Improving the Accuracy and Efficiency of Abnormal Cervical Squamous Cell Detection With Cytologist-in-the-Loop Artificial Intelligence.

Population-based cervical cytology screening techniques are demanding and laborious and have relatively poor diagnostic accuracy. In this study, we present a cytologist-in-the-loop artificial intelligence (CITL-AI) system to improve the accuracy and efficiency of abnormal cervical squamous cell detection in cervical cancer screening. The artificial intelligence (AI) system was developed using 8000 digitalized whole slide images, including 5713 negative and 2287 positive cases. External validation was performed using an independent, multicenter, real-world data set of 3514 women, who were screened for cervical cancer between 2021 and 2022. Each slide was assessed using the AI system, which generated risk scores. These scores were then used to optimize the triaging of true negative cases. The remaining slides were interpreted by cytologists who had varying degrees of experience and were categorized as either junior or senior specialists. Stand-alone AI had a sensitivity of 89.4% and a specificity of 66.4%. These data points were used to establish the lowest AI-based risk score (ie, 0.35) to optimize the triage configuration. A total of 1319 slides were triaged without missing any abnormal squamous cases. This also reduced the cytology workload by 37.5%. Reader analysis found CITL-AI had superior sensitivity and specificity compared with junior cytologists (81.6% vs 53.1% and 78.9% vs 66.2%, respectively; both with P < .001). For senior cytologists, CITL-AI specificity increased slightly from 89.9% to 91.5% (P = .029); however, sensitivity did not significantly increase (P = .450). Therefore, CITL-AI could reduce cytologists' workload by more than one-third while simultaneously improving diagnostic accuracy, especially compared with less experienced cytologists. This approach could improve the accuracy and efficiency of abnormal cervical squamous cell detection in cervical cancer screening programs worldwide.

Assessing artificial intelligence enabled liquid-based cytology for triaging HPV-positive women: a population-based cross-sectional study.

INTRODUCTION: Cytology-based triaging is commonly used to manage the care of women with positive human papillomavirus (HPV) results, but it suffers from subjectivity and a lack of sensitivity and reproducibility. The diagnostic performance of an artificial intelligence-enabled liquid-based cytology (AI-LBC) triage approach remains unclear. Here, we compared the clinical performance of AI-LBC, human cytologists and HPV16/18 genotyping at triaging HPV-positive women. MATERIAL AND METHODS: HPV-positive women were triaged using AI-LBC, human cytologists and HPV16/18 genotyping. Histologically confirmed cervical intraepithelial neoplasia grade 2/3 or higher (CIN2+/CIN3+) were accepted as thresholds for clinical performance assessments. RESULTS: Of the 3514 women included, 13.9% (n = 489) were HPV-positive. The sensitivity of AI-LBC was comparable to that of cytologists (86.49% vs 83.78%, P = 0.744) but substantially higher than HPV16/18 typing at detecting CIN2+ (86.49% vs 54.05%, P = 0.002). While the specificity of AI-LBC was significantly lower than HPV16/18 typing (51.33% vs 87.17%, P < 0.001), it was significantly higher than cytologists at detecting CIN2+ (51.33% vs 40.93%, P < 0.001). AI-LBC reduced referrals to colposcopy by approximately 10%, compared with cytologists (51.53% vs 60.94%, P = 0.003). Similar patterns were also observed for CIN3+. CONCLUSIONS: AI-LBC has equivalent sensitivity and higher specificity compared with cytologists, with more efficient colposcopy referrals for HPV-positive women. AI-LBC could be particularly useful in regions where experienced cytologists are few in number. Further investigations are needed to determine triaging performance through prospective designs.

Cervical cytology screening facilitated by an artificial intelligence microscope: A preliminary study.

