Two-step artificial intelligence system for endoscopic gastric biopsy improves the diagnostic accuracy of pathologists.

Background: Endoscopic biopsy is the pivotal procedure for the diagnosis of gastric cancer. In this study, we applied whole-slide images (WSIs) of endoscopic gastric biopsy specimens to develop an endoscopic gastric biopsy assistant system (EGBAS). Methods: The EGBAS was trained using 2373 WSIs expertly annotated and internally validated on 245 WSIs. A large-scale, multicenter test dataset of 2003 WSIs was used to externally evaluate EGBAS. Eight pathologists were compared with the EGBAS using a man-machine comparison test dataset. The fully manual performance of the pathologists was also compared with semi-manual performance using EGBAS assistance. Results: The average area under the curve of the EGBAS was 0·979 (0·958-0·990). For the diagnosis of all four categories, the overall accuracy of EGBAS was 86·95%, which was significantly higher than pathologists (P< 0·05). The EGBAS achieved a higher κ score (0·880, very good κ) than junior and senior pathologists (0·641 ± 0·088 and 0·729 ± 0·056). With EGBAS assistance, the overall accuracy (four-tier classification) of the pathologists increased from 66·49 ± 7·73% to 73·83 ± 5·73% (P< 0·05). The length of time for pathologists to manually complete the dataset was 461·44 ± 117·96 minutes; this time was reduced to 305·71 ± 82·43 minutes with EGBAS assistance (P = 0·00). Conclusions: The EGBAS is a promising system for improving the diagnosis ability and reducing the workload of pathologists.

Intra-arterial infusion of tirofiban and urokinase for thromboembolic complications during coil embolization of ruptured intracranial aneurysms.

AIM: To investigate the effectiveness and safety of intra-arterial tirofiban and urokinase for thromboembolic complications during detachable coil treatment of ruptured intracranial aneurysms. MATERIAL AND METHODS: Fourteen patients who had a thromboembolic complication during detachable coil treatment of ruptured cerebral aneurysms from May 2011 to October 2013 were enrolled in this study. Within one hour of thrombus formation, patients underwent intra-arterial infusion of tirofiban plus urokinase with digital subtraction angiography monitoring. Blood flow was checked every 5 min with angiography until complete or partial recanalization of the occluded artery occurred. RESULTS: Of the 14 patients, 10 exhibited complete recanalization immediately after the thrombolytic treatment, and had no neurological dysfunction except one patient with mild hemiplegia. Two patients with partial recanalization exhibited mild neurological dysfunction and one died of cardiac infarction during the recovery period. Two patients had intracranial hemorrhage. In one of these, this was caused by rupture of the aneurysm and the patient died during the thrombolytic treatment. In the remaining patient, intracranial hemorrhage was caused by a puncture of the left posterior internal frontal artery caused by mechanical thrombolysis. CONCLUSION: Intra-arterial administration of tirofiban plus urokinase is an effective and safe treatment for thromboembolism during detachable coil treatment of ruptured intracranial aneurysms.

Suppressive effect of berberine on experimental dextran sulfate sodium-induced colitis.

The anti-inflammatory effect of berberine was evaluated in murine model of acute experimental colitis induced by dextran sulfate sodium (DSS). Berberine, given orally at 40, 20, 10 mg/kg for 10 days, ameliorated all the supposed inflammatory symptoms of the induced colitis, such as body weightloss, blood hemoglobin reduction, high myeloperoxidase levels, and malondialdehyde content-inflamed mucosa. Furthermore, the cytokine production of splenic lymphocytes was analyzed. The results showed the IFN-γ and IL-12 were increased, but IL-4 and IL-10 were decreased in DSS-induced colitis,when those were compared with the normal control. But the administration of berberine to DSS-induced colitis mice showed lower production of IFN-γ and IL-12 and higher production of IL-4 and IL-10 than the DSS-induced colitis mice. The results suggest that the protective effects of berberine against the DSS-induced colitis may be associated with the regulation of cytokine production.