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Machine learning predicts unpredicted deaths with high accuracy following hepatopancreatic surgery

Hepatobiliary Surgery and Nutrition 2021年第1期10卷 20-30,I0001,I0002页

作者： kota Sahara Anghela Z.Paredes diamantis I.Tsilimigras kazunari Sasaki Amika Moro JMadison Hyer Rittal Mehta Syeda A.Farooq Lu Wu Itaru Endo Timothy M.Pawlik Division of Surgical Oncology The Ohio State University Wexner Medical Center and James Comprehensive Cancer CenterColumbusOHUSA Gastroenterological Surgery Division Yokohama City University School of MedicineYokohamaJapan Department of General Surgery Digestive Disease and Surgery InstituteCleveland ClinicClevelandOHUSA

Background:Machine learning to predict morbidity and mortality-especially in a population traditionally considered low risk-has not been previously *** sought to characterize the incidence of death among patients with a low estimated morbidity and mortality risk based on the National Surgical Quality Improvement Program(NSQIP)estimated probability(EP),as well as develop a machine learning model to identify individuals at risk for“unpredicted death”(UD)among patients undergoing hepatopancreatic(HP)***:The NSQIP database was used to identify patients who underwent elective HP surgery between *** risk of morbidity and mortality was stratified into three tiers(low,intermediate,or high estimated)using a k-means clustering method with bin sorting.A machine learning classification tree and multivariable regression analyses were used to predict 30-day mortality with a 10-fold cross validation.C statistics were used to compare model ***:Among 63,507 patients who underwent an HP procedure,median patient age was 63(IQR:54-71)*** underwent either pancreatectomy(n=38,209,60.2%)or hepatic resection(n=25,298,39.8%).Patients were stratified into three tiers of predicted morbidity and mortality risk based on the NSQIP EP:low(n=36,923,58.1%),intermediate(n=23,609,37.2%)and high risk(n=2,975,4.7%).Among 36,923 patients with low estimated risk of morbidity and mortality,237 patients(0.6%)experienced a *** to the classification tree analysis,age was the most important factor to predict UD(importance 16.9)followed by preoperative albumin level(importance:10.8),disseminated cancer(importance:6.5),preoperative platelet count(importance:6.5),and sex(importance 5.9).Among patients deemed to be low risk,the c-statistic for the machine learning derived prediction model was 0.807 compared with an AUC of only 0.662 for the NSQIP ***:A prognostic model derived using machine learning methodology performed better than t

关键词： Mortality unpredicted machine learning National Surgical Quality Improvement Program(NSQIP)

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Ocular Manifestations in Rheumatoid Arthritis

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Open Journal of Ophthalmology 2016年第3期6卷 170-175页

作者： diamantis Almaliotis Marina Zakalka Antony Gerofotis kleopas Chatzicharalampous Maria Efstathiou Michael Daniilidis Vasileios karampatakis Laboratory of Experimental Ophthalmology Aristotle University of Thessaloniki Thessaloniki Greece 1st Department of Pathology of ΑHΕΠΑ Hospital Aristotle University of Thessaloniki Thessaloniki Greece Department of Haematology Theageneio Anticancer Hospital Thessaloniki Greece

Rheumatoid arthritis (RA) is the most common autoimmune disease. Ocular manifestations of this autoimmune disease vary and are mainly keratoconjunctivitis sicca, episcleritis, scleritis and keratitis. Their appearance, as well as their severity are related to RA chronicity and resistance to therapy. The treatment consists of corticosteroids, NSAIDs and cytotoxic drugs, depending on the type of ocular manifestations and the patient’s response to treatment.

关键词： Rheumatoid Arthritis Ocular Manifestations Autoimmunity Nodules Red Eye Sicca Scleritis Episcleritis Schirmer’s Test Corticosteroids keratitis

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Preventing pediatric cardiothoracic trauma:Role of policy and legislation

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World Journal of Cardiology 2018年第7期10卷 49-51页

作者： konstantinos S Mylonas Pouya Hemmati diamantis I Tsilimigras Pavlos Texakalidis konstantinos P Economopoulos Pediatric Cardiology Working Group Society of Junior DoctorsAthens 15123Greece Department of Surgery Mayo ClinicRochesterMN 55902United States School of Medicine National and Kapodistrian University of AthensAthens 11527Greece Pavlos Texakalidis Konstantinos P EconomopoulosSurgery Working GroupSociety of Junior DoctorsAthens 15123Greece School of Medicine Faculty of Health SciencesAristotle University of ThessalonikiThessaloniki 54621Greece Department of Surgery Duke University Medical CenterDurhamNC 27710United States

Data from the last 50 years suggest that pediatric pa-tients typically suffer cardiothoracic injuries following blunt traumatic force(70%) in the setting of either motor vehicle crashes(53.5%) or vehicle-pedestrian accidents(18.2%). Penetrating trauma accounts for 30% of pediatric cardiothoracic injuries, half of which are gunshot wounds. Graduated driver licensing progr-ams, gun-control legislation, off-road vehicle regulation, initiatives such as "Prevent the Bleed", as well as prof-essional society recommendations are key in preventing pediatric cardiothoracic injuries.

