Abstract
Background
The clinical spectrum of acute SARS-CoV-2 infection ranges from an asymptomatic to life-threatening disease. Considering the broad spectrum of severity, reliable biomarkers are ...required for early risk stratification and prediction of clinical outcomes. Despite numerous efforts, no COVID-19-specific biomarker has been established to guide further diagnostic or even therapeutic approaches, most likely due to insufficient validation, methodical complexity, or economic factors. COVID-19-associated coagulopathy is a hallmark of the disease and is mainly attributed to dysregulated immunothrombosis. This process describes an intricate interplay of platelets, innate immune cells, the coagulation cascade, and the vascular endothelium leading to both micro- and macrothrombotic complications. In this context, increased levels of immunothrombotic components, including platelet and platelet-leukocyte aggregates, have been described and linked to COVID-19 severity.
Methods
Here, we describe a label-free quantitative phase imaging approach, allowing the identification of cell-aggregates and their components at single-cell resolution within 30 min, which prospectively qualifies the method as point-of-care (POC) testing.
Results
We find a significant association between the severity of COVID-19 and the amount of platelet and platelet-leukocyte aggregates. Additionally, we observe a linkage between severity, aggregate composition, and size distribution of platelets in aggregates.
Conclusions
This study presents a POC-compatible method for rapid quantitative analysis of blood cell aggregates in patients with COVID-19.
Successful adoption of artificial intelligence (AI) in medical imaging requires medical professionals to understand underlying principles and techniques. However, educational offerings tailored to ...the need of medical professionals are scarce. To fill this gap, we created the course “AI for Doctors: Medical Imaging”. An analysis of participants’ opinions on AI and self-perceived skills rated on a five-point Likert scale was conducted before and after the course. The participants’ attitude towards AI in medical imaging was very optimistic before and after the course. However, deeper knowledge of AI and the process for validating and deploying it resulted in significantly less overoptimism with respect to perceivable patient benefits through AI (p = 0.020). Self-assessed skill ratings significantly improved after the course, and the appreciation of the course content was very positive. However, we observed a substantial drop-out rate, mostly attributed to the lack of time of medical professionals. There is a high demand for educational offerings regarding AI in medical imaging among medical professionals, and better education may lead to a more realistic appreciation of clinical adoption. However, time constraints imposed by a busy clinical schedule need to be taken into account for successful education of medical professionals.
This update on plasma cell myeloma has been elaborated by a Swiss expert panel as a result of the plethora of new data on the treatment of plasma cell myeloma reported recently. It adds new insights ...to the more extensive review that was published 3 years ago and may help clinicians on decision making for their patients. The new recommendations for distinguishing plasma cell myeloma from smouldering myeloma are briefly presented, including a section on contemporary imaging studies with this respect. Former panel recommendations that remain unchanged by new results will not be discussed in detail as the major focus of this review is on treatment-relevant new developments.
Pretransplant risk scores such as the revised Pretransplant Assessment of Mortality (rPAM) score help to predict outcome of patients receiving allogeneic hematopoietic cell transplantation ...(allo‐HCT). Since the rPAM has not been validated externally in a heterogeneous patient population with different diseases, we aimed to validate the rPAM score in a real‐world cohort of allo‐HCT patients. A total of 429 patients were included receiving their first allo‐HCT from 2008 to 2015. The predictive capacity of the rPAM score for 4‐year overall survival (OS), nonrelapse mortality (NRM), and cumulative incidence of relapse (CIR) after allo‐HCT was evaluated. Moreover, we evaluated the impact of the rPAM score for OS and used uni‐ and multivariable analyses to identify patient‐ and transplant‐related predictors for OS. In rPAM score categories of <17, 17–23, 24–30, and >30, the OS probability at 4 years differed significantly with 61%, 36%, 26%, and 10%, respectively (P < 0.0001). In contrast to CIR, the NRM increased significantly in patients with higher rPAM scores (P < 0.001). Regarding the OS, the rPAM score had an area under the receiver operating characteristics curve of 0.676 (95% confidence interval CI, 0.625‐0.727) at 4 years. In the multivariable analysis, the rPAM score was associated with OS—independently of conditioning regimens (adjusted hazard ratio per 1‐unit increase, 1.10; 95% CI, 1.06‐1.10; P < 0.001). Additionally, forced expiratory volume in 1 second and the disease risk index were the components of the rPAM significantly associated with outcome. In our large real‐world cohort with extended follow‐up, the rPAM score was validated as an independent predictor of OS in patients with hematologic disorders undergoing allo‐HCT.
The first hematopoietic stem cell transplantation (HSCT), the replacement of the hematopoietic system, by hematopoietic stem cells from the patient (autologous HSCT) or from another person ...(allogeneic HSCT), was performed almost 45 years ago. Today autologous HSCT is used to bridge hematopoietic failure after high dose chemotherapy for the treatment of selected hematopoietic and non-hematopoietic tumours. Allogeneic HSCT is used to treat congenital or acquired marrow failure, and, more commonly, to exploit the graft versus tumour effect of allogeneic cells against high risk hematologic malignancies. In 2010, 30,000 patients were treated with HSCT (12,000 allogeneic and 18,000 autologous HSCT) in Europe. Substantial progress has been made in the field of allogeneic HSCT in the last decade. First the article describes advances in patient and donor selection, the current concepts of choosing the optimal stem cell source and the most appropriate preparative regimen. Furthermore, recent advances in supportive care are described. We describe how these innovations have allowed indications for allogeneic HSCT to be expanded. Finally, prospects for future developments will be outlined.
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