Prediction of Heart Disease using Machine Learning Algorithms with Feature Selection Techniques

Data is an asset in the digital era, and enormous data was generating day by day in all the fields, including the healthcare industry. The data on the healthcare industry data consists of personal information and disease-related information about a patient and stored in various formats and units. Machine learning and Artificial Intelligence techniques will help us analyze the voluminous amount of data to identify the hidden patterns of a specific disease from the healthcare data and help us predict a particular disease in the future. In this paper, we proposed a decision support system to predict heart disease, especially cardiovascular disease, through machine learning algorithms. This system experimented with the reduced set feature of the UCI Machine learning repository dataset using a linear kernel-based support vector machine algorithm. This system has also compared it with other machine learning algorithms such as K-Nearest Neighbours, Decision tree, and Random forest in Python. All four machine learning algorithms' performance has been evaluated based on accuracy, misclassification rate, precision, recall, and f-score value. From the experimental results, SVM with a linear kernel function classification algorithm produces better accuracy of 95.08% compared with others for predicting heart disease.

Assessment of Mental Workload by Visual Motor Activity among Control Group and Patient Suffering from Depressive Disorder

Major depressive disorder (MDD) is a mood state that is not usually associated with vision problems. Recent research has found that the inhibitory neurotransmitter GABA levels in the occipital brain have dropped. Aim. The aim of the research is to evaluate mental workload by single channel electroencephalogram (EEG) approach through visual-motor activity and comparison of parameter among depressive disorder patient and in control group. Method. Two tests of a visual-motor task similar to reflect drawings were performed in this study to compare the visual information processing of patients with depression to that of a placebo group. The current study looks into the accuracy of monitoring cognitive burden with single-channel portable EEG equipment. Results. The alteration of frontal brain movement in reaction to fluctuations in cognitive burden stages generated through various vasomotor function was examined. By applying a computerised oculomotor activity analogous to reflector image diagram, we found that the complexity of the path to be drawn was more important than the real time required accomplishing the job in determining perceived difficulty in depressive disorder patients. The overall perceived difficulty of the exercise is positively linked with EEG activity measured from the motor cortex region at the start of every experiment test. The average rating for task completion for depression patients and in control group observed and no statistical significance association reported between rating scale and time spent on each trial (p=1.43) for control group while the normalised perceived difficulty rating had 0.512, 0.623, and 0.821 correlations with the length of the pathway, the integer of inclination in the pathway, and the time spent to complete every experiment test, respectively (p < 0.0001) among depression patients. The findings imply that alterations in comparative cognitive burden levels during an oculomotor activity considerably modify frontal EEG spectrum. Conclusion. Patients with depression perceived the optical illusion in the arrays as weaker, resulting in a little bigger disparity than individuals who were not diagnosed with depression. This discovery provided light on the prospect of adopting a user-friendly mobile EEG technology to assess mental workload in everyday life.

Is Freehand Technique of Pedicle Screw Insertion in Thoracolumbar Spine Safe and Accurate? Assessment of 250 Screws

Background:

Pedicle screw fixation is one of the widely used procedures for instrumentation and stabilization of the thoracic and lumbar spine. It has the advantage of stabilizing all the three columns in single approach. Various assistive techniques are available to place the pedicle screws more accurately but at the expense of increased exposure to radiation, prolonged surgical duration, and cost.

Objective:

The objective of this study is to determine the accuracy and safety of pedicle screw fixation in the thoracolumbar spine using freehand surgical technique.

Materials and Methods:

We evaluated all patients who underwent pedicle screw fixation of the thoracolumbar spine for various ailments at our institute from January 2016 to December 2017 with postoperative computed tomography scan for placement accuracy. We used Gertzbein classification to grade pedicle breaches. Screw penetration more than 4 mm was taken as critical and those less than that were classified as noncritical.

Results:

A total of 256 screws inserted in T1–L5 vertebrae were included from 40 consecutive patients. Six screws were excluded according to selection criteria. The mean age was 39 years. Trauma (36 patients) was the common reason for which the pedicle screw fixation was done followed by degenerative disease (2 patients) and tumour (2 patients). A total of ten pedicle screw breaches (4%) were identified in eight patients. Among these, three critical breaches (1.2%) were occurred in two patients which required revision. The remaining seven breaches were noncritical and kept under close observation and follow-up.

