Tag: pubmed

PLoS One. 2025 Jul 8;20(7):e0327565. doi: 10.1371/journal.pone.0327565. eCollection 2025.

ABSTRACT

INTRODUCTION: Skilled birth attendants play an important role in reducing maternal mortality. Although Ethiopia has shown a remarkable reduction in maternal mortality, maternal health service utilization, such as skilled birth attendance, remains low. Thus, this study aims to assess the urban-rural disparity in skilled birth attendance in Ethiopia using the 2019 Ethiopian mini demographic health survey.

METHODS AND MATERIALS: The study was based on data obtained from demographic and health surveys in Ethiopia. A total weighted sample of 5,527 women who gave birth within 5 years preceding the survey was included. The result of descriptive statistics was reported using the frequency, percentages, graphs, and tables. A multivariate decomposition analysis was used to identify factors contributing to the disparity of skilled birth attendance across residence. Statistical significance was defined at a 95% confidence interval with a p-value of less than 0.05.

RESULT: Skilled birth attendance utilization among women in Ethiopia was 49.8% (95% CI: 48.5-51.1). The disparity in skilled birth attendance coverage between urban and rural areas was significantly high (Urban coverage was 72.1% and rural coverage was 42.5%). Endowment coefficients (women’s characteristics) explained 88% of the urban-rural disparity in the magnitude of skilled birth attendance. Women with secondary and above educational status, four or more antenatal care visits, households with televisions and radio, women in the richest wealth index and women with five or more parity were the determinants that explained the urban-rural disparity in skilled birth attendance.

CONCLUSION AND RECOMMENDATIONS: There was a significant disparity in skilled birth attendance utilization between urban and rural areas. Factors like maternal education, wealth status, antenatal care visits, and media access explained the disparity. To attain equitable progress towards universal coverage of SBA, special efforts and resources should be targeted towards rural women. Initiatives aimed at enhancing access to health services and health care consultations for the rural community are also recommended.

PMID:40627778 | DOI:10.1371/journal.pone.0327565

IEEE Trans Biomed Eng. 2025 Jul 8;PP. doi: 10.1109/TBME.2025.3587003. Online ahead of print.

ABSTRACT

Knee Osteoarthritis (KOA) is a prevalent musculoskeletal disorder that severely impacts mobility and quality of life, particularly among older adults. Its diagnosis often relies on subjective assessments using the Kellgren-Lawrence (KL) grading system, leading to variability in clinical evaluations. To address these challenges, we propose a confidence-driven deep learning framework for early KOA detection, focusing on distinguishing KL-0 and KL-2 stages. The Siamese-based framework integrates a novel multi-level feature extraction architecture with a hybrid loss strategy. Specifically, multi-level Global Average Pooling (GAP) layers are employed to extract features from varying network depths, ensuring comprehensive feature representation, while the hybrid loss strategy partitions training samples into high-, medium-, and low-confidence subsets. Tailored loss functions are applied to improve model robustness and effectively handle uncertainty in annotations. Experimental results on the Osteoarthritis Initiative (OAI) dataset demonstrate that the proposed framework achieves competitive accuracy, sensitivity, and specificity, comparable to those of expert radiologists. Cohen’s kappa values ($kappa$ $>$ 0.85)) confirm substantial agreement, while McNemar’s test ($p$ $>$ 0.05) indicates no statistically significant differences between the model and radiologists. Additionally, Confidence distribution analysis reveals that the model emulates radiologists’ decision-making patterns. These findings highlight the potential of the proposed approach to serve as an auxiliary diagnostic tool, enhancing early KOA detection and reducing clinical workload. Our code is available at https://github.com/ZWang78/Confidence.

PMID:40627470 | DOI:10.1109/TBME.2025.3587003

Future Oncol. 2025 Jul 8:1-12. doi: 10.1080/14796694.2025.2526319. Online ahead of print.

ABSTRACT

BACKGROUND: Early-onset colorectal cancer, diagnosed before 50 years (EOCRC), is rising. Previous studies suggest younger patients experience longer diagnostic intervals potentially contributing to poorer outcomes.

RESEARCH DESIGN AND METHODS: A prospective cohort study comparing EOCRC patients in Canterbury, Aotearoa New Zealand, with a control group of late-onset patients (65+ years, LOCRC). Pathways to diagnosis and diagnostic intervals were compared.

RESULTS: Sixty-three consecutive EOCRC patients were compared 64 LOCRC patients. The younger cohort was more likely to have advanced disease (stage four in 32% v 17%). Pathways to diagnosis were comparable between the groups (p > 0.05). EOCRC patients, however, visited their GP more frequently before diagnosis (p = 0.04), and 40% had an appraisal interval (time from symptoms to seeking medical advice) exceeding 3 months compared to 26% of LOCRC patients, though this was not significant (p = 0.146). Stage four EOCRCs were less likely to have appraisal intervals >3 months (OR 0.28, p = 0.046).

