Search Results (5,468)

Background/Objectives: Determining how a patient with metastatic cancer is responding to therapy can be difficult for medical oncologists, especially with text-only radiology reports. In this investigation, we assess the clinical usefulness of a new algorithm-based analysis that provides spatial location and quantification for each detected lesion region of interest (ROI) and compare it to information included in radiology reports in the United States. Methods: Treatment response radiology reports for FDG PET/CT scans were retrospectively gathered from 228 patients with metastatic cancers. Each radiology report was assessed for the presence of both qualitative and quantitative information. A subset of patients (N = 103) was further analyzed using an algorithm-based service that provides the clinician with comprehensive quantitative information, including change over time, of all detected ROI with visualization of anatomical location. For each patient, three medical oncologists from different practices independently rated the usefulness of the additional analysis overall and in four subcategories. Results: In the 228 radiology reports, quantitative information of size and uptake was provided for at least one lesion at one time point in 78% (size) and 95% (uptake) of patients. This information was reported for both analyzed time points (current scan and previous comparator) in 52% (size) and 66% (uptake) of patients. Only 7% of reports quantified the total number of lesions, and none of the reports quantified changes in all lesions for patients with more than a few lesions. In the assessment of the augmentative algorithm-based analysis, the majority of oncologists rated it as overall useful for 98% of patients (101/103). Within specific categories of use, the majority of oncologists voted to use it for making decisions regarding systemic therapy in 97% of patients, for targeted therapy decisions in 72% of patients, for spatial location information in 96% of patients, and for patient education purposes in 93% of patients. Conclusions: For patients with metastatic cancer, the algorithm-based analysis of all ROI would allow oncologists to better understand treatment response and support their work to more precisely optimize the patient’s therapy. Full article

Deep learning has significantly advanced the field of medical image segmentation. However, the complexity of network structures often leads to high computational demands, limiting their practical efficiency. To enhance the efficiency of image segmentation, this paper introduces an innovative, concise, and lightweight deep learning network. First, to reduce model complexity, we replaced the attention mechanism in the traditional vision transformer (ViT) structure with a shift operation, creating the ShiftViT architecture. This substitution significantly decreased computation and the number of parameters while preserving model performance. Second, to retain and enhance fine-grained features and facilitate more precise information transfer across different layers, we employed a full-scale progressive skip connection strategy. This approach effectively integrates multi-scale feature information, further enhancing model performance. Additionally, to further reduce network complexity, inspired by the independence of probabilities, we opted for depth-wise separable convolution over traditional convolution. This enhances the relative independence between layers. Together, these modifications achieved superior segmentation results on both the Synapse and Automated Cardiac Diagnostic Challenge (ACDC) datasets compared to mainstream models, with substantial advantages in terms of computational efficiency and parameter count. The proposed approach represents an effective solution for medical image applications with limited computational resources and holds great promise for clinical practice. Full article

Background: Induction therapy with basiliximab is recommended in kidney transplant (KT) recipients with a low immunological risk (LIR) profile. Whether basiliximab is associated with a decreased risk of acute rejection (AR) and graft loss is controversial. Methods: In our institution, LIR patients (absence of anti-HLA antibodies before KT) are inducted with basiliximab in case of living-donor KT, while deceased-donor KT recipients receive no induction. Maintenance immunosuppression is similar, including a combination of tacrolimus (Tac), mycophenolate (MPA) and steroids. In this single-center retrospective study, we included all adult LIR patients who underwent KT between 1 January 2015 and 31 December 2022. Results: Of the 471 patients included, 354 received no induction and 117 received basiliximab. The median (IQR) number of HLA A-B-DR mismatches was 3 (2–3) and 2 (2–4) in the no induction group and the basiliximab group, respectively. The cumulative incidences in the no induction group vs. the basiliximab group of acute rejection and graft loss over 5 years post-KT were similar at 8.9% vs. 7.8% (p = 0.8) and 8.5% vs. 4.2% (p = 0.063), respectively. In multivariable Cox regression analysis, delayed graft function emerged as an independent risk factor for acute rejection (hazard ratio [HR] 2.75, 95% confidence interval [CI] 1.23–6.13, p = 0.014) and graft loss (HR 9.32, CI 4.10–21.1, p < 0.001). Conclusions: Basiliximab did not provide any advantage in terms of rate of acute rejection and graft survival within 5 years post KT compared with a strategy without induction therapy in patients with a low immunological risk profile receiving triple maintenance immunosuppression Tac/MPA/steroids. Full article

