The recent Coronavirus Disease 2019 (COVID-19) pandemic has placed severe stress on healthcare systems worldwide, which is amplified by the critical shortage of COVID-19 tests.
In this study, we ...propose to generate a more accurate diagnosis model of COVID-19 based on patient symptoms and routine test results by applying machine learning to reanalyzing COVID-19 data from 151 published studies. We aim to investigate correlations between clinical variables, cluster COVID-19 patients into subtypes, and generate a computational classification model for discriminating between COVID-19 patients and influenza patients based on clinical variables alone.
We discovered several novel associations between clinical variables, including correlations between being male and having higher levels of serum lymphocytes and neutrophils. We found that COVID-19 patients could be clustered into subtypes based on serum levels of immune cells, gender, and reported symptoms. Finally, we trained an XGBoost model to achieve a sensitivity of 92.5% and a specificity of 97.9% in discriminating COVID-19 patients from influenza patients.
We demonstrated that computational methods trained on large clinical datasets could yield ever more accurate COVID-19 diagnostic models to mitigate the impact of lack of testing. We also presented previously unknown COVID-19 clinical variable correlations and clinical subgroups.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Background Negative symptoms are a core feature of schizophrenia. The evolution and trajectory of primary negative symptoms were under-studied. We aimed at evaluating the prevalence and ...stability of primary negative symptoms, and factors associated with persistent primary negative symptoms in a first-episode sample. Method Ninety-three Hong Kong Chinese aged 18 to 55 years presenting with first-episode schizophrenia-spectrum disorder were studied. Data on premorbid adjustment, socio-demographics, and baseline clinical and cognitive profiles were obtained. Psychopathological and vocational reassessments were conducted at 12, 24 and 36 months. Primary negative symptoms were defined as the presence of clinically significant negative symptoms excluding depression and extra-pyramidal signs. Results At baseline, 25.8% of subjects exhibited primary negative symptoms. A quarter of patients had their initial primary negative symptoms status retained 12 months after treatment initiation. In both Year 2 and Year 3 of study period, around 70% of subjects had their primary negative symptoms status maintained for 12 months. At the end of three-year follow-up, 23.7% were categorized as having persistent primary negative symptoms. Male sex, unemployment at intake, prolonged duration of untreated psychosis, poorer premorbid academic and social functioning, poorer insight and worse vocational outcome were found to be associated with persistent primary negative symptoms. Conclusion Clinical status of primary negative symptoms in first-episode schizophrenia-spectrum disorder was unstable in the initial year of treatment. Baseline symptom assessment may not reliably predict development of persistent primary negative symptoms. Studying negative symptoms should take into account the longitudinal perspective, especially in the early course of psychotic disorders.
To develop a 3D adiabatic T
prepared ultrashort echo time cones (3D AdiabT
UTE-Cones) sequence for whole knee imaging on a clinical 3T scanner.
A train of adiabatic full passage pulses were used for ...spin locking, followed by time-efficient multispoke UTE acquisition to detect signals from both short and long T
tissues in the whole knee joint. A modified signal model was proposed for multispoke UTE data fitting. The feasibility of this 3D AdiabT
UTE-Cones technique was demonstrated through numerical simulation, phantom, and ex vivo knee sample studies. The 3D AdiabT
UTE-Cones technique was then applied to 6 in vivo knee joints of healthy volunteers to measure T
values of quadriceps tendon, patellar tendon, anterior cruciate ligament (ACL), posterior cruciate ligament (PCL), meniscus, patellar cartilage, and muscle.
Numerical simulation, phantom and ex vivo knee sample studies demonstrated the feasibility of whole knee imaging using the proposed multispoke 3D AdiabT
UTE-Cones sequence. The healthy volunteer knee study demonstrated an averaged T
of 13.9 ± 0.7 ms for the quadriceps tendon, 9.7 ± 0.8 ms for the patellar tendon, 34.9 ± 2.8 ms for the ACL, 21.6 ± 1.4 ms for the PCL, 22.5 ± 1.9 ms for the meniscus, 44.5 ± 2.4 ms for the patellar cartilage, and 43.2 ± 1.1 ms for the muscle.
The 3D AdiabT
UTE-Cones sequence allows volumetric T
assessment of both short and long T
tissues in the knee joint on a clinical 3T scanner.
Background:
Widespread adoption of fresh allograft transplantation remains limited, predominantly by supply issues. To overcome these limitations, a preshaped, cylindrical sterilized and ...decellularized osteochondral allograft (SDOCA) implant was recently introduced as a clinical treatment option.
