Assessment Of Severity Research Articles

Disparities in quantification of mitral valve regurgitation between cardiovascular magnetic resonance imaging and trans-thoracic echocardiography: a systematic review.

Primary mitral regurgitation (MR) is a prevalent valvular heart disease. Therapy stratification for MR depends on accurate assessment of MR severity and left ventricular (LV) dimensions. While trans-thoracic echocardiography (TTE) has been the standard/preferred assessment method, cardiovascular magnetic resonance imaging (CMR) has gained recognition for its superior assessment of LV dimensions and MR severity. Both imaging modalities have their own advantages and limitation for therapy guidance. However, the differences between the two modalities for assessing/grade severity and clinical impact of MR remains unclear. This systematic review aims to evaluate the differences between TTE and CMR in quantifying MR severity and LV dimensions, providing insights for optimal clinical management. A literature search was performed from inception up to March 21st 2023. This resulted in 2,728 articles. After screening, 22 articles were deemed eligible for inclusion in the meta-analysis. The included study variables were, mitral valve regurgitation volume (MRVOL), regurgitation fraction (MRFRAC), LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV stroke volume (LVSV), and LV ejection fraction (LVEF). TTE showed a significant higher MRVOL (10.4ml, I2 = 88%, p = 0.002) and MRFRAC (6.3%, I2 = 51%, p = 0.05) compared to CMR, while CMR demonstrated a higher LVEDV (21.9ml, I2 = 66%, p = < 0.001) and LVESV (16.8ml, I2 = 0%, p = < 0.001) compared to TTE. Our findings demonstrate substantial disparities in TTE and CMR derived measurements for parameters that play a pivotal role in the clinical stratification guidelines. This discrepancy prompts a critical question regarding the prognostic value of both imaging modalities, which warrants future research.

A multi-scale assessment of desertification severity in the Eastern Mediterranean region based on albedo-MSAVI feature space.

Resampling the same satellite image to conduct a multi-scale assessment of desertification can be accompanied by distortion of terrestrial objects and spectral information, which can lead to uncertainty in the generated information. To address this, this study assesses desertification severity in an area of arid and semi-arid climate in the Eastern Mediterranean (Jordan)that is characterised by cloudless scenesusingmulti-sensor data of the same scene at the same time. To this end, Sentinel-2 at 10 m and 60 m, Landsat-8 at 30 m and MODIS at 250 m and 500 m were collected to extract albedo and modified soil adjusted vegetation index (MSAVI), and subsequently to construct albedo-MSAVI feature space. Using the negative correlation between albedo and MSAVI, desertification degree index (DDI) was generated. The resulting multi-scale DDI maps bear a relative resemblance in terms of spatial distribution, patterns, and proportions. The DDI maps indicate that extremely serious and serious desertification are widespread, accounting for 50% of the study area, primarily in the eastern portions. However, finer DDI maps (10 m, 30 m and 60 m) are essential for detecting small-scale desertification characteristics due to their ability to capture local spatial variabilities, while coarser ones (250 m and 500 m) are better suited for capturing broad-scale desertification patterns driven by climatic factors, in which MODIS data exhibit a relatively higher positive correlation with seasonal average precipitation. Although finer DDI maps show higher accuracy compared to coarser ones, the accuracy of DDI maps of MODIS has shown an increase within a homogeneous landscape. Accordingly, synchronised multi-scale assessment of desertification severity is not only influenced by the spatial resolution but also by the landscape heterogeneity and the type of satellite sensor utilised. The multi-scale approach applied in this study can provide insights on scale-dependent desertificationthat help in devising overarching mitigation strategies.

How Severe Was the 2022 Flash Drought in the Yangtze River Basin?

