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To systematically quantify the diagnostic accuracy and identify potential covariates affecting the performance of artificial intelligence (AI) in diagnosing orthopedic fractures.PubMed, Embase, Web of Science, and Cochrane Library were systematically searched for studies on AI applications in diagnosing orthopedic fractures from inception to September 29, 2021. Pooled sensitivity and specificity and the area under the receiver operating characteristic curves (AUC) were obtained. This study was registered in the PROSPERO database prior to initiation (CRD 42021254618).Thirty-nine were eligible for quantitative analysis. The overall pooled AUC, sensitivity, and specificity were 0.96 (95% CI 0.94-0.98), 90% (95% CI 87-92%), and 92% (95% CI 90-94%), respectively. In subgroup analyses, multicenter designed studies yielded higher sensitivity (92% vs. 88%) and specificity (94% vs. 91%) than single-center studies. AI demonstrated higher sensitivity with transfer learning (with vs. without: 92% vs. 87%) or data augmentation (with vs. without: 92% vs. 87%), compared to those without. Utilizing plain X-rays as input images for AI achieved results comparable to CT (AUC 0.96 vs. 0.96). Moreover, AI achieved comparable results to humans (AUC 0.97 vs. 0.97) and better results than non-expert human readers (AUC 0.98 vs. 0.96; sensitivity 95% vs. 88%).AI demonstrated high accuracy in diagnosing orthopedic fractures from medical images. Larger-scale studies with higher design quality are needed to validate our findings.• Multicenter study design, application of transfer learning, and data augmentation are closely related to improving the performance of artificial intelligence models in diagnosing orthopedic fractures. • Utilizing plain X-rays as input images for AI to diagnose fractures achieved results comparable to CT (AUC 0.96 vs. 0.96). • AI achieved comparable results to humans (AUC 0.97 vs. 0.97) but was superior to non-expert human readers (AUC 0.98 vs. 0.96, sensitivity 95% vs. 88%) in diagnosing fractures.

Low health literacy (HL) adversely affects medical adherence and health outcomes in patients with chronic diseases. However, the association between HL and enhanced recovery after surgery (ERAS) adherence and postoperative outcomes has not been investigated in patients undergoing colorectal surgery.The data of all patients from a single academic institution who underwent colorectal surgery on an ERAS pathway from January 2019 to July 2020 were prospectively collected. HL levels were assessed using the Brief Health Literacy Screen (BHLS), a proven tool that was used by surgeons after recruitment. According to the HL score, the participants were categorized into low HL (≤9 points) and high HL (10-15 points) groups. The primary outcome was ERAS adherence. Adherence was measured in 22 perioperative elements, and high adherence was defined as adherence to 17 to 22 elements. Secondary outcomes included postoperative complications, hospital length of stay (LOS), hospital charges, mortality, and readmissions.Of the 865 eligible patients, the high HL group consisted of 329 patients (38.0%), and the low HL group contained 536 patients (62.0%). After propensity score matching (1:1), 240 unique pairs of patients with similar characteristics were selected. Patients with high HL levels had a significantly higher rate of high adherence to ERAS standards than those with low HL levels (55% vs 25.8%; adjusted P.001). In terms of adherence to each item, high HL levels were significantly associated with higher adherence to preoperative optimization (90.8% vs 71.7%; adjusted P.001), postoperative gum chewing (59.2% vs 44.6%; adjusted P = .01), early feeding (59.2% vs 31.3%; adjusted P.001), and early mobilization (56.7% vs 30.4%; adjusted P.001). In the overall study population, adjusted logistic regression analyses also showed that high HL levels were associated with a significantly increased rate of high adherence when compared with low HL levels (adjusted odds ratio [OR], 3.57; 95% confidence interval (CI), 2.50-5.09; P.001). In addition, low HL levels were associated with a significantly higher incidence of postoperative complications (32.1% vs 20.8%; P.01), longer hospital LOS (9 [interquartile range {IQR}, 7-11] vs 7 [IQR, 6-9] d; P.001), and higher hospital charges (10,489 [IQR, 8995-11942] vs 8466 [IQR, 7733-9384] dollar; P.001) among propensity-matched patients. However, there were no differences in the mortality and readmission rates between the HL groups.Low HL levels were associated with lower adherence to ERAS elements among propensity-matched patients undergoing colorectal surgery.

