Severity Visual Score Research Articles

Estimating Fusarium head blight severity in winter wheat using deep learning and a spectral index

AbstractFusarium head blight (FHB) of wheat (Triticum aestivum L.), caused by the fungal pathogen Fusarium graminearum (Fg), reduces grain yield and quality due to the production of the mycotoxin deoxynivalenol. Manual rating for incidence (percent of infected wheat heads/spikes) and severity (percent of spikelets infected) to estimate FHB resistance is time‐consuming and subject to human error. This study uses a deep learning model, combined with a spectral index, to provide rapid phenotyping of FHB severity. An object detection model was used to localize wheat heads within boundary boxes. Corresponding boxes were used to prompt Meta's Segment Anything Model to segment wheat heads. Using 2576 images of wheat heads point inoculated with Fg in a controlled environment, a spectral index was developed using the red and green bands to differentiate healthy from infected tissue and estimate disease severity. Stratified random sampling was applied to pixels within the segmentation mask, and the model classified pixels as healthy or infected with an accuracy of 87.8%. Linear regression determined the relationship between the index and visual severity scores. The severity estimated by the index was able to predict visual scores (R2 = 0.83, p = < 2e‐16). This workflow was also applied to plot size images of infected wheat heads from an outside dataset with varying cultivars and lighting to assess model transferability. It correctly classified pixels as healthy or infected with a prediction accuracy of 85.8%. These methods may provide rapid estimation of FHB severity to improve selection efficiency for resistance or estimate disease pressure for effective management.

Radiological findings in low-dose CT for COVID-19 pneumonia in 182 patients: Correlation of signs and severity with patient outcome.

To characterize computed tomography (CT) findings of coronavirus disease 2019 (COVID-19) pneumonia and their value in outcome prediction.Chest CTs of 182 patients with a confirmed diagnosis of COVID-19 infection by real-time reverse transcription polymerase chain reaction were evaluated for the presence of CT-abnormalities and their frequency. Regarding the patient outcome each patient was categorized in 5 progressive stages and the duration of hospitalization was determined. Regression analysis was performed to find which CT findings are predictive for patient outcome and to assess prognostic factors for the hospitalization duration.Multivariate statistical analysis confirmed a higher age (OR = 1.023, P = .025), a higher total visual severity score (OR = 1.038, P = .002) and the presence of crazy paving (OR = 2.160, P = .034) as predictive parameters for patient outcome. A higher total visual severity score (+0.134 days; P = .012) and the presence of pleural effusion (+13.985 days, P = 0.005) were predictive parameters for a longer hospitalization duration. Moreover, a higher sensitivity of chest CT (false negatives 10.4%; true positives 78.6%) in comparison to real-time reverse transcription polymerase chain reaction was obtained.An increasing percentage of lung opacity as well as the presence of crazy paving and a higher age are associated with a worse patient outcome. The presence of a higher total visual severity score and pleural effusion are significant predictors for a longer hospitalization duration. These results are underscoring the value of chest CT as a diagnostic and prognostic tool in the pandemic outbreak of COVID-19, to facilitate fast detection and to preserve the limited (intensive) care capacity only for the most vulnerable patients.

Multicenter Study of Temporal Changes and Prognostic Value of a CT Visual Severity Score in Hospitalized Patients With Coronavirus Disease (COVID-19).

BACKGROUND. Chest CT findings have the potential to guide treatment of hospitalized patients with coronavirus disease (COVID-19). OBJECTIVE. The purpose of this study was to assess a CT visual severity score in hospitalized patients with COVID-19, with attention to temporal changes in the score and the role of the score in a model for predicting in-hospital complications. METHODS. This retrospective study included 161 inpatients with COVID-19 from three hospitals in China who underwent serial chest CT scans during hospitalization. CT examinations were evaluated using a visual severity scoring system. The temporal pattern of the CT visual severity score across serial CT examinations during hospitalization was characterized using a generalized spline regression model. A prognostic model to predict major complications, including in-hospital mortality, was created using the CT visual severity score and clinical variables. External model validation was evaluated by two independent radiologists in a cohort of 135 patients from a different hospital. RESULTS. The cohort included 91 survivors with nonsevere disease, 55 survivors with severe disease, and 15 patients who died during hospitalization. Median CT visual lung severity score in the first week of hospitalization was 2.0 in survivors with non-severe disease, 4.0 in survivors with severe disease, and 11.0 in nonsurvivors. CT visual severity score peaked approximately 9 and 12 days after symptom onset in survivors with nonsevere and severe disease, respectively, and progressively decreased in subsequent hospitalization weeks in both groups. In the prognostic model, in-hospital complications were independently associated with a severe CT score (odds ratio [OR], 31.28), moderate CT score (OR, 5.86), age (OR, 1.09 per 1-year increase), and lymphocyte count (OR, 0.03 per 1 × 109/L increase). In the validation cohort, the two readers achieved C-index values of 0.92-0.95, accuracy of 85.2-86.7%, sensitivity of 70.7-75.6%, and specificity of 91.4-91.5% for predicting in-hospital complications. CONCLUSION. A CT visual severity score is associated with clinical disease severity and evolves in a characteristic fashion during hospitalization for COVID-19. A prognostic model based on the CT visual severity score and clinical variables shows strong performance in predicting in-hospital complications. CLINICAL IMPACT. The prognostic model using the CT visual severity score may help identify patients at highest risk of poor outcomes and guide early intervention.

