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Biomedical subjects

J Y Lo

Publications and source records attributed to J Y Lo.

At least 19 recordsLinked to original sources

A neural network approach to breast cancer diagnosis as a constraint satisfaction problem.

A constraint satisfaction neural network (CSNN) approach is proposed for breast cancer diagnosis using mammographic and patient history findings. Initially, the diagnostic decision to biopsy was formulated as a constraint satisfaction problem. Then, an associative memory type neural network was applied to solve the problem. The proposed network has a flexible, nonhierarchical architecture that allows it to operate not only as a predictive tool but also as an analysis tool for knowledge discovery of association rules. The CSNN was developed and evaluated using a database of 500 nonpalpable breast lesions with definitive histopathological diagnosis. The CSNN diagnostic performance was evaluated using receiver operating characteristic analysis (ROC). The results of the study showed that the CSNN ROC area index was 0.84+/-0.02. The CSNN predictive performance is competitive with that achieved by experienced radiologists and backpropagation artificial neural networks (BP-ANNs) presented before. Furthermore, the study illustrates how CSNN can be used as a knowledge discovery tool overcoming some of the well-known limitations of BP-ANNs.

Age Factors↗

Computerized classification of suspicious regions in chest radiographs using subregion Hotelling observers.

We propose to investigate the use of subregion Hotelling observers (SRHOs) in conjunction with perceptrons for the computerized classification of suspicious regions in chest radiographs for being nodules requiring follow up. Previously, 239 regions of interest (ROIs), each containing a suspicious lesion with proven classification, were collected. We chose to investigate the use of SRHOs as part of a multilayer classifier to determine the presence of a nodule. Each SRHO incorporates information about signal, background, and noise correlation for classification. For this study, 225 separate Hotelling observers were set up in a grid across each ROI. Each separate observer discriminates an 8 by 8 pixel area. A round robin sampling scheme was used to generate the 225 features, where each feature is the output of the individual observers. These features were then rank ordered by the magnitude of the weights of a perceptron. Once rank ordered, subsets of increasing number of features were selected to be used in another perceptron. This perceptron was trained to minimize mean squared error and the output was a continuous variable representing the likelihood of the region being a nodule. Performance was evaluated by receiver operating characteristic (ROC) analysis and reported as the area under the curve (Az). The classifier was optimized by adding additional features until the Az declined. The optimized subset of observers then were combined using a third perceptron. A subset of 80 features was selected which gave an Az of 0.972. Additionally, at 98.6% sensitivity, the classifier had a specificity of 71.3% and increased the positive predictive value from 60.7% to 84.1 %. Preliminary results suggest that using SRHOs in combination with perceptrons can provide a successful classification scheme for pulmonary nodules. This approach could be incorporated into a larger computer aided detection system for decreasing false positives.

Algorithms↗

Differences in clinical and laboratory diagnostic characteristics of penicilliosis marneffei in human immunodeficiency virus (HIV)- and non-HIV-infected patients.

We compared the clinical and laboratory features of human immunodeficiency virus (HIV)- and non-HIV-infected patients with penicilliosis marneffei. HIV-infected patients had a higher incidence of fungemia. A total of 85.7% of the HIV-negative patients had underlying diseases including hematologic malignancies or had received therapy with corticosteroids or cytotoxic agents. By a Penicillium marneffei-specific mannoprotein Mp1p enzyme-linked immunosorbent assay, serum antigen titers were found to be higher in HIV-positive patients, whereas serum antibody levels were found to be higher in HIV-negative patients.

AIDS-Related Opportunistic Infections↗

Segmentation of suspicious clustered microcalcifications in mammograms.

We have developed a multistage computer-aided diagnosis (CAD) scheme for the automated segmentation of suspicious microcalcification clusters in digital mammograms. The scheme consisted of three main processing steps. First, the breast region was segmented and its high-frequency content was enhanced using unsharp masking. In the second step, individual microcalcifications were segmented using local histogram analysis on overlapping subimages. For this step, eight histogram features were extracted for each subimage and were used as input to a fuzzy rule-based classifier that identified subimages containing microcalcifications and assigned the appropriate thresholds to segment any microcalcifications within them. The final step clustered the segmented microcalcifications and extracted the following features for each cluster: the number of microcalcifications, the average distance between microcalcifications, and the average number of times pixels in the cluster were segmented in the second step. Fuzzy logic rules incorporating the cluster features were designed to remove nonsuspicious clusters, defined as those with typically benign characteristics. A database of 98 images, with 48 images containing one or more microcalcification clusters, provided training and testing sets to optimize the parameters and evaluate the CAD scheme, respectively. The results showed a true positive rate of 93.2% and an average of 0.73 false positive clusters per image. A comparison of our results with other reported segmentation results on the same database showed comparable sensitivity and at the same time an improved false positive rate. The performance of the CAD scheme is encouraging for its use as an automatic tool for efficient and accurate diagnosis of breast cancer.

