Applying machine learning methods to predict the hospital re-admission within 30 days of total hip arthroplasty and hemiarthroplasty.

BACKGROUND: Total hip arthroplasty (THA) and hemiarthroplasty are common treatments for severe hip joint disease. To predict the probability of re-admission after discharge when patients are hospitalized will support providing appropriate health education and guidance. METHODS: The research aims to use logistic regression (LR), decision trees (DT), random forests (RF), and artificial neural networks (ANN) to establish predictive models and compare their performances on re-admissions within 30 days after THA or hemiarthroplasty. The data of this study includes patient demographics, physiological measurements, disease history, and clinical laboratory test results. RESULTS: There were 508 and 309 patients in the THA and hemiarthroplasty studies respectively from September 2016 to December 2018. The accuracies of the four models LR, DT, RF, and ANN in the THA experiment are 94.3%, 93.2%, 97.3%, and 93.9%, respectively. In the hemiarthroplasty experiment, the accuracies of the four models are 92.4%, 86.1%, 94.2%, and 94.8%, respectively. Among these, we found that the RF model has the best sensitivity and ANN model has the best area under the receiver operating characteristic (AUROC) score in both experiments. CONCLUSIONS: The THA experiment confirmed that the performance of the RF model is better than the other models. The key factors affecting the prognosis after THA surgery are creatinine, sodium, anesthesia duration, and dialysis. In the hemiarthroplasty experiment, the ANN model showed more accurate results. Poor kidney function increases the risk of hospital re-admission. This research highlights that RF and ANN model perform well on the hip replacement surgery outcome prediction.

Long-term results of duodenectomy with highly selective vagotomy in the treatment of complicated duodenal ulcers.

BACKGROUND: Highly selective vagotomy and complete circular or partial duodenectomy have been applied to complicated duodenal ulcer for many years. These procedures seem to provide better clinical results than truncal vagotomy and antrectomy. METHODS: A retrospective analysis was conducted of 120 patients with complicated duodenal ulcer who underwent surgical treatment between 1986 and 1999. Patients with obstruction were treated with either circular complete (17) or partial duodenectomy (3) combined with highly selective vagotomy or truncal vagotomy and antrectomy (37). Those with perforation were treated primarily with highly selective vagotomy and partial duodenectomy, highly selective vagotomy alone, or truncal vagotomy and pyloroplasty. Every patient was followed up either by a clinic visit (75%) or questionnaire to determine the presence of ulcer pain, dumping, diarrhea, vomiting, weight loss, and Visick grade. RESULTS: Long-term follow-up of patients treated with duodenectomy and highly selective vagotomy for obstruction showed that 94% had sustained weight gain whereas more than half of those treated with truncal vagotomy and antrectomy had weight loss. In patients with perforation, duodenectomy and highly selective vagotomy offered no advantage over highly selective vagotomy alone. CONCLUSIONS: Highly selective vagotomy and complete circular or partial duodenectomy provide fewer sequelae and better weight gain long term than truncal vagotomy and antrectomy for patients with obstructing duodenal ulcers.

Differences in gastric emptying between highly selective vagotomy and posterior truncal vagotomy combined with anterior seromyotomy.

Gastric emptying has been reported to be both delayed and unchanged following posterior truncal vagotomy combined with anterior seromyotomy (PTV + AS). When compared to highly selective vagotomy (HSV), our clinical experience was that PTV + AS not uncommonly produced postprandial distress. We studied gastric emptying of both liquids and solids 3 and 12 months following HSV and PTV + AS to determine what if any differences there were in gastric emptying between the two procedures. We compared these results with those from studies done in both normal subjects and unoperated duodenal ulcer patients. In 26 duodenal ulcer patients with perforation (n = 18) or bleeding (n = 8), who were treated with HSV (n = 10) or PTV + AS (n = 16), gastric emptying of liquids and solids was evaluated at 3 months and 12 months postoperatively. At 3 months, gastric emptying of liquids was delayed in both the HSV and PTV + AS groups as compared to values in both normal subjects and unoperated duodenal ulcer patients. The emptying of solids was markedly delayed by PTV + AS in contrast to HSV at 3 months (167.1 +/- 28.4 minutes vs. 79.9 +/- 16.7 minutes; P <0.05). The lag duration was not affected. A limited number of patients studied at 12 months showed similar and near-normal emptying of solids in both the HSV and PTV + AS groups (67.5 +/- 7.0 minutes vs. 70 +/- 6.6 minutes). PTV + AS in contrast to HSV produces more marked delayed emptying of liquids and solids at 3 months; with time (1 year) these values return to near normal.

Partial or complete circular duodenectomy with highly selective vagotomy for severe obstructing duodenal ulcer disease: an initial experience.

