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1.
Sci Rep ; 11(1): 209, 2021 Jan 08.
Artigo em Inglês | MEDLINE | ID: mdl-33420222

RESUMO

In 2016, the WHO included haemoglobin values within normal ranges as a diagnostic criterion for Polycythaemia Vera (PV). Since then, concerns have arisen that a large number of patients are undergoing unnecessary screening for PV. To address this issue, we estimated the prevalence of JAK2 p.V617F in individuals with elevated haemoglobin or haematocrit and developed and validated a screening algorithm for PV. A total of 15,366 blood counts performed in seven non-consecutive days were reviewed, of which 1001 were selected for subsequent JAK2 p.V617F mutation screening. Eight (0.8%) new JAK2 p.V617F-mutated cases were detected. From ROC curves, a two-step algorithm was developed based on the optimal cut-off for the detection of the JAK2 p.V617F mutation. The algorithm was prospectively validated in an independent cohort of 15,298 blood counts. A total of 1595 (10.4%) cases met the criterion for haemoglobin or haematocrit, of whom 581 passed to step 2 (3.8% of the total). The JAK2 p.V617F mutation was detected in 7 of the 501 patients tested, which accounts for 0.04% of the total cohort and 0.4% of patients with erythrocytosis. In conclusion, this data show that our two-step algorithm improves the selection of candidates for JAK2 p.V617F testing.

2.
J Clin Med ; 10(2)2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33419107

RESUMO

The purpose is to analyze the medical characteristics of children with special health care needs (CSHCN) recommended for dental treatment under general anesthesia (GA), postoperative complications, and dental treatment outcomes under the regulation of the Spanish Dental Care Program (PADI). 111 clinical records were selected. The study population was divided into three age groups. The quantitative data was specified as the mean ± SD. For the qualitative variables, the Chi-Square test was used. One-way ANOVA and Bonferroni tests were used to examine the effect of the "age group" and the number of treatment procedures. A total of 1473 treatment procedures were performed, of which 110 (7.5%) were cleanings, 898 (61%) were restorative procedures, 332 (21.7%) were extractions, 22 (1.6%) were endodontic treatments, 62 (4.2%) were pulpotomies, and 59 (4%) were stainless steel crowns. Regarding the mean number of incisor root canal treatments (RCT), age group 3 received a significantly higher mean number of incisor RCTs than age group 1 (p = 0.02). Age group 1 received a higher average of pulpotomies and stainless-steel crowns (p = 0.00) compared to groups 2 and 3. GA is a safe procedure for the dental treatment of CSHCN, with minimal postoperative complications, which should be included among dental public programs.

3.
Ther Apher Dial ; 25(1): 33-43, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32352233

RESUMO

Expanded hemodialysis (HDx) provides increased clearance of conventional and large middle molecules through innovative medium cutoff (MCO) membranes. However, there is a paucity of real-world data regarding the benefits and safety of HDx. This large observational study evaluated outcomes among patients in Colombia undergoing HDx at a extended dialysis clinical services provider. This was a prospective single cohort study of prevalent patients who were treated with HDx; baseline information was collected from the most recent data before patients were started on HDx. Patients were followed prospectively for 1 year for changes in serum albumin and other laboratory parameters compared with the baseline. Survival, hospitalization and safety were assessed from the start of HDx. A total of 1000 patients were invited to enroll; 992 patients met the inclusion criteria for data analysis and 638 patients completed the year of follow-up. Seventy-four (8%) patients died during 866 patient-years (PY) of follow-up; the mortality rate was 8.54 deaths/100 PY (95% confidence interval [CI], 6.8-10.7). There were 673 hospitalization events with a rate of 0.79 events/PY (95% CI, 0.73-0.85) with 6.91 hospital days/PY (95% CI, 6.74-7.09). The observed variability from baseline and maximum average change in mean serum albumin levels were -1.8% and -3.5%, respectively. No adverse events were related to the MCO membrane. HDx using an MCO membrane maintains stable serum albumin levels and is safe in terms of nonoccurrence of dialyzer related adverse events.