Flash droughts, characterized by their rapid onset and severe impacts, have critical implications for the ecological environment and water resource security. However, inconsistent definitions of flash droughts have hindered scientific assessments of drought severity, limiting efforts in disaster prevention and mitigation. In this study, we propose a new method for explicitly characterizing flash drought events, with particular emphasis on the process of soil moisture recovery. The temporal and spatial evolution of flash droughts over the Yangtze River Basin was analyzed, and the severity of the extreme flash drought in 2022 was assessed by comparing its characteristics and impacts with those of three typical dry years. Additionally, the driving factors of the 2022 flash drought were evaluated from multiple perspectives. Results indicate that the new identification method for flash droughts is reasonable and reliable. In recent years, the frequency and duration of flash droughts have significantly increased, with the Dongting Lake and Poyang Lake basins being particularly affected. Spring and summer were identified as peak seasons for flash droughts, with the middle reaches most affected in spring, while summer droughts tend to impact the entire basin. Compared to 2006, 2011, and 2013, the flash drought in 2022 affected the largest area, with the highest number of grids experiencing two flash drought events and a development rate exceeding 15%. Moreover, the summer heat in 2022 was more extreme than in the other three years, extending from spring to fall, especially during July–August. Its evolution was driven by the Western Pacific Subtropical High, which suppressed precipitation and elevated temperatures. The divergence of water vapor flux intensified water shortages, while anomalies in latent and sensible heat fluxes increased surface evaporation and heat transfer, further disturbing the regional water cycle. This study provides valuable insights for flash drought monitoring and early warning in the context of a changing climate.

Predicting full-thickness necrosis in adult acute corrosive ingestion injuries in a sub-Saharan African setting

BACKGROUND Corrosive ingestion remains an important global pathology with high morbidity and mortality. Data on the acute management of adult corrosive injuries from sub-Saharan Africa is scarce, with international investigative algorithms, relying heavily on computed tomography (CT), having limited availability in this setting. AIM To investigate the corrosive injury spectrum in a low-resource setting and the applicability of parameters for predicting full-thickness (FT) necrosis and mortality. METHODS A retrospective analysis of a prospective corrosive injury registry (March 1, 2017–October 31, 2023) was performed to include all adult patients with acute corrosive ingestion managed at a single, academic referral centre in Cape Town, South Africa. Patient demographics, corrosive ingestion details, initial investigations, management, and short-term outcomes were described using descriptive statistics while multivariate analysis with receiver operator characteristic area under the curve graphs (ROC AUC) were used to identify factors predictive of FT necrosis and 30-day mortality. RESULTS One-hundred patients were included, with a mean age of 32 years (SD: 11.2 years) and a male predominance (65.0%). The majority (73.0%) were intentional suicide attempts. Endoscopy on admission was the most frequent initial investigation performed (95 patients), while only 17 were assessed with CT. Seventeen patients had full thickness necrosis at surgery, of which eleven underwent emergency resection and six were palliated. Thirty-day morbidity and mortality were 27.0% and 14.0%, respectively. Patients with full thickness necrosis and those with an established perforation had a 30-day mortality of 58.8% and 91.0%, respectively. Full thickness necrosis was associated with a cumulative 2-year survival of only 17.6%. Multivariate analyses with ROC AUC showed admission endoscopy findings, CT findings, and blood gas findings (pH, base excess, lactate), to all have significant predictive value for full thickness necrosis, with endoscopy proving to have the best predictive value (AUC 0.850). CT and endoscopy findings were the only factors predictive of early mortality, with CT performing better than endoscopy (AUC 0.798 vs 0.759). CONCLUSION Intentional corrosive injuries result in devastating morbidity and mortality. Locally, early endoscopy remains the mainstay of severity assessment, but referral for CT imaging should be considered especially when blood gas findings are abnormal.

ACVECC-Veterinary Committee on Trauma registry report 2020-2021.

