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
BACKGROUND Colon capsule endoscopy(CCE)is a modern,non-invasive method for large bowel visualization,offering a less invasive alternative to traditional colonoscopy(TC).While TC remains the gold standard for comprehen...BACKGROUND Colon capsule endoscopy(CCE)is a modern,non-invasive method for large bowel visualization,offering a less invasive alternative to traditional colonoscopy(TC).While TC remains the gold standard for comprehensive large bowel assessment,including the detection and treatment of various conditions,the effectiveness of CCE in detecting polyps is less established.AIM To systematically review and compare the polyp detection rates(PDR)of CCE and TC.METHODS A systematic literature search was conducted using four scientific databases:CINAHL,MEDLINE via EBSCO,Cochrane Library,and MEDLINE/PubMed.A standardized search command was utilized to ensure consistency.Full papers were retrieved if they compared PDR between CCE and TC and involved patients over 18 years old.A meta-analysis was then conducted using the meta package in R software.RESULTS Initially,339 articles were identified,with 128 duplicates and 15 non-English articles excluded,leaving 196 for screening.After further exclusions,9 articles were included in the review.The meta-analysis revealed minimal differences in PDR between CCE and TC.The pooled PDR for TC was 0.61(95%CI:0.48–0.72),and for CCE,it was 0.61(95%CI:0.48–0.73).The overall comparison of the pooled PDR of both methods was 0.96(95%CI:0.90–1.02),indicating that CCE is noninferior to TC.CONCLUSION CCE has emerged as a modern and safe diagnostic alternative to TC for polyp detection,demonstrating noninferiority when compared to the conventional method.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
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
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
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
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
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
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
Objective: to analyze the detection rate and role of tumor markers in gastric cancer and pathological examination. Methods: a total of 156 patients were selected from June 2019 to June 2020. 78 patients clinically dia...Objective: to analyze the detection rate and role of tumor markers in gastric cancer and pathological examination. Methods: a total of 156 patients were selected from June 2019 to June 2020. 78 patients clinically diagnosed with gastric cancer were included in the observation group, and 78 patients diagnosed with benign gastric lesions during the same period were included in the control group. Tumor markers and pathological examinations were performed for all patients. The positive detection rate of vascular endothelial growth factor and serum tumor markers were compared between the two groups, and the function of tumor markers was analyzed using pathological examination as the standard. Results: the positive rate of VASCULAR endothelial growth factor in the observation group was 91.03%, which was significantly higher than that in the control group (66.07%) (P<0.05). The clinical stage, histological differentiation and lymph node metastasis of gastric cancer in the observation group were not statistically significant compared with pathological examination by tumor markers (P > 0.05). Serum CEA, VEGF, CA125 and CA724 in observation group were significantly higher than those in control group (P<0.05). Conclusion: the application of tumor markers in the examination of gastric cancer can be used to determine the biochemical components and characteristics of different tissues, which is close to the results of pathological examination and has high application value. The combination of the two markers can improve the accuracy of clinical diagnosis of gastric cancer.展开更多
Objective: to analyze the value and detection rate of dynamic video electroencephalogram in epilepsy monitoring. Methods: the study was carried out from November 2019 to October 2021. Seventy patients with epilepsy ad...Objective: to analyze the value and detection rate of dynamic video electroencephalogram in epilepsy monitoring. Methods: the study was carried out from November 2019 to October 2021. Seventy patients with epilepsy admitted to our hospital were included in the study. All patients were examined by routine electroencephalogram and dynamic video electroencephalogram, and the results were comprehensively evaluated. Results: clinical seizures and abnormal discharges were detected in 31.4% and 98.6% of the patients in the observation group and 5.7% and 55.7% of the patients in the control group. The detection rates of clinical seizures and abnormal discharges in the observation group were higher than those in the control group (P < 0.05). The detection rate of mild seizure in the observation group was lower than that in the control group, and the positive detection rate of moderate seizure, severe seizure and epilepsy in the observation group was higher than that in the control group (P < 0.05). Dynamic video-electroencephalogram confirmed that the epileptic seizure types were facial tonic-clonic seizure, absence seizure, myoclonic seizure, tonic seizure and dystonic seizure, accounting for 28.6%, 21.4%, 15.7%, 21.4% and 12.9% respectively;In the examination of the onset position of epilepsy by dynamic video-electroencephalogram, 40 cases of onset position were detected, and the others were not clear. 