Generating valid test data through data cloning

One of the most difficult, time-consuming and error-prone tasks during software testing is that of manually generating the data required to properly run the test. This is even harder when we need to generate data of a certain size and such that it satisfies a set of conditions, or business rules, specified over an ontology. To solve this problem, some proposals exist to automatically generate database sample data. However, they are only able to generate data satisfying primary or foreign key constraints but not more complex business rules in the ontology. We propose here a more general solution for generating test data which is able to deal with expressive business rules. Our approach, which is entirely based on the chase algorithm, first generates a small sample of valid test data (by means of an automated reasoner), then clones this sample data, and finally, relates the cloned data with the original data. All the steps are performed iteratively until a valid database of a certain size is obtained. We theoretically prove the correctness of our approach, and experimentally show its practical applicability.This work is partially supported by the SUDOQU project, PID2021-126436OB-C21 from MCIN/AEI, 10.13039/501100011033, FEDER, UE and by the Generalitat de Catalunya, Spain (under 2017-SGR-1749); Sergi Nadal is partly supported by the Spanish Ministerio de Ciencia e Innovación , as well as the European Union - NextGenerationEU, under project FJC2020-045809-I.Peer ReviewedPostprint (published version

Improving patient outcomes in psoriasis : strategies to ensure treatment adherence

Psoriasis is a frequent inflammatory disease with a chronic and relapsing course. Therefore, patients with psoriasis are likely to undergo different treatments for long periods of time. Traditionally, therapies used in psoriasis have been associated with poor levels of adherence due to the complexity of the regimens and the poor results obtained with the topical therapies. These poor outcomes are associated with high levels of frustration and anxiety, which decrease adherence and worsen the disease. With the recent introduction of highly efficacious biologic therapies, patients can achieve very good and prolonged responses. However, most patients with psoriasis have mild disease and may be treated with skin-directed therapies. Therefore, it is important to develop strategies to improve adherence in order to achieve better outcomes, and to improve the overall quality of life. Hence, acknowledging the causes of nonadherence is crucial for implementing these strategies. In this summary, we review the causes of nonadherence, and we provide behavioral strategies in order to improve adherence and, ultimately, the outcome of patients with psoriasis

A multicenter case-control study comparing sun exposure habits and use of photoprotection measures in patients diagnosed with different types of skin cancer

Melanoma; Photoprotection measures; Squamous cell carcinomaMelanoma; Mesures de fotoprotecció; Carcinoma de cèl·lules escamosesMelanoma; Medidas de fotoprotección; Carcinoma de células escamosasBackground While skin cancer awareness programs have significantly furthered public understanding about the harmful effects of the sun, there is a disparity between photoprotection knowledge and protection practices. Objective To compare sun exposure habits and photoprotection measures in patients diagnosed with basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma versus controls. Methods Multicentre case–control observational study carried out by 13 Spanish dermatologists between April 2020 and August 2022. Patients diagnosed with BCC, SCC, or melanoma were considered cases. The control group consisted of individuals with no history of skin cancer. Results Of the 254 cases (56.2% female; mean age, 62.67 ± 15.65), 119 (31.2%) had BCC, 62 (16.27%) SCC, and 73 (19.1%) melanoma. The control group consisted of 127 (33.33%) individuals. Avoiding sun exposure between 12:00 and 16:00 was the most commonly used photoprotection measure (habitually/always: 63.1%), followed by the use of sunscreen (habitually/always: 58.9%). Patients with melanoma were less likely to use clothing and shade to avoid sun exposure (p  50. No differences were observed in photoprotection measures between people with and without a previous history of skin cancer. Conclusions We describe differences in photoprotection measures and sun exposure patterns among patients diagnosed with different skin tumor types. Whether these differences may influence the type of tumor each developed will require further investigation

The Influence of the Exposome in the Cutaneous Squamous Cell Carcinoma, a Multicenter Case–Control Study

