22 research outputs found
Development of machine learning system for airway prediction from facial image with mobile device
Goals: A reliable prognostic tool for a difficult airway (DA) may enhance patientsâ safety during orotracheal intubation by decreasing
unanticipated DAs. We aim to examine the applicability of an Artificial Intelligence-Deep Learning (AI-DL) algorithm to measure airwayâs anatomy, and to predict DA based on published models.
Materials and methods: Observational prospective cohort study with n=503 patients recruited at Galdakao-Usansolo and Basurto University Hospitals (Biscay, Spain) between 2018 and 2020. Two pre-operative photos for each patient were collected: a frontal view, in which patients were instructed to open their mouth completely; and a lateral view, with head in vertical ex tension.
Smartphones with general-purpose cameras were used, and a cue card was added to the scene as reference. Patientsâ medical records were logged. After intubation, HAN score and IDS-ASA criteria for intubation difficulty [1] were collected.
Our anaesthesiology team defined a set of relevant orofacial landmarks, whereas our data-science team developed an AI-DL algorithm, trained to identify locate them automatically within the images. In a previous evaluation, the system achieved an accuracy comparable to the consensus of two human annotators [2]. Landmark positions output by the AI-DL method were subsequently used by the system to ex tract two anatomical measurements: thyromental distance and interincisor gap. Finally, these two were integrated into a published model for DA prognosis: Naguib et al. 2006 [3], which also employed patientsâ height and Mallampati score.
Results and discussion: The estimated incidence of DA was 6.36% (32 out of 503 patients) according to the IDS-ASA criteria. Naguibâs
model, when used in combination with our automatic AI-DL based measurements, achieved 53.12% sensitivity and 79.83% specificity; compared to cliniciansâ subjective assessment, who obtained 25.00% sensitivity and 93.63% specificity.
Conclusion(s): In this work, we evaluated an AI-DL method to predict DA for intubation, with two pre-operative photos and Naguibâs model. Our results complemented expert judgementsâ predictive ability in terms of sensitivity, substantially lowering false negatives; at the expense of a restrained loss in specificity (false positives). Thus, our proposal may provide anaesthesiologists with an automatic, objective and accessible decision support tool for the prognosis of DAs
Automated location of orofacial landmarks to characterize airway morphology in anaesthesia via deep convolutional neural networks
Background:A reliable anticipation of a difficult airway may notably enhance safety during anaesthesia. In current practice, clinicians use bedside screenings by manual measurements of patientsâ morphology.
Objective:To develop and evaluate algorithms for the automated extraction of orofacial landmarks, which characterize airway morphology.
Methods:We defined 27 frontal + 13 lateral landmarks. We collected n=317 pairs of pre-surgery photos from patients undergoing general anaesthesia (140 females, 177 males). As ground truth reference for supervised learning, landmarks were independently annotated by two anaesthesiologists.
We trained two ad-hoc deep convolutional neural network architectures based on InceptionResNetV2 (IRNet) and MobileNetV2 (MNet), to predict simultaneously: (a) whether each landmark is visible or not (occluded, out of frame), (b) its 2D-coordinates (x, y). We implemented successive stages of transfer learning, combined with data augmentation. We added custom top layers on top of these networks, whose weights were fully tuned for our application. Performance in landmark extraction was evaluated by 10-fold cross-validation (CV) and compared against 5 state-of-the-art deformable models.
Results:With annotatorsâ consensus as the âgold standardâ, our IRNet-based network performed comparably to humans in the frontal view: median CV loss L=1.277·10-3, inter-quartile range (IQR) [1.001, 1.660]; versus median 1.360, IQR [1.172, 1.651], and median 1.352, IQR [1.172, 1.619], for each annotator against consensus, respectively. MNet yielded slightly worse results: median 1.471, IQR [1.139, 1.982].
