BACKGROUND Sessile serrated lesions(SSLs)are premalignant polyps implicated in up to 30%of colorectal cancers.Australia reports high SSL detection rates(SSL-DRs),yet with marked variability(3.1%-24%).This substantial ...BACKGROUND Sessile serrated lesions(SSLs)are premalignant polyps implicated in up to 30%of colorectal cancers.Australia reports high SSL detection rates(SSL-DRs),yet with marked variability(3.1%-24%).This substantial variation raises concerns about missed lesions and post-colonoscopy colorectal cancer.This study investigates determinants associated with SSL-DR variation in regional Australia.AIM To study how patient,clinical,and colonoscopy factors are associated with SSL detection in a regional Australian practice.We aimed to contribute high-detection data to the literature by analyzing the association of SSL detection with various determinants.METHODS This retrospective,cross-sectional analysis examined 1450 colonoscopies performed at Port Macquarie Gastroenterology during 2023.Sigmoidoscopies and repeat procedures were excluded.Multivariate logistic regression analyzed associations between SSL detection and patient demographics,clinical indications,procedural factors,and comorbidities.RESULTS The overall SSL-DR was 30.7%.Multivariate analysis identified several independent predictors:Clinical indication,bowel preparation quality,inflammatory bowel disease status,and serrated polyposis syndrome.The faecal occult blood test positive(FOBT)(+)cohort showed the highest predicted SSL detection probability(39.8%),while clinical symptoms showed the lowest(22.3%).After adjustment,SSL detection odds were 2.3 times greater among FOBT(+)patients than those with clinical symptoms(adjusted odds ratio=2.30,95%confidence interval:1.20-4.40,P=0.004).CONCLUSION SSL-DR as a quality indicator requires contextualization regarding clinical indications,bowel preparation quality,and comorbidities.There was a significantly higher prevalence of SSLs in FOBT(+)patients.Despite comprehensive adjustment,this study cannot fully explain the wide SSL-DR variation in Australia,highlighting the need for standardized detection protocols and further research to ensure optimal cancer prevention outcomes.展开更多
A recent study by Nishizawa et al presented significant findings regarding the advantages of next-generation colonoscopes,specifically the CF-XZ1200 and CFEZ1500 models,in enhancing the adenoma and sessile serrated le...A recent study by Nishizawa et al presented significant findings regarding the advantages of next-generation colonoscopes,specifically the CF-XZ1200 and CFEZ1500 models,in enhancing the adenoma and sessile serrated lesion detection rates.As colorectal cancer remains a leading cause of cancer-related mortality globally,the implications of improved detection rates are substantial.This letter advocated the adoption of advanced colonoscopy technology,emphasizing the robust methodology of the study,including propensity score matching,which enhanced the validity of its conclusions.Notable improvements in image quality,facilitated by innovations such as 4 K resolution and texture enhancement imaging,enable endoscopists to identify even the smallest lesions,ultimately leading to improved patient outcomes.Given the compelling evidence presented,it is imperative for healthcare institutions to prioritize the integration of these advanced scopes into routine practice to enhance screening efficacy and reduce the burden of colorectal cancer.展开更多
BACKGROUND Adenoma detection rate(ADR),a key colonoscopy quality metric,varies with patient demographics and procedural factors.AIM To identify independent predictors of≥25%ADR,develop a risk model,and propose withdr...BACKGROUND Adenoma detection rate(ADR),a key colonoscopy quality metric,varies with patient demographics and procedural factors.AIM To identify independent predictors of≥25%ADR,develop a risk model,and propose withdrawal durations based on different insertion times.METHODS We retrospectively analyzed 830 cases using logistic regression and identified four key factors,validated in a prospective cohort of 5699 patients.Their importance was confirmed using random forest(RF),extreme gradient boosting(XGBoost)and light gradient boosting machine(LightGBM).Attempts to determine targetachieving withdrawal time by grouping cases based on insertion time and Cox regression were inconclusive.Using the 5699-case dataset,we developed a predictive model combining support vector machine(SVM)with XGBoost.We built a Shiny app using this model for clinical application.RESULTS Multivariate logistic regression identified age[odds ratio(OR)=1.05;95%confidence interval(CI):1.03-1.08;P<0.001],male(OR=1.79;95%CI:1.32-2.41;P=0.005),higher endoscopist experience(OR=1.79;95%CI:1.20-2.68;P=0.005),and longer withdrawal time(P<0.001)as independent risk factors for colorectal adenoma.A nomogram demonstrated strong discrimination[area under the curve(AUC)=0.720],with robust calibration and decision-curve performance.Feature importance via RF,XGBoost,and LightGBM confirmed key predictors.A hybrid model combining SVM regression for withdrawal-time estimation and XGBoost classification achieved stable results,with XGBoost reporting AUCs of 0.640 in training and 0.610 in testing,and similar validation outcomes.Deployed via a Shiny app for clinical use.However,model discrimination was modest(AUC:0.61-0.64),suggesting that clinical utility requires further refinement.CONCLUSION A hybrid SVM-XGBoost model using four key endoscopic factors was independently validated and is available as a Shiny app,delivering real-time decision support to streamline endoscopy and enhance clinical outcomes.展开更多
Screening colonoscopy with adenoma removal is the gold standard strategy to reduce colorectal cancer(CRC)incidence.Nevertheless,it remains an imperfect tool as nearly Twenty-five percent of adenomas can be missed duri...Screening colonoscopy with adenoma removal is the gold standard strategy to reduce colorectal cancer(CRC)incidence.Nevertheless,it remains an imperfect tool as nearly Twenty-five percent of adenomas can be missed during inspection by experienced endoscopists.Missed lesions are one of the primary reasons for post colonoscopy CRC and are associated with a significant variability in adenoma detection rate(ADR),which is the most important quality indicator for colonoscopy.Increasing ADR unquestionably decreases carcinoma miss rate.Simple measures to improve ADR include among others slower withdrawal time and position change.The introduction of optical imaging innovations has improved mucosal visualization.Moreover,auxiliary devices attached to the colonoscope tip have been introduced,aiming to improve lumen visualization by flattening the folds and revealing lesions hidden in blind spots,thereby increasing ADR.Digital image analysis using artificial intelligence is the latest approach to polyp detection.All of the above approaches have been separately evaluated concerning their effect in ADR;however,it has not been thoroughly investigated whether any benefit exists from their combined use.We aim to review the available data on the efficacy of each technique/technology and whether their combination offers any additional benefit while remaining cost-effective.展开更多
