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Incidence of and risk factors for myelodysplastic syndrome in patients with rheumatologic diseases
No full textObjective
We investigated the incidence of and risk factors for myelodysplastic syndrome (MDS) in patients with rheumatologic disease.
Methods
We conducted a retrospective cohort study of patients who were diagnosed with rheumatologic diseases at a tertiary care hospital between May 2009 and July 2022 and identified the patients who were subsequently diagnosed with MDS. Each patient with MDS was matched with five age- and sex-matched controls chosen from the cohort of patients with each specific rheumatologic disease.
Results
During a total follow-up of 55 841 person-years (PY), MDS occurred in 64 patients, yielding an incidence rate of 1.15/1000 PY {median age 57.0 years [interquartile range (IQR) 41.0-69.0], median duration to MDS diagnosis 6.5 years (IQR 3.0-9.0)]. In an age-matched analysis, SLE was a significant risk factor for MDS [adjusted hazard ratio 2.61 (CI 1.19, 36.06), P = 0.01]. Refractory cytopenia with multilineage dysplasia was the most common phenotype of MDS (35.9%), and more than half of the patients had karyotypes with a favourable prognosis (54.7%). Compared with matched controls, RA, SLE and AS patients with MDS had lower levels of haemoglobin at the time of diagnosis of rheumatologic disease. Furthermore, the MDS patients with SLE and Behçet’s disease had higher levels of glucocorticoid use in terms of frequency of use and mean dose than control patients.
Conclusion
SLE is a significant risk factor for MDS among patients with rheumatologic diseases. A lower haemoglobin level at the time of diagnosis of rheumatologic disease was associated with the future development of MDS
Survey on Value Elements Provided by Artificial Intelligence and Their Eligibility for Insurance Coverage With an Emphasis on Patient-Centered Outcomes
No full textObjective: This study aims to explore the opinions on the insurance coverage of artificial intelligence (AI), as categorized based on the distinct value elements offered by AI, with a specific focus on patient-centered outcomes (PCOs). PCOs are distinguished from traditional clinical outcomes and focus on patient-reported experiences and values such as quality of life, functionality, well-being, physical or emotional status, and convenience.
Materials and methods: We classified the value elements provided by AI into four dimensions: clinical outcomes, economic aspects, organizational aspects, and non-clinical PCOs. The survey comprised three sections: 1) experiences with PCOs in evaluating AI, 2) opinions on the coverage of AI by the National Health Insurance of the Republic of Korea when AI demonstrated benefits across the four value elements, and 3) respondent characteristics. The opinions regarding AI insurance coverage were assessed dichotomously and semi-quantitatively: non-approval (0) vs. approval (on a 1-10 weight scale, with 10 indicating the strongest approval). The survey was conducted from July 4 to 26, 2023, using a web-based method. Responses to PCOs and other value elements were compared.
Results: Among 200 respondents, 44 (22%) were patients/patient representatives, 64 (32%) were industry/developers, 60 (30%) were medical practitioners/doctors, and 32 (16%) were government health personnel. The level of experience with PCOs regarding AI was low, with only 7% (14/200) having direct experience and 10% (20/200) having any experience (either direct or indirect). The approval rate for insurance coverage for PCOs was 74% (148/200), significantly lower than the corresponding rates for other value elements (82.5%-93.5%; P ≤ 0.034). The approval strength was significantly lower for PCOs, with a mean weight ± standard deviation of 5.1 ± 3.5, compared to other value elements (P ≤ 0.036).
