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To evaluate the clinical benefit of new medicines for type 2 diabetes mellitus (T2DM), the Dutch guideline committee T2DM in primary care established the importance of outcomes and minimal clinically important differences (MCIDs). The present study used an online questionnaire to investigate healthcare professionals' opinions about the importance of outcomes and preferences for MCIDs. A total of 211 physicians, pharmacists, practice nurses, diabetes nurses, nurse practitioners and physician assistants evaluated the importance of mortality, macro- and microvascular morbidity, HbA1c, body weight, quality of life, (overall) hospital admissions and severe and other hypoglycemia on a 9-point scale. All outcomes were considered critical (mean scores 7-9), except for body weight and other hypoglycemia (mean scores 4-6). Only HbA1c and hospital admissions were valued differently by the guideline committee (not critical). Other relevant outcomes according to the respondents were adverse events, ease of use and costs. Median MCIDs were 4 mmol/mol for HbA1c (guideline 5 mmol/mol) and 3 kg for body weight (guideline 5 kg weight gain and 2,5 kg weight loss). Healthcare professionals preferred relative risk reductions of 20% for mortality (guideline 10%) and macrovascular morbidity (guideline 25%) and 50% for other hypoglycaemia (guideline 25%). The MCID of 25% for microvascular morbidity, hospital admissions and severe hypoglycaemia corresponded to the guideline-MCID. Healthcare professionals' preferences were thus comparable to the views of the guideline committee. However, healthcare professionals had a stricter view on the importance of HbA1c and hospital admissions and the MCIDs for mortality and other hypoglycemia.Deep learning based retinopathy classification with optical coherence tomography (OCT) images has recently attracted great attention. However, existing deep learning methods fail to work well when training and testing datasets are different due to the general issue of domain shift between datasets caused by different collection devices, subjects, imaging parameters, etc. To address this practical and challenging issue, we propose a novel deep domain adaptation (DDA) method to train a model on a labeled dataset and adapt it to an unlabelled dataset (collected under different conditions). It consists of two modules for domain alignment, that is, adversarial learning and entropy minimization. selleck inhibitor We conduct extensive experiments on three public datasets to evaluate the performance of the proposed method. The results indicate that there are large domain shifts between datasets, resulting a poor performance for conventional deep learning methods. The proposed DDA method can significantly outperform existing methods for retinopathy classification with OCT images. It achieves retinopathy classification accuracies of 0.915, 0.959 and 0.990 under three cross-domain (cross-dataset) scenarios. Moreover, it obtains a comparable performance with human experts on a dataset where no labeled data in this dataset have been used to train the proposed DDA method. We have also visualized the learnt features by using the t-distributed stochastic neighbor embedding (t-SNE) technique. The results demonstrate that the proposed method can learn discriminative features for retinopathy classification.Rare diseases affect 10% of the first-world population, yet over 95% lack even a single pharmaceutical treatment. In the present age of information, we need ways to leverage our vast data and knowledge to streamline therapeutic development and lessen this gap. Here, we develop and implement an innovative informatic approach to identify therapeutic molecules, using the Connectivity Map and LINCS L1000 databases and disease-associated transcriptional signatures and pathways. We apply this to cystic fibrosis (CF), the most common genetic disease in people of northern European ancestry leading to chronic lung disease and reduced lifespan. We selected and tested 120 small molecules in a CF cell line, finding 8 with activity, and confirmed 3 in primary CF airway epithelia. Although chemically diverse, the transcriptional profiles of the hits suggest a common mechanism associated with the unfolded protein response and/or TNFα signaling. This study highlights the power of informatics to help identify new therapies and reveal mechanistic insights while moving beyond target-centric drug discovery.
Patients with acute heart failure (AHF) often present with an increased heart rate (HR), and the HR changes dramatically after initial treatment for AHF. However, the HR change after admission and the relationship between HR change in the early phase and prognosis have not been fully elucidated.
From a multicentre AHF registry, we retrospectively evaluated 1527 consecutive patients admitted with AHF. HR change (%) was calculated by [HR (at admission)-HR (24h after admission)]×100∕HR (at admission). The median HR change was 15.1% (range, 2.0-28.4%). The HR decreased most in the first 24h and then gradually thereafter [admission 98 (81-117) b.p.m., 24h 80 (70-92) b.p.m., 48h 78 (68-90) b.p.m., and 72h 77 (67-88) b.p.m.]. In Kaplan-Meier analysis, the cumulative event-free rates in the composite endpoint of death and rehospitalization due to AHF showed better according to larger HR change (P=0.012, log rank). Cox proportional hazards analysis showed that HR change was a prognostic factor for composite endpoint adjusted by age and sex [hazard ratio, 0.995; 95% confidence interval (CI), 0.991-0.998; P=0.006]. HR change was associated with outcome adjusted by age and sex in patients with sinus rhythm (hazard ratio, 0.993; 95% CI, 0.988-0.999; P=0.015), but not in patients with atrial fibrillation (hazard ratio, 0.996; 95% CI, 0.990-1.002; P=0.15).
A decrease in HR in the first 24h after admission indicates better prognosis in patients with AHF, although the prognostic influence may differ between patients with sinus rhythm and those with atrial fibrillation.
A decrease in HR in the first 24 h after admission indicates better prognosis in patients with AHF, although the prognostic influence may differ between patients with sinus rhythm and those with atrial fibrillation.
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