Insights from teaching artificial intelligence to medical students in Canada

Clinical artificial intelligence (AI) applications are rapidly developing but existing medical school curricula provide limited teaching covering this area. Here we describe an AI training curriculum we developed and delivered to Canadian medical undergraduates and provide recommendations for future training.

Genome and Transcriptome Biomarkers of Response to Immune Checkpoint Inhibitors in Advanced Solid Tumors

PURPOSE

Immune checkpoint inhibitors (ICI) have revolutionized the treatment of solid tumors with dramatic and durable responses seen across multiple tumor types. However, identifying patients who will respond to these drugs remains challenging, particularly in the context of advanced and previously treated cancers.

EXPERIMENTAL DESIGN

We characterized fresh tumor biopsies from a heterogeneous pan-cancer cohort of 98 patients with metastatic predominantly pretreated disease through the Personalized OncoGenomics program at BC Cancer (Vancouver, Canada) using whole genome and transcriptome analysis (WGTA). Baseline characteristics and follow-up data were collected retrospectively.

RESULTS

We found that tumor mutation burden, independent of mismatch repair status, was the most predictive marker of time to progression (P = 0.007), but immune-related CD8⁺ T-cell and M1-M2 macrophage ratio scores were more predictive for overall survival (OS; P = 0.0014 and 0.0012, respectively). While CD274 [programmed death-ligand 1 (PD-L1)] gene expression is comparable with protein levels detected by IHC, we did not observe a clinical benefit for patients with this marker. We demonstrate that a combination of markers based on WGTA provides the best stratification of patients (P = 0.00071, OS), and also present a case study of possible acquired resistance to pembrolizumab in a patient with non-small cell lung cancer.

CONCLUSIONS

Interpreting the tumor-immune interface to predict ICI efficacy remains challenging. WGTA allows for identification of multiple biomarkers simultaneously that in combination may help to identify responders, particularly in the context of a heterogeneous population of advanced and previously treated cancers, thus precluding tumor type-specific testing.

Experience with Four French Catheters for Outpatient Coronary Angiography

Previous studies have demonstrated the efficacy and safety of outpatient cardiac catheterization on stable patients at low risk. We present our experience with four French catheters in 104 patients (72 male, 32 female, mean age 51 years old) with coronary angiography done as an outpatient procedure. No heparin was given during the procedure. After initial hemostasis had been attained, the patients returned to day center with vital signs monitored regularly. Patients were allowed ambulation after 4 hours' bed rest and were discharged the same afternoon. Normal coronary angiogram study was found in 76% of the study population. Single-vessel disease, double-vessel disease, triple-vessel disease, and left-main disease were found in 12%, 9.6%, 2%, and 1%, respectively. Nearly all of the patients demonstrated normal ventricular contraction (99%). Average procedural time was 20.2 +/- 4.4 minutes. Average hemostatic time was 8.4 +/- 3.1 minutes. No mortality directly attributed to the catheterization occurred in our study population. Moreover, there were no myocardial infarction, acute pulmonary edema, severe allergic reaction, and cerebrovascular accident. Femoral puncture site complication was only limited to superficial skin bruise. Quality of the cineangiogram was good in majority of the patients. Therefore, this study demonstrates that outpatient cardiac catheterization using four French Judkins catheter is a safe and cost-effective procedure.

Injection of vasodilators into arterial grafts through cardiac catheter to relieve spasm

Both native coronary artery and coronary bypass grafts may develop vasospasm after coronary artery bypass grafting. We recommend that whenever there is a high suspicion of vasospasm in arterial grafts and the native coronary artery unresponsive to or not suitable for usual vasodilator therapy, prompt selective graft arteriogram should be performed. Intraluminal injection of vasodilators such as calcium antagonists in combination with nitroglycerin may provide an effective antispastic therapy and this procedure could be lifesaving as demonstrated in the present report.

Radical-Mediated Diastereoselective Construction of a Chiral Synthon for Synthesis of Dolabellanes

[reaction: see text] A useful trans-substituted multifunctional cyclopentane with a chiral quaternary center was selectively synthesized by free radical Michael addition to the (Z)-propionate or -malonate derivatives. The stereoselectivity could be reversed by changing the configuration of the double bond.