Application of narrow-band imaging without magnifying in diagnosis of colorectal lesions by NICE classification / 上海交通大学学报（医学版）

Objective: To evaluate narrow-band imaging (NBI) without magnifying in the diagnosis of colorectal lesions by NBI International Colorectal Endoscopic Criteria (NICE classification), and analyze the safety and practicability of "do-not-resect" and "resect and discard" policies in clinical practice. Methods: The patients undergoing screening or surveillance colonoscopy, who were found colorectal lesions in the examination, from May to December in 2017 were enrolled. All the patients were examined by NBI without magnifying by any of the designated two physicians. NICE classification was used to diagnose colorectal lesions, and the diagnostic confidence of each lesion was recorded. The results of endoscopy were compared with those of pathology, and the accuracy rate and the confidence rate of diagnosis were calculated. The sensitivity, specificity, positive predictive value and negative predictive value of the diagnostic method for differentiating superficial tumors from non-tumors were also calculated. Finally, the feasibility, safety and cost savings of using "do-not-resect" and "resect and discard" policies in clinic were analyzed. Results: A total of 764 lesions were detected in the 636 enrolled patients. The overall accuracy of NICE classification was 84.95% and the diagnostic confidence rate was 81.68%. The sensitivity, specificity, positive predictive value and negative predictive value for differentiating tumors from non-tumors were 91.77%, 67.68%, 88.69%, and 74.86%, respectively. The diagnostic accuracy of diminutive colorectal lesions (≤5 mm) with high confidence was 94.98%, and the negative predictive value of diminutive rectosigmoid lesions (≤5 mm) with high confidence was 96.25%. They achieved the criteria of "resect and discard" and "do-not-resect" policies. If "do-not-resect" and "resect and discard" policies had been executed in clinical practice, ¥165 490 could have been saved and the omission diagnostic rates of "do-not-resect" and "resect and discard" policies would have been 3.75% and 0, respectively, in this study. Conclusion: It is feasible to use NBI without magnifying in differentiating tumors from non-tumors. The diminutive colorectal lesions and rectosigmoid lesions with high diagnostic confidence may achieve the criteria of "resect and discard" and "do-not-resect" policies, respectively.

Wall shear stress: tensión de corte de la pared / Wall shear stress / Wall shear stress: esforço de cisalhamento da parede

Para analizar los resultados obtenidos mediante cirugías funcionales en las fosas nasales (septumplastia y turbinoplastia fundamentalmente), o para evaluar los trastornos funcionales generados por alteraciones anatómicas endonasales, recurrimos usualmente a respuestas de los pacientes a través de cuestionarios subjetivos (escala visual análoga), o en forma objetiva a las rinodebitomanometría y la rinomanometría acústica. En forma más reciente contamos con análisis de modelos dinámicos de flujo computarizados. Este último permite cuantificar los efectos del flujo de aire sobre las paredes nasales, fenómeno llamado wall shear stress, transpolando el término usado en el sistema cardiovascular respecto al efecto de la presión sanguínea sobre las paredes arteriales, que traducido al castellano sería tensión de corte en la pared (nasal). Este método es laborioso, costoso y de difícil acceso. Presentamos una alternativa para diagnosticar este fenómeno durante la consulta: la observación con el videoendoscopio del efecto producido por el paso del aire en forma crónica en la mucosa de las paredes nasales, realzando estos cambios mediante el uso de narrow band imaging.

When analyzing the results obtained by functional surgeries of the nostrils (mainly septumplasty and turbinoplasty), or when assessing functional disorders generated by endonasal anatomical alte rations, we usually resort to subjective questionnaires (analog visual scale), and, objetively, to rhinodebitomanometry and acoustic rhinomanometry. Nowadays, analysis of computerized Dynamic flow models allows to quantify the tension that nasal walls receive from airflow, phenomenon called wall shear stress. This concept was transposed from cardiovascular system, regarding the effect of blood pressure on the arterial walls. This method is laborious and expensive. We present an alternative method to diagnose this phenomenon in the consulting room: the observation with the videoendoscope of the effect produced by chronic air flow on nasal walls' mucosa. This changes are enhanced by the use of narrow banding imaging

