Deep learning driven colorectal lesion detection in gastrointestinal endoscopic and pathological imaging.

Colorectal cancer has the second highest incidence of malignant tumors and is the fourth leading cause of cancer deaths in China. Early diagnosis and treatment of colorectal cancer will lead to an improvement in the 5-year survival rate, which will reduce medical costs. The current diagnostic methods for early colorectal cancer include excreta, blood, endoscopy, and computer-aided endoscopy. In this paper, research on image analysis and prediction of colorectal cancer lesions based on deep learning is reviewed with the goal of providing a reference for the early diagnosis of colorectal cancer lesions by combining computer technology, 3D modeling, 5G remote technology, endoscopic robot technology, and surgical navigation technology. The findings will supplement the research and provide insights to improve the cure rate and reduce the mortality of colorectal cancer.

Clinical Features and Risk Factors for Nasal Rosacea: A Hospital-Based Retrospective Study.

INTRODUCTION: At present, some studies have reported that nasal rosacea may be an independent disease, but phenotypic characteristics and risk factors for nasal rosacea remain unknown. This study aimed to clarify the clinical features and explore the risk factors for nasal rosacea. METHODS: A hospital-based retrospective study was conducted, including 1615 rosacea patients and 1501 healthy individuals. The patients were divided into three groups based on the involved areas of the lesions (non-nasal, intermediate and nasal rosacea group). Their demographic data and clinical features were obtained from patients' medical records, and risk factors of nasal rosacea were analyzed. RESULTS: There were 927 (57.4%), 647 (40.1%) and 41 (2.5%) cases in the non-nasal, intermediate and nasal rosacea groups, respectively. Of 41 patients with nasal rosacea, all (100.0%) had fixed erythema and 17 cases (41.5%) had phymatous changes. Compared with control group, male gender (adjusted odds ratio [aOR] = 2.39, 95% confidence interval [CI] = 1.14, 4.99), obesity (aOR = 3.19, 95% CI 1.86, 11.79) and alcohol use (aOR = 1.58, 95% CI 1.22, 5.40) were risk factors for nasal rosacea, but these three factors were not risk factors for non-nasal rosacea and intermediate rosacea groups. Among patients with nasal lesions (compared with patients without nasal phymatous changes), family history of rosacea was a risk factor (aOR = 2.12, 95% CI 1.01, 4.46) for nasal phymatous changes and Fitzpatrick IV skin type was a protective factor (aOR = 0.49, 95% CI 0.28, 0.86). CONCLUSION: Nasal rosacea has relatively specific clinical features and independent risk factors, suggesting that it may be a special type of rosacea.

Peroral traction-assisted natural orifice trans-anal flexible endoscopic rectosigmoidectomy followed by intracorporeal colorectal anastomosis in a live porcine model.

BACKGROUND: Compared to traditional open surgery, laparoscopic surgery has become a standard approach for colorectal cancer due to its great superiorities including less postoperative pain, a shorter hospital stay, and better quality of life. In 2007, Whiteford et al reported the first natural orifice trans-anal endoscopic surgery (NOTES) sigmoidectomy using transanal endoscopic microsurgery. To date, all cases of NOTES colorectal resection have included a hybrid laparoscopic approach with the use of established rigid platforms. AIM: To introduce a novel technique of peroral external traction-assisted transanal NOTES rectosigmoidectomy followed by intracorporeal colorectal end-to-end anastomosis by using only currently available and flexible endoscopic instrumentation in a live porcine model. METHODS: Three female pigs weighing 25-30 kg underwent NOTES rectosigmoid resection. After preoperative work-up and bowel preparation, general anesthesia combined with endotracheal intubation was achieved. One dual-channel therapeutic endoscope was used. Carbon dioxide insufflation was performed during the operation. The procedure of trans-anal NOTES rectosigmoidectomy included the following eight steps: (1) The rectosigmoid colon was tattooed with India ink by submucosal injection; (2) Creation of gastrostomy by directed submucosal tunneling; (3) Peroral external traction using endoloop ligation; (4) Creation of rectostomy on the anterior rectal wall by directed 3 cm submucosal tunneling; (5) Peroral external traction-assisted dissection of the left side of the colon; (6) Trans-anal rectosigmoid specimen transection, where an anvil was inserted into the proximal segment after purse-string suturing; (7) Intracorporeal colorectal end-to-end anastomosis using a circular stapler by a single stapling technique; and (8) Closure of gastrostomy using endoscopic clips. All animals were euthanized immediately after the procedure, abdominal exploration was performed, and the air-under-water leak test was carried out. RESULTS: The procedure was completed in all three animals, with the operation time ranging from 193 min to 259 min. Neither major intraoperative complications nor hemodynamic instability occurred during the operation. The length of the resected specimen ranged from 7 cm to 13 cm. With the assistance of a trans-umbilical rigid grasper, intracorporeal colorectal, tension-free, end-to-end anastomosis was achieved in the three animals. CONCLUSION: Peroral traction-assisted transanal NOTES rectosigmoidectomy followed by intracorporeal colorectal end-to-end anastomosis is technically feasible and reproducible in an animal model and is worthy of further improvements.

