Scientia, Dipòsit d’Informació Digital del Departament de Salut
Not a member yet
12576 research outputs found
Sort by
Swarm learning with weak supervision enables automatic breast cancer detection in magnetic resonance imaging
Full text linkSwarm learning; Breast cancer; Magnetic resonance imagingAprenentatge en eixam; Càncer de mama; Imatges per ressonància magnèticaAprendizaje en enjambre; Cáncer de mama; Imágenes por resonancia magnéticaBackground
Over the next 5 years, new breast cancer screening guidelines recommending magnetic resonance imaging (MRI) for certain patients will significantly increase the volume of imaging data to be analyzed. While this increase poses challenges for radiologists, artificial intelligence (AI) offers potential solutions to manage this workload. However, the development of AI models is often hindered by manual annotation requirements and strict data-sharing regulations between institutions.
Methods
In this study, we present an integrated pipeline combining weakly supervised learning—reducing the need for detailed annotations—with local AI model training via swarm learning (SL), which circumvents centralized data sharing. We utilized three datasets comprising 1372 female bilateral breast MRI exams from institutions in three countries: the United States (US), Switzerland, and the United Kingdom (UK) to train models. These models were then validated on two external datasets consisting of 649 bilateral breast MRI exams from Germany and Greece.
Results
Upon systematically benchmarking various weakly supervised two-dimensional (2D) and three-dimensional (3D) deep learning (DL) methods, we find that the 3D-ResNet-101 demonstrates superior performance. By implementing a real-world SL setup across three international centers, we observe that these collaboratively trained models outperform those trained locally. Even with a smaller dataset, we demonstrate the practical feasibility of deploying SL internationally with on-site data processing, addressing challenges such as data privacy and annotation variability.
Conclusions
Combining weakly supervised learning with SL enhances inter-institutional collaboration, improving the utility of distributed datasets for medical AI training without requiring detailed annotations or centralized data sharing.Open Access funding enabled and organized by Projekt DEAL
Novetats farmacoterapèutiques
Full text linkGrups farmacològics; Novetats; Indicadors; Línies assistencialsGrupos farmacológicos; Novedades; Indicadores; Líneas asistencialesPharmacological groups; Novelties; Indicators; Assistance linesL’indicador de novetats farmacoterapèutiques inclou: - Utilització de nous medicaments sense valor terapèutic afegit amb alternatives terapèutiques més adequades (MATMA, fàrmacs categoritzats com a D per part del Programa d’harmonització farmacoterapèutica [PHF] del CatSalut), i - Seguiment de certs medicaments de prescripció majoritària per l’atenció hospitalària categoritzats com a C per part del PHF del CatSalut. Aquest indicador s’aplica a les àrees de gestió assistencial (AGA) i també a diferents línies assistencials: equips d’atenció primària (EAP), unitats proveïdores (UP) d’atenció hospitalària i centres de salut mental d’adults (CSMA). Per a l’AGA i l’atenció hospitalària, és un indicador compost, mentre que per als EAP i CSMA, només es calcula l’indicador d’utilització de MATMA
Loss of Cdkn1a protects against MASLD alone or with alcohol intake by preserving lipid homeostasis
Full text linkHepatocyte; Senescence; Steatotic liver diseaseHepatocito; Senescencia; Esteatosis hepáticaHepatòcit; Senescència; Esteatosi hepàticaBackground & Aims
Expression of P21, encoded by the CDKN1A gene, has been associated with fibrosis progression in steatotic liver disease (SLD); however, the underlying mechanisms remain unknown. In the present study, we investigated the function of CDKN1A in SLD.
Methods
CDKN1A expression levels were evaluated in different patient cohorts with SLD, fibrosis, and advanced chronic liver disease (ACLD). Cdkn1a-/- and Cdkn1a+/+ mice were fed with either a Western diet (WD), a Lieber-DeCarli (LdC) diet plus multiple EtOH (ethanol) binges, or a DuAL diet (metabolic dysfunction-associated fatty liver disease and alcohol-related liver). Primary hepatocytes were isolated and functional assays performed.
