A hybrid ensemble deep learning approach for reliable breast cancer detection

Among the cancer diseases, breast cancer is considered one of the most prevalent threats requiring early detection for a higher recovery rate. Meanwhile, the manual evaluation of malignant tissue regions in histopathology images is a critical and challenging task. Nowadays, deep learning becomes a leading technology for automatic tumor feature extraction and classification as malignant or benign. This paper presents a proposed hybrid deep learning-based approach, for reliable breast cancer detection, in three consecutive stages: 1) fine-tuning the pre-trained Xception-based classification model, 2) merging the extracted features with the predictions of a two-layer stacked LSTM-based regression model, and finally, 3) applying the support vector machine, in the classification phase, to the merged features. For the three stages of the proposed approach, training and testing phases are performed on the BreakHis dataset with nine adopted different augmentation techniques to ensure generalization of the proposed approach. A comprehensive performance evaluation of the proposed approach, with diverse metrics, shows that employing the LSTM-based regression model improves accuracy and precision metrics of the fine-tuned Xception-based model by 10.65% and 11.6%, respectively. Additionally, as a classifier, implementing the support vector machine further boosts the model by 3.43% and 5.22% for both metrics, respectively. Experimental results exploit the efficiency of the proposed approach with outstanding reliability in comparison with the recent state-of-the-art approaches

Burnout among surgeons before and during the SARS-CoV-2 pandemic: an international survey

Background: SARS-CoV-2 pandemic has had many significant impacts within the surgical realm, and surgeons have been obligated to reconsider almost every aspect of daily clinical practice. Methods: This is a cross-sectional study reported in compliance with the CHERRIES guidelines and conducted through an online platform from June 14th to July 15th, 2020. The primary outcome was the burden of burnout during the pandemic indicated by the validated Shirom-Melamed Burnout Measure. Results: Nine hundred fifty-four surgeons completed the survey. The median length of practice was 10 years; 78.2% included were male with a median age of 37 years old, 39.5% were consultants, 68.9% were general surgeons, and 55.7% were affiliated with an academic institution. Overall, there was a significant increase in the mean burnout score during the pandemic; longer years of practice and older age were significantly associated with less burnout. There were significant reductions in the median number of outpatient visits, operated cases, on-call hours, emergency visits, and research work, so, 48.2% of respondents felt that the training resources were insufficient. The majority (81.3%) of respondents reported that their hospitals were included in the management of COVID-19, 66.5% felt their roles had been minimized; 41% were asked to assist in non-surgical medical practices, and 37.6% of respondents were included in COVID-19 management. Conclusions: There was a significant burnout among trainees. Almost all aspects of clinical and research activities were affected with a significant reduction in the volume of research, outpatient clinic visits, surgical procedures, on-call hours, and emergency cases hindering the training. Trial registration: The study was registered on clicaltrials.gov "NCT04433286" on 16/06/2020

The Development of QMMS: A Case Study for Reliable Online Quiz Maker and Management System

The e-learning and assessment systems became a dominant technology nowadays and distribute across the globe. With severe consequences of COVID19-like crises, the key importance of such technology appeared in which courses, quizzes and questionnaires have to be conducted remotely. Moreover, the use of Learning Management Systems (LMSs), such as blackboard, eCollege, and Moodle, has been sanctioned in all respects of education. This paper presents an open-source interactive Quiz Maker and Management System (QMMS) that suits the research, education (under-grad, grad, or post-grad), and industrial organizations to perform distant quizzes, training and questionnaires with an integration facility with other LMS tools such as Moodle. The proposed system supports three basic levels: 1) administration, 2) instructors, and 3) learners at the micro-level teaching. The proposed system is adopted using .Net framework integrated with SQL-Server database engine that compromise between performance, security and stability. The proposed QMMS is described through different phases of Software Development Life Cycle (SDLC) including detailed analysis, design, implementation, testing, verification, and maintenance in order to exploit the importance of the analysis and design of LMS from the software engineering point of view. A comparative analysis, among the proposed system and a recent list of challenging ones, is presented in different aspects that shows the effectiveness, reliability and validity of proposed tool. Moreover, the proposed QMMS shows an enhancement ratio of up to 42.19% in response time perspective as compared to Moodle system in the case of massive concurrent transactions

Risk factors for ectasia after laser in situ keratomileusis in an Egyptian population sample

Purpose The aim of this study was to determine the prevalence and risk factors of post-laser in situ keratomileusis (post-LASIK) ectasia in an Egyptian population sample. Design This is a retrospective case–control study. Patients and methods The study included 44 patients, who were classified into two groups. The first group (post-LASIK ectasia) included 31 eyes (18 patients) and the second group (LASIK without complications) included 52 eyes (26 patients). The comparison between the two groups included the pre-LASIK refractive error, corrected distance visual acuity (CDVA), corneal curvature, corneal thickness, corneal elevations, ectasia risk scoring, flap thickness, and residual stroma after LASIK. We also evaluated the changes that occurred in patients with ectasia in comparison to their pre-LASIK parameters. Results The prevalence of post-LASIK ectasia was 0.22%. The degree of myopia, astigmatism, maximum keratometry reading (K-max), ectasia risk scoring, and flap lift for retreatment were significantly higher in the ectasia group compared with the control group (P=0.041, 0.006, 0.016, 0.038, and 0.017, respectively), while the CDVA and residual stroma after LASIK were significantly less in the ectasia group (P=0.039 and 0.003, respectively). There was a statistically significant increase in astigmatism and change in its type and increased K-max and corneal elevations after ectasia. Conclusions The degree of myopia, astigmatism, CDVA, K-max, ectasia risk scoring, residual stroma after LASIK, and retreatment are risk factors for ectasia development

