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To establish a breast lesion risk stratification system using ultrasound images to predict breast malignancy and assess Breast Imaging Reporting and Data System (BI-RADS) categories simultaneously.This multicenter study prospectively collected a dataset of ultrasound images for 5012 patients at thirty-two hospitals from December 2018 to December 2020. A deep learning (DL) model was developed to conduct binary categorization (benign and malignant) and BI-RADS categories (2, 3, 4a, 4b, 4c, and 5) simultaneously. The training set of 4212 patients and the internal test set of 416 patients were from thirty hospitals. The remaining two hospitals with 384 patients were used as an external test set. Three experienced radiologists performed a reader study on 324 patients randomly selected from the test sets. We compared the performance of the DL model with that of three radiologists and the consensus of the three radiologists.In the external test set, the DL model achieved areas under the receiver operating characteristic curve (AUCs) of 0.980 and 0.945 for the binary categorization and six-way categorizations, respectively. In the reader study set, the DL BI-RADS categories achieved a similar AUC (0.901 vs. 0.933, p = 0.0632), sensitivity (90.98% vs. 95.90%, p = 0.1094), and accuracy (83.33% vs. 79.01%, p = 0.0541), but higher specificity (78.71% vs. 68.81%, p = 0.0012) than those of the consensus of the three radiologists.The DL model performed well in distinguishing benign from malignant breast lesions and yielded outcomes similar to experienced radiologists. This indicates the potential applicability of the DL model in clinical diagnosis.• The DL model can achieve binary categorization for benign and malignant breast lesions and six-way BI-RADS categorizations for categories 2, 3, 4a, 4b, 4c, and 5, simultaneously. • The DL model showed acceptable agreement with radiologists for the classification of breast lesions. • The DL model performed well in distinguishing benign from malignant breast lesions and had promise in helping reduce unnecessary biopsies of BI-RADS 4a lesions.

The Kähler potentials of modular symmetry models receive unsuppressed contributions which may be controlled by a flavor symmetry, where the combination of the two symmetry types is referred to as eclectic flavor symmetry. After briefly reviewing the consistency conditions of eclectic flavor symmetry models, including those with generalised (g)CP, we perform a comprehensive bottom-up study of eclectic flavor symmetry models based on Ω(1) ≅ ∆(27) ⋊ T′, consisting of the flavor symmetry ∆(27) in a semi-direct product with the modular symmetry T′. The modular transformations of different ∆(27) multiplets are given by solving the consistency condition. The eight nontrivial singlets of ∆(27) are related by T′ modular symmetry, and they have to be present or absent simultaneously in any Ω(1) model. The most general forms of the superpotential and Kähler potential invariant under Ω(1) are discussed, and the corresponding fermion mass matrices are presented. Based on the eclectic flavor group Ω(1), two concrete lepton models which can successfully describe the experimental data of lepton masses and mixing parameters are constructed. For the two models without gCP, all six mixing parameters vary in small regions. A nearly maximal atmospheric mixing angle θ23 and Dirac CP phase δCP are obtained in the first model. After considering the compatible gCP symmetry and the assumption of $$ \mathfrak{R}\tau $$ R τ = 0 in the first model, the μ − τ reflection symmetry is preserved in the charged lepton diagonal basis. As a consequence, the atmospheric mixing angle and Dirac CP phase are predicted to be maximal, and two Majorana CP phases are predicted to be π.

