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BACKGROUND: Convalescent plasma has been widely used to treat coronavirus disease 2019 (Covid-19) under the presumption that such plasma contains potentially therapeutic antibodies to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that can be passively transferred to the plasma recipient. Whether convalescent plasma with high antibody levels rather than low antibody levels is associated with a lower risk of death is unknown. METHODS: In a retrospective study based on a U.S. national registry, we determined the anti-SARS-CoV-2 IgG antibody levels in convalescent plasma used to treat hospitalized adults with Covid-19. The primary outcome was death within 30 days after plasma transfusion. Patients who were enrolled through July 4, 2020, and for whom data on anti-SARS-CoV-2 antibody levels in plasma transfusions and on 30-day mortality were available were included in the analysis. RESULTS: Of the 3082 patients included in this analysis, death within 30 days after plasma transfusion occurred in 115 of 515 patients (22.3%) in the high-titer group, 549 of 2006 patients (27.4%) in the medium-titer group, and 166 of 561 patients (29.6%) in the low-titer group. The association of anti-SARS-CoV-2 antibody levels with the risk of death from Covid-19 was moderated by mechanical ventilation status. A lower risk of death within 30 days in the high-titer group than in the low-titer group was observed among patients who had not received mechanical ventilation before transfusion (relative risk, 0.66; 95% confidence interval [CI], 0.48 to 0.91), and no effect on the risk of death was observed among patients who had received mechanical ventilation (relative risk, 1.02; 95% CI, 0.78 to 1.32). CONCLUSIONS: Among patients hospitalized with Covid-19 who were not receiving mechanical ventilation, transfusion of plasma with higher anti-SARS-CoV-2 IgG antibody levels was associated with a lower risk of death than transfusion of plasma with lower antibody levels. (Funded by the Department of Health and Human Services and others; ClinicalTrials.gov number, NCT04338360.).
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Anticuerpos Antivirales/sangre , COVID-19/terapia , SARS-CoV-2/inmunología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , COVID-19/inmunología , COVID-19/mortalidad , Femenino , Hospitalización , Humanos , Inmunización Pasiva , Inmunoglobulina G/sangre , Masculino , Persona de Mediana Edad , Sistema de Registros , Respiración Artificial , Estudios Retrospectivos , Factores de Riesgo , Tiempo de Tratamiento , Estados Unidos/epidemiología , Adulto Joven , Sueroterapia para COVID-19RESUMEN
Background Clinical decision making and drug development for fibrostenosing Crohn disease is constrained by a lack of imaging definitions, scoring conventions, and validated end points. Purpose To assess the reliability of MR enterography features to describe Crohn disease strictures and determine correlation with stricture severity. Materials and Methods A retrospective study of patients with symptomatic terminal ileal Crohn disease strictures who underwent MR enterography at tertiary care centers (Cleveland Clinic: September 2013 to November 2020; Mayo Clinic: February 2008 to March 2019) was conducted by using convenience sampling. In the development phase, blinded and trained radiologists independently evaluated 26 MR enterography features from baseline and follow-up examinations performed more than 6 months apart, with no bowel resection performed between examinations. Follow-up examinations closest to 12 months after baseline were selected. Reliability was assessed using the intraclass correlation coefficient (ICC). In the validation phase, after five features were redefined, reliability was re-estimated in an independent convenience sample using baseline examinations. Multivariable linear regression analysis identified features with at least moderate interrater reliability (ICC ≥0.41) that were independently associated with stricture severity. Results Ninety-nine (mean age, 40 years ± 14 [SD]; 50 male) patients were included in the development group and 51 (mean age, 45 years ± 16 [SD]; 35 female) patients were included in the validation group. In the development group, nine features had at least moderate interrater reliability. One additional feature demonstrated moderate reliability in the validation group. Stricture length (ICC = 0.85 [95% CI: 0.75, 0.91] and 0.91 [95% CI: 0.75, 0.96] in development and validation phase, respectively) and maximal associated small bowel dilation (ICC = 0.74 [95% CI: 0.63, 0.80] and 0.73 [95% CI: 0.58, 0.87] in development and validation group, respectively) had the highest interrater reliability. Stricture length, maximal stricture wall thickness, and maximal associated small bowel dilation were independently (regression coefficients, 0.09-3.97; P < .001) associated with stricture severity. Conclusion MR enterography definitions and scoring conventions for reliably assessing features of Crohn disease strictures were developed and validated, and feature correlation with stricture severity was determined. © RSNA, 2024 Supplemental material is available for this article. See also the article by Rieder and Ma et al in this issue. See also the editorial by Galgano and Summerlin in this issue.