BACKGROUND: Cervical cytology screening is usually laborious with a heavy workload and poor diagnostic consistency. The authors have developed an artificial intelligence (AI) microscope that can provide onsite diagnostic assistance for cervical cytology screening in real time. METHODS: A total of 2167 cervical cytology slides were selected from a cohort of 10,601 cases from Shenzhen Maternity and Child Healthcare Hospital, and the training data set consisted of 42,073 abnormal cervical epithelial cells. The recognition results of an AI technique were presented in a microscope eyepiece by an augmented reality technique. Potentially abnormal cells were highlighted with binary classification results in a 10× field of view (FOV) and with multiclassification results according to the Bethesda system in 20× and 40× FOVs. In addition, 486 slides were selected for the reader study to evaluate the performance of the AI microscope. RESULTS: In the reader study, which compared manual reading with AI assistance, the sensitivities for the detection of low-grade squamous intraepithelial lesions and high-grade squamous intraepithelial lesions were significantly improved from 0.837 to 0.923 (P < .001) and from 0.830 to 0.917 (P < .01), respectively; the κ score for atypical squamous cells of undetermined significance (ASCUS) was improved from 0.581 to 0.637; the averaged pairwise κ of consistency for multiclassification was improved from 0.649 to 0.706; the averaged pairwise κ of consistency for binary classification was improved from 0.720 to 0.798; and the averaged pairwise κ of ASCUS was improved from 0.557 to 0.639. CONCLUSIONS: The results of this study show that an AI microscope can provide real-time assistance for cervical cytology screening and improve the efficiency and accuracy of cervical cytology diagnosis.

Identification of Five Cytotoxicity-Related Genes Involved in the Progression of Triple-Negative Breast Cancer.

Background: Breast cancer is one of the deadly tumors in women, and its incidence continues to increase. This study aimed to identify novel therapeutic molecules using RNA sequencing (RNA-seq) data of breast cancer from our hospital. Methods: 30 pairs of human breast cancer tissue and matched normal tissue were collected and RNA sequenced in our hospital. Differentially expressed genes (DEGs) were calculated with raw data by the R package "edgeR", and functionally annotated using R package "clusterProfiler". Tumor-infiltrating immune cells (TIICs) were estimated using a website tool TIMER 2.0. Effects of key genes on therapeutic efficacy were analyzed using RNA-seq data and drug sensitivity data from two databases: the Cancer Cell Line Encyclopedia (CCLE) and the Cancer Therapeutics Response Portal (CTRP). Results: There were 2,953 DEGs between cancerous and matched normal tissue, as well as 975 DEGs between primary breast cancer and metastatic breast cancer. These genes were primarily enriched in PI3K-Akt signaling pathway, calcium signaling pathway, cAMP signaling pathway, and cell cycle. Notably, CD8+ T cell, M0 macrophage, M1 macrophage, regulatory T cell and follicular helper T cell were significantly elevated in cancerous tissue as compared with matched normal tissue. Eventually, we found five genes (GALNTL5, MLIP, HMCN2, LRRN4CL, and DUOX2) were markedly corelated with CD8+ T cell infiltration and cytotoxicity, and associated with therapeutic response. Conclusion: We found five key genes associated with tumor progression, CD8+ T cell and therapeutic efficacy. The findings would provide potential molecular targets for the treatment of breast cancer.

Home Videos as a Cost-Effective Tool for the Diagnosis of Paroxysmal Events in Infants: Prospective Study.

BACKGROUND: The diagnosis of paroxysmal events in infants is often challenging. Reasons include the child's inability to express discomfort and the inability to record video electroencephalography at home. The prevalence of mobile phones, which can record videos, may be beneficial to these patients. In China, this advantage may be even more significant given the vast population and the uneven distribution of medical resources. OBJECTIVE: The aim of this study is to investigate the value of mobile phone videos in increasing the diagnostic accuracy and cost savings of paroxysmal events in infants. METHODS: Clinical data, including descriptions and home videos of episodes, from 12 patients with paroxysmal events were collected. The investigation was conducted in six centers during pediatric academic conferences. All 452 practitioners present were asked to make their diagnoses by just the descriptions of the events, and then remake their diagnoses after watching the corresponding home videos of the episodes. The doctor's information, including educational background, profession, working years, and working hospital level, was also recorded. The cost savings from accurate diagnoses were measured on the basis of using online consultation, which can also be done easily by mobile phone. All data were recorded in the form of questionnaires designed for this study. RESULTS: We collected 452 questionnaires, 301 of which met the criteria (66.6%) and were analyzed. The mean correct diagnoses with and without videos was 8.4 (SD 1.7) of 12 and 7.5 (SD 1.7) of 12, respectively. For epileptic seizures, mobile phone videos increased the mean accurate diagnoses by 3.9%; for nonepileptic events, it was 11.5% and both were statistically different (P=.006 for epileptic events; P<.001 for nonepileptic events). Pediatric neurologists with longer working years had higher diagnostic accuracy; whereas, their working hospital level and educational background made no difference. For patients with paroxysmal events, at least US $673.90 per capita and US $128 million nationwide could be saved annually, which is 12.02% of the total cost for correct diagnosis. CONCLUSIONS: Home videos made on mobile phones are a cost-effective tool for the diagnosis of paroxysmal events in infants. They can facilitate the diagnosis of paroxysmal events in infants and thereby save costs. The best choice for infants with paroxysmal events on their initial visit is to record their events first and then show the video to a neurologist with longer working years through online consultation.

