scholarly journals Can Electric Nose Breath Analysis Identify Abdominal Wall Hernia Recurrence and Aortic Aneurysms? A Proof-of-Concept Study

2020 ◽  
pp. 155335062091789
Author(s):  
Elwin H. H. Mommers ◽  
Lottie van Kooten ◽  
Simon W. Nienhuijs ◽  
Tammo S. de Vries Reilingh ◽  
Tim Lubbers ◽  
...  
Keyword(s):  
Neural Network ◽  
At Risk ◽  
Aortic Aneurysm ◽  
Area Under The Curve ◽  
Recurrent Hernia ◽  
Hernia Recurrence ◽  
Aortic Aneurysms ◽  
Healthy Controls ◽  
Proof Of Concept ◽  
Patients At Risk

Introduction. This pilot study evaluates if an electronic nose (eNose) can distinguish patients at risk for recurrent hernia formation and aortic aneurysm patients from healthy controls based on volatile organic compound analysis in exhaled air. Both hernia recurrence and aortic aneurysm are linked to impaired collagen metabolism. If patients at risk for hernia recurrence and aortic aneurysms can be identified in a reliable, low-cost, noninvasive manner, it would greatly enhance preventive options such as prophylactic mesh placement after abdominal surgery. Methods. From February to July 2017, a 3-armed proof-of-concept study was conducted at 3 hospitals including 3 groups of patients (recurrent ventral hernia, aortic aneurysm, and healthy controls). Patients were measured once at the outpatient clinic using an eNose with 3 metal-oxide sensors. A total of 64 patients (hernia, n = 29; aneurysm, n = 35) and 37 controls were included. Data were analyzed by an automated neural network, a type of self-learning software to distinguish patients from controls. Results. Receiver operating curves showed that the automated neural network was able to differentiate between recurrent hernia patients and controls (area under the curve 0.74, sensitivity 0.79, and specificity 0.65) as well as between aortic aneurysm patients and healthy controls (area under the curve 0.84, sensitivity 0.83, and specificity of 0.81). Conclusion. This pilot study shows that the eNose can distinguish patients at risk for recurrent hernia and aortic aneurysm formation from healthy controls.

Abstract 038: A Novel Histology Based Classification System to Identify Patients at Risk for Postoperative Atrial Fibrillation

2013 ◽  
Vol 113 (suppl_1) ◽  
Author(s):  
Mahek Mirza ◽  
Anton Strunets ◽  
Ekhson Holmuhamedov ◽  
Jasbir Sra ◽  
Paul H Werner ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
At Risk ◽  
Classification System ◽  
Area Under The Curve ◽  
Postoperative Atrial Fibrillation ◽  
Right Atrial ◽  
Class Iii ◽  
Atrial Fibrosis ◽  
Patients At Risk ◽  
The Impact

Postoperative atrial fibrillation (PoAF) is a common complication in up to 40% of patients after cardiac surgery, increasing morbidity, hospital stay and costs. The myocardial substrate underlying PoAF is not fully characterized. The objective was to assess the impact of atrial fibrosis on incident AF and define the fibrosis threshold level predictive of PoAF. Methods: Right atrial appendages removed from patients undergoing elective CABG with no history of AF or class III/IV heart failure were used to characterize the ratio of collagen to myocardium (Masson’s trichrome; NIH ImageJ software; Fig A), which was correlated with incident AF. Percentage burden of fibrosis predictive of PoAF with high sensitivity and specificity was determined by ROC curve. Results: Of 28 patients (67±10 years, 64% males), 15 had PoAF. There were no age, gender or comorbidity differences between groups. Compared to the group that remained in sinus rhythm, patients with PoAF had a significantly higher ratio of extracellular collagen to myocardium (45±16% vs. 5±4%, p <0.001; Fig B). A threshold ratio of 12.7% collagen to myocardium (ROC area under the curve 0.997; z statistic 137; P<0.0001) with 96% sensitivity and 97% specificity identified those with PoAF (Fig C). A classification system based on histological extent of atrial fibrosis is proposed for identifying patients at risk for PoAF (Fig D). Conclusion: Ongoing studies will confirm the predictive value of this new classification system for identifying the atrial substrate predisposing PoAF and correlate with preoperative cardiac imaging and circulatory serum biomarkers to provide a novel noninvasive tool to stratify patients at risk for PoAF.

scholarly journals MEWS++: Enhancing the Prediction of Clinical Deterioration in Admitted Patients through a Machine Learning Model

