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2.
Artigo em Inglês | MEDLINE | ID: mdl-33452433

RESUMO

Heterogeneity in the clinical presentation of major depressive disorder and response to antidepressants limits clinicians' ability to accurately predict a specific patient's eventual response to therapy. Validated depressive symptom profiles may be an important tool for identifying poor outcomes early in the course of treatment. To derive these symptom profiles, we first examined data from 947 depressed subjects treated with selective serotonin reuptake inhibitors (SSRIs) to delineate the heterogeneity of antidepressant response using probabilistic graphical models (PGMs). We then used unsupervised machine learning to identify specific depressive symptoms and thresholds of improvement that were predictive of antidepressant response by 4 weeks for a patient to achieve remission, response, or nonresponse by 8 weeks. Four depressive symptoms (depressed mood, guilt feelings and delusion, work and activities and psychic anxiety) and specific thresholds of change in each at 4 weeks predicted eventual outcome at 8 weeks to SSRI therapy with an average accuracy of 77% (p = 5.5E-08). The same four symptoms and prognostic thresholds derived from patients treated with SSRIs correctly predicted outcomes in 72% (p = 1.25E-05) of 1996 patients treated with other antidepressants in both inpatient and outpatient settings in independent publicly-available datasets. These predictive accuracies were higher than the accuracy of 53% for predicting SSRI response achieved using approaches that (i) incorporated only baseline clinical and sociodemographic factors, or (ii) used 4-week nonresponse status to predict likely outcomes at 8 weeks. The present findings suggest that PGMs providing interpretable predictions have the potential to enhance clinical treatment of depression and reduce the time burden associated with trials of ineffective antidepressants. Prospective trials examining this approach are forthcoming.

5.
medRxiv ; 2020 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-33140056

RESUMO

To determine the effect of COVID-19 convalescent plasma on mortality, we aggregated patient outcome data from randomized clinical trials (RCT), matched-control, case series, and case report studies. Random-effects analyses of RCT data demonstrated that hospitalized COVID-19 patients transfused with convalescent plasma exhibited a lower mortality rate compared to patients receiving standard treatments. These data provide evidence favoring the efficacy of human convalescent plasma as a therapeutic agent in hospitalized COVID-19 patients.

6.
Radiology ; 297(3): 699-707, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-32990514

RESUMO

Background There is a wide variation in radiation dose levels that can be used with chest CT in order to detect indeterminate pulmonary nodules. Purpose To compare the performance of lower-radiation-dose chest CT with that of routine dose in the detection of indeterminate pulmonary nodules 5 mm or greater. Materials and Methods In this retrospective study, CT projection data from 83 routine-dose chest CT examinations performed in 83 patients (120 kV, 70 quality reference mAs [QRM]) were collected between November 2013 and April 2014. Reference indeterminate pulmonary nodules were identified by two nonreader thoracic radiologists. By using validated noise insertion, five lower-dose data sets were reconstructed with filtered back projection (FBP) or iterative reconstruction (IR; 30 QRM with FBP, 10 QRM with IR, 5 QRM with FBP, 5 QRM with IR, and 2.5 QRM with IR). Three thoracic radiologists circled pulmonary nodules, rating confidence that the nodule was a 5-mm-or-greater indeterminate pulmonary nodule, and graded image quality. Analysis was performed on a per-nodule basis by using jackknife alternative free-response receiver operating characteristic figure of merit (FOM) and noninferiority limit of -0.10. Results There were 66 indeterminate pulmonary nodules (mean size, 8.6 mm ± 3.4 [standard deviation]; 21 part-solid nodules) in 42 patients (mean age, 51 years ± 17; 21 men and 21 women). Compared with the FOM for routine-dose CT (size-specific dose estimate, 6.5 mGy ± 1.8; FOM, 0.86 [95% confidence interval: 0.80, 0.91]), FOM was noninferior for all lower-dose configurations except for 2.5 QRM with IR. The sensitivity for subsolid nodules at 70 QRM was 60% (range, 48%-72%) and was significantly worse at a dose of 5 QRM and lower, whether or not IR was used (P < .05). Diagnostic image quality decreased with decreasing dose (P < .001) and was better with IR at 5 QRM (P < .05). Conclusion CT images reconstructed at dose levels down to 10 quality reference mAs (size-specific dose estimate, 0.9 mGy) had noninferior performance compared with routine dose in depicting pulmonary nodules. Iterative reconstruction improved subjective image quality but not performance at low dose levels. © RSNA, 2020 Online supplemental material is available for this article. See also the editorial by White and Kazerooni in this issue.

