Machine learning to differentiate pulmonary hypertension due to left heart disease from pulmonary arterial hypertension

Background and aims

Pulmonary hypertension due to left heart disease (PH-LHD) is the most frequent form of PH. As differential diagnosis with pulmonary arterial hypertension (PAH) has therapeutic implications, it is important to accurately and noninvasively differentiate PH-LHD from PAH before referral to PH centres. The aim was to develop and validate a machine learning (ML) model to improve prediction of PH-LHD in a population of PAH and PH-LHD patients.

Methods

Noninvasive PH-LHD predictors from 172 PAH and 172 PH-LHD patients from the PH centre database at the University Hospitals of Leuven (Leuven, Belgium) were used to develop an ML model. The Jacobs score was used as performance benchmark. The dataset was split into a training and test set (70:30) and the best model was selected after 10-fold cross-validation on the training dataset (n=240). The final model was externally validated using 165 patients (91 PAH, 74 PH-LHD) from Erasme Hospital (Brussels, Belgium).

Results

In the internal test dataset (n=104), a random forest-based model correctly diagnosed 70% of PH-LHD patients (sensitivity: n=35/50), with 100% positive predicted value, 78% negative predicted value and 100% specificity. The model outperformed the Jacobs score, which identified 18% (n=9/50) of the patients with PH-LHD without false positives. In external validation, the model had 64% sensitivity at 100% specificity, while the Jacobs score had a sensitivity of 3% for no false positives.

Conclusions

ML significantly improves the sensitivity of PH-LHD prediction at 100% specificity. Such a model may substantially reduce the number of patients referred for invasive diagnostics without missing PAH diagnoses.

Dealing with loss: food and eating in women with ovarian cancer on parenteral nutrition

BACKGROUND

Malignant bowel obstruction is a common complication of ovarian cancer, resulting in limited oral intake. Home parenteral nutrition (HPN) may be offered to patients in this condition to meet nutritional requirements. However, it is not known how they experience being unable to eat. The present study reports how patients related to food when receiving HPN.

METHODS

The investigation was a qualitative study underpinned by phenomenology with women with advanced ovarian cancer in bowel obstruction receiving parenteral nutrition. Interview transcripts were analysed thematically guided by the techniques of Van Manen.

RESULTS

We recruited 20 women to the study. Participants were interviewed a maximum of four times and a total of 39 in-depth longitudinal interviews were conducted. Participants could tolerate minimal amounts of food, if they had a venting gastrostomy. Not being able to eat engendered a sense of sadness and loss, and most women found it challenging to be in the presence of others eating. They adopted strategies to cope, which included fantasising about food and watching cookery programmes. These approaches were not a long-term solution; either participants came to terms with their loss or the strategies became less effective in providing relief.

CONCLUSIONS

Home parenteral nutrition meets the nutritional requirements of patients with malignant bowel obstruction but cannot replace the non-nutritive functions of food. Healthcare professionals can offer a patient-centred approach by acknowledging the difficulties that patients may face and, wherever possible, encourage them to focus on the positive benefits of interacting with people rather than the loss of eating on social occasions.

Abstract 4039: PAX8 increases migration and metastasis of high grade serous ovarian cancer through upregulation of Rho GTPases

High grade serous ovarian cancer, the most lethal subtype of ovarian cancer, can originate in either the fallopian tube epithelium (FTE) or ovarian surface epithelium (OSE). PAX8 is a lineage specific transcription factor that is ubiquitously expressed in HGSOC. We have shown that knockdown of PAX8 using shRNA in multiple ovarian tumor cells lines leads to apoptosis, suggesting that PAX8 plays an essential role in cancer survival. In this study, we used CRISPR technology to delete PAX8 from the OVCAR8 cell line. PAX8 deletion led to a decrease in migration and invasion in vitro and an increase in survival and a reduction in tumor volume in vivo. Previous work using RNA-sequencing and ChIP-sequencing identified cell adhesion as a top differentially expressed gene between malignant ovarian cancer and benign fallopian tube cell lines. We performed quantitative proteomic analysis of the OVCAR8-PAX8-/- cell line to define PAX8 altered proteins. We also performed quantitative proteomics and transcriptomic analyses on a previously generated murine OSE cell line with forced PAX8 expression (MOSE-PAX8). These analyses identified several genes that contribute to an increase in migration and EMT. Specifically, our data indicates PAX8 upregulates key drivers involved in altering cell morphology including the GTPases: RhoA, Cdc42, and Ras. Inhibition of RhoA led to a greater decrease in migration for both OVCAR8-PAX8-/- and MOSE-PAX8 when compared to control. Inhibition of Ras had a greater effect in OVCAR8-PAX8-/- while inhibition of Cdc42 had a greater effect in MOSE-PAX8. These data provide a mechanistic explanation for the role of PAX8 on increasing migration and metastasis in ovarian cancer.

