Comparison between white light endoscopy and narrow-band imaging endoscopy in predicting histological healing of ulcerative colitis in remission / 中华消化内镜杂志

Objective:To investigate the predictive value of mucosal vascular pattern (MVP) under narrow-band imaging (NBI) enteroscopy in patients with ulcerative colitis (UC) in clinical remission for histological healing and clinical recurrence.Methods:A total of 142 patients with UC in clinical remission who visited the First Affiliated Hospital of Weifang Medical University from January 2018 to January 2021 were included in the study and underwent colonoscopy. The white light and NBI endoscopic images were collected and biopsies were obtained. The Mayo endoscopic score (MES) was calculated based on white light images, and MVP staging was evaluated based on mucosal vascular patterns under NBI. Nancy index (NI) was used to evaluate histological healing and patients were followed up for 1 year. The Spearman correlation coefficients of MES and MVP with histological healing and recurrence were calculated. The receiver operator characteristic (ROC) curve was plotted and the area under curve (AUC) was applied to evaluate the accuracy of white light and NBI endoscopy for predicting histological healing of UC in clinical remission.Results:According to the MVP criteria, 47 were defined as clear, 63 blurred, and 32 invisible. Spearman correlation analysis showed a significant correlation between MVP under NBI and histological healing ( r=0.549, P<0.001) and a moderate correlation between MES under white light and histological healing ( r=0.462, P<0.001). Spearman correlation analysis showed a moderate correlation between MVP under NBI and clinical recurrence ( r=0.451, P<0.001) and a moderate correlation between MES under white light and clinical recurrence ( r=0.352, P<0.001). AUC of NBI for diagnosing histological healing of UC in clinical remission was 0.809 (95% CI: 0.738-0.879), with a sensitivity of 84.6% (77/91) and specificity of 64.7% (33/51), superior to the white light endoscopy, of which AUC, sensitivity and specificity were 0.763 (95% CI: 0.678-0.848), 81.3% (74/91) and 66.7% (34/51). Conclusion:MVP staging under NBI could predict histological healing of UC patients in clinical remission and is superior to white light endoscopy.

Characteristics performance of laryngopharyngeal reflux in narrow band imaging / 临床耳鼻咽喉头颈外科杂志

Objective:To study the application value of narrow-band imaging in the diagnosis of laryngopharyngeal reflux. Methods:A total of 275 patients admitted to the inpatient department or laryngoscopy room of the Otolaryngology Head and Neck Surgery Department of the First Affiliated Hospital of Harbin Medical University from September 2022 to April 2023 due to throat discomfort were selected as the research subjects. All of them completed RSI, RFS scoring scales and electronic laryngoscopy（including ordinary white light and NBI）. According to the expert consensus of LPRD in 2022, RSI and RFS scoring scale were used as diagnostic criteria to divide them into LPR group and non-LPR group. Chi-square test was used to analyze the differences of positive rates of characteristic manifestations under NBI among different groups. The consistency of NBI and scale diagnostic methods was analyzed by Kappa, and RSI and RFS scoring were used as diagnostic criteria, The diagnostic efficiency of NBI method was analyzed. Results:There were 190 people in the LPR group, 157 of whom showed characteristic performance under the NBI mode, with a positive rate of 82.6%（157/190）; there were 85 people in the non-LPR group, with a positive rate of 18.8%（16/85）. There was a statistically significant difference in the positive rate between the two groups（χ²=102.47, P<0.05）. The consistency rate between RSI, RFS and NBI was 82.2%（226/275）. Kappa consistency analysis was used, and Kappa=0.605（P<0.05）, indicating good consistency between the two diagnostic methods. Using RSI and RFS as diagnostic criteria for LPR, the sensitivity of NBI diagnostic method was 82.6%（157/190）, specificity 81.2%（69/85）, positive predictive value 90.8%（157/173） and negative predictive value 67.6%（69/102）. Conclusion:Narrow-band imaging, as a new endoscopic imaging technique, can show small changes in mucosal surface micro vessels and play an important role in the diagnosis of laryngopharyngeal reflux.

Efficacy of non-invasive diagnostic methods in the diagnosis and screening of oral cancer and precancer / Eficácia de métodos diagnósticos não invasivos no diagnóstico e triagem de lesões pré-malignas e malignas na cavidade oral; revisão sistemática e meta-análise

Abstract Introduction: Traditional meta-analyses on the diagnostic accuracy of oral lesions have been conducted, but they were inherently limited to direct pairwise comparisons between a single method and a single alternative, while multiple diagnostic options and the ranking thereof were methodologically not possible. Objective: To evaluate the diagnostic values of various methods in patients with oral potential malignant disease by performing a network meta-analysis. Methods: Two authors independently searched the databases (MEDLINE, SCOPUS, the Cochrane Register of Controlled Trials, and Google scholar) up to June 2020 for studies comparing the diagnostic accuracy of various tools (autofluorescence, chemiluminescence, cytology, narrow band imaging, and toluidine blue) with visual examination or other tools. The outcomes of interest for this analysis were sensitivity, specificity, negative predictive value, positive predictive value and accuracy. Both a standard pairwise meta-analysis and network meta-analysis were conducted. Results: Treatment networks consisting of six interventions were defined for the network metaanalysis. The results of traditional meta-analysis showed that, among six methods, narrow band imaging showed higher sensitivity, specificity, negative predictive value, positive predictive value, and accuracy compared to visual examination. The results of network meta-analysis showed that autofluorescence, chemiluminescence, and narrow band imaging had higher sensitivity compared with visual examination, and that chemiluminescence and narrow band imaging had higher negative predictive value compared with visual examination. However, autofluorescence and chemiluminescence had lower specificity compared with visual examination. There were no significant differences in positive predictive value and accuracy among the six interventions. Conclusion: This study demonstrated that narrow banding imaging has superiority in terms of sensitivity and negative predictive value compared with the other five tested agents.

