Set Of Clinical Parameters Research Articles

Predicting the Shape of Corneas from Clinical Data with Machine Learning Models

ObjectiveIn ophthalmology, there is a need to explore the relationships between clinical parameters of the cornea and the corneal shape. This study explores the paradigm of machine learning with nonlinear regression methods to verify whether corneal shapes can effectively be predicted from clinical data only, in an attempt to better assess and visualize their effects on the corneal shape. MethodsThe dimensionality of a database of normal anterior corneal surfaces was first reduced by Zernike modeling into short vectors of 12 to 20 coefficients used as targets. The associated structural, refractive and demographic corneal parameters were used as predictors. The nonlinear regression methods were borrowed from the scikit-learn library. All possible regression models (method + predictors + targets) were pre-tested in an exploratory step and those that performed better than linear regression were fully tested with 10-fold validation. The best model was selected based on mean RMSE scores measuring the distance between the predicted corneal surfaces of a model and the raw (non-modeled) true surfaces. The quality of the best model's predictions was visually assessed thanks to atlases of average elevation maps that displayed the centroids of the predicted and true surfaces on a number of clinical variables. ResultsThe best model identified was gradient boosting regression using all available clinical parameters to predict 16 Zernike coefficients. The predicted and true corneal surfaces represented in average elevation maps were remarkably similar. The most explicative predictor was the radius of the best-fit sphere, and departures from that sphere were mostly explained by the eye side and by refractive parameters (axis and cylinder). ConclusionIt is possible to make a reasonably good prediction of the normal corneal shape solely from a set of clinical parameters. In so doing, one can visualize their effects on the corneal shape and identify its most important contributors.

Effect of Continuous Infusion Therapy With Low-dose Terlipressin Combined With Norepinephrine on Hemodynamics, Inflammatory Markers, and Prognosis in Patients With Severe Septic Shock.

The present study investigated the impact of continuous infusion therapy with low-dose terlipressin (TP) combined with norepinephrine on hemodynamics, inflammatory markers, and prognosis in patients with severe septic shock. Seventy-four patients with severe septic shock were randomly assigned to either a control group (n = 37) or an observation group (n = 37). Patients in the control group received norepinephrine alone, while those in the observation group received a continuous infusion of low-dose TP in addition to norepinephrine. To assess the effect of treatment, a set of clinical parameters was evaluated in both groups before and after treatment. These parameters included hemodynamic indicators (heart rate [HR], mean arterial pressure [MAP], central venous pressure [CVP], cardiac index [CI], and systemic vascular resistance index [SVRI]), levels of serum inflammatory markers (interleukin-8 [IL-8], tumor necrosis factor-α [TNF-α], and hypersensitivity C-reactive protein [hs-CRP]), renal function indicators (blood urea nitrogen [BUN], serum creatinine [SCr], and cystatin C [Cys-C]), serum procalcitonin (PCT), and lactate, as well as lactate clearance rate (LCR). Additionally, the acute physiology and chronic health evaluation II (APACHE II) score, 28-day mortality rate, multiple organ dysfunction syndrome (MODS) incidence rate, and adverse reaction incidence were also determined. Compared to baseline values, MAP, CVP, CI, SVRI, and LCR increased in both groups after treatment, while HR, levels of IL-8, TNF-α, hs-CRP, BUN, SCr, PCT, and lactate all decreased. Additionally, APACHE II scores also decreased. Furthermore, the observation group exhibited higher MAP, CVP, CI, SVRI, and LCR, along with lower HR, levels of IL-8, TNF-α, hs-CRP, BUN, SCr, PCT, and lactate than the control group after treatment. The observation group also had lower APACHE II score, 28-day mortality rate, MODS incidence rate, and adverse reaction incidence than the control group after treatment (P < .05). Continuous infusion therapy with low-dose TP combined with norepinephrine was effective in treating patients with severe septic shock, improving hemodynamic parameters, reducing the levels of inflammatory markers, promoting renal function recovery, and reducing the mortality rate.

