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Shazly T, Eberth JF, Kostelnik CJ, Uline MJ, Chitalia VC, Spinale FG, Alshareef A, Kolachalama VB. Hydrophilic Coating Microstructure Mediates Acute Drug Transfer in Drug-Coated Balloon Therapy. ACS Appl Bio Mater 2024; 7:3041-3049. [PMID: 38661721 DOI: 10.1021/acsabm.4c00080] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
Drug-coated balloon (DCB) therapy is a promising endovascular treatment for obstructive arterial disease. The goal of DCB therapy is restoration of lumen patency in a stenotic vessel, whereby balloon deployment both mechanically compresses the offending lesion and locally delivers an antiproliferative drug, most commonly paclitaxel (PTX) or derivative compounds, to the arterial wall. Favorable long-term outcomes of DCB therapy thus require predictable and adequate PTX delivery, a process facilitated by coating excipients that promotes rapid drug transfer during the inflation period. While a variety of excipients have been considered in DCB design, there is a lack of understanding about the coating-specific biophysical determinants of essential device function, namely, acute drug transfer. We consider two hydrophilic excipients for PTX delivery, urea (UR) and poly(ethylene glycol) (PEG), and examine how compositional and preparational variables in the balloon surface spray-coating process impact resultant coating microstructure and in turn acute PTX transfer to the arterial wall. Specifically, we use scanning electron image analyses to quantify how coating microstructure is altered by excipient solid content and balloon-to-nozzle spray distance during the coating procedure and correlate obtained microstructural descriptors of coating aggregation to the efficiency of acute PTX transfer in a one-dimensional ex vivo model of DCB deployment. Experimental results suggest that despite the qualitatively different coating surface microstructures and apparent PTX transfer mechanisms exhibited with these excipients, the drug delivery efficiency is generally enhanced by coating aggregation on the balloon surface. We illustrate this microstructure-function relation with a finite element-based computational model of DCB deployment, which along with our experimental findings suggests a general design principle to increase drug delivery efficiency across a broad range of DCB designs.
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Affiliation(s)
- Tarek Shazly
- Department of Biomedical Engineering Program, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, United States
- Department of Mechanical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, United States
- Cardiovascular Translational Research Center, University of South Carolina, Columbia, South Carolina 29208, United States
| | - John F Eberth
- Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, United States
| | - Colton J Kostelnik
- Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, Pennsylvania 19104, United States
- Aerospace Engineering and Engineering Mechanics, The University of Texas at Austin, Austin, Texas 78712, United States
| | - Mark J Uline
- Department of Biomedical Engineering Program, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, United States
- Cardiovascular Translational Research Center, University of South Carolina, Columbia, South Carolina 29208, United States
- Department of Chemical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, United States
| | - Vipul C Chitalia
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, United States
- VA Coston Healthcare System, Boston, Massachusetts 02115, United States
| | - Francis G Spinale
- Department of Biomedical Engineering Program, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, United States
- Cardiovascular Translational Research Center, University of South Carolina, Columbia, South Carolina 29208, United States
- Department of Cell Biology and Anatomy, School of Medicine, University of South Carolina, Columbia, South Carolina 29208, United States
| | - Ahmed Alshareef
- Department of Biomedical Engineering Program, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, United States
- Department of Mechanical Engineering, College of Engineering and Computing, University of South Carolina, Columbia, South Carolina 29208, United States
- Cardiovascular Translational Research Center, University of South Carolina, Columbia, South Carolina 29208, United States
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, United States
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, Massachusetts 02115, United States
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Cordella C, Di Filippo L, Kolachalama VB, Kiran S. Connected Speech Fluency in Poststroke and Progressive Aphasia: A Scoping Review of Quantitative Approaches and Features. Am J Speech Lang Pathol 2024:1-38. [PMID: 38652820 DOI: 10.1044/2024_ajslp-23-00208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Abstract
PURPOSE Speech fluency has important diagnostic implications for individuals with poststroke aphasia (PSA) as well as primary progressive aphasia (PPA), and quantitative assessment of connected speech has emerged as a widely used approach across both etiologies. The purpose of this review was to provide a clearer picture on the range, nature, and utility of individual quantitative speech/language measures and methods used to assess connected speech fluency in PSA and PPA, and to compare approaches across etiologies. METHOD We conducted a scoping review of literature published between 2012 and 2022 following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews guidelines. Forty-five studies were included in the review. Literature was charted and summarized by etiology and characteristics of included patient populations and method(s) used for derivation and analysis of speech/language features. For a subset of included articles, we also charted the individual quantitative speech/language features reported and the level of significance of reported results. RESULTS Results showed that similar methodological approaches have been used to quantify connected speech fluency in both PSA and PPA. Two hundred nine individual speech-language features were analyzed in total, with low levels of convergence across etiology on specific features but greater agreement on the most salient features. The most useful features for differentiating fluent from nonfluent aphasia in both PSA and PPA were features related to overall speech quantity, speech rate, or grammatical competence. CONCLUSIONS Data from this review demonstrate the feasibility and utility of quantitative approaches to index connected speech fluency in PSA and PPA. We identified emergent trends toward automated analysis methods and data-driven approaches, which offer promising avenues for clinical translation of quantitative approaches. There is a further need for improved consensus on which subset of individual features might be most clinically useful for assessment and monitoring of fluency. SUPPLEMENTAL MATERIAL https://doi.org/10.23641/asha.25537237.
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Affiliation(s)
- Claire Cordella
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Lauren Di Filippo
- Department of Speech, Language and Hearing Sciences, Boston University, MA
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, MA
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, MA
| | - Swathi Kiran
- Department of Speech, Language and Hearing Sciences, Boston University, MA
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Zhang M, Lotfollahzadeh S, Elzinad N, Yang X, Elsadawi M, Gower AC, Belghasem M, Shazly T, Kolachalama VB, Chitalia VC. Alleviating iatrogenic effects of paclitaxel via antiinflammatory treatment. Vasc Med 2024:1358863X241231942. [PMID: 38623630 DOI: 10.1177/1358863x241231942] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/17/2024]
Abstract
BACKGROUND Paclitaxel (PTX) is touted as an essential medicine due to its extensive use as a chemotherapeutic agent for various cancers and an antiproliferative agent for endovascular applications. Emerging studies in cardio-oncology implicate various vascular complications of chemotherapeutic agents. METHODS We evaluated the inflammatory response induced by the systemic administration of PTX. The investigation included RNAseq analysis of primary human endothelial cells (ECs) treated with PTX to identify transcriptional changes in pro-inflammatory mediators. Additionally, we used dexamethasone (DEX), a well-known antiinflammatory compound, to assess its effectiveness in counteracting these PTX-induced changes. Further, we studied the effects of PTX on monocyte chemoattractant protein-1 (MCP-1) levels in the media of ECs. The study also extended to in vivo analysis, where a group of mice was injected with PTX and subsequently harvested at different times to assess the immediate and delayed effects of PTX on inflammatory mediators in blood and aortic ECs. RESULTS Our RNAseq analysis revealed that PTX treatment led to significant transcriptional perturbations in pro-inflammatory mediators such as MCP-1 and CD137 within primary human ECs. These changes were effectively abrogated when DEX was administered. In vitro experiments showed a marked increase in MCP-1 levels in EC media following PTX treatment, which returned to baseline upon treatment with DEX. In vivo, we observed a threefold increase in MCP-1 levels in blood and aortic ECs 12 h post-PTX administration. Similar trends were noted for CD137 and other downstream mediators like tissue factor, vascular cell adhesion molecule 1, and E-selectin in aortic ECs. CONCLUSION Our findings illustrate that PTX exposure induces an upregulation of atherothrombotic mediators, which can be alleviated with concurrent administration of DEX. Considering these observations, further long-term investigations should focus on understanding the systemic implications associated with PTX-based therapies and explore the clinical relevance of DEX in mitigating such risks.
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Affiliation(s)
- Mengwei Zhang
- Department of Medicine, Renal Section, Boston University School of Medicine, Boston, MA, USA
| | - Saran Lotfollahzadeh
- Department of Medicine, Renal Section, Boston University School of Medicine, Boston, MA, USA
| | - Nagla Elzinad
- Department of Medicine, Renal Section, Boston University School of Medicine, Boston, MA, USA
| | - Xiaosheng Yang
- Department of Medicine, Renal Section, Boston University School of Medicine, Boston, MA, USA
| | - Murad Elsadawi
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Adam C Gower
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Clinical and Translational Science Institute, Boston University School of Medicine, Boston, MA, USA
| | - Mostafa Belghasem
- Department of Biomedical Science, Kaiser Permanente Bernard J Tyson School of Medicine, Pasadena, CA, USA
| | - Tarek Shazly
- College of Engineering & Computing, University of South Carolina, Columbia, SC, USA
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA
| | - Vipul C Chitalia
- Department of Medicine, Renal Section, Boston University School of Medicine, Boston, MA, USA
- Veterans Affairs Boston Healthcare System, Boston, MA, USA
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Zheng Y, Conrad RD, Green EJ, Burks EJ, Betke M, Beane JE, Kolachalama VB. Graph attention-based fusion of pathology images and gene expression for prediction of cancer survival. IEEE Trans Med Imaging 2024; PP:1-1. [PMID: 38587959 DOI: 10.1109/tmi.2024.3386108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/10/2024]
Abstract
Multimodal machine learning models are being developed to analyze pathology images and other modalities, such as gene expression, to gain clinical and biological insights. However, most frameworks for multimodal data fusion do not fully account for the interactions between different modalities. Here, we present an attention-based fusion architecture that integrates a graph representation of pathology images with gene expression data and concomitantly learns from the fused information to predict patient-specific survival. In our approach, pathology images are represented as undirected graphs, and their embeddings are combined with embeddings of gene expression signatures using an attention mechanism to stratify tumors by patient survival. We show that our framework improves the survival prediction of human non-small cell lung cancers, outperforming existing state-of-the-art approaches that leverage multimodal data. Our framework can facilitate spatial molecular profiling to identify tumor heterogeneity using pathology images and gene expression data, complementing results obtained from more expensive spatial transcriptomic and proteomic technologies.
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Gindra RH, Zheng Y, Green EJ, Reid ME, Mazzilli SA, Merrick DT, Burks EJ, Kolachalama VB, Beane JE. Graph Perceiver Network for Lung Tumor and Bronchial Premalignant Lesion Stratification from Histopathology. Am J Pathol 2024:S0002-9440(24)00124-X. [PMID: 38588853 DOI: 10.1016/j.ajpath.2024.03.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 02/29/2024] [Accepted: 03/11/2024] [Indexed: 04/10/2024]
Abstract
Bronchial premalignant lesions (PMLs) precede the development of invasive lung squamous cell carcinoma (LUSC), posing a significant challenge in distinguishing those likely to advance to LUSC from those that might regress without intervention. In this context, we present a novel computational approach, the Graph Perceiver Network, leveraging hematoxylin and eosin-stained whole slide images to stratify endobronchial biopsies of PMLs across a spectrum from normal to tumor lung tissues. The Graph Perceiver Network outperforms existing frameworks in classification accuracy predicting LUSC, lung adenocarcinoma, and nontumor (normal) lung tissue on The Cancer Genome Atlas and Clinical Proteomic Tumor Analysis Consortium datasets containing lung resection tissues while efficiently generating pathologist-aligned, class-specific heat maps. The network was further tested using endobronchial biopsies from two data cohorts, containing normal to carcinoma in situ histology, and it demonstrated a unique capability to differentiate carcinoma in situ lung squamous PMLs based on their progression status to invasive carcinoma. The network may have utility in stratifying PMLs for chemoprevention trials or more aggressive follow-up.
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Affiliation(s)
- Rushin H Gindra
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts; Institute of AI for Health, Helmholtz Zentrum München, Munich, Germany; Research Center for Environmental Health, Munich, Germany; Center for Translational Cancer Research, School of Medicine, Technische Universität München, Munich, Germany
| | - Yi Zheng
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts; Department of Computer Science, Boston University, Boston, Massachusetts
| | - Emily J Green
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Mary E Reid
- Roswell Park Comprehensive Cancer Center, Buffalo, New York
| | - Sarah A Mazzilli
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Daniel T Merrick
- Department of Pathology, University of Colorado School of Medicine, Aurora, Colorado
| | - Eric J Burks
- Department of Pathology and Laboratory Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts; Department of Computer Science, Boston University, Boston, Massachusetts; Faculty of Computing and Data Sciences, Boston University, Boston, Massachusetts.
| | - Jennifer E Beane
- Department of Medicine, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts.
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Xue C, Kowshik SS, Lteif D, Puducheri S, Jasodanand VH, Zhou OT, Walia AS, Guney OB, Zhang JD, Pham ST, Kaliaev A, Andreu-Arasa VC, Dwyer BC, Farris CW, Hao H, Kedar S, Mian AZ, Murman DL, O’Shea SA, Paul AB, Rohatgi S, Saint-Hilaire MH, Sartor EA, Setty BN, Small JE, Swaminathan A, Taraschenko O, Yuan J, Zhou Y, Zhu S, Karjadi C, Ang TFA, Bargal SA, Plummer BA, Poston KL, Ahangaran M, Au R, Kolachalama VB. AI-based differential diagnosis of dementia etiologies on multimodal data. medRxiv 2024:2024.02.08.24302531. [PMID: 38585870 PMCID: PMC10996713 DOI: 10.1101/2024.02.08.24302531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
Differential diagnosis of dementia remains a challenge in neurology due to symptom overlap across etiologies, yet it is crucial for formulating early, personalized management strategies. Here, we present an AI model that harnesses a broad array of data, including demographics, individual and family medical history, medication use, neuropsychological assessments, functional evaluations, and multimodal neuroimaging, to identify the etiologies contributing to dementia in individuals. The study, drawing on 51,269 participants across 9 independent, geographically diverse datasets, facilitated the identification of 10 distinct dementia etiologies. It aligns diagnoses with similar management strategies, ensuring robust predictions even with incomplete data. Our model achieved a micro-averaged area under the receiver operating characteristic curve (AUROC) of 0.94 in classifying individuals with normal cognition, mild cognitive impairment and dementia. Also, the micro-averaged AUROC was 0.96 in differentiating the dementia etiologies. Our model demonstrated proficiency in addressing mixed dementia cases, with a mean AUROC of 0.78 for two co-occurring pathologies. In a randomly selected subset of 100 cases, the AUROC of neurologist assessments augmented by our AI model exceeded neurologist-only evaluations by 26.25%. Furthermore, our model predictions aligned with biomarker evidence and its associations with different proteinopathies were substantiated through postmortem findings. Our framework has the potential to be integrated as a screening tool for dementia in various clinical settings and drug trials, with promising implications for person-level management.
