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Nevin Manimala Statistics

Unsupervised contrastive peak caller for ATAC-seq

Genome Res. 2023 May 22:gr.277677.123. doi: 10.1101/gr.277677.123. Online ahead of print.

ABSTRACT

The assay for transposase-accessible chromatin with sequencing (ATAC-seq) is a common assay to identify chromatin accessible regions by using a Tn5 transposase that can access, cut, and ligate adapters to DNA fragments for subsequent amplification and sequencing. These sequenced regions are quantified and tested for enrichment in a process referred to as “peak calling”. Most unsupervised peak calling methods are based on simple statistical models and suffer from elevated false positive rates. Newly developed supervised deep learning methods can be successful, but they rely on high quality labeled data for training, which can be difficult to obtain. Moreover, though biological replicates are recognized to be important, there are no established approaches for using replicates in the deep learning tools, and the approaches available for traditional methods either cannot be applied to ATAC-seq, where control samples may be unavailable, or are post-hoc and do not capitalize on potentially complex, but reproducible signal in the read enrichment data. Here, we propose a novel peak caller that uses unsupervised contrastive learning to extract shared signals from multiple replicates. Raw coverage data are encoded to obtain low-dimensional embeddings and optimized to minimize a contrastive loss over biological replicates. These embeddings are passed to another contrastive loss for learning and predicting peaks and decoded to denoised data under an autoencoder loss. We compared our Replicative Contrastive Learner (RCL) method with other existing methods on ATAC-seq data, using annotations from ChromHMM genome and transcription factor ChIP-seq as noisy truth. RCL consistently achieved the best performance.

PMID:37217250 | DOI:10.1101/gr.277677.123

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Nevin Manimala Statistics

Anticipating artificial intelligence in mammography screening: views of Swedish breast radiologists

BMJ Health Care Inform. 2023 May;30(1):e100712. doi: 10.1136/bmjhci-2022-100712.

ABSTRACT

OBJECTIVES: Artificial intelligence (AI) is increasingly tested and integrated into breast cancer screening. Still, there are unresolved issues regarding its possible ethical, social and legal impacts. Furthermore, the perspectives of different actors are lacking. This study investigates the views of breast radiologists on AI-supported mammography screening, with a focus on attitudes, perceived benefits and risks, accountability of AI use, and potential impact on the profession.

METHODS: We conducted an online survey of Swedish breast radiologists. As early adopter of breast cancer screening, and digital technologies, Sweden is a particularly interesting case to study. The survey had different themes, including: attitudes and responsibilities pertaining to AI, and AI’s impact on the profession. Responses were analysed using descriptive statistics and correlation analyses. Free texts and comments were analysed using an inductive approach.

RESULTS: Overall, respondents (47/105, response rate 44.8%) were highly experienced in breast imaging and had a mixed knowledge of AI. A majority (n=38, 80.8%) were positive/somewhat positive towards integrating AI in mammography screening. Still, many considered there to be potential risks to a high/somewhat high degree (n=16, 34.1%) or were uncertain (n=16, 34.0%). Several important uncertainties were identified, such as defining liable actor(s) when AI is integrated into medical decision-making.

CONCLUSIONS: Swedish breast radiologists are largely positive towards integrating AI in mammography screening, but there are significant uncertainties that need to be addressed, especially regarding risks and responsibilities. The results stress the importance of understanding actor-specific and context-specific challenges to responsible implementation of AI in healthcare.

PMID:37217249 | DOI:10.1136/bmjhci-2022-100712

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Nevin Manimala Statistics

Radiomic and clinical data integration using machine learning predict the efficacy of anti-PD-1 antibodies-based combinational treatment in advanced breast cancer: a multicentered study

J Immunother Cancer. 2023 May;11(5):e006514. doi: 10.1136/jitc-2022-006514.

ABSTRACT

BACKGROUND: Immune checkpoint inhibitors (ICIs)-based therapy, is regarded as one of the major breakthroughs in cancer treatment. However, it is challenging to accurately identify patients who may benefit from ICIs. Current biomarkers for predicting the efficacy of ICIs require pathological slides, and their accuracy is limited. Here we aim to develop a radiomics model that could accurately predict response of ICIs for patients with advanced breast cancer (ABC).

