Validation of a Point-of-Care Optical Coherence Tomography Device with Machine Learning Algorithm for Detection of Oral Potentially Malignant and Malignant Lesions

Non-invasive strategies that can identify oral malignant and dysplastic oral potentially-malignant lesions (OPML) are necessary in cancer screening and long-term surveillance. Optical coherence tomography (OCT) can be a rapid, real time and non-invasive imaging method for frequent patient surveillance. Here, we report the validation of a portable, robust OCT device in 232 patients (lesions: 347) in different clinical settings. The device deployed with algorithm-based automated diagnosis, showed efficacy in delineation of oral benign and normal (n = 151), OPML (n = 121), and malignant lesions (n = 75) in community and tertiary care settings. This study showed that OCT images analyzed by automated image processing algorithm could distinguish the dysplastic-OPML and malignant lesions with a sensitivity of 95% and 93%, respectively. Furthermore, we explored the ability of multiple (n = 14) artificial neural network (ANN) based feature extraction techniques for delineation high grade-OPML (moderate/severe dysplasia). The support vector machine (SVM) model built over ANN, delineated high-grade dysplasia with sensitivity of 83%, which in turn, can be employed to triage patients for tertiary care. The study provides evidence towards the utility of the robust and low-cost OCT instrument as a point-of-care device in resource-constrained settings and the potential clinical application of device in screening and surveillance of oral cancer.

A smart tele-cytology point-of-care platform for oral cancer screening

Early detection of oral cancer necessitates a minimally invasive, tissue-specific diagnostic tool that facilitates screening/surveillance. Brush biopsy, though minimally invasive, demands skilled cyto-pathologist expertise. In this study, we explored the clinical utility/efficacy of a tele-cytology system in combination with Artificial Neural Network (ANN) based risk-stratification model for early detection of oral potentially malignant (OPML)/malignant lesion. A portable, automated tablet-based tele-cytology platform capable of digitization of cytology slides was evaluated for its efficacy in the detection of OPML/malignant lesions (n = 82) in comparison with conventional cytology and histology. Then, an image pre-processing algorithm was established to segregate cells, ANN was trained with images (n = 11,981) and a risk-stratification model developed. The specificity, sensitivity and accuracy of platform/ stratification model were computed, and agreement was examined using Kappa statistics. The tele-cytology platform, Cellscope, showed an overall accuracy of 84–86% with no difference between tele-cytology and conventional cytology in detection of oral lesions (kappa, 0.67–0.72). However, OPML could be detected with low sensitivity (18%) in accordance with the limitations of conventional cytology. The integration of image processing and development of an ANN-based risk stratification model improved the detection sensitivity of malignant lesions (93%) and high grade OPML (73%), thereby increasing the overall accuracy by 30%. Tele-cytology integrated with the risk stratification model, a novel strategy established in this study, can be an invaluable Point-of-Care (PoC) tool for early detection/screening in oral cancer. This study hence establishes the applicability of tele-cytology for accurate, remote diagnosis and use of automated ANN-based analysis in improving its efficacy.

Intra-operative point-of-procedure delineation of oral cancer margins using optical coherence tomography

OBJECTIVES

Surgical margin status is a significant determinant of treatment outcome in oral cancer. Negative surgical margins can decrease the loco-regional recurrence by five-fold. The current standard of care of intraoperative clinical examination supplemented by histological frozen section, can result in a risk of positive margins from 5 to 17 percent. In this study, we attempted to assess the utility of intraoperative optical coherence tomography (OCT) imaging with automated diagnostic algorithm to improve on the current method of clinical evaluation of surgical margin in oral cancer.

MATERIALS AND METHODS

We have used a modified handheld OCT device with automated algorithm based diagnostic platform for imaging. Intraoperatively, images of 125 sites were captured from multiple zones around the tumor of oral cancer patients (n = 14) and compared with the clinical and pathologic diagnosis.