Results
A significant increase in CDKN1A expression was observed in patients with steatohepatitis and fibrosis (with a positive correlation with both NAFLD Activity Score and fibrosis staging scores), cirrhosis and ACLD. Cdkn1a+/+ mice, fed a DuAL diet exhibited liver injury and cell death increased reactive oxygen species (ROS), and markers of senescence (γH2AX, β-GAL, Cdkn1a/p53) contributing to steatosis and inflammation. In contrast, Cdkn1a-/- mutant mice showed a significant decrease in senescence-associated markers as well as in markers of liver injury, hepatic steatosis and an increase in fatty acid oxidation and reduction in free fatty acid uptake as well as de novo lipogenesis. Mechanistically, activation of the AMPK-SIRT3 was observed in Cdkn1a-deleted animals.
Conclusions
Cdkn1a deletion protected against preclinical SLD by promoting fatty acid oxidation and preventing free fatty acid uptake and de novo lipogenesis via the AMPK-SIRT3 axis. CDKN1A expression was found to be directly correlated with increased severity of NAFLD Activity Score and fibrosis in patients with SLD. CDKN1A could be a potential theragnostic target for the treatment of metabolic dysregulation in patients with SLD, with and without alcohol consumption.
Impact and implications:
Expression of p21, encoded by the CDKN1A gene, has been associated with fibrosis progression in steatotic liver disease (SLD), but the molecular mechanisms remain elusive. Interestingly, in this study we found that Cdkn1a deletion protected against preclinical SLD by promoting fatty acid oxidation and preventing free fatty acid uptake and de novo lipogenesis, via the AMPK-SIRT3 axis. Translationally, Cdkn1a expression was found to be directly correlated with increased severity of NAFLD Activity Score (NAS) and fibrosis in SLD patients, and therefore, CDKN1A might be used potential theragnostic target for the treatment of metabolically induced SLD, with and without alcohol consumption.This work was supported by the MICIU/AEI/10.13039/501100011033 PID2020-113299RA-I00, PID2020-11782RB-I00, PID2020-117941RB-I00, PID2021-124425OB-I00, PID2023-150260OB-I00, and PID2023-151347OB-I00, all of which were co-financed with Fondos FEDER, UE, Basque Government, Department of Education (IT1476-2), the Institute of Health Carlos III (ISCIII) (awards numbers PI20/00505 and PI23/00171), EXOHEP2-CM (S2022/BMD-7409), HORIZON-HLTH-2022-STAYHLTH-02 under agreement No 101095679 and the Dynamic Resilience Program - Wellcome Leap. CSG is an Atracción de Talento (CAM) 2019 2019-T1/BMD-13313. The research group belongs to the validated Research Groups Ref. 970935 ‘Liver Pathophysiology’, 920631 ‘Lymphocyte immunobiology’, 920361 ‘Inmunogenética e inmunología de las mucosas’ and IBL-6 (imas12-associated). ALP and AH are recipients of a UCM Real Colegio Complutense (RCC) Harvard - Santander scholarships CT17/17 and CT15/23, respectively. BRM is supported by the ‘Miguel Servet Type I’ program (CP19/00098, funded by the Institute of Health Carlos III, Spain; co-funded by the ‘Fondo Europeo de Desarrollo Regional’)
Censos d’establiments i serveis en l’àmbit de la protecció de la salut: mapa de gestió de riscos
Full text linkProtecció de la salut; Censos; Mapes de riscosHealth protection; Censuses; Risk mapsProtección de la salud; Censos; Mapas de riesgosEl document “Censos d’establiments i serveis en l’àmbit de la protecció de la salut” que ara es presenta, va ser elaborat el primer trimestre del 2025 com a document intern de treball per als professionals de la Secretaria de Salut Pública (Agència de Salut Pública de Catalunya-ASPCAT). Aquesta memòria ofereix el recull de la informació disponible sobre els censos i la tipologia dels establiments i objectes d’intervenció en l’àmbit de la protecció de la salut, a partir de les dades extretes el 31.12.2024 del Registre sanitari d’indústries i productes alimentaris de Catalunya (RSIPAC), del Registre oficial d’establiments i serveis plaguicides (ROESP) i de la informació facilitada per les Subdireccions Regionals i l’Agència de Salut Pública de Barcelona a través del Sistema d’Informació de Protecció de la Salut (CEAPS)
A Closer Look at Periocular Necrotizing Fasciitis: A Systematic Review of Literature
