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Thiruganasambandamoorthy V, Probst M, Poterucha TJ, Sandhu RK, Toarta C, Raj SR, Sheldon R, Rahgozar A, Grant L. Role of Artificial Intelligence in Improving Syncope Management. Can J Cardiol 2024:S0828-282X(24)00429-X. [PMID: 38838932 DOI: 10.1016/j.cjca.2024.05.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/25/2024] [Accepted: 05/01/2024] [Indexed: 06/07/2024] Open
Abstract
Syncope is common in the general population and is a common presenting symptom in acute care settings. Substantial costs are attributed to care of patients with syncope. Current challenges include differentiating syncope from its mimickers, identifying serious underlying conditions that caused the syncope, and wide variations in current management. While validated risk tools exist especially for short-term prognosis, there is inconsistent application, and the current approach does not meet the patient needs/expectations. Artificial intelligence (AI) techniques such as machine learning methods including natural language processing can potentially address the current challenges in syncope management. Preliminary evidence from published studies indicates that it is possible to accurately differentiate syncope from its mimickers and predict short-term prognosis/ hospitalization. More recently AI analysis of ECG has shown promise in detection of serious structural and functional cardiac abnormalities which has the potential to improve syncope care. Future AI studies have the potential to address current issues in syncope management. AI can automatically prognosticate risk in real time by accessing traditional and non-traditional data. However, steps to mitigate known problems such generalizability, patient privacy, data protection, and liability will be needed. In the past AI has had limited impact due to underdeveloped analytical methods, lack of computing power, poor access to powerful computing systems, and availability of reliable high-quality data. All impediments except data have been solved. AI will live up to its promise to transform syncope care if the health care system can satisfy AI requirement of large scale, robust, accurate, and reliable data.
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Affiliation(s)
- Venkatesh Thiruganasambandamoorthy
- Department of Emergency Medicine, University of Ottawa, Ottawa, Ontario, Canada; Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; School of Epidemiology and Public Health, University of Ottawa, Ottawa, Ontario, Canada.
| | - Marc Probst
- Department of Emergency Medicine, Columbia University Irving Medical Center, New York, New York, United States of America
| | - Timothy J Poterucha
- Seymour, Paul, and Gloria Milstein Division of Cardiology, Department of Medicine, Columbia University Irving Medical Center, New York, NY, USA
| | - Roopinder K Sandhu
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Cristian Toarta
- Department of Emergency Medicine, McGill University, Montreal, Quebec, Canada; McGill University Health Centre, Montreal, Quebec, Canada
| | - Satish R Raj
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Robert Sheldon
- Libin Cardiovascular Institute, Department of Cardiac Sciences, University of Calgary, Calgary, AB, Canada
| | - Arya Rahgozar
- Ottawa Hospital Research Institute, The Ottawa Hospital, Ottawa, Ontario, Canada; School of Engineering Design and Teaching Innovation (SEDTI), University of Ottawa, Ottawa, Ontario
| | - Lars Grant
- Department of Emergency Medicine, McGill University, Montreal, Quebec, Canada; Lady Davis Research Institute, Montreal, Quebec, Canada; Jewish General Hospital, Montreal, Quebec, Canada
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2
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Aamir A, Jamil Y, Bilal M, Diwan M, Nashwan AJ, Ullah I. Artificial Intelligence in Enhancing Syncope Management - An Update. Curr Probl Cardiol 2024; 49:102079. [PMID: 37716544 DOI: 10.1016/j.cpcardiol.2023.102079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2023] [Accepted: 09/11/2023] [Indexed: 09/18/2023]
Abstract
This review looks into the use of Artificial Intelligence (AI) in the management of syncope, a condition characterized by a brief loss of consciousness caused by cerebral hypoperfusion. With rising prevalence, high costs, and difficulty in diagnosis and risk stratification, syncope poses significant healthcare challenges. AI has the potential to improve symptom differentiation, risk assessment, and patient management. Machine learning, specifically Artificial Neural Networks, has shown promise in accurate risk stratification. AI-powered clinical decision support tools can improve patient evaluation and resource utilization. While AI holds great promise for syncope management, challenges such as data quality, class imbalance, and defining risk categories remain. Ethical concerns about patient privacy, as well as the need for human empathy, complicate AI integration. Collaboration among data scientists, clinicians, and ethics experts is critical for the successful implementation of AI, which has the potential to improve patient outcomes and healthcare efficiency in syncope management.
