Search Results (8,401)

Optical coherence tomography (OCT) is a leading imaging technique for diagnosing retinal disorders such as age-related macular degeneration and diabetic retinopathy. Its ability to detect structural changes, especially in the optic nerve head, has made it vital for early diagnosis and monitoring. This paper surveys techniques for ocular disease prediction using OCT, focusing on both hand-crafted and deep learning-based feature extractors. While the field has seen rapid growth, a detailed comparative analysis of these methods has been lacking. We address this by reviewing research from the past 20 years, evaluating methods based on accuracy, sensitivity, specificity, and computational cost. Key diseases examined include glaucoma, diabetic retinopathy, cataracts, amblyopia, and macular degeneration. We also assess public OCT datasets widely used in model development. A unique contribution of this paper is the exploration of adversarial attacks targeting OCT-based diagnostic systems and the vulnerabilities of different feature extraction techniques. We propose a practical, robust defense strategy that integrates with existing models and outperforms current solutions. Our findings emphasize the value of combining classical and deep learning methods with strong defenses to enhance the security and reliability of OCT-based diagnostics, and we offer guidance for future research and clinical integration. Full article

Volumetric video streaming holds transformative potential for telemedicine, enabling immersive remote consultations, surgical training, and real-time collaborative diagnostics. However, transmitting sensitive patient data (e.g., 3D medical scans, surgeon head/gaze movements) raises critical privacy risks, including exposure of biometric identifiers and protected health information (PHI). To address the above concerns, we propose SecureTeleMed, a dual-track encryption scheme tailored for volumetric video based telemedicine. SecureTeleMed combines viewport obfuscation and region of interest (ROI)-aware frame encryption to protect both patient data and clinician interactions while complying with healthcare privacy regulations (e.g., HIPAA, GDPR). Evaluations show SecureTeleMed reduces privacy leakage by 89% compared to baseline encryption methods, with sub-50 ms latency suitable for real-time telemedicine applications. Full article

Hepatocellular carcinoma (HCC) remains a global health challenge due to molecular heterogeneity and frequent delayed diagnosis. This comprehensive review synthesizes recent immunohistochemistry (IHC) advancements for HCC diagnosis, prognostication, and therapeutic prediction. We systematically evaluate conventional markers, such as hepatocyte paraffin 1 (HepPar1), arginase-1 (Arg-1), and glypican-3 (GPC3), as well as emerging biomarkers, detailing their diagnostic sensitivities and specificities in HCC with varied tumor differentiation. Prognostic immunostaining markers, such as Ki-67 proliferation index and vascular endothelial growth factor (VEGF) overexpression, correlate with reduced 5-year survival, while novel immune checkpoint IHC markers (PD-L1 and CTLA-4) predict response to immunotherapy, particularly in advanced HCC. This work provides evidence-based recommendations for optimizing IHC utilization in clinical practice while identifying knowledge gaps in biomarker validation and standardization. Full article

Exhaled breath analysis (EBA) is an advanced, non-invasive diagnostic technique that utilizes volatile organic compounds (VOCs) to detect and monitor various diseases. This review examines EBA’s historical development and current status as a promising diagnostic tool. It highlights the significant contributions of modern methods such as gas chromatography–mass spectrometry (GC-MS), ion mobility spectrometry (IMS), and electronic noses in enhancing the sensitivity and specificity of EBA. Furthermore, it emphasizes the transformative role of nanotechnology and machine learning in improving the diagnostic accuracy of EBA. Despite challenges such as standardization and environmental factors, which must be addressed for the widespread adoption of this technique, EBA shows excellent potential for early disease detection and personalized medicine. The review also highlights the potential of photonic crystal fiber (PCF) sensors, known for their superior sensitivity, in the field of EBA. Full article

Infectious keratitis (IK), including bacterial, fungal, parasitic, and viral etiologies, continues to represent a significant cause of ocular morbidity in the United States and around the world. Corneal scraping for smears and cultures remains the gold standard in diagnosing IK; however, molecular diagnoses, including metagenomic deep sequencing (MDS), are promising emerging diagnostic tools. Despite recent interest in procedural treatment such as riboflavin photoactivated chromophore corneal collagen cross-linking (PACK-CXL) and Rose Bengal photodynamic antimicrobial therapy (RB-PDAT), medical treatment advances have remained stagnant. Methods: This review highlights IK pathogens obtained from corneal cultures at Bascom Palmer Eye Institute (BPEI) from 2011 to 2021 and provides the current BPEI algorithms for initial management of IK or as a referred clinically worsening patient. The roles of corticosteroid therapy, PACK-CXL, and RB-PDAT for IK are also summarized. Results: A total of 9326 corneal cultures were performed at BPEI between 2011 and 2021, and only 3609 (38.7%) had a positive organism identified, of which bacteria were the most common (83.4%). Fortified vancomycin and tobramycin are recommended as first-line medical therapy for IK patients based on culture sensitivity data for the top Gram-negative (Pseudomonas aeruginosa) and Gram-positive (Staphylococcus aureus) bacteria. PACK-CXL and RB-PDAT may benefit IK patients with corneal melting and fungal IK, respectively. Conclusions: Drug holidays, minimizing contamination, and optimizing sample order are crucial to maximizing corneal culture positivity. PACK-CXL and RB-PDAT are promising procedural advancements for IK therapy. Full article

