•Normal and glaucoma classes are classified using digital fundus images.•Gabor transformation and principal component analysis are used to extract the features.•Bhattacharyya space algorithm, t-test, ...Wilcoxon test, Receiver Operating Curve (ROC), and entropy method are used for feature ranking.•Support Vector Machine (SVM) classifier gives the highest average accuracy of 93.10%, sensitivity of 89.75% and specificity of 96.20% using 23 features.•A Glaucoma Risk Index (GRI) is developed using selected principal components to classify the two classes using just one number.
Increase in intraocular pressure (IOP) is one of the causes of glaucoma which can lead to blindness if not detected and treated at an early stage. Glaucoma symptoms are not always obvious; hence patients seek treatment only when the condition progressed significantly. Early detection and treatment will decrease the chances of vision loss due to glaucoma. This paper proposes a novel automated glaucoma diagnosis method using various features extracted from Gabor transform applied on digital fundus images. In this work, we have used 510 images to classify into normal and glaucoma classes. Various features namely mean, variance, skewness, kurtosis, energy, and Shannon, Rényi, and Kapoor entropies are extracted from the Gabor transform coefficients. These extracted features are subjected to principal component analysis (PCA) to reduce the dimensionality of the features. Then these features are ranked using various ranking methods namely: Bhattacharyya space algorithm, t-test, Wilcoxon test, Receiver Operating Curve (ROC), and entropy. In this work, t-test ranking method yielded the highest performance with an average accuracy of 93.10%, sensitivity of 89.75% and specificity of 96.20% using 23 features with Support Vector Machine (SVM) classifier. Also, we have proposed a Glaucoma Risk Index (GRI) developed using principal components to classify the two classes using just one number.
Randomized controlled trials (RCTs) comparing percutaneous coronary intervention (PCI) with drug-eluting stents and coronary artery bypass grafting (CABG) for patients with left main coronary artery ...disease (LMCAD) have reported conflicting results. We performed a systematic review up to May 23, 2021, and 1-stage reconstructed individual patient data meta-analysis (IPDMA) to compare outcomes between both groups. The primary outcome was 10-year all-cause mortality. Secondary outcomes included myocardial infarction (MI), stroke, and unplanned revascularization at 5 years. We performed individual patient data meta-analysis using published Kaplan-Meier curves to provide individual data points in coordinates and numbers at risk were used to increase the calibration accuracy of the reconstructed data. Shared frailty model or, when proportionality assumptions were not met, a restricted mean survival time model were fitted to compare outcomes between treatment groups. Of 583 articles retrieved, 5 RCTs were included. A total of 4,595 patients from these 5 RCTs were randomly assigned to PCI (n = 2,297) or CABG (n = 2,298). The cumulative 10-year all-cause mortality after PCI and CABG was 12.0% versus 10.6%, respectively (hazard ratio HR 1.093, 95% confidence interval CI 0.925 to 1.292; p = 0.296). PCI conferred similar time-to-MI (restricted mean survival time ratio 1.006, 95% CI 0.992 to 1.021, p=0.391) and stroke (restricted mean survival time ratio 1.005, 95% CI 0.998 to 1.013, p = 0.133) at 5 years. Unplanned revascularization was more frequent after PCI than CABG (HR 1.807, 95% CI 1.524 to 2.144, p <0.001) at 5 years. This meta-analysis using reconstructed participant-level time-to-event data showed no statistically significant difference in cumulative 10-year all-cause mortality between PCI versus CABG in the treatment of LMCAD.
Percutaneous coronary intervention versus coronary artery bypass graft in patients with left main coronary artery disease. CABG: coronary artery bypass graft; DES: drug-eluting stent; LIMA: left internal mammary artery; PCI: percutaneous coronary intervention. Display omitted
A randomized clinical study of patients with advanced epithelial ovarian cancer after debulking surgery showed that high-dose (120 mg/m2) cis-platinum (DDP) in combination with cyclophosphamide (600 ...mg/m2) had a significantly higher response and survival rate than the low-dose DDP (60 mg/m2) and cyclophosphamide combination. The 3-year actuarial survival rate of the high-dose group was 60% and that of the low-dose group was 30%. Though moderate to severe marrow toxicity was evident in 80% of the patients in the high-dose group and 40% of the low-dose group, no serious sepsis or death developed as a result of the marrow depression. Mild neurotoxicity was observed in 55% of the patients in the high-dose group and only 20% in the low-dose group. Mild nephrotoxicity was seen in 25 and 17% of patients in the high- and low-dose groups, respectively. It was concluded that the 120 mg/m2 dose DDP and cyclophosphamide combination should be used in the treatment of carcinoma of the ovary in spite of its toxicities. However, it should only be used in institutions with supportive facilities in the management of patients with severe marrow depression.
