Symptom clusters and unplanned hospital readmission in Chinese patients with acute myocardial infarction on admission.

Backgroud: Acute myocardial infarction (AMI) has a high morbidity rate, high mortality rate, high readmission rate, high health care costs, and a high symptomatic, psychological, and economic burden on patients. Patients with AMI usually present with multiple symptoms simultaneously, which are manifested as symptom clusters. Symptom clusters have a profound impact on the quality of survival and clinical outcomes of AMI patients. Objective: The purpose of this study was to analyze unplanned hospital readmissions among cluster groups within a 1-year follow-up period, as well as to identify clusters of acute symptoms and the characteristics associated with them that appeared in patients with AMI. Methods: Between October 2021 and October 2022, 261 AMI patients in China were individually questioned for symptoms using a structured questionnaire. Mplus 8.3 software was used to conduct latent class analysis in order to find symptom clusters. Univariate analysis is used to examine characteristics associated with each cluster, and multinomial logistic regression is used to analyze a cluster membership as an independent predictor of hospital readmission after 1-year. Results: Three unique clusters were found among the 11 acute symptoms: the typical chest symptom cluster (64.4%), the multiple symptom cluster (29.5%), and the atypical symptom cluster (6.1%). The cluster of atypical symptoms was more likely to have anemia and the worse values of Killip class compared with other clusters. The results of multiple logistic regression indicated that, in comparison to the typical chest cluster, the atypical symptom cluster substantially predicted a greater probability of 1-year hospital readmission (odd ratio 8.303, 95% confidence interval 2.550-27.031, P < 0.001). Conclusion: Out of the 11 acute symptoms, we have found three clusters: the typical chest symptom, multiple symptom, and atypical symptom clusters. Compared to patients in the other two clusters, those in the atypical symptom cluster-which included anemia and a large percentage of Killip class patients-had worse clinical indicators at hospital readmission during the duration of the 1-year follow-up. Both anemia and high Killip classification suggest that the patient's clinical presentation is poor and therefore the prognosis is worse. Intensive treatment should be considered for anemia and high level of Killip class patients with atypical presentation. Clinicians should focus on patients with atypical symptom clusters, enhance early recognition of symptoms, and develop targeted symptom management strategies to alleviate their discomfort in order to improve symptomatic outcomes.

Fully automatic quantification for hand synovitis in rheumatoid arthritis using pixel-classification-based segmentation network in DCE-MRI.

PURPOSE: A classification-based segmentation method is proposed to quantify synovium in rheumatoid arthritis (RA) patients using a deep learning (DL) method based on time-intensity curve (TIC) analysis in dynamic contrast-enhanced magnetic resonance imaging (DCE-MRI). MATERIALS AND METHODS: This retrospective study analyzed a hand MR dataset of 28 RA patients (six males, mean age 53.7 years). A researcher, under expert guidance, used in-house software to delineate regions of interest (ROIs) for hand muscles, bones, and synovitis, generating a dataset with 27,255 pixels with corresponding TICs (muscle: 11,413, bone: 8502, synovitis: 7340). One experienced musculoskeletal radiologist performed ground truth segmentation of enhanced pannus in the joint bounding box on the 10th DCE phase, or around 5 min after contrast injection. Data preprocessing included median filtering for noise reduction, phase-only correlation algorithm for motion correction, and contrast-limited adaptive histogram equalization for improved image contrast and noise suppression. TIC intensity values were normalized using zero-mean normalization. A DL model with dilated causal convolution and SELU activation function was developed for enhanced pannus segmentation, tested using leave-one-out cross-validation. RESULTS: 407 joint bounding boxes were manually segmented, with 129 synovitis masks. On the pixel-based level, the DL model achieved sensitivity of 85%, specificity of 98%, accuracy of 99% and precision of 84% for enhanced pannus segmentation, with a mean Dice score of 0.73. The false-positive rate for predicting cases without synovitis was 0.8%. DL-measured enhanced pannus volume strongly correlated with ground truth at both pixel-based (r = 0.87, p < 0.001) and patient-based levels (r = 0.84, p < 0.001). Bland-Altman analysis showed the mean difference for hand joints at the pixel-based and patient-based levels were -9.46 mm3 and -50.87 mm3, respectively. CONCLUSION: Our DL-based DCE-MRI TIC shape analysis has the potential for automatic segmentation and quantification of enhanced synovium in the hands of RA patients.