Molecular diagnoses of Entamoeba histolytica and Strongyloides stercoralis in human samples are becoming increasingly common. To contribute to the ongoing standardization of molecular diagnostic approaches targeting these parasites, we compared three published E. histolytica- and S. stercoralis-specific real-time PCR assays in test comparisons without a reference standard. Latent class analysis (LCA) was used to calculate diagnostic accuracy estimations for the three compared assays per parameter. The comparison was conducted using stool samples from Ghanaian individuals. In the course of the assessment of 873 stool samples, the number of detected positive PCR results ranged from 10 to 15 for S. stercoralis and from 4 to 54 for E. histolytica depending on the applied assay. Diagnostic accuracy estimates of real-time PCR sensitivity for S. stercoralis and E. histolytica ranged from 89% to 100% and from 75% to 100%, respectively; diagnostic estimates of specificity ranged from 99% to 100% and from 94% to 100%, respectively. Diagnostic accuracy-adjusted prevalence estimates were 1.2% for S. stercoralis and 0.5% for E. histolytica. High cycle threshold values of real-time PCR > 35 showed a particularly reduced likeliness of reproducibility when applying competitor real-time PCR assays. There were no clear-cut differences in terms of diagnostic accuracy favoring either small-subunit ribosomal ribonucleic acid (SSU rRNA) gene sequences or the S. stercoralis dispersed repetitive sequence for S. stercoralis PCR. The same applied to the comparison of real-time PCRs targeting SSU rRNA gene sequences and the SSU rRNA episomal repeat sequence (SREPH) of E. histolytica. In conclusion, interchangeability of the compared real-time PCR assays was higher for the assessed S. stercoralis assays compared with the assessed E. histolytica assays. Regional diagnostic accuracy testing seems advisable before literature-adapted assays for rare tropical pathogens like S. stercoralis and E. histolytica are applied in different study regions. Full article

Background and Objectives: Type 2 diabetes (T2DM) substantially increases cardiovascular risk; beyond the well-recognized left-ventricular involvement in diabetic cardiomyopathy, emerging data indicate subclinical right-ventricular (RV) dysfunction may also be present. This study aimed to evaluate whether speckle-tracking echocardiography identifies subclinical right-ventricular systolic dysfunction in type 2 diabetes, despite normal conventional indices and preserved global systolic function. Materials and Methods: We conducted a cross-sectional, single-center study in accordance with STROBE recommendations, enrolling 77 participants, 36 adults with T2DM, and 41 non-diabetic controls, between December 2024 and July 2025. All participants underwent comprehensive transthoracic echocardiography, including conventional parameters (tricuspid annular plane systolic excursion (TAPSE), tricuspid annular systolic velocity (TV S’), right ventricular fractional area change (RVFAC)) and deformation imaging (right ventricular global longitudinal strain (RV GLS), right ventricular free wall longitudinal strain (RVFWS)) using speckle-tracking echocardiography. Biochemical and clinical data, including glycosylated hemoglobin (HbA1c), were recorded. Correlation and ROC curve analyses were performed to explore associations and predictive value. Results: The mean age was comparable between the two groups (62.08 ± 9.54 years vs. 60.22 ± 13.39 years; p = 0.480). While conventional RV parameters did not differ significantly between groups, diabetic patients had significantly lower RV GLS (−13.86 ± 6.07% vs. −18.59 ± 2.27%, p < 0.001) and RVFWS (−15.64 ± 4.30% vs. −19.03 ± 3.53%, p < 0.001). HbA1c levels correlated positively with RV strain impairment (RVFWS r = 0.41, p < 0.001). Both RV GLS and RVFWS were independent predictors of RV dysfunction in logistic regression analysis. ROC analysis showed good diagnostic performance for RV GLS, AUC = 0.84 with an optimal cut-off −17.2% (sensitivity 86.1% and specificity 80.5%) and RVFWS, AUC = 0.76 with cut-off −17.6% (sensitivity 77.8; specificity 80.5%) in identifying early myocardial involvement. Conclusions: RV systolic dysfunction may occur early in T2DM, even when traditional echocardiographic indices remain within normal limits. Speckle-tracking echocardiography, particularly RV GLS and RVFWS, offers sensitive detection of subclinical myocardial impairment, reinforcing its value in early cardiovascular risk stratification among diabetic patients. Full article

