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Prediction of Mortality Among Patients With Isolated Traumatic Brain Injury Using Machine Learning Models in Asian Countries: An International Multi-Center Cohort Study

Song J, Shin SD, Jamaluddin SF, Chiang WC, Tanaka H, Song KJ, et al.

J Neurotrauma, 2023 Jul;40(13-14):1376-1387.
PMID: 36656672 DOI: 10.1089/neu.2022.0280

Abstract Traumatic brain injury (TBI) is a significant healthcare concern in several countries, accounting for a major burden of morbidity, mortality, disability, and socioeconomic losses. Although conventional prognostic models for patients with TBI have been validated, their performance has been limited. Therefore, we aimed to construct machine learning (ML) models to predict the clinical outcomes in adult patients with isolated TBI in Asian countries. The Pan-Asian Trauma Outcome Study registry was used in this study, and the data were prospectively collected from January 1, 2015, to December 31, 2020. Among a total of 6540 patients (≥ 15 years) with isolated moderate and severe TBI, 3276 (50.1%) patients were randomly included with stratification by outcomes and subgrouping variables for model evaluation, and 3264 (49.9%) patients were included for model training and validation. Logistic regression was considered as a baseline, and ML models were constructed and evaluated using the area under the precision-recall curve (AUPRC) as the primary outcome metric, area under the receiver operating characteristic curve (AUROC), and precision at fixed levels of recall. The contribution of the variables to the model prediction was measured using the SHapley Additive exPlanations (SHAP) method. The ML models outperformed logistic regression in predicting the in-hospital mortality. Among the tested models, the gradient-boosted decision tree showed the best performance (AUPRC, 0.746 [0.700-0.789]; AUROC, 0.940 [0.929-0.952]). The most powerful contributors to model prediction were the Glasgow Coma Scale, O2 saturation, transfusion, systolic and diastolic blood pressure, body temperature, and age. Our study suggests that ML techniques might perform better than conventional multi-variate models in predicting the outcomes among adult patients with isolated moderate and severe TBI.
Fulltext Impact of population aging on the presentation of out-of-hospital cardiac arrest in the Pan Asian Resuscitation Outcomes Study

Tagami T, Tanaka H, Shin SD, Ma MH, Ko PC, Karim S, et al.

Acute medicine & surgery, 2019 05 22;7(1):e430.
PMID: 31988755 DOI: 10.1002/ams2.430

Aim: As a population ages, it can impact on the characteristics and outcomes of cardiogenic out-of-hospital cardiac arrest (OHCA) patients. This study aimed to evaluate the relationship between the age incidence of cardiogenic OHCA and population aging.
Methods: This was a post-hoc analysis of the Pan Asian Resuscitation Outcomes Study (PAROS) database. Data on the population old-age dependency ratio (i.e. elderly/non-elderly) were extracted from publicly accessible sources (United Nations and World Health Organization).
Results: We analyzed 40,872 OHCA cases from seven PAROS countries over the period 2009 to 2013. We found significant correlation between the population old-age dependency ratio and elderly/non-elderly ratio in OHCA patients (r = 0.92, P = 0.003). There was a significant correlation between the population old-age dependency ratio and risk differences of 30-day survival rates for non-elderly and elderly OHCA patients (r = 0.89, P = 0.007).
Conclusions: Our findings suggest that the proportion of elderly among OHCA patients will increase, and outcomes could increasingly differ between elderly and non-elderly as a society ages progressively. This has implications for planning and delivery of emergency services as a society ages.
Genetic polymorphism of the vitamin D-binding protein (DBP) in crab-eating macaques (Macaca fascicularis)

Tanaka H, Kawamoto Y, Terao K

J Med Primatol, 1991 May;20(3):126-32.
PMID: 1895332

Vitamin D-binding protein (DBP) of crab-eating macaques (Macaca fascicularis) was examined by means of three electrophoretic methods. DBP phenotypes were observed to be one or two bands in each method. All of DBP molecular variants could be detected by the simultaneous typing with these three methods. Family analysis suggested that DBP variants followed the mode of autosomal codominant inheritance. A total of 17 phenotypes governed by at least 11 alleles were observed in the populations of Malaysia, Indonesia, and the Philippines. The genetic variability was high in Malaysian and Indonesian populations but low in the Philippine population.
Modifiable Factors Associated With Survival After Out-of-Hospital Cardiac Arrest in the Pan-Asian Resuscitation Outcomes Study

Tanaka H, Ong MEH, Siddiqui FJ, Ma MHM, Kaneko H, Lee KW, et al.

