Graph Embedded Intuitionistic Fuzzy Random Vector Functional Link Neural Network for Class Imbalance Learning.

The domain of machine learning is confronted with a crucial research area known as class imbalance (CI) learning, which presents considerable hurdles in the precise classification of minority classes. This issue can result in biased models where the majority class takes precedence in the training process, leading to the underrepresentation of the minority class. The random vector functional link (RVFL) network is a widely used and effective learning model for classification due to its good generalization performance and efficiency. However, it suffers when dealing with imbalanced datasets. To overcome this limitation, we propose a novel graph-embedded intuitionistic fuzzy RVFL for CI learning (GE-IFRVFL-CIL) model incorporating a weighting mechanism to handle imbalanced datasets. The proposed GE-IFRVFL-CIL model offers a plethora of benefits: 1) leveraging graph embedding (GE) to preserve the inherent topological structure of the datasets; 2) employing intuitionistic fuzzy (IF) theory to handle uncertainty and imprecision in the data; and 3) the most important, it tackles CI learning. The amalgamation of a weighting scheme, GE, and IF sets leads to the superior performance of the proposed models on KEEL benchmark imbalanced datasets with and without Gaussian noise. Furthermore, we implemented the proposed GE-IFRVFL-CIL on the Alzheimer's Disease Neuroimaging Initiative (ADNI) dataset and achieved promising results, demonstrating the model's effectiveness in real-world applications. The proposed GE-IFRVFL-CIL model offers a promising solution to address the CI issue, mitigates the detrimental effect of noise and outliers, and preserves the inherent geometrical structures of the dataset.

Incidental lymphadenopathy in renal transplantation.

INTRODUCTION: Iliac lymphadenectomy is performed to provide anastomotic access during the vascular implantation procedure in renal transplantation. Iliac lymph nodes (LNs) are often enlarged, but there are no standardised guidelines for the management of incidentally enlarged LNs during transplantation. We aimed to evaluate histological findings of LNs sent for examination at our unit. METHODS: Patients were evaluated in two distinct date cycles. In the first cycle, lymphadenectomy and histological assessment were performed at the discretion of the transplanting surgeon. In the second cycle, all incidentally enlarged LNs were sent for histological assessment, regardless of size. RESULTS: In the first cycle (n = 76), 11 patients (14.47%) had incidentally enlarged iliac LNs on lymphadenectomy and histology showed only reactive changes. In the second cycle (n = 165), eight patients (4.85%) had incidentally enlarged LNs on lymphadenectomy. One patient was found to have mature B cell chronic lymphocytic leukaemia. The patient was referred to haematology and a "watch and wait" approach was taken, with the patient still alive at last follow-up (511 days post-transplantation). DISCUSSION: There are currently no published guidelines on the management of incidentally enlarged iliac LNs during transplantation. Current literature suggests that clinically significant lymphadenopathy needs to be investigated in all patients. Based on our centre's experience of a 5.26% (1 in 19) positive pathological LN sampling, we recommend that all incidental LNs with suspicious features and/or that are greater than 10mm in diameter should be considered for histological, microbiological and molecular assessment as appropriate.

Graph embedded ensemble deep randomized network for diagnosis of Alzheimer's disease.

Randomized shallow/deep neural networks with closed form solution avoid the shortcomings that exist in the back propagation (BP) based trained neural networks. Ensemble deep random vector functional link (edRVFL) network utilize the strength of two growing fields, i.e., deep learning and ensemble learning. However, edRVFL model doesn't consider the geometrical relationship of the data while calculating the final output parameters corresponding to each layer considered as base model. In the literature, graph embedded frameworks have been successfully used to describe the geometrical relationship within data. In this paper, we propose an extended graph embedded RVFL (EGERVFL) model that, unlike standard RVFL, employs both intrinsic and penalty subspace learning (SL) criteria under the graph embedded framework in its optimization process to calculate the model's output parameters. The proposed shallow EGERVFL model has only single hidden layer and hence, has less representation learning. Therefore, we further develop an ensemble deep EGERVFL (edEGERVFL) model that can be considered a variant of edRVFL model. Unlike edRVFL, the proposed edEGERVFL model solves graph embedded based optimization problem in each layer and hence, has better generalization performance than edRVFL model. We evaluated the proposed approaches for the diagnosis of Alzheimer's disease and furthermore on UCI datasets. The experimental results demonstrate that the proposed models perform better than baseline models. The source code of the proposed models is available at https://github.com/mtanveer1/.