METHODS: Pretreatment contrast-enhanced CT (CECT) image and clinicopathological features of 240 patients with ABC who underwent ICIs-based treatment in three academic hospitals from February 2018 to January 2022 were assigned into a training cohort and an independent validation cohort. For radiomic features extraction, CECT images of patients 1 month prior to ICIs-based therapies were first delineated with regions of interest. Data dimension reduction, feature selection and radiomics model construction were carried out with multilayer perceptron. Combined the radiomics signatures with independent clinicopathological characteristics, the model was integrated by multivariable logistic regression analysis.

RESULTS: Among the 240 patients, 171 from Sun Yat-sen Memorial Hospital and Sun Yat-sen University Cancer Center were evaluated as a training cohort, while other 69 from Sun Yat-sen University Cancer Center and the First Affiliated Hospital of Sun Yat-sen University were the validation cohort. The area under the curve (AUC) of radiomics model was 0.994 (95% CI: 0.988 to 1.000) in the training and 0.920 (95% CI: 0.824 to 1.000) in the validation set, respectively, which were significantly better than the performance of clinical model (0.672 for training and 0.634 for validation set). The integrated clinical-radiomics model showed increased but not statistical different predictive ability in both the training (AUC=0.997, 95% CI: 0.993 to 1.000) and validation set (AUC=0.961, 95% CI: 0.885 to 1.000) compared with the radiomics model. Furthermore, the radiomics model could divide patients under ICIs-therapies into high-risk and low-risk group with significantly different progression-free survival both in training (HR=2.705, 95% CI: 1.888 to 3.876, p<0.001) and validation set (HR=2.625, 95% CI: 1.506 to 4.574, p=0.001), respectively. Subgroup analyses showed that the radiomics model was not influenced by programmed death-ligand 1 status, tumor metastatic burden or molecular subtype.

CONCLUSIONS: This radiomics model provided an innovative and accurate way that could stratify patients with ABC who may benefit more from ICIs-based therapies.

PMID:37217246 | DOI:10.1136/jitc-2022-006514

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Nevin Manimala Statistics

The effect of prolonged 60° head of bed elevation on sacral subepidermal oedema in healthy adults: A quantitative prospective exploratory study

Int Wound J. 2023 May 22. doi: 10.1111/iwj.14240. Online ahead of print.

ABSTRACT

Head of bed elevation is used to manage some medical and surgical conditions however this may increase a patient’s risk of sacral pressure injuries. Novel point-of-care technologies that measure subepidermal moisture can identify changes in localised subepidermal oedema and potential pressure injury risk. This prospective exploratory study investigated variations in sacral subepidermal oedema in healthy adults during 120-min of 60° head of bed elevation. Sacral subepidermal oedema was measured at 20-min intervals using the Provisio® subepidermal moisture scanner. Descriptive analysis, one-way repeated measures analysis of variance and an independent t-test were conducted. Slightly more male volunteers (n = 11; 55%) were recruited and the sample mean age was 39.3 years (SD 14.7) with an average body mass index of 25.8 (SD 4.3). Little variation in the mean sacral subepidermal moisture of healthy adults was observed. There was a statistically significant difference in the mean sacral subepidermal moisture measurements between males and females (Mean difference 0.18; 95% confidence intervals: 0.02 to 0.35; P = .03). Healthy adults can tolerate prolonged 60° head of bed elevation without developing increased subepidermal sacral oedema. This warrants further investigation in other populations, in various positions and over different time periods.

PMID:37217227 | DOI:10.1111/iwj.14240

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Nevin Manimala Statistics

The causal role of C-reactive protein and interleukin-6 on anxiety and depression symptoms and life satisfaction: Mendelian randomisation analyses in the HUNT study

Psychol Med. 2023 May 23:1-8. doi: 10.1017/S0033291723001290. Online ahead of print.

ABSTRACT

BACKGROUND: Serum levels of C-reactive protein (CRP) and interleukin-6 (IL-6) have been associated with anxiety and depression in cross-sectional and Mendelian randomisation studies, but results regarding the effect size and direction have been mixed. A recent Mendelian Randomisation (MR) study suggested that CRP may decrease and IL-6 may increase anxiety and depression symptoms.