Objective This study aimed to incorporate clinicopathological, sonographic, and mammographic characteristics to construct and validate a nomogram model for predicting disease-free survival (DFS) in patients with triple-negative breast cancer (TNBC). Methods Patients diagnosed with TNBC at our institution between 2011 and 2015 were retrospectively evaluated. A nomogram model was generated based on clinicopathological, sonographic, and mammographic variables that were associated with 1-, 3-, and 5-year DFS determined by multivariate logistic regression analysis in the training set. The nomogram model was validated according to the concordance index (C-index) and calibration curves in the validation set. Results A total of 636 TNBC patients were enrolled and divided into training cohort (n = 446) and validation cohort (n = 190). Clinical factors including tumor size > 2 cm, axillary dissection, presence of LVI, and sonographic features such as angular/spiculated margins, posterior acoustic shadows, and presence of suspicious lymph nodes on preoperative US showed a tendency towards worse DFS. The multivariate analysis showed that no adjuvant chemotherapy (HR = 6.7, 95% CI: 2.6, 17.5, p < 0.0005), higher axillary tumor burden (HR = 2.7, 95% CI: 1.0, 7.1, p = 0.045), and ≥ 3 malignant features on ultrasound (HR = 2.4, CI: 1.1, 5.0, p = 0.021) were identified as independent prognostic factors associated with poorer DFS outcomes. In the nomogram, the C-index was 0.693 for the training cohort and 0.694 for the validation cohort. The calibration plots also exhibited excellent consistency between the nomogram-predicted and actual survival probabilities in both the training and validation cohorts. Conclusions Clinical variables and sonographic features were correlated with the prognosis of TNBCs. The nomogram model based on three variables including no adjuvant chemotherapy, higher axillary tumor load, and more malignant sonographic features showed good predictive performance for poor survival outcomes of TNBC. Key Points • The absence of adjuvant chemotherapy, heavy axillary tumor load, and malignant-like sonographic features can predict DFS in patients with TNBC. • Mammographic features of TNBC could not predict the survival outcomes of patients with TNBC. • The nomogram integrating clinicopathological and sonographic characteristics is a reliable predictive model for the prognostic outcome of TNBC.

Elastography ultrasound (EUS) imaging is a vital ultrasound imaging modality. The current use of EUS faces many challenges, such as vulnerability to subjective manipulation, echo signal attenuation, and unknown risks of elastic pressure in certain delicate tissues. The hardware requirement of EUS also hinders the trend of miniaturization of ultrasound equipment. Here we show a cost-efficient solution by designing a deep neural network to synthesize virtual EUS (V-EUS) from conventional B-mode images. A total of 4580 breast tumor cases were collected from 15 medical centers, including a main cohort with 2501 cases for model establishment, an external dataset with 1730 cases and a portable dataset with 349 cases for testing. In the task of differentiating benign and malignant breast tumors, there is no significant difference between V-EUS and real EUS on high-end ultrasound, while the diagnostic performance of pocket-sized ultrasound can be improved by about 5% after V-EUS is equipped.

Sonographic features are associated with pathological and immunohistochemical characteristics of triple-negative breast cancer (TNBC). To predict the biological property of TNBC, the performance using quantitative high-throughput sonographic feature analysis was compared with that using qualitative feature assessment. We retrospectively reviewed ultrasound images, clinical, pathological, and immunohistochemical (IHC) data of 252 female TNBC patients. All patients were subgrouped according to the histological grade, Ki67 expression level, and human epidermal growth factor receptor 2 (HER2) score. Qualitative sonographic feature assessment included shape, margin, posterior acoustic pattern, and calcification referring to the Breast Imaging Reporting and Data System (BI-RADS). Quantitative sonographic features were acquired based on the computer-aided radiomics analysis. Breast cancer masses were manually segmented from the surrounding breast tissues. For each ultrasound image, 1688 radiomics features of 7 feature classes were extracted. The principal component analysis (PCA), least absolute shrinkage and selection operator (LASSO), and support vector machine (SVM) were used to determine the high-throughput radiomics features that were highly correlated to biological properties. The performance using both quantitative and qualitative sonographic features to predict biological properties of TNBC was represented by the area under the receiver operating characteristic curve (AUC). In the qualitative assessment, regular tumor shape, no angular or spiculated margin, posterior acoustic enhancement, and no calcification were used as the independent sonographic features for TNBC. Using the combination of these four features to predict the histological grade, Ki67, HER2, axillary lymph node metastasis (ALNM), and lymphovascular invasion (LVI), the AUC was 0.673, 0.680, 0.651, 0.587, and 0.566, respectively. The number of high-throughput features that closely correlated with biological properties was 34 for histological grade (AUC 0.942), 27 for Ki67 (AUC 0.732), 25 for HER2 (AUC 0.730), 34 for ALNM (AUC 0.804), and 34 for LVI (AUC 0.795). High-throughput quantitative sonographic features are superior to traditional qualitative ultrasound features in predicting the biological behavior of TNBC. • Sonographic appearances of TNBCs showed a great variety in accordance with its biological and clinical characteristics. • Both qualitative and quantitative sonographic features of TNBCs are associated with tumor biological characteristics. • The quantitative high-throughput feature analysis is superior to two-dimensional sonographic feature assessment in predicting tumor biological property.