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Affiliation(s)
- Chonghua Xue
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Electrical & Computer Engineering, Boston University, MA, USA
| | - Sahana S. Kowshik
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Faculty of Computing & Data Sciences, Boston University, MA, USA
| | - Diala Lteif
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Computer Science, Boston University, MA, USA
| | - Shreyas Puducheri
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Varuna H. Jasodanand
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Olivia T. Zhou
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Anika S. Walia
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Osman B. Guney
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Electrical & Computer Engineering, Boston University, MA, USA
| | - J. Diana Zhang
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- School of Chemistry, University of New South Wales, Sydney, Australia
| | - Serena T. Pham
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Artem Kaliaev
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - V. Carlota Andreu-Arasa
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Brigid C. Dwyer
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Chad W. Farris
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Honglin Hao
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Sachin Kedar
- Departments of Neurology & Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Asim Z. Mian
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Daniel L. Murman
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sarah A. O’Shea
- Department of Neurology, Columbia University Irving Medical Center, New York, NY, USA
| | - Aaron B. Paul
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Saurabh Rohatgi
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | | | - Emmett A. Sartor
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Bindu N. Setty
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Juan E. Small
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | | | - Olga Taraschenko
- Department of Neurological Sciences, University of Nebraska Medical Center, Omaha, NE, USA
| | - Jing Yuan
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Zhou
- Department of Neurology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuhan Zhu
- Department of Neurology, Brigham & Women’s Hospital, Boston, MA, USA
| | - Cody Karjadi
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Ting Fang Alvin Ang
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Sarah A. Bargal
- Department of Computer Science, Georgetown University, Washington DC, USA
| | | | | | - Meysam Ahangaran
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Rhoda Au
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University Alzheimer’s Disease Research Center, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Faculty of Computing & Data Sciences, Boston University, MA, USA
- Department of Computer Science, Boston University, MA, USA
- Boston University Alzheimer’s Disease Research Center, Boston, MA, USA
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Bacon KL, Felson DT, Jafarzadeh SR, Kolachalama VB, Hausdorff JM, Gazit E, Stefanik JJ, Corrigan P, Segal NA, Lewis CE, Nevitt MC, Kumar D. Gait Alterations and Association With Worsening Knee Pain and Physical Function: A Machine Learning Approach With Wearable Sensors in the Multicenter Osteoarthritis Study. Arthritis Care Res (Hoboken) 2024. [PMID: 38523250 DOI: 10.1002/acr.25327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2023] [Revised: 01/23/2024] [Accepted: 03/21/2024] [Indexed: 03/26/2024]
Abstract
OBJECTIVE The objective of this study was to identify gait alterations related to worsening knee pain and worsening physical function, using machine learning approaches applied to wearable sensor-derived data from a large observational cohort. METHODS Participants in the Multicenter Osteoarthritis Study (MOST) completed a 20-m walk test wearing inertial sensors on their lower back and ankles. Parameters describing spatiotemporal features of gait were extracted from these data. We used an ensemble machine learning technique ("super learning") to optimally discriminate between those with and without worsening physical function and, separately, those with and without worsening pain over two years. We then used log-binomial regression to evaluate associations of the top 10 influential variables selected with super learning with each outcome. We also assessed whether the relation of altered gait with worsening function was mediated by changes in pain. RESULTS Of 2,324 participants, 29% and 24% had worsening knee pain and function over two years, respectively. From the super learner, several gait parameters were found to be influential for worsening pain and for worsening function. After adjusting for confounders, greater gait asymmetry, longer average step length, and lower dominant frequency were associated with worsening pain, and lower cadence was associated with worsening function. Worsening pain partially mediated the association of cadence with function. CONCLUSION We identified gait alterations associated with worsening knee pain and those associated with worsening physical function. These alterations could be assessed with wearable sensors in clinical settings. Further research should determine whether they might be therapeutic targets to prevent worsening pain and worsening function.
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Affiliation(s)
| | | | | | | | - Jeffrey M Hausdorff
- Tel Aviv University and Tel Aviv Sourasky Medical Center, Tel Aviv, Israel, and Rush University Medical Center, Chicago, Illinois
| | - Eran Gazit
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | | | | | - Neil A Segal
- University of Kansas Medical Center, Kansas City
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Surendran T, Park LK, Lauber MV, Cha B, Jhun RS, Capellini TD, Kumar D, Felson DT, Kolachalama VB. Survival analysis on subchondral bone length for total knee replacement. Skeletal Radiol 2024:10.1007/s00256-024-04627-1. [PMID: 38388702 DOI: 10.1007/s00256-024-04627-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Revised: 02/01/2024] [Accepted: 02/15/2024] [Indexed: 02/24/2024]
Abstract
OBJECTIVE Use subchondral bone length (SBL), a new MRI-derived measure that reflects the extent of cartilage loss and bone flattening, to predict the risk of progression to total knee replacement (TKR). METHODS We employed baseline MRI data from the Osteoarthritis Initiative (OAI), focusing on 760 men and 1214 women with bone marrow lesions (BMLs) and joint space narrowing (JSN) scores, to predict the progression to TKR. To minimize bias from analyzing both knees of a participant, only the knee with a higher Kellgren-Lawrence (KL) grade was considered, given its greater potential need for TKR. We utilized the Kaplan-Meier survival curves and Cox proportional hazards models, incorporating raw and normalized values of SBL, JSN, and BML as predictors. The study included subgroup analyses for different demographics and clinical characteristics, using models for raw and normalized SBL (merged, femoral, tibial), BML (merged, femoral, tibial), and JSN (medial and lateral compartments). Model performance was evaluated using the time-dependent area under the curve (AUC), Brier score, and Concordance index to gauge accuracy, calibration, and discriminatory power. Knee joint and region-level analyses were conducted to determine the effectiveness of SBL, JSN, and BML in predicting TKR risk. RESULTS The SBL model, incorporating data from both the femur and tibia, demonstrated a predictive capacity for TKR that closely matched the performance of the BML score and the JSN grade. The Concordance index of the SBL model was 0.764, closely mirroring the BML's 0.759 and slightly below JSN's 0.788. The Brier score for the SBL model stood at 0.069, showing comparability with BML's 0.073 and a minor difference from JSN's 0.067. Regarding the AUC, the SBL model achieved 0.803, nearly identical to BML's 0.802 and slightly lower than JSN's 0.827. CONCLUSION SBL's capacity to predict the risk of progression to TKR highlights its potential as an effective imaging biomarker for knee osteoarthritis.
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Affiliation(s)
- Tejus Surendran
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - Lisa K Park
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - Meagan V Lauber
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - Baekdong Cha
- Sargent College, Boston University, Boston, MA, USA
| | - Ray S Jhun
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - Terence D Capellini
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, USA
| | - Deepak Kumar
- Sargent College, Boston University, Boston, MA, USA
| | - David T Felson
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA.
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, MA, 02215, USA.
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Ding H, Kim M, Searls E, Sunderaraman P, De Anda-Duran I, Low S, Popp Z, Hwang PH, Li Z, Goyal K, Hathaway L, Monteverde J, Rahman S, Igwe A, Kolachalama VB, Au R, Lin H. Digital neuropsychological measures by defense automated neurocognitive assessment: reference values and clinical correlates. Front Neurol 2024; 15:1340710. [PMID: 38426173 PMCID: PMC10902432 DOI: 10.3389/fneur.2024.1340710] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2023] [Accepted: 01/29/2024] [Indexed: 03/02/2024] Open
Abstract
Introduction Although the growth of digital tools for cognitive health assessment, there's a lack of known reference values and clinical implications for these digital methods. This study aims to establish reference values for digital neuropsychological measures obtained through the smartphone-based cognitive assessment application, Defense Automated Neurocognitive Assessment (DANA), and to identify clinical risk factors associated with these measures. Methods The sample included 932 cognitively intact participants from the Framingham Heart Study, who completed at least one DANA task. Participants were stratified into subgroups based on sex and three age groups. Reference values were established for digital cognitive assessments within each age group, divided by sex, at the 2.5th, 25th, 50th, 75th, and 97.5th percentile thresholds. To validate these values, 57 cognitively intact participants from Boston University Alzheimer's Disease Research Center were included. Associations between 19 clinical risk factors and these digital neuropsychological measures were examined by a backward elimination strategy. Results Age- and sex-specific reference values were generated for three DANA tasks. Participants below 60 had median response times for the Go-No-Go task of 796 ms (men) and 823 ms (women), with age-related increases in both sexes. Validation cohort results mostly aligned with these references. Different tasks showed unique clinical correlations. For instance, response time in the Code Substitution task correlated positively with total cholesterol and diabetes, but negatively with high-density lipoprotein and low-density lipoprotein cholesterol levels, and triglycerides. Discussion This study established and validated reference values for digital neuropsychological measures of DANA in cognitively intact white participants, potentially improving their use in future clinical studies and practice.
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Affiliation(s)
- Huitong Ding
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Minzae Kim
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Edward Searls
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Preeti Sunderaraman
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Ileana De Anda-Duran
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, United States
| | - Spencer Low
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Zachary Popp
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Phillip H. Hwang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Zexu Li
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Kriti Goyal
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Lindsay Hathaway
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Jose Monteverde
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Salman Rahman
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Akwaugo Igwe
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Computer Science, Faculty of Computing & Data Sciences, Boston University, Boston, MA, United States
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Slone Epidemiology Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Honghuang Lin
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
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Ahangaran M, Sun E, Le K, Sun J, Wang WM, Tan TH, Burdine LJ, Dvanajscak Z, Cassol CA, Sharma S, Kolachalama VB. A web-based tool for real-time adequacy assessment of kidney biopsies. medRxiv 2024:2024.02.01.24302147. [PMID: 38370740 PMCID: PMC10871452 DOI: 10.1101/2024.02.01.24302147] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/20/2024]
Abstract
The escalating incidence of kidney biopsies providing insufficient tissue for diagnosis poses a dual challenge, straining the healthcare system and jeopardizing patients who may require rebiopsy or face the prospect of an inaccurate diagnosis due to an unsampled disease. Here, we introduce a web-based tool that can provide real-time, quantitative assessment of kidney biopsy adequacy directly from photographs taken with a smartphone camera. The software tool was developed using a deep learning-driven automated segmentation technique, trained on a dataset comprising nephropathologist-confirmed annotations of the kidney cortex on digital biopsy images. Our framework demonstrated favorable performance in segmenting the cortex via 5-fold cross-validation (Dice coefficient: 0.788±0.130) (n=100). Offering a bedside tool for kidney biopsy adequacy assessment has the potential to provide real-time guidance to the physicians performing medical kidney biopsies, reducing the necessity for re-biopsies. Our tool can be accessed through our web-based platform: http://www.biopsyadequacy.org.
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Affiliation(s)
- Meysam Ahangaran
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Emily Sun
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Khang Le
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Jiawei Sun
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - William M. Wang
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Tian Herng Tan
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Lyle J. Burdine
- Department of Surgery, University of Arkansas for Medical Sciences, Little Rock, AR, US
| | | | | | | | - Vijaya B. Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Computer Science, Boston University, Boston, MA, USA; Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA
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11
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De Anda‐Duran I, Sunderaraman P, Searls E, Moukaled S, Jin X, Popp Z, Karjadi C, Hwang PH, Ding H, Devine S, Shih LC, Low S, Lin H, Kolachalama VB, Bazzano L, Libon DJ, Au R. Comparing Cognitive Tests and Smartphone-Based Assessment in 2 US Community-Based Cohorts. J Am Heart Assoc 2024; 13:e032733. [PMID: 38226519 PMCID: PMC10926794 DOI: 10.1161/jaha.123.032733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Accepted: 12/04/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Smartphone-based cognitive assessments have emerged as promising tools, bridging gaps in accessibility and reducing bias in Alzheimer disease and related dementia research. However, their congruence with traditional neuropsychological tests and usefulness in diverse cohorts remain underexplored. METHODS AND RESULTS A total of 406 FHS (Framingham Heart Study) and 59 BHS (Bogalusa Heart Study) participants with traditional neuropsychological tests and digital assessments using the Defense Automated Neurocognitive Assessment (DANA) smartphone protocol were included. Regression models investigated associations between DANA task digital measures and a neuropsychological global cognitive Z score (Global Cognitive Score [GCS]), and neuropsychological domain-specific Z scores. FHS participants' mean age was 57 (SD, 9.75) years, and 44% (179) were men. BHS participants' mean age was 49 (4.4) years, and 28% (16) were men. Participants in both cohorts with the lowest neuropsychological performance (lowest quartile, GCS1) demonstrated lower DANA digital scores. In the FHS, GCS1 participants had slower average response times and decreased cognitive efficiency scores in all DANA tasks (P<0.05). In BHS, participants in GCS1 had slower average response times and decreased cognitive efficiency scores for DANA Code Substitution and Go/No-Go tasks, although this was not statistically significant. In both cohorts, GCS was significantly associated with DANA tasks, such that higher GCS correlated with faster average response times (P<0.05) and increased cognitive efficiency (all P<0.05) in the DANA Code Substitution task. CONCLUSIONS Our findings demonstrate that smartphone-based cognitive assessments exhibit concurrent validity with a composite measure of traditional neuropsychological tests. This supports the potential of using smartphone-based assessments in cognitive screening across diverse populations and the scalability of digital assessments to community-dwelling individuals.
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Affiliation(s)
- Ileana De Anda‐Duran
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Preeti Sunderaraman
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Edward Searls
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Shirine Moukaled
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Xuanyi Jin
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - Zachary Popp
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Cody Karjadi
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Phillip H. Hwang
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Huitong Ding
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Sherral Devine
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Ludy C. Shih
- Department of NeurologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Spencer Low
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Honghuang Lin
- University of Massachusetts Chan Medical SchoolWorcesterMAUSA
| | - Vijaya B. Kolachalama
- Department of MedicineBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Computer ScienceBoston UniversityBostonMAUSA
| | - Lydia Bazzano
- Department of EpidemiologyTulane University School of Public Health and Tropical MedicineNew OrleansLAUSA
| | - David J. Libon
- Department of PsychologyRowan UniversityMullica HillNJUSA
- New Jersey Institute of Successful AgingRowan University School of Osteopathic MedicineStratfordNJUSA
| | - Rhoda Au
- Framingham Heart StudyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy and NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
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12
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Sunderaraman P, De Anda‐Duran I, Karjadi C, Peterson J, Ding H, Devine SA, Shih LC, Popp Z, Low S, Hwang PH, Goyal K, Hathaway L, Monteverde J, Lin H, Kolachalama VB, Au R. Design and Feasibility Analysis of a Smartphone-Based Digital Cognitive Assessment Study in the Framingham Heart Study. J Am Heart Assoc 2024; 13:e031348. [PMID: 38226510 PMCID: PMC10926817 DOI: 10.1161/jaha.123.031348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 11/09/2023] [Indexed: 01/17/2024]
Abstract
BACKGROUND Smartphone-based digital technology is increasingly being recognized as a cost-effective, scalable, and noninvasive method of collecting longitudinal cognitive and behavioral data. Accordingly, a state-of-the-art 3-year longitudinal project focused on collecting multimodal digital data for early detection of cognitive impairment was developed. METHODS AND RESULTS A smartphone application collected 2 modalities of cognitive data, digital voice and screen-based behaviors, from the FHS (Framingham Heart Study) multigenerational Generation 2 (Gen 2) and Generation 3 (Gen 3) cohorts. To understand the feasibility of conducting a smartphone-based study, participants completed a series of questions about their smartphone and app use, as well as sensory and environmental factors that they encountered while completing the tasks on the app. Baseline data collected to date were from 537 participants (mean age=66.6 years, SD=7.0; 58.47% female). Across the younger participants from the Gen 3 cohort (n=455; mean age=60.8 years, SD=8.2; 59.12% female) and older participants from the Gen 2 cohort (n=82; mean age=74.2 years, SD=5.8; 54.88% female), an average of 76% participants agreed or strongly agreed that they felt confident about using the app, 77% on average agreed or strongly agreed that they were able to use the app on their own, and 81% on average rated the app as easy to use. CONCLUSIONS Based on participant ratings, the study findings are promising. At baseline, the majority of participants are able to complete the app-related tasks, follow the instructions, and encounter minimal barriers to completing the tasks independently. These data provide evidence that designing and collecting smartphone application data in an unsupervised, remote, and naturalistic setting in a large, community-based population is feasible.
