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Therapeutic value of endoscopy for primary duodenal lesions 内镜对原发性十二指肠病变的治疗价值
Pub Date : 2019-05-20 DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.05.005
Yongqiu Wei, Qiaozhi Zhou, Peng Li, M. Ji, Y. Niu, Yong-jun Wang, Shutian Zhang
Objective To study the therapeutic value of endoscopy for primary duodenal lesions. Methods Data of 79 consecutive patients with primary duodenal lesions, who underwent endoscopic treatment from January 2015 to January 2018 at Beijing Friendship Hospital, were retrospectively analyzed. Patients were divided into the complication group and the non-complication group, and further grouped according to lesion locations and endoscopic categories. Baseline data of patients, endoscopic treatment, wound closure method, pathological results, the occurrence and outcome of complications were studied. Results A total of 79 patients successfully went through endoscopic treatment, including 59 cases of endoscopic mucosal resection (EMR), 5 cases of endoscopic submucosal dissection (ESD), 6 cases of full-thickness resection with OTSC metal clips, and 9 cases of endoscopic piecemeal mucosal resection (EPMR). In all 79 cases, complications occurred in 8 patients (10.1%) during the perioperative period, all at the duodenal descending segment and duodenal papilla. In all 47 cases whose lesions located at duodenal papilla and duodenal descending segment, the complication incidence was 17.0% (8/47), significantly higher than that of non-descending and papilla part [0 (0/32), P=0.012]. Two (2.5%) cases had complications requiring further intervention with endoscopy or surgery. Among 8 patients with complications, 1 patient (2.1%) developed intraoperative perforation, 1 patient (2.1%) developed delayed bleeding, 6 patients (12.8%) developed mild acute pancreatitis, and these 8 patients recovered after treatment. These 47 patients were further divided into the duodenoscopy group and the gastroscopy group according to endoscopic categories, the complications incidence in the duodenoscopy group (28.0%, 7/25) was also significantly higher than that in the gastroscopy group [4.5%(1/22), P=0.037]. Conclusion Endoscopic treatment is safe and effective for primary duodenal lesions. But for the operations in the duodenal descending segment and the duodenal papilla, as well as in the case of duodenoscopy, it is necessary to be more vigilant about the occurrence of complications. Key words: Duodenal disease; Endoscopy; Endoscopic mucosal resection; Endoscopic submucosal dissection
目的探讨内镜对原发性十二指肠病变的治疗价值。方法回顾性分析2015年1月至2018年1月在北京友谊医院接受内镜治疗的79例原发性十二指肠病变患者的资料。将患者分为并发症组和非并发症组,并根据病变部位和内镜类别进一步分组。研究了患者的基线数据、内镜治疗、伤口闭合方法、病理结果、并发症的发生和转归。结果共有79例患者成功接受了内镜治疗,其中内镜黏膜切除术(EMR)59例,内镜黏膜下剥离术(ESD)5例,OTSC金属夹全厚度切除术6例,内镜粘膜碎片切除术(EPMR)9例。在所有79例病例中,8例(10.1%)患者在围手术期出现并发症,均发生在十二指肠降段和十二指肠乳头。病变位于十二指肠乳头和十二指肠降段的47例患者中,并发症发生率为17.0%(8/47),明显高于非降段和十二指肠乳头部分[0(0/32),P=0.012]。2例(2.5%)出现并发症,需要进一步进行内镜或手术干预。在8名并发症患者中,1名患者(2.1%)出现术中穿孔,1名(2.1%)发生延迟性出血,6名患者(12.8%)出现轻度急性胰腺炎,这8名患者在治疗后康复。根据内镜类型将47例患者进一步分为十二指肠镜组和胃镜组,十二指肠镜组并发症发生率(28.0%,7/25)也明显高于胃镜组[4.5%(1/22),P=0.037]。结论内镜治疗原发性十二指肠病变安全有效。但对于十二指肠降段和十二指肠乳头的手术,以及十二指肠镜检查的情况,有必要对并发症的发生提高警惕。关键词:十二指肠疾病;内窥镜;内镜黏膜切除术;内镜黏膜下剥离术
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引用次数: 0
Clinical effects of gastric peroral endoscopic myotomy on the treatment of gastroparesis after subtotal gastrectomy 胃经口内镜肌切开术治疗胃大部切除术后胃轻瘫的临床疗效
Pub Date : 2019-05-20 DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.05.004
Jiacheng Tan, S. Shrestha, Panpan Wang, Jinjun Shi, Yanjia Lu, Qi Gao, Tong Lu, Ruihua Shi