Analisar os resultados obtidos através de cirurgias funcionais nas passagens nasais (septuplastia e turbinoplastia fundamentalmente), ou avaliar os distúrbios funcionais gerados por alterações anatômicas endonasais, Geralmente recorre-se a respostas do paciente através de questionários subjetivos (escala analógica visual), ou de forma objetiva à rinodebitomanometria e rinomanometria acústica. Mais recentemente, temos análises de modelos de fluxo dinâmicos computadorizados. Este último permite quantificar os efeitos do fluxo de ar nas paredes nasais, um fenômeno chamado wall shear stress, transpolar o termo usado no sistema cardiovascular em relação ao efeito da pressão arterial nas paredes arteriais, que traduzido para o português seria esforço de cisalhamento da parede (Nasal). Este método é trabalhoso, caro e de difícil acesso. Apresentamos uma alternativa para diagnosticar esse fenômeno durante a consulta: observação com o videoendoscópio do efeito produzido pela passagem de ar de forma crônica na mucosa das paredes nasais, aprimorando essas mudanças através do uso de narrow band imaging

Mucosal microvascular morphological changes in superifcial nasopharyngeal carcinoma and its clinical value under narrow band imaging / 中国内镜杂志

Objective To evaluate the mucosal microvascular morphological changes in superficial nasopharyngeal carcinoma (NPC) and its clinical value under narrow band imaging (NBI).Methods From 2015.01 to 2016.01, 182 patients at high risk for NPC received biopsy of superficial nasopharyngeal lesions due to the existence of irregular vessel under NBI while they were examined with electronic nasopharyngolaryngoscope quipped with white light mode and NBI mode. Compared the mucosal microvascular morphological characteristics of different diseases based on pathological result and evaluated the diagnostic efifcacy of NBI.Result Under NBI, the mucosal microvascular morphological characteristics of nasopharyngeal carcinoma under NBI mode were of that concentrated brown spots (CBS, 38.24 %) and irregularly dilated branching vessels (IDBV, 41.18 %) with demarcation line (DL, 52.94 %). In addition, IDBV were the main microvascular pattern in fresh NPC cases (57.89 %,P = 0.000), while CBS were the main microvascular pattern in post-radiation local recurrent NPC cases (60.00 %,P = 0.000). The sensitivity, speciifcity, positive predictive value, negative predictive values and diagnostic coincidence rate of NBI in NPC screening were 79.41 %, 95.95 %, 81.82 %, 95.30 % and 92.86 %, respectively.Conclusion NBI endoscopy is a promising tool for improving the early diagnosis of NPC by detecting mucosal microvascular morphological changes in superifcial NPC.

Iniciación en imágenes de banda estrecha: diferencias entre polipos hiperplásicos y adenomas: ¿20 minutos son suficientes? / Starting in narrow-band imaging: differences between hyperplastic polyps and adenomas: 20 minutes are enough?

Los dos principales tipos de pólipos en el colon son los adenomas y los pólipos hiperplásicos. La imagen de banda estrecha (NBI) es una tecnología que mejora la visualización de los patrones vasculares en la superficie del pólipo pudiendo ayudar a diferenciar entre adenomas y los pólipos hiperplásicos con un alto grado de precisión. Este estudio pretende evaluar la diferencia y variabilidad inter e intraobservador, antes y después de una clase didáctica de puntos claves sobre las imágenes de banda estrecha para su entendimiento, diferenciación y reconocimiento. 14 gastroenterólogos y se seleccionaron 50 imágenes de pólipos hiperplasicos y adenomas verificados por estudio histológico. El puntaje de incremento en la adecuada identificación de las lesiones varió entre 37,86% a 78,57%. En esta evaluación inicial se mostró que los hallazgos dados con el uso de NBI son reproducibles, fáciles de aprender, bastante exactos, y tienen un alto potencial para su uso en la práctica clínica diaria permitiendo la caracterización en tiempo real de los pólipos en colon

