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AESurv: autoencoder survival analysis for accurate early prediction of coronary heart disease.
No full textCoronary heart disease (CHD) is one of the leading causes of mortality and morbidity in the United States. Accurate time-to-event CHD prediction models with high-dimensional DNA methylation and clinical features may assist with early prediction and intervention strategies. We developed a state-of-the-art deep learning autoencoder survival analysis model (AESurv) to effectively analyze high-dimensional blood DNA methylation features and traditional clinical risk factors by learning low-dimensional representation of participants for time-to-event CHD prediction. We demonstrated the utility of our model in two cohort studies: the Strong Heart Study cohort (SHS), a prospective cohort studying cardiovascular disease and its risk factors among American Indians adults; the Women\u27s Health Initiative (WHI), a prospective cohort study including randomized clinical trials and observational study to improve postmenopausal women\u27s health with one of the main focuses on cardiovascular disease. Our AESurv model effectively learned participant representations in low-dimensional latent space and achieved better model performance (concordance index-C index of 0.864 ± 0.009 and time-to-event mean area under the receiver operating characteristic curve-AUROC of 0.905 ± 0.009) than other survival analysis models (Cox proportional hazard, Cox proportional hazard deep neural network survival analysis, random survival forest, and gradient boosting survival analysis models) in the SHS. We further validated the AESurv model in WHI and also achieved the best model performance. The AESurv model can be used for accurate CHD prediction and assist health care professionals and patients to perform early intervention strategies. We suggest using AESurv model for future time-to-event CHD prediction based on DNA methylation features
Elevated myocardial extracellular volume fraction as a new predictor of conduction defects after transcatheter aortic valve replacement.
No full textUse of a bioactive matrix glove in the treatment of paediatric hand burns: a case series.
No full textOBJECTIVE: Burns to the hand are a common injury in paediatrics and can be traumatic to children, both physically and psychologically. Timely conservative or operative management is critical to maximise healing and minimise long-term complications in these young patients. Here, we present the cases of patients treated with a novel skin substitute formed into a prefabricated glove. The glove (PermeaDerm, Inc., US) is a bioactive matrix composed of a silicone composite membrane embedded with collagen and aloe extract with variable porosity that allows moisture to pass to a secondary dressing. To our knowledge, our group was the first to treat a small set of paediatric patients with hand burns with the glove.
METHOD: A chart review was conducted to analyse hospital course, treatment length, complications and outcomes for each patient.
RESULTS: The age range of the five patients included in this case series was seven months to three years. All five patients had scald burns to the hand. Overall, healing with the glove was successful, with little scarring or altered skin pigmentation, and a full range of motion at the affected joints.
CONCLUSION: Hand burns in paediatric patients are traumatic and cumbersome to the patient and their families. This bioactive matrix glove allows for a one-time application, decreases operating room time and need, and reduces the demand for multiple dressing changes. In our set of five patients, the glove showed promising results as a safe and effective noninvasive treatment option for hand burns in paediatric patients
False Positive Babesia microti Result in New-Onset Systemic Lupus Erythematosus Manifesting With Febrile Illness.
No full textFalse positive serologic results are common in systemic lupus erythematosus (SLE) due to the presence of autoantibodies. We present a case of a young patient initially suspected of having a tick-borne disease with a false positive Babesia microti antibody result, and later diagnosed with SLE. Acute babesiosis was excluded after additional laboratory tests such as Babesia polymerase chain reaction (PCR) and blood smear for parasites. The patient\u27s symptoms were then thought to be a new manifestation of SLE and prompted the initiation of systemic steroids with subsequent improvement. False positive serologic Babesia microti test result was attributed to SLE autoantibodies
Survival Following Quadruplet and Triple Therapy in Transplant in-Eligible Multiple Myeloma - a Meta-Analysis of Recent Clinical Trials
No full textINTRODUCTION In the management of transplant-ineligible multiple myeloma (TIMM), therapeutic strategies are crucial for improving patient outcomes. Recent clinical trials have explored the efficacy of Quadruplet therapy and Triplet therapy in this context. Quadruplet therapy, involving an additional drug, has been proposed to offer enhanced benefits in overall survival and progression-free survival. AIM This meta-analysis aimed to evaluate the comparative effectiveness (overall survival [OS] and progression-free survival [PFS]) of Quadruplet vs Triplet therapy in TIMM regimens to inform clinical decision-making and optimize patient care. METHODS Type of Study: Meta-analysis of Phase 3 clinical trials Endpoint: Evaluate OS and PFS in Quadruplet vs Triplet therapy Search strategy: PRISMA protocol using keywords ((“multiple myeloma”[Title/Abstract] AND (“quadruple therapy”[Title/Abstract] OR “triple therapy”[Title/Abstract] OR (“bortezomib-lenalidomide-dexamethasone”[All Fields] AND “VRd”[Title/Abstract]) OR (“lenalidomide-dexamethasone”[All Fields] AND “Rd”[Title/Abstract]) OR (“bortezomib-melphalan-prednisone”[All Fields] AND “VMP”[Title/Abstract]) OR (“CD38-targeted”[All Fields] AND “antibody”[Title/Abstract]))) NOT “Transplant-eligible”[All Fields]) AND ((y_10[Filter]) AND (clinicaltrial[Filter] OR