Multibacillary lepromatous leprosy detected in Olmedo, Ecuador. Case report

Introduction: hansen's disease or leprosy is an infectious disease caused by Mycobacterium leprae, which mainly affects the skin, peripheral nerves and mucosa of the upper respiratory tract. It has a chronic course as old as humanity itself.Clinical case: the clinical case of a 51-year-old male patient, native and from the Olmedo canton, province of Manabí, with a farmer occupation, who began to present in November 2008 with macular, hyperchromic skin lesions, which progressed, is presented. to multiple nodules, located in the lower limbs and then spreading to the upper limbs, thorax and abdomen, neck and face. The set of clinical parameters and positive biopsy results allowed the case to be classified as Lepromatous Leprosy (multibacillary). Triple multitherapy (Dapsone, Rifampicin, Clofazimine) was prescribed, showing an improvement in the number and size of the lesions at the end of therapy.Discussion: this is the first clinical case of lepromatous leprosy detected in the Olmedo canton, Manabí province, Ecuador. Due to the novelty in the territory, the patient had this condition for years without being diagnosed or treated adequately and even once under treatment, there were delays in acquiring the medications that extended their application from 12 months to a period of 25 months.Conclusions: the clinical case presented highlights that Hansen's Disease is an emerging health problem in the Olmedo canton, highlighting the need to make sustained efforts for its identification, treatment and prevention in the territory

Comparative studies on the detection of Theileria annulata infection by clinical, parasitological and molecular techniques in buffaloes (Bubalus bubalis)

During the period of 2019-2021, a total of 715 buffaloes were screened for Theileria infections. A set of clinical parameters were used to identify the theileriosis suspected animals which were later confirmed through microscopic tests (peripheral thin blood smear examination and lymph node biopsy smear examination) and molecular assay (cytochrome b based T. annulata specific polymerase chain reaction test). On the basis of clinical evaluation, 33.43% (239/715) buffaloes were suspected for the presence of theileriosis. Through laboratory examination, 63.60% (152/239), 7.48% (16/214) and 100% (239/239) were found positive for Theileria infection by blood smear examination, lymph node biopsy and PCR, respectively, among the clinically suspected theileriosis animals. The efficiency of PCR was recorded to be highest, followed by microscopic examination of peripheral blood smears, and the lowest value was obtained for lymph node biopsy smear examination. The results indicated that PCR is a highly sensitive diagnostic technique for confirmatory diagnosis of T. annulata parasitic infection in buffaloes, even at very low level of parasitemia. Analysis of the data based on thin blood smear examination revealed that the field incidence of theileriosis was 11.55% in the south-western region of Gujarat, India. The high incidences of T. annulata infection in buffaloes may be due to the sub-tropical climate of the region which is favorable for the growth and development of vector ticks and parasites.

Rising Resonance Frequency Is the Sole Sign of Early Middle Ear Disease in Children With Adenoid Hypertrophy.

The present study seeks to estimate the potential of multifrequency tympanometry in the diagnosis of primal otologic disorder in children with adenoid hypertrophy (AH). Prospective observational study. Tertiary pediatric institution. One hundred thirty-one children presenting consecutively at the otolaryngology clinic were divided on the basis of AH into 98 patients and 33 controls. Middle ear status was assessed using pneumatic otoscopy, standard, and wide band tympanometry. Tympanogram type/intratympanic pressure, and resonance frequency (RF) were correlated with each other as well as with a set of clinical parameters. Receiver operating characteristic analysis was employed to reveal the diagnostic value of RF. Mean RF declined in chronic otitis media with effusion by 43.25% (p < 0.001). In our entire cohort, children with AH under the age of 7 years presented with a relative risk = 2.43 of producing "B" tympanogram (p = 0.016) than their older peers. In patients' ears with normal, type "A," tympanogram, RF was the sole tympanometric marker of AH, being elevated by 28.26% in mean value (p = 0.010). On receiver operating characteristic analysis of RF's discriminating capability, the area under the curve was equal to 0.647 (p = 0.010). The optimal cut-off value of RF was set at 899 Hz. AH may induce middle ear stiffening, as RF's increase indicates. Wide band tympanometry output could be a warning sign of ongoing compliance reduction to the sound transmission apparatus, at a time point when physical examination and 226 Hz tympanometry are still unremarkable.