Background: Therapeutics of urticaria in Chinese outpatients remain to be illustrated.Objectives: To investigate clinical treatment of outpatients with urticaria, and provide theoretical evidence for selection of medication regimens.Methods: In this hospital-based multicenter study, urticaria outpatients filled in a questionnaire at initial visit and were followed-up (once per week, for 4 weeks).Results: 1715 urticaria outpatients were recruited and 647 completed 4- week’s follow-up. Their total UAS7 was reduced (27.44 at baseline, 16.87 in 1 week, 12.39 in 2 weeks, 7.21 in 3 weeks, 4.2 in 4 weeks). 71.8% patients recovered from urticaria (therapy was highly effective in 11%, whereas effective in 14.2%). The second-generation H1 antihistamines (sgAHs) (at conventional dose) were the most commonly prescribed drugs, with ebastine, levocetirizine and olopatadine being the leading ones (41.1%, 36.2%, and 16%, respectively). Combinations of several antihistamines (649 cases, 37.8%) at conventional dose were far more common than a single drug at escalated dose (59 cases, 3.4%). The combination of ebastine with levocetirizine was the most frequent options (18.25%, 313 cases), followed by combination of ebastine with compound glycyrrhizin (18.2%, 312 cases). The usage rates of tripterygium glycoside (19.6%), hydroxychloroquine (17.2%) and system application glucocorticoids (5.5%) in angioneurotic edema were much higher than in dermographic urticaria and chronic spontaneous urticaria. Conclusions: This study identifies curative therapy for Chinese outpatients with urticaria. The sgAHs, especially ebastine, are the most commonly prescribed drugs. Olopatadine has fast-acting and curative effects. Compound glycyrrhizin holds potential as a versatile collaborator.Combinations of several antihistamines at conventional dose is common.

BACKGROUND The increasing prevalence of neck pain poses a huge socioeconomic burden. Physiotherapy exercise plays a vital role in the management of neck pain; consequently, the current COVID-19 pandemic accompanying the lockdown has resulted in a shortage of physiotherapy care. YouTube, in particular, is a leading source due to its easy access to information and visual advantages for internet users. However, the nature of these videos is often unscientific, misleading, and even harmful. OBJECTIVE The study aimed to investigate the quality and reliability of neck pain physiotherapy exercise videos shared on YouTube and identified factors associated with the overall video quality and reliability. METHODS On 15 April 2022, a YouTube search was performed using the keywords “neck pain relief exercises”, “neck pain physiotherapy” and “neck pain rehabilitation”. Videos were categorized by 3 doctors based on whether the video content provided useful or misleading information. Furthermore, the reliability and quality of the videos were assessed using the Journal of the American Medical Association (JAMA) benchmark criteria, the 5-point DISCERN tool, and the 5-point global quality score criteria (GQS). Spearman correlation analysis was applied to assess the correlation between JAMA, GQS, DISCERN, and video power index (VPI). A multiple linear regression analysis was performed to identify video characteristics affecting the JAMA, GQS, DISCERN, and VPI. RESULTS Out of the 89 videos selected for the study, 38 (42.7%) were classified as useful, whereas 51 (57.3%) provided misleading information. A total of 36.0% of videos (32/89) were generated by nonphysicians compared to 12.4% of videos (11/89) contributed by academic sources. In the useful information group, the videos had a higher JAMA (P.05). Even though the academic and physician group provide the highest percentage of useful information (7/11), a statistical difference was not noted between the useful and misleading video groups regarding the uploading sources (P=.144). CONCLUSIONS YouTube videos on neck pain physiotherapy exercises have low quality and reliability. Our findings suggest that academic and physician groups should provide and promote high-quality video content to YouTube users and patients. CLINICALTRIAL This study did not require a trial registration since it is not a clinical trial and only publicly available data were used.

