Prediction of postoperative final degree and recurrence of pectus excavatum using machine learning algorithms

Background

Chest wall re-depression after bar removal (BR) in pectus excavatum (PE) is insufficiently investigated. However, it is not easy to investigate chest wall re-depression due to its multifactorial characteristics. Herein, we investigated chest wall re-depression after BR using machine learning algorithms. To the best of my knowledge, this is the first study of chest wall re-depression after BR using machine learning algorithms.

Methods

We retrospectively reviewed 199 consecutive subjects who underwent both minimally invasive repair of pectus excavatum (MIRPE) and BR at a single hospital from March 2012 to June 2020. We investigated attributes of chest wall re-depression and risk factors for recurrence after BR, predicted final degree and recurrence of PE after BR, and suggested the optimal age at the time of MIRPE based on recurrence. Data for the chest wall re-depression were analyzed to discover differences according to age group [<10 years (early repair group; EG) vs. ≥10 years (late repair group; LG)].

Results

We observed no significant difference between the Haller index and radiographical pectus index (RPI) (P=0.431) and a significant correlation between Haller index and RPI (P<0.001). RPI significantly increased for the first 6 months after BR in both age groups (both P<0.001) and was maintained at 1 year after BR. RPI value of the LG were significantly higher than those of the EG for the entire period after MIRPE (P=0.041). Recurrence of PE in the LG was significantly more frequent than in the EG (P<0.001). RPI values before and after MIRPE and age group were identified as independent risk factors for recurrence after BR (P<0.001, P=0.007, and P=0.001, respectively). The linear regression model outperformed for final RPI with performance scores of mean squared error 0.198, root mean squared error 0.445, mean absolute error 0.336, and R2 0.415. In addition, the logistic regression model outperformed for predicting recurrence with performance scores of 0.865 the area under the curve, 0.884 accuracy, 0.859 F1, 0.865 precision, and 0.884 recall.

Conclusions

The present study shows that machine learning algorithms can provide good estimates for postoperative results in PE. An approach integrating machine learning models and readily available clinical data can be used to create other models in the thoracic surgery field.

Subepithelial neutrophil infiltration as a predictor of the surgical outcome of chronic rhinosinusitis with nasal polyps

BACKGROUND

Neutrophils present as major inflammatory cells in refractory chronic rhinosinusitis with nasal polyps (CRSwNP), regardless of the endotype. However, their role in the pathophysiology of CRSwNP remains poorly understood. We investigated factors predicting the surgical outcomes of CRSwNP patients with focus on neutrophilic localization.

METHODS

We employed machine-learning methods such as the decision tree and random forest models to predict the surgical outcomes of CRSwNP. Immunofluorescence analysis was conducted to detect human neutrophil elastase (HNE), Bcl-2, and Ki-67 in NP tissues. We counted the immunofluorescence-positive cells and divided them into three groups based on the infiltrated area, namely, epithelial, subepithelial, and perivascular groups.

RESULTS

On machine learning, the decision tree algorithm demonstrated that the number of subepithelial HNE-positive cells, Lund-Mackay (LM) scores, and endotype (eosinophilic or non-eosinophilic) were the most important predictors of surgical outcomes in CRSwNP patients. Additionally, the random forest algorithm showed that, after ranking the mean decrease in the Gini index or the accuracy of each factor, the top three ranking factors associated with surgical outcomes were the LM score, age, and number of subepithelial HNE-positive cells. In terms of cellular proliferation, immunofluorescence analysis revealed that Ki-67/HNE-double positive and Bcl-2/HNE-double positive cells were significantly increased in the subepithelial area in refractory CRSwNP.

CONCLUSION

Our machine-learning approach and immunofluorescence analysis demonstrated that subepithelial neutrophils in NP tissues had a high expression of Ki-67 and could serve as a cellular biomarker for predicting surgical outcomes in CRSwNP patients.

