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A Neural Network Classifies Traumatic Brain Injury Outcomes: Glasgow Coma Triples Are Needed
Hermann Prossinger,
Hubert Hetz,
Alexandra Acimovic,
Reinhard Berger,
Karim Mostafa,
Alexander Grieb,
Heinz Steltzer
Issue:
Volume 11, Issue 6, November 2022
Pages:
150-158
Received:
14 September 2022
Accepted:
12 October 2022
Published:
11 November 2022
DOI:
10.11648/j.cmr.20221106.11
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Abstract: The Glasgow Coma Score (GCS) is statistically dubious because its calculation assumes that (a) the diagnostic scores used to assess degree of consciousness are numerical and (b) there is an implied metric. The assessed diagnostic scores are, however, categorical and there exists no metric; hence, summing is neither permitted nor medically informative. Novel methods: In this paper, we statistically analyze the Glasgow Coma Triples (GCTs) of 162 patients (114 males; 48 females; aged 3–93 years) by using unsupervised machine-learning techniques: first, one-hot encoding; second, a dimension reduction autoencoder; and finally KDE (Kernel Density Estimation). Results: We find that this sequence can classify how the resulting segmentation (triage) results in (a) the dead patients clustering separately from the survivors, and (b) the survivors clustering into five groups with different hospital discharge outcomes: from those with GCT={1,1,1} to those with GCT={4,6,5}, albeit with varying trajectories. Conclusions: The use of machine learning techniques can uncover the medical progressions of TBI patients that are impossible to discover using conventional GCS analysis. We also find a triage for outcomes, including five clusters for surviving patients. Further research is needed to verify what medically determines these varying trajectories and their ranges in probabilities; using GCS cannot contribute to these extended investigations, however.
Abstract: The Glasgow Coma Score (GCS) is statistically dubious because its calculation assumes that (a) the diagnostic scores used to assess degree of consciousness are numerical and (b) there is an implied metric. The assessed diagnostic scores are, however, categorical and there exists no metric; hence, summing is neither permitted nor medically informati...
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Kounis Syndrome Due to SARS-CoV-2 Vaccination: A Case Report
Tomohisa Tokura,
Akihide Konn
Issue:
Volume 11, Issue 6, November 2022
Pages:
159-162
Received:
18 October 2022
Accepted:
12 November 2022
Published:
22 November 2022
DOI:
10.11648/j.cmr.20221106.12
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Abstract: Background: The SARS-CoV-2 vaccine is a major player in the global coronavirus disease 2019 COVID-19 pandemic response. The frequency of anaphylaxis due to the SARS-CoV-2 vaccination (COMIRNATY intramuscular injection®) is reported to be higher than initially described. Herein, we describe a case of acute myocardial infarction after anaphylaxis (Kounis syndrome) following vaccination. the reasons why we report this case is to call for caution when considering vaccination. Health care providers need to be aware of these side effects and be informed on how to best treat these side effects. Case Presentation: A 97-year-old woman developed coughing and wheezing a few minutes after she received her first COMIRNATY intramuscular injection®. She was diagnosed with anaphylaxis and was administered intramuscular epinephrine. Two days later, a twelve-lead electrocardiogram showed new broad ST segment depression and atrial fibrillation; elevated cardiac enzymes were also noted. High levels of WBC, AST, and LDH were elevated on the day following vaccination. She was referred to our hospital and diagnosed with NSTEMI (non-ST-elevation myocardial infarction). On the fourth day of illness, she was discharged. However, she died on the fifth day of illness in the nursing home. Discussion: In anaphylaxis, mast cells become activated and degranulate, releasing various inflammatory mediators, which trigger coronary artery spasm or rupture coronary artery plaques. This is referred to as Kounis syndrome. A high CRP value on the day following vaccination suggests the presence of a high inflammatory response due to the release of inflammatory mediators. Since anaphylaxis developed immediately after vaccination and there was no ingestion of other antigens that can cause anaphylaxis, it is obvious that this anaphylaxis was caused by the vaccine. There have been sporadic reports of Kounis syndrome in Japan, but the problem is that this disease is not widely recognized. It is also a problem that there are very few reports of Kounis syndrome due to vaccination. It is assumed that there are many undiagnosed cases. Conclusions: We encountered a patient who developed acute myocardial infarction after anaphylaxis, characteristic of Kounis syndrome, due to the SARS-CoV-2 vaccine. Kounis syndrome affects the coronaries arteries, and may have secondary symptoms such as anaphylaxis, respiratory distress and altered blood values. Caution and close follow-up needs to be exercised in patients who develop anaphylaxis after vaccination. Furthermore, the risks and side effects of the vaccine should be acknowledged.