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Affiliation(s)
- Preeti Sunderaraman
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Ileana De Anda‐Duran
- Department of EpidemiologyTulane University School of Public Health & Tropical MedicineNew OrleansLAUSA
| | - Cody Karjadi
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Julia Peterson
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Huitong Ding
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Sherral A. Devine
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Ludy C. Shih
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Zachary Popp
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Spencer Low
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Phillip H. Hwang
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Kriti Goyal
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Lindsay Hathaway
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Jose Monteverde
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Honghuang Lin
- Department of MedicineUniversity of Massachusetts Chan Medical SchoolWorcesterMAUSA
| | - Vijaya B. Kolachalama
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of MedicineBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of Computer Science and Faculty of Computing & Data SciencesBoston UniversityBostonMAUSA
| | - Rhoda Au
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research CenterBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
- Department of MedicineBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
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13
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Popp Z, Low S, Igwe A, Rahman MS, Kim M, Khan R, Oh E, Kumar A, De Anda‐Duran I, Ding H, Hwang PH, Sunderaraman P, Shih LC, Lin H, Kolachalama VB, Au R. Shifting From Active to Passive Monitoring of Alzheimer Disease: The State of the Research. J Am Heart Assoc 2024; 13:e031247. [PMID: 38226518 PMCID: PMC10926806 DOI: 10.1161/jaha.123.031247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2024]
Abstract
Most research using digital technologies builds on existing methods for staff-administered evaluation, requiring a large investment of time, effort, and resources. Widespread use of personal mobile devices provides opportunities for continuous health monitoring without active participant engagement. Home-based sensors show promise in evaluating behavioral features in near real time. Digital technologies across these methodologies can detect precise measures of cognition, mood, sleep, gait, speech, motor activity, behavior patterns, and additional features relevant to health. As a neurodegenerative condition with insidious onset, Alzheimer disease and other dementias (AD/D) represent a key target for advances in monitoring disease symptoms. Studies to date evaluating the predictive power of digital measures use inconsistent approaches to characterize these measures. Comparison between different digital collection methods supports the use of passive collection methods in settings in which active participant engagement approaches are not feasible. Additional studies that analyze how digital measures across multiple data streams can together improve prediction of cognitive impairment and early-stage AD are needed. Given the long timeline of progression from normal to diagnosis, digital monitoring will more easily make extended longitudinal follow-up possible. Through the American Heart Association-funded Strategically Focused Research Network, the Boston University investigative team deployed a platform involving a wide range of technologies to address these gaps in research practice. Much more research is needed to thoroughly evaluate limitations of passive monitoring. Multidisciplinary collaborations are needed to establish legal and ethical frameworks for ensuring passive monitoring can be conducted at scale while protecting privacy and security, especially in vulnerable populations.
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Affiliation(s)
- Zachary Popp
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Spencer Low
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Akwaugo Igwe
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Md Salman Rahman
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of MedicineBostonMAUSA
| | - Minzae Kim
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston UniversityBostonMAUSA
| | - Raiyan Khan
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston UniversityBostonMAUSA
| | - Emily Oh
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston UniversityBostonMAUSA
| | - Ankita Kumar
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston UniversityBostonMAUSA
| | - Ileana De Anda‐Duran
- Department of EpidemiologyTulane University School of Public Health & Tropical MedicineNew OrleansLAUSA
| | - Huitong Ding
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Phillip H. Hwang
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
| | - Preeti Sunderaraman
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Ludy C. Shih
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Honghuang Lin
- Department of MedicineUniversity of Massachusetts Chan Medical SchoolWorcesterMA
| | - Vijaya B. Kolachalama
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of MedicineBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
| | - Rhoda Au
- Department of Anatomy & NeurobiologyBoston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of MedicineBostonMAUSA
- Department of EpidemiologyBoston University School of Public HealthBostonMAUSA
- Framingham Heart StudyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of NeurologyBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
- Department of MedicineBoston University Chobanian & Avedisian School of Medicine School of MedicineBostonMAUSA
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14
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Romano MF, Shih LC, Paschalidis IC, Au R, Kolachalama VB. Large Language Models in Neurology Research and Future Practice. Neurology 2023; 101:1058-1067. [PMID: 37816646 PMCID: PMC10752640 DOI: 10.1212/wnl.0000000000207967] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 09/06/2023] [Indexed: 10/12/2023] Open
Abstract
Recent advancements in generative artificial intelligence, particularly using large language models (LLMs), are gaining increased public attention. We provide a perspective on the potential of LLMs to analyze enormous amounts of data from medical records and gain insights on specific topics in neurology. In addition, we explore use cases for LLMs, such as early diagnosis, supporting patient and caregivers, and acting as an assistant for clinicians. We point to the potential ethical and technical challenges raised by LLMs, such as concerns about privacy and data security, potential biases in the data for model training, and the need for careful validation of results. Researchers must consider these challenges and take steps to address them to ensure that their work is conducted in a safe and responsible manner. Despite these challenges, LLMs offer promising opportunities for improving care and treatment of various neurologic disorders.
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Affiliation(s)
- Michael F Romano
- From the Department of Medicine (M.F.R., R.A., V.B.K.), Boston University Chobanian & Avedisian School of Medicine, MA; Department of Radiology and Biomedical Imaging (M.F.R.), University of California, San Francisco; Department of Neurology (L.C.S., R.A.), Boston University Chobanian & Avedisian School of Medicine; Department of Electrical and Computer Engineering (I.C.P.), Division of Systems Engineering, and Department of Biomedical Engineering; Faculty of Computing and Data Sciences (I.C.P., V.B.K.), Boston University; Department of Anatomy and Neurobiology (R.A.); The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine; Department of Epidemiology, Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (R.A.); and Department of Computer Science (V.B.K.), Boston University, MA
| | - Ludy C Shih
- From the Department of Medicine (M.F.R., R.A., V.B.K.), Boston University Chobanian & Avedisian School of Medicine, MA; Department of Radiology and Biomedical Imaging (M.F.R.), University of California, San Francisco; Department of Neurology (L.C.S., R.A.), Boston University Chobanian & Avedisian School of Medicine; Department of Electrical and Computer Engineering (I.C.P.), Division of Systems Engineering, and Department of Biomedical Engineering; Faculty of Computing and Data Sciences (I.C.P., V.B.K.), Boston University; Department of Anatomy and Neurobiology (R.A.); The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine; Department of Epidemiology, Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (R.A.); and Department of Computer Science (V.B.K.), Boston University, MA
| | - Ioannis C Paschalidis
- From the Department of Medicine (M.F.R., R.A., V.B.K.), Boston University Chobanian & Avedisian School of Medicine, MA; Department of Radiology and Biomedical Imaging (M.F.R.), University of California, San Francisco; Department of Neurology (L.C.S., R.A.), Boston University Chobanian & Avedisian School of Medicine; Department of Electrical and Computer Engineering (I.C.P.), Division of Systems Engineering, and Department of Biomedical Engineering; Faculty of Computing and Data Sciences (I.C.P., V.B.K.), Boston University; Department of Anatomy and Neurobiology (R.A.); The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine; Department of Epidemiology, Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (R.A.); and Department of Computer Science (V.B.K.), Boston University, MA
| | - Rhoda Au
- From the Department of Medicine (M.F.R., R.A., V.B.K.), Boston University Chobanian & Avedisian School of Medicine, MA; Department of Radiology and Biomedical Imaging (M.F.R.), University of California, San Francisco; Department of Neurology (L.C.S., R.A.), Boston University Chobanian & Avedisian School of Medicine; Department of Electrical and Computer Engineering (I.C.P.), Division of Systems Engineering, and Department of Biomedical Engineering; Faculty of Computing and Data Sciences (I.C.P., V.B.K.), Boston University; Department of Anatomy and Neurobiology (R.A.); The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine; Department of Epidemiology, Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (R.A.); and Department of Computer Science (V.B.K.), Boston University, MA
| | - Vijaya B Kolachalama
- From the Department of Medicine (M.F.R., R.A., V.B.K.), Boston University Chobanian & Avedisian School of Medicine, MA; Department of Radiology and Biomedical Imaging (M.F.R.), University of California, San Francisco; Department of Neurology (L.C.S., R.A.), Boston University Chobanian & Avedisian School of Medicine; Department of Electrical and Computer Engineering (I.C.P.), Division of Systems Engineering, and Department of Biomedical Engineering; Faculty of Computing and Data Sciences (I.C.P., V.B.K.), Boston University; Department of Anatomy and Neurobiology (R.A.); The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine; Department of Epidemiology, Boston University School of Public Health; Boston University Alzheimer's Disease Research Center (R.A.); and Department of Computer Science (V.B.K.), Boston University, MA.
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15
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Shazly T, Uline M, Webb C, Pederson B, Eberth JF, Kolachalama VB. Novel Payloads to Mitigate Maladaptive Inward Arterial Remodeling in Drug-Coated Balloon Therapy. J Biomech Eng 2023; 145:121004. [PMID: 37542712 PMCID: PMC10578076 DOI: 10.1115/1.4063122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Revised: 08/03/2023] [Accepted: 08/03/2023] [Indexed: 08/07/2023]
Abstract
Drug-coated balloon therapy is a minimally invasive endovascular approach to treat obstructive arterial disease, with increasing utilization in the peripheral circulation due to improved outcomes as compared to alternative interventional modalities. Broader clinical use of drug-coated balloons is limited by an incomplete understanding of device- and patient-specific determinants of treatment efficacy, including late outcomes that are mediated by postinterventional maladaptive inward arterial remodeling. To address this knowledge gap, we propose a predictive mathematical model of pressure-mediated femoral artery remodeling following drug-coated balloon deployment, with account of drug-based modulation of resident vascular cell phenotype and common patient comorbidities, namely, hypertension and endothelial cell dysfunction. Our results elucidate how postinterventional arterial remodeling outcomes are altered by the delivery of a traditional anti-proliferative drug, as well as by codelivery with an anti-contractile drug. Our findings suggest that codelivery of anti-proliferative and anti-contractile drugs could improve patient outcomes following drug-coated balloon therapy, motivating further consideration of novel payloads in next-generation devices.
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Affiliation(s)
- Tarek Shazly
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; College of Engineering and Computing, Department of Mechanical Engineering, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208
| | - Mark Uline
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208; College of Engineering and Computing, Department of Chemical Engineering, University of South Carolina, Columbia, SC 29208
| | - Clinton Webb
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208; Cardiovascular Translational Research Center, University of South Carolina, Columbia, SC 29208; School of Medicine, Department of Cell Biology and Anatomy, University of South Carolina, Columbia, SC 29208
| | - Breanna Pederson
- College of Engineering and Computing, Biomedical Engineering Program, University of South Carolina, Columbia, SC 29208
| | - John F. Eberth
- Biomedical Engineering, Science and Health Systems, Drexel University, Philadelphia, PA 19104
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118; Department of Computer Science and Faculty of Computing and Data Sciences, Boston University, Boston, MA 02115
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16
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Lteif D, Sreerama S, Bargal SA, Plummer BA, Au R, Kolachalama VB. Disease-driven domain generalization for neuroimaging-based assessment of Alzheimer's disease. medRxiv 2023:2023.09.22.23295984. [PMID: 37808872 PMCID: PMC10557812 DOI: 10.1101/2023.09.22.23295984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/10/2023]
Abstract
Development of deep learning models to assess the degree of cognitive impairment on magnetic resonance imaging (MRI) scans has high translational significance. Performance of such models is often affected by potential variabilities stemming from independent protocols for data generation, imaging equipment, radiology artifacts, and demographic distributional shifts. Domain generalization (DG) frameworks have the potential to overcome these issues by learning signal from one or more source domains that can be transferable to unseen target domains. We developed an approach that leverages model interpretability as a means to improve generalizability of classification models across multiple cohorts. Using MRI scans and clinical diagnosis obtained from four independent cohorts (Alzheimer's Disease Neuroimaging Initiative (ADNI, n = 1,821), the Framingham Heart Study (FHS, n = 304), the Australian Imaging Biomarkers and Lifestyle Study of Ageing (AIBL, n = 661), and the National Alzheimer's Coordinating Center (NACC, n = 4,647)), we trained a deep neural network that used model-identified regions of disease relevance to inform model training. We trained a classifier to distinguish persons with normal cognition (NC) from those with mild cognitive impairment (MCI) and Alzheimer's disease (AD) by aligning class-wise attention with a unified visual saliency prior computed offline per class over all training data. Our proposed method competes with state-of-the-art methods with improved correlation with postmortem histology, thus grounding our findings with gold standard evidence and paving a way towards validating DG frameworks.
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Affiliation(s)
- Diala Lteif
- Department of Computer Science, Boston University, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Sandeep Sreerama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Sarah A Bargal
- Department of Computer Science, Georgetown University, Washington, DC, USA
| | - Bryan A Plummer
- Department of Computer Science, Boston University, Boston, MA, USA
| | - Rhoda Au
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Anatomy & Neurobiology and Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA; Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA; the Framingham Heart Study, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center, Boston, MA, USA
| | - Vijaya B Kolachalama
- Department of Computer Science, Boston University, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center, Boston, MA, USA
- Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA
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17
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Romano MF, Zhou X, Balachandra AR, Jadick MF, Qiu S, Nijhawan DA, Joshi PS, Mohammad S, Lee PH, Smith MJ, Paul AB, Mian AZ, Small JE, Chin SP, Au R, Kolachalama VB. Deep learning for risk-based stratification of cognitively impaired individuals. iScience 2023; 26:107522. [PMID: 37646016 PMCID: PMC10460987 DOI: 10.1016/j.isci.2023.107522] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 07/19/2023] [Accepted: 07/28/2023] [Indexed: 09/01/2023] Open
Abstract
Quantifying the risk of progression to Alzheimer's disease (AD) could help identify persons who could benefit from early interventions. We used data from the Alzheimer's Disease Neuroimaging Initiative (ADNI, n = 544, discovery cohort) and the National Alzheimer's Coordinating Center (NACC, n = 508, validation cohort), subdividing individuals with mild cognitive impairment (MCI) into risk groups based on cerebrospinal fluid amyloid-β levels and identifying differential gray matter patterns. We then created models that fused neural networks with survival analysis, trained using non-parcellated T1-weighted brain MRIs from ADNI data, to predict the trajectories of MCI to AD conversion within the NACC cohort (integrated Brier score: 0.192 [discovery], and 0.108 [validation]). Using modern interpretability techniques, we verified that regions important for model prediction are classically associated with AD. We confirmed AD diagnosis labels using postmortem data. We conclude that our framework provides a strategy for risk-based stratification of individuals with MCI and for identifying regions key for disease prognosis.
