AIM:To evaluate the diagnosis of different differentiated gastric intraepithelial neoplasia (IN) by magnifica-tion endoscopy combined with narrow-band imaging (ME-NBI) and confocal laser endomicroscopy (CLE). METHODS:...AIM:To evaluate the diagnosis of different differentiated gastric intraepithelial neoplasia (IN) by magnifica-tion endoscopy combined with narrow-band imaging (ME-NBI) and confocal laser endomicroscopy (CLE). METHODS:Eligible patients with suspected gastric IN lesions previously diagnosed by endoscopy in secondary hospitals and scheduled for further diagnosis and tratment were recruited for this study. Excluded from the study were patients who had liver cirrhosis, impaired renal function, acute gastrointestinal (GI) bleeding, coagulopathy, esophageal varices, jaundice, and GI post-surgery. Also excluded were those who were pregnant, breastfeeding, were younger than 18 years old, or were unable to provide informed consent. All patients had all mucus and bile cleared from their stom-achs. They then received upper GI endoscopy. When a mucosal lesion is found during observation with whitelight imaging, the lesion is visualized using maximal magnification, employing gradual movement of the tip of the endoscope to bring the image into focus. Saved images are analyzed. Confocal images were evaluated by two endoscopists (Huang J and Li MY), who were familiar with CLE, blinded to the related information about the lesions, and asked to classify each lesion as either a low grade dysplasia (LGD) or high grade dysplasia (HGD) according to given criteria. The results were compared with the final histopathologic diagnosis. ME-NBI images were evaluated by two endoscopists (Lu ZS and Ling-Hu EQ) who were familiar with NBI, blinded to the related information about the lesions and CLE images, and were asked to classify each lesion as a LGD or HGD according to the "microvascular pattern and surface pattern" classification system. The results were compared with the final histopathologic diagnosis. RESULTS: The study included 32 pathology-proven low grade gastric IN and 26 pathology-proven high grade gastric IN that were detected with any of the modalities. CLE and ME-NBI enabled clear visualization of the vascular microsurface patterns and microvascular structures of the gastric mucosa. The accuracy of the CLE and the ME-NBI diagnosis was 88% (95% CI:78%-98%) and 81% (95% CI: 69%-93%), respectively. The kappa coefficient of agreement between the histopathology and the in vivo CLE imaging was 0.755; between the histopathology and the in vivo CLE imaging was 0.615. McNemar's test (binomial distribution used) indicated that the agreement was significant (P < 0.05). When patients were diagnosed by MENBI with CLE, the overall accuracy of the diagnosis was 86.21% (95% CI:73%-96%), and the kappa coefficient of agreement was 0.713, according to McNemar's test (P < 0.05). CONCLUSION:Higher diagnostic accuracy, sensitivityand specificity of CLE over ME-NBI indicate the feasibility of these two techniques for the efficacious diagnostic classification of gastric IN.展开更多
AIM To evaluate the clinical impact of confocal laser endomicroscopy(CLE) in the diagnosis and management of patients with an uncertain diagnosis.METHODS A retrospective chart review was performed.Patients who underwe...AIM To evaluate the clinical impact of confocal laser endomicroscopy(CLE) in the diagnosis and management of patients with an uncertain diagnosis.METHODS A retrospective chart review was performed.Patients who underwent CLE between November 2013 and October 2015 and exhibited a poor correlation between endoscopic and histological findings were included.Baseline characteristics,indications,previous diagnostic studies,findings at the time of CLE,clinical management and histological results were analyzed.Interventions based on CLE findings were also analyzed.We compared the diagnostic accuracy of CLE and target biopsies of surgical specimens.RESULTS A total of 144 patients were included.Of these,51%(74/144) were female.The mean age was 51 years old.In all,41/144(28.4%) lesions were neoplastic(13 bile duct,10 gastric,8 esophageal,6 colonic,1 duodenal,1 rectal,1 ampulloma and 1 pancreatic).The sensitivity,specificity,positive predictive value,negative predictive value,and observed agreement when CLE was used to detect N-lesions were 85.37%,87.38%,72.92%,93.75% and 86.81%,respectively.Cohen's Kappa was 69.20%,thus indicating good agreement.Changes in management were observed in 54% of the cases.CONCLUSION CLE is a new diagnostic tool that has a significant clinical impact on the diagnosis and treatment of patients with uncertain diagnosis.展开更多
