Diagnostics

Open AccessArticle

Helicobacter pylori Infection in Children: A Possible Reason for Headache?

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Andrei Tudor Cernomaz

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Iuliana Magdalena Starcea

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Diagnostics 2023, 13(7), 1293; https://doi.org/10.3390/diagnostics13071293 (registering DOI) - 29 Mar 2023

Abstract

(1) Background: The correlation between infection with Helicobacter pylori (H. pylori) and headache has been argued and explored for a long time, but a clear association between the simultaneous presence of the two in children has not been established yet. In [...] Read more.

(1) Background: The correlation between infection with Helicobacter pylori (H. pylori) and headache has been argued and explored for a long time, but a clear association between the simultaneous presence of the two in children has not been established yet. In this study, we aimed to explore this relationship in children from the Northeast region of Romania. (2) Methods: A retrospective study exploring the correlation between children having H. pylori infection and headache or migraine was conducted on a batch of 1757 children, hospitalized over 3 years in a pediatric gastroenterology department in Northeast Romania. (3) Results: A total of 130 children of both sexes had headache. From 130 children, 54 children (41.5%) also presented H. pylori infection. A significant association between headache and H. pylori infection (χ2; p < 0.01) was noticed. (4) Conclusions: More studies are needed on this relationship, and we emphasize the importance of further analyses, as they present great clinical importance for both prompt diagnosis and treatment. Full article

(This article belongs to the Special Issue Pediatric Gastrointestinal Diseases: Diagnosis and Management)

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Open AccessArticle

Altered Functional Brain Network Structure between Patients with High and Low Generalized Anxiety Disorder

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Diagnostics 2023, 13(7), 1292; https://doi.org/10.3390/diagnostics13071292 (registering DOI) - 29 Mar 2023

Abstract

To investigate the differences in functional brain network structures between patients with a high level of generalized anxiety disorder (HGAD) and those with a low level of generalized anxiety disorder (LGAD), a resting-state electroencephalogram (EEG) was recorded in 30 LGAD patients and 21 [...] Read more.

To investigate the differences in functional brain network structures between patients with a high level of generalized anxiety disorder (HGAD) and those with a low level of generalized anxiety disorder (LGAD), a resting-state electroencephalogram (EEG) was recorded in 30 LGAD patients and 21 HGAD patients. Functional connectivity between all pairs of brain regions was determined by the Phase Lag Index (PLI) to construct a functional brain network. Then, the characteristic path length, clustering coefficient, and small world were calculated to estimate functional brain network structures. The results showed that the PLI values of HGAD were significantly increased in alpha2, and significantly decreased in the theta and alpha1 rhythms, and the small-world attributes for both HGAD patients and LGAD patients were less than one for all the rhythms. Moreover, the small-world values of HGAD were significantly lower than those of LGAD in the theta and alpha2 rhythms, which indicated that the brain functional network structure would deteriorate with the increase in generalized anxiety disorder (GAD) severity. Our findings may play a role in the development and understanding of LGAD and HGAD to determine whether interventions that target these brain changes may be effective in treating GAD. Full article

(This article belongs to the Special Issue Biomedical Signal Processing and Analysis)

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Open AccessArticle

Implementation of an Attention Mechanism Model for Facial Beauty Assessment Using Transfer Learning

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Diagnostics 2023, 13(7), 1291; https://doi.org/10.3390/diagnostics13071291 (registering DOI) - 29 Mar 2023

Abstract

An important consideration in medical plastic surgery is the evaluation of the patient’s facial symmetry. However, because facial attractiveness is a slightly individualized cognitive experience, it is difficult to determine face attractiveness manually. This study aimed to train a model for assessing facial [...] Read more.

An important consideration in medical plastic surgery is the evaluation of the patient’s facial symmetry. However, because facial attractiveness is a slightly individualized cognitive experience, it is difficult to determine face attractiveness manually. This study aimed to train a model for assessing facial attractiveness using transfer learning while also using the fine-grained image model to separate similar images by first learning features. In this case, the system can make assessments based on the input of facial photos. Thus, doctors can quickly and objectively treat patients’ scoring and save time for scoring. The transfer learning was combined with CNN, Xception, and attention mechanism models for training, using the SCUT-FBP5500 dataset for pre-training and freezing the weights as the transfer learning model. Then, we trained the Chang Gung Memorial Hospital Taiwan dataset to train the model based on transfer learning. The evaluation uses the mean absolute error percentage (MAPE) value. The root mean square error (RMSE) value is used as the basis for experimental adjustment and the quantitative standard for the model’s predictive. The best model can obtain 0.50 in RMSE and 18.5% average error in MAPE. A web page was developed to infer the deep learning model to visualize the predictive model. Full article

(This article belongs to the Section Machine Learning and Artificial Intelligence in Diagnostics)

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Open AccessReview

An Overview of Clinical Manifestations of Dermatological Disorders in Intensive Care Units: What Should Intensivists Be Aware of?

