Pattern recognition in data as a diagnosis tool

Medical data often appear in the form of numerical matrices or sequences. We develop mathematical tools for automatic screening of such data in two medical contexts: diagnosis of systemic lupus erythematosus (SLE) patients and identification of cardiac abnormalities. The idea is first to implement adequate data normalizations and then identify suitable hyperparameters and distances to classify relevant patterns. To this purpose, we discuss the applicability of Plackett-Luce models for rankings to hyperparameter and distance selection. Our tests suggest that, while Hamming distances seem to be well adapted to the study of patterns in matrices representing data from laboratory tests, dynamic time warping distances provide robust tools for the study of cardiac signals. The techniques developed here may set a basis for automatic screening of medical information based on pattern comparison.

BEDSIDE LAPAROSCOPY AS DIAGNOSTIC TOOL REVIEW OF ABDOMINAL PATHOLOGIES IN CRITICALLY ILL PATIENTS: REVIEW

Introduction: The diagnosis of abdominal pathologies in critically ill patients is often difficult because of inconclusive laboratory tests or imaging results, or the inability to safely transfer a patient to the radiology room. These causes give a delayed diagnosis of abdominal pathology in the intensive care unit (ICU) and increase rate of morbidity and mortality. The aim of this retrospective study is to evaluate the safety and diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients. Aim: The aim of this retrospective study is to evaluate the safety and diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients. Materials and Methods: A literature research was carried out including PubMed, Medline, Embase, Cochrane and Google Scholar databases to identify articles reporting on importance of diagnostic accuracy of bedside diagnostic laparoscopy in the identification of intra-abdominal pathology in critically ill patients. Conclusions: Bedside diagnostic laparoscopy represents a safe and accurate technique for diagnosing intraabdominal pathology in an ICU setting and should be taken into consideration when patient transfer to radiology or the operating room is considered unsafe or when routine radiological examinations are not conclusive enough to reach a definite diagnosis. Keywords: Bedside laparoscopy, critically ill patients, ultrasonography (US), computed tomography (CT) , emergency surgery

Plasma Level’s of Neuregulin-1 in Healthy People

Aim. To determine the median levels of neuregulin-1 (NRG-1; endothelium-derived growth factor and the natural agonist of the ERBB3 and ERBB4 receptors) NRG-1 in healthy volunteers and to study the associations of NRG-1 levels with gender and age.Material and Methods. Ninety seven healthy participants were enrolled (median age of 44 [32-54], men 45 men [46.4%]). The following age groups were identified: 20-29 y.о. (n=20, men – 50.0%), 30-39 y.о. (n=21, men – 52.4%), 40-49 y.о. (n=22, men – 45.5%), 50-59 y.о. (n=22, men – 36.4%); 60-69 y.о. (n=12, men – 50.0%). Peripheral blood samples were collected at the time of enrolment, standard laboratory tests were performed, and NRG-1 levels were determined in the plasma samples by ELISA.Results. In the cohort of 97 healthy participants the median value of NRG-1 was 0.3 [0.121-2.24] ng/ml. NRG-1 levels did not differ significantly between men and women (p=0.145), indicating that NRG-1 levels are not influenced by gender. The levels of NRG-1 were similar in the different age groups: age 20-29 years=0.26 [0.17-0.37] ng/ml; age 30-39=0.24 [0.1-0.39] ng/ml; age 40-49=0.31 [0.19-1.15] ng/ml; age 50-59=0.37 [0.19-1.0] ng/ml; age 60-69=0.4 [0.13-0.81] ng/ml. Correlation analysis between NRG-1 levels and route blood measurements (haemoglobin, lipids, glucose, creatinine, and uretic acid) did not show significant associations.Conclusions. In this study, the median value of NRG-1 plasma levels were determined. The results of the study show that age and gender had no influence on NRG-1 values.

Laboratory Tests to Optimize the Milking Machine Settings with Air Inlet Teat Cups for Sheep and Goats