Resumo Introdução: Metanálises tradicionais sobre a precisão diagnóstica de lesões orais têm sido conduzidas, mas são inerentemente limitadas a comparações pareadas diretas entre um único método e uma única opção, enquanto múltiplas opções de diagnóstico e suas classificações ainda não foram metodologicamente possíveis. Objetivo: Avaliar os valores diagnósticos de vários métodos em pacientes com doença oral potencialmente maligna e fazer uma metanálise de rede. Método: Dois autores pesquisaram independentemente os bancos de dados (Medline, Scopus, Cochrane Register of Controlled Trials e Google Scholar) até junho de 2020 para estudos que comparassem a precisão diagnóstica de várias ferramentas (autofluorescência, quimioluminescência, citologia, imagem de banda estreita e cloreto de tolônio) com exame visual ou outras ferramentas. Os resultados de interesse para esta análise foram sensibilidade, especificidade, valor preditivo negativo, valor preditivo e precisão. Tanto uma metanálise pareada padrão quanto uma metanálise de rede foram conduzidas. Resultados: Redes de tratamento compostas por seis intervenções foram definidas para a metanálise de rede. Os resultados da metanálise tradicional mostraram que, entre seis métodos, a imagem de banda estreita apresentou maior sensibilidade, especificidade, valor preditivo negativo, valor preditivo e precisão em comparação ao exame visual. Os resultados da metanálise de rede mostraram que a autofluorescência, a quimioluminescência e a imagem de banda estreita obtiveram maior sensibilidade em comparação com o exame visual e que a quimioluminescência e a imagem de banda estreita apresentaram maior valor preditivo negativo em comparação com o exame visual. Entretanto, a autofluorescência e a quimioluminescência mostraram especificidade inferior em comparação com o exame visual. Não houve diferenças significativas no valor preditivo e na precisão entre as seis intervenções. Conclusão: Este estudo demonstrou que a imagem de banda estreita demonstra superioridade em termos de sensibilidade e valor preditivo negativo em comparação com os outros cinco agentes testados.

Diagnostic Accuracy of the Japan Narrow-Band Imaging Expert Team (Jnet) Classification System for the Differential Diagnosis of Colorectal Polyps

Background: Real time visual differentiation of colorectal polyps into benign and malignant helps to decide the appropriate treatment strategy and avoid the unnecessary risk associated with endoscopic therapies and need for repeat procedures. The Japan NBI Expert Team (JNET) classification developed in 2014 classifies colorectal polyps into types 1(Hyperplastic polyps including sessile serrated polyps), 2A (low grade dysplasia), 2B (high grade dysplasia/ superficial submucosal invasive carcinomas) and 3 (deep submucosal invasive carcinomas). We conducted this study to evaluate the diagnostic accuracy of the JNET classification for colorectal polyps. Methods: All patients undergoing colonoscopy in a tertiary care Centre in south India from February to July 2020, who had colorectal polyps were included in the study. A prospective image evaluation to identify the JNET class was done by 2 independent observers blinded to the histological diagnosis and the result was compared with the final histopathological diagnosis. Inflammatory polyps were excluded. The collected data was statistically analyzed to assess the diagnostic accuracy. Result: 139 polyps from 102 patients were included in the study. Most common locations were ascending colon (31%) or rectosigmoid (30.3%). 21 polyps were hyperplastic polyps, 78 polyps were LGD, 23 were HGD/SM-S and 17 were SM-D polyps. On NBI imaging, 23, 76, 30, and 10 polyps were classified as JNET types 1, 2a, 2b and 3 respectively. The diagnostic accuracy of JNET classification was 98.5%, 88.4%, 83% and 93.5% respectively. Conclusion: The JNET classification has a high diagnostic accuracy for predicting the histology of colorectal polyps and hence recommended.

Modificaciones del segmento anterior ocular tras extracción del cristalino versus iridotomía periférica láser en el cierre angular primario

RESUMEN Introducción: el tratamiento inicial para el cierre angular primario está dirigido a modificar el segmento anterior ocular y a estabilizar la enfermedad. Objetivo: evaluar si existen diferencias entre los pacientes tratados con facoemulsificación o iridotomía periférica láser, en cuanto a mejoría de los parámetros anatómicos del segmento anterior ocular. Materiales y métodos: se realizó un estudio cuasi experimental con un grupo de control histórico en la provincia Pinar del Río, entre enero de 2011 y enero de 2020. El mismo incluyó 196 ojos de 144 pacientes con cierre angular primario, tratados con facoemulsificación o iridotomía periférica láser. El análisis estadístico se realizó a través del programa SPSS. Resultados: en el preoperatorio no hubo diferencias significativas para la amplitud de la cámara anterior. En el postoperatorio sí existieron diferencias muy significativas (p < 0,001) entre los dos procedimientos quirúrgicos para ambos ojos. En la amplitud angular también existieron diferencias muy significativas (p < 0,001) entre el preoperatorio y el postoperatorio de ambos grupos. La presencia de sinequias anteriores periféricas fue escasa, sin diferencias entre los valores basales, y a los dos meses en ambos ojos para cada grupo. La evidencia de cierre angular, al final del período, entre el grupo de facoemulsificación y el de iridotomía, fue de 4,9 % vs. 23,2 % (p = 0,029) en el ojo derecho, y de 2,7 % vs. 29,0 % (p = 0,003) en el izquierdo. Conclusiones: tanto la extracción del cristalino como la iridotomía periférica láser mejoran los parámetros anatómicos del segmento anterior, aunque los resultados son superiores en ojos tratados con facoemulsificación.

