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Objective To investigate the effect of rimimazolam tosylate on hemodynamics during the induction of general anesthesia in elderly patients.Methods A total of 90 elderly patients who received non-cardiac surgery under tracheal intubation general anesthesia in our hospital were selected,and randomly divided into the remimazolam tosylate group(group R)and the etomidate group(group E).During anesthesia induction,patients in the group R were given 0.3 mg/kg of remimazolam tosylate,and patients in the group E were given 0.3 mg/kg of etomidate.The heart rate(HR),mean arterial pressure(MAP),and bispectral index(BIS)before the induction of anesthesia(T0),after the induction of anesthesia(T1),and after tracheal intubation(T2)of patients in the two groups were compared.The induction time,extubation time,Ramsay sedation score 5 minutes after extubation,time out of the postanesthesia care unit(PACU),operation time,anesthesia time and incidence of adverse reactions in the two groups were counted.Results There was no significant difference in the MAP,HR or BIS of patients at T0 between the two groups(P>0.05);the MAP of patients at T1 and T2 in the group R were higher than those in the group E(P<0.05),and the HR of patients at T2 was lower than that in the group E(P<0.05).Compared with T0,the HR,MAP and BIS of patients at T1 and T2 in the group R were decreased;the MAP and BIS of patients at T1 and T2 in the group E were decreased,HR of patients was decreased at T1 and increased at T2,with statistically significant differences(P<0.05).The induction time and extubation time of patients in the group R were shorter than those in the group E(P<0.05).There was no significant difference in the Ramsay sedation score,time out of the PACU,operation time oranesthesia time of patients between the two groups(P>0.05).The incidences of myoclonus and hypotension of patients in the group E were higher than those in the group R,and the total incidence of adverse reactions in the group E was higher than that in the group R,with statistically significant differences(P<0.05).Conclusion Compared to etomidate,remazolam tosylate is more stable in inducing hemodynamics and has fewer adverse reactions in elderly patients under general anesthesia.
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Purpose The study aims to investigate the effects of various ages,genders and body mass index(BMI)on amide proton transfer weighted(APTw)in the right kidney of normal Chinese.Materials and Methods A total of 182 healthy volunteers enrolled from September 2021 to February 2022 at Xi'an GaoXin Hospital were prospectively performed.There were 7 groups(11-80 years)according to age per 10 years;2 groups according to gender,male and female;4 groups according to BMI,slim group,normal group,overweight group and obese group.3D-APTw imaging of the right kidney was performed via intermittent breath-holding.The correlation between APT values and age and BMI was analyzed,and the differences in APT values between age groups,different BMI groups and gender were analyzed,respectively.Results A total of 131 cases were finally included.There was a weak positive correlation between APT and age(r=0.325,P<0.001).There were statistical difference in APT values among different age groups(F=3.566,P=0.003),the post-hoc analysis showed that the APT values of 11-20 years[(1.853±0.357)%]old group was significantly lower than those of 41-50 years[(2.387±0.432)%]old group and 51-60 years[(2.336±0.451)%]old group(P<0.05);the APT value of male[1.980(2.320,1.820)%]was significantly lower than that of female[2.284(2.586,1.825)%;Z=2.301,P=0.021].There was a very weak positive correlation between APT and BMI(r=0.181,P=0.039),with statistically different APT values among BMI groups(F=3.265,P=0.024).The results of intra-group analysis showed that APT values in emaciation group were significantly lower than those in normal group,overweight group and obesity group,respectively(all P<0.05).Conclusion The APT value of the right kidney may be correlated with age and BMI,with males lower than females.The effect of age,gender and BMI on APT on the clinical application of 3D-APTw may be considered.
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ObjectiveTo explore the efficacy and safety of using a tourniquet in amputation for lower limb gangrene. MethodsAll patients underwent amputation for lower limb gangrene from January, 2009 to June, 2023 in Beijing Bo'ai Hospital were reviewed, involving 41 patients with a total of 44 limbs, and they were divided into non-tourniquet group (n = 28) and tourniquet group (n = 16) according to whether a tourniquet was used during surgery. The amputation field clearness, surgical bleeding, incision healing, reoperation rate within 30 days post-operation, intraoperative blood pressure and heart rate, and operation time were compared. ResultsThe amputation field was clearer in the tourniquet group (χ2 = 42.385, P < 0.001), with less bleeding (Z = -2.082, P < 0.05). No tourniquet-related local damages, such as nerve damage and skin injuries, was observed in the limbs using tourniquets. The incidence of grade A of incision healing was not significantly different (χ2 = 0.028, P = 0.624). ConclusionApplication of tourniquet can improve the amputation field clearness and reduce bleeding during amputation for lower limb gangrene, without affecting incision healing.
