Nevin Manimala

J Xray Sci Technol. 2021 Oct 24. doi: 10.3233/XST-210982. Online ahead of print.

ABSTRACT

The accurately automatic classification of medical pathological images has always been an important problem in the field of deep learning. However, the traditional manual extraction of features and image classification usually requires in-depth knowledge and more professional researchers to extract and calculate high-quality image features. This kind of operation generally takes a lot of time and the classification effect is not ideal. In order to solve these problems, this study proposes and tests an improved network model DenseNet-201-MSD to accomplish the task of classification of medical pathological images of breast cancer. First, the image is preprocessed, and the traditional pooling layer is replaced by multiple scaling decomposition to prevent overfitting due to the large dimension of the image data set. Second, the BN algorithm is added before the activation function Softmax and Adam is used in the optimizer to optimize performance of the network model and improve image recognition accuracy of the network model. By verifying the performance of the model using the BreakHis dataset, the new deep learning model yields image classification accuracy of 99.4%, 98.8%, 98.2%and 99.4%when applying to four different magnifications of pathological images, respectively. The study results demonstrate that this new classification method and deep learning model can effectively improve accuracy of pathological image classification, which indicates its potential value in future clinical application.

PMID:34719472 | DOI:10.3233/XST-210982

Work. 2021 Oct 27. doi: 10.3233/WOR-213605. Online ahead of print.

ABSTRACT

BACKGROUND: Dental students have been identified as having a high level of stress.

OBJECTIVE: This study aimed to assess the prevalence of anxiety and depression among undergraduate dental students of university of Hail and to determine the association of anxiety and depression in terms of gender and respective year of study.

METHODS: This was an observational cross-sectional study. Nonprobability sampling technique was used to assess the prevalence and association of anxiety and depression among male and female dental students of preclinical and clinical years of College of Dentistry, University of Hail, Saudi Arabia. Students were contacted personally, explained the purpose of the study and asked to participate in the study. Students were asked to complete both Beck’s depression inventory and Beck’s anxiety inventory to assess the level of their respective status.

RESULTS: The results of the survey revealed that a greater number of females suffered from ‘moderate’ level of anxiety (12.3%) as compared to males (3.2%). Additionally, the percentage for females to experience ‘borderline’ (11.6%) and ‘moderate’ (9.7%) level of depression was higher than their male counterparts -‘borderline’ (7.7%) and ‘moderate’ (2.6%). The level of anxiety and depression compared with genders was found to be statistically significant. It was noted that final year students (8.4%) experienced ‘moderate’ level of anxiety and there was a peak rise in level of depression among 4th year (6.5%) and 6th year (5.8%) students as compared with other years.

CONCLUSION: The finding of the study emphasizes that the overall percentage of level of depression is comparatively higher than level of anxiety among dental students.

PMID:34719467 | DOI:10.3233/WOR-213605

J Neonatal Perinatal Med. 2021 Oct 26. doi: 10.3233/NPM-210869. Online ahead of print.

ABSTRACT

BACKGROUND: Currently there is limited information to guide health professionals regarding the optimal time frame to initiate safe and effective oral feedings to preterm infants. The study aims to revise and validate a streamlined version of the “Traditional Chinese-Preterm Oral Feeding Readiness Assessment Scale”, the TC-POFRAS®, and evaluate its construct validity in the clinical decisions regarding feeding readiness of preterm infants.

METHODS: Eighty-one clinically stable preterm infants were assessed using the TC-POFRAS for oral feeding readiness. Item-total correlation analysis was used to check if any item was inconsistent with the averaged TC-POFRAS scores. Cronbach’s α coefficient was used to evaluate the inter-item consistency. Exploratory factor analysis was used to determine the coherence of variables to reorganize assessment domains. The revised version of TC-POFRAS (TC-POFRAS®) was developed and a new cut-off score based on discriminant accuracy was established.

