BACKGROUND The risk of gastric cancer increases in patients with Helicobacter pylori-associated chronic atrophic gastritis(CAG).X-ray examination can evaluate the condition of the stomach,and it can be used for gastri...BACKGROUND The risk of gastric cancer increases in patients with Helicobacter pylori-associated chronic atrophic gastritis(CAG).X-ray examination can evaluate the condition of the stomach,and it can be used for gastric cancer mass screening.However,skilled doctors for interpretation of X-ray examination are decreasing due to the diverse of inspections.AIM To evaluate the effectiveness of stomach regions that are automatically estimated by a deep learning-based model for CAG detection.METHODS We used 815 gastric X-ray images(GXIs)obtained from 815 subjects.The ground truth of this study was the diagnostic results in X-ray and endoscopic examinations.For a part of GXIs for training,the stomach regions are manually annotated.A model for automatic estimation of the stomach regions is trained with the GXIs.For the rest of them,the stomach regions are automatically estimated.Finally,a model for automatic CAG detection is trained with all GXIs for training.RESULTS In the case that the stomach regions were manually annotated for only 10 GXIs and 30 GXIs,the harmonic mean of sensitivity and specificity of CAG detection were 0.955±0.002 and 0.963±0.004,respectively.CONCLUSION By estimating stomach regions automatically,our method contributes to the reduction of the workload of manual annotation and the accurate detection of the CAG.展开更多
IM To assess the accuracy and limitations of endoscopic ultrasonography (EUS) in the preoperative staging of gastric carcinoma in comparison with computed tomography (CT).METHODS According to the new (1987) TN stagi...IM To assess the accuracy and limitations of endoscopic ultrasonography (EUS) in the preoperative staging of gastric carcinoma in comparison with computed tomography (CT).METHODS According to the new (1987) TN staging, 62 patients with gastric carcinomas were examined preoperatively by EUS and compared with the postoperative pathological TN staging. CT of abdomen was performed before surgery in 32 of the patients.RESULTS The overall accuracy of T staging was 839% for EUS and 281% for CT. For the detection of regional lymph node metastases, EUS accuracy was 790%, sensitivity 800% and specificity 875%, versus 500% accuracy for CT. The coincidence of perigastric infiltration was 900% for EUS and 412% for CT. The most frequent causes of misdiagnosis by EUS were microscopic tumor invasion and peritumorous inflammatory or fibrous changes.CONCLUSION EUS is a reliable method for the clinical evaluation of locoregional extension of gastric cancer and more accurate than CT in the preoperative staging of gastric carcinoma.展开更多
Objective: To investigate imaging findings of tumors invading parapharyngeal space. Methods: Magnetic resonance imaging (MRI) computerized tomography (CT), magnetic resonance angiography (MRA) and digital subtruation...Objective: To investigate imaging findings of tumors invading parapharyngeal space. Methods: Magnetic resonance imaging (MRI) computerized tomography (CT), magnetic resonance angiography (MRA) and digital subtruation angiography (DSA) findings of 19 patients with tumors infiltrating parapharyngeal space by surgery and pathology were analysed, including four branchial cleft cysts, three jugular glomus tumors, four carotid body tumors, three neurilemomas and five carcinomas of nasopharynx involving parapharyngeal space. Fifteen patients underwent MRI scanning nine patients had CT scanning, three patients MRA and five patients DSA. Results: MRI provided clinically useful informations about the size, shape, extent and site of the parapharyngeal space tumors, and also their effects on adjacent structures. The main MRI features of paraganglioma presented as many low signal tortuous and creeping vessels in the tumor. The main CT features of jugular glomus tumor revealed as jugular foramen enlargement with bone destruction. Tumor vessels were clearly displayed by MRA and DSA. Conclusion: MRI was superior to CT in the diagnosis of tumors invading parapharyngeal space. The location and nature of the lesions could be diagnosed accurately by MRI combined with CT or DSA.展开更多
BACKGROUND The enteric nervous system(ENS)is situated along the entire gastrointestinal tract and is divided into myenteric and submucosal plexuses in the small and large intestines.The ENS consists of neurons,glial c...BACKGROUND The enteric nervous system(ENS)is situated along the entire gastrointestinal tract and is divided into myenteric and submucosal plexuses in the small and large intestines.The ENS consists of neurons,glial cells,and nerves assembled into ganglia,surrounded by telocytes,interstitial cells of Cajal,and connective tissue.Owing to the complex spatial organization of several interconnections with nerve fascicles,the ENS is difficult to examine in conventional histological sections of 3-5μm.AIM To examine human ileum full-thickness biopsies using X-ray phase-contrast nanotomography without prior staining to visualize