2020 ◽  
Vol 9 (2) ◽  
pp. 343 ◽  
Author(s):  
Arash Kia ◽  
Prem Timsina ◽  
Himanshu N. Joshi ◽  
Eyal Klang ◽  
Rohit R. Gupta ◽  
...  
Keyword(s):  
Machine Learning ◽  
At Risk ◽  
Area Under The Curve ◽  
Learning Model ◽  
Clinical Deterioration ◽  
Early Warning Score ◽  
Support Vector ◽  
Adult Age ◽  
Machine Learning Model ◽  
Patients At Risk

Early detection of patients at risk for clinical deterioration is crucial for timely intervention. Traditional detection systems rely on a limited set of variables and are unable to predict the time of decline. We describe a machine learning model called MEWS++ that enables the identification of patients at risk of escalation of care or death six hours prior to the event. A retrospective single-center cohort study was conducted from July 2011 to July 2017 of adult (age > 18) inpatients excluding psychiatric, parturient, and hospice patients. Three machine learning models were trained and tested: random forest (RF), linear support vector machine, and logistic regression. We compared the models’ performance to the traditional Modified Early Warning Score (MEWS) using sensitivity, specificity, and Area Under the Curve for Receiver Operating Characteristic (AUC-ROC) and Precision-Recall curves (AUC-PR). The primary outcome was escalation of care from a floor bed to an intensive care or step-down unit, or death, within 6 h. A total of 96,645 patients with 157,984 hospital encounters and 244,343 bed movements were included. Overall rate of escalation or death was 3.4%. The RF model had the best performance with sensitivity 81.6%, specificity 75.5%, AUC-ROC of 0.85, and AUC-PR of 0.37. Compared to traditional MEWS, sensitivity increased 37%, specificity increased 11%, and AUC-ROC increased 14%. This study found that using machine learning and readily available clinical data, clinical deterioration or death can be predicted 6 h prior to the event. The model we developed can warn of patient deterioration hours before the event, thus helping make timely clinical decisions.

scholarly journals Predicting Persistent Opioid Use, Abuse, and Toxicity Among Cancer Survivors

2019 ◽  
Vol 112 (7) ◽  
pp. 720-727 ◽  
Author(s):  
Lucas K Vitzthum ◽  
Paul Riviere ◽  
Paige Sheridan ◽  
Vinit Nalawade ◽  
Rishi Deka ◽  
...  
Keyword(s):  
Risk Factors ◽  
At Risk ◽  
Cancer Survivors ◽  
Critical Role ◽  
Multivariable Analysis ◽  
Area Under The Curve ◽  
Opioid Abuse ◽  
Opioid Use ◽  
Multivariable Logistic Regression Model ◽  
Patients At Risk

Abstract Background Although opioids play a critical role in the management of cancer pain, the ongoing opioid epidemic has raised concerns regarding their persistent use and abuse. We lack data-driven tools in oncology to understand the risk of adverse opioid-related outcomes. This project seeks to identify clinical risk factors and create a risk score to help identify patients at risk of persistent opioid use and abuse. Methods Within a cohort of 106 732 military veteran cancer survivors diagnosed between 2000 and 2015, we determined rates of persistent posttreatment opioid use, diagnoses of opioid abuse or dependence, and admissions for opioid toxicity. A multivariable logistic regression model was used to identify patient, cancer, and treatment risk factors associated with adverse opioid-related outcomes. Predictive risk models were developed and validated using a least absolute shrinkage and selection operator regression technique. Results The rate of persistent opioid use in cancer survivors was 8.3% (95% CI = 8.1% to 8.4%); the rate of opioid abuse or dependence was 2.9% (95% CI = 2.8% to 3.0%); and the rate of opioid-related admissions was 2.1% (95% CI = 2.0% to 2.2%). On multivariable analysis, several patient, demographic, and cancer and treatment factors were associated with risk of persistent opioid use. Predictive models showed a high level of discrimination when identifying individuals at risk of adverse opioid-related outcomes including persistent opioid use (area under the curve [AUC] = 0.85), future diagnoses of opioid abuse or dependence (AUC = 0.87), and admission for opioid abuse or toxicity (AUC = 0.78). Conclusion This study demonstrates the potential to predict adverse opioid-related outcomes among cancer survivors. With further validation, personalized risk-stratification approaches could guide management when prescribing opioids in cancer patients.