7.
Circ Arrhythm Electrophysiol ; 13(8): e008437, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32986471

RESUMO

BACKGROUND: Identification of systolic heart failure among patients presenting to the emergency department (ED) with acute dyspnea is challenging. The reasons for dyspnea are often multifactorial. A focused physical evaluation and diagnostic testing can lack sensitivity and specificity. The objective of this study was to assess the accuracy of an artificial intelligence-enabled ECG to identify patients presenting with dyspnea who have left ventricular systolic dysfunction (LVSD). METHODS: We retrospectively applied a validated artificial intelligence-enabled ECG algorithm for the identification of LVSD (defined as LV ejection fraction ≤35%) to a cohort of patients aged ≥18 years who were evaluated in the ED at a Mayo Clinic site with dyspnea. Patients were included if they had at least one standard 12-lead ECG acquired on the date of the ED visit and an echocardiogram performed within 30 days of presentation. Patients with prior LVSD were excluded. We assessed the model performance using area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity. RESULTS: A total of 1606 patients were included. Median time from ECG to echocardiogram was 1 day (Q1: 1, Q3: 2). The artificial intelligence-enabled ECG algorithm identified LVSD with an area under the receiver operating characteristic curve of 0.89 (95% CI, 0.86-0.91) and accuracy of 85.9%. Sensitivity, specificity, negative predictive value, and positive predictive value were 74%, 87%, 97%, and 40%, respectively. To identify an ejection fraction <50%, the area under the receiver operating characteristic curve, accuracy, sensitivity, and specificity were 0.85 (95% CI, 0.83-0.88), 86%, 63%, and 91%, respectively. NT-proBNP (N-terminal pro-B-type natriuretic peptide) alone at a cutoff of >800 identified LVSD with an area under the receiver operating characteristic curve of 0.80 (95% CI, 0.76-0.84). CONCLUSIONS: The ECG is an inexpensive, ubiquitous, painless test which can be quickly obtained in the ED. It effectively identifies LVSD in selected patients presenting to the ED with dyspnea when analyzed with artificial intelligence and outperforms NT-proBNP. Graphic Abstract: A graphic abstract is available for this article.


Assuntos
Inteligência Artificial , Serviço Hospitalar de Cardiologia , Diagnóstico por Computador , Dispneia/etiologia , Eletrocardiografia , Serviços Médicos de Emergência , Insuficiência Cardíaca Sistólica/diagnóstico , Processamento de Sinais Assistido por Computador , Disfunção Ventricular Esquerda/diagnóstico , Função Ventricular Esquerda , Idoso , Dispneia/fisiopatologia , Feminino , Insuficiência Cardíaca Sistólica/complicações , Insuficiência Cardíaca Sistólica/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Estudos Retrospectivos , Volume Sistólico , Sístole , Disfunção Ventricular Esquerda/complicações , Disfunção Ventricular Esquerda/fisiopatologia
8.
AJR Am J Roentgenol ; 2020 07 29.
Artigo em Inglês | MEDLINE | ID: mdl-32755210

