Machine learning models for screening carotid atherosclerosis in asymptomatic adults

Carotid atherosclerosis (CAS) is a risk factor for cardiovascular and cerebrovascular events, but duplex ultrasonography isn’t recommended in routine screening for asymptomatic populations according to medical guidelines. We aim to develop machine learning models to screen CAS in asymptomatic adults. A total of 2732 asymptomatic subjects for routine physical examination in our hospital were included in the study. We developed machine learning models to classify subjects with or without CAS using decision tree, random forest (RF), extreme gradient boosting (XGBoost), support vector machine (SVM) and multilayer perceptron (MLP) with 17 candidate features. The performance of models was assessed on the testing dataset. The model using MLP achieved the highest accuracy (0.748), positive predictive value (0.743), F1 score (0.742), area under receiver operating characteristic curve (AUC) (0.766) and Kappa score (0.445) among all classifiers. It’s followed by models using XGBoost and SVM. In conclusion, the model using MLP is the best one to screen CAS in asymptomatic adults based on the results from routine physical examination, followed by using XGBoost and SVM. Those models may provide an effective and applicable method for physician and primary care doctors to screen asymptomatic CAS without risk factors in general population, and improve risk predictions and preventions of cardiovascular and cerebrovascular events in asymptomatic adults.

Cough hypersensitivity in patients with metabolic syndrome: a clinical finding and its possible mechanisms

Purpose To investigate the changes of cough sensitivity in patients with metabolic syndrome and its possible mechanisms. Method A total of 29 metabolic syndrome (MetS) patients with OSAHS (group-1), 22 MetS patients without OSAHS (group-2), and 25 healthy controls (group-3) were included. All participants underwent a routine physical examination and completed the gastroesophageal reflux disease questionnaire (GerdQ), and the inflammatory mediator profile were determined. The cough threshold for capsaicin, induced sputum cell count and cell classification, and inflammatory mediators in induced sputum supernatants were compared. The correlation between capsaicin cough sensitivity and various indicators in the MetS population was analyzed. Results The minimum concentration of inhaled capsaicin needed to induce ≥ 5 coughs (C5) was significantly different among three groups (H = 14.393, P = 0.001) and lower for group-1 and group-2 than it for group-3 (P = 0.002, P = 0.005). The percentage of neutrophils in induced sputum and the concentrations of calcitonin gene-related peptide (CGRP), substance P (SP), and interleukin 8 (IL-8) in the sputum supernatant of group-1 and group-2 were significantly higher than those of group-3. Besides, the pepsin concentrations were significantly different among the 3 groups (F = 129.362, P < 0.001), which significantly was highest in group-1 (P < 0.001) and lowest in group-3 (P < 0.001). Triglycerides, AHI, pepsin concentration and BMI were risk factors of increased capsaicin cough sensitivity. Conclusion Increased capsaicin cough sensitivity in MetS patients is closely related to sleep apnea and gastroesophageal reflux. For patients in MetS patients without OSAHS, gastroesophageal reflux is an important factor for increased capsaicin cough sensitivity. Airway inflammation, especially airway neurogenic inflammation, may also play a role in the pathogenesis of increased capsaicin cough sensitivity. Trial registration The protocol was registered in the Chinese Clinical Trials Register (http://www.chictr.org.cn/) (ChiCTR1800014768). Written informed consent was obtained from all participants before enrollment.

Ovarian Gonadoblastoma with the Karyotype of 46, XX: A Case Report

Gonadoblastoma is a rare tumor comprised of sex cord derivatives and germ cells. The risk for developing gonadoblastoma increases significantly in patients who possess a Y chromosome or Y chromosome material. A 49-year-old Chinese woman found a pelvic mass during a routine physical examination. Pathological analysis after surgery indicated that the tumor was unilateral ovarian gonadoblastoma with dysgerminoma. Compared with other cases in the literature, our patient was the oldest, and the tumor mass was smaller. Karyotype analysis of peripheral blood lymphocytes revealed that the woman had a 46, XX female karyotype. Whole-exon sequencing revealed that some mutations, such as altered somatic genes in the Forkhead box protein O (FoxO) signaling pathway and KIT, might cause the disease. In conclusion, we described a rare case of gonadoblastoma in a woman who had normal routine menstruation, sexual development, and successful pregnancies and possessed a normal female 46, XX karyotype.

