Detection Of High-risk Patients Research Articles

Development and validation of a CT-based nomogram for accurate hepatocellular carcinoma detection in high risk patients

PurposeTo establish and validate a CT-based nomogram for accurately detecting HCC in patients at high risk for the disease.MethodsA total of 223 patients were divided into training (n=161) and validation (n=62) cohorts between January of 2017 and May of 2022. Logistic analysis was performed, and clinical model and radiological model were developed separately. Finally, a nomogram was established based on clinical and radiological features. All models were evaluated using the area under the curve (AUC). DeLong’s test was used to evaluate the differences among these models.ResultsIn the multivariate analysis, gender (p = 0.014), increased Alpha-fetoprotein (AFP) (p = 0.017), non-rim arterial phase hyperenhancement (APHE) (p = 0.011), washout (p = 0.011), and enhancing capsule (p = 0.001) were the independent differential predictors of HCC. A nomogram was formed with well-fitted calibration curves based on these five factors. The area under the curve (AUC) of the nomogram in the training and validation cohorts was 0.961(95%CI: 0.935~0.986) and 0.979 (95% CI: 0.949~1), respectively. The nomogram outperformed the clinical and the radiological models in training and validation cohorts.ConclusionThe nomogram incorporating clinical and CT features can be a simple and reliable tool for detecting HCC and achieving risk stratification in patients at high risk for HCC.

Accelerate oral cancer detection in high-risk patients

Accelerate oral cancer detection in high-risk patients

AI-enabled electrocardiography alert intervention and all-cause mortality: a pragmatic randomized clinical trial.

The early identification of vulnerable patients has the potential to improve outcomes but poses a substantial challenge in clinical practice. This study evaluated the ability of an artificial intelligence (AI)-enabled electrocardiogram (ECG) to identify hospitalized patients with a high risk of mortality in a multisite randomized controlled trial involving 39 physicians and 15,965 patients. The AI-ECG alert intervention included an AI report and warning messages delivered to the physicians, flagging patients predicted to be at high risk of mortality. The trial met its primary outcome, finding that implementation of the AI-ECG alert was associated with a significant reduction in all-cause mortality within 90 days: 3.6% patients in the intervention group died within 90 days, compared to 4.3% in the control group (4.3%) (hazard ratio (HR) = 0.83, 95% confidence interval (CI) = 0.70-0.99). A prespecified analysis showed that reduction in all-cause mortality associated with the AI-ECG alert was observed primarily in patients with high-risk ECGs (HR = 0.69, 95% CI = 0.53-0.90). In analyses of secondary outcomes, patients in the intervention group with high-risk ECGs received increased levels of intensive care compared to the control group; for the high-risk ECG group of patients, implementation of the AI-ECG alert was associated with a significant reduction in the risk of cardiac death (0.2% in the intervention arm versus 2.4% in the control arm, HR = 0.07, 95% CI = 0.01-0.56). While the precise means by which implementation of the AI-ECG alert led to decreased mortality are to be fully elucidated, these results indicate that such implementation assists in the detection of high-risk patients, prompting timely clinical care and reducing mortality. ClinicalTrials.gov registration: NCT05118035 .

Clinical outcomes of hepatocellular carcinoma surveillance in Melbourne, Australia.