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Ali Al Bshabshe

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Wesam F. Mousa

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Nashwa Nor El-Dein

Diagnostics 2023, 13(7), 1290; https://doi.org/10.3390/diagnostics13071290 (registering DOI) - 29 Mar 2023

Abstract

Acute skin failure is rarely the primary diagnosis that necessitates admission to an intensive care unit. Dermatological manifestations in critically ill patients, on the other hand, are relatively common and can be used to make a key diagnosis of an adverse drug reaction [...] Read more.

Acute skin failure is rarely the primary diagnosis that necessitates admission to an intensive care unit. Dermatological manifestations in critically ill patients, on the other hand, are relatively common and can be used to make a key diagnosis of an adverse drug reaction or an underlying systemic illness, or they may be caused by factors related to a prolonged stay or invasive procedures. In intensive care units, their classification is based on the aetiopathogenesis of the cutaneous lesion and, in the meantime, distinguishes critical patients. When evaluating dermatological manifestations, several factors must be considered: onset, morphology, distribution, and associated symptoms and signs. This review depicts dermatological signs in critical patients in order to lay out better recognition. Full article

(This article belongs to the Special Issue Pathology and Diagnosis of Skin Disease)

Open AccessArticle

Deep-Learning-Enabled Computer-Aided Diagnosis in the Classification of Pancreatic Cystic Lesions on Confocal Laser Endomicroscopy

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Tsung-Chun Lee

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Clara Lavita Angelina

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Diagnostics 2023, 13(7), 1289; https://doi.org/10.3390/diagnostics13071289 (registering DOI) - 29 Mar 2023

Abstract

Accurate classification of pancreatic cystic lesions (PCLs) is important to facilitate proper treatment and to improve patient outcomes. We utilized the convolutional neural network (CNN) of VGG19 to develop a computer-aided diagnosis (CAD) system in the classification of subtypes of PCLs in endoscopic [...] Read more.

Accurate classification of pancreatic cystic lesions (PCLs) is important to facilitate proper treatment and to improve patient outcomes. We utilized the convolutional neural network (CNN) of VGG19 to develop a computer-aided diagnosis (CAD) system in the classification of subtypes of PCLs in endoscopic ultrasound-guided needle-based confocal laser endomicroscopy (nCLE). From a retrospectively collected 22,424 nCLE video frames (50 videos) as the training/validation set and 11,047 nCLE video frames (18 videos) as the test set, we developed and compared the diagnostic performance of three CNNs with distinct methods of designating the region of interest. The diagnostic accuracy for subtypes of PCLs by CNNs with manual, maximal rectangular, and U-Net algorithm-designated ROIs was 100%, 38.9%, and 66.7% on a per-video basis and 88.99%, 73.94%, and 76.12% on a per-frame basis, respectively. Our per-frame analysis suggested differential levels of diagnostic accuracy among the five subtypes of PCLs, where non-mucinous PCLs (serous cystic neoplasm: 93.11%, cystic neuroendocrine tumor: 84.31%, and pseudocyst: 98%) had higher diagnostic accuracy than mucinous PCLs (intraductal papillary mucinous neoplasm: 84.43% and mucinous cystic neoplasm: 86.1%). Our CNN demonstrated superior specificity compared to the state-of-the-art for the classification of mucinous PCLs (IPMN and MCN), with high specificity (94.3% and 92.8%, respectively) but low sensitivity (46% and 45.2%, respectively). This suggests the complimentary role of CNN-enabled CAD systems, especially for clinically suspected mucinous PCLs. Full article

(This article belongs to the Section Machine Learning and Artificial Intelligence in Diagnostics)

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Open AccessArticle

Pre-Analytical Evaluation of Streck Cell-Free DNA Blood Collection Tubes for Liquid Profiling in Oncology

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Diagnostics 2023, 13(7), 1288; https://doi.org/10.3390/diagnostics13071288 (registering DOI) - 29 Mar 2023

Abstract

Excellent pre-analytical stability is an essential precondition for reliable molecular profiling of circulating tumor DNA (ctDNA) in oncological diagnostics. Therefore, in vitro degradation of ctDNA and the additional release of contaminating genomic DNA from lysed blood cells must be prevented. Streck Cell-Free DNA [...] Read more.

