Privacy-preserving model evaluation for logistic and linear regression using homomorphically encrypted genotype data.

OBJECTIVE: Linear and logistic regression are widely used statistical techniques in population genetics for analyzing genetic data and uncovering patterns and associations in large genetic datasets, such as identifying genetic variations linked to specific diseases or traits. However, obtaining statistically significant results from these studies requires large amounts of sensitive genotype and phenotype information from thousands of patients, which raises privacy concerns. Although cryptographic techniques such as homomorphic encryption offers a potential solution to the privacy concerns as it allows computations on encrypted data, previous methods leveraging homomorphic encryption have not addressed the confidentiality of shared models, which can leak information about the training data. METHODS: In this work, we present a secure model evaluation method for linear and logistic regression using homomorphic encryption for six prediction tasks, where input genotypes, output phenotypes, and model parameters are all encrypted. RESULTS: Our method ensures no private information leakage during inference and achieves high accuracy (≥93% for all outcomes) with each inference taking less than ten seconds for ∼200 genomes. CONCLUSION: Our study demonstrates that it is possible to perform linear and logistic regression model evaluation while protecting patient confidentiality with theoretical security guarantees. Our implementation and test data are available at https://github.com/G2Lab/privateML/.

The Effect of Pregabalin on Microglia Differentiation in Rat with Neuropathic pain: A Preliminary Study.

This study investigated the effects of pregabalin on microglial differentiation in rats with neuropathic pain (NP) induced by sciatic nerve ligation and transection. After confirming NP, the rats were randomly allocated to either a pregabalin or control group. The pregabalin group received intraperitoneal injections of 10 mg/kg pregabalin, while the control group received an equivalent volume of normal saline following surgery. On postoperative day 28, neuronal damage, microglial activity, and microglial differentiation were assessed. The pregabalin group exhibited significantly less neuronal damage compared to the control group, along with a significant decrease in activated microglial expression in both the brain and spinal cord. Pregabalin treatment also significantly altered the microglial phenotype expression, with a decrease in the M1 phenotype percentage and an increase in the M2 phenotype percentage in both the brain (M1 phenotype: 43.52 ± 12.16% and 18.00 ± 8.57% in the control and pregabalin groups, respectively; difference: 27.26 [15.18-42.10], p = 0.002; M2 phenotype: 16.88 ± 6.47% and 39.63 ± 5.82% in the control and pregabalin groups, respectively; difference 22.04 [17.17-32.70], p < 0.001) and the spinal cord ipsilateral to nerve injury (M1 phenotype: 44.35 ± 12.12% and 13.78 ± 5.39% in the control and pregabalin groups, respectively; difference 30.46 [21.73-44.45], p < 0.001; M2 phenotype: 7.64 ± 3.91% and 33.66 ± 7.95% in the control and pregabalin groups, respectively; difference 27.41 [21.21-36.30], p < 0.001). Overall, pregabalin treatment significantly decreased the microglial M1 phenotype while increasing the microglial M2 phenotype in NP rats.

Comparison emergence of sedation, using dexmedetomidine and remimazolam, in spinal anaesthesia - double blinded randomized controlled trial.

Background: Continuous intravenous infusion of remimazolam may be suitable for sedation in patients undergoing regional anaesthesia. However, there have been no studies comparing remimazolam and dexmedetomidine for this purpose. This study compared emergence from sedation between dexmedetomidine and remimazolam following continuous intravenous infusion in patients undergoing spinal anaesthesia. Methods: This double-blinded, randomised controlled trial assessed the sedative effects of dexmedetomidine and remimazolam. Following spinal anaesthesia, patients were sedated using continuous intravenous infusion of either dexmedetomidine (D group) or remimazolam (R group).The D group received dexmedetomidine administered at 6 mL/kg/h (6 µg/kg/h) for 10 minutes, followed by 1 mL/kg/h (1 µg/kg/h). The R group received remimazolam administered at 6 mL/kg/h (6 mg/kg/h) for 10 minutes, followed by 1 mL/kg/h (1 mg/kg/h). Sedation levels were evaluated using the Modified Observer's Assessment of Alertness/Sedation (MOAA/S) scale. The time to reach MOAA/S ≤ 3 from the start of drug infusion and the time to reach MOAA/S = 5 from the end of infusion were recorded. Hemodynamic parameters and respiratory rate were also monitored. Results: The R group reached MOAA/S ≤ 3 significantly faster than the D group during induction of sedation (4 ± 1 minutes and 11 ± 3 minutes, respectively, p < 0.001). The R group also reached MOAA/S = 5 significantly faster than the D group during emergence from sedation (11 ± 3 minutes and 16 ± 5 minutes, respectively, p < 0.001). Both groups maintained stable hemodynamic parameters and respiratory rate without any significant differences, although the mean heart rate was significantly lower in the D group than in the R group after the start of infusion. Conclusion: Remimazolam demonstrated significantly faster induction of and emergence from sedation compared to dexmedetomidine, with no significant differences in haemodynamics or respiratory depression.

