The paper presents general description of combined structural system and initial analysis of an innovative system proposed as the main support structure for tall or heavy loaded buildings located on subsoil of very sm...The paper presents general description of combined structural system and initial analysis of an innovative system proposed as the main support structure for tall or heavy loaded buildings located on subsoil of very small load-carrying ability or in earthquake areas. Moreover there is presented also an innovative two-stage method of the approximate calculation of the statically indeterminate trusses. Both are invented by the author by application of the principles of the superposition method.展开更多
Many real⁃world machine learning applications face the challenge of dealing with changing data over time,known as concept drift,and the issue of data indeterminacy,where all the true labels available are unrealistic.T...Many real⁃world machine learning applications face the challenge of dealing with changing data over time,known as concept drift,and the issue of data indeterminacy,where all the true labels available are unrealistic.This can lead to a decrease in the accuracy of the prediction models.The aim of this study is to introduce a new approach for detecting drift,which is based on neutrosophic set theory.This approach takes into account uncertainty in the prediction model and is able to handle indeterminate information,considering its impact on the models performance.The proposed method reads data into windows and calculates a set of values based on the concept of neutrosophic membership.These values are then used in the Neutrosophic Support Vector Machine(N⁃SVM).To address the issue of indeterminate true label data,the values issued by N⁃SVM are expressed as entropy and used as input for the ADWIN(Adaptive Windowing)change detector.When a drift is detected,the prediction model is retrained by including only the most recent instances with the original training data set.The proposed method gives promising results in terms of drift detection accuracy compared to the state of existing drift detection methods such as KSWIN,ADWIN,and DWM.展开更多
HIV-indeterminate Western blotting(WB)results are typically obtained in WB confirmatory assays,and the number of indeterminate samples may increase with the detection of HIV infections,which will present considerable ...HIV-indeterminate Western blotting(WB)results are typically obtained in WB confirmatory assays,and the number of indeterminate samples may increase with the detection of HIV infections,which will present considerable challenges for the management of HIV/AIDS.Nucleic acid detection has been used as a laboratory test for screening suspected or indeterminate samples.However,the effectiveness of these assays for the differential diagnosis of HIV-indeterminate WB samples remained undetermined.In this study,210 subjects with HIV-indeterminate WB results were detected from 6360 positive HIV screening samples between 2015 and 2016 in southeastern China,in which HIV-indeterminate WB results accounted for 3.30%.The highest proportion of indeterminate results was observed in pregnant and lying-in women receiving physical examinations(16.67%),followed by that in voluntary blood donors(8.82%).The most common WB band patterns were p24,gpl60 and p24,and gpl60.The follow-up study revealed that the highest negative and positive conversion rates of HIV antibodies were in samples with a single p24 band(80.28%),and with gpl60 and p24 bands(86.21%),respectively.Among the Env,Gag,and Pol antibodies,samples with a Gag band showed the highest negative conversion rate(81.25%),whereas the highest positive conversion rate was observed in samples with an Env band(56.76%).In addition,quantitative and qualitative HIV nucleic acid testing exhibited the highest sensitivity(96.3%)and specificity(97.85%),respectively.Our results indicate a lower proportion of HIV indeterminate WB results in southeastern China compared to previous reports,and the follow-up re-examination of patients with HIV indeterminate results should be performed.Nucleic acid testing facilitates the identification of HIV infections.展开更多
Due to the need for improvement in the diagnosis and minimally invasive therapy of the bile duct disorders new technologies for cholangioscopy have been recently developed. Per-oral cholangioscopy has become an import...Due to the need for improvement in the diagnosis and minimally invasive therapy of the bile duct disorders new technologies for cholangioscopy have been recently developed. Per-oral cholangioscopy has become an important diagnostic and therapeutic tool leading to avoidance of aggressive and unnecessary surgery in many clinical scenarios. This paper focuses on the newly developed SpyGlass DS technology, its advantages, and the technique of single-operator cholangioscopy(SOC), biliary indications and possible adverse events. We also review the available literature; discuss the limitations and future expectations.Digital SOC(D-SOC) is a useful technique, which provides endoscopic imaging of the biliary tree, optical diagnosis, biopsy under direct vision and therapeutic interventions. The implementations are diagnostic and therapeutic. Diagnostic indications are indeterminate biliary strictures, unclear filling defects, staging of cholangiocarcinoma, staging of ampullary tumors(extension into the common bile duct), unclear bile duct dilation, exploring cystic lesions of the biliary tree,unexplained hemobilia, posttransplant biliary complications. Therapeutic indications are lithotripsy of difficult stones, retrieval of migrated stents, foreign body removal, guide wire placement, transpapillary gallbladder drainage and endoscopic tumor ablative therapy. Most studied and established indications are the diagnosis of indeterminate biliary stricture and intraductal lithotripsy of difficult stones. The adverse events are not different and more common compared to those of Endoscopic retrograde cholangiopancreatography(ERCP)alone. D-SOC is a safe and effective procedure, adjunct to the standard ERCP and the newly available digital technology overcomes many of the limitations of the previous generations of cholangioscopes.展开更多
AIM:To investigate the clinicopathologic parameters of pulmonary metastasis in colorectal cancer(CRC) patients after lung operation of indeterminate pulmonary nodules(IPNs).METHODS:From a prospective database of CRCpa...AIM:To investigate the clinicopathologic parameters of pulmonary metastasis in colorectal cancer(CRC) patients after lung operation of indeterminate pulmonary nodules(IPNs).METHODS:From a prospective database of CRCpatients,40 cases that underwent lung operation between November 2008 and December 2012 for suspicious metastatic pulmonary nodules on chest computed tomography(CT)were enrolled.The decision to perform a lung operation was made if the patient met the following criteria:(1)completely resected or resectable primary CRC;(2)completely resectable IPNs;(3)controlled or controllable extrapulmonary metastasis;and(4)adequate general condition and pulmonary function to tolerate pulmonary operation.Lung operation was performed by a thoracic surgeon without CT-guided biopsy for pathologic confirmation.RESULTS:A total of 40 cases of lung resection was performed in 29 patients.Five patients underwent repeated lung resection.The final pathology result showed metastasis from the CRC in 30 cases(75%)and benign pathology in 10 cases(25%).The primary tumor site was the rectum in 26/30(86.6%)cases with pulmonary metastasis,but only 3/10(30%)cases in the benign group had a primary rectal cancer(P=0.001).Positron emission tomography(PET)-CT was performed for 22/30(73.4%)patients in the lung metastasis group and for 6/10(60.0%)patients in the benign group.PET-CT revealed hot uptake of18fluorine 2-fluoro-2-deoxy-D-glucose with all IPNs in both groups.The group with pulmonary metastasis had a higher incidence of primary rectal cancer(P=0.001),a more advanced tumor stage(P=0.011),and more frequent lymphatic invasion of tumor cells(P=0.005).Six cases with previous liver metastasectomy were present in the lung metastasis group.Serum carcinoembryonic antigen levels before lung operation were not elevated in any of the patients.CONCLUSION:The stage and location of the primary tumor and tumor cell infiltration of lymphatics provide useful indicators for deciding on lung resection of IPNs in CRC.展开更多
