Detection Rate Research Articles

Using Machine Learning and Electronic Health Records to Identify Neuropsychiatric Risk Scores for Delirium in ICU and General Hospital Settings.

Delirium is a common and acute neuropsychiatric syndrome that requires timely intervention to prevent its associated morbidity and mortality. Yet, its diagnosis and symptoms are often overlooked due to its variable clinical presentation and fluctuating nature. Thus, in this study, we address the barriers to delirium diagnosis by utilizing a machine learning-based predictive algorithm for incident delirium that relies on archived electronic health records (EHRs) data. We used the Medical Information Mart for Intensive Care (MIMIC) database to create a detailed dataset for identifying delirium in intensive care unit (ICU) patients. Our approach involved training machine learning models on this dataset to pinpoint critical clinical features for delirium detection. These features were then refined and applied to non-ICU patients using EHRs from the American University of Beirut Medical Center (AUBMC). Our study assessed machine learning models like Extreme Gradient Boosting (XGBoost), Categorical Boosting (CatBoost), Classification and Regression Trees (CART), Random Forest (RF), Neural Oblivious Decision Ensembles (NODE), and Logistic Regression (LR), highlighting superior delirium detection in diverse clinical settings. The CatBoost model excelled in ICU environments with an F1 Score of 89.2%, while XGBoost performed best in general hospital settings with a 75.4% F1 Score. Interpretations using Tabular Local Interpretable Model-agnostic Explanations (LIME) revealed critical indicators such as prothrombin time and hematocrit levels, enhancing model transparency and clinical applicability. These clinical insights help differentiate the delirium predictors between ICU patients, who are often sensitive to various factors. The proposed predictive algorithm improves delirium detection rates and streamlines efficiency in hospital electronic systems, thereby enabling prompt interventions to prevent delirium progression and associated complications. The clinical indicators for delirium that we identified in general hospital settings and ICU can greatly help healthcare professionals identify potential causes of delirium and reduce misdiagnosis.

Investigating Specific Calprotectin and Immunological Markers Associated With Intestinal Infections Caused by Entamoeba histolytica

Background: Entamoeba histolytica is a parasitic organism that infects the intestines and causes dysentery, characterized by intestine inflammation. Objectives: We aimed to estimate calprotectin levels and their relationship to the severity and progression of intestinal inflammation. Methods: We conducted a cross-sectional study in Al-Habbobi Teaching Hospital Thi-Qar, Al-Nasseriah, Iraq, from March 10 to October 1, 2023. The sample included 50 men and 50 women aged in three groups: 25–29, 30-34, and >34 years. We employed microscopy, direct wet method, and formal-ether concentration approach to detect parasites. Also, we employed nzyme-linked immunosorbent assay (ELISA) for measuring fecal calprotectin (FC) and C-reactive protein (CRP), and XP-Sysmex for detecting white blood cells. Results: The calprotectin levels below 50 ng/mL were more common in the second age group. The third age group had calprotectin values of 50 ng/mL. In the first age group (25–29 years old), calprotectin frequency was similar. CRP levels were equal in the first age group. In the second age group (30–34 years), negative CRP outnumbered positive CRP. Positive CRP was more common than negative in the third age group of >34 years. The group above 35 had the highest general stool examination (GSE) and antigen Ag detection rates, while those aged 30–34 years in the control group had the highest. Conclusion: Calprotectin levels less than 50 ng/mL were more frequent in the age group of 30-34 years, while calprotectin levels greater than 50 ng/mL were more frequent in the age group <35 years. CRP levels were equal in frequency in the first age group. Negative CRP was more common than positive CRP in the second age group. Positive CRP was more common than negative CRP in the third age group.

