Leveraging AI technology in sarcoidosis.

PURPOSE OF REVIEW: Sarcoidosis is a systemic, granulomatous disease of uncertain cause. Diagnosis may be difficult, prognosis uncertain and response to treatment unpredictable. The application of artificial intelligence to sarcoidosis may provide clinical decision support for these challenges. This review will provide an overview of current and potential future applications of artificial intelligence in sarcoidosis. RECENT FINDINGS: The predominant application of artificial intelligence in sarcoidosis is imaging. Imaging models may differentiate sarcoidosis from other pulmonary disorders. Models, which predict survival and identify key factors relevant to prognosis are also available. The application of cluster analysis to organize sarcoidosis patients into developmental phenotypes is underway. Machine learning algorithms to evaluate the treatment response of sarcoidosis patients do not yet exist but similar models may evaluate patients with other inflammatory disease. The potential applications of artificial intelligence to sarcoidosis is vast, but there are practical limitations that warrant consideration. These include: the accessibility of data, biases in data, cost and privacy. SUMMARY: The application of artificial intelligence in medicine is still in its early stages but models are poised to support the diagnostic and prognostic challenges in sarcoidosis patients. The predictive power of these artificial intelligence is likely to come from combining various models, trained on content-rich datasets from phenotypically heterogeneous sarcoidosis patients.

Automated hearing screening for children: A pilot study in China.

OBJECTIVE: To establish the reliability and validity of an automated hearing screening test system for children. DESIGN: Cross-sectional within a comparative study of subjects. STUDY SAMPLE: Subjects were 325 first-grade and second-grade children (6-10 years old) from primary schools in Shenzhen, China. RESULTS: Using the conventional pure-tone screening test with the pass/refer criterion set as 25 dB HL, as the 'gold standard", the sensitivity and specificity of the automated hearing screening test was 0.63 and 0.82, respectively. No specific pattern in the failure rates was observed to relate to the students' grade. There was no statistically significant age effect or gender effect. CONCLUSIONS: The results suggest that with further improvement in terms of its sensitivity and specificity, it may be feasible to use the automated hearing screening test system to conduct routine school hearing screenings.

Early data from the first population-wide breast cancer-specific registry in Hong Kong.

BACKGROUND: Current measures for breast cancer prevention and options for treatment adopted in Hong Kong are mainly based on research data and clinical evidence from overseas. It is essential to establish a cancer-specific registry to monitor the status of breast cancer in Hong Kong. OBJECTIVES: We summarized the current status of breast cancer in Hong Kong based on the data collected from Hong Kong Breast Cancer Registry (HKBCR). METHODS: Prevalent and newly diagnosed breast cancers (including in situ and invasive breast cancers) were registered in the HKBCR. Information on patient demographics, risk factors, medical information, and survival were analyzed and reported in this study. RESULTS: Data of 2,330 breast cancer patients were analyzed. We observed an earlier median age at diagnosis in Hong Kong than those reported in other countries. Distribution of cancer stage was: stage 0 (11.4%), stage I (31.4%), stage II (41%), stage III (12.5%), stage IV (0.8%), and unclassified (2.9%). The percentages of patients who received surgery, chemotherapy, radiation therapy, and endocrine therapy were 98.7, 67.9, 64.8, and 64.1%, respectively. At a median follow-up of 1.2 years, locoregional recurrence was recorded at 2%, distant recurrence at 2.8%, and breast-cancer-related mortality at 0.3%. CONCLUSIONS: The HKBCR serves as a surveillance program to monitor disease and treatment patterns. It is pivotal to support research for more effective breast cancer prevention and treatment strategies in Hong Kong.

Assessment of caregiver burden in patients undergoing in- and out-patient neurosurgery.

