Application of an artificial intelligence-assisted endoscopic diagnosis system to the detection of focal gastric lesions (with video) / 中华消化内镜杂志

Objective:To construct a real-time artificial intelligence (AI)-assisted endoscepic diagnosis system based on YOLO v3 algorithm, and to evaluate its ability of detecting focal gastric lesions in gastroscopy.Methods:A total of 5 488 white light gastroscopic images (2 733 images with gastric focal lesions and 2 755 images without gastric focal lesions) from June to November 2019 and videos of 92 cases (288 168 clear stomach frames) from May to June 2020 at the Digestive Endoscopy Center of Renmin Hospital of Wuhan University were retrospectively collected for AI System test. A total of 3 997 prospective consecutive patients undergoing gastroscopy at the Digestive Endoscopy Center of Renmin Hospital of Wuhan University from July 6, 2020 to November 27, 2020 and May 6, 2021 to August 2, 2021 were enrolled to assess the clinical applicability of AI System. When AI System recognized an abnormal lesion, it marked the lesion with a blue box as a warning. The ability to identify focal gastric lesions and the frequency and causes of false positives and false negatives of AI System were statistically analyzed.Results:In the image test set, the accuracy, the sensitivity, the specificity, the positive predictive value and the negative predictive value of AI System were 92.3% (5 064/5 488), 95.0% (2 597/2 733), 89.5% (2 467/ 2 755), 90.0% (2 597/2 885) and 94.8% (2 467/2 603), respectively. In the video test set, the accuracy, the sensitivity, the specificity, the positive predictive value and the negative predictive value of AI System were 95.4% (274 792/288 168), 95.2% (109 727/115 287), 95.5% (165 065/172 881), 93.4% (109 727/117 543) and 96.7% (165 065/170 625), respectively. In clinical application, the detection rate of local gastric lesions by AI System was 93.0% (6 830/7 344). A total of 514 focal gastric lesions were missed by AI System. The main reasons were punctate erosions (48.8%, 251/514), diminutive xanthomas (22.8%, 117/514) and diminutive polyps (21.4%, 110/514). The mean number of false positives per gastroscopy was 2 (1, 4), most of which were due to normal mucosa folds (50.2%, 5 635/11 225), bubbles and mucus (35.0%, 3 928/11 225), and liquid deposited in the fundus (9.1%, 1 021/11 225).Conclusion:The application of AI System can increase the detection rate of focal gastric lesions.

Opuntia humifusa aqueous extract alleviates ethanol-induced gastric ulcer in a mouse model

Objective: To investigate the effect of Opuntia humifusa aqueous extract on gastric ulcers. Methods: An ethanol-induced model was used to examine the protective effect of Opuntia humifusa against gastric ulcers. The gastric ulcer index was evaluated via clinical observation and image analysis. Various inflammatory indicators were determined by RT-PCR and Western blotting assays. Results: The gastric ulcer index was reduced to 8% in the group treated with Opuntia humifusa aqueous extract compared with that in the control group. RT-PCR analysis revealed that MUC5AC expression was reduced to 39% in the control group compared with the non-treated group, whereas the omeprazole and Opuntia humifusa aqueous extract-treated groups increased the expression to 95% and 79%, respectively. Moreover, the expressions of various cytokines including TNF-α, IL-1β, and IL-6 were increased in the control group, while decreasing in Opuntia humifusa aqueous extract-treated group. Opuntia humifusa aqueous extract also suppressed the expressions of iNOS, COX-2, and its transcription factor NF-κB and increased mucus content considerably as compared to the control group. Conclusions: These results suggest that Opuntia humifusa aqueous extract is suitable as an alternative remedy for gastric ulcer treatment.

Opuntia humifusa aqueous extract alleviates ethanol-induced gastric ulcer in a mouse model

Objective: To investigate the effect of Opuntia humifusa aqueous extract on gastric ulcers. Methods: An ethanol-induced model was used to examine the protective effect of Opuntia humifusa against gastric ulcers. The gastric ulcer index was evaluated via clinical observation and image analysis. Various inflammatory indicators were determined by RT-PCR and Western blotting assays. Results: The gastric ulcer index was reduced to 8％ in the group treated with Opuntia humifusa aqueous extract compared with that in the control group. RT-PCR analysis revealed that MUC5AC expression was reduced to 39％ in the control group compared with the non-treated group, whereas the omeprazole and Opuntia humifusa aqueous extract-treated groups increased the expression to 95％ and 79％, respectively. Moreover, the expressions of various cytokines including TNF-α, IL-1β, and IL-6 were increased in the control group, while decreasing in Opuntia humifusa aqueous extract-treated group. Opuntia humifusa aqueous extract also suppressed the expressions of iNOS, COX-2, and its transcription factor NF-κB and increased mucus content considerably as compared to the control group. Conclusions: These results suggest that Opuntia humifusa aqueous extract is suitable as an alternative remedy for gastric ulcer treatment.

