Prediction of response to antiretroviral therapy by human experts and by the EuResist data‐driven expert system (the EVE study)

Objectives

The EuResist expert system is a novel data‐driven online system for computing the probability of 8‐week success for any given pair of HIV‐1 genotype and combination antiretroviral therapy regimen plus optional patient information. The objective of this study was to compare the EuResist system vs. human experts (EVE) for the ability to predict response to treatment.

Methods

The EuResist system was compared with 10 HIV‐1 drug resistance experts for the ability to predict 8‐week response to 25 treatment cases derived from the EuResist database validation data set. All current and past patient data were made available to simulate clinical practice. The experts were asked to provide a qualitative and quantitative estimate of the probability of treatment success.

Results

There were 15 treatment successes and 10 treatment failures. In the classification task, the number of mislabelled cases was six for EuResist and 6–13 for the human experts [mean±standard deviation (SD) 9.1±1.9]. The accuracy of EuResist was higher than the average for the experts (0.76 vs. 0.64, respectively). The quantitative estimates computed by EuResist were significantly correlated (Pearson r=0.695, P<0.0001) with the mean quantitative estimates provided by the experts. However, the agreement among experts was only moderate (for the classification task, inter‐rater κ=0.355; for the quantitative estimation, mean±SD coefficient of variation=55.9±22.4%).

Conclusions

With this limited data set, the EuResist engine performed comparably to or better than human experts. The system warrants further investigation as a treatment‐decision support tool in clinical practice.     

Extensive nodular cutaneous amyloidosis: an unusual presentation

Amyloidosis is characterized by the deposition of a group of unrelated proteins leading to changes in tissue architecture and function. The nodular variant is the rarest form of the cutaneous amyloidoses. We report a patient with localized nodular amyloidosis without systemic amyloid involvement or paraproteinaemia after 6 years of follow-up. The unusual aspects of our case were a plaque presentation rather than nodular, and the disseminated pattern observed.     

Dedicated MR receiver coils: a simple design and construction method

We describe a simple method for design and construction of dedicated receiver coils for use in magnetic resonance imaging. We have been successful in constructing dedicated coils for multiple regions of the body using this method.     

Pain sensitivity of and pain radiation from the internal female genital organs

The aim of this study was to determine the sensitivity and the localization of pain from the internal female genital organs. In 28 women undergoing a ring sterilization, the internal genital organs were pinched with a 3 mm forceps and the pain sensitivity and localization were recorded. Pain localization was vague, and pinching of the medial and distal end of the oviduct, or of the anterior, posterior or left or right uterosacral ligament could not be discriminated. The sensitivity of the pouch of Douglas and of the uterosacrals was greater than of the oviduct, uterus or ovaries. Small typical endometriotic lesions were specifically more painful. The pain from the uterus was felt mainly in the hypogastric region. The oviducts and ovaries radiated mainly to the iliac fossa, whereas pain stimulation of the uterosacrals and pouch of Douglas was felt predominantly in the perineal-perivulvar-perianal region. Radiation to the lower back was rare and never occurred in isolation.      

Comparative effects of the antimigraine drugs sumatriptan and ergotamine on the distribution of cardiac output in anaesthetized pigs

The haemodynamic effects of sumatriptan, a 5-HT1-like receptor agonist, and ergotamine, an agonist at alpha-adrenergic, dopamine as well as 5-HT receptors, were compared using intracardiac injection of radioactive microspheres of different sizes in anaesthetized pigs. Ergotamine (0.02 mg.kg-1) and sumatriptan (0.3 mg.kg-1) decreased systemic vascular conductance and cardiac output. Only ergotamine raised arterial blood pressure. Both sumatriptan and ergotamine decreased arteriovenous anastomotic, but not capillary, blood flow in the head and body skin. Arteriovenous and capillary blood flow in the dura mater and nasal mucosa and capillary blood flow in the brain, kidneys, adrenals, intestine, heart, spleen and muscle remained unchanged. However, kidney conductance was decreased by both drugs, spleen conductance by sumatriptan and heart, liver and adrenal conductances were decreased by ergotamine. Thus, both sumatriptan and ergotamine constricted arteriovenous anastomoses in the skin, but not in the dura mater or nasal mucosa. Ergotamine constricted the vasculature more than sumatriptan, although both drugs may differentially decrease vascular conductances in some organs.