RESULTS: Based on the results from statistical analysis, five items (“lips posture,” “tongue posture,” “biting reflex,” “gag reflex,” and “tongue cupping”) were deleted from the original TC-POFRAS to form the TC-POFRAS®. The TC-POFRAS®’s global accuracy was 92.1%. The cut-off value of 19 was the one that presented the most optimization of sensitivity based on specificity. The TC-POFRAS® was reconstructed into corrected gestational age and five behavioral domains.

CONCLUSIONS: The TC-POFRAS® is considered a valid, safe, and accurate objective instrument to assist health professionals to initiate oral feeding of the preterm infants.

PMID:34719446 | DOI:10.3233/NPM-210869

Ann Hepatobiliary Pancreat Surg. 2021 Nov 1. Online ahead of print.

ABSTRACT

Oncological scoring systems in surgery are used as evidence-based decision aids to best support management through assessing prognosis, effectiveness and recurrence. Currently, the use of scoring systems in the hepato-pancreato-biliary (HPB) field is limited as concerns over precision and applicability prevent their widespread clinical implementation. The aim of this review was to discuss clinically useful oncological scoring systems for surgical management of HPB patients. A narrative review was conducted to appraise oncological HPB scoring systems. Original research articles of established and novel scoring systems were searched using Google Scholar, PubMed, Cochrane, and Ovid Medline. Selected models were determined by authors. This review discusses nine scoring systems in cancers of the liver (CLIP, BCLC, ALBI Grade, RETREAT, Fong’s score), pancreas (Genç’s score, mGPS), and biliary tract (TMHSS, MEGNA). Eight models used exclusively objective measurements to compute their scores while one used a mixture of both subjective and objective inputs. Seven models evaluated their scoring performance in external populations, with reported discriminatory c-statistic ranging from 0.58 to 0.82. Selection of model variables was most frequently determined using a combination of univariate and multivariate analysis. Calibration, another determinant of model accuracy, was poorly reported amongst nine scoring systems. A diverse range of HPB surgical scoring systems may facilitate evidence-based decisions on patient management and treatment. Future scoring systems need to be developed using heterogenous patient cohorts with improved stratification, with future trends integrating machine learning and genetics to improve outcome prediction.

PMID:34719429

J Pharm Health Care Sci. 2021 Nov 1;7(1):38. doi: 10.1186/s40780-021-00223-w.

ABSTRACT

BACKGROUND: Pharmacist plays an integral role in promoting antimicrobial stewardship (AS) strategies by committing to the evidence-based activities in this field. The present study aims to document trends in actual achievements through bibliometric analysis and identify the future direction of pharmacists with expertise in AS by describing the characteristics of articles on AS written by Japanese pharmacists.

METHODS: The study searched for articles written in Japanese and English on Ichushi-Web and MEDLINE, respectively, until December 2020 for published articles relevant to AS. The articles were classified into the seven groups according to content. Interrupted time series analysis (ITSA) was performed to identify the effect of the certification system for infection control pharmacy specialists (ICPSs) on the number of articles in Japanese.

RESULTS: The study retrieved 476 and 145 titles from Ichushi-Web and MEDLINE, respectively, out of which 383 and 123 articles written in Japanese and English, respectively, were considered relevant to AS. A continued publication was found for Japanese articles written by pharmacists assigned to large-sized hospitals since 1998, whereas few articles in English were published until 2017. The most frequent content of articles in both languages was intervention (56.7 and 59.0%, respectively). ITSA indicated that the number of publication slightly increased before [β1 = 1.33, 95% confidence interval (CI): – 0.62-3.28; P = 0.169] the implementation of the system. Moreover, the level (β2 = 11.41, 95%CI: – 0.23-23.05; P = 0.054) increased after the implementation of the system, whereas the slope decreased (β3 = – 2.07, 95%CI: – 4.16-0.03; P = 0.053). However, the changes were not statistically significant.

CONCLUSION: The study identified the contribution of pharmacists by documenting trends in AS practice and by conducting bibliometric analysis. The implementation of the ICPS certification system positively influenced the trend of publications. Therefore, the study recommends that policymakers and stakeholders should promote and support the evidence-based activities for AS for pharmacists in small- to medium-sized hospitals.

