Circulating blood biomarkers correlated with the prognosis of advanced triple negative breast cancer.

BACKGROUND: Immune checkpoint inhibitors (ICIs) can improve survivals of metastatic triple negative breast cancer (mTNBC); however, we still seek circulating blood biomarkers to predict the efficacy of ICIs. MATERIALS AND METHODS: In this study, we analyzed the data of ICIs treated mTNBC collected in Anhui Medical University affiliated hospitals from 2018 to 2023. The counts of lymphocytes, monocytes, platelets, and ratio indexes (NLR, MLR, PLR) in peripheral blood were investigated via the Kaplan-Meier curves and the Cox proportional-hazards model. RESULTS: The total of 50 mTNBC patients were treated with ICIs. High level of peripheral lymphocytes and low level of NLR and MLR at baseline and post the first cycle of ICIs play the predictable role of immunotherapies. Lymphocytes counts (HR = 0.280; 95% CI: 0.095-0.823; p = 0.021) and NLR (HR = 1.150; 95% CI: 1.052-1.257; p = 0.002) are significantly correlated with overall survival. High NLR also increases the risk of disease progression (HR = 2.189; 95% CI:1.085-4.414; p = 0.029). When NLR at baseline ≥ 2.75, the hazard of death (HR = 2.575; 95% CI:1.217-5.447; p = 0.013) and disease progression (HR = 2.189; 95% CI: 1.085-4.414; p = 0.029) significantly rise. HER-2 expression and anti-tumor therapy lines are statistically correlated with survivals. CONCLUSIONS: Before the initiation of ICIs, enriched peripheral lymphocytes and poor neutrophils and NLR contribute to the prediction of survivals.

Colorimetric Evaluation of a Reintegration via Spectral Imaging-Case Study: Nasrid Tiling Panel from the Alhambra of Granada (Spain).

Color reintegration is a restoration treatment that involves applying paint or colored plaster to an object of cultural heritage to facilitate its perception and understanding. This study examines the impact of lighting on the visual appearance of one such restored piece: a tiled skirting panel from the Nasrid period (1238-1492), permanently on display at the Museum of the Alhambra (Spain). Spectral images in the range of 380-1080 nm were obtained using a hyperspectral image scanner. CIELAB and CIEDE2000 color coordinates at each pixel were computed assuming the CIE 1931 standard colorimetric observer and considering ten relevant illuminants proposed by the International Commission on Illumination (CIE): D65 plus nine white LEDs. Four main hues (blue, green, yellow, and black) can be distinguished in the original and reintegrated areas. For each hue, mean color difference from the mean (MCDM), CIEDE2000 average distances, volumes, and overlapping volumes were computed in the CIELAB space by comparing the original and the reintegrated zones. The study reveals noticeable average color differences between the original and reintegrated areas within tiles: 6.0 and 4.7 CIEDE2000 units for the yellow and blue tiles (with MCDM values of 3.7 and 4.5 and 5.8 and 7.2, respectively), and 16.6 and 17.8 CIEDE2000 units for the black and green tiles (with MCDM values of 13.2 and 12.2 and 10.9 and 11.3, respectively). The overlapping volume of CIELAB clouds of points corresponding to the original and reintegrated areas ranges from 35% to 50%, indicating that these areas would be perceived as different by observers with normal color vision for all four tiles. However, average color differences between the original and reintegrated areas changed with the tested illuminants by less than 2.6 CIEDE2000 units. Our current methodology provides useful quantitative results for evaluation of the color appearance of a reintegrated area under different light sources, helping curators and museum professionals to choose optimal lighting.

Predicting ICU Mortality in Acute Respiratory Distress Syndrome Patients Using Machine Learning: The Predicting Outcome and STratifiCation of severity in ARDS (POSTCARDS) Study.