Conclusion: There is currently limited demand for insurance coverage for AI that demonstrates benefits in terms of non-clinical PCOs
Early detection of low QRS voltage and its association with mortality in patients with sepsis
No full textVarious electrocardiographic changes occur during sepsis, but data on the clinical importance of a low QRS voltage in sepsis are still limited. We aimed to evaluate the association between low QRS voltage identified early in sepsis and mortality in patients with sepsis. Between September 2019 and December 2020, all consecutive adult patients diagnosed with sepsis in the emergency room or general ward at Samsung Medical Center were enrolled. Patients without a 12-lead electrocardiogram recorded within 48 h of recognition of sepsis were excluded. In 432 eligible patients, 12-lead electrocardiogram was recorded within the median of 24 min from the first recognition of sepsis, and low QRS voltage was identified in 115 (26.6%) patients. The low QRS group showed more severe organ dysfunction and had higher levels of N-terminal pro-brain natriuretic peptide. The hospital mortality was significantly higher in the low QRS voltage group than in the normal QRS voltage group (49.6% vs. 28.1%, p < 0.001). Similarly, among the 160 patients who required intensive care unit admission, significantly more patients in the low QRS group died in the intensive care unit (35.9% vs. 18.2%, p = 0.021). Low QRS voltage was associated with increased hospital mortality in patients with sepsis
ACO-based Scheme in Edge Learning NOMA Networks for Task-Oriented Communications
No full textConventional communications systems centered on data prioritize maximizing network throughput using Shannon’s theory, which is primarily concerned with securely transmitting the data despite limited radio resources. However, in the realm of edge learning, these methods frequently fall short because they depend on traditional source coding and channel coding principles, ultimately failing to improve learning performance. Consequently, it is crucial to transition from a data-centric viewpoint to a task-oriented communications approach in wireless system design. Therefore, in this paper, we propose efficient communications under a task-oriented principle by optimizing power allocation and edge learning-error prediction in an edge-aided non-orthogonal multiple access (NOMA) network. Furthermore, we propose a novel approach based on the ant colony optimization (ACO) algorithm to jointly minimize the learning error and optimize the power allocation variables. Moreover, we investigate four additional benchmark schemes (particle swarm optimization, quantum particle swarm optimization, cuckoo search, and butterfly optimization algorithms). Satisfactorily, simulation results validate the superiority of the ACO algorithm over the baseline schemes, achieving the best performance with less computation time. In addition, the integration of NOMA in the proposed task-oriented edge learning system obtains higher sum rate values than those achieved by conventional schemes
Distinctive CD39+CD9+ lung interstitial macrophages suppress IL-23/Th17-mediated neutrophilic asthma by inhibiting NETosis
No full textThe IL-23-Th17 axis is responsible for neutrophilic inflammation in various inflammatory diseases. Here, we discover a potential pathway to inhibit neutrophilic asthma. In our neutrophil-dominant asthma (NDA) model, single-cell RNA-seq analysis identifies a subpopulation of CD39+CD9+ interstitial macrophages (IMs) suppressed by IL-23 in NDA conditions but increased by an IL-23 inhibitor αIL-23p19. Adoptively transferred CD39+CD9+ IMs suppress neutrophil extracellular trap formation (NETosis), a representative phenotype of NDA, and also Th17 cell activation and neutrophilic inflammation. CD39+CD9+ IMs first attach to neutrophils in a CD9-dependent manner, and then remove ATP near neutrophils that contribute to NETosis in a CD39-dependent manner. Transcriptomic data from asthmatic patients finally show decreased CD39+CD9+ IMs in severe asthma than mild/moderate asthma. Our results suggest that CD39+CD9+ IMs function as a potent negative regulator of neutrophilic inflammation by suppressing NETosis in the IL-23-Th17 axis and can thus serve as a potential therapeutic target for IL-23-Th17-mediated neutrophilic asthma
Efficacy and Safety of Pioglitazone Add-on in Patients with Type 2 Diabetes Mellitus Inadequately Controlled with Metformin and Dapagliflozin: A Multicenter, Randomized, Double-blind, and Placebo-controlled Study
No full textPurpose
The purpose of this study was to determine the efficacy and safety profile of pioglitazone compared with placebo (PBO) in patients with type 2 diabetes (T2D) inadequately controlled with metformin and dapagliflozin.
Methods
In this prospective, multicenter, randomized, double-blind, PBO-controlled trial, 366 patients with T2D who did not meet glycemic targets (7.0% ≤ glycosylated hemoglobin [HbA1c] ≤ 10.5%), despite treatment with metformin ≥1000 mg and dapagliflozin 10 mg, received either a PBO, 15 mg of pioglitazone daily (PIO15), or 30 mg of pioglitazone daily (PIO30). The primary end point was the mean change in HbA1c from baseline at 24 weeks across the groups.