Multiple lipomata of the tricuspid valve and papillary muscle: case report

Background Cardiac lipomas are rare benign primary tumours of the heart. Due to the nature of these tumours, they are often asymptomatic and diagnosed incidentally. Whether asymptomatic patients with cardiac lipomas should perform surgery still remains controversial. Case summary A 34-year-old Asian male who was incidentally found hyperechoic masses in the right ventricle (RV) on the transthoracic echocardiogram by annually routine physical examination was admitted to our cardiology department. His medical history was unremarkable. The repeated transthoracic and transoesophageal echocardiogram showed multiple solitary and well-demarcated masses in the RV. On the cardiac magnetic resonance imaging, four discrete masses (considering the possibility of it being a lipoma) partially occluding the right ventricular outflow tract (RVOT) were observed. During the open-heart resection surgery, it was found that the tricuspid valve and papillary muscle were covered by multiple adipose masses in the RV that arose from the interventricular septum and the free wall, resulting in partial RVOT obstruction. These excised masses were histopathologically confirmed as lipomata characterized by the mature adipocytes with entrapped myocardial cells. The patient had no cardiac abnormality in the 1-month follow-up after the surgery. Discussion This rare clinical case of multiple lipomata of the tricuspid valve and papillary muscle acknowledges that multimodality imaging is the cornerstone for the assessment and diagnosis. Surgery should be performed in cases of symptomatic or large lipomas as well as when a lipoma is considered to be high risk because of RVOT obstruction.

Conservative Surgical Approach to Pleomorphic Adenoma in Parotid Gland: Case Report

Pleomorphic adenoma is a benign neoplasm of the salivary glands that affects most frequently females in the fourth and sixth decade of life. As it is usually an asymptomatic lesion, it is diagnosed upon routine physical examination. Treatment consists in surgical removal with partial or total involvement of the parotid gland. Conservative enucleation is the least invasive surgical option for this type of lesion. The present work aimed to report a case of pleomorphic adenoma of the parotid gland with eight years of evolution. The tumor was treated conservatively. Patient has been followed for sixth months, and no sensory alterations, fistulae, clinical signs of recurrence, nor any other alteration have been observed so far. Due to the benign nature of the lesion, an evolution with favorable prognosis is expected. Keywords: Adenoma. Benign Neoplasia. Tumor ResumoO Adenoma pleomórfico é uma neoplasia benigna de glândulas salivares, que acomete com maior frequência pessoas do sexo feminino entre a quarta e sexta década de vida. Por se tratar de uma lesão muitas vezes assintomática, geralmente é descoberta através do exame físico de rotina. O seu tratamento consiste em remoção cirúrgica podendo envolver ou não a glândula parótida de maneira parcial ou total. A enucleação conservadora é a modalidade cirúrgica menos invasiva para este tipo de lesão. O presente trabalho tem por objetivo relatar um caso de adenoma pleomórfico em glândula parótida com oito anos de evolução. O tumor foi tratado de maneira conservadora. A paciente está sendo acompanhada há 6 meses e não foram observados até momento alterações sensoriais, fistulas, indícios clínicos de recidiva ou qualquer outra alteração. Devido ao caráter benigno da lesão, espera-se evolução com prognóstico favorável. Palavras-chave: Adenoma. Neoplasia Benigna. Tumor.

