Machine Learning Prediction Model for Acute Renal Failure After Acute Aortic Syndrome Surgery

BackgroundAcute renal failure (ARF) is the most common major complication following cardiac surgery for acute aortic syndrome (AAS) and worsens the postoperative prognosis. Our aim was to establish a machine learning prediction model for ARF occurrence in AAS patients.MethodsWe included AAS patient data from nine medical centers (n = 1,637) and analyzed the incidence of ARF and the risk factors for postoperative ARF. We used data from six medical centers to compare the performance of four machine learning models and performed internal validation to identify AAS patients who developed postoperative ARF. The area under the curve (AUC) of the receiver operating characteristic (ROC) curve was used to compare the performance of the predictive models. We compared the performance of the optimal machine learning prediction model with that of traditional prediction models. Data from three medical centers were used for external validation.ResultsThe eXtreme Gradient Boosting (XGBoost) algorithm performed best in the internal validation process (AUC = 0.82), which was better than both the logistic regression (LR) prediction model (AUC = 0.77, p < 0.001) and the traditional scoring systems. Upon external validation, the XGBoost prediction model (AUC =0.81) also performed better than both the LR prediction model (AUC = 0.75, p = 0.03) and the traditional scoring systems. We created an online application based on the XGBoost prediction model.ConclusionsWe have developed a machine learning model that has better predictive performance than traditional LR prediction models as well as other existing risk scoring systems for postoperative ARF. This model can be utilized to provide early warnings when high-risk patients are found, enabling clinicians to take prompt measures.

Implementation of SARS-CoV-2 monoclonal antibody infusion sites at three medical centers in the United States: Strengths and challenges assessment to inform COVID-19 pandemic and future public health emergency use

Monoclonal antibody therapeutics to treat COVID-19 have been authorized by the U.S. Food and Drug Administration under Emergency Use Authorization (EUA). Many barriers exist when deploying a novel therapeutic during an ongoing pandemic, and it is critical to assess the needs of incorporating monoclonal antibody infusions into pandemic response activities. We examined the monoclonal antibody infusion site process during the COVID-19 pandemic and conducted a descriptive analysis using data from three sites at medical centers in the U.S. supported by the National Disaster Medical System. Monoclonal antibody implementation success factors included engagement with local medical providers, therapy batch preparation, placing the infusion center in proximity to emergency services, and creating procedures resilient to EUA changes. Infusion process challenges included confirming patient SARS-CoV-2 positivity, strained staff, scheduling, and pharmacy coordination. Infusion sites are effective when integrated into pre-existing pandemic response ecosystems and can be implemented with limited staff and physical resources.

STABILIZATION OF SUBSIDENCE OF BUILDINGS OF MODERN MEDICAL CENTERS

the group of deformed structures includes buildings that have received unacceptable subsidence and deformation during the period of their construction and especially operation, which, however, do not interfere with the perfor-mance of their main functions, but may eventually collapse. Their causes are errors in engineering and geological surveys and design; violation of the rules for performing construction work and operation of buildings and struc-tures. Long-term geodetic observations of the precipitation of the foundations of buildings on pile foundations have shown that both absolute and relative stabilized values of subsidence in the vast majority of cases are less than them and the normative limit values are calculated. Therefore, the group of deformed buildings on pile foun-dations includes somewhat less often similar objects with shallow foundations. The reasons for excessive subsid-ence of the foundations of pile foundations of buildings (and as a result, the occurrence and development of cracks and other deformations in load – bearing structures), in addition to these, are most often: unjustified use of increasing correction coefficients for the results of compression tests of highly acidic soils; the lower ends of the piles falling into layers of weak soil; the tip of the piles sinking from the design mark; overestimation of the bear-ing capacity of the piles due to non-compliance with the optimal time of their "rest" after immersion or erroneous interpretation of the graphs "load-pile sediment"; excessively close placement of neighboring piles in the plan, which when they are immersed, especially in the sand, leads to "pushing" up previously submerged; uneven load-ing of piles as part of the grillage; deformation of existing buildings and structures when driving piles near and tongue-and-groove, the development of pits, etc.