Impact of centralization of services on outcomes in a rare tumour: Retroperitoneal sarcomas.

BACKGROUND AND AIM: The retroperitoneal tumor (RPT) service in the North West costal region of England was centralized in May 2011 by the merger of the Merseyside, Cheshire and Lancashire, Cumbria sarcoma networks. Our aim was to analyze the impact of centralization of services on patient outcomes. METHODS: An analysis from 01/12/2004 to 30/11/2017 was undertaken from prospectively maintained database and electronic patient records; follow-up was until 30/04/2018. This time period encompassed 6.5 years before and after centralization of services took place. Survival analysis was done for Retroperitoneal Sarcomas (RPS) and also compared the impact of centralization. RESULTS: 72 patients (27 men), median age 69 (21-90) years) underwent 95 operations with an intention to excise RPS. Overall there were 52 (54.7%) multi-visceral resections (MVR). 91/95 (95.8%) patients with primary tumors had surgery with a curative (R0/1) intent. 30-day and 90-day operative mortality was 3.2% (n = 3) and 4.2% (n = 4) respectively. The 5-year survival for patients undergoing resection for RPTs was 51.3%. 79 (83.1%) of the resections in this series occurred in the 6.5-years post-centralization with an increase in MVR between the two time points (p < 0.0006). Despite the more radical nature of surgery post-centralization, there was no difference in 5-year survival for RPS patients when compared to pre-centralization, p = 0.575. However the 5-yr survival post-centralization compared favorability to national outcomes. CONCLUSION: Centralization in the management of RPS has resulted in an increase in resection rates and more complex MVRs, without compromising R0/1 resection rates; peri-operative mortality or overall survival.

A case report of an angiomyxoma in the liver.

Angiomyxomas are uncommon myxoid tumours arising most commonly from the pelvis. A 46-year-old woman with a history of polycystic kidney disease presented asymptomatically for surveillance ultrasonography; changes were noted in the size and morphology of her liver cysts. Subsequent radiological assessment displayed features suspicious of malignancy and a right hemihepatectomy was performed with curative intent. Pathological examination of the resected specimen found histology consistent with an angiomyxoma arising primarily from the liver parenchyma. Follow-up review of the patient has been uneventful with annual imaging showing no evidence of recurrence. Angiomyxomas do not characteristically invade other tissues. However, any liver lesion displaying suspicious features of malignancy should be resected in the absence of disseminated disease.

Patient safety in orthopaedics: state of the art.

We summarise and highlight the safety concerns within the field of trauma and orthopaedic surgery with particular emphasis placed on current controversies and reforms within the United Kingdom National Health Service.

The results of uncemented total hip replacement in children with juvenile idiopathic arthritis at ten years.

The inherent challenges of total hip replacement (THR) in children include the choice of implant for the often atypical anatomical morphology, its fixation to an immature growing skeleton and the bearing surface employed to achieve a successful long-term result. We report the medium-term results of 52 consecutive uncemented THRs undertaken in 35 paediatric patients with juvenile idiopathic arthritis. The mean age at the time of surgery was 14.4 years (10 to 16). The median follow-up was 10.5 years (6 to 15). During the study period 13 THRs underwent revision surgery. With revision as an endpoint, subgroup analysis revealed 100% survival of the 23 ceramic-on-ceramic THRs and 55% (16 of 29) of the metal- or ceramic-on-polyethylene. This resulted in 94% (95% CI 77.8 to 98.4) survivorship of the femoral component and 62% (95% CI 41.0 to 78.0) of the acetabular component. Revision of the acetabular component for wear and osteolysis were the most common reasons for failure accounting for 11 of the 13 revisions. The success seen in patients with a ceramic-on-ceramic articulation seems to indicate that this implant strategy has the potential to make a major difference to the long-term outcome in this difficult group of patients.

