Interpretable pap smear cell representation for cervical cancer screening

Screening is critical for prevention and early detection of cervical cancer but it is time-consuming and laborious. Supervised deep convolutional neural networks have been developed to automate pap smear screening and the results are promising. However, the interest in using only normal samples to train deep neural networks has increased owing to class imbalance problems and high-labeling costs that are both prevalent in healthcare. In this study, we introduce a method to learn explainable deep cervical cell representations for pap smear cytology images based on one class classification using variational autoencoders. Findings demonstrate that a score can be calculated for cell abnormality without training models with abnormal samples and localize abnormality to interpret our results with a novel metric based on absolute difference in cross entropy in agglomerative clustering. The best model that discriminates squamous cell carcinoma (SCC) from normals gives 0.908 +- 0.003 area under operating characteristic curve (AUC) and one that discriminates high-grade epithelial lesion (HSIL) 0.920 +- 0.002 AUC. Compared to other clustering methods, our method enhances the V-measure and yields higher homogeneity scores, which more effectively isolate different abnormality regions, aiding in the interpretation of our results. Evaluation using in-house and additional open dataset show that our model can discriminate abnormality without the need of additional training of deep models.Comment: 20 pages, 6 figure

3D target localization of modified 3D MUSIC for a triple-channel K-band radar

In this paper, a modified 3D multiple signal classification (MUSIC) algorithm is proposed for joint estimation of range, azimuth, and elevation angles of K-band radar with a small 2 × 2 horn antenna array. Three channels of the 2 × 2 horn antenna array are utilized as receiving channels, and the other one is a transmitting antenna. The proposed modified 3D MUSIC is designed to make use of a stacked autocorrelation matrix, whose element matrices are related to each other in the spatial domain. An augmented 2D steering vector based on the stacked autocorrelation matrix is proposed for the modified 3D MUSIC, instead of the conventional 3D steering vector. The effectiveness of the proposed modified 3D MUSIC is verified through implementation with a K-band frequency-modulated continuous-wave (FMCW) radar with the 2 × 2 horn antenna array through a variety of experiments in a chamber. © 2018 by the authors. Licensee MDPI, Basel, Switzerland.1

Robust self-cancellation-based time-of-arrival estimation algorithm to carrier frequency offset for bi-directional chirp signals

This study presents a robust self-cancellation-based time-of-arrival (TOA) estimation algorithm against carrier frequency offset (CFO). The proposed algorithm is developed to exploit the up and down chirp of bi-directional chirp signals. Using the relationship between the phase shifts of the transformed signals of the up and down chirp symbols, the CFO-induced error of the TOA estimates can be cancelled without pre-estimation and compensation through the proposed method. The root mean squared error of the proposed algorithm is analysed and verified through simulations in an additive white Gaussian noise and multi-path channel in the presence of CFO.FALS

Comparison of Multi- and Single-Site Robotic Myomectomy Using the Da Vinci^® SP Surgical System: A Propensity Score Matching Analysis

Objective: This study aimed to compare the surgical outcomes between robotic multi-site myomectomy (RMSM) and robotic single-site myomectomy (RSSM), using the da Vinci® SP surgical system and perform propensity score matching analysis to ensure inter-group comparability. Methods: This retrospective study included 105 patients who underwent either three-incision RMSM or RSSM using the da Vinci® SP surgical system. We retrospectively reviewed and compared surgical outcomes using 1:1 propensity score matching. Results: After 1:1 propensity score matching, there were no differences in the total operation time and estimated blood loss between the groups. The docking time (p p = 0.0001) were significantly shorter in the RSSM group than in the RMSM group. Conclusions: The surgical outcomes of RSSM were comparable to those of RMSM. Moreover, compared to RMSM, RSSM using the da Vinci® SP surgical system has shorter docking and morcellation times, and duration of hospital stay

Late solitary pelvic metastasis of hepatocellular carcinoma mimicking alpha-fetoprotein-producing gynaecologic tumour

Extrahepatic spread of hepatocellular carcinoma (HCC) is uncommon; and, pelvic metastasis, in particular, is extremely rare. A 71-year-old woman was admitted for evaluation of pelvic solitary solid mass. She had undergone a left lobectomy 28 years previously. Magnetic resonance imaging of the abdomen and pelvis demonstrated a heterogeneous mass in the right pelvic cavity, whereas no space-occupying lesions or ascites were detected in the liver. CA 125 levels were within normal limits; however, serum alpha-fetoprotein levels were markedly elevated. She underwent laparoscopic pelvic mass excision, total hysterectomy, and bilateral salpingo-oophorectomy. Histopathologic findings and immunochemical staining results indicated metastatic HCC. Herein, we report an unusual case of a patient with solitary recurrence in the pelvic cavity 28 years after initial diagnosis and treatment