Nasopharyngeal carcinoma (NPC) is an epithelial squamous cell carcinoma on the mucosal lining of the nasopharynx. The etiology of NPC remains elusive despite many reported studies. Most studies ...employ a single platform approach, neglecting the cumulative influence of both the genome and transcriptome toward NPC development. We aim to employ an integrated pathway approach to identify dysregulated pathways linked to NPC. Our approach combines imputation NPC GWAS data from a Malaysian cohort as well as published expression data GSE12452 from both NPC and non‐NPC nasopharynx tissues. Pathway association for GWAS data was performed using MAGENTA while for expression data, GSA‐SNP was used with gene p values derived from differential expression values from GEO2R. Our study identified NPC association in the gene ontology (GO) axonemal dynein complex pathway (pGWAS-GSEA = 1.98 × 10−2; pExpr‐GSEA = 1.27 × 10−24; pBonf‐Combined = 4.15 × 10−21). This association was replicated in a separate cohort using gene expression data from NPC and non‐NPC nasopharynx tissues (pAmpliSeq‐GSEA = 6.56 × 10−4). Loss of function in the axonemal dynein complex causes impaired cilia function, leading to poor mucociliary clearance and subsequently upper or lower respiratory tract infection, the former of which includes the nasopharynx. Our approach illustrates the potential use of integrated pathway analysis in detecting gene sets involved in the development of NPC in the Malaysian cohort.
What's new?
By combining previously reported genome‐wide association studies and gene expression data in nasopharyngeal carcinoma tissues (NPC), the authors made an unexpected new connection with key proteins in the dynein complex present in a ciliary cytoskeletal structure called axoneme. Their findings point to a loss of function of the axonemal dynein complex in NPCs, which the authors confirmed in independent tissue studies.
The most recent version of the European Society for Medical Oncology (ESMO) Clinical Practice Guidelines for the diagnosis, treatment and follow-up of renal cell carcinoma was published in 2019 with ...an update planned for 2021. It was therefore decided by both the ESMO and the Singapore Society of Oncology (SSO) to convene a special, virtual guidelines meeting in May 2021 to adapt the ESMO 2019 guidelines to take into account the ethnic differences associated with the treatment of renal cell carcinomas in Asian patients. These guidelines represent the consensus opinions reached by experts in the treatment of patients with renal cell carcinoma representing the oncological societies of China (CSCO), India (ISMPO), Japan (JSMO), Korea (KSMO), Malaysia (MOS), Singapore (SSO) and Taiwan (TOS). The voting was based on scientific evidence and was independent of the current treatment practices and drug access restrictions in the different Asian countries. The latter were discussed when appropriate.
•This article provides ESMO expert recommendations adapted for the treatment of renal cell carcinomas in Asian patients.•The aim was to provide guidance for the optimisation of the management of such patients across Asia.•The availability and applicability of certain procedures as they relate to certain of the recommendations are discussed.
Diabetic retinopathy (DR) is a leading cause of vision loss among diabetic patients in developed countries. Early detection of occurrence of DR can greatly help in effective treatment. Unfortunately, ...symptoms of DR do not show up till an advanced stage. To counter this, regular screening for DR is essential in diabetic patients. Due to lack of enough skilled medical professionals, this task can become tedious as the number of images to be screened becomes high with regular screening of diabetic patients. An automated DR screening system can help in early diagnosis without the need for a large number of medical professionals. To improve detection, several pattern recognition techniques are being developed. In our study, we used trace transforms to model a human visual system which would replicate the way a human observer views an image. To classify features extracted using this technique, we used support vector machine (SVM) with quadratic, polynomial, radial basis function kernels and probabilistic neural network (PNN). Genetic algorithm (GA) was used to fine tune classification parameters. We obtained an accuracy of 99.41 and 99.12 % with PNN–GA and SVM quadratic kernels, respectively.
Applying path analysis to 237 secondary school students and 320 post-secondary students in Singapore, parents' education was found to have important effects on adolescents' educational aspiration as ...mediated through educational track and adolescents' financial stress and self-esteem. This effect is strong for adolescents in both secondary and post-secondary education, with slight differences in the specific psychological process. The findings imply calibration of education towards parity and psychosocial interventions to improve adolescents' self-concepts, coping and aspirations. However, in the context of fast economic transformation, a burgeoning middle class, a differentiated education system, and high-income inequality, policy and psychosocial interventions will have limited effectiveness without addressing labour market disparities and the social stigma of vocational and technical education.
Neurosurgeons today are inundated with rapidly amassing neurosurgical research publications. Systematic reviews and meta-analyses have consequently surged in popularity because, when executed ...properly, they constitute a high level of evidence and may save busy neurosurgeons many hours of combing and reviewing the literature for relevant articles. Meta-analysis refers to the quantitative (and discretionary) component of systematic reviews. It involves applying statistical techniques to combine effect sizes from multiple studies, which might offer more actionable insights than a systematic review without meta-analysis. Well-executed meta-analyses may prove instructive for clinical practice, but poorly conducted ones sow confusion and have the potential to cause harm. Unfortunately, recent audits have found the conduct and reporting of meta-analyses in neurosurgery (but also other surgical disciplines) to be relatively lackluster in methodologic rigor and compliance to established guidelines. Some of these deficiencies can be easily remedied through better awareness and adherence to prescribed standards—which will be reviewed in this article—but others stem from inherent problems with the source data (e.g., poor reporting of original research) as well as unique constraints faced by surgery as a field (e.g., lack of equipoise for randomized trials, or existence of learning curves for novel surgical procedures, which can lead to temporal heterogeneity), which may require unconventional tools (e.g., cumulative meta-analysis) to address. Therefore, it is also our goal to take stock of the unique issues encountered by surgeons who do meta-analysis and to highlight various techniques—some of which less well-known—to address such challenges.
PDF
