Affective medicine. A review of affective computing efforts in medical informatics

BACKGROUND

Affective computing (AC) is concerned with emotional interactions performed with and through computers. It is defined as "computing that relates to, arises from, or deliberately influences emotions". AC enables investigation and understanding of the relation between human emotions and health as well as application of assistive and useful technologies in the medical domain.

OBJECTIVES

1) To review the general state of the art in AC and its applications in medicine, and 2) to establish synergies between the research communities of AC and medical informatics.

METHODS

Aspects related to the human affective state as a determinant of the human health are discussed, coupled with an illustration of significant AC research and related literature output. Moreover, affective communication channels are described and their range of application fields is explored through illustrative examples.

RESULTS

The presented conferences, European research projects and research publications illustrate the recent increase of interest in the AC area by the medical community. Tele-home healthcare, AmI, ubiquitous monitoring, e-learning and virtual communities with emotionally expressive characters for elderly or impaired people are few areas where the potential of AC has been realized and applications have emerged.

CONCLUSIONS

A number of gaps can potentially be overcome through the synergy of AC and medical informatics. The application of AC technologies parallels the advancement of the existing state of the art and the introduction of new methods. The amount of work and projects reviewed in this paper witness an ambitious and optimistic synergetic future of the affective medicine field.

Effect of nonharmonic forcing on bluff-body vortex dynamics

Forced nonharmonic excitation of the two-dimensional flow about a circular cylinder is studied by numerical simulations at mean Reynolds numbers of 180 and 150. Moderate deviations of the forced inflow velocity waveform from a pure harmonic generate different modes of phase-locked vortex formation in the cylinder wake, involving combinations of single and/or pairs of vortices for the same forcing frequency and peak-to-peak amplitude. The dynamical response of the wake oscillator is studied by employing phase portraits of the drag and lift coefficients that display modified limit-cycle behavior due to nonharmonic excitation. It is further shown that changing solely the velocity waveform can incite transition from a quasiperiodic state to a phase-locked state. The findings demonstrate that the wake oscillator is admissible to an infinite number of phase-locked and/or modulated states characterized by a single point on the frequency-amplitude plane.

Shockwave Therapy as First-Line Treatment for Peyronie's Disease: A Prospective Study

BACKGROUND AND PURPOSE

To assess in a prospective study whether shockwave therapy (SWT) is effective as a first-line treatment for Peyronie's disease.

PATIENTS AND METHODS

Forty patients with previously untreated Peyronie's disease underwent SWT with the Epos overhead-module device (Dornier). The pain severity (visual analog pain scale [VAS] 0-5), the degree of penile angulation after vasoactive drug injection, plaque size by ultrasound measurement, and erectile dysfunction (IIEF score) were assessed prior to and after treatment. Of the 40 patients, 7 underwent two sessions and the rest three sessions. The time interval between treatments was 2 weeks. At a power level of 2 to 5 (mean 4), a maximum of 3000 shockwaves per plaque per treatment were applied. The mean follow-up was 12 months.

RESULTS

All patients completed the protocol. The tolerance and safety were excellent. Of the 25 patients with pain on erection, 12 (48%) noticed relief after the first session, while 9 more were pain free at the end of the treatment (VAS reduction 2.8; P<0.0001, and 2; P<0.001, respectively). For 25 patients (62.5%), an improvement in penile angulation>20 degrees was observed, with a mean reduction of 35 degrees (range 20 degrees-60 degrees ) (P<0.001). No significant change in plaque size was noted. Among 28 patients with erectile dysfunction, 18 (64.2%) had a marked increase in erection quality (IIEF score change: +4 for 10 patients, +6 for 4 patients, +8 for 2 patients, +9 for 2 patients).

CONCLUSION

Our results support SWT as an effective and safe first-line treatment for Peyronie's disease.

