Transfer-Learning-Based Intrusion Detection Framework in IoT Networks.

Cyberattacks in the Internet of Things (IoT) are growing exponentially, especially zero-day attacks mostly driven by security weaknesses on IoT networks. Traditional intrusion detection systems (IDSs) adopted machine learning (ML), especially deep Learning (DL), to improve the detection of cyberattacks. DL-based IDSs require balanced datasets with large amounts of labeled data; however, there is a lack of such large collections in IoT networks. This paper proposes an efficient intrusion detection framework based on transfer learning (TL), knowledge transfer, and model refinement, for the effective detection of zero-day attacks. The framework is tailored to 5G IoT scenarios with unbalanced and scarce labeled datasets. The TL model is based on convolutional neural networks (CNNs). The framework was evaluated to detect a wide range of zero-day attacks. To this end, three specialized datasets were created. Experimental results show that the proposed TL-based framework achieves high accuracy and low false prediction rate (FPR). The proposed solution has better detection rates for the different families of known and zero-day attacks than any previous DL-based IDS. These results demonstrate that TL is effective in the detection of cyberattacks in IoT environments.

Effects of Inhaled Corticosteroids on the Innate Immunological Response to Pseudomonas aeruginosa Infection in Patients with COPD.

Inhaled corticosteroids (ICS) use is associated with an increased risk of Pseudomonas aeruginosa (PA) infection in patients with COPD. We aimed to evaluate the effects of ICS on alveolar macrophages in response to PA in COPD patients with and without baseline ICS treatment (COPD and COPD + ICS, respectively) as well as smoker and nonsmoker controls. To do so, cells were infected with PA and cotreated with budesonide (BUD) or fluticasone propionate (FLU). The analysis of NF-κB and c-jun activity revealed a significant increase in both factors in response to PA cotreated with BUD/FLU in smokers but not in COPD or COPD + ICS patients when compared with PA infection alone. The expression of Toll-like receptor 2 (TLR2) and the transcription factor c-jun were induced upon PA infection in nonsmokers only. Moreover, in the smoker and COPD groups, there was a significant increase in TLR2 and a decrease in c-jun expression when treated with BUD/FLU after PA infection, which were not observed in COPD + ICS patients. Therefore, the chronic use of ICS seemingly makes the macrophages tolerant to BUD/FLU stimulation compared with those from patients not treated with ICS, promoting an impaired recognition of PA and activity of alveolar macrophages in terms of altered expression of TLR2 and cytokine production, which could explain the increased risk of PA infection in COPD patients under ICS treatment.

Hsa-Mir-320c, Hsa-Mir-200c-3p, and Hsa-Mir-449c-5p as Potential Specific miRNA Biomarkers of COPD: A Pilot Study.

Chronic obstructive pulmonary disease (COPD) is a chronic inflammatory disease commonly induced by cigarette smoke. The expression of miRNAs can be altered in patients with COPD and could be used as a biomarker. We aimed to identify a panel of miRNAs in bronchoalveolar lavage (BAL) to differentiate COPD patients from smokers and non-smokers with normal lung function. Accordingly, forty-five subjects classified as COPD, smokers, and non-smokers (n = 15 per group) underwent clinical, functional characterization and bronchoscopy with BAL. The mean age of the studied population was 61.61 ± 12.95 years, BMI 25.72 ± 3.82 Kg/m2, FEV1/FVC 68.37 ± 12.00%, and FEV1 80.07 ± 23.63% predicted. According to microarray analysis, three miRNAs of the most upregulated were chosen: miR-320c, miR-200c-3p, and miR-449c-5p. These miRNAs were validated by qPCR and were shown to be differently expressed in COPD patients. ROC analysis showed that these three miRNAs together had an area under the curve of 0.89 in differentiating COPD from controls. Moreover, in silico analysis of candidate miRNAs by DIANA-miRPath showed potential involvement in the EGFR and Hippo pathways. These results suggest a specific 3-miRNA signature that could be potentially used as a biomarker to distinguish COPD patients from smokers and non-smoker subjects.

Inhaled corticosteroid dose is associated with Pseudomonas aeruginosa infection in severe COPD.