ABSTRACT Introduction: initial treatment for the primary angle closure is aimed to modify the anterior ocular segment and to stabilize the disease. Objective: to assess if there are differences between patients treated with phacoemulsification or peripheral laser iridotomy, in terms of improvement of the anatomical parameters of the anterior ocular segment. Materials and methods: a quasi-experimental study was led with a historic control group in the province of Pinar del Rio, between January 2011 and January 2020. It included 196 eyes of 144 patients with primary angular closure, treated with phacoemulsification or laser peripheral iridotomy. The statistical analysis was carried out using SPSS program. Results: in the preoperative period there were not significant differences for the amplitude of the anterior chamber. In the postoperative there were very significant differences (p < 0.001) between the two surgical procedures for both ayes. In angular amplitude there were also very significant differences (p < 0.001) between preoperative y postoperative periods of both groups. The presence of peripheral anterior synechia was scarce, without differences between baseline values, and after two months in both eyes for each group. The evidence of angular closure, at the end of the period, between the phacoemulsification group and the iridotomy one was 4.9 % vs. 23.2 % (p = 0.029) in the right eye, and 2.7 % vs. 29.0 % (p = 0.003) in the left. Conclusions: both, crystalline lens extraction and laser peripheral iridotomy improve the anatomical parameters of the anterior segment, although the results are greater in ayes treated with phacoemulsification.

A model of predicting infiltration depth of colorectal cancer based on narrow band imaging system and endoscopic ultrasonography / 中国医师杂志

Objective:To establish a model of improving diagnostic capability in infiltration depth of colorectal cancer (CRC) with combining narrow band imaging system(NBI) and endoscopic ultrasonography (EUS).Methods:CRC patients who were treated in Chongqing Fifth People′s Hospital from April 2015 to March 2021 were selected retrospectively as the research objects. All patients were diagnosed by postoperative pathological diagnosis. In the end, a total of 288 CRC patients were included. Using the random number table method, the study subjects were divided into modeling group ( n=192) and verification group ( n=96) at a ratio of 2∶1. The patients′ general information, NBI and EUS examination results were collected; logistic regression was used to analyze the independent risk factors of CRC submucosal infiltration, and a model was built to predict the depth of CRC infiltration; receiver operating characteristic (ROC) was used to identify the diagnostic ability of model. The diagnostic efficacy of CRC submucosal infiltration was verified internally by the verification group. Results:In the modeling group, lymph node metastasis ( OR=6.492, 95% CI: 5.128-7.855, P<0.001), low tumor differentiation ( OR=2.736, 95% CI: 1.731-3.741, P<0.001) and tumor length ( OR=2.049, 95% CI: 1.524-2.574, P<0.001) were independent risk factors for submucosal infiltration in CRC patients; The nomograph model constructed according to the above independent risk factors had a strong diagnostic ability for the depth of submucosal infiltration of CRC, and was internally validated in the validation group. AUC values of the modeling group and the validation group were 0.945 (0.935-0.955) and 0.951 (0.942-0.961), respectively. Conclusions:The nomogram model established by the combination of endoscopic narrow band imaging technology and ultrasound endoscopy can diagnose the depth of CRC infiltration better.

Predictive value of mucosal vascular pattern under narrow-band imaging colonoscopy in colonic epithelial proliferation of patients with ulcerative colitis / 中华消化杂志

Objective:To investigate the predictive value of mucosal vascular pattern (MVP) in colonic epithelial proliferation of patients with ulcerative colitis (UC) under narrow-band imaging (NBI) colonoscopy.Methods:From December 1, 2012 to January 31, 2015, 42 patients with UC visiting Peking Union Medical College Hospital and receiving NBI colonoscopy were selected. The images of 119 colorectal lesions of all the patients under the conventional white light and NBI endoscopy were collected and at least one biopsy of each lesion was obtained for histological assessment. All the endoscopic images were randomly allocated to one endoscopist (associated chief physician) for the MVP and the Mayo endoscopic score (MES) assessment. The degree of mucosal inflammation was graded from 0 to 4 according to the histological colitis score. The degree and distribution of Ki-67 expression were evaluated by immunohistochemical staining. Student-Newman-Keuls (SNK)- q test and Spearman rank correlation analysis were used for statistical analysis. Results:Under NBI colonoscopy, the MVP of patients with UC was divided into clear type, obscure type and absent type. According to the morphology of mucosal glandular duct, the absent type was divided into crypt opening subtype and villous subtype. There was a positive correlation between MVP under NBI mode and the MES under white light mode ( r=0.80, P<0.001). The Ki-67 staining indexes of MVP obscure type, absent type, crypt opening subtype and villous subtype of absent type were all higher than that of MVP clear type (30.3±12.8, 45.9±12.5, 45.5±12.1 and 46.3±13.1 vs. 15.6±7.3), and the differences were statistically significant (SNK- q test, all P<0.001); and the Ki-67 staining indexes of MVP absent type, crypt opening subtype and villous subtype of MVP absent type were all higher than that of MVP obscure type, and the differences were statistically significant (SNK- q test, all P<0.001). There was a positive correlation between the MVP type under NBI colonoscopy and the distribution of Ki-67 expression ( r=0.49, P<0.001). The Ki-67 staining indexes of inflammation grade 2, 3 and 4 were higher than that of grade 1 (28.8±10.9, 40.2±11.6 and 49.5±10.3 vs. 17.1±8.4), and the difference was statistically significant (SNK- q test, all P<0.001); the Ki-67 staining indexes of inflammation grade 3 and 4 were higher than that of grade 2, and Ki-67 staining index of inflammation grade 4 was higher than that of grade 3, and the differences were statistically significant (SNK- q test, all P<0.001). The distribution of Ki-67 expression was positively correlated with the degree of histological inflammation ( r=0.56, P<0.001). Conclusions:The MVP under NBI colonoscopy may indirectly predict the colonic epithelial proliferation of patients with UC, which may be closely related to the degree of mucosal inflammation.

Clinical value of narrow-band imaging endoscopy in children with esophageal polyps / 中华消化内镜杂志

To investigate the diagnostic value of narrow-band imaging (NBI) endoscopy for esophageal polyps in children. Microscopic morphology of various polyps in 35 children with esophageal polyps in Children's Hospital of Shanghai from January 2016 to June 2020 were observed under both traditional white light endoscopy and NBI endoscopy. The sensitivity and specificity of traditional white light endoscopy and NBI endoscopy were compared with the pathological results as the gold standard. A total of 70 esophageal polypoid lesions were found in 35 children, including 27 single polyps. Pathological results indicated that the majority of polyps were non-neoplastic polyps (52.9%, 37/70).The sensitivity of NBI endoscopy in the diagnosis of esophageal neoplastic polyps was significantly higher than that of white light endoscopy [93.9% (31/33) VS 90.9% (30/33), P < 0.001], and the specificity was also higher [89.2% (33/37) VS 78.4% (29/37), P=0.864]. By observing the microscopic structure of esophageal polyps, NBI endoscopy contributes to the clinical prediction of the pathological properties of polyps. Its sensitivity is superior to the white light endoscopy.