BACKGROUND Colorectal cancer(CRC)can be prevented by screening and early detection.Colonoscopy is used for screening,and adenoma detection rate(ADR)is used as a key quality indicator of sufficient colonoscopy.However,...BACKGROUND Colorectal cancer(CRC)can be prevented by screening and early detection.Colonoscopy is used for screening,and adenoma detection rate(ADR)is used as a key quality indicator of sufficient colonoscopy.However,ADR can vary significantly among endoscopists,leading to missed polyps or cancer.Artificial intelligence(AI)has shown promise in improving ADR by assisting in real-time polyp identification or diagnosis.While multiple randomized controlled trials(RCTs)and metanalyses highlight the benefits of AI in increasing detection rates and reducing missed polyps,concerns remain about its real-world applicability,impact on procedure time,and cost-effectiveness.AIM To explore the current status of AI assistance colonoscopy in adenoma detection and improving quality of colonoscopy.METHODS This systematic review followed PRISMA guidelines,both PubMed and Web of Science databases were used for articles search.Metanalyses and systematic reviews that assessed AI's role during colonoscopy.English article only published between January 2000 and January 2025 were included.Articles related to nonadenoma indications were excluded.Data extraction was independently performed by two researchers for accuracy and consistency.RESULTS 22 articles met the inclusion criteria,with significant heterogeneity(I2=28%-91%)observed in multiple studies.The number of studies per metanalysis ranged from 5 to 33,with higher heterogeneity in analyses involving more than 18 RCTs.AI demonstrated improvement in ADR,with an approximate 20%increase across multiple studies.However,its effectiveness in detecting flat or serrated adenomas remains unproven.Endoscopists with low ADR benefit more from AI-colonoscopies,while expert endoscopists outperformed AI in ADR,adenoma miss rate,and the identification of advanced lesions.No significant change in withdrawal time was observed when comparing AI-assisted colonoscopy to conventional endoscopy.CONCLUSION While AI-assisted colonoscopy has been shown to improve procedural quality,particularly for junior endoscopists and those with lower ADR,its performance decreases when compared to expert endoscopists in real-time clinical practice.This is especially evident in non-randomized studies,where AI demonstrates limited real-world benefits despite its benefit in controlled settings.Furthermore,no meta-analyses have specifically examined AI's impact on the learning experience of fellows and residents.Some experts caution that reliance on AI may prevent trainees from developing essential observational skills,potentially leading to less thorough examinations.Further research is needed to determine the actual benefits of AI-colonoscopy,particularly its role in cancer prevention.As technology advances,improved outcomes are expected,especially in detecting small,flat,and lesions at difficult anatomical locations.展开更多
Objective:To investigate the detection rate and sonographic characteristics of color Doppler ultrasound in the diagnosis of papillary thyroid microcarcinoma(PTMC).Methods:A retrospective analysis was conducted on 50 c...Objective:To investigate the detection rate and sonographic characteristics of color Doppler ultrasound in the diagnosis of papillary thyroid microcarcinoma(PTMC).Methods:A retrospective analysis was conducted on 50 cases of PTMC confirmed by postoperative pathology from January 2020 to December 2024,all of which underwent preoperative color Doppler ultrasound examination.The detection rate was calculated,and the two-dimensional ultrasound characteristics and CDFI manifestations were analyzed.Results:Among the 50 cases of PTMC confirmed by pathology,the detection rate of color Doppler ultrasound was 88.00%,and the diagnostic accuracy rate was 96.00%.Two-dimensional ultrasound characteristics:The mean lesion size was(6.83±1.51)mm;42 cases(84.00%)had irregular shapes;45 cases(90.00%)had unclear boundaries;46 cases(92.00%)had hypoechoic lesions;38 cases(76.00%)exhibited microcalcifications;and 40 cases(80.00%)had an aspect ratio≥1.CDFI characteristics:The highest proportion was grade Ⅱ,with 23 cases(46.00%);39 cases(78.00%)had an RI≥0.7,and the average RI value was(0.75±0.06).Conclusion:Color Doppler ultrasound demonstrates a high detection rate for PTMC,with typical features including hypoechogenicity,irregular shape,microcalcifications,and high RI,making it the preferred imaging modality for early clinical diagnosis of PTMC.展开更多
AIMTo define the role of small-bowel transit time in the detection rate of significant small-bowel lesions.METHODSSmall-bowel capsule endoscopy records, prospectively collected from 30 participating centers in the Lom...AIMTo define the role of small-bowel transit time in the detection rate of significant small-bowel lesions.METHODSSmall-bowel capsule endoscopy records, prospectively collected from 30 participating centers in the Lombardy Registry from October 2011 to December 2013, were included in the study if the clinical indication was obscure gastrointestinal bleeding and the capsule reached the cecum. Based on capsule findings, we created two groups: P2 (significant findings) and P0-1 (normal/negligible findings). Groups were compared for age, gender, small-bowel transit time, type of instrument, modality of capsule performance (outpatients vs inpatients), bowel cleanliness, and center volume.RESULTSWe retrieved and scrutinized 1,433 out of 2,295 capsule endoscopy records (62.4%) fulfilling the inclusion criteria. Patients were 67 ± 15 years old, and 815 (57%) were males. In comparison with patients in the P0-1 group, those in the P2 group (n = 776, 54%) were older (P < 0.0001), had a longer small-bowel transit time (P = 0.0015), and were more frequently examined in low-volume centers (P < 0.001). Age and small-bowel transit time were correlated (P < 0.001), with age as the sole independent predictor on multivariable analysis. Findings of the P2 group were artero-venous malformations (54.5%), inflammatory (23.6%) and protruding (10.4%) lesions, and luminal blood (11.5%).CONCLUSIONIn this selected, prospectively collected cohort of small-bowel capsule endoscopy performed for obscure gastrointestinal bleeding, a longer small-bowel transit time was associated with a higher detection rate of significant lesions, along with age and a low center volume, with age serving as an independent predictor.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
