Int J Med Inform

Objective:Electronic health record (EHR) systems contain structured data (such as diagnostic codes) and unstructured data (clinical documentation). Clinical insights can be derived from analyzing both. The use of natural language processing (NLP) algorithms to effectively analyze unstructured data has been well demonstrated. Here we examine the utility of NLP for the identification of patients with non-alcoholic fatty liver disease, assess patterns of disease progression, and identify gaps in care related to breakdown in communication among providers.Materials and Methods:All clinical notes available on the 38,575 patients enrolled in the Mount Sinai BioMe cohort were loaded into the NLP system. We compared analysis of structured and unstructured EHR data using NLP, free-text search, and diagnostic codes with validation against expert adjudication. We then used the NLP findings to measure physician impression of progression from early-stage NAFLD to NASH or cirrhosis. Similarly, we used the same NLP findings to identify mentions of NAFLD in radiology reports that did not persist into clinical notes.Results:Out of 38,575 patients, we identified 2,281 patients with NAFLD. From the remainder, 10,653 patients with similar data density were selected as a control group. NLP outperformed ICD and text search in both sensitivity (NLP: 0.93, ICD: 0.28, text search: 0.81) and F2 score (NLP: 0.92, ICD: 0.34, text search: 0.81). Of 2281 NAFLD patients, 673 (29.5%) were believed to have progressed to NASH or cirrhosis. Among 176 where NAFLD was noted prior to NASH, the average progression time was 410 days. 619 (27.1%) NAFLD patients had it documented only in radiology notes and not acknowledged in other forms of clinical documentation. Of these, 170 (28.4%) were later identified as having likely developed NASH or cirrhosis after a median 1057.3 days.Discussion:NLP-based approaches were more accurate at identifying NAFLD within the EHR than ICD/text search-based approaches. Suspected NAFLD on imaging is often not acknowledged in subsequent clinical documentation. Many such patients are later found to have more advanced liver disease. Analysis of information flows demonstrated loss of key information that could have been used to help prevent the progression of early NAFLD (NAFL) to NASH or cirrhosis.Conclusion:For identification of NAFLD, NLP performed better than alternative selection modalities and facilitated. It then facilitated analysis of knowledge flow between physician and enabled the identification of breakdowns where key information was lost that could have slowed or prevented later disease progression.20192020-09-01T00:00:00ZR01 HL085757/HL/NHLBI NIH HHS/United StatesU01 HG009610/HG/NHGRI NIH HHS/United StatesU01 DK106962/DK/NIDDK NIH HHS/United StatesR01 DK096549/DK/NIDDK NIH HHS/United StatesU01 HG007278/HG/NHGRI NIH HHS/United StatesR01 GM106085/GM/NIGMS NIH HHS/United StatesR01 DK108803/DK/NIDDK NIH HHS/United StatesT32 DK007757/DK/NIDDK NIH HHS/United StatesU01 OH011326/OH/NIOSH CDC HHS/United StatesU01 DK116100/DK/NIDDK NIH HHS/United StatesR01 DK112258/DK/NIDDK NIH HHS/United StatesK23 DK107908/DK/NIDDK NIH HHS/United States31445275PMC6717556841

L’effet d’une potentialisation cholinergique sur la régionalisation et la synchronisation corticale d’un conditionnement visuel