RESULTS

OCT showed sensitivity and specificity of 100%, equivalent to histological diagnosis (kappa, ĸ = 0.922), in detection of malignancy within tumor and tumor margin areas. In comparison, for dysplastic lesions, OCT-based detection showed a sensitivity of 92.5% and specificity of 68.8% and a moderate concordance with histopathology diagnosis (ĸ = 0.59). Additionally, the OCT scores could significantly differentiate squamous cell carcinoma (SCC) from dysplastic lesions (mild/moderate/severe; p ≤ 0.005) as well as the latter from the non-dysplastic lesions (p ≤ 0.05).

CONCLUSION

The current challenges associated with clinical examination-based margin assessment could be improved with intra-operative OCT imaging. OCT is capable of identifying microscopic tumor at the surgical margins and demonstrated the feasibility of mapping of field cancerization around the tumor.

Validation of the Diet Satisfaction Questionnaire: a new measure of satisfaction with diets for weight management

Objective

The Diet Satisfaction Questionnaire was developed to fill the need for a validated measure to evaluate satisfaction with weight‐management diets. This paper further develops the questionnaire, examining the factor structure of the original questionnaire, cross‐validating a revised version in a second sample and relating diet satisfaction to weight loss during a 1‐year trial.

Methods

The 45‐item Diet Satisfaction Questionnaire (DSat‐45) uses seven scales to assess characteristics that influence diet satisfaction: Healthy Lifestyle, Convenience, Cost, Family Dynamics, Preoccupation with Food, Negative Aspects, and Planning and Preparation. It was administered five times during a 1‐year weight‐loss trial (n = 186 women) and once as an online survey in a separate sample (n = 510 adults). Confirmatory factor analysis was used to assess and refine the DSat‐45 structure, and reliability and validity data were examined in both samples for the revised questionnaire, the DSat‐28. Associations were examined between both DSat questionnaires and weight loss in the trial.

Results

Internal consistency (reliability) was moderate for the DSat‐45. Confirmatory factor analysis showed improved fit for a five‐factor structure, resulting in the DSat‐28 that retained four of the original scales and a shortened fifth scale. This revised questionnaire was reliable in both samples. Weight loss across the year‐long trial was positively related to satisfaction with Healthy Lifestyle, Preoccupation with Food, and Planning and Preparation in both versions of the questionnaire.

Conclusions

Measures of reliability and validity were improved in the more concise DSat‐28 compared to the DSat‐45. This shorter measure should be used in future work to evaluate satisfaction with weight‐management diets.

Mobile microscopy as a screening tool for oral cancer in India: A pilot study

Oral cancer is the most common type of cancer among men in India and other countries in South Asia. Late diagnosis contributes significantly to this mortality, highlighting the need for effective and specific point-of-care diagnostic tools. The same regions with high prevalence of oral cancer have seen extensive growth in mobile phone infrastructure, which enables widespread access to telemedicine services. In this work, we describe the evaluation of an automated tablet-based mobile microscope as an adjunct for telemedicine-based oral cancer screening in India. Brush biopsy, a minimally invasive sampling technique was combined with a simplified staining protocol and a tablet-based mobile microscope to facilitate local collection of digital images and remote evaluation of the images by clinicians. The tablet-based mobile microscope (CellScope device) combines an iPad Mini with collection optics, LED illumination and Bluetooth-controlled motors to scan a slide specimen and capture high-resolution images of stained brush biopsy samples. Researchers at the Mazumdar Shaw Medical Foundation (MSMF) in Bangalore, India used the instrument to collect and send randomly selected images of each slide for telepathology review. Evaluation of the concordance between gold standard histology, conventional microscopy cytology, and remote pathologist review of the images was performed as part of a pilot study of mobile microscopy as a screening tool for oral cancer. Results indicated that the instrument successfully collected images of sufficient quality to enable remote diagnoses that show concordance with existing techniques. Further studies will evaluate the effectiveness of oral cancer screening with mobile microscopy by minimally trained technicians in low-resource settings.