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Enfermedad de Crohn , Imagen por Resonancia Magnética , Humanos , Enfermedad de Crohn/diagnóstico por imagen , Femenino , Masculino , Imagen por Resonancia Magnética/métodos , Estudios Retrospectivos , Adulto , Reproducibilidad de los Resultados , Constricción Patológica/diagnóstico por imagen , Persona de Mediana EdadRESUMEN
Nimodipine, an L-type cerebroselective calcium channel antagonist, is the only drug approved by the US Food and Drug Administration for the neuroprotection of patients with aneurysmal subarachnoid hemorrhage (aSAH). Four randomized, placebo-controlled trials of nimodipine demonstrated clinical improvement over placebo; however, these occurred before precision medicine with pharmacogenomics was readily available. The standard enteral dose of nimodipine recommended after aSAH is 60 mg every 4 h. However, up to 78% of patients with aSAH develop systemic arterial hypotension after taking the drug at the recommended dose, which could theoretically limit its neuroprotective role and worsen cerebral perfusion pressure and cerebral blood flow, particularly when concomitant vasospasm is present. We investigated the association between nimodipine dose changes and clinical outcomes in a consecutive series of 150 patients (mean age, 56 years; 70.7% women) with acute aSAH. We describe the pharmacogenomic relationship of nimodipine dose reduction with clinical outcomes. These results have major implications for future individualized dosing of nimodipine in the era of precision medicine.
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Bloqueadores de los Canales de Calcio , Nimodipina , Farmacogenética , Hemorragia Subaracnoidea , Humanos , Nimodipina/administración & dosificación , Nimodipina/efectos adversos , Hemorragia Subaracnoidea/tratamiento farmacológico , Hemorragia Subaracnoidea/genética , Hemorragia Subaracnoidea/complicaciones , Persona de Mediana Edad , Femenino , Masculino , Bloqueadores de los Canales de Calcio/administración & dosificación , Bloqueadores de los Canales de Calcio/efectos adversos , Bloqueadores de los Canales de Calcio/uso terapéutico , Anciano , Farmacogenética/métodos , Resultado del Tratamiento , Relación Dosis-Respuesta a Droga , Adulto , Medicina de Precisión/métodos , Vasoespasmo Intracraneal/tratamiento farmacológicoRESUMEN
Cardiovascular disease remains the leading cause of death in women. Given accumulating evidence on sex- and gender-based differences in cardiovascular disease development and outcomes, the need for more effective approaches to screening for risk factors and phenotypes in women is ever urgent. Public health surveillance and health care delivery systems now continuously generate massive amounts of data that could be leveraged to enable both screening of cardiovascular risk and implementation of tailored preventive interventions across a woman's life span. However, health care providers, clinical guidelines committees, and health policy experts are not yet sufficiently equipped to optimize the collection of data on women, use or interpret these data, or develop approaches to targeting interventions. Therefore, we provide a broad overview of the key opportunities for cardiovascular screening in women while highlighting the potential applications of artificial intelligence along with digital technologies and tools.
