Medical Screening Research Articles

Improving food insecurity screening across a health system throughout the COVID-19 pandemic

BackgroundFood insecurity has direct and indirect negative outcomes on the physical and mental health of children, with impacts throughout adult life. Rates of food insecurity have increased dramatically since the...

Study of North Jordanian women's knowledge of breast cancer causes and medical imaging screening advantages

Backgroundamong both industrialized and developing nations, breast cancer is the most prevalent type of cancer among women. The purpose of this research project is to evaluate adult females in northern Jordan's level of awareness regarding breast cancer risk factors and potential causes. A link between certain variables and their comprehension of breast cancer risk factors was established, enabling us to take appropriate measures to increase women's awareness. MethodsWe conducted a cross-sectional study using a self-administered questionnaire to assess the awareness of breast cancer risk factors, treatment beliefs, and screening practices among adult females in north Jordan. There was a scoring system used. IBM SPSS Statistics (Version 20.0) was used to conduct all statistical analyses. ResultsOnly 18.11% of participants (n = 201) reported having little understanding of breast cancer risk factors; 36.31% of participants (n = 403) reported having fair knowledge; and 45.58% of participants (n = 506) reported having a good grasp of breast cancer risk factors. ConclusionThe study's findings show that North Jordanian women are well informed about breast cancer and its potential causes. To improve females' knowledge of breast cancer, however, we advocate for the need for ongoing medical education programs.

Potentially inappropriate prescribing in elderly patients with epilepsy at two referral hospitals in Ethiopia.

The prevalence of drug therapy problems in patients with epilepsy has been reported to be as high as 70-90%. Moreover, elderly patients with epilepsy are highly vulnerable to inappropriate therapies. This study aimed to evaluate potentially inappropriate prescriptions (PIP) in elderly patients with epilepsy at the adult neurology clinics of two referral hospitals in Addis Ababa, Ethiopia. A cross-sectional study was conducted on 81 patients with epilepsy and the medication appropriateness index (MAI), the Beers, and Screening Tool of Older Persons' Prescriptions and Screening Tool to Alert to the Right Treatment (STOPP/START) criteria were used to assess PIP. Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 25. Of the 81 study participants, 41(50.6%) were male, and the mean age was 67.33 ± 17.43 years. One-fourth of the study participants (25.9%) had polypharmacy and drug-drug interactions (DDIs) were documented in 64 (79%) patients. Based on the MAI, of the 263 medications that were prescribed for elderly epileptic patients, 110 (41.8%) had drug interactions, 44 (16.7%) had inappropriate indications, 31 (11.8%) were ineffective, and 12 (4.6%) were prescribed incorrect doses. Based on the STOPP and START criteria, PIP was reported in 31(38.3%) and 13(16.1%) patients, respectively. Polypharmacy and DDIs are common in elderly epilepsy patients. The MAI, Beer's criteria, and STOPP/START criteria indicate a high prevalence of PIP in elderly patients with epilepsy.

A Self-Paced Walk Test for Individual Calibration of Heart Rate to Energy Expenditure

Introduction: Estimating free-living physical activity (PA) with continuous heart rate (HR) monitoring is challenging due to individual variation in the relationship between HR and energy expenditure. This variation can be captured through individual calibration with graded exercise tests, but structured tests with prescribed load require medical screening and are not always feasible in population settings. We present and evaluate an individual calibration method using HR response to a less demanding self-paced walk test. Methods: Six hundred and forty-three participants from the Fenland Study (Cambridgeshire, the United Kingdom) completed a 200-m self-paced walk test, a treadmill test, and 1 week of continuous HR and accelerometry monitoring. Mixed-effects regression was used to derive a walk test calibration model from HR response to the walk using treadmill-based parameters as criterion. Free-living PA estimates from the calibration model were compared with treadmill-calibrated and non-exercise-calibrated estimates. Results: Walk calibration captured 57% of the variance in the HR–energy expenditure relationship determined by the treadmill test. Applying walk calibration to data from free-living yielded similar PA estimates to those using treadmill calibration (52.7 vs. 52.0 kJ·kg−1·day−1; mean difference: 0.7 kJ·kg−1·day−1, 95% confidence interval [−0.0, 1.5]) and high correlation (r = .89). Individual differences were observed (root mean square error: 10.0 kJ·kg−1·day−1; 95% limits of agreement: −20.6, 19.1 kJ·kg−1·day−1). Walk calibration improved precision by 29% compared with nonexercise group calibration (root mean square error: 14.0 kJ·kg−1·day−1; 95% limits of agreement: −30.4, 24.5 kJ·kg−1·day−1). Conclusions: A 200-m self-paced walk test captures between-individual variation in the HR–energy expenditure relationship and facilitates estimation of free-living PA in population settings.