RESUMO

BACKGROUND: Background parenchymal uptake (BPU) on molecular breast imaging (MBI) was identified as a breast cancer risk factor beyond mammographic density in a case-control study, but has not been confirmed in a cohort study. OBJECTIVE: To examine association of BPU with breast cancer, and to estimate absolute risk and discriminatory accuracy of BPU using a cohort study. METHODS: A retrospective cohort of women having MBI from 2004-2015, without prior breast cancer, was established. Radiologists, blinded to future breast cancer diagnoses, assessed BPU at baseline MBI as low (photopenic or minimal) or elevated (mild, moderate, or marked). Associations of BPU with breast cancer were estimated with multivariable Cox proportional hazards models of time to diagnosis. Five-year absolute risk was calculated for study subgroups. Discriminatory accuracy of BPU was assessed. RESULTS: Among 2992 women with mean age 56.3 years (sd 10.6) at MBI, breast cancer events occurred in 144 over 7.3 years median follow-up. Median time to diagnosis was 4.2 years (range 0.5-11.6 years) after MBI. Elevated BPU was associated with greater breast cancer risk (HR=2.39 [1.68, 3.41]; p=<0.001). This association remained in postmenopausal women (HR=3.50 [2.31, 5.31; p<0.001]) but was not significant in premenopausal women (HR=1.29 [0.72, 2.32]; p=0.39). Women with elevated BPU had five-year absolute risk of 4.3% (2.9, 5.7) vs. 2.5% (1.8, 3.1) for those with low BPU. Postmenopausal women with dense breasts and elevated BPU had five-year absolute risk of 8.1% (4.3, 11.8) vs. 2.8% (1.8, 3.8) for those with low BPU. Among postmenopausal women, discriminatory accuracy for invasive cancer was improved with addition of BPU over Gail risk score alone (C-statistic 65.1 vs. 59.1; p=0.04) and over BCSC risk score alone (66.4 vs. 60.4; p=0.04). CONCLUSION: BPU on MBI is an independent breast cancer risk factor, with the strongest association observed among postmenopausal women with dense breasts. In postmenopausal women, BPU provides incremental discrimination in breast cancer risk prediction when combined with the Gail model or BCSC model. CLINICAL IMPACT: Elevated BPU on MBI may identify a subset of women with dense breasts who would benefit most from supplemental screening or preventive options.

9.
Mayo Clin Proc ; 95(9): 1888-1897, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32861333

RESUMO

OBJECTIVE: To provide an update on key safety metrics after transfusion of convalescent plasma in hospitalized coronavirus 2019 (COVID-19) patients, having previously demonstrated safety in 5000 hospitalized patients. PATIENTS AND METHODS: From April 3 to June 2, 2020, the US Food and Drug Administration Expanded Access Program for COVID-19 convalescent plasma transfused a convenience sample of 20,000 hospitalized patients with COVID-19 convalescent plasma. RESULTS: The incidence of all serious adverse events was low; these included transfusion reactions (n=78; <1%), thromboembolic or thrombotic events (n=113; <1%), and cardiac events (n=677, ~3%). Notably, the vast majority of the thromboembolic or thrombotic events (n=75) and cardiac events (n=597) were judged to be unrelated to the plasma transfusion per se. The 7-day mortality rate was 13.0% (12.5%, 13.4%), and was higher among more critically ill patients relative to less ill counterparts, including patients admitted to the intensive care unit versus those not admitted (15.6 vs 9.3%), mechanically ventilated versus not ventilated (18.3% vs 9.9%), and with septic shock or multiple organ dysfunction/failure versus those without dysfunction/failure (21.7% vs 11.5%). CONCLUSION: These updated data provide robust evidence that transfusion of convalescent plasma is safe in hospitalized patients with COVID-19, and support the notion that earlier administration of plasma within the clinical course of COVID-19 is more likely to reduce mortality.