AIM To investigate the reproducibility of the in vivo endoscopic ultrasound(EUS)-guided needle based confocal endomicroscopy(n CLE) image patterns in an ex vivo setting and compare these to surgical histopathology for...AIM To investigate the reproducibility of the in vivo endoscopic ultrasound(EUS)-guided needle based confocal endomicroscopy(n CLE) image patterns in an ex vivo setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions(PCLs). METHODS In a prospective study evaluating EUS-nC LE for evaluation of PCLs, 10 subjects underwent an in vivo nC LE(AQFlex nC LE miniprobe; Cellvizio, MaunaK ea, Paris, France) during EUS and ex vivo probe based CLE(pC LE) of the PCL(Gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from ex vivo CLE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for in vivo and ex vivo CLE imaging respectively. RESULTS A total of 10 subjects(mean age 53 ± 12 years; 5 female) with a mean PCL size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms(IPMNs), 3 mucinous cystic neoplasms(MCNs), 2 cystic neuroendocrine tumors(cystic-NETs), 1 serous cystadenoma(SCA), and 2 squamous lined PCLs. Characteristic in vivo nC LE image patterns included papillary projections for IPMNs, horizon-type epithelial bands for MCNs, nests and trabeculae of cells for cystic-NETs, and a "fern pattern" of vascularity for SCA. Identical image patterns were observed during ex vivo pC LE imaging of the surgically resected PCLs. Both in vivo and ex vivo CLE imaging findings correlated with surgical histopathology.CONCLUSION In vivo n CLE patterns are reproducible in ex vivo p CLE for all major neoplastic PCLs. These findings add further support the application of EUS-nC LE as an imaging biomarker in the diagnosis of PCLs.展开更多
AIM: To investigate the morphological changes of meibomian glands in patients with type 2 diabetes mellitus(DM).·METHODS: Of 118 eyes(118 patients) with type 2 DM(DM group) and 100 eyes of 100 control subjects(co...AIM: To investigate the morphological changes of meibomian glands in patients with type 2 diabetes mellitus(DM).·METHODS: Of 118 eyes(118 patients) with type 2 DM(DM group) and 100 eyes of 100 control subjects(control group) were enrolled. After completing an ocular surface disease index(OSDI) questionnaire, the non-invasive tear film break-up time(NI-BUT) and the structure of the meibomian glands(MGs, meibography) were assessed by the Keratograph 5M system. Partial or complete loss of MG was scored for each eyelid from grade 0(no loss) to grade 3(lost area was >2/3 of the total MG area), which were also examined by laser scanning confocal microscopy(LSCM). The primary outcomes were meibomian gland acinar unit density(MGAUD),meibomian gland acinar longest diameter(MGALD) and meibomian gland acinar shortest diameter(MGASD).·RESULTS: Compared with control group, the OSDI was significantly higher in DM group(Z =-5.916; P <0.001),while the NI-BUT was significantly lower(Z =-7.765; P <0.001). Keratograph showed that there were more MGs dropout in DM group than that in control group. The meiboscore was significantly higher in DM group compared with control group(Z =-3.937; P <0.001).LSCM revealed that there were cytological alterations of MGs in DM group compared with control group, which included enlargement of MG acinar units and decreased in density of MG acinar units. Specifically, there were lower MGAUD, larger MGALD and MGASD in DM group than control group(Z =-10.120,-9.4442,-7.771; P <0.001).· CONCLUSION: Compared with the normal control participants, the patients with type 2 DM had more unstable tear films and severe symptoms of dry eye.Using Keratograph 5M system and LSCM, we found that the patients with type 2 DM had more significant morphological and cytological changes and dysfunction in MGs.展开更多
Laser scanning confocal microscopy(LSCM) was used to study the inhibition of austenite grain growth by the inclusions and the effect of cerium on the trend of acicular ferrite(AF) and ferrite side plate(FSP) transform...Laser scanning confocal microscopy(LSCM) was used to study the inhibition of austenite grain growth by the inclusions and the effect of cerium on the trend of acicular ferrite(AF) and ferrite side plate(FSP) transformation temperature in coarse grain heat affected zone(CGHAZ) of Ce-alloyed weld metals. The results showed there were lots of tiny cerium oxides and sulfides inclusions in the CGHAZ of Ce-alloyed weld metals. When the concentration of Ce was 0.021%, the volume fraction of inclusions in weld metal CGHAZ was higher and the inclusion size was smaller, therefore austenite grain size was smaller with the increase of hightemperature residence time. Cerium tended to segregate at austenite grain boundaries, so FSP transformation temperature decreased and FSP transformation was suppressed. On the contrary, AF transformation temperature increased because AF transformation was promoted in CGHAZ of the Ce-alloyed weld metal, especially when the concentration of Ce was 0.021%.展开更多