Patients with indeterminate colitis(IC) are significantly younger at diagnosis with onset of symptoms before the age of 18 years with significant morbidity in the interim. The successful care of IC is based on microsc...Patients with indeterminate colitis(IC) are significantly younger at diagnosis with onset of symptoms before the age of 18 years with significant morbidity in the interim. The successful care of IC is based on microscopic visual predict precision of eventual ulcerative colitis(UC) or Crohn's colitis(CC) which is not offered in 15%-30% of inflammatory bowel disease(IBD) patients even after a combined state-of-the-art classification system of clinical, visual endoscopic, radiologic and histologic examination. These figures have not changed over the past 3 decades despite the introduction of newer diagnostic modalities. The patient outcomes after restorative proctocolectomy and ileal pouch-anal anastomosis may be painstaking if IC turns into CC. Our approach is aiming at developing a single sensitive and absolute accurate diagnostic test tool during the first clinic visit through endoscopic biopsy derived proteomic patterns. Matrix-assisted-laser desorption/ionization mass spectrometry(MS) and/or imaging MS technologies permit a histology-directed cellular test of endoscopy biopsy which identifies phenotype specific proteins, as biomarker that would assist clinicians more accurately delineate IC as beingeither a UC or CC or a non-IBD condition. These novel studies are underway on larger cohorts and are highly innovative with significances in differentiating a UC from CC in patients with IC and could lend mechanistic insights into IBD pathogenesis.展开更多
AIM:To assess the diagnostic ability of endoscopic ultrasonography(EUS)for evaluating causes of dista biliary strictures shown on endoscopic retrograde chol angiopancreatography(ERCP)or magnetic resonance cholangiopan...AIM:To assess the diagnostic ability of endoscopic ultrasonography(EUS)for evaluating causes of dista biliary strictures shown on endoscopic retrograde chol angiopancreatography(ERCP)or magnetic resonance cholangiopancreatography(MRCP),even without iden tifiable mass on computed tomography(CT). METHODS:The diagnostic ability of EUS was retro spectively analyzed and compared with that of routine cytology(RC)and tumor markers in 34 patients with distal biliary strictures detected by ERCP or MRCP a Dokkyo Medical School Hospital from December 2005 to December 2008,without any adjacent mass or ec centric thickening of the bile duct on CT that could cause biliary strictures.Findings considered as benign strictures on EUS included preservation of the normasonographic layers of the bile duct wall,irrespective of the presence of a mass lesion.Other strictures were considered malignant.Final diagnosis of underlying diseases was made by pathological examination in 18 cases after surgical removal of the samples,and by clinical follow-up for>10 mo in 16 cases. RESULTS:Seventeen patients(50%)were finally di- agnosed with benign conditions,including 6"normal" subjects,while 17 patients(50%)were diagnosed with malignant disease.In terms of diagnostic ability,EUS showed 94.1%sensitivity,82.3%specificity,84.2% positive predictive value,93.3%negative predictive value(NPV)and 88.2%accuracy for identifying ma- lignant and benign strictures.EUS was more sensi- tive than RC(94.1%vs 62.5%,P=0.039).NPV was also better for EUS than for RC(93.3%vs 57.5%,P= 0.035).In addition,EUS provided significantly higher sensitivity than tumor markers using 100 U/mL as the cutoff level of carbohydrate antigen 19-9(94.1%vs 53%,P=0.017).On EUS,biliary stricture that was fi- nally diagnosed as malignant showed as a hypoechoic, irregular mass,with obstruction of the biliary duct and invasion to surrounding tissues. CONCLUSION:EUS can diagnose biliary strictures caused by malignant tumors that are undetectable on CT.Earlier detection by EUS would provide more therapeutic options for patients with early-stage pancreaticobiliary cancer.展开更多
Biliary strictures are considered indeterminate when basic work-up, including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing, are non-diagnostic. Indeterminat...Biliary strictures are considered indeterminate when basic work-up, including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing, are non-diagnostic. Indeterminate biliary strictures can easily be mischaracterized which may dramatically affect patient's outcome. Early and accurate diagnosis of malignancy impacts not only a patient's candidacy for surgery, but also potential timely targeted chemotherapies. A significant portion of patients with indeterminate biliary strictures have benign disease and accurate diagnosis is, thus, paramount to avoid unnecessary surgery. Current sampling strategies have suboptimal accuracy for the diagnosis of malignancy. Emerging data on other diagnostic modalities, such as ancillary cytology techniques, single operator cholangioscopy, and endoscopic ultrasonography-guided fine needle aspiration, revealed promising results with much improved sensitivity.展开更多
In order to solve the problems of excess ovality and cross-section distortion of longitudinally submerged arc welding pipes after forming,a new three-roller continuous setting round process was proposed.This process c...In order to solve the problems of excess ovality and cross-section distortion of longitudinally submerged arc welding pipes after forming,a new three-roller continuous setting round process was proposed.This process can be divided into three stages:loading stage,roll bending stage and unloading stage.Based on the discretization idea,the mechanical model of the primary statically indeterminate problem of the longitudinally submerged arc welding pipes at the roll bending stage was established,and the deformation response was obtained.The simulation and theoretical results show that there are three positive bending regions and three reverse bending regions along the circumference of the pipe.The loading force of each roller shows growth,stability and downward trend with time.The error between the theoretical fitting curve and the simulated data point is very small,and the simulation results verify the reliability of the theoretical calculation.The experimental results show that the residual ovality decreases with the increase of the reduction,and the reduction of the turning point is the optimum reduction.In addition,the residual ovality of the pipe is less than 0.7%without cross-section distortion,which verifies the feasibility of this process.展开更多
There is currently no gold standard test for the diagnosis of inflammatory bowel disease (IBD). Physicians must rely on a number of diagnostic tools including clinical and endoscopic evaluation as well as histologic, ...There is currently no gold standard test for the diagnosis of inflammatory bowel disease (IBD). Physicians must rely on a number of diagnostic tools including clinical and endoscopic evaluation as well as histologic, serologic and radiologic assessment. The real difficulty for physicians in both primary and secondary care is differentiating between patients suffering from functional symptoms and those with true underlying IBD. Alongside this, there is always concern regarding the possibility of a missed, or delayed diagnosis of ulcerative colitis (UC) or Crohn’s disease. Even once the diagnosis of IBD has been made, there is often uncertainty in distinguishing between cases of UC or Crohn’s. As a consequence, in cases of incorrect diagnosis, optimal treatment and management may be adversely affected. Endoscopic evaluation can be uncomfortable and inconvenient for patients. It carries significant risks including perforation and in terms of monetary cost, is expensive. The use of biomarkers to help in the diagnosis and differentiation of IBD has been increasing over time. However, there is not yet one biomarker, which is sensitive of specific enough to be used alone in diagnosing IBD. Current serum testing includes C-reactive protein and erythrocyte sedimentation rate, which are cheap, reliable but non-specific and thus not ideal. Stool based testing such as faecal calprotectin is a much more specific tool and is currently in widespread clinical use. Non-invasive sampling is of the greatest clinical value and with the recent advances in metabolomics, genetics and proteomics, there are now more tools available to develop sensitive and specific biomarkers to diagnose and differentiate between IBD. Many of these new advances are only in early stages of development but show great promise for future clinical use.展开更多
Peroral cholangioscopy(POC) is an important tool for the management of a selected group of biliary diseases. Because of its direct visualization, POC allows targeted diagnostic and therapeutic procedures. POC can be p...Peroral cholangioscopy(POC) is an important tool for the management of a selected group of biliary diseases. Because of its direct visualization, POC allows targeted diagnostic and therapeutic procedures. POC can be performed using a dedicated cholangioscope that is advanced through the accessory channel of a duodenoscope or via the insertion of a small-diameter endoscope directly into the bile duct. POC was first described in the 1970 s, but the use of earlier generation devices was substantially limited by the cumbersome equipment setup and high repair costs. For nearly ten years, several technical improvements, including the single-operator system, high-quality images, the development of dedicated accessories and the increased size of the working channel, have led to increased diagnostic accuracy, thus assisting in the differentiation of benign and malignant intraductal lesions, targeting biopsies and the precise delineation of intraductal tumor spread before surgery. Furthermore, lithotripsy of difficult bile duct stones, ablative therapies for biliary malignancies and direct biliary drainage can be performed under POC control. Recent developments of new types of conventional POCs allow feasible, safe and effective procedures at reasonable costs. In the current review, we provide an updated overview of POC, focusing our attention on the main current clinical applications and on areas for future research.展开更多
