Multimodal feature fusion in deep learning for comprehensive dental condition classification

BACKGROUND

Dental health issues are on the rise, necessitating prompt and precise diagnosis. Automated dental condition classification can support this need.

OBJECTIVE

The study aims to evaluate the effectiveness of deep learning methods and multimodal feature fusion techniques in advancing the field of automated dental condition classification.

METHODS AND MATERIALS

A dataset of 11,653 clinically sourced images representing six prevalent dental conditions-caries, calculus, gingivitis, tooth discoloration, ulcers, and hypodontia-was utilized. Features were extracted using five Convolutional Neural Network (CNN) models, then fused into a matrix. Classification models were constructed using Support Vector Machines (SVM) and Naive Bayes classifiers. Evaluation metrics included accuracy, recall rate, precision, and Kappa index.

RESULTS

The SVM classifier integrated with feature fusion demonstrated superior performance with a Kappa index of 0.909 and accuracy of 0.925. This significantly surpassed individual CNN models such as EfficientNetB0, which achieved a Kappa of 0.814 and accuracy of 0.847.

CONCLUSIONS

The amalgamation of feature fusion with advanced machine learning algorithms can significantly bolster the precision and robustness of dental condition classification systems. Such a method presents a valuable tool for dental professionals, facilitating enhanced diagnostic accuracy and subsequently improved patient outcomes.

The Lower Limit of Reference of Urinary Albumin/Creatinine Ratio and the Risk of Chronic Kidney Disease Progression in Patients With Type 2 Diabetes Mellitus

A urine albumin/creatinine ratio (UACR) <30 mg/g is considered to be normal, while increased risk of incident hypertension and cardiovascular disease mortality in subjects with high normal UACR level had been observed. However, a mild elevated but normal UACR level was associated with the risk of initiating chronic kidney disease (CKD) is uncertain. We investigated whether higher normal UACR is associated with the risk of developing CKD. A total of 4821 subjects with type 2 diabetes mellitus (T2DM), an estimated glomerular filtration rate >60 ml/min/1.73 m² and UACR <30 mg/g enrolled in a diabetes disease management program between 2006 and 2020 were studied. The optimal cutoff point for baseline UACR as a predictor for progression to CKD according to the 2012 KDIGO definition was calculated using receiving operating characteristic curve analysis. After a mean of 4.9 years follow-up, the CKD risk progression increased in parallel with the quartiles of baseline UACR <30 mg/g (p for trend <0.0001). UACR cutoff points of 8.44 mg/g overall, 10.59 mg/g in males and 8.15 mg/g in females were associated with the risk of CKD progression. In multivariate Cox regression analysis, the hazard ratios for the association between UACR (>8.44 mg/g, >10.9 mg/g, >8.15 mg/g in overall, male, and female patients, respectively) and the risk of CKD progression were significant. This study demonstrated that a cutoff UACR value of >10 mg/g could significantly predict the cumulative incidence and progression of CKD in patients with T2DM.

Survival Analysis of Antineoplastic Treatment for Older Patients with Metastatic Non-Small-Cell Lung Cancer: A Clinical Database Study

PURPOSE

To explore whether antineoplastic treatment can improve overall survival (OS) in older patients with metastatic non-small-cell lung cancer (mNSCLC).

PATIENTS AND METHODS

Using the cancer registry database of a tertiary medical center in Taiwan, we followed patients 65 years old and above with pathologically proved mNSCLC. Chi-square test and Cox regression were used to analyze differences in clinical characteristics, the treatments they received, and factors predicting survival. Kaplan-Meier survival analysis was used to analyze OS differences.

RESULTS

A total of 542 older patients were diagnosed with mNSCLC from 2011 to 2017. Multivariate Cox regression showed that patients receiving targeted therapy (TT) alone, chemotherapy (CT) alone, and crossover (CO) treatment were at significantly less risk of short OS [hazard ratio (HR) 0.351, 95% confidence interval (CI), 0.257-0.479; HR 0.517, CI 0.376-0.711; and HR 0.544, CI 0.373-0.792, respectively]. Patients at significantly increased risk of short OS were those aged ≥85 years and those assigned poorer Eastern Cooperative Oncology Group Performance Status (ECOG-PS) scores (HR 1.513, CI 1.135-2.017, and HR 2.854, CI 2.188-3.724, respectively). The result of Kaplan-Meier survival analysis of 418 patients with ECOG-PS scores 0-2 suggested that patients who received antineoplastic treatments had a significantly better median OS than those receiving supportive care (SC), those receiving TT having the best result (SC, 4.00 months; TT, 21.17 months; CT, 12.83 months; CO, 15.83 months, P<0.001).

CONCLUSION

Antineoplastic treatments, especially TT, can improve OS for selected older patients with mNSCLC.

Influence of alcohol use on mortality and expenditure during hospital admission: a cross-sectional study

OBJECTIVES

This study was designed to investigate the effect of alcohol intoxication on clinical presentation of hospitalised adult trauma patients at a Level I trauma centre using propensity score matching.

DESIGN

Cross-sectional study.

SETTING

Taiwan.

PARTICIPANTS

Detailed data of 929 hospitalised adult trauma patients with alcohol intoxication, aged 20-65 years, and 10 104 corresponding patients without alcohol intoxication were retrieved from the Trauma Registry System between 1 January 2009 and 31 December 2014. Alcohol intoxication was defined as a blood alcohol concentration (BAC) ≥50 mg/dL.

MAIN OUTCOME MEASURES

In-hospital mortality and expenditure.