The Preventive Effect of Urinary Trypsin Inhibitor on Postoperative Cognitive Dysfunction, on the Aspect of Behavior, Evaluated by Y-Maze Test, via Modulation of Microglial Activity.

This experimental study was designed to evaluate the effect of ulinastatin, a urinary trypsin inhibitor, on postoperative cognitive dysfunction (POCD) in rats under general anesthesia with isoflurane, on the aspect of behavior, as evaluated using a Y-maze test and focusing on microglial activity. Ulinastatin (50,000 U/mL) and normal saline (1 mL) were randomly (1:1) administered intraperitoneally to the ulinastatin and control groups, respectively, before general anesthesia. Anesthesia with isoflurane 1.5 volume% was maintained for 2 h. The Y-maze test was used to evaluate cognitive function. Neuronal damage using caspase-1 expression, the degree of inflammation through cytokine detection, and microglial activation with differentiation of the phenotypic expression were evaluated. Twelve rats were enrolled in the study and evenly allocated into the two groups, with no dropouts from the study. The Y-maze test showed similar results in the two groups before general anesthesia (63 ± 12% in the control group vs. 64 ± 12% in the ulinastatin group, p = 0.81). However, a significant difference was observed between the two groups after general anesthesia (17 ± 24% in the control group vs. 60 ± 12% in the ulinastatin group, p = 0.006). The ulinastatin group showed significantly lower expression of caspase-1. Pro-inflammatory cytokine levels were significantly lower in the ulinastatin group than in the control group. The ulinastatin group had a significantly lower microglial activation (41.74 ± 10.56% in the control group vs. 4.77 ± 0.56% in the ulinastatin, p < 0.001), with a significantly lower activation of M1 phenotypes (52.19 ± 7.83% in the control group vs. 5.58 ± 0.76% in the ulinastatin group, p < 0.001). Administering ulinastatin before general anesthesia prevented neuronal damage and cognitive decline after general anesthesia, in terms of the aspect of behavior, as evaluated by the Y-maze test. The protective effect of ulinastatin was associated with the inhibition of microglial activation, especially the M1 phenotype.

The Effect of Ketamine on Endoplasmic Reticulum Stress in Rats with Neuropathic Pain.

This study aimed to investigate the effects of ketamine, an N-methyl-D-aspartate (NMDA) receptor antagonist, on endoplasmic reticulum (ER) stress in rats with neuropathic pain (NP). NP was induced in rats through ligation and transection of the sciatic nerve. After confirmation of NP, the animals were randomly divided into ketamine and control groups. The ketamine group was administered 50 mg/kg of ketamine at 15, 18, and 21 days after surgery. The expression of NMDA receptor subtype 2B (NR2B) and ER stress markers in the spinal cord (L5) was evaluated. The ipsilateral side of the surgery in the ketamine group was less sensitive to mechanical and cold stimulations. The expression of NR2B on the ipsilateral side was significantly lower in the ketamine group than in the control group (18.93 ± 1.40% vs. 31.08 ± 0.74%, p < 0.05). All markers for ER stress on the ipsilateral side of the surgery in both groups had higher expression than those on the contralateral side. The expression of activating transcription factor-6 (ATF-6) on the ipsilateral side was significantly lower in the ketamine group than in the control group (p < 0.05). Systemic administration of ketamine inhibited the expression of NMDA receptors and improved NP symptoms. Among the markers of ER stress, the therapeutic effect of ketamine is associated with the inhibition of ATF-6 expression.