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Affiliation(s)
- Alifiya Aamir
- Dow University of Health Sciences, Karachi, Pakistan
| | - Yumna Jamil
- Dow University of Health Sciences, Karachi, Pakistan
| | - Maham Bilal
- Dow University of Health Sciences, Karachi, Pakistan
| | | | | | - Irfan Ullah
- Kabir Medical College, Gandhara University, Peshawar, Pakistan; Department of Internal Medicine, Khyber Teaching Hospital, Peshawar, Pakistan
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3
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Dipaola F, Gatti M, Menè R, Shiffer D, Giaj Levra A, Solbiati M, Villa P, Costantino G, Furlan R. A Hybrid Model for 30-Day Syncope Prognosis Prediction in the Emergency Department. J Pers Med 2023; 14:4. [PMID: 38276219 PMCID: PMC10817569 DOI: 10.3390/jpm14010004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Revised: 12/06/2023] [Accepted: 12/11/2023] [Indexed: 01/27/2024] Open
Abstract
Syncope is a challenging problem in the emergency department (ED) as the available risk prediction tools have suboptimal predictive performances. Predictive models based on machine learning (ML) are promising tools whose application in the context of syncope remains underexplored. The aim of the present study was to develop and compare the performance of ML-based models in predicting the risk of clinically significant outcomes in patients presenting to the ED for syncope. We enrolled 266 consecutive patients (age 73, IQR 58-83; 52% males) admitted for syncope at three tertiary centers. We collected demographic and clinical information as well as the occurrence of clinically significant outcomes at a 30-day telephone follow-up. We implemented an XGBoost model based on the best-performing candidate predictors. Subsequently, we integrated the XGboost predictors with knowledge-based rules. The obtained hybrid model outperformed the XGboost model (AUC = 0.81 vs. 0.73, p < 0.001) with acceptable calibration. In conclusion, we developed an ML-based model characterized by a commendable capability to predict adverse events within 30 days post-syncope evaluation in the ED. This model relies solely on clinical data routinely collected during a patient's initial syncope evaluation, thus obviating the need for laboratory tests or syncope experienced clinical judgment.
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Affiliation(s)
- Franca Dipaola
- Internal Medicine, Syncope Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
| | | | - Roberto Menè
- Department of Medicine and Surgery, University of Milano-Bicocca, 20100 Milan, Italy;
| | - Dana Shiffer
- Emergency Department, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
| | | | - Monica Solbiati
- Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università Degli Studi Di Milano, 20100 Milan, Italy; (M.S.); (G.C.)
| | - Paolo Villa
- Emergency Medicine Unit, Luigi Sacco Hospital, ASST Fatebenefratelli Sacco, 20100 Milan, Italy;
| | - Giorgio Costantino
- Emergency Department, Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Università Degli Studi Di Milano, 20100 Milan, Italy; (M.S.); (G.C.)
| | - Raffaello Furlan
- Internal Medicine, Syncope Unit, IRCCS Humanitas Research Hospital, 20089 Milan, Italy;
- Department of Biomedical Sciences, Humanitas University, 20072 Milan, Italy;
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4
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Yuan G, Lv B, Hao C. Application of artificial neural networks in reproductive medicine. HUM FERTIL 2023; 26:1195-1201. [PMID: 36628627 DOI: 10.1080/14647273.2022.2156301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 09/01/2022] [Indexed: 01/12/2023]
Abstract
With the emergence of the age of information, the data on reproductive medicine has improved immensely. Nonetheless, healthcare workers who wish to utilise the relevance and implied value of the various data available to aid clinical decision-making encounter the difficulty of statistically analysing such large data. The application of artificial intelligence becoming widespread in recent years has emerged as a turning point in this regard. Artificial neural networks (ANNs) exhibit beneficial characteristics of comprehensive analysis and autonomous learning, owing to which these are being applied to disease diagnosis, embryo quality assessment, and prediction of pregnancy outcomes. The present report aims to summarise the application of ANNs in the field of reproduction and analyse its further application potential.
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Affiliation(s)
- Guanghui Yuan
- Department of Qingdao Medical College, Qingdao University, Qingdao, Shandong, China
| | - Bohan Lv
- Department of Intensive Care Unit, The Affiliated Hospital of Qingdao University, Qingdao, Shandong, China
| | - Cuifang Hao
- Department of Reproductive Medicine, The Affiliated Women and Children's Hospital of Qingdao University, Qingdao, Shandong, China
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5
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Dipaola F, Gatti M, Giaj Levra A, Menè R, Shiffer D, Faccincani R, Raouf Z, Secchi A, Rovere Querini P, Voza A, Badalamenti S, Solbiati M, Costantino G, Savevski V, Furlan R. Multimodal deep learning for COVID-19 prognosis prediction in the emergency department: a bi-centric study. Sci Rep 2023; 13:10868. [PMID: 37407595 DOI: 10.1038/s41598-023-37512-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Accepted: 06/22/2023] [Indexed: 07/07/2023] Open
Abstract
Predicting clinical deterioration in COVID-19 patients remains a challenging task in the Emergency Department (ED). To address this aim, we developed an artificial neural network using textual (e.g. patient history) and tabular (e.g. laboratory values) data from ED electronic medical reports. The predicted outcomes were 30-day mortality and ICU admission. We included consecutive patients from Humanitas Research Hospital and San Raffaele Hospital in the Milan area between February 20 and May 5, 2020. We included 1296 COVID-19 patients. Textual predictors consisted of patient history, physical exam, and radiological reports. Tabular predictors included age, creatinine, C-reactive protein, hemoglobin, and platelet count. TensorFlow tabular-textual model performance indices were compared to those of models implementing only tabular data. For 30-day mortality, the combined model yielded slightly better performances than the tabular fastai and XGBoost models, with AUC 0.87 ± 0.02, F1 score 0.62 ± 0.10 and an MCC 0.52 ± 0.04 (p < 0.32). As for ICU admission, the combined model MCC was superior (p < 0.024) to the tabular models. Our results suggest that a combined textual and tabular model can effectively predict COVID-19 prognosis which may assist ED physicians in their decision-making process.
