Diagnostics最新文献

Background/Objectives: Fetal health is essential in prenatal care, influencing both maternal and fetal outcomes. Cardiotocography (CTG) monitors uterine contractions and fetal heart rate, yet manual interpretation exhibits significant inter-examiner variability. Machine learning offers automated alternatives; however, class imbalance in CTG datasets where pathological cases constitute less than 10% leads to poor detection of minority classes. This study aims to provide the first systematic benchmark comparing five resampling strategies across seven classifier families for multi-class CTG classification, evaluated using imbalance-aware metrics rather than overall accuracy alone. Methods: Seven machine learning models were employed: Naïve Bayes (NB), Random Forest (RF), Linear Discriminant Analysis (LDA), k-Nearest Neighbors (KNN), Linear Support Vector Machine (SVM), Multinomial Logistic Regression (MLR), and Multi-Layer Perceptron (MLP). To address class imbalance, we evaluated the original unbalanced dataset (base) and five resampling methods: SMOTE, BSMOTE, ADASYN, NearMiss, and SCUT. Performance was evaluated on a held-out test set using Balanced Accuracy (BACC), Macro-F1, the Macro-Matthews Correlation Coefficient (Macro-MCC), and Macro-Averaged ROC-AUC. We also report per-class ROC curves. Results: Among all models, RF proved most reliable. Training on the original distribution (base) yielded the highest BACC (0.9118), whereas RF combined with BSMOTE provided the strongest class-balanced performance (Macro-MCC = 0.8533, Macro-F1 = 0.9073) with a near-perfect ROC-AUC (approximately 0.986-0.989). Overall, resampling effects proved model dependent. While some classifiers achieved optimal performance on the natural class distribution, oversampling techniques, particularly SMOTE and BSMOTE, demonstrated significant improvements in minority class discrimination and class-balanced metrics across multiple model families. Notably, certain models benefited substantially from resampling, exhibiting enhanced Macro-F1, BACC, and minority class recall without sacrificing overall accuracy. Conclusions: These findings establish robust, model-agnostic baselines for CTG-based fetal health screening. They highlight that strategic oversampling can translate improved minority class discrimination into clinically meaningful performance gains, supporting deployment in cost-sensitive and threshold-aware clinical settings.

Background: Manual review of EEG recordings in clinical settings is inherently time-consuming and labor-intensive. These challenges highlight a pressing need for automated EEG analysis tools capable of supporting clinicians by improving efficiency and diagnostic accuracy. Objectives: This study aims to develop and validate an AI-based model for the automated interpretation of adult EEG recordings. Unlike previous approaches that emphasize seizure detection during ictal states, our model targets the early prediction of seizure risk through systematic annotation and recognition of interictal patterns. Methods: The model is designed to accurately distinguish between normal and abnormal EEGs, encompassing both interictal and ictal activity. Abnormal EEGs will be further classified into three clinically relevant categories: (1) non-epileptiform abnormalities such as focal or diffuse slowing, (2) epileptiform discharges, and (3) electrographic seizures. Three AI-based classification algorithms were implemented: Support Vector Machine (SVM), Random Forest (RF), and K-Nearest Neighbors (KNN). Results: RF demonstrated optimal performance across most tasks, achieving 96.50% accuracy for normal activity identification. This AI-driven system enhances the efficiency, consistency, and accessibility of EEG interpretation. It is particularly valuable in settings with limited access to neurophysiologists and offers an innovative approach to improving diagnostic timelines and clinical decision-making. Conclusions: Ultimately, this tool will support physicians in diagnosing neurological conditions and monitoring patient progress over time.

