Journal: Communications Medicine

Abbreviation

Commun Med

Publisher

Nature

Journal Volumes

ISSN

2730-664X

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2021 - 202512
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Publications 1 - 10 of 12
  • Mitigating Bias in Machine Learning for Medicine
    Item type: Other Journal Item
    Vokinger, Kerstin Noëlle; Feuerriegel, Stefan; Kesselheim, Aaron S. (2021)
    Communications Medicine
    Several sources of bias can affect the performance of machine learning systems used in medicine and potentially impact clinical care. Here, we discuss solutions to mitigate bias across the different development steps of machine learning-based systems for medical applications.
  • Surgical and transcatheter aortic valve replacement after orthotopic heart transplantation: a case series
    Item type: Journal Article
    Roehrich , Luise; Hinkov , Hristian; Knosalla , Christoph; et al. (2025)
    Communications Medicine
    Background Aortic valve dysfunction is a rare but relevant long-term complication after orthotopic heart transplantation (HTX). Treatment options include surgical (SAVR) and transcatheter (TAVR) aortic valve replacement, but evidence is limited to the level of case reports. Methods A total of 2054 patients underwent HTX between 1986 and 2023 at the Deutsches Herzzentrum der Charité, Berlin, Germany, 16 of them underwent aortic valve replacement (SAVR, N = 7; TAVR, N = 9) after HTX. In this case series we report on the outcomes of these 16 patients (age 29-73 years). Results Isolated aortic valve regurgitation occurs in 5 (31%) patients (TAVR N = 1, SAVR N = 4), while 11 patients (69%) suffer from aortic valve stenosis. Severe pre-procedural heart failure is present in 38% of the patients. Thirty-day mortality is 0%, in-hospital mortality is N = 2 (22%) patients due to sepsis, both patients were severely decompensated prior to TAVR. An uneventful postoperative course occurs in 8 (50%) patients, the patient’s functional status improves in 12 (75%) cases. Conclusion TAVR is the increasingly preferred treatment for aortic valve dysfunction after heart transplantation, but SAVR is a feasible alternative for individuals who are ineligible for TAVR. Further information is needed on the appropriate procedural timing in these high-risk patients.
  • Impact of commonly administered drugs on the progression of spinal cord injury: a systematic review
    Item type: Journal Article
    Bourguignon, Lucie; Lukas, Louis; Kondiles, Bethany R.; et al. (2024)
    Communications Medicine
    BackgroundComplications arising from acute traumatic spinal cord injury (SCI) are routinely managed by various pharmacological interventions. Despite decades of clinical application, the potential impact on neurological recovery has been largely overlooked. This study aims to highlight commonly administered drugs with potential disease-modifying effects.MethodsThis systematic literature review included studies referenced in PubMed, Scopus and Web of Science from inception to March 31st, 2021, which assess disease-modifying properties on neurological and/or functional recovery of drugs routinely administered following spinal cord injury. Drug effects were classified as positive, negative, mixed, no effect, or not (statistically) reported. Risk of bias was assessed separately for animal, randomized clinical trials, and observational human studies.ResultsWe analyzed 394 studies conducting 486 experiments that evaluated 144 unique or combinations of drugs. 195 of the 464 experiments conducted on animals (42%) and one study in humans demonstrate positive disease-modifying properties on neurological and/or functional outcomes. Methylprednisolone, melatonin, estradiol, and atorvastatin are the most common drugs associated with positive effects. Two studies on morphine and ethanol report negative effects on recovery.ConclusionDespite a large heterogeneity observed in study protocols, research from bed to bench and back to bedside provides an alternative approach to identify new candidate drugs in the context of SCI. Future research in human populations is warranted to determine if introducing drugs like melatonin, estradiol, or atorvastatin would contribute to enhancing neurological outcomes after acute SCI.
  • High-resolution spatial prediction of anemia risk among children aged 6 to 59 months in low- and middle-income countries
    Item type: Journal Article
    Seiler, Johannes; Wetscher, Mattias; Harttgen, Kenneth; et al. (2025)
    Communications Medicine