BACKGROUND Histological changes after direct-acting antivirals(DAAs)therapy in hepatitis C virus(HCV)patients has not been elucidated.Whether the predominantly progressive,indeterminate and predominately regressive(P-...BACKGROUND Histological changes after direct-acting antivirals(DAAs)therapy in hepatitis C virus(HCV)patients has not been elucidated.Whether the predominantly progressive,indeterminate and predominately regressive(P-I-R)score,evaluating fibrosis activity in hepatitis B virus patients has predictive value in HCV patients has not been investigated.AIM To identify histological changes after DAAs therapy and to evaluate the predictive value of the P-I-R score in HCV patients.METHODS Chronic HCV patients with paired liver biopsy specimens before and after DAAs treatment were included.Sustained virologic response(SVR)was defined as an undetectable serum HCV RNA level at 24 wk after treatment cessation.The Ishak system and P-I-R score were assessed.Inflammation improvement and fibrosis regression were defined as a≥2-points decrease in the histology activity index(HAI)score and a≥1-point decrease in the Ishak fibrosis score,respectively.Fibrosis progression was defined as a≥1-point increase in the Ishak fibrosis score.Histologic improvement was defined as a≥2-points decrease in the HAI score without worsening of the Ishak fibrosis score after DAAs therapy.The P-I-R score was also assessed.“absolutely reversing or advancing”was defined as the same directionality implied by both change in the Ishak score and posttreatment P-I-R score;and“probably reversing or advancing”was defined as only one parameter showing directionality.RESULTS Thirty-eight chronic HCV patients with paired liver biopsy specimens before and after DAAs treatment were included.The mean age of these patients was 40.9±14.6 years and there were 53%(20/38)males.Thirty-four percent(13/38)of patients were cirrhotic.Eighty-two percent(31/38)of patients achieved inflammation improvement.The median HAI score decreased significantly after SVR(pretreatment 7.0 vs posttreatment 2.0,Z=-5.146,P=0.000).Thirty-seven percent(14/38)of patients achieved fibrosis improvement.The median Ishak score decreased significantly after SVR(pretreatment 4.0 vs posttreatment 3.0,Z=-2.354,P=0.019).Eighty-two percent(31/38)of patients showed histological improvement.The P-I-R score was evaluated in 61%(23/38)of patients.The progressive group showed lower platelet(P=0.024)and higher HAI scores(P=0.070)before treatment.In patients with stable Ishak stage after treatment:Progressive injury was seen in 22%(4/18)of patients,33%(6/18)were classified as indeterminate and regressive changes were seen in 44%(8/18)of patients who were judged as probably reversing by the Ishak and P-I-R systems.CONCLUSION Significant improvement of necroinflammation and partial remission of fibrosis in HCV patients occurred shortly after DAAs therapy.The P-I-R score has potential in predicting fibrosis in HCV patients.展开更多
The introduction of wireless capsule endoscopy in 2000 has revolutionized our ability to visualize parts of the small bowel mucosa classically unreached by the conventional endoscope, and since the recent introduction...The introduction of wireless capsule endoscopy in 2000 has revolutionized our ability to visualize parts of the small bowel mucosa classically unreached by the conventional endoscope, and since the recent introduction of colon capsule endoscopy, a promising alternative method has been available for the evaluation of large bowel mucosa. The advantages of wireless capsule endoscopy include its non-invasive character and its ability to visualize proximal and distal parts of the intestine, while important disadvantages include the procedure's inability of tissue sampling and significant incompletion rate. Its greatest limitation is the prohibited use in cases of known or suspected stenosis of the intestinal lumen due to high risk of retention. Wireless capsule endoscopy plays an important role in the early recognition of recurrence, on Crohn's disease patients who have undergone ileocolonic resection for the treatment of Crohn's disease complications, and in patients' management and therapeutic strategy planning, before obvious clinical and laboratory relapse. Although capsule endoscopy cannot replace traditional endoscopy, it offers valuable information on the evaluation of intestinal disease and has a significant impact on disease reclassification of patients with a previous diagnosis of ulcerative colitis or inflammatory bowel disease unclassified/indeterminate colitis. Moreover, it may serve as an effective alternative where colonoscopy is contraindicated and in cases with incomplete colonoscopy studies. The use of patency capsule maximizes safety and is advocated in cases of suspected small or large bowel stenosis.展开更多
Different histopathological manifestations of focal liver lesions show varying common and uncommon imaging findings and some pathologies may show similar appearance despite of different histopathology.It is necessary ...Different histopathological manifestations of focal liver lesions show varying common and uncommon imaging findings and some pathologies may show similar appearance despite of different histopathology.It is necessary to characterise focal liver lesions accurately as not only benign and malignant lesions are managed differently,but also certain benign lesions have differing management.These lesions are increasingly being detected due to rapid growth of use of crosssectional imaging as well as improvement in image quality and new imaging techniques.Contrast enhanced magnetic resonance imaging(MRI)is considered the gold standard technique in characterising focal liver lesions.Addition of gadoxetic acid has been shown to significantly increase diagnostic accuracy in the detection and characterization of liver abnormalities.Classic imaging characteristics of common liver lesions,including their behaviour on gadoxetic acid enhanced MRI,have been described in literature over recent years.It is important to be familiar with the typical aspects of these lesions as well as know the uncommon and overlapping imaging features to reach an accurate diagnosis.In this article,we will review the well-described characteristic imaging findings of common and rare focal liver lesions and present several challenging cases encountered in the clinical setting,namely hepatocellular adenoma,focal nodular hyperplasia,hepatic angiomyolipoma,hepatocellular carcinoma,intrahepatic cholangiocarcinoma,neuroendocrine tumours as well as a pleomorphic liposarcoma of the liver.展开更多
Sheath blight disease (ShB) has a severe impact on the production of rice. ABI3/VP1-like 1(RAVL1) negatively regulated the rice defense mechanism against ShB, however, this regulatorymechanism is not clearly understoo...Sheath blight disease (ShB) has a severe impact on the production of rice. ABI3/VP1-like 1(RAVL1) negatively regulated the rice defense mechanism against ShB, however, this regulatorymechanism is not clearly understood. In this study, we identified that indeterminate domain 3 (IDD3) waspositively regulated by RAVL1. Further, chromatin immunoprecipitation (ChIP) assay, yeast one-hybridassay and transient expression assay indicated a direct binding between RAVL1 and the IDD3 promoterregion. IDD3 was ubiquitously expressed in different tissues and at different stages, and its expressionwas significantly enhanced by Rhizoctonia solani infection. IDD3 exhibited transcription activation activityin yeast and IDD3-GFP was found to be localized in the nucleus. IDD3 mutants exhibited no significantdifferences in response to ShB, while IDD3 overexpressors were more susceptible to ShB compared withwild type (WT) plants. Furthermore, IDD3 repressors were less susceptible to R. solani than WT plants.Interestingly, the expression of brassinosteroid-related genes (D2, D11 and BRI1) was lower in IDD3repressors and higher in IDD3 overexpressors compared with WT. However, the ChIP assay revealedthat IDD3 did not directly bind to the D2 and D11 promoters. Overexpression of IDD3 in BRI1 mutantd61-1 inhibited the activity of IDD3, reducing its susceptibility to ShB compared with IDD3 overexpressorand WT plants, indicating that IDD3 negatively regulated the rice defense mechanism against ShB by activatingthe BR signaling pathway. Thus, our analyses provided information to enhance the understanding of therice defense mechanism against ShB.展开更多
