Artificial Intelligence Algorithms to Diagnose Glaucoma and Detect Glaucoma Progression: Translation to Clinical Practice

Purpose: This concise review aims to explore the potential for the clinical implementation of artificial intelligence (AI) strategies for detecting glaucoma and monitoring glaucoma progression. / Methods: Nonsystematic literature review using the search combinations "Artificial Intelligence," "Deep Learning," "Machine Learning," "Neural Networks," "Bayesian Networks," "Glaucoma Diagnosis," and "Glaucoma Progression." Information on sensitivity and specificity regarding glaucoma diagnosis and progression analysis as well as methodological details were extracted. / Results: Numerous AI strategies provide promising levels of specificity and sensitivity for structural (e.g. optical coherence tomography [OCT] imaging, fundus photography) and functional (visual field [VF] testing) test modalities used for the detection of glaucoma. Area under receiver operating curve (AROC) values of > 0.90 were achieved with every modality. Combining structural and functional inputs has been shown to even more improve the diagnostic ability. Regarding glaucoma progression, AI strategies can detect progression earlier than conventional methods or potentially from one single VF test. / Conclusions: AI algorithms applied to fundus photographs for screening purposes may provide good results using a simple and widely accessible test. However, for patients who are likely to have glaucoma more sophisticated methods should be used including data from OCT and perimetry. Outputs may serve as an adjunct to assist clinical decision making, whereas also enhancing the efficiency, productivity, and quality of the delivery of glaucoma care. Patients with diagnosed glaucoma may benefit from future algorithms to evaluate their risk of progression. Challenges are yet to be overcome, including the external validity of AI strategies, a move from a "black box" toward "explainable AI," and likely regulatory hurdles. However, it is clear that AI can enhance the role of specialist clinicians and will inevitably shape the future of the delivery of glaucoma care to the next generation. / Translational Relevance: The promising levels of diagnostic accuracy reported by AI strategies across the modalities used in clinical practice for glaucoma detection can pave the way for the development of reliable models appropriate for their translation into clinical practice. Future incorporation of AI into healthcare models may help address the current limitations of access and timely management of patients with glaucoma across the world

Risk stratification for small for gestational age for the Brazilian population: a secondary analysis of the Birth in Brazil study.

Risk-stratification screening for SGA has been proposed in high-income countries to prevent perinatal morbidity and mortality. There is paucity of data from middle-income settings. The aim of this study is to explore risk factors for SGA in Brazil and assess potential for risk stratification. This population-based study is a secondary analysis of Birth in Brazil study, conducted in 266 maternity units between 2011 and 2012. Univariate and multivariate logistic regressions were performed, and population attributable fraction estimated for early and all pregnancy factors. We calculated absolute risk, odds ratio, and population prevalence of single or combined factors stratified by parity. Factors associated with SGA were maternal lupus (ORadj 4.36, 95% CI [2.32-8.18]), hypertensive disorders in pregnancy (ORadj 2.72, 95% CI [2.28-3.24]), weight gain < 5 kg (ORadj 2.37, 95% CI [1.99-2.83]), smoking at late pregnancy (ORadj 2.04, 95% CI [1.60-2.59]), previous low birthweight (ORadj 2.22, 95% CI [1.79-2.75]), nulliparity (ORadj 1.81, 95% CI [1.60-2.05]), underweight (ORadj 1.61, 95% CI [1.36-1.92]) and socioeconomic status (SES) < 5th centile (ORadj 1.23, 95% CI [1.05-1.45]). Having two or more risk factors (prevalence of 4.4% and 8.0%) was associated with a 2 and fourfold increase in the risk for SGA in nulliparous and multiparous, respectively. Early and all pregnancy risk factors allow development of risk-stratification for SGA. Implementation of risk stratification coupled with specific strategies for reduction of risk and increased surveillance has the potential to contribute to the reduction of stillbirth in Brazil through increased detection of SGA, appropriate management and timely delivery

Strength training to prevent falls in older adults: A systematic review with meta-analysis of randomized controlled trials

We performed a systematic review with meta-analysis of randomized controlled trials (RCTs) to assess the effects of strength training (ST), as compared to alternative multimodal or unimodal exercise programs, on the number of falls in older adults (=60 years). Ten databases were consulted (CINAHL, Cochrane Library, EBSCO, EMBASE, PEDro, PubMed, Scielo, Scopus, SPORTDiscus and Web of Science), without limitations on language or publication date. Eligibility criteria were as follows: RCTs with humans =60 years of age of any gender with one group performing supervised ST and a group performing another type of exercise training, reporting data pertaining falls. Certainty of evidence was assessed with Grading of Recommendations, Assessment, Development and Evaluation (GRADE). Meta-analysis used a random effects model to calculate the risk ratio (RR) for number of falls. Five RCTs with six trials were included (n = 543, 76% women). There was no difference between ST and alternative exercise interventions for falls (RR = 1.00, 95% CI 0.77–1.30, p = 0.99). The certainty of evidence was very low. No dose–response relationship could be established. In sum, ST showed comparable RR based on number of falls in older adults when compared to other multimodal or unimodal exercise modalities, but evidence is scarce and heteroge-neous, and additional research is required for more robust conclusions. Registration: PROSPERO CRD42020222908