Evaluation of the clinical application value of artificial intelligence in diagnosing head and neck aneurysms

ObjectiveTo evaluate the performance of a semi-automated artificial intelligence (AI) software program (CerebralDoc® system) in aneurysm detection and morphological measurement.MethodsIn this study, 354 cases of computed tomographic angiography (CTA) were retrospectively collected in our hospital. Among them, 280 cases were diagnosed with aneurysms by either digital subtraction angiography (DSA) and CTA (DSA group, n = 102), or CTA-only (non-DSA group, n = 178). The presence or absence of aneurysms, as well as their location and related morphological features determined by AI were evaluated using DSA and radiologist findings. Besides, post-processing image quality from AI and radiologists were also rated and compared.ResultsIn the DSA group, AI achieved a sensitivity of 88.24% and an accuracy of 81.97%, whereas radiologists achieved a sensitivity of 95.10% and an accuracy of 84.43%, using DSA results as the gold standard. The AI in the non-DSA group achieved 81.46% sensitivity and 76.29% accuracy, as per the radiologists’ findings. The comparison of position consistency results showed better performance under loose criteria than strict criteria. In terms of morphological characteristics, both the DSA and the non-DSA groups agreed well with the diagnostic results for neck width and maximum diameter, demonstrating excellent ICC reliability exceeding 0.80. The AI-generated images exhibited superior quality compared to the standard software for post-processing, while also demonstrating a significantly reduced processing time.ConclusionsThe AI-based aneurysm detection rate demonstrates a commendable performance, while the extracted morphological parameters exhibit a remarkable consistency with those assessed by radiologists, thereby showcasing significant potential for clinical application.

Pathogen distribution and infection patterns in pediatric severe pneumonia: A targeted next-generation sequencing study

ObjectiveSevere pneumonia in children represents a significant clinical challenge due to its high incidence and associated mortality. This study aimed to assess the distribution of pathogens and patterns of infection in pediatric patients with severe pneumonia. MethodsThis study included 110 pediatric patients diagnosed with severe pneumonia, who were admitted to Guangxi Maternal and Child Health Hospital between July 2021 and November 2023. Pathogen-targeted next-generation sequencing (tNGS) was employed to identify respiratory pathogens in these cases. ResultsPathogens were detected in 109 out of 110 cases, yielding a positive detection rate of 99.09%. Among these cases, 25 (22.72%) involved single-pathogen infections, while 84 (76.36%) were characterized by mixed infections. The infection pattern in children with severe pneumonia was relatively common with bacterial-viral coinfection (28.2%, 31/110). A total of 39 pathogens were identified from the 110 children with severe pneumonia, with the top three pathogens being Mycoplasma pneumoniae (30.91%, 34/110), Human Respiratory Syncytial Virus Type A (26.36%, 29/110), and Human Herpesvirus (18.18%, 20/110). Notably, 38.2% (13/34) of the cases were found to have macrolide-resistant Mycoplasma pneumoniae (MRMP). Additionally, 40% (44/110) of the children required admission to the intensive care unit (ICU). ConclusionThe application of tNGS demonstrates significant utility in the detection of pathogens in pediatric patients with severe pneumonia. The predominant pathogens identified in this study are Mycoplasma pneumoniae, Human Respiratory Syncytial Virus, and Human Herpesvirus. Furthermore, mixed infections involving multiple pathogens were observed in 76.36% of the cases, and a substantial proportion (40%) of these patients necessitated intensive care.

Application of Whole-Exome Sequencing in the Prenatal Diagnosis of Foetuses With Central Nervous System Abnormalities.

To investigate the clinical value of whole-exome sequencing (WES) in the diagnosis of foetuses with central nervous system (CNS) abnormalities but having a normal karyotyping and chromosomal microarray result. During the period of 2016-2022, there were a total of 149 foetuses with CNS abnormalities but having negative karyotyping and chromosomal microarray analysis results; WES was performed on these foetuses and their parents. Variants were classified according to ACMG guidelines, and the association of pathogenic variants with specific types of CNS abnormalities was explored. Among these 149 foetuses, three categories of abnormalities, namely, single CNS abnormality, multiple CNS abnormalities, CNS abnormalities along with other organ system abnormalities were identified, for which the detection rate of P/LP variants is 17.4% (12/69), 28.6% (14/49) and 54.8% (17/31), respectively. WES brought about an increase of 28.9% in diagnostic yield in the prenatal evaluation of foetuses with CNS abnormalities but having negative karyotyping and chromosome array results. WES may also be of benefit for the diagnosis of foetuses with isolated CNS abnormalities, as well as for making more informed interpretations of imaging findings and for providing better genetic counselling.

