A machine learning-based severity prediction tool for diabetic sensorimotor polyneuropathy using Michigan neuropathy screening instrumentations

Background: Diabetic Sensorimotor polyneuropathy (DSPN) is a major long-term complication in diabetic patients associated with painful neuropathy, foot ulceration and amputation. The Michigan neuropathy screening instrument (MNSI) is one of the most common screening techniques for DSPN, however, it does not provide any direct severity grading system. Method: For designing and modelling the DSPN severity grading systems for MNSI, 19 years of data from Epidemiology of Diabetes Interventions and Complications (EDIC) clinical trials were used. MNSI variables and patient outcomes were investigated using machine learning tools to identify the features having higher association in DSPN identification. A multivariable logistic regression-based nomogram was generated and validated for DSPN severity grading. Results: The top-7 ranked features from MNSI: 10-gm filament, Vibration perception (R), Vibration perception (L), previous diabetic neuropathy, the appearance of deformities, appearance of callus and appearance of fissure were identified as key features for identifying DSPN using the extra tree model. The area under the curve (AUC) of the nomogram for the internal and external datasets were 0.9421 and 0.946, respectively. From the developed nomogram, the probability of having DSPN was predicted and a DSPN severity scoring system for MNSI was developed from the probability score. The model performance was validated on an independent dataset. Patients were stratified into four severity levels: absent, mild, moderate, and severe using a cut-off value of 10.5, 12.7 and 15 for a DSPN probability less than 50%, 75% to 90%, and above 90%, respectively. Conclusions: This study provides a simple, easy-to-use and reliable algorithm for defining the prognosis and management of patients with DSPN.

Real-time Surgical Tools Recognition in Total Knee Arthroplasty Using Deep Neural Networks

Total knee arthroplasty (TKA) is a commonly performed surgical procedure to mitigate knee pain and improve functions for people with knee arthritis. The procedure is complicated due to the different surgical tools used in the stages of surgery. The recognition of surgical tools in real-time can be a solution to simplify surgical procedures for the surgeon. Also, the presence and movement of tools in surgery are crucial information for the recognition of the operational phase and to identify the surgical workflow. Therefore, this research proposes the development of a real-time system for the recognition of surgical tools during surgery using a convolutional neural network (CNN). Surgeons wearing smart glasses can see essential information about tools during surgery that may reduce the complication of the procedures. To evaluate the performance of the proposed method, we calculated and compared the Mean Average Precision (MAP) with state-of-the-art methods which are fast R-CNN and deformable part models (DPM). We achieved 87.6% mAP which is better in comparison to the existing methods. With the additional improvements of our proposed method, it can be a future point of reference, also the baseline for operational phase recognition.