Effectiveness Of Various Treatment Options Research Articles

Unveiling the Link Between Breast Cancer Treatment and Osteoporosis: Implications for Anticancer Therapy and Bone Health

Background: The interplay between breast cancer treatment and osteoporosis has important consequences for anticancer therapy and patient bone health. Many breast cancer therapies involve hormonal treatments that lower estrogen levels, which can lead to an increased risk of osteoporosis due to reduced bone mineral density. Aromatase inhibitors, chemotherapy, and surgeries such as oophorectomy can further aggravate bone loss, highlighting the necessity of prioritizing bone health during cancer treatment.Objective: This review is aimed at investigating the complex relationship between breast cancer therapies and bone health by examining the molecular and cellular mechanisms through which anticancer treatments lead to bone loss. It also seeks to assess the effects of various treatment options, such as selective estrogen receptor modulators (SERMs) and bisphosphonates, on reducing bone loss and maintaining bone health during cancer therapy.Method: The review explores the mechanisms underlying bone loss in breast cancer patients undergoing treatment, focusing on factors such as estrogen depletion, inflammatory cytokines, and changes in bone remodelling processes. Additionally, it evaluates the efficacy of different therapeutic interventions, including pharmacological treatments like bisphosphonates and third‐generation SERMs, in mitigating bone‐related side effects.Results: The findings indicate a critical need to balance the effectiveness of breast cancer treatments with the preservation of bone health. Pharmacological treatments like bisphosphonates and denosumab have been identified as essential for managing bone health in breast cancer patients. Furthermore, third‐generation SERMs show potential in reducing bone loss associated with cancer therapy.

Feed intake and growth performance of crossbred dairy calves fed on a basal diet of wheat straw treated with urea-molasses, urea-lime, and effective microorganisms

ABSTRACT The effects of various treatment options on the nutritional value of wheat straw as well as the growth performance of crossbred calves fed the treated wheat straw were evaluated. Twenty-four female calves (75% Friesian-Borana), weighing 99.3 ± 19.7 kg (aged 6–9 months), were divided into four groups of six animals using a randomized complete block design. The feeding trial lasted approximately 104 days. The dietary treatments were: untreated wheat straw (control T1), wheat straw treated with urea-molasses (T2), urea-lime (T3), and effective microorganisms (T4). Results showed that the treatment options affected the physical silage quality and chemical composition of wheat straw. Calves in the T3 and T4 groups had a higher daily DM intake (3.7 and 3.5 kg/head, respectively) than those in T2 (3.1 kg/head) and T1 (3.02 kg/head) groups. Calves in the T3 (422.7 g/d) and T4 (391 g/d) groups gained greater weight than those in the T2 (281.7 g/d) and T1 (204.4 g/d) groups (P < 0.001). Thus, improving the feed value of wheat straw with urea-lime or effective microorganisms treatment options suggested in this trial could result in cost-effective and significant growth performances when crossbred calves were supplemented with concentrate at a rate of 1.2% of their live weights.

Psychological Assessment and Treatment Effectiveness in Mastalgia: Developing a Treatment Algorithm.