Study Design Retrospective cohort study. Objectives This study aimed to explore the effect of preoperative cervical spondylosis on the heterotopic ossification (HO) formation in different locations after cervical disc replacement (CDR). Methods The degree of preoperative cervical spondylosis was evaluated radiologically, including the intervertebral disc, uncovertebral joints, facet joints and ligaments. The effects of cervical spondylosis on the HO formation after CDR were analyzed according to the location of HO. Multivariate logistic regression was performed to identify the independent factors. Results 149 patients with a total of 196 arthroplasty segments were involved in this study. HO, anterior HO (AHO), and posterior HO (PHO) developed in 59.69%, 22.96%, and 41.84% levels, respectively. The significant factors in univariate analysis for PHO after CDR included the disc height loss, anterior osteophytes, preoperative uncovertebral joint osteophytes and facet joint degeneration. The incidence of adjacent segment degeneration (ASD) was significantly higher in the PHO group compared to that without PHO at the last follow-up ( P = .003). The disc height loss in high-grade HO was significantly more than that in low-grade group ( P = .039). Multivariate analysis identified disc height loss was the only independent factor for PHO ( P = .009). No significant degenerative factors related to the formation of AHO were found. Conclusions Preoperative cervical spondylosis predominantly affected the HO formation in the posterior disc space after CDR. The disc height loss was an independent risk factor for PHO formation. Rigorous criteria for the extent of preoperative disc height loss should be used when selecting appropriate candidates for CDR.

Time-delay reservoir computing uses a nonlinear node associated with a feedback loop to construct a large number of virtual neurons in the neural network. The clock cycle of the computing network is usually synchronous with the delay time of the feedback loop, which substantially constrains the flexibility of hardware implementations. This work shows an asynchronous reservoir computing network based on a semiconductor laser with an optical feedback loop, where the clock cycle (20 ns) is considerably different to the delay time (77 ns). The performance of this asynchronous network is experimentally investigated under various operation conditions. It is proved that the asynchronous reservoir computing shows highly competitive performance on the prediction task of Santa Fe chaotic time series, in comparison with the synchronous counterparts.

Background Heterotopic ossification (HO) is a common complication after cervical disc replacement (CDR). Biomechanical factors including endplate coverage and intervertebral disc height change may be related to HO formation. However, there is a dearth of quantitative analysis for endplate coverage, intervertebral height change and their combined effects on HO. Methods Patients who underwent single-level or two-level CDR with Prestige-LP were retrospectively reviewed. Clinical outcomes were evaluated through Japanese Orthopaedic Association (JOA) score, Neck Disability Index (NDI) score, and visual analogue scale (VAS) score. Radiological data, including the prosthesis-endplate depth ratio, intervertebral height change, posterior heterotopic ossification (PHO) and angular parameters, were collected. Logistic regression analysis was used to identify the potential risk factors. Receiver operating characteristic curves were plotted and the cut-off values of each potential factors were calculated. Results A total of 138 patients with 174 surgical segments were evaluated. Both the prosthesis-endplate depth ratio (P P P P P Conclusions Inadequate endplate coverage and excessive change of intervertebral height are both potential risk factors for the PHO after CDR. Endplate coverage less than 93.8% or intervertebral height change more than 1.8 mm would increase the risk of PHO. The combination of these two factors may exacerbate the non-uniform distribution of stress in the bone-implant interface and promote HO development.

Sambucus williamsii Hance (SWH) has effectively been adopted to treat joint and bone disorders. Diabetes-induced osteopenia (DOP) is caused primarily by impaired bone formation as a result of hyperglycemia. We had previously demonstrated that SWH extract accelerated fracture healing and promoted osteoblastic MC3T3-E1 cell proliferation and osteogenic differentiation. This study assessed the impacts of SWH extract on diabetes-induced bone loss and explored the mechanisms underlying its osteoprotective effects.This work employed MC3T3-E1 cell line for evaluating how SWH extract affected osteogenesis, oxidative stress (OS), and the underlying mechanism in vitro. Streptozotocin-induced osteopenia mouse model was applied with the purpose of assessing SWH extract's osteoprotection on bone homeostasis in vivo.The increased OS of MC3T3-E1 cells exposed to high glucose (HG) was largely because of the upregulation of pro-oxidant genes and the downregulation of antioxidant genes, whereas SWH extract reduced the OS by modulating NADPH oxidase-4 and thioredoxin-related genes by activating cyclic guanosine monophosphate (cGMP) production and increasing the level of cGMP-mediated protein kinase G type-2 (PKG2). The oral administration of SWH extract maintained bone homeostasis in type 1 diabetes mellitus (T1DM) mice by enhancing osteogenesis while decreasing OS. In bones from hyperglycemia-induced osteopenia mice and HG-treated MC3T3-E1 cells, the SWH extract achieved the osteoprotective effects through activating the cGMP/PKG2 signaling pathway, upregulating the level of antioxidant genes, as well as downregulating the level of pro-oxidant genes.SWH extract exerts osteoprotective effects on hyperglycemia-induced osteopenia by reversing OS via cGMP/PKG signal transduction and is a potential therapy for DOP.

