Visceral Adiposity Independently Predicts Time to Flare in Inflammatory Bowel Disease but Body Mass Index Does Not

BACKGROUND

Obesity is associated with progression of inflammatory bowel disease (IBD). Visceral adiposity may be a more meaningful measure of obesity compared with traditional measures such as body mass index (BMI). This study compared visceral adiposity vs BMI as predictors of time to IBD flare among patients with Crohn's disease and ulcerative colitis.

METHODS

This was a retrospective cohort study. IBD patients were included if they had a colonoscopy and computed tomography (CT) scan within a 30-day window of an IBD flare. They were followed for 6 months or until their next flare. The primary exposure was the ratio of visceral adipose tissue to subcutaneous adipose tissue (VAT:SAT) obtained from CT imaging. BMI was calculated at the time of index CT scan.

RESULTS

A total of 100 Crohn's disease and 100 ulcerative colitis patients were included. The median age was 43 (interquartile range, 31-58) years, 39% had disease duration of 10 years or more, and 14% had severe disease activity on endoscopic examination. Overall, 23% of the cohort flared with median time to flare 90 (interquartile range, 67-117) days. Higher VAT:SAT was associated with shorter time to IBD flare (hazard ratio of 4.8 for VAT:SAT ≥1.0 vs VAT:SAT ratio <1.0), whereas higher BMI was not associated with shorter time to flare (hazard ratio of 0.73 for BMI ≥25 kg/m2 vs BMI <25 kg/m2). The relationship between increased VAT:SAT and shorter time to flare appeared stronger for Crohn's than for ulcerative colitis.

CONCLUSIONS

Visceral adiposity was associated with decreased time to IBD flare, but BMI was not. Future studies could test whether interventions that decrease visceral adiposity will improve IBD disease activity.

Fully Automated Measurement of the Insall-Salvati Ratio with Artificial Intelligence

Patella alta (PA) and patella baja (PB) affect 1-2% of the world population, but are often underreported, leading to potential complications like osteoarthritis. The Insall-Salvati ratio (ISR) is commonly used to diagnose patellar height abnormalities. Artificial intelligence (AI) keypoint models show promising accuracy in measuring and detecting these abnormalities.An AI keypoint model is developed and validated to study the Insall-Salvati ratio on a random population sample of lateral knee radiographs. A keypoint model was trained and internally validated with 689 lateral knee radiographs from five sites in a multi-hospital urban healthcare system after IRB approval. A total of 116 lateral knee radiographs from a sixth site were used for external validation. Distance error (mm), Pearson correlation, and Bland-Altman plots were used to evaluate model performance. On a random sample of 2647 different lateral knee radiographs, mean and standard deviation were used to calculate the normal distribution of ISR. A keypoint detection model had mean distance error of 2.57 ± 2.44 mm on internal validation data and 2.73 ± 2.86 mm on external validation data. Pearson correlation between labeled and predicted Insall-Salvati ratios was 0.82 [95% CI 0.76-0.86] on internal validation and 0.75 [0.66-0.82] on external validation. For the population sample of 2647 patients, there was mean ISR of 1.11 ± 0.21. Patellar height abnormalities were underreported in radiology reports from the population sample. AI keypoint models consistently measure ISR on knee radiographs. Future models can enable radiologists to study musculoskeletal measurements on larger population samples and enhance our understanding of normal and abnormal ranges.

CANDI: an R package and Shiny app for annotating radiographs and evaluating computer-aided diagnosis

Motivation

Radiologists have used algorithms for Computer-Aided Diagnosis (CAD) for decades. These algorithms use machine learning with engineered features, and there have been mixed findings on whether they improve radiologists’ interpretations. Deep learning offers superior performance but requires more training data and has not been evaluated in joint algorithm-radiologist decision systems.

Results

We developed the Computer-Aided Note and Diagnosis Interface (CANDI) for collaboratively annotating radiographs and evaluating how algorithms alter human interpretation. The annotation app collects classification, segmentation, and image captioning training data, and the evaluation app randomizes the availability of CAD tools to facilitate clinical trials on radiologist enhancement.

Availability and implementation

Demonstrations and source code are hosted at (https://candi.nextgenhealthcare.org), and (https://github.com/mbadge/candi), respectively, under GPL-3 license.

Supplementary information

Supplementary material is available at Bioinformatics online.

Detecting insertion, substitution, and deletion errors in radiology reports using neural sequence-to-sequence models

Background

Errors in grammar, spelling, and usage in radiology reports are common. To automatically detect inappropriate insertions, deletions, and substitutions of words in radiology reports, we proposed using a neural sequence-to-sequence (seq2seq) model.