Cette thèse démontre qu’une potentialisation cholinergique durant un conditionnement visuel typique permet de raffiner la réponse et la connectivité des neurones des aires corticales visuelles ainsi que des aires associatives supérieures via un phénomène plastique. Afin de déterminer cet effet sur un conditionnement visuel monoculaire sur la réponse corticale, nous avons utilisé un système d’imagerie calcique à large champ sur des souris adultes exprimant le rapporteur calcique GCaMP6s. La potentialisation cholinergique était causée par l’administration de donepezil (DPZ), un inhibiteur de l’acétylcholinestérase qui dégrade l’acétylcholine. Cette technique, possédant de bonnes résolutions spatiale et temporelle, a permis l’observation de l’activité neuronale dans les couches supra granulaires du cortex visuel primaire (V1), des aires secondaires (A, AL, AM, LM, PM, RL) ainsi que dans le cortex retrosplénial (RSC). Il a été alors possible de mesurer les modifications d’activité neuronale de ces aires au repos et lors de la présentation de stimulations visuelles, composées de réseaux sinusoïdaux d’orientation et de contraste varié. La réponse corticale des animaux naïfs est similaire en matière d’amplitude et de sensibilité au contraste pour chacune des orientations de stimulations visuelles présentées. Le conditionnement visuel accompagné de l’administration de DPZ diminue significativement la réponse neuronale évoquée par le stimulus conditionné dans la majorité des aires observés alors qu’il ne modifie pas la réponse à la stimulation non conditionnée. Cet effet n’est pas présent sans potentialisation cholinergique. Il est intéressant de noter qu’un effet sur la corrélation d’activation est observé exclusivement dans les aires de la voie visuelle ventrale. Finalement, le conditionnement monoculaire diminue la corrélation au repos entre les aires visuelles monoculaire et binoculaire de chacun des hémisphères, un effet qui disparaît lors de l’administration du DPZ durant le conditionnement. En conclusion, nos résultats démontrent une diminution de l’amplitude et de l’étalement de la réponse corticale dans les couches supra-granulaires de PM et de V1 en réponse à notre traitement. Nous suggérons que ces résultats démontrent une diminution de la réponse excitatrice causée par l’augmentation de l’activité inhibitrice en réponse à la stimulation conditionnée.The cholinergic system of the basal forebrain modulates the visual cortex and enhances visual acuity and discrimination when activated during visual conditioning. As wide-field calcium imaging provides cortical maps with a fine regional and temporal resolution, we used this technique to determine the effects of the cholinergic potentiation of visual conditioning on cortical activity and connectivity in the visual cortex and higher associative areas. Mesoscopic calcium imaging was performed in head-fixed GCaMP6s adult mice during resting state or monocular presentation of conditioned (0.03 cpd, 30°, 100% contrast) or non-conditioned 1Hz-drifting gratings (30°, 50 and 75% contrast; 90°, 50, 75 and 100% contrast), before and after conditioning. The conditioned stimulus was presented 10 min daily for a week. Donepezil (DPZ, 0.3 mg/kg, s.c.), a cholinesterase inhibitor that potentiates cholinergic transmission, or saline were injected prior to each conditioning session and compared to a sham-conditioned group. Cortical maps were established, then amplitude, duration, and latency of the peak response, as well as size of activation were measured in the primary visual cortex (V1), secondary visual areas (AL, A, AM, PM, LM, RL), the retrosplenial cortex (RSC) , and higher cortical areas. Visual stimulation increased calcium signaling in all primary and secondary visual areas, but no other cortices (except RSC). The cortical responses were sensitive to contrast but not to grating orientation. There were no significant effects of sham-conditioning or conditioning alone, but DPZ treatment during conditioning significantly decreased the evoked neuronal activity response for the conditioned stimulus in V1, AL, PM, and LM. The size of activated area and signal-to-noise ratio were affected in some cortical areas. There was no effect for the non-conditioned stimuli. Interestingly, signal correlation appeared only between V1 and the ventral visual pathway and RSC and was decreased by DPZ administration. The resting state activity was slightly correlated and rarely affected by treatments, except between binocular and monocular V1 in both hemispheres. In conclusion, despite the previously observed enhancement of the cortical response of layer 4 after visual conditioning with cholinergic potentiation, mesoscale cortical calcium imaging showed that cholinergic potentiation diminished the cortical activation in layer 2/3 and sharpened the responses to the conditioned visual stimulus in V1 and PM, via a layer-dependent effect