Browse Articles

Bridging local and global tortuosity of retinal vessels: Objective testing of index performance

Retinal vessel tortuosity is a clinically significant parameter that aids in the diagnosis and risk stratification of various ocular and systemic diseases. While local tortuosity indices aim to quantify the winding nature of vessels in the intuitive way perceived by ophthalmologists, their integration into global measures for entire networks remains challenging. This study introduces a novel framework for objectively evaluating global tortuosity indices based on the concept of vessel compositionality. Within this framework, we compare the tortuosity of an unbranched vessel segment to the combined tortuosities of its constituent sub-segments. By analyzing the relationship between local and global tortuosity measures across a representative set of vessel segments, we can objectively assess (using the Spearman rank correlation coefficient) their performance and identify optimal combinations of local indices and global weighting schemes. This approach eliminates the need for subjective assessments of the global tortuosity by specialists, providing a purely mathematical and objective evaluation. Our findings demonstrate the influence of different factors on global tortuosity, including vessel partitioning, local index selection, and weighting schemes. This framework provides a valuable tool for understanding the behavior of tortuosity measures and optimizing their application in clinical settings.

A Gilded Age for Patients? The Broken Promises of Profit-Driven Medicine

Medical staff’s perspectives on patients’ anxieties and interventions in a rehabilitation ward: A qualitative study

Background Anxiety and depression in rehabilitation patients can adversely impact clinical outcomes. They may have anxieties about the differences in their physical conditions and living environments compared to before hospitalization. Although medical staff address patients’ anxieties, the content of anxieties and the type of intervention have not been clarified. This study aimed to highlight the contents of anxieties and interventions for patients undergoing rehabilitation, based on medical staff’s perspectives. Methods Seventeen medical staff were interviewed about the anxieties they perceived patients experience at the convalescent rehabilitation ward (early, middle, and late phases of hospitalization) and the corresponding interventions. Text mining and hierarchical cluster analysis were used to classify the contents of anxieties and interventions. This study was conducted based on the consolidated criteria for reporting qualitative research. Results Patients’ anxieties were classified into six clusters. Among the clusters, prospects for rehabilitation plans, hospital life (e.g., unfamiliar hospital environment), and family situation (e.g., concerns about family life at home) were identified in the early to middle phases, and life at home after discharge was identified in the late phase. The prognosis of physical function and prospects of social life (e.g., return to work) were identified throughout all phases. The types of interventions for these anxieties were classified into eight clusters. The medical staff provided information about patients’ prospects and helped them contact family members in the early phase. In the middle phase, feedback on patients’ improvement in physical function was incorporated. In the late phase, information on social resources was provided to address anxieties about life after discharge. Conclusion This study showed that patients’ anxiety and interventions varied according to hospitalization phases. The findings underscore appropriate ways and the timing of interventions to keep patients in a better psychological state, potentially leading to better rehabilitation outcomes.

Combination Therapy for Chronic Kidney Disease and Type 2 Diabetes — A Promising Prelude

Nerve-to-cancer transfer of mitochondria during cancer metastasis

Assessing the reliability and educational value of YouTube videos on computer-controlled local anesthesia in dentistry

Objective This study aimed to assess the scientific accuracy, content quality, and educational value of YouTube™ videos related to computer-controlled local anesthesia (CCLA) techniques in dentistry. Materials and methods A total of 100 videos were screened using predefined keywords, and 48 met the inclusion criteria. Videos were assessed using the Global Quality Scale (GQS), DISCERN tool, JAMA benchmark criteria, and the Video Information and Quality Index (VIQI). Scientific content was scored using a structured rubric across six domains. Interobserver reliability was evaluated using Weighted Kappa and Intraclass Correlation Coefficient (ICC). Confidence intervals were calculated for key metrics. Group comparisons were performed using the Mann-Whitney U test, and correlations were analyzed using Spearman’s rho (p < 0.05). Results Videos from academic sources had significantly higher scores across all quality and reliability indicators. The mean GQS was 2.6 (95% CI: 2.3–2.9), DISCERN 11.7 (95% CI: 10.8–12.6), JAMA 1.8 (95% CI: 1.7–1.9), and VIQI 12.5 (95% CI: 11.7–13.3). Strong positive correlations were found between DISCERN and VIQI (r = 0.809), and between total content score and both DISCERN (r = 0.803) and VIQI (r = 0.655). Conclusion Although YouTube™ provides accessible information on CCLA, many videos lack scientific rigor and educational depth. Content produced by academic institutions is significantly more reliable. Dental educators are encouraged to integrate high-quality video content into curricula to improve media literacy and student learning outcomes.

