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The introduction of new therapeutic agents in chronic lymphocytic leukemia (CLL) and follicular lymphoma (FL), including the new kinase inhibitor idelalisib, has changed the therapeutic landscape of these diseases. However, the use of idelalisib is associated with a peculiar profile of side effects, which require an optimization of the current approach to prophylaxis and supportive treatment. Moving from the recognition that the abovementioned issue represents an unmet need in CLL and FL, a multidisciplinary panel of experts was convened to produce a consensus document aiming to provide practical recommendations for the management of the side effects during idelalisib therapy for CLL and FL. The present publication represents a consensus document from a series of meetings held during 2017. The Panel generated clinical key questions using the criterion of clinical relevance through a Delphi process and explored 4 domains, ie, diarrhea/colitis, transaminitis, pneumonitis, and infectious complications. Using the consensus method, the Panel was able to shape recommendations which may assist hematologist to minimize adverse events and guarantee adherence to treatment in patients with CLL and FL candidate to receive idelalisib.

Background Electrocardiograms (ECGs) are routinely recorded and stored in a variety of paper or scanned image format. Current ECG recording machines record ECG on graph paper, also it provides digitized ECG signal along with automated cardiovascular diagnosis (CVD). However, such recording machines cannot analyse preserved paper ECG records as it requires input in terms of digitized signal. Therefore, it is important to extract ECG signal from these preserved paper ECG records using digitization method. There are different paper degradations that adversely affect digitization process. The purpose of this work is to perform an image enhancement and digitization of the degraded ECG images to extract continuous ECG signal. Methods In this paper, we propose entropy-based bit plane slicing (EBPS) algorithm in which pre-processing is done using dominant color detection and local bit plane slicing. Maximum entropy based adaptive bit plane selection is applied to the pre-processed image. Discontinuous ECG correction (DECGC) is then done to produce continuous ECG signal. Results The algorithm is tested on 836 different degraded paper ECG records obtained from various diagnostic centers. After analysis with 101 known ground truth ECG signals the accuracy, sensitivity, specificity and overall F-measure of ECG is 99.42%, 99.69%, 99.81% and 99.26% respectively. The RMS error and correlation between the extracted digitized signal and ground truth for 101 cases is 0.040 and 99.89% respectively. Conclusions The EBPS method is able to remove all types of degradation in paper ECG records to generate a uniform digitized signal. Instead of manual measurement and prediction from archived paper ECG records, automated prediction (using already existing cardiovascular diagnosis software) is possible with the help of extracted digitized signal obtained using proposed digitization method, which will also help retrospective cardiovascular analysis.

SciPy is an open source scientific computing library for the Python programming language. SciPy 1.0 was released in late 2017, about 16 years after the original version 0.1 release. SciPy has become a de facto standard for leveraging scientific algorithms in the Python programming language, with more than 600 unique code contributors, thousands of dependent packages, over 100,000 dependent repositories, and millions of downloads per year. This includes usage of SciPy in almost half of all machine learning projects on GitHub, and usage by high profile projects including LIGO gravitational wave analysis and creation of the first-ever image of a black hole (M87). The library includes functionality spanning clustering, Fourier transforms, integration, interpolation, file I/O, linear algebra, image processing, orthogonal distance regression, minimization algorithms, signal processing, sparse matrix handling, computational geometry, and statistics. In this work, we provide an overview of the capabilities and development practices of the SciPy library and highlight some recent technical developments., Comment: Article source data is available here: https://github.com/scipy/scipy-articles

Background:: Paper-based and computer-based insulin infusion algorithms facilitate appropriate glycemic therapy. The data comparing these algorithms in the management of diabetic ketoacidosis in the intensive care unit (ICU) setting are limited. We aimed to determine the differences in time to diabetic ketoacidosis resolution and incidence of hypoglycemia between computer and paper-based insulin infusion. Methods:: Single-institution retrospective review of patients admitted to the ICU with diabetic ketoacidosis between 4/1/2015 and 7/20/2018. Our institution introduced computer-based insulin infusion (Glucommander) to the intensive care unit on 3/28/2016. Patients were grouped into either paper-based group (preintervention) or a computer-based group (postintervention). Summary and univariate analyses were performed. Results:: A total of 620 patients (paper-based=247; computer-based=373) with a median (IQR) age of 40 (26-56) years were included; 46% were male. Patients in the computer-based group were significantly older (p=0.003); otherwise, there were no significant differences in gender, race, body mass index and HbA1c. The mean (±SD) time to diabetic ketoacidosis resolution in the computer-based group was significantly lower than the paper-based group (p=0.02). The number of patients in the paper-based group who developed severe hypoglycemia ( Conclusions:: Our analyses demonstrate statistically significant decreases in time to DKA resolution and hypoglycemic events in DKA patients who were managed using a computer-based insulin infusion algorithm providing a more effective and safer option when compared to paper-based insulin infusion.