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Affiliation(s)
- Franca Dipaola
- Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas Research Hospital, Humanitas University, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy
| | | | - Alessandro Giaj Levra
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Italy
- IRCCS Humanitas Research Hospital, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Roberto Menè
- Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy
- Heart Rhythm Department, Clinique Pasteur, Toulouse, France
| | - Dana Shiffer
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Italy
| | - Roberto Faccincani
- Emergency Department, Humanitas Mater Domini, Castellanza, Varese, Italy
| | - Zainab Raouf
- IRCCS-Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | - Antonio Secchi
- IRCCS-Ospedale San Raffaele, Università Vita-Salute San Raffaele, Milan, Italy
| | | | - Antonio Voza
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Italy
- Emergency Department, IRCCS - Humanitas Clinical and Research Center, Via Manzoni 56, Rozzano, Italy
| | - Salvatore Badalamenti
- Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas Research Hospital, Humanitas University, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy
| | - Monica Solbiati
- Emergency Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy
| | - Giorgio Costantino
- Emergency Department, Fondazione IRCCS Ca' Granda, Ospedale Maggiore, Milan, Italy
| | - Victor Savevski
- AI Center, IRCCS - Humanitas Research Hospital, Via Manzoni 56, Rozzano, Italy
| | - Raffaello Furlan
- Internal Medicine, Humanitas Clinical and Research Center, IRCCS, Humanitas Research Hospital, Humanitas University, Via A. Manzoni, 56, 20089, Rozzano, Milan, Italy.
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, Pieve Emanuele, Italy.
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6
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Statz GM, Evans AZ, Johnston SL, Adhaduk M, Mudireddy AR, Sonka M, Lee S, Barsotti EJ, Ricci F, Dipaola F, Johansson M, Sheldon RS, Thiruganasambandamoorthy V, Kenny RA, Bullis TC, Pasupula DK, Van Heukelom J, Gebska MA, Olshansky B. Can Artificial Intelligence Enhance Syncope Management?: A JACC: Advances Multidisciplinary Collaborative Statement. JACC. ADVANCES 2023; 2:100323. [PMID: 38939607 PMCID: PMC11198330 DOI: 10.1016/j.jacadv.2023.100323] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 02/24/2023] [Indexed: 06/29/2024]
Abstract
Syncope, a form of transient loss of consciousness, remains a complex medical condition for which adverse cardiovascular outcomes, including death, are of major concern but rarely occur. Current risk stratification algorithms have not completely delineated which patients benefit from hospitalization and specific interventions. Patients are often admitted unnecessarily and at high cost. Artificial intelligence (AI) and machine learning may help define the transient loss of consciousness event, diagnose the cause, assess short- and long-term risks, predict recurrence, and determine need for hospitalization and therapeutic intervention; however, several challenges remain, including medicolegal and ethical concerns. This collaborative statement, from a multidisciplinary group of clinicians, investigators, and scientists, focuses on the potential role of AI in syncope management with a goal to inspire creation of AI-derived clinical decision support tools that may improve patient outcomes, streamline diagnostics, and reduce health-care costs.