Predictors for operation time of endoscopic submucosal dissection for superficial gastric lesions / 中华消化内镜杂志

Objective@#To investigate the risk factors of operation time of endoscopic submucosal dissection (ESD) for superficial gastric lesions.@*Methods@#Clinicopathologic data of 193 patients (195 lesions) diagnosed with early gastric cancer preoperatively who received ESD in Beijing Friendship Hospital from January 2015 to December 2017 were retrospectively collected, including basic information (age, gender, body mass index, comorbidities), lesion characteristics (size, location, morphology), the operators′ experience of ESD, operation time, and postoperative pathology, etc. Univariate analysis was performed to find the risk factors of ESD operation time, and logistic regression analysis was performed on the factors with statistical differences in univariate analysis to find the independent risk factors of ESD operation time over 120 min.@*Results@#The mean age of the patients was 63.34±9.11 years. The median time of ESD operation was 120.00 (95.00, 165.00) min and the median size of the lesions was 1.50 (1.00, 2.38) cm. Early gastric cancer was diagnosed by postoperative pathology in 164 lesions (84.10%), among which 162 lesions (98.78%) achieved en bloc resection, and 148 lesions (90.24%) achieved curative resection. The gender (P=0.018), location(P<0.001) and size (r=0.209, P=0.007) were risk factors of the operation time by univariate analysis, while age, body mass index, American Society of Anesthesiologists (ASA) grade, roughness of lesion surface, presence or absence of white moss and ulcer, depth of lesion invasion, operative period, gross shape of lesion, degree of differentiation, and experience of operator were not associated with operation time (all P>0.05). Multivariate analysis showed that the lesion located in cardia/fundus of stomach (OR=5.656, 95%CI: 2.291-13.964, P<0.001), body of stomach (OR=2.667, 95%CI: 1.048-6.785, P=0.040) and >2 cm in size (OR=2.761, 95%CI: 1.229-6.205, P=0.014) were independent risk factors for the operation time longer than 120 min.@*Conclusion@#Lesions located in the cardia/fundus, body of stomach and >2 cm in size are independent risk factors for long operation time of ESD.

Occurrence of gastric ulcers in horses exercised on a treadmill / Ocorrência de úlceras gástricas em cavalos exercitados em esteira rolante

ABSTRACT: The most frequently causes of gastric ulcers in horses are fasting, feeding type and management, as well as administration of certain medications. More recently, exercise has also been identified as an important factor in the development of gastric lesions in athlete horses. The purpose of the present study was to assess whether treadmill exercise predisposes the horses to the occurrence of gastric ulcers. Five Arabian horses underwent a twelve-week training period on a treadmill and a gastroscopic evaluation before and after the training period. All animals showed gastric lesions after the training period. Based on these results, it is concluded that Arabian horses undergoing exercise on a treadmill may develop gastric lesions varying in number and severity.

RESUMO: As causas mais frequentes de úlceras gástricas em cavalos são jejum, tipo de alimentação e manejo, bem como a administração de alguns medicamentos. Mais recentemente, o exercício também foi identificado como um fator importante no desenvolvimento das lesões gástricas em cavalos atletas. O objetivo do presente estudo foi avaliar se o exercício em esteira rolante predispõe os cavalos à ocorrência de úlceras gástricas. Cinco cavalos árabes foram submetidos a um período de doze semanas de treinamento em esteira rolante e a avaliação gastroscópica antes e após o período de treinamento. Todos os animais apresentaram lesões gástricas após o treinamento. Com base nesses resultados, conclui-se que cavalos árabes submetidos a exercício em esteira rolante podem desenvolver lesões gástricas em número e gravidade variados.