Artificial Intelligence Quantification of Enhanced Synovium Throughout the Entire Hand in Rheumatoid Arthritis on Dynamic Contrast-Enhanced MRI.

BACKGROUND: Challenges persist in achieving automatic and efficient inflammation quantification using dynamic contrast-enhanced (DCE) MRI in rheumatoid arthritis (RA) patients. PURPOSE: To investigate an automatic artificial intelligence (AI) approach and an optimized dynamic MRI protocol for quantifying disease activity in RA in whole hands while excluding arterial pixels. STUDY TYPE: Retrospective. SUBJECTS: Twelve RA patients underwent DCE-MRI with 27 phases for creating the AI model and tested on images with a variable number of phases from 35 RA patients. FIELD STRENGTH/SEQUENCE: 3.0 T/DCE T1-weighted gradient echo sequence (mDixon, water image). ASSESSMENT: The model was trained with various DCE-MRI time-intensity number of phases. Evaluations were conducted for similarity between AI segmentation and manual outlining in 51 ROIs with synovitis. The relationship between synovial volume via AI segmentation with rheumatoid arthritis magnetic resonance imaging scoring (RAMRIS) across whole hands was then evaluated. The reference standard was determined by an experienced musculoskeletal radiologist. STATISTICAL TEST: Area under the curve (AUC) of receiver operating characteristic (ROC), Dice and Spearman's rank correlation coefficients, and interclass correlation coefficient (ICC). A P-value <0.05 was considered statistically significant. RESULTS: A minimum of 15 phases (acquisition time at least 2.5 minutes) was found to be necessary. AUC ranged from 0.941 ± 0.009 to 0.965 ± 0.009. The Dice score was 0.557-0.615. Spearman's correlation coefficients between the AI model and ground truth were 0.884-0.927 and 0.736-0.831, for joint ROIs and whole hands, respectively. The Spearman's correlation coefficient for the additional test set between the model trained with 15 phases and RAMRIS was 0.768. CONCLUSION: The AI-based classification model effectively identified synovitis pixels while excluding arteries. The optimal performance was achieved with at least 15 phases, providing a quantitative assessment of inflammatory activity in RA while minimizing acquisition time. EVIDENCE LEVEL: 3 TECHNICAL EFFICACY: Stage 2.

SEEI: spherical evolution with feedback mechanism for identifying epistatic interactions.

BACKGROUND: Detecting epistatic interactions (EIs) involves the exploration of associations among single nucleotide polymorphisms (SNPs) and complex diseases, which is an important task in genome-wide association studies. The EI detection problem is dependent on epistasis models and corresponding optimization methods. Although various models and methods have been proposed to detect EIs, identifying EIs efficiently and accurately is still a challenge. RESULTS: Here, we propose a linear mixed statistical epistasis model (LMSE) and a spherical evolution approach with a feedback mechanism (named SEEI). The LMSE model expands the existing single epistasis models such as LR-Score, K2-Score, Mutual information, and Gini index. The SEEI includes an adaptive spherical search strategy and population updating strategy, which ensures that the algorithm is not easily trapped in local optima. We analyzed the performances of 8 random disease models, 12 disease models with marginal effects, 30 disease models without marginal effects, and 10 high-order disease models. The 60 simulated disease models and a real breast cancer dataset were used to evaluate eight algorithms (SEEI, EACO, EpiACO, FDHEIW, MP-HS-DHSI, NHSA-DHSC, SNPHarvester, CSE). Three evaluation criteria (pow1, pow2, pow3), a T-test, and a Friedman test were used to compare the performances of these algorithms. The results show that the SEEI algorithm (order 1, averages ranks = 13.125) outperformed the other algorithms in detecting EIs. CONCLUSIONS: Here, we propose an LMSE model and an evolutionary computing method (SEEI) to solve the optimization problem of the LMSE model. The proposed method performed better than the other seven algorithms tested in its ability to identify EIs in genome-wide association datasets. We identified new SNP-SNP combinations in the real breast cancer dataset and verified the results. Our findings provide new insights for the diagnosis and treatment of breast cancer. AVAILABILITY AND IMPLEMENTATION: https://github.com/scutdy/SSO/blob/master/SEEI.zip .

