Early detection

早期检测
  • 文章类型: Journal Article
    边缘性人格障碍是一种常见的,通常出现在青春期后期或成年早期的可治疗病症。在许多临床环境中,边缘性人格障碍患者的比例不成比例。早期识别和干预边缘性人格障碍可以帮助解决当前影响年轻人的心理健康问题。学院和大学心理健康机构有机会识别边缘性人格障碍,并帮助指导学生和家庭进行适当的治疗。大学临床医生在教育校园管理员方面也有作用,他们可能很少或根本不熟悉标准的边缘性人格障碍症状或障碍的轨迹。
    Borderline personality disorder is a common, treatable condition that usually presents in late adolescence or early adulthood. Patients with borderline personality disorder are disproportionately represented in many clinical settings. Early identification and intervention of borderline personality disorder could help address the current mental health affecting young adults. College and university mental health settings have an opportunity to identify borderline personality disorder and to help guide students and families to appropriate treatment. College-based clinicians also have a role in educating campus administrators who may have little or no familiarity with standard borderline personality disorder symptoms or the trajectory of the disorder.
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  • 文章类型: Journal Article
    肺癌仍然是全球健康问题,要求非侵入性的发展,提示,选择性,和即时诊断工具。相应地,使用纳米生物传感器的呼气分析已成为一种有前景的非侵入性芯片鼻技术,通过监测多种生物标志物,如呼出气中的挥发性有机化合物/气体,用于早期检测肺癌.这篇全面的综述总结了采用化学电阻模块纳米生物传感器的最先进的基于呼吸的肺癌诊断,并得到了理论发现的支持。它揭示了与肺癌相关的呼吸生物标志物产生的基本机制和生物学基础,技术进步,和临床实施基于纳米生物传感器的呼吸分析。它探索了优点,挑战,以及在临床环境中实施这些纳米生物传感器的潜在替代解决方案,包括标准化,生物相容性/毒性分析,绿色和可持续技术,生命周期评估,和策划监管模式。它强调了纳米生物传感器在促进精确,实时,通过呼气分析现场检测肺癌,导致改善患者预后,加强临床管理,和远程个性化监控。此外,将这些生物传感器与人工智能相结合,机器学习,物联网,生物信息学,讨论了组学技术,为智能芯片上鼻子肺癌嗅探纳米生物传感器的前景提供见解。总的来说,这篇综述巩固了基于呼吸组学生物传感器的肺癌筛查知识,阐明其在推进最先进的医疗诊断以减轻医院负担并拯救人类生命方面的重要性和潜在应用。
    Lung cancer remains a global health concern, demanding the development of noninvasive, prompt, selective, and point-of-care diagnostic tools. Correspondingly, breath analysis using nanobiosensors has emerged as a promising noninvasive nose-on-chip technique for the early detection of lung cancer through monitoring diversified biomarkers such as volatile organic compounds/gases in exhaled breath. This comprehensive review summarizes the state-of-the-art breath-based lung cancer diagnosis employing chemiresistive-module nanobiosensors supported by theoretical findings. It unveils the fundamental mechanisms and biological basis of breath biomarker generation associated with lung cancer, technological advancements, and clinical implementation of nanobiosensor-based breath analysis. It explores the merits, challenges, and potential alternate solutions in implementing these nanobiosensors in clinical settings, including standardization, biocompatibility/toxicity analysis, green and sustainable technologies, life-cycle assessment, and scheming regulatory modalities. It highlights nanobiosensors\' role in facilitating precise, real-time, and on-site detection of lung cancer through breath analysis, leading to improved patient outcomes, enhanced clinical management, and remote personalized monitoring. Additionally, integrating these biosensors with artificial intelligence, machine learning, Internet-of-things, bioinformatics, and omics technologies is discussed, providing insights into the prospects of intelligent nose-on-chip lung cancer sniffing nanobiosensors. Overall, this review consolidates knowledge on breathomic biosensor-based lung cancer screening, shedding light on its significance and potential applications in advancing state-of-the-art medical diagnostics to reduce the burden on hospitals and save human lives.
