Purpose:
A computer-aided detection (CADe) system based on quantitative tissue clustering algorithm was proposed to identify potential tumors in automated breast ultrasound (ABUS) images.
Methods:
...Our three-dimensional (3D) ABUS images database included 148 biopsy-verified lesions (size 0.4–7.9 cm; mean 1.76 cm). An ABUS volume was comprised of 229–282 slices of two-dimensional (2D) images. For tumor detection, the fast 3D mean shift method was used to remove the speckle noise and the segment tissues with similar properties. The hypoechogenic regions, i.e., the tumor candidates, were extracted using fuzzy c-means clustering. Seven features related to echogenicity and morphology were quantified and used to predict the likelihood of identifying a tumor and filtering out the false-positive (FP) regions.
Results:
The sensitivity of the proposed CADe system achieved 89.19% (132/148) with 2.00 FPs per volume. For the volumes without lesion, the FP rate was 1.27. The sensitivity was 92.50% (74/80) for malignant tumors and 85.29% (58/68) for benign tumors.
Conclusions:
The proposed CADe system provides an automatic and quantitative procedure for tumor detection in ABUS images. Further studies are needed to reduce the FP rate of the CADe algorithm.
While physical and mental health benefits of regular physical activity are well known, increasing evidence suggests that limiting sedentary behaviour is also important for health. Evidence shows ...associations of physical activity and sedentary behaviour with health-related quality of life (HRQoL), however, these findings are based predominantly on duration measures of physical activity and sedentary behaviour (e.g., minutes/week), with less attention on frequency measures (e.g., number of bouts). We examined the association of HRQoL with physical activity and sedentary behaviour, using both continuous duration (average daily minutes) and frequency (average daily bouts≥10 min) measures. Baseline data from the WALK 2.0 trial were analysed. WALK 2.0 is a randomised controlled trial investigating the effects of Web 2.0 applications on engagement, retention, and subsequent physical activity change. Daily physical activity and sedentary behaviour (duration = average minutes, frequency = average number of bouts ≥10 minutes) were measured (ActiGraph GT3X) across one week, and HRQoL was assessed with the 'general health' subscale of the RAND 36-Item Health Survey. Structural equation modelling was used to evaluate associations. Participants (N = 504) were 50.8±13.1 (mean±SD) years old with a BMI of 29.3±6.0. The 465 participants with valid accelerometer data engaged in an average of 24.0±18.3 minutes and 0.64±0.74 bouts of moderate-vigorous physical activity per day, 535.2±83.8 minutes and 17.0±3.4 bouts of sedentary behaviour per day, and reported moderate-high general HRQoL (64.5±20.0). After adjusting for covariates, the duration measures of physical activity (path correlation = 0.294, p<0.05) and sedentary behaviour were related to general HRQoL (path coefficient = -0.217, p<0.05). The frequency measure of physical activity was also significant (path coefficient = -0.226, p<0.05) but the frequency of sedentary behaviour was not significantly associated with general HRQoL. Higher duration levels of physical activity in fewer bouts, and lower duration of sedentary behaviour are associated with better general HRQoL. Further prospective studies are required to investigate these associations in different population groups over time.
The magnitude of the tissue damage from surgery impacts the trauma response. This response is proportional to the severity of surgical stress. Systemic cytokines are recognized as markers of ...postoperative tissue trauma. Microendoscopic discectomy (MED) recently has become popular for treating lumbar disc herniations, and is associated with favorable clinical outcomes compared with open discectomy (OD). This study postulates that MED is a less traumatic procedure, and therefore has a lower surgical stress response compared to OD. In this study, a quantitative comparison of the overall effects of surgical trauma resulting from MED and OD was performed through analyzing patient systemic cytokines response. From April, 2002 to June, 2003, 22 consecutive patients who had symptomatic lumbar disc herniations were prospectively randomized to undergo either intracanalicular MED (
N
=
10) or OD (
N
=
12). In this study, the Vertebroscope System (Zeppelin, Pullach, Germany) was used to perform the endoscopic discectomy procedure in all MED patients. Serum levels of tumor necrosis factor-α (TNF-α), Interleukin-1β (IL-1β), Interleukin-6 (IL-6), and Interleukin-8 (IL-8) were measured before surgery and at 1, 2, 4, 8 and 24
h after surgery using an enzyme-linked immunosorbent assay. Serum C-reactive protein (CRP) was measured at the same time interval. The results showed the MED patients had shorter postoperative hospital stay (mean, 3.57
±
0.98 vs. 5.92
±
2.39 days,
p
=
0.025) and less intraoperative blood loss (mean, 87.5
±
69.4 vs. 190
±
115
ml,
p
=
0.042). The operating length, including the set-up time, was longer in the MED group (mean, 109
