Scan Results Research Articles

A-102 Clinical Evaluation of Novel Markers in Brain Injury

Abstract Background Traumatic brain injury (TBI) is a significant health concern affecting individuals of all ages, demanding precise diagnostic methodologies to guide effective clinical management. According to the 2010 definition, a TBI results from an external force causing an alteration in brain function or other evidence of brain pathology. Current diagnostic tools, i.e. CT scans and the Glasgow Coma Scale (GCS), are inefficient because they are time and labor intensive. The need for rapid diagnostic tools is underscored by the drawbacks of existing methods, such as CT scans, which are expensive, expose patients to large amounts of radiation, and lead to delayed treatment. Recent advances in TBI diagnosis involve novel biomarkers, such as Glial Fibrillary Acidic Protein (GFAP) and Ubiquitin C-Terminal Hydrolase L1 (UCH-L1), which have shown promise in revolutionizing the assessment of head traumas. GFAP, a glial-specific protein, is elevated in circulation after a TBI, distinguishing it from multi-trauma patients without brain injuries. UCH-L1, found in neurons, is significantly elevated in TBI patients compared to uninjured controls. A 2021 study further supports the clinical effectiveness of these biomarkers, demonstrating their capacity to exclude CT-positive injury in acute TBI cases. The primary aim of this study is to explore the clinical utility of the Abbott Alinity TBI assay, specifically biomarkers GFAP and UCH-L1, in emergency department patients with a history of head trauma. Methods A retrospective study involving 238 emergency department patients with a history of head trauma and noncontrast CT scans was conducted using the Abbott Alinity TBI assay. Serum samples were collected, and biomarker values were established and compared to CT scan results. The study was comprised of 94 females and 144 males spanning various age groups. The GFAP and UCH-L1 cutoffs used were FDA approved, at 35.0 ng/L and 400.0 ng/L, respectively. If either marker was above the cutoff the patient ruled at risk for TBI. Results Results demonstrated the assay correctly identified all CT-positive cases (100% sensitivity), placing them in the rule-in group, while identifying 44 patients with a 0 chance of TBI. The negative predictive value for the TBI overall was 100% (95% CI: 91.96%-100%). The GFAP assay alone identified 30/31 positive CT scans, reporting a 98.77% (95% CI: 92.03%-99.82%) negative predictive value. The UCH-L1 assay reported 26/31 positive CT scans with a negative predictive value of 94.68% (95% CI: 88.71-97.58%). Analyzing the data revealed the TBI assay would have reduced CT scans by 18.5%. Conclusions The results of this study did show a potential reduction in the number of patients sent to CT making it a valuable tool for triaging patients presenting with head trauma; however, the complexity of neurological problems may lead to increased false positives, reducing assay specificity. Despite this limitation, this study concludes that the GFAP and UCH-L1 markers could be used to triage patients into CT rule-out and rule-in groups, thereby streamlining clinical management. In conclusion, this assay, incorporating GFAP and UCH-L1 biomarkers, presents as a promising diagnostic tool for emergency departments.

A-090 Performance of GFAP and UCH-L1 Biomarkers for Traumatic Brain Injury in the ARCHITECT i1000SR TBI Test