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Affiliation(s)
- Giselle M. Statz
- Division of Cardiovascular Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Aron Z. Evans
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Samuel L. Johnston
- Division of Cardiovascular Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Mehul Adhaduk
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Avinash R. Mudireddy
- The Iowa Initiative for Artificial Intelligence, University of Iowa, Iowa City, Iowa, USA
| | - Milan Sonka
- The Iowa Initiative for Artificial Intelligence, University of Iowa, Iowa City, Iowa, USA
| | - Sangil Lee
- Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - E. John Barsotti
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, Iowa, USA
| | - Fabrizio Ricci
- Department of Neurosciences, Imaging and Clinical Sciences, Institute for Advanced Biomedical Technologies, University G. d’Annunzio, Chieti, Italy
| | - Franca Dipaola
- Internal Medicine, Syncope Unit, IRCCS Humanitas Research Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Madeleine Johansson
- Department of Cardiology, Skåne University Hospital, Lund University, Malmo, Sweden
| | - Robert S. Sheldon
- Department of Cardiac Sciences, University of Calgary, Calgary, Alberta, Canada
| | | | - Rose-Anne Kenny
- Department of Medical Gerontology, School of Medicine, Trinity College, Dublin, Ireland
| | - Tyler C. Bullis
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Deepak K. Pasupula
- Division of Cardiovascular Disease, Department of Internal Medicine, MercyOne North Iowa Heart Center, Mason City, Iowa, USA
| | - Jon Van Heukelom
- Department of Emergency Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Milena A. Gebska
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
| | - Brian Olshansky
- Department of Internal Medicine, Roy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, Iowa, USA
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7
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Wang A, Xiu X, Liu S, Qian Q, Wu S. Characteristics of Artificial Intelligence Clinical Trials in the Field of Healthcare: A Cross-Sectional Study on ClinicalTrials.gov. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:13691. [PMID: 36294269 PMCID: PMC9602501 DOI: 10.3390/ijerph192013691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Revised: 10/13/2022] [Accepted: 10/20/2022] [Indexed: 06/16/2023]
Abstract
Artificial intelligence (AI) has driven innovative transformation in healthcare service patterns, despite a lack of understanding of its performance in clinical practice. We conducted a cross-sectional analysis of AI-related trials in healthcare based on ClinicalTrials.gov, intending to investigate the trial characteristics and AI's development status. Additionally, the Neo4j graph database and visualization technology were employed to construct an AI technology application graph, achieving a visual representation and analysis of research hotspots in healthcare AI. A total of 1725 eligible trials that were registered in ClinicalTrials.gov up to 31 March 2022 were included in this study. The number of trial registrations has dramatically grown each year since 2016. However, the AI-related trials had some design drawbacks and problems with poor-quality result reporting. The proportion of trials with prospective and randomized designs was insufficient, and most studies did not report results upon completion. Currently, most healthcare AI application studies are based on data-driven learning algorithms, covering various disease areas and healthcare scenarios. As few studies have publicly reported results on ClinicalTrials.gov, there is not enough evidence to support an assessment of AI's actual performance. The widespread implementation of AI technology in healthcare still faces many challenges and requires more high-quality prospective clinical validation.
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Affiliation(s)
| | | | | | | | - Sizhu Wu
- Correspondence: ; Tel.: +86-10-5232-8760
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Boonstra A, Laven M. Influence of artificial intelligence on the work design of emergency department clinicians a systematic literature review. BMC Health Serv Res 2022; 22:669. [PMID: 35585603 PMCID: PMC9118875 DOI: 10.1186/s12913-022-08070-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 05/11/2022] [Indexed: 11/30/2022] Open
Abstract
Objective This systematic literature review aims to demonstrate how Artificial Intelligence (AI) is currently used in emergency departments (ED) and how it alters the work design of ED clinicians. AI is still new and unknown to many healthcare professionals in emergency care, leading to unfamiliarity with its capabilities. Method Various criteria were used to establish the suitability of the articles to answer the research question. This study was based on 34 selected peer-reviewed papers on the use of Artificial Intelligence (AI) in the Emergency Department (ED), published in the last five years. Drawing on the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, all articles were scanned, read full-text, and analyzed afterward. Results The majority of the AI applications consisted of AI-based tools to aid with clinical decisions and to relieve overcrowded EDs of their burden. AI support was mostly offered during triage, the moment that sets the patient trajectory. There is ample evidence that AI-based applications could improve the clinical decision-making process. Conclusion The use of AI in EDs is still in its nascent stages. Many studies focus on the question of whether AI has clinical utility, such as decision support, improving resource allocation, reducing diagnostic errors, and promoting proactivity. Some studies suggest that AI-based tools essentially have the ability to outperform human skills. However, it is evident from the literature that current technology does not have the aims or power to do so. Nevertheless, AI-based tools can impact clinician work design in the ED by providing support with clinical decisions, which could ultimately help alleviate a portion of the increasing clinical burden. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-022-08070-7.
