Routine tests for both planning and evaluating image quality in tele-echocardiography

Both in real-time and "store & forward" tele-echocardiography (T-E), a coding process has to be applied to the echocardiography videoclips in order to limit the bandwidth needed and adapt it to the bandwidths furnished by network providers. The compression process degrades the videoclips, affecting thus the quality of the videoclips and potentially compromising the diagnostic accuracy of the T-E. In this work the authors investigated on the use of automatic tools for the video quality assessment by means of objective methods with particular care to the role of the system administrator. As the use of tests on video quality assessment (based on subjective methods) is hampered by the high number of needed resources (persons, laboratories and time). The use of valid objective methods is thus desirable. The study reviewed different tools with this specific aim. One of the more suitable tool was found to be represented by a software package designed by the Institute of Telecommunication Sciences and the National Telecommunication and Information Administration, the NTIA/ITS VQM tool. This tool gives back objective-quantitative data as outcomes, however embeds models emulating the subjective perception. This study reviewed and analyzed in depth the functionalities of the tool to improve the image quality in TE over the network. The tool was also found suitable for a more general process of T-E assessment, from a health technology assessment (HTA) perspective

Synergic use of SAR imagery and high resolution atmospheric model to estimate marine wind fields : an application in presence of an atmospheric gravity wave episode.

A study aimed at retrieving sea surface wind fields of semi-enclosed basins from combined use of SAR imagery and a high resolution mesoscale numerical atmospheric model, is presented. Two consecutive ERS-2 SAR frames and a set of NOAA/AVHRR and MODIS images acquired over the North Tyrrhenian Sea on March 30, 2000 were used for the analysis. SAR wind speeds and directions at 10 m above the sea surface were retrieved using the semi-empirical backscatter models CMOD4 and CMOD-IFREMER. Surface wind vectors predicted by the meteorological ETA model were exploited as guess input to SAR wind inversion procedure. ETA is a three-dimensional, primitive equation, grid-point model currently operational at the National Centers for Environmental Prediction of the U.S. National Weather Service. The model was adapted to run with a resolution up to about 4.0 Km. It was found that the inversion methodology was not able to resolve wind speed modulations due to the action of an atmospheric gravity wave, called “lee wave”, which occurred in the analyzed area. A simple atmospheric wave propagation model was thus used to account for the SAR observed surface wind speed modulation. Synergy with ETA model outputs was further exploited in simulations where atmospheric parameters up-wind the atmospheric wave were provided as input to the lee wave propagation model

A web-based health technology assessment in tele-echocardiography: the experience within an Italian project

Due to major advances in the information technology, telemedicine applications are ready for a widespread use. Nonetheless, to allow their diffusion in National Health Care Systems (NHCSs) specific methodologies of health technology assessment (HTA ) should be used to assess the standardization, the overall quality, the interoperability, the addressing to legal, economic and cost benefit aspects. One of the limits to the diffusion of the digital tele-echocardiography (T-E) applications in the NHCS lacking of a specific methodology for the HTA . In the present study, a solution offering a structured HTA of T-E products was designed. The methodology assured also the definition of standardized quality levels for the application. The first level represents the minimum level of acceptance; the other levels are accessory levels useful for a more accurate assessment of the product. The methodology showed to be useful to rationalize the process of standardization and has received a high degree of acceptance by the subjects involved in the study.Grazie ai grandi progressi nell\u27information technology le applicazioni di telemedicina sono mature per un uso diffuso. Tuttavia per permettere la loro introduzione nel sistema sanitario nazionale devono essere utilizzate specifiche metodologie di health technology assessment (HTA ) per valutare il grado di standardizzazione, la qualit? totale, l\u27interoperabilit?, il rispetto dei requisiti legali ed economici e il rapporto costo-beneficio. Con riferimento alla tele-ecocardiografia digitale uno dei limiti ? la mancanza di una specifica metodologia di HTA . Nel presente studio, ? stata proposta una soluzione che offre un HTA strutturato di prodotti di tele-ecocardiografia (T-E) digitale. La metodologia ha assicurato anche la definizione di livelli standardizzati di qualit? per l\u27applicazione. Il primo livello rappresenta il livello minimo di accettazione; gli altri livelli riguardano aspetti accessori e sono utili per una pi? accurata valutazione del prodotto. La metodologia si ? mostrata di utilit? per razionalizzare il processo di standardizzazione ed ha ricevuto un elevato grado di accettazione dei soggetti coinvolti