Adaptive Dropout Method Based on Biological Principles.

Dropout is one of the most widely used methods to avoid overfitting neural networks. However, it rigidly and randomly activates neurons according to a fixed probability, which is not consistent with the activation mode of neurons in the human cerebral cortex. Inspired by gene theory and the activation mechanism of brain neurons, we propose a more intelligent adaptive dropout, in which a variational self-encoder (VAE) overlaps to an existing neural network to regularize its hidden neurons by adaptively setting activities to zero. Through alternating iterative training, the discarding probability of each hidden neuron can be learned according to the weights and thus effectively avoid the shortcomings of the standard dropout method. The experimental results in multiple data sets illustrate that this method can better suppress overfitting in various neural networks than can the standard dropout. Additionally, this adaptive dropout technique can reduce the number of neurons and improve training efficiency.

A New Varying-Parameter Recurrent Neural-Network for Online Solution of Time-Varying Sylvester Equation.

Solving Sylvester equation is a common algebraic problem in mathematics and control theory. Different from the traditional fixed-parameter recurrent neural networks, such as gradient-based recurrent neural networks or Zhang neural networks, a novel varying-parameter recurrent neural network, [called varying-parameter convergent-differential neural network (VP-CDNN)] is proposed in this paper for obtaining the online solution to the time-varying Sylvester equation. With time passing by, this kind of new varying-parameter neural network can achieve super-exponential performance. Computer simulation comparisons between the fixed-parameter neural networks and the proposed VP-CDNN via using different kinds of activation functions demonstrate that the proposed VP-CDNN has better convergence and robustness properties.

An improved deep learning approach for detection of thyroid papillary cancer in ultrasound images.

Unlike daily routine images, ultrasound images are usually monochrome and low-resolution. In ultrasound images, the cancer regions are usually blurred, vague margin and irregular in shape. Moreover, the features of cancer region are very similar to normal or benign tissues. Therefore, training ultrasound images with original Convolutional Neural Network (CNN) directly is not satisfactory. In our study, inspired by state-of-the-art object detection network Faster R-CNN, we develop a detector which is more suitable for thyroid papillary carcinoma detection in ultrasound images. In order to improve the accuracy of the detection, we add a spatial constrained layer to CNN so that the detector can extract the features of surrounding region in which the cancer regions are residing. In addition, by concatenating the shallow and deep layers of the CNN, the detector can detect blurrier or smaller cancer regions. The experiments demonstrate that the potential of this new methodology can reduce the workload for pathologists and increase the objectivity of diagnoses. We find that 93:5% of papillary thyroid carcinoma regions could be detected automatically while 81:5% of benign and normal tissue could be excluded without the use of any additional immunohistochemical markers or human intervention.

Frequency-domain model of tonal blade thickness and loading noise.

A tonal thickness noise and loading noise model of rotating blades has been developed as an extension of the exact frequency-domain solutions for rotating monopole and dipole point sources. The present model has two advantages over the previous methods and models for noise prediction. The first is the unified expression for sources in subsonic and supersonic rotation even at rest. The second is that the present model has no limit on the location of the observer and no interpolation error. Two test cases are carried out to validate the present model and emphasize its advantage at the noise prediction for sources in supersonic rotation. Moreover, as a specified application of the present model for the rotating blades whose tip radius is acoustically compact, acoustic energy distribution at different frequencies and in different directions is analyzed. Result shows that the acoustic energy of acoustically compact rotating blades is mainly concentrated at the source frequency while propagating along the axial direction, leaving the rest propagating along the radial direction at the other frequencies.

An exact frequency-domain solution of the sound radiated from the rotating dipole point source.

An exact solution of the acoustic field around the rotating dipole source has been derived by using a series expansion method and the gradient calculation in the spherical and cylindrical coordinate systems which extends a previously published solution for a rotating monopole source. The proposed exact solution establishes an analytical method to predict the sound radiated from the rotating blades once the acoustic sources have been known.