Objective To preliminarily evaluate the safety and efficacy of the uncovertebral joint fusion cage in a goat model of cervical spine interbody fusion. Methods Twenty-four healthy adult goats were randomly assigned to one of the two following groups: Group A, goats were implanted with an uncovertebral joint fusion cage combined with a local autograft and Group B, goats were implanted with a non-profile cage filled with a local autograft. The goats were prospectively evaluated for 24 weeks and then were sacrificed for evaluation. X-rays, CT and micro-CT scanning, and undecalcified bone histological analysis were used for the evaluation of fusion. Results 75.0% (9/12) of the goats in Group A were evaluated as having fusion at 12 weeks, compared to 41.7% (5/12) in Group B. 83.3% (10/12) of the goats in Group A were evaluated as having fusion at 24 weeks compared to 58.3% (7/12) in Group B. The fusion grading scores in Group A were significantly higher than that in Group B both at 12 weeks and 24 weeks (P P Conclusions Preliminary results of this study demonstrated that uncovertebral joint fusion cage is effective for achieving early bone formation and fusion without increase of serious complications.

Sleep deprivation adversely affects the digestive system. Multiple studies have suggested sleep deprivation and oxidative stress are closely related. Autophagy can be triggered by oxidative stress as a self-defense strategy to promote survival. In this study, we investigated the effects of sleep deprivation on liver functions, oxidative stress, and concomitant hepatocyte autophagy, as well as the associated pathways. Enzymatic and nonenzymatic biochemical markers in the serum were used to assess hepatic function and damage. To evaluate the occurrence of autophagy, expression of autophagy-related proteins was tested and autophagosomes were labeled. Additionally, methane dicarboxylic aldehyde (MDA), antioxidant enzymes, and the protein kinase B (AKT)/mammalian target of rapamycin (mTOR) signaling pathway were analyzed using chemical methods and a Western blot. Serum alanine transaminase, aspartate aminotransferase, and alkaline phosphatase increased in sleep-deprived rats. Total protein and albumin abundance was also abnormal. Sleep deprivation induced histopathological changes in the liver. The superoxide dismutase level decreased significantly in the liver of sleep-deprived rats. In contrast, the MDA content increased in the sleep deprivation group. Moreover, the microtubule-associated protein 1 light chain 3 beta (LC3B) II/I ratio and Beclin I content increased considerably in the sleep-deprived rats, while p62 levels decreased. Sleep deprivation apparently inhibited the AKT/mTOR signaling pathway. We conclude that sleep deprivation can induce oxidative stress and ultimately cause liver injury. Autophagy triggered by oxidative stress appears to be mediated by the AKT/mTOR pathway and plays a role in relieving oxidative stress caused by sleep deprivation.