OBJECTIVES: To assess the value of machine learning approaches in the development of a multivariable model for early prediction of ICU death in patients with acute respiratory distress syndrome (ARDS). DESIGN: A development, testing, and external validation study using clinical data from four prospective, multicenter, observational cohorts. SETTING: A network of multidisciplinary ICUs. PATIENTS: A total of 1,303 patients with moderate-to-severe ARDS managed with lung-protective ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We developed and tested prediction models in 1,000 ARDS patients. We performed logistic regression analysis following variable selection by a genetic algorithm, random forest and extreme gradient boosting machine learning techniques. Potential predictors included demographics, comorbidities, ventilatory and oxygenation descriptors, and extrapulmonary organ failures. Risk modeling identified some major prognostic factors for ICU mortality, including age, cancer, immunosuppression, Pa o2 /F io2 , inspiratory plateau pressure, and number of extrapulmonary organ failures. Together, these characteristics contained most of the prognostic information in the first 24 hours to predict ICU mortality. Performance with machine learning methods was similar to logistic regression (area under the receiver operating characteristic curve [AUC], 0.87; 95% CI, 0.82-0.91). External validation in an independent cohort of 303 ARDS patients confirmed that the performance of the model was similar to a logistic regression model (AUC, 0.91; 95% CI, 0.87-0.94). CONCLUSIONS: Both machine learning and traditional methods lead to promising models to predict ICU death in moderate/severe ARDS patients. More research is needed to identify markers for severity beyond clinical determinants, such as demographics, comorbidities, lung mechanics, oxygenation, and extrapulmonary organ failure to guide patient management.

Color vision deficiencies and camouflage: a comparative study between normal and CVD observers.

There is a belief that observers with color vision deficiencies (CVD) perform better in detecting camouflaged objects than normal observers. Some studies have concluded contradictory findings when studying the performance of normal and CVD observers in the camouflage detection tasks in different conditions. This work presents a literature review on this topic, dividing it into three different and contradictory types of results: better performance for CVD, for normal observers, or same performance. Besides, two psychophysical experiments have been designed and carried out in a calibrated computer monitor on both normal and CVD human observers to measure the searching times of the different types of observers needed to find camouflaged stimuli in two different types of stimuli. Results show the trend that, in our experimental conditions, normal observers need shorter searching times than CVD observers in finding camouflaged stimuli both in images of natural scenes and in images with synthetic stimuli.

Long-term effects of blue-blocking spectacle lenses on color perception.

The use of blue-blocking filters is increasing in spectacle lens users. Despite the low absorption in the blue range, some users complain about these filters because they affect their color perception. In a pilot study we have evaluated how the long-term use of 8 different blue-blocking filters impact the color perception during more than 2 weeks on a group of 18 normal color vision observers, compared with a control group of 10 observers. The evaluation was done using the FM100, the Color Assessment and Diagnosis (CAD) and an achromatic point measurement. Our results show that there is a trend to worsen with the filters on.

CVD-MET: an image difference metric designed for analysis of color vision deficiency aids.

Color vision deficiency (CVD) has gained in relevance in the last decade, with a surge of proposals for aid systems that aim to improve the color discrimination capabilities of CVD subjects. This paper focuses on the proposal of a new metric called CVD-MET, that can evaluate the efficiency and naturalness of these systems through a set of images using a simulation of the subject's vision. In the simulation, the effect of chromatic adaptation is introduced via CIECAM02, which is relevant for the evaluation of passive aids (color filters). To demonstrate the potential of the CVD-MET, an evaluation of a representative set of passive and active aids is carried out both with conventional image quality metrics and with CVD-MET. The results suggest that the active aids (recoloration algorithms) are in general more efficient and produce more natural images, although the changes that are introduced do not shift the CVD's perception of the scene towards the normal observer's perception.

Drug cost avoidance analysis of cancer clinical trials in Spain: a study on cost contributors and their impact.