CONCLUSION: Pathways to diagnosis were similar between EOCRC and LOCRC patients. Shorter diagnostic intervals were associated with advanced disease, indicating that shortening diagnostic intervals alone may not improve outcomes. Diagnosing CRC prior to symptoms develop (screening) is likely the best way to improve outcomes.

PMID:40627443 | DOI:10.1080/14796694.2025.2526319

Kardiologiia. 2025 Jul 7;65(6):34-43. doi: 10.18087/cardio.2025.6.n2933.

ABSTRACT

Aim To monitor the dynamics of biomarkers during chemotherapy, targeted chemotherapy and targeted monotherapy in patients with HER2-positive breast cancer (BC); to analyze the emergence timing of these changes; to compare early biochemical and echocardiographic criteria; and to determine the best time for assessing latent subclinical cardiac dysfunction.Material and methods Patients with BC (229 women aged 57±11 years) treated sequentially with anthracyclines, a combination of docetaxel and trastuzumab, and trastuzumab monotherapy were examined during three blocks of BC therapy until the development of clinical cardiotoxicity. Time-related changes in high-sensitivity cardiac troponin I, N-terminal pro-brain natriuretic peptide (NT-proBNP), left ventricular (LV) global longitudinal strain (GLS) and LV ejection fraction (EF) (up to 12 speckle-tracking echocardiograms/up to 12 laboratory tests) were analyzed. Clinical cardiotoxicity was defined as a symptomatic decrease in LV EF ≥10% from the baseline value of 54% or more.Results Clinically significant cardiotoxicity developed in 6.3-10.9% of cases depending on the treatment option for BC. Early manifestations of cardiotoxicity were detected already at 3 weeks after the start of the first course of chemotherapy. For the BC treatment with anthracyclines and targeted chemotherapy with docetaxel and trastuzumab, the markers of clinical cardiotoxicity were high-sensitivity cardiac troponin I, NT-proBNP and GLS LV. For the trastuzumab monotherapy, only GLS LV had a prognostic value. No statistically significant changes in the concentrations of high-sensitivity troponin I and NT-proBNP were found.Conclusion For timely detection of clinical cardiotoxicity, laboratory tests (high-sensitivity troponin I, NT-proBNP) and echocardiography (GLS LV) are recommended to be performed every 3 weeks before the next course of BC therapy. While doing so, their sensitivity will depend on the treatment option for BC.

PMID:40627425 | DOI:10.18087/cardio.2025.6.n2933

Kardiologiia. 2025 Jul 7;65(6):23-33. doi: 10.18087/cardio.2025.6.n2949.

ABSTRACT

Aim Clinical and economic analysis of the feasibility of using new-generation drugs of the PCSK-9 inhibitor class (alirocumab and evolocumab) and the drugs that utilize in their action the effect of ribonucleic acid interference (inclisiran) in the treatment of patients with a high risk of cardiovascular events in medical organizations of the Moscow Region (MR).Material and methods Based on statistical and literature data on morbidity, as well as data from real-life practice about using alirocumab, evolocumab, and inclisiran in medical organizations of the MR, populations of patients with hypercholesterolemia and cardiovascular pathology were identified in that region. Two analytical models were developed that include the structure and number of patients receiving a combination therapy (high-dose statins + ezetimibe + alirocumab/evolocumab/inclisiran). To estimate the economic feasibility of the treatment with innovative drugs, direct medical costs were calculated for various therapeutic regimens. The cost of pharmacotherapy was calculated per patient per one-year course. A budget impact analysis (BIA) and a sensitivity analysis of the results were performed. The modeling period of the study was 3 years.Results The number of patients in different populations receiving the combination therapy will be 12,228 and 895 people in the first year, and 12,973 and 950 people in the third year, taking into account the determined increase in the patient number. The total costs of treating one patient with hypercholesterolemia and cardiovascular diseases during the first year of therapy with inclisiran are 23.31 and 27.66% lower than with evolocumab and alirocumab, respectively. The BIA revealed a slight increase in the total cost of treating patients in each population (by 1.39 and 1.69% compared to 2024). The increase in the regional budget will be related only with the annual increase in the number of patients with hypercholesterolemia. The sensitivity analysis showed the robustness of the results to changes in the initial parameter values.Conclusion The treatment of patients with dyslipidemia and high risk of cardiovascular events with alirocumab/evolocumab/inclisiran as part of the combination therapy is an economically justified strategy in the settings of the regional healthcare system.

