Machine Learning Model for Predicting Postoperative Survival of Patients with Colorectal Cancer / Journal of the Korean Cancer Association, 대한암학회지

Purpose@#Machine learning (ML) is a strong candidate for making accurate predictions, as we can use large amount of data with powerful computational algorithms. We developed a ML based model to predict survival of patients with colorectal cancer (CRC) using data from two independent datasets. @*Materials and Methods@#A total of 364,316 and 1,572 CRC patients were included from the Surveillance, Epidemiology, and End Results (SEER) and a Korean dataset, respectively. As SEER combines data from 18 cancer registries, internal validation was done using 18-Fold-Cross-Validation then external validation was performed by testing the trained model on the Korean dataset. Performance was evaluated using area under the receiver operating characteristic curve (AUROC), sensitivity and positive predictive values. @*Results@#Clinicopathological characteristics were significantly different between the two datasets and the SEER showed a significant lower 5-year survival rate compared to the Korean dataset (60.1% vs. 75.3%, p < 0.001). The ML-based model using the Light gradient boosting algorithm achieved a better performance in predicting 5-year-survival compared to American Joint Committee on Cancer stage (AUROC, 0.804 vs. 0.736; p < 0.001). The most important features which influenced model performance were age, number of examined lymph nodes, and tumor size. Sensitivity and positive predictive values of predicting 5-year-survival for classes including dead or alive were reported as 68.14%, 77.51% and 49.88%, 88.1% respectively in the validation set. Survival probability can be checked using the web-based survival predictor (http://colorectalcancer.pythonanywhere.com). @*Conclusion@#ML-based model achieved a much better performance compared to staging in individualized estimation of survival of patients with CRC.

Role of non invasive ventilation in limiting re-intubation after planned extubation

Introduction: In critically ill adult patients, particularly patients with chronic obstructive pulmonary disease [COPD], early use of non invasive ventilation [NIV] after weaning may be associated with the decrease of mortality. The effect of this benefit is not so clear in ICU mixed populations

Aim of the work: Compare the efficacy of NIV to Oxygen Mask in preventing re-intubation if NIV was used immediately following planned extubation in patients with respiratory failure of various etiologies requiring mechanical ventilation for more than 48 h

Patients and methods: One hundred and twenty patients were randomly enrolled in this study. Sixty patients assigned to the noninvasive-ventilation group received ventilation through a full facial mask from a BIPAP ventilator located in the intensive care unit immediately after extubation [group I] while the other sixty patients put on oxygen mask group will be [group II] and act as control group

Results: There was no significant difference regarding sex distribution and smoking pattern, also APACHE II score, hemodynamic and electrolytes which might have a role in respiratory failure showed no statistically significant differences between both studied groups .The mean duration of mechanical ventilation was lower in group I than in group II, 6.2 +/- 1.6 versus 7.1 +/- 1.8 days, respectively, however this difference was not significant [p-0.09]. The overall re-intubation rate [15%] was significantly lower in group I compared to group II which was 25% and p-value 0.04. The re-intubation rate of COPD patients in group I was statistically lower than group II [p-0.019]. Hospital mortality rate showed a statistically significant difference between both groups, with four deaths during ICU stay in the NIV group [6.6%], while there were 10 deaths [16.6%] in the Oxygen Mask group [p < 0.035]

Conclusion: Early application of non invasive ventilation could be effective in limiting the need for re-intubation and decrease mortality in electively extubated patients with various aetiologies of respiratory failure. Also selected patients with respiratory failure [COPD] may get more benefit from this therapy

Assessment of synovitis in early rheumatoid arthritis by CXCL13 serum levels and power doppler ultrasonography: correlation with disease activity

