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Abstract Cancer staging is an essential clinical attribute informing patient prognosis and clinical trial eligibility. However, it is not routinely recorded in structured electronic health records. Here, we present BB-TEN: Big Bird – TNM staging Extracted from Notes, a generalizable method for the automated classification of TNM stage directly from pathology report text. We train a BERT-based model using publicly available pathology reports across approximately 7000 patients and 23 cancer types. We explore the use of different model types, with differing input sizes, parameters, and model architectures. Our final model goes beyond term-extraction, inferring TNM stage from context when it is not included in the report text explicitly. As external validation, we test our model on almost 8000 pathology reports from Columbia University Medical Center, finding that our trained model achieved an AU-ROC of 0.815–0.942. This suggests that our model can be applied broadly to other institutions without additional institution-specific fine-tuning.

La intervención en el patrimonio arquitectónico precisa un estudio previo global que abarque tanto su desarrollo histórico como sus características morfológicas y constructivas, así como su relación con el entorno en que se encuentra. En este trabajo se presenta la metodología empleada para la intervención en la fortificación histórica en tapia de cal y canto de Belver de los Montes, Zamora. La interpretación de las características histórico-constructivas de los restos mediante análisis multidisciplinares permite plantear una forma coherente de abordar las obras de consolidación de un tramo del recinto, que se encuentra en un estado de conservación precario. La metodología desarrollada para este ejemplo concreto podría servir de referencia para futuras intervenciones en elementos de arquitectura fortificada de similares características.

Visual literacy is essential for engineers. Technological professions have important visual characterization, both in the transmission of information and problem-solving. This means that future engineers must be proficient at communicating, thinking, and learning visually. However, engineering curricula takes partially the need to have visually literate students. The VLEE project was established to develop learning resources to enhance engineers' visual skills and abilities. VLEE recently published the 'Visual literacy for Engineering Education Competence Framework', which, for the first time, addresses visual literacy learning specific to engineering. Our approach offers new opportunities for engineering students, following competency-based education, and attempts to contribute to a campus-wide collaborative effort to develop students' communication, learning, and critical thinking skills using visual materials. This guide is considered relevant for all educators and experts in engineering education in order to help them successfully tackle the challenges that future professionals will inevitably face in the 21st century.

Category: Ankle; Trauma Introduction/Purpose: The use of artificial intelligence (AI) is particularly salient to visually oriented medical professions, especially orthopedics. The most prominent use of AI in orthopedics comes in the form of medical imaging examinations. AI has a huge potential to help doctors make diagnoses by acting as a second pair of eyes. Some results suggested a very high level of agreement between AI models’ and the clinician’s assessments of radiographs. Furthermore, it was also suggested that the sensitivity and specificity of emergency medicine physicians for detecting some pathologies are significantly improved when aided by an AI tool. In view of these observations, our study aimed to create an AI-based ankle fracture detection tool that can be used on smart devices for X-ray interpretation. Methods: We examined 2,193 patients’ charts from 2 academic and 1 community hospital in Boston. We retrieved the anteroposterior (AP), oblique, and lateral ankle X-rays of each patient. Patients with ankle fractures and adults older than 18 years met our inclusion criteria. We excluded patients younger than 18 years old and those with any artifact, such as a cast, screws, or other artifacts in their X-rays. The study comprised 352 healthy controls and a total of 579 ankle fracture patients. Other than the digital images obtained from Electronic patient records (EPR), we used two different smart devices, a cellphone, and a tablet, to capture images from the monitor screen. Using Machine Learning models, we developed a fracture detection model using all three types of imaging and named it the “combination model”. We subsequently tested the combination model on digital X-rays, smart devices, and on both datasets together (Table 1). Results: We extracted the X-rays of a total of 931 patients in this study. Following the development and testing of our AI models, we noticed that all performed well with AUCs and accuracies above 0.85 and 0.86, respectively (Table1). The best performance was found when the combination model was tested on images taken from the camera of our smart devices, with an AUC of 0.88, a sensitivity of 0.86, and an accuracy of 0.89. This performance was closely followed by that of our model tested on a mix of both smart devices and original digital images with an AUC of 0.88, a sensitivity of 0.86, and an accuracy of 0.88. Conclusion: Our AI-based tool showed promising performance in the detection of ankle fractures using smart devices and images obtained from the monitor screen. We were able to reach an accuracy of diagnosis on smart device-captured images that were comparable with the original digital X-rays. The outcome of this study can be used to help providers who lack sufficient experience in detecting fractures. It can also be used for educational purposes for trainees in this field.

