Multi-Omics Profiling Suggesting Intratumoral Mast Cells as Predictive Index of Breast Cancer Lung Metastasis

Breast cancer lung metastasis has a high mortality rate and lacks effective treatments, for the factors that determine breast cancer lung metastasis are not yet well understood. In this study, data from 1067 primary tumors in four public datasets revealed the distinct microenvironments and immune composition among patients with or without lung metastasis. We used multi-omics data of the TCGA cohort to emphasize the following characteristics that may lead to lung metastasis: more aggressive tumor malignant behaviors, severer genomic instability, higher immunogenicity but showed generalized inhibition of effector functions of immune cells. Furthermore, we found that mast cell fraction can be used as an index for individual lung metastasis status prediction and verified in the 20 human breast cancer samples. The lower mast cell infiltrations correlated with tumors that were more malignant and prone to have lung metastasis. This study is the first comprehensive analysis of the molecular and cellular characteristics and mutation profiles of breast cancer lung metastasis, which may be applicable for prognostic prediction and aid in choosing appropriate medical examinations and therapeutic regimens.

EMERGING ADULTHOOD: REPRODUCTIVE HEALTH ANDREPRODUCTIVEATTITUDES

The objective assessments of the reproductive health of students of both sexes, enrolled in the bachelor's training program, belonging to the group «emerging adulthood», obtained from the results of medical examinations, are considered. The data on reproductive behavior and reproductive attitudes of students, obtained in the course of a pilot sociological study, are analyzed. A comparison is made with the available literature data, and further in-depth studies are substantiated

Quantitative Imaging Parameters in the Diagnosis of Endometriomas

The classic imaging diagnosis of endometriomas encounters multiple limitations, including the subjective evaluation of medical examinations and a similar imaging appearance with other adnexal lesions, especially the functional hemorrhagic cysts. For this reason, a definite diagnosis of endometriomas can be made only by pathological analysis, which reveals particular features in terms of cellularity and biochemical components of their fluid content. It is theorized that these histopathological features can also be reflected in medical images, altering the pixel intensity and distribution, but these changes are too subtle to be assessed by the naked eye. New quantitative imaging evaluations and emerging computer-aided diagnosis techniques can provide a detailed description of image contents that can be furtherly processed by algorithms, aiming to provide a more accurate and non-invasive diagnosis for this disease.

A Decision Support System with Artificial Intelligence and Natural Language Processing to Mitigate the Deduction Rate of Health Insurance Claims

Globally, 20% to 40% of medical resources are wasted, which could be avoided through professional audit of health insurance claims. The professional audit can pinpoint excessive use of unnecessary medicines and medical examinations. Taiwan’s National Health Insurance Bureau (TNHIB) deducts the weight that medical resources carry if regarded as unnecessary or abused when examining health insurance claims. The ratio of the deducted weight to the total weight claimed by a hospital is defined as the health insurance claim deduction rate (HICDR). A high HICDR increases the operating expenses of the hospital. In addition, it takes the hospital many resources to prepare and file appeals for the deduction. This study aims to: (1) minimize the weight deducted by the TNHIB for a hospital; and (2) facilitate efficient appeals to claim denials. It is expected that HICDR will be reduced through big data analytics. In this study, evidence-based medicine (EBM) is involved to clarify the debate, dilemmas, conflicts of interests in examining health insurance claims. A natural language method—latent Dirichlet allocation (LDA), was used to analyze patients’ medical records. The topics derived from the LDA are used as factors in the logistic regression model to estimate the probability of each claim to be deducted. The experimental results on various medical departments show that the proposed predictive model can produce accurate results, and lead to more than 41.7% reduction to the deduction of the health insurance claims. It is equivalent to more than a 750 thousand NT dollars saving per year. The efficiency of application is validated compared to the manual process that is time-consuming and labor intensive. Moreover, it is expected that this study will supplement the insufficiency of traditional methods and propose a new and effective solution to reduce the deduction rate.

A pilot study of Korean Medical Examination

Objectives: This study aimed to evaluate the feasibility of the Korean medical examination protocol, which included 14 questionnaires and 20 medical examination devices.Methods: We conducted a pilot observational study of 90 subjects to measure the time required to fulfill each item of the Korean medical examination, to evaluate patient satisfaction, and to report improvements that can be made to the Korean medical examination protocol based on clinical coordinator and subject feedback.Results: Among the 90 subjects included in the study (59 women and 31 men; mean [standard deviation] age, 37.2 [12.3] years), over 80% intended to receive a Korean medical examination if hospitals provided it and would recommend a Korean medical examination to others. The average time spent on the overall Korean medical examination was approximately 88.0 (21.4) minutes. Three areas for improvements were reported: survey issues, including the number of items, understanding, and readability; error issues in device measurements; and environmental issues affecting the sequence of medical examinations and temperature.Conclusions: Most subjects were satisfied with the Korean medical examination. Future studies should be conducted with larger samples to collect data continuously.