Conclusion:

Pedicle screw had become the workhorse of posterior stabilization of the spine. Based on external anatomy and landmarks alone, freehand technique for pedicle screw fixation can be performed with acceptable safety and accuracy avoiding cumulative radiation exposure and prolonged operative time.

High temperature dielectric relaxation anomalies in Ca0.9Nd0.1Ti0.9Al0.1O3−δ single crystals

We herein report dielectric studies on Ca_0.9Nd_0.1Ti_0.9Al_0.1O_3−δ single crystals grown by the optical floating zone technique in the temperature range from room temperature to 660 K.

Optical and spectroscopic studies of Ca0.9Nd0.1Ti0.9Al0.1O3 single crystals grown by an optical floating zone technique

Single crystals of multifunctional Ca_0.9Nd_0.1Ti_0.9Al_0.1O₃ have been grown in air and also in argon atmosphere using an optical floating zone technique.

P2RY1 and P2RY12 polymorphisms and on-aspirin platelet reactivity in patients with coronary artery disease

INTRODUCTION

Association of P2RY1 and P2RY12 polymorphisms with on-aspirin platelet reactivity was investigated.

MATERIALS AND METHODS

Platelet reactivity was assessed by the light transmission aggregometry and TxB(2) assay in 423 patients with coronary artery disease (CAD) on aspirin. High residual platelet reactivity (RPR) was defined by ≥20% and ≥70% maximal aggregation stimulated with 0.5 mg/mL arachidonic acid (AA) and 10 μm ADP, respectively. Moderate RPR was considered aggregation ≥20% with AA, ≥70% with ADP, or ≥1 ng/mL stimulated TxB(2) . Fourteen P2RY1 and 35 P2RY12 single nucleotide polymorphisms (SNPs) were genotyped.

RESULTS

High RPR was detected in 24% of the patients. Moderate RPR was observed in 31% with AA, 57% with 5 μm ADP, and 82% with 10 μm ADP. Stimulated TxB(2) was ≥1 ng/mL in 23% of patients. P2RY12 SNP rs9859538 was associated with high RPR (OR = 2.16, 95% CI = 1.24-3.75, P-value = 0.004). Four P2RY12 SNPs, rs1491974, rs10513398, rs3732765, and rs10935841, showed association with moderate RPR (OR = 1.79-2.94, P-value = 0.04-0.028), while five, rs7615865, rs1388623, rs1388622, rs7634096, and rs7637803, were associated with low RPR (OR = 0.50-0.55, P-value = 0.008-0.026), following ADP stimulation. TxB(2) level <1 ng/mL was linked to five P2RY1 SNPs, rs1439010, rs1371097, rs701265, rs12497578, and rs2312265 (OR = 0.36-0.54, P-value = 0.003-0.039).

CONCLUSIONS

Polymorphisms in P2RY1 and P2RY12 are associated with on-aspirin platelet reactivity in patients with CAD.

Single nucleotide polymorphisms in multiple novel thrombospondin genes may be associated with familial premature myocardial infarction

BACKGROUND

Recent advances in high-throughput genomics technology have expanded our ability to catalogue allelic variants in large sets of candidate genes related to premature coronary artery disease.

METHODS AND RESULTS

A total of 398 families were identified in 15 participating medical centers; they fulfilled the criteria of myocardial infarction, revascularization, or a significant coronary artery lesion diagnosed before 45 years in men or 50 years in women. A total of 62 vascular biology genes and 72 single-nucleotide polymorphisms were assessed. Previously undescribed variants in 3 related members of the thrombospondin protein family were prominent among a small set of single-nucleotide polymorphisms that showed a statistical association with premature coronary artery disease. A missense variant of thrombospondin 4 (A387P) showed the strongest association, with an adjusted odds ratio for myocardial infarction of 1.89 (P=0.002 adjusted for covariates) for individuals carrying the P allele. A variant in the 3' untranslated region of thrombospondin-2 (change of thymidine to guanine) seemed to have a protective effect against myocardial in individuals homozygous for the variant (adjusted odds ratio of 0.31; P=0.0018). A missense variant in thrombospondin-1 (N700S) was associated with an adjusted odds ratio for coronary artery disease of 11.90 (P=0.041) in homozygous individuals, who also had the lowest level of thrombospondin-1 by plasma assay (P=0.0019).

