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AI-Based Imaging Technology May Predict Lung Cancer Outcomes – Medscape



Advanced imaging technology that uses artificial intelligence (AI) can potentially predict which patients with lung cancer are likely to experience cancer progression after surgery, according to new data.

The technology, known as highly multiplexed imaging mass cytometry (IMC), can provide cellular-level detail of the tumor immune microenvironment, which may allow clinicians to identify patients who need additional treatment, as well as those who don’t.


Dr Logan Walsh

“It is well known that the frequency of certain cell populations within the tumor microenvironment correlates with clinical outcomes. These observations help us understand the biology underlying cancer progression,” senior author Logan Walsh, PhD, assistant professor of human genetics and the Rosalind Goodman Chair in Lung Cancer Research at McGill University’s Rosalind and Morris Goodman Cancer Institute in Montreal, told Medscape Medical News.

“We wanted to test whether using completely unbiased AI could find and use the spatial topography of the tumor microenvironment from IMC data to predict clinical outcomes,” he said. “It turns out the answer is yes! AI can predict clinical outcomes when combined with IMC with extremely high accuracy from a single 1-mm2 tumor core.”

The study was published on February 1 in Nature.

The Immune Landscape

Lung cancer is the leading cause of cancer-related death in Canada, surpassing breast, colon, and prostate cancer deaths combined, the study authors write.

Lung adenocarcinoma, a non–small cell lung cancer, is the most common subtype and is characterized by distinct cellular and molecular features. The tumor immune microenvironment influences disease progression and therapy response, the authors write. Understanding the spatial landscape of the microenvironment could provide insight into disease progression, therapeutic vulnerabilities, and biomarkers of response to existing treatments.

In a collaborative study, Walsh and colleagues from McGill University and Université Laval profiled the cellular composition and spatial organization of the tumor immune microenvironment in tumors from 416 patients with lung adenocarcinoma across five histologic patterns. They used IMC to assess at samples from the universities’ biobanks that patients had provided for research purposes.

The research team detected more than 1.6 million cells, which allowed spatial analysis of immune lineages and activation states with distinct clinical correlates, including survival. They used a supervised lineage assignment approach to classify 14 distinct immune cell populations, along with tumor cells and endothelial cells.

High-grade solid tumors had the greatest immune infiltrate (44.6%), compared with micropapillary (37%), acinar (39.7%), papillary (32.8%), and lepidic architectures (32.7%). Macrophages were the most frequent cell population in the tumor immune microenvironment, representing 12.3% of total cells and 34.1% of immune cells.

The prevalence of CD163+ macrophages was strongly correlated with FOXP3+ immunoregulatory T cells in the solid pattern. This relationship was less pronounced in low-grade lepidic and papillary architectures. This finding could suggest an interplay between macrophage and T-cell populations in the tumor immune microenvironment across lung adenocarcinoma patterns.

Using a deep neural network model, the researchers also analyzed the relationship between immune populations and clinical or pathologic variables by examining the frequency of individual cell types as a percentage of total cells in each image. Each image was cross-referenced with clinical data from patients, including sex, age, body mass index, smoking status, stage, progression, survival, and histologic subtype.

Overall, the researchers found that various clinical outcomes, including cancer progression, could be predicted with high accuracy using a single 1-mm2 tumor core. For instance, they could predict progression in stage IA and IB resected lung cancer with 95.9% accuracy.

Additional Applications

“We were not surprised that AI was able to predict clinical outcomes, but we were surprised that it was able to do so with such high accuracy and precision,” said Walsh. “We were also surprised to learn that our predictions were equally accurate using only six-plex data, compared with 35-plex. This hinted to us that we could potentially scale down the number of markers to a practical number that would be amenable to technologies available in routine pathology labs.”

Walsh and colleagues are now validating the predictive tool using a lower-plex technology. In addition, they are investigating the immune landscapes of primary and metastatic brain tumors.