Abstract Background Traumatic Brain Injury (TBI) has been recognized as an important cause of death and disability and is a growing public health problem. An estimated 69 million people globally experience a TBI annually. The vast majority (80%) of patients evaluated for TBI in the Emergency Department will receive head CT scans, however less than 10% will have findings of acute traumatic abnormalities. This highlights the need for objective, rapid, accurate tools to help clinicians evaluate and triage patients with suspected TBI and reduce unnecessary radiation exposure. Blood based biomarkers such as glial fibrillary acidic protein (GFAP) and ubiquitin C-terminal hydrolase L1 (UCH-L1) have shown utility to predict acute traumatic intracranial injury on CT scan after TBI. Methods The ARCHITECT TBI test is a panel of in vitro diagnostic chemiluminescent microparticle immunoassays for the measurement of GFAP and UCH-L1 in plasma and serum. A method comparison study was performed to compare the GFAP and UCH-L1 assays on ARCHITECT i1000SR to the FDA cleared Alinity i assays. Performance characteristics such as detection limits, imprecision, linearity, and measuring interval were established following CLSI guidance. Results The analytical measuring interval (AMI) extends from the limit of quantitation (LoQ) to the upper LoQ and is determined by the range that demonstrates acceptable performance for linearity, imprecision, and bias. The AMI is 6.1 to 42,000 pg/mL for GFAP and 26.3 to 25,000 pg/mL for UCH-L1. Within-laboratory imprecision ranged from 2.2 to 6.2% CV for GFAP and 2.2 to 4.5% CV for UCH-L1. The Overall Reproducibility (includes repeatability, between-run, between-day, between-instrument variance components) results ranged from 2.7 to 6.8% CV for GFAP and 2.4 to 3.9 %CV for UCH-L1. The method comparison study evaluated 123 specimens across the range of 6.5-32,548.6 pg/mL for GFAP, and 51.5-24,127.7 for UCH-L1. The correlation coefficients were 1.0, with a slope of 1.03 and 1.06, an intercept of -0.6 and -6.0, for GFAP and UCH-L1, respectively. The results support use of the established GFAP and UCH-L1 cutoffs and clinical performance findings in a multi-site pivotal study which enrolled 1899 mild TBI (Glasgow Coma Scale score 13 to 15) subjects. 116 of the 120 specimens with a positive CT scan had a positive TBI interpretation (Sensitivity 96.7%). Of the 1779 subjects with negative CT scan results, 713 had a negative TBI interpretation (Specificity 40.1%). The negative predictive value (NPV) of the test was 99.4% (713/717). Conclusions The ARCHITECT TBI test performance was evaluated compared to the Alinity i TBI test across a broad concentration range of GFAP and UCH-L1. The results support equivalence of the ARCHITECT TBI test to the Alinity i TBI test. The established cutoffs were evaluated in a prospective cohort of mild TBI subjects and demonstrated high sensitivity and NPV relative to head CT scan results, supporting the utility to rule out the need for CT scan in mild TBI subjects presenting to the emergency department. Funding This work is in collaboration with the US Army Medical Materiel Development Activity, US Army Medical Research and Development Command CRADA 20-1266-CRA.

Gaze tracking embedded collaborative robots for automated metrology and reverse engineering

Conventional geometric metrology, or three-dimensional (3D) scanning, and reverse engineering heavily rely on the experience of the operators. With an increasing need for automation, robot arms have been adopted for this task. However, due to the large variety of parts and designs, automated path planning could provide a scanning solution that may overlook the critical area, which could potentially deteriorate the scan results. This article explores the integration of collaborative robotics (cobots) with eye-tracking technology to improve the autonomous 3D scanning process. The primary objective of this study is to enhance the accuracy and efficiency of cobots in 3D scanning, particularly in the capture of functionally critical areas, and to provide a detailed description of regions with complex geometric features. The study develops a framework where the scanning path of the robot-driven scanner is partially guided by eye tracking data, that is, calibrated gaze tracking, to improve the automated 3D scanning process. This framework provides an innovative integration of human gaze movement with automatic robot path planning, providing a new way of human-autonomy teaming. Case studies are presented to present and validate the proposed framework to automatically improve the 3D point cloud collection process, specifically in areas that usually require human manual intervention to capture details.

Visuospatial function impairment in patients with subacute-chronic isolated frontal lobe ischemic stroke: A cross-sectional study using MoCA-Ina in a private hospital

Background. Stroke is one of the leading causes of disability, resulting in both limb disability and also cognitive impairment. Cognitive impairment can occur post-stroke due to lesions in specific cortex areas. Visuospatial function, a domain of cognitive function related to visual imaging, is commonly affected by parietal lobe lesions. However, visuospatial processing also requires sustained attention, planning, and error correction, functions of the frontal lobe. There is a paucity of studies evaluating the relationship between isolated frontal lobe stroke and patients’ visuospatial function. Objective. To analyze the relationship between subacute-chronic frontal lobe ischemic stroke and visuospatial function in post-ischemic stroke patients using the MoCA-Ina. Material and methods. Patients from Siloam Karawaci General Hospital’s neurology outpatient department with ages under 65 years, Glasgow Coma Scale of 15, diagnosis of first-time stroke based on CT scan result, and ischemic lesion confined to one brain lobe were recruited using non-probability consecutive sampling for this cross-sectional study. Patients were divided into frontal lobe and non-frontal lobe stroke subgroups. Visuospatial function was assessed using MoCA-Ina and analyzed using Mann Whitney U test. Outcomes. Fifty patients were included; 25 had frontal lobe stroke, and 25 had non-frontal lobe stroke. The median visuospatial score was lower in the frontal lobe group (2, min/max = 0/4) compared to the non-frontal lobe group (3, min/ max = 0/5), with a p-value of 0.044. There was no significant difference in visuospatial scores between different frontal hemisphere locations. Conclusion. Subacute-chronic frontal lobe ischemic stroke affects visuospatial function in post-ischemic stroke patients.