Objective To investigate the efficacy and safety of gastric peroral endoscopic myotomy (G-POEM) for postsurgical gastroparesis. Methods A retrospective analysis was performed on data of 47 patients with gastroparesis after subtotal gastrectomy, who underwent G-POEM at Zhongda Hospital Southeast University form August 2016 to June 2018. G-POEM procedure, complications related to G-POEM, and improvement of symptoms and gastric emptying function were observed. Results All patients underwent G-POEM successfully. No serious G-POEM-related complications were observed. During a follow-up period of 9.8±5.8 months (range 3-18 months), the scores of gastroparesis cardinal symptoms index (GCSI) were 1.6±0.5, 1.2±0.4, 1.1±0.6, 1.4±0.3 and 1.7±0.3 respectively at the 1st, 3rd, 6th, 12th, and 18th months after G-POEM, and all scores were lower than that before G-POEM (3.8±1.1, all P<0.01). The results showed the symptoms of gastroparesis were improved significantly. Gastric emptying imaging showed the hemi-emptying time was 23.8±8.8 min, 21.2±9.5 min, 20.9±8.3 min and 26.4±7.8 min at the 1st, 6th, 12th and 18th months after G-POEM, respectively, significantly shorter than that before G-POEM (67.8±12.5 min, all P<0.01). Three-dimensional ultrasonography results of gastric antrum volume showed that the hemi-emptying time was 26.4 (21.8, 40.3) min, 22.6 (13.9, 32.7) min, 24.3 (18.2, 36.5) min and 26.8 (16.4, 38.5) min at the 1st, 6th, 12th and 18th months after G-POEM, respectively, which were all significantly shorter than that before G-POEM [72.5 (48.3, 108.6) min, all P<0.01]. Conclusion G-POEM has a satisfactory long-term efficacy on the treatment of gastroparesis after subtotal gastrectomy with good safety. Key words: Gastroparesis; Efficiency; Safety; Gastric peroral endoscopic myotomy
目的探讨经口胃内镜下肌切开术(G-POEM)治疗术后胃轻瘫的疗效和安全性。方法回顾性分析2016年8月至2018年6月在东南大学中大医院行G-POEM治疗的47例胃大部切除术后胃轻瘫患者的资料。观察G-POEM手术、与G-POEM相关的并发症以及症状和胃排空功能的改善。结果所有患者均成功行G-POEM。未见严重的g - poem相关并发症。随访9.8±5.8个月(3 ~ 18个月),G-POEM治疗后1、3、6、12、18个月胃轻瘫主要症状指数(GCSI)评分分别为1.6±0.5、1.2±0.4、1.1±0.6、1.4±0.3、1.7±0.3,均低于G-POEM治疗前(3.8±1.1,均P<0.01)。结果显示胃轻瘫症状明显改善。胃排空成像显示,G-POEM治疗后第1、6、12、18个月的半排空时间分别为23.8±8.8 min、21.2±9.5 min、20.9±8.3 min和26.4±7.8 min,均显著短于G-POEM治疗前(67.8±12.5 min,均P<0.01)。胃窦容积三维超声检查结果显示,G-POEM术后第1、6、12、18个月的半排空时间分别为26.4 (21.8,40.3)min、22.6 (13.9,32.7)min、24.3 (18.2,36.5)min和26.8 (16.4,38.5)min,均显著短于G-POEM术前[72.5 (48.3,108.6)min, P均<0.01]。结论G-POEM治疗胃大部切除术后胃轻瘫远期疗效满意,安全性好。关键词:胃轻瘫;效率;安全;胃经口内窥镜切肌术
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引用次数: 0
Diagnostic value of epithelial vessel branch using non-magnifying narrow-band imaging on early esophageal cancer 上皮血管分支非放大窄带成像对早期食管癌症的诊断价值
Pub Date : 2019-04-20 DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.04.011
Shu Li, Dong-liang Yu, Xin Wang, Ai‐qin Li, M. Zou, Yuqi He
Objective To evaluate the clinical value of epithelial vessel branch detected by non-magnifying narrow-band imaging (NM-NBI) in diagnosis of early esophageal cancer. Methods A retrospective analysis was performed on data of 59 patients, who underwent endoscopy with NM-NBI and iodine staining to screen early esophageal cancer in PLA General Hospital from January 2013 to May 2015. The final diagnosis for all lesions were determined by pathology. The diagnostic accuracy, sensitivity and specificity of NM-NBI and iodine staining for early esophageal cancer were compared. Results The accuracy, sensitivity and specificity of NM-NBI on the epithelial vessel branch in diagnosis of early esophageal cancer were 83.1% (49/59), 91.3% (21/23) and 77.8% (28/36), respectively, and the corresponding statistical values of iodine staining were 55.9% (33/59), 95.7% (22/23) and 30.6% (11/36), respectively. The accuracy (χ2=1.45, P=0.028) and specificity (χ2=21.4, P=0.000) of epithelial vessel branch by NM-NBI were significantly higher than those of iodine staining, and there was no significant difference in the sensitivity between the two methods (χ2=22.3, P=1.000). Conclusion The observation of epithelial vessel branch using NM-NBI was useful and reliable in diagnosis of early esophageal cancer with high accuracy and specificity, and can be possible for application in the clinic. Key words: Esophageal neoplasms; Early esophageal cancer; Narrow-band imaging; Epithelial vessel branch
目的评价非放大窄带成像(NM-NBI)检测上皮血管分支在早期食管癌症诊断中的临床价值。方法回顾性分析2013年1月至2015年5月解放军总医院收治的59例癌症早期筛查患者的临床资料。所有病变的最终诊断均由病理学决定。比较NM-NBI和碘染色对早期食管癌症的诊断准确性、敏感性和特异性。结果NM-NBI在早期食管癌症诊断中的准确率、敏感性和特异性分别为83.1%(49/59)、91.3%(21/23)和77.8%(28/36),碘染色的相应统计值分别为55.9%(33/59)、95.7%(22/23)和30.6%(11/36)。NM-NBI检测上皮血管分支的准确性(χ2=1.45,P=0.028)和特异性(χ2=21.4,P=0.000)均显著高于碘染色,结论NM-NBI观察食管上皮血管分支对早期食管癌症的诊断具有较高的准确性和特异性,具有一定的临床应用价值。关键词:食管肿瘤;早期食管癌症;窄带成像;上皮血管分支
