Purpose: Histopathologic characterizations of central compartment atopic disease (CCAD) by whole-slide imaging remains lacking. We aim to study clinical presentations and cellular endotyping diagnosis of Chinese CCAD using artificial intelligence (AI). Methods: A total of 72 patients diagnosed with chronic rhinosinusitis with nasal polyps (CRSwNP) were enrolled. CCAD was defined by positive result of serology specific IgE, endoscopic and radiological findings. The aeroallergen sensitization status, endoscopic results, radiological findings, and symptoms were evaluated and compared between patients with CCAD (n=14), eosinophilic CRSwNP (ENP, n=32) and non-eosinophilic CRSwNP (NENP, n=26). The cellular endotypes including eosinophils, neutrophils, lymphocytes, and plasma cells were analyzed by the AI chronic rhinosinusitis evaluation platform 2.0. Results: CCAD was most common in male (71.43%). The positive rate of aeroallergen in patients with CCAD is 100%, which is much higher than those in patients with ENP (40.63%) and NENP (23.08%). Allergic rhinitis incidence was found to be 57.14% in Chinese CCAD subjects, which is obviously higher when compared with those in patients with ENP (21.88%) or NENP (0.00%). The presence of asthma was not significantly different between groups. Chinese CCAD population demonstrated mild symptoms and lower endoscopic and radiological scores than those in patients with ENP and NENP. For cellular endotypes in CCAD subjects, the median of eosinophils, neutrophils, lymphocytes, and plasma cells was 26.55%, 0.49%, 60.85%, and 7.33%, respectively. The proportion of eosinophils in nasal tissue and peripheral blood mononuclear cells from the CCAD group is between the proportions in those patients with ENP and NENP. Conclusion: Chinese CCAD was associated with aeroallergen sensitivity, and displayed an eosinophil-dominant inflammatory pattern. Thus, proper management with allergy control and topical steroids could be recommended for CCAD treatment.

Background: Community-acquired pneumonia (CAP) is a leading cause of morbidity and mortality worldwide. Although there are many predictors of death for CAP, there are still some limitations. This study aimed to build a simple and accurate model based on available and common clinical-related feature variables for predicting CAP mortality by adopting machine learning techniques. Methods: This was a single-center retrospective study. The data used in this study were collected from all patients (≥ 18 years) with CAP admitted to research hospitals between January 2012 and April 2020. Each patient had 62 clinical-related features, including clinical diagnostic and treatment features. Patients were divided into two endpoints, and by using Tensorflow2.4.1 as the modeling framework, a three-layer fully connected neural network (FCNN) was built as a base model for classification. For a comprehensive comparison, seven classical machine learning methods and their integrated stacking patterns were introduced to model and compare the same training and test data. Results: A total of 3997 patients with CAP were included; 205 (5.12%) died in the hospital. After performing deep learning methods, this study established an ensemble FCNN model based on 12 FCNNs. By comparing with seven classical machine learning methods, the area under the curve of the ensemble FCNN was 0.975 when using deep learning algorithms to classify poor from good prognosis based on available and common clinical-related feature variables. The predicted outcome was poor prognosis if the ControlNet’s poor prognosis score was greater than the cutoff value of 0.50. To confirm the scientificity of the ensemble FCNN model, this study analyzed the weight of random forest features and found that mainstream prognostic features still held weight, although the model is perfect after integrating other factors considered less important by previous studies. Conclusion: This study used deep learning algorithms to classify prognosis based on available and common clinical-related feature variables in patients with CAP with high accuracy and good generalizability. Every clinical-related feature is important to the model.

Background: Diagnosis of kidney transplant rejection currently relies on manual histopathological assessment, which is subjective and susceptible to inter-observer variability, leading to limited reproducibility. We aim to develop a deep learning system for automated assessment of whole-slide images (WSIs) from kidney allograft biopsies to enable detection and subtyping of rejection and to predict the prognosis of rejection.Method: We collected H&E-stained WSIs of kidney allograft biopsies at 400x magnification from January 2015 to September 2023 at two hospitals. These biopsy specimens were classified as T cell-mediated rejection, antibody-mediated rejection, and other lesions based on the consensus reached by two experienced transplant pathologists. To achieve feature extraction, feature aggregation, and global classification, we employed multi-instance learning and common convolution neural networks (CNNs). The performance of the developed models was evaluated using various metrics, including confusion matrix, receiver operating characteristic curves, the area under the curve (AUC), classification map, heat map, and pathologist-machine confrontations.Results: In total, 906 WSIs from 302 kidney allograft biopsies were included for analysis. The model based on multi-instance learning enables detection and subtyping of rejection, named renal rejection artificial intelligence model (RRAIM), with the overall 3-category AUC of 0.798 in the independent test set, which is superior to that of three transplant pathologists under nearly routine assessment conditions. Moreover, the prognosis models accurately predicted graft loss within 1 year following rejection and treatment response for rejection, achieving AUC of 0.936 and 0.756, respectively.Conclusion: We first developed deep-learning models utilizing multi-instance learning for the detection and subtyping of rejection and prediction of rejection prognosis in kidney allograft biopsies. These models performed well and may be useful in assisting the pathological diagnosis.