CONCLUSIONS

This large-scale genetic study has identified the potential of multiple novel variants in the thrombospondin gene family to be associated with familial premature myocardial infarction. Notwithstanding multiple caveats, thrombospondins specifically and high-throughput genomic technology in general deserve further study in familial ischemic heart disease.

Endothelial cell expression of monocyte chemotactic protein-1, tissue factor, and thrombomodulin on hydrophilic plasma polymers

Endothelial cells (EC) from human aortas, microvessels, and pulmonary arteries were examined for their expression and activity of monocyte chemotactic protein-1 (MCP-1), tissue factor, and thrombomodulin in response to tumor necrosis factor-alpha (TNFalpha) on the hydrophilic plasma polymers gamma-butyrolactone (GBL) and N-vinyl-2-pyrrolidone (NVP), along with a fibronectin (FN) control. RNAs isolated from EC grown on these substrates were subjected to reverse transcription-polymerase chain reaction (RT-PCR) and dot-blot analysis. EC expression of MCP-1 and tissue factor was very low in the absence of TNFalpha but high for constitutively expressed thrombomodulin. TNFalpha induced EC expression and activity of MCP-1 and tissue factor and suppressed that of thrombomodulin on all substrates. Greater differences were seen with regard to cell origin, but little difference was seen among substrates. Basal secretion of MCP-1 was very low in aortic and pulmonary artery EC and even less in microvascular EC. TNFalpha increased MCP-1 secretion significantly in aortic and pulmonary artery EC but to a lesser extent in microvascular EC. In contrast, tissue factor expression was greater in pulmonary artery EC compared to microvascular and aortic EC. Basal expression of thrombomodulin was largely comparable for all three cell types grown on different surfaces, but TNFalpha suppressed thrombomodulin to different extents depending on the origin of the EC. The activity of tissue factor and thrombomodulin and the secretion of MCP-1 by EC were largely correlated with the expression of these genes. We conclude that EC origin may be an important determinant of cellular function on hydrophilic plasma polymer substrates. However, the differences in cellular function due to variations in substrate surface hydrophilicity could have been masked by the extracellular matrix remodeling that presumably occurred during EC growth to confluence.

Integrated drug and alcohol intervention: development of an opportunistic intervention program to reduce alcohol and other substance use among psychiatric patients

OBJECTIVE

This paper describes the rationale, aims and processes involved in developing and implementing an opportunistic intervention program to reduce substance misuse detected among psychiatric patients.

METHOD

In this randomised, opportunistic intervention program, eligible patients recruited from a large psychiatric hospital and its associated community mental health centres are assigned to receive an integrated drug and alcohol intervention (IDAI) or alternatively allocated to a minimal intervention condition (MI). The IDAI is based on motivational enhancement and cognitive-behavioural principles, and incorporates harm-reduction approaches. This clinical program is based on the research findings and recommendations of the mental health and the drug and alcohol literature.

RESULTS

A collaborative partnership between the Mental Health Services and the Drug and Alcohol Services was formed. Following a relatively short training period, mental health staff were trained to opportunistically detect drug and alcohol problems among psychiatric patients and offer appropriate integrated clinical care.

CONCLUSION

The process of implementing an integrated opportunistic intervention program is achievable and can be readily incorporated in psychiatric hospitals and community mental health clinics.

Care of the mentally ill offender. A model service

Caring for mentally ill offenders has been a contentious issue in almost all parts of the world. In some countries such as New South Wales in Australia, a humane approach has gradually evolved over the years. This paper describes a successful service delivery model for forensic patients in a metropolitan psychiatric hospital in Sydney. Issues relating to selection criteria, problems associated with caring for the mentally ill offender in a general psychiatric hospital environment and the integration of the forensic patients with civilian psychiatric patients are discussed.