Launch of the first canine mobile blood donation center in Asia: development, outcomes, and influence of an animal bloodmobile.

A mobile blood donation station allows a maximum number of donors to donate blood at any location. In veterinary medicine, no previous studies have reported the use of bloodmobiles for blood donation in animals. We assessed Asia's first canine mobile blood donation center, which was trialed using a modified vehicle in South Korea. A vehicle was modified into a canine bloodmobile with two sections: the front as a laboratory and the back as a blood collection room with necessary equipment. To recruit companion dogs nationwide, the campaign was advertised on television and promoted via social media. Applications of the dogs meeting the following criteria were accepted: in general good health, between 2-8 years old, body weight above 25kg, vaccinated, regularly on heartworm and ectoparasite prophylactics. Pre-donation procedures included medical screening and informed consent, followed by blood collection in a routine fashion. Post-donation, dogs were monitored for complications and owners completed a post-donation survey. Of the 750 applicants, 48 donor dogs were selected for investigation. Ten failed to donate blood owing to the following issues: behavioral problems (2/48), positive results on vector-borne disease screening tests (5/48), in-tubing clot formation (2/48), and absence on the relevant appointment date (1/48). Blood collection took approximately 12 minutes, and the entire procedure lasted an average of 1.5 hours per donor. The prevalence rates of dog erythrocyte antigen 1-negative and 1-positive blood were 32.6% and 67.4%, respectively. There were no donation-related complications, except for one dog that had contact dermatitis induced by clipper irritation. The post-donation survey completed by 46 owners revealed that most were satisfied with the campaign. The convenience of the mobile blood drive (93.5%) was a key factor contributing to high owner satisfaction and willingness to participate in future campaigns (95.7%), in line with findings from prior veterinary and human blood donation motivation research. The bloodmobile effectively increased engagement in canine blood donation by enhancing accessibility. To optimize canine mobile blood drives, procuring larger vehicles and enhancing infrastructure for future campaigns would be beneficial. In conclusion, this study showed that Asia's first canine bloodmobile was successful in terms of improving the convenience, accessibility, and efficacy of canine blood donation. Although the concept is still unfamiliar to the public, active promotion of canine blood donation can help ensure a robust blood donation culture in the veterinary field.

An innovative method and a medical screening device for cancer detection in real-time

Histopathology is the main technique to assess the presence of cancer cells in biopsy material and for the evaluation of positive resection margins, but it is not real-time. Older methods to assess resection margin intraoperatively are either time-consuming or exhibit a low accuracy. More recent imaging techniques have various drawbacks, like the need for exogenous contrast agents or excessive time to assess the entire resection surface or a low diagnostic performance in detecting certain types of cancer. The purpose of the current research work is the development of a medical screening device for cancer cells detection with very high accuracy and selectivity, based on a newly developed method in order to experimentally measure in real-time the excitation response of the charged elements of the biological tissue under study to the applied alternative electrical field, over a wide range of frequency spectra. The aim of this study is to present an innovative method and results from a prototype medical screening device, which allows the selective and “real-time” detection of cancer cells of any type among normal cells in any tissue type. The innovation of the proposed method lies in the view of the cell membrane emulation as an electrical circuit and also in the ability to experimentally measure in real-time the excitation response of the charged elements of the biological tissue under studies like ions, interfaces or dipoles to the applied alternative electrical field, over a wide range of frequency spectra according to the dielectric spectroscopy method. The ions can very easily follow the variations of the applied alternating electric field moving along the dynamic lines of the field. In contrast, the incapability of the abnormal neoplastic cellular formations to follow the frequency changes causes them to perform dipole oscillation instead of moving along the dynamic lines of the field. This experimentally appears as a significant increase of the capacitive component contribution to the total impedance of the tissue, relative to the purely electrical resistance contribution of the ions. A model, backed by the relevant mathematical equations, has been developed to integrate the unknown impedance of both the tissue under assessment and the interdigital micro-sensor with the known complex impedance of the data acquisition system. The ability to selectively detect cancer cells has an obvious interest and various applications in cancer diagnosis and therapy.

