SAGE Open Medicine最新文献

Objectives: Radiation exposure has been a cause of concern in computed tomography imaging. Reducing radiation dose increases the image noise which can be compensated by using reconstruction techniques. Recently artificial intelligence-based reconstruction technique has been introduced. Therefore, the purpose of the study was to prospectively compare the image quality between Idose4 and Precise Image in normal BMI individuals.

Methods: Sixty-six consecutive patients with a normal body habitus undergoing contrast-enhanced abdomen and pelvis scan were included in the study. All scans were performed using 100 kVp and tube current modulation. The acquired images were reconstructed to iDose4 and precise imaging. Quantitatively images were analyzed by placing regions of interest in different organs to estimate the image noise, signal-to-noise ratio, and contrast-to-noise ratio. Qualitative analysis was done by two radiologists on a five-point Likert scale.

Results: Image noise was significantly reduced using Precise Image across the plain (9.11 ± 1.43 vs 8.18 ± 1.2), arterial (14.34 ± 2.1 vs 10.21 ± 1.5), and portovenous phase (14.78 ± 2.30 vs 11.97 ± 2.07) with maximum noise reduction in the arterial and portovenous phases. Signal-to-noise ratio and contrast-to-noise ratio was significantly improved in all the organs across the plain, arterial, and portovenous phases. Qualitative analysis showed no significant difference between Idose4 and Precise Image with regards to visualization of large vessels in the arterial and portovenous phases. However, precise image was graded better than Idose4 with respect to visualization/conspicuity, image noise, and artifacts.

Conclusion: Precise Image can be useful in reducing the image noise and improving the signal-to-noise ratio and contrast-to-noise ratio in low-dose computed tomography protocol among normal BMI individuals.

Background: Cytomegalovirus infection is a common complication following hematopoietic stem cell transplantation that significantly influences clinical outcomes.

Objectives: To develop and validate a predictive model for cytomegalovirus infection risk in patients with β-thalassemia major undergoing hematopoietic stem cell transplantation.

Design: Retrospective cohort study.

Methods: Clinical data from 291 β-thalassemia major patients undergoing hematopoietic stem cell transplantation were retrospectively analyzed. Independent risk factors identified via univariate and multivariate logistic regression analyses formed the basis of a predictive nomogram. The model's performance was evaluated by the concordance index (C-index), receiver operating characteristic curves, calibration plots, and decision curve analysis. Internal validation was performed using bootstrap resampling, and external validation was conducted with an independent cohort of 84 patients from another center.

Results: Three independent predictors of cytomegalovirus infection were identified: serum albumin levels, donor type, and grade III-IV acute graft-versus-host disease. A nomogram incorporating these predictors was established, demonstrating good discriminative ability (C-index: 0.745; 95% CI: 0.684-0.807). Internal and external validations yielded C-indices of 0.746 and 0.649, respectively. Receiver operating characteristic analysis showed an area under the curve of 0.745 in the training cohort and 0.649 in the validation cohort.

Conclusion: We developed and validated a reliable predictive model for assessing cytomegalovirus infection risk after hematopoietic stem cell transplantation in β-thalassemia major patients. This scoring system offers clinicians a practical tool for early risk stratification and intervention.

Objectives: Previous studies reported that many inflammatory factors have associations with osteoporosis. This study use Mendelian randomization (MR) analysis to explore the causal genetic relationship between 41 inflammatory factors and osteoporosis.

Methods: A bidirectional two-sample MR analysis was performed by employing five Mendelian randomization analysis methods including MR Egger regression, weighted median, inverse-variance weighted and weight mode methods. Summary statistics from the genome-wide association study (GWAS) of 41 inflammatory cytokines and osteoporosis were included in this study. This study examined the MR analysis results for heterogeneity and horizontal pleiotropy.

Results: Using the inverse variance weighted (IVW) method, this analysis indicated that elevated monocyte chemotactic protein-1 (MCP-1) levels were potentially linked to a 22% increased likelihood of osteoporosis (Odds Ratio (OR) = 1.22, 95% CI: 1.04-1.43, p = 0.014). Additionally, through the IVW approach, we observed that higher tumor necrosis factor-related apoptosis inducing ligand (TRAIL) levels were possibly associated with a 15% greater risk of osteoporosis (OR = 1.12, 95% CI: 1.03-1.29, p = 0.012). Other 39 inflammatory cytokines don't have casual genetic association with osteoporosis. When this study use MR to estimate the influence of osteoporosis on inflammatory factors, none of the p-values with IVW method were lower than 0.05.

