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Jacheć, Wojciech, Anna Polewczyk, Maciej Polewczyk, Andrzej Tomasik, and Andrzej Kutarski. "Transvenous Lead Extraction SAFeTY Score for Risk Stratification and Proper Patient Selection for Removal Procedures Using Mechanical Tools." Journal of Clinical Medicine 9, no. 2 (January 28, 2020): 361. http://dx.doi.org/10.3390/jcm9020361.
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Background: To ensure the safety and efficacy of the increasing number of transvenous lead extractions (TLEs), it is necessary to adequately assess the procedure-related risk. Methods: We analyzed potential clinical and procedural risk factors associated with 2049 TLE procedures. The TLEs were performed between 2006 and 2016 using only simple tools for lead extraction. Logistic regression analysis was used to develop a risk prediction scoring system for TLEs. Results: Multivariate analysis showed that the sum of lead dwell times, anemia, female gender, the number of procedures preceding TLE, and removal of leads implanted in patients under the age of 30 had a significant influence on the occurrence of major complications during a TLE. This information served as a basis for developing a predictive SAFeTY TLE score, where: S = sum of lead dwell times, A = anemia, Fe = female, T = treatment (previous procedures), Y = young patients, and TLE = transvenous lead extraction. In order to facilitate the use of the SAFeTY TLE Score, a simple calculator was constructed. Conclusion: The SAFeTY TLE score is easy to calculate and predicts the potential occurrence of procedure-related major complications. High-risk patients (scoring more than 10 on the SAFeTY TLE scale) must be treated at high-volume centers with surgical backup.
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Wang, Yan, and Zhisheng Wu. "The establishment of a stroke-associated pneumonia predictive scoring system." Neurology Asia 26, no. 3 (September 2021): 485–90. http://dx.doi.org/10.54029/2021xdx.
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Background & Objective: Stroke-associated pneumonia (SAP) is a common complication of ischemic stroke, increasing the length of hospital stay and costs, and affecting prognosis. This study aimed to determine the incidence of SAP, investigate the risk factors that lead to SAP to facilitate a more targeted response to the prevention of SAP. Methods: A retrospective study was performed to analyze the factors that predict SAP in an acute stroke population from a university affiliated hospital in Fujian, China. A SAP risk score table was constructed. Results: A total of 1,016 patients with acute cerebral infarction were enrolled. The incidence of SAP was 13.58%. Multivariate regression analysis found that age, NIHSS, GCS scores, dysphagia, heart failure, creatinine, and proton pump inhibitors (PPIs) use were independently associated with SAP. Based on the data, a SAP risk score table was constructed with age > 75 years -2 points, NIHSS ≥ 16 -2 points, GCS score ≤ 8 -1.5 points, dysphagia - 5 points, heart failure - 1.5 points, creatinine - 1 point, PPIs use - 1.5 points, a total of 14.5 points. The optimal value was 3 points. Conclusions: Age, NIHSS, GCS score, dysphagia, heart failure, creatinine, and PPIs use were predictive of SAP.
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MacCann, Carolyn, Gerald Matthews, Moshe Zeidner, and Richard D. Roberts. "PSYCHOLOGICAL ASSESSMENT OF EMOTIONAL INTELLIGENCE: A REVIEW OF SELF‐REPORT AND PERFORMANCE‐BASED TESTING." International Journal of Organizational Analysis 11, no. 3 (March 1, 2003): 247–74. http://dx.doi.org/10.1108/eb028975.
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This article provides a review and conceptual comparison between self‐report and performance‐based measures of emotional intelligence. Analyses of reliability, psychometric properties, and various forms of validity lead to the conclusion that self‐report techniques measure a dispositional construct, that may have some predictive validity, but which is highly correlated with personality and independent of intelligence. Although seemingly more valid, performance‐based measures have certain limitations, especially when scored with reference to consensual norms, which leads to problems of skew and restriction of range. Scaling procedures may partially ameliorate these scoring weaknesses. Alternative approaches to scoring, such as expert judgement, also suffer problems since the nature of the requisite expertise is unclear. Use of experimental paradigms for studying individual differences in information‐processing may, however, inform expertise. Other difficulties for performance‐based measures include limited predictive and operational validity, restricting practical utility in organizational settings. Further research appears necessary before tests of E1 are suitable for making real‐life decisions about individuals.
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Prelevic, Rade, Miroslav Stojadinovic, Dejan Simic, Aleksandar Spasic, and Nikola Petrovic. "Scoring system development for prediction of extravesical bladder cancer." Vojnosanitetski pregled 71, no. 9 (2014): 851–57. http://dx.doi.org/10.2298/vsp130814040p.
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Background/Aim. Staging of bladder cancer is crucial for optimal management of the disease. However, clinical staging is not perfectly accurate. The aim of this study was to derive a simple scoring system in prediction of pathological advanced muscle-invasive bladder cancer (MIBC). Methods. Logistic regression and bootstrap methods were used to create an integer score for estimating the risk in prediction of pathological advanced MIBC using precystectomy clinicopathological data: demographic, initial transurethral resection (TUR) [grade, stage, multiplicity of tumors, lymphovascular invasion (LVI)], hydronephrosis, abdominal and pelvic CT radiography (size of the tumor, tumor base width), and pathological stage after radical cystectomy (RC). Advanced MIBC in surgical specimen was defined as pT3-4 tumor. Receiving operating characteristic (ROC) curve quantified the area under curve (AUC) as predictive accuracy. Clinical usefulness was assessed by using decision curve analysis. Results. This single-center retrospective study included 233 adult patients with BC undergoing RC at the Military Medical Academy, Belgrade. Organ confined disease was observed in 101 (43.3%) patients, and 132 (56.7%) had advanced MIBC. In multivariable analysis, 3 risk factors most strongly associated with advanced MIBC: grade of initial TUR [odds ratio (OR) = 4.7], LVI (OR = 2), and hydronephrosis (OR = 3.9). The resultant total possible score ranged from 0 to 15, with the cut-off value of > 8 points, the AUC was 0.795, showing good discriminatory ability. The model showed excellent calibration. Decision curve analysis showed a net benefit across all threshold probabilities and clinical usefulness of the model. Conclusion. We developed a unique scoring system which could assist in predicting advanced MIBC in patients before RC. The scoring system showed good performance characteristics and introducing of such a tool into daily clinical decision-making may lead to more appropriate integration of perioperative chemotherapy. Clinical value of this model needs to be further assessed in external validation cohorts.
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Aggarwal, Amulya, Alok V. Mathur, Ram K. Verma, Megha Gupta, and Dheeraj Raj. "Comparison of BISAP and Ranson’s score for predicting severe acute pancreatitis and establish the validity of BISAP score." International Surgery Journal 7, no. 5 (April 23, 2020): 1473. http://dx.doi.org/10.18203/2349-2902.isj20201854.
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Background: Pancreatitis can lead to serious complications with severe morbidity and mortality. So an early, quick and accurate scoring system is necessary to stratify the patients according to their severity so as to enable early initiation of required management and care. Scoring system commonly used have some drawbacks. This study aimed to compare bedside index for severity in acute pancreatitis (BISAP) and Ranson’s score to predict severe acute pancreatitis and establish the validity of a simple and accurate clinical scoring system for stratifying patients.Methods: This is a prospective comparative study on 100 patients diagnosed with acute pancreatitis admitted in department of general surgery. Parameters included in the BISAP and Ranson’s criteria were studied at the time of admission and after 48 hours. Result of these two were compared with that of revised Atlanta classification.Results: As per the BISAP score, the sensitivity and specificity were 95.8 % (95% CI, 76.8-99.8), 94.7 % (95% CI, 86.3-98.3) whereas positive likelihood ratio, negative likelihood ratio 18.21 (95% CI, 6.9-47.44), 0.04 (95% CI, 0.01-0.30) and accuracy was 95 % (95% CI, 88.72%-98.36%). On using Ranson’s score, the sensitivity and specificity were 91.6 (95% CI, 71.5-98.5) and 89.4 (95% CI, 79.8-95) with a positive predictive value 8.71 (95% CI, 4.47-18.96) and negative predictive value of 0.09 (95% CI, 0.02-0.35) and accuracy of 90% (95% CI, 82.38%-95.10%)..Conclusions: BISAP score outperformed Ranson’s score in terms of Sensitivity and specificity of prediction of severe pancreatitis. The authors recommend inclusion of BISAP Scoring system in standard treatment protocol of management of acute pancreatitis.
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Bontempi, Luca, Antonio Curnis, Paolo Della Bella, Manuel Cerini, Andrea Radinovic, Lorenza Inama, Francesco Melillo, et al. "The MB score: a new risk stratification index to predict the need for advanced tools in lead extraction procedures." EP Europace 22, no. 4 (February 22, 2020): 613–21. http://dx.doi.org/10.1093/europace/euaa027.
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Abstract Aims A validated risk stratification schema for transvenous lead extraction (TLE) could improve the management of these procedures. We aimed to derive and validate a scoring system to efficiently predict the need for advanced tools to achieve TLE success. Methods and results Between November 2013 and March 2018, 1960 leads were extracted in 973 consecutive TLE procedures in two national referral sites using a stepwise approach. A procedure was defined as advanced extraction if required the use of powered sheaths and/or snares. The study population was a posteriori 1:1 randomized in derivation and validation cohorts. In the derivation cohort, presence of more than two targeted leads (odds ratio [OR] 1.76, P = 0.049), 3-year-old (OR 3.04, P = 0.001), 5-year-old (OR 3.48, P < 0.001), 10-year-old (OR 3.58, P = 0.008) oldest lead, implantable cardioverter-defibrillator (OR 3.84, P < 0.001), and passive fixation lead (OR 1.91, P = 0.032) were selected by a stepwise procedure and constituted the MB score showing a C-statistics of 0.82. In the validation group, the MB score was significantly associated with the risk of advanced extraction (OR 2.40, 95% confidence interval 2.02-2.86, P < 0.001) and showed an increase in event rate with increasing score. A low value (threshold = 1) ensured 100% sensibility and 100% negative predictive value, while a high value (threshold = 5) allowed a specificity of 92.8% and a positive predictive value of 91.9%. Conclusion In this study, we developed and tested a simple point-based scoring system able to efficiently identify patients at low and high risk of needing advanced tools during TLE procedures.
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Chua, Siang Li, and Wai Leng Chow. "Development of predictive scoring model for risk stratification of no-show at a public hospital specialist outpatient clinic." Proceedings of Singapore Healthcare 28, no. 2 (August 20, 2018): 96–104. http://dx.doi.org/10.1177/2010105818793155.
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Aim: No-shows are patients who miss scheduled specialist outpatient clinic (SOC) appointments. A predictive scoring model for the risk stratification of no-shows was developed to improve the utilisation of resources. Method: The administrative records of new SOC appointments for subsidised patients in 2013 were analysed. Univariate analysis was performed on 16 variables comprising patient demographics, appointment/visit records and historical outpatient records. Multiple logistic regression (MLR) was applied to determine independent risk factors of no-shows. The adjusted parameter estimates from MLR were used to develop a predictive model for risk stratification of no-show. Model validation was performed using 2014 data. Result: Out of 75,677 appointments in 2013, 28.6% were no-shows. Univariate analysis showed that 11 variables were associated with no-shows. Six variables (age, race, specialty, lead time, referral source, previous visit status) remained independently associated with no-shows in the MLR model, and their odds ratios were used to develop the weighted predictive scoring model. Weighted scores were 0 to 19, and five levels of no-show risk were derived: extremely low (score: 0–4; odds ratio (OR): 1.0); low (5–6; OR: 2.5); medium (7–8; OR: 5.6); high (9–10; OR: 9.2); and extremely high (11–19; OR: 16.7). The predictive ability of the model was tested using receiver operation curve analysis, where the area under curve (AUC) was 72%. AUC remained at 72% upon validation with 2014 data. Conclusion: The prediction model developed using only administrative data was robust and can be used for the risk stratification of SOC no-show for better resource utilisation to improve access to care.
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Adachi, Kazuhide, Takeshi Kawase, Kazunari Yoshida, Takahito Yazaki, and Satoshi Onozuka. "ABC Surgical Risk Scale for skull base meningioma: a new scoring system for predicting the extent of tumor removal and neurological outcome." Journal of Neurosurgery 111, no. 5 (November 2009): 1053–61. http://dx.doi.org/10.3171/2007.11.17446.
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Object Surgery for skull base meningiomas (SBMs) can lead to complications because these lesions are difficult to approach and can involve cranial nerves and arteries. The authors propose a scoring system to evaluate the relative risks and benefits of surgical treatment of SBMs. Methods The authors used a 2-step process to construct their scale. First, they derived significant predictive variables from retrospective data on 132 SBM cases treated surgically (primary surgeries only) between May 2000 and December 2005. Next, they validated the predictive accuracy of their scoring system in 60 consecutive cases treated surgically between January 1995 and April 2000, including both primary and repeated surgeries. Finally, they investigated the effect of the surgery on the patients' preoperative symptoms for consecutive cases treated surgically between January 1995 and December 2005, including both primary surgeries and retreatments. Results Five items that predicted surgical risk were identified: 1) tumor attachment size; 2) arterial involvement; 3) brainstem contact; 4) central cavity location; and 5) cranial nerve group involvement. The authors named their scoring system the ABC Surgical Risk Scale, after the initial letters of these items. Each factor was assigned a score of 0–2 points, and an additional point was added for previous surgical treatment or for radiation, giving a possible total score of 12 points. On average, the scoring system allocated 2 points for gross-total resections, 6.1 points for near-total resections, and 9 points for subtotal resections, with significant differences between groups. For cases scoring ≥ 8 points, the percentage of cases showing neurological deterioration postoperatively exceeded the percentage showing improvement. Conclusions The authors conclude that this scoring system can be used to predict the extent of tumor removal and that the scores reflect the surgical risk.
