Automatic Recognition of Laryngoscopic Images Using a Deep-Learning Technique

Objectives/Hypothesis: To develop a deep-learning–based computer-aided diagnosis system for distinguishing laryngeal neoplasms (benign, precancerous lesions, and cancer) and improve the clinician-based accuracy of diagnostic assessments of laryngoscopy findings. Study Design: Retrospective study. Methods: A total of 24,667 laryngoscopy images (normal, vocal nodule, polyps, leukoplakia and malignancy) were collected to develop and test a convolutional neural network (CNN)-based classifier. A comparison between the proposed CNN-based classifier and the clinical visual assessments (CVAs) by 12 otolaryngologists was conducted. Results: In the independent testing dataset, an overall accuracy of 96.24% was achieved; for leukoplakia, benign, malignancy, normal, and vocal nodule, the sensitivity and specificity were 92.8% vs. 98.9%, 97% vs. 99.7%, 89% vs. 99.3%, 99.0% vs. 99.4%, and 97.2% vs. 99.1%, respectively. Furthermore, when compared with CVAs on the randomly selected test dataset, the CNN-based classifier outperformed physicians for most laryngeal conditions, with striking improvements in the ability to distinguish nodules (98% vs. 45%, P <.001), polyps (91% vs. 86%, P <.001), leukoplakia (91% vs. 65%, P <.001), and malignancy (90% vs. 54%, P <.001). Conclusions: The CNN-based classifier can provide a valuable reference for the diagnosis of laryngeal neoplasms during laryngoscopy, especially for distinguishing benign, precancerous, and cancer lesions. Level of Evidence: NA Laryngoscope, 130:E686–E693, 2020

A Novel Cationic Lignin-amine Emulsifier with High Performance Reinforced via Phenolation and Mannich Reactions

A novel cationic lignin-amine emulsifier with high surface activity was prepared from kraft lignin (KL) via the phenolation of KL to obtain phenolated kraft lignin (PKL) and improve reaction sites. The introduction of dehydroabietyl groups as hydrophobic groups and diethylenetriamino groups as hydrophilic groups in PKL, by Mannich reactions, enhanced the performance of the emulsifier. The results showed that the number of the hydroxyphenyl groups in PKL was 0.27/C9 unit when 1 mol lignin was treated with 10 mol phenol at 60 °C for 6 h under 60 wt% sulfuric acid. The numbers of dehydroabietyl groups and diethylenetriamino groups in PKL were 0.18/C9 and 0.13/C9 unit, respectively. The surface tension of the emulsifier was 30.03 mN·m-1 at a concentration of 0.03 M hydrochloric acid aqueous solution with a pH 2.0, which is close to the commercial surfactant cetyltrimethylammonium bromide (CTAB). The zeta potential of the emulsifier was 45.1 mV, and its emulsifiability was 72 min. In contrast, the surface tension of the emulsifier prepared by non-phenolated lignin at the same condition was 38.67 mN·m-1, where the maximum zeta potential was 40.03 mV and its emulsifiability was 53 min. As expected, the performance of the emulsifier was reinforced by the phenolation reaction