BACKGROUND Ulcerative colitis(UC)is a chronic and debilitating inflammatory bowel disease.Cumulative evidence indicates that excess hydrogen peroxide,a potent neutrophilic chemotactic agent,produced by colonic epithel...BACKGROUND Ulcerative colitis(UC)is a chronic and debilitating inflammatory bowel disease.Cumulative evidence indicates that excess hydrogen peroxide,a potent neutrophilic chemotactic agent,produced by colonic epithelial cells has a causal role leading to infiltration of neutrophils into the colonic mucosa and subsequent development of UC.This evidence-based mechanism identifies hydrogen peroxide as a therapeutic target for reducing agents in the treatment of UC.CASE SUMMARY Presented is a 41-year-old female with a 26-year history of refractory UC.Having developed steroid dependence and never achieving complete remission on treatment by conventional and advanced therapies,she began treatment with oral R-dihydrolipoic acid(RDLA),a lipid-soluble reducing agent with intracellular site of action.Within a week,rectal bleeding ceased.She was asymptomatic for three years until a highly stressful experience,when she noticed blood in her stool.RDLA was discontinued,and she began treatment with oral sodium thiosulfate pentahydrate(STS),a reducing agent with extracellular site of action.After a week,rectal bleeding ceased,and she resumed oral RDLA and discontinued STS.To date,she remains asymptomatic with normal stool calprotectin while on RDLA.CONCLUSION STS and RDLA are reducing agents that serve as highly effective and safe therapy for the induction and maintenance of remission in UC,even in patients refractory or poorly controlled by conventional and advanced therapies.Should preliminary findings be validated by subsequent clinical trials,the use of reducing agents could potentially prevent thousands of colectomies and represent a paradigm shift in the treatment of UC.展开更多
目的利用2023年新推出的YOLOv8m网络,开发一款人工智能辅助系统,旨在实现腺瘤性息肉的自动定位和诊断。方法使用4个结肠息肉数据集,总计包括9411张静态图像和25段视频。所涵盖的息肉类别包括增生性息肉和腺瘤性息肉。利用LabelMe工具对...目的利用2023年新推出的YOLOv8m网络,开发一款人工智能辅助系统,旨在实现腺瘤性息肉的自动定位和诊断。方法使用4个结肠息肉数据集,总计包括9411张静态图像和25段视频。所涵盖的息肉类别包括增生性息肉和腺瘤性息肉。利用LabelMe工具对图像进行标注,并将标注数据转换成适用于深度学习模型训练的YOLO格式。在模型训练方面,采用预训练的YOLOv5m和YOLOv8m模型,并结合实时数据增强以及多种图像处理技术进行迁移学习训练。模型性能的评估采用多个指标,包括敏感性、特异性、假阳性率和检测速度(每秒帧数,frames per second,FPS)、平均精度(mean average precision,mAP)等。此外,还使用混淆矩阵进行详细评估,并将模型的性能与不同资历的医师进行比较分析。结果在对1411个息肉的验证集进行评估中,YOLOv8m模型在多项性能指标上超越了YOLOv5。YOLOv8m的整体准确率为98.58%,在腺瘤性息肉、增生性息肉检测的敏感性分别为98.06%和99.32%,特异性分别为99.33%和98.09%,不同类型息肉预测的mAP50为0.994。在与内镜医师的性能比较中,YOLOv8m模型在准确率(98.58%)和处理速度(60.61帧/s)方面均优于低年资(准确率为86.02%)和高年资内镜医师(准确率为93.14%),其处理速度是低年资内镜医师的67.2倍。结论基于YOLOv8m网络的深度学习模型能够快速、精确地检测与分类结直肠息肉,在辅助内镜医师提高腺瘤性息肉检出率方面展现出很大的应用潜力。展开更多
BACKGROUND Crohn’s disease(CD)is a chronic inflammatory bowel disease with unknown etiology.Inflammatory chemical mediators synthesized from arachidonic acid,an n-6 polyunsaturated fatty acid(PUFA),have been shown to...BACKGROUND Crohn’s disease(CD)is a chronic inflammatory bowel disease with unknown etiology.Inflammatory chemical mediators synthesized from arachidonic acid,an n-6 polyunsaturated fatty acid(PUFA),have been shown to activate CD.Additionally,n-3 PUFAs are metabolized by the same enzyme as n-6 PUFAs and known to inhibit the arachidonic acid cascade.Our previous study noted that the presence of erythrocyte membrane fatty acids is a characteristic finding in Japanese CD patients.It was thus speculated that FADS2 