MKELM: Mixed Kernel Extreme Learning Machine using BMDA optimization for web services based heart disease prediction in smart healthcare.

In recent years, cardiovascular disease becomes a prominent source of death. The web services connect other medical equipments and the computers via internet for exchanging and combining the data in novel ways. The accurate prediction of heart disease is important to prevent cardiac patients prior to heart attack. The main drawback of heart disease is delay in identifying the disease in the early stage. This objective is obtained by using the machine learning method with rich healthcare information on heart diseases. In this paper, the smart healthcare method is proposed for the prediction of heart disease using Biogeography optimization algorithm and Mexican hat wavelet to enhance Dragonfly algorithm optimization with mixed kernel based extreme learning machine (BMDA-MKELM) approach. Here, data is gathered from the two devices such as sensor nodes as well as the electronic medical records. The android based design is utilized to gather the patient data and the reliable cloud-based scheme for the data storage. For further evaluation for the prediction of heart disease, data are gathered from cloud computing services. At last, BMDA-MKELM based prediction scheme is capable to classify cardiovascular diseases. In addition to this, the proposed prediction scheme is compared with another method with respect to measures such as accuracy, precision, specificity, and sensitivity. The experimental results depict that the proposed approach achieves better results for the prediction of heart disease when compared with other methods.

Tuberculosis detection in chest X-ray using Mayfly-algorithm optimized dual-deep-learning features.

World-Health-Organization (WHO) has listed Tuberculosis (TB) as one among the top 10 reasons for death and an early diagnosis will help to cure the patient by giving suitable treatment. TB usually affects the lungs and an accurate bio-imaging scheme will be apt to diagnose the infection. This research aims to implement an automated scheme to detect TB infection in chest radiographs (X-ray) using a chosen Deep-Learning (DL) approach. The primary objective of the proposed scheme is to attain better classification accuracy while detecting TB in X-ray images. The proposed scheme consists of the following phases namely, (1) image collection and pre-processing, (2) feature extraction with pre-trained VGG16 and VGG19, (3) Mayfly-algorithm (MA) based optimal feature selection, (4) serial feature concatenation and (5) binary classification with a 5-fold cross validation. In this work, the performance of the proposed DL scheme is separately validated for (1) VGG16 with conventional features, (2) VGG19 with conventional features, (3) VGG16 with optimal features, (4) VGG19 with optimal features and (5) concatenated dual-deep-features (DDF). All experimental investigations are conducted and achieved using MATLAB® program. Experimental outcome confirms that the proposed system with DDF yields a classification accuracy of 97.8%using a K Nearest-Neighbor (KNN) classifier.

ESVM-SWRF: Ensemble SVM-based sample weighted random forests for liver disease classification.

Recently, a significant way to diagnose the disease is using the model of medical data mining. The most challenging task in the healthcare field is to face a large amount of data during disease analyzes and prediction. Once the data are transformed into valuable data by means of data mining models then the actual prediction and decision making is easier. The existing studies met few shortcomings because of higher execution time, more computational complexities, less scalability, slow convergence, and lack of providing the solution. In this article, we have proposed an ensemble SVM-based sample weighted random forests (eSVM-swRF) with novel improved colliding body optimization (NICBO) algorithm to predict liver diseases. The extraction, loading, transformation, and analysis (ELTA) are used to pre-process the patient data. The significant feature with a suitable model is generated depending upon the filter-based method. Based on eSVM-swRF, the parameter values such as penalty parameter (P), threshold (T), and mTry are optimized via a novel improved colliding boding optimization (NICBO) algorithm. The UCI dataset provides liver disease data for this study. The implementation platform of RapidMiner Studio version 7.6 with different evaluation measures is used to validate the performance of eSVM-swRF with the NICBO method. Anyway, the proposed method yields outstanding performance than other existing methods such as Particle Swarm Optimization-based Support Vector Machine (PSO-SVM), fuzzy adaptive, and neighbor weighted k-NN (FuzzyANWKNN), Naïve Bayes-based Support Vector Machine (NB-SVM), and Neural network.

Neck of femur fracture: Previous history of malignancy is not an indication to send femoral head for routine histology.