Accuracy and influencing factors of type B2 vessels for predicting the invasion depth of superficial esophageal squamous cell carcinoma under narrow band imaging-magnifying endoscopy / 中华消化内镜杂志

Objective:To evaluate type B2 vessels for predicting the invasion depth of superficial esophageal squamous cell carcinoma (SESCC) under narrow band imaging-magnifying endoscopy (NBI-ME), and to analyse the influencing factors of over-prediction and under-prediction.Methods:A total of 86 SESCC patients with 86 lesions confirmed by postoperative pathology, who underwent NBI-ME to evaluate the invasion depth of esophageal tumor and were observed for type B2 vessels in Department of Digestive Endoscopy of Fujian Provincial Hospital from January 2015 to April 2020, were included in the case-control study. According to the postoperative pathological results, the patients were divided into the correct prediction group ( n=25) and the wrong prediction group ( n=61), and the accuracy of prediction was calculated. The wrong prediction group was further divided into the over-prediction group ( n=49) and the under-prediction group ( n=12) to find the influencing factors of over-prediction and under-prediction, respectively. Further, multivariate Logistic analysis was performed to explore the independent influential factors for the prediction. Results:The accuracy of type B2 vessels under NBI-ME for predicting the invasion depth of SESCC was only 29.07% (25/86), and the over-prediction rate and under-prediction rates were 56.98% (49/86) and 13.95% (12/86), respectively. Univariate analysis showed that the classification of type B2 area ( χ2=36.25, P<0.001), the distinct endoscopic features (nodules, thickening and obvious depression, χ2=22.90, P<0.001), and inflammation around type B2 vessels ( χ2=9.54, P=0.004) were related to the over-prediction of the invasion depth of SESCC, and the distinct endoscopic features were related to the under-prediction of the invasion depth ( P=0.016). Multivariate Logistic regression analysis showed that B2-narrow (type B2 area ≤5 mm) ( P<0.001, OR=241.988,95% CI:15.229-3 845.252) and inflammation around type B2 vessels ( P=0.033, OR=12.801, 95% CI: 1.226-133.713) were independent risk factors for over-predicting the invasion depth of SESCC, while the distinct endoscopic features were independent protective factors for over-prediction ( P<0.001, OR=0.012, 95% CI: 0.001-0.150). The distinct endoscopic feature was an independent risk factor for under-predicting invasion depth of SESCC with type B2 vessels ( P=0.027, OR=7.899, 95% CI: 1.259-49.565). Conclusion:The accuracy of predicting the invasion depth of SESCC is low only based on type B2 vessels in NBI-ME, and over-prediction is prone to occur. B2-narrow, inflammation around type B2 vessels and without nodules, thickening and obvious depression are closely related to the over-prediction of invasion depth of SESCC by type B2 in NBI-ME, and nodules, thickening and obvious depression are closely associated with the under-prediction. However, whether the combined assessment of type B2 vessels under NBI-ME and endoscopic manifestation can improve the accuracy of prediction needs to be confirmed by further studies.

The Impact of Narrow-band Imaging on the Pre- and Intra- operative Assessments of Neoplastic and Preneoplastic Laryngeal Lesions. A Systematic Review

Abstract Introduction Narrow-band imaging is an endoscopic diagnostic tool that, focusing on superficial vascular changes, is useful to detect suspicious laryngeal lesions, enabling their complete excision with safe and tailored resection margins. Objectives To analyze the applications and benefits of narrow-band imaging in detecting premalignant and malignant laryngeal lesions through a comparison with white-light endoscopy. Data Synthesis A literature search was performed in the PubMed, Scopus and Web of Science databases using strict keywords. Then, two authors independently analyzed the articles, read the titles and abstracts, and read completely only the relevant studies according to certain eligibility criteria. In total, 14 articles have been included in the present review; the sensitivity, specificity, positive and negative predictive values, and accuracy of pre- and/or intraoperative narrow-band imaging were analyzed. The analysis showed that narrow-band imaging is better than white-light endoscopy in terms of sensitivity, specificity, positive and negative predictive values, and accuracy regarding the ability to identify cancer and/or precancerous laryngeal lesions. Moreover, the intraoperative performance of narrow-band imaging resulted more effective than the in-office performance. Conclusion Narrow-band imaging is an effective diagnostic tool to detect premalignant and malignant laryngeal lesions and to define proper resection margins. Moreover, narrow-band imaging is useful in cases of leukoplakia that may cover a possible malignant lesion and that cannot be easily assessed with white-light endoscopy. Finally, a shared, simple and practical classification of laryngeal lesions, such as that of the European Laryngological Society, is required to identify a shared lesion management strategy. Key Points Narrow-band imaging is useful in detecting suspicious laryngeal lesions and proper resection margins showing intraepithelial papillary capillary loops (IPCLs) that are considered a main cancer feature. Narrow-band imaging is used both pre- and intraoperatively, but it provides more precise information if used during surgery. Compared with white-light endoscopy, narrow-band imaging enables a better assessment of the lesions covered by a thick white plaque (such as in cases of leukoplakia) The classification of the European Laryngological Society is the simplest and the most practical for the identification of various laryngeal lesions compared with other classifications.

