The assessment of bone age and skeletal maturity and its comparison to chronological age is an important task in the medical environment for the diagnosis of pediatric endocrinology, orthodontics and ...orthopedic disorders, and legal environment in what concerns if an individual is a minor or not when there is a lack of documents. Being a time-consuming activity that can be prone to inter- and intra-rater variability, the use of methods which can automate it, like Machine Learning techniques, is of value.
The goal of this paper is to present the state of the art evidence, trends and gaps in the research related to bone age assessment studies that make use of Machine Learning techniques.
A systematic literature review was carried out, starting with the writing of the protocol, followed by searches on three databases: Pubmed, Scopus and Web of Science to identify the relevant evidence related to bone age assessment using Machine Learning techniques. One round of backward snowballing was performed to find additional studies. A quality assessment was performed on the selected studies to check for bias and low quality studies, which were removed. Data was extracted from the included studies to build summary tables. Lastly, a meta-analysis was performed on the performances of the selected studies.
26 studies constituted the final set of included studies. Most of them proposed automatic systems for bone age assessment and investigated methods for bone age assessment based on hand and wrist radiographs. The samples used in the studies were mostly comprehensive or bordered the age of 18, and the data origin was in most of cases from United States and West Europe. Few studies explored ethnic differences.
There is a clear focus of the research on bone age assessment methods based on radiographs whilst other types of medical imaging without radiation exposure (e.g. magnetic resonance imaging) are not much explored in the literature. Also, socioeconomic and other aspects that could influence in bone age were not addressed in the literature. Finally, studies that make use of more than one region of interest for bone age assessment are scarce.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Revised edition of widely acclaimed medical training resource features extensive and invaluable additions Performing clinical examinations is an important skill developed throughout medical training ...and vocational experience. For nearly a quarter century, this learner-friendly handbook has filled a gap in the literature by providing an affordable and portable resource on clinical examination best practices. Essentials of Clinical Examination, 9th Edition reflects contributions from 119 medical students, 44 residents, 16 artists, 6 layout editors, and 38 esteemed faculty members at the University of Toronto. Supported by Toronto Medical Student Publications, each chapter has been thoroughly reviewed by expert residents and faculty members in their respective specialties to ensure the highest caliber content. Created by health learners for health learners, this highly accessible, evidence-informed reference is indispensable for clinical rotations and OSCE preparation. All 24 chapters underwent extensive revisions to reflect the most pertinent, up-to-date information. Section one provides overviews of major anatomy and body systems, while section two is organized by subspecialty. Each of the subspecialty chapters is consistently formatted with detailed and clear explanations covering clinical history, common presentations, differential diagnoses with distinguishing clinical features, and physical examination maneuvers. Key Highlights * The addition of new summary tables, detailed diagrams, and improved graphics enhance understanding and retention of knowledge * New social, pediatric, and geriatric awareness pearls help learners better contextualize concepts through a culturally and socially sensitive lens * Integrated clinical questions at the end of each chapter enable readers to consolidate knowledge and apply it to real-life situations encountered during rotations The latest edition of this long heralded guide is must-have reading for residents, clerks, and medical students to inform and practice core clinical examination skills that are essential to effective patient management.
We aimed at creating and validating a prognostic model incorporating easily accessible clinical and laboratory parameters to forecast the likelihood of short-term progression of carotid ...atherosclerosis.
A prediction model was developed and validated for carotid plaque progression within 2 years in an early middle-age population in China. Progression was defined as the new appearance of carotid plaque or stenosis among participants who had normal carotid status at baseline. Leveraging data from a health check-up chain, predictors were identified using statistical methods including stepwise logistic regression, Markov Chain Monte Carlo (MCMC) simulation, random forest analysis and least absolute shrinkage selection operator (Lasso). Model performance was assessed. Bootstrap internal validation, validation on another check-up population and subgroup analysis were also conducted.
Among 7765 participants, predictors including age, diastolic blood pressure, uric acid levels, high-density lipoprotein cholesterol (HDL-C), and low-density lipoprotein cholesterol (LDL-C) were identified for carotid plaque progression in 2 years. The developed prediction model demonstrated good discrimination (AUC = 0.755, 95%CI:0.736–0.774) and calibration ability (slope = 0.922 and interception = 0.007) among development data, as well as among validation data (AUC = 0.759, 95%CI:0.674–0.770; slope = 1.076 and intercept = −0.014). Internal validation using bootstrap method yielded an adjusted AUC of 0.753. The model's performance remained consistent across different subgroups.
Our study presents a validated risk prediction model for carotid plaque progression in an early middle age population, offering a valuable tool for early identification and monitoring of cardiovascular risks. The model's robustness and applicability across different subgroups highlight its potential utility in preemptive cerebrovascular and cardiovascular disease management.
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•Development and validation of a prognostic model for short-term progression of carotid atherosclerosis in an early middle-age Chinese population.•Easily accessible predictors were identified including age, diastolic blood pressure, uric acid levels, LDL-C, and HDL-C.•Model demonstrated good discrimination and calibration in validation data.•Internal validation yielded an adjusted AUC of 0.753, and performance was consistent across different subgroups.•The model offers a practical tool for early identification and monitoring of cardiovascular risks in clinical practice.