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Inteligencia Artificial/tendencias , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/fisiopatología , Tecnología Digital/tendencias , Tamizaje Masivo/tendencias , Enfermedades Cardiovasculares/epidemiología , Tecnología Digital/métodos , Femenino , Humanos , Longevidad/fisiología , Tamizaje Masivo/métodos , Menopausia/fisiología , Embarazo , Complicaciones Cardiovasculares del Embarazo/diagnóstico , Complicaciones Cardiovasculares del Embarazo/epidemiología , Complicaciones Cardiovasculares del Embarazo/fisiopatologíaRESUMEN
OBJECTIVES: Photon-counting detector (PCD) computed tomography (CT) offers improved spatial and contrast resolution, which can impact quantitative measurements. This work aims to determine in human subjects the effect of dual-source PCD-CT on the quantitation of coronary artery calcification (CAC) compared with dual-source energy-integrating detector (EID) CT in both 1- and 3-mm images. METHODS: This prospective study enrolled patients receiving a clinical EID-CT CAC examination to undergo a research PCD-CT CAC examination. Axial images were reconstructed with a 512 × 512 matrix, 200-mm field of view, 3-mm section thickness/1.5-mm interval using a quantitative kernel (Qr36). Sharper kernels (Qr56/QIR strength 4 for PCD and Qr49/ADMIRE strength 5 for EID) were used to reconstruct images with 1-mm section thickness/0.5-mm interval. Pooled analysis was performed for all calcifications with nonzero values, and volume and Agatston scores were compared between EID-CT and PCD-CT. A Wilcoxon signed-rank test was performed with P < 0.05 considered statistically significant. RESULTS: In 21 subjects (median age, 58 years; range, 50-75 years; 13 male [62%]) with a total of 42 calcified arteries detected at 3 mm and 46 calcified arteries at 1-mm images, EID-CT CAC volume and Agatston scores were significantly lower than those of PCD-CT ( P ≤ 0.001). At 3-mm thickness, the mean (standard deviation) volume and Agatston score for EID-CT were 55.5 (63.4) mm 3 and 63.8 (76.9), respectively, and 61.5 (69.4) mm 3 and 70.4 (85.3) for PCD-CT ( P = 0.0001 and P = 0.0013). At 1-mm thickness, the mean (standard deviation) volume and score for EID-CT were 50.0 (56.3) mm 3 and 61.1 (69.3), respectively, and 59.5 (63.9) mm 3 and 72.5 (79.9) for PCD-CT ( P < 0.0001 for both). The applied radiation dose (volume CT dose index) for the PCD-CT scan was 2.1 ± 0.6 mGy, which was 13% lower than for the EID-CT scan (2.4 ± 0.7 mGy, P < 0.001). CONCLUSIONS: Relative to EID-CT, PCD-CT demonstrated a small but significant increase in coronary artery calcium volume and Agatston score.
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Calcinosis , Calcio , Humanos , Masculino , Persona de Mediana Edad , Vasos Coronarios/diagnóstico por imagen , Estudios Prospectivos , Fotones , Fantasmas de Imagen , Tomografía Computarizada por Rayos X/métodosRESUMEN
Background Compared with energy-integrating detector (EID) CT, the improved resolution of photon-counting detector (PCD) CT coupled with high-energy virtual monoenergetic images (VMIs) has been shown to decrease calcium blooming on images in phantoms and cadaveric specimens. Purpose To determine the impact of dual-source PCD CT on visual and quantitative estimation of percent diameter luminal stenosis compared with dual-source EID CT in patients. Materials and Methods This prospective study recruited consecutive adult patients from an outpatient facility between January and March 2022. Study participants underwent clinical dual-source EID coronary CT angiography followed by a research dual-source PCD CT examination. For PCD CT, multienergy data were used to create VMIs at 50 and 100 keV. Two readers independently reviewed EID CT images followed by PCD CT images after a washout period. Readers visually graded the most severe stenosis in terms of percent diameter luminal stenosis for the left main, left anterior descending, right, and circumflex coronary arteries, unblinded to scanner type. Quantitative measures of percent stenosis were made using commercial software. Visual and quantitative estimates of percent stenosis were compared between EID CT and PCD CT using the Wilcoxon signed-rank test. Results A total of 25 participants (median age, 59 years [range, 18-78 years]; 16 male participants) were enrolled. On EID CT images, readers 1 and 2 identified 39 and 32 luminal stenoses, respectively, with a percent diameter luminal stenosis greater than 0%. Visual estimates of percent stenosis were lower on PCD CT images than EID CT images (reader 1: median 20.6% [IQR, 8.8%-61.2%] vs 31.8% [IQR, 12.9%-69.7%], P < .001; reader 2: 6.5% [IQR, 0.4%-54.1%] vs 22.9% [IQR, 1.8%-67.4%], P = .002). No difference was observed between EID CT and PCD CT for quantitative measures of percent stenosis (median difference, -1.5% [95% CI: -3.0%, 2.5%]; P = .51). Conclusion Relative to using EID CT, using PCD CT led to decreases in visual estimates of percent stenosis. © RSNA, 2023 See also the editorial by Murphy and Donnelly in this issue.