Ultrasound surveillance for hepatocellular carcinoma (HCC) may improve early tumour detection but may additionally result in surveillance-related harm through increased evaluation of non-HCC lesions. The incidence of these outcomes has not been reported outside North America. We aimed to report the outcomes of HCC surveillance with respect to both surveillance-related benefits and harms. We reviewed all HCC surveillance ultrasounds at a large Victorian tertiary hospital network in 2017 and followed their outcomes until 2021. Surveillance-related benefits were defined as early-stage HCC detection. Surveillance-related harm was defined as contrast imaging, biopsies or surgery performed to evaluate non-HCC liver lesions or false-positive alpha-fetoprotein levels. Five hundred and fifty-three patients were included (mean age 54.5 ± 12.3 years, males 67.5%, cirrhosis 50.3%). The most common liver disease aetiology was hepatitis B (53.9%). Over a median of 4.7 years follow-up, early-stage HCC was detected in 3.3% (5.4% in cirrhotic vs 1.1% in non-cirrhotic patients, P < 0.01). 75% of all HCCs were early-stage. Surveillance-related harm occurred in 12.5% (15.5% in cirrhotic vs 9.5% in non-cirrhotic patients, P < 0.04), although most harm was mild (12.1%). In subgroup analysis, the detection of early-stage HCC ranged between 0% (screened outside of guideline criteria and alcoholic cirrhotic patients) and 7.2% (hepatitis C cirrhosis). Harm occurred between 9% (non-cirrhotic hepatitis B) and 20.8% (thrombocytopenia). In our study, HCC surveillance was associated with early tumour detection, although many patients experienced mild surveillance-related harm. Novel surveillance strategies and pathways are required to improve detection in high-risk patients and minimise harm in low-risk patients.

Comparison of non-contrast abbreviated MRI and ultrasound as surveillance modalities for HCC

Ultrasonography (US) is recommended for HCC surveillance in high-risk patients but has limited performance in detecting early-stage HCC. We aimed to compare the diagnostic performance of biannual US and annual non-contrast abbreviated magnetic resonance imaging (NC-AMRI) as HCC surveillance modalities in high-risk patients. This prospective, multicenter cohort study enrolled participants with an estimated annual risk of HCC greater than 5% between October 2015 and April 2017. Participants underwent six rounds of HCC surveillance at 6-month intervals, with both US and NC-AMRI at rounds 1, 3, and 5, and only US at rounds 2, 4, and 6. The sensitivity, diagnostic yield (DY), and false referral rate (FRR) for HCC detection by US and NC-AMRI were compared. In total, 208 participants underwent 980 US and 516 NC-AMRI examinations during 30 months of follow-up. Among them, 34 HCCs were diagnosed in 31 participants, with 20 (64.5%) classified as very early-stage and 11 (35.5%) as early-stage HCC. The sensitivity of annual NC-AMRI (71.0%, 22/31) was marginally higher than that of biannual US (45.2%, 14/31; p= 0.077). NC-AMRI showed a significantly higher DY than US (4.26% vs. 1.43%, p <0.001), with a similar FRR (2.91% vs. 3.06%, p= 0.885). A simulation of alternating US and NC-AMRI at 6-month intervals yielded a sensitivity of 83.9% (26/31), significantly exceeding that of biannual US (p= 0.006). Annual NC-AMRI showed a marginally higher sensitivity than biannual US for HCC detection in high-risk patients. The DY of annual NC-AMRI was significantly higher than that of biannual US, without increasing the FRR. Thus, alternating US and NC-AMRI at 6-month intervals could be an optimal surveillance strategy for high-risk patients. Current guidelines permit the use of magnetic resonance imaging (MRI) as a surveillance tool for hepatocellular carcinoma in patients in whom ultrasonography (US) is inadequate. However, the specific indications, imaging sequences, and intervals for MRI surveillance remain unclear. In our study, we found that annual non-contrast abbreviated MRI exhibited marginally higher sensitivity and significantly better diagnostic yield than biannual US in patients at high risk of hepatocellular carcinoma. Alternating US and non-contrast abbreviated MRI at 6-month intervals led to significantly improved sensitivity compared to biannual US, making it a potentially optimal surveillance strategy for high-risk patients. NCT02551250.

A-295 - Use of 3-dimensional total body photography and digital dermoscopy with artificial intelligence algorithms for early melanoma detection in high-risk patients

A-295 - Use of 3-dimensional total body photography and digital dermoscopy with artificial intelligence algorithms for early melanoma detection in high-risk patients

Assessing lung cancer screening in the Jefferson Health Northeast system.

