Assessment of a new volumetric capnography-derived parameter to reflect compression quality and to predict return of spontaneous circulation during cardiopulmonary resuscitation in a porcine model.

We aimed to evaluate a volumetric capnography (Vcap)-derived parameter, the volume of CO2 eliminated per minute and per kg body weight (VCO2/kg), as an indicator of the quality of chest compression (CC) and to predict the return to spontaneous circulation (ROSC) under stable ventilation status. Twelve male domestic pigs were utilized for the randomized crossover study. After 4 min of untreated ventricular fibrillation (VF), mechanical cardiopulmonary resuscitation and ventilation were administered. Following 5-min washout periods, each animal underwent two sessions of experiments: three types of CC quality for 5 min stages in the first session, followed by advanced life support, consecutively in two sessions. Different CC quality had a significant effect on the partial pressure of end-tidal carbon dioxide (PetCO2), VCO2/kg, aortic pressure (mean), aortic systolic pressure, aortic diastolic pressure, right atrial pressure (mean), and carotid blood flow (P < 0.05). With the improvement in CC quality, the values of PetCO2 and VCO2/kg also increased, and the difference between the groups was statistically significant (P < 0.05). The Spearman rank test revealed a significant correlation between the Vcap-derived parameters and hemodynamics. PetCO2 and VCO2/kg have similar capabilities for discriminating survivors from non-survivors, and the area under the curve for both was 0.97. VCO2/kg had similar performance as PetCO2 in reflecting the quality of CC and prediction of achieving ROSC under stable ventilation status in a porcine model of VF-related cardiac arrest. However, VCO2/kg requires a longer time to achieve a stable state after adjusting for quality of CC than PetCO2.

Different Types of Ligand Exchange Induced by Au Substitution in a Maintained Nanocluster Template.

Precisely regulating the ligand exchange on the nanocluster (NC) surface is challenging but important for fully understanding metal-ligand interactions and transformations. In this work, the homosilver nanocluster Ag40(TBBM)22(CH3COO)10 (Ag40) and its Au-substitution derivative AuAg39(TBBM)20(CH3COO)12 (AuAg39) have been synthesized and characterized by single-crystal X-ray crystallography (SC-XRD), nuclear magnetic resonance (NMR), X-ray photoelectron spectroscopy (XPS), and thermogravimetric analysis (TGA). By precisely controlling the template metal exchange progress, the intermediate product, namely, AuAg39(TBBM)21(CH3COO)11 (AuAg39-inter), was also obtained and then characterized by SC-XRD. These three nanoclusters possess a similar metallic framework, albeit some of the thiol ligands of Ag40 have been replaced by the introduced acetate ligands in both AuAg39-inter and AuAg39. Furthermore, Ag40 and AuAg39 NCs can serve as chiral amplifiers for testing the ee values of 2-chloropropionic acid, ibuprofen, naproxen, and isoleucine with high sensitivity.

Identification of Dysfunctional Gut Microbiota Through Rectal Swab in Patients with Different Severity of Acute Pancreatitis.

BACKGROUND: Acute pancreatitis (AP) has a wide spectrum of severity and can be associated with considerable morbidity and mortality. Whether gut microbiota dysbiosis is associated with AP severity remains obscure. AIMS: We aim to investigate the differences in the alterations of gut microbiota in different grades of AP severity. METHODS: We collected clinical information and rectal swab samples from 80 individuals. The gut microbiota was tested by 16S rRNA gene sequencing, gut microbiota species composition analysis, difference analysis, random forest model prediction analysis, and gut microbiota species correlation network analysis. RESULTS: There was a different microbiota profile in different severity grades. Bacteroides, Escherichis-Shigella, and Enterococcus were dominant species in mild, moderately severe, and severe AP, respectively. Finegoldia was the most significantly increased and Blautia the most decreased species in mild AP. Anaerococcus was the most significantly increased and Eubacterium hallii the most decreased species in moderately severe AP. Enterococcus was the most significantly increased and Eubacterium hallii the most decreased species in severe AP. Finegoldia, Eubacterium_hallii, and Lachnospiraceae were potential diagnostic biomarkers for mild AP and Eubacterium_hallii and Anaerococcus for moderately severe AP. There was a positive interaction between Firmicutes and Bacteroidetes in mild AP. CONCLUSIONS: The disturbed gut microbiota is different among grades of AP, suggesting their potential role in the progression of disease severity. There was a different microbiota profile in different severity grades. Bacteroides, Escherichis-Shigella, and Enterococcus were dominant gut microbiota species in MAP, MSAP, and SAP, respectively. Finegoldia was the most significantly increased and Blautia the most decreased gut microbiota species in MAP. Anaerococcus was the most significantly increased and Eubacterium hallii the most decreased species in MSAP. Enterococcus was the most significantly increased and Eubacterium hallii the most decreased species in SAP. Finegoldia, Eubacterium_hallii, and Lachnospiraceae were potential diagnostic biomarkers for MAP and Eubacterium_hallii and Anaerococcus for MSAP. There was a positive interaction between Firmicutes and Bacteroidetes in MAP.