Assuntos
Infecções por Coronavirus/terapia , Segurança do Paciente , Pneumonia Viral/terapia , Adolescente , Adulto , Sistemas de Notificação de Reações Adversas a Medicamentos , Idoso , Idoso de 80 Anos ou mais , Infecções por Coronavirus/mortalidade , Estado Terminal , Feminino , Hospitalização , Humanos , Imunização Passiva/efeitos adversos , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/mortalidade , Estados Unidos , Adulto Jovem
10.
Circ Heart Fail ; 13(8): e006414, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32809874

RESUMO

BACKGROUND: Comorbidity-driven microvascular inflammation is posited as a unifying pathophysiologic mechanism for heart failure with preserved ejection fraction (HFpEF). Obesity is proinflammatory and common in HFpEF. We hypothesized that unique obesity-inflammation HFpEF phenotypes exist and are associated with differences in clinical features, fibrosis biomarkers, and functional performance. METHODS: Patients (n=301) from 3 HFpEF clinical trials were studied. Unsupervised machine learning (hierarchical clustering) with obese status and 13 inflammatory biomarkers as input variables was performed. Associations of clusters with HFpEF severity and fibrosis biomarkers (PIIINP [procollagen III N-terminal peptide], CITP [C-telopeptide for type I collagen], IGFBP7 [insulin-like growth factor-binding protein-7], and GAL-3 [galectin-3]) were assessed. RESULTS: Hierarchical clustering revealed 3 phenotypes: pan-inflammatory (n=129; 64% obese), noninflammatory (n=83; 55% obese), and obese high CRP (C-reactive protein; n=89; 98% obese). The pan-inflammatory phenotype had more comorbidities and heart failure hospitalizations; higher left atrial volume, NT-proBNP (N-terminal pro-B-type natriuretic peptide), and fibrosis biomarkers; and lower glomerular filtration rate, peak oxygen consumption, 6-minute walk distance, and active hours/day (P<0.05 for all). The noninflammatory phenotype had the most favorable values for all measures. The obese high CRP phenotype resembled the noninflammatory phenotype except for isolated elevation of CRP and lower functional performance. Hierarchical cluster assignment was independent of CRP genotype combinations that alter CRP levels and more biologically plausible than other clustering approaches. Multiple traditional analytic techniques confirmed and extended the hierarchical clustering findings. CONCLUSIONS: Unique obesity-inflammation phenotypes exist in HFpEF and are associated with differences in comorbidity burden, HFpEF severity, and fibrosis. These data support comorbidity-driven microvascular inflammation as a pathophysiologic mechanism for many but not all HFpEF patients.

11.
medRxiv ; 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32817978

RESUMO

IMPORTANCE: Passive antibody transfer is a longstanding treatment strategy for infectious diseases that involve the respiratory system. In this context, human convalescent plasma has been used to treat coronavirus disease 2019 (COVID-19), but the efficacy remains uncertain. OBJECTIVE: To explore potential signals of efficacy of COVID-19 convalescent plasma. DESIGN: Open-label, Expanded Access Program (EAP) for the treatment of COVID-19 patients with human convalescent plasma. SETTING: Multicenter, including 2,807 acute care facilities in the US and territories. PARTICIPANTS: Adult participants enrolled and transfused under the purview of the US Convalescent Plasma EAP program between April 4 and July 4, 2020 who were hospitalized with (or at risk of) severe or life threatening acute COVID-19 respiratory syndrome. INTERVENTION: Transfusion of at least one unit of human COVID-19 convalescent plasma using standard transfusion guidelines at any time during hospitalization. Convalescent plasma was donated by recently-recovered COVID-19 survivors, and the antibody levels in the units collected were unknown at the time of transfusion. Main Outcomes and Measures: Seven and thirty-day mortality. RESULTS: The 35,322 transfused patients had heterogeneous demographic and clinical characteristics. This cohort included a high proportion of critically-ill patients, with 52.3% in the intensive care unit (ICU) and 27.5% receiving mechanical ventilation at the time of plasma transfusion. The seven-day mortality rate was 8.7% [95% CI 8.3%-9.2%] in patients transfused within 3 days of COVID-19 diagnosis but 11.9% [11.4%-12.2%] in patients transfused 4 or more days after diagnosis (p<0.001). Similar findings were observed in 30-day mortality (21.6% vs. 26.7%, p<0.0001). Importantly, a gradient of mortality was seen in relation to IgG antibody levels in the transfused plasma. For patients who received high IgG plasma (>18.45 S/Co), seven-day mortality was 8.9% (6.8%, 11.7%); for recipients of medium IgG plasma (4.62 to 18.45 S/Co) mortality was 11.6% (10.3%, 13.1%); and for recipients of low IgG plasma (<4.62 S/Co) mortality was 13.7% (11.1%, 16.8%) (p=0.048). This unadjusted dose-response relationship with IgG was also observed in thirty-day mortality (p=0.021). The pooled relative risk of mortality among patients transfused with high antibody level plasma units was 0.65 [0.47-0.92] for 7 days and 0.77 [0.63-0.94] for 30 days compared to low antibody level plasma units. CONCLUSIONS AND RELEVANCE: The relationships between reduced mortality and both earlier time to transfusion and higher antibody levels provide signatures of efficacy for convalescent plasma in the treatment of hospitalized COVID-19 patients. This information may be informative for the treatment of COVID-19 and design of randomized clinical trials involving convalescent plasma. TRIAL REGISTRATION: ClinicalTrials.gov Identifier: NCT04338360.

