Colorectal cancer(CRC) is the third most common cancer in males and second in females, and globally the fourth cause for cancer death worldwide. Oncological screening of CRC has a major role in the management of the d...Colorectal cancer(CRC) is the third most common cancer in males and second in females, and globally the fourth cause for cancer death worldwide. Oncological screening of CRC has a major role in the management of the disease and it is mostly performed by colonoscopy. Anyway, effectiveness of endoscopic screening for CRC strictly depends on adequate detection and removal of potentially precancerous lesions, and accuracy of colonoscopy in detection of adenomas is still suboptimal. For this reason, several technological advances have been implemented in order to improve the diagnostic sensitivity of colonoscopy in adenoma detection. Among these:(1) Visual technologies such as chromoendoscopy and narrow band imaging;(2) optical innovation as high definition endoscopy, full-spectrum endoscopy or Third Eye Retroscope; and(3) mechanical advances as Cap assisted colonoscopy, Endocuff, Endoring and G-Eye endoscope. All these technologies advances have been tested over time by clinical studies with mixed results. Which of them is more likely to be successful in the next future?展开更多
The rate of adenoma detection is the most reliable quality indicator of colonoscopy.Studies have reported that colonoscopy performed in morning has a higher adenoma detection rate(ADR)than that performed in the aftern...The rate of adenoma detection is the most reliable quality indicator of colonoscopy.Studies have reported that colonoscopy performed in morning has a higher adenoma detection rate(ADR)than that performed in the afternoon.These studies have explained that several physician-related factors such as undergoing an emergency procedure the night before colonoscopy,accumulated workload,and increased fatigue level in the afternoon might have led to such finding.However,several opposing articles have indicated that the time of day and ADR is not quite related.Complex confounding factors can impact study results.Colonoscopy withdrawal time and bowel preparation quality are key factors.However,queue list numbers,participation of academic fellows,nurses'assistance,and the number of colonoscopies allocated per hour are also notable factors.Recently,an attempt has been made to homogenize the ADR in the morning and afternoon through artificial intelligence-assisted colonoscopy.This review article introduces the history of this long-debated topic,discusses points to consider in real-world practice,and suggests new ideas for planning future research.By understanding this issue,the rate of adenoma detection during colonoscopy is expected to be improved further.展开更多
Colonoscopy remains the standard strategy for screening for colorectal cancer around the world due to its efficacy in both detecting adenomatous or precancerous lesions and the capacity to remove them intra-procedural...Colonoscopy remains the standard strategy for screening for colorectal cancer around the world due to its efficacy in both detecting adenomatous or precancerous lesions and the capacity to remove them intra-procedurally.Computeraided detection and diagnosis(CAD),thanks to the brand new developed innovations of artificial intelligence,and especially deep-learning techniques,leads to a promising solution to human biases in performance by guarantying decision support during colonoscopy.The application of CAD on real-time colonoscopy helps increasing the adenoma detection rate,and therefore contributes to reduce the incidence of interval cancers improving the effectiveness of colonoscopy screening on critical outcome such as colorectal cancer related mortality.Furthermore,a significant reduction in costs is also expected.In addition,the assistance of the machine will lead to a reduction of the examination time and therefore an optimization of the endoscopic schedule.The aim of this opinion review is to analyze the clinical applications of CAD and artificial intelligence in colonoscopy,as it is reported in literature,addressing evidence,limitations,and future prospects.展开更多
Heart rate is an important vital characteristic which indicates physical and mental health status.Typically heart rate measurement instruments require direct contact with the skin which is time-consuming and costly.Th...Heart rate is an important vital characteristic which indicates physical and mental health status.Typically heart rate measurement instruments require direct contact with the skin which is time-consuming and costly.Therefore,the study of non-contact heart rate measurement methods is of great importance.Based on the principles of photoelectric volumetric tracing,we use a computer device and camera to capture facial images,accurately detect face regions,and to detect multiple facial images using a multi-target tracking algorithm.Then after the regional segmentation of the facial image,the signal acquisition of the region of interest is further resolved.Finally,frequency detection of the collected Photo-plethysmography(PPG)and Electrocardiography(ECG)signals is completed with peak detection,Fourier analysis,and a Waveletfilter.The experimental results show that the subject’s heart rate can be detected quickly and accurately even when monitoring multiple facial targets simultaneously.展开更多
AIM: To determine the diagnostic yield of the "third eye retroscope",on adenoma detection rate during screening colonoscopy.METHODS: The "third eye retroscope" when used with standard colonoscopy p...AIM: To determine the diagnostic yield of the "third eye retroscope",on adenoma detection rate during screening colonoscopy.METHODS: The "third eye retroscope" when used with standard colonoscopy provides an additional retrograde view to visualize lesions on the proximal aspects of folds and flexures.We searched MEDLINE(Pub Med and Ovid),SCOPUS(including MEDLINE and EMBASE databases),Cochrane Database of Systemic Reviews,Google Scholar,and CINAHL Plus databases to identify studies that evaluated diagnostic yield of "third eye retroscope" during screening colonoscopy.Der Simonian Laird random effects model was used to generate the overall effect for each outcome.We evaluated statistical heterogeneity among the studies by using the Cochran Q statistic and quantified by I2 statistics.RESULTS: Four distinct studies with a total of 920 patients,mean age 59.83(95%CI: 56.77-62.83) years,were included in the review.The additional adenoma detection rate(AADR) defined as the number of additional adenomas identified due to "third eye retroscope" device in comparison to standard colonoscopy alone was 19.9%(95%CI: 7.3-43.9).AADR for right and left colon were 13.9%(95%CI: 9.4-20) and 10.7(95%CI: 1.9-42),respectively.AADR for polyps ≥ 6 mm and ≥ 10 mm were 24.6%(95%CI: 16.6-34.9) and 24.2%(95%CI: 12.9-40.8),respectively.The additional polyp detection rate defined as the number of additional polyps identified due to "third eye retroscope" device in comparison to standard colonoscopy alone was 19.8%(95%CI: 7.9-41.8).There were no complications reported with use of "third eye retroscope" device.CONCLUSION: The "third eye retroscope" device when used with standard colonoscopy is safe and detects 19.9% additional adenomas,compared to standard colonoscopy alone.展开更多
BACKGROUND Improved adenoma detection at colonoscopy has decreased the risk of developing colorectal cancer.However,whether image-enhanced endoscopy(IEE)further improves the adenoma detection rate(ADR)is controversial...BACKGROUND Improved adenoma detection at colonoscopy has decreased the risk of developing colorectal cancer.However,whether image-enhanced endoscopy(IEE)further improves the adenoma detection rate(ADR)is controversial.AIM To compare IEE with white-light imaging(WLI)endoscopy for the detection and identification of colorectal adenoma.METHODS This was a multicenter,randomized,controlled trial.Participants were enrolled between September 2019 to April 2021 from 4 hospital in China.Patients were randomly assigned to an IEE group with WLI on entry and IEE on withdrawal(n=2113)or a WLI group with WLI on both entry and withdrawal(n=2098).The primary outcome was the ADR.The secondary endpoints were the polyp detection rate(PDR),adenomas per colonoscopy,adenomas per positive colonoscopy,and factors related to adenoma detection.RESULTS A total of 4211 patients(966 adenomas)were included in the analysis(mean age,56.7 years,47.1%male).There were 2113 patients(508 adenomas)in the IEE group and 2098 patients(458 adenomas)in the WLI group.The ADR in two group were not significantly different[24.0%vs 21.8%,1.10,95%confidence interval(CI):0.99-1.23,P=0.09].The PDR was higher with IEE group(41.7%)than with WLI group(36.1%,1.16,95%CI:1.07-1.25,P=0.01).Differences in mean withdrawal time(7.90±3.42 min vs 7.85±3.47 min,P=0.30)and adenomas per colonoscopy(0.33±0.68 vs 0.28±0.62,P=0.06)were not significant.Subgroup analysis found that with narrowband imaging(NBI),between-group differences in the ADR,were not significant(23.7%vs 21.8%,1.09,95%CI:0.97-1.22,P=0.15),but were greater with linked color imaging(30.9%vs 21.8%,1.42,95%CI:1.04-1.93,P=0.04).the second-generation NBI(2G-NBI)had an advantage of ADR than both WLI and the first-generation NBI(27.0%vs 21.8%,P=0.01;27.0%vs 21.2.0%,P=0.01).CONCLUSION This prospective study confirmed that,among Chinese,IEE didn’t increase the ADR compared with WLI,but 2G-NBI increase the ADR.展开更多