Objective To evaluate the design characteristics of studies that evaluated the performance of artificial intelligence (AI) algorithms for the diagnostic analysis of medical images. Materials and methods PubMed MEDLINE and Embase databases were searched to identify original research articles published between January 1, 2018 and August 17, 2018 that investigated the performance of AI algorithms that analyze medical images to provide diagnostic decisions. Eligible articles were evaluated to determine 1) whether the study used external validation rather than internal validation, and in case of external validation, whether the data for validation were collected, 2) with diagnostic cohort design instead of diagnostic case-control design, 3) from multiple institutions, and 4) in a prospective manner. These are fundamental methodologic features recommended for clinical validation of AI performance in real-world practice. The studies that fulfilled the above criteria were identified. We classified the publishing journals into medical vs. non-medical journal groups. Then, the results were compared between medical and non-medical journals. Results Of 516 eligible published studies, only 6% (31 studies) performed external validation. None of the 31 studies adopted all three design features: diagnostic cohort design, the inclusion of multiple institutions, and prospective data collection for external validation. No significant difference was found between medical and non-medical journals. Conclusion Nearly all of the studies published in the study period that evaluated the performance of AI algorithms for diagnostic analysis of medical images were designed as proof-of-concept technical feasibility studies and did not have the design features that are recommended for robust validation of the real-world clinical performance of AI algorithms.

Question: 1—Echocardiography images Images were acquired from end of diastole to end of systole at different phases (7 phases) within a cardiac cycle by a Vivid 3 GE Health echocardiography machine. To obtain worthy images at denoted phases, it would be dependent to operator (for the best clinical examination). Of course, having assumed images not only were acquired from A4C and A2C but also from short-axis views. Short axis views have not been used at your papers, so some radial, circumferential and sample rotatory data would be missed. Response: It is simply possible for us to record and analyze images of short-axis views. However, according to American Society of Echocardiography (ASE) [1, 2], in the modified Simpson’s rule which is a method for LV volume computation from 2-D echocardiography images, it suffices to acquire apical two and four chamber views (A4C, A2C) for left ventricular (LV) volume computation. Question: 2—Observed data yi′ s Echocardiography images paly role of observed data and they are symbolized by yi′ s. there is a sequence of observed data y1, y2,…,yN. N is the number of obtained images. In fact we have made a chain of displacement, rotation and pure strain or nonrigid transformation (deformation) by these observed data that is started from y1 and is ended up to yN. This chain has some conceptual interpretations of the elasticity of the global left ventricular motion/function and the regional LV fiber arrangement/movement. Response: Yes, it is correct. Question: 3—Embed observed data to a high dimensional space Response: Yes, it is correct. Question: 4—Image processing on yi′ s and geodesic distance between yi′ s Observed data y1, y2,…,yN are embed to a meshed surface sized number of pixels of an image. Translation, rotation and pure deformation of y1, y2,…,yN are occurred/and studied at this surface utilizing the mathematical elasticity theory. A distance metric is defined that computes distances between observed points. Medical interpretations of observed points over the time should be checked/and stated clearly at your manuscripts. Images are not usual images but also are images from the left ventricle. Motion (displacement and velocity), deformation (strain and strain rate) and torsion of each myocardial sample have to be extracted during a cardiac cycle in the mentioned surface. These are used on the creation of graph G referred to their papers. Response: In this stage, we have just computed the distance between the two images in a cardiac cycle using non-rigid image registration regardless of relationship between images over the time. Therefore by this method, the motion and longitudinal deformation (short-axis views are needed to get for radial and circumferential deformations) of LV myocardium between all of two images in a cardiac cycle are extracted (for example, between end systole image and end diastole image, etc.). Then, in other stage of our method (calculation of the matrix of pairwise geodesic distance and apply multidimensional scaling on the resulting geodesic distance matrix to construct the low dimensional data points xi), motion and longitudinal deformation of LV myocardium during a cardiac cycle are extracted. Question: 5—An Isomap f The main tool at this method is the function “f” which is an isometric map [2, 3]. I will be interested to know the structure/formula or relationship of this isometric function which has most probably a lot of practical information of the left ventricular function and structure. I mean, how we can get a good representation of such a this function “f” for heart science study? Is it “f” known as an algebraic function? What information has been coded to fibers (f−1) of this isometric function “f”? Response: Isomap algorithm is one of the most popular sets of nonlinear dimensionality reduction (NLDR) algorithms. This algorithm attempts to extract low-dimensional data points from input points in a high-dimensional space in such a way that pairwise geodesic distances (the distance between two points measured over the manifold) are preserved. So that nearby and far points in high-dimensional space map to nearby and far points in low-dimensional space. This method is frequently used for visualization of medial image set. Detail of this method is described in Tenenbaum et al. and Borg et al. [3, 4]. It should be noted that we do not change the structure or formula of isomap algorithm. We only define a new image distance function based on image registration in calculation of geodesic distance between yi′ s in isomap algorithm. With this modification, Isomap algorithm is specified for assessment of the left ventricular function and structure. However, precise mathematical descriptions of f and (f−1) applied to echocardiography images and using the other NLDR algorithms need further researches in the following of this article. Question: 6—A reconstructed curve on a 2D manifold space & hidden data xi′ s; f(yi) = xi Isometric function results in a reconstructive curve crossing from hidden data (xi′ s) in a surface. It’s natural that some information (maybe clinical information) would betransferred to these hidden points like the curve of LV volume changes and so on and so on. A main question is: what are these new points xi′ s exactly (medically point of view)? What the other data has been come out from these hidden points? I think all of these questions back to gain a good understanding of isometric function “f”. Response: These points xi′ s will probably enable physicians to diagnose and follow up many cardiac structures and functions that also open doors to much more research at imaging cardiology in the future. References 1. AlizadehSani Z, Shalbaf A, Behnam H, Shalbaf R: Automatic computation of left ventricularvolume changes over a cardiac cycle from echocardiography images by nonlinear dimensionality reduction. J Digit Imaging : July, 2014 2. Tenenbaum JB, de Silva V, Langford JC: global geometric framework for nonlinear dimensionalityreduction. Science 290:2319–2323, 2000. Reprint available online: http://web.mit.edu/cocosci/Papers/sci_reprint.pdf 3. Ledesma-Carbayo MJ, Kybic J, Desco M, et al.: Spatio-temporal nonrigid registration for ultrasoundcardiac motion estimation. IEEE Trans Med Imaging 24:1113–1126, 2005.