Entry of Migrant Workers to Malaysia: Consideration to Implement Mass Drug Administration Against Intestinal Parasitic Infections.

Over the last five decades, widespread industrialisation and urbanisation have resulted in the influx of low-skilled workers, particularly from Southeast and West Asia to Malaysia. The current practice for migrant workers entry for employment requires mandatory medical screening for infectious diseases. However, screening for parasitic infections in Malaysia is woefully inadequate. Many migrants come from low-income countries where parasitic infections are common, which may have public health implications for their overall well-being as parasitic infections, although not critical, may impact their overall productivity. The high prevalence of intestinal parasitic infections (IPIs) recorded among migrant workers in Malaysia necessitates improvement in the national health policy to include mandatory mass administration of a single dose of anthelmintic drugs to all low-skilled migrant labourers, particularly upon entry into the country, admission, and encourage continuous surveillance. A constant stream of migrant labourers is anticipated, potentially resulting in an ongoing occurrence of parasitic infections within the population. The implementation of economic measures like health awareness initiatives, routine deworming campaigns, and improved sanitation facilities holds the potential to reduce the spread of these infections notably. More often than not, taking preventive actions proves to be more financially efficient over time compared to addressing severe infections at a later stage.

Breast Cancer Detection using Image Processing and Machine Learning: A Comprehensive Review and Improved Segmentation Approach

Breast cancer stands as one of the most prevalent health concerns for women. Early detection of breast cancer can significantly improve the chances of survival. In developed countries, more than 19.9% of women will die per year due to breast cancer. Regular breast cancer screening is an important way to detect cancer early. Image processing techniques are highly used for different types of cancer detection applications with medical screening. Segmentation of the breast tumor region is a critical step in image processing related to this manner. Lots of research work can be found on developing ways for detecting breast cancers. However still, there is a need for a standard and robust cancer region segmentation method. Right cancer region segmentation is significant for better feature extraction and better classification. This study presents a comprehensive literature review about technologies used with image enhancement and tumor segmentation. Further, the study proposes a robust approach to image enhancement and cancer region segmentation for breast cancer detection using image processing techniques and machine learning. In this work, mammograms are enhanced using Contrast Limited Adaptive Histogram Equalization and denoised using the Median blurring filter. This study enables an effective image segmentation approach with two stages: removing the background using thresholding, tumor region segmentation using a combination of thresholding, and Canny edge detection. Segmented tumor region’s features are extracted using the Gabor filter. Here the accuracy of the approach is compared with three main machine learning classifiers: Decision Tree, Random Forest, Multinomial Logistic Regression and mammograms are classified into three classes (malignant, benign and normal). Finally, an ensemble approach is proposed using the hard voting mechanism to improve the accuracy. With the dataset of mini-MIAS this proposed approach achieved 78.89% accuracy. Results demonstrated that the proposed breast cancer detection approach improves the performance of segmentation breast tumor regions.