Hybridization in human evolution: Insights from other organisms

During the late Pleistocene, isolated lineages of hominins exchanged genes thus influencing genomic variation in humans in both the past and present. However, the dynamics of this genetic exchange and associated phenotypic consequences through time remain poorly understood. Gene exchange across divergent lineages can result in myriad outcomes arising from these dynamics and the environmental conditions under which it occurs. Here we draw from our collective research across various organisms, illustrating some of the ways in which gene exchange can structure genomic/phenotypic diversity within/among species. We present a range of examples relevant to questions about the evolution of hominins. These examples are not meant to be exhaustive, but rather illustrative of the diverse evolutionary causes/consequences of hybridization, highlighting potential drivers of human evolution in the context of hybridization including: influences on adaptive evolution, climate change, developmental systems, sex-differences in behavior, Haldane’s rule and the large X-effect, and transgressive phenotypic variation.Peer Reviewedhttps://deepblue.lib.umich.edu/bitstream/2027.42/151330/1/evan21787.pdfhttps://deepblue.lib.umich.edu/bitstream/2027.42/151330/2/evan21787_am.pd

GESTAÇÃO DE RISCO: PERCEPÇÃO E SENTIMENTOS DAS GESTANTES COM AMNIORREXE PREMATURA

Premature amniorrhexis, risky pregnancy, became a global concern because of the harm to the mother and fetus. Aim to identify the knowledge of women of premature amniorrhexis and get to know their perceptions and their feelings about this pathology. Descriptive study with a qualitative approach, developed in a public maternity ward. 11 women participated while hospitalized with a diagnosis of premature amniorrhexis, in the months of September and October 2007. The collection of semi-structured data was used, from which emerged the categories: Women's knowledge in relation to premature amniorrhexis, requiring information, and their feelings experienced, and reaction before their water broke. The results showed that women know little of the disease, or fear for the life of their children, and do not know what to do before that. Additionally health care professionals should regard women as human beings that need support and understanding.Amniorrexe prematuro, embarazo de riesgo, se convirti&oacute; en preocupaci&oacute;n mundial debido a los agravios en la gestante y en el feto. Objetivamos identificar el conocimiento de las gestantes sobre amniorrexe prematura y conocer sus percepciones y sus sentimientos ante esta patolog&iacute;a. Estudio descriptivo con un enfoque cualitativo, desarrollado en una maternidad p&uacute;blica. Participaron 11 gestantes hospitalizadas con diagn&oacute;stico de amniorrexe prematura, en los meses de septiembre y octubre de 2007. Se utiliz&oacute; en la recogida de datos entrevista semi-estructurada a partir de la cual surgieron las categor&iacute;as: conocimiento de las gestantes en relaci&oacute;n con amniorrexe prematura, que requieren la informaci&oacute;n, los sentimientos experimentados, la reacci&oacute;n ante la ruptura de la bolsa de aguas. Los resultados mostraron que las mujeres saben poco de la enfermedad, el temor por la vida de sus hijos y no saben qu&eacute; hacer ante esta situaci&oacute;n. De ah&iacute; la necesidad de los profesionales de la salud de mirar a las gestantes como seres que necesitan de apoyo y comprensi&oacute;n.Amniorrexe prematura, gesta&ccedil;&atilde;o de risco, tornou-se preocupa&ccedil;&atilde;o mundial devido os agravos na gestante e no feto. Objetivamos identificar o conhecimento de gestantes sobre amniorrexe prematura e conhecer suas percep&ccedil;&otilde;es e seus sentimentos diante desta patologia. Estudo descritivo com abordagem qualitativa, desenvolvido em uma maternidade p&uacute;blica. Participaram 11 gestantes internadas com o diagn&oacute;stico de amniorrexe prematura, nos meses de setembro e outubro de 2007. Utilizou-se na coleta de dados entrevista semi-estruturada de onde emergiram as categorias: conhecimento das gestantes em rela&ccedil;&atilde;o &agrave; amniorrexe prematura, necessitando de informa&ccedil;&otilde;es, sentimentos vivenciados, rea&ccedil;&atilde;o diante do rompimento da bolsa das &aacute;guas. Os resultados revelaram que as gestantes pouco conhecem da patologia, temem pela vida dos filhos e n&atilde;o sabem o que fazer diante dessa situa&ccedil;&atilde;o. Consideramos ent&atilde;o a necessidade dos profissionais de sa&uacute;de olhar para as gestantes como seres que necessitam de apoio e compreens&atilde;o