To report summative data from the American College of Veterinary Emergency and Critical Care (ACVECC)-Veterinary Committee on Trauma (VetCOT) registry, with further individual evaluation of university and private practices and level I and II Veterinary Trauma Centers (VTCs). Multi-institutional registry data report, January 1, 2020, to December 31, 2021. VTCs identified and verified by ACVECC-VetCOT. Dogs and cats with evidence of trauma. Data were input to a web-based data capture system (REDCap) by data entry personnel trained in registry software use and operational definitions of data variables. Patient data on demographics, trauma type, preadmission care, trauma severity assessment at presentation (modified Glasgow Coma Score and Animal Trauma Triage score), key laboratory parameters, interventions, and outcome were collected. Summary descriptive data for each species are reported. Twenty-two VTCs contributed data to the VetCOT registry during a 24-month period, culminating in a total of 9758 complete trauma case records for dogs and 11734 for cats. Head trauma in dogs and cats was seen at a higher percentage in both university-only VTCs (encompassing both level I and II) (20.1% and 24.1%, respectively) and level I-only VTCs (24.3% and 24.1%, respectively), in comparison to private-only VTCs (encompassing both level I and II) (13.5% and 16.2%, respectively) and individual level II VTCs (14.1% and 18.9%, respectively). Canine and feline surgical procedures were performed at a higher percentage at university VTCs (50% and 40.5%, respectively) compared to private VTCs (39.2% and 28.6%, respectively). Overall survival to discharge for dogs and cats remains high at 93.1% and 83.6%, respectively. The VetCOT registry has continued to show powerful potential in collating a large, multifaceted, international dataset in trauma for both dogs and cats. As published in previous VetCOT registry reports, survival to discharge has remained static across both university and private practice veterinary hospitals; however, further breakdown has identified university and level I VTCs admitting and managing a higher number of head traumas, as well as university VTCs performing a higher proportion of surgical procedures. Data from this registry will continue to aid in the design of clinical trials, prospective observational studies, and translational research, which will improve the understanding and outcome of trauma patients.

Review article: Measuring disease severity in inflammatory bowel disease - Beyond treat to target.

Inflammatory bowel disease (IBD) follows a heterogenous disease course and predicting a patient's prognosis is challenging. There is a wide burden of illness in IBD and existing tools measure disease activity at a snapshot in time. Comprehensive assessment of IBD severity should incorporate disease activity, prognosis, and the impacts of disease on a patient. This review investigates the concept of disease severity in adults with IBD to highlight key components contributing to this. To perform this narrative review, a Medline search was conducted for full-text articles available at 1st March 2024 using search terms which encompassed disease activity assessment, disease severity, prognosis, natural history of Crohn's disease (CD) and ulcerative colitis (UC), and the burden of IBD. Current methods of disease assessment in IBD have evolved from a focus on the burden of symptoms to one that includes inflammatory targets, genetic, serological, and proteomic profiles, and assessments of quality-of-life (QoL), disability, and psychosocial health. Longitudinal studies of IBD suggest that the burden of illness is driven by disease phenotype, clinical markers of complicated disease course (previous intestinal resection, corticosteroid use, perianal disease in CD, recent hospitalisations in UC), gut inflammation, and the impact of IBD on the patient. Disease severity in IBD can be difficult to conceptualise due to the multitude of factors that contribute to IBD outcomes. Measurement of IBD severity may better encapsulate the full burden of illness rather than gut inflammation alone at a single timepoint and may be associated with longitudinal outcomes.

Rationale and Design of the DEFIANCE Study: A Randomized Controlled Trial of Mechanical Thrombectomy Versus Anticoagulation Alone for Iliofemoral Deep Vein Thrombosis

BackgroundDeep vein thrombosis (DVT) is a common medical condition that is associated with clinically significant sequelae, including postthrombotic syndrome (PTS). Anticoagulation alone remains the guideline-recommended treatment for many patients with iliofemoral DVT. Recent technological advances have led to an increase in the use of mechanical thrombectomy for DVT, but mechanical thrombectomy-based procedures have not yet been compared with standard-of-care anticoagulation therapy in randomized studies. MethodsThe DEFIANCE study (ClinicalTrials.gov: NCT05701917) is an international and actively enrolling randomized controlled trial (RCT) in lower extremity DVT assessing an interventional strategy that includes mechanical thrombectomy with the ClotTriever System (Inari Medical, Irvine, CA) versus anticoagulation alone. Approximately 300 patients with unilateral iliofemoral DVT and symptom duration ≤12 weeks will be randomized 1:1. Study conduct includes an independent core laboratory for duplex ultrasound assessment, an independent medical monitor for safety adjudication, and evaluation of PTS severity on the Villalta scale using best clinical practices. The primary endpoint is a composite outcome structured as a hierarchal win ratio of 1) the occurrence of treatment failure or therapy escalation as adjudicated by the medical monitor, with failure defined as amputation or gangrene of the target leg or venous thromboembolism-related mortality, and 2) the assessment of PTS severity at the 6-month follow-up visit. In addition to being a component of the primary endpoint, the severity of PTS at 6 months is also evaluated as a stand-alone secondary endpoint. An additional secondary endpoint is a composite of outcomes at the 10-day visit and is structured as a hierarchal win ratio of 1) vessel compressibility on duplex ultrasound, 2) patient-reported pain, and 3) improvement of edema. The safety endpoints are access site complications requiring endovascular or surgical repair and the occurrence through the 30-day visit of mortality, major bleeding, or new symptomatic pulmonary embolism. ConclusionsDEFIANCE will be the first RCT to evaluate a mechanical thrombectomy-based interventional approach versus anticoagulation therapy alone for DVT. The results will inform the treatment of patients with iliofemoral DVT and the prevention of PTS-associated morbidity. Trial RegistrationDEFIANCE: RCT of ClotTriever System Versus Anticoagulation In Deep Vein Thrombosis (DEFIANCE), ClinicalTrials.gov: NCT05701917, URL: https://clinicaltrials.gov/study/NCT05701917?cond=Deep%20Vein%20Thrombosis&term=defiance&rank=1

