ABSTRACT
Objective:To develop an diagnostic equipment with artificial intelligence (AI) real-time assistance under endoscopy (endoscopic AI equipment) for the detection of gastrointestinal protruding lesions, and to evaluate its performance and safety.Methods:From January to December 2017, at Endoscopy Center of West China Hospital, Sichuan University, the endoscopic images of individuals who underwent routine gastroscopy and colonoscopy were collected. The model was established based on convolutional neural network and the endoscopic AI equipment was developed. From June to December 2019, a prospective, single center, blinded and parallel controlled study was conducted to compare the differences in evaluation of protruding lesions of the same patient under gastroscopy or colonoscopy between endoscopist and the endoscopic AI equipment and to evaluated the impact of lesion size (lesions <5 mm and ≥5 mm) on the detection of endoscopic AI equipment. The main outcome measure was the detection time difference in reporting the protruding lesion between endoscopic AI equipment and endoscopist; and the secondary indicator was the accuracy of endoscopic AI equipment in detecting the protruding lesion. Wilcoxon rank sum test and chi-square test were used for statistical analysis.Results:A total of 71 582 white light endoscopy images were used for endoscopic AI equipment training, which included 41 376 images of protruding lesions. The endoscopic AI equipment was successfully developed and obtained the registration certificate of medical devices of the People′s Republic of China (Sichuan Instrument Standard, 20202060049). The accuracy, sensitivity, and specificity of endoscopic AI equipment in detecting protruding lesions were 96.4%, 95.1% and 92.8%, respectively. The detection time of each protruding lesions under gastroscopy of endoscopic AI equipment was 1.524 seconds faster than that of endoscopist; but the detection time of each protruding lesions under colonoscopy was 0.070 seconds slower than that of endoscopist, and the differences were statistically significant ( Z=-5.505 and -4.394, both P<0.01). The detection time of each protruding lesions under gastroscopy or colonoscopy of endoscopic AI equipment was not inferior to that of endoscopist. The detection rate of protruding lesions under colonoscopy by endoscopic AI equipment was 89.9% (249/277) and the sensitivity was 89.9%; the detection rate of protruding lesions under colonoscopy was 87.0% (450/517) and the sensitivity was 86.9%. There were no statistically significant differences in the detection time difference, sensitivity and missed diagnostic rate between the lesions <5 mm and ≥5 mm detected by endoscopic AI equipment under gastroscopy (all P>0.05). The sensitivity of endoscopic AI equipment in detecting the lesions ≥5 mm under colonoscopy was higher than that of lesions <5 mm (96.8% vs. 84.9%), and the missed diagnostic rate was lower than that of lesions <5 mm (3.2%, 3/94 vs. 15.1%, 61/405), and the differences were statistically significant ( χ2=9.615 and 9.612, both P=0.002). No adverse events on patients and medical staffs occurred, and there were no cases of equipment electricity leakage, and abnormal work reported during the use of endoscopic AI equipment. Conclusions:The endoscopic AI equipment can report the protruding lesions simultaneously with endoscopists, and the accuracy is close to 90%, which is expected to be a practical assistant for endoscopists to avoid missed detection of protruding lesions.
ABSTRACT
Objective To explore the difference of inflammatory cytokines and STAT3 expressions in intestinal mucosal tissue between Uyghur and Han patients with ulcerative colitis (UC) in Xinjiang Uyghur Autonomous Region.Methods Thirty inpatients (15 Uyghur cases and 15 Han cases) with UC in this hospital from June 2015 to October 2016 were selected as the UC group.Contemporaneous 26 individuals (13 Uyghur cases and 13 Han cases) undergoing physical examination served as the control group.The colonic mucosa tissue were taken for detecting the mRNA expression of IFN-γ,IL-22,IL-17A and IL-17F by reversal transcription-polymerase chain reaction (RT-PCR).The expression of STAT3 was detected by using the immunohistochemical staining technique.Results Compared with the Uyghur control group,the mRNA levels of IFN-γ,IL-22,IL-17A and IL-17F in the Uyghur UC group were up-regulated,the differences were statistically significant (P＜0.05);compared with the Han healthy control group,the mRNA levels of above inflammatory cytokines in the Han UC group were up-regulated,the differences were statistically significant (P＜0.05);but the mRNA levels of above inflammatory cytokines had no statistical difference between the Uyghur UC group and Han UC group (P＞0.05).The immunohistochemical method found that the STAT3 was found to be colored in the cytoplasm of intestinal mucosal epithelial cells.The positive expression rate of STAT3 in Han and Uyghur UC groups was higher than that in the corresponding control group,the differences were statistically significant (P＜0.05),however there was no statistically significant difference between Uyghur UC group and Han UC group,the difference was not statistically significant (P＞0.05).Conclusion In Xinjiang Uyghur Autonomous Region,the expressions of intestinal mucosal IFN-γ,IL-22,IL-17A,IL-17F and STAT3 in Uyghur and Han patients with UC are significantly increased,but the above cytokines may has no obvious difference in UC occurrence and development between Uyghur and Han patients.
