Population Screening Research Articles

Porous Silicon Particle-Assisted Mass Spectrometry Technology Unlocks Serum Metabolic Fingerprints in the Progression From Chronic Hepatitis B to Hepatocellular Carcinoma.

Hepatocellular carcinoma (HCC) is a common malignancy and generally develops from liver cirrhosis (LC), which is primarily caused by the chronic hepatitis B (CHB) virus. Reliable liquid biopsy methods for HCC screening in high-risk populations are urgently needed. Here, we establish a porous silicon-assisted laser desorption ionization mass spectrometry (PSALDI-MS) technology to profile metabolite information hidden in human serum in a high throughput manner. Serum metabolites can be captured in the pore channel of APTES-modified porous silicon (pSi) particles and well-preserved during storage or transportation. Furthermore, serum metabolites captured in the APTES-pSi particles can be directly detected on the LDI-MS without the addition of an organic matrix, thus greatly accelerating the acquisition of metabolic fingerprints of serum samples. The PSALDI-MS displays the capability of high throughput (5 min per 96 samples), high reproducibility (coefficient of variation <15%), high sensitivity (LOD ∼ 1 pmol), and high tolerance to background salt and proteins. In a multicenter cohort study, 1433 subjects including healthy controls (HC), CHB, LC, and HCC volunteers were enrolled and nontargeted serum metabolomic analysis was performed on the PSALDI-MS platform. After the selection of feature metabolites, a stepwise diagnostic model for the classification of different liver disease stages was constructed by the machine learning algorithm. In external testing, the accuracy of 91.2% for HC, 71.4% for CHB, 70.0% for LC, and 95.3% for HCC was achieved by chemometrics. Preliminary studies indicated that the diagnostic model constructed from serum metabolic fingerprint also displays good predictive performance in a prospective observation. We believe that the combination of PSALDI-MS technology and machine learning may serve as an efficient tool in clinical practice.

Characterization of adrenal glands on computed tomography with a 3D V-Net-based model

ObjectivesTo evaluate the performance of a 3D V-Net-based segmentation model of adrenal lesions in characterizing adrenal glands as normal or abnormal.MethodsA total of 1086 CT image series with focal adrenal lesions were retrospectively collected, annotated, and used for the training of the adrenal lesion segmentation model. The dice similarity coefficient (DSC) of the test set was used to evaluate the segmentation performance. The other cohort, consisting of 959 patients with pathologically confirmed adrenal lesions (external validation dataset 1), was included for validation of the classification performance of this model. Then, another consecutive cohort of patients with a history of malignancy (N = 479) was used for validation in the screening population (external validation dataset 2). Parameters of sensitivity, accuracy, etc., were used, and the performance of the model was compared to the radiology report in these validation scenes.ResultsThe DSC of the test set of the segmentation model was 0.900 (0.810–0.965) (median (interquartile range)). The model showed sensitivities and accuracies of 99.7%, 98.3% and 87.2%, 62.2% in external validation datasets 1 and 2, respectively. It showed no significant difference comparing to radiology reports in external validation datasets 1 and lesion-containing groups of external validation datasets 2 (p = 1.000 and p > 0.05, respectively).ConclusionThe 3D V-Net-based segmentation model of adrenal lesions can be used for the binary classification of adrenal glands.Critical relevance statementA 3D V-Net-based segmentation model of adrenal lesions can be used for the detection of abnormalities of adrenal glands, with a high accuracy in the pre-surgical scene as well as a high sensitivity in the screening scene.Key PointsAdrenal lesions may be prone to inter-observer variability in routine diagnostic workflow.The study developed a 3D V-Net-based segmentation model of adrenal lesions with DSC 0.900 in the test set.The model showed high sensitivity and accuracy of abnormalities detection in different scenes.Graphical