Excellent pre-analytical stability is an essential precondition for reliable molecular profiling of circulating tumor DNA (ctDNA) in oncological diagnostics. Therefore, in vitro degradation of ctDNA and the additional release of contaminating genomic DNA from lysed blood cells must be prevented. Streck Cell-Free DNA blood collection tubes (cfDNA BCTs) have proposed advantages over standard K₂EDTA tubes, but mainly have been tested in healthy individuals. Blood was collected from cancer patients (n = 53) suffering from colorectal (n = 21), pancreatic (n = 11), and non-small-cell lung cancer (n = 21) using cfDNA BCT tubes and K₂EDTA tubes that were processed immediately or after 3 days (BCTs) or 6 hours (K₂EDTA) at room temperature. The cfDNA isolated from these samples was characterized in terms of yield using LINE-1 qPCR; the level of gDNA contamination; and the mutation status of KRAS, NRAS, and EGFR genes using BEAMing ddPCR. CfDNA yield and gDNA levels were comparable in both tube types and were not affected by prolonged storage of blood samples for at least 3 days in cfDNA BCTs or 6 hours in K₂EDTA tubes. In addition, biospecimens collected in K₂EDTA tubes and cfDNA BCTs stored for up to 3 days demonstrated highly comparable levels of mutational load across all respective cancer patient cohorts and a wide range of concentrations. Our data support the applicability of clinical oncology specimens collected and stored in cfDNA BCTs for up to 3 days for reliable cfDNA and mutation analyses. Full article

(This article belongs to the Special Issue Cell-Free Nucleic Acids—New Insights into Physico-Chemical Properties, Analytical Considerations, and Clinical Applications)

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Open AccessReview

Wilson’s Disease—Genetic Puzzles with Diagnostic Implications

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Grażyna Gromadzka

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Maria Bendykowska

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Adam Przybyłkowski

Diagnostics 2023, 13(7), 1287; https://doi.org/10.3390/diagnostics13071287 - 29 Mar 2023

Abstract

(1) Introduction: Wilson’s disease (WND) is an autosomal recessive disorder of copper metabolism. The WND gene is ATP7B, located on chromosome 13. WND is characterized by high clinical variability, which causes diagnostic difficulties. (2) Methods: The PubMed, Science Direct, and Wiley Online [...] Read more.

(1) Introduction: Wilson’s disease (WND) is an autosomal recessive disorder of copper metabolism. The WND gene is ATP7B, located on chromosome 13. WND is characterized by high clinical variability, which causes diagnostic difficulties. (2) Methods: The PubMed, Science Direct, and Wiley Online Library medical databases were reviewed using the following phrases: “Wilson’s disease”, “ATP7B genotype”, “genotype-phenotype”, “epigenetics”, “genetic modifiers”, and their combinations. Publications presenting the results of experimental and clinical studies, as well as review papers, were selected, which concerned: (i) the diversity of genetic strategies and tests used in WND diagnosis; (ii) the difficulties of genetic diagnosis, including uncertainty as to the pathogenicity of variants; (iii) genetic counseling; (iv) phenotypic effects of ATP7B variants in patients with WND and in heterozygous carriers (HzcWND); (v) genetic and epigenetics factors modifying the clinical picture of the disease. (3) Results and conclusions: The genetic diagnosis of WND is carried out using a variety of strategies and tests. Due to the large number of known variants in the ATP7B gene (>900), the usefulness of genetic tests in routine diagnostics is still relatively small and even analyses performed using the most advanced technologies, including next-generation sequencing, require additional tests, including biochemical evidence of abnormal copper metabolism, to confirm the diagnosis of WND. Pseudodominant inheritance, the presence of three various pathogenic variants in the same patient, genotypes indicating the possibility of segmental uniparental disomy, have been reported. Genotype–phenotype relationships in WND are complex. The ATP7B genotype, to some extent, determines the clinical picture of the disease, but other genetic and epigenetic modifiers are also relevant. Full article

(This article belongs to the Special Issue Advances in Wilson's Disease and Other Neurodegenerations with Brain Metal Accumulations)

Open AccessInteresting Images

Cutaneous Sarcoidosis-like Eruption Following Second Dose of Moderna mRNA-1273 Vaccine: Case or Relationship?