OBJECTIVE: To evaluate partial and complete circular duodenectomy combined with highly selective vagotomy (HSV) for relief of gastric retention. DESIGN: A retrospective, case-comparison study. SETTING: University hospital referral center. PATIENTS: Eighteen patients with severe obstructing duodenal ulcer disease defined by failure of a saline load test and endoscopic narrowing of the gastric outlet to 5 mm or less. METHODS: In patients with severe obstructing ulcer the diseased duodenal segment was excised with electrocautery (partial excision, 10 patients; complete excision, 8 patients). An HSV was then done. Postoperative fasting gastric residuum measurement and measurement of the emptying of liquids and solids was done at 3 months and patients were weighed at 3 and 12 months. RESULTS: No patient experienced postoperative gastric retention or required reoperation in a 2-year follow up. The early emptying of liquid (20 minutes) in complete circular duodenectomy plus HSV was more rapid than in normal subjects and duodenal ulcer patients. The emptying of solids was slightly delayed in partial duodenectomy plus HSV compared with duodenal ulcer patients but not with normal controls. The emptying of solids in duodenal ulcer patients was more rapid than in normal controls. Weight gain was excellent at 3 and 12 months. CONCLUSION: Partial duodenectomy and complete circular duodenectomy plus HSV are more efficacious than alternative nonresective procedures in restoring gastric emptying to near normal and restoring weight in patients with obstructing duodenal ulcer.

Status of trace elements in patients with idiopathic dilated cardiomyopathy in central Taiwan.

BACKGROUND: Sporadic cases of dilated cardiomyopathy (DCM) are often seen in central Taiwan. Though trace elements may play a role in the pathogenesis of idiopathic DCM, there are no reports concerning study of Taiwan's population in relation to trace elements in patients with DCM. METHODS: Serum selenium, zinc, copper and iron concentrations and blood glutathione peroxidase (GPX) activity were measured in 32 patients with DCM (24 males, 8 females; mean age, 44 +/- 14 years) and 31 age-matched normal volunteers (16 males, 15 females; mean age, 38 +/- 12 years). RESULTS: The average serum selenium concentration of 27.6 +/- 8.4 micrograms/l found in the DCM group was significantly lower than the average concentration of 47.2 +/- 14.7 micrograms/l in the normal group. Blood GPX activity was also significantly lower in the DCM group than in the normal group. Serum selenium concentration correlated well with blood GPX activity in the studied subjects. Serum copper and iron concentrations were significantly higher in the DCM group than in the normal group. There was no difference in serum zinc concentration between the two groups. CONCLUSIONS: Deficiency of serum selenium in association with a low blood GPX activity, and high serum copper and iron concentrations, are found in patients with idiopathic DCM in central Taiwan.

Value of local electrogram characteristics predicting successful catheter ablation of left-versus right-sided accessory atrioventricular pathways by radiofrequency current.

Despite similar guidance by local electrogram criteria, catheter ablation of right-sided accessory atrioventricular (AV) pathways by radiofrequency current has been less effective than that of left-sided ones. In order to elucidate the possible diversities in local electrosignal criteria, we systematically analyzed the morphological and timing characteristics of 215 bipolar local electrograms from catheter ablation sites of 65 left-sided accessory AV pathways and of 356 from those of 37 right-sided ones in 92 consecutive patients with Wolff-Parkinson-White syndrome or AV reentrant tachycardia incorporating concealed accessory AV pathways. After stepwise multivariate analysis, we selected the presence of a possible accessory pathway potential, local ventricular activation preceding QRS complex for 20 ms or more during ventricular insertion mapping, and the local retrograde ventriculoatrial (VA) continuity, local retrograde VA interval < or = 50 ms, electrogram stability (left-sided targets only), retrograde accessory pathway potential (right-sided targets only) during atrial insertion mapping, as independent local electrogram predictors for successful ablation of left- and right-sided accessory AV pathways. Combination of all local electrogram predictors could have moderate chance of success (80 and 51%) for the ventricular and atrial insertion ablation of left-sided accessory AV pathways, but only low probability of success (40% in ventricular insertion ablation) or very low sensitivity (12.5% in atrial insertion ablation) for right-sided ones. In conclusion, with the present approach, successful catheter ablation of right-sided accessory AV pathways, compared to left-sided ones, still necessitate a breakthrough in the precision mapping and the efficiency of energy delivery.

Apical segmental dysfunction in hypertrophic cardiomyopathy: progression into end-stage heart failure with sudden cardiac death.

Apical segmental dysfunction is an unusual finding in hypertrophic cardiomyopathy (HCM). It is characterized by a poor clinical course and a high incidence of malignant ventricular tachyarrhythmias. Long-term prognosis of patients with HCM and apical segmental dysfunction is still unclear. We report 2 cases of apical segmental dysfunction in HCM in whom progressive apical dilatation and congestive heart failure developed. Both patients died suddenly, and intractable ventricular tachyarrhythmias were documented in 1 case during resuscitation. This report provides further evidence that apical segmental dysfunction might predict a subgroup of patients with HCM who are likely to develop end-stage heart failure and are at high risk of sudden cardiac death.