Role of lysophosphatidylcholine in the inhibition of endothelial cell motility by oxidized low density lipoprotein

Endothelial cell (EC) movement is required for the development and repair of blood vessels. We have previously shown that LDL oxidized by transition metals almost completely suppressed the wound-healing migratory response of vascular EC in vitro. We now report that lysophosphatidylcholine (lysoPC), a lipid component of oxidized LDL, has an important role in the antimigratory activity of the lipoprotein. Purified 1-palmitoyl lysoPC inhibited movement with a half-maximal activity at 12-15 micrometers, and near complete inhibition at 20 micrometers; the inhibitory concentration of lysoPC was consistent with its abundance in oxidized LDL. The inhibition was not due to cytotoxicity since protein synthesis was unaffected and since EC movement was restored after removal of lysoPC. Lysophospholipid activity was dependent on lipid structure. LysoPC's containing 1-position C16 or C18 saturated fatty acids were antimigratory, but those containing C < or = 14 saturated fatty acids or polyunsaturated fatty acids were not. The activity of 1-palmitoyl lysolipids with various head groups was examined. Lysophosphatidylinositol was more antimigratory than lysophosphatidylglycerol and lysophosphatidylcholine, which were more potent than lysophosphatidylserine and lysophosphatidylethanolamine. Monoglyceride was inactive while lysophosphatidate had promigratory activity. These results are consistent with head group size rather than charge as a critical determinant of activity. To show that lysophospholipids within an intact lipoprotein were active, LDL was treated with bee venom phospholipase A2 (PLA2). The modified lipoprotein inhibited EC movement to the same extent as iron-oxidized LDL and antimigratory activity correlated with the amount of lysoPC formed. To determine antimigratory activity of lysoPC present in oxidized LDL, lipid extracts from oxidized LDL were fractionated by normal phase HPLC. The fraction comigrating with lysoPC had nearly the same activity as the total extract confirming that lysoPC (or a co-eluting lipid) was a major antimigratory molecule in oxidized LDL. These studies demonstrate that lysoPC in oxidized LDL limit EC wound healing responses in vitro, and suggest a possible role for lysolipids in limiting endothelial regeneration after a denuding injury in vivo.

Activation of cytosolic phospholipase A2 by basic fibroblast growth factor via a p42 mitogen-activated protein kinase-dependent phosphorylation pathway in endothelial cells

Basic fibroblast growth factor (FGF) stimulates the proliferation, differentiation, and motility of multiple cell types. Signal transduction by FGF is mediated by high affinity FGF receptors that have autophosphorylating tyrosine kinase activity and also elicit the release of low molecular weight signaling molecules, including inositol 1,4,5-trisphosphate, diacylglycerol, and arachidonate. We have shown previously that basic FGF-stimulated, phospholipase A2 (PLA2)-mediated arachidonate release regulates endothelial cell (EC) motility (Sa, G., and Fox, P.L. (1994) J. Biol. Chem. 269, 3219-3225). Here we identify the phospholipase responsible for basic FGF-mediated arachidonate release as cytosolic PLA2 (cPLA2) by demonstrating in EC lysates a requirement for micromolar Ca2+, dithiothreitol insensitivity, and inactivation by anti-cPLA2 antiserum. The role of cPLA2 is also indicated by the observed mechanisms of activation which show a requirement for p42 mitogen-activated protein kinase activity, cPLA2 phosphorylation, and cPLA2 translocation from cytosol to membranes. Phosphorylation of cPLA2, arachidonate release from prelabeled intact cells, and cell motility all have similar concentration dependencies on basic FGF. Since arachidonate release is required for basic FGF-stimulated motility of EC, our results show that p42 mitogen-activated protein kinase activation of cPLA2 may be a regulatory event in stimulation of cellular release of this important eicosanoid precursor during cellular responses to basic FGF.

Electrode placement, stimulus dosing and seizure monitoring during ECT

Electroconvulsive therapy is one of the most useful, safe and predictable treatment modalities in psychiatry. For optimal results proper application of the procedure is essential. Over the years the procedure has undergone considerable refinement, yet not all those who administer the treatment are fully conversant with this. This paper addresses issues relating to electrode placement, stimulus dosing and seizure monitoring from practical and clinical points of view. Right unilateral ECT, if administered with high electrical stimulus, produces results close to bilateral treatment with substantially less cognitive impairment. However, certain patients may only respond to bilateral ECT. Adequate training for clinicians administering ECT is recommended.

