Machine Learning Models and Applications for Early Detection.

From the various perspectives of machine learning (ML) and the multiple models used in this discipline, there is an approach aimed at training models for the early detection (ED) of anomalies. The early detection of anomalies is crucial in multiple areas of knowledge since identifying and classifying them allows for early decision making and provides a better response to mitigate the negative effects caused by late detection in any system. This article presents a literature review to examine which machine learning models (MLMs) operate with a focus on ED in a multidisciplinary manner and, specifically, how these models work in the field of fraud detection. A variety of models were found, including Logistic Regression (LR), Support Vector Machines (SVMs), decision trees (DTs), Random Forests (RFs), naive Bayesian classifier (NB), K-Nearest Neighbors (KNNs), artificial neural networks (ANNs), and Extreme Gradient Boosting (XGB), among others. It was identified that MLMs operate as isolated models, categorized in this article as Single Base Models (SBMs) and Stacking Ensemble Models (SEMs). It was identified that MLMs for ED in multiple areas under SBMs' and SEMs' implementation achieved accuracies greater than 80% and 90%, respectively. In fraud detection, accuracies greater than 90% were reported by the authors. The article concludes that MLMs for ED in multiple applications, including fraud, offer a viable way to identify and classify anomalies robustly, with a high degree of accuracy and precision. MLMs for ED in fraud are useful as they can quickly process large amounts of data to detect and classify suspicious transactions or activities, helping to prevent financial losses.

Evaluation of potency and metabolic stability of diphyllin-derived Vacuolar-ATPase inhibitors.

Diphyllin is a naturally occurring lignan comprised of an aryl naphthalene lactone scaffold that demonstrates beneficial biological activities in disease models of cancer, obesity, and viral infection. A target of diphyllin and naturally occurring derivatives is the vacuolar ATPase (V-ATPase) complex. Although diphyllin-related natural products are active with in vitro models for viral entry, the potencies and unknown pharmacokinetic properties limit well-designed in vivo evaluations. Previous studies demonstrated that diphyllin derivatives have the utility of blocking the Ebola virus cell entry pathway. However, diphyllin shows limited potency and poor oral bioavailability in mice. An avenue to improve the potency was used in a new library of synthetic derivatives of diphyllin. Diphyllin derivatives exploiting ether linkages at the 4-position with one-to-three carbon spacers to an oxygen or nitrogen atom provided compounds with EC50 values ranging from 7 to 600 nM potency and selectivity up to >500 against Ebola virus in infection assays. These relative potencies are reflected in the Ebola virus infection of primary macrophages, a cell type involved in early pathogenesis. A target engagement study reveals that reducing the ATPV0a2 protein expression enhanced the potency of diphyllin derivatives to block EBOV entry, consistent with effects on the endosomal V-ATPase function. Despite the substantial enhancement of antiviral potencies, limitations were identified, including rapid clearance predicted by in vitro microsome stability assays. However, compounds with similar or improved half-lives relative to diphyllin demonstrated improved pharmacokinetic profiles in vivo. Importantly, these derivatives displayed suitable plasma levels using oral administration, establishing the feasibility of in vivo antiviral testing.

Combined Charlson comorbidity/C-Reactive Protein Index Is a Novel Predictor in Renal Cell Carcinoma: Analysis of the International Marker Consortium for Renal Cancer (INMARC) Registry.