Ann Emerg Med, 2018 05;71(5):608-617.e15.
PMID: 28985969 DOI: 10.1016/j.annemergmed.2017.07.484

STUDY OBJECTIVE: The study aims to identify modifiable factors associated with improved out-of-hospital cardiac arrest survival among communities in the Pan-Asian Resuscitation Outcomes Study (PAROS) Clinical Research Network: Japan, Singapore, South Korea, Malaysia, Taiwan, Thailand, and the United Arab Emirates (Dubai).
METHODS: This was a prospective, international, multicenter cohort study of out-of-hospital cardiac arrest in the Asia-Pacific. Arrests caused by trauma, patients who were not transported by emergency medical services (EMS), and pediatric out-of-hospital cardiac arrest cases (<18 years) were excluded from the analysis. Modifiable out-of-hospital factors (bystander cardiopulmonary resuscitation [CPR] and defibrillation, out-of-hospital defibrillation, advanced airway, and drug administration) were compared for all out-of-hospital cardiac arrest patients presenting to EMS and participating hospitals. The primary outcome measure was survival to hospital discharge or 30 days of hospitalization (if not discharged). We used multilevel mixed-effects logistic regression models to identify factors independently associated with out-of-hospital cardiac arrest survival, accounting for clustering within each community.
RESULTS: Of 66,780 out-of-hospital cardiac arrest cases reported between January 2009 and December 2012, we included 56,765 in the analysis. In the adjusted model, modifiable factors associated with improved out-of-hospital cardiac arrest outcomes included bystander CPR (odds ratio [OR] 1.43; 95% confidence interval [CI] 1.31 to 1.55), response time less than or equal to 8 minutes (OR 1.52; 95% CI 1.35 to 1.71), and out-of-hospital defibrillation (OR 2.31; 95% CI 1.96 to 2.72). Out-of-hospital advanced airway (OR 0.73; 95% CI 0.67 to 0.80) was negatively associated with out-of-hospital cardiac arrest survival.
CONCLUSION: In the PAROS cohort, bystander CPR, out-of-hospital defibrillation, and response time less than or equal to 8 minutes were positively associated with increased out-of-hospital cardiac arrest survival, whereas out-of-hospital advanced airway was associated with decreased out-of-hospital cardiac arrest survival. Developing EMS systems should focus on basic life support interventions in out-of-hospital cardiac arrest resuscitation.
Development of haptic based piezoresistive artificial fingertip: Toward efficient tactile sensing systems for humanoids

TermehYousefi A, Azhari S, Khajeh A, Hamidon MN, Tanaka H

Mater Sci Eng C Mater Biol Appl, 2017 Aug 01;77:1098-1103.
PMID: 28531983 DOI: 10.1016/j.msec.2017.04.040

Haptic sensors are essential devices that facilitate human-like sensing systems such as implantable medical devices and humanoid robots. The availability of conducting thin films with haptic properties could lead to the development of tactile sensing systems that stretch reversibly, sense pressure (not just touch), and integrate with collapsible. In this study, a nanocomposite based hemispherical artificial fingertip fabricated to enhance the tactile sensing systems of humanoid robots. To validate the hypothesis, proposed method was used in the robot-like finger system to classify the ripe and unripe tomato by recording the metabolic growth of the tomato as a function of resistivity change during a controlled indention force. Prior to fabrication, a finite element modeling (FEM) was investigated for tomato to obtain the stress distribution and failure point of tomato by applying different external loads. Then, the extracted computational analysis information was utilized to design and fabricate nanocomposite based artificial fingertip to examine the maturity analysis of tomato. The obtained results demonstrate that the fabricated conformable and scalable artificial fingertip shows different electrical property for ripe and unripe tomato. The artificial fingertip is compatible with the development of brain-like systems for artificial skin by obtaining periodic response during an applied load.
Fulltext Development of Frequency Based Taste Receptors Using Bioinspired Glucose Nanobiosensor