Exposome; Squamous cell carcinomaExposoma; Carcinoma cutáneo de células escamosasExposoma; Carcinoma cutani de cèl·lules escamosesIntroduction: The concept of exposome refers to the total of harmful and beneficial environmental exposures that can help predict the organism’s biological responses over time. Ultraviolet radiation (UVR) from sun exposure has been recognized as the main etiological agent of skin cancer, and squamous cell carcinoma (SCC) is one most commonly associated with chronic exposure. However, in recent years, evidence suggests that lifestyle, environmental pollution, and contaminants in water and food can have an influence. Objectives: To study the relationship between SCC and sun exposure, pollution, stress, and lifestyle in a Spanish cohort. Materials and Method: A multicenter case–control study was carried out in which 13 dermatologists from different regions of Spain recruited cases and controls between April 2020 and August 2022. The group of cases were patients diagnosed with SCC and, as a control group, people who attended Dermatology consultations as companions with no history of skin cancer. Results: A total of 62 patients with SCC and 126 controls were included (62.9% males, median age 76.46 (10.1) and 33.3%, median age 55.7 (15), respectively). The SCC group had experienced more outside work than the controls (75% vs. 22.4%, p < 0.001), less recreational exposure (sunbathing, p = 0.05, and outdoor sports, p = 0.01), and a lower annual income (p = 0.01), with an increase in tobacco exposure (p < 0.001), without differences in other carcinogens, such as ionizing radiation or chemical exposure. The control group had a higher daily screentime use (p < 0.001) and practiced more relaxation activities (p = 0.03). A higher linolenic acid intake and lower coffee consumption were the only dietary variables associated with SCC (p < 0.05). Some chronic medications (anxiolytics, antidepressants, beta-blockers, statins, hydrochlorothiazide, ACE inhibitors, metformin, and omeprazole) were also statistically associated with SCC. Statistical significance for all aforementioned variables was maintained in the multivariate analysis (p < 0.05). Conclusions: The study found a significant association between SCC and multiple exposome-related factors in addition to chronic sun exposure in the Spanish population. Primary prevention strategies should target specific populations, such as outdoor workers promoting sun-safe behaviors and stress-reducing activities, in addition to adequate skin photoprotection in patients under certain medications associated with SCC

Using Artificial Intelligence as a Diagnostic Decision Support Tool in Skin Disease : Protocol for an Observational Prospective Cohort Study

Dermatological conditions are a relevant health problem. Each person has an average of 1.6 skin diseases per year, and consultations for skin pathology represent 20% of the total annual visits to primary care and around 35% are referred to a dermatology specialist. Machine learning (ML) models can be a good tool to help primary care professionals, as it can analyze and optimize complex sets of data. In addition, ML models are increasingly being applied to dermatology as a diagnostic decision support tool using image analysis, especially for skin cancer detection and classification. This study aims to perform a prospective validation of an image analysis ML model as a diagnostic decision support tool for the diagnosis of dermatological conditions. In this prospective study, 100 consecutive patients who visit a participant general practitioner (GP) with a skin problem in central Catalonia were recruited. Data collection was planned to last 7 months. Anonymized pictures of skin diseases were taken and introduced to the ML model interface (capable of screening for 44 different skin diseases), which returned the top 5 diagnoses by probability. The same image was also sent as a teledermatology consultation following the current stablished workflow. The GP, ML model, and dermatologist's assessments will be compared to calculate the precision, sensitivity, specificity, and accuracy of the ML model. The results will be represented globally and individually for each skin disease class using a confusion matrix and one-versus-all methodology. The time taken to make the diagnosis will also be taken into consideration. Patient recruitment began in June 2021 and lasted for 5 months. Currently, all patients have been recruited and the images have been shown to the GPs and dermatologists. The analysis of the results has already started. This study will provide information about ML models' effectiveness and limitations. External testing is essential for regulating these diagnostic systems to deploy ML models in a primary care practice setting

Non-invasive clinical and microscopic evaluation of the response to treatment with clobetasol cream vs. calcipotriol/betamethasone dipropionate foam in mild to moderate plaque psoriasis : an investigator-initiated, phase IV, unicentric, open, randomized clinical trial