Rethinking prostate cancer screening in transgender women

Introduction: Over the years, the number of people openly identifying as transgender has steadily increased, leading to a greater need for transgender-specific healthcare information. Among transgender women (TW), there remains a risk of prostate cancer since the prostate is not removed during gender-affirming hormone therapy (GAHT) or surgery; however, there is limited knowledge about prostate cancer screening in the transgender population. Although there are few reported cases of prostate cancer screening or prostate-specific antigen (PSA) testing in TW, the impact of hormone therapies on PSA levels is well-documented. Notably, GAHT for TW and hormone therapy for treating prostate cancer share similarities. Drawing on these similarities, we aimed to develop guidelines for baseline PSA levels and prostate cancer screening in TW. Methods: Through a systematic review, we examined the existing PubMed publications on PSA levels and prostate cancer screening in TW, as well as expected PSA levels in patients with prostate cancer undergoing hormone therapies. We also investigated other aspects considered for the diagnosis of prostate cancer. Given the limited research on TW, we also included relevant case studies. These publications and case reports were reviewed and analyzed to create a comprehensive overview of expected baseline PSA levels and prostate cancer screening guidelines for TW. Results: Currently, there are no established guidelines for PSA or prostate cancer screening in TW; however, these case studies indicated a range of PSA values from 3.3 to &lt;100 ng/ml. Existing literature on expected PSA levels in prostate cancer patients undergoing hormone therapy shows a reduction in PSA of over 50% post-therapy. This evidence suggests that PSA values in TW presenting with prostate cancer may be lower than those observed in cisgender males with the disease. Conclusions: While TW exhibit lower prostate cancer incidence compared to cisgender men, the impact of hormone therapy on PSA levels presents significant challenges for screening and diagnosis. The parallels between PSA level reductions in TG women and cisgender men undergoing estrogen therapy highlight the need for revised screening protocols. Addressing these challenges through targeted research and personalized care approaches will be vital for improving prostate cancer management in transgender individuals.

The accuracy of anthropometric indices in detecting hypertension in Sudanese adults: a cross-sectional study

BackgroundHypertension is an increasing health problem; hence, efforts have been made to promote the disease's early detection and modify prognoses. We aim to evaluate the accuracy of body mass index (BMI), waist circumference (WC), and waist-height ratio (WHtR) in detecting hypertension among adults in Northern Sudan.MethodsAdults were recruited for a multi-stage sampling survey in Northern Sudan. Sociodemographic and anthropometric index (BMI, WC, and WHtR) information were collected. A receiver operating characteristic (ROC) curve with its area under the curve (AUC) was obtained, and a multivariate binary analysis was performed.ResultsOf the 301 included adults, 113 (37.5%) were females and 188 (62.5%) were males. The median (interquartile range, IQR) age was 45.0 (32.0‒59.0) years. The median (IQR) of BMI, WC, and WHtR was 25.6 (21.9‒29.7) kg/m2, 83.0 (73.0‒94.8) cm, and 0.51 (0.43‒0.58), respectively; these values were significantly higher in adults with hypertension compared with adults without hypertension. A total of 166 (55.1%) adults had hypertension. BMI (AUC = 0.69 at the cutoff 22.5 kg/m2, sensitivity = 0.89, specificity = 0.53, YI = 0.35) and WHtR for both males and females (AUC = 0.68 at the cutoff 0.48, sensitivity = 0.75, specificity = 0.60, YI = 0.35) were more accurate than WC (AUC = 0.66 at the cutoff 77.5 cm, sensitivity = 0. 77, specificity = 0.56, YI = 0.33). The multivariate binary analysis revealed that being female (adjusted odds ratio [AOR] = 2.23, 95.0% CI = 1.25‒3.97), having increased age (AOR = 1.04, 95% CI = 1.02‒1.05), and having a higher BMI (AOR = 1.10, 95% CI = 1.04‒1.16) were associated with hypertension.ConclusionBMI, WC, and WHtR showed moderate predictive power, suggesting that these indices have a limited role in diagnosing hypertension at the individual level and are more appropriate for population screening than for individual diagnosis. BMI performs better than WC in terms of hypertension detection.

Impact of population screening for Lynch syndrome insights from the All of Us data

Lynch Syndrome (LS) is a common genetic cancer condition that allows for personalized cancer prevention and early cancer detection in identified gene carriers. We used data from the All of Us (AOU) Research Initiative to assess the prevalence of LS in the general U.S. population, and analyzed demographic, personal, and family cancer history, stratified by LS genotype to compare LS and non-LS carriers. The results suggest that population-based germline testing for LS may identify up to 63.2% of carriers who might remain undetected due to lack of personal or family cancer history. LS affects about 1 in 354 individuals in this U.S. cohort, where pathogenic variants in the genes MSH6 and PMS2 account for the majority of cases. These results underscore the need to optimize the identification of LS across diverse populations and population-based germline testing may capture the most individuals who can benefit from precision cancer screening and prevention.