Background Mastalgia often impairs the physical, social, and sexual lives of women. It may manifest in both cyclical or acyclical patterns. The psychoneurotic association of mastalgia has been claimed for a long time in various available literature. Several treatment options have been used and are available in the market for mastalgia, but no specific guidelines are currently in place at the global or local levels. This study aims to evaluate the psychological status and effectiveness of various treatment options in women presenting with mastalgia. Methods This study was conducted in the General Surgery outpatient department from February 1 to November 30, 2021,at King George's Medical University, Lucknow, India. Females of all age groups presenting to the General Surgery outpatient department with unilateral/bilateral breast pain and/or chest wall pain were considered for this study. Pregnant patients, those with a history of allergy to drugs, or those who were lost to follow-upwere excluded from the study. The psychological status of patients was assessed using the Depression Anxiety and Stress Scale(DASS-42) scale. Pain assessment was performed using a visual analog scale (VAS). Patients were divided into five categories: (i) isolated chest wall pain, (ii) isolated breast pain, (iii) both chest wall and breast pain, (iv) pain with an associated lump(s), and (v) pain and tenderness isolated over the lump, and two groups: Group-A: VAS≤4, and Group-B: VAS>4. Group B patients in Category iv were randomized into two groups: topical non-steroidal anti-inflammatory drugs (NSAIDs) or evening primrose oil+vitamin E. The next line of treatment was tamoxifen 10mg followed by danazol 100mg followed by ormeloxifene 30mg. Results The mean age of 106 participants enrolled was 31.59±10.52 years. The mean scores,using the DASS-42 scale, for depression, anxiety, and stress were 7.31±8.53, 7.08±6.57, and 11.15±8.07, respectively. The depression, anxiety, and stress scores had no significant correlation with pain scores (p =0.84, 0.99, and 0.97 for depression, anxiety, and stress, respectively), or duration (p=0.69, 0.66, and 0.85 for depression, anxiety, and stress, respectively). Twenty-nine of 43 patients (67.44%) responded to topical NSAIDs as first-line treatment, and out of the remaining, 6.98% responded to evening primrose oil + vitamin E, 18.60% to tamoxifen, and 4.65% to danazol. Twenty-nine of 32 patients (90.63%) responded to evening primrose oil+vitamin E as first-line treatment, while 6.25% and 3.12% responded to tamoxifen and danazol, respectively. Conclusions Both topical NSAIDs and evening primrose oil + vitamin E were found effective first-line treatment options in the majority of patients. Hence, it is always advisable to start such patients on topical NSAIDs, or evening primrose oil + vitamin E, before switching over (if no resolution of pain is reported with these drugs) to higher and more severe treatment options. The duration or severity of pain did not correlate with the psychological condition of the patient.

Bariatric Surgeon Perspective on Revisional Bariatric Surgery (RBS) for Weight Recurrence.

Weight recurrence (WR) after bariatric surgery occurs in nearly 20% of patients. Revisional bariatric surgery (RBS) may benefit this population but remains controversial among surgeons. Explore surgeon perspectives and practices for patients with WR after primary bariatric surgery (PBS). Web-based survey of bariatric surgeons. A 21-item survey was piloted and posted on social media closed groups (Facebook) utilized by bariatric surgeons. Survey items included demographic information, questions pertaining to the definition of suboptimal and satisfactory response to bariatric surgery, and general questions related to different WR management options. One hundred ten surgeons from 19 countries responded to the survey. Ninety-eight percent responded that WR was multifactorial, including behavioral and biological factors. Failure of PBS was defined as excess weight loss < 50% by 31.4%, as excess weight loss <25% by 12.8%, and as comorbidity recurrence by 17.4%. Surgeon responses differed significantly by gender (P = .036). 29.4% believed RBS was not successful, while 14.1% were unsure. Nevertheless, 73% reported that they would perform RBS if sufficient evidence of benefit existed. Most frequently performed revisional procedures included conversion of sleeve gastrectomy to Roux-en-Y gastric bypass (RYGB), adjustable gastric band to RYGB, and RYGB revision (21.9% versus 18.2% versus 15.3%, respectively). This survey demonstrates significant variability in surgeon perception regarding causes and the effectiveness of RBS. Moreover, they disagree on what constitutes a nonsatisfactory response to PBS and to whom they offer RBS. These findings may relate to limited available clinical evidence on best management options for this patient population. Clinical trials investigating the comparative effectiveness of various treatment options are needed.

Inferring spatial transcriptomics markers from whole slide images to characterize metastasis-related spatial heterogeneity of colorectal tumors: A pilot study