Automatic 3-dimensional quantification of orthodontically induced root resorption in cone-beam computed tomography images based on deep learning

Orthodontically induced root resorption (OIRR) is a common and undesirable consequence of orthodontic treatment. Traditionally, studies employ manual methods to conduct 3-dimensional quantitative analysis of OIRR via cone-beam computed tomography (CBCT), which is often subjective and time-consuming. With advancements in computer technology, deep learning-based approaches have gained traction in medical image processing. This study presents a deep learning-based model for the fully automatic extraction of root volume information and the localization of root resorption from CBCT images. In this cross-sectional, retrospective study, 4534 teeth from 105 patients were used to train and validate an automatic model for OIRR quantification. The protocol encompassed several steps: preprocessing of CBCT images involving automatic tooth segmentation and conversion into point clouds, followed by segmentation of tooth crowns and roots via the Dynamic Graph Convolutional Neural Network. The root volume was subsequently calculated, and OIRR localization was performed. The intraclass correlation coefficient was employed to validate the consistency between the automatic model and manual measurements. The proposed method strongly correlated with manual measurements in terms of root volume and OIRR severity assessment. The intraclass correlation coefficient values for average volume measurements at each tooth position exceeded 0.95 (P<0.001), with the accuracy of different OIRR severity classifications surpassing 0.8. The proposed methodology provides automatic and reliable tools for OIRR assessment, offering potential improvements in orthodontic treatment planning and monitoring.

Comparative Study Of BISAP Score With APACHE-II Scoring System To Determine The Severity Of Acute Pancreatitis

Introduction: Acute pancreatitis (AP) is a significant abdominal emergency characterized by inflammation of the pancreas, primarily due to autodigestion by pancreatic enzymes. Early severity assessment is crucial for management, as severe cases lead to complications and mortality. While various scoring systems exist, the Bedside Index for Severity in Acute Pancreatitis (BISAP) and APACHE-II (Acute Physiology and Chronic Health Evaluation) scores are commonly used, each with unique advantages and limitations in severity prediction. Objective: This study aims to compare the effectiveness of BISAP and APACHE-II scores in predicting acute pancreatitis severity, helping clinicians optimize treatment decisions. Methods: This observational study was conducted at SMS Hospital, Jaipur, involving 76 patients diagnosed with AP based on clinical, biochemical, and imaging criteria. Participants were assessed using both BISAP and APACHE-II scoring within 24 hours of admission, with a focus on accuracy in predicting severe cases and outcomes. Results: Among participants, the mean age was 43 years, and 84.2% were male. Gallstone disease was the leading cause of AP (55.2%), followed by alcohol (34.2%). BISAP scores ≥3 was associated with significantly higher mortality, highlighting BISAP’s predictive accuracy. The mean BISAP score was 1.86 ± 1.09, while the APACHE-II score was 6.97 ± 5.66, indicating more severe classifications using BISAP. The study found a moderate positive correlation between BISAP and APACHE-II scores, though only BISAP scores significantly predicted patient outcomes. Conclusion: BISAP offers a rapid and accurate assessment tool for AP severity, especially suitable for early intervention in high-risk patients. Compared to APACHE-II, BISAP is simpler, cost-effective, and demonstrates a high negative predictive value, making it more practical for acute settings.