the ENS.METHODS Six patients were diagnosed with gastrointestinal dysmotility and neuropathy based on routine clinical and histopathological examinations.As controls,fullthickness biopsies were collected from healthy resection ileal regions after hemicolectomy for right colon malignancy.From the paraffin blocks,4-μm thick sections were prepared and stained with hematoxylin and eosin for localization of the myenteric ganglia under a light microscope.A 1-mm punch biopsy(up to 1 cm in length)centered on the myenteric plexus was taken and placed into a Kapton®tube for mounting in the subsequent investigation.X-ray phase-contrast tomography was performed using two custom-designed laboratory setups with micrometer resolution for overview scanning.Subsequently,selected regions of interest were scanned at a synchrotron-based end-station,and high-resolution slices were reported.In total,more than 6000 virtual slices were analyzed from nine samples.RESULTS In the overview scans,the general architecture and quality of the samples were studied,and the myenteric plexus was localized.High-resolution scans revealed details,including the ganglia,interganglional nerve fascicles,and surrounding tissue.The ganglia were irregular in shape and contained neurons and glial cells.Spindle-shaped cells with very thin cellular projections could be observed on the surface of the ganglia,which appeared to build a network.In the patients,there were no alterations in the general architecture of the myenteric ganglia.Nevertheless,several pathological changes were observed,including vacuolar degeneration,autophagic activity,the appearance of sequestosomes,chromatolysis,and apoptosis.Furthermore,possible expulsion of pyknotic neurons and defects in the covering cellular network could be observed in serial slices.These changes partly corresponded to previous light microscopy findings.CONCLUSION The analysis of serial virtual slices could provide new information that cannot be obtained by classical light microscopy.The advantages,disadvantages,and future possibilities of this method are also discussed.展开更多
BACKGROUND Colonoscopy within 24 h of hospital admission for colonic diverticular bleeding(CDB)is recommended.However,little is known about rates of rebleeding within 30 d.We posited that a group of patients who under...BACKGROUND Colonoscopy within 24 h of hospital admission for colonic diverticular bleeding(CDB)is recommended.However,little is known about rates of rebleeding within 30 d.We posited that a group of patients who underwent contrast-enhanced computed tomography(CT)within 4 h of the last hematochezia and colonoscopy within 24 h would experience fewer incidences of rebleeding.AIM To evaluate the outcomes of early colonoscopy for CDB among different groups of patients.METHODS Data from 182 patients with CDB who underwent contrast-enhanced CT and colonoscopy between January 2011 and December 2018 at the study site were retrospectively reviewed.Patients were divided into groups based on the timing of the CT imaging,within or at 4 h were defined as urgent CTs(n=100)and those performed after 4 h were defined as elective CTs(n=82).Main outcomes included rebleeding within 30 d and the identification of stigmata of recent hemorrhage(SRH)(i.e.,active bleeding,non-bleeding visible vessels,or adherent clots).RESULTS In total,182 patients(126 men and 56 women)with median ages of 68.6(range,37-92)and 73.7(range,48-93)years,respectively,underwent CT imaging and colonoscopy within 24 h of the last hematochezia.Patients for whom CT was performed within 4 h of the last hematochezia were included in the urgent CT group(n=100)and patients for whom CT was performed after 4 h were included in the elective CT group(n=82).SRH were identified in 35.0%(35/100)of the urgent CT cases and 7.3%(6/82)of the elective CT cases(P<0.01).Among all patients with extravasation-positive images on CT,SRH was identified in 31 out of 47 patients(66.0%)in the urgent CT group and 4 out of 20 patients(20.0%)in the elective CT group(P<0.01).Furthermore,rates of rebleeding within 30 d were significantly improved in the urgent CT and extravasation-positive cases(P<0.05).Results from the evaluation of early colonoscopy did not show a difference in the ability to detect SRH identification or rebleeding rates.Only cases by urgent CT reduced risk of rebleeding due to the evidence of active bleeding on the image.CONCLUSION To improve rates of rebleeding,colonoscopy is recommended within 24 h in patients with extravasation-positive CT images within 4 h of the last hematochezia.Otherwise,elective colonoscopy can be performed.展开更多