PMID:34719400 | DOI:10.1186/s40780-021-00223-w

BMC Genomics. 2021 Nov 1;22(1):666. doi: 10.1186/s12864-021-07949-9.

ABSTRACT

BACKGROUND: Historically, geneticists have relied on genotyping arrays and imputation to study human genetic variation. However, an underrepresentation of diverse populations has resulted in arrays that poorly capture global genetic variation, and a lack of reference panels. This has contributed to deepening global health disparities. Whole genome sequencing (WGS) better captures genetic variation but remains prohibitively expensive. Thus, we explored WGS at “mid-pass” 1-7x coverage.

RESULTS: Here, we developed and benchmarked methods for mid-pass sequencing. When applied to a population without an existing genomic reference panel, 4x mid-pass performed consistently well across ethnicities, with high recall (98%) and precision (97.5%).

CONCLUSION: Compared to array data imputed into 1000 Genomes, mid-pass performed better across all metrics and identified novel population-specific variants with potential disease relevance. We hope our work will reduce financial barriers for geneticists from underrepresented populations to characterize their genomes prior to biomedical genetic applications.

PMID:34719381 | DOI:10.1186/s12864-021-07949-9

Protein Pept Lett. 2021 Oct 22. doi: 10.2174/0929866528666211022152556. Online ahead of print.

ABSTRACT

BACKGROUND: Current treatments of osteoarthritis are unsatisfied, a new approach towards the treatment of osteoarthritis is urged considering the state at present.

OBJECTIVES: The objective of this study is to investigate the effect of fraxin on knee OA in a rat model and probe into the possible molecular mechanism.

METHODS: Primary Murine Chondrocytes were isolated and cell apoptosis analyses were performed. Rat OA models were established using meniscectomy method and allocated into three groups. Knee joint specimens were collected for qRT-PCR, western blotting and histological analysis. Statistical analyses were processed by using a SPSS.

RESULTS: The apoptosis rate of fraxin group is significantly reduced compared with the OA group or the control group. Fraxin remarkably down-regulated the expression of cleaved-Caspase-3 while significantly up-regulated the expression of Bcl-2, both on mRNA and protein levels. Toluidine blue stain results show relatively lighter articular cartilage damage compared with OA group.

CONCLUSION: Fraxin prevents knee osteoarthritis by inhibiting chondrocyte apoptosis, which makes it a potential candidate as an anti-OA drug for clinical use.

PMID:34719360 | DOI:10.2174/0929866528666211022152556

Cranio. 2021 Oct 30:1-7. doi: 10.1080/08869634.2021.1992211. Online ahead of print.

ABSTRACT

OBJECTIVE: To compare the comfort and anxiety levels of patients undergoing two different temporomandibular joint (TMJ) arthrocentesis techniques.

METHODS: Fifty female patients were randomly assigned into two groups of 25 based on the treatment modality: Group 1, single-puncture Type-1 arthrocentesis (SPA); Group 2, conventional double-puncture arthrocentesis (DPA). Preoperative and postoperative anxiety was scored with the State-Trait Anxiety Inventory-S (STAI-S) questionnaire. Blood pressure and heart rate were assessed preoperatively during the application of local anesthesia and at needle insertion into the joint cavity, the 5th and 10th minute of the procedure, and end of the procedure.

RESULTS: STAI-S scores were lower postoperative than preoperative in both groups. Heart rate and mean arterial pressure were highest during anesthesia and needle insertion (p < 0.005). Changes in heart rate, mean arterial pressure, and STAI-S scores were statistically similar between the groups.

CONCLUSION: DPA and SPA were tolerated similarly by the patients.

PMID:34719355 | DOI:10.1080/08869634.2021.1992211

Emerg Med Australas. 2021 Oct 30. doi: 10.1111/1742-6723.13892. Online ahead of print.

