A Heuristic Machine Learning-Based Optimization Technique to Predict Lung Cancer Patient Survival.

Cancer has been a significant threat to human health and well-being, posing the biggest obstacle in the history of human sickness. The high death rate in cancer patients is primarily due to the complexity of the disease and the wide range of clinical outcomes. Increasing the accuracy of the prediction is equally crucial as predicting the survival rate of cancer patients, which has become a key issue of cancer research. Many models have been suggested at the moment. However, most of them simply use single genetic data or clinical data to construct prediction models for cancer survival. There is a lot of emphasis in present survival studies on determining whether or not a patient will survive five years. The personal issue of how long a lung cancer patient will survive remains unanswered. The proposed technique Naive Bayes and SSA is estimating the overall survival time with lung cancer. Two machine learning challenges are derived from a single customized query. To begin with, determining whether a patient will survive for more than five years is a simple binary question. The second step is to develop a five-year survival model using regression analysis. When asked to forecast how long a lung cancer patient would survive within five years, the mean absolute error (MAE) of this technique's predictions is accurate within a month. Several biomarker genes have been associated with lung cancers. The accuracy, recall, and precision achieved from this algorithm are 98.78%, 98.4%, and 98.6%, respectively.

Obstructive sleep apnoea in craniofacial microsomia: analysis of 755 patients.

A retrospective cohort study was set up to analyse the prevalence and treatment of obstructive sleep apnoea (OSA) in relation to the severity of the deformity in patients with craniofacial microsomia (CFM). This study included a population of 755 patients with CFM from three craniofacial centres. Medical charts were reviewed for severity of the deformity, types of breathing difficulty, age at which breathing difficulty first presented, treatment for OSA, and treatment outcome. In total, 133 patients (17.6%) were diagnosed with OSA. Patients with Pruzansky IIB/III classification or bilateral craniofacial microsomia were significantly more often diagnosed with OSA than unilaterally affected patients of Pruzansky I/IIA classification. The initial treatment of OSA consisted of adenotonsillectomy, tracheotomy, or non-invasive positive pressure ventilation. Thirty-seven patients received more than one treatment (range 1-3). In this study, the prevalence of OSA in patients with CFM was higher than the prevalence in the healthy population described in the literature. Although several treatment modalities are available for the treatment of OSA in patients with CFM, treatment should be individualized and based on clinical symptoms, the severity of the deformity, and comorbidities.

A review of mouthguards: effectiveness, types, characteristics and indications for use.

Participation in sport carries an increased risk of sustaining dental trauma which can be reduced by the use of a mouthguard. Mouthguards work by dissipating the force of impact, thus reducing the force which is transferred to the dentition. There are different types of mouthguard available which vary in design, costs and the level of protection provided. This article aims to review the use of mouthguards in sport, the common barriers to their use and also the different types of mouthguards and their characteristics.

The multidisciplinary management of hypodontia: a team approach.

Hypodontia is a frequently encountered condition within general dental practice. Its successful management involves the interplay of a number of clinicians. The general dental practitioner plays a key role in the management of patients. The aim of this short article is to outline some of the principles of the multidisciplinary management of hypodontia with an emphasis on orthodontic treatment.

The role of the general dental practitioner in managing patients who self-harm.

There has been a reported increase in the incidence of self-harm within the United Kingdom. This is of great concern, as a number of studies have shown self-harm to be a major risk factor to completed suicide. However, the identification of self-harm provides an opportunity for support and treatment. Mental health is an area that often receives little attention in the undergraduate dental curriculum. Yet dental practitioners, as healthcare professionals, need to be vigilant for any risk factors or signs of mental illness among their patients and make appropriate onward referrals. The purpose of this article is to examine the current evidence and aspects of self-harm, particularly in young adults and adolescents that are relevant within a dental settling.

The quality of orthodontic practice websites.

OBJECTIVE: To evaluate orthodontic practice websites for the reliability of information presented, accessibility, usability for patients and compliance to General Dental Council (GDC) regulations on ethical advertising. SETTING: World Wide Web. MATERIALS AND METHODS: The term 'orthodontic practice' was entered into three separate search engines. The 30 websites from the UK were selected and graded according to the LIDA tool (a validated method of evaluating healthcare websites) for accessibility, usability of the website and reliability of information on orthodontic treatment. The websites were then evaluated against the GDC's Principles for ethical advertising in nine different criteria. RESULTS: On average, each website fulfilled six out of nine points of the GDC's criteria, with inclusion of a complaints policy being the most poorly fulfilled criteria. The mean LIDA score (a combination of usability, reliability and accessibility) was 102/144 (standard deviation 8.38). The websites scored most poorly on reliability (average 43% SD 11.7), with no single website reporting a clear, reliable method of content production. Average accessibility was 81% and usability 73%. CONCLUSIONS: In general, websites did not comply with GDC guidelines on ethical advertising. Furthermore, practitioners should consider reporting their method of information production, particularly when making claims about efficiency and speed of treatment in order to improve reliability.