Follow Up Care After Penile Sparing Surgery for Penile Cancer: Current Perspectives.

Penile cancer (PeCa) is a rare urologic tumor worldwide. In 2024, 2100 new cases and 500 deaths are estimated in the United States. Radical surgery via total penectomy has historically been the cornerstone of treatment, since it provides excellent long-term oncological control. The rationale of surgery for penile cancer was to achieve a 2 cm macroscopic surgical margin that is historically advocated to reduce recurrences. Over time, numerous studies have demonstrated that resection margin status does not affect patients' survival. Different penile-sparing techniques are currently recommended in the European Association of Urology-American Society of Clinical Oncology (EAU-ASCO) guidelines for the treatment of localized primary PeCa. Centralization of care could yield multiple benefits, including improved disease awareness, higher rates of penile-sparing surgery, enhanced detection rates, increased utilization of less invasive lymph node staging techniques, enhanced quality of specialized histopathological examinations, and the establishment of specialized multidisciplinary teams. Compared to more aggressive treatments, the higher recurrence rates after penile-sparing surgery do not hamper neither the metastasis-free survival nor the overall survival. Repeated penile-sparing surgery could be considered for selected cases. The psychological impact of penile cancer is not negligible since the perceived loss of masculinity might adversely affect mental health and overall well-being. Quality of life may be compromised by sexual and urinary dysfunction which may be the result either of the loss of penile tissue or the psychological status of the patient. It is of utmost importance to offer rehabilitative treatment as sexual therapy, physical therapy, occupational therapy, family and peer counseling.

Development and validation of the Florey Dementia Risk Score web-based tool to screen for Alzheimer's disease in primary care

It is estimated that ∼60% of people with Alzheimer's disease (AD) are undetected or undiagnosed, with higher rates of underdiagnosis in low-to middle-income areas with limited medical resources. To promote health equity, we have developed a web-based tool that utilizes easy-to-collect clinical data to enhance AD detection rate in primary care settings. This study was leveraged on the data collected from participants of the Australian Imaging, Biomarker & Lifestyle (AIBL) study and the Religious Orders Study and Memory and Aging Project (ROSMAP). The study included three phases: (1) constructing and evaluating a model on retrospective cohort data (1407 AIBL participants), (2) performing simulated trials to assess model accuracy (30 AIBL participants) and missing data tolerability (30 AIBL participants), and (3) external evaluation using a non-Australian dataset (500 ROSMAP participants). The auto-score machine learning algorithm was employed to develop the Florey Dementia Risk Score (FDRS). All the simulated trials and evaluation were performed using a web-based FDRS tool. FDRS achieved an area under the curve (AUC) of approximately 0.82 [95% CI, 0.75-0.88], with a sensitivity of 0.74 [0.60-0.86] and a specificity of 0.73 [0.70-0.79]. The accuracy of the simulated pilot trial for 30 AIBL participants with complete record was 87% (26/30 correct), while it only slightly decreased (80.0-83.3%, depending on imputation methods) for another 30 AIBL participants with one or two missing data. FDRS achieved an AUC of 0.82 [0.77-0.86] of 500 ROSMAP participants. The FDRS tool offers a potential low-cost solution to AD screening in primary care. The present study warrants future trials of FDRS for optimization and to confirm its generalizability across a more diverse population, especially people in low-income countries. National Health and Medical Research Council, Australia (GNT2007912) and Alzheimer's Association, USA (23AARF-1020292).