Extracellular biosynthesis, OVAT/statistical optimization, and characterization of silver nanoparticles (AgNPs) using Leclercia adecarboxylata THHM and its antimicrobial activity

Abstract Background The biosynthesis of silver nanoparticles (AgNPs) is an area of interest for researchers due to its eco-friendly approach. The use of biological approaches provides a clean and promising alternative process for the synthesis of AgNPs. We used for the first time the supernatant of Leclercia adecarboxylata THHM under optimal conditions to produce AgNPs with an acceptable antimicrobial activity against important clinical pathogens. Results In this study, soil bacteria from different locations were isolated and screened for their potential to form AgNPs. The selected isolate, which was found to have the ability to biosynthesize AgNPs, was identified by molecular methods as Leclercia adecarboxylata THHM and its 16S rRNA gene was deposited in GenBank under the accession number OK605882. Different conditions were screened for the maximum production of AgNPs by the selected bacteria. Five independent variables were investigated through optimizations using one variable at a time (OVAT) and the Plackett–Burman experimental design (PBD). The overall optimal parameters for enhancing the biosynthesis of AgNPs using the supernatant of Leclercia adecarboxylata THHM as a novel organism were at an incubation time of 72.0 h, a concentration of 1.5 mM silver nitrate, a temperature of 40.0 °C, a pH of 7.0, and a supernatant concentration of 30% (v/v) under illumination conditions. The biosynthesized AgNPs have been characterized by UV–visible spectroscopy (UV–Vis), transmission electron microscopy (TEM), and Fourier transform infrared spectroscopy (FTIR). The biosynthesized AgNPs showed an absorption peak at 423 nm, spherical shape, and an average particle size of 17.43 nm. FTIR shows the bands at 3321.50, 2160.15, and 1636.33 cm−1 corresponding to the binding vibrations of amine, alkyne nitrile, and primary amine bands, respectively. The biosynthesized AgNPs showed antimicrobial activity against a variety of microbial pathogens of medical importance. Using resazurin-based microtiter dilution, the minimum inhibitory concentration (MIC) values for AgNPs were 500 µg/mL for all microbial pathogens except for Klebsiella pneumoniae ATCC13883, which has a higher MIC value of 1000 µg/mL. Conclusions The obtained data revealed the successful green production of AgNPs using the supernatant of Leclercia adecarboxylata THHM that can be effectively used as an antimicrobial agent against most human pathogenic microbes

Diagnostic accuracy of computed tomography angiography in detection of post traumatic renal vascular injury

Objectives: To evaluate accuracy of computed tomography angiography (CTA) in evaluation of post traumatic renal vascular injury. Patients and methods: 38 patients were presented with post traumatic intermittent or persistent hematuria. Renal CTA and digital subtraction angiography (DSA) were done for all patients. Results: CTA demonstrated pseudoaneurysm (PA) in 30 patients (78.9%) and no vascular lesions in 8 patient (21.1%). CTA had 86.11% sensitivity and 50% specificity in detection of post traumatic renal pseudoaneurysms, CTA missed diagnosis of renal arteriovenous fistula (RAVF) in 10 patients which discovered later by DSA. Conclusion: CTA with MIP as non invasive technique widely replaced renal DSA in detection of posttraumatic renal pseudoaneurysm. Renal DSA is still best modality in detection of RAVF and also has the upper hand in planning of selective renal artery embolization for the management of persistent or delayed hemorrhage from renal vessels. Keywords: Renal CTA, Renal vascular injur

Evaluation of CT perfusion parameters for assessment of split renal function in healthy donors

Objectives: To assess feasibility of automatically calculated CT perfusion parameters using two different methods of drawing regions of interest (ROIs) to reflect split renal function in comparison with MAG3 renography. Methods and materials: 51 potential kidney donors (24 males, 27 females) were prospectively evaluated by preoperative CT perfusion. Post processing was done twice; one with ROI around renal cortex only and the other around cortex and medulla. Perfusion parameters (perfusion, peak enhancement intensity PEI and blood volume BV) were compared between the two methods. Split values for each of these parameters were calculated and compared to split renal function measured by MAG3 renography using paired samples t test. Results: Perfusion was significantly lower in method 2 than in method 1 while PEI and BV showed no significant difference between the two methods. Split values of CT parameters showed no significant difference from corresponding renography split function (p value > 0.1) except BV by method 1 and perfusion by method 2 which showed significant difference (p value < 0.05). Conclusion: Certain CT perfusion parameters can reflect split renal function. Perfusion was more accurate in reflecting split renal function with ROI around the cortex while BV was more accurate with ROI around the whole parenchyma

Long-term follow-up of CT-guided percutaneous radiofrequency ablation of T1 renal cell carcinoma

Abstract Background Radiofrequency ablation (RFA) has an established role in effective treatment of renal cell carcinomas (RCCs), as most of RCCs are diagnosed incidentally in early stages. Long-term follow-up is however important to consolidate the technique. Most of the literature contains series of short-term follow-ups of periods shorter than 2 years. This study in hand demonstrates the results of longer-term follow-up than the previously published series. Results Data analysis of 31 patient records involved in this study demonstrated the high clinical efficacy of RFA for long term, 12-year follow-up, by following the absence of tumor recurrences, as shown on regular interval contrast enhanced computed tomography (CT) and or magnetic resonance imaging (MRI). Conclusions RFA continues to prove its competent role in treating RCCs on longer-term follow-ups; the smaller the size of a tumor and the more peripheral the tumor is, the more effective the therapy. Even in larger early stages tumors, repeating the ablative sessions results in complete ablation without the need for more invasive surgical interventions