    Background Anemia, a severe condition among children associated with adverse health effects such as impaired growth, limited physical and cognitive development, and increased mortality risk, remains widespread, particularly in low- and middle-income countries. This study combines Demographic and Health Surveys data with remotely sensed climate, demographic, environmental, and geo-spatial information, creating a data set comprising about 750,000 observations on childhood anemia from 37 countries. It is used to provide high-resolution spatio-temporal estimates of all forms of childhood anemia between 2005 and 2020. Methods Employing full probabilistic Bayesian distributional regression models, the research accurately predicts age-specific and spatially varying anemia risks. These models enable the assessment of the complete distribution of hemoglobin levels. Additionally, this analysis also provides predictions at a high resolution, allowing precise monitoring of this indicator, aligned with Sustainable Development Goal (SDG) 2. Results This analysis provides high-resolution estimates for all forms of anemia and reveals and identifies striking disparities within and between countries. Based on these estimates, the prevalence of anemia decreased from 65.0% [62.6%–67.4%] in sub-Saharan Africa and 63.1% [60.6%–65.5%] in South Asia in 2010 to 63.4% [60.7%–66.0%] in sub-Saharan Africa and 58.8% [56.4%–61.3%] in South Asia in 2020. This translates into approximately 98.7 [94.5–102.8] million and 95.1 [91.1–99.0] million affected children aged 6 to 59 months in 2020, respectively, making it a major public health concern. Conclusions Our approach facilitates the monitoring of age-specific spatio-temporal dynamics and the identification of hotspots related to this important global public health issue. To our knowledge, this represents the first high-resolution mapping of anemia risk in children. In addition, these results reveal striking disparities between and within countries and highlight the influence of socio-economic and environmental factors on this condition. The findings can guide efforts to improve health systems, promote education, and implement interventions that break the cycle of poverty and anemia.
  • Restoring brain connectivity by phrenic nerve stimulation in sedated and mechanically ventilated patients
    Item type: Journal Article
    Bassi, Thiago; Rohrs, Elizabeth C.; Parfait, Melodie; et al. (2024)
    Communications Medicine
    Background: In critically ill patients, deep sedation and mechanical ventilation suppress the brain-diaphragm-lung axis and are associated with cognitive issues in survivors. Methods: This exploratory crossover design study investigates whether phrenic nerve stimulation can enhance brain activity and connectivity in six deeply sedated, mechanically ventilated patients with acute respiratory distress syndrome. Results: Our findings indicate that adding phrenic stimulation on top of invasive mechanical ventilation in deeply sedated, critically ill, moderate acute respiratory distress syndrome patients increases cortical activity, connectivity, and synchronization in the frontal-temporal-parietal cortices. Conclusions: Adding phrenic stimulation on top of invasive mechanical ventilation in deeply sedated, critically ill, moderate acute respiratory distress syndrome patients increases cortical activity, connectivity, and synchronization. The observed changes resemble those during diaphragmatic breathing in awake humans. These results suggest that phrenic nerve stimulation has the potential to restore the brain-diaphragm-lung crosstalk when it has been shut down or impaired by mechanical ventilation and sedation. Further research should evaluate the clinical significance of these results.
  • Multi-resolution deep learning characterizes tertiary lymphoid structures and their prognostic relevance in solid tumors
    Item type: Journal Article
    van Rijthoven, Mart; Obahor, Simon; Pagliarulo, Fabio; et al. (2024)
    Communications Medicine
    Background: Tertiary lymphoid structures (TLSs) are dense accumulations of lymphocytes in inflamed peripheral tissues, including cancer, and are associated with improved survival and response to immunotherapy in various solid tumors. Histological TLS quantification has been proposed as a novel predictive and prognostic biomarker, but lack of standardized methods of TLS characterization hampers assessment of TLS densities across different patients, diseases, and clinical centers. Methods: We introduce an approach based on HookNet-TLS, a multi-resolution deep learning model, for automated and unbiased TLS quantification and identification of germinal centers in routine hematoxylin and eosin stained digital pathology slides. We developed HookNet-TLS using n = 1019 manually annotated TCGA slides from clear cell renal cell carcinoma, muscle-invasive bladder cancer, and lung squamous cell carcinoma. Results: Here we show that HookNet-TLS automates TLS quantification across multiple cancer types achieving human-level performance and demonstrates prognostic associations similar to visual assessment. Conclusions: HookNet-TLS has the potential to be used as a tool for objective quantification of TLS in routine H&E digital pathology slides. We make HookNet-TLS publicly available to promote its use in research.
  • Ethnic disparities in publicly-available pulse oximetry databases
    Item type: Other Journal Item
    Sinaki, Fatemeh Y.; Ward, Rabab; Abbott, Derek; et al. (2022)
    Communications Medicine
    Inaccuracies have been reported in pulse oximetry measurements taken from people who identified as Black. Here, we identify substantial ethnic disparities in the population numbers within 12 pulse oximetry databases, which may affect the testing of new oximetry devices and impact patient outcomes.