As the leading cause of global mortality, cardiovascular diseases demand improved and innovative strategies for early detection and risk assessment to enhance prevention and timely treatment. This comprehensive review examines the potential of combining high-sensitivity cardiac troponins (hs-cTns) and homocysteine (Hcy) as complementary biomarkers for enhanced cardiovascular risk prediction. hs-cTn assays have revolutionized cardiovascular diagnostics by enabling the detection of minimal myocardial injury, improving early diagnosis of acute coronary syndrome, and providing robust prognostic information in both symptomatic and asymptomatic populations. Hcy, while established as a marker of vascular dysfunction, presents an interpretative challenge due to multiple confounding factors and inconsistent therapeutic responses. Emerging evidence demonstrates significant correlations between elevated Hcy and troponins across various clinical conditions, suggesting that their combined assessment—reflecting both myocardial injury and vascular dysfunction—may improve cardiovascular risk stratification. While initial findings are promising, additional studies are required to validate the clinical value of the combined marker approach. Future development of personalized interpretation algorithms, and multi-marker panels incorporating these biomarkers, may significantly advance cardiovascular medicine and enable more effective population-specific risk management strategies. Full article

Background/Objectives: Current bone-based landmark approaches have shown variable accuracy and poor reproducibility. We validated a two-point “tuberculum sellae–anterior clinoid process” (TS–ACP) line traced on routine 3D-computed tomography angiography (CTA) for predicting distal dural ring (DDR) position and quantified the interobserver agreement. Methods: We retrospectively reviewed data from 85 patients (87 aneurysms) who were treated via clipping between June 2012 and December 2024. Two blinded neurosurgeons classified each aneurysm as extradural, intradural, or straddling the TS–ACP line. The intraoperative DDR inspection served as the reference standard. Diagnostic accuracy, χ² statistics, and Cohen’s κ were calculated. Results: The TS–ACP line landmarks were identifiable in all cases. The TS–ACP line classification correlated strongly with operative findings (χ² = 138.3, p = 6.4 × 10⁻²⁹). The overall accuracy was 89.7% (78/87), and sensitivity and specificity for identifying intradural aneurysms were 94% and 82%, respectively. The interobserver agreement was substantial (κ = 0.78). Nine aneurysms were misclassified, including four cavernous-sinus lesions that partially crossed the DDR. Retrospective fusion using constructive interference in steady-state magnetic resonance imaging corrected these errors. Conclusions: The TS–ACP line represents a rapid, reproducible tool that reliably localizes the DDR on standard 3D-CTA, showing higher accuracy than previously reported single-landmark techniques. Its high accuracy and substantial inter-observer concordance support incorporation into routine preoperative assessments. Because the method depends on only two easily detectable bony points, it is well-suited for automated implementation, offering a practical pathway toward artificial intelligence-assisted stratification of paraclinoid aneurysms. Full article

Background/Objectives. Multi-drug-resistant (MDR) microorganisms pose a significant challenge in healthcare settings, particularly with beta-lactam-resistant Gram-negative bacteria and glycopeptide-resistant enterococci. Culture represents the most reliable technique in determining their presence within surveillance swabs. However, it requires a long time-to-result (TTR) and shows low sensitivity. Molecular techniques integrate diagnostic procedures, allowing TTR reduction and precise identification of genes. Methods. During our usual surveillance campaign, we had the opportunity to evaluate the Allplex Entero-DR assay (Seegene Inc., Seoul, Republic of Korea) and the Entero-DR Plus assay (Arrow Diagnostics srl, Genova, Italy) molecular kits for the detection of extended-β-lactamases (ESBL), carbapenem- and vancomycin-resistant genes, as well as Acinetobacter spp. and Pseudomonas aeruginosa spp. identification directly from rectal swabs. A comparison between these tests and the culture-based routine completed the study. Results. The analysis included 300 rectal swabs from the University Hospital Policlinico (Catania, Italy). One hundred and eighty-eight samples (62.6%) resulted as positive for at least one Allplex™ target, reaching optimal sensitivity and negative predictive value (100%). Our results underlined the ubiquitous blaCTX-M and van genes presence and demonstrated the diffusion of double-carbapenemases genes and metallo-β-lactamases-producing strains. In our epidemiological setting, few data were collected about carbapenem-resistant P. aeruginosa and Acinetobacter spp., which require further evaluations on simultaneous respiratory colonization and higher sample numbers. Conclusions. Our analysis highlighted the importance of combining conventional and advanced diagnostic methods in investigating MDR pathogens. The right approach should be based on the prevalence and variability of resistance mechanisms within a specific epidemiological area. Remarkably, molecular screenings may exclude negative samples within high-risk areas due to a significant negative predictive value. Full article