The influence of maxillary central incisor height-to-width ratio on perceived smile aesthetics.

OBJECTIVE: To determine the influence of varying the width-to-height ratio of maxillary central incisors on perceived smile aesthetics. DESIGN: Cross-sectional study. SETTING: Postgraduate dental teaching hospital. METHODS: A posed female smile was digitally modified using Adobe Photoshop(®). Three images were created; central incisors with normal form, tooth wear and delayed apical migration. For each image the length of the teeth was altered to create a set of nine images with normal form (66% to 96% width-to-height ratios), and sets of five images with tooth wear and with delayed apical migration (78% to 96% ratios). The images in each set were ranked in order of most to least attractive by 32 dentists, 32 technicians and 32 patients. RESULTS: An 82% width-to-height ratio was perceived as the most attractive for normal central incisors although there is variability in the responses. There is a definite trend towards the extremes of very long or very short teeth being less attractive. The very long central incisors, and those with tooth wear were perceived as unattractive. The patients rated fewer images from the tooth wear and delayed apical migration sets as unattractive compared to the dentists and technicians. CONCLUSION: The width-to-height ratios perceived as most attractive correspond with the higher end of ideal ratios proposed in the dental literature (75-80% width-to-height ratio). Significant differences exist between the aesthetic perceptions of dentists, technicians and patients and there is lack of agreement within each group, in particular within the patient group. The individual variability in patient response should be taken into account during treatment planning.

The influence of varying maxillary incisal edge embrasure space and interproximal contact area dimensions on perceived smile aesthetics.

OBJECTIVE: The aim of this study was to determine the influence of incisal edge embrasure space and interproximal contact area dimensions on perceived smile aesthetics. DESIGN: Cross-sectional study. SETTING: Postgraduate dental teaching hospital. METHODS: A photograph of a smiling female, displaying only the lips and maxillary teeth was digitally altered. First, the proportions of the incisal edge embrasure spaces were modified to produce five different images. Secondly, the lengths of the interproximal contact areas were altered to produce five different images. The two sets of photographs were ranked from 'most attractive' to 'least attractive' by 35 dentists, 35 dental technicians and 35 patients. RESULTS: An embrasure space arrangement where the size of the embrasures increases progressively distally from the midline was deemed most attractive; absence of embrasure spaces was deemed least attractive. In assessing the interproximal contact areas, all groups assessed an arrangement where the areas between the teeth were equal (and 50% the length of the central incisor) as most attractive, and where the contact areas increased in length progressively distally from the midline as least attractive. There were few statistically significant differences between the groups in these perceptions. CONCLUSION: Whilst there is broad agreement in what the participant groups deem to be aesthetic, our findings do not wholly correspond to the 'ideals' that have been previously suggested in the dental literature.

The pattern of ankle fractures sustained by outdoor activities at the Snowdonia National Park, North Wales, United Kingdom.

OBJECTIVE: The aim of this study was to review the pattern of ankle fractures sustained by patients brought to the Emergency Department at Ysbyty Gwynedd from The Snowdonia National Park. MATERIALS AND METHODS: The study group included all patients with ankle fractures on the mountain medicine database between March 2004 and December 2006. The presence of talar shift and comminution of the medial malleolus was noted. The pattern of fractures were analysed and compared with the literature. Radiographs were obtained for 20 casualties. RESULTS: 70% of these were injured whilst hill walking. Open fractures represented 12% of injuries. 75% of fractures required operative fixation. Weber B injuries were the commonest followed by Weber C and A. Talar shift was seen in 80% of the cases and 45% showed comminution of the medial malleolus. CONCLUSIONS: In our case series we observed a high proportion of open and unstable ankle fractures, with the majority treated by operative fixation. The high rate of comminution of the medial malleolus has previously not been reported in the literature and has the potential of making operative fixation technically difficult. Encouraging the use of walking poles particularly at the time of descending may help to reduce the incidence of ankle fractures in hill walkers.

Smile aesthetics.

The aim of this article is to outline some of the factors practitioners should take into consideration when planning optimal smile aesthetics. The components of the smile that will be discussed include the smile are, incisor/gingival display, smile width, gingival aesthetics, tooth proportionality/symmetry, contacts/connectors/embrasures and the dental midlines.

The influence of varying maxillary lateral incisor dimensions on perceived smile aesthetics.

