Brit J Hosp Med
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Review
Prediction of Cervical Cancer Lymph Node Metastasis via a Multimodal Transfer Learning Approach.
Aims/Background In the treatment of patients with cervical cancer, lymph node metastasis (LNM) is an important indicator for stratified treatment and prognosis of cervical cancer. This study aimed to develop and validate a multimodal model based on contrast-enhanced multiphase computed tomography (CT) images and clinical variables to accurately predict LNM in patients with cervical cancer. Methods This study included 233 multiphase contrast-enhanced CT images of patients with pathologically confirmed cervical malignancies treated at the Affiliated Dongyang Hospital of Wenzhou Medical University. ⋯ The area under the curve (AUC) was used to assess the predictive efficacy of the model. Results The results indicate that the deep transfer learning model exhibited high diagnostic performance within the internal validation set, with an AUC of 0.82, accuracy of 0.88, sensitivity of 0.83, and specificity of 0.89. Conclusion We constructed a comprehensive, multiparameter model based on the concept of deep transfer learning, by pre-training the model with contrast-enhanced multiphase CT images and an array of clinical variables, for predicting LNM in patients with cervical cancer, which could aid the clinical stratification of these patients via a noninvasive manner.
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Aims/Background Both membranous nephropathy (MN) and immunoglobulin A nephropathy (IgAN) are immune complex-mediated glomerular diseases, but the concurrent occurrence of these two conditions in the same patient is not common, a phenomenon that is currently not supported by clinical data in terms of treatment and prognosis. This study explores the clinical and pathological characteristics, as well as the treatment outcomes, of patients affected by MN and IgAN simultaneously. Methods The clinical data, pathological features, and diagnostic and therapeutic information of seven cases of MN complicated by IgAN, treated between December 2015 and December 2022, were retrospectively analyzed. ⋯ Conclusion MN accompanied by IgAN tends to occur more frequently in middle-aged and elderly individuals, with a relatively low incidence. The latent feature of the comorbidities manifests as a form of IgAN superimposed on the background of MN. Utilizing ACEI or ARB in combination with steroids or various immunosuppressive therapies represents a potentially effective treatment strategy.
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Polypharmacy is common among older people and is associated with multiple adverse outcomes. Assessing whether it is appropriate or inappropriate for an individual is more informative than relying on a simple pill count. Modern medicine is based on single disease guidelines that promote prescribing but tend not to have deprescribing criteria. ⋯ Prescribing can be inappropriate if it is not evidence-based, harm is likely to exceed the benefit, includes hazardous medications or combinations of medicines, the patient experiences therapeutic burden, there is reduced adherence or prescribing cascades. Medicines optimisation aims to improve prescribing quality for an individual patient and may include deprescribing. It is a complex process that includes shared decision-making, careful follow-up, and communication of any resulting prescription changes.
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Identifying Prostatic Utricle Translucent Membrane in Hematospermia Patients Using a Novel Nomogram.
Aims/Background Hematospermia, characterized by blood in the ejaculate, is a common and distressing condition in urology. Identifying the underlying causes, including translucent membranes in the prostatic utricle, is crucial for effective management. Despite advancements in diagnostic techniques, reliable predictive tools are needed to enhance preoperative planning and patient outcomes. ⋯ The nomogram demonstrated strong predictive capability, as evidenced by its performance in ROC and calibration curve analyses. Furthermore, the DCA indicated that the nomogram offered significant clinical net benefits in predicting the presence of a translucent membrane. Conclusion Clinical use of the developed nomogram can assist clinicians in identifying patients with hematospermia who have translucent membrane in the prostatic utricle and in developing individualized treatment.
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Aims/Background The clinical presentation of non-lactational mastitis (NLM) shares similarities with some symptoms and examination results of breast cancer (BC), which can lead to misdiagnosis or delayed treatment. Current studies on breast lesions mostly focus on the diagnostic performance of a single imaging technique. This study aims to construct a discrimination diagnostic model for NLM and BC based on such imaging features as ultrasound and magnetic resonance imaging (MRI) and to validate the application value of the model, assisting clinicians in improving disease diagnosis and refining medical decisions. ⋯ The DCA results showed that the model had high net benefits for discriminating NLM and BC. The calibration curve analysis showed that the model had good consistency with the actual diagnosis of NLM and BC, with a chi-square value of 4.545 and a p-value of 0.155 according to the Hosmer-Lemeshow test. Conclusion Age, internal blood flow, calcification, edge, enhancement characteristics, ADC, and TIC curve types are important factors in distinguishing NLM and BC, and the model based on the above characteristics to distinguish NLM and BC has a high net benefit in distinguishing the two.