ELDER ABUSE RISK ASSESSMENT MODEL FOR ALZHEIMER’S DISEASE WITH SOCIAL DETERMINANTS OF HEALTH AND MEDICAL FACTORS

Abstract Older adults with Alzheimer’s Disease and Related Dementias (ADRD) are at an increased risk for elder abuse (EA). Using a 20% national Medicare database, we developed an EA risk-assessment model, including older adults with and without ADRD. Beneficiaries aged 66 and older in 2016, without an EA diagnosis in 2015 or 2016, and Medicare Part A/B/D eligible with no HMO through 2018 were included (N=2,261,166; ADRD, n=187,805, 8.3%). Outcome of interest was an EA diagnosis. The cohort was split into three subsets, training (50%), testing (25%), and validation (25%). Predictive models included demographics, comorbidities, symptoms, injury history, claims-based frailty scores (0-1), medical screening and procedures, and social determinants of health (SDoH). Only 0.2% had an EA diagnosis. EA models were conducted using logistic regression and machine learning methods (random forest, gradient-boosted tree classification, and multilayer perceptron classification). The logistic regression model was the best predictive model (AUC=0.73; Sensitivity=0.80; Specificity=0.47; GINI Impurity=0.50; Agreement=46.77%). Many SDoHs (e.g., primary support and marital problems, housing/income problems and dual eligibility, Black Race), STI testing, behavioral health and medical conditions, and greater frailty were associated with increased risk of EA at 2 years for the total sample (with and without ADRD). For those with ADRD, SDoHs (e.g., marital and housing/income problems), male sex, aged 71-75 (vs 66-70), lung cancer, PTSD , and greater frailty were associated with increased EA risk. Coupled with qualitative interviews, our findings will guide the selection of the most pertinent risk and protective factors to incorporate into an EA screening intervention tool.

Assessment of on-site and remote cardiac rehabilitation in Romania

: Introduction: It is well known that cardiovascular diseases are the leading cause of death worldwide. In Romania in 2015, cardiovascular diseases led to 153.953 deaths, representing 59.3% of deaths from all causes. Most people in Romania today have an unhealthy lifestyle, characterised mainly by a poor nutritious diet, low physical activity and a lack of medical screening. Purpose: Considering these deficits of secondary prevention in the treatment line of the Romanian cardiovascular patient, we aimed through this study to assess the current access of the Romanian population to on-site and remote cardiac rehabilitation programs as well as their opinion regarding the telemedicine for future cardiovascular care modelling. Methods: It was a prospective observational study, which was carried out by means of an online questionnaire composed of 26 items. It was dispersed in the online environment, including Social Media platforms, where it was active for ten weeks. Results: Our online evaluation questionnaire had 1115 participants, with a minimum age of 18 years old, a preponderance of female sex and a predominantly urban background. The study participants were from all educational levels, from low to superior. We observed that most participants have an internet connection at home and use at least one form of technology daily, but most have never used a telemedicine service. Conclusions: In conclusion, the access of cardiovascular patients to on-site cardiac rehabilitation services is extremely low and for remote ones, it is almost non-existent. For a middle-income country like Romania with such a high incidence of cardiovascular disease, it is almost mandatory to provide publicly funded cardiac telerehabilitation services also for the future.

The Clinical Diagnosis-Based Nationwide Epidemiology of Metabolic Dysfunction-Associated Liver Disease in Korea.

Although most epidemiological studies have been conducted using a relatively small population or subjects who had medical screenings, the present study aimed to investigate the incidence and prevalence of MASLD (formerly NAFLD) in Korea using nationwide registry data provided by the Health Insurance Review and Assessment Service (HIRA). Using nationwide medical records provided by HIRA, we analyzed the entire dataset of patients with MASL (KCD10-K76.0) and MASH (KCD10-K75.8) from 2010 to 2021 and calculated the incidence and prevalence by year, age, and gender. The prevalence and incidence rates were calculated by analyzing the HIRA data covering almost the entire population of Korea for 12 years, from 2010 to 2021, with an average population of 50,856,244 during this period. Statistical analyses included calculating confidence intervals using Ulm's formula and conducting sex- and age-specific analyses with a Cochran-Armitage test for trends. The annual incidence of MASL/MASH increased significantly from 9.71/0.37 in 2010 to 13.95/5.52 per 1000 persons in 2021 (p < 0.01). The annual prevalence of MASL increased from 15.69 in 2010 to 34.23 per 1000 persons in 2021, while the annual prevalence of MASH increased from 0.49 to 9.79 per 1000 persons between 2010 and 2021 (p < 0.01). Regarding the sex-dimorphic feature of MASLD, there was a male predominance in those < 50 years old but a female predominance in those ≥ 50 years old for the incidence and prevalence of MASL and the incidence of MASH. The incidence of MASL increased by 3% to 4% every year, while the incidence of MASH increased 14.91-fold from 2010 to 2021. The increasing trend is noteworthy compared with previous reports.