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Gerardo Cazzato

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Francesca Ambrogio

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Caterina Foti

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Marialessandra Capuzzolo

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Diagnostics 2023, 13(7), 1286; https://doi.org/10.3390/diagnostics13071286 - 29 Mar 2023

Abstract

Various adverse reactions to SARS-CoV-2 vaccines have been described since the first months of the vaccination campaign. In addition to more frequent reactions, rare reactions, such as sarcoidosis-like, rashes have been reported. We present a case of a 23-year-old woman with a rash [...] Read more.

Various adverse reactions to SARS-CoV-2 vaccines have been described since the first months of the vaccination campaign. In addition to more frequent reactions, rare reactions, such as sarcoidosis-like, rashes have been reported. We present a case of a 23-year-old woman with a rash on the chin and peribuccal region, which developed approximately 3 weeks after the administration of the second dose of the Moderna mRNA-1273 vaccine. We briefly discuss other reports in the literature. Full article

(This article belongs to the Special Issue Current Issue and Perspectives in Dermatopathology)

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Open AccessArticle

An Improved Skin Lesion Boundary Estimation for Enhanced-Intensity Images Using Hybrid Metaheuristics

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Shairyar Malik

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Tallha Akram

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Muhammad Awais

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Muhammad Attique Khan

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Diagnostics 2023, 13(7), 1285; https://doi.org/10.3390/diagnostics13071285 - 28 Mar 2023

Abstract

The demand for the accurate and timely identification of melanoma as a major skin cancer type is increasing daily. Due to the advent of modern tools and computer vision techniques, it has become easier to perform analysis. Skin cancer classification and segmentation techniques [...] Read more.

The demand for the accurate and timely identification of melanoma as a major skin cancer type is increasing daily. Due to the advent of modern tools and computer vision techniques, it has become easier to perform analysis. Skin cancer classification and segmentation techniques require clear lesions segregated from the background for efficient results. Many studies resolve the matter partly. However, there exists plenty of room for new research in this field. Recently, many algorithms have been presented to preprocess skin lesions, aiding the segmentation algorithms to generate efficient outcomes. Nature-inspired algorithms and metaheuristics help to estimate the optimal parameter set in the search space. This research article proposes a hybrid metaheuristic preprocessor, BA-ABC, to improve the quality of images by enhancing their contrast and preserving the brightness. The statistical transformation function, which helps to improve the contrast, is based on a parameter set estimated through the proposed hybrid metaheuristic model for every image in the dataset. For experimentation purposes, we have utilised three publicly available datasets, ISIC-2016, 2017 and 2018. The efficacy of the presented model is validated through some state-of-the-art segmentation algorithms. The visual outcomes of the boundary estimation algorithms and performance matrix validate that the proposed model performs well. The proposed model improves the dice coefficient to 94.6% in the results. Full article

(This article belongs to the Special Issue Medical Image Processing and Analysis)

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Open AccessArticle

Performing the ABC Method Twice for Gastric Cancer Risk Stratification: A Retrospective Study Based on Data from a Large-Scale Screening Facility

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Diagnostics 2023, 13(7), 1284; https://doi.org/10.3390/diagnostics13071284 - 28 Mar 2023

Abstract

The ABC method is a classification method used for stratifying the risk of gastric cancer. However, whether the ABC method should be performed only once or multiple times throughout an individual’s lifetime remains unclear. Therefore, this study aimed to analyze whether performing ABC [...] Read more.

The ABC method is a classification method used for stratifying the risk of gastric cancer. However, whether the ABC method should be performed only once or multiple times throughout an individual’s lifetime remains unclear. Therefore, this study aimed to analyze whether performing ABC screening twice in a lifetime is useful. We retrospectively analyzed the data of individuals who participated in health checkups in 2010 and 2015. We collected data on patient characteristics, pepsinogen levels, anti-Helicobacter pylori antibody titers, and the presence of gastric cancer. Overall, 7129 participants without a history of H. pylori eradication were included in this study. The participants’ average age in 2010 was 48.4 ± 8.3 years, and 58.1% were male. In addition, 11 and 20 cases of new H. pylori infection (0.15%) and spontaneous eradication (0.28%), respectively, were recorded. No significant difference was found in the incidence of gastric cancer between participants who underwent the ABC method once and those who underwent it twice (Group A: 0.16% vs. 0.16%; Group B: 0.47% vs. 0.39%; and Group C + D: 1.97% vs. 1.82%). Therefore, performing the ABC method twice, 5 years apart, does not significantly improve gastric cancer risk stratification. Full article

(This article belongs to the Special Issue Advances in the Detection and Screening of Gastric Cancer)

