Deep Learning Meets Hyperspectral Image Analysis: A Multidisciplinary Review

Modern hyperspectral imaging systems produce huge datasets potentially conveying a great abundance of information; such a resource, however, poses many challenges in the analysis and interpretation of these data. Deep learning approaches certainly offer a great variety of opportunities for solving classical imaging tasks and also for approaching new stimulating problems in the spatial–spectral domain. This is fundamental in the driving sector of Remote Sensing where hyperspectral technology was born and has mostly developed, but it is perhaps even more true in the multitude of current and evolving application sectors that involve these imaging technologies. The present review develops on two fronts: on the one hand, it is aimed at domain professionals who want to have an updated overview on how hyperspectral acquisition techniques can combine with deep learning architectures to solve specific tasks in different application fields. On the other hand, we want to target the machine learning and computer vision experts by giving them a picture of how deep learning technologies are applied to hyperspectral data from a multidisciplinary perspective. The presence of these two viewpoints and the inclusion of application fields other than Remote Sensing are the original contributions of this review, which also highlights some potentialities and critical issues related to the observed development trends

Adenosine and lymphocyte regulation

Adenosine is a potent extracellular messenger that is produced in high concentrations under metabolically unfavourable conditions. Tissue hypoxia, consequent to a compromised cellular energy status, is followed by the enhanced breakdown of ATP leading to the release of adenosine. Through the interaction with A2 and A3 membrane receptors, adenosine is devoted to the restoration of tissue homeostasis, acting as a retaliatory metabolite. Several aspects of the immune response have to be taken into consideration and even though in general it is very important to dampen inflammation, in some circumstances, such as the case of cancer, it is also necessary to increase the activity of immune cells against pathogens. Therefore, adenosine receptors that are defined as ‘sensors–of metabolic changes in the local tissue environment may be very important targets for modulation of immune responses and drugs devoted to regulating the adenosinergic system are promising in different clinical situations

Modulation of the Akt/Ras/Raf/MEK/ERK pathway by A3 adenosine receptor

Downstream A3 receptor signalling plays an important role in the regulation of cell death and proliferation. Therefore, it is important to determine the molecular pathways involved through A3 receptor stimulation. The phosphatidylinositide-3-OH kinase (PI3K)/Akt and the Raf/mitogen-activated protein kinase (MAPK/ERK) kinase (MEK)/mitogen-activated protein kinase (MAPK) pathways have central roles in the regulation of cell survival and proliferation. The crosstalk between these two pathways has also been investigated. The focus of this review centres on downstream mediators of A3 adenosine receptor signalling

The emerging role of insulin-like growth factor 1 receptor (IGF1r) in gastrointestinal stromal tumors (GISTs)

Recent years have seen a growing interest in insulin-like growth factor 1 receptor (IGF1R) in medical oncology. Interesting data have been reported also on IGF1r in gastrointestinal stromal tumors (GISTs) especially in children and in young adult patients whose disease does not harbour mutations on KIT and PDGFRA and are poorly responsive to conventional therapies. However, it is too early to reach conclusions on IGF1R as a novel therapeutic target in GIST because the receptor's biological role is still to be defined and the clinical significance in patients needs to be studied in larger studies. We update and comment the current literature on IGF1R in GISTs and discuss the future perspectives in this promising field

Early pediatric palliative care involvement in a child with a large deletion of the short arm (p) of chromosome 10: a case report

Background: We present a case of a Chinese child with one of the largest terminal deletions (21 Mb) of the short arm of chromosome 10 (10p) reported to date. Distal monosomy 10p is a rare chromosomal disorder characterized by intellectual disability, postnatal growth retardation, structural birth defects and dysmorphisms. Mutations in certain 10p regions have been associated with distinct clinical features, but the real weight of each component cannot be estimated in a large deletion like that of our child; therefore, long-term prognosis is difficult to predict precisely, although it certainly foresees a severe impact on the psychomotor development of the child.Case Description: Diagnosis was made in the early neonatal period because of several dysmorphic features and multiple organ involvement. Since the patient's care needs were complex, the Pediatric Palliative Care (PPC) and Pain Service team was involved as a case manager and coordinator from the beginning. In the Veneto region of Italy, our PPC center offers a palliative care approach, through the national health system, embedded with curative-restorative care providing many support activities (such as physiotherapy, physiological support and home assistance) valuable for patients and their families' quality of life. Despite overlap in many characteristics of our child and other children who receive PPC services, the experience of children who have rare genetic conditions and undetermined prognosis with PPC services is still largely unknown. Periodic hospitalization for multidisciplinary follow-up and reassessment of patient's needs were arranged and any rehabilitation program focused on improving her skills was followed. At 5 years of age, her medical condition is controlled and well managed.Conclusions: This case represents a good example of complex care management by the PPC team, which takes into account the patient's and family's needs enhancing their quality of lives, as reported and underlined by parents themselves. This approach could be considered for other children with rare medical conditions without a definite prognosis