ABSTRACT
Objective To investigate which is better for gastroduodenal endoscopic ultrasound (EUS) between right lateral position and left lateral position of patients guided by nurses. Methods A total of 79 patients were randomly assigned to the left and right lateral position groups. Each patient received EUS examination in three parts, which were sinuses ventriculi, duodenal bulb and descendant duodenum. The operating time and the water volume of each patient were recorded in the procedure of EUS. Results Operating time in sinuses ventriculi, duodenal bulb and descendant duodenum of left lateral position group was (9.0±4.0) min, (6.5±3.2) min and (13.6±10.9) min, while (5.7±3.0) min, (3.6± 1.7) min and ( 6.6±5.7) min in right lateral position group, the differences were significant (t=3.098, 2.190, 3.210, P<0.05) . In the meantime, water volume was (892.0±169.5) ml, (898.6±145.9) ml and (1 012.0± 333.2) ml in sinuses ventriculi, duodenal bulb and descendant duodenum of left lateral position group, while (327.1±79.3) ml, (260.6±30.4) ml and (263.8±17.7) ml in three parts of right lateral position group, respectively. Significant differences were found in water volume among subgroups (t=13.798, 11.290, 4.930, P<0.01 or 0.05). Conclusions In the process of EUS for submucosal lesions at gastric antrum and duodenum, right lateral position instructed by nurses can shorten the operating time and make the procedure easier. This might reduce risks of regurgitation, aspiration, and other related complications.
ABSTRACT
Diarrhea is a common intestinal symptom in macaque.The corresponding intestinal lesions of macaque are mainly described at autopsy but less observed by colonoscopy.The aim of this study was to develop a colonoscopic technique and to obtain endoscopic images of the entire colon in macaques.Eight healthy adult macaques ( 5 males and 3 females) without diarrhea for 2 months, were fed Glauber’ s salt through nasogastric tubes.The colon cleanliness was well matched to the endoscopic observation of macaque colon.The procedure took 10-20 min for each animal.There was no obvious abnormality in the colon of four animals except some slight differences of mucosal structure from that of human beings.Small pieces of erosion and ulcer in the colons were observed in four macaques which presented mild diarrhea for less than 1 day, while a severe stenosis was observed in one of those four macaques.No animal died during and one week after the endoscopic procedure.Colonoscopy may safely performed in macaques.The images taken by colonoscopy may be important to establish diagnosis and treatment of colitis in macaques in time and to evaluate the efficacy of drug intervention as well.This technique is also helpful to provide qualified macaques for scientific researches.
ABSTRACT
Objective:To investigate the optimal administration approach of using aspirin by observing the effects of the rats in-testinal mucosal barrier and somatostatin receptors level with different administration approaches of using non-steroid anti-inflammatory drugs-aspirin.Methods:32 SD rats were randomly divided into 4 groups:oral intake group,enema group,intraperitoneal injection group and control group.Every group had 8 rats.The ileum mucosal injury was scored.The level and distribution of SSTRs in every group was detected by ELISA and immunohistochemistry, respectively, The IOD score in each group was measured by image analysis.Results:(1) The scores of ileum mucosal injury in aspirin experimental groups were significantly higher than that in control group (P0.05).Conclusion:Aspirin can damage the rat intestinal mucosa.Aspirin could lead to the decrease of SSTR1-5 expression in the intestinal mucosa.All subtypes of SSTR in rat small intestine mucosa were expressed, suggesting that aspirin could affect the barrier function of the intestine.There were different influences on SSTR1-5 expression by different administration approaches,suggesting aspirin by parenteral approach may reduce the intestinal damage.
ABSTRACT
Objective:To investigate the changes of somatostatin ,epidermal growth factor receptor ,prostaglandin E2 and mucus of ileum in SD rats injected aspirin.Methods:32 SD rats were randomly divided into 4 groups:oral intake group ,coloclyster group ,in-traperitoneal injection group and normal control group.Ileal tissue sections were stained by Alcian blue.The positive area and IOD of Alcian blue was counted by image analysis in each group.The concentration of SST ,EGFR and PGE2 were detected by ELISA immuno-histochemistry ,and the IOD of each index was measured by image analysis in each group.Results:The score of ileum mucosal injury were highest in aspirin treatment groups ( P<0.05 ) ,but the score was no difference among aspirin treatment groups.The area and IOD of mucus in aspirin treatment groups were less than normal control group .The Area ( 602.17 ±158.03 ) and level of IOD ( 249.54 ± 113.19) in intraperitoneal injection group was the lowest (P<0.05).There were no differences of level of SST ,EGFR was observed among all groups .The concentration and IOD of PGE2 in normal control group was the highest (P<0.05).However,his discrepancy was not obvious among three groups of aspirin.Conclusion: Aspirin, in the four routes of administration , can cause damage to the mucosa of the rat small intestine in two weeks.The integrity of the small intestinal mucosa and mucus secretion were damaged significantly ,and it was the worst in intraperitoneal injection group.These changes might be correlated with the reduction of PGE 2.No clear results showed that the SST and EGFR were involved in the pathophysiology of the NSAIDs .
