Bayesian Logical Neural Networks for Human-Centered Applications in Medicine

Medicine is characterized by its inherent ambiguity, i.e., the difficulty to identify and obtain exact outcomes from available data. Regarding this problem, electronic Health Records (EHRs) aim to avoid imprecisions in the data recording, for instance by its recording in an automatic way or by the integration of data that is both readable by humans and machines. However, the inherent biology and physiological processes introduce a constant epistemic uncertainty, which has a deep implication in the way the condition of the patients is estimated. For instance, for some patients, it is not possible to speak about an exact diagnosis, but about the suspicion of a disease, which reveals that the medical practice is often ambiguous. In this work, we report a novel modeling methodology combining explainable models, defined on Logic Neural Networks (LONNs), and Bayesian Networks (BN) that deliver ambiguous outcomes, for instance, medical procedures (Therapy Keys (TK)), depending on the uncertainty of observed data. If epistemic uncertainty is generated from the underlying physiology, the model delivers exact or ambiguous results depending on the individual parameters of each patient. Thus, our model does not aim to assist the customer by providing exact results but is a user-centered solution that informs the customer when a given recommendation, in this case, a therapy, is uncertain and must be carefully evaluated by the customer, implying that the final customer must be a professional who will not fully rely on automatic recommendations. This novel methodology has been tested on a database for patients with heart insufficiency.

Effects of the Wenyang Zhenshuai Granule on the Expression of LncRNA-MiR143HG/miR-143 Regulating ERK5 in H9C2 Cardiomyocytes

Chronic heart failure (CHF) is a complex clinical syndrome caused by a variety of heart problems, with a high incidence. The 5-year survival rate of patients with clinical symptoms is similar to that of malignant tumors. Wenyang Zhenshuai granules are a safe and effective granule of traditional Chinese medicine components, including aconite, dried ginger, licorice, and red ginseng. In contemporary clinical applications, it is widely used in acute and chronic heart insufficiency, coronary heart disease, and arrhythmia. This research cultured H9C2 cardiomyocytes and divided them into the normal control group, LncRNA-MiR143HG overexpression group, LncRNA-MiR143HG silence group, Adriamycin (ADR) group, ADR + medicated serum group, ADR + LncRNA-MiR143HG overexpression + medicated serogroup, and ADR + LncRNA-MiR143HG silence + medicated serogroup. The cells of each group were treated differently, and the survival rate of each group of cells and the expression levels of LncRNA-MiR143HG/miR-143 and ERK5 were detected at the end of the experiment, and the expression of LncRNA-MiR143HG/miR-143 in H9C2 cardiomyocytes was regulated by Wenyang Zhenshuai granules’ impact. The results of this study showed that, in the doxorubicin-induced H9C2 cardiomyocyte injury model, the expression of miR-143 was upregulated, and the expression of LncRNA-MiR143HG and ERK5 was significantly downregulated. Wenyang Zhenshuai granules can downregulate the expression of miR-143 to promote ERK5 protein expression and phosphorylation. The process is regulated by LncRNA-MiR143HG/miR-143, which may be one of its important mechanisms for the treatment of chronic heart failure.

Underscreening and undertreatment? Periodontal service provision in very old Germans

Objectives We aimed to assess periodontal services utilization in very old Germans. Methods A comprehensive sample of very old (≥ 75 years), insured at a large Northeastern statutory insurer was followed over 6 years (2012–2017). We assessed periodontal service provision, entailing (1) periodontal screening index (PSI), (2) periodontal status/treatment planning, (3) periodontal therapy (scaling and root planning with or without access surgery), (4) postoperative reevaluation, and (5) any of these four services groups. Association of utilization with (1) sex, (2) age, (3) region, (4) social hardship status, (5) ICD-10 diagnoses, and (6) diagnoses-related groups was explored. Results 404.610 individuals were followed; 173,733 did not survive follow-up. The mean (SD) age was 81.9 (5.4) years. 29.4% (119,103 individuals) utilized any periodontal service, nearly all of them the PSI. Periodontal status/treatment planning, treatment provision, and reevaluation were provided to only a small fraction (1.54–1.57%, or 6224–6345) of individuals. The utilization of the PSI increased between 2012 and 2017; no such increase was observed for treatment-related services. Utilization decreased with age; those aged > 85 years received nearly no services at all. Decreases were more pronounced for treatment-related services. Utilization was lower in rural than urban areas, those with hardship status, and those severely ill (e.g., dementia, heart insufficiency). In multivariable analysis, a previous PSI measurement tripled the odds of receiving treatment-related services (OR: 3.2; 95% CI: 3.0-3.4). Conclusions Periodontal services utilization was low. Screening for periodontal disease significantly increased therapy provision. Social, demographic, regional, and general health aspects were associated with utilization. Clinical significance The utilization of periodontal services in the very old in Northeast Germany was low, and even screening was only performed in a minority of individuals. Policies to increase identification and management of periodontitis especially in the most vulnerable individuals are needed.