Identifying and treating metabolic dysfunction-associated steatotic liver disease among at-risk Veterans.

Metabolic dysfunction-associated steatotic liver disease (MASLD), an increasing public health concern, remains challenging to diagnose and risk-stratify. We assessed the 1) prevalence of MASLD risk factors among Veterans in Veterans Health Administration (VA) care, 2) factors associated with MASLD diagnosis; and 3) associations between MASLD diagnosis and receipt of care. Veterans with MASLD risk factors, including obesity, pre-diabetes, diabetes, or dyslipidemia, were identified using International Classification of Diseases-10 codes and followed in 2019-2022. Multivariable logistic regression and propensity score-adjusted models identified demographic and clinical characteristics associated with a diagnosis of MASLD or cirrhosis and receipt of elastography, specialty care for liver disease, VA weight management (MOVE!) participation, and glucagon-like peptide-1 (GLP-1) analog prescriptions. Among approximately 9 million Veterans, 4,159,699 (45%) had risk factors for MASLD and were included in further analysis. MASLD or cirrhosis was diagnosed in 6% of the at-risk cohort. At-risk Veterans diagnosed with MASLD were younger with more metabolic risk factors, increased rates of alcohol use disorder, and higher FIB-4 scores and ALT values. Over one-year follow-up, 6% engaged in MOVE!, 9% had specialty care for liver disease, 3% were prescribed GLP-1 analogs, and 2% underwent staging elastography. MASLD diagnosis was significantly associated with receipt of MOVE!, specialty care consultation, and GLP-1 analog prescription. Few at-risk Veterans carried a MASLD diagnosis or had undergone staging elastography. Because MASLD diagnosis was associated with linkage to hepatology care and weight loss therapy services, implementation of population screening and management services for MASLD is critically needed.

Analysis of hepatitis B mortality trends in China from 2006 to 2021

Objective: To analyze the epidemiological characteristics of hepatitis B mortality among Chinese residents from 2006 to 2021 and predict the mortality trends from 2022 to 2027, providing reference for hepatitis B prevention and control efforts. Methods: A retrospective study was conducted using hepatitis B mortality data from 2006 to 2021 published by the Chinese Center For Disease Control And Prevention. Age-standardized mortality rates (ASMR) were calculated based on the 2000 Chinese population as the standard population. The crude mortality rate (CMR) and ASMR were analyzed for temporal, regional, gender, and age distribution characteristics. The Joinpoint regression model was used to analyze trends, and the grey model was applied to predict CMR and ASMR from 2022 to 2027. Results: From 2006 to 2021, a total of 77 722 hepatitis B deaths were recorded, with an average CMR of 2.69/10 thousands and an ASMR of 2.00/10 thousands. The ASMR showed an overall decreasing trend for both males (AAPC=-5.4%, 95%CI: -8.1 to -2.7, P<0.001) and females (AAPC=-5.7%, 95%CI: -8.4 to -3.0, P<0.001). Declining trends were also observed in urban areas (AAPC=-5.0%, 95%CI: -7.7 to -2.2, P=0.001) and rural areas (AAPC=-5.7%, 95%CI: -9.0 to -2.4, P=0.001). Regional analysis indicated that the western, central, and eastern regions had average ASMRs of 2.86/10 thousands, 2.05/10 thousands, and 1.42/10 thousands, respectively, all showing downward trends. The grey model predicted that from 2022 to 2027, the CMR would decrease annually from 2.36/10 thousands to 2.03/10 thousands, while the ASMR would decline from 1.37/10 thousands to 1.04/10 thousands. Conclusions: Hepatitis B mortality rates in China, reflected by CMR and ASMR, have shown a consistent downward trend, indicating progress in hepatitis B prevention and control. Future efforts should prioritize targeted screening and preventive measures for rural populations, western regions, and males to further reduce mortality.

Co-occurrence of bronchiectasis, airway wall thickening, and emphysema in Chinese low-dose CT screening.

