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1.
Int J Mol Sci ; 21(18)2020 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-32916960

RESUMO

STIM1 is an endoplasmic reticulum (ER) protein that modulates the activity of a number of Ca2+ transport systems. By direct physical interaction with ORAI1, a plasma membrane Ca2+ channel, STIM1 activates the ICRAC current, whereas the binding with the voltage-operated Ca2+ channel CaV1.2 inhibits the current through this latter channel. In this way, STIM1 is a key regulator of Ca2+ signaling in excitable and non-excitable cells, and altered STIM1 levels have been reported to underlie several pathologies, including immunodeficiency, neurodegenerative diseases, and cancer. In both sporadic and familial Alzheimer's disease, a decrease of STIM1 protein levels accounts for the alteration of Ca2+ handling that compromises neuronal cell viability. Using SH-SY5Y cells edited by CRISPR/Cas9 to knockout STIM1 gene expression, this work evaluated the molecular mechanisms underlying the cell death triggered by the deficiency of STIM1, demonstrating that STIM1 is a positive regulator of ITPR3 gene expression. ITPR3 (or IP3R3) is a Ca2+ channel enriched at ER-mitochondria contact sites where it provides Ca2+ for transport into the mitochondria. Thus, STIM1 deficiency leads to a strong reduction of ITPR3 transcript and ITPR3 protein levels, a consequent decrease of the mitochondria free Ca2+ concentration ([Ca2+]mit), reduction of mitochondrial oxygen consumption rate, and decrease in ATP synthesis rate. All these values were normalized by ectopic expression of ITPR3 in STIM1-KO cells, providing strong evidence for a new mode of regulation of [Ca2+]mit mediated by the STIM1-ITPR3 axis.

2.
Antioxidants (Basel) ; 9(9)2020 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-32825644

RESUMO

The retinal pigment epithelium (RPE) plays a key role in retinal health, being essential for the protection against reactive oxygen species (ROS). Nevertheless, excessive oxidative stress can induce RPE dysfunction, promoting visual loss. Our aim is to clarify the possible implication of CYP2E1 in ethanol (EtOH)-induced oxidative stress in RPE alterations. Despite the increase in the levels of ROS, measured by fluorescence probes, the RPE cells exposed to the lowest EtOH concentrations were able to maintain cell survival, measured by the Cell Proliferation Kit II (XTT). However, EtOH-induced oxidative stress modified inflammation and angiogenesis biomarkers, analyzed by proteome array, ELISA, qPCR and Western blot. The highest EtOH concentration used stimulated a large increase in ROS levels, upregulating the cytochrome P450-2E1 (CYP2E1) and promoting cell death. The use of antioxidants such as N-acetylcysteine (NAC) and diallyl sulfide (DAS), which is also a CYP2E1 inhibitor, reverted cell death and oxidative stress, modulating also the upstream angiogenesis and inflammation regulators. Because oxidative stress plays a central role in most frequent ocular diseases, the results herein support the proposal that CYP2E1 upregulation could aggravate retinal degeneration, especially in those patients with high baseline oxidative stress levels due to their ocular pathology and should be considered as a risk factor.

3.
Chemistry ; 2020 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-32812653

RESUMO

The spin crossover salt [Fe(bpp) 2 ](isonicNO) 2 ·2.4H 2 O ( 1 ·2.4H 2 O) (bpp = 2,6-bis(pyrazol-3-yl)pyridine; isonicNO = isonicotinate N-oxide anion) exhibits a very abrupt spin crossover at T 1 /2 = 274.4 K. This triggers a supramolecular linkage (H-bond) isomerization that responds reversibly towards light irradiation or temperature change. Isotopic effects in the thermomagnetic behaviour reveal the importance of hydrogen bonds in defining the magnetic state. Further, the title compound can be reversibly dehydrated to afford 1 , a material that also exhibits spin crossover coupled to H-bond isomerization, leading to strong kinetic effects in the thermomagnetic properties.