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  • 文章类型: Journal Article
    背景:鼻咽癌(NPC)诊断相对较晚,预后较差,需要早期检测以减轻疾病负担。这项诊断测试准确性荟萃分析评估了9个EBV相关IgA抗体组(EBNA1-IgA,VCA-IgA,EA-IgA,Zta-IgA,EBNA1-IgA+VCA-IgA,VCA-IgA+EA-IgA,VCA-IgA+Rta-IgG,EBNA1-IgA+VCA-IgA+Zta-IgA和VCA-IgA+EA-IgA+Rta-IgG),旨在为NPC筛查确定合适的血清学检测生物标志物。
    方法:PubMed,Embase,从1月1日起检索中国国家知识基础设施和中国生物医学文献数据库,2000年9月30日,2023年,关键词是鼻咽癌,IgA,筛选,早期发现,早期诊断,敏感性和特异性。包括有关血清EBV相关IgA抗体组对NPC的诊断价值的文章。研究选择,数据提取,质量评估由两名研究人员独立进行,在分歧的情况下,咨询了第三位研究人员。使用双变量模型进行统计分析。通过诊断准确性研究质量评估工具(QUADAS-2)评估纳入研究的质量。
    结果:共包括70篇文章,涉及11863例NPC病例和34995例对照。在9个EBV相关的IgA抗体组中,EBNA1-IgA+VCA-IgA[0.928(0.898,0.950)],VCA-IgA+Rta-IgG[0.925(0.890,0.949)],EBNA1-IgA+VCA-IgA+Zta-IgA[0.962(0.909,0.985)]和VCA-IgA+EA-IgA+Rta-IgG[0.945(0.918,0.964)]表现出更高的合并敏感性(95CI)。就诊断优势比(DOR)(95CI)而言,EBNA1-IgA+VCA-IgA[107.647(61.173,189.430)],VCA-IgA+Rta-IgG[105.988(60.118,186.857)]和EBNA1-IgA+VCA-IgA+Zta-IgA[344.450(136.351,870.153)]表现优越。此外,EBNA1-IgA+VCA-IgA和VCA-IgA+Rta-IgG的SROC曲线更有利。然而,检测到VCA-IgA(P=0.005)和EBNA1-IgA+VCA-IgA(P=0.042)的发表偏倚.
    结论:一般来说,血清EBNA1-IgA的平行检测,使用ELISA的VCA-IgA和Zta-IgA抗体在所研究的组中显示出更好的合并敏感性和DOR。在使用较少的指标的情况下,血清VCA-IgA和EBNA1-IgA/Rta-IgG抗体组表现出相当的性能。
    背景:系统评论国际前瞻性注册登记号:CRD42023426984,注册于2023年5月28日。
    BACKGROUND: Nasopharyngeal carcinoma (NPC) is diagnosed relatively late and has a poor prognosis, requiring early detection to reduce the disease burden. This diagnostic test accuracy meta-analysis evaluated the serological diagnostic value of nine EBV-related IgA antibody panels (EBNA1-IgA, VCA-IgA, EA-IgA, Zta-IgA, EBNA1-IgA + VCA-IgA, VCA-IgA + EA-IgA, VCA-IgA + Rta-IgG, EBNA1-IgA + VCA-IgA + Zta-IgA and VCA-IgA + EA-IgA + Rta-IgG), aiming to identify suitable serological detection biomarkers for NPC screening.
    METHODS: PubMed, Embase, China National Knowledge Infrastructure and Chinese BioMedical Literature Database were searched from January 1st, 2000 to September 30th, 2023, with keywords nasopharyngeal carcinoma, IgA, screening, early detection, early diagnosis, sensitivity and specificity. Articles on the diagnostic value of serum EBV-related IgA antibody panels for NPC were included. Study selection, data extraction, and quality assessment were performed independently by two researchers, and a third researcher was consulted in the case of disagreement. Bivariate models were used for statistical analysis. The quality of included studies was evaluated through Quality Assessment of Diagnostic Accuracy Studies tool (QUADAS-2).