Multi-mission satellite remote sensing data for improving land hydrological models via data assimilation

Satellite remote sensing offers valuable tools to study Earth and hydrological processes and improve land surface models. This is essential to improve the quality of model predictions, which are affected by various factors such as erroneous input data, the uncertainty of model forcings, and parameter uncertainties. Abundant datasets from multi-mission satellite remote sensing during recent years have provided an opportunity to improve not only the model estimates but also model parameters through a parameter estimation process. This study utilises multiple datasets from satellite remote sensing including soil moisture from Soil Moisture and Ocean Salinity Mission and Advanced Microwave Scanning Radiometer Earth Observing System, terrestrial water storage from the Gravity Recovery And Climate Experiment, and leaf area index from Advanced Very-High-Resolution Radiometer to estimate model parameters. This is done using the recently proposed assimilation method, unsupervised weak constrained ensemble Kalman filter (UWCEnKF). UWCEnKF applies a dual scheme to separately update the state and parameters using two interactive EnKF filters followed by a water balance constraint enforcement. The performance of multivariate data assimilation is evaluated against various independent data over different time periods over two different basins including the Murray–Darling and Mississippi basins. Results indicate that simultaneous assimilation of multiple satellite products combined with parameter estimation strongly improves model predictions compared with single satellite products and/or state estimation alone. This improvement is achieved not only during the parameter estimation period (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\sim $$\end{document}∼ 32% groundwater RMSE reduction and soil moisture correlation increase from \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\sim $$\end{document}∼ 0.66 to \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\sim $$\end{document}∼ 0.85) but also during the forecast period (\documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\sim $$\end{document}∼ 14% groundwater RMSE reduction and soil moisture correlation increase from \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\sim $$\end{document}∼ 0.69 to \documentclass[12pt]{minimal} \usepackage{amsmath} \usepackage{wasysym} \usepackage{amsfonts} \usepackage{amssymb} \usepackage{amsbsy} \usepackage{mathrsfs} \usepackage{upgreek} \setlength{\oddsidemargin}{-69pt} \begin{document}$$\sim $$\end{document}∼ 0.78) due to the effective impacts of the approach on both state and parameters.

Effects of feminine cleanser Inclear on sperm motility: A prospective study

Objective

The objective of this study is to estimate the effects of Inclear, a feminine cleanser, on sperm motility.

Methods

Semen samples were obtained from infertile male patients. Following liquefaction, the raw semen samples were diluted with Ham's F-10 nutrient mixture medium containing 0.4% human serum albumin solution at a ratio of 1:3. The semen samples were subsequently centrifuged to separate the seminal plasma from the serum. The supernatant was discarded, and the pellet was resuspended. The sample was again centrifuged to remove cell debris, and the supernatant was removed. The final pellet was gently loosened by resuspension and incubated in medium alone as a control, and in a 10% solution of the medium plus Inclear. A sampling time of 30 minutes was selected on the basis of sperm transport studies. Sperm motility was evaluated with computer-assisted sperm analysis.

Results

A total of 20 samples were analyzed. The mean age of patients was 34.40±2.96 years. There was no difference in sperm concentration and motility in the two samples at 0 minute and 30 minutes of incubation. In both semen samples, the sperm concentration and motility decreased after an incubation period of 30 minutes. However, there was no statistical difference between the samples. Sperm concentration and motility were not significantly different between the control and Inclear samples after 0 minute and 30 minutes of incubation.

Conclusion

Inclear has no negative effects on sperm motility. This product can be recommended to pregnancy planners for vaginal hygiene and as a vaginal lubricant.

Reconstruction of chronic osteomyelitis of the nose using a thin latissimus dorsi perforator flap

Osteomyelitis is an acute or chronic inflammatory process that occurs in bone. Although cranial bones are rarely involved, timely diagnosis and early treatment are mandatory because of its proximity to critical neurovascular structures and aesthetic considerations.A 57-year-old woman, who had a comminuted open nasal bone fracture 20 years ago, presented a firm, painful swelling nose. Whole-body bone scan images indicated increased uptake of the nasal bone, which was suspected to be osteomyelitis. After debridement, the nose was reconstructed with a thin latissimus dorsi perforator flap.In this article, we report a rare case of chronic osteomyelitis of the nose and provide a brief review of the literature. It is important for clinicians to consider osteomyelitis for early diagnosis and treatment.