Precise nodule segmentation in thyroid ultrasound images is important for clinical quantitative analysis and diagnosis. Fully supervised deep learning method can effectively extract representative features from nodules and background. Despite the great success, deep learning–based segmentation methods still face a critical hindrance: the difficulty in acquiring sufficient training data due to high annotation costs. To this end, we propose a weakly supervised framework called uncertainty to fine generative adversarial network (U2F-GAN) for nodule segmentation in thyroid ultrasound images that exploits only a handful of rough bounding box annotations to successfully generate reliable labels from these weak supervisions. Based on feature-matching GAN, the proposed method alternates between generating masks and learning a segmentation network in an adversarial manner. Super-pixel processing mechanism is adopted to reflect low-level image structure features for learning and inferring semantic segmentation, which largely improve the efficiency of training process. In addition, we introduce a similarity comparison module and a distributed loss function with constraints to effectively remove noise in localization annotations and enhance the generalization capability of the network, thus strengthen the overall segmentation performance. Compared to existing weakly supervised approaches, our proposed U2F-GAN yields a significant performance boost. The segmentation results are also comparable to fully supervised methods, but the annotation burden is much lower. Also, the training speed of the network model is much faster than other methods with weak supervisions, which enables the network to be updated in time, thus is beneficial to high-throughput medical image setting.

Background An accurate preoperative assessment of cervical lymph node metastasis (LNM) is important for choosing an optimal therapeutic strategy for papillary thyroid carcinoma (PTC) patients. This study aimed to develop and validate two ultrasound (US) nomograms for the individual prediction of central and lateral compartment LNM in patients with PTC. Methods A total of 720 PTC patients from 3 institutions were enrolled in this study. They were categorized into a primary cohort, an internal validation, and two external validation cohorts. Radiomics features were extracted from conventional US images. LASSO regression was used to select optimized features to construct the radiomics signature. Two nomograms integrating independent clinical variables and radiomics signature were established with multivariate logistic regression. The performance of the nomograms was assessed with regard to discrimination, calibration, and clinical usefulness. Results The radiomics scores were significantly higher in patients with central/lateral LNM. A radiomics nomogram indicated good discrimination for central compartment LNM, with an area under the curve (AUC) of 0.875 in the training set, the corresponding value in the validation sets were 0.856, 0.870 and 0.870, respectively. Another nomogram for predicting lateral LNM also demonstrated good performance with an AUC of 0.938 and 0.905 in the training and internal validation cohorts, respectively. The AUC for the two external validation cohorts were 0.881 and 0.903, respectively. The clinical utility of the nomograms was confirmed by the decision curve analysis. Conclusion The nomograms proposed here have favorable performance for preoperatively predicting cervical LNM, hold promise for optimizing the personalized treatment, and might greatly facilitate the decision-making in clinical practice.

We consider for the first time level 7 modular invariant flavour models where the lepton mixing originates from the breaking of modular symmetry and couplings responsible for lepton masses are modular forms. The latter are decomposed into irreducible multiplets of the finite modular group $\Gamma_7$, which is isomorphic to $PSL(2,Z_{7})$, the projective special linear group of two dimensional matrices over the finite Galois field of seven elements, containing 168 elements, sometimes written as $PSL_2(7)$ or $\Sigma(168)$. At weight 2, there are 26 linearly independent modular forms, organised into a triplet, a septet and two octets of $\Gamma_7$. A full list of modular forms up to weight 8 are provided. Assuming the absence of flavons, the simplest modular-invariant models based on $\Gamma_7$ are constructed, in which neutrinos gain masses via either the Weinberg operator or the type-I seesaw mechanism, and their predictions compared to experiment., Comment: 45 pages, 3 figures