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Angiografía por Tomografía Computarizada , Tomografía Computarizada por Rayos X , Adulto , Humanos , Masculino , Persona de Mediana Edad , Angiografía por Tomografía Computarizada/métodos , Constricción Patológica , Angiografía Coronaria/métodos , Fantasmas de Imagen , Fotones , Estudios Prospectivos , Tomografía Computarizada por Rayos X/métodos , Adolescente , Adulto Joven , Anciano , FemeninoRESUMEN
Background Substantial interreader variability exists for common tasks in CT imaging, such as detection of hepatic metastases. This variability can undermine patient care by leading to misdiagnosis. Purpose To determine the impact of interreader variability associated with (a) reader experience, (b) image navigation patterns (eg, eye movements, workstation interactions), and (c) eye gaze time at missed liver metastases on contrast-enhanced abdominal CT images. Materials and Methods In a single-center prospective observational trial at an academic institution between December 2020 and February 2021, readers were recruited to examine 40 contrast-enhanced abdominal CT studies (eight normal, 32 containing 91 liver metastases). Readers circumscribed hepatic metastases and reported confidence. The workstation tracked image navigation and eye movements. Performance was quantified by using the area under the jackknife alternative free-response receiver operator characteristic (JAFROC-1) curve and per-metastasis sensitivity and was associated with reader experience and image navigation variables. Differences in area under JAFROC curve were assessed with the Kruskal-Wallis test followed by the Dunn test, and effects of image navigation were assessed by using the Wilcoxon signed-rank test. Results Twenty-five readers (median age, 38 years; IQR, 31-45 years; 19 men) were recruited and included nine subspecialized abdominal radiologists, five nonabdominal staff radiologists, and 11 senior residents or fellows. Reader experience explained differences in area under the JAFROC curve, with abdominal radiologists demonstrating greater area under the JAFROC curve (mean, 0.77; 95% CI: 0.75, 0.79) than trainees (mean, 0.71; 95% CI: 0.69, 0.73) (P = .02) or nonabdominal subspecialists (mean, 0.69; 95% CI: 0.60, 0.78) (P = .03). Sensitivity was similar within the reader experience groups (P = .96). Image navigation variables that were associated with higher sensitivity included longer interpretation time (P = .003) and greater use of coronal images (P < .001). The eye gaze time was at least 0.5 and 2.0 seconds for 71% (266 of 377) and 40% (149 of 377) of missed metastases, respectively. Conclusion Abdominal radiologists demonstrated better discrimination for the detection of liver metastases on abdominal contrast-enhanced CT images. Missed metastases frequently received at least a brief eye gaze. Higher sensitivity was associated with longer interpretation time and greater use of liver display windows and coronal images. © RSNA, 2022 Online supplemental material is available for this article.
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Neoplasias Hepáticas , Masculino , Humanos , Adulto , Neoplasias Hepáticas/patología , Errores Diagnósticos , Estudios Retrospectivos , Tomografía Computarizada por Rayos X/métodosRESUMEN
BACKGROUND: Artificial intelligence (AI), and more specifically deep learning, models have demonstrated the potential to augment physician diagnostic capabilities and improve cardiovascular health if incorporated into routine clinical practice. However, many of these tools are yet to be evaluated prospectively in the setting of a rigorous clinical trial-a critical step prior to implementing broadly in routine clinical practice. OBJECTIVES: To describe the rationale and design of a proposed clinical trial aimed at evaluating an AI-enabled electrocardiogram (AI-ECG) for cardiomyopathy detection in an obstetric population in Nigeria. DESIGN: The protocol will enroll 1,000 pregnant and postpartum women who reside in Nigeria in a prospective randomized clinical trial. Nigeria has the highest reported incidence of peripartum cardiomyopathy worldwide. Women aged 18 and older, seen for routine obstetric care at 6 sites (2 Northern and 4 Southern) in Nigeria will be included. Participants will be randomized to the study intervention or control arm in a 1:1 fashion. This study aims to enroll participants representative of the general obstetric population at each site. The primary outcome is a new diagnosis of cardiomyopathy, defined as left ventricular ejection fraction (LVEF) < 50% during pregnancy or within 12 months postpartum. Secondary outcomes will include the detection of impaired left ventricular function (at different LVEF cut-offs), and exploratory outcomes will include the effectiveness of AI-ECG tools for cardiomyopathy detection, new diagnosis of cardiovascular disease, and the development of composite adverse maternal cardiovascular outcomes. SUMMARY: This clinical trial focuses on the emerging field of cardio-obstetrics and will serve as foundational data for the use of AI-ECG tools in an obstetric population in Nigeria. This study will gather essential data regarding the utility of the AI-ECG for cardiomyopathy detection in a predominantly Black population of women and pave the way for clinical implementation of these models in routine practice. TRIAL REGISTRATION: Clinicaltrials.gov: NCT05438576.
