Efficient Prediction of Missed Clinical Appointment Using Machine Learning.

Public health and its related facilities are crucial for thriving cities and societies. The optimum utilization of health resources saves money and time, but above all, it saves precious lives. It has become even more evident in the present as the pandemic has overstretched the existing medical resources. Specific to patient appointment scheduling, the casual attitude of missing medical appointments (no-show-ups) may cause severe damage to a patient's health. In this paper, with the help of machine learning, we analyze six million plus patient appointment records to predict a patient's behaviors/characteristics by using ten different machine learning algorithms. For this purpose, we first extracted meaningful features from raw data using data cleaning. We applied Synthetic Minority Oversampling Technique (SMOTE), Adaptive Synthetic Sampling Method (Adasyn), and random undersampling (RUS) to balance our data. After balancing, we applied ten different machine learning algorithms, namely, random forest classifier, decision tree, logistic regression, XG Boost, gradient boosting, Adaboost Classifier, Naive Bayes, stochastic gradient descent, multilayer perceptron, and Support Vector Machine. We analyzed these results with the help of six different metrics, i.e., recall, accuracy, precision, F1-score, area under the curve, and mean square error. Our study has achieved 94% recall, 86% accuracy, 83% precision, 87% F1-score, 92% area under the curve, and 0.106 minimum mean square error. Effectiveness of presented data cleaning and feature selection is confirmed by better results in all training algorithms. Notably, recall is greater than 75%, accuracy is greater than 73%, F1-score is more significant than 75%, MSE is lesser than 0.26, and AUC is greater than 74%. The research shows that instead of individual features, combining different features helps make better predictions of a patient's appointment status.

Kinesin 12 (KIF15) contributes to the development and tumorigenicity of prostate cancer.

In Asia, prostate cancer is becoming a growing concern, impacting both socially and economically, compared with what is seen in western countries. Hence, it is essential to know the mechanisms associated with the development and tumorigenesis of PCa for primary diagnosis, risk management, and development of therapy strategies against PCa. Kinesin family member 15 (KIF15), a kinesin family member, is a plus-end-directed kinesin that functions to form bipolar spindles. There is emerging evidence indicating that KIF15 plays a significant role in several malignancies, such as pancreatic cancer, hepatocellular carcinoma, lung adenocarcinoma, and breast cancer. Still, the function of KIF15 remains unclear in prostate cancer. Here, we study the functional importance of KIF15 in the tumorigenesis of PCa. The bioinformatic analysis from PCa patients revealed high KIF15 expression compared to normal prostate tissues. High expression hinting at a possible functional role of KIF15 in regulating cell proliferation of PCa, which was demonstrated by both in vitro and in vivo assays. Downregulation of KIF15 silenced the expression of CDK2, p-RB, and Cyclin D1 and likewise blocked the cells at the G1 stage of the cell cycle. In addition, KIF15 downregulation inhibited MEK-ERK signaling by significantly silencing p-ERK and p-MEK levels. In conclusion, this study confirmed the functional significance of KIF15 in the growth and development of prostate cancer and could be a novel therapeutic target for the treatment of PCa.

Incidence of Hepatocellular Carcinoma in Primary Biliary Cholangitis: A Systematic Review and Meta-Analysis.

BACKGROUND: The risk and determinants of HCC in patients with primary biliary cholangitis (PBC) are unclear. We conducted a systematic review and meta-analysis of the incidence of HCC and risk factors associated with HCC risk among patients with PBC. METHODS: We searched PubMed, EMBASE, MEDLINE, Cochrane databases and reference lists from relevant articles to identify cohort studies that examined incidence of HCC in patients with PBC from inception through November 2019. RESULTS: A total of 29 studies including 22,615 patients met the eligibility criteria. The median cohort size was 292 patients followed for an average of 76 months. The pooled incidence rate for patients with PBC was 4.17 per 1000 patient-years (95% CI 3.17-5.47). On subgroup analysis, the incidence of HCC in patients with PBC cirrhosis was 15.7 per 1000 patient-years (95% CI 8.73-28.24). The HCC incidence rate was 9.82 per 1000 person-years (95% CI 5.92-16.28) in men and 3.82 per 1000 person-years (95% CI 2.85-5.11) in women. CONCLUSIONS: Cirrhosis is the strongest risk factor for HCC in patients with PBC. Male gender was also a risk factor. Our meta-analysis supports current recommendations of HCC surveillance in patients with PBC cirrhosis. Further studies are needed to evaluate risk factors in this population.

