Powering the Internet of Things Through Light Communication

© 2019 IEEE. Personal use of this material is permitted. Permission from IEEE must be obtained for all other uses, in any current or future media, including reprinting/republishing this material for advertising or promotional purposes,creating new collective works, for resale or redistribution to servers or lists, or reuse of any copyrighted component of this work in other works.Novel solutions are required to connect billions of devices to the network as envisioned by the IoT. In this article we propose to use LiFi, which is based on off-the-shelf LEDs, as an enabler for the IoT in indoor environments. We present LiFi4IoT, a system which, in addition to communication, provides three main services that the radio frequency (RF) IoT networks struggle to offer: precise device positioning; the possibility of delivering power, since energy can be harvested from light; and inherent security due to the propagation properties of visible light. We analyze the application space of IoT in indoor scenarios, and propose a LiFi4IoT access point (AP) that communicates simultaneously with IoT devices featuring different types of detectors, such as CMOS camera sensors, PDs, and solar cells. Based on the capabilities of these technologies, we define three types of energy self-sufficient IoT "motes" and analyze their feasibility. Finally, we identify the main research directions to enable the LiFi4IoT vision and provide preliminary results for several of these.Peer ReviewedPostprint (author's final draft

Machine Learning in Melanoma Diagnosis. Limitations About to be Overcome

[spa] Antecedentes: La clasificación automática de imágenes es una rama prometedora del aprendi-zaje automático (de sus siglas en inglés Machine Learning [ML]), y es una herramienta útil enel diagnóstico de cáncer de piel. Sin embargo, poco se ha estudiado acerca de las limitacionesde su uso en la práctica clínica diaria.Objetivo: Determinar las limitaciones que existen en cuanto a la selección de imágenes usadaspara el análisis por ML de las neoplasias cutáneas, en particular del melanoma.Métodos: Se dise ̃nó un estudio de cohorte retrospectivo, donde se incluyeron de forma conse-cutiva 2.849 imágenes dermatoscópicas de alta calidad de tumores cutáneos para su valoraciónpor un sistema de ML, recogidas entre los a ̃nos 2010 y 2014. Cada imagen dermatoscópica fueclasificada según las características de elegibilidad para el análisis por ML.Resultados: De las 2.849 imágenes elegidas a partir de nuestra base de datos, 968 (34%) cum-plieron los criterios de inclusión. De los 528 melanomas, 335 (63,4%) fueron excluidos. Laausencia de piel normal circundante (40,5% de todos los melanomas de nuestra base de datos)y la ausencia de pigmentación (14,2%) fueron las causas más frecuentes de exclusión para elanálisis por ML.Discusión: Solo el 36,6% de nuestros melanomas se consideraron aceptables para el análisispor sistemas de ML de última generación. Concluimos que los futuros sistemas de ML deberánser entrenados a partir de bases de datos más grandes que incluyan imágenes representativasde la práctica clínica habitual. Afortunadamente, muchas de estas limitaciones están siendosuperadas gracias a los avances realizados recientemente por la comunidad científica, como seha demostrado en trabajos recientes. [eng] Background: Automated image classification is a promising branch of machine learning (ML)useful for skin cancer diagnosis, but little has been determined about its limitations for generalusability in current clinical practice.Objective: To determine limitations in the selection of skin cancer images for ML analysis,particularly in melanoma.Methods: Retrospective cohort study design, including 2,849 consecutive high-quality dermos-copy images of skin tumors from 2010 to 2014, for evaluation by a ML system. Each dermoscopyimage was assorted according to its eligibility for ML analysis.Results: Of the 2,849 images chosen from our database, 968 (34%) met the inclusion criteriafor analysis by the ML system. Only 64.7% of nevi and 36.6% of melanoma met the inclusioncriteria. Of the 528 melanomas, 335 (63.4%) were excluded. An absence of normal surroundingskin (40.5% of all melanomas from our database) and absence of pigmentation (14.2%) were themost common reasons for exclusion from ML analysis.Discussion: Only 36.6% of our melanomas were admissible for analysis by state-of-the-art MLsystems. We conclude that future ML systems should be trained on larger datasets which includerelevant non-ideal images from lesions evaluated in real clinical practice. Fortunately, many ofthese limitations are being overcome by the scientific community as recent works show

Cost of Treating Cutaneous T-Cell Lymphoma in Spain: Analysis of MICADOS Study Data by Disease Stage