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Objective To design a mobile container-based negative pressure chamber compatible with kinds of carriers to isolate and treat patients with respiratory infectious diseases.Methods A negative pressure chamber with standard container sizes was developed whose enclosure structure involved in 2 mm-thick galvanized steel plate,10 mm-thick high-performance thermal isolation polyurethane foam board,2 mm-thick galvanized steel plate and 10 mm-thick integral inner panel.There were three functional areas included in the chamber for clean office area,semi-polluted passage and polluted ward with toilet.Negative pressure differences between the functional areas were generated by full DC air supply and exhaust system to form directional air flow in the chamber.The patient's exhaled air was purified before emission with the high-efficiency particulate air filtration system.The negative pressure chamber was equipped with a portable life monitoring and support device,a remote consultation and guidance system,a water and electricity support system and etc.Results Air quality tests showed that the negative pressure chamber met the national standards in air cleanliness,static pressure difference,number of dust particles,settled bacteria,microorganisms on the surface of the object and etc.Conclusion The negative pressure chamber compatible with kinds of carriers can be used for the isolation and emergency treatment of patients with respiratory infectious diseases and the long-distance transport of critically ill patients.[Chinese Medical Equipment Journal,2023,44(9):24-28]
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Guaranteeing the rights and safety of subjects is an important responsibility of all participants in the medical devices clinical trial, including medical institutions, sponsors and researchers. The legal disputes caused by serious adverse events in the clinical trial of medical devices are characterized by complex legal relationships, great difficulty in handling, and many points of dispute. Based on a typical case of medical device clinical trials, this paper discussed the litigation subject qualification, the treatment of contract breach and tort in medical device clinical trial, analyzed the responsibility of different subjects, and provided constructive suggestions on the risk management of medical device clinical trial.
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OBJECTIVES@#Congenital birth defects are the main source of disease burden among children under 5 years old in China. This study aims to compare the trends in disease burden of different congenital birth defects among Chinese children under 5 years old from 1990 to 2019, and to provide a scientific basis for strengthening the comprehensive prevention and control of birth defects.@*METHODS@#Based on data from the Global Burden Disease (GBD) in 2019, the incidence mortality rate, and disability-adjusted life years (DALYs) rate of congenital birth defects among Chinese children under 5 years old from 1990 to 2019 were selected as evaluation indicators. The Joinpoint regression model was used to analyze the trends in disease burden of different types with congenital birth defects over three decades. The study also compared the differences in disease burden of congenital birth defects among children under 5 years old by gender.@*RESULTS@#Compared to 1990, the DALYs rates of congenital heart anomalies (1 931.91/100 000), digestive congenital anomalies (364.63/100 000), neural tube defects (277.20/100 000), congenital musculoskeletal and limb anomalies (133.33/100 000), and Down syndrome (128.22/100 000) in children under 5 years old in China in 2019 were decreased 70.78%, 71.61%, 86.21%, 36.84% and 73.65%, respectively. From 1990 to 2019, the mortality rates and DALYs rates of different congenital birth defects showed an overall downward trend, but the incidence of digestive congenital anomalies and Down syndrome showed an upward trend after 2005 and 2001, respectively. Except for congenital musculoskeletal and limb anomalies, incidence of the remaining categories of birth defects were higher in boys than that in girls.@*CONCLUSIONS@#The disease burden of congenital birth defects in children under 5 years old in China is decreased substantially from 1990 to 2019, but the burden of congenital heart anomalies is still serious and the incidence of some birth defect diseases is on the rise, and it is still crucial to strengthen the prevention and treatment for birth defects in children and propose targeted measures according to their gender characteristics.
