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This study aimed to increase the knowledge on how to enhance the performance of artificial intelligence (AI)-enabled electrocardiography (ECG) to detect atrial fibrillation (AF) on sinus rhythm ECG (SR-ECG).
It is a retrospective analysis of a single-center, prospective cohort study (Shinken Database). We developed AI-enabled ECG using SR-ECG to predict AF with a convolutional neural network (CNN). Among new patients in our hospital (n=19,170), 276 AF label (having ECG on AF [AF-ECG] in the ECG database) and 1896 SR label with following three conditions were identified in the derivation dataset (1) without structural heart disease, (2) in AF label, SR-ECG was taken within 31days from AF-ECG, and (3) in SR label, follow-up≥1,095days. Three patterns of AF label were analyzed by timing of SR-ECG to AF-ECG (before/after/before-or-after, CNN algorithm 1 to 3). The outcome measurement was area under the curve (AUC), sensitivity, specificity, accuracy, and F1 score. As an extra-testing dataset, the performance of AI-enabled ECG was tested in patients with structural heart disease.
The AUC of AI-enabled ECG with CNN algorithm 1, 2, and 3 in the derivation dataset was 0.83, 0.88, and 0.86, respectively; when tested in patients with structural heart disease, 0.75, 0.81, and 0.78, respectively.
We confirmed high performance of AI-enabled ECG to detect AF on SR-ECG in patients without structural heart disease. The performance enhanced especially when SR-ECG after index AF-ECG was included in the algorithm, which was consistent in patients with structural heart disease.
We confirmed high performance of AI-enabled ECG to detect AF on SR-ECG in patients without structural heart disease. The performance enhanced especially when SR-ECG after index AF-ECG was included in the algorithm, which was consistent in patients with structural heart disease.
The release of lipid-laden plaque material subsequent to ST-segment elevation myocardial infarction (STEMI) may contribute to the no-reflow phenomenon. The aim of this study was to investigate the association between in vivo cholesterol crystals (CCs) detected by optical coherence tomography (OCT) and the no-reflow phenomenon after successful percutaneous coronary intervention (PCI) in patients with acute STEMI.
We investigated 182 patients with STEMI. Based on the thrombolysis in myocardial infarction (TIMI) flow grade after PCI, patients were divided into a no-reflow group (n=31) and a reflow group (n=151). On OCT, CCs were defined as thin, high-signal intensity regions within a plaque. A multivariable logistic regression analysis was performed to determine predictors for the no-reflow phenomenon.
The prevalence of CCs was higher in the no-reflow group than the reflow group (no-reflow group, 77% vs. reflow group, 53%; p=0.012). The multivariable logistic model showed that the CC number, lipid arc and ostial lesions were positive independent predictors of no-reflow. The combination of a lipid arc≥139°and CC number≥12 showed good predictive performance for the no-reflow phenomenon (sensitivity, 48%; specificity, 93%; and accuracy, 86%).
In vivo CCs at the culprit plaque are associated with the no-reflow phenomenon after PCI in patients with STEMI. The combination of the number of CCs and lipid arc can predict the no-reflow phenomenon after PCI with a high accuracy of 86%.
In vivo CCs at the culprit plaque are associated with the no-reflow phenomenon after PCI in patients with STEMI. The combination of the number of CCs and lipid arc can predict the no-reflow phenomenon after PCI with a high accuracy of 86%.
Automated speech analysis has emerged as a scalable, cost-effective tool to identify persons with Alzheimer's disease dementia (ADD). Yet, most research is undermined by low interpretability and specificity.
Combining statistical and machine learning analyses of natural speech data, we aimed to discriminate ADD patients from healthy controls (HCs) based on automated measures of domains typically affected in ADD semantic granularity (coarseness of concepts) and ongoing semantic variability (conceptual closeness of successive words). To test for specificity, we replicated the analyses on Parkinson's disease (PD) patients.
Relative to controls, ADD (but not PD) patients exhibited significant differences in both measures. Also, these features robustly discriminated between ADD patients and HC, while yielding near-chance classification between PD patients and HCs.
Automated discourse-level semantic analyses can reveal objective, interpretable, and specific markers of ADD, bridging well-established neuropsychological targets with digital assessment tools.
Automated discourse-level semantic analyses can reveal objective, interpretable, and specific markers of ADD, bridging well-established neuropsychological targets with digital assessment tools.
Studies show that there is a mental health selection into marriage among the general population. This study explored the association between mental disorder and marriage formation among non-Western migrant women living in Norway, and whether the association varied with region of origin, income, education and having a dependent child.
Using linked national register data, we followed 49,329 non-Western never married migrant women aged 18-60 living in Norway between 2006 and 2014. As a proxy for mental disorders, we investigated whether outpatient mental health service use was associated with marital formation using discrete time logistic regression analyses.