Prognostic Performance of Bedside Lung Ultrasound Score (LUSS) and ROX Index in Hypoxemic Respiratory Failure Due to COVID-19

Background: Noninvasive ventilation, mainly helmet CPAP, was widely used during the COVID-19 pandemic, even outside of intensive care units. Both the ROX index and the LUS score (LUSS) have been proposed as tools to predict negative outcomes in patients with hypoxemia treated with noninvasive ventilation (NIV) outside of ICUs. We aim to evaluate whether the combination of LUSS with the ROX index improves the predictive performance of these indices in patients with hypoxemia due to COVID-19 pneumonia, treated with NIV outside of ICUs. Methods: This is a monocentric prospective observational study conducted at the university teaching hospital Fondazione IRCCS San Gerardo dei Tintori (Monza, Italy) from February to April 2021. LUSS and ROX were collected at the same time in noninvasively ventilated patients outside of the ICU. An LUS exam was performed by 3 emergency medicine attending physicians with at least 5 years’ experience in point-of-care ultrasonography using a 12-zone system. To evaluate the accuracy of the prognostic indices in predicting a composite outcome (endotracheal intubation and mortality), ROC curves were used. A logistic multivariable model was used to explore the predictors of the composite outcome of endotracheal intubation and in-hospital mortality. An unadjusted Kaplan–Meier analysis was used to explore the association with the composite outcome of survival without invasive mechanical ventilation at the 30-day follow-up by stratifying the 3 indices by their best cut-offs. Results: A total of 79 patients were included in the statistical analysis and stratified into 2 groups based on the presence of a negative outcome, which was reported in 24 patients out of 79 (30%). A great proportion of patients (66 patients—84%) were treated with helmet CPAP. All three indices (LUSS, ROX and LUSS/ROX) were independently associated with negative outcomes in the multivariable analyses. Although the comparison between the AUROC of LUSS or ROX versus LUSS/ROX did not reveal a statistically significant difference, we observed a trend toward a higher accuracy for predicting negative outcomes using the LUSS/ROX index as compared to using LUSS. With the Kaplan–Maier approach, all three indices stratified by the best cut-off reported a significant association with the outcome of 30-day survival without mechanical ventilation. Conclusions: A multimodal noninvasive approach that combines ultrasound (i.e., LUSS) and a bedside clinical evaluation (i.e., the ROX index) may help clinicians to predict outcomes and to identify patients who would benefit the most from invasive respiratory support

Translaryngeal tracheostomy in acute respiratory distress syndrome patients

Objective: To prevent gas exchange deterioration during translaryngeal tracheostomy (TLT) in patients with acute respiratory distress syndrome (ARDS) ventilation is maintained through a small diameter endotracheal tube (ETT; 4.0 mm i.d.) advanced beyond the tracheostoma. We report on the feasibility of uninterrupted ventilation delivered through a high-resistance ETT in ARDS patients, and relevant ventilatory adjustments and monitoring. Design and setting: Prospective, observational clinical study in an eight-bed intensive care unit of a university hospital. Patients: Eight consecutive ARDS patients scheduled for tracheostomy. Interventions: During TLT volume control ventilation was maintained through the 4.0-mm i.d. ETT. Tidal volume, respiratory rate, and inspiratory to expiratory ratio were kept constant. Fractional inspiratory oxygen was 1. Positive end expiratory pressure (PEEP) set on the ventilator (PEEPvent) was reduced to maintain total PEEP (PEEPtot) at baseline level according to the measured intrinsic PEEP (auto-PEEP). Measurements and main results: Data were collected before tracheostomy and while on mechanical ventilation with the 4.0-mm i.d. ETT. Neither PaCO2nor PaO2changed significantly (54.5\uc2\ub110.0 vs. 56.4\uc2\ub17.0 and 137\uc2\ub169 vs. 140\uc2\ub159 mmHg, respectively). Auto-PEEP increased from 0.6\uc2\ub11.1 to 9.8\uc2\ub16.5 cmH2O during ventilation with the 4.0-mm i.d. ETT. By decreasing PEEPventwe obtained a stable PEEPtot(11.4\uc2\ub14.3 vs. 11.8\uc2\ub14.3 cmH2O), and end-inspiratory occlusion pressure (26.7\uc2\ub17.4 vs. 28.0\uc2\ub16.6 cmH2O). Peak inspiratory pressure rose from 33.8\uc2\ub18.1 to 77.8\uc2\ub112.7 cmH2O. Conclusions: The high-resistance ETT allows ventilatory assistance during the whole TLT procedure. Assessment of stability in plateau pressure and PEEPtotby end-inspiratory and end-expiratory occlusions prevent hyperinflation and possibly barotrauma