RESULTS

Patients with alcohol intoxication presented with significantly higher short-term mortality (OR: 3.0, 95% CI 2.0 to 4.4; p<0.001) than patients without alcohol intoxication. However, on comparison with propensity score-matched patients with respect to sex, age, comorbidity, Glasgow Coma Scale (GCS), injury region based on Abbreviated Injury Scale (AIS) and Injury Severity Score (ISS), alcohol intoxication did not significantly influence mortality (OR: 0.8, 95% CI 0.5 to 1.4; p=0.563). This implied that the higher mortality of alcohol-intoxicated patients was attributable to patient characteristics such as a higher injury severity rather than alcohol intoxication. Even on comparison with sex-matched, age-matched and comorbidity-matched patients without alcohol intoxication, patients with alcohol intoxication still had significantly higher total expenditure (17.4% higher), cost of operation (40.3% higher), cost of examination (52.8% higher) and cost of pharmaceuticals (38.3% higher).

CONCLUSIONS

The associated higher mortality of adult trauma patients with alcohol intoxication was completely attributable to other patient characteristics and associated injury severity rather than the effects of alcohol. However, patients with alcohol intoxication incurred significantly higher expenditure than patients without alcohol intoxication, even on comparison with sex-matched, age-matched and comorbidity-matched patients without alcohol intoxication.

Brachial-ankle pulse wave velocity as an early indicator of left ventricular diastolic function among hypertensive subjects

While increased arterial stiffness is a known risk of cardiovascular disease, pulse wave velocity (PWV) is a conventionally adopted index of arterial stiffness. However, the relationship between PWV and left ventricular functions are not thoroughly evaluated. This cross-sectional study investigated whether PWV measurement is an early indicator of left ventricular (LV) dysfunction. A noninvasive, volume-plethysmographic apparatus was used to determine blood pressure, electrocardiogram, heart sounds, and PWV in 42 consecutively diagnosed subjects with hypertension, and 42 sex- and age-matched nonhypertension subjects were studied. Arterial stiffness and aortic stiffness were evaluated by brachial-ankle (b-a) PWV, heart-carotid (h-c) PWV, heart-femoral (h-f) PWV, carotid-femoral (c-f) PWV, and femoral-ankle (f-a) PWV. Function of LV was estimated by tissue Doppler imaging (TDI) echocardiography. Hypertension subjects exhibited higher b-a PWV and late diastolic mitral flow velocity values than those of nonhypertensive subjects. Pearson correlation analysis revealed that LV diastolic function (Em(av)) negatively correlated with c-f PWV and b-a PWV. Multiple linear regression analysis indicated that b-a PWV was independently and negatively associated with LV diastolic function (Em(av)). Further analysis by stratified hypertensive status, the b-a PWV were independently and negatively associated with Em(av) in hypertensive subjects (p = 0.004) only. In conclusion, the b-a PWV, but not c-f PWV, h-c PWV, h-f PWV, or f-a PWV, is significantly correlated with LV diastolic function in hypertensive subjects, indicating that b-a PWV involving both central and peripheral components of arterial stiffness may be an early indicator of LV dysfunction.

Interleukin-8 secretion by cultured oral epidermoid carcinoma cells induced with nicotine and/or arecoline treatments

Interleukin-8 (IL-8) is one of the multifunctional cytokines that can play a role on immune and inflammatory activities. Other in vitro observations indicated that IL-8 is a growth factor for keratinocytes. However, as the role of IL-8 in oral cancer cells is unclear, this study is thus designed to examine IL-8 secretion in cultured oral epidermoid carcinoma KB CCL17 cells treated with nicotine and/or arecoline. The cultures were treated with nicotine (1 or 100 microM) and arecoline (1 or 100 microM), alone or both, for 72 hrs. Enzyme-linked immunosorbent assay (ELISA) was used to examine IL-8 concentrations in culture supernatants. A repeated measure analysis of variance was used to identify differences among the treatments. Nicotine and arecoline, single or combined treatment, increased IL-8 secretion in KB CCL17 cells. When monoclonal 1 microgram/ml of antibody was added against IL-1 alpha or IL-1 beta in the treatment, IL-8 concentration significantly decreased compared with the non-added one. Exposure of cells to antibody against IL-1 alpha or IL-1 beta showed no significant increase in cell growth as compared with the control (medium alone). However, incubation of cells for 72 hrs in the presence of nicotine and/or arecoline treatments and antibody against IL-1 alpha or IL-1 beta significantly increased cell growth as compared with the antibody free one. It was concluded that IL-8 secretion by KB CCL17 cells may be partially mediated by IL-1 which could inhibit the KB CCL17 cell growth. Thus, IL-8 may be a vital participant in the cascade of interacting cytokines during smoking and areca quid chewing, inducing inflammation in oral cancer.

Nicotine- and arecoline-induced interleukin-1 secretion and intercellular adhesion molecular-1 expression in human oral epidermoid carcinoma cells in vitro

The purpose was to examine interleukin (IL)-1 concentrations and intercellular adhesion molecule (ICAM)-1 expression in nicotine/arecoline-exposed oral KB CCL17 cultures. Enzyme-linked immunosorbent assay was used to quantify IL-1 concentrations in culture supernatants. A repeated-measures analysis of variance was used to identify differences among the groups. IL-1 beta concentrations increased by 2.6, 2.7 and 7.5 times those of the control in groups treated with 1 microM nicotine, arecoline or with both, respectively. IL-1 beta concentrations were more dramatically increased when the agents tested were at 100 microM concentration. Similar, although less dramatic, alterations in IL-1 alpha concentrations were observed. The fluorescence intensity of ICAM-1 (CD54) analysed by flow cytometry was also significantly increased in a dose-dependent manner when the cells were treated with nicotine and/or arecoline. Nicotine and arecoline therefore significantly increased IL-1 alpha and -1 beta secretions and the surface expression of ICAM-1 in KB CCL17 cells.