PMID:40627424 | DOI:10.18087/cardio.2025.6.n2949

Kardiologiia. 2025 Jul 7;65(6):3-11. doi: 10.18087/cardio.2025.6.n2936.

ABSTRACT

Aim To determine the array of metabolomic profiles and structural and functional parameters of the vascular wall associated with the risk of cardiovascular toxicity of antitumor therapy (ATT) in oncohematological patients.Material and methods This study included 59 patients, among them 34 patients with lymphomas (non-Hodgkin and Hodgkin lymphoma) and 25 with multiple myeloma. Before and after 3 courses of ATT (anthracyclines, proteasome inhibitors), finger photoplethysmography and transthoracic echocardiography were performed as well as metabolomic profiling (98 metabolites) by high-performance liquid chromatography in combination with tandem mass spectrometry. Statistical analysis of the results included parametric and nonparametric tests, logistic regression, and cross-validation.Results The study showed that even before the initiation of ATT, cancer patients had signs of endothelial dysfunction and increased vascular wall stiffness (increased aSI, RI, and IO indices), which significantly worsened after the specific treatment. Metabolomic profiling identified a set of metabolites associated with the risk of cardiovascular toxicity, including increased concentrations of amino acids (asparagine, serine, glutamate, glutamine, taurine, citrulline), short-chain acylcarnitines (C18:1 OH-carnitine, C16:1 OH-carnitine, C14OH-carnitine, C2 carnitine), choline metabolism intermediates (TMAO, dimethylglycine, choline), tryptophan metabolites (hydroxyindoleacetic acid, kynurenic acid). Additionally, a logistic regression model was developed based on the analysis of the metabolomic profile, which showed a high prognostic power (AUC = 0.84) for predicting cardiovascular toxicity of ATT.Conclusion The study identified key metabolites and structural and functional parameters of blood vessels that allow detection of an increased risk of cardiovascular complications of ATT in patients with lymphomas and multiple myeloma before the initiation of a specific treatment. Increased concentrations of amino acids, acylcarnitines, and choline metabolites may serve as an additional risk factor for the onset/progression of cardiovascular complications. The proposed integrative approach, including both metabolomic profiling and non-invasive assessment of the vascular wall condition, opens broad prospects for personalized cardioprotection of cancer patients and more accurate monitoring of the cardiovascular status during ATT.

PMID:40627422 | DOI:10.18087/cardio.2025.6.n2936

Proc Natl Acad Sci U S A. 2025 Jul 15;122(28):e2420287122. doi: 10.1073/pnas.2420287122. Epub 2025 Jul 8.

ABSTRACT

Stimulus-driven, multiarea processing in the inferotemporal (IT) cortex is thought to be critical for transforming sensory inputs into useful representations of the world. What are the formats of these neural representations and how are they computed across the nodes of the IT networks? A growing literature in computational neuroscience focuses on the computational-level objective of acquiring high-level image statistics that supports useful distinctions, including between object identities or categories. Here, inspired by classic theories of vision, we suggest an alternative possibility. We show that inferring 3D objects may be a distinct computational-level objective of IT, implemented via an algorithm analogous to graphics-based generative models of how 3D scenes form and project to images, but in the reverse order. Using perception of bodies as a case study, we show that inverse graphics spontaneously emerges in inference networks trained to map images to 3D objects. Remarkably, this correspondence to the reverse of a graphics-based generative model also holds across the body processing network of the macaque IT cortex. Finally, inference networks recapitulate the feedforward progression across the stages of this IT network and do so better than the currently dominant vision models, including both supervised and unsupervised variants, none of which aligns with the reverse of graphics. This work suggests inverse graphics as a multiarea neural algorithm implemented within IT, and points to ways for replicating primate vision capabilities in machines.

PMID:40627399 | DOI:10.1073/pnas.2420287122

Proc Natl Acad Sci U S A. 2025 Jul 15;122(28):e2500874122. doi: 10.1073/pnas.2500874122. Epub 2025 Jul 8.

ABSTRACT

This study examines the theoretical and methodological limitations of migration research in understanding gender-specific trends of migration. In particular, theory-driven methods suffer from the gender blindness of migration theories, while data-driven methods suffer from the scarcity of gender disaggregated migration data. This research aims to evaluate how these dual limitations affect the accuracy of commonly used migration prediction models. By analyzing migration flows disaggregated by gender, the study compares the performance of deterministic methods and probabilistic gravity-type models in predicting migrant flows with varying gender compositions. The findings reveal significant differences in the predictive performance of gravity-type models based on the gender composition of migration flows. Drawing on migration theories and case studies, the study contextualizes these findings, concluding that the lack of robust theoretical frameworks and the limited availability of gender-specific migration data have critically undermined the accuracy of current prediction and forecasting methods. The implications of this research highlight the urgent need for a critical reassessment of migration theories and methodologies through the lens of gender biases, paving the way for more inclusive and accurate migration predictions.