Objective:The aim of this study was to clarify the differences between the prostatic levels of chemical elements in patients with benign prostatic hyperplasia(BPH)and healthy male.Methods:We evaluated the prostatic le...Objective:The aim of this study was to clarify the differences between the prostatic levels of chemical elements in patients with benign prostatic hyperplasia(BPH)and healthy male.Methods:We evaluated the prostatic level of 66 chemical elements in 43 patients with BPH and 37 healthy males.Measurements were performed using five instrumental analytical methods.Results:In the hyperplastic prostates,we have observed a significant increase in the mean level of Bi,Cr,Hg,K,Sb,and Se accompanied a significant decrease in the mean level of Al,Ce,Cs,Dy,Er,Gd,Ho,La,Mo,Nd,Pb,Pr,Sm,Sn,Tb,Tm,U,and Y.No differences were found in the mean prostatic level of other chemical elements including Ag,Al,Au,B,Ba,Be,Br,Ca,Cd,Co,Cu,Fe,Li,Mg,Mn,Na,Nb,Ni,P,Rb,S,Sc,Si,Th,Ti,Tl,Yb,Zn,and Zr between BPH patients and healthy males.Conclusions:The finding of chemical element contents and correlation between pairs of chemical element mass fractions indicates that there is a great disturbance of prostatic chemical element metabolism in BPH gland.Trace elements Bi,Cr,Hg,K,Sb,and Se may be regarded as the possible tissue biomarkers of hyperplastic transformation of prostate gland.Obtained data did not confirm a critical role of Cd and Pb accumulation in the pathogenesis of BPH.A potential age-related Zn,Fe,and Se deficiency in the prostate tissue has not been found as being involved in the etiology of BPH.展开更多
Objective： To evaluate the clinical feasibility and effect of the computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails. Methods： The hardware components of the system inc...Objective： To evaluate the clinical feasibility and effect of the computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails. Methods： The hardware components of the system included a PC computer with a monitor, auto mechanical stereotactical locating cubic frame, foot holder and localization operative apparatus. Special navigation software can be used for registration of X-ray fluoroscopic images and real-time controlling navigation of tools. Twenty-one cases of dose tibial and fibular fractures were treated with dosed intramedullary nailing, 6 of which involved in middle third, 12 in middle and lower third, 3 in lower third. C-arm alignment and registration time, fluoroscopic time and drilling time involved in the locking procedure were recorded. The size of unreamed or reamed tibial nails ranged from 8/300-11/330. Results： All distal holes except 1 were locked successfully. In 9 of 41 locked holes （21.95 % ）, the drill bit touched the canal of locking hole without damage of the nail and clinical consequences. The fluoroscopy time per pair of screws was 2.23 s± 0.31s. Conclusions： The computer-assisted auto-frame navigation system for distal locking is well designed, easy to operate and do not need additional instrmnents during the procedure. The developed system enables the physician to precisely navigate surgical instruments throughout the anatomy using just a few computer-calibrated radiographic images. The total time of x-ray exposure per procedure can be significantly reduced.展开更多
文摘BACKGROUND The risk of gastric cancer increases in patients with Helicobacter pylori-associated chronic atrophic gastritis(CAG).X-ray examination can evaluate the condition of the stomach,and it can be used for gastric cancer mass screening.However,skilled doctors for interpretation of X-ray examination are decreasing due to the diverse of inspections.AIM To evaluate the effectiveness of stomach regions that are automatically estimated by a deep learning-based model for CAG detection.METHODS We used 815 gastric X-ray images(GXIs)obtained from 815 subjects.The ground truth of this study was the diagnostic results in X-ray and endoscopic examinations.For a part of GXIs for training,the stomach regions are manually annotated.A model for automatic estimation of the stomach regions is trained with the GXIs.For the rest of them,the stomach regions are automatically estimated.Finally,a model for automatic CAG detection is trained with all GXIs for training.RESULTS In the case that the stomach regions were manually annotated for only 10 GXIs and 30 GXIs,the harmonic mean of sensitivity and specificity of CAG detection were 0.955±0.002 and 0.963±0.004,respectively.CONCLUSION By estimating stomach regions automatically,our method contributes to the reduction of the workload of manual annotation and the accurate detection of the CAG.
文摘IM To assess the accuracy and limitations of endoscopic ultrasonography (EUS) in the preoperative staging of gastric carcinoma in comparison with computed tomography (CT).METHODS According to the new (1987) TN staging, 62 patients with gastric carcinomas were examined preoperatively by EUS and compared with the postoperative pathological TN staging. CT of abdomen was performed before surgery in 32 of the patients.RESULTS The overall accuracy of T staging was 839% for EUS and 281% for CT. For the detection of regional lymph node metastases, EUS accuracy was 790%, sensitivity 800% and specificity 875%, versus 500% accuracy for CT. The coincidence of perigastric infiltration was 900% for EUS and 412% for CT. The most frequent causes of misdiagnosis by EUS were microscopic tumor invasion and peritumorous inflammatory or fibrous changes.CONCLUSION EUS is a reliable method for the clinical evaluation of locoregional extension of gastric cancer and more accurate than CT in the preoperative staging of gastric carcinoma.