Abstract: Background: The SARS-CoV-2 vaccine is a major player in the global coronavirus disease 2019 COVID-19 pandemic response. The frequency of anaphylaxis due to the SARS-CoV-2 vaccination (COMIRNATY intramuscular injection®) is reported to be higher than initially described. Herein, we describe a case of acute myocardial infarction after anaphylaxis (Ko...
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Biomarker of Cerebral Injury S100 During Carotid Endarterectomy
Makovec Matej,
Mrđa Bozidar,
Stirn Barbara
Issue:
Volume 11, Issue 6, November 2022
Pages:
163-171
Received:
21 September 2022
Accepted:
8 October 2022
Published:
8 December 2022
DOI:
10.11648/j.cmr.20221106.13
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Abstract: Background: The aim of this pilot investigation was to see if a raised serum S100B level or a decrease in rSO2 following carotid revascularization with CEA might be used to detect neurological instability in CEA patients. Increased serum S100B levels during CEA, we hypothesized, would be linked to neurological symptoms after surgery. Patients and methods: A total of 64 consecutive CEAs in 60 patients operated under LA during an 18-month period were prospectively evaluated. The cerebral oximeter was used to measure cerebral oxygen saturation (rSO2) before and after cross-clamping along with serum concentration of S100B protein. Selective shunting was performed when neurological changes occurred, regardless of NIRS. Results: The neurological symptoms that occurred after clamping correlated with an increase in the serum level of S100B (P =.040). The cut-off of 22.5% of S100B increase was determined to be optimal for identifying patients with neurological symptoms. There was no correlation between rSO2 decline and neurological symptoms (P =.675). Two (3.1%) perioperative strokes occurred. Conclusions: Awake neuromonitoring has been found to provide a sensitive and direct evaluation of brain tissue perfusion and is specific to CEA under LA. Although there was a favorable connection between CEA and an increase in serum S100B protein, due to the long assessment time, serum S100B monitoring was not practicable (usually 3 hours).
Abstract: Background: The aim of this pilot investigation was to see if a raised serum S100B level or a decrease in rSO2 following carotid revascularization with CEA might be used to detect neurological instability in CEA patients. Increased serum S100B levels during CEA, we hypothesized, would be linked to neurological symptoms after surgery. Patients and m...
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Bidirectional Study of Oral Recurrent Aphthous Ulcers and Inflammatory Bowel Disease
Xiang Guo,
Jing-Yi Zhong,
Sunchuri Diwas,
Meng-Fei Zhou,
Long Lian,
Si-Yu Tao,
Zhu-Ling Guo
Issue:
Volume 11, Issue 6, November 2022
Pages:
172-177
Received:
6 November 2022
Accepted:
30 November 2022
Published:
15 December 2022
DOI:
10.11648/j.cmr.20221106.14
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Abstract: Objective: To investigate the etiological mechanisms, treatment and oral manifestations of inflammatory bowel disease (IBD) in relation to recurrent aphthous ulcer (RAU). Materials and Methods: By summarizing and reviewing the research in the literature on the etiological mechanisms and treatment of RAU and IBD in the past decade in China and abroad. By summarizing and reviewing the research in the literature on the etiological mechanisms and treatment of RAU and IBD in the past decade in China and abroad. To explore the interaction between oral and intestinal lesions. Results: Some specific bacteria in the oral cavity may translocate and colonize the intestine, affecting the microecological balance of the gut and interfering with the disease process of IBD. Also, in patients with IBD, their oral salivary microbiome is altered and may show extraintestinal manifestations such as oral mucosal lesions. The occurrence of RAU may aggravate the dysbiosis and immune abnormalities of the intestinal mucosal flora that will be indirectly caused by patients with IBD, as well as malnutrition. Conclusion: Patients with IBD and RAU can affect the microecology of the oral-intestinal axis. patients with IBD are at increased risk of oral mucosal disease and oral symptoms and are associated with the activity of IBD. Due to the complex pathogenic interactions between RAU and IBD. It is recommended that dentists and gastroenterologists should be aware of the bidirectional association between the two diseases for early recognition and multidisciplinary medical management.