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Affiliation(s)
- Michael F. Romano
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Radiology and Biomedical Imaging, University of California, San Francisco, San Francisco, CA, USA
| | - Xiao Zhou
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Computer Science, Boston University, Boston, MA, USA
| | - Akshara R. Balachandra
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Medicine, Stanford University School of Medicine, Stanford, CA, USA
| | - Michalina F. Jadick
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Shangran Qiu
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Diya A. Nijhawan
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Prajakta S. Joshi
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of General Dentistry, Boston University School of Dental Medicine, Boston, MA, USA
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Shariq Mohammad
- Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA
| | - Peter H. Lee
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Maximilian J. Smith
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Aaron B. Paul
- Department of Radiology, Massachusetts General Hospital, Boston, MA, USA
| | - Asim Z. Mian
- Department of Radiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Juan E. Small
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Sang P. Chin
- Department of Computer Science, Boston University, Boston, MA, USA
- Department of Brain and Cognitive Sciences, Massachusetts Institute of Technology, Cambridge, MA, USA
- Center of Mathematical Sciences & Applications, Harvard University, Cambridge, MA, USA
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Boston University Alzheimer’s Disease Research Center, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Computer Science, Boston University, Boston, MA, USA
- Boston University Alzheimer’s Disease Research Center, Boston, MA, USA
- Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA
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18
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Idrees N, Haroon S, Zhang Y, Mangio JC, Siracuse JJ, Francis JM, Ganguli S, Daly K, Diamond M, Vilvendhan R, Cabral H, Dember LM, Farber A, Kolachalama VB, Chitalia VC. Contrast Venography Versus Intravenous Ultrasound in Hemodialysis Arteriovenous Access Dysfunction. Kidney Int Rep 2023; 8:1887-1891. [PMID: 37705907 PMCID: PMC10496077 DOI: 10.1016/j.ekir.2023.06.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 05/16/2023] [Accepted: 06/12/2023] [Indexed: 09/15/2023] Open
Affiliation(s)
- Najia Idrees
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Veterans Affairs Boston Healthcare System, Boston MA 02118, USA
| | - Samir Haroon
- Section of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Yichi Zhang
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
| | - Joanna Crisa Mangio
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jeffrey J. Siracuse
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Jean M. Francis
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Suvranu Ganguli
- Section of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Kevin Daly
- Section of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Matthew Diamond
- Section of Interventional Radiology, Department of Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Rajendran Vilvendhan
- Department of Radiology, Interventional Radiology, Lahey Hospital and Medical Center, Beth Israel Lahey Health, Harvard Medical School, Boston, Massachusetts, USA
| | - Howard Cabral
- Department of Biostatistics, School of Public Health, Boston University, Boston, Massachusetts, USA
| | - Laura M. Dember
- Renal-Electrolyte and Hypertension Division, Department of Medicine; Center for Clinical Epidemiology and Biostatistics; and Department of Biostatistics, Epidemiology and Informatics; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Alik Farber
- Division of Vascular and Endovascular Surgery, Department of Surgery, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Vijaya B. Kolachalama
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, Massachusetts, USA
| | - Vipul C. Chitalia
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Veterans Affairs Boston Healthcare System, Boston MA 02118, USA
- Boston University Chobanian & Avedisian School of Medicine, Boston, MA 02118, USA
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19
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Costello KE, Felson DT, Jafarzadeh SR, Guermazi A, Roemer FW, Segal NA, Lewis CE, Nevitt MC, Lewis CL, Kolachalama VB, Kumar D. Gait, physical activity and tibiofemoral cartilage damage: a longitudinal machine learning analysis in the Multicenter Osteoarthritis Study. Br J Sports Med 2023; 57:1018-1024. [PMID: 36868795 PMCID: PMC10423491 DOI: 10.1136/bjsports-2022-106142] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/20/2023] [Indexed: 03/05/2023]
Abstract
OBJECTIVE To (1) develop and evaluate a machine learning model incorporating gait and physical activity to predict medial tibiofemoral cartilage worsening over 2 years in individuals without advanced knee osteoarthritis and (2) identify influential predictors in the model and quantify their effect on cartilage worsening. DESIGN An ensemble machine learning model was developed to predict worsened cartilage MRI Osteoarthritis Knee Score at follow-up from gait, physical activity, clinical and demographic data from the Multicenter Osteoarthritis Study. Model performance was evaluated in repeated cross-validations. The top 10 predictors of the outcome across 100 held-out test sets were identified by a variable importance measure. Their effect on the outcome was quantified by g-computation. RESULTS Of 947 legs in the analysis, 14% experienced medial cartilage worsening at follow-up. The median (2.5-97.5th percentile) area under the receiver operating characteristic curve across the 100 held-out test sets was 0.73 (0.65-0.79). Baseline cartilage damage, higher Kellgren-Lawrence grade, greater pain during walking, higher lateral ground reaction force impulse, greater time spent lying and lower vertical ground reaction force unloading rate were associated with greater risk of cartilage worsening. Similar results were found for the subset of knees with baseline cartilage damage. CONCLUSIONS A machine learning approach incorporating gait, physical activity and clinical/demographic features showed good performance for predicting cartilage worsening over 2 years. While identifying potential intervention targets from the model is challenging, lateral ground reaction force impulse, time spent lying and vertical ground reaction force unloading rate should be investigated further as potential early intervention targets to reduce medial tibiofemoral cartilage worsening.
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Affiliation(s)
- Kerry E Costello
- Mechanical and Aerospace Engineering, University of Florida, Gainesville, Florida, USA
- Physical Therapy, Boston University, Boston, Massachusetts, USA
- Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - David T Felson
- Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - S Reza Jafarzadeh
- Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Ali Guermazi
- Radiology, VA Boston Healthcare System, West Roxbury, Massachusetts, USA
| | - Frank W Roemer
- Radiology, Universitatsklinikum Erlangen, Erlangen, Germany
- Radiology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Neil A Segal
- Rehabilitation Medicine, The University of Kansas Medical Center, Kansas City, Kansas, USA
- Epidemiology, The University of Iowa, Iowa City, Iowa, USA
| | - Cora E Lewis
- Epidemiology, The University of Alabama, Birmingham, Alabama, USA
| | - Michael C Nevitt
- Epidemiology & Biostatistics, University of California, San Francisco, California, USA
| | - Cara L Lewis
- Physical Therapy, Boston University, Boston, Massachusetts, USA
- Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Vijaya B Kolachalama
- Computational Biomedicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Computer Science, Boston University, Boston, Massachusetts, USA
| | - Deepak Kumar
- Physical Therapy, Boston University, Boston, Massachusetts, USA
- Rheumatology, Boston University School of Medicine, Boston, Massachusetts, USA
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20
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Abstract
We reviewed foundational concepts in artificial intelligence (AI) and machine learning (ML) and discussed ways in which these methodologies may be employed to enhance progress in clinical trials and research, with particular attention to applications in the design, conduct, and interpretation of clinical trials for neurologic diseases. We discussed ways in which ML may help to accelerate the pace of subject recruitment, provide realistic simulation of medical interventions, and enhance remote trial administration via novel digital biomarkers and therapeutics. Lastly, we provide a brief overview of the technical, administrative, and regulatory challenges that must be addressed as ML achieves greater integration into clinical trial workflows.
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Affiliation(s)
- Matthew I Miller
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - Ludy C Shih
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, 02118, USA
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA.
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, MA, 02115, USA.
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21
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Zhang JD, Xue C, Kolachalama VB, Donald WA. Interpretable Machine Learning on Metabolomics Data Reveals Biomarkers for Parkinson's Disease. ACS Cent Sci 2023; 9:1035-1045. [PMID: 37252351 PMCID: PMC10214508 DOI: 10.1021/acscentsci.2c01468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Indexed: 05/31/2023]
Abstract
The use of machine learning (ML) with metabolomics provides opportunities for the early diagnosis of disease. However, the accuracy of ML and extent of information obtained from metabolomics can be limited owing to challenges associated with interpreting disease prediction models and analyzing many chemical features with abundances that are correlated and "noisy". Here, we report an interpretable neural network (NN) framework to accurately predict disease and identify significant biomarkers using whole metabolomics data sets without a priori feature selection. The performance of the NN approach for predicting Parkinson's disease (PD) from blood plasma metabolomics data is significantly higher than other ML methods with a mean area under the curve of >0.995. PD-specific markers that predate clinical PD diagnosis and contribute significantly to early disease prediction were identified including an exogenous polyfluoroalkyl substance. It is anticipated that this accurate and interpretable NN-based approach can improve diagnostic performance for many diseases using metabolomics and other untargeted 'omics methods.
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Affiliation(s)
- J. Diana Zhang
- School
of Chemistry, University of New South Wales, Sydney 2052, Australia
- Department
of Medicine, Boston University School of
Medicine, Boston, Massachusetts 02118, United States
| | - Chonghua Xue
- Department
of Medicine, Boston University School of
Medicine, Boston, Massachusetts 02118, United States
| | - Vijaya B. Kolachalama
- Department
of Medicine, Boston University School of
Medicine, Boston, Massachusetts 02118, United States
- Department
of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, Massachusetts 02215, United States
| | - William A. Donald
- School
of Chemistry, University of New South Wales, Sydney 2052, Australia
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22
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Tseng AE, Carossino M, Gertje HP, O'Connell AK, Gummuluru S, Kolachalama VB, Balasuriya UBR, Connor JH, Bennett RS, Liu DX, Hensley LE, Crossland NA. Hepatic proinflammatory myeloid phenotypes are a hallmark of Ebola virus Kikwit pathogenesis in rhesus monkeys. Vet Pathol 2023:3009858231171906. [PMID: 37170900 DOI: 10.1177/03009858231171906] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/13/2023]
Abstract
The liver is an early systemic target of Ebola virus (EBOV), but characterization beyond routine histopathology and viral antigen distribution is limited. We hypothesized Ebola virus disease (EVD) systemic proinflammatory responses would be reflected in temporally altered liver myeloid phenotypes. We utilized multiplex fluorescent immunohistochemistry (mfIHC), multispectral whole slide imaging, and image analysis to quantify molecular phenotypes of myeloid cells in the liver of rhesus macaques (Macaca mulatta; n = 21) infected with EBOV Kikwit. Liver samples included uninfected controls (n = 3), 3 days postinoculation (DPI; n = 3), 4 DPI (n = 3), 5 DPI (n = 3), 6 DPI (n = 3), and terminal disease (6-8 DPI; n = 6). Alterations in hepatic macrophages occurred at ≥ 5 DPI characterized by a 1.4-fold increase in CD68+ immunoreactivity and a transition from primarily CD14-CD16+ to CD14+CD16- macrophages, with a 2.1-fold decrease in CD163 expression in terminal animals compared with uninfected controls. An increase in the neutrophil chemoattractant and alarmin S100A9 occurred within hepatic myeloid cells at 5 DPI, followed by rapid neutrophil influx at ≥ 6 DPI. An acute rise in the antiviral myxovirus resistance protein 1 (MxA) occurred at ≥ 4 DPI, with a predilection for enhanced expression in uninfected cells. Distinctive expression of major histocompatibility complex (MHC) class II was observed in hepatocytes during terminal disease. Results illustrate that EBOV causes macrophage phenotype alterations as well as neutrophil influx and prominent activation of interferon host responses in the liver. Results offer insight into potential therapeutic strategies to prevent and/or modulate the host proinflammatory response to normalize hepatic myeloid functionality.
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Affiliation(s)
- Anna E Tseng
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- National Emerging Infectious Diseases Laboratories, NEIDL Comparative Pathology Laboratory, Boston University, Boston, MA, USA
| | - Mariano Carossino
- Louisiana Animal Disease Diagnostic Laboratory (LADDL), Louisiana State University, Baton Rouge, LA, USA
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - Hans P Gertje
- National Emerging Infectious Diseases Laboratories, NEIDL Comparative Pathology Laboratory, Boston University, Boston, MA, USA
| | - Aoife K O'Connell
- National Emerging Infectious Diseases Laboratories, NEIDL Comparative Pathology Laboratory, Boston University, Boston, MA, USA
| | - Suryaram Gummuluru
- National Emerging Infectious Diseases Laboratories, NEIDL Comparative Pathology Laboratory, Boston University, Boston, MA, USA
- Department of Microbiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Computer Science, Boston University, Boston, MA, USA
| | - Udeni B R Balasuriya
- Louisiana Animal Disease Diagnostic Laboratory (LADDL), Louisiana State University, Baton Rouge, LA, USA
- Department of Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA
| | - John H Connor
- National Emerging Infectious Diseases Laboratories, NEIDL Comparative Pathology Laboratory, Boston University, Boston, MA, USA
- Department of Microbiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Richard S Bennett
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland, USA
| | - David X Liu
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland, USA
| | - Lisa E Hensley
- Integrated Research Facility, National Institute for Allergy and Infectious Diseases (NIAID), Frederick, Maryland, USA
| | - Nicholas A Crossland
- Department of Pathology and Laboratory Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- National Emerging Infectious Diseases Laboratories, NEIDL Comparative Pathology Laboratory, Boston University, Boston, MA, USA
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23
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Anda-Duran ID, Hwang PH, Popp ZT, Low S, Ding H, Rahman S, Igwe A, Kolachalama VB, Lin H, Au R. Matching science to reality: how to deploy a participant-driven digital brain health platform. Front Dement 2023; 2:1135451. [PMID: 38706716 PMCID: PMC11067045 DOI: 10.3389/frdem.2023.1135451] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/07/2024]
Abstract
Introduction Advances in digital technologies for health research enable opportunities for digital phenotyping of individuals in research and clinical settings. Beyond providing opportunities for advanced data analytics with data science and machine learning approaches, digital technologies offer solutions to several of the existing barriers in research practice that have resulted in biased samples. Methods A participant-driven, precision brain health monitoring digital platform has been introduced to two longitudinal cohort studies, the Boston University Alzheimer's Disease Research Center (BU ADRC) and the Bogalusa Heart Study (BHS). The platform was developed with prioritization of digital data in native format, multiple OS, validity of derived metrics, feasibility and usability. A platform including nine remote technologies and three staff-guided digital assessments has been introduced in the BU ADRC population, including a multimodal smartphone application also introduced to the BHS population. Participants select which technologies they would like to use and can manipulate their personal platform and schedule over time. Results Participants from the BU ADRC are using an average of 5.9 technologies to date, providing strong evidence for the usability of numerous digital technologies in older adult populations. Broad phenotyping of both cohorts is ongoing, with the collection of data spanning cognitive testing, sleep, physical activity, speech, motor activity, cardiovascular health, mood, gait, balance, and more. Several challenges in digital phenotyping implementation in the BU ADRC and the BHS have arisen, and the protocol has been revised and optimized to minimize participant burden while sustaining participant contact and support. Discussion The importance of digital data in its native format, near real-time data access, passive participant engagement, and availability of technologies across OS has been supported by the pattern of participant technology use and adherence across cohorts. The precision brain health monitoring platform will be iteratively adjusted and improved over time. The pragmatic study design enables multimodal digital phenotyping of distinct clinically characterized cohorts in both rural and urban U.S. settings.
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Affiliation(s)
- Ileana De Anda-Duran
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, United States
| | - Phillip H. Hwang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
| | - Zachary Thomas Popp
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Spencer Low
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Huitong Ding
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Salman Rahman
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Akwaugo Igwe
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
| | - Vijaya B. Kolachalama
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, MA, United States
| | - Honghuang Lin
- Department of Medicine, University of Massachusetts Chan Medical School, Worcester, MA, United States
| | - Rhoda Au
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
- Department of Anatomy and Neurobiology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Boston University Alzheimer’s Disease Research Center, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
- Department of Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, United States
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De Anda-Duran I, Carmichael O, Kolachalama VB, Fernandez C, Au R, Libon D, Bazzano LA. Abstract MP03: Adiponectin Levels in Young Adulthood and the Association With Midlife Cognition: The Bogalusa Heart Study. Circulation 2023. [DOI: 10.1161/circ.147.suppl_1.mp03] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
Abstract
Objective:
Adiponectin (ApN), has anti-inflammatory and anti-atherogenic properties. Low levels of ApN are found even after normalization of glucose in patients with diabetes, and are implicated in atherosclerosis, and dementia onset but results vary across the lifespan. We assessed the relation of ApN levels in young adulthood, with midlife atherosclerosis, measured by carotid intima media thickness (cIMT), and with cognitive function among Black and White individuals from the Bogalusa Heart Study (BHS).
Methods:
A total of 604 participants from the BHS, a community cohort in rural Louisiana, were examined for ApN levels with lowest quartile of ApN levels (<5.4 μg/mL) defined as low-ApN. Structural equation models assessed mediation via the temporal association of low-ApN (age 36±4) with midlife (age 49±5) cIMT, dichotomized above the 50
th
percentile (>0.88mm), and a global cognitive score(GCS) standardized for age, race and sex. Adjusted models included education attendance.
Results:
Individuals with low-ApN were more likely men [ 56.2% (77), p<0.001] and White [54.7% (75), p<0.001]. No differences in education were found. There was a direct association between low-ApN and GCS (P=0.025), low-ApN and cIMT ≥ 50
th
(P=0.001), and cIMT ≥ 50
th
and GCS (P=0.002). (
Figure1)
In mediation analysis, the ratio of Indirect effect/Total effect was 0.108, indicating that ~11% of the effect of low-ApN on GCS was mediated by cIMT. Education was not associated with low-ApN.
Conclusion:
Low-ApN levels in early adulthood was associated with poor cognition after ~10 years of follow-up, and the association was partially mediated by subclinical atherosclerosis. This suggests that ApN may play a role in neurodegeneration mechanisms and contribute to the development of dementia, underscoring the importance of addressing cardiometabolic influences earlier in the lifespan to prevent/delay cognitive decline.