Willingness-to-Pay and Benefit-Cost Analysis of IPL for Rosacea Treatment: A Cross-Sectional Study in China.

BACKGROUND: Intense pulsed light (IPL), as a therapeutic approach for rosacea, had advantage in removing erythema and telangiectasia and was gradually accepted by rosacea patients, but there have been few studies on economic evaluation of this therapy. PURPOSE: This study aimed to detect willingness-to-pay (WTP) of IPL treatment for rosacea and to conduct a benefit-cost analysis (BCA) among the Chinese population, so as to provide an economic reference for doctors to make treatment decisions. MATERIALS AND METHODS: An observational, cross-sectional study assessed respondent's demographic characteristics and willingness-to-pay (WTP) of IPL and rosacea patients' clinical data and Dermatology Life Quality Index (DLQI). WTP was obtained by contingent valuation (CV) method. In brief, contrast figures of three cases treated with IPL (Case1, Case2, and Case3 represented the increasing severity of rosacea) were showed and WTP was inquired. The costs were obtained according the market and compared with WTP (benefits) to get a benefit-cost ratio (BCR). Predictors of cost-effective WTP were identified using the multivariable logistic regression model. RESULTS: A total of 303 rosacea patients and 202 controls were included in the study. The average cost of a single IPL treatment for rosacea was USD 208.04 in Changsha, China. The mean WTP for Case 1, Case 2, and Case 3 was USD 201.57, 214.64, and 221.74, respectively. WTP was statistically lower for Case 1 than that for Case 2 or Case 3 (P<0.05). The BCRs were 0.85, 1.03, and 1.06 for Case 1, Case 2, and Case 3, respectively. WTP is significantly associated with household monthly income, previous treatment cost, and DLQI after adjustments for demographic characteristics (P<0.05). CONCLUSION: IPL is an acceptable treatment for rosacea with moderate to severe erythema. For patients with relatively high income or severely impaired quality of life, IPL is an economically feasible therapy and deserves to be recommended.

Combining Faster R-CNN and Model-Driven Clustering for Elongated Object Detection.

While analyzing the performance of state-of-the-art R-CNN based generic object detectors, we find that the detection performance for objects with low object-region-percentages (ORPs) of the bounding boxes are much lower than the overall average. Elongated objects are examples. To address the problem of low ORPs for elongated object detection, we propose a hybrid approach which employs a Faster R-CNN to achieve robust detections of object parts, and a novel model-driven clustering algorithm to group the related partial detections and suppress false detections. First, we train a Faster R-CNN with partial region proposals of suitable and stable ORPs. Next, we introduce a deep CNN (DCNN) for orientation classification on the partial detections. Then, on the outputs of the Faster R-CNN and DCNN, the algorithm of adaptive model-driven clustering first initializes a model of an elongated object with a data-driven process on local partial detections, and refines the model iteratively by model-driven clustering and data-driven model updating. By exploiting Faster R-CNN to produce robust partial detections and model-driven clustering to form a global representation, our method is able to generate a tight oriented bounding box for elongated object detection. We evaluate the effectiveness of our approach on two typical elongated objects in the COCO dataset, and other typical elongated objects, including rigid objects (pens, screwdrivers and wrenches) and non-rigid objects (cracks). Experimental results show that, compared with the state-of-the-art approaches, our method achieves a large margin of improvements for both detection and localization of elongated objects in images.

