Recent Advances in Melanoma Diagnosis and Prognosis Using Machine Learning Methods

PURPOSE OF REVIEW

The purpose was to summarize the current role and state of artificial intelligence and machine learning in the diagnosis and management of melanoma.

RECENT FINDINGS

Deep learning algorithms can identify melanoma from clinical, dermoscopic, and whole slide pathology images with increasing accuracy. Efforts to provide more granular annotation to datasets and to identify new predictors are ongoing. There have been many incremental advances in both melanoma diagnostics and prognostic tools using artificial intelligence and machine learning. Higher quality input data will further improve these models' capabilities.

Meat intake, meat cooking methods, and meat-derived mutagen exposure and risk of sessile serrated lesions

BACKGROUND

Red and processed meat, recognized carcinogens, are risk factors for colorectal neoplasia, including polyps, the precursor for colorectal cancer. The mechanism is unclear. One possible explanation is the mutagenic activity of these foods, perhaps due to generation during cooking [e.g., heterocyclic amine (HCA) intake]. Few studies have evaluated meat intake and sessile serrated lesion (SSL) risk, a recently recognized precursor, and no study has evaluated meat cooking methods and meat-derived mutagens with SSL risk.

OBJECTIVE

We evaluated intakes of meat, meat cooking methods, and inferred meat mutagens with SSL risk and in comparison to risk of other polyps.

METHODS

Meat, well-done meat, and inferred meat mutagen intakes were evaluated. Polytomous logistic regression models were used to estimate ORs and 95% CIs among cases (556 hyperplastic polyp, 1753 adenoma, and 208 SSL) and controls (3804) in the large colonoscopy-based, case-control study, the Tennessee Colorectal Polyp Study.

RESULTS

The highest quartile intakes of red meat (OR: 2.38; 95% CI: 1.44, 3.93), processed meat (OR: 2.03; 95% CI: 1.30, 3.17), well-done red meat (OR: 2.19; 95% CI: 1.34, 3.60), and the HCA 2-amino-3,8-dimethylimidazo[4,5-f]quinoxaline (MeIQX; OR: 2.48; 95% CI: 1.49, 4.16) were associated with increased risk of SSLs in comparison to the lowest quartile intake.

CONCLUSIONS

High intakes of red and processed meats are strongly and especially associated with SSL risk and part of the association may be due to HCA intake. Future studies should evaluate other mechanism(s) and the potential for primary prevention.

Abstract P4-08-02: Understanding the mechanisms of action underlying the role of IL6ST, a key biomarker for prediction of response to endocrine therapy

Introduction: IL6ST is regarded as a putative ER target gene. Recently it has been recognised as a key biomarker for prediction of response to endocrine therapy (ET), having been included as the primary biomarker in our EA2Clin test and as an ER-signalling gene in the EndoPredict test. In both tests higher IL6ST expression is associated with a better response to ET and better prognosis. Despite its importance as a biomarker, little is known about its functional role in breast cancer (BC).

Methods: Pre- and on-treatment (at 14-days and at surgery) samples were collected from 102 post-menopausal women with ER+ BC, treated with 3-6 months of neoadjuvant ET. RNA was extracted for whole-genome expression analysis. From a subset with available fresh frozen tissue (28 patients, 83 samples) protein was extracted and proteome analysis using mass spectrometry is currently underway – results available for SABCS 2017. Immunohistochemistry was performed on FFPE tissue microarrays (TMAs) comprising pre-treatment samples from 102 patients. Cytoplasmic/membrane staining was scored using a graduated scale (0-3+) and nuclear staining was graded using an Immunoscore.

Results: IL6ST exists in membrane-bound and soluble forms of varying size. The full-length membrane bound molecule comprises 8 domains: 6 extracellular, 1 transmembrane and 1 cytoplasmic. In the EA2Clin test, pre-treatment BC tissues are stained for IL6ST with an antibody specific for a region spanning the transmembrane and cytoplasmic domains. TMAs were stained for IL6ST with both this and a second antibody binding the extracellular part, detecting both full-length and most soluble isoforms. Levels of both were correlated (R=0.82, P<0.0001).

IL6ST is known to mediate the action of cytokines including IL6, OSM and LIF via downstream regulation of pathways such as JAK/STAT. TMAs were stained for antibodies against IL6ST, OSM, IL6, total STAT3, pSTAT3 (Tyr705) and pSTAT3 (Ser727). IL6ST was scored as low (0/1+) or high (2+/3+). There was a positive association between levels of IL6ST and IL6 (P=0.02) and total STAT3 (P=0.003). There was no association between IL6ST and OSM or either pSTAT3.

Supervised gene expression analysis comparing pre-treatment samples with high and low IL6ST levels revealed increased levels of STAT3-regulated genes: cell cycle (CEBPD, CDKN1B), apoptosis (NFIL3, ATF3, BCL2), extracellular matrix remodelling (ADM, SEPRINE1-3) and interferon signalling (IFIT1, IFI44, IFI27). Unsupervised gene enrichment analysis revealed increased expression of genes involved with JAK/STAT, PI3K, mTOR and ERBB1 signalling in tumours expressing higher IL6ST levels. Lower levels were associated with increased energy generation, cellular metabolism and epithelial-mesenchymal transition.