378 Background: Despite early diagnosis of lung cancer with annual low-dose CT scans for high-risk patients, the 2022 screening rate in Pennsylvania is 9% which is slightly better than the national average of 6%. This study assesses lung cancer screening in the Jefferson Health Northeast (JNE) system compared to the Pennsylvania state average and identifies possible areas of improvement. Methods: This is a retrospective study of 1701 lung cancer screened patients from January to December 2022 within the JNE system. Screening results in each hospital were compared with one another. Age, race, and smoking history were assessed in patients with a positive screen, defined as Lung-RADS score of 4. The results were compared to the 2022 Pennsylvania state lung cancer screening rates. Results: Of 1701 patients screened, 52.7 % were female and 47.3% were male. The majority of these patients were Caucasian (87.2%) then African American (6.0%), Hispanic (1.9%), and Asian (0.8%). Among the screened patients, 56.4% were current smokers while 43.6% were former smokers. 131 patients screened positive. 23 new cases were confirmed. Of these 1.9% and 1.2% were African Americans and Caucasians respectively; 56.5% and 34.8% were current and former smokers respectively; 56.5% were female and 34.8% were male. The majority of cases were adenocarcinoma (43.5%) and squamous cell carcinoma (39.1%). Even though Bucks Hospital had the highest positive screening rate (8.2%), Torresdale Hospital documented the majority of new cases (60.9%). Conclusions: Within the JNE population, early diagnosis of lung cancer through screening remains challenging. Here we demonstrated that despite 7.7% of patients had a positive screen, only 1.4% of all patients screened were confirmed to have lung cancer. Data for positively screened patients did not ascertain successful follow-up. We suggest including the Lung-RADS score within the patient’s chart. Familiarizing healthcare providers with this will improve lung cancer detection in high-risk patients.

Electronic alert outpatient protocol improves the quality of care for the risk of postcontrast acute kidney injury following computed tomography.

Prevention and diagnosis of postcontrast acute kidney injury (AKI) after contrast-enhanced computed tomography is burdensome in outpatient department. We investigated whether an electronic alert system could improve prevention and diagnosis of postcontrast AKI. In March 2018, we launched an electronic alert system that automatically identifies patients with a baseline estimated glomerular filtration rate of &lt;45 mL/min/1.73 m2, provides a prescription of fluid regimen, and recommends a follow-up for serum creatinine measurement. Participants prescribed contrast-enhanced computed tomography at outpatient department before and after the launch of the system were categorized as historical and alert group, respectively. Propensity for the surveillance of postcontrast AKI was compared using logistic regression. Risks of AKI, admission, mortality, and renal replacement therapy were analyzed. The historical and alert groups included 289 and 309 participants, respectively. The alert group was more likely to be men and take diuretics. The most frequent volume of prophylactic fluid in historical and alert group was 1,000 and 750 mL, respectively. Follow-up for AKI was more common in the alert group (adjusted odds ratio, 6.00; p &lt; 0.001). Among them, incidence of postcontrast AKI was not statistically different. The two groups did not differ in risks of admission, mortality, or renal replacement therapy. The electronic alert system could assist in the detection of high-risk patients, prevention with reduced fluid volume, and proper diagnosis of postcontrast AKI, while limiting the prescribing clinicians' burden. Whether the system can improve long-term outcomes remains unclear.

Recommendations for risk minimization when using Janus kinase inhibitors for the treatment of chronic inflammatory skin diseases.

In accordance with article 20 of Regulation (EC) No 726/2004, the Pharmacovigilance Risk Assessment Committee (PRAC) of the European Medicines Agency (EMA) has re-evaluated the safety of Janus kinase inhibitors for the treatment of inflammatory diseases and formulated safety information deviating from the previous indications in the respective summary of product characteristics of the products concerned. These refer to the consideration of a possibly increased risk of venous thromboembolic or severe cardiovascular events, an increased infection rate and an increase in the prevalence of skin cancer across drugs and indications. Therefore, in patients with independent risk factors (age 65 years and older, smokers or former smokers, patients with oral contraception or hormone replacement therapy and other risk factors), it is recommended to use Janus kinase inhibitors therapeutically only if there are no suitable treatment alternatives. To facilitate a pragmatic and thorough detection of high-risk patients in everyday clinical practice, an interdisciplinary checklist was developed that is suitable as a working tool from the perspective of the dermatologist.