    RESULTS: A total of 70 articles were included, involving 11 863 NPC cases and 34 995 controls. Among the nine EBV-related IgA antibody panels, EBNA1-IgA + VCA-IgA [0.928 (0.898, 0.950)], VCA-IgA + Rta-IgG [0.925 (0.890, 0.949)], EBNA1-IgA + VCA-IgA + Zta-IgA [0.962 (0.909, 0.985)] and VCA-IgA + EA-IgA + Rta-IgG [0.945 (0.918, 0.964)] demonstrated higher pooled sensitivity (95%CI). In terms of diagnostic odds ratio (DOR) (95%CI), EBNA1-IgA + VCA-IgA [107.647 (61.173, 189.430)], VCA-IgA + Rta-IgG [105.988 (60.118, 186.857)] and EBNA1-IgA + VCA-IgA + Zta-IgA [344.450 (136.351, 870.153)] showed superior performance. Additionally, the SROC curves for EBNA1-IgA + VCA-IgA and VCA-IgA + Rta-IgG were more favorable. However, publication bias was detected for VCA-IgA (P = 0.005) and EBNA1-IgA + VCA-IgA (P = 0.042).
    CONCLUSIONS: In general, parallel detection of serum EBNA1-IgA, VCA-IgA and Zta-IgA antibodies using ELISA demonstrates better pooled sensitivity and DOR among the studied panels. In the cases where fewer indicators are used, serum VCA-IgA and EBNA1-IgA/Rta-IgG antibody panel exhibits a comparable performance.
    BACKGROUND: The International Prospective Register of Systematic Reviews registration number: CRD42023426984, registered on May 28, 2023.
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  • 文章类型: Journal Article
    早期神经退行性变化的临床识别需要对健康衰老中的大脑和认知进行准确和可访问的表征。我们评估了简短的在线认知评估是否可以提供与全面的神经心理学电池相当的对大脑形态的见解。在141名健康的中年和老年人中,我们比较了Creyos,一个相对简短的在线认知电池,对个人进行全面的认知评估。我们使用多变量技术来研究每种测试以从结构磁共振成像(sMRI)中提取的皮质沟宽度为索引的脑形态信息的能力。我们发现,与全面的当面评估相比,在线测试显示出与皮质沟宽度的关联强度相当。这些发现表明,在我们的风险样本中,在线评估在与大脑形态的关联方面与现场分析相当。凭借其成本效益,在线认知测试可以更公平地早期发现和干预神经退行性疾病.
    Clinical identification of early neurodegenerative changes requires an accurate and accessible characterization of brain and cognition in healthy aging. We assessed whether a brief online cognitive assessment can provide insights into brain morphology comparable to a comprehensive neuropsychological battery. In 141 healthy mid-life and older adults, we compared Creyos, a relatively brief online cognitive battery, to a comprehensive in person cognitive assessment. We used a multivariate technique to study the ability of each test to inform brain morphology as indexed by cortical sulcal width extracted from structural magnetic resonance imaging (sMRI).We found that the online test demonstrated comparable strength of association with cortical sulcal width compared to the comprehensive in-person assessment.These findings suggest that in our at-risk sample online assessments are comparable to the in-person assay in their association with brain morphology. With their cost effectiveness, online cognitive testing could lead to more equitable early detection and intervention for neurodegenerative diseases.
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  • 文章类型: Journal Article
    背景:数字认知评估,特别是那些可以在家里完成的,作为参与者和患者的低负担生物标志物,但它们在诊断阿尔茨海默病(AD)或预测其发展轨迹方面的有效性仍不清楚。这里,我们评估了这些数字认知评估为识别认知下降高危人群提供的效用或附加值.
    方法:我们分析了500名阿尔茨海默病神经影像学计划参与者,他们接受了简短的数字认知评估和淀粉样β(Aβ)/tau正电子发射断层扫描,检查他们区分认知状态和预测认知衰退的能力。
    结果:在检测轻度认知障碍和未来认知衰退方面,数字认知评估的表现优于皮质Aβ和内嗅tau,记忆歧视赤字正在成为预测下降和未来tau积累的最关键指标。
    结论:数字评估可有效识别高危个体,支持其作为早期AD检测和监测的低负担工具的效用。
    结论:与β淀粉样蛋白和tau蛋白相比,数字认知评估的表现可预测轻度认知障碍的进展。记忆歧视的缺陷表明未来的认知能力下降。受损的助记符歧视预测未来的内嗅和下颞tau。
    BACKGROUND: Digital cognitive assessments, particularly those that can be done at home, present as low-burden biomarkers for participants and patients alike, but their effectiveness in the diagnosis of Alzheimer\'s disease (AD) or predicting its trajectory is still unclear. Here, we assessed what utility or added value these digital cognitive assessments provide for identifying those at high risk of cognitive decline.
