Introduction： Gastrointestinal Dieulafoy＇s lesion is a rare entity, of unknown etiology, and corresponds to an arterial malformation at the submucosal space that can be a source of life-threatening hemorrhage. We re...Introduction： Gastrointestinal Dieulafoy＇s lesion is a rare entity, of unknown etiology, and corresponds to an arterial malformation at the submucosal space that can be a source of life-threatening hemorrhage. We report a case of a Cecum Dieulafoy＇s bleeding lesion that was managed endoscopically with a favorable outcome. Case report： Female, 70-year-old, diagnosed with type 2 diabetes, hypothyroidism, and chronic heart failure associated with rheumatic mitral stenosis, submitted to biological valve replacement in 2006 and with permanent atrial fibrillation using vitamin K antagonist anticoagulant for thrombosis prophylaxis. Her background includes a stroke in 2004 without any permanent disability. In 2016, the patient experienced voluptuous and painless lower gastrointestinal bleeding with severe acute anemia, requiring hospital admission, fluid resuscitation and blood transfusion. Urgent colonoscopy revealed a small reddish vascular malformation at the cecum with oozing active bleeding, about 3 mm in size. Initially argon plasma coagulation was performed with satisfactory and immediate hemostasis. One week later, she recurred with hematochezia. The lesion at the cecum was reassessed and it was possible to notice a large caliber vessel surrounded by a normal appearance mucosa, compatible with Dieulafoy＇s lesion and it was treated with an endoscopic clip placement with a good long-term response. Conclusion： Endoscopy is the method of choice for diagnosis of Dieulafuy＇s lesion and may provide efficient treatment with mechanical hemostasis such as endoclip placement with a high success rate.展开更多
Dieulafoy’s lesions are rare vascular malformations of the gastrointestinal tract. A Dieulafoy’s lesion is an aberrant vessel that does not reduce in caliber when it extends from the submucosa to the mucosa. Damage ...Dieulafoy’s lesions are rare vascular malformations of the gastrointestinal tract. A Dieulafoy’s lesion is an aberrant vessel that does not reduce in caliber when it extends from the submucosa to the mucosa. Damage to this artery can cause severe and intermittent arterial bleeding from small vascular stumps that are difficult to visualize. Furthermore, these catastrophic bleeding episodes frequently result in hemodynamic instability and the need for transfusion of multiple blood products. Recently, uremic syndrome has been identified as a risk factor for gastric mucosal lesions. We present two clinical cases of acute digestive bleeding due to Dielafoy lesion with chronic kidney disease as the main cause, where two different therapies were performed endoscopically. We concluded with the results of our patients that the best therapy was the application of the hemostatic hemoclip on the injury vs the injection with adrenaline on the wound site. Uremia is identified as a risk factor for upper gastrointestinal bleeding in patients with pre-existing Dieulafoy’s lesion, as well as a higher incidence of new bleeding.展开更多