Prevalence of Osteoporosis and Indications for Bone-Treatment In Older Adults Living with Frailty Enrolled in a Local Integrated Care Programme

Abstract Background Osteoporosis is estimated to affect more than 250,000 adults in Ireland, with 29.4% (€463.3 million) of the total healthcare cost attributable to osteoporosis-related fracture management, resulting in significant health and economic impact.(1,2) As such, early identification of osteoporosis and addressing associated risk factors are crucial steps in reducing osteoporosis-associated morbidity and mortality. This retrospective audit aims to assess the prevalence of osteoporosis and indications for initiating bone treatment among older adults living with frailty enrolled in the Limerick Integrated Care Programme for Older Persons (ICPOP). Methods All older adults attending ICPOP between 01/06/2023 to 29/02/2024 were included in the data collection. Data collected included patient age, gender, presence of vitamin D deficiency (<50), presence of osteopenia or osteoporosis via DEXA scan results, history of fragility fractures, and bone health treatment and its indication. Results A total of 310 patients (192 female, 118 male; age 70–98) attended ICPOP during the specified time period. DEXA scans identified osteopenia in 109 patients and osteoporosis in 69 patients. 86 patients experienced a history of fragility fractures, of which 30 were confirmed to have osteoporosis on DEXA. 93 patients (30.3%) displayed vitamin D deficiency, with the majority (81.7%) not previously receiving vitamin D supplementation. 151 patients were in receipt of bone treatment, of which 86 patients (56.9%) were newly commenced on bone treatment following interaction with ICPOP. The indications were osteoporosis on DEXA scan (44 patients), history of recent fragility fracture (20 patients), and high FRAX score (22 patients). Conclusion The increase in detection of risk factors and presence for osteoporosis, and initiating bone health treatment, achieved by way of an integrated care programme for older persons highlights the importance of proactive screening and timely initiation of treatment.

Dual role of Sfrp4 in bone remodelling during orthodontic tooth movement.

The objective of this study was to determine changes in gene expression by establishing an orthodontic tooth movement (OTM) rat model with appropriate and excessive orthodontic force. Using a closed coil nickel-titanium spring, the OTM was carried out to apply a mesial force of 50 or 100 g to the maxillary first molars. Micro-CT, histological and immunohistochemical staining were used to evaluate the bone formation at the tension site and the bone resorption and bone formation at pressure site. Then RNA sequencing and bioinformatic analysis were performed. According to the results of the Mirco-CT scan of OTM rat models, both the 50 g group and the 100 g group showed variable degrees of reduction in alveolar bone density on the tension and pressure sides. The results of histological and immunohistochemical staining demonstrated that the periodontal tissue and osteogenic ability of the 50 g group were restored at the 14 days, while the 100 g group caused severe periodontal tissue damage. The GO and KEGG analysis results, as well as the number of differentially expressed genes (DEGs), varied depending on the loading time and value of appliance, according to the results of the RNA sequencing. And the immunohistochemical staining results showed that Sfrp4 functioned by efficiently influencing both bone formation and bone absorption. Appropriate orthodontic force value could cause appropriate movement of teeth in rats without adverse periodontal damage. Simultaneously, distinct gene expression patterns were observed at various force levels and time intervals.

Shale anisotropic rock-physics model incorporating the effect of compaction and nonplate mixtures on clay preferred orientation

Compared with other sedimentary rocks, the strong elastic anisotropy of shale is extremely prominent, which is mainly caused by the preferred orientation and platy nature of its clay minerals. Especially in seismic reservoir characterization, a suitable and correct estimation of the shale elastic anisotropy can improve the accuracy of the shale seismic inversion and prediction. Due to the long-term compaction of shale and the rearrangement of minerals, its microstructure and macrostructure are more complex, resulting in obvious anisotropic characteristics of shale. Existing methods do not incorporate the impact of nonplate particles on clay platelets, or indirectly incorporate it through empirical formulas, resulting in poor applicability and errors in the rock-physics models. To reveal the main causes of the anisotropy of clay minerals, a theoretical model incorporating the effect of compaction and nonplate particles on the preferred orientation of clay platelets is developed using experimental data and electronic scanning results. Based on theoretical analysis, an orientation distribution function (ODF) based on the effect of compaction and nonplate particles is derived, which not only incorporates the influence of compaction but also further incorporates the effect of other nonplate particles, such as quartz, which makes the established shale anisotropic rock-physics model more reasonable and accurate. Then, an improved anisotropic shale rock-physics model is developed using the compaction and nonplate particles-based ODF. The prediction results indicate that the presence of nonplate particles has an inhibitory effect on the preferred orientation of clay platelets, which is verified by the measured experimental data and indicates that our method is reliable and effective.