Cough Hypersensitivity in Patients With Metabolic Syndrome: A Clinical Finding and Its Possible Mechanisms

Purpose: To investigate the changes of cough sensitivity in patients with metabolic syndrome and its possible mechanisms. Method: A total of 29 metabolic syndrome (MetS) patients with OSAHS (group-1), 22 MetS patients without OSAHS (group-2), and 25 healthy controls (group-3) were included. All participants underwent a routine physical examination and completed the gastroesophageal reflux disease questionnaire (GerdQ), and the inflammatory mediator profile were determined. The cough threshold for capsaicin, induced sputum cell count and cell classification, and inflammatory mediators in induced sputum supernatants were compared. The correlation between capsaicin cough sensitivity and various indicators in the MetS population was analyzed. Results: The minimum concentration of inhaled capsaicin needed to induce ≥2 coughs (C2) was significantly different among three groups (H = 13.856, P < 0.001) and lower for group-1 and group-2 than it for group-3 (P = 0.001, P = 0.003), which was similar with the C5 concentrations (the minimum concentration of inhaled capsaicin needed to induce ≥5 coughs). The percentage of neutrophils in induced sputum and the concentrations of calcitonin gene-related peptide (CGRP), substance P (SP), and interleukin 8 (IL-8) in the sputum supernatant of group-1 and group-2 were significantly higher than those of group-3. Besides, the pepsin concentrations were significantly different among the 3 groups (F = 129.362, P < 0.001), which significantly was highest in group-1(P < 0.001) and lowest in group-3 (P < 0.001). In group-1, lgC2 and lgC5 were both negatively correlated with the apnea-hypopnea index (AHI, r = -0.577, P = 0.001; r = -0.394, P = 0.035). Conclusion: Increased capsaicin cough sensitivity in MetS patients is closely related to sleep apnea and gastroesophageal reflux. For patients in MetS patients without OSAHS, gastroesophageal reflux is an important factor for increased capsaicin cough sensitivity. Airway inflammation, especially airway neurogenic inflammation, may also play a role in the pathogenesis of increased capsaicin cough sensitivityTrial registration: The protocol was registered in the Chinese Clinical Trials Register (http://www. chictr. org. cn/) (ChiCTR1800014768). Written informed consent was obtained from all participants before enrollment.

Development of a Self-reported Olfactory Dysfunction Questionnaire (SODQ) to screen olfactory disorders in China

Background: The diagnosis of olfactory dysfunction is challenging given the negligence during routine physical examination, inconvenience of diagnosis in clinical practice, and the inattention to cross-cultural adaptability. The study aimed to develop and validate a simple and effective self-reported olfactory dysfunction questionnaire (SODQ) for the initial screening of clinical olfactory disorders in China. Methods: A total of 121 subjects participated in the study; of these, 96 subjects completed the T&T olfactometer test and 12-item questionnaire, and 25 participants were retested using the SODQ after one week. The T&T olfactometer test examined the olfactory function and the questionnaire measured the ability to perceive common odors in daily life. We evaluated the factor structure, reliability, validity, and discriminative ability of the SODQ. Results: The final version of the SODQ consisted of 10 items with one factor. Test–retest and internal consistency were excellent. Convergent validity of the questionnaire with the T&T olfactory test was high. Furthermore, the discrimination ability was high for the questionnaire with an area under the curve of 0.95 and a cut-off point of 22. Conclusions: The SODQ is a brief, valid, and repeatable tool that has the potential to effectively screen for clinical olfactory disorders from a subjective perspective.

Influence of Serum Albumin on HbA1c and HbA1c-Defined Glycemic Status: A Retrospective Study