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Child, Preschool , Female , Humans , Male , China/epidemiology , Cost of Illness , Down Syndrome/epidemiology , East Asian People , Congenital Abnormalities/epidemiologyABSTRACT
Background and Objectives@#Apoptosis is an outstanding determinant of glucocorticoid (GC)-induced osteonecrosis of the femoral head (ONFH). Human umbilical cord mesenchymal stem cells (hUC-MSCs) have been demonstrated to be associated with apoptosis in diseases models. However, the role of hUC-MSCs in GC-induced ONFH via regulating apoptosis still needs further study. @*Methods@#and Results: In the present study, a GC-induced ONFH model was built in vivo through a consecutive injection with lipopolysaccharide (LPS) and methylprednisolone. The necrosis and apoptosis of the femoral head was evaluated by histological and Terminal-deoxynucleoitidyl Transferase Mediated Nick End Labeling (TUNEL) assay. The level of collagen and TRAP positive cells were determined by Masson and TRAP staining, respectively. M1 macrophage polarization was assessed using immunofluorescence assay. The level of proinflammatory cytokines including tumor necrosis factor (TNF)‐α, Interleukin (IL)‐1β and IL-6 of femoral head was determined by enzyme-linked immunosorbent assay (ELISA) kits. The protein expression of AKT, mTOR, p-AKT and p-mTOR was detected using western blot assay. The results showed that hUC-MSCs treatment prominently promoted the GC-induced the decrease of the collagen level and the increase of TRAP positive cells. Besides, hUC-MSCs treatment decreased necrosis and apoptosis, macrophage polarization, the level of TNF‐α, IL‐1β and IL-6, the protein expression of p-AKT and p-mTOR, and the radio of p-AKT to AKT and p-mTOR to mTOR of femoral head in vivo. @*Conclusions@#Therefore, the present study revealed that hUC-MSCs improved the necrosis and osteocyte apoptosis in GC-induced ONFH model through reducing the macrophage polarization, which was associated with the inhibition of AKT/mTOR signaling pathway.
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ObjectiveTo analyze the epidemiological and clinical characteristics of children's lower extremity amputation and amputation rehabilitation, and to explain the causes of children's amputation and the complications after amputation. MethodsFrom January, 2016 to March, 2021, 51 amputation related children were retrospectively analyzed. The correlation between the cause of amputation and complications post amputation were analyzed. ResultsTraumatic amputations accounted for 58.82%, and the main cause was traffic accidents (70%). Amputations caused by diseases accounted for 41.18%, and the main cause was congenital limb deformities (80.95%). Traumatic amputation was more likely to have stump complications than expected (P < 0.05). The possibility of stump complications after disease-specific amputation was lower than expected (P < 0.05). ConclusionTraffic trauma is the main cause of amputation in children and is characterized clinically by a high incidence of unsatisfactory stumps, mainly due to soft tissue abnormalities, and most cases require stump revision to improve the poor residuals for prosthetic restoration of ambulation. Congenital pseudarthrosis of the tibia is the main cause of disease-specific amputation, and the outcome of amputation often cannot be definitely avoided even after long-term limb preservation treatment.
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This study integrates metabolomics and network pharmacology techniques to systematically analyze the possible mechanism of Pudilan Xiaoyan oral liquid (PDL) in the treatment of acute respiratory infections. GC-MS metabolomics analysis found 8 endogenous metabolites, 3-phosphoglycerate, α-aminoadipate, D-ribulose-5-phosphate, β-mannosylglyceric acid, D-fructose, urea, D-maltose and ornithine in the serum of mice with acute respiratory infection induced by LPS; these substances can be used as biomarkers for PDL use in the treatment of acute respiratory infections. Biological network studies revealed 10 potential targets for intervention by PDL in the glycolysis and pentose phosphate pathways, including GPI, G6PD, H6PD, PFKM, TALDO1, TKT, GAPDH, HK1, PKLR and TPI1. All animal experiments were carried out with approval of the Animal Ethics Committee of Nanjing University of Chinese Medicine. Our findings indicate that the strategy of combining metabolomics and network analysis can provide information on the possible mechanism of PDL in acute respiratory infections, and reveal that PDL may ameliorate the pathological process of acute respiratory infections by regulating disordered metabolic pathways.