A Randomized Trial of Automated Insulin Delivery in Type 2 Diabetes

Detecting structural heart disease from electrocardiograms using AI

Seroprevalence and risk factors of hantavirus and hepatitis E virus exposure among wildlife farmers in Vietnam

Background Wildlife farming is a growing industry, but it poses substantial risks for zoonotic disease transmission, including infections caused by hantaviruses and hepatitis E virus (HEV). This study aimed to determine seroprevalences of these viruses among wildlife farmers and identify associated risk factors. Methods A cross-sectional study was conducted among 210 wildlife farmers in Lao Cai and Dong Nai provinces in Vietnam who raised bats, bamboo rats, civets, and wild boars. Of these, 207 provided serum samples for serological testing for hantavirus and HEV antibodies. Apparent (AP) and true (TP) prevalences were estimated, and multivariable logistic regression was performed to identify risk factors. Results The AP of hantavirus IgG was 8.7%, 95% confidence interval (CI): 5.4–13.6 (TP: 4.7%, 95% credible interval (CrI): 0.2–11.1). HEV IgG AP was 26.7%, 95%CI: 20.8–33.2 (TP: 27.1%, 95%CrI: 21.3–33.4). Hantavirus IgM testing was also performed due to higher IgG seroprevalence compared to earlier studies, detecting IgM antibodies in 1.9% of samples (95%CI: 0.6–5.2) (TP: 1.7%, 95%CrI: 0.1–4.7). Hantavirus seropositivity was significantly associated with engaging only in wildlife farming, and not participating in other activities such as hunting, trading, slaughtering, processing, guano collection, or consumption (OR = 2.7, 95% CI: 1.1–6.9). HEV seropositivity was significantly associated with men gender (OR = 3.1, 95%CI: 1.4–7.3), older age (OR = 1.03, 95%CI: 1.0–1.1), raw meat consumption (OR = 6.8, 95%CI: 1.6–31.8), residing at higher altitudes (OR = 31.6, 95%CI: 5.5–204.4), and reporting use of protective clothing (OR = 4.0, 95%CI: 1.4–11.2), although their proper use was not assessed. Conclusions This study highlights behavioural and environmental risk factors associated with wildlife farming and zoonotic pathogens exposure. Public health interventions should focus on biosecurity, proper hygiene practices, and risk communication to reduce the transmission in wildlife farming settings.

E-Cigarette– or Vaping-Associated Lung Injury

Distribution of interscan measurement error in AI-based 3D MRI analysis of knee cartilage thickness in osteoarthritis

Purpose A novel AI-based 3D analysis system was developed to automatically extract bone and cartilage from MRI data and provide average cartilage thickness. This study aimed to analyze the interscan measurement error of knee cartilage thickness in osteoarthritis patients. Methods Fifty knee osteoarthritis patients underwent two scans using MRI systems from five different vendors. Each model included five Kellgren-Lawrence grade (KL) 1–2 and five KL3–4 patients. Cartilage thickness was automatically quantified for seven regions, and interscan measurement error was analyzed. Results In the KL1–2 group, measurements with errors ≤0.05 mm, ≤ 0.10 mm, and ≤0.20 mm were 42%, 75%, and 97%, respectively. For the KL3–4 group, these proportions were 31%, 59%, and 90%. The entire cohort (KL1–4) showed errors ≤0.05 mm, ≤ 0.10 mm, and ≤0.20 mm in 37%, 67%, and 93% of measurements. Differences between KL1–2 and KL3–4 groups were significant for all thresholds. Conclusion Overall, 93% of interscan measurement errors were within 0.20 mm when using fully automatic MRI 3D analysis software to assess knee cartilage thickness in osteoarthritis patients. This study provides valuable insights into the reliability of automated cartilage thickness measurements across different disease severities and MRI systems.

Training Health Communicators — The Need for a New Approach

Spinal cord swelling and intradural compression predict neurological recovery after acute cervical traumatic spinal cord injury