Conclusions:

• This is the first matched whole-genome and mass spectrometry proteome analysis of sequential ET-treated BC patients

• IL6ST predicts response to ET – it is used in2 independent assays

• Levels of full-length IL6ST appear to be the most important for ET response prediction

• IL6ST may have an active role in BC cells, mediating signalling of cytokines such as IL6 through the JAK/STAT pathway and subsequent downstream transcriptional regulation.

Citation Format: Turnbull AK, Fernando A, Martinez-Perez C, Finch AJ, von Kriegsheim A, Wills J, Quinn N, Selli C, Mosley D, Langdon SP, Sims AH, Dixon JM. Understanding the mechanisms of action underlying the role of IL6ST, a key biomarker for prediction of response to endocrine therapy [abstract]. In: Proceedings of the 2017 San Antonio Breast Cancer Symposium; 2017 Dec 5-9; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2018;78(4 Suppl):Abstract nr P4-08-02.

Coccidioidomycosis in human immunodeficiency virus-infected persons in Arizona, 1994-1997: incidence, risk factors, and prevention

From 1 January 1995 through 31 June 1997, 153 cases of coccidioidomycosis in human immunodeficiency virus (HIV)-infected persons were identified in Arizona (incidence, 41/1000 persons living with AIDS). A case-control study was conducted to evaluate risk factors for coccidioidomycosis in HIV-infected persons. A case was defined as laboratory-confirmed, incident coccidioidomycosis in a person infected with HIV for > or =3 months, and each case patient had 3 control patients matched by county, age group, sex, HIV/AIDS status, and CD4 lymphocyte count. Multivariable analysis identified black race and a history of oropharyngeal or esophageal candidiasis to be associated with increased risk of coccidioidomycosis; protease inhibitor therapy was associated with a reduced risk. In persons with previous history of oropharyngeal or esophageal candidiasis, having received an azole drug was associated with a reduced risk (odds ratio, 0.4; 95% confidence interval, 0.2-0.9; P=.04). Physicians may need to consider azole chemoprophylaxis for HIV-infected persons who live in areas of endemicity, have CD4 cell counts <200/microL, are black, or have a history of thrush.

Active Imaging through Cirrus Clouds

The presence of clouds of ice particles in the uplink and downlink path of an illumination beam can severely impede the performance of an active imaging system. Depending on the optical depth of the cloud, i.e., its density and depth, the beam can be completely scattered and extinguished, or the beam can pass through the cloud with some fraction attenuated, scattered, and depolarized. In particular, subvisual cirrus clouds, i.e., high, thin cirrus clouds that cannot be observed from the ground, can affect the properties and alignment of both uplink and downlink beams. This paper discusses the potential for active imaging in the presence of cirrus clouds. We document field data results from an active imaging experiment conducted several years ago, which the authors believe to show the effects of cirrus clouds on an active imaging system. To verify these conclusions, we include the results of a simulation of the interaction of a coherent illumination scheme with a cirrus cloud.

The chaplain/pastoral counselor as a behavioral medicine consultant in cardiac rehabilitation: a team approach

Pastoral Behavioral Medicine Consultants can make a valuable contribution to the modern hospital particularly if physicians and other health care professionals are joined in offering creative and effective programs for healing. This article discusses several programs in which the traditional hospital chaplain's role is extended to that of a pastoral/behavioral medicine consultant (PBMC). The examples are meant to stimulate the reader's interest, ideas and intuition about innovative ways that the modern PBMC can not only survive but flourish in chaplain/pastoral counseling ministries.

Projections of the mesencephalic locomotor region in the rat

Retrograde labeling and electrophysiological techniques were used to determine the organization of efferent projections of the mesencephalic locomotor region (MLR) in the rat. Injections of horseradish peroxidase (HRP) or fluorescent dyes were made into suspected terminal zones of the MLR. After allowing for retrograde transport, the same animals underwent precollicular transection under anesthesia. The MLR was identified physiologically by the induction of controlled locomotion on a treadmill at low current (less than 50 microA) levels. Stimulation sites were marked and the brain processed accordingly. Retrogradely labeled cells in proximity (less than 0.5 mm) to locomotion-inducing stimulation sites were considered to be putative MLR neurons and were plotted according to stereotactic coordinates. These studies revealed the intrinsic organization of MLR neurons projecting to various brainstem sites. This organization may be related to the different types of transmitter systems involved in mediating MLR function.

Factors influencing breast feeding in an urban WIC program

Participants in a New York City WIC program were surveyed using a bilingual, self-administered questionnaire to determine significant differences in selected demographic, sociocultural, and educational characteristics of women who chose to breast feed versus bottle feed their infants. Differences in those characteristics were also compared for women breast feeding their infants for various lengths of time. Of the hypotheses tested, those with significant results included an increased incidence of breast feeding in women who had a higher educational attainment, entered prenatal care in the first trimester, had spent most of their lives outside the U.S., had the baby's father's support for breast feeding, and had previously breast fed. Increased duration of breast feeding was significantly associated with father's support of breast feeding, receipt of breast-feeding information, and the delayed introduction and infrequent use of breast-milk substitutes. The incidence of breast feeding reported (56.3%) compares favorably with rates reported for higher-income population segments. Early cessation of breast feeding was frequent; possible strategies to resolve this problem are presented.