Resource use efficiency of cotton in improved vs conventional planting geometry with exogenous application of bio-stimulant and synthetic growth retardant / Eficiência do uso de recursos do algodão na geometria de plantio melhorada vs convencional com aplicação exógena de bioestimulante e retardante de crescimento sintético

Abstract Plant growth regulators and improved planting density are the innovative techniques in the establishment of more productive cotton crop. A field study was planned to assess the role of growth regulators in the resource utilization efficiency of cotton cultivars under different row spacing at Agronomic Research Area, Bahauddin Zakariya University Multan and Usmania Agricultural Farm, Shujaabad during Kharif 2012. The study was comprised of cotton cultivars viz. CIM-573 and CIM-598, cultivated under conventional (75 cm), medium (50 cm) and improved ultra-narrow row spacing (25 cm) and foliar spray of growth regulators viz. moringa leaf extract (MLE) and mepiquat chloride (MC), either alone or in combination, distilled water as a control. The application of MLE alone and in combination (MLE + MC) showed the promoting effect on crop growth rate, net assimilation rate, leaf area index, leaf area duration, sympodial branches and number of bolls leading to higher seed cotton yield of both cotton cultivars grown under conventional row spacing. While application of MC averts the plant growth without considerably improving the productivity. MLE being rich source of growth promoting hormone and nutrients showed its potential to a far greater extent under conventional row spacing in efficient utilization of available resources compared to MC and distilled water.

Resumo Reguladores de crescimento de plantas e melhor densidade de plantio são técnicas inovadoras no estabelecimento de culturas mais produtivas de algodão. Um estudo de campo foi planejado com o objetivo de avaliar o papel dos reguladores de crescimento na eficiência de uso de recursos de cultivares de algodão sob diferentes espaçamentos na Área de Pesquisa Agronômica, da Universidade Multil de Bahauddin Zakariya, e na Fazenda Agrícola da Usmania, Shujabad, durante o Kharif 2012. O estudo foi composto de cultivares de algodão CIM-573 e CIM-598, cultivados em espaçamento de linhas convencional (75 cm), médio (50 cm) e superestreito (25 cm) e de pulverização foliar de reguladores de crescimento, a saber, extrato de folhas de moringa (MLE) e cloreto de mepiquat (MC), isoladamente ou em combinação, e água destilada como controle. A aplicação de MLE isoladamente e em combinação (MLE + MC) mostrou efeito promotor na taxa de crescimento da cultura, taxa de assimilação líquida, índice de área foliar, duração de área foliar, ramos simpodiais e número de cápsulas levando à maior produção de algodão nas cultivares com espaçamento de linha convencional. Em contrapartida, a aplicação de MC evitou o crescimento da planta sem melhorar consideravelmente a produtividade. O MLE, por ser uma rica fonte de hormônio promotor de crescimento e nutrientes, mostrou seu potencial em uma extensão muito maior sob o espaçamento convencional entre as linhas no uso eficiente dos recursos disponíveis em comparação com o MC e a água destilada.

Comparison of the diagnostic effect of early gastric cancer between magnifying blue laser imaging model and magnifying narrow-band imaging model based on deep learning / 中华消化杂志

Objective:To develop early gastric cancer (EGC) detection system of magnifying blue laser imaging (ME-BLI) model and magnifying narrow-band imaging (ME-NBI) model based on deep convolutional neural network, to compare the performance differences of the two models and to explore the effects of training methods on the accuracy.Methods:The images of benign gastric lesions and EGC under ME-BLI and ME-NBI were respectively collected. A total of five data sets and three test sets were collected. Data set 1 included 2 024 noncancerous lesions and 452 EGC images under ME-BLI. Data set 2 included 2 024 noncancerous lesions and 452 EGC images under ME-NBI. Data set 3 was the combination of data set 1 and 2 (a total of 4 048 noncancerous lesions and 904 EGC images under ME-BLI and ME-NBI). Data set 4: on the basis of data set 2, another 62 noncancerous lesions and 2 305 EGC images under ME-NBI were added (2 086 noncancerous lesions and 2 757 EGC images under ME-NBI). Data set 5: on the basis of data set 3, another 62 noncancerous lesions and 2 305 EGC images under ME-NBI were added(4 110 noncancerous lesions and 3 209 EGC images under ME-NBI and ME-BLI). Test set A included 422 noncancerous lesions and 197 EGC images under ME-BLI. Test set B included 422 noncancerous lesions and 197 EGC images under ME-NBI. Test set C was the combination of test set A and B (844 noncancerous and 394 EGC images under ME-BLI and ME-NBI). Five models were constructed according to these five data sets respectively and their performance was evaluated in the three test sets. Per-lesion video was collected and used to compare the performance of deep convolutional neural network models under ME-BLI and ME-NBI for the detection of EGC in clinical environment, and compared with four senior endoscopy doctors. The primary endpoint was the diagnostic accuracy of EGG, sensitivity and specificity. Chi-square test was used for statistical analysis.Results:The performance of model 1 was the best in test set A with the accuracy, sensitivity and specificity of 76.90% (476/619), 63.96% (126/197) and 82.94% (350/422), respectively. The performance of model 2 was the best in test set B with the accuracy, sensitivity and specificity of 86.75% (537/619), 92.89% (183/197) and 83.89% (354/422), respectively. The performance of model 3 was the best in test set B with the accuracy, sensitivity and specificity of 86.91% (538/619), 84.26% (166/197) and 88.15% (372/422), respectively. The performance of model 4 was the best in test set B with the accuracy, sensitivity and specificity of 85.46% (529/619), 95.43% (188/197) and 80.81% (341/422), respectively. The performance of model 5 was the best in test set B, with the accuracy, sensitivity and specificity of 83.52% (517/619), 96.95% (191/197) and 77.25% (326/422), respectively. In terms of image recognition of EGC, the accuracy of models 2 to 5 was higher than that of model 1, and the differences were statistically significant ( χ2=147.90, 149.67, 134.20 and 115.30, all P<0.01). The sensitivity and specificity of models 2 and 3 were higher than those of model 1, the specificity of model 2 was lower than that of model 3, and the differences were statistically significant ( χ2=131.65, 64.15, 207.60, 262.03 and 96.73, all P < 0.01). The sensitivity of models 4 and 5 was higher than those of models 1 to 3, and the specificity of models 4 and 5 was lower than those of models 1 to 3, and the differences were statistically significant ( χ2=151.16, 165.49, 71.35, 112.47, 132.62, 153.14, 176.93, 74.62, 14.09, 15.47, 6.02 and 5.80, all P<0.05). The results of video test based on lesion showed that the average accuracy of doctors 1 to 4 was 68.16%. And the accuracy of models 1 to 5 was 69.47% (66/95), 69.47% (66/95), 70.53% (67/95), 76.84% (73/95) and 80.00% (76/95), respectively. There were no significant differences in the accuracy among models 1 to 5 and between models 1 to 5 and doctors 1 to 4 (all P>0.05). Conclusions:ME-BLI EGC recognition model based on deep learning has good accuracy, but the diagnostic effecacy is sligntly worse than that of ME-NBI model. The effects of EGC recognition model of ME-NBI combined with ME-BLI is better than that of a single model. A more sensitive ME-NBI model can be obtained by increasing the number of ME-NBI images, especially the images of EGG, but the specificity is worse.