4.
Polymers (Basel) ; 12(12)2020 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-33260898

RESUMO

In this work, we present a comparative study of benzoid poly(3,4-ethylenedioxythiophene)-poly(styrenesulfonate) (PEDOT:PSS) as electrode and as hole carrier transport layer (HTL) in the manufacture of organic photovoltaic devices using Fischer metal-carbene complexes. The performance of the different devices was evaluated for solar cell applications. Scanning electronic microscopy (SEM) and X-ray diffraction (XRD) were used to characterize the thin films that integrated the devices. A more ordered and crystallized active film microstructure is observed when using benzoid PEDOT:PSS as nucleation layer. The optical gap for both direct and indirect electronic transitions was evaluated from ultraviolet-visible spectroscopy data (UV-vis), as well as the absorption coefficient (α), and the values are in the range of 2.10-2.93 eV. Photovoltaic devices with conventional architecture, using two different chromium carbenes as active layers, were manufactured, and their electrical behavior was studied. The devices were irradiated with different wavelengths between the infrared and ultraviolet regions of the electromagnetic spectrum. Using the PEDOT:PSS film as hole carrier transport layer (HTL) decreases the slope on the ohmic and space charge limited current (SCLC) regions and eliminates the trap-charge limited current (T-CLC) mechanism. Furthermore, a saturation current of ~1.95 × 10-10 A and higher current values ~1.75 × 10-2 A at 4 V, ~4 orders in magnitude larger were observed. The PEDOT:PSS films as HTL in the devices reduced the injection barrier, thus showing a better performance than as anodes in this type of organic solar cells.

5.
Rev Salud Publica (Bogota) ; 21(1): 9-16, 2020 Nov 13.
Artigo em Espanhol | MEDLINE | ID: mdl-33206933

RESUMO

OBJECTIVE: To describe strategies for malaria elimination based on the perception of Afro-Colombian residents in Guapi, in the context of the Integrated Management Strategy for the Promotion, Prevention and Control of Vector-Borne Diseases in Colombia (EGI-ETV). MATERIALS AND METHODS: Qualitative study based on focus group discourse analysis. Eight participants from the urban area of Guapi were divided into two groups. The first group included three female nursing assistants, and was called "women with more experience"; they were workers in the current health system and former Malaria Eradication Service officers. The second group was made up of female nursing assistants, and was called "women with limited experience"; they were workers in the current health system and were not directly trained in the malaria program. An inductive and interpretative analysis was performed. RESULTS: Eight subcategories emerged, framed in the EGI-EVT, making emphasis on promotion and prevention aimed at reducing malaria, especially in rural areas. This problem must be addressed comprehensively, including other health issues and social determinants that affect them, such as: basic sanitation, access to health services, lack of education, use of popular treatments, and lack of infrastructure, among others. CONCLUSION: Participants consider that malaria in Guapi can be reduced but not eliminated. This problem needs to be addressed from an institutional and community perspective, taking into account cultural differences, based on strategies that include community empowerment and administrative and institutional strengthening of the program.

6.
mSystems ; 5(6)2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33172970

RESUMO

Marine microbes are known to degrade hydrocarbons; however, microbes inhabiting deep-sea sediments remain largely unexplored. Previous studies into the classical pathways of marine microbial metabolism reveal diverse chemistries; however, metabolic profiling of marine microbes cultured with hydrocarbons is limited. In this study, taxonomic (amplicon sequencing) profiles of two environmental deep-sea sediments (>1,200 m deep) were obtained, along with taxonomic and metabolomic (mass spectrometry-based metabolomics) profiles of microbes harbored in deep-sea sediments cultured with hydrocarbons as the sole energy source. Samples were collected from the Gulf of México (GM) and cultured for 28 days using simple (toluene, benzene, hexadecane, and naphthalene) and complex (petroleum API 40) hydrocarbon mixtures as the sole energy sources. The sediment samples harbored diverse microbial communities predominantly classified into Woeseiaceae and Kiloniellaceae families, whereas Pseudomonadaceae and Enterobacteriaceae families prevailed after sediments were cultured with hydrocarbons. Chemical profiling of microbial metabolomes revealed diverse chemical groups belonging primarily to the lipids and lipid-like molecules superclass, as well as the organoheterocyclic compound superclass (ClassyFire annotation). Metabolomic data and prediction of functional profiles indicated an increase in aromatic and alkane degradation in samples cultured with hydrocarbons. Previously unreported metabolites, identified as intermediates in the degradation of hydrocarbons, were annotated as hydroxylated polyunsaturated fatty acids and carboxylated benzene derivatives. In summary, this study used mass spectrometry-based metabolomics coupled to chemoinformatics to demonstrate how microbes from deep-sea sediments could be cultured in the presence of hydrocarbons. This study also highlights how this experimental approach can be used to increase the understanding of hydrocarbon degradation by deep-sea sediment microbes.IMPORTANCE High-throughput technologies and emerging informatics tools have significantly advanced knowledge of hydrocarbon metabolism by marine microbes. However, research into microbes inhabiting deep-sea sediments (>1,000 m) is limited compared to those found in shallow waters. In this study, a nontargeted and nonclassical approach was used to examine the diversity of bacterial taxa and the metabolic profiles of hydrocarbon-degrading deep-sea microbes. In conclusion, this study used metabolomics and chemoinformatics to demonstrate that microbes from deep-sea sediment origin thrive in the presence of toxic and difficult-to-metabolize hydrocarbons. Notably, this study provides evidence of previously unreported metabolites and the global chemical repertoire associated with the metabolism of hydrocarbons by deep-sea microbes.

