Few Shot Learning in Histopathological Images:Reducing the Need of Labeled Data on Biological Datasets

Although deep learning pathology diagnostic algorithms are proving comparable results with human experts in a wide variety of tasks, they still require a huge amount of well annotated data for training. Generating such extensive and well labelled datasets is time consuming and is not feasible for certain tasks and so, most of the medical datasets available are scarce in images and therefore, not enough for training. In this work we validate that the use of few shot learning techniques can transfer knowledge from a well defined source domain from Colon tissue into a more generic domain composed by Colon, Lung and Breast tissue by using very few training images. Our results show that our few-shot approach is able to obtain a balanced accuracy (BAC) of 90% with just 60 training images, even for the Lung and Breast tissues that were not present on the training set. This outperforms the finetune transfer learning approach that obtains 73% BAC with 60 images and requires 600 images to get up to 81% BAC.This study has received funding from the European Union’s Horizon 2020 research and innovation programme under grant agreement No. 732111 (PICCOLO project)

Sistema de intermediación digital de la oficina registral de pucallpa y tramitación de partes notariales en Coronel Portillo – 2020

En esta investigación que tuvo como objetivo fundamentar cuál es la relación del Sistema de Intermediación Digital de la oficina registral de Pucallpa y la Tramitación de Partes Notariales en la población de Coronel Portillo – 2020. La metodología que utilice fue de tipo cuantitativa, aplicada y no experimental; su diseño es correlacional– transversal, cuya población la conformaron 40 personas: 5 Notarios Públicos, 10 Asistentes de Notarios, 4 Registradores Públicos, 10 Asistentes Registrales y 11 Usuarios, de los cuales 40 han sido el total de la muestra. La técnica que utilice fue la encuesta y el instrumento fue un cuestionario. Como método de análisis de datos utilice, tablas y Gráficos, seempleó la Prueba de Alfa de Cronbach, cuyos índices de confiabilidad del cuestionario es de ,874. De acuerdo a los resultados obtenidos, se tiene que, el Sistema de Intermediación Digital, realiza un aporte positivo a la tramitación departes notariales en la población de Coronel Portillo en el año 2020. Concluyendo que entre Sistema de Intermediación Digital y la tramitación de partes notariales existe un índice de relación bastante relación, cuyo cumplimiento se da con un nivel alto

Enfoque JIT para reducir la demanda insatisfecha en una fábrica de dulces

El presente trabajo de investigación se realiza con el objetivo de cubrir la demanda insatisfecha y reducir las actividades improductivas a través del enfoque JIT. Para el desarrollo del mismo, se tuvo como objetivos realizar el balance de línea y el desarrollo de los puntos para el enfoque JIT. Todo ello se realizó mediante cálculos, como la determinación del Takt Time, la eficiencia, el WIP, el # de kanbans, entre otros. Como resultados de la aplicación de este enfoque, se obtuvo la reducción de valor no agregado a un 38%, se logró una eficiencia de la línea del 83%, así mismo, por el sistema kanban se determinó la producción por día de 488 unidades logrando cubrir la demanda, llevando a cabo su producción mediante una distribución tipo U

Classification of the severity of diabetic neuropathy: a new approach taking uncertainties into account using fuzzy logic

OBJECTIVE: This study proposes a new approach that considers uncertainty in predicting and quantifying the presence and severity of diabetic peripheral neuropathy. METHODS: A rule-based fuzzy expert system was designed by four experts in diabetic neuropathy. The model variables were used to classify neuropathy in diabetic patients, defining it as mild, moderate, or severe. System performance was evaluated by means of the Kappa agreement measure, comparing the results of the model with those generated by the experts in an assessment of 50 patients. Accuracy was evaluated by an ROC curve analysis obtained based on 50 other cases; the results of those clinical assessments were considered to be the gold standard. RESULTS: According to the Kappa analysis, the model was in moderate agreement with expert opinions. The ROC analysis (evaluation of accuracy) determined an area under the curve equal to 0.91, demonstrating very good consistency in classifying patients with diabetic neuropathy. CONCLUSION: The model efficiently classified diabetic patients with different degrees of neuropathy severity. In addition, the model provides a way to quantify diabetic neuropathy severity and allows a more accurate patient condition assessment

Autofluorescence image reconstruction and virtual staining for in-vivo optical biopsying