Citation Format: Laura Hardy, Melissa Pergande, Angel Hernandez, Stephanie Cologna, Joanna Burdette. PAX8 increases migration and metastasis of high grade serous ovarian cancer through upregulation of Rho GTPases [abstract]. In: Proceedings of the American Association for Cancer Research Annual Meeting 2018; 2018 Apr 14-18; Chicago, IL. Philadelphia (PA): AACR; Cancer Res 2018;78(13 Suppl):Abstract nr 4039.

PTEN loss in the fallopian tube induces hyperplasia and ovarian tumor formation

The signaling events involved in the onset of ovarian cancer from the fallopian tube epithelium (FTE) are crucial for early detection and treatment of the disease, but they remain poorly defined. Conditional homozygous knockout of PTEN mediated by PAX8-cre recombinase was sufficient to drive endometrioid and serous borderline ovarian carcinoma, providing the first model of FTE-derived borderline tumors. In addition, heterozygous PTEN deletion in the FTE resulted in hyperplasia, providing a model to study early events of human ovarian pathogenesis. To uncover the mechanism underlying the invasion of cancerous oviductal cells to the ovary, PTEN-deficient murine oviductal cells were developed and tagged with green fluorescent protein. Loss of PTEN increased cell migration, invasion, and upregulated WNT4, a key regulator of Müllerian duct development during embryogenesis. Further investigation revealed that WNT4 was required for increased migration and colonization of the ovary by PTEN-deficient oviductal cells in a β-catenin independent manner. Human tumor microarrays and ovarian cancer cells lines confirmed WNT4 expression in cancer and its role in migration. Together, these findings provide a novel model to study the mechanism of fallopian tube tumor initiation and invasion to the ovary mediated by loss of PTEN, which may help to define early events of human ovarian carcinogenesis.

Defining a Reference Range for Vital Signs in Healthy Term Pregnant Women Undergoing Caesarean Section

Early warning systems (EWS), used to identify deteriorating hospitalised patients, are based on measurement of vital signs. When the patients are pregnant, most EWS still use non-pregnant reference ranges of vital signs to determine trigger thresholds. There are no published reference ranges for all vital signs in pregnancy. We aimed to define vital signs reference ranges for term pregnancy in the preoperative period, and to determine the appropriateness of EWS trigger criteria in pregnancy. We conducted a one-year retrospective study in a tertiary referral obstetric hospital. The study sample was healthy term women undergoing planned caesarean section (CS). Systolic blood pressure (SBP), diastolic blood pressure (DBP), heart rate (HR), oxygen saturation (SpO2) and temperature were all measured automatically and data was extracted from the medical record. Two hundred and fifty-eight women met inclusion criteria. Results were (mean ± SD [standard deviation]) SBP 118 ± 11.2 mmHg, DBP 75 ± 10.3 mmHg, HR 84 ± 10.2 /minute, respiratory rate 18 ± 1.5 /minute, SpO2 99% ± 1.0% and temperature 36.4°C ± 0.43°C. The reference ranges (mean ± 2SD) determined were SBP 96–140 mmHg, DBP 54–96 mmHg, HR 64-104 /minute, RR 15–21 /minute, SpO2 97%–100% and temperature 35.5°C–37.3°C. This study defined a reference range for vital signs in healthy term pregnant women undergoing CS. Study findings suggest that currently used criteria for EWS triggers, based on non-pregnant values, may be too extreme for timely detection of deteriorating pregnant patients. Further research examining the modified HR triggers of ≤50 and ≥110 /minute in pregnant women and their relationship to clinical outcomes is required.

Exploiting coherence for real-time studies by single-bunch imaging

First real-time studies of ultra-fast processes by single-bunch imaging at the European Synchrotron Radiation Facility are reported. By operating the storage ring of the ESRF in single-bunch mode with its correspondingly increased electron bunch charge density per singlet, the polychromatic photon flux density at insertion-device beamlines is sufficient to capture hard X-ray images exploiting the light from a single bunch (the corresponding bunch length is 140 ps FWHM). Hard X-ray imaging with absorption contrast as well as phase contrast in combination with large propagation distances is demonstrated using spatial samplings of 11 µm and 35 µm pixel size. The images acquired allow one to track crack propagation in a bursting piece of glass, breaking of an electrical fuse as well as cell wall rupture in an aqueous foam. Future developments and their potential in the frame of the proposed Phase II of the ESRF Upgrade Program are discussed.