Identification of the Patients at Risk (for Recurrent Hernia Disease)

2007 ◽  
pp. 397-399
Author(s):  
P. R. Mertens ◽  
P. Lynen-Jansen ◽  
U. Klinge
Keyword(s):  
At Risk ◽  
Recurrent Hernia ◽  
Patients At Risk

Reduced Incidence of Acute and Chronic Graft-versus-Host Disease (GvHD) without Increased Relapse in Patients with High-Risk Myeloid Disorders Given Thymoglobulin (THY) as Part of the Transplant Conditioning Regimen: A Dose-Finding Study.

Blood ◽  
2004 ◽  
Vol 104 (11) ◽  
pp. 181-181 ◽  
Author(s):  
H. Joachim Deeg ◽  
F. R. Appelbaum ◽  
B. Storer ◽  
M. Cassarella ◽  
B. Scott ◽  
...  
Keyword(s):  
At Risk ◽  
Chronic Gvhd ◽  
Conditioning Regimen ◽  
Area Under The Curve ◽  
State Level ◽  
Dose Finding ◽  
Refractory Anemia ◽  
Finding Study ◽  
Patients At Risk

Abstract GvHD is a major cause of morbidity and mortality after allogeneic hemopoietic cell transplantation (HCT). Recent data suggest that rabbit anti-thymocyte globulin (THY) given pre-transplant is effective in reducing the incidence of GvHD. We transplanted 54 patients, 9-65 (median 49) years of age, with advanced myelodysplastic syndrome (MDS, beyond Refractory Anemia[RA], n=29), myelofibrosis (n=12), or other myeloid disorders (n=13), after conditioning with a regimen of targeted busulfan (BU; steady state level 800-900ng/ml), cyclophosphamide (CY) and THY (Thymoglobulin, Sangstat) which was given on days -3,-2 and -1. The starting dose was 4.5 mg/kg (total), to be escalated (in cohorts of 15 patients) to 6.0 and 7.5 mg/kg, dependent upon GvHD incidence and EBV reactivation ≥1000 copies). Patients also received methotrexate (MTX) + cyclosporine (CSP). Seventeen ( patients were accrued in the first cohort (2 did not receive the prescribed dose of THY), and none activated EBV; among 20 patients in the second cohort (5 with incomplete THY dose) one re-activated EBV, and, thus, the third cohort was to receive the same dose, 6 mg/kg, (n=17; two with incomplete THY dose). Donors were HLA-identical siblings in 28, and HLA matched unrelated volunteers in 26 patients. All but two patients had sustained engraftment; 32 (59%) developed acute, and 24 of 46 patients at risk (52%) developed chronic GvHD. The incidence of acute/chronic GvHD was 41%/45% for related, and 60%/36% for unrelated patients given the prescribed doses of THY (80%/85% for the 9 patients in both groups with incomplete THY dose). Relapse incidence for patients given the prescribed dose of THY was 16% for related, and 2% for unrelated recipients; it was 44% among the 9 patients who did not receive the full dose of THY. There was a suggestion that greater ‘area under the curve’ for the CY metabolite CEPM was correlated with non-relapse mortality. Overall, 38 patients (70%) are surviving with a follow-up of 3-20 (median 13) months. Concurrently, 27 patients, 11-64 (median 51) years of age, with low-risk MDS (RA) were conditioned with the identical targeted BUCY regimen (and MTX+CSP) but without THY, and transplanted from HLA-identical related (n=14) or unrelated donors(n=13). All patients engrafted, and none relapsed; 24 (89%) developed acute, and 24 of 25 patients at-risk (96%) developed chronic GvHD. Overall 18 patients (67%) are surviving at 9-39 (median 23) months; there was no difference between related and unrelated transplants. These data suggest that THY, added to targeted BUCY, reduced the incidence of acute and chronic GvHD. With EBV monitoring it may be possible to further escalate the dose of THY and further reduce the incidence of GvHD. However, because of actual or presumed toxicity, 16% of patients did not receive the prescribed dose of THY. There was no evidence for an increase in infections or relapse compared to historical data. The projected survival of patients with advanced disease is encouraging, but longer follow-up is needed.

scholarly journals Evaluating the diagnostic accuracy of maximal aortic diameter, length and volume for prediction of aortic dissection

Heart ◽  
2020 ◽  
Vol 106 (12) ◽  
pp. 892-897 ◽  
Author(s):  
Samuel Heuts ◽  
Bouke P Adriaans ◽  
Bartosz Rylski ◽  
Casper Mihl ◽  
Sebastiaan C A M Bekkers ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Predictive Accuracy ◽  
Area Under The Curve ◽  
Aortic Aneurysms ◽  
Aortic Diameter ◽  
Prophylactic Surgery ◽  
Receiver Operating Curve ◽  
Acute Type ◽  
Maximal Diameter ◽  
Patients At Risk