Does the incorporation of portion-control strategies in a behavioral program improve weight loss in a 1-year randomized controlled trial?

BACKGROUND/OBJECTIVES

Controlling food portion sizes can help reduce energy intake, but the effect of different portion-control methods on weight management is not known. In a 1-year randomized trial, we tested whether the efficacy of a behavioral weight-loss program was improved by incorporating either of the two portion-control strategies instead of standard advice about eating less.

SUBJECTS/METHODS

The Portion-Control Strategies Trial included 186 women with obesity (81%) or overweight (19%). Participants were randomly assigned to one of three equally intensive behavioral programs, consisting of 19 individual sessions over 12 months. The Standard Advice Group was instructed to eat less food while making healthy choices, the Portion Selection Group was instructed to choose portions based on the energy density using tools such as food scales and the Pre-portioned Foods Group was instructed to structure meals around pre-portioned foods such as single-serving main dishes, for which some vouchers were provided. In an intention-to-treat analysis, a mixed-effects model compared weight loss trajectories across 23 measurements; at month 12, weight was measured for 151 participants (81%).

RESULTS

The trajectories showed that the Pre-portioned Foods Group initially lost weight at a greater rate than the other two groups (P=0.021), but subsequently regained weight at a greater rate (P=0.0005). As a result, weight loss did not differ significantly across groups at month 6 (mean±s.e. 5.2±0.4 kg) or month 12 (4.5±0.5 kg). After 1 year, measured weight loss averaged 6% of baseline weight. The frequency of using portion-control strategies initially differed across groups, then declined over time and converged at months 6 and 12.

CONCLUSIONS

Incorporating instruction on portion-control strategies within a 1-year behavioral program did not lead to a greater weight loss than standard advice. Using pre-portioned foods enhanced early weight loss, but this was not sustained over time. Long-term maintenance of behavioral strategies to manage portions remains a challenge.

Meta-Analyses of Microarray Datasets Identifies ANO1 and FADD as Prognostic Markers of Head and Neck Cancer

The head and neck squamous cell carcinoma (HNSCC) transcriptome has been profiled extensively, nevertheless, identifying biomarkers that are clinically relevant and thereby with translational benefit, has been a major challenge. The objective of this study was to use a meta-analysis based approach to catalog candidate biomarkers with high potential for clinical application in HNSCC. Data from publically available microarray series (N = 20) profiled using Agilent (4X44K G4112F) and Affymetrix (HGU133A, U133A_2, U133Plus 2) platforms was downloaded and analyzed in a platform/chip-specific manner (GeneSpring software v12.5, Agilent, USA). Principal Component Analysis (PCA) and clustering analysis was carried out iteratively for segregating outliers; 140 normal and 277 tumor samples from 15 series were included in the final analysis. The analyses identified 181 differentially expressed, concordant and statistically significant genes; STRING analysis revealed interactions between 122 of them, with two major gene clusters connected by multiple nodes (MYC, FOS and HSPA4). Validation in the HNSCC-specific database (N = 528) in The Cancer Genome Atlas (TCGA) identified a panel (ECT2, ANO1, TP63, FADD, EXT1, NCBP2) that was altered in 30% of the samples. Validation in treatment naïve (Group I; N = 12) and post treatment (Group II; N = 12) patients identified 8 genes significantly associated with the disease (Area under curve>0.6). Correlation with recurrence/re-recurrence showed ANO1 had highest efficacy (sensitivity: 0.8, specificity: 0.6) to predict failure in Group I. UBE2V2, PLAC8, FADD and TTK showed high sensitivity (1.00) in Group I while UBE2V2 and CRYM were highly sensitive (>0.8) in predicting re-recurrence in Group II. Further, TCGA analysis showed that ANO1 and FADD, located at 11q13, were co-expressed at transcript level and significantly associated with overall and disease-free survival (p<0.05). The meta-analysis approach adopted in this study has identified candidate markers correlated with disease outcome in HNSCC; further validation in a larger cohort of patients will establish their clinical relevance.