Background/Objectives: Hydrocephalus is a complex neurological disorder marked by abnormal cerebrospinal fluid dynamics and ventricular enlargement. Despite breakthroughs in neuroimaging, diagnosis and longitudinal the application of imaging markers for the diagnosis and longitudinal monitoring of hydrocephalus remains challenging in routine clinical practice. The present study examines the behavior and cross-modality agreement of commonly used linear ventricular measurements under routine imaging conditions, at a single Romanian tertiary-care center characterized by heterogeneous acquisition protocols and limited availability of advanced volumetric techniques. Methods: We conducted a single-center retrospective observational study of 68 adults with hydrocephalus. Linear ventricular metrics, including Evans index and third-ventricle width, were measured on all available CT and MRI scans. CT-MRI agreement was assessed using paired examinations within a 90-day window. Longitudinal changes were analyzed using first-last and pre-post VP shunt comparisons. Associations between baseline imaging features and VP shunt placement were evaluated using rule-based and odds ratio analyses. Results: CT and MRI measurements demonstrated strong agreement for both Evans index (r = 0.93) and third-ventricle width (r = 0.90), with minimal systematic bias. Longitudinal analyses demonstrated small-magnitude changes in ventricular size following intervention, with substantial inter-individual variability. VP utilization increased across Evans index strata, reaching 100% in patients with values ≥0.50. Transependymal cerebrospinal fluid exudation showed the strongest association with subsequent VP shunting. Imaging-based rules exhibited expected trade-offs between sensitivity and specificity. Conclusions: Standard linear ventricular parameters exhibited adequate cross-modality agreement and clinically important longitudinal behavior in this cohort. While insufficient as standalone predictors, these readily available imaging markers remain important tools when combined with a comprehensive clinical assessment.

Background/Objectives: Acute respiratory failure (ARF) is associated with a high mortality. This study aimed to explore the association of arterial partial pressure of carbon dioxide (PaCO₂) in relation to survival outcomes in mechanically ventilated patients with ARF. Methods: This multicenter retrospective cohort study integrated the data from the eICU Collaborative Research Database (eICU-CRD; n = 10,946), the Medical Information Mart for Intensive Care IV (MIMIC-IV; n = 6683), and clinical records from two university-affiliated intensive care units in China (n = 410). The patients were categorized into low, normal, and high PaCO₂ groups using a restricted cubic spline model to explore the relationship between PaCO₂ and mortality. The 28-day survival distributions among the three groups were compared using Kaplan-Meier curves, with statistical significance assessed via the log-rank test. A multivariable Cox proportional hazards model was constructed to evaluate the independent prognostic value of PaCO₂ for multiple complications. Hazard ratios (HRs) and 95% confidence intervals (CIs) were calculated for the low and high PaCO₂ groups relative to the normal PaCO₂ group. Results: A U-shaped relationship was observed between PaCO₂ and mortality, with both low PaCO₂ (<36.4 mmHg) and high PaCO₂ (>57.9 mmHg) associated with an increased mortality risk. Kaplan-Meier survival analysis demonstrated that patients in the intermediate PaCO₂ range (36.4-57.9 mmHg) exhibited the highest survival rate (65.2%), whereas those in the low and high PaCO₂ groups had significantly lower survival rates (60.0% and 63.2%) (log-rank test, p < 0.001). Adjusted survival analyses further revealed that complications such as sepsis and chronic kidney disease significantly influenced the mortality across PaCO₂ strata. Compared with the intermediate PaCO₂ group, the hazard of death increased by 25.5% in the low PaCO₂ group and by 18.9% in the high PaCO₂ group. Conclusions: This retrospective analysis indicates that arterial PaCO₂ levels within the optimal range are associated with improved survival in patients with acute respiratory failure (ARF) on mechanical ventilation, but prospective studies are needed to establish causality and consider potential confounding factors.

In contemporary practice, dental implants are widely recognized as a reliable and effective solution for rehabilitating edentulous patients. Nevertheless, implant placement in the atrophied maxilla presents considerable challenges, with treatment planning influenced by various factors such as patient demographics, anatomical constraints, and economic considerations. Advances in imaging technology have positioned cone-beam computed tomography (CBCT) as the preferred modality for enhancing implant placement accuracy. By producing high-resolution three-dimensional radiographic images, CBCT facilitates precise assessment of maxillary anatomy at the proposed implant site-including bone height, width, length, and angulation-thereby optimizing surgical planning and improving the predictability and success rates of implant integration. Moreover, the timing of implant placement must account for the necessity of maxillary augmentation to ensure implant stability and reduce the risk of postoperative complications. This review discusses the clinical utility of CBCT as a diagnostic tool for preoperative assessment, focusing on the identification of critical anatomical landmarks and the determination of indications for bone augmentation, thereby highlighting its crucial role in enabling accurate treatment planning, minimizing surgical risks, and promoting the long-term survival of dental implants.