ObjectiveManagement of thoracic aortic aneurysms (TAAs) comprises regular diameter follow-up until the indication criterion for prophylactic surgery is reached. However, this approach is unable to predict the majority of acute type A aortic dissections (ATAADs). The current study aims to evaluate the diagnostic accuracy of ascending aortic diameter, length and volume for occurrence of ATAAD.MethodsThis two-centre observational cohort study retrospectively screened 477 consecutive patients who presented with ATAAD between 2009 and 2018. Of those, 25 (5.2%) underwent CT angiography (CTA) within 2 years before dissection onset. Aortic diameter, length and volume of these patients (‘pre-ATAAD’) were compared with those of TAA controls (n=75). Receiver operating curve analysis was performed to evaluate the predictive accuracy of the three different measurements.Results96% of patients with pre-ATAAD did not meet the surgical diameter threshold of 55 mm before dissection onset. Maximal aortic diameters (45 (40–49) mm vs 46 (44–49) mm, p=0.075) and volume (126 (95–157) cm3 vs 124 (102–136) cm3, p=0.909) were comparable between patients with pre-ATAAD and TAA controls. Conversely, ascending aortic length (84±9 mm vs 90±16 mm, p=0.031) was significantly larger in patients with pre-ATAAD. All three parameters had an area under the curve of >0.800. At the 55 mm cut-off point, the maximal diameter yielded a positive predictive value (PPV) of 20%. While maintaining same specificity levels, measurements of aortic volume and length showed superior diagnostic accuracy (PPV 55% and 70%, respectively).ConclusionMeasurements of aortic volume and length have superior diagnostic accuracy compared with the maximal diameter and could improve the timely identification of patients at risk for ATAAD.

scholarly journals Numbers and phenotype of non-classical CD14dimCD16+ monocytes are predictors of adverse clinical outcome in patients with coronary artery disease and severe SARS-CoV-2 infection

2020 ◽  
Author(s):  
Karin Anne Lydia Mueller ◽  
Carolin Langnau ◽  
Manina Günter ◽  
Simone Pöschel ◽  
Sarah Gekeler ◽  
...  
Keyword(s):  
Coronary Artery Disease ◽  
At Risk ◽  
Respiratory Failure ◽  
Coronary Artery ◽  
T Cell Activation ◽  
Cell Activation ◽  
Healthy Controls ◽  
Patients At Risk ◽  
Progressive Respiratory Failure ◽  
Artery Disease

Abstract Aims  To elucidate the prognostic role of monocytes in the immune response of patients with coronary artery disease (CAD) at risk for life-threatening heart and lung injury as major complications of SARS-CoV-2 infection. Methods and results  From February to April 2020, we prospectively studied a cohort of 96 participants comprising 47 consecutive patients with CAD and acute SARS-CoV-2 infection (CAD + SARS-CoV-2), 19 CAD patients without infections, and 30 healthy controls. Clinical assessment included blood sampling, echocardiography, and electrocardiography within 12 h of admission. Respiratory failure was stratified by the Horovitz Index (HI) as moderately/severely impaired when HI ≤200 mmHg. The clinical endpoint (EP) was defined as HI ≤200 mmHg with subsequent mechanical ventilation within a follow-up of 30 days. The numbers of CD14dimCD16+ non-classical monocytes in peripheral blood were remarkably low in CAD + SARS-CoV-2 compared with CAD patients without infection and healthy controls (P &lt; 0.0001). Moreover, these CD14dimCD16 monocytes showed decreased expression of established markers of adhesion, migration, and T-cell activation (CD54, CD62L, CX3CR1, CD80, and HLA-DR). Decreased numbers of CD14dimCD16+ monocytes were associated with the occurrence of EP. Kaplan–Meier curves illustrate that CAD + SARS-CoV-2 patients with numbers below the median of CD14dimCD16+ monocytes (median 1443 cells/mL) reached EP significantly more often compared to patients with numbers above the median (log-rank 5.03, P = 0.025). Conclusion  Decreased numbers of CD14dimCD16+ monocytes are associated with rapidly progressive respiratory failure in CAD + SARS-CoV-2 patients. Intensified risk assessments comprising monocyte sub- and phenotypes may help to identify patients at risk for respiratory failure.