Association of PIK3CG gene polymorphisms with attention-deficit/hyperactivity disorder: A case-control study.

Attention-deficit/hyperactivity disorder (ADHD) is a complicated neurodevelopmental disorder with high heritability. This study explores the association of PIK3CG gene single nucleotide polymorphisms (rs1129293, rs12536620, rs12667819, rs17847825, rs2230460) with ADHD in children and the relation of interaction between SNPs and environmental factors, including blood lead levels (BLLs) and feeding style. A case-control study was conducted with children aged 6-18years old, consisting of 389 children newly diagnosed with ADHD via the DSM-IV at the Wuhan Women and Children Medical Care Center, and 393 control participants were healthy children for physical examination during the same period. All participants were tested using the Chinese Wechsler Intelligence Scale for Children and Parent Symptom Questionnaire (PSQ). Furthermore, a self-designed questionnaire was used to investigate the general situation and related environmental factors, and the BLLs were measured by atomic absorption spectrophotometry. The genotyping was performed using Sequenom MassArray. In our study, PIK3CG gene rs12667819 was consistently shown to be associated with ADHD risk in dominant model (OR=1.656, 95% CI=1.229-2.232), ADHD-I type (OR=2.278, 95% CI=1.666-4.632), and symptom scores. Moreover, rs12536620 has been observed to be related to ADHD-C type and symptom scores. Intriguingly, gene-environmental interactions analysis consistently revealed the potential interactions of rs12667819 collaborating with blood lead (Pmul=0.045) and feeding style (Pmul=0.041) to modify ADHD risk. Expression quantitative trait loci analysis suggested that rs12667819 may mediate PIK3CG gene expression. Therefore, our results suggest that selected PIK3CG gene variants may have a significant effect on ADHD risk.

Attention-deficit/hyperactivity disorder associated with KChIP1 rs1541665 in Kv channels accessory proteins.

Attention-deficit/hyperactivity disorder (ADHD) is an early onset childhood neurodevelopmental disorder with high heritability. A number of genetic risk factors and environment factors have been implicated in the pathogenesis of ADHD. Genes encoding for subtypes of voltage-dependent K channels (Kv) and accessory proteins to these channels have been identified in genome-wide association studies (GWAS) of ADHD. We conducted a two-stage case-control study to investigate the associations between five key genes (KChIP4, KChIP1, DPP10, FHIT, and KCNC1) and the risk of developing ADHD. In the discovery stage comprising 256 cases and 372 controls, KChIP1 rs1541665 and FHIT rs3772475 were identified; they were further genotyped in the validation stage containing 328cases and 431 controls.KChIP1 rs1541665 showed significant association with a risk of ADHD at both stages, with CC vs TT odds ratio (OR) = 1.961, 95% confidence interval (CI) = 1.366-2.497, in combined analyses (P-FDR = 0.007). Moreover, we also found rs1541665 involvement in ADHD-I subtype (OR (95% CI) = 2.341(1.713, 3.282), and Hyperactive index score (P = 0.005) in combined samples.Intriguingly, gene-environmental interactions analysis consistently revealed the potential interactionsof rs1541665 collaboratingwith maternal stress pregnancy (Pmul = 0.021) and blood lead (Padd = 0.017) to modify ADHD risk. In conclusion, the current study provides evidence that genetic variants of Kv accessory proteins may contribute to the susceptibility of ADHD.Further studies with different ethnicitiesare warranted to produce definitive conclusions.

SLC6A1 gene involvement in susceptibility to attention-deficit/hyperactivity disorder: A case-control study and gene-environment interaction.