High-density lipoprotein stimulates endothelial cell movement by a mechanism distinct from basic fibroblast growth factor

Endothelial cell (EC) migration is a regulatory event in the formation and repair of blood vessels. Although serum contains substantial promigratory activity, the responsible components and especially the role of lipoproteins have not been determined. We examined the effect of plasma high-density lipoprotein (HDL) on the movement of ECs in vitro. Confluent cultures of bovine aortic ECs in serum-free medium were "wounded," and migration was measured after 24 hours. HDL stimulated migration in a concentration-dependent manner with a half-maximal response at 25 to 40 micrograms cholesterol per milliliter and a maximal twofold stimulation at approximately 150 micrograms cholesterol per milliliter. HDL-stimulated migration was not due to cell proliferation, since migration was increased in the presence of hydroxyurea at a concentration that blocked proliferation. At optimal concentrations, HDL was at least as stimulatory as basic fibroblast growth factor (FGF). However, the activity of HDL was not due to contamination by basic FGF, since antibodies to basic FGF did not block HDL-stimulated movement and since the maximum promigratory activities of basic FGF and HDL were additive. These results indicate that HDL and basic FGF may use distinct signaling pathways to initiate EC movement. This possibility was confirmed by results showing that pertussis toxin suppressed basic FGF-stimulated but not HDL-stimulated EC motility and that inhibitors of phospholipase A2, aristolochic acid and ONO-RS-082, also blocked the promigratory activity of basic FGF but had no effect on the activity of HDL.(ABSTRACT TRUNCATED AT 250 WORDS)

Evidence that the Gh protein is a signal mediator from alpha 1-adrenoceptor to a phospholipase C. I. Identification of alpha 1-adrenoceptor-coupled Gh family and purification of Gh7 from bovine heart

Our previous studies on alpha 1-adrenoceptor-mediated signaling suggested that Gh is a signal mediator. Gh consists of a 74-kDa GTP-binding alpha-subunit and a 50-kDa beta-subunit. Studies using the alpha 1-agonist-receptor-G-protein ternary complexes from various tissues and species revealed that the intensity (GTP-binding) of the [alpha-32P]GTP-labeled proteins resulting from activating the alpha 1-receptor was significantly attenuated by phentolamine. The molecular masses of GTP-binding proteins were 74 kDa in rat heart and liver, 77 kDa in dog heart, 78 kDa (Gh7 alpha) in bovine heart and liver, and 80 kDa in human heart. Supporting these observations, a specific antibody to Gh7 alpha not only recognized these GTP-binding proteins in the ternary complex preparations, but also co-immunoprecipitated alpha 1-adrenoceptors, indicating a tight association of these GTP-binding proteins with the alpha 1-adrenoceptor. These results also demonstrate that functional and structural similarities exist among these GTP-binding proteins. Additionally, one of the identified G-proteins (termed Gh7) was purified from bovine heart. Gh7 consisted of the 78-kDa GTP-binding protein and a 50-kDa protein.

Oxidized low density lipoprotein inhibits the migration of aortic endothelial cells in vitro

Endothelial cell (EC) migration is a critical and initiating event in the formation of new blood vessels and in the repair of injured vessels. Compelling evidence suggests that oxidized low density lipoprotein (LDL) is present in atherosclerotic lesions, but its role in lesion formation has not been defined. We have examined the role of oxidized LDL in regulating the wound-healing response of vascular EC in vitro. Confluent cultures of bovine aortic EC were "wounded" with a razor, and migration was measured after 18 to 24 h as the number of cells moving into the wounded area and the mean distance of cells from the wound edge. Oxidized LDL markedly reduced migration in a concentration- and oxidation-dependent manner. Native LDL or oxidized LDL with a thiobarbituric acid (TBA) reactivity < 5 nmol malondialdehyde equivalents/mg cholesterol was not inhibitory; however, oxidized LDL with a TBA reactivity of 8-12 inhibited migration by 75-100%. Inhibition was half-maximal at 250-300 micrograms cholesterol/ml and nearly complete at 350-400 micrograms/ml. The antimigratory activity was not due to cell death since it was completely reversed 16 h after removal of the lipoprotein. The inhibitor molecule was shown to be a lipid; organic solvent extracts of oxidized LDL inhibited migration to nearly the same extent as the intact particle. When LDL was variably oxidized by dialysis against FeSO4 or CuSO4, or by UV irradiation, the inhibitory activity correlated with TBA reactivity and total lipid peroxides, but not with electrophoretic mobility or fluorescence (360 ex/430 em). This indicates that a lipid hydroperoxide may be the active species. These results suggest the possibility that oxidized LDL may limit the healing response of the endothelium after injury.