Differences of endoscopic features between undifferentiated-typed early gastric cancer and gastric mucosa-associated lymphoid tissue lymphoma / 中华消化内镜杂志

Objective:To analyze and compare the features of undifferentiated-typed early gastric cancer (UD-EGC) and gastric mucosa-associated lymphoid tissue(MALT) lymphoma under white light endoscopy (WLE) and magnifying endoscopy-narrow band imaging (ME-NBI).Methods:Data of patients with complete endoscopic images of WLE and ME-NBI in Shanghai General Hospital, Shanghai Jiao Tong University from March 2015 to July 2019 were retrospectively analyzed.Twenty-six UD-EGC patients and seven gastric MALT lymphoma patients in ⅠE1 stage were included, and the characteristics of the two diseases under WLE and ME-NBI were compared and summarized.Results:There were no significant differences in age, sex or infiltration depth of lesions between the two groups.Under WLE, UD-EGC was often manifested as a single lesion located in the lower part of the stomach, with unclear lesion boundaries. While MALT lymphoma lesions were mostly multifocal with clear boundaries, located in the middle of the stomach. Under ME-NBI, the microsurface pattern of UD-EGC showed dilation or disappearance of areas between the recesses, and the spiral microvascular pattern. However, the microsurface pattern of MALT lymphomas were characterized by " cross-road traffic sign" , " pebble sign" , and the presentation of residual glandular duct at the lesion was similar to that of Helicobacter pylori ( HP)-related gastritis. Furthermore, the microvascular pattern of MALT lymphomas often showed " tree like appearance (TLA)" . After HP eradication therapy, the morphology of microsurface pattern and microvascular pattern in the original lesion area gradually returned to normal. Conclusion:UD-EGC and gastric MALT lymphoma showed particular features in the number, site and boundary under WLE, and they showed significantly different microsurface pattern and microvascular pattern under ME-NBI. Differentiation of the two diseases will help reduce the risk of missed diagnosis and misdiagnosis.

Deep learning for the improvement of the accuracy of colorectal polyp classification / 中华消化内镜杂志

Objective:To evaluate deep learning in improving the diagnostic rate of adenomatous and non-adenomatous polyps.Methods:Non-magnifying narrow band imaging (NBI) polyp images obtained from Endoscopy Center of Renmin Hospital, Wuhan University were divided into three datasets. Dataset 1 (2 699 adenomatous and 1 846 non-adenomatous non-magnifying NBI polyp images from January 2018 to October 2020) was used for model training and validation of the diagnosis system. Dataset 2 (288 adenomatous and 210 non-adenomatous non-magnifying NBI polyp images from January 2018 to October 2020) was used to compare the accuracy of polyp classification between the system and endoscopists. At the same time, the accuracy of 4 trainees in polyp classification with and without the assistance of this system was compared. Dataset 3 (203 adenomatous and 141 non-adenomatous non-magnifying NBI polyp images from November 2020 to January 2021) was used to prospectively test the system.Results:The accuracy of the system in polyp classification was 90.16% (449/498) in dataset 2, superior to that of endoscopists. With the assistance of the system, the accuracy of colorectal polyp diagnosis was significantly improved. In the prospective study, the accuracy of the system was 89.53% (308/344).Conclusion:The colorectal polyp classification system based on deep learning can significantly improve the accuracy of trainees in polyp classification.

Influence of artificial intelligence on endoscopists′ performance in diagnosing gastric cancer by magnifying narrow banding imaging / 中华消化内镜杂志

Objective:To assess the influence of an artificial intelligence (AI) -assisted diagnosis system on the performance of endoscopists in diagnosing gastric cancer by magnifying narrow banding imaging (M-NBI).Methods:M-NBI images of early gastric cancer (EGC) and non-gastric cancer from Renmin Hospital of Wuhan University from March 2017 to January 2020 and public datasets were collected, among which 4 667 images (1 950 images of EGC and 2 717 of non-gastric cancer)were included in the training set and 1 539 images (483 images of EGC and 1 056 of non-gastric cancer) composed a test set. The model was trained using deep learning technique. One hundred M-NBI videos from Beijing Cancer Hospital and Renmin Hospital of Wuhan University between 9 June 2020 and 17 November 2020 were prospectively collected as a video test set, 38 of gastric cancer and 62 of non-gastric cancer. Four endoscopists from four other hospitals participated in the study, diagnosing the video test twice, with and without AI. The influence of the system on endoscopists′ performance was assessed.Results:Without AI assistance, accuracy, sensitivity, and specificity of endoscopists′ diagnosis of gastric cancer were 81.00%±4.30%, 71.05%±9.67%, and 87.10%±10.88%, respectively. With AI assistance, accuracy, sensitivity and specificity of diagnosis were 86.50%±2.06%, 84.87%±11.07%, and 87.50%±4.47%, respectively. Diagnostic accuracy ( P=0.302) and sensitivity ( P=0.180) of endoscopists with AI assistance were improved compared with those without. Accuracy, sensitivity and specificity of AI in identifying gastric cancer in the video test set were 88.00% (88/100), 97.37% (37/38), and 82.26% (51/62), respectively. Sensitivity of AI was higher than that of the average of endoscopists ( P=0.002). Conclusion:AI-assisted diagnosis system is an effective tool to assist diagnosis of gastric cancer in M-NBI, which can improve the diagnostic ability of endoscopists. It can also remind endoscopists of high-risk areas in real time to reduce the probability of missed diagnosis.