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引用次数: 0
Application and development of artificial intelligence in digestive endoscopy improvement 人工智能在消化内镜改进中的应用与发展
Pub Date : 2019-04-20 DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.04.003
Chen Zhiyuan, Zhang Zifan, Luowei Wang
随着人工智能在各领域的应用,消化内镜质量控制能否踏着这个科技浪潮进行一次全新的变革,智能化的质控管理方式如何在消化内镜领域提高质控效率及质量越来越受到关注。本文从消化内镜质量控制的现状和面临的问题出发,着重探讨了人工智能在消化内镜质量控制方面的应用现状和发展前景,为消化内镜质量控制的智能化发展提供了一种现实可行的构想。
随着人工智能在各领域的应用,消化内镜质量控制能否踏着这个科技浪潮进行一次全新的变革,智能化的质控管理方式如何在消化内镜领域提高质控效率及质量越来越受到关注。本文从消化内镜质量控制的现状和面临的问题出发,着重探讨了人工智能在消化内镜质量控制方面的应用现状和发展前景,为消化内镜质量控制的智能化发展提供了一种现实可行的构想。
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引用次数: 0
Effects of peroral endoscopic myotomy on achalasia in geriatric patients 经口内窥镜下肌切开术治疗老年贲门失弛缓症的疗效
Pub Date : 2019-04-20 DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.04.010
Xin-yang Liu, Jing Cheng, Zuqiang Liu, Quan-Lin Li
Objective To evaluate the safety, feasibility, perioperative and long-term efficacy of peroral endoscopic myotomy (POEM) for achalasia (AC) in geriatric patients. Methods Data of 41 patients aged over 65 diagnosed with achalasia and treated with POEM in Zhongshan Hospital from August 2010 to December 2014 were retrospectively studied. Perioperative complications, preoperative and postoperative Eckardt score and pressure of the lower esophageal sphincter, esophageal reflux and clinical failure were analyzed. Results All 41 patients underwent POEM successfully, with median operation time of 42 min. Median hospitalization was 3 days. Major perioperative adverse events occurred in 4 cases (9.75%), whose hospitalization was longer than 5 days for perioperative adverse events. During median follow-up period of 40 months (interquartile range 24-57 months), median Eckardt score decreased from 8 to 1(P<0.001)and pressure of the lower esophageal sphincter decreased from 23.85 mmHg(1 mmHg=0.133 kPa) to 9.05 mmHg (P=0.005). Clinical reflux occurred in 12 cases (29.27%) and the 5-year success rate of POEM was 87.80% (36/41). Conclusion POEM is a safe and reliable treatment for geriatric AC patients with confirmed short-term and long-term effectiveness. Key words: Esophageal achalasia; Geriatrics; Peroral endoscopic myotomy
目的评价经口内镜下肌切开术(POEM)治疗老年贲门失弛缓症(AC)的安全性、可行性、围手术期及远期疗效。方法回顾性分析2010年8月至2014年12月中山医院经POEM治疗的41例65岁以上贲门失弛缓症患者的资料。分析围手术期并发症、术前术后食管下括约肌Eckardt评分及压力、食管反流及临床失败情况。结果41例患者均成功行POEM手术,平均手术时间42 min,平均住院时间3 d。发生重大围手术期不良事件4例(9.75%),住院时间超过5天。中位随访40个月(四分位数间距24-57个月),中位Eckardt评分从8降至1(P<0.001),食管下括约肌压力从23.85 mmHg(1 mmHg=0.133 kPa)降至9.05 mmHg(P=0.005)。临床返流12例(29.27%),POEM 5年成功率87.80%(36/41)。结论POEM是一种安全可靠的治疗老年性AC的方法,短期和长期疗效确切。关键词:食道失弛缓症;老年病学;经口内窥镜肌切开术
{"title":"Effects of peroral endoscopic myotomy on achalasia in geriatric patients","authors":"Xin-yang Liu, Jing Cheng, Zuqiang Liu, Quan-Lin Li","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.04.010","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.04.010","url":null,"abstract":"Objective \u0000To evaluate the safety, feasibility, perioperative and long-term efficacy of peroral endoscopic myotomy (POEM) for achalasia (AC) in geriatric patients. \u0000 \u0000 \u0000Methods \u0000Data of 41 patients aged over 65 diagnosed with achalasia and treated with POEM in Zhongshan Hospital from August 2010 to December 2014 were retrospectively studied. Perioperative complications, preoperative and postoperative Eckardt score and pressure of the lower esophageal sphincter, esophageal reflux and clinical failure were analyzed. \u0000 \u0000 \u0000Results \u0000All 41 patients underwent POEM successfully, with median operation time of 42 min. Median hospitalization was 3 days. Major perioperative adverse events occurred in 4 cases (9.75%), whose hospitalization was longer than 5 days for perioperative adverse events. During median follow-up period of 40 months (interquartile range 24-57 months), median Eckardt score decreased from 8 to 1(P<0.001)and pressure of the lower esophageal sphincter decreased from 23.85 mmHg(1 mmHg=0.133 kPa) to 9.05 mmHg (P=0.005). Clinical reflux occurred