14.
J Clin Invest ; 130(9): 4791-4797, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32525844

RESUMO

BACKGROUNDConvalescent plasma is the only antibody-based therapy currently available for patients with coronavirus disease 2019 (COVID-19). It has robust historical precedence and sound biological plausibility. Although promising, convalescent plasma has not yet been shown to be safe as a treatment for COVID-19.METHODSThus, we analyzed key safety metrics after transfusion of ABO-compatible human COVID-19 convalescent plasma in 5000 hospitalized adults with severe or life-threatening COVID-19, with 66% in the intensive care unit, as part of the US FDA expanded access program for COVID-19 convalescent plasma.RESULTSThe incidence of all serious adverse events (SAEs), including mortality rate (0.3%), in the first 4 hours after transfusion was <1%. Of the 36 reported SAEs, there were 25 reported incidences of related SAEs, including mortality (n = 4), transfusion-associated circulatory overload (n = 7), transfusion-related acute lung injury (n = 11), and severe allergic transfusion reactions (n = 3). However, only 2 of 36 SAEs were judged as definitely related to the convalescent plasma transfusion by the treating physician. The 7-day mortality rate was 14.9%.CONCLUSIONGiven the deadly nature of COVID-19 and the large population of critically ill patients included in these analyses, the mortality rate does not appear excessive. These early indicators suggest that transfusion of convalescent plasma is safe in hospitalized patients with COVID-19.TRIAL REGISTRATIONClinicalTrials.gov NCT04338360.FUNDINGMayo Clinic, Biomedical Advanced Research and Development Authority (75A50120C00096), National Center for Advancing Translational Sciences (UL1TR002377), National Heart, Lung, and Blood Institute (5R35HL139854 and R01 HL059842), National Institute of Diabetes and Digestive and Kidney Diseases (5T32DK07352), Natural Sciences and Engineering Research Council of Canada (PDF-532926-2019), National Institute of Allergy and Infectious Disease (R21 AI145356, R21 AI152318, and AI152078), Schwab Charitable Fund, United Health Group, National Basketball Association, Millennium Pharmaceuticals, and Octapharma USA Inc.


Assuntos
Betacoronavirus , Infecções por Coronavirus/terapia , Pneumonia Viral/terapia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Ensaios de Uso Compassivo , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Feminino , Humanos , Imunização Passiva/efeitos adversos , Imunização Passiva/mortalidade , Masculino , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Segurança , Reação Transfusional/epidemiologia , Reação Transfusional/etiologia , Lesão Pulmonar Aguda Relacionada à Transfusão/epidemiologia , Lesão Pulmonar Aguda Relacionada à Transfusão/etiologia , Estados Unidos/epidemiologia , United States Food and Drug Administration , Adulto Jovem
15.
J Clin Endocrinol Metab ; 105(7)2020 Jul 01.
Artigo em Inglês | MEDLINE | ID: mdl-32374825