BACKGROUND: Neck of femur fractures is the most common fractures associated with low-velocity injury in the elderly. Some patients may require further histological examination of the femoral head due clinical suspicion of malignance as a cause of fracture. OBJECTIVES: To review whether standard screening question(s) could be used to identify patients that require histological examinations following neck of femur fracture. STUDY DESIGN AND METHODS: Femoral heads sent for histological examination over a period of 5 years were identified from hospital database. All patients presenting acutely with neck of femur fracture above the age of 70 were included, and their case notes were retrospectively reviewed. Reason for histopathological examination were categorised into three screening questions: (Q1) clinical suspicion based on history alone, i.e. neck of femur fracture with no clear history of fall or trauma or preceding hip pain, (Q2) radiological evidence of suspicious abnormality on admission radiographs, (Q3) previous history of malignancy or concurrent malignancy or (Q4) combination of above. RESULTS: In total, 119 samples of femoral head were sent and 18 patients had a positive histology. The sensitivity and specificity of these questions individually showed very poor correlation to positive histology with lowest for (Q3) previous history of malignancy (0.39 and 0.51, respectively). However, combining Q1 and Q2 the sensitivity is improved to 1.0 (95% CI 1.0-1.0) and specificity to 0.35 (95% CI 0.25-0.44) with a positive predictive value of 0.21 (95% CI 0.13-0.30) and negative predictive value of 1.00 (95% CI 1.00-1.00). CONCLUSION: History of previous malignancy poorly correlates with positive histology. Routine request based on these screening criteria is not cost-effective in patient management. LEVEL OF EVIDENCE: Prognostic level III.

Comparative Evaluation of Safety and Efficacy of Glimepiride and Sitagliptin in Combination with Metformin in Patients with Type 2 Diabetes Mellitus: Indian Multicentric Randomized Trial - START Study.

BACKGROUND AND OBJECTIVE: Modern sulfonylureas like glimepiride offer effective glycemic control with extrapancreatic benefits and good tolerability. The objective of the present study was to evaluate and compare safety and efficacy of glimepiride and sitagliptin in combination with metformin in patients with type 2 diabetes mellitus (T2DM). METHODS: In this open-label, randomized, comparative, multicenter study, a total of 305 T2DM patients who were either drug naïve or uncontrolled on metformin were randomized to glimepiride 1 or 2 mg/sustained-release metformin 1000 mg once daily (glimepiride group, n = 202) or sitagliptin 50 mg/metformin 500 mg twice daily (sitagliptin group, n = 103) for 12 weeks. Primary endpoint was change in glycosylated hemoglobin (HbA1c). Secondary endpoints were change in fasting plasma glucose (FPG), postprandial plasma glucose (PPG), body mass index (BMI) and to assess overall safety profile. RESULTS: At 12 weeks, there was a statistically significant difference in the mean HbA1c reduction in glimepiride group (0.42%) as compared to sitagliptin group (0.30%) (P = 0.001). Mean reduction in FPG and PPG was also statistically significant in the glimepiride group as compared to the sitagliptin group (P = 0.008). There was no significant difference in terms of change in BMI (0.07 ± 0.39 kg/m2 vs. 0.08 ± 0.31 kg/m2) in glimepiride and sitagliptin groups, respectively, (P = 0.644) between both the groups. The incidences of hypoglycemic events were also comparable among both the groups. CONCLUSION: In T2DM patients, glimepiride/metformin combination exhibited significant reduction in glycemic parameters as compared to sitagliptin/metformin combination. Moreover, there was no significant difference between both the groups in terms of change in BMI and incidence of hypoglycemia.

Anxiety and depression predict poor outcomes in arthroscopic subacromial decompression.

BACKGROUND: Subacromial impingement is common and frequently treated with arthroscopic subacromial decompression (ASD); however, its efficacy has recently been questioned. Poor surgical outcomes have been associated with anxiety and depression within other orthopedic subspecialties but not within this group of patients. We hypothesized that anxiety and depression are associated with worse outcomes after ASD. METHODS: A retrospective review of prospectively collected data was carried out of patients undergoing ASD. Inclusion criteria were short-term relief with injection therapy and presence of Hawkins sign. Rotator cuff tears were excluded. Patients completed the Oxford Shoulder Score (OSS), Hospital Anxiety and Depression Scale (HADS), and visual analog scale for pain before and after surgery in outpatient clinic follow-up at 6 weeks and by postal questionnaire at 6 months. RESULTS: The 86 patients who participated in the study were analyzed in 2 groups defined by HADS scores, group A being depressed and group B nondepressed. Both groups had less pain and improved OSS at 6 months; however, group B improved faster with improved scores at 6 weeks, which were maintained to 6 months. Group B had less pain and higher OSS at 6 months than group A. There was strong negative correlation (P < .01) between preoperative HADS score and 6-week and 6-month OSS and HADS scores. There was strong positive correlation (P < .01) between HADS score and 6-week and 6-month pain scores. High preoperative HADS score was negatively correlated to 6-month satisfaction (P < .05). CONCLUSION: Patients with HADS score >11 before ASD have worse outcomes. This should be taken into account when counseling patients for surgery.