    METHODS: We analyzed >500 Alzheimer\'s Disease Neuroimaging Initiative participants who underwent a brief digital cognitive assessment and amyloid beta (Aβ)/tau positron emission tomography scans, examining their ability to distinguish cognitive status and predict cognitive decline.
    RESULTS: Performance on the digital cognitive assessment was superior to both cortical Aβ and entorhinal tau in detecting mild cognitive impairment and future cognitive decline, with mnemonic discrimination deficits emerging as the most critical measure for predicting decline and future tau accumulation.
    CONCLUSIONS: Digital assessments are effective at identifying at-risk individuals, supporting their utility as low-burden tools for early AD detection and monitoring.
    CONCLUSIONS: Performance on digital cognitive assessments predicts progression to mild cognitive impairment at a higher proficiency compared to amyloid beta and tau. Deficits in mnemonic discrimination are indicative of future cognitive decline. Impaired mnemonic discrimination predicts future entorhinal and inferior temporal tau.
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  • 文章类型: Journal Article
    胶质瘤是高度复杂且代谢活跃的脑肿瘤,预后不良。最近的报道发现,在早期肿瘤发展过程中血液代谢物的水平发生了变化,提示肿瘤的发展可以在临床表现前几年发现。在这项研究中,我们对健康对照组和未来神经胶质瘤患者的血液样本进行了代谢物分析,神经胶质瘤诊断前8年,在神经胶质瘤手术的那天.我们发现与神经胶质瘤早期发展相关的代谢物与能量转换增加有关,正如TCA相关代谢物如富马酸盐水平升高所强调的那样,苹果酸,乳酸和丙酮酸在诊断前的病例。我们还发现,与手术时胶质瘤进展相关的代谢物主要是高水平的氨基酸和氨基酸分解代谢的代谢物,11个氨基酸和两个支链α-酮酸水平升高,酮亮氨酸和酮异亮氨酸。神经胶质瘤肿瘤组织中的高氨基酸周转目前用于PET成像,肿瘤边缘的诊断和勾画。通过检查疾病发作的基于血液的代谢进展模式,我们证明了这种高氨基酸转换在简单的血液样本中也可以检测到。这些发现为胶质瘤发展和进展过程中的代谢改变提供了额外的见解。
    Gliomas are highly complex and metabolically active brain tumors associated with poor prognosis. Recent reports have found altered levels of blood metabolites during early tumor development, suggesting that tumor development could be detected several years before clinical manifestation. In this study, we performed metabolite analyses of blood samples collected from healthy controls and future glioma patients, up to eight years before glioma diagnosis, and on the day of glioma surgery. We discovered that metabolites related to early glioma development were associated with an increased energy turnover, as highlighted by elevated levels of TCA-related metabolites such as fumarate, malate, lactate and pyruvate in pre-diagnostic cases. We also found that metabolites related to glioma progression at surgery were primarily high levels of amino acids and metabolites of amino acid catabolism, with elevated levels of 11 amino acids and two branched-chain alpha-ketoacids, ketoleucine and ketoisoleucine. High amino acid turnover in glioma tumor tissue is currently utilized for PET imaging, diagnosis and delineation of tumor margins. By examining blood-based metabolic progression patterns towards disease onset, we demonstrate that this high amino acid turnover is also detectable in a simple blood sample. These findings provide additional insight of metabolic alterations during glioma development and progression.