Background/Objectives: Magnetic resonance imaging (MRI) and MRI–ultrasound (US) fusion-targeted biopsy have improved prostate cancer diagnosis, particularly for clinically significant disease. However, the added value of combining systematic biopsy with targeted biopsy remains debated. This study aimed to evaluate the diagnostic accuracy of MRI–US fusion-targeted and systematic transperineal biopsies in detecting prostate cancer and explore the correlation between PI-RADS score and histology. Methods: We retrospectively analyzed 356 patients with 452 MRI-detected lesions who underwent both MRI–US fusion-targeted and transperineal systematic biopsies between 2020 and 2023. Clinically significant prostate cancer (csPCa) was defined as International Society of Urological Pathology (ISUP) grade ≥ 2. Diagnostic performance metrics (sensitivity, specificity, and accuracy) were calculated for each technique using the combined result as a reference. Subgroup analysis was performed for patients under active surveillance. Results: Prostate cancer was diagnosed in 323 of 452 lesions (71%) and csPCa in 223 lesions (49%). Targeted biopsy demonstrated higher sensitivity (93.7%) and accuracy (79.9%) than systematic biopsy (85.7% sensitivity and 77.6% accuracy), although systematic biopsy provided slightly higher specificity. Systematic biopsy alone identified 8.2% of PCa cases missed by targeted biopsy and upgraded 9.9% of lesions to csPCa. csPCa detection increased with PI-RADS score (23% in PI-RADS 3 and 73% in PI-RADS 5). In active surveillance patients, csPCa was found in 65% of lesions. Conclusions: MRI–US fusion-targeted biopsy improves csPCa detection, but systematic biopsy remains valuable, especially for identifying additional or higher-grade disease. The combined approach provides an optimal diagnostic yield, supporting its continued use in both initial and repeat biopsy settings. Full article

Soybean (Glycine max (L.) Merrill) is highly sensitive to water deficit, particularly during the vegetative phase, when morphological and metabolic plasticity support continued growth and photosynthetic efficiency. We applied eleven water regimes, from full irrigation (W100) to total water withholding (W0), to plants grown under controlled conditions. After 14 days, we quantified morphophysiological, biochemical, leaf optical, gas exchange, and chlorophyll a fluorescence traits. Drought induces significant reductions in leaf area, biomass, pigment pools, and photosynthetic rates (A, g_s, ΦPSII) while increasing the levels of oxidative stress markers (electrolyte leakage, ROS) and proline accumulation. OJIP transients and JIP test metrics revealed reduced electron-transport efficiency and increased energy dissipation for many parameters under severe stress. Principal component analysis (PCA) clearly separated those treatments. PC1 captured growth and water status variation, whereas PC2 reflected photoprotective adjustments. These data show that progressive drought limits carbon assimilation via coordinated diffusive and biochemical constraints and that the accumulation of proline, phenolics, and lignin is associated with osmotic adjustment, antioxidant buffering, and cell wall reinforcement under stress. The combined use of hyperspectral sensors, gas exchange, chlorophyll fluorescence, and multivariate analyses for phenotyping offers a rapid, nondestructive diagnostic tool for assessing drought severity and the possibility of selecting drought-resistant genotypes and phenotypes in a changing stress environment. Full article

