搜索结果：Case reports in transplantation

In 2004, Dai, Lathrop, Lutz, and Mayordomo defined and investigated the finite-state dimension (a finite-state version of algorithmic dimension) of a sequence $S \in Σ^\infty$ and, in 2018, Case and Lutz defined and investigated the mutual (algorithmic) dimension between two sequences $S \in Σ^\infty$ and $T \in Σ^\infty$. In this paper, we propose a definition for the lower and upper finite-state mutual dimensions $mdim_{FS}(S:T)$ and $Mdim_{FS}(S:T)$ between two sequences $S \in Σ^\infty$ and $T \in Σ^\infty$ over an alphabet $Σ$. Intuitively, the finite-state dimension of a sequence $S \in Σ^\infty$ represents the density of finite-state information contained within $S$, while the finite-state mutual dimension between two sequences $S \in Σ^\infty$ and $T \in Σ^\infty$ represents the density of finite-state information shared by $S$ and $T$. Thus ``finite-state mutual dimension'' can be viewed as a ``finite-state'' version of mutual dimension and as a ``mutual'' version of finite-state dimension. The main results of this investigation are as follows. First, we show that finite-state mutual dimension, defined using information-lossless finite-state compressors, has all of the pro

Ensemble learning is a widespread technique to improve the prediction performance of neural networks. However, it comes at the price of increased memory and inference time. In this work we propose a novel model fusion technique called \emph{Neuron Transplantation (NT)} in which we fuse an ensemble of models by transplanting important neurons from all ensemble members into the vacant space obtained by pruning insignificant neurons. An initial loss in performance post-transplantation can be quickly recovered via fine-tuning, consistently outperforming individual ensemble members of the same model capacity and architecture. Furthermore, NT enables all the ensemble members to be jointly pruned and jointly trained in a combined model. Comparing it to alignment-based averaging (like Optimal-Transport-fusion), it requires less fine-tuning than the corresponding OT-fused model, the fusion itself is faster and requires less memory, while the resulting model performance is comparable or better. The code is available under the following link: https://github.com/masterbaer/neuron-transplantation.

A set $S\subseteq V$ is a dominating set of $G$ if every vertex in $V - S$ is adjacent to at least one vertex in $S$. The domination number $γ(G)$ of $G$ equals the minimum cardinality of a dominating set $S$ in $G$; we say that such a set $S$ is a $γ$-set. A generalization of this is partial domination which was introduced in 2017 by Case, Hedetniemi, Laskar, and Lipman [3,2] . In partial domination a set $S$ is a $p$-dominating set if it dominates a proportion $p$ of the vertices in $V$. The p-domination number $γ_{p}(G)$ is the minimum cardinality of a $p$-dominating set in $G$. In this paper, we investigate further properties of partial dominating sets, particularly ones related to graph products and locating partial dominating sets. We also introduce the concept of a $p$-influencing set as the union of all $p$-dominating sets for a fixed $p$ and investigate some of its properties.

This study presents an Initial Data Analysis (IDA) of the German Transplantation Registry (TxReg) data for a better data understanding and to inform future data analyses. The IDA is focusing on data on first-time kidney-only transplantations in adult recipients from deceased donors between 2006 and 2016 and refers to data from 14,954 recipients and 9,964 donors across 25 tables. Investigated aspects include missing data patterns and structure, data consistency, and availability of event time data. Results show that missing data proportions vary widely, with some tables nearly complete while others have over 50% missing values. Missing data patterns are identified using a decision tree approach. An influx and outflux analysis demonstrates that some variables have high potential for imputing missing data, while others were less suitable for imputation. We identified 168 multi-sourced variables that are reported by multiple data providers in parallel leading to discrepancies for some variables but also providing opportunities for missing data imputation. Our findings on event time data demonstrate the importance of carefully selecting the variables used for event time analyses as resu

Renal transplantation emerges as the most effective solution for end-stage renal disease. Occurring from complex causes, a substantial risk of transplant chronic dysfunction persists and may lead to graft loss. Medical imaging plays a substantial role in renal transplant monitoring in clinical practice. However, graft supervision is multi-disciplinary, notably joining nephrology, urology, and radiology, while identifying robust biomarkers from such high-dimensional and complex data for prognosis is challenging. In this work, taking inspiration from the recent success of Large Language Models (LLMs), we propose MEDIMP -- Medical Images with clinical Prompts -- a model to learn meaningful multi-modal representations of renal transplant Dynamic Contrast-Enhanced Magnetic Resonance Imaging (DCE MRI) by incorporating structural clinicobiological data after translating them into text prompts. MEDIMP is based on contrastive learning from joint text-image paired embeddings to perform this challenging task. Moreover, we propose a framework that generates medical prompts using automatic textual data augmentations from LLMs. Our goal is to learn meaningful manifolds of renal transplant DCE MR