文摘Objective: To investigate imaging findings of tumors invading parapharyngeal space. Methods: Magnetic resonance imaging (MRI) computerized tomography (CT), magnetic resonance angiography (MRA) and digital subtruation angiography (DSA) findings of 19 patients with tumors infiltrating parapharyngeal space by surgery and pathology were analysed, including four branchial cleft cysts, three jugular glomus tumors, four carotid body tumors, three neurilemomas and five carcinomas of nasopharynx involving parapharyngeal space. Fifteen patients underwent MRI scanning nine patients had CT scanning, three patients MRA and five patients DSA. Results: MRI provided clinically useful informations about the size, shape, extent and site of the parapharyngeal space tumors, and also their effects on adjacent structures. The main MRI features of paraganglioma presented as many low signal tortuous and creeping vessels in the tumor. The main CT features of jugular glomus tumor revealed as jugular foramen enlargement with bone destruction. Tumor vessels were clearly displayed by MRA and DSA. Conclusion: MRI was superior to CT in the diagnosis of tumors invading parapharyngeal space. The location and nature of the lesions could be diagnosed accurately by MRI combined with CT or DSA.
基金Supported by the Development Foundation of Region Skane,No.REGSKANE-818781 and No.2018-Projekt0024the Foundation Skane University Hospital,No.2020-0000028.
文摘BACKGROUND The enteric nervous system(ENS)is situated along the entire gastrointestinal tract and is divided into myenteric and submucosal plexuses in the small and large intestines.The ENS consists of neurons,glial cells,and nerves assembled into ganglia,surrounded by telocytes,interstitial cells of Cajal,and connective tissue.Owing to the complex spatial organization of several interconnections with nerve fascicles,the ENS is difficult to examine in conventional histological sections of 3-5μm.AIM To examine human ileum full-thickness biopsies using X-ray phase-contrast nanotomography without prior staining to visualize the ENS.METHODS Six patients were diagnosed with gastrointestinal dysmotility and neuropathy based on routine clinical and histopathological examinations.As controls,fullthickness biopsies were collected from healthy resection ileal regions after hemicolectomy for right colon malignancy.From the paraffin blocks,4-μm thick sections were prepared and stained with hematoxylin and eosin for localization of the myenteric ganglia under a light microscope.A 1-mm punch biopsy(up to 1 cm in length)centered on the myenteric plexus was taken and placed into a Kapton®tube for mounting in the subsequent investigation.X-ray phase-contrast tomography was performed using two custom-designed laboratory setups with micrometer resolution for overview scanning.Subsequently,selected regions of interest were scanned at a synchrotron-based end-station,and high-resolution slices were reported.In total,more than 6000 virtual slices were analyzed from nine samples.RESULTS In the overview scans,the general architecture and quality of the samples were studied,and the myenteric plexus was localized.High-resolution scans revealed details,including the ganglia,interganglional nerve fascicles,and surrounding tissue.The ganglia were irregular in shape and contained neurons and glial cells.Spindle-shaped cells with very thin cellular projections could be observed on the surface of the ganglia,which appeared to build a network.In the patients,there were no alterations in the general architecture of the myenteric ganglia.Nevertheless,several pathological changes were observed,including vacuolar degeneration,autophagic activity,the appearance of sequestosomes,chromatolysis,and apoptosis.Furthermore,possible expulsion of pyknotic neurons and defects in the covering cellular network could be observed in serial slices.These changes partly corresponded to previous light microscopy findings.CONCLUSION The analysis of serial virtual slices could provide new information that cannot be obtained by classical light microscopy.The advantages,disadvantages,and future possibilities of this method are also discussed.
