Definition of an automated Content-Based Image Retrieval (CBIR) system for the comparison of dermoscopic images of pigmented skin lesions

<p>Abstract</p> <p>Background</p> <p>New generations of image-based diagnostic machines are based on digital technologies for data acquisition; consequently, the diffusion of digital archiving systems for diagnostic exams preservation and cataloguing is rapidly increasing. To overcome the limits of current state of art text-based access methods, we have developed a novel content-based search engine for dermoscopic images to support clinical decision making.</p> <p>Methods</p> <p>To this end, we have enrolled, from 2004 to 2008, 3415 caucasian patients and collected 24804 dermoscopic images corresponding to 20491 pigmented lesions with known pathology. The images were acquired with a well defined dermoscopy system and stored to disk in 24-bit per pixel TIFF format using interactive software developed in C++, in order to create a digital archive.</p> <p>Results</p> <p>The analysis system of the images consists in the extraction of the low-level representative features which permits the retrieval of similar images in terms of colour and texture from the archive, by using a hierarchical multi-scale computation of the Bhattacharyya distance of all the database images representation with respect to the representation of user submitted (query).</p> <p>Conclusion</p> <p>The system is able to locate, retrieve and display dermoscopic images similar in appearance to one that is given as a query, using a set of primitive features not related to any specific diagnostic method able to visually characterize the image. Similar search engine could find possible usage in all sectors of diagnostic imaging, or digital signals, which could be supported by the information available in medical archives.</p

Vasculitis and COVID-19: what do we have to know?

As the main title 'COVID-19 revolution: a new challenge for the internist' states, the global coronavirus infection disease 2019 (COVID-19) pandemic represented a new challenge for the internists. This paper is part of a series of articles written during the difficult period of the ongoing global pandemic and published all together in this fourth issue of the Italian Journal of Medicine, with the aim of sharing the direct experiences of those who were the first to face this severe emergency, expressing each point of view in the management of COVID-19 in relation to other diseases. Each article is therefore the result of many efforts and a joint collaboration between many colleagues from the Departments of Internal Medicine or Emergency Medicine of several Italian hospitals, engaged in the front line during the pandemic. These preliminary studies therefore cover diagnostic tools available to health care personnel, epidemiological reflections, possible new therapeutic approaches, discharge and reintegration procedures to daily life, the involvement of the disease not only in the lung, aspects related to various comorbidities, such as: coagulopathies, vasculitis, vitamin D deficiency, gender differences, etc.. The goal is to offer a perspective, as broad as possible, of everything that has been done to initially face the pandemic in its first phase and provide the tools for an increasingly better approach, in the hope of not arriving unprepared to a possible second wave. This paper in particular deals with vasculitis and COVID-19

Economic impact of the use of Hyalubrix® in the treatment of hip osteoarthritis in Italy

The present study aims at evaluating the economic impact of the use of hyaluronic acid (Hyalubrix®60/HyalOne) as an alternative to surgery in the treatment of hip osteoarthritis, consistently with the therapeutic protocol envisaged in the Ortobrix study. To quantify the cost and efficacy of the treatment options under evaluation, the perspective of both the Italian NHS and the Society was considered. To this end, a decision analysis model was created over a 4-year period, to quantify the cost of treatments, procedures and adverse events, as well as the benefits expressed as survival rates and reduced lost workdays. The results show that, since the treatment with Hyalubrix® enables to avoid or delay the need for Total Hip Replacement (THR) surgery, it is possible to reduce mortality, adverse events and total costs. Hyalubrix®, given in the hip by ultrasound-guided intra-articular injection as an alternative to surgery is the most favourable option, helping preserve the survival rate over a 4-year period, of approximately 1 in 100 patients considered candidates for THR, preserve work capacity for a total differential amount of 500 days, and achieve considerable savings in economic terms, of approximately 550,000 € and 600,000€ euros from the NHS and the Societal perspectives, respectively