Assembly of the Thiolated [Au1 Ag22 (S-Adm)12 ]3+ Superatom Complex into a Framework Material through Direct Linkage by SbF6 - Anions.

Building framework materials with desirable properties and enhanced functionalities with nanocluster/superatom complexes as building blocks remains a challenge in the field of nanomaterials. In this study, the chiral [Au1 Ag22 (S-Adm)12 ]3+ nanocluster/superatom complex (SC, in which S-Adm=1-adamantanethiol) was employed as a building block to construct the three-dimensional (3D) superatom complex inorganic framework (SCIF) materials SCIF-1 and SCIF-2 through inorganic SbF6 - linkers. SCIF-1 is racemic due to the assembly of two SC enantiomers in a single crystal. In SCIF-2, the SC enantiomers are packed in separate crystals, thus producing larger channels and a circularly polarized luminescence (CPL) response. These two 3D SCIF materials exhibit unique sensitive photoluminescence (PL) in protic solvents. Our study provides a new pathway for creating novel open-framework materials with superatom complexes and a foundation for the further development of 3D framework materials for sensing and other applications.

Low Serum Ionized Calcium, Elevated High-Sensitivity C-Reactive Protein, Neutrophil-Lymphocyte Ratio, and Body Mass Index (BMI) Are Risk Factors for Severe Acute Pancreatitis in Patients with Hypertriglyceridemia Pancreatitis.

BACKGROUND To investigate the clinical characteristics of hypertriglyceridemia pancreatitis (HTGP) and evaluate the correlative risk factors for severe acute pancreatitis (SAP) in HTGP patients. MATERIAL AND METHODS A total of 1005 patients with acute pancreatitis (AP) admitted to Peking Union Medical College Hospital (PUMCH) from 1 Jan 2013 to 1 Aug 2018 were retrospectively reviewed. After screening, we enrolled 159 patients with HTGP and 172 with non-hypertriglyceridemia pancreatitis (NHTGP). We gathered and assessed demographic and blood biochemical information and analyzed the risk factors for SAP. RESULTS Age, serum amylase (AMY), lipase (LIP), and serum ionized calcium (Ca²âº) in the HTGP group were lower than in the NHTGP group (P<0.05), while high-sensitivity C-reactive protein (hsCRP), neutrophil-lymphocyte ratio (NLR), and body mass index (BMI) in the HTGP group were higher than in the NHTGP group (P<0.05). Among the HTGP patients, the results indicated that Ca²âº (OR=0.018, P<0.001, 95%CI: 0.002-0.129) was an independent protective factor for SAP, while higher CRP (OR=1.008, P=0.004, 95%CI: 1.003-1.013), NLR (OR=1.314, P<0.001, 95%CI: 1.161-1.488), and BMI (OR=1.597, P=0.002, 95%CI: 1.195-2.314) were independent risk factors for SAP. CONCLUSIONS Patients with HTGP had lower serum Ca²âº and higher hsCRP, NLR, and BMI, and these were associated with higher risk of developing SAP.

[The effect of blood volume change on the accuracy of pulse contour cardiac output].