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Tazenkova, Olga Andreevna. "Application of Credit Risk Scoring Methods in Corporate Borrower Monitoring." Russian Digital Libraries Journal 24, no. 4 (September 12, 2021): 689–709. http://dx.doi.org/10.26907/1562-5419-2021-24-4-689-709.
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A method for assessing the risk of default of a corporate borrower at the monitoring stage based on a scoring assessment is proposed. This paper provides proof of the hypothesis that scoring methods for assessing credit risks can be used not only at the stage of initial assessment of a potential borrower when making a decision on lending, but also at the stage of its monitoring when accompanying a transaction. Monitoring is a periodic review of the credit quality of the corporate borrower with whom the loan agreement is concluded. This is done for the purpose of timely detection of negative signals, as well as timely response to threatening trends in the borrower's activities. Some credit institutions save on monitoring by relying on the decision-making system, considering it flawless. However, this saving can be a fatal mistake, since many things change over time during the "life" of the enterprise. This is facilitated by both external factors (political, economic) and internal (incorrect development strategy of the organization, inability to assess its own credit capabilities, unscrupulous counterparties). The proposed method is a system of automatic risk signals that have been tested for predictive ability, excluding manual procedures. The proposed solution includes markers (risk signals) that have a predictive ability above average, which can lead to a default of the corporate borrower. In addition, color marking is applied – red, yellow, green, which allows you to visualize the criticality of the identified risk signal depending on the predictive ability - a visual representation of the borrower's risks in order to facilitate interpretation. The analysis of the developed method showed how much it is possible to speed up the monitoring process, which will allow for a prompt response to the identified risk signals, as well as to predict the likely deterioration of the borrower's credit quality in the loan or guarantee portfolio without compromising the quality of risk assessment.
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Suppramote, Orawan, Prapatsara Pongpunpisand, Kanlaya Ladkam, and Somkiat Rujirawat. "A novel risk score for prediction of hypersensitivity reactions in cancer patients receiving carboplatin: Retrospective observational analysis." Journal of Clinical Oncology 34, no. 3_suppl (January 20, 2016): e282-e282. http://dx.doi.org/10.1200/jco.2016.34.3_suppl.e282.
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e282 Background: Hypersentitivity reactions (HSRs) from carboplatin are high incidence and most severity in Chulabhorn hospital. These reactions are associated with several causes including patient factors and experience in drug used. A reliable and valid tool for evaluated risk of HSRs before started carboplatin infusion should lead to prevent or decrease severity of the reactions. We innovated risk score to screen patient at high risk of HSRs. Methods: From October 2013 to September 2014, all cancer patients who received carboplatin in Chulabhorn hospital were included. A retrospective study design to developed risk scoring system for prediction of patients at high risk of carboplatin hypersensitivity called “Hypersensitivity risk score”. The hypersensitivity risk score was calculated for all patients receiving carboplatin and data for carboplatin hypersensitivity were obtained from medical records. Expected and observed HSRs were analyzed by using receiver operating characteristic (ROC) curve. Results: Seventy-three cancer patients received carboplatin and five (7%) patients had HSRs. Our scoring algorithm based on cancer type, number of carboplatin retreatment, duration between each retreatment, and number of carboplatin infusions prior to first reaction. All significant predictors were weighted into points and categorized to risk group which ranged from 0 to 8 . The ROC analysis for hypersensitivity risk score indicated good predictive accuracy with an area under the curve of 0.96 (95 %CI: 0.91-1.00). Data showed high sensitivity (80%) and specificity (94.85%) for a risk score cut-off of 4. The hypersensitivity risk score clearly differentiated the low (0-1), intermediate (2-3) and intermediate-high (4-5) and high (6-8) risk patients. Conclusions: The hypersensitivity risk score is a simple scoring system with high predictive value and differentiates low versus high risk patients. This score should be used for screen high risk of hypersensitivity reactions in patients receiving carboplatin.
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Elsharawy, Mohamed Amin. "Arterial Reconstruction after Mangled Extremity: Injury Severity Scoring Systems Are Not Predictive of Limb Salvage." Vascular 13, no. 2 (March 1, 2005): 114–19. http://dx.doi.org/10.1258/rsmvasc.13.2.114.
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The Vascular Unit at Suez Canal University Hospital in Egypt covers a wide area with high rates of severe injuries. This is a prospective study of mangled extremities to identify risk factors associated with limb loss in these patients. Between December 2000 and August 2003, a prospective study on all patients with arterial injuries in mangled extremities was undertaken. All patients were scored using the Mangled Extremity Severity Score (MESS) and the Mangled Extremity Severity Index (MESI). During this period, arterial reconstruction was performed in 62 patients. Primary patency, secondary patency, and limb salvage rates were 81%, 85.5%, and 93.5%, respectively. The only factor affecting limb salvage (statistical trend) was the site of trauma (upper limb 100% vs lower limb 89%; p = .08%). There was no significant effect related to the mechanism of trauma (blunt 90% vs stab 100%; p = .125), MESS (< 7, 100% vs > 7, 91%; p = .22), and MESI (< 20, 100% vs > 20, 90.5%; p = .154). Upper limb injuries were the least likely to lead to amputation. We recommend that all injuries, whatever their score, should be surgically explored before treatment decisions are made.
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Chan, Kelvin K. W., Feng Xie, Andrew R. Willan, and Eleanor M. Pullenayegum. "Underestimation of Variance of Predicted Health Utilities Derived from Multiattribute Utility Instruments." Medical Decision Making 37, no. 3 (July 10, 2016): 262–72. http://dx.doi.org/10.1177/0272989x16650181.
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Background. Parameter uncertainty in value sets of multiattribute utility-based instruments (MAUIs) has received little attention previously. This false precision leads to underestimation of the uncertainty of the results of cost-effectiveness analyses. The aim of this study is to examine the use of multiple imputation as a method to account for this uncertainty of MAUI scoring algorithms. Method. We fitted a Bayesian model with random effects for respondents and health states to the data from the original US EQ-5D-3L valuation study, thereby estimating the uncertainty in the EQ-5D-3L scoring algorithm. We applied these results to EQ-5D-3L data from the Commonwealth Fund (CWF) Survey for Sick Adults ( n = 3958), comparing the standard error of the estimated mean utility in the CWF population using the predictive distribution from the Bayesian mixed-effect model (i.e., incorporating parameter uncertainty in the value set) with the standard error of the estimated mean utilities based on multiple imputation and the standard error using the conventional approach of using MAUI (i.e., ignoring uncertainty in the value set). Result. The mean utility in the CWF population based on the predictive distribution of the Bayesian model was 0.827 with a standard error (SE) of 0.011. When utilities were derived using the conventional approach, the estimated mean utility was 0.827 with an SE of 0.003, which is only 25% of the SE based on the full predictive distribution of the mixed-effect model. Using multiple imputation with 20 imputed sets, the mean utility was 0.828 with an SE of 0.011, which is similar to the SE based on the full predictive distribution. Conclusion. Ignoring uncertainty of the predicted health utilities derived from MAUIs could lead to substantial underestimation of the variance of mean utilities. Multiple imputation corrects for this underestimation so that the results of cost-effectiveness analyses using MAUIs can report the correct degree of uncertainty.
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Mutumba, Songiso, and J. Mulundika. "Diagnostic Accuracy of the Alvarado Scoring System in Patients Undergoing Appendicectomy at the University Teaching Hospital in Lusaka." University of Zambia Journal of Agricultural and Biomedical Sciences 4, no. 2 (April 1, 2020): 21–28. http://dx.doi.org/10.53974/unza.jabs.4.2.441.
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Background: The use of the Alvarado scoring system as a tool for diagnosing acute appendicitis has been associated with a reduction of negative appendicectomies. This study aimed to assess the diagnostic accuracy of the Alvarado scoring system at predicting acute appendicitis in patients undergoing appendicectomy at the University Teaching Hospital (UTH). Methods: A prospective study was done to evaluate the diagnostic value of the Alvarado score in patients undergoing appendicectomy at the UTH. Data was collected from the participants diagnosed with acute appendicitis and undergoing appendicectomy. The Alvarado scores for all the participants enrolled into the study were tabulated and correlated with the histopathology results. The sensitivity and the specificity of the Alvarado score was determined and used to construct the ROC curve using the SPSS version 20. The area under the curve was used to determine the diagnostic accuracy of the Alvarado score in this study. Setting: The University Teaching Hospital in Lusaka, Zambia. Results: To determine the diagnostic accuracy of the Alvarado score the ROC curve test was run in SPSS version 20. The results showed that the area under the curve was C=0.842 with SE=0.047 and 95% CI from 0.750 to 0.934. The area under the curve represents the probability that the Alvarado score result for a randomly chosen positive case will exceed the result for a randomly chosen negative case. It shows from the ROC that the Alvarado score is a good indicator to anticipate acute appendicitis. In other words, these results have confirmed that the Alvarado scoring system has very high predictive ability to discriminate acute appendicitis from normal appendix subjects. Conclusion: The use of the Alvarado scoring system as a tool for diagnosing acute appendicitis at UTH will reduce the rate of negative appendicectomies. This will lead to a reduction in unnecessary operations, which are a burden on the health care system.
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Koppad, Sanjay N., Abhinandan B. Vandakudri, Mallikarjun Desai, and Harsha Kodliwadmath. "EVALUATION OF OHMANN SCORE AND CORRELATION WITH ULTRASOUND FOR DIAGNOSING ACUTE APPENDICITIS." Journal of Surgical Sciences 3, no. 2 (June 10, 2016): 59–63. http://dx.doi.org/10.33695/jss.v3i2.50.
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Acute appendicitis is a common surgical condition that requires prompt diagnosis. However adecision to operate based on the clinical suspicion alone can lead to removal of the normalappendix in 15-30% cases. Besides the modern imaging techniques, scoring systems, based onclinical signs and symptoms and routine laboratory assessments, have been used as a diagnosticaid. However, differences in sensitivities and specificities were observed if the scores were appliedto various populations and clinical settings. The purpose of this paper is to assess the validity of theOhmann score and the correlation of ultrasound in diagnosis of acute appendicitis. A total of 80patients were enrolled in this study, 52 male patients and 28 females patients suspected of acuteappendicitis that were admitted, investigated and treated. After detailed examination andinvestigations, the Ohmann score was applied to these patients. A cut off point of 9 was taken.Patients were divided into two groups, group I score of ≥ 9 and group 2 score of < 9. This studywas conducted at SDM College of Medical Sciences and Hospital Dharwad.Proportion of truepositive for score ≥ 9 is 86.9%, Proportion of true negatives for score <9 is 87.1%. Sensitivity andspecificity of this study being 96% and 66.7%, positive predictive value and negative predictivevalue being 82.8 % and 90.9% respectively. Diagnostic odds ratio being 48 and P value of <0.005.The high scores in Ohmann scoring system is dependable aid in the early diagnosis of acuteappendicitis. Combined with ultrasound, the Ohmann scoring system has high sensitivity andspecificity, in the prediction of acute appendicitis.
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Baimas-George, Maria, Russell C. Kirks, Allyson Cochran, Erin H. Baker, B. Lauren Paton, Lynnette M. Schiffern, Brent D. Matthews, John B. Martinie, Dionisios Vrochides, and David A. Iannitti. "Patient Factors Lead to Extensive Variation in Outcomes and Cost From Cholecystectomy." American Surgeon 86, no. 6 (June 2020): 643–51. http://dx.doi.org/10.1177/0003134820923311.
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Background Cholecystectomy is a common procedure with significantly varied outcomes. We analyzed differences in comorbidities, outcomes, and cost of cholecystectomy by acute care surgery (ACS) versus hepatopancreaticobiliary (HPB) surgery. Study design Patients were retrospectively identified between 2008 and 2015. Exclusion criteria included the following: (1) part of another procedure; (2) abdominal trauma; (3) ICU admission; vasopressors. Results One hundred and twenty-six ACS and 122 HPB patients were analyzed. The HPB subset had higher burden of comorbid disease and significantly lower projected 10-year survival (87.4% ACS vs 68.5% HPB, P < .0001). Median lengths of stay were longer in HPB patients (2 vs 5 days, P < .0001) as were readmission rates (30-day 5.6% vs 13.1%, P = .040; 90-day 7.9% vs 20.5%, P = .005). Median cost was higher including operative supply cost ($969.42 vs $1920.66, P < .0001) and total cost of care ($7340.66 vs $19 338.05, P < .0001). A predictive scoring system for difficult gallbladders was constructed and a phone application was created. Conclusion Cholecystectomy in a complicated patient can be difficult with longer hospital stays and higher costs. The utilization of procedure codes to explain disparities is not sufficient. Incorporation of comorbidities needs to be addressed for planning and reimbursement.