To assess the co-occurrence of incidental CT lung findings (emphysema, bronchiectasis, and airway wall thickening) as well as associated risk factors in low-dose CT (LDCT) lung cancer screening in a Chinese urban population. Data from 978 participants aged 40-74 years from the Chinese NELCIN-B3 urban population study who underwent LDCT screening were selected. CT scans were reviewed for incidental lung findings: emphysema, bronchiectasis and airway wall thickness. Emphysema was defined in three ways (≥ trace, ≥ mild, or ≥ moderate) depending on severity. Participants were described and stratified by presence or absence of incidental lung findings. Logistic regression analyses were performed to examine the relationship between participant characteristics and CT findings. Mean age was 61.3 years ± 6.8 and 533 (54.6%) were female. 48% of participants had incidental lung findings: 19.9% had emphysema (≥ mild), 9.2% had bronchiectasis, and 35.7% had airway wall thickening. Among 978 participants, 2.1% showed all three findings. Multivariable analysis showed that higher age (OR: 1.06; 95% CI: 1.04-1.08; p < 0.001), male sex (OR: 1.68; 95% CI: 1.14-2.47; p = 0.008) smoking history (OR: 1.76; 95% CI: 1.02-3.03; p = 0.04 for former smokers; OR: 2.45; 95% CI: 1.59-3.78; p < 0.001 for current smokers), and the presence of respiratory symptoms (OR: 1.42; 95% CI: 1.01-2.00; p = 0.04) were associated with the risk of having at least one incidental lung findings. When different definitions of emphysema were used, the results remained consistent. In a Chinese urban population undergoing LDCT lung cancer screening, 48% had at least one incidental CT lung finding, which was associated with higher age, male sex, questionnaire-based respiratory symptoms and smoking history. Question Reporting of incidental lung findings that indicate lung disease risk lacks consensus in the cancer screening setting and needs evidence of co-occurrence in general populations. Findings Almost half of the 978 participants had at least one incidental lung CT finding; these were associated with older age, male sex, respiratory symptoms, and smoking history. Clinical relevance Incidental lung findings and related risk factors are often observed in low-dose CT lung cancer screening, and careful consideration of their relevance should be given to their inclusion in future screenings.

Emerging Concepts and Success Stories in Type 1 Diabetes Research: A Road Map for a Bright Future.

Type 1 diabetes treatment stands at a crucial and exciting crossroad since the 2022 U.S. Food and Drug Administration (FDA) approval of teplizumab to delay disease development. In this Perspective article, we discuss four major conceptual and practical issues that emerged as key to further advance type 1 diabetes research and therapies. First, collaborative networks leveraging the synergy between the type 1 diabetes research and care community members are key to fostering innovation, know-how and translation into the clinical arena worldwide. Second, recent clinical trials in presymptomatic stage 2 and recent-onset stage 3 disease have shown the promise, and potential pitfalls, of using immunomodulatory and/or beta-cell protective agents to achieve sustained remission or prevention. Third, the increasingly appreciated heterogeneity of clinical, immunological, and metabolic phenotypes and disease trajectories is of critical importance to advance the decision-making process for tailored type 1 diabetes care and therapy. Fourth, the clinical benefits of early diagnosis of beta-cell autoimmunity warrant consideration of general population screening for islet autoantibodies, which requires further efforts to address the technical, organizational and ethical challenges inherent to a sustainable program. Efforts are underway to integrate these four concepts into the future directions of type 1 diabetes research and therapy.

Artificial intelligence as a proficient tool in detecting pulmonary tuberculosis in massive population screening programs: a case study in Chennai, India.

To evaluate the performance of Genki, a computer-aided detection (CADe) software, in detecting tuberculosis (TB) using chest radiography in a mobile TB screening program in Chennai, India. Genki, an AI-based CADe software, was employed in four mobile diagnostic units in remote areas of Chennai, India for screening TB. Patients from remote areas of Chennai who visited the vans and registered in the screening program underwent chest radiography, and the acquired X-ray scans were analyzed using Genki, which provided an assessment of each scan as either "TB suggestive" or "TB not suggestive". Subsequently, sputum or swab from the patients with "TB suggestive" results was collected to confirm the diagnosis. In total, 25,598 patients were screened between January and December 2022. When the annotations from the expert radiologists were considered to be true, Genki demonstrated an aggregated sensitivity of 98%, specificity of 96.9%, and accuracy of 96.9% in detecting TB from chest X-ray scans of the screened population. Furthermore, it exhibited a sensitivity, specificity, and accuracy of >95%, >94%, and >94%, respectively, for both sexes (male and female) and all age groups (14-35, 36-60, and ≥61 years). Genki demonstrated excellent value as a TB screening tool in remote locations in Chennai, India. Employing a CADe-based approach for systematic TB screening is cost-effective and reduces workload in high-burden and low-resource settings.