Liquid Biopsy: An Evolving Paradigm for Non-invasive Disease Diagnosis and Monitoring in Medicine.

Liquid biopsy stands as an innovative instrument in the realm of precision medicine, enabling non-invasive disease diagnosis and the early detection of cancer. Liquid biopsy helps in the extraction of circulating tumor DNA (ctDNA), circulating tumor cells (CTCs), and cell-free DNA (cfDNA) from blood samples and other body fluids, thereby facilitating disease diagnosis and prediction of high-risk patients.Various techniques such as advanced sequencing methods and biomarker-based cell capture have led to the isolation and study of the different biomarkers such as ctDNA, cfDNA, and CTCs. These biopsies also have immense potential in the early detection and diagnosis of various diseases across all medical specialties, prediction and screening of high-risk cases, and detection of different immune response patterns in response to infectious diseases, and also help in predicting treatment outcomes. Although liquid biopsy has the potential to disrupt the field of medical diagnosis, it is met by various challenges such as limited tumor-derived components, less specificity, and inadequate advancement in methods to isolate biomarkers. Despite all these challenges, liquid biopsies provide the potential to become a minimally invasive method of diagnosisthat would facilitate real-time monitoring of patients, which differentiates them from traditional tissue biopsies. This article aims to provide a complete overview of the current technologies, different biomarkers, and body fluids that can be used in liquid biopsy and its clinical applications and the potential impact that liquid biopsy holds in the field of precision medicine, facilitating early diagnosis and prompt management of various diseases and cancers.

Retrospective Analysis of Medical Attrition for Pilot Applicants to the British Army Air Corps.

INTRODUCTION: Management of aeromedical risk is essential for flight safety. Given the many operator stressors for pilots, militaries maintain a vested interest in selecting aircrew applicants who meet rigorous initial medical standards. Very little published literature exists regarding the extent of medical disqualifications or precluding conditions for initial candidates.METHODS: For the British Army, pilot selection is a phased, multistep process that includes Phase I medical screening followed by a comprehensive Phase II medical exam. De-identified summary data were retrospectively reviewed for medical fitness and disqualifying categories for the 5-yr period of 2018-2022, inclusive. For those ultimately deemed unfit for aviation service, etiology was grouped into general categories.RESULTS: Approximately one-third (30.2%) of candidates were disqualified at Phase I initial medical screening with leading categories of attrition due to respiratory etiology, especially a history of asthma or reactive airway disease, followed by ophthalmology. For the Phase II medical exam cohort, 21.0% were medically disqualified with most attrition from anthropometry and ophthalmology. There were no statistical differences in disqualifications for gender or pathway of entry (civilian vs. serving personnel).DISCUSSION: Major categories of medical attrition were similar to that of other nations, yet the published literature in this area is surprisingly tenuous. Given the desire for evidence-based medical selection standards, it is important for regular review of processes and standards such that the risks of known physiological challenges are judiciously weighed with the benefits of a large, diverse pool of selection as well as force structure and recruitment demand.Adams MS, Goldie CE, Gaydos SJ. Retrospective analysis of medical attrition for pilot applicants to the British Army Air Corps. Aerosp Med Hum Perform. 2023; 94(12):939-943.