4.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32792301

RESUMO

INTRODUCTION: Artificial nutrition (AI) is one of the most representative examples of coordinated therapeutic programs, and therefore requires adequate development and organization. The first clinical nutrition units (CNUs) emerged in the public hospitals of the Spanish National Health System (NHS) in the 80s and have gradually been incorporated into the departments of endocrinology and nutrition (DENs). The purpose of our article is to report on the results found in the RECALSEEN study as regards the professional and organizational aspects relating to CNUs and their structure and operation. MATERIALS AND METHODS: Data were collected from the RECALSEEN study, a cross-sectional, descriptive study of the DENs in the Spanish NHS in 2016. The survey was compiled from March to September 2017. Qualitative variables were reported as frequency distributions (number of cases and percentages), and quantitative variables as the mean, median, and standard deviation (SD). RESULTS: A total of 88 (70%) DENs, out of a total of 125 general acute hospitals of the NHS with 200 or more installed beds, completed the survey. CNUs were available in 83% of DENs (98% in hospitals with 500 or more beds). As a median, DENs had one nurse dedicated to nutrition (35% did not have this resource). Fifty-three percent of DENs with nutrition units had dieticians integrated into the unit (median: 1). DENs located in hospitals with 500 or more beds are more complex and have a wide portfolio of monographic unit services (morbid obesity, 78.3%; artificial home nutrition, 87%; chronic diseases, 65.2%) and specific techniques (impedanciometry, 78%). However, only 14% of the centers perform universal screening tests for malnutrition, and a secondary diagnosis of malnutrition only appears in 12.3 reports per 1000 hospital discharges. DISCUSSION: After the 1997 and 2003 studies, the results of 2017 show a marked growth and consolidation of CNUs within the DENs in most hospitals. Today, the growth of this specialty is largely due to the care demand created by hospital clinical nutrition. CNUs still have an insufficient nursing staff and dietitians/nutritionists, and in the latter case, atypical contracts or grants funded by research projects or the pharmaceutical industry are common. Units for specific nutritional diseases and participation in multidisciplinary groups, quite heterogeneous, are concentrated in hospitals with 500 or more beds and represent an excellent opportunity for CNU development. CONCLUSIONS: Many DENs of Spanish hospitals include CNUs where care is provided by endocrinologists, who devote most of their time to clinical nutrition in more than half of the hospitals. This is most common in large centers with a high workload in relation to staffing. There is considerable heterogeneity between hospitals in terms of both the number and type of activity of the CNUs.

5.
Aging Cell ; : e13183, 2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32638492

RESUMO

Osteopontin (OPN), a senescence-associated secretory phenotype factor, is increased in patients with nonalcoholic fatty liver disease (NAFLD). Cellular senescence has been associated with age-dependent hepatosteatosis. Thus, we investigated the role of OPN in the age-related hepatosteatosis. For this, human serum samples, animal models of aging, and cell lines in which senescence was induced were used. Metabolic fluxes, lipid, and protein concentration were determined. Among individuals with a normal liver, we observed a positive correlation between serum OPN levels and increasing age. This correlation with age, however, was absent in patients with NAFLD. In wild-type (WT) mice, serum and liver OPN were increased at 10 months old (m) along with liver p53 levels and remained elevated at 20m. Markers of liver senescence increased in association with synthesis and concentration of triglycerides (TG) in 10m OPN-deficient (KO) hepatocytes when compared to WT hepatocytes. These changes in senescence and lipid metabolism in 10m OPN-KO mice liver were associated with the decrease of 78 kDa glucose-regulated protein (GRP78), induction of ER stress, and the increase in fatty acid synthase and CD36 levels. OPN deficiency in senescent cells also diminished GRP78, the accumulation of intracellular TG, and the increase in CD36 levels. In 20m mice, OPN loss led to increased liver fibrosis. Finally, we showed that OPN expression in vitro and in vivo was regulated by p53. In conclusion, OPN deficiency leads to earlier cellular senescence, ER stress, and TG accumulation during aging. The p53-OPN axis is required to inhibit the onset of age-related hepatosteatosis.