Comparison of thromboelastographic profiles in pediatric patients with congenital heart disease according to existence of cyanosis.

PURPOSE: Congenital heart disease (CHD) is divided into two groups according to cyanosis status. Cyanotic CHD has a low level of systemic oxygenation and is accompanied by increased erythropoiesis. We hypothesized that pediatric patients with CHD would exhibit different thromboelastographic profiles according to their cyanosis status. METHODS: The study recruited 70 pediatric patients younger than 12 months who were undergoing surgery for CHD. Patients were allocated to the acyanotic group or cyanotic group after preoperative evaluations of their diagnosis and peripheral oxygen saturation in the operating room on room air. After inducing anesthesia, blood samples were collected. Hematologic and thromboelastographic profiles were evaluated. RESULTS: Demographic data were similar between groups. The thromboelastographic profiles did not differ significantly between the groups. Hematologic profiles generally did not significantly differ between groups, except hematocrit (Hct) was higher in the cyanotic group (41.7 ± 6.8% vs. 35.3 ± 5.3%, p < 0.001). In patients under 3 months of age, prothrombin time (PT) (cyanotic group 15.4 ± 1.1 s vs. acyanotic group 14.2 ± 2.4 s, p = 0.02) and international normalized ratio (INR) (cyanotic group 1.24 ± 0.12 vs. acyanotic group 1.12 ± 0.27, p = 0.01) were significantly greater in the cyanotic group. CONCLUSION: There were no differences in thromboelastographic profiles between the patients with or without cyanosis, regardless of age. The Hct was higher in the cyanotic group in patients under 12 months, while the PT was prolonged and the INR was increased in the cyanotic group in patients under 3 months.

Usefulness of the perfusion index for monitoring the response to intravenous ketamine infusion therapy in patients with complex regional pain syndrome.

BACKGROUND: This study was performed to compare the perfusion index (PI) between affected and unaffected limbs in patients with complex regional pain syndrome (CRPS); it also evaluated the usefulness of the PI for monitoring the response to intravenous ketamine infusion therapy in such patients. METHODS: In total, 46 patients with CRPS in one arm or leg were enrolled in this study. The PIs of the unaffected (PIControl ) and affected (PICRPS ) limbs were simultaneously evaluated before and after treatment. RESULTS: PICRPS was significantly lower than PIControl at all time points. The change in PI from immediately before to 30 min after intravenous ketamine infusion therapy (TBefore and T30 min , respectively) in the affected limb was significantly correlated with the change in visual analog pain scale (VAS) between the two time points (r = 0.646, p < 0.001). The area under the curve for the changes in VAS and PICRPS between TBefore and T30 min was 0.928. The optimal threshold value for the change in PICRPS between TBefore and T30 min , to distinguish responders with a ≥ 50-point reduction in VAS score from nonresponders, was 22.60% with a sensitivity of 0.811 (95% CI: 0.774-0.848) and a specificity of 0.889 (95% CI: 0.848-0.930). Thirty-one patients showed a ≥ 50-point reduction in VAS score [67% (95% CI: 54%-80%)] and 15 patients showed a < 50-point reduction in VAS score [33% (95% CI: 20%-46%)]. Thirty patients showed an increased PI ≥ 22.60% [65% (95% CI: 50%-78%)] and 16 patients showed an increased PI < 22.60% [35% (95% CI: 22%-50%)]. Twenty-seven patients had a ≥ 50-point reduction in VAS score and an increased PI ≥ 22.60% [59% (95% CI: 44%-74%)]. Eleven patients had shown a < 50-point pain reduction in VAS score and increased PI < 22.60% [24% (95% CI: 13%-37%)]. CONCLUSION: The PI significantly differed between affected and unaffected limbs in patients with CRPS. The PI may be useful for monitoring the response to intravenous ketamine therapy in patients with CRPS.

Secure tumor classification by shallow neural network using homomorphic encryption.