A financial analysis of revision hip arthroplasty: the economic burden in relation to the national tariff.

Revision arthroplasty of the hip is expensive owing to the increased cost of pre-operative investigations, surgical implants and instrumentation, protracted hospital stay and drugs. We compared the costs of performing this surgery for aseptic loosening, dislocation, deep infection and peri-prosthetic fracture. Clinical, demographic and economic data were obtained for 305 consecutive revision total hip replacements in 286 patients performed at a tertiary referral centre between 1999 and 2008. The mean total costs for revision surgery in aseptic cases (n = 194) were £11 897 (sd 4629), for septic revision (n = 76) £21 937 (sd 10 965), for peri-prosthetic fracture (n = 24) £18 185 (sd 9124), and for dislocation (n = 11) £10 893 (sd 5476). Surgery for deep infection and peri-prosthetic fracture was associated with longer operating times, increased blood loss and an increase in complications compared to revisions for aseptic loosening. Total inpatient stay was also significantly longer on average (p < 0.001). Financial costs vary significantly by indication, which is not reflected in current National Health Service tariffs.

Clinical testing of ulnar collateral ligament injuries of the thumb.

The diagnosis of complete tears of the ulnar collateral ligament of the thumb metacarpophalangeal (MP) joint depends on demonstration of excessive laxity of the ligament, but there is controversy on whether laxity greater than a certain cut-off value or laxity greater than the opposite thumb is the criterion for diagnosis. We examined 200 thumbs of 100 normal individuals in extension and in 30 degrees of flexion. In 34% of subjects there was a difference of 10 degrees or more between right and left thumbs in extension, and 12% had a difference of at least 15 degrees. In flexion, 22% of thumbs differed by 10 degrees or more and 3% by 15 degrees or more. Comparison with the uninjured contralateral thumb is unreliable in many individuals. We recommend the lack of a definite end point on stress examination as indicating complete rupture of the ulnar collateral ligament.

Ossified cephalhematoma.

Ossified cephalhematoma is a rare clinical entity and a pathological curiosity. Even though cephalhematoma is frequently encountered, ossified cephalhematoma is seen only sporadically and is restricted to only few case reports in the literature. Its pathogenesis is unclear, and the clinical course is different in neonates and juveniles. The risk factors are known, but why it gets ossified in some cases is not understood. We report a case of ossified cephalhematoma which developed in a 10-week-old male child in the right parietal region and discuss its possible pathogenesis.

Tuberose sclerosis complex: analysis of growth rates aids differentiation of renal cell carcinoma from atypical or minimal-fat-containing angiomyolipoma.

AIM: To study the radiological characteristics of renal masses in individuals with tuberous sclerosis complex (TSC) using serial CT, and to examine how renal cell carcinoma (RCC) may be differentiated from indeterminate cysts or masses. METHODS: This was a retrospective study of 12 cases of TSC in which dedicated renal CT followed after US had demonstrated cystic or sonographically unusual renal masses. The CT density of all masses was measured and the masses categorized as simple cysts, complex cysts, angiomyolipomas or indeterminate solid masses. Subjects were maintained on regular follow-up with repeat CT or MRI and interval renal US. Indeterminate masses that showed rapid growth were considered suspicious for renal cell carcinoma and biopsy or nephrectomy followed. RESULTS: Comparative data were available for a median of 4 years. In each case the renal masses were multiple and bilateral; mean mass diameter was 3.6 cm. Among a total of 206 masses, 18 were simple cysts and 3 were complex cysts. Of the complex cysts, 1 proved to be an angiomyolipoma on histology and the other 2 showed no growth. Of the solid masses, 133 were typical angiomyolipomas (AMLs) and 52 were indeterminate. On follow-up, only 3 indeterminate masses showed rapid growth (>0.5 cm/year), of which only 1 proved to be an RCC on biopsy. The other 2 were minimal-fat AMLs, and the remainder of the masses showed no or slow growth. CONCLUSION: Many renal masses associated with TSC are radiologically indeterminate. A growth threshold of >0.5 cm/year identified the only RCC in this study (0.5% of all masses). Yearly radiological follow-up of indeterminate renal masses is recommended for individuals with TSC.