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Coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), was found initially in Wuhan, China in early December 2019. The pandemic has spread to 216 countries and regions, infecting more than 23310 000 people and causing over 800 000 deaths globally by Aug. 24, 2020, according to World Health Organization (https://www.who.int/emergencies/diseases/ novel-coronavirus-2019). Fever, cough, and dyspnea are the three common symptoms of the condition, whereas the conventional transmission route for SARS-CoV-2 is through droplets entering the respiratory tract. To date, infection control measures for COVID-19 have been focusing on the involvement of the respiratory system. However, ignoring potential faecal transmission and the gastrointestinal involvement of SARS-CoV-2 may result in mistakes in attempts to control the pandemic.
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Humans , Betacoronavirus/isolation & purification , COVID-19 , China/epidemiology , Coronavirus Infections/virology , Environmental Microbiology , Feces/virology , Gastrointestinal Diseases/virology , Models, Biological , Pandemics , Pneumonia, Viral/virology , RNA, Viral/genetics , SARS-CoV-2 , Virus SheddingABSTRACT
As the first line of defense of the host immune system, natural killer cells play important roles in anti-tumor immunity, either by direct anti-tumor effects, or by assisting T cell immune responses. However, NK cells are usually functionally exhausted in tumor microenvironment, accompanied with dysregulated expression of an array of surface receptors, restricting the effector potentials of NK cells. NK-based checkpoint immunotherapy aims to trigger anti-tumor efficacy by blocking NK cell surface inhibitory receptors, unleashing NK cells from inhibitory signals of the tumor microenvironment, and reversing NK cell exhaustion, representing a novel strategy in cancer therapy. With more in-depth research to reveal the mechanisms of action, indications, and biomarkers for specific NK cell checkpoint molecules, we shall fully exploit the potentials of NK-based checkpoint blockade immunotherapy.
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Flavonoids have many physiological and pharmacological activities. Ionic liquids are increasingly used in the extraction of flavonoids from natural products due to their unique properties. In this paper, various extraction methods of natural flavonoids were reviewed and summarized. The effects of anion and cation type, length of carbon chain, and bond cooperation on the extraction of natural flavonoids in ionic liquids, especially imidazole type ionic liquids, were also reviewed. Suggestions on selection of extractant for ionic liquid extraction of flavonoids were given. The advice of the green recovery of ionic liquids and the development of edible ionic liquids for the future direction of development were suggested. This study will lay the foundation for the basic research and industrial application of ionic liquids in the extraction of natural flavonoids.
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The analysis of Forsythia suspensa was performed on Waters Symmetry C18 column( 4. 6 mm×250 mm,5 μm) and mobile phase was methanol( A)-0. 1% formic acid aqueous solution( B) with the elution gradient. Column temperature was maintained at 30℃,and the flow rate was 1. 0 m L·min-1 with detection wavelength 265 nm. The HPLC-PDA fingerprint of F. suspensa was optimized.Chemical constituents in F. suspensa were analyzed by UFLC-Q-TOF-MS in positive and negative ion mode. The quality of 48 batches of F. suspensa from different habitats,processing methods and specifications was evaluated by similarity evaluation and cluster analysis.The 18 common peaks were confirmed. The similarity of F. suspensa from different habitats was more than 0. 98,and 56 chemical constituents were identified. Different processing methods had great influence on the quality of F. suspensa. Compared with boiled and direct drying,the quality of F. suspensa processed by sun-drying was obviously decreased. The similarity was about 0. 58. Different specifications of F. suspensa also had obvious distinction,and the similarity was about 0. 78. The effective components of grown F. suspensa,such as forsythoside A and phillyrin,were significantly reduced. The results of cluster analysis were basically consistent with the results of similarity evaluation. The establishment of fingerprint and the recognition of chemical pattern of F. suspensa can provide a more comprehensive reference for the quality control of herbs.