Clinical application for female distal ureteric calculi associated with narrow by the F4.8 visual micro-percutaneous nephrolithotomy / 中华泌尿外科杂志

Objective:To evaluate the clinical efficacy and safety of using the F4.8 Visual Puncture Micro-percutaneous nephrolithotomy to treat the female distal calculi associated with stricture.Methods:From June 2017 to December 2019, 32 female patients with distal ureteric calculi associated with stricture, aged(35.0±10.3) years ( range from 16 to 75 years)old, were enrolled into this retrospective study. They were diagnosed by colour doppler ultrasound, IVU(intravenous Urography), or CT, et al. The average stone size was (13.0±3.6)mm in diameter(range from 3 to 20 mm), and the stone obstruction duration was from 2 to 35 days, with average of(5±17) days. Twenty-seven cases were on the unilateral ureter and 5 cases were on the bilateral ureters. There were 17 cases undergoing ESWL 2 weeks before. Six cases of stone diameter less than 6 mm were administered medical therapy for more than 7 days. All the 32 case underwent ureteroscopic lithotripsy but failed because of the ureter stricture. They all suffered from hydronephrosis, with the diameter of renal collecting system from 15 to 45 mm, with(23±15)mm on average. The lithotomy position was taken, and the F4.8 Visual Micro-percutaneous nephrolithotomy using 0.9% Sodium chloride was applied to enter into ureter through urethra. There were 21 cases of ureter orifice stricture, including 8 cases associated with avulsion or perforation, 9 cases associated with intramural ureter abnormality and stricture, the zebra guidewire being failed to enter. The F4.8 Visual Micro-percutaneous nephrolithotomy cooperated with water pressure modulation was used to flush and open the ureter orifice and intramural ureter for entering. Holmium lase was used for lithotripsy. Two cases stone were infective and obstructed seriously. F4.8 Visual Micro-percutaneous nephrolithotriptor entered the ureter and destroyed the stones, and the stone fragments were discharged. Stone migrated upward and escaped occurred in 1 case, then the zebra guidewire was indwelled and ureteroscope was used for lithotripsy successfully. All cases were indewelled F4.7 doubld-J tube and urethral catheter after operation.Result:All the 32 patients underwent lithotripsy successful by one-stage. The operation time was 15-43 min [averaged (35.0±8.7)min]. All patients were recovered and discharged 4-7(averaged 5.3) days after operation. Three patients occured fever, T>38.5℃, and they recovered by using sensitive antibiotics according to the blood and urine culture. No severe complications occurred, such as ureteral perforation or extravasation. All patients were reviewed by ultrasound and KUB 3 days after operation, finding 24 cases with stone free, and 8 cases of a little residual stone, with the stone free rate of 75%. One month later, ultrasound and IVU was performed, and no residual stone was detected, with the stone free rate of 100%. The hydronephrosis alleviated by varying degrees. The diameter of the renal collecting system was from 0 to 35 mm, with(12±9)mm on average. The IVU showed the ureter was unobstructed. Conclusions:The F4.8 Visual Micro-percutaneous nephrolithotomy is safe and effective for the female distal calculi associated with stricture, when routine ureteroscopic lithotripsy failed.

Application of narrow band imaging-magnifying endoscopy to the further assessment of gastric low-grade intraepithelial neoplasia in biopsy / 中华消化内镜杂志

Objective:To evaluate narrow band imaging-magnifying endoscopy (NBI-ME) for the further assessment of lesions of low-grade intraepithelial neoplasia (LGIN) in the gastric biopsy.Methods:Data of 180 patients who underwent NBI-ME before endoscopic submucosal dissection (ESD) for biopsy of gastric LGIN at the First Affiliated Hospital of Soochow University from January 2017 to October 2020 were analyzed retrospectively. Taking the pathological results after ESD as the gold standard, the sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy of NBI-ME in predicting the pathological upgrading of gastric LGIN lesions after ESD were calculated, and the receiver operator characteristic (ROC) curve was drawn.Results:Among 180 gastric LGIN lesions, 115 (63.89%) were pathological upgraded and 65 (36.11%) were not after ESD. There were 10 missed diagnoses, 19 misdiagnoses, and 151 correct diagnoses in NBI-ME examination before ESD. The sensitivity, the specificity, the positive predictive value, the negative predictive value, and the accuracy of NBI-ME in predicting the pathological upgrading of gastric LGIN lesions after ESD were 91.3% (105/115), 70.8% (46/65), 84.7% (105/124), 82.1%(46/56) and 83.9% (151/180), respectively. The area under the ROC curve was 0.810 (95% CI: 0.737-0.883). Conclusion:Further NBI-ME examination of gastric LGIN lesions diagnosed by biopsy pathology can accurately predict whether the lesions have pathological upgrading after ESD, which is of important guiding significance for the patients to choose the treatment strategy of further follow-up or endoscopic resection.