La música tiene una gran capacidad de transformación personal y social, y la práctica instrumental puede revolucionar las formas de aprendizaje hacia modelos más democráticos, inclusivos, integrales y multiculturales. Algunos proyectos como El Sistema (Caracas, Venezuela), In-Harmony (Liverpool, Reino Unido) y DaLaNota (Madrid, España) trabajan en esta línea. Este artículo propone un estudio de caso sobre [Anonimizado], único proyecto musical en España en un CEIP público de niños en riesgo de exclusión social, inserto en horario lectivo. A través de observaciones sistemáticas, entrevistas, análisis de documentos y noticias de prensa se estudian los factores de impacto del proyecto a lo largo de sus más de 10 años de andadura. Las claves de impacto pivotan sobre tres temáticas: 1) La estructura del proyecto: su flexibilidad curricular; la implicación de su profesorado; la inclusión de la música en el currículo escolar; el número de maestros de música con los que se cuenta; la participación en conciertos públicos; y la colaboración con otras instituciones. 2) Los aprendizajes: nuevas formas de enseñanza en coro, instrumento, orquesta y banda; una metodología transversalizada a través de dichas actividades y de las diversas asignaturas; un repertorio consensuado y compartido; una pluralidad de profesores invitados; y una metodología adaptada a las necesidades emocionales y sociales de los niños. 3) El paradigma Social, que aborda las tensiones surgidas en el entramado social y el impacto del proyecto en los participantes y sus familias.

Acute lymphoblastic leukemia (ALL) is the most common pediatric cancer, and the infiltration of leukemic cells is critical for disease progression and relapse. Nuclear deformability plays a critical role in cancer cell invasion through confined spaces; however, the direct impact of epigenetic changes on the nuclear deformability of leukemic cells remains unclear. Here, we characterized how 3D collagen matrix conditions induced H3K4 methylation in ALL cell lines and clinical samples. We used specific shRNA and chemical inhibitors to target WDR5 (a core subunit involved in H3K4 methylation) and determined that targeting WDR5 reduced the H3K4 methylation induced by the 3D environment and the invasiveness of ALL cells in vitro and in vivo. Intriguingly, targeting WDR5 did not reduce the adhesion or the chemotactic response of leukemia cells, suggesting a different mechanism by which H3K4 methylation might govern ALL cell invasiveness. Finally, we conducted biochemical, and biophysical experiments to determine that 3D environments promoted the alteration of the chromatin, the morphology, and the mechanical behavior of the nucleus in ALL cells. Collectively, our data suggest that 3D environments control an upregulation of H3K4 methylation in ALL cells, and targeting WDR5 might serve as a promising therapeutic target against ALL invasiveness in vivo.

Esta investigación aborda en qué medida es posible la convivencia de una práctica arteterapéutica (no formal) en un contexto formal, en particular en un centro de difícil desempeño. Para ello se han llevado a cabo a lo largo de ocho meses 50 talleres en horario lectivo con todo el alumnado de primaria. La investigación ha tratado de evidenciar las tensiones producidas por la inclusión de estos procesos basados en creación y expresión libre mediante técnicas cercanas a la performance. Dichas tensiones permiten explorar la compatibilidad de este tipo de prácticas, en principio antagónicas por sus principios y métodos, con el modelo de aprendizaje formal. Los resultados muestran que tanto el vínculo temprano como la habituación a las prácticas han ayudado a su progresiva aceptación, a un gradual diálogo con todos los agentes implicados y a la transformación de algunas de las tensiones encontradas. La investigación respalda la idea de que la convivencia es posible, al menos en un entorno de las características del centro estudiado.