Reconstruction of infected abdominal wall defects using latissimus dorsi free flap

INTRODUCTION

Infected abdominal defects are a challenge to surgeons. In this study, we describe 10 cases in which the latissimus dorsi myocutaneous flap was used for successful reconstruction of abdominal wall defects severely infected with methicillin-resistant Staphylococcus aureus (MRSA).

METHODS

Retrospective review of 10 patients with abdominal wall defects that were reconstructed using the latissimus dorsi myocutaneous flap between 2002 and 2010. All patients had abdominal defects with hernias, combined with MRSA infections. The sizes of the flaps ranged from 120 to 364 cm(2) . The deep inferior epigastric artery was the recipient vessel in nine patients and the internal mammary vessels were used for one patient.

RESULTS

There were no complications relating to the flaps, although there were other minor complications including wound dehiscence, haematoma and fluid correction. After reconstruction, there were no signs of infection during follow-up periods, and the patients were satisfied with the final results.

CONCLUSION

Reconstruction using the latissimus dorsi myocutaneous flap, including muscle fascia structures, is a potential treatment option for severely infected large abdominal wall defects.

Anti-inflammatory amino acid derivatives from the ascidian Herdmania momus

Four new amino acid derivatives, herdmanines A-D (1-4), were isolated from the marine ascidian Herdmania momus. Herdmanines A-C contain the unusual D-form of arginine. Compounds 3 and 4 had a moderate suppressive effect on the production of NO, with IC₅₀ values of 96 and 9 μM, respectively. These compounds were found to inhibit the mRNA expression of iNOS. The inhibitory activities on the production and mRNA expression of pro-inflammatory cytokines such as TNF-α, IL-1β, and IL-6 were evaluated.

Predictive value of sperm motility characteristics assessed by computer-assisted sperm analysis in intrauterine insemination with superovulation in couples with unexplained infertility

Objective

To determine whether characteristics of sperm motility obtained by computer-assisted sperm analysis (CASA) could predict pregnancy after intrauterine insemination (IUI) in couples with unexplained infertility.

Methods

Three hundred eighty-three cycles of intrauterine insemination with superovulation were retrospectively analyzed. Semen analysis was performed with CASA before and after swim-up and the parameters were compared between pregnant and non-pregnant women.

Results

The pregnancy rate per cycle was 14.1%. Pregnant and non-pregnant women were comparable in terms of age, infertility duration, the number of dominant follicles. While sperm concentration, motility, and parameters such as average path velocity (VAP) and percentage rapid (RAPID) before semen preparation were significantly different between the pregnancy and non-pregnancy groups, there were no differences in sperm parameters when comparing the two groups after preparation. Using a receiver operating characteristic curve to measure sensitivity and specificity, the optimal threshold value for the predictors of pregnancy was revealed to be a concentration of ≥111×10⁶/mL, a motility of ≥51.4%, and RAPID ≥30.1% before preparation for IUI.

Conclusion

Sperm parameters including concentration, motility, and RAPID before sperm preparation could have predictive value for pregnancy outcome after intrauterine insemination with superovulation in couples with unexplained infertility, and would be helpful when counseling patients before they make the decision to proceed with IVF/ICSI-ET.

Removal of manganese from water using combined chelation/membrane separation systems

The addition of the chelating polymer polyacrylic acid (PAA) to assist in the removal of manganese from groundwater by membranes was investigated using membranes with different pore sizes under various operating conditions. Negligible manganese removal was achieved with the UF and NF membranes at acidic pH values, but removals exceeding 90% could be achieved at elevated pH (pH 9), presumably due to the formation of manganese hydroxides. Mn removal increased substantially when PAA was added to the feed solution, due to chelation of Mn by the PAA and rejection of the chelates by the membranes. The chelate could be broken at acidic pH, releasing free PAA that could then be separated from the Mn ions and reused. Smaller PAA molecules were lost in the first regeneration cycle, but negligible PAA was lost in subsequent cycles. In the systems with PAA, nitrate ions were rejected more efficiently than in the PAA-free systems, presumably because of electrical repulsion between nitrate ions and PAA sorbed on the membrane surface. With increasing PAA dose, the volumetric flux first decreased and then increased; the latter result was accompanied by a change in the physical-chemical form of the polymers, as indicated by an increase in turbidity.