OBJECTIVE: Analyze the cost contributors and their impact on the drug cost avoidance (DCA) resulting from cancer clinical trials over the period of 2015-2020 in a tertiary-level hospital in Spain (HCUVA). METHODS: We performed a cross-sectional, observational, retrospective study of a total of 53 clinical trials with 363 patients enrolled. We calculated the DCA from the price of the best standard of care (i.e.: drugs that the institution would otherwise fund). A linear regression model was used to determine cost contributors and estimate their impact. RESULTS: The total DCA was ~ 4.9 million euros (31 clinical trials; 177 enrollees), representing ~ 30% and ~ 0,05% approximately of the annual pharmaceutical expenditures at the HCUVA and for the Spanish Health System, respectively. Cancer type analysis showed that lung cancer had the highest average DCA by trial, indicating that treatments in these trials were the most expensive. Linear regression analysis showed that the number of patients in a trial did not significantly affect that trial's DCA. Instead, cancer type, phase trials, and intention of treatment were significant cost contributors to DCA. Compared to digestive cancer trials, breast and lung trials were significantly more expensive, (p < 0.05 and p < 0.1, respectively). Phase III trials were more expensive than Phase II (p < 0.01) and adjuvant trials were less expensive than palliative (p < 0.05). CONCLUSION: We studied cost contributors that significantly impacted the estimated DCA from cancer clinical trials. Our work provides the groundwork to explore DCA contributors with potential to enhance public relations material and serve as a negotiating tool for budgeting, thus playing an important role to inform decisions about resource allocation.

Stratification for Identification of Prognostic Categories In the Acute RESpiratory Distress Syndrome (SPIRES) Score.

OBJECTIVES: To develop a scoring model for stratifying patients with acute respiratory distress syndrome into risk categories (Stratification for identification of Prognostic categories In the acute RESpiratory distress syndrome score) for early prediction of death in the ICU, independent of the underlying disease and cause of death. DESIGN: A development and validation study using clinical data from four prospective, multicenter, observational cohorts. SETTING: A network of multidisciplinary ICUs. PATIENTS: One-thousand three-hundred one patients with moderate-to-severe acute respiratory distress syndrome managed with lung-protective ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The study followed Transparent Reporting of a multivariable prediction model for Individual Prognosis Or Diagnosis guidelines for prediction models. We performed logistic regression analysis, bootstrapping, and internal-external validation of prediction models with variables collected within 24 hours of acute respiratory distress syndrome diagnosis in 1,000 patients for model development. Primary outcome was ICU death. The Stratification for identification of Prognostic categories In the acute RESpiratory distress syndrome score was based on patient's age, number of extrapulmonary organ failures, values of end-inspiratory plateau pressure, and ratio of Pao2 to Fio2 assessed at 24 hours of acute respiratory distress syndrome diagnosis. The pooled area under the receiver operating characteristic curve across internal-external validations was 0.860 (95% CI, 0.831-0.890). External validation in a new cohort of 301 acute respiratory distress syndrome patients confirmed the accuracy and robustness of the scoring model (area under the receiver operating characteristic curve = 0.870; 95% CI, 0.829-0.911). The Stratification for identification of Prognostic categories In the acute RESpiratory distress syndrome score stratified patients in three distinct prognostic classes and achieved better prediction of ICU death than ratio of Pao2 to Fio2 at acute respiratory distress syndrome onset or at 24 hours, Acute Physiology and Chronic Health Evaluation II score, or Sequential Organ Failure Assessment scale. CONCLUSIONS: The Stratification for identification of Prognostic categories In the acute RESpiratory distress syndrome score represents a novel strategy for early stratification of acute respiratory distress syndrome patients into prognostic categories and for selecting patients for therapeutic trials.

Analysis of adolescent oncology cases from 2008 through 2018 in a tertiary-level hospital: an opportunity for improvement.

Purpose: The purpose of this study was to disclose the variability of pathways currently taken in the treatment of adolescent patients from diagnosis to final follow-up with a view to developing a more homogenous system. Patients & methods: A cross-sectional, observational and retrospective study of the cancer diagnosis and assignment to medical care teams in adolescent patients (12-20 years) from January 2008 to December 2018 was conducted. A total of 345 adolescent patients aged between 12 and 20 years, diagnosed with cancer and treated at Hospital Clinico Universitario Virgen de la Arrixaca were included. Results: CNS tumors, followed by leukemia were the most frequent tumors. At the time of diagnosis, the highest incidences of patients were assisted in the pediatrics service adult oncology service (21.7%) and hematology (11%). Conclusion: Our aim is to highlight the need for a better transition for patients from pediatric to adult oncology and hematology services.