The objective of this study is to describe the caregiver burden, as well as the financial burden among caregivers after inpatient and outpatient neurosurgical patients. In this single center, observational study, adult patients undergoing elective inpatient or outpatient neurosurgery (supratentorial tumor resection or lumbar microdiscectomy) and his/her caregiver were recruited for the study. Bakas Caregiving Outcome Scale (BCOS) was used to assess caregiver burden and data was collected from preoperative period until post-operative day (POD) 30. Cost burden was assessed by a cost diary from day of surgery till POD 7. Forty-eight patient-caregiver pairs (21 inpatient craniotomies, 7 outpatient craniotomies, and 20 outpatient microdiscectomies) completed the study. BCOS values were in the negative impact range (<60) on POD1 in craniotomy group and improved to positive impact range (>60) after POD3. Median BCOS score remained at 60 in outpatient microdiscectomy. 56% of caregiver had at least 1 day of loss of income and 20% lost income throughout first 8 days. Median Cost (in Canadian dollars) associated with caregiving ranged from C$57 to C$250 amongst different groups. We concluded that caring for patients after craniotomy is psychologically demanding which leads to an increase in caregiver burden. In addition, there is a cost burden for the care givers in the form of missed workdays and additional direct expenses. Further studies are needed to recognize this problem and address the burden among the caregivers in the neurosurgical population.

Oropharyngeal infection with metastatic hand infection: an uncommon variant of Lemierre's syndrome.

Lemierre's syndrome is caused by acute oropharyngeal infection with septic secondary thrombophlebitis of the internal jugular vein and metastatic infection. Fusobacterium necrophorum is the most commonly implicated aetiological agent. The authors present the case of a healthy young man presenting with a history of general malaise and sore throat who developed septic metastatic complications in the left upper limb. He made a complete recovery after treatment with a combination of parenteral antibiotics and a multidisciplinary approach. Early ultrasound scanning of the neck and blood cultures are advocated to diagnose this potentially fatal condition. Management involves a high degree of clinical suspicion for this often 'forgotten' condition and treatment is further discussed in the article.

Hospital costs associated with inpatient versus outpatient awake craniotomy for resection of brain tumors.

BACKGROUND: With increasing fiscal restraints on health care systems, procedural cost-effectiveness has become an important metric for evaluating surgical procedures. While outpatient craniotomy has been shown to be safe and effective, the economic implications of this procedure has yet to be examined. Here, we present the first cost analysis comparing inpatient versus outpatient awake craniotomy for tumor resection/biopsy. METHODS: We conducted a retrospective chart review on consecutive patients undergoing awake craniotomy for tumor resection/biopsy at a publicly funded tertiary care center from Sept 2014 to Aug 2015. Patient demographics, comorbidities and surgical factors were recorded. Direct and indirect costs for each patient visit were calculated based on institutional records. RESULTS: A total of 50 consecutive patients undergoing awake craniotomy for tumor resection were included in this study (29 outpatients, 21 inpatients). Rates of complications and 30-day readmission were similar between groups. The total costs associated with inpatient surgery were nearly double that of outpatient surgery ($10649 versus $5242, P < 0.001). In-patient surgery resulted in a nearly 6-fold increase in unit/bed costs compared to out-patient surgery ($4142 versus $758, P < 0.001). There were no differences in the costs incurred from the operating room, laboratory, or anesthesia departments. CONCLUSIONS: Costs associated with outpatient craniotomy are nearly half compared to inpatient craniotomy and this is largely driven by reductions in bed resource utilization and allied health services. Outpatient neurosurgery for tumor resection is therefore a safe and feasible option for appropriately selected patients and confers an overall cost reduction.

Superhydrophobic-like tunable droplet bouncing on slippery liquid interfaces.