8 cases were found in frontal region, 13 cases in temporal region, 10 cases in temporal frontal region, 5 cases in occipital-temporal posterior region and 4 cases in frontal center. Conclusion: compared with routine ECG, the detection rate of dynamic video electroencephalogram is higher in epilepsy detection. It can also clarify the type and initial location of epileptic seizures and the severity of epilepsy, which can provide a basis for clinical diagnosis and treatment of the disease.展开更多
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
Introduction:In China,the prevalence of abnormal spinal curvature in children and adolescents is high and the number of cases is increasing in recent years,which seriously threatens physical and mental health of child...Introduction:In China,the prevalence of abnormal spinal curvature in children and adolescents is high and the number of cases is increasing in recent years,which seriously threatens physical and mental health of children and adolescents.Public health surveillance of these abnormalities is crucial for developing targeted interventions.Methods:This study evaluated detection rates and risk factors of spinal curvature abnormalities among children and adolescents in Jiangsu Province,China.This study analyzed data from the population-based“Surveillance for Common Disease and Health Risk Factors Among Students”project,implemented annually from September to November during 2021–2023.Abnormal spinal curvature was assessed using the national“Technical Guide for Prevention and Control of Abnormal Spinal Curvature in Children and Adolescents.”Detection rates were calculated,and associated factors were evaluated using multivariate logistic regression.Results:Annual detection rates were 2.6%,1.8%,and 2.3%,respectively,among children and adolescents aged 6–17 years.Detection rates increased with age and were significantly higher among females compared to males.Adequate physical activity,sufficient sleep,and correct reading and writing postures were protective factors against spinal curvature abnormalities,while low body weight was associated with increased risk.Conclusion:The emerging burden of abnormal spinal curvature necessitates targeted public health interventions,particularly for high school students and females.Beyond implementing early lifestyle interventions such as sufficient outdoor activities,appropriate referrals to public health specialists and orthopedic surgeons may provide additional risk mitigation.Successful outcomes require multisectoral collaboration and parental engagement to achieve sustainable public health improvements.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
BACKGROUND Recently,Olympus Corporation released new scopes(XZ1200/EZ1500).However,there have been few reports on this topic,although improvement in adenoma detection rate(ADR)by texture and color enhancement imaging(...BACKGROUND Recently,Olympus Corporation released new scopes(XZ1200/EZ1500).However,there have been few reports on this topic,although improvement in adenoma detection rate(ADR)by texture and color enhancement imaging(TXI)or computer-aided detection system(CAD)has been reported.AIM To investigate the effects of the scope on the detection of adenomas and sessile serrated lesions(SSLs).METHODS The subjects were patients who underwent pancolonic chromoendoscopy using the EVIS X1 video system center between May 2023 and October 2024.The patients were divided into the new(CF-XZ1200/CF-EZ1500)and 290 series(CF-HQ290Z/PCF-H290Z)groups.Propensity score matching was performed for age,sex,examination purpose,endoscopist,preparation,TXI use,and CAD use.The effects of the scope were analyzed in terms of the ADR,SSL detection rate(SDR),and mean number of adenomas per colonoscopy(APC).RESULTS Of the 7014 patients enrolled,2138 pairs were extracted by propensity score matching(mean age 55.4 years,45.5%male).The new scopes group had a significantly higher ADR than the 290 series group[51.5%vs 45.5%,odds ratio(OR)=1.27,95%CI:1.13-1.43,P<0.001].Similarly,the new scopes group had significantly higher SDR(7.8%vs 5.7%,OR=1.41,95%CI:1.11-1.80,P=0.005)and APC(0.90 vs 0.76,OR=1.11,95%CI:1.05-1.17,P<0.001)than the 290 series group.CONCLUSION In conclusion,the new scope(CF-XZ1200/CF-EZ1500)enhanced the detection of adenomas and SSLs compared to the old ones(290 series).展开更多