BACKGROUND Colonoscopy is considered a valid primary screening tool for colorectal cancer(CRC). The decreasing risk of CRC observed in patients undergoing colonoscopy is correlated with the adenoma detection rate(ADR)...BACKGROUND Colonoscopy is considered a valid primary screening tool for colorectal cancer(CRC). The decreasing risk of CRC observed in patients undergoing colonoscopy is correlated with the adenoma detection rate(ADR). Due to the fact that screening programs usually start from the age of 50, very few data are available on the risk of adenoma between 40 and 49 years. However, the incidence of CRC is increasing in young populations and it is not uncommon in routine practice to detect adenomas or even advanced neoplasia during colonoscopy in patients under 50 years.AIM To compare the ADR and advanced neoplasia detection rate(ANDR) according to age in a large series of patients during routine colonoscopy.METHODS All consecutive patients who were scheduled for colonoscopy were included.Exclusion criteria were as follows: patients scheduled for partial colonoscopy or interventional colonoscopy(for stent insertion or stenosis dilation).Colonoscopies were performed in our unit by a team of 30 gastroenterologists in2016. We determined the ADR and ANDR in each age group in the whole population and in the population with an average risk of CRC(excluding patients with personal or family history of advanced adenoma or cancer).RESULTS6027 colonoscopies were performed in patients with a median age of 57 years(range, 15-96). The ADR and ANDR were 28.6% and 9.7%, respectively, in the whole population. When comparing patients aged 40-44(n = 382) and 45-49 years (n = 515), a strong increase in all parameters from 45 years was observed, with the ADR rising from 9.7% in patients aged 40-44 to 21.2% between 45 and 49(P <0.001) and the ANDR increasing from 3.1% in patients aged 40-44 to 6.4% in those aged 45-49 years(P < 0.03). With regard to patients aged 50-54(n = 849), a statistically significant increase in the ADR and ANDR was not observed between patients aged 45-49 and those aged 50-54 years. In the population with an average risk of CRC, the ADR and ANDR were still significantly higher in patients aged 45-49 compared with those aged 40-44 years.CONCLUSION This study shows a significant two-fold increase in the ADR and ANDR in patients aged 45 years and over.展开更多
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
AIM To investigate changes in polyp detection throughout fellowship training, and estimate colonoscopy volume required to achieve the adenoma detection rate(ADRs) and polyp detection rate(PDRs) of attending gastroente...AIM To investigate changes in polyp detection throughout fellowship training, and estimate colonoscopy volume required to achieve the adenoma detection rate(ADRs) and polyp detection rate(PDRs) of attending gastroenterologists.METHODS We reviewed colonoscopies from July 1, 2009 to June 30, 2014. Fellows' procedural logs were used to retrieve colonoscopy procedural volumes, and these were treated as the time variable. Findings from screening colonoscopies were used to calculate colonoscopy outcomes for each fellow for the prior 50 colonoscopies at each time point. ADR and PDR were plotted against colonoscopy procedural volumes to produce individual longitudinal graphs. Repeated measures linear mixed effects models were used to study the change of ADR and PDR with increasing procedural volume.RESULTS During the study period, 12 fellows completed full three years of training and were included in the analysis. The average ADR and PDR were, respectively, 31.5% and 41.9% for all fellows, and 28.9% and 38.2% for attendings alone. There was a statistically significant increase in ADR with increasing procedural volume(1.8%/100 colonoscopies, P = 0.002). Similarly, PDR increased 2.8%/100 colonoscopies(P = 0.0001), while there was no significant change in advanced ADR(0.04%/100 colonoscopies, P = 0.92). The ADR increase was limited to the right side of the colon, while the PDR increased in both the right and left colon. The adenoma per colon and polyp per colon also increased throughout training. Fellows reached the attendings' ADR and PDR after 265 and 292 colonoscopies, respectively.CONCLUSION We found that the ADR and PDR increase with increasing colonoscopy volume throughout fellowship. Our findings support recent recommendations of ≥ 275 colonoscopies for colonoscopy credentialing.展开更多
In recent decades,many software reliability growth models（SRGMs） have been proposed for the engineers and testers in measuring the software reliability precisely.Most of them is established based on the non-homogene...In recent decades,many software reliability growth models（SRGMs） have been proposed for the engineers and testers in measuring the software reliability precisely.Most of them is established based on the non-homogeneous Poisson process（NHPP）,and it is proved that the prediction accuracy of such models could be improved by adding the describing of characterization of testing effort.However,some research work indicates that the fault detection rate（FDR） is another key factor affects final software quality.Most early NHPPbased models deal with the FDR as constant or piecewise function,which does not fit the different testing stages well.Thus,this paper first incorporates a multivariate function of FDR,which is bathtub-shaped,into the NHPP-based SRGMs considering testing effort in order to further improve performance.A new model framework is proposed,and a stepwise method is used to apply the framework with real data sets to find the optimal model.Experimental studies show that the obtained new model can provide better performance of fitting and prediction compared with other traditional SRGMs.展开更多
AIM To investigated the association between adenoma detection rate(ADR) and sessile serrated ADR(SSADR) and significant predictors for sessile serrated adenomas(SSA) detection.METHODS This study is a retrospective, si...AIM To investigated the association between adenoma detection rate(ADR) and sessile serrated ADR(SSADR) and significant predictors for sessile serrated adenomas(SSA) detection.METHODS This study is a retrospective, single-center analysis. Total colonoscopies performed by the gastroenterologists at the University of Tokyo Hospital between January and December 2014 were retrospectively identified. Polyps were classified as low-grade or high-grade adenoma, cancer, SSA, or SSA with cytological dysplasia, and the prevalence of each type of polyp was investigated. Predictors of adenoma and SSA detection were examined using logistic generalized estimating equation models. The association between ADR and SSADR for each gastroenterologist was investigated by calculating a correlation coefficient weighted by the number of each gastroenterologist's examination.RESULTS A total of 3691 colonoscopies performed by 35 gastroenterologists were assessed. Overall, 978 (26.5%) low-and 84 (2.2%) high-grade adenomas, 81 (2.2%) cancers, 66 (1.8%) SSAs, and 2 (0.1%) SSAs with cytological dysplasia were detected. Overall ADR was 29.5%(men 33.2%, women 23.8%) and overall SSADR was 1.8%(men 1.7%, women 2.1%). In addition, 672 low-grade adenomas (68.8% of all the detected lowgrade adenomas), 58 (69.9%) high-grade adenomas, 29 (34.5%) cancers, 52 (78.8%) SSAs, and 2 (100%) SSAs with cytological dysplasia were found in the proximal colon. Adenoma detection was the only significant predictor of SSA detection (adjusted OR: 2.53, 95%CI: 1.53-4.20; P < 0.001). The correlation coefficient between ADR and SSADR weighted by the number of each gastroenterologist's examinations was 0.606(P < 0.001).CONCLUSION Our results demonstrated that ADR is correlated to SSADR. In addition, patients with adenomas had a higher prevalence of SSAs than those without adenomas.展开更多