Conclusion: This is the first bidirectional MR analysis to explore the causal genetic relationship between inflammatory cytokines and osteoporosis. This study found that MCP-1 and TRAIL are probably the upstream factors correlated with osteoporosis, and no inflammatory cytokine was involved in osteoporosis development downstream.

Immune checkpoint inhibitors therapy in cancer patients may induce immune-related diabetes mellitus through islet β-cell destruction, necessitating systematic glycemic management. This scoping review aims to identify and synthesize evidence on glycemic management strategies for immune-related diabetes mellitus. Guided by Arksey and O'Malley's five-stage scoping review framework, we strictly adhered to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews checklist. A systematic search was conducted across guideline repositories, academic databases, and professional oncology/endocrinology association websites. The search period spanned from database inception to June 30, 2024. Of 5085 initially identified records, 9 studies met inclusion criteria. Evidence was synthesized into five key domains: (1) risk assessment and early detection, (2) therapeutic interventions and monitoring, (3) patient education, (4) glycemic target optimization, and (5) multidisciplinary care coordination. This review consolidates evidence-based best practices for immune-related diabetes mellitus management derived from rigorous methodology. Clinicians should tailor these strategies to individual patient profiles to optimize outcomes while mitigating treatment disruptions.

Background: Evidence-based practice in intrapartum care is critical for lowering maternal and neonatal mortality and morbidity. Evidence-based practice, according to the World Health Organization Quality of Care Framework for Maternal and Newborn Health, is an important component of intrapartum care. However, little is understood about evidence-based intrapartum care practice in Ethiopia, particularly in the study setting.

Objective: To assess evidence-based intrapartum care practice and associated factors among obstetric care professionals in Jimma Zone public hospitals in Southwest Ethiopia.

Methods: A facility-based cross-sectional study was carried out on 217 obstetric care providers in Jimma Zone public hospitals in southwest Ethiopia. The study used a census approach to include all eligible participants within the specified population. Data were collected from June 1 to 30, 2023, using semistructured self-administered questionnaires. The collected data were entered into EpiData version 4.6 and exported to Statistical Packages for Social Sciences version 25 for analysis. Multivariable logistic regression was run to see the association between evidence-based intrapartum care practice and predictor variables. Statistical significance was set at p-values less than 0.05 in the multivariable logistic regression.

Results: Overall, 41.2% (95% CI: 40.8-42.3) of obstetric care providers in Jimma Zone public hospitals used evidence-based practices for intrapartum care. Attending in-service training (AOR (95% CI): 3.5 (1.61-9.71)), accessibility of obstetric care guidelines (AOR (95% CI): 2.082 (1.222-3.547)), having regular case presentation (AOR (95% CI): 2.5 (1.234-6.743)), having knowledge (AOR (95% CI): 2.3 (1.222-3.547)), attitude of obstetric care providers (AOR (95% CI): 1.847 (1.065-3.204)), having less than 2 years of work experience (AOR (95% CI): 1.32 (1.012-3.56)), and having 2-5 years of work experience (AOR (95% CI): 3.49 (1.23-6.312)) were among factors significantly associated with evidence-based intra-partum care practice of obstetric care providers in Jimma Zone public hospitals.

Conclusions: This study indicated that the majority of obstetric care providers did not practice evidence-based intrapartum care, which requires attention from all stakeholders. It is recommended for hospitals in the Jimma Zone to make guidelines available, provide in-service trainings, and identify systematic strategies to improve the knowledge and attitude of obstetric care providers.

Objective: To establish and validate a deep learning model that simultaneously segments pediatric burn wounds and grades burn depth under complex, real-world imaging conditions.

Methods: We retrospectively collected 4785 smartphone or camera photographs from hospitalized children over 5 years and annotated 14,355 burn regions as superficial second-degree, deep second-degree, or third-degree. Images were resized to 256 × 256 pixels and augmented by flipping and random rotation. A DeepLabv3 network with a ResNet101 backbone was enhanced with channel- and spatial attention modules, dropout-reinforced Atrous Spatial Pyramid Pooling, and a weighted cross-entropy loss to counter class imbalance. Ten-fold cross-validation (60 epochs, batch size 8) was performed using the Adam optimizer (learning rate 1 × 10⁻⁴).

Results: The proposed Deep Fusion Network (attention-enhanced DeepLabv3-ResNet101, Dfusion) model achieved a mean segmentation Dice coefficient of 0.8766 ± 0.012 and an intersection-over-union of 0.8052 ± 0.015. Classification results demonstrated an accuracy of 97.65%, precision of 88.26%, recall of 86.76%, and an F1-score of 85.33%. Receiver operating characteristic curve analysis yielded area under the curve values of 0.82 for superficial second-degree, 0.76 for deep second-degree, and 0.78 for third-degree burns. Compared with baseline DeepLabv3, FCN-ResNet101, U-Net-ResNet101, and MobileNet models, Dfusion improved Dice by 15.2%-19.7% and intersection-over-union by 14.9%-23.5% (all p < 0.01). Inference speed was 0.38 ± 0.03 s per image on an NVIDIA GTX 1060 GPU, highlighting the modest computational demands suitable for mobile deployment.