Varis dışı üst gastrointestinal kanamada klinik sonuçların tahmininde risk puanlama sistemlerinin karşılaştırılması: prospektif randomize çalışma

Aim: Non-variceal upper gastrointestinal bleeding (UGIB) is a typical gastrointestinal emergency. Detection of high-risk patients is crucial to organize medical care accordingly. This study aims to compare risk assessment scores for their ability to predict prognosis in nonvariceal-UGIB. &#x0D; Material and Method: Adult patients with nonvariceal-UGIB applied to the emergency department were recruited prospectively. Clinical and Complete Rockall score (RS), Glascow-Blatchford score (GBS), AIMS65, and T-Score were compared for endpoints: (1) need for endoscopic treatment, (2) hospitalization, (3) rebleeding, and (4) 30-day mortality.&#x0D; Results: A total of 469 patients were included. While 133 (28.0%) patients were discharged within 24 hours, 336 (72.0%) were hospitalized. The median length of hospital stay was 6.6 (0.0-8.0) days. Endoscopic treatment and transfusion were required in 109 (23.0%) and 255 (54.0%) patients, respectively. Rebleeding was observed in 36 (8.0%) patients. The 30-day mortality rate was 11.0 %. Complete Rockall score was superior among all risk scores regarding the prediction of the need for endoscopic treatment (AUC: 0.707, p

A DECISION TREE-BASED CLASSIFIER COMPARES THREE DATA ANALYSIS METHODS FOR THE IDENTIFICATION OF MIRNAS ASSOCIATED WITH EARLY-STAGE LUNG CANCER

Lung cancer is a major global health problem, with high mortality rates and increasing incidence in developing countries and among women. MicroRNAs (miRNAs) have emerged as potential biomarkers for lung cancer diagnosis and treatment due to their stability, abundance, and easy detection in tumor tissues and body fluids. However, there is no consensus on the most suitable statistical method for identifying differentially expressed miRNAs (DE-miRNAs) in large datasets. In this study, we compared the performance of EdgeR, DESeq2, and the Wilcoxon-Mann-Whitney test in identifying deregulated miRNAs in lung adenocarcinoma using a large miRNA sequencing dataset from The Cancer Genome Atlas. We focused on miRNAs associated with early-stage disease to identify potential biomarkers for disease detection in high-risk patients. Our results demonstrate the usefulness of applied computational mathematics/statistics in improving miRNA analysis using large cancer datasets and contribute to the identification of clinically applicable biomarkers for lung cancer diagnosis and treatment.

Impact of Noninvasive Respiratory Support in Patients With COVID-19 Requiring Veno-Venous Extracorporeal Membrane Oxygenation: A Question of Time?