Biophysical Phenomena↗

beta-lactamases in Shigella flexneri isolates from Hong Kong and Shanghai and a novel OXA-1-like beta-lactamase, OXA-30.

Ninety-one ampicillin-resistant Shigella flexneri strains from Hong Kong and Shanghai were studied for production of beta-lactamases. TEM-1-like and OXA-1-like enzymes were identified in 21 and 79% of the strains, respectively, by isoelectric focusing (IEF). No difference in the pattern of beta-lactamase production was found between strains from Hong Kong and Shanghai. Four ribotypes were detected. Over 88% of OXA-producing strains had the same ribotype. All TEM-1-like strains harbored a plasmid which hybridized positively with the bla(TEM) probe. Total DNA from OXA-1-like strains failed to hybridize or only hybridized weakly with an OXA probe. The OXA resistance was not transferable. OXA-1-like enzymes exhibited substrate and inhibition profiles similar to that of OXA-1 and were shown to have a pI of 7.3 by further IEF using a narrow-range ampholine gel. The gene encoding the OXA-1-like enzyme from one isolate (CH-07) was cloned, sequenced, and found to differ from bla(OXA-1) at codon 131 (AGA-->GGA; Arg to Gly), resulting in the novel designation OXA-30. The predominance of OXA-type enzymes in ampicillin-resistant S. flexneri suggests host preference for specific beta-lactamases.

Anti-Bacterial Agents↗

Case-based reasoning computer algorithm that uses mammographic findings for breast biopsy decisions.

OBJECTIVE: We present case-based reasoning computer software developed from mammographic findings to provide support for the clinical decision to perform biopsy of the breast. SUBJECTS AND METHODS: The case-based reasoning system is designed to support the decision to perform biopsy in those patients who have suspicious findings on diagnostic mammography. Currently, between 66% and 90% of biopsies are performed on benign lesions. Our system is designed to help decrease the number of benign biopsies without missing malignancies. Clinicians interpret the mammograms using a standard reporting lexicon. The case-based reasoning system compares these findings with a database of cases with known outcomes (from biopsy) and returns the fraction of similar cases that were malignant. This malignancy fraction is an intuitive response that the clinician can then consider when making the decision regarding biopsy. RESULTS: The system was evaluated using a round-robin sampling scheme and performed with an area under the receiver operating characteristic curve of 0.83, comparable with the performance of a neural network model. If only the cases returning a malignancy fraction of greater than a threshold of 0.10 are sent to biopsy, no malignancies would be missed, and the number of benign biopsies would be decreased by 25%. At a threshold of 0.21, 98%, of the malignancies would be biopsied, and the number of benign biopsies would be decreased by 41%. CONCLUSION: This preliminary investigation indicates that the case-based reasoning approach to computer-aided diagnosis has the potential to improve the accuracy of breast cancer diagnosis on mammography.

Adult↗

Effect of patient history data on the prediction of breast cancer from mammographic findings with artificial neural networks.

RATIONALE AND OBJECTIVES: The authors evaluated the contribution of medical history data to the prediction of breast cancer with artificial neural network (ANN) models based on mammographic findings. MATERIALS AND METHODS: Three ANNs were developed: The first used 10 Breast Imaging Reporting and Data System (BI-RADS) variables; the second, the BI-RADS variables plus patient age; the third, the BI-RADS variables, patient age, and seven other history variables, for a total of 18 inputs. Performance of the ANNs and the original radiologist's impression were evaluated with five metrics: receiver operating characteristic area index (Az); specificity at given sensitivities of 100%, 98%, and 95%; and positive predictive value. RESULTS: All three ANNs consistently outperformed the radiologist's impression over all five performance metrics. The patient-age variable was particularly valuable. Adding the age variable to the basic ANN model, which used only the BI-RADS findings, significantly improved Az (P = .028). In fact, replacing all history data with just the age variable resulted in virtually no changes for Az or specificity at 98% sensitivity (P = .324 and P = .410, respectively). CONCLUSION: Patient age was an important variable for the prediction of breast cancer from mammographic findings with the ANNs. For this data set, all history data could be replaced with age alone.

Adult↗

A neural network to predict symptomatic lung injury.