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Chromatography, High Pressure Liquid , Drugs, Chinese Herbal/chemistry , Forsythia/chemistry , Quality ControlABSTRACT
To establish a method for the simultaneous determination of 9 components, namely gardenoside, paeoniflorin, forsythoside A, baicalin, forsythin, glycyrrhizic acid, rhein, honokiol, and magnolol in Xiao'er Chiqiao Qingre granules(XECQ Gra). Ultra performance liquid chromatography (UPLC) was used on an Acquity UPLC HSS T3 C₁₈ column (2.1 mm×100 mm, 1.8 μm) with 0.1% phosphoric acid acetonitrile (A)-0.1% phosphoric acid solution (B) as mobile phase for gradient elution. The flow rate was 0.3 mL·min⁻¹ ; the column temperature was set at 30 °C, and the determination wavelength was set at 220 nm. All the 9 compounds were well separated, and showed good linear relationship within their concentrations (r>=0.999). The average recoveries were between 95.84%-101.4% and the RSD values were all less than 3.0%. The method is simple, reliable, and accurate, and could be used for the quality control of XECQ Gra.
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A new sensitive method for detection of cumulative radon radiation based on the lead was established. PS2.M which stabilized by K+with hemin as a co-factor exhibits superior peroxidase-like activity, and can effectively catalyze the H2O2-mediated oxidation of TMB. In the presence of Pb2+, K+-stabilized PS2.M DNAzymes are induced to undergo a conformational change,because Pb2+has a higher efficiency with regard to stabilizing G-quadruplexes than K+, accompanied by a decrease of catalytic activity and a sharp decrease of readout signal. In the work, a novel"turn-off"model of colorimetry-Pb2+biosensor based on superior peroxidase-like activity of G-quadruplex for Pb2+analysis was developed. The fading degree of reaction system (△A value) was linearly related to Pb2+concentration in the range of 5. 0×10-9-1. 8× 10-7mol/L. The linear regression equation was △A=0.36+0.13C (10-8mol/L), with R=0.9987. The detection limits of lead and radon were 3.76 nmol/L(S/N=3) and 1.96×103Bq·h/m3(S/N=3), respectively. The method exhibited good selectivity, high sensitivity and convenient operation, and could avoid the radioactive hazard in determination of the radon in environment.
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Seven cucurbitane-type triterpenoids were isolated from the ethanol extract of the tubers of Hemsleya dolichocarpa, with a combination of various chromatographic approaches, including silica gel, Sephadex LH-20, Semi-HPLC and so on. On the basis of spectroscopic data analysis, they were identified as 3β,11α,26,27-tetrahydroxycucurbita-5,24(E)-diene-3,26-glucosides (1), scandenogenin D (2), jinfushanencin F (3), scandenoside R3 (4), scandenoside R1 (5), scandenogenin A (6), scandenoside R2 (7). Among them, compound 1 is a new triterpenoid, compound 2 showed remarkable activity against human cancer cell line HeLa with IC50 value of 6.78 μmol·L-1.
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Objective To observe the influence of direct peritoneal resuscitation on liver function in hemorrhagic shock rabbits with pyruvate peritoneal dialysis solution instead of lactate peritoneal dialysis solution. Methods 48 hemorrhagic shock rabbits were randomly divided into conventional intravenous resuscitation group (group A),intravenous resuscitation plus intraperitoneal injection of lactate peritoneal dialysis solution group (group B),intravenous resuscitation plus intraperitoneal injection of pyruvate peritoneal dialysis group(group C), intravenous pyruvate peritoneal dialysis resuscitation plus intraperitoneal injection of pyruvate peritoneal dialysis group(group D). The hemodynamic changes were observed and the AST and ALT were measured respectively before and 60 min after shock ,60 min and 180 min after resuscitation. The dry/wet weight ratio ,MDA and SOD of liver tissue were measured,and the liver morphological changes were observed. Results After the completion of shock resuscitation,MAP of all groups were almost restored to the basal level. 180 min after resuscitation,the MAP of animals in group A was lowered than that in group B,C and D(P<0.05). After shock,ALT and AST were signifi-cantly higher than those before shock ,but no significant difference was found between groups (P > 0.05). After resuscitation,ALT and AST continued to decline in all groups,but the decline range increased with the order of A, B,C,D group(P < 0.05). The water content and MDA in liver tissue decreased with the order of A,B,C,D group,while the SOD increased and the differences between groups were significant(P<0.05). And the degree of liver tissue morphological injury also relieved correspondingly. Conclusion Pyruvate substituting lactate peritoneal dialysis solution peritoneal resuscitation can be more effective in reducing liver damage of hemorrhagic shock rabbits.