Conclusion: Dfusion provides accurate, end-to-end segmentation and depth grading of pediatric burn wounds captured in uncontrolled environments. Its robust performance and modest computational demand support deployment on mobile devices, offering rapid, objective assistance for clinicians in resource-limited settings and enabling more precise triage and treatment planning for pediatric burn care.

Rheumatoid arthritis significantly increases the risk of cardiovascular disease due to chronic inflammation. This review's purpose is to critically analyze the intricate relationship between rheumatoid arthritis and cardiovascular disease, highlighting the mechanisms by which systemic inflammation contributes to cardiovascular risk and the effectiveness of current treatment strategies. We systematically evaluate existing literature on conventional cardiovascular risk factors in rheumatoid arthritis patients, as well as inflammation-specific markers that influence cardiovascular outcomes. Our conclusions indicate that while several treatment modalities, including methotrexate and other disease-modifying agents, may mitigate cardiovascular risk, there is a prevalent underestimation of true risk by standard cardiovascular disease assessment protocols. This review provides unique contributions by emphasizing the importance of integrating novel risk factors into assessment protocols and advocating for personalized management strategies that cater to the specific needs of rheumatoid arthritis patients. By synthesizing these elements, we aim to enhance understanding and guide clinicians in improving outcomes for rheumatoid arthritis patients at heightened risk of cardiovascular complications.

Objective: Intravenous solutions such as dextrose 5% in water and 0.9% sodium chloride (normal saline) differ in electrolyte composition from human plasma and may contribute to serum chloride derangements (dyschloremia). This retrospective study aimed to explore the relationship between fluid composition, particularly medication diluents, and dyschloremia development in the intensive care unit.

Methods: This was a retrospective chart review of adult intensive care unit patients with normal serum chloride on admission who developed dyschloremia after 48 h of intensive care unit admission. Data were collected on fluid types and volumes administered in the intensive care unit in the 7 days prior to dyschloremia onset. Descriptive statistics and chi-square tests were used to compare characteristics between patients who developed hyperchloremia and hypochloremia.

Results: Of 884 screened patients, 85 developed dyschloremia after 48 h (41 hypochloremia, 44 hyperchloremia). There was no significant association between the proportion of normal saline or dextrose 5% in water-containing fluids and the type of dyschloremia. However, dexmedetomidine, typically diluted in normal saline, was associated with hyperchloremia.

Conclusion: While total fluid composition was not associated with dyschloremia type, high-volume use of specific diluent-medication combinations may contribute. Strategies to minimize diluent volume could help reduce dyschloremia risk.

Purpose: This study aimed to investigate the pathogenic characteristics of Vibrio parahaemolyticus in Taizhou City, China, to provide a scientific basis for the diagnosis and control of Vibrio parahaemolyticus in the region.

Methods: Bacterial strains were isolated from stool specimens of diarrheal patients at the First People's Hospital of Wenling City. The virulence genes, serotypes, and antibiotic susceptibility of these strains were determined.

Results: From June 1, 2020 to May 31, 2023, a total of 97 strains of Vibrio parahaemolyticus were isolated from stool specimens of diarrheal patients at the First People's Hospital of Wenling City. The results of virulence gene detection showed that 87.6% of the strains were thermostable direct hemolysin (TDH; tdh)⁺, thermolabile hemolysin (tlh)⁺, and tdh-related hemolysin (trh)^-, 11.3% were tdh ^- tlh ⁺ trh ^-, and 1.0% were tdh ⁺ tlh ⁺ trh ⁺. Six different serotypes were identified, with O3:K4 and O4:K4 being the most common, accounting for 42.3% and 32.0%, respectively. The other serotypes identified were O3:K6, O4:K8, and O1:KUT, accounting for 11.3%, 10.3%, and 3.1%, respectively. Furthermore, the results of antimicrobial susceptibility tests showed that most strains were sensitive to the tested drugs, while some strains exhibited resistance to cefuroxime (32.6%) and cefazolin (43.6%).

Conclusion: The majority of the isolated Vibrio parahaemolyticus strains carried the tdh gene, and the O3:K4 serotype dominated in Taizhou City from 2020 to 2023, followed by the O4:K4 serotype. Furthermore, some strains exhibited resistance to cefuroxime and cefazolin.