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Verburgh, E., R. Achten, B. Maes, A. Hagemeijer, M. Boogaerts, C. De Wolf-Peeters, and G. Verhoef. "Additional Prognostic Value of Bone Marrow Histology in Patients Subclassified According to the International Prognostic Scoring System for Myelodysplastic Syndromes." Journal of Clinical Oncology 21, no. 2 (January 15, 2003): 273–82. http://dx.doi.org/10.1200/jco.2003.04.182.
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Purpose: The most recent and powerful prognostic instrument established for myelodysplastic syndromes (MDS) is the International Prognostic Scoring System (IPSS), which is primarily based on medullary blast cell count, number of cytopenias, and cytogenetics. Although this prognostic system has substantial predictive power in MDS, further refinement is necessary, especially as far as lower-risk patients are concerned. Histologic parameters, which have long proved to be associated with outcome, are promising candidates to improve the prognostic accuracy of the IPSS. Therefore, we assessed the additional predictive power of the presence of abnormally localized immature precursors (ALIPs) and CD34 immunoreactivity in bone marrow (BM) biopsies of MDS patients. Patients and Methods: Cytogenetic, morphologic, and clinical data of 184 MDS patients, all from a single institution, were collected, with special emphasis on the determinants of the IPSS score. BM biopsies of 173 patients were analyzed for the presence of ALIP, and CD34 immunoreactivity was assessable in 119 patients. Forty-nine patients received intensive therapy. Results: The presence of ALIP and CD34 immunoreactivity significantly improved the prognostic value of the IPSS, with respect to overall as well as leukemia-free survival, in particular within the lower-risk categories. In contrast to the IPSS, both histologic parameters also were predictive of outcome within the group of intensively treated MDS patients. Conclusion: Our data confirm the importance of histopathologic evaluation in MDS and indicate that determining the presence of ALIP and an increase in CD34 immunostaining in addition to the IPSS score could lead to an improved prognostic subcategorization of MDS patients.
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Yoshimura, Jumpei, Kazuma Yamakawa, Akira Kodate, Mari Kodate, and Satoshi Fujimi. "Prognostic accuracy of different disseminated intravascular coagulation criteria in critically ill adult patients: a protocol for a systematic review and meta-analysis." BMJ Open 8, no. 12 (December 2018): e024878. http://dx.doi.org/10.1136/bmjopen-2018-024878.
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IntroductionDisseminated intravascular coagulation (DIC) is a common and serious condition that can lead to poor outcomes in critically ill patients. To make a correct diagnosis and improve the outcome of patients with DIC, several organisations have put forward DIC scoring systems. However, which criteria is the best to use for diagnosing DIC remains a continuing controversy even though many studies have been conducted to validate the diagnostic accuracy of each DIC scoring system.Methods and analysisWe will conduct a systematic review and meta-analysis of the diagnostic accuracy of DIC criteria for the prediction of mortality in critically ill adult patients. The primary objective is to assess the predictive values of the DIC criteria of Japanese Association for Acute Medicine, International Society on Thrombosis and Haemostasis, Japanese Ministry of Health and Welfare, Korean Society on Thrombosis and Hemostasis and Chinese Diagnostic Scoring System for 28-day mortality. We will search electronic bibliographic databases such as MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials. Two reviewers will independently screen titles and abstracts, perform full article reviews and extract study data. We will report study characteristics and assess methodological quality using the Quality of Diagnostic Accuracy Studies-II tool. If pooling is appropriate, we will compute parameter estimates using bivariate random-effects and hierarchical summary receiver operating characteristic models to produce summary receiver operating curves, summary operating points (pooled sensitivity and specificity) and 95% confidence regions around the summary operating points. Clinical and methodological subgroup and sensitivity analyses will be performed to explore heterogeneity.Ethics and disseminationThis systematic review will help physicians diagnose DIC accurately and improve their clinical practice in critically ill settings. Approval from an ethics committee is not required. The findings will be disseminated through publication in a peer-reviewed journal.PROSPERO registration numberCRD42017079350.
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Kandathil, Shaun M., Mario Garza-Fabre, Julia Handl, and Simon C. Lovell. "Reliable Generation of Native-Like Decoys Limits Predictive Ability in Fragment-Based Protein Structure Prediction." Biomolecules 9, no. 10 (October 15, 2019): 612. http://dx.doi.org/10.3390/biom9100612.
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Our previous work with fragment-assembly methods has demonstrated specific deficiencies in conformational sampling behaviour that, when addressed through improved sampling algorithms, can lead to more reliable prediction of tertiary protein structure when good fragments are available, and when score values can be relied upon to guide the search to the native basin. In this paper, we present preliminary investigations into two important questions arising from more difficult prediction problems. First, we investigated the extent to which native-like conformational states are generated during multiple runs of our search protocols. We determined that, in cases of difficult prediction, native-like decoys are rarely or never generated. Second, we developed a scheme for decoy retention that balances the objectives of retaining low-scoring structures and retaining conformationally diverse structures sampled during the course of the search. Our method succeeds at retaining more diverse sets of structures, and, for a few targets, more native-like solutions are retained as compared to our original, energy-based retention scheme. However, in general, we found that the rate at which native-like structural states are generated has a much stronger effect on eventual distributions of predictive accuracy in the decoy sets, as compared to the specific decoy retention strategy used. We found that our protocols show differences in their ability to access native-like states for some targets, and this may explain some of the differences in predictive performance seen between these methods. There appears to be an interaction between fragment sets and move operators, which influences the accessibility of native-like structures for given targets. Our results point to clear directions for further improvements in fragment-based methods, which are likely to enable higher accuracy predictions.
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Kumar, Karan, Christina Miedzinski, Sheenu Rajiv, Nicole Mollenkopf, Michael B. Streiff, and Clifford M. Takemoto. "Heparin Induced Thrombocytopenia in Pediatric Patients: Utility of Laboratory Testing." Blood 118, no. 21 (November 18, 2011): 1171. http://dx.doi.org/10.1182/blood.v118.21.1171.1171.
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Abstract Abstract 1171 Background: Heparin-induced thrombocytopenia (HIT) is characterized by the development of platelet-activating antibodies in response to heparin exposure, resulting in thrombocytopenia and a paradoxical risk for thrombotic complications. The diagnosis of HIT rests on clinical findings with supporting laboratory evaluation. The major features of HIT (thrombocytopenia and thrombosis after heparin exposure) are often seen in critically-ill children, but this is usually due to causes other than HIT. Clinical scoring systems (such as the 4T scoring system) to assess the pre-test probability of HIT are used widely in adults, but have yet to be fully validated in children. However, without prompt diagnosis and discontinuation of heparin, HIT can result in life and limb threatening thrombosis; on the other hand, overdiagnosis of HIT can lead to unnecessary exposure to alternative anticoagulants. Tests for HIT antibodies include ELISA immunoassays (EIA) for anti-PF4/heparin antibodies, which are widely available. The ELISA has high sensitivity but poor specificity with a high false positive rate. Functional tests, such as the 14C serotonin release assay (SRA), have high sensitivity and specificity, but are not routinely performed at most hospitals. In adults, higher antibody titers by ELISA are associated with SRA positivity and clinical manifestations of HIT. While the predictive value of these laboratory tests have been studied extensively for the diagnosis of HIT in adults, relatively little is known about their performance in the evaluation of pediatric patients. The aim of this study is to assess the utility of the ELISA and SRA tests, and clinical scoring systems to diagnosis HIT pediatric patients. Methods/Results: We identified 194 patients < 22 years of age who were referred for HIT testing between March 2001 and February 2010 at Johns Hopkins Hospital. 263 samples were evaluated by ELISA and/or SRA. ELISA was performed on 221 samples. Using the adult cut off value of 0.4 OD, 197 were negative, and 25 were positive (11%). SRA was performed on 39 samples and 3 were positive (8%). We found that positive SRA assays were found only in patients with ELISA OD values > 1.0. Two out of these three patients with SRA positivity had clinical HIT as diagnosed by treating physicians. The 4T Score (Warkentin, Br J Haem, 2003) and the HIT Expert Probability (Cuker, J Thromb Haemost, 2010) are pre-test scoring models that stratifies patients to high, intermediate, and low probability of HIT but have not been evaluated in pediatrics. A retrospective evaluation of utility of these scoring systems is currently underway. Conclusion: The utility of HIT antibody testing has not been formally evaluated in children. Only a subset of patients with positive ELISA tests will show SRA positivity. Higher titers of anti-PF4/heparin antibodies are associated with SRA positivity in pediatric patients, similar to adults. Further studies to validate predictive scoring systems in pediatic patients for the diagnosis of HIT is warranted. Disclosures: Streiff: BristolMyers Squibb: Research Funding; sanofi-aventis: Consultancy; Daiichi-Sankyo: Consultancy; Eisai:; sanofi-aventis: Honoraria.
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Bracha, H. Stefan, and Frederick M. Burkle. "Utility of Fear Severity and Individual Resilience Scoring as a Surge Capacity, Triage Management Tool during Large-Scale, Bio-Event Disasters." Prehospital and Disaster Medicine 21, no. 5 (October 2006): 290–96. http://dx.doi.org/10.1017/s1049023x00003897.
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AbstractThreats of bioterrorism and emerging infectious disease pandemics may result in fear-related consequences. If left undetected and untreated, fearbased signs and symptoms may be extremely debilitating and lead to chronic problems with a risk of permanent damage to the brain's locus coeruleus and stress response circuits. The triage management of susceptible, exposed, and infectious victims seeking care must be sensitive and specific enough to identify individuals with excessive levels of fear in order to address the nuances of fear-based symptoms at the initial point of contact. These acute conditions, which include hyper-vigilant fear, are managed best by timely and effective information, rapid evaluation, and possibly medications that uniquely address the locus-coeruleus-driven noradrenalin over-activation. It is recommended that a Fear and Resilience (FR) Checklist be included as an essential triage tool to identify those most at risk. The use of this checklist facilitates an enhanced capacity to respond to limitations brought about by surge capacity requirements. Whereas the utility of such a checklist is evident, predictive validity studies will be required. In addition to identifying individuals who are emotionally, medically, and socially hypo-resilient, the fear and resilience Checklist simultaneously identifies individuals who are hyper-resilient and can be asked to volunteer, and thus, rapidly expand the surge capacity.
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Saha, Anup Kumar, Ankit Sandhu, and Kumar Vikram. "Application of Modified Alvarado scoring system in the diagnosis of acute appendicitis: a study in a tertiary care hospital." International Journal of Research in Medical Sciences 6, no. 10 (September 25, 2018): 3192. http://dx.doi.org/10.18203/2320-6012.ijrms20183876.
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Background: Acute Appendicitis is one of the common surgical diseases which require early intervention; however, it may lead to higher negative appendicectomy rates, in uncertain Diagnosis. Negative appendicectomy rate is 20-40%. There are various scoring systems to assist in diagnosis. The aim of this study is to assess the effectiveness of Modified Alvarado Scoring System (MASS) in patients with acute appendicitis in AGMC and GBP Hospital.Methods: This was a cross sectional study to evaluate the effectiveness of MASS in patients presenting with acute appendicitis. The Principal Investigator scored all the patients according to the variables of MASS and divided them into three groups. Group I included patients with MASS of four and below, Group II were patients with MASS of 5-6 and Group III included patients with MASS of seven and above. The diagnosis of acute appendicitis was confirmed by histopathological examination. Data was collected using a coded, pre-tested questionnaire and analyzed using SPSS statistical software version 11.5.Results: In this study, 36 cases out of 42 cases had acute appendicitis. The sensitivity of Modified Alvarado Score of >7 was 85.7% (proportion of true positive). The sensitivity was highest among males i.e., 92% while in females, it was 76.4%. Negative appendicectomy rates were highest among females (23.6%), whereas in case of males it was 8%.Conclusions: The present study has shown that MASS provides high degree of sensitivity, specificity, PPV, NPV and accuracy in the diagnosis of acute appendicitis and has found to be more helpful in and high positive predictive value for male patients as compared to females.
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Neuhaus, Jochen, and Bo Yang. "Liquid Biopsy Potential Biomarkers in Prostate Cancer." Diagnostics 8, no. 4 (September 21, 2018): 68. http://dx.doi.org/10.3390/diagnostics8040068.
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Prostate cancer (PCa) is the second most common cancer in men worldwide with an incidence of 14.8% and a mortality of 6.6%. Shortcomings in comprehensive medical check-ups in low- and middle-income countries lead to delayed detection of PCa and are causative of high numbers of advanced PCa cases at first diagnosis. The performance of available biomarkers is still insufficient and limited applicability, including logistical and financial burdens, impedes comprehensive implementation into health care systems. There is broad agreement on the need of new biomarkers to improve (i) early detection of PCa, (ii) risk stratification, (iii) prognosis, and (iv) treatment monitoring. This review focuses on liquid biopsy tests distinguishing high-grade significant (Gleason score (GS) ≥ 7) from low-grade indolent PCa. Available biomarkers still lack performance in risk stratification of biopsy naïve patients. However, biomarkers with highly negative predictive values may help to reduce unnecessary biopsies. Risk calculators using integrative scoring systems clearly improve decision-making for invasive prostate biopsy. Emerging biomarkers have the potential to substitute PSA and improve the overall performance of risk calculators. Until then, PSA should be used and may be replaced whenever enough evidence has accumulated for better performance of a new biomarker.
