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      Precision medicine in stroke: towards personalized outcome predictions using artificial intelligence

      review-article
      1 , 2 , 3 , 4 ,
      Brain
      Oxford University Press
      stroke recovery, outcome, precision medicine: machine learning, big data

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          Abstract

          Stroke ranks among the leading causes for morbidity and mortality worldwide. New and continuously improving treatment options such as thrombolysis and thrombectomy have revolutionized acute stroke treatment in recent years. Following modern rhythms, the next revolution might well be the strategic use of the steadily increasing amounts of patient-related data for generating models enabling individualized outcome predictions. Milestones have already been achieved in several health care domains, as big data and artificial intelligence have entered everyday life.

          The aim of this review is to synoptically illustrate and discuss how artificial intelligence approaches may help to compute single-patient predictions in stroke outcome research in the acute, subacute and chronic stage. We will present approaches considering demographic, clinical and electrophysiological data, as well as data originating from various imaging modalities and combinations thereof. We will outline their advantages, disadvantages, their potential pitfalls and the promises they hold with a special focus on a clinical audience. Throughout the review we will highlight methodological aspects of novel machine-learning approaches as they are particularly crucial to realize precision medicine. We will finally provide an outlook on how artificial intelligence approaches might contribute to enhancing favourable outcomes after stroke.

          Abstract

          Bonkhoff and Grefkes discuss existing artificial intelligence approaches and single-subject prediction scenarios within stroke outcome research in the acute, subacute and chronic stages. They outline how an increasing data richness could allow new scientific insights and ultimately contribute to improved outcomes after stroke.

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          Most cited references207

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          Highly accurate protein structure prediction with AlphaFold

          Proteins are essential to life, and understanding their structure can facilitate a mechanistic understanding of their function. Through an enormous experimental effort 1 – 4 , the structures of around 100,000 unique proteins have been determined 5 , but this represents a small fraction of the billions of known protein sequences 6 , 7 . Structural coverage is bottlenecked by the months to years of painstaking effort required to determine a single protein structure. Accurate computational approaches are needed to address this gap and to enable large-scale structural bioinformatics. Predicting the three-dimensional structure that a protein will adopt based solely on its amino acid sequence—the structure prediction component of the ‘protein folding problem’ 8 —has been an important open research problem for more than 50 years 9 . Despite recent progress 10 – 14 , existing methods fall far short of atomic accuracy, especially when no homologous structure is available. Here we provide the first computational method that can regularly predict protein structures with atomic accuracy even in cases in which no similar structure is known. We validated an entirely redesigned version of our neural network-based model, AlphaFold, in the challenging 14th Critical Assessment of protein Structure Prediction (CASP14) 15 , demonstrating accuracy competitive with experimental structures in a majority of cases and greatly outperforming other methods. Underpinning the latest version of AlphaFold is a novel machine learning approach that incorporates physical and biological knowledge about protein structure, leveraging multi-sequence alignments, into the design of the deep learning algorithm. AlphaFold predicts protein structures with an accuracy competitive with experimental structures in the majority of cases using a novel deep learning architecture.
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            Deep learning.

            Deep learning allows computational models that are composed of multiple processing layers to learn representations of data with multiple levels of abstraction. These methods have dramatically improved the state-of-the-art in speech recognition, visual object recognition, object detection and many other domains such as drug discovery and genomics. Deep learning discovers intricate structure in large data sets by using the backpropagation algorithm to indicate how a machine should change its internal parameters that are used to compute the representation in each layer from the representation in the previous layer. Deep convolutional nets have brought about breakthroughs in processing images, video, speech and audio, whereas recurrent nets have shone light on sequential data such as text and speech.
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              Random Forests

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                Author and article information

                Journal
                Brain
                Brain
                brainj
                Brain
                Oxford University Press
                0006-8950
                1460-2156
                February 2022
                16 December 2021
                16 December 2021
                : 145
                : 2
                : 457-475
                Affiliations
                [1 ]J. Philip Kistler Stroke Research Center, Massachusetts General Hospital, Harvard Medical School , Boston, MA, USA
                [2 ]Cognitive Neuroscience, Institute of Neuroscience and Medicine (INM-3), Research Centre Juelich , Juelich, Germany
                [3 ] Department of Neurology, University Hospital Cologne , Cologne, Germany
                [4 ] Medical Faculty, University of Cologne , Cologne, Germany
                Author notes
                Correspondence to: Professor Christian Grefkes, MD Institute of Neuroscience and Medicine - Cognitive Neuroscience (INM-3) Forschungszentrum Juelich 52425 Juelich, Germany E-mail: c.grefkes@ 123456fz-juelich.de
                Author information
                https://orcid.org/0000-0002-1656-720X
                Article
                awab439
                10.1093/brain/awab439
                9014757
                34918041
                7f32704a-1a68-4e9e-b842-461ba4420e81
                © The Author(s) 2022. Published by Oxford University Press on behalf of the Guarantors of Brain.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial License ( https://creativecommons.org/licenses/by-nc/4.0/), which permits non-commercial re-use, distribution, and reproduction in any medium, provided the original work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 13 March 2021
                : 02 November 2021
                : 21 November 2021
                : 02 March 2022
                Page count
                Pages: 19
                Funding
                Funded by: MGH, doi 10.13039/100005294;
                Funded by: ECOR Fund;
                Funded by: Deutsche Forschungsgemeinschaft, doi 10.13039/501100001659;
                Award ID: 431549029
                Categories
                Review Article
                AcademicSubjects/MED00310
                AcademicSubjects/SCI01870

                Neurosciences
                stroke recovery,outcome,precision medicine: machine learning,big data
                Neurosciences
                stroke recovery, outcome, precision medicine: machine learning, big data

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