Miami Valley Hospital South

OBJECTIVE: To evaluate the application of artificial intelligence (AI), i.e. deep learning and other machine-learning techniques, to amniotic fluid (AF) metabolomics and proteomics, alone and in combination with sonographic, clinical and demographic factors, in the prediction of perinatal outcome in asymptomatic pregnant women with short cervical length (CL). METHODS: AF samples, which had been obtained in the second trimester from asymptomatic women with short CL (< 15 mm) identified on transvaginal ultrasound, were analyzed. CL, funneling and the presence of AF 'sludge' were assessed in all cases close to the time of amniocentesis. A combination of liquid chromatography coupled with mass spectrometry and proton nuclear magnetic resonance spectroscopy-based metabolomics, as well as targeted proteomics analysis, including chemokines, cytokines and growth factors, was performed on the AF samples. To determine the robustness of the markers, we used six different machine-learning techniques, including deep learning, to predict preterm delivery < 34 weeks, latency period prior to delivery < 28 days after amniocentesis and requirement for admission to a neonatal intensive care unit (NICU). Omics biomarkers were evaluated alone and in combination with standard sonographic, clinical and demographic factors to predict outcome. Predictive accuracy was assessed using the area under the receiver-operating characteristics curve (AUC) with 95% CI, sensitivity and specificity. RESULTS: Of the 32 patients included in the study, complete omics, demographic and clinical data and outcome information were available for 26. Of these, 11 (42.3%) patients delivered ≥ 34 weeks, while 15 (57.7%) delivered < 34 weeks. There was no statistically significant difference in CL between these two groups (mean ± SD, 11.2 ± 4.4 mm vs 8.9 ± 5.3 mm, P = 0.31). Using combined omics, demographic and clinical data, deep learning displayed good to excellent performance, with an AUC (95% CI) of 0.890 (0.810-0.970) for delivery < 34 weeks' gestation, 0.890 (0.790-0.990) for delivery < 28 days post-amniocentesis and 0.792 (0.689-0.894) for NICU admission. These values were higher overall than for the other five machine-learning methods, although each individual machine-learning technique yielded statistically significant prediction of the different perinatal outcomes. CONCLUSIONS: This is the first study to report use of AI with AF proteomics and metabolomics and ultrasound assessment in pregnancy. Machine learning, particularly deep learning, achieved good to excellent prediction of perinatal outcome in asymptomatic pregnant women with short CL in the second trimester. Copyright © 2018 ISUOG. Published by John Wiley & Sons Ltd.

The relationship between heparin concentration and activated partial thromboplastin time (aPTT) in pooled plasma was compared with that in patient samples to assess the feasibility of using heparin-spiked pooled plasma in determining a therapeutic range for aPTT. Blood samples were taken from 32 patients who had been receiving intravenous unfractionated heparin sodium for more than 24 hours. The samples were stored at -70 degrees C until anti-Xa assay within three months of collection. Pooled normal plasma was spiked with unfractionated heparin sodium to produce nominal anti-Xa concentrations of 0, 0.05, 0.1, 0.2, and 0.5 unit/mL. Heparin concentrations and a aPTT values were measured, and the relationship between the two was determined by linear regression. For the ex vivo samples, the range of aPTT values corresponding to therapeutic heparin concentrations of 0.3-0.7 anti-Xa unit/mL was 64-106 seconds, which corresponds to an aPTT range of 2.3-3.9 times the mean of the normal range (compared with the traditionally defined therapeutic range of 1.5-2.5 times the control value). For the in vitro samples, the aPTT range corresponding to heparin concentrations of 0.3-0.7 unit/mL was 121-256 seconds, which corresponds to an aPTT range of 4.4-9.4 times the mean of the normal range. Each institution should establish a therapeutic aPTT range by calibrating aPTT values against heparin concentrations from blood samples of patients receiving intravenous heparin.