Pelvic organ prolapse impacts an increasing number of women in the United States. The standard approach to correcting apical pelvic organ prolapse uses the sacral anterior longitudinal ligament (SALL) to lift the vaginal apex; however, this approach may result in recurrent prolapse. A newer procedure utilizes the pectineal ligament (PL), which may be a more reliable anchor point. This study compares the biomechanical properties of these two ligaments to elucidate which can withstand more stress to provide long-term stability following prolapse. Seventeen formalin-embalmed donors were used (PL: 17 right, 16 left; SALL, 15). The PL was evaluated to better characterize the ligament’s properties within the pelvis using digital calipers and descriptive statistics. Mean values were statistically evaluated using an independent t test (p = 0.05) but no differences in laterality were appreciable. The PL and SALL samples were harvested and evaluated using a mechanical tester to determine their force at failure (N), toughness (Jm⁻²), and elastic modulus (MPa). The PL had increased values in the mean force at failure and toughness than the SALL when evaluated by each side as well as a combined mean value. These differences were statistically significant (p = 0.05) for toughness as evaluated using an independent t-test (right, p = 0.004; left, p = 0.005; combined, p = 0.002) and force at failure [right, p = 0.001 (independent t-test); left, p = 0.004 and combined, p = 0.005 (Mann–Whitney U test), indicating that the PL may permit more deformation, but greater resistance to catastrophic failure as compared to the SALL. When evaluating any statistical differences in modulus, the individual and combined values were increased for the PL as compared to the SALL but were not significant (right, p = 0.290; left, p = 0.143; combined, p = 0.110) suggesting a stiffer material that may be more prone to catastrophic failure once a tear has begun. Collectively, these inherent biomechanical properties of the pectineal ligament indicate the ligament may be a more reliable anchor point for pelvic organ prolapse repair than the SALL. Full article

This paper presents a 13-level switched capacitor inverter with a novel modulation method designed to minimize the number of switches and significantly reduce switching losses. The inverter stands out for its simplicity, requiring only ten semiconductor switches to generate 13 levels. A key feature is the inherent self-voltage balancing of the capacitors, which eliminates the need for additional control mechanisms. The inverter’s unique architecture, comprising high-voltage and low-voltage modules, enables modulation using a hybrid PWM approach that combines step waveform modulation with level-shifted PWM (LS-PWM). This innovative technique dramatically lowers the switching frequency of the high-voltage module’s switches, independent of the carrier frequency, thereby limiting the number of switches in high-frequency operation and achieving substantial reductions in switching losses. This paper provides a detailed analysis of the inverter’s operating modes, voltage-balancing mechanisms, and parameter calculations. The advantages of the topology presented in this paper are demonstrated by comparison. Finally, the simulation and experimental results confirm the practicality and effectiveness of the proposed inverter and its modulation strategy. Full article

Resource Dependence Theory suggests that (a) power balance with resource interdependency, (b) formal/informal procedures for resource exchange, and (c) matching in goals and operational philosophies positively affect partnering implementation (information exchange and joint decision-making). Additionally, improved partnering implementation positive affects commitment fulfillment and dispute resolution. In a setting where SMEs supply to small local retailers, the SMEs do not suffer from low bargaining power and rely on informal contracts, and both firms are compatible. The small trading partners in this study predominantly have face-to-face and telephonic interactions with each other (possible due to the small number). Knowledge of one another and a simple transaction process reduces risk and uncertainty, and leads to trust. In this study, trust is a contextual factor, and we aim to determine if there is a positive effect of (a), (b), and (c) on partnering implementation, and if the effect strengthens with an increase in the level of trust. Survey data are used to calibrate and validate a structural equation model independently. Through empirical research, we aim to identify deviations in results, determine the cause of deviation in the study characteristics, and add explanatory power to research findings. Except for the influence of trust on the positive relationship between informal procedures and partnering implementation, the finding fits with the theoretical bases. With a high level of trust, clarity in time, accuracy, and relevance of information exchanged may be lacking, compromising decision-making and adding to the ambiguity of partnering implementation with an informal agreement. Full article