Cumulative Impact Assessment to Identify Environmental Health Vulnerable Areas: A Focus on Cumulative Stressors and Resiliency Index

To develop and implement policies that effectively protect public health from environmental pollution and hazards, it is essential to consider a range of environmental, social, and economic factors. Understanding regional differences driven by these factors is crucial. This study conducted a cumulative impact assessment using a screening method to identify regions most vulnerable to environmental and health risks. It applies the Cumulative Stressors and resiliency index (CSRI) to assess 250 local governments based on 17 indicators, which include both environmental stressors and resiliency buffers factors. The study also examines, the spatial distribution and correlation between asthma emergency visit rates and CSRI scores. In terms of cumulative impact, when factoring in community resilience, certain areas in the Chungcheong and Jeollabuk provinces stood out. These regions, characterized by high environmental exposure and pathological factors, ranked among the top 10% of areas experiencing environmental inequality based on the CSRI. Furthermore, an ANOVA analysis of CSRI scores and asthma emergency visit rates showed a significant statistically difference. The high-CSRI score group had an asthma emergency visit rate of 27.97 per 100,000 people, while the low-CSRI score group had a rate of 20.12. The findings from this study provide valuable scientific evidence to support the development of targeted policies. By screening areas and population that are particularly sensitive or vulnerable, the results enable a more rational and systematic approach to manage limited environmental health resources and personnel.

Assessing the performance of chest x‐ray screening in detecting early‐stage lung cancer in the general population

AbstractChest x‐ray (CXR) is widely used for lung cancer screening in Japan. We evaluated the sensitivity and specificity of CXR in detecting early lung cancer and its histological types. We cross‐referenced lung cancer municipality screening data with the regional cancer registry database. The results of individuals screened at least once from 2016 to 2018 were utilized to calculate CXR's sensitivity and specificity for lung cancer diagnosed within 1 year of screening (n = 161,251) by stage and its histological types. We stratified analyses based on sex, age, smoking status, first screening, and screening intervals. CXR's sensitivity and specificity for early‐stage lung cancer were 73.6% (95% confidence interval [CI], 66.8–79.6) and 94.1% (95% CI, 94.0–94.2), respectively. No significant differences were found in sex or smoking status. The sensitivity for early‐stage adenocarcinoma was 76.0% (95% CI, 68.3–82.7), which was higher than that for early‐stage squamous cell carcinoma (70.4% [95% CI, 67.3–86.0]). However, no significant differences were observed (p = .532). No significant differences were found in sex or smoking status for early‐stage adenocarcinoma or early‐stage squamous cell carcinoma. Due to its moderate sensitivity and high specificity, CXR could be a useful tool for mass screening in the general population. However, because CXR failed to detect 26.4% of early‐stage cases, practitioners should inform high‐risk patients of other screening options.

Screening of native wild Salvia nemorosa populations for chemical compositions, antioxidant activity and UHPLC-HRMS profiling

Screening of native wild Salvia nemorosa populations for chemical compositions, antioxidant activity and UHPLC-HRMS profiling

Pattern of Thyroid Disorders in a Tertiary Care Centre of a High-Altitude Region of Nepal: A hospital-based retrospective study