Abstract: Objective: To investigate the etiological mechanisms, treatment and oral manifestations of inflammatory bowel disease (IBD) in relation to recurrent aphthous ulcer (RAU). Materials and Methods: By summarizing and reviewing the research in the literature on the etiological mechanisms and treatment of RAU and IBD in the past decade in China and abroa...
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Research Progress of Space Navigation Capability Based on Image Technology
Huihui Wang,
Linjing Zhang,
Liyi Chi,
Yanhai Zhang,
Linli Chang,
Wanqi Bai
Issue:
Volume 11, Issue 6, November 2022
Pages:
178-182
Received:
27 November 2022
Accepted:
13 December 2022
Published:
23 December 2022
DOI:
10.11648/j.cmr.20221106.15
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Abstract: Spatial navigation ability refers to the complex process of the human body building cognitive maps in the brain according to the external environment. It is crucial to study spatial navigation ability to understand human cognitive functions. With the advent of advanced neuroimaging technologies, such as positron emission tomography and magnetic resonance imaging, more and more evidence indicates that differences in the navigation ability of empty individuals are related to differences in brain structure and function. Functional magnetic resonance imaging (fMRI) and weighted magnetic resonance imaging (DTI) are two common methods of functional imaging and structural imaging. fMRI mimics animal experiments by measuring changes in signals related to blood oxygen levels in different regions of the brain, solving a major problem in human studies. On the other hand, structural connections are stable for short periods and are more suitable for studying differences in a single spatial navigation network without uniform training. Structural networks can be evaluated by DTI. DTI is highly sensitive to the Brownian motion of water molecules in voxels, especially in white matter. DTI results suggested that etiology is associated with disrupted fiber connections and decreased FA values, both of which occur in the prefrontal and prefrontal lobe-motor pathways. As far as we know, there is no systematic review of neuroimaging technologies related to spatial navigation functions. In order to fill this gap, in this review, we combine the structure and function of brain imaging and multimodal imaging technology and summarize the central brain regions and brain imaging features related to spatial navigation function. It provides a new method for selecting and dialing the spatial navigation ability of specific populations and a new idea for diagnosing clinical spatial navigation dysfunction.
Abstract: Spatial navigation ability refers to the complex process of the human body building cognitive maps in the brain according to the external environment. It is crucial to study spatial navigation ability to understand human cognitive functions. With the advent of advanced neuroimaging technologies, such as positron emission tomography and magnetic res...
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Philosophical Reflections on Music Therapy Research in China
Issue:
Volume 11, Issue 6, November 2022
Pages:
183-187
Received:
8 December 2022
Accepted:
23 December 2022
Published:
28 December 2022
DOI:
10.11648/j.cmr.20221106.16
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Abstract: Introduction: As the concept of music therapy has entered China, local music therapy has been tapped. Nowadays, although the development of music therapy in China has been quite fruitful. However, local music therapy concepts are increasingly colliding with Western music therapies. Some problems in the research have begun to emerge. This study attempts to analyze the potential reasons behind the problems. Method: To review the current state of development of music therapy in China and to summarize, compare and analyze some existing representative scholars' views. Results: In China, there are differences between indigenous music therapy concepts and Western music therapy concepts. These researchers have questioned the credibility of each other's research and the validity of their research methods. Discussion: The conflict between different theories and different fields of research thinking has led to mutual doubts about the credibility of research findings. The problem arises because of the cognitive paradigm barriers that exist when researchers from different fields conduct cross-disciplinary research. The difficulty in describing the "unexpressed premises" of the research and the multiplicity of levels of music therapy research are the main reasons for this. Underlying the reasons for this is a problem with the scientific methodology of music therapy. The problem is the unification of rationalism and empiricism.
Abstract: Introduction: As the concept of music therapy has entered China, local music therapy has been tapped. Nowadays, although the development of music therapy in China has been quite fruitful. However, local music therapy concepts are increasingly colliding with Western music therapies. Some problems in the research have begun to emerge. This study atte...
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