Attention-deficit/hyperactivity disorder (ADHD) is an early onset childhood neurodevelopmental disorder with an estimated heritability of approximately 76%. We conducted a case-control study to explore the role of the SLC6A1 gene in ADHD. The genotypes of eight variants were determined using Sequenom MassARRAY technology. The participants in the study were 302 children with ADHD and 411 controls. ADHD symptoms were assessed using the Conners Parent Symptom Questionnaire. In our study, rs2944366 was consistently shown to be associated with the ADHD risk in the dominant model (odds ratio [OR]=0.554, 95% confidence interval [CI]=0.404-0.760), and nominally associated with Hyperactive index score (P=0.027). In addition, rs1170695 has been found to be associated with the ADHD risk in the addictive model (OR=1.457, 95%CI=1.173-1.809), while rs9990174 was associated with the Hyperactive index score (P=0.010). Intriguingly, gene-environmental interactions analysis consistently revealed the potential interactions of rs1170695 with blood lead (Pmul=0.044) to modify the ADHD risk. Expression quantitative trait loci analysis suggested that these positive single nucleotide polymorphisms (SNPs) may mediate SLC6A1 gene expression. Therefore, our results suggest that selected SLC6A1 gene variants may have a significant effect on the ADHD risk.

The Association of SNAP25 Gene Polymorphisms in Attention Deficit/Hyperactivity Disorder: a Systematic Review and Meta-Analysis.

Attention deficit/hyperactivity disorder (ADHD) is one of the most highly heritable psychiatric disorders in childhood. The risk gene mutation accounts for about 60 to 90 % cases. Synaptosomal-associated protein of 25 kDa (SNAP-25) is a presynaptic plasma membrane protein which is expressed highly and specifically in the neuronal cells. A number of evidences have suggested the role of SNAP-25 in the etiology of ADHD. Notably, the animal model of coloboma mouse mutant bears a ∼2-cM deletion encompassing genes including SNAP25 and displays spontaneous hyperkinetic behavior. Previous investigators have reported association between SNPs in SNAP25 and ADHD, and controversial results were observed. In this study, we analyzed the possible association between six polymorphisms (rs3746544, rs363006, rs1051312, rs8636, rs362549, and rs362998) of SNAP25 and ADHD in a pooled sample of ten family-based studies and four case-control studies by using meta-analysis. The combined analysis results were significant only for rs3746544 (P = 0.010) with mild association (odds ratio (OR) = 1.14). And, the meta-analysis data for rs8636, rs362549, and rs362998 are the first time to be reported; however, no positive association was detected. In conclusion, we report some evidence supporting the association of SNAP25 to ADHD. Future research should emphasize genome-wide association studies in more specific subgroups and larger independent samples.

Implementation and establishment of rapid response system for non-hospitalized patients / 中华护理杂志

We established the rapid response system for non-hospitalized patients from 2012 in order to improve the effectiveness of emergent critical care for non-hospitalized patients when emergency happened.From January 2013 to December 2016,there were 122 cases with RRS activation for non-hospitalized patients.The time to arrive was 3.16±0.41 min,and 107 cases(86.89％)were sent to the emergency department.Fifteen patients(14.02％)were classified as level 1,26(24.03％)as level Ⅱ,48(16.82％)as level Ⅲ,and 18(16.82％) as level ⅣV,and 83％ were critical patients.Rapid response system is important to cope with emergency in non-hospitalized patients.

Induction of melasma by 1064-nm Q-switched neodymium:yttrium-aluminum-garnet laser therapy for acquired bilateral nevus of Ota-like macules (Hori nevus): A study on related factors in the Chinese population.