Background: Diabetes mellitus (DM) has been associated with salivary disorders such as xerostomia and hyposalivation. The aim of this study was to determine the prevalence of these disorders and their risk factors in DM patients. Methods: DM patients from two health centers were included. Epidemiological and DM control‐related variables were collected. Xerostomia Inventory was filled out by the patients and unstimulated whole salivary flow was collected. Logistic regression tests were performed. Results: A total of 168 patients were included (46.4% men, 53.6% women, mean age 72.54 [SD 11.03 years]). Thirteen patients had Type 1 DM and 155 had Type 2 DM. 52.4% experienced xerostomia and 41.1% had unstimulated whole salivary flow hyposalivation. Women were more likely to suffer hyposalivation than men (OR 2.5, 95% CI 1.32–4.73; p = 0.005). Patients with T2DM were less likely to suffer UWS hyposalivation than T1DM patients (OR 0.28, 95% CI 0.08–0.95; p = 0.04). Glycemic control was not significantly worse in patients with xerostomia and hyposalivation. The drugs for the treatment of DM were not associated with salivary disorders. However, some drugs to treat other comorbidities such hypertension and neurological diseases were associated with xerostomia and hyposalivation. Conclusions: The prevalence of xerostomia and unstimulated whole salivary flow hyposalivation in patients with DM is high. Female sex, T1DM, and the use of certain non‐antidiabetic drugs increased the risk of suffering these disorders. The possible association between DM, xerostomia, and/or hyposalivation is complex and may be influenced by multiple factors. Therefore, further studies are needed to evaluate whether DM influences these salivary disorders. [ABSTRACT FROM AUTHOR]

Background MicroRNAs (miRNAs) have a crucial role in regulating immune response against infectious diseases, showing changes early in disease onset and before the detection of the pathogen. Thus, we aimed to analyze the plasma miRNA profile at COVID-19 onset to identify miRNAs as early prognostic biomarkers of severity and survival. Methods and results Plasma miRNome of 96 COVID-19 patients that developed asymptomatic/mild, moderate and severe disease was sequenced together with a group of healthy controls. Plasma immune-related biomarkers were also assessed. COVID-19 patients showed 200 significant differentially expressed (SDE) miRNAs concerning healthy controls, with upregulated putative targets of SARS-CoV-2, and inflammatory miRNAs. Among COVID-19 patients, 75 SDE miRNAs were observed in asymptomatic/mild compared to symptomatic patients, which were involved in platelet aggregation and cytokine pathways, among others. Moreover, 137 SDE miRNAs were identified between severe and moderate patients, where miRNAs targeting the SARS CoV-2 genome were the most strongly disrupted. Finally, we constructed a mortality predictive risk score (miRNA-MRS) with ten miRNAs. Patients with higher values had a higher risk of 90-days mortality (hazard ratio=4.60; p-value

Purpose: to determine whether pre-surgical treatment using long-acting somatostatin analogues (SSAs) may improve surgical outcomes in acromegaly. Methods: retrospective study of 48 patients with acromegaly operated by endoscopic transsphenoidal approach and for first time. Surgical remission was evaluated based on the 2010 criteria. Results: most patients, 83.3% (n = 40), harbored macroadenomas and 31.3% (n = 15) invasive pituitary adenomas. In this case, 14 patients were treated with lanreotide LAR and 6 with octreotide LAR, median monthly doses of 97.5 [range 60–120] and 20 [range 20–30] mg, respectively, for at least 3 months preoperatively. Presurgical variables were comparable between pre-treated and untreated patients (p > 0.05). Surgical remission was more frequent in those pre-treated with monthly doses ≥90 mg of lanreotide or ≥30 mg of octreotide than in untreated or pre-treated with lower doses (OR = 4.64, p = 0.025). However, no differences were found between pre-treated and untreated patients when lower doses were included or between those treated for longer than 6 months compared to those untreated or pre-treated for shorter than 6 months. Similarly, no differences were found either in terms of surgical or endocrine complications (OR = 0.65, p = 0.570), independently of the doses and the duration of SSA treatment (p > 0.05). Conclusions: the dose of SSAs is a key factor during pre-surgical treatment, since the beneficial effects in surgical remission were observed with monthly doses equal or higher than 90 mg of lanreotide and 30 mg of octreotide, but not with lower doses.