To determine the effect of sedation with propofol on adenoma detection rate (ADR) and cecal intubation rates (CIR) in average risk screening colonoscopies compared to moderate sedation. METHODSWe conducted a retrospec...To determine the effect of sedation with propofol on adenoma detection rate (ADR) and cecal intubation rates (CIR) in average risk screening colonoscopies compared to moderate sedation. METHODSWe conducted a retrospective chart review of 2604 first-time average risk screening colonoscopies performed at MD Anderson Cancer Center from 2010-2013. ADR and CIR were calculated in each sedation group. Multivariable regression analysis was performed to adjust for potential confounders of age and body mass index (BMI). RESULTSOne-third of the exams were done with propofol (n = 874). Overall ADR in the propofol group was significantly higher than moderate sedation (46.3% vs 41.2%, P = 0.01). After adjustment for age and BMI differences, ADR was similar between the groups. CIR was 99% for all exams. The mean cecal insertion time was shorter among propofol patients (6.9 min vs 8.2 min; P < 0.0001). CONCLUSIONDeep sedation with propofol for screening colonoscopy did not significantly improve ADR or CIR in our population of average risk patients. While propofol may allow for safer sedation in certain patients (e.g., with sleep apnea), the overall effect on colonoscopy quality metrics is not significant. Given its increased cost, propofol should be used judiciously and without the implicit expectation of a higher quality screening exam.展开更多
AIM To assess the interendoscopist variability in the detection of colorectal polyps according to their location and histological type.METHODS This study was a retrospective analysis of prospectively collected data fr...AIM To assess the interendoscopist variability in the detection of colorectal polyps according to their location and histological type.METHODS This study was a retrospective analysis of prospectively collected data from a regional colorectal cancer(CRC) screening program; 2979 complete colonoscopies from 18 endoscopists were included. Variability in performance between endoscopists for detection of at least one adenoma(A), one proximal adenoma(PA), one distal adenoma(DA), and one proximal serrated polyp(PSP) was assessed by using multilevel logistic regression models.RESULTS The observed detection rates among the 18 endoscopists ranged from 24.6% to 47.6%(mean = 35.7%) for A, from 19.1% to 39.0%(mean = 29.4%) for DA, from 6.0% to 22.9%(mean = 12.4%) for PA, and from 1.3% to 19.3%(mean = 6.9%) for PSP.After adjusting for patient-level variables(sex, age), the interendoscopist detection rates variability achieved a significant level for A, PA, and PSP but not for DA(P = 0.03, P = 0.02, P = 0.02 and P = 0.08, respectively). This heterogeneity, as measured by the variance partition coefficient, was approximately threefold higher for PA(6.6%) compared with A(2.1%), and twofold higher for PSP(12.3%) compared with PA.CONCLUSION These results demonstrate significant interendoscopist variability for proximal polyp particularly for serrated p o l y p s, b u t n o t f o r d i s t a l a d e n o m a d e t e c t i o n. These findings contribute to explain the decreased effectiveness of complete colonoscopies at preventing proximal CRCs and the need to carefully assess the proximal colon during scope procedure.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
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
This paper focuses on the fast rate fault detection filter (FDF) problem for a class of multirate sampled-data (MSD) systems. A lifting technique is used to convert such an MSD system into a linear time-invariant disc...This paper focuses on the fast rate fault detection filter (FDF) problem for a class of multirate sampled-data (MSD) systems. A lifting technique is used to convert such an MSD system into a linear time-invariant discrete-time one and an unknown input observer (UIO) is considered as FDF to generate residual. The design of FDF is formulated as an H∞ optimization problem and a solvable condition as well as an optimal solution are derived. The causality of the residual generator can be guaranteed so that the fast rate residual can be implemented via inverse lifting. A numerical example is included to demonstrate the feasibility of the obtained results.展开更多
AIM: To retrospectively compare previous-day vs splitdose preparation in terms of bowel cleanliness and polyp detection in patients referred for polypectomy. METHODS: Fifty patients underwent two colonoscopies: one di...AIM: To retrospectively compare previous-day vs splitdose preparation in terms of bowel cleanliness and polyp detection in patients referred for polypectomy. METHODS: Fifty patients underwent two colonoscopies: one diagnostic in a private clinic and a second for polypectomy in a University Hospital. The latter procedures were performed within 12 wk of the index ones. Examinations were accomplished by two experienced endoscopists, different in each facility. Twenty-seven patients underwent screening/surveillance colonoscopy, while the rest were symptomatic. Previous day bowel preparation was utilized initially and splitdose for polypectomy. Colon cleansing was evaluated using the Aronchick scale. We measured the number of detected polyps, and the polyp miss rates per-polyp.RESULTS: Excellent/good preparation was reported in 38 cases with previous-day preparation(76%) vs 46 with split-dose(92%), respectively(P = 0.03). One hundred and twenty-six polyps were detected initially and 169 subsequently(P < 0.0001); 88 vs 126 polyps were diminutive(P < 0.0001), 25 vs 29 small(P = 0.048) and 13 vs 14 equal or larger than 10 mm. The miss rates for total, diminutive, small and large polyps were 25.4%, 30.1%, 13.7% and 6.6%, respectively. Multivariate analysis revealed that split-dose preparation was significantly associated(OR, P) with increased number of polyps detected overall(0.869, P < 0.001), in the right(0.418, P = 0.008) and in the left colon(0.452, P = 0.02). CONCLUSION: Split-dose preparation improved colon cleansing, enhanced polyp detection and unmasked significant polyp miss rates.展开更多