Placental abruption (PA) without vaginal bleeding is known to be associated with severe outcomes when compared to symptomatic cases; the presence of hypertensive disorders of pregnancy (HDP) is an additional negative prognostic factor. According to guidelines, severe HDP are indications for prompt delivery after maternal-fetal stabilization. Considering gestational age, parity and clinical obstetric examination, the induction of labor should be prioritized to avoid additional risks associated with cesarean section. However, since only a minority of cases of PA may be detected by ultrasonography (US), findings consistent with this suspicion should contribute to the establishment of an appropriate mode of delivery. We present two cases affected by severe HDP, eclampsia and HELLP syndrome, admitted to St. Luke Catholic Hospital, Wolisso, Ethiopia. In both cases, obstetric point-of-care (POC) US revealed a live premature fetus and a solid heterogeneous placental mass, raising the suspicion of concealed placental abruption. To expedite delivery, cesarean section was promptly offered. PA was confirmed in both cases; the first had stillbirth and postpartum hemorrhage, while the second ended up with healthy mother and newborn. In conclusion, POC-US imaging could play a role in optimizing delivery mode and timing for patients with HDP in low-resourced settings. Additional research is warranted to determine the impact of this technique in the management of obstetric emergencies.

Objectives: This study aimed to evaluate the validity, reliability, and diagnostic accuracy of the Low Sit-High Step (LS-HS) Test as an original, cost-effective, and clinically practical tool for assessing lower-extremity muscle strength and function, with a specific focus on its sensitivity in detecting early-stage sarcopenia. Methods: This cross-sectional study included 205 participants divided into four groups: probable sarcopenia, sarcopenia, and two control groups (young and middle-to-older adults). The LS-HS Test was compared across groups and against standard assessments to evaluate its efficacy in measuring lower-extremity function. Reliability was verified through Cronbach's alpha and ICC. Multinomial logistic regression was used to determine the test's predictive power, while ROC analysis assessed its diagnostic accuracy for sarcopenia screening. Results: The LS-HS scores were significantly higher in participants with probable sarcopenia and sarcopenia (p< 0.05). Multinomial logistic regression revealed that the LS-HS performance was a significant predictor of both probable sarcopenia and sarcopenia (p < 0.001). The test demonstrated excellent internal consistency (Cronbach's α = 0.938) and very high inter-rater and test-retest reliability (ICC = 0.998). ROC analysis confirmed high diagnostic accuracy in distinguishing both probable sarcopenia (AUC = 0.768) and sarcopenia (AUC = 0.704) (all p< 0.01). Conclusions: The LS-HS Test is a valid, reliable, and sensitive tool for assessing lower-extremity functional capacity. Its ability to identify early functional decline, often manifesting before significant muscle mass loss, positions it as an effective alternative to traditional assessments in routine clinical practice, particularly for the early detection and monitoring of the sarcopenia spectrum.

Background: Point-of-care ultrasound (POCUS) has emerged as a valuable tool for rapid diagnosis, procedural guidance, and real-time clinical decision-making in neonatal and pediatric critical care. Despite its growing use in acute medicine, the evidence describing its implementation, utility, and impact in interfacility and prehospital transport settings remains limited. This scoping review aims to systematically map the current body of evidence on POCUS use during neonatal and pediatric transport and to identify knowledge gaps to inform future research, training, and clinical integration. Methods: A scoping review was conducted following PRISMA-ScR 2020 guidelines, searching PubMed, Embase, Scopus, CINAHL, and Web of Science for studies describing POCUS use during neonatal and pediatric transport. Results: Of 3676 unique articles identified, 20 met inclusion criteria, including 10 cohort studies, 3 case series, 4 case reports, 2 narrative reviews, and 1 textbook chapter. Fifteen studies reported extractable patient-level data and were included in quantitative synthesis, encompassing 4278 patients. Among these, 1153 (27.0%) patients were under 18 years old, and 576 (13.5%) had POCUS performed during transport. POCUS was primarily used for diagnostic assessment-mainly lung and cardiac imaging-with variability in protocols, operator training, and transport characteristics. Eleven studies (73.3%) reported that POCUS altered clinical management, influencing management in 106 (18.4%) patients through diagnostic clarification, resuscitation decisions, medical or ventilator adjustments, and changes in transport destination. Conclusions: Evidence suggests that POCUS supports clinical decision-making and timely intervention during neonatal and pediatric transport, though use remains inconsistent. Future studies should focus on developing structured training frameworks, validating transport-specific protocols, and assessing the impact of POCUS on clinical outcomes and transport safety.