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  • 文章类型: Journal Article
    贲门腺癌(GCA)和食管鳞状细胞癌(ESCC)在中国面临着巨大的健康挑战。经常在晚期被诊断为预后不良。然而,早期检测的有效生物标志物仍然难以捉摸。本研究旨在整合甲基化组和转录组数据,以鉴定DNA甲基化标记,用于早期检测GCA和ESCC。在发现阶段,我们对36个配对的GCA和非肿瘤相邻组织(NAT)进行了Infinium甲基化EPIC阵列分析,通过对内部和公开数据的联合分析,确定GCA/ESCC和NAT之间的差异甲基化CpG位点(DMC)。在验证阶段,对来自50例GCA和50例ESCC患者的配对肿瘤和NAT样本进行靶向焦磷酸测序和定量实时RT-PCR。在应用阶段,一组独立的438个样本,包括GCA,ESCC,高、低度发育不良(HGD/LGD),和正常控制,使用焦磷酸测序测试选定的DMC。我们的分析验证了三个特定于GCA的,两个特定的ESCC,和一个肿瘤共有的DMC,与NAT相比,肿瘤样品中的靶基因表达明显高甲基化和降低。利用这些DMC,我们开发了一个GCA特异性4标记组(cg27284428,cg11798358,cg07880787和cg00585116),受试者工作特征曲线下面积(AUC)为0.917,可有效区分贲门HGD/GCA患者和贲门LGD/正常对照.同样,ESCC特异性3标记组(cg14633892,cg04415798和cg00585116)在区分食管HGD/ESCC病例方面的AUC为0.865.此外,整合cg00585116,年龄,和饮酒产生了肿瘤共享逻辑模型,对两种癌症/HGD具有良好的区分度(AUC,0.767;95%置信区间,0.720-0.813)。5倍交叉验证后模型的平均AUC为0.764。总之,我们的研究鉴定了能够准确区分GCA/ESCC和HGD与LGD和正常对照的新型DNA甲基化标记。这些发现为未来微创癌症筛查方法中的靶向DNA甲基化测定提供了有希望的前景。
    Gastric cardia adenocarcinoma (GCA) and esophageal squamous cell carcinoma (ESCC) present significant health challenges in China, often diagnosed at advanced stages with poor prognoses. However, effective biomarkers for early detection remain elusive. This study aimed to integrate methylome and transcriptome data to identify DNA methylation markers for the early detection of GCA and ESCC. In the discovery stage, we conducted Infinium MethylationEPIC array analysis on 36 paired GCA and non-tumor adjacent tissues (NAT), identifying differentially methylated CpG sites (DMCs) between GCA/ESCC and NAT through combined analyses of in-house and publicly available data. In the validation stage, targeted pyrosequencing and quantitative real-time RT-PCR were performed on paired tumor and NAT samples from 50 GCA and 50 ESCC patients. In the application stage, an independent set of 438 samples, including GCA, ESCC, high- and low-grade dysplasia (HGD/LGD), and normal controls, was tested for selected DMCs using pyrosequencing. Our analysis validated three GCA-specific, two ESCC-specific, and one tumor-shared DMCs, exhibiting significant hypermethylation and decreased expression of target genes in tumor samples compared with NAT. Leveraging these DMCs, we developed a GCA-specific 4-marker panel (cg27284428, cg11798358, cg07880787, and cg00585116) with an area under the receiver operating characteristic curve (AUC) of 0.917, effectively distinguishing between cardia HGD/GCA patients and cardia LGD/normal controls. Similarly, an ESCC-specific 3-marker panel (cg14633892, cg04415798, and cg00585116) achieved an AUC of 0.865 in distinguishing esophageal HGD/ESCC cases. Furthermore, integrating cg00585116, age, and alcohol consumption yielded a tumor-shared logistic model with good discrimination for two cancer/HGD (AUC, 0.767; 95% confidence interval, 0.720-0.813). The mean AUC of the model after 5-fold cross-validation was 0.764. In summary, our study identifies novel DNA methylation markers capable of accurately distinguishing GCA/ESCC and HGD from LGD and normal controls. These findings offer promising prospects for targeted DNA methylation assays in future minimally invasive cancer screening methods.