A preliminary study of the anti-inflammatory and anti-apoptotic effects of crocin against gastric ischemia-reperfusion injury in rats

The aim of the present study was to investigate the protective effect of crocin on gastric mucosal lesions caused by ischemia-reperfusion (I/R) injury in rats. Thirty-two male rats were randomly divided into sham, I/R, I/R + crocin pretreatment and crocin alone groups. To induce I/R lesions, the celiac artery was clamped for 30 min, and the clamp was then removed to allow reperfusion for 3 h. Crocin-pretreated rats received crocin (15 mg/kg, i.p.) 30 min prior to the induction of I/R injury. Samples of gastric mucosa were collected to quantify the protein expression of caspase-3, an apoptotic factor, and inducible nitric oxide synthase (iNOS), a pro-inflammatory protein, by Western blot. Pretreatment with crocin decreased the total area of gastric lesions and decreased the protein expression levels of caspase-3 and iNOS induced by I/R injury. Our findings showed a protective effect of crocin in gastric mucosa against I/R injury. This effect of crocin was mainly mediated by reducing the protein expression of iNOS and caspase-3.

O objetivo do presente estudo foi investigar o efeito protetor da crocina em lesões da mucosa gástrica causadas por isquemia-reperfusão (I/R) em ratos. Trinta e dois ratos machos aleatoriamente divididos em grupos de ratos normais, operados como controle, I/R. I/R + pré-tratamento com crocina e crocina sozinha. Para induzir lesões I/R, a artéria celíaca foi grampeada durante 30 minutos e, em seguida, o grampo foi removido para permitir a reperfusão por 3 h. Ratos com pré-tratamento com crocina receberam crocina (15 mg/kg, ip) 30 minutos antes da indução do dano I/R. Amostras de mucosa gástrica foram coletadas para qiuantificar a expressão da proteína da caspase-3, o fator apoptótico, e óxido nítrico sintase induzível (iNOS), uma proteína anti-inflamatória, pela técnica de Western Blot. O pré-tratamento com crocina diminuiu a área total de lesões gástricas e a expressão de níveis de caspase-3 e iNOS induzidas pelo dano I/R. Nossos resultados mostraram o efeito protetor da crocina na mucosa gástrica contra o dano I/R. Este efeito foi mediado, principalmente, por diminuição da expressão das proteínas iNOS e caspase-3.

Lesões gástricas em suínos e sua relação com a presença de Helicobacter spp. / Lesiones gástricas en porcinos y su relación com la presencia de Helicobacter spp / Gastric lesions in swine and the relationship with the presence of Helicobacter spp.

O objetivo deste trabalho foi estabelecer uma relação entre a presença de lesões gástricas e a presença de Helicobacter spp. na mucosa gástrica de suínos abatidos na região noroeste do estado do Paraná. Foram colhidos e examinados 250 estômagos de suínos, machos castrados e fêmeas inteiras, com idade entre 140 e 160 dias, com peso de 90 a 100 Kg/P.V. As lesões da pars esophageae na região glandular foram classificadas conforme a severidade em graus 1, 2 e 3. Fragmentos das regiões aglandular e glandular foram processadas para exame histológico e para pesquisa de Helicobacter spp. A análise macroscópica revelou que todos os estômagos apresentavam algum tipo de lesão (hiperqueratose, erosão epitelial e gastrite ulcerativa). A ocorrência de erosões e úlceras foi observada em 161 (64,40%) estômagos, na região aglandular, e em 89 (35,60%) na região glandular. Utilizando a coloração de Warthin-Starry, observou-se Helicobacter spp. na mucosa gástrica de 109 (43,6%) amostras. Dessas, 105 (42,00%) estavam localizadas na região aglandular: 37 (14,8%) foram classificadas como grau 1; 25 (10,00%) como grau 2; 43 (17,20%) como grau 3. Na região aglandular foram encontradas quatro amostras positivas para Helicobacter spp. A análise estatística demonstrou que não há diferença significativa entre suínos com ou sem lesões gástricas em relação à presença do Helicobacter spp.