Methods

Head CT and chest radiograph reports from Mount Sinai Hospital (MSH) (n=61,722 and 818,978, respectively), Mount Sinai Queens (MSQ) (n=30,145 and 194,309, respectively) and MIMIC-III (n=32,259 and 54,685) were converted into sentences. Insertions, substitutions, and deletions of words were randomly introduced. Seq2seq models were trained using corrupted sentences as input to predict original uncorrupted sentences. Three models were trained using head CTs from MSH, chest radiographs from MSH, and head CTs from all three collections. Model performance was assessed across different sites and modalities. A sample of original, uncorrupted sentences were manually reviewed for any error in syntax, usage, or spelling to estimate real-world proofreading performance of the algorithm.

Results

Seq2seq detected 90.3% and 88.2% of corrupted sentences with 97.7% and 98.8% specificity in same-site, same-modality test sets for head CTs and chest radiographs, respectively. Manual review of original, uncorrupted same-site same-modality head CT sentences demonstrated seq2seq positive predictive value (PPV) 0.393 (157/400; 95% CI, 0.346-0.441) and negative predictive value (NPV) 0.986 (789/800; 95% CI, 0.976-0.992) for detecting sentences containing real-world errors, with estimated sensitivity of 0.389 (95% CI, 0.267-0.542) and specificity 0.986 (95% CI, 0.985-0.987) over n=86,211 uncorrupted training examples.

Conclusions

Seq2seq models can be highly effective at detecting erroneous insertions, deletions, and substitutions of words in radiology reports. To achieve high performance, these models require site- and modality-specific training examples. Incorporating additional targeted training data could further improve performance in detecting real-world errors in reports.

Extensive elemental mapping unlocks Mg/Ca ratios as climate proxy in seasonal records of Mediterranean limpets

Elemental analysis of biogeochemical archives is an established technique used to study climate in a range of applications, including ocean circulation, glacial/interglacial climates, and anthropogenic climate change. Data from mollusc archives are especially important because of their global abundance and sub-annual resolution. Despite this potential, they are underrepresented among palaeoclimate studies, due to enigmatic physiological influences skewing the elemental record. Understanding the patterns behind these influences will improve data interpretation and lead to the development of new climate proxies. Here, we show for the first time that extensive spatial mapping of multiple mollusc specimens using Laser Induced Breakdown Spectroscopy (LIBS) across a wider region can resolve enigmatic patterns within the elemental record caused by physiological influences. 2D elemental (Mg/Ca) maps of whole limpet shells (Patella caerulea) from across the Mediterranean revealed patterns of variability within individual mollusc records as well as within isochronous parts of specimens. By registering and quantifying these patterns, we established previously uninterpretable correlations with temperature (R² > 0.8, p < 0.01). This outcome redefines the possibilities of accessing sub-annual climate proxies and presents the means to assess annual temperature ranges using oxygen isotope analysis requiring only 2 samples per shell.

Measuring the Degree of Unmatched Patient Records in a Health Information Exchange Using Exact Matching

BACKGROUND

Health information exchange (HIE) facilitates the exchange of patient information across different healthcare organizations. To match patient records across sites, HIEs usually rely on a master patient index (MPI), a database responsible for determining which medical records at different healthcare facilities belong to the same patient. A single patient's records may be improperly split across multiple profiles in the MPI.

OBJECTIVES

We investigated the how often two individuals shared the same first name, last name, and date of birth in the Social Security Death Master File (SSDMF), a US government database containing over 85 million individuals, to determine the feasibility of using exact matching as a split record detection tool. We demonstrated how a method based on exact record matching could be used to partially measure the degree of probable split patient records in the MPI of an HIE.

METHODS

We calculated the percentage of individuals who were uniquely identified in the SSDMF using first name, last name, and date of birth. We defined a measure consisting of the average number of unique identifiers associated with a given first name, last name, and date of birth. We calculated a reference value for this measure on a subsample of SSDMF data. We compared this measure value to data from a functioning HIE.

RESULTS

We found that it was unlikely for two individuals to share the same first name, last name, and date of birth in a large US database including over 85 million individuals. 98.81% of individuals were uniquely identified in this dataset using only these three items. We compared the value of our measure on a subsample of Social Security data (1.00089) to that of HIE data (1.1238) and found a significant difference (t-test p-value < 0.001).

