Exploring Optimal Granularity for Extractive Summarization of Unstructured Health Records: Analysis of the Largest Multi-Institutional Archive of Health Records in Japan

Automated summarization of clinical texts can reduce the burden of medical professionals. "Discharge summaries" are one promising application of the summarization, because they can be generated from daily inpatient records. Our preliminary experiment suggests that 20-31% of the descriptions in discharge summaries overlap with the content of the inpatient records. However, it remains unclear how the summaries should be generated from the unstructured source. To decompose the physician's summarization process, this study aimed to identify the optimal granularity in summarization. We first defined three types of summarization units with different granularities to compare the performance of the discharge summary generation: whole sentences, clinical segments, and clauses. We defined clinical segments in this study, aiming to express the smallest medically meaningful concepts. To obtain the clinical segments, it was necessary to automatically split the texts in the first stage of the pipeline. Accordingly, we compared rule-based methods and a machine learning method, and the latter outperformed the formers with an F1 score of 0.846 in the splitting task. Next, we experimentally measured the accuracy of extractive summarization using the three types of units, based on the ROUGE-1 metric, on a multi-institutional national archive of health records in Japan. The measured accuracies of extractive summarization using whole sentences, clinical segments, and clauses were 31.91, 36.15, and 25.18, respectively. We found that the clinical segments yielded higher accuracy than sentences and clauses. This result indicates that summarization of inpatient records demands finer granularity than sentence-oriented processing. Although we used only Japanese health records, it can be interpreted as follows: physicians extract "concepts of medical significance" from patient records and recombine them ..

Lamina Densa Malformation Involved in Histogenesis of Primary Localized Cutaneous Amyloidosis

Skin lesions of lichenoid amyloidosis and macular amyloidosis were immunohistochemically investigated using five monoclonal antibodies against basement membrane zone (BMZ) components. A hemidesmosomal component did not contribute to amyloid deposits, but components of the lamina densa and anchoring fibrils were associated with amyloid deposits in the uppermost dermis. Immunoelectron microscopy revealed that these BMZ components were not only aggregated in the BMZ and dermis, but were also involved in the individual amyloid islets. The lamina densa was disrupted in the interface areas just above the amyloid deposits, where cytoplasm of the basal cells directly faced the aggregate of amyloid filaments. Aggregates of some BMZ components were continuous to the amyloid islets from the lamina densa area. These findings suggest that a lamina densa malformation is involved in amyloid production in the interface of the BMZ, and support the secretion theory rather than the fibrillar body theory of amyloidogenesis in these types of primary localized cutaneous amyloidosis

Characterization and Distribution of Prostaglandin D Synthetase in Rat Skin

The biochemical properties and immunohistochemical localization of prostaglandin D synthetase were investigated in adult rat skin. The activity of prostaglandin D synthetase, which isomerizes prostaglandin H2 to prostaglandin D2, was detected in the 100,000 g supernatant of the homogenate of adult rat skin. Whole skin showed considerable activity (1.9 nmol/min/mg protein), and prostaglandin D2 was the major prostaglandin among those formed from prostaglandin H2 in the presence of glutathione. The epidermis, which was separated from whole skin by heating (55°C, 30 s), exhibited about three times higher activity (3.5) than the dermis (1.0). The enzymatic properties of both layers were similar; they were absolutely glutathione-dependent, were inhibited only a few percent by 1mM 1-chloro-2,4-dinitrobenzene, and were completely absorbed by anti-rat spleen prostaglandin D synthetase antibody. Immunohistochemical studies, using anti-rat spleen prostaglandin D synthetase antibody and the immunoperoxidase method, showed that prostaglandin D synthetase was localized in Langerhans cells (not in keratinocytes) in the epidermis, in macrophages or histiocytes, and also in mast cells in the dermis. Immunoelectron microscopy also supported these findings. These results suggest that prostaglandin D2 is one of the most important arachidonic acid metabolites and plays a significant role in immunological function in the skin via Langerhans cells and macrophages

Changes in growth of marbled sole Pseudopleuronectes yokohamae between high and low stock-size periods in Tokyo Bay, Japan

We examined the age and growth of the marbled sole Pseudopleuronectes yokohamae collected from Tokyo Bay, Japan, during two study periods between 2002 and 2008, when the stock size was consistently low. The von Bertalanffy growth equations were found to differ significantly between sexes, and females attained a larger standard length than males of the same age. These results were then compared with those reported for 1974?1983 and 1986?1988, two study periods when the stock size was high. The growth of both sexes of marbled sole in Tokyo Bay during the 2000s was found to be significantly higher than that in the 1970s and 1980s. To explore possible factors causing these changes in the growth, we examined bottom water temperature and population density. We found that the population density decreased and the bottom water temperature increased between the late 1970s and the late 2000s. However, despite evidence of changes in population densities and water temperatures, further study is needed to determine the main factors causing the observed changes in growth

Comparison between surface-reading and cross-section methods using sagittal otolith for age determination of the marbled sole Pseudopleuronectes yokohamae

To find an appropriate method for age determination in the marbled sole Pseudopleuronectes yokohamae in Tokyo Bay, Japan, sagittal otoliths of 1,343 individuals were observed by surface-reading and cross-section methods and the results were compared. Opaque zones occurred once a year and were regarded as annuli in both methods. The surface-reading method sometimes provided a lower count of the number of annuli than the cross-section method, and the frequency of this discrepancy was highest in older fish (males above 5 years, females above 4 years). The oldest female fish was estimated to be age 10 years by the cross-section method but 8 years by the surface-reading method. The cross-section method could provide a more accurate estimate of age and is therefore likely to be indispensable to estimations of longevity. In contrast, the surface-reading method is superior in terms of cost and time efficiency but is likely to underestimate the ages of older fish. However, growth equations based on age estimated by the surface-reading method were sufficiently accurate if males ?5 years and females ?4 years were combined as specific, single age groups of 5+ and 4+, respectively

Epitope Mapping of the Laminin Molecule in Murine Skin Basement Membrane Zone: Demonstration of Spatial Differences in Ultrastructural Localization

Results of studies performed to date with polyclonal anti-laminin antibodies have been conflicting as to the ultrastructural localization of this glycoprotein in skin basement membrane zone (BMZ). Whereas initial reports suggested its presence solely within the lamina lucida (LL), others have suggested that laminin is instead an exclusive component of the lamina densa (LD). In an attempt to more critically address this issue, we have examined both intact and partially separated (via 1M NaCl) murine skin BMZ by indirect immunoelectron microscopy via a two-step immunoperoxidase technique on unfixed cryopreserved tissue, utilizing nine well-characterized monoclonal antibodies with binding specificity for laminin. Localization of the sites of the epitopes recognized by these antibodies on isolated laminin molecules was previously determined by rotary shadowing and by biochemical analyses on enzymatic fragments of laminin. Whereas at least faint immunoreactants were detected in both regions with eight of nine antibodies, predominant staining was noted within the LL with three of eight and within (and even sparsely below) the LD in three of eight. One antibody bound solely to the LL; another bound equally within both regions. Although some overlap was noted, it appears that the epitope on the distal portion of the long arm of the laminin molecule resides primarily within the skin LD, whereas epitopes on more central portions of the short arms are present within the LL or within both LL and LD. The findings of stratification of laminin epitopes within skin BMZ supports a similar recent observation in mouse kidney and suggests that portions of the laminin molecule span both LD and LL, and that there may be a non-random spatial orientation for the laminin molecule within murine skin BMZ