Preparation and Evaluation of Polymer-Based Ultrasound Gel and Its Application in Ultrasonography

Ultrasound imaging is a widely used technique in every health care center and hospital. Ultrasound gel is used as a coupling medium in all ultrasound procedures to replace air between the transducer and the patient’s skin, as ultrasound waves have trouble in traveling through air. This research was performed to formulate an inexpensive alternative to commercially available ultrasound gel as it is expensive and imported from other countries. Different formulations with different concentrations of carbopol 980 (CAR 980) and methylparaben were prepared with natural ingredients such as aloe vera gel and certain available chemicals that have no harmful effects on the skin. To justify the efficiency of the formulations; necessary physicochemical characteristics such as visual clarity, homogeneity, transparency, skin irritation, antibacterial activity, pH, stability, spreadability, conductivity, acoustic impedance, viscosity, and cost were evaluated. Moreover, a comparison study was also conducted with commercially available ultrasound gel that was utilized as a control. All samples showed excellent transparency and no microbial growth. S1 was the only formulation that met all of the requirements for commercial ultrasound gel and produced images that were similar to those produced by commercial ultrasound gel. So, this formulation could be used as an alternative to expensive commercial ultrasound gel for taking images in hospitals and medical centers.

Multicenter Study of Benign Thyroid Nodules with Radiofrequency Ablation: Results of 762 Cases over 4 Years in Taiwan

Background: To evaluate the effectiveness and safety of radiofrequency ablation (RFA) treatment for benign thyroid nodules (BTNs) in five medical centers in Taiwan. Methods: From April 2016 to July 2020, 762 patients underwent ultrasound guided RFA treatment of 826 benign thyroid nodules at five medical centers in Taiwan. The RFA procedure was performed by radiologists, otolaryngologists, or surgeons. Patients were grouped into three subgroups according to the initial volume of BTNs. The volume reduction ratio (VRR) of each nodule, and complications were analyzed at 1, 3, and 6 months after RFA treatment and the three groups compared. Results: The large nodular group showed greater VRR compared to the other two groups at first 1-month follow-up. At 6-months follow-up, there was no significant difference of VRR among the three groups. Goiters with difference in size can attain a successful VRR (>50%) although different specialists demonstrated variable VRR after 6-months follow-up. A total of 40 (4.8%) complications were reported. All patients recovered spontaneously without surgery intervention. Conclusions: The reliability and safety of RFA for benign thyroid nodules had been established. RFA has gradually become an alternative to surgery in the treatment of benign thyroid nodules in Taiwan.

The Casualty Stabilization–Transportation Problem in a Large-Scale Disaster

We address the problem of picking up, stabilizing, and transporting casualties in response to mass-injury disasters. Our proposed methodology establishes the itinerary for collecting, on-site stabilization, and transporting victims considering capacitated vehicles and medical care centers. Unlike previous works, we minimize the time required to achieve on-site stabilization of each victim according to his age and level of severity of the injuries for their subsequent transfer to specialized medical centers. Thus, more critical patients will be the first to be stabilized, maximizing their chances of survival. In our methodology, the victims’ age, the injuries’ severity level, and their deterioration over time are considered critical factors in prioritizing care for each victim. We tested our approach using simulated earthquake scenarios in the city of Iquique, Chile, with multiple injuries. The results show that explicitly considering the on-site stabilization of the vital functions of the prioritized victims as an objective, before their transfer to a specialized medical center, allows treating and stabilizing patients earlier than with traditional objectives.