Uniform criteria for total hip replacement surgery in patients with hip osteoarthritis: a decision tool to guide treatment decisions.

BackgroundUniform criteria for performing hip replacement surgery in hip osteoarthritis patients are currently lacking. As a result, variation in surgery and inappropriateness of care may occur. The aim of this study was to develop a consensus-based decision tool to support the decision-making process for hip replacement surgery.MethodsPatients with a diagnosis of unilateral or bilateral osteoarthritis were included. Consensus rounds with orthopedic surgeons were organized to blindly reassess medical files and to decide whether surgery is indicated or not, based on all available pre-treatment information. We compared the outcomes obtained from the blind reassessment by the consensus group with the actual treatment. Furthermore, prediction models were fitted on the reassessment outcome to identify which set of clinical parameters would be most predictive and uniformly shared in the decision to operate.Two prediction models were fitted, one model without radiologic outcomes and one model where radiologic outcomes were included.ResultsIn total, 364 medical files of osteoarthritis patients were included and reassessed in the analyses. Key predictors in the prediction model without radiology were age, flexion, internal rotation and the Hip disability and Osteoarthritis Outcome Score–quality of life. The discriminative power was high (Area Under Receiver Operating Curve (AUC) = 0.86). Key predictors in the prediction model with radiology were age, internal rotation and Kellgren and Lawrence severity score (AUC = 0.94).ConclusionThe study yielded a decision tool with uniform criteria for hip replacement surgery in osteoarthritis patients. The tool will guide the clinical decision-making process of physicians on whether to perform hip surgery and should be used together with information about patient preferences and social context.

428. Very High Clinical Likelihood (VHCL) Of COVID-19 Infection: Peering Beyond A Negative Nasopharyngeal Swab

BackgroundDiagnosis of COVID-19 relies upon RT-PCR assays for SARS-CoV-2 from a nasopharyngeal swab (NPS). However, results depend upon duration of illness at the time of testing and operator performance. False negatives occur 10–30% of the time. In our center we formulated & applied a clinical prediction tool for diagnosis of COVID-19 infection. Patients who satisfied criteria were designated as having COVID-19 regardless of NPS results. Herein, we describe the set of patients who fulfilled full and strict clinical criteria (VHCL) (Table 1) and had at least 2 negative NPSs on hospital admission.Table 1: Clinical criteria for Very High Clinical Likelihood of COVID-19 Infection (VHCL COVID-19) MethodsA retrospective descriptive study was conducted from March 4th to April 11th, 2020. We evaluated patients with ≥ 2 consecutive negative NPS COVID-19 results admitted to our hospital. Of these, we identified patients fitting all 5 criteria for Very High Clinical Likelihood (VHCL) of COVID-19 infection (Table 1). We analyzed symptoms & lab data (including results of repeat NPS testing if performed) in those patients.Results1855 patients were diagnosed with COVID-19 in the study period. Of these, 23 had ≥ 2 negative COVID-19 NPS results but met criteria for VHCL (Table 2). Of these 23, 7 had a subsequent 3rd NPS that was positive-proving infection. Similar to other reports, patients had low lymphocytes and elevated procalcitonin, ferritin, C-reactive protein levels. And consistent with proven cases, our cohort presented after a median of 5 days of symptoms (Table 3).Table 2: Clinical and laboratory characteristics of VHCL COVID-19 patients [Rows Bolded include those patients who had a 3rd NPS swab that was positive]. Table 3: Demographic and Median Lab Data of VHCL COVID-19 patients ConclusionIt is critical to be mindful of the imperfection of laboratory testing & to integrate clinical criteria to diagnostic algorithms. This is especially true in the COVID-19 pandemic, which is marked by high morbidity & mortality. In our study, we demonstrated how a set of clinical parameters (which we termed VHCL) can aid in widening the net of patients diagnosed with COVID-19 despite negative laboratory tests. While 16 patients in our cohort did not have a confirmatory result, the strict criteria for VHCL & the close match of other study variables with those of proven cases supports the value of VHCL designation. Applying VHCL can optimize infection control, identify patients for emerging therapeutics & aid in contact tracing to reduce nosocomial & community transmission of COVID-19.Disclosures All Authors: No reported disclosures

Chemometric Expertise Of Clinical Monitoring Data Of Prolactinoma Patients

AbstractThe present investigation indicates hidden relationships between the several clinical parameters usually monitored on prolactinoma patients using non-hierarchical cluster analysis. The major goal of the chemometric data mining is to offer a possible mode of optimization of the monitoring procedure by selecting a reduced number of health status indicators. The intelligent data analysis reveals the formation of three patterns of prolactinoma patients each one of them described by a set of clinical parameters. Thus, better strategies for considering patients with this diagnosis could be developed and clinically applied.