BACKGROUND: Disclosure of patients' genetic information in the process of applying machine learning techniques for tumor classification hinders the privacy of personal information. Homomorphic Encryption (HE), which supports operations between encrypted data, can be used as one of the tools to perform such computation without information leakage, but it brings great challenges for directly applying general machine learning algorithms due to the limitations of operations supported by HE. In particular, non-polynomial activation functions, including softmax functions, are difficult to implement with HE and require a suitable approximation method to minimize the loss of accuracy. In the secure genome analysis competition called iDASH 2020, it is presented as a competition task that a multi-label tumor classification method that predicts the class of samples based on genetic information using HE. METHODS: We develop a secure multi-label tumor classification method using HE to ensure privacy during all the computations of the model inference process. Our solution is based on a 1-layer neural network with the softmax activation function model and uses the approximate HE scheme. We present an approximation method that enables softmax activation in the model using HE and a technique for efficiently encoding data to reduce computational costs. In addition, we propose a HE-friendly data filtering method to reduce the size of large-scale genetic data. RESULTS: We aim to analyze the dataset from The Cancer Genome Atlas (TCGA) dataset, which consists of 3,622 samples from 11 types of cancers, genetic features from 25,128 genes. Our preprocessing method reduces the number of genes to 4,096 or less and achieves a microAUC value of 0.9882 (85% accuracy) with a 1-layer shallow neural network. Using our model, we successfully compute the tumor classification inference steps on the encrypted test data in 3.75 minutes. As a result of exceptionally high microAUC values, our solution was awarded co-first place in iDASH 2020 Track 1: "Secure multi-label Tumor classification using Homomorphic Encryption". CONCLUSIONS: Our solution is the first result of implementing a neural network model with softmax activation using HE. Also, HE optimization methods presented in this work enable machine learning implementation using HE or other challenging HE applications.

Effects of general anaesthesia with an inhalational anaesthetic agent on the expression of exosomes in rats.

Background: We hypothesized that the expression of exosomes under general anaesthesia with an inhalational anaesthetic agent would be changed. The study was designed to confirm the effect of general anesthesia with an inhalational anaesthetic agent on the expression of exosomes in rats. Methods: After intraperitoneal administration for the mixture of ketamine and xylazine, tracheal intubation was performed. Just before the connection to ventilator, Control group and Anaesthesia group, according to anaesthesia with isoflurane, were allocated. The expressions of exosomes were checked in bronchoalveolar lavage (BAL), the blood and the tissues from the lung and the brain. Cytokines in the blood were also assessed. Results: The expressions of cluster of differentiation (CD)63 and CD81 as markers for the exosomes in the blood was increased after anaesthesia with isoflurane (CD63, 0.078 ± 0.057 % in Control group vs. 0.180 ± 0.036 % in Anaesthesia group, p = 0.02; CD81, 0.028 ± 0.034 % in Control group vs. 0.245 ± 0.054 % in Anaesthesia group, p < 0.01). However, the increased expression of them were not checked in BAL, and the tissues from the lung and the brain. The cytokines in the blood did not show any significant difference before and after anaesthesia with isoflurane. Conclusion: General anaesthesia with an inhalational anaesthetic agent increased the expression of exosomes in the blood. However, the change was limited in the blood, not the alveoli and the brain.

A secure SNP panel scheme using homomorphically encrypted K-mers without SNP calling on the user side.

BACKGROUND: Single Nucleotide Polymorphism (SNP) in the genome has become crucial information for clinical use. For example, the targeted cancer therapy is primarily based on the information which clinically important SNPs are detectable from the tumor. Many hospitals have developed their own panels that include clinically important SNPs. The genome information exchange between the patient and the hospital has become more popular. However, the genome sequence information is innate and irreversible and thus its leakage has serious consequences. Therefore, protecting one's genome information is critical. On the other side, hospitals may need to protect their own panels. There is no known secure SNP panel scheme to protect both. RESULTS: In this paper, we propose a secure SNP panel scheme using homomorphically encrypted K-mers without requiring SNP calling on the user side and without revealing the panel information to the user. Use of the powerful homomorphic encryption technique is desirable, but there is no known algorithm to efficiently align two homomorphically encrypted sequences. Thus, we designed and implemented a novel secure SNP panel scheme utilizing the computationally feasible equality test on two homomorphically encrypted K-mers. To make the scheme work correctly, in addition to SNPs in the panel, sequence variations at the population level should be addressed. We designed a concept of Point Deviation Tolerance (PDT) level to address the false positives and false negatives. Using the TCGA BRCA dataset, we demonstrated that our scheme works at the level of over a hundred thousand somatic mutations. In addition, we provide a computational guideline for the panel design, including the size of K-mer and the number of SNPs. CONCLUSIONS: The proposed method is the first of its kind to protect both the user's sequence and the hospital's panel information using the powerful homomorphic encryption scheme. We demonstrated that the scheme works with a simulated dataset and the TCGA BRCA dataset. In this study, we have shown only the feasibility of the proposed scheme and much more efforts should be done to make the scheme usable for clinical use.