Meta-analysis of COVID-19 patients to understand the key predictors of mortality in the non-vaccinated groups in remote settings

Various studies have looked into the impact of the COVID-19 vaccine on large populations. However, very few studies have looked into the remote setting of hospitals where vaccination is challenging due to social structure, myths, and misconceptions. There is a consensus that elevated inflammatory markers such as CRP, ferritin, D-dimer correlate with increased severity of COVID-19 and are associated with worse outcomes. In the present study, through retrospective meta-analysis, we have looked into ~20 months of SARS-COV2 infected patients with known mortality status and identified predictors of mortality concerning their comorbidities, various clinical parameters, inflammatory markers, superimposed infections, length of hospitalization, length of mechanical ventilation and ICU stay. Studies with larger sample sizes have covered the outcomes through epidemiological, social, and survey-based analysis; however, most studies cover larger cohorts from tertiary medical centers. In the present study, we assessed the outcome of non-vaccinated COVID 19 patients in a remote setting for 20 months from January 1, 2020, to August 30, 2021, at CHI Mercy Health in Roseburg, Oregon. We also included two vaccinated patients from September 2021 to add to the power of our cohort. The study will provide a comprehensive methodology and deep insight into multi-dimensional data in the unvaccinated group, translational biomarkers of mortality, and state-of-art to conduct such studies in various remote hospitals.

Evaluation of cut-off values in acute paracetamol overdose following the United Kingdom guidelines

Background The United Kingdom guideline for acute paracetamol overdose has recommended the use of ‘100-treatment line’. Emergency medical centers in some developing countries lack the resources for timely reporting of paracetamol concentrations, hence treatment depends on reported dose. This study aimed to examine whether using an reported dose is safe to predict concentration above the 100-line. Methods Data were retrieved from two emergency medical centers retrospectively, between 2010 and 2017. The inclusion criteria were single acute paracetamol overdose, presentation within 15 h, and age ≥ 14 years. Multiple linear regression was performed to determine the effect of ingested dose on paracetamol concentration. Subgroups were created based on ingested dose, rate of concentration above 100-line were investigated. Results One hundred and seventy-two patients were enrolled in the primary analysis; median dose was 133.3 mg/kg and 46 (37.8%) had concentration above 100-line in the first test. Only dose per weight was moderately correlated with the first concentration (R2 = 0.410, p < 0.001). In the ≤200 mg/kg ingestion group, 18 patients showed concentration above 100-line and 8 showed acute liver injury. The cut-off value of 150 mg/kg showed 82.6% sensitivity and 73.8% specificity to predict concentration above 100-line. Conclusion Where paracetamol concentration is not available and activated charcoal is readily used, following United Kingdom guideline, it is safe to use an ingested dose of > 150 mg/kg as the cut-off value for N-acetylcysteine treatment with risk stratification for hepatotoxicity if the patient is ≥14 years and visit the ED within 15 h after an acute paracetamol overdose.

The Impact of New Coronavirus on Cancer Patients

t the end of 2019, a new coronavirus (severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)) emerged in China and then spread worldwide. Presently, Coronavirus Disease 2019 (COVID-19) is a main public health issue. As of August 2021, more than 200 million confirmed cases from coronavirus and more than 4 million deaths have been reported by WHO in 222 countries. The data sources are Google Scholar, PubMed, and Science Direct articles. Publications were searched without regard to time in order to obtain a holistic and comprehensive perspective of the research done on this issue thus far. The SARS-CoV-2 can be transmitted from the human-to-human by respiratory droplets and shows great potential for a pandemic. Therefore, on March 11, 2020, COVID-19 was introduced as a global pandemic by WHO. Cancer patients are at high risk for exposure to the coronavirus. In the present article, we discuss the impact of the COVID-19 pandemic on the quality of life of cancer patients and their treatment process. One of these challenges is not visiting the patients in medical centers and hospitals for afraid of contracting the virus. Therefore, the diagnosis and treatment of cancer patients may be delayed, which is a serious threat to the lives of cancer patients. In this article, in addition to the impact of coronavirus on the lives of cancer patients, the severity of the disease in these patients, their required medical care, and the vaccination process are discussed.