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1.
BMC Pediatr ; 24(1): 252, 2024 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-38622583

RESUMEN

BACKGROUND: Cystic fibrosis is a chronic genetic disease that can affect the function of the respiratory system. Previous reviews of the effects of respiratory muscle training in people with cystic fibrosis are uncertain and do not consider the effect of age on disease progression. This systematic review aims to determine the effectiveness of respiratory muscle training in the clinical outcomes of children and adolescents with cystic fibrosis. METHODS: Up to July 2023, electronic databases and clinical trial registries were searched. Controlled clinical trials comparing respiratory muscle training with sham intervention or no intervention in children and adolescents with cystic fibrosis. The primary outcomes were respiratory muscle strength, respiratory muscle endurance, lung function, and cough. Secondary outcomes included exercise capacity, quality of life and adverse events. Two review authors independently extracted data and assessed study quality using the Cochrane Risk of Bias Tool 2. The certainty of the evidence was assessed according to the GRADE approach. Meta-analyses where possible; otherwise, take a qualitative approach. RESULTS: Six studies with a total of 151 participants met the inclusion criteria for this review. Two of the six included studies were published in abstract form only, limiting the available information. Four studies were parallel studies and two were cross-over designs. There were significant differences in the methods and quality of the methodology included in the studies. The pooled data showed no difference in respiratory muscle strength, lung function, and exercise capacity between the treatment and control groups. However, subgroup analyses suggest that inspiratory muscle training is beneficial in increasing maximal inspiratory pressure, and qualitative analyses suggest that respiratory muscle training may benefit respiratory muscle endurance without any adverse effects. CONCLUSIONS: This systematic review and meta-analysis indicate that although the level of evidence indicating the benefits of respiratory muscle training is low, its clinical significance suggests that we further study the methodological quality to determine the effectiveness of training. TRIAL REGISTRATION: The protocol for this review was recorded in the International Prospective Register of Systematic Reviews (PROSPERO) under registration number CRD42023441829.


Asunto(s)
Fibrosis Quística , Niño , Adolescente , Humanos , Fibrosis Quística/terapia , Calidad de Vida , Ejercicios Respiratorios/métodos , Enfermedad Crónica , Músculos Respiratorios
2.
PLoS Biol ; 22(4): e3002566, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38652717

RESUMEN

Phage therapy is a therapeutic approach to treat multidrug-resistant (MDR) infections that employs lytic bacteriophages (phages) to eliminate bacteria. Despite the abundant evidence for its success as an antimicrobial in Eastern Europe, there is scarce data regarding its effects on the human host. Here, we aimed to understand how lytic phages interact with cells of the airway epithelium, the tissue site that is colonized by bacterial biofilms in numerous chronic respiratory disorders. Using a panel of Pseudomonas aeruginosa phages and human airway epithelial cells (AECs) derived from a person with cystic fibrosis (CF), we determined that interactions between phages and epithelial cells depend on specific phage properties as well as physiochemical features of the microenvironment. Although poor at internalizing phages, the airway epithelium responds to phage exposure by changing its transcriptional profile and secreting antiviral and proinflammatory cytokines that correlate with specific phage families. Overall, our findings indicate that mammalian responses to phages are heterogenous and could potentially alter the way that respiratory local defenses aid in bacterial clearance during phage therapy. Thus, besides phage receptor specificity in a particular bacterial isolate, the criteria to select lytic phages for therapy should be expanded to include mammalian cell responses.


Asunto(s)
Fibrosis Quística , Citocinas , Células Epiteliales , Pseudomonas aeruginosa , Humanos , Pseudomonas aeruginosa/virología , Células Epiteliales/virología , Células Epiteliales/metabolismo , Células Epiteliales/inmunología , Citocinas/metabolismo , Fibrosis Quística/terapia , Fibrosis Quística/inmunología , Fibrosis Quística/metabolismo , Terapia de Fagos , Bacteriófagos/fisiología , Bacteriófagos/genética , Mucosa Respiratoria/virología , Mucosa Respiratoria/metabolismo , Mucosa Respiratoria/inmunología , Infecciones por Pseudomonas/terapia , Infecciones por Pseudomonas/inmunología , Fagos Pseudomonas/metabolismo , Biopelículas
3.
Rev Med Liege ; 79(3): 175-180, 2024 Mar.
Artículo en Francés | MEDLINE | ID: mdl-38487912

