Machine learning algorithms identify hypokalaemia risk in people with hypertension in the United States National Health and Nutrition Examination Survey 1999-2018

BACKGROUND

Hypokalaemia is a side-effect of diuretics. We aimed to use machine learning to identify features predicting hypokalaemia risk in hypertensive patients.

METHODS

Participants with hypertension in the United States National Health and Nutrition Examination Survey 1999-2018 were included for analysis. To select the most suitable algorithm, we tested and evaluated five machine learning algorithms commonly employed in epidemiological studies: Logistic Regression, k-Nearest Neighbor, Random Forest, Recursive Partitioning and Regression Trees, and eXtreme Gradient Boosting. These algorithms were accessed using a set of 38 screened features. We then selected the key hypokalaemia-associated features in the hypertension group and their cardiovascular diseases (CVD) subgroup using the SHapley Additive exPlanations (SHAP) values. Using SHAP values, the key features and their impact pattern on hypokalaemia risk were determined.

RESULTS

A total of 25,326 hypertensive participants were included for analysis, of whom 4,511 had known CVD. The Random Forest algorithm had the highest AUROC (hypertension dataset: 0.73 [95%CI, 0.71-0.76]; CVD subgroup: 0.72 [95%CI, 0.66-0.78]). Moreover, the nomogram based on the top twelve key features screened by random forest retained good performance: age, sex, race, poverty income ratio, body mass index, systolic and diastolic blood pressure, non-potassium-sparing diuretics use and duration, renin-angiotensin blockers use and duration, and CVD history in hypertension dataset; while in CVD subgroup, the additional key features were comorbid diabetes, education level, smoking status, and use of bronchodilators.

CONCLUSION

Our predictive model based on the random forest algorithm performed best among the tested and evaluated five algorithms. Hypokalaemia-associated key features have been identified in hypertensive patients and the subgroup with CVD. These findings from machine learning facilitate the development of artificial intelligence to highlight hypokalaemia risk in hypertension patients.

Association between high sensitivity cardiac troponin and mortality risk in the non-diabetic population: findings from the National Health and Nutrition Examination Survey

OBJECTIVE

We investigated the association of high-sensitivity cardiac troponin (Hs-cTn) with all-cause and cardiovascular mortality in non-diabetic individuals.

METHODS

This study included 10,393 participants without known diabetes and cardiovascular disease from the US National Health and Nutrition Examination Survey (NHANES). Serum Hs-cTnI and Hs-cTnT concentrations were measured. Prediabetes was defined as fasting blood glucose between 100 and 125 mg/dL or HbA1c between 5.7 and 6.4%. Cox proportional hazard models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CIs) for mortality risk. Time-dependent receiver operating characteristics (tROC) curves were utilized to measure the predictive performance of the biomarkers. Net Reclassification Improvement (NRI) were calculated to estimate the improvement in risk classification for adding Hs-cTnT or Hs-cTnI to the standard models based on Framingham risk factors.

RESULTS

The mean age of the participants was 48.1 ± 19.1 years, with 53.3% being female and 25.8% being prediabetic. After multivariable adjustment, compared to those with Hs-cTnI concentration less than the limit of detection, the HRs (95% CIs) of the participants with Hs-cTnI concentration higher than the 99th upper reference limit were 1.74 (1.35, 2.24) for all-cause mortality and 2.10 (1.36, 3.24) for cardiovascular mortality. The corresponding HRs (95% CIs) for Hs-cTnT were 2.07 (1.53, 2.81) and 2.92 (1.47, 5.80) for all-cause and cardiovascular mortality. There was a significant interaction between prediabetes and Hs-cTnI on the mortality risk; a positive relationship was only observed in prediabetic individuals. No interaction was observed between prediabetes and Hs-cTnT on mortality risk. The Areas Under tROC indicated both Hs-cTnT and Hs-cTnI show better predictive performance in cardiovascular mortality than in all-cause mortality. NRI (95% CI) for adding Hs-cTnT to the standard model were 0.25 (0.21, 0.27) and 0.33 (0.26, 0.39) for all-cause and cardiovascular mortality. The corresponding NRI (95% CI) for Hs-cTnI were 0.04 (0, 0.06) and 0.07 (0.01, 0.13).

CONCLUSIONS

Elevated blood levels of Hs-cTnI and Hs-cTnT are associated with increased mortality. Measurement of Hs-cTnT in non-diabetic subjects, particularly those with prediabetes, may help identify individuals at an increased risk of cardiovascular disease and provide early and more intensive risk factor modification.

Using Hematuria as Detection of Post-kidney Transplantation Upper Urinary Tract Urothelial Carcinoma Is Associated With Delayed Diagnosis of Cancer Occurrence

OBJECTIVES

Kidney transplantation (KT) is an important renal replacement therapy for end-stage renal disease (ESRD). The incidence of upper urinary tract urothelial carcinoma (UTUC) is relatively higher in Taiwan. According to our institutional database, early onset of post-KT UTUC is not uncommon. Early detection of post-KT UTUC is an important issue to improve oncologic outcome. Because painless hematuria is a common symptom for UTUC, this study analyzes whether using hematuria as post-KT UTUC screening delayed cancer diagnosis or not.