Itching is a leading symptom of eczema or dermatitis and has a great impact on patients’ lives. Previous studies on itching have focused mostly on atopic dermatitis (AD). A cross-sectional multicenter study was conducted among outpatients with eczema from 39 tertiary hospitals in mainland China from July 1 to September 30, 2014. This work elaborates on itching in different types of eczema. Itching was very common (97%, 8499/8758) in outpatients with eczema. The severity of the itch increased with age and disease duration (P P P P P

To investigate the influence of deep slow-wave sleep deprivation on the oxidative stress of testicular tissue in rats.Thirty-six 5-week-old male Wistar rats were equally randomized into deep slow-wave sleep deprivation group (SD1), deep slow-wave sleep and duration sleep deprivation group ( SD2), and a cage control group (CC). The rat model of deep slow-wave sleep deprivation was established using the flowerpot technique. The rats in the SD1 group were interfered every 24 minutes and deprived of 12 hours of sleep at night, those in the SD2 group deprived of 8 minutes of sleep at an interval of 24 minutes and 12 hours of sleep at night, and those in the CC group exposed to 12 hours of daylight and 12 hours of darkness. After 28 days, all the rats were executed for measurement of the testis volume and protein content, determination of the methane dicarboxylic aldehyde (MDA) level and activities of superoxide dismutase (SOD) and glutathione peroxidase (GSH-Px), and observation of the pathological changes in the testicular tissue under the microscope.Compared with the CC group, the rats in the SD1 and SD2 groups showed significantly reduced body weight (［268.5 ± 1.6］ vs ［248.1 ± 25.1］and［232.9 ± 10.1］g, P0.05) and increased relative testis mass (［50.0 ± 1.3］ vs ［57.9 ± 6.1］ and ［54.9 ± 3.5］ ×10⁻², P0.05). Statistically significant differences were found between the CC and SD2 groups in the contents of protein (［6.3 ± 1.4］ vs ［4.5 ± 0.9］ gpro/L, P0.05) and MDA (［1.1 ± 0.1］ vs ［1.3 ± 0.3］ nmol/mgpro, P0.05) and the activities of SOD (［104.3 ± 33.1］ vs ［135.2 ± 26.9］ U/mgpro, P0.05) and GSH-Px (［15.6 ± 4.0］ vs ［21.7 ± 4.3］ U/mgpro, P0.05), but not between the CC and SD1 groups (P0.05). The lumens in the testis were narrowed, with obvious hyperplasia, hyperemia and edema in the peripheral interstitial tissue, but no significant pathologic changes were observed in the testis tissue of the SD1 group.Long-term deprivation of deep slow-wave sleep impairs the structure of the testis tissue and induces oxidative stress response in rats.目的：研究深慢波睡眠剥夺对大鼠睾丸组织氧化应激反应的影响。 方法：36只5周龄健康雄性Wistar大鼠，随机分为深慢波睡眠时相剥夺组（SD1组）、深慢波睡眠时相及时长剥夺组（SD2组）组和空白对照组（CC组），每组12只，利用小平台水环境建立深慢波睡眠剥夺模型。SD1组每间隔24 min干扰1次，SD2组每间隔24 min剥夺睡眠8 min；夜间都进行12 h的完全睡眠剥夺。CC组模拟正常的12 h光照、12 h黑暗时间。28 d后，大鼠股动脉放血，留取睾丸组织进行称重，测定睾丸组织中蛋白含量、丙二醛（MDA）、谷胱甘肽过氧化物酶(GSH-Px)、超氧化物岐化酶（SOD）水平，显微镜下观察睾丸病理结构的改变。结果：SD1、SD2组大鼠的终末体质量［（248.1±25.1） g、（232.9±10.1） g］均下降，与CC组［（268.5± 1.6）g］相比差异有统计学意义（P均0.05）；与CC组相比，SD2组睾丸相对质量明显升高［（54.9±3.5）×10⁻² vs （50.0±1.3）×10⁻²，P0.05］。与CC组相比，SD2组睾丸组织蛋白含量、MDA含量、SOD活性和GSH-Px均有显著差异［蛋白含量：（4.5±0.9）g pro/L vs 6.3±1.4）g pro/L； MDA含量: （1.3±0.3）nmol/mg pro vs （1.1±0.1）nmol/mg pro；SOD活性：（135.2±26.9）U/mg pro vs （104.3±33.1）U/mg pro； GSH-Px活性： （21.7±4.3）U/mg pro vs（15.6±4.0）U/mg pro，P均0.05］，而与SD1组比较差异无统计学意义。SD1组睾丸病理学改变不明显，但SD2组睾丸生精小管管腔变小，周围间质部分增加，间质充血水肿明显。结论：长期深慢波睡眠剥夺对大鼠睾丸组织结构产生损伤并引起氧化应激反应。.

