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The Polyphony programme is a rapidly established collaboration whose aim is to build and maintain a collection of current healthcare knowledge about detection, diagnosis and treatment of COVID‐19 infections, and use Artificial Intelligence (knowledge engineering) techniques to apply the results in patient care. The initial goal is to assess whether the platform is adequate for rapidly building executable models of clinical expertise, while the longer term goal is to use the resulting COVID‐19 knowledge model as a reference and resource for medical training, research and, with partners, develop products and services for better patient care. In this Polyphony progress‐report we describe the first prototype of a care pathway and decision support system that is accessible on OpenClinical.net, a knowledge sharing repository. Pathfinder 1 demonstrates services including situation assessment and inference, decision making, outcome prediction and workflow management. Pathfinder 1 represents encouraging evidence that it is possible to rapidly develop and deploy practical clinical services for patient care and we hope to validate an advanced version in a collaborative internet trial. Finally, we discuss wider implications of the Polyphony framework for developing rapid learning systems in healthcare, and how we may prepare for using AI in future public health emergencies. This article is protected by copyright. All rights reserved.

Transurethral resection of bladder tumour (TURBT) is the first step in management of bladder cancers. A urology trainee in the UK must do at least 120 procedures during their training years before being a consultant. In our article, we are reporting a retrospective audit of the quality of TURBT across 2 major cancer centres in Lancashire. We assessed the adherence of surgical procedure to the national and international guidelines among different grades of urological surgeons who work in the 2 trusts.

CT Perfusion (CTP) derived cerebral blood flow (CBF) thresholds have been proposed as the optimal parameter for distinguishing the infarct core prior to reperfusion. Previous threshold-derivation studies have been limited by uncertainties introduced by infarct expansion between the acute phase of stroke and follow-up imaging, or DWI lesion reversibility. In this study a model is proposed for determining infarction CBF thresholds at 3hr ischemia time by comparing contemporaneously acquired CTP derived CBF maps to 18F-FFMZ-PET imaging, with the objective of deriving a CBF threshold for infarction after 3 hours of ischemia. Endothelin-1 (ET-1) was injected into the brain of Duroc-Cross pigs (n = 11) through a burr hole in the skull. CTP images were acquired 10 and 30 minutes post ET-1 injection and then every 30 minutes for 150 minutes. 370 MBq of 18F-FFMZ was injected ~120 minutes post ET-1 injection and PET images were acquired for 25 minutes starting ~155-180 minutes post ET-1 injection. CBF maps from each CTP acquisition were co-registered and converted into a median CBF map. The median CBF map was co-registered to blood volume maps for vessel exclusion, an average CT image for grey/white matter segmentation, and 18F-FFMZ-PET images for infarct delineation. Logistic regression and ROC analysis were performed on infarcted and non-infarcted pixel CBF values for each animal that developed infarct. Six of the eleven animals developed infarction. The mean CBF value corresponding to the optimal operating point of the ROC curves for the 6 animals was 12.6 ± 2.8 mL·min-1·100g-1 for infarction after 3 hours of ischemia. The porcine ET-1 model of cerebral ischemia is easier to implement then other large animal models of stroke, and performs similarly as long as CBF is monitored using CTP to prevent reperfusion.

Background: There are currently many on-going clinical trials assessing therapies for the treatment of patients with heart failure. Aims: The purpose of this series of papers is to present concise summaries of current randomised trials in the field of heart failure and myocardial infarction (MI). Methods: Data from large double-blind, placebo-controlled trials, which are on-going or have only recently been published, are given in a format allowing easy comparison. Where appropriate, data from smaller studies are included. Results: Major studies which are examined in this issue include CIBIS II, MERIT-HF, RESOLVD, SPICE, VEST, MACH-1, ATLAS, RALES, CIDS and CASH. These trials assess the efficacy and safety of beta-blocker, angiotensin-II-receptor blocker, positive inotropic agent, calcium antagonist, angiotensin-converting enzyme (ACE) inhibitor, aldosterone receptor blocker, and antiarrhythmic interventions in the treatment of heart failure. Conclusions: The presentation of data from these on-going trials should allow an up-to-date assessment, by physicians, of the most appropriate and effective treatment for patients with heart failure. It is evident that some therapies may play no further role in the treatment of heart failure, due to the increased risk of mortality associated with their administration, whilst others may convey significant benefits.

Purpose: In diabetes, pancreatic beta cell mass declines significantly prior to onset of fasting hyperglycemia. This decline may be due to endoplasmic reticulum (ER) stress, and the system L amino acid transporter LAT1 may be a biomarker of this process. In this study, we used 5-(2-18F-fluoroethoxy)-L-tryptophan (18F-L-FEHTP) to target LAT1 as a potential biomarker of beta cell function in diabetes. Procedures: Uptake of 18F-L-FEHTP was determined in wild-type C57BL/6 mice by ex vivo biodistribution. Both dynamic and static positron emission tomography (PET) images were acquired in wild-type and Akita mice, a model of ER stress-induced diabetes, as well as in mice treated with streptozotocin (STZ). LAT1 expression in both groups of mice was evaluated by immunofluorescence microscopy. Results: Uptake of 18F-L-FEHTP was highest in the pancreas, and static PET images showed highly specific pancreatic signal. Time-activity curves showed significantly reduced 18F-L-FEHTP uptake in Akita mice, and LAT1 expression was also reduced. However, mice treated with STZ, in which beta cell mass was reduced by 62%, showed no differences in 18F-L-FEHTP uptake in the pancreas, and there was no significant correlation of 18F-L-FEHTP uptake with beta cell mass. Conclusions: 18F-L-FEHTP is highly specific for the pancreas with little background uptake in kidney or liver. We were able to detect changes in LAT1 in a mouse model of diabetes, but these changes did not correlate with beta cell function or mass. Therefore, 18F-L-FEHTP PET is not a suitable method for the noninvasive imaging of changes in beta cell function during the progression of diabetes.

Although 35 mm slides are a popular visual aid in an educational setting, relatively little has been written about methods for their storage and retrieval. Some reasons for the lack of published work in this area are suggested. The first description of the role of 35 mm slides in the pharmaceutical industry is presented. Additionally, an account of the development of a simple slide storage and retrieval system for a collection of 3000 biomedical slides is given.