Predicting COVID-19 Outcomes: Machine Learning Predictions Across Diverse Datasets

Background The COVID-19 infection has spread rapidly since its emergence and has affected a large part of the global population. With the increasing number of cases, researchers are trying to predict the prognosis of patients by using different data with artificial intelligence methods such as machine learning (ML). In this study, we aimed to predict mortality risk in COVID-19 patients using ML algorithms with different datasets. Methodology In this retrospective study, we evaluated the fever, oxygen saturation, laboratory results, thorax computed tomography (CT) findings, and comorbid diseases at admission to the hospital of 404 patients whose diagnosis was confirmed by the reverse transcription polymerase chain reaction test. Different datasets were created by combining the data. The Synthetic Minority Oversampling Technique was used to reduce the imbalance in the dataset. K-nearest neighbors, support vector machine, stochastic gradient descent, random forest, neural network, naive Bayes, logistic regression, gradient boosting, XGBoost, and AdaBoost models were used to create the ML algorithm, and the accuracy rates of mortality prediction were compared. Results When the dataset was created with CT parenchyma score, pulmonary artery and inferior vena cava diameters, and laboratory results, mortality was predicted with an accuracy of 98.4% with the gradient boosting model. Conclusions The study demonstrates that patient prognosis can be accurately predicted using simple measurements from thorax CT scans and laboratory findings.

The Role of Diffusion-Weighted Imaging in the Evaluation of Treatment of Newly Diagnosed Type 2 Diabetic Patients

INTRODUCTION

To compare the pre and post-treatment pancreatic apparent diffusion coefficient (ADC) values of type II diabetes patients with control subjects, and also to evaluate its effectiveness in evaluating the response to treatment.

METHODS

The study included 35 newly diagnosed type 2 diabetic patients and 35 non-diabetic participants, matched for sex and age. Insulin and metformin treatment was given to the patients. Abdominal diffusion-weighted MR imaging was performed before and after the treatment. ADCs of the control group and patients pre and post-treatment were compared. In addition, the clinical parameters of the patients related to diabetes were recorded.

RESULTS

There was a significant difference between the median pancreatic ADC values of the patients pre and post-treatment. While there was a significant difference between the median pancreatic ADC values of the patient and the control groups before the treatment, no significant difference after the treatment was observed. There was a positive correlation between mean pancreatic ADC values and age, as well as a negative correlation with Hb1Ac level and eGFR.

CONCLUSION

Pancreatic ADC values of newly diagnosed type II diabetes patients can be used as a marker of pancreatic function in the evaluation of response to treatment and clinical decisions.

The effect of brace use on clinical outcomes after arthroscopic meniscus repair

OBJECTIVE

It was aimed to evaluate the necessity of using range of motion (ROM) restrictive braces in the postoperative follow-up and rehabilitation of patients who underwent arthroscopic repair due to meniscal tear.

PATIENTS AND METHODS

Among the patients who applied to our Orthopedics and Traumatology Department with knee pain, stuck and locking sensation, between January 2020 and December 2020, the files of those who were diagnosed with meniscus tear and underwent arthroscopic repair as a result of physical examination and Magnetic Resonance Imaging (MRI) examination, were evaluated retrospectively. Patients who underwent reconstruction in the same session due to concomitant ligament injury and who had repaired with a technique other than the all-inside repair technique were not included in the study. A total of 48 patients were included in the study to form two equal groups. The results of the patients were evaluated using the Lysholm Score, Modified Cincinnati Score and clinical examination results.

RESULTS

The mean age of the patients was 35.3 (18-51). It was determined that the mean Lysholm score was increased by 22.3 points to 89.5, the average Modified Cincinnati score was determined to be 26.95 with an increase of 1.31 points, and the average visual analog scale (VAS) score decreased from 7.2 to 2.1.

CONCLUSIONS

As a result of the current literature and our study, it was concluded that there is no need for ROM restriction in the knee joint in patients who undergo arthroscopic meniscus repair. It was determined that the biomechanical changes demonstrated by cadaver studies and MRI models were not reflected in clinical results.