Droplet impacting on solid or liquid interfaces is a ubiquitous phenomenon in nature. Although complete rebound of droplets is widely observed on superhydrophobic surfaces, the bouncing of droplets on liquid is usually vulnerable due to easy collapse of entrapped air pocket underneath the impinging droplet. Here, we report a superhydrophobic-like bouncing regime on thin liquid film, characterized by the contact time, the spreading dynamics, and the restitution coefficient independent of underlying liquid film. Through experimental exploration and theoretical analysis, we demonstrate that the manifestation of such a superhydrophobic-like bouncing necessitates an intricate interplay between the Weber number, the thickness and viscosity of liquid film. Such insights allow us to tune the droplet behaviours in a well-controlled fashion. We anticipate that the combination of superhydrophobic-like bouncing with inherent advantages of emerging slippery liquid interfaces will find a wide range of applications.

Automated hearing screening for preschool children.

OBJECTIVES: To establish the reliability and validity of an automated hearing screening test system for preschoolers and to investigate the risk factors for hearing loss. METHODS: The study used a cross-sectional design in a comparative study of subjects. The automated hearing screening test was performed in 6231 preschoolers (3-7 years old) from 41 kindergartens in Shanghai, China. Sensitivity and specificity of the automated test were investigated with subjects who failed the screening test and a group of control subjects. RESULTS: Six hundred and forty-seven children were referred for diagnostic audiological assessment after the automated pure-tone screening test. Using the conventional pure-tone audiometry as the "gold standard," the sensitivity and specificity of the automated hearing screening test increased from 0.33 and 0.15 in the youngest age group to 0.95 and 1.00 in the oldest age group, respectively. There was no statistically significant gender effect, but there was an age effect (χ(2 )= 22.96, p < 0.01). In the univariate analysis of 104 cases and 201 controls, significantly elevated odds ratios (OR) for hearing loss were correlated with universal newborn hearing screening test results (OR = 28.15, p < 0.01), parental suspicion of hearing loss (OR = 10.10, p < 0.05), and attendance at preschool before the age of five (OR = 0.51, p < 0.05). CONCLUSIONS: The results suggest that the automated hearing screening test system can be used in screening programmes for preschoolers aged older than five years.

Risk factors and natural history of breast cancer in younger Chinese women.

AIM: To investigate the age differences in the risk factors, clinicopathological characteristics and patterns of treatment of female breast cancer patients. METHODS: Seven thousand one hundred and fifty-two women with primary breast cancer from the Hong Kong Breast Cancer Registry were recruited after receiving patients' consent, they were asked to complete standardized questionnaires which captured their sociodemographic characteristics and risk factors associated with breast cancer development. Among them, clinicopathological data and patterns of treatment were further collected from medical records of 5523 patients with invasive breast cancers. Patients were divided into two groups according to the age at diagnosis: younger (< 40 years old) vs older patients (≥ 40 years old) for subsequent analyses. RESULTS: Analysis on the sociodemographic characteristics and exposure to risk factors were performed on 7152 women with primary breast cancer and the results revealed that younger patients were more likely to have unhealthy lifestyles; these include a lack of exercise (85.4% vs 73.2%, P < 0.001), having high stress in life (46.1% vs 35.5%, P < 0.001), having dairy/meat-rich diets (20.2% vs 12.9%, P < 0.001), having alcohol drinking habit (7.7% vs 5.2%, P = 0.002). Younger patients were also more likely to have hormone-related risk factors including nulliparity (43.3% vs 17.8%, P < 0.001) and an early age at menarche (20.7% vs 13.2%, P < 0.001). Analyses on clinicopathological characteristics and patterns of treatment were performed on 5523 women diagnosed with invasive breast cancer. The invasive tumours in younger patients showed more aggressive pathological features such as having a higher percentage of grade 3 histology (45.7% vs 36.5%, P < 0.001), having a higher proportion of tumours with lymphovascular invasion (39.6% vs 33.2%, P = 0.003), and having multifocal disease (15.7% vs 10.3%, P < 0.001); they received different patterns of treatment than their older counterparts. CONCLUSION: Younger patients in Hong Kong are more likely to encounter risk factors associated with breast cancer development and have more aggressive tumours than their older counterparts.