METHODS: Among 68 769 participants of the population-based Trøndelag Health Study (HUNT), we performed cross-sectional observational and one-sample MR analyses of serum CRP and two-sample MR analysis of serum IL-6. The main outcomes were symptoms of anxiety and depression assessed using the Hospital Anxiety and Depression Scale (HADS) and life satisfaction assessed using a seven-level ordinal questionnaire where higher scores indicate lower life satisfaction.

RESULTS: In cross-sectional observational analyses, a doubling in serum CRP level was associated with 0.27% (95% CI -0.20 to 0.75) difference in HADS depression score (HADS-D), -0.77% (95% CI -1.24 to -0.29) difference in HADS anxiety score (HADS-A) and -0.10% (95% CI -0.41 to 0.21) difference in life satisfaction score. In one-sample MR analyses, a doubling in serum CRP was associated with 2.43% (95% CI -0.11 to 5.03) higher HADS-D, 1.94% (95% CI -0.58 to 4.52) higher HADS-A, and 2.00% (95% CI 0.45 to 3.59) higher life satisfaction score. For IL-6, causal point estimates were in the opposite direction, but imprecise and far from conventional criteria for statistical significance.

CONCLUSIONS: Our results do not support a major causal role of serum CRP on anxiety and depression symptoms and life satisfaction, but provides weak evidence that serum CRP may modestly increase anxiety and depression symptoms and reduce life satisfaction. Our findings do not support the recent suggestion that serum CRP may lower anxiety and depression symptoms.

PMID:37217205 | DOI:10.1017/S0033291723001290

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Nevin Manimala Statistics

Cavitary pulmonary lesion wall thickness, presence of additional nodules, and intralesional contrast enhancement are associated with malignancy in dogs and cats

J Am Vet Med Assoc. 2023 May 18:1-7. doi: 10.2460/javma.23.02.0076. Online ahead of print.

ABSTRACT

OBJECTIVE: To investigate the CT features of cavitary pulmonary lesions and determine their utility to differentiate malignant from benign lesions.

ANIMALS: This retrospective study included cases from 5 veterinary medical centers between January 1 2010, and December 31, 2020. Inclusion criteria included having a gas-filled cavitary pulmonary lesion on thoracic CT and definitive diagnosis by either cytology or histopathology. Forty-two animals (27 dogs and 15 cats) were included in this study.

PROCEDURES: Medical records systems/imaging databases were searched, and cases meeting inclusion criteria were selected. The CT studies were interpreted by a third-year radiology resident, and findings were reviewed by a board-certified veterinary radiologist.

RESULTS: 7 of the 13 lesion characteristics investigated were not statistically associated with the final diagnosis of the lesion, whereas 6 were statistically associated. Those that were associated included the presence of intralesional contrast enhancement, type of intralesional contrast enhancement (heterogenous and homogenous analyzed separately), presence of additional nodules, wall thickness of the lesion at its thickest point, and wall thickness at the thinnest point.

CLINICAL RELEVANCE: Results from the present study showed that thoracic CT imaging of cavitary pulmonary lesions can be used to further refine the list of differential diagnoses. Based on this data set, in lesions that have heterogenous contrast enhancement, additional pulmonary nodules, and wall thickness > 40 mm at their thickest point, it would be reasonable to consider malignant neoplastic disease higher on the list of differentials than other causes.

PMID:37217176 | DOI:10.2460/javma.23.02.0076

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Nevin Manimala Statistics

Is Convolutional Neural Network Accurate for Automatic Detection of Zygomatic Fractures on Computed Tomography?

J Oral Maxillofac Surg. 2023 May 2:S0278-2391(23)00393-2. doi: 10.1016/j.joms.2023.04.013. Online ahead of print.

ABSTRACT

PURPOSE: Zygomatic fractures involve complex anatomical structures of the mid-face and the diagnosis can be challenging and labor-consuming. This research is aimed to evaluate the performance of an automatic algorithm for the detection of zygomatic fractures based on convolutional neural network (CNN) on spiral computed tomography (CT).