Typically,smart grid systems enhance the ability of conventional power system networks as it is vulnerable to several kinds of attacks.These vulnerabil-ities might cause the attackers or intruders to collapse the enti...Typically,smart grid systems enhance the ability of conventional power system networks as it is vulnerable to several kinds of attacks.These vulnerabil-ities might cause the attackers or intruders to collapse the entire network system thus breaching the confidentiality and integrity of smart grid systems.Thus,for this purpose,Intrusion detection system(IDS)plays a pivotal part in offering a reliable and secured range of services in the smart grid framework.Several exist-ing approaches are there to detect the intrusions in smart grid framework,however they are utilizing an old dataset to detect anomaly thus resulting in reduced rate of detection accuracy in real-time and huge data sources.So as to overcome these limitations,the proposed technique is presented which employs both real-time raw data from the smart grid network and KDD99 dataset thus detecting anoma-lies in the smart grid network.In the grid side data acquisition,the power trans-mitted to the grid is checked and enhanced in terms of power quality by eradicating distortion in transmission lines.In this approach,power quality in the smart grid network is enhanced by rectifying the fault using a FACT device termed UPQC(Unified Power Quality Controller)and thereby storing the data in cloud storage.The data from smart grid cloud storage and KDD99 are pre-pro-cessed and are optimized using Improved Aquila Swarm Optimization(IASO)to extract optimal features.The probabilistic Recurrent Neural Network(PRNN)classifier is then employed for the prediction and classification of intrusions.At last,the performance is estimated and the outcomes are projected in terms of grid voltage,grid current,Total Harmonic Distortion(THD),voltage sag/swell,accu-racy,precision,recall,F-score,false acceptance rate(FAR),and detection rate of the classifier.The analysis is compared with existing techniques to validate the proposed model efficiency.展开更多
BACKGROUND There has been significant interest in use of computer aided detection(CADe)devices in colonoscopy to improve polyp detection and reduce miss rate.AIM To investigate the use of CADe amongst veterans.METHODS...BACKGROUND There has been significant interest in use of computer aided detection(CADe)devices in colonoscopy to improve polyp detection and reduce miss rate.AIM To investigate the use of CADe amongst veterans.METHODS Between September 2020 and December 2021,we performed a randomized controlled trial to evaluate the impact of CADe.Patients at Veterans Affairs Palo Alto Health Care System presenting for screening or low-risk surveillance were randomized to colonoscopy performed with or without CADe.Primary outcomes of interest included adenoma detection rate(ADR),adenomas per colonoscopy(APC),and adenomas per extraction.In addition,we measured serrated polyps per colonoscopy,non-adenomatous,non-serrated polyps per colonoscopy,serrated polyp detection rate,and procedural time.RESULTS A total of 244 patients were enrolled(124 with CADe),with similar patient characteristics(age,sex,body mass index,indication)between the two groups.Use of CADe was found to have decreased number of adenomas(1.79 vs 2.53,P=0.030)per colonoscopy compared to without CADe.There was no significant difference in number of serrated polyps or non-adenomatous non-serrated polyps per colonoscopy between the two groups.Overall,use of CADe was found to have lower ADR(68.5%vs 80.0%,P=0.041)compared to without use of CADe.Serrated polyp detection rate was lower with CADe(3.2%vs 7.5%)compared to without CADe,but this was not statistically significant(P=0.137).There was no significant difference in withdrawal and procedure times between the two groups or in detection of adenomas per extraction(71.4%vs 73.1%,P=0.613).No adverse events were identified.CONCLUSION While several randomized controlled trials have demonstrated improved ADR and APC with use of CADe,in this RCT performed at a center with high ADR,use of CADe was found to have decreased APC and ADR.Further studies are needed to understand the true impact of CADe on performance quality among endoscopists as well as determine criteria for endoscopists to consider when choosing to adopt CADe in their practices.展开更多
Heart rate is an important data reflecting human vital characteristics and an important reference index to describe human physical and mental state.Currently,widely used heart rate measurement devices require direct c...Heart rate is an important data reflecting human vital characteristics and an important reference index to describe human physical and mental state.Currently,widely used heart rate measurement devices require direct contact with a person’s skin,which is not suitable for people with burns,delicate skin,newborns and the elderly.Therefore,the research of non-contact heart rate measurement method is of great significance.Based on the basic principle of Photoplethysmography,we use the camera of computer equipment to capture the face image,detect the face region accurately,and detect multiple faces in the image based on multi-target tracking algorithm.Then the region segmentation of the face image is carried out to further realize the signal acquisition of the region of interest.Finally,peak detection,Fourier analysis and wavelet analysis were used to detect the frequency of PPG and ECG signals.The experimental results show that the heart rate information can be quickly and accurately detected even in the case of monitoring multiple face targets.展开更多
The number and variety of applications of artificial intelligence(AI)in gastr-ointestinal(GI)endoscopy is growing rapidly.New technologies based on machine learning(ML)and convolutional neural networks(CNNs)are at var...The number and variety of applications of artificial intelligence(AI)in gastr-ointestinal(GI)endoscopy is growing rapidly.New technologies based on machine learning(ML)and convolutional neural networks(CNNs)are at various stages of development and deployment to assist patients and endoscopists in preparing for endoscopic procedures,in detection,diagnosis and classification of pathology during endoscopy and in confirmation of key performance indicators.Platforms based on ML and CNNs require regulatory approval as medical devices.Interactions between humans and the technologies we use are complex and are influenced by design,behavioural and psychological elements.Due to the substantial differences between AI and prior technologies,important differences may be expected in how we interact with advice from AI technologies.Human-AI interaction(HAII)may be optimised by developing AI algorithms to minimise false positives and designing platform interfaces to maximise usability.Human factors influencing HAII may include automation bias,alarm fatigue,algorithm aversion,learning effect and deskilling.Each of these areas merits further study in the specific setting of AI applications in GI endoscopy and professional societies should engage to ensure that sufficient emphasis is placed on human-centred design in development of new AI technologies.展开更多
BACKGROUND Limited data currently exists on the clinical utility of Artificial Intelligence Assisted Colonoscopy(AIAC)outside of clinical trials.AIM To evaluate the impact of AIAC on key markers of colonoscopy quality...BACKGROUND Limited data currently exists on the clinical utility of Artificial Intelligence Assisted Colonoscopy(AIAC)outside of clinical trials.AIM To evaluate the impact of AIAC on key markers of colonoscopy quality compared to conventional colonoscopy(CC).METHODS This single-centre retrospective observational cohort study included all patients undergoing colonoscopy at a secondary centre in Brisbane,Australia.CC outcomes between October 2021 and October 2022 were compared with AIAC outcomes after the introduction of the Olympus Endo-AID module from October 2022 to January 2023.Endoscopists who conducted over 50 procedures before and after AIAC introduction were included.Procedures for surveillance of inflammatory bowel disease were excluded.Patient demographics,proceduralist specialisation,indication for colonoscopy,and colonoscopy quality metrics were collected.Adenoma detection rate(ADR)and sessile serrated lesion detection rate(SSLDR)were calculated for both AIAC and CC.RESULTS The study included 746 AIAC procedures and 2162 CC procedures performed by seven endoscopists.Baseline patient demographics were similar,with median age of 60 years with a slight female predominance(52.1%).Procedure indications,bowel preparation quality,and caecal intubation rates were comparable between groups.AIAC had a slightly longer withdrawal time compared to CC,but the difference was not statistically significant.The introduction of AIAC did not significantly change ADR(52.1%for AIAC vs 52.6%for CC,P=0.91)or SSLDR(17.4%for AIAC vs 18.1%for CC,P=0.44).CONCLUSION The implementation of AIAC failed to improve key markers of colonoscopy quality,including ADR,SSLDR and withdrawal time.Further research is required to assess the utility and cost-efficiency of AIAC for high performing endoscopists.展开更多
Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma detection.Nevertheless,almost a quarter of procedures are still carried out with suboptimal prepar...Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma detection.Nevertheless,almost a quarter of procedures are still carried out with suboptimal preparation,resulting in longer procedure times,higher risk of complications,and higher likelihood of missing lesions.Current guidelines recommend high-volume or low-volume polyethylene glycol(PEG)/non-PEG-based split-dose regimens.In patients who have had insufficient bowel cleansing,the colonoscopy should be repeated the same day or the next day with additional bowel cleansing as a salvage option.A strategy that includes a prolonged low-fiber diet,a split preparation regimen,and a colonoscopy within 5 h of the end of preparation may increase cleansing success rates in the elderly.Furthermore,even though no specific product is specifically recommended in the other cases for difficult-to-prepare patients,clinical evidence suggests that 1-L PEG plus ascorbic acid preparation are associated with higher cleansing success in hospitalized and inflammatory bowel disease patients.Patients with severe renal insufficiency(creatinine clearance<30 mL/min)should be prepared with isotonic high volume PEG solutions.Few data on cirrhotic patients are currently available,and no trials have been conducted in this population.An accurate characterization of procedural and patient variables may lead to a more personalized approach to bowel preparation,especially in patients undergoing resection of left colon lesions,where intestinal preparation has a poor outcome.The purpose of this review was to summarize the evidence on the risk factors influencing the quality of bowel cleansing in difficult-to-prepare patients,as well as strategies to improve colonoscopy preparation in these patients.展开更多
Dispersed computing is a new resourcecentric computing paradigm.Due to its high degree of openness and decentralization,it is vulnerable to attacks,and security issues have become an important challenge hindering its ...Dispersed computing is a new resourcecentric computing paradigm.Due to its high degree of openness and decentralization,it is vulnerable to attacks,and security issues have become an important challenge hindering its development.The trust evaluation technology is of great significance to the reliable operation and security assurance of dispersed computing networks.In this paper,a dynamic Bayesian-based comprehensive trust evaluation model is proposed for dispersed computing environment.Specifically,in the calculation of direct trust,a logarithmic decay function and a sliding window are introduced to improve the timeliness.In the calculation of indirect trust,a random screening method based on sine function is designed,which excludes malicious nodes providing false reports and multiple malicious nodes colluding attacks.Finally,the comprehensive trust value is dynamically updated based on historical interactions,current interactions and momentary changes.Simulation experiments are introduced to verify the performance of the model.Compared with existing model,the proposed trust evaluation model performs better in terms of the detection rate of malicious nodes,the interaction success rate,and the computational cost.展开更多
BACKGROUND Anemia in infants and young children can have long-term effects on cognitive and physical development.In Ma'anshan City,China,there has been growing concern about the prevalence of anemia among children...BACKGROUND Anemia in infants and young children can have long-term effects on cognitive and physical development.In Ma'anshan City,China,there has been growing concern about the prevalence of anemia among children aged 6 to 36 mo.Understanding the factors influencing this condition is crucial for targeted interventions and improving overall child health in the region.AIM To analyze the anemia status and influencing factors of infants and young children aged 6 to 36 mo in Ma'anshan City,China.Providing scientific evidence for reducing the incidence of anemia and improving the health level of children in this age group.METHODS The study encompassed 37698 infants and young children,aged from 6 to 36 mo,who underwent health examinations at the Ma'anshan Maternal and Child Health Hospital from January 2018 to October 2022 were included in the study.Basic information,physical examination,and hemoglobin detection data were collected.Descriptive analysis was used to analyze the prevalence of anemia in children in the region,and univariate analysis was used to analyze the influencing factors of anemia.RESULTS The mean hemoglobin level of infants and young children aged 9 to 36 mo increased with age,and the anemia detection rate decreased with age.The anemia detection rate in rural infants aged 6,9,and 12 mo was higher than that in urban infants.Although the anemia detection rate was higher in 6-mo-old boys than girls,it was higher in 24-mo-old girls than boys.There were statistically significant differences in the anemia detection rates among 9-mo-old and 12-mo-old infants with different nutritional statuses(emaciation,overweight,obese,and normal).Moreover,there were no statistically significant differences in anemia detection rates among infants and young children with different nutritional statuses at other ages.Besides,the anemia detection rates in obese infants aged 9 and 12 mo were higher than those in normal and overweight infants,with statistically significant differences.Finally,there were no statistically significant differences in the anemia detection rates between emaciation infants and those with other nutritional statuses.CONCLUSION The anemia situation among infants and young children aged 6 to 36 mo in Ma'anshan City,China,is relatively prominent and influenced by various factors.Our result shown that attention should be paid to the anemic infant and young child population,with strengthened education and targeted prevention and dietary guidance to help them establish good living habits,improve nutritional status,and reduce the occurrence of anemia to improve children's health levels.展开更多
BACKGROUND Antiretroviral treatment(ART)has improved the life expectancy of patients living with human immunodeficiency virus(HIV).As these patients age,they are at increased risk for developing non-acquired immunodef...BACKGROUND Antiretroviral treatment(ART)has improved the life expectancy of patients living with human immunodeficiency virus(HIV).As these patients age,they are at increased risk for developing non-acquired immunodeficiency syndrome defining malignancies(NADMs)such as colon cancers.AIM To determine which factors are associated with the development of precancerous polyps on screening colonoscopy in patients with HIV and to investigate whether HIV disease status,measured by viral load and CD4 count,might influence precancerous polyp development.METHODS A retrospective review of records at two urban academic medical centers was performed for HIV patients who had a screening colonoscopy between 2005-2015.Patients with a history of colorectal cancer or polyps,poor bowel preparation,or inflammatory bowel disease were excluded.Demographic data such as sex,age,race,and body mass index(BMI)as well as information regarding the HIV disease status such as CD4 count,viral load,and medication regimen were collected.Well-controlled patients were defined as those that had viral load<50 copies,and poorly-controlled patients were those with viral load≥50.Patients were also stratified based on their CD4 count,comparing those with a low CD4 count to those with a high CD4 count.Using colonoscopy reports in the medical record,the size,histology,and number of polyps were recorded for each patient.Precancerous polyps included adenomas and proximal serrated polyps.Data was analyzed using Fisher’s exact tests and logistic regression through SAS 3.8 software.RESULTS Two hundred and seven patients met our inclusion criteria.The mean age was 56.13 years,and 58%were males.There were no significant differences in terms of age,race or ethnicity,insurance,and smoking status between patients with CD4 counts above or below 500.BMI was lower in patients with CD4 count<500 as compared to those with count>500(P=0.0276).In patients with CD4>500,53.85%of patients were female,and 70.87%of patients with CD4<500 were male(P=0.0004).Only 1.92%of patients with CD4≥500 had precancerous polyps vs 10.68%of patients with CD4<500(P=0.0102).When controlled for sex,BMI,and ART use,patients with CD4<500 were 9.01 times more likely to have precancerous polyps[95%confidence interval(CI):1.69-47.97;P=0.0100].Patients taking non-nucleoside reverse transcriptase inhibitors were also found to be 10.23 times more likely to have precancerous polyps(95%CI:1.08-97.15;P=0.0428).There was not a significant difference noted in precancerous polyps between those that had viral loads greater or less than 50 copies.CONCLUSION Patients with low CD4 counts were more likely to have precancerous polyps on their screening colonoscopy although the etiology for this association is unclear.We also found an increased risk of precancerous polyps in patients taking non-nucleoside reverse transcriptase inhibitors,which is contradictory to prior literature showing ART has decreased the risk of development of NADMs.However,there have not been studies looking at colorectal cancer and ART by drug class,to our knowledge.Further prospective studies are needed to determine the effect of HIV control and therapies on polyp development.展开更多
In the United States,colorectal cancer(CRC)is the second leading cause of mortality in men and women.We are now seeing an increasing number of patients with advanced-stage diagnosis and mortality from colorectal cance...In the United States,colorectal cancer(CRC)is the second leading cause of mortality in men and women.We are now seeing an increasing number of patients with advanced-stage diagnosis and mortality from colorectal cancer before 50 years of age,which requires earlier screening.With the increasing need for CRC screening through colonoscopy,and thus endoscopists,easier and simpler techniques are needed to train proficient endoscopists.The most widely used approach by endoscopists is air insufflation colonoscopy,where air distends the colon to allow visualization of the colonic mucosa.This technique is uncomfortable for patients and requires an anesthetist to administer sedation.In addition,patients commonly complain about discomfort post-op as air escapes into the small bowel and cannot be adequately removed.Current research into the use of water insufflation colonoscopies has proved promising in reducing the need for sedation,decreasing discomfort,and increasing the visibility of the colonic mucosa.Future direction into water insufflation colonoscopies which have shown to be simpler and easier to teach may increase the number of proficient endoscopists in training to serve our aging population.展开更多