Background: Millions of people globally suffer from thyroid disorders, with over half of them are unaware of their conditions. Untreated, these disorders can lead to severe health complications such as heart problems, pregnancy complications, goiter, bone health issues, etc. Jumla, a high-altitude Himalayan region in Nepal, includes iodine-deficient areas, making it prone to thyroid disorders. This study aimed to identify the prevalence and pattern of thyroid disorders in this region. Methods: A retrospective hospital-based cross-sectional study was conducted using data from the Karnali Academy of Health Sciences, Jumla, spanning from 1st January–31st December 2023. Participants of all ages with complete thyroid function test results (fT3, fT4, and TSH assessed via chemiluminescence immunoassay) were included. Data were extracted from Bahmni EMR, cleaned in MS-Excel, and analyzed in R software, with a significance threshold of p &lt; 0.05. Results: Among 816 participants (mean age: 35.66 ± 14.60 years), 660 (80.8%) were female, and 156 (19.1%) were male. The most represented age group was 25–34 years. Subclinical hypothyroidism was the most prevalent disorder, affecting 33 males (21.15%) and 143 females (21.66%). Primary hyperthyroidism was the least common, found in 1 male (0.64%) and 7 females (1.06%). Other disorders included secondary hypothyroidism, secondary hyperthyroidism, primary hypothyroidism, and subclinical hyperthyroidism. Conclusion: Subclinical hypothyroidism was the most common thyroid disorder, with females disproportionately affected. Wider population screening for early detection and management is essential to mitigate health risks.

Deciphering the Vulnerability of Pollen to Heat Stress for Securing Crop Yields in a Warming Climate.

Climate change is leading to more frequent and severe extreme temperature events, negatively impacting agricultural productivity and threatening global food security. Plant reproduction, the process fundamental to crop yield, is highly susceptible to heatwaves, which disrupt pollen development and ultimately affect seed-set and crop yields. Recent research has increasingly focused on understanding how pollen grains from various crops react to heat stress at the molecular and cellular levels. This surge in interest over the last decade has been driven by advances in genomic technologies, such as single-cell RNA sequencing, which holds significant potential for revealing the underlying regulatory reprogramming triggered by heat stress throughout the various stages of pollen development. This review focuses on how heat stress affects gene regulatory networks, including the heat stress response, the unfolded protein response, and autophagy, and discusses the impact of these changes on various stages of pollen development. It highlights the potential of pollen selection as a key strategy for improving heat tolerance in crops by leveraging the genetic variability among pollen grains. Additionally, genome-wide association studies and population screenings have shed light on the genetic underpinnings of traits in major crops that respond to high temperatures during male reproductive stages. Gene-editing tools like CRISPR/Cas systems could facilitate precise genetic modifications to boost pollen heat resilience. The information covered in this review is valuable for selecting traits and employing molecular genetic approaches to develop heat-tolerant genotypes.

Identifying risk factors for carbapenem-resistant Acinetobacter baumannii carriage upon admission: a case-case control study

BackgroundActive screening programs and early detection of asymptomatic carriers are effective in preventing carbapenem-resistant Acinetobacter baumannii (CRAB) dissemination in healthcare facilities. This study aims to identify risk factors associated with CRAB carriage among patients upon admission to an acute care hospital.MethodsA case-case-control study was conducted at an acute care hospital. Starting in June 2020, new admissions to medical wards underwent rectal and buccal screening. Patients with CRAB or carbapenem-susceptible A. baumannii (CSAB) carriage were compared to controls, randomly selected from patients with negative cultures, at a one-to-one ratio. Multinomial logistic regression using a backward stepwise method was employed to identify factors associated with CRAB and CSAB carriage. A Chi-square Automatic Interaction Detector analysis was also conducted to further elucidate risk factors.ResultsThe study included 115 CRAB carriers, 117 CSAB carriers and 121 controls. Increasing age was associated with a reduced risk of CSAB (OR: 0.96, p < 0.001) and CRAB carriage (OR: 0.97, p = 0.02), while higher Charlson Comorbidity Index scores increased the risk for both. CRAB carriage was significantly associated with admission from long-term acute care hospitals (OR: 7.68, p < 0.001) and presence of pressure ulcers (OR: 89.98, p < 0.001). Decision tree analysis identified pressure ulcers, prior location, and Charlson score as key predictors, with CRAB carriage reaching 77.3% in patients admitted from long-term acute care hospitals with pressure ulcers.ConclusionPressure ulcers were strongly associated with the carriage of both susceptible and resistant strains of A. baumannii. CRAB carriage was predominantly observed in patients transferred from long-term acute care hospitals, highlighting the need for targeted screening in this high-risk population.