Purpose In many MRI scenarios, magnetization is often excited from spatial regions that are not of immediate interest. Excitation of uninteresting magnetization can complicate the design of efficient imaging methods, leading to either artifacts or acquisitions that are longer than necessary. While there are many hardware‐ and sequence‐based approaches for suppressing unwanted magnetization, this paper approaches this longstanding problem from a different and complementary angle, using beamforming to suppress signals from unwanted regions without modifying the acquisition hardware or pulse sequence. Unlike existing beamforming approaches, we use a spatially invariant sensor‐domain approach that can be applied directly to raw data to facilitate image reconstruction. Theory and Methods We use beamforming to linearly mix a set of original coils into a set of region‐optimized virtual (ROVir) coils. ROVir coils optimize a signal‐to‐interference ratio metric, are easily calculated using simple generalized eigenvalue decomposition methods, and provide coil compression. Results ROVir coils were compared against existing coil‐compression methods, and were demonstrated to have substantially better signal suppression capabilities. In addition, examples were provided in a variety of different application contexts (including brain MRI, vocal tract MRI, and cardiac MRI; accelerated Cartesian and non‐Cartesian imaging; and outer volume suppression) that demonstrate the strong potential of this kind of approach. Conclusion The beamforming‐based ROVir framework is simple to implement, has promising capabilities to suppress unwanted MRI signal, and is compatible with and complementary to existing signal suppression methods. We believe that this general approach could prove useful across a wide range of different MRI applications., Click here for author‐reader discussions

Aims Prediction of mitral (MR) and tricuspid (TR) regurgitation progression on transthoracic echocardiography (TTE) is needed to personalize valvular surveillance intervals and prognostication. Methods and results Structured TTE report data at Beth Israel Deaconess Medical Center, 26 January 2000–31 December 2017, were used to determine time to progression (≥1+ increase in severity). TTE predictors of progression were used to create a progression score, externally validated at Massachusetts General Hospital, 1 January 2002–31 December 2019. In the derivation sample (MR, N = 34 933; TR, N = 27 526), only 5379 (15.4%) individuals with MR and 3630 (13.2%) with TR had progression during a median interquartile range) 9.0 (4.1–13.4) years of follow-up. Despite wide inter-individual variability in progression rates, a score based solely on demographics and TTE variables identified individuals with a five- to six-fold higher rate of MR/TR progression over 10 years (high- vs. low-score tertile, rate of progression; MR 20.1% vs. 3.3%; TR 21.2% vs. 4.4%). Compared to those in the lowest score tertile, those in the highest tertile of progression had a four-fold increased risk of mortality. On external validation, the score demonstrated similar performance to other algorithms commonly in use. Conclusion Four-fifths of individuals had no progression of MR or TR over two decades. Despite wide interindividual variability in progression rates, a score, based solely on TTE parameters, identified individuals with a five- to six-fold higher rate of MR/TR progression. Compared to the lowest tertile, individuals in the highest score tertile had a four-fold increased risk of mortality. Prediction of long-term MR/TR progression is not only feasible but prognostically important.