BACKGROUND Colonoscopy is the accepted gold standard for the detection of colorectal cancer. However, colonoscopy is less effective in preventing colon cancer in the right side compared with the left side.AIM To inves...BACKGROUND Colonoscopy is the accepted gold standard for the detection of colorectal cancer. However, colonoscopy is less effective in preventing colon cancer in the right side compared with the left side.AIM To investigate the feasibility of a novel type of retroflexion colonoscope, EC-3490 Ti colonoscope, for detection of proximal colon lesions.METHODS In this prospective trial, we recruited patients who underwent colonoscopy for screening or surveillance. When the endoscopists could not grasp the whole observation of the right-side colon mucosa in the forward view(FV), insertion and withdrawal were repeatedly performed in the FV group with the EC38-i10 F colonoscope while retroflexion was performed in the retroflexed view(RV) group with the EC-3490 Ti colonoscope. Adenoma detection rate, the total number of adenomas per positive participant, the success rate of retroflexion, and endoscope withdrawal time were recorded and compared.RESULTS The total adenoma detection rate(39.3% vs 37.7%, P = 0.646) did not show any significant difference between the two groups. However, the polyp detection rate(59.6% vs 51.0%, P = 0.002), adenoma detection rate in the right colon(21.6% vs 14.4%, P = 0.012), and the total number of adenomas per positive participant(2.1 vs 1.7, P = 0.011) reached statistical significance. Retroflexion was achieved in 91.7% of our cohort. Compared with the FV group, the withdrawal time was significantly prolonged in the RV group(586.1 ± 124.4 s vs 508.8 ± 129.6 s, P < 0.001). In contrast, the proportion of additional ancillary pressure decreased(27.4% vs 45.7%, P < 0.001), and the visual analog scale pain scores did not increase(2.7 ± 1.4 vs 2.8 ± 1.4, P = 0.377).CONCLUSION Retroflexion in the proximal colon could be performed successfully and safely with the EC-3490 Ti colonoscope. This maneuver could detect more adenomas effectively.展开更多
Test selection is to select the test set with the least total cost or the least total number from the alternative test set on the premise of meeting the required testability indicators.The existing models and methods ...Test selection is to select the test set with the least total cost or the least total number from the alternative test set on the premise of meeting the required testability indicators.The existing models and methods are not suitable for system level test selection.The first problem is the lack of detailed data of the units’fault set and the test set,which makes it impossible to establish a traditional dependency matrix for the system level.The second problem is that the system level fault detection rate and the fault isolation rate(referred to as"two rates")are not enough to describe the fault diagnostic ability of the system level tests.An innovative dependency matrix(called combinatorial dependency matrix)composed of three submatrices is presented.The first problem is solved by simplifying the submatrix between the units’fault and the test,and the second problem is solved by establishing the system level fault detection rate,the fault isolation rate and the integrated fault detection rate(referred to as"three rates")based on the new matrix.The mathematical model of the system level test selection problem is constructed,and the binary genetic algorithm is applied to solve the problem,which achieves the goal of system level test selection.展开更多
BACKGROUND Ensuring colonoscopy procedure quality is vital to the success of screening and surveillance programmes for bowel cancer in Australia. However, the data on the performance of quality metrics, through adequa...BACKGROUND Ensuring colonoscopy procedure quality is vital to the success of screening and surveillance programmes for bowel cancer in Australia. However, the data on the performance of quality metrics, through adequate adenoma detection, bowel preparation, and procedure completion rates, in the Australian public sector is limited. Understanding these can inform quality improvement to further strengthen our capacity for prevention and early detection of colorectal cancer.AIM To determine the quality of colonoscopy in Australian teaching hospitals and their association with proceduralist specialty, trainee involvement, and location.METHODS We retrospectively evaluated 2443 consecutive colonoscopy procedure reports from 1 January to 1 April, 2018 from five public teaching tertiary hospitals in Australia(median 60 years old, 49% male). Data for bowel preparation quality,procedure completion rates, and detection rates of clinically significant adenomas, conventional adenomas, and serrated lesions was collected and compared to national criteria for quality in colonoscopy. Participating hospital, proceduralist specialty, and trainee involvement indicators were used for stratification. Data was analysed using Chi-squared tests of independence, MannWhitney U, One-way ANOVA, and multivariate binary logistic regression.RESULTS Fifty-two point two percent(n = 1276) and 43.3%(n = 1057) were performed by medical and surgical proceduralists respectively, whilst 29.8%(n = 728) involved a trainee. Inadequate bowel preparation affected 7.3% of all procedures. The procedure completion rate was 95.1%, which increased to 97.5% after adjustment for bowel preparation quality. The pooled cancer, adenoma, and serrated lesion detection rates for all five hospitals were 3.5%, 40%, and 5.9% respectively. Assessed hospitals varied significantly by patient age(P < 0.001), work-force composition(P < 0.001), adequacy of bowel preparation(P < 0.001), and adenoma detection rate(P < 0.001). Two hospitals(40%) did not meet all national criteria for quality, due to a procedure completion rate of 94.5% or serrated lesion detection rate of 2.6%. Although lower than the other hospitals, the difference was not significant. Compared with surgical specialists, procedures performed by medical specialists involved older patients [65 years(inter-quartile range, IQR 58-73) vs 64 years(IQR 56-71);P = 0.04] and were associated with a higher adenoma detection rate [odds ratio(OR) 1.53;confidence interval: 1.21-1.94;P < 0.001]. Procedures involving trainee proceduralists were not associated with differences in the detection of cancer, adenoma, or serrated lesions, compared with specialists, or according to their medical or surgical background. On multivariate analysis, cancer detection was positively associated with patient age(OR 1.04;P < 0.001) and negatively associated with medical compared to surgical proceduralists(OR 0.54;P = 0.04). Conventional adenoma detection rates were independently associated with increasing patient age(OR 1.04;P < 0.001), positively associated with medical compared to surgical proceduralists(OR 1.41;P = 0.002) and negatively associated with male gender(OR 0.53;P < 0.001).CONCLUSION Significant differences in the quality of colonoscopy in Australia exist, even when national benchmarks are achieved. The role of possible contributing factors, like procedural specialty and patient gender need further evaluation.展开更多
The aim of this study was to determine the frequency of infectious diseases among people entering/exiting via Manzhouli port. We analyzed infectious disease data from the Manzhouli International Travel Health care Cen...The aim of this study was to determine the frequency of infectious diseases among people entering/exiting via Manzhouli port. We analyzed infectious disease data from the Manzhouli International Travel Health care Center covering 2012 through 2014, as well as performed several laboratory tests to measure rates of infection. The frequencies of infectious diseases as well as their association with occupation and year of occurrence were calculated for people entering and exiting via the port. The total proportion of infectious diseases measured was 2.18%. Hepatitis B was the most commonly occurring at 1.68%, followed by syphilis, hepatits C and HIV, which were 0.23%, 0.21% and 0.04%, respectively. Contract workers, traffic staff, foreigners and those married abroad were more likely to be infected. Furthermore, there were significant differences among three years. Strategies should be developed and preventive policies should be implemented aimed at protecting the at risk populations at Manzhouli port, especially with regard to contract workers, traffic staff, foreigners and those married abroad.展开更多
文摘Colorectal cancer(CRC) is the third most common cancer in males and second in females, and globally the fourth cause for cancer death worldwide. Oncological screening of CRC has a major role in the management of the disease and it is mostly performed by colonoscopy. Anyway, effectiveness of endoscopic screening for CRC strictly depends on adequate detection and removal of potentially precancerous lesions, and accuracy of colonoscopy in detection of adenomas is still suboptimal. For this reason, several technological advances have been implemented in order to improve the diagnostic sensitivity of colonoscopy in adenoma detection. Among these:(1) Visual technologies such as chromoendoscopy and narrow band imaging;(2) optical innovation as high definition endoscopy, full-spectrum endoscopy or Third Eye Retroscope; and(3) mechanical advances as Cap assisted colonoscopy, Endocuff, Endoring and G-Eye endoscope. All these technologies advances have been tested over time by clinical studies with mixed results. Which of them is more likely to be successful in the next future?