Treatment response for psoriasis is typically evaluated using clinical scores. However, patients can relapse after clinical clearance, suggesting persistent inflammation. Dermoscopy, reflectance confocal microscopy (RCM) and optical coherence tomography (OCT) can non-invasively improve treatment response assessment. To compare the clinical and non-invasive microscopic features in a psoriatic target lesion treated with clobetasol cream or calcipotriol/betamethasone dipropionate foam (Cal/BD foam). Prospective, unicentric, open, randomized clinical trial comparing clinical data [total clinical score (TCS)] and microscopic data (dermoscopy, RCM and OCT) in psoriasis patients treated with clobetasol or Cal/BD foam. We included 36 adult patients (22 men). At week 4, more patients treated with Cal/BD foam achieved TCS ≤1 than with clobetasol (63.2% vs. 18.8%, P = 0.016). Treatment satisfaction was higher with Cal/BD foam (P < 0.03). Microscopically, Cal/BD foam induced more reduction in epidermal thickness at week 4 (P < 0.049). Dilated horizontal blood vessels were more common with clobetasol than with Cal/BD foam at week 8 (69.2% vs. 31.2%, P = 0.159). If epidermal hyperplasia was noted at baseline, the response was poorer with clobetasol (P = 0.029). Small sample size, open study, imaging sampling bias. Cal/BD foam is more effective than clobetasol, has better patient satisfaction and induces greater reduction in the hyperkeratosis/acanthosis, regardless of baseline epidermal hyperplasia

A multicenter case-control study comparing sun exposure habits and use of photoprotection measures in patients diagnosed with different types of skin cancer

Background: While skin cancer awareness programs have significantly furthered public understanding about the harmful effects of the sun, there is a disparity between photoprotection knowledge and protection practices. Objective: To compare sun exposure habits and photoprotection measures in patients diagnosed with basal cell carcinoma (BCC), squamous cell carcinoma (SCC), and melanoma versus controls. Methods: Multicentre case–control observational study carried out by 13 Spanish dermatologists between April 2020 and August 2022. Patients diagnosed with BCC, SCC, or melanoma were considered cases. The control group consisted of individuals with no history of skin cancer. Results: Of the 254 cases (56.2% female; mean age, 62.67 ± 15.65), 119 (31.2%) had BCC, 62 (16.27%) SCC, and 73 (19.1%) melanoma. The control group consisted of 127 (33.33%) individuals. Avoiding sun exposure between 12:00 and 16:00 was the most commonly used photoprotection measure (habitually/always: 63.1%), followed by the use of sunscreen (habitually/always: 58.9%). Patients with melanoma were less likely to use clothing and shade to avoid sun exposure (p  50. No differences were observed in photoprotection measures between people with and without a previous history of skin cancer. Conclusions: We describe differences in photoprotection measures and sun exposure patterns among patients diagnosed with different skin tumor types. Whether these differences may influence the type of tumor each developed will require further investigation

Usefulness of in vivo reflectance confocal microscopy and automated videomosaics in the treatment and management of skin cancers = Ús de la microscòpia confocal de reflectància in vivo i dels videomosaics automatitzats en el tractament i seguiment dels càncers cutanis