Liquid chromatographic resolution of biphenyl dimethyl dicarboxylate (DDB) and its analogues on a chiral stationary phase

Racemic biphenyl dimethyl dicarboxylate (DDB) and its analogues have been successfully resolved on a commercial HPLC chiral column, (3R,4S)-Whelk-O 1. In general, cyclic amide analogues of DDB, which were derived from pyrrolidine or piperidine, showed greater enantioselectivity and greater retention than the corresponding N,N-dialkyl amide or N-alkyl amide or ester analogues. From these results, it was concluded that the carbonyl oxygen of the DDB analogues plays an important role as a hydrogen bond acceptor, though the steric bulkiness of the amide functionality of DDB analogues may be another factor governing chiral recognition. The conformational stability of the two enantiomers of DDB and its analogues was also found to be high enough for the two enantiomers to be resolvable on (3R,4S)-Whelk-O 1.

Note on the use of reciprocity of chiral recognition in designing liquid chromatographic chiral stationary phases

A new high-performance liquid chromatographic chiral stationary phase (CSP) was prepared from (S)-N-(3,5-dimethylbenzoyl)leucine N-phenyl N-allyl amide. The new CSP was applied for the resolution of N-(3,5-dinitrobenzoyl)-alpha-amino amides and esters and the chromatographic resolution results were compared with those on another CSP derived from (S)-N-(3,5-dimethoxylbenzoyl)leucine N-phenyl N-allyl amide. The new CSP was found to exert greater enantioselectivity than the other one. These results are contrary to what was expected from the reciprocity of chiral recognition. From these results it was concluded that the reciprocity of chiral recognition should be used with some degree of care in developing effective CSPs or in predicting chromatographic resolution behaviors.

New chiral crown ether stationary phase for the liquid chromatographic resolution of alpha-amino acid enantiomers

A new chiral stationary phase (CSP) for the liquid chromatographic separation of enantiomers was prepared by bonding a novel enantiopure (diphenyl-substituted 1,1'-binaphthyl) crown ether to 5 microm silica gel. The resulting CSP was applied to the separation of the enantiomers of various natural and unnatural alpha-amino acids. All alpha-amino acids tested were resolved very well on the new CSP, with the exception of proline, which does not contain a primary amino group. The resolution of alpha-amino acid enantiomers on this new CSP was found to be dependent on the type and amounts of organic and acidic modifiers, and on column temperature.

Effect of the double bond pi-conjugation of the aromatic group of racemic analytes on the liquid chromatographic separation of enantiomers

Various arylcarbinol esters were resolved on a commercial chiral column, (S, S) Whelk-O1. Among others, the analytes in which the aryl group is in conjugation with the double bond(s) to the chiral center were resolved much better on (S, S) Whelk-O1 than the corresponding non-double bonded analytes. From these results, it was proposed that the double bond pi-conjugation of the aromatic group of racemic analytes is very important for the chiral recognition. In addition, the size of the acyl group of arylcarbinol esters has been demonstrated to be important for the chiral recognition. In general, the large acyl group such as pivaloyl group was very effective for the chiral recognition of arylcarbinol esters on (S, S) Whelk-O1.