6.
Childs Nerv Syst ; 36(9): 1835-1841, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32601901

RESUMO

PURPOSE: Due to the generalization of new microsurgical equipment, intraoperative fluorescence techniques have extended in neurosurgical practice, mainly in neurovascular and neuro-oncology patients. The aim of identifying pathological tissue and also differentiating from the normal brain helps neurosurgeons to approach other kinds of intracranial entities such as infections. METHODS: It is described in the case of an 11-year-old patient who underwent a subdural empyema by performing a craniotomy and evacuation of the purulent collection. After a non-optimal evolution, a frontobasal meningoencephalitis was assessed with cerebral involvement and associated intracranial hypertension. Indocyanine green (ICG) was used in reintervention for demonstrating a great damage of cortical vascularization around the infected area as well as fluorescein (FL), which identified a large area of avascularized tissue. RESULTS: Both techniques allowed a selective excision of the affected brain parenchyma while preserving viable parenchymal areas. Radiological evolution and clinical outcome were good. CONCLUSIONS: The identification of vascular patterns in brain lesions and the recognition of viable or necrotized tissues are suitable for a selective resection of the parenchyma, minimizing morbidity. Clinical outcome is related to a safe and effective management of inflammatory and infectious processes.

7.
Childs Nerv Syst ; 36(9): 1843, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32691195

RESUMO

The original version of this article unfortunately contained an error. The corresponding author did not notice that one of the co-authors "Javier Márquez Márquez Rivas" was incorrectly presented. The correct name is "Javier Márquez Rivas". Given in this article is the corrected author name.

8.
Med Image Anal ; 64: 101754, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32580056

RESUMO

External beam radiotherapy is a commonly used treatment option for patients with cancer in the thoracic and abdominal regions. However, respiratory motion constitutes a major limitation during the intervention. It may stray the pre-defined target and trajectories determined during planning from the actual anatomy. We propose a novel framework to predict the in-plane organ motion. We introduce a recurrent encoder-decoder architecture which leverages feature representations at multiple scales. It simultaneously learns to map dense deformations between consecutive images from a given input sequence and to extrapolate them through time. Subsequently, several cascade-arranged spatial transformers use the predicted deformation fields to generate a future image sequence. We propose the use of a composite loss function which minimizes the difference between ground-truth and predicted images while maintaining smooth deformations. Our model is trained end-to-end in an unsupervised manner, thus it does not require additional information beyond image data. Moreover, no pre-processing steps such as segmentation or registration are needed. We report results on 85 different cases (healthy subjects and patients) belonging to multiples datasets across different imaging modalities. Experiments were aimed at investigating the importance of the proposed multi-scale architecture design and the effect of increasing the number of predicted frames on the overall accuracy of the model. The proposed model was able to predict vessel positions in the next temporal image with a median accuracy of 0.45 (0.55) mm, 0.45 (0.74) mm and 0.28 (0.58) mm in MRI, US and CT datasets, respectively. The obtained results show the strong potential of the model by achieving accurate matching between the predicted and target images on several imaging modalities.

9.
Kidney Int ; 98(3): 732-743, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32495741

RESUMO

A high frequency of regulatory B (Breg) cells, generally transitional B cells, has been associated with long-term kidney allograft survival and operational tolerance. However, circulating follicular helper T cells (cTfh) correlate with graft rejection. In order to better understand the interplay between these cell subsets and to determine their association with graft outcome we studied transitional and IL10+ Breg cells, as well as cTfh, pre- and post-transplantation in a prospective cohort of 200 kidney transplant recipients and in healthy volunteers. Patients with end-stage kidney disease had higher frequencies of transitional and IL10+ Breg cells compared to controls, and these subsets decreased during the one-year post-transplant follow-up. Higher frequencies of pre-transplant IL10+ Breg cells, and a larger reduction in these cells early post-transplantation, predicted acute rejection and graft failure. Moreover, IL10+ Breg cells correlated with cTfh pre-transplantation, and a post-transplant increase in the cTfh/IL10+Breg ratio preceded acute rejection. Thus, evaluation of pre-transplant IL10+ Breg cells and the regular monitoring of the cTfh/IL10+Breg ratio may be useful to assess post-transplant risk. Hence, our observations suggest the need to develop therapeutic strategies aimed at preserving regulatory B cells, and depleting Tfh, post-transplantation.