Distal radioulnar joint dislocation in association with elbow injuries.

Traumatic distal radioulnar joint (DRUJ) dislocation with or without an associated fracture is a rare injury. When coupled with a radial head fracture this is commonly known as the Essex-Lopresti injury. We report two cases of elbow dislocation with ipsilateral radial neck fractures and associated true DRUJ dislocations. This has not been previously described in the literature. In elbow injuries with wrist involvement, symptoms in the latter may be subtle. Due to inadequate examination of the affected joint, poor initial radiographic views, and general rarity of this injury, distal radioulnar joint dislocations are frequently missed. We hope our experience illustrates the need to examine thoroughly the joint above and below the injured site, and to be aware of the potential for DRUJ instability in all patients with elbow injuries.

Fourth derivative spectrophotometric determination of fungicide thiram (tetramethyldithiocarbamate) using sodium molybdate and its application.

A procedure has been developed for the direct fourth derivative spectrophotometric determination of tetramethyldithiocarbamate by converting it into its molybdenum complex, which is then extracted in to methyl isobutyl ketone (MIBK). Beer's law is obeyed over the concentration range 24mugmL(-1) in the final solution. The analytical sensitivity is calculated to be 0.004(d(4)A/dlambda(4)) mug(-1)mL(-1) from the slope of the calibration curve. The detection limit is 0.3mugmL(-1) for thiram (signal to noise ratio = 2). Various parameters, such as effect of acid concentration, interference of a large number of ions in the determination of thiram have been studied in detail. The method is sensitive, highly selective and can be used for the determination of thiram in a commercial sample, in mixtures with various dithiocarbamates (zineb, maneb, etc.) and from wheat grains.

The spectrum of glomerular diseases in the kingdom of bahrain: an epidemiological study based on renal biopsy interpretation.

Glomerular diseases continue to be the leading cause of end-stage renal disease globally. Hence it is important to recognize the glomerular disease pattern in any given geographical area to understand the pathobiology in the region as well as the incidence and progression of the disorder. A total of 498 renal biopsies were performed on patients with proteinuria, hematuria, and mild to moderate renal impairment during a period of 13 years (between January 1990 and December 2002) at a tertiary care hospital. Primary glomerular disease accounted for two-thirds of the glomerular diseases, which was 44.8% of all renal biopsies. The most common histological lesion was minimal change disease (30%). Focal segmental glomerulosclerosis was the second most common lesion (23.8%) followed by membranoproliferative glomerulonephritis (14.3%). Secondary glomerular disease included 33.6% of glomerular diseases with 22.7% with lupus nephritis as the commonest lesion (38.9%) followed by diabetic nephropathy (31.9%) and hypertension (20.4%). Tubulointerstitial diseases accounted for 13.1% of all renal biopsies, whereas transplant diseases were noted in 12.2%. The miscellaneous group including inadequate biopsies, which constituted 7.2% of all the tissues. The results of this analysis were compared with surveys from other parts of the world.

Scaphoid views: a need for standardisation.