Measuring parameters of the cancer ecosystem for cancer ecological staging.

e14684 Background: Cancer progression through clonal evolution and emergent phenotypic heterogeneity is thought to reflect stochastic events such as genetic drift. This divergence over time in the character of a neoplasm might also reflect genetic selection, analogous to other populations in nature, to maximize niche resource utilization. We hypothesized that selection pressures operate in patients with cancer to drive cancer evolution, are clinically identifiable, their influence measurable. Methods: To develop a system for cancer ecology staging, a feasibility study recruited 15 patients with active cancer from any site, with expected survival of more than 6 months and providing informed consent. A set of clinical parameters obtained from a patient questionnaire, physical exam and laboratory testing was used to generate eight separate ecological profiles of tumor microenvironment, chronic inflammation, energy balance, psychosocial stress, GI microbiome, endocrine environment, skeletal remodeling and environmental mutagenesis. A scoring system, based on evidence of positive selection was designed to quantitate the individual profiles. Profile scores were then aggregated using a 2-D radar plot to generate a polygon, an ‘ecogram’, whose area, it is hypothesized, corresponds to the net level of selection pressure influencing tumor evolution. Results: Ecological profiles were obtained from each of 15 patients allowing determination of the ecogram area (EA) bounded by the polygon. EA determinations ranged widely among the 15 patient, from 0-12.7 arbitrary units (au, mean 5.01± 0.80). Ecograms from individual patients demonstrated unique shapes suggesting specificity for individual patient ecology. EA measurements were then used to inform an ecological staging system based on a simplified dichotomization, low/high, of ecosystem resources and threats. Of 15 patients, 6 were considered to have high resources (EA &gt; 5au) available to support tumor evolution. High anti-tumor threat, measured by CD3 lymphocyte immunohistochemical scoring, was detected in 11 patients. Conclusions: An ecological assessment of patients with active cancer appears feasible. Inter-patient variation in ecogram area and morphology suggests there are potential important differences in genetic selection found between patients and should be correlated with survival outcomes in future studies, validation offering a target for ecosystem ‘restoration’.

A multivariate relationship between the kinematic and clinical parameters of knee osteoarthritis population

BackgroundBiomechanical and clinical parameters contribute very closely to functional evaluations of the knee joint. To better understand knee osteoarthritis joint function, the association between a set of knee biomechanical data and a set of clinical parameters of an osteoarthritis population (OA) is investigated in this study.MethodsThe biomechanical data used here are a set of characteristics derived from 3D knee kinematic patterns: flexion/extension, abduction/adduction, and tibial internal/external rotation measurements, all determined during gait recording. The clinical parameters include a KOOS questionnaire and the patient’s demographic characteristics. Canonical correlation analysis (CCA) is used (1) to evaluate the multivariate relationship between biomechanical data and clinical parameter sets, and (2) to cluster the most correlated parameters. Multivariate models were created within the identified clusters to determine the effect of each parameter’s subset on the other. The analyses were performed on a large database containing 166 OA patients.ResultsThe CCA results showed meaningful correlations that gave rise to three different clusters. Multivariate linear models were found explaining the subjective clinical parameters by evaluating the biomechanical data contained within each cluster.ConclusionThe results showed that a multivariate analysis of the clinical symptoms and the biomechanical characteristics of knee joint function allowed a better understanding of their relationships.

Increased lipocalin-2 vs reduced oxytocin in relation with adiposity, atherogenicity and hematological indices in metabolic syndrome patients with and without prediabetes.