Findings
For the 366 participants (PBO, n = 124; PIO15, n = 118; PIO30, n = 124), the mean age was 55.6 years and mean duration of diabetes was 8.7 years, with a baseline HbA1c of 7.9%. After 24 weeks, HbA1c reduced significantly in the PIO15 and PIO30 groups from baseline, with intergroup differences of -0.38% and -0.83%, respectively, compared with the PBO group. The proportion of patients with HbA1c levels <7% was significantly higher in the PIO15 and PIO30 groups than in the PBO group. The adverse event rates did not significantly differ across the groups, indicating favorable safety profiles for triple combination therapy using metformin, dapagliflozin, and pioglitazone.
Implications
The addition of pioglitazone as a third oral antidiabetic medication is an appropriate option for patients with T2D inadequately controlled with metformin and dapagliflozin based on the resulting significant efficacy in glycemic control and favorable safety profile. ClinicalTrials.gov identifier: NCT04885712
Clinical Activity of TGF-β Inhibitor Vactosertib in Combination with Imatinib in Desmoid Tumors: A Multicenter Phase Ib/II Study
No full textPurpose: The study was to determine the activity and safety of the TGF-β inhibitor vactosertib in combination with imatinib in patients with desmoid tumors.
Patients and methods: In this investigator-initiated, open-label, multicenter, phase Ib/II trial, patients with desmoid tumors not amenable to locoregional therapies (surgery and/or radiotherapy) or with disease progression following at least one treatment were enrolled. Participants were administered 400 mg imatinib daily in combination with vactosertib (5 days on and 2 days off, twice a day) every 28 days. In phase Ib, the vactosertib dose was set at 100 mg (level -1) and 200 mg (level 1) to determine the recommended phase II dose (RP2D). Phase II assessed the efficacy, with the primary endpoint being progression-free rate (PFR) at 16 weeks.
Results: No dose-limiting toxicities were observed during phase Ib; therefore RP2D was defined at doses of 400 mg imatinib daily in combination with 200 mg vactosertib. Of the 27 patients evaluated, 7 (25.9%) achieved a confirmed partial response and 19 (70.4%) were stable. The PFR at 16 weeks and 1 year were 96.3% and 81.0%, respectively. Most toxicities were mild to moderate myalgia (n = 10, 37%), anemia (n = 10, 37%), and nausea (n = 9, 33.3%). Common grade 3 to 4 toxicities included neutropenia (n = 6, 22.2%) and anemia (n = 5, 18.5%).
Conclusions: The vactosertib and imatinib combination was well tolerated, with promising clinical activity in patients with progressive, locally advanced desmoid tumors. This is the first study investigating a novel target agent, a TGF-β inhibitor, in this rare and difficult-to-treat desmoid tumor
Factors Influencing Attitudes toward Brain Death Organ Donation of Medical Staff in Operating Room
No full text본 연구는 수술실 의료진을 대상으로 죽음에 대한 인식, 일 가치감, 뇌사자 장기기증에 대한 태도를 확인하고, 뇌사자 장기기증에 대한 태도에 영향을 미치 는 요인을 알아보기 위한 서술적 조사 연구이다.
연구 대상자는 서울 소재 A병원 수술실에서 장기이식 수술에 1회 이상 참여한 경험이 있는 수술실 간호사, 마취과 간호사, 수술전담 간호사, 의사를 대상으로 설문 조사를 실시하였고, 수집된 자료는 SPSS 26.0 프로그램을 활용하여 기술통 계, 독립 t-test, 일원배치 분산분석, 피어슨 상관분석, 다중회귀분석을 실시하 였다.
본 연구의 결과는 다음과 같다.
1. 대상자는 총 157명이었으며 평균 연령은 36.8세였으며 총 임상경력은 15년 이상이 41.4%로 가장 많았고 직종은 간호사 75.8%, 의사가 24.2%이었다. 뇌사자 장기이식 수술에 참여한 횟수는 15회 이상이 37.6%로 가장 많았고, 장기기증에 관한 교육은 56.1%가 교육 경험이 없었다. 가족 또는 지인의 죽음 경험은 86.6%, 본인의 장기기증에 63.1%는 희망 의사가 없었고, 가족의 장기기증에 81.5%는 희 망 의사가 없었다.
2. 대상자의 뇌사자 장기기증에 대한 태도는 100점 만점에 68.21±8.01였으며 죽음에 대한 인식은 180점 만점에 111.41±12.32였고, 일 가치감은 70점 만점에 49.29±6.57으로 나타났다.