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Cardiomiopatías , Trastornos Puerperales , Embarazo , Humanos , Femenino , Función Ventricular Izquierda , Volumen Sistólico , Inteligencia Artificial , Nigeria/epidemiología , Periodo Periparto , Estudios Prospectivos , Cardiomiopatías/diagnóstico , Cardiomiopatías/epidemiología , Cardiomiopatías/etiología , Trastornos Puerperales/diagnóstico , Trastornos Puerperales/epidemiologíaRESUMEN
INTRODUCTION/AIMS: In the Diabetes Control and Complications Trial (DCCT), the minimal nerve conduction (NC) criterion for diabetic sensorimotor polyneuropathy (DSPN) was abnormality of NC in more than one peripheral nerve without specifying the attributes of NCs to be evaluated. In the present study, we assess individual and composite scores of NCs meeting the DCCT criterion and signs for improved diagnosis and assessment of DSPN severity. METHODS: Evaluated were 13 attributes and 6 composite NC scores and signs and symptoms in 395 healthy subjects (HS) and 388 persons with diabetes (DM). RESULTS: Percent abnormality between subjects with DM and HS was remarkably different among individual attributes and the six composite NC scores. For diagnosis of DSPN using the DCCT criterion, assessment of conduction velocities (CVs) and distal latencies (DLs) provided sensitive diagnoses of DSPN. NC amplitudes provided stronger measures of severity. In studied cohorts, DSPN was staged: N0, no NC abnormality using NC score 2 (CVs and DLs), 60.0%; N1, NC abnormality only, 18.4%; N2, NC abnormality and signs of feet or legs, 16.3%; and N3, NC abnormality and signs of thighs, 5.3%. DISCUSSION: For sensitive and standard diagnosis of DSPN using the DCCT NC criterion, specifically defined composite scores of CVs and DLs, e.g., score 2, is recommended. A composite score of amplitudes, e.g., score 4, provides a stronger measure of neuropathy severity. Also, provided are HS reference values of evaluated attributes of NCs and estimates of staged severity of DSPN of mid North American DM cohorts.
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Diabetes Mellitus , Neuropatías Diabéticas , Polineuropatías , Humanos , Pierna , Conducción Nerviosa/fisiología , América del NorteRESUMEN
BACKGROUND. Anatomic redundancy between phases can be used to achieve denoising of multiphase CT examinations. A limitation of iterative reconstruction (IR) techniques is that they generally require use of CT projection data. A frequency-split multi-band-filtration algorithm applies denoising to the multiphase CT images themselves. This method does not require knowledge of the acquisition process or integration into the reconstruction system of the scanner, and it can be implemented as a supplement to commercially available IR algorithms. OBJECTIVE. The purpose of the present study is to compare radiologists' performance for low-contrast and high-contrast diagnostic tasks (i.e., tasks for which differences in CT attenuation between the imaging target and its anatomic background are subtle or large, respectively) evaluated on multiphase abdominal CT between routine-dose images and radiation dose-reduced images processed by a frequency-split multiband-filtration denoising algorithm. METHODS. This retrospective single-center study included 47 patients who underwent multiphase contrast-enhanced CT for known or suspected liver metastases (a low-contrast task) and 45 patients who underwent multiphase contrast-enhanced CT for pancreatic cancer staging (a high-contrast task). Radiation dose-reduced images corresponding to dose reduction of 50% or more were created using a validated noise insertion technique and then underwent denoising using the frequency-split multi-band-filtration algorithm. Images were independently evaluated in multiple sessions by different groups of abdominal radiologists for each task (three readers in the low-contrast arm and four readers in the high-contrast arm). The noninferiority of denoised radiation dose-reduced images to routine-dose images was assessed using the jackknife alternative free-response ROC (JAFROC) figure-of-merit (FOM; limit of noninferiority, -0.10) for liver metastases detection and using the Cohen kappa statistic and reader confidence scores (100-point scale) for pancreatic cancer vascular invasion. RESULTS. For liver metastases detection, the JAFROC FOM for denoised radiation dose-reduced images was 0.644 (95% CI, 0.510-0.778), and that for routine-dose images was 0.668 (95% CI, 0.543-0.792; estimated difference, -0.024 [95% CI, -0.084 to 0.037]). Intraobserver agreement for pancreatic cancer vascular invasion was substantial to near perfect when the two image sets were compared (κ = 0.53-1.00); the 95% CIs of all differences in confidence scores between image sets contained zero. CONCLUSION. Multiphase contrast-enhanced abdominal CT images with a radiation dose reduction of 50% or greater that undergo denoising by a frequency-split multiband-filtration algorithm yield performance similar to that of routine-dose images for detection of liver metastases and vascular staging of pancreatic cancer. CLINICAL IMPACT. The image-based denoising algorithm facilitates radiation dose reduction of multiphase examinations for both low- and high-contrast diagnostic tasks without requiring manufacturer-specific hardware or software.