METHODS

From 2005 to 2012, 128 ESRD patients were found to have UTUCs. There were 28 patients who underwent KT and were regularly followed up at our institution. All the patients underwent standard nephroureterectomy.

RESULTS

In ESRD patients with UTUC, the post-KT group revealed significantly less gross hematuria and microscopic hematuria at presentation compared with the non-KT group (43% versus 76%, P = .001 and 64% versus 86%, P = .011). For those patients with gross hematuria, non-organ-confined UTUC occurred more in the post-KT group compared with the non-KT group (42% versus 12%, P = .009). For those patients with microscopic hematuria, non-organ-confined UTUC occurred more in the post-KT group compared with the non-KT group with borderline significance (33% versus 16%, P = .085).

CONCLUSIONS

According to our observation, using gross or microscopic hematuria as detection of post-KT UTUC is associated with delayed diagnosis of cancer occurrence. Closer upper urinary tract image study such as sonography may help earlier cancer screening.

Charge Transport in Electronic-Ionic Composites

Composite electrodes consisting of cathode particles and an ion-conducting phase can address the limited ion accessibility of the cathode in high-energy all-solid-state lithium batteries. In this Letter, we discuss the microstructure-conductivity relationship in an electronic-ionic composite with a focus on lithium ion conductivity. This study is the first step toward further understanding of electrochemical reactions in all solid multiphase systems.

[Influence of leptin receptor gene K109R polymorphism on the risk of nonalcoholic fatty liver disease and its interaction with PNPLA3 I148M polymorphism]

OBJECTIVE

To investigate the influence of leptin receptor (LEPR) gene K109R polymorphism on the risk of nonalcoholic fatty liver disease (NAFLD) and its interaction with PNPLA3 I148M polymorphism in the Han Chinese population in Qingdao, China.

METHODS

Blood samples were collected from 296 NAFLD patients and 321 healthy controls, and the genotypes of these patients were determined by PCR and genotyping. Related statistical analyses were performed to compare genotypes, alleles, and clinical data between the two groups. Generalized multifactor dimensionality reduction (GMDR) was used to investigate the interaction between LEPR K109R and PNPLA3 I148M genes.

RESULTS

The distribution of LEPR K109R genotypes and alleles showed no significant differences between the NAFLD group and the control group (P > 0.05). PNPLA3 I148M gene polymorphisms were closely associated with the risk of NAFLD, and the risk of NAFLD in G mutant gene carriers was 2.07 times that in patients who did not carry this gene (OR = 2.07, 95% CI 1.423-3.013, P < 0.001). The joint action of LEPR K109R and PNPLA3 I148M significantly increased the risk of NAFL (OR = 3.393, 95% CI 1.856-6.201, P < 0.001).

CONCLUSION

In the Han Chinese population in Qingdao, LEPR K109R gene polymorphism is not associated with the risk of NAFLD, but its interaction with PNPLA3 I148M polymorphism can significantly increase the risk of NAFLD.

Disordered materials: a survey of amorphous solids

A brief historical perspective and a review of the current research on amorphous or glassy materials are presented. Glass formation by natural processes and by laboratory synthesis techniques is described. Recent efforts to characterize and model the atomic scale structure of amorphous phases are surveyed. The relation between amorphous and liquid states is emphasized in a discussion of thermodynamics and kinetics. The topic of crystal-to-glass transformation in the solid state and the related issue of crystal stability and melting are discussed.

Reliable model-based kinematics analysis system for articulated fingers

the kinematical measurement is regarded as the major indicator of the kinetic functions. In this study, we focused on developing a novel measurement method for kinematics of articulated finger in motion by using biomechanical model prediction and real-time video-based image analysis technique. In contrast to the marker-based system, the proposed 3D model provides more information, appearing on multiple projected 2D images, to estimate more reliable finger kinematics. The proposed method is compact, fast, and can be operated with X-ray fluoroscopy simultaneously. It means that the system provides the capability of synchronous validation between motion video and X-ray fluoroscopy. The proposed system was implemented on a personal computer and can be a new tool in diagnosis and rehabilitation for hand diseases.

WITHDRAWN: A radio frequency biosensor with gold nanoparticle probes

This article has been withdrawn at the request of the author(s) and/or editor. The Publisher apologizes for any inconvenience this may cause. The full Elsevier Policy on Article Withdrawal can be found at http://www.elsevier.com/locate/withdrawalpolicy.

Emergency department management of mild traumatic brain injury in the USA

OBJECTIVE

To describe the emergency department (ED) management of isolated mild traumatic brain injury (TBI) in the USA and to examine variation in care across age and insurance types.

METHODS

A secondary analysis of ED visits for isolated mild TBI in the National Hospital Ambulatory Medical Care Survey 1998-2000 was performed. Mild TBI was defined by International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9) codes for skull fracture, concussion, intracranial injury (unspecified), and head injury (unspecified). Available ED care variables were analysed by patient age and insurance categories using multivariate logistic regression.

