clinical assessment.

Abstract Background Identifying individuals with mild cognitive impairment (MCI) at risk of progressing to Alzheimer’s disease (AD) provides a unique opportunity for early interventions. Therefore, accurate and long-term prediction of the conversion from MCI to AD is desired but, to date, remains challenging. Here, we developed an interpretable deep learning model featuring a novel design that incorporates interaction effects and multimodality to improve the prediction accuracy and horizon for MCI-to-AD progression. Methods This multi-center, multi-cohort retrospective study collected structural magnetic resonance imaging (sMRI), clinical assessments, and genetic polymorphism data of 252 patients with MCI at baseline from the Alzheimer’s Disease Neuroimaging Initiative (ADNI) database. Our deep learning model was cross-validated on the ADNI-1 and ADNI-2/GO cohorts and further generalized in the ongoing ADNI-3 cohort. We evaluated the model performance using the area under the receiver operating characteristic curve (AUC), accuracy, sensitivity, specificity, and F1 score. Results On the cross-validation set, our model achieved superior results for predicting MCI conversion within 4 years (AUC, 0.962; accuracy, 92.92%; sensitivity, 88.89%; specificity, 95.33%) compared to all existing studies. In the independent test, our model exhibited consistent performance with an AUC of 0.939 and an accuracy of 92.86%. Integrating interaction effects and multimodal data into the model significantly increased prediction accuracy by 4.76% (P = 0.01) and 4.29% (P = 0.03), respectively. Furthermore, our model demonstrated robustness to inter-center and inter-scanner variability, while generating interpretable predictions by quantifying the contribution of multimodal biomarkers. Conclusions The proposed deep learning model presents a novel perspective by combining interaction effects and multimodality, leading to more accurate and longer-term predictions of AD progression, which promises to improve pre-dementia patient care.

Objective To investigate the clinical application value of blood heparin-binding protein (HBP), procalcitonin (PCT), and C-reactive protein(CRP) in the early diagnosis of childhood sepsis. Methods A retrospective analysis was performed for 20 children with general sepsis (general sepsis group), 16 children with severe sepsis (severe sepsis group), and 12 children with septic shock (septic shock group) who were admitted to the pediatric intensive care unit and the neonatal intensive care unit of our hospital from November 2017 to May 2019, and 22 non-sepsis children with local infection (local infection control group) and 18 children with non-infectious disease (non-infection control group) who were admitted to the general ward during the same period of time were enrolled as control group. The levels of blood HBP, PCT, and CRP were measured and compared between groups, and the receiver operating characteristic (ROC) curve was used to investigate the value of each index in the early diagnosis of sepsis. Results The septic shock group had significantly higher levels of blood HBP and PCT than the severe sepsis group and the general sepsis group (P0.05), but all these three groups had a significantly higher level of blood CRP than the non-infection control group (P

Abstract Background Gaucher disease (GD) is a rare autosomal recessive condition associated with clinical features such as splenomegaly, hepatomegaly, anemia, thrombocytopenia, and bone abnormalities. Three clinical forms of GD have been defined based on the absence (type 1, GD1) or presence (types 2 and 3) of neurological signs. Early diagnosis can reduce the likelihood of severe, often irreversible complications. The aim of this study was to validate the ability of factors from the Gaucher Earlier Diagnosis Consensus (GED-C) scoring system to discriminate between patients with GD1 and controls using real-world data from electronic patient medical records from Maccabi Healthcare Services, Israel’s second-largest state-mandated healthcare provider. Methods We applied the GED-C scoring system to 265 confirmed cases of GD and 3445 non-GD controls matched for year of birth, sex, and socioeconomic status identified from 1998 to 2022. The analyses were based on two databases: (1) all available data and (2) all data except free-text notes. Features from the GED-C scoring system applicable to GD1 were extracted for each individual. Patients and controls were compared for the proportion of the specific features and overall GED-C scores. Decision tree and random forest models were trained to identify the main features distinguishing GD from non-GD controls. Results The GED-C scoring distinguished individuals with GD from controls using both databases. Decision tree models for the databases showed good accuracy (0.96 [95% CI 0.95–0.97] for Database 1; 0.95 [95% CI 0.94–0.96] for Database 2), high specificity (0.99 [95% CI 0.99–1]) for Database 1; 1.0 [95% CI 0.99–1] for Database 2), but relatively low sensitivity (0.53 [95% CI 0.46–0.59] for Database 1; 0.32 [95% CI 0.25–0.38]) for Database 2). The clinical features of splenomegaly, thrombocytopenia (

Gallbladder carcinoma (GBC) is one of the most common malignant tumors in the biliary system, which is difficult to diagnose in the early stage due to its high degree of malignancy, invasiveness and lack of specific clinical manifestations. In this paper, we summarize ultrasound, CT and other imaging manifestations in the early stage of GBC, and describe the role of protein markers and microRNA marker as biomarkers in the diagnosis of early GBC. The enhanced understanding of the relevant features might help to improve the accuracy of the diagnosis of early gallbladder carcinoma.

