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This monograph is an up-to-date, in-depth and more advanced
continuation of its accompanying monograph entitled Brain-Body
Interactions: Contemporary Outcome Prediction in Aneurysmal
Subarachnoid Hemorrhage using Bayesian Neural Networks and Fuzzy
Logic. The current monograph is divided into five sections. The
first section synthesises the most current evidence of underlying
pathophysiologic mechanisms of brain-body associations in
aneurysmal subarachnoid hemorrhage. It also describes
pathophysiologic manifestations of central autonomic nervous system
dysfunctions in ischemic stroke, intracerebral hemorrhage and
aneurysmal subarachnoid hemorrhage. The second section synthesises
and critically appraises the methodologic quality of existing
studies (including prospective and retrospective cohort studies and
randomised controlled trials) that derive clinical predictor tools
and clinical predictors used to determine outcome prognosis in
patients with aneurysmal subarachnoid hemorrhage. The third section
makes use of two aneurysmal subarachnoid hemorrhage databases
incorporating advances in the treatment of aneurysmal subarachnoid
hemorrhage. Both single prognostic factors and brain-body
interactions are explored to make several novel observations which
significantly influence clinical outcome in patients with ruptured
cerebral aneurysms. In its fourth section, clinical prognostic
decision-making tools are created using classification and
regression tree analysis. Prognostic subgroups demonstrate the
interplay of various underlying pathophysiologic mechanisms which,
together, adversely influence long-term neurologic and functional
outcomes in those with aneurysmal subarachnoid hemorrhage. Finally,
in Section Five, exploratory analyses are conducted using
artificial neural networks to further explore the brain-body
interface in aneurysmal subarachnoid hemorrhage, with in-depth
discussions of the autonomic nervous system and its dysfunction in
pathologic states. Using these clinical prognostic models, the
clinician can tailor individual-specific treatment efforts to
prevent and treat various alterations in the brain-body interface
in order to maximise the chances of survival and recovery after
aneurysmal subarachnoid haemorrhage.
This monograph serves as an in-depth guide to the use of the
innovative combination of Bayesian analysis, artificial neural
networks and fuzzy logic to create an individualized clinical
prediction model applicable to many areas in medicine. This guide
assumes no prior knowledge of advanced statistics or clinical
medicine. Both the applied research scientist and clinician will be
able to follow the clinical case of outcome prediction in ruptured
brain aneurysms and apply this innovative prognostication model to
different areas in medicine. By using Bayesian neural networks with
fuzzy logic inferences, the practitioner can create a system that
incorporates one's own experience (Bayesian concepts), recognizes
unknown areas in medicine (artificial neural networks) and grey
zones in diagnoses and prognoses (fuzzy logic inferences). This
monograph also profiles contemporary research advances in the
diagnosis and treatment of aneurysmal subarachnoid hemorrhage.
Application of this clinical prediction modelling system to the
case of ruptured brain aneurysms has led to clarification of
clinical prognostication in this area, as well as discovery of
brain-body interactions that are important in influencing outcome
in these patients. The potential impact of such monograph is to
demonstrate how to create such clinical outcome prediction model,
as well to help find new prognostic factors and brain-body
interactions, that when recognized and treated early, can lead to
better clinical outcome for the patient.
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