To the Editor: We read with great interest the article by Ahmad et al.1 about right timing for veno-venous extracorporeal membrane oxygenation (V-V ECMO) institution after noninvasive respiratory support (RS) in acute respiratory distress syndrome (ARDS) due to coronavirus disease 2019 (COVID-19). Authors claimed that patients receiving V-V ECMO after a noninvasive support period longer than 3 days have worse clinical outcomes (i.e., lower rates of ECMO liberation and discharge at home) than the ones with an earlier ECMO institution. However, this remarkable observation, consistent with lower ECMO survival rates observed by other authors in this setting after prolonged noninvasive oxygenation strategies,2 needs further confirmation due to some limits of the current study.1 First, among baseline characteristics, there are no clear biochemical or radiological markers of illness severity, such as static respiratory system compliance, PaO2/FiO2 ratio (PF ratio), D-dimer concentrations, and signs (i.e., pneumothorax or pneumomediastinum) suggestive of barotrauma at CT-scan imaging, collected within 24 hours of patient admission. The lack of triage criteria does not allow the detection of high-risk patients, which most likely benefit from early treatment with V-V ECMO. Noninvasive RS is known to have better results in mild-to-moderate ARDS treatment.3 In the subgroup of patients treated with noninvasive RS for more than 3 days, the PF ratio before endotracheal intubation (ETI) is significantly lower than that in the ones who received ECMO earlier, possibly due to higher severity of COVID-19.1 Thus, worse clinical outcomes are more likely to result from greater intrinsic aggressiveness of the disease, with a dismal prognosis, and from inadequacy of noninvasive RS for severe ARDS rather than from duration of treatment. As Ahmad et al.1 suggest, this difference in the PF ratio may also reflect lung damage due to COVID-19 disease progression, as well as delay before ETI or damage related to spontaneous breathing. They inferred that prolonged RS may promote self-induced lung injury (SILI), since spontaneous breathing in severe ARDS entails higher peak inspiratory pressure and tidal volumes.4 By the way, the association of noninvasive RS and SILI is still matter of debate,5 since both barotrauma and volutrauma are quite uncommon among noninvasive approaches. Of note, the article made no mention to peak inspiratory pressure nor to tidal volumes recorded during noninvasive support. Furthermore, authors grouped together patients receiving high-flow nasal oxygen (HFNC) and noninvasive ventilation (NIV): possibly due to the small sample size (78 patients, 33 of which treated with noninvasive RS over 3 days before V-V ECMO), they did not clearly analyze factors associated with failure of such noninvasive approach, for example, compliance to the treatment, ventilation parameters, sedation, adequate fit to interface, nor specify criteria for therapeutic upgrade (i.e., muscular weakness, diaphragm atrophy, and hemodynamic instability). The retrospective nature of the study limits the power of its results: further clinical trials, with a prospective design, carried on a population stratified for risk, are needed to confirm whether 3 days represent a critical duration for noninvasive RS.

Correlation Between Quantitative PSMA PET Parameters and Clinical Risk Factors in Non-Metastatic Primary Prostate Cancer Patients

BackgroundPSMA PET is frequently used for staging of prostate cancer patients. Furthermore, there is increasing interest to use PET information for personalized local treatment approaches in surgery and radiotherapy, especially for focal treatment strategies. However, it is not well established which quantitative imaging parameters show highest correlation with clinical and histological tumor aggressiveness.MethodsThis is a retrospective analysis of 135 consecutive patients with non-metastatic prostate cancer and PSMA PET before any treatment. Clinical risk parameters (PSA values, Gleason score and D’Amico risk group) were correlated with quantitative PET parameters maximum standardized uptake value (SUVmax), mean SUV (SUVmean), tumor asphericity (ASP) and PSMA tumor volume (PSMA-TV).ResultsMost of the investigated imaging parameters were highly correlated with each other (correlation coefficients between 0.20 and 0.95). A low to moderate, however significant, correlation of imaging parameters with PSA values (0.19 to 0.45) and with Gleason scores (0.17 to 0.31) was observed for all parameters except ASP which did not show a significant correlation with Gleason score. Receiver operating characteristics for the detection of D’Amico high-risk patients showed poor to fair sensitivity and specificity for all investigated quantitative PSMA PET parameters (Areas under the curve (AUC) between 0.63 and 0.73). Comparison of AUC between quantitative PET parameters by DeLong test showed significant superiority of SUVmax compared to SUVmean for the detection of high-risk patients. None of the investigated imaging parameters significantly outperformed SUVmax.ConclusionOur data confirm prior publications with lower number of patients that reported moderate correlations of PSMA PET parameters with clinical risk factors. With the important limitation that Gleason scores were only biopsy-derived in this study, there is no indication that the investigated additional parameters deliver superior information compared to SUVmax.