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Open AccessArticle

Analysis of Optical Coherence Tomography (OCT) and Optical Coherence Tomography Angiography (OCTA) Parameters in Young Adults after SARS-CoV-2 Infection (COVID-19) Compared with Healthy Young Controls

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Anahita Bajka

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Daniel Rudolf Muth

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Maximilian Robert Justus Wiest

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Patricia Schlagenhauf

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Sandrine Anne Zweifel

Diagnostics 2023, 13(7), 1283; https://doi.org/10.3390/diagnostics13071283 - 28 Mar 2023

Abstract

Purpose: To compare retinal changes in young adults with previous SARS-CoV-2 infection with healthy young controls using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Methods: This prospective single-center study was conducted at the University Hospital of Zurich, Zurich, Switzerland. Participants [...] Read more.

Purpose: To compare retinal changes in young adults with previous SARS-CoV-2 infection with healthy young controls using optical coherence tomography (OCT) and optical coherence tomography angiography (OCTA). Methods: This prospective single-center study was conducted at the University Hospital of Zurich, Zurich, Switzerland. Participants were imaged from May to November 2021 using the SOLIX device (Visionix International SAS, Pont-de-l’Arche, France). We performed 12 mm × 12 mm, 6.4 mm × 6.4 mm, 6 mm × 6 mm and 3 mm × 3 mm OCT and OCTA scans, as well as fundus photography of each participant’s eyes. Results: In total, 466 participants were imaged. Of these, 233 were healthy controls with negative RT-PCR tests for SARS-CoV-2, 168 were young adults who had a SARS-CoV-2 infection at least 180 days previously, 19 were participants who had a SARS-CoV-2 infection < 180 days previously, and 46 were participants with asymptomatic SARS-CoV-2 infection (i.e., serologically positive but with no symptoms). Compared with healthy controls, statistically significant differences were found for OCTA recordings of the optic disc for the whole image (WI) and WI capillary vessel density, with both being higher in the SARS-CoV-2 group. Conclusion: Statistically significant results were only observed for selected variables, and in parts, only unilaterally, with relatively large p values (p = 0.02–0.03). Thus, we did not interpret these as clinically significant, leading to the conclusion that young and otherwise healthy individuals (mainly men) seem to recover from mild COVID-19 infections with no ophthalmological residues. Full article

(This article belongs to the Special Issue Optical Coherence Tomography Angiography (OCTA) as a New Diagnostic Tool in Ocular and Systemic Diseases - Volume 2)

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Open AccessArticle

A Foreground Prototype-Based One-Shot Segmentation of Brain Tumors

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Ananthakrishnan Balasundaram

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Muthu Subash Kavitha

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Yogarajah Pratheepan

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Dhamale Akshat

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Maddirala Venkata Kaushik

Diagnostics 2023, 13(7), 1282; https://doi.org/10.3390/diagnostics13071282 - 28 Mar 2023

Abstract

The potential for enhancing brain tumor segmentation with few-shot learning is enormous. While several deep learning networks (DNNs) show promising segmentation results, they all take a substantial amount of training data in order to yield appropriate results. Moreover, a prominent problem for most [...] Read more.

The potential for enhancing brain tumor segmentation with few-shot learning is enormous. While several deep learning networks (DNNs) show promising segmentation results, they all take a substantial amount of training data in order to yield appropriate results. Moreover, a prominent problem for most of these models is to perform well in unseen classes. To overcome these challenges, we propose a one-shot learning model to segment brain tumors on brain magnetic resonance images (MRI) based on a single prototype similarity score. With the use of recently developed few-shot learning techniques, where training and testing are carried out utilizing support and query sets of images, we attempt to acquire a definitive tumor region by focusing on slices containing foreground classes. It is unlike other recent DNNs that employed the entire set of images. The training of this model is carried out in an iterative manner where in each iteration, random slices containing foreground classes of randomly sampled data are selected as the query set, along with a different random slice from the same sample as the support set. In order to differentiate query images from class prototypes, we used a metric learning-based approach based on non-parametric thresholds. We employed the multimodal Brain Tumor Image Segmentation (BraTS) 2021 dataset with 60 training images and 350 testing images. The effectiveness of the model is evaluated using the mean dice score and mean IoU score. The experimental results provided a dice score of 83.42 which was greater than other works in the literature. Additionally, the proposed one-shot segmentation model outperforms the conventional methods in terms of computational time, memory usage, and the number of data. Full article

(This article belongs to the Section Machine Learning and Artificial Intelligence in Diagnostics)

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Open AccessArticle

Clinical Impact of Preoperative Biliary Drainage in Patients with Ductal Adenocarcinoma of the Pancreatic Head

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José Guilherme Tralhão

Diagnostics 2023, 13(7), 1281; https://doi.org/10.3390/diagnostics13071281 - 28 Mar 2023

Abstract

Our aim was to study the association between preoperative biliary drainage (PBD) and morbidity following cephalic pancreaticoduodenectomy (CPD) for pancreatic ductal adenocarcinoma (PDAC) and its prognostic impact, which is still controversial in the literature. A retrospective study was conducted, which included 128 patients [...] Read more.

