Age Estimation Using Machine Learning Algorithms with Parameters Obtained from X-ray Images of the Calcaneus.

BACKGROUND: Determination of bone age is a critical issue for forensics, surgery, and basic sciences. AIM: This study aims to estimate age with high accuracy and precision using Machine Learning (ML) algorithms with parameters obtained from calcaneus x-ray images of healthy individuals. METHOD: The study was carried out by retrospectively examining the foot X-ray images of 341 people aged 18-65 years. Maximum width of the calcaneus (MW), body width (BW), maximum length (MAXL), minimum length (MINL), facies articularis cuboidea height (FACH), maximum height (MAXH), and tuber calcanei width (TKW) parameters were measured from the images. The measurements were then grouped as 20-45 years of age, 46-64 years of age, 65 and older, and age estimation was made by using these at the input of ML models. RESULTS: As a result of the ML input of the measurements obtained, a 0.85 Accuracy (Acc) rate was obtained with the Extra Tree Classifier algorithm. The accuracy rate of other algorithms was found to vary between 0.78 and 0.82. The contribution of parameters to the overall result was evaluated by using the shapley additive explanations (SHAP) analyzer of Random Forest algorithm and the MAXH parameter was found to have the highest contribution in age estimation. CONCLUSIONS: As a result of our study, calcaneus bone was found to have high accuracy and precision in age estimations.

Sex prediction with morphometric measurements of first and fifth metatarsal and phalanx obtained from X-ray images by using machine learning algorithms.

BACKGROUND: The aim of this study is to predict sex with machine learning (ML) algorithms by making morphometric measurements on radiological images of the first and fifth metatarsal and phalanx bones. MATERIALS AND METHODS: In this study, radiologic images of 263 individuals (135 female, 128 male) between the ages of 27 and 60 were analysed retrospectively. The images in digital imaging and communications in medicine (DICOM) format were transferred to personal workstation Radiant DICOM Viewer programme. Length and width measurements of the first and fifth metatarsal and foot phalanx bones were performed on the transferred images. In addition, the ratios of the total length of the first proximal and distal phalanx and length of the first metatarsal and total length of fifth proximal, middle, and distal phalanx and maximum length of fifth metatarsal were calculated. RESULTS: As a result of machine learning algorithms, highest accuracy, specificity, sensitivity, and Matthews correlation coefficient values were found as 0.85, 0.86, 0.85, and 0.71, respectively with decision tree algorithm. It was found that accuracy rates of other algorithms varied between 0.74 and 0.83. CONCLUSIONS: As a result of our study, it was found that sex estimation was made with high accuracy rate by using machine learning algorithms on X-ray images of the first and fifth metatarsal and foot phalanx. We think that in cases when pelvis, cranium and long bones are harmed and examination is difficult, bones of the first and fifth metatarsal and foot phalanx can be used for sex estimation.

Comparison of anthropometric and conic beam computed tomography measurements of patients with and without difficult intubation risk according to modified mallampati score: New markers for difficult intubation.

BACKGROUND: The aim of this study was to compare the anthropometric and cone beam computed tomography (CBCT) measurements taken from risk-free and risky groups by using the modified Mallampati score (MMS). PATIENTS AND METHODS: A total of 176 volunteers between the ages of 18 and 65 in four different MMS classes were included in the study. The patients in classes MMS I and MMS II were accepted as risk-free and the patients in classes MMS III and MMS IV were accepted as risky for intubation. The Mann-Whitney U test was performed on the data to compare the anthropometric and radiological measurements taken from the risk-free and risky groups. A receiver operating characteristic (ROC) analysis was applied to the parameters that had a statistically significant difference. RESULTS: According to the analysis results, statistically significant differences were found in the neck circumference (NC), maximum interincisal distance (MID), thyromental distance (TMD) and sternomental distance (SMD) of the anthropometric measurements of men and women between the risk-free and risky groups (P < 0.05). In terms of CBCT measurements, the thickness of the tongue (TT), distance between the uvula and posterior wall of pharynx (U-Ph), distance between posterior nasal spine and nasopharynx (Snp-Nph) and length of the epiglottis (LE) were found to have statistically significant differences between the risk-free and risky groups of men and women (P < 0.05). CONCLUSION: The NC, MID, TMD and SMD anthropometric measurements and TT, U-Ph, Snp-Nph and LE radiologic measurements were found to support MMS, which is one of the most widely used bedside intubation prediction tests. In addition to the inclusion of CBCT for intubation prediction, U-Ph and Snp-Nph radiologic measurements were added as difficult intubation markers.