7.
Blood Purif ; : 1-9, 2020 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-33176299

RESUMO

INTRODUCTION: A new generation of hemodialysis (HD) membranes called medium cut-off (MCO) membranes possesses enhanced capacities for middle molecule clearance, which have been associated with adverse outcomes in this population. These improvements could potentially positively impact patient-reported outcomes (PROs). OBJECTIVE: The objective of this study was to evaluate the impact of MCO membranes on PROs in a cohort of HD patients in Colombia. METHODS: This was a prospective, multicenter, observational cohort study of 992 patients from 12 renal clinics in Colombia who were switched from high-flux HD to MCO therapy and observed for 12 months. Changes in Kidney Disease Quality of Life 36-Item Short Form Survey (KDQoL-SF36) domains, Dialysis Symptom Index (DSI), and restless legs syndrome (RLS) 12 months after switching to MCO membranes were compared with time on high-flux membranes. Repeated measures of ANOVA were used to evaluate changes in KDQoL-SF36 scores; severity scoring was used to assess DSI changes over time; Cochran's Q test was used to evaluate changes in frequency of diagnostic criteria of RLS. RESULTS: During 12 months of follow-up, 3 of 5 KDQoL-SF36 domains improved compared with baseline: symptoms (p < 0.0001), effects of kidney disease (p < 0.0001), and burden of kidney disease (p < 0.001). The proportion of patients diagnosed with RLS significantly decreased from 22.1% at baseline to 10% at 12 months (p < 0.0001). No significant differences in the number of symptoms (DSI, p = 0.1) were observed, although their severity decreased (p = 0.009). CONCLUSIONS: In conventional HD patients, the expanded clearance of large middle molecules with MCO-HD membranes was associated with higher health-related quality of life scores and a decrease in the prevalence of RLS.

9.
Artigo em Inglês | MEDLINE | ID: mdl-33123880

RESUMO

In the present work, a spatio-temporal study of arsenic (As) concentration in groundwater and its impact in barley uptake is presented. The impact of As on barley is studied through the determination of its bioaccumulation in the soil-plant system, As uptake, as well as a correlation between As concentration in water and its temperature in the groundwater. For the groundwater, spatial and temporal variability of As concentration in central Mexico was determined through a geostatistical analysis using ordinary kriging. The results show that the variability of As in the ground water is correlated with its temperature (R2 > 0.83). The As accumulation in the structures of plant follows the order root > leaf > ear in concentration. The bioaccumulation factor BAFT suggests that As is mobilized to the aerial parts of the barely for both As concentrations used in the irrigation water. However, for As concentration lower than 25 µg L-1, the BAFT is lower than 0.57, suggesting that the amount of As in root is the same as that contained in the aerial parts; whereas, for higher As concentrations (from 170 to 250 µg L-1), the BAFT is around 0.92, indicating that the As is mainly contained in root. The spatial distribution of As concentration trend in groundwaters along the time is the same, which means high As concentration areas remain in the same groundwaters and these areas are presenting the highest water temperature. These results shall contribute to understand the bioaccumulation of As in barley and the As spatial variability in central Mexico.