Our aim was to study the association between preoperative biliary drainage (PBD) and morbidity following cephalic pancreaticoduodenectomy (CPD) for pancreatic ductal adenocarcinoma (PDAC) and its prognostic impact, which is still controversial in the literature. A retrospective study was conducted, which included 128 patients who underwent CPD for PDAC, divided into two groups: those who underwent PBD (group 1) and those who did not undergo this procedure (group 2). Group 1 was subdivided according to the drainage route: endoscopic retrograde cholangiopancreatography (ERCP), group 1.1, and percutaneous transhepatic cholangiography (PTC), group 1.2. 34.4% of patients underwent PBD, and 47.7% developed PBD-related complications, with 37% in group 1.1 and 64.7% in group 1.2 (p = 0.074). There was a significant difference between group 1 and 2 regarding bacterial colonization of the bile (45.5% vs. 3.6%, p < 0.001), but no difference was found in the colonization by multidrug-resistant bacteria, the development of Clavien–Dindo ≥ III complications, clinically relevant pancreatic fistula and delayed gastric emptying (DGE), intra-abdominal abscess, hemorrhage, superficial surgical site infection (SSI), and readmission. Between groups 1.1 and 1.2, there was a significant difference in clinically relevant DGE (44.4% vs. 5.9%, p = 0.014) and Clavien–Dindo ≥ III complications (59.3% vs. 88.2%, p = 0.040). There were no significant differences in median overall survival and disease-free survival (DFS) between groups 1 and 2. Groups 1.1 and 1.2 had a significant difference in DFS (10 vs. 5 months, p = 0.017). In this group of patients, PBD was associated with increased bacterial colonization of the bile, without a significant increase in postoperative complications or influence in survival. ERCP seems to contribute to the development of clinically significant DGE. Patients undergoing PTC appear to have an early recurrence. Full article

(This article belongs to the Special Issue Diagnosis and Management of Hepatobiliary Pancreatic Disease)

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Open AccessFeature PaperArticle

Virus-Specific Stem Cell Memory CD8+ T Cells May Indicate a Long-Term Protection against Evolving SARS-CoV-2

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Diagnostics 2023, 13(7), 1280; https://doi.org/10.3390/diagnostics13071280 - 28 Mar 2023

Abstract

Immune memory to SARS-CoV-2 is key for establishing herd immunity and limiting the spread of the virus. The duration and qualities of T-cell-mediated protection in the settings of constantly evolving pathogens remain an open question. We conducted a cross-sectional study of SARS-CoV-2-specific CD4+ [...] Read more.

Immune memory to SARS-CoV-2 is key for establishing herd immunity and limiting the spread of the virus. The duration and qualities of T-cell-mediated protection in the settings of constantly evolving pathogens remain an open question. We conducted a cross-sectional study of SARS-CoV-2-specific CD4+ and CD8+ T-cell responses at several time points over 18 months (30–750 days) post mild/moderate infection with the aim to identify suitable methods and biomarkers for evaluation of long-term T-cell memory in peripheral blood. Included were 107 samples from 95 donors infected during the periods 03/2020–07/2021 and 09/2021–03/2022, coinciding with the prevalence of B.1.1.7 (alpha) and B.1.617.2 (delta) variants in Bulgaria. SARS-CoV-2-specific IFNγ+ T cells were measured in ELISpot in parallel with flow cytometry detection of AIM+ total and stem cell-like memory (T_SCM) CD4+ and CD8+ T cells after in vitro stimulation with peptide pools corresponding to the original and delta variants. We show that, unlike IFNγ+ T cells, AIM+ virus-specific CD4+ and CD8+ T_SCM are more adequate markers of T cell memory, even beyond 18 months post-infection. In the settings of circulating and evolving viruses, CD8+ T_SCM is remarkably stable, back-differentiated into effectors, and delivers immediate protection, regardless of the initial priming strain. Full article

(This article belongs to the Special Issue Detection and Assessment of SARS-CoV-2 Variants)

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Open AccessCase Report

The Diagnostic Challenge of Osteoid Osteoma in the Bones of the Hand—A Case Series

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Sinef Yarar-Schlickewei

Diagnostics 2023, 13(7), 1279; https://doi.org/10.3390/diagnostics13071279 - 28 Mar 2023

Abstract

Osteoid osteoma (OO) is a benign bone tumor that rarely occurs in the bones of the hand. Due to the comparatively non-specific symptoms when occurring in the hand, OO is often misdiagnosed at first presentation, posing a diagnostic challenge. In the present case [...] Read more.