Unveiling Artificial Intelligence’s Power: Precision, Personalization, and Progress in Rheumatology

This review examines the increasing use of artificial intelligence (AI) in rheumatology, focusing on its potential impact in key areas. AI, including machine learning (ML) and deep learning (DL), is revolutionizing diagnosis, treatment personalization, and prognosis prediction in rheumatologic diseases. Specifically, AI models based on convolutional neural networks (CNNs) demonstrate significant efficacy in analyzing medical images for disease classification and severity assessment. Predictive AI models also have the ability to forecast disease trajectories and treatment responses, enabling more informed clinical decisions. The role of wearable devices and mobile applications in continuous disease monitoring is discussed, although their effectiveness varies across studies. Despite existing challenges, such as data privacy concerns and issues of model generalizability, the compelling results highlight the transformative potential of AI in rheumatologic disease management. As AI technologies continue to evolve, further research will be essential to address these challenges and fully harness the potential of AI to improve patient outcomes in rheumatology.

Effective encoder-decoder network for pupil light reflex segmentation in facial photographs of ptosis patients

Accurate segmentation of pupil light reflexes is essential for the reliable assessment of ptosis severity, a condition characterized by the drooping of the upper eyelid. This study introduces a novel encoder-decoder network specialized in reflex segmentation by focusing on addressing issues related to very small regions of interest from an architectural perspective. Specifically, the proposed network is designed to exploit low-level features effectively by integrating a multi-level skip connection and a 1 × 1 convolution-enhanced initial encoding stage. Assessed using a photograph image dataset from Chung-Ang University Hospital, which includes 87 healthy subjects, 64 with ptosis, and 257 with Graves’ orbitopathy (collected between January 2010 and February 2023), the proposed network outperforms five conventional encoder-decoders. Over 30 trials, the proposed network achieved a mean Dice coefficient of 0.767 and an Intersection over Union of 0.653, indicating a statistically significant improvement in the segmentation of reflex. Our findings show that an elaborate design based on the lowest-level skip connection and 1 × 1 convolution at initial stage enhances the segmentation of pupil light reflexes. The source code of the proposed network is available at https://github.com/tkdgur658/ReflexNet.

Portuguese translation, cultural adaptation and psychometric properties of the temporomandibular joint scale: a cross-sectional study

BackgroundThe temporomandibular joint (TMJ) scale assesses the severity of temporomandibular joint disorders (TMD), yet a European Portuguese translation is lacking.ObjectivesTo translate, cross-culturally adapt and to examine the psychometric properties (construct validity and reliability) of the TMJ scale.MethodsTranslation and cultural adaptation were carried out according to international recommendations, including initial translation, evaluation of this translation and cultural adaptation by a panel of experts, and back translation. The final Portuguese version was used to examine the reliability and validity, and participants with TMD were recruited from a Portuguese outpatient clinic. Reliability measures included internal consistency with Cronbach’s alpha and test-retest reliability with the intraclass correlation coefficient (ICC2,1). The Spearman correlation comparing the TMJ scale with the Fonseca and Helkimo indexes was used to assess the construct validity.ResultsA total of 63 participants (23 ± 2 years; 61,9% female) were included. Similar internal consistency was observed between the two moments of application (0.921 and 0.918), and test-retest reliability was excellent, with an ICC2,1 = 0.998 (95%CI: 0.988–0.999). Robust positive correlations (rho 0.554–0.611, p < 0.001) were found between the TMJ scale and Fonseca and Helkimo indexes.ConclusionThe European Portuguese version of TMJ scale is now available to improve the assessment of severity of TMD in routine clinical practice. This version is also reliable and valid.