BACKGROUND Magnetic resonance enterography (MRE) and wireless capsule endoscopy (WCE) are equally accepted modalities for noninvasive screening of small bowel involvement (SBI) in children with Crohn’s disease (CD) a...BACKGROUND Magnetic resonance enterography (MRE) and wireless capsule endoscopy (WCE) are equally accepted modalities for noninvasive screening of small bowel involvement (SBI) in children with Crohn’s disease (CD) and indeterminate colitis (IC) albeit there is a paucity of data comparing the two and thereby guiding the clinician in selecting the ideal diagnostic approach. Therefore, the goal of this study is to provide additional evidence for capsule endoscopy role in the evaluation of established Crohn’s disease exacerbation compared to MRE in relation to Pediatric Crohn's Disease Activity Index (PCDAI), and histological indices. AIM To prospectively compare the findings of MRE and WCE and their agreement with PCDAI or histology in children with CD or IC. METHODS Consecutive patients diagnosed with CD and IC were screened for inclusion. After informed consent, patient’s demographic and clinical data was abstracted. The current pediatric disease activity index (PCDAI) and endoscopic findings were included. Patients underwent MRE and WCE including preprocedural patency capsule within a maximum of 7 d of each other. Pathological presence of active small bowel disease in ileal and duodenal biopsies were collected if the endoscopy was performed within 2 mo of the WCE study. Patients who failed to pass the PC were excluded from the study. WCE was read by two different experienced gastroenterologists (Attard TM and Colombo JM) blinded to each other's findings and to the findings on MRE (Mardis NJ). Agreement between WCE reviewers, WCE and MRE findings and concordance between positive PCDAI and SBI based on MRE compared with WCE was computed. RESULTS Forty-five patients were included in the study, 18 withdrew and 27 (20 males and 20 CD), mean age (standard deviation) 13.46 (2.4) years, completed the study protocol. There were no instances of capsule retention. Concordance between gastroenterologist reviewers was excellent for the diagnosis of small intestinal CD with good correlation between the two Lewis scores (r=0.875, P<0.001). Concordance between WCE and MRE was poor (69%). In CD patients, when both MRE and WCE were compared using PCDAI>10 as the standard reference reflecting active small intestinal CD, the sensitivity of MRE and WCE were 100% and 83% respectively and the specificity of MRE and WCE were 57.14% and 78.6%, respectively. If the histology in ileum or/and duodenum was used as the reference for active small bowel involvement, WCE had a higher specificity as compared to MRE (83.3% vs 50%). In patients with Crohn’s disease, those with a positive PCDAI (>10) were more likely to have a positive WCE as compared to those with a negative PCDAI (83% vs 21%;P=0.018). CONCLUSION We suggest that MRE and WCE have a complementary role in the assessment of SBI in CD. WCE detected SBI with a much higher specificity while MRE had a higher sensitivity.展开更多
Flexure-based mechanisms are widely utilized in nano manipulations. The closed-form statics and dynamics modeling is difficult due to the complex topologies, the inevitable compliance of levers, the Hertzian contact i...Flexure-based mechanisms are widely utilized in nano manipulations. The closed-form statics and dynamics modeling is difficult due to the complex topologies, the inevitable compliance of levers, the Hertzian contact interface, etc. This paper presents the closed-form modeling of an XY nano-manipulator consisting of statically indeterminate symmetric(SIS) structures using leaf and circular flexure hinges. Theoretical analysis reveals that the lever’s compliance, the contact stiffness, and the load mass have significant influence on the static and dynamic performances of the system.Experiments are conducted to verify the effectiveness of the established models. If no piezoelectric actuator(PEA) is installed, the influence of the contact stiffness can be eliminated. Experimental results show that the estimation error on the output stiffness and first natural frequency can reach 2% and 1.7%, respectively. If PEAs are installed, the contact stiffness shows up in the models. As no effective method is currently available to measure or estimate the contact stiffness, it is impossible to precisely estimate the performance of the overall system. In this case, the established closed-form models can be utilized to calculate the bounds of the performance. The established closed-form models are widely applicable in the design and optimization of planar flexure-based mechanisms.展开更多
Choledochoscopy,or cholangioscopy,is an endoscopic procedure for direct visualization within the biliary tract for diagnostic or therapeutic purposes.Since its conception in 1879,many variations and improvements are m...Choledochoscopy,or cholangioscopy,is an endoscopic procedure for direct visualization within the biliary tract for diagnostic or therapeutic purposes.Since its conception in 1879,many variations and improvements are made to ensure relevance in diagnosing and managing a range of intrahepatic and extrahepatic biliary pathologies.This ranges from improved visual impression and optical guided biopsies of indeterminate biliary strictures and clinically indistinguishable pathologies to therapeutic uses in stone fragmentation and other ablative therapies.Furthermore,with the evolving understanding of biliary disorders,there are significant innovative ideas and techniques to fill this void,such as nuanced instances of biliary stenting and retrieving migrated ductal stents.With this in mind,we present a review of the current advancements in choledochoscopy with new supporting evidence that further delineates the role of choledochoscopy in various diagnostic and therapeutic interventions,complications,limitations and put forth areas for further study.展开更多
BACKGROUND The clinical and histological features of chronic hepatitis B(CHB)patients who fall into the"grey zone(GZ)"and do not fit into conventional natural phases are unclear.AIM To explore the impact of ...BACKGROUND The clinical and histological features of chronic hepatitis B(CHB)patients who fall into the"grey zone(GZ)"and do not fit into conventional natural phases are unclear.AIM To explore the impact of varying the threshold of alanine aminotransferase(ALT)levels in identifying significant liver injury among GZ patients.METHODS This retrospective analysis involved a cohort of 1617 adult patients diagnosed with CHB who underwent liver biopsy.The clinical phases of CHB patients were determined based on the European Association for the Study of the Liver 2017 Clinical Practice Guidelines.GZ CHB patients were classified into four groups:GZ-A(HBeAg positive,normal ALT levels,and HBV DNA≤10^(7) IU/mL),GZ-B(HBeAg positive,elevated ALT levels,and HBV DNA<10^(4) or>10^(7) IU/mL),GZC(HBeAg negative,normal ALT levels,and HBV DNA≥2000 IU/mL),and GZ-D(HBeAg negative,elevated ALT levels,and HBV DNA≤2000 IU/mL).Significant hepatic injury(SHI)was defined as the presence of notable liver inflammation(≥G2)and/or significant fibrosis(≥S2).RESULTS The results showed that 50.22%of patients were classified as GZ,and 63.7%of GZ patients developed SHI.The study also found that lowering the ALT treatment thresholds to the American Association for the Study of Liver Diseases 2018 treatment criteria(35 U/L for men and 25 U/L for women)can more accurately identify patients with significant liver damage in the GZ phases.In total,the proportion of patients with ALT≤40 U/L who required antiviral therapy was 64.86%[(221+294)/794].When we lowered the ALT treatment threshold to the new criteria(30 U/L for men and 19 U/L for women),the same outcome was revealed,and the proportion of patients with ALT≤40 U/L who required antiviral therapy was 75.44%[(401+198)/794].Additionally,the proportion of SHI was 49.1%in patients under 30 years old and increased to 55.3%in patients over 30 years old(P=0.136).CONCLUSION These findings suggest the importance of redefining the natural phases of CHB and using new ALT treatment thresholds for better diagnosis and management of CHB patients in the GZ phases.展开更多
Peroral cholangioscopy(POC)is an endoscopic procedure that allows direct intraductal visualization of the biliary tract.POC has emerged as a vital tool for indeterminate biliary stricture evaluation and treatment of d...Peroral cholangioscopy(POC)is an endoscopic procedure that allows direct intraductal visualization of the biliary tract.POC has emerged as a vital tool for indeterminate biliary stricture evaluation and treatment of difficult biliary stones.Over several generations of devices,POC has fulfilled additional clinical needs where other diagnostic or therapeutic modalities have been inadequate.With adverse event rates comparable to standard endoscopic retrograde cholangioscopy and unique technical attributes,the role of POC is likely to continue expand.In this frontiers article,we highlight the existing and growing clinical applications of POC as well as areas of ongoing research.展开更多
文摘The paper presents general description of combined structural system and initial analysis of an innovative system proposed as the main support structure for tall or heavy loaded buildings located on subsoil of very small load-carrying ability or in earthquake areas. Moreover there is presented also an innovative two-stage method of the approximate calculation of the statically indeterminate trusses. Both are invented by the author by application of the principles of the superposition method.