Ultra-secure storage and analysis of genetic data for the advancement of precision medicine.

Cloud computing provides the opportunity to store the ever-growing genotype-phenotype data sets needed to achieve the full potential of precision medicine. However, due to the sensitive nature of this data and the patchwork of data privacy laws across states and countries, additional security protections are proving necessary to ensure data privacy and security. Here we present SQUiD, a secure queryable database for storing and analyzing genotype-phenotype data. With SQUiD, genotype-phenotype data can be stored in a low-security, low-cost public cloud in the encrypted form, which researchers can securely query without the public cloud ever being able to decrypt the data. We demonstrate the usability of SQUiD by replicating various commonly used calculations such as polygenic risk scores, cohort creation for GWAS, MAF filtering, and patient similarity analysis both on synthetic and UK Biobank data. Our work represents a new and scalable platform enabling the realization of precision medicine without security and privacy concerns.

The preventive effect of 5-hydroxytryptamine-3 receptor antagonist on blood pressure reduction and postoperative nausea and vomiting during general anesthesia induction: A double-blinded, randomized controlled trial.

STUDY OBJECTIVE: Administering a 5-hydroxytryptamine-3 receptor (5-HT3) at anesthesia induction may aid in achieving hemodynamic stability during general anesthesia induced using opioids. Therefore, we aimed to evaluate the effect of ramosetron, a 5-HT3 antagonist, administered on hypotension at the induction of total intravenous anesthesia (TIVA) with propofol and remifentanil. Additionally, we aimed to compare the impact of ramosetron administration at anesthesia induction versus that at the end of the surgery on postoperative nausea and vomiting (PONV). DESIGN: Patients were randomly allocated to the Induction group (administration of ramosetron [0.3 mg/5 ml] at anesthesia induction and normal saline [5 ml] at the end of the surgery) or End group (administration of normal saline [5 ml] at anesthesia induction and ramosetron [0.3 mg/5 ml] at the end of the surgery). Hemodynamic status, PONV, and postoperative pain were assessed. SETTING: Operating room, post-anesthetic care unit, and general ward. PATIENTS: In total, 176 non-smoking patients without any past medical history undergoing laparoscopic gynecological surgeries under TIVA were included in the study. MEASUREMENTS: Blood pressure (BP), heart rate, PONV, visual analog scale (VAS). MAIN RESULTS: The Induction group exhibited significantly higher BP at anesthesia induction and required significantly lower doses of phenylephrine and ephedrine during anesthesia than the End group had. However, PONV and postoperative pain were similar between the two groups. CONCLUSIONS: Administering ramosetron at anesthesia induction resulted in significantly better hemodynamic stability with significantly lesser requirement of phenylephrine and ephedrine than administering at the end of the surgery did. Therefore, we recommend ramosetron administration at anesthesia induction rather than at the end of the surgery to prevent PONV and the decrease in the mean BP during TIVA with propofol and remifentanil.

Prediction of postoperative pulmonary complications in older patients undergoing lobectomy for lung cancer based on skeletal muscle mass.

