281 research outputs found
A New Deep State-Space Analysis Framework for Patient Latent State Estimation and Classification from EHR Time Series Data
Many diseases, including cancer and chronic conditions, require extended
treatment periods and long-term strategies. Machine learning and AI research
focusing on electronic health records (EHRs) have emerged to address this need.
Effective treatment strategies involve more than capturing sequential changes
in patient test values. It requires an explainable and clinically interpretable
model by capturing the patient's internal state over time.
In this study, we propose the "deep state-space analysis framework," using
time-series unsupervised learning of EHRs with a deep state-space model. This
framework enables learning, visualizing, and clustering of temporal changes in
patient latent states related to disease progression.
We evaluated our framework using time-series laboratory data from 12,695
cancer patients. By estimating latent states, we successfully discover latent
states related to prognosis. By visualization and cluster analysis, the
temporal transition of patient status and test items during state transitions
characteristic of each anticancer drug were identified. Our framework surpasses
existing methods in capturing interpretable latent space. It can be expected to
enhance our comprehension of disease progression from EHRs, aiding treatment
adjustments and prognostic determinations.Comment: 21 pages, 6 figure
Comparison of Total Laparoscopic Hysterectomy with Abdominal Total Hysterectomy in Patients with Benign Disease: A Retrospective Cohort Study
Background: The present study aimed to determine whether total laparoscopic hysterectomy (TLH) is being implemented safely and appropriately compared with abdominal total hysterectomy (ATH) in our hospital. Methods: We retrospectively reviewed clinical records of 102 patients who underwent total hysterectomy for benign gynecological disease at Japanese Red Cross Yamaguchi Hospital from January 2017 to August 2018. We examined periods of hospital stay, operation time, blood loss, weight of the uterus, frequency of perioperative complications, and the duration from the first visit to the date of surgery. P < 0.05 was considered to be statistically significant indicated statistical significance. Results: TLH and ATH were performed in 55 (53%) and 47 (46%) cases, respectively. The TLH group had significantly longer total operation time [133 (82-205) min vs. 87 (57-155) min, P < 0.0001], lesser blood loss [5 (5-35) g vs. 100 (10-820) g, P < 0.0001], shorter hospital stay [7 (5-14) days vs. 10 (9-26) days, P < 0.0001], and lighter uterine weight [206 (27-658) g vs. 554 (79-2284) g, P < 0.0001] than the ATH group. The frequency of perioperative complications did not differ between the two groups (3.5% vs. 8.0%, P = 0.4103). Conclusion: TLH had a longer operation time and a lesser excised uterine weight, but it had less intraoperative blood loss, shorter hospital stay, and no difference in perioperative complication frequency when compared with ATH
Knowledge and perceptions of the COVID-19 pandemic among patients with myasthenia gravis: follow up survey
Introduction
We previously conducted a survey study in April 2020 at the beginning of the SARS-CoV-2 (COVID-19) pandemic to understand how it affected patients with myasthenia gravis (MG). Since then, significant advances have occurred in the following areas: knowledge about the SARS-CoV-2 virus, infection risk mitigation, patient management, risks for MG patients, and a global vaccination program. We conducted a follow-up survey in February 2021 to assess how these advances impacted the care and perception of MG patients.
Methods
We conducted a prospective online survey study of MG patients at a large academic practice in the Duke Health System.
Results
Seventy-eight patients participated in the survey including 55 from previous survey and 23 newly identified patients. The top reported change in the interaction with healthcare providers was an increase in telemedicine visits (74%). The median satisfaction score (0-100 scale) for telemedicine visits was 74. Ninety-six percent of survey participants expressed concern about pandemic and nearly half of participants showed anxiety based on Generalized Anxiety Disorder-7 score. The top 3 concerns related to COVID-19 were getting hospitalized (62%), exacerbation (62%) and death (53%).
Discussion
Although the results of follow-up survey were overall similar to the previous study, most of patients switched from in-person clinic visits to telemedicines. The overwhelmingly large portion of patients continue to have concern and anxiety for pandemic but the patients with severe symptoms have higher anxiety scores.
Conclusion
This follow-up survey demonstrated the adjustment of MG patients to new methods of communication, significant psychological impact of COVID-19 on them and their good healthcare literacy.  
Knowledge and perceptions of the COVID-19 pandemic among patients with myasthenia gravis: follow up survey
Introduction
We previously conducted a survey study in April 2020 at the beginning of the SARS-CoV-2 (COVID-19) pandemic to understand how it affected patients with myasthenia gravis (MG). Since then, significant advances have occurred in the following areas: knowledge about the SARS-CoV-2 virus, infection risk mitigation, patient management, risks for MG patients, and a global vaccination program. We conducted a follow-up survey in February 2021 to assess how these advances impacted the care and perception of MG patients.
Methods
We conducted a prospective online survey study of MG patients at a large academic practice in the Duke Health System.