文摘Many real⁃world machine learning applications face the challenge of dealing with changing data over time,known as concept drift,and the issue of data indeterminacy,where all the true labels available are unrealistic.This can lead to a decrease in the accuracy of the prediction models.The aim of this study is to introduce a new approach for detecting drift,which is based on neutrosophic set theory.This approach takes into account uncertainty in the prediction model and is able to handle indeterminate information,considering its impact on the models performance.The proposed method reads data into windows and calculates a set of values based on the concept of neutrosophic membership.These values are then used in the Neutrosophic Support Vector Machine(N⁃SVM).To address the issue of indeterminate true label data,the values issued by N⁃SVM are expressed as entropy and used as input for the ADWIN(Adaptive Windowing)change detector.When a drift is detected,the prediction model is retrained by including only the most recent instances with the original training data set.The proposed method gives promising results in terms of drift detection accuracy compared to the state of existing drift detection methods such as KSWIN,ADWIN,and DWM.
基金supported by grants from the Cultivation of Young Talents Project Fund from the Fujian Provincial Health and Family Planning Commission (Grant No. 2015-ZQN-ZD11)the Pilot Project of Fujian Provincial Department of Science and Technology (Grant No. 2016Y0010)+2 种基金the Jiangsu Provincial Project of Invigorating Health Care through Science, Technology and EducationJiangsu Provincial Medical Youth Talentthe Project of Invigorating Health Care through Science, Technology and Education (Grant No. QNRC2016621)
文摘HIV-indeterminate Western blotting(WB)results are typically obtained in WB confirmatory assays,and the number of indeterminate samples may increase with the detection of HIV infections,which will present considerable challenges for the management of HIV/AIDS.Nucleic acid detection has been used as a laboratory test for screening suspected or indeterminate samples.However,the effectiveness of these assays for the differential diagnosis of HIV-indeterminate WB samples remained undetermined.In this study,210 subjects with HIV-indeterminate WB results were detected from 6360 positive HIV screening samples between 2015 and 2016 in southeastern China,in which HIV-indeterminate WB results accounted for 3.30%.The highest proportion of indeterminate results was observed in pregnant and lying-in women receiving physical examinations(16.67%),followed by that in voluntary blood donors(8.82%).The most common WB band patterns were p24,gpl60 and p24,and gpl60.The follow-up study revealed that the highest negative and positive conversion rates of HIV antibodies were in samples with a single p24 band(80.28%),and with gpl60 and p24 bands(86.21%),respectively.Among the Env,Gag,and Pol antibodies,samples with a Gag band showed the highest negative conversion rate(81.25%),whereas the highest positive conversion rate was observed in samples with an Env band(56.76%).In addition,quantitative and qualitative HIV nucleic acid testing exhibited the highest sensitivity(96.3%)and specificity(97.85%),respectively.Our results indicate a lower proportion of HIV indeterminate WB results in southeastern China compared to previous reports,and the follow-up re-examination of patients with HIV indeterminate results should be performed.Nucleic acid testing facilitates the identification of HIV infections.
文摘Due to the need for improvement in the diagnosis and minimally invasive therapy of the bile duct disorders new technologies for cholangioscopy have been recently developed. Per-oral cholangioscopy has become an important diagnostic and therapeutic tool leading to avoidance of aggressive and unnecessary surgery in many clinical scenarios. This paper focuses on the newly developed SpyGlass DS technology, its advantages, and the technique of single-operator cholangioscopy(SOC), biliary indications and possible adverse events. We also review the available literature; discuss the limitations and future expectations.Digital SOC(D-SOC) is a useful technique, which provides endoscopic imaging of the biliary tree, optical diagnosis, biopsy under direct vision and therapeutic interventions. The implementations are diagnostic and therapeutic. Diagnostic indications are indeterminate biliary strictures, unclear filling defects, staging of cholangiocarcinoma, staging of ampullary tumors(extension into the common bile duct), unclear bile duct dilation, exploring cystic lesions of the biliary tree,unexplained hemobilia, posttransplant biliary complications. Therapeutic indications are lithotripsy of difficult stones, retrieval of migrated stents, foreign body removal, guide wire placement, transpapillary gallbladder drainage and endoscopic tumor ablative therapy. Most studied and established indications are the diagnosis of indeterminate biliary stricture and intraductal lithotripsy of difficult stones. The adverse events are not different and more common compared to those of Endoscopic retrograde cholangiopancreatography(ERCP)alone. D-SOC is a safe and effective procedure, adjunct to the standard ERCP and the newly available digital technology overcomes many of the limitations of the previous generations of cholangioscopes.
文摘AIM:To investigate the clinicopathologic parameters of pulmonary metastasis in colorectal cancer(CRC) patients after lung operation of indeterminate pulmonary nodules(IPNs).METHODS:From a prospective database of CRCpatients,40 cases that underwent lung operation between November 2008 and December 2012 for suspicious metastatic pulmonary nodules on chest computed tomography(CT)were enrolled.The decision to perform a lung operation was made if the patient met the following criteria:(1)completely resected or resectable primary CRC;(2)completely resectable IPNs;(3)controlled or controllable extrapulmonary metastasis;and(4)adequate general condition and pulmonary function to tolerate pulmonary operation.Lung operation was performed by a thoracic surgeon without CT-guided biopsy for pathologic confirmation.RESULTS:A total of 40 cases of lung resection was performed in 29 patients.Five patients underwent repeated lung resection.The final pathology result showed metastasis from the CRC in 30 cases(75%)and benign pathology in 10 cases(25%).The primary tumor site was the rectum in 26/30(86.6%)cases with pulmonary metastasis,but only 3/10(30%)cases in the benign group had a primary rectal cancer(P=0.001).Positron emission tomography(PET)-CT was performed for 22/30(73.4%)patients in the lung metastasis group and for 6/10(60.0%)patients in the benign group.PET-CT revealed hot uptake of18fluorine 2-fluoro-2-deoxy-D-glucose with all IPNs in both groups.The group with pulmonary metastasis had a higher incidence of primary rectal cancer(P=0.001),a more advanced tumor stage(P=0.011),and more frequent lymphatic invasion of tumor cells(P=0.005).Six cases with previous liver metastasectomy were present in the lung metastasis group.Serum carcinoembryonic antigen levels before lung operation were not elevated in any of the patients.CONCLUSION:The stage and location of the primary tumor and tumor cell infiltration of lymphatics provide useful indicators for deciding on lung resection of IPNs in CRC.