INTRODUCTION: Patients with chronic obstructive pulmonary disease (COPD) with frequent exacerbations (ExCOPD) are commonly treated with inhaled corticosteroids (ICS) and are at risk of infections caused by potential pathogenic bacteria (PPB) including Pseudomonas aeruginosa (PsA). OBJECTIVES: To investigate the association between the use of ICS and PsA infection among ExCOPD. METHODS: Case-control study with longitudinal follow-up that recruited ExCOPD after a hospitalisation due to exacerbation between 2012 and 2020. Patients with isolation of PsA (COPD-PsA) in sputum either during admission or follow-up were compared with those with other or no PPB. Clinical, functional characteristics, DDD, use of ICS and survival were evaluated. Cox regression analysis was performed to evaluate the risk factors associated to PsA infection and mortality. RESULTS: 358 patients (78% male, mean age 73±9 years) were enrolled and followed up for a median of 4 years (IQR=3-8). 173 patients (48.3%) had at least a positive culture for PsA. COPD-PsA had more frequent exacerbations, more severe airflow limitation and higher mortality (69.4% vs 46.5%, p<0.001). There were no differences in the use of ICS between groups but the dose of ICS was significantly higher among COPD-PsA (median of 500 µg fluticasone propionate equivalents (IQR=250-1000) vs 400 µg (IQR=200-1000), p=0.007). Blood eosinophil count (BEC) was not different between ICS users and non-users. In multivariate analysis, the dose of ICS was an independent risk factor for PsA infection and mortality but not ICS use. CONCLUSIONS: ICS dose, but not its use, could be a risk factor for PsA infection in patients with severe COPD regardless of BEC.

Implementation of an Integrated Care Model for Frequent-Exacerbator COPD Patients: A Controlled Prospective Study / Implementación de un modelo de atención integral para pacientes con EPOC con agudizaciones frecuentes: un estudio prospectivo controlado

Introduction: Frequent-exacerbator COPD (fe-COPD) associated with frequent hospital admissions have high morbidity, mortality and use of health resources. These patients should be managed in personalized integrated care models (ICM). Accordingly, we aimed to evaluate the long-term effectiveness of a fe-COPD ICM on emergency room (ER) visits, hospital admissions, days of hospitalization, mortality and improvement of health status. Methods: Prospective-controlled study with analysis of a cohort of fe-COPD patients assigned to ICM and followed-up for maximally 7 years that were compared to a parallel cohort who received standard care. All patients had a confirmed diagnosis of COPD with a history of ≥2 hospital admissions due to exacerbations in the year before enrollment. The change in CAT score and mMRC dyspnea scale, hospital admissions, ER visits, days of hospitalization, and mortality were analyzed. Results: 141 patients included in the ICM were compared to 132 patients who received standard care. The ICM reduced hospitalizations by 38.2% and ER visits by 69.7%, with reduction of hospitalizations for COPD exacerbation, ER visits and days of hospitalization (p<0.05) compared to standard care. Further, health status improved among the ICM group after 1 year of follow-up (p=0.001), effect sustained over 3 years. However, mortality was not different between groups (p=0.117). Last follow-up CAT score>17 was the strongest independent risk factor for mortality and hospitalization among ICM patients. (AU)

Introducción: La EPOC con agudizaciones frecuentes (EPOC-AF), que se asocia a ingresos hospitalarios recurrentes, presenta altas tasas de morbilidad y mortalidad, y un importante uso de los recursos sanitarios. Estos pacientes deberían ser tratados en modelos de atención integral (MAI) personalizada. Por este motivo, nuestro objetivo fue evaluar la efectividad a largo plazo de un MAI para EPOC-AF valorando las visitas a urgencias, los ingresos hospitalarios, los días de hospitalización, la mortalidad y la mejora del estado de la salud. Métodos: Estudio prospectivo controlado que analizó una cohorte de pacientes con EPOC-AF incluidos en un MAI y en seguimiento durante un máximo de 7 años en comparación con una cohorte paralela que recibió atención estándar. Todos los pacientes tenían diagnóstico confirmado de EPOC y antecedentes de ≥2 ingresos hospitalarios por agudizaciones durante el año anterior a su inclusión en el estudio. Se analizaron los cambios en la puntuación del CAT© y en la escala de disnea del MRC, en los ingresos hospitalarios, las visitas a urgencias, los días de hospitalización y la mortalidad. Resultados: Se compararon 141 pacientes incluidos en el MAI con 132 pacientes que recibieron atención estándar. El MAI redujo las hospitalizaciones en un 38,2% y las visitas a urgencias en un 69,7%, mostrando reducción de las hospitalizaciones por exacerbación de la EPOC, las visitas a urgencias y los días de hospitalización (p<0,05) en comparación con la atención estándar. Además, el estado de salud mejoró en los pacientes del grupo del MAI después de un año de seguimiento (p=0,001), un efecto que se mantuvo durante 3 años. Sin embargo, la mortalidad no fue diferente entre ambos grupos (p=0,117). Una puntuación en el CAT©>17 en el último control de seguimiento fue el factor independiente de riesgo más fuertemente asociado a la mortalidad y la hospitalización de los pacientes en el MAI. (AU)