Purpose: We investigated the utilization of privacy-preserving, locally-deployed, open-source Large Language Models (LLMs) to extract diagnostic information from free-text cardiovascular magnetic resonance (CMR) reports. Materials and Methods: We evaluated nine open-source LLMs on their ability to identify diagnoses and classify patients into various cardiac diagnostic categories based on descriptive findings in 109 clinical CMR reports. Performance was quantified using standard classification metrics including accuracy, precision, recall, and F1 score. We also employed confusion matrices to examine patterns of misclassification across models. Results: Most open-source LLMs demonstrated exceptional performance in classifying reports into different diagnostic categories. Google's Gemma2 model achieved the highest average F1 score of 0.98, followed by Qwen2.5:32B and DeepseekR1-32B with F1 scores of 0.96 and 0.95, respectively. All other evaluated models attained average scores above 0.93, with Mistral and DeepseekR1-7B being the only exceptions. The top four LLMs outperformed our board-certified cardiologist (F1 score of 0.94) across all evaluation metrics in analyzing CMR reports.

Liver transplantation continues to be the gold standard for treating patients with end-stage liver diseases. However, despite the huge success of liver transplantation in improving patient outcomes, long term graft survival continues to be a major problem. The current clinical practice in the management of liver transplant patients is centered around immunosuppressive multidrug regimens. Current research has been focusing on phenotypic personalized medicine as a novel approach in the optimization of immunosuppression, a regressional math modeling focusing on individual patient dose and response using specific markers like transaminases. A prospective area of study includes the development of a mechanistic computational math modeling for optimizing immunosuppression to improve patient outcomes and increase long-term graft survival by exploring the intricate immune/drug interactions to help us further our understanding and management of medical problems like transplants, autoimmunity, and cancer therapy. Thus, by increasing long-term graft survival, the need for redo transplants will decrease, which will free up organs and potentially help with the organ shortage problem promoting eq

Numerous tutorials and research papers focus on methods in either survival analysis or causal inference, leaving common complications in medical studies unaddressed. In practice one must handle problems jointly, without the luxury of ignoring essential features of the data structure. In this paper, we follow incident cases of end-stage renal disease and examine the effect on all-cause mortality of starting treatment with transplant, so-called pre-emptive kidney transplantation, versus dialysis. The question is relatively simple: which treatment start is expected to bring the best survival for a target population? To address the question, we emulate a target trial drawing on the Swedish Renal Registry to estimate a causal effect on survival curves. Aware of important challenges, we see how previous studies have selected patients into treatment groups based on events occurring post treatment initiation. Our study reveals the dramatic impact of resulting immortal time bias and other typical features of long term incident disease registries, including: missing or mismeasured covariates during (the early) phases of the register, varying risk profile of patients entering treatment groups

In clinical studies, the risk of the primary (terminal) event may be modified by intermediate events, resulting in semicompeting risks. To study the treatment effect on the terminal event mediated by the intermediate event, researchers wish to decompose the total effect into direct and indirect effects. In this article, we extend the randomized interventional approach to time-to-event outcomes, where both intermediate and terminal events are subject to right censoring. We envision a random draw for the intermediate event process from a reference distribution, either marginally over time-varying confounders or conditionally given the observed history. We present the identification formula for interventional effects. We also discuss some variants of the identification assumptions. We estimate the treatment effects using nonparametric maximum likelihood estimation and propose a sensitivity analysis that incorporates a latent frailty. As an illustration, we study the effect of matched unrelated donor versus haploidentical donor on death mediated by relapse in a hematopoietic cell transplantation study with graft-versus-host disease (GVHD) as the time-varying confounder. We find that ma