Background and aim:Adequate bowel preparation is important for safe and effective colonoscopy.Quality indicators(QI)for colonoscopy include achieving at least 95%completion rate and an adenoma detection rate(ADR)of at...Background and aim:Adequate bowel preparation is important for safe and effective colonoscopy.Quality indicators(QI)for colonoscopy include achieving at least 95%completion rate and an adenoma detection rate(ADR)of at least 25%in average-risk men and 15%in average-risk women aged over 50.Our aim was to investigate the impact of bowel preparation on ADR and colonoscopy completion rates.Methods:This retrospective cohort study included patients who underwent colonoscopy between January 2008 and December 2009.The main outcome measurements were ADR and colonoscopy completion rates to the cecum.Results:A total of 2519 patients was included;1030(41.0%)had excellent preparation,1145(45.5%)good-,240(9.5%)fair-,and 104(4.1%)poor preparation.Colonoscopy completion rates were significantly lower in patients with poor or fair preparation(72.1%and 75.4%,respectively)than in those with good and excellent preparation(99.7%and 99.9%,respectively;P<0.001),and significantly lower than the QI of 95%(P<0.001).ADR in men and women combined was similar in all four grades of preparation(excellent,good,fair and poor)at 24.2%vs.26.8%vs.32.1%vs.22.1%,respectively;P¼0.06.All the groups had ADR above the QI(25%for men and 15%for women)with evidence of significantly higher ADR in the women with excellent or good preparation and in men with excellent,good or fair preparation.On multivariate analysis,male gender was significantly associated with increased ADR(P<0.001),while the quality of bowel preparation did not influence ADR.Conclusions:Patients with fair and poor standards of preparation have significantly lower colonoscopy completion rates than those with excellent and good preparation.However,there was no difference in ADR between the different grades of preparation.展开更多
To solve the problem of poor detection and limited application range of current intrusion detection methods,this paper attempts to use deep learning neural network technology to study a new type of intrusion detection...To solve the problem of poor detection and limited application range of current intrusion detection methods,this paper attempts to use deep learning neural network technology to study a new type of intrusion detection method.Hence,we proposed an intrusion detection algorithm based on convolutional neural network(CNN)and AdaBoost algorithm.This algorithm uses CNN to extract the characteristics of network traffic data,which is particularly suitable for the analysis of continuous and classified attack data.The AdaBoost algorithm is used to classify network attack data that improved the detection effect of unbalanced data classification.We adopt the UNSW-NB15 dataset to test of this algorithm in the PyCharm environment.The results show that the detection rate of algorithm is99.27%and the false positive rate is lower than 0.98%.Comparative analysis shows that this algorithm has advantages over existing methods in terms of detection rate and false positive rate for small proportion of attack data.展开更多
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BACKGROUND Colon capsule endoscopy(CCE)is a modern,non-invasive method for large bowel visualization,offering a less invasive alternative to traditional colonoscopy(TC).While TC remains the gold standard for comprehensive large bowel assessment,including the detection and treatment of various conditions,the effectiveness of CCE in detecting polyps is less established.AIM To systematically review and compare the polyp detection rates(PDR)of CCE and TC.METHODS A systematic literature search was conducted using four scientific databases:CINAHL,MEDLINE via EBSCO,Cochrane Library,and MEDLINE/PubMed.A standardized search command was utilized to ensure consistency.Full papers were retrieved if they compared PDR between CCE and TC and involved patients over 18 years old.A meta-analysis was then conducted using the meta package in R software.RESULTS Initially,339 articles were identified,with 128 duplicates and 15 non-English articles excluded,leaving 196 for screening.After further exclusions,9 articles were included in the review.The meta-analysis revealed minimal differences in PDR between CCE and TC.The pooled PDR for TC was 0.61(95%CI:0.48–0.72),and for CCE,it was 0.61(95%CI:0.48–0.73).The overall comparison of the pooled PDR of both methods was 0.96(95%CI:0.90–1.02),indicating that CCE is noninferior to TC.CONCLUSION CCE has emerged as a modern and safe diagnostic alternative to TC for polyp detection,demonstrating noninferiority when compared to the conventional method.
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.
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.
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.
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 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.