CONCLUSIONS

This method may assist HIEs in detecting split patient records.

Identifying homelessness using health information exchange data

BACKGROUND

Homeless patients experience poor health outcomes and consume a disproportionate amount of health care resources compared with domiciled patients. There is increasing interest in the federal government in providing care coordination for homeless patients, which will require a systematic way of identifying these individuals.

OBJECTIVE

We analyzed address data from Healthix, a New York City-based health information exchange, to identify patterns that could indicate homelessness.

METHODS

Patients were categorized as likely to be homeless if they registered with the address of a hospital, homeless shelter, place of worship, or an address containing a keyword synonymous with "homelessness."

RESULTS

We identified 78,460 out of 7,854,927 Healthix patients (1%) as likely to have been homeless over the study period of September 30, 2008 to July 19, 2013. We found that registration practices for these patients varied widely across sites.

CONCLUSIONS

The use of health information exchange data enabled us to identify a large number of patients likely to be homeless and to observe the wide variation in registration practices for homeless patients within and across sites. Consideration of these results may suggest a way to improve the quality of record matching for homeless patients. Validation of these results is necessary to confirm the homeless status of identified individuals. Ultimately, creating a standardized and structured field to record a patient's housing status may be a preferable approach.

Transcription linked to recombination: a gene-internal promoter coincides with the recombination hot spot II of the human MLL gene

The MLL gene is frequently involved in chromosomal translocations associated with high-risk acute leukaemia. Infant and therapy-related acute leukaemia patients display chromosomal breakpoints preferentially clustered in the telomeric portion of the MLL breakpoint cluster region (SCII). Here, we demonstrate that SCII colocalizes with a gene-internal promoter element in the mouse and human MLL gene, respectively. The mRNA generated encodes an N-terminally truncated version of MLL that still exhibits many functional regions, including the C-terminal SET-domain. Etoposide-induced DNA double-strand breaks colocalize with the binding site of RNA polymerase II and the transcription initiation region, but not with a nearby Topo II consensus sequence. Thus, the observed genomic instability of the human MLL gene is presumably linked to transcriptional processes. The consequences of this novel finding for the creation of chromosomal translocations, the biology of the MLL protein and for MLL-mediated acute leukaemia are discussed.

[Neovascular glaucoma diagnosed following carotid endarterectomy]

We report a case of bilateral asymptomatic rebeosis iridis related to a bilateral obstruction of the carotid arteries. The iridocorneal angles were closed by a neovascular membrane and intraocular pressures were normal within both eyes (normotensive neovascular glaucoma). After left carotid endarterectomy, the increased perfusion of the ciliary body and the increased secretion of aqueous humor resulted in a sudden bilateral ocular hypertension. Management of ocular neovascularization related to carotid artery obstruction may involve the destruction of areas of retinal ishchemia (laser panretinal photocoagulation or cryotherapy) before carotid surgery.

Colonic bacterial activity determines the symptoms in people with fructose-malabsorption

BACKGROUND/AIM

This study was performed to find a parameter to discriminate symptomatic from asymptomatic subjects with fructose-malabsorption.

PATIENTS AND METHODS

Thirty-four subjects (12 m, 22 f; average age, 28.6 years; range 16-60) were investigated after an overnight fast. After intake of 25 g fructose, H2-tests were carried out. Endexspiratory breath samples were taken before the ingestion of the tested sugar and at 30 minute intervals over a 2 hour period. Hydrogen determination was performed immediately after sampling. Results were considered pathological if there was a rise in hydrogen over 20 ppm and a twofold increase from the initial value. Aerobic and anaerobic cultures from stool bacteria were set and incubated with 0.5 g fructose.

RESULTS

Among 34 healthy controls, 13 malabsorbers (38%) were detected. Out of these malabsorbers, 6 (46%) reported gastrointestinal concomitant symptoms. Symptomatic and asymptomatic subjects with fructose-malabsorption showed a comparable increase in hydrogen levels. The disappearance rate of fructose in the stool cultures was significantly elevated in the symptomatic group compared with the asymptomatic, but only in the anaerobic culture.

CONCLUSION

This activity of colonic bacteria, significantly discriminating symptomatic subjects with fructose-malabsorption from asymptomatic, enhances the importance of fructose-malabsorption in the differential diagnosis of people with non-specific abdominal complaints. Antibiotic therapy in severe cases should be considered a therapeutical approach. Moreover these results may support the role of nutritional carbohydrates in the pathogenesis of colonic diseases.