This study evaluated potential effects of mercury (Hg) on benthic macroinvertebrates in the South River, Virginia, USA. The study used a multiple lines of evidence approach, including spatially and temporally matched sediment chemistry, biological, and toxicological information (Sediment Quality Triad), exposure and effect analysis in bulk and interstitial sediment and interstitial water, and critical body residue analysis. Ten-day Chironomus dilutus and Hyalella azteca toxicity tests established site-specific no-effect concentrations (NOEC) at 18.9 μg/g total Hg (THg) and 102 ng/g methylmercury (MeHg). However, the benthic community at these locations was impaired, with lower mayfly and caddisfly composition. Few locations had concentrations of THg and MeHg that exceeded the NOEC in bulk or interstitial sediment. The THg concentrations in interstitial water were far below concentrations expected to reduce survival in benthic invertebrates, and only a low percentage of samples exceeded sublethal (growth) low-effect concentrations (LOEC) for THg or MeHg. The THg concentrations in invertebrate tissue did not exceed the NOEC or LOEC in the South River, and MeHg concentrations exceeded the LOEC at all locations, including those with no evidence of benthic impairment, illustrating the uncertainty associated with this line of evidence. Finally, statistical modeling that evaluated diversity of sensitive invertebrate species as a function of Hg exposure, geomorphological parameters, and physicochemical variables indicated that physicochemical and geomorphological parameters were most predictive of benthic community; where Hg was indicated, we were unable to distinguish between models with or without interstitial water Hg. Overall, the lines of evidence indicate that Hg, while clearly toxic to invertebrates at sufficiently high exposure concentrations, is not negatively impacting invertebrate communities in the South River. This study illustrates the difficulty of assessing risks to invertebrates using traditional tools of risk assessment and identifies critical gaps in knowledge that complicate the management of Hg risk. Integr Environ Assess Manag 2019;00:000-000. © 2019 SETAC.

The North America Clinical Trials Network (NACTN) for Spinal Cord Injury (SCI) is a consortium of tertiary medical centers that has maintained a prospective SCI registry since 2004, and it has espoused that early surgical intervention is associated with improved outcome. It has previously been shown that initial presentation to a lower acuity center and necessity of transfer to a higher acuity center reduce rates of early surgery. The NACTN database was evaluated to examine the association between interhospital transfer (IHT), early surgery, and outcome, taking into account distance traveled and site of origin for the patient. Data from a 15-year period of the NACTN SCI Registry were analyzed (years 2005–2019). Patients were stratified into transfers directly from the scene to a Level 1 trauma center (NACTN site) versus IHT from a Level 2 or 3 trauma facility. The main outcome was surgery within 24 hours of injury (yes/no), whereas secondary outcomes were length of stay, death, discharge disposition, and 6-month American Spinal Injury Association Impairment Scale (AIS) grade conversion. For the IHT patients, distance traveled for transfer was calculated by measuring the shortest distance between origin and NACTN hospital. Analysis was performed with Brown-Mood test and chi-square tests. Of 724 patients with transfer data, 295 (40%) underwent IHT and 429 (60%) were admitted directly from the scene of injury. Patients who underwent IHT were more likely to have a less severe SCI (AIS D; p = 0.002), have a central cord injury ( p = 0.004), and have a fall as their mechanism of injury ( p &lt; 0.0001) than those directly admitted to an NACTN center. Of the 634 patients who had surgery, direct admission to an NACTN site was more likely to result in surgery within 24 hours compared with IHT patients (52% vs. 38%) ( p &lt; 0.0003). Median IHT distance was 28 miles (interquartile range [IQR] = 13–62 miles). There was no significant difference in death, length of stay, discharge to a rehab facility versus home, or 6-month AIS grade conversion rates between the two groups. Patients who underwent IHT to an NACTN site were less likely to have surgery within 24 hours of injury, compared with those directly admitted to the Level 1 trauma facility. Although there was no difference in mortality rates, length of stay, or 6-month AIS conversion between groups, patients with IHT were more likely be older with a less severe level of injury (AIS D). This study suggests there are barriers to timely recognition of SCI in the field, appropriate admission to a higher level of care after recognition, and challenges related to the management of individuals with less severe SCI.