The neuropeptide hormone- Oxytocin (OXT) and glycoprotein Lipocalin-2 (LCN-2) are strongly associated with cardiometabolic risks of insulin resistance in metabolic syndrome (MetS) and prediabetes (preDM). In a cross sectional design we aimed to compare and correlate plasma levels of OXT and LCN-2 and a set of clinical parameters, adiposity indices, atherogenicity indices, and hematological indices in 29 MetS/preDM individuals and 29 non-diabetic MetS subjects vs 30 normoglycemic lean controls. Colorimetric enzymatic assays of biomarkers were procured. LCN-2 concentration (ng/mL) increased significantly in MetS/preDM vs controls. Substantially in MetS recruits (both non-diabetic and pre-diabetics; n = 58); OXT directly correlated with visceral adiposity index (VAI), non-HDL-C/HDL-C ratio, TC/HDL-C ratio, LDL-C/HDL-C ratio, lipid accumulation product (LAP), and atherogenicity index of plasma (AIP). Impressively, LCN-2 correlated proportionally with waist circumference (WC), red cell distribution width (RDW), neutrophils, and neutrophils to lymphocytes ratio (NLR), but inversely with lymphocytes in the 58 (non- and preDM) MetS participants. These pronounced variations and correlations of OXT and LCN-2 emphasize their putative molecular roles in MetS and preDM pathophysiologies. Thus, OXT and LCN-2 can be surrogate prognostic/diagnostic tools for the MetS/preDM pharmacotherapy/prevention (Tab. 3, Fig. 1, Ref. 44).

Plasminogen Activator Inhibitor-2 Polymorphism Associates with Recurrent Coronary Event Risk in Patients with High HDL and C-Reactive Protein Levels

The objective of this work was to investigate whether fibrinolysis plays a role in establishing recurrent coronary event risk in a previously identified group of postinfarction patients. This group of patients was defined as having concurrently high levels of high-density lipoprotein cholesterol (HDL-C) and C-reactive protein (CRP) and was previously demonstrated to be at high-risk for recurrent coronary events. Potential risk associations of a genetic polymorphism of plasminogen activator inhibitor-2 (PAI-2) were probed as well as potential modulatory effects on such risk of a polymorphism of low-density lipoprotein receptor related protein (LRP-1), a scavenger receptor known to be involved in fibrinolysis in the context of cellular internalization of plasminogen activator/plansminogen activator inhibitor complexes. To this end, Cox multivariable modeling was performed as a function of genetic polymorphisms of PAI-2 (SERPINB, rs6095) and LRP-1 (LRP1, rs1800156) as well as a set of clinical parameters, blood biomarkers, and genetic polymorphisms previously demonstrated to be significantly and independently associated with risk in the study population including cholesteryl ester transfer protein (CETP, rs708272), p22phox (CYBA, rs4673), and thrombospondin-4 (THBS4, rs1866389). Risk association was demonstrated for the reference allele of the PAI-2 polymorphism (hazard ratio 0.41 per allele, 95% CI 0.20-0.84, p=0.014) along with continued significant risk associations for the p22phox and thrombospondin-4 polymorphisms. Additionally, further analysis revealed interaction of the LRP-1 and PAI-2 polymorphisms in generating differential risk that was illustrated using Kaplan-Meier survival analysis. We conclude from the study that fibrinolysis likely plays a role in establishing recurrent coronary risk in postinfarction patients with concurrently high levels of HDL-C and CRP as manifested by differential effects on risk by polymorphisms of several genes linked to key actions involved in the fibrinolytic process.

Biomarker profiles and their relation to clinical variables in mild cognitive impairment

The aim of the study was to compare clinical variables between MCI patients at different risk for Alzheimer’s disease (AD) according to their biomarker profile. Fifty-four percent out of 39 MCI patients had a low Aβ42 and high tau in cerebrospinal fluid (CSF) (high-risk), 26% either a low CSF Aβ42 or high CSF tau (intermediate-risk) and 20% a normal CSF Aβ42 and tau (low-risk). Both high- and intermediate-risk subjects differed from the low-risk group in episodic memory, executive functions and the preclinical AD scale (PAS), which combines a set of clinical parameters. Subjects at high risk did not differ from subjects with an intermediate risk. Aβ42 levels correlated with the MTA and PAS scores, tau levels with episodic memory. These correlations suggest that the biomarkers are not independent when compared to the other AD markers. Longitudinal studies are necessary to interpret the correlations between biomarkers, imaging, and neuropsychological markers.