OBJECTIVE: To study the accuracy of pulse contour cardiac output (PCCO) during blood volume change. METHODS: Hemorrhagic shock model was made in twenty dogs followed by volume resuscitation. Two PiCCO catheters were placed into each model to monitor the cardiac output (CO). One of catheters was used to calibrate CO by transpulmonary thermodilution technique (COTP) (calibration group), and the other one was used to calibrate PCCO (none-calibration group). In the hemorrhage phase, calibration was carried out each time when the blood volume dropped by 5 percents in the calibration group until the hemorrhage volume reached to 40 percent of the basic blood volume. Continuous monitor was done in the none-calibration group.Volume resuscitation phase started after re-calibration in the two groups. Calibration was carried out each time when the blood equivalent rose by 5 percents in calibration group until the percentage of blood equivalent volume returned back to 100. Continuous monitor was done in none-calibration group. COTP, PCCO, mean arterial pressure (MAP), systemic circulation resistance (SVR), global enddiastolic volume (GEDV) were recorded respectively in each time point. RESULTS: (1) At the baseline, COTP in calibration group showed no statistic difference compared with PCCO in none-calibration group (P >0.05). (2) In the hemorrhage phase, COTP and GEDV in calibration group decreased gradually, and reached to the minimum value (1.06 ± 0.57) L/min, (238 ± 93) ml respectively at TH8. SVR in calibration group increased gradually, and reached to the maximum value (5 074 ± 2 342) dyn · s · cm⁻5 at TH6. However, PCCO and SVR in none-calibration group decreased in a fluctuating manner, and reached to the minimum value (2.42 ± 1.37) L/min, (2 285 ± 1 033) dyn · s · cm⁻5 respectively at TH8. COTP in the calibration group showed a significant statistic difference compared with PCCO in the none-calibration group at each time point (At TH1-8, t values were respectively -5.218, -5.495, -4.639, -6.588, -6.029, -5.510, -5.763 and -5.755, all P < 0.01). From TH1 to TH8, the difference in percentage increased gradually. There were statistic differences in SVR at each time point between the two groups (At TH1 and TH4, t values were respectively 2.866 and 2.429, both P < 0.05, at TH2 - TH3 and TH5 - TH8, t values were respectively 3.073, 3.590, 6.847, 8.425, 6.910 and 8.799, all P < 0.01). There was no statistic difference in MAP between the two groups (P > 0.05). (3) In the volume resuscitation phase, COTP and GEDV in the calibration group increased gradually. GEDV reached to the maximum value ((394±133) ml) at TR7, and COTP reached to the maximum value (3.15 ± 1.42) L/min at TR8. SVR in the calibration group decreased gradually, and reached to the minimum value (3 284 ± 1 271) dyn · s · cm⁻5 at TR8. However, PCCO and SVR in the none-calibration group increased in a fluctuating manner. SVR reached to the maximum value (8 589 ± 4 771) dyn · s · cm⁻5 at TR7, and PCCO reached to the maximum value (1.35 ± 0.70) L/min at TR8. COTP in the calibration group showed a significant statistic difference compared with PCCO in the none-calibration group at each time point (At TR1-8, t values were respectively 8.195, 8.703, 7.903, 8.266, 9.600, 8.340, 8.938, 8.332, all P < 0.01). From TR1 to TR8, the difference in percentage increased gradually. There were statistic differences in SVR at each time point between the two groups (At TR1, t value was -2.810, P < 0.05, at TR2-8, t values were respectively -6.026, -6.026, -5.375, -6.008, -5.406, -5.613 and -5.609, all P < 0.05). There was no statistic difference in MAP between the two groups (P > 0.05). CONCLUSION: PCCO could not reflect the real CO in case of rapid blood volume change, which resulting in the misjudgment of patient's condition. In clinical practice, more frequent calibrations should be done to maintain the accuracy of PCCO in rapid blood volume change cases.

Driving plasmonic nanoantennas with triangular lasers and slot waveguides.

Plasmonic nanoantennas can generate high-intensity electric fields in a very small area. However, being passive devices, they need to be excited by external laser sources. The excitation of nanoantennas by semiconductor lasers can be inefficient and a significant amount of light may return back to the laser source after being scattered by the nanoantenna. In this paper, it is shown that the amount of light being returned to the semiconductor laser can be reduced by using dielectric slot waveguides. These waveguides can transport the incident light to the nanoantennas, but the amount of nondirectional back-scattered light is reduced after propagation through the slot waveguide.

Interdependence between nanoclusters AuAg24 and Au2Ag41.

Whole series of nanoparticles have now been reported, but probing the competing or coexisting effects in their synthesis and growth remains challenging. Here, we report a bi-nanocluster system comprising two ultra-small, atomically precise nanoclusters, AuAg24(SR)18- and Au2Ag41(SR)26(Dppm)2+ (SR = cyclohexyl mercaptan, Dppm = bis(diphenylphosphino)-methane). The mechanism by which these two nanoclusters coexist is elucidated, and found to entail formation of the unstable AuAg24(SR)18-, followed by its partial conversion to Au2Ag41(SR)26(Dppm)2+ in the presence of di-phosphorus ligands, and an interdependent bi-nanocluster system is established, wherein the two oppositely charged nanoclusters protect each other from decomposition. AuAg24(SR)18 and Au2Ag41(SR)26(Dppm)2 are fully characterized by single crystal X-ray diffraction (SC-XRD) analysis - it is found that their co-crystallization results in single crystals comprising equimolar amounts of each. The findings highlight the interdependent relationship between two individual nanoclusters, which paves the way for new perspectives on nanocluster formation and stability.