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Affiliation(s)
- Albert Boonstra
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands.
| | - Mente Laven
- Faculty of Economics and Business, University of Groningen, Groningen, The Netherlands
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Bacchi S, Gilbert T, Gluck S, Cheng J, Tan Y, Chim I, Jannes J, Kleinig T, Koblar S. Daily estimates of individual discharge likelihood with deep learning natural language processing in general medicine: a prospective and external validation study. Intern Emerg Med 2022; 17:411-415. [PMID: 34333736 DOI: 10.1007/s11739-021-02816-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 07/21/2021] [Indexed: 12/11/2022]
Abstract
Machine learning, in particular deep learning, may be able to assist in the prediction of the length of stay and timing of discharge for individual patients. Artificial neural networks applied to medical text have previously shown promise in this area. In this study, a previously derived artificial neural network was applied to prospective and external validation datasets. In the prediction of discharge within the next 2 days, when the algorithm was applied to prospective and external datasets, the area under the receiver operator curve for this task were 0.78 and 0.74, respectively. The performance in the prediction of discharge within the next 7 days was more limited (area under the receiver operator curve 0.68 and 0.67). This study has shown that in prospective and external validation datasets the previously derived deep learning algorithms have demonstrated moderate performance in the prediction of which patients will be discharged within the next 2 days. Future studies may seek to further refine or evaluate the effect of the implementation of such algorithms.
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Affiliation(s)
- Stephen Bacchi
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.
- School of Medicine, Faculty Health and Medical Science, University of Adelaide, Adelaide, SA, 5005, Australia.
| | - Toby Gilbert
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Samuel Gluck
- School of Medicine, Faculty Health and Medical Science, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Joy Cheng
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Yiran Tan
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
- School of Medicine, Faculty Health and Medical Science, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Ivana Chim
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Jim Jannes
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
- School of Medicine, Faculty Health and Medical Science, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Timothy Kleinig
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
- School of Medicine, Faculty Health and Medical Science, University of Adelaide, Adelaide, SA, 5005, Australia
| | - Simon Koblar
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
- School of Medicine, Faculty Health and Medical Science, University of Adelaide, Adelaide, SA, 5005, Australia
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10
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Sutton R, Ricci F, Fedorowski A. Risk stratification of syncope: Current syncope guidelines and beyond. Auton Neurosci 2022; 238:102929. [PMID: 34968831 DOI: 10.1016/j.autneu.2021.102929] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/27/2021] [Accepted: 12/08/2021] [Indexed: 11/28/2022]
Abstract
Syncope is an alarming event carrying the possibility of serious outcomes, including sudden cardiac death (SCD). Therefore, immediate risk stratification should be applied whenever syncope occurs, especially in the Emergency Department, where most dramatic presentations occur. It has long been known that short- and long-term syncope prognosis is affected not only by its mechanism but also by presence of concomitant conditions, especially cardiovascular disease. Over the last two decades, several syncope prediction tools have been developed to refine patient stratification and triage patients who need expert in-hospital care from those who may receive nonurgent expert care in the community. However, despite promising results, prognostic tools for syncope remain challenging and often poorly effective. Current European Society of Cardiology syncope guidelines recommend an initial syncope workup based on detailed patient's history, physical examination supine and standing blood pressure, resting ECG, and laboratory tests, including cardiac biomarkers, where appropriate. Subsequent risk stratification based on screening of features aims to identify three groups: high-, intermediate- and low-risk. The first should immediately be hospitalized and appropriately investigated; intermediate group, with recurrent or medium-risk events, requires systematic evaluation by syncope experts; low-risk group, sporadic reflex syncope, merits education about its benign nature, and discharge. Thus, initial syncope risk stratification is crucial as it determines how and by whom syncope patients are managed. This review summarizes the crucial elements of syncope risk stratification, pros and cons of proposed risk evaluation scores, major challenges in initial syncope management, and how risk stratification impacts management of high-risk/recurrent syncope.
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Affiliation(s)
- Richard Sutton
- National Heart & Lung Institute, Imperial College, Dept. of Cardiology, Hammersmith Hospital, Du Cane Road, London W12 0HS, United Kingdom
| | - Fabrizio Ricci
- Department of Neuroscience, Imaging and Clinical Sciences, "G.d'Annunzio" University of Chieti-Pescara, Via Luigi Polacchi, 11, 66100 Chieti, Italy; Casa di Cura Villa Serena, Città Sant'Angelo, Italy
| | - Artur Fedorowski
- Dept. of Cardiology, Karolinska University Hospital, and Department of Medicine, Karolinska Institute, Stockholm, Sweden.