Association of Programmed Death Ligand-1 Overexpression with the Grade and Stage of Oral Squamous Cell Carcinoma.

ABSTARCT Programmed Death Ligand-1(PD-L) expression can be used to predict targeted therapy against PD-L1/PD-1 pathway in oral squamous cell carcinoma (OSCC). Forty-nine patients were included in the study. Out of the total, 42 well differentiated tumor 3 (7.1%) exhibited strong PD-L1 membranous and cytoplasmic staining, 14 (33.3%) weak staining, and 25 (29.5%) negative staining. Moderately differentiated tumor, (6/49), showed strong staining in 1 (16.7%), weak in none, and negative in 5 (83.3%) cases. Poorly differentiated tumor (1/1) showed strong staining (100%) (p = 0.018). Stage I tumors (n = 38) showed strong staining pattern in 4 (10.5%) cases, weak in 10 (26.3%), and negative in 24 (63.2%) cases. Stage II (n = 8) tumors had strong PD-L1 expression in 1 (12.5%), weak in 3 (37.5%), and negative in 4 (50%) cases. Stage III had negative in 2/3 (66.7%), weak in 1/3 (33.3%) cases, (p = 0.929). Key Word: Grade, PD-L1, Stage, Squamous cell carcinoma, Oral cracinoma.

Microbial synthesized cadmium oxide nanoparticles induce oxidative stress and protein leakage in bacterial cells.

The bactericidal activity of metal oxide nanoparticles (NPs) offers extensive opportunities in bioengineering and biomedicines. Bioengineered transition metals used in various forms against lethal microbes. In this study, Cadmium Oxide nanoparticles (CdO-NPs) were prepared through the co-precipitation method using fungal strain Penicillium oxalicum and cadmium acetate solution. The structure and elemental composition of the prepared NPs were determined by X-ray diffraction (XRD), Fourier transform infrared spectroscopy (FTIR), UV-Vis absorption spectroscopy, scanning electron microscope (SEM) and energy dispersive spectroscopy (EDS). Antibacterial activity was assessed through well diffusion method against Staphylococcus aureus (S. aureus), Shigella dysenteriae (S. dysenteriae), and Pseudomonas aeruginosa (P. aeruginosa). In addition, reactive oxygen species (ROS), reducing sugars and protein leakage contribution was examined against selected strains. The XRD analysis proved that the synthesized CdO-NPs possess a crystalline structure with an average crystalline size of 40-80 nm. FTIR confirmed the presence of organic compounds on the particle surface, while UV showed stability of the particles. SEM and EDS confirmed that CdO-NPs were successfully prepared and spherical. The maximum zone of inhibition against S. dysenteriae and P. aeruginosa was found and showed a less optical density of 0.086 after 18 h. ROS, reducing sugar, and protein leakage assay showed a significant difference as compared to control. Based on the present study, it is recommended that microbial mediated synthesized nanoparticles can be used as biomedicines for the treatment of different types of bacterial infections.

Age at onset of GERD symptoms predicts risk of Barrett's esophagus.

OBJECTIVES: Symptoms of gastroesophageal reflux disease (GERD) are the primary risk factor for Barrett's esophagus (BE). However, the significance of age at symptom onset is unknown. We examined the effects of multiple dimensions of GERD exposure on BE risk and whether these associations are modified by other risk factors for BE. METHODS: Data were from a cross-sectional study of 683 Veterans Affairs patients undergoing an elective esophagogastroduodenoscopy (EGD) or a study EGD concurrently with colonoscopy from primary care clinics. We compared 236 patients with both endoscopically suspected and histologically confirmed BE to 447 primary-care patients ("primary-care controls") without endoscopically suspected BE on their study EGD. Odds ratios (ORs) and 95% confidence intervals (CIs) were calculated using multivariate logistic regression. RESULTS: Age at onset <30 years of frequent (at least weekly) GERD symptoms was associated with highest risk of BE (OR=15.1, 95% CI 7.91-28.8), and risk increased linearly with earlier age at onset of symptoms (P-trend=0.001). This association was independent of cumulative GERD symptom duration. People with early onset GERD symptoms who reported ever using proton pump inhibitors were at especially high risk of BE (OR=31.1, 95% CI 13.9-69.7). In people with frequent GERD symptoms, BE risk was almost 80% lower among Helicobacter pylori-positive patients (OR=2.60, 95% CI 1.26-5.40) than those negative for H. pylori (OR=8.24, 95% CI 5.00-13.6). CONCLUSIONS: Risk of BE increased linearly with earlier age at onset of frequent GERD symptoms. Age at symptom onset may help practitioners decide which patients with GERD symptoms to refer for endoscopic screening for BE.