Introduction: Early diagnosis of cervical cancer at the precancerous stage is critical for effective treatment and improved patient outcomes. Objective: This study aims to explore the use of SWIN Transformer and Convolutional Neural Network (CNN) hybrid models combined with transfer learning to classify precancerous colposcopy images. Methods: Out of 913 images from 200 cases obtained from the Colposcopy Image Bank of the International Agency for Research on Cancer, 898 met quality standards and were classified as normal, precancerous, or cancerous based on colposcopy and histopathological findings. The cases corresponding to the 360 precancerous images, along with an equal number of normal cases, were divided into a 70/30 train–test split. The SWIN Transformer and CNN hybrid model combines the advantages of local feature extraction by CNNs with the global context modeling by SWIN Transformers, resulting in superior classification performance and a more automated process. The hybrid model approach involves enhancing image quality through preprocessing, extracting local features with CNNs, capturing the global context with the SWIN Transformer, integrating these features for classification, and refining the training process by tuning hyperparameters. Results: The trained model achieved the following classification performances on fivefold cross-validation data: a 94% Area Under the Curve (AUC), an 88% F1 score, and 87% accuracy. On two completely independent test sets, which were never seen by the model during training, the model achieved an 80% AUC, a 75% F1 score, and 75% accuracy on the first test set (precancerous vs. normal) and an 82% AUC, a 78% F1 score, and 75% accuracy on the second test set (cancer vs. normal). Conclusion: These high-performance metrics demonstrate the models’ effectiveness in distinguishing precancerous from normal colposcopy images, even with modest datasets, limited data augmentation, and the smaller effect size of precancerous images compared to malignant lesions. The findings suggest that these techniques can significantly aid in the early detection of cervical cancer at the precancerous stage. Full article

Federated learning enables model training on multiple clients locally, without the need to transfer their data to a central server, thus ensuring data privacy. In this paper, we investigate the impact of Non-Independent and Identically Distributed (non-IID) data on the performance of federated training, where we find a reduction in accuracy of up to 29% for neural networks trained in environments with skewed non-IID data. Two optimization strategies are presented to address this issue. The first strategy focuses on applying a cyclical learning rate to determine the learning rate during federated training, while the second strategy develops a sharing and pre-training method on augmented data in order to improve the efficiency of the algorithm in the case of non-IID data. By combining these two methods, experiments show that the accuracy on the CIFAR-10 dataset increased by about 36% while achieving faster convergence by reducing the number of required communication rounds by 5.33 times. The proposed techniques lead to improved accuracy and faster model convergence, thus representing a significant advance in the field of federated learning and facilitating its application to real-world scenarios. Full article

Introduction: Head and neck squamous cell carcinoma (HNSCC) ranks sixth among cancers in the world, and the 5-year survival rate ranges from 25% to 60%. The risk factors for HNSCC are primarily smoking, alcohol consumption and human papillomavirus (HPV). Data indicate that 15–20% of cancers are caused by infectious agents, 20–30% by smoking and 30–35% by unhealthy lifestyles, diet, lack of physical activity and obesity. Dysbiosis is a microbiome imbalance, which promotes oncogenesis by intensifying inflammatory processes and affecting the host’s metabolism. Profiling the microbiome in various types of cancer is currently the subject of research and analysis. However, there is still little information on the correlation of the microbiome with HNSCC and its impact on oncogenesis, the course of the disease and its treatment. Objective: The aim of the study was to prospectively assess risk factors with assessment of the impact of the microbiome on the risk of squamous cell carcinoma of the larynx. The study included a group of 44 patients diagnosed with squamous cell carcinoma of the larynx and 30 patients from the control group. Results: In the control group, bacteria of the normal microbiome dominated—the genus Streptococcus, Gemella, Neisseria and Kingella. In the group of patients with laryngeal cancer, Prevotella, Clostridiales and Stomatobaculum were found significantly more often. Porphyromonas, Fusobacterium, Lactobacillus, Actinobacteria, Actinomyces and Shaalia odontolytica were also found at a higher percentage in the study group. Analyzing the phylum, Firmicutes dominated in the control group; there were statistically significantly more of them than in patients from the study group. Bacteroides and Bacillota were found significantly more often in patients with laryngeal cancer. Conclusions: The importance of the microbiome in oncology has been confirmed in many studies. Independent risk factors for laryngeal cancer were primarily a lower number of Firmicutes in the microbiome, but also an increased leukocyte level above 6.52 × 10³/mm and a decreased total protein level below 6.9 g/dL. Prevotella, Clostridiales, Stomatobaculum, Porphyromonas, Fusobacterium, Lactobacillus, Actinobacteria, Actinomyces and Shaalia were considered to be the bacteria contributing to the development of laryngeal cancer. Streptococcus, Gemella, Neisserie and Kingella were considered to be protective bacteria. Moreover, the study confirmed the significant impact of smoking, alcohol consumption and poor oral hygiene on the development of laryngeal cancer. The microbiome, its identification and manipulation may constitute a breakthrough discovery for improving the diagnosis and oncological therapy of laryngeal cancer, and also of the entire group of HNSCC. Profiling the microbiome may allow for personalized therapy related to its modification. Assessing the microbiome of patients diagnosed with cancer may provide an opportunity to predict treatment response and effectiveness. Full article