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11
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Ippoliti R, Falavigna G, Zanelli C, Bellini R, Numico G. Neural networks and hospital length of stay: an application to support healthcare management with national benchmarks and thresholds. COST EFFECTIVENESS AND RESOURCE ALLOCATION 2021; 19:67. [PMID: 34627288 PMCID: PMC8502324 DOI: 10.1186/s12962-021-00322-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2020] [Accepted: 09/23/2021] [Indexed: 11/25/2022] Open
Abstract
Background The problem of correct inpatient scheduling is extremely significant for healthcare management. Extended length of stay can have negative effects on the supply of healthcare treatments, reducing patient accessibility and creating missed opportunities to increase hospital revenues by means of other treatments and additional hospitalizations. Methods Adopting available national reference values and focusing on a Department of Internal and Emergency Medicine located in the North-West of Italy, this work assesses prediction models of hospitalizations with length of stay longer than the selected benchmarks and thresholds. The prediction models investigated in this case study are based on Artificial Neural Networks and examine risk factors for prolonged hospitalizations in 2018. With respect current alternative approaches (e.g., logistic models), Artificial Neural Networks give the opportunity to identify whether the model will maximize specificity or sensitivity. Results Our sample includes administrative data extracted from the hospital database, collecting information on more than 16,000 hospitalizations between January 2018 and December 2019. Considering the overall department in 2018, 40% of the hospitalizations lasted more than the national average, and almost 3.74% were outliers (i.e., they lasted more than the threshold). According to our results, the adoption of the prediction models in 2019 could reduce the average length of stay by up to 2 days, guaranteeing more than 2000 additional hospitalizations in a year. Conclusions The proposed models might represent an effective tool for administrators and medical professionals to predict the outcome of hospital admission and design interventions to improve hospital efficiency and effectiveness.
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Affiliation(s)
- Roberto Ippoliti
- Faculty of Business Administration and Economics, Bielefeld University, Bielefeld, North Rhine-Westphalia, Germany.
| | - Greta Falavigna
- Research Institute on Sustainable Economic Growth (IRCrES), National Research Council of Italy (CNR), Moncalieri, TO, Italy
| | - Cristian Zanelli
- Quality and Management Control Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, AL, Italy
| | - Roberta Bellini
- Quality and Management Control Unit, Azienda Ospedaliera SS Antonio e Biagio e Cesare Arrigo, Alessandria, AL, Italy
| | - Gianmauro Numico
- Medical Oncology Unit, Azienda Ospedaliera Santa Croce e Carle, Cuneo, CN, Italy
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Falavigna G. Deep learning algorithms with mixed data for prediction of Length of Stay. Intern Emerg Med 2021; 16:1427-1428. [PMID: 33851300 PMCID: PMC8043423 DOI: 10.1007/s11739-021-02736-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 04/01/2021] [Indexed: 11/30/2022]
Affiliation(s)
- Greta Falavigna
- Research Institute on Sustainable Economic Growth (IRCrES-CNR), National Council of Research of Italy, via Real Collegio 30, 10024, Moncalieri, TO, Italy.
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Bacchi S, Gluck S, Tan Y, Chim I, Cheng J, Gilbert T, Jannes J, Kleinig T, Koblar S. Mixed-data deep learning in repeated predictions of general medicine length of stay: a derivation study. Intern Emerg Med 2021; 16:1613-1617. [PMID: 33728577 DOI: 10.1007/s11739-021-02697-w] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/30/2020] [Accepted: 03/05/2021] [Indexed: 12/11/2022]
Abstract
The accurate prediction of likely discharges and estimates of length of stay (LOS) aid in effective hospital administration and help to prevent access block. Machine learning (ML) may be able to help with these tasks. For consecutive patients admitted under General Medicine at the Royal Adelaide Hospital over an 8-month period, daily ward round notes and relevant discrete data fields were collected from the electronic medical record. These data were then split into training and testing sets (7-month/1-month train/test split) prior to use in ML analyses aiming to predict discharge within the next 2 days, discharge within the next 7 days and an estimated date of discharge (EDD). Artificial neural networks and logistic regression were effective at predicting discharge within 48 h of a given ward round note. These models achieved an area under the receiver operator curve (AUC) of 0.80 and 0.78, respectively. Prediction of discharge within 7 days of a given note was less accurate, with artificial neural network returning an AUC of 0.68 and logistic regression an AUC of 0.61. The generation of an exact EDD remains inaccurate. This study has shown that repeated estimates of LOS using daily ward round notes and mixed-data inputs are effective in the prediction of general medicine discharges in the next 48 h. Further research may seek to prospectively and externally validate models for prediction of upcoming discharge, as well as combination human-ML approaches for generating EDDs.
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Affiliation(s)
- Stephen Bacchi
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia.
- University of Adelaide, Adelaide, SA, 5005, Australia.