Video compression with dense motion fields

We propose a motion-compensated video coding system employing dense motion fields. The dense motion field is calculated at the transmitter, and the motion information is efficiently encoded and transmitted along with the residual frame. The motion estimation is performed by existing techniques in the literature, while we focus on the coding of the motion field and the displaced frame difference (DFD) frame. The dense motion field formulation leads to several novel and distinct advantages. The motion field is encoded in a lossy manner to make the motion rate manageable. The more accurate and precise motion description allows us to predict where the DFD energy will be significant, thus leading to a more efficient DFD encoder compared to applying traditional still-image coding techniques. Furthermore, the dense motion field framework allows us to refine and tailor the motion estimation process such that the resulting DFD frame is easier to encode. Simulations demonstrate superior performance against standard block-based coders, with greater advantages for sequences with more complex motion.

Chemoradiation as primary or adjuvant treatment for locally advanced carcinoma of the vulva

PURPOSE

To determine the impact of primary or adjuvant chemotherapy and radiation (CRT) on the survival rates of patients with locally advanced vulvar carcinoma.

METHODS AND MATERIALS

Between 1973 and 1998, 54 patients with vulvar cancer were treated with radiation therapy, among which 20 received CRT, while 34 patients received radiation therapy (RT) alone. Of the 20 patients, 14 were treated for primary or recurrent disease (pCRT), and 6 after radical vulvectomy for high-risk disease (aCRT). Of the 34 patients, 12 were treated primarily (pRT) and 22 received adjuvant treatment (aRT). Chemotherapy consisted of 2 courses of 5-fluorouracil (5-FU) and mitomycin C administered during RT. Six patients received cisplatin in place of mitomycin C. In CRT groups, radiation was administered to the vulva, pelvic, and inguinal lymph nodes to a median dose of 45 Gy with additional 6-17 Gy to gross disease. In RT groups, the median dose to the microscopic diseases was 45 Gy. Nine patients received external beam boost and 16 patients received supplementary brachytherapy in the forms of (226)Ra or (241)Am plaques to sites of macroscopic disease.

RESULTS

Overall survival was superior in the patients treated with pCRT versus pRT with statistical significance (p = 0.04). There was also a statistically significant improvement in disease-specific (p = 0.03) and relapse-free survival (p = 0.01) favoring pCRT. No statistically significant trends of improved survival rates favoring aCRT over aRT were observed.

CONCLUSION

Concurrent radiation therapy and chemotherapy decreases local relapse rate, improves disease-specific and overall survival over RT alone as primary treatment for locally advanced vulvar cancer.

Liquid chromatographic resolution of 2-hydroxycarboxylic acids on a new chiral stationary phase derived from (S)-leucine

Enantiomers of racemic 2-hydroxycarboxylic acids have been resolved as their O-ethoxycarbonyl pi-basic anilide derivatives on a new chiral stationary phase (CSP) derived from N-(3,5-dinitrobenzoyl)leucine N-phenyl N-alkylamide and the resolution results have been compared with those on various commercial pi-acidic CSPs. The resolution results demonstrate that the new CSP derived from N-(3,5-dinitrobenzoyl)leucine N-phenyl N-alkylamide is most effective among the five CSPs tested for the resolution of 2-hydroxycarboxylic acid derivatives. In order to elucidate the chiral recognition mechanism exerted by the new CSP, the resolution of slightly differently modified derivatives of 2-hydroxycarboxylic acids on the new CSP has been investigated. Based on the resolution results, a chiral recognition mechanism utilizing three simultaneous interactions such as the face to face pi-pi interaction and the two hydrogen bonding interactions between the CSP and the more retained enantiomer of the analyte has been proposed.

Effects of hypoxia on corneal epithelial permeability

PURPOSE

Epithelial permeability to fluorescein (Pdc) increases with closed-eye soft contact lens wear. Possible mechanisms responsible for this change include corneal hypoxia (and acidosis) during overnight wear and interference of the lens with normal tear exchange. In this study we used a local environmental chamber to examine the effects of hypoxia on Pdc.