Lay abstract This study shows the reality of the care of adolescent cancer patients in a hospital in southern Spain. A cross-sectional, observational and retrospective study of cancer diagnoses and assignment to medical care teams in adolescent patients (12­20 years) from January 2008 to December 2018 was conducted. A total of 345 adolescent patients between 12 and 20 years old who had a cancer diagnosis and were treated at Hospital Clinico Universitario Virgen de la Arrixaca were included. CNS tumors, followed by leukemia were the most frequent. At the time of diagnosis, the patients were most commonly attended by the pediatrics service, which concentrates 46.5% of the study population. There is great variability in the treatment and follow-up of the same tumors. The need for a better transition for patients from pediatric to adult oncology and hematology services is demonstrated.

Eight-Channel Multispectral Image Database for Saliency Prediction.

Saliency prediction is a very important and challenging task within the computer vision community. Many models exist that try to predict the salient regions on a scene from its RGB image values. Several new models are developed, and spectral imaging techniques may potentially overcome the limitations found when using RGB images. However, the experimental study of such models based on spectral images is difficult because of the lack of available data to work with. This article presents the first eight-channel multispectral image database of outdoor urban scenes together with their gaze data recorded using an eyetracker over several observers performing different visualization tasks. Besides, the information from this database is used to study whether the complexity of the images has an impact on the saliency maps retrieved from the observers. Results show that more complex images do not correlate with higher differences in the saliency maps obtained.

Band Selection for Dehazing Algorithms Applied to Hyperspectral Images in the Visible Range.

Images captured under bad weather conditions (e.g., fog, haze, mist, dust, etc.), suffer from poor contrast and visibility, and color distortions. The severity of this degradation depends on the distance, the density of the atmospheric particles and the wavelength. We analyzed eight single image dehazing algorithms representative of different strategies and originally developed for RGB images, over a database of hazy spectral images in the visible range. We carried out a brute force search to find the optimum three wavelengths according to a new combined image quality metric. The optimal triplet of monochromatic bands depends on the dehazing algorithm used and, in most cases, the different bands are quite close to each other. According to our proposed combined metric, the best method is the artificial multiple exposure image fusion (AMEF). If all wavelengths within the range 450-720 nm are used to build a sRGB renderization of the imagaes, the two best-performing methods are AMEF and the contrast limited adaptive histogram equalization (CLAHE), with very similar quality of the dehazed images. Our results show that the performance of the algorithms critically depends on the signal balance and the information present in the three channels of the input image. The capture time can be considerably shortened, and the capture device simplified by using a triplet of bands instead of the full wavelength range for dehazing purposes, although the selection of the bands must be performed specifically for a given algorithm.

Metasurface-based contact lenses for color vision deficiency: comment.

Recently Karepov and Ellenbogen [Opt. Lett.45, 1379 (2020)OPLEDP0146-959210.1364/OL.384970] claimed that a new metasurface-based contact lens is able to correct deuteranomaly. Unfortunately, their results are not supported by psychophysical experiments, and some key assumptions in their simulations were misinterpreted. All of this has led to wrong conclusions providing false expectations to the color vision deficiency community.

Evaluation of Cleaning Processes Using Colorimetric and Spectral Data for the Removal of Layers of Limewash from Medieval Plasterwork.

In the cultural heritage preservation of medieval buildings, it is common to find plaster walls covered in lime, which previously were painted in polychromy. The conservation interventions usually try to remove the whitewash, whilst maintaining the original color of the painted wall as much as possible. However, there is no agreement on which cleaning technique best preserves the original appearance of the colored plaster. Different pigments found below the lime layer may behave differently depending on the cleaning technique used. Usually, colorimetric or photometric area-based measurements are carried out to study the color of the cleaned areas to compare with their original color, obtained from pre-made plaster probes. However, this methodology fails when the mean color difference is not enough to fully characterize the changes in texture and color appearance. This study presents a set of experiments carried out using two different pigments (cinnabar and malachite) covered with lime, and treated with nine different cleaning techniques on plaster probes prepared according to medieval techniques. We have studied the effect of the cleaning process on the color and the homogeneity of the samples using a hyperspectral imaging workflow. Four different analysis methods are presented and discussed. Our results show that the proposed analysis is able to provide a much more comprehensive and diversified characterization of the quality of the cleaning method compared to the commonly used colorimetric or photometric area-based measurements.