New volumetric capnography-derived parameter: a potentially valuable tool for detecting hyperventilation during cardiopulmonary resuscitation in a porcine model.

BACKGROUND: Volumetric capnography is increasingly being applied in cardiopulmonary resuscitation. However, during cardiopulmonary resuscitation, the abnormal ventilation state affects the monitoring effect of the most commonly used capnography-derived parameter, the partial carbon dioxide end-tidal pressure (PetCO2). In this study, we evaluated the ability of a new volumetric capnography-derived parameter, the ratio between the PetCO2 and the volume of carbon dioxide (CO2) eliminated per min and per kilogram of body weight, for detecting hyperventilation during cardiopulmonary resuscitation. METHODS: We used 12 porcine models of primary ventricular fibrillation-induced cardiac arrest. Ventricular fibrillation was induced and left untreated for 4 min. Standardized chest compressions were performed throughout the experiment using mechanical cardiopulmonary resuscitation. Following 5 min of normal ventilation as a washout period, each animal underwent 4 types of ventilation. The main outcome measures were the PetCO2, the ratio between the PetCO2 and the volume of CO2 eliminated per min and per kilogram of body weight with each ventilation type. RESULTS: Different ventilation types had a significant effect on the volumetric capnography-derived parameters. The PetCO2 and ratio between the PetCO2 and the volume of CO2 eliminated per min and per kilogram of body weight values during cardiopulmonary resuscitation was significantly higher in non-hyperventilating than in hyperventilating animals. The ratio reflected hyperventilation accurately and immediately, with an area under the curve (AUC) of 0.98. The optimal cut-off point of the ratio for discriminating hyperventilation from non-hyperventilation was 6.36, with a sensitivity and specificity of 0.99 and 0.89, respectively. CONCLUSIONS: The ratio between the PetCO2 and the volume of CO2 eliminated per min and per kilogram of body weight showed good performance in discriminating hyperventilation from non-hyperventilation and was sensitive to changes in ventilation status. This ratio may be a valuable clinical indicator for monitoring the ventilation status during cardiopulmonary resuscitation.

Modified volumetric capnography-derived parameter: A potentially stable indicator in monitoring cardiopulmonary resuscitation efficacy in a porcine model.

AIM: We aimed to investigate whether the ability of the volumetric capnography-derived parameter, the volume of CO2 eliminated per minute and per kg body weight (V'CO2 kg-1), in monitoring the quality of CPR and predicting the return of spontaneous circulation (ROSC) remains undisturbed by hyperventilation. METHODS: This randomised crossover study included 12 male domestic pigs. After 4 min of untreated ventricular fibrillation, mechanical CPR was administered. Following 5-min washout periods, each animal underwent two sessions of experiments; four 5-min ventilation trials followed by advanced life support, consecutively in the two sessions. RESULTS: Different ventilation types had no significant impact on V'CO2 kg-1 or haemodynamics. However, PETCO2 was significantly affected by the ventilation type and coronary perfusion pressure (P < 0.05). The means ±â€¯standard deviations of PETCO2 decreased linearly with an increase in the respiratory rate (RR) (P < 0.05). The PETCO2 decreased from 20.42 ±â€¯9.51 to 16.16 ±â€¯5.07 (P < 0.05) as the tidal volume increased from 10 to 20 mL min-1. No significant differences in V'CO2 kg-1 were observed between the three RR levels of ventilation types (P = 0.274). Post hoc analysis demonstrated a significant difference between the highest value of V'CO2 kg-1 in double tidal volume hyperventilation and normal ventilation and triple respiratory rate hyperventilation (P < 0.05). The AUC for V'CO2 kg-1 and PETCO2 in discriminating between survivors and non-survivors was 0.80 and 0.71, respectively. CONCLUSIONS: V'CO2 kg-1 performs better than PETCO2 in monitoring the quality of CPR during hyperventilation. In predicting ROSC during variations in a ventilation state, V'CO2 kg-1 has good predictive ability.

The Novel Compound Heterozygous Mutations of ECEL1 Identified in a Family with Distal Arthrogryposis Type 5D.