Upper gastrointestinal bleeding remains a significant cause of hospital admissions. Even though the incidence of peptic ulcer disease and gastritis is decreasing, the incidence rates in neoplasm, Dieulafoy’s lesions,...Upper gastrointestinal bleeding remains a significant cause of hospital admissions. Even though the incidence of peptic ulcer disease and gastritis is decreasing, the incidence rates in neoplasm, Dieulafoy’s lesions, angiodysplasia, and esophagitis are trending up, which necessities physicians to be aware of those pathologies and their specifics. Here, we represent a case of a 62-year-old male on dual antiplatelet therapy who was transferred to our hospital due to severe melena with suspicion of upper gastrointestinal bleeding. Due to hemodynamic instability, the patient was intubated and started on vasopressors. However, several repeated EGDs and CTs of the abdomen with GI bleeding protocol did not reveal the location of active bleeding to stop it. At the same time, clinically, the patient was hemodynamically unstable with continued melena. On the last EGD, a small area of concern resembling gastric varix was clipped for identification purposes, and the patient underwent a selective angiogram with further diagnosis of Dieulafoy’s lesion, which was successfully embolized. Our case demonstrates that Dieulafoy’s lesions can present as severe life-threatening hemorrhage, hard to diagnose with traditional methods such as EGD or CTs, in which case it is recommended to proceed with an angiogram sooner rather than later for further diagnosis and treatment if needed.展开更多
[目的]本文旨在解决在自然环境下不同成熟度苹果目标检测精度较低的问题。[方法]提出了一种改进的YOLOv5s模型SODSTR-YOLOv5s(YOLOv5s with small detection layer and omni-dimensional dynamic convolution and swin transformer bloc...[目的]本文旨在解决在自然环境下不同成熟度苹果目标检测精度较低的问题。[方法]提出了一种改进的YOLOv5s模型SODSTR-YOLOv5s(YOLOv5s with small detection layer and omni-dimensional dynamic convolution and swin transformer block),用于不同成熟度苹果检测。首先改进YOLOv5s的多尺度目标检测层,在Prediction中构建检测160×160特征图的检测头,提高小尺寸的不同成熟度苹果的检测精度;其次在Backbone结构中融合Swin Transformer Block,加强同级成熟度的苹果纹理特征融合,弱化纹理特征分布差异带来的消极影响,提高模型泛化能力;最后将Neck结构的Conv模块替换为动态卷积模块ODConv,细化局部特征映射,实现局部苹果细粒度特征的充分提取。基于不同成熟度苹果数据集进行试验,验证改进模型的性能。[结果]改进模型SODSTR-YOLOv5s检测的精确率、召回率、平均精度均值分别为89.1%、95.5%、93.6%,高、中、低成熟度苹果平均精度均值分别为94.1%、93.1%、93.7%,平均检测时间为16 ms,参数量为7.34 M。相比于YOLOv5s模型,改进模型SODSTR-YOLOv5s精确率、召回率、平均精度均值分别提高了3.8%、5.0%、2.9%,参数量和平均检测时间分别增加了0.32 M和5 ms。[结论]改进模型SODSTR-YOLOv5s提升了在自然环境下对不同成熟度苹果的检测能力,能较好地满足实际采摘苹果的检测要求。展开更多
针对煤矿高噪声、低照度、运动模糊与大批量煤矸混杂等复杂工况环境因素导致煤矸识别存在误检、漏检以及检测精度低的问题,提出一种基于CFS-YOLO算法的煤矸智能识别模型。采用ConvNeXt V2(Convolutional Neural Network with NeXt Units...针对煤矿高噪声、低照度、运动模糊与大批量煤矸混杂等复杂工况环境因素导致煤矸识别存在误检、漏检以及检测精度低的问题,提出一种基于CFS-YOLO算法的煤矸智能识别模型。采用ConvNeXt V2(Convolutional Neural Network with NeXt Units Version 2)特征提取模块替换主干网络末端的2个C3(Cross Stage Partial Bottle Neck Mudule)模块,通过将掩码自动编码器(Masked Autoencoders,MAE)和全局响应归一化(Global Response Normalization,GRN)层添加到ConvNeXt架构中,有效缓解特征崩溃问题以及保持特征在网络传递过程中的多样性;采用Focal-EIOU(Focal and Efficient Intersection Over Union)损失函数替换原CIOU(Computer Intersection Over Union)损失函数,通过其Focal-Loss机制和调整样本权重的方式优化边界框回归任务中的样本不平衡问题,提高模型的收敛速度和定位精度;添加无参注意力机制(Simple Attention Mechanism,SimAM)于主干网络每个C3模块的后端,凭借其注意力权重自适应调整策略,提升模型对尺度变化较大或低分辨率煤矸目标关键特征的提取能力。通过消融试验和对比试验验证所提CFS-YOLO模型的有效性与优越性。试验结果表明:CFS-YOLO模型对于煤矸在煤矿高噪声、低照度、运动模糊与大批量煤矸混杂等复杂环境下的检测效果均得到有效提高,模型的平均精度均值达到90.2%,相较于原YOLOv5s模型的平均精度均值提高了3.7%,平均检测速度达到90.09 FPS,可充分满足煤矸实时检测的需求。同时与YOLOv5s、YOLOv7-tiny与YOLOv8n等6种YOLO系列算法相比,CFS-YOLO模型对煤矿复杂环境的适应性最强且综合检测性能最佳,可为煤矸的智能高效分选提供技术支持。展开更多