±
35.9 vs. 72.1
±
17.8
min,
p
=
0.01). The mean size of skin incision made for the MED patients was 1.86
±
0.13
cm (range 1.7–2.0
cm); and 6.3
±
0.98
cm for the OD patients (range 5.5–8
cm),
p
=
0.001. The patients’ pain severity of the involved limbs on 10-point Visual Analog Scale before operation in MED group was 7.5
±
0.3 (range 6–9) and 8
±
0.2 (range 7–9) in OD group,
p
=
0.17; and after surgery, 1.5
±
0.2 (range 1–2) in MED group and 1.4
±
0.1 (range 1–3) in OD group,
p
=
0.91. CRP levels peaked at 24
h in both groups, and OD patients displayed a significantly greater postoperative rise in serum CRP (mean, 27.78
±
15.02 vs. 13.84
±
6.25
mg/l,
p
=
0.026). Concentrations of TNF-α, IL-1β, and IL-8 were detected only sporadically. Serum IL-6 increased less significantly following MED than after OD. In the MED group, IL-6 level peaked 8
h after surgery, with the response statistically less than in the open group (mean, 6.27
±
5.96 vs. 17.18
±
11.60
pg/ml,
p
=
0.025). A statistically significant correlation was identified between IL-6 and CRP values (
r
=
0.79). Using the modified MacNab criteria, the clinical outcomes were 90% satisfactory (9/10) in MED patients and 91.6% satisfactory (11/12) in OD patients at a mean 18.9 months (range 10–25) follow-up. Based on the current data, surgical trauma, as reflected by systemic IL-6 and CRP response, was significantly less following MED than following OD. The difference in the systemic cytokine response may support that the MED procedure is less traumatic. Moreover, our MED patients had achieved satisfactory clinical outcomes as the OD patients at a mean 18.9 months follow-up after surgery.
In this study, a computer-aided diagnosis (CAD) system for whole-slide images (WSIs) with breast cancer was proposed to achieve lesion detection and classification. Different from the previously ...proposed works that performed segmentation directly and applied the segmentation metrics for performance evaluation, here we computed the accuracy in patch-level, region-level, and slide-level to access our proposed framework to meet the clinical requirements, instead of simply regarding it as an AI segmentation task. To achieve that for WSIs, lesion detection was conducted at high magnification (× 40) first for region proposal by patching using the modified AlexNet model; and then, several patches were sampled from the detected regions at lower magnification (× 10) to observe cells’ patterns for lesion classification by the model of ResNet50. With such fashion, the deep features being distinguishing in lesion classification from the convolutional neural networks (CNN) were further analyzed in this work to provide comprehensive interpretability for the proposed CAD system based on pathological knowledge. For our experiments, a total of 186 slides of WSIs were collected and classified into three categories: Non-Carcinoma, Ductal Carcinoma in Situ (DCIS), and Invasive Ductal Carcinoma (IDC). The slide-level accuracy rate for the three-category classification reached 90.8% (99/109) through a fivefold cross-validation and achieved 94.8% (73/77) on the testing set. In addition, the learned features reflect the clinical insights in lesion classification for explainable AI, which enhanced the reliability and validity of our proposed system.
Background
Vibrio necrotizing fasciitis is a rare and life-threatening soft tissue infection, with fulminant clinical courses and high mortality rates. However, the lack of specific disease ...characteristics and diagnostic tools during the initial examination may delay diagnosis.
Questions/purposes
We (1) asked whether the clinical indicators could predict laboratory findings during the initial stage of Vibrio necrotizing fasciitis and (2) determined the relationships between the laboratory risk indicator for necrotizing fasciitis (LRINEC) score and the diagnosis of Vibrio infection.
Methods
We retrospectively reviewed 70 patients with 71 episodes of Vibrio necrotizing fasciitis and sepsis. Of the 70 patients, 68 had a history of contact with seawater or raw seafood; 66 had underlying chronic diseases.
Results
Eighteen patients (25.7%) died a mean 18.7 days after admission, and 52 patients survived. A systolic blood pressure of 90 mm Hg or less at the time of admission to the emergency room was associated with mortality. Patients who died had lower leukocyte counts, segmented leukocyte counts, platelet counts, and serum albumin levels compared with the patients who survived and higher counts of band forms of leukocytes. Only eight patients (11%) who survived had a LRINEC score of 6 or greater.
Conclusions
The LRINEC scoring system is not applicable when treating such a highly lethal disease. We propose that severe hypoalbuminemia, severe thrombocytopenia, and increased banded forms of leukocytes are laboratory risk indicators of necrotizing fasciitis that aid in pointing toward initiation of early surgery and predict a higher risk of death.
Level of Evidence
Level III Prognostic study. See the Guidelines for Authors for complete descriptions of levels of evidence.