Background: Immune checkpoint blockade (ICB) has revolutionized lung adenocarcinoma (LUAD) therapy, yet predictive bio-markers remain suboptimal. We hypothesized that BCL2A1 expression in CD8⁺ T cells may reflect immune endurance and complement PD-L1 in predicting ICB response. Methods: Integrating bulk and single-cell RNA-seq across multiple LUAD cohorts, this study performed differential expression, survival, and pathway analyses in a discovery cohort (n = 60) and validated findings across five independent cohorts (n = 126). Results: Single-cell profiling identified BCL2A1 enrichment in tissue-resident memory and proliferating subsets that appeared preferentially expanded in responders; cell-cell communication analysis revealed that BCL2A1^high CD8⁺ T cells exhibited significantly enhanced outgoing signaling capacity (p = 0.0278), with proliferating subsets serving as intra-CD8⁺ coordination hubs and MIF pathway interactions achieving the highest intensity among all axes examined. BCL2A1 was significantly upregulated in responders (FDR < 0.05) and associated with improved ICB survival (HR = 0.43, p < 0.05), but not in non-ICB settings, suggesting treatment-specific prognostic relevance. A tri-marker model integrating BCL2A1, PD-L1 (CD274), and a 27-gene HOT score demonstrated favorable predictive performance (AUC = 0.826 discovery; macro-AUC = 0.774 validation), outperforming PD-L1 alone (AUC = 0.706) and established signatures including TIDE, IPS, TIS, and IFNG. Cross-platform simulations suggested high reproducibility (ρ = 0.982-0.993). Conclusions: These findings suggest BCL2A1 may serve as a bio-marker of CD8⁺ T-cell survival and enhanced intercellular coordination, and its integration with PD-L1 and immune activation markers may yield a reproducible ICB response predictor, pending clinical validation.

Objective: Solid pseudopapillary neoplasms (SPN) and pancreatoblastoma (PB) have a low overall incidence but represent the most common pancreatic tumors in childhood. Currently, there is a lack of systematic descriptions of contrast-enhanced ultrasound (CEUS) features for these two tumors in pediatric populations. This study aims to retrospectively analyze and compare the CEUS characteristics of SPN and PB to explore key imaging differentiation points. Methods: This retrospective study collected data on 22 patients with solid pseudopapillary neoplasms and pancreatic blastomas of the pancreas who were pathologically diagnosed at a children's hospital between September 2019 and May 2025. The ultrasound contrast-enhanced imaging findings for both tumor types were summarized and analyzed. Two physicians with different levels of experience performed qualitative analysis of the contrast-enhanced images, while quantitative analysis was conducted using time-intensity curve (TIC) analysis software. Results: This study included a total of 22 pediatric patients (19 with SPN and 3 with PB). Significant differences existed between the two groups in age (13.51 years vs. 2.94 years) and Ki-67 index (5.00% vs. 30.00%). Qualitative analysis revealed high heterogeneity in SPN enhancement patterns, with capsular enhancement with cystic components being the most common (42.11%). All PBs (100%) consistently demonstrated the "disorganized nourishing vessels" sign. Quantitative analysis revealed that PBs exhibited numerically higher IMAX values (179.84% vs. 60.56%) and faster WoR trends (773.88 vs. 275.38). Inter-observer consistency analysis supported measurement reliability (key parameters ICC > 0.80). Conclusions: This preliminary study indicates differences in CEUS characteristics between pediatric SPN and PB; PB tends to exhibit rapid, high enhancement with chaotic feeding vessels and rapid washout, whereas SPN more commonly presents with moderate, slow enhancement patterns, often accompanied by features associated with cystic components. These findings provide new hemodynamic clues for their imaging differentiation. Given the extremely small sample size of PB cases, the above conclusions should be regarded as preliminary hypotheses awaiting validation in future large-scale studies.