10.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32349942

RESUMO

INTRODUCTION: Hypoglycemia is the major limiting factor in the glycemic management of type 1 diabetes. Severe hypoglycemia puts patients at risk of injury and death. Recurrent hypoglycemia leads to impaired awareness of hypoglycemia and this increases the risk of severe hypoglycemia. Recent studies have reported rates for severe hypoglycemia of 35% in type 1 diabetic patients. OBJECTIVES: To assess the prevalence of severe hypoglycemia in type 1 diabetes mellitus patients and to evaluate the relationship between this and impaired awareness of hypoglycemia according to the Clarke test. PATIENTS AND METHODS: The following data were collected from a cohort of type 1 diabetic patients: age, gender, duration of type 1 diabetes, treatment (multiple daily insulin injection or continuous subcutaneous insulin infusion), glycemia self-control, HbA1c, episodes of severe hypoglycemia and impaired awareness of hypoglycemia. RESULTS: Of the participants, 39.8% had had at least one episode of severe hypoglycemia (in the previous 6 months), 11.4% with loss of consciousness (in the previous 12 months). According to the Clark test, 40.9% had impaired awareness of hypoglycemia. Older age and longer duration of diabetes were associated with a higher prevalence of severe hypoglycemia with unconsciousness; older age and a lower level of HbA1c were associated with impaired awareness of hypoglycemia. CONCLUSIONS: Our study allows us to confirm the high rate of severe hypoglycemia and impaired awareness of hypoglycemia in patients with type 1 diabetes.

11.
Int J Mol Sci ; 21(9)2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32366039

RESUMO

Salmonella enterica serovar Typhimurium is a human and animal pathogen that uses type III secretion system effectors to manipulate the host cell and fulfill infection. SseK1 is a Salmonella effector with glycosyltransferase activity. We carried out a yeast two-hybrid screen and have identified tubulin-binding cofactor B (TBCB) as a new binding partner for this effector. SseK1 catalyzed the addition of N-acetylglucosamine to arginine on TBCB, and its expression promoted the stabilization of the microtubule cytoskeleton of HEK293T cells. The conserved Asp-x-Asp (DxD) motif that is essential for the activity of SseK1 was required for the binding and modification of TBCB and for the effect on the cytoskeleton. Our study has identified a novel target for SseK1 and suggests that this effector may have a role in the manipulation of the host cell microtubule network to provide a safe niche for this pathogen.