To investigate whether adenoma and polyp detection rates (ADR and PDR, respectively) in screening colonoscopies performed in the presence of fellows differ from those performed by attending physicians alone. METHODSWe...To investigate whether adenoma and polyp detection rates (ADR and PDR, respectively) in screening colonoscopies performed in the presence of fellows differ from those performed by attending physicians alone. METHODSWe performed a retrospective review of all patients who underwent a screening colonoscopy at Grady Memorial Hospital between July 1, 2009 and June 30, 2015. Patients with a history of colon polyps or cancer and those with poor colon preparation or failed cecal intubation were excluded from the analysis. Associations of fellowship training level with the ADR and PDR relative to attendings alone were assessed using unconditional multivariable logistic regression. Models were adjusted for sex, age, race, and colon preparation quality. RESULTSA total of 7503 colonoscopies met the inclusion criteria and were included in the analysis. The mean age of the study patients was 58.2 years; 63.1% were women and 88.2% were African American. The ADR was higher in the fellow participation group overall compared to that in the attending group: 34.5% vs 30.7% (P = 0.001), and for third year fellows it was 35.4% vs 30.7% (aOR = 1.23, 95%CI: 1.09-1.39). The higher ADR in the fellow participation group was evident for both the right and left side of the colon. For the PDR the corresponding figures were 44.5% vs 40.1% (P = 0.0003) and 45.7% vs 40.1% (aOR = 1.25, 95%CI: 1.12-1.41). The ADR and PDR increased with increasing fellow training level (P for trend < 0.05). CONCLUSIONThere is a stepwise increase in ADR and PDR across the years of gastroenterology training. Fellow participation is associated with higher adenoma and polyp detection.展开更多
文摘BACKGROUND Sessile serrated lesions(SSLs)are premalignant polyps implicated in up to 30%of colorectal cancers.Australia reports high SSL detection rates(SSL-DRs),yet with marked variability(3.1%-24%).This substantial variation raises concerns about missed lesions and post-colonoscopy colorectal cancer.This study investigates determinants associated with SSL-DR variation in regional Australia.AIM To study how patient,clinical,and colonoscopy factors are associated with SSL detection in a regional Australian practice.We aimed to contribute high-detection data to the literature by analyzing the association of SSL detection with various determinants.METHODS This retrospective,cross-sectional analysis examined 1450 colonoscopies performed at Port Macquarie Gastroenterology during 2023.Sigmoidoscopies and repeat procedures were excluded.Multivariate logistic regression analyzed associations between SSL detection and patient demographics,clinical indications,procedural factors,and comorbidities.RESULTS The overall SSL-DR was 30.7%.Multivariate analysis identified several independent predictors:Clinical indication,bowel preparation quality,inflammatory bowel disease status,and serrated polyposis syndrome.The faecal occult blood test positive(FOBT)(+)cohort showed the highest predicted SSL detection probability(39.8%),while clinical symptoms showed the lowest(22.3%).After adjustment,SSL detection odds were 2.3 times greater among FOBT(+)patients than those with clinical symptoms(adjusted odds ratio=2.30,95%confidence interval:1.20-4.40,P=0.004).CONCLUSION SSL-DR as a quality indicator requires contextualization regarding clinical indications,bowel preparation quality,and comorbidities.There was a significantly higher prevalence of SSLs in FOBT(+)patients.Despite comprehensive adjustment,this study cannot fully explain the wide SSL-DR variation in Australia,highlighting the need for standardized detection protocols and further research to ensure optimal cancer prevention outcomes.
文摘A recent study by Nishizawa et al presented significant findings regarding the advantages of next-generation colonoscopes,specifically the CF-XZ1200 and CFEZ1500 models,in enhancing the adenoma and sessile serrated lesion detection rates.As colorectal cancer remains a leading cause of cancer-related mortality globally,the implications of improved detection rates are substantial.This letter advocated the adoption of advanced colonoscopy technology,emphasizing the robust methodology of the study,including propensity score matching,which enhanced the validity of its conclusions.Notable improvements in image quality,facilitated by innovations such as 4 K resolution and texture enhancement imaging,enable endoscopists to identify even the smallest lesions,ultimately leading to improved patient outcomes.Given the compelling evidence presented,it is imperative for healthcare institutions to prioritize the integration of these advanced scopes into routine practice to enhance screening efficacy and reduce the burden of colorectal cancer.
基金Supported by the Young and Middle-Aged Talents Program of Wuxi Health Commission,No.BJ2020011Cohort Research Program of Wuxi Medical Center,Nanjing Medical University,No.WMCC202314Wuxi People’s Hospital 2024“Wild Goose Array Talent”Reserve Discipline Leader,No.2024-YZ-HBDTR-YC-2024.
文摘BACKGROUND Adenoma detection rate(ADR),a key colonoscopy quality metric,varies with patient demographics and procedural factors.AIM To identify independent predictors of≥25%ADR,develop a risk model,and propose withdrawal durations based on different insertion times.METHODS We retrospectively analyzed 830 cases using logistic regression and identified four key factors,validated in a prospective cohort of 5699 patients.Their importance was confirmed using random forest(RF),extreme gradient boosting(XGBoost)and light gradient boosting machine(LightGBM).Attempts to determine targetachieving withdrawal time by grouping cases based on insertion time and Cox regression were inconclusive.Using the 5699-case dataset,we developed a predictive model combining support vector machine(SVM)with XGBoost.We built a Shiny app using this model for clinical application.RESULTS Multivariate logistic regression identified age[odds ratio(OR)=1.05;95%confidence interval(CI):1.03-1.08;P<0.001],male(OR=1.79;95%CI:1.32-2.41;P=0.005),higher endoscopist experience(OR=1.79;95%CI:1.20-2.68;P=0.005),and longer withdrawal time(P<0.001)as independent risk factors for colorectal adenoma.A nomogram demonstrated strong discrimination[area under the curve(AUC)=0.720],with robust calibration and decision-curve performance.Feature importance via RF,XGBoost,and LightGBM confirmed key predictors.A hybrid model combining SVM regression for withdrawal-time estimation and XGBoost classification achieved stable results,with XGBoost reporting AUCs of 0.640 in training and 0.610 in testing,and similar validation outcomes.Deployed via a Shiny app for clinical use.However,model discrimination was modest(AUC:0.61-0.64),suggesting that clinical utility requires further refinement.CONCLUSION A hybrid SVM-XGBoost model using four key endoscopic factors was independently validated and is available as a Shiny app,delivering real-time decision support to streamline endoscopy and enhance clinical outcomes.