Natural killer (NK) cell assay within bladder mucosa of patients bearing transitional cell carcinoma (TCC) after interferon (IFN) therapy: an immunohistochemical and ultrastructural study

The authors studied the number and the ultrastructural evidence of NK cell activation in the non-involved urothelium in patients with transitional cell carcinoma (TCC) of the urinary bladder, before and after transurethral resection (TUR) and interferon (IFN) therapy. Eight male patients, free of recurrence 1 year after TUR and IFN-a2b therapy, were studied. Each patient received 22 instillations of 50MU of IFN-a2b over a period of 1 year. Two specimens from the non-involved urothelium, one adjacent to and another away from the tumour, were obtained before and after therapy, for immunohistochemical and ultrastructural studies. The number of NK cells was evaluated immunohistochemically in paraffin sections with the CD57 monoclonal antibody, and their activation was detected by routine electron microscopy processing. Before treatment, few NK cells were randomly found in the lamina propria. At the end of therapy, however, their number increased and NK cells were found to infiltrate the urothelium, a finding that was not observed before treatment. The number of NK cells did not correlate with the degree of the inflammatory infiltrate of the mucosa. Moreover, the ultrastructural study revealed activation of NK cells with enhanced cytolytic activity. IFN therapy increases the number and promotes the activation of NK cells within the bladder mucosa. This finding could be of clinical significance in the prevention of tumour recurrence, given that NK cells enhance the immunological defense mechanisms of the bladder.

Ultrastructural study of the urothelial lysosomal system in patients with transitional cell carcinoma after transurethral resection and interferon therapy

The epithelial cells of human bladder urothelium contain a prominent lysosomal system on the surface layer which involves autophagic, phagocytotic and excretory processes. The noninvolved urothelium of tumor-bearing patients, however, does not contain this well-developed lysosomal system. Interferon restores the differentiation of the urothelium. Its action on the lysosomal system, however, has not been investigated. We studied ultrastructurally the noninvolved urothelium of eight patients with transitional cell carcinoma who after transurethral resection and intravesicular interferon instillations for 2 years did not develop recurrence. We noted that the number and size of lysosomes increased, being most numerous within the cells of the surface layer. Characteristic large lysosomes with the morphology of multivesicular bodies were also evident. These multivesicular bodies were almost entirely filled with small vesicles containing a dense core. Our findings show that after 2 years of interferon administration a re-appearance of a highly developed lysosomal system of the noninvolved urothelium was evident. This restoration to the normal morphology with reappearance of the lysosomal system, which could be partly attributed to interferon therapy, may be of clinical significance for prevention of tumor recurrence.

[Results of combined surgical and radiotherapeutic treatment of the carcinoma of the urinary bladder of stage P2/P3]

The authors studied the survival rates of the P2 and P3 patients within a group of 287 patients suffering from carcinomas of the urinary bladder who had been treated by urologic operation and radiotherapy. A differentiation was made between the surgical methods transurethral resection (TUR), bladder wall resection and cystectomy. P2 patients presented significantly higher three-year survival rates after bladder wall resection or cystectomy (10/17) than after TUR (7/23). In stage P3, no differences were found with regard to the surgical method. The results are discussed and compared to those communicated in literature.

[Metastasis to the lymph nodes from an occult primary tumor: aspects of diagnostics and therapy (author's transl)]

Sixty-one patients with lymph node metastases and occult primary tumor are reported. The patients were analyzed with respect to age and sex, as well as to the histologic diagnosis of the lymph nodes examined. In 24 of these patients, the primary tumor was found later; in 12 of these, not until autopsy. Site and histologic type of the lymph node metastases permit conclusions about the primary tumor. Treatment of the metastasis by surgery or irradiation ist indicated in order to hinder expansion and, in cases of late discovery of primary tumor, to take advantage of the remaining chances for a cure. The prognosis is unfavorable when the primary tumor remains undiscovered. In our patient group, the average survival time following confirmation of a lymph node metastasis was only 25 months. Lymph node metastases in the neck region are a special case. Here, the occult primary tumor ist sometimes cured in connection with surgery and/or irradiation of the cervical region.

[Cobalt teletherapy of the carcinoma of the urinary bladder (author's transl)]

A three-year survival rate of 40% of a group of 287 patients was achieved by a standardized Co-60 teletherapy. This survival rate and the radiogenic late effects observed over a ten-year period are compared with results communicated in literature. Important prognostic factors were the findings of a pretherapeutic urogram, the tumor localization, histologic findings, the stade and the surgical proceeding. In this connexion, the W.H.O. classification containing the stades of penetration and the degrees of malignity proved to be valuable. Taking into consideration the own results and those found in literature, the authors propose a therapy depending on the stade and based on modern diagnostic methods and a reliable histologic classification.