RESUMO

CONTEXT: The effect of physiological changes in night-time cortisol and glucagon on endogenous glucose production (EGP) and nocturnal glycemia are unknown. OBJECTIVE: To determine the effects of changes in cortisol and glucagon on EGP during the night. DESIGN: Two overnight protocols were conducted. In Protocol 1, endogenous cortisol was blocked with metyrapone and hydrocortisone infused either at constant (constant) or increasing (variable) rates to mimic basal or physiological nocturnal cortisol concentrations. In Protocol 2, endogenous glucagon was blocked with somatostatin and exogenous glucagon was infused at either basal or elevated rates to mimic nocturnal glucagon concentrations observed in nondiabetic (ND) and type 2 diabetes (T2D) individuals. EGP was measured using [3-3H] glucose and gluconeogenesis estimated with 2H2O in all studies. SETTING: Mayo Clinic Clinical Research Trials Unit, Rochester, MN, US. PARTICIPANTS: In Protocol 1, 34 subjects (17 ND and 17 T2D) and in Protocol 2, 39 subjects (21 ND and 18 T2D) were studied. MAIN OUTCOME MEASURES: Endogenous glucose production. RESULTS: EGP, gluconeogenesis, and glycogenolysis were higher with variable than with constant cortisol at 7 am in T2D subjects. In contrast, nocturnal EGP did not differ in ND subjects between variable and constant cortisol. While elevated glucagon increased EGP, glycogenolysis, and gluconeogenesis in ND, the data in T2D subjects indicated that EGP and gluconeogenesis but not glycogenolysis were higher during the early part of the night. CONCLUSION: Nocturnal hyperglucagonemia, but not physiological rise in cortisol, contributes to nocturnal hyperglycemia in T2D due to increased gluconeogenesis.

16.
J Am Acad Dermatol ; 2020 May 17.
Artigo em Inglês | MEDLINE | ID: mdl-32434009

RESUMO

Artificial intelligence (AI) 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. Though experts will never be replaced by AI, it will certainly impact the specialty of dermatology. In this first article of a two-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 two of the series, the clinical applications of deep learning in dermatology will be reviewed considering limitations and opportunities.

17.
J Am Acad Dermatol ; 2020 May 16.
Artigo em Inglês | MEDLINE | ID: mdl-32428608

RESUMO

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.

18.
Exp Physiol ; 105(4): 721-731, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32003484

RESUMO

NEW FINDINGS: What is the central question of this study? Are sex difference in the central airways present in healthy paediatric patients? What is the main finding and its importance? In patients ≤12 years we found no sex differences in central airway luminal area. After 14 years, the males had significantly larger central airway luminal areas than the females. The sex differences were minimized, but preserved when correcting for height. Luminal area is the main determinant of airway resistance and our finding could help explain sex differences in pulmonary system limitations to exercise in paediatric patients. ABSTRACT: Cross-sectional airway area is the main determinant of resistance to airflow in the respiratory system. In paediatric patients (<18 years), previous evidence for sex differences in cross-sectional airway area was limited to patients with history of pulmonary disease or cadaveric studies with small numbers of subjects. These studies either only report tracheal data and do not include a range of ages or correct for height. Therefore, we sought to assess sex differences in airway luminal area utilizing paediatric patients of varying ages and no history of respiratory disease. Using three-dimensional reconstructions from high-resolution computed tomography scans, we retrospectively assessed the cross-sectional airway area in healthy paediatric females (n = 97) and males (n = 128) over a range of ages (1-17 years). The areas of the trachea, left main bronchus, left upper lobe, left lower lobe, right main bronchus, intermediate bronchus and right upper lobe were measured at three discrete points by a blinded investigator. No differences between the sexes were noted in the cross-sectional areas of the youngest (ages 1-12 years) patients (P > 0.05). However, in patients ≥14 years the cross-sectional areas were larger in the males compared to females in most airway sites. For instance, the cross-sectional size of the trachea was 25% (218 ± 44 vs. 163 ± 24 mm2 , P < 0.01) larger in males vs. females among ages 13-17 years. When accounting for height, these sex differences in airway areas were attenuated, but persisted. Our results indicate that sex differences in paediatric airway cross-sectional area manifest after age ≥14 years and are independent of height.