PURPOSE: Low-grade serous carcinoma (LGSOC) of the ovary, fallopian tube, or peritoneum is a hormonally driven, relatively chemoresistant malignancy with limited treatment options in the recurrent setting. Given frequent estrogen receptor (ER) expression and dysregulation of the cyclin-dependent kinases 4 and 6 (CDK4/6)-p16-Rb pathway, features shared with hormone receptor-positive breast cancer, dual endocrine, and CDK4/6 inhibition is a biologically rational strategy. This phase II trial evaluated ribociclib plus letrozole in recurrent LGSOC. METHODS: This open-label, single-arm, multicenter phase II study enrolled women with measurable, recurrent LGSOC. Patients received ribociclib (600 mg orally, once daily, days 1-21 of a 28-day cycle) and letrozole (2.5 mg orally, once daily). The primary end point was investigator-assessed objective response rate (ORR) per RECIST 1.1. Secondary end points included clinical benefit rate (CBR), progression-free survival (PFS), overall survival (OS), and safety. RESULTS: Of 74 patients screened, 51 were enrolled and 49 treated. The confirmed ORR was 30.6% (90% CI, 19.9 to 43.2), including one complete and 14 partial responses. Among responders, the median duration of response was 21.2 months. The CBR was 84% (90% CI, 72.5 to 91.6). The median PFS was 14.5 months (90% CI, 10.1 to 28.8), and the median OS was 44.5 months (90% CI, 31.8 to not reached). The most common grade ≥3 adverse event (AE) was neutropenia (47%), managed with dose modifications. Three grade 5 events (6%) occurred but were unrelated to treatment. Treatment discontinuation because of AEs occurred in 4%. No dose-limiting toxicities were observed. CONCLUSION: Ribociclib plus letrozole met the primary end point, achieving meaningful response rates and durable disease control in recurrent LGSOC. The safety profile was consistent with prior CDK4/6 inhibitor studies. This combination represents a therapeutic option in this rare and genomically distinct subtype.

Cervical spine injuries (CSIs) are heterogeneous in nature and often lead to long-term disability and morbidity. However, there are few recent and comprehensive epidemiological studies on CSI. The objective of this study was to characterize recent trends in CSI patient demographics, incidence, etiology, and injury level. The National Electronic Injury Surveillance System was used to extract data on CSIs from 2002 to 2022. Weighted national estimates of CSI incidence were computed using yearly population estimates interpolated from U.S. census data. Data analysis involved extracting additional information from patient narratives to categorize injury etiology (i.e., fall) and identify CSI level. K-means clustering was performed on cervical levels to define upper versus lower cervical injuries. Appropriate summary statistics including mean with 95% confidence intervals and frequency were reported for age, sex, race, ethnicity, etiology, and disposition. Age between groups was compared using an independent weighted Z -test. All categorical variables were compared using Pearson chi-squared tests with Bonferroni correction for multiple comparisons. Ordinary least squares linear regression was used to quantify the rate of change of various metrics with time. A total of 11,822 patient records met the study criteria. The mean age of patients was 62.4 ± 22.7 years, 52.4% of whom were male and 61.4% of whom were White, 7.4% were Black, 27.8% were not specified, and the remaining comprised a variety of ethnicities. The most common mechanism of CSI was a fall (67.3%). There was a significant increase in the incidence of cervical injuries between 2003 and 2022 ( p &lt; 0.001). Unbiased K-means clustering defined upper cervical injuries as C1–C3 and lower cervical injuries as C4–C7. The mean age of patients with upper CSIs was 72.3 ± 19.6, significantly greater than the age of those with lower CSIs (57.1 ± 23.1, p &lt; 0.001). Compared with lower CSI, White patients were more likely to have an upper CSI (67.4% vs. 73.7%; p &lt; 0.001). While Black/African American (7.5% vs. 3.8%) and Hispanic (2.5% vs. 1.0%) patients were more likely to have a lower CSI ( p &lt; 0.001). Our study identified a significant increase in the incidence of CSIs over time, which was associated with increasing patient age. Our study detected a pragmatic demarcation of classifying upper injuries as C1–C3 and lower cervical injuries as C4–C7. Upper injuries were seen more often in older, White females who were treated and admitted, and lower injuries were seen more often in young, Black male patients who were released without admission.

