PCaGuard: A Software Platform to Support Optimal Management of Prostate Cancer

Background and Objective  Prostate cancer (PCa) is a severe public health issue and the most common cancer worldwide in men. Early diagnosis can lead to early treatment and long-term survival. The addition of the multiparametric magnetic resonance imaging in combination with ultrasound (mpMRI-U/S fusion) biopsy to the existing diagnostic tools improved prostate cancer detection. Use of both tools gradually increases in every day urological practice. Furthermore, advances in the area of information technology and artificial intelligence have led to the development of software platforms able to support clinical diagnosis and decision-making using patient data from personalized medicine. Methods  We investigated the current aspects of implementation, architecture, and design of a health care information system able to handle and store a large number of clinical examination data along with medical images, and produce a risk calculator in a seamless and secure manner complying with data security/accuracy and personal data protection directives and standards simultaneously. Furthermore, we took into account interoperability support and connectivity to legacy and other information management systems. The platform was implemented using open source, modern frameworks, and development tools. Results  The application showed that software platforms supporting patient follow-up monitoring can be effective, productive, and of extreme value, while at the same time, aiding toward the betterment medicine clinical workflows. Furthermore, it removes access barriers and restrictions to specialized care, especially for rural areas, providing the exchange of medical images and patient data, among hospitals and physicians. Conclusion  This platform handles data to estimate the risk of prostate cancer detection using current state-of-the-art in eHealth systems and services while fusing emerging multidisciplinary and intersectoral approaches. This work offers the research community an open architecture framework that encourages the broader adoption of more robust and comprehensive systems in standard clinical practice.     

Characteristics and outcomes of cancer patients who develop pulmonary embolism: A cross-sectional study

Pulmonary embolism (PE), along with deep vein thrombosis, are collectively known as venous thromboembolism (VTE). Predisposing factors for PE include post-operative conditions, pregnancy, cancer and an advanced age; of note, a number of genetic mutations have been found to be associated with an increased risk of PE. The association between cancer and VTE is well-established, and cancer patients present a higher risk of a thrombotic event compared to the general population. In addition, PE is a significant cause of morbidity and mortality among cancer patients. The aim of the present study was to illustrate the clinical characteristics, laboratory findings, radiology features and outcomes of cancer patients who developed PE, collected from an anticancer hospital. For this purpose, adult cancer patients diagnosed with PE by imaging with computed tomography pulmonary angiography were enrolled. The following data were recorded: Demographics, comorbidities, type of cancer, time interval between cancer diagnosis and PE occurrence, the type of therapy received and the presence of metastases, clinical signs and symptoms, predisposing factors for PE development, laboratory data, radiological findings, electrocardiography findings, and the type of therapy received for PE and outcomes in a follow-up period of 6 months. In total, 60 cancer patients were enrolled. The majority of the cancer patients were males. The most common type of cancer observed was lung cancer. The majority of cases of PE occurred within the first year from the time of cancer diagnosis, while the majority of patients had already developed metastases. In addition, the majority of cancer patients had received chemotherapy over the past month, while they were not receiving anticoagulants and had central obstruction. A large proportion of patients had asymptomatic PE. The in-hospital mortality rate was 13.3% and no relapse or mortality were observed during the follow-up period. The present study demonstrates that elevated levels of lactic acid and an increased platelet count, as well as low serum levels of carcinoembryonic antigen, albumin and D-dimer, may be potential biomarkers for asymptomatic PE among cancer patients.     

Keratoacanthoma formation after skin grafting: A brief report and pathophysiological hypothesis

Keratoacanthoma formation after skin grafting is rare. We report the third case in the literature of multiple keratoacanthomas developed at both split‐thickness skin graft donor and recipient sites. We provide possible explanations for this poorly understood phenomenon and highlight its implications on treatment options.     

Comment on “Artificial intelligence in gastroenterology: A state-of-the-art review”

Colon capsule endoscopy (CCE) was introduced nearly two decades ago. Initially, it was limited by poor image quality and short battery time, but due to technical improvements, it has become an equal diagnostic alternative to optical colonoscopy (OC). Hastened by the coronavirus disease 2019 pandemic, CCE has been introduced in clinical practice to relieve overburdened endoscopy units and move investigations to out-patient clinics. A wider adoption of CCE would be bolstered by positive patient experience, as it offers a diagnostic investigation that is not inferior to other modalities. The shortcomings of CCE include its inability to differentiate adenomatous polyps from hyperplastic polyps. Solving this issue would improve the stratification of patients for polyp removal. Artificial intelligence (AI) has shown promising results in polyp detection and characterization to minimize incomplete CCEs and avoid needless examinations. Onboard AI appears to be a needed application to enable near-real-time decision-making in order to diminish patient waiting times and avoid superfluous subsequent OCs. With this letter, we discuss the potential and role of AI in CCE as a diagnostic tool for the large bowel.     