clinicaltrialphasei[Filter] OR clinicaltrialphaseii[Filter] OR clinicaltrialphaseiii[Filter] OR clinicaltrialphaseiv[Filter] OR multicenterstudy[Filter] OR observationalstudy[Filter] OR randomizedcontrolledtrial[Filter]) AND (fft[Filter]) AND (humans[Filter]) AND (english[Filter])) to identify clinical trials from last 10 years. • Inclusion criteria: Only Clinical trials recruited TIMM patients in the last 10 years • Exclusion criteria: Studies other than clinical trials, non-human, non-English, and non-full text studies were excluded. Study selection & Data extraction: Using eligibility criteria and keywords, we screened the abstracts and evaluated them for their inclusion in our meta-analysis. From screen abstracts, full-length articles were obtained and studied individually for their eligibility in quantitative analysis (meta-analysis). Data on study name, design, country, duration, sample size, population characteristics [country, mean/median age, sex], type of intervention, and outcomes (OS and PFS) were collected. Statistical analysis: Review Manager 5.3 software was used to analyze the data. We performed random effects models to estimate the pooled effect size (pooled odds ratio) and 95% confidence interval (95% CI). Forest plots were obtained. p\u3c 0.05 was considered statistically significant. Heterogeneity (I2 values) was identified and I2\u3e75% represented high heterogeneity. Risk of bias analysis was performed using the Newcastle-Ottawa Scale. RESULTS Out of 51 studies, fulfilling the criteria, nine studies had data on the management of TIMM, of which five studies had data on outcomes of Quadruplet vs Triplet therapy. ALCYONE, IMROZ, and OCTANS were the main multicenter, randomized, and open-label clinical trials covering 160+ sites in 25+ countries. We found 607 patients (of 1196) on Quadruplet and 368 patients (of 1142) on Triplet therapy. Quadruplet therapy had 88% higher odds of OS [OR: 1.88, 95%CI: 1.51-2.35, p\u3c 0.00001, I2: 0%] and 178% higher odds of PFS [2.78, 0.83-9.33, p=0.1, I2: 92%] in compared to Triplet therapy. [Pooled OR for survival: 2.30, 1.36-3.87, p=0.002, I2: 0%]. Quadruplet therapy had higher odds of MRD negative [4.04, 2.32-7.03, p\u3c 0.00001, I2: 52%] and RR [2.25, 1.66-3.05, p\u3c 0.00001, I2: 0%] in compared to Triplet therapy. NOS suggested a moderate risk of bias. CONCLUSION In conclusion, our meta-analysis demonstrates that Quadruplet therapy significantly outperforms Triplet therapy in transplant-ineligible multiple myeloma patients, with notable improvements in overall survival and progression-free survival. The Quadruplet regimen also enhances the likelihood of achieving minimal residual disease negativity and a higher response rate. These findings underscore the potential benefits of integrating an additional drug into treatment regimens for better clinical outcomes
Menopausal hormone therapy and coronary heart disease: the roller-coaster history.
No full textIn the USA it is estimated that more than one million women become menopausal each year. Coronary heart disease (CHD) is the leading cause of mortality in menopausal woman globally. The majority of perimenopausal to postmenopausal women experience bothersome symptoms including hot flashes, night sweats, mood liability, sleep disturbances, irregular bleeding and sexual dysfunction. While menopausal hormone therapy (HT) effectively treats most of these symptoms, use of HT has become confusing, especially related to CHD risk. Despite years of observational and retrospective studies supporting a CHD benefit and improved survival among HT users, the Heart and Estrogen/Progestin Replacement Study (HERS) and the Women\u27s Health Initiative (WHI) raised doubts about this long-held premise. The timing hypothesis has since emerged and states that when HT is initiated in younger women, soon after menopause onset, there may be cardiovascular benefit. The following review discusses the roller-coaster history of HT use as it pertains to CHD in postmenopausal women. Studies that highlight HT\u27s CHD benefit are reviewed and provide reassurance that HT utilized in appropriately selected younger postmenopausal women close to the onset of menopause is safe from a cardiovascular perspective, in line with consensus recommendations
Evaluation and Management of Biliary Dyskinesia in Children and Adolescents: A Systematic Review From the APSA Outcomes and Evidence-Based Committee.
No full textINTRODUCTION: The diagnosis and management of biliary dyskinesia in children and adolescents remains variable and controversial. The American Pediatric Surgical Association Outcomes and Evidence-Based Practice Committee (APSA OEBP) performed a systematic review of the literature to develop evidence-based recommendations.
METHODS: Through an iterative process, the membership of the APSA OEBP developed five a priori questions focused on diagnostic criteria, indications for cholecystectomy, short and long-term outcomes, predictors of success/benefit, and outcomes of medical management. A systematic review was conducted, and articles were selected for review following Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) guidelines. Risk of bias was assessed using Methodologic Index for Non-Randomized Studies (MINORS) criteria. The Oxford Levels of Evidence and Grades of Recommendation were utilized.
RESULTS: The diagnostic criteria for biliary dyskinesia in children and adolescents are not clearly defined. Cholecystectomy may provide long-term partial or complete relief in some patients; however, there are no reliable predictors of symptom relief. Some patients may experience resolution of symptoms with non-operative management.
CONCLUSIONS: Pediatric biliary dyskinesia remains an ill-defined clinical entity. Pediatric-specific guidelines are necessary to better characterize the condition, guide work-up, and provide management recommendations. Prospective studies are necessary to more reliably identify patients who may benefit from cholecystectomy.
LEVEL OF EVIDENCE: Level 3-4.
TYPE OF STUDY: Systematic Review of Level 3-4 Studies