[eng] Skin cancer is major health problem due to its increased incidence in the last decades. Standard treatment of skin cancer is still surgery, which can be challenging to perform since most skin cancers are located in visible areas such as the face. Hence, methods to improve skin cancer treatment and minimize scarring are crucial. In this sense, non-invasive imaging technologies can be of great help in determining the margins of skin cancers prior to their treatment, as well as they offer a great opportunity to monitor its treatment and detect early relapses. Reflectance confocal microscopy (RCM) is one of this non-invasive imaging technologies which has cellular resolution and has shown to have high diagnostic accuracy for different types of skin cancers such as keratinocyte carcinomas, melanomas or Paget disease. Currently two RCM microscopes are commercially available: 1) a wide-probe microscope which requires attaching a metal/plastic ring on the skin to obtain image mosaics up to 8 x 8 mm; 2) a handheld RCM (HRCM) microscope which allows free imaging along the skin with a field of view which ranges from 0.75 to 1 mm. HRCM has the advantage that permits imaging areas larger than 8 x 8 mm by navigating over the skin but lacks mosaicking capabilities in its native software, making orientation complicated. However, it is intuitive to think that HRCM is the ideal tool to predefine the margins of skin cancers and to monitor its responses to treatment due to its versatility, especially when the size of tumor is larger than 8 mm. The goal of the current thesis was to develop a computer algorithm to obtain static 2D mosaics obtained from dynamic videos obtained with HRCM, and to apply this technique to address some of the challenges that physicians encounter when managing skin cancers, such as defining the skin cancer margins prior to surgery (particularly important in some skin cancers such as lentigo maligna [LM] which have ill-defined margins), identifying residual tumor directly in the surgical wound, and identifying small foci of tumor in recurrent or persistent skin cancers which present in a patchy fashion such as extramammary Paget’s disease (EMPD). The research for this thesis resulted in 5 publications summarized herein. The first publication describes the videomosaicking algorithm as well as clinical to showcase how this algorithm can be used not only in RCM but in other microscopic imaging systems. The second publication applies the videomosaicking algorithm to delineate the preoperative margins in a consecutive series of 23 LM/LM melanoma, showing that the HRCM with videomosaicking can correctly predict the surgical defect after staged excision with minimal variations. In the third publication, HRCM was used to identify persistence or recurrence of EMPD after different treatments. Here, the videomosaicking algorithm was used in some of the patients and showed that the diagnostic accuracy improved when videomosaics were added to the conventional HRCM examination. In the fourth and fifth publications HRCM and videomosaics were used to image directly in the surgical wound after treating keratinocyte carcinomas (after laser ablation in the 4th publication, and after Mohs surgery in the 5th publication), showing it is possible to identify residual tumor using HRCM and videomosaics directly inside the surgical wound. In summary, this thesis shows how videomosaics expand the usefulness of HRCM in skin cancer management and overcome its main challenges by expanding the field of view and obtaining architectural information which is crucial when evaluating microscopic images.[cat] El càncer de pell representa un important problema de salut pública ja que la seva incidència no ha parat d’augmentar en les darreres dècades. El tractament estàndard del càncer de pell segueix essent la cirurgia, que sovint pot ser complexa i potencialment morbida ja que la majoria dels càncers de pell aparèixen en sones zones visibles com la cara. Per tant, qualsevol mètode que permeti millorar-ne el tractament i minimitzar-ne les cicatrius és crucial. En aquest sentit, les tecnologies d'imatge no invasives poden ser de gran ajuda per determinar els marges tumorals abans del seu tractament, controlar la resposta al tractament i detectar la presència de persistència o recurrència de forma precoç. La microscòpia confocal de reflectància és una d'aquestes tecnologies d'imatge no invasiva que posseeix una resolució cel·lular i ha demostrat tenir una alta precisió diagnòstica per als diferents tipus de càncers de pell. Actualment dos microscopis confocals de reflectancia estan disponibles al mercat: 1) un microscopi de sonda àmplia que requereix adherir un anell de metall/plàstic a la pell per tal obtenir mosaics d'imatges de fins a 8 x 8 mm; 2) un microscopi de mà que permet obtenir imatges de forma lliure amb un camp de visió que oscil·la entre 0,75 i 1 mm. El microscopi de mà té l’avantatge que permet avaluar àrees superiors a 8 x 8 mm navegant pel damunt de la pell segons les necessitats de l’operador, però no té la capacitat de generar mosaic en el seu programari natiu, de manera que l’orientació és complicada. No obstant, és lògic pensar que el microscopi de mà és l’eina ideal per predefinir els marges dels càncers de pell i controlar-ne la resposta al tractament gràcies a la seva versatilitat, especialment quan la mida del tumor és superior a 8 mm. L’objectiu d’aquesta tesi doctoral ha estat desenvolupar un algoritme informàtic per obtenir mosaics 2D estàtics obtinguts a partir de vídeos dinàmics obtinguts amb el microscopi confocal de mà, i aplicar aquesta tècnica per abordar alguns dels reptes que els metges es troben en fer front a càncers de pell, com ara definir els marges dels càncers de pell abans de la cirurgia (especialment important en alguns d’ells com el lentigen maligne que tenen marges mal definits), identificar el tumor residual directament a la ferida quirúrgica, així com identificar petits focus de tumor recurrents o persistents en entitats com la malaltia de Paget extramamària o carcinomes queratinocítics