Analysis of treatment pathways for three chronic diseases using OMOP CDM.

The present study examined treatment pathways (the ordered sequence of medications that a patient is prescribed) for three chronic diseases (hypertension, type 2 diabetes, and depression), compared the pathways with recommendations from guidelines, discussed differences and standardization of medications in different medical institutions, explored population diversification and changes of clinical treatment, and provided clinical big data analysis-based data support for the development and study of drugs in China. In order to run the "Treatment Pathways in Chronic Disease" protocol in Chinese data sources,we have built a large data research and analysis platform for Chinese clinical medical data. Data sourced from the Clinical Data Repository (CDR) of the First Affiliated Hospital of Nanjing Medical University was extracted, transformed, and loaded into an observational medical outcomes partnership common data model (OMOP CDM) Ver. 5.0. Diagnosis and medication information for patients with hypertension, type 2 diabetes, and depression from 2005 to 2015 were extracted for observational research to obtain treatment pathways for the three diseases. The most common medications used to treat diabetes and hypertension were metformin and acarbose, respectively, at 28.5 and 20.9% as first-line medication. New drugs were emerging for depression; therefore, the favorite medication changed accordingly. Most patients with these three diseases had different treatment pathways from other patients with the same diseases. The proportions of monotherapy increased for the three diseases, especially in recent years. The recommendations presented in guidelines show some predominance. High-quality, effective guidelines incorporating domestic facts should be established to further guide medication and improve therapy at local hospitals. Medical institutions at all levels could improve the quality of medical services, and further standardize medications in the future. This research is the first application of the CDM model and OHDSI software in China, which were used to study, treatment pathways for three chronic diseases (hypertension, type 2 diabetes and depression), compare the pathways with recommendations from guidelines, discuss differences and standardization of medications in different medical institutions, demonstrate the urgent need for quality national guidelines, explores population diversification and changes of clinical treatment, and provide clinical big data analysis-based data support for the development and study of drugs in China.

Characterizing Brain Tumor Regions Using Texture Analysis in Magnetic Resonance Imaging.

PURPOSE: To extract texture features from magnetic resonance imaging (MRI) scans of patients with brain tumors and use them to train a classification model for supporting an early diagnosis. METHODS: Two groups of regions (control and tumor) were selected from MRI scans of 40 patients with meningioma or glioma. These regions were analyzed to obtain texture features. Statistical analysis was conducted using SPSS (version 20.0), including the Shapiro-Wilk test and Wilcoxon signed-rank test, which were used to test significant differences in each feature between the tumor and healthy regions. T-distributed stochastic neighbor embedding (t-SNE) was used to visualize the data distribution so as to avoid tumor selection bias. The Gini impurity index in random forests (RFs) was used to select the top five out of all features. Based on the five features, three classification models were built respectively with three machine learning classifiers: RF, support vector machine (SVM), and back propagation (BP) neural network. RESULTS: Sixteen of the 25 features were significantly different between the tumor and healthy areas. Through the Gini impurity index in RFs, standard deviation, first-order moment, variance, third-order absolute moment, and third-order central moment were selected to build the classification model. The classification model trained using the SVM classifier achieved the best performance, with sensitivity, specificity, and area under the curve of 94.04%, 92.3%, and 0.932, respectively. CONCLUSION: Texture analysis with an SVM classifier can help differentiate between brain tumor and healthy areas with high speed and accuracy, which would facilitate its clinical application.

A predictive model for respiratory distress in patients with COVID-19: a retrospective study.

BACKGROUND: Coronavirus disease 2019 (COVID-19), associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has become a global public health crisis. We retrospectively evaluated 863 hospitalized patients with COVID-19 infection, designated IWCH-COVID-19. METHODS: We built a successful predictive model after investigating the risk factors to predict respiratory distress within 30 days of admission. These variables were analyzed using Kaplan-Meier and Cox proportional hazards (PHs) analyses. Hazard ratios (HRs) and performance of the final model were determined. RESULTS: Neutrophil count >6.3×109/L, D-dimer level ≥1.00 mg/L, and temperature ≥37.3 °C at admission showed significant positive association with the outcome of respiratory distress in the final model. Complement C3 (C3) of 0.9-1.8 g/L, platelet count >350×109/L, and platelet count of 125-350×109/L showed a significant negative association with outcomes of respiratory distress in the final model. The final model had a C statistic of 0.891 (0.867-0.915), an Akaike's information criterion (AIC) of 567.65, and a bootstrap confidence interval (CI) of 0.866 (0.842-0.89). This five-factor model could help in early allocation of medical resources. CONCLUSIONS: The predictive model based on the five factors obtained at admission can be applied for calculating the risk of respiratory distress and classifying patients at an early stage. Accordingly, high-risk patients can receive timely and effective treatment, and health resources can be allocated effectively.

Automated detection of cardiovascular disease by electrocardiogram signal analysis: a deep learning system.

Automated electrocardiogram (ECG) diagnosis could be a useful aid for clinical use. We applied a deep learning method to build a system for automated detection and classification of ECG signals. We first trained a convolutional neural network (CNN) to detect cardiovascular disease in ECG signals using a training data set of 259,789 ECG signals collected from the cardiac function rooms of a tertiary care hospital. The CNN classification was validated using an independent test data set of 18,018 ECG signals. The labels used covered >90% of clinical diagnoses. The system grouped ECGs into 18 classifications-17 different types of abnormalities and normal ECG. The overall accuracy of the model was tested and found to be close to 95%; the accuracy for diagnosis of normal rhythm/atrial fibrillation was 99.15%. The proposed CNN model could help reduce misdiagnosis and missed diagnosis in primary care settings and also improve efficiency and save manpower cost for large general hospitals.