关键词： Pediatric trauma Blunt cardiac trauma Penetrating cardiac trauma Injury Children Policy Legislation

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Using the win ratio to compare laparoscopic versus open liver resection for colorectal cancer liver metastases

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Hepatobiliary Surgery and Nutrition 2023年第5期12卷 692-703,I0017页

作者： Alessandro Paro J.Madison Hyer Brandon S.Avery diamantis I.Tsilimigras Fabio Bagante Alfredo Guglielmi Andrea Ruzzenente Sorin Alexandrescu George Poultsides kazunari Sasaki Federico Aucejo Timothy M.Pawlik Department of Surgery The Ohio State University Wexner Medical Center and James Cancer Hospital and Solove Research InstituteColumbusOHUSA University of Verona VeronaItaly Fundeni Clinical Institute BucharestRomania Stanford University StanfordCAUSA Cleveland Clinic Foundation ClevelandOHUSA

Background:We sought to assess the overall benefit of laparoscopic versus open hepatectomy for treatment of colorectal liver metastases(CRLMs)using the win ratio,a novel methodological ***:CRLM patients undergoing curative-intent resection in 2001-2018 were identified from an international multi-institutional *** were paired and matched based on age,number and size of lesions,lymph node status and receipt of preoperative *** win ratio was calculated based on margin status,severity of postoperative complications,90-day mortality,time to recurrence,and time to ***:Among 962 patients,the majority underwent open hepatectomy(n=832,86.5%),while a minority underwent laparoscopic hepatectomy(n=130,13.5%).Among matched patient-to-patient pairs,the odds of the patient undergoing laparoscopic resection“winning”were 1.77[WR:1.77,95%confidence interval(CI):1.42-2.34].The win ratio favored laparoscopic hepatectomy independent of low(WR:2.94,95%CI:1.20-6.39),medium(WR:1.56,95%CI:1.16-2.10)or high(WR:7.25,95%CI:1.13-32.0)tumor burden,as well as unilobar(WR:1.71,95%CI:1.25-2.31)or bilobar(WR:4.57,95%CI:2.36-8.64)*** odds of“winning”were particularly pronounced relative to short-term outcomes(i.e.,90-day mortality and severity of postoperative complications)(WR:4.06,95%CI:2.33-7.78).Conclusions:Patients undergoing laparoscopic hepatectomy had 77%increased odds of“winning”.Laparoscopic liver resection should be strongly considered as a preferred approach to resection in CRLM patients.

关键词： Colorectal liver metastases(CRLMs) minimally invasive surgery laparoscopic liver resection win ratio

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Contrast Sensitivity and Eye Drops

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Open Journal of Ophthalmology 2012年第3期2卷 60-63页

作者： Theodosios Chatzibalis konstantinos Stamoulas Athanasios karamitsos diamantis Almaliotis Vasiliki Mirtsou-Fidani Nikolaos Georgiadis Vasileios karampatakis 1st Eye Clinic Medical School Aristotle University of Thessaloniki. Laboratory of Experimental Ophthalmology Medical School Aristotle University of Thessaloniki Laboratory of Pharmacology Medical School Aristotle University of Thessaloniki

Purpose: To evaluate the influence of commonly used eye drops on contrast sensitivity (CS). Design: Prospective study. Participants: One hundred twenty volunteers (120) were enrolled. Methods: The CS of ophthalmologically healthy individuals was evaluated at baseline examination before the instillation, 20 and 40 minutes after the instillation of diclofenac sodium and commonly used antiglaucoma eye drops (latanoprost, brimonidine tartrate, combination of dorzolamide hydrochloride and timolol maleate). CS was assessed at 7 spatial frequencies varying from 1.5 c/d to 20 c/d by the use of Mentor B-VAT II-SG video acuity tester. Results: Diclofenac sodium induced a mild, however statistically significant decrease on the CS in 4 out of 30 subjects 20 minutes after instillation at the spatial frequency of 1.5 c/d and 3 c/d (p p > 0.05). Brimonidine tartrate decreased CS in 4 out of 30 subjects 20 minutes after the instillation at a high spatial frequency (20 c/d) yet this decrease was marginally statistically significant (p = 0.057). CS returned to baseline scores 40 minutes after the instillation for all drugs. Conclusions: Diclofenac sodium eye drops had a mild temporal effect on the low spatial frequencies of 1.5 c/d and 3 c/d in some individuals. Latanoprost and dorzolamide/timolol had a non-statistically significant effect on the same spatial frequencies. Brimonidine eye drops had a temporal effect on the high spatial frequency of 20 c/d with marginal statistical significance. The CS scores returned to normal, in all cases, within the next 40 minutes after the instillation. Ophthalmologists should be aware of the fact that some eye drops may have an influence on CS.