“This study is important, as it helps us to understand and appreciate the biological and mechanistic factors that may influence treatment outcomes. Our standard clinical predictors for predicting risk of recurrence and probability of response to therapy are not optimal,” Yee Ung, MD, an associate professor of radiation oncology at Sunnybrook Health Sciences Centre in Toronto, told Medscape.

Ung, who wasn’t involved with this study, has researched noninvasive hypoxia imaging and targeting in lung cancer. Ideally, he said, future studies should incorporate the use of noninvasive imaging predictive factors, in addition to the tumor immune microenvironment and clinical factors, to predict outcomes and provide personalized treatment.

“As we begin to investigate and understand more about cancer biology down to the cellular and molecular level, we need to strategically use AI methodologies in the processing and analysis of data,” he said.

The study was supported by the McGill Interdisciplinary Initiative in Infection and Immunity, the Brain Tumour Funders’ Collaborative, the Canadian Institutes of Health Research, and the Canadian Foundation for Innovation. Walsh and Ung have disclosed no relevant financial relationships.

Nature. Published February 1, 2023. Full text

Carolyn Crist is a health and medical journalist who reports on the latest studies for Medscape, MDedge, and WebMD.

For more news, follow Medscape on Facebook, Twitter, Instagram, and YouTube.

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'Worrisome' deadly fungus spreading through US at alarming rate – Sky News



A drug-resistant and potentially deadly fungus is spreading rapidly through US health facilities, according to a government study.

Researchers from the Centres for Disease Control and Prevention (CDC) reported the fungus, a type of yeast called Candida auris or C. auris, can cause severe illness in people with weakened immune systems.

The number of people diagnosed, as well as the number who were found through screening to be carrying C. auris, has been rising at an alarming rate since the fungus was first reported in the US in 2016.

A strain of Candida auris cultured in a petri dish at the Centers for Disease Control and Prevention (CDC) in 2019

The fungus was identified in 2009 in Asia, but scientists have said C. auris first appeared around the world about a decade earlier.

Dr Meghan Lyman, chief medical officer of the CDC’s mycotic diseases branch, said the increases, “especially in the most recent years, are really concerning to us”.

“We’ve seen increases not just in areas of ongoing transmission, but also in new areas,” she said.

Dr Lyman also said she was concerned about the increasing number of fungus samples resistant to the common treatments for it.

More on United States

Dr Waleed Javaid, an epidemiologist and director of infection prevention and control at Mount Sinai Downtown in New York, said the fungus was “worrisome”.

“But we don’t want people who watched ‘The Last Of Us’ to think we’re all going to die,” Dr Javaid said.

“This is an infection that occurs in extremely ill individuals who are usually sick with a lot of other issues.”

Read more:
Is The Last Of Us’ real ‘zombie’ fungus an actual threat?

The fungus, which can be found on the skin and throughout the body, is not a threat to healthy people.

But about one-third of people who become sick with C. auris die.

The fungus has been detected in more than half of all US states. The number of infections in the US increased by 95% between 2020 and 2021.

Read more:
Species of fungus discovered in Scotland
Fungal infections ‘increased significantly’ during COVID pandemic

The new research comes as Mississippi is facing a growing outbreak of the fungus.

Since November, 12 people in the state have been infected with four “potentially associated deaths”, according to the state’s health department.

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More dead birds found in Caledon could be linked to bird flu



Possible cases of bird flu have been found in Caledon as potential outbreaks of the virus are popping up in Brampton and across southern Ontario.

The City of Brampton issued a warning about two possible avian flu incidents on Friday after dead birds were found in the area of Professor’s Lake and Duncan Foster Valley South.​

Now the Town of Caledon says a number of dead birds have also been found in a pond near Coleraine Dr. and Harvest Moon Dr. and that the deaths may be related to bird flu.

The Town has closed a trail in the area out of precaution and says testing is being conducted by the Canadian Wildlife Health Cooperative to determine the birds’ cause of death.


Peel Public Health says that while avian influenza is a threat to birds, the risk to humans is very low.