Morphological Changes in the Tibial Tunnel After ACL Reconstruction With the Outside-In Technique and Adjustable Suspensory Fixation

Background

Anterior cruciate ligament reconstruction (ACLR) using the complete tibial tunnel technique and adjustable-loop cortical suspensory fixation is known to leave a "dead space" that holds the loop device in the tibial tunnel. The consequence of the dead space and its effect on graft healing are still uncertain.

Purpose

To investigate morphological changes in the tibial tunnel and their effect on graft healing, and to identify factors affecting bone healing in the tibial loop tunnel after ACLR with a quadrupled semitendinosus tendon autograft using adjustable suspensory fixation.

Study Design

Case series; Level of evidence, 4.

Methods

Included were 48 patients (34 male, 14 female; mean age, 25.2 ± 5.6 years) who underwent ACLR with a quadrupled semitendinosus tendon autograft using adjustable suspensory fixation. To evaluate tibial tunnel morphology, computed tomography was performed at 1 day and 6 months postoperatively. At 1 year postoperatively, graft healing was assessed on magnetic resonance imaging using the graft signal-to-noise quotient (SNQ). Multivariate regression and correlation analyses were performed to determine any associations between volumetric changes in bone healing and operative variables.

Results

At 6 months after ACLR, a mean of 63.2% of the tibial loop tunnel was filled by bone. Multivariate regression analysis showed that remnant preservation was significantly associated with the loop tunnel filling rate (P < .001). At 1 year after ACLR, the tibial loop tunnel was almost completely closed (98.5%). There were no correlations between loop tunnel volume and graft integration or graft SNQ. A significant but weak correlation was found between graft tunnel volume and intratunnel graft SNQ (P = .10) as well as integration grade in the tibial tunnel (P = .30).

Conclusion

Excellent bone filling in the tibial loop tunnel was seen at 1 year after ACLR. Remnant preservation was significantly associated with the loop tunnel filling rate. A weak correlation was found between graft tunnel volume and intratunnel graft SNQ as well as integration grade in the tibial tunnel.

Retrobulbar Blood Flow Parameters in Patients With Anisometropic Amblyopia

Introduction We aim to compare retrobulbar blood flow parameters between the amblyopic eye and the fellow eye in patients with anisometropic amblyopia. Methods Peak systolic velocity (PSV) and end-diastolic velocity (EDV) of the ophthalmic artery (OA), central retinal artery (CRA), and posterior ciliary artery (PCA) were measured by color Doppler imaging (CDI), and the resistivity index (RI) and pulsatility index (PI) were calculated in 62 patients aged 12-40 years with anisometropic amblyopia. Results The mean PSV values of OA, CRA, and PCA in amblyopic and fellow eyes were 30.38 ± 10.34, 8.45 ± 2.27, and 8.03 ± 2.77, and 33.73 ± 14.46, 8.35 ± 2.05, and 8.81 ± 2.77, respectively. The mean EDV values of OA, CRA, and PCA in amblyopic and fellow eyes were 6.86 ± 2.64, 1.47 ± 1.59, and 1.94 ± 2.03, and 8.57 ± 4.30, 1.80 ± 1.73, and 2.32 ± 1.20, respectively. The mean RI values of OA, CRA, and PCA in amblyopic and fellow eyes were 0.77 ± 0.10, 0.85 ± 0.14, and 0.78 ± 0.15, and 0.75 ± 0.07, 0.79 ± 0.20, and 0.74 ± 0.13, respectively. OA-PSV and OA-EDV values were significantly lower in the amblyopic eye than in the healthy eye (p < 0.05). OA-RI values were significantly higher (p < 0.05) in the amblyopic eye than in the healthy eye. Conclusions Considering the decrease in PSV and EDV and the increase in RI, which are the blood flow parameters of the amblyopic eye, our study may provide guidance to focus on increasing blood flow in the treatment of amblyopia.