Efecto de la extracción del cristalino en la presión intraocular de pacientes con glaucoma por cierre angular primario / Effect of crystalline lens extraction on intraocular pressure in patients with primary angle closure glaucoma

Objetivo: Describir el efecto de la extracción del cristalino transparente en la presión intraocular de pacientes con glaucoma por cierre angular primario. Métodos: Se realizó un estudio descriptivo longitudinal prospectivo en la provincia de Pinar del Río, entre enero del año 2013 y diciembre de 2019, que incluyó a 54 ojos de 54 pacientes con glaucoma por cierre angular primario y cristalino transparente, tratados con facoaspiración. El análisis estadístico se realizó a través del programa SPSS. Resultados: Hubo diferencias muy significativas (p< 0,001) en los valores de presión intraocular media entre el preoperatorio y el posoperatorio. El número de medicamentos no mostró diferencias significativas (p= 0,317) y el porcentaje de reducción promedio de la presión intraocular fue de 33,9 ± 4,3. Al final del período de seguimiento el 68,5 por ciento manifestó valores de 18 mmHg o más. El estadio glaucomatoso, la existencia o no de sinequias anteriores periféricas, el valor medio de la presión intraocular preoperatoria y del número de medicamentos mostraron diferencias significativas (p= 0,006; p= 0,001; p= 0,001 y p= 0,045 respectivamente) entre las categorías de control de la presión intraocular. Conclusión: La extracción del cristalino transparente reduce la presión intraocular en pacientes con glaucoma por cierre angular primario, lo que se corrobora a mediano plazo; aunque la mayoría de los ojos tratados no alcanzan un control total y mantienen el número de medicamentos sin variación(AU)

Objective: Describe the effect of clear lens extraction on intraocular pressure in patients with primary angle closure glaucoma. Methods: A prospective longitudinal descriptive study was conducted in the Province of Pinar del Río from January 2013 to December 2019. The study included 54 eyes of 54 patients with primary angle closure glaucoma and clear lens treated with phacoaspiration. Statistical analysis was based on SPSS software. Results: Very significant differences were found (p< 0.001) between preoperative and postoperative intraocular pressure values. Significant differences were not observed in the number of drugs indicated (p= 0.317). Average intraocular pressure reduction percentage was 33.9 ± 4.3. By the end of the follow-up period, 68.5 percent displayed values of 18 mmHg or higher. Significant differences were found between the intraocular pressure control categories with respect to the stage of the disease, the existence or non-existence of previous peripheral synechiae, the mean preoperative intraocular pressure value, and the number of drugs (p= 0.006; p= 0.001; p= 0.001 and p= 0.045, respectively). Conclusion: Clear lens extraction reduces intraocular pressure in patients with primary angle closure glaucoma, a fact corroborated in the medium term, though most of the eyes treated do not achieve total control and the number of drugs remains unaltered(AU)

Comparative Study of Safety and Efficacy of Narrow Band Ultraviolet B (NBUVB) and Psoralen Ultraviolet A (PUVA) Therapy in Psoriasis Vulgaris

Introduction: Psoriasis is a group of chronic, inflammatoryand proliferative condition of skin, associated withsystemic manifestations in many organ systems. The mostcharacteristic lesions consist of erythematous, scaly, sharplydemarcated indurated plaques, present particularly over theextensor surfaces and scalp). Phototherapy is one of the mostefficacious treatment options for psoriasis. New, emergingstudies are beginning to define the biological mechanismsby which phototherapy improves psoriasis- with NBUVBand psoralen ultraviolet A (PUVA) as the most widely usedapplications.Material and methods: This prospective study was carriedout on 76 patients attending OPD of Rohilkhand medicalcollege and hospital in one year from November 2017 toOctober 2018. The patients were randomly divided intotwo groups;Systemic PUVA (Trimethylpsoralen+UVA) andNBUVB groups and therapy will be administered thrice perweek on non-consecutive days.Results: The initial mean PASI score was 17.43 and 17.01in group A and group B patients respectively, while posttreatment PASI score was 3.08 and 2.01 in respective groups.The average cumulative dose for 80% clearance with PUVAwas found to be 60.51 J/cm2 while with NBUVB it wasfound to be 6.76 J/cm2. Side effects were observed in 28.94%patients in group A while 5.2% patientsin group B. Amongstgroup A 18.42%, 7.8% and 2.6% patients presented witherythema, burning and vesiculations respectively while undergroup B 2.6% patients in each group presented with erythemaand burning.Conclusion: Both PUVA and NBUVB are effective for thetreatment of psoriasis vulgaris. However, NBUVB has adistinct edge over PUVA in terms of efficacy and lesser sideeffects. The advantages of NBUVB therapy over PUVAtherapy includes lack of psoralen-related side effects and lessmean cumulative dose for clearance and so, good adherence.

Role of narrow band imaging in the diagnosis of premalignant and malignant lesions of oral cavity / 中华耳鼻咽喉头颈外科杂志

Objective@#To investigate the role of narrow band imaging (NBI) endoscopy in diagnosing oral premalignant and malignant lesions.@*Methods@#NBI and white light (WLI) endoscopy were performed on 85 patients (47 females, 38 males, aged from 12 to 83 years old, the medium age was 58 years) with 144 oral lesions from July 2016 to October 2017 in the First Affiliated Hospital of Xiamen University. NBI findings were classified into 5 types according to the Ni′s classification and compared with histopathological results. Sensitivity, specificity, accuracy, positive predictive value (PPV) and negative predictive value (NPV) of NBI and WLI were calculated. Accuracy of NBI on premalignant and malignant lesions were compared with that of WLI. The connection between NBI findings and pathological results were investigated. SPSS 22.0 software was used to analyze the data.@*Results@#Sensitivity, specificity, PPV, and NPV of NBI vs WLI were 96.5% vs 81.2%, 98.3% vs 98.3%, 98.8% vs 98.6%, and 95.1% vs 78.4%, respectively. NBI findings showed high accordance with the phathological results (kappa=0.943,P<0.01). However, consistency between WLI findings and the phathological results was relatively low (kappa=0.765, P<0.01). NBI was more accurate in diagnosing both premalignant (P<0.01) and malignant lesions (especially for high-grade intraepithelial neoplasia, P<0.01) than WLI. There was remarkable correlation between NBI findings and the phathological results (r=0.836, P<0.01).@*Conclusions@#NBI shows high accuracy in detecting premalignant and malignant lesions of oral cavity. Ni′s NBI classification is helpful to diagnose the premalignant and early malignant lesions as well as to evaluate tumor invasion. Thus, NBI can contribute more to early diagnosis and therapy of premalignant and malignant lesions of oral cavity.