Over 150 000 Americans are diagnosed with colorectal cancer (CRC) every year, and annually over 50 000 individuals will die from CRC, necessitating improvements in screening, prognostication, disease management, and therapeutic options. Tumor metastasis is the primary factor related to the risk of recurrence and mortality. Yet, screening for nodal and distant metastasis is costly, and invasive and incomplete resection may hamper adequate assessment. Signatures of the tumor-immune microenvironment (TIME) at the primary site can provide valuable insights into the aggressiveness of the tumor and the effectiveness of various treatment options. Spatially resolved transcriptomics technologies offer an unprecedented characterization of TIME through high multiplexing, yet their scope is constrained by cost. Meanwhile, it has long been suspected that histological, cytological, and macroarchitectural tissue characteristics correlate well with molecular information (e.g., gene expression). Thus, a method for predicting transcriptomics data through inference of RNA patterns from whole slide images (WSI) is a key step in studying metastasis at scale. In this work, we collected tissue from 4 stage-III (pT3) matched colorectal cancer patients for spatial transcriptomics profiling. The Visium spatial transcriptomics (ST) assay was used to measure transcript abundance for 17 943 genes at up to 5000 55-micron (i.e., 1–10 cells) spots per patient sampled in a honeycomb pattern, co-registered with hematoxylin and eosin (H&E) stained WSI. The Visium ST assay can measure expression at these spots through tissue permeabilization of mRNAs, which are captured through spatially (i.e., x–y positional coordinates) barcoded, gene specific oligo probes. WSI subimages were extracted around each co-registered Visium spot and were used to predict the expression at these spots using machine learning models. We prototyped and compared several convolutional, transformer, and graph convolutional neural networks to predict spatial RNA patterns at the Visium spots under the hypothesis that the transformer- and graph-based approaches better capture relevant spatial tissue architecture. We further analyzed the model’s ability to recapitulate spatial autocorrelation statistics using SPARK and SpatialDE. Overall, the results indicate that the transformer- and graph-based approaches were unable to outperform the convolutional neural network architecture, though they exhibited optimal performance for relevant disease-associated genes. Initial findings suggest that different neural networks that operate on different scales are relevant for capturing distinct disease pathways (e.g., epithelial to mesenchymal transition). We add further evidence that deep learning models can accurately predict gene expression in whole slide images and comment on understudied factors which may increase its external applicability (e.g., tissue context). Our preliminary work will motivate further investigation of inference for molecular patterns from whole slide images as metastasis predictors and in other applications.

Biomechanical investigation of the effects of various treatment options on the talus in supination external rotation type 4 ankle injuries with ruptured deltoid ligament: Finite element analysis

Purpose: The purpose of this study is the biomechanical investigation of the rotation, stress and deformation caused in the talus, under a specific load, by various fixation methods in ankle which has supination external rotation (SER) injury and deltoid rupture.&#x0D; Method: Ankle of a healthy individual was analyzed with the help of a package program which was based on finite elements method (FEM). Then, SER injury model was created. Lateral malleolar plate was fixed with a screw and created different repair models for ankle fit. In the analysis section, forces obtained from the literature were applied to the healthy and repaired models. As the result of the analyses, mechanical values which occured in the talus were obtained.&#x0D; Results: As a result of this study, mechanical changes in talus, which were caused by, (in order) deltoid ligament repair, suture button syndesmosis fixation, syndesmosis fixation with transfixation screw, suture button fixation + deltoid ligament repair and transfixation screw + deltoid ligament repair in the SER type 4 injury model with deltoid ligament rupture, were evaluated.&#x0D; Conlusion: This study showed that the application of syndesmosis screw together with deltoid ligament repair in the treatment of SER type 4 ankle injuries with rupture of deltoid ligament made regression, displacement and talus rotations on the talus almost normal. In addition, syndesmosis fixation screw applications give better results than syndesmosis fixation suture button applications.

Efficacy of preoperative therapy in patients with high and low risk of distant metastasis in non-small cell lung cancer

Background. To select the optimal treatment for non-small cell lung cancer (NSCLC), it is important to predict the risk of distant metastasis and the effectiveness of therapy. The effect of neoadjuvant chemotherapy (NAC) on distant metastasis remains poorly understood. In this study we evaluated the feasibility of predicting the risk of distant metastasis and effectiveness of various treatment options for pre- and intraoperative therapy in NSCLC patients with high and low risk of distant metastasis, divided based on the assessment of morphological changes in the epithelium of small bronchi located near the primary tumor.Material and Methods. The study included 171 patients with NSCLC (T1-4N0-3M0). Various premalignant lesions: isolated basal cell hyperplasia (BCH+SM-D-), basal cell hyperplasia with squamous cell metaplasia (BCH+SM+D-) and squamous cell metaplasia with dysplasia (BCH-SM+D+) were identified in the bronchial epithelium of small bronchi taken at a distance of 3–5 cm from the tumor. Preliminary studies have shown that the detection of BCH+SM-D- or BCH-SM+D-in small bronchi are the markers of high risk of NSCLC distant metastasis, and the detection of BCH+SM+D- and BCH-SM-D- are the markers of low risk of NSCLC distant metastasis. 52.6 % of patients (90/171) received 2–3 courses of neoadjuvant chemotherapy (NAC), 41.1 % (37/90) of patients underwent intraoperative radiation therapy (IORT) at a single dose of 10–15 Gy and 47.4 % (81/171) of patients received platinum-based adjuvant chemotherapy (AC).Results. Both treatment options (NAC+IORT+ and NAC+IORT–) effectively reduced the incidence of distant metastases in the high-risk group patients during the first 2 years of follow-up compared with the high-risk group patients who did not received therapy. In the low-risk group patients, distant metastases rarely occurred, regardless of the treatment option. Adjuvant chemotherapy was found to have no influence on the frequency of distant metastases. Metastasis-free and overall survival rates were better in the low-risk group patients or in patients who received the NAC+IORT+ regimen.Conclusion. Combination of NAC and IORT resulted in the increase in metastasis-free and overall survival rates.