Axenic in vitro culture of Schistosoma mansoni miracidia

Miracidia of Schistosoma mansoni have been grown axenically. The use of saline solution of 0.75% facilitated the shedding of epidermal plates which if occurred promote a rapid sporocystogenesis. Also, the use of a ratio of 1:3 (fetal calf serum and medium 199) in addition to chernin balanced salt solution (SBSS) was ideal for maintaining sporocysts up to 14 days. All the miracidia sheded their epidermal plates 2 hours post cultivation. At the end of the second week post cultivation, the daughter sporocysts measured 690u in length by 50u in width. The usage of plastic flat sided flasks with plenty of culture medium was very important for induction a proper growth of sporocysts because it was possible that adherence of sporocysts to each other might delay their growth.

Studies on the sacculant portion of the kidney of Biomphalaria glabrata Say (1818) as a haemopoietic organ

The term immunity signifies all those properties of the host which confer resistance to a specific infectious agent. This resistance may be of all degrees ranging from complete to incomplete susceptibility. The defensive functions is performed by various cellular and humoral components which interact with each other producing a co-ordinated immune response directed towards eliminating the pathogen or minimizing its danger. Snails as other members of the Animal Kingdom have their own immune system. The present study concentrated on the sacculant portion of the kidney of B. glabrata as a haemopoietic stem cell. The histological picture of this portion in the kidney as well as in-vitro culture was studied. (I) The histological studies showed that (a) the sacculant portion constituted the last fifth of the kidney highly folded with primitive epithelial tissue, (b) amoebocytes (10.7 +/- 0.98m) rounded, oval or amoeboid, showing flattening and spreading when encapsulated around foreign particles, when doing so, both the cytoplasm and nucleus were more basophilic, (c) the haemocytes in the sacculant portion were distributed either as clustering forming amoebocytic plugs or dense aggregation or being normal in distribution (d) there was a significant correlation between haemocytic diameter and shell weight and between shell weight and shell diameter but no significant correlation between haemocytic diameter and shell diameter. (II) The in-vitro studies showed that (a) The medium 199 and fetal calf serum (3:1) produced higher number of granulocytes, (b) the cells differed in shape and size from those shown in histological studies of the kidney itself (c) the majority of the cells were large sized granulocytes and very few small sized hyalinocytes, (d) granulation of cytoplasm took place in the culture medium used more than in the sacculant portion, (e) only the smaller granulocytes showed greater ability for mitotic division. The results were photographed and discussed.

The metacercariae of sibling species of Meiogymnophallus, including M. rebecqui comb. nov. (Digenea: Gymnophallidae), and their effects on closely related Cerastoderma host species (Mollusca: bivalvia)

The morphology and ecology are described for four sibling species of digenean metacercariae: Meiogymnophallus minutus (Cobbold 1859), M. strigatus (Lebour 1908) from the estuarine cockle Cerastoderma edule L. and M. fossarum (Bartoli, 1965) and M. rebecqui (Bartoli, 1983) comb. nov. from the brackish water lagoon cockle C. glaucum (Poiret). Although occupying different sites within the two species of cockle, both M. minutus and M. fossarum infections result in pathological effects that may cause heavy host mortality. Remarkably, they also result in an inversion of the cockles in situ in the sand such that predation by the final host species is enhanced.

Effect of the behavioural stress on susceptibility of Syrian hamsters to Schistosoma mansoni infection: effect on number and fertility of worm burden

Effect of pairing on susceptibility of male Syrian hamsters to Schistosoma mansoni infection in comparison to their isolated counter-parts have been studied. Pairing resulted in significant differences between paired and isolated hamsters in measurements of eggs, miracidia, number of adult worms recovered and mean testicular number of males. Paired hamsters seemed to be immunologically suppressed and such a suppression resulted in increasing the fertility and number of worms recovered. The width of the male schistosomes recovered from the paired hamsters was two folds and the length was four folds greater than those recovered from isolated ones. The mean testicular number was 8.17 +/- 0.53 in males recovered from paired hamsters and 6.16 +/- 0.71 in those recovered from isolated ones. Of interest was, the demonstration of a male with two groups of testes recovered from a paired hamster. It was concluded that the stressed host reflex effects on the number and fertility of the schistosome worms burden, and hence the severity of the disease and its complications.