Factors Associated with Worsening Oxygenation in Patients with Non-severe COVID-19 Pneumonia.

BackgroundThis study aimed to determine the parameters for worsening oxygenation in non-severe coronavirus disease 2019 (COVID-19) pneumonia.MethodsThis retrospective cohort study included cases of confirmed COVID-19 pneumonia in a public hospital in South Korea. The worsening oxygenation group was defined as that with SpO2 ≤94% or received oxygen or mechanical ventilation (MV) throughout the clinical course versus the non-worsening oxygenation group that did not experience any respiratory event. Parameters were compared, and the extent of viral pneumonia from an initial chest computed tomography (CT) was calculated using artificial intelligence (AI) and measured visually by a radiologist.ResultsWe included 136 patients, with 32 (23.5%) patients in the worsening oxygenation group; of whom, two needed MV and one died. Initial vital signs and duration of symptoms showed no difference between the two groups; however, univariate logistic regression analysis revealed that a variety of parameters on admission were associated with an increased risk of a desaturation event. A subset of patients was studied to eliminate potential bias, that ferritin ≥280 μg/L (p=0.029), lactate dehydrogenase ≥240 U/L (p=0.029), pneumonia volume (p=0.021), and extent (p=0.030) by AI, and visual severity scores (p=0.042) were the predictive parameters for worsening oxygenation in a sex-, age-, and comorbid illness-matched case-control study using propensity score (n=52).ConclusionOur study suggests that initial CT evaluated by AI or visual severity scoring as well as serum markers of inflammation on admission are significantly associated with worsening oxygenation in this COVID-19 pneumonia cohort.

A preliminary report on the use of Midodrine in treating refractory gastroesophageal disease: Randomized Double-Blind Controlled Trial.

Background:Gastroesophageal reflux disease (GERD) is a common disease with various clinical presentations. Acid suppression with proton pump inhibitors and lifestyle modification may not lead to satisfactory response in a substantial portion of patients. We investigated the possible effect of midodrine in patients with refractory GERD.Methods:Patients suffering from GERD and were refractory to one-month course of pantoprazole 40mg twice daily entered the study. This was a pilot, randomized, double-blind, and placebo-controlled study. After randomization, one group received Midodrine 5mg before meals for one month, and the other group received placebo for the same period. Meanwhile, pantoprazole was continued 40mg twice daily in both arms. The severity of symptoms was evaluated by the visual scoring system. Quality of life (QoL) in both groups was measured using a standardized version of Quality of Life in Reflux and Dyspepsia questionnaire (QOLRAD).Results:A total of twenty patients were enrolled in this study. There was a significant interaction between the groups and time on all measured scores based on QOLRAD questionnaire. All the markers in the Midodrine group had significant improvement over time, but the placebo group did not show any significant improvement. Both visual severity score and total QoL score in Midodrine arm showed a U shape change during 6 weeks.Conclusions:Midodrine before a meal could be useful in alleviating symptoms and improving QoL in the patients with refractory gastroesophageal disease. (www.actabiomedica.it)

Usefulness of the Japanese version of the 5-D itch scale for rating pruritus experienced by patients undergoing hemodialysis