Field investigation of the feasibility of MICP for Mitigating Natural Rainfall-Induced erosion in gravelly clay slope

Rainfall-induced erosion on slopes is a prevalent natural process leading to soil loss. One promising application of microbially induced carbonate precipitation (MICP) is to mitigate rainfall-induced erosion. Conducting field tests is an essential step to verify and improve its performance. In the current work, field tests were conducted to assess the feasibility of using MICP to mitigate rainfall-induced erosion on a gravelly clay slope in Longyan, Fujian, China. A temporary laboratory was set up to cultivate bacteria, and a non-sterilizing method was employed to prepare large volumes of bacterial suspensions in a single batch. Slopes were treated by spraying solutions onto their surfaces. The amount of discharged soils and 3D surface scanning results were used for evaluating the erosion intensity of the slopes. The results demonstrated that the method could effectively mitigate the surface erosion caused by natural rainfall and prevent erosion-induced collapse. Notably, approximately one year after the treatment, the grass had started to grow on the heavily cemented slope, indicating that the MICP method is both effective and eco-friendly for soil stabilization method. However, further improvements are needed to enhance the uniformity and long-term durability of the MICP treatment.

Investigation of optical coherence tomography angiography findings in patients with bipolar disorder

ObjectivesBipolar Disorder (BD) is an important psychiatric disease that progresses with attacks, can be chronic and causes serious mental problems. In this study, we aimed to identify the retinal vascular pathologies in BD patients by optical coherence tomography angiography (OCTA) imaging. MethodsRetinal vascular analysis from 35 BD patients and 30 healthy controls (HCs) were scanned using the OCTA machine. In addition, psychometric tests such as the Young Mania Rating Scale (YMRS) and Clinical Global Impression Scale (CGI-S) were applied to BD patients to assess the severity of the disease and determine the patient's level of functionality. ResultsAs a result of OCTA scans, there were significant differences between the groups as following; Deep retinal vessel density (VD) in the total, parafoveal and perifoveal area, Macular thickness in the inner parafoveal area, VD of retinal capillary plexuses in the inside disk and the Choroidal thickness (p < 0.05). Furthermore, according to the results of Pearson correlation analysis between OCTA scans and YMRS and CGI-S scores, it was determined that there was no significant relationship in any measurement (p > 0.05). ConclusionIn our study, it was determined that there were general differences in deep retinal vascular density and inner macular thickness in BD patients. These findings demonstrate that the deep and inner zone of the retina is affected in BD patients.

Comparative effectiveness of 6x R-CHOP21 versus 6x R-CHOP21 + 2 R for patients with advanced-stage diffuse large B-cell lymphoma

First-line treatment for advanced-stage diffuse large B-cell lymphoma (DLBCL) typically involves 6x R-CHOP21 or 6x R-CHOP21 with two additional rituximab administrations (6x R-CHOP21 + 2 R). In contemporary practice, this treatment choice might be guided by interim PET scan results. This nationwide, population-based study investigates the comparative effectiveness of these treatment regimens in an era where interim PET-guided treatment decisions were not standard practice. Utilizing the Netherlands Cancer Registry, we identified 1577 adult patients diagnosed with advanced-stage DLBCL between 2014–2018 who completed either 6x R-CHOP21 (43%) or 6x R-CHOP21 + 2 R (57%). We used propensity scores to assess differences in event-free survival (EFS) and overall survival (OS). At five years, EFS (hazard ratio of 6x R-CHOP21 + 2 R versus 6x R-CHOP21 [HR] = 0.89; 95% confidence interval [CI], 0.72–1.09) and OS (HR = 0.93; 95% CI, 0.73–1.18) were not significantly different between both regimens. In exploratory risk-stratified analysis according to the International Prognostic Index (IPI), high-IPI patients (i.e., scores of 4-5) benefit most from 6x R-CHOP21 + 2 R (5-year absolute risk difference of EFS = 16.8%; 95% CI, −0.4%−34.1% and OS = 12.1%; 95% CI, −5.4–29.6%). Collectively, this analysis reveals no significant differences on average in EFS and OS between the two treatments. However, the potential benefits for high-risk patients treated with 6x R-CHOP21 + 2 R underscore the need for future research.