文摘Screening colonoscopy with adenoma removal is the gold standard strategy to reduce colorectal cancer(CRC)incidence.Nevertheless,it remains an imperfect tool as nearly Twenty-five percent of adenomas can be missed during inspection by experienced endoscopists.Missed lesions are one of the primary reasons for post colonoscopy CRC and are associated with a significant variability in adenoma detection rate(ADR),which is the most important quality indicator for colonoscopy.Increasing ADR unquestionably decreases carcinoma miss rate.Simple measures to improve ADR include among others slower withdrawal time and position change.The introduction of optical imaging innovations has improved mucosal visualization.Moreover,auxiliary devices attached to the colonoscope tip have been introduced,aiming to improve lumen visualization by flattening the folds and revealing lesions hidden in blind spots,thereby increasing ADR.Digital image analysis using artificial intelligence is the latest approach to polyp detection.All of the above approaches have been separately evaluated concerning their effect in ADR;however,it has not been thoroughly investigated whether any benefit exists from their combined use.We aim to review the available data on the efficacy of each technique/technology and whether their combination offers any additional benefit while remaining cost-effective.
文摘BACKGROUND Colorectal cancer(CRC)can be prevented by screening and early detection.Colonoscopy is used for screening,and adenoma detection rate(ADR)is used as a key quality indicator of sufficient colonoscopy.However,ADR can vary significantly among endoscopists,leading to missed polyps or cancer.Artificial intelligence(AI)has shown promise in improving ADR by assisting in real-time polyp identification or diagnosis.While multiple randomized controlled trials(RCTs)and metanalyses highlight the benefits of AI in increasing detection rates and reducing missed polyps,concerns remain about its real-world applicability,impact on procedure time,and cost-effectiveness.AIM To explore the current status of AI assistance colonoscopy in adenoma detection and improving quality of colonoscopy.METHODS This systematic review followed PRISMA guidelines,both PubMed and Web of Science databases were used for articles search.Metanalyses and systematic reviews that assessed AI's role during colonoscopy.English article only published between January 2000 and January 2025 were included.Articles related to nonadenoma indications were excluded.Data extraction was independently performed by two researchers for accuracy and consistency.RESULTS 22 articles met the inclusion criteria,with significant heterogeneity(I2=28%-91%)observed in multiple studies.The number of studies per metanalysis ranged from 5 to 33,with higher heterogeneity in analyses involving more than 18 RCTs.AI demonstrated improvement in ADR,with an approximate 20%increase across multiple studies.However,its effectiveness in detecting flat or serrated adenomas remains unproven.Endoscopists with low ADR benefit more from AI-colonoscopies,while expert endoscopists outperformed AI in ADR,adenoma miss rate,and the identification of advanced lesions.No significant change in withdrawal time was observed when comparing AI-assisted colonoscopy to conventional endoscopy.CONCLUSION While AI-assisted colonoscopy has been shown to improve procedural quality,particularly for junior endoscopists and those with lower ADR,its performance decreases when compared to expert endoscopists in real-time clinical practice.This is especially evident in non-randomized studies,where AI demonstrates limited real-world benefits despite its benefit in controlled settings.Furthermore,no meta-analyses have specifically examined AI's impact on the learning experience of fellows and residents.Some experts caution that reliance on AI may prevent trainees from developing essential observational skills,potentially leading to less thorough examinations.Further research is needed to determine the actual benefits of AI-colonoscopy,particularly its role in cancer prevention.As technology advances,improved outcomes are expected,especially in detecting small,flat,and lesions at difficult anatomical locations.
文摘Objective:To investigate the detection rate and sonographic characteristics of color Doppler ultrasound in the diagnosis of papillary thyroid microcarcinoma(PTMC).Methods:A retrospective analysis was conducted on 50 cases of PTMC confirmed by postoperative pathology from January 2020 to December 2024,all of which underwent preoperative color Doppler ultrasound examination.The detection rate was calculated,and the two-dimensional ultrasound characteristics and CDFI manifestations were analyzed.Results:Among the 50 cases of PTMC confirmed by pathology,the detection rate of color Doppler ultrasound was 88.00%,and the diagnostic accuracy rate was 96.00%.Two-dimensional ultrasound characteristics:The mean lesion size was(6.83±1.51)mm;42 cases(84.00%)had irregular shapes;45 cases(90.00%)had unclear boundaries;46 cases(92.00%)had hypoechoic lesions;38 cases(76.00%)exhibited microcalcifications;and 40 cases(80.00%)had an aspect ratio≥1.CDFI characteristics:The highest proportion was grade Ⅱ,with 23 cases(46.00%);39 cases(78.00%)had an RI≥0.7,and the average RI value was(0.75±0.06).Conclusion:Color Doppler ultrasound demonstrates a high detection rate for PTMC,with typical features including hypoechogenicity,irregular shape,microcalcifications,and high RI,making it the preferred imaging modality for early clinical diagnosis of PTMC.
文摘AIMTo define the role of small-bowel transit time in the detection rate of significant small-bowel lesions.METHODSSmall-bowel capsule endoscopy records, prospectively collected from 30 participating centers in the Lombardy Registry from October 2011 to December 2013, were included in the study if the clinical indication was obscure gastrointestinal bleeding and the capsule reached the cecum. Based on capsule findings, we created two groups: P2 (significant findings) and P0-1 (normal/negligible findings). Groups were compared for age, gender, small-bowel transit time, type of instrument, modality of capsule performance (outpatients vs inpatients), bowel cleanliness, and center volume.RESULTSWe retrieved and scrutinized 1,433 out of 2,295 capsule endoscopy records (62.4%) fulfilling the inclusion criteria. Patients were 67 ± 15 years old, and 815 (57%) were males. In comparison with patients in the P0-1 group, those in the P2 group (n = 776, 54%) were older (P < 0.0001), had a longer small-bowel transit time (P = 0.0015), and were more frequently examined in low-volume centers (P < 0.001). Age and small-bowel transit time were correlated (P < 0.001), with age as the sole independent predictor on multivariable analysis. Findings of the P2 group were artero-venous malformations (54.5%), inflammatory (23.6%) and protruding (10.4%) lesions, and luminal blood (11.5%).CONCLUSIONIn this selected, prospectively collected cohort of small-bowel capsule endoscopy performed for obscure gastrointestinal bleeding, a longer small-bowel transit time was associated with a higher detection rate of significant lesions, along with age and a low center volume, with age serving as an independent predictor.
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.