Spectral Filter Selection for Increasing Chromatic Diversity in CVD Subjects.

This paper analyzes, through computational simulations, which spectral filters increase the number of discernible colors (NODC) of subjects with normal color vision, as well as red-green anomalous trichromats and dichromats. The filters are selected from a set of filters in which we have modeled spectral transmittances. With the selected filters we have carried out simulations performed using the spectral reflectances captured either by a hyperspectral camera or by a spectrometer. We have also studied the effects of these filters on color coordinates. Finally, we have simulated the results of two widely used color blindness tests: Ishihara and Farnsworth-Munsell 100 Hue (FM100). In these analyses the selected filters are compared with the commercial filters from EnChroma and VINO companies. The results show that the increase in NODC with the selected filters is not relevant. The simulation results show that none of these chosen filters help color vision deficiency (CVD) subjects to pass the set of color blindness tests studied. These results obtained using standard colorimetry support the hypothesis that the use of color filters does not cause CVDs to have a perception similar to that of a normal observer.

Single Image Dehazing Algorithm Analysis with Hyperspectral Images in the Visible Range.

In foggy or hazy conditions, images are degraded due to the scattering and attenuation of atmospheric particles, reducing the contrast and visibility and changing the color. This degradation depends on the distance, the density of the atmospheric particles and the wavelength. We have tested and applied five single image dehazing algorithms, originally developed to work on RGB images and not requiring user interaction and/or prior knowledge about the images, on a spectral hazy image database in the visible range. We have made the evaluation using two strategies: the first is based on the analysis of eleven state-of-the-art metrics and the second is two psychophysical experiments with 126 subjects. Our results suggest that the higher the wavelength within the visible range is, the higher the quality of the dehazed images. The quality increases for low haze/fog levels. The choice of the best performing algorithm depends on the criterion prioritized by the metric design strategy. The psychophysical experiment results show that the level of agreement between observers and metrics depends on the criterion set for the observers' task.

A Prognostic Enrichment Strategy for Selection of Patients With Acute Respiratory Distress Syndrome in Clinical Trials.

OBJECTIVES: Incomplete or ambiguous evidence for identifying high-risk patients with acute respiratory distress syndrome for enrollment into randomized controlled trials has come at the cost of an unreasonable number of negative trials. We examined a set of selected variables early in acute respiratory distress syndrome to determine accurate prognostic predictors for selecting high-risk patients for randomized controlled trials. DESIGN: A training and testing study using a secondary analysis of data from four prospective, multicenter, observational studies. SETTING: A network of multidisciplinary ICUs. PATIENTS: We studied 1,200 patients with moderate-to-severe acute respiratory distress syndrome managed with lung-protective ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We evaluated different thresholds for patient's age, PaO2/FIO2, plateau pressure, and number of extrapulmonary organ failures to predict ICU outcome at 24 hours of acute respiratory distress syndrome diagnosis. We generated 1,000 random scenarios as training (n = 900, 75% of population) and testing (n = 300, 25% of population) datasets and averaged the logistic coefficients for each scenario. Thresholds for age (< 50, 50-70, > 70 yr), PaO2/FIO2 (≤ 100, 101-150, > 150 mm Hg), plateau pressure (< 29, 29-30, > 30 cm H2O), and number of extrapulmonary organ failure (< 2, 2, > 2) stratified accurately acute respiratory distress syndrome patients into categories of risk. The model that included all four variables proved best to identify patients with the highest or lowest risk of death (area under the receiver operating characteristic curve, 0.86; 95% CI, 0.84-0.88). Decision tree analyses confirmed the accuracy and robustness of this enrichment model. CONCLUSIONS: Combined thresholds for patient's age, PaO2/FIO2, plateau pressure, and extrapulmonary organ failure provides prognostic enrichment accuracy for stratifying and selecting acute respiratory distress syndrome patients for randomized controlled trials.

Assessment of VINO filters for correcting red-green Color Vision Deficiency.

