Autism Spectrum Disorder Detection by Hybrid Convolutional Recurrent Neural Networks from Structural and Resting State Functional MRI Images

This study aims to increase the accuracy of autism spectrum disorder (ASD) diagnosis based on cognitive and behavioral phenotypes through multiple neuroimaging modalities. We apply machine learning (ML) algorithms to classify ASD patients and healthy control (HC) participants using structural magnetic resonance imaging (s-MRI) together with resting state functional MRI (rs-f-MRI and f-MRI) data from the large multisite data repository ABIDE (autism brain imaging data exchange) and identify important brain connectivity features. The 2D f-MRI images were converted into 3D s-MRI images, and datasets were preprocessed using the Montreal Neurological Institute (MNI) atlas. The data were then denoised to remove any confounding factors. We show, by using three fusion strategies such as early fusion, late fusion, and cross fusion, that, in this implementation, hybrid convolutional recurrent neural networks achieve better performance in comparison to either convolutional neural networks (CNNs) or recurrent neural networks (RNNs). The proposed model classifies subjects as autistic or not according to how functional and anatomical connectivity metrics provide an overall diagnosis based on the autism diagnostic observation schedule (ADOS) standard. Our hybrid network achieved an accuracy of 96% by fusing s-MRI and f-MRI together, which outperforms the methods used in previous studies

Protez kalp kapak trombozu olan hastalarda trombolitik tedavininhemen sonrasında endotel fonksiyonlarında gözlenen iyileşme

Objective: Prosthetic valve thrombosis (PVT) is a serious complication among patients with prosthetic heart valves. Thrombolytic therapy (TT) is now widely used as first-line treatment for PVT. Endothelial dysfunction has previously been reported in patients with PVT. The aim of this study was to investigate the changes in endothelial function soon after TT in PVT patients.Methods: The study group included 85 patients with PVT [female: 53 (62.3%); age: 48.7 +/- 13.9 years] who were evaluated prospectively before and shortly after TT. All of the patients were evaluated using transthoracic and transesophageal echocardiography. TT was administered in all cases with a low-dose, ultra-slow infusion regimen. Endothelial function was evaluated using a noninvasive measurement of flow-mediated dilatation (FMD) of the brachial artery during reactive hyperemia.Results: The study population included 38 (44.7%) obstructive and 47 (55.3%) non-obstructive PVT patients. The obstructive PVT patients had lower baseline FMD values than the non-obstructive PVT group (5.31 +/- 0.76% vs. 5.87 +/- 0.84%; p=0.003). TT was successful in 79 patients (92.9%). FMD was significantly increased in the successfully thrombolyzed patients after TT (5.65 +/- 0.86% vs. 7.13 +/- 1.26%; p<0.001). There was no significant difference in the FMD values after TT in patients who were unresponsive to TT (5.07 +/- 0.61% vs. 5.38 +/- 0.95%; p=0.371). There was a significant increase in FMD values after TT in patients with obstructive PVT (5.31 +/- 0.76% vs. 8.22 +/- 1.15%; p<0.001). However, this difference was not statistically significant for patients with non-obstructive PVT (5.87 +/- 0.84% vs. 6.11 +/- 0.95%; p=0.276).Conclusion: This study demonstrated that successful TT may contribute to improvement of impaired endothelial function in patients with obstructive PVT.Amaç: Protez kapak trombozu (PKT) gelişimi protez kalpkapaklı hastalarda ciddi bir komplikasyondur. Son zamanlarda trombolitik tedavi (TT) PKT tedavisinde ilk tercih olarakyaygın olarak kullanılmaktadır. Daha önceki çalışmalarda PKThastalarında endotel disfonksiyonunun varlığı bildirilmiştir.Bu çalışmada, PKT hastalarında TT sonrasında endotelfonksiyonlarında olan değişiklikleri araştırmayı amaçladık.Yöntemler: Bu çalışmaya TT öncesi ve sonrası prospektifolarak takip edilen 85 PKT hastası [kadın: 53 (%62,3), ortalama yaş: 48,7±13,9 yıl] dahil edildi. Tüm hastalar transtorasik ve transözofajiyal ekokardiyografi ile değerlendirildi. Tümhastalarda düşük doz ultra yavaş infüzyon rejimine göre TTuygulandı. Endotel fonksiyonları reaktif hipereminin nedenolduğu akım aracılı genişleme (Flow Mediated Dilation, FMD)ölçülmesi ile değerlendirildi.Bulgular: Çalışmaya 38 (%44,7) tıkayıcı ve 47 (%55,3)tıkayıcı olmayan PKT hastası alındı. Tıkayıcı PKT hastalarıtıkayıcı olmayan PKT hastalarına göre daha düşük bazal FMDdeğerlerine sahiplerdi (%5,31±0,76 ve %5,87±0,84; p=0,003).TT 79 (%92,9) PKT hastasında başarılı idi. Ortama FMDdeğerleri başarılı TT grubunda TT sonrasında anlamlı olarakyükseldi (%5,65±0,86 ve %7,13±1,26; p<0,001). BaşarısızTT grubunda TT sonrası FMD değerlerinde anlamlı değişiklikizlenmedi (%5,07±0,61 ve %5,38±0,95; p=0,371). TıkayıcıPKT olan hastalarda TT sonrasında FMD değerleri anlamlıolarak yükseldi (%5,31±0,76 ve %8,22±1,15; p<0,001).Fakat, tıkayıcı olmayan PKT hastalarında TT sonrası FMDdeğerlerinde anlamlı değişiklik izlenmedi (%5,87±0,84 ve%6,11±0,95; p=0,276).Sonuç: Bu çalışmada, tıkayıcı PKT hastalarında başarılıTT’nin bozulan endotel fonksiyonlarının düzelmesine katkısunabildiği gösterilmiştir