Feasible and effective use of a simulation-based curriculum for post-graduate emergency medicine trainees in India to improve learner self-efficacy, knowledge, and skills.

BACKGROUND: Pediatric emergency medicine training is in its infancy in India. Simulation provides an educational avenue to equip trainees with the skills to improve pediatric care. We hypothesized that a simulation-based curriculum can improve Indian post-graduate emergency medicine (EM) trainees' self-efficacy, knowledge, and skills in pediatric care. METHODS: We designed a simulation-based curriculum for management of common pediatric emergencies including sepsis, trauma, and respiratory illness and pediatric-specific procedures including vascular access and airway skills. Training included didactics, procedural skill stations, and simulation. Measures included a self-efficacy survey, knowledge test, skills checklist, and follow-up survey. Results were analyzed using the Wilcoxon signed-rank test and paired-samples t test. A 6-month follow-up survey was done to evaluate lasting effects of the intervention. RESULTS: Seventy residents from four academic hospitals in India participated. Trainees reported feeling significantly more confident, after training, in performing procedures, and managing pediatric emergencies (p < 0.001). After the simulation-based curriculum, trainees demonstrated an increase in medical knowledge of 19% (p < 0.01) and improvement in procedural skills from baseline to mastery of 18%, 20%, 16%, and 19% for intubation, bag-valve mask ventilation, intravenous access, and intraosseous access respectively (p < 0.01). At 6-month follow-up, self-efficacy in procedural skills and management of pediatric emergencies improved from baseline. CONCLUSIONS: A simulation-based curriculum is an effective and sustainable way to improve Indian post-graduate EM trainees' self-efficacy, knowledge, and skills in pediatric emergency care.

The accidental introduction of invasive animals as hitchhikers through inanimate pathways: a New Zealand perspective.

Hitchhiker organisms have been known since the earliest days of international travel, but changes in global trade mean that there are more now than ever before. They include a number of serious invasive species and are among the most difficult of quarantine problems to manage. Invasive animals transported as hitchhikers, other than plant pests, fall largely outside the international frameworks for biosecurity risk analysis. However, this is not necessarily a barrierto either risk analysis or effective management. While there are a number of challenges in managing hitchhiker organisms, the risk analysis tools that are needed already exist. However, opening up access to appropriate information, increasing international cooperation and developing new biosecurity treatments suitable for large-volume pathways will enable significant improvements.

Newer therapies in the drug treatment of epilepsy.

OBJECTIVE: To provide a review of recent developments in the pharmacotherapy of epilepsy. DATA SOURCES: A MEDLINE search was performed to identify pertinent literature (1966-June 2001). Selected articles emphasized those published from 1997 to 2001. Bibliographies of identified articles were also evaluated. STUDY SELECTION AND DATA EXTRACTION: All identifiable sources written in English. DATA SYNTHESIS: Epilepsy is a common neurologic disorder, and antiepileptic drugs (AEDs) are the mainstays of therapy. The focus of this article is on the 3 latest AEDs--levetiracetam, oxcarbazepine, and zonisamide. We discuss human data published as both original studies and reviews from the last 4 years, except where noted. We apply a general template for all 3 drugs and provide information on clinical trials, adverse effects, pharmacokinetics, drug interactions, and clinical use. CONCLUSIONS: Levetiracetam, oxcarbazepine, and zonisamide are reasonable options for many patients whose seizures are not yet controlled or who suffer from intolerable adverse effects. All 3 agents are approved for adjunctive use in patients with partial seizures. Oxcarbazepine also has approval for monotherapy in partial seizures. All 3 drugs are well tolerated by most patients and have characteristics that potentially make them easier to use with medications other than the older AEDs. Further clinical experience is needed before specific recommendations can be given for their place among older and newer AEDs.

Outer membrane protein profiling to distinguish between Haemophilus aegyptius and non-capsulate Haemophilus influenzae biotype III.

Outer membrane protein profiling was used to assist in determining the identity of an isolate of Haemophilus spp. that was presumptively identified as non-capsulate Haemophilus influenzae biotype III. The possibility that this strain was in fact Haemophilus aegyptius was queried because of clinical information and the source of the isolate. Sodium dodecyl-sulphate polyacrylamide gel electrophoresis was used to establish the identity of the isolate as non-capsulate H. influenzae biotype III and no H. aegyptius. Generally, protein profiling compared very favourably with other standard tests for identifying H. aegyptius: the method was easily and rapidly performed and gave an unequivocal result.