  • Recommendations for evaluating photoplethysmography-based algorithms for blood pressure assessment
    Item type: Review Article
    Elgendi, Mohamed; Haugg, Fridolin; Fletcher, Richard Ribon; et al. (2024)
    Communications Medicine
    Photoplethysmography (PPG) is a non-invasive optical technique that measures changes in blood volume in the microvascular tissue bed of the body. While it shows potential as a clinical tool for blood pressure (BP) assessment and hypertension management, several sources of error can affect its performance. One such source is the PPG-based algorithm, which can lead to measurement bias and inaccuracy. Here, we review seven widely used measures to assess PPG-based algorithm performance and recommend implementing standardized error evaluation steps in their development. This standardization can reduce bias and improve the reliability and accuracy of PPG-based BP estimation, leading to better health outcomes for patients managing hypertension.
  • Optical coherence tomography quantifies gradient refractive index and mechanical stiffness gradient across the human lens
    Item type: Journal Article
    Kling, Sabine; Frigelli, Matteo; Aydemir, M. Enes; et al. (2024)
    Communications Medicine
    Background: As a key element of ocular accommodation, the inherent mechanical stiffness gradient and the gradient refractive index (GRIN) of the crystalline lens determine its deformability and optical functionality. Quantifying the GRIN profile and deformation characteristics in the lens has the potential to improve the diagnosis and follow-up of lenticular disorders and guide refractive interventions in the future. Methods: Here, we present a type of optical coherence elastography able to examine the mechanical characteristics of the human crystalline lens and the GRIN distribution in vivo. The concept is demonstrated in a case series of 12 persons through lens displacement and strain measurements in an age-mixed group of human subjects in response to an external (ambient pressure modulation) and an intrinsic (micro-fluctuations of accommodation) mechanical deformation stimulus. Results: Here we show an excellent agreement between the high-resolution strain map retrieved during steady-state micro-fluctuations and earlier reports on lens stiffness in the cortex and nucleus suggesting a 2.0 to 2.3 times stiffer cortex than the nucleus in young lenses and a 1.0 to 7.0 times stiffer nucleus than the cortex in the old lenses. Conclusions: Optical coherence tomography is suitable to quantify the internal stiffness and refractive index distribution of the crystalline lens in vivo and thus might contribute to reveal its inner working mechanism. Our methodology provides new routes for ophthalmic pre-surgical examinations and basic research.
  • Oral microbiome diversity associates with carotid intima media thickness in middle-aged male subjects
    Item type: Journal Article
    Akhi, Ramin; Lavrinienko, Anton; Hakula, Miia; et al. (2025)
    Communications Medicine
    Background Although there have been significant advancements in reducing the burden of cardiovascular disease (CVD) by modifying traditional CVD risk factors, substantial risks persist, particularly among male subjects who exhibit heightened susceptibility to atherosclerosis. In this context, we aim to study the link between oral microbiome and carotid intima media thickness (cIMT). Methods The Northern Finland Birth Cohort of 1966 (mean age 46 years, n = 869) underwent an extensive health examination, including the measurement of cIMT. The oral microbiome was also investigated using high-throughput 16S rRNA gene sequencing. Results Here we show that oral microbiome diversity links with atherosclerosis risk factors, namely smoking, glycemic balance, low-grade inflammation, and periodontitis. After excluding CVD-influencing factors (n = 339), oral microbiome genera (p = 0.030), Shannon index (p = 0.001), β-diversity Bray–Curtis (p < 0.001), and Jaccard (p < 0.001) are associated with cIMT in males, but not in the female sub-cohort. Furthermore, in the male sub-cohort (n = 131), the genera Prevotella, Megasphaera, and Veillonella associate positively with cIMT, while Absconditabacteria, Capnocytophaga, Gemella, Fusobacterium, Neisseria, Aggregatibacter, Tannerella, Treponema, Cardiobacterium, and Bacteroidales associate inversely with cIMT. We examine the involvement of serum total immunoglobulins and antibodies to phosphorylcholine (PCho) and malondialdehyde-acetaldehyde LDL (MAA-LDL) with cIMT. Subjects with high cIMT have lower levels of serum total IgA (p = 0.009), IgA to PCho (p = 0.017), and IgG to PCho (p = 0.008). The relative abundance of cIMT-associated genera correlates with serum IgA antibodies. Conclusions This middle-aged birth cohort study shows that male oral microbiome diversity links to cIMT, suggesting a potential sex-specific interaction between the oral microbiome and atherosclerosis.
Publications 1 - 10 of 12