Purpose:
To evaluate functional outcomes and graft survivorship among patients treated with the SDOCA implant for knee cartilage injuries.
Study Design:
Case series; Level of evidence, 4.
Methods:
An institutional review board–approved database was used to identify a series of patients with prospectively collected data who had been treated with the SDOCA implant. The surgeries were performed at 2 centers by 2 surgeons. Patient-reported outcomes, magnetic resonance imaging (MRI), and the number and type of reoperations were assessed. Failure was defined as structural damage of the graft diagnosed by arthroscopy or MRI, and any reoperation resulting in removal of the allograft. Patients were evaluated pre- and postoperatively using the Knee injury and Osteoarthritis Outcome Score (KOOS) and Marx Sports Activity Scale. MRI was assessed preoperatively and postoperatively.
Results:
There were 32 patients with a mean age (±SD) of 35.1 ± 10.6 years; 59% were male. Twenty-three (72%) knees had previous surgery. The mean defect area (±SD) was 2.9 ± 2.0 cm2, and the mean allograft size was 13.18 ± 2.3 mm (6 grafts ≤9 mm and 59 grafts ≥11 mm). The median number of allografts per knee was 2 (range, 1-5 grafts). Twenty-three of the 32 knees (72%) were considered failures by the definition detailed above. Of these, 14 knees (43%) had further surgery after the index procedure. Implant survivorship was 19.6% at 2 years. The mean follow-up duration was 1.29 years (range, 0.11-2.8 years). KOOS pain, activities of daily living (ADL), sports and recreation (sport/rec), and knee-related quality of life improved significantly from the preoperative visit to latest follow-up. Age was significantly predictive of failure, with a hazard ratio of 1.68 per 1 SD older (95% CI, 1.05-2.68; P = .030). The MOCART (magnetic resonance observation of cartilage repair tissue) feature effusion was the only score to correlate with KOOS (symptoms, pain, ADL, sport/rec).
Conclusion:
The SDOCA implant demonstrated a 72% failure rate within the first 2 years of implantation at these 2 institutions.
Triple-negative breast cancer is a subtype of breast cancer with aggressive tumor behavior and distinct disease etiology. Due to the lack of an effective targeted medicine, treatment options for ...triple-negative breast cancer are few and recurrence rates are high. Although various multi-gene prognostic markers have been proposed for the prediction of breast cancer outcome, most of them were proven clinically useful only for estrogen receptor-positive breast cancers. Reliable identification of triple-negative patients with a favorable prognosis is not yet possible.
Clinicopathological information and microarray data from 157 invasive breast carcinomas were collected at National Taiwan University Hospital from 1995 to 2008. Gene expression data of 51 triple-negative and 106 luminal breast cancers were generated by oligonucleotide microarrays. Hierarchical clustering analysis revealed that the majority (94%) of triple-negative breast cancers were tightly clustered together carrying strong basal-like characteristics. A 45-gene prognostic signature giving 98% predictive accuracy in distant recurrence of our triple-negative patients was determined using the receiver operating characteristic analysis and leave-one-out cross validation. External validation of the prognostic signature in an independent microarray dataset of 59 early-stage triple-negative patients also obtained statistical significance (hazard ratio 2.29, 95% confidence interval (CI) 1.04-5.06, Cox P=0.04), outperforming five other published breast cancer prognostic signatures. The 45-gene signature identified in this study revealed that TGF-β signaling of immune/inflammatory regulation may play an important role in distant metastatic invasion of triple-negative breast cancer.
Gene expression data and recurrence information of triple-negative breast cancer were collected and analyzed in this study. A novel set of 45-gene signature was found to be statistically predictive in disease recurrence of triple-negative breast cancer. The 45-gene signature, if further validated, may be a clinically useful tool in risk assessment of distant recurrence for early-stage triple-negative patients.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
Abstract Pain after stroke is commonly reported but often incompletely managed, which prevents optimal recovery. This situation occurs in part because of the esoteric nature of poststroke pain and ...its limited presence in current discussions of stroke management. The major specific afflictions that affect patients with stroke who experience pain include central poststroke pain, complex regional pain syndrome, and pain associated with spasticity and shoulder subluxation. Each disorder carries its own intricacies that require specific approaches to treatment and understanding. This review aims to present and clarify the major pain syndromes that affect patients who have experienced a stroke in order to aid in their diagnosis and treatment.
In this study, we aimed to develop a new technique, ultrashort echo time Cones double echo steady state (UTE-Cones-DESS), for highly efficient morphological imaging of musculoskeletal tissues with ...short T
s. We also proposed a novel, single-point Dixon (spDixon)-based approach for fat suppression.