The 2 main types of colon polyps are adenomas and hyperplastic. Narrow band imaging (NBI) is a novel technology that enhances the visualization of surface mucosal and vascular patterns on the polyp surface. The patterns seen on the polyp surface with NBI that can help differentiate between adenomas and hyperplastic polyps with a high degree of accuracy. The aim of this study was to evaluate the interobserver and intraobserver agreement (among endoscopists). 14 gastroenterologists and 50 images were selected hyperplastic polyps and adenomas verified by histology. The score of increase in the effective identification of lesions ranged from 37.86% to 78.57%. This initial evaluation showed that the NBI polyp patterns described in our pilot study are reproducible, easy to learn, reasonably accurate, and have the potential for use in daily clinical practice for the realtime differentiation of colon polyps

Diagnóstico de las lesiones neoplásicas y no-neoplásicas y predicción de la invasión submucosa del cáncer colorrectal temprano durante la colonoscopia / Diagnosis of neoplastic and non-neoplastic lesions and prediction of submucosal invasion of early cancer during colonoscopy

La cromoendoscopia de magnificación es una nueva y atractiva herramienta que permite un análisis detallado de la arquitectura morfológica de los orificios de las criptas de la mucosa. En esta revisión describimos, principalmente, la eficacia de la cromoendoscopia de magnificación y de la colonoscopia de magnificación con NBI para el diagnóstico diferencial de las lesiones colorrectales, incluyendo una distinción entre lesiones neoplásicas y no-neoplásicas y también entre cáncer temprano tratable endoscópicamente o no, basados en una revisión de la literatura. Hemos conducido un estudio prospectivo mostrando que una combinación de la colonoscopia de magnificación y la cromoendoscopia es actualmente un método más confiable que la colonoscopia convencional y la cromoendoscopia para la distinción entre lesiones neoplásicas y no-neoplásicas del colon y del recto. La colonoscopia de magnificación con NBI es tan precisa como la cromoendoscopia de magnificación. Nosotros utilizamos colonoscopia de magnificación con NBI más que la cromoendoscopia para distinguir de rutina los pólipos neoplásicos de los no-neoplásicos. Los colonoscopistas pueden predecir la profundidad de la invasión del cáncer colorrectal por medio de la cromoendoscopia de magnificación, la colonoscopia de magnificación con NBI y a través del signo de no-levantamiento. Entre estos métodos, la cromoendocopia de magnificación es el más confiable, con una exactitud, sensibilidad y especificidad de 98,8%, 85,6% y 99,4%, respectivamente. Aunque su confiabilidad depende de la habilidad del que hace la observación, la difusión de las aplicaciones de la técnica de magnificación podría influir en las indicaciones de biopsias de muestreo durante la colonoscopia y en las de mucosectomía.

Magnifying chromoendoscopy is an exciting new tool that allows detailed analysis of the morphological architecture of mucosal crypt orifices. In this review, we principally describe the efficacy of magnifying chromoendoscopy and magnifying colonoscopy with narrow band imaging (NBI) for differential diagnosis of colorectal lesions, including distinction between non-neoplastic and neoplastic lesions, and also between endoscopically treatable early invasive cancers and untreatable cancers, based on a review of the literature. We have conducted a prospective study showing that a combination of magnifying colonoscopy and chromoendoscopy is currently a more reliable method than conventional endoscopy and chromoendoscopy for separating non-neoplastic from neoplastic lesions of the colon and rectum. Magnifying colonoscopy with NBI is convenient and as accurate as chromoendoscopy with magnification. We principally use only magnifying colonoscopy with NBI, rather than chromoendoscopy, to routinely distinguish neoplastic from non-neoplastic polyps. Colonoscopists can predict the depth of invasion of early colorectal cancer by magnifying chromoendoscopy, magnifying colonoscopy with NBI and the non-lifting sign. Among these approaches, magnifying chromoendoscopy is diagnostically the most reliable, with an accuracy, sensitivity, and specificitiy of 98.8%, 85.6%, and 99.4%, respectively. Although its reliability depends on the skill of magnifying observation, widespread applications of the magnification technique could influence the indications for biopsy sampling during colonoscopy and the indications for mucosectomy.