The recent WHO report on antibiotic resistances shows a dramatic increase of microbial resistance against antibiotics. With only a few new antibiotics in the pipeline, a different drug delivery ...approach is urgently needed. We have obtained evidence demonstrating the effectiveness of a cell based drug delivery system that utilizes the innate immune system as targeting carrier for antibacterial drugs. In this study we show the efficient loading of neutrophil granulocytes with chlorhexidine and the complete killing of E. coli as well as Fusobacterium necrophorum in in-vitro studies. Fusobacterium necrophorum causes hepatic abscesses in cattle fed high grain diets. We also show in a mouse model that this delivery system targets infections of F. necrophorum in the liver and reduces the bacterial burden by an order of magnitude from approximately 2•106 to 1•105.
Only a few cases of primary ovarian mucinous carcinoid tumor have been documented in the literature till date. We present a case of primary ovarian mucinous carcinoid tumor, atypical type, and review ...the reported cases.
A 33-year-old woman with a left ovarian tumor was diagnosed with primary ovarian mucinous carcinoid tumor, atypical type. She underwent left salpingo-oophorectomy and ipsilateral lymph node dissection. After 5 years, the tumor recurred on the right side, with large para-aortic lymphadenopathy that caused hydronephrosis. Complete surgical staging was performed, followed by nine cycles of weekly paclitaxel and gemcitabine. The tumor progressed after discontinuing the chemotherapy, and the patient died of disease 26 months after recurrence.
Our patient demonstrated a more aggressive clinical course compared to that reported in previous literature. Based on this experience, complete surgical staging is highly recommended after the patient accomplished her fertility plan. Ovarian carcinoid tumors are relatively chemoresistant compared with epithelial ovarian cancers. The regimen of weekly paclitaxel and gemcitabine stabilized the disease but did not reach remission of the tumor. Further studies are required to determine the appropriate chemotherapy regimen.
Poor supervision, impaired exercise adherence, and low compliance with exercise regimens result in inconsistent effects regarding exercise interventions. A supervised-walk training regimen (9 ...km/week) may have a positive effect on functional recovery in female total knee arthroplasty (TKA). This study aimed to evaluate the effect of a supervised walking regimen on lower limb muscle strength, functional fitness, and patient-reported outcomes in female TKA. Twenty-eight female TKA were allocated into a control (CON) (
= 14) or walk training (WT) (
= 14) group. WT on treadmills was initiated 12 weeks after TKA. All patients were examined for lower muscle strength (including extension and flexion of hip and knee), physical function (including a 6-min walk test, 8-foot up-and-go test, and 30-s chair stand test), and Knee Injury and Osteoarthritis Outcome Score (KOOS) questionnaire. Knee flexor (WT: CON; 64.4 ± 4.1 nm/kg: 43.7±3.3 nm/kg;
= 0.001; effect size: 5.62) and extensor strengths (WT: CON; 73.1 ± 7.5 nm/kg: 48.2 ± 2.4 nm/kg;
= 0.001; effect size: 4.47) statistically increased in the WT group compared to the CON group. The 6-min walk test (from 341.3 ± 20.5 m to 405.5 ± 30.7 m;
= 0.001; effect size: 2.46) and 8-foot up-and-go test (from 9.5 ± 0.7 s to 8.3 ± 0.7 s;
= 0.002; effect size: 1.71) tests also showed significant improvements in the WT group in the follow-up compared to the baseline. An increase in quality of life score according to the KOOS questionnaire (WT: CON; 91.0 ± 2.8: 68.1 ± 5.8;
= 0.001; effect size: 5.02) was noted in the WT group compared to the CON group in the follow-up. WT facilitated improvements in knee muscle strength and functional outcomes in TKA patients.
Fragile X syndrome (FXS) is the most frequent genetic cause of intellectual disability (ID). It was previously believed that the FXS prevalence was low in Chinese population, and the cost-efficiency ...of FXS carrier screening was questioned. This retrospective observational study was conducted between September 2014 and May 2017 to determine the prevalence of FXS carriers in a large Chinese cohort of pregnant women. The FMR1 CGG repeat status was determined in 20,188 pregnant Taiwanese women and we identified 26 women with premutation (PM). The PM allele was transmitted to the fetus in 17 pregnancies (56.6%), and six of 17 expanded to full mutation (FM). One asymptomatic woman had a FM allele with 280 CGG repeats. Prenatal genetic diagnosis of her first fetus revealed a male carrying a FMR1 gene deletion of 5' UTR and exon 1. Her second fetus was a female carrying a FM allele as well. This is so far the largest study of the FXS carrier screening in Chinese women. The prevalence of premutation allele for FXS in normal asymptomatic Taiwanese women was found to be as high as 0.13% (1 in 777) in this study. The empirical evidence suggests that reproductive FXS carrier screening in Taiwan might be cost-effective.
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