Molecular Typing of Cryptosporidium in Cattle in Federal Capital Territory, Nigeria

Cryptosporidium is an enteric pathogen with worldwide distribution in humans and animals with cattle as their reservoirs. Molecular tools have been very useful in determining the epidemiology of this zoonotic pathogen of public health importance. Despite the importance of this pathogen to humans and animals, there is limited published information on the risk factors of its epidemiology in the Federal Capital Territory of Nigeria. Positive faecal samples of 400 cattle in 46 farms located in 6 area councils of the FCT that were earlier screened for Cryptosporidium on light microscopy were genotyped by nested PCR using primers that targeted 18S ssUrRNA gene and followed by RFLP. The PCR-RFLP products were further sub genotyped by nested PCR and GP 60 KDa gene amplification. The nucleotides of the amplicons were subsequently sequenced. The overall PCR detection rate was 5.5%. Analysis of the 18S rRNA gene of the PCR-RFLP fragments revealed Cryptosporidium ryanae (18.3%), C. andersoni (8.5%) and C. parvum (4.2%). Analysis of the nucleotide sequence of the GP 60KDa gene of all the C. parvum detected showed all to be 100% subtype family IIa and 100% sub genotype IIaA18G3R1. In conclusion, this study has established the presence of Cryptosporidium in cattle in the FCT. The detection of the zoonotic C. parvum, its subtype IIa and its allele IIaA18G3R1 is an indication of source of zoonotic transmission of the parasite in the FCT, Nigeria.

GALAD Score for the Diagnosis of Hepatocellular Carcinoma in Sub-Saharan Africa: A Validation Study in Ghanaian Patients.

Hepatocellular carcinoma (HCC) is one of the leading causes of cancer-related mortality worldwide including sub-Saharan Africa. The GALAD score, derived from Gender, Age, Lens culinaris agglutinin-reactive fraction of alpha fetoprotein, Alpha fetoprotein, and Des-carboxy-prothrombin, has high accuracy in diagnosing HCC in Asia, Europe, and North America; however, it has not been validated in an African cohort. The aim of this study was to assess the performance of the GALAD score in the diagnosis of HCC in sub-Saharan Africa. Clinical data from patients with cirrhosis (n = 93) or HCC (n = 78) from outpatient hepatology clinics at three teaching hospitals in Ghana were abstracted, and serum samples were analyzed. A logistic regression model predicting HCC status based on the GALAD score was constructed to obtain the ROC curve for GALAD. The AUC with 95% confidence interval (CI) was calculated. The median GALAD score was higher among patients with HCC versus cirrhosis controls (8.0 vs. -4.1, P < 0.01). The AUC of the GALAD score for HCC detection was 0.86 (95% CI, 0.79-0.92). At a cut-off value of -0.37, the GALAD score had a sensitivity of 0.81 and a specificity of 0.86. The AUC (95% CI) was 0.87 (0.80-0.95) and 0.81 (0.67-0.94) in hepatitis B virus-positive and hepatitis B virus-negative patients, respectively. The GALAD score has a high accuracy for HCC detection. It has great potential to improve HCC surveillance in sub-Saharan Africa where imaging resources are limited. Significance: The GALAD score or its relevant modifications have the potential to aid in improving HCC surveillance efforts in low-resource settings in sub-Saharan Africa. This could enhance early detection rates of HCC and potentially improve survival rates in resource-limited settings.

Age Matters: Adenoma Detection Rates in Average-risk Screening Patients Aged 45 to 49 Compared With Those Aged 50 to 54.

This study aims to address gaps in medical knowledge by determining whether adenoma detection rate (ADR) in average-risk screening patients aged 45 to 49 is equivalent to screening patients aged 50 to 54. Current guidelines recommend initiating colon cancer screening at age 45, yet our understanding of the effects of ADR in average-risk individuals among 45- to 49-year-olds is still limited. A retrospective analysis was conducted on records of average-risk screening colonoscopies performed on patients aged 45 to 54 from January 2018 to August 2022. Exclusions were prior diagnoses of colorectal cancer or adenomatous polyps, inflammatory bowel disease, personal or family history of genetic cancer syndromes, incomplete colonoscopy, and inadequate bowel preparation. The primary outcome was ADR in the age 45 to 49 group compared with the age 50 to 54 group. Of the 3199 average-risk screening colonoscopies performed, 879 and 2116 patients were included in the age 45 to 49 and 50 to 54 groups, respectively. Both groups were predominantly female, White ethnicity, never smokers, and obese. ADR was found to be 27% in the age 45 to 49 group compared with 34% in the age 50 to 54 group (odds ratio 0.70, 90% CI: 0.60-0.83, P -value for equivalence=0.81 w/ margin 0.77 to 1.30). The study did not demonstrate equivalent ADR between the 2 age groups, with ADR being substantially lower in the age 45 to 49 group (27% vs. 34%). Despite this, the ADR in the 45 to 49 age range surpasses the established benchmark of 25%, supporting the decision to lower the screening age to 45 years. Ongoing national monitoring is essential to comprehensively evaluate the impact of these updated guidelines.