Odontogenic keratocysts (OKCs) are a common presentation in almost all patients with nevoid basal cell carcinoma syndrome (NBCCS) or Gorlin syndrome, irrespective of race. In most patients with NBCCS, OKC presents as multiple lesions affecting the jaws which makes it a signpost for the investigation of patients with the syndrome. In approximately 40% of pediatric patients, the initial presentation is that of a single OKC, which may often result in missing the diagnosis of NBCCS. This is particularly common in patients without clinically apparent NBCCS-related manifestations. This review examines the clinicopathological features that clinicians and oral pathologists may look for in pediatric patient with OKC and OKC surgical specimens that may serve as indicators for the diagnosis of NBCCS. Although these features do not diagnose NBCCS by themselves, they may significantly help in initiating the diagnostic process at an early stage with an obvious benefit to the child and relatives.

The occurrence of an accident or a disease can disrupt the social and occupational integration of the patient. The general practitioner must be able to identify this situation at risk of work disability. The clinical situations concerned are those of patients who can no longer, a priori, continue working under the same conditions. The analysis of the professional literature has made it possible to identify the chronological course of care, from the acute phase to the resumption of work or cessation of activity, respecting the rights. It identifies the contacts and the tools to be used in each step. The main challenges are related to legislative and regulatory developments. [ABSTRACT FROM AUTHOR]

Telediagnosis uses information and communication technologies to support diagnosis, shortening geographical distances. It helps make decisions about various oral lesions. The objective of this scoping review was to map the existing literature on digital strategies to assist in the diagnosis of oral squamous cell carcinoma. this review was structured based on the 5-stage methodology proposed by Arksey and O’Malley, the Joanna Briggs Institute Manual for Evidence Synthesis and followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for scoping reviews. The methods were registered on the Open Science Framework. The research question was: What digital strategies have been used to assist in the diagnosis of oral squamous cell carcinoma? The search was conducted on PubMed/MEDLINE, Scopus, Web of Science, Embase, and ScienceDirect. Inclusion criteria comprised studies on telediagnosis, teleconsultation or teleconsultation mediated by a professional and studies in English, without date restrictions. The search conducted in June 2023 yielded 1,798 articles, from which 16 studies were included. Telediagnosis was reported in nine studies, involving data screening through applications, clinical images from digital cameras, mobile phones or artificial intelligence. Histopathological images were reported in four studies. Both, telediagnosis and teleconsultation, were mentioned in seven studies, utilizing images and information submission services to platforms, WhatsApp or applications. One study presented teleconsultations involving slides and another study introduced teleconsultation mediated by a professional. Digital strategies telediagnosis and teleconsultations enable the histopathological diagnosis of oral cancer through clinical or histopathological images. The higher the observed diagnostic agreement, the better the performance of the strategy.

Lung cancer is the leading cause of cancer-related deaths worldwide. Early diagnosis and treatment play a crucial role in improving the prognosis for lung cancer. However, the issue of overtreatment and delayed diagnosis remains prevalent due to the considerable limitations of manual film review in facilitating early detection and treatment of lung cancer. In recent years, artificial intelligence (AI) has emerged as a valuable tool for clinicians to screen and evaluate benign and malignant pulmonary nodules, offering numerous advantages. Nevertheless, the sensitivity and specificity of AI are neither sufficient to completely replace medical experts nor capable of assuming direct responsibility for clinical diagnosis and treatment.Therefore, we propose the concept of a Human-Computer Multi-Disciplinary Team (MDT), which involves collaborative decision-making between human physicians and AI systems. The human-computer MDT approach in pulmonary nodule evaluation presents a novel model for diagnosis and treatment, leveraging the respective strengths of human expertise and AI capabilities. This review provides an overview of the background, medical application, advantages and limitations, future trends, and reporting format of the Human-Computer MDT in pulmonary nodule evaluation.Its aim is to explore standardized methods for enhancing early diagnosis in lung cancer. With the rapid advancement of AI and the field of meta-cosmic medicine, human-computer MDT are expected to become more widespread and play an important role in the implementation of the Healthy China 2030 plan, particularly in improving primary medical care in the future.