Background: This retrospective study was designed to evaluate preoperative pulmonary function test (PFT) results and skeletal muscle mass, represented by the erector spinae muscle (EM), as predictors of postoperative pulmonary complications (PPCs) in older patients undergoing lobectomy for lung cancer. Methods: The medical records, including preoperative PFT, chest computed tomography (CT) and PPCs, of patients older than 65 years undergoing lobectomy for lung cancer were retrospectively examined at Konkuk University Medical Center from January 2016 to December 2021. The sum of cross-sectional areas (CSAs) of the right and left EMs at the level of the spinous process with the 12th thoracic vertebra was used as the skeletal muscle mass (CSABoth). Results: Data from a total of 197 patients were included in the analyses. In total, 55 patients had PPCs. The preoperative functional vital capacity (FVC) and forced expiratory volume in 1 second (FEV1) showed significantly poorer values and the CSABoth had significantly lower values in patients with than in those without PPCs. The preoperative FVC and FEV1 showed significant positive correlations with CSABoth. Multiple logistic regression analysis identified age, diabetes mellitus (DM), preoperative FVC and CSABoth as risk factors for PPCs. The areas under the curves for FVC and CSABoth were 0.727 (95% CI, 0.650-0.803; P<0.001) and 0.685 (95% CI, 0.608-0.762; P<0.001), respectively. The optimal threshold values of FVC and CSABoth to predict PPCs based on a receiver operating characteristic curve analysis were 2.685 L (sensitivity =64.1% and specificity =61.8%) and 28.47 mm2 (sensitivity =62.0% and specificity =61.5%), respectively. Conclusions: PPCs in older patients undergoing lobectomy for lung cancer were associated with lower preoperative FVC and FEV1 values and a lower skeletal muscle mass. Skeletal muscle mass, represented by the EM, was significantly correlated with the preoperative FVC and FEV1. Therefore, skeletal muscle mass may be useful for the prediction of PPCs in patients undergoing lobectomy for lung cancer.

Back Muscle Mass as a Predictor of Postoperative Complications in Posterior Lumbar Interbody Fusion Surgery.

BACKGROUND: There is a lack of studies on utilising skeletal muscle mass via preoperative lumbar computed tomography or magnetic resonance imaging as a predictor of postoperative complications of posterior lumbar interbody fusion (PLIF) surgery in elderly patients. METHODS: Patients aged >65 years who underwent PLIF were enrolled. The sum of the cross-sectional areas of the erector spinae muscles (CSABoth) was presented as the skeletal muscle mass. Postoperative complications were assessed using CSABoth, pulmonary function testing, and prognostic nutritional index (PNI). RESULTS: Patients with postoperative complications showed significantly lower values of CSABoth (median 2266.70 (2239.73-2875.10) mm2 vs. 3060.30 (2749.25-3473.30) mm2, p < 0.001), functional vital capacity, forced expiratory volume at 1 s, and PNI. However, multiple logistic regression analysis identified American Society of Anaesthesiologists Physical Status (ASA PS) I (odds ratio 0.307 (95% confidence interval 0.110-0.852), p = 0.023), ASA PS III (4.033 (1.586-10.254), p = 0.003), CSABoth (0.999 (0.999-1.000), p < 0.001), and postoperative red blood cell (RBC) transfusion (1.603 (1.193-2.152), p = 0.002) as risk factors for postoperative complications after PLIF surgery. CONCLUSIONS: CSABoth, ASA PS III, and postoperative RBC transfusion might be used as predictors of postoperative complications after PLIF in patients aged >65 years.

Effects of Compression of the Ulnar Artery on the Radial Artery Catheterization.