In the lateral view, both networks attained performances statistically poorer than humans: median CV loss L=2.141·10-3, IQR [1.676, 2.915], and median 2.611, IQR [1.898, 3.535], respectively; versus median 1.507, IQR [1.188, 1.988], and median 1.442, IQR [1.147, 2.010] for both annotators. However, standardized effect sizes in CV loss were small: 0.0322 and 0.0235 (non-significant) for IRNet, 0.1431 and 0.1518 (p<0.05) for MNet; therefore quantitatively similar to humans.
The best performing state-of-the-art model (a deformable regularized Supervised Descent Method, SDM) behaved comparably to our DCNNs in the frontal scenario, but notoriously worse in the lateral view.
Conclusions:We successfully trained two DCNN models for the recognition of 27 + 13 orofacial landmarks pertaining to the airway. Using transfer learning and data augmentation, they were able to generalize without overfitting, reaching expert-like performances in CV. Our IRNet-based methodology achieved a satisfactory identification and location of landmarks: particularly in the frontal view, at the level of anaesthesiologists. In the lateral view, its performance decayed, although with a non-significant effect size. Independent authors had also reported lower lateral performances; as certain landmarks may not be clear salient points, even for a trained human eye.BERC.2022-2025
BCAM Severo Ochoa accreditation CEX2021-001142-S / MICIN / AEI / 10.13039/50110001103
Desarrollo de sistema de Machine Learning para la prediccion de vĂa aĂ©rea a partir de imagen facial con dispositivo movil
El manejo de una vĂa aĂ©rea difĂcil (VAD) representa aĂșn una causa importante de lesiones relacionadas con la anestesia, cuyas complicaciones son potencialmente mortales. El notable interĂ©s en la predicciĂłn de VAD ha provocado el desarrollo de modelos de
predicciĂłn, algunos de los cuales ya incluyen algoritmos de Inteligencia Artificial a partir de imĂĄgenes.
Se realizó un estudio observacional, de cohortes prospectivo, en el que se tomaron imågenes de los pacientes sometidos a una anestesia general, recogiendo la información pre-anestésica asà como la información post-intubación. Nuestro equipo desarrolló un
algoritmo automĂĄtico de detecciĂłn de puntos faciales de cara a la toma de medidas de variables ya validadas de predicciĂłn de VAD, que se integraron con el modelo predictivo de Naguib.
La incidencia estimada de VAD en nuestra muestra de 503 pacientes fue de un 6,36%. La valoraciĂłn subjetiva (pre-intervenciĂłn) de los clĂnicos obtuvo una sensibilidad de 25.00%, con una especificidad de 93.63%. En comparaciĂłn, nuestra herramienta alcanzĂł una sensibilidad del 53.12% y una especificidad del 79.83%. El AUC obtenida, o ĂĄrea bajo la curva ROC, fue de 0.680.
Integrando nuestro sistema de mediciĂłn IA-ML con el modelo de Naguib, los resultados muestran que estamos cerca de igualar la capacidad predictiva del clĂnico. El potencial del anĂĄlisis facial en la predicciĂłn de VAD nos anima a seguir investigando y a desarrollar modelos propios. Creemos que proporcionarĂĄ al anestesiĂłlogo una herramienta de ayuda en la toma de decisiones automĂĄtica, objetiva y accesible
Very low frequency Syndromes
DismorfologĂa, CitogenĂ©tica y ClĂnica: Resultados de estudios sobre los datos del ECEMCThe aim of this chapter is to summarize updated knowledge about the clinical characteristics, etiology, genetic and molecular aspects, as well as mechanisms involved in syndromes having very low frequency, in order to promote their better recognition. During the last five years, a total of 30 syndromes have been published in this chapter of the BoletĂn del ECEMC. This issue includes the following selected syndromes: Crouzon, Pfeiffer, Apert, Saethre-Chotzen, Carpenter and Muenke. All share craniosynostosis as the main clinical feature but also present with other birth defects, the most important