Full text linkStreptococcus pyogenes; Eye infections; Necrotizing fasciitisStreptococcus pyogenes; Infeccions oculars; Fasciïtis necrotitzantStreptococcus pyogenes; Infecciones oculares; Fascitis necrotizanteBackground: Periocular necrotizing fasciitis (PNF) is a rare but life-threatening emergency that requires immediate recognition, as delayed diagnosis can worsen patient outcomes. To address this critical issue, we conducted the largest and most comprehensive systematic review to date, providing valuable insights into the diagnosis and treatment of PNF to improve clinical practice and patient prognosis. Methods: A search on Pubmed, Scopus, Embase, and WOS from January 2013 to August 2024 was performed. Only the cases of NF affecting the periocular region were included with no age limitations. Article selection and data extraction were performed independently by two investigators to avoid bias. Bias on individual studies is low as they represent case reports or case series, and publication bias is partially addressed including all the large case series even if no individual data could be retrieved. Results: The cohort included a total of 183 patients with PNF, with detailed patient-specific data for 107 individuals and only aggregated data for another 76. The average age at diagnosis was 54.2 years, and females constituted 44% of the population sample. Notably, 49.6% of the patients were immunocompromised. Streptococcus pyogenes was the predominant causative organism, identified in 79.8% of the cases. Most infections were unilateral (72.1%) without extension beyond the periocular area (54.7%). Most patients (89.6%) underwent surgical debridement alongside intravenous antibiotics. Septic shock occurred in 26.8% of the patients, and the overall mortality rate was 4.9%. Visual acuity was unaffected in 67.5% of the patients, though 18.2% progressed to blindness on the affected side. Reconstructive efforts predominantly involved skin grafting, both free and local pedunculate flaps as well as secondary healing in some instances. Conclusions: This systematic review summarizes the understanding of periocular necrotizing fasciitis’ (PNF) demographic trends, clinical manifestations, causative pathogens, and patient outcomes. Vigilance for PNF should be heightened when the clinical assessment of the patient’s eyelids reveals rapidly spreading edema and induration, subcutaneous emphysema, or necrotic bullae and/or eschar. Prompt identification and expedited intervention, including debridement and targeted antibiotic therapy, critically influence prognosis. Despite optimal management, patients may still suffer from significant aesthetic impairment, severe complications such as vision loss, or death due to septic shock
A comparative analysis of risk stratification tools in SSc-associated pulmonary arterial hypertension: a EUSTAR analysis
Full text linkPulmonary arterial hypertension; Risk stratification; Systemic sclerosisHipertensió arterial pulmonar; Estratificació del risc; Esclerosi sistèmicaHipertensión arterial pulmonar; Estratificación del riesgo; Esclerosis sistémicaObjectives
The 2022 European Society of Cardiology and European Respiratory Society (ESC/ERS) guidelines for pulmonary arterial hypertension (PAH) recommend risk stratification to optimize management. However, the performance of generic PAH risk stratification tools in patients with SSc-associated PAH remains unclear. Our objective was to identify the most accurate approach for risk stratification at SSc-PAH diagnosis.
Methods
In this multicentre, international cohort study from the European Scleroderma Trials and Research (EUSTAR) group database, we screened 11 risk stratification tools upon SSc-PAH diagnosis. We compared the performance of the three top-ranked tools to predict mortality with the ESC/ERS three-strata model, the currently recommended tool for baseline risk assessment. We also assessed the impact of incorporating SSc-specific characteristics into the tools. Kaplan–Meier analyses and Cox regression with area under the ROC curve (AUC) were conducted.
Results
The ESC/ERS three-strata model had a lower ability to predict mortality than the ESC/ERS four-strata model, ‘SPAHR updated’ and ‘REVEAL Lite 2’. The ESC/ERS four-strata model divided ‘intermediate-risk’ patients into two groups with significantly different long-term survival rates and is the easiest applicable tool. Incorporating SSc-specific characteristics did not significantly improve the predictive ability of any model, but a low diffusing capacity of the lung for carbon monoxide (DLCO) was an independent predictor of mortality.