12.
J Neurosurg Pediatr ; : 1-10, 2020 May 15.
Artigo em Inglês | MEDLINE | ID: mdl-32413865

RESUMO

OBJECTIVE: Treatment of posthemorrhagic hydrocephalus in preterm infants is a matter of debate among pediatric neurosurgeons. Neuroendoscopic lavage (NEL) has been proposed as a suitable technique for the management of this pathology. The authors present their experience with 46 patients treated with NEL after germinal matrix hemorrhage, describe their technique, and analyze the outcomes. METHODS: A retrospective analysis of patients affected by grade III or IV intraventricular hemorrhage (IVH) treated with NEL was performed. Nonmodifiable risk factors such as gestational age, weight at birth, modified Papile grade, and intercurrent diseases were reviewed. Safety analysis was performed, evaluating the incidence of postoperative complications. Effectivity was measured using radiological (frontal horn index and white matter injury), CSF biochemical (proteins, blood, and cellularity), and clinical variables. Permanent shunt rate and shunt survival were analyzed. The motor outcome was measured using the Gross Motor Function Classification System (GMFCS) at 18-24 months, and the neurocognitive outcome was evaluated according to the grade of adaptation to schooling. RESULTS: Forty-six patients met the inclusion criteria. Patients were treated with a single NEL in 21 cases, 2 lavages in 13 cases, and 3 lavages in 12 cases. The mean gestational age at birth was 30.04 weeks, and the mean weight at birth was 1671.86 g. Hyaline membrane disease was described in 4.8% of the cases, hematological sepsis in 43.47%, persistent ductus arteriosus in 23.9%, and necrotizing enterocolitis in 10.9% of the cases. Modified Papile grade III and IV IVHs were observed in 60.9% and 39.1% of the cases, respectively. Postoperative infection was diagnosed in 10 of the 46 cases, CSF leak in 6, and rebleeding in 3. The mean frontal horn index decreased from 49.54 mm to 45.50 mm after NEL. No white matter injury was observed in 18 of 46 patients, focal injury was described in 13 patients, and diffuse bilateral white matter injury was observed in 15 patients. All CSF biochemical levels improved after lavage. The shunt rate was 58.7%, and shunt survival at 1 year was 50%. GMFCS grades I, II, III, IV, and V were observed in 44.74%, 21.05%, 2.63%, 15.79%, and 15.79% of patients, respectively. Good neurocognitive results were observed in 53.3% of the cases. CONCLUSIONS: Neuroendoscopic lavage was a suitable alternative for the management of IVH in preterm infants in our series. Good motor and neurocognitive results were achieved by this technique, and the permanent shunt rate was reduced compared with historical controls.

13.
Nanomaterials (Basel) ; 10(5)2020 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-32357422

RESUMO

A portable reconfigurable platform for hemoglobin determination based on inner filter quenching of room-temperature phosphorescent carbon dots (CDs) in the presence of H2O2 is described. The electronic setup consists of a light-emitting diode (LED) as the carbon dot optical exciter and a photodiode as a light-to-current converter integrated in the same instrument. The reconfigurable feature provides adaptability to use the platform as an analytical probe for CDs coming from different batches with some variations in luminescence characteristics. The variables of the reaction were optimized, such as pH, concentration of reagents, and response time; as well as the variables of the portable device, such as LED voltage, photodiode sensitivity, and adjustment of the measuring range by a reconfigurable electronic system. The portable device allowed the determination of hemoglobin with good sensitivity, with a detection limit of 6.2 nM and range up to 125 nM.

14.
Sci Rep ; 10(1): 6580, 2020 04 20.
Artigo em Inglês | MEDLINE | ID: mdl-32313105

RESUMO

Tumor invasion requires efficient cell migration, which is achieved by the generation of persistent and polarized lamellipodia. The generation of lamellipodia is supported by actin dynamics at the leading edge where a complex of proteins known as the WAVE regulatory complex (WRC) promotes the required assembly of actin filaments to push the front of the cell ahead. By using an U2OS osteosarcoma cell line with high metastatic potential, proven by a xenotransplant in zebrafish larvae, we have studied the role of the plasma membrane Ca2+ channel ORAI1 in this process. We have found that epidermal growth factor (EGF) triggered an enrichment of ORAI1 at the leading edge, where colocalized with cortactin (CTTN) and other members of the WRC, such as CYFIP1 and ARP2/3. ORAI1-CTTN co-precipitation was sensitive to the inhibition of the small GTPase RAC1, an upstream activator of the WRC. RAC1 potentiated ORAI1 translocation to the leading edge, increasing the availability of surface ORAI1 and increasing the plasma membrane ruffling. The role of ORAI1 at the leading edge was studied in genetically engineered U2OS cells lacking ORAI1 expression that helped us to prove the key role of this Ca2+ channel on lamellipodia formation, lamellipodial persistence, and cell directness, which are required for tumor cell invasiveness in vivo.

