Tag: nevin manimala

Int J Cardiovasc Imaging. 2023 Aug 11. doi: 10.1007/s10554-023-02924-9. Online ahead of print.

ABSTRACT

Echocardiographic deformation curves provide detailed information on myocardial function. Deep neural networks (DNNs) may enable automated detection of disease features in deformation curves, and improve the clinical assessment of these curves. We aimed to investigate whether an explainable DNN-based pipeline can be used to detect and visualize disease features in echocardiographic deformation curves of phospholamban (PLN) p.Arg14del variant carriers. A DNN was trained to discriminate PLN variant carriers (n = 278) from control subjects (n = 621) using raw deformation curves obtained by 2D-speckle tracking in the longitudinal axis. A visualization technique was used to identify the parts of these curves that were used by the DNN for classification. The PLN variant carriers were clustered according to the output of the visualization technique. The DNN showed excellent discriminatory performance (C-statistic 0.93 [95% CI 0.87-0.97]). We identified four clusters with PLN-associated disease features in the deformation curves. Two clusters showed previously described features: apical post-systolic shortening and reduced systolic strain. The two other clusters revealed novel features, both reflecting delayed relaxation. Additionally, a fifth cluster was identified containing variant carriers without disease features in the deformation curves, who were classified as controls by the DNN. This latter cluster had a very benign disease course regarding development of ventricular arrhythmias. Applying an explainable DNN-based pipeline to myocardial deformation curves enables automated detection and visualization of disease features. In PLN variant carriers, we discovered novel disease features which may improve individual risk stratification. Applying this approach to other diseases will further expand our knowledge on disease-specific deformation patterns. Overview of the deep neural network-based pipeline for feature detection in myocardial deformation curves. Firstly, phospholamban (PLN) p.Arg14del variant carriers and controls were selected and a deep neural network (DNN) was trained to detect the PLN variant carriers. Subsequently, a clustering-based approach was performed on the attention maps of the DNN, which revealed 4 distinct phenotypes of PLN variant carriers with different prognoses. Moreover, a cluster without features and a benign prognosis was detected.

PMID:37566298 | DOI:10.1007/s10554-023-02924-9

Protein J. 2023 Aug 11. doi: 10.1007/s10930-023-10146-0. Online ahead of print.

ABSTRACT

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder that affects approximately 1/68 children, with a more recent study suggesting numbers as high as 1/36. According to Diagnostic and Statistical Manual of Mental Disorders, the etiology of ASD is unknown and diagnosis of this disorder is behavioral. There is currently no biomarker signature for ASD, however, identifying a biomarker signature is crucial as it would aid in diagnosis, identifying treatment targets, monitoring treatments, and identifying the etiology of the disorder. Here we used nanoliquid chromatography-tandem mass spectrometry (nanoLC-MS/MS) to investigate the saliva from individuals with ASD and matched controls in a 14 vs 14 study. We found numerous proteins to have statistically significant dysregulations, including lactotransferrin, transferrin, polymeric immunoglobulin receptor, Ig A L, Ig J chain, mucin 5 AC, and lipocalin 1 isoform X1. These findings are consistent with previous studies by our lab, and others, and point to dysregulations in the immune system, lipid metabolism and/or transport, and gastrointestinal disturbances, which are common and reoccurring topics in ASD research.

PMID:37566278 | DOI:10.1007/s10930-023-10146-0

Eur Radiol. 2023 Aug 11. doi: 10.1007/s00330-023-10061-z. Online ahead of print.

ABSTRACT

OBJECTIVES: To evaluate the performance of natural language processing (NLP) models to predict isocitrate dehydrogenase (IDH) mutation status in diffuse glioma using routine MR radiology reports.

MATERIALS AND METHODS: This retrospective, multi-center study included consecutive patients with diffuse glioma with known IDH mutation status from May 2009 to November 2021 whose initial MR radiology report was available prior to pathologic diagnosis. Five NLP models (long short-term memory [LSTM], bidirectional LSTM, bidirectional encoder representations from transformers [BERT], BERT graph convolutional network [GCN], BioBERT) were trained, and area under the receiver operating characteristic curve (AUC) was assessed to validate prediction of IDH mutation status in the internal and external validation sets. The performance of the best performing NLP model was compared with that of the human readers.

RESULTS: A total of 1427 patients (mean age ± standard deviation, 54 ± 15; 779 men, 54.6%) with 720 patients in the training set, 180 patients in the internal validation set, and 527 patients in the external validation set were included. In the external validation set, BERT GCN showed the highest performance (AUC 0.85, 95% CI 0.81-0.89) in predicting IDH mutation status, which was higher than LSTM (AUC 0.77, 95% CI 0.72-0.81; p = .003) and BioBERT (AUC 0.81, 95% CI 0.76-0.85; p = .03). This was higher than that of a neuroradiologist (AUC 0.80, 95% CI 0.76-0.84; p = .005) and a neurosurgeon (AUC 0.79, 95% CI 0.76-0.84; p = .04).

