RESUMO
BACKGROUND: Machine learning (ML) models can improve prediction of major adverse cardiovascular events (MACE), but in clinical practice some values may be missing. We evaluated the influence of missing values in ML models for patient-specific prediction of MACE risk. METHODS: We included 20,179 patients from the multicenter REFINE SPECT registry with MACE follow-up data. We evaluated seven methods for handling missing values: 1) removal of variables with missing values (ML-Remove), 2) imputation with median and unique category for continuous and categorical variables, respectively (ML-Traditional), 3) unique category for missing variables (ML-Unique), 4) cluster-based imputation (ML-Cluster), 5) regression-based imputation (ML-Regression), 6) missRanger imputation (ML-MR), and 7) multiple imputation (ML-MICE). We trained ML models with full data and simulated missing values in testing patients. Prediction performance was evaluated using area under the receiver-operating characteristic curve (AUC) and compared with a model without missing values (ML-All), expert visual diagnosis and total perfusion deficit (TPD). RESULTS: During mean follow-up of 4.7 ± 1.5 years, 3,541 patients experienced at least one MACE (3.7% annualized risk). ML-All (reference model-no missing values) had AUC 0.799 for MACE risk prediction. All seven models with missing values had lower AUC (ML-Remove: 0.778, ML-MICE: 0.774, ML-Cluster: 0.771, ML-Traditional: 0.771, ML-Regression: 0.770, ML-MR: 0.766, and ML-Unique: 0.766; p < 0.01 for ML-Remove vs remaining methods). Stress TPD (AUC 0.698) and visual diagnosis (0.681) had the lowest AUCs. CONCLUSION: Missing values reduce the accuracy of ML models when predicting MACE risk. Removing variables with missing values and retraining the model may yield superior patient-level prediction performance.
Assuntos
Imagem de Perfusão do Miocárdio , Humanos , Aprendizado de Máquina , Imagem de Perfusão do Miocárdio/métodos , Sistema de Registros , Tomografia Computadorizada de Emissão de Fóton Único/métodosRESUMO
Objetivo: Comparar el ángulo de la guía condílea sagital obtenida del registro radiográfico y clínico en pacientes dentados. Materiales y métodos: La muestra estuvo conformada por un grupo único de estudio de 32 pacientes, en el que se evaluó la radiografía lateral estricta y los registros posicionales: en relación céntrica, registro protrusivo a 5 mm en lateralidad derecha y registro protrusivo a 5 mm en lateralidad izquierda. Con el registro posicional del arco facial se articuló el modelo superior, con el registro posicional en relación céntrica se articuló el modelo inferior, con los registros laterales protrusivos de los lados derecho e izquierdo se obtuvo la medida del ángulo de la guía condílea sagital para la programación del articulador semiajustable. El plan estadístico en la presente investigación utilizó el programa SPSS versión 24, la normalidad fue evaluada usando el test de Shapiro-Wilk, también se realizaron las pruebas de T de Student y correlación de Pearson. Resultados: Se determinó estadísticamente que el género y la edad influyen en la medida del ángulo de la guía condílea sagital. El método radiográfico presentó un ángulo de guía condílea de 35,69 ±5,18 y con el método clínico fue 35,69 ± 5,16 (p > 0,05). La prueba de correlación de Pearson sí mostró una correlación importante entre ambos métodos r = 0,948, p < 0,001. Conclusiones: Existe alta correlación en las medidas obtenidas del ángulo de la guía condílea sagital con los registros radiográficos y clínicos; esta concordancia permitiría reemplazar un método por el otro. (AU)
Objective: To compare the angle of the sagittal condylar guidance obtained from the radiographic and clinical records of dentate patients. Materials and Methods: The sample consisted of 32 patients in whom strict lateral radiography and positional records were performed: in centric relation, protrusive recording 5 mm in right laterality and protrusive recording 5 mm in left laterality. With the positional registration of the facebow, the upper model was articulated, while the lower model was articulated with the positional registration in centric relation, and with the protrusive lateral registrations on the right and left side the condylar guidance was obtained for programming the semi-adjustable articulator. Statistics were performed with the SPSS program version 24 in Spanish. Normality was evaluated using the Shapiro-Wilk test, for data with normal distribution, and the Student's T test and Pearson's correlation were performed in descriptive statistics. Results: The statistical analyses showed that gender and age influence the angle measurement of the sagittal condylar guide. The radiographic method presented a condylar guide angle of 35.69 ± 5.18, being 35.69 ± 5.16 with the clinical method (p> 0.05). Pearson's correlation test showed an important correlation between the two methods (r = 0.948, p <0.001). Conclusions: There is a high correlation in the measurements obtained from the angle of the sagittal condylar guide and the radiographic and clinical records, indicating that both methods are effective. (AU)
Assuntos
Humanos , Masculino , Feminino , Adulto , Adulto Jovem , Radiografia Panorâmica , Cefalometria , Oclusão Dentária , Côndilo Mandibular , Epidemiologia Descritiva , Estudos Transversais , Estudos Retrospectivos , Estudos Observacionais como AssuntoRESUMO
Objective: To compare the angle of the sagittal condylar guidance obtained from the radiographic and clinical records of dentate patients. Materials and Methods: The sample consisted of 32 patients in whom strict lateral radiography and positional records were performed: in centric relation, protrusive recording 5 mm in right laterality and protrusive recording 5 mm in left laterality. With the positional registration of the facebow, the upper model was articulated, while the lower model was articulated with the positional registration in centric relation, and with the protrusive lateral registrations on the right and left side the condylar guidance was obtained for programming the semi-adjustable articulator. Statistics were performed with the SPSS program version 24 in Spanish. Normality was evaluated using the Shapiro-Wilk test, for data with normal distribution, and the Student's T test and Pearson's correlation were performed in descriptive statistics. Results: The statistical analyses showed that gender and age influence the angle measurement of the sagittal condylar guide. The radiographic method presented a condylar guide angle of 35.69 ± 5.18, being 35.69 ± 5.16 with the clinical method (p> 0.05). Pearson's correlation test showed an important correlation between the two methods (r = 0.948, p <0.001). Conclusions: There is a high correlation in the measurements obtained from the angle of the sagittal condylar guide and the radiographic and clinical records, indicating that both methods are effective.