ASSOCIATION OF ALBUMINURIAAND URIC ACID IN PATIENTS WITH TYPE 2 DIABETES MELLITUS

Introduction: There are two possibilities of increase serum uric acid level it could be increase production or decrease excretion higher serum uric acid level in diabetic nephropathy is mostly due to abnormality in uric acid excretion or hyperuricemia may result from increased net tubular reabsorption. On the other hand, higher levels of serum insulin may decrease uric acid clearance by the kidneys. Today there is great interest in the potential that uric acid may represent a remediable risk factor for CKD. So we studied the relation between hyperuricemia and albuminuria in type 2 diabetes mellitus patients in asansol district hospital west Bengal.Aims: The aim of this study is to evaluate the association between serum uric acid &amp; urinary Albumin to Creatinine Ratio (ACR) among patients with type 2 diabetes mellitus. Materials And Methods: This study was hospital based observational and prospective study to nd out relationship between serum uric acid level &amp; albuminuria in type 2 Diabetes Mellitus patients. 83 patients aged between 40 to 80 years was selected from Medicine OPD and indoor wards, Department of General Medicine, KPC Hospital, West Bengal from 1august 2020 to 1august 2021. Type 2 Diabetics Melitus (T2DM) patients and Age: between 40 to 80 years were included in this study. Result: 41(49.4%) patients had Normoalbuminuria, 26(31.3%) patients had Microalbuminuria and 16(19.3%) patients had Macroalbuminuria.37(44.6%) patients had Hyperuricemia and 46(55.4%) patients had Normouricemia.25(30.1%) patients had ALT. Association of hypertensive / normotensive vs. Albuminuria was not statistically signicant (p=0.3579).Association of hyperuricemia / normouricemia vs. Albuminuria was statistically signicant (p&lt;0.0001)..Poor control of HBA1C was signicantly associated with albumin excretion in urine (p&lt;0.0001).Distribution of mean GFR vs. albuminuria was statistically signicant (p&lt;0.0001). Distribution of mean urinary ACR vs. albuminuria was statistically signicant (p&lt;0.0001). Distribution of mean serum uric acid vs. albuminuria was statistically signicant (p&lt;0.0001). Conclusion : Hypertension, raised HbA1C levels, high blood sugar levels and raised serum creatinine levels are the major risk factors. Hence early detection of high risk patients and the early initiation of renal and cardiovascular protective agents helps in reducing morbidity and mortality due to type 2 diabetes mellites. There was negative correlation between serum uric acid with GFR and HDL, which were statistically signicant.

Evaluation of serum lactate dehydrogenase as early diagnostic biomarker in pregnancy with preeclampsia and eclampsia

Pregnancy is a physiological state associated with many alterations in biochemical, physiological, hematological &amp; immunological processes. Preeclampsia and eclampsia complicate 6-8% of all pregnancies and lead to various maternal and fetal complications. The aim of the present study was to evaluate serum LDH levels in the normal pregnant women and pregnant women with preeclampsia and eclampsia in ante-partum period and to study the correlation of maternal and perinatal outcomes with serum LDH levels.This prospective study was conducted among ANC mothers from 18-35 years with term singleton pregnancy attending OBG OPD and labour room at Navodaya Medical College Hospital &amp; Research Centre, Raichur. After taking informed consent &amp; detailed clinical examination, relevant laboratory investigations were performed. The serum LDH estimated using fully automated ERBA biochemical analyser.In the present study, a total of 200 pregnant women were included, out of which 100 were normal pregnant women which served as control group; remaining 34 (17%) cases were included in pregnancy with eclampsia and 66 (33%) were pregnancy with pre-eclampsia. In 29 cases of study group with Serum LDH in the range of 600-800 IU/L, 08 (27.6%) had severe pre-eclampsia and 18 (62.0%) had eclampsia. Of 34 eclampsia cases, 18(52.9%) had Serum LDH range 600-800IU/L and 14 (41.2%) had serum LDH &amp;#62;800IU/L. The mean Serum LDH in study group was 570.5 IU/L and in control group was 201.5 IU/L. The patients had maternal complications like abruption, PPH, DIC, eclampsia with LDH&amp;#62;600. Neonatal complications like IUGR, fetal distress, neonatal death, LBW, premature birth, IUD were increased with raised LDH. Serum LDH is the earliest marker in blood during hypoxia and oxidative stress. It is raised in cases of pre-eclampsia and eclampsia. Detection of high-risk patients with increased levels of LDH mandates close monitoring, prompt and correct management to decrease both maternal and foetal morbidity and mortality. Estimation of serum Lactate Dehydrogenase can be used as a prognostic marker for preeclampsia and eclampsia.