AIMS: Several views are needed to visualise the scaphoid. These are routinely called 'scaphoid views'. The authors believe that asking for scaphoid views from the radiology department often leads to a wide variety and number of radiographic views being taken. METHODS: 50 radiographers were asked which and how many views of the scaphoid they would take, in the acute setting and then in the out-patient department. RESULTS: We found a wide variation in the descriptive terms used by radiographers for particular views. There was also little agreement on how many and which radiographic views to take when asked for 'scaphoid views'. CONCLUSIONS: Not only is there complete lack of agreement on what 'scaphoid views' should be, it was also discovered that there was little agreement on the nomenclature of the individual views themselves. Loss of information can result from the wrong views being taken and unnecessary radiation exposure. We recommend five particular views, which together visualise all areas of the scaphoid.

Renal biopsy findings in the kingdom of bahrain: a 13-year retrospective study.

Glomerular diseases continue to be the leading cause of end-stage renal disease globally. Hence, it is important to recognize the pattern of these diseases in any given geographical area. A total of 498 renal biopsies performed on patients with proteinuria, hematuria and mild to moderate renal impairment during a period of 13 years (between January 1990 and December 2002) at the Salmaniya Medical Complex (a tertiary care hospital of the Kingdom of Bahrain), were reviewed and categorized. Primary glomerular disease accounted for two-third of the glomerular diseases, which in turn constituted 44.8% of all renal biopsies. The most common histological lesion was minimal change disease (30%). Focal and segmental glomerulosclerosis was the second most common lesion (23.8%) followed by membranoproliferative glomerulonephritis (14.3%). Secondary glomerular disease comprised 33.6% of glomerular diseases (22.7% of all the renal biopsies) with lupus nephritis forming the commonest lesion (38.9%) followed by diabetic nephropathy (31.9%) and hypertension (20.4%). Tubulointerstitial diseases accounted for 13.1% of all renal biopsies whereas transplant diseases were noted in 12.2%. The miscellaneous group including inadequate biopsies constituted 7.2% of all the biopsies. The results of this analysis were compared with surveys from other parts of the World.

Oesophageal cancer in Bahrain.

ABSTRACT Data from all 148 cases of oesophageal cancer in Bahrain during 1952-99 were analysed according to patient sex and age and site and histological pattern of tumour, and compared with other Gulf countries. In Bahrain, oesophageal cancer accounted for 2.6% of malignant neoplasms. The female:male ratio was 1.8:1, and the majority of patients were > or =51 years and < or =70 years of age. The lower and upper third of the oesophagus were the most and least frequently involved sites, respectively. Squamous carcinoma (males) and adenocarcinoma (females) were the main histological types. There is varying consistency between these data and those of other Gulf countries having similar anthropological and demographic profiles. A prospective study may help to better understand the aetiology of the disease and inform preventive policies.

Oesophageal cancer in Bahrain

Data from all 148 cases of oesophageal cancer in Bahrain during 1952-99 were analysed according to patient sex and age and site and histological pattern of tumour, and compared with other Gulf countries. In Bahrain, oesophageal cancer accounted for 2.6% of malignant neoplasms. The female:male ratio was 1.8:1, and the majority of patients were >/=51 years and </=70 years of age. The lower and upper third of the oesophagus were the most and least frequently involved sites, respectively. Squamous carcinoma [males] and adenocarcinoma [females] were the main histological types. There is varying consistency between these data and those of other Gulf countries having similar anthropological and demographic profiles. A prospective study may help to better underst and the aetiology of the disease and inform preventive policies

T594M mutation of the beta-subunit of the epithelial sodium channel in Ghanaian populations from Kumasi and London and a possible association with hypertension.

We have tested 186 individuals from Ghana, 95 indigenous and 91 who have settled in the United Kingdom, for the presence of the T594M mutation in the beta-subunit of the epithelial sodium channel, which is associated with hypertension in black populations. The group living in Ghana had a mean age of 27 years and were normotensive, but had an increased frequency of the T allele compared to the London-based population. If this is reflected in larger studies, and the link with hypertension is maintained in the Ghanaian population, this mutation could be a significant cause of hypertension in Ghana.