CONCLUSION: BERT GCN was externally validated to predict IDH mutation status in patients with diffuse glioma using routine MR radiology reports with superior or at least comparable performance to human reader.

CLINICAL RELEVANCE STATEMENT: Natural language processing may be used to extract relevant information from routine radiology reports to predict cancer genotype and provide prognostic information that may aid in guiding treatment strategy and enabling personalized medicine.

KEY POINTS: • A transformer-based natural language processing (NLP) model predicted isocitrate dehydrogenase mutation status in diffuse glioma with an AUC of 0.85 in the external validation set. • The best NLP models were superior or at least comparable to human readers in both internal and external validation sets. • Transformer-based models showed higher performance than conventional NLP model such as long short-term memory.

PMID:37566271 | DOI:10.1007/s00330-023-10061-z

Eur Radiol. 2023 Aug 11. doi: 10.1007/s00330-023-10021-7. Online ahead of print.

ABSTRACT

OBJECTIVES: The current study aimed to explore the moderating role of psychological resilience in the association between workload and depressive symptoms among radiology residents during standardized residency training (SRT) in China.

METHODS: A nationwide cross-sectional online survey was conducted among radiology residents in China. Workload was measured by working hours per week and the frequency of frontline nightwork in the last month. Resilience was assessed by the 2-item Connor-Davidson Resilience Scale. Depressive symptoms were measured by the Depression Anxiety Stress Scales. The hierarchical regression and simple slope analyses were performed to examine the moderating effect of resilience.

RESULTS: Among 3666 radiology residents, the mean age was 27.3 years (SD = 2.6) and 58% were female. About 24.4% of the participants reported medium to severe depressive symptoms. The hierarchical regression showed that working hours (b_a = 0.11, 95%CI: 0.08, 0.14) and having frontline nightwork more than once (b_a = 1.22, 95%CI: 0.67, 1.78) were positively associated with depressive symptoms; the moderating effect of resilience was significant in the association of depressive symptoms with working hours (b_a = – 0.02, 95%CI: – 0.03, – 0.01) and having frontline nightwork more than once (b_a = – 0.28, 95%CI: – 0.49, – 0.07). The simple slope test showed the association between workload-related variables and depressive symptoms was only significant in those with a relatively lower level of resilience.

CONCLUSIONS: The study found that resilience was an important modifier buffering the positive association between workload and depressive symptoms among radiology residents in China. Future medical training programs are suggested to include effective intervention components to increase personal resilience.

CLINICAL RELEVANCE STATEMENT: Heavy workload in clinical setting may pose adverse effect on mental health and job performance of radiology residents. The study investigated whether psychological resilience would mitigate the association between workload and depressive symptoms among Chinese radiology residents.

KEY POINTS: • Radiology residents with a heavier workload presented a higher level of depressive symptoms in China. • Psychological resilience mitigated the positive association between workload and depressive symptoms. • The association between workload and depressive symptoms was only statistically significant in radiology residents with a relatively lower level of resilience.

PMID:37566268 | DOI:10.1007/s00330-023-10021-7

Rheumatol Int. 2023 Aug 11. doi: 10.1007/s00296-023-05403-5. Online ahead of print.

ABSTRACT

Fibromyalgia is characterized by widespread pain, fatigue, sleep disturbances, mood disturbances, and cognitive impairment. Most individuals with fibromyalgia experience poorly managed symptoms and increased healthcare service use. Multicomponent therapies, with a focus on nonpharmacological modalities, are increasingly supported in the literature. However, given the limited resources available, implementation in smaller communities remains a challenge. This research tested a community-based multidisciplinary group intervention for individuals diagnosed with FM living in a small urban centre. The primary outcome was perceptions of quality of care and secondary outcomes included disease-related functioning, anxious and depressive symptoms, pain beliefs, and health service utilization. A pilot randomized control trial was conducted in which 60 patients diagnosed with fibromyalgia were randomized into a 10-week community-based multidisciplinary group intervention program or usual care. Treatment components included twice-weekly exercise sessions and weekly education sessions (e.g., pain education, cognitive behavioral strategies for stress, nutrition, peer support). The trial (NCT03270449) was registered September 1 2017. Statistically significant post-intervention improvements were found in the primary outcome, perceived quality of care (Cohen’s d = 0.61, 0.66 for follow up care and goal setting, respectively). Secondary outcomes showing statistically significant improvements were disease-related daily functioning (Cohen’s d = 0.70), depressive symptoms (Cohen’s d = 0.87), and pain beliefs (Cohen’s d = 0.61, 0.67, 0.82 for harm, disability and control, respectively). No adverse events were reported. Community-based multidisciplinary group interventions for fibromyalgia show promise for improving satisfaction with quality of care, disease-related functioning, and depression, and fostering more adaptive pain beliefs.