Clinical features in adult patients with in-hospital cardiovascular events with confirmed 2009 Influenza A (H1N1) virus infection: Comparison with those without in-hospital cardiovascular events

Background: Comprehensive data regarding in-hospital cardiovascular events of adults with confirmed 2009 influenza A (H1N1) (2009 H1N1) infections are limited. The aim of this study was to determine the clinical characteristics, laboratory parameters, and electrocardiographic (ECG) findings for adults with 2009 H1N1 infections and to assess the differences in these parameters among adult patients with and without in-hospital cardiovascular events. Methods: Seventy-one patients were enrolled from the 2009 H1N1 registry database (our hospital registry of confirmed 2009 H1N1 infection during the year 2009) and divided according to the presence of in-hospital cardiovascular events. Six patients had cardiovascular events (CV group) and 65 did not (NCV group). Results: The CV group was more likely to be old (p = 0.023). Regarding co-morbidities, underlying coronary heart disease (p = 0.001), congestive heart failure (p = 0.001), diabetes (p = 0.001), and hypertension (p = 0.014) had significant influences on cardiovascular events. The CV group was also more likely to have chest pain (p = 0.034), dyspnea (p = 0.045), higher leukocyte count (p = 0.014), higher C-reactive protein (p = 0.010), higher glucose level (p = 0.001), and higher N-terminal probrain natriuretic peptide level (p = 0.010) than the NCV group. In addition, the CV group had a significantly higher in-hospital mortality rate (p = 0.010) and cardiac mortality rate (p = 0.001) than the NCV group. However, there were no significant differences in ECG findings between the two groups. Conclusion: Our study demonstrated that the CV group had higher in-hospital and cardiac mortality rates than the NCV group. A meticulous therapeutic approach should be considered for elderly patients with 2009 H1N1 infections having coronary heart disease, congestive heart failure, diabetes, hypertension, and high levels of leukocyte count, hs-CRP, glucose, and NT-proBNP at the time of admission

Potential Association between Vaginal Microbiota and Cervical Carcinogenesis in Korean Women: A Cohort Study

Convincing studies demonstrated that vaginal flora is one of the most impactful key components for the well-being of the genital tract in women. Nevertheless, the potential capability of vaginal-derived bacterial communities as biomarkers to monitor cervical carcinogenesis (CC) has yet to be studied actively compared to those of bacterial vaginosis (BV). We hypothesized that vaginal microbiota might be associated with the progression of CC. In this study, we enrolled 23 participants, including healthy controls (HC group; n = 7), patients with cervical intraepithelial neoplasia (CIN) 2 and 3 (CIN group, n = 8), and patients with invasive cervical cancer (CAN group; n = 8). Amplicon sequencing was performed using the Ion Torrent PGM to characterize the vaginal microbiota. Patients with CIN and CAN presented vaginal microbiota dysbiosis compared with HC. The alpha diversity analysis revealed that CC has a trend to be increased in terms of diversity indexes. Moreover, CC was associated with the abundance of specific microbes, of which Lactobacillus and Gardnerella were the most significantly different between HC and CIN, whereas Streptococcus was differentially abundant in CAN compared with CIN. We then evaluated their diagnostic abilities. Testing in terms of diagnostic ability using the three genera revealed considerably high performance with an area under the receiver-operating characteristic curve of 0.982, 0.953, and 0.922. The current study suggests that the presence of Gardnerella and Streptococcus may be involved in the advancment of CC

Potential Association between Vaginal Microbiota and Cervical Carcinogenesis in Korean Women: A Cohort Study

Convincing studies demonstrated that vaginal flora is one of the most impactful key components for the well-being of the genital tract in women. Nevertheless, the potential capability of vaginal-derived bacterial communities as biomarkers to monitor cervical carcinogenesis (CC) has yet to be studied actively compared to those of bacterial vaginosis (BV). We hypothesized that vaginal microbiota might be associated with the progression of CC. In this study, we enrolled 23 participants, including healthy controls (HC group; n = 7), patients with cervical intraepithelial neoplasia (CIN) 2 and 3 (CIN group, n = 8), and patients with invasive cervical cancer (CAN group; n = 8). Amplicon sequencing was performed using the Ion Torrent PGM to characterize the vaginal microbiota. Patients with CIN and CAN presented vaginal microbiota dysbiosis compared with HC. The alpha diversity analysis revealed that CC has a trend to be increased in terms of diversity indexes. Moreover, CC was associated with the abundance of specific microbes, of which Lactobacillus and Gardnerella were the most significantly different between HC and CIN, whereas Streptococcus was differentially abundant in CAN compared with CIN. We then evaluated their diagnostic abilities. Testing in terms of diagnostic ability using the three genera revealed considerably high performance with an area under the receiver-operating characteristic curve of 0.982, 0.953, and 0.922. The current study suggests that the presence of Gardnerella and Streptococcus may be involved in the advancment of CC