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Neoplasias Hepáticas , Tomografía Computarizada por Rayos X , Humanos , Estudios Retrospectivos , Dosis de Radiación , Tomografía Computarizada por Rayos X/métodos , Neoplasias Hepáticas/diagnóstico por imagen , Algoritmos , Interpretación de Imagen Radiográfica Asistida por Computador/métodosRESUMEN
In this short narrative, we highlight some of our experiences leading the US Convalescent Plasma Program at the beginning of the pandemic in the spring and summer of 2020. This includes a brief summary of how the program emerged and high-level lessons we learned. We also share our impressions about why convalescent plasma was used at scale in the United States, early in the pandemic and share ideas that might inform the use of convalescent plasma in future outbreaks of novel infectious diseases.
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COVID-19 , Humanos , Estados Unidos , SARS-CoV-2 , Sueroterapia para COVID-19 , Brotes de Enfermedades , Pandemias , Inmunización PasivaRESUMEN
Electronic health records have facilitated the extraction and analysis of a vast amount of data with many variables for clinical care and research. Conventional regression-based statistical methods may not capture all the complexities in high-dimensional data analysis. Therefore, researchers are increasingly using machine learning (ML)-based methods to better handle these more challenging datasets for the discovery of hidden patterns in patients' data and for classification and predictive purposes. This article describes commonly used ML methods in structured data analysis with examples in orthopedic surgery. We present practical considerations in starting an ML project and appraising published studies in this field.
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Registros Electrónicos de Salud , Aprendizaje Automático , HumanosRESUMEN
INTRODUCTION: Perceived age is defined as how old a person looks to external evaluators. It reflects the underlying biological age, which is a measure based on physical and physiological parameters reflecting a person's aging process more accurately than chronological age. People with a higher biological age have shorter lives compared to those with a lower biological age with the same chronological age. Our review aims to find whether increased perceived age is a risk factor for overall mortality risk or comorbidities. METHODS: A literature search of three databases was conducted following the PRISMA guidelines for studies analyzing perceived age or isolated facial characteristics of old age and their relationship to mortality risk or comorbidity outcomes. Data on the number of patients, type and characteristics of evaluation methods, evaluator characteristics, mean chronologic age, facial characteristics studied, measured outcomes, and study results were collected. RESULTS: Out of 977 studies, 15 fulfilled the inclusion criteria. These studies found an increase in mortality risk of 6-51% in older-looking people compared to controls (HR 1.06-1.51, p < 0.05). In addition, perceived age and some facial characteristics of old age were also associated with cardiovascular risk and myocardial infarction, cognitive function, bone mineral density, and chronic obstructive pulmonary disease (COPD). CONCLUSION: Perceived age promises to be a clinically useful predictor of overall mortality and cardiovascular, pulmonary, cognitive, and osseous comorbidities. LEVEL OF EVIDENCE III: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Factores de Edad , Comorbilidad , Mortalidad , Anciano , HumanosRESUMEN
Photodamage is caused by chronic sun exposure and ultraviolet radiation and presents as wrinkles, sagging, and pigmented spots. An increase in the ultraviolet index can increase a person's perceived age by worsening skin photodamage. However, since the ultraviolet index varies considerably between geographical regions, perceived age might vary substantially among them. This review aims to describe the differences in chronological and perceived age in regions of the world with different ultraviolet indexes. A literature search of three databases was conducted for studies analyzing perceived age and its relationship to sun exposure. Ultraviolet indexes from the included studies were retrieved from the National Weather Service and the Tropospheric Emission Monitoring Internet Service. Out of 104 studies, seven fulfilled the inclusion criteria. Overall, 3,352 patients were evaluated for perceived age. All studies found that patients with the highest daily sun exposures had the highest perceived ages for their chronological age ( p < 0.05). People with high sun exposure behaviors living in regions with high ultraviolet indexes will look significantly older than same-aged peers living in lower ultraviolet index regions.