Shear wave elastography evaluation in predicting the success of ultrasound-guided saline enema hydrostatic reduction technique in ileocolic intussusception

BACKGROUND

Intussusception is the invagination of the proximal intestinal segment into the distal portion. Reduction procedures with fluid or air have been used as the primary treatment of choice in clinically stable children.

PURPOSE

To evaluate the role of intestinal wall elasticity measurements by shear wave elastography (SWE) to predict the success of ultrasound-guided saline enema (USGSE) reduction.

METHODS

USGSE was performed, if not contraindicated otherwise, after the diagnosis of ileocecal intussusception via the ultrasound (US). The length and diameter of the intussusception and the median stiffness of the intestine were measured before USGSE.

RESULTS

Seventeen children were diagnosed with ileocolic intussusception via grayscale US assessment. Two children whose SWE images became artifacts due to inadaptability were excluded from the study. Thus, the study involved 15 patients (9 boys, 6 girls; age range = 11-48 months). There was no statistically significant association between age and median stiffness measurement in kilopascal (kPa). (P > 0.05). A moderate positive correlation was observed between the median stiffness measurement (kPa) and the length of intussusception (r = 0.547; P = 0.035). There was no statistically significant relationship between median stiffness measurement (kPa) and short-axis diameter of intussusception (P > 0.05).

CONCLUSIONS

Stiffness assessment of the intestinal wall in ileocolic intussusception during the US examination, which is the gold standard in the intussusception assessment, can be used as a new criterion for predicting the performance of the USGSE technique and might be useful in making decisions regarding the clinical management of ileocolic intussusception.

Do deep inspiration breath-holds and free-breathing affect pancreatic tissue stiffness in shear wave elastography?

PURPOSE

The use of ultrasound (US) elastography to assess the pancreas is subject to serious limitations, and it is not easy to perform US elastography for the pancreas with satisfactory and reproducible accuracy. The aim of our study was to show the normal pancreatic stiffness values with shear wave elastography (SWE) and to evaluate the pancreatic tissue stiffness at two different respiratory phases.

METHODS

Sixty-three subjects were included in the study. Median values of pancreatic stiffness were recorded. Values during deep inspiration and free breathing were compared.

RESULTS

The stiffness values of the pancreatic tissue measured during deep inspiration breath holds and during free breathing were 5.70 ± 1.74 kPa and 4.15 ± 1.70 kPa, respectively. It was found that the values of pancreatic tissue stiffness measured during deep inspiration were statistically significantly higher than those measured during physiological breathing (p < 0.001).

CONCLUSIONS

Because of the reference value differences between different ultrasound elastography devices, it is important to know the reference ranges of normal pancreatic stiffness according to the device, in order to distinguish possible pathologies. In addition, the variability of pancreatic stiffness measurements with respiratory phases should be considered in clinical applications.

Tibial slope, remnant preservation, and graft size are the most important factors affecting graft healing after ACL reconstruction

PURPOSE

The aim of this study was to determine the anatomic, operative and biological factors that influenced graft healing after single-bundle anterior cruciate ligament (ACL) reconstruction.

METHODS

One hundred fourteen consecutive patients who underwent anatomic single-bundle ACL reconstruction with quadrupled hamstring tendon autografts between 2016 and 2019 were retrospectively analyzed. Ninety-four patients met the inclusion criteria with minimum follow-up of 12 months. Patients were evaluated with multiple clinical measurements, including International Knee Documentation Committee Subjective Knee Form (IKDC-SKF), Lyshom Scores, and Marx activity scale. To evaluate graft healing, the signal-to-noise quotient (SNQ) was measured at intra-articular graft and intra-tunnel integration were evaluated on magnetic resonance imaging (MRI) at one year after surgery. Potential factors affecting graft healing, including age, sex, body mass index, time from injury to surgery, posterior tibial slope, lateral femoral condyle ratio, notch width index, meniscal injury, remnant preservation, tunnel aperture locations, graft size, graft bending angle, graft/remaining notch volume ratio were evaluated for their association with graft SNQ value by stepwise regression analysis.