Clinical experience on the limited role of ultrasound for breast cancer screening in BRCA1 and BRCA2 mutations carriers aged 30–39 years

PurposeIn BRCA germline pathogenic sequence variants (PSV) carriers aged 30–39 years imaging is recommended at six-month intervals. The European society for medical oncology recommendation of the use of 6-monthly MRI six-monthly MRI screening is being considered at our institution, particularly for younger carriers under the age of 35, although it is not mandatory. If 6-monthly MRI is unavailable, annual MRI may be supplemented by ultrasound (with or without mammography). The aim of this study was to evaluate the utility of ultrasound screening added to mammography, as a 6-month supplement to annual MRI in BRCA PSV carriers aged 30–39 years. Materials and methodsThis IRB approved retrospective study included BRCA PSV carriers aged 30–39 years, who underwent breast cancer screening at our institution between January 2015 and March 2023. Participants were divided into two groups, those who had supplemental whole-breast US and mammography at six months and underwent screening before March 2019, and those who had only mammography without supplemental US and enrolled in screening after March 2019. Patient characteristics, cancer detection rates and cancer characteristics were compared between the two groups. ResultsOverall, 200 asymptomatic BRCA1/2 PSV carriers undergoing screening in our institution were included in the study. Mean age was 35.7 ± 3.5 years, and mean follow-up time was 37.4 ± 38.0 months. There were 118 (59 %) women screened with supplemental US, and 82 (41 %) women without. Eight cancers were diagnosed during the study period, four in women with supplemental US and four in women without. The sensitivity of whole-breast screening US was 25 % (1/4), specificity 85.7 % (222/259), PPV 2.6 % (1/38), and NPV 98.7 % (222/225). Of the four cancers detected in women screened with supplemental US, one was diagnosed by whole-breast US, two by MRI, and one by mammography. Of eight cancers included in this study, two were not detectable by targeted second-look US. All eight cancers were detectable by MRI. ConclusionThe addition of whole-breast ultrasound to mammography and MRI screening in BRCA PSV carriers aged 30–39 years offered limited incremental benefit. MRI with 6 months supplemental mammography without US detected all cancer cases.

Can artificial intelligence aid the urologists in detecting bladder cancer?

ABSTRACT Introduction: The emergence of artificial intelligence (AI)-based support system endoscopy, including cystoscopy, has shown promising results by training deep learning algorithms with large datasets of images and videos. This AI-aided cystoscopy has the potential to significantly transform the urological practice by assisting the urologists in identifying malignant areas, especially considering the diverse appearance of these lesions. Methods: Four databases, the PubMed, ProQuest, EBSCOHost, and ScienceDirect were searched, along with a manual hand search. Prospective and retrospective studies, experimental studies, cross-sectional studies, and case–control studies assessing the utilization of AI for the detection of bladder cancer through cystoscopy and comparing with the histopathology results as the reference standard were included. The following terms and their variants were used: “artificial intelligence,” “cystoscopy,” and “bladder cancer.” The risk of bias was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 tool. A random effects model was used to calculate the pooled sensitivity and specificity. The Moses–Littenberg model was used to derive the Summary Receiver Operating Characteristics (SROC) curve. Results: Five studies were selected for the analysis. Pooled sensitivity and specificity were 0.953 (95% confidence interval [CI]: 0.908–0.976) and 0.957 (95% CI: 0.923–0.977), respectively. Pooled diagnostic odd ratio was 449.79 (95% CI: 12.42–887.17). SROC curve (area under the curve: 0.988, 95% CI: 0.982–0.994) indicated a strong discriminating power of AI-aided cystoscopy in differentiation normal or benign bladder lesions from the malignant ones. Conclusions: Although the utilization of AI for aiding in the detection of bladder cancer through cystoscopy remains questionable, it has shown encouraging potential for enhancing the detection rates. Future studies should concentrate on identification of the patients groups which could derive maximum benefit from accurate identification of the bladder cancer, such as those with intermediate or high-risk invasive tumors.