BackgroundPruritus in patients undergoing hemodialysis reduces quality of life via insomnia and depression, and negatively affects prognosis. For diagnosing pruritus, selecting therapeutic strategies, and determining therapeutic outcomes, methods are needed for objectively quantifying the degree of itchiness. In 2015, the Japanese version of the 5-D itch scale (5D-J), originally developed in the USA in 2010, was developed as a simple self-administered questionnaire; it evaluated the degree of itchiness based on five components: (1) duration of itchiness, (2) degree of itchiness, (3) direction of itchiness, (4) disability caused by itchiness, and (5) distribution of itchiness. 5D-J is useful for comprehensively assessing multiple elements related to itchiness. We used 5D-J to assess the degree of itchiness experienced by patients undergoing hemodialysis to investigate its clinical usefulness.MethodsSubjects were 336 patients undergoing maintenance hemodialysis at our facility in October 2016; they were selected from 383 patients, of whom 20 were excluded because their itchiness had a dermatologic origin and 27 were excluded because their localized itchiness was related to vascular access, respectively. The status of itchiness (duration, degree, direction, disability, and distribution) of the patients was surveyed in October 2016 using 5D-J; total scores were calculated and used for assessing the itchiness experienced by patients. We additionally investigated whether 5D-J scores correlated with visual analog scale (VAS) and Shiratori severity scores for pruritus.ResultsDegree was reported as “not present” by 124 patients (36.9%), “mild” by 164 (48.8%), “moderate” by 46 (13.7%), “severe” by 2 (0.6%), and “unbearable” by 0 (0%). Total score was 5 points in 55 patients (16.4%), 6–9 in 176 (52.4%), 10–14 in 95 (28.3%), 15–19 in 9 (2.7%), 20–24 in 1 (0.3%), and 25 in 0 (0%). The 5D-J total and VAS scores were strongly correlated (r = 0.7159; p < 0.001). The 5D-J total score correlated with “daytime itchiness” (r = 0.6441; p < 0.001) and “nighttime itchiness” (r = 0.6352; p < 0.001) on the Shiratori severity score.Conclusions5D-J may be useful for objectively assessing itchiness experienced by patients undergoing hemodialysis.

EEG Characteristics of Dementia With Lewy Bodies, Alzheimer's Disease and Mixed Pathology.

Introduction: Previous studies on electroencephalography (EEG) to discriminate between dementia with Lewy bodies (DLB) and Alzheimer’s disease (AD) have been promising. These studies did not consider the pathological overlap of the two diseases. DLB-patients with concomitant AD pathology (DLB/AD+) have a more severe disease manifestation. The EEG may also be influenced by a synergistic effect of the two pathologies. We aimed to compare EEG characteristics between DLB/AD+, “pure” DLB (DLB/AD−) and AD.Methods: We selected probable DLB patients who had an EEG and cerebrospinal fluid (CSF) available, from the Amsterdam Dementia Cohort (ADC). Concomitant AD-pathology was defined as a CSF tau/Aβ-42 ratio > 0.52. Forty-one DLB/AD+ cases were matched for age (mean 70 (range 53–85)) and sex (85% male) 1:1 to DLB/AD− and AD-patients. EEGs were assessed visually, with Fast Fourier Transform (FFT), network- and connectivity measures.Results: EEG visual severity score (range 1–5) did not differ between DLB/AD− and DLB/AD+ (2.7 in both groups) and was higher compared to AD (1.9, p < 0.01). Both DLB groups had a lower peak frequency (7.0 Hz and 6.9 Hz in DLB vs. 8.2 in AD, p < 0.05), more slow-wave activity and more prominent disruptions of connectivity and networks, compared to AD. No significant differences were found between DLB/AD+ and DLB/AD−.Discussion: EEG abnormalities are more pronounced in DLB, regardless of AD co-pathology. This emphasizes the valuable role of EEG in discriminating between DLB and AD. It suggests that EEG slowing in DLB is influenced more by the α-synucleinopathy, or the associated cholinergic deficit, than by amyloid and tau pathology.

Saber-sheath trachea as a marker of severe airflow obstruction in chronic obstructive pulmonary disease

Saber-sheath trachea is a specific radiographic parameter for chronic obstructive pulmonary disease (COPD), which consists of marked coronal narrowing associated with sagittal widening (tracheal index<2/3-0.67). The aim of this study was to investigate the correlation between saber-sheath trachea and clinical-radiological findings in a group of patients with COPD of varying severity. We evaluated the chest radiographs of 71 patients with COPD distributed as follows: GOLD class I, 8/71 (11.3%); class II, 34/71 (47.9%); class III, 16/71(22.5%); class IV, 13/71 (18.3%). In 52/71 (73.2%) patients we also evaluated chest computed tomography (CT) scans. We analyzed the prevalence of saber-sheath trachea and its correlation with the Tiffenau index, GOLD stage and radiological signs of COPD. Moreover, we evaluated the sensitivity, specificity and accuracy of chest radiography as compared to CT taken as the gold standard, and the correlation between the radiographic and CT tracheal index. Saber-sheath trachea was found in 18/71 (25.4%) patients, with a greater prevalence in patients with lower Tiffenau Index (p=0.02), GOLD stages III-IV and visual severity score 3 (severe) on chest CT. Saber-sheath trachea was not found to be related to other radiological signs of COPD. The sensitivity, specificity and accuracy values of radiography were 72.2, 97.0 and 88.5%, with perfect concordance between the radiographic and CT tracheal index (p<0.00001). Saber-sheath trachea is linked to the functional severity of airway obstruction, but not to other radiological signs of COPD. Thus, evaluation of the trachea at chest radiography is strongly recommended.