The course and distribution of the infra patellar nerve in relation to ACL reconstruction.

INTRODUCTION: A common complication after ACL (anterior cruciate ligament reconstruction) is injury to the infra-patellar branch of the saphenous nerve (IPBSN). Very little about its origin and course of this nerve has been described. The aim of this study was to understand the course of IPBSN in relation to surgery around the knee. MATERIALS AND METHOD: The course of the nerve was dissected and traced in 25 knees from 14 cadaveric knees (10 males; four females). An incision was made posterior to the medial condyle of the tibia and continued deeper towards the saphenous nerve which is located under the sartorius muscle. The saphenous nerve branch was then followed to distally supply the anterior leg (IPBSN). The relationship of saphenous nerve and IPBSN to each other and the hamstrings were recorded. RESULTS: Four paths of IPBSN, in relation to the sartorius muscle, were identified: (1) posterior--inferior posterior border of the muscle, (2) transmuscular--penetrating through the muscle, (3) anterior--anterior border of the muscle, (4) posterior patellar--posterior of the muscle at the level of the patellar bone and (5) combined. The posterior pathway of IPSBN was the most common (57%) and had the closest proximity to the tendons of semitendinosus and gracilis muscles. The terminal branches of the IPSBN crossed over the patellar tendon in every dissection. CONCLUSIONS: A posterior path IPBSN is more prone to damage during a tendon harvest due to its proximity to the gracilis and semitendinosus muscle tendons.

Elbow dislocation with complete triceps avulsion.

Radio-ulnar Fracture dislocation of the elbow is a high-energy trauma which can be associated with significant ligamentous injury in adults. We report an unusual triad of injury in a patient with avulsion injury of the triceps. This injury can be thought of as a variant of "terrible triad" with dislocation of radio-ulnar joint, radial head fracture, and medial collateral ligament injury with avulsion of the triceps. Elbow has to be stabilized with early repair of the ligaments for a successful outcome.

Skin necrosis associated with thromboprophylaxis after total knee replacement.

Thromboprophylaxis are routinely given to prevent venous thromboembolism (VTE) in patients after total hip and knee replacement surgeries. Low molecular weight heparin (LMWH) (fractioned heparin) is effective in the prevention and treatment of VTE. The predicable effect of LMWH has popularized it for routine clinical use. Although LMWH has lesser complication rate, compared to unfractioned heparin (UFH), sporadic clinical complication has been reported. We report a rare case of skin necrosis secondary to use of LMWH tinzaparin used for routine thromboprophylaxis after total knee replacement.

Metallosis in a total knee arthroplasty.

A 70-year-old woman presented with right knee pain and a 'grinding' sensation 6 months after a total knee replacement for osteoarthritis. Clinical examination revealed a valgus deformity, patellofemoral crepitus and a reduced knee flexion. Radiographs revealed distinctive findings including the 'bubble sign', 'cloud sign' and the 'metal line sign', which are diagnostic of metallosis. Metallosis is an uncommon complication of total joint replacements, where bone and periprosthetic soft tissues are infiltrated by metallic debris from wearing of the prostheses. This usually occurs in high-wear joints such as hips and knees. Treatment for patients diagnosed with metallosis is synovectomy and a revision surgery. Our patient underwent revision surgery 5 years after her initial surgery.

Complete recovery following intra-arterial tenecteplase administration in a woman with acute ischemic stroke.

A 23-year-old woman, who underwent a percutaneous transluminal mitral commissurotomy for a tight mitral stenosis, developed an acute ischemic stroke involving the proximal right middle cerebral artery territory. She had a dense left hemiplegia with a National Institutes of Health Stroke Scale score of 12. She was emergently treated within 1 hour with intra-arterial tenecteplase and made a dramatic recovery. Intra-arterial tenecteplase is an attractive option for treating acute ischemic stroke with proximal or major vessel occlusion.