The aim of this study was to investigate the effects of Astragaloside IV (AS) on cigarette smoke (CS)-induced chronic obstructive pulmonary disease (COPD). Our results showed that AS alleviated CS-induced pathological injury in lung tissue. AS also increased superoxide dismutase (SOD) and reduced the level of malondialdehyde (MDA) in serum and lung. AS also reduced cytokines including tumor necrosis factor-α (TNF-α), interleukin-6 (IL-6), and interleukin-1β (IL-1β) in serum and lung. More, AS significantly reduced the protein expression of JAK3/STAT3/NF-κB pathway in CS-induced mice. In vitro, cigarette smoke extract (CSE) stimulation exposed to normal human bronchial epithelial (HBE) cells. Results further confirmed that AS significantly inhibited the protein levels of JAK3/STAT3/NF-κB pathway in CSE-induced HBE. Our result showed that AS might effectively ameliorate COPD via JAK3/STAT3/NF-κB pathway.

This study described a template-free method for the synthesis of hierarchically macro-mesoporous Mn-TiO2 catalysts. The promoting effect of Mn doping and the hierarchically macro-mesoporous architecture on TiO2 based catalysts was also investigated for the selective reduction of NO with NH3. The results show that the catalytic performance of TiO2 based catalysts was improved greatly after Mn doping. Meanwhile, the Mn-TiO2 catalyst with the hierarchically macro-mesoporous architecture has a better catalytic activity than that without such an architecture.

Pursuing better imaging quality and miniaturizing imaging devices are two trends in the current development of ultrasound imaging. While the first one leads to more complex and expensive imaging equipment, poor image quality is a common problem of portable ultrasound imaging systems. In this paper, an image reconstruction method was proposed to break through the imaging quality limitation of portable devices by introducing generative adversarial network (GAN) model into the field of ultrasound image reconstruction. We combined two GAN generator models, the encoder-decoder model and the U-Net model to build a sparse skip connection U-Net (SSC U-Net) to tackle this problem. To produce more realistic output, stabilize the training procedure, and improve spatial resolution in the reconstructed ultrasound images, a new loss function which combines adversarial loss, L1 loss, and differential loss was proposed. Three datasets including 50 pairs of simulation, 40 pairs of phantom, and 72 pairs of in vivo images were used to evaluate the reconstruction performance. Experimental results show that our SSC U-Net is able to reconstruct ultrasound images with improved quality. Compared with U-Net, our SSC U-Net is able to preserve more details in the reconstructed images and improve full width at half maximum (FWHM) of point targets by 3.23%.

In this study, we aimed to evaluate the clinical and pathological factors that associated with sonographic appearances of triple-negative (TN) invasive breast carcinoma. With the ethical approval, 560 patients who were pathologically confirmed as invasive breast carcinoma were reviewed for ultrasound, clinical, and pathological data. Logistic regression analysis was used to identify the typical sonographic features for TN invasive breast carcinomas. The effect of clinical and pathological factors on the sonographic features of TN invasive breast carcinoma was studied. There were 104 cases of TN invasive breast carcinoma. The independent sonographic features for the TN subgroup included regular shape (odds ratio, OR = 1.73, p = 0.033), no spiculated/angular margin (OR = 2.09, p = 0.01), posterior acoustic enhancement (OR = 2.09, p = 0.004), and no calcifications (OR = 2.11, p = 0.005). Higher pathological grade was significantly associated with regular tumor shape of TN breast cancer (p = 0.012). Higher Ki67 level was significantly associated with regular tumor shape (p = 0.023) and absence of angular/spiculated margin (p = 0.005). Higher human epidermal growth factor receptor 2 (HER2) score was significantly associated with the presence of calcifications (p = 0.033). We conclude that four sonographic features are associated with TN invasive breast carcinoma. Heterogeneity of sonographic features was associated with the pathological grade, Ki67 proliferation level and HER2 score of TN breast cancers.