A Dynamic Sandbox Detection Technique in a Private Cloud Environment

In specific private cloud scenarios, how to defend against malicious software and ensure data security is one of the current research hotspots, and sandbox is an important detection method. This paper proposes a dynamic behavior detection technique based on sandboxing, which real-time monitors and analyzes malicious software behavior. By improving the sandbox behavior weight, integrating virtual resources, and designing fine-grained access control, the detection accuracy and efficiency are enhanced based on zero trust access control system. The simulated attacks are identified on the testing platform, drawing knowledge graphs, achieving effective discovery and tracing. Meanwhile, this paper verified through experiments that the system consumption of the detection method is within an acceptable range, expanding the detection range and reducing the missed detection rate.

Enhancing Sensitivity in Detecting Severe Fever With Thrombocytopenia Syndrome Virus: Development of a Reverse Transcription-Droplet Digital Polymerase Chain Reaction.

Severe fever with thrombocytopenia syndrome (SFTS) is a highly fatal disease. Droplet digital polymerase chain reaction (ddPCR) presents unparalleled sensitivity and enables absolute quantification of viral load. In this prospective study, we enrolled 111 patients with SFTS and collected 259 continuous samples. Our findings unveil a robust reverse transcription (RT)-ddPCR method for SFTS with a limit of detection of 2.46 copies/µL (95% CI, 1.50-11.05), surpassing the sensitivity of RT-quantitative polymerase chain reaction at 103.29 copies/µL (95% CI, 79.69-216.35). Longitudinal cohort analysis revealed significantly higher RT-ddPCR detection rates at days 10 to 11, 13 to 14, and ≥15 of the disease course as compared with RT-quantitative polymerase chain reaction (P < .05). Positive RT-ddPCR results were associated with declined platelet and elevated aspartate aminotransferase and lactate dehydrogenase on the same day vs negative RT-ddPCR samples. RT-ddPCR exhibits commendable diagnostic efficacy in SFTS, and it remains detectable in blood samples from patients with an extended disease course. Furthermore, RT-ddPCR correlates with clinical laboratory tests, furnishing valuable reference data for clinical diagnosis.

Searching for the Highest-z Dual Active Galactic Nuclei in the Deepest Chandra Surveys

We present an analysis searching for dual active galactic nuclei (AGN) among 62 high-redshift (2.5 < z < 3.5) X-ray sources selected from the X-UDS, AEGIS-XD, CDF-S, and COSMOS-Legacy Chandra surveys. We aim to quantify the frequency of dual AGN in the high-redshift Universe, which holds implications for black hole merger timescales and low-frequency gravitational wave detection rates. We analyze each X-ray source using BAYMAX, an analysis tool that calculates the Bayes factor for whether a given archival Chandra AGN is more likely a single or dual point source. We find no strong evidence for dual AGN in any individual source in our sample. We increase our sensitivity to search for dual AGN across the sample by comparing our measured distribution of Bayes factors to that expected from a sample composed entirely of single point sources and find no evidence for dual AGN in the sample distribution. Although our analysis utilizes one of the largest Chandra catalogs of high-z X-ray point sources available to study, the findings remain limited by the modest number of sources observed at the highest spatial resolution with Chandra and the typical count rates of the detected sources. Our nondetection allows us to place an upper limit on the X-ray dual AGN fraction at 2.5 < z < 3.5 of 4.8% at the 95% confidence level. Expanding substantially on these results at X-ray wavelengths will require future surveys spanning larger sky areas and extending to fainter fluxes than has been possible with Chandra. We illustrate the potential of the AXIS mission concept in this regard.

