Clinical and technical factors in endoscopic skull base surgery associated with reconstructive success

BACKGROUND

In this study, we identified key discrete clinical and technical factors that may correlate with primary reconstructive success in endoscopic skull base surgery (ESBS).

METHODS

ESBS cases with intraoperative cerebrospinal fluid (CSF) leaks at four tertiary academic rhinology programs were retrospectively reviewed. Logistic regression identified factors associated with surgical outcomes by defect subsite (anterior cranial fossa [ACF], suprasellar [SS], purely sellar, posterior cranial fossa [PCF]).

RESULTS

Of 706 patients (50.4% female), 61.9% had pituitary adenomas, 73.4% had sellar or SS defects, and 20.5% had high-flow intraoperative CSF leaks. The postoperative CSF leak rate was 7.8%. Larger defect size predicted ACF postoperative leaks; use of rigid reconstruction and older age protected against sellar postoperative leaks; and use of dural sealants compared to fibrin glue protected against PCF postoperative leaks. SS postoperative leaks occurred less frequently with the use of dural onlay. Body-mass index, intraoperative CSF leak flow rate, and the use of lumbar drain were not significantly associated with postoperative CSF leak. Meningitis was associated with larger tumors in ACF defects, nondissolvable nasal packing in SS defects, and high-flow intraoperative leaks in PCF defects. Sinus infections were more common in sellar defects with synthetic grafts and nondissolvable nasal packing.

CONCLUSIONS

Depending on defect subsite, reconstructive success following ESBS may be influenced by factors, such as age, defect size, and the use of rigid reconstruction, dural onlay, and tissue sealants.

Prevalence of common autosomal recessive mutation carriers in women in the Southern Vietnam following the application of expanded carrier screening

The common autosomal recessive (AR) mutation carrier is still unknown in Vietnam. This study aims to identify the most common AR gene mutation carriers in women of reproductive age to build a Vietnamese-specific carrier screening panel for AR and X-linked disorders in the preconception and prenatal healthcare program. A cross-sectional study was conducted at University Medical Center-Branch 2 in Ho Chi Minh City from December 1st, 2020, to June 30th, 2023. 338 women have consented to take a 5 mL blood test to identify 540 recessive genes. The carrier screening panel was designed based on the American College of Medical Genetics and Genomics (ACMG)-recommended genes and suggestions from 104 clinical experts in Vietnam. Obstetricians and genetic experts counseled all positive testing results to discuss the possibility of recessive diseases in their offspring. The most common recessive disorders were defined at a prevalence of 1 in 60 or greater, and those were added to a Vietnamese-specific carrier screening panel. 338 non-pregnant and pregnant women underwent the expanded carrier screening (ECS). The carrier frequency was 63.6%, in which 215 women carried at least one AR gene mutation. GJB2 hearing impairment was identified as the most common chronic condition (1 in 5). The second most common AR disorder was beta-thalassemia (1 in 16), followed by cystic fibrosis (1 in 23), G6PD deficiency (1 in 28), Wilson's disease (1 in 31), Usher's syndrome (1 in 31), and glycogen storage disease (1 in 56). Seven common recessive genes were added in ethnic-based carrier screening. Women in the South of Vietnam have been carried for many recessive conditions at high frequency, such as hearing impairment, genetic anemia, and cystic fibrosis. It is necessary to implement a preconception and prenatal screening program by using seven widely popular AR genes in a Vietnamese-specific carrier screening panel to reduce the burden related to AR and X-linked disorders.

Prenatal diagnosis of non-typical Chiari malformation type I associated with de novo Nuclear Factor I A gene mutation: a case report

BACKGROUND

Chiari malformation is one of the most common Central nervous system (CNS) abnormalities that can be detected in routine fetal scanning. Chiari malformation type I (CMI) is a congenital defect characterized by a displacement of the cerebellar tonsils through the foramen magnum. The etiology of CMI has not been well established and suggested having multifactorial contributions, especially genetic deletion. Clinical characteristics of this anomaly may express in different symptoms from neurological dysfunction and/or skeletal abnormalities in the later age, but it is rarely reported in pregnancy.

CASE PRESENTATION

We present a case in which the Chiari malformation type I was diagnosed with comorbidities of facial anomalies (flatting forehead and micrognathia) and muscular-skeletal dysmorphologies (clenched hands and clubfeet) at the 24+6 weeks of gestation in a 29-year-old Vietnamese pregnant woman. The couple refused an amniocentesis, and the pregnancy was followed up every 4 weeks until a spontaneous delivery occurred at 38 weeks. The newborn had a severe asphyxia and seizures at birth required to have an emergency resuscitation at delivery. He is currently being treated in the intensive neonatal care unit. He carries the novel heterozygous NFIA gene mutation confirmed after birth. No further postnatal malformation detected.

CONCLUSION

CMI may only represent with facial abnormalities and muscle-skeletal malformations at the early stage of pregnancy, which may also alert an adverse outcome. A novel heterozygous NFIA gene mutation identified after birth helps to confirm prenatal diagnosis of CMI and to provide an appropriate consultation.

