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2.
Int J Sports Physiol Perform ; 14(9): 1159-1169, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31575820

RESUMO

PURPOSE: Despite the volume of available literature focusing on marathon running and the prediction of performance, no single prediction equations exists that is accurate for all runners of varying experiences and abilities. Indeed the relative merits and utility of the existing equations remain unclear. Thus, the aim of this study was to collate, characterize, compare, and contrast all available marathon prediction equations. METHODS: A systematic review was conducted to identify observational research studies outlining any kind of prediction algorithm for marathon performance. RESULTS: Thirty-six studies with 114 equations were identified. Sixty-one equations were based on training and anthropometric variables, whereas 53 equations included variables that required laboratory tests and equipment. The accuracy of these equations was denoted via a variety of metrics; r2 values were provided for 68 equations (r2 = .10-.99), and an SEE was provided for 19 equations (SEE 0.27-27.4 min). CONCLUSION: Heterogeneity of the data precludes the identification of a single "best" equation. Important variables such as course gradient, sex, and expected weather conditions were often not included, and some widely used equations did not report the r2 value. Runners should therefore be wary of relying on a single equation to predict their performance.


Assuntos
Algoritmos , Desempenho Atlético , Comportamento Competitivo , Corrida , Antropometria , Atletas , Teste de Esforço , Humanos , Estudos Observacionais como Assunto , Condicionamento Físico Humano
3.
Med Clin North Am ; 103(6): 1055-1075, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31582004

RESUMO

This article presents a nongeneticist's guide to understanding the genetics of Parkinson disease (PD), including clinical diagnostic criteria, differential diagnoses, symptom management, when to suspect a hereditary factor, a summary of autosomal dominant and recessive PD genes, and proposed algorithm for genetic testing. There is increasing availability of genetic testing for PD but there are few recommendations on how these tests should be used in clinical practice. This article guides clinicians on the overall management of patients with PD, with emphasis on determining which patients should have genetic testing and how to interpret the results.


Assuntos
Testes Genéticos/métodos , Doença de Parkinson , Algoritmos , Gerenciamento Clínico , Predisposição Genética para Doença , Humanos , Doença de Parkinson/diagnóstico , Doença de Parkinson/genética , Doença de Parkinson/terapia
4.
Medicine (Baltimore) ; 98(39): e17311, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574860

RESUMO

Immune infiltration of nasopharyngeal carcinoma (NPC) is closely associated with the patients' prognosis. However, previous studies have not interpreted the difference of infiltrating immune cells in NPC.We comprehensively analyzed the tumor-infiltrating immune cells present in NPC for the first time, which was based on a scientific deconvolution algorithm (CIBERSORT) and the gene expression data of GSE64634. The fractions of 22 immune cells were assessed to reveal the associations between normal samples and NPC samples.Profiles of immune infiltration vary significantly between normal samples and NPC samples, and the variation could characterize the individual differences. NPC samples contained a higher proportion for M1 macrophages, whereas memory B cells and CD4 memory resting T cells were relatively lower.Our data suggest that the differences in the infiltrating immune cells in NPC and these differences would probably facilitate patient consultation and individualized treatment.


Assuntos
Linfócitos do Interstício Tumoral , Carcinoma Nasofaríngeo , Neoplasias Nasofaríngeas , Adulto , Algoritmos , Linfócitos B/imunologia , Linfócitos B/patologia , Linfócitos T CD4-Positivos/imunologia , Linfócitos T CD4-Positivos/patologia , China , Correlação de Dados , Feminino , Expressão Gênica , Humanos , Memória Imunológica , Linfócitos do Interstício Tumoral/classificação , Linfócitos do Interstício Tumoral/imunologia , Linfócitos do Interstício Tumoral/patologia , Macrófagos/imunologia , Macrófagos/patologia , Masculino , Pessoa de Meia-Idade , Carcinoma Nasofaríngeo/diagnóstico , Carcinoma Nasofaríngeo/imunologia , Carcinoma Nasofaríngeo/patologia , Neoplasias Nasofaríngeas/diagnóstico , Neoplasias Nasofaríngeas/imunologia , Neoplasias Nasofaríngeas/patologia , Prognóstico , Reprodutibilidade dos Testes
6.
Bratisl Lek Listy ; 120(9): 650-657, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31475548

RESUMO

In this contribution we present graph theoretical approach to image processing focus on biological data. We use the graph cut algorithms and extend them for obtaining segmentation of biological data. We deal with tumor brain cells and rats brain to show the existence and presence of inflammatory molecules. We introduce a completely new method for filtering of data (Tab. 3, Schema 4, Fig. 7, Ref. 13). Keywords: graph cuts, segmentation, tumore analyses of cells, computer morphometry.