The Efficacy of Various Pharmacological Agents on Long-Term Outcomes in Patients With Heart Failure With Preserved Ejection Fraction: A Meta-Analysis of Randomized Control Trials.

The beneficial impacts of various drugs on long-term outcomes in patients with heart failure with preserved ejection fraction (HFpEF) have been a matter of controversy. The aim of this meta-analysis was to systematically review randomized control trials (RCTs) involving patients with heart failure with preserved left ventricular ejection fraction (LVEF) and identify the effects of various treatment options [angiotensin-converting enzyme (ACE) inhibitors, beta-blockers, angiotensin receptor blockers, and aldosterone receptor blockers] on all-cause mortality, cardiovascular mortality, and hospitalization due to cardiovascular reasons. The current meta-analysis has been conducted as per the Preferred Reporting Items of Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed without any restrictions on language by using the electronic databases Cochrane Library, EMBASE, and PubMed up to July 20, 2022. The outcomes assessed in this meta-analysis included all-cause mortality, cardiovascular mortality, and hospitalization due to cardiovascular reasons. Overall, 10 articles were included in the current meta-analysis with a pooled sample size of 13,336 patients with HFpEF. In comparison to the placebo, among all four pharmacological agents, beta-blockers were the only agent that decreased the risk of all-cause mortality and cardiovascular outcomes. On the other hand, a significant reduction in hospitalization due to cardiac-related reasons was reported in patients on ACE inhibitors as compared to placebo. No other pharmacological agent had an impact on hospitalization due to cardiac-related reasons. The current meta-analysis indicates the possible benefits of beta-blockers in HFpEF in terms of reducing cardiovascular death and all-cause mortality.

Acute Hydroxychloroquine Overdose: A Review of Published Pediatric Cases With Confirmed Hydroxychloroquine Exposure.

This review aimed to explore and summarize information from available cases of pediatric acute hydroxychloroquine overdose with confirmed hydroxychloroquine exposure to give the clinicians a helpful perspective for its better recognition and management. Electronic searches were conducted in PubMed/MEDLINE, Web of Science, Scopus, EBSCO and Serbian Citation Index. The abstracts from 2 toxicology conferences were manually checked for additional relevant publications, as well as reference lists of the retrieved publications. Descriptive statistics, narrative summation, and tabulation of the extracted data were made. Nine publications and a total of 9 patients were included in the review. Reported age of the patients varied from 2.5 to 16 years (median, 16 years). There were more female patients (77.8%). Estimated total ingested hydroxychloroquine dose was reported in 7 cases (77.8%), and it ranged from 4.0 to 20.0 g (median: 12.0 g). Four patients (44.4%) ingested hydroxychloroquine with a coingestant. Altered mental status (100.0%), cardiotoxicity (88.9%), hypotension (77.8%), and hypokalemia (55.6%) were the most commonly reported clinical manifestations. The majority of the patients were hospitalized (88.9%). More than half of the patients (55.6%) were reported to be treated in the intensive care unit. Most frequently reported therapeutic measures were the following: administration of intravenous fluids/infusions (77.8%), vasopressors (77.8%), bicarbonate therapy-sodium bicarbonate (66.7%), potassium replacement (55.6%), and intubation/ventilation (55.6%). Three patients (33.3%) died. Management of acute hydroxychloroquine overdose in children should be symptomatic and tailored to observed clinical manifestations. There is a need for additional investigations to better understand the impact and effectiveness of various treatment options.

A Comprehensive Understanding of Choroidal Metastasis from Lung Cancer.