RESULTS

The incidence of isolated mild TBI cases attending ED was 153,296 per year, or 56.4/100,000 people. Of the patients with isolated mild TBI, 44.3% underwent computed tomography, 23.9% underwent other non-extremity, non-chest x rays, 17.1% received wound care and 14.1% received intravenous fluids. However, only 43.8% had an assessment of pain. Of those with documented pain, only 45.5% received analgesics in the ED. Nearly 38% were discharged without recommendations for specific follow up. Several aspects of ED care varied by age but not by insurance type.

CONCLUSION

Substantial ED resources are devoted to the care of isolated mild TBI. The present study identified deficiencies in and variation around several important aspects of ED care. The development of guidelines specific for mild TBI could reduce variation and improve emergency care for this injury.

Emphysematous pyelonephritis in a renal allograft: successful treatment with percutaneous drainage and nephrostomy

Emphysematous pyelonephritis in renal transplant allograft occurs rarely. This is a case report on a 55-year-old man who had renal transplantation in 1983 and developed post-transplant diabetes mellitus in 1984. This patient suffered from fever and right low abdominal pain and was subsequently diagnosed as emphysematous pyelonephritis by computerized tomography. He was successfully treated with percutaneous drainage, percutaneous nephrostomy and parenteral antibiotics. Although the management of emphysematous pyelonephritis has been a subject of controversy, we recommend consideration of renal preservation in patients with few risk factors, especially in those patients presenting with chronic renal insufficiency, solitary kidney and transplant allograft.

Central nervous system infection due to Clostridium septicum: a case report and review of the literature

A patient with end stage breast cancer was admitted to hospital due to fever, chills, multiply eroded discharging wounds, and sudden onset of left hemiparesis. Clostridium septicum bacteremia and brain abscess were diagnosed. The patient was treated successfully with intravenous penicillin and clindamycin and stereotactic aspiration of the abscess. Eleven cases of C. septicum central nervous system infection are reviewed. They showed an extremely fulminant course and high fatality. Nevertheless, some relationship seems to exist between outcome and type of brain lesion. Hemolytic-uremic syndrome associated with central nervous system infection is also discussed, because all these cases in the literature were due to this organism. Early diagnosis and aggressive treatment, including surgical drainage and appropriate antibiotics, are the key to improving the prognosis. A long-term prophylactic oral antimicrobial agent is suggested for patients who survive this infection.

Overexpression of MDM-2 mRNA and mutation of the p53 tumor suppressor gene in bladder carcinoma cell lines

To investigate the importance of oncogenes and tumor suppressor genes in bladder carcinogenesis, we determined the status of the expression of the MDM-2 and p53 genes and genetic alterations in the p53 gene in five bladder carcinoma cell lines and one kidney urothelial carcinoma cell line. Overexpression of MDM-2 mRNA was observed in three bladder carcinoma cell lines, J82, SCaBER, and BFTC-905. Amplification of the MDM-2 gene was not detected in any of the six cell lines by southern analysis. The deletion in the p53 gene was observed in J82, and point mutation was detected in J82 and BFTC-909, the kidney urothelial carcinoma cell line. In contrast, no mutations were found in codons 12, 13, and 61 in the Ha-ras and Ki-ras genes in these six cell lines. These results indicate that alterations in the p53-regulated pathway are important in bladder carcinogenesis.

Drug-use profiles, race, age, and risk of HIV infection among intravenous drug users in San Francisco

We examined the relationship of HIV serostatus to drug use profile, high risk behavior, drug treatment status, and demographic characteristics of 505 intravenous drug users (IVDUs) in San Francisco. We found five identifiable drug-injection profiles described as Omnijector, Primarily Heroin, Primarily Heroin/Cocaine, Primarily Cocaine, and Primarily Speed which fell into "higher risk" and "lower risk" categories in relation to HIV seroprevalence of members (17.0 and 9.8%), respectively. This difference was not significant when effects of race were held constant (adjusted OR = 1.66, 95% CI = 0.91, 3.01). In logistic regression analysis, only Black race and age under 30 were significant predictors of HIV seropositivity (OR = 2.95, 95% CI = 1.57, 5.52 and OR = 2.05, 95% CI = 1.01, 4.13, respectively). Neither membership in higher risk profile nor frequency of injection (including daily or greater injection of cocaine) contributed to the model. We conclude that Black IVDUs under 30 are at greatest risk of HIV infection, that multiple patterns of drug use injection and habituation require additional resources to treat, and that the heterogeneous distribution of HIV weakens the predictive power of known behavioral risk factors in this population.

Diet and cancer of the stomach: a case-control study in China

A case-control study focusing on the role of single food items was undertaken in the Heilongjiang area, 241 patients with histologically verified stomach cancer and an equal number of controls (with non-neoplastic diseases) matched by age, sex and area of residence being interviewed during a 2-year period. Questions asked covered economic status, occupation, histories of smoking and drinking, diet and dietary habits and disease history. Data concerning the average frequency and quantity of consumption of single food items were obtained by the same interviewer. An inverse association between the consumption of vegetables and stomach cancer was observed whereas high intake of potatoes and of salted and fermented soya paste appeared to be high-risk factors. Specifically, Chinese cabbage plays an important role in reducing the risk of developing stomach cancer.