The estrogen receptor alpha:insulin receptor substrate 1 complex in breast cancer: structure-function relationships

Background: Insulin receptor substrate 1 (IRS-1) is a signaling molecule that exerts a key role in mediating cross talk between estrogen receptor a (ERa) and insulin-like growth factor 1 (IGF-1) in breast cancer cells. Previously, we demonstrated that a fraction of IRS-1 binds ERa, translocates to the nucleus, and modulates ERa-dependent transcription at estrogen response elements (ERE). Here, we studied structure–function relationships of the ERa:IRS-1 complex under IGF-1 and/or estradiol (E2) stimulation. Materials and methods: ERa and IRS-1 deletion mutants were used to analyze structural and functional ERa/IRS-1 interactions. IRS-1 binding to ERE and IRS-1 role in ERa-dependent ERE transcription was examined by chromatin immunoprecipitation and gene reporter analysis, respectively. The requirement for IRS-1 in ERa function was tested with RNAi technology. Results: Nuclear translocation of IRS-1 was induced by E2, IGF-1, and a combination of both stimuli. ERa/IRS-1 binding was direct and involved the activation function-1 (AF-1)/DNA binding domain (DBD) region of ERa and two discrete regions of IRS-1 (the N-terminal pleckstrin homology domain and a region within the C-terminus). IRS-1 knock down abrogated IGF-1-dependent transcriptional activity of unliganded ERa, but induced the activity of liganded ERa. Conclusions: ERa/IRS-1 interactions are direct and involve the ERa AF-1/DBD domain and IRS-1 domains mapping within N- and C-terminus. IRS-1 may act as a repressor of liganded ERa and coactivator of unliganded ERa

Biological Function of PD-L2 and Correlation With Overall Survival in Type II Endometrial Cancer

In cancer, upregulation of coinhibitory B7 ligands has been associated with immune evasion. So far, anti-programmed death-1 (PD-1) and anti-PD-ligand 1 (PD-L1) antibodies have been used in immuno-oncology, with promising outcomes; however, it is still needed to identify other markers, especially for endometrial cancer (EC). EC is a gynecological malignancy historically classified into two types: type I, with mostly estrogen-dependent endometrioid diseases, and the most aggressive type II, including mainly estrogen-independent and non-endometrioid tumors. PD ligand-2 (PD-L2) is known as the second ligand of the PD-1 receptor and, upon its binding, contributes to T-cell exhaustion. Up to now, very few information are available about PD-L2 in cancers, and no data have been reported for EC. The aim of this work was to characterize the PD-L1 and PD-L2 ligand expression profile in EC cell lines, focusing the attention on the biological role of PD-L2 and its prognostic impact in human type II EC biopsies. Using in silico analysis of TCGA data, we performed a molecular profiling in a cohort of 506 patients, both types I and II, and PD-1 ligands expression was also analyzed in different primary human EC cell lines. Moreover, PD-L2 staining was evaluated in a cohort of human type II EC samples and correlated with the overall survival (OS), progression-free survival (PFS), and additional clinicopathological data. From the in silico analysis, PD-L2 was more expressed than PD-L1 in EC cell lines. PD-L2 was found highly expressed in 64.44% of tumor specimens, predominantly in the serous subtype, in both stromal and epithelial components, while in peritumoral and normal tissues it was predominantly moderate or low. In vitro, we investigated the cell autonomous role of PD-L2 in controlling cell survival, migration, and chemoresistance

Dynamic Interstitial Cell Response during Myocardial Infarction Predicts Resilience to Rupture in Genetically Diverse Mice.

Cardiac ischemia leads to the loss of myocardial tissue and the activation of a repair process that culminates in the formation of a scar whose structural characteristics dictate propensity to favorable healing or detrimental cardiac wall rupture. To elucidate the cellular processes underlying scar formation, here we perform unbiased single-cell mRNA sequencing of interstitial cells isolated from infarcted mouse hearts carrying a genetic tracer that labels epicardial-derived cells. Sixteen interstitial cell clusters are revealed, five of which were of epicardial origin. Focusing on stromal cells, we define 11 sub-clusters, including diverse cell states of epicardial- and endocardial-derived fibroblasts. Comparing transcript profiles from post-infarction hearts in C57BL/6J and 129S1/SvImJ inbred mice, which displays a marked divergence in the frequency of cardiac rupture, uncovers an early increase in activated myofibroblasts, enhanced collagen deposition, and persistent acute phase response in 129S1/SvImJ mouse hearts, defining a crucial time window of pathological remodeling that predicts disease outcome