Over-Under Triage nell’attivazione del Trauma Team: un’analisi retrospettiva nella ASST Monza

Introduction: Meeting the literature standards during the triage process of trauma victims, allows to make optimal use of the resources available in Trauma Centers and defines their level of quality and efficiency. Otherwise, it may occur over or under-triage. Up to now, in the reality under study and in the national literature, there wasn’t any available data about efficiency and effectiveness in the triage of traumatic patients, therefore the primary objective of this study is to evaluate the over and under-triage rate in activating Trauma Team (TT) in the ASST of Monza-San Gerardo Hospital. Method: The study design is retrospective monocentric observational. Results: During the analysis, the TT-activation in ASST of Monza-San Gerardo Hospital produced an over-triage of 62,9% and an under-triage of 1,7% for the same year. Discussion: The use of TT-activation algorithm is the first step of the entire care process of the trauma victim. This tool should guarantee the right balance between high sensitivity (under-triage → 0, accepting the risk of high over-triage rate) and high specificity (minimum over-triage rate with the possibility of higher under-triage). However, there is no sharing of these algorithms as they are inhomogeneous in the different realities; for example, the definition of major trauma, of TT and of its composition is still uneven. Conclusion: This study measured the over and under-triage rate related to the TT activation in the ASST of Monza. It is therefore advisable to monitor those rates periodically, as possible indicators of quality of assistance and to pursue the mission of increasing efficiency as well as effectiveness.Introduzione: Il rispetto degli standard presenti in letteratura durante il triage di persone vittima di trauma, permette di sfruttare in modo ottimale le risorse di cui dispongono i Trauma Center e ne definisce il livello di qualità ed efficienza. In caso contrario si può assistere ad over o under-triage. Fino a questo momento, nella realtà oggetto di studio e nella letteratura nazionale, non era disponibile alcuna misurazione di efficienza ed efficacia circa il relativo triage del paziente traumatico; pertanto l’obiettivo primario è ottenere dati relativi alle percentuali di over-triage e under-triage circa l’attivazione del Trauma Team (TT) nell’ASST di Monza-Ospedale San Gerardo. Metodo: Il disegno di studio è osservazionale retrospettivo monocentrico. Risultati: Nell’Ospedale San Gerardo, nel periodo esaminato, si è prodotto un over-triage del 62,9% ed un under-triage, relativo al medesimo anno, dell’1,7%. Discussione: Utilizzare un algoritmo decisionale di attivazione del TT è alla base dell’intero processo assistenziale della persona vittima di trauma. Questo strumento dovrebbe riportare il giusto compromesso tra sensibilità elevata (under-triage → 0, accettando il rischio di avere un over-triage elevato) e specificità elevata (over-triage minimo ma con possibilità di creare un più elevato under-triage). Non vi è tuttavia condivisione di tali algoritmi che risultano disomogenei nelle diverse realtà come è ancora disomogenea la definizione di trauma maggiore, del TT e della sua composizione. Conclusioni: Abbiamo misurato le percentuali di over e under triage relative all’attivazione del TT dell’ASST di Monza. Ci si aspetta di poterle monitorarle periodicamente, quali possibili indicatori di qualità d’assistenza al cittadino, ponendosi come mission, al pari dell’efficacia, di incrementare l’efficienza.&nbsp

ECMO for intractable status asthmaticus following atracurium

Intraoperative allergic reactions are rare but serious events associated with increased morbidity and mortality. We report the salvage of intraoperative anaphylaxis leading to extreme hypercapnic respiratory failure by veno-venous extracorporeal membrane oxygenation (ECMO). A 38-year-old woman undergoing thyroidectomy developed intractable bronchospasm after administration of atracurium, leading to extreme hypercapnic respiratory failure (PaCO2\uc2\ua0>\uc2\ua0250\uc2\ua0mmHg, pH 6.773). After the failure of conventional medical therapy and ventilatory optimization, the patient was connected to a veno-venous ECMO circuit. PaCO2of 45.6\uc2\ua0mmHg and pH of 7.25 were achieved in 1\uc2\ua0h, by slowly increasing sweep gas flows up to 3.5 L/min and using continuous end-tidal CO2monitoring to gauge the procedure. After extubation and disconnection from ECMO, the patient was discharged on the 6th day without sequelae. Rapid reversal of extreme hypercapnic acidosis by ECMO was feasible, without any neurologic sequelae. Veno-venous ECMO support may be a valuable option for the salvage of intraoperative anaphylaxis