Intradural spinal cord compression impairs perfusion pressure and is putatively rate-limiting for recovery after traumatic spinal cord injury (tSCI). After cervical tSCI, even minimally improved tissue preservation may help promote neurological recovery. To assess the nature and extent of spinal cord swelling and compression post-acute cervical tSCI, we evaluated several baseline MRI parameters including BASIC score, intramedullary lesion (IML) length, maximal canal compromise (MCC), maximal spinal cord compression (MSCC), extent of cord compression (ECC), maximal swollen anteroposterior diameter adjacent to injury site (Dmax), and maximal cord swelling (MCS) in 169 consecutive patients across 2 centers. In patients with either primarily intradural or combined (MSCC ≤5% or >5%, respectively) cord compression, we examined the predictive value of clinical and imaging admission parameters on American Spinal Injury Association Impairment Scale (AIS) severity and conversion up to 1-year follow-up. 37 (21.9%) patients presented with primarily intradural while 132 (78.1%) had combined cord compression. MSCC, MCS, and Dmax values differed significantly between the two groups (p < 0.0001, < 0.01 and < 0.001, respectively). MSCC was associated with age, MCC and MCS at baseline, while MCS was associated with age, MSCC and Dmax, on multivariable analysis. Logistic regression analysis of areas under receiver operating characteristic curve (AUROC) confirmed ECC (AUC 0.678) and MCS (AUC 0.922) as good and excellent predictors, respectively of AIS-conversion at 1-year for intradural compression participants. Additionally, MCS was significantly more accurate in predicting AIS-conversion in intradural group and the probability of AIS-conversion significantly decreased with each 1% increase in MCS (p = 0.003; OR 0.949), for both compression subtypes. In conclusion, baseline measures of cord swelling predict AIS-conversion likelihood up to 1-year. The deleterious effects of intradural cord compression, either isolated or presenting with extradural compression, may benefit from supplemental decompression strategies in addition to current standard-of-care.

Chipping Away at an Old Foe

Perception of rural adolescents and parents regarding child marriage: Findings of a community-based cross-sectional study in Bangladesh

Background Child marriage is a blazing global issue influenced by gender inequity, poverty, social norms, and insecurity. It has disastrous social, economic, and health-related consequences. Bangladesh ranks among the top ten countries in terms of child marriage, and rural girls are the most vulnerable group to it. Our study aimed to assess and compare the perception of rural adolescents and parents regarding child marriage, as well as focusing on the key factors governing such perception of the participants. Methods This community-based cross-sectional study randomly selected four unions of Dhamrai upazila (Sub-district) under the Dhaka district as study areas. The study recruited 1030 participants (515 adolescents and 515 parents) from 515 rural households using a systematic random sampling method and specific selection criteria. Data enumerators collected data through face-to-face interviews using a pretested semi-structured questionnaire and obtained informed written consent from parents and assent from adolescents. The study assessed perception related to child marriage by 25 statements formulated based on expert opinions. These statements were further organized into four domains- social, economic, psychological, and environmental through thematic analysis. We categorized the perception as “support” and “do not support” child marriage using a scoring system ranging from 0 to 25, based on the responses to 25 statements by a two-level Likert scale. Participants who obtained scores of ≥80% were considered not to support child marriage. Results The current study revealed that 25.8% of adolescents and 27.0% of parents supported child marriage. Participants lacking formal schooling were 3 times (AOR 3.00; 95% CI 1.27–7.09, p = 0.01) and participants with primary level education were 2.69 times (AOR 2.69; 95% CI 1.27–7.09, p = 0.01) more likely to support child marriage compared to participants with at least higher secondary level of education. Parents and adolescents did not differ significantly (p < 0.05) in total and domain-specific perception scores. However, substantial differences existed in various statements across the domains, and maximum disagreement was found in the environmental domain. Conclusion Supportive perception toward child marriage still exists in rural Bangladesh, and it is more prevalent among people with less or no formal education. Despite exceptions, both groups had overall similar perceptions regarding child marriage. Exploration of factors favoring support for child marriage and designing educational as well as community-based interventions specific and suitable to adolescents and parents is crucial to improve perception regarding child marriage.

Anti-staphylococcal activity, antibiotic-resistance modulation effects and action of Harungana madagascariensis (Hypericaceae) fruit extracts on the antioxidant system of multidrug-resistant Staphylococcus aureus

Global public health is facing a real challenge due to infections caused by multidrug-resistant bacteria. Among these bacteria, Staphylococcus aureus is known to rapidly develops antibiotic resistance. This study aimed to evaluate the antibacterial potential of Harungana madagascariensis fruit extracts and their effects on the antioxidant system of multidrug-resistant Staphylococcus aureus. Moreover, the extracts were evaluated for their antibiotic-resistance modulation effects against some multidrug-resistant Staphylococcus aureus. The antibacterial activity of the extracts and their effect in combination with antibiotics were assessed using the micro-dilution method. The catalase activity was assessed by measuring the height of foam, whereas the lipid peroxidation was carried out through spectrophotometric quantification of malondialdehyde. The phytochemical analysis of extracts was carried out using qualitative and quantitative standard assays. The tested extracts showed antibacterial activities, with minimum inhibitory concentrations ranging from 32 to 2048 μg/mL. The most active extract (hexane extract) has inhibited the catalase activity and induced the lipid peroxidation in S. aureus DO18SA, indicating its ability to interact with the antioxidant system of the bacteria. Moreover, the dichloromethane/methanol extract increased by 2–128-fold the activity of levofloxacin, ampicillin, and cefotaxime against selected multidrug-resistant S. aureus. It also showed synergistic effect with cefotaxime against D051SA. Alkaloids, triterpenes, and phenols were detected in all the extracts, whereas the other phytochemical classes were selectively distributed. The methanol extract had the highest phenolic content (142.20 ± 16.75 mg GAE/g of extract). Overall, the findings of this study suggest that extracts of Harungana madagascariensis fruits could be valuable sources of new agents for treating multidrug-resistant Staphylococcus aureus infections.