Balance between solitude and socializing: everyday solitude time both benefits and harms well-being

Two literatures argue that time alone is harmful (i.e., isolation) and valuable (i.e., positive solitude). We explored whether people benefit from a balance between their daily solitude and social time, such that having 'right' quantities of both maximizes well-being. Participants (n = 178) completed a 21-day diary study, which quantified solitude time in hours through reconstructing daily events. This procedure minimized retrospective bias and tested natural variations across time. There was no evidence for a one-size-fits-all 'optimal balance' between solitude and social time. Linear effects suggested that people were lonelier and less satisfied on days in which they spent more hours in solitude. These detrimental relations were nullified or reduced when daily solitude was autonomous (choiceful) and did not accumulate across days; those who were generally alone more were not, on the whole, lonelier. On days in which people spent more time alone they felt less stress and greater autonomy satisfaction (volitional, authentic, and free from pressure). These benefits were cumulative; those who spent more time alone across the span of the study were less stressed and more autonomy satisfied overall. Solitude time risks lowering well-being on some metrics but may hold key advantages to other aspects of well-being. PROTOCOL REGISTRATION: The stage 1 protocol for this Registered Report was accepted in principle on June 1, 2022. The protocol, as accepted by the journal, can be found at: https://doi.org/10.17605/OSF.IO/5KXQ3 .

Efficient automated error detection in medical data using deep-learning and label-clustering

Medical datasets inherently contain errors from subjective or inaccurate test results, or from confounding biological complexities. It is difficult for medical experts to detect these elusive errors manually, due to lack of contextual information, limiting data privacy regulations, and the sheer scale of data to be reviewed. Current methods for training robust artificial intelligence (AI) models on data containing mislabeled examples generally fall into one of several categories-attempting to improve the robustness of the model architecture, the regularization techniques used, the loss function used during training, or selecting a subset of data that contains cleaner labels. This last category requires the ability to efficiently detect errors either prior to or during training, either relabeling them or removing them completely. More recent progress in error detection has focused on using multi-network learning to minimize deleterious effects of errors on training, however, using many neural networks to reach a consensus on which data should be removed can be computationally intensive and inefficient. In this work, a deep-learning based algorithm was used in conjunction with a label-clustering approach to automate error detection. For dataset with synthetic label flips added, these errors were identified with an accuracy of up to 85%, while requiring up to 93% less computing resources to complete compared to a previous model consensus approach developed previously. The resulting trained AI models exhibited greater training stability and up to a 45% improvement in accuracy, from 69 to over 99% compared to the consensus approach, at least 10% improvement on using noise-robust loss functions in a binary classification problem, and a 51% improvement for multi-class classification. These results indicate that practical, automated a priori detection of errors in medical data is possible, without human oversight.

Bioaccumulation and metabolic impact of environmental PFAS residue on wild-caught urban wetland tiger snakes (Notechis scutatus)

PFAS contamination of urban waters is widespread but understanding the biological impact of its accumulation is limited to humans and common ecotoxicological model organisms. Here, we combine PFAS exposure and bioaccumulation patterns with whole organism responses and omics-based ecosurveillance methods to investigate the potential impacts of PFAS on a top predator of wetlands, the tiger snake (Notechis scutatus). Tiger snakes (18 male and 17 female) were collected from four wetlands with varying PFAS chemical profiles and concentrations in Perth, Western Australia. Tiger snake livers were tested for 28 known PFAS compounds, and Σ28PFAS in liver tissues ranged between 322 ± 193 μg/kg at the most contaminated site to 1.31 ± 0.86 μg/kg at the least contaminated site. The dominant PFAS compound detected in liver tissues was PFOS. Lower body condition was associated with higher liver PFAS, and male snakes showed signs of high bioaccumulation whereas females showed signs of maternal offloading. Biochemical profiles of snake muscle, fat (adipose tissue), and gonads were analysed using a combination of liquid chromatography triple quadrupole (QqQ) and quadrupole time-of-flight (QToF) mass spectrometry methodologies. Elevated PFAS was associated with enriched energy production and maintenance pathways in the muscle, and had weak associations with energy-related lipids in the fat tissue, and lipids associated with cellular genesis and spermatogenesis in the gonads. These findings demonstrate the bioavailability of urban wetland PFAS in higher-order reptilian predators and suggest a negative impact on snake health and metabolic processes. This research expands on omics-based ecosurveillance tools for informing mechanistic toxicology and contributes to our understanding of the impact of PFAS residue on wildlife health to improve risk management and regulation.

Biochemical Failure in Intermediate Risk Prostate Cancer: Then What? Long-Term Data from a Phase III Trial

PURPOSE/OBJECTIVE(S)

Aiming to determine long-term outcomes post biochemical failure (BF) in patients (pts) treated for intermediate-risk prostate cancer, we analyzed data from our prospective randomized trial (PCS III).

MATERIALS/METHODS

From December 2000 to September 2010, 600 pts with intermediate risk prostate cancer (IRPC) received prostate radiotherapy (RT) with or without short-term (6 months) androgen deprivation therapy (ADT) on a Phase III trial. We report death rate from prostate cancer, rate and timing of BF plus the final clinical outcome of patients, alive or dead, with BF. Chi-squared test was used to compare BF and prostate cancer progression (PCP) rates between patient with or without ADT.