ABSTRACT
Objective To explore the common causes of epilepsy and the etiologic characteristics in different age groups of patients with epilepsy.Methods A retrospective survey was made in 5572 epilepsy patients in Epileptic Center of Guangdong 999 Brain Hospital from January 2003 to December 2009.According to the diagnostic criteria published in 2005 from ILAE,all the diagnoses of 5572 cases were made by epileptic specialists.Based on history,cranial MRI or CT and pathologic data,causes of epilepsy were classified into idiopathic,symptomatic and cryptogenic epilepsy.The cases of symptomatic epilepsy were further arranged into different categories in different age grades,such as head trauma,perinatal injuries,infection in central nervous system, cerebral vascular disease, brain tumor, disorders of cortical development,neurocutaneous syndrome and others.The cases with febrile seizures and family history were collected,and positive ratio of febrile seizures and family history were contrasted in different categories of cases by Kruskal-Wallis test ( nonparametric test ).Results In 5572 cases,66 were idiopathic,2834 symptomatic,2672 cryptogenic,and the ratio of these causes was 1％,51％,48％ respectively.Among 2834 cases of symptomatic epilepsy,822 were head trauma,497 were perinatal injuries,360 were infection in central nervous system,249 were brain tumor,150 were cerebral vascular disease,135 were disorders of cortical development,62 were neurocutaneous syndrome and 559 were others. In brief,head trauma,perinatal injuries,infection in central nervous system,brain tumor and cerebral vascular disease were top 5 causes of symptomatic epilepsy. Hippocampal sclerosis was found in 744 cases in those of eryptogenic epilepsy.The importance of febrile seizures( idiopathic:15.2％ ( 10/66 ),symptomatic:6.5％ ( 185/2834 ),cryptogenic:9.4％ ( 250/2672 ) ; x2 =181.393,P =0.000 ) and family history ( idiopathic:83.3％ ( 55/66 ),symptomatic:1.1％ (31/2834),cryptogenic:0.4％ (12/2672) ; x2 =68.354,P =0.000) was statistically different in different causes of epilepsy.Febrile seizures was the most frequent in cases with hippocampal sclerosis than those with other causes,and family history was the most frequent in neurocutaneous syndrome in symptomatic cases.Perinatal injurics was thc first causc in cases of infancy and childhood,head trauma was the top one in those of juvenile and adulthood,and cerebral vascular disease was the main cause in senile cases. Conclusions In the whole epileptic cases of 5572, 1％ was idiopathic,51％ was symptomatic,and 48％ cryptogenic. The main causes of them were head trauma,perinatal injuries,infection in central nervous system,brain tumor,and cerebral vascular disease.
ABSTRACT
Objective To study change of insulin resistance and beta-cell function of the patients in hyper-tension with normal glucose tolerance(NGT) to phthogonesis of type 2 diabetes mellitus(T2DM). Methods 84 pa-tients with hypertension were divided into NGT group,and groups of impaired glucose tolerance(IGT) with groups of T2DM. The blood pressure, height, weight, waist circumference, hip circumference, high-density lipoproteins (HDL-C)and total cholesterol(TC) ,fasting plasma glucose(FPG) and fasting plasma insulin(FINS) were measured to deter-mine the body mass index(BMI) ,waist/hip ratio(WHR) ,insulin secretion function[ including Homa β-cell function index(HBCI) and fasting β-cell function index(FBCI)] and insulin resistance level [ including Homa model insulin resistance index(IR) and insulin action index(IAI)] ,statistic comparison were measured between the groups of dif-ferent glucose tolerances. Results The BMI, WHR, diastolic blood pressure ( DBP), TC in IGT group and T2DM group were bigger or higher than those in NGT group ( P<0.05, P<0.01 ), the IAI, HOMA-IS and FBCI in T2DM group were lower than those in NGT group with these in NGT group were lower than those in NGT group( P<0.05 ,P<0.01 ). The HOMA-IR in IGT group and T2DM group were higher than those in NGT group with these in T2DM group were higher than those in NGT group. Conclusion T2DM group and IGT group had more insulin resistance level,sensitivity of insulin and islet β-cell function decrease than those in IGT group,the IGT group and T2DM group are analogous at the body weight is heavier, with waist/hips ratio, triglyceride level and DBP are higher than those in the NGT group in clinic.