Background and Objectives: Pregnant women face an increased risk of experiencing negative consequences due to COVID-19 infection. Our study aimed to identify outcomes for both mothers and fetuses associated with COVID-19 during each trimester, as well as to identify post-COVID symptoms in this population. Materials and Methods: Among the total population, 14 females were infected during the first trimester, 25 during the second, and 66 during the third trimester. Weekly follow-ups were conducted until delivery. Seventy-five females (71.4%; 95% CI:26.9–115.9%) were admitted to the hospital secondary to COVID-19 infection. Maternal hospitalization was independently associated with COVID-19 severity (adjusted odds ratio (aOR) = 3.9; 95% CI: 1.6–9.2 at p = 0.002 relative to the reference group (mild infection)) and the presence of dyspnea at initial assessment (aOR = 6.9; 95% CI: 1.7–28.2 at p = 0.007 relative to nondyspneic patients). Results: The duration of hospitalization (mean ± SD) was higher in the third trimester than the first and second trimesters (10.1 ± 0.8 vs. 4.0 ± 1.2 days and 10.1 ± 0.8 vs. 6.2 ± 1.4 days, respectively, at p < 0.05). The number of maternal deaths in the third trimester was higher than in the first and second trimesters (16 (24.2%) vs. no deaths and 16 (24.2%) vs. 1 (4%) deaths, respectively, at p < 0.05). In terms of fetal outcomes, a good fetal condition was more likely if the mother was infected during the first trimester (92.9%) than the second (80%) or third trimesters (66.7%), but the difference was not significant. The percentage of preterm deliveries was insignificantly higher in the second trimester (16%) than the first (7.1%) and third (4.5%) trimesters. Conclusions: The most common post-COVID symptoms included persistent loss of smell, dry eyes, post-partum depression, knee pain, and myalgia. Post-COVID symptoms were more prevalent in patients infected during the third trimester. The adverse outcomes of COVID-19 infection for both mother and fetus were more severe in cases where the infection occurred during the third trimester compared to the second and first trimesters. Therefore, it is crucial to adhere to precautionary measures against COVID-19, prioritize vaccination, and provide comprehensive care for pregnant mothers. Full article

Wire rope isolator (WRI) devices are widely used in vibration reduction industrial equipment, and stiffness is the key parameter that determines isolation effectiveness. WRI devices show slight nonlinearity under small loads, and the manufacturers generally only provide the initial parameters. To investigate the mechanical behavior changes in the WRI devices under repeated loads, five types of WRI specimens were tested under various amplitudes, loading speeds, and preloads. The test results of large symmetrical compression and tension loads showed that the WRI devices demonstrated stable hysteresis curves under repeated loads, while the hysteresis curves were independent of the loading speed. The test results of small cyclic loads with large preloads show that the stiffness of the WRI specimen follows the logarithmic law, with the cycle number under various loading conditions. Particularly, the stiffness of the specimen increases by about 10–30% after 50 cycles. The initial stiffness K_a decreases linearly with the preloads, while the decrease is quadratic in relation to the cyclic load. The hardening coefficient C_a shows a positive correlation with the loading capacity of the WRI devices, while it shows a negative correlation with the preload and cyclic load amplitudes. It is recommended to consider the stiffness increase in the WRI devices during the evaluation of isolation effectiveness. Full article

Asphalt binder performance grades (PGs) are important metrics in designing pavements for effective transportation infrastructure. The PG system relies on the binder’s stiffness and is determined through energy- and time-intensive physical testing. Physical properties, like stiffness, can also be determined by spin–lattice NMR relaxometry, a non-destructive chemical method. NMR relaxometry can quantify the molecular mobility of materials by determining relaxation times from exponential decays of excited nuclear magnetization. While relaxation times have been used to determine physical properties of materials, a quantitative relation to the PG grades of asphalt binder is yet to be established. In this study, T₁ NMR relaxation analyses were used to differentiate between solid asphalt binders and determine the fastest yet still-reliable method of modeling exponential decay data. Algorithms that fit exponential decay relaxation data using one, two, or three independent relaxation times were compared with a 128-coefficient discrete inverse Laplace transformation to determine the best mathematical fit for a comparative analysis. The number of data points was then reduced from 256 to 64 to 16 and finally to 8 data points on a relaxation curve to reduce the testing time and determine the minimum number of data points needed for comparison. Two batches of PG 64-22 asphalt binder, along with samples of PG 76-22 and 94-10 binders, were investigated. The best compromise between measuring time and data reliability was found by acquiring 64 data points and then using a biexponential model to fit the experimental data. The PG 64-22 sources provided similar results, indicating similar physical properties. The PG 64-22 and PG 76-22 binders could also be compared via monoexponential data fits, but the PG 94-10 samples required an additional relaxation parameter for comparison. To differentiate all three binder grades, the primary relaxation times, along with their relative ratios, were utilized. Full article