关键词： Cornea Ocular Surface External Disease

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Novel approaches for the treatment of ventricular tachycardia

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World Journal of Cardiology 2018年第7期10卷 52-59页

作者： Michael Spartalis Eleftherios Spartalis Eleni Tzatzaki diamantis I Tsilimigras Demetrios Moris Christos kontogiannis Efthimios Livanis Dimitrios C Iliopoulos Vassilis Voudris George N Theodorakis ESC Working Group on Cardiac Cellular Electrophysiology Sophia Antipolis Cedex 06903France Division of Cardiology Onassis Cardiac Surgery CenterAthens 17674Greece Laboratory of Experimental Surgery and Surgical Research University of Athens Medical SchoolAthens 11527Greece Department of Surgery Duke UniversityDurhamNC 27710United States Department of Clinical Therapeutics “Alexandra”HospitalUniversity of AthensAthens 11528Greece

Ventricular tachycardia(VT) is a crucial cause of sudden cardiac death(SCD) and a primary cause of mortality and morbidity in patients with structural cardiac disease. VT includes clinical disorders varying from benign to lifethreatening. Most life-threatening episodes are correlated with coronary artery disease, but the risk of SCD varies in certain populations, with various underlying heart conditions, specific family history, and genetic variants. The targets of VT management are symptom alleviation, improved quality of life, reduced implantable cardioverter defibrillator shocks, prevention of reduction of left ventricular function, reduced risk of SCD, and improved overall survival. Antiarrhythmic drug therapy and endocardial catheter ablation remains the cornerstone of guideline-endorsed VT treatment strategies in patients with structural cardiac abnormalities. Novel strategies such as epicardial ablation, surgical cryoablation, transcoronary alcohol ablation, pre-procedural imaging, and stereotactic ablative radiotherapy are an appealing area of res-earch. In this review, we gathered all recent advances in innovative therapies as well as experimental evidence focusing on different aspects of VT treatment that could be significant for future favorable clinical applications.

关键词： Ventricular tachycardia Catheter ablation Epicardial Sudden cardiac death Novel techniques Substrate

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自身免疫性肝炎-进化的概念（下）

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传染病网络动态 2006年第7期 22-23页

作者： Ioannis diamantis Dimittrios T．Boumpas 鲁俊峰（编译）杨露绮（审校）

9．细胞因子 1型和2型细胞因子组成了免疫调节网络，其以繁多的作用和广泛的交叉调节功能为特点。细胞因子网络影响着自身免疫性肝炎的发生、临床表现和结果。在1型和2型自身免疫性肝炎的儿童中已经描述了不同的细胞因子模式。2型细胞... 详细信息

9．细胞因子 1型和2型细胞因子组成了免疫调节网络，其以繁多的作用和广泛的交叉调节功能为特点。细胞因子网络影响着自身免疫性肝炎的发生、临床表现和结果。在1型和2型自身免疫性肝炎的儿童中已经描述了不同的细胞因子模式。2型细胞因子的应答可使自身免疫性肝炎区别于慢性病毒性肝炎。IL-2和IL-4一般较少，1型自身免疫性肝炎病人的成人中其血清浓度低于正常人。1型细胞因子在肝脏中炎症活动期间占优势。2型细胞因子在缓解期的循环系统中占优势。这些结果表明在疾病活动期细胞因子模式的变化，或是免疫反应的原因，或是其结果。

关键词：自身免疫性肝炎细胞因子网络免疫调节网络慢性病毒性肝炎进化临床表现 IL-4 IL-2 血清浓度肝炎病人

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自身免疫性肝炎一进化的概念（上）

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传染病网络动态 2006年第6期 20-22页

作者： Ioannis diamantis Dimittrios T．Boumpas 鲁俊峰（编译）杨露绮（审校）

1．序言自身免疫性肝炎（AIH）是一种尚未解决的原因不明的肝脏炎症。在北欧，AIH平均每年发病率是1．9／100 000。在欧洲占肝移植的2．6％，在美国占5．9％。女性多于男性（3．6：1）。所有年龄段和各种族的人群均有易感性。

关键词：自身免疫性肝炎进化肝脏炎症原因不明年发病率 AIH 肝移植易感性年龄段

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Visual Allesthesia in a Patient with Glioblastoma Multiforme

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Open Journal of Ophthalmology（眼科学期刊） 2012年第3期

作者： Antonios Reptsis Iordanis Demirtzoglou Athanasios Nikolakopoulos diamantis Almaliotis Angeliki Cheva Vasileios karampatakis

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Contrast Sensitivity and Eye Drops

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Open Journal of Ophthalmology（眼科学期刊） 2012年第3期

作者： Theodosios Chatzibalis konstantinos Stamoulas Athanasios karamitsos diamantis Almaliotis Vasiliki Mirtsou-Fidani Nikolaos Georgiadis Vasileios karampatakis

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