Stratifying individuals into non-alcoholic fatty liver disease risk levels using time series machine learning models

Non-alcoholic fatty liver disease (NAFLD) affects 25% of the population worldwide, and its prevalence is anticipated to increase globally. While most NAFLD patients are asymptomatic, NAFLD may progress to fibrosis, cirrhosis, cardiovascular disease, and diabetes. Research reports, with daunting results, show the challenge that NAFLD's burden causes to global population health. The current process for identifying fibrosis risk levels is inefficient, expensive, does not cover all potential populations, and does not identify the risk in time. Instead of invasive liver biopsies, we implemented a non-invasive fibrosis assessment process calculated from clinical data (accessed via EMRs/EHRs). We stratified patients' risks for fibrosis from 2007 to 2017 by modeling the risk in 5579 individuals. The process involved time-series machine learning models (Hidden Markov Models and Group-Based Trajectory Models) profiled fibrosis risk by modeling patients’ latent medical status resulted in three groups. The high-risk group had abnormal lab test values and a higher prevalence of chronic conditions. This study can help overcome the inefficient, traditional process of detecting fibrosis via biopsies (that are also medically unfeasible due to their invasive nature, the medical resources involved, and costs) at early stages. Thus longitudinal risk assessment may be used to make population-specific medical recommendations targeting early detection of high risk patients, to avoid the development of fibrosis disease and its complications as well as decrease healthcare costs.

Прогнозування ризику розвитку хронічного бронхіту у підлітків-курців

Мета дослідження — побудова зручної для застосування в практичній медицині прогностичної моделі ризику розвитку хронічної патології органів дихання у підлітків-курців. Матеріали та методи. Проведено обстеження 73 підлітків-курців віком від 14 до 18 років (середній вік — 16,4 ± 0,2 року). Усі обстежені були розподілені на 2 групи: групу 1 становили 36 підлітків-курців із хронічним бронхітом (середній вік — 16,8 ± 0,2 року) та групу порівняння — 37 умовно здорових підлітків-курців (середній вік — 15,9 ± 0,2 року). Нами були вивчені клініко-анамнестичні, функціонально-інструментальні дані (показники спірометрії, рентгенографії органів грудної клітки, рівня оксиду азоту в конденсаті повітря, що видихається, сили дихальних м’язів) та молекулярно-генетичні фактори ризику розвитку хронічної патології органів дихання у підлітків-курців — усього 103 ознаки. Для створення прогностичної моделі ризику розвитку хронічного бронхіту було застосовано метод послідовного (секвенціального) аналізу Вальда та стратегію Байєса. Результати. Принцип роботи з математичною моделлю прогнозу ризику розвитку хронічної патології органів дихання у підлітків-курців полягає у підсумуванні діагностичних коефіцієнтів (ДК), що відповідають виявленим у пацієнта ознакам. При сумі ДК +13 діагностують розвиток хронічного бронхіту у підлітків-курців із вірогідністю помилки ≤ 5 % (р &lt; 0,05); при сумі +20 вірогідність прогнозу становить 99 % (р &lt; 0,01). Висновки. Розроблений нами алгоритм прогнозування ризику розвитку хронічного бронхіту у підлітків-курців буде сприяти ранньому виявленню груп пацієнтів високого ризику з формування даної патології для проведення персоніфікованих профілактичних заходів, що дозволить практичним лікарям запобігати хронізації патологічного процесу та покращувати якість життя.

Early detection of gastric neoplasia: is artificial intelligence the solution?