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Objective:To explore the value of echocardiography for diagnosing infectious endocarditis (IE).Methods:A total of 487 patients with cardiovascular implantable electronic devices (CIED) infection treated in our hospital from 2013-01 to 2015-06 were enrolled.Based on symptoms,blood culture and echocardiography,9 patients with suspected IE were further examined by 18F-FDG PET-CT to confirm their diagnosis and classification.Definitive therapy was conducted and the patients were followed-up for 1 year to confirm the diagnostic accuracy of echocardiography on CIED induced IE.Results:3 patients were preliminarily diagnosed for bacteremia since no vegetation was found by echocardiography,while IE was finally diagnosed by PET-CT.2 patients were preliminarily diagnosed for IE by echocardiography presented valvular vegetation,while PET-CT showed no evidence of vegetation;then one of them was diagnosed as bacteremia by positive blood culture and another was diagnosed as non-infection.4 patients were preliminarily diagnosed for IE by echocardiography indicated existing vegetation after CIED lead extraction,while PET-CT demonstrated no infection sign in heart chamber and the finally diagnosed was as "non-infectious fibrous residual tissue".According to final diagnosis,definitive therapies were performed to specific patients with at least 1 year follow-up study,no one had new and recurrent infection.Conclusion:Echocardiography had deficiency for diagnosing vegetation in heart chamber especially in suspicious IE patients after CIED lead extraction.It is necessary to make accurate diagnosis with other method for guiding appropriate therapy.
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Objective To explore the efficacy of arthroscopic treatment for acute avulsion fracture of posterior cruciate ligament (PCL) using double titanium plate TightRope. Methods From December 2014 to January 2015, two cases with acute avulsion fracture of PCL were treated with double titanium plate TightRope under arthroscopy, after assessment of three dimensional reconstructive CT and MRI. Rehabili-tation was carried out after operation. Results One case succeeded with double titanium plate TightRope, and rehabilitation could be per-formed early postoperatively. Another case failed in TightRope fixation, and accepted two internal hollow screws fixation instead. Rehabili-tation was delayed until two weeks postoperatively. The function of the knee was satisfactory in the former patient after three months, who could extend the knee in a normal range, without pain or locking. The same effect was gained in the latter patient after four months. Conclu-sion For acute tibial avulsion fracture of PCL with larger and intact fragment without osteoporosis, arthroscopic restoration and fixation with double titanium plate TightRope offers the opportunity to achieve anatomic reconstruction and rigid fixation for early rehabilitation in adult patients.
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Objective To investigate the diagnostic value of serum tumors M2 pyruvate kinase (TuM2-PK),carcino-embryonic antigen (CEA),CA199,CA724,CA125 and CA242 in colon cancer.Methods Serum levels of TuM2-PK,CEA,CA199,CA724,CA125 and CA242 in 231 patients with colon cancer,105 patients with colon benign lesion diseases and 166 normal controls were measured by the ELISA and electrochemiluminescence assays.The operation working characteristic curve (ROC) and the logistic regression-ROC were used to evaluate the diagnostic value of tumor markers for colon cancer individually and in combination.The models of logistic regression analysis and partial least-squares discriminant analysis (PLS-DA) were established to diagnose patients with colon cancer based on the optimal panel of serum tumor markers.Resalts Concentrations of serum TuM2-PK,CEA,CA199,CA125 and CA724 in the colon cancer group are higher than those in the colon benign diseases group and the normal controls (P<0.05).The area under the operation working characteristic curve (AUC) of CA199 is the highest 0.79 [95% confidence interval (95%CI),0.75-0.83] at the cutoff value of 69.5 U/L with 64.1% of sensitivity and 89.7% of specificity.The AUC of combined serum tumor markers based on logistic regression analysis is higher than those in individuals,of which serum (CEA+ CA199+TuM2-PK) is the optimal [AUC=0.89,95% confidence interval(95%CI),0.86-0.92].The diagnostic accuracy of logistic analysis and PLS-DA model for colon cancer is 82.7% and 77.5%,and for colon cancer is 93.7% and 95.6%,respectively.Conclusion The combination of serum tumor markers CEA,CA199 and TuM2-PK is more suitable as a diagnostic model for the screening of colon cancer.