RESULTS

Median age at randomization was 71 years (IQR 66-74). With a median follow-up (FU) of 13.5 years (IQR 11.2-17.0), 74.5% (447/600) were free from BF at last FU. Of these, 211 died, 79 stopped FU after 10 years, 9 were lost to FU, 6 withdrew from the study and 142 are still on FU, at a median follow-up of 13.2 years (IQR = 10.9 - 16.2). A total of 153 pts (25.5%) developed BF at a median time of 6.5 years post-randomization. Among BF pts, 82/153 died: we documented 32 deaths from prostate cancer (DPC) at a median time of 6 years post-BF and 50/153 pts died from other causes at a median time of 4.7 years from BF. 48/153 BF pts continue on FU: 34 show no clinical evidence of cancer, 9 developed a second cancer and 5 show clinical evidence of PCP. 20/153 pts stopped FU after 10 years: 3 of them with PCP. 3/153 pts were lost to FU: 1 after 3 years with prostate bone metastasis and 2 after 13 years of FU. In the first 5 years post-randomization, 47 pts (7.8%) presented BF with 1 (0.2%) DPC; between 6 and 10 years, there were another 84 (14%) BFs and 11 (1.8%) DPC. Finally, after 10 years and beyond, we recorded an additional 22 (3.7%) BFs and 20 (3.3%) DPC. The rate of patients who received ADT was significantly lower in patients with BF (74/153 = 48.4%) compared to patients without BF (324/447 = 72.5%), p<0.001. The rate of patients who received ADT was also significantly lower in patients with PCP (19/48 = 39.6%) compared to patients without PCP (379/552 = 68.7%), p<0.001.

CONCLUSION

In our trial for intermediate-risk prostate cancer, a quarter of the pts developed BF. Most of the BFs occurred between 5- and 10- year post-randomization. Deaths due to prostate cancer post-BF occurred at a median time of 6 years, justifying the need for long-term FU. BF and PCP were significantly higher in patients not receiving ADT.

Effect of Helicobacter pylori on non-homologous end joining-mediated repair of proximal DNA double-strand breaks in GCV6 cells

Infection with Helicobacter pylori is the strongest known risk factor for gastric cancer, which is one of the leading causes of cancer-related mortality worldwide. H. pylori can contribute to carcinogenesis by inducing the genomic instability of infected cells through increasing accumulation of DNA double-stranded breaks (DSBs) and deregulating DSB repair systems. However, the mechanism of this phenomenon is still being elucidated. This study aims to investigate the impact of H. pylori on the efficacy of non-homologous end joining (NHEJ)-mediated repair of DSB. In this study, we used a human fibroblast cell line bearing a single copy of an NHEJ-reporter substrate stably inserted into the genome, which provides a quantitative measurement of NHEJ. Our results indicated the potential abilities of H. pylori strains to alter the NHEJ-mediated repair of proximal DSB in infected cells. In addition, we found an association between the alteration in the NHEJ efficiency, and the inflammation responses of infected cells caused by H. pylori.

The effect of medication event reminder monitoring on treatment adherence of TB patients

BACKGROUND: TB control remains a serious public health problem, compounded by poor treatment adherence, which increases the likelihood of onward transmission. We evaluated the effectiveness of medication event reminder monitoring (MERM) upon treatment adherence in a high TB burden setting.METHODS: We conducted an open-label parallel group randomised controlled trial among pulmonary TB adults. Participants were provided with a MERM device to store their medications. In the intervention arm, the devices were set to provide daily medication intake reminders. Primary outcome was the proportion of patient-months in which at least 6/30 doses were missed. Secondary outcomes included 1) the proportion of patient-months in which at least 14/30 doses were missed, and 2) the proportion of doses missed.RESULTS: Of 2,142 patients screened, 798 (37.3%) met the inclusion criteria and 250 participants were enrolled. The mean ratio (MR) for poor adherence between the intervention and control groups was 0.72 (95% CI 0.55-0.86). The intervention was also associated with a reduction in the proportion of patients missing at least 14/30 doses (MR 0.61, 95% CI 0.54-0.68) and the percentage of total doses missed (MR 0.75, 95% CI 0.68-0.80).CONCLUSION: MERM is effective in improving TB treatment adherence in a resource-limited environment.

Vitrified before and after genome editing via electroporation

BACKGROUND

Cryopreservation of bovine zygotes allows for a flexible schedule of genome editing via electroporation. However, vitrification-induced cell membrane damage may not only affect embryonic development but also genome mutation.

OBJECTIVE

To investigate the effects of vitrification of zygotes before and after electroporation treatments on the development and genome mutation of bovine presumptive zygotes.

MATERIALS AND METHODS

In vitro-derived bovine zygotes were electroporated with the CRISPR/Cas9 system immediately (Vitrified-EP) or 2 h after incubation (Vitrified-2h-EP) following vitrification and warming, or electroporated before vitrification (EP-vitrified).

RESULTS

The development rates of vitrified-warmed zygotes were significantly lower (p < 0.05) than those of control zygotes that were not vitrified. Moreover, no differences were observed in the mutation rates and mutation efficiency of the blastocysts resulting from electroporated zygotes, irrespective of the timing of electroporation treatment.

CONCLUSION

Our results suggest that vitrification before and after electroporation treatments does not affect the genome editing of zygotes.