10.
J Clin Med ; 9(10)2020 Sep 28.
Artigo em Inglês | MEDLINE | ID: mdl-32998337

RESUMO

It is unclear to which extent the higher mortality associated with hypertension in the coronavirus disease (COVID-19) is due to its increased prevalence among older patients or to specific mechanisms. Cross-sectional, observational, retrospective multicenter study, analyzing 12226 patients who required hospital admission in 150 Spanish centers included in the nationwide SEMI-COVID-19 Network. We compared the clinical characteristics of survivors versus non-survivors. The mean age of the study population was 67.5 ± 16.1 years, 42.6% were women. Overall, 2630 (21.5%) subjects died. The most common comorbidity was hypertension (50.9%) followed by diabetes (19.1%), and atrial fibrillation (11.2%). Multivariate analysis showed that after adjusting for gender (males, OR: 1.5, p = 0.0001), age tertiles (second and third tertiles, OR: 2.0 and 4.7, p = 0.0001), and Charlson Comorbidity Index scores (second and third tertiles, OR: 4.7 and 8.1, p = 0.0001), hypertension was significantly predictive of all-cause mortality when this comorbidity was treated with angiotensin-converting enzyme inhibitors (ACEIs) (OR: 1.6, p = 0.002) or other than renin-angiotensin-aldosterone blockers (OR: 1.3, p = 0.001) or angiotensin II receptor blockers (ARBs) (OR: 1.2, p = 0.035). The preexisting condition of hypertension had an independent prognostic value for all-cause mortality in patients with COVID-19 who required hospitalization. ARBs showed a lower risk of lethality in hypertensive patients than other antihypertensive drugs.

11.
Rev. Fac. Med. (Bogotá) ; 68(3): 405-412, July-Sept. 2020. tab, graf
Artigo em Inglês | LILACS-Express | LILACS | ID: biblio-1143729

RESUMO

Abstract Introduction: Instruments for measuring quality of life must be validated before being used in different cultural contexts. There is a specific scale (FACT-Lym) to assess health-related quality of life (HRQOL) in patients with lymphoma, but it has not been validated in Colombia yet. Objective: To determine the clinimetric properties of the FACT-Lym scale in Colombian patients with lymphoma. Materials and methods: A validation study of a scale was conducted based on the classical test theory. The FACT-Lym scale was administered to 301 patients diagnosed with different types of lymphomas and treated at the National Cancer Institute of Colombia, and their sociodemographic and clinical data were recorded. The statistical analysis included exploratory factor analysis, confirmatory factor analysis, construct validity, internal consistency, test-re-test reliability and sensitivity to change. Results: The exploratory factor analysis confirmed a two-factor structure of the scale, while the confirmatory analysis showed adequate adjustment of the model. Internal consistency was measured using the Cronbach's alpha coefficient (>0.8 on the global scale and on each of the factors). Correlation values significantly different from zero were found between the FACT-Lym scale and the FACT-G scale domains. No significant changes were observed in any domain of the FACT-Lym scale after the completion or suspension of treatment. Conclusions: The validation of the FACT-Lym questionnaire in Colombia showed it has a consistent factorial structure and adequate reliability. However, its sensitivity to change should be verified by evaluating its performance in other patient groups.


Resumen Introducción. Los instrumentos para medir la calidad de vida se deben validar antes de ser utilizados en diferentes contextos culturales. En la actualidad existe una escala específica (FACT-Lym) para medir la calidad de vida en pacientes con linfoma, sin embargo esta no ha sido validada en Colombia. Objetivo. Establecer las propiedades clinimétricas de la escala FACT-Lym en pacientes colombianos con linfoma. Materiales y métodos. Se realizó un estudio de validación de escalas según la teoría clásica de test. Se aplicó la escala FACT-Lym a 301 pacientes del Instituto Nacional de Cancerología diagnosticados con diferentes tipos de linfoma y se registraron sus datos sociodemográficos y clínicos. El análisis estadístico incluyó análisis factorial exploratorio, análisis factorial confirmatorio, validez de constructo, consistencia interna, confiabilidad test re-test y sensibilidad al cambio. Resultados. El análisis factorial exploratorio confirmó una estructura de dos factores de la escala, mientras que el análisis confirmatorio mostró un adecuado ajuste del modelo estructural. La consistencia interna se midió con el coeficiente alfa de Cronbach (>0.8 en la escala global y en cada uno de los factores). Se encontraron valores de correlación significativamente diferentes a cero entre la FACT-Lym y los dominios de la escala FACT-G. No se observaron cambios significativos en ninguno de los dominios de la FACT-Lym luego de completar o suspender el tratamiento. Conclusiones. La validación de la escala FACT-Lym en Colombia mostró que esta tiene una estructura factorial consistente y una adecuada confiabilidad. Sin embargo, su sensibilidad al cambio debe verificarse evaluando su desempeño en otras poblaciones.