MLP-RL-CRD: diagnosis of cardiovascular risk in athletes using a reinforcement learning-based multilayer perceptron

Objective. Pre-participation medical screening of athletes is necessary to pinpoint individuals susceptible to cardiovascular events. Approach. The article presents a reinforcement learning (RL)-based multilayer perceptron, termed MLP-RL-CRD, designed to detect cardiovascular risk among athletes. The model underwent training using a publicized dataset that included the anthropological measurements (such as height and weight) and biomedical metrics (covering blood pressure and pulse rate) of 26 002 athletes. To address the data imbalance, a novel RL-based technique was adopted. The problem was framed as a series of sequential decisions in which an agent classified a received instance and received a reward at each level. To resolve the insensitivity to the initialization of conventional gradient-based learning methods, a mutual learning-based artificial bee colony (ML-ABC) was proposed. Main Results. The model outcomes were validated against positive (P) and negative (N) ECG findings that had been labeled by experts to signify individuals ‘at risk’ and ‘not at risk,’ respectively. The MLP-RL-CRD approach achieves superior outcomes (F-measure 87.4%; geometric mean 89.6%) compared with other deep models and traditional machine learning techniques. Optimal values for crucial parameters, including the reward function, were identified for the model based on experiments on the study dataset. Ablation studies, which omitted elements of the suggested model, affirmed the autonomous, positive, stepwise influence of these components on performing the model. Significance. This study introduces a novel, effective method for early cardiovascular risk detection in athletes, merging reinforcement learning and multilayer perceptrons, advancing medical screening and predictive healthcare. The results could have far-reaching implications for athlete health management and the broader field of predictive healthcare analytics.

Analysis of Graphene Pythagoras Tree Fractal Antenna with Thin SiO2 Substrate in Terahertz Regime

Abstract The Pythagoras Tree Fractal patch is considered on a SiO2 substrate thickness of 1.5 µm to radiate at four frequencies of 4.975THz, 5.38THz, 6.73THz, and 7.61THz with Voltage Standing Wave Ratio (VSWR) ≤ 2. This is a very creative fractal design of a multiband THz antenna, based on a very thin graphene layer, the study proved a value in terms of high radiation efficiency and high gain, at the level of current research we made a comparison study where the design has evidently huge potential regarding applicability for telecommunication technology in the terahertz regime. The demand for high-performance terahertz (THz) antennas has increased significantly in recent years due to their potential applications in various fields such as medical imaging, security screening, and wireless communications. In this paper, the authors present an analysis of a graphene Pythagoras Tree Fractal (GPTF) antenna with a thin SiO2 substrate for THz regime. The GPTF antenna is designed using a fractal geometry approach, which provides multiple resonant frequencies and enhances the overall radiation efficiency. The thin SiO2 substrate is used to reduce the substrate losses and improve the radiation performance of the antenna. The authors use the Finite-Difference Time-Domain (FDTD) software to simulate the performance of the proposed antenna. The results show that the proposed antenna exhibits high gain, low return loss, and wide bandwidth, making it a promising candidate for THz applications.

Halogen-bonding boosting the high performance X-ray imaging of organic scintillators.

Organic scintillators with efficient X-ray excited luminescence are essential for medical diagnostics and security screening. However, achieving excellent organic scintillation materials is challenging due to low X-ray absorption coefficients and inferior radioluminescence (RL) intensity. Herein, supramolecular interactions are incorporated, particularly halogen bonding, into organic scintillators to enhance their radioluminescence properties. By introducing heavy atoms (X=Cl, Br, I) into 9,10-bis(4-pyridyl)anthracene (BPA), the formation of halogen bonding (BPA-X) enhances their X-ray absorption coefficient and restricts the molecular vibration and rotation, which boosts their RL intensity. The RL intensity of BPA-Cl and BPA-Br fluorochromes increased by over 2 and 6.3 times compared to BPA, respectively. Especially, BPA-Br exhibits an ultrafast decay time of 8.25ns and low detection limits of 25.95±2.49nGys-1. The flexible film constructed with BPA-Br exhibited excellent X-ray imaging capabilities. Furthermore, this approach is also applicable to organic phosphors. The formation of halogen bonding in bromophenyl-methylpyridinium iodide (PYI) led to a fourfold increase in RL intensity compared to bromophenyl-methyl-pyridinium (PY). It suggests that halogen bonding serves as a promising and effective molecular design strategy for the development of high-performance organic scintillator materials, presenting new opportunities for their applications in radiology and security screening.