“Most cases of human avian flu have been traced to handling infected poultry or their droppings,” said Dr. Nicholas Brandon, acting Medical Officer of Health for PPH. “Residents are asked to follow the recommended guidance to limit the spread of avian flu and protect the health and safety of residents and pets.”

Peel Public Health is recommending residents and pet owners are asked to take the following precautions:

  • Keep animals away from any waterfowl or fecal matter
  • Do not feed or otherwise interact with the waterfowl
  • Keep cats indoors
  • Keep dogs on a leash (as required under the municipal by-law)
  • Do not feed pets (e.g., dogs or cats) any raw meat from game birds or poultry
  • Pet birds, if not normally kept indoors, should be restricted to the indoors
  • Bird feeders should be removed or washed with soap and water frequently to reduce the chance of bacterial or viral contamination

The cause of the birds’ death in all three of the cases in Peel has not been confirmed but Brampton Animal Services is actively monitoring the areas.

If the birds test negative for Avian Influenza a full necropsy will be conducted to determine the cause of death, the City of Brampton said on Friday.

Last week the Toronto Zoo shut down some of its bird enclosures after an avian flu case was detected at a southern Ontario poultry farm.

A highly pathogenic type of H5N1 avian flu has been tearing through Canadian flocks since early 2022, killing millions of birds and infecting a record number of avian species.

The Canadian Food Inspection Agency detected a case at a commercial poultry operation southeast of Hamilton on Tuesday, the second reported Ontario site in a week after a lull in detected cases going back to the end of December.

With files from The Canadian Press


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Developing postoperative delirium associated with a faster rate of cognitive decline, says study



Credit: Unsplash/CC0 Public Domain

Research published today (March 20) in the JAMA Internal Medicine finds that developing postoperative delirium is associated with a 40% faster rate of cognitive decline over those who do not develop delirium.

“Delirium is associated with faster cognitive decline,” said Zachary J. Kunicki, Ph.D., MS, MPH Assistant Professor located at the Warren Alpert Medical School of Brown University, the first author. “Whether causes this faster rate of decline, or is simply a marker of those who are at risk of experiencing faster rates of decline, is still to be determined.”

“This study has the longest follow-up period of any study examining persons with delirium following ,” said Sharon K. Inouye, MD, MPH Director, Aging Brain Center, Hinda and Arthur Marcus Institute for Aging Research, the senior author and principal investigator on the work. “While future studies are needed, this study raises the possibility that delirium may predispose to permanent cognitive decline and potentially dementia. This highlights the importance of delirium prevention to preserve brain health in who undergo surgery,” she said.

Delirium is the most common post-operative complication in older adults and is associated with poor outcomes, including long-term cognitive decline and incident dementia.


Richard N. Jones, ScD, Warren Alpert Medical School of Brown University is co-senior author of the article, “Six-year cognitive trajectory in older adults following and delirium.”

“The SAGES cohort has followed 560 older adults (age 70 and older), measuring their cognition every six months for 36 months, then annually afterwards for up to six years. Using a detailed cognitive testing battery, comprised of 11 different tests, we found that cognitive changes after surgery are complex and that delirium influences every timepoint. The average cognitive changes seen after surgery include an abrupt drop at one month after surgery, an increase at two months after surgery, a stable period from 6–30 months after surgery, and then steady decline from 3–6 years after surgery.

“Delirium is associated with a sharper drop at one month, greater recovery at two months, and faster decline in all time periods from six months to six years, respectively. The results suggest that either delirium itself may contribute to cognitive decline after surgery, or that delirium may serve to identify those at risk for future more rapid cognitive decline. Future research will be needed to examine whether either or both of these hypotheses best explain the relationship between delirium and ,” say the authors.

More information:
Six-Year Cognitive Trajectory in Older Adults Following Major Surgery and Delirium, JAMA Internal Medicine (2023). DOI: 10.1001/jamainternalmed.2023.0144

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Hebrew SeniorLife Hinda and Arthur Marcus Institute for Aging Research

Developing postoperative delirium associated with a faster rate of cognitive decline, says study (2023, March 20)
retrieved 20 March 2023

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