in 12 cases (29.27%) and the 5-year success rate of POEM was 87.80% (36/41). \u0000 \u0000 \u0000Conclusion \u0000POEM is a safe and reliable treatment for geriatric AC patients with confirmed short-term and long-term effectiveness. \u0000 \u0000 \u0000Key words: \u0000Esophageal achalasia; Geriatrics; Peroral endoscopic myotomy","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"269-272"},"PeriodicalIF":0.0,"publicationDate":"2019-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"41398665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Application of artificial intelligence gastroscope in blind area monitoring and independent image acquisition 人工智能胃镜在盲区监测和独立图像采集中的应用
Pub Date : 2019-04-20 DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.04.004
Xia Li, Lianlian Wu
Objective To analyze the blind area monitoring and independent image acquisition function of gastroscopic elves (a real-time gastroscopic monitoring system) in gastroscopy. Methods A total of 38 522 gastroscopic images from the database of Digestive Endoscopy Center of Renmin Hospital of Wuhan University were collected to train and validate the gastroscopic elves.Using computer to generate random numbers, 91 gastroscopic videos were selected to assess the position recognition accuracy of the gastroscopic elves, and 45 gastroscopic videos and matching gastroscopic images collected by endoscopists were selected to compare the coverage number and rate of gastroscopy sites between gastroscopic elves and endoscopists image acquisition. Two endoscopists entered the study to perform gastroscopies with or without gastroscopic elves. Forty-five gastroscopies respectively performed by the endoscopist A before and after usage of gastroscopic elves were collected, and 42 gastroscopies divided into 20 and 22 performed by the endoscopist B without use of gastroscopic elves in the same period were also collected. The coverage rate of gastroscopy sites was compared between the two endoscopists. Results The total position recognition accuracy of gastroscopic elves was 85.125% (1 156/1 358). The coverage rate of gastroscopic sites for the endoscopist A was (76.790±8.848)% and (87.325±7.065)%, respectively, before and after using gastroscopic elves, and the coverage rate in the same period for the endoscopist B was (75.926 ±11.565)% and (75.253 ±14.662)%, respectively. The coverage rate before using gastroscopic elves had no statistical difference between the two endoscopists (t=0.324, P=0.747). The coverage rate for the endoscopist A after using gastroscopic elves was higher than that before using gastroscopic elves (t=6.222, P=0.001), and that of the endoscopist B in the same period (t′=3.588, P=0.002). The coverage number and rate of gastroscopy sites for gastroscopic elves and endoscopists image acquisition were 20.956 ±3.406 and (77.613±12.613)%, and 15.467±2.296 and (57.284±8.503)%, respectively, with statistical differences (t=11.523, P=0.000; t=11.523, P=0.000). Conclusion Gastroscopic elves can improve the coverage number and rate of gastroscopy sites, and is worthy of promotion in clinics. Key words: Gastroscopy; Artificial intelligence; Blind area monitoring; Independent image acquisition
目的分析实时胃镜监测系统(gastroscopic elf)在胃镜检查中的盲区监测和独立图像采集功能。方法收集武汉大学人民医院消化内镜中心数据库中的38 522张胃镜图像,对胃镜检查人员进行训练和验证。利用计算机生成随机数,选取91个胃镜视频评估胃镜精灵的位置识别准确性,选取内镜医师采集的45个胃镜视频和匹配的胃镜图像,比较胃镜精灵与内镜医师图像采集的胃镜位置覆盖率和胃镜位置覆盖率。两名内窥镜医师进入研究,分别使用或不使用胃镜进行胃镜检查。收集A内镜医师在使用胃镜精灵前后分别进行的胃镜检查45例,同时收集B内镜医师同期未使用胃镜精灵进行的胃镜检查42例,分为20例和22例。比较两种内镜医师胃镜检查部位的覆盖率。结果胃镜下机器人的总位置识别准确率为85.125%(1 156/1 358)。A内镜医师使用胃镜前后胃镜部位覆盖率分别为(76.790±8.848)%和(87.325±7.065)%,B内镜医师同期胃镜部位覆盖率分别为(75.926±11.565)%和(75.253±14.662)%。两种内镜医师使用胃镜前的覆盖率差异无统计学意义(t=0.324, P=0.747)。内镜医师A在使用胃镜精灵后的覆盖率高于未使用胃镜精灵前(t=6.222, P=0.001),同期内镜医师B的覆盖率高于未使用胃镜精灵前(t ' =3.588, P=0.002)。胃镜和内镜影像采集的胃镜部位覆盖率分别为20.956±3.406和(77.613±12.613)%、15.467±2.296和(57.284±8.503)%,差异有统计学意义(t=11.523, P=0.000;t = 11.523, P = 0.000)。结论人工胃镜检查可提高胃镜检查部位的覆盖率和覆盖率,值得在临床推广。关键词:胃镜检查;人工智能;盲区监测;独立图像采集