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  • 文章类型: Journal Article
    无细胞DNA(cfDNA)分析已显示出基于非遗传特征检测早期肺癌的潜力。为了区分肺癌患者和健康个体,收集926例肺癌患者和611例健康个体的外周血,然后进行cfDNA提取.进行低通全基因组测序和靶向甲基化测序,并评估cfDNA的各种特征。通过我们的定制算法使用最佳功能,构建了整体堆叠模型,称为ESim-seq(具有集成模型的早期筛查技术)。在独立验证队列中,ESim-seq模型的曲线下面积(AUC)为0.948(95%CI:0.915-0.981),在所有阶段的敏感性为79.3%(95%CI:71.5-87.0%),特异性为96.0%(95%CI:90.6-100.0%)。具体来说,在I期患者中,ESim-seq模型的敏感性为76.5%(95%CI:67.3-85.8%),II期患者为100%(95%CI:100.0-100.0%),在独立验证队列中,III期患者为100%(95%CI:100.0-100.0%),IV期患者为87.5%(95%CI:64.6%-100.0%)。此外,我们构建了LCSC模型(肺癌亚型多分类),能够准确区分小细胞肺癌患者和非小细胞肺癌患者,AUC为0.961(95%CI:0.949-0.957)。本研究建立了评估cfDNA特征的框架,并证明了整合多种特征对肺癌早期检测的益处。
    Cell-free DNA (cfDNA) analysis has shown potential in detecting early-stage lung cancer based on non-genetic features. To distinguish patients with lung cancer from healthy individuals, peripheral blood were collected from 926 lung cancer patients and 611 healthy individuals followed by cfDNA extraction. Low-pass whole genome sequencing and targeted methylation sequencing were conducted and various features of cfDNA were evaluated. With our customized algorithm using the most optimal features, the ensemble stacked model was constructed, called ESim-seq (Early Screening tech with Integrated Model). In the independent validation cohort, the ESim-seq model achieved an area under the curve (AUC) of 0.948 (95% CI: 0.915-0.981), with a sensitivity of 79.3% (95% CI: 71.5-87.0%) across all stages at a specificity of 96.0% (95% CI: 90.6-100.0%). Specifically, the sensitivity of the ESim-seq model was 76.5% (95% CI: 67.3-85.8%) in stage I patients, 100% (95% CI: 100.0-100.0%) in stage II patients, 100% (95% CI: 100.0-100.0%) in stage III patients and 87.5% (95% CI: 64.6%-100.0%) in stage IV patients in the independent validation cohort. Besides, we constructed LCSC model (Lung Cancer Subtype multiple Classification), which was able to accurately distinguish patients with small cell lung cancer from those with non-small cell lung cancer, achieving an AUC of 0.961 (95% CI: 0.949-0.957). The present study has established a framework for assessing cfDNA features and demonstrated the benefits of integrating multiple features for early detection of lung cancer.
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  • 文章类型: Journal Article
    农业被认为是坦桑尼亚经济的支柱,超过60%的居民依靠它生存。玉米是我国的主要粮食作物,占所有农田产量的45%。然而,它的生产力受到了早期检测玉米病害的局限性的挑战。玉米条纹病毒(MSV)和玉米致死性坏死病毒(MLN)是农民经常发现太晚的常见疾病。这导致需要开发一种早期检测这些疾病的方法,以便可以及时治疗。这项研究调查了在坦桑尼亚开发深度学习模型以早期检测玉米疾病的潜力。收集数据的地区是阿鲁沙,乞力马扎罗山,还有Manyara.通过植物的观察收集数据。该研究提出了卷积神经网络(CNN)和视觉变换器(ViT)模型。四类图像数据用于训练这两种模型:MLN,健康,MSV,错了。结果显示,ViT模型超过了CNN模型,准确率为93.1%和90.96%,分别。进一步的研究应集中在移动应用程序开发和部署模型上,以更高的精度在现实生活中早期发现上述疾病。
    Agriculture is considered the backbone of Tanzania\'s economy, with more than 60% of the residents depending on it for survival. Maize is the country\'s dominant and primary food crop, accounting for 45% of all farmland production. However, its productivity is challenged by the limitation to detect maize diseases early enough. Maize streak virus (MSV) and maize lethal necrosis virus (MLN) are common diseases often detected too late by farmers. This has led to the need to develop a method for the early detection of these diseases so that they can be treated on time. This study investigated the potential of developing deep-learning models for the early detection of maize diseases in Tanzania. The regions where data was collected are Arusha, Kilimanjaro, and Manyara. Data was collected through observation by a plant. The study proposed convolutional neural network (CNN) and vision transformer (ViT) models. Four classes of imagery data were used to train both models: MLN, Healthy, MSV, and WRONG. The results revealed that the ViT model surpassed the CNN model, with 93.1 and 90.96% accuracies, respectively. Further studies should focus on mobile app development and deployment of the model with greater precision for early detection of the diseases mentioned above in real life.