Improving the Regulatory Framework in the Field of Preventive Medicine as a Factor of Public Health Safety

In 2020, within the framework of the RFBR grant «Legal and Criminological Problems of Preventive Medicine», the first stage of the study on criminological risks in the field of preventive medicine (hereinafter referred to as PM) was conducted and its results were published. It was found that corruption risks are the main threat to criminological security in the field of PM. This article presents the results of a new study, which is a continuation of the work under the designated RFBR grant. The anti-corruption expertise of a number of legal acts regulating relations in the field of PM showed that they create significant prerequisites for corruption during preventive medical examinations, and as a result, a decrease in the safety of public health. The analysis of the results of the discussion of draft departmental regulations on the official government website, as well as the results of a survey of medical professionals, lead to the same conclusion. An analysis of the totality of the results obtained in the course of the study suggests that the current model of organizing preventive medical examinations is largely the result of lobbying on the part of medical organizations that receive income from PM, including corruption lobbying. The authors come to the conclusion that the organization of preventive medical examinations should be put under effective public control, and adjustments should be made to the anti-corruption expertise of draft normative legal acts on preventive medical examinations: medical specialists should be involved in such expertise and preliminary sociological studies should be conducted to establish the acceptability of the projected legal regulation for the participants in the relations.

Simulation of aerosol dispersion during medical examinations

The main route of transmission of the SARS-CoV2 virus has been shown to be airborne. The objective of this study is to analyze the aerosol dispersion and potential exposure to medical staff within a typical medical examination room during classical airway procedures. The multiphase simulation of the aerosol particles in the airflow is based on a Lagrangian-Eulerian approach. All simulation cases with surgical mask show partially but significantly reduced maximum dispersion distances of the aerosol particles compared to the cases without surgical mask. The simulations have shown that medical examiner are exposed to large amount of aerosol particles, especially during procedures such as laryngoscopy where the examiner's head is directly in front of the patient's face. However, exposure can be drastically reduced if the patient wears a mask which is possible for the most of the procedures studied, such as otoscopy, sonography, or anamnesis.

FORENSIC MEDICAL ASSESSMENT OF INJURY SEVERITY OF LARYNX AND HYOID BONE BASED ON PRE-JUDICIAL AND JUDICIAL INVESTIGATION

Victims with fatal and non-fatal closed blunt trauma of the larynx and hyoid bone often become the object of forensic medical service during the pre-judicial and judicial investigation. The purpose of this study is to analyze the features of expert qualification of bodily injuries in victims with closed blunt trauma of the larynx and hyoid bone, depending on the nature and severity to determine ways to unify its forensic diagnosis. Materials and methods. The study was based on the conclusions of 35 forensic medical examinations of cases of closed blunt trauma of the larynx and hyoid bone, obtained from the leading expert institution of the Kharkiv region. Results. We determined the peculiarities of estimating the degrees of severity of above bodily injuries. Severe injuries were found in 12 (34.4%) cases of death of the victims from mechanical asphyxia, in one case of reflex cardiac arrest, and in one case of traumatic shock. Injuries of moderate severity were established by experts in 6 (17.1%) cases of lethal and in 6 (17.1%) cases of non-lethal cases with laryngeal cartilage fractures; in 2 (6.2%) cases of non-lethal injuries with acute oedema, hematoma, laryngeal stenosis of the second degree. 7 (20%) cases of non-lethal laryngeal injuries with further development of acute posttraumatic laryngitis were qualified as simple injuries. Conclusion. There are no clear morphoclinical criteria for objective assessment of injuries of the larynx and hyoid bone that can lead to pre-diagnostic expert errors. According to the results of the work, the ways to unify forensic medical assessment and diagnosis of such injury was determined.

Whispered Hearing Analyzer — a device for preventive examinations to detect early hearing loss

Introduction. The problem of hearing loss and deafness, due to the general prevalence of hearing loss in different age groups, is significant not only for medicine, but also for the social sphere of society. Nowadays, just as 40 years ago, preventive medical examinations and initial examinations by an otorhinolaryngologist use methods of testing hearing by means of whispered speech, which has its own characteristics for everyone. This leads to diagnostic errors and does not allow to detect hearing loss in its early stages. Purpose of the study—development of a whispered-speech apparatus for early express diagnosis of hearing loss, and study of the effectiveness of the developed apparatus. Materials and methods. The Department of Hygiene at the Izhevsk State Medical Academy, as part of the program "Umnic-2018" a whispered hearing analyzer — a device for early express diagnosis of hearing loss was developed. The device was tested on the basis of otorhinolaryngologist offices in Izhevsk and Tchaikovsky. The study group included 53 patients aged 19 to 76. As part of the testing of the device, the subjects underwent whispered speech hearing tests using acumetric Voyacek word tables; express diagnostics of the hearing level with the whispered hearing analyzer and tonal threshold audiometry using the ITERA II diagnostic audiometer (Otometrics, Denmark). Results. As a result of the testing of the developed device, we found that the use of the whispered hearing analyzer allows you to reduce the time of examination and increase its diagnostic efficiency compared to conventional methods of hearing level examination at medical check-ups. Discussion. The Whispering Hearing Analyzer is designed to quickly and accurately detect hearing loss during medical examinations. The results obtained with this instrument can only tell you that you have a hearing loss, but it is not possible to make a diagnosis. Conclusion. The problem of disabling hearing loss can be solved through preventive measures, one of which is the developed device for early express diagnosis of hearing loss. The use of this device eliminates the occurrence of diagnostic errors associated with the researcher's speech characteristics, thereby making it possible to detect hearing loss at an early stage.