{"title":"Application of artificial intelligence gastroscope in blind area monitoring and independent image acquisition","authors":"Xia Li, Lianlian Wu","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.04.004","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.04.004","url":null,"abstract":"Objective \u0000To analyze the blind area monitoring and independent image acquisition function of gastroscopic elves (a real-time gastroscopic monitoring system) in gastroscopy. \u0000 \u0000 \u0000Methods \u0000A total of 38 522 gastroscopic images from the database of Digestive Endoscopy Center of Renmin Hospital of Wuhan University were collected to train and validate the gastroscopic elves.Using computer to generate random numbers, 91 gastroscopic videos were selected to assess the position recognition accuracy of the gastroscopic elves, and 45 gastroscopic videos and matching gastroscopic images collected by endoscopists were selected to compare the coverage number and rate of gastroscopy sites between gastroscopic elves and endoscopists image acquisition. Two endoscopists entered the study to perform gastroscopies with or without gastroscopic elves. Forty-five gastroscopies respectively performed by the endoscopist A before and after usage of gastroscopic elves were collected, and 42 gastroscopies divided into 20 and 22 performed by the endoscopist B without use of gastroscopic elves in the same period were also collected. The coverage rate of gastroscopy sites was compared between the two endoscopists. \u0000 \u0000 \u0000Results \u0000The total position recognition accuracy of gastroscopic elves was 85.125% (1 156/1 358). The coverage rate of gastroscopic sites for the endoscopist A was (76.790±8.848)% and (87.325±7.065)%, respectively, before and after using gastroscopic elves, and the coverage rate in the same period for the endoscopist B was (75.926 ±11.565)% and (75.253 ±14.662)%, respectively. The coverage rate before using gastroscopic elves had no statistical difference between the two endoscopists (t=0.324, P=0.747). The coverage rate for the endoscopist A after using gastroscopic elves was higher than that before using gastroscopic elves (t=6.222, P=0.001), and that of the endoscopist B in the same period (t′=3.588, P=0.002). The coverage number and rate of gastroscopy sites for gastroscopic elves and endoscopists image acquisition were 20.956 ±3.406 and (77.613±12.613)%, and 15.467±2.296 and (57.284±8.503)%, respectively, with statistical differences (t=11.523, P=0.000; t=11.523, P=0.000). \u0000 \u0000 \u0000Conclusion \u0000Gastroscopic elves can improve the coverage number and rate of gastroscopy sites, and is worthy of promotion in clinics. \u0000 \u0000 \u0000Key words: \u0000Gastroscopy; Artificial intelligence; Blind area monitoring; Independent image acquisition","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"240-245"},"PeriodicalIF":0.0,"publicationDate":"2019-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"45950957","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
The community structure of intestinal bacteria from cirrhosis patients and its influence factors 肝硬化患者肠道细菌群落结构及影响因素分析
Pub Date : 2019-04-20 DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.04.012
Lei Zhang, Yong-Na Wu, Jing Zhang, Tuo Chen, Xun Li, Guangxiu Liu
Objective To investigate the community structure of intestinal bacteria from patients with cirrhosis and its influencing factors. Methods From 2016 to 2017, 24 patients with liver cirrhosis (the LC group) and 23 healthy family members of patients (the HC group) were enrolled at the First Hospital of Lanzhou University. A comparative analysis of the community structure of intestinal bacteria was performed using 16S rRNA gene sequencing in LC and HC groups. Combined with LEfSe analysis and NMDS analysis, the differential markers were screened and the factors affecting the intestinal community structure of subjects were studied. Results The dominant six phylum of bacteria in intestines in LC and HC groups included Firmicutes, Bacteroides, Proteobacteria, Actinobacteria, Fusobacteria and Tenericumes. However, in the LC sample, Firmicutes was significantly reduced, while Bacteroides was significantly increased. The diversity of intestinal