Cardiovascular disease in older patients with end-stage renal disease and chronic dialysis in Vietnam

Funding Acknowledgements

Type of funding sources: None.

Background

Patients with chronic kidney disease, especially end-stage renal disease, exhibit a very high cardiovascular risk. In Vietnam, chronic kidney disease and cardiovascular disease (CVD) are very common in older people. However, there is limited studies on the complexity of CVD and other geriatric syndromes in older patients with end-stage renal disease and chronic dialysis.

Purpose

In this study in older patients with end-stage renal disease and chronic dialysis, we aim to: (1) Examine the prevalence of CVD and its impact on hospitalization, and (2) Compare the burden of common geriatric syndromes in patients with and without CVD.

Methods

This is a prospective, observational, multi-centre study conducted at two dialysis units of two major hospitals in Vietnam. Consecutive patients aged 60 years or older who were diagnosed with end-stage renal disease and on chronic dialysis were recruited from November 2020 to June 2021. CVD was defined as having one of these conditions: heart failure, ischemic heart disease, and stroke. Participants were assessed for these common geriatric conditions: frailty (defined as a Clinical Frailty Scale total score ≥5), malnutrition (defined as a total score ≤7 from the Mini Nutritional Assessment Short Form), impairment in activities of daily living (defined as ADL score &lt;6), impairment in instrumental activities of daily living (defined as IADL score &lt;8), high risk of falls (assessed by the STEADI questionnaire), and polypharmacy (defined as the concurrent use of ≥5 medications). Participants were followed for 6 months after discharge. Multivariable logistic regression analysis was applied to examine the impact of CVD on 6-month hospitalization, adjusting for age, sex, and the geriatric conditions. Results were presented as odds ratios (ORs) and 95% confidence intervals (CIs).

Results

There were 175 participants (mean age 72.4 ± 8.5, 58.9% female). CVD was present in 80% of the participants (ischemic heart disease: 49.7%, heart failure: 60.0%, stroke 25.7%). Participants with CVD had significantly higher prevalence of geriatric syndromes compared to those without CVD (Table 1). During 6-month follow-up, 48.6% of the participants had at least one hospitalization. In multivariable logistic regression model, the presence of CVD increased the risk of hospitalization (adjusted OR 4.70, 95%CI 1.72 – 12.85), allowing for age, sex, frailty, ADL impairment, IADL impairment, fall risk, malnutrition, polypharmacy (Table 2).

Conclusion

In this study, there was a very high prevalence of CVD in older patients with end-stage renal disease and chronic dialysis. Participants with CVD had higher burden of geriatric syndromes and their risk of 6-month hospitalization increased by approximately 5 times.

Contrast induced nephropathy in older Vietnamese patients undergoing coronary angiography and intervention

Funding Acknowledgements

Type of funding sources: None.

Background

The prevalence of coronary heart disease increases with age and older people accounted for a large proportion of patients presenting with coronary heart disease. Advancement in percutaneous coronary intervention (PCI) has contributed to reduced mortality in patients with coronary artery disease. However, coronary angiography and percutaneous intervention have also increased the risk of developing contrast induced nephropathy (CIN), especially in older patients. More than ten risk assessment tools have been developed to predict CIN. Among these, the Mehran risk score has been the most commonly used in Vietnam. In recent years, new simple risk prediction models have been proposed, including the contrast volume-to-glomerular filtration rate ratio (CV/GFR ratio). The CV/GFR ratio is calculated as the ratio of contrast medium quantity to glomerular filtration rate.

Purpose

The aim of this study was to (1) examine the incidence of CIN in a cohort of older patients undergoing coronary angiography and/or PCI at a tertiary hospital in Vietnam, (2) compare the validity of the CV/GFR ratio and the Mehran score in predicting CIN, and (3) to identify optimal cut-off points of these scales by which can help identify older patients with high risk of developing CIN in this population.

Methods

A prospective observational study was conducted in patients aged ≥ 60 years at a tertiary hospital in Vietnam from September 2019 to May 2020. CIN was defined as 25% increase in serum creatinine from baseline or 0.5mg/dL absolute increase in serum creatinine occurring within 48 hours post IV contrast administration. The CV/GFR ratio and the Mehran score were applied for predicting risk of CIN. Previous studies suggest Mehran score &gt;5 or CV/GFR ratio &gt;3.7 as a predictor of an early abnormal increase in serum creatinine after PCI. Receiver Operator Characteristic (ROC) was applied to evaluate area under the curve (AUC) of the CV/GFR ratio and Mehran score in predicting CIN, and the sensitivity, specificity for common cut-off points that were suggested in previous studies.

Results

A total of 170 participants were included in this study. They had a mean age of 70 years, 33.1% were women. The incidence of CIN was 9.4%. Participants with CIN had higher prevalence of chronic kidney disease, heart failure and anaemia at admission. The AUC of the CV/GFR ratio against CIN was 0.79 (95%CI 0.65-0.92), and of the Mehran score against CIN was 0.65 (95%CI 0.51-0.82) (Figure 1). The sensitivity and specificity for common cut-off points of the CV/GFR ratio and Mehran score are presented in Figure 2.

Conclusions

Our study found that CIN was common in older patients after PCI. Both CV/GFR ratio and Mehran score had good diagnostic value for predicting CIN in the study participants.