The association between ADAMTS14/rs4747096 gene polymorphism and some risk factors and knee osteoarthritis

Knee osteoarthritis (KOA) is an important cause of disability in the world and it denotes a public health defiance of the upcoming years.Aim To examine the connection between ADAMTS14 gene rs4747096 polymorphism and KOA and to assess risk factors associated with KOA.Methods A case control study was conducted on 158 patients with KOA and 120 controls with comparable age and sex randomly recruited from National Research Centre employees. All participants were subjected to full history taking, assessment of KOA severity using WOMAC scoring system, and thorough clinical examination. Blood sample was collected for detection of ADAMTS14/rs4747096 gene polymorphism.Results The frequency of ADAMTS14 gene rs4747096 genotypes among patients with KOA was 73.5% for AA, 25.7% for AG, and 0.7% for GG compared to controls 963%, 31.3%, and 5.6% respectively and the frequency of alleles among patients was 86.4% for A and 78.7% for G compared to controls (78.7% and 21.3% respectively, P < 0.05. The study found that the median levels of total WOMAC score and its domains were significantly higher among KOA patients than controls. The logistic regression analysis revealed that age ≥ 50 years, BMI ≥ 35, and long standing at work were predictive factors for KOA (P < 0.05). Regarding different genetic patterns, only the A recessive pattern of inheritance was found to be a predictive risk factor for KOA.Conclusion For ADAMTS14 rs4747096 genotype, the AA and AG genotypes significantly increased the risk of KOA. The recessive pattern of inheritance, older age, morbid obesity, and prolonged standing at work were the predictive risk factors for KOA. Further studies with larger sample size are encouraged to investigate the mechanism by which this genotype can affect the development of KOA.

Automated Posterior Scleral Topography Assessment for Enhanced Staphyloma Visualization and Quantification With Improved Maculopathy Correlation.

To quantitatively characterize the posterior morphology of high myopia eyes with posterior staphyloma. Surface points of the eyeball were automatically extracted from magnetic resonance imaging scans using deep learning. Subsequently, the topography of posterior staphylomas was constructed to facilitate accurate visualization and quantification of their location and severity. In the three-dimensional Cartesian coordinate system established with surface points, measurements of distances (D) from each point to the hypothetical pre-elongation eye center within the eyeball and local curvatures (C) at each point on the posterior sclera were computed. Using this data, specific parameters were formulated. The concordance of these parameters with traditional staphyloma classification methods and their association with myopic traction maculopathy (MTM) grades based on the ATN classifications were investigated. The study included 102 eyes from 52 participants. The measured parameters, particularly the variance of distance (Dvar) and the maximum value of the curvature and distance product (C · Dmax), demonstrated efficacy in differentiating various types of posterior staphyloma and exhibited strong correlations with the grades of MTM. The automated generation of the posterior scleral topography facilitated visualization and quantification of staphyloma location and severity. Simple geometric parameters can quantify staphyloma shape and correlate well with retinal complications. Future works on expanding these measures to more imaging modalities could improve their clinical use and deepen insights into the link between posterior staphyloma and related retinal diseases. This work has the potential to be translated into clinical practice, allowing for the accurate assessment of staphyloma severity and ultimately improving disease management.

Cerebellar Structural and N-Acetylaspartate, Choline, and Creatine Metabolic Profiles in Parkinson’s Disease and Essential Tremor

Background: The role of the cerebellum in Parkinson’s disease (PD), particularly in tremor-dominant subtypes, is increasingly recognized. Magnetic resonance imaging (MRI) and magnetic resonance spectroscopy (MRS) provide anatomical and metabolic insights, suggesting compensatory hyperactivity or degenerative changes in the cerebellum in PD. Volumetric analysis of cerebellar structures in MRI images, combined with metabolic profiles from MRS, offers possibilities for differentiating PD from essential tremor (ET). The cerebellum may be a potential therapeutic target due to its role in neurocircuitry of PD and ET. Methods: Brain structural data were obtained using MRI, and cerebellar metabolic profiles, focusing on the quantification of N-acetylaspartate (NAA), choline, and creatine peaks were obtained using MRS. This study enrolled patients with ET and PD, both with and without tremor, as well as disease controls with cerebellar atrophy (including spinocerebellar ataxia and multiple system atrophy). Volumetric analysis of cerebellar structures was performed. Differences in MRI and MRS parameters were analyzed using one-way analysis of covariance with a significance threshold of p &lt; 0.05. Results: From November 2018 to March 2023, 111 patients were enrolled, including 29 ET, 29 cerebellar atrophy, 12 PD without tremor, and 41 PD with tremor. No significant differences in cerebellar volume and N-acetylaspartate/creatine and choline/creatine ratios were found between ET and PD with tremor. Conclusions: This preliminary retrospective study suggests similarities in cerebellar structures and metabolic profiles between ET and PD, highlighting the need for advanced imaging techniques to better differentiate between these conditions. Future research should integrate clinical data, such as tremor severity and cognitive assessments, to explore the relationships with cerebellar MRI parameters.