Community physiotherapy for children with cystic fibrosis: A family satisfaction survey

BACKGROUND AND PURPOSE

Input of a specialist physiotherapist is integral to the management of children with cystic fibrosis (CF). In recent years, many regional centres have developed specialist physiotherapy posts based in the community. The aim of this study was to ascertain the effectiveness of the community physiotherapy service in Newcastle upon Tyne, from the families' point of view.

METHODS

The current service was reviewed and a questionnaire was developed and sent to all families with a child/children attending the regional paediatric centre for full care. It was adapted from a standardised patient satisfaction survey and included both open and closed questions.

RESULTS

One hundred and six questionnaires were sent with a response rate of 50%. Eighty-nine percent of respondents had been reviewed by the community physiotherapist. Ninety-one percent were satisfied with the overall service provided. They felt involved in the treatment plan (94%) and understood the reasons for follow up visits (92%). Eighty-five percent of respondents had a contact number for the community physiotherapist. Comments from parents were generally positive. Many families requested increased input in the home as they found it more beneficial than review in the clinic setting.

CONCLUSIONS

There was a high rate of satisfaction with specialist physiotherapy support in the community for children with CF among families who responded to the patient satisfaction survey.

The effects of a motivational general-mastery imagery intervention on the sport confidence of high-level badminton players

A multiple-baseline across-participants design was used to examine the effects of a Motivational General-Mastery imagery intervention on the sport confidence of 4 high-leveljunior badminton players. Sport confidence data were collected once a week for 21 weeks prior to international and county matches. The imagery intervention consisted of six imagery sessions (two per week for 3 weeks) and was administered using a multiple-baseline design with interventions commencing at Weeks 5, 7, 9, and 11 for Participants 1, 2, 3, and 4, respectively. Results of visual inspection and Binomial tests suggested significant increases in sport confidence for Participants 1 and 2, a significant decrease in sport confidence for Participant 3, and a delayed increase in sport confidence for Participant 4. The results are discussed in terms of the implications of using mastery imagery and the usefulness of multiple-baseline designs for furthering imagery research.

Evaluation of the Pneupac Ventipac portable ventilator in critically ill patients

We assessed adequacy of ventilation in 20 critically ill patients with multiple organ failure using a Pneupac Ventipac portable ventilator and the effects on patients' haemodynamic stability. Baseline data were recorded over 15 min for a range of respiratory, haemodynamic and oxygen transport variables during ventilation with a standard intensive care ventilator (Engström Erica). Patients were then ventilated for 40 min using the portable ventilator. Finally, they were ventilated for a further 40 min using the standard intensive care ventilator. Heart rate, arterial and pulmonary artery pressures were recorded at 5-min intervals throughout the study period. Cardiac index and other haemodynamic data derived from a pulmonary artery catheter were recorded at 20-min intervals. Blood gas analysis was performed and oxygen transport data (oxygen delivery, oxygen consumption and physiological shunt) were calculated at the end of each of the three periods of ventilation. In general, no significant adverse effects of ventilation using the portable ventilator were observed for any of the variables studied. Arterial PO(2) increased significantly during ventilation with the portable ventilator, reflecting the use of a higher inspired oxygen fraction during this part of the study. Oxygen consumption decreased significantly in one patient during ventilation by the portable ventilator although none of the other variables measured in this patient was altered. We conclude that ventilation of critically ill patients using the Pneupac Ventipac portable ventilator was safe, satisfactory and associated with minimal adverse effects on respiratory, haemodynamic and oxygen transport variables.

Effect of task-relevant cues and state anxiety on motor performance

12 experienced, female trampolinists participated in a field study designed to test the conscious processing hypothesis, which predicts that the combination of task-relevant knowledge and high state anxiety will impair motor performance. Results supported the hypothesis; however, an alternative attentional explanation of the data was also identified.

Local distinguishability of multipartite orthogonal quantum states

We consider one copy of a quantum system prepared in one of two orthogonal pure states, entangled or otherwise, and distributed between any number of parties. We demonstrate that it is possible to identify which of these two states the system is in by means of local operations and classical communication alone. The protocol we outline is both completely reliable and completely general; it will correctly distinguish any two orthogonal states 100% of the time.