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BACKGROUND: Heart rate-corrected QT interval (QTc) prolongation, whether secondary to drugs, genetics including congenital long QT syndrome, and/or systemic diseases including SARS-CoV-2-mediated coronavirus disease 2019 (COVID-19), can predispose to ventricular arrhythmias and sudden cardiac death. Currently, QTc assessment and monitoring relies largely on 12-lead electrocardiography. As such, we sought to train and validate an artificial intelligence (AI)-enabled 12-lead ECG algorithm to determine the QTc, and then prospectively test this algorithm on tracings acquired from a mobile ECG (mECG) device in a population enriched for repolarization abnormalities. METHODS: Using >1.6 million 12-lead ECGs from 538 200 patients, a deep neural network (DNN) was derived (patients for training, n = 250 767; patients for testing, n = 107 920) and validated (n = 179 513 patients) to predict the QTc using cardiologist-overread QTc values as the "gold standard". The ability of this DNN to detect clinically-relevant QTc prolongation (eg, QTc ≥500 ms) was then tested prospectively on 686 patients with genetic heart disease (50% with long QT syndrome) with QTc values obtained from both a 12-lead ECG and a prototype mECG device equivalent to the commercially-available AliveCor KardiaMobile 6L. RESULTS: In the validation sample, strong agreement was observed between human over-read and DNN-predicted QTc values (-1.76±23.14 ms). Similarly, within the prospective, genetic heart disease-enriched dataset, the difference between DNN-predicted QTc values derived from mECG tracings and those annotated from 12-lead ECGs by a QT expert (-0.45±24.73 ms) and a commercial core ECG laboratory [10.52±25.64 ms] was nominal. When applied to mECG tracings, the DNN's ability to detect a QTc value ≥500 ms yielded an area under the curve, sensitivity, and specificity of 0.97, 80.0%, and 94.4%, respectively. CONCLUSIONS: Using smartphone-enabled electrodes, an AI DNN can predict accurately the QTc of a standard 12-lead ECG. QTc estimation from an AI-enabled mECG device may provide a cost-effective means of screening for both acquired and congenital long QT syndrome in a variety of clinical settings where standard 12-lead electrocardiography is not accessible or cost-effective.
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Inteligencia Artificial , Electrocardiografía/métodos , Cardiopatías/diagnóstico , Frecuencia Cardíaca/fisiología , Adulto , Anciano , Área Bajo la Curva , COVID-19/fisiopatología , COVID-19/virología , Electrocardiografía/instrumentación , Femenino , Cardiopatías/fisiopatología , Humanos , Síndrome de QT Prolongado/diagnóstico , Síndrome de QT Prolongado/fisiopatología , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Curva ROC , SARS-CoV-2/aislamiento & purificación , Sensibilidad y Especificidad , Teléfono InteligenteRESUMEN
We characterized coronavirus disease 2019 (COVID-19) breakthrough cases admitted to a single center in Florida. With the emergence of delta variant, an increased number of hospitalizations was seen due to breakthrough infections. These patients were older and more likely to have comorbidities. Preventive measures should be maintained even after vaccination.
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Vacunas contra la COVID-19 , COVID-19 , COVID-19/epidemiología , COVID-19/prevención & control , Florida/epidemiología , Hospitalización , Humanos , SARS-CoV-2RESUMEN
BACKGROUND: While COVID-19 immunization programs attempted to reach targeted rates, cases rose significantly since the emergence of the delta variant. This retrospective cohort study describes the correlation between antispike antibodies and outcomes of hospitalized, breakthrough cases during the delta variant surge. METHODS: All patients with positive SARS-CoV-2 polymerase chain reaction hospitalized at Mayo Clinic Florida from 19 June 2021 to 11 November 2021 were considered for analysis. Cases were analyzed by vaccination status. Breakthrough cases were then analyzed by low and high antibody titers against SARS-CoV-2 spike protein, with a cut-off value of ≥132 U/ml. Outcomes included hospital length of stay (LOS), need for intensive care unit (ICU), mechanical ventilation, and mortality. We used 1:1 nearest neighbor propensity score matching without replacement to assess for confounders. RESULTS: Among 627 hospitalized patients with COVID-19, vaccine breakthrough cases were older with more comorbidities compared to unvaccinated. After propensity score matching, the unvaccinated patients had higher mortality (27 [28.4%] vs. 12 [12.6%], p = 0.002) and LOS (7 [1.0-57.0] vs. 5 [1.0-31.0] days, p = 0.011). In breakthrough cases, low-titer patients were more likely to be solid organ transplant recipients (16 [34.0%] vs. 9 [12.3%], p = 0.006), with higher need for ICU care (24 [51.1%] vs. 22 [11.0%], p = 0.034), longer hospital LOS (median 6 vs. 5 days, p = 0.013), and higher mortality (10 [21.3%] vs. 5 [6.8%], p = 0.025) than high-titer patients. CONCLUSIONS: Hospitalized breakthrough cases were more likely to have underlying risk factors than unvaccinated patients. Low-spike antibody titers may serve as an indicator for poor prognosis in breakthrough cases admitted to the hospital.