Immunomodulating Therapies in Acute Myocarditis and Recurrent/Acute Pericarditis

The field of inflammatory disease of the heart or "cardio-immunology " is rapidly evolving due to the wider use of non-invasive diagnostic tools able to detect and monitor myocardial inflammation. In acute myocarditis, recent data on the use of immunomodulating therapies have been reported both in the setting of systemic autoimmune disorders and in the setting of isolated forms, especially in patients with specific histology (e.g., eosinophilic myocarditis) or with an arrhythmicburden. A role for immunosuppressive therapies has been also shown in severe cases of coronavirus disease 2019 (COVID-19), a condition that can be associated with cardiac injury and acute myocarditis. Furthermore, ongoing clinical trials are assessing the role of high dosage methylprednisolone in the context of acute myocarditis complicated by heart failure or fulminant presentation or the role of anakinra to treat patients with acute myocarditis excluding patients with hemodynamically unstable conditions. In addition, the explosion of immune-mediated therapies in oncology has introduced new pathophysiological entities, such as immune-checkpoint inhibitor-associated myocarditis and new basic research models to understand the interaction between the cardiac and immune systems. Here we provide a broad overview of evolving areas in cardio-immunology. We summarize the use of new imaging tools in combination with endomyocardial biopsy and laboratory parameters such as high sensitivity troponin to monitor the response to immunomodulating therapies based on recent evidence and clinical experience. Concerning pericarditis, the normal composition of pericardial fluid has been recently elucidated, allowing to assess the actual presence of inflammation; indeed, normal pericardial fluid is rich in nucleated cells, protein, albumin, LDH, at levels consistent with inflammatory exudates in other biological fluids. Importantly, recent findings showed how innate immunity plays a pivotal role in the pathogenesis of recurrent pericarditis with raised C-reactive protein, with inflammasome and IL-1 overproduction as drivers for systemic inflammatory response. In the era of tailored medicine, anti-IL-1 agents such as anakinra and rilonacept have been demonstrated highly effective in patients with recurrent pericarditis associated with an inflammatory phenotype.Peer reviewe

Multicriteria Optimization Model to Generate on-DEM Optimal Channel Networks

The theory of optimal channel networks (OCNs) explains the existence of self‐similarities in river networks by multiple optimality principles, namely, (i) the minimum energy expenditure in any link, (ii) the equal energy expenditure per unit area of channel anywhere, and (iii) the minimum total energy expenditure (TEE). These principles have been used to generate OCNs from 2‐D networks. The existing notion of OCN considers the concavity of river longitudinal profiles as a priori condition. Attempts to generate OCNs starting from a random 3‐D digital elevation model (DEM) and minimizing solely TEE have failed to reproduce concave profiles. Yet alternative approaches can be devised from the three optimality principles, for instance, focusing on the local energy expenditure (LEE). In this paper, we propose a Multiobjective modeling framework for Riverscape Exploration (MoRE) via simultaneous optimization of multiple OCN criteria. MoRE adopts a multiobjective evolutionary algorithm and radial basis functions to efficiently guide DEM elevation variations required to shape 3‐D OCNs. By minimizing both TEE and the variance in LEE, MoRE successfully reproduces realistic on‐DEM, OCN‐based riverscapes, for the first time. Simulated networks possess scaling laws of upstream area and length and river longitudinal profile resembling those of real river networks. The profile concavity of generated on‐DEM OCNs emerges as a consequence of the minimization of TEE constrained to the equalization of LEE. Minimizing TEE under this condition generates networks that possess specific patterns of LEE, where the scaling of slope with basin area resembles the patterns observed in real river networks

Indirect comparison of etanercept, infliximab, and adalimumab for psoriatic arthritis: Mixed treatment comparison using placebo as common comparator