MATERIALS AND METHODS: We designed a cross-sectional retrospective diagnostic trial study. Clinical records and CT scans of patients with zygomatic fractures were reviewed. The sample consisted of two types of patients with different zygomatic fractures statuses (positive or negative) in Peking University School of Stomatology from 2013 to 2019. All CT samples were randomly divided into three groups at a ratio of 6:2:2 as training set, validation set, and test set, respectively. All CT scans were viewed and annotated by three experienced maxillofacial surgeons, serving as the gold standard. The algorithm consisted of two modules as follows: (1) segmentation of the zygomatic region of CT based on U-Net, a type of CNN model; (2) detection of fractures based on Deep Residual Network 34(ResNet34). The region segmentation model was used first to detect and extract the zygomatic region, then the detection model was used to detect the fracture status. The Dice coefficient was used to evaluate the performance of the segmentation algorithm. The sensitivity and specificity were used to assess the performance of the detection model. The covariates included age, gender, duration of injury, and the etiology of fractures.

RESULTS: A total of 379 patients with an average age of 35.43 ± 12.74 years were included in the study. There were 203 nonfracture patients and 176 fracture patients with 220 sites of zygomatic fractures (44 patients underwent bilateral fractures). The Dice coefficientof zygomatic region detection model and gold standard verified by manual labeling were 0.9337 (coronal plane) and 0.9269 (sagittal plane), respectively. The sensitivity and specificity of the fracture detection model were 100% (p>.05).

CONCLUSION: The performance of the algorithm based on CNNs was not statistically different from the gold standard (manual diagnosis) for zygomatic fracture detection in order for the algorithm to be applied clinically.

PMID:37217163 | DOI:10.1016/j.joms.2023.04.013

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Nevin Manimala Statistics

Identification of pathogenic variants in the Brazilian cohort with Familial Hypercholesterolemia using exon-targeted gene sequencing

Gene. 2023 May 20:147501. doi: 10.1016/j.gene.2023.147501. Online ahead of print.

ABSTRACT

Familial hypercholesterolemia (FH) is a monogenic disease characterized by high plasma low-density lipoprotein cholesterol (LDL-c) levels and increased risk of premature atherosclerotic cardiovascular disease. Mutations in FH-related genes account for 40% of FH cases worldwide. In this study, we aimed to assess the pathogenic variants in FH-related genes in the Brazilian FH cohort FHBGEP using exon-targeted gene sequencing (ETGS) strategy. FH patients (n=210) were enrolled at five clinical sites and peripheral blood samples were obtained for laboratory testing and genomic DNA extraction. ETGS was performed using MiSeq platform (Illumina). To identify deleterious variants in LDLR, APOB, PCSK9, and LDLRAP1, the long-reads were subjected to Burrows-Wheeler Aligner (BWA) for alignment and mapping, followed by variant calling using Genome Analysis Toolkit (GATK) and ANNOVAR for variant annotation. The variants were further filtered using in-house custom scripts and classified according to the American College Medical Genetics and Genomics (ACMG) guidelines. A total of 174 variants were identified including 85 missense, 3 stop-gain, 9 splice-site, 6 InDel, and 71 in regulatory regions (3’UTR and 5’UTR). Fifty-two patients (24.7%) had 30 known pathogenic or likely pathogenic variants in FH-related genes according to the American College Medical and Genetics and Genomics guidelines. Fifty-three known variants were classified as benign, or likely benign and 87 known variants have shown uncertain significance. Four novel variants were discovered and classified as such due to their absence in existing databases. In conclusion, ETGS and in silico prediction studies are useful tools for screening deleterious variants and identification of novel variants in FH-related genes, they also contribute to the molecular diagnosis in the FHBGEP cohort.

PMID:37217153 | DOI:10.1016/j.gene.2023.147501

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Nevin Manimala Statistics

Retinal Displacement After Scleral Buckle Versus Combined Buckle and Vitrectomy for Rhegmatogenous Retinal Detachment: ALIGN SB vs PPV-SB

Ophthalmol Retina. 2023 May 20:S2468-6530(23)00223-3. doi: 10.1016/j.oret.2023.05.012. Online ahead of print.

ABSTRACT

PURPOSE: To assess the risk of retinal displacement following scleral buckle (SB) versus pars plana vitrectomy with scleral buckle (PPV-SB).

DESIGN: Multi-center prospective non-randomized clinical trial.