Assessment of synovitis in rheumatoid arthritis [RA] is a major issue for proper treatment; it has been proven that high resolution ultrasound [US] examination could be of valuable help. The B-cell chemokine, CXCL13, is a proposed serum biomarker of synovitis in RA. We aimed to find out the presence of synovitis in patients with recent-onset RA and its correlation with disease activity. We evaluated 30 patients with early RA for the presence and degree of synovitis by performing high resolution US and obtaining serum CXCL13 levels. In addition, we correlated these results with disease activity score 28 [DAS 28]. Results of high resolution US and serum CXCL13 were also obtained for 20 healthy age- and sex-matched volunteers and served as controls. Serum CXCL13 level was significantly increased in early RA patients vs. controls [p < 0.001]. High resolution US revealed that RA patients had a significant increased synovial thickness and high power Doppler US score. In RA patients, DAS 28 had a significant correlation with serum CXCL13 [r = 0.42, p = 0.02], synovial thickness [r = 0.39, p = 0.03] and power Doppler US score [r = 0.43, p = 0.02]. Serum CXCL13 level correlated with synovial thickness [r = 0.63, p = 0.001] and power Doppler US score [r = 0.69, p = 0.001] Recent-onset RA patients suffer from synovitis as evidenced by significantly increased serum CXCL13 and by high resolution US. Serum CXCL13 is a reliable marker of synovial inflammation which correlates better with synovial thickening and power Doppler US scores than DAS28

Ureteral stent versus percutaneous nephrostomy for diversion of stone-induced hydronephrosis

Urinary diversion of the obstructed hydronephrosis kidney is indicated by symptoms, such as persistent renal colic, febrile UTI [urosepsis], and uraemia. This study is an attempt to evaluate [PCN] versus ureteral stent in cases of stone-induced hydronephrosis regarding relief of symptoms and quality of life. A total of 40 patients with stone-induced hydronephrosis were randomized into either [PCN] or stent insertion groups. These patients were then evaluated regarding to [a]- the procedure [use of analgesics, x-ray exposure, success of insertion], [b]- relief of accompanying symptoms [duration of diversion, intravenous administration of antibiotics for high temperature]; and [c]- the quality of life. Two groups of patients: [a] - the group of [PCN] has an average age of 55 years, and a male-to-female ratio of 12:8. [b]- The group of ureteral stent has an average age of 49 years, and a male-to-female ratio of 9:11. - [PCN] was successfully completed in 100% of patients and stents were successful in 80%, with a 20% conversion to [secondary PCN].- The x-ray exposure was shorter in the [PCN] group [p = 0. 052].- Administration of analgesics was more frequent in the stent group [p = 0. 061]. - [PCN] indwelling time was shorter [50% less than 2 weeks] than that of stents [25% less than 2 weeks] [p = 0.043]. - Antibiotics were administered for greater than 6 days in 0% of patients who underwent [PCN] versus 70% in those with stents [p = 0.174]. - Reduction in quality of life was moderate but more pronounced in patients with stents compared to those who underwent [PCN], and was more distinct in males and younger patients. The quality of life progressively improved in the course of diversion with [PCN] but deteriorated with stents. Our results demonstrated that [PCN] is superior to ureteral stents when diversion is indicated in cases of stone-induced hydronephrosis, especially in patients with a high temperature, as well as in males

Clinically insignificant residual fragments [CIRFs] after [ESWL]

To assess the significance of asymptomatic residual stone fragments of less than 4 mm [clinically insignificant residual fragments [CIRFs] after extracorporeal shock wave lithotripsy [ESWL]. Eighty-one patients were followed up for 6 to 60 months [mean 15] after ESWL to determine the fate of the CIRFs. -Of the 81 patients, 6 were lost to follow-up, leaving 75 patients. -During follow-up, fragments passed spontaneously in 18 patients, remained stable in 13 patients, and became clinically significant in 44 patients who developed one or more complications. For the latter patients, repeated ESWL was done in 16, percutaneous nephrolithotomy in 3, and ureteroscopic stone removal in 4 patients. The remaining 21 patients were treated conservatively with analgesics. -We found that: a]- 53% of the CIRFs located in the pelvis passed spontaneously, and most of the CIRFs in caliceal location became clinically significant. b]- as the stone burden and number of stone fragments increased, the risk of CIRFs becoming clinically significant increased. c]- The clearance rate was highest in the first 6 months. Finally, as the duration of follow-up increased, the rate of complications increased. Patients with residual stones after ESWL require close follow-up and timely adjuvant therapy. As the number and size of residual fragments increased, the risk of complications increased. A pelvic location was a favorable factor for spontaneous passage. Although the complete clearance rate of CIRFs with repeated ESWL was lower than for the operative interventions, most patients improved with this modality