Risk assessment of dietary perchlorate exposure in typical areas of fireworks manufacturing in China using a perchlorate intake model

Perchlorate can disrupt the production of thyroid hormones, impact metabolism, and even affect the cognitive development of infants and toddlers. Typical areas of fireworks manufacturing might face severe perchlorate pollution due to perchlorate is an important raw material. But related study has not been reported. We assess the risk caused by perchlorate and identify the critical exposure pathways for different age/gender groups in typical area of fireworks manufacturing. Liuyang city, a major fireworks manufacturing center in China, was selected as study region. Perchlorate concentrations were measured in 230 local food samples from Liuyang using LC/MS/MS. Risks for different age/gender groups were estimated using a perchlorate intake model. The detection rate of perchlorate in samples from all eight food groups, including vegetables, fruits, meat, seafood, egg, cereal, beans, and drinking water was 100%, and the perchlorate concentrations were higher than those reported in the United States, Canada, South Korea, Kuwait, and other regions of China. Liuyang residents are currently facing an extremely high perchlorate dietary exposure risk, with the mean Estimated Daily Intakes (EDIs) approximately 6-49 times higher than US EPA's recommended reference dose (RfD, 0.7μg/kg bw/day), and 14-115 times higher than the tolerable daily intake (TDI, 0.3μg/kg bw/day) established by EFSA. Breast milk and drinking water are identified as the primary exposure pathways for infants and toddlers under the age of two, contributing 44-86% and 13-41% to their total exposure, respectively. For individuals > two years, vegetable consumption (constituting 54-66% of exposures) and ingestion of drinking water (constituting 23-32% of exposures) represent the chief exposure routes. The Hazard Quotient (HQ) values for Liuyang City residents all exceed 2, indicating an extremely high non-carcinogenic risk associated with perchlorate. Scientific and systematic perchlorate pollution control measures should be taken by local government.

Granulomas without foreign body giant cells in perianal fistula tissue suggest Crohn's disease.

Histopathological characteristics of granulomas in perianal fistula of patients with Crohn's disease (CD) remain unexplored. We aimed to assess the histopathological features of granulomas in perianal fistula in CD. A retrospective analysis was conducted by reviewing the medical and pathological records of 4430 cases who underwent perianal fistulectomy at our hospital between June 2015 and June 2023. The patients were divided into the CD group, tuberculosis (TB), and non-CD group, respectively, based on their final diangosis. The detection rate of granulomas and differential histopathological features were investigated. Among the 4430 patients, granulomas were identified in 41 cases, including 25 had CD, 2 had pulmonary TB, and 14 only exhibiting perianal lesions with no other comorbidities. Additionally, there were altogether 93 CD cases, resulting in a detection rate of granuloma of 26.9%, which was considerably higher than that in the non-CD group (26.9% vs 0.3%, p < 0.001). The majority (85.7%) of the perianal fistula tissues in the non-CD group contained foreign body giant cells, while this was observed in only 1 (4.0%) out of the 25 cases with CD. We proposed that granulomas in the perianal fistula in the non-CD group were mostly foreign body granulomas. Moreover, granulomas in the non-CD group were larger than that of the CD group (1135 μm vs 519 μm, p < 0.001). Most CD cases have less granulomas (≤3) and no foreign body giant cells. Ribbon-like granulomas can be seen only in CD cases.

Handling imbalance dataset issue in insider threat detection using machine learning methods

Insider threats, characterized by their baleful impact and substantial costs, arise from internal factors within organizations. These threats are rare and usually unnoticed, as the malicious actions are often submerged in numerous normal activities, causing dataset imbalance and making detection hard. To address these challenges, in this paper we propose a Two-Step Insider Threat Detection (TSITD) approach. First, it preprocesses the CERT r4.2 and r5.2 datasets into day-long sequences. Second, it handles the dataset imbalance and detects threats by forming various combinations of sampling techniques and classifiers, referred to as TSITD models. When we compare these TSITD models to baseline models, we observe a significant improvement in anomaly detection rate and balanced accuracy. The TSITD models also achieve higher rankings when evaluated using the Technique for Order of Preference by Similarity to Ideal Solution (TOPSIS) method.