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Affiliation(s)
| | | | | | | | - Rhoda Au
- Boston Univ, Sch of Medicine, Boston, MA
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25
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Zhang M, Lotfollahzadeh S, Elzinad N, Yang X, Elsadawi M, Gower A, Belghasem M, Shazly T, Kolachalama VB, Chitalia V. Alleviating iatrogenic effects of paclitaxel via anti-inflammatory treatment. Res Sq 2023:rs.3.rs-2487922. [PMID: 36778300 PMCID: PMC9915804 DOI: 10.21203/rs.3.rs-2487922/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
Background Paclitaxel is touted as an essential medicine due to its extensive use as a chemotherapeutic for various cancers and an antiproliferative agent for restenosis. Due to recent concerns related to long-term mortality, paclitaxel (PTX)-based endovascular therapy is now surrounded by controversies. Objective Examine the inflammatory mediators driven by the systemic administration of PTX and explore the means to suppress these effects. Methods RNAseq analysis, cell and mouse models. Results RNAseq analysis of primary human endothelial cells (ECs) treated with PTX demonstrated transcriptional perturbations of a set of pro-inflammatory mediators, including monocyte chemoattractant protein-1 (MCP-1) and CD137, which were validated in EC lysates. These perturbations were abrogated with dexamethasone, a prototypic anti-inflammatory compound. The media of ECs pre-treated with PTX showed a significant increase in MCP-1 levels, which were reverted to baseline levels with DEX treatment. A group of mice harvested at different time points after PTX injection were analyzed for immediate and delayed effects of PTX. A 3-fold increase in MCP-1 was noted in blood and aortic ECs after 12 hours of PTX treatment. Similar changes in CD137 and downstream mediators such as tissue factor, VCAM-1 and E-selectin were noted in aortic ECs. Conclusions Our study shows that systemic PTX exposure upregulates atherothrombotic markers, and co-delivery of DEX can subdue the untoward toxic effects. Long-term studies are needed to probe the mechanisms driving systemic complications of PTX-based therapies and evaluate the clinical potential of DEX to mitigate risk.
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26
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Shazly T, Torres WM, Secemsky EA, Chitalia VC, Jaffer FA, Kolachalama VB. Understudied factors in drug-coated balloon design and evaluation: A biophysical perspective. Bioeng Transl Med 2023; 8:e10370. [PMID: 36684110 PMCID: PMC9842065 DOI: 10.1002/btm2.10370] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 05/28/2022] [Accepted: 06/12/2022] [Indexed: 01/25/2023] Open
Abstract
Drug-coated balloon (DCB) percutaneous interventional therapy allows for durable reopening of the narrowed lumen via physical tissue expansion and local anti-restenosis drug delivery, providing an alternative to traditional uncoated balloons or a permanent indwelling implant such as a conventional metallic drug-eluting stent. While DCB-based treatment of peripheral arterial disease (PAD) has been incorporated into clinical guidelines, DCB use has been recently curtailed due to reports that showed evidence of increased mortality risk in patients treated with paclitaxel (PTX)-coated balloons. Given the United States Food and Drug Administration's 2019 consequent warning regarding PTX-eluting DCBs and the subsequent marked reduction in clinical DCB use, there is now a critical need to better understand the compositional and mechanical factors underlying DCB efficacy and safety. Most work to date on DCB refinement has focused on designing both the enabling balloon catheter and alternate coatings composed of various drugs and excipients, followed by device evaluation in preclinical and clinical studies. We contend that improvement in DCB performance will require a better understanding of the biophysical factors operative during and following balloon deployment, and moreover that the elaboration and demonstrated control of these factors are needed to address current concerns with DCB use. This article provides a perspective on the biophysical interactions that govern DCB performance and offers new design strategies for the development of next-generation DCB devices.
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Affiliation(s)
- Tarek Shazly
- College of Engineering & ComputingUniversity of South CarolinaColumbiaSouth CarolinaUSA
| | - William M. Torres
- College of Engineering & ComputingUniversity of South CarolinaColumbiaSouth CarolinaUSA
- Exponent Inc.PhiladelphiaPennsylvaniaUSA
| | - Eric A. Secemsky
- Smith Center for Outcomes Research in CardiologyBeth Israel Deaconess Medical CenterBostonMassachusettsUSA
| | - Vipul C. Chitalia
- Department of Medicine, Boston University School of MedicineBoston Veterans Affairs Healthcare SystemBostonMassachusettsUSA
| | - Farouc A. Jaffer
- Cardiovascular Research Center and Cardiology DivisionMassachusetts General HospitalBostonMassachusettsUSA
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University School of Medicine; Department of Computer Science and Faculty of Computing & Data SciencesBoston UniversityBostonMassachusettsUSA
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27
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Anda-Duran ID, Kolachalama VB, Carmichael OT, Hwang PH, Fernandez C, Au R, Bazzano LA, Libon DJ. Midlife Neuropsychological Profiles and Associated Vascular Risk: The Bogalusa Heart Study. J Alzheimers Dis 2023; 94:101-113. [PMID: 37212094 PMCID: PMC10443183 DOI: 10.3233/jad-220931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/23/2023]
Abstract
BACKGROUND Individuals with Alzheimer's disease (AD) often present with coexisting vascular pathology that is expressed to different degrees and can lead to clinical heterogeneity. OBJECTIVE To examine the utility of unsupervised statistical clustering approaches in identifying neuropsychological (NP) test performance subtypes that closely correlate with carotid intima-media thickness (cIMT) in midlife. METHODS A hierarchical agglomerative and k-means clustering analysis based on NP scores (standardized for age, sex, and race) was conducted among 1,203 participants (age 48±5.3 years) from the Bogalusa Heart Study. Regression models assessed the association between cIMT ≥50th percentile and NP profiles, and global cognitive score (GCS) tertiles for sensitivity analysis. RESULTS Three NP profiles were identified: Mixed-low performance [16%, n = 192], scores ≥1 SD below the mean on immediate, delayed free recall, recognition verbal memory, and information processing; Average [59%, n = 704]; and Optimal [26%, n = 307] NP performance. Participants with greater cIMT were more likely to have a Mixed-low profile [OR = 3.10, 95% CI (2.13, 4.53), p < 0.001] compared to Optimal. After adjusting for education and cardiovascular (CV) risks, results remained. The association with GCS tertiles was more attenuated [lowest (34%, n = 407) versus highest (33%, n = 403) tertile: adjusted OR = 1.66, 95% CI (1.07, 2.60), p = 0.024]. CONCLUSION As early as midlife, individuals with higher subclinical atherosclerosis were more likely to be in the Mixed-low profile, underscoring the potential malignancy of CV risk as related to NP test performance, suggesting that classification approaches may aid in identifying those at risk for AD/vascular dementia spectrum illness.
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Affiliation(s)
- Ileana De Anda-Duran
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA
| | - Owen T. Carmichael
- Louisiana State University’s Pennington Biomedical Research Center, Baton Rouge, LA, USA
| | - Phillip H. Hwang
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Camilo Fernandez
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Boston University Alzheimer’s Disease Center, Boston, MA, USA
| | - Lydia A. Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | - David J. Libon
- Department of Psychology, Rowan University, Glassboro, NJ, USA
- New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Stratford, NJ, USA
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28
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Karjadi C, Xue C, Cordella C, Kiran S, Paschalidis IC, Au R, Kolachalama VB. Fusion of Low-Level Descriptors of Digital Voice Recordings for Dementia Assessment. J Alzheimers Dis 2023; 96:507-514. [PMID: 37840494 PMCID: PMC10657667 DOI: 10.3233/jad-230560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/29/2023] [Indexed: 10/17/2023]
Abstract
Digital voice recordings can offer affordable, accessible ways to evaluate behavior and function. We assessed how combining different low-level voice descriptors can evaluate cognitive status. Using voice recordings from neuropsychological exams at the Framingham Heart Study, we developed a machine learning framework fusing spectral, prosodic, and sound quality measures early in the training cycle. The model's area under the receiver operating characteristic curve was 0.832 (±0.034) in differentiating persons with dementia from those who had normal cognition. This offers a data-driven framework for analyzing minimally processed voice recordings for cognitive assessment, highlighting the value of digital technologies in disease detection and intervention.
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Affiliation(s)
- Cody Karjadi
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Anatomy & Neurobiology and Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | - Chonghua Xue
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
| | | | - Swathi Kiran
- Sargent College, Boston University, Boston, MA, USA
- Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA
| | - Ioannis Ch. Paschalidis
- Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA
- Departments of Electrical & Computer Engineering, Systems Engineering and Biomedical Engineering, Boston University, Boston, MA, USA
| | - Rhoda Au
- The Framingham Heart Study, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Departments of Anatomy & Neurobiology and Neurology, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
- Alzheimer’s Disease Research Center, Boston University, Boston, MA, USA
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University Chobanian & Avedisian School of Medicine, Boston, MA, USA
- Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA
- Alzheimer’s Disease Research Center, Boston University, Boston, MA, USA
- Department of Computer Science, Boston University, Boston, MA, USA
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29
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Bacon KL, Felson DT, Jafarzadeh SR, Kolachalama VB, Hausdorff JM, Gazit E, Segal NA, Lewis CE, Nevitt MC, Kumar D. Relation of gait measures with mild unilateral knee pain during walking using machine learning. Sci Rep 2022; 12:22200. [PMID: 36564397 PMCID: PMC9789148 DOI: 10.1038/s41598-022-21142-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 09/22/2022] [Indexed: 12/24/2022] Open
Abstract
Gait alterations in those with mild unilateral knee pain during walking may provide clues to modifiable alterations that affect progression of knee pain and osteoarthritis (OA). To examine this, we applied machine learning (ML) approaches to gait data from wearable sensors in a large observational knee OA cohort, the Multicenter Osteoarthritis (MOST) study. Participants completed a 20-m walk test wearing sensors on their trunk and ankles. Parameters describing spatiotemporal features of gait and symmetry, variability and complexity were extracted. We used an ensemble ML technique ("super learning") to identify gait variables in our cross-sectional data associated with the presence/absence of unilateral knee pain. We then used logistic regression to determine the association of selected gait variables with odds of mild knee pain. Of 2066 participants (mean age 63.6 [SD: 10.4] years, 56% female), 21.3% had mild unilateral pain while walking. Gait parameters selected in the ML process as influential included step regularity, sample entropy, gait speed, and amplitude dominant frequency, among others. In adjusted cross-sectional analyses, lower levels of step regularity (i.e., greater gait variability) and lower sample entropy(i.e., lower gait complexity) were associated with increased likelihood of unilateral mild pain while walking [aOR 0.80 (0.64-1.00) and aOR 0.79 (0.66-0.95), respectively].
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Affiliation(s)
- Kathryn L Bacon
- Boston University Chobanian & Avedisian School of Medicine, 650 Albany Street, Suite X200, Boston, MA, 02118, USA.
| | - David T Felson
- Boston University Chobanian & Avedisian School of Medicine, 650 Albany Street, Suite X200, Boston, MA, 02118, USA
| | - S Reza Jafarzadeh
- Boston University Chobanian & Avedisian School of Medicine, 650 Albany Street, Suite X200, Boston, MA, 02118, USA
| | - Vijaya B Kolachalama
- Boston University Chobanian & Avedisian School of Medicine, 650 Albany Street, Suite X200, Boston, MA, 02118, USA
| | | | - Eran Gazit
- Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
| | - Neil A Segal
- University of Kansas Medical Center, Kansas City, USA
| | - Cora E Lewis
- University of Alabama at Birmingham, Birmingham, AL, USA
| | | | - Deepak Kumar
- Boston University Chobanian & Avedisian School of Medicine, 650 Albany Street, Suite X200, Boston, MA, 02118, USA
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30
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Zheng Y, Gindra RH, Green EJ, Burks EJ, Betke M, Beane JE, Kolachalama VB. A Graph-Transformer for Whole Slide Image Classification. IEEE Trans Med Imaging 2022; 41:3003-3015. [PMID: 35594209 PMCID: PMC9670036 DOI: 10.1109/tmi.2022.3176598] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
Deep learning is a powerful tool for whole slide image (WSI) analysis. Typically, when performing supervised deep learning, a WSI is divided into small patches, trained and the outcomes are aggregated to estimate disease grade. However, patch-based methods introduce label noise during training by assuming that each patch is independent with the same label as the WSI and neglect overall WSI-level information that is significant in disease grading. Here we present a Graph-Transformer (GT) that fuses a graph-based representation of an WSI and a vision transformer for processing pathology images, called GTP, to predict disease grade. We selected 4,818 WSIs from the Clinical Proteomic Tumor Analysis Consortium (CPTAC), the National Lung Screening Trial (NLST), and The Cancer Genome Atlas (TCGA), and used GTP to distinguish adenocarcinoma (LUAD) and squamous cell carcinoma (LSCC) from adjacent non-cancerous tissue (normal). First, using NLST data, we developed a contrastive learning framework to generate a feature extractor. This allowed us to compute feature vectors of individual WSI patches, which were used to represent the nodes of the graph followed by construction of the GTP framework. Our model trained on the CPTAC data achieved consistently high performance on three-label classification (normal versus LUAD versus LSCC: mean accuracy = 91.2 ± 2.5%) based on five-fold cross-validation, and mean accuracy = 82.3 ± 1.0% on external test data (TCGA). We also introduced a graph-based saliency mapping technique, called GraphCAM, that can identify regions that are highly associated with the class label. Our findings demonstrate GTP as an interpretable and effective deep learning framework for WSI-level classification.
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31
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Amini S, Hao B, Zhang L, Song M, Gupta A, Karjadi C, Kolachalama VB, Au R, Paschalidis IC. Automated detection of mild cognitive impairment and dementia from voice recordings: A natural language processing approach. Alzheimers Dement 2022; 19:10.1002/alz.12721. [PMID: 35796399 PMCID: PMC10148688 DOI: 10.1002/alz.12721] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 03/20/2022] [Accepted: 05/18/2022] [Indexed: 11/06/2022]
Abstract
INTRODUCTION Automated computational assessment of neuropsychological tests would enable widespread, cost-effective screening for dementia. METHODS A novel natural language processing approach is developed and validated to identify different stages of dementia based on automated transcription of digital voice recordings of subjects' neuropsychological tests conducted by the Framingham Heart Study (n = 1084). Transcribed sentences from the test were encoded into quantitative data and several models were trained and tested using these data and the participants' demographic characteristics. RESULTS Average area under the curve (AUC) on the held-out test data reached 92.6%, 88.0%, and 74.4% for differentiating Normal cognition from Dementia, Normal or Mild Cognitive Impairment (MCI) from Dementia, and Normal from MCI, respectively. DISCUSSION The proposed approach offers a fully automated identification of MCI and dementia based on a recorded neuropsychological test, providing an opportunity to develop a remote screening tool that could be adapted easily to any language.
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Affiliation(s)
- Samad Amini
- Department of Electrical & Computer Engineering, Division of Systems Engineering, and Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Boran Hao
- Department of Electrical & Computer Engineering, Division of Systems Engineering, and Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Lifu Zhang
- Department of Electrical & Computer Engineering, Division of Systems Engineering, and Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Mengting Song
- Department of Electrical & Computer Engineering, Division of Systems Engineering, and Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Aman Gupta
- Department of Electrical & Computer Engineering, Division of Systems Engineering, and Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
| | - Cody Karjadi
- Framingham Heart Study, Boston University, Boston, Massachusetts, USA
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
- Faculty of Computing & Data Sciences, Boston University, Boston, Massachusetts, USA
- Department of Computer Science, Boston University, Boston, Massachusetts, USA
| | - Rhoda Au
- Framingham Heart Study, Boston University, Boston, Massachusetts, USA
- Departments of Anatomy & Neurobiology, Neurology, and Epidemiology, Boston University School of Medicine and School of Public Health, Boston, Massachusetts, USA
| | - Ioannis Ch. Paschalidis
- Department of Electrical & Computer Engineering, Division of Systems Engineering, and Department of Biomedical Engineering, Boston University, Boston, Massachusetts, USA
- Faculty of Computing & Data Sciences, Boston University, Boston, Massachusetts, USA
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32
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Griffith KN, Schwartzman DA, Pizer SD, Bor J, Kolachalama VB, Jack B, Garrido MM. Local Supply Of Postdischarge Care Options Tied To Hospital Readmission Rates. Health Aff (Millwood) 2022; 41:1036-1044. [PMID: 35787076 DOI: 10.1377/hlthaff.2021.01991] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
The extent to which patients' risk for readmission after a hospitalization is influenced by local availability of postdischarge care options is not currently known. We used national, hospital-level data to assess whether the supply of postdischarge care options in hospitals' catchment areas was associated with readmission rates for Medicare patients after hospitalizations for acute myocardial infarction, heart failure, or pneumonia. Overall, readmission rates were negatively associated with per capita supply of primary care physicians (-0.16 percentage points per standard deviation) and licensed nursing home beds (-0.09 percentage points per standard deviation). In contrast, readmission rates were positively associated with per capita supply of nurse practitioners (0.09 percentage points per standard deviation). Our results suggest potential modifications to the Hospital Readmissions Reduction Program to account for local health system characteristics when assigning penalties to hospitals.