The objective was to establish a relationship between the presence of gastric lesions and the presence of Helicobacter spp. on the gastric mucous of swine slaughtered in the Northwestern region of Parana State. A total of 250 stomachs were collected and examined from swine - barrows and entire sows - aged 140 to 160 days, weighing between 90-100 Kg/LW. Lesions of gastric mucous in the glandular region were classified as 1, 2 or 3, according to severity levels. Fragments of the forestomach and glandular regions were processed for histological examination and for testing for Helicobacter spp. Macroscopic analysis revealed that all stomachs presented some type of injury. The occurrence of erosions and ulcers were observed in 161 (64.40%) stomachs in the forestomach region, and in 89 (35.60%) in the glandular one. Using Warthin-Starry stain, Helicobacter spp. was found in the gastric mucous of 142 (56.80%) samples. Among these, 89 (62.68%) were located in the forestomach area, with 27 (30.34%) classified as grade 1; 30 (33.71%) as grade 2, and 32 (35.96%) as grade 3. In the glandular region, 53 samples were found: 14 (26.42%) were classified as grade 1; 19 (35.85) as grade 2, and 20 (37.74%) as grade 3. From the 108 (43.20%) animals that were considered negative for Helicobacter spp., 57 (52.78%) were classified as grade 1; 29 (26.86%) as grade 2, and 22 (20.37%) as grade 3. Statistical analysis did not reveal significant difference between gastric lesions in swine and the presence of Helicobacter spp.

El objetivo de este estudio fue establecer relación entre la presencia de lesiones gástricas y la presencia de Helicobacter spp. en la mucosa gástrica de porcinos sacrificados en la región noroeste del Estado de Paraná. Se recogieron y examinaron 250 estómagos de cerdos machos castrados y hembras enteras, con edad entre 140 y 160 días, con peso de 90 a 100 kg / PV. Las lesiones de pars esophageae en la región glandular se clasificaron de acuerdo a la severidad en grados 1, 2 y 3. Fragmentos de las regiones aglandular y glandular fueron procesadas para examen histológico y pesquisa de Helicobacter spp. El análisis macroscópico reveló que todos los estómagos presentaban algún tipo de lesión (hiperqueratosis, erosión epitelial y gastritis ulcerosa). La aparición de erosiones y úlceras se observó en 161 (64,40%) estómagos en la región aglandular, y en 89 (35,60%) en la región glandular. Utilizando la coloración de Warthin-Starry, se observó Helicobacter spp. en la mucosa gástrica de 109 (43,6%) muestras. De estas, 105 (42,00%) estaban localizadas en la región aglandular: 37(14,8%) fueron clasificadas como grado 1, 25 (10,00%) como grado 2; 43 (17,20%) como grado 3. En la región aglandular se encontró cuatro muestras positivas para Helicobacter spp. El análisis estadístico demostró que no hay diferencia significativa entre porcinos con o sin lesiones gástricas en relación a la presencia de Helicobacter spp.

Diagnostic value of confocal laser endomicroscopy for non-protruding gastric lesions / 中华消化内镜杂志

Objective To discuss the differential diagnostic value of confocal laser endomicroscopy (CLE)for benign and malignant non-protruding gastric lesions.Methods A total of 37 patients with nonprotruding gastric lesions diagnosed by conventional gastroscopy underwent CLE.Fluorescein sodium was intravenously injected,and target biopsy was obtained.Malignant lesionss diagnosed with CLE or biopsy were treated by endoscopy or surgery.Patients with benign lesions were give routine medication and followed up every 3 months until the lesions were cured.Results CLE diagnosed 11 malignant and 26 benign lesions.However,1 of 11 cancers was confirmed as benign by histopathology,while 1 of 26 benign lesions was confirmed cancer.Lesions in 12 patients were resected,with 3 by endoscopy,and 9 by surgery,and findings of post-operative pathology were consistent with those of target biopsy.No malignancy was found during the follow-up of benign lesions,and all lesions were healed after 3.16(3.58 ± 1.20)months.The sensitivity,specificity,and accuracy of CLE in diagnosis of malignant non-protruding gastric lesion were 90.9％,96.2％,and 90.9％,respectively.The positive and negative predictive values were 90.9％ and 96.2％,respectively.The Kappa value of CLE and histopathology was 0.871.Conclusion CLE is of significant value for the diagnosis of non-protruding gastric lesions,and may replace biopsy in real-time histological diagnosis.