Evaluation of manual and electronic healthcare-associated infections surveillance: a multi-center study with 21 tertiary general hospitals in China.

BACKGROUND: Healthcare-associated infections (HAIs) are still a major health threats worldwide. Traditional surveillance methods involving manual surveillance by infection control practitioners (ICPs) for data collection processes are laborious, inefficient, and generate data of variable quality. In this study, we sought to evaluate the impact of surveillance and interaction platform system (SIPS) for HAIs surveillance compared to manual survey in tertiary general hospitals. METHODS: A large multi-center study including 21 tertiary general hospitals and 63 wards were performed to evaluate the impact of electronic SIPS for HAIs. RESULTS: We collected 4,098 consecutive patients and found that the hospitals installed with SIPS significantly increased work efficiency of ICPs achieving satisfactory diagnostic performance of HAIs with 0.73 for sensitivity, 0.81 for specificity and 0.81 area under the curve (AUC). However, there were significant heterogeneity own to regions, time of SIPS installation, departments and sample size. CONCLUSIONS: SIPS significantly improved ICPs efficiency and HAIs monitoring effectiveness, but there were shortcomings such as untimely maintenance and high cost.

[Determination of gold in thiourea and sulfuric acid solution by AAS].

The concentrations of gold in thiourea and sulfuric acid solutions using gold standard solutions in diluent royal water were determined by AAS. The linear range was 0.2-12 x 10(-6), and RSD < 5%. This method simplifies the analysis of gold in thiourea and sulfuric acid solution. Thiourea declines the absorbency of gold while sulfuric acid plays a contrary role. The determined value were satisfactor after being modified by the blank curve.

[EXAFS study on the stripping mechanism in N263/alkaline cyanide gold solution/sulfuric thiourea system].

Quaternary ammonium salt has strong affinity with gold in cyanide solutions, but it is not readily stripped. Stripping with acidic thiourea solutions and air sparging shows promise. There are some reports on the process of thiourea stripping, but little about its mechanism. In this paper, the stripping mechanism of N263/sulphuric thiourea/alkaline cyanide gold solution is studied by EXAFS. According to the experiments, sulphuric acid, thiourea and gold-thiourea complex can be extracted by N263 as a neutral molecule, and the stripping process can be described as following: (1) Sulphuric acid and thiourea are extracted by N263; (2) In organic phase, gold-cyanide complex is converted to gold-thiourea complex, which exists as Au[SC(NH2)2]2HSO4, and CN- forms HCN with acid at the same time; (3) HCN is removed by air sparging, and Au[SC(NH2)2]2HSO4 is distributed between organic phase and liquor phase, most of which transfers to liquor phase and is stripped.

[Further study on possibility of diffusion of Oncomelania hupensis with water in river channels of the east route of South-to-North Water Diversion Project].