bacteria was significantly reduced, and the Firmicutes/Bacteroides ratio was significantly decreased, suggesting a variation of the community structure in intestinal bacteria of cirrhosis patients. The LEfSe result indicated that the abundance of Enterococcus, Lactobacillales, Bacilli, and Bacteroidetes showed a significant difference in the LC sample, which may be used as potential marked bacterial groups for cirrhosis. The NMDS analysis revealed a positive relationship between the concentration of Cd and Pb and the abundance of intestinal bacteria in the LC sample. Conclusion The community structure of intestinal bacteria from patients with cirrhosis has changed. Enterococcus, Lactobacillales, Bacilli, and Bacteroidetes are potential marked bacterial groups. The concentration of Cd and Pb in the intestinal tract of cirrhosis patients may interact with the abundance and structure of bacteria, and further affect the occurrence and development of cirrhosis. Key words: Cirrhosis; Intestinal bacteria; Bacterial community structure; Influencing factor
目的了解肝硬化患者肠道细菌群落结构及其影响因素。方法选取2016 - 2017年兰州大学第一医院肝硬化患者24例(LC组)和健康患者家属23例(HC组)。采用16S rRNA基因测序对LC组和HC组肠道细菌群落结构进行比较分析。结合LEfSe分析和NMDS分析,筛选差异标志物,研究受试者肠道群落结构的影响因素。结果LC组和HC组肠道内优势菌门为厚壁菌门、拟杆菌门、变形菌门、放线菌门、梭菌门和细毛菌门。而LC样品中厚壁菌门明显减少,拟杆菌门明显增加。肝硬化患者肠道细菌多样性显著降低,厚壁菌门/拟杆菌门比值显著降低,提示肝硬化患者肠道细菌群落结构发生了变化。LEfSe结果显示LC样品中Enterococcus、Lactobacillales、Bacilli、Bacteroidetes丰度差异显著,可作为肝硬化潜在的标记菌群。NMDS分析显示LC样品中Cd和Pb浓度与肠道细菌丰度呈正相关。结论肝硬化患者肠道菌群结构发生了变化。肠球菌、乳酸杆菌、芽孢杆菌和拟杆菌门是潜在的标记细菌群。肝硬化患者肠道内Cd和Pb浓度可能与细菌的丰度和结构相互作用,进而影响肝硬化的发生和发展。关键词:肝硬化;肠道细菌;细菌群落结构;影响因素
{"title":"The community structure of intestinal bacteria from cirrhosis patients and its influence factors","authors":"Lei Zhang, Yong-Na Wu, Jing Zhang, Tuo Chen, Xun Li, Guangxiu Liu","doi":"10.3760/CMA.J.ISSN.1007-5232.2019.04.012","DOIUrl":"https://doi.org/10.3760/CMA.J.ISSN.1007-5232.2019.04.012","url":null,"abstract":"Objective \u0000To investigate the community structure of intestinal bacteria from patients with cirrhosis and its influencing factors. \u0000 \u0000 \u0000Methods \u0000From 2016 to 2017, 24 patients with liver cirrhosis (the LC group) and 23 healthy family members of patients (the HC group) were enrolled at the First Hospital of Lanzhou University. A comparative analysis of the community structure of intestinal bacteria was performed using 16S rRNA gene sequencing in LC and HC groups. Combined with LEfSe analysis and NMDS analysis, the differential markers were screened and the factors affecting the intestinal community structure of subjects were studied. \u0000 \u0000 \u0000Results \u0000The dominant six phylum of bacteria in intestines in LC and HC groups included Firmicutes, Bacteroides, Proteobacteria, Actinobacteria, Fusobacteria and Tenericumes. However, in the LC sample, Firmicutes was significantly reduced, while Bacteroides was significantly increased. The diversity of intestinal bacteria was significantly reduced, and the Firmicutes/Bacteroides ratio was significantly decreased, suggesting a variation of the community structure in intestinal bacteria of cirrhosis patients. The LEfSe result indicated that the abundance of Enterococcus, Lactobacillales, Bacilli, and Bacteroidetes showed a significant difference in the LC sample, which may be used as potential marked bacterial groups for cirrhosis. The NMDS analysis revealed a positive relationship between the concentration of Cd and Pb and the abundance of intestinal bacteria in the LC sample. \u0000 \u0000 \u0000Conclusion \u0000The community structure of intestinal bacteria from patients with cirrhosis has changed. Enterococcus, Lactobacillales, Bacilli, and Bacteroidetes are potential marked bacterial groups. The concentration of Cd and Pb in the intestinal tract of cirrhosis patients may interact with the abundance and structure of bacteria, and further affect the occurrence and development of cirrhosis. \u0000 \u0000 \u0000Key words: \u0000Cirrhosis; Intestinal bacteria; Bacterial community structure; Influencing factor","PeriodicalId":10072,"journal":{"name":"Chinese Journal of Digestive Endoscopy","volume":"36 1","pages":"277-282"},"PeriodicalIF":0.0,"publicationDate":"2019-04-20","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"47838284","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Comparison of intraductal ultrasonography characteristics between cholangiocarcinoma and benign bile duct stricture 胆管癌与良性胆管狭窄的导管内超声特征比较
