Impact of System and Diagnostic Errors on Medical Litigation Outcomes: Machine Learning-Based Prediction Models

No prediction models using use conventional logistic models and machine learning exist for medical litigation outcomes involving medical doctors. Using a logistic model and three machine learning models, such as decision tree, random forest, and light-gradient boosting machine (LightGBM), we evaluated the prediction ability for litigation outcomes among medical litigation in Japan. The prediction model with LightGBM had a good predictive ability, with an area under the curve of 0.894 (95% CI; 0.893-0.895) in all patients' data. When evaluating the feature importance using the SHApley Additive exPlanation (SHAP) value, the system error was the most significant predictive factor in all clinical settings for medical doctors' loss in lawsuits. The other predictive factors were diagnostic error in outpatient settings, facility size in inpatients, and procedures or surgery settings. Our prediction model is useful for estimating medical litigation outcomes

Complication of Type 1 Diabetes in Craniofacial and Dental Hard Tissue

Diabetes mellitus (DM) is a chronic systemic disease arisen under the conditions when the body cannot produce enough insulin or cannot use it effectively. Type 1 diabetes is caused by an autoimmune reaction, where the body’s defense system attacks the insulin-producing β-cells in the pancreas. Type 1 diabetes incidence has been rising all over the world, especially under the age of 15 years. There are strong premonitions of geographic difference; however, the overall annual increase in a number of affected population is estimated to be approximately 3%

Guillain-Barré syndrome complicated by posterior reversible encephalopathy syndrome and reversible cerebral vasoconstriction syndrome

Introduction: Guillain-Barré syndrome is an immune-mediated inflammatory polyneuritis characterised by rapidly progressive flaccid paralysis. Guillain-Barré syndrome may present with posterior reversible encephalopathy syndrome or reversible cerebral vasoconstriction syndrome in rare cases. Case description: A woman in her 60s with a history of follicular lymphoma presented with a one-week history of difficulty walking and thunderclap headaches. The patient was diagnosed with Guillain-Barré syndrome based on neurological examination, cerebrospinal fluid analysis and nerve conduction findings. Further diagnosis of posterior reversible encephalopathy and reversible cerebral vasoconstriction syndromes was based on imaging findings and headache history. The patient was treated with intravenous immunoglobulin and amlodipine, and symptoms improved. Discussion: We reviewed the literature on Guillain-Barré syndrome associated with posterior reversible encephalopathy and/or reversible cerebral vasoconstriction syndrome. The underlying pathophysiology may involve dysautonomia resulting in unstable blood pressure, and hyponatraemia causing endothelial dysfunction. The SNOOP mnemonic highlights the ‘red flags’. This SNOOP mnemonic suggests the possibility of secondary headaches that require imaging studies. In this case, the patient exhibited three SNOOP symptoms: S (history of malignancy: follicular lymphoma), O (sudden-onset headache) and O (over 50 years old). Conclusion: This case highlights the importance of considering coexisting central neurological disorders in patients with Guillain-Barré syndrome

Hydrochloric Acid Leaching of Cobalt-Rich Ferromanganese Crust using Hydrogen Peroxide and Sodium Sulfite as Reducing Agents

Hydrochloric acid leaching of Co, Ni, Cu, Mn and Fe from the cobalt-rich ferromanganese crust under reducing conditions was performed using hydrogen peroxide and sodium sulfite as reducing agents. Hydrochloric acid concentration more than 3.0 mol/dm3 is required to obtain the high extraction of Co and Ni without reducing agents at ambient temperature. The high extraction of Cu in dilute hydrochloric acid solution without reducing agents at ammbient temperature explains the different form of Cu from other metals present in cobalt-rich ferromanganese crusts. When hydrogen peroxide or sodium sulfite was used as reducing agent, the high extraction of Co and Ni was obtained with dilute hydrochloric acid at ambient temperature. In particular, hydrogen peroxide extracts metals in stoichiometric amounts. The extraction of Ni depends significantly on the leaching temperature, regardless of the presence or absence of reducing agents