RVoutflow tract pacing versus RV Apical pathophysiologic Effects and prognostic implications

Right ventricular apical pacing has been reported to be associated with adverse haemodynamic effects and alternative sites of pacing have been recommended. On the other hand RV septal pacing was claimed to be more physiological. The present work is intended to compare the classic right ventricular apical DDD pacing to RV outflow tract [RVOT] pacing in both normal and diseased hearts. We studied 30 patients [pts] with complete heart block [CHB]. Fourteen pts [Group I] had no underlying heart disease [8M and 6F with mean age 64.1 +/- 6.4, range 54-76 years] and 16 [Group II] had heart disease [10M, 6F, with mean age 67.5 +/- 8.9, range 58-86 years] including DCM in 12, 1HD in 3 and RHD in Ipt. Right ventricular apical pacing was conducted in 7pts from group I and 8pts from group II. RVA was conducted in 7pts of group I and 8pts of group II. Besides clinical evaluation, all pts were subjected to 2D echo before, and 6 months after pacing. Echo parameters studied included LVEDD, LVESD, EF% and CO with effects expressed in terms of% changes in various parameters. Compared to RVA pacing RVOT pacing in group I [pts with normal heart] induced insignificant% decrease in LVEDD [2.4 +/- 4.8vs 8.6 +/- 9.3, p value =0.146] or LVESD [4.6 +/- 7.8vs 8.3 +/- 6.0,p value =0.113] and insignificant increase in EF [2.4 +/- 4.6vs 0.42.6, p value =0.113] and CO [2.8 +/- 8.0vs 3.3 +/- 3.5, p value =0.08]. However in RVOT pacing in group II [pts with disease heart] induced significantly greater% decrease in LVEDD [3.0 +/- 2.8vs 1.2 +/- 2.3, p=0.005] in LVESD [3.7 +/- 0.9vs 2.5 +/- 2.3, p=0.000], and significantly greater% increase in EF [8.9 +/- 3.3vs I.7 +/- 1.2,p=0.001] and CO [5.8 +/- 9.6vs 10.7 +/- 18.3, p=0.04] in comparison to RVA pacing in group II In the presence of underlying cardiac dysfunction, DDD pacing by RVOT lead is hemodynamically more advantageous to classic RV apical pacing in terms of improving dimensions and enhancing systolic function. We recommend RVOT pacing in the presence of underlying HD to avoid the so called pacing-induced cardiomyopathy.

Conservative treatment versus mastectomy in the treatment of stage I and II breast cancer

Analysis of the patterns of failure for breast cancer patients who underwent modified mastectomy, or lumpectomy with axillary dissection and radiation therapy, as well as the prognostic factors that have an independent effect on treatment failures and overall survival. Sixty six patients with clinical stage I and II breast cancer were randomly assigned to undergo either modified radical mastectomy or lumpectomy, axillary, dissection and radiation therapy. All patients with positive nodes received adjuvant systemic therapy. Annual mammography was an integral component of the follow-up program. Diagnostic studies for systemic disease were performed as clinically indicated. At five years, overall survival was 79% for patients assigned to mastectomy and 91% for those assigned to lumpectomy [P=0. 97]. Disease-free survival was 74% for patients assigned to mastectomy and 72% for those assigned to lumpectomy [P=0.7]. The rate of local recurrence was 8.8% after mastectomy and 12.5% after lumpectomy [P=0.92]. Breast conservation with lumpectomy and irradiation offers results at five years that are equivalent to those obtained with mastectomy