12.
Sci Rep ; 10(1): 15224, 2020 Sep 16.
Artigo em Inglês | MEDLINE | ID: mdl-32938969

RESUMO

The aerosol properties of Mount Etna's passive degassing plume and its short-term processes and radiative impact were studied in detail during the EPL-RADIO campaigns (summer 2016-2017), using a synergistic combination of observations and radiative transfer modelling. Summit observations show extremely high particulate matter concentrations. Using portable photometers, the first mapping of small-scale (within [Formula: see text] from the degassing craters) spatial variability of the average size and coarse-to-fine burden proportion of volcanic aerosols is obtained. A substantial variability of the plume properties is found at these spatial scales, revealing that processes (e.g. new particle formation and/or coarse aerosols sedimentation) are at play, which are not represented with current regional scale modelling and satellite observations. Statistically significant progressively smaller particles and decreasing coarse-to-fine particles burden proportion are found along plume dispersion. Vertical structures of typical passive degassing plumes are also obtained using observations from a fixed LiDAR station constrained with quasi-simultaneous photometric observations. These observations are used as input to radiative transfer calculations, to obtain the shortwave top of the atmosphere (TOA) and surface radiative effect of the plume. For a plume with an ultraviolet aerosol optical depth of 0.12-0.14, daily average radiative forcings of [Formula: see text] and [Formula: see text], at TOA and surface, are found at a fixed location [Formula: see text] downwind the degassing craters. This is the first available estimation in the literature of the local radiative impact of a passive degassing volcanic plume.

13.
R Soc Open Sci ; 7(7): 200290, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32874626

RESUMO

A series of carbohydrate-linked 1,2,3-triazole derivatives were synthesized in good yields from glucofuranose and allofuranose diacetonides using as key step a three-component 1,3-dipolar azide-alkyne cycloaddition catalysed by a Cu-Al mixed oxide. In this multi-component reaction, Cu-Al mixed oxide/sodium ascorbate system serves as a highly reactive, recyclable and efficient heterogeneous catalyst for the regioselective synthesis of 1,4-disubstituted 1,2,3-triazoles. The reported protocol has significant advantages over classical CuI/N,N-diisopropylethylamine (DIPEA) or CuSO4/sodium ascorbate conditions in terms of efficiency and reduced synthetic complexity. In addition, the selective deprotection of synthesized di-O-isopropylidene derivatives was also carried out leading to the corresponding mono-O-isopropylidene products in moderate yields. Some of the synthesized triazole glycoconjugates were tested for their in vitro antimicrobial activity using the disc diffusion method against Gram-positive bacteria (Staphylococcus aureus and Bacillus subtilis), Gram-negative bacteria (Escherichia coli and Pseudomonas aeruginosa), as well as fungus (Aspergillus niger) and yeast (Candida utilis). The results revealed that these compounds exhibit moderate to good antimicrobial activity mainly against Gram-negative bacteria.

15.
Polymers (Basel) ; 12(8)2020 Aug 07.
Artigo em Inglês | MEDLINE | ID: mdl-32784622

RESUMO

The dielectric breakdown of solid polymeric materials is due to the inception and propagation of electrical trees inside them. The remaining useful life of the solid dielectrics could be determined using propagation simulations correlated with non-intrusive measurements such as partial discharges (PD). This paper presents a brief review of the different models for simulating electrical tree propagation in solid dielectrics. A novel improved physical-stochastic model is proposed, which allows quantitatively and qualitatively analyzing the electrical tree propagation process in polymeric dielectrics. Simulation results exhibit good agreement with measurements presented in the literature. It is concluded that the model allows adequately predicting the tree propagation behavior and additional experimental analyses are required in order to improve the model accuracy.

17.
Nat Commun ; 11(1): 3709, 2020 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-32709843

RESUMO

Cryo-electron tomography combined with subtomogram averaging (StA) has yielded high-resolution structures of macromolecules in their native context. However, high-resolution StA is not commonplace due to beam-induced sample drift, images with poor signal-to-noise ratios (SNR), challenges in CTF correction, and limited particle number. Here we address these issues by collecting tilt series with a higher electron dose at the zero-degree tilt. Particles of interest are then located within reconstructed tomograms, processed by conventional StA, and then re-extracted from the high-dose images in 2D. Single particle analysis tools are then applied to refine the 2D particle alignment and generate a reconstruction. Use of our hybrid StA (hStA) workflow improved the resolution for tobacco mosaic virus from 7.2 to 4.4 Å and for the ion channel RyR1 in crowded native membranes from 12.9 to 9.1 Å. These resolution gains make hStA a promising approach for other StA projects aimed at achieving subnanometer resolution.