Abstract The derivation of protective values for aquatic life can be enhanced by the development and use of bioavailability models. Recent advances to metals bioavailability modeling are applicable to other analyte groups and should be widely considered. We conducted a meta-analysis of the available aquatic toxicity literature for fluoride to evaluate the utility of hardness, alkalinity, and chloride as toxicity-modifying factors (TMFs) in empirical bioavailability models of freshwater taxa. The resulting optimal multiple linear regression model predicting acute fluoride toxicity to the invertebrate Hyalella azteca included all three TMFs (observed vs. predicted 50% lethal concentrations, R2 = 0.88) and the optimal model predicting toxicity to the fish Oncorhynchus mykiss included alkalinity and hardness (R2 = 0.37). At &amp;gt;20 mg/L chloride, the preliminary final acute values for fluoride were within 1 order of magnitude and ranged from approximately 18.1 to 56.3 mg/L, depending on water chemistry. Sensitivity of H. azteca to low-chloride conditions increased model uncertainty when chloride was &amp;lt;20 mg/L. Because of limited toxicity data, chronic bioavailability models were not developed, and final chronic values were derived using an acute-to-chronic ratio (ACR) approach. Accounting for TMFs, the geometric mean ACR was 5.4 for fish and invertebrate taxa (n = 6). The present assessment highlights the need to expand bioavailability modeling to include inorganic anions, particularly fluoride, and demonstrates that existing promulgated protective values for fluoride are likely overly conservative. More toxicological studies are recommended to further refine multivariate empirical bioavailability models for inorganic anions. Environ Toxicol Chem 2022;41:396–409. © 2021 The Authors. Environmental Toxicology and Chemistry published by Wiley Periodicals LLC on behalf of SETAC. Abstract Hardness, alkalinity, and chloride are toxicity-modifying factors that influence the bioavailability of fluoride to freshwater taxa. Toxicity-modifying factors need to be considered when assessing protective values for aquatic life, such as the final acute value. FAV = final acute value; TMF = toxicity-modifying factor.

Background: Traumatic thoracolumbar fracture fixation without neurological injury can be performed using the traditional open, mini-open Wiltse, and percutaneous approaches. This systematic review and meta-analysis aims to compare perioperative outcomes between these approaches. Methods: PubMed, Web of Science, Scopus, Embase, and the Cochrane Library were searched for all relevant observational comparative studies. Results: 5 randomized trials and 22 comparative cohort studies were included. Compared to the traditional open approach (n=959), the Wiltse approach (n=410) was associated with significantly lower operative time, intraoperative estimated blood loss (EBL), and length of stay (LOS). There was no significant difference between the two in terms of postoperative visual analog scale (VAS) and Cobb angle. Compared to the percutaneous approach (n=980), the Wiltse approach was associated with shorter operative and fluoroscopy time, as well as significantly improved Cobb and vertebral body angles. The percutaneous approach was associated with improved vertebral body height. There was no significant difference between the two for blood loss, postoperative VAS, or LOS. Compared to the traditional open approach, the percutaneous approach was associated with shorter operative time, lower EBL, shorter LOS and better postoperative VAS and Oswestry Disability Index. There was no difference between the two in postoperative Cobb angle, vertebral angle, or vertebral body height. Overall study heterogeneity was high. Conclusions: Utilization of minimally invasive surgical approaches holds great promise for lowering patient morbidity and optimizing care. A prospective trial is needed to assess outcomes and guide surgical decision making.

Noticias preliminares de la campaña de 1983.

Using radiographic absorptiometry we measured changes in phalangeal bone mineral density (BMD) in mass units/cm2 of a CAPD patient group (N = 32) during a nominal two-year span and compared the average rate of change with the normal rate due to aging. We did the same for five patient groups on hemodialysis (HD) ranging in size from N = 46 to N = 87. Average annual BMD rates of change of the CAPD group and of one HD group were not significantly different from normal aging. Theaverage BMD of each of the other four HD groups declined significantly relative to norms.