Adaptação transcultural do inventário neurocomportamental (NBI) para o Brasil / Cross-cultural adaptation of the neurobehavior inventory (NBI) for Brazil

OBJETIVO: Realizar a adaptação transcultural de instrumento para avaliação das alterações comportamentais tipicamente descritas em portadores de epilepsia do lobo temporal (ELT), o Inventário Neuro-Comportamental (NBI) para a população brasileira. MÉTODOS: Inicialmente, foi feita a tradução do instrumento original para o português. Esta versão foi revisada e retrotraduzida para o inglês. A seguir, a versão retrotraduzida foi comparada à versão original em inglês, sendo corrigidas as divergências no texto em português. Em um segundo momento, 15 pacientes do Ambulatório de Epilepsia do Hospital das Clínicas da UFMG portadores de ELT responderam ao inventário. À aplicação do questionário, eventuais dificuldades e os itens mal compreendidos foram analisados pelos autores. RESULTADOS: Na versão final para o português, os itens 11, 14, 17, 61 e 75 foram modificados. Sete pacientes (46,7 por cento) eram do sexo feminino, com idade entre 26 e 65 anos. A maioria dos pacientes (93,3 por cento) apresentou uma pontuação total elevada. Os domínios mais comumente alterados foram hiperreligiosidade, detalhismo e crença na predestinação pessoal (73,3 por cento dos pacientes em cada um deles). CONCLUSÃO: A versão em português do NBI pode ser um instrumento útil para avaliar alterações comportamentais na ELT aplicada ao contexto clínico dos pacientes brasileiros.

PURPOSE: To perform the cross-cultural adaptation of an instrument designed to measure behavioral changes typically described in temporal lobe epilepsy (TLE), the Neurobehavior Inventory (NBI), for Brazilian population. METHODS: At first the original instrument was translated to Portuguese-Brazilian language. This version was revised and translated back into English. Later, both English versions were compared and the divergences were corrected in the Portuguese text. The second step consisted of the application of the inventory to 15 TLE patients from the Epilepsy Program, Federal University of Minas Gerais. The authors analyzed eventual difficulties and misunderstandings in the application of the questionnaire. RESULTS: In the final Portuguese version, the questions 11, 14, 17, 61 and 75 were considered difficult to understand and were modified. Seven (46.7 percent) subjects were women, with 26 to 65 years. Most of the patients (93.3 percent) had a high total score level. Religious convictions, interest in details and sense of personal destiny were the most common altered domains (73.3 percent of the patients in each one of them). CONCLUSION: The Portuguese-Brazilian version of the NBI may be a useful instrument to evaluate TLE behavioral alterations in the Brazilian clinical context.

Evaluación del tratamiento de pacientes con enfermedad de Graves Basedow y su relación con indicadores de necesidades básicas insatisfechas / Medical treatment evaluation in patients with Graves Basedow disease in relation to indicators of unsatisfied basic needs

El objetivo del presente trabajo fue, evaluar el cumplimiento del tratamiento médico de pacientes con diagnóstico de enfermedad de Graves Basedow y la evolución de la misma (remisión o recidiva) en relación a indicadores de necesidades básicas insatisfechas (NBI). Se practicó la revisión retrospectiva de 156 pacientes con diagnóstico de enfermedad de Graves Basedow, los cuales tuvieron un seguimiento entre 3 y 36 años (: 9.6 años), evaluándose en cada caso los diferentes tratamientos de inicio instituidos (metimazol-MMI-, yodo radiactivo o cirugía). De los pacientes que iniciaron y continuaron el tratamiento médico con metimazol (n=140), se revisó el cumplimiento y la eficacia del mismo, relacionándolo con los indicadores de privación (NBI). De los 156 pacientes estudiados, (137 mujeres Y 19 hombres), con una edad : 42.3 años, el tratamiento de inicio fue: con metimazol en 144, con radio yodo en 6 y con cirugía en 6 pacientes. De los 144 casos que comenzaron el tratamiento con MMI, 140 lo continuaron; de los cuales el 42,86% (n=60), presentaron indicadores de necesidades básicas insatisfechas mientras que el 57.14% (n=80) no presentaron indicadores de NBI. De los 140 pacientes que continuaron el tratamiento médico, el 24,28% (n=34), presentaron remisión de la enfermedad. El 90% de los casos que presentaron algún indicador/es de NBI no cumplieron con el tratamiento vs. el 17.5% de los pacientes NO NBI. La enfermedad remitió con tratamiento con metimazol en el 3.3% de los casos con NBI y en el 40% de los casos NO NBI. Teniendo en cuenta los resultados obtenidos, creemos que podría ser de utilidad, evaluar en los casos de pacientes con enfermedad de Graves Basedow la presencia de indicadores de privación, antes de instituir el tratamiento antitiroideo apropiado.