文摘The rate of adenoma detection is the most reliable quality indicator of colonoscopy.Studies have reported that colonoscopy performed in morning has a higher adenoma detection rate(ADR)than that performed in the afternoon.These studies have explained that several physician-related factors such as undergoing an emergency procedure the night before colonoscopy,accumulated workload,and increased fatigue level in the afternoon might have led to such finding.However,several opposing articles have indicated that the time of day and ADR is not quite related.Complex confounding factors can impact study results.Colonoscopy withdrawal time and bowel preparation quality are key factors.However,queue list numbers,participation of academic fellows,nurses'assistance,and the number of colonoscopies allocated per hour are also notable factors.Recently,an attempt has been made to homogenize the ADR in the morning and afternoon through artificial intelligence-assisted colonoscopy.This review article introduces the history of this long-debated topic,discusses points to consider in real-world practice,and suggests new ideas for planning future research.By understanding this issue,the rate of adenoma detection during colonoscopy is expected to be improved further.
文摘Colonoscopy remains the standard strategy for screening for colorectal cancer around the world due to its efficacy in both detecting adenomatous or precancerous lesions and the capacity to remove them intra-procedurally.Computeraided detection and diagnosis(CAD),thanks to the brand new developed innovations of artificial intelligence,and especially deep-learning techniques,leads to a promising solution to human biases in performance by guarantying decision support during colonoscopy.The application of CAD on real-time colonoscopy helps increasing the adenoma detection rate,and therefore contributes to reduce the incidence of interval cancers improving the effectiveness of colonoscopy screening on critical outcome such as colorectal cancer related mortality.Furthermore,a significant reduction in costs is also expected.In addition,the assistance of the machine will lead to a reduction of the examination time and therefore an optimization of the endoscopic schedule.The aim of this opinion review is to analyze the clinical applications of CAD and artificial intelligence in colonoscopy,as it is reported in literature,addressing evidence,limitations,and future prospects.
基金supported by the National Nature Science Foundation of China(Grant Number:61962010).
文摘Heart rate is an important vital characteristic which indicates physical and mental health status.Typically heart rate measurement instruments require direct contact with the skin which is time-consuming and costly.Therefore,the study of non-contact heart rate measurement methods is of great importance.Based on the principles of photoelectric volumetric tracing,we use a computer device and camera to capture facial images,accurately detect face regions,and to detect multiple facial images using a multi-target tracking algorithm.Then after the regional segmentation of the facial image,the signal acquisition of the region of interest is further resolved.Finally,frequency detection of the collected Photo-plethysmography(PPG)and Electrocardiography(ECG)signals is completed with peak detection,Fourier analysis,and a Waveletfilter.The experimental results show that the subject’s heart rate can be detected quickly and accurately even when monitoring multiple facial targets simultaneously.
文摘AIM: To determine the diagnostic yield of the "third eye retroscope",on adenoma detection rate during screening colonoscopy.METHODS: The "third eye retroscope" when used with standard colonoscopy provides an additional retrograde view to visualize lesions on the proximal aspects of folds and flexures.We searched MEDLINE(Pub Med and Ovid),SCOPUS(including MEDLINE and EMBASE databases),Cochrane Database of Systemic Reviews,Google Scholar,and CINAHL Plus databases to identify studies that evaluated diagnostic yield of "third eye retroscope" during screening colonoscopy.Der Simonian Laird random effects model was used to generate the overall effect for each outcome.We evaluated statistical heterogeneity among the studies by using the Cochran Q statistic and quantified by I2 statistics.RESULTS: Four distinct studies with a total of 920 patients,mean age 59.83(95%CI: 56.77-62.83) years,were included in the review.The additional adenoma detection rate(AADR) defined as the number of additional adenomas identified due to "third eye retroscope" device in comparison to standard colonoscopy alone was 19.9%(95%CI: 7.3-43.9).AADR for right and left colon were 13.9%(95%CI: 9.4-20) and 10.7(95%CI: 1.9-42),respectively.AADR for polyps ≥ 6 mm and ≥ 10 mm were 24.6%(95%CI: 16.6-34.9) and 24.2%(95%CI: 12.9-40.8),respectively.The additional polyp detection rate defined as the number of additional polyps identified due to "third eye retroscope" device in comparison to standard colonoscopy alone was 19.8%(95%CI: 7.9-41.8).There were no complications reported with use of "third eye retroscope" device.CONCLUSION: The "third eye retroscope" device when used with standard colonoscopy is safe and detects 19.9% additional adenomas,compared to standard colonoscopy alone.
基金Supported by the National Key R&D Program of China,No. 2018YFC1315005National Natural Science Foundation of China,No. 82002515+1 种基金Shanghai Sailing Program,No. 20YF1407200China Postdoctoral Science Foundation,No. 2020M681177
文摘BACKGROUND Improved adenoma detection at colonoscopy has decreased the risk of developing colorectal cancer.However,whether image-enhanced endoscopy(IEE)further improves the adenoma detection rate(ADR)is controversial.AIM To compare IEE with white-light imaging(WLI)endoscopy for the detection and identification of colorectal adenoma.METHODS This was a multicenter,randomized,controlled trial.Participants were enrolled between September 2019 to April 2021 from 4 hospital in China.Patients were randomly assigned to an IEE group with WLI on entry and IEE on withdrawal(n=2113)or a WLI group with WLI on both entry and withdrawal(n=2098).The primary outcome was the ADR.The secondary endpoints were the polyp detection rate(PDR),adenomas per colonoscopy,adenomas per positive colonoscopy,and factors related to adenoma detection.RESULTS A total of 4211 patients(966 adenomas)were included in the analysis(mean age,56.7 years,47.1%male).There were 2113 patients(508 adenomas)in the IEE group and 2098 patients(458 adenomas)in the WLI group.The ADR in two group were not significantly different[24.0%vs 21.8%,1.10,95%confidence interval(CI):0.99-1.23,P=0.09].The PDR was higher with IEE group(41.7%)than with WLI group(36.1%,1.16,95%CI:1.07-1.25,P=0.01).Differences in mean withdrawal time(7.90±3.42 min vs 7.85±3.47 min,P=0.30)and adenomas per colonoscopy(0.33±0.68 vs 0.28±0.62,P=0.06)were not significant.Subgroup analysis found that with narrowband imaging(NBI),between-group differences in the ADR,were not significant(23.7%vs 21.8%,1.09,95%CI:0.97-1.22,P=0.15),but were greater with linked color imaging(30.9%vs 21.8%,1.42,95%CI:1.04-1.93,P=0.04).the second-generation NBI(2G-NBI)had an advantage of ADR than both WLI and the first-generation NBI(27.0%vs 21.8%,P=0.01;27.0%vs 21.2.0%,P=0.01).CONCLUSION This prospective study confirmed that,among Chinese,IEE didn’t increase the ADR compared with WLI,but 2G-NBI increase the ADR.