PMID:37566253 | DOI:10.1007/s00296-023-05403-5

Arch Gynecol Obstet. 2023 Aug 11. doi: 10.1007/s00404-023-07168-5. Online ahead of print.

ABSTRACT

OBJECTIVE: To evaluate and compare mini-laparotomy (MLPT) with laparoscopic (LPS) myomectomy perioperative and reproductive outcomes.

METHODS: We systematically searched for related articles in the MEDLINE, Embase, Web of Science and the Cochrane library databases. Nine studies (4 randomized, 3 retrospective, 1 prospective and 1 case-control study) which involved 1723 patients met the inclusion criteria and were considered eligible for inclusion.

RESULTS: Demographic characteristics were similar between the two groups. LPS was associated with shorter hospital stay (p = 0.04), lower blood loss (p < 0.00001), shorter duration of median ileus (p < 0.00001) and fewer episodes of postoperative fever (p = 0.04). None of the reproductive factors examined (pregnancy rate, preterm delivery, vaginal delivery and delivery with caesarean section) in women diagnosed with unexplained infertility and/or symptomatic leiomyomas reached statistical significance although the results represent a small size effect.

CONCLUSION: Our analysis demonstrated that LPS seems to be an alternative, safe and reliable surgical procedure for uterine leiomyoma treatment and in everyday practice seems to offer improved outcomes-regarding at least the perioperative period-over MLPT.

PMID:37566224 | DOI:10.1007/s00404-023-07168-5

Clin Cancer Res. 2023 Aug 11:CCR-23-1109. doi: 10.1158/1078-0432.CCR-23-1109. Online ahead of print.

ABSTRACT

PURPOSE: Targeting the PD-1/PD-L1 interaction has led to durable responses in fewer than half of patients with mismatch repair-deficient (MMR-d) advanced colorectal cancers (CRC). Immune contexture, including spatial distribution of immune cells in the tumor microenvironment, may predict immunotherapy outcome.

PATIENTS AND METHODS: Immune contexture and spatial distribution, including cell-to-cell distance measurements, were analyzed by multiplex immunofluorescence in primary CRCs with d-MMR (N=33) from patients treated with anti-PD-1 antibodies. By digital image analysis, density, ratio, intensity, and spatial distribution of PD-L1, PD-1, CD8, CD3, CD68, LAG3, TGFβR2, MHC-I, CD14, B2M, and pan-cytokeratin were computed. Feature selection was performed by regularized Cox regression with LASSO, and a proportional hazards model was fitted to predict progression-free survival (PFS).

RESULTS: For predicting survival among patients with MMR-d advanced CRC receiving PD-1 blockade, cell-to-cell distance measurements, but not cell densities or ratios, achieved statistical significance univariately. By multivariable feature selection, only mean number of PD-1+ cells within 10μm of a PD-L1+ cell was significantly predictive of progression-free survival (PFS). Dichotomization of this variable revealed that those with high versus low values had significantly prolonged PFS [median not reached (>83 months) vs 8.5 months (95% CI: 4.7-NR)] with a median PFS of 28.4 months for all patients [HRadj= 0.14, 95% CI: 0.04, 0.56; p=0.005]. Expression of PD-1 was observed on CD8+ T-cells; PD-L1 on CD3+ and CD8+ T-lymphocytes, macrophages (CD68+) and tumor cells.

CONCLUSIONS: In d-MMR CRCs, PD-1+ to PD-L1+ receptor to ligand proximity is a potential predictive biomarker for the effectiveness of PD-1 blockade.

PMID:37566222 | DOI:10.1158/1078-0432.CCR-23-1109

Int Endod J. 2023 Aug 11. doi: 10.1111/iej.13961. Online ahead of print.

ABSTRACT

AIM: The aim of this study is to compare the stress produced on the internal walls of simulated canals by nine rotary and four reciprocating systems.

METHODOLOGY: Sixty-five isotropic transparent blocks containing a 60° curved and tapered simulated canal were selected and distributed into 13 groups (n = 5) according to the preparation system: BioRace, HyFlex EDM, iRaCe, Mtwo, One RECI, ProTaper Next, RaCe EVO, Reciproc, Reciproc Blue, R-Motion, VDW.ROTATE, XP-Endo Rise Shaper, and XP-Endo Shaper. Each resin block was mounted in a vice and a digital camera recorded the entire sequence of each preparation system through a circular polariscope set for dark field analysis. The video frames when each instrument reached the end of the coronal, middle, and apical thirds of the canal were extracted from the recordings and analysed by two independent observers regarding the stress generated on the canal walls using a semi-quantitative evaluation on a 0-5 scale. Intra- and inter-observer agreement were subjected to the Cohen’s Kappa coefficient test, whilst the experimental results were compared using Kruskal-Wallis test post hoc pairwise comparisons with Bonferroni correction (α = 5%).