19.
J Am Coll Cardiol ; 75(7): 722-733, 2020 02 25.
Artigo em Inglês | MEDLINE | ID: mdl-32081280

RESUMO

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is an uncommon but important cause of sudden cardiac death. OBJECTIVES: This study sought to develop an artificial intelligence approach for the detection of HCM based on 12-lead electrocardiography (ECG). METHODS: A convolutional neural network (CNN) was trained and validated using digital 12-lead ECG from 2,448 patients with a verified HCM diagnosis and 51,153 non-HCM age- and sex-matched control subjects. The ability of the CNN to detect HCM was then tested on a different dataset of 612 HCM and 12,788 control subjects. RESULTS: In the combined datasets, mean age was 54.8 ± 15.9 years for the HCM group and 57.5 ± 15.5 years for the control group. After training and validation, the area under the curve (AUC) of the CNN in the validation dataset was 0.95 (95% confidence interval [CI]: 0.94 to 0.97) at the optimal probability threshold of 11% for having HCM. When applying this probability threshold to the testing dataset, the CNN's AUC was 0.96 (95% CI: 0.95 to 0.96) with sensitivity 87% and specificity 90%. In subgroup analyses, the AUC was 0.95 (95% CI: 0.94 to 0.97) among patients with left ventricular hypertrophy by ECG criteria and 0.95 (95% CI: 0.90 to 1.00) among patients with a normal ECG. The model performed particularly well in younger patients (sensitivity 95%, specificity 92%). In patients with HCM with and without sarcomeric mutations, the model-derived median probabilities for having HCM were 97% and 96%, respectively. CONCLUSIONS: ECG-based detection of HCM by an artificial intelligence algorithm can be achieved with high diagnostic performance, particularly in younger patients. This model requires further refinement and external validation, but it may hold promise for HCM screening.


Assuntos
Cardiomiopatia Hipertrófica/diagnóstico , Eletrocardiografia , Modelos Cardiovasculares , Redes Neurais de Computação , Adulto , Idoso , Algoritmos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
20.
Abdom Radiol (NY) ; 45(3): 623-631, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31980866

RESUMO

PURPOSE: To determine how small bowel neuroendocrine neoplasms (SBNEN's) are diagnosed and examine the effect of CT enterography (CTE) on diagnosis and rates of disease-free survival. METHODS: Histopathologically-confirmed SBNEN's diagnosed at our institution between 1996 and 2016 were identified. Clinical presentation, radiology, endoscopy, surgery, and pathology reports were reviewed and compared between consecutive 5-year periods. RESULTS: Of the 178 SBNEN initially diagnosed at our institution, the incidence increased 12-fold from 9 (during 1996-2000) to 114 (during 2011-2016). Comparing the first 5 to the last 5 years, GI bleeding and abdominal pain increased significantly as indications (with both increasing from 0 to > 25%, p ≤ 0.023). Initial diagnosis by radiology increased 2-fold [from 33% (n = 3) to 66% (n = 75); p = 0.263]. Detection of a small bowel mass and the suggestion that SBNEN was present varied significantly between imaging modalities (p < 0.0001; CTE - 95% (52/55) and 91% (50/55) vs. abdominal CT 45% (37/85) and 35% (29/85), respectively). Recurrence rates increased with SBNEN size (p = 0.012; e.g., of SBNEN diagnosed by endoscopy, 18% of SBNEN measuring 0.6 ± 0.3 cm recurred vs. 75% measuring 3.7 ± 1.0 cm). Rates of disease-free survival, and the incidence of local and liver metastases were decreased when tumors were first identified by CTE rather than other CT/MR imaging modalities (p = 0.0034, 0.0475, and 0.0032, respectively). CONCLUSION: There has been a dramatic increase in SBNENs detected by CTE and endoscopy over the last 20 years. SBNEN's detected by CTE and small tumors detected at endoscopy have longer disease-free survival after surgical resection.

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