Background: Glycated hemoglobin (HbA1c) is commonly used in the diagnosis and evaluation of glycemic control in diabetes, and it may be influenced by several non-glycemic and glycemic factors, including albumin. This retrospective study investigated the influence of albumin on HbA1c and HbA1c-defined glycemic status.Methods: The demographic, hematological, and biochemical data were collected for 11,922 patients undergoing routine physical examination. Univariate and multivariate linear regression analyses, stratified analyses and interaction analyses, and multiple logistic regression were conducted to identify the association between albumin and HbA1c in people with different glycemic status.Results: HbA1c levels were inversely associated with serum albumin level (P &lt; 0.0001) in all participants. Risk factors leading to the association included age &gt; 45 years, high fasting plasma glucose (≥7.0 mmol/L), and anemia. The negative association between HbA1c and albumin was curved (P &lt; 0.0001) and had a threshold effect in the HbA1c-defined diabetic population; the association was significantly stronger when the albumin level fell below 41.4 g/L (β: −0.31, 95% CI: −0.45 to −0.17, P &lt; 0.0001). A 2 g/L increase in albumin reduced the odds of HbA1c-defined dysglycemia, diabetes, and poor glycemia control by 12% to 36%, after adjustment for all possible confounders.Conclusions: HbA1c was inversely associated with albumin level in all participants, and the association was significantly stronger in people with diabetes (defined by HbA1c criteria). For diabetic patients with lower albumin level, there was an increased risk of an erroneous HbA1c-based identification and management of glycemic status.

Gape Angle in Asymptomatic Dogs with Normal Occlusion

This study reports the gape angle (vertical temporomandibular joint range of motion for mouth opening) in conscious and anesthetized dogs. Mouth opening was reported as an angle in this study. Additionally, conscious and anesthetized measurements were compared to see if the state of anesthesia affected this measurement in asymptomatic patients. This prospective study evaluated 165 anesthetized dogs. Patients were placed in 1 of 2 groups: dental patients or non-dental patients. Only patients who were reported by owners to be asymptomatic for oral pain were included in the study. All dogs that met inclusion criteria had the maxillary length and interincisal distance measured. There was no difference (p = 0.590) between the mean (+/-SD) gape angle of conscious 44.0o (+/- 4.1+o) and anesthetized patients 43.9o (+/- 3.9o). No difference was seen in the gape angle between dental (44.2o) and non-dental patients (43.2o) (p = 0.183), or between conscious (43.8o) and anesthetized patients (43.7o) (p = 0.610). This study suggests that a consistent gape angle of 44o exists in dogs not exhibiting overt signs of oral pain and the gape angle is easy to measure in conscious patients and may be a useful tool during routine physical examination to identify patients with restricted range of motion. Immediate clinical application of this information can be used to monitor progress of treated patients affected by disorders that cause a decreased gape angle.

Association of 8p22-23-rs2254546 Genotypes with Coronary Artery Status and Resistance to Intravenous Immunoglobulin in Iranian Children with Kawasaki Disease

Background: Kawasaki disease (KD) is a frequent cause of acquired heart disease in infants and young children, which may be triggered by infectious agents, with the highest incidence in Asian countries. Several genotypes are identified as susceptibility genes for KD, but none is known in the Iranian population. Objectives: Due to the racial differences in the frequency and significance of the identified genes, we aimed to investigate the 8p22-23-rs2254546 genotypes in a sample of Iranian children and their association with aneurysm and resistance to treatment. Methods: In this prospective cross-sectional study, 100 children with KD as the sample group were compared with 100 matched unrelated healthy Iranian children with no history of KD or immune-related disease. The control subjects were ethnically recruited from the same hospital at the time of a routine physical examination. The 8p22-23-rs2254546 genotypes were analyzed using the polymerase chain reaction (PCR) and direct sequencing techniques, and the frequency of the three genotypes (GA, AA, and GG) was reported. Finally, the frequency of aneurysm and IVIG resistance was reported, and their associations with 8p22-23-rs2254546 genotypes were tested by SPSS software. Results: Of 100 patients with a mean age of 1.9 ± 1.7 (0.1 - 10.2) years, 57% were boys and 43% were girls. Of them, 62% had GG, 30% GA, and 8% AA genotypes. Besides, 21% of the studied patients were resistant to IVIG, and 19% had aneurysm, but resistance to IVIG and aneurysm was not associated with GG and GA genotypes of 8p22-23-rs2254546 (P = 0.29 and 0.88, respectively). Conclusions: The majority of the children with KD were shown to have this genetic susceptibility, which shows the importance of the 8p22-23-rs2254546 genotype in Iranian children. However, this genotype was not associated with the risk of resistance to IVIG and aneurysm.