Assuntos
Algoritmos , Neoplasias Encefálicas/patologia , Processamento de Imagem Assistida por Computador , Modelos Teóricos , Animais , Encéfalo/citologia , Ratos
7.
J Am Soc Nephrol ; 30(10): 1780-1781, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31488608
9.
Sheng Wu Gong Cheng Xue Bao ; 35(9): 1619-1632, 2019 Sep 25.
Artigo em Chinês | MEDLINE | ID: mdl-31559744

RESUMO

With the development of mass spectrometry technologies and bioinformatics analysis algorithms, disease research-driven human proteome project (HPP) is advancing rapidly. Protein biomarkers play critical roles in clinical applications and the biomarker discovery strategies and methods have become one of research hotspots. Feature selection and machine learning methods have good effects on solving the "dimensionality" and "sparsity" problems of proteomics data, which have been widely used in the discovery of protein biomarkers. Here, we systematically review the strategy of protein biomarker discovery and the frequently-used machine learning methods. Also, the review illustrates the prospects and limitations of deep learning in this field. It is aimed at providing a valuable reference for corresponding researchers.


Assuntos
Aprendizado de Máquina , Algoritmos , Biomarcadores , Humanos , Espectrometria de Massas , Proteômica
10.
Am Surg ; 85(8): 813-820, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560300

RESUMO

Management of pyogenic hepatic abscesses (PHA) varies among surgeons and institutions. Recent studies have advocated for first-line percutaneous drainage (PD) of all accessible hepatic abscesses, with surgery reserved as rescue only. Our study aimed to internally validate an established multimodal algorithm for PHA at a high-volume hepatopancreatobiliary center. Patients treated by the hepatopancreatobiliary service for PHA were retrospectively reviewed from 2008 through 2018. The algorithm defined intended first-line treatment as antibiotics for type I abscesses (<3 cm), PD for type II (≥3, unilocular), and surgical intervention (minimally invasive drainage or resection, when possible) for type III (≥3 cm, multilocular). Outcomes were compared between patients who received first-line treatment following the algorithm versus alternate therapy. Of 330 patients with PHA, 201 met inclusion criteria. Type III abscesses had significantly lower failure following algorithmic approach with surgery compared with PD (4% vs 28%, P = 0.018). Type II abscesses failed first-line PD in 27 per cent (13/48) with 11 patients requiring surgical rescue, whereas first-line surgery failed in only 13 per cent (2/15). No deaths occurred after any surgical intervention, and there was no statistical difference in major complications between first-line surgical intervention and PD for type II or III abscesses. These results support the algorithmic approach and demonstrate that minimally invasive surgical intervention is a safe and effective modality for large PHA. We recommend that select patients with large, complex abscesses should be considered for a first-line minimally invasive surgical approach depending on surgical experience and available resources.


Assuntos
Abscesso Hepático Piogênico/cirurgia , Procedimentos Cirúrgicos Minimamente Invasivos , Algoritmos , Drenagem/métodos , Feminino , Humanos , Abscesso Hepático Piogênico/mortalidade , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
11.
Am Surg ; 85(8): 883-894, 2019 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-31560308

RESUMO

Postoperative laboratory testing is an underrecognized but substantial contributor to health-care costs. We aimed to develop and validate a clinically meaningful laboratory (CML) protocol with individual risk stratification using generalizable and institution-specific predictive analytics to reduce laboratory testing and maximize cost savings for low-risk patients. An institutionally based risk model was developed for pancreaticoduodenectomy and hepatectomy, and an ACS-NSQIP®-based model was developed for distal pancreatectomy. Patients were stratified in each model to the CML by individual risk of major complications, readmission, or death. Clinical outcomes and estimated cost savings were compared with those of a historical cohort with standard of care. Over 34 months, 394 patients stratified to the CML for pancreaticoduodenectomy or hepatectomy saved an estimated $803,391 (44.4%). Over 13 months, 52 patients stratified to the CML for distal pancreatectomy saved an estimated $81,259 (30.5%). Clinical outcomes for 30-day major complications, readmission, and mortality were unchanged after implementation of either model. Predictive analytics can target low-risk patients to reduce laboratory testing and improve cost savings, regardless of whether an institutional or a generalized risk model is implemented. Broader application is important in patient-centered health care and should transition from predictive to prescriptive analytics to guide individual care in real time.