Orbifold Family Unification in SO(2N) Gauge Theory

We study the possibility of family unification on the basis of SO(2N) gauge theory on the five-dimensional space-time, $M^4\times S^1/Z_2$. Several SO(10), $SU(4) \times SU(2)_L \times SU(2)_R$ or SU(5) multiplets come from a single bulk multiplet of SO(2N) after the orbifold breaking. Other multiplets including brane fields are necessary to compose three families of quarks and leptons.Comment: 28 page

Clusterin is a potential molecular predictor for ovarian cancer patient's survival: targeting Clusterin improves response to paclitaxel

<p>Abstract</p> <p>Background</p> <p>Clusterin is a cytoprotective chaperone protein involved in numerous physiological processes, carcinogenesis, tumor growth and tissue remodelling. The purpose of this study was to investigate whether clusterin (CLU), an antiapoptotic molecule, could be a potential predictor molecule for ovarian cancer and whether or not targeting this molecule can improve survival of ovarian cancer patients.</p> <p>Methods</p> <p>Clusterin expression was compared between ten primary and their recurrent tumors from same patients immunohistochemically. We analyzed prognostic significance of CLU expression in another 47 ovarian cancer tissue samples by immunohistochemistry. We used small interference RNA to knock down CLU in the chemo-resistant ovarian cancer cell lines. KF-TX and SKOV-3-TX, paclitaxel-resistant ovarian cancer cells, were established from parental KF and SKOV-3 chemo-sensitive cell lines, respectively. Either siRNA or second generation antisense oligodeoxynucleotide against CLU (OGX-011), which is currently evaluated in clinical phase II trials in other cancer s, was used to modulate sensitivity to paclitaxel (TX) in ovarian cancer cells <it>in vitro</it>. Cellular viability assay, FACS analysis and annexin V staining were used to evaluate the comparative effect of CLU knocking down in ovarian cancer cells.</p> <p>Results</p> <p>Immunohistochemical analysis of CLU expression in primary ovarian cancer tissue specimens and their recurrent counterparts from same patients demonstrated higher expression of CLU in the recurrent resistant tumors compared with their primary tumors. High expression of CLU by immunohistochemistry among 47 surgical tissue specimens of early-stage (stage I/II) ovarian cancer, who underwent complete cytoreduction as a primary surgery, significantly related to poor survival, while none of other clinicopathological factors analyzed were related to survival in this patient cohort. Secretory CLU (s-CLU; 60 KDa) expression was upregulated in TX-resistant ovarian cancer cells compared to parental cells. Transfection of siRNA or OGX-011 clearly reduced CLU expression. Cell viability assay, FACS analysis and annexin V staining demonstrated that targeting CLU expression by siRNA or OGX-011 sensitized ovarian cancer cells to TX.</p> <p>Conclusion</p> <p>We conclude that CLU could be a potential molecular target to predict survival while targeting this s-CLU may improve survival of patients with ovarian cancer.</p

Acute Hydrocephalus Associated with Streptococcus anginosus Meningitis

Introduction: Meningitis-related acute hydrocephalus is rare, challenging to diagnose, and has a high mortality rate.  Case description: Here we describe the case of a 76-year-old patient diagnosed with bacterial meningitis who developed acute hydrocephalus and subsequently died.  Discussion: Although meningitis-related acute hydrocephalus is usually non-occlusive, occlusive hydrocephalus may also occur. Moreover, worsening hydrocephalus despite cerebrospinal fluid drainage should prompt a diagnosis of obstructive hydrocephalus. In such conditions, potential management strategies include ventriculoperitoneal shunt and endoscopic third ventriculostomy. Conclusion: In patients with meningitis-related hydrocephalus, worsening despite appropriate antibiotic administration, treatment may be complicated by ventriculitis and obstructive hydrocephalus, which can be fatal. If intracranial pressure is not medically controlled, bilateral decompression craniectomy should be considered as a potential management strategy