A ‘Fair Play’? Comparison of an Objective Structured Clinical Examination of Final Year Medical Students Training in Psychiatry and their Supervisors' Appraisals

Objective: Expected standards for student performance in psychiatry can vary between supervisors and institutions. Recently, the University of Auckland required its academic departments to have an objective standard assessment or test for each student on a clinical attachment. We aimed to compare an objective structured clinical examination of final year medical students training in psychiatry and their supervisors' appraisals. Method: Assessment in psychiatry initially consisted of a two-hour written test. Subsequently, the test in psychiatry changed to a standardised, modified, objective, structured, clinical examination (OSCE) using simulated patients. The clinical supervisor rated each student on a set of clinical parameters using a scale of 1-6. In addition, members of the academic department of psychiatry separately tested the students with a modified OSCE on the last day of their clinical attachment. The results of the OSCE are compared with clinical attachment assessments and the previous method of evaluation, the written test. Results: There was no correlation between the written test and the supervisor's assessment for the clinical attachment indicating that the written test was not a good method of evaluating student performance. The correlation between the clinical attachment grading and the OSCE for year 1 was 0.4 (p=0.002) and for year 2 was 0.5 (p=0.001). However, marks for the OSCE were consistently lower than those given for the clinical attachment. Conclusions: The introduction of the modified OSCE had the desired outcome of changing students' focus from the pursuit of theoretical knowledge to the attainment of practical skills.

Relationship of demographic and clinical factors to free and total prostate-specific antigen

Objectives. To characterize the role of demographic and clinical parameters in the measurements of prostate-specific antigen (PSA), free PSA (fPSA), and percent free PSA (%fPSA). Methods. This was a cohort study of volunteers to a randomized screening trial. A central laboratory determined PSA and fPSA for the Prostate, Lung, Colorectal and Ovarian (PLCO) Cancer Screening Trial. A baseline evaluation of free and total PSA was done for 7183 white, black, Asian, Hispanic, and other male volunteers, aged 55 to 74 years. Comparisons were made across racial and ethnic groups and across a set of clinical parameters from a baseline questionnaire. Results. The median levels of serum PSA were less than 2.1 ng/mL in each age-race grouping of the study participants. The levels of free and total PSA were higher in black (n = 868, 12%) participants than in white (n = 4995, 70%) and Asian (n = 849, 11.8%) participants. Individuals who identified themselves as ethnically Hispanic (n = 339, 4.7%) had median PSA levels higher than whites who were not Hispanic. The free and total PSA levels increased with age, particularly among men 70 to 74 years old. However, the %fPSA levels showed less variation among the four racial groups or by age. The free and total PSA levels were higher among those who had a history of benign prostatic disease. Conclusions. Demographic (age and race/ethnicity) and clinical (history of benign prostatic disease) variables had a moderate effect on the measures of PSA and fPSA and very little effect on %fPSA.

Is serum β2-microglobulin a tumor marker in gastrointestinal cancer?

Serial determinations of serum β2-microglobulin (β2m) and carcinoembryogenic antigen (CEA) were performed in 314 patients with histologically confirmed gastrointestinal cancer. The data were correlated with a set of clinical parameters. Pre-operative serum β2m levels did not discriminate different classes of tumor extension nor different stages of resectability of tumors in contrast to CEA. During post-operative surveillance the correlation of the time courses of serum β2m and CEA with the clinical course of malignant disease was studied in a selected group of 165 patients with resected primary carcinoma of the gastrointestinal tract. During the follow-up 74 165 patients showed disease progression or recurrence. In the β2m follow-up 66% false negative indications ( 49 74 ) of malignant disease were observed, whereas in the CEA follow-up it was 5% ( 4 74 ). The ratio of correct positive/false positive indications was 25 10 in the β2m follow-up and 70 10 in the CEA follow-up. The data indicate that the formation of serum β2m is not directly tumor associated in gastrointestinal cancer.