Background. The epidemiology of atopic dermatitis (AD) in Chinese outpatients is yet to be clarified.Objectives. To investigate population-based prevalence and clinical features of AD in Chinese outpatients.Methods. A multicenter cross-sectional study was conducted in outpatients with eczema or dermatitis from 39 tertiary hospitals in 15 provinces.Results. This study included 682 patients diagnosed with AD, with the mean age of28.8±20.1years and the median course of5.3±6.9years. AD patients had more severe itching (30.4% versus 13.8%,p<0.001) and clinically suspected bacterial infection (21.7% versus 16.1%,p<0.001) than those of other types of dermatitis. Older patients were more susceptible to have a history of flexion dermatitis (p<0.001), bacterial infection (p=0.005), and severe itching (p<0.001). Outpatients with clinically suspected bacterial infection had 3.53-fold increased risk of AD than those without it (p<0.001). The morbidity rate of AD in the (20–25°N) region is 2.86 times higher than that in the (40–45°N) region [OR (95% CI): 0.352 (0.241–0.514),p<0.001].Conclusions. AD is characterized by unique clinical/demographic features. Bacterial infection and latitude region may have an impact on the incidence of AD in China.

Purpose: The purpose of this study is to compare the measurements of breast density using three-dimensional (3-D) automated whole breast ultrasound (ABUS) and magnetic resonance imaging (MRI). Methods: In this study, 3-D ABUS and MRI breast images were obtained from 40 patients—bilaterally in 27 patients and unilaterally (due to operation in the contralateral breast) in 13 patients. To differentiate the fibroglandular and fatty tissues in ABUS and MRI images, the fuzzy C-mean classifier was used. Calculated values for percent density and breast volume from the two modalities were compared to and correlated with linear regression analysis. Intraoperator and interoperator variations among eight cases were evaluated to verify the consistency of the density analysis. Results: Mean percent density and breast volume derived from ABUS (17.63±11.87% and 418.30±132.97 cm3, respectively) and MRI images (23.79±16.62% and 544.90±207.41 cm3) demonstrated good correlation (R=0.917 and R=0.884). Intraoperator and interoperator analyses yielded slightly larger coefficients of variation for percent density and breast volume in ABUS compared to MRI. However, the differences were not statistically significant. Conclusions: ABUS and MRI showed high correlation for breast density and breast volume quantification. Both modalities could provide useful breast density information to physicians.

Little is known about the classification and bacterial infection in outpatients with eczema and dermatitis in China.To investigate the prevalence of eczema and dermatitis in outpatients of dermatology clinics in China, examine classification and proportion of common types of dermatitis and the possible bacterial infection, and analyze the possible related factors.Outpatients with eczema or dermatitis from 39 tertiary hospitals of 15 provinces in mainland China from July 1 to September 30, 2014, were enrolled in this cross-sectional and multicenter study. Among 9393 enrolled outpatients, 636 patients (6.7%) were excluded because of incomplete information.The leading subtypes of dermatitis were unclassified eczema (35.5%), atopic dermatitis (13.4%), irritant dermatitis (9.2%), and widespread eczema (8.7%). Total bacterial infection rate was 52.3%, with widespread eczema, stasis dermatitis, and atopic dermatitis being the leading three (65.7%, 61.8%, and 61.4%, respectively). Clinically very likely bacterial infection has a significant positive correlation with disease duration, history of allergic disease, history of flexion dermatitis, and severe itching.Atopic dermatitis has become a common subtype of dermatitis in China. Secondary bacterial infection is common in all patients with dermatitis, and more attentions should be paid on this issue in other type of dermatitis apart from atopic dermatitis.