Pub Date : 2019-04-20 DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.04.009
Qingwei Jiang, Xi Wu, Fang Yao, Dong-sheng Wu, Z. Meng, A. Yang
Objective To conclude the intraductal ultrasonography (IDUS) characteristics of cholangiocarcinoma and improve endoscopic diagnosis for cholangiocarcinoma by comparing manifestations of IDUS between cholangiocarcinoma and benign bile duct stricture. Methods A total of 52 patients undergoing endoscopic retrograde cholangiopancreatography (ERCP) and IDUS with definite diagnosis of cholangiocarcinoma from January 2012 to January 2017 were included in this retrospective study, and 59 patients undergoing ERCP and IDUS during the same period with definite diagnosis of benign bile duct stricture were included as control. Clinical data, indices of laboratory tests, and manifestations of IDUS (including length of stricture, echo feature, thickness of bile duct, symmetry, and integrity of outer membrane of bile duct wall) were collected and compared between the two groups. Results The clinical manifestations and results of laboratory examination showed no significant differences between the two groups. Intraductal brushing cytology and forceps biopsy showed 28.9% and 40.0% malignant evidence respectively. IDUS showed thicker bile duct in the cholangiocarcinoma group (6.8±4.0 mm VS 4.1±2.3 mm, P<0.01). Proportion of hypoechoic and nonsymmetrical thickened bile duct was higher in the cholangiocarcinoma group (78.8% VS 44.1%, 92.3% VS 50.8%, respectively, all P<0.01). Outer membrane of bile duct destruction occurred in 8 cases (15.4%) in the cholangiocarcinoma group, whereas none was seen in the control group. Conclusion Hypoecho and nonsymmetrical thickness on IDUS may be indicators of cholangiocarcinoma, and destruction of bile duct outer membrane is highly suggestive of cholangiocarcinoma. Key words: Endosonography; Cholangiopancreatography, endoscopic retrograde; Bile duct neoplasms; Diagnosis
目的通过比较胆管癌和良性胆管狭窄的导管内超声表现,总结胆管癌的导管内声像图特征,提高胆管癌的内镜诊断水平。方法回顾性研究纳入2012年1月至2017年1月接受内镜逆行胰胆管造影(ERCP)和IDUS确诊为胆管癌的52例患者,并将同期接受ERCP和IDUS的59例确诊为良性胆管狭窄的患者作为对照。收集两组的临床数据、实验室检查指标和IDUS表现(包括狭窄长度、回声特征、胆管厚度、胆管壁对称性和外膜完整性),并进行比较。结果两组患者的临床表现及实验室检查结果无明显差异。导管内刷毛细胞学和钳子活检分别显示28.9%和40.0%的恶性证据。胆管癌组IDUS显示胆管较厚(6.8±4.0mm VS 4.1±2.3mm,P<0.01)。胆管低回声和不对称增厚的比例在胆管癌组中较高(分别为78.8%VS 44.1%、92.3%VS 50.8%,均P<0.01),而在对照组中没有观察到。结论IDUS低回声和不对称厚度可能是胆管癌的标志,胆管外膜破坏高度提示胆管癌。关键词:腔内超声;胰胆管造影,内镜逆行;胆管肿瘤;诊断
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引用次数: 0
Construction of artificial intelligence assisted diagnosis model for colonoscopy 结肠镜人工智能辅助诊断模型的构建
Pub Date : 2019-04-20 DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.04.006
Xiao Chen, Jianting Cai, Jiamin Chen, Li-ming Shao, Qingwei Chen, Chuangao Xie, Dan-dan Zhong, Rong Bai, Yin Bai
Objective To establish an artificial intelligence deep learning model using clinical colonoscopy images and video to assist the diagnosis by colonoscopy. Methods More than 600 000 colonoscopy images were collected in endoscopic center of the Second Affiliated Hospital of Zhejiang University School of Medicine from 2014 to 2018, and endoscopic experts recorded a large number of high-quality operation video of colonoscopy as analysis data. After repeated discussion by six experts, the classified intestinal sites and pathological features were determined, and fuzzy and confusable images were deleted. The final selection result was approximately 1 out of 4. And then the features of images were marked using an independently developed software. The deep learning algorithm was developed using TensorFlow platform of Google. Results After repeated comparison and analysis of the results of machine training and judgment results combined with pathology from endoscopic experts, the sensitivity of the model for some diseases (such as colon polyps) was 