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Affiliation(s)
- Kevin N Griffith
- Kevin N. Griffith , Vanderbilt University Medical Center, Nashville, Tennessee, and Veterans Affairs Boston Healthcare System, Boston, Massachusetts
| | - David A Schwartzman
- David A. Schwartzman, Washington University in St. Louis, St. Louis, Missouri
| | - Steven D Pizer
- Steven D. Pizer, Veterans Affairs Boston Healthcare System and Boston University, Boston, Massachusetts
| | | | | | | | - Melissa M Garrido
- Melissa M. Garrido, Veterans Affairs Boston Healthcare System and Boston University
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33
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Qiu S, Miller MI, Joshi PS, Lee JC, Xue C, Ni Y, Wang Y, De Anda-Duran I, Hwang PH, Cramer JA, Dwyer BC, Hao H, Kaku MC, Kedar S, Lee PH, Mian AZ, Murman DL, O'Shea S, Paul AB, Saint-Hilaire MH, Alton Sartor E, Saxena AR, Shih LC, Small JE, Smith MJ, Swaminathan A, Takahashi CE, Taraschenko O, You H, Yuan J, Zhou Y, Zhu S, Alosco ML, Mez J, Stein TD, Poston KL, Au R, Kolachalama VB. Multimodal deep learning for Alzheimer's disease dementia assessment. Nat Commun 2022; 13:3404. [PMID: 35725739 PMCID: PMC9209452 DOI: 10.1038/s41467-022-31037-5] [Citation(s) in RCA: 46] [Impact Index Per Article: 23.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Accepted: 05/06/2022] [Indexed: 02/02/2023] Open
Abstract
Worldwide, there are nearly 10 million new cases of dementia annually, of which Alzheimer's disease (AD) is the most common. New measures are needed to improve the diagnosis of individuals with cognitive impairment due to various etiologies. Here, we report a deep learning framework that accomplishes multiple diagnostic steps in successive fashion to identify persons with normal cognition (NC), mild cognitive impairment (MCI), AD, and non-AD dementias (nADD). We demonstrate a range of models capable of accepting flexible combinations of routinely collected clinical information, including demographics, medical history, neuropsychological testing, neuroimaging, and functional assessments. We then show that these frameworks compare favorably with the diagnostic accuracy of practicing neurologists and neuroradiologists. Lastly, we apply interpretability methods in computer vision to show that disease-specific patterns detected by our models track distinct patterns of degenerative changes throughout the brain and correspond closely with the presence of neuropathological lesions on autopsy. Our work demonstrates methodologies for validating computational predictions with established standards of medical diagnosis.
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Grants
- R01 AG054076 NIA NIH HHS
- R01 AG016495 NIA NIH HHS
- U19 AG065156 NIA NIH HHS
- P30 AG066515 NIA NIH HHS
- RF1 AG062109 NIA NIH HHS
- RF1 AG072654 NIA NIH HHS
- R01 NS115114 NINDS NIH HHS
- R01 HL159620 NHLBI NIH HHS
- R56 AG062109 NIA NIH HHS
- P30 AG013846 NIA NIH HHS
- R21 CA253498 NCI NIH HHS
- K23 NS075097 NINDS NIH HHS
- U19 AG068753 NIA NIH HHS
- P30 AG066546 NIA NIH HHS
- R01 AG033040 NIA NIH HHS
- The Karen Toffler Charitable Trust, the Michael J. Fox Foundation, the Lewy Body Dementia Association, the Alzheimer’s Drug Discovery Foundation, the American Heart Association (20SFRN35460031), and the National Institutes of Health (R01-HL159620, R21-CA253498, RF1-AG062109, RF1-AG072654, U19-AG065156, P30-AG066515, R01-NS115114, K23-NS075097, U19-AG068753 and P30-AG013846).
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Affiliation(s)
- Shangran Qiu
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Physics, College of Arts & Sciences, Boston University, Boston, MA, USA
| | - Matthew I Miller
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Prajakta S Joshi
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of General Dentistry, Boston University School of Dental Medicine, Boston, MA, USA
- The Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA
| | - Joyce C Lee
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Chonghua Xue
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Yunruo Ni
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Yuwei Wang
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA
| | - Ileana De Anda-Duran
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA, USA
| | - Phillip H Hwang
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
| | - Justin A Cramer
- Department of Radiology, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Brigid C Dwyer
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Honglin Hao
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Michelle C Kaku
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Sachin Kedar
- Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
- Department Neurology, Emory University School of Medicine, Atlanta, GA, USA
- Department Ophthalmology, Emory University School of Medicine, Atlanta, GA, USA
| | - Peter H Lee
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Asim Z Mian
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Daniel L Murman
- Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Sarah O'Shea
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Aaron B Paul
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | | | - E Alton Sartor
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Aneeta R Saxena
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Ludy C Shih
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Juan E Small
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Maximilian J Smith
- Department of Radiology, Lahey Hospital & Medical Center, Burlington, MA, USA
| | - Arun Swaminathan
- Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | | | - Olga Taraschenko
- Department of Neurological Sciences, College of Medicine, University of Nebraska Medical Center, Omaha, NE, USA
| | - Hui You
- Department of Radiology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Jing Yuan
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Yan Zhou
- Department of Neurology, Peking Union Medical College Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China
| | - Shuhan Zhu
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
| | - Michael L Alosco
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center, Boston, MA, USA
| | - Jesse Mez
- The Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center, Boston, MA, USA
| | - Thor D Stein
- Boston University Alzheimer's Disease Research Center, Boston, MA, USA
- Department of Pathology and Laboratory Medicine, Boston University School of Medicine, Boston, MA, USA
- Boston VA Healthcare System, Boston, MA, USA
- Bedford VA Healthcare System, Bedford, MA, USA
| | | | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
- The Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Boston University Alzheimer's Disease Research Center, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA.
- Boston University Alzheimer's Disease Research Center, Boston, MA, USA.
- Department of Computer Science, Boston University, Boston, MA, USA.
- Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA.
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Weizenbaum EL, Fulford D, Torous J, Pinsky E, Kolachalama VB, Cronin-Golomb A. Smartphone-Based Neuropsychological Assessment in Parkinson's Disease: Feasibility, Validity, and Contextually Driven Variability in Cognition. J Int Neuropsychol Soc 2022; 28:401-413. [PMID: 33998438 PMCID: PMC10474573 DOI: 10.1017/s1355617721000503] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
OBJECTIVES The prevalence of neurodegenerative disorders demands methods of accessible assessment that reliably captures cognition in daily life contexts. We investigated the feasibility of smartphone cognitive assessment in people with Parkinson's disease (PD), who may have cognitive impairment in addition to motor-related problems that limit attending in-person clinics. We examined how daily-life factors predicted smartphone cognitive performance and examined the convergent validity of smartphone assessment with traditional neuropsychological tests. METHODS Twenty-seven nondemented individuals with mild-moderate PD attended one in-lab session and responded to smartphone notifications over 10 days. The smartphone app queried participants 5x/day about their location, mood, alertness, exercise, and medication state and administered mobile games of working memory and executive function. RESULTS Response rate to prompts was high, demonstrating feasibility of the approach. Between-subject reliability was high on both cognitive games. Within-subject variability was higher for working memory than executive function. Strong convergent validity was seen between traditional tests and smartphone working memory but not executive function, reflecting the latter's ceiling effects. Participants performed better on mobile working memory tasks when at home and after recent exercise. Less self-reported daytime sleepiness and lower PD symptom burden predicted a stronger association between later time of day and higher smartphone test performance. CONCLUSIONS These findings support feasibility and validity of repeat smartphone assessments of cognition and provide preliminary evidence of the effects of context on cognitive variability in PD. Further development of this accessible assessment method could increase sensitivity and specificity regarding daily cognitive dysfunction for PD and other clinical populations.
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Affiliation(s)
- Emma L. Weizenbaum
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
| | - Daniel Fulford
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- Department of Occupational Therapy and Rehabilitation Sciences, Boston University, Boston, MA, USA
| | - John Torous
- Department of Psychiatry, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Emma Pinsky
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
- Department of Psychology, Bryn Mawr College, Bryn Mawr, PA, USA
| | - Vijaya B. Kolachalama
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA
- Department of Computer Science, and Faculty of Computing and Data Sciences, Boston University Alzheimer’s Disease Center; Boston University, Boston, MA, USA
| | - Alice Cronin-Golomb
- Department of Psychological and Brain Sciences, Boston University, Boston, MA, USA
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De Anda-Duran I, Alonso CF, Libon DJ, Carmichael OT, Kolachalama VB, Suglia SF, Au R, Bazzano LA. Carotid Intima-media Thickness and Midlife Cognitive Function: Impact of Race and Social Disparities in the Bogalusa Heart Study. Neurology 2022; 98:e1828-e1836. [PMID: 35228334 PMCID: PMC9109147 DOI: 10.1212/wnl.0000000000200155] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2021] [Accepted: 01/18/2022] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Carotid intima-media thickness (c-IMT) is a measurement of atherosclerosis, a progressive disease that develops as early as childhood and has been linked with cognitive impairment and dementia in the elderly. However, the relationship between c-IMT and midlife cognitive function as well as race and social disparities on this relationship remains unclear. We examined the association between c-IMT and cognitive function in midlife among Black and White participants from a semi-rural community-based cohort in Bogalusa, Louisiana. METHODS In this cross-sectional analysis of participants from the Bogalusa Heart Study, linear regression models were used to determine the association between c-IMT dichotomized above the 50th percentile (> 0.87mm), an a demographically standardized global cognitive (GCS) and individual cognitive domain-based z-scores. Stratified analyses were performed to evaluate the impact of race and the individual's education status. RESULTS A total of 1,217 participants (age 48 ± 5.28 years) were included, 66% (804) self-identified as White and 34% (413) as Black. Of those, 58% (708) were women, and 42% (509) were men Having a c-IMT > 50th percentile was inversely associated with GCS ([B ± SE]: -0.39 ± 0.18, P=0.03), independent of cardiovascular risk factors (CVRFs) and achieved education. The effect remained significant in Black and White participants after adjustment for CVRFs (Blacks: [B ± SE]: -1.25 ± 0.45, P=0.005; Whites: [B ± SE]: -0.92 ± 0.35, P=0.008), but not for education. The interaction between c-IMT >50th percentile and education was significant (P=0.03), and stratified analysis showed an association with GCS among those with lower achieved education ([B ± SE]: -0.81 ± 0.33, P=0.013) independent of major CVRFs. DISCUSSION Subclinical atherosclerosis, measured as c-IMT, was associated with worse midlife cognitive function, independent of major CVRFs. The association was buffered by education and may be stronger among Black than White participants, likely due to corresponding structural and social determinants. These findings underscore the importance of establishing preventive measures in midlife and suggest subclinical atherosclerosis as a potential target to prevent cognitive decline.
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Affiliation(s)
- Ileana De Anda-Duran
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA
| | | | - David J Libon
- Department of Psychology, Rowan University, Glassboro, NJ, USA.,New Jersey Institute for Successful Aging, School of Osteopathic Medicine, Rowan University, Glassboro, NJ, USA
| | - Owen T Carmichael
- Louisiana State University's Pennington Biomedical Research Centre, Baton Rouge, LA, USA
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Computer Science and Faculty of Computing and Data Sciences , Boston University, Boston, MA, USA
| | - Shakira F Suglia
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA, and Boston University Alzheimer's Disease Center, Boston, MA, USA
| | - Lydia A Bazzano
- Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, LA, USA.,Department of Medicine, Tulane University School of Medicine, New Orleans, LA, USA
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Romano MF, Kolachalama VB. Deep learning for subtyping the Alzheimer's disease spectrum. Trends Mol Med 2022; 28:81-83. [PMID: 34996710 PMCID: PMC10100785 DOI: 10.1016/j.molmed.2021.12.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 12/14/2021] [Indexed: 01/25/2023]
Abstract
In a recent article from Cell Reports Medicine, Kwak et al. generate novel insights about subtyping cognitively impaired individuals based on structural imaging. Quantifying heterogeneity in Alzheimer's disease via subtyping could help us harness new disease-modifying therapies and improve patient care by providing a more targeted approach.
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Affiliation(s)
- Michael F Romano
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Medicine, St. Elizabeth's Medical Center, Brighton, MA, USA; Department of Medicine, Tufts University School of Medicine, Boston, MA, USA
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA.
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Au R, Kolachalama VB, Paschalidis IC. Redefining and Validating Digital Biomarkers as Fluid, Dynamic Multi-Dimensional Digital Signal Patterns. Front Digit Health 2022; 3:751629. [PMID: 35146485 PMCID: PMC8822623 DOI: 10.3389/fdgth.2021.751629] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2021] [Accepted: 12/13/2021] [Indexed: 11/16/2022] Open
Abstract
"Digital biomarker" is a term broadly and indiscriminately applied and often limited in its conceptualization to mimic well-established biomarkers as defined and approved by regulatory agencies such as the United States Food and Drug Administration (FDA). There is a practical urgency to revisit the definition of a digital biomarker and expand it beyond current methods of identification and validation. Restricting the promise of digital technologies within the realm of currently defined biomarkers creates a missed opportunity. A whole new field of prognostic and early diagnostic digital biomarkers driven by data science and artificial intelligence can break the current cycle of high healthcare costs and low health quality that is being driven by today's chronic disease detection and treatment approaches. This new class of digital biomarkers will be dynamic and require developing new FDA approval pathways and next-generation gold standards.