The objectives of this article are to reflect on the rationale behind the use of echocardiographic screening for rheumatic heart disease and to provide key recommendations about steps needed to implement and improve echocardiographic screening programs in Latin America. Rheumatic heart disease remains a public health problem affecting mainly low-income and lower-middle-income countries and populations. Latin America is an area with economic inequalities, and the epidemiology of rheumatic heart disease remains largely unknown. Echocardiographic screening is useful for updating the epidemiology and providing early diagnosis of the disease. We discuss different approaches used in successful echocardiographic screening programs worldwide and in Latin America. We then identify the key elements needed to establish successful echocardiographic screening programs in Latin America, including increased awareness and involvement from multiple sectors (e.g. the community, health care professionals, scientific organizations and public health entities), identification of areas in need, development of a plan and structure that include different screening approaches, and how to ensure appropriate follow up for those who screen positive.

AbstractObjective The exploration of non-invasive biomarkers for assessing tumor response is critical to optimize treatment decisions. In this study, we aimed at determining the potential role of RAI14 in the early diagnosis and evaluation of chemotherapy efficacy in triple-negative breast cancer (TNBC).Methods We recruited 116 patients newly diagnosed with breast cancer, 30 patients with benign breast disease and 30 healthy controls. In addition, 57 TNBC patients were collected in serum at different time points (C0, C2 and C4) for chemotherapy monitoring. The expression of serum RAI14 and CA15-3 were quantified by Elisa and electrochemiluminescence assay, respectively. Then we compared the performances of markers with the chemotherapy efficacy assessed by imaging.Results RAI14 is significantly overexpressed in TNBC and is linked to adverse clinicopathological features such as tumor burden, CA15-3 levels and the ER, PR, and HER2 status of the patients. ROC curve analysis showed that RAI14 improves the diagnostic performance for CA15-3(AUCRAI14 = 0.934 vs. AUCCA15-3 = 0.836), especially embodied in early-stage breast cancer diagnosis and patients with CA15-3 negativity. Furthermore, RAI14 behaves well in reproducing treatment response which was consistent with clinical Imaging assessment.Conclusions Recent studies showed that RAI14 has a complementary effect to CA15-3 and a test combining the two parameters can improve the detection rate of early triple-negative breast cancer. At the same time, RAI14 plays a more important role in chemotherapy monitoring than CA15-3 as the change in its concentration is in line with the tumor volume variation. Taken together, RAI14 is a reliable novel marker in the early diagnosis and chemotherapy monitoring of triple-negative breast cancer.

Abstract Background In recent years, conventional coagulation (CC) and thromboelastography (TEG) parameters have been reported to be closely related to the progression of pancreatic cancer (PC). However, the potential utility of these parameters in differentiating benign and malignant pancreatic diseases is still unclear. Objectives A retrospective study was conducted to evaluate the efficacy of coagulation parameters in differentiating pancreatic cancer/early stage pancreatic cancer (EPC, TNM stages I and II) from benign control conditions, and to further explore whether coagulation parameters could improve the differential value of CA199. Methods Receiver operating characteristic (ROC) curves and logistic regression analysis were used to identify the diagnostic value of each coagulation parameter or combination of parameters. Results Compared with benign pancreatic disease (BPD), patients with pancreatic malignant tumors had significant coagulation disorders, specifically manifested as abnormal increases or decreases in several CC and TEG parameters (such as activated partial thromboplastin time (APTT), fibrinogen (FIB), D-dimer (DD2), K time, R time, Angle, maximum amplitude (MA), coagulation index (CI), and Ly30). In the training group, ROC curve showed that FIB, DD2, Angle, MA, and CI had favorable efficacy at differentiating PC or EPC from BPD (for PC, AUC = 0.737, 0.654, 0.627, 0.602, 0.648; for EPC, AUC = 0.723, 0.635, 0.630, 0.614, 0.648). However, several combined diagnostic indicators based on FIB, DD2 and CI failed to outperform the individual coagulation indexes in diagnostic efficiency. Combinations of certain coagulation indexes with CA199 outperformed CA199 alone at identifying PC or EPC, especially FIB + CA199 (for PC, AUC = 0.904; for EPC, AUC = 0.905), FIB + DD2 + CA199 (for PC, AUC = 0.902; for EPC, AUC = 0.900), FIB + CI + CA199 (for PC, AUC = 0.906; for EPC, AUC = 0.906), and FIB + DD2 + CI + CA199 (for PC, AUC = 0.905; for EPC, AUC = 0.900). The results from a validation set also confirmed that these combinations have advantageous diagnostic value for PC and EPC. Conclusions A significant hypercoagulable state was common in PC. Some CC and TEG parameters are valuable in the differential diagnosis of benign and malignant pancreatic diseases. In addition, coagulation indexes combined with CA199 can further enhance the differential diagnosis efficacy of CA199 in PC and EPC.