RESULTS: The inter- and intra-observer agreement were 0.98 and 1, respectively. Most instruments demonstrated acceptable performance (scores ≤ 2) in all thirds. Other instruments, such as the HyFlex EDM 25.12 (coronal and middle thirds), Reciproc Blue R25 and Reciproc R25 (coronal and apical thirds), R-Motion 30.04 (apical third), and VDW.ROTATE 20.05 (apical third) showed scores higher than 3. Statistical analysis revealed a significant difference amongst the tested systems at the coronal, middle, and apical thirds (p < .05).

CONCLUSION: None of the canal instrumentation protocols were stress-free, showing varying levels of stress concentrations. Various factors seemed to influence the magnitude of stress and its distribution pattern on the canal walls. Overall, instruments characterized by a larger taper, lower speed, reciprocating motion, and made of heat-treated NiTi alloy exhibited higher patterns of stress distribution.

PMID:37566206 | DOI:10.1111/iej.13961

J Burn Care Res. 2023 Aug 11:irad120. doi: 10.1093/jbcr/irad120. Online ahead of print.

ABSTRACT

Every year millions of people are burned and many of them are transported to specialized burn centers. One of the most important challenges in the face of burn patients in urban areas is deciding about referring patients to specialized burn centers. In this study correlation between referral distance and mortality rate is investigated. Our cross-sectional analytic study included admission data of 7248 burn patients from Imam Reza Burn Center (Mashhad, Iran) over 9 years. The outcomes of interest were mortality, length of hospital stay and the Abbreviated Burn Severity Index (ABSI). Also, we measured the distance between the patient referral location to Mashhad. SPSS version 16 was used for data analysis. Overall, 52.7% of admitted patients were referred from hospitals in other cities. The referred group had more severe burn injury(p<0.001), higher mortality rate(p<0.001) and longer length of hospital stay(p<0.001). The referred distance was associated with an increased risk of death (Odds ratio=1.68, CI95%=1.47-1.92) but after controlling the severity of burns, only ABSI was the statistically significant predictor of mortality (Odds ration=2.17, CI95%=2.05-2.28). Therefore, increasing the distance from urban areas to specialized burn center did not increase the mortality rate. After adjusting for ABSI, the mortality rate in referred patients was not related to referral distance. By observing referral points based on available guidelines, distance from a referral burn center does not affect mortality rate independently. Therefore, equipping the existing burn centers instead of building new ones and focusing on improving referral system cand be a good strategy in low- and middle-income countries with limited resources.

PMID:37565463 | DOI:10.1093/jbcr/irad120

Med Sci Sports Exerc. 2023 Aug 11. doi: 10.1249/MSS.0000000000003275. Online ahead of print.

ABSTRACT

INTRODUCTION/PURPOSE: Heavy lifting may produce strain on the pelvic floor muscles (PFM) due to high increases in intraabdominal pressure, but knowledge of the impact of weightlifting on the PFM is lacking. Therefore, this study aimed to investigate acute effects of heavy weightlifting on the PFM in strength-trained women and whether general strength in whole-body exercises correlated to PFM strength.

METHODS: Forty-seven nulliparous women between 18-35 years who regularly performed weightlifting and were able to lift their own body weight x 1.2 in back squat and 1.5 in deadlift were included in this experimental crossover study. They participated in baseline evaluations (questionnaire/measurements of background characteristics and pelvic floor disorders, 1 repetition maximum (1RM) tests in back squat and deadlift) and one test day where they were randomized to start with 60 minutes of weightlifting (4 sets of 4 repetitions at 75-85% of 1RM in back squat and deadlift) or seated rest of 60 minutes. Vaginal pressure measurements of PFM resting pressure, strength, and endurance and sEMG-measurements of PFM resting activity were performed before/after weightlifting and rest.

RESULTS: No statistically significant differences were found when comparing the change in PFM resting pressure, strength, endurance, and resting activity after heavy weightlifting and rest. There were no statistically significant correlations between PFM strength and maximum (1RM) or relative strength (1RM/bodyweight) in either back squat or deadlift.

CONCLUSIONS: Our results imply that heavy weightlifting is well tolerated by the PFM in short-term among young, nulliparous, and strength-trained women. Strength in whole-body exercises was not correlated to PFM strength.

PMID:37565457 | DOI:10.1249/MSS.0000000000003275