Occupational exposure and the risk of Barrett's esophagus: a case-control study.

BACKGROUND: Case-control studies in the United States and Europe have linked occupational exposure to volatile sulfur compounds, solvents, and pesticide to increased risk of esophageal adenocarcinoma. However, the association between occupational exposures and the risk of Barrett's esophagus (BE) is unclear given the absence of studies in this area. METHODS: This is a case-control study in patients undergoing endoscopy who were either referred directly or were eligible for screening colonoscopy and recruited from primary care clinics. All participants completed a survey on (1) self-reported occupational exposures to asbestos, metal dust, organic solvents, and pesticides, and (2) self reported longest held job and job-related activities. The latter were assigned by an industrial hygienist who was blinded to the case and control status into one of 99 standard occupational categories used by the US Department of Labor. Each occupational category was then assigned an expected level of exposure to the same four classes of agents in addition to radiation. We compared the self-reported exposure and the expected occupational exposure based on the self-reported occupation between cases with definitive BE and controls without BE. We examined the associations adjusting for age, sex, race, and patient recruitment source in a multivariable logistic regression analysis. RESULTS: We examined 226 cases of definitive BE and 1,424 controls without BE. There was a greater proportion of patients with self-reported asbestos exposure in cases than controls (16.2 % vs. 12.0 %; p = 0.08) but no significant differences in metal dust, organic solvents, or pesticides. The multivariate model did not show an independent association between self-reported asbestos exposure and BE. For the calculated occupational exposure, there were no significant differences between cases and controls for asbestos (29.6 % vs. 27.5 %; p = 0.5), metal dust, organic solvents, pesticides, or radiation exposure. Among commonly reported occupation, there were significantly greater proportion of retail sales workers in BE cases than controls (10.8 % vs. 4.9 %; p = 0.01). CONCLUSIONS: Exposure to asbestos and sedentary jobs may be risk factors for Barrett's esophagus. Further studies are needed to confirm this finding.

Resolution of papilledema associated with OSA treatment.

Obstructive sleep apnea (OSA) is a common disorder and is associated with brain functional and morphological alterations. The association between OSA and papilledema, however, is not well known. We describe a 53-year-old morbidly obese female who presented with impaired vision due to bilateral papilledema. Polysomnography revealed severe OSA. She was treated with continuous positive airway pressure, and within a few weeks her papilledema and vision improved. This case report is consistent with association of OSA with papilledema but does not prove causality.

High-dose chemotherapy with autologous stem cell rescue in stage IIIB inflammatory breast cancer.

BACKGROUND: Despite the advances in breast cancer care, inflammatory breast cancer (IBC) has a poor prognosis. The purpose of this study was to determine the efficacy of high-dose chemotherapy (HDCT) with thiotepa, mitoxantrone and carboplatin (TMJ regimen) in women with TNM stage IIIB IBC. PATIENTS AND METHODS: Between 1991 and 1998, twenty-eight patients with stage IIIB IBC underwent an autologous stem cell transplant after undergoing chemotherapy, surgery and/or radiation. Stem cells were collected from the bone marrow and periphery after mobilization with growth factors. Patients received thiotepa 250 mg/m2 once daily i.v. for 3 days, mitoxantrone 40 mg/m2 for 1 day and carboplatin 333 mg/m2 once daily i.v. for 3 days as the conditioning regimen for the HDCT. Radiation therapy and tamoxifen was offered to patients post HDCT if appropriate. Progression-free survival and overall survival was assessed over a 15-year period. RESULTS: At the time of last follow-up in May, 2007, sixteen patients had relapsed. The median overall survival was 49.5 months. The median progression free survival was 40 months. There were no transplant-related deaths. Mucositis and infections were the major side-effects. These results show that HDCT with the TMJ regimen is safe and effective in patients with stage IIIB IBC.