Objectives: To evaluate whether the severity of xerostomia in older polymedicated patients impacts oral health‐related quality of life (OHRQoL). Background: Medication‐associated xerostomia is common in older people. Xerostomia may impair OHRQoL. Materials and methods: This cross‐sectional study included older hypertensive patients from two health centres. We assessed the severity of xerostomia and OHRQoL using the Xerostomia Inventory (XI) tool, and the Oral Health Impact Profile‐14 (OHIP‐14) instrument, respectively. We measured unstimulated (UWS) and stimulated (SWS) salivary flows. Univariate and multiple linear regression analyses evaluated the associations of XI and OHIP‐14 and different explanatory variables. Results: Of the 218 patients enrolled, 51.8% had xerostomia, and 38.1% and 27.5% suffered from UWS and SWS hyposalivation, respectively. Patients with xerostomia, UWS, and SWS hyposalivation scored significantly higher on the XI. However, only those with xerostomia or UWS hyposalivation had significantly higher OHIP‐14 scores. A moderate correlation was observed between XI and OHIP‐14 scores. The multiple regression model showed that factors with the greatest impact on XI were the patient's complaint of xerostomia, UWS flow rate, age and sex. However, only the XI score was significantly associated with the OHIP‐14 score. Conclusion: Xerostomia has a negative impact on OHRQoL in older polymedicated patients, but this impact is less than in other types of xerostomia. Longitudinal studies are needed to determine whether changes in the detected explanatory variables influence XI and OHIP scores in these patients. [ABSTRACT FROM AUTHOR]

La educación musical se está encaminando hacia metodologías más inclusivas y democráticas. En ese camino, el uso de la tecnología digital es una herramienta eficaz para promover experiencias y aprendizajes que estimulen la creatividad e inclusión. Los instrumentos digitales favorecen esos objetivos en tanto se pueden adaptar a las necesidades de las personas y no requieren de habilidades musicales para su inter pretación. El estudio describe una exper i encia educativa centrada en el uso del dispositivo MotionComposer como vehículo para el desarrollo de competencias digitales, transversales y el conocimiento sobre educación musical inclusiva. El objetivo es analizar las percepciones de futuros educadores sobre las posibilidades de este dispositivo en su formación y desempeño profesional. Se realizan acciones educativas para su posterior análisis a través de observaciones y cuestionarios. Los resultados señalan las potencialidades educativas del MotionComposer como recurso que promueve la inclusión, el aprendizaje-servicio, la experimentación y expresión musical y artística, la innovación y el desarrollo de aprendizajes transdisciplinares y transversales necesarios para el desempeño profesional. Music education is moving towards more inclusive and democratic methodologies. On this path, the use of digital technology appears as an effective resource to promote experiences and learning that stimulate creativity and educational inclusion in diverse contexts. Digital instruments favor these objectives as they can be adapted to people's needs and do not require technical and musical skills for their interpretation. The present study describes an educational experience focused on the use of the MotionComposer musical device as a vehicle for the development of digital and transversal competencies and knowledge about inclusive music education in the context of educator training. The objective is to analyze the perceptions of students of the Degrees of Education about the possibilities offered by this device in their training and professional performance. Several educational actions have been carried out for subsequent analysis through observations and questionnaires. The results highlight the educational potential of MotionComposer as a resource that promotes inclusion, service-learning, musical experimentation and expression, innovation and the development of transdisciplinary and transversal learning necessary for the professional performance of future educators. [ABSTRACT FROM AUTHOR]

Purpose: To evaluate whether presurgical treatment using long-acting somatostatin receptor ligands (SRL) may change pituitary tumor consistency and improve surgical outcome in GH-secreting pituitary macroadenomas. Methods: Retrospective study of 40 patients with GH-secreting pituitary macroadenomas operated for the first time by endoscopic transsphenoidal approa ch. Tumor consistency was evaluated intraoperatively and then correlated with histopa thological fibrosis parameters and surgical outcomes. Surgical remission was report ed based on the 2010 criteria. Results: The mean tumor size of GH-secreting macroadenomas was of 16.9 ± 8.2 mm and 25 were invasive pituitary adenomas (PAs). Presurgical treatment with long-acting SRL was performed in 17 patients (11 lanreotide, 6 octreotide). The cure rate was higher in those patients pre-treated with monthly doses ≥30 mg of octreotide or ≥90 mg of lanreotide than in those treated with lower doses or untreated (8/11 (72.7%) vs 11/29 (37.9%), P = 0.049). However, although the proportion of soft tumors increased as higher doses of SRL were considered in the pre-treated group, no stati stical significance was reached, even when the highest approved monthly doses were used (6/6 (100%) vs 23/34 (67.7%), P = 0.102). Moreover, we found that the remission rate was similar between fibrous and soft tumors (P = 0.873) and also of surgical complications (P = 0.859), despite of the higher prevalence of Knosp >2 (P = 0.035) and very large PA (P = 0.025) in fibrous tumors than in soft tumors. Conclusions: Although presurgical treatment with high doses of SRL was associated with a 2.2-fold greater chance of surgical remission, this benefit was not related with changes in tumor consistency induced by the presurgical treatment.