RESUMEN

It is estimated that in highly medicalised countries, median life expectancy for most newborns with cystic fibrosis now exceeds 70 years, approaching that of the general population. However, socio-economic disparities between countries continue to have a devastating impact on the prognosis of patients in Eastern Europe, Africa, India and South America. In Morocco, very limited genetic data suggest that the prevalence of this disease is at least of the same order as in Belgium. But as it is not really recognised by the national health system, patients are denied access even to symptomatic treatment. As a result, their outcome is tragic, similar to what it was 60 years ago in the most medicalised countries. A pilot project for a first paediatric reference centre in Casablanca is currently being set up. If properly resourced, this project can only be a success and should be the first step on the road towards cystic fibrosis care in this country. In a very humble way, several Belgian stakeholders are trying to support this project.


Dans les pays les plus médicalisés, l'espérance de vie médiane de la plupart des nouveau-nés atteints de mucoviscidose excède aujourd'hui 70 ans et se rapproche de celle de la population générale. Ailleurs, en Europe de l'Est comme en Afrique, en Inde ou en Amérique du Sud, les disparités socio-économiques des pays continuent à impacter très durement le pronostic des patients. Au Maroc, des données génétiques très fragmentaires suggèrent que la prévalence de la mucoviscidose est au moins du même ordre qu'en Belgique. Mais la maladie n'y est pas réellement reconnue par le système de santé, de telle sorte que même le traitement symptomatique reste inaccessible aux patients et leur pronostic est tragique, similaire à ce qu'il était il y a 60 ans dans les pays les plus médicalisés. À Casablanca, le projet pilote d'un premier Centre pédiatrique de Référence est en train de se mettre en place. S'il bénéficie d'un support adéquat, ce projet ne peut être qu'un succès et doit constituer un tout premier pas sur le chemin vers une prise en charge des patients dans ce pays. Très modestement, plusieurs intervenants belges tentent d'y apporter leur soutien.


Asunto(s)
Fibrosis Quística , Niño , Humanos , Recién Nacido , Fibrosis Quística/epidemiología , Fibrosis Quística/terapia , Proyectos Piloto , Bélgica/epidemiología
4.
Med Sci (Paris) ; 40(3): 258-267, 2024 Mar.
Artículo en Francés | MEDLINE | ID: mdl-38520101

RESUMEN

Over time, cystic fibrosis has become a model of synergy between research in pathophysiology and cell biology, and clinical advances. Therapies targeting the CFTR protein, in particular CFTR modulators, have transformed the prognosis of patients, bringing the hope of a normal life with the possibility of starting a family and growing old, challenging established statistics. However, patients are not yet cured, and side effects remain insufficiently documented. Epidemiological changes create new challenges for the management of cystic fibrosis. Approximately 10 % of patients still lack a therapeutic option. The community of researchers, pharmaceutical industries, patient associations, and health authorities remains committed to monitor the long-term effects of these still poorly characterised treatments, and to explore new pharmacological approaches, such as gene therapies.


Title: Traitements de la mucoviscidose - Révolution clinique et nouveaux défis. Abstract: Avec le temps, la mucoviscidose est devenue un exemple de synergie entre la recherche en biologie cellulaire et les progrès cliniques. Les thérapies protéiques ont enfin apporté l'espoir d'une vie normale aux patients, bouleversant ainsi les statistiques épidémiologiques établies. Néanmoins, les patients ne guérissent pas, et l'évolution épidémiologique de la maladie ouvre de nouveaux défis pour la prise en charge des malades. Par ailleurs, environ 10 % des patients demeurent sans solution thérapeutique. De nouvelles stratégies sont ainsi envisagées et la communauté des chercheurs, industriels, patients et autorités de santé reste mobilisée pour suivre les effets à long terme de ces nouveaux traitements et explorer de nouvelles approches pharmacologiques.