Glaucoma usually does not show any symptoms and may not be noticed until it reaches the advanced stage. In our study, demographic and clinical findings of patients who were diagnosed with glaucoma incidentally and were not aware of their disease and any symptoms are presented. Our study group consisted of people who did not have any symptoms and only wanted to receive an eye health report. Additional tests (visual field examination, retinal nerve fiber layer (RNFL) analysis, central corneal thickness etc.) for the diagnosis of glaucoma were planned for all participants over the age of 18 with suspected glaucoma (intraocular pressure >21mmHg, optic nerve changes (cup/disc (c/d) ratio of 0.6 and above, c/d asymmetry greater than 0.2 between optic discs, peripapillary atrophy, optic disc hemorrhage etc.) in routine examinations. The diagnosis and classification of glaucoma was defined according to the International Society for Geographical and Epidemiological Ophthalmology Classification. Glaucoma was diagnosed in 51 eyes of 35 out of 1024 patients, including 24 male patients and 11 female patients. The mean age of the patients was 62.31±12.392 years. There was 14 patients in primary open-angle glaucoma, 10 patients in pseudoexfoliation glaucoma, 6 patients in normotensive glaucoma, 1 patient with chronic angle-closure glaucoma, 1 patient with pigmentary glaucoma, 1 patient with angle-recession glaucoma, 1 patient with steroid-related glaucoma, and 1 patient with vitreoretinal surgery-related glaucoma. The mean visual acuity (VA) was 0.6 and above in all types except the patient who had the vitrectomy surgery. Primary open-angle glaucoma was the most common in incidentally diagnosed glaucoma patients. The presence of a high VA before symptoms develop in patients with glaucoma indicates the importance of early diagnosis in the prognosis of the disease. [Med-Science 2023; 12(3.000): 618-22]

Introduction: Mucormycosis is an opportunistic fungal infection that became a public health emergency during the second wave of Coronavirus Disease-2019 (COVID-19). It is an acute, angioinvasive, opportunistic, and emerging mycosis caused by mucormycetes, resulting in a significantly fatal fungal infection among immunocompromised and/or immunosuppressed individuals. Mucormycosis has a specific predilection for blood vessels (angioinvasive) and tissues, leading to extensive necrosis and thromboembolic events. Globally, the incidence rate of mucormycosis varies from 0.005 to 1.7 per million people. Early diagnosis and appropriate therapy are crucial for clinical outcomes. Aim: To evaluate the mycological profile of mucormycosis during the COVID-19 pandemic using automated Matrix Assisted Laser Desorption Ionisation Time of Flight Mass Spectroscopy (MALDI-ToF-MS) in comparison with conventional fungal identification methods. Materials and Methods: A retrospective cohort study was conducted, collecting data from July 2020 to June 2022, involving 1,176 patients from various clinical departments who attended PSG Hospitals affiliated with PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India. Data analysis was performed from July 2022 to August 2022. Clinical specimens, including Bronchoalveolar Lavage (BAL), Sputum, Cerebrospinal Fluid (CSF), nasal swabs, tracheal aspirates, pus, blood, corneal scraping, eye discharge, and necrotised tissues, were subjected to Potassium Hydroxide (KOH) mount, conventional culture coupled with micrometry-aided microscopy, and MALDI-ToF-MS among suspected mucormycosis cases. The results were collected in Microsoft Excel, and data analysis was conducted using the International Business Machines Statistical Package for the Social Sciences statistical software (IBM SPSS) version 24.0. The study variables were expressed as descriptive statistics: frequency (N) and percentage (%). The incidence of mucormycosis, mycological profile, and diagnostic utility of conventional micrometry-aided microscopy-assisted culture were compared with the automated MALDI-ToF-MS protein signature method of testing. Results: Fungal elements were positive in 130 (11.05%) out of a total of 1,176 clinical samples, such as necrotised tissue, biopsy, and sputum, in the KOH mount. Fungal culture was positive in 258 (21.94%) out of 1176 samples, with mucormycosis detected in 73 (28.29%) of the culture-positive samples. The incidence of mucormycosis in this study was 73 (6.21%) out of 1176. A total of 101 (8.59%) samples showed positive results for mucormycetes through KOH, culture, and MALDI-ToF-MS. MALDI-ToF-MS could rapidly and specifically identify and confirm the causative agents of mucormycosis at their genus and species levels compared to KOH or culture. Conclusion: Simple, low-cost, and less laborious conventional culture coupled with micrometry-aided microscopy can detect Mucorales at the species level, where KOH microscopy could not differentiate between species. MALDI-ToF-MS can be employed for the rapid detection and confirmation of mucormycosis agents at the genus or species level.