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Taillardat, Maxime, Olivier Mestre, Michaël Zamo, and Philippe Naveau. "Calibrated Ensemble Forecasts Using Quantile Regression Forests and Ensemble Model Output Statistics." Monthly Weather Review 144, no. 6 (June 1, 2016): 2375–93. http://dx.doi.org/10.1175/mwr-d-15-0260.1.
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Abstract Ensembles used for probabilistic weather forecasting tend to be biased and underdispersive. This paper proposes a statistical method for postprocessing ensembles based on quantile regression forests (QRF), a generalization of random forests for quantile regression. This method does not fit a parametric probability density function (PDF) like in ensemble model output statistics (EMOS) but provides an estimation of desired quantiles. This is a nonparametric approach that eliminates any assumption on the variable subject to calibration. This method can estimate quantiles using not only members of the ensemble but any predictor available including statistics on other variables. The method is applied to the Météo-France 35-member ensemble forecast (PEARP) for surface temperature and wind speed for available lead times from 3 up to 54 h and compared to EMOS. All postprocessed ensembles are much better calibrated than the PEARP raw ensemble and experiments on real data also show that QRF performs better than EMOS, and can bring a real gain for human forecasters compared to EMOS. QRF provides sharp and reliable probabilistic forecasts. At last, classical scoring rules to verify predictive forecasts are completed by the introduction of entropy as a general measure of reliability.
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Abugabal, Yehia I., Manal Hassan, Roberto Pestana, Lianchun Xiao, Lauren Girard, Kanwal Pratap Singh Raghav, Jeffrey Morris, et al. "IGF-Child-Pugh score as a predictor of treatment outcome in advanced hepatocellular carcinoma patients treated with sorafenib." Journal of Clinical Oncology 37, no. 15_suppl (May 20, 2019): 4076. http://dx.doi.org/10.1200/jco.2019.37.15_suppl.4076.
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4076 Background: Our recent published studies concluded that Lower levels of Insulin like growth factors-I (IGF-I) is correlated with shorter overall survival (OS) in HCC, and IGF-CP scores assigned based on serum bilirubin, serum albumin level, prothrombin time, and plasma IGF-1 provides better prognostic stratification. Sorafenib is the first frontline drug approved for the treatment of CP class A patients with advanced HCC. CP class A is the standard criterion for active therapy and trials entry in HCC. In this study we aimed at evaluating the predictive ability of IGF-CP to sub-stratify old CP classes and better predict sorafenib outcomes. Methods: Total of101 patients were prospectively enrolled from MD Anderson Cancer Center (MDACC). Blood sample were collected and tested for IGF-I and IGF-CP was calculated into class A, B and C. Median OS and progression free survival (PFS) were analyzed, and log rank test was used to compare PFS and OS between subgroups of IGF-CTP score of patients. Results: Among CP class, patients who were reclassified as IGF-CP (B) (Old A/new B) had significantly shorter OS in months (m) was 7.6m (95% CI= 5.23-26.51m ) and PFS of 2.99m (95% CI=2.53-5.26m) with (P<0.001) in both, as compared to patients’ who classified as class A by both scoring systems (AA), who had OS of 15.43m (95% CI=12.3-31.18m) and PFS of 4.97m (95% CI=3.26-7.2m), (P<0.001) in both. Conclusions: IGF-CTP score sub-stratified CP A class, and provided better prognostic stratification and accuracy than CP score in predicting sorafenib survival outcomes in HCC. This approach may lead to a paradigm shift in predicting efficacy and toxicity of systemic HCC therapies and in stratifying patients for active therapy and selection in HCC clinical trials.
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Jain, Deepanshu, Sanna Fatima, Shilpa Jain, and Shashideep Singhal. "Volumetric Laser Endomicroscopy for Barrett’s Esophagus – Looking at the Fine Print." Journal of Gastrointestinal and Liver Diseases 26, no. 3 (September 1, 2017): 291–97. http://dx.doi.org/10.15403/jgld.2014.1121.263.jai.
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Barrett’s esophagus (BE) is a premalignant condition. The incidence of adenocarcinoma in BE has been reported to be between 0.1-3%. Dysplasia in BE is patchy and extensive biopsy sampling is labor intensive, low yield and does not eliminate the sampling error completely. Volumetric laser endomicroscopy (VLE) is expected to enable endoscopists to do targeted biopsy of dysplastic/cancerous lesions (not visible on white light endoscopy) among patients with BE. We reviewed 7 studies with a total of 62 subjects who had undergone VLE. Of 34 patients with available data, VLE correlated with histology in 17 subjects (50%). It missed the underlying diagnosis in one subject (2.9%). VLE led to inadvertent biopsy in 16 patients (47.1%), and led or would have led to upstaging of disease in 11 subjects (32.4%). In the entire cohort, the sensitivity, specificity, positive predictive value and negative predictive value (NPV) of VLE for diagnosis of dysplasia, buried Barrett’s or intramucosal carcinoma was 92.3%, 23.8%, 42.9% and 83.3%, respectively. High sensitivity and NPV can potentially help space out the surveillance intervals. Low specificity does lead to a high number of biopsies, which are likely less than non targeted biopsies. Volumetric laser endomicroscopy is a safe and sensitive test to identify mucosal lesions in patients with BE which are invisible under standard white light endoscopy.Abbreviations: BE: Barrett’s Esophagus; BB: Buried Barrett’s; EAC: Esophageal adenocarcinoma; EDS: Evans Dysplasia Score; EMR: Endoscopic Mucosal Resection; GERD: Gastro-esophageal reflux disease; HGD: High grade dysplasia; IMC: Intra-mucosal adenocarcinoma; LGD: Low grade dysplasia; NBI: Narrow Band Imaging; OCT-SI: Optical Coherence Tomography Scoring Index; RFA: Radiofrequency ablation; SGS: Sub-squamous glandular structures; VLE: Volumetric Laser Endomicroscopy; WLE: White Light Endoscopy.
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Ehresman, Jeff, Andrew Schilling, Zach Pennington, Chengcheng Gui, Xuguang Chen, Daniel Lubelski, A. Karim Ahmed, et al. "A novel MRI-based score assessing trabecular bone quality to predict vertebral compression fractures in patients with spinal metastasis." Journal of Neurosurgery: Spine 32, no. 4 (April 2020): 499–506. http://dx.doi.org/10.3171/2019.9.spine19954.
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OBJECTIVEVertebral compression fractures (VCFs) in patients with spinal metastasis can lead to destabilization and often carry a high risk profile. It is therefore important to have tools that enable providers to predict the occurrence of new VCFs. The most widely used tool for bone quality assessment, dual-energy x-ray absorptiometry (DXA), is not often available at a patient’s initial presentation and has limited sensitivity. While the Spinal Instability Neoplastic Score (SINS) has been associated with VCFs, it does not take patients’ baseline bone quality into consideration. To address this, the authors sought to develop an MRI-based scoring system to estimate trabecular vertebral bone quality (VBQ) and to assess this system’s ability to predict the occurrence of new VCFs in patients with spinal metastasis.METHODSCases of adult patients with a diagnosis of spinal metastasis, who had undergone stereotactic body radiation therapy (SBRT) to the spine or neurosurgical intervention at a single institution between 2012 and 2019, were retrospectively reviewed. The novel VBQ score was calculated for each patient by dividing the median signal intensity of the L1–4 vertebral bodies by the signal intensity of cerebrospinal fluid (CSF). Multivariable logistic regression analysis was used to identify associations of demographic, clinical, and radiological data with new VCFs.RESULTSAmong the 105 patients included in this study, 56 patients received a diagnosis of a new VCF and 49 did not. On univariable analysis, the factors associated with new VCFs were smoking status, steroid use longer than 3 months, the SINS, and the novel scoring system—the VBQ score. On multivariable analysis, only the SINS and VBQ score were significant predictors of new VCFs and, when combined, had a predictive accuracy of 89%.CONCLUSIONSAs a measure of bone quality, the novel VBQ score significantly predicted the occurrence of new VCFs in patients with spinal metastases independent of the SINS. This suggests that baseline bone quality is a crucial factor that requires assessment when evaluating these patients’ conditions and that the VBQ score is a novel and simple MRI-based measure to accomplish this.
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Staccini, P., and L. Fernandez-Luque. "All that Glitters Is not Gold: Consumer Health Informatics and Education in the Era of Social Media and Health Apps." Yearbook of Medical Informatics 25, no. 01 (August 2016): 188–93. http://dx.doi.org/10.15265/iy-2016-045.
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Summary Objective: To summarize the state of the art published during the year 2015 in the areas related to consumer health informatics and education with a special emphasis on unintended consequences of applying mobile and social media technologies in that domain. Methods: We conducted a systematic review of articles published in PubMed with a predefined set of queries, which lead to the selection of over 700 potential relevant articles. Section editors screened those papers on the title, abstract, and finally complete paper basis, taking into account the papers’ relevance for the section topic. The 15 most representative papers were finally selected by consensus between the two section editors and submitted for full review and scoring to external reviewers and the yearbook editors. Based on the final scoring, section editors selected the best five papers. Results: The five best papers can be grouped in two major areas: 1) Digital health literacy and 2) Quality and safety concerns. Regarding health literacy issues of patients with chronic conditions such as asthma, online interventions should rather focus on changing patient beliefs about the disease than on supporting them in the management of their pathology since personally controlled health management systems do not show expected benefits,. Nevertheless, encouraging and training chronic patients for an active online health information–seeking behaviour substantially decreases state anxiety level. Regarding safety and privacy issues, even recommended health-related apps available on mobile phones do not guarantee personal data protection. Furthermore, the analysis indicated that patients undergoing Internet interventions experienced at least one adverse event that might be related to treatment. At least, predictive factors have been identified in order to credit or not a health rumour. Conclusions: Trusting digital and connected health can be achieved if patients, health care professionals, and industrials build a shared model of health data management integrating ethics rules. Only increasing efforts in education with regards of digital health would help reach this goal., This would not resolve all frauds and security issues but at least improve their detection.
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Janicek, Milos Josef. "Alternative measure of therapy impact (TXI): Length of sojourn on treatment—Value of early restaging imaging for prediction of response to nivolumab among patients with advanced cancer." Journal of Clinical Oncology 38, no. 5_suppl (February 10, 2020): 106. http://dx.doi.org/10.1200/jco.2020.38.5_suppl.106.
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106 Background: Cross-sectional Imaging (CI) plays an essential role in early assessment of patients on immune checkpoint inhibitors (ICIs), yet often remains inconclusive in the setting of advanced disease, prior cancer treatment, toxicity, and cancer unrelated findings. We propose a robust, reproducible imjScore based on measurable tumor response on the first two re-staging scans that may predict TXI. We are testing prognostic value of early imaging, time lag of ICIs effect, against Duration of clinically effective treatment as a Measure of Treatment Impact. Methods: Retrospective review of CI studies in 92 patients with advanced stage solid tumors treated with Nivolumab (Nivo) during 6/2015-8/2018 at BMC on standard clinical protocols. Time on therapy (TOTx) was used as a surrogate marker of therapy impact. Modified imRECIST score utilizing ∑ of 5 discrete cancer lesions at baseline, 1st, and 2nd CI since initiation of Nivolumab were adjusted for TOTx. Our imjSCORE averages "predicted days on therapy" from best fit function of tumor change/day [%] at each time point vs. TOTx and ratios between 1st and 2nd scan. Results: Median TOTx was 70 days (range 1-1029). Differences in imRECIST scores derived from two early restaging CI studies adjusted for TOTx were able to identify with high statistical significance two groups of "SHORT" vs "LONG" sojourn on Nivolumab around Median of 70 days. Early Progression curve was associated with shorter benefit of Nivo; Pseudo-progression curve showed significantly shorter sojourn on Nivolumab compared to initial Regression or Stable score curves (P < .002). Conclusions: The imjScore may differentiate with high likelihood patients with short versus long sojourn on Nivo as a novel measure of TXI. Our CI-based imjSCORE validates early imaging with a response curve and standardized analysis of the 1st and 2nd post-treatment scans. If validated with other ICIs, this scoring tool may allow early prediction of ICIs treatment response and clinical outcome. Further correlation with clinical biomarkers may lead to development of predictive nomograms of "short" versus "long" TXI.
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Butter, Rogier, Gerrit Hooijer, Myrtle van der Wel, Jos Bart, Susan ter Borg, Loes van Velthuysen, and Marc J. van de Vijver. "HER2 heterogeneity in adenocarcinoma of the distal esophagus and stomach." Journal of Clinical Oncology 38, no. 15_suppl (May 20, 2020): 4567. http://dx.doi.org/10.1200/jco.2020.38.15_suppl.4567.