Background: Posttransplant renal function is critically important for kidney transplant recipients. Accurate prediction of graft function would greatly help in deciding acceptance or discard of allocated kidneys.Methods: : Whole-slide images (WSIs) of H&E-stained donor kidney biopsies at × 200 magnification between January 2015 and December 2019 were collected. The clinical characteristics of each donor and corresponding recipient were retrieved. Graft function was indexed with a stable estimated glomerular filtration rate (eGFR) and reduced graft function (RGF). We used convolutional neural network (CNN)-based models, such as EfficientNet-B5, Inception-V3, and VGG19 for the prediction of these two outcomes.Results: In total, 219 recipients with H&E-stained slides of the donor kidneys were included for analysis [biopsies from standard criteria donor (SCD)/expanded criteria donor (ECD) was 191/28]. The results showed distinct improvements in the prediction performance of the deep learning algorithm plus the clinical characteristics model. The EfficientNet-B5 plus clinical data model showed the lowest mean absolute error (MAE) and root mean square error (RMSE). Compared with the clinical data model, the area under the receiver operating characteristic (ROC) curve (AUC) of the clinical data plus image model for eGFR classification increased from 0.69 to 0.83. In addition, the predictive performance for RGF increased from 0.66 to 0.80. Gradient-weighted class activation mappings (Grad-CAMs) showed that the models localized the areas of the tubules and interstitium near the glomeruli, which were discriminative features for RGF.Conclusion: Our results preliminarily show that deep learning for formalin-fixed paraffin-embedded H&E-stained WSIs improves graft function prediction accuracy for deceased-donor kidney transplant recipients.

Objectives: This study aimed to develop a deep learning-based model to predict the risk of high-risk extra-glandular organ involvement (HR-OI) in patients with Sjogren’s syndrome (SS) using whole-slide images (WSI) from labial gland biopsies. Methods: We collected WSI data from 221 SS patients. Pre-trained models, including ResNet50, InceptionV3, and EfficientNet-B5, were employed to extract image features. A classification model was constructed using multi-instance learning and ensemble learning techniques. Results: The ensemble model achieved high area under the receiver operating characteristic (ROC) curve values on both internal and external validation sets, indicating strong predictive performance. Moreover, the model was able to identify key pathological features associated with the risk of HR-OI. Conclusions: This study demonstrates that a deep learning-based model can effectively predict the risk of HR-OI in SS patients, providing a novel basis for clinical decision-making. Key Points 1. What is already known on this topic?• Sjogren’s syndrome (SS) is a chronic autoimmune disease affecting the salivary and lacrimal glands.• Accurate prediction of high-risk extra-glandular organ involvement (HR-OI) is crucial for timely intervention and improved patient outcomes in SS.• Traditional methods for HR-OI prediction rely on clinical data and lack objectivity. 2. What this study adds?• This study proposes a novel deep learning-based model using whole-slide images (WSI) from labial gland biopsies for predicting HR-OI in SS patients.• Our model utilizes pre-trained convolutional neural networks (CNNs) and a Vision Transformer (ViT) module to extract informative features from WSI data.• The ensemble model achieves high accuracy in predicting HR-OI, outperforming traditional methods.• The model can identify key pathological features in WSI data associated with HR-OI risk. 3. How this study might affect research, practice or policy?• This study provides a novel and objective approach for predicting HR-OI in SS patients, potentially leading to improved clinical decision-making and personalized treatment strategies.• Our findings encourage further investigation into the role of deep learning and WSI analysis in SS diagnosis and risk stratification.• The development of a non-invasive and objective diagnostic tool based on WSI analysis could benefit clinical practice and inform policy decisions regarding patient care for SS.The development of a non-invasive and objective diagnostic tool based on WSI analysis could benefit clinical practice and inform policy decisions regarding patient care for SS.