scholarly journals Combining Genetic Variants to Improve Risk Prediction for NAFLD and Its Progression to Cirrhosis: A Proof of Concept Study

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Umberto Vespasiani-Gentilucci ◽  
Chiara Dell’Unto ◽  
Antonio De Vincentis ◽  
Andrea Baiocchini ◽  
Marco Delle Monache ◽  
...  
Keyword(s):  
Single Nucleotide Polymorphisms ◽  
Medical Care ◽  
Allele Frequency ◽  
Genetic Variants ◽  
Healthy Controls ◽  
Nucleotide Polymorphisms ◽  
Proof Of Concept ◽  
Single Nucleotide ◽  
Risk Of Progression ◽  
Patients At Risk

Background & Aims. Identifying NAFLD patients at risk of progression is crucial to orient medical care and resources. We aimed to verify if the effects determined by different single nucleotide polymorphisms (SNPs) could add up to multiply the risk of NAFLD and NASH-cirrhosis. Methods. Three study populations, that is, patients diagnosed with NASH-cirrhosis or with noncirrhotic NAFLD and healthy controls, were enrolled. PNPLA3 rs738409, TM6SF2 rs58542926, KLF6 rs3750861, SOD2 rs4880, and LPIN1 rs13412852 were genotyped. Results. One hundred and seven NASH-cirrhotics, 93 noncirrhotic NAFLD, and 90 controls were enrolled. At least one difference in allele frequency between groups was significant, or nearly significant, for the PNPLA3, TM6SF2, and KLF6 variants (p<0.001, p<0.05, and p=0.06, resp.), and a risk score based on these SNPs was generated. No differences were observed for SOD2 and LPIN1 SNPs. When compared to a score of 0, a score of 1-2 quadrupled, and a score of 3-4 increased 20-fold the risk of noncirrhotic NAFLD; a score of 3-4 quadrupled the risk of NASH-cirrhosis. Conclusions. The effects determined by disease-associated variants at different loci can add up to multiply the risk of NAFLD and NASH-cirrhosis. Combining different disease-associated variants may represent the way for genetics to keep strength in NAFLD diagnostics.

scholarly journals Impact of Inflammatory Immune Dysfunction in Psoriasis Patients at Risk for COVID-19

Vaccines ◽  
2021 ◽  
Vol 9 (5) ◽  
pp. 478
Author(s):  
Tatiana Mina Yendo ◽  
Maria Notomi Sato ◽  
Anna Cláudia Calvielli Castelo Branco ◽  
Anna Julia Pietrobon ◽  
Franciane Mouradian Emidio Teixeira ◽  
...  
Keyword(s):  
At Risk ◽  
Viral Infections ◽  
Healthy Controls ◽  
Therapeutic Approaches ◽  
Immune Mediated ◽  
Immunological Mechanisms ◽  
Cytokine Levels ◽  
Patients At Risk ◽  
Low Levels ◽  
Immune Imbalance

Psoriasis is an immune-mediated dermatosis usually associated with comorbidities. Treatment varies from topicals to systemic drugs and data on susceptibility to viral infections in psoriatic patients are scarce. The objectives of this study were to analyze psoriatic patients on different therapies who were at risk for COVID-19 for seroprevalence of SARS-COV-2, pro-inflammatory cytokine profile, comorbidities and outcomes in order to unveil the immunological mechanisms involved in the anti-viral response in patients with psoriasis. Seventy-five patients with psoriasis were divided according to treatment: immunobiologics, methotrexate, topicals and acitretin. Twenty healthy controls were included. Plasma samples were collected for: IgG SARS-COV-2 (ELISA); IL-27, IL-29 and IL-18 (ELISA); and IL-1β, IL-17A, IL-6 and TNF (cytometric array). Seropositivity for SARS-COV-2 was detected in 24 out of 75 psoriasis patients and did not relate to COVID-19 symptoms and/or hospitalization, despite associated comorbidities. Psoriasis patients who were asymptomatic for SARS-COV-2 exhibited immune imbalance with high levels of IL-18, IL-17A and IL-6, and low levels of IL-27 compared to healthy controls. Psoriasis groups showed significant increased cytokine levels only in the group with immunobiologics. Despite immune deviations and lower IL-27, which has a potential antiviral impact, psoriatic patients did not exhibit complications related to COVID-19. An understanding of this kind of proinflammatory profile of psoriatic patients and of the lack of severe outcomes for COVID-19 is essential to establish novel therapeutic approaches and preventive measures, including with regard to the concomitance of viral infections.

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