The incidence of lung cancer with intraocular metastasis is low, of which choroidal metastasis is the most painful metastatic lesion. The clinical symptoms resulting from choroidal metastasis from lung cancer easily detected although they are rarely identified prior to the diagnosis of the primary malignancy. The quality of life of patients is inevitably impaired. Some lung cancer patients complain of ocular symptoms as the first manifestation of lung cancer. Early diagnosis and treatment can significantly overcome or delay the visual impairment and improve prognosis. The main therapeutic modalities include systemic and local treatments, while observation is also a treatment option. Currently, the feasibility and effectiveness of various treatment options are controversial worldwide. Herein, we summarize the underlying mechanisms, epidemiology, clinical features, auxiliary examinations, diagnosis, and recent treatment options for intraocular metastases.

ANALYSIS OF EFFICACY OF USING PLATELET-RICH PLASMA AND BETAMETHAZONE IN THE TREEATMENT OF ALOPECIA AREATA

In the era of evidence-based medicine, confirming a disease by using various instrumental methods is one of the important tasks. This enables to reduce the number of diagnostic errors and to prescribe the appropriate treatment in accordance with the current views on the problem of alopecia areata in each case. Moreover, monitoring the course of the disease, data recording and their statistical processing opens up the prospect for obtaining evidence-based treatment methods. Studying the effectiveness of various treatment options and approaches including the registration of results obtained and their statistical processing is of great clinical significance. The aim of this study is to compare the efficiency of monotherapy with betamethasone injections, with platelet-rich plasma, and their combination. The venous blood of 104 patients aged (35.7 ± 8.9 years with alopecia areata was used in the study. All patients were randomly divided to three groups. The group І received intradermal injections of betamethasone (4 sessions per month). The group ІІ received intradermal injections of platelet-rich plasma once every 2 weeks for 16 weeks. The group ІІІ received 4 sessions of betamethasone which were alternated with 4 sessions of platelet-rich plasma treatment at interval of 2 weeks. The patients were examined before the treatment and in 3, 6 and 17 months. The following factors as the age, sex, smoking habit, the presence of alopecia in relatives, the duration, shape and stage of the disease, the index of the severity of alopecia and hair growth, the presence of "yellow and black dots", "conical" and terminal hair were considered in the study. Statistical analysis was performed using SPSS (version 22.0.). The results have shown the combination therapy allows us to obtain the best result, especially in long follow-up period.

Precision population analytics: population management at the point-of-care

ObjectiveTo present clinicians at the point-of-care with real-world data on the effectiveness of various treatment options in a precision cohort of patients closely matched to the index patient.Materials and MethodsWe developed disease-specific, machine-learning, patient-similarity models for hypertension (HTN), type II diabetes mellitus (T2DM), and hyperlipidemia (HL) using data on approximately 2.5 million patients in a large medical group practice. For each identified decision point, an encounter during which the patient’s condition was not controlled, we compared the actual outcome of the treatment decision administered to that of the best-achieved outcome for similar patients in similar clinical situations.ResultsFor the majority of decision points (66.8%, 59.0%, and 83.5% for HTN, T2DM, and HL, respectively), there were alternative treatment options administered to patients in the precision cohort that resulted in a significantly increased proportion of patients under control than the treatment option chosen for the index patient. The expected percentage of patients whose condition would have been controlled if the best-practice treatment option had been chosen would have been better than the actual percentage by: 36% (65.1% vs 48.0%, HTN), 68% (37.7% vs 22.5%, T2DM), and 138% (75.3% vs 31.7%, HL).ConclusionClinical guidelines are primarily based on the results of randomized controlled trials, which apply to a homogeneous subject population. Providing the effectiveness of various treatment options used in a precision cohort of patients similar to the index patient can provide complementary information to tailor guideline recommendations for individual patients and potentially improve outcomes.

Melanotic neuroectodermal tumor of infancy: a description of the experience of Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology and literature review

Melanotic neuroectodermal tumor of infancy (MNTI) is a rare type of tumor with uncertain clinical behavior. The tumor commonly occurred in the head and neck region. Radical surgical resection is the standard of treatment, which is often associated with high risks of severe postoperative complications due to tumor localization. Alternative methods of treatment including chemotherapy/radiotherapy are used in metastatic, locally advanced and relapsed cases of MNTI. The aim of this study was to analyze clinical and morphological characteristics of the tumor, evaluate the effectiveness of various treatment options, and to describe two clinical cases of MNTI.