Constructing flexible fiber bridging claws of micro/nano short aramid fiber at interlayer of basalt fiber reinforced polymer for improving compressive strength with and without impact

The high-performance Basalt Fiber Reinforced Polymer (BFRP) composites have been prepared by guiding Micro/Nano Short Aramid Fiber (MNSAF) into the interlayer to improve the resin-rich region and the interfacial transition region, and the flexible fiber bridging claws of MNSAF were constructed to grasp the adjacent layers for stronger interlaminar bond. The low-velocity impact results show that the MNSAF could improve the impact resistance of BFRP composites. The compression test results demonstrate that the compressive strength and the residual compressive strength after impact of MNSAF-reinforced BFRP composites were greater than those of unreinforced one, exhibiting the greatest 56.2% and 73.3% increments respectively for BFRP composites improved by 4 wt% MNSAF. X-ray micro-computed tomography scanning results indicate that the “fiber bridging claws” contributed to better mechanical interlocking to inhibit the crack generation and propagation under impact and compression load, and the original delamination-dominated failure of unreinforced BFRP composites was altered into shear-dominated failure of MNSAF-reinforced BFRP composites. Overall, the MNSAF interleaving might be an effective method in manufacturing high-performance laminated fiber in industrial production.

Impact of putatively beneficial genomic loci on gene expression in little brown bats (Myotis lucifugus, Le Conte, 1831) affected by white-nose syndrome.

Genome-wide scans for selection have become a popular tool for investigating evolutionary responses in wildlife to emerging diseases. However, genome scans are susceptible to false positives and do little to demonstrate specific mechanisms by which loci impact survival. Linking putatively resistant genotypes to observable phenotypes increases confidence in genome scan results and provides evidence of survival mechanisms that can guide conservation and management efforts. Here we used an expression quantitative trait loci (eQTL) analysis to uncover relationships between gene expression and alleles associated with the survival of little brown bats (Myotis lucifugus) despite infection with the causative agent of white-nose syndrome. We found that 25 of the 63 single-nucleotide polymorphisms (SNPs) associated with survival were related to gene expression in wing tissue. The differentially expressed genes have functional annotations associated with the innate immune system, metabolism, circadian rhythms, and the cellular response to stress. In addition, we observed differential expression of multiple genes with survival implications related to loci in linkage disequilibrium with focal SNPs. Together, these findings support the selective function of these loci and suggest that part of the mechanism driving survival may be the alteration of immune and other responses in epithelial tissue.

Prognostic significance of a negative PSMA PET/CT in biochemical recurrence of prostate cancer

BackgroundProstate-specific membrane antigen (PSMA) positron emission tomography/computed tomography (PET/CT) is becoming standard of care for men with biochemical recurrence (BCR) of prostate cancer. The implications of a negative PSMA PET/CT scan in this population remain unclear. This study aims to assess the outcome of patients with BCR post radical prostatectomy (RP) who have negative [18F]DCFPyL PET/CT scan at relapse.MethodsThis is a post-hoc subgroup analysis of a prospective non randomized clinical trial. One hundred and one patients (median age, 75 years) with BCR after RP, who tested negative on [18F]DCFPyL PET/CT and subsequently either underwent salvage radiotherapy (sRT) with or without androgen deprivation therapy (ADT) or were followed without active treatment, were included. Freedom from progression (FFP) after negative PSMA PET/CT was determined based on follow-up imaging selected as per clinical practice. Uni- and multivariate Cox regression analyses were performed to examine the association of patients' characteristics, tumor-specific variables, and treatment with clinical progression at the last follow-up. FFP at 1-, 2-, and 3-year were reported using Kaplan Meier analysis.ResultsThe median PSA level at PET/CT was 0.56 ng/mL (range, 0.4–11.3). Sixty five (64%) patients were followed without receiving further treatment, and 36 (36%) received sRT (18% to the prostate bed only and 18% to the prostate bed and pelvic lymph nodes) within 3 months of the PSMA PET. Seventeen of the sRT patients (17 of 36, 47%) received concomitant androgen deprivation therapy (ADT). Median follow-up was 39 months. Subsequent clinical progression was detected in 21 patients (21%), with 52% in pelvic lymph nodes, 52% in the prostatic fossa, 19% in distant lymph nodes, 14% in lungs, and 10% in bones. The FFP was 95% (95% CI: 91%-99%) at 12 months, 87% (95% CI: 81%-94%) at 24 months, and 79% (95% CI: 71%-88%) at 36 months. Multivariate Cox regression analysis revealed that an initial International Society of Urological Pathology (ISUP) grade 5 was significantly associated with clinical progression at the last follow-up (hazard ratio, 5.1, P value, 0.04). Furthermore, the receipt of sRT correlated significantly with lower clinical progression at the last follow-up (hazard ratio, 0.2, P value, 0.03), whereas other clinical and tumor-specific parameters did not. Following surveillance-only and sRT, 29% (19 of 65) and 6% (2 of 36) of patients, respectively, showed clinical progression. In the sRT group, no significant difference was observed in FFP between patients who underwent sRT to the prostatic fossa versus those who received sRT to the prostatic fossa and pelvic lymph nodes, although the numbers in these groups were small.ConclusionsThis study suggests that salvage radiotherapy is associated with a decreased or delayed clinical progression in patients with biochemical recurrence following radical prostatectomy who have negative PSMA PET/CT scan results. The analysis also underscores the prognostic significance of the initial ISUP grade, with ISUP grade 5 being associated with worse outcomes.Trial registrationRegistered September 14, 2016; NCT02899312.