Assuntos
Protocolos Clínicos , Controle de Custos , Testes Diagnósticos de Rotina/economia , Hepatectomia , Preços Hospitalares/estatística & dados numéricos , Pancreatectomia , Pancreaticoduodenectomia , Cuidados Pós-Operatórios/economia , Medição de Risco/métodos , Algoritmos , Feminino , Humanos , Masculino , Estudos Prospectivos , Melhoria de Qualidade , Estados Unidos
12.
Medicine (Baltimore) ; 98(36): e17015, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31490385

RESUMO

Synthetic cannabinoids have become increasingly popular drugs of abuse due to low cost and inability to detect these substances on routine drug screenings. In the United States, incidence of synthetic cannabinoid contamination with long-acting anticoagulant rodenticides (LAARs) resulting in coagulopathy and bleeding complications has been described.We sought to describe the natural history, management approach, and outcomes of bleeding secondary to synthetic cannabinoid-associated LAAR toxicity in an observational case series of patients evaluated at an urban academic medical system.We conducted an observational study of patients with suspected exposure to LAAR-contaminated synthetic cannabinoids and associated bleeding treated within the Johns Hopkins Health System.In this 16 subject cohort, hematuria was the most common bleeding symptom at presentation. The majority of the cohort (75%) had international normalized ratio (INR) > 9.6 at presentation. Of the 13 patients with brodifacoum testing, 12/13 (92%) were positive. Twelve patients (75%) had at least 1 INR value below 2 within 24 hours of the first INR measurement. Of this cohort, 1/16 (6%) died in hospital. The median length of hospital stay was 4 days, (interquartile range = 3-6). The average cost of pharmacological treatment for coagulopathy during inpatient hospitalization was $5300 (range, $2241-$8086).In patients presenting with unexplained coagulopathy it is important for emergency department providers to consider LAAR intoxication and consider formal testing for brodifacoum to assist with treatment planning. Use of a standardized management algorithm including intravenous/oral vitamin K, judicious use of blood products and close laboratory monitoring is essential to optimizing outcomes.


Assuntos
Transtornos da Coagulação Sanguínea/tratamento farmacológico , Rodenticidas/envenenamento , Vitamina K/uso terapêutico , Adulto , Algoritmos , Transtornos da Coagulação Sanguínea/induzido quimicamente , Canabinoides , Contaminação de Medicamentos , Feminino , Humanos , Masculino , Estudos Retrospectivos , Drogas Ilícitas
13.
Isr Med Assoc J ; 21(7): 503, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31507131

RESUMO

BACKGROUND: Benign rolandic epilepsy or benign childhood epilepsy with centrotemporal spikes (BCECTS) is a common childhood epileptic syndrome. The syndrome resolves in adolescence, but 1-7% of patients have an atypical presentation, some of which require aggressive medical treatment. Early treatment may prevent complications and neurocognitive deterioration. Variants include Landau-Kleffner syndrome (LKS) and electrical status epilepticus during sleep (ESES). OBJECTIVES: To determine data driven identification of risk factors and characterization of new subtypes of BCECTS based on anontology. To use data mining analysis and correlation between the identified groups and known clinical variants. METHODS: We conducted a retrospective cohort study comprised of 104 patients with a diagnosis of BCECTS and a minimum of 2 years of follow-up, between the years 2005 and 2017. The medical records were obtained from the epilepsy service unit of the pediatric neurology department at Dana-Dwek Hospital, Tel Aviv Sourasky Medical Center. We developed a BCECTS ontology and performed data preprocessing and analysis using the R Project for Statistical Computing (https://www.r-project.org/) and machine learning tools to identify risk factors and characterize subgroups. RESULTS: The ontology created a uniform and understandable infrastructure for research. With the ontology, a more precise characterization of clinical symptoms and EEG activity of BCECTS was possible. Risk factors for the development of severe atypical presentations were identified: electroencephalography (EEG) with spike wave (P < 0.05), EEG without evidence of left lateralization (P < 0.05), and EEG localization (centrotemporal, frontal, or frontotemporal) (P < 0.01). CONCLUSIONS: Future use of the ontology infrastructure for expanding characterization for multicenter studies as well as future studies of the disease are needed. Identifying subgroups and adapting them to known clinical variants will enable identification of risk factors, improve prediction of disease progression, and facilitate adaptation of more accurate therapy. Early identification and frequent follow-up may have a significant impact on the prognosis of the atypical variants.