Use of tumor-infiltrating lymphocytes and interleukin-2 in the immunotherapy of patients with metastatic melanoma. A preliminary report.

Lymphocytes extracted from freshly resected melanomas can be expanded in vitro and can often mediate specific lysis of autologous tumor cells but not allogeneic tumor or autologous normal cells. We treated 20 patients with metastatic melanoma by means of adoptive transfer of these tumor-infiltrating lymphocytes and interleukin-2, after the patients had received a single intravenous dose of cyclophosphamide. Objective regression of the cancer was observed in 9 of 15 patients (60 percent) who had not previously been treated with interleukin-2 and in 2 of 5 patients (40 percent) in whom previous therapy with interleukin-2 had failed. Regression of cancer occurred in the lungs, liver, bone, skin, and subcutaneous sites and lasted from 2 to more than 13 months. Toxic effects of interleukin-2 occurred, although the treatment course was short (five days); these side effects were reversible. It appears that in patients with metastatic melanoma, this experimental treatment regimen can produce higher response rates than those achieved with interleukin-2 administered alone or with lymphokine-activated killer cells. It is too early to determine whether this new form of immunotherapy can improve survival, but further trials seem warranted.

The effect of maintenance cimetidine therapy on the medical, social and economic aspects of patients with chronic gastric ulcers. A placebo-controlled prospective study.

We studied the effect of cimetidine maintenance therapy on the socioeconomic life of patients with gastric ulcers in the year after healing and the extent to which treatment was cost-effective. One hundred and seventy patients with a healed ulcer were studied for periods of up to one year after healing; 116 patients completed one year of observation. A double-blind randomized prospective study was performed that compared cimetidine (400 mg at night) with placebo. Analysis was performed on the intention-to-treat principle. The treated group showed benefit over the placebo group; major or minor symptoms were experienced on fewer days, and more months were symptom-free. Male patients were wakened with ulcer pain on fewer nights, led a more normal social life, and had less ulcer-related sick-leave; female patients had less total sick leave. The proven ulcer recurrence rate was lower in the treated group. Fewer endoscopies were performed in this group and the resultant cost saving was equivalent to the cost expenditure on cimetidine treatment. A modest saving in wages was afforded treated patients in the workforce, due to the reduction in sick leave. The principal benefit of cimetidine treatment appeared to be the lessening of the pain and discomfort and, hence, the distress and anxiety that was associated with ulcer disease. The cost-saving due to the reduced number of endoscopies compensated for the cost-expenditure of the cimetidine treatment.

The application of enzyme-linked immunosorbent assays (ELISA) to neuropeptides.

Procedures are presented for routine evaluation of antibody specificity, titre, and quantitation of antigen levels in tissue extracts without the use of radiolabeled probes. A colorimetric, enzyme-linked immunosorbent assay (ELISA) is described for general use with neuropeptides, using neurotensin as a primary example. These assays use rabbit anti-neurotensin immune serum which is colorimetrically identified after combination with an alkaline phosphatase-conjugated, affinity purified, goat anti-rabbit IgG and reaction with the chromogenic substrate, p-nitrophenyl phosphate. Because the principle of these methods can be adapted for use with various proteins and neuropeptides, they should find widespread applicability in neurobiology.

Features independent of stain intensity for evaluating Feulgen-stained cells.

Eleven features that are independent of stain intensity are described. Values greater than 1.4 times the average optical density were shown to define the visually darker areas of the image, which were considered to be condensed chromatin. Use of the 11 features permitted the discrimination between (1) lymphocytes and macrophages of rats, (2) macrophages from the spleens of rats and monocytes from peripheral blood and (3) macrophages from the spleens of rats injected with complete Freund's adjuvant and those from the spleens of normal rats.

Viral events necessary for the induction of interferon in chick embryo cells.

Temperature-sensitive mutants of Sindbis virus were employed to investigate the nature of the viral event(s) which induces chick-embryo cells to produce interferon. Chick embryo cells induced by the parental heat-resistant strain of Sindbis virus produced essentially equal amounts of interferon at 29 and 42 C. An RNA(-) and three RNA(+) strains [temperature-sensitive mutants unable (RNA(-)) and able (RNA(+)) to make ribonucleic acid] produced interferon at 29 C but not at 42 C. It is concluded that viral RNA per se and the replication of viral RNA do not induce interferon production by chick embryo cells.