Network security enhancement with advanced techniques in network scanning.

This article details the development and evaluation of an advanced network scanning framework that uses Scapy for packet manipulation and Tkinter for the GUI. The framework aims to improve detection accuracy, resource efficiency, and user interface usability, addressing the shortcomings of traditional methods. Key components include a Network Scanner, Packet Handler, Security Measures, and a GUI, all designed for comprehensive network security. Tested in a controlled environment, the framework achieved a 100% detection rate, surpassing traditional methods, and demonstrated resource efficiency with a 20% reduction in CPU usage and a 60 MB decrease in memory usage. The analysis showed network diversity and low utilization, suggesting capacity for future expansion. The framework's GUI effectively displayed scan results, enhancing usability. The novelty of this research lies in its integration of optimized ARP packet handling with a user-friendly interface, ensuring real-time threat detection and scalability. The study contributes to the advancement of network scanning techniques and proposes future enhancements like machine learning integration for better threat detection.

Clinical diagnosis of stroke patients using SIRIRAJ stroke score and Computed Tomography

Background &amp; Objectives: Stroke is a significant cause of disability and death globally, with ischemic and hemorrhagic types. Rapid diagnosis is critical, particularly in resource-limited settings where access to neuroimaging is restricted. Thus, this study aimed to diagnose stroke patients usingthe Siriraj Stroke Score (SSS) and computed tomography at Janaki Medical College TeachingHospital.Materials and Methods: A total of 97 stroke patients presented within 72 hours of onset atJanaki Medical College Teaching Hospital, Nepal, were included in this study. Patients wereclinically assessed using the SSS and subsequently underwent CT brain scanning to confirm thestroke subtype. The SSS was calculated based on consciousness level, headache, vomiting,atheroma markers, and diastolic blood pressure. The results from SSS were compared with the CTscan findings to determine the clinical diagnosis.Results: The study found that 56.7% of the patients had hemorrhagic strokes, with intraparenchymal hematoma being the most common subtype. The SSS showed a strong correlation with CT scan results, particularly for hemorrhagic strokes, where most patients with a score above 1 were accurately diagnosed.Conclusion: The Siriraj Stroke Score is a valuable tool for initial stroke assessment, especially insettings where advanced neuroimaging is not immediately available. The study supports usingSSS in early stroke management, which could improve patient outcomes in resource-limited environments.