Asunto(s)
Fibrosis Quística , Humanos , Fibrosis Quística/genética , Fibrosis Quística/terapia , Mutación , Regulador de Conductancia de Transmembrana de Fibrosis Quística/genética , Terapia Genética
6.
Respir Med ; 223: 107555, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-38307319

RESUMEN

BACKGROUND: High frequency chest wall oscillation (HFCWO) is a form of airway clearance therapy that has been available since the mid-1990s and is routinely used by patients suffering from retained pulmonary secretions. Patients with cystic fibrosis (CF), neuromuscular disease (NMD), and other disorders, including bronchiectasis (BE) and COPD (without BE), are commonly prescribed this therapy. Limited evidence exists describing HFCWO use in the BE population, its impact on long-term management of disease, and the specific patient populations most likely to benefit from this therapy. This study sought to characterize the clinical characteristics of patients with BE who have documented use of HFCWO at baseline and 1-year follow-up. METHODS: An analysis from a large national database registry of patients with BE was performed. Demographic and clinical characteristics of all patients receiving HFCWO therapy at baseline are reported. Patients were stratified into two groups based on continued or discontinued use of HFCWO therapy at 1-year follow-up. RESULTS: Over half (54.8 %) of patients who reported using HFCWO therapy had a Modified Bronchiectasis Severity Index (m-BSI) classified as severe, and the majority (81.4 %) experienced an exacerbation in the prior two years. Of patients with 1-year follow-up data, 73 % reported continued use of HFCWO. Compared to patients who discontinued therapy, these patients were more severe at baseline and at follow-up suggesting that patients with more severe disease are more likely to continue HFCWO therapy. CONCLUSIONS: Patients who have more severe disease and continue to experience exacerbations and hospitalizations are more likely to continue HFCWO therapy. CLINICAL TRIAL REGISTRATION: NA.


Asunto(s)
Bronquiectasia , Oscilación de la Pared Torácica , Fibrosis Quística , Humanos , Bronquiectasia/terapia , Fibrosis Quística/complicaciones , Fibrosis Quística/terapia , Bases de Datos Factuales , Sistema de Registros
7.
J Cyst Fibros ; 23(1): 165-168, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38184455

RESUMEN

Bronchial artery embolisation (BAE) is a treatment used to manage haemoptysis. We performed a 7-year review of BAE procedures for haemoptysis at our CF centre aiming to evaluate the incidence and outcomes of patients with neurovascular complications post-BAE. Our review suggests that whilst BAE is an effective method for controlling life-threatening haemoptysis, patients are at risk of developing neurovascular complications with long term residual symptoms, and therefore careful consideration should be given in offering BAE, especially to otherwise well patients with chronic small volume haemoptysis and managing teams should have a low threshold to image symptomatic patients.


Asunto(s)
Fibrosis Quística , Embolización Terapéutica , Humanos , Fibrosis Quística/complicaciones , Fibrosis Quística/terapia , Arterias Bronquiales , Estudios Retrospectivos , Hemoptisis/diagnóstico , Hemoptisis/etiología , Hemoptisis/terapia , Resultado del Tratamiento , Embolización Terapéutica/efectos adversos
8.
Pediatr Pulmonol ; 59(4): 825-833, 2024 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-38197494

RESUMEN

There is a lack of research that has focused on attention-deficit hyperactivity disorder (ADHD) in people with cystic fibrosis (pwCF). Given ADHD is associated with executive functioning impairments, exploring ADHD in the context of living with cystic fibrosis (CF) is of great importance. The purpose of the current systematic review was to examine ADHD in pwCF across the lifespan in terms of its prevalence, its impact on various health outcomes, and treatments for managing ADHD. This systematic review followed the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. Articles reporting studies of any design that focused on ADHD in pwCF were included. Studies were excluded if they did not meet this criterion and if they were written in languages other than English. PsycINFO, MEDLINE, EMBASE, and CINAHL databases were searched. Search items were based on three concepts: (1) terms related to CF, (2) terms related to ADHD, and (3) terms related to age. Ten studies were included in this systematic review. Reported prevalence rates of ADHD in pwCF ranged from 5.26% to 21.9%. The reported relationships between ADHD and CF and other health outcomes is inconsistent. In terms of treatment considerations, pharmacological interventions and behavioural strategies for managing ADHD in the context of living with CF have been reported as being successful. Additional research is needed to further explore ADHD in the CF population and health variables that may be associated with CF prognosis.