OBJECTIVE: The aim of this study was to determine the influence of varying the dimensions of the maxillary lateral incisors on perceived smile aesthetics. DESIGN: Clinical study. SETTING: Postgraduate dental teaching hospital. METHODS: A photograph of a female smile displaying only the lips and teeth was digitally altered. First, the width of the maxillary lateral incisors, in proportion to the central incisor, was altered at 5% intervals to produce six images (52%, 57%, 62% [the 'golden proportion'], 67%, 72% and 77%). In a second group, the length of the lateral incisor was altered at 0.5 mm increments to produce five images with the lateral incisor 0.5 mm, 1 mm, 1.5 mm, 2 mm and 2.5 mm shorter than the adjacent central incisor. The photos were ranked from 'most attractive' to 'least attractive' by 41 hypodontia patients, 46 non-hypodontia 'control' patients and 30 dentists. RESULTS: The 67% followed by the 72% lateral-to-central width proportions were the 'most preferred' by all groups. A maxillary lateral incisor that is 1-1.5 mm shorter than the central incisor was the 'most popular' maxillary lateral incisor length. The very short and very long maxillary lateral incisor was consistently perceived as 'least attractive'. CONCLUSION: There is no evidence to suggest that the golden proportion should be considered the ideal aesthetic standard when creating space for the replacement of missing lateral incisors.

Radial pressure waveform dP/dt max is a poor indicator of left ventricular systolic function.

BACKGROUND: The first derivative of left ventricular (LV) pressure over time (dP/dt max) is a marker of LV systolic function that can be assessed during cardiac catheterization and echocardiography. Radial artery dP/dt max has been proposed as a possible marker of LV systolic function and we sought to test this hypothesis. MATERIALS AND METHODS: We compared simultaneously recorded radial dP/dt max (by high-fidelity tonometry) with LV dP/dt max (by high-fidelity catheter and echocardiography parameters analogous to LV dP/dt max). In study 1, beat-to-beat radial dP/dt max and LV dP/dt max were recorded at rest and during supine exercise in 12 males (aged 61 +/- 12 years) undergoing cardiac catheterization. In study 2, 2D-echocardiography and radial dP/dt max were recorded in 54 patients (separate to study 1; 39 men; aged 64 +/- 10 years) at baseline and peak dobutamine-induced stress. Three basal septum measures were taken as being analogous to LV dP/dt max: 1. Peak systolic strain rate; 2. Strain rate (SR-dP/dt max) during isovolumic contraction (IVCT) and; 3. Tissue velocity during IVCT. RESULTS: In study 1 there was a significant difference between resting LV dP/dt max (1461 +/- 383 mmHg s(-1)) and radial dP/dt max (1182 +/- 319 mmHg s(-1); P < 0.001), and a poor, but statistically significant, correlation between the variables (R(2) = 0.006; P < 0.05). Similar results were observed during exercise. In study 2 there were weak (R(2) = -0.12; P = 0.01) to non-significant associations between radial dP/dt max and all echocardiographic measures analogous to LV dP/dt max at rest or peak stress. CONCLUSION: Radial pressure waveform dP/dt max is not a reliable marker of LV systolic function.

Adult and paediatric basic life support: an update for the dental team.

The aim of this paper is to review the current Resuscitation Council (UK) basic life support guidelines. The main changes made to the guidelines published in 2000 are that for adult basic life support no initial rescue breaths should be delivered before commencing chest compressions and that the compression to ventilation ratio should be 30:2 irrespective of the number of rescuers. For children over the age of one year, two rescuers should provide life support with a compression to ventilation ratio of 15:2. There is still a need to deliver rescue breaths before starting compressions in the child patient.

Alternating hemiplegia of childhood: no mutations in the glutamate transporter EAAT1.

Alternating hemiplegia of childhood (AHC) is a severe brain disorder, mainly characterised by episodes of hemiplegia, progressive mental retardation, and other severe paroxysmal and permanent neurological symptoms. Clinically and genetically, there is some overlap with sporadic (SHM) and familial (FHM) hemiplegic migraine, a severe monogenic subtype of migraine. Although no mutations were detected in the FHM1 CACNA1A and FHM2 ATP1A2 genes in sporadic AHC patients, a mutation was found in the FHM2 ATP1A2 gene in a family with AHC. Recently, a missense mutation was found in the SLC1A3 gene that encodes the glutamate transporter EAAT1, in a patient with alternating hemiplegia, episodic ataxia, seizures, and headache. Because of the remarkable clinical similarities and the potential role of glutamate in AHC, we analysed six sporadic patients with AHC for mutations in the SLC1A3 gene. No mutations were found. The SLC1A3 EAAT1 glutamate transporter gene does not seem to be involved in the pathogenesis of AHC.