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4567 Background: Patients with HER2 positive adenocarcinoma of the esophagus or stomach are eligible for HER2 targeted therapy, which can improve survival in selected patients. Previous research shows that HER2 gene amplification and HER2 overexpression is frequently heterogeneous within these tumors. Biopsies taken from heterogeneous tumors for predictive testing may therefore result in false-negative outcomes. The objective of this study was to assess HER2 amplification and expression in biopsies and paired resection specimens with adenocarcinoma of the esophagus or stomach, from patients who did not receive neoadjuvant systemic therapy. Methods: Paired biopsies and resection specimens of patients with adenocarcinomas of the esophagus or stomach were retrospectively selected. Immunostaining was performed on all samples using antibody 4B5 (Ventana Medical Systems) and Silver-In-Situ-Hybridization was performed in selected cases. Scoring for HER2 was performed according to the method described by Hofmann et al. (2008). Results: We included 378 cases for analysis. In both biopsies and resection specimens 14% of the cases were HER2 positive. Intratumor heterogeneity in HER2 positive tumors was present in 45% ( n= 24/53) in biopsies and 75% ( n= 39/52) in resection specimens. In HER2 positive resection specimens, 65% ( n= 34/52) of paired biopsies were also positive. In the 18 remaining discordant tumors (resection HER2 positive, biopsy negative), intratumor heterogeneity was present in 16/18 cases. For HER2 negative resection specimens all paired biopsies were also HER2 negative. SISH was performed in 110 tumors. Agreement of HER2 gene amplification between biopsy and resection specimens was observed in 86% (n = 95/110). Five HER2 negative biopsies were positive in the resection specimen. Conclusions: The results of this study indicate that predictive HER2 assessment in adenocarcinoma of the esophagus or stomach can lead to false negative results based on biopsies. As a result, patients with HER2 positive tumors can unintentionally be denied neoadjuvant HER2 targeted therapy. The set of patients investigated in this present study is unique because of the absence of any systemic and/or radiation therapy between the biopsy and the resection of the tumor. Hopefully these results can help in developing methods for improved patient selection for HER2 targeted therapy.
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Lim, Joel KB, Syeda Kashfi Qadri, Theresa SW Toh, Cheryl Bin Lin, Yee Hui Mok, and Jan Hau Lee. "Extracorporeal Membrane Oxygenation for Severe Respiratory Failure During Respiratory Epidemics and Pandemics: A Narrative Review." Annals of the Academy of Medicine, Singapore 49, no. 4 (April 30, 2020): 199–214. http://dx.doi.org/10.47102/annals-acadmed.sg.202046.
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Introduction: Epidemics and pandemics from zoonotic respiratory viruses, such as the 2019 novel coronavirus, can lead to significant global intensive care burden as patients progress to acute respiratory distress syndrome (ARDS). A subset of these patients develops refractory hypoxaemia despite maximal conventional mechanical ventilation and require extracorporeal membrane oxygenation (ECMO). This review focuses on considerations for ventilatory strategies, infection control and patient selection related to ECMO for ARDS in a pandemic. We also summarise the experiences with ECMO in previous respiratory pandemics. Materials and Methods: A review of pertinent studies was conducted via a search using MEDLINE, EMBASE and Google Scholar. References of articles were also examined to identify other relevant publications. Results: Since the H1N1 Influenza pandemic in 2009, the use of ECMO for ARDS continues to grow despite limitations in evidence for survival benefit. There is emerging evidence to suggest that lung protective ventilation for ARDS can be further optimised while receiving ECMO so as to minimise ventilator-induced lung injury and subsequent contributions to multi-organ failure. Efforts to improve outcomes should also encompass appropriate infection control measures to reduce co-infections and prevent nosocomial transmission of novel respiratory viruses. Patient selection for ECMO in a pandemic can be challenging. We discuss important ethical considerations and predictive scoring systems that may assist clinical decision-making to optimise resource allocation. Conclusion: The role of ECMO in managing ARDS during respiratory pandemics continues to grow. This is supported by efforts to redefine optimal ventilatory strategies, reinforce infection control measures and enhance patient selection. Ann Acad Med Singapore 2020;49:199–214 Key words: Acute Respiratory Distress Syndrome, Coronavirus disease 2019, ECMO, Infection control, Mechanical ventilation
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Lim, Tse Hui, Alvin Soon Tiong Lim, Aye Aye Thike, Sim Leng Tien, and Puay Hoon Tan. "Implications of the Updated 2013 American Society of Clinical Oncology/College of American Pathologists Guideline Recommendations on Human Epidermal Growth Factor Receptor 2 Gene Testing Using Immunohistochemistry and Fluorescence In Situ Hybridization for Breast Cancer." Archives of Pathology & Laboratory Medicine 140, no. 2 (February 1, 2016): 140–47. http://dx.doi.org/10.5858/arpa.2015-0108-oa.
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Context Human epidermal growth factor receptor 2 (HER2/neu) amplification is used as a predictive marker for trastuzumab treatment in breast cancer. Both immunohistochemistry (IHC) and fluorescence in situ hybridization (FISH) testing algorithms have been based on the 2007 American Society of Clinical Oncology/College of American Pathologists (ASCO/CAP) guidelines. In late 2013, the guidelines were updated with new scoring criteria. Objective —To assess the impact of the revised ASCO/CAP recommendations on both IHC and FISH results by using the dual-color HER2/neu and centromeric FISH probes. Design Retrospective analysis of 590 invasive carcinomas with concurrent IHC and dual-color HER2/neu and centromeric 17 (CEP17) FISH results, based on 2007 ASCO/CAP guidelines, was conducted from July 2011 to June 2013. With the revised guidelines, patients were recategorized and concordance rates between the 2 assays were recalculated. Results —Overall concordance rates for FISH and IHC decreased from 94.9% to 93.8% with reclassification. Negative FISH cases decreased from 79.1% to 69.3%. However, equivocal FISH cases were significantly increased from 0.7% to 9.5%, leading to more retesting. Both positive IHC and FISH cases were also noted to be increased, leading to more patients being eligible for trastuzumab treatment, especially those patients with concurrent HER2/neu and CEP17 polysomy. Approximately 1% of patients with initial FISH negative results were reclassified as having positive results when both the ratios and average copy number of HER2/neu were considered under the revised guidelines. Conclusions The revised 2013 ASCO/CAP guidelines can potentially lead to more patients being eligible for trastuzumab therapy but additional retesting is to be expected owing to an increased number of equivocal FISH cases.
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Kılıcgedik, Alev, Abdulrahman Naser, Ahmet Seyfeddin Gurbuz, Seyhmus Kulahcioglu, Ruken Bengi Bakal, Tuba Unkun, Fatih Yilmaz, Gokhan Kahveci, and Cevat Kirma. "Red Cell Distribution Width with CHADS2 and CHA2DS2-VASc score is associated with Post-operative Atrial Fibrillation after Coronary Artery Bypass Grafting." Heart Surgery Forum 21, no. 3 (May 16, 2018): 170. http://dx.doi.org/10.1532/hsf.1886.
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Background: The use of the CHA2DS2-VASc scoring system and red cell distribution width (RDW) as post-op Atrial Fibrillation (POAF) predictors may be promising for the identification of patients that are at a higher risk of POAF.Methods: A total of 358 patients (57 patients with POAF, and 301 patients with non-POAF ) with sinus rhythm undergoing a coronary artery bypass graft (CABG) operation were included in the study retrospectively. Preoperative RDW levels and electrocardiograms with sinus rhythm were recorded. Patients with at least one 12-lead electrocardiogram with atrial fibrillation in the postoperative period, with or without medical or electrical cardioversion, were considered to have postoperative atrial fibrillation. A CHADS2 and CHA2DS2-VASc score was calculated for all of the patients.Results: RDW levels were significantly higher in POAF group. RDW levels were significantly correlated with CHADS2 ( r = 0.15, P = .007) and CHA2DS2-VASc (r = 0.19 P = .0001) scores. CHA2DS2-VASc scores were significantly higher in patients with POAF, whereas CHADS2 scores did not differ between groups. In multivariate analysis, left atrial diameter (LAD) (OR:2.44 [95% CI 1.16 – 5.1], P = .018), age (OR:1.04 [95% CI 1.01 – 1.08], P = .01), and RDW (OR:1.16 [95% CI 1.0 – 1.36], P = .05) were found to be predictive for POAF. The area under the receiver-operating characteristic curve of RDW was 0.65 (0.57 – 0.72, P = .0001) with 68.4% sensitivity and 51.2 % specificity to predict POAF.Conclusion: Our study showed that age, LAD, and the reduced probability of RDW are predictors of POAF, and that RDW is strongly associated with the thromboembolic risk as determined by CHADS2 and CHA2DS2-VASc scores.
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Huang, Benjamin J., Jenny L. Smith, Rhonda E. Ries, Amanda R. Leonti, Erin Lynn Crowgey, Scott N. Furlan, Timothy Shaw, et al. "Integrated Stem Cell Signature and Cytomolecular Risk Determination in Pediatric Acute Myeloid Leukemia." Blood 136, Supplement 1 (November 5, 2020): 28–29. http://dx.doi.org/10.1182/blood-2020-142638.
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Acute myeloid leukemia (AML) remains a therapeutic challenge with high mortality rates despite intensive and myeloablative therapies. Structural and sequence alterations have been linked to outcomes in pediatric AML and have been used for risk-based therapy allocation with modest success. Given the vast heterogeneity of AML, conventional cytogenetic and mutational (cytomolecular) biomarkers have not yielded a robust prognostic model: nearly one-third of pediatric patients deemed "low risk" relapse and, inversely, approximately one-third of those in "high risk" categories have favorable outcomes. AML studies in adults previously identified a leukemia stem cell score (LSC17) that was highly prognostic across five independent cohorts comprised of adult patients with diverse AML subtypes (n = 908). We reasoned that incorporating a similar scoring system in pediatric AML would lead to improved prognostic risk models. To assess for the effects of LSC17 on pediatric AML, we leveraged transcriptome sequencing data from bone marrow aspirates and peripheral blood collected from 1,503 children, adolescents, and young adults with AML at the time of diagnosis. Patients were enrolled on one of three upfront phase III Children's Oncology Group trials spanning the past three decades: CCG-2961, AAML0531, and AAML1031. In aggregate, patients with a high LSC17 score had an event free survival (EFS) of 36.9 ± 3.5% at 5 years from diagnosis compared to 55.3 ± 3.7% for those with low LSC17 scores (p < 0.0001). (Figure 1A) LSC17 scores were also associated with adverse overall survival (OS): 51.9 ± 3.9% versus 73.8 ± 3.5% (p < 0.0001) (data not shown). Intriguingly, we found that LSC17 scores significantly cluster within fusion groups and that median LSC17 scores closely correlate with survival based on fusion status (Figure 1B). Thus, when the impact of LSC17 scores was evaluated in the context of established cytomolecular risk groups, LSC17 scores were no longer predictive of outcome (Figure 1C). We then asked whether LSC gene expression data could be utilized to generate a more robust risk classification schema in the context of disease defining structural variants. Importantly, AMLs diagnosed in children, adolescents, and young adults are associated with frequent driver gene fusion alterations that also play an important role in risk stratification and transcriptional landscape (Figure 1D). We went on to confirm that AML fusion groups occupy distinct transcriptional stages of hematopoietic stem cell and myeloid progenitor maturation based on gene set enrichment analysis (GSEA) using normal hematopoiesis transcriptome experiments as their reference (data not shown). To develop more predictive biomarkers related to stemness, we used the 54 original LSC genes identified by Ng S, et al. and performed linear regression based on a least absolute shrinkage and selection operator (LASSO) algorithm to fit a Cox regression model for patients within each fusion group. The study population was divided into discovery (n = 752) and validation (n = 752) cohorts using stratified randomization based on fusion status (RUNX1-RUNX1T1, CBFB-MYH11, KMT2A, NUP98, CBFA2T3-GLIS2, and Other/None). In the discovery cohort, we identified distinct LSC signatures that best distinguished outcome cohorts in patients with conventional high/standard risk disease (KMT2A, NUP98, and Other/None fusions) (Figure 1E). For patients deemed favorable risk (RUNX1-RUNX1T1 and CBFB-MYH11 or core binding factor/CBF), LSC signatures were not reliably predictive based on "leave one out" cross validation. Therefore, we performed multivariable analysis incorporating clinical, mutational, and transcriptional signatures to determine the factors that best discriminated outcomes with CBF AML, and found GLIS2-like transcriptional signatures were most predictive. These cytomolecular and LSC (CM-LSC) biomarkers were then combined to build a robust risk determination model that was then validated in an independent cohort (Figure 1F). This study demonstrates that a 54 LSC gene expression panel can enhance the predictive power of conventional cytomolecular markers and can more effectively partition patients into risk groups. Figure 1 Disclosures Cooper: Celgene: Other: Spouse was an employee of Celgene (through August 2019).
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JONES, S. D. M., A. K. W. TONG, and W. M. ROBERTSON. "THE PREDICTION OF BEEF CARCASS LEAN CONTENT BY AN ELECTRONIC PROBE, A VISUAL SCORING SYSTEM AND CARCASS MEASUREMENTS." Canadian Journal of Animal Science 69, no. 3 (September 1, 1989): 641–48. http://dx.doi.org/10.4141/cjas89-077.