Myocardial ultrasonic tissue characterization in patients with thyroid dysfunction

<p>Abstract</p> <p>Background</p> <p>Structural myocardial abnormalities have been extensively documented in hypothyroidism. Experimental studies in animal models have also shown involvement of thyroid hormones in gene expression of myocardial collagen. This study was planned to investigate the ability of ultrasonic tissue characterization, as evaluated by integrated backscatter (IBS), to early identify myocardial involvement in thyroid dysfunction.</p> <p>Patients and Methods</p> <p>We studied 15 patients with hyperthyroidism (HYPER), 8 patients with hypothyroidism (HYPO), 14 patients with subclinical hypothyroidism (SCH) and 19 normal (N) subjects, who had normal LV systolic function. After treatment, 10 HYPER, 6 HYPO, and 8 SCH patients were reevaluated. IBS images were obtained and analyzed in parasternal short axis (papillary muscle level) view, at left ventricular (LV) posterior wall. The following IBS variables were analyzed: 1) the corrected coefficient (CC) of IBS, obtained by dividing IBS intensity by IBS intensity measured in a rubber phantom, using the same equipment adjustments, at the same depth; 2) cardiac cyclic variation (CV) of IBS - peak-to-peak difference between maximal and minimal values of IBS during cardiac cycle; 3) cardiac cyclic variation index (CVI) of IBS - percentual relationship between the cyclic variation (CV) and the mean value of IBS intensity.</p> <p>Results</p> <p>CC of IBS was significantly larger (p < 0.05) in HYPER (1.57 ± 0.6) and HYPO (1.53 ± 0.3) as compared to SCH (1.32 ± 0.3) or N (1.15 ± 0.27). The CV (dB) (HYPO: 7.5 ± 2.4; SCH: 8.2 ± 3.1; HYPER: 8.2 ± 2.0) and the CVI (HYPO: 35.6 ± 19.7%; SCH: 34.7 ± 17.5%; HYPER: 37.8 ± 11.6%) were not significantly different in patients with thyroid dysfunction as compared to N (7.0 ± 2.0 and 44.5 ± 15.1%).</p> <p>Conclusions</p> <p>CC of IBS was able to differentiate cardiac involvement in patients with overt HYPO and HYPER who had normal LV systolic function. These early myocardial structural abnormalities were partially reversed by drug therapy in HYPER group. On the other hand, although mean IBS intensity tended to be slightly larger in patients with SCH as compared to N, this difference was not statistical significant.</p

Metaplastic breast carcinomas exhibit EGFR, but not HER2, gene amplification and overexpression: immunohistochemical and chromogenic in situ hybridization analysis

INTRODUCTION: Metaplastic breast carcinomas constitute a heterogeneous group of neoplasms, accounting for less than 1% of all invasive mammary carcinomas. Approximately 70–80% of metaplastic breast carcinomas overexpress the epidermal growth factor receptor (EGFR). Human epidermal growth factor receptor (HER)2 and EGFR have attracted much attention in the medical literature over the past few years owing to the fact that humanized monoclonal antibodies against HER2 and therapies directed against the extracellular ligand-binding domain or the intracellular tyrosine kinase domain of EGFR have proven successful in treating certain types of human cancer. We investigated whether HER2 and EGFR overexpression was present and evaluated gene amplification in a series of metaplastic breast carcinomas. METHOD: Twenty-five metaplastic breast carcinomas were immunohistochemically analyzed using a monoclonal antibody (31G7) for EGFR and two antibodies for HER2 (Herceptest and CB11) and scored using the Herceptest scoring system. Gene amplification was evaluated by chromogenic in situ hybridization using Zymed Spot-Light EGFR and HER2 amplification probe. The results were evaluated by bright field microscopy under 40× and 63× objective lenses. RESULTS: Nineteen (76%) metaplastic breast carcinomas exhibited EGFR ovexpression, and among these EGFR amplification (defined either by large gene clusters or >5 signals/nucleus in >50% of neoplastic cells) was detected in seven cases (37%): three carcinomas with squamous differentiation and four spindle cell carcinomas. One case exhibited HER2 overexpression of grade 2+ (>10% of cells with weak to moderate complete membrane staining), but HER2 gene amplification was not detected. CONCLUSION: Metaplastic breast carcinomas frequently overexpressed EGFR, which was associated with EGFR gene amplification in one-third of cases. Our findings suggest that some patients with metaplastic breast carcinomas might benefit from novel therapies targeting EGFR. Because most metaplastic breast carcinomas overexpress EGFR without gene amplification, further studies to evaluate EGFR activating mutations are warranted