Development of an artificial intelligence model for predicting the likelihood of human embryo euploidy based on blastocyst images from multiple imaging systems during IVF

STUDY QUESTION

Can an artificial intelligence (AI) model predict human embryo ploidy status using static images captured by optical light microscopy?

SUMMARY ANSWER

Results demonstrated predictive accuracy for embryo euploidy and showed a significant correlation between AI score and euploidy rate, based on assessment of images of blastocysts at Day 5 after IVF.

WHAT IS KNOWN ALREADY

Euploid embryos displaying the normal human chromosomal complement of 46 chromosomes are preferentially selected for transfer over aneuploid embryos (abnormal complement), as they are associated with improved clinical outcomes. Currently, evaluation of embryo genetic status is most commonly performed by preimplantation genetic testing for aneuploidy (PGT-A), which involves embryo biopsy and genetic testing. The potential for embryo damage during biopsy, and the non-uniform nature of aneuploid cells in mosaic embryos, has prompted investigation of additional, non-invasive, whole embryo methods for evaluation of embryo genetic status.

STUDY DESIGN, SIZE, DURATION

A total of 15 192 blastocyst-stage embryo images with associated clinical outcomes were provided by 10 different IVF clinics in the USA, India, Spain and Malaysia. The majority of data were retrospective, with two additional prospectively collected blind datasets provided by IVF clinics using the genetics AI model in clinical practice. Of these images, a total of 5050 images of embryos on Day 5 of in vitro culture were used for the development of the AI model. These Day 5 images were provided for 2438 consecutively treated women who had undergone IVF procedures in the USA between 2011 and 2020. The remaining images were used for evaluation of performance in different settings, or otherwise excluded for not matching the inclusion criteria.

PARTICIPANTS/MATERIALS, SETTING, METHODS

The genetics AI model was trained using static 2-dimensional optical light microscope images of Day 5 blastocysts with linked genetic metadata obtained from PGT-A. The endpoint was ploidy status (euploid or aneuploid) based on PGT-A results. Predictive accuracy was determined by evaluating sensitivity (correct prediction of euploid), specificity (correct prediction of aneuploid) and overall accuracy. The Matthew correlation coefficient and receiver-operating characteristic curves and precision-recall curves (including AUC values), were also determined. Performance was also evaluated using correlation analyses and simulated cohort studies to evaluate ranking ability for euploid enrichment.

MAIN RESULTS AND THE ROLE OF CHANCE

Overall accuracy for the prediction of euploidy on a blind test dataset was 65.3%, with a sensitivity of 74.6%. When the blind test dataset was cleansed of poor quality and mislabeled images, overall accuracy increased to 77.4%. This performance may be relevant to clinical situations where confounding factors, such as variability in PGT-A testing, have been accounted for. There was a significant positive correlation between AI score and the proportion of euploid embryos, with very high scoring embryos (9.0-10.0) twice as likely to be euploid than the lowest-scoring embryos (0.0-2.4). When using the genetics AI model to rank embryos in a cohort, the probability of the top-ranked embryo being euploid was 82.4%, which was 26.4% more effective than using random ranking, and ∼13-19% more effective than using the Gardner score. The probability increased to 97.0% when considering the likelihood of one of the top two ranked embryos being euploid, and the probability of both top two ranked embryos being euploid was 66.4%. Additional analyses showed that the AI model generalized well to different patient demographics and could also be used for the evaluation of Day 6 embryos and for images taken using multiple time-lapse systems. Results suggested that the AI model could potentially be used to differentiate mosaic embryos based on the level of mosaicism.

LIMITATIONS, REASONS FOR CAUTION

While the current investigation was performed using both retrospectively and prospectively collected data, it will be important to continue to evaluate real-world use of the genetics AI model. The endpoint described was euploidy based on the clinical outcome of PGT-A results only, so predictive accuracy for genetic status in utero or at birth was not evaluated. Rebiopsy studies of embryos using a range of PGT-A methods indicated a degree of variability in PGT-A results, which must be considered when interpreting the performance of the AI model.

WIDER IMPLICATIONS OF THE FINDINGS

These findings collectively support the use of this genetics AI model for the evaluation of embryo ploidy status in a clinical setting. Results can be used to aid in prioritizing and enriching for embryos that are likely to be euploid for multiple clinical purposes, including selection for transfer in the absence of alternative genetic testing methods, selection for cryopreservation for future use or selection for further confirmatory PGT-A testing, as required.

STUDY FUNDING/COMPETING INTEREST(S)

Life Whisperer Diagnostics is a wholly owned subsidiary of the parent company, Presagen Holdings Pty Ltd. Funding for the study was provided by Presagen with grant funding received from the South Australian Government: Research, Commercialisation, and Startup Fund (RCSF). 'In kind' support and embryology expertise to guide algorithm development were provided by Ovation Fertility. 'In kind' support in terms of computational resources provided through the Amazon Web Services (AWS) Activate Program. J.M.M.H., D.P. and M.P. are co-owners of Life Whisperer and Presagen. S.M.D., M.A.D. and T.V.N. are employees or former employees of Life Whisperer. S.M.D, J.M.M.H, M.A.D, T.V.N., D.P. and M.P. are listed as inventors of patents relating to this work, and also have stock options in the parent company Presagen. M.V. sits on the advisory board for the global distributor of the technology described in this study and also received support for attending meetings.