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Five hundred and thirty-one beef carcasses were used to establish if Hennessy Grading Probe (HGP) measurements provided a more accurate assessment of carcass lean content than a visual scoring system or linear carcass measurements. Carcasses were probed at the 5th/6th, 11th/12th, 12th/13th ribs, 2nd/3rd lumbar and sacral crest position (P8). Carcasses were then visually appraised for overall fat cover and muscle thickness. Following 24 h of cooling, the measurements by HGP and visual scores were repeated. Fat thickness and loin eye area were recorded at the 12th rib. Precision for the prediction of carcass lean by HGP was similar in warm or cold carcasses and the lowest error of prediction for the probe was associated with measurements made at the 12th/13th rib (RSD 31.8 g kg−1). A combined visual score for overall fat cover and muscle thickness was more precise (RSD 28.6 g kg−1) than probe measurements for predicting lean yield in warm and cold carcasses. Canada grade had the lowest precision (RSD 34.7 g kg−1) for predicting lean yield, but measurements of average fat thickness and loin eye area at the 12th rib gave the best overall prediction (RSD 27.1 g kg−1) of carcass lean content. It was concluded that the HGP provided a method to classify warm carcasses for lean content, but the improvement in precision over conventional grading procedures was not large. Key words: Beef, carcass, grading, Hennessy grading probe, composition
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Suter, Robert, Vasileios Stathias, Anna Jermakowicz, Alexa Semonche, Michael Ivan, Ricardo Komotar, Stephan Schürer, and Nagi Ayad. "COMP-16. COMPREHENSIVE TRANSCRIPTOMIC ANALYSIS OF SINGLE CELLS FROM RECURRENT AND PRIMARY GLIOBLASTOMA TO PREDICT CELL-TYPE SPECIFIC THERAPEUTICS." Neuro-Oncology 21, Supplement_6 (November 2019): vi64. http://dx.doi.org/10.1093/neuonc/noz175.259.
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Abstract Glioblastoma (GBM) remains the most common adult brain tumor, with poor survival expectations, and no new therapeutic modalities approved in the last decade. Our laboratories have recently demonstrated that the integration of a transcriptional disease signature obtained from The Cancer Genome Atlas’ GBM dataset with transcriptional cell drug-response signatures in the LINCS L1000 dataset yields possible combinatorial therapeutics. Considering the extreme intra-tumor heterogeneity associated with the disease, we hypothesize that the utilization of single-cell RNA-sequencing (scRNA-seq) of patient tumors will further strengthen our predictive model by providing insight on the unique transcriptomes of the cellular niches present within these tumors, and into the transcriptional dynamics of these same cellular niches. By sequencing single-cell transcriptomes from recurrent GBM tumors resected from patients at the University of Miami, and integrating our datasets with previously published scRNA-seq data from primary GBM tumors, we are able to gain additional insight into the differences between these clinical distinctions. We have analyzed the differential expression of kinases both across and within distinct cell populations of primary and recurrent GBM tumors. This transcriptional map of kinase expression represents the heterogeneity of potential targets within individual tumors and between recurrent and primary GBM. Additionally, by generating disease signatures unique to each cellular population, and integrating these with transcriptional drug-response signatures from LINCS, we are able to predict compounds to target specific cell populations within GMB tumors. Additional computational techniques such as RNA velocity analysis and cell cycle scoring elucidate temporal insights to further prioritize these cell-type specific therapeutics, and reveal the intra-cellular dynamics present within these tumors. Collectively, our studies suggest that we have developed a novel omics pipeline based on the single cell RNA-sequencing of individual GBM cells that addresses intra-tumor heterogeneity, and may lead to novel therapeutic combinations for the treatment of this incurable disease.
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Khanam, Kazi Farzana, Tamanna Chowdhury, Sultana Gulshana Banu, and Shahedul Islam. "Determination of HER-2/neu gene Status by Chromogenic in Situ Hybridisation Assay on Borderline (2+) Immunohistochemistry Cases in Patients with Invasive Breast Carcinoma: An Experimental Study on Preserved Tissue." Bangladesh Medical Research Council Bulletin 43, no. 1 (January 2, 2018): 08–15. http://dx.doi.org/10.3329/bmrcb.v43i1.35137.
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HER-2 (also known as HER-2/neu) is a member of the epidermal growth factor (EGF) receptor family. The amplification of oncogene HER-2 is presented in 20 to 30% of breast cancers and results in an increase of the protein expression. HER-2 over expression has also been shown to correlate with poor prognosis. It is associated with poorly differentiated high grade tumors with lymph node involvement, greater risk of recurrence and relative resistance to some types of chemotherapy. The receptor is however a target for treatment with anti HER-2 antibody trastuzumab (Herceptin). Immunohistochemistry analysis for HER 2 scoring is subjective, requires trained personnel and expertise. One of the main concerns with IHC is that there is evidence of significant inter-observer variation in the assessment of staining, which can lead to misclassification of HER2 status. Chromogenic in situ hybridization (CISH) testing is sensitive and specific in detecting HER-2/neu gene amplification. Direct evaluation of gene amplification using CISH assay is a reliable method for routine diagnostic evaluation of HER2/neu status in breast cancer patients, especially in specimens showing 2+ IHC score. This observational experimental study was carried out in the Department of Pathology, Bangabandhu Sheikh Mujib Medical University, Dhaka, during the period of July 2014 to June 2015, The aim of this study was to assess HER-2 expression accurately in equivocal immunohistochemistry (2+) invasive breast cancer cases by Chromogenic in situ hybridization (CISH) and to associate the findings of CISH assay with the histologic prognostic and predictive factors (eg: tumor size, regional lymph node metastases, tumor grade and type. A total of 20 archival paraffin tissue blocks and IHC slides with IHC score 2+ for HER-2 were included in this study. All the slides were reviewed. CISH assay was done on section from archival paraffin block.CISH assay showed amplification of the HER-2 neu gene in 30% of cases. Majority (60%) was nonamplified. In two cases the results were unsatisfactory for interpretation. The differences were not statistically significant (p>0.05) among three groups (amplified, nonamplified and unsatisfactory) regarding the baseline characteristics (age and sex) with CISH. All the results of CISH assay in association with tumor size, tumor grade and lymphnode metastasis were not statistically significant. HER-2 / neu status is the one of the most important prognostic and predictive factor. It is a target for treatment with anti HER-2 antibody trastuzumab (Herceptin). Detection of HER-2/ neu status by IHC may sometimes be difficult and inaccurate, specially in IHC score 2+ cases. Based on the findings of the study, CISH can be considered a useful, simple and reproducible method for detecting HER-2/ neu gene amplification in cases with borderline (2+) immunohistochemistry score , and patients may be benefited from Trastuzumab therapy.
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Milovanovic, Tamara, Sanja Dragasevic, Milica Stojkovic Lalosevic, Sanja Zgradic, Biljana Milicic, Igor Dumic, Stefan Kmezic, et al. "Ultrasonographic Evaluation of Fatty Pancreas in Serbian Patients with Non Alcoholic Fatty Liver Disease—A Cross Sectional Study." Medicina 55, no. 10 (October 17, 2019): 697. http://dx.doi.org/10.3390/medicina55100697.
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Background and Objectives: The aim of the study was to determine the association between presences of fatty pancreas (FP) with the features of metabolic syndrome (MeS) in patients with non–alcoholic fatty liver disease (NAFLD) and to establish a new noninvasive scoring system for the prediction of FP in patients with NAFLD. Material and Methods: 143 patients with NAFLD were classified according to FP severity grade into the two groups and evaluated for diagnostic criteria of MeS. All patients underwent sonographic examination with adiposity measurements and the liver biopsy. Liver fibrosis was evaluated semi-quantitatively according to the METAVIR scoring system and using non-invasive markers of hepatic fibrosis. Results: Waist circumference (WC) was predictive for increased risk of FP in NAFLD patients. Elevated fasting plasma glucose, total cholesterol, serum amylase and lipase levels were associated with presence of severe FP (p value = 0.052, p value = 0.007, p value = 0.014; p value = 0.024, respectively). Presence of increased amounts of mesenteric fat was associated with severe FP (p value = 0.013). The results of this study demonstrated highly significant association between NAFLD and presence of FP. The model for predicting the presence of FP was designed with probability value above 6.5. Conclusion: Pancreatic fat accumulation leads to worsening of pancreatic function which in turns exacerbates severity of metabolic syndrome associated with both, NAFLD and NAFPD.
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Crane, C. H., J. S. Yordy, G. R. Varadhachary, W. Haque, R. A. Wolff, P. Das, S. Krishnan, J. B. Fleming, J. L. Abbruzzese, and G. A. Staerkel. "Use of DPC-4 immunostaining of diagnostic cytology specimens to predict the pattern of tumor progression in locally advanced pancreatic cancer patients (LAPC)." Journal of Clinical Oncology 29, no. 4_suppl (February 1, 2011): 209. http://dx.doi.org/10.1200/jco.2011.29.4_suppl.209.
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209 Background: An autopsy study has identified DPC-4 as a potential biomarker of the pattern of disease spread in pancreatic cancer patients (Iacobuzio-Donahue et al, JCO, 2009). We sought to determine whether DPC-4 expression determined by immunohistochemistry (IHC) staining of primary tumor cytology specimens correlates with the clinical pattern of progression in patients with locally advanced pancreatic cancer (LAPC). Methods: LAPC patients with ECOG 0-1 PS were treated with gemcitabine (1000 mg/m2), oxaliplatin (100 mg/m2), and cetuximab for (500mg/m2) q2wks for 4 doses followed by XRT (50.4 Gy to the gross tumor only) with capecitabine (825 mg/m2 twice daily, days of radiation) and cetuximab on a multiinstitutional trial. Forty-one of 58 patients treated at our institution had cytology specimens suitable for IHC staining. The patterns of progression were determined based on radiographic studies and clinical symptoms. Findings were blinded from the IHC results. Patients were categorized as 1) local disease dominant, 2) distant disease dominant, 3) indeterminate pattern, and 4) no progression. The IHC scoring of DPC-4 was determined by an experienced cytopathologist who was blinded from the clinical data. Results: Median, 1yr and 3yr actuarial OS are 18.2 months, 67.2% and 18.5%. Dominant progression pattern was local (n=15), distant (n=14), indeterminate (n=8), and no progression (n=4). Intact DPC expression correlated with local dominant progression (11/15) and DPC-4 loss correlated with distant dominant progression (10/14), p=0.016. The median DM free survival rate was 18.0 for intact DPC-4 versus 12.5 mo for DPC-4 loss patients (p=NS). There was no significant difference in overall survival based on DPC-4 status. Conclusions: Determination of DPC-4 expression from cytology specimens is feasible. DPC-4 expression correlated with the pattern of progression and is consistent with previous autopsy data. DPC-4 expression does not appear to be predictive or prognostic. Prospective validation of DPC-4 as a biomarker of disease progression is warranted and may lead to personalized treatment strategies for patients with LAPC. [Table: see text]
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Hellström-Lindberg, Eva, Cheryl Willman, A. John Barrett, and Yogen Saunthararajah. "Achievements in Understanding and Treatment of Myelodysplastic Syndromes." Hematology 2000, no. 1 (January 1, 2000): 110–32. http://dx.doi.org/10.1182/asheducation.v2000.1.110.110.
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Abstract The myelodysplastic syndromes (MDS) constitute a challenge for the biologist as well as for the treating physician. In Section I, Dr. Willman reviews the current classifications and disease mechanisms involved in this heterogeneous clonal hematopoietic stem cell disorder. A stepwise genetic progression model is proposed in which inherited or acquired genetic lesions promote the acquisition of “secondary” genetic events mainly characterized by gains and losses of specific chromosome regions. The genetic risk to develop MDS is likely multifactorial and dependent on various constellations of risk-producing and -protecting alleles. In Section II Dr. Barrett with Dr. Saunthararajah addresses the immunologic factors that may act as important secondary events in the development of severe pancytopenia. T cells from patients with MDS may suppress autologous erythroid and granulocytic growth in vitro, and T cell suppression by antithymocyte globulin or cyclosporine may significantly improve cytopenia, especially in refractory anemia. Recent studies have also demonstrated an increased vessel density in MDS bone marrow, and a phase II trial of thalidomide showed responses in a subgroup of MDS patients especially in those with low blast counts. In Section III Dr. Hellström-Lindberg presents results of allogeneic and autologous stem cell transplantation (SCT), intensive and low-dose chemotherapy. The results of allogeneic SCT in MDS are slowly improving but are still poor for patients with unfavorable cytogenetics and/or a high score according to the International Prognostic Scoring System. A recently published study of patients between 55-65 years old showed a disease-free survival (DFS) at 3 years of 39%. Consolidation treatment with autologous SCT after intensive chemotherapy may result in long-term DFS in a proportion of patients with high-risk MDS. Low-dose treatment with 5-azacytidine has been shown to significantly prolong the time to leukemic transformation or death in patients with high-risk MSA. Erythropoietin and granulocyte colony-stimulating factor may synergistically improve hemoglobin levels, particularly in sideroblastic anemia. Recent therapeutic advances have made it clear that new biological information may lead to new treatment modalities and, in combination with statistically developed predictive models, help select patients for different therapeutic options.