文摘Typically,smart grid systems enhance the ability of conventional power system networks as it is vulnerable to several kinds of attacks.These vulnerabil-ities might cause the attackers or intruders to collapse the entire network system thus breaching the confidentiality and integrity of smart grid systems.Thus,for this purpose,Intrusion detection system(IDS)plays a pivotal part in offering a reliable and secured range of services in the smart grid framework.Several exist-ing approaches are there to detect the intrusions in smart grid framework,however they are utilizing an old dataset to detect anomaly thus resulting in reduced rate of detection accuracy in real-time and huge data sources.So as to overcome these limitations,the proposed technique is presented which employs both real-time raw data from the smart grid network and KDD99 dataset thus detecting anoma-lies in the smart grid network.In the grid side data acquisition,the power trans-mitted to the grid is checked and enhanced in terms of power quality by eradicating distortion in transmission lines.In this approach,power quality in the smart grid network is enhanced by rectifying the fault using a FACT device termed UPQC(Unified Power Quality Controller)and thereby storing the data in cloud storage.The data from smart grid cloud storage and KDD99 are pre-pro-cessed and are optimized using Improved Aquila Swarm Optimization(IASO)to extract optimal features.The probabilistic Recurrent Neural Network(PRNN)classifier is then employed for the prediction and classification of intrusions.At last,the performance is estimated and the outcomes are projected in terms of grid voltage,grid current,Total Harmonic Distortion(THD),voltage sag/swell,accu-racy,precision,recall,F-score,false acceptance rate(FAR),and detection rate of the classifier.The analysis is compared with existing techniques to validate the proposed model efficiency.
文摘BACKGROUND There has been significant interest in use of computer aided detection(CADe)devices in colonoscopy to improve polyp detection and reduce miss rate.AIM To investigate the use of CADe amongst veterans.METHODS Between September 2020 and December 2021,we performed a randomized controlled trial to evaluate the impact of CADe.Patients at Veterans Affairs Palo Alto Health Care System presenting for screening or low-risk surveillance were randomized to colonoscopy performed with or without CADe.Primary outcomes of interest included adenoma detection rate(ADR),adenomas per colonoscopy(APC),and adenomas per extraction.In addition,we measured serrated polyps per colonoscopy,non-adenomatous,non-serrated polyps per colonoscopy,serrated polyp detection rate,and procedural time.RESULTS A total of 244 patients were enrolled(124 with CADe),with similar patient characteristics(age,sex,body mass index,indication)between the two groups.Use of CADe was found to have decreased number of adenomas(1.79 vs 2.53,P=0.030)per colonoscopy compared to without CADe.There was no significant difference in number of serrated polyps or non-adenomatous non-serrated polyps per colonoscopy between the two groups.Overall,use of CADe was found to have lower ADR(68.5%vs 80.0%,P=0.041)compared to without use of CADe.Serrated polyp detection rate was lower with CADe(3.2%vs 7.5%)compared to without CADe,but this was not statistically significant(P=0.137).There was no significant difference in withdrawal and procedure times between the two groups or in detection of adenomas per extraction(71.4%vs 73.1%,P=0.613).No adverse events were identified.CONCLUSION While several randomized controlled trials have demonstrated improved ADR and APC with use of CADe,in this RCT performed at a center with high ADR,use of CADe was found to have decreased APC and ADR.Further studies are needed to understand the true impact of CADe on performance quality among endoscopists as well as determine criteria for endoscopists to consider when choosing to adopt CADe in their practices.
文摘Heart rate is an important data reflecting human vital characteristics and an important reference index to describe human physical and mental state.Currently,widely used heart rate measurement devices require direct contact with a person’s skin,which is not suitable for people with burns,delicate skin,newborns and the elderly.Therefore,the research of non-contact heart rate measurement method is of great significance.Based on the basic principle of Photoplethysmography,we use the camera of computer equipment to capture the face image,detect the face region accurately,and detect multiple faces in the image based on multi-target tracking algorithm.Then the region segmentation of the face image is carried out to further realize the signal acquisition of the region of interest.Finally,peak detection,Fourier analysis and wavelet analysis were used to detect the frequency of PPG and ECG signals.The experimental results show that the heart rate information can be quickly and accurately detected even in the case of monitoring multiple face targets.
文摘The number and variety of applications of artificial intelligence(AI)in gastr-ointestinal(GI)endoscopy is growing rapidly.New technologies based on machine learning(ML)and convolutional neural networks(CNNs)are at various stages of development and deployment to assist patients and endoscopists in preparing for endoscopic procedures,in detection,diagnosis and classification of pathology during endoscopy and in confirmation of key performance indicators.Platforms based on ML and CNNs require regulatory approval as medical devices.Interactions between humans and the technologies we use are complex and are influenced by design,behavioural and psychological elements.Due to the substantial differences between AI and prior technologies,important differences may be expected in how we interact with advice from AI technologies.Human-AI interaction(HAII)may be optimised by developing AI algorithms to minimise false positives and designing platform interfaces to maximise usability.Human factors influencing HAII may include automation bias,alarm fatigue,algorithm aversion,learning effect and deskilling.Each of these areas merits further study in the specific setting of AI applications in GI endoscopy and professional societies should engage to ensure that sufficient emphasis is placed on human-centred design in development of new AI technologies.
文摘BACKGROUND Limited data currently exists on the clinical utility of Artificial Intelligence Assisted Colonoscopy(AIAC)outside of clinical trials.AIM To evaluate the impact of AIAC on key markers of colonoscopy quality compared to conventional colonoscopy(CC).METHODS This single-centre retrospective observational cohort study included all patients undergoing colonoscopy at a secondary centre in Brisbane,Australia.CC outcomes between October 2021 and October 2022 were compared with AIAC outcomes after the introduction of the Olympus Endo-AID module from October 2022 to January 2023.Endoscopists who conducted over 50 procedures before and after AIAC introduction were included.Procedures for surveillance of inflammatory bowel disease were excluded.Patient demographics,proceduralist specialisation,indication for colonoscopy,and colonoscopy quality metrics were collected.Adenoma detection rate(ADR)and sessile serrated lesion detection rate(SSLDR)were calculated for both AIAC and CC.RESULTS The study included 746 AIAC procedures and 2162 CC procedures performed by seven endoscopists.Baseline patient demographics were similar,with median age of 60 years with a slight female predominance(52.1%).Procedure indications,bowel preparation quality,and caecal intubation rates were comparable between groups.AIAC had a slightly longer withdrawal time compared to CC,but the difference was not statistically significant.The introduction of AIAC did not significantly change ADR(52.1%for AIAC vs 52.6%for CC,P=0.91)or SSLDR(17.4%for AIAC vs 18.1%for CC,P=0.44).CONCLUSION The implementation of AIAC failed to improve key markers of colonoscopy quality,including ADR,SSLDR and withdrawal time.Further research is required to assess the utility and cost-efficiency of AIAC for high performing endoscopists.