ABSTRACT

OBJECTIVE: To analyse the mission profiles of helicopter emergency medical service (HEMS) winch operations involving LifeFlight Retrieval Medicine physicians in Queensland, Australia, specifically focusing on patients’ clinical characteristics, extrication methods and scene times.

METHODS: A retrospective analysis was performed to identify all helicopter winch missions involving physicians during 2019. Demographic, clinical and non-clinical data were accessed from an electronic database used to log cases and findings presented using descriptive statistics.

RESULTS: Out of 4356 HEMS missions involving physicians, 100 (2.3%) were winch operations. Of these, 31 (31%) occurred overwater and 12 (12%) at night. In total, 106 patients were attended, and eight patient deaths occurred. Most patients were traumatically injured (66%), male (66%) and had a median (interquartile range) age of 43.5 (28-59) years. Thirteen missions (13%) involved drowning victims. This group had a higher burden of injury and comprised half of the patients treated with endotracheal intubation. Median scene time was 30 min (20-40), and the winch stretcher was the predominant patient extrication method. Physician winching occurred in 63 (63%) missions and was associated with increased scene time and increased use of the winch stretcher.

CONCLUSIONS: Winch operations involving physicians occur infrequently in Queensland HEMS, although almost a third of missions occur overwater. Drowning victims are encountered more frequently than reported elsewhere in Australian HEMS and comprised half of the patients who underwent endotracheal intubation. Patients’ severity of illness and injury may contribute to the associations between winching of physicians, increased scene times and increased use of the winch stretcher.

PMID:34719134 | DOI:10.1111/1742-6723.13892

PM R. 2021 Oct 31. doi: 10.1002/pmrj.12732. Online ahead of print.

ABSTRACT

BACKGROUND: Neck pain (NP) affects as much as 70% of individuals at some point in their lives. Systematic reviews indicate that manual treatments can be moderately effective in the management of chronic, nonspecific NP. However, there is a paucity of studies specifically evaluating the efficacy of osteopathic manipulative treatment (OMT).

OBJECTIVE: To evaluate the efficacy of OMT in reducing pain and disability in patients with chronic NP.

DESIGN: Single-blinded, cross-over, randomized controlled trial.

SETTING: University-based, osteopathic manipulative medicine outpatient clinic.

PARTICIPANTS: 97 participants, 21-65 years old, with chronic, nonspecific NP.

INTERVENTIONS: Participants were randomized to two trial arms: immediate OMT intervention or waiting period first. The intervention consisted of 3-4 OMT sessions over 4-6 weeks, after which the participants switched groups.

MAIN OUTCOME MEASURES: Primary outcome measures were pain intensity (average and current) on the numerical rating scale and Neck Disability Index. Secondary outcomes included PROMIS-29 health domains and Fear Avoidance Beliefs Questionnaire. Outcomes obtained prior to the cross-over allocation were evaluated using general linear models and after adjusting for baseline values.

RESULTS: 38 and 37 participants were available for the analysis in the OMT and waiting period groups, respectively. The results showed significantly better primary outcomes in the immediate OMT group for reductions in average pain (-1.02, 95%CI:[-1.72, -0.32], P = 0.005), current pain (-1.02, 95%CI:[-1.75, -0.30], P = 0.006), disability (-5.30%, 95%CI:[-9.2%, -1.3%], P = 0.010) and improved secondary outcomes (PROMIS) related to sleep (-3.25, 95%CI: [-6.95, -1.54], P = 0.003), fatigue (-3.26, 95%CI:[-6.04, -0.48], P = 0.022), and depression (-2.59, 95%CI:[-4.73, -0.45], P = 0.018). The effect sizes were in the clinically meaningful range between 0.5 and 1 SD. No study-related serious adverse events were reported.

CONCLUSIONS: OMT is relatively safe and effective in reducing pain and disability along with improving sleep, fatigue, and depression in patients with chronic NP immediately following treatment delivered over approximately 4-6 weeks.

TRIAL REGISTRATION: ClinicalTrials.gov NCT# 02261259. This article is protected by copyright. All rights reserved.

PMID:34719122 | DOI:10.1002/pmrj.12732