Premenstrual syndrome: a review of the literature

Premenstrual syndrome is defined as a combination of physical and mental symptoms that have a significant impact on a woman’s quality of life and develop into the second phase of the menstrual cycle. Many patients have not been diagnosed, and therefore pathogenetic treatment is not carried out, although these complaints may disrupt the daily lives of patients and relationships with others. The article presents a review of the literature and studies that assessed the effectiveness of various treatment options (antidepressants, hormone therapy, lifestyle modification and herbal therapy).

Effects of Congenital Heart Disease Treatmenton Quality of Life

With rising survival rates of patients with congenital heart disease (CHD), functional health variables have become the key aspect in treatment evaluation. The effectiveness of various treatment options on the health-related quality of life (HRQoL) and the objectively measured exercise capacity as peak oxygen uptake (VO2 peak) remains rather unclear and hence, its investigation is the primary aim of this study. Data from 1014 patients (≥14-years-old, various CHD) were retrospectively reviewed. The patients had completed at least twice the SF-36 questionnaire on HRQoL prior to a cardiopulmonary exercise test. Each patient was assigned to 1 of 4 treatment groups (i.e., surgery, catheter intervention, drug therapy, and surveillance) according to the received treatment between the baseline and the follow-up examination. After 4.0 ± 2.2 years of follow-up, patients with surgery and catheter intervention showed an increase in the physical summary score of HRQoL as compared to the other treatment groups (p <0.001). This effect remained also significant in a multivariable model accounting for anthropometric and baseline data. No significant differences in the mental summary score of HRQoL and the VO2 peak were evident between the different treatment groups in the multivariable model. No significant correlation was found between the changes in HRQoL and VO2 peak over time. In conclusion, despite insignificant changes in aerobic capacity, adolescents and adults with CHD report better physical HRQoL following surgery and catheter intervention compared to the other treatment options. HRQoL and exercise capacity need to be considered concurrently in the evaluation of adolescents and adults with CHD.

Steroid Refractory Chronic Graft-Versus-Host Disease: Cost-Effectiveness Analysis

Given the increasing incidence of chronic graft-versus-host disease (cGVHD) and its rapidly escalating costs due to many lines of drug treatments, we aimed to perform a meta-analysis to assess the comparative effectiveness of various treatment options. Using these results, we then conducted a cost-effectiveness analysis for the frequently utilized agents in steroid-refractory cGVHD. We searched for studies examining tacrolimus, sirolimus, rituximab, ruxolitinib, hydroxychloroquine, imatinib, bortezomib, ibrutinib, extracorporeal photopheresis, pomalidomide, and methotrexate. Studies with a median follow-up period shorter than 6 months and enrolling fewer than 5 patients were excluded. Meta-analysis for overall and organ system–specific GVHD response (overall response [ORR], complete response [CR], and partial response [PR]) was conducted for each intervention. Cost per CR and cost per CR + PR were calculated as the quotient of the 6-month direct treatment cost by CR and CR + PR. Forty-one studies involving 1047 patients were included. CR rates ranged from 7% to 30% with rituximab and methotrexate, respectively, and ORR ranged from 30% to 85% with tacrolimus and ruxolitinib, respectively. Cost per CR ranged from US$1,187,657 with ruxolitinib to US$680 with methotrexate. Cost per ORR ranged from US$453 for methotrexate to US$242,236 for ibrutinib. The most cost-effective strategy was methotrexate for all of the organ systems. Pomalidomide was found to be the least cost-effective treatment for eye, gastrointestinal, fascia/joint, skin, and oral GVHD, and imatinib was found to be the least cost-effective treatment for liver and extracorporeal photopheresis for lung GVHD. We observed huge cost-effectiveness differences among available agents. Attention to economic issues when treating cGVHD is important to recommend how treatments should be sequenced, knowing that many patients will cycle through available agents.