Overall, outpatient mental health service use was associated with lower odds of marital formation, even after controlling for sociodemographic factors. Interaction analyses suggested that the relationship was weaker for South Asian women, who had the highest odds of marriage formation, compared with Sub-Saharan African women, who had the lowest. The relationship was also stronger for women with children and women with low incomes.
Mental health selection effects may depend on the universality of marriage. Since marriage may be associated with psychosocial and economic benefits, it is important to identify and treat mental disorder among non-Western migrant women, particularly those with childcare responsibilities and low income.
Mental health selection effects may depend on the universality of marriage. Since marriage may be associated with psychosocial and economic benefits, it is important to identify and treat mental disorder among non-Western migrant women, particularly those with childcare responsibilities and low income.Traumatic tricuspid valve injury is rare, accounting for 0.02% of traumatic injuries. The majority of cases result from blunt force trauma to the chest, however penetrating injuries have been documented in literature. Patients' can be in the full spectrum of disease, from asymptomatic to cardiogenic shock. Indications for surgery include right heart failure or evidence of right heart volume overload in the setting of significant tricuspid regurgitation. Early surgical repair is warranted to preserve right ventricular function. Surgery also needs to be planned in conjunction with the patients' other injuries. In some cases, it may be beneficial for surgery to be delayed whilst the patient is closely observed, in order for the patient to recover from concomitant injuries. We report two cases of tricuspid regurgitation in the context of blunt trauma, and our approach to the management of these patients.
Primary small cell ovarian cancer of pulmonary type (SCCOPT) remains a rare ovarian tumor. Its aggressive nature is associated with poor survival outcomes. Current treatment algorithms rely on systemic chemotherapy, primarily involving platinum agents. However, given its low incidence, less is known about the potential benefits of other treatments.
We report a case of an 80-year-old woman who was found to have a complex pelvic mass with a mildly elevated CA-125. She underwent a laparotomy for staging with tumor debulking; she had bulky unresectable adenopathy and pathology was consistent with stage IIIC SCCOPT. Postoperative imaging revealed progression of disease. see more She received six cycles of carboplatin and etoposide followed by consolidative radiation therapy to her
-aortic lymph nodes. She remains disease-free for over four years after completion of adjuvant therapy.
Histologically, SCCOPT resembles small cell carcinomas of the lung, which are treated with a combination of chemotherapy and radiation therapy. New approaches that build upon the current treatment approaches and incorporate strategies from non-gynecologic tumor types could be beneficial.
Histologically, SCCOPT resembles small cell carcinomas of the lung, which are treated with a combination of chemotherapy and radiation therapy. New approaches that build upon the current treatment approaches and incorporate strategies from non-gynecologic tumor types could be beneficial.Epithelioid sarcoma (ES) is rare and aggressive soft tissue neoplasm characterized by tumor cells showing epithelioid morphology and immunohistochemically, characteristic loss of INI1/ SMARCB1 in most cases. The proximal-type ES usually involves the deeper soft tissues of the vulva or perineum is an extremely rare entity with diagnostic challenges. Surgery is the mainstay of treatment in localized diseases. Radiation and chemotherapy are used in the advanced and metastatic setting, however, their role in the adjuvant setting is uncertain. Anthracycline and gemcitabine-based chemotherapy are given in metastatic and recurrent tumors. We report 4 cases of ES treated over a period of 6 years at our center. All the cases initially presented at a local hospital with vulvar swelling with a benign mimic (3/4) or squamous cell carcinoma (1/4). The median age of diagnosis was 34 years (range 17-80). The diagnosis was established with epithelioid morphology of tumor cells and immunohistochemically characteristic loss of INI1/SMARCB1 in all cases. 3 cases were treated with upfront surgery and two of them received adjuvant radiotherapy. One case received upfront palliative therapy due to lung metastasis at the time of presentation. On median follow-up of 24 months (2-63), 2 cases were disease-free. One case had a recurrence in the lungs and chest wall after a disease-free interval of 63 months. She underwent surgical excision of metastatic deposits, however developed second lung recurrence after 3 months and is being treated with Adriamycin-based chemotherapy. All patients are alive at the last follow-up.This dataset provides a comprehensive snapshot of 277 New Zealand young adult's (M age = 18.93, SD = 3.28) real-time behaviours and experiences during a seven-week nationwide lockdown. Participants were recruited through a university student participant pool and data were collected online during 20-27th April 2020 (Alert Level 4) and 6-13th May 2020 (Alert Level 3), constituting the 26th-33rd and 42nd-49th day (respectively) of a nationwide lockdown to manage the first wave of COVID-19 in Aotearoa New Zealand. Data have been used previously [1]. Data includes participants' self-reported compliance with legally mandated COVID-19 lockdown policies, as well as participants' self-reported knowledge of lockdown policies, lockdown characteristics, trust in government and information sources, COVID-19 specific worries, recent anxiety, depression, and stress symptoms, cognitive reappraisal and expressive suppression use, and Big Five personality traits. The dataset is freely accessible (CC-BY-4.0 license) at https//osf.
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