Segmentation-based BI-RADS ensemble classification of breast tumours in ultrasound images.

BACKGROUND: The development of computer-aided diagnosis systems in breast cancer imaging is exponential. Since 2016, 81 papers have described the automated segmentation of breast lesions in ultrasound images using artificial intelligence. However, only two papers have dealt with complex BI-RADS classifications. PURPOSE: This study addresses the automatic classification of breast lesions into binary classes (benign vs. malignant) and multiple BI-RADS classes based on a single ultrasonographic image. Achieving this task should reduce the subjectivity of an individual operator's assessment. MATERIALS AND METHODS: Automatic image segmentation methods (PraNet, CaraNet and FCBFormer) adapted to the specific segmentation task were investigated using the U-Net model as a reference. A new classification method was developed using an ensemble of selected segmentation approaches. All experiments were performed on publicly available BUS B, OASBUD, BUSI and private datasets. RESULTS: FCBFormer achieved the best outcomes for the segmentation task with intersection over union metric values of 0.81, 0.80 and 0.73 and Dice values of 0.89, 0.87 and 0.82, respectively, for the BUS B, BUSI and OASBUD datasets. Through a series of experiments, we determined that adding an extra 30-pixel margin to the segmentation mask counteracts the potential errors introduced by the segmentation algorithm. An assembly of the full image classifier, bounding box classifier and masked image classifier was the most accurate for binary classification and had the best accuracy (ACC; 0.908), F1 (0.846) and area under the receiver operating characteristics curve (AUROC; 0.871) in the BUS B and ACC (0.982), F1 (0.984) and AUROC (0.998) in the UCC BUS datasets, outperforming each classifier used separately. It was also the most effective for BI-RADS classification, with ACC of 0.953, F1 of 0.920 and AUROC of 0.986 in UCC BUS. Hard voting was the most effective method for dichotomous classification. For the multi-class BI-RADS classification, the soft voting approach was employed. CONCLUSIONS: The proposed new classification approach with an ensemble of segmentation and classification approaches proved more accurate than most published results for binary and multi-class BI-RADS classifications.

The context-dependent role of the Na+/Ca2+-exchanger (NCX) in pancreatic stellate cell migration.

Pancreatic stellate cells (PSCs) that can co-metastasize with cancer cells shape the tumor microenvironment (TME) in pancreatic ductal adenocarcinoma (PDAC) by producing an excessive amount of extracellular matrix. This leads to a TME characterized by increased tissue pressure, hypoxia, and acidity. Moreover, cells within the tumor secrete growth factors. The stimuli of the TME trigger Ca2+ signaling and cellular Na+ loading. The Na+/Ca2+ exchanger (NCX) connects the cellular Ca2+ and Na+ homeostasis. The NCX is an electrogenic transporter, which shuffles 1 Ca2+ against 3 Na+ ions over the plasma membrane in a forward or reverse mode. Here, we studied how the impact of NCX activity on PSC migration is modulated by cues from the TME. NCX expression was revealed with qPCR and Western blot. [Ca2+]i, [Na+]i, and the cell membrane potential were determined with the fluorescent indicators Fura-2, Asante NaTRIUM Green-2, and DiBAC4(3), respectively. PSC migration was quantified with live-cell imaging. To mimic the TME, PSCs were exposed to hypoxia, pressure, acidic pH (pH 6.6), and PDGF. NCX-dependent signaling was determined with Western blot analyses. PSCs express NCX1.3 and NCX1.9. [Ca2+]i, [Na+]i, and the cell membrane potential are 94.4 nmol/l, 7.4 mmol/l, and - 39.8 mV, respectively. Thus, NCX1 usually operates in the forward (Ca2+ export) mode. NCX1 plays a differential role in translating cues from the TME into an altered migratory behavior. When NCX1 is operating in the forward mode, its inhibition accelerates PSC migration. Thus, NCX1-mediated extrusion of Ca2+ contributes to a slow mode of migration of PSCs.

Impact of Invasive Pulmonary Aspergillosis in Critically Ill Surgical Patients with or without Solid Organ Transplantation.

BACKGROUND: Critically ill patients, especially those who have undergone solid organ transplantation (SOT), are at risk of invasive pulmonary aspergillosis (IPA). The outcome relevance of adequately treated putative IPA (pIPA) is a matter of debate. The aim of this study is to assess the outcome relevance of pIPA in a cohort of critically ill patients with and without SOT. METHODS: Data from 121 surgical critically ill patients with pIPA (n = 30) or non-pIPA (n = 91) were included. Cox regression analysis was used to identify risk factors for mortality and unfavourable outcomes after 28 and 90 days. RESULTS: Mortality rates at 28 days were similar across the whole cohort of patients (pIPA: 31% vs. non-pIPA: 27%) and did not differ in the subgroup of patients after SOT (pIPA: 17% vs. non-pIPA: 22%). A higher Sequential Organ Failure Assessment (SOFA) score and evidence of bacteraemia were identified as risk factors for mortality and unfavourable outcome, whereas pIPA itself was not identified as an independent predictor for poor outcomes. CONCLUSIONS: Adequately treated pIPA did not increase the risk of death or an unfavourable outcome in this mixed cohort of critically ill patients with or without SOT, whereas higher disease severity and bacteraemia negatively affected the outcome.

Job satisfaction among family nurses in Poland: A questionnaire-based study.

Aim: To define the level of job satisfaction among Polish family nurses. Attempts were made to assess whether job satisfaction depends on the job location, form of employment, family structure and financial situation. Design: A cross-sectional study was conducted among Polish family nurses who were professionally active in 2018. Method: A self-administered questionnaire which included a standardized questionnaire "The Satisfaction with Job Scale" by A. M. Zalewska and our survey questionnaire was administered to 225 of participants (returned 220). The data were collected in 2018. Results: Our study showed that the Polish family nurses are moderately satisfied with their job. A higher level of job satisfaction was reported by those family nurses with longer job seniority, those who were working in the country, those who were owners or co-owners of a primary healthcare unit, those who were living in a complete family or as single and those who could afford to buy what they wanted and possessed savings.

Behavioural categories of professionalism of nurses in Poland and Belarus: A comparative survey.

AIM AND OBJECTIVES: To compare the self-reported level of professionalism among nurses in Poland and Belarus and to indicate the areas in which differences in professional behaviours of nurses in both countries exist. BACKGROUND: Nurses constitute the largest group of healthcare providers, and the term professionalism is closely related to nursing profession. DESIGN: This investigation is a comparative survey and descriptive analysis of professional behaviours among nurses in Poland (n = 205) and Belarus (n = 236). The study was reported according to the STROBE checklist. METHODS: The Professionalism in Nursing Behaviors' Inventory Image Survey adapted from Adams and Miller (2001) was used to collect the data. The questionnaire contains 46 questions addressing the following behavioural categories: educational preparation, publications, research, professional organisation, community service, competence, code for nurses, theory and autonomy. RESULTS: The mean total score of professionalism was significantly different between the two countries (p < .0001). Significant differences, with higher scores in the group of respondents from Belarus, were also revealed in the following subscales of professionalism: "Professional organisation," "Community service," "Competence" and "Publication." Nurses from Poland had higher levels of "Educational preparation" and "Use of theory." No statistically significant differences were indicated in the "Autonomy" and "Research" subscales. CONCLUSION: Differences in the professionalism level of nurse practitioners in Poland and Belarus are related to nurses' professional position and the context in which they practice. RELEVANCE TO CLINICAL PRACTICE: The results of the present study can help the healthcare management and nursing leaders to support the professional development of nurses and strive for a higher level of professionalism.