文摘Introduction： Gastrointestinal Dieulafoy＇s lesion is a rare entity, of unknown etiology, and corresponds to an arterial malformation at the submucosal space that can be a source of life-threatening hemorrhage. We report a case of a Cecum Dieulafoy＇s bleeding lesion that was managed endoscopically with a favorable outcome. Case report： Female, 70-year-old, diagnosed with type 2 diabetes, hypothyroidism, and chronic heart failure associated with rheumatic mitral stenosis, submitted to biological valve replacement in 2006 and with permanent atrial fibrillation using vitamin K antagonist anticoagulant for thrombosis prophylaxis. Her background includes a stroke in 2004 without any permanent disability. In 2016, the patient experienced voluptuous and painless lower gastrointestinal bleeding with severe acute anemia, requiring hospital admission, fluid resuscitation and blood transfusion. Urgent colonoscopy revealed a small reddish vascular malformation at the cecum with oozing active bleeding, about 3 mm in size. Initially argon plasma coagulation was performed with satisfactory and immediate hemostasis. One week later, she recurred with hematochezia. The lesion at the cecum was reassessed and it was possible to notice a large caliber vessel surrounded by a normal appearance mucosa, compatible with Dieulafoy＇s lesion and it was treated with an endoscopic clip placement with a good long-term response. Conclusion： Endoscopy is the method of choice for diagnosis of Dieulafuy＇s lesion and may provide efficient treatment with mechanical hemostasis such as endoclip placement with a high success rate.
文摘Dieulafoy’s lesions are rare vascular malformations of the gastrointestinal tract. A Dieulafoy’s lesion is an aberrant vessel that does not reduce in caliber when it extends from the submucosa to the mucosa. Damage to this artery can cause severe and intermittent arterial bleeding from small vascular stumps that are difficult to visualize. Furthermore, these catastrophic bleeding episodes frequently result in hemodynamic instability and the need for transfusion of multiple blood products. Recently, uremic syndrome has been identified as a risk factor for gastric mucosal lesions. We present two clinical cases of acute digestive bleeding due to Dielafoy lesion with chronic kidney disease as the main cause, where two different therapies were performed endoscopically. We concluded with the results of our patients that the best therapy was the application of the hemostatic hemoclip on the injury vs the injection with adrenaline on the wound site. Uremia is identified as a risk factor for upper gastrointestinal bleeding in patients with pre-existing Dieulafoy’s lesion, as well as a higher incidence of new bleeding.
文摘Upper gastrointestinal bleeding remains a significant cause of hospital admissions. Even though the incidence of peptic ulcer disease and gastritis is decreasing, the incidence rates in neoplasm, Dieulafoy’s lesions, angiodysplasia, and esophagitis are trending up, which necessities physicians to be aware of those pathologies and their specifics. Here, we represent a case of a 62-year-old male on dual antiplatelet therapy who was transferred to our hospital due to severe melena with suspicion of upper gastrointestinal bleeding. Due to hemodynamic instability, the patient was intubated and started on vasopressors. However, several repeated EGDs and CTs of the abdomen with GI bleeding protocol did not reveal the location of active bleeding to stop it. At the same time, clinically, the patient was hemodynamically unstable with continued melena. On the last EGD, a small area of concern resembling gastric varix was clipped for identification purposes, and the patient underwent a selective angiogram with further diagnosis of Dieulafoy’s lesion, which was successfully embolized. Our case demonstrates that Dieulafoy’s lesions can present as severe life-threatening hemorrhage, hard to diagnose with traditional methods such as EGD or CTs, in which case it is recommended to proceed with an angiogram sooner rather than later for further diagnosis and treatment if needed.