文摘Objective: to analyze the detection rate and role of tumor markers in gastric cancer and pathological examination. Methods: a total of 156 patients were selected from June 2019 to June 2020. 78 patients clinically diagnosed with gastric cancer were included in the observation group, and 78 patients diagnosed with benign gastric lesions during the same period were included in the control group. Tumor markers and pathological examinations were performed for all patients. The positive detection rate of vascular endothelial growth factor and serum tumor markers were compared between the two groups, and the function of tumor markers was analyzed using pathological examination as the standard. Results: the positive rate of VASCULAR endothelial growth factor in the observation group was 91.03%, which was significantly higher than that in the control group (66.07%) (P<0.05). The clinical stage, histological differentiation and lymph node metastasis of gastric cancer in the observation group were not statistically significant compared with pathological examination by tumor markers (P > 0.05). Serum CEA, VEGF, CA125 and CA724 in observation group were significantly higher than those in control group (P<0.05). Conclusion: the application of tumor markers in the examination of gastric cancer can be used to determine the biochemical components and characteristics of different tissues, which is close to the results of pathological examination and has high application value. The combination of the two markers can improve the accuracy of clinical diagnosis of gastric cancer.
文摘Objective: to analyze the value and detection rate of dynamic video electroencephalogram in epilepsy monitoring. Methods: the study was carried out from November 2019 to October 2021. Seventy patients with epilepsy admitted to our hospital were included in the study. All patients were examined by routine electroencephalogram and dynamic video electroencephalogram, and the results were comprehensively evaluated. Results: clinical seizures and abnormal discharges were detected in 31.4% and 98.6% of the patients in the observation group and 5.7% and 55.7% of the patients in the control group. The detection rates of clinical seizures and abnormal discharges in the observation group were higher than those in the control group (P < 0.05). The detection rate of mild seizure in the observation group was lower than that in the control group, and the positive detection rate of moderate seizure, severe seizure and epilepsy in the observation group was higher than that in the control group (P < 0.05). Dynamic video-electroencephalogram confirmed that the epileptic seizure types were facial tonic-clonic seizure, absence seizure, myoclonic seizure, tonic seizure and dystonic seizure, accounting for 28.6%, 21.4%, 15.7%, 21.4% and 12.9% respectively;In the examination of the onset position of epilepsy by dynamic video-electroencephalogram, 40 cases of onset position were detected, and the others were not clear. 8 cases were found in frontal region, 13 cases in temporal region, 10 cases in temporal frontal region, 5 cases in occipital-temporal posterior region and 4 cases in frontal center. Conclusion: compared with routine ECG, the detection rate of dynamic video electroencephalogram is higher in epilepsy detection. It can also clarify the type and initial location of epileptic seizures and the severity of epilepsy, which can provide a basis for clinical diagnosis and treatment of the disease.
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.
基金Supported by Ministry of Science and Technology(Grant No.G2023141005L)Ministry of Education(Grant No.1125000172)+2 种基金Jiangsu Provincial Social Science Foundation(Grant No.24SHB005)SEU Innovation Capability Enhancement Plan for Doctoral Students(Grant No.CXJH_SEU 25220)Jiangsu Provincial Department of Science and Technology.
文摘Introduction:In China,the prevalence of abnormal spinal curvature in children and adolescents is high and the number of cases is increasing in recent years,which seriously threatens physical and mental health of children and adolescents.Public health surveillance of these abnormalities is crucial for developing targeted interventions.Methods:This study evaluated detection rates and risk factors of spinal curvature abnormalities among children and adolescents in Jiangsu Province,China.This study analyzed data from the population-based“Surveillance for Common Disease and Health Risk Factors Among Students”project,implemented annually from September to November during 2021–2023.Abnormal spinal curvature was assessed using the national“Technical Guide for Prevention and Control of Abnormal Spinal Curvature in Children and Adolescents.”Detection rates were calculated,and associated factors were evaluated using multivariate logistic regression.Results:Annual detection rates were 2.6%,1.8%,and 2.3%,respectively,among children and adolescents aged 6–17 years.Detection rates increased with age and were significantly higher among females compared to males.Adequate physical activity,sufficient sleep,and correct reading and writing postures were protective factors against spinal curvature abnormalities,while low body weight was associated with increased risk.Conclusion:The emerging burden of abnormal spinal curvature necessitates targeted public health interventions,particularly for high school students and females.Beyond implementing early lifestyle interventions such as sufficient outdoor activities,appropriate referrals to public health specialists and orthopedic surgeons may provide additional risk mitigation.Successful outcomes require multisectoral collaboration and parental engagement to achieve sustainable public health improvements.