OBJECTIVE: To study the drifting law of floats and potential risks of Oncomelania hupensis diffusion in the water diversion rivers of the east route of South-to-North Water Diversion Project. METHODS: The O. hupensis snails in the river channels were monitored by the salvage method and snail luring method with rice straw curtains, and the diffusion possibility of snails along with water was assessed through the drift test of floats with GPS. RESULTS: In the flood seasons from 2006 to 2013, totally 8 338.0 kg of floats were salvaged, and 2 100 rice straw curtains were put into water in the Li Canal and Jinbao shipping channel, but no Oncomelania snails were found. The drift test of floats with GPS before water diversion showed that the flow velocity on water surface (northbound) was 0.45 m/s, the average drift velocity of the floats was 0.56 - 0.60 m/s, and the average drift distances each time were 999.70 - 1 995.50 m in the Gaoshui River section, while there were no obvious drift in Jinbao shipping channel section. During the water diversion period, the flow velocity on water surface (northbound) was 0.45 m/s, the average drift velocity of the floats was 0.35 - 0.41m/s, and the average drift distances each time were 1 248.06 -1 289.44 m in the Gaoshui River, while in Jinbao shipping channel section, the flow velocity on water surface was 0.28 m/s, the average drift velocity of the floats was 0.25 - 0.27 m/s, and the average drift distances each time were 477.76 - 496.38 m. The drift test showed that the floats gradually closed to the river bank as affected by water flow, wind direction and ship waves, when blocked by the reeds, water plants or other obstacles, and they would stopped and could not continue to drift without outside help. CONCLUSIONS: There are no Oncomelania snails found in the river channels of the east route of South-to-North Water Diversion Project. The drifting distance of the floating debris along with the water is restricted by the flow rate and shore environment.

[Effect of comprehensive measures on schistosomiasis control in an aquaculture zone].

OBJECTIVE: To evaluate the effect of comprehensive measures on the control of schistosomiasis in an aquaculture zone, so as to provide the evidence for formulating the schistosomiasis control strategy in special environments. METHODS: From 2003 to 2012, the comprehensive control measures including individual prevention, detection and treatment of schistosomiasis patients, environmental modification, and health education were implemented in an aquaculture zone of Luyang Lake, Jiangdu District of Yangzhou City, Jiangsu Province. The changes in human morbidity of schistosomiasis and the status of Oncomelania snails were investigated annually. RESULTS: No acute infection of Schistosoma japonicum was detected for successive 10 years, and only 5 cases of chronic infection were found in the latest 5 years in the aquaculture zone. Since 2007, no snail habitats were found. CONCLUSIONS: The comprehensive control measures are effective.

[Effect of sand buried on elimination of Oncomelania hupensis snails in marshland along Yangtze River in Jiangdu District, Jiangsu Province].

OBJECTIVE: To evaluate the effect of sand buried on the elimination of Oncomelania snails in the marshland along the Yangtze River downstream. METHODS: The areas along the Yangtze River were chosen as the investigated objects in Jiangdu District, Jiangsu Province. The datum review and field investigations were used to observe the change of snail area after the sand buried. RESULTS: There were 11 sand buried projects along the Yangtze River in Jiangdu District, Jiangsu Province. The snail areas decreased by 93.73% after the sand buried. CONCLUSION: The sand buried is an effective method of snail control in the marshland along the Yangtze River. This method can be combined with economic construction and development projects for popularization and application.

[Technology of preventing oncomelania snail diffusion in east route of South-to-North Water Diversion Project II. Effect of sand buried and reed protection on snail control in area of water source].

OBJECTIVE: To evaluate the effect of sand buried and reed protection on Oncomelania snail control in the area of water source of the east route of South-to-North Water Diversion Project. METHODS: The Oncomelania snail eggs were counted after the snails raised seven days in the sand of different contents in the spawning period. The survival of the snails was observed when the snails were raised on the sand surface in the laboratory. The change of the densities of living snails and reed growth were observed in the area of water source. RESULTS: The snails did not lay eggs in the pure sand environment. There was a negative correlation between the number of snail eggs and the content of sand (r = -0.965, P = 0.008). The mortality rates of the snails were increasing with the increase of the time in the sand environment. The mortality rates of the snails were 96.00% and 100% when the snails were raised 3 months and 6 months around 25 degrees C respectively. The field test showed that the snails were not discovered after the sand buried, the second spring, after the flood season, and the third spring. However, the density of living snails of the control group dropped by 93.65% 2 weeks after using molluscicide, but increased by 100% and kept in 0.37 snails/0.1 m2 after the flood season and the third year spring, respectively. The reed growth was good in the second spring after the sand buried. CONCLUSIONS: The sand environment is unfavorable for laying eggs and survival of the snails. The sand buried method has the effects of snail control and reed protection. In addition, the method could also prevent the snail spread in the flood season.