文摘Adequate bowel cleansing is critical for a high-quality colonoscopy because it affects diagnostic accuracy and adenoma detection.Nevertheless,almost a quarter of procedures are still carried out with suboptimal preparation,resulting in longer procedure times,higher risk of complications,and higher likelihood of missing lesions.Current guidelines recommend high-volume or low-volume polyethylene glycol(PEG)/non-PEG-based split-dose regimens.In patients who have had insufficient bowel cleansing,the colonoscopy should be repeated the same day or the next day with additional bowel cleansing as a salvage option.A strategy that includes a prolonged low-fiber diet,a split preparation regimen,and a colonoscopy within 5 h of the end of preparation may increase cleansing success rates in the elderly.Furthermore,even though no specific product is specifically recommended in the other cases for difficult-to-prepare patients,clinical evidence suggests that 1-L PEG plus ascorbic acid preparation are associated with higher cleansing success in hospitalized and inflammatory bowel disease patients.Patients with severe renal insufficiency(creatinine clearance<30 mL/min)should be prepared with isotonic high volume PEG solutions.Few data on cirrhotic patients are currently available,and no trials have been conducted in this population.An accurate characterization of procedural and patient variables may lead to a more personalized approach to bowel preparation,especially in patients undergoing resection of left colon lesions,where intestinal preparation has a poor outcome.The purpose of this review was to summarize the evidence on the risk factors influencing the quality of bowel cleansing in difficult-to-prepare patients,as well as strategies to improve colonoscopy preparation in these patients.
基金supported in part by the National Science Foundation Project of P.R.China (No.61931001)the Fundamental Research Funds for the Central Universities under Grant (No.FRFAT-19-010)the Scientific and Technological Innovation Foundation of Foshan,USTB (No.BK20AF003)。
文摘Dispersed computing is a new resourcecentric computing paradigm.Due to its high degree of openness and decentralization,it is vulnerable to attacks,and security issues have become an important challenge hindering its development.The trust evaluation technology is of great significance to the reliable operation and security assurance of dispersed computing networks.In this paper,a dynamic Bayesian-based comprehensive trust evaluation model is proposed for dispersed computing environment.Specifically,in the calculation of direct trust,a logarithmic decay function and a sliding window are introduced to improve the timeliness.In the calculation of indirect trust,a random screening method based on sine function is designed,which excludes malicious nodes providing false reports and multiple malicious nodes colluding attacks.Finally,the comprehensive trust value is dynamically updated based on historical interactions,current interactions and momentary changes.Simulation experiments are introduced to verify the performance of the model.Compared with existing model,the proposed trust evaluation model performs better in terms of the detection rate of malicious nodes,the interaction success rate,and the computational cost.
文摘BACKGROUND Anemia in infants and young children can have long-term effects on cognitive and physical development.In Ma'anshan City,China,there has been growing concern about the prevalence of anemia among children aged 6 to 36 mo.Understanding the factors influencing this condition is crucial for targeted interventions and improving overall child health in the region.AIM To analyze the anemia status and influencing factors of infants and young children aged 6 to 36 mo in Ma'anshan City,China.Providing scientific evidence for reducing the incidence of anemia and improving the health level of children in this age group.METHODS The study encompassed 37698 infants and young children,aged from 6 to 36 mo,who underwent health examinations at the Ma'anshan Maternal and Child Health Hospital from January 2018 to October 2022 were included in the study.Basic information,physical examination,and hemoglobin detection data were collected.Descriptive analysis was used to analyze the prevalence of anemia in children in the region,and univariate analysis was used to analyze the influencing factors of anemia.RESULTS The mean hemoglobin level of infants and young children aged 9 to 36 mo increased with age,and the anemia detection rate decreased with age.The anemia detection rate in rural infants aged 6,9,and 12 mo was higher than that in urban infants.Although the anemia detection rate was higher in 6-mo-old boys than girls,it was higher in 24-mo-old girls than boys.There were statistically significant differences in the anemia detection rates among 9-mo-old and 12-mo-old infants with different nutritional statuses(emaciation,overweight,obese,and normal).Moreover,there were no statistically significant differences in anemia detection rates among infants and young children with different nutritional statuses at other ages.Besides,the anemia detection rates in obese infants aged 9 and 12 mo were higher than those in normal and overweight infants,with statistically significant differences.Finally,there were no statistically significant differences in the anemia detection rates between emaciation infants and those with other nutritional statuses.CONCLUSION The anemia situation among infants and young children aged 6 to 36 mo in Ma'anshan City,China,is relatively prominent and influenced by various factors.Our result shown that attention should be paid to the anemic infant and young child population,with strengthened education and targeted prevention and dietary guidance to help them establish good living habits,improve nutritional status,and reduce the occurrence of anemia to improve children's health levels.
基金The project,“Adenoma prevalence,characteristics,and outcomes on screening colonoscopy in patients with HIV in an Urban Safety Net Hospital and Urban University Hospital”was approved by SUNY Downstate Health Sciences IRB on October 13,2020,No.1306045.
文摘BACKGROUND Antiretroviral treatment(ART)has improved the life expectancy of patients living with human immunodeficiency virus(HIV).As these patients age,they are at increased risk for developing non-acquired immunodeficiency syndrome defining malignancies(NADMs)such as colon cancers.AIM To determine which factors are associated with the development of precancerous polyps on screening colonoscopy in patients with HIV and to investigate whether HIV disease status,measured by viral load and CD4 count,might influence precancerous polyp development.METHODS A retrospective review of records at two urban academic medical centers was performed for HIV patients who had a screening colonoscopy between 2005-2015.Patients with a history of colorectal cancer or polyps,poor bowel preparation,or inflammatory bowel disease were excluded.Demographic data such as sex,age,race,and body mass index(BMI)as well as information regarding the HIV disease status such as CD4 count,viral load,and medication regimen were collected.Well-controlled patients were defined as those that had viral load<50 copies,and poorly-controlled patients were those with viral load≥50.Patients were also stratified based on their CD4 count,comparing those with a low CD4 count to those with a high CD4 count.Using colonoscopy reports in the medical record,the size,histology,and number of polyps were recorded for each patient.Precancerous polyps included adenomas and proximal serrated polyps.Data was analyzed using Fisher’s exact tests and logistic regression through SAS 3.8 software.RESULTS Two hundred and seven patients met our inclusion criteria.The mean age was 56.13 years,and 58%were males.There were no significant differences in terms of age,race or ethnicity,insurance,and smoking status between patients with CD4 counts above or below 500.BMI was lower in patients with CD4 count<500 as compared to those with count>500(P=0.0276).In patients with CD4>500,53.85%of patients were female,and 70.87%of patients with CD4<500 were male(P=0.0004).Only 1.92%of patients with CD4≥500 had precancerous polyps vs 10.68%of patients with CD4<500(P=0.0102).When controlled for sex,BMI,and ART use,patients with CD4<500 were 9.01 times more likely to have precancerous polyps[95%confidence interval(CI):1.69-47.97;P=0.0100].Patients taking non-nucleoside reverse transcriptase inhibitors were also found to be 10.23 times more likely to have precancerous polyps(95%CI:1.08-97.15;P=0.0428).There was not a significant difference noted in precancerous polyps between those that had viral loads greater or less than 50 copies.CONCLUSION Patients with low CD4 counts were more likely to have precancerous polyps on their screening colonoscopy although the etiology for this association is unclear.We also found an increased risk of precancerous polyps in patients taking non-nucleoside reverse transcriptase inhibitors,which is contradictory to prior literature showing ART has decreased the risk of development of NADMs.However,there have not been studies looking at colorectal cancer and ART by drug class,to our knowledge.Further prospective studies are needed to determine the effect of HIV control and therapies on polyp development.