基金Supported by NIH/NIDDK R21DK095186-01A1,Nos.3U54 CA091408–09S1,U54RR026140/U54MD007593,and UL1 RR024975Research Foundation,American Society of Colon and Rectal Surgeons,Limited Project Grant(LPG-086)
文摘Patients with indeterminate colitis(IC) are significantly younger at diagnosis with onset of symptoms before the age of 18 years with significant morbidity in the interim. The successful care of IC is based on microscopic visual predict precision of eventual ulcerative colitis(UC) or Crohn's colitis(CC) which is not offered in 15%-30% of inflammatory bowel disease(IBD) patients even after a combined state-of-the-art classification system of clinical, visual endoscopic, radiologic and histologic examination. These figures have not changed over the past 3 decades despite the introduction of newer diagnostic modalities. The patient outcomes after restorative proctocolectomy and ileal pouch-anal anastomosis may be painstaking if IC turns into CC. Our approach is aiming at developing a single sensitive and absolute accurate diagnostic test tool during the first clinic visit through endoscopic biopsy derived proteomic patterns. Matrix-assisted-laser desorption/ionization mass spectrometry(MS) and/or imaging MS technologies permit a histology-directed cellular test of endoscopy biopsy which identifies phenotype specific proteins, as biomarker that would assist clinicians more accurately delineate IC as beingeither a UC or CC or a non-IBD condition. These novel studies are underway on larger cohorts and are highly innovative with significances in differentiating a UC from CC in patients with IC and could lend mechanistic insights into IBD pathogenesis.
文摘AIM:To assess the diagnostic ability of endoscopic ultrasonography(EUS)for evaluating causes of dista biliary strictures shown on endoscopic retrograde chol angiopancreatography(ERCP)or magnetic resonance cholangiopancreatography(MRCP),even without iden tifiable mass on computed tomography(CT). METHODS:The diagnostic ability of EUS was retro spectively analyzed and compared with that of routine cytology(RC)and tumor markers in 34 patients with distal biliary strictures detected by ERCP or MRCP a Dokkyo Medical School Hospital from December 2005 to December 2008,without any adjacent mass or ec centric thickening of the bile duct on CT that could cause biliary strictures.Findings considered as benign strictures on EUS included preservation of the normasonographic layers of the bile duct wall,irrespective of the presence of a mass lesion.Other strictures were considered malignant.Final diagnosis of underlying diseases was made by pathological examination in 18 cases after surgical removal of the samples,and by clinical follow-up for>10 mo in 16 cases. RESULTS:Seventeen patients(50%)were finally di- agnosed with benign conditions,including 6"normal" subjects,while 17 patients(50%)were diagnosed with malignant disease.In terms of diagnostic ability,EUS showed 94.1%sensitivity,82.3%specificity,84.2% positive predictive value,93.3%negative predictive value(NPV)and 88.2%accuracy for identifying ma- lignant and benign strictures.EUS was more sensi- tive than RC(94.1%vs 62.5%,P=0.039).NPV was also better for EUS than for RC(93.3%vs 57.5%,P= 0.035).In addition,EUS provided significantly higher sensitivity than tumor markers using 100 U/mL as the cutoff level of carbohydrate antigen 19-9(94.1%vs 53%,P=0.017).On EUS,biliary stricture that was fi- nally diagnosed as malignant showed as a hypoechoic, irregular mass,with obstruction of the biliary duct and invasion to surrounding tissues. CONCLUSION:EUS can diagnose biliary strictures caused by malignant tumors that are undetectable on CT.Earlier detection by EUS would provide more therapeutic options for patients with early-stage pancreaticobiliary cancer.
文摘Biliary strictures are considered indeterminate when basic work-up, including transabdominal imaging and endoscopic retrograde cholangiopancreatography with routine cytologic brushing, are non-diagnostic. Indeterminate biliary strictures can easily be mischaracterized which may dramatically affect patient's outcome. Early and accurate diagnosis of malignancy impacts not only a patient's candidacy for surgery, but also potential timely targeted chemotherapies. A significant portion of patients with indeterminate biliary strictures have benign disease and accurate diagnosis is, thus, paramount to avoid unnecessary surgery. Current sampling strategies have suboptimal accuracy for the diagnosis of malignancy. Emerging data on other diagnostic modalities, such as ancillary cytology techniques, single operator cholangioscopy, and endoscopic ultrasonography-guided fine needle aspiration, revealed promising results with much improved sensitivity.
基金supported by the National Natural Science Foundation of China (Nos. 52005431, 51705449 and 51975509)the Natural Science Foundation of Hebei Province of China (No. E2020203086)the National Major Science and Technology Projects of China (No. 2018ZX04007002)
文摘In order to solve the problems of excess ovality and cross-section distortion of longitudinally submerged arc welding pipes after forming,a new three-roller continuous setting round process was proposed.This process can be divided into three stages:loading stage,roll bending stage and unloading stage.Based on the discretization idea,the mechanical model of the primary statically indeterminate problem of the longitudinally submerged arc welding pipes at the roll bending stage was established,and the deformation response was obtained.The simulation and theoretical results show that there are three positive bending regions and three reverse bending regions along the circumference of the pipe.The loading force of each roller shows growth,stability and downward trend with time.The error between the theoretical fitting curve and the simulated data point is very small,and the simulation results verify the reliability of the theoretical calculation.The experimental results show that the residual ovality decreases with the increase of the reduction,and the reduction of the turning point is the optimum reduction.In addition,the residual ovality of the pipe is less than 0.7%without cross-section distortion,which verifies the feasibility of this process.
文摘There is currently no gold standard test for the diagnosis of inflammatory bowel disease (IBD). Physicians must rely on a number of diagnostic tools including clinical and endoscopic evaluation as well as histologic, serologic and radiologic assessment. The real difficulty for physicians in both primary and secondary care is differentiating between patients suffering from functional symptoms and those with true underlying IBD. Alongside this, there is always concern regarding the possibility of a missed, or delayed diagnosis of ulcerative colitis (UC) or Crohn’s disease. Even once the diagnosis of IBD has been made, there is often uncertainty in distinguishing between cases of UC or Crohn’s. As a consequence, in cases of incorrect diagnosis, optimal treatment and management may be adversely affected. Endoscopic evaluation can be uncomfortable and inconvenient for patients. It carries significant risks including perforation and in terms of monetary cost, is expensive. The use of biomarkers to help in the diagnosis and differentiation of IBD has been increasing over time. However, there is not yet one biomarker, which is sensitive of specific enough to be used alone in diagnosing IBD. Current serum testing includes C-reactive protein and erythrocyte sedimentation rate, which are cheap, reliable but non-specific and thus not ideal. Stool based testing such as faecal calprotectin is a much more specific tool and is currently in widespread clinical use. Non-invasive sampling is of the greatest clinical value and with the recent advances in metabolomics, genetics and proteomics, there are now more tools available to develop sensitive and specific biomarkers to diagnose and differentiate between IBD. Many of these new advances are only in early stages of development but show great promise for future clinical use.
文摘Peroral cholangioscopy(POC) is an important tool for the management of a selected group of biliary diseases. Because of its direct visualization, POC allows targeted diagnostic and therapeutic procedures. POC can be performed using a dedicated cholangioscope that is advanced through the accessory channel of a duodenoscope or via the insertion of a small-diameter endoscope directly into the bile duct. POC was first described in the 1970 s, but the use of earlier generation devices was substantially limited by the cumbersome equipment setup and high repair costs. For nearly ten years, several technical improvements, including the single-operator system, high-quality images, the development of dedicated accessories and the increased size of the working channel, have led to increased diagnostic accuracy, thus assisting in the differentiation of benign and malignant intraductal lesions, targeting biopsies and the precise delineation of intraductal tumor spread before surgery. Furthermore, lithotripsy of difficult bile duct stones, ablative therapies for biliary malignancies and direct biliary drainage can be performed under POC control. Recent developments of new types of conventional POCs allow feasible, safe and effective procedures at reasonable costs. In the current review, we provide an updated overview of POC, focusing our attention on the main current clinical applications and on areas for future research.