Osteoid osteoma (OO) is a benign bone tumor that rarely occurs in the bones of the hand. Due to the comparatively non-specific symptoms when occurring in the hand, OO is often misdiagnosed at first presentation, posing a diagnostic challenge. In the present case study, six cases of phalangeal and carpal OO, treated surgically at our department between 2006 and 2020, were retrospectively reviewed. We compared all cases regarding demographic data, clinical presentation, imaging findings, time to diagnosis, surgical treatment, and clinical outcome in follow-up examinations. When OO occurs in the bones of the hand, it can lead to swelling and deformities, such as enlargement of the affected bone and nail hypertrophy. Initial misdiagnoses such as primary bone tumors other than OO, tendinitis, osteomyelitis, or arthritis are common. Most of the presented cases showed a prolonged time until diagnosis, whereby the primarily performed imaging modality was often not sensitive. CT proved to be the most sensitive sectional imaging modality for diagnosing OO. With adequate surgical treatment, complications and recurrence are rare. Full article

(This article belongs to the Special Issue Advances in Orthopedic Imaging)

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Open AccessArticle

A Novel Cuffless Blood Pressure Prediction: Uncovering New Features and New Hybrid ML Models

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Diagnostics 2023, 13(7), 1278; https://doi.org/10.3390/diagnostics13071278 - 28 Mar 2023

Abstract

This paper investigates new feature extraction and regression methods for predicting cuffless blood pressure from PPG signals. Cuffless blood pressure is a technology that measures blood pressure without needing a cuff. This technology can be used in various medical applications, including home health [...] Read more.

This paper investigates new feature extraction and regression methods for predicting cuffless blood pressure from PPG signals. Cuffless blood pressure is a technology that measures blood pressure without needing a cuff. This technology can be used in various medical applications, including home health monitoring, clinical uses, and portable devices. The new feature extraction method involves extracting meaningful features (time and chaotic features) from the PPG signals in the prediction of systolic blood pressure (SBP) and diastolic blood pressure (DBP) values. These extracted features are then used as inputs to regression models, which are used to predict cuffless blood pressure. The regression model performances were evaluated using root mean squared error (RMSE), R², mean square error (MSE), and the mean absolute error (MAE). The obtained RMSE was 4.277 for systolic blood pressure (SBP) values using the Matérn 5/2 Gaussian process regression model. The obtained RMSE was 2.303 for diastolic blood pressure (DBP) values using the rational quadratic Gaussian process regression model. The results of this study have shown that the proposed feature extraction and regression models can predict cuffless blood pressure with reasonable accuracy. This study provides a novel approach for predicting cuffless blood pressure and can be used to develop more accurate models in the future. Full article

(This article belongs to the Special Issue Biomedical Signal Processing and Analysis)

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Open AccessArticle

Automatic Classification of Histopathology Images across Multiple Cancers Based on Heterogeneous Transfer Learning

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Diagnostics 2023, 13(7), 1277; https://doi.org/10.3390/diagnostics13071277 - 28 Mar 2023

Abstract

Background: Current artificial intelligence (AI) in histopathology typically specializes on a single task, resulting in a heavy workload of collecting and labeling a sufficient number of images for each type of cancer. Heterogeneous transfer learning (HTL) is expected to alleviate the data bottlenecks [...] Read more.