Aim: In sub-Saharan Africa, approximately 40 million pregnant women are exposed to parasitic diseases such as malaria caused by Plasmodium falciparum, Schistosome parasites, and soil-transmitted helminths (STHs). When parasitic diseases share the same habitat and overlap in distribution, then high co-infection rates occur. The co-infection can lead to consequences for the child, such as intrauterine growth retardation, low birth weight, pre-term delivery, and neonatal mortality. Methods: The objective of the study was to determine the nature and extent of coinfection from 100 samples collected from the Battor (50) and Adidome (50) towns of Ghana in collaboration with the Noguchi Memorial Institute for Medical Research, University of Ghana. Results: Out of 50 for the Adidome towns determined for P. falciparum by Rapid Diagnostic Test (RDT), Malaria Pan-specific Antigen (PAN), and Malaria Pf kit, 39 were true positive (TP), 8 were true negative (TN), and 30 were false negative (FN). For Battor, 19 were TP, 12 TN, and 20 FN. For S. mansoni in Adidome via polymerase chain reaction (PCR) and loop-mediated isothermal amplification (LAMP), 21 tested positive, and 29 were negative, with 52.5% sensitivity and 100% specificity. For S. haematobium, 28 were positive and 22 negative using PCR with 70% sensitivity and 100% specificity. In LAMP, 28 were positive, and 22 negatives, with 70% sensitivity and 100% specificity. In Battor PCR for S. mansoni, 28 positives and 22 negatives with 68.3% sensitivity and 100% specificity. In LAMP, 32 were positive, and 18 were negative, with 80% sensitivity and 100% specificity. For S. haematobium, PCR showed 30 positive and 20 negative, with 73.2% sensitivity and 100% specificity. With LAMP, 21 were positive, and 29 negatives, with 51% sensitivity and 100% specificity. In both towns, 20–30 years had the highest infection prevalence for P. falciparum, S. mansoni, S. haematobium, and Strongyloides stercoralis. Conclusion: The results will be utilized as a part of the continuous surveillance for future research aiming at gathering nationally representative data in Ghana on the prevalence of coinfection and proposing interventions based on that for the vulnerable pregnant women population. Full article

Brain natriuretic peptide (BNP) is an important biomarker for the diagnosis and prediction of chronic heart failure (CHF). Aiming at the problems of the low sensitivity and poor portability of traditional BNP detection methods, this study proposes a Surface-enhanced Raman-scattering (SERS) fiber-optic sensor based on a multimode fiber (MMF)–no core fiber (NCF) structure. The sensor achieves BNP detection by significantly amplifying the Raman signal of the toluidine blue (TB) marker through the synergistic effect of NCF’s unique optical transmission modes and localized surface plasmon resonance (LSPR). To optimize the sensor performance, we first investigated the effect of the NCF length on the Raman signal, using Rhodamine 6G (R6G), and determined the optimal structural parameters. Combined with the microfluidic chip integration technology, the antibody–BNP–antibody sandwich structure was adopted, and TB was used as the Raman label to realize the quantitative detection of BNP. Experimental results demonstrate that the detection limit of the sensor is lower than the clinical diagnostic threshold and exhibits stability. The sensor sensitivity can be adjusted by regulating the laser power. With its stability and high portability, this sensor provides a new solution for the early diagnosis of heart failure and demonstrates broad application prospects in biomarker detection. Full article

Objective: The aim of this study was to evaluate the diagnostic accuracy of conventional CT values and the dual-energy computed tomography (DECT)-derived effective atomic number (Zeff), fat fraction (FF) and iodine concentration (IC) for the differentiation of hypodense liver lesions in patients with colorectal cancer (CRC). Methods: One hundred and twenty patients (mean age: 65 ± 12 years) affected by CRC who underwent dual-source DECT as part of tumor staging between December 2015 and June 2023 were retrospectively evaluated. Spectral datasets were reconstructed for each patient and regions of interest were applied at the level of hypodense liver lesions to collect CT, Zeff, FF and IC values. To assess diagnostic accuracy, receiver operating characteristic (ROC) curves were constructed to evaluate the area under the curve (AUC), sensitivity, and specificity using biopsy or MRI (in cases when biopsy was not indicated or feasible) as a reference standard. The Youden index was used to identify optimal cut-off values for potential clinical applications. Results: A total of 223 lesions (147 metastases and 76 cysts) were evaluated. CT, FF and IC values differed significantly between metastases and cysts (p < 0.0001), showing high diagnostic accuracy. FF showed significantly higher diagnostic accuracy compared to all other parameters (all p ≤ 0.0074), with an AUC value of 0.97 (95% CI: 0.94–0.99). For a cut-off > 15.9, the sensitivity reached 91.8% (95% CI: 86.2–95.7) and the specificity reached 98.7% (95% CI: 92.9–100). Zeff numbers did not differ considerably (p = 0.781) between the two entities and demonstrated a lower AUC (0.511; 95% CI: 0.44–0.58). Conclusions: FF measurements proved to have high diagnostic accuracy compared to CT values, IC, and Zeff in the evaluation of hypodense liver lesions in patients suffering from colorectal carcinoma. Full article