Evaluation of the developmental toxicity of five compounds with the frog embryo teratogenesis assay: Xenopus (FETAX) and a metabolic activation system

The potential teratogenic hazard of five compounds was evaluated using the Frog Embryo Teratogenesis Assay--Xenopus (FETAX) and a metabolic activation system. Embryos of the South African clawed frog, Xenopus laevis, were exposed to (i) three compounds suspected to be proteratogenic in mammalian test systems--[2-acetylaminofluorene (2-AAF), rifampicin (RA) and benzo[a]pyrene (BP)] for 96 h; (ii) one compound unaffected by mixed-functional oxidase (MFO) metabolism--ZnSO4; (iii) one compound thought to be inactivated by cytochrome P-450--cytochalasin D (CD). Two separate static renewal tests were conducted with and without the presence of an exogenous metabolic activation system (MAS). The metabolic activation system consisted of Aroclor 1254-induced rat liver microsomes. The teratogenic potential of each compound and the effects of metabolic activation were based on teratogenic indices [TI = 96 h LC50/96 h EC50 (malformation)], types and severity of malformation, and effects on embryo growth. Metabolic activation increased the potential teratogenic hazard of 2-AAF, RA and BP by TI factors of 1.3, 2.8 and 6.8, respectively. The teratogenic potential of ZnSO4 was virtually unaffected by the MAS. The MAS significantly reduced the teratogenic potential of CD by a TI factor of 2.7. These results demonstrate the utility and importance of a MAS for in vitro developmental toxicity screens such as FETAX. Consistent use of a MAS with FETAX should reduce the number of potential false-positive and false-negative test results.

Site selection by Microphallus pygmaeus Levinsen, 1881 (Trematoda: Microphallidae) in the laboratory mouse

When Microphallus pygmaeus Levinsen, 1881 was inoculated orally to laboratory mice, most specimens, failed to attach to the intestinal wall and passed out rapidly with the faeces. Those which did settle were distributed more or less evenly throughout the small intestine by 4 h after inoculation. By day 1 after inoculation the worms had developed to oviposition and most were found in the ileum. By 2 days after inoculation all worms were established, and they remained in this region where they grew and continued egg production with very little further mortality until day 6 after inoculation. Thereafter, gravid worms progressively detached and passed rapidly through the caecum, colon, and rectum with the faeces. All parasites had been voided by about day 12 inoculation. In spite of high mortality, distribution in the small intestine is also affected by the site of implantation.

Retention and egg production of Microphallus pygmaeus in mice: the influence of the adrenal cortex

Fewer adult Microphallus pygmaeus are recovered from the small intestine of adrenalectomized male mice than from sham-operated counterparts. Preinfection intraperitoneal injection of 2 IU or 4 IU ACTH daily for 7 days increases the initial primary worm burden in male mice. Preinfection intramuscular injection of 325 micrograms corticosterone daily for 7 days increases the initial worm burden and alters the subsequent rate of decline and duration of the primary infection. However, egg production is unaffected. The changes in parasite numbers are attributed to the immunosuppressive action of corticosterone.

Aerobic glucose metabolism in the digestive gland of Littorina saxatilis rudis (Maton) and in the daughter sporocysts of Microphallus similis (Jäg.)