being limb malformations, specially syndactyly and polydactyly. Over 100 syndromes with craniosynostosis have been described, usually involving multiple sutures, and several of them are associated with limb malformations. The clinical overlapping between those syndromes makes difficult to perform a neonatal diagnosis, based on their clinical findings. However, molecular genetic testing, specifically of the FRGR1-3 and TWIST1 genes, could help to establish the diagnosis of some of them. Early diagnosis is important for establishing the most suitable treatment for each patient, as well as to offer an accurate genetic counselling and the possibility of preimplantational and/or prenatal diagnosis.N
Un examen actualizado de la percepción de las barreras para la implementación de la farmacogenómica y la utilidad de los pares fårmaco/gen en América Latina y el Caribe
La farmacogenĂłmica (PGx) se considera un campo emergente en los paĂses en desarrollo. La investigaciĂłn sobre PGx en la regiĂłn de AmĂ©rica Latina y el Caribe (ALC) sigue siendo escasa, con informaciĂłn limitada en algunas poblaciones. Por lo tanto, las extrapolaciones son complicadas, especialmente en poblaciones mixtas. En este trabajo, revisamos y analizamos el conocimiento farmacogenĂłmico entre la comunidad cientĂfica y clĂnica de ALC y examinamos las barreras para la aplicaciĂłn clĂnica. Realizamos una bĂșsqueda de publicaciones y ensayos clĂnicos en este campo en todo el mundo y evaluamos la contribuciĂłn de ALC. A continuaciĂłn, realizamos una encuesta regional estructurada que evaluĂł una lista de 14 barreras potenciales para la aplicaciĂłn clĂnica de biomarcadores en funciĂłn de su importancia. AdemĂĄs, se analizĂł una lista emparejada de 54 genes/fĂĄrmacos para determinar una asociaciĂłn entre los biomarcadores y la respuesta a la medicina genĂłmica. Esta encuesta se comparĂł con una encuesta anterior realizada en 2014 para evaluar el progreso en la regiĂłn. Los resultados de la bĂșsqueda indicaron que los paĂses de AmĂ©rica Latina y el Caribe han contribuido con el 3,44% del total de publicaciones y el 2,45% de los ensayos clĂnicos relacionados con PGx en todo el mundo hasta el momento. Un total de 106 profesionales de 17 paĂses respondieron a la encuesta. Se identificaron seis grandes grupos de obstĂĄculos. A pesar de los continuos esfuerzos de la regiĂłn en la Ășltima dĂ©cada, la principal barrera para la implementaciĂłn de PGx en ALC sigue siendo la misma, la "necesidad de directrices, procesos y protocolos para la aplicaciĂłn clĂnica de la farmacogenĂ©tica/farmacogenĂłmica". Las cuestiones de coste-eficacia se consideran factores crĂticos en la regiĂłn. Los puntos relacionados con la reticencia de los clĂnicos son actualmente menos relevantes. SegĂșn los resultados de la encuesta, los pares gen/fĂĄrmaco mejor clasificados (96%-99%) y percibidos como importantes fueron CYP2D6/tamoxifeno, CYP3A5/tacrolimus, CYP2D6/opioides, DPYD/fluoropirimidinas, TMPT/tiopurinas, CYP2D6/antidepresivos tricĂclicos, CYP2C19/antidepresivos tricĂclicos, NUDT15/tiopurinas, CYP2B6/efavirenz y CYP2C19/clopidogrel. En conclusiĂłn, aunque la contribuciĂłn global de los paĂses de ALC sigue siendo baja en el campo del PGx, se ha observado una mejora relevante en la regiĂłn. La percepciĂłn de la utilidad de las pruebas PGx en la comunidad biomĂ©dica ha cambiado drĂĄsticamente, aumentando la concienciaciĂłn entre los mĂ©dicos, lo que sugiere un futuro prometedor en las aplicaciones clĂnicas de PGx en ALC.Pharmacogenomics (PGx) is considered an emergent field in developing countries. Research on PGx in the Latin American and the Caribbean (LAC) region remains scarce, with limited information in some populations. Thus, extrapolations are complicated, especially in mixed populations. In this paper, we reviewed and analyzed pharmacogenomic knowledge among the LAC scientific and