基金The National Natural Science Foundation of China,No.81870406the Beijing Natural Science Foundation,No.7182174and the China National Science and Technology Major Project for Infectious Diseases Control during the 13th Five-Year Plan Period,No.2017ZX10202202.
文摘BACKGROUND Histological changes after direct-acting antivirals(DAAs)therapy in hepatitis C virus(HCV)patients has not been elucidated.Whether the predominantly progressive,indeterminate and predominately regressive(P-I-R)score,evaluating fibrosis activity in hepatitis B virus patients has predictive value in HCV patients has not been investigated.AIM To identify histological changes after DAAs therapy and to evaluate the predictive value of the P-I-R score in HCV patients.METHODS Chronic HCV patients with paired liver biopsy specimens before and after DAAs treatment were included.Sustained virologic response(SVR)was defined as an undetectable serum HCV RNA level at 24 wk after treatment cessation.The Ishak system and P-I-R score were assessed.Inflammation improvement and fibrosis regression were defined as a≥2-points decrease in the histology activity index(HAI)score and a≥1-point decrease in the Ishak fibrosis score,respectively.Fibrosis progression was defined as a≥1-point increase in the Ishak fibrosis score.Histologic improvement was defined as a≥2-points decrease in the HAI score without worsening of the Ishak fibrosis score after DAAs therapy.The P-I-R score was also assessed.“absolutely reversing or advancing”was defined as the same directionality implied by both change in the Ishak score and posttreatment P-I-R score;and“probably reversing or advancing”was defined as only one parameter showing directionality.RESULTS Thirty-eight chronic HCV patients with paired liver biopsy specimens before and after DAAs treatment were included.The mean age of these patients was 40.9±14.6 years and there were 53%(20/38)males.Thirty-four percent(13/38)of patients were cirrhotic.Eighty-two percent(31/38)of patients achieved inflammation improvement.The median HAI score decreased significantly after SVR(pretreatment 7.0 vs posttreatment 2.0,Z=-5.146,P=0.000).Thirty-seven percent(14/38)of patients achieved fibrosis improvement.The median Ishak score decreased significantly after SVR(pretreatment 4.0 vs posttreatment 3.0,Z=-2.354,P=0.019).Eighty-two percent(31/38)of patients showed histological improvement.The P-I-R score was evaluated in 61%(23/38)of patients.The progressive group showed lower platelet(P=0.024)and higher HAI scores(P=0.070)before treatment.In patients with stable Ishak stage after treatment:Progressive injury was seen in 22%(4/18)of patients,33%(6/18)were classified as indeterminate and regressive changes were seen in 44%(8/18)of patients who were judged as probably reversing by the Ishak and P-I-R systems.CONCLUSION Significant improvement of necroinflammation and partial remission of fibrosis in HCV patients occurred shortly after DAAs therapy.The P-I-R score has potential in predicting fibrosis in HCV patients.
文摘The introduction of wireless capsule endoscopy in 2000 has revolutionized our ability to visualize parts of the small bowel mucosa classically unreached by the conventional endoscope, and since the recent introduction of colon capsule endoscopy, a promising alternative method has been available for the evaluation of large bowel mucosa. The advantages of wireless capsule endoscopy include its non-invasive character and its ability to visualize proximal and distal parts of the intestine, while important disadvantages include the procedure's inability of tissue sampling and significant incompletion rate. Its greatest limitation is the prohibited use in cases of known or suspected stenosis of the intestinal lumen due to high risk of retention. Wireless capsule endoscopy plays an important role in the early recognition of recurrence, on Crohn's disease patients who have undergone ileocolonic resection for the treatment of Crohn's disease complications, and in patients' management and therapeutic strategy planning, before obvious clinical and laboratory relapse. Although capsule endoscopy cannot replace traditional endoscopy, it offers valuable information on the evaluation of intestinal disease and has a significant impact on disease reclassification of patients with a previous diagnosis of ulcerative colitis or inflammatory bowel disease unclassified/indeterminate colitis. Moreover, it may serve as an effective alternative where colonoscopy is contraindicated and in cases with incomplete colonoscopy studies. The use of patency capsule maximizes safety and is advocated in cases of suspected small or large bowel stenosis.
文摘Different histopathological manifestations of focal liver lesions show varying common and uncommon imaging findings and some pathologies may show similar appearance despite of different histopathology.It is necessary to characterise focal liver lesions accurately as not only benign and malignant lesions are managed differently,but also certain benign lesions have differing management.These lesions are increasingly being detected due to rapid growth of use of crosssectional imaging as well as improvement in image quality and new imaging techniques.Contrast enhanced magnetic resonance imaging(MRI)is considered the gold standard technique in characterising focal liver lesions.Addition of gadoxetic acid has been shown to significantly increase diagnostic accuracy in the detection and characterization of liver abnormalities.Classic imaging characteristics of common liver lesions,including their behaviour on gadoxetic acid enhanced MRI,have been described in literature over recent years.It is important to be familiar with the typical aspects of these lesions as well as know the uncommon and overlapping imaging features to reach an accurate diagnosis.In this article,we will review the well-described characteristic imaging findings of common and rare focal liver lesions and present several challenging cases encountered in the clinical setting,namely hepatocellular adenoma,focal nodular hyperplasia,hepatic angiomyolipoma,hepatocellular carcinoma,intrahepatic cholangiocarcinoma,neuroendocrine tumours as well as a pleomorphic liposarcoma of the liver.
基金the Science and Technology Innovation Talents of Shenyang,China(Grant No.RC190489).
文摘Sheath blight disease (ShB) has a severe impact on the production of rice. ABI3/VP1-like 1(RAVL1) negatively regulated the rice defense mechanism against ShB, however, this regulatorymechanism is not clearly understood. In this study, we identified that indeterminate domain 3 (IDD3) waspositively regulated by RAVL1. Further, chromatin immunoprecipitation (ChIP) assay, yeast one-hybridassay and transient expression assay indicated a direct binding between RAVL1 and the IDD3 promoterregion. IDD3 was ubiquitously expressed in different tissues and at different stages, and its expressionwas significantly enhanced by Rhizoctonia solani infection. IDD3 exhibited transcription activation activityin yeast and IDD3-GFP was found to be localized in the nucleus. IDD3 mutants exhibited no significantdifferences in response to ShB, while IDD3 overexpressors were more susceptible to ShB compared withwild type (WT) plants. Furthermore, IDD3 repressors were less susceptible to R. solani than WT plants.Interestingly, the expression of brassinosteroid-related genes (D2, D11 and BRI1) was lower in IDD3repressors and higher in IDD3 overexpressors compared with WT. However, the ChIP assay revealedthat IDD3 did not directly bind to the D2 and D11 promoters. Overexpression of IDD3 in BRI1 mutantd61-1 inhibited the activity of IDD3, reducing its susceptibility to ShB compared with IDD3 overexpressorand WT plants, indicating that IDD3 negatively regulated the rice defense mechanism against ShB by activatingthe BR signaling pathway. Thus, our analyses provided information to enhance the understanding of therice defense mechanism against ShB.