15.
Nutr. hosp ; 37(2): 260-266, mar.-abr. 2020. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-190589

RESUMO

OBJETIVO: describir el estado nutricional de los mayores hospitalizados en una unidad geriátrica de agudos (UGA) y su asociación con la mortalidad y la estancia hospitalaria. MATERIAL Y MÉTODOS: estudio retrospectivo de 1084 personas mayores de 65 años en una UGA. Se emplearon el Mini Nutritional Assessment®-Short Form (MNA®-SF) y la valoración global subjetiva (VGS). La asociación entre estado nutricional, mortalidad y estancia hospitalaria prolongada (> 7 días) se analizó mediante un modelo de regresión y el análisis de riesgos de Cox. RESULTADOS: edad media de 86,5 años: 58,7% de mujeres. La puntuación media del MNA®-SF fue de 8,9, estando el 20,0% sin riesgo nutricional, el 48,2% en riesgo nutricional y el 31,7% con malnutrición. Mediante la VGS, el 22,1% estaban bien nutridos, el 54,7% moderadamente desnutridos y el 23,2% gravemente desnutridos. El acuerdo entre VGS y MNA®-SF fue bueno (kappa = 0,654; p < 0,001), clasificando correctamente al 78,5% de los participantes. La malnutrición se asoció a peor estado cognitivo, mayor discapacidad, peor deambulación y niveles menores de proteínas totales, albúmina, colesterol y transferrina. Los pacientes con malnutrición según el MNA®-SF presentaron una mortalidad ajustada mayor que la de los bien nutridos (HR: 1,80; IC 95%: 1,01-3,20), igual que aquellos con VGS de C frente a los de A (HR: 1,66; IC 95%: 0,96-2,86). Los pacientes con VGS de B (OR: 1,42; IC 95%: 1,04-1,96) y C (OR: 1,73; IC 95%: 1,18-2,54) presentaron mayor riesgo ajustado de estancia hospitalaria prolongada frente a los bien nutridos. Los pacientes con malnutrición según el MNA®-SF presentaron mayor riesgo ajustado de estancia hospitalaria prolongada (OR: 1,59; IC 95%: 1,09-2,33) frente a los bien nutridos. CONCLUSIONES: el riesgo nutricional y la malnutrición son muy frecuentes en los mayores hospitalizados en una UGA y se asocian con mayor mortalidad y estancias más prolongadas


OBJECTIVE: to describe the nutritional status of older adults hospitalized in an acute geriatric unit (AGU) and its association with mortality and days of hospitalization. MATERIAL AND METHODS: a retrospective study in 1,084 adults older than 65 years, hospitalized in an AGU. The Mini Nutritional Assessment®-Short Form (MNA®-SF) and subjective global assessment (SGA) were used. The association between nutritional status, mortality, and long hospital stay (> 7 days) was analyzed using regression models and Cox hazard models. RESULTS: mean age was 86.5 years: 58.7 % were women. Mean MNA®-SF score was 8.9 (20.0 %, well nourished; 48.2 %, at nutritional risk, and 31.7 % with malnutrition). Using the SGA, 22.1 % were well nourished, 54.7 % had moderate malnutrition, and 23.2 % had severe malnutrition. Agreement between SGA and MNA®-SF was good (kappa, 0.654; p < 0.001), and correctly classified 78.5 % of participants. Malnutrition was associated with poorer cognitive status, greater disability, worse ambulation, and lower levels of total protein, albumin, cholesterol, and transferrin. Patients with malnutrition in the MNA®-SF assessment had a higher adjusted mortality risk than those who were well nourished (HR, 1.80; 95 % CI, 1.01-3.20), same as those with SGA C versus A (HR, 1.66; 95 % CI, 0.96-2.86). Patients with SGA B and C presented a higher adjusted risk of long hospitalization as compared to well nourished subjects (OR, 1.42; 95 % CI, 1.04-1.96 and OR, 1.73; 95 % CI, 1.18-2.54, respectively. Patients with malnutrition per the MNA-SF® presented a higher adjusted risk of long hospitalization as compared to well nourished subjects (OR, 1.59; 95 % CI, 1.09-2.33). CONCLUSIONS: nutritional risk and malnutrition are very common in older adults in AGUs, and are associated with higher mortality and longer hospital stay


