AI & Digital Pathology

This talk is part of a limited series co-presented by SBME, BMI&AI, and BC Translational DPI.

Talk: “Artificial Intelligence and digital pathology: dealing with the annotation bottleneck”

The introduction of scanners that are capable of digitizing microscopic slides at high magnification has led to an explosion of interest in computational pathology in general and deep learning applied to whole slide images (WSIs) in particular. In my lab at Sunnybrook, we are developing AI models that can detect cancer, automatically segment regions of interest, and learn predictive and prognostic models that can be used to guide treatment decisions. In this talk I will outline some of the unique challenges of working with these extremely large WSIs and discuss some of the approaches that we have developed to overcome the problems of sparse annotations and weak, noisy labels, including self-supervision and multiple instance learning. I will also outline some of the challenges in deploying AI algorithms to the clinic.

Register for free here.

mRNA Vaccine, Covid-19, & Myocarditis

“According to the World Health Organization and cardiology societies, myocarditis is defined as an inflammatory disorder of the heart muscle that is characterized by lymphocytic and monocytic infiltrates within the myocardium, myocyte degeneration, and nonischemic necrosis (the so-called Dallas criteria).

It follows that for a truly definitive diagnosis of myocarditis occurring after vaccination, endomyocardial biopsy would need to be performed and viral myocarditis (including from Covid-19 infection) would need to be ruled out to exclude a chance occurrence of myocarditis temporally associated with the vaccine.

Most of the reported cases that occurred after vaccination had an uneventful course. The take-home messages from the two studies may be that clinically suspected myocarditis is temporally associated with the BNT162b2 mRNA vaccine but is rare, is more common in young male patients, and (with a few exceptions) is self-limiting. As acknowledged by the authors, temporal association does not imply causation, and the risk of vaccinal myocarditis is very low. The results of these two studies are valuable for doctors, patients, and the public to reduce the fear of myocarditis as a reason for excluding young people from vaccination, especially since myocarditis has also been temporally associated with Covid-19. Meanwhile, active surveillance for myocarditis should continue, and endomyocardial biopsy could be performed in severe cases to affirm the diagnosis and possibly to guide therapy, such as the use of antiviral drugs or immunosuppressive and immunomodulatory agents.”

More on Receipt of mRNA Vaccine against Covid-19 and Myocarditis via NEJM.

On the topic:
Mevorach D, Anis E, Cedar N, et al. Myocarditis after BNT162b2 mRNA vaccine against Covid-19 in Israel. N Engl J Med 2021;385:2140-2149.
Witberg G, Barda N, Hoss S, et al. Myocarditis after Covid-19 vaccination in a large health care organization. N Engl J Med 2021;385:2132-2139.
Caforio ALP, Baritussio A, Basso C, Marcolongo R. Clinically suspected and biopsy-proven myocarditis temporally associated with SARS-CoV-2 infection. Annu Rev Med 2021 September 10 (Epub ahead of print).

Ridding Canadian Medicine of Conversion Therapy

“’Conversion therapy’ is an umbrella term describing a poorly defined set of psychological, behavioural, physical and faith-based interventions that work to suppress same-sex attraction, or to deter patients from expressing gender identities discordant with sex assigned at birth. More than 50 health professional organizations — including the Canadian Psychiatric Association and American Medical Association — have issued consensus statements denouncing conversion therapy, owing to substantial empirical evidence that these practices are ineffective and associated with poor health outcomes, notably including suicide ideation and attempts. Despite these denouncements, conversion therapy continues to occur in Canada, in both licensed and unlicensed practice settings, affecting as many as 10% of Two-Spirit, lesbian, gay, bisexual, transgender and queer (2SLGBTQ+) people. The recent passage by the federal Parliament of Bill C-4, banning conversion therapy, creates a new opportunity for synergy between medicine and the law, protecting the rights and health of 2SLGBTQ+ people in Canada.

Canada’s medical regulators should act to augment any federal legislation by making it clear that they will take prompt disciplinary action against members who cause harm through engaging in or supporting conversion therapy interventions. Although several provinces and territories (e.g., Ontario, Nova Scotia and Yukon) have passed legislation prohibiting the use of public funds for conversion therapy, it is unclear how these laws are currently enforced, and mutually reinforcing strategies to deter conversion therapy practices — including legislation and regulatory action — are likely required, given the insidious and covert forms these practices often take. Canadian citizens have the right to access 2SLGBTQ+-affirming medical care. Therefore, individual physicians who are unfamiliar or uncomfortable with providing gender-affirming medicine have a responsibility to refer their patients to doctors who can provide these services.”

More on Ridding Canadian medicine of conversion therapy via CMAJ.