Síndrome de Sézary; Coste de la enfermedad; FarmacoeconomíaSézary syndrome; Cost of disease; PharmacoeconomicsSíndrome de Sézary; Cost de la malaltia; FarmacoeconomiaAntecedentes y objetivo No se dispone de datos españoles sobre el coste asociado al linfoma cutáneo de células T (LCCT). Además, la incorporación de nuevos tratamientos hace necesario analizar el coste real de la enfermedad. El estudio MICADOS analizó dos objetivos principales: Por un lado, evaluó el impacto en la calidad de vida en los pacientes con LCCT, y por otro lado, estudió los costes de la enfermedad. En esta publicación se recoge el segundo de los objetivos del estudio. Métodos El coste de la enfermedad se estudió bajo la perspectiva del Sistema Nacional de Salud (SNS) con un horizonte temporal de un año. Participaron 23 dermatólogos y hematólogos de 15 hospitales públicos españoles. Se incluyeron pacientes adultos con LCCT del tipo micosis fungoide (MF) y síndrome de Sézary (SS). Resultados Se incluyeron 141 pacientes, el 57,4% masculinos, con una edad media de 63,6 años (IC 95%: 61,4-65,7). Los costes directos anuales medios por pacientes del estudio fueron de 34.214€, siendo de 11.952,47€ en estadio I, 23.506,21€ en estadio II, 38.771,81€ en estadio III y 72.748,84€ en estadio IV. El coste anual directo total estimado de todos los pacientes en España con MF/SS resultó en 78.301.171€, donde el 81% de los costes fueron atribuibles a pacientes en estadio I, el 7% al estadio II, el 6% al estadio III y el 6% al estadio IV. Conclusiones Este estudio ofrece una evaluación precisa del coste directo del LCCT en pacientes con MF/SS en España, mostrando costes que varían sustancialmente en función del estadio. Los costes soportados por el paciente y los costes indirectos deberán considerarse en futuras investigaciones.Background and objective The cost of treating cutaneous T-cell lymphoma (CTCL) in Spain is unknown. With the advent of new treatments, it is more important than ever to gain an accurate picture of the true costs involved. The MICADOS study had 2 primary objectives: 1) to evaluate the impact of CTCL on patient quality of life, and 2) to evaluate the costs associated with the disease. This article reports the results of the cost analysis. Methods We estimated the cost of treating CTCL over a period of 1 year from the perspective of the Spanish National Health System. Twenty-three dermatologists and hematologists from 15 public hospitals analyzed data for adult patients with mycosis fungoides (MF) or Sézary syndrome (SS). Results A total of 141 patients (57.4% male) with a mean age of 63.6 years (95% CI: 61.4-65.7 years) were included. The mean direct annual cost of treating CTCL was €34,214 per patient. The corresponding costs by stage were €11,952.47 for stage I disease, €23,506.21 for stage II disease, €38,771.81 for stage III disease, and €72,748.84 for stage IV disease. The total direct annual cost of treating MF/SS in public hospitals in Spain was estimated at €78,301,171; stage I disease accounted for 81% of all costs, stage II for 7%, and stages III and IV for 6% each. Conclusions The MICADOS study offers an accurate picture of the direct cost of treating CTCL in patients with MF/SS in Spain and shows that costs vary significantly according to disease stage. Patient-borne and indirect costs should be analyzed in future studies.El estudio fue financiado en su totalidad por Kyowa Kirin Farmacéutica, S.L

Skin manifestations in COVID-19: prevalence and relationship with disease severity

Background: Data on the clinical patterns and histopathology of SARS-CoV-2 related skin lesions, as well as on their relationship with the severity of COVID-19 are limited. Methods and Materials: Retrospective analysis of a prospectively collected cohort of patients with SARS-CoV-2 infection in a teaching hospital in Barcelona, Spain, from 1 April to 1 May 2020. Clinical, microbiological and therapeutic characteristics, clinicopathological patterns of skin lesions, and direct immunofluorescence and immunohistochemical findings in skin biopsies were analyzed. Results: Fifty-eight out of the 2761 patients (2.1%) either consulting to the emergency room or admitted to the hospital for COVID-19 suspicion during the study period presented COVID-19 related skin lesions. Cutaneous lesions could be categorized into six patterns represented by the acronym "GROUCH": Generalized maculo-papular (20.7%), Grover's disease and other papulo-vesicular eruptions (13.8%), livedo Reticularis (6.9%), Other eruptions (22.4%), Urticarial (6.9%), and CHilblain-like (29.3%). Skin biopsies were performed in 72.4%, including direct immunofluorescence in 71.4% and immunohistochemistry in 28.6%. Patients with chilblain-like lesions exhibited a characteristic histology and were significantly younger and presented lower rates of systemic symptoms, radiological lung infiltrates and analytical abnormalities, and hospital and ICU admission compared to the rest of patients. Conclusion: Cutaneous lesions in patients with COVID-19 appear to be relatively rare and varied. Patients with chilblain-like lesions have a characteristic clinicopathological pattern and a less severe presentation of COVID-19