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Anticuerpos Antivirales , COVID-19 , Hospitalización , Glicoproteína de la Espiga del Coronavirus/inmunología , Anticuerpos Antivirales/sangre , COVID-19/diagnóstico , COVID-19/inmunología , Vacunas contra la COVID-19 , Humanos , Estudios Retrospectivos , SARS-CoV-2RESUMEN
The efficacy of COVID-19 convalescent plasma (CCP) as a treatment for hospitalized patients with COVID-19 remains somewhat controversial; however, many studies have not evaluated CCP documented to have high neutralizing antibody titer by a highly accurate assay. To evaluate the correlation of the administration of CCP with titer determined by a live viral neutralization assay with 7- and 28-day death rates during hospitalization, a total of 23 118 patients receiving a single unit of CCP were stratified into two groups: those receiving high titer CCP (>250 50% inhibitory dilution, ID50; n = 13 636) or low titer CCP (≤250 ID50; n = 9482). Multivariable Cox regression was performed to assess risk factors. Non-intubated patients who were transfused with high titer CCP showed 1.1% and 1.7% absolute reductions in overall 7- and 28-day death rates, respectively, compared to those non-intubated patients receiving low titer CCP. No benefit of CCP was observed in intubated patients. The relative benefit of high titer CCP was confirmed in multivariable Cox regression. Administration of CCP with high titer antibody content determined by live viral neutralization assay to non-intubated patients is associated with modest clinical efficacy. Although shown to be only of modest clinical benefit, CCP may play a role in the future should viral variants develop that are not neutralized by other available therapeutics.
Asunto(s)
COVID-19 , SARS-CoV-2 , Anticuerpos Neutralizantes , Anticuerpos Antivirales , COVID-19/terapia , Humanos , Inmunización Pasiva , Resultado del Tratamiento , Sueroterapia para COVID-19RESUMEN
Because of a convergence of the availability of large data sets, graphics-specific computer hardware, and important theoretical advancements, artificial intelligence has recently contributed to dramatic progress in medicine. One type of artificial intelligence known as deep learning has been particularly impactful for medical image analysis. Deep learning applications have shown promising results in dermatology and other specialties, including radiology, cardiology, and ophthalmology. The modern clinician will benefit from an understanding of the basic features of deep learning to effectively use new applications and to better gauge their utility and limitations. In this second article of a 2-part series, we review the existing and emerging clinical applications of deep learning in dermatology and discuss future opportunities and limitations. Part 1 of this series offered an introduction to the basic concepts of deep learning to facilitate effective communication between clinicians and technical experts.
Asunto(s)
Aprendizaje Profundo , Radiología , Humanos , Inteligencia Artificial , Dermatólogos , Radiología/métodos , RadiografíaRESUMEN
Artificial intelligence is generating substantial interest in the field of medicine. One form of artificial intelligence, deep learning, has led to rapid advances in automated image analysis. In 2017, an algorithm demonstrated the ability to diagnose certain skin cancers from clinical photographs with the accuracy of an expert dermatologist. Subsequently, deep learning has been applied to a range of dermatology applications. Although experts will never be replaced by artificial intelligence, it will certainly affect the specialty of dermatology. In this first article of a 2-part series, the basic concepts of deep learning will be reviewed with the goal of laying the groundwork for effective communication between clinicians and technical colleagues. In part 2 of the series, the clinical applications of deep learning in dermatology will be reviewed and limitations and opportunities will be considered.