基金Supported by the donation of wireless Small bowel capsule and patency capsules from Giving imaging,Ltd Medtronic company with the funding agreement from Given investigator-initiated study No.13-12
文摘BACKGROUND Magnetic resonance enterography (MRE) and wireless capsule endoscopy (WCE) are equally accepted modalities for noninvasive screening of small bowel involvement (SBI) in children with Crohn’s disease (CD) and indeterminate colitis (IC) albeit there is a paucity of data comparing the two and thereby guiding the clinician in selecting the ideal diagnostic approach. Therefore, the goal of this study is to provide additional evidence for capsule endoscopy role in the evaluation of established Crohn’s disease exacerbation compared to MRE in relation to Pediatric Crohn's Disease Activity Index (PCDAI), and histological indices. AIM To prospectively compare the findings of MRE and WCE and their agreement with PCDAI or histology in children with CD or IC. METHODS Consecutive patients diagnosed with CD and IC were screened for inclusion. After informed consent, patient’s demographic and clinical data was abstracted. The current pediatric disease activity index (PCDAI) and endoscopic findings were included. Patients underwent MRE and WCE including preprocedural patency capsule within a maximum of 7 d of each other. Pathological presence of active small bowel disease in ileal and duodenal biopsies were collected if the endoscopy was performed within 2 mo of the WCE study. Patients who failed to pass the PC were excluded from the study. WCE was read by two different experienced gastroenterologists (Attard TM and Colombo JM) blinded to each other's findings and to the findings on MRE (Mardis NJ). Agreement between WCE reviewers, WCE and MRE findings and concordance between positive PCDAI and SBI based on MRE compared with WCE was computed. RESULTS Forty-five patients were included in the study, 18 withdrew and 27 (20 males and 20 CD), mean age (standard deviation) 13.46 (2.4) years, completed the study protocol. There were no instances of capsule retention. Concordance between gastroenterologist reviewers was excellent for the diagnosis of small intestinal CD with good correlation between the two Lewis scores (r=0.875, P<0.001). Concordance between WCE and MRE was poor (69%). In CD patients, when both MRE and WCE were compared using PCDAI>10 as the standard reference reflecting active small intestinal CD, the sensitivity of MRE and WCE were 100% and 83% respectively and the specificity of MRE and WCE were 57.14% and 78.6%, respectively. If the histology in ileum or/and duodenum was used as the reference for active small bowel involvement, WCE had a higher specificity as compared to MRE (83.3% vs 50%). In patients with Crohn’s disease, those with a positive PCDAI (>10) were more likely to have a positive WCE as compared to those with a negative PCDAI (83% vs 21%;P=0.018). CONCLUSION We suggest that MRE and WCE have a complementary role in the assessment of SBI in CD. WCE detected SBI with a much higher specificity while MRE had a higher sensitivity.
基金Supported by National Natural Science Foundation of China(Grant Nos.61403214,61327802,U1613220)Tianjin Provincial Natural Science Foundation of China(Grant Nos.14JCZDJC31800,14JCQNJC04700)
文摘Flexure-based mechanisms are widely utilized in nano manipulations. The closed-form statics and dynamics modeling is difficult due to the complex topologies, the inevitable compliance of levers, the Hertzian contact interface, etc. This paper presents the closed-form modeling of an XY nano-manipulator consisting of statically indeterminate symmetric(SIS) structures using leaf and circular flexure hinges. Theoretical analysis reveals that the lever’s compliance, the contact stiffness, and the load mass have significant influence on the static and dynamic performances of the system.Experiments are conducted to verify the effectiveness of the established models. If no piezoelectric actuator(PEA) is installed, the influence of the contact stiffness can be eliminated. Experimental results show that the estimation error on the output stiffness and first natural frequency can reach 2% and 1.7%, respectively. If PEAs are installed, the contact stiffness shows up in the models. As no effective method is currently available to measure or estimate the contact stiffness, it is impossible to precisely estimate the performance of the overall system. In this case, the established closed-form models can be utilized to calculate the bounds of the performance. The established closed-form models are widely applicable in the design and optimization of planar flexure-based mechanisms.
文摘Choledochoscopy,or cholangioscopy,is an endoscopic procedure for direct visualization within the biliary tract for diagnostic or therapeutic purposes.Since its conception in 1879,many variations and improvements are made to ensure relevance in diagnosing and managing a range of intrahepatic and extrahepatic biliary pathologies.This ranges from improved visual impression and optical guided biopsies of indeterminate biliary strictures and clinically indistinguishable pathologies to therapeutic uses in stone fragmentation and other ablative therapies.Furthermore,with the evolving understanding of biliary disorders,there are significant innovative ideas and techniques to fill this void,such as nuanced instances of biliary stenting and retrieving migrated ductal stents.With this in mind,we present a review of the current advancements in choledochoscopy with new supporting evidence that further delineates the role of choledochoscopy in various diagnostic and therapeutic interventions,complications,limitations and put forth areas for further study.
基金The Natural Science Foundation of Guangdong Province for Distinguished Young Scholar,No.2022B1515020024National Natural Science Foundation of China,No.82070574The Natural Science Foundation Team Project of Guangdong Province,No.2018B030312009.
文摘BACKGROUND The clinical and histological features of chronic hepatitis B(CHB)patients who fall into the"grey zone(GZ)"and do not fit into conventional natural phases are unclear.AIM To explore the impact of varying the threshold of alanine aminotransferase(ALT)levels in identifying significant liver injury among GZ patients.METHODS This retrospective analysis involved a cohort of 1617 adult patients diagnosed with CHB who underwent liver biopsy.The clinical phases of CHB patients were determined based on the European Association for the Study of the Liver 2017 Clinical Practice Guidelines.GZ CHB patients were classified into four groups:GZ-A(HBeAg positive,normal ALT levels,and HBV DNA≤10^(7) IU/mL),GZ-B(HBeAg positive,elevated ALT levels,and HBV DNA<10^(4) or>10^(7) IU/mL),GZC(HBeAg negative,normal ALT levels,and HBV DNA≥2000 IU/mL),and GZ-D(HBeAg negative,elevated ALT levels,and HBV DNA≤2000 IU/mL).Significant hepatic injury(SHI)was defined as the presence of notable liver inflammation(≥G2)and/or significant fibrosis(≥S2).RESULTS The results showed that 50.22%of patients were classified as GZ,and 63.7%of GZ patients developed SHI.The study also found that lowering the ALT treatment thresholds to the American Association for the Study of Liver Diseases 2018 treatment criteria(35 U/L for men and 25 U/L for women)can more accurately identify patients with significant liver damage in the GZ phases.In total,the proportion of patients with ALT≤40 U/L who required antiviral therapy was 64.86%[(221+294)/794].When we lowered the ALT treatment threshold to the new criteria(30 U/L for men and 19 U/L for women),the same outcome was revealed,and the proportion of patients with ALT≤40 U/L who required antiviral therapy was 75.44%[(401+198)/794].Additionally,the proportion of SHI was 49.1%in patients under 30 years old and increased to 55.3%in patients over 30 years old(P=0.136).CONCLUSION These findings suggest the importance of redefining the natural phases of CHB and using new ALT treatment thresholds for better diagnosis and management of CHB patients in the GZ phases.
文摘Peroral cholangioscopy(POC)is an endoscopic procedure that allows direct intraductal visualization of the biliary tract.POC has emerged as a vital tool for indeterminate biliary stricture evaluation and treatment of difficult biliary stones.Over several generations of devices,POC has fulfilled additional clinical needs where other diagnostic or therapeutic modalities have been inadequate.With adverse event rates comparable to standard endoscopic retrograde cholangioscopy and unique technical attributes,the role of POC is likely to continue expand.In this frontiers article,we highlight the existing and growing clinical applications of POC as well as areas of ongoing research.