Conclusion
Considering its ability to predict mortality, risk segregation capabilities and clinical applicability, this study provides a rationale for using the simplified ESC/ERS four-strata model at SSc-PAH diagnosis as an alternative to the comprehensive ESC/ERS three-strata model. We propose considering DLCO as an individual prognostic marker in SSc-PAH
Profile and Usefulness of Serum Cytokines to Predict Prognosis in Myelin Oligodendrocyte Glycoprotein Antibody−Associated Disease
Full text linkSerum Cytokines; Prognosis; Myelin oligodendrocyte glycoproteinCitocinas séricas; Pronóstico; Glicoproteína de oligodendrocitos de mielinaCitocines sèriques; Pronòstic; Glicoproteïna d'oligodendròcits de mielinaObjectives
To characterize the serum cytokine profile in myelin oligodendrocyte glycoprotein antibody–associated disease (MOGAD) at onset and during follow-up and assess their utility for predicting relapses and disability.
Methods
This retrospective multicentric cohort study included patients aged 16 years and older meeting MOGAD 2023 criteria, with serum samples collected at baseline (≤3 months from disease onset) and follow-up (≥6 months from the baseline), and age-matched and time to sampling–matched patients with multiple sclerosis (MS). Eleven cytokines were assessed using the ELLA system. Data comparisons and statistical analyses between cytokine levels and clinical outcomes were performed.
Results
Eighty-eight patients with MOGAD and 32 patients with MS were included. Patients with MOGAD showed higher IL6 (p = 0.036), IL8 (p = 0.012), and IL18 (p = 0.026) baseline levels compared with those with MS, in non–optic neuritis (ON) presentations. BAFF values increased over time, especially in patients with MOGAD treated with anti-CD20 (p = 0.002). Baseline BAFF, CXCL10, IL10, and IL8 levels correlated with disease severity at MOGAD onset (all p < 0.05). Finally, higher baseline BAFF levels predicted lower risk of relapses (hazard ratio 0.41 [0.19; 0.89], p = 0.024).
Discussion
This study suggests a proinflammatory Th17-dominant profile in non-ON MOGAD patients, with a novel finding of a potential protective role of BAFF on relapses. These results shed new light on the pathogenesis of MOGAD, potentially guiding therapeutic decisions.This study has been funded by Instituto Carlos III through the projects PI20/00800 granted to A.C.-C. and Fondation pour l'aide à la recherche sur la sclérose en plaques (ARSEP) (ARSEP-1276). A. Cobo-Calvo is supported by Joan Rodes contract JR19/00007 and Javier Villacieros-Álvarez by P-FIS grant FI21/00282
Left Ventricular Elastance With Resting Volumetric Transthoracic Echocardiography Identifies Different Phenotypes in Heart Failure With Preserved Ejection Fraction: A Retrospective Analysis of a Multicenter Prospective Observational Study
Full text linkEchocardiography; Heart failure; PhenotypeEcocardiografia; Insuficiència cardíaca; FenotipEcocardiografía; Insuficiencia cardíaca; FenotipoBackground: Heart failure with preserved ejection fraction (HFpEF) is a heterogeneous entity including different phenotypes of near normal, normal, and supernormal left ventricular (LV) function. The aim of this study was to assess the value of resting LV elastance (also known as force) using transthoracic echocardiography to identify HFpEF phenotypes.
Methods: In a prospective, observational, multicenter study, 2,380 patients with HFpEF were recruited from July 2016 to May 2024. Systolic blood pressure (SBP) was measured. LV end-diastolic volume (LVEDV), LV end-systolic volume (LVESV), LV ejection fraction, force (SBP/LVESV), stroke volume (SV), arterial elastance, ventricular-arterial coupling, and left atrial volume index were assessed. Global longitudinal strain was available in 1,164 patients (48.9%). Six hundred eighty patients finished follow-up with a composite endpoint of major adverse cardiac events (MACEs). Patients were divided into three groups: group 1, low force (75th percentile, >5.48 mmHg/mL).
Results: The three groups showed a gradient with descending values (group 3 > group 2 > group 1) for SBP, LV ejection fraction, global longitudinal strain, arterial elastance, and ventricular-arterial coupling, with the opposite gradient (group 1 > group 2 > group 3) for LVEDV, LVESV, SV, and left atrial volume index values (P < .01 for all). After a median follow-up period of 16 months, 205 MACEs occurred in 138 patients. The cumulative MACE rate was lowest in group 2 (14.7% person-years) and higher in groups 1 (16.1% person-years) and 3 (22.9% person-years; log-rank P = .036).