3. 뇌사자 장기기증에 대한 태도는 종교(t=-2.035, p =.044), 학력(t=2.240, p =.027), 직종(t=2.072, p =.040), 본인의 장기기증 희망(t=2.354, p <.001), 가 족의 장기기증 희망(t=8.943, p <.001)에 따라 유의한 차이가 있었다. 죽음에 대한 인식은 성별(t=-2.550, p =.012), 결혼(t=-2.665, p =.009), 장기 기증에 관한 교육 경험(t=1.973, p =.050), 본인의 장기기증 희망(t=2.905, p =.004), 가족의 장기기증 희망(t=2.944, p =.004)에 따라 유의한 차이가 있었다. 일 가치감은 성별(t=-3.108, p =.002), 연령(F=3.294, p =.022), 결혼(t=-3.255, p =.001), 종교(t=2.559, p =.011), 학력(t=-2.762, p =.006), 직종(t=-3.361, p =.001)에 따라 유의한 차이가 있었다.
4. 대상자의 뇌사자 장기기증에 대한 태도는 죽음에 대한 인식(r = .30, p <.001) 과 일 가치감(r = .22, p = .007)에 통계적으로 유의한 양적 상관관계가 있는 것 으로 나타났다.
5. 대상자의 뇌사자 장기기증에 대한 태도에 영향을 미치는 요인은 본인의 장기 기증 희망(β=.48, p <.001), 가족의 장기기증 희망(β=.25, p =.001), 죽음에 대한 인식(β=.13, p =.021)이 였으며, 설명력은 50.4%로 나타났다.
본 연구에서 수술실 의료진의 뇌사자 장기기증에 대한 태도는 매우 긍정적인 편은 아니며 죽음에 대한 인식과 장기기증 희망이 뇌사자 장기기증에 대한 태도 에 영향을 미치는 중요한 요인으로 나타났다. 수술실 의료진의 뇌사자 장기기증 에 대한 긍정적 태도 향상을 위해 죽음에 대한 인식을 높이고 뇌사자 장기기증 에 대한 정보 획득과 교육을 고려한 맞춤형 접근이 필요하다.
주요어: 뇌사자, 장기기증, 태도, 수술실 의료진Maste
Statistical Methods for Comparing Predictive Values in Medical Diagnosis
No full textEvaluating the performance of a binary diagnostic test, including artificial intelligence classification algorithms, involves measuring sensitivity, specificity, positive predictive value, and negative predictive value. Particularly when comparing the performance of two diagnostic tests applied on the same set of patients, these metrics are crucial for identifying the more accurate test. However, comparing predictive values presents statistical challenges because their denominators depend on the test outcomes, unlike the comparison of sensitivities and specificities. This paper reviews existing methods for comparing predictive values and proposes using the permutation test. The permutation test is an intuitive, non-parametric method suitable for datasets with small sample sizes. We demonstrate each method using a dataset from MRI and combined modality of mammography and ultrasound in diagnosing breast cancer
Classification feasibility test on multi-lead electrocardiography signals generated from single-lead electrocardiography signals
No full textNowadays, Electrocardiogram (ECG) signals can be measured using wearable devices, such as smart watches. Most wearable devices provide only a few details; however, they have the advantage of recording data in real time. In this study, 12-lead ECG signals were generated from lead I and their feasibility was tested to obtain more details. The 12-lead ECG signals were generated using a U-net-based generative adversarial network (GAN) that was trained on ECG data obtained from the Asan Medical Center. Subsequently, unseen PTB-XL PhysioNet data were used to produce real 12-lead ECG signals for classification. The generated and real 12-lead ECG signals were then compared using a ResNet classification model; and the normal, atrial fibrillation (A-fib), left bundle branch block (LBBB), right bundle branch block (RBBB), left ventricular hypertrophy (LVH), and right ventricular hypertrophy (RVH) were classified. The mean precision, recall, and f1-score for the real 12-lead ECG signals are 0.70, 0.72, and 0.70, and that for the generated 12-lead ECG signals are 0.82, 0.80, and 0.81, respectively. In our study, according to the result generated 12-lead ECG signals performed better than real 12-lead ECG