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Affiliation(s)
- Rhoda Au
- Department of Anatomy and Neurobiology, Neurology and Framingham Heart Study, Boston University School of Medicine, Boston, MA, United States
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, United States
- Boston University Alzheimer's Disease Center, Boston, MA, United States
| | - Vijaya B. Kolachalama
- Boston University Alzheimer's Disease Center, Boston, MA, United States
- Department of Medicine, Boston University School of Medicine, Boston, MA, United States
- Faculty of Computing and Data Sciences, Boston University, Boston, MA, United States
| | - Ioannis C. Paschalidis
- Faculty of Computing and Data Sciences, Boston University, Boston, MA, United States
- Department of Electrical and Computer Engineering, Division of Systems Engineering, and Department of Biomedical Engineering, Boston University, Boston, MA, United States
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38
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Romano MF, Balachandra A, Zhou X, Jadick M, Qiu S, Nijhawan D, Chin SP, Au R, Kolachalama VB. Comparative analysis of cerebrospinal fluid markers and multimodal imaging in predicting Alzheimer’s disease progression. Alzheimers Dement 2021. [DOI: 10.1002/alz.054457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Affiliation(s)
| | | | - Xiao Zhou
- Boston University School of Medicine Boston MA USA
- College of Arts & Sciences Boston University Boston MA USA
| | | | - Shangran Qiu
- Boston University School of Medicine Boston MA USA
- College of Arts & Sciences Boston University Boston MA USA
| | | | - Sang P. Chin
- College of Arts & Sciences Boston University Boston MA USA
| | - Rhoda Au
- The Framingham Heart Study Boston University School of Medicine Boston University School of Public Health Boston MA USA
- Boston University Alzheimer’s Disease Center Boston University Boston MA USA
| | - Vijaya B. Kolachalama
- Boston University School of Medicine Boston MA USA
- College of Arts & Sciences Boston University Boston MA USA
- Boston University Alzheimer’s Disease Center Boston University Boston MA USA
- Faculty of Computing & Data Sciences Boston University Boston MA USA
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39
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De Anda‐Duran I, Fernandez‐Alonso C, Carmichael OT, Au R, Bazzano L, Kolachalama VB. Blood pressure trajectories from early life and their association with cognitive function changes in midlife. Alzheimers Dement 2021. [DOI: 10.1002/alz.056628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Affiliation(s)
| | | | | | - Rhoda Au
- Boston University Alzheimer’s Disease Center, Boston University Boston MA USA
- The Framingham Heart Study, Boston University School of Medicine; Boston University School of Public Health Boston MA USA
- Boston University Schools of Medicine & Public Health Boston MA USA
| | | | - Vijaya B Kolachalama
- Boston University Alzheimer’s Disease Center, Boston University Boston MA USA
- Hariri Institute for Computing and Computational Science & Engineering, Boston University Boston MA USA
- College of Arts & Sciences, Boston University Boston MA USA
- Boston University School of Medicine Boston MA USA
- Faculty of Computing & Data Sciences, Boston University Boston MA USA
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40
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Verma A, Chitalia VC, Waikar SS, Kolachalama VB. Machine Learning Applications in Nephrology: A Bibliometric Analysis Comparing Kidney Studies to Other Medicine Subspecialities. Kidney Med 2021; 3:762-767. [PMID: 34693256 PMCID: PMC8515072 DOI: 10.1016/j.xkme.2021.04.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
RATIONALE & OBJECTIVES Artificial intelligence driven by machine learning algorithms is being increasingly employed for early detection, disease diagnosis, and clinical management. We explored the use of machine learning-driven advancements in kidney research compared with other organ-specific fields. STUDY DESIGN Cross-sectional bibliometric analysis. SETTING & PARTICIPANTS ISI Web of Science database was queried using specific Medical Subject Headings (MeSH) terms about the organ system, journal International Standard Serial Number, and research methodology. In parallel, we screened the National Institutes of Health (NIH) RePORTER website to explore funded grants that proposed the use of machine learning as a methodology. PREDICTORS Number of publications using machine learning as a research method. OUTCOME Articles were characterized by research methodology among 5 organ systems (brain, heart, kidney, liver, and lung). Grants funded by NIH for machine learning were characterized by study sections. ANALYTICAL APPROACH Percentages of articles using machine learning and other research methodologies were compared among 5 organ systems. RESULTS Machine learning-based articles that are focused on the kidney accounted for 3.2% of the total relevant articles from the 5 organ systems. Specifically, brain research published over 19-fold higher number of articles than kidney research. As compared with machine learning, conventional statistical approaches such as the Cox proportional hazard model were used 9-fold higher in articles related to kidney research. In general, a lower utilization of machine learning-based approaches was observed in organ-specific specialty journals than the broad interdisciplinary journals. The digestive disease, kidney, and urology study sections funded 122 applications proposing machine learning-based approaches compared to 265 applications from the neurology, neuropsychology, and neuropathology study sections. LIMITATIONS Observational study. CONCLUSIONS Our analysis suggests lowest use of machine learning as a research tool among kidney researchers compared with other organ-specific researchers, underscoring a need to better inform the kidney research community about this emerging data analytic tool.
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Affiliation(s)
- Ashish Verma
- Renal Division, Brigham and Women’s Hospital, Boston, MA
- Section of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston, MA
| | - Vipul C. Chitalia
- Section of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston, MA
- Boston Veterans Affairs Healthcare System, Boston, MA
| | - Sushrut S. Waikar
- Section of Nephrology, Boston University School of Medicine and Boston Medical Center, Boston, MA
| | - Vijaya B. Kolachalama
- Section of Computational Biomedicine, Department of Medicine, School of Medicine, Boston University, Boston, MA
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, MA
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41
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Xue C, Karjadi C, Paschalidis IC, Au R, Kolachalama VB. Detection of dementia on voice recordings using deep learning: a Framingham Heart Study. Alzheimers Res Ther 2021; 13:146. [PMID: 34465384 PMCID: PMC8409004 DOI: 10.1186/s13195-021-00888-3] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Accepted: 08/12/2021] [Indexed: 11/10/2022]
Abstract
BACKGROUND Identification of reliable, affordable, and easy-to-use strategies for detection of dementia is sorely needed. Digital technologies, such as individual voice recordings, offer an attractive modality to assess cognition but methods that could automatically analyze such data are not readily available. METHODS AND FINDINGS We used 1264 voice recordings of neuropsychological examinations administered to participants from the Framingham Heart Study (FHS), a community-based longitudinal observational study. The recordings were 73 min in duration, on average, and contained at least two speakers (participant and examiner). Of the total voice recordings, 483 were of participants with normal cognition (NC), 451 recordings were of participants with mild cognitive impairment (MCI), and 330 were of participants with dementia (DE). We developed two deep learning models (a two-level long short-term memory (LSTM) network and a convolutional neural network (CNN)), which used the audio recordings to classify if the recording included a participant with only NC or only DE and to differentiate between recordings corresponding to those that had DE from those who did not have DE (i.e., NDE (NC+MCI)). Based on 5-fold cross-validation, the LSTM model achieved a mean (±std) area under the receiver operating characteristic curve (AUC) of 0.740 ± 0.017, mean balanced accuracy of 0.647 ± 0.027, and mean weighted F1 score of 0.596 ± 0.047 in classifying cases with DE from those with NC. The CNN model achieved a mean AUC of 0.805 ± 0.027, mean balanced accuracy of 0.743 ± 0.015, and mean weighted F1 score of 0.742 ± 0.033 in classifying cases with DE from those with NC. For the task related to the classification of participants with DE from NDE, the LSTM model achieved a mean AUC of 0.734 ± 0.014, mean balanced accuracy of 0.675 ± 0.013, and mean weighted F1 score of 0.671 ± 0.015. The CNN model achieved a mean AUC of 0.746 ± 0.021, mean balanced accuracy of 0.652 ± 0.020, and mean weighted F1 score of 0.635 ± 0.031 in classifying cases with DE from those who were NDE. CONCLUSION This proof-of-concept study demonstrates that automated deep learning-driven processing of audio recordings of neuropsychological testing performed on individuals recruited within a community cohort setting can facilitate dementia screening.
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Affiliation(s)
- Chonghua Xue
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - Cody Karjadi
- The Framingham Heart Study, Boston University, Boston, MA, 02118, USA
- Departments of Anatomy & Neurobiology and Neurology, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Ioannis Ch Paschalidis
- Departments to Electrical & Computer Engineering, Systems Engineering and Biomedical Engineering; Faculty of Computing & Data Sciences, Boston University, Boston, MA, 02118, USA
| | - Rhoda Au
- The Framingham Heart Study, Boston University, Boston, MA, 02118, USA
- Departments of Anatomy & Neurobiology and Neurology, Boston University School of Medicine, Boston, MA, 02118, USA
- Boston University Alzheimer's Disease Center, Boston, MA, 02118, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Vijaya B Kolachalama
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA.
- Boston University Alzheimer's Disease Center, Boston, MA, 02118, USA.
- Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, MA, 02115, USA.
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Xue C, Karjadi C, Paschalidis IC, Au R, Kolachalama VB. Detection of dementia on voice recordings using deep learning: a Framingham Heart Study. Alzheimers Res Ther 2021. [PMID: 34465384 DOI: 10.1186/s13195-021-00888-3.pdf] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Identification of reliable, affordable, and easy-to-use strategies for detection of dementia is sorely needed. Digital technologies, such as individual voice recordings, offer an attractive modality to assess cognition but methods that could automatically analyze such data are not readily available. METHODS AND FINDINGS We used 1264 voice recordings of neuropsychological examinations administered to participants from the Framingham Heart Study (FHS), a community-based longitudinal observational study. The recordings were 73 min in duration, on average, and contained at least two speakers (participant and examiner). Of the total voice recordings, 483 were of participants with normal cognition (NC), 451 recordings were of participants with mild cognitive impairment (MCI), and 330 were of participants with dementia (DE). We developed two deep learning models (a two-level long short-term memory (LSTM) network and a convolutional neural network (CNN)), which used the audio recordings to classify if the recording included a participant with only NC or only DE and to differentiate between recordings corresponding to those that had DE from those who did not have DE (i.e., NDE (NC+MCI)). Based on 5-fold cross-validation, the LSTM model achieved a mean (±std) area under the receiver operating characteristic curve (AUC) of 0.740 ± 0.017, mean balanced accuracy of 0.647 ± 0.027, and mean weighted F1 score of 0.596 ± 0.047 in classifying cases with DE from those with NC. The CNN model achieved a mean AUC of 0.805 ± 0.027, mean balanced accuracy of 0.743 ± 0.015, and mean weighted F1 score of 0.742 ± 0.033 in classifying cases with DE from those with NC. For the task related to the classification of participants with DE from NDE, the LSTM model achieved a mean AUC of 0.734 ± 0.014, mean balanced accuracy of 0.675 ± 0.013, and mean weighted F1 score of 0.671 ± 0.015. The CNN model achieved a mean AUC of 0.746 ± 0.021, mean balanced accuracy of 0.652 ± 0.020, and mean weighted F1 score of 0.635 ± 0.031 in classifying cases with DE from those who were NDE. CONCLUSION This proof-of-concept study demonstrates that automated deep learning-driven processing of audio recordings of neuropsychological testing performed on individuals recruited within a community cohort setting can facilitate dementia screening.
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Affiliation(s)
- Chonghua Xue
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - Cody Karjadi
- The Framingham Heart Study, Boston University, Boston, MA, 02118, USA.,Departments of Anatomy & Neurobiology and Neurology, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Ioannis Ch Paschalidis
- Departments to Electrical & Computer Engineering, Systems Engineering and Biomedical Engineering; Faculty of Computing & Data Sciences, Boston University, Boston, MA, 02118, USA
| | - Rhoda Au
- The Framingham Heart Study, Boston University, Boston, MA, 02118, USA.,Departments of Anatomy & Neurobiology and Neurology, Boston University School of Medicine, Boston, MA, 02118, USA.,Boston University Alzheimer's Disease Center, Boston, MA, 02118, USA.,Department of Epidemiology, Boston University School of Public Health, Boston, MA, 02118, USA
| | - Vijaya B Kolachalama
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA. .,Boston University Alzheimer's Disease Center, Boston, MA, 02118, USA. .,Department of Computer Science and Faculty of Computing & Data Sciences, Boston University, Boston, MA, 02115, USA.
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Zheng Y, Cassol CA, Jung S, Veerapaneni D, Chitalia VC, Ren KYM, Bellur SS, Boor P, Barisoni LM, Waikar SS, Betke M, Kolachalama VB. Deep-Learning-Driven Quantification of Interstitial Fibrosis in Digitized Kidney Biopsies. Am J Pathol 2021; 191:1442-1453. [PMID: 34033750 PMCID: PMC8453248 DOI: 10.1016/j.ajpath.2021.05.005] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/11/2021] [Revised: 05/01/2021] [Accepted: 05/11/2021] [Indexed: 12/25/2022]
Abstract
Interstitial fibrosis and tubular atrophy (IFTA) on a renal biopsy are strong indicators of disease chronicity and prognosis. Techniques that are typically used for IFTA grading remain manual, leading to variability among pathologists. Accurate IFTA estimation using computational techniques can reduce this variability and provide quantitative assessment. Using trichrome-stained whole-slide images (WSIs) processed from human renal biopsies, we developed a deep-learning framework that captured finer pathologic structures at high resolution and overall context at the WSI level to predict IFTA grade. WSIs (n = 67) were obtained from The Ohio State University Wexner Medical Center. Five nephropathologists independently reviewed them and provided fibrosis scores that were converted to IFTA grades: ≤10% (none or minimal), 11% to 25% (mild), 26% to 50% (moderate), and >50% (severe). The model was developed by associating the WSIs with the IFTA grade determined by majority voting (reference estimate). Model performance was evaluated on WSIs (n = 28) obtained from the Kidney Precision Medicine Project. There was good agreement on the IFTA grading between the pathologists and the reference estimate (κ = 0.622 ± 0.071). The accuracy of the deep-learning model was 71.8% ± 5.3% on The Ohio State University Wexner Medical Center and 65.0% ± 4.2% on Kidney Precision Medicine Project data sets. Our approach to analyzing microscopic- and WSI-level changes in renal biopsies attempts to mimic the pathologist and provides a regional and contextual estimation of IFTA. Such methods can assist clinicopathologic diagnosis.
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Affiliation(s)
- Yi Zheng
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Computer Science, College of Arts and Sciences, Boston University, Boston, Massachusetts
| | - Clarissa A Cassol
- Arkana Laboratories, Little Rock, Arkansas; Department of Pathology, The Ohio State University, Columbus, Ohio
| | - Saemi Jung
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Divya Veerapaneni
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts
| | - Vipul C Chitalia
- Section of Nephrology, Boston University School of Medicine & Boston Medical Center, Boston, Massachusetts
| | - Kevin Y M Ren
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada
| | - Shubha S Bellur
- Department of Pathology and Molecular Medicine, Queen's University, Kingston, Ontario, Canada; Medical Renal and Genitourinary Pathology, William Osler Health System, Brampton, Ontario, Canada
| | - Peter Boor
- Institute of Pathology & Department of Nephrology & Electron Microscopy Facility, RWTH Aachen University Hospital, Aachen, Germany
| | - Laura M Barisoni
- Department of Pathology and Medicine, Duke University, Durham, North Carolina
| | - Sushrut S Waikar
- Section of Nephrology, Boston University School of Medicine & Boston Medical Center, Boston, Massachusetts
| | - Margrit Betke
- Department of Computer Science, College of Arts and Sciences, Boston University, Boston, Massachusetts; Faculty of Computing and Data Sciences, Boston University, Boston, Massachusetts
| | - Vijaya B Kolachalama
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts; Department of Computer Science, College of Arts and Sciences, Boston University, Boston, Massachusetts; Faculty of Computing and Data Sciences, Boston University, Boston, Massachusetts.
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Diana Zhang J, Baker MJ, Liu Z, Mohibul Kabir KM, Kolachalama VB, Yates DH, Donald WA. Medical diagnosis at the point-of-care by portable high-field asymmetric waveform ion mobility spectrometry: a systematic review and meta-analysis. J Breath Res 2021; 15:10.1088/1752-7163/ac135e. [PMID: 34252887 PMCID: PMC10422980 DOI: 10.1088/1752-7163/ac135e] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Accepted: 07/12/2021] [Indexed: 12/30/2022]
Abstract
Non-invasive medical diagnosis by analysing volatile organic compounds (VOCs) at the point-of-care is becoming feasible owing to recent advances in portable instrumentation. A number of studies have assessed the performance of a state-of-the-art VOC analyser (micro-chip high-field asymmetric waveform ion mobility spectrometry, FAIMS) for medical diagnosis. However, a comprehensive meta-analysis is needed to investigate the overall diagnostic performance of these novel methods across different medical conditions. An electronic search was performed using the CAplus and MEDLINE database through the SciFinder platform. The review identified a total of 23 studies and 2312 individuals. Eighteen studies were used for meta-analysis. A pooled analysis found an overall sensitivity of 80% (95% CI, 74%-85%,I2= 62%), and specificity of 78% (95% CI, 70%-84%,I2= 80%), which corresponds to the overall diagnostic performance of micro-chip FAIMS across many different medical conditions. The diagnostic accuracy was particularly high for coeliac and inflammatory bowel disease (sensitivity and specificity from 74% to 97%). The overall diagnostic performance was similar across breath, urine, and faecal matrices with sparse logistic regression and random forests algorithms resulting in higher diagnostic accuracy. Sources of variability likely arise from differences in sample storage, sampling protocol, method of data analysis, type of disease, sample matrix, and potentially to clinical and disease factors. The results of this meta-analysis indicate that micro-chip FAIMS is a promising candidate for disease screening at the point-of-care, particularly for gastroenterology diseases. This review provides recommendations that should improve the techniques relevant to diagnostic accuracy of future VOC and point-of-care studies.