文摘AIM:To evaluate the diagnosis of different differentiated gastric intraepithelial neoplasia (IN) by magnifica-tion endoscopy combined with narrow-band imaging (ME-NBI) and confocal laser endomicroscopy (CLE). METHODS:Eligible patients with suspected gastric IN lesions previously diagnosed by endoscopy in secondary hospitals and scheduled for further diagnosis and tratment were recruited for this study. Excluded from the study were patients who had liver cirrhosis, impaired renal function, acute gastrointestinal (GI) bleeding, coagulopathy, esophageal varices, jaundice, and GI post-surgery. Also excluded were those who were pregnant, breastfeeding, were younger than 18 years old, or were unable to provide informed consent. All patients had all mucus and bile cleared from their stom-achs. They then received upper GI endoscopy. When a mucosal lesion is found during observation with whitelight imaging, the lesion is visualized using maximal magnification, employing gradual movement of the tip of the endoscope to bring the image into focus. Saved images are analyzed. Confocal images were evaluated by two endoscopists (Huang J and Li MY), who were familiar with CLE, blinded to the related information about the lesions, and asked to classify each lesion as either a low grade dysplasia (LGD) or high grade dysplasia (HGD) according to given criteria. The results were compared with the final histopathologic diagnosis. ME-NBI images were evaluated by two endoscopists (Lu ZS and Ling-Hu EQ) who were familiar with NBI, blinded to the related information about the lesions and CLE images, and were asked to classify each lesion as a LGD or HGD according to the "microvascular pattern and surface pattern" classification system. The results were compared with the final histopathologic diagnosis. RESULTS: The study included 32 pathology-proven low grade gastric IN and 26 pathology-proven high grade gastric IN that were detected with any of the modalities. CLE and ME-NBI enabled clear visualization of the vascular microsurface patterns and microvascular structures of the gastric mucosa. The accuracy of the CLE and the ME-NBI diagnosis was 88% (95% CI:78%-98%) and 81% (95% CI: 69%-93%), respectively. The kappa coefficient of agreement between the histopathology and the in vivo CLE imaging was 0.755; between the histopathology and the in vivo CLE imaging was 0.615. McNemar's test (binomial distribution used) indicated that the agreement was significant (P < 0.05). When patients were diagnosed by MENBI with CLE, the overall accuracy of the diagnosis was 86.21% (95% CI:73%-96%), and the kappa coefficient of agreement was 0.713, according to McNemar's test (P < 0.05). CONCLUSION:Higher diagnostic accuracy, sensitivityand specificity of CLE over ME-NBI indicate the feasibility of these two techniques for the efficacious diagnostic classification of gastric IN.
文摘AIM To evaluate the clinical impact of confocal laser endomicroscopy(CLE) in the diagnosis and management of patients with an uncertain diagnosis.METHODS A retrospective chart review was performed.Patients who underwent CLE between November 2013 and October 2015 and exhibited a poor correlation between endoscopic and histological findings were included.Baseline characteristics,indications,previous diagnostic studies,findings at the time of CLE,clinical management and histological results were analyzed.Interventions based on CLE findings were also analyzed.We compared the diagnostic accuracy of CLE and target biopsies of surgical specimens.RESULTS A total of 144 patients were included.Of these,51%(74/144) were female.The mean age was 51 years old.In all,41/144(28.4%) lesions were neoplastic(13 bile duct,10 gastric,8 esophageal,6 colonic,1 duodenal,1 rectal,1 ampulloma and 1 pancreatic).The sensitivity,specificity,positive predictive value,negative predictive value,and observed agreement when CLE was used to detect N-lesions were 85.37%,87.38%,72.92%,93.75% and 86.81%,respectively.Cohen's Kappa was 69.20%,thus indicating good agreement.Changes in management were observed in 54% of the cases.CONCLUSION CLE is a new diagnostic tool that has a significant clinical impact on the diagnosis and treatment of patients with uncertain diagnosis.