Assuntos
Canais de Cálcio/química , Microscopia Crioeletrônica/métodos , Processamento de Imagem Assistida por Computador/métodos , Tomografia com Microscopia Eletrônica/métodos , Substâncias Macromoleculares/química , Canal de Liberação de Cálcio do Receptor de Rianodina/química , Razão Sinal-Ruído , Imagem Individual de Molécula , Fluxo de Trabalho
18.
J Clin Med ; 9(6)2020 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-32486396

RESUMO

Medication-related osteonecrosis of the jaw (MRONJ) is defined as the exposed necrotic bone involving the maxillofacial structures in bisphosphonate treated patients, and the pathophysiology of this disease remains unclear. The aim of this study was to assess the effects of the allogeneic transplantation of bone marrow-derived mesenchymal stem cells (BM-MSCs) in a model of Wistar mice with induced MRONJ disease. BM-MSCs from five male Wistar rats were characterized and cultured on ß-tricalcium phosphate (ß-TCP) granules. Thirty female Wistar rats were injected intraperitoneally with zoledronic acid and afterwards upper jaw molars were extracted. The animals were randomized to receive: Group 1: 1 × 106 BM-MSCs/ß-TCP construct in the alveolar socket; and Group 2: Saline solution/ß-TCP construct. A clinical and histological analysis was performed. Nested polymerase chain reaction (PCR) was assessed to verify the presence of transplanted male rat cells in the female recipient jaws. Clinical and histological findings evidenced that none of the animals in Group 1 exhibited uncovered sockets or bone exposure associated to MRONJ, whereas we detected 33% of MRONJ cases in Group 2. In addition, male rat cells were detected in the maxillae site four weeks after transplantation in the BM-MSCs-group. Allogeneic BM-MSCs in extractions sites ameliorates MRONJ incidence in zoledronic acid-treated rats compared to non-MSC treatments.

20.
Mod Pathol ; 33(11): 2169-2185, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32467650

RESUMO

Pathologists are responsible for rapidly providing a diagnosis on critical health issues. Challenging cases benefit from additional opinions of pathologist colleagues. In addition to on-site colleagues, there is an active worldwide community of pathologists on social media for complementary opinions. Such access to pathologists worldwide has the capacity to improve diagnostic accuracy and generate broader consensus on next steps in patient care. From Twitter we curate 13,626 images from 6,351 tweets from 25 pathologists from 13 countries. We supplement the Twitter data with 113,161 images from 1,074,484 PubMed articles. We develop machine learning and deep learning models to (i) accurately identify histopathology stains, (ii) discriminate between tissues, and (iii) differentiate disease states. Area Under Receiver Operating Characteristic (AUROC) is 0.805-0.996 for these tasks. We repurpose the disease classifier to search for similar disease states given an image and clinical covariates. We report precision@k = 1 = 0.7618 ± 0.0018 (chance 0.397 ± 0.004, mean ±stdev ). The classifiers find that texture and tissue are important clinico-visual features of disease. Deep features trained only on natural images (e.g., cats and dogs) substantially improved search performance, while pathology-specific deep features and cell nuclei features further improved search to a lesser extent. We implement a social media bot (@pathobot on Twitter) to use the trained classifiers to aid pathologists in obtaining real-time feedback on challenging cases. If a social media post containing pathology text and images mentions the bot, the bot generates quantitative predictions of disease state (normal/artifact/infection/injury/nontumor, preneoplastic/benign/low-grade-malignant-potential, or malignant) and lists similar cases across social media and PubMed. Our project has become a globally distributed expert system that facilitates pathological diagnosis and brings expertise to underserved regions or hospitals with less expertise in a particular disease. This is the first pan-tissue pan-disease (i.e., from infection to malignancy) method for prediction and search on social media, and the first pathology study prospectively tested in public on social media. We will share data through http://pathobotology.org . We expect our project to cultivate a more connected world of physicians and improve patient care worldwide.

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