Strangüle ve inkarsere hernilerin değerlendirilmesinde yeni bir teknik: Near infrared spectroscopy

ABSTRACT BACKGROUND: The present study aims to investigate the usefulness of NIRS in identifying decreased blood flow in intestinal tissue inside the hernial sac in incarcerated hernias. METHODS: Forty patients with manually irreducible inguinal hernias and with ileus determined by clinical findings and imaging were included in this study. Patients’ intestinal oxygenatıons were measured by placing NIRS probes over the areas of inguinal hernia and over non-herniated areas immediately lateral to these. Differences in oxygenation between normal and herniated areas were evaluated. RESULTS: Forty patients, 14 women (35.0%) and 26 (65.0%) men, with a mean age of 65±14, were enrolled in this study. Intestinal oxygenation was lower in areas of irreducible hernia compared to normal regions (p<0.001). Incarceration and/or strangulation were detected when hernial sacs with low intestinal oxygenation were operated on. Low NIRS measurements were able to identify incarceration and/or strangulation in the intestine but were unable to distinguish between them. CONCLUSION: In conclusion, in the light of the findings of this study, although not capable of differentiating incarceration from strangulation, NIRS appears to be a good method for showing impaired intestinal oxygenation. NIRS can be used to support ultrasonography findings in irreducible hernias. Therefore, this technique could be used in the future to evaluate and monitor intestinal oxygenation in the Emergency Department.AMAÇ: Bu çalışmamızın amacı, redükte edilemeyen inguinal hernilerde bağırsak oksijenizasyonunu değerlendirmek için yeni bir yöntem olan near infrared spektrofotometri (NIR) spektroskopi tekniğini kullanmaktır. Böylece erken dönemde bağırsak oksijenizasyonu hakkında bilgi edinmeyi ve NIRS’nin kullanılabilirliğini değerlendirmeyi amaçladık. GEREÇ VE YÖNTEM: Çalışmamıza inguinal hernileri olup elle redükte edilemeyen ve klinik bulgu ve görüntüleme yöntemleri ile ileus tespit edilen 40 hasta alındı. Hastaların inguninal herni olan bölgeleri ile tam lateralinde herni olmayan bölgelerine NIRS propları yapıştırılarak bağırsak oksijenizasyonları ölçüldü. Normal ve herni olan bölgeler arasındaki oksijenizasyon farkları değerlendirildi. BULGULAR: Yaş ortalaması 65±14 olan, 14’ü kadın (%35.0) ve 26’sı erkek (%65.0) toplam 40 hasta bu çalışmaya alındı. Hastaların redükte edilemeyen herni bölgesinde bağırsak oksijenizasyonları normal bölgelerine göre düşüktü (p<0.001). Bağırsak oksijenizasyonları düşük olan inguinal herni keseleri ameliyat edildiğinde inkarserasyon ve/veya strangülasyon tespit edildi. NIRS ölçümlerinin düşük ölçülmesi bağırsaktaki inkarserasyon ve/ veya strangülasyonu tespit edebiliyordu fakat ikisi birbirinden ayırt edilemiyordu. TARTIŞMA: Bu çalışmanın bulguları ışığında, strangülasyondan hapsedilmeyi ayırt edememesine rağmen, NIRS bozulmuş bağırsak oksijenasyonu için iyi bir yöntem olarak görünmektedir. NIRS, indirgenemez fıtıklarda ultrasonografi bulgularını desteklemek için kullanılabilir. Bu nedenle, gelecekte acil serviste bağırsak oksijenasyonunu değerlendirmek ve izlemek için bu teknik kullanılabili