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  • 文章类型: Journal Article
    目的:基于结肠镜检查的监测以预防结直肠癌(CRC)给患者和医疗保健带来了巨大的负担。粪便测试可能有助于减少结肠镜检查,通过将结肠镜检查限制在患AN风险增加的个体。
    方法:这项横断面观察性研究包括50-75岁有监测指征的个体。在肠道准备之前,参与者收集样本进行多目标粪便DNA(mt-sDNA)检测和两项粪便免疫化学检测(FIT).计算所有监测适应症的测试准确性。仅用于息肉切除术后的适应症,最常见且与相对较低的CRC风险相关,使用ASCCA模型评估了以粪便为基础的监测的长期影响.模拟基于粪便的策略以调整每个测试的阳性阈值,以获得至少与结肠镜检查监测一样有效的策略。
    结果:3453名个体在所有粪便检查和结肠镜检查中均有结果。2226以前做过息肉切除术,1003以前的CRC和224家族风险。对于mt-sDNA测试,AN的受试者工作特征曲线下面积为0.72(95%CI;0.69-0.75),FITOC传感器为0.61(95%CI;0.58-0.64),FITFOB-Gold为0.59(95%CI;0.56-0.61)。基于粪便的息肉切除术后监测策略至少与结肠镜检查监测一样有效,结肠镜检查次数减少了15-41%,并且需要在一个人的一生中进行5.6-9.5次粪便测试。基于Mt-sDNA的监测比结肠镜检查监测更昂贵,而基于FIT的监测节省了成本。
    结论:这项研究表明,基于粪便的息肉切除术后监测策略是安全且具有成本效益的,有可能减少高达41%的结肠镜检查次数。
    OBJECTIVE: Colonoscopy-based surveillance to prevent colorectal cancer (CRC) causes substantial burden for patients and healthcare. Stool tests may help to reduce surveillance colonoscopies, by limiting colonoscopies to individuals at increased risk of AN.
    METHODS: This cross-sectional observational study included individuals aged 50-75 with surveillance indication. Before bowel preparation, participants collected samples for a multitarget stool DNA (mt-sDNA) test and two fecal immunochemical tests (FITs). Test accuracies were calculated for all surveillance indications. Only for the post-polypectomy indication, most common and associated with a relatively low CRC risk, long-term impact of stool-based surveillance was evaluated with the ASCCA model. Stool-based strategies were simulated to tune each tests\' positivity threshold to obtain strategies at least as effective as colonoscopy surveillance.
    RESULTS: 3453 individuals had results for all stool tests and colonoscopy. 2226 had previous polypectomy, 1003 previous CRC and 224 familial risk. Areas under the receiver operating characteristic curve for AN were 0.72 (95% CI; 0.69-0.75) for the mt-sDNA test, 0.61 (95% CI; 0.58-0.64) for the FIT OC-Sensor and 0.59 (95% CI; 0.56-0.61) for the FIT FOB-Gold. Stool-based post-polypectomy surveillance strategies at least as effective as colonoscopy surveillance, reduced the number of colonoscopies by 15-41% and required 5.6-9.5 stool tests over the lifetime of a person. Mt-sDNA-based surveillance was more costly than colonoscopy surveillance, whereas FIT-based surveillance saved costs.
    CONCLUSIONS: This study shows that stool-based post-polypectomy surveillance strategies can be safe and cost-effective, with potential to reduce the number of colonoscopies by up to 41%.
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