TRIAL REGISTRATION NUMBER

N/A.

A novel decentralized federated learning approach to train on globally distributed, poor quality, and protected private medical data

Training on multiple diverse data sources is critical to ensure unbiased and generalizable AI. In healthcare, data privacy laws prohibit data from being moved outside the country of origin, preventing global medical datasets being centralized for AI training. Data-centric, cross-silo federated learning represents a pathway forward for training on distributed medical datasets. Existing approaches typically require updates to a training model to be transferred to a central server, potentially breaching data privacy laws unless the updates are sufficiently disguised or abstracted to prevent reconstruction of the dataset. Here we present a completely decentralized federated learning approach, using knowledge distillation, ensuring data privacy and protection. Each node operates independently without needing to access external data. AI accuracy using this approach is found to be comparable to centralized training, and when nodes comprise poor-quality data, which is common in healthcare, AI accuracy can exceed the performance of traditional centralized training.

Predictive performance of the Garvan Fracture Risk Calculator: a registry-based cohort study

The G arvan Fracture Risk Calculator predicts risk of osteoporotic fractures. We evaluated its predictive performance in 16,682 women and 2839 men from Manitoba, Canada, and found significant risk stratification, with a strong gradient across scores. The tool outperformed clinical risk factors and bone mineral density for fracture risk stratification.

INTRODUCTION

The optimal model for fracture risk estimation to guide treatment decision-making remains controversial. Our objective was to evaluate the predictive performance of the Garvan Fracture Risk Calculator (FRC) in a large clinical registry from Manitoba, Canada.

METHODS

Using the population-based Manitoba Bone Mineral Density (BMD) registry, we identified women and men aged 50-95 years undergoing baseline BMD assessment from September 1, 2012, onwards. Five-year Garvan FRC predictions were generated from clinical risk factors (CRFs) with and without femoral neck BMD. We identified incident non-traumatic osteoporotic fractures (OFs) and hip fractures (HFs) from population-based healthcare data sources to March 31, 2018. Fracture risk was assessed from area under the receiver operating characteristic curve (AUROC). Cox regression analysis and calibration ratios (5-year observed/predicted) were assessed for risk quintiles. All analyses were sex stratified.

RESULTS

We included 16,682 women (mean age 66.6 + / - SD 8.7 years) and 2839 men (mean age 68.7 + / - SD 10.2 years). During a mean observation time of 2.6 years, incident OFs were identified in 681 women and 140 men and HFs in 199 women and 22 men. AUROC showed significant fracture risk stratification with the Garvan FRC. Tool predictions without BMD were better than from age or decreasing weight, and the tool with BMD performed better than BMD alone. Garvan FRC with BMD performed better than without BMD, especially for HF prediction (AUROC 0.86 in women, 0.82 in men). There was a strong gradient of increasing risk across Garvan FRC quintiles (highest versus lowest, hazard ratios women 5.75 and men 3.43 for any OF; women 101.6 for HF). Calibration differences were noted, with both over- and underestimation in risk.

CONCLUSIONS

Garvan FRC outperformed CRFs and BMD alone for fracture risk stratification, particularly for HF, but may require recalibration for accurate predictions in this population.

What Time Alone Offers: Narratives of Solitude From Adolescence to Older Adulthood

Solitude – the state of being alone and not physically with another – can be rewarding. The present research explored the potential benefits of solitude from a pragmatist approach: a ground-up, top-down perspective that is receptive to new knowledge but informed by theory. Participant recruitment was stratified by age and gender, and the sample involved 2,035 individuals including adolescents (13–16 years), adults (35–55 years), or older adults (65+ years). Data were analyzed with a mixed-methods approach. Coded themes from brief narratives about solitude were extracted, and their frequencies (i.e., their salience to participants) were compared across the lifespan. Themes were then correlated with two indicators of well-being in solitude: self-determined motivation for solitude and peaceful mood. Several prominent themes emerged when talking about time spent in solitude. With the exception of feeling competent in solitude, which was described frequently but consistently unrelated to self-reported well-being regardless of age, benefits of solitude tended to shift over the lifespan. Some qualities, such as a sense of autonomy (self-connection and reliance; absence of pressure), were salient and consequential for everyone, but increasingly so from adolescence to older adulthood. Older adults also reported feeling most peaceful in solitude and described their social connection and alienation less frequently, suggesting they see solitude and social time as more distinct states. Findings are discussed in light of existing work on solitude across the lifespan, and theoretical frameworks that spoke well to the data (e.g., self-determination theory).

Development and validation of the risk engine for an Australian Health Economics Model of Osteoporosis

The Australian Health Economics Model of Osteoporosis (AusHEMO) has shown good face, internal and cross validities, and can be used to assist healthcare decision-making in Australia.

PURPOSE

This study aimed to document and validate the risk engine of the Australian Health Economics Model of Osteoporosis (AusHEMO).

METHODS

AusHEMO is a state-transition microsimulation model. The fracture risks were simulated using fracture incidence rates from the Dubbo Osteoporosis Epidemiology Study. The AusHEMO was validated regarding its face, internal and cross validities. Goodness-of-fit analysis was conducted and Lin's coefficient of agreement and mean absolute difference with 95% limits of agreement were reported.