Milking machine design and performance are directly related to the milkability of sheep and goats, with the aim of milking quickly, completely and gently. This leads to an increase in the milk yield with improved quality, and the maintenance of healthy udders. The aim of this study was to carry out laboratory tests to determine the optimal level of vacuum, pulsation rate and pulsation ratio of new milking machines in high and low milk lines for sheep and goats. This study was conducted at the Department of Research and Development, Siliconform, Germany. For this purpose, different levels of vacuum (32, 34, 36, 38 and 40 kPa), milk jet (2, 2.5, 3 and 4 mm), milk line (high line and low line) and pulsation ratio (50:50 and 60:40) were used. First minute water flow (1st WF/kg) was used as an indicator for assessing the best combination in the milking machine. In addition, the cyclic vacuum fluctuation was measured in the inner chamber of the teat cup during the 1st WF/kg with the aid of a Vacuscope device. Statistical analysis was conducted using the mixed procedure in SAS. Our results show that the vacuum level, the milk jet and the pulsation ratio had a significant influence (p < 0.05) on the 1st WF/kg in the two milking machines for goats and sheep. In conclusion, the ideal conditions for milking goats with air inlet teat cups in the milking machine are a vacuum level of 36–38 kPa (low line) and 38–40 kPa (high line), a pulsation rate of 90 cycles/min and a pulsation ratio of 60:40, while the ideal conditions in the sheep milking machines are a vacuum level of 35–36 kPa (low line) and 36–38 kPa (high line), a pulsation rate of 120 cycles/min and a pulsation ratio of 60:40 or 50:50.

Interpreting the full blood count

The full blood count (FBC) is one of the most commonly requested blood tests in medical practice and can provide a wealth of useful information about a patient’s general state of health, as well as highlighting abnormalities which indicate systemic or sinister pathologies. This article seeks to explore the different parameters of the FBC, and how these relate to some more common clinical presentations, as well as their relation to morphological findings seen on the blood film. As with most investigations, differential diagnoses suggested by any individual laboratory tests are wide and are most valuable when combined with history and examination.

International practice variation in perioperative laboratory testing in glioblastoma patients—a retrospective cohort study

Purpose Although standard-of-care has been defined for the treatment of glioblastoma patients, substantial practice variation exists in the day-to-day clinical management. This study aims to compare the use of laboratory tests in the perioperative care of glioblastoma patients between two tertiary academic centers—Brigham and Women’s Hospital (BWH), Boston, USA, and University Medical Center Utrecht (UMCU), Utrecht, the Netherlands. Methods All glioblastoma patients treated according to standard-of-care between 2005 and 2013 were included. We compared the number of blood drawings and laboratory tests performed during the 70-day perioperative period using a Poisson regression model, as well as the estimated laboratory costs per patient. Additionally, we compared the likelihood of an abnormal test result using a generalized linear mixed effects model. Results After correction for age, sex, IDH1 status, postoperative KPS score, length of stay, and survival status, the number of blood drawings and laboratory tests during the perioperative period were 3.7-fold (p < 0.001) and 4.7-fold (p < 0.001) higher, respectively, in BWH compared to UMCU patients. The estimated median laboratory costs per patient were 82 euros in UMCU and 256 euros in BWH. Furthermore, the likelihood of an abnormal test result was lower in BWH (odds ratio [OR] 0.75, p < 0.001), except when the prior test result was abnormal as well (OR 2.09, p < 0.001). Conclusions Our results suggest a substantially lower clinical threshold for ordering laboratory tests in BWH compared to UMCU. Further investigating the clinical consequences of laboratory testing could identify over and underuse, decrease healthcare costs, and reduce unnecessary discomfort that patients are exposed to.

Decreasing Laboratory Testing for Neonatal Jaundice Through Revision of a Clinical Practice Pathway

OBJECTIVES: The purpose of this study was to minimize unnecessary laboratory services for hospitalized neonates with hyperbilirubinemia by revising a local clinical practice pathway (CPP). METHODS: A retrospective cohort study was performed to compare the number of laboratory tests and blood draws in patients hospitalized with neonatal hyperbilirubinemia before and after implementation of a revised CPP. The study included infants with neonatal hyperbilirubinemia &lt;14 days old admitted after their birth hospitalization between April 2017 and October 2019. Primary outcome measures included the total number of blood draws and the number of laboratory tests obtained per patient and length of stay. Secondary outcome measures included 7-day readmission rate, charges, and discharge bilirubin level. RESULTS: The median number of blood draws per patient after implementation of the CPP decreased to 2 (interquartile range [IQR], 2–3) compared with 3 (IQR, 2–3) before implementation (Poisson model–based estimated mean difference, 1.1; 95% confidence interval, 1.0–1.3; P = .018). The median number of laboratory tests per patient after implementation decreased from 4 (IQR, 3–6) to 3 (IQR, 2–4; Poisson model–based estimated mean difference, 1.3; 95% confidence interval, 1.2–1.5; P &lt; .0001). There was no significant change in length of stay, readmission rate, charges, or discharge bilirubin level. CONCLUSIONS: Implementation of a revised CPP was associated with a significant decrease in the number of blood draws and laboratory tests per patient for infants admitted to the hospital for neonatal hyperbilirubinemia.