OBJECTIVE: To evaluate predictive ability of a novel combined index, Charlson comorbidity index and C-reactive protein (CCI-CRP), for outcomes in renal cell carcinoma (RCC), and compare predictive outcomes with of CCI-CRP to its separate components and to the UCLA integrated staging system (UISS). PATIENTS AND METHODS: We retrospectively analyzed INMARC registry of RCC patients. Receiver Operator Characteristics (ROC) analysis was fitted to identify threshold defining low-CRP (LCRP) and high-CRP (HCRP). Patients were stratified according to CCI [low-CCI ≤ 3 (LCCI); intermediate-CCI 4-6 (ICCI); high-CCI > 6 (HCCI)] and CRP level. Kaplan-Meier analysis (KMA) was conducted for overall (OS) and cancer-specific survival (CSS). Based on survival analysis distribution we proposed a new stratification: CCI-CRP. Model performance was assessed with ROC/area under the curve (AUC) analysis and compared to CCI and CRP alone, and UISS. RESULTS: We analyzed 2,890 patients (median follow-up 30 months). ROC identified maximum product sensitivity and specificity for CRP at 3.5 mg/L. KMA revealed 5-year OS of 95.6% for LCRP/LCCI, 83% LCRP/ICCI, 73.3% LCRP/HCCI, 62.6% HCRP/LCCI, 51.6% HCRP/ICCI and 40.5% HCRP/HCCI (P < .001). From this distribution, new CCI-CRP is proposed: low CCI-CRP (LCRP/LCCI and LCRP/ICCI), intermediate CCI-CRP (LCRP/HCCI and HCRP/LCCI), and high CCI-CRP (HCRP/ICCI and HCRP/HCCI). AUC for CCI-CRP showed improved performance for predicting OS/CSS vs. CCI alone (0.73 vs. 0.63/0.77 vs. 0.60), CRP alone (0.73 vs. 0.71/0.77 vs. 0.74) and UISS (0.73 vs 0.67/0.77 vs 0.73). CONCLUSIONS: CCI-CRP, exhibits increased prognostic performance for survival outcomes in RCC compared to CCI and CRP alone, and UISS. Further investigation is requisite.

Association of Elevated C-Reactive Protein with Worsened Outcomes in Different Histologies of Renal Cortical Tumors: Analysis of the INMARC Registry.

BACKGROUND: To evaluate relationship between histological subtypes of renal cell carcinoma (RCC) and preoperative c-reactive protein (CRP). PATIENTS AND METHODS: We queried the International Marker Consortium for Renal Cancer database for patients affected by RCC. Patients were classified according to their histology: benign tumors, clear cell (cc) RCC, chromophobe (ch) RCC, papillary (p) RCC, and variant histology (vh) RCC; and according to CRP (mg/L): low CRP ≤5 and high CRP >5. Primary outcome was all-cause mortality (ACM). Secondary outcomes were cancer-specific mortality (CSM), recurrence and association between CRP and histology. Multivariable analysis (MVA) via Cox regression and multivariable logistic regression were fitted to elucidate predictors of outcomes. RESULTS: Total 3902 patients (high CRP n = 1266) were analyzed; median follow up 51 (IQR 20-91) months. On MVA elevated CRP was an independent risk factor associated with increased risk of ACM in benign tumors (HR 5.98, P < .001), ccRCC (HR 2.69, P < .001), chRCC (HR 3.99, P < .001), pRCC (HR 1.76, P = .009) and vhRCC (HR 2.97, P =.007). MVA for CSM showed CRP as risk factor in ccRCC (HR 2.77, P < .001), chRCC (HR 6.16, P = .003) and pRCC (HR 2.29, P = .011), while in vhRCC was not (P = .27). MVA for recurrence reported CRP as risk factor for ccRCC (HR 1.30, P = .013), while in chRCC (P = .33), pRCC (P = .34) and vhRCC (P = .52) was not. On multivariable logistic regression CRP was a predictor of pRCC (OR 1.003, P = .002), while decreasing CRP was associated with benign tumors (OR 0.994, P = .048). CONCLUSION: Elevated CRP was a robust predictor of worsened ACM in all renal cortical neoplasms. While most frequently observed in pRCC patients, elevated CRP was independently associated with worsened CSM in non-vhRCC. Conversely, elevated CRP was least likely to be noted in benign tumors, and elevation in this subgroup of patients should prompt further consideration for surveillance given increased risk of ACM. Further investigation is requisite.

Organizing pneumonia due to anti-synthetase syndrome: Presentation of a clinical case

Introduction: Organizing pneumonia is a rare clinico-pathological syndrome. This crypto-genic or secondary condition is of unknown origin, and may be infectious, or associated with autoimmune diseases, cancer, drugs, or radiation. Case description: The case is presented of a 52-year-old patient who was diagnosed with organizing pneumonia secondary to anti-synthetase syndrome. Discussion: It is intended to make known that not all pulmonary consolidative clinical pictures correspond to infectious processes. In this case, an organizing pneumonia secondary to anti-synthetase syndrome is documented. Despite being a disorder that is classified as an idiopathic inflammatory myopathy, it manifests as an interstitial lung disease with predominantly respiratory symptoms.

