Accurate diagnosis of colorectal cancer based on histopathology images using artificial intelligence.

BACKGROUND: Accurate and robust pathological image analysis for colorectal cancer (CRC) diagnosis is time-consuming and knowledge-intensive, but is essential for CRC patients' treatment. The current heavy workload of pathologists in clinics/hospitals may easily lead to unconscious misdiagnosis of CRC based on daily image analyses. METHODS: Based on a state-of-the-art transfer-learned deep convolutional neural network in artificial intelligence (AI), we proposed a novel patch aggregation strategy for clinic CRC diagnosis using weakly labeled pathological whole-slide image (WSI) patches. This approach was trained and validated using an unprecedented and enormously large number of 170,099 patches, > 14,680 WSIs, from > 9631 subjects that covered diverse and representative clinical cases from multi-independent-sources across China, the USA, and Germany. RESULTS: Our innovative AI tool consistently and nearly perfectly agreed with (average Kappa statistic 0.896) and even often better than most of the experienced expert pathologists when tested in diagnosing CRC WSIs from multicenters. The average area under the receiver operating characteristics curve (AUC) of AI was greater than that of the pathologists (0.988 vs 0.970) and achieved the best performance among the application of other AI methods to CRC diagnosis. Our AI-generated heatmap highlights the image regions of cancer tissue/cells. CONCLUSIONS: This first-ever generalizable AI system can handle large amounts of WSIs consistently and robustly without potential bias due to fatigue commonly experienced by clinical pathologists. It will drastically alleviate the heavy clinical burden of daily pathology diagnosis and improve the treatment for CRC patients. This tool is generalizable to other cancer diagnosis based on image recognition.

Flush Drowning as a Cause of Whitewater Deaths.

INTRODUCTION: Most recreational whitewater fatalities are caused by fixed underwater entrapment or by "flush drowning," an obscure term frequently associated with high-volume rivers, continuous rapids, cold water, and a lack of prolonged underwater entrapment. Although entrapment drowning is typically associated with submersion hypoxia, flush drownings likely involve diverse mechanisms of death; as such, a concise definition is elusive. This said, certain risk factors may be predictively associated with flush drownings. We attempt to further characterize causes of fatal river accidents and possible effects of water temperature on injury pattern. METHODS: We reviewed river mortality data collected from the American Whitewater Association accident database comparing fatal whitewater accident trends in the Rocky Mountain region versus the Southeastern United States. We limited data from the Southeast to the months of June through August to create a warm water cohort. We then divided lethal accidents into flush drowning, entrapment submersion, or miscellaneous events, defining each category in specific terms. RESULTS: Flush drownings were more common in the Rocky Mountains than in the Southeast subgroup and involved older victims on average than entrapment drowning or miscellaneous events. Entrapment drownings were common in both regions, primarily occurring at fallen trees or rock formations. CONCLUSIONS: Flush drownings appear to occur more frequently in older persons. Although hypothetical, the relative increase in flush drowning in the Rocky Mountains might partly be the result of colder water temperatures. If the cause of flush drowning is better understood, safety in whitewater recreation may be improved.

Application of remedy studies to the development of a soil washing pilot plant that uses mineral processing technology: a practical experience.

Soil washing employing mineral processing technology to treat radionuclide-contaminated soils has been examined as a remedy alternative to the exclusive excavation, transportation, and disposal of the soil. Successful application depends on a thorough remedy study, employing a systematic tiered approach that is efficient, self-limiting, and cost effective. The study includes: (1) site and soil characterization to determine the basic mineral and physical properties of both the soil and contaminants and to identify their relative associations; (2) treatment studies to evaluate the performance of process units for contaminant separation; (3) conceptual process design to develop a treatment pilot plant; and (4) engineering design to construct, test, and optimize the actual full-scale plant. A pilot plant using soil washing technology for the treatment of radium-contaminated soil was developed, tested, and demonstrated. The plant used particle-size separation to produced a remediated product that represented approximately 50% of the contaminated soil. Subsequently, it was modified for more effective performance and application to soil with alternate characteristics; it awaits further testing. The economic analysis of soil washing using the pilot plant as a model indicates that a remedy plan based on mineral processing technology is very competitive with the traditional alternative employing excavation, transportation, and disposal exclusively, even when disposal costs are modest or when recovery of remediated soil during treatment is low. This paper reviews the tiered approach as it applies to mineral processing technology to treat radionuclide-contaminated soils and a pilot plant developed to test the soil washing process.

Conversion of failed ileal pouch-anal anastomosis to continent ileostomy.

PURPOSE: We report the results of converting 42 failed ileal pouch-anal anastomoses to a continent ileostomy (using the Barnett modification of the Kock pouch) performed in the course of 1,334 consecutive continent ostomy procedures. METHOD: Results were obtained from a data registry that tracks long-term outcomes of consecutive continent ostomy procedures performed by 12 surgeons in five centers in the United States. RESULTS: Forty of the 42 patients with failed ileal pouch-anal anastomoses have a functioning continent ostomy. Two patients have had pouch excision. Quality of life for the patients with ileal pouch-anal anastomoses as measured by the SF-36 index improved postoperatively. Long-term outcomes for the patients with ileal pouch-anal anastomoses were similar to those for the larger population of patients who underwent the continent ostomy procedure for other reasons. CONCLUSION: Conversion of a failed ileal pouch-anal anastomosis to a continent ileostomy is a satisfactory alternative to the Brooke ileostomy in appropriate cases.

Graves' ophthalmopathy: III. Effect of transantral orbital decompression on optic neuropathy.

Twenty-five patients (48 eyes) underwent transantral, surgical decompression of their orbits for treatment of Graves' ophthalmopathy with optic neuropathy. Visual acuity improved in 77%, remained unchanged in 17%, and worsened in 6%. Colour vision improved in 76%, remained unchanged in 20%, and worsened in 4%. Visual fields improved in 67%, remained unchanged in 12%, and worsened in 22%. In general the worse the vision preoperatively the greater the relative improvement postoperatively. Clinical and radiological findings failed to correlate with visual outcome of surgical intervention. The study shows surgery to be highly effective in restoring optic nerve function for patients with severe Graves' ophthalmopathy.