The objective of the present paper was to evaluate the compliance of medical treatment in patients with Graves Basedow disease diagnosis and the disease evolution (remission or relapse) in relation to indicators of unsatisfied basic needs. A retrospective review of 156 patients with Graves Basedow diagnosis was performed. They were followed up between 3 and 36 years (: 9.6 years), in each case, evaluating the different initial treatments implemented (methimazole-MMI, radioactive iodine or surgery). In those patients who started and followed medical treatment with methimazole (n= 140), compliance and efficacy were reviewed in relation to deprivation indicators. Out of the 156 patients studied (137 women and 19 men), with a mean age of : 42.3 years old, the initial treatment was: 144 patients with methimazole, 6 patients with radioiodine and 6 patients submitted to surgery. Out of the 144 cases who started treatment with MMI, 140 continued with it, of which 42.86% (n=60) showed unsatisfied basic needs indicators whereas 57.14% (n= 80) did not present indicators of unsatisfied basic needs. Out of the 140 patients who continued the medical treatment, 24.28 (n= 34) showed disease remission. Concerning the cases that showed some indicators of unsatisfied basic needs, 90% did not comply with the treatment versus 17.5% which did not present unsatisfied basic needs. The disease showed remission with methimazole treatment in 3.3% of the cases with unsatisfied basic needs and in 40% of the cases which did not present unsatisfied basic needs. Taking into account the results obtained, we believe that in the cases of patients with Graves Basedow disease, it might be useful to evaluate the presence of deprivation indicators before implementing the appropriate antithyroid treatment.

Utilidad de las imágenes de banda angosta (N. B. I) en la endoscopia diagnóstica / Usefulness of the narrow band image (N. B. I) in the diagnostic endoscopy

El NBI (Narrow Band Imaging) o imagen de banda angosta es una herramienta de visualización endoscópica desarrollada en Japón en el National Cancer Center por los doctores Gono K. y Sano Y., en el año 2001. Esta “cromoendoscopia digital”, aunada a los sistemas de magnificación endoscópicos permite una valoración más detallada de la superficie mucosa y de su patrón vascular, facilitando de esta manera el diagnóstico y seguimiento de lesiones tempranas del tracto gastrointestinal, así como el de patologías premalignas como el esófago de Barrett, el cáncer, los pólipos y la enfermedad inflamatoria intestinal, entre otras. En el presente artículo se expone una revisión de los principios ópticos del NBI y de la utilidad del mismo en la endoscopia diagnóstica y terapéutica de rutina y la experiencia con la misma en nuestra institución (Hospital Cardiovascular del niño de Cundinamarca).

The NBI (Narrow Band Imaging) or image of narrow band is a tool of endoscopic visualization developed in Japan in the National Cancer Center for the Drs. Gono K. and Sano Y. in the year 2001. This “digital Chromoendoscopy” linked to the systems of magnification endoscope allows a more detailed evaluation of the mucous surface and of its vascular net, facilitating hereby the diagnosis and follow-up of early injuries of the gastrointestinal tract, as well as of pathologies as Barrett’s oesophagus, the cancer, the polyps and the inflammatory intestinal disease, among others. In this article we expose a review of the optical principles of the NBI and of the utility of the same one in the routine diagnoses and therapeutic endoscopy and the experience with the same one in our institution (Cardiovascular Hospital of the child of Cundinamarca).