Training for shorter ultra-trail races results in a higher injury rate, a more diverse injury profile, and more severe injuries: 2022 Mac ultra races

ObjectivesDetermine and compare the epidemiology, clinical characteristics, and injury severity among race entrants training towards different ultra-trail race distances. DesignRetrospective cross-sectional study. SettingThe six months training period before the 2022 Mac Ultra races (46 km, 80 km, 161 km and 322 km). ParticipantsOf the 245 race entrants, 162 (66% of Mac ultra-trail runners) consented to analyse their data. Outcome measuresInjury rate (injuries per 1000 h of running), point prevalence (% of currently injured participants), injury severity (time loss), and the frequency (n, %) of injuries reported during pre-race medical screening in the six months before the race. Using inferential statistics, we compared the injury rates between the different race distance categories (46 km, 80 km, 161 km, 322 km). All tests were performed at a 5% level of significance. ResultsWe reported a statistically significantly higher injury rate among 46 km study participants (3.09 injuries per 1000 h) compared to the injury rates reported among 80 km (0.68 injuries per 1000 h; p = 0.001) and 161 km (1.09 injuries per 1000 h; p = 0.028) participants. The lower limb (89%) was the most injured anatomical region, with only 46 km study participants reporting upper limb, trunk, and head injuries (11%). Muscle/tendon was the most reported injured tissue type (56%), with muscle injuries (31%) the most reported pathology type. Shorter distance ultra-trail runners reported the highest injury severity. ConclusionUltra-trail runners training towards shorter ultra-trail distance races presented with a higher injury rate, more diverse injury profile, and a higher injury severity.

Understanding Thrombosis and Hemorrhage in Myeloproliferative Neoplasms through a Nationwide Study

Introduction The incidence of Myeloproliferative Neoplasms (MPNs), including Essential Thrombocythemia (ET), Polycythemia Vera (PV), and Primary Myelofibrosis (PMF) are increased. Thrombosis and hemorrhage are major complications of ET and PV. Leukemic transformation is a rare but fatal complication of MPNs. However, their incidence and risk factors of thrombosis and hemorrhage in a nationwide population are not fully known. Methods This study used nationwide data from the Korean National Health Insurance System (NHIS). We assessed thrombosis, hemorrhage, and leukemic transformation events in a cohort of all 9,779 patients diagnosed with MPNs during 2011-2016. A Big data formed by the NHIS contains demographic, clinical characteristics (smoking, body mass index, dates of birth, last follow up date, gender), health care utilization, treatment medication and health screening for the whole Korean population (Table 1). Results Of total 9,779 patients with MPNs, 5,970 (61.04%) had ET, 2,655(27.2%) PV, 586 (5.9%) PMF, and 568 (5.8%) unspecified MPN (MPN-U). 2,187 (22.4%) patients were diagnosed arterial thromboembolism including cerebral infarction and other thromboembolism during follow-up. And 1,029 (10.5%) patients were diagnosed venous thrombus including pulmonary thromboembolism. 254 (2.6%) patients were diagnosed intracerebral hemorrhage. Secondary leukemia (acute myeloid leukemia (n=482, 4.9%), acute lymphocytic leukemia (n=38, 0.4%), chronic myeloid leukemia (n=423, 4.3%), and chronic lymphocytic leukemia (n=22, 0.2%)) arising from MPNs were noted. Secondary myelofibrosis was noted in 321 (3.3%) patients with MPNs. Multivariate analysis revealed several risk factors for thrombosis and hemorrhage in patients with PV and ET. In patients with PV, age over 60 years (hazard ratio [HR]=2.199, 95% confidence interval [CI]=1.863-2.596, p&amp;lt;0.001), hypertension (HR=1.519, 95% CI=1.269-1.818, p&amp;lt;0.001), and atrial fibrillation/flutter (HR=1.561, 95% CI=1.088-2.241, p=0.016) were identified as significant risk factors for thrombosis. Additionally, age over 60 years (HR=2.896, 95% CI=1.637-5.123, p&amp;lt;0.001) was associated with an increased risk of hemorrhage in patients with PV. In patients with ET, multivariate analysis identified age over 60 years (HR=2.495, 95% CI=2.217-2.809, p&amp;lt;0.001), male sex (HR=1.147, 95% CI=1.034-1.271, p=0.009), hypertension (HR=1.563, 95% CI=1.385-1.764, p&amp;lt;0.001), dyslipidemia (HR=1.216, 95% CI=1.084-1.364, p=0.001), atrial fibrillation/flutter (HR=1.537, 95% CI=1.091-2.165, p=0.014), and hematologic malignancy (HR=1.294, 95% CI=1.097-1.527, p=0.002) as significant risk factors for thrombosis. Moreover, age over 60 years (HR=2.657, 95% CI=1.744-4.048, p&amp;lt;0.001) and hypertension (HR=1.775, 95% CI=1.161-2.713, p=0.008) were found to be significant risk factors for hemorrhage in patients with ET. Conclusions This is the first Korean nationwide study to understand thrombosis and hemorrhage in patients with MPNs. This set of data can be utilized to compare the Asian patients with MPNs to international data and guidelines.