Assuntos
Algoritmos , Mineração de Dados , Eletroencefalografia/métodos , Epilepsia Rolândica/diagnóstico , Estudos de Coortes , Epilepsia Rolândica/fisiopatologia , Seguimentos , Humanos , Prognóstico , Estudos Retrospectivos , Fatores de Risco
14.
Nan Fang Yi Ke Da Xue Xue Bao ; 39(8): 972-979, 2019 Aug 30.
Artigo em Chinês | MEDLINE | ID: mdl-31511219

RESUMO

OBJECTIVE: To evaluate rectal toxicity of radiotherapy for prostate cancer using a novel predictive model based on multi-modality and multi-classifier fusion. METHODS: We retrospectively collected the clinical data from 44 prostate cancer patients receiving external beam radiation (EBRT), including the treatment data, clinical parameters, planning CT data and the treatment plans. The clinical parameter features and dosimetric features were extracted as two different modality features, and a subset of features was selected to train the 5 base classifiers (SVM, Decision Tree, K-nearest-neighbor, Random forests and XGBoost). To establish the multi-modality and multi-classifier fusion model, a multi-criteria decision-making based weight assignment algorithm was used to assign weights for each base classifier under the same modality. A repeat 5-fold cross-validation and the 4 indexes including the area under ROC curve (AUC), accuracy, sensitivity and specificity were used to evaluate the proposed model. In addition, the proposed model was compared quantitatively with different feature selection methods, different weight allocation algorithms, the model based on single mode single classifier, and two integrated models using other fusion methods. RESULTS: Repeated (5 times) 5-fold cross validation of the proposed model showed an accuracy of 0.78 for distinguishing toxicity from non-toxicity with an AUC of 0.83, a specificity of 0.79 and a sensitivity of 0.76. CONCLUSIONS: Compared with the models based on a single mode or a single classifier and other fusion models, the proposed model can more accurately predict rectal toxicity of radiotherapy for prostate cancer.


Assuntos
Neoplasias da Próstata , Reto , Algoritmos , Área Sob a Curva , Humanos , Masculino , Estudos Retrospectivos
15.
Stud Health Technol Inform ; 267: 126-133, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31483264

RESUMO

Magnetic Resonance Fingerprinting (MRF) is an imaging technique acquiring unique time signals for different tissues. Although the acquisition is highly accelerated, the reconstruction time remains a problem, as the state-of-the-art template matching compares every signal with a set of possible signals. To overcome this limitation, deep learning based approaches, e.g. Convolutional Neural Networks (CNNs) have been proposed. In this work, we investigate the applicability of Recurrent Neural Networks (RNNs) for this reconstruction problem, as the signals are correlated in time. Compared to previous methods based on CNNs, RNN models yield significantly improved results using in-vivo data.


Assuntos
Algoritmos , Redes Neurais (Computação) , Bases de Dados Genéticas , Espectroscopia de Ressonância Magnética
16.
Stud Health Technol Inform ; 267: 164-172, 2019 Sep 03.
Artigo em Inglês | MEDLINE | ID: mdl-31483269

RESUMO

Phenotyping means the determination of clinical relevant phenotypes, e.g. by classification or calculation based on EHR data. Within the German Medical Informatics Initiative, the SMITH consortium is working on the implementation of a phenotyping pipeline. to extract, structure and normalize information from the EHR data of the hospital information systems of the participating sites; to automatically apply complex algorithms and models and to enrich the data within the research data warehouses of the distributed data integration centers with the computed results. Here we present the overall picture and essential building blocks and workflows of this concept.


