Preparing Radiologists to Lead in the Era of Artificial Intelligence: Designing and Implementing a Focused Data Science Pathway for Senior Radiology Residents.

Artificial intelligence and machine learning (AI-ML) have taken center stage in medical imaging. To develop as leaders in AI-ML, radiology residents may seek a formative data science experience. The authors piloted an elective Data Science Pathway (DSP) for 4th-year residents at the authors' institution in collaboration with the MGH & BWH Center for Clinical Data Science (CCDS). The goal of the DSP was to provide an introduction to AI-ML through a flexible schedule of educational, experiential, and research activities. The study describes the initial experience with the DSP tailored to the AI-ML interests of three senior radiology residents. The authors also discuss logistics and curricular design with common core elements and shared mentorship. Residents were provided dedicated, full-time immersion into the CCDS work environment. In the initial DSP pilot, residents were successfully integrated into AI-ML projects at CCDS. Residents were exposed to all aspects of AI-ML application development, including data curation, model design, quality control, and clinical testing. Core concepts in AI-ML were taught through didactic sessions and daily collaboration with data scientists and other staff. Work during the pilot period led to 12 accepted abstracts for presentation at national meetings. The DSP is a feasible, well-rounded introductory experience in AI-ML for senior radiology residents. Residents contributed to model and tool development at multiple stages and were academically productive. Feedback from the pilot resulted in establishment of a formal AI-ML curriculum for future residents. The described logistical, planning, and curricular considerations provide a framework for DSP implementation at other institutions. Supplemental material is available for this article. © RSNA, 2020.

Benign epithelial oral lesions - association with human papillomavirus.

BACKGROUND: The presence of human papilloma virus in benign oral lesions has been studied by different techniques obtaining extremely variable results. The objective of this study was to determine the presence of human papillomavirus in 83 cases of benign hyperplastic epithelial oral lesions. MATERIAL AND METHODS: Eighty-three oral lesions with clinical or histopathological features suggestive of HPV infection were retrieved from the files of four oral pathology services. Demographic data were obtained from patient's medical charts. All cases had available clinical image, H&E preparations and paraffin blocks with enough tissue for HPV detection by in situ hybridization, and immunohistochemical reactions for Ki67. RESULTS: Episomal positivity for wide spectrum HPV was observed in 24% of the cases; most of them (70%) HPV 6/11 positive. HPV 16/18 was not detected. Condyloma acuminatum was the most common lesion associated with HPV (75%), followed by verruca vulgaris (15%), squamous papilloma and multifocal epithelial hyperplasia, 5% each. Koilocytes were identified in all the HPV positive cases. Ki67 showed an abnormal proliferation pattern in 90% of the HPV positive cases; most of them (70%) showing groups of proliferating cells in focal superficial regions, and in 20% positivity was seen almost in the whole thickness of the epithelium. HPV negative cases showed Ki67 positive cells restricted to the basal layer. CONCLUSIONS: Regarding oral lesions associated with HPV, condyloma is the most common lesion expressing low-risk subtypes. The etiology of squamous papilloma remains controversial as HPV was found in 1.9% of the cases. The identification of koilocytes and the pattern of expression of Ki67 reflect HPV infection and are helpful for classification. Papillary oral lesions not associated to HPV deserve further studies to better clarify its etiology.

Clinicopathological analysis of head and neck rhabdomyosarcoma: A series of 10 cases and literature review.

BACKGROUND: To describe the clinicopathological characteristics of a series of head and neck rhabdomyosarcoma (RMS) and to review the literature. MATERIAL AND METHODS: Cases diagnosed as RMS affecting the head and neck region were retrospectively retrieved from the files of two Brazilian institutions from January 2006 to January 2017. Data on clinical features (sex, age and affected site), microscopic subtype, immunohistochemical results, treatment employed and follow-up status were obtained from the patient's medical charts. RESULTS: During the period considered, 10 cases of RMS were identified. Females predominated (4M:6F), the mean age at diagnosis was 16.5 years-old and the orbit was the most affected site (4 cases). Microscopically, most cases were classified as embryonal RMS (6 cases) and the Desmin/Myogenin/Myo-D1 immunohistochemical positivity was useful to confirm the diagnosis. Chemotherapy and radiotherapy were applied to 9 and 8 patients respectively, whereas 2 patients were treated by surgery. Recurrences occurred in 3 patients and distant metastasis in 2 cases. Nine patients were alive in their last follow-up, 3 of them with disease, whereas 1 patient died due to the disease. CONCLUSION: Head and neck RMS is an aggressive malignant neoplasm which demands especial concern to achieve early diagnosis and successful treatment.

[Consumption of cannabis in adolescents]. / Abus et dépendance au cannabis à l'adolescence : diagnostic.