Investigating the potential advantages of a new design metacarpophalangeal joint.

This paper investigates a new metacarpophalangeal joint design aimed at treating patients with moderate to severe forms of arthritis affecting the index, long, ring, and little fingers. Current small joint arthroplasty designs, including those for the metacarpophalangeal joint of the hand, have had limited success owing to mechanical failures and can be divided into two main families: single-piece elastomer implants and surface articulating implants. The design proposed in this study involves combining the principles of a surface weight-bearing articulating implant with those of a spanning elastomeric implant. The design consists of metacarpal and proximal phalangeal articulating housings and a central flexible spanning elastomer rod that maintains the alignment of the metacarpal and proximal phalangeal components. A preliminary finite element analysis was used to investigate the stresses in the design, the wear of the articulating bearing surfaces for different material combinations, and the stresses between the central elastomer rod and the articulating housings. This preliminary analysis shows that the design should withstand the probable loading conditions experienced within the human body and that the wear rates of the articulating surfaces and the central elastomer are acceptable.

The mortality, morbidity and cost benefits of elective total knee arthroplasty in the nonagenarian population.

With the increasing life expectancy, a greater number of elderly patients are being referred to an orthopaedic department to have elective total knee arthroplasty (TKA). Total knee arthroplasty should be considered in the very elderly only after carefully balancing the benefits of surgery against the risks of surgery. The aim of this study was to analyse the mortality, morbidity and cost benefits of elective TKA in a cohort group of the nonagenarian population. Between 1990 and 2006, 42 patients >or=90 years of age had TKA surgery. Patient's notes were retrospectively analysed. A cost-benefit analysis was carried out by comparing the surgical costs against nursing home placement. The mean age at surgery was 90.4 years (range: 90-90.6). There was one major and 11 minor postoperative complications with no immediate or late postoperative deaths. The Knee Society Scores improved from 25 points (range: 8-44) to 81 points (range: 60-95), and the WOMAC Scores improved from 62 points (range: 54-73) to 41 points (range: 34-46) (p<0.002). The calculated cost-benefit savings for 42 patients at 5 years after TKA was estimated to be pound 2,746,839. Total knee arthroplasty in the nonagenarian population is safe, beneficial and cost-effective.

The safety of hip injection with corticosteroid in the diagnosis and treatment of osteoarthritis.

INTRODUCTION: Injection of steroid and local anaesthetic into hip and knee joints has been a recommended treatment for osteoarthritic pain for decades. There have been recent studies showing a higher incidence of infection leading to early revision of joint prostheses in patients who have had corticosteroid injections prior to joint replacement surgery. OBJECTIVE: The aim of our study was to determine if there is any risk of infection in patients undergoing total hip arthroplasty (THA) after a hip joint injection. PATIENTS AND METHODS: A retrospective search was conducted using the hospital computer database to identify patients who underwent hip injection and subsequent THA between 2000 and 2004. The study included a review all case notes to specifically identify prosthetic infection or early joint replacement surgery. RESULTS: One hundred and twenty-eight patients had hip joint injections and subsequently underwent successful total hip replacement. In this study there was no evidence of associated risk of prosthetic infection or early revision of total hip arthroplasty after hip joint injection with corticosteroids (average time of follow-up 3.2 years). CONCLUSIONS: Hip injection is safe provided a strict aseptic protocol is maintained. The time period of pain relief with hip injection is limited (average 2 months). For diagnostic purposes injections with local anaesthetic only is recommended. A large randomised control study would probably further substantiate these findings.

Contamination by persistent organic pollutants in dumping sites of Asian developing countries: implication of emerging pollution sources.