The UTE-Cones-DESS sequence was implemented on a 3T MR system. It uses a short radiofrequency (RF) pulse followed by a pair of balanced spiral-out and spiral-in readout gradients separated by an unbalanced spoiling gradient in-between. The readout gradients are applied immediately before or after the RF pulses to achieve a UTE image (S
) and a spin/stimulated echo image (S
). Weighted echo subtraction between S
and S
was performed to achieve high contrast specific to short T
tissues, and spDixon was applied to suppress fat by using the intrinsic complex signal of S
and S
. Six healthy volunteers and five patients with osteoarthritis were recruited for whole-knee imaging. Additionally, two healthy volunteers were recruited for lower leg imaging.
The UTE-Cones-DESS sequence allows fast volumetric imaging of musculoskeletal tissues with excellent image contrast for the osteochondral junction, tendons, menisci, and ligaments in the knee joint as well as cortical bone and aponeurosis in the lower leg within 5 min. spDixon yields efficient fat suppression in both S
and S
images without requiring any additional acquisitions or preparation pulses.
The rapid UTE-Cones-DESS sequence can be used for high contrast morphological imaging of short T
tissues, providing a new tool to assess their association with musculoskeletal disorders.
The COVID-19 pandemic caused by the SARS-CoV-2 virus, overlaps with the ongoing epidemics of cigarette smoking and electronic cigarette (e-cig) vaping. However, there is scarce data relating COVID-19 ...risks and outcome with cigarette or e-cig use. In this study, we mined three independent RNA expression datasets from smokers and vapers to understand the potential relationship between vaping/smoking and the dysregulation of key genes and pathways related to COVID-19. We found that smoking, but not vaping, upregulates ACE2, the cellular receptor that SARS-CoV-2 requires for infection. Both smoking and use of nicotine and flavor-containing e-cigs led to upregulation of pro-inflammatory cytokines and inflammasome-related genes. Specifically, chemokines including CCL20 and CXCL8 are upregulated in smokers, and CCL5 and CCR1 are upregulated in flavor/nicotine-containing e-cig users. We also found genes implicated in inflammasomes, such as CXCL1, CXCL2, NOD2, and ASC, to be upregulated in smokers and these e-cig users. Vaping flavor and nicotine-less e-cigs, however, did not lead to significant cytokine dysregulation and inflammasome activation. Release of inflammasome products, such as IL-1B, and cytokine storms are hallmarks of COVID-19 infection, especially in severe cases. Therefore, our findings demonstrated that smoking or vaping may critically exacerbate COVID-19-related inflammation or increase susceptibility to COVID-19.
To evaluate the 3-dimensional (3D) zero echo time (ZTE) magnetic resonance imaging (MRI) technique and compare it with 3D computed tomography (CT) for the assessment of the glenoid bone.
ZTE MRI ...using multiple resolutions and multislice CT were performed in 6 shoulder specimens before and after creation of glenoid defects and in 10 glenohumeral instability patients. Two musculoskeletal radiologists independently generated 3D volume-rendered images of the glenoid en face. Post-processing times and glenoid widths were measured. Inter-modality and inter-rater agreement was assessed.
Intraclass correlation coefficients (ICCs) for inter-modality assessment showed almost perfect agreement for both readers, ranging from 0.949 to 0.991 for the ex vivo study and from 0.955 to 0.987 for the in vivo patients. Excellent interobserver agreement was found for both the ex vivo (ICCs ≥ 0.98) and in vivo (ICCs ≥ 0.92) studies. For the ex vivo study, Bland-Altman analyses for CT versus MRI showed a mean difference of 0.6 to 1 mm at 1.0-mm3 MRI resolution, 0.3 to 0.6 mm at 0.8-mm3 MRI resolution, and 0.3 to 0.6 mm at 0.6-mm3 MRI resolution for both readers. For the in vivo study, Bland-Altman analyses for CT versus MRI showed a mean difference of 0.6 to 0.8 mm at 1.0-mm3 MRI resolution, 0.5 to 0.6 mm at 0.8-mm3 MRI resolution, and 0.4 to 0.8 mm at 0.7-mm3 MRI resolution for both readers. Mean post-processing times to generate 3D images of the glenoid ranged from 32 to 46 seconds for CT and from 33 to 64 seconds for ZTE MRI.
Three-dimensional ZTE MRI can potentially be considered as a technique to determine glenoid width and can be readily incorporated into the clinical workflow.
Level II, development of diagnostic criteria (consecutive patients with consistently applied reference standard and blinding).
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