RESULTS

A total of 94 patients were evaluated with mean follow-up 28.5 ± 9 months. Univariate regression analysis showed that posterior tibial slope, notch width index, remnant preserving procedure, high femoral tunnel, anterior tibial tunnel, graft bending angle, and graft/remaining notch volume ratio significantly associated with graft SNQ values. Multivariate regression analysis showed that lateral tibial slope, remnant preservation, and graft/remaining notch volume ratio were independent factors correlated with graft SNQ values. Also, the graft SNQ values was weakly correlated with femoral tunnel integration and Marx activity scale at one year. There was no correlation between graft SNQ values and IKDC-SKF and Lysholm scores. There was no correlation between graft SNQ values and International Knee Documentation Committee and Lysholm scores.

CONCLUSIONS

Tibial slope, remnant preservation and graft/remaining notch volume ratio were significant independent associated factors of graft SNQ value at one year. The graft SNQ values were also weakly correlated with femoral tunnel integration and the Marx activity scale. These factors should be taken into account for ensuring the ideal graft healing and for the return to sport decision-making.

LEVEL OF EVIDENCE

Level IV.

Shear wave elastography evaluation of brachial plexus in multiple sclerosis

BACKGROUND

Multiple sclerosis (MS) is a chronic neuroinflammatory disease characterized by inflammation involving the peripheral nerves. Shear wave elastography (SWE) is potentially a method of choice for detecting peripheral nerve involvement.

PURPOSE

To compare the degree of thickening and nerve elasticity of brachial plexus (BP) nerve roots and evaluate the usefulness of sonoelastography in patients with clinically diagnosed MS without brachial plexopathy.

MATERIAL AND METHODS

Thirty-two patients with MS and 32 controls were included in the study. Bilateral C5, C6, and C7 mean nerve root diameters, and mean elasticity values in kiloPascal (kPa) were measured in the patient and control groups. The relationship between the age, height, and weight values and nerve diameter-elasticity values of the patient and control groups was compared.

RESULTS

The elasticity values of the C5 and C6 nerve roots were increased, and the nerve root thickness was decreased in the MS group compared to that in the control (P < 0.05). There was no difference between the C7 mean nerve root elasticity (kPa) and diameter measurements in the patient and control groups (P > 0.05).

CONCLUSION

Our study showed an increase in the BP nerve root elasticity values (kPa) in patients with MS compared to that of the control group and a decrease in diameter values thought to be related to the possible chronic atrophic process. The results are consistent with the demyelinating process of the peripheral nervous system (PNS) due to MS.

Shear-wave elastography evaluation of adrenal glands in healthy newborns: a preliminary study

OBJECTIVES

Establishing standard shear-wave elastography (SWE) values for healthy newborns can help distinguish normal conditions of the adrenal gland (AG) from pathological conditions. We aimed to establish a reference data set for AG stiffness values using SWE in healthy newborns.

METHODS

The quantitative stiffness of the AG was measured in the coronal plane in kilopascal (kPa). The quantitative descriptive statistics were presented as mean with standard deviation and median with range. The relationship between the quantitative variables was calculated using "Spearman's rank correlation coefficient test." The intraclass correlation coefficient (ICC) test was used to analyze intraobserver reliability. A p-value <0.05 was considered statistically significant.

RESULTS

A total of 120 AGs of 60 healthy newborns (30 females and 30 males) was examined. The mean stiffness values of the right AG for the first and second visits were 7.51±2.45 and 7.54±2.49 kPa, respectively, and those of the left AG for the first and second visits were 7.60±2.03 and 7.42±1.97 kPa, respectively. There was no statistically significant difference between the mean values of adrenal stiffness and the length and width of AG and weight, height, and age (p>0.05). The ICC values for mean stiffness values of each AG were >0.80-0.90, indicating good intraobserver agreement.

CONCLUSIONS

This study is the first SWE study to evaluate the AG in healthy newborns. Our study's data can be used as a reference for future research.