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Affiliation(s)
- J Diana Zhang
- School of Chemistry, University of New South Wales, Sydney, Australia
| | - Merryn J Baker
- School of Chemistry, University of New South Wales, Sydney, Australia
| | - Zhixin Liu
- Stats Central, University of New South Wales, Sydney, Australia
| | - K M Mohibul Kabir
- School of Chemistry, University of New South Wales, Sydney, Australia
| | - Vijaya B Kolachalama
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA; Department of Computer Science and Faculty of Computing and Data Sciences, Boston University, Boston, MA, United States of America
| | - Deborah H Yates
- Department of Thoracic Medicine, St Vincent’s Hospital and St Vincent’s Clinical School, UNSW Sydney, Sydney, Australia
| | - William A Donald
- School of Chemistry, University of New South Wales, Sydney, Australia
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Xu D, Zhou F, Sun W, Chen L, Lan L, Li H, Xiao F, Li Y, Kolachalama VB, Li Y, Wang X, Xu H. Relationship Between Serum Severe Acute Respiratory Syndrome Coronavirus 2 Nucleic Acid and Organ Damage in Coronavirus 2019 Patients: A Cohort Study. Clin Infect Dis 2021; 73:68-75. [PMID: 32720678 PMCID: PMC7454386 DOI: 10.1093/cid/ciaa1085] [Citation(s) in RCA: 35] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2020] [Accepted: 07/24/2020] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread worldwide and has the ability to damage multiple organs. However, information on serum SARS-CoV-2 nucleic acid (RNAemia) in patients affected by coronavirus disease 2019 (COVID-19) is limited. METHODS Patients who were admitted to Zhongnan Hospital of Wuhan University with laboratory-confirmed COVID-19 were tested for SARS-COV-2 RNA in serum from 28 January 2020 to 9 February 2020. Demographic data, laboratory and radiological findings, comorbidities, and outcomes data were collected and analyzed. RESULTS Eighty-five patients were included in the analysis. The viral load of throat swabs was significantly higher than of serum samples. The highest detection of SARS-CoV-2 RNA in serum samples was between 11 and 15 days after symptom onset. Analysis to compare patients with and without RNAemia provided evidence that computed tomography and some laboratory biomarkers (total protein, blood urea nitrogen, lactate dehydrogenase, hypersensitive troponin I, and D-dimer) were abnormal and that the extent of these abnormalities was generally higher in patients with RNAemia than in patients without RNAemia. Organ damage (respiratory failure, cardiac damage, renal damage, and coagulopathy) was more common in patients with RNAemia than in patients without RNAemia. Patients with vs without RNAemia had shorter durations from serum testing SARS-CoV-2 RNA. The mortality rate was higher among patients with vs without RNAemia. CONCLUSIONS In this study, we provide evidence to support that SARS-CoV-2 may have an important role in multiple organ damage. Our evidence suggests that RNAemia has a significant association with higher risk of in-hospital mortality.
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Affiliation(s)
- Dan Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Fuling Zhou
- Department of Hematology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Wenbo Sun
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Liangjun Chen
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Lan Lan
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Huan Li
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Feng Xiao
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Ying Li
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Vijaya B Kolachalama
- Department of Medicine, Boston University School of Medicine, Boston, Massachusetts, USA
| | - Yirong Li
- Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Xinghuan Wang
- Department of Urology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
| | - Haibo Xu
- Department of Radiology, Zhongnan Hospital of Wuhan University, Wuhan, Hubei, China
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Chang GH, Park LK, Le NA, Jhun RS, Surendran T, Lai J, Seo H, Promchotichai N, Yoon G, Scalera J, Capellini TD, Felson DT, Kolachalama VB. Subchondral bone length in knee osteoarthritis: A deep learning derived imaging measure and its association with radiographic and clinical outcomes. Arthritis Rheumatol 2021; 73:2240-2248. [PMID: 33973737 DOI: 10.1002/art.41808] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Accepted: 05/06/2021] [Indexed: 11/10/2022]
Abstract
OBJECTIVE Develop a bone shape measure that reflects the extent of cartilage loss and bone flattening in knee osteoarthritis (OA) and test it against estimates of disease severity. METHODS A fast region-based convolutional neural network was trained to crop the knee joints in sagittal dual-echo steady state MRI sequences obtained from the Osteoarthritis Initiative (OAI). Publicly available annotations of the cartilage and menisci were used as references to annotate the tibia and the femur in 61 knees. Another deep neural network (U-Net) was developed to learn these annotations. Model predictions were compared with radiologist-driven annotations on an independent test set (27 knees). The U-Net was applied to automatically extract the knee joint structures on the larger OAI dataset (9,434 knees). We defined subchondral bone length (SBL), a novel shape measure characterizing the extent of overlying cartilage and bone flattening, and examined its relationship with radiographic joint space narrowing (JSN), concurrent WOMAC pain and disability as well as subsequent partial or total knee replacement (KR). Odds ratios for each outcome were estimated using relative changes in SBL on the OAI dataset into quartiles. RESULT Mean SBL values for knees with JSN were consistently different from knees without JSN. Greater changes of SBL from baseline were associated with greater pain and disability. For knees with medial or lateral JSN, the odds ratios between lowest and highest quartiles corresponding to SBL changes for future KR were 5.68 (95% CI:[3.90,8.27]) and 7.19 (95% CI:[3.71,13.95]), respectively. CONCLUSION SBL quantified OA status based on JSN severity. It has promise as an imaging marker in predicting clinical and structural OA outcomes.
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Affiliation(s)
- Gary H Chang
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA, 02118
| | - Lisa K Park
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA, 02118
| | - Nina A Le
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA, 02118
| | - Ray S Jhun
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA, 02118
| | - Tejus Surendran
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA, 02118
| | - Joseph Lai
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA, 02118
| | - Hojoon Seo
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA, 02118
| | - Nuwapa Promchotichai
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA, 02118
| | - Grace Yoon
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA, 02118
| | - Jonathan Scalera
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA, 02118
| | - Terence D Capellini
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, USA, 02138.,Broad Institute of MIT and Harvard, Cambridge, MA, USA, 02142
| | - David T Felson
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, USA - 02118; Centre for Epidemiology, University of Manchester and the NIHR Manchester BRC, Manchester University, NHS Trust, Manchester, UK
| | - Vijaya B Kolachalama
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA, USA, 02118.,Department of Computer Science, Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA, 02215
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47
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Zhou X, Qiu S, Joshi PS, Xue C, Killiany RJ, Mian AZ, Chin SP, Au R, Kolachalama VB. Enhancing magnetic resonance imaging-driven Alzheimer's disease classification performance using generative adversarial learning. Alzheimers Res Ther 2021; 13:60. [PMID: 33715635 PMCID: PMC7958452 DOI: 10.1186/s13195-021-00797-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Accepted: 02/22/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Generative adversarial networks (GAN) can produce images of improved quality but their ability to augment image-based classification is not fully explored. We evaluated if a modified GAN can learn from magnetic resonance imaging (MRI) scans of multiple magnetic field strengths to enhance Alzheimer's disease (AD) classification performance. METHODS T1-weighted brain MRI scans from 151 participants of the Alzheimer's Disease Neuroimaging Initiative (ADNI), who underwent both 1.5-Tesla (1.5-T) and 3-Tesla imaging at the same time were selected to construct a GAN model. This model was trained along with a three-dimensional fully convolutional network (FCN) using the generated images (3T*) as inputs to predict AD status. Quality of the generated images was evaluated using signal to noise ratio (SNR), Blind/Referenceless Image Spatial Quality Evaluator (BRISQUE) and Natural Image Quality Evaluator (NIQE). Cases from the Australian Imaging, Biomarker & Lifestyle Flagship Study of Ageing (AIBL, n = 107) and the National Alzheimer's Coordinating Center (NACC, n = 565) were used for model validation. RESULTS The 3T*-based FCN classifier performed better than the FCN model trained using the 1.5-T scans. Specifically, the mean area under curve increased from 0.907 to 0.932, from 0.934 to 0.940, and from 0.870 to 0.907 on the ADNI test, AIBL, and NACC datasets, respectively. Additionally, we found that the mean quality of the generated (3T*) images was consistently higher than the 1.5-T images, as measured using SNR, BRISQUE, and NIQE on the validation datasets. CONCLUSION This study demonstrates a proof of principle that GAN frameworks can be constructed to augment AD classification performance and improve image quality.
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Affiliation(s)
- Xiao Zhou
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
- Department of Computer Science, College of Arts & Sciences, Boston University, Boston, MA, USA
| | - Shangran Qiu
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
- Department of Physics, College of Arts & Sciences, Boston University, Boston, MA, USA
| | - Prajakta S Joshi
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of General Dentistry, Boston University School of Dental Medicine, Boston, MA, USA
| | - Chonghua Xue
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - Ronald J Killiany
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Boston University Alzheimer's Disease Center, Boston, MA, USA
| | - Asim Z Mian
- Department of Radiology, Boston University School of Medicine, Boston, MA, USA
| | - Sang P Chin
- Department of Computer Science, College of Arts & Sciences, Boston University, Boston, MA, USA
- Department of Brain and Cognitive Science, Massachusetts Institute of Technology, Cambridge, MA, USA
- Center of Mathematical Sciences & Applications, Harvard University, Cambridge, MA, USA
| | - Rhoda Au
- Department of Anatomy and Neurobiology, Boston University School of Medicine, Boston, MA, USA
- Department of Neurology, Boston University School of Medicine, Boston, MA, USA
- Boston University Alzheimer's Disease Center, Boston, MA, USA
- The Framingham Heart Study, Boston University School of Medicine, Boston, MA, USA
- Department of Epidemiology, Boston University School of Public Health, Boston, MA, USA
| | - Vijaya B Kolachalama
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA.
- Department of Computer Science, College of Arts & Sciences, Boston University, Boston, MA, USA.
- Boston University Alzheimer's Disease Center, Boston, MA, USA.
- Faculty of Computing & Data Sciences, Boston University, Boston, MA, USA.
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48
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Amini S, Zhang L, Hao B, Gupta A, Song M, Karjadi C, Lin H, Kolachalama VB, Au R, Paschalidis IC. An Artificial Intelligence-Assisted Method for Dementia Detection Using Images from the Clock Drawing Test. J Alzheimers Dis 2021; 83:581-589. [PMID: 34334396 PMCID: PMC9049046 DOI: 10.3233/jad-210299] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Widespread dementia detection could increase clinical trial candidates and enable appropriate interventions. Since the Clock Drawing Test (CDT) can be potentially used for diagnosing dementia-related disorders, it can be leveraged to develop a computer-aided screening tool. OBJECTIVE To evaluate if a machine learning model that uses images from the CDT can predict mild cognitive impairment or dementia. METHODS Images of an analog clock drawn by 3,263 cognitively intact and 160 impaired subjects were collected during in-person dementia evaluations by the Framingham Heart Study. We processed the CDT images, participant's age, and education level using a deep learning algorithm to predict dementia status. RESULTS When only the CDT images were used, the deep learning model predicted dementia status with an area under the receiver operating characteristic curve (AUC) of 81.3% ± 4.3%. A composite logistic regression model using age, level of education, and the predictions from the CDT-only model, yielded an average AUC and average F1 score of 91.9% ±1.1% and 94.6% ±0.4%, respectively. CONCLUSION Our modeling framework establishes a proof-of-principle that deep learning can be applied on images derived from the CDT to predict dementia status. When fully validated, this approach can offer a cost-effective and easily deployable mechanism for detecting cognitive impairment.
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Affiliation(s)
- Samad Amini
- Department of Electrical & Computer Engineering, Division of Systems Engineering, and Department of Biomedical Engineering, Boston University
| | - Lifu Zhang
- Department of Electrical & Computer Engineering, Division of Systems Engineering, and Department of Biomedical Engineering, Boston University
| | - Boran Hao
- Department of Electrical & Computer Engineering, Division of Systems Engineering, and Department of Biomedical Engineering, Boston University
| | - Aman Gupta
- Department of Electrical & Computer Engineering, Division of Systems Engineering, and Department of Biomedical Engineering, Boston University
| | - Mengting Song
- Department of Electrical & Computer Engineering, Division of Systems Engineering, and Department of Biomedical Engineering, Boston University
| | | | - Honghuang Lin
- Department of Medicine, Boston University School of Medicine
| | - Vijaya B. Kolachalama
- Department of Medicine, Boston University School of Medicine
- Faculty of Computing & Data Sciences, Boston University
- Department of Computer Science, Boston University
| | - Rhoda Au
- Framingham Heart Study, Boston University
- Departments of Anatomy & Neurobiology, Neurology, and Epidemiology, Boston University School of Medicine and School of Public Health
| | - Ioannis Ch. Paschalidis
- Department of Electrical & Computer Engineering, Division of Systems Engineering, and Department of Biomedical Engineering, Boston University
- Faculty of Computing & Data Sciences, Boston University
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49
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Chang GH, Felson DT, Qiu S, Guermazi A, Capellini TD, Kolachalama VB. Correction to: Assessment of knee pain from MR imaging using a convolutional Siamese network. Eur Radiol 2020; 30:6968. [PMID: 32700018 DOI: 10.1007/s00330-020-07073-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
The original version of this article, published on 13 February 2020, unfortunately contained a mistake.
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Affiliation(s)
- Gary H Chang
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - David T Felson
- Section of Rheumatology, Department of Medicine, Boston University School of Medicine, Boston, MA, 02118, USA
- Centre for Epidemiology, University of Manchester and the NIHR Manchester BRC, Manchester University, NHS Trust, Manchester, UK
| | - Shangran Qiu
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA
| | - Ali Guermazi
- Department of Radiology, Boston University School of Medicine, Boston, MA, 02118, USA
| | - Terence D Capellini
- Department of Human Evolutionary Biology, Harvard University, Cambridge, MA, 02138, USA
- Broad Institute of MIT and Harvard, Cambridge, MA, 02142, USA
| | - Vijaya B Kolachalama
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, 72 E. Concord Street, Evans 636, Boston, MA, 02118, USA.
- Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA, 02118, USA.
- Hariri Institute for Computing and Computational Science and Engineering, Boston University, Boston, MA, 02215, USA.
- Boston University Alzheimer's Disease Center, Boston, MA, 02118, USA.
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50
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Wollacott AM, Xue C, Qin Q, Hua J, Bohnuud T, Viswanathan K, Kolachalama VB. Quantifying the nativeness of antibody sequences using long short-term memory networks. Protein Eng Des Sel 2020; 32:347-354. [PMID: 31504835 PMCID: PMC7372931 DOI: 10.1093/protein/gzz031] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 06/11/2019] [Accepted: 07/07/2019] [Indexed: 11/12/2022] Open
Abstract
Antibodies often undergo substantial engineering en route to the generation of a therapeutic candidate with good developability properties. Characterization of antibody libraries has shown that retaining native-like sequence improves the overall quality of the library. Motivated by recent advances in deep learning, we developed a bi-directional long short-term memory (LSTM) network model to make use of the large amount of available antibody sequence information, and use this model to quantify the nativeness of antibody sequences. The model scores sequences for their similarity to naturally occurring antibodies, which can be used as a consideration during design and engineering of libraries. We demonstrate the performance of this approach by training a model on human antibody sequences and show that our method outperforms other approaches at distinguishing human antibodies from those of other species. We show the applicability of this method for the evaluation of synthesized antibody libraries and humanization of mouse antibodies.
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Affiliation(s)
| | - Chonghua Xue
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - Qiuyuan Qin
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | - June Hua
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
| | | | | | - Vijaya B Kolachalama
- Section of Computational Biomedicine, Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA.,Hariri Institute of Computing and Computational Science & Engineering, Boston University, Boston, MA 02115, USA.,Whitaker Cardiovascular Institute, Boston University School of Medicine, Boston, MA 02118, USA.,Boston University Alzheimer's Disease Center, Boston, MA 02118, USA
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