Over the past 10 years, the consumption of cannabis among adolescents has dramatically increased. Today, adolescent cannabis use is a major public health problem. Two forms of cannabis are commonly smoked: herb (marijuana) and resin. These forms have a high concentration of tetrahydrocannabinol, the active molecule of cannabis. Recent research has helped understand how the cannabinoid system works. This system combines specific receptors and specific molecules: the endocannabinoids. The effects of cannabis use are now well documented. Some adolescents report subjective positive effects. They use it not only on a recreational basis, but also to deal with their emotions. Over the long term, cannabis increases the risk of depression and schizophrenia for those adolescents who are at risk. Use, misuse, and dependence are frequently associated with heavy psychopathologic problems such as vulnerability and depression. Many cannabis dependence psychotherapies have shown their efficacy and efficiency. Motivational interviews, cognitive behavioral therapy, multidimensional family therapy (MDFT), and residential treatment have proved highly effective. MDFT seems very effective, especially in cases of heavy use.

[Multidimensional family therapy: which influences, which specificities?]. / La thérapie familiale multidimensionnelle (MDFT) : quelles influences, quelles spécificités ?

BACKGROUND: Among illegal psycho-active drugs, cannabis is the most consumed by French adolescents. Multidimensional family therapy (MDFT) is a family-based outpatient therapy which has been developed for adolescents with drug and behavioral problems. MDFT has shown its effectiveness in adolescents with substance abuse disorders (notably cannabis abuse) not only in the United States but also in Europe (International Cannabis Need of Treatment project). MDFT is a multidisciplinary approach and an evidence-based treatment, at the crossroads of developmental psychology, ecological theories and family therapy. Its psychotherapeutic techniques find its roots in a variety of approaches which include systemic family therapy and cognitive therapy. OBJECTIVE: The aims of this paper are: to describe all the backgrounds of MDFT by highlighting its characteristics; to explain how structural and strategy therapies have influenced this approach; to explore the links between MDFT, brief strategic family therapy and multi systemic family therapy; and to underline the specificities of this family therapy method. DISCUSSION: The multidimensional family therapy was created on the bases of 1) the integration of multiple therapeutic techniques stemming from various family therapy theories; and 2) studies which have shown family therapy efficiency. Several trials have shown a better efficiency of MDFT compared to group treatment, cognitive-behavioral therapy and home-based treatment. Studies have also highlighted that MDFT led to superior treatment outcomes, especially among young people with severe drug use and psychiatric co-morbidities. In the field of systemic family therapies, MDFT was influenced by: 1) the structural family therapy (S. Minuchin), 2) the strategic family theory (J. Haley), and 3) the intergenerational family therapy (Bowen and Boszormenyi-Nagy). MDFT has specific aspects: MDFT therapists think in a multidimensional perspective (because an adolescent's drug abuse is a multidimensional disorder), they work with the system and the subsystem, focusing on the emotional expression and the parental and adolescent enactment (a principle of change and intervention). MDFT includes four modules (adolescent, parent, family interaction, and extra-familial systems) in three steps (1) build the foundation, (2) prompt action and change by working the themes, and (3) seal the changes and exit). The supervision philosophy and methodology is also based on the principle of multidimensionality. Indeed, many different supervision methods are used in a coordinated way to produce the required adherence and clinical skill (written case conceptualizations, videotape presentation and live supervision). CONCLUSION: Family vulnerability and chronicity factors are a major challenge of modern research. MDFT questions the reciprocal adjustments that have to be made by the subject and his/her familial environment. It also helps to clarify the therapeutic interventions in order to enhance better adolescent development. For this purpose, MDFT offers a specific therapeutic frame, for it is a family therapy focused on adolescents with cannabis abuse problems. Its action and questioning on parental practices and adolescents lead to better psycho-educational support. It focuses the therapeutic process on emotions and family capacity for change.

Long-term outcome of cardiac pacing in octogenarians and nonagenarians.

AIMS: The number of patients >80 years receiving pacemakers (PMs) is increasing. Little is known about survival and complications in this specific subgroup. We aim to determine predictors of long-term survival. METHODS AND RESULTS: Pacemaker-related complications and death occurring in patients receiving a first PM for conventional bradycardia indications were systematically documented (the FollowPace registry). This report describes 481 patients ≥80 years during a mean follow-up of 5.8 (SD 1.2) years. Within 2 months 54 PM complications occurred in 47 patients (9.8%). During follow-up, 35 adverse PM events were reported in 33 patients (6.9%). Complication rates in patients ≥80 years were comparable with those for patients <80 years. Survival rates were 86, 75, and 49% after 1, 2, and 5 years, respectively, and were comparable with survival for age- and sex-matched controls from the general Dutch population. Most patients died of non-cardiac causes. Age at the time of implantation, male gender, the presence of congestive heart failure, coronary pathology, and diabetes mellitus were independent predictors of all-cause mortality. CONCLUSION: This large study of long-term cardiac pacing for bradycardia in octogenarians and nonagenarians showed a cumulative 5-year survival of ~50%, which compares with that of age- and sex-matched controls. These data suggest a beneficial impact of bradycardia pacing, restoring life expectancy to previous levels. The occurrence of PM complications during long-term follow-up is not infrequent with 18.1% of patients experiencing a PM-related complication during a mean of 5.8 years follow-up. The complication rate was not higher than in younger PM patients.