Management of 10 Children With Inflammatory Rosacea With Topical Ivermectin.

Rosacea diagnosis and treatment in children are challenging, due to its rarity and to the lack of approved pharmacological agents for its treatment in this age group. In this case series, response to treatment with once daily applications of ivermectin (IVM) 1% cream for 12 weeks in 10 children affected by mild to severe inflammatory rosacea was evaluated clinically by Investigator Erythema Severity Assessment (IESA), Investigator Global Assessment of Severity (IGA-S), Investigator Global Assessment score of Global Efficacy (IGA-GE), and instrumentally by dermoscopy and Erythema-Directed Digital Photography (EDDP). Clinical improvement was achieved at the end of treatment compared to baseline (IESA: 2.3 vs. 0.5; IGA-S: 2.1 vs. 0.3) and confirmed by IGA-GE (0 = 55%, 1 = 33%, 3 = 11%) and instrumental monitoring (EDDP: 2.7 vs. 0.6). Once daily IVM application may be an effective therapeutic option for children with rosacea.

Biomarkers of rheumatoid arthritis-associated interstitial lung disease: a systematic review and meta-analysis

BackgroundInterstitial Lung Disease (ILD) represents the most common extra-articular manifestation of Rheumatoid Arthritis (RA) and is a major cause of mortality. This study aims to identify and evaluate biomarkers associated with Rheumatoid Arthritis-Associated Interstitial Lung Disease (RA-ILD).MethodsWe searched PubMed, Cochrane Library, EMBASE, and Web of Science databases for studies related to biomarkers of RA-ILD up until October 7, 2023. The Newcastle-Ottawa Scale (NOS) and standards recommended by the Agency for Healthcare Research and Quality (AHRQ) were used for quality assessment, and meta-analysis was conducted using Stata18.0 software.ResultsA total of 98 articles were assessed for quality, 48 of which were included in the meta-analysis. 83 studies were of high quality, and 15 were of moderate quality. The meta-analysis showed significant differences in biomarkers such as C-Reactive Protein (CRP), Erythrocyte Sedimentation Rate (ESR), Anti-Cyclic Citrullinated Peptide (anti-CCP) antibody, Rheumatoid Factor (RF), Krebs von den Lungen-6 (KL-6), Surfactant Protein D (SP-D), Carcinoembryonic Antigen (CEA), Carbohydrate Antigen 19-9 (CA19-9), Matrix Metalloproteinase-7 (MMP-7), C-X-C Motif Chemokine Ligand 10 (CXCL-10), and Neutrophil-to-Lymphocyte Ratio (NLR) between RA-ILD patients and RA patients. However, Platelet-to-Lymphocyte Ratio [Platelet-to-Lymphocyte Ratio (PLR)], Cancer Antigen 125 [Cancer Antigen 125 (CA-125)], and Cancer Antigen 153 [Cancer Antigen 153 (CA-153)] did not show significant differences between the two groups. KL-6, MMP-7, and Human Epididymis Protein 4 (HE4) are negatively correlated with lung function, and KL-6 is associated with the prognosis of RA-ILD.ConclusionsBiomarkers hold promising clinical value for prediction, diagnosis, severity assessment, and prognosis evaluation in RA-ILD. However, these findings need to be validated through multicenter, large-sample, prospective cohort studies.Systematic review registrationhttps://www.crd.york.ac.uk/prospero/, identifier CRD42023448372.

Deep learning-based algorithm for staging secondary caries in bitewings.