Laser treatment has emerged as a common treatment modality for acquired bilateral nevus of Ota-like macules (ABNOM). To identify the ratio of melasma induction and exacerbation before and after laser therapy for ABNOM and to observe the risk factors related to the induction and exacerbation of melasma by laser therapy, we analyzed related factors of 1268 adult Chinese patients who underwent 1064-nm Q-switched neodymium:yttrium-aluminum-garnet (Nd:YAG) laser (QNYL) treatment using case series and case-control studies. Overall, 24.0% of the ABNOM patients had mixed melasma. Among the ABNOM patients without melasma, after laser therapy the development of melasma was more frequently noted in patients older than 35 years (P < 0.0001), as well in patients whose ABNOM was less than 10 cm(2) (P = 0.027), ABNOM were light (similar to yellow-brown) in color (P = 0.021) and skin types were closer to type IV (P < 0.0001). New melasma lesions also appeared most frequently in the zygomatic region (P < 0.0001). Among the ABNOM patients with melasma, 89.5% experienced worsening of their melasma, irrespective of their related factors above. We concluded that the risk of inducing melasma is great after 1064-nm QNYL treatment in ABNOM patients, and particularly in the patients with both ABNOM and melasma. ABNOM patients should be treated as early as possible and before the age of 35 years.

[Morphological Characteristics and Molecular Identification of Trichuris sp. from Giraffe].

Objective: To investigate the morphological characteristics of Trichuris sp. from giraffe in Hefei wild zoo and identify its species using molecular techniques. Methods: Morphological characteristics of Trichuris collected from giraffe were analyzed. The internal transcribed spacer 1（ITS-1） was amplified by PCR and the PCR product was sequenced. The resulting sequence was homology analysis in GenBank and its heredity evolution tree was constructed by MEGA 4.0 software. Results: The male worms had a body length of 35.89-58.56 mm, an esophagus to body length ration of 0.29-0.40, and a spicule length of 1.96-3.89 mm. The thick and thin proportions of body were 7.02-23.45 mm and 28.05-40.05 mm respectively. These data showed different degrees of variation with previous reports. The PCR resulted in a product of 491 bp, comprising part of 18S rRNA and full length ITS-1. Sequence alignment showed that the identified Trichuris was most homologous（98.6%） with T. bos taurus HE608848, T. capreolus JX218218, and T. japanese AB367795, but it was only 46.0% homologous with T. discolor AB367794. In the heredity evolution tree, it was not located on the same branch as T. discolor, T. ovis and T. bos taurus. Conclusions: The Trichuris sp. collected from giraffe is different from previous reports in morphology and ITS-1 sequence. Further research is needed to determine if it is a new species.

[Establishment of LAMP Detection for Toxoplasma gondii Based on the 529 bp Repeat Sequence].

Objective: To establish the loop mediated isothermal amplification（LAMP） technique for determining Toxoplama gondii. Methods: The primers for LAMP of the conserved 529 bp sequence was designed by the Primer Explorer 4.0 software. The LAMP reaction was made on the constructed pMD-19T-529 bp recombinant plasmid as a template, and was optimized in loop primer, concentrations of betaine and MgSO4, and reaction temperature. The optimized LAMP and PCR were performed in ultra-pure water, on pig genome, Cryptosporidium parvum genome, Isospora suis genome, and pMD-19T-529 bp, respectively, to test the sensitivity of LAMP. The pMD-19T-529 bp was serially diluted to 109-100 copies/ml to test the specificity of LAMP. Results: LAMP using the designed primers amplified the 529 bp fragment of T. gondii. The optimized LAMP system had a total reaction volume of 25 µl, with the optimal concentrations of betaine and MgSO4 being 0.4 mol/L and 6 mmol/L, respectively. The amplification efficiency of 30 min reaction in the presence of loop primer was comparable to that of 60 min reaction without loop primer, which indicated that addition of loop primer shortened the reaction time by 30 min. The optimal reaction condition was 63 ℃ 30 min, 80 ℃ 3 min. The established LAMP method specifically amplifed the 529 bp fragment of T. gondii, and its efficiency was 10 times of PCR（detection threshold 103 copies/ml vs. 104 copies/ml）. Conclusion: The established LAMP for detecting Toxoplama gondii 529 bp repeat sequence shows high specificity and sensitivity.

The Physiology of BDNF and Its Relationship with ADHD.