The prevalence of atopic dermatitis (AD) has increased substantially. Previous studies have focused mostly on pediatric patients, while epidemiological investigation on adult AD has been very limited. The aim of this study was to determine the prevalence and clinical features of adult AD in outpatients with dermatitis and eczema in China mainland. A multicenter cross-sectional study was conducted among outpatients with eczema or dermatitis from 39 tertiary hospitals of 15 provinces in China from July 1 to September 30, 2014. Of 8758 patients, 407 were adult AD. Compared with adults with other types of dermatitis, the mean age (41.8 ± 14.3 vs 42.04 ± 15.38 years, P 0.05). The highest (8.7%) and lowest prevalence (3.7%) of adult AD were in 25°N to 30°N and 35°N to 40°N latitude region. A substantial part of adult outpatients with eczema or dermatitis is adult AD. Middle age, more body location involvement, more suspected bacterial infection, and severe itching are the main clinical feathers of adult AD. Geographical environment and economic situation work in synergy to adult AD.

Automated whole breast ultrasound (ABUS) has become a popular screening tool in recent years. To reduce the review time and misdetection from ABUS images by physicians, a computer-aided detection (CADe) system for ABUS images based on a multiview method is proposed in this study. A total of 58 pathology-proven lesions from 41 patients were used to evaluate the performance of the system. In the proposed CADe system, the fuzzy c-mean clustering method was applied to detect tumor candidates from these ABUS images. Subsequently, the tumor likelihoods of these candidates could be estimated by a logistic linear regression model based on the intensity, morphology, location, and size features in the transverse, longitudinal, and coronal views. Finally, the multiview tumor likelihoods of the tumor candidates could be obtained from the estimated tumor likelihoods of the three views, and the tumor candidates with high multiview tumor likelihoods were regarded as the detected tumors in the proposed system. The sensitivities of the multiview tumor detection for selecting 5, 10, 20, and 30 tumor candidates with the largest multiview tumor likelihoods were 79.31%, 86.21%, 96.55%, and 98.28%, respectively.

Automated whole breast ultrasound (ABUS) is an emerging screening tool for detecting breast abnormalities. In this study, a computer-aided detection (CADe) system based on multi-scale blob detection was developed for analyzing ABUS images. The performance of the proposed CADe system was tested using a database composed of 136 breast lesions (58 benign lesions and 78 malignant lesions) and 37 normal cases. After speckle noise reduction, Hessian analysis with multi-scale blob detection was applied for the detection of tumors. This method detected every tumor, but some nontumors were also detected. The tumor like lihoods for the remaining candidates were estimated using a logistic regression model based on blobness, internal echo, and morphology features. The tumor candidates with tumor likelihoods higher than a specific threshold (0.4) were considered tumors. By using the combination of blobness, internal echo, and morphology features with 10-fold cross-validation, the proposed CAD system showed sensitivities of 100%, 90%, and 70% with false positives per pass of 17.4, 8.8, and 2.7, respectively. Our results suggest that CADe systems based on multi-scale blob detection can be used to detect breast tumors in ABUS images.

New automated whole breast ultrasound (ABUS) machines have recently been developed and the ultrasound (US) volume dataset of the whole breast can be acquired in a standard manner. The purpose of this study was to develop a novel computer-aided diagnosis system for classification of breast masses in ABUS images. One hundred forty-seven cases (76 benign and 71 malignant breast masses) were obtained by a commercially available ABUS system. Because the distance of neighboring slices in ABUS images is fixed and small, these continuous slices were used for reconstruction as three-dimensional (3-D) US images. The 3-D tumor contour was segmented using the level-set segmentation method. Then, the 3-D features, including the texture, shape and ellipsoid fitting were extracted based on the segmented 3-D tumor contour to classify benign and malignant tumors based on the logistic regression model. The Student's t test, Mann-Whitney U test and receiver operating characteristic (ROC) curve analysis were used for statistical analysis. From the Az values of ROC curves, the shape features (0.9138) are better than the texture features (0.8603) and the ellipsoid fitting features (0.8496) for classification. The difference was significant between shape and ellipsoid fitting features (p = 0.0382). However, combination of ellipsoid fitting features and shape features can achieve a best performance with accuracy of 85.0% (125/147), sensitivity of 84.5% (60/71), specificity of 85.5% (65/76) and the area under the ROC curve Az of 0.9466. The results showed that ABUS images could be used for computer-aided feature extraction and classification of breast tumors.