Assuntos
Humanos , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Estado Nutricional , Saúde do Idoso Institucionalizado , Avaliação Nutricional , Estudos Retrospectivos , Tempo de Internação , Desnutrição/epidemiologia , Serviços de Saúde para Idosos , Repertório de Barthel
16.
Comput Methods Programs Biomed ; 191: 105415, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32114416

RESUMO

BACKGROUND: The amount of information available about millions of different subjects is growing every day. This has led to the birth of new search tools specialized in different domains, because classical information retrieval models have trouble dealing with the special characteristics of some of these domains. Evidence-based Medicine is a case of a complex domain where classical information retrieval models can help search engines retrieve documents by considering the presence or absence of terms, but these must be complemented with other specific strategies which allow retrieving and ranking documents including the best current evidence and methodological quality. OBJECTIVE: The goal is to present a ranking algorithm able to select the best documents for clinicians considering aspects related to the relevance and the quality of said documents. METHODS: In order to assess the effectiveness of this proposal, an experimental methodology has been followed by using Medline as a data set and the Cochrane Library as a gold standard. RESULTS: Applying the evaluation methodology proposed, and after submitting 40 queries on the platform developed, the MAP (Mean Average Precision) obtained was 20.26%. CONCLUSIONS: Successful results have been achieved with the experiments, improving on other studies, but under different and even more complex circumstances.

17.
J Digit Imaging ; 2020 Mar 19.
Artigo em Inglês | MEDLINE | ID: mdl-32193665

RESUMO

In developed countries, colorectal cancer is the second cause of cancer-related mortality. Chemotherapy is considered a standard treatment for colorectal liver metastases (CLM). Among patients who develop CLM, the assessment of patient response to chemotherapy is often required to determine the need for second-line chemotherapy and eligibility for surgery. However, while FOLFOX-based regimens are typically used for CLM treatment, the identification of responsive patients remains elusive. Computer-aided diagnosis systems may provide insight in the classification of liver metastases identified on diagnostic images. In this paper, we propose a fully automated framework based on deep convolutional neural networks (DCNN) which first differentiates treated and untreated lesions to identify new lesions appearing on CT scans, followed by a fully connected neural networks to predict from untreated lesions in pre-treatment computed tomography (CT) for patients with CLM undergoing chemotherapy, their response to a FOLFOX with Bevacizumab regimen as first-line of treatment. The ground truth for assessment of treatment response was histopathology-determined tumor regression grade. Our DCNN approach trained on 444 lesions from 202 patients achieved accuracies of 91% for differentiating treated and untreated lesions, and 78% for predicting the response to FOLFOX-based chemotherapy regimen. Experimental results showed that our method outperformed traditional machine learning algorithms and may allow for the early detection of non-responsive patients.