This study aimed to investigate the effects of genetic polymorphisms on tacrolimus blood levels and intra-individual variability in recipients of heart transplants during the early post-transplantation period. Demographic information, concomitant medications, daily tacrolimus dose, trough concentration, and physiological and biochemical information of 87 Chinese recipients of heart transplants were collected. Trough concentrations were determined using a chemiluminescent micro-particle immunoassay, and 17 selected single nucleic acid polymorphisms were genotyped by direct sequencing. We assessed intra-individual variability by calculating the coefficient of variation of tacrolimus trough concentration and analyzed factors associated with tacrolimus concentration and intra-individual variability. Our study found that low body weight and a high percentage of neutrophils significantly influenced the coefficient of variation of tacrolimus. CYP3A5*1D and CYP3A7 rs776744 haplotypes correlated significantly with an intra-individual coefficient of variation of tacrolimus trough concentration during the early postoperative period. Patients with the CYP3A5*1D rs15524 and CYP3A7 rs776744 TT h

Graft-versus-host disease (GVHD) is a rare but often fatal complication in liver transplantation, with a very high mortality rate. By harnessing multi-modal deep learning methods to integrate heterogeneous and imbalanced electronic health records (EHR), we aim to advance early prediction of GVHD, paving the way for timely intervention and improved patient outcomes. In this study, we analyzed pre-transplant electronic health records (EHR) spanning the period before surgery for 2,100 liver transplantation patients, including 42 cases of graft-versus-host disease (GVHD), from a cohort treated at Mayo Clinic between 1992 and 2025. The dataset comprised four major modalities: patient demographics, laboratory tests, diagnoses, and medications. We developed a multi-modal deep learning framework that dynamically fuses these modalities, handles irregular records with missing values, and addresses extreme class imbalance through AUC-based optimization. The developed framework outperforms all single-modal and multi-modal machine learning baselines, achieving an AUC of 0.836, an AUPRC of 0.157, a recall of 0.768, and a specificity of 0.803. It also demonstrates the effectiveness of our approac

The study of disparities in the liver transplantation process may focus on quantifying causal effects, particularly the average, direct, or indirect effects of various social determinants of health on being listed as a candidate for transplant. Selection bias arises when the data sample does not represent the target population, defined here as all individuals referred to the transplant clinic. Listing decisions are made for the subset of patients who complete the evaluation process, who may differ systematically from the referred population. There is evidence that selection is associated with patient characteristics that also impact outcomes. Using data only from the selected population may yield biased causal effect estimates. However, incorporating data from the referred population allows for analytic correction. This correction leverages hypothesized causal relationships among selection, the outcome (getting listed), exposures, and mediators. Using directed acyclic graphs (DAGs), we establish graphical conditions under which a reweighted mediation formula identifies effect of interest - direct, indirect, and path-specific effects - in the presence of sample selection. In a clini

The ability to estimate and predict pathogen variant dynamics can inform public health responses, including planning for increased transmission or severity, shifts in population immunity, or changes to vaccine or therapeutic effectiveness. The COVID-19 pandemic demonstrated the importance of monitoring SARS-CoV-2 variant evolution through viral genome sequencing, enabling predictive models to estimate variant frequencies in the recent past, present, and short-term future. Collaborative forecasting Hubs provided a valuable way to centralize predictive modeling of epidemiological indicators such as cases, hospitalizations, and deaths during the pandemic; however, none existed for variant dynamics. Here, we discuss the creation of the United States SARS-CoV-2 Variant Nowcast Hub, designed to solicit estimates of the relative abundance of a specified set of SARS-CoV-2 variants at the U.S. state level. We discuss the design decisions and challenges in building the Hub and its scoring procedures. Using submissions from the Hub's first respiratory virus season (nowcast dates October 9th, 2024 to June 4th, 2025), we evaluate five individual models and a baseline model. We found that the ba

Context. JavaScript is a popular programming language today with several implementations competing for market dominance. Although a specification document and a conformance test suite exist to guide engine development, bugs occur and have important practical consequences. Implementing correct engines is challenging because the spec is intentionally incomplete and evolves frequently. Objective. This paper investigates the use of test transplantation and differential testing for revealing functional bugs in JavaScript engines. The former technique runs the regression test suite of a given engine on another engine. The latter technique fuzzes existing inputs and then compares the output produced by different engines with a differential oracle. Method. We conducted experiments with engines from five major players-Apple, Facebook, Google, Microsoft, and Mozilla-to assess the effectiveness of test transplantation and differential testing. Results. Our results indicate that both techniques revealed several bugs, many of which confirmed by developers. We reported 35 bugs with test transplantation (23 of these bugs confirmed and 19 fixed) and reported 24 bugs with differential testing (17 o