Background: Current artificial intelligence (AI) in histopathology typically specializes on a single task, resulting in a heavy workload of collecting and labeling a sufficient number of images for each type of cancer. Heterogeneous transfer learning (HTL) is expected to alleviate the data bottlenecks and establish models with performance comparable to supervised learning (SL). Methods: An accurate source domain model was trained using 28,634 colorectal patches. Additionally, 1000 sentinel lymph node patches and 1008 breast patches were used to train two target domain models. The feature distribution difference between sentinel lymph node metastasis or breast cancer and CRC was reduced by heterogeneous domain adaptation, and the maximum mean difference between subdomains was used for knowledge transfer to achieve accurate classification across multiple cancers. Result: HTL on 1000 sentinel lymph node patches (L-HTL-1000) outperforms SL on 1000 sentinel lymph node patches (L-SL-1-1000) (average area under the curve (AUC) and standard deviation of L-HTL-1000 vs. L-SL-1-1000: 0.949 ± 0.004 vs. 0.931 ± 0.008, p value = 0.008). There is no significant difference between L-HTL-1000 and SL on 7104 patches (L-SL-2-7104) (0.949 ± 0.004 vs. 0.948 ± 0.008, p value = 0.742). Similar results are observed for breast cancer. B-HTL-1008 vs. B-SL-1-1008: 0.962 ± 0.017 vs. 0.943 ± 0.018, p value = 0.008; B-HTL-1008 vs. B-SL-2-5232: 0.962 ± 0.017 vs. 0.951 ± 0.023, p value = 0.148. Conclusions: HTL is capable of building accurate AI models for similar cancers using a small amount of data based on a large dataset for a certain type of cancer. HTL holds great promise for accelerating the development of AI in histopathology. Full article

(This article belongs to the Special Issue Digital Pathology: Diagnosis, Prognosis, and Prediction of Diseases)

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Open AccessReview

Imaging in Gastric Cancer: Current Practice and Future Perspectives

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Cammillo Talei Franzesi

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Rocco Corso

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Davide Ippolito

Diagnostics 2023, 13(7), 1276; https://doi.org/10.3390/diagnostics13071276 - 28 Mar 2023

Abstract

Gastric cancer represents one of the most common oncological causes of death worldwide. In order to treat patients in the best possible way, the staging of gastric cancer should be accurate. In this regard, endoscopy ultrasound (EUS) has been considered the reference standard [...] Read more.

Gastric cancer represents one of the most common oncological causes of death worldwide. In order to treat patients in the best possible way, the staging of gastric cancer should be accurate. In this regard, endoscopy ultrasound (EUS) has been considered the reference standard for tumor (T) and nodal (N) statuses in recent decades. However, thanks to technological improvements, computed tomography (CT) has gained an important role, not only in the assessment of distant metastases (M status) but also in T and N staging. In addition, magnetic resonance imaging (MRI) can contribute to the detection and staging of primary gastric tumors thanks to its excellent soft tissue contrast and multiple imaging sequences without radiation-related risks. In addition, MRI can help with the detection of liver metastases, especially small lesions. Finally, positron emission tomography (PET) is still considered a useful diagnostic tool for the staging of gastric cancer patients, with a focus on nodal metastases and peritoneal carcinomatosis. In addition, it may play a role in the treatment of gastric cancer in the coming years thanks to the introduction of new labeling peptides. This review aims to summarize the most common advantages and pitfalls of EUS, CT, MRI and PET in the TNM staging of gastric cancer patients. Full article

(This article belongs to the Special Issue The Role of Radiology Imaging in Oncology)

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Open AccessReview

Endoscopic Ultrasound-Guided Tissue Acquisition of Pancreaticobiliary Cancer Aiming for a Comprehensive Genome Profile

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Diagnostics 2023, 13(7), 1275; https://doi.org/10.3390/diagnostics13071275 - 28 Mar 2023

Abstract

In recent years, cancer genomic medicine centered on comprehensive genome profile (CGP) analysis has become widely used in the field of pancreatic cancer. Endoscopic ultrasound-guided tissue acquisition (EUS-TA) has played an important role in pancreatic cancer, and recently, more EUS-TA tissue samples are [...] Read more.

In recent years, cancer genomic medicine centered on comprehensive genome profile (CGP) analysis has become widely used in the field of pancreatic cancer. Endoscopic ultrasound-guided tissue acquisition (EUS-TA) has played an important role in pancreatic cancer, and recently, more EUS-TA tissue samples are considered for CGP analysis. Differences exist between the Oncoguide NCC Oncopanel System and Foundation One CDx Cancer Genome Profile, which are CGP tests approved by insurance programs in Japan, including the analysis criteria, optimal needle selection for meeting these criteria, and puncture target. It is important to understand not only the specimen collection factors, but also the specimen processing factors that can increase the success rate of CGP testing. Furthermore, cancer genome medicine is expected to enter an era of increasing turbulence in the future, and endoscopists need to respond flexibly to these changes. Herein, we review the current status of cancer genome medicine in pancreatic and biliary tract cancers and cancer gene panel testing using EUS-TA. Full article

(This article belongs to the Special Issue Endoscopic Ultrasound-Guided Fine-Needle Aspiration (EUS-FNA)—Volume 2)

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