The ability of whole-body SUVmax in F-18 FDG PET/CT to predict suboptimal cytoreduction during primary debulking surgery for advanced ovarian cancer

Abstract Background The aim of this study was to (1) evaluate the ability of F-18 fluorodeoxyglucose positron emission tomography/computed tomography (FDG PET/CT) parameters to predict suboptimal cytoreduction and (2) to create a risk model for predicting suboptimal cytoreduction in advanced ovarian cancer. From 2011 to 2015, 51 patients underwent primary cytoreductive surgery for advanced ovarian cancer were enrolled. A residual disease with maximal diameter >  1 cm was considered a suboptimal surgical result. The SUVmax values for nine abdominal regions, the sum of 9 regional SUVmax (WB1SUVmax) and WB2SUVmax (WB1SUVmax plus SUVmax of lymph nodes) were used for PET parameter. Multiple logistic regression analysis was used to determine the predictive value of PET and clinical parameters for risk model. In addition, assessments of disease-free survival (DFS) and overall survival (OS) were performed. Results Seventeen of the 51 patients (33.3%) underwent suboptimal cytoreduction. The ECOG status (OR, 4.091), SUVmax of central (OR, 5.250), right upper (OR, 4.148), left upper (OR, 5.921) and WB2SUVmax (OR, 4.148) were associated with suboptimal cytoreduction. The risk model can divide the risk groups of suboptimal cytoreduction (area under the curve (AUC), 0.775; p = 0.0001). The DFS and OS in the high-risk group were significantly worse than those in the low-risk group (p = 0.0379 for DFS; p = 0.0211 for OS). Conclusions The presence of hypermetabolic lesions in the central, right upper, and left upper regions showed predictive value for suboptimal cytoreduction. Our risk model may be helpful for selecting patients who may show suboptimal cytoreduction

Survival Impact of Residual Cancer Cells in Intraoperative Peritoneal Washes following Radical Hysterectomy for Cervical Cancer

Objective: Residual cancer cells (RCCs) contribute to cancer recurrence either because of tumor spillage or undetectable pre-existing micrometastatic tumor clones. We hypothesized that the pathologic evaluation of intraoperative peritoneal washes may reveal RCCs. The aim of this study was to evaluate the survival impact of RCCs identified in intraoperative peritoneal washes and their correlation with clinicopathologic parameters following radical hysterectomy for cervical cancer. Methods: A total of 229 patients with cervical cancer who underwent radical hysterectomy with pelvic and/or paraaortic lymphadenectomy were included. The intraoperative peritoneal washes after surgery were filtered through a strainer and the presence of tumor cells in the residual aspirate was determined. Univariate and multivariate analyses of clinicopathological parameters were performed to identify predictors of recurrence. Results: RCCs in intraoperative peritoneal washes were identified in 19 patients (8.3%). Multivariate analysis revealed that deep stromal invasion (hazard ratio [HR], 13.32; 95% confidence interval [CI], 1.81–98.27; p = 0.0111), lymph node metastasis (HR, 2.00; 95% CI, 1.01–3.99; p = 0.0482), and neoadjuvant chemotherapy (HR, 2.34; 95% CI, 1.89–4.61; p = 0.0139) were associated with tumor recurrence. However, the presence of RCCs was not associated with tumor recurrence (HR, 2.60; 95% CI, 0.74–9.11; p = 0.1352). Multiple logistic regression analysis revealed that RCCs were associated with neoadjuvant chemotherapy (odds ratio [OR], 0.22; 95% CI, 0.05–0.99; p = 0.0488) and large tumor size (OR, 4.16; 95% CI, 0.77–22.48; p = 0.0981). Conclusions: Although the presence of RCCs in intraoperative peritoneal washes do not significantly impact survival outcomes, there was a tendency of inferior survival outcomes in patients with RCCs. RCCs were associated with neoadjuvant chemotherapy and large tumor size