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      Applied Machine Learning for the Prediction of Growth of Abdominal Aortic Aneurysm in Humans

      research-article
      a , , , b , , c , a , a , a , , c , , the Oxford Abdominal Aortic Aneurysm Study and, the Oxford Regional Vascular Service
      EJVES Short Reports
      Elsevier
      Abdominal aortic aneurysm, Aneurysm progression, Machine learning, Biomarker, Flow mediated dilatation

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          Abstract

          Objective

          Accurate prediction of abdominal aortic aneurysm (AAA) growth in an individual can allow personalised stratification of surveillance intervals and better inform the timing for surgery. The authors recently described the novel significant association between flow mediated dilatation (FMD) and future AAA growth. The feasibility of predicting future AAA growth was explored in individual patients using a set of benchmark machine learning techniques.

          Methods

          The Oxford Abdominal Aortic Aneurysm Study (OxAAA) prospectively recruited AAA patients undergoing the routine NHS management pathway. In addition to the AAA diameter, FMD was systemically measured in these patients. A benchmark machine learning technique (non-linear Kernel support vector regression) was applied to predict future AAA growth in individual patients, using their baseline FMD and AAA diameter as input variables.

          Results

          Prospective growth data were recorded at 12 months (360 ± 49 days) in 94 patients. Of these, growth data were further recorded at 24 months (718 ± 81 days) in 79 patients. The average growth in AAA diameter was 3.4% at 12 months, and 2.8% per year at 24 months. The algorithm predicted the individual's AAA diameter to within 2 mm error in 85% and 71% of patients at 12 and 24 months.

          Conclusions

          The data highlight the utility of FMD as a biomarker for AAA and the value of machine learning techniques for AAA research in the new era of precision medicine.

          Highlights

          • Flow mediated dilatation of brachial artery is a biomarker of AAA progression.

          • It is feasible to predict future AAA growth in individuals using machine learning techniques.

          • Endothelial dysfunction is a key feature in human AAA disease.

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          Most cited references11

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          Management of abdominal aortic aneurysms clinical practice guidelines of the European society for vascular surgery.

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            Machine Learning and Decision Support in Critical Care

            Clinical data management systems typically provide caregiver teams with useful information, derived from large, sometimes highly heterogeneous, data sources that are often changing dynamically. Over the last decade there has been a significant surge in interest in using these data sources, from simply re-using the standard clinical databases for event prediction or decision support, to including dynamic and patient-specific information into clinical monitoring and prediction problems. However, in most cases, commercial clinical databases have been designed to document clinical activity for reporting, liability and billing reasons, rather than for developing new algorithms. With increasing excitement surrounding “secondary use of medical records” and “Big Data” analytics, it is important to understand the limitations of current databases and what needs to change in order to enter an era of “precision medicine.” This review article covers many of the issues involved in the collection and preprocessing of critical care data. The three challenges in critical care are considered: compartmentalization, corruption, and complexity. A range of applications addressing these issues are covered, including the modernization of static acuity scoring; on-line patient tracking; personalized prediction and risk assessment; artifact detection; state estimation; and incorporation of multimodal data sources such as genomic and free text data.
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              Intra- and interobserver variability in the measurements of abdominal aortic and common iliac artery diameter with computed tomography. The Tromsø study.

              to assess intra- and interobserver variability in the measurement of aortic and common iliac artery diameter by means of computed tomography (CT). reproducibility study. three radiologists performed measurements of aortic diameter at five different levels and of both common iliac arteries with CT. Fifty-nine subjects were examined, 29 with and 30 without abdominal aortic aneurysms (AAA) as assessed by ultrasound. intraobserver variability varied between radiologists, measurement plane (anterior-posterior vs transverse) and measurement level. The interobserver variability was markedly higher at the bifurcation than at the suprarenal level and higher than intraobserver variability for measurements at all levels. Both intraobserver and interobserver variability increased with increasing vessel diameter and were largest in patients with AAA. The absolute intraobserver difference of the maximal infrarenal aortic diameter was 2mm or less in 94% of intraobserver pairs. The corresponding interobserver difference was 82%. interobserver variability of CT measurements of aortic and common iliac artery diameter is not negligible and should be taken into account when making clinical decisions. When assessing change in aortic diameter, previous CT-scans should be reviewed simultaneously as a routine to exclude interobserver variability.
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                Author and article information

                Contributors
                Journal
                EJVES Short Rep
                EJVES Short Rep
                EJVES Short Reports
                Elsevier
                2405-6553
                01 May 2018
                2018
                01 May 2018
                : 39
                : 24-28
                Affiliations
                [a ]Nuffield Department of Surgical Sciences, University of Oxford, Oxford, UK
                [b ]Department of Engineering Science, University of Oxford, Oxford, UK
                [c ]Nuffield Department of Primary Care Health, University of Oxford, Oxford, UK
                Author notes
                []Corresponding author. regent.lee@ 123456nds.ox.ac.uk
                [†]

                These authors contributed equally.

                [‡]

                These authors are joint senior author.

                Article
                S2405-6553(18)30009-4
                10.1016/j.ejvssr.2018.03.004
                6033055
                29988820
                6d8d25df-188a-4cb7-81b4-2351aca59be2
                © 2018 The Author(s)

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                : 22 January 2018
                : 15 March 2018
                : 25 March 2018
                Categories
                Original Research

                abdominal aortic aneurysm,aneurysm progression,machine learning,biomarker,flow mediated dilatation

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