| | - Samuel Gluck
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, SA, 5005, Australia
| | - Yiran Tan
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, SA, 5005, Australia
| | - Ivana Chim
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Joy Cheng
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
| | - Toby Gilbert
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, SA, 5005, Australia
| | - Jim Jannes
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, SA, 5005, Australia
| | - Timothy Kleinig
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, SA, 5005, Australia
| | - Simon Koblar
- Royal Adelaide Hospital, Port Road, Adelaide, SA, 5000, Australia
- University of Adelaide, Adelaide, SA, 5005, Australia
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14
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Dipaola F, Shiffer D, Gatti M, Menè R, Solbiati M, Furlan R. Machine Learning and Syncope Management in the ED: The Future Is Coming. ACTA ACUST UNITED AC 2021; 57:medicina57040351. [PMID: 33917508 PMCID: PMC8067452 DOI: 10.3390/medicina57040351] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2021] [Revised: 03/30/2021] [Accepted: 04/02/2021] [Indexed: 11/16/2022]
Abstract
In recent years, machine learning (ML) has been promisingly applied in many fields of clinical medicine, both for diagnosis and prognosis prediction. Aims of this narrative review were to summarize the basic concepts of ML applied to clinical medicine and explore its main applications in the emergency department (ED) setting, with a particular focus on syncope management. Through an extensive literature search in PubMed and Embase, we found increasing evidence suggesting that the use of ML algorithms can improve ED triage, diagnosis, and risk stratification of many diseases. However, the lacks of external validation and reliable diagnostic standards currently limit their implementation in clinical practice. Syncope represents a challenging problem for the emergency physician both because its diagnosis is not supported by specific tests and the available prognostic tools proved to be inefficient. ML algorithms have the potential to overcome these limitations and, in the future, they could support the clinician in managing syncope patients more efficiently. However, at present only few studies have addressed this issue, albeit with encouraging results.
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Affiliation(s)
- Franca Dipaola
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (D.S.); (R.F.)
- Internal Medicine, Humanitas Clinical and Research Center—IRCCS, Rozzano, 20089 Milan, Italy
- Correspondence: ; Tel.: +39-0282247266
| | - Dana Shiffer
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (D.S.); (R.F.)
| | - Mauro Gatti
- IBM, Active Intelligence Center, 40121 Bologna, Italy;
| | - Roberto Menè
- Department of Medicine and Surgery, University of Milano-Bicocca, 20126 Milan, Italy;
| | - Monica Solbiati
- Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, 20122 Milan, Italy;
- Dipartimento di Scienze Cliniche e di Comunità, Università degli Studi di Milano, 20122 Milan, Italy
| | - Raffaello Furlan
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, 20090 Milan, Italy; (D.S.); (R.F.)
- Internal Medicine, Humanitas Clinical and Research Center—IRCCS, Rozzano, 20089 Milan, Italy
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15
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Erba L, Furlan L, Monti A, Marsala E, Cernuschi G, Solbiati M, Bracco C, Bandini G, Pecorino Meli M, Casazza G, Montano N, Sbrojavacca R, Costantino G. Short vs long-course antibiotic therapy in pyelonephritis: a comparison of systematic reviews and guidelines for the SIMI choosing wisely campaign. Intern Emerg Med 2021; 16:313-323. [PMID: 32566969 DOI: 10.1007/s11739-020-02401-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 06/06/2020] [Indexed: 12/11/2022]
Abstract
BACKGROUND The Italian Society of Internal Medicine (SIMI) Choosing Wisely Campaign has recently proposed, among its five items, to reduce the prescription of long-term intravenous antibiotics if not indicated. The aim of our study was to assess the available evidences on optimal duration of antibiotic treatment in pyelonephritis through a systematic review of secondary studies. MATERIALS AND METHODS We searched for all guidelines on pyelonephritis and systematic reviews assessing the optimal duration of antibiotic therapy in this type of infection. We compared the recommendations of the three most cited and recent guidelines on the topic of interest. We extracted data of non-duplicated RCT from the selected systematic reviews and performed meta-analyses for clinical and microbiological failure. A trial sequential analysis (TSA) was also achieved to identify the need for further evidence. RESULTS We identified 4 systematic reviews, including data from 10 non-duplicated RCTs (1536 patients). The meta-analysis showed a higher rate of clinical cure for short-course antibiotic treatment (RR for clinical failure 0.70, 95% CI [0.53-0.94]). No significant difference in the rate of microbiological failure (RR 1.06, 95% CI [0.75-1.49]) was observed. In terms of clinical cure, the TSA suggests that current evidence is sufficient to consider short course at least as effective as long-course treatment. Selected guidelines recommend considering shorter courses, but do not cite most of the published RCTs. CONCLUSIONS Short-course antibiotic treatment is at least as effective as longer courses for both microbiological and clinical success in the treatment of acute uncomplicated pyelonephritis.