Valor de la endosonografía en el diagnóstico de lesiones submucosas gástricas / Value of endoscopic ultrasonography for diagnosis

La endosonografía (ES) es una herramienta útil en el estudio de patologías digestivas. Con el objetivo de evaluar la utilidad de la ES, en establecer el tipo, profundidad y extensión de lesiones submucosas (LSM) gástricas, se comparó la descripción endosonográfica de 7 pacientes con LSM gástricas, con los hallazgos histopatológicos de las piezas operatorias resecadas. Se observó concordancia en el tipo de tumor en 5 casos y en la profundidad de la lesión en 4 casos. La ES puede ayudar a definir el diagnóstico, etapificación y conducta terapéutica de las LSM.

Endoscopic ultrasonography (EUS) is a useful tool in the study of gastrointestinal diseases. The aim was to estimate the value of EUS to establish the type, deep andextension of submucosal gastric lesions (SGL). The results of EUS studies of 7 patients with SGL were compared with the histological findings of the resected lesions. EUS suggested correctly the type of tumor in 5 cases, and the deep extension in 4 cases. We believe EUSmay be useful in the diagnose, staging and defining the therapeutic choice of SGL.

Lesões gástricas em suínos: Ocorrência e relação com o gênero, peso ao abate e presença de helicobacter spp.1 / Gastric lesions in swine: occurrence and correlation with sex, weight and helicobacter spp infection

O objetivo deste estudo foi determinar a ocorrência de lesões gástricas em suínos de abate e verificar a relação das lesões com o gênero, o peso da carcaça e a presença de Helicobacter spp na mucosa gástrica. Foram colhidos e examinados 236 estômagos de suínos. As lesões da pars esophagea e região glandular foram classificadas conforme a severidade em graus 0, 1, 2 e 3. Fragmentos das regiões aglandular e glandular foram processados para exame histológico e para pesquisa de Helicobacter spp. A análise macroscópia reveleu que 203 (86.1) estômagos apresentavam algum tipo de lesão. A ocorrência de erosões e úlceras na região aglandular foi observada em 104 (44.1) animais e na região glandular em 22 (9.3). A ulceração na região gastroesofágica estava presente em 45 animais (19.1), dos quais 25 (21.1) eram machos e 20 (16.5) fêmeas. O peso médio da carcaça foi de 82.7 kg nos animais sem lesões e com paraqueratose na pars esophagea e de 79.5 Kg nos animais com erosões e ulcerações. Utilizando a coloração de Warthin-Starry, observamos Helicobacter spp na mucosa gástrica de 112 (47.5) amostras. Destas, 54 (48.2) foram classificadas como grau 2 ou 3 (pars esophagea) e 58 (51.8) como grau 0 e 1. Dos animais positivos para o helicobacter spp, 26 (23.2) apresentavam úlceras na pars esophagea e 24 (21.4) apresentavam a mucosa sem alterações. Dos 124 (52.5) animais negativos, 50 (40.3) foram classificados como grau 2 ou 3 e 74 (59.7) como grau 0 ou 1. A análise estatística revelou que não há diferença significativa entre suínos com ou sem lesões gástricas em relação á presença de helicobacter spp, gênero e peso da carcaça

The aim of this study was to investigate the association between the lesions of the gastric mucosa inslaughter pigs and sex, carcass weight and presence of Helicobacter spp. Stomachs from 236 swinewere examined. Gastroesophageal lesions were classified in agreement severity in grade 0, 1, 2 and 3.Fragments from the aglandular and glandular area were processed for histology and for identification ofHelicobacter spp in tissue sections. Macroscopic analysis revealed 203 (86.1%) stomachs with somedegree of lesion. Grade 2 and 3 lesions were observed in 104 (44.1%) animals. Grade 3 lesions wereobserved in 25 (21.1%) castrated males and 20 (16.5%) females. The average carcass weight of animalswith grade 0 and 1 lesions and grade 2 and 3 was 82,5 Kg and 79,5 Kg, respectively. One hundred andtwelve (47.5%) pigs were positive for Helicobacter spp. by Warthin-Starry stain method ; among them,54 (48.2%) had grade 2 and 3 lesions; and 58 (51.8%) had grade 0 and 1 lesions. One hundred and twenty-four (52.5%) were negative for Helicobacter spp; among them 50 (40.3%) had grade 2 and 3 lesions, and74 (59.7%) had grade 0 and 1. There was no significant difference between pigs with and without gastriclesions in regard to the presence of Helicobacter spp, sex and weight