Background: The study was designed to evaluate the effects of compression of the ulnar artery on blood flow (BF) and internal cross-sectional area (CSAi) of the radial artery. We also evaluated the success rate and time of successful ultrasound-guided radial artery catheterization at the first attempt with or without compression of the ulnar artery. Methods: Patients were randomly allocated to the Compression group or Standard group to be treated with or without the application of ulnar artery compression, respectively. Hemodynamic stability was confirmed, and ultrasound-guided radial artery catheterization was performed. In the Compression group, an assistant compressed the ulnar artery at 5 cm above the wrist crease and the catheterization was performed after the loss of the distal ulnar artery BF. In the Standard group, the catheterization was performed without compression of the ulnar artery. Before and after the catheterization, BF and CSAi of the radial artery were evaluated. Success rate and time to successful catheterization at the first attempt were recorded. Results: BF and CSAi of the radial artery were similar in the two groups (37.5 [19.3−66] vs. 37.0 [20.6−53.7] mL/min, respectively, p = 0.63; 4.0 [4.0−6.0] vs. 4.0 [3.0−5.0] mm2, respectively, p = 0.095). In the Compression group, BF and CSAi were changed to 80.9 [35.9−128.5] mL/min (p < 0.001) and 5.0 [4.0−7.0] mm2 (p < 0.001), respectively, after compression of the ulnar artery. There was a trend that the success rate of ultrasound-guided radial artery catheterization at the first attempt was higher in the Compression group than in the Standard group (58/59 vs. 53/59, respectively, p = 0.05), although the difference was not statistically significant. However, the time to successful ultrasound-guided radial artery catheterization at the first attempt was significantly shorter in the Compression group than in the Standard group (34 [27−41] s vs. 46 [36−60] s, p < 0.001). Conclusion: Compression of the ulnar artery augmented BF and CSAi of the radial artery. It resulted in a significantly shorter success time for ultrasound-guided radial artery catheterization at the first attempt.

The Neutrophil-to-Lymphocyte Ratio and Preoperative Pulmonary Function Test Results as Predictors of In-Hospital Postoperative Complications after Hip Fracture Surgery in Older Adults.

Purpose: This study retrospectively evaluated the usefulness of the neutrophil-to-lymphocyte ratio (NLR), prognostic nutritional index (PNI), and pulmonary function test (PFT) results as objective predictors of in-hospital postoperative complications after hip fracture surgery in older adults. Methods: The patients aged >65 years who underwent hip fracture surgery under general anaesthesia were enrolled. In-hospital postoperative complications with preoperative NLR, PNI and PFT results were evaluated. The NLR was calculated as the preoperative neutrophil count/lymphocyte count in peripheral blood. The PNI was calculated as the serum albumin (g/dL) × 10 + total lymphocyte count × 0.005 (/mm3). Results: One hundred ninety nine patients were analysed. The most common postoperative complications were respiratory complications. Compared with patients who did not have postoperative complications, patients with postoperative complications had a significantly higher NLR (8.01 ± 4.70 vs. 5.12 ± 4.34, p < 0.001), whereas they had a significantly lower PNI (38.33 ± 6.80 vs. 42.67 ± 6.47, p < 0.001), preoperative functional vital capacity (FVC; 2.04 ± 0.76 vs. 2.45 ± 0.71 L, p < 0.001), and forced expiratory volume at 1 s (FEV1; 1.43 ± 0.53 vs. 1.78 ± 0.58 L, p < 0.001). Multiple logistic regression analysis identified NLR (odds ratio [OR], 1.142; 95% confidence interval [CI], 1.060−1.230; p < 0.001) and FEV1 (OR, 0.340; 95% CI, 0.191−0.603; p < 0.001) as risk factors for postoperative complications after hip fracture surgery. Conclusion: Preoperative NLR and FEV1 are objective predictors of in-hospital postoperative complications after hip fracture surgery in older patients.

The relative frequency of pruritus in postherpetic neuralgia patients presenting to the pain clinic and associative factors.

Postherpetic neuralgia (PHN) is the most common complication of herpes zoster, whereas postherpetic pruritus (PHP) a rare one. Although PHN has been extensively studied, few studies have investigated PHP. The purpose of this study was to investigate PHP incidence and associated factors in patients with PHN. This was a retrospective study of patients with PHN. A total of 645 patients were included. This study conducted in a single university hospital. Data included age, sex, height, weight, pain score, PHN site, medications, nerve blocks, and pulsed radiofrequency treatment. Data also included PHP onset and duration among those with PHP. We divided patients into 2 groups: the control group (group C), comprising those without PHP, and pruritus group (group P), comprising those with PHP. The correlation of PHP with other factors was analyzed. Of 207 patients, 58 were in group P whereas 149 in group C. The mean onset time and duration of PHP were 96.5 and 278.6 days, respectively. Pain scores were lower in group P than in group C after 3 and 4 months following vesicle formation. Patients with PHN in the trigeminal nerve had a higher incidence of PHP compared to those with PHN in others. Twenty-eight percent of patients with PHN developed PHP. At 3 and 4 months after vesicle formation, patients with PHP had greater pain improvement compared to those without. Patients with PHN in the trigeminal nerve also had a higher incidence of PHP compared to others.