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Hellström-Lindberg, Eva, Cheryl Willman, A. John Barrett, and Yogen Saunthararajah. "Achievements in Understanding and Treatment of Myelodysplastic Syndromes." Hematology 2000, no. 1 (January 1, 2000): 110–32. http://dx.doi.org/10.1182/asheducation.v2000.1.110.20000110.
Full textAbstract:
The myelodysplastic syndromes (MDS) constitute a challenge for the biologist as well as for the treating physician. In Section I, Dr. Willman reviews the current classifications and disease mechanisms involved in this heterogeneous clonal hematopoietic stem cell disorder. A stepwise genetic progression model is proposed in which inherited or acquired genetic lesions promote the acquisition of “secondary” genetic events mainly characterized by gains and losses of specific chromosome regions. The genetic risk to develop MDS is likely multifactorial and dependent on various constellations of risk-producing and -protecting alleles. In Section II Dr. Barrett with Dr. Saunthararajah addresses the immunologic factors that may act as important secondary events in the development of severe pancytopenia. T cells from patients with MDS may suppress autologous erythroid and granulocytic growth in vitro, and T cell suppression by antithymocyte globulin or cyclosporine may significantly improve cytopenia, especially in refractory anemia. Recent studies have also demonstrated an increased vessel density in MDS bone marrow, and a phase II trial of thalidomide showed responses in a subgroup of MDS patients especially in those with low blast counts. In Section III Dr. Hellström-Lindberg presents results of allogeneic and autologous stem cell transplantation (SCT), intensive and low-dose chemotherapy. The results of allogeneic SCT in MDS are slowly improving but are still poor for patients with unfavorable cytogenetics and/or a high score according to the International Prognostic Scoring System. A recently published study of patients between 55-65 years old showed a disease-free survival (DFS) at 3 years of 39%. Consolidation treatment with autologous SCT after intensive chemotherapy may result in long-term DFS in a proportion of patients with high-risk MDS. Low-dose treatment with 5-azacytidine has been shown to significantly prolong the time to leukemic transformation or death in patients with high-risk MSA. Erythropoietin and granulocyte colony-stimulating factor may synergistically improve hemoglobin levels, particularly in sideroblastic anemia. Recent therapeutic advances have made it clear that new biological information may lead to new treatment modalities and, in combination with statistically developed predictive models, help select patients for different therapeutic options.
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Revel-Vilk, Shoshana, Gabriel Chodick, Varda Shalev, and Noga Gadir. "Study Design: Development of an Advanced Machine Learning Algorithm for the Early Diagnosis of Gaucher Disease Using Real-World Data." Blood 136, Supplement 1 (November 5, 2020): 13–14. http://dx.doi.org/10.1182/blood-2020-134414.
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Background: Gaucher disease (GD) is a rare, autosomal recessive condition, characterized by deficiency of the lysosomal enzyme β-glucocerebrosidase. The main disease features are anemia, thrombocytopenia, hepato-splenomegaly and bone infarction, osteonecrosis, and pathological fractures. However, diagnosis of GD can be challenging, especially for non-specialists, owing to wide variability in age at presentation, non-specific features, severity and type of clinical manifestations, and lack of awareness of the early signs and symptoms of the disease. Delayed and misdiagnosis of GD may lead to irreversible bone disease, severe growth retardation, and high risk of bleeding; in rare cases, misdiagnosis may be life-threatening. Developing a system for early and accurate diagnosis of GD is thus an essential unmet need. The development of an algorithm for early diagnosis of patients with rare diseases such as GD may help reduce delays in diagnosis and enable prompt, appropriate initiation of therapy, earlier decision-making, prevent potentially irreversible morbidities and unnecessary tests (some invasive), reduce anxiety, and facilitate genetic counseling. This study aims to develop a predictive model for the accurate diagnosis of GD using machine learning based on real-world clinical data. Methods: This study will be comprised of three parts. Part 1, a retrospective observational database analysis, will use data from the electronic patient database of the Maccabi Healthcare Service (MHS), the second largest Health Maintenance Organization in Israel. The MHS includes 2.2 million health records from 25% of the Israeli population. Clinical records have been fully computerized for >20 years and are fully integrated with automated central laboratory, digitized imaging and pharmacy purchase data. Patients with confirmed GD who have been enrolled in the MHS health plan for ≥1 year will be eligible for inclusion, with approximately 250 patients with GD expected to be enrolled. Using MHS data from patients with GD, the Gaucher Earlier Diagnosis Consensus (GED-C) scoring system, developed by a consensus panel using Delphi methodology on the signs and co-variables that may be important for the diagnosis of GD, will be evaluated and compared with alternative scores developed directly from clinical data based on supervised machine learning. In Part 2, a clinical study, the best performing modeled scores from Part 1 will be applied to the MHS database to identify individuals who may have undiagnosed GD ('GD suspects'). Samples for diagnostic testing (using a specific and sensitive biomarker (glucosylsphingosine, lyso-Gb1) followed by beta-glucocerebrosidase (GBA) genotyping for positive samples) will be collected from MHS biobank (for individuals who have consented). Individuals not participating in the biobank will be asked to provide a sample. This part of the study will evaluate the predictive value of the modeled scores, and assess the sensitivity and specificity of the model for the diagnosis of new patients with GD. In Part 3, analysis of data from newly diagnosed patients identified in Part 2 will be used to develop machine learning models for the diagnosis of GD (Figure 1). Signs and co-variables included in the GED-C score will be used, eliminating features that are non-informative. Features will be quantitative where possible, and interaction terms will be added for age of onset and trend for key features. A number of methods will be developed, with the best performing, based on its precision at a given sensitivity level, being selected as the final model. External validation of the best identified model is planned, to ensure unbiased estimate of the model's accuracy. Discussion: The main goal of the study is to develop an algorithm to help detect patients with GD, independent of physicians' ability to recognize signs and symptoms, using the application of machine learning to data from a large health database. The study is expected to result in a practical tool that will alert physicians to the possibility of GD. The resulting model will also improve our understanding of GD based on the relative importance of features for GD prediction. Such tools will have a positive impact on patient care and quality of life and on healthcare costs and may lead to a change in approach for diagnosing rare diseases. Disclosures Revel-Vilk: Takeda: Honoraria; sanofi-Genzyme: Honoraria; Pfizer: Honoraria. Chodick:Novartis Pharma AG: Other: Institutional grant. Gadir:Takeda: Current Employment.
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De Oliveira, Ricardo Santos. "Connections." Archives of Pediatric Neurosurgery 2, no. 3(September-December) (December 6, 2020): e642020. http://dx.doi.org/10.46900/apn.v2i3(september-december).64.
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The human brain contains around 86 billion nerve cells and about as many glial cells [1]. In addition, there are about 100 trillion connections between the nerve cells alone. While mapping all the connections of a human brain remains out of reach, scientists have started to address the problem on a smaller scale. The term artificial neural networks (ANNs or simply neural networks (NNs), encompassing a family of nonlinear computational methods that, at least in the early stage of their development, were inspired by the functioning of the human brain. Indeed, the first ANNs were nothing more than integrated circuits devised to reproduce and understand the transmission of nerve stimuli and signals in the human central nervous system [2]. The correct way of doing it is to the first study human behavior. The human brain has a biological neural network that has billions of interconnections. As the brain learns, these connections are either formed, changed or removed, similar to how an artificial neural network adjusts its weights to account for a new training example. This complexity is the reason why it is said that practice makes one perfect since a greater number of learning instances allow the biological neural network to become better at whatever it is doing. Depending upon the stimulus, only a certain subset of neurons are activated in the nervous system. Recently, Moreau et al., [3] published an interesting paper studying how artificial intelligence can help doctors and patients with meningiomas make better treatment decisions, according to a new study. They demonstrated that their models were capable of predicting meaningful individual-specific clinical outcome variables and show good generalizability across the Surveillance, Epidemiology, and End Results (SEER) database to predict meningioma malignancy and survival after specific treatments. Statistical learning models were trained and validated on 62,844 patients from the SEER database and a model scoring for the malignancy model was performed using a series of metrics. A free smartphone and web application were also provided for readers to access and test the predictive models (www.meningioma.app). The use of artificial intelligence techniques is gradually bringing efficient theoretical solutions to a large number of real-world clinical problems related to the brain (4). Specifically, recently, thanks to the accumulation of relevant data and the development of increasingly effective algorithms, it has been possible to significantly increase the understanding of complex brain mechanisms. The researchers' efforts are creating increasingly sophisticated and interpretable algorithms, which could favor a more intensive use of “intelligent” technologies in practical clinical contexts. Brain and machine working together will improve the power of these methods to make individual-patient predictions could lead to improved diagnosis, patient counseling, and outcomes.
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Zuna, Jan, Mari Arens, Rolf Koehler, Renate Panzer-Grümayer, Anja Möricke, Claus R. Bartram, Ruth Joas, et al. "Repeated Bone Marrow Aspiration At the End of Induction Therapy: Implications for Treatment Stratification in Paediatric Acute Lymphoblastic Leukaemia." Blood 118, no. 21 (November 18, 2011): 756. http://dx.doi.org/10.1182/blood.v118.21.756.756.
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Abstract Abstract 756FN2 Bone marrow (BM) aspiration at the end of induction therapy plays a crucial role for the evaluation of remission and the minimal residual disease (MRD), both critical for treatment stratification in modern treatment protocols for paediatric acute lymphoblastic leukaemia (ALL). However, the aspiration is repeated in 15–20% of patients, either due to non-representative morphology or to insufficient material needed for MRD analysis. We prospectively analysed 320 paediatric ALL patients treated according to ALL-BFM 2000 (n=301) or ALL IC-BFM 2002 (n=19) protocols with repeated BM aspiration at the end of induction therapy, on treatment day 33. Fourteen patients had more than one re-puncture. The median follow-up was 69 months, 45 (14%) patients had an event (relapse/death). The cause for the repeated BM aspiration was non-representative morphology (32%), insufficient material for MRD analysis (33%) or both (35% cases). In order to evaluate prognostic significance of the re-punctures and to determine which of the repeated samples should be used for the final treatment stratification we analysed MRD levels and MRD stratification, morphology, leukocyte count (WBC) and the length of treatment delay caused by waiting for the repeated aspiration. MRD data were collected and interpreted according to the EuroMRD guidelines in one central reference laboratory per each participating country. Morphology was evaluated centrally using an own scoring system (with a max value of 26 points). Treatment delay between the original and the last aspiration was one-third longer in patients with subsequent event compared to patients remaining in complete remission (CR) (median 8 (range 2 – 21) vs. 6 (1 - 28) days, respectively; p=0.020). Patients with a subsequent event had significantly higher WBC at the time of the last repeated BM aspiration, compared to patients without event (p=0.019), while there was no difference relative to the original aspiration (p=0.9). Analysis of the BM morphology at the original aspiration showed no significant difference between patients with an event vs. those in CR. However, the repeated aspiration of patients with a subsequent event had significantly better morphology (median 18.5/26 vs. 15/26 points, p=0.0012) mainly due to higher cellularity (p=0.003) and number of megakaryocytes (p=0.048). MRD levels were identical or decreased in 88% and increased in 12% of cases comparing the original aspiration to the repeated aspiration. In 63 patients (20%) the different MRD levels would lead to different treatment stratification. Higher MRD was associated with treatment failure; the best predictive values for subsequent event were obtained using the MRD results of the original aspiration (p=3.1e-07) or the highest of the detected MRD levels (p=6.0e-07). The last aspiration before proceeding with treatment had the lowest, though still a highly significant predictive value (p=8.6e-06). Corresponding results are obtained when MRD levels are substituted by final MRD risk stratification into standard, medium or high risk (p<0.0001, p=0.0005 and p=0.0008 for the prediction of treatment failure using the MRD level in the original, the highest and the last aspiration, respectively). In conclusion, our data show that the original BM aspiration – independently of the quality of morphology – is not inferior for MRD treatment stratification, and that it actually has the best predictive value. In cases where sample quality precludes MRD analysis, the repeated sample with the highest MRD level should be used for stratification in order to not underestimate the putative risk of treatment failure. Longer treatment delay caused by waiting for a more representative sample seems to worsen the outcome. Notion that patients with a subsequent event need more time for BM regeneration is not justified, as their cellularity, overall morphology and also WBC before proceeding with treatment are better than in patients remaining in long-term CR. Any decision to perform a re-puncture at the end of induction therapy due to a non-representative morphology should be critically weighed. If possible, any unnecessary prolongation of treatment delay should be avoided unless being inevitable for other reasons, and therapy should be continued as soon as possible. Support: Deutsche Krebshilfe, Germany (Projects 50–2698 Schr1; 50–2722 BA6/7); St. Anna Kinderkrebsforschung, Austria; MSM0021620813; IGA NS/1000-4. Disclosures: No relevant conflicts of interest to declare.
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Baranwal, Anmol, and Sindhu Joseph. "Quality and Value-Focused Decision Making in Heparin-Induced Thrombocytopenia: The Impact of the American Society of Hematology's Choosing Wisely Initiative." Blood 128, no. 22 (December 2, 2016): 2342. http://dx.doi.org/10.1182/blood.v128.22.2342.2342.