[Carbohydrate substitutes: comparative study of intestinal absorption of fructose, sorbitol and xylitol]

BACKGROUND

The carbohydrate substitutes fructose, sorbitol and xylitol are gaining more and more importance in the production of dietary food. But they can provoke gastrointestinal side-effects. In a randomized double blind study the rate of malabsorption of these sugars was compared and the concomitant symptoms were recorded.

SUBJECTS AND METHODS

25 healthy controls received 25 g of each sugar within 3 consecutive days. The intestinal absorption was determined by H2-exhalation tests and the clinical symptoms were recorded.

RESULTS

The rate of malabsorption was 84% for sorbitol, 36% for fructose and 12% for xylitol (p < 0.01 for sorbitol versus fructose and xylitol). 57% of the participants with pathological H2-test after sorbitol and 56% after fructose reported symptoms, while all of the 3 malabsorbers of xylitol were symptomatic.

CONCLUSIONS

There is an advantage to administering xylitol and fructose with regard to the intestinal absorption and concomitant symptoms as compared with sorbitol. H2-exhalation tests appear to be a reliable diagnostic tool to detect carbohydrate malabsorption and should find broader application in patients suffering from non-specific abdominal complaints.

[Comparison of preparation techniques with reference to final spermatozoa concentration and survival and fertilization rate in vitro in normal and pathologic ejaculates]

Various methods are available in the preparation of normal and pathological ejaculates within the framework of available techniques of assisted reproduction. The authors examined the recovery rate, the long-term motility and the fertilization rate in vitro after both normal and pathological test results, of preparations, using one of the three most commonly used techniques. Centrifugation with its resulting swim up (Z) is a method still widely used because of the good sperm recovery rate it produces. However, in our tests, it achieved the lowest level capacity, compared with sperm separation by migration/sedimentation, with resultant swim up (M) and Percoll gradient centrifugation (P). The statistically highly significant fast decline of motility after preparation by Z, compared with the other two above mentioned techniques, in both normal and pathological ejaculates is a further indication, that Z has a negative influence upon the integrity of the spermatozoa. The results of research submitted here suggest the abandonment of Z in its standard form in favour of other techniques. After normal test results, both M and P might be used, but in the case of pathological ejaculate, P would be recommended.

[Steroid and protein hormone concentrations in serum and follicular fluid after stimulation for in vitro fertilization]

Sixty patients with tubal infertility were stimulated for IVF with a fixed schedule consisting of clomiphene and pure follicle stimulating hormone. They responded with an optimal estradiol increase and 2 to 4 embryos were transferred. Conception cycles (n = 17) could be differentiated from non-conception cycles (n = 43) by serum estradiol, serum progesterone, the serum progesterone/estradiol-ratio and serum LH concentrations. Testosterone, androstenedione and FSH in serum and follicular fluid showed no significant relation to a possible therapy outcome. We conclude from our findings, that, during the peri-implantation period, certain LH patterns followed by an optimal progesterone/estradiol-ratio in the serum support an embryo survival after transfer to the uterus.

[Risks and follow-up of choledocho-jejunostomy for nonresectable cancers of the head of the pancreas. A prospective study]

In 44 patients with palliative operative procedures due to non-resectable pancreatic cancer the preoperative risk factors and the intra- and postoperative course as well as the long-term results were prospectively investigated. Postoperatively 2 patients developed severe complications and 3 patients died. The median survival time was 5 months. The results of this investigation show, that the biliodigestive anastomosis offers a good palliation in patients with non-resectable pancreatic cancer. Indication for non-operative palliative procedure are patients in poor general condition with a life expectance of less than 4 months.

Relevant factors in the prognosis of ductal pancreatic carcinoma

Because it is important to assess relevant prognostic factors when deciding which patients will profit from pancreatic resection and which will not, 484 patients with ductal pancreatic carcinoma who were operated on between 1 January 1978 and 31 December 1987 in the Department of General and Abdominal Surgery of Mainz Medical School were studied retrospectively. Prognostically favourable factors were: a history of 8 weeks or less, the presence of jaundice, the absence of back pain, a well to moderately differentiated carcinoma, a tumour less than 3 cm in diameter, a preoperative CA19-19 value of less than 400 U/ml, and no sign of lymph node metastases or other metastatic spread. Only 19 patients (3.9%) satisfied these criteria. Our objective is to now check these results in a prospective study with a larger number of patients and, in addition, to compare the quality of life of patients who were treated by resection with that of those who received palliative treatment.