Asunto(s)
Trastorno por Déficit de Atención con Hiperactividad , Fibrosis Quística , Humanos , Trastorno por Déficit de Atención con Hiperactividad/complicaciones , Trastorno por Déficit de Atención con Hiperactividad/epidemiología , Fibrosis Quística/complicaciones , Fibrosis Quística/epidemiología , Fibrosis Quística/terapia , Prevalencia , Función Ejecutiva
9.
Clin Nutr ; 43(2): 413-445, 2024 02.
Artículo en Inglés | MEDLINE | ID: mdl-38169175

RESUMEN

BACKGROUND: Nutritional status is paramount in Cystic Fibrosis (CF) and is directly correlated with morbidity and mortality. The first ESPEN-ESPGHAN-ECFS guidelines on nutrition care for infants, children, and adults with CF were published in 2016. An update to these guidelines is presented. METHODS: The study was developed by an international multidisciplinary working group in accordance with officially accepted standards. Literature since 2016 was reviewed, PICO questions were discussed and the GRADE system was utilized. Statements were discussed and submitted for on-line voting by the Working Group and by all ESPEN members. RESULTS: The Working Group updated the nutritional guidelines including assessment and management at all ages. Supplementation of vitamins and pancreatic enzymes remains largely the same. There are expanded chapters on pregnancy, CF-related liver disease, and CF-related diabetes, bone disease, nutritional and mineral supplements, and probiotics. There are new chapters on nutrition with highly effective modulator therapies and nutrition after organ transplantation.


Asunto(s)
Fibrosis Quística , Terapia Nutricional , Lactante , Niño , Adulto , Humanos , Fibrosis Quística/terapia , Estado Nutricional , Vitaminas , Vitamina A
11.
Scand J Med Sci Sports ; 34(1): e14564, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38268067

RESUMEN

INTRODUCTION: Among the limited studies on physical exercise interventions in adults with cystic fibrosis (CF), few have specifically addressed the improvement of peripheral muscle strength and body fat-free mass. The aim of this study was to examine the impacts of a remotely supervised, individualized 8-week resistance training program of moderate to high intensity on strength and body composition in these subjects. METHODS: This was a randomized controlled trial performed in adults with CF. The exercise group (EX) performed three 1-h resistance training sessions per week over 8 weeks. The control group (CON) followed the physical activity recommendations of their physician. The main outcomes were muscle strength and body composition, with secondary measures including pulmonary function and quality of life. Two-way repeated measures analysis was used. RESULTS: In 23 participants (age 32.13 ± 7.72 years), the intervention showed a significant beneficial effect on leg press strength, with a large effect size, both in absolute (p = 0.011; η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.281) and relative (p = 0.007; η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.310) terms. Large intervention effects were observed on total fat mass (p < 0.001; η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.415), body adiposity index (p < 0.001; η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.436), and fat mass index (p < 0.001; η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.445), all showing reduction in the EX group. In addition, significant large size effects were detected on total fat-free mass (p = 0.046; η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.177), trunk fat-free mass (p = 0.039; η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.188), and fat-free mass index (p = 0.048; η p 2 $$ {\eta}_{\mathrm{p}}^2 $$ = 0.174), all favoring exercise. No significant effects were observed on pulmonary function and quality of life. CONCLUSIONS: An 8-week remotely supervised resistance training program, with moderate to high intensity, effectively improved lower limb muscle strength and body composition.