In Asian developing countries, large amounts of municipal wastes are dumped daily in open dumping sites without proper management. This practice may cause several adverse environmental consequences and increased health risk to local communities. To elucidate contamination by persistent organic pollutants (POPs)--including dichloro-diphenyl-trichloroethane and its metabolites (DDTs), hexachlorocyclohexanes (HCHs), chlordanes, hexachlorobenzene (HCB), and polychlorinated biphenyls (PCBs)--in such dumping sites, soil samples were collected from open dumping sites and respective control sites in Cambodia, India, and Vietnam from 1999 through 2001. Our results demonstrated that DDTs, PCBs, and HCHs were dominant contaminants in the dumping sites. However, the contamination pattern was not consistent, showing higher HCHs in India than in Cambodia and Vietnam. Interestingly, in all of the countries, extremely higher levels of POPs were observed in the dumping sites compared with those in the respective control sites, suggesting significant amplification of POP contamination in the dumping sites of Asian developing countries. Mean concentrations of DDTs and PCBs were 350 and 140 ng/g dry weight, respectively, in the dumping sites of Cambodia and 26 and 210 ng/g, respectively, in India. These residue levels were hundreds to thousands times higher than those in general soils, implying possible risk to human health of the local communities, especially to the rag pickers, including children who work in these sites to collect recyclable materials. Composition of DDT compounds suggested their recent use in populated areas, which in turn might have caused increased levels of DDTs in the open dumping sites. In addition, composition of HCH isomers revealed their different use pattern in different countries.

Elevated BNP with normal systolic function in asymptomatic individuals at-risk for heart failure: a marker of diastolic dysfunction and clinical risk.

BACKGROUND: B-type natriuretic peptide (BNP) is widely accepted in the evaluation of left ventricular systolic dysfunction and heart failure. However, little is known of the implications of elevated BNP levels in individuals with preserved systolic function (PSF). AIMS: To investigate the drivers and clinical implications of elevated BNP levels in asymptomatic individuals with established PSF. METHODS: We enrolled 154 individuals who all underwent physical examination, BNP evaluation and Doppler-echocardiographic studies. They were divided into those above and below the median BNP level (50 pg/ml). RESULTS: Independent predictors of higher BNP were older age, more severe left ventricular hypertrophy (LVH), reduced E/A ratio and ischaemic heart disease. Survival and multivariable analysis demonstrated more death and/or admission in those above the median BNP (HR: 4.79, p=0.007). CONCLUSIONS: Elevated BNP is the strongest, independent predictor of serious adverse cardiovascular outcomes in this population and requires closer clinical follow-up.

Organochlorine residues in odontocete species from the southeast coast of India.

Blubber from bottle-nose dolphins, spinner dolphins, humpback dolphin (Tursiops truncatus, Stenella longirostris and Sousa chinensis) were collected from the Bay of Bengal (southeast coast of India) and analyzed for the organochlorine pesticides hexachlorocyclohexane (HCHs), p,p'-dichlorodiphenyl trichloroethane (DDTs), and polychlorinated biphenyls (PCBs). All nine specimens analyzed contained considerable levels of all the three chemical classes where DDT was in the range of 3330-23330 ng/g; HCHs in the range of 95-765 ng/g; and PCBs in the range of 210-1220 ng/g (wet weight basis). The reasons for this and the variations in the isomer pattern of HCHs and DDT and its metabolites in marine mammal tissues are discussed.

Widespread contamination by tris(4-chlorophenyl)methane and tris(4-chlorophenyl)methanol in cetaceans from the North Pacific and Asian coastal waters.

For understanding global distribution, transport and behavior of tris(4-chlorophenyl)methane (TCPMe) and tris(4-chlorophenyl)methanol (TCPMOH), the two newly identified microcontaminants, the present study determined their concentrations and other persistent organochlorines (OCs) in the blubber of nine species of adult male cetaceans collected from various locations in the North Pacific Ocean and coastal waters of some Asian countries, during 1985-97. Concentrations of TCPMe and TCPMOH were found to be highest in northern right whale dolphins, which may be attributable to wide distribution of this species, including some heavily polluted areas such as coastal California. Elevated residue levels of TCPMe and TCPMOH were observed in both off-shore and coastal species, suggesting widespread contamination of these compounds in the marine environment. Higher contamination of TCPMe and TCPMOH was found in cetaceans from temperate and cold waters than those from tropical regions. The latitudinal distribution of TCPMe and TCPMOH in cetaceans from the North Pacific and Asian coastal waters was similar to that of DDTs, suggesting less transportable nature of TCPMe and TCPMOH in the marine environment. Data on the occurrence of TCPMe and TCPMOH further indicated high bioaccumulation potential of these compounds, which was comparable to DDTs. Relative concentrations of TCPMe/TCPMOH in cetaceans were apparently higher than those observed in seals, suggestive of lower metabolic capacity for these compounds in cetaceans than in pinnipeds, which is similar to classic contaminants like polychlorinated biphenyls and DDTs.