General anesthesia, using remimazolam, for the patient with myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD): A case report.

RATIONALE: Myelin oligodendrocyte glycoprotein antibody associated disease (MOGAD) is one of auto-immune demyelinating diseases of nervous system. Although both regional anesthesia and general anesthesia has been successfully performed in the patient with demyelinating diseases of nervous system, it has been controversial which one is better. PATIENT CONCERNS: Forty-four male patient was admitted for arthroscopic elbow surgery due to limitation of range of motion. The patient was diagnosed as MOGAD with anti-N-methyl-D-aspartate (NMDA) receptor encephalitis, and steroid was used to prevent and treat symptoms and signs. DIAGNOSIS: He was diagnosed as MOGAD with anti-NMDA receptor encephalitis, 1 year ago. The patient complaint of dizziness, diplopia, nausea, vomiting, seizure, general weakness and so on when he was confirmed as MOGAD with anti-NMDA receptor encephalitis. The diagnosis of MOGAD was confirmed with positive anti-myelin oligodendrocyte glycoprotein (MOG) Immunoglobulin (Ig)G and negative anti-aquaporin 4 (AQP4) IgG in the blood. INTERVENTIONS AND OUTCOMES: After steroid cover, total intravenous anesthesia (TIVA) with remimazolam and remifentanil was established for the patients. Rocuronium was administered under monitoring of neuromuscular blockade, using train of 4 (TOF). The operation was performed without any event under right lateral decubitus position. The patient was uneventfully recovered from anesthesia. LESSONS: The case report showed total intravenous anesthesia with remimazolam and remifentanil under proper monitoring was successfully performed in the patient with MOGAD.

Ultrafast homomorphic encryption models enable secure outsourcing of genotype imputation.

Genotype imputation is a fundamental step in genomic data analysis, where missing variant genotypes are predicted using the existing genotypes of nearby "tag" variants. Although researchers can outsource genotype imputation, privacy concerns may prohibit genetic data sharing with an untrusted imputation service. Here, we developed secure genotype imputation using efficient homomorphic encryption (HE) techniques. In HE-based methods, the genotype data are secure while it is in transit, at rest, and in analysis. It can only be decrypted by the owner. We compared secure imputation with three state-of-the-art non-secure methods and found that HE-based methods provide genetic data security with comparable accuracy for common variants. HE-based methods have time and memory requirements that are comparable or lower than those for the non-secure methods. Our results provide evidence that HE-based methods can practically perform resource-intensive computations for high-throughput genetic data analysis. The source code is freely available for download at https://github.com/K-miran/secure-imputation.

Privacy-preserving approximate GWAS computation based on homomorphic encryption.

BACKGROUND: One of three tasks in a secure genome analysis competition called iDASH 2018 was to develop a solution for privacy-preserving GWAS computation based on homomorphic encryption. The scenario is that a data holder encrypts a number of individual records, each of which consists of several phenotype and genotype data, and provide the encrypted data to an untrusted server. Then, the server performs a GWAS algorithm based on homomorphic encryption without the decryption key and outputs the result in encrypted state so that there is no information leakage on the sensitive data to the server. METHODS: We develop a privacy-preserving semi-parallel GWAS algorithm by applying an approximate homomorphic encryption scheme HEAAN. Fisher scoring and semi-parallel GWAS algorithms are modified to be efficiently computed over homomorphically encrypted data with several optimization methodologies; substitute matrix inversion by an adjoint matrix, avoid computing a superfluous matrix of super-large size, and transform the algorithm into an approximate version. RESULTS: Our modified semi-parallel GWAS algorithm based on homomorphic encryption which achieves 128-bit security takes 30-40 minutes for 245 samples containing 10,000-15,000 SNPs. Compared to the true p-value from the original semi-parallel GWAS algorithm, the F1 score of our p-value result is over 0.99. CONCLUSIONS: Privacy-preserving semi-parallel GWAS computation can be efficiently done based on homomorphic encryption with sufficiently high accuracy compared to the semi-parallel GWAS computation in unencrypted state.