文摘[目的]本文旨在解决在自然环境下不同成熟度苹果目标检测精度较低的问题。[方法]提出了一种改进的YOLOv5s模型SODSTR-YOLOv5s(YOLOv5s with small detection layer and omni-dimensional dynamic convolution and swin transformer block),用于不同成熟度苹果检测。首先改进YOLOv5s的多尺度目标检测层,在Prediction中构建检测160×160特征图的检测头,提高小尺寸的不同成熟度苹果的检测精度;其次在Backbone结构中融合Swin Transformer Block,加强同级成熟度的苹果纹理特征融合,弱化纹理特征分布差异带来的消极影响,提高模型泛化能力;最后将Neck结构的Conv模块替换为动态卷积模块ODConv,细化局部特征映射,实现局部苹果细粒度特征的充分提取。基于不同成熟度苹果数据集进行试验,验证改进模型的性能。[结果]改进模型SODSTR-YOLOv5s检测的精确率、召回率、平均精度均值分别为89.1%、95.5%、93.6%,高、中、低成熟度苹果平均精度均值分别为94.1%、93.1%、93.7%,平均检测时间为16 ms,参数量为7.34 M。相比于YOLOv5s模型,改进模型SODSTR-YOLOv5s精确率、召回率、平均精度均值分别提高了3.8%、5.0%、2.9%,参数量和平均检测时间分别增加了0.32 M和5 ms。[结论]改进模型SODSTR-YOLOv5s提升了在自然环境下对不同成熟度苹果的检测能力,能较好地满足实际采摘苹果的检测要求。
文摘针对煤矿高噪声、低照度、运动模糊与大批量煤矸混杂等复杂工况环境因素导致煤矸识别存在误检、漏检以及检测精度低的问题,提出一种基于CFS-YOLO算法的煤矸智能识别模型。采用ConvNeXt V2(Convolutional Neural Network with NeXt Units Version 2)特征提取模块替换主干网络末端的2个C3(Cross Stage Partial Bottle Neck Mudule)模块,通过将掩码自动编码器(Masked Autoencoders,MAE)和全局响应归一化(Global Response Normalization,GRN)层添加到ConvNeXt架构中,有效缓解特征崩溃问题以及保持特征在网络传递过程中的多样性;采用Focal-EIOU(Focal and Efficient Intersection Over Union)损失函数替换原CIOU(Computer Intersection Over Union)损失函数,通过其Focal-Loss机制和调整样本权重的方式优化边界框回归任务中的样本不平衡问题,提高模型的收敛速度和定位精度;添加无参注意力机制(Simple Attention Mechanism,SimAM)于主干网络每个C3模块的后端,凭借其注意力权重自适应调整策略,提升模型对尺度变化较大或低分辨率煤矸目标关键特征的提取能力。通过消融试验和对比试验验证所提CFS-YOLO模型的有效性与优越性。试验结果表明:CFS-YOLO模型对于煤矸在煤矿高噪声、低照度、运动模糊与大批量煤矸混杂等复杂环境下的检测效果均得到有效提高,模型的平均精度均值达到90.2%,相较于原YOLOv5s模型的平均精度均值提高了3.7%,平均检测速度达到90.09 FPS,可充分满足煤矸实时检测的需求。同时与YOLOv5s、YOLOv7-tiny与YOLOv8n等6种YOLO系列算法相比,CFS-YOLO模型对煤矿复杂环境的适应性最强且综合检测性能最佳,可为煤矸的智能高效分选提供技术支持。