Asunto(s)
Fibrosis Quística , Entrenamiento de Fuerza , Adulto , Humanos , Adulto Joven , Fibrosis Quística/terapia , Calidad de Vida , Composición Corporal , Fuerza Muscular
12.
Cell Rep Med ; 5(1): 101371, 2024 01 16.
Artículo en Inglés | MEDLINE | ID: mdl-38232705

RESUMEN

Antibiotics and cystic fibrosis transmembrane conductance regulator (CFTR) modulators play a pivotal role in cystic fibrosis (CF) treatment, but both have limitations. Antibiotics are linked to antibiotic resistance and disruption of the airway microbiome, while CFTR modulators are not widely accessible, and structural lung damage and pathogen overgrowth still occur. Complementary strategies that can beneficially modulate the airway microbiome in a preventive way are highly needed. This could be mediated via oral probiotics, which have shown some improvement of lung function and reduction of airway infections and exacerbations, as a cost-effective approach. However, recent data suggest that specific and locally administered probiotics in the respiratory tract might be a more targeted approach to prevent pathogen outgrowth in the lower airways. This review aims to summarize the current knowledge on the CF airway microbiome and possibilities of microbiome treatments to prevent bacterial and/or viral infections and position them in the context of current CF therapies.


Asunto(s)
Fibrosis Quística , Microbiota , Humanos , Fibrosis Quística/terapia , Fibrosis Quística/microbiología , Regulador de Conductancia de Transmembrana de Fibrosis Quística , Pulmón , Antibacterianos/uso terapéutico
13.
Curr Gastroenterol Rep ; 26(1): 9-19, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38057499

RESUMEN

PURPOSE OF REVIEW: To discuss all the various motility disorders impacting people with Cystic Fibrosis (PwCF) and provide diagnostic and management approaches from a group of pediatric and adult CF and motility experts and physiologists with experience in the management of this disease. RECENT FINDINGS: Gastrointestinal (GI) symptoms coexist with pulmonary symptoms in PwCF regardless of age and sex. The GI manifestations include gastroesophageal reflux disease, esophageal dysmotility gastroparesis, small bowel dysmotility, small intestinal bacterial overgrowth syndrome, distal idiopathic obstruction syndrome, constipation, and pelvic floor disorders. They are quite debilitating, limiting the patients' quality of life and affecting their nutrition and ability to socialize. This genetic disorder affects many organ systems and is chronic, potentially impacting fertility and future family planning, requiring a multidisciplinary approach. Our review discusses the treatments of motility disorders in CF, their prevalence and pathophysiology. We have provided a framework for clinicians who care for these patients that can help to guide their clinical management.


Asunto(s)
Fibrosis Quística , Reflujo Gastroesofágico , Enfermedades Gastrointestinales , Adulto , Humanos , Niño , Fibrosis Quística/complicaciones , Fibrosis Quística/terapia , Calidad de Vida , Enfermedades Gastrointestinales/diagnóstico , Enfermedades Gastrointestinales/etiología , Enfermedades Gastrointestinales/terapia , Reflujo Gastroesofágico/complicaciones , Tracto Gastrointestinal , Motilidad Gastrointestinal/fisiología
14.
Ann Otol Rhinol Laryngol ; 133(3): 340-344, 2024 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-37953524

RESUMEN

BACKGROUND: Many people with cystic fibrosis (PwCF) have chronic rhinosinusitis (CRS). CRS requires additional management beyond that of pulmonary disease and leads to increased utilization of healthcare resources. Elexacaftor/tezacaftor/ivacaftor (ETI) is a highly effective modulator therapy that has been shown to improve CRS in PwCF. However, the impact of ETI on rhinologic healthcare utilization is understudied. OBJECTIVE: To compare rates of rhinologic healthcare utilization and procedures among PwCF prior to and after initiating ETI therapy. METHODS: A single-center, cohort study investigating adult PwCF was performed in January 2023. Demographics, clinical characteristics, and data related to CF treatment were retrospectively abstracted. Characteristics of the cohort were compared over 2 periods: the 12-months prior to ETI initiation and the 12-months after ETI initiation. Post-ETI data were linearly extrapolated if a subject had not yet completed the full 12 months of ETI. Paired t-testing, Wilcoxon signed rank testing, and regression analysis were performed. RESULTS: Of 126 PwCF, 98 (77.8%) were on ETI therapy and 35 (27.7%) were both on ETI and concurrently followed by the rhinology service (ETI-ENT). Rhinology clinic visits (P = .007) and frequency of obtaining nasal cultures (P = .046) decreased for the ETI-ENT cohort after initiating ETI treatment. There were no significant changes in the number of endoscopic sinus surgeries (P = .452) performed. Beyond ETI use, regression analysis did not identify any factors associated with changes in utilization. CONCLUSION: Aspects of rhinology healthcare utilization by PwCF decreased after initiation of ETI therapy. Additional studies are needed to determine rhinologic healthcare requirements for PwCF who remain on ETI for the long-term and to evaluate larger cohorts of PwCF on ETI.