clinical community and examined barriers to clinical application. We performed a search for publications and clinical trials in the field worldwide and evaluated the contribution of LAC. Next, we conducted a regional structured survey that evaluated a list of 14 potential barriers to the clinical implementation of biomarkers based on their importance. In addition, a paired list of 54 genes/drugs was analyzed to determine an association between biomarkers and response to genomic medicine. This survey was compared to a previous survey performed in 2014 to assess progress in the region. The search results indicated that Latin American and Caribbean countries have contributed 3.44% of the total publications and 2.45% of the PGx-related clinical trials worldwide thus far. A total of 106 professionals from 17 countries answered the survey. Six major groups of barriers were identified. Despite the regionâs continuous efforts in the last decade, the primary barrier to PGx implementation in LAC remains the same, the âneed for guidelines, processes, and protocols for the clinical application of pharmacogenetics/pharmacogenomicsâ. Cost-effectiveness issues are considered critical factors in the region. Items related to the reluctance of clinicians are currently less relevant. Based on the survey results, the highest ranked (96%â99%) gene/drug pairs perceived as important were CYP2D6/tamoxifen, CYP3A5/tacrolimus, CYP2D6/opioids, DPYD/fluoropyrimidines, TMPT/thiopurines, CYP2D6/tricyclic antidepressants, CYP2C19/tricyclic antidepressants, NUDT15/thiopurines, CYP2B6/efavirenz, and CYP2C19/clopidogrel. In conclusion, although the global contribution of LAC countries remains low in the PGx field, a relevant improvement has been observed in the region. The perception of the usefulness of PGx tests in biomedical community has drastically changed, raising awareness among physicians, which suggests a promising future in the clinical applications of PGx in LAC
Outcomes from elective colorectal cancer surgery during the SARS-CoV-2 pandemic
This study aimed to describe the change in surgical practice and the impact of SARS-CoV-2 on mortality after surgical resection of colorectal cancer during the initial phases of the SARS-CoV-2 pandemic
First lacustrine varve chronologies from Mexico: impact of droughts, ENSO and human activity since AD 1840 as recorded in maar sediments from Valle de Santiago
4to. Congreso Internacional de Ciencia, TecnologĂa e InnovaciĂłn para la Sociedad. Memoria acadĂ©mica
Este volumen acoge la memoria acadĂ©mica de la Cuarta ediciĂłn del Congreso Internacional de Ciencia, TecnologĂa e InnovaciĂłn para la Sociedad, CITIS 2017, desarrollado entre el 29 de noviembre y el 1 de diciembre de 2017 y organizado por la Universidad PolitĂ©cnica Salesiana (UPS) en su sede de Guayaquil.
El Congreso ofreciĂł un espacio para la presentaciĂłn, difusiĂłn e intercambio de importantes investigaciones nacionales e internacionales ante la comunidad universitaria que se dio cita en el encuentro. El uso de herramientas tecnolĂłgicas para la gestiĂłn de los trabajos de investigaciĂłn como la plataforma Open Conference Systems y la web de presentaciĂłn del Congreso http://citis.blog.ups.edu.ec/, hicieron de CITIS 2017 un verdadero referente entre los congresos que se desarrollaron en el paĂs.
La preocupaciĂłn de nuestra Universidad, de presentar espacios que ayuden a generar nuevos y mejores cambios en la dimensiĂłn humana y social de nuestro entorno, hace que se persiga en cada ediciĂłn del evento la presentaciĂłn de trabajos con calidad creciente en cuanto a su producciĂłn cientĂfica.
Quienes estuvimos al frente de la organizaciĂłn, dejamos plasmado en estas memorias acadĂ©micas el intenso y prolĂfico trabajo de los dĂas de realizaciĂłn del Congreso Internacional de Ciencia, TecnologĂa e InnovaciĂłn para la Sociedad al alcance de todos y todas