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.
基金Ethics Committee of the Certified Institutional Review Board of the Yoyogi Mental Clinic(No.RKK227).
文摘BACKGROUND Recently,Olympus Corporation released new scopes(XZ1200/EZ1500).However,there have been few reports on this topic,although improvement in adenoma detection rate(ADR)by texture and color enhancement imaging(TXI)or computer-aided detection system(CAD)has been reported.AIM To investigate the effects of the scope on the detection of adenomas and sessile serrated lesions(SSLs).METHODS The subjects were patients who underwent pancolonic chromoendoscopy using the EVIS X1 video system center between May 2023 and October 2024.The patients were divided into the new(CF-XZ1200/CF-EZ1500)and 290 series(CF-HQ290Z/PCF-H290Z)groups.Propensity score matching was performed for age,sex,examination purpose,endoscopist,preparation,TXI use,and CAD use.The effects of the scope were analyzed in terms of the ADR,SSL detection rate(SDR),and mean number of adenomas per colonoscopy(APC).RESULTS Of the 7014 patients enrolled,2138 pairs were extracted by propensity score matching(mean age 55.4 years,45.5%male).The new scopes group had a significantly higher ADR than the 290 series group[51.5%vs 45.5%,odds ratio(OR)=1.27,95%CI:1.13-1.43,P<0.001].Similarly,the new scopes group had significantly higher SDR(7.8%vs 5.7%,OR=1.41,95%CI:1.11-1.80,P=0.005)and APC(0.90 vs 0.76,OR=1.11,95%CI:1.05-1.17,P<0.001)than the 290 series group.CONCLUSION In conclusion,the new scope(CF-XZ1200/CF-EZ1500)enhanced the detection of adenomas and SSLs compared to the old ones(290 series).
文摘Background and aim:Adequate bowel preparation is important for safe and effective colonoscopy.Quality indicators(QI)for colonoscopy include achieving at least 95%completion rate and an adenoma detection rate(ADR)of at least 25%in average-risk men and 15%in average-risk women aged over 50.Our aim was to investigate the impact of bowel preparation on ADR and colonoscopy completion rates.Methods:This retrospective cohort study included patients who underwent colonoscopy between January 2008 and December 2009.The main outcome measurements were ADR and colonoscopy completion rates to the cecum.Results:A total of 2519 patients was included;1030(41.0%)had excellent preparation,1145(45.5%)good-,240(9.5%)fair-,and 104(4.1%)poor preparation.Colonoscopy completion rates were significantly lower in patients with poor or fair preparation(72.1%and 75.4%,respectively)than in those with good and excellent preparation(99.7%and 99.9%,respectively;P<0.001),and significantly lower than the QI of 95%(P<0.001).ADR in men and women combined was similar in all four grades of preparation(excellent,good,fair and poor)at 24.2%vs.26.8%vs.32.1%vs.22.1%,respectively;P¼0.06.All the groups had ADR above the QI(25%for men and 15%for women)with evidence of significantly higher ADR in the women with excellent or good preparation and in men with excellent,good or fair preparation.On multivariate analysis,male gender was significantly associated with increased ADR(P<0.001),while the quality of bowel preparation did not influence ADR.Conclusions:Patients with fair and poor standards of preparation have significantly lower colonoscopy completion rates than those with excellent and good preparation.However,there was no difference in ADR between the different grades of preparation.
基金supported in part by the National Key R&D Program of China(No.2022YFB3904503)National Natural Science Foundation of China(No.62172418)。
文摘To solve the problem of poor detection and limited application range of current intrusion detection methods,this paper attempts to use deep learning neural network technology to study a new type of intrusion detection method.Hence,we proposed an intrusion detection algorithm based on convolutional neural network(CNN)and AdaBoost algorithm.This algorithm uses CNN to extract the characteristics of network traffic data,which is particularly suitable for the analysis of continuous and classified attack data.The AdaBoost algorithm is used to classify network attack data that improved the detection effect of unbalanced data classification.We adopt the UNSW-NB15 dataset to test of this algorithm in the PyCharm environment.The results show that the detection rate of algorithm is99.27%and the false positive rate is lower than 0.98%.Comparative analysis shows that this algorithm has advantages over existing methods in terms of detection rate and false positive rate for small proportion of attack data.