gene polymorphisms,which induce PUFA metabolizing enzymes,are involved in the pathogenesis of CD,though no such relationship was found.AIM To investigate the relationship of FADS2 polymorphisms with serum and erythrocyte membrane fatty acid composition ratios,and disease activity.METHODS Using previously reported findings regarding FADS2 genetic polymorphisms,the records of 52 CD patients undergoing treatment at Jikei University Kashiwa Hospital were analyzed.Mutations noted were divided into three groups;wild-type(GG),heterozygous mutants(GA),and homozygous(AA),with the activities of delta-6 and delta-5 desaturases compared using redefined d6d index(rd.d6di)and d5d index(d5di).Additionally,comparisons of serum and erythrocyte membranes for fatty acid composition,and also gene polymorphisms and CD activity index(CDAI)were performed.RESULTS The presence of the rs174538 mutation in FADS2 resulted in reduction of only rd.d6di in the erythrocyte membrane(P<0.01).In contrast,that mutation was found to be associated with d5di induced by FADS1 in serum(P=0.019)as well as the erythrocyte membrane(P<0.0001),and also with reduction in the fatty acid composition of arachidonic acid in both serum(P<0.0001)and the erythrocyte membrane(P<0.01).Regarding disease activity,a positive correlation of CDAI score with rd.d6di in both serum(P<0.05)and the erythrocyte membrane(P<0.05)was found only in the rs174538 wild-type group.In contrast,there was no correction between CDAI and d5di in either serum or erythrocyte membrane samples.CONCLUSION The rs174538 mutation alters the fatty acid profile through strong linkage to the FADS1 gene.In wild-type individuals,rd.d6di was positively correlated with CDAI,suggesting predictive utility of disease severity.展开更多
文摘BACKGROUND Ulcerative colitis(UC)is a chronic and debilitating inflammatory bowel disease.Cumulative evidence indicates that excess hydrogen peroxide,a potent neutrophilic chemotactic agent,produced by colonic epithelial cells has a causal role leading to infiltration of neutrophils into the colonic mucosa and subsequent development of UC.This evidence-based mechanism identifies hydrogen peroxide as a therapeutic target for reducing agents in the treatment of UC.CASE SUMMARY Presented is a 41-year-old female with a 26-year history of refractory UC.Having developed steroid dependence and never achieving complete remission on treatment by conventional and advanced therapies,she began treatment with oral R-dihydrolipoic acid(RDLA),a lipid-soluble reducing agent with intracellular site of action.Within a week,rectal bleeding ceased.She was asymptomatic for three years until a highly stressful experience,when she noticed blood in her stool.RDLA was discontinued,and she began treatment with oral sodium thiosulfate pentahydrate(STS),a reducing agent with extracellular site of action.After a week,rectal bleeding ceased,and she resumed oral RDLA and discontinued STS.To date,she remains asymptomatic with normal stool calprotectin while on RDLA.CONCLUSION STS and RDLA are reducing agents that serve as highly effective and safe therapy for the induction and maintenance of remission in UC,even in patients refractory or poorly controlled by conventional and advanced therapies.Should preliminary findings be validated by subsequent clinical trials,the use of reducing agents could potentially prevent thousands of colectomies and represent a paradigm shift in the treatment of UC.