RESUMO
OBJECTIVES: To determine the immunogenicity and reactogenicity of a combined DTPw-HBV/Hib vaccine, in comparison with DTPw-HBV and Hib vaccines given as separate concomitant injections. METHODS: In an open, randomized study, healthy infants were injected with either DTPw-HBV/Hib vaccine or separate DTPw-HBV and Hib vaccines at 2, 4 and 6 months of age, with a booster at 18 months. RESULTS: Both vaccination regimens were immunogenic, with seropositivity rates of 100% after the booster vaccination for all vaccine components. Even as early as 2 months after the second dose of the primary vaccination, most patients had seroprotective antibody titers, the proportion of seropositive subjects approaching 100% for tetanus, hepatitis B, and Hib. Post-primary and post-booster geometric mean titers (GMTs) were well above seroprotective thresholds for each vaccine antigen in both groups, with no clinically relevant differences in the groups. The separate and combined administrations showed comparable reactogenicity profiles, and neither showed a significant increase in reactogenicity with successive doses. CONCLUSIONS: The results of this study support the combination of Hib and DTPw-HBV vaccination in routine infant immunization at 2, 4 and 6 months of age with a booster at 18 months. Maximum benefit is obtained from compliance with the full course, but substantial benefit is likely to be achieved even in partially compliant patients, provided they receive at least two doses. Furthermore, these results demonstrate the tolerability of a fourth (booster) administration, where the addition of the Hib vaccine to DTPw-HBV did not lead to an increase in the overall reactogenicity.
Assuntos
Vacina contra Difteria, Tétano e Coqueluche , Vacinas Anti-Haemophilus , Vacinas contra Hepatite B , Vacinas Combinadas , Anticorpos Antibacterianos/sangue , Anticorpos Antivirais/sangue , Vacina contra Difteria, Tétano e Coqueluche/administração & dosagem , Vacina contra Difteria, Tétano e Coqueluche/efeitos adversos , Vacina contra Difteria, Tétano e Coqueluche/imunologia , Feminino , Infecções por Haemophilus/prevenção & controle , Vacinas Anti-Haemophilus/administração & dosagem , Vacinas Anti-Haemophilus/efeitos adversos , Vacinas Anti-Haemophilus/imunologia , Haemophilus influenzae tipo b/imunologia , Vacinas contra Hepatite B/administração & dosagem , Vacinas contra Hepatite B/efeitos adversos , Vacinas contra Hepatite B/imunologia , Humanos , Imunização Secundária , Lactente , Masculino , Vacinas Combinadas/administração & dosagem , Vacinas Combinadas/efeitos adversos , Vacinas Combinadas/imunologiaRESUMO
Como as características clínicas da infecçäo humana por campylobacter em pacientes recém-nascidos näo estäo ainda bem documentadas, considerou-se interessante comunicar a ocorrência de dois casos simultâneos de enterite por C. coli em gêmeos monozigotos. Discute-se a história clínica, os aspectos epidemiológicos e microbiológicos, o desenvolvimento de imunidade bem cocmo a síntese de Ig totais, tendo em consideraçäo as estreitas relaçöes genético-ecológicas destes dois casos
Assuntos
Recém-Nascido , Humanos , Masculino , Infecções por Campylobacter , Doenças em Gêmeos , Gastroenterite/microbiologia , Campylobacter/isolamento & purificação , Imunoglobulina A/análise , Imunoglobulina G/análise , Doenças do Prematuro/imunologia , Doenças do Prematuro/microbiologiaRESUMO
Se comunican cinco casos detectados en los últimos 3 añosde infecciones sistémicas producidas por H.Influenzae resistentes a ampicilina ycloramfenicol, en el Servicio de Pediatría del Hospital Reginal de Valdivia