Chronic Pelvic Pain in Women: A Review Lamvu, Georgine; Carrillo, Jorge; Ouyang, Chensi ...
JAMA : the journal of the American Medical Association,
06/2021, Letnik:
325, Številka:
23
Journal Article
Recenzirano
IMPORTANCE: Chronic pelvic pain (CPP) is a challenging condition that affects an estimated 26% of the world’s female population. Chronic pelvic pain accounts for 40% of laparoscopies and 12% of ...hysterectomies in the US annually even though the origin of CPP is not gynecologic in 80% of patients. Both patients and clinicians are often frustrated by a perceived lack of treatments. This review summarizes the evaluation and management of CPP using recommendations from consensus guidelines to facilitate clinical evaluation, treatment, improved care, and more positive patient-clinician interactions. OBSERVATIONS: Chronic pelvic pain conditions often overlap with nonpelvic pain disorders (eg, fibromyalgia, migraines) and nonpain comorbidities (eg, sleep, mood, cognitive impairment) to contribute to pain severity and disability. Musculoskeletal pain and dysfunction are found in 50% to 90% of patients with CPP. Traumatic experiences and distress have important roles in pain modulation. Complete assessment of the biopsychosocial factors that contribute to CPP requires obtaining a thorough history, educating the patient about pain mechanisms, and extending visit times. Training in trauma-informed care and pelvic musculoskeletal examination are essential to reduce patient anxiety associated with the examination and to avoid missing the origin of myofascial pain. Recommended treatments are usually multimodal and require an interdisciplinary team of clinicians. A single-organ pathological examination should be avoided. Patient involvement, shared decision-making, functional goal setting, and a discussion of expectations for long-term care are important parts of the evaluation process. CONCLUSIONS AND RELEVANCE: Chronic pelvic pain is like other chronic pain syndromes in that biopsychosocial factors interact to contribute and influence pain. To manage this type of pain, clinicians must consider centrally mediated pain factors as well as pelvic and nonpelvic visceral and somatic structures that can generate or contribute to pain.
Understanding the genetic and molecular drivers of phenotypic heterogeneity across individuals is central to biology. As new technologies enable fine-grained and spatially resolved molecular ...profiling, we need new computational approaches to integrate data from the same organ across different individuals into a consistent reference and to construct maps of molecular and cellular organization at histological and anatomical scales. Here, we review previous efforts and discuss challenges involved in establishing such a common coordinate framework, the underlying map of tissues and organs. We focus on strategies to handle anatomical variation across individuals and highlight the need for new technologies and analytical methods spanning multiple hierarchical scales of spatial resolution.
Satija, Regev, Marioni, and colleagues recommend approaches to create a reference map of the human body down to the single-cell level—a task made challenging by the diverse human form.
Blood and urine tests are commonly performed by clinicians in both ambulatory and hospital settings that detect chronic and acute kidney disease. Thresholds for these tests have been established that ...signal the presence and severity of kidney injury or dysfunction. In the appropriate clinical context of a patient's history and physical examination, an abnormal test result should trigger specific actions for clinicians, including reviewing patient medication use, follow-up testing, prescribing lifestyle modifications, and specialist referral. Tests for kidney disease can also be used to determine the future risk for kidney failure as well as cardiovascular death.
Muscle power has been proposed to be the primary therapeutic target for resistance training interventions aimed at enhancing physical function in older adults. However, no recommendations exist on ...ideal testing protocols to assess muscle power in older adults, and the safety of this procedure has not been adequately evaluated in the literature.
A systematic review was conducted to identify studies evaluating muscle power exerted by older people in resistance exercises through May 2017. Information from muscle power testing protocols regarding familiarization, warm-up, measuring instrument, exercise, intensity, volume, rest intervals, data collection, and analysis was collected, as well as that regarding adverse events. Reporting bias was evaluated according to the recommendations given by the Cochrane Collaboration group.
From 65 studies that met inclusion criteria, 3,484 older subjects and 11,841 muscle power tests distributed in 6,105 testing sessions were identified. A full description of the different muscle power testing protocols was conducted. In addition, a risk of adverse events of 0.15%-0.69% (one adverse event every 144-658 muscle power tests) was found. However, adverse events were poorly reported, with most of the studies showing a high risk of reporting bias.
Major discrepancies were found in muscle power testing protocols among studies. This might limit consensus on designing optimal training programs to improve muscle power and physical function in older adults, and understanding the main mechanisms involved in the age-related loss of muscle power. Finally, muscle power testing was found to be safe in older people with a broad range of health and functional states.
Diagnostic evaluation for infertility in women should be conducted in a systematic, expeditious, and cost-effective manner to identify all relevant factors with initial emphasis on the least invasive ...methods for detection of the most common causes of infertility. The purpose of this committee opinion is to provide a critical review of the current methods and procedures for the evaluation of the infertile female, and it replaces the document of the same name, last published in 2012 (Fertil Steril 2012;98:302–7).
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