Modern photonic technologies are emerging, allowing the acquisition of in-vivo endoscopic tissue imaging at a microscopic scale, with characteristics comparable to traditional histological slides, and with a label-free modality. This raises the possibility of an ‘optical biopsy’ to aid clinical decision making. This approach faces barriers for being incorporated into clinical practice, including the lack of existing images for training, unfamiliarity of clinicians with the novel image domains and the uncertainty of trusting ‘black-box’ machine learned image analysis, where the decision making remains inscrutable. In this paper, we propose a new method to transform images from novel photonics techniques (e.g. autofluorescence microscopy) into already established domains such as Hematoxilyn-Eosin (H-E) microscopy through virtual reconstruction and staining. We introduce three main innovations: 1) we propose a transformation method based on a Siamese structure that simultaneously learns the direct and inverse transformation ensuring domain back-transformation quality of the transformed data. 2) We also introduced an embedding loss term that ensures similarity not only at pixel level, but also at the image embedding description level. This drastically reduces the perception distortion trade-off problem existing in common domain transfer based on generative adversarial networks. These virtually stained images can serve as reference standard images for comparison with the already known H-E images. 3) We also incorporate an uncertainty margin concept that allows the network to measure its own confidence, and demonstrate that these reconstructed and virtually stained images can be used on previously-studied classification models of H-E images that have been computationally degraded and de-stained. The three proposed methods can be seamlessly incorporated on any existing architectures. We obtained balanced accuracies of 0.95 and negative predictive values of 1.00 over the reconstructed and virtually stained image-set on the detection of color-rectal tumoral tissue. This is of great importance as we reduce the need for extensive labeled datasets for training, which are normally not available on the early studies of a new imaging technology.The authors would like to thank all pathologists that generated the BIOPOOL dataset (FP7-ICT-296162) that has been used for this work and specially to M. Saiz, A. Gaafar, S. Fernandez, A. Saiz, E. de Miguel, B. Catón, J. J. Aguirre, R. Ruiz, Ma A. Viguri, and R. Rezola

Anemia and use of erythropoietin in hemodialysis patients at Hospital de Clínicas de Porto Alegre

Anemia é freqüente em pacientes com insuficiência renal crônica e deve-se, principalmente, à diminuição da síntese endógena de eritropoetina. Desde a década de 1980, o uso da eritropoetina recombinante tornou-se o tratamento de escolha da anemia nesses pacientes. Realizamos um estudo com os pacientes em hemodiálise na Unidade de Hemodiálise do Hospital de Clínicas de Porto Alegre, tendo encontrado uma porcentagem de 82,6% desses indivíduos em uso de eritropoetina recombinante (epoetina). A dose semanal média de epoetina observada foi de 10.260 UI. A hemoglobina média dos pacientes foi de 10,3 g/ dL; quando avaliamos a variação entre os valores médios de Hb dos pacientes em uso dessa medicação, entre os meses de setembro de 2005 e fevereiro de 2006, não houve significância na mesma.Anemia is a very common finding in the course of chronic renal failure; the main cause of this pathology is reduced production of endogenous erythropoietin. Since the 1980’s, the use recombinant human erythropoietin has become the treatment of choice for anemia in this group of patients. We conducted a study with hemodialysis patients in the Hemodialysis Unit at Hospital de Clínicas de Porto Alegre, a university hospital in southern Brazil. We found that 82.6% of the patients were using recombinant erythropoietin (epoetin). The average weekly epoetin dose was 10,260 IU. Mean hemoglobin value was 10.3 g/dL and there was no significant difference between the mean hemoglobin values of the patients using this drug from September 2005 to February 2006

ANEMIA E USO DE ERITROPOETINA NOS PACIENTES EM HEMODIÁLISE NO HOSPITAL DE CLÍNICAS DE PORTO ALEGRE

RESUMOAnemia é freqüente em pacientes com insuficiência renal crônica e deve-se,principalmente, à diminuição da síntese endógena de eritropoetina. Desde a década de1980, o uso da eritropoetina recombinante tornou-se o tratamento de escolha da anemianesses pacientes.Realizamos um estudo com os pacientes em hemodiálise na Unidade de Hemodiálisedo Hospital de Clínicas de Porto Alegre, tendo encontrado uma porcentagem de 82,6%desses indivíduos em uso de eritropoetina recombinante (epoetina). A dose semanal médiade epoetina observada foi de 10.260 UI. A hemoglobina média dos pacientes foi de 10,3 g/dL; quando avaliamos a variação entre os valores médios de Hb dos pacientes em usodessa medicação, entre os meses de setembro de 2005 e fevereiro de 2006, não houvesignificância na mesma.Unitermos: Anemia, eritropoetina, insuficiência renal crônica

Fenilcetonúria no Sistema Único de Saúde: Avaliação de Adesão ao Tratamento em um Centro de Atendimento do Rio Grande do Sul