LOGISTIC REGRESSION TECHNIQUE FOR CARDIOVASCULAR DISEASE PREDICTION

Cardiovascular diseases (CVDs) are the most common cause of death in the world. Over four out of five CVD deaths are due to heart attacks and strokes. CVD high mortality has led to about 17 million deaths worldwide. Several machine and deep learning techniques are used to classify the presence and absence of CVD. This paper presents a logistic regression (LR) technique for predicting the risk of heart diseases (HD). The goal is to create an LR algorithm and build a prediction model that would foretell the development of HD. The dataset included data on 207 patients, featuring the following: age, sex, chest pain type, blood pressure, cholesterol levels, fasting blood sugar &gt; 120 mg/dl, electrocardiogram results, maximum heart rate, exercise-induced angina, ST depression, slope of the ST segment, number of major vessels colored by fluoroscopy, and thallium scan results. Using this dataset to train the LR technique, a robust model was created to accurately predict the existence of HD in new patients. With an accuracy of 81%, a precision of 83%, and a recall score of 76%, the accuracy, precision, and recall key metrics were used to evaluate the model's efficacy. The model’s accuracy was compared to alternative methods, such as K-Nearest Neighbors and Decision Tree classifiers, which yielded accuracy of 81% and 76%, respectively. The obtained results are of great significance for healthcare providers – the proposed model can assist in identifying those who are at high risk of heart diseases and allow for early implementation of prophylactic...

Comprehensive perioperative and minimally invasive post-operative defect approach of massive palatal pleomorphic adenoma: Case series

Introduction and importanceExtensive Palatal post-operative defect management following excision of neoplasm is one of the most difficult challenges for oral and maxillofacial surgeons regarding its limited surgical access and visibility on narrow area, airway management difficulty during intubation, richness of maxillary vascular network resulting in enormous bleeding risk. Decision making regarding its surgical approach and impact on speech and mastication is important. This case series aim to describe comprehensive step by step perioperative and palatal defect management approach based on tumor pathological characteristic and anatomical perspective to achieve good surgical outcome. Cases presentationTwo cases of massive palatal pleomorphic adenoma were presented. Both of cases occurs in female patients. Lesions was crossing the midline, impair speech and causing discomfort. Preoperative diagnostic from CT scan and FNAB result was pleomorphic adenoma. Clinical discussionSurgery for both cases done with wide periosteal sacrificing excision, ostectomy and surgical obturator placement from intraoral approach under general anesthesia with nasal intubation. Eventually the wounds healed without wound dehiscence and fistula, no speech impairment and no sign of reccurency. ConclusionUnderstanding pathological characteristic of pleomorphic adenoma and basic anatomy of surrounding structure are important to formulate minimal invasive surgical and post-operative defect management planning and improve patient's quality of life.

Relationship Between Brain CT Scan Findings, Consciousness Levels, and Outcomes in Brain Trauma Patients: A Cross-Sectional Study

Background: Trauma is the fourth leading cause of mortality worldwide. The Glasgow Coma Scale (GCS) is a crucial tool for evaluating the consciousness levels of trauma patients, serving as a diagnostic instrument for assessing injury severity and the condition of brain trauma patients. Additionally, Computed Tomography (CT) Scans are the most practical and accurate imaging modality for diagnosing the types and locations of lesions in cases of brain trauma in the emergency department. The study was designed to explore the correlation between pathological findings in Brain CT scans and the consciousness levels of brain trauma patients, as assessed by the GCS. Methods: This cross-sectional descriptive-analytical study investigated 200 brain trauma patients admitted to the emergency department of Khatam Al-Anbia Hospital in Zahedan. Upon arrival, an emergency medicine specialist recorded the patients’ consciousness levels based on the GCS criteria. After performing a CT scan and determining the type and location of the lesion, a radiologist, emergency medicine, and neurosurgery specialists determined the continuation of the treatment process. Subsequently, patients requiring admission to the neurosurgery department or intensive care unit were monitored. The final patient status (deceased/survivor) was tracked at the end of the treatment period and added to the checklist. Following data coding and entry into the computer, descriptive statistics, including mean, standard deviation, and confidence intervals, were used for evaluation. Additionally, the Chi-square and independent t-tests, along with SPSS 22, were employed to examine the relationship between consciousness levels and CT scan results. Results: Three out of 200 patients were excluded from the study due to transfers to other medical facilities during treatment. The mean age of the remaining patients was 27.94 ± 11.25. Results showed that 67.5% of all patients survived, while 32.4% succumbed to injuries. The initial GCS score was 14-15 for 83 patients (42.1%), 9-13 for 69 patients (35%), and 3-8 for 45 patients (22.8%). Brain CT scans of trauma patients predominantly revealed subdural hematomas in 48 patients (24.3%). In the examination of the relationship between the mechanism of brain trauma and mortality, 75% of patients involved in falls and 65.5% in accidents survived, while all patients who experienced other causes of trauma survived. Ultimately, no significant difference was observed between the mechanism of brain trauma and patient mortality (p=0.318). Furthermore, all patients with a GCS score of 14-15 (100%), 85.6% with a GCS score of 9-13, and 35.5% with a GCS score of 3-8 survived. A significant relationship between initial consciousness levels and mortality rates in the emergency department was evident (p=0.001). Statistical analysis indicated that 66.7% of patients with subdural hematomas, 75% with epidural hematomas, 81% with cerebral contusions, 35.3% with intracerebral hemorrhages (ICH), and 92.3% with diffuse axonal injuries (DAI) ultimately survived, signifying a significant relationship between CT scan results and mortality rates (p=0.01). Moreover, the highest mortality rate was observed in patients with ICH, with a frequency of 64.7%. Conclusions: Simultaneously evaluating consciousness levels using the GCS, along with considering the type of pathology identified in CT scans of brain trauma patients admitted to the emergency department, significantly aids in determining patient mortality rates. Promptly initiating the patient’s treatment process can lead to reduced complications from brain trauma and, in some cases, decreased mortality.