Recently, the whole breast ultrasound (US) is a new advanced screening technique for detecting breast abnormalities. Because a lot of images are acquired for a case, the computer-aided system is needed to help the physicians to reduce the diagnosis time. In the automatic whole breast US, the ribs are the pivotal landmark just like the pectoral muscle in the mammography. In this paper, we develop an automatic rib detection method for the whole breast ultrasound. The ribs could be helpful to define the screening area of a CAD system to reduce the tumor detection time and could be used to register different passes for a case. In the proposed rib detection system, the whole breast images are subsampled at first in order to reduce the computation of rib detection without reducing the detection performance. Due to the shadowing is occurred under the rib in the whole breast ultrasound images and is the sheet-like structure, the Hessian analysis and sheetness function are adopted to enhance the sheet-like structure. Then, the orientation thresholding is adopted to segment the sheet-like structures. In order to remove the non-rib components in the segmented sheet-like structures, some features of ribs in whole breast ultrasound are used. Thus, the connected component labeling is applied and then some characteristics such as orientation, length and radius are calculated. Finally, some criteria are applied to remove non-rib components. In our experiments, there are 65 ribs in 15 test cases and the 62 ribs have been detected by the proposed system with the detection ratio 95.38%. The ratio of position difference under 5 mm is 87.10 % and the ratio of length difference under 10 mm is 85.48 %. The results show that the proposed system almost could detect the ribs in the breast US images and has a good accuracy.

Purpose: A computer-aided detection (CADe) system based on quantitative tissue clustering algorithm was proposed to identify potential tumors in automated breast ultrasound (ABUS) images. Methods: Our three-dimensional (3D) ABUS images database included 148 biopsy-verified lesions (size 0.4–7.9 cm; mean 1.76 cm). An ABUS volume was comprised of 229–282 slices of two-dimensional (2D) images. For tumor detection, the fast 3D mean shift method was used to remove the speckle noise and the segment tissues with similar properties. The hypoechogenic regions, i.e., the tumor candidates, were extracted using fuzzy c-means clustering. Seven features related to echogenicity and morphology were quantified and used to predict the likelihood of identifying a tumor and filtering out the false-positive (FP) regions. Results: The sensitivity of the proposed CADe system achieved 89.19% (132/148) with 2.00 FPs per volume. For the volumes without lesion, the FP rate was 1.27. The sensitivity was 92.50% (74/80) for malignant tumors and 85.29% (58/68) for benign tumors. Conclusions: The proposed CADe system provides an automatic and quantitative procedure for tumor detection in ABUS images. Further studies are needed to reduce the FP rate of the CADe algorithm.

Purpose: To estimate the volumetric breast density by using the new three‐dimensional (3‐D) ultrasound technique, automated whole breast ultrasound (ABUS), was proposed in this paper. Method and Materials: In this study, the ABUS and MRI data were obtained from 40 patients. The ABUS images were acquired by the ABUS machine using the 10 MHz linear transducer with width 14.7cm. Although the ABUS can scan the larger area of breast automatically, two to five passes of scanning are necessary to completely scan the whole breast. In this study, two passes are used to cover the whole breast. The volumetric data contain serial 2‐D 548×348 slices with 16, 35, and 76 pixels/cm in the transverse, longitudinal, and coronal directions, respectively. Because the overlapping regions should be calculated only once in the density analysis, a vertical line across the nipple to cut the overlapping region in each image. Moreover, the non‐breast region below the retromammary fat should not be included in the density analysis. Hence, the lowest horizontal plane was manually selected to cut the non‐breast region. After segmenting the breast region, the fuzzy c‐mean (FCM) classifier was used to differentiate the fibroglandular and fatty tissues in the ABUS and MRIimages. The percent density and fibroglandular tissue volume were compared and correlated in both imaging modalities with the linear regressionanalysis.Results: The density of 3‐D ABUS and MRIimages for different BI‐RADS categories of images was analyzed and the correlation factor R2 was up to 0.760. The volumes of ABUS and MRIimages are also compared and their correlation factor R2 is 0.835. Conclusion: ABUS and MRI have high positive correlation for breast density quantification and both of them could provide the useful breast density information to physicians.