Conclusions: Patients with HFpEF present with different LV contractile phenotypes, easily identified with resting LV force and volumetric transthoracic echocardiography. The dominant hemodynamic feature of hypocontractile phenotype is a preload recruitment with larger LVEDV and normal SV, while the hypercontractile phenotype is characterized by a small left ventricle with reduced SV. The hypercontractile and hypocontractile phenotypes are associated with a higher risk for subsequent events
Blood-based prognostic scores and early dynamics under immunotherapy to select patients with metastatic solid tumors for continuing immune check-point inhibition: a prospective longitudinal study
Get PDFCancer; Immune check-point inhibitors; ImmunotherapyCàncer; Inhibidors dels punts de control immunitari; ImmunoteràpiaCáncer; Inhibidores de puntos de control inmunitario; InmunoterapiaIntroduction: Immune check-point inhibitors (ICI) were a major breakthrough in cancer care, but optimal patient selection remains elusive in most tumors.
Methods: Overall 173 adult patients with metastatic solid tumors candidates to ICI in clinical trials at our Institution were prospectively recruited. Blood samples were collected at cycle 1 (C1D1) and 2 (C2D1) and until the occurrence of progressive disease (PD). C1D1 LIPI, RMH, PMHI, NLR, dNLR, PIPO and GRIm prognostic scores were calculated. The primary endpoint was identifying the best score to predict rapid PD (≤ 4 months) with ICI using logistic regressions accounting for tumor type, and receiving operators characteristics (ROC) with area under curve (AUC), accompanied by an extensive comparison of the score performances in the prediction of overall survival (OS), progression-free survival (PFS), overall response rates (ORR) and durable clinical benefit (DCB). Secondary objectives included describing study cohort outcomes and studying the association between the selected score at C1D1, C2D1 and its dynamics with OS and PFS.
Results: C1D1 LIPI was the best predictor of rapid PD, OS and PFS, regardless of cancer type, compared to other scores. No score was associated to ORR and only RMH to DCB. Baseline LIPI detected three categories of patients with significantly different OS (p < 0.001) and PFS (p = 0.013). The same was observed at C2D1 for OS and PFS (both p = 0.020). Significant LIPI class shifts were observed in the overall population (p < 0.001), rapid progressors (p = 0.029) and non-rapid progressors (p = 0.009). Retaining a good LIPI or experiencing a shift towards a better prognostic class was associated to improved OS (p = 0.009) and PFS (p = 0.006). C2D1 LIPI, but not C1D1, remained significantly associated to rapid PD in multivariable analysis.
Conclusions: LIPI may improve patient selection for ICI and guide treatment adjustments according to on-treatment dynamics in a pancancer context.Open Access funding provided thanks to the CRUE-CSIC agreement with Springer Nature
Escáner ultrasónico portátil para medir el volumen de orina en la vejiga en pacientes adultos hospitalizados con sospecha de retención urinaria
Full text linkEscàners; Ultrasons; Bufeta urinària; Retenció urinàriaEscáners; Ultrasonidos; Vejiga; Retención urinariaScanners; Ultrasound; Bladder; Urinary retentionAquest informe té per objectiu l'avaluació de l'evidència de l'escàner ultrasònic portàtil de bufeta amb marcatge CE en la valoració de la necessitat de sondatge vesical en pacients adults hospitalitzats amb sospita de retenció urinària, en comparació amb la pràctica clínica habitual, a través d'una revisió sistemàtica de la literatura que comprèn l'anàlisi de la seguretat clínica, eficàcia, efectivitat clínica i eficiència.Este informe tiene como objetivo la evaluación de la evidencia del escáner ultrasónico portátil de vejiga con marcado CE en la valoración de la necesidad de sondaje vesical en pacientes adultos hospitalizados con sospecha de retención urinaria, en comparación con la práctica clínica habitual, mediante una revisión sistemática de la literatura que comprende el análisis de la seguridad clínica, la eficacia, la efectividad clínica y la eficiencia.This report aims to evaluate the evidence on the CE-marked portable bladder ultrasound scanner for assessing the need for bladder catheterization in hospitalized adult patients with suspected urinary retention, in comparison with standard clinical practice, through a systematic review of the literature that includes analysis of clinical safety, efficacy, clinical effectiveness, and efficiency