Features of the glucose influence on the heart activity and the changes in the potentials of the stomach and the intestines at the heart insufficiency conditions

In acute rat experiments (thiopental sodium narcosis), it is established that introducing a 5 % glucose solution into the stomach lowers a frequency of heart rates (HR) and an amplitude of potentials of smooth muscles of the stomach and simultaneously raises doubtfully and shortly the potentials of sooth muscles (PSM) of the colon. Food additives used in the glutamate sodium, benzoate, tartrazine complex do not influence HR, but as before, reduces PSM of the stomach, and in the thick gut precise exciting or brake responses are marked. In the preliminarily developed heart insufficiency conditions, the glucose infusion into the stomach does not change HR. At the same time, the action of glucose, as well as of food additives, still results in reliable reactions of the stomach and the thick gut. Important is the present work information on the ability of glucose and food additives to modulate the heart activity estimated through the indicators of modification of electrocardiogram teeth. As appeared, the infusion of the specified irritants in the stomach of rats in control and heart insufficiency is accompanied by precise enough changes in such indicators as the RST duration, the amplitude and duration of the Т-wave, i. e. the prognostic attributes of the opportunity of occurrence of heart аrrhythmia, fibrillations.

Insufficient Oral Behaviour and the High Need for Periodontal Treatment in Patients with Heart Insufficiency and after Heart Transplantation: A Need for Special Care Programs?

Background: The aim of this cross-sectional study was the assessment of dental behaviour and oral health condition of heart transplant recipients (HTx) in comparison to patients with heart insufficiency (HI). Methods: Patients attending the Department for Cardiac Surgery, Leipzig Heart Center, Germany were recruited. Standardized questionnaires regarding dental behaviour and periodontal complaints were applied. A dental (decayed-, missing- and filled-teeth index) and periodontal examination (periodontal probing depth (PPD) and clinical attachment loss (CAL)) was performed. Based on the oral findings, dental and periodontal treatment need was determined. Statistics: T-test, Mann-Whitney U test, Chi-square test, and Fisher-test (p < 0.05). Results: A total of 201 patients (HTx: 112, HI: 89) were included. HTx patients were significantly more often allocated to dentists (p < 0.01). Furthermore, the HTx patients rated feeling informed appropriately about oral health more often (p < 0.01). HTx patients used interdental cleaning (p < 0.01) and mouth rinse (p = 0.02) more often than HI patients. No differences between groups were present regarding dental status and periodontitis severity (p > 0.05). Periodontal treatment need was high, showing prevalence of 79.5% (HTx) and 87.6% (HI, p = 0.14), respectively. Conclusions: Both groups show insufficient oral behaviour and a high need for periodontal treatment. Special care programs for HTx candidates and recipients appear recommendable.

Evaluation of Tryptic Podocin Peptide in Urine Sediment Using LC-MS-MRM Method as a Potential Biomarker of Glomerular Injury in Dogs with Clinical Signs of Renal and Cardiac Disorders

The early asymptomatic stage of glomerular injury is a diagnostic challenge in the course of renal and extra-renal disease, e.g., heart insufficiency. It was found that podocin, a podocyte-specific protein present in the urine, may serve as a biomarker in the diagnosis of glomerular disease in humans and animals including glomerulonephritis, glomerulosclerosis, amyloidosis, or nephropathy. Therefore, there is a need of development of the sensitive and straightforward method of urinary podocin identification. In this work, we report our extended research under the glomerular injury investigation in dogs by application of clinical examination and LC-MS-MRM method in the identification of canine podocin in urine samples. The LC-MS-MRM method is based on the identification of podocin tryptic peptide with the 218H-AAEILAATPAAVQLR-OH232 sequence. The model peptide was characterized by the highest ionization efficiency of all the proposed model podocin tryptic peptides in a canine urine sediment according to the LC-MS/MS analysis. The obtained results revealed the presence of the model peptide in 40.9% of dogs with MMVD (active glomerular injury secondary to heart disease = cardiorenal syndrome-CRS) and 33.3% dogs with chronic kidney disease. The potential applicability of the developed methodology in the analysis of podocin in canine urine sediments was confirmed.

Plasma marinobufagenin immunoreactivity in patients with chronic kidney disease: a case control study

Experimental data have shown increased plasma levels of marinobufagenin in kidney failure. In this case-controlled retrospective analysis, we evaluated plasma marinobufagenin immunoreactivity in hemodialysis patients compared with subjects with normal kidney function. Sixty-eight adult hemodialysis patients with chronic kidney disease (34 females and 34 males) as well as 68 age-, gender-, and blood pressure-matched subjects without chronic kidney disease were enrolled. Patients on stable hemodialysis regimen for at least 3 mo before the study were included. Exclusion criteria were: age <18 yr, severe liver or heart insufficiency, and overhydration. Subjects without chronic kidney disease must have had an estimated glomerular filtration rate ≥60 ml·min−1·1.72 m−2 according to the Modification of Diet in Renal Disease formula. Plasma marinobufagenin immunoreactivity was significantly ( P < 0.001) higher in hemodialysis patients (1.66 ± 1.13 nmol/l) compared with subjects with normal kidney function (0.46 ± 0.23). In hemodialysis patients, plasma marinobufagenin immunoreactivity was higher in men compared with women. A significant positive correlation has been found between plasma marinobufagenin immunoreactivity and serum NT-proBNP, NT-proANP, or aldosterone concentrations in all analyzed subjects. In hemodialyzed patients with plasma marinobufagenin immunoreactivity above median value 5-yr, all-cause mortality was higher compared with those with plasma marinobufagenin concentration below median. We have shown that plasma marinobufagenin immunoreactivity is increased in patients with end-stage kidney failure treated with hemodialysis parallel to the increase in serum NT-proBNP, NT-proANP, and aldosterone concentrations. Higher marinobufagenin immunoreactivity has been associated with worse survival in hemodialyzed patients.