文摘BACKGROUND Colonoscopy within 24 h of hospital admission for colonic diverticular bleeding(CDB)is recommended.However,little is known about rates of rebleeding within 30 d.We posited that a group of patients who underwent contrast-enhanced computed tomography(CT)within 4 h of the last hematochezia and colonoscopy within 24 h would experience fewer incidences of rebleeding.AIM To evaluate the outcomes of early colonoscopy for CDB among different groups of patients.METHODS Data from 182 patients with CDB who underwent contrast-enhanced CT and colonoscopy between January 2011 and December 2018 at the study site were retrospectively reviewed.Patients were divided into groups based on the timing of the CT imaging,within or at 4 h were defined as urgent CTs(n=100)and those performed after 4 h were defined as elective CTs(n=82).Main outcomes included rebleeding within 30 d and the identification of stigmata of recent hemorrhage(SRH)(i.e.,active bleeding,non-bleeding visible vessels,or adherent clots).RESULTS In total,182 patients(126 men and 56 women)with median ages of 68.6(range,37-92)and 73.7(range,48-93)years,respectively,underwent CT imaging and colonoscopy within 24 h of the last hematochezia.Patients for whom CT was performed within 4 h of the last hematochezia were included in the urgent CT group(n=100)and patients for whom CT was performed after 4 h were included in the elective CT group(n=82).SRH were identified in 35.0%(35/100)of the urgent CT cases and 7.3%(6/82)of the elective CT cases(P<0.01).Among all patients with extravasation-positive images on CT,SRH was identified in 31 out of 47 patients(66.0%)in the urgent CT group and 4 out of 20 patients(20.0%)in the elective CT group(P<0.01).Furthermore,rates of rebleeding within 30 d were significantly improved in the urgent CT and extravasation-positive cases(P<0.05).Results from the evaluation of early colonoscopy did not show a difference in the ability to detect SRH identification or rebleeding rates.Only cases by urgent CT reduced risk of rebleeding due to the evidence of active bleeding on the image.CONCLUSION To improve rates of rebleeding,colonoscopy is recommended within 24 h in patients with extravasation-positive CT images within 4 h of the last hematochezia.Otherwise,elective colonoscopy can be performed.
文摘Objective:The aim of this study was to clarify the differences between the prostatic levels of chemical elements in patients with benign prostatic hyperplasia(BPH)and healthy male.Methods:We evaluated the prostatic level of 66 chemical elements in 43 patients with BPH and 37 healthy males.Measurements were performed using five instrumental analytical methods.Results:In the hyperplastic prostates,we have observed a significant increase in the mean level of Bi,Cr,Hg,K,Sb,and Se accompanied a significant decrease in the mean level of Al,Ce,Cs,Dy,Er,Gd,Ho,La,Mo,Nd,Pb,Pr,Sm,Sn,Tb,Tm,U,and Y.No differences were found in the mean prostatic level of other chemical elements including Ag,Al,Au,B,Ba,Be,Br,Ca,Cd,Co,Cu,Fe,Li,Mg,Mn,Na,Nb,Ni,P,Rb,S,Sc,Si,Th,Ti,Tl,Yb,Zn,and Zr between BPH patients and healthy males.Conclusions:The finding of chemical element contents and correlation between pairs of chemical element mass fractions indicates that there is a great disturbance of prostatic chemical element metabolism in BPH gland.Trace elements Bi,Cr,Hg,K,Sb,and Se may be regarded as the possible tissue biomarkers of hyperplastic transformation of prostate gland.Obtained data did not confirm a critical role of Cd and Pb accumulation in the pathogenesis of BPH.A potential age-related Zn,Fe,and Se deficiency in the prostate tissue has not been found as being involved in the etiology of BPH.
基金This study was supported by Chinese National High Technology Development Programs (2002AA-4201100)
文摘Objective： To evaluate the clinical feasibility and effect of the computer-assisted auto-frame navigation system for distal locking of tibial intramedullary nails. Methods： The hardware components of the system included a PC computer with a monitor, auto mechanical stereotactical locating cubic frame, foot holder and localization operative apparatus. Special navigation software can be used for registration of X-ray fluoroscopic images and real-time controlling navigation of tools. Twenty-one cases of dose tibial and fibular fractures were treated with dosed intramedullary nailing, 6 of which involved in middle third, 12 in middle and lower third, 3 in lower third. C-arm alignment and registration time, fluoroscopic time and drilling time involved in the locking procedure were recorded. The size of unreamed or reamed tibial nails ranged from 8/300-11/330. Results： All distal holes except 1 were locked successfully. In 9 of 41 locked holes （21.95 % ）, the drill bit touched the canal of locking hole without damage of the nail and clinical consequences. The fluoroscopy time per pair of screws was 2.23 s± 0.31s. Conclusions： The computer-assisted auto-frame navigation system for distal locking is well designed, easy to operate and do not need additional instrmnents during the procedure. The developed system enables the physician to precisely navigate surgical instruments throughout the anatomy using just a few computer-calibrated radiographic images. The total time of x-ray exposure per procedure can be significantly reduced.