Brain-derived neurotrophic factor (BDNF) is a major neurotrophin in the central nervous system that plays a critical role in the physiological brain functions via its two independent receptors: tropomyosin-related kinase B (TrkB) and p75, especially in the neurodevelopment. Disrupting of BDNF and its downstream signals has been found in many neuropsychological diseases, including attention-deficit hyperactivity disorder (ADHD), a common mental disorder which is prevalent in childhood. Understanding the physiological functions of BDNF during neural development and its potential relationship with ADHD will help us to elucidate the possible mechanisms of ADHD and to develop therapeutic approaches for this disease. In this review, we summarized the important literatures for the physiological functions of BDNF in the neurodevelopment. We also performed an association study on the functional genetic variation of BDNF and ADHD by a case-control study in the Chinese mainland population and revealed the potential correlation between BDNF and ADHD which needs further research to confirm.

A search-and-validate method for face identification from single line drawings.

Several studies have been made in finding the faces of an object depicted in a line drawing, but the problem has not been completely solved. Although existing methods can find the correct faces in most cases, there is no mechanism to ascertain that they are indeed correct, leaving the human user to do so. This paper uses a two-stage approach--find potential faces, then validate their correctness--to ensure that only correct faces are delivered ultimately. The face finding itself uses a double breadth-first search algorithm, which yields the shortest path, to find the potential faces. The basic premise is that the smallest faces found are more likely the correct ones. They serve as the "seed" potential faces, from which the algorithm proceeds to search for more faces. If the potential faces found satisfy the validation rules, then they are accepted as correct. Otherwise, the wrong potential faces are identified and removed, and new ones found in their place. The validation process is then repeated. The algorithm is fast and reliable, can deal with planar-faced manifold and nonmanifold objects, and can deliver the different results when a drawing has multiple interpretations. Our extensive tests show that the method can deal with most cases efficiently, including those that previous methods cannot solve.

[In vitro study on the differentiation of bone marrow mesenchymal stem cells into epidermal stem cells].

OBJECTIVE: To explore the feasibility of the differentiation of bone marrow mesenchymal stem cells into epidermal stem cells. METHODS: Human bone mesenchymal stem cells (BMSCs) were isolated from the bone marrow of volunteers' ilium, and were purified and cultured in vitro and induced by supernatant liquid of HaCat cells. The morphologic changes of BMSCs were observed with electron microscope, and immunohistochemical examination was carried out to detect the positive staining of cytokeratin 10, cytokeratin 19 and integrin beta1 after one week induction. RESULTS: Large numbers of flat-polygon cells were closely connected and developed like road metal. The plenty threadlike keratins were observed in the cytoplasm. The immunohistochemical examination showed the positive staining of few cytokeratin 10, a great deal of cytokeratin 19 and integrin beta1 after the one week induction. CONCLUSION: Human BMSCs can differentiate into epidermal stem cells with supernatant liquid of HaCat cells and EGFs in vitro.

In vitro study on the differentiation of bone marrow mesenchymal stem cells into epidermal stem cells / 中南大学学报(医学版)

OBJECTIVE@#To explore the feasibility of the differentiation of bone marrow mesenchymal stem cells into epidermal stem cells.@*METHODS@#Human bone mesenchymal stem cells (BMSCs) were isolated from the bone marrow of volunteers' ilium, and were purified and cultured in vitro and induced by supernatant liquid of HaCat cells. The morphologic changes of BMSCs were observed with electron microscope, and immunohistochemical examination was carried out to detect the positive staining of cytokeratin 10, cytokeratin 19 and integrin beta1 after one week induction.@*RESULTS@#Large numbers of flat-polygon cells were closely connected and developed like road metal. The plenty threadlike keratins were observed in the cytoplasm. The immunohistochemical examination showed the positive staining of few cytokeratin 10, a great deal of cytokeratin 19 and integrin beta1 after the one week induction.@*CONCLUSION@#Human BMSCs can differentiate into epidermal stem cells with supernatant liquid of HaCat cells and EGFs in vitro.