Editorial Note: A dual-channel secondary closed-loop supply chain considering retail groups and fairness concerns

A novel approach for joint indoor localization and activity recognition using a hybrid CNN-GRU and MRF framework

This work proposes a new hybrid model for joint indoor localization and activity recognition by combining a Convolutional Neural Network-Gated Recurrent Unit (CNN-GRU) model with a Markov Random Field (MRF) for better classification. The CNN-GRU successfully captures spatial and temporal dependencies, while the MRF models the mutual relations of activities and locations by estimating their joint probability distribution. The new system was tested on a public smart home dataset with four activities (sitting, lying, walking, and standing) and four indoor locations (kitchen, bedroom, living room, and stairs). The hybrid framework obtained an accuracy of 95% for activity recognition and 93% for indoor localization with a combined activity-location classification accuracy of 81%. Such results confirm the ability of the system to provide robust predictions in real-world smart environments, make it highly suitable for healthcare and intelligent living applications, and is efficient and deployable in real-world scenarios, addressing the critical challenges of noisy and dynamic indoor environments.

Inequalities in disease burden and care quality of neglected tropical diseases and malaria, 1990–2021: Findings from the 2021 Global Burden of Disease Study

Background Neglected Tropical Diseases (NTDs) and malaria represent significant public health threats, particularly in regions with low Socio-Demographic Index (SDI) levels. Despite global efforts to enhance prevention and control, disparities still persist. We aimed to assess the quality of care for NTDs and malaria through the quality of care index (QCI) to analyse differences in regions, genders, age groups, and to provide measures to improve the quality of care to reduce the burden of disease. Methods Using data from the Global Burden of Disease Study 2021 (GBD 2021), four secondary indicators were calculated using six primary indicators: incidence, mortality, prevalence, the disability-adjusted life years (DALYs), years of life lost, and years lived with disability to calculate the QCI through principal component analysis, and the gender disparity ratio was the ratio of female QCI to male QCI. Results Globally, the incidence of NTDs and malaria increased, while age-standardized mortality rates (ASMRs) and DALYs declined from 1990 to 2021. In 2021, the QCI was highest in Bahrain, Qatar, and the United Arab Emirates, with scores of 91.9, 91.5, and 91.5, respectively. In contrast, Uganda, Niger, and Burkina Faso had the lowest QCIs, at 78.5, 77.1, and 75.2, respectively. QCI showed a positive correlation with a country’s level of economic development, with lower quality of care observed in those under 10 and over 95 years, and largely equal quality of care received between genders. Conclusions This study revealed differences in the quality of care for NTDs and malaria across regions, genders, and age groups. There is an urgent need to improve care quality, particularly in low SDI areas and among young children. The study provides recommendations for enhancing the quality of care for NTDs and malaria and for developing more effective public health interventions.

Measurement and evolution of government attention to the health industry in China based on the BERTopic model

Objectives This paper aims to measure the government’s attention to the health industry accurately, which is crucial for understanding policy directions and resource allocation strategies. Methods Addressing the limitations of traditional word frequency methods, such as restricted word segmentation and ambiguous terms, the BERTopic (Bidirectional Encoder Representations from Transformers Topic Modeling) is applied to measure government attention at the sentence level. Rule matching in an ambiguous dictionary, which is expanded by utilizing the word2vec model, is to achieve accurate identification of unclassified topics. This approach reveals policy concerns at the semantic level. Results The BERTopic model is a more precise instrument for evaluating the health industry’s attention. Furthermore, significant regional differences are detected. Attention in the Northeast has declined, remained stable in the Central and Western regions, and continuously increased in the Eastern region. The main areas of government attention in the health industry are sports and fitness, environmental governance, medical services, and healthy older individuals’ care. The mode of medical care in healthy retirement has evolved to a combination of medical care and health preservation. Conclusions It is recommended that the balanced development of the health industry across regions be promoted based on specific local conditions. Efforts should also be made to enhance the efficiency of medical services, optimize the allocation mechanism for medical resources, establish a systematic medical treatment plan, and encourage the comprehensive and coordinated development of the health industry.