Imágenes de banda angosta (IBA): nuevo aporte al diagnóstico endoscópico / Narrow band imaging (NBI): a new endoscopic diagnostic approach

La técnica endoscópica IBA, representa un importante avance en el diagnóstico endoscópico, al mejorar la visualización de la superficie de la mucosa y su patrón vascular. Los datos aportados por esta técnica son útiles en el diagnóstico diferencial entre lesiones superficiales benignas y malignas, permitiendo la toma de biopsias dirigidas a áreas de riesgo, sin la necesidad del uso de colorantes y las dificultades técnicas que se relacionan con su uso.

The NBI, is a new tool that represent an important advance in endoscopy, improving observation of the mucosal surface and vascular pattern. These findings are useful for, differential diagnosis between benign and malignant superficial lesions and allows to target areas of risk and to obtain biopsies in several mucosal lesions, without use of dye spraying and technical problems related to this procedure

Planificación en niños de edad preescolar: efectos de la pertenencia a hogares con necesidades básicas insatisfechas (NBI) / Planning on preschoolers: effects of belonging to households with unsatisfied basic needs (NBI)

En el presente trabajo se comparó el desempeño de niños provenientes de hogares con (NBS) y sin (NBI) satisfacción de necesidades básicas en una prueba clásica de planificación: Torre de Londres (TOL). Se observó que la muestra de 4 años de niños NBI alcanzó niveles máximos más bajos, un promedio mayor de tiempos de planificación y ejecución, mayor cantidad de ensayos con número insuficiente de movimientos en distintos niveles de dificultad y puntajes más bajos. En la de 5 años se observó la misma tendencia exceptuando el nivel máximo alcanzado y el puntaje. Estos hallazgos sugieren que de la constelación de condiciones ambientales de los hogares NBI (caracterizados predominantemente como habitando viviendas de tipo inconveniente y en condiciones de hacinamiento) resulta una deprivación tal que afectaría las condiciones de desarrollo del desempeño dependendiente de circuitos prefrontales, caracterizable como menos eficiente en el manejo de los recursos de los procesos de memoria de trabajo espacial y planificación...

Planificación en niños de edad preescolar: efectos de la pertenencia a hogares con necesidades básicas insatisfechas (NBI) / Planning in preschool children: effects of belonging to households with unsatisfied basic needs (UBN) and the street: possibilities of facilitating resilient processes

En el presente trabajo se comparó el desempeño de niños provenientes de hogares con (NBS) y sin (NBI) satisfacción de necesidades básicas en una prueba clásica de planificación: Torre de Londres (TOL). Se observó que la muestra de 4 años de niños NBI alcanzó niveles máximos más bajos, un promedio mayor de tiempos de planificación y ejecución, mayor cantidad de ensayos con número insuficiente de movimientos en distintos niveles de dificultad y puntajes más bajos. En la de 5 años se observó la misma tendencia exceptuando el nivel máximo alcanzado y el puntaje. Estos hallazgos sugieren que de la constelación de condiciones ambientales de los hogares NBI (caracterizados predominantemente como habitando viviendas de tipo inconveniente y en condiciones de hacinamiento) resulta una deprivación tal que afectaría las condiciones de desarrollo del desempeño dependendiente de circuitos prefrontales, caracterizable como menos eficiente en el manejo de los recursos de los procesos de memoria de trabajo espacial y planificación.

This study compares performance of preschool children with satisfied (SBN) and unsatisfied basic needs (UBN) (poverty criterion) on a typical cognitive function task: Tower of London (TOL). Compared with SBN children, UBN 4-year-olds reached lower maximum levels, increased thinking- and executive time, more trials with insufficient moves at different levels of difficulty and lower scores. UBN 5-year-olds showed the same tendency except for maximum levels and score. These findings suggest that UBN home environment brings about a condition that affects prefrontal-circuit-dependent performance, which becomes less efficient in the processing of spatial working memory and planning strategies.