METHODS

After baseline slit-lamp examination, autofluorescence, and central corneal thickness measurements, 35 subjects were fitted with a pair of airtight swimming goggles. One eye was exposed to a humidified gas mixture containing 95% nitrogen (N2) and 5% carbon dioxide (CO2), and the fellow (control) eye was exposed to air. The experimental eye and the eye measured first were assigned using a randomized block design. After the subjects wore the goggles for 1 hour, corneal thickness measurements were repeated and Pdc was assessed as previously described. A final slit-lamp examination was performed by a masked examiner to assess epithelial integrity.

RESULTS

There was no significant difference in the mean ln(Pdc) (95% confidence interval) for eyes exposed to N2/CO2 when compared with paired eyes exposed to air (-2.70 [-2.99, -2.41] vs -2.51 [-2.72, -2.30] ln[nm/sec], P = .272). Although there was also no substantial difference in the slit-lamp appearance of the experimental and control eyes, the mean (95% confidence interval) change in corneal thickness for the hypoxic eyes was 19.78 (15.72, 23.84) microm compared with 3.40 (-0.67, 7.47) microm (P < .0001) in the control eyes.

CONCLUSION

One hour of hypoxia caused a significant increase in corneal thickness with no apparent change in Pdc. This suggests that other factors, either alone or in combination with hypoxia, may be responsible for increased Pdc during closed-eye contact lens wear.

Myofascial pain syndrome and trigger-point management

BACKGROUND AND OBJECTIVES

Myofascial pain syndrome (MPS) is a common condition often resulting in referral to a pain clinic. The epidemiology, pathogenesis, and various diagnostic tools are reviewed, and a variety of treatment methods are discussed.

METHODS

Extensive periodical literature and textbooks are reviewed, and selected manuscripts are critically analyzed.

RESULTS

The incidence of MPS with associated trigger points appears to vary between 30 and 85% of people presenting to pain clinics, and the condition is more prevalent in women than in men. Patients complain of regional persistent pain, ranging in intensity and most frequently found in the head, neck, shoulders, extremities, and low back. Muscle histologic abnormalities have been described in some studies. Similarly, electromyographic, thermographic, and pressure algometric studies have inconsistently identified abnormalities. A multidisciplinary approach to treatment appears to be most beneficial and may include such modalities as trigger-point injections, dry needling, stretch and spray, and transcutaneous electrical nerve stimulation.

CONCLUSIONS

The definitive pathogenesis of MPS is currently unknown, and no single diagnostic method is consistently positive. While trigger-point injection is the most widely employed method of treatment, other modes of therapy have also proved to be effective.

Diagnosis of primary cardiac lymphoma. Report of a case with cytologic examination of pericardial fluid and imprints of transvenously biopsied intracardiac tissue

BACKGROUND

Primary cardiac lymphoma (PCL) is a treatable disease when appropriately diagnosed. Therefore, a prompt, safe method with high diagnostic accuracy is prerequisite to successful therapy for PCL.

CASE

A 57-year-old male presented with exertional dyspnea and atrial fibrillations. A pericardial effusion (PE) and several tumor masses occupying both atria were found. Cytologic examinations of PE and of imprints of the tissues obtained by transvenous biopsy of the cardiac tumors revealed numerous small, round tumor cells and lymphoglandular bodies, suggestive of malignant lymphoma. This cytologic impression was confirmed by immunocytochemical studies on the same cytologic material. Histologic studies reaffirmed the diagnosis of B-cell lymphoma. The patient received eight courses of chemotherapy, with complete remission of the illness.

CONCLUSION

Cardiac lymphoma can be quickly and safely diagnosed by cytologic examination of PE or transvenously biopsied cardiac tissue, with confirmation by immunocytochemical studies. Exploratory thoracotomy for biopsy can be avoided.

Phosphorus determination in phosphoglycerides from thin-layer chromatograms

Phosphoglyceride phosphorus is readily determined directly on silica gel removed from thin-layer chromatograms, without elution, by a nondigestive procedure with a sulfuric-periodic acid reagent. The method is specific for hydrolyzable phosphoglyceride containing two acid-hydrolyzable groups. Cariolipin reacts only partially, while sphingomyelin, diether lecithin, and phosphonate cephalin fail completely to react.