99% under laboratory conditions. In the clinical colonoscopy test, the sensitivity, specificity, and overall accuracy of this model for diagnosis of colon polyps were 98.30% (4 187/4 259), 88.10% (17 620/20 000), and 92.92% [2×98.30%×88.10%/(98.30%+ 88.10%)], respectively. The sensitivity and specificity for ulcerative colitis were 78.32% (2 671/3 410), and 67.06% (13 412/20 000), respectively. The diagnosis time spent on a single image was 0.5±0.03 s, and it was the real time for application, including system recognition, text prompt in video image, background record and storage. Conclusion The artificial intelligence assisted diagnosis model developed by our team can identify colonic polyps, colorectal cancer, colorectal eminence, colonic diverticulum, ulcerative colitis, etc. The auxiliary diagnosis model of colon disease can guide beginners to carry out colonoscopy, and can improve lesion detection rate, reduce misdiagnosis rate, and improve the overall operating efficiency of endoscopic center, which is conducive to the quality control of colonoscopy. Key words: Colonoscopy; Artificial intelligence; Quality control; Assisted diagnosis
目的建立基于临床结肠镜图像和视频的人工智能深度学习模型,辅助结肠镜诊断。方法收集浙江大学医学院附属第二医院内镜中心2014 - 2018年结肠镜检查影像60余万张,内镜专家录制大量高质量的结肠镜手术视频作为分析资料。经过6位专家的反复讨论,确定了分类的肠道部位和病理特征,并删除了模糊和易混淆的图像。最终的选择结果大约是1 / 4。然后使用自主开发的软件对图像特征进行标记。利用b谷歌的TensorFlow平台开发深度学习算法。结果通过对机器训练结果和内镜专家病理判断结果的反复对比分析,在实验室条件下,该模型对部分疾病(如结肠息肉)的敏感性可达99%。在临床结肠镜检查中,该模型诊断结肠息肉的敏感性为98.30%(4 187/4 259),特异性为88.10%(17 620/2 000),总体准确性为92.92% [2×98.30%×88.10%/(98.30%+ 88.10%)]。溃疡性结肠炎的敏感性为78.32%(2 673 / 410),特异性为67.06%(13 412/20 000)。单幅图像的诊断时间为0.5±0.03 s,实时应用,包括系统识别、视频图像中的文本提示、后台记录和存储。结论本团队开发的人工智能辅助诊断模型可识别结肠息肉、结直肠癌、结直肠隆起、结肠憩室、溃疡性结肠炎等疾病。结肠疾病辅助诊断模式可以指导初学者进行结肠镜检查,并且可以提高病变检出率,减少误诊率,提高内镜中心整体操作效率,有利于结肠镜检查的质量控制。关键词:结肠镜检查;人工智能;质量控制;辅助诊断
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引用次数: 1
Application of artificial intelligence assisted diagnosis based on deep learning for early esophageal cancer 基于深度学习的人工智能辅助诊断在癌症早期诊断中的应用
Pub Date : 2019-04-20 DOI: 10.3760/CMA.J.ISSN.1007-5232.2019.04.005
S. Cai, Ayimukedisi Yalikong, Ran Li, Yan Bo, L. Yao, P. Zhou, Y. Zhong
Objective To improve the detection rate of early esophageal cancer during endoscopy by construction of artificial intelligence assistant diagnosis system. Methods A total of 2 400 esophageal images were collected from Zhongshan Hospital of Fudan University from January 2016 to December 2017, including 1 200 images of early esophageal cancer and 1 200 images of normal esophageal mucosa. The lesions in pictures were marked with rectangular box by using computer program. Among them, 2 000 pictures were divided into the training set and 400 pictures into the test set. An assistant diagnostic model of early esophageal cancer was established by back propagation algorithm in computer deep learning. The training model was tested and the sensitivity and specificity of the system at different cut-off points in the test set was calculated. Receiver operating characteristic (ROC) curve was used to evaluate the performance of the diagnostic model. Results The area under ROC curve (AUC) of the auxiliary diagnostic model was 0.996 1. The sensitivity and specificity were satisfactory. Conclusion The deep learning model constructed in this study has good specificity, sensitivity and AUC value in the diagnosis of early esophageal cancer, and can assist endoscopists in real-time diagnosis in clinical examination. Key words: Endoscopy, digestive system; Early esophageal cancer; Deep learning; Computer-assisted diagnosis
目的通过构建人工智能辅助诊断系统,提高早期食管癌内镜检查的检出率。方法收集2016年1月至2017年12月复旦大学中山医院食管影像2 400张,其中早期食管癌影像1 200张,正常食管黏膜影像1 200张。用计算机程序用矩形方框对图片中的病灶进行标记。其中,2000张图片被分成训练集,400张图片被分成测试集。采用计算机深度学习中的反向传播算法,建立了早期食管癌的辅助诊断模型。对训练模型进行测试,计算系统在测试集中不同截止点的敏感性和特异性。采用受试者工作特征(ROC)曲线评价诊断模型的性能。结果辅助诊断模型的ROC曲线下面积(AUC)为0.996 1。敏感性和特异性均令人满意。结论本研究构建的深度学习模型对早期食管癌的诊断具有良好的特异性、敏感性和AUC值,可辅助内镜医师在临床检查中进行实时诊断。关键词:内窥镜;消化系统;早期食管癌;深度学习;计算机辅助诊断
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引用次数: 0
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中华消化内镜杂志
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