PMID:40627387 | DOI:10.1073/pnas.2500874122

Dentomaxillofac Radiol. 2025 Jul 8:twaf054. doi: 10.1093/dmfr/twaf054. Online ahead of print.

ABSTRACT

OBJECTIVES: To reduce the problems arising from the inability to identify dental implant brands, this study aims to classify various dental implant brands using deep learning algorithms on panoramic radiographs.

METHODS: Images of four different dental implant systems (NucleOSS, Medentika, Nobel, and Implance) were used from a total of 5,375 cropped panoramic radiographs. To enhance image clarity and reduce blurriness, the Contrast Limited Adaptive Histogram Equalization (CLAHE) filter was applied. GoogleNet, ResNet-18, VGG16, and ShuffleNet deep learning algorithms were utilized to classify the four different dental implant systems. To evaluate the classification performance of the algorithms, ROC curves and confusion matrices were generated. Based on these confusion matrices, accuracy, precision, sensitivity, and F1 score were calculated. The Z-test was used to compare the performance metrics across different algorithms.

RESULTS: The accuracy rates of the deep learning algorithms were obtained as 96.00% for GoogleNet, 84.40% for ResNet-18, 98.90% for VGG16, and 84.80% for ShuffleNet. A statistically significant difference was found between the accuracy rate of the VGG16 algorithm and those of GoogleNet, ShuffleNet, and ResNet-18 (p < 0.001, p < 0.001, and p < 0.001, respectively).

CONCLUSIONS: With the achievement of high accuracy rates, deep learning algorithms are considered a valuable and powerful method for identifying dental implant brands.

PMID:40627380 | DOI:10.1093/dmfr/twaf054

JAMA Netw Open. 2025 Jul 1;8(7):e2519410. doi: 10.1001/jamanetworkopen.2025.19410.

ABSTRACT

IMPORTANCE: National Immunization Technical Advisory Groups recommend long-acting monoclonal antibody prophylaxis for the prevention of respiratory syncytial virus (RSV) disease for children at high risk in the first season, regardless of RSV vaccination during pregnancy, and for those who remain at increased risk in the second season.

OBJECTIVE: This study assessed which groups of children with chronic medical conditions (CMCs) are at higher risk of RSV hospitalization during their first and second RSV seasons.

DESIGN, SETTING, AND PARTICIPANTS: This retrospective, population-based, season-stratified cohort analysis was conducted among children who were born between April 1, 2013, and March 31, 2023, in British Columbia, Canada (population of 5.7 million in 2024), and were enrolled in the provincial medical service plan and followed up until the day before their third RSV season or April 1, 2024, whichever occurred first.

EXPOSURE: Any CMC diagnosed in the first 2 years of life.

MAIN OUTCOMES AND MEASURES: Respiratory syncytial virus-related hospitalizations.

RESULTS: The final cohort consisted of 431 937 children (32 959 [7.6%] born at <37 weeks’ gestation; 222 207 boys [51.4%]) followed up for a median of 728 days (IQR, 642-729 days), including 25 452 children (5.9%) diagnosed with at least 1 of 1116 distinct CMCs. In total, 4567 children (1.1%) experienced a combined total of 4592 RSV hospitalizations, combining data from the first and second RSV seasons. In the first RSV season, the RSV hospitalization rate per 1000 person-years for children with CMCs was 15.9 (95% CI, 14.2-17.6) and for children without CMCs was 8.0 (95% CI, 7.7-8.3). In the second RSV season, the RSV hospitalization rate per 1000 person-years for children with CMCs was 7.8 (95% CI, 6.7-8.8) and for children without CMCs was 2.2 (95% CI, 2.1-2.3). Children with multisystem CMCs, particularly those affecting the respiratory, cardiovascular, or gastrointestinal systems, had second-season RSV hospitalization rates that were at least 2-fold higher than the rate among all children in the first season. Second-season rates among children with Down syndrome or those who were born prematurely (<28 weeks of gestation) were 5-fold higher than for all children in the first season.

CONCLUSIONS AND RELEVANCE: This population-based retrospective cohort study identified specific groups of higher-risk children with CMCs who could most benefit from prophylaxis with long-acting monoclonal antibodies in their first and second RSV seasons. This study supports expanded eligibility criteria for long-acting monoclonal antibody prophylaxis.

PMID:40627354 | DOI:10.1001/jamanetworkopen.2025.19410