TermehYousefi A, Tateno K, Bagheri S, Tanaka H

Sci Rep, 2017 05 09;7(1):1623.
PMID: 28487527 DOI: 10.1038/s41598-017-01855-5

A method to fabricate a bioinspired nanobiosensor using electronic-based artificial taste receptors for glucose diagnosis is presented. Fabricated bioinspired glucose nanobiosensor designated based on an artificial taste bud including an amperometric glucose biosensor and taste bud-inspired circuits. In fact, the design of the taste bud-inspired circuits was inspired by the signal-processing mechanism of taste nerves which involves two layers. The first, known as a type II cell, detects the glucose by glucose oxidase and transduces the current signal obtained for the pulse pattern is conducted to the second layer, called type III cell, to induce synchronisation of the neural spiking activity. The oscillation results of fabricated bioinspired glucose nanobiosensor confirmed an increase in the frequency of the output pulse as a function of the glucose concentration. At high glucose concentrations, the bioinspired glucose nanobiosensor showed a pulse train of alternating short and long interpulse intervals. A computational analysis performed to validate the hypothesis, which was successfully reproduced the alternating behaviour of bioinspired glucose our nanobiosensor by increasing the output frequency and alternation of pulse intervals according to the reduction in the resistivity of the biosensor.
Fulltext Are there any real Helicobacter pylori infection-negative gastric cancers in Asia?

Tokudome S, Ando R, Ghadimi R, Tanaka T, Hattori N, Yang Z, et al.

Asian Pac J Cancer Prev, 2007 Mar;8(3):462-3.
PMID: 18159988

The great variability in gastric cancer rates across Asia, with very high incidences in Japan and Korea, and exceedingly low incidences in ethnic Malays, whether in Malaysia or Indonesia, appears largely due to variation in Helicobacter pylori infection rates. While between 2% and 10.6% of gastric cancers in a recent Japanese survey were considered to be negative for bacterial infection on the basis of seropositivity and H. pylori-dependent mucosal atrophy, it is notoriously difficult to preclude past infection. The situation is greatly complicated by reported differences in the etiology of gastric cardia and non-cardia cancers. In the Western world there do appear to be tumours arising close to the esophageal-gastric junction which are not related to H. pylori and associated inflammation, but in most Asian populations these appear to be very rare. Therefore preventive efforts, and particularly screening, should be focused on markers of bacterial infection, with avoidance of unnecessary exposure to X-ray radiation.
Genotypes of Japanese encephalitis virus isolated in three states in Malaysia

Tsuchie H, Oda K, Vythilingam I, Thayan R, Vijayamalar B, Sinniah M, et al.

Am J Trop Med Hyg, 1997 Feb;56(2):153-8.
PMID: 9080873

Two hundred forty nucleotides from the pre-membrane gene region of 12 Japanese encephalitis virus (JEV) strains isolated from three different regions of Malaysia from 1993 to 1994 were sequenced and compared with each other and with the JEV strains from different geographic areas in Asia. These 12 Malaysian isolates were classified into two genotypes. The four JEV strains isolated from Sarawak in 1994 and the four JEV strains isolated from Sepang, Selangor in 1993 were classified into one genotype that included earlier isolated strains from Malaysia (JE-827 from Sarawak in 1968 and WTP/70/22 from Kuala Lumpur in 1970). The four JEV strains from Ipoh, Perak in 1994 were classified into another genotype that included JEV strains isolated from northern Thailand and Cambodia. In an earlier report, 10 JEV strains from Sabak Bernam, Selangor in 1992 were classified into the largest genotype that included strains isolated in temperate regions such as Japan, China, and Taiwan. The data indicate that at least three genotypes of JEV have been circulating in Malaysia.
Characteristics of non-accidental injuries in children and adolescents in Asia: a cross-national, multicenter cohort study

Wang PY, Tseng WC, Lee MC, Hsu LM, Shin SD, Jamaluddin SF, et al.

Sci Rep, 2023 Apr 23;13(1):6602.
PMID: 37088796 DOI: 10.1038/s41598-023-33471-x

Children and adolescents are vulnerable to non-accidental injury. Early identification and prevention rely on detailed epidemiological studies, which are limited in Asia. This retrospective study used the registry data of Pan-Asian Trauma Outcome Study (PATOS) from October 1, 2015 to December, 31, 2020. Pediatric patients (aged 24. The study enrolled 451 patients with non-accidental injuries, accounting for 2.81% of pediatric trauma events presented to an emergency department in the PATOS registry. The overall mortality rate was 0.9%, similar to those in Western countries. Mortality rate was high in preschool children (8.7%, p = 0.017) than in other age groups. The sex-specific incidence was higher in boys (3.10% vs. 2.13%, p = 0.001). In adolescents, more events occurred on the street (25.9%), whereas home remained the most common locale in girls of all ages. In the multivariable regression analysis, abdominal and multiple injuries were risk factors for major trauma.