METHODS: The study took place at VitreoRetinal Surgery in Minneapolis, USA; Sankara Nethralaya in Chennai, India and St. Michael’s Hospital in Toronto, Canada from July 2019 to February 2022. Patients who underwent successful SB or PPV-SB for fovea-involving rhegmatogenous retinal detachment (RRD) with gradable post-operative fundus autofluorescence (FAF) imaging were included in the final analysis. Two masked graders assessed FAF images 3-months post-operatively. Metamorphopsia and aniseikonia were assessed with MCHARTs and the New Aniseikonia Test, respectively. The primary outcome was the proportion of patients with retinal displacement detected with retinal vessel printings (RVPs) on FAF in SB vs PPV-SB.

RESULTS: Ninety-one eyes were included in this study of which 46.2%(42/91) had SB and 53.8%(49/91) underwent PPV-SB. At 3-months post-operatively, 16.7%(7/42) in the SB group and 38.8%(19/49) in the PPV-SB group had evidence of retinal displacement (difference=22.1%;odds ratio=3.2,95%CI=1.2-8.6;p=0.02) on FAF. The statistical significance of this association increased after adjustment for extent of retinal detachment, baseline logMAR, lens status, and gender in a multivariate regression analysis (p=0.01). Retinal displacement was detected in 22.5%(6/27) of patients in the SB group with external subretinal fluid drainage and 6.7%(1/15) of patients without external drainage (difference=15.8%,odds ratio=4.0,95%CI=0.4-36.9;p=0.19). Mean vertical metamorphopsia, horizontal metamorphopsia and aniseikonia were similar between patients in the SB and PPV-SB groups. There was a trend to worse horizontal metamorphopsia in patients with retinal displacement vs those without retinal displacement (p=0.067).

CONCLUSIONS: SB, is associated with less retinal displacement compared to PPV-SB, indicating that traditional PPV techniques cause retinal displacement. There is a trend towards increased risk of retinal displacement in SB eyes that underwent external drainage compared to SB eyes without drainage which is consistent with our understanding, that the iatrogenic movement of subretinal fluid, such as that which occurs intraoperatively during external drainage with SB, may induce retinal stretch and displacement if the retina is then fixed in the stretched position. There was a trend to worse horizontal metamorphopsia at 3-months in patients with retinal displacement.

PMID:37217137 | DOI:10.1016/j.oret.2023.05.012

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Use of a surgically implanted, nondischargeable, extracorporeal continuous flow circulatory support system as a bridge to heart transplant

Rev Esp Cardiol (Engl Ed). 2023 May 20:S1885-5857(23)00139-1. doi: 10.1016/j.rec.2023.05.002. Online ahead of print.

ABSTRACT

INTRODUCTION AND OBJECTIVES: We aimed to describe the clinical outcomes of the use of the CentriMag acute circulatory support system as a bridge to emergency heart transplantation (HTx).

METHODS: We conducted a descriptive analysis of the clinical outcomes of consecutive HTx candidates included in a multicenter retrospective registry who were treated with the CentriMag device, configured either for left ventricular support (LVS) or biventricular support (BVS). All patients were listed for high-priority HTx. The study assessed the period 2010 to 2020 and involved 16 transplant centers around Spain. We excluded patients treated with isolated right ventricular support or venoarterial extracorporeal membrane oxygenation without LVS. The primary endpoint was 1-year post-HTx survival.

RESULTS: The study population comprised 213 emergency HTx candidates bridged on CentriMag LVS and 145 on CentriMag BVS. Overall, 303 (84.6%) patients received a transplant and 53 (14.8%) died without having an organ donor during the index hospitalization. Median time on the device was 15 days, with 66 (18.6%) patients being supported for > 30 days. One-year posttransplant survival was 77.6%. Univariable and multivariable analyses showed no statistically significant differences in pre- or post-HTx survival in patients managed with BVS vs LVS. Patients managed with BVS had higher rates of bleeding, need for transfusion, hemolysis and renal failure than patients managed with LVS, while the latter group showed a higher incidence of ischemic stroke.

CONCLUSIONS: In a setting of candidate prioritization with short waiting list times, bridging to HTx with the CentriMag system was feasible and resulted in acceptable on-support and posttransplant outcomes.

PMID:37217134 | DOI:10.1016/j.rec.2023.05.002