Results
Seventy-eight patients participated in the survey including 55 from previous survey and 23 newly identified patients. The top reported change in the interaction with healthcare providers was an increase in telemedicine visits (74%). The median satisfaction score (0-100 scale) for telemedicine visits was 74. Ninety-six percent of survey participants expressed concern about pandemic and nearly half of participants showed anxiety based on Generalized Anxiety Disorder-7 score. The top 3 concerns related to COVID-19 were getting hospitalized (62%), exacerbation (62%) and death (53%).
Discussion
Although the results of follow-up survey were overall similar to the previous study, most of patients switched from in-person clinic visits to telemedicines. The overwhelmingly large portion of patients continue to have concern and anxiety for pandemic but the patients with severe symptoms have higher anxiety scores.
Conclusion
This follow-up survey demonstrated the adjustment of MG patients to new methods of communication, significant psychological impact of COVID-19 on them and their good healthcare literacy.  
Molecular mechanism of cerebral edema improvement via IL-1RA released from the stroke-unaffected hindlimb by treadmill exercise after cerebral infarction in rats
Cerebral edema following cerebral infarction can be severe and directly affect mortality and mobility. Exercise therapy after cerebral infarction is an effective therapeutic approach; however, the molecular mechanism remains unclear. Myokines such as interleukin-1 receptor antagonist (IL-1RA) are released during skeletal muscle contraction with effects on other organs. We hypothesized that myokine release during exercise might improve brain edema and confirmed the hypothesis using transient middle cerebral artery occlusion (tMCAO) model rats. Rats subjected to tMCAO were divided according to the severity of illness and further assigned to exercise and non-exercise groups. Treadmill exercises were performed at a speed of 2–8 m/min for 10 min from 1–6 days post-reperfusion after tMCAO. Exercise significantly reduced edema and neurological deficits in severely ill rats, with a reduction in aquaporin-4 (AQP4) expression in the ischemic core and increased blood IL-1RA release from the stroke-unaffected hindlimb muscle after tMCAO. Administration of IL-1RA into the lateral ventricles significantly reduced edema and AQP4 expression in the ischemic core. In conclusion, treadmill exercise performed in the early phase of stroke onset alleviated the decrease in blood IL-1RA following ischemic stroke. IL-1RA administration decreased astrocytic AQP4 expression in the ischemic core, suppressing brain edema.Gono R., Sugimoto K., Yang C., et al. Molecular mechanism of cerebral edema improvement via IL-1RA released from the stroke-unaffected hindlimb by treadmill exercise after cerebral infarction in rats. Journal of Cerebral Blood Flow and Metabolism, 43(5), 812-827. © 2023 SAGE Publishing. DOI: 10.1177/0271678X231151569
Description and Discussion on DCASE 2022 Challenge Task 2: Unsupervised Anomalous Sound Detection for Machine Condition Monitoring Applying Domain Generalization Techniques
We present the task description and discussion on the results of the DCASE
2022 Challenge Task 2: ``Unsupervised anomalous sound detection (ASD) for
machine condition monitoring applying domain generalization techniques''.
Domain shifts are a critical problem for the application of ASD systems.
Because domain shifts can change the acoustic characteristics of data, a model
trained in a source domain performs poorly for a target domain. In DCASE 2021
Challenge Task 2, we organized an ASD task for handling domain shifts. In this
task, it was assumed that the occurrences of domain shifts are known. However,
in practice, the domain of each sample may not be given, and the domain shifts
can occur implicitly. In 2022 Task 2, we focus on domain generalization
techniques that detects anomalies regardless of the domain shifts.
Specifically, the domain of each sample is not given in the test data and only
one threshold is allowed for all domains. Analysis of 81 submissions from 31
teams revealed two remarkable types of domain generalization techniques: 1)
domain-mixing-based approach that obtains generalized representations and 2)
domain-classification-based approach that explicitly or implicitly classifies
different domains to improve detection performance for each domain.Comment: arXiv admin note: substantial text overlap with arXiv:2106.0449
Methotrexate-associated lymphoproliferative disorder with multiple pulmonary nodules and bilateral cervical lymphadenopathy
As has been well recognized, methotrexate (MTX) leads to a state of immunosuppression and can provide a basis for the development of lymphoproliferative disorders (LPDs). MTX-associated LPDs can affect nodal sites as well as extranodal sites, though the manifestation of an LPD in the form of multiple pulmonary nodules is rare. Here, we report two cases of MTX-associated LPD with multiple bilateral pulmonary nodules, which was a finding suggestive of lung cancer, and bilateral cervical lymphadenopathy. After withdrawal of MTX, the multiple bilateral pulmonary nodules and bilateral cervical lymphadenopathy disappeared without chemotherapy in both cases. From these results, patients with pulmonary nodules and cervical lymphadenopathy should be examined for head and neck malignant tumors. Also, physicians should carefully check the administration of MTX. In patients with an MTX-associated LPD, we need to make an early diagnosis and consider discontinuing the administration of MTX as soon as possible
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