Asunto(s)
Fibrosis Quística , Adulto , Humanos , Fibrosis Quística/complicaciones , Fibrosis Quística/terapia , Estudios de Cohortes , Estudios Retrospectivos , Atención Ambulatoria , Nariz , Mutación
16.
Biomech Model Mechanobiol ; 23(1): 335-348, 2024 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-37861917

RESUMEN

Various therapeutic methods are employed to facilitate the clearance of secretions accumulated in the respiratory tracts of individuals with lower respiratory tract disorders. High-frequency chest wall oscillation (HFCWO) device, designed to apply variable amplitude and frequency vibrations to the individuals' chests, stands out among these therapies. In this study, the effectiveness of this treatment method was investigated numerically using computational fluid dynamics (CFD) on the generated mucus-obstructed bronchial geometry. The conducted analyses compared the effects of vibrations acting in the axial, radial, and tangential directions on the clearance of mucus, which exhibits non-Newtonian flow behavior with shear-thinning properties. Simultaneously, the effects of changes in vibration amplitude and frequency, pressure differentials, fluid properties, and ciliary movements on the flow were separately examined and interpreted. The findings demonstrate that ciliary movements are insufficient in mucus-accumulated airways, applied vibrations enhance mucus clearance, and potential improvements in flow are quite sensitive to boundary conditions.


Asunto(s)
Oscilación de la Pared Torácica , Fibrosis Quística , Humanos , Fibrosis Quística/terapia , Volumen Espiratorio Forzado , Moco , Oscilación de la Pared Torácica/métodos , Bronquios
17.
J Cyst Fibros ; 23(1): 5-7, 2024 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-38129256
20.
Pac Symp Biocomput ; 29: 534-548, 2024.
Artículo en Inglés | MEDLINE | ID: mdl-38160305

RESUMEN

The availability of multiple publicly-available datasets studying the same phenomenon has the promise of accelerating scientific discovery. Meta-analysis can address issues of reproducibility and often increase power. The promise of meta-analysis is especially germane to rarer diseases like cystic fibrosis (CF), which affects roughly 100,000 people worldwide. A recent search of the National Institute of Health's Gene Expression Omnibus revealed 1.3 million data sets related to cancer compared to about 2,000 related to CF. These studies are highly diverse, involving different tissues, animal models, treatments, and clinical covariates. In our search for gene expression studies of primary human airway epithelial cells, we identified three studies with compatible methodologies and sufficient metadata: GSE139078, Sala Study, and PRJEB9292. Even so, experimental designs were not identical, and we identified significant batch effects that would have complicated functional analysis. Here we present quantile discretization and Bayesian network construction using the Hill climb method as a powerful tool to overcome experimental differences and reveal biologically relevant responses to the CF genotype itself, exposure to virus, bacteria, and drugs used to treat CF. Functional patterns revealed by cluster Profiler included interferon signaling, interferon gamma signaling, interleukins 4 and 13 signaling, interleukin 6 signaling, interleukin 21 signaling, and inactivation of CSF3/G-CSF signaling pathways showing significant alterations. These pathways were consistently associated with higher gene expression in CF epithelial cells compared to non-CF cells, suggesting that targeting these pathways could improve clinical outcomes. The success of quantile discretization and Bayesian network analysis in the context of CF suggests that these approaches might be applicable to other contexts where exactly comparable data sets are hard to find.


Asunto(s)
Fibrosis Quística , Animales , Humanos , Teorema de Bayes , Biología Computacional , Fibrosis Quística/genética , Fibrosis Quística/complicaciones , Fibrosis Quística/terapia , Regulador de Conductancia de Transmembrana de Fibrosis Quística/genética , Reproducibilidad de los Resultados
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