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Affiliation(s)
- Luca Erba
- Università Degli Studi Di Milano, Milan, Italy.
| | | | - Alice Monti
- Università Degli Studi Di Milano, Milan, Italy
| | | | - Giulia Cernuschi
- UOC Pronto Soccorso E Medicina D'Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Monica Solbiati
- UOC Pronto Soccorso E Medicina D'Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Christian Bracco
- Department of Internal Medicine, Santa Croce and Carle General Hospital, Cuneo, Italy
| | - Giulia Bandini
- Medicina Interna, Università Degli Studi Di Firenze, AOU Careggi, Firenze, Italy
| | - Monica Pecorino Meli
- Dipartimento Delle Professioni Sanitarie, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
| | - Giovanni Casazza
- Dipartimento Di Scienze Biomediche E Cliniche "L. Sacco", Università Degli Studi Di Milano, Milan, Italy
| | - Nicola Montano
- Dipartimento Di Medicina Interna, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento Di Scienze Cliniche E Di Comunità, Università Degli Studi Di Milano, Milan, Italy
| | - Rodolfo Sbrojavacca
- Dipartimento Di Pronto Soccorso E Medicina D'Urgenza, Azienda Ospedaliera Universitaria Di Udine, Udine, Italy
| | - Giorgio Costantino
- UOC Pronto Soccorso E Medicina D'Urgenza, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan, Italy
- Dipartimento Di Scienze Cliniche E Di Comunità, Università Degli Studi Di Milano, Milan, Italy
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Zou LX, Sun L. Analysis of Hemorrhagic Fever With Renal Syndrome Using Wavelet Tools in Mainland China, 2004-2019. Front Public Health 2020; 8:571984. [PMID: 33335877 PMCID: PMC7736046 DOI: 10.3389/fpubh.2020.571984] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Accepted: 11/09/2020] [Indexed: 01/24/2023] Open
Abstract
Introduction : Hemorrhagic fever with renal syndrome (HFRS) is a life-threatening public health problem in China, accounting for ~90% of HFRS cases reported globally. Accurate analysis and prediction of the HFRS epidemic could help to establish effective preventive measures. Materials and Methods : In this study, the geographical information system (GIS) explored the spatiotemporal features of HFRS, the wavelet power spectrum (WPS) unfolded the cyclical fluctuation of HFRS, and the wavelet neural network (WNN) model predicted the trends of HFRS outbreaks in mainland China. Results : A total of 209,209 HFRS cases were reported in mainland China from 2004 to 2019, with the annual incidence ranged from 0 to 13.05 per 100,0000 persons at the province level. The WPS proved that the periodicity of HFRS could be half a year, 1 year, and roughly 7-year at different time intervals. The WNN structure of 12-6-1 was set up as the fittest forecasting model for the HFRS epidemic. Conclusions : This study provided several potential support tools for the control and risk-management of HFRS in China.
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Affiliation(s)
- Lu-Xi Zou
- School of Management, Zhejiang University, Hangzhou, China
| | - Ling Sun
- Department of Nephrology, Xuzhou Central Hospital, The Xuzhou School of Clinical Medicine of Nanjing Medical University, Xuzhou, China.,Xuzhou Clinical School of Xuzhou Medical University, Xuzhou, China
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17
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Falavigna G. Prediction of general medical admission length of stay with natural language processing and deep learning: a pilot study. Intern Emerg Med 2020; 15:917-918. [PMID: 32062745 DOI: 10.1007/s11739-020-02291-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Accepted: 01/30/2020] [Indexed: 11/27/2022]
Affiliation(s)
- Greta Falavigna
- Research Institute on Sustainable Economic Growth of Italian National Council of Research (IRCrES-CNR), Via Real Collegio 30, 10024, Moncalieri, TO, Italy.
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Shirasawa K, Esumi T, Hirakawa H, Tanaka H, Itai A, Ghelfi A, Nagasaki H, Isobe S. Phased genome sequence of an interspecific hybrid flowering cherry, 'Somei-Yoshino' (Cerasus × yedoensis). DNA Res 2020; 26:379-389. [PMID: 31334758 PMCID: PMC6796508 DOI: 10.1093/dnares/dsz016] [Citation(s) in RCA: 33] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2019] [Accepted: 06/26/2019] [Indexed: 12/17/2022] Open
Abstract
We report the phased genome sequence of an interspecific hybrid, the flowering cherry ‘Somei-Yoshino’ (Cerasus × yedoensis). The sequence data were obtained by single-molecule real-time sequencing technology, split into two subsets based on genome information of the two probable ancestors, and assembled to obtain two haplotype phased genome sequences of the interspecific hybrid. The resultant genome assembly consisting of the two haplotype sequences spanned 690.1 Mb with 4,552 contigs and an N50 length of 1.0 Mb. We predicted 95,076 high-confidence genes, including 94.9% of the core eukaryotic genes. Based on a high-density genetic map, we established a pair of eight pseudomolecule sequences, with highly conserved structures between the two haplotype sequences with 2.4 million sequence variants. A whole genome resequencing analysis of flowering cherries suggested that ‘Somei-Yoshino’ might be derived from a cross between C. spachiana and either C. speciosa or its relatives. A time-course transcriptome analysis of floral buds and flowers suggested comprehensive changes in gene expression in floral bud development towards flowering. These genome and transcriptome data are expected to provide insights into the evolution and cultivation of flowering cherry and the molecular mechanism underlying flowering.
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