RESULTS

The development of AusHEMO followed general and osteoporosis-specific health economics guidelines. AusHEMO showed good face validity regarding the model's structure, evidence, problem formulation and results. In addition, the model has been proven good internal and cross validities in goodness-of-fit test. Lin's coefficient was 0.99, 1 and 0.94 for validation against the fracture incidence rates, Australian life expectancies and residual lifetime fracture risks, respectively.

CONCLUSIONS

In summary, the development of the risk engine of AusHEMO followed the best practice for osteoporosis disease modelling and the model has been shown to have good face, internal and cross validities. The AusHEMO can be confidently used to predict long-term fracture-related outcomes and health economic evaluations when costs data are included. Health policy-makers in Australia can use the AusHEMO to select which osteoporosis interventions such as medications and public health interventions represent good value for money.

The endemic Helicobacter pylori population in Southern Vietnam has both South East Asian and European origins

Background

The burden of Helicobacter pylori-induced gastric cancer varies based on predominant H. pylori population in various geographical regions. Vietnam is a high H. pylori burden country with the highest age-standardized incidence rate of gastric cancer (16.3 cases/100,000 for both sexes) in Southeast Asia, despite this data on the H. pylori population is scanty. We examined the global context of the endemic H. pylori population in Vietnam and present a contextual and comparative genomics analysis of 83 H. pylori isolates from patients in Vietnam.

Results

There are at least two major H. pylori populations are circulating in symptomatic Vietnamese patients. The majority of the isolates (~ 80%, 66/83) belong to the hspEastAsia and the remaining belong to hpEurope population (~ 20%, 17/83). In total, 66 isolates (66/83) were cagA positive, 64 were hspEastAsia isolates and two were hpEurope isolates. Examination of the second repeat region revealed that most of the cagA genes were ABD type (63/66; 61 were hspEastAsia isolates and two were hpEurope isolates). The remaining three isolates (all from hspEastAsia isolates) were ABC or ABCC types. We also detected that 4.5% (3/66) cagA gene from hspEastAsia isolates contained EPIYA-like sequences, ESIYA at EPIYA-B segments. Analysis of the vacA allelic type revealed 98.8% (82/83) and 41% (34/83) of the strains harboured the s1 and m1 allelic variant, respectively; 34/83 carried both s1m1 alleles. The most frequent genotypes among the cagA positive isolates were vacA s1m1/cagA + and vacA s1m2/cagA + , accounting for 51.5% (34/66) and 48.5% (32/66) of the isolates, respectively.

Conclusions

There are two predominant lineages of H. pylori circulating in Vietnam; most of the isolates belong to the hspEastAsia population. The hpEurope population is further divided into two smaller clusters.

Supplementary Information

The online version contains supplementary material available at 10.1186/s13099-021-00452-2.

Development of the Asia Pacific Consortium on Osteoporosis (APCO) Framework: clinical standards of care for the screening, diagnosis, and management of osteoporosis in the Asia-Pacific region

Guidelines for doctors managing osteoporosis in the Asia-Pacific region vary widely. We compared 18 guidelines for similarities and differences in five key areas. We then used a structured consensus process to develop clinical standards of care for the diagnosis and management of osteoporosis and for improving the quality of care.

PURPOSE

Minimum clinical standards for assessment and management of osteoporosis are needed in the Asia-Pacific (AP) region to inform clinical practice guidelines (CPGs) and to improve osteoporosis care. We present the framework of these clinical standards and describe its development.

METHODS

We conducted a structured comparative analysis of existing CPGs in the AP region using a "5IQ" model (identification, investigation, information, intervention, integration, and quality). One-hundred data elements were extracted from each guideline. We then employed a four-round Delphi consensus process to structure the framework, identify key components of guidance, and develop clinical care standards.

RESULTS

Eighteen guidelines were included. The 5IQ analysis demonstrated marked heterogeneity, notably in guidance on risk factors, the use of biochemical markers, self-care information for patients, indications for osteoporosis treatment, use of fracture risk assessment tools, and protocols for monitoring treatment. There was minimal guidance on long-term management plans or on strategies and systems for clinical quality improvement. Twenty-nine APCO members participated in the Delphi process, resulting in consensus on 16 clinical standards, with levels of attainment defined for those on identification and investigation of fragility fractures, vertebral fracture assessment, and inclusion of quality metrics in guidelines.

CONCLUSION

The 5IQ analysis confirmed previous anecdotal observations of marked heterogeneity of osteoporosis clinical guidelines in the AP region. The Framework provides practical, clear, and feasible recommendations for osteoporosis care and can be adapted for use in other such vastly diverse regions. Implementation of the standards is expected to significantly lessen the global burden of osteoporosis.

Assessing the clinical utility of genetic profiling in fracture risk prediction: a decision curve analysis

Using decision curve analysis on 2188 women and 1324 men, we found that an osteogenomic profile constructed from 62 genetic variants improved the clinical net benefit of fracture risk prediction over and above that of clinical risk factors and BMD.