Presentación de los resultados preliminares de la campaña de excavaciones. Incluye apéndice con estudio de divisores hispano-cartagineses.<br />

This work aims at presenting an example of<br> application of the APIs for the step of hydrodynamic model<br> calibration and validation in the case of an ongoing study The<br> study site is a gravel bed river where the fine sediment<br> dynamics is a main concern of the river management.

A propulsion model has been proposed for front crawl swimming (Carmigniani et al., 2020). The aim of this study is to validate this model through a progressive speed test using instrumented paddles to estimate the propulsion forces in swimming.

Art. III.-An account of the beneficial effects of Ergot, in a case of Hydatids of the Uterus, By Dr. P. B. Johnson, of MConnelsville,

Introduction: Identifying and determining appropriate treatment of adult hip septic arthritis (SA) can be quite challenging. Although rare, the annual incidence of this diagnosis is approximately 8 cases per 100,000 patients. The timing of patient symptoms is wide spread. The presentation may be acute, subacute, or even chronic, and moreover, the disease process may be masked by an underlying etiology. Once diagnosed, SA requires rapid and aggressive treatment. Case Report: A 67-year-old patient presented with left hip pain. Physical examination shifted the differential diagnosis from osteoarthritis to a possible septic joint. Elevated inflammatory markers were revealed. Joint aspiration was obtained, which demonstrated rare Group G streptococcus. Two-stage hip arthroplasty was performed. Intra-operative cultures still reveal no growth of bacteria, and the patient is progressing well. Conclusion: Adult septic hip arthritis is a rare diagnosis. Hence, a proper history, physical examination, infectious laboratory workup is important. The treatment of the condition is based on the duration of symptoms and the physician's clinical gestalt.

We describe a methodology to build vectorial kinetic schemes, targetting the numerical solution of linear symmetric-hyperbolic systems of conservation laws -a minimal application case for those schemes. Precisely, we fully detail the construction of kinetic schemes that satisfy a discrete equivalent to a convex extension (an additional non-trivial conservation law) of the target system -the (linear) acoustic and elastodynamics systems, specifically -. Then, we evaluate numerically the convergence of various possible kinetic schemes toward smooth solutions, in comparison with standard finite-difference and finite-volume discretizations on Cartesian meshes. Our numerical results confirm the interest of ensuring a discrete equivalent to a convex extension, and show the influence of remaining parameter variations in terms of error magnitude, both for ''first-order'' and ''second-order'' kinetic schemes\,: the parameter choice with largest CFL number (equiv., smallest spurious diffusion in the equivalent equation analysis) has the smallest discretization error.

Cannabis is a highly discussed topic in medicine today. From therapeutic applications in conditions such as chronic pain, multiple sclerosis, epilepsy, chemotherapy-induced nausea and vomiting, and inflammatory bowel disease to the growing prevalence of recreational use, cannabis remains at the forefront of medical and societal conversations. In this review, we will explore the history of marijuana use in medicine, examine the current evidence supporting its pharmacological benefits, and delve into its impact on the developing brain. Additionally, we will highlight the pivotal role pharmacists play in this evolving landscape and guide you through the latest research findings.

We propose a new mixing length profile, based on an extension of von Kármán similarity hypothesis, as well as the associated mixing velocity profile. This profile was compared with other profiles and was tested on three academic and experimental cases. The validation of the model was made from a set of reference examples and concerns the erosion of a bottom of sand in a uniform flow, and the filling of an extraction pit resulting from the tests presented in the European project SANDPIT. -- On propose un nouveau profil de longueur de mélange lm (z), basé sur une extension de l'hypothèse de similitude de von Kármán, ainsi que le profil de vitesse de mélange associé. Ce profil a été comparé à d'autres profils et testé sur trois cas test académiques et expérimentaux. La validation du modèle a été effectuée à partir d'un ensemble d'exemples de références et concernent l'érosion d'un fond de sable érodable dans un écoulement uniforme en canal, et le remplissage d'une fosse d'extraction issus des essais présentés dans le projet Européen SANDPIT.