Psoriatic arthritis (PsA) is a chronic inflammatory joint disorder that is commonly associated with skin psoriatic lesions and can lead to severe disability. Current pharmacologic therapy for PsA includes TNFα-blocking agents for patients who are intolerant of or have an inadequate response to conventional disease-modifying antirheumatic drugs. Currently, there are no published randomized controlled trials providing a head-to-head comparison of the effectiveness of the three TNFα-blocking agents used most often to treat patients with PsA (adalimumab, etanercept, and infliximab). In this study, we have performed the first indirect comparison among these biologic agents, in this setting, using a mixed treatment comparison analysis of the data from pivotal trials regarding efficacy profiles of adalimumab, etanercept, and infliximab evaluated as American College of Rheumatology (ACR) 20 response. Our results suggest that etanercept is expected to provide the greatest ACR20 response among the anti-TNFα agents compared with placebo in the treatment of patients with PsA unresponsive to conventional treatments. This analysis may be relevant for clinical decision-making, hence improving the management of PsA patients

Treatment of osteoarthritis knee pain: update on use of intra-articular hylan G-F 20

Alberto Migliore1, Francesca Giovannangeli1, Emanuele Bizzi1, Bruno Lagan&amp;agrave;2, Mauro Granata31Department of Rheumatology, S Pietro FBF Hospital, 2Department of Rheumatology, Second Medical School, Sapienza University, 3Rheumatology and Osteoporosis Center, San Filippo Neri Hospital, Rome, ItalyBackground: Osteoarthritis is a public health concern, particularly in modern society, and is the leading osteoarticular pathology in developed countries. The increased prevalence of osteoarthritis with aging, coupled with the aging of populations, makes osteoarthritis a high priority health care problem. Viscosupplementation is a well established treatment option in knee osteoarthritis that is included in the professional guidelines for treatment of this joint disease.Objective: This review assessed the efficacy and safety of viscosupplementation with hylan G-F 20 (Synvisc&amp;reg;) in the management of joint pain in knee osteoarthritis.Methods: Three databases were searched, ie, Medline (1970&amp;ndash;2010), the Database of Abstract on Reviews and Effectiveness, and the Cochrane Database of Systematic Reviews. Reference lists of relevant articles were examined for additional references.Results: Eighteen studies were identified (six European, five Turkish, three US, two Canadian, one Swiss and one English), which reported efficacy of viscosupplementation in a total of 3689 patients undergoing viscosupplementation treatment with Synvisc for knee osteoarthritis compared with low molecular weight viscosupplementation, high molecular weight viscosupplementation, medium molecular weight viscosupplementation, placebo, corticosteroids, nonsteroidal anti-inflammatory drugs, and physical therapy.Conclusion: Synvisc viscosupplementation in the treatment of knee osteoarthritis is a safe and effective therapeutic option that could also reduce the direct and indirect costs related to this disease.Keywords: viscosupplementation, knee osteoarthritis, hyaluronic acid, hyaluronan, sodium hyaluronate, hylan G-F 20, intra-articular injectio

Indirect comparison of etanercept, infliximab, and adalumimab for psoriatic arthritis: mixed treatment comparison using placebo as common comparator

[No abstract available

Analyzing tradeoffs between hydropower production and hydrological alteration to support water resources planning in large river systems

In many countries water is a key renewable resource to complement carbon-emitting energy production in the face of demand pressure from fast-growing industrial production and urbanization. In this study, we analyze the case of the Red River Vietnam, a large basin of 169.000 kmq where the storing capacity, mainly targeted at hydropower production, has steadily increased since from the Eighties through the construction of a number of reservoirs (Hoa Binh completed in 1994, Tuyen Quang in 2008, Son La in 2012), which nowadays account for the 15% of the national electric power production. On the other hand, reservoir operation dramatically alters downstream river hydrology, geomorphological processes and riverine ecosystems. In this work, we focus in particular on the alteration of the hydrological regime downstream of the Hoa Binh reservoir and explore re-operation options to mitigate the hydrological alteration while guaranteeing reasonable hydropower production. To reach this goal we (i) define an index of hydrological alteration starting from the well established set of Indicators of Hydrological Alteration and applying a novel selection and aggregation procedure; (ii) embed such an index into a multi-objective optimization process, to design reservoir operating policies that represent Pareto-optimal solutions between maximization of hydropower production and minimization of hydrological alteration. This work demonstrates the potential of multi-objective optimization and simulation tools to analyze tradeoffs between conflicting needs and thus support the evaluation and planning of sustainable energy production programs