Assuntos
Registros Eletrônicos de Saúde , Informática Médica , Algoritmos , Fenótipo
17.
JAMA ; 322(10): 918, 2019 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-31503292
18.
BMC Surg ; 19(1): 136, 2019 Sep 13.
Artigo em Inglês | MEDLINE | ID: mdl-31519173

RESUMO

OBJECTIVES: The pectoralis major flap has been considered the workhorse flap for chest and sternoclavicular defect reconstruction. There have been many configurations of the pectoralis major flap reported in the literature for use in reconstruction sternoclavicular defects either involving bone, soft tissue elements, or both. This study reviews the different configurations of the pectoralis major flap for sternoclavicular defect reconstruction and provides the first ever classification for these techniques. We also provide an algorithm for the selection of these flap variants for sternoclavicular defect reconstruction. METHODS: EMBASE, Cochrane library, Ovid medicine and PubMed databases were searched from its inception to August of 2019. We included all studies describing surgical management of sternoclavicular defects. The studies were reviewed, and the different configurations of the pectoralis major flap used for sternoclavicular defect reconstruction were cataloged. We then proposed a new classification system for these procedures. RESULTS: The study included 6 articles published in the English language that provided a descriptive procedure for the use of pectoralis major flap in the reconstruction of sternoclavicular defects. The procedures were classified into three broad categories. In Type 1, the whole pectoris muscle is used. In Type 2, the pectoralis muscle is split and either advanced medially (type 2a) or rotated (type 2b) to fill the defect. In type 3, the clavicular portion of the pectoralis is islandized on a pedicle, either the thoracoacromial artery (type 3a) or the deltoid branch of the thoracoacromial artery (type 3b). CONCLUSION: There are multiple configurations of the pectoralis flap reported in the English language literature for the reconstruction of sternoclavicular defects. Our classification system, the Opoku Classification will help surgeons select the appropriate configuration of the pectoralis major flap for sternoclavicular joint defect reconstruction based on size of defect, the status of the vascular anatomy, and acceptability of upper extremity disability. It will also help facilitate communication when describing the different configurations of the pectoralis major flap for reconstruction of sternoclavicular joint defects.


Assuntos
Músculos Peitorais/transplante , Procedimentos Cirúrgicos Reconstrutivos/métodos , Retalhos Cirúrgicos/cirurgia , Ferimentos e Lesões/cirurgia , Algoritmos , Clavícula/cirurgia , Humanos , Infecção/cirurgia , Osteomielite/cirurgia , Músculos Peitorais/cirurgia , Procedimentos Cirúrgicos Reconstrutivos/classificação , Esterno/cirurgia , Retalhos Cirúrgicos/irrigação sanguínea , Parede Torácica/cirurgia , Ferimentos e Lesões/etiologia
19.
Anticancer Res ; 39(9): 4589-4596, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31519555

RESUMO

Despite recent advances in the treatment of gastric cancer, mortality related to this disease is still substantial. Surgery and chemotherapy represent the cornerstones of patient management. Targeted treatments that include anti-angiogenic agents and the advent of immunotherapies can contribute to improved patient prognosis. Herein, we present an Austrian consensus on the systemic treatment of patients with gastric adenocarcinoma and lower gastroesophageal junction, including those with human epidermal growth factor receptor 2 (HER2)-positive disease. The consensus considers the curative setting, as well as first-line to late-line systemic treatment options in the palliative setting. For HER2-positive disease, first-line and second-line therapies are discussed, as well as HER2 testing. Potential future therapies are also listed, with a focus on anti-angiogenic treatments and checkpoint inhibition, that might provide a further step forward in the management of patients with gastric cancer.


Assuntos
Adenocarcinoma/terapia , Algoritmos , Neoplasias Gástricas/terapia , Adenocarcinoma/diagnóstico , Adenocarcinoma/etiologia , Áustria , Terapia Combinada , Consenso , Gerenciamento Clínico , Humanos , Neoplasias Gástricas/diagnóstico , Neoplasias Gástricas/etiologia
20.
Stud Health Technol Inform ; 264: 1867-1869, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31438383

RESUMO

The aim of this work is to study the influence of contamination with infusion in clinical chemistry tests and to design an algorithm for detection of inadequate blood specimen. We show that panic value of postassium (K+)/ glucose (GLU) or decrease of total protein (TP), albumin (ALB), urea nitrogen (BUN), uric acid (UA), high-density lipoprotein cholesterol (HDL-C), total cholesterol (T-CHO), and calcium (Ca) is an index of contamination of drip infusion solution. Through a clinical study, we show that our algorithm is useful for preventing adverse medical errors.


Assuntos
Química Clínica , Algoritmos , Nitrogênio da Ureia Sanguínea , HDL-Colesterol , Ácido Úrico
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