Mold, Mycotoxins and a Dysregulated Immune System

“Fungi represent one of the most diverse and abundant eukaryotes on earth. The interplay between mold exposure and the host immune system is still not fully elucidated. Literature research focusing on up-to-date publications is providing a heterogenous picture of evidence and opinions regarding the role of mold and mycotoxins in the development of immune diseases. While the induction of allergic immune responses by molds is generally acknowledged, other direct health effects like the toxic mold syndrome are controversially discussed. However, recent observations indicate a particular importance of mold/mycotoxin exposure in individuals with pre-existing dysregulation of the immune system, due to exacerbation of underlying pathophysiology including allergic and non-allergic chronic inflammatory diseases, autoimmune disorders, and even human immunodeficiency virus (HIV) disease progression. In this review, we focus on the impact of mycotoxins regarding their impact on disease progression in pre-existing immune dysregulation. This is complemented by experimental in vivo and in vitro findings to present cellular and molecular modes of action. Furthermore, we discuss hypothetical mechanisms of action, where evidence is missing since much remains to be discovered.”

More on Mold, Mycotoxins and a Dysregulated Immune System: A Combination of Concern? via International Journal of Molecular Sciences.

Diabetes: Management & Remission

Diabetes Painting via Artist Agne Kisonaite

“The typical impact on morbidity and mortality for those with type 2 diabetes is rather grim and in excess of many cancers. The average 10-year survival rates for breast cancer and non-Hodgkin lymphoma are 84% and 55%, respectively; the average 10-year lifespan for type 2 diabetes is 50%.[2] While the goal for most patients with cancer is remission, the patient with type 2 diabetes is taught that they need to live with this incurable disease. This need not be the case.

Increasing evidence points to the ability of patients to not only halt the onset of type 2 diabetes, but also to enter remission after a type 2 diabetes diagnosis. Bariatric surgery (RYGB, BPD) has been shown to result in durable remission in the majority of patients with type 2 diabetes,[3] and research has demonstrated that counseling patients to engage in modest caloric reduction using portion control and limited use of meal replacements resulted in roughly 10% of patients experiencing remission after 2 years.[4]

The Diabetes Remission Clinical Trial (DiRECT) in particular provides compelling evidence for the efficacy of structured, diet-induced weight loss on type 2 diabetes remission outcomes.[5] The randomized controlled trial’s intervention consisted of withdrawal of antidiabetic/antihypertensive drugs, total diet replacement for 12 to 20 weeks, stepped food reintroduction (2 to 8 weeks), and then structured support for weight-loss maintenance. At 24 months, 36% of intervention group participants had remission of diabetes, lower weight (average 8 kg), lower blood pressure, a 50% reduction in cardiovascular disease risk, lower health care costs, and better quality of life. Post-hoc analysis of patients experiencing remission found a return to normal pancreas volume, morphology, and beta cell capacity.[6] Importantly, the trial was conducted entirely in primary care practices, assisted by nurses and dietitians.”

Read more on Type 2 diabetes: Turning management into remission via BCMJ.
Also view Roundup: 25 Artists Sweetening Their Works With Diabetes Illustrations via DesignMantic.

CPD: Incorporating Virtual Musculoskeletal Examinations during a Pandemic

Join our highly experienced and knowledgeable panelists as they answer your questions and share best practices in managing virtual musculoskeletal examinations (specifically, wrist/hand and shoulder) in the context of the COVID-19 pandemic.

Feb 10 (Thu) | 1830–2000 PST
Target Audience: Physicians and other health care providers.
Meet our panel:

  • Dr. Fay Leung, Orthopedic Surgeon, Clinical Associate Professor, UBC Department of Orthopaedics
  • Dr. Rod French, Plastic Surgeon, Clinical Assistant Professor, UBC Division of Plastic Surgery
  • Moderator: Dr. Brenda Hardie, Family Physician

Learn More & Register

Holographic Technology

Jean-Baptiste Marc Bourgery, 1831-1854.

“The National University Health System in Singapore has started a research and development programme to explore the use of mixed reality technology in clinical care. 

In a press statement, the healthcare group said a team of neurosurgeons from the National University Hospital has studied the potential of holographic technology to locate brain tumours during surgeries.

WHAT IT DOES

In a proof of concept demonstration, a holographic visor was used to create a 3D hologram of a patient’s brain scan that was projected into space and superimposed onto a patient’s head during surgery.

The hologram was generated using a 3D medical software called Virtual Surgery Intelligence by German medical MR platform developer apoQlar. 

The MR technology enables surgeons to identify tumours ‘quickly and precisely’ and know their exact location and which angle to make an incision. Surgeons can also view the holographic image from different angles, as well as interact with and control it by gesture and speech recognition.” 

Read more on NUHS demonstrates use of holographic tech in brain surgery: The healthcare group has started exploring the use of mixed-reality tech in clinical care via HIMSS.