Experiments, some in vitro and some in vivo, with glucose-U-14C, acetate-U-14C, succinate-1,4-14C, pyruvate-U-14C and citrate-1,5-14C indicate that the digestive gland of Littorina saxatilis rudis and the daughter sporocysts of Microphallus similis aerobically catabolise glucose via an EMP pathway, a TCA cycle, phosphoenolpyruvate carboxylation and malate decarboxylation. The host and parasite have similar transamination and synthetic reactions and alanine as a major carbohydrate excretory product. Oxidative metabolism appears to be less efficient in the parasite than in the host.

Reproduction in the daughter sporocyst of Cercaria bucephalopsis hai meana (Lacaze-Duthiers, 1854) (Bucephalidae) and the Cercaria dichotoma Lebour, 1911 (non Müller) (Gymnophallidae)

The germ-cell cycle and method of reproduction in the daughter sporocysts of the bucephalid Cercaria bucephalopsis haimeana (Lacaze-Duthiers, 1854) and the gymnophallid Cercaria dichotoma Lebour, 1911 (non Müller) from the edible cockle, Cardium edule L., have been investigated by the examination of stained sections. A review is given of the principal interpretative theories which attempt to explain the nature of the reproduction and the homology of the germinal sacs of the Digenea. It is suggested that the life-cycle includes a cyclic alternation of homologous generations. Of these, the miracidium/mother-sporocyst and the daughter germinal-sac generations usually reproduce by apomictic parthenogenesis but polyembryony may also occur secondarily in some species.

We are very grateful to Dr Gwendolen Rees and Professor E. W. Knight-Jones for considerable help with the manuscript.

Studies on the morphology, ecology and life-cycle of Meiogymnophallus minutus (Cobbold, 1859) comb. nov. (Trematoda: Gymnophallidae)

Meiogymnophallvs minutus (Cobbold, 1859) comb, nov., from Cardium edule L. and Haematopus ostralegus occidentalis Neumann is shown to be synonymous with Lecithodendrium somateriae (non Levinsen, 1881) Jameson, 1902 in partim, Cercaria margaritae Lebour, 1907, Oymnophalloides oedemiae (Jameson & Nicoll, 1913) James, 1964, Cercaria cambrensis Cole, 1938, and Gymnophallus nereicola Rebecq & Prévot, 1962. The intensity of infestation of cockles, with the metacercariae, increases with the size and particularly with the age of this host and varies with the seasonal migrations of the final host. The connexion between the metacercaria and the adult is demonstrated experimentally. Domestic ducklings used as experimental hosts were susceptible to infection when fed with minced cockles but not when fed on baby chick crumbs.

We are very grateful to Professor E. W. Knight-Jones for the provision of working facilities and for help with the manuscript and to the Science Research Council for a grant to one of us (E.A.B.) which made the work possible.

The ultrastructure of the daughter sporocyst of Cercaria bucephalopsis haimaena Lacaze-Duthiers, 1854 (Digenea: Bucephalidae) from the edible cockle, Cardium edule L

The body wall of the daughter sporocyst of Cercaria bucephalopsis haimaena Lacaze-Duthiers, 1854, is shown by the electron-microscope to consist of an external syncytial tegument, lying on a basement membrane, and an internal cellular subtegument, which surrounds a body cavity containing developing cercariae.

The syncytial tegument has areas of dense cytoplasm alternating with sparse reticulate cytoplasm. The dense cytoplasm contains nuclei, a few mitochondria and secretory products which probably include a neutral mucopolysaccharide. This may be the precursor of the acid mucopolysaccharide in the sparse reticulate cytoplasm and on the surface of the daughter sporocyst.

Nutrients are probably absorbed through the outer plasma membrane of the tegument, pass through the sparse reticulate cytoplasm in the middle region of the tegument, the inner plasma membrane and basement membrane into the subtegument.

The ultrastructure of the tegument of adult and larval Digenea are compared.

We would like to thank Dr Gwendolen Rees for allowing us to examine the electron-micrographs of Parorchis acanthus. We are also grateful to Professor E. W. Knight-Jones for the provision of excellent working facilities and to the Science Research Council, for a grant to one of us (E.A.B.) which made the work possible.