Patient life circumstances, including social determinants of health (SDOH), shape both health outcomes and care access, contributing to persistent disparities across gender, race, and socioeconomic status. Liver transplantation exemplifies these challenges, requiring complex eligibility and allocation decisions where SDOH directly influence patient evaluation. We developed an artificial intelligence (AI)-driven framework to analyze how broadly defined SDOH -- encompassing both traditional social determinants and transplantation-related psychosocial factors -- influence patient care trajectories. Using large language models, we extracted 23 SDOH factors related to patient eligibility for liver transplantation from psychosocial evaluation notes. These SDOH ``snapshots'' significantly improve prediction of patient progression through transplantation evaluation stages and help explain liver transplantation decisions including the recommendation based on psychosocial evaluation and the listing of a patient for a liver transplantation. Our analysis helps identify patterns of SDOH prevalence across demographics that help explain racial disparities in liver transplantation decisions. We hi

Ensuring large language models (LLM) behave consistently with human goals, values, and intentions is crucial for their safety but yet computationally expensive. To reduce the computational cost of alignment training of LLMs, especially for those with a huge number of parameters, and to reutilize learned value alignment, we propose ConTrans, a novel framework that enables weak-to-strong alignment transfer via concept transplantation. From the perspective of representation engineering, ConTrans refines concept vectors in value alignment from a source LLM (usually a weak yet aligned LLM). The refined concept vectors are then reformulated to adapt to the target LLM (usually a strong yet unaligned base LLM) via affine transformation. In the third step, ConTrans transplants the reformulated concept vectors into the residual stream of the target LLM. Experiments demonstrate the successful transplantation of a wide range of aligned concepts from 7B models to 13B and 70B models across multiple LLMs and LLM families. Remarkably, ConTrans even surpasses instruction-tuned models in terms of truthfulness. Experiment results validate the effectiveness of both inter-LLM-family and intra-LLM-famil

In medical imaging, access to data is commonly limited due to patient privacy restrictions and the issue that it can be difficult to acquire enough data in the case of rare diseases.[1] The purpose of this investigation was to develop a reusable open-source synthetic image generation pipeline, the GAN Image Synthesis Tool (GIST), that is easy to use as well as easy to deploy. The pipeline helps to improve and standardize AI algorithms in the digital health space by generating high quality synthetic image data that is not linked to specific patients. Its image generation capabilities include the ability to generate imaging of pathologies or injuries with low incidence rates. This improvement of digital health AI algorithms could improve diagnostic accuracy, aid in patient care, decrease medicolegal claims, and ultimately decrease the overall cost of healthcare. The pipeline builds on existing Generative Adversarial Networks (GANs) algorithms, and preprocessing and evaluation steps were included for completeness. For this work, we focused on ensuring the pipeline supports radiography, with a focus on synthetic knee and elbow x-ray images. In designing the pipeline, we evaluated the p

In this work, we present a flexible method for explaining, in human readable terms, the predictions made by decision trees used as decision support in liver transplantation. The decision trees have been obtained through machine learning applied on a dataset collected at the liver transplantation unit at the Coruña University Hospital Center and are used to predict long term (five years) survival after transplantation. The method we propose is based on the representation of the decision tree as a set of rules in a logic program (LP) that is further annotated with text messages. This logic program is then processed using the tool xclingo (based on Answer Set Programming) that allows building compound explanations depending on the annotation text and the rules effectively fired when a given input is provided. We explore two alternative LP encodings: one in which rules respect the tree structure (more convenient to reflect the learning process) and one where each rule corresponds to a (previously simplified) tree path (more readable for decision making).

In this paper we present web-liver, a rule-based system for decision support in the medical domain, focusing on its application in a liver transplantation unit for implementing policies for donor-patient matching. The rule-based system is built on top of an interpreter for logic programs with partial functions, called lppf, that extends the paradigm of Answer Set Programming (ASP) adding two main features: (1) the inclusion of partial functions and (2) the computation of causal explanations for the obtained solutions. The final goal of web-liver is assisting the medical experts in the design of new donor-patient matching policies that take into account not only the patient severity but also the transplantation utility. As an example, we illustrate the tool behaviour with a set of rules that implement the utility index called SOFT.