文摘In the United States,colorectal cancer(CRC)is the second leading cause of mortality in men and women.We are now seeing an increasing number of patients with advanced-stage diagnosis and mortality from colorectal cancer before 50 years of age,which requires earlier screening.With the increasing need for CRC screening through colonoscopy,and thus endoscopists,easier and simpler techniques are needed to train proficient endoscopists.The most widely used approach by endoscopists is air insufflation colonoscopy,where air distends the colon to allow visualization of the colonic mucosa.This technique is uncomfortable for patients and requires an anesthetist to administer sedation.In addition,patients commonly complain about discomfort post-op as air escapes into the small bowel and cannot be adequately removed.Current research into the use of water insufflation colonoscopies has proved promising in reducing the need for sedation,decreasing discomfort,and increasing the visibility of the colonic mucosa.Future direction into water insufflation colonoscopies which have shown to be simpler and easier to teach may increase the number of proficient endoscopists in training to serve our aging population.
基金Digestive Medical Coordinated Development Center of Beijing Hospitals Authority,No. XXZ015Capital Citizens Health Cultivation Project of Beijing Municipal Science&Technology Commission,No. Z161100000116084+1 种基金Medical and Health Public Foundation of Beijing,No. YWJKJJHKYJJ-B17262-067Science and Technology Development Project of China State Railway Group,No. N2019Z004。
文摘BACKGROUND Colonoscopy is the accepted gold standard for the detection of colorectal cancer. However, colonoscopy is less effective in preventing colon cancer in the right side compared with the left side.AIM To investigate the feasibility of a novel type of retroflexion colonoscope, EC-3490 Ti colonoscope, for detection of proximal colon lesions.METHODS In this prospective trial, we recruited patients who underwent colonoscopy for screening or surveillance. When the endoscopists could not grasp the whole observation of the right-side colon mucosa in the forward view(FV), insertion and withdrawal were repeatedly performed in the FV group with the EC38-i10 F colonoscope while retroflexion was performed in the retroflexed view(RV) group with the EC-3490 Ti colonoscope. Adenoma detection rate, the total number of adenomas per positive participant, the success rate of retroflexion, and endoscope withdrawal time were recorded and compared.RESULTS The total adenoma detection rate(39.3% vs 37.7%, P = 0.646) did not show any significant difference between the two groups. However, the polyp detection rate(59.6% vs 51.0%, P = 0.002), adenoma detection rate in the right colon(21.6% vs 14.4%, P = 0.012), and the total number of adenomas per positive participant(2.1 vs 1.7, P = 0.011) reached statistical significance. Retroflexion was achieved in 91.7% of our cohort. Compared with the FV group, the withdrawal time was significantly prolonged in the RV group(586.1 ± 124.4 s vs 508.8 ± 129.6 s, P < 0.001). In contrast, the proportion of additional ancillary pressure decreased(27.4% vs 45.7%, P < 0.001), and the visual analog scale pain scores did not increase(2.7 ± 1.4 vs 2.8 ± 1.4, P = 0.377).CONCLUSION Retroflexion in the proximal colon could be performed successfully and safely with the EC-3490 Ti colonoscope. This maneuver could detect more adenomas effectively.
基金supported by the National Natural Science Foundation of China(51605482)the Equipment Pre-research Project(41403020101).
文摘Test selection is to select the test set with the least total cost or the least total number from the alternative test set on the premise of meeting the required testability indicators.The existing models and methods are not suitable for system level test selection.The first problem is the lack of detailed data of the units’fault set and the test set,which makes it impossible to establish a traditional dependency matrix for the system level.The second problem is that the system level fault detection rate and the fault isolation rate(referred to as"two rates")are not enough to describe the fault diagnostic ability of the system level tests.An innovative dependency matrix(called combinatorial dependency matrix)composed of three submatrices is presented.The first problem is solved by simplifying the submatrix between the units’fault and the test,and the second problem is solved by establishing the system level fault detection rate,the fault isolation rate and the integrated fault detection rate(referred to as"three rates")based on the new matrix.The mathematical model of the system level test selection problem is constructed,and the binary genetic algorithm is applied to solve the problem,which achieves the goal of system level test selection.
文摘BACKGROUND Ensuring colonoscopy procedure quality is vital to the success of screening and surveillance programmes for bowel cancer in Australia. However, the data on the performance of quality metrics, through adequate adenoma detection, bowel preparation, and procedure completion rates, in the Australian public sector is limited. Understanding these can inform quality improvement to further strengthen our capacity for prevention and early detection of colorectal cancer.AIM To determine the quality of colonoscopy in Australian teaching hospitals and their association with proceduralist specialty, trainee involvement, and location.METHODS We retrospectively evaluated 2443 consecutive colonoscopy procedure reports from 1 January to 1 April, 2018 from five public teaching tertiary hospitals in Australia(median 60 years old, 49% male). Data for bowel preparation quality,procedure completion rates, and detection rates of clinically significant adenomas, conventional adenomas, and serrated lesions was collected and compared to national criteria for quality in colonoscopy. Participating hospital, proceduralist specialty, and trainee involvement indicators were used for stratification. Data was analysed using Chi-squared tests of independence, MannWhitney U, One-way ANOVA, and multivariate binary logistic regression.RESULTS Fifty-two point two percent(n = 1276) and 43.3%(n = 1057) were performed by medical and surgical proceduralists respectively, whilst 29.8%(n = 728) involved a trainee. Inadequate bowel preparation affected 7.3% of all procedures. The procedure completion rate was 95.1%, which increased to 97.5% after adjustment for bowel preparation quality. The pooled cancer, adenoma, and serrated lesion detection rates for all five hospitals were 3.5%, 40%, and 5.9% respectively. Assessed hospitals varied significantly by patient age(P < 0.001), work-force composition(P < 0.001), adequacy of bowel preparation(P < 0.001), and adenoma detection rate(P < 0.001). Two hospitals(40%) did not meet all national criteria for quality, due to a procedure completion rate of 94.5% or serrated lesion detection rate of 2.6%. Although lower than the other hospitals, the difference was not significant. Compared with surgical specialists, procedures performed by medical specialists involved older patients [65 years(inter-quartile range, IQR 58-73) vs 64 years(IQR 56-71);P = 0.04] and were associated with a higher adenoma detection rate [odds ratio(OR) 1.53;confidence interval: 1.21-1.94;P < 0.001]. Procedures involving trainee proceduralists were not associated with differences in the detection of cancer, adenoma, or serrated lesions, compared with specialists, or according to their medical or surgical background. On multivariate analysis, cancer detection was positively associated with patient age(OR 1.04;P < 0.001) and negatively associated with medical compared to surgical proceduralists(OR 0.54;P = 0.04). Conventional adenoma detection rates were independently associated with increasing patient age(OR 1.04;P < 0.001), positively associated with medical compared to surgical proceduralists(OR 1.41;P = 0.002) and negatively associated with male gender(OR 0.53;P < 0.001).CONCLUSION Significant differences in the quality of colonoscopy in Australia exist, even when national benchmarks are achieved. The role of possible contributing factors, like procedural specialty and patient gender need further evaluation.
文摘The aim of this study was to determine the frequency of infectious diseases among people entering/exiting via Manzhouli port. We analyzed infectious disease data from the Manzhouli International Travel Health care Center covering 2012 through 2014, as well as performed several laboratory tests to measure rates of infection. The frequencies of infectious diseases as well as their association with occupation and year of occurrence were calculated for people entering and exiting via the port. The total proportion of infectious diseases measured was 2.18%. Hepatitis B was the most commonly occurring at 1.68%, followed by syphilis, hepatits C and HIV, which were 0.23%, 0.21% and 0.04%, respectively. Contract workers, traffic staff, foreigners and those married abroad were more likely to be infected. Furthermore, there were significant differences among three years. Strategies should be developed and preventive policies should be implemented aimed at protecting the at risk populations at Manzhouli port, especially with regard to contract workers, traffic staff, foreigners and those married abroad.
