Development of a Deep Learning-Based Model for Diagnosing Breast Nodules With Ultrasound.

OBJECTIVES: Artificial intelligence (AI) has been an important addition to medicine. We aimed to explore the use of deep learning (DL) to distinguish benign from malignant lesions with breast ultrasound (BUS). METHODS: The DL model was trained with BUS nodule data using a standard protocol (1271 malignant nodules, 1053 benign nodules, and 2144 images of the contralateral normal breast). The model was tested with 692 images of 256 breast nodules. We used the accuracy, precision, recall, harmonic mean of recall and precision, and mean average precision as the indices to assess the DL model. We used 100 BUS images to evaluate differences in diagnostic accuracy among the AI system, experts (>25 years of experience), and physicians with varying levels of experience. A receiver operating characteristic curve was generated to evaluate the accuracy for distinguishing between benign and malignant breast nodules. RESULTS: The DL model showed 73.3% sensitivity and 94.9% specificity for the diagnosis of benign versus malignant breast nodules (area under the curve, 0.943). No significant difference in diagnostic ability was found between the AI system and the expert group (P = .951), although the physicians with lower levels of experience showed significant differences from the AI and expert groups (P = .01 and .03, respectively). CONCLUSIONS: Deep learning could distinguish between benign and malignant breast nodules with BUS. On BUS images, DL achieved diagnostic accuracy equivalent to that of expert physicians.

[Effect of selective gut decontamination in regulation of inflammatory reaction in patients with systemic inflammatory response syndrome].

OBJECTIVE: To explore the effect of selective gut decontamination in regulation of inflammatory reaction compared with rhubarb and glycerine enema for catharsis in patients with systemic inflammatory response syndrome ( SIRS ), and to discuss its mechanisms. METHODS: A prospective randomized controlled trial was conducted. Fifty-seven patients with SIRS admitted to Department of General Surgery of Aviation General Hospital from June 2009 to June 2014 were enrolled. The patients were randomly divided into rhubarb decontaminate group, traditional decontaminate group and blank control group, with 19 cases in each group. Besides the treatment for primary disease, including anti-infection, operation, alleviate pain, nutritional support, and maintaining water and electrolyte balance, the patients in rhubarb decontaminate group received aqueous extract from rhubarb 15-20 g by gastric tube, enema, or peros, twice a day; and those in traditional decontaminate group received glycerine enema or glycerol enema, twice a day; while no gavage or enema was prescribed in blank control group. Peripheral blood was collected before and 72 hours after treatment. Enzyme linked immunosorbent assay (ELISA) was used to determine the concentration of lipopolysaccharide (LPS) and inflammatory mediators. RESULTS: Compared with blank control group and traditional decontaminate group, the levels of interleukins (IL-1, IL-8), LPS, platelet activating factor (PAF), tumor necrosis factor-α (TNF-α), and γ- interferon (IFN-γ) before treatment was similar to that of rhubarb decontaminate group [IL-1 (ng/L): 53.154±5.783, 50.564±5.771, 51.082±6.403, F=0.994, P=0.377; IL-8 (ng/L): 70.492±6.146, 68.376±6.112, 68.673±8.384, F=0.514, P=0.601; LPS (µg/L): 11.630±2.449, 10.858±2.307, 10.463±2.145, F=1.261, P=0.291; PAF (µg/L): 4.173±0.395, 4.051±0.362, 4.078±0.487, F=0.446, P=0.642; TNF-α (ng/L): 132.498±10.772, 129.735±12.881, 127.207±11.514, F=0.963, P=0.388; IFN-γ (µg/L): 45.645±4.558, 43.692±5.578, 43.767±5.028, F=0.904, P=0.411]. The above parameters after treatment were significantly lower than those before treatment in three groups. The effect on the LPS and pro-inflammatory factors of the rhubarb decontaminate group was more obvious than that of the blank control group and traditional decontaminate group [LPS(µg/L): 7.571±1.113 vs. 9.008±1.904, 8.874±1.808, F=4.416, P=0.017; IL-1 (ng/L): 45.309±3.563 vs. 48.731±4.466, 46.112±4.322, F=3.557, P=0.035; IL-8 (ng/L): 60.492±5.346 vs. 65.553±5.384, 63.437±5.462, F=4.213, P=0.020; PAF (µg/L): 3.519±0.250 vs. 3.832±0.356, 3.766±0.309, F=5.450, P=0.007; TNF-α (ng/L): 114.988±8.772 vs. 123.230±10.433, 118.534±9.519, F=3.525, P=0.036; IFN-γ (µg/L): 38.683±3.190 vs. 41.831±4.122, 39.161±3.972, F=3.820, P=0.028]. CONCLUSIONS: The usage of selective gut decontamination can inhibit the release of endotoxin and inflammatory mediators in patients with SIRS, and it will get a better effect using rhubarb, and the mechanism may be related to the protection of intestinal mucosal barrier function.

Management of sternal osteomyelitis and mediastinal infection following median sternotomy.

BACKGROUND: Median sternotomy is considered the most usually performed procedure in cardiac operations. This study aimed to assess clinical effectiveness of bilateral pectoralis major muscle flaps (BPMMF) for management of sternal osteomyelitis and mediastinal infection following median sternotomy. METHODS: Clinical data were collected and retrospectively analyzed from twelve patients who underwent the BPMMF transposition for management of sternal osteomyelitis and mediastinal infection following median sternotomy from January 2006 to June 2009. Procedure consisted of rigorous debridement of necrotic tissues, dead space obliteration using the BPMMF, and placement of drainage tubes connected to a negative pressures generator for adequate drainage. RESULTS: No patients died of drainage, and all 12 patients had viable BPMMF when discharged from hospital. At 1 week post discharge, 2 patients presented with sternal infection but recovered following local debridement and medication. No patients showed infection recurrence during the follow-up period over 10 months. CONCLUSIONS: Sternal osteomyelitis and mediastinal infection following median sternotomy may be effectively managed through rigorous debridement of infected soft tissues, resection of the damaged sternal segment, transposition of the BPMMF to fill the damaged sternum resulting from debridement, and adequate postoperative drainage.