Urine is better for rare earth elements bimonitoring in long-term exposed population: an exposure-response relationship study

With the soaring use of rare earth elements (REEs) worldwidely in high-technology and clean energy industries, there were growing concerns for adverse health effect from the REEs exposure. However, there is a lack of biomonitoring research concerning both urine and blood in population with definite exposure. We performed a biomonitoring study that involved 103 REEs exposed males and 110 males as non-REEs exposed controls. We measured the levels of REEs in environment and urine and blood samples from participants, and explored the exposure-response relationship between REEs in environment and body fluids. The effects of exposure duration and smoking status on the internal exposure level of REEs were also investigated. The results showed environmental REEs level of exposure group was significantly higher than that of control group (range of geometric mean of exposure vs. control: 1.08-4.07×104 ng/m3 vs. <LOD-2.16×102 ng/m3). Six elements with detection rates higher than 60% in blood or urine samples were lanthanum (La), cerium (Ce), praseodymium (Pr), neodymium (Nd), samarium (Sm), gadolinium (Gd). We found the REEs concentrations both in urine and blood of exposure population were significantly higher than controls, median range of the above 6 elements of urine and blood was 0.02-1.06 μmol/mol vs. <LOD-0.01 μmol/mol creatinine and 0.01-0.79 μg/L vs. <LOD-0.38 μg/L. The correlations between both blood and urine level of REEs and environment level showed significant. The correlation coefficients with urine levels are higher than with blood. Biomonitoring results showed good exposure-response relationship in urine REEs, while no positive response in blood samples. Smoking status, drinking status and years of exposure showed little effect on the level of REEs. Our results suggested that both blood and urine can be used to monitor REEs exposure, while urinary REEs is promising for risk assessment in population.

Serologic Evidence for Early SARS-CoV-2 Circulation in Lima, Peru, 2020.

During early 2021, Peru had the highest COVID-19-associated per-capita mortality rate. Socioeconomic inequality, insufficiently prepared healthcare, and surveillance systems are factors explaining the mortality rate, which can be severely worsened by early undetected SARS-CoV-2 circulation. We tested 1,441 individuals with fever sampled during August 2019-May 2021, several months before the first SARS-CoV-2 seroprevalence study available so far in Lima, Peru, for SARS-CoV-2-specific antibodies. The testing algorithm included a chemiluminescence immunoassay and surrogate virus neutralization test. Early positive samples (N = 24) from January-March 2020 were further tested using a plaque-reduction neutralization test (PRNT) and avidity test against the SARS-CoV-2 spike and nucleoprotein. None of the early samples were PRNT-confirmed, in contrast to 81.8% (18/22) of a subsample from April 2020 onward (Fisher exact test; P <0.0001). Therefore, we excluded non-PRNT-confirmed samples from subsequent analyses. The SARS-CoV-2 antibody detection rate was 0.9% in mid-April 2020 (1/104; 95% CI: 0.1-5.8%), suggesting viral circulation in early-middle March 2020, consistent with the first molecular detection of SARS-CoV-2 in Peru on March 2020. Mean avidity increase of 62-77% to 81-94% from all PRNT-confirmed SARS-CoV-2-positive samples during early 2020 were consistent with onset of SARS-CoV-2 circulation during late February/March 2020. Early circulation was also confirmed in a susceptible, exposed, infected, and recovered mathematical model that calculated an effective reproduction number >1 during February-March 2020. Early introduction of SARS-CoV-2 thus contributed to the high COVID-19 mortality rate in Peru. Emphasizing the role of diagnostic confirmation in understanding the pandemic's trajectory, this study highlights the importance of early detection and accurate testing in managing infectious disease outbreaks.