Magnetoencephalographic evidence of the interhemispheric asymmetry in echoic memory lifetime and its dependence on handedness and gender

The echoic memory trace (EMT) refers to neuronal activity associated with the short-term retention of stimulus-related information, especially within the primary and association auditory cortex. Using magnetoencephalography it is possible to determine quantitatively the lifetime of the EMT. Previous studies assumed that each new stimulus drives the EMT to its full strength, which then passively decays. In this study we show the limitations of this assumption using trains of auditory stimuli designed specifically for computing the EMT lifetime and its contextual sensitivity. We estimated a time-dependent EMT using a data-driven approach, which allows contributions from a relatively wide area around the auditory cortex in our quantitative measures. We identified: (1) internally generated cortical activations during the silent period between stimuli well separated in time from each other, which had influence on the morphology of the neuromagnetic response to the next external stimulus; and (2) EMTs with different lifetimes that modulate the amplitude of the evoked responses at different latencies, suggesting the existence of multiple neural delay lines. Long EMT lifetimes were observed on the descending part of the M100 complex, which showed handedness and gender-dependent interhemispheric asymmetry. Specifically, all subjects showed longer EMT lifetimes on the left hemisphere, except left-handed males. Distributed source analysis of the data for one left- and one right-handed male subject identified a secondary generator in the right-handed subject, which was located posterior to the early primary generator and dominated the auditory response at late latencies, where EMT lifetime asymmetry was high. The identified multiple neural delay lines and their laterality may provide a link between macroneuronal activity and left hemisphere specialization for processing linguistic material.     

Putative predictors of efficacy for immune checkpoint inhibitors in non-small-cell lung cancer: facing the complexity of the immune system

Introduction: In non-small-cell lung cancer (NSCLC) the recent introduction of immunotherapy in daily clinical practice produced a wave of enthusiasm, however, this was rapidly moderated by the evidence that only some patients could experience a relevant clinical benefit. Therefore, a great effort from the scientific community has been dedicated to the identification and validation of reliable biomarkers able to drive the activity of immunotherapeutic agents.

Areas covered: This analysis aims to review the main findings about predictive biomarkers for immunotherapy in lung cancer, retracing the history of PD-L1 and focusing on a series of innovative candidates, such as mutational load, immune cell populations and microbiome.

Expert commentary: Considering the complexity of the immune system-cancer interactions, the idea of identifying a single biomarker able to drive the activity of different immunotherapeutic agents alone, borrowing the idea of targeted therapy, is likely to represent an unrealistic objective. Nevertheless, the identification of those factors either positively or negatively affecting the response is mandatory in order to recruit the appropriate patients, but also to deeply understand the mechanisms of immune response and improve the clinical benefit deriving from these agents in monotherapy or in a biologically-rationale combination.     

Fixation of the annulus of the mitral valve with a rigid ring Hemodynamic studies

Currently available prostheses used for replacement of the mitral valve feature a rigid ring for fixation to the annulus of the mitral valve. The effect on the hemodynamics of the left heart of fixation of the annulus of the mitral valve bysuturing a ring from a 1M or a 2M Starr-Edwards valve under cardiopulmonary bypass, leaving the valve leaflets and chordae tendineae intact, was studied in 6 dogs.

Intracardiac and intravascular pressures, cardiac output, and the size of the left ventricle were measured in these animals and a control group of 5 normal dogs in the “resting state” and during induced changes in peripheral vascular resistance (intra-aortic administration of angiotensin II and acetylcholine). Small diastolic pressure differences were detected between the left atrium and the left ventricle in the dogs operated on during the control resting state. These atrial-to-ventricular pressure gradients were greatly increased with the high flow and tachycardia associated with vasodilatation. This increased resistance to flow across the mitral valve constituted the major hemodynamic difference between the two animal groups under the conditions of the study.     

The effects of muscle damage on walking biomechanics are speed-dependent

The purpose of the present study was to examine the effects of muscle damage on walking biomechanics at different speeds. Seventeen young women completed a muscle damage protocol of 5 × 15 maximal eccentric actions of the knee extensors and flexors of both legs at 60°/s. Lower body kinematics and swing-phase kinetics were assessed on a horizontal treadmill pre- and 48 h post-muscle damaging exercise at four walking speeds. Evaluated muscle damage indices included isometric torque, delayed onset muscle soreness, and serum creatine kinase. All muscle damage indices changed significantly after exercise, indicating muscle injury. Kinematic results indicated that post-exercise knee joint was significantly more flexed (31–260%) during stance-phase and knee range of motion was reduced at certain phases of the gait cycle at all speeds. Walking post-exercise at the two lower speeds revealed a more extended knee joint (3.1–3.6%) during the swing-phase, but no differences were found between pre- and post-exercise conditions at the two higher speeds. As speed increased, maximum dorsiflexion angle during stance-phase significantly decreased pre-exercise (5.7–11.8%), but remained unaltered post-exercise across all speeds (p > 0.05). Moreover, post-exercise maximum hip extension decreased (3.6–18.8%), pelvic tilt increased (5.5–10.6%), and tempo-spatial differences were found across all speeds (p < 0.05). Limited effects of muscle damage were observed regarding swing-phase kinetics. In conclusion, walking biomechanics following muscle damage are affected differently at relatively higher walking speeds, especially with respect to knee and ankle joint motion. The importance of speed in evaluating walking biomechanics following muscle damage is highlighted.