Objective: Predict individual septic children's personalized physiologic responses to vasoactive titrations by training a Recurrent Neural Network (RNN) using EMR data. Materials and Methods: This study retrospectively analyzed EMR of patients admitted to a pediatric ICU from 2009 to 2017. Data included charted time series vitals, labs, drugs, and interventions of children with septic shock treated with dopamine, epinephrine, or norepinephrine. A RNN was trained to predict responses in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP) and mean arterial pressure (MAP) to 8,640 titrations during 652 septic episodes and evaluated on a holdout set of 3,883 titrations during 254 episodes. A linear regression model using titration data as its sole input was also developed and compared to the RNN model. Evaluation methods included the correlation coefficient between actual physiologic responses and RNN predictions, mean absolute error (MAE), and area under the receiver operating characteristic curve (AUC). Results: The actual physiologic responses displayed significant variability and were more accurately predicted by the RNN model than by titration alone (r=0.20 vs r=0.05, p<0.01). The RNN showed MAE and AUC improvements over the linear model. The RNN's MAEs associated with dopamine and epinephrine were 1-3% lower than the linear regression model MAE for HR, SBP, DBP, and MAP. Across all vitals vasoactives, the RNN achieved 1-19% AUC improvement over the linear model. Conclusion: This initial attempt in pediatric critical care to predict individual physiologic responses to vasoactive dose changes in children with septic shock demonstrated an RNN model showed some improvement over a linear model. While not yet clinically applicable, further development may assist clinical administration of vasoactive medications in children with septic shock.
WASHINGTON D.C. [USA]: According to a recent study, a new artificial intelligence technology can accurately identify rare genetic disorders using a photograph of a patient's face. Named DeepGestalt, the AI technology outperformed clinicians in identifying a range of syndromes in three trials and could add value in personalised care, CNN reported. The study was published in the journal Nature Medicine. According to the study, eight per cent of the population has disease with key genetic components and many may have recognisable facial features. The study further adds that the technology could identify, for example, Angelman syndrome, a disorder affecting the nervous system with characteristic features such as a wide mouth with widely spaced teeth etc. Speaking about it, Yaron Gurovich, the chief technology officer at FDNA and lead researcher of the study said, "It demonstrates how one can successfully apply state of the art algorithms, such as deep learning, to a challenging field where the available data is small, unbalanced in terms of available patients per condition, and where the need to support a large amount of conditions is great."
For effective treatment of Alzheimer disease (AD), it is important to identify subjects who are most likely to exhibit rapid cognitive decline. Herein, we developed a novel framework based on a deep convolutional neural network which can predict future cognitive decline in mild cognitive impairment (MCI) patients using flurodeoxyglucose and florbetapir positron emission tomography (PET). The architecture of the network only relies on baseline PET studies of AD and normal subjects as the training dataset. Feature extraction and complicated image preprocessing including nonlinear warping are unnecessary for our approach. Accuracy of prediction (84.2%) for conversion to AD in MCI patients outperformed conventional feature-based quantification approaches. ROC analyses revealed that performance of CNN-based approach was significantly higher than that of the conventional quantification methods (p < 0.05). Output scores of the network were strongly correlated with the longitudinal change in cognitive measurements. These results show the feasibility of deep learning as a tool for predicting disease outcome using brain images.
Babak Ehteshami Bejnordi, from the Radboud University Medical Center in Nijmegen, Netherlands, and colleagues compared the performance of automated deep learning algorithms for detecting metastases in hematoxylin and eosin-stained tissue sections of lymph nodes of women with breast cancer with pathologists' diagnoses in a diagnostic setting. The researchers found that the area under the receiver operating characteristic curve (AUC) ranged from 0.556 to 0.994 for the algorithms. The lesion-level, true-positive fraction achieved for the top-performing algorithm was comparable to that of the pathologist without a time constraint at a mean of 0.0125 false-positives per normal whole-slide image. Daniel Shu Wei Ting, M.D., Ph.D., from the Singapore National Eye Center, and colleagues assessed the performance of a DLS for detecting referable diabetic retinopathy and related eye diseases using 494,661 retinal images. The researchers found that the AUC of the DLS for referable diabetic retinopathy was 0.936, and sensitivity and specificity were 90.5 and 91.6 percent, respectively.
Varadarajan, Avinash, Bavishi, Pinal, Raumviboonsuk, Paisan, Chotcomwongse, Peranut, Venugopalan, Subhashini, Narayanaswamy, Arunachalam, Cuadros, Jorge, Kanai, Kuniyoshi, Bresnick, George, Tadarati, Mongkol, Silpa-archa, Sukhum, Limwattanayingyong, Jirawut, Nganthavee, Variya, Ledsam, Joe, Keane, Pearse A, Corrado, Greg S, Peng, Lily, Webster, Dale R
Diabetic eye disease is one of the fastest growing causes of preventable blindness. With the advent of anti-VEGF (vascular endothelial growth factor) therapies, it has become increasingly important to detect center-involved diabetic macular edema. However, center-involved diabetic macular edema is diagnosed using optical coherence tomography (OCT), which is not generally available at screening sites because of cost and workflow constraints. Instead, screening programs rely on the detection of hard exudates as a proxy for DME on color fundus photographs, often resulting in high false positive or false negative calls. To improve the accuracy of DME screening, we trained a deep learning model to use color fundus photographs to predict DME grades derived from OCT exams. Our "OCT-DME" model had an AUC of 0.89 (95% CI: 0.87-0.91), which corresponds to a sensitivity of 85% at a specificity of 80%. In comparison, three retinal specialists had similar sensitivities (82-85%), but only half the specificity (45-50%, p<0.001 for each comparison with model). The positive predictive value (PPV) of the OCT-DME model was 61% (95% CI: 56-66%), approximately double the 36-38% by the retina specialists. In addition, we used saliency and other techniques to examine how the model is making its prediction. The ability of deep learning algorithms to make clinically relevant predictions that generally require sophisticated 3D-imaging equipment from simple 2D images has broad relevance to many other applications in medical imaging.