Major efforts have focused on earlier endoscopic detection of gastric cancer, due to associated improved outcomes and reduced mortality. 1 Banks M Graham D Jansen M et al. British Society of Gastroenterology guidelines on the diagnosis and management of patients at risk of gastric adenocarcinoma. Gut. 2019; 68: 1545-1575 Crossref PubMed Scopus (130) Google Scholar Unfortunately, endoscopic detection remains inadequate, with potentially one in ten gastric cancers being missed. 2 Pimenta-Melo AR Monteiro-Soares M Libânio D Dinis-Ribeiro M Missing rate for gastric cancer during upper gastrointestinal endoscopy: a systematic review and meta-analysis. Eur J Gastroenterol Hepatol. 2016; 28: 1041-1049 Crossref PubMed Scopus (67) Google Scholar Furthermore, the current endoscopic standard of care, which uses white light imaging, has suboptimal sensitivity for early gastric cancer. 3 Yoshida N Doyama H Yano T et al. Early gastric cancer detection in high-risk patients: a multicentre randomised controlled trial on the effect of second-generation narrow band imaging. Gut. 2021; 70: 67-75 Crossref PubMed Scopus (17) Google Scholar Effect of a deep learning-based system on the miss rate of gastric neoplasms during upper gastrointestinal endoscopy: a single-centre, tandem, randomised controlled trialThe use of an AI system during upper gastrointestinal endoscopy significantly reduced the gastric neoplasm miss rate. AI-assisted endoscopy has the potential to improve the yield of gastric neoplasms by endoscopists. Full-Text PDF

Comparing Visual Scoring of Lung Injury with a Quantifying AI-Based Scoring in Patients with COVID-19.

Objectives:Fast diagnosis of Coronavirus Disease 2019 (COVID-19), and the detection of high-risk patients are crucial but challenging in the pandemic outbreak. The aim of this study was to evaluate if deep learning-based software correlates well with the generally accepted visual-based scoring for quantification of the lung injury to help radiologist in triage and monitoring of COVID-19 patients.Materials and methods:In this retrospective study, the lobar analysis of lung opacities (% opacities) by means of a prototype deep learning artificial intelligence (AI)-based software was compared to visual scoring. The visual scoring system used five categories (0: 0%, 1: 0–5%, 2: 5–25%, 3: 25–50%, 4: 50–75% and 5: >75% involvement). The total visual lung injury was obtained by the sum of the estimated grade of involvement of each lobe and divided by five.Results:The dataset consisted of 182 consecutive confirmed COVID-19 positive patients with a median age of 65 ± 16 years, including 110 (60%) men and 72 (40%) women. There was a correlation coefficient of 0.89 (p < 0.001) between the visual and the AI-based estimates of the severity of lung injury.Conclusion:The study indicates a very good correlation between the visual scoring and AI-based estimates of lung injury in COVID-19.

The atherosclerosis burden score.

Purpose: We carried out this study to evaluate the predictive value of atherosclerosis burden score (ABS) to predict coronary artery disease (CAD) among asymptomatic patients without known cardiovascular disease (CVD), as compared to other imaging or functional techniques, namely coronary artery calcium (CAC) score, carotid intima-media thickness (C-IMT), and ankle brachial index (ABI). Patients and methods: This prospective study included 198 asymptomatic consecutive patients referred for evaluation of their cardiovascular (CV) risk and for therapeutic advice. Traditional CV risk factors, ABS, CAC score, C-IMT, ABI and an ECG-synchronized coronary CT-angiography (CCTA) were performed for each patient. We compared the predictive values of these atherosclerosis markers to detect CAD defined as coronary stenosis ≥30% objectivated by CCTA. Results: Among the whole sample, the area under the receiver-operating characteristic curve (ROC-AUC) was significantly higher for CAC score (0.81, p=0.015) than for ABS, the reference (0.70) but these values were lower for C-IMT (0.60, p=0.16) and particularly for ABI (0.56, p=0.0015). However, among patients at intermediate risk of coronary heart disease (CHD), according to Framingham risk score (FRS), the differences between the ROC-AUC values for ABS (0.70) and CAC score (0.76, p=0.36) were less pronounced. Again, as compared to ABS, the ROC-AUC values were lower for C-IMT (0.60, p=0.21) and ABI (0.57, p=0.06). Conclusions: ABS, an ultrasonographic score based on the assessment of carotid and femoral plaque burden, predicts more accurately CAD than other non-radiation tools analyzed here, and has a similar performance to CAC in patients at intermediate CHD risk. Thus, ABS could be an appropriate non-invasive and safe method to improve the detection of high-risk patients who will benefit from a more intensive therapy for the primary prevention of CVD.