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Abstract Introduction: For patients admitted to hospital, the use of heparin and its analogs is very common. Heparin administration can result in heparin-induced thrombocytopenia (HIT). Development of HIT is independent of the dose of heparin administration. Presence of HIT is determined by platelet antibody assays and confirmed by serotonin release assay. However, hospitalized patients have many comorbidities and are on several medications, both of which may be responsible for thrombocytopenia. The 4T scoring system was developed in 2006 to determine the pretest probability of HIT. Scores of 0-3, 4-5, and 6-8 are considered to correspond to a low, intermediate, and high probability of HIT, respectively. The 4T score was validated by a meta-analysis published in 2012 which reported that the negative predictive value of a low 4T score is close to 100% (Blood 2012;120(20):4160-4167). Inappropriate testing for thrombocytopenia can lead to inadvertent use of the platelet factor 4 assays, halting heparin administration unnecessarily and the over-treatment of patients with alternative anticoagulants. The American Society of Hematology (ASH) highlighted this in its 2014 Choosing Wisely guidelines (Blood 2014;124(24):3524-3528). The Choosing Wisely recommendations include using the 4T scoring system to assess the pretest probability of HIT. ASH recommends against testing and treating patients who have low pretest probability of HIT. We wanted to assess the impact of ASH Choosing Wisely recommendations on the appropriateness of checking for HIT. Methods: All the patients, admitted between January 2013 to March 2016, who had a HIT test done (CPT code 86022), were extracted from the hospital database. Of these patients, 140 were randomly selected before and after the publication of ASH Choosing Wisely guidelines. The immediately previous platelet count before ordering a HIT test was used to calculate the platelet nadir. The percentage in platelet count fall was determined by the difference between the immediately previous platelet count before ordering HIT test and the maximum platelet count documented on current admission. Timing of platelet count fall was determined as the number of days from HIT testing ordered to when patient received the first dose of heparin, or from the date of the immediately previous platelet count before ordering HIT test to the maximum platelet count, whichever is less. Patients were considered to have suspected thrombosis if an ultrasound doppler lower extremity or CT chest was ordered, but the results were not available at the time of ordering the HIT test. 4T scores were calculated for the first HIT test ordered to determine if the patients were a low-risk or intermediate- to high-risk for HIT. We did a chi-square test without Yate's correction to check if there has been a proportionate increase in HIT testing for patients with 4T score greater than 3, after the Choosing Wisely recommendations were published in 2014. Student's t-test was used to determine if there has been a decrease in the number of HIT tests ordered per patient after the release of Choosing Wisely guidelines. Patients who were not fit to be calculated for 4T score were excluded. Results: A total of 280 patient charts were reviewed. 23 patients were excluded as they received recent heparin and had platelet count fall within less than 4 days. Of the 129 patients admitted in 2013-2014, 31 (24%) were considered high/intermediate risk 4T score category. Of the 128 patients admitted from January 2015 to March 2016, 26 (20.3%) were considered high/intermediate risk 4T score category. The chi-square test did not show any difference between the two groups (chi-score 0.515 with 1 degrees of freedom, P = 0.47). However, the Student's t-test showed that the number of HIT tests ordered per patient declined significantly after the release of the Choosing Wisely guidelines (t = 2.09, P = 0.038). Conclusions: Physician adherence to 4T scoring system has not yet changed after the release of ASH Choosing Wisely guidelines. However, repeated testing for HIT has declined significantly after the guideline release. More efforts need to be taken to improve the quality of care in this population. Disclosures Baranwal: MacNeal Hospital: Employment.
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Xu, Siqi, Li Wang, and Xianchao Pan. "An evaluation of combined strategies for improving the performance of molecular docking." Journal of Bioinformatics and Computational Biology 19, no. 02 (February 27, 2021): 2150003. http://dx.doi.org/10.1142/s0219720021500037.
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Molecular docking is a fast and efficient computational method for the prediction of the binding mode and binding affinity between a ligand and a target protein at the atomic level. However, the performance of current docking programs is less than satisfactory. Herein, with a focus on free programs and scoring functions, the performances of LeDock and three standalone scoring functions were tested by 195 high-quality protein–ligand complexes. Results showed that the success rate for the best pose of the free available docking program LeDock achieved 89.20%, indicative of a strong sampling power. Based on the poses generated by LeDock, a comparative evaluation on other three non-commercial scoring functions, including DSX (DrugScore X), PoseScore and X-score was performed. Among all the evaluated scoring functions, DSX and X-score exhibited the best scoring power and ranking power, respectively. The performances of LeDock, DSX and X-score were similar in docking power test, which was much better than the PoseScore. Accordingly, it was suggested that the combination of pose sampling by LeDock with rescoring by DSX or X-score could improve the prediction accuracy of molecular docking and applied in the lead discovery.
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Yonchev, Dimitar, and Jürgen Bajorath. "Integrating computational lead optimization diagnostics with analog design and candidate selection." Future Science OA 6, no. 3 (March 1, 2020): FSO451. http://dx.doi.org/10.2144/fsoa-2019-0131.
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Aim: Combining computational lead optimization diagnostics with analog design and computational approaches for assessing optimization efforts are discussed and the compound optimization monitor is introduced. Methods: Approaches for compound potency prediction are described and a new analog design algorithm is introduced. Calculation protocols are detailed. Results & discussion: The study rationale is explained. Compound optimization monitor diagnostics are combined with a thoroughly evaluated approach for compound design and candidate prioritization. The diagnostic scoring scheme is further extended. Future perspective: Opportunities for practical applications of the integrated computational methodology are described and further development perspectives are discussed.
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Ibrahim, Aminu Alhassan, Mukadas Oyeniran Akindele, Sokunbi Oluwaleke Ganiyu, Bashir Kaka, and Bashir Bello. "The Hausa Back Beliefs Questionnaire: Translation, cross-cultural adaptation and psychometric assessment in mixed urban and rural Nigerian populations with chronic low back pain." PLOS ONE 16, no. 4 (April 13, 2021): e0249370. http://dx.doi.org/10.1371/journal.pone.0249370.
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Introduction Negative attitudes and beliefs about low back pain (LBP) can lead to reduced function and activity and consequently disability. One self-report measure that can be used to assess these negative attitudes and beliefs and to determine their predictive nature is the Back Beliefs Questionnaire (BBQ). This study aimed to translate and cross-culturally adapt the BBQ into Hausa and assess its psychometric properties in mixed urban and rural Nigerian populations with chronic LBP. Methods The BBQ was translated and cross-culturally adapted into Hausa (Hausa-BBQ) according to established guidelines. To assess psychometric properties, a consecutive sample of 200 patients with chronic LBP recruited from urban and rural clinics of Nigeria completed the questionnaire along with measures of fear-avoidance beliefs, pain catastrophizing, functional disability, physical and mental health, and pain. One hundred of the 200 patients completed the questionnaire twice at an interval of 7–14 days to assess test-retest reliability. Internal construct validity was assessed using exploratory factor analysis, and external construct validity was assessed by examining convergent, divergent, and known-groups validity. Reliability was assessed by calculating internal consistency (Cronbach’s α), intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change at 95% confidence interval (MDC95), and limits of agreement using Bland-Altman plots. Reliability (ICC, SEM and MDC95) was also assessed separately for rural and urban subgroups. Results The factor analysis revealed a four-factor solution explaining 58.9% of the total variance with the first factor explaining 27.1%. The nine scoring items loaded on the first factor hence supporting a unidimensional scale. The convergent and divergent validity were supported as 85% (6:7) of the predefined hypotheses were confirmed. Known-groups comparison showed that the questionnaire discriminated well for those who differed in education (p < 0.05), but not in age (p > 0.05). The internal consistency and ICC (α = 0.79; ICC = 0.91) were adequate, with minimal SEM and MDC95 (1.9 and 5.2, respectively). The limits of agreements were –5.11 to 5.71. The ICC, SEM and MDC95 for the urban and rural subgroups were comparable to those obtained for the overall population. Conclusions The Hausa-BBQ was successfully adapted and psychometrically sound in terms of internal and external construct validity, internal consistency, and test-retest reliability in mixed urban and rural Hausa-speaking populations with chronic LBP. The questionnaire can be used to detect and categorize specific attitudes and beliefs about back pain in Hausa culture to prevent or reduce potential disability due to LBP.
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Thakur, Bhushankumar A., Parnika Ravindra Shinde, and Anuj R. Sharma. "A clinicopathology study to establish the accuracy of diagnosis of acute appendicitis in case of acute right lower quadrant pain of abdomen." International Surgery Journal 4, no. 8 (July 24, 2017): 2419. http://dx.doi.org/10.18203/2349-2902.isj20173102.
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Background: Acute appendicitis, one of the most common surgical emergency is also one of the most challenging surgical dilemma for every surgeon, both in diagnosis and treatment. A negative exploration on one hand has to be weighed against the risk of subsequent perforation during expectant management especially in doubtful cases. We conducted a study to find out if diagnosis by scoring systems and graded ultrasonography improves clinical outcomes for patients with suspected appendicitis.Methods: It was a prospective and observational study including 52 patients of clinically suspected acute appendicitis presenting in the surgical emergency. All patients underwent clinical scoring using Alvarado scores and Ohmann’s score and Ultrasonography. Later, based on the intra operative findings and histopathological diagnosis of acute appendicitis, the sensitivity, specificity, positive predictive value and negative predictive value were calculated individually and by combining the scoring systems and imaging together.Results: The sensitivity, specificity, PPV and NPV of ultrasonography when combined with scoring systems (both Alvarado and Ohmann’s) is increased significantly as compared to when used individually for diagnosis of acute appendicitis. As calculated by our study, the sensitivity of USG was 90.32%, specificity 80.95%, PPV 87.5%, NPV 85% and diagnostic accuracy of 86.54% which has been comparable with the other studies in the previous literature.Conclusions: Combination of scoring systems with Ultrasonography leads to the prompt diagnosis and early treatment of many cases of appendicitis. Hence, improving clinical outcomes in doubtful cases.
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Joshi, Mukund Raj, Tanka Prasad Bohara, Shail Rupakheti, Anuj Parajuli, Dipendra Kumar Shrestha, Dimindra Karki, and Uttam Laudari. "Pre-operative Prediction of Difficult Laparoscopic Cholecystectomy." Journal of Nepal Medical Association 53, no. 200 (December 31, 2015): 221–26. http://dx.doi.org/10.31729/jnma.2734.
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Introduction: Laparoscopic cholecystectomy is one of the most common operation performed. Though LC have become safer and easier at times it can be difficult. Difficult cases can result in prolonged operative time, bleeding, bile spillage, conversion to open technique and bile duct injury resulting in unplanned prolonged hospital stay, increase in estimated cost to the patients and for the surgeon it leads to increased stress during operation and time pressure to complete the operative list. . Identification of difficult cases has potential advantages for surgeons, patients and their relatives. We aim to develop and validate a scoring system to predict difficult LC preoperatively.
Methods: Prospective study. History, physical examination, abdominal ultrasound and biochemical parameters were included to develop a scoring system. Hundred patients undergoing LC were included and preoperative scores were calculated preoperatively to predict difficult LC which was compared with operative assessment.
Results: Sensitivity and specificity of the preoperative scoring for difficult case was 53.8 % and 89.2 % respectively with PPV of 63.64 % and NPV of 84.62%. Only three parameters (history of acute cholecystitis, gall bladder wall thickness and contracted gall bladder) were statistically significant to predict difficult LC individually. Area under ROC curve was 0.779 (95 % CI, 0.657-0.883).
Conclusions: Preoperative scoring system can be used to predict difficult LC. Surgeons can plan operation based on predicted difficulty. Patients and relatives can be counselled preoperatively for the possibility of difficult operation, prolonged hospital stay and increased cost in predicted difficult case.
Keywords: difficult cholecystectomy; laparoscopic cholecystectomy; symptomatic cholelithiasis.
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Lekwijit, Suparerk, and Daricha Sutivong. "Optimizing the liquidity parameter of logarithmic market scoring rules prediction markets." Journal of Modelling in Management 13, no. 3 (August 13, 2018): 736–54. http://dx.doi.org/10.1108/jm2-06-2017-0066.
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Purpose Prediction markets are techniques to aggregate dispersed public opinions via market mechanisms to predict uncertain future events’ outcome. Many experiments have shown that prediction markets outperform other traditional forecasting methods in terms of accuracy. Logarithmic market scoring rules (LMSR) is one of the most simple and widely used market mechanisms; however, market makers have to confront crucial design decisions including the setting of the parameter “b” or the “liquidity parameter” in the price functions. As the liquidity parameter has significant effects on the market performance, this paper aims to provide a comprehensive basis for the setting of the parameter. Design/methodology/approach The analyses include the effects of the liquidity parameter on the forecast standard error and the amount of time for the market price to converge to the true value. These experiments use artificial prediction markets, the proposed simulation models that mimic real prediction markets. Findings The simulation results indicate that prediction market’s forecast standard error decreases as the value of the liquidity parameter increases. Moreover, for any given number of traders in the market, there exists an optimal liquidity parameter value that yields appropriate price adaptability and leads to the fastest price convergence. Originality/value Understanding these tradeoffs, the market makers can effectively determine the liquidity parameter value under various objectives on the standard error, the time to convergence and cost.