Introdução: Fenilcetonúria (PKU) é um erro inato do metabolismo no qual ocorre um aumento dos níveis séricos do aminoácido fenilalanina. O presente estudo teve como objetivo avaliar a adesão ao tratamento de pacientes com PKU atendidos em um centro de referência do Rio Grande do Sul. Métodos: Estudo transversal de pacientes com PKU atendidos no ambulatório do Serviço de Genética Médica do Hospital de Clínicas de Porto Alegre, Brasil. Os parâmetros de adesão considerados foram a mediana de fenilalanina plasmática no último ano (critério 1); o consumo de fenilalanina (critério 2); o consumo de fórmula metabólica (critério 3); e o questionamento direto aos pacientes/familiares (critério 4). Resultados: Dos 45 pacientes incluídos no estudo, (mediana de idade de 11 anos), 51% eram do sexo masculino. De acordo com o critério utilizado, foram considerados aderentes 20 (critério 1); 16 (critério 2); 27 (critério 3) e 33 (critério 4) pacientes, respectivamente. Não houve concordância entre os critérios de adesão utilizados. Foram encontradas diferenças quando comparados os critérios 1 e 2 (P =0,027), critérios 1 e 3 (P =0,002) e critérios 3 e 4 (P =0,015). Conclusão: A adesão ao tratamento é dificilmente quantificada por parâmetros isolados. A distinta percepção por parte dos pacientes dá suporte à necessidade de busca de novas estratégias que promovam adesão, bem como do estudo de métodos que avaliem a mesma.   

Novel Pixelwise Co-Registered Hematoxylin-Eosin and Multiphoton Microscopy Image Dataset for Human Colon Lesion Diagnosis

Colorectal cancer presents one of the most elevated incidences of cancer worldwide. Colonoscopy relies on histopathology analysis of hematoxylin-eosin (H&E) images of the removed tissue. Novel techniques such as multi-photon microscopy (MPM) show promising results for performing real-time optical biopsies. However, clinicians are not used to this imaging modality and correlation between MPM and H&E information is not clear. The objective of this paper is to describe and make publicly available an extensive dataset of fully co-registered H&E and MPM images that allows the research community to analyze the relationship between MPM and H&E histopathological images and the effect of the semantic gap that prevents clinicians from correctly diagnosing MPM images. The dataset provides a fully scanned tissue images at 10x optical resolution (0.5 µm/px) from 50 samples of lesions obtained by colonoscopies and colectomies. Diagnostics capabilities of TPF and H&E images were compared. Additionally, TPF tiles were virtually stained into H&E images by means of a deep-learning model. A panel of 5 expert pathologists evaluated the different modalities into three classes (healthy, adenoma/hyperplastic, and adenocarcinoma). Results showed that the performance of the pathologists over MPM images was 65% of the H&E performance while the virtual staining method achieved 90%. MPM imaging can provide appropriate information for diagnosing colorectal cancer without the need for H&E staining. However, the existing semantic gap among modalities needs to be corrected.This work was supported by the PICCOLO project. This project has received funding from the European Union's Horizon 2020 Research and Innovation Programme under grant agreement No. 732111. The sole responsibility of this publication lies with the authors. The European Union is not responsible for any use that may be made of the information contained therein. This research has also been supported by the project ONKOTOOLS (KK2020/00069) funded by the Basque Government Industry Department under the ELKARTEK program

Randomized double-blind clinical trial of a new human epoetin versus a commercially available formula for anemia control in patients on hemodialysis

OBJECTIVES: Anemia is a common complication among chronic kidney disease patients on hemodialysis, occurring mostly due to erythropoietin deficiency. This randomized noninferiority trial sought to compare the efficacy and safety of a new epoetin formulation developed by Bio-Manguinhos, a biologics manufacturer affiliated with the Brazilian government, with those of a commercially available product currently used in Brazil (a biosimilar epoetin formulation). METHODS: The sample size needed to enable demonstration of noninferiority with a statistical power of 85% for a between-group difference in hemoglobin levels of no more than 1.5 g/dL was calculated. In total, 74 patients were randomly assigned to receive the epoetin formulation from Bio-Manguinhos (n = 36) or the biosimilar epoetin formulation (n = 38) in a double-blind fashion. The inclusion criteria were current epoetin therapy and stable hemoglobin levels for at least 3 months prior to the study. The primary and secondary outcomes were mean monthly hemoglobin levels and safety, respectively. The dose was calculated according to international criteria and adjusted monthly in both groups according to hemoglobin levels and at the assistant physicians' discretion. Iron storage was estimated at baseline and once monthly. Clinicaltrials.gov: NCT01184495. RESULTS: The study was conducted for 6 months after randomization. The mean baseline hemoglobin levels were 10.9±1.2 and 10.96±1.2 g/dL (p = 0.89) in the Bio-Manguinhos epoetin and biosimilar epoetin groups, respectively. During the study period, there was no significant change in hemoglobin levels in either group (p = 0.055, ANOVA). The epoetin from Bio-Manguinhos was slightly superior in the last 3 months of follow-up. The adverse event profiles of the two formulations were also similar. CONCLUSIONS: The epoetin formulations tested in this study are equivalent in efficacy and safety