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PURPOSE: Identification of mature sperm at microdissection testicular sperm extraction (mTESE) is a crucial step of sperm retrieval to help patients with non-obstructive azoospermia (NOA) proceed to intracytoplasmic sperm injection. Touch print smear (TPS) cytology allows immediate interpretation and prompt sperm identification intraoperatively. In this study, we leverage machine learning (ML) to facilitate TPS reading and conquer the learning curve for new operators. MATERIALS AND METHODS: One hundred seventy-six microscopic TPS images from the testicular specimen of patients with azoospermia at Taipei Veterans General Hospital were retrospectively collected, including categories of Sertoli cell, primary spermatocytes, round spermatids, elongated spermatids, immature sperm, and mature sperm. Among them, 118 images were assigned as the training set and 29 images as the validation set. RetinaNet (Lin et al. in IEEE Trans Pattern Anal Mach Intell. 42:318-327, 2020), a one-stage detection framework, was adopted for cell detection. The performance was evaluated at the cell level with average precision (AP) and recall, and the precision-recall (PR) curve was displayed among an independent testing set that contains 29 images that aim to assess the model. RESULTS: The training set consisted of 4772 annotated cells, including 1782 Sertoli cells, 314 primary spermatocytes, 443 round spermatids, 279 elongated spermatids, 504 immature sperm, and 1450 mature sperm. This study demonstrated the performance of each category and the overall AP and recall on the validation set, which were 80.47% and 96.69%. The overall AP and recall were 79.48% and 93.63% on the testing set, while increased to 85.29% and 93.80% once the post-meiotic cells were merged into one category. CONCLUSIONS: This study proposed an innovative approach that leveraged ML methods to facilitate the diagnosis of spermatogenesis at mTESE for patients with NOA. With the assistance of ML techniques, surgeons could determine the stages of spermatogenesis and provide timely histopathological diagnosis for infertile males.
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Background/purpose: The development of dental radiology in Taiwan has been over a century. This study explored mainly the profile of dental radiation workers and their occupational radiation exposure in Taiwan from 2013 to 2020. Materials and methods: This study used the secondary data analysis to survey mainly the changes of manpower of the dental radiation workers and their occupational radiation exposure in Taiwan from 2013 to 2020. Results: The number of monitored dental radiation workers increased from 678 in 2013 to 770 in 2020. However, the proportion of monitored dental radiation workers to the total monitored medical radiation workers decreased from 4.29% in 2013 to 3.67% in 2020. Although the number of monitored dental radiation workers increased, the number of the measurably exposed dental radiation workers decreased from 2013 to 2020. The annual collective exposure dose fluctuated from 5.21 man-Sv to 15.47 man-Sv, but it showed a decreasing trend. Furthermore, the mean annual effective exposure dose of total monitored dental radiation workers (0.01-0.02 mSv) and that of the measurably exposed dental radiation workers (0.15-1.11 mSv) were relatively low among various medical radiation workers. In overall, the proportion of medical radiation technologists to dentists varied from 0.41 to 0.45. Conclusion: Although the number of monitored dental radiation workers increase, the number of the measurably exposed dental radiation workers, the proportion of the measurably exposed dental radiation workers to the total monitored dental radiation workers, and the annual collective exposure dose for monitored dental radiation workers decrease from 2013 to 2020.
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BACKGROUND: A systematic review and meta-analysis were performed to compare the post-recurrence survival with hepatic re-resection versus transarterial chemoembolization (TACE) for recurrent hepatocellular carcinoma (HCC) after initial resection. MATERIALS AND METHODS: All relevant papers were searched via PubMed, EMBASE, and Cochrane Library databases. Hazard ratios (HRs) with 95% confidence intervals (CIs) were pooled using a random-effects model. Subgroup analysis was performed according to country. Sensitivity analysis was performed in studies which clearly reported the recurrent regions, in moderate/high-quality studies, in studies published in full-text form, and in studies published after 2005. RESULTS: In total, twelve papers were included in our study. Five and seven of them were of moderate- and poor-quality, respectively. The overall meta-analysis demonstrated a statistically significantly higher post-recurrence survival in the hepatic re-resection group than in those undergoing TACE (HR=0.64, 95%CI=0.52-0.79, P<0.0001). Heterogeneity was statistically significant and statistical significance remained in the subgroup analysis. Sensitivity analyses were also consistent with the overall analysis. CONCLUSIONS: Hepatic re-resection might provide a better post-recurrence survival than TACE for recurrent HCC after initial resection. However, considering the low quality of published studies and the potential bias of treatment selection, further randomized trials should be warranted to confirm these findings.