Algorithm of automatic identification of diabetic retinopathy foci based on ultra-widefield scanning laser ophthalmoscopy

AIM:To propose an algorithm for automatic detection of diabetic retinopathy(DR)lesions based on ultra-widefield scanning laser ophthalmoscopy(SLO).METHODS:The algorithm utilized the FasterRCNN(Faster Regions with CNN features)+ResNet50(Residua Network 50)+FPN(Feature Pyramid Networks)method for detecting hemorrhagic spots,cotton wool spots,exudates,and microaneurysms in DR ultra-widefield SLO.Subimage segmentation combined with a deeper residual network FasterRCNN+ResNet50 was employed for feature extraction to enhance intelligent learning rate.Feature fusion was carried out by the feature pyramid network FPN,which significantly improved lesion detection rates in SLO fundus images.RESULTS:By analyzing 1076 ultra-widefield SLO images provided by our hospital,with a resolution of 2600×2048 dpi,the accuracy rates for hemorrhagic spots,cotton wool spots,exudates,and microaneurysms were found to be 87.23%,83.57%,86.75%,and 54.94%,respectively.CONCLUSION:The proposed algorithm demonstrates intelligent detection of DR lesions in ultra-widefield SLO,providing significant advantages over traditional fundus color imaging intelligent diagnosis algorithms.

Three-dimensional conformal radiotherapy combined with FOLFOX4 chemotherapy for unresectable recurrent rectal cancer

瞄准：为 unresectable 与 FOLFOX4 化疗在联合调查三维的保角的放射疗法(3-DCRT ) 的效果周期性的直肠的癌症。方法：有 unresectable 的 48 个病人周期性的直肠的癌症被与在 2001 年 9 月和 2003 年 10 月之间的 FOLFOX4 化疗相结合的 3-DCRT 或 3-DCRT 使随机化并且对待。为没有优先的放射历史的病人，起始的放射被传统的方法与 40 Gy 的肿瘤剂量给整个骨盆，为周期性的损害由 3-DCRT 列在后面到 60 Gy (范围 56-66 Gy ) 的中部的全部的累积肿瘤剂量；为放射以后的周期性的病人， 3-DCRT 直接为周期性的损害被给 40 Gy (36-46 Gy ) 的中部的肿瘤剂量。为在学习组的病人，有 FOLFOX4 政体的二周期化疗与放射疗法并发地被给，为收到常规骨盆放射的病人交上第五个星期，第一个周期和第二个周期与放射的开始同时给或为直接收到 3-DCRT 的病人交上 3-DCRT 的最后星期。顺序的 FOLFOX4 政体化疗在学习被给病人的另外一个 2-4 周期(一般水准 3.6 周期) 组织，在在 chemoradiation 以后的 2-3 wk 开始。症状 relieve，肿瘤反应，幸存和毒性的结果在学习组和控制组之间被记录并且比较。结果：为学习组和控制组，疼痛缓和率是 95.2% 和 91.3%(P 】 0.05 ) ；全面反应率是 56.5% 和 40.0%(P 】 0.05 ) ；1 年、 2 年的幸存率是 86.9% ， 50.2% 和 80.0% ， 23.9% ，与 25 瞬间和 16 瞬间的中部的生存时间(P 【 0.05 ) ；2 年的远转移率是 39.1% 和 56.0%(P = 0.054 ) 分别地。副作用，除了是的外部神经病，相对，在学习的 severer 组织，是类似的在二个组和井容忍了。结论：三维的保角的放射疗法为周期性的直肠的癌症是的 unresectable 与 FOLFOX4 化疗结合了一条可行、有效的治疗学的途径，和罐头减少远转移率并且改进幸存率。

Port site and distant metastases of gallbladder cancer after laparoscopic cholecystectomy diagnosed by positron emission tomography

We report port site and distant metastases of unsuspected gallbladder cancer after laparoscopic cholecystectomy diagnosed by positron emission tomography (PET) in two patients. Patient 1, a 72-year-old woman was diagnosed as cholelithiasis and cholecystitis and received laparoscopic cholecystectomy. Unsuspected gallbladder cancer was discovered with histological result of well-differentiated squamous cell carcinoma of the gallbladder inf iltrating the entire wall. A PET scan using F-18-fl uorodeoxyglucose (FDG- PET) before radical resection revealed residual tumor in the gallbladder fossa and recurrence at port site and metastases in bilateral hilar lymph nodes. Patient 2, a 69-year-old woman underwent laparoscopic cholecystectomy more than one year ago with pathologically confi rmed unsuspected adenosquamous carcinoma of stage pT1b. At 7-mo follow-up after surgery, the patient presented with nodules in the periumbilical incision. Excisional biopsy of the nodule revealed adenosquamous carcinoma. The patient was examined by FDG-PET, demonstrating increased FDG uptake in the right lobe of the liver and mediastinal lymph nodes consistent with metastatic disease. This report is followed by a discussion about the utility of FDG-PET in the gallbladder cancer.

Adjuvant radiotherapy for gallbladder cancer:A dosimetric comparison of conformal radiotherapy and intensity-modulated radiotherapy

AIM: To assess the efficacy and toxicity of conformal radiotherapy (CRT) and compare with intensity-modulated radiotherapy (IMRT) in the treatment of gallbladder cancer. METHODS: Between November 2003 and January 2010, 20 patients with gallbladder cancer were treated with CRT with or without chemotherapy after surgical resection. Preliminary survival data were collected and examined using both Kaplan-Meier and actuarial analysis. Demographic and treatment parameters were collected. All patients were planned to receive 46-56 Gy in 1.8 or 2.0 Gy per fraction. CRT planning was compared with IMRT. RESULTS: The most common reported acute toxicities requiring medication (Radiation Therapy Oncology Group, Radiation Therapy Oncology Group Grade 2) were nausea (10/20 patients) and diarrhea (3/20). There were no treatment-related deaths. Compared with CRT planning, IMRT significantly reduced the volume of right kidney receiving > 20 Gy and the volume of liver receiving > 30 Gy. IMRT has a negligible impact on the volume of left kidney receiving > 20 Gy. The 95% of prescribed dose for a planning tumor volume using either 3D CRT or IMRT planning were 84.0% ± 6.7%, 82.9% ± 6.1%, respectively (P > 0.05). CONCLUSION: IMRT achieves similar excellent target coverage as compared with CRT planning, while reducing the mean liver dose and volume above threshold dose. IMRT offers better sparing of the right kidney compared with CRT planning, with a significantly lower mean dose and volume above threshold dose.