A nonlinear neural network that simultaneously uses pre-radiotherapy (RT) biological and physical data was developed to predict symptomatic lung injury. The input data were pre-RT pulmonary function, three-dimensional treatment plan doses and demographics. The output was a single value between 0 (asymptomatic) and 1 (symptomatic) to predict the likelihood that a particular patient would become symptomatic. The network was trained on data from 97 patients for 400 iterations with the goal to minimize the mean-squared error. Statistical analysis was performed on the resulting network to determine the model's accuracy. Results from the neural network were compared with those given by traditional linear discriminate analysis and the dose-volume histogram reduction (DVHR) scheme of Kutcher. Receiver-operator characteristic (ROC) analysis was performed on the resulting network which had Az = 0.833 +/- 0.04. (Az is the area under the ROC curve.) Linear discriminate multivariate analysis yielded an Az = 0.813 +/- 0.06. The DVHR method had Az = 0.521 +/- 0.08. The network was also used to rank the significance of the input variables. Future studies will be conducted to improve network accuracy and to include functional imaging data.

Adult↗

An evaluation of susceptibility testing methods for ampicillin-sulbactam using a panel of beta-lactamase-producing bacteria.

Bacteria possessing TEM-1-like beta-lactamases are generally regarded as susceptible to ampicillin-sulbactam (SAM), while those harboring OXA-1 enzymes are considered resistant. The current study was undertaken to compare susceptibility testing using various combinations of ampicillin and sulbactam to improve clinical correlation. Members of the Enterobacteriaceae family harboring TEM-1, SHV-1 or OXA-1-like beta-lactamases were tested using the agar dilution method. A substantial proportion of strains harboring OXA-1-like beta-lactamases showed false susceptibility to SAM at the 1:1 ratio or fixed sulbactam concentration of 8 microg/ml. At a fixed sulbactam concentration of 4 microg/ml, the activity of ampicillin-sulbactam appeared to be reduced, with large numbers of TEM-1 producers becoming frankly resistant. Results obtained with the 2:1 ratio exhibited the closest correlation with that obtained by the currently recommended disk diffusion test. However, very major errors were still found between the disk diffusion test and agar dilution test, suggesting the necessity for consideration of a change in criteria for interpretation of disk diffusion test results. In conclusion, SAM susceptibility testing by agar dilution using other than a 2:1 ratio is not recommended and results should be interpreted with caution.

Agar↗

Predictive model for the diagnosis of intraabdominal abscess.

RATIONALE AND OBJECTIVES: The authors investigated the use of an artificial neural network (ANN) to aid in the diagnosis of intraabdominal abscess. MATERIALS AND METHODS: An ANN was constructed based on data from 140 patients who underwent abdominal and pelvic computed tomography (CT) between January and December 1995. Input nodes included data from clinical history, physical examination, laboratory investigation, and radiographic study. The ANN was trained and tested on data from all 140 cases by using a round-robin method and was compared with linear discriminate analysis. A receiver operating characteristic curve was generated to evaluate both predictive models. RESULTS: CT examinations in 50 cases were positive for abscess. This finding was confirmed by means of laboratory culture of aspirations from CT-guided percutaneous drainage in 38 patients, ultrasound-guided percutaneous drainage in five patients, surgery in five patients, and characteristic appearance on CT scans without aspiration in two patients. CT scans in 90 cases were negative for abscess. The sensitivity and specificity of the ANN in predicting the presence of intraabdominal abscess were 90% and 51%, respectively. Receiver operating characteristic analysis showed no statistically significant difference in performance between the two predictive models. CONCLUSION: The ANN is a useful tool for determining whether an intraabdominal abscess is present. It can be used to set priorities for CT examinations in order to expedite treatment in patients believed to be more likely to have an abscess.

Abdominal Abscess↗

Correlation of in vitro susceptibility testing results for amoxicillin-clavulanate and ampicillin-sulbactam using a panel of beta-lactamase-producing Enterobacteriaceae.

Correlation between in vitro susceptibility results for amoxicillin-clavulanate (AMC) and ampicillin-sulbactam (SAM) was studied using 136 clinical and control strains of Enterobacteriaceae harboring TEM-1, SHV-1 or OXA-1-like beta-lactamases. Determination of minimal inhibitory concentration of antibiotics was performed by agar dilution. The beta-lactamases were initially characterized using isoelectric focusing. Further identification was done by DNA hybridization with or without prior PCR amplification. All strains sensitive to SAM were found to be sensitive also to AMC. In contrast, among those susceptible to AMC, only 50% were sensitive to SAM while 36% gave intermediate results and 14% were resistant. Major differences were found solely among SHV-producers while minor differences occurred mostly among TEM-producers. This phenomenon is probably related to the differential activities of clavulanate and sulbactam against various beta-lactamases. In conclusion, testing of Enterobacteriaceae isolates for susceptibility to AMC and SAM should be performed and reported individually to avoid erroneous designation of susceptibility.

Amoxicillin-Potassium Clavulanate Combination↗

Treatment of adenovirus-associated haemorrhagic cystitis with ganciclovir.

We report a 47-year-old bone marrow transplant recipient with haemorrhagic cystitis caused by adenovirus successfully treated with ganciclovir. This is the first report on the use of ganciclovir for the successful treatment of adenoviral infection. Shell vial culture may be more sensitive than conventional culture in the detection of adenovirus in such patients.