In our ongoing research on the effectiveness of different passive tools for aiding Color Vision Deficiency (CVD) subjects, we have analyzed the VINO 02 Amp Oxy-Iso glasses using two strategies: 1) 52 observers were studied using four color tests (recognition, arrangement, discrimination, and color-naming); 2) the spectral transmittance of the lenses were used to model the color appearance of natural scenes for different simulated CVD subjects. We have also compared VINO and EnChroma glasses. The spectral transmission of the VINO glasses significantly changed color appearance. This change would allow some CVD subjects, above all the deutan ones, to be able to pass recognition tests but not the arrangement tests. To sum up, our results support the hypothesis that glasses with filters are unable to effectively resolve the problems related to color vision deficiency.

Spectral Image Processing for Museum Lighting Using CIE LED Illuminants.

This work presents a spectral color-imaging procedure for the detailed colorimetric study of real artworks under arbitrary illuminants. The results demonstrate this approach to be a powerful tool for art and heritage professionals when deciding which illumination to use in museums, or which conservation or restoration techniques best maintain the color appearance of the original piece under any illuminant. Spectral imaging technology overcomes the limitations of common area-based point-measurement devices such as spectrophotometers, allowing a local study either pixelwise or by selected areas. To our knowledge, this is the first study available that uses the proposed CIE (Commission Internationale de l'Éclairage) light-emitting diode (LED) illuminants in the context of art and heritage science, comparing them with the three main CIE illuminants A, D50, and D65. For this, the corresponding colors under D65 have been calculated using a chromatic adaptation transform analogous to the one in CIECAM02. For the sample studied, the CIE LED illuminants with the lowest average CIEDE2000 color differences from the standard CIE illuminants are LED-V1 for A and LED-V2 for D50 and D65, with 1.23, 1.07, and 1.57 units, respectively. The work studied is a Moorish epigraphic frieze of plasterwork with a tiled skirting from the Nasrid period (12th-15th centuries) exhibited in the Museum of the Alhambra (Granada, Spain).

Is Overall Mortality the Right Composite Endpoint in Clinical Trials of Acute Respiratory Distress Syndrome?

OBJECTIVES: Overall mortality in patients with acute respiratory distress syndrome is a composite endpoint because it includes death from multiple causes. In most acute respiratory distress syndrome trials, it is unknown whether reported deaths are due to acute respiratory distress syndrome or the underlying disease, unrelated to the specific intervention tested. We investigated the causes of death after contracting acute respiratory distress syndrome in a large cohort. DESIGN: A secondary analysis from three prospective, multicenter, observational studies. SETTING: A network of multidisciplinary ICUs. PATIENTS: We studied 778 patients with moderate-to-severe acute respiratory distress syndrome treated with lung-protective ventilation. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: We examined death in the ICU from individual causes. Overall ICU mortality was 38.8% (95% CI, 35.4-42.3). Causes of acute respiratory distress syndrome modified the risk of death. Twenty-three percent of deaths occurred from refractory hypoxemia due to nonresolving acute respiratory distress syndrome. Most patients died from causes unrelated to acute respiratory distress syndrome: 48.7% of nonsurvivors died from multisystem organ failure, and cancer or brain injury was involved in 37.1% of deaths. When quantifying the true burden of acute respiratory distress syndrome outcome, we identified 506 patients (65.0%) with one or more exclusion criteria for enrollment into current interventional trials. Overall ICU mortality of the "trial cohort" (21.3%) was markedly lower than the parent cohort (relative risk, 0.55; 95% CI, 0.43-0.70; p < 0.000001). CONCLUSIONS: Most deaths in acute respiratory distress syndrome patients are not directly related to lung damage but to extrapulmonary multisystem organ failure. It would be challenging to prove that specific lung-directed therapies have an effect on overall survival.

Do EnChroma glasses improve color vision for colorblind subjects?

The commercialization of EnChroma glasses has generated great expectations for people to be able to see new colors or even correct color vision deficiency (CVD). We evaluate the effectiveness of these glasses using two complementary strategies for the first time. The first consists of using the three classical types of tests - recognition, arrangement and discrimination - with and without glasses, with a high number of individuals. In the second, we use the spectral transmittance of the glasses to simulate the appearance of stimuli in a set of scenes for normal observers and observers with CVD. The results show that the glasses introduce a variation of the perceived color, but neither improve results in the diagnosis tests nor allow the observers with CVD to have a more normal color vision.