基金Supported by American College of Gastroenterology Pilot Research Grant.The Gastroflex UHD probe for the ex vivo evaluation was provided by Cellvizio,Mauna Kea Technologies,Paris,France
文摘AIM To investigate the reproducibility of the in vivo endoscopic ultrasound(EUS)-guided needle based confocal endomicroscopy(n CLE) image patterns in an ex vivo setting and compare these to surgical histopathology for characterizing pancreatic cystic lesions(PCLs). METHODS In a prospective study evaluating EUS-nC LE for evaluation of PCLs, 10 subjects underwent an in vivo nC LE(AQFlex nC LE miniprobe; Cellvizio, MaunaK ea, Paris, France) during EUS and ex vivo probe based CLE(pC LE) of the PCL(Gastroflex ultrahigh definition probe, Cellvizio) after surgical resection. Biopsies were obtained from ex vivo CLE-imaged areas for comparative histopathology. All subjects received intravenous fluorescein prior to EUS and pancreatic surgery for in vivo and ex vivo CLE imaging respectively. RESULTS A total of 10 subjects(mean age 53 ± 12 years; 5 female) with a mean PCL size of 34.8 ± 14.3 mm were enrolled. Surgical histopathology confirmed 2 intraductal papillary mucinous neoplasms(IPMNs), 3 mucinous cystic neoplasms(MCNs), 2 cystic neuroendocrine tumors(cystic-NETs), 1 serous cystadenoma(SCA), and 2 squamous lined PCLs. Characteristic in vivo nC LE image patterns included papillary projections for IPMNs, horizon-type epithelial bands for MCNs, nests and trabeculae of cells for cystic-NETs, and a "fern pattern" of vascularity for SCA. Identical image patterns were observed during ex vivo pC LE imaging of the surgically resected PCLs. Both in vivo and ex vivo CLE imaging findings correlated with surgical histopathology.CONCLUSION In vivo n CLE patterns are reproducible in ex vivo p CLE for all major neoplastic PCLs. These findings add further support the application of EUS-nC LE as an imaging biomarker in the diagnosis of PCLs.
文摘AIM: To investigate the morphological changes of meibomian glands in patients with type 2 diabetes mellitus(DM).·METHODS: Of 118 eyes(118 patients) with type 2 DM(DM group) and 100 eyes of 100 control subjects(control group) were enrolled. After completing an ocular surface disease index(OSDI) questionnaire, the non-invasive tear film break-up time(NI-BUT) and the structure of the meibomian glands(MGs, meibography) were assessed by the Keratograph 5M system. Partial or complete loss of MG was scored for each eyelid from grade 0(no loss) to grade 3(lost area was >2/3 of the total MG area), which were also examined by laser scanning confocal microscopy(LSCM). The primary outcomes were meibomian gland acinar unit density(MGAUD),meibomian gland acinar longest diameter(MGALD) and meibomian gland acinar shortest diameter(MGASD).·RESULTS: Compared with control group, the OSDI was significantly higher in DM group(Z =-5.916; P <0.001),while the NI-BUT was significantly lower(Z =-7.765; P <0.001). Keratograph showed that there were more MGs dropout in DM group than that in control group. The meiboscore was significantly higher in DM group compared with control group(Z =-3.937; P <0.001).LSCM revealed that there were cytological alterations of MGs in DM group compared with control group, which included enlargement of MG acinar units and decreased in density of MG acinar units. Specifically, there were lower MGAUD, larger MGALD and MGASD in DM group than control group(Z =-10.120,-9.4442,-7.771; P <0.001).· CONCLUSION: Compared with the normal control participants, the patients with type 2 DM had more unstable tear films and severe symptoms of dry eye.Using Keratograph 5M system and LSCM, we found that the patients with type 2 DM had more significant morphological and cytological changes and dysfunction in MGs.
基金Project supported by the National Natural Science Foundation of China(U1260103)
文摘Laser scanning confocal microscopy(LSCM) was used to study the inhibition of austenite grain growth by the inclusions and the effect of cerium on the trend of acicular ferrite(AF) and ferrite side plate(FSP) transformation temperature in coarse grain heat affected zone(CGHAZ) of Ce-alloyed weld metals. The results showed there were lots of tiny cerium oxides and sulfides inclusions in the CGHAZ of Ce-alloyed weld metals. When the concentration of Ce was 0.021%, the volume fraction of inclusions in weld metal CGHAZ was higher and the inclusion size was smaller, therefore austenite grain size was smaller with the increase of hightemperature residence time. Cerium tended to segregate at austenite grain boundaries, so FSP transformation temperature decreased and FSP transformation was suppressed. On the contrary, AF transformation temperature increased because AF transformation was promoted in CGHAZ of the Ce-alloyed weld metal, especially when the concentration of Ce was 0.021%.