Backgroundmetabolic changes through SARS-CoV-2 infection has been reported but not fully comprehended. This metabolic dysregulation affects multiple organs during COVID-19 and its early detection can be used as a prognosis marker of severity. Therefore, we aimed to characterize metabolic and cytokine profile at COVID-19 onset and its relationship with disease severity to identify metabolic profiles predicting disease progression.Material and Methodswe performed a retrospective cross-sectional study in 123 COVID-19 patients which were stratified as asymptomatic/mild, moderate and severe according to the highest COVID-19 severity status, and a group of healthy controls. We performed an untargeted plasma metabolic profiling (gas chromatography and capillary electrophoresis-mass spectrometry (GC and CE-MS)) and cytokine evaluation.ResultsAfter data filtering and identification we observed 105 metabolites dysregulated (66 GC-MS and 40 CE-MS) which shown different expression patterns for each COVID-19 severity status. These metabolites belonged to different metabolic pathways including amino acid, energy, and nitrogen metabolism among others. Severity-specific metabolic dysregulation was observed, as an increased transformation of L-tryptophan into L-kynurenine. Thus, metabolic profiling at hospital admission differentiate between severe and moderate patients in the later phase of worse evolution. Several plasma pro-inflammatory biomarkers showed significant correlation with deregulated metabolites, specially with L-kynurenine and L-tryptophan. Finally, we describe a strong sex-related dysregulation of metabolites, cytokines and chemokines between severe and moderate patients. In conclusion, metabolic profiling of COVID-19 patients at disease onset is a powerful tool to unravel the SARS-CoV-2 molecular pathogenesis.ConclusionsThis technique makes it possible to identify metabolic phenoconversion that predicts disease progression and explains the pronounced pathogenesis differences between sexes.

PurposeTo evaluate which radiological classification, Knosp, revised-Knosp, or Hardy–Wilson classification, is better for the prediction of surgical outcomes in the endoscopic endonasal transsphenoidal (EET) surgery of pituitary adenomas (PAs).MethodsThis is a retrospective study of patients with PAs who underwent EET PA resection for the first time between January 2009 and December 2020. Radiological cavernous sinus invasiveness was defined as a Knosp or revised-Knosp grade >2 or a grade E in the Hardy–Wilson classification.ResultsA total of 228 patients with PAs were included. Cavernous sinus invasion was evident in 35.1% and suprasellar extension was evident in 74.6%. Overall, surgical cure was achieved in 64.3% of patients. Surgical cure was lower in invasive PAs than in non-invasive PAs (28.8% vs. 83.1%, p < 0.0001), and the risk of major complications was higher (13.8% vs. 3.4%, p = 0.003). The rate of surgical cure decreased as the grade of Knosp increased (p < 0.001), whereas the risk of complications increased (p < 0.001). Patients with Knosp 3B PAs tended to achieve surgical cure less commonly than Knosp 3A PAs (30.0% vs. 56.0%, p = 0.164). Similar results were observed based on the invasion and extension of Hardy–Wilson classification (stage A–C 83.1% vs. E 28.8% p < 0.0001, grade 0–II 81.1% vs. III–IV 59.7% p = 0.008). The Knosp classification offered the greatest diagnostic accuracy for the prediction of surgical cure (AUC 0.820), whereas the invasion Hardy–Wilson classification lacked utility for this purpose (AUC 0.654).ConclusionThe Knosp classifications offer a good orientation for the estimation of surgical cure and the risk of complications in patients with PAs submitted to EET surgery. However, the invasion Hardy–Wilson scale lacks utility for this purpose.