Optic Canal Diameters According to Age in the Pediatric Population

PURPOSE

To determine the normal range of optic canal diameters in the Turkish pediatric population.

METHODS

Brain, orbital, and maxillofacial computed tomography examinations were evaluated retrospectively. Children with cranial bone disorders affecting the bone structure of the optic canal were excluded from the study. Oblique axial and oblique sagittal multiplanar reformatted images were created in accordance with the axis of the optic canal on both sides, and measurements were taken from the shortest transverse and craniocaudal diameters of the optic canal in these images.

RESULTS

Two hundred computed tomography examinations were evaluated. One hundred two of the patients were female and the rest were male. Patient ages ranged from 1 to 211 months (mean ± standard deviation: 86.42 ± 65.39 months). There was no significant difference between the transverse and craniocaudal optic canal diameters between sexes (P > .05). Therefore, the analyses were reevaluated in the entire patient series, regardless of sex. No significant correlation was found in the correlation test performed between optic canal diameters according to the age of the patients. No statistically significant difference was observed between the right and left optic canal diameters.

CONCLUSIONS

The determination of normal values of tissues, structures, and organs that differs with age has an important role in pediatric radiology. The authors believe that the determination of normal optic canal diameters according to certain age groups will meet the needs of daily practice. [J Pediatr Ophthalmol Strabismus. 2021;58(5):319-323.].

Evaluation of schwannoma using the 3D-SPACE sequence: comparison with the 3D-CISS sequence in 3T-MRI

Background/aim

The purpose of this study is to compare the diagnostic accuracy and interobserver reliability of the T2-weighted 3D-SPACE (three-dimensional sampling perfection with application-optimized contrasts by using different flip angle evolutions) sequence in comparison with T2-weighted 3D-CISS (three-dimensional constructive interference in steady state) sequences for diagnosis of schwannomas.

Materials and methods

Forty patients with cerebellopontine angle (CPA), internal acoustic canal (IAC), and cochlear schwannoma who had undergone magnetic resonance imaging (MRI) using the 3D-CISS and 3D-SPACE sequences were identified. The sequences were retrospectively evaluated by two radiologists for the qualitative analyses, which were subsequently compared using the Mann–Whitney U test. Following this, kappa values were used for interobserver agreement. P < 0.05 was considered to be of statistical significance.

Results

The interobserver agreement was found to be excellent between the two observers for the interpretation of all qualitative analyses for both sequences (kappa value > 0.8). The 3D-SPACE sequences demonstrated significantly better qualitative scores and fewer artifacts compared with the 3D-CISS sequences (p < 0.05).

Conclusion

Our results demonstrate that 3D-SPACE is superior to 3D-CISS in the imaging process of the schwannoma in terms of image quality, description of the relationship between the lesion and cranial nerve, signal differentiation between lesion and cistern, and signal differentiation between the lesion and adjacent brain.

Measuring stiffness of normal medial collateral ligament in healthy volunteers via shear wave elastography

PURPOSE

We aim to determine a reference data set for normal medial collateral ligament (MCL) stiffness values using shear wave elastography (SWE).

METHODS

Quantitative stiffness of the MCL was measured at three levels: the proximal (MCL area from the level of the medial meniscus to the level of the femoral attachment), the middle (MCL area at the level of the medial meniscus), and the distal (MCL area from the level of the medial meniscus to the level of the tibial attachment) segments of the MCL at a knee position of 0°.

RESULTS

A total of 60 MCL of 30 healthy volunteers (15 female, 15 male) were examined. The mean stiffness values of the proximal, middle, and distal MCL for observer 1 were 32.25 ± 6.44, 34.25 ± 6.84, and 35.47 ± 6.98, respectively. The mean stiffness values of the proximal, middle, and distal MCL for observer 2 were 33.56 ± 6.76, 35.44 ± 6.91, and 36.32 ± 7.04, respectively.

CONCLUSION

SWE has a strong potential to be a method of choice for evaluating MCL stiffness. Our study participants were healthy volunteers and the data can be used as reference data for future studies.