Health System for Exercise Rehabilitation Detection Retina Images and IoT Blockchain

Smart Healthcare which is based on deep learning is becoming increasingly popular because of its practical applications and has grown popular after its incorporation with IoT. Degenerative eye disease is the main factor of blindness in people of working age. Asian nations with large populations, like India and China, are on the edge of a diabetes epidemic. In terms of medical screening and diagnosis, a large number of diabetes patients posed a huge problem for skilled clinicians. The idea is to employ deep learning algorithms to detect blind spots in the eye and estimate the severity of the stage. We present an optimum approach for detecting blindness in retinal images based on recently released pre-trained EfficientNet models, as well as a comparative assessment of many innovative neural network models, in this study. On a benchmark dataset of retina images obtained by diagnostic imaging at various imaging phases, our EfficientNet-B5-based model assessment performs better than CNN and ResNet50 models.

The prevalence of anomalies in the lumbar spine in the Turkish male population

Aims: It was aimed to determine the prevalence of lumbosacral anomalies in young male population.&#x0D; Methods: 56.798 male patients, between 18-49 years old, were included in this study during their medical screening in Dışkapı Yıldırım Beyazıt Training and Research Hospital from July 2016-July 2020. The presence of spina bifida occulta (SBO) and transitional vertebrae (TV) anomalies were recorded in the candidates. SBO patients were evaluated according to their S1 and L5 origins, and TV patients were evaluated separately according to sacralization and lumbarization. We identified transitional vertebrae by counting down from the last thoracic vertebra on the AP X-rays, then if necessary looking at the lateral view for confirmation. If hypoplastic ribs were identified, the vertebra immediately beneath would be designated as L1. Castellvi types I, II, III, and IV were included as transitional states.&#x0D; Results: 56798 patients were evaluated retrospectively. The mean age of the patients was 23.28 (18-49 years). Radiological anomalies were detected in 2577 (4.5%) of 56798 cases. No radiological anomaly was observed in other cases. Spina bifida occulta was detected in 1478 (2,6%) patients. Lumbosacral transitional vertebrae were detected in 1099 cases (1.9%). 745 (1.3%) of these anomalies are sacralization and 354 (0.6%) of them are lumbalization.&#x0D; Conclusion: In the light of this information, we think that knowing the frequency of lumbosacral anomalies, especially LSVT, in our society should be considered in the evaluation before spinal surgery operations.