DeepSurv: personalized treatment recommender system using a Cox proportional hazards deep neural network

BackgroundMedical practitioners use survival models to explore and understand the relationships between patients’ covariates (e.g. clinical and genetic features) and the effectiveness of various treatment options. Standard survival models like the linear Cox proportional hazards model require extensive feature engineering or prior medical knowledge to model treatment interaction at an individual level. While nonlinear survival methods, such as neural networks and survival forests, can inherently model these high-level interaction terms, they have yet to be shown as effective treatment recommender systems.MethodsWe introduce DeepSurv, a Cox proportional hazards deep neural network and state-of-the-art survival method for modeling interactions between a patient’s covariates and treatment effectiveness in order to provide personalized treatment recommendations.ResultsWe perform a number of experiments training DeepSurv on simulated and real survival data. We demonstrate that DeepSurv performs as well as or better than other state-of-the-art survival models and validate that DeepSurv successfully models increasingly complex relationships between a patient’s covariates and their risk of failure. We then show how DeepSurv models the relationship between a patient’s features and effectiveness of different treatment options to show how DeepSurv can be used to provide individual treatment recommendations. Finally, we train DeepSurv on real clinical studies to demonstrate how it’s personalized treatment recommendations would increase the survival time of a set of patients.ConclusionsThe predictive and modeling capabilities of DeepSurv will enable medical researchers to use deep neural networks as a tool in their exploration, understanding, and prediction of the effects of a patient’s characteristics on their risk of failure.

Disability in adult patients with chronic low back pain in a north central Nigerian hospital

Background: Chronic low back pain (CLBP) is a common health problem that is often associated with physical disability and reduced quality of life. Functional disability is the inability to perform age-approximate physical, mental and social activities of daily living. It is, therefore, pertinent to determine the prevalence of disability in patients with CLBP as this will help clinicians to look out for risk factors associated with disability and thus facilitate management decisions. Aim: The aim of this study is to determine the prevalence and level of disability in patients with CLBP. Patients and Methods: Patients with CLBP observed at the orthopaedic clinic of Benue State University Teaching Hospital, Makurdi from June 2016 to February 2017 were recruited for this study. A designed questionnaire was used to collect data. Oswestry low back pain disability questionnaire was used to assess the level of disability. Results: A total of 126 patients with CLBP were evaluated, consisting of 45 males (35.7%) and 81 females (64.3%) with a male:female ratio of 1:1.8. The prevalence of disability in patients with CLBP in this study was 78.6%. 66 (52.4%) of patients had a moderate disability, 32 (25.4%) of patients had a severe disability, 27 (21.4%) of patients had mild or no disability and only one patient (0.8%) was crippled. There was a significant association between the age and level of disability (P = 0.001). Conclusion: Disability in patients with chronic back pain is a common health problem in our environment. Determination of disability prevalence will create more awareness for the need to assess risk factors and evaluate the effectiveness of various treatment options.

Genitourinary syndrome of menopause - is the problem solved? State of the art 2018.

Vulvovaginal atrophy accompanied by lower urinary tract dysfunction related to low levels of estrogen and androgens is labeled as genitourinary syndrome of menopause (GSM). Although this condition affects most postmenopausal women worldwide, it seems to be underdiagnosed and undertreated. Women should be properly advised to choose an adequate treatment modality to improve their quality of life, sexual relationships and social activity. The aim of this article to is increase knowledge of GSM. The current treatment options, both hormonal and non-hormonal, are reviewed. Topical estrogen therapy still remains the gold standard, but the demand for individually tailored therapy is growing. New treatment modalities are continuously included in clinical practice. They should consider the whole personality of a woman as well as cultural and social factors. Further studies on GSM and on the effectiveness of various treatment options are necessary to achieve this purpose.

Diagnostic value of histopathological examination results obtained during screening of patients with diagnosed atypical hyperplasia.

Vulvovaginal atrophy accompanied by lower urinary tract dysfunction related to low levels of estrogen and androgens is labeled as genitourinary syndrome of menopause (GSM). Although this condition affects most postmenopausal women worldwide, it seems to be underdiagnosed and undertreated. Women should be properly advised to choose an adequate treatment modality to improve their quality of life, sexual relationships and social activity. The aim of this article is to increase knowledge of GSM. The current treatment options, both hormonal and non-hormonal, are reviewed. Topical estrogen therapy still remains the gold standard, but the demand for individually tailored therapy is growing. New treatment modalities are continuously included in clinical practice. They should consider the whole personality of a woman as well as cultural and social factors. Further studies on GSM and on the effectiveness of various treatment options are necessary to achieve this purpose.