18.
Nutr Hosp ; 37(2): 260-266, 2020 Apr 16.
Artigo em Espanhol | MEDLINE | ID: mdl-32124619

RESUMO

Introduction: Objective: to describe the nutritional status of older adults hospitalized in an acute geriatric unit (AGU) and its association with mortality and days of hospitalization. Material and methods: a retrospective study in 1,084 adults older than 65 years, hospitalized in an AGU. The Mini Nutritional Assessment®-Short Form (MNA®-SF) and subjective global assessment (SGA) were used. The association between nutritional status, mortality, and long hospital stay (> 7 days) was analyzed using regression models and Cox hazard models. Results: mean age was 86.5 years: 58.7% were women. Mean MNA®-SF score was 8.9 (20.0%, well nourished; 48.2%, at nutritional risk, and 31.7% with malnutrition). Using the SGA, 22.1% were well nourished, 54.7% had moderate malnutrition, and 23.2% had severe malnutrition. Agreement between SGA and MNA®-SF was good (kappa, 0.654; p < 0.001), and correctly classified 78.5% of participants. Malnutrition was associated with poorer cognitive status, greater disability, worse ambulation, and lower levels of total protein, albumin, cholesterol, and transferrin. Patients with malnutrition in the MNA®-SF assessment had a higher adjusted mortality risk than those who were well nourished (HR, 1.80; 95% CI, 1.01-3.20), same as those with SGA C versus A (HR, 1.66; 95% CI, 0.96-2.86). Patients with SGA B and C presented a higher adjusted risk of long hospitalization as compared to well nourished subjects (OR, 1.42; 95% CI, 1.04-1.96 and OR, 1.73; 95% CI, 1.18-2.54, respectively. Patients with malnutrition per the MNA-SF® presented a higher adjusted risk of long hospitalization as compared to well nourished subjects (OR, 1.59; 95% CI, 1.09-2.33). Conclusions: nutritional risk and malnutrition are very common in older adults in AGUs, and are associated with higher mortality and longer hospital stay.

19.
IEEE J Biomed Health Inform ; 24(9): 2671-2680, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32092019

RESUMO

Care pathways (CPWs) are "multidisciplinary care plans that detail essential care steps for patients with specific clinical problems." While CPWs impact on health or cost outcomes is vastly studied, an in-depth analysis of the real-world implementation of the CPWs is an area that still remains underexplored. The present work describes how to apply an existing process mining methodology to construct the empirical CPW process models. These process models are a unique piece of information for health services research: for example to evaluate their conformance against the theoretical CPW described on clinical guidelines or to evaluate the impact of the process in health outcomes. To this purpose, this work relies on the design and implementation of a solution that a) synthesizes the expert knowledge on how health care is delivered within and across providers as an activity log, and b) constructs the CPW process model from that activity log using process mining techniques. Unlike previous research based on ad hoc data captures, current approach is built on the linkage of various heterogeneous real-world data (RWD) sets that share a minimum semantic linkage. RWD, defined as secondary use of routinely collected data as opposite to ad hoc data extractions, is a unique source of information for the CPW analysis due to its coverage of the caregiving activities and its wide availability. The viability of the solution is demonstrated by constructing the CPW process model of Code Stroke (Acute Stroke CPW) in the Aragon region (Spain).

20.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-32007441

RESUMO

AIM: To evaluate the long-term clinical effect of continuous subcutaneous insulin infusion (CSII) in adult type 1 diabetes mellitus (T1DM) patients in a regional public healthcare system real-world scenario. METHODS: All adult T1DM patients on CSII for ≥10 years subjected to follow-up in the regional Castilla-La Mancha Public Health Service were included. The primary efficacy outcome was the variation in HbA1c during follow-up. Direct patient data were compiled through the web-based Spanish national registry on CSII therapy. RESULTS: A total of 69 T1DM adult patients were treated with insulin pumps for ≥10 years in our region. The mean age was 45.0±10.5 years, with a T1DM duration of 13.9±8.5 years. The mean duration of CSII therapy was 11.4±2.1 years. The main indications for treatment were high glucose variability (39%), problematic hypoglycemia (26%), and HbA1c >53mmol/mol (7%) on multiple daily injections (20%). Sensor-augmented pump therapy was used by 31% of the patients. Glycosylated hemoglobin did not change during follow-up (58±11mmol/mol vs. 58±11mmol/mol; 7.5±1.0 vs. 7.5±1.0; p=0.66). However, the percentage of patients with at least one episode of severe hypoglycemia during the last year and unnoticed hypoglycemia decreased from 36% to 7% (p=0.006) and from 38% to 32% (p<0.001), respectively. The proportion of subjects with ≥1 episode of diabetic ketoacidosis in the last year decreased from 30% to 6% (p=0.045). CONCLUSIONS: The reduction of severe hypoglycemia without deterioration of glycemic control can be sustained over long-term CSII therapy.

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