Despite the notable progress in developing artificial intelligence (AI)-based tools for caries detection in bitewings, limited research has addressed the detection and staging of secondary caries. Therefore, we aimed to develop a Convolutional neural network (CNN)-based algorithm for these purposes using a novel approach for determining lesion severity. We used a dataset from a Dutch dental practice-based research network containing 2,612 restored teeth in 413 bitewings from 383 patients aged 15 to 88 years and trained the Mask R-CNN architecture with a Swin Transformer backbone. Two-stage training fine-tuned caries detection accuracy and severity assessment. Annotations of caries around restorations were made by two evaluators and checked by two other experts. Aggregated accuracy metrics (mean ± Standard Deviation - SD) in detecting teeth with secondary caries were calculated considering two thresholds: detecting all lesions and dentine lesions. The correlation between the lesion severity scores obtained with the algorithm and the annotators' consensus was determined using the Pearson correlation coefficient and Bland-Altman plots. Our refined algorithm showed high specificity in detecting all lesions (0.966 ± 0.025) and dentine lesions (0.964 ± 0.019). Sensitivity values were lower: 0.737 ± 0.079 for all lesions and 0.808 ± 0.083 for dentine lesions. The areas under ROC curves (SD) were 0.940 (0.025) for all lesions and 0.946 (0.023) for dentine lesions. The correlation coefficient for severity scores was 0.802. We developed an improved algorithm to support clinicians in detecting and staging secondary caries in bitewing, incorporating an innovative approach for annotation, considering the lesion severity as a continuous outcome.

Optimizing the Prediction of Depression Remission: A Longitudinal Machine Learning Approach.

Decisions about when to change antidepressant treatment are complex and benefit from accurate prediction of treatment outcome. Prognostic accuracy can be enhanced by incorporating repeated assessments of symptom severity collected during treatment. Participants (n = 714) from the Genome-Based Therapeutic Drugs for Depression study received escitalopram or nortriptyline over 12 weeks. Remission was defined as scoring ≤ 7 on the Hamilton Rating Scale. Predictors included demographic, clinical, and genetic variables (at 0 weeks) and measures of symptom severity (at 0, 2, 4, and 6 weeks). Longitudinal descriptors extracted with growth curves and topological data analysis were used to inform prediction of remission. Repeated assessments produced gradual and drug-specific improvements in predictive performance. By Week 4, models' discrimination in all samples reached levels that might usefully inform treatment decisions (area under the receiver operating curve (AUC) = 0.777 for nortriptyline; AUC = 0.807 for escitalopram; AUC = 0.794 for combined sample). Decisions around switching or modifying treatments for depression can be informed by repeated symptom assessments collected during treatment, but not until 4 weeks after the start of treatment.

Fecal microbiota transplantation against moderate-to-severe atopic dermatitis: A randomized, double-blind controlled explorer trial.

Fecal microbiota transplantation (FMT) is a novel treatment for inflammatory diseases. Herein, we assess its safety, efficacy, and immunological impact in patients with moderate-to-severe atopic dermatitis (AD). In this randomized, double-blind, placebo-controlled clinical trial, we performed the efficacy and safety assessment of FMT for moderate-to-severe adult patients with AD. All patients received FMT or placebo once a week for 3 weeks, in addition to their standard background treatments. Patients underwent disease severity assessments at weeks 0, 1, 2, 4, 8, 12, and 16, and blood and fecal samples were collected for immunologic analysis and metagenomic shotgun sequencing, respectively. Safety was monitored throughout the trial. Improvements in eczema area and severity index (EASI) scores and percentage of patients achieving EASI 50 (50% reduction in EASI score) were greater in patients treated with FMT than in placebo-treated patients. No serious adverse reactions occurred during the trial. FMT treatment decreased the Th2 and Th17 cell proportions among the peripheral blood mononuclear cells, and the levels of TNF-α, and total IgE in serum. By contrast, the expression levels of IL-12p70 and perforin on NK cells were increased. Moreover, FMT altered the abundance of species and functional pathways of the gut microbiota in the patients, especially the abundance of Megamonas funiformis and the pathway for 1,4-dihydroxy-6-naphthoate biosynthesis II. FMT was a safe and effective therapy in moderate-to-severe adult patients with AD; the treatment changed the gut microbiota compositions and functions.