Implementation of an Integrated Care Model for Frequent-Exacerbator COPD Patients: A Controlled Prospective Study.

INTRODUCTION: Frequent-exacerbator COPD (fe-COPD) associated with frequent hospital admissions have high morbidity, mortality and use of health resources. These patients should be managed in personalized integrated care models (ICM). Accordingly, we aimed to evaluate the long-term effectiveness of a fe-COPD ICM on emergency room (ER) visits, hospital admissions, days of hospitalization, mortality and improvement of health status. METHODS: Prospective-controlled study with analysis of a cohort of fe-COPD patients assigned to ICM and followed-up for maximally 7 years that were compared to a parallel cohort who received standard care. All patients had a confirmed diagnosis of COPD with a history of ≥2 hospital admissions due to exacerbations in the year before enrollment. The change in CAT score and mMRC dyspnea scale, hospital admissions, ER visits, days of hospitalization, and mortality were analyzed. RESULTS: 141 patients included in the ICM were compared to 132 patients who received standard care. The ICM reduced hospitalizations by 38.2% and ER visits by 69.7%, with reduction of hospitalizations for COPD exacerbation, ER visits and days of hospitalization (p<0.05) compared to standard care. Further, health status improved among the ICM group after 1 year of follow-up (p=0.001), effect sustained over 3 years. However, mortality was not different between groups (p=0.117). Last follow-up CAT score>17 was the strongest independent risk factor for mortality and hospitalization among ICM patients. CONCLUSIONS: An ICM for fe-COPD patients effectively decreases ER and hospital admissions and improves health status, but not mortality.

Implementation of an Integrated Care Model for Frequent-Exacerbator COPD Patients: A Controlled Prospective Study.

INTRODUCTION: Frequent-exacerbator COPD (fe-COPD) associated with frequent hospital admissions have high morbidity, mortality and use of health resources. These patients should be managed in personalized integrated care models (ICM). Accordingly, we aimed to evaluate the long-term effectiveness of a fe-COPD ICM on emergency room (ER) visits, hospital admissions, days of hospitalization, mortality and improvement of health status. METHODS: Prospective-controlled study with analysis of a cohort of fe-COPD patients assigned to ICM and followed-up for maximally 7 years that were compared to a parallel cohort who received standard care. All patients had a confirmed diagnosis of COPD with a history of ≥2 hospital admissions due to exacerbations in the year before enrollment. The change in CAT score and mMRC dyspnea scale, hospital admissions, ER visits, days of hospitalization, and mortality were analyzed. RESULTS: 141 patients included in the ICM were compared to 132 patients who received standard care. The ICM reduced hospitalizations by 38.2% and ER visits by 69.7%, with reduction of hospitalizations for COPD exacerbation, ER visits and days of hospitalization (p<0.05) compared to standard care. Further, health status improved among the ICM group after 1 year of follow-up (p=0.001), effect sustained over 3 years. However, mortality was not different between groups (p=0.117). Last follow-up CAT score>17 was the strongest independent risk factor for mortality and hospitalization among ICM patients. CONCLUSIONS: An ICM for fe-COPD patients effectively decreases ER and hospital admissions and improves health status, but not mortality.

Valoración funcional respiratoria previa a la reducción de volumen pulmonar en pacientes con enfisema / Functional respiratory assessment before lung volume reduction in patients with emphysema

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