[Exploration of model of Oncomelania snail survey post-transmission control in Jiangdu City].

OBJECTIVE: To explore the model of Oncomelania snail survey in inland areas, so as to reduce the burden of farmers as well as to improve the quality of snail survey. METHODS: A database of environment in snail survey was established, and specialized personnel were organized at town level. The general survey combined with survey in turn was used. RESULTS: After the improvement of the survey model, the personnel numbers and amounts of labor used, especially the cost afforded at village level decreased significantly, without any influence on the quality of snail survey. CONCLUSIONS: The improvement of snail survey model can enhance the efficiency and quality of survey, and can reduce the burden of farmers, but careful organization, strengthened management, and standardized operations are needed in the procedure.

[Impact of simulation operation high water level on Oncomelania hupensis natural growth in water diversion rivers of east route of South-to-North water Diversion Project].

OBJECTIVE: To verify the impact of operation high water level on Oncomelania hupensis natural growth in the water diversion rivers of the east route of South-to-North Water Diversion Project. METHODS: The data of the daily mean water level were investigated in the stilling pool of Jiangdu Pumping Station during the water diversion under the emergency anti-drought, and the water level data of the previous year served as the control. The dynamic of natural growth of O. hupensis snails was observed before and after the high water level in the beach wetlands of the stilling pool of Jiangdu Pumping Station. The water level of emergency anti-drought was as simulation operation water level of the east route of South-to-North Water Diversion Project in the stilling pool, and then the effects of operation water level on O. hupensis natural growth in the water diversion rivers of the east route of South-to-North Water Diversion Project were studied. RESULTS: The altitude of the beach wetlands was 6.4 to 7.2 meters in the stilling pool of Jiangdu Pumping Station. The water diversion was 255 days continuously and the pumped water was 6.235 billion cubic meters in the Jiangdu Pumping Station from November 2010 to July 2011. There were 216, 136 days and 39 days when daily mean water level were more than or equal to 7.2, 7.6 and 8.0 meters during the water diversion, respectively. The snail densities were 0.856 snails/0.1m2 and 0.0153 snails/0.1m2, respectively, before and after the No.3 beach wetlands flooded in the stilling pool of Jiangdu Pumping Station. The densities of living snails decreased by 98.21%, and there was no any progeny of snail. The snails were not detected in other environment of the stilling pool. CONCLUSION: The operation high water level can effectively restrain snail breeding in the water diversion rivers of the east route of South-to-North Water Diversion Project.

[Study on surveillance and early-warning system of schistosomiasis in first phase of east route of South-to-North Water Diversion Project. III. Indexes of surveillance and early-warning and risk assessment].

OBJECTIVE: To establish the index system of surveillance and early-warning on schistosomiasis and to provide the scientific basis for risk assessment and emergency plan in first phase of east route of South-to-North Water Diversion Project. METHODS: The Delphi method and the multidimensional synthetic evaluation were used in the evaluation of indexes of surveillance and early-warning on schistosomiasis in the east route of the project. RESULTS: There were 53 indexes evaluated in the index system, and among them, there were 3 first grade indexes, 10 second grade indexes and 40 third grade indexes. The indexes on Oncomelania snails were the most important. According to the habitation position of snails, the four grades on surveillance and early-warning of schistosomiasis were established in the east route. The grade I of the early-warning meant that snails crossed the first level of the pumping station. The grade II meant that snails crossed N 32 degrees 54'. The grade III meant that snails crossed N 33 degrees 03' or Jinhu pumping station. The grade IV meant that snails crossed N 33 degrees 15' or Hongze Station. Other 4 indexes on schistosome infection in people and livestock were confirmed as indicative indexes. According to the relationship among the indexes, the evaluation methods were determined on the risk of schistosomiasis transmission. CONCLUSIONS: The index system of surveillance and early-warning and the methods of risk assessment of schistosomiasis have been confirmed in first phase of east route of South-to-North Water Diversion Project. The primary index is related to snails and the supplementary is related to schistosome infection in people and livestock in the system.