Necessity and Components of Essential Health Screening for the Older Adult Population in Korea

Necessity and Components of Essential Health Screening for the Older Adult Population in Korea

Coronary calcium score and emphysema extent on different CT radiation dose protocols in lung cancer screening.

To assess the consistency of automated measurements of coronary artery calcification (CAC) burden and emphysema extent on computed tomography (CT) images acquired with different radiation dose protocols in a lung cancer screening (LCS) population. The patient cohort comprised 361 consecutive screenees who underwent a low-dose CT (LDCT) scan and an ultra-low-dose CT (ULDCT) scan at an incident screening round. Exclusion criteria for CAC measurements were software failure and previous history of CVD, including coronary stenting, whereas for emphysema assessment, software failure only. CT images were retrospectively analyzed by a fully automated AI software for CAC scoring, using three predefined Agatston score categories (0-99, 100-399, and ≥ 400), and emphysema quantification, using the percentage of low attenuation areas (%LAA). Demographic and clinical data were obtained from the written questionnaire completed by each participant at the first visit. Agreement for CAC and %LAA categories was measured by the k-Cohen Index with Fleiss-Cohen weights (Kw) and Intraclass Correlation Coefficient (ICC) with 95% Confidence Interval (CI). An overlap of CAC strata was observed in 275/327 (84%) volunteers, with an almost perfect agreement (Kw = 0.86, 95% CI 0.82-0.90; ICC = 0.86, 95% CI 0.79-0.90), while an overlap of %LAA strata was found in 204/356 (57%) volunteers, with a moderate agreement (Kw = 0.57, 95% CI 0.51-0.63; ICC = 0.57, 95% CI 0.21-0.75). Automated CAC quantification on ULDCT seems feasible, showing similar results to those obtained on LDCT, while the quantification of emphysema tended to be overestimated on ULDCT images. Question Evidence demonstrating that coronary artery calcification and emphysema can be automatedly quantified on ultra-low-dose chest CT is still awaited. Findings Coronary artery calcification and emphysema measurements were similar among different CT radiation dose protocols; their automated quantification is feasible on ultra-low-dose CT. Clinical relevance Ultra-low-dose CT-based LCS might offer an opportunity to improve the secondary prevention of cardiovascular and respiratory diseases through automated quantification of both CAC burden and emphysema extent.

Retinopathy of prematurity in Germany over 13 years: incidences, treatment preferences and effects of national guideline changes

ObjectiveRetinopathy of prematurity (ROP) is a leading yet avoidable cause of childhood blindness. Screening for ROP is highly effective in preventing blindness secondary to ROP. We provide epidemiological data on...

Artificial intelligence-based computer-aided diagnosis for breast cancer detection on digital mammography in Hong Kong.

Research concerning artificial intelligence in breast cancer detection has primarily focused on population screening. However, Hong Kong lacks a population-based screening programme. This study aimed to evaluate the potential of artificial intelligence-based computer-assisted diagnosis (AI-CAD) program in symptomatic clinics in Hong Kong and analyse the impact of radio-pathological breast cancer phenotype on AI-CAD performance. In total, 398 consecutive patients with 414 breast cancers were retrospectively identified from a local, prospectively maintained database managed by two tertiary referral centres between January 2020 and September 2022. The full-field digital mammography images were processed using a commercial AI-CAD algorithm. An abnormality score <30 was considered a false negative, whereas a score of ≥90 indicated a high-score tumour. Abnormality scores were analysed with respect to the clinical and radio-pathological characteristics of breast cancer, tumour-to-breast area ratio (TBAR), and tumour distance from the chest wall for cancers presenting as a mass. The median abnormality score across the 414 breast cancers was 95.6; sensitivity was 91.5% and specificity was 96.3%. High-score cancers were more often palpable, invasive, and presented as masses or architectural distortion (P<0.001). False-negative cancers were smaller, more common in dense breast tissue, and presented as asymmetrical densities (P<0.001). Large tumours with extreme TBARs and locations near the chest wall were associated with lower abnormality scores (P<0.001). Several strengths and limitations of AI-CAD were observed and discussed in detail. Artificial intelligence-based computer-assisted diagnosis shows potential value as a tool for breast cancer detection in symptomatic setting, which could provide substantial benefits to patients.