NLRP3 inflammasome pathway involved in the pathogenesis of metabolic associated fatty liver disease

The prevalence of Metabolic-associated fatty liver disease (MAFLD) has been steadily increasing worldwide, paralleling the global epidemic of obesity and diabetes. It is estimated that approximately one-quarter of the global population is affected by MAFLD. Despite its high prevalence, MAFLD often goes undiagnosed due to the lack of specific symptoms in its early stages. However, as the disease progresses, it can lead to more severe liver-related complications such as fibrosis, cirrhosis, and hepatocellular carcinoma. Therefore, we aimed to investigate the expression levels of the nucleotide-binding oligomerization domain, leucine-rich repeat (LRR)—containing proteins (NLR) family pyrin domain-containing protein 3 [NLRP3] inflammasome pathway components, NLRP3 and interleukin 1β (IL-1β) genes in patients with MAFLD with various degrees of steatosis and fibrosis. Participants were classified into two equal groups; MAFLD group: consisted of 120 patients with different degrees of hepatic fibrosis and steatosis based on fibro scan results. The non-MAFLD group was comprised of 107 participants. Molecular analysis of pyrin domain-containing protein 3 and IL-1β relative gene expressions was performed in the blood of all participants, using Real-time quantitative polymerase chain reaction (RT-qPCR). Patients with post-MAFLD hepatic fibrosis had significantly higher relative gene expression levels of IL-1β and NLRP3; with IL-1β > 1.1 had AUC of 0.919, sensitivity of 88.33, specificity of 96.26, PPV of 96.4, and NPV of 88 and 92.3 accuracy (p value < 0.001). NLRP3 > 1.33 had a sensitivity of 97.5, specificity of 99.07, PPV of 99.2, NPV of 97.2, and 98.3 accuracy with an AUC of 0.991 (p value < 0.001) as predictors of post-MAFLD hepatic fibrosis.. A significant increase in the mean relative gene expression levels of both IL-1β and NLRP3 found in patients with early fibrosis (F0-F1-2); 31.97 ± 11.8 and 6.76 ± 2.18, respectively; compared with patients with advanced hepatic fibrosis stages (F2-F3); 2.62 ± 3.71 and 4.27 ± 2.99 (p < 0.001 each). The present study provides novel evidence for the possible involvement of IL-1β and NLRP3 inflammasome in metabolic-associated fatty liver disease pathogenesis and could be valid markers for the early detection of post-MAFLD hepatic fibrosis.

Advanced image analysis for medical diagnostics: a system for segmentation and classification using level set methods and AI algorithms

This work aims to implement and utilize an advanced computer system for image analysis and processing through artificial intelligence. The system will evaluate images from multiple sources. As a result, a comprehensive e-Medicus system will be developed to capture and analyze X-ray data and classify cancer cells. This innovative tool, with its unique features tailored for medical facilities, will assist them in capturing and analyzing X-ray images and CT scan results. The e-Medicus system offers several benefits for medical facilities, including efficient automation of photo analysis, tracking changes in a patient's condition over time, and facilitating the identification of medical changes and data classification. A multimedia presentation of the change process will use the contour set function, allowing for topological changes in solution properties. The system integrates novel procedures and algorithms from theoretical computer science and numerical mathematics, leveraging neural networks, genetic algorithms, semantic networks, image ontology, rough set theory, contour set methods, and hybrid algorithms. These developed algorithms enhance methods and concepts in image segmentation, gathering, transmitting, storing, extracting, and effectively presenting information.