Global patterns of care in advanced stage mycosis fungoides/Sezary syndrome: a multicenter retrospective follow-up study from the Cutaneous Lymphoma International Consortium

ABSTRACT Background Advanced-stage mycosis fungoides (MF)/Sezary syndrome (SS) patients are weighted by an unfavorable prognosis and share an unmet clinical need of effective treatments. International guidelines are available detailing treatment options for the different stages but without recommending treatments in any particular order due to lack of comparative trials. The aims of this second CLIC study were to retrospectively analyze the pattern of care worldwide for advanced-stage MF/SS patients, the distribution of treatments according to geographical areas (USA versus non-USA), and whether the heterogeneity of approaches has potential impact on survival. Patients and methods This study included 853 patients from 21 specialist centers (14 European, 4 USA, 1 each Australian, Brazilian, and Japanese). Results Heterogeneity of treatment approaches was found, with up to 24 different modalities or combinations used as first-line and 36% of patients receiving four or more treatments. Stage IIB disease was most frequently treated by total-skin-electron-beam radiotherapy, bexarotene and gemcitabine; erythrodermic and SS patients by extracorporeal photochemotherapy, and stage IVA2 by polychemotherapy. Significant differences were found between USA and non-USA centers, with bexarotene, photopheresis and histone deacetylase inhibitors most frequently prescribed for first-line treatment in USA while phototherapy, interferon, chlorambucil and gemcitabine in non-USA centers. These differences did not significantly impact on survival. However, when considering death and therapy change as competing risk events and the impact of first treatment line on both events, both monochemotherapy (SHR = 2.07) and polychemotherapy (SHR = 1.69) showed elevated relative risks. Conclusion This large multicenter retrospective study shows that there exist a large treatment heterogeneity in advanced MF/SS and differences between USA and non-USA centers but these were not related to survival, while our data reveal that chemotherapy as first treatment is associated with a higher risk of death and/or change of therapy and thus other therapeutic options should be preferable as first treatment approach

Brentuximab vedotin in the treatment of cutaneous T-cell lymphomas: Data from the Spanish Primary Cutaneous Lymphoma Registry

[Background] Brentuximab vedotin (BV) has been approved for CD30-expressing cutaneous T-cell lymphoma (CTCL) after at least one previous systemic treatment. However, real clinical practice is still limited.[Objectives] To evaluate the response and tolerance of BV in a cohort of patients with CTCL.[Methods] We analysed CTCL patients treated with BV from the Spanish Primary Cutaneous Lymphoma Registry (RELCP).[Results] Sixty-seven patients were included. There were 26 females and the mean age at diagnosis was 59 years. Forty-eight were mycosis fungoides (MF), 7 Sézary syndrome (SS) and 12 CD30+ lymphoproliferative disorders (CD30 LPD). Mean follow-up was 18 months. Thirty patients (45%) showed at least 10% of CD30+ cells among the total lymphocytic infiltrate. The median number of BV infusions received was 7. The overall response rate (ORR) was 67% (63% in MF, 71% in SS and 84% in CD30 LPD). Ten of 14 patients with folliculotropic MF (FMF) achieved complete or partial response (ORR 71%). The median time to response was 2.8 months. During follow-up, 36 cases (54%) experienced cutaneous relapse or progression. The median progression free survival (PFS) was 10.3 months. The most frequent adverse event was peripheral neuropathy (PN) (57%), in most patients (85%), grades 1 or 2.[Conclusions] These results confirm the efficacy and safety of BV in patients with advanced-stage MF, and CD30 LPD. In addition, patients with FMF and SS also showed a favourable response. Our data suggest that BV retreatment is effective in a proportion of cases.The Spanish Primary Cutaneous Lymphoma Registry (RELCP) is promoted by the Fundación Piel Sana Academia Española de Dermatología y Venereología, which received an unrestricted grant support from Kyowa Kirin.Peer reviewe