To achieve higher thermal efficiency in a gas turbine, increasing the turbine inlet temperature is necessary. The rotor blade at the first stage tolerates the highest temperature, and the serpentine internal channel located in the middle chord of the rotor blade is vital in guaranteeing the blade’s service life. Therefore, it is essential to illustrate the evolution of the rotating internal channel in a gas turbine blade. In the paper, the influence of the Coriolis force, including its mechanisms, on the conventional rotating channel are reviewed and analyzed. A way to utilize the positive heat transfer effect of the Coriolis force is proposed. Recent investigations on corresponding novel rotating channels with a channel orientation angle of 90° (called bilaterally enhanced U-channels) are illustrated. Moreover, numerical investigations about the Re effects on bilaterally enhanced smooth U-channels were carried out in the study. The results indicated that bilaterally enhanced U-channels can utilize the Coriolis force positive heat transfer effect on the leading and the trailing walls at the same time. Re and Ro are vital non-dimensional numbers that influence the performance of bilaterally enhanced U-channels. Re and Ro have an independent influence on the heat transfer performance of the bilaterally enhanced U-channel. Ro is good for the heat transfer of the bilaterally enhanced U-channel on both the leading and the trailing walls. Therefore, the bilaterally enhanced U-channel is suitable for application in the middle chord region of a turbine blade, since it can utilize the rotation effect of the rotating blade to improve the heat transfer ability of the blade and thus reduced the blade temperature. At the same Ro, Re positively affects the Nu on the leading and the trailing walls of the Coriolis-utilization rotating smooth U-channel, but plays a negligible role on Nu/Nu₀. Full article

Currently, the tasks of intelligent data analysis in medicine are becoming increasingly common. Existing artificial intelligence tools provide high effectiveness in solving these tasks when analyzing sufficiently large datasets. However, when there is very little training data available, current machine learning methods do not ensure adequate classification accuracy or may even produce inadequate results. This paper presents an enhanced input-doubling method for classification tasks in the case of limited data analysis, achieved via expanding the number of independent attributes in the augmented dataset with probabilities of belonging to each class of the task. The authors have developed an algorithmic implementation of the improved method using two Naïve Bayes classifiers. The method was modeled on a small dataset for cardiovascular risk assessment. The authors explored two options for the combined use of Naïve Bayes classifiers at both stages of the method. It was found that using different methods at both stages potentially enhances the accuracy of the classification task. The results of the improved method were compared with a range of existing methods used for solving the task. It was demonstrated that the improved input-doubling method achieved the highest classification accuracy based on various performance indicators. Full article

Since the publication of the Adverse Childhood Experiences (ACEs) Study in 1998, there has been a dramatic increase in the number of studies exploring the immunoendocrinological sequelae of toxic stress. However, the literature exploring this in relation to paediatric atopy predominantly revolves around asthma. This review aims to (1) explore the association between ACEs and non-asthmatic, non-iatrogenic paediatric allergies (NANIPA) in the developed world and (2) further focus on the association between exposure to violence and NANIPA. Methods: PubMed and Scopus were searched for articles examining adversity and NANIPA before age 18. Non-English papers, publications before 1998, reviews, opinion pieces and case reports/series were excluded. Screening, data extraction, and risk-of-bias were independently reviewed by the first two authors. Results: Nine of the one thousand eighty-nine records identified were included. Four pertained to objective 1, four to objective 2, and one pertained to both. Regarding objective 1, all studies reported a positive dose-response relationship between ACEs and NANIPA, which was most significant among preschoolers and diminished with age. Studies relevant to objective 2 were too heterogenous to compare. However, two interesting associations emerged: (1) The types of violence significantly associated with NANIPA in adolescence differ in a sex-dependent manner, and (2) verbal abuse and bullying are the violence types most powerfully and significantly associated with NANIPA. Conclusion: Psychological stress is a probable IgE-independent driver of atopy in children exposed to adversity and/or violence. While the literature is too underdeveloped to allow for meaningful cross-comparison between studies, this review has identified many interesting areas for future research. Full article