文摘目的利用2023年新推出的YOLOv8m网络,开发一款人工智能辅助系统,旨在实现腺瘤性息肉的自动定位和诊断。方法使用4个结肠息肉数据集,总计包括9411张静态图像和25段视频。所涵盖的息肉类别包括增生性息肉和腺瘤性息肉。利用LabelMe工具对图像进行标注,并将标注数据转换成适用于深度学习模型训练的YOLO格式。在模型训练方面,采用预训练的YOLOv5m和YOLOv8m模型,并结合实时数据增强以及多种图像处理技术进行迁移学习训练。模型性能的评估采用多个指标,包括敏感性、特异性、假阳性率和检测速度(每秒帧数,frames per second,FPS)、平均精度(mean average precision,mAP)等。此外,还使用混淆矩阵进行详细评估,并将模型的性能与不同资历的医师进行比较分析。结果在对1411个息肉的验证集进行评估中,YOLOv8m模型在多项性能指标上超越了YOLOv5。YOLOv8m的整体准确率为98.58%,在腺瘤性息肉、增生性息肉检测的敏感性分别为98.06%和99.32%,特异性分别为99.33%和98.09%,不同类型息肉预测的mAP50为0.994。在与内镜医师的性能比较中,YOLOv8m模型在准确率(98.58%)和处理速度(60.61帧/s)方面均优于低年资(准确率为86.02%)和高年资内镜医师(准确率为93.14%),其处理速度是低年资内镜医师的67.2倍。结论基于YOLOv8m网络的深度学习模型能够快速、精确地检测与分类结直肠息肉,在辅助内镜医师提高腺瘤性息肉检出率方面展现出很大的应用潜力。
文摘BACKGROUND Crohn’s disease(CD)is a chronic inflammatory bowel disease with unknown etiology.Inflammatory chemical mediators synthesized from arachidonic acid,an n-6 polyunsaturated fatty acid(PUFA),have been shown to activate CD.Additionally,n-3 PUFAs are metabolized by the same enzyme as n-6 PUFAs and known to inhibit the arachidonic acid cascade.Our previous study noted that the presence of erythrocyte membrane fatty acids is a characteristic finding in Japanese CD patients.It was thus speculated that FADS2 gene polymorphisms,which induce PUFA metabolizing enzymes,are involved in the pathogenesis of CD,though no such relationship was found.AIM To investigate the relationship of FADS2 polymorphisms with serum and erythrocyte membrane fatty acid composition ratios,and disease activity.METHODS Using previously reported findings regarding FADS2 genetic polymorphisms,the records of 52 CD patients undergoing treatment at Jikei University Kashiwa Hospital were analyzed.Mutations noted were divided into three groups;wild-type(GG),heterozygous mutants(GA),and homozygous(AA),with the activities of delta-6 and delta-5 desaturases compared using redefined d6d index(rd.d6di)and d5d index(d5di).Additionally,comparisons of serum and erythrocyte membranes for fatty acid composition,and also gene polymorphisms and CD activity index(CDAI)were performed.RESULTS The presence of the rs174538 mutation in FADS2 resulted in reduction of only rd.d6di in the erythrocyte membrane(P<0.01).In contrast,that mutation was found to be associated with d5di induced by FADS1 in serum(P=0.019)as well as the erythrocyte membrane(P<0.0001),and also with reduction in the fatty acid composition of arachidonic acid in both serum(P<0.0001)and the erythrocyte membrane(P<0.01).Regarding disease activity,a positive correlation of CDAI score with rd.d6di in both serum(P<0.05)and the erythrocyte membrane(P<0.05)was found only in the rs174538 wild-type group.In contrast,there was no correction between CDAI and d5di in either serum or erythrocyte membrane samples.CONCLUSION The rs174538 mutation alters the fatty acid profile through strong linkage to the FADS1 gene.In wild-type individuals,rd.d6di was positively correlated with CDAI,suggesting predictive utility of disease severity.