[Angioneurotic edema of the tongue, induced by administration of ACE inhibitors]

Inhibitors of angiotensin converting enzyme can rarely cause an angioneurotic edema of the upper airways. This complication depends on the interaction with hormones regulating the vascular resistance such as the kallikrein kinin and the prostaglandin systems. We present two cases of angioneurotic edema of the tongue induced by inhibitors of angiotensin converting enzyme. We describe the symptoms of this side effect and discuss possible therapeutic approaches.

[Prognostically relevant factors in cancer of Vater's ampulla]

In order to evaluate the relevant factors for prognosis for patients with cancer of Vater's papilla our own patient material between 1. 1. 1978 and 31. 12. 1987 was studied retrospectively. The influence of age, sex, duration of anamnesis, tumor size, tumor morphology and tumor stage on the prognosis were analyzed in 32 patients with cancer of Vater's papilla. The 5 year survival rate after Whipple procedure was 56.1%. Statistically significant factors for prognosis were tumor size, lymph node metastases and tumor stage.

[Prognostically relevant factors in ductal pancreatic cancer]

Prognosis of patients with pancreatic carcinoma is bad. Less than 1% of all patients and even after pancreas resection only 10% survive more than 5 years. To evaluate the factors which influence the prognosis we analyzed retrospectively all patients who were operated on a pancreas cancer (n = 484) from January 1, 1978 to December 31, 1987. Age, sex, perineural invasion and lymphangiosis carcinomatosa had no prognostic influence. The duration of symptoms, degree of cellular differentiation, tumor size, preoperative level of the tumor associated antigen CA-19-9, nodal involvement and stage were statistically significant for prognosis. R1 and R2-resections had no better prognosis than other palliative procedures.

Calcium and calmodulin antagonism for inhibition of uterine contractions

In search for a new tocolytic agent we investigated felodipine, a calmodulin-antagonizing drug. Felodipine reduced the spontaneous activity of 22 uterine strips taken from the uterus in the course of a cesarean section to 52 +/- 12% (mean +/- SEM) after 10 min, to 20 +/- 7% after 20 min and to 12 +/- 4% after 60 min (P less than 0.001).

Effects of retinoids and interferon-gamma on cultured breast cancer cells in comparison with tumor necrosis factor alpha

The combination of retinoic acid or tumor necrosis factor alpha (TNF-alpha) with interferon gamma (IFN-gamma) resulted in a synergistic amplification of the anti-proliferative effect of IFN-gamma on cultured breast cancer cells. Retinoic acid could be replaced by other biologically active retinoids. This synergism was also observed for the induction of 2'-5'-oligoadenylate-synthetase, an enzyme which is not expressed constitutively on BT-20 human breast cancer cells and not inducible by retinoic acid or TNF-alpha alone. However, both substances augmented the IFN-gamma-mediated expression. On the other hand, only TNF-alpha and not retinoic acid was able to increase the IFN-gamma induced expression of HLA-DR on the cell surface. Both cytokines antagonized the IFN-gamma effect on detachability of cultured BT-20 cells. The combinations of retinoic acid with IFN-gamma increased the down-regulation of specific binding sites for 125I-IFN-gamma. On the other hand, IFN-gamma exerted no effect on the concentration of the cytoplasmic binding protein for retinoic acid. Data obtained in this study demonstrate a different pattern of action between retinoic acid and TNF-alpha regarding their synergism in combination with IFN-gamma.

Characterization of an interferon-resistant mutant of the human breast cancer cell line BT-20

The human breast cancer cells BT-20 were treated for 18 months in the continuous presence of interferon-gamma (HuIFN-gamma; 500 U/ml). These cells have become completely resistant to HuIFN-gamma and interestingly also to IFN-alpha 2. However, the expression of HLA-DR and the regulation of cell adhesion to tissue culture plastic remained partially under the domain of HuIFN-gamma. A reduced number of IFN-gamma binding sites in comparison to the wild-type cells were observed on the IFN-resistant BT-20 cells.

The relation between saliva estriol levels in pregnancy and infant birth weight

Specimens of saliva were obtained from 106 women with normal pregnancies and from 42 women, whose children turned out to small for dates (birthweight below the 10th centile). Saliva estriol was highly significantly (P less than 0.0001) decreased in the group with a newborn with a birthweight below the 10th centile (500 +/- 340 ng/ml, mean +/- SD) when compared with the group with infants whose birthweight was over the 10th centile (813 +/- 449 ng/ml). Estriol determination in saliva seems to be a simple, non invasive method of aiding the detection of fetal growth retardation.