METHODS: To overcome these limitations, our research introduces the ALLDet classifier, an innovative tool employing deep transfer learning for the automated analysis and categorization of ALL from White Blood Cell (WBC) nuclei images. Our investigation encompassed the evaluation of nine state-of-the-art pre-trained convolutional neural network (CNN) models, namely VGG16, VGG19, ResNet50, ResNet101, DenseNet121, DenseNet201, Xception, MobileNet, and EfficientNetB3. We augmented this approach by incorporating a sophisticated contour-based segmentation technique, derived from the Chan-Vese model, aimed at the meticulous segmentation of blast cell nuclei in blood smear images, thereby enhancing the accuracy of our analysis.
RESULTS: The empirical assessment of these methodologies underscored the superior performance of the EfficientNetB3 model, which demonstrated exceptional metrics: a recall specificity of 98.5%, precision of 95.86%, F1-score of 97.16%, and an overall accuracy rate of 97.13%. The Chan-Vese model's adaptability to the irregular shapes of blast cells and its noise-resistant segmentation capability were key to capturing the complex morphological changes essential for accurate segmentation.
CONCLUSION: The combined application of the ALLDet classifier, powered by EfficientNetB3, with our advanced segmentation approach, emerges as a formidable advancement in the early detection and accurate diagnosis of ALL. This breakthrough not only signifies a pivotal leap in leukemia diagnostic methodologies but also holds the promise of significantly elevating the standards of patient care through the provision of timely and precise diagnoses. The implications of this study extend beyond immediate clinical utility, paving the way for future research to further refine and enhance the capabilities of artificial intelligence in medical diagnostics.
OBJECTIVE: To evaluate the cost-effectiveness of HLA-B*15:02 genotyping in Asian Australian patients with epilepsy.
DESIGN, SETTING, AND PARTICIPANTS: A model with components of decision analysis and Markov simulation was developed to simulate clinical trajectories of adult Asian Australian patients with newly diagnosed epilepsy being considered for carbamazepine treatment. Cost-effectiveness and cost-utility analyses over a lifetime time horizon were conducted from the perspective of the Australian health care sector. The study was conducted in May 2023 and data analysis was performed from August 2023 to November 2023.
INTERVENTION: No HLA-B*15:02 genotyping and the empirical initiation of treatment with carbamazepine vs HLA-B*15:02 genotyping and the initiation of treatment with valproate in allele carriers.
MAIN OUTCOMES AND MEASURES: Life-years (LYs), quality-adjusted life-years (QALYs), and costs in 2023 Australian dollars (A$); incremental cost-effectiveness ratios.
RESULTS: HLA-B*15:02 screening was associated with an additional mean cost of A$114 (95% CI, -A$83 to A$374; US$76; 95% CI, -US$55 to US$248) and a reduction in 0.0152 LYs (95% CI, 0.0045 to 0.0287 LYs) but improvement by 0.00722 QALYs (95% CI, -0.0247 to -0.01210) compared with no screening, resulting in an incremental cost-effectiveness ratio of A$15 839 per QALY gained (US$10 523 per QALY). Therefore, universal genotyping for Asian Australian individuals was cost-effective compared with current standards of practice at the A$50 000 per QALY willingness-to-pay threshold. Sensitivity analyses demonstrated that the intervention remained cost-effective across a range of costs, utilities, transition probabilities, and willingness-to-pay thresholds. At the A$50 000 per QALY willingness-to-pay threshold, universal screening was the preferred strategy in 88.60% of simulations.
CONCLUSIONS AND RELEVANCE: The results of this economic evaluation suggest that HLA-B*15:02 screening represents a cost-effective choice for Asian Australian patients with epilepsy who are being considered for treatment with carbamazepine.
AIMS: This systematic review aims to determine the factors associated with mosquito control among construction workers.
METHODS: Primarily, articles related to factors associated with mosquito control among construction workers were collected from two different online databases (ScienceDirect and EBSCOhost). Two independent reviewers were assigned to screen the titles and abstracts of the collected data, stored in Microsoft Excel, against the inclusion and exclusion criteria. Afterwards, the quality of the included articles was critically assessed using the Mixed Method Appraisal Tool (MMAT). Of the 171 articles identified, 4 were included in the final review.
RESULTS: Based on the thorough evaluation, mosquito-related knowledge, practical mosquito prevention measures, and Larval Source Management (LSM) were identified as vital factors associated with mosquito control among construction workers. The significant association between mosquito-related knowledge and control practices indicates higher knowledge linked to effective practices, particularly among female workers and those who were recently infected with malaria. Concurrently, there were notable challenges regarding sustainable preventive measures and larval control methods in construction settings.
CONCLUSION: Implementing effective mosquito control, including knowledge and practice on mosquito control together with vector control, is highly required to suppress the expanding mosquito population. It is recommended that employers provide continuous mosquito control education and training to their employees and reward them with incentives, while employees should comply with the guidelines set by their employers to ensure successful mosquito control and reduce the spread of mosquito-borne diseases in the construction industry.
PURPOSE: To evaluate the anti-atherogenic mechanism of 80% ethanol extract of CV leaves on tumor necrosis factor-α (TNF-α)-activated human umbilical vein endothelial cells (HUVECs).
METHODS: Qualitative analysis of the CV extract was carried out by using liquid chromatography with tandem mass spectrometry (LC-MS/MS). The cell viability of HUVECs treated with CV extract was determined by MTT assay. The effect of CV extract on monocyte adhesion was determined by monocyte-endothelial adhesion assay. Protein expressions of ICAM-1, VCAM-1 and nuclear factor-kappa B (NF-κB) signaling pathway were determined by western blot while production of monocyte chemoattractant protein-1 (MCP-1) was determined by ELISA.