The prognostic value of ambulatory blood pressure monitoring in untreated mild-to-moderate hypertensive patients: correlation with echocardiography.

BACKGROUND: Target organ damage by hypertension should be related to the daily duration of blood pressure elevation. METHODS: Thirty-six previously untreated patients with mild to moderate hypertension were examined by 2-D, M-mode, Doppler echocardiography and with 24-hour ambulatory blood pressure monitoring. The resulting parameters were compared with those of normotensive subjects. Elevated BP values during the waking hours (> 125/85 mmHg) and sleeping hours (> 115/80 mmHg) were used to calculate the total percentage of abnormal BP values (load) in each patients. RESULTS: In patients with hypertension, left atrial index and left ventricular mass index were significantly greater than those of normotensive subjects (21 +/- 4 vs 18 +/- 3 mm/m2, p < 0.05; 127 +/- 25 vs 94 +/- 19 gm/m2, p < 0.01). Doppler measurement of diastolic filling velocity was significantly different between the two groups, with an early LV filling velocity lower (38 +/- 11 vs 45 +/- 10 cm/sec, p < 0.05) and a late LV filling velocity higher (50 +/- 9 vs 45 +/- 12 cm/sec, p < 0.05) in the hypertensives. Casual systolic and diastolic BP values did not correlate with cardiac structural and functional variables. There were significantly inverse correlations between both sleeping diastolic blood pressure and sleeping DBP load and fractional shortening (r = -0.39, p < 0.05; r = -0.43, p < 0.01, respectively). CONCLUSIONS: These data showed that the majority of patients with hypertension have either cardiac structural or functional abnormalities, or both. High nocturnal diastolic blood pressure and DBP load may have a more determinant effect on systolic function in mild to moderate hypertensive patients.

Mass isolation of highly purified canine islets using an automated method and Histopaque Ficoll gradients.

Eighteen pancreata from adult mongrel dogs were used for the study of islet isolation. The pancreas was distended with collagenase in Hanks' solution. The automated screen method and Histopaque Ficoll gradients were used to isolate and purify the canine islets. In vitro, the viability of isolated islets was assessed by both histology and perifusion studies. In vivo, the islet function was evaluated by using a nude mice xenograft model. Fair to good isolation and purification was found in 12 experiments. Before and after purification, the isolated islet count was 4767.1 +/- 560.1 and 3637.7 +/- 333.4 islet equivalence (I.E.)/gm pancreatic tissue. The purity was above 90%. Aldehyde Fuchsin stain disclosed islets with copious beta granules. The stimulation index of islets responding to 16.7 mM glucose plus 1 mM 3-isobutyl-1-methylxanthine (IBMX) versus 1.67 mM glucose was 12.93 +/- 4.75. Normoglycemia was restored and maintained for up to 2 weeks in 7 of 10 and up to 3 weeks in 5 of 10 diabetic nude mice transplanted with canine islets. In conclusion, the automated screen method and Histopaque Ficoll gradients afford a good yield of highly purified canine islets, and functional viability was verified both in vitro and in vivo. This will be an ideal model for isolation of human islets.

Relationship between cardiovascular functions and ionic hypocalcemia induced by citrate infusion in anhepatic swines: CaCl2 therapy in severe ionic hypocalcemia.

Baseline and serial values of serum [Ca++], [K+], [Na+], arterial blood gas tensions, acid-base status, temperature and hemodynamic functions were measured during infusion of citrate-phosphate-dextrose (CPD) solution (0.35 ml.kg-1 x min-1) in anhepatic pigs of three randomized groups. Thirteen pigs (group I) continued to receive intravenous infusion of CPD solution until cardiac arrest. When mean arterial pressure (MAP) decreased to about 50 mmHg (group II, n = 7), or 40 mmHg (group III, n = 7) infusion of CPD solution was discontinued, and pigs received CaCl2 (20 mg/kg) intravenously. Serial (1, 4, 8, and 12 min after CaCl2 administration) values of all the above variables and serum citrate at baseline and lowest [Ca++] were measured. After hepatectomy and venovenous bypass, cardiac output (CO) decreased 30%. When ionic hypocalcemia was above 0.7 mM, there was no significant change of cardiovascular functions. When [Ca++] was between 0.34-0.7 mM, there were linear relationships between [Ca++] and CO, systemic vascular resistance (SVR) and MAP, respectively. When [Ca++] was below 0.34 mM, cardiovascular functions decreased abruptly, and the pigs died at [Ca++] of 0.26 +/- 0.06 mM. When [Ca++] decreased to 0.36 +/- 0.06 mM and MAP to 50 +/- 4 mmHg, most hemodynamic functions could be reversed by calcium therapy. However, when [Ca++] decreased to 0.33 +/- 0.05 mM and MAP to 40 +/- 2 mmHg, hemodynamic functions could not be reversed by calcium therapy alone.