文摘BACKGROUND Colonoscopy is considered a valid primary screening tool for colorectal cancer(CRC). The decreasing risk of CRC observed in patients undergoing colonoscopy is correlated with the adenoma detection rate(ADR). Due to the fact that screening programs usually start from the age of 50, very few data are available on the risk of adenoma between 40 and 49 years. However, the incidence of CRC is increasing in young populations and it is not uncommon in routine practice to detect adenomas or even advanced neoplasia during colonoscopy in patients under 50 years.AIM To compare the ADR and advanced neoplasia detection rate(ANDR) according to age in a large series of patients during routine colonoscopy.METHODS All consecutive patients who were scheduled for colonoscopy were included.Exclusion criteria were as follows: patients scheduled for partial colonoscopy or interventional colonoscopy(for stent insertion or stenosis dilation).Colonoscopies were performed in our unit by a team of 30 gastroenterologists in2016. We determined the ADR and ANDR in each age group in the whole population and in the population with an average risk of CRC(excluding patients with personal or family history of advanced adenoma or cancer).RESULTS6027 colonoscopies were performed in patients with a median age of 57 years(range, 15-96). The ADR and ANDR were 28.6% and 9.7%, respectively, in the whole population. When comparing patients aged 40-44(n = 382) and 45-49 years (n = 515), a strong increase in all parameters from 45 years was observed, with the ADR rising from 9.7% in patients aged 40-44 to 21.2% between 45 and 49(P <0.001) and the ANDR increasing from 3.1% in patients aged 40-44 to 6.4% in those aged 45-49 years(P < 0.03). With regard to patients aged 50-54(n = 849), a statistically significant increase in the ADR and ANDR was not observed between patients aged 45-49 and those aged 50-54 years. In the population with an average risk of CRC, the ADR and ANDR were still significantly higher in patients aged 45-49 compared with those aged 40-44 years.CONCLUSION This study shows a significant two-fold increase in the ADR and ANDR in patients aged 45 years and over.
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?
基金Supported by(in part) National Center for Advancing Translational Sciences of the National Institutes of Health,No.UL1TR000454
文摘AIM To investigate changes in polyp detection throughout fellowship training, and estimate colonoscopy volume required to achieve the adenoma detection rate(ADRs) and polyp detection rate(PDRs) of attending gastroenterologists.METHODS We reviewed colonoscopies from July 1, 2009 to June 30, 2014. Fellows' procedural logs were used to retrieve colonoscopy procedural volumes, and these were treated as the time variable. Findings from screening colonoscopies were used to calculate colonoscopy outcomes for each fellow for the prior 50 colonoscopies at each time point. ADR and PDR were plotted against colonoscopy procedural volumes to produce individual longitudinal graphs. Repeated measures linear mixed effects models were used to study the change of ADR and PDR with increasing procedural volume.RESULTS During the study period, 12 fellows completed full three years of training and were included in the analysis. The average ADR and PDR were, respectively, 31.5% and 41.9% for all fellows, and 28.9% and 38.2% for attendings alone. There was a statistically significant increase in ADR with increasing procedural volume(1.8%/100 colonoscopies, P = 0.002). Similarly, PDR increased 2.8%/100 colonoscopies(P = 0.0001), while there was no significant change in advanced ADR(0.04%/100 colonoscopies, P = 0.92). The ADR increase was limited to the right side of the colon, while the PDR increased in both the right and left colon. The adenoma per colon and polyp per colon also increased throughout training. Fellows reached the attendings' ADR and PDR after 265 and 292 colonoscopies, respectively.CONCLUSION We found that the ADR and PDR increase with increasing colonoscopy volume throughout fellowship. Our findings support recent recommendations of ≥ 275 colonoscopies for colonoscopy credentialing.
基金supported by the National Natural Science Foundation of China(61070220)the Anhui Provincial Natural Science Foundation(1408085MKL79)
文摘In recent decades,many software reliability growth models（SRGMs） have been proposed for the engineers and testers in measuring the software reliability precisely.Most of them is established based on the non-homogeneous Poisson process（NHPP）,and it is proved that the prediction accuracy of such models could be improved by adding the describing of characterization of testing effort.However,some research work indicates that the fault detection rate（FDR） is another key factor affects final software quality.Most early NHPPbased models deal with the FDR as constant or piecewise function,which does not fit the different testing stages well.Thus,this paper first incorporates a multivariate function of FDR,which is bathtub-shaped,into the NHPP-based SRGMs considering testing effort in order to further improve performance.A new model framework is proposed,and a stepwise method is used to apply the framework with real data sets to find the optimal model.Experimental studies show that the obtained new model can provide better performance of fitting and prediction compared with other traditional SRGMs.
文摘AIM To investigated the association between adenoma detection rate(ADR) and sessile serrated ADR(SSADR) and significant predictors for sessile serrated adenomas(SSA) detection.METHODS This study is a retrospective, single-center analysis. Total colonoscopies performed by the gastroenterologists at the University of Tokyo Hospital between January and December 2014 were retrospectively identified. Polyps were classified as low-grade or high-grade adenoma, cancer, SSA, or SSA with cytological dysplasia, and the prevalence of each type of polyp was investigated. Predictors of adenoma and SSA detection were examined using logistic generalized estimating equation models. The association between ADR and SSADR for each gastroenterologist was investigated by calculating a correlation coefficient weighted by the number of each gastroenterologist's examination.RESULTS A total of 3691 colonoscopies performed by 35 gastroenterologists were assessed. Overall, 978 (26.5%) low-and 84 (2.2%) high-grade adenomas, 81 (2.2%) cancers, 66 (1.8%) SSAs, and 2 (0.1%) SSAs with cytological dysplasia were detected. Overall ADR was 29.5%(men 33.2%, women 23.8%) and overall SSADR was 1.8%(men 1.7%, women 2.1%). In addition, 672 low-grade adenomas (68.8% of all the detected lowgrade adenomas), 58 (69.9%) high-grade adenomas, 29 (34.5%) cancers, 52 (78.8%) SSAs, and 2 (100%) SSAs with cytological dysplasia were found in the proximal colon. Adenoma detection was the only significant predictor of SSA detection (adjusted OR: 2.53, 95%CI: 1.53-4.20; P < 0.001). The correlation coefficient between ADR and SSADR weighted by the number of each gastroenterologist's examinations was 0.606(P < 0.001).CONCLUSION Our results demonstrated that ADR is correlated to SSADR. In addition, patients with adenomas had a higher prevalence of SSAs than those without adenomas.