INTRODUCTION

Genetic profiling is a promising tool for assessing fracture risk. This study sought to use the decision curve analysis (DCA), a novel approach to determine the impact of genetic profiling on fracture risk prediction.

METHODS

The study involved 2188 women and 1324 men, aged 60 years and above, who were followed for up to 23 years. Bone mineral density (BMD) and clinical risk factors were obtained at baseline. The incidence of fracture and mortality were recorded. A weighted individual genetic risk score (GRS) was constructed from 62 BMD-associated genetic variants. Four models were considered: CRF (clinical risk factors); CRF + GRS; Garvan model (GFRC) including CRF and femoral neck BMD; and GFRC + GRS. The DCA was used to evaluate the clinical net benefit of predictive models at a range of clinically reasonable risk thresholds.

RESULTS

In both women and men, the full model GFRC + GRS achieved the highest net benefits. For 10-year risk threshold > 18% for women and > 15% for men, the GRS provided net benefit above those of the CRF models. At 20% risk threshold, adding the GRS could help to avoid 1 additional treatment per 81 women or 1 per 24 men compared with the Garvan model. At lower risk thresholds, there was no significant difference between the four models.

CONCLUSIONS

The addition of genetic profiling into the clinical risk factors can improve the net clinical benefit at higher risk thresholds of fracture. Although the contribution of genetic profiling was modest in the presence of BMD + CRF, it appeared to be able to replace BMD for fracture prediction.

IQ driving QI: the Asia Pacific Consortium on Osteoporosis (APCO): an innovative and collaborative initiative to improve osteoporosis care in the Asia Pacific

Asia Pacific Consortium on Osteoporosis (APCO) comprises of clinical experts from across the Asia Pacific region, uniting to develop solutions to problems facing osteoporosis management and care. The vision of APCO is to reduce the burden of osteoporosis and fragility fractures in the Asia Pacific region.

INTRODUCTION

The Asia Pacific (AP) region comprises 71 countries with vastly different healthcare systems. It is predicted that by 2050, more than half the world's hip fractures will occur in this region. The Asia Pacific Consortium on Osteoporosis (APCO) was set up in May 2019 with the vision of reducing the burden of osteoporosis and fragility fractures in the AP region.

METHODS

APCO has so far brought together 39 clinical experts from countries and regions across the AP to develop solutions to challenges facing osteoporosis management and fracture prevention in this highly populous region of the world. APCO aims to achieve its vision by engaging with relevant stakeholders including healthcare providers, policy makers and the public. The initial APCO project is to develop and implement a Framework of pan-AP minimum clinical standards for the screening, diagnosis and management of osteoporosis.

RESULTS AND CONCLUSIONS

The Framework will serve as a platform upon which new national clinical guidelines can be developed or existing guidelines be revised, in a standardised fashion. The Framework will also facilitate benchmarking for provision of quality of care. It is hoped that the principles underlying the formation and functioning of APCO can be adopted by other regions and that every health care facility and progressively every country in the world can follow our aspirational path and progress towards best practice.

Microbiome dataset analysis from a shrimp pond in Ninh Thuan, Vietnam using shotgun metagenomics

Vietnam is one of the top shrimp producing and exporting countries in the world [1]. However, viral and bacterial epidemic diseases cause severe damages to shrimp farming, resulting in millions of US dollars losses annually [2]. Furthermore, inappropriate use of antibiotics in shrimp rearing lead to increased emergence of drug resistant pathogens [3]. Current practices for water quality control, mostly based on chemical and physical parameters; neglected biological criteria necessary for maintaining pond health. Ninh Thuan is a region situated in the South Central Coast of Vietnam. Due to its geographic location, a large part of this region is dedicated to shrimp (Litopenaeus vannamei) post-larvae production and rearing. This article presents a microbiome dataset from two water samples collected in a shrimp rearing pond in Ninh Thuan. We used Oxford Nanopore Technologies (ONT) for metagenomic sequencing of the samples to characterize microbial communities and antibiotic resistance profiles. The metagenome dataset generated will provide an understanding and comparison framework of the microbial diversity and functionality among shrimp ponds with potential application in health management and shrimp rearing industry.

A critical review on life cycle assessment and plant-wide models towards emission control strategies for greenhouse gas from wastewater treatment plants

For decades, there has been a strong interest in mitigating greenhouse gas (GHG) emissions from wastewater treatment plants (WWTPs). Numerous models were developed to measure the emissions and propose the quantification. Existing studies looked at the relationship between GHG emissions and operational cost (OCI), which is one of the most important indicators for decision-makers. Other parameters that can influence the control strategies include the effluent quality (EQI) and total environmental impacts. Plant-wide models are reliable methods to examine the OCI, EQI and GHG emissions while Life cycle assessment (LCA) works to assess the potential environmental impacts. A combined LCA and plant-wide model proved to be a valuable tool evaluating and comparing strategies for the best performance of WWTPs. For this study involving a WWTP, the benchmark model is used while LCA is the decision tool to find the most suitable treatment strategy. LCA adds extra criteria that complement the existing criteria provided by such models. Complementing the cost/performance criteria is proposed for plant-wide models, including environmental evaluation, based on LCA, which provides an overall better assessment of WWTPs. It can capture both the dynamic effects and potential environmental impacts. This study provides an overview of the integration between plant-wide models and LCA.