Adenoviridae↗

Predicting breast cancer invasion with artificial neural networks on the basis of mammographic features.

PURPOSE: To evaluate whether an artificial neural network (ANN) can predict breast cancer invasion on the basis of readily available medical findings (ie, mammographic findings classified according to the American College of Radiology Breast Imaging Reporting and Data System and patient age). MATERIALS AND METHODS: In 254 adult patients, 266 lesions that had been sampled at biopsy were randomly selected for the study. There were 96 malignant and 170 benign lesions. On the basis of nine mammographic findings and patient age, a three-layer backpropagation network was developed to predict whether the malignant lesions were in situ or invasive. RESULTS: The ANN predicted invasion among malignant lesions with an area under the receiver operating characteristic curve (Az) of .91 +/- .03. It correctly identified all 28 in situ cancers (specificity, 100%) and 48 of 68 invasive cancers (sensitivity, 71%). CONCLUSION: The ANN used mammographic features and patient age to accurately classify invasion among breast cancers, information that was previously available only by means of biopsy. This knowledge may assist in surgical planning and may help reduce the cost and morbidity of unnecessary biopsy.

Biopsy↗

Herpes simplex virus type 2 infection in a 5-year-old boy presenting with recurrent chest wall vesicles and a possible history of herpes encephalitis.

A 5-year-old hyperkinetic but otherwise healthy child presented with recurrent irritable vesicles and erosions of the anterior chest wall; they have been apparent since the age of 15 months. Wound swab cultures yielded herpes simplex virus type-2 (HSV-2) and Western blot serology showed past exposure to both HSV-1 and HSV-2. Skin biopsy results further supported a herpes virus infection. Magnetic resonance imaging of the brain showed right temporal lobe atrophy. An evaluation showed no evidence of sexual abuse in the patient but a Western blot assay of the mother's serum for HSV-2 was positive, while the father's was negative. In view of the diagnosis of HSV-2 infection in such a young patient, the possible routes of transmission and the time of acquisition of infection were explored. We believe the most likely route of infection in this child was postnatal, through intimate contact with the mother.

Child, Preschool↗

Structure-function relationship of lipoprotein lipase-mediated enhancement of very low density lipoprotein binding and catabolism by the low density lipoprotein receptor. Functional importance of a properly folded surface loop covering the catalytic center.

We examined the structure-function relationship of human lipoprotein lipase (hLPL) in its ability to enhance the binding and catabolism of very low density lipoproteins (VLDL) in COS cells. Untransfected COS cells did not bind to or catabolize normal VLDL. Expression of wild-type hLPL by transient transfection enhanced binding, uptake, and degradation of the VLDL (a property of LPL that we call bridge function). Heparin pretreatment and a monoclonal antibody ID7 that blocks LDL receptor-binding domain of apoE both inhibited binding, and apoE2/E2 VLDL from a Type III hyperlipidemic subject did not bind. However, LDL did not reduce 125I-VLDL binding to the hLPL-expressing cells, whereas rabbit beta-VLDL was an effective competitor. By contrast, LDL reduced uptake and degradation of 125I-VLDL to the same extent as excess unlabeled VLDL or beta-VLDL. These data suggest that binding occurs by direct interaction of VLDL with LPL but the subsequent catabolism of the VLDL is mediated by the LDL receptor. Mutant hLPLs that were catalytically inactive, S132A, S132D, as well as the partially active mutant, S251T, and S172G, gave normal enhancement of VLDL binding and catabolism, whereas the partially active mutant S172D had markedly impaired capacity for the process; thus, there is no correlation between bridge function and lipolytic activity. A naturally occurring genetic variant hLPL, S447-->Ter, has normal bridge function. The catalytic center of LPL is covered by a 21-amino acid loop that must be repositioned before a lipid substrate can gain access to the active site for catalysis. We studied three hLPL loop mutants (LPL-cH, an enzymatically active mutant with the loop replaced by a hepatic lipase loop; LPL-cP, an enzymatically inactive mutant with the loop replaced by a pancreatic lipase loop; and C216S/C239S, an enzymatically inactive mutant with the pair of Cys residues delimiting the loop substituted by Ser residues) and a control double Cys mutant, C418S/C438S. Two of the loop mutants (LPL-cH and LPL-cP) and the control double Cys mutant C418S/C438S gave normal enhancement of VLDL binding and catabolism, whereas the third loop mutant, C216S/C239S, was completely inactive. We conclude that although catalytic activity and the actual primary sequence of the loop of LPL are relatively unimportant (wild-type LPL loop and pancreatic lipase loops have little sequence similarity), the intact folding of the loop, flanked by disulfide bonds, must be maintained for LPL to express its bridge function.

Animals↗