RESULTS: LC-MS/MS analysis showed that CV extract composed of five main compounds, including schaftoside, orientin, isovitexin, 6-caffeoyl-D-glucose, and 3,3'-di-O-methyl ellagic acid. Treatment of CV extract at a concentration range from 5 to 60 µg/mL for 24 h maintained HUVECs viability above 90 %, therefore concentrations of 20, 40 and 60 μg/mL were selected for the subsequent experiments. All concentrations of CV extract showed a significant inhibitory effect on monocyte adhesion to TNF-α-activated HUVECs (p
METHODS: Medical records of breast cancer women with T2DM who received NACT from January 2016 to January 2021 at the medical center in the Gujranwala Institute of Nuclear Medicine and Radiotherapy, Pakistan, were identified and retrieved retrospectively. Variables, including pathological responses, diabetes status, and other clinical data, were collected. Patients were grouped as diabetic and nondiabetic based on the doctor's diagnosis or the diabetic's medication history recorded upon the breast cancer diagnosis. Factors influencing the pathological complete response (pCR) were determined using multivariate logistic regression utilizing IBM SPSS Statistics (version 20).
RESULTS: A total of 1372 patient files who received NACT and breast cancer surgery from January 2016 to January 2021 were selected. Out of 1372 breast cancer women receiving NACT, 345 (25.1%) had pre-existing diabetes, while 1027 (74.85%) were without pre-existing diabetes. The most common molecular subtypes of breast cancer were luminal A and B. Two hundred fifty-eight patients (18.8%) had a pCR after receiving NACT. The pCR in diabetic patients was 3.9%, and in nondiabetes, 14.9%. Most women had a pathological partial response (pPR) after the NACT 672 (48.9%). The pPR in diabetic patients was 11.0%, and in nondiabetic patients, it was 38.0%. In nondiabetics, the odds of achieving pPR increase more than pathological no response after the NACT with odd ratio: 1.71 (95% confidence interval: 1.24-2.37). The probability of pCR in patients with luminal B was 1.67 times higher than that in patients with triple-negative breast cancer with odd ratio: 1.67, 95% confidence interval (1.00-2.79), P = 0.05.
CONCLUSIONS: The results of the study show that T2DM may have an adverse impact on pCR and pPR following NACT and surgery. Further investigation is needed to explore how changes in blood glucose levels over time impact pathological responses.
DESIGN: This systematic review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 flow checklist. A population-exposure-outcome framework was established. Population referred to the general global population of all ages, the exposure of interest was air pollution and its projection, and the outcome was the occurrence of NCDs attributable to air pollution and burden of disease (BoD) based on the health indices of mortality, morbidity, disability-adjusted life years, years of life lost and years lived with disability.
DATA SOURCES: The Web of Science, Ovid MEDLINE and EBSCOhost databases were searched for articles published from 2005 to 2023.
ELIGIBILITY CRITERIA FOR SELECTING STUDIES: The eligible articles were evaluated using the modified scale of a checklist for assessing the quality of ecological studies.
DATA EXTRACTION AND SYNTHESIS: Two reviewers searched, screened and selected the included studies independently using standardised methods. The risk of bias was assessed using the modified scale of a checklist for ecological studies. The results were summarised based on the projection of the BoD of NCDs attributable to air pollution.
RESULTS: This review included 11 studies from various countries. Most studies specifically investigated various air pollutants, specifically particulate matter <2.5 µm (PM2.5), nitrogen oxides and ozone. The studies used coupled-air quality and climate modelling approaches, and mainly projected health effects using the concentration-response function model. The NCDs attributable to air pollution included cardiovascular disease (CVD), respiratory disease, stroke, ischaemic heart disease, coronary heart disease and lower respiratory infections. Notably, the BoD of NCDs attributable to air pollution was projected to decrease in a scenario that promotes reduced air pollution, carbon emissions and land use and sustainable socioeconomics. Contrastingly, the BoD of NCDs was projected to increase in a scenario involving increasing population numbers, social deprivation and an ageing population.
CONCLUSION: The included studies widely reported increased premature mortality, CVD and respiratory disease attributable to PM2.5. Future NCD projection studies should consider emission and population changes in projecting the BoD of NCDs attributable to air pollution in the climate change era.
PROSPERO REGISTRATION NUMBER: CRD42023435288.
METHODS AND ANALYSIS: We are undertaking an international multicentre, double-blind, placebo-RCT to evaluate whether 12 months of erdosteine is beneficial for children and adults with bronchiectasis. We will recruit 194 children and adults with bronchiectasis to a parallel, superiority RCT at eight sites across Australia, Malaysia and Philippines. Our primary endpoint is the rate of exacerbations over 12 months. Our main secondary outcomes are QoL, exacerbation duration, time-to-next exacerbation, hospitalisations and lung function.
ETHICS AND DISSEMINATION: The Human Research Ethics Committees (HREC) of Children's Health Queensland (for all Australian sites), University of Malaya Medical Centre (Malaysia) and St. Luke's Medical Centre (Philippines) approved the study. We will publish the results and share the outcomes with the academic and medical community, funding and relevant patient organisations.
TRIAL REGISTRATION NUMBER: ACTRN12621000315819.
OBJECTIVES: To map self-management for pain in patients with cancer at all phases of the disease before examining the potential of pain self-care interventions for ill patients with cancer.
METHODS: A search was conducted on six electronic databases to locate studies published in English, from 2013 to 2023. We followed Arskey and O'Malley's Scoping Reviews guidelines.
RESULTS: This study thoroughly examined the provision of cancer pain self-management by healthcare professionals and identified four intervention types from 23 studies. Education emerged as the most prevalent form of self-management for cancer pain.
CONCLUSION: Guiding patients in managing their pain effectively, starting from their hospitalisation and extending to their discharge.