基金Supported by the National Cancer Institute of the National Institutes of Health(in part),No.K07CA160753 to Pande M
文摘To determine the effect of sedation with propofol on adenoma detection rate (ADR) and cecal intubation rates (CIR) in average risk screening colonoscopies compared to moderate sedation. METHODSWe conducted a retrospective chart review of 2604 first-time average risk screening colonoscopies performed at MD Anderson Cancer Center from 2010-2013. ADR and CIR were calculated in each sedation group. Multivariable regression analysis was performed to adjust for potential confounders of age and body mass index (BMI). RESULTSOne-third of the exams were done with propofol (n = 874). Overall ADR in the propofol group was significantly higher than moderate sedation (46.3% vs 41.2%, P = 0.01). After adjustment for age and BMI differences, ADR was similar between the groups. CIR was 99% for all exams. The mean cecal insertion time was shorter among propofol patients (6.9 min vs 8.2 min; P < 0.0001). CONCLUSIONDeep sedation with propofol for screening colonoscopy did not significantly improve ADR or CIR in our population of average risk patients. While propofol may allow for safer sedation in certain patients (e.g., with sleep apnea), the overall effect on colonoscopy quality metrics is not significant. Given its increased cost, propofol should be used judiciously and without the implicit expectation of a higher quality screening exam.
文摘AIM To assess the interendoscopist variability in the detection of colorectal polyps according to their location and histological type.METHODS This study was a retrospective analysis of prospectively collected data from a regional colorectal cancer(CRC) screening program; 2979 complete colonoscopies from 18 endoscopists were included. Variability in performance between endoscopists for detection of at least one adenoma(A), one proximal adenoma(PA), one distal adenoma(DA), and one proximal serrated polyp(PSP) was assessed by using multilevel logistic regression models.RESULTS The observed detection rates among the 18 endoscopists ranged from 24.6% to 47.6%(mean = 35.7%) for A, from 19.1% to 39.0%(mean = 29.4%) for DA, from 6.0% to 22.9%(mean = 12.4%) for PA, and from 1.3% to 19.3%(mean = 6.9%) for PSP.After adjusting for patient-level variables(sex, age), the interendoscopist detection rates variability achieved a significant level for A, PA, and PSP but not for DA(P = 0.03, P = 0.02, P = 0.02 and P = 0.08, respectively). This heterogeneity, as measured by the variance partition coefficient, was approximately threefold higher for PA(6.6%) compared with A(2.1%), and twofold higher for PSP(12.3%) compared with PA.CONCLUSION These results demonstrate significant interendoscopist variability for proximal polyp particularly for serrated p o l y p s, b u t n o t f o r d i s t a l a d e n o m a d e t e c t i o n. These findings contribute to explain the decreased effectiveness of complete colonoscopies at preventing proximal CRCs and the need to carefully assess the proximal colon during scope procedure.
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.
基金Supported by National Natural Science Foundation of P. R. China (60374021)the Natural Science Foundation of Shandong Province (Y2002G05)the Youth Scientists Foundation of Shandong Province (03BS091, 05BS01007) and Education Ministry Foundation of P. R. China (20050422036)
文摘This paper focuses on the fast rate fault detection filter (FDF) problem for a class of multirate sampled-data (MSD) systems. A lifting technique is used to convert such an MSD system into a linear time-invariant discrete-time one and an unknown input observer (UIO) is considered as FDF to generate residual. The design of FDF is formulated as an H∞ optimization problem and a solvable condition as well as an optimal solution are derived. The causality of the residual generator can be guaranteed so that the fast rate residual can be implemented via inverse lifting. A numerical example is included to demonstrate the feasibility of the obtained results.
文摘AIM: To retrospectively compare previous-day vs splitdose preparation in terms of bowel cleanliness and polyp detection in patients referred for polypectomy. METHODS: Fifty patients underwent two colonoscopies: one diagnostic in a private clinic and a second for polypectomy in a University Hospital. The latter procedures were performed within 12 wk of the index ones. Examinations were accomplished by two experienced endoscopists, different in each facility. Twenty-seven patients underwent screening/surveillance colonoscopy, while the rest were symptomatic. Previous day bowel preparation was utilized initially and splitdose for polypectomy. Colon cleansing was evaluated using the Aronchick scale. We measured the number of detected polyps, and the polyp miss rates per-polyp.RESULTS: Excellent/good preparation was reported in 38 cases with previous-day preparation(76%) vs 46 with split-dose(92%), respectively(P = 0.03). One hundred and twenty-six polyps were detected initially and 169 subsequently(P < 0.0001); 88 vs 126 polyps were diminutive(P < 0.0001), 25 vs 29 small(P = 0.048) and 13 vs 14 equal or larger than 10 mm. The miss rates for total, diminutive, small and large polyps were 25.4%, 30.1%, 13.7% and 6.6%, respectively. Multivariate analysis revealed that split-dose preparation was significantly associated(OR, P) with increased number of polyps detected overall(0.869, P < 0.001), in the right(0.418, P = 0.008) and in the left colon(0.452, P = 0.02). CONCLUSION: Split-dose preparation improved colon cleansing, enhanced polyp detection and unmasked significant polyp miss rates.
文摘To investigate whether adenoma and polyp detection rates (ADR and PDR, respectively) in screening colonoscopies performed in the presence of fellows differ from those performed by attending physicians alone. METHODSWe performed a retrospective review of all patients who underwent a screening colonoscopy at Grady Memorial Hospital between July 1, 2009 and June 30, 2015. Patients with a history of colon polyps or cancer and those with poor colon preparation or failed cecal intubation were excluded from the analysis. Associations of fellowship training level with the ADR and PDR relative to attendings alone were assessed using unconditional multivariable logistic regression. Models were adjusted for sex, age, race, and colon preparation quality. RESULTSA total of 7503 colonoscopies met the inclusion criteria and were included in the analysis. The mean age of the study patients was 58.2 years; 63.1% were women and 88.2% were African American. The ADR was higher in the fellow participation group overall compared to that in the attending group: 34.5% vs 30.7% (P = 0.001), and for third year fellows it was 35.4% vs 30.7% (aOR = 1.23, 95%CI: 1.09-1.39). The higher ADR in the fellow participation group was evident for both the right and left side of the colon. For the PDR the corresponding figures were 44.5% vs 40.1% (P = 0.0003) and 45.7% vs 40.1% (aOR = 1.25, 95%CI: 1.12-1.41). The ADR and PDR increased with increasing fellow training level (P for trend < 0.05). CONCLUSIONThere is a stepwise increase in ADR and PDR across the years of gastroenterology training. Fellow participation is associated with higher adenoma and polyp detection.