Nevsehir Hacı Bektas Veli University International Professional Education Conference (IPEC) 23-29 August 2021

Nevşehir Hacı Bektaş Veli Üniversitesi Uluslararası Profesyonel Eğitim Konferansı (IPEC) 23-29 Ağustos 2021 bildiri özetler

Comparison of Different Anticoagulation Regimens Regarding Maternal and Fetal Outcomes in Pregnant Patients With Mechanical Prosthetic Heart Valves (from the Multicenter ANATOLIA-PREG Registry)

Mechanical prosthetic heart valves (MPHVs) are highly thrombogenic, and a pregnancyinduced procoagulant status increases the risk of MPHV thrombosis. Despite numerous case reports, 2 major registries and meta-analyses/systematic reviews, optimal anticoagulation therapy during pregnancy remains controversial. The goal of this study was to evaluate different anticoagulation regimens in pregnant patients with MPHVs. The outcomes of anticoagulation regimens were assessed retrospectively in pregnant women (110 women; 155 pregnancies) with MPHVs. The study population was divided into 5 groups according to anticoagulation regimens used; high-dose warfarin (>5 mg/d) throughout pregnancy (group 1), low-dose warfarin (<= 5 mg/d) throughout pregnancy (group 2), low molecular weight heparin (LMWH) throughout pregnancy (group 3), first trimester LMWH, 2nd and 3rd trimester warfarin (group 4), first 2 trimester LMWH, and 3rd trimester warfarin (group 5). Of 155 pregnancies, 55 (35%) resulted in fetal loss; whereas 41 (27%) cases with abortion (miscarriage and therapeutic) and 14 (9%) stillbirths occurred. The comparison of the groups showed that the whole abortion rates including therapeutic abortion were significantly higher in Group 1, and lower in groups 3 and 5 (p <0.001). However, miscarriage rates were similar between the groups. A total of 53 pregnancies (34%) suffered from prosthetic valves thrombosis (PVT) during pregnancy or in the postpartum period. Group 2 had significantly lower rates of PVT than the other groups (p <0.001). In conclusion, the current data suggests that there is no optimal therapy, and that all managements have advantages and disadvantages. Low-dose warfarin (<= 5 mg/day) regimen with therapeutic international normalized ratio levels may provide effective maternal protection throughout pregnancy with acceptable fetal outcomes. (C) 2020 Elsevier Inc. All rights reserved

Thrombolysis or Surgery in Patients With Obstructive Mechanical Valve Thrombosis The Multicenter HATTUSHA Study

BACKGROUND Prosthetic valve thrombosis (PVT) is one of the life-threatening complications of prosthetic heart valve replacement. Due to the lack of randomized controlled trials, the optimal treatment of PVT remains controversial between thrombolytic therapy (TT) and surgery. OBJECTIVES This study aimed to prospectively evaluate the outcomes of TT and surgery as the first-line treatment strategy in patients with obstructive PVT. METHODS A total of 158 obstructive PVT patients (women: 103 [65.2%]; median age 49 years [IQR: 39-60 years]) were enrolled in this multicenter observational prospective study. TT was performed using slow (6 hours) and/or ultraslow (25 hours) infusion of low-dose tissue plasminogen activator (t-PA) (25 mg) mostly in repeated sessions. The primary endpoint of the study was 3-month mortality following TT or surgery. RESULTS The initial management strategy was TT in 83 (52.5%) patients and surgery in 75 (47.5%) cases. The success rate of TT was 90.4% with a median t-PA dose of 59 mg (IQR: 37.5-100 mg). The incidences of outcomes in surgery and TT groups were as follows: minor complications (29 [38.7%] and 7 [8.4%], respectively), major complications (31 [41.3%] and 5 [6%], respectively), and the 3-month mortality rate (14 [18.7%] and 2 [2.4%], respectively). CONCLUSIONS Low-dose and slow/ultraslow infusion of t-PA were associated with low complications and mortality and high success rates and should be considered as a viable treatment in patients with obstructive PVT. (J Am Coll Cardiol 2022;79:977-989) (c) 2022 by the American College of Cardiology Foundation