Introducción: La neumonía organizativa es un síndrome clínico-patológico poco frecuente, dentro del cual se desconoce la etiología de la denominada neumonía criptogénica o secundaria, que puede ser infecciosa o asociada con enfermedades autoinmunes, cáncer, fármacos o radiación. Descripción del caso: Se presenta el caso de una paciente de 52 arios a quien se le diagnostica neumonía organizativa secundaria a síndrome antisintetasa. Discusión: Se busca dar a conocer que no todos los cuadros clínicos de consolidación pulmonar corresponden a procesos infecciosos. En este caso se documentó una neumonía organizativa secundaria a síndrome antisintetasa, la cual a pesar de ser una patología que se cataloga como una miopatía inflamatoria idiopática, se manifestó como una enfermedad pulmonar intersticial con síntomas predominantemente respiratorios.

Embolia pulmonar tumoral: una manifestación inicial infrecuente del cáncer / Pulmonary tumour embolism: An infrequent initial manifestation of cancer

Resumen Generalmente la embolia pulmonar puede ser resultado de una trombosis, sin embargo, existen otros tipos de embolismos pulmonares. Se describe el caso de una paciente de 44 años de edad con artritis reumatoide, uso de terapia biológica y sin diagnóstico previo de cáncer, que presentó embolismo pulmonar en el contexto de trombosis venosa en miembros inferiores sin respuesta a la anticoagulación por lo que se estudiaron otras posibles etiologías, documentando finalmente embolismo tumoral por adenocarcinoma de origen desconocido posiblemente de mama. La posibilidad de embolia pulmonar tumoral se debe considerar ante la no respuesta al tratamiento con anticoagulación.

Abstract Pulmonary embolism is usually caused by thrombosis; however there are other types of pulmonary embolisms. The case is presented of a 44 year-old patient with rheumatoid arthritis on biological therapy, with no previous diagnosis of cancer. The patient had a pulmonary embolism in the context of venous thrombosis in the lower limbs, with no response to anticoagulation treatment. It was finally documented as a tumour embolism due to adenocarcinoma of unknown origin, possibly of the breast. The possibility of a pulmonary tumour embolism should be considered in the absence of a response to anticoagulation therapy.

Consenso de la Sociedad Colombiana de Anestesiología y Reanimación, SCARE, y de la Sociedad Colombiana de Cirugía Plástica sobre las recomendaciones para el manejo de pacientes electivos de bajo riesgo(1) / Colombian Society of Anesthesiology and Resuscitation and Colombian Plastic Surgery Society Consensus (1)

Este documento define algunos aspectos particulares al ejercicio de la anestesia en cirugía plástica que pretenden mejorar la seguridad de los pacientes. Se hace énfasis en la presentación de estrategias para reducir las complicaciones graves prevenibles más comunes, como los eventos de trombosis, embolias e infecciones. Se establece que estas metas se logran con la participación de los cirujanos y de los anestesiólogos. Estas recomendaciones son adiciones puntuales a las normas mínimas que ha desarrollado la SCARE.

This document defines some particular aspects involved in practising anaesthesia in plastic surgery which are intended to improve patient safety. It presents strategies for reducing the most common serious preventable complications, such as thrombotic, embolic and infectious events. It should be stressed that these goals have been established and must be achieved with surgeons and anaesthesiologists’ participation. These recommendations provide detailed are additions to the Minimum Standards which SCARE has developed.

Revisión semiologica respiratoria Tos: acercamiento a la fisiopatología, enfoque y tratamiento / Review respiratory semiology: cough approach to the pathophysiology, diagnosis and treatment

La tos es uno de los síntomas respiratorios más amplios y comunes dentro de la consulta médica, encontrándose, en la práctica clínica diaria, grandes dificultades para un adecuado abordaje diagnóstico, clasificación y tratamiento. Puede ser subestimada en la mayoría de los casos, por lo que se hace prioritaria la revisión de este síntoma, abarcando fisiopatología, orientación diagnóstica y aproximación terapéutica.