INTRODUCTION: Distal arthrogryposis type 5D (DA5D) is an autosomal recessive disease. The clinical symptoms include contractures of the joints of limbs, especially camptodactyly of the hands and/or feet, unilateral ptosis, a round-shaped face, arched eyebrows, and micrognathia, without ophthalmoplegia. ECEL1 is a DA5D causative gene that encodes a membrane-bound metalloprotease. ECEL1 plays important roles in the final axonal arborization of motor nerves in limb skeletal muscles and neuromuscular junction formation during prenatal development. METHODS: A DA5D family with webbing of the elbows and fingers was recruited. We performed whole-exome sequencing (WES) and filtered mutations by disease-causing genes of arthrogryposis multiplex congenita (AMC). Mutational analysis and cosegregation confirmation were then performed. RESULTS: We identified novel compound heterozygous mutations of ECEL1 (NM_004826: c.69C>A, p.C23∗ and c.1810G>A, p.G604R) in the proband. CONCLUSIONS: We detected causative mutations in a DA5D family, expanding the spectrum of known ECEL1 mutations and contributing to the clinical diagnosis of DA5D.

Effects of different triglyceride-lowering therapies in patients with hypertriglyceridemia-induced acute pancreatitis.

The aim of the present study was to investigate the effects of various triglyceride (TG)-lowering therapies on hypertriglyceridemia-induced acute pancreatitis (HTGAP). A total of 132 patients with HTGAP were retrospectively divided into an insulin intensive therapy (IIT), a plasma exchange (PE) and a non-intensive insulin therapy (NIIT) group according to the TG-lowering therapies they had received. The clinical and biochemical data of the subjects were analyzed. The baseline data, including sex, age, TG, amylase, severe acute pancreatitis and systemic inflammatory response syndrome were not significantly different among the three groups (P>0.05). The 24-h TG clearance rate (χ2=7.74, P=0.021), onset to treatment time (χ2=14.50, P<0.001) and the time required to reach the target TG level (χ2=6.12, P=0.047) were different in these three groups, but no significant differences were observed between the IIT and NIIT groups (P>0.05). The incidence of therapy-associated complications in the PE group (30.23%) was higher than that in the IIT (2.17%) and NIIT (4.65%) groups. The difference in the incidence of therapy-associated complications was significant among the three groups (P<0.001), but no significant difference was present between the IIT and NIIT groups (P>0.05). In the PE group, the length of stay was increased compared with that in the IIT and NIIT groups (χ2=7.05, P<0.05), while there was no significant difference between the IIT and NIIT groups (P>0.05). The present study suggested that NIIT at presentation had a similar therapeutic efficacy to that of IIT to improve the prognosis of HTGAP, and NIIT and IIT were associated with fewer complications than PE treatment. NIIT may favorably perform in patients presenting early after symptom onset and may be considered for clinical application.

Coupling of light from microdisk lasers into plasmonic nano-antennas.

An optical dipole nano-antenna can be constructed by placing a sub-wavelength dielectric (e.g., air) gap between two metallic regions. For typical applications using light in the infrared region, the gap width is generally in the range between 50 and 100 nm. Owing to the close proximity of the electrodes, these antennas can generate very intense electric fields that can be used to excite nonlinear effects. For example, it is possible to trigger surface Raman scattering on molecules placed in the vicinity of the nano-antenna, allowing the fabrication of biological sensors and imaging systems in the nanometric scale. However, since nano-antennas are passive devices, they need to receive light from external sources that are generally much larger than the antennas. In this article, we numerically study the coupling of light from microdisk lasers into plasmonic nano-antennas. We show that, by using micro-cavities, we can further enhance the electric fields inside the nano-antennas.

Successful treatment of fulminant myocarditis in an adult in emergency department: A case report.

RATIONALE: Fulminant myocarditis (FM) has poor prognosis and the usual treatment is inotropes and symptomatic support. The initiation of extracorporeal membrane oxygenation (ECMO) and intra-aortic balloon pumping (IABP) in the emergency department (ED) is a rare event. PATIENT CONCERNS: We report the case of a 45-year-old man with a complaint of 4 days of high fever and dry cough in the emergency department. DIAGNOSIS: Transthoracic echocardiogram and the medical history showed presumptive diagnosis was fulminant myocarditis with cardiogenic shock. INTERVENTIONS: The patient's condition deteriorated drastically and ECMO was initiated immediately after admission. He experienced electrical storm twice during ECMO support and was successfully treated with the combination with IABP. OUTCOMES: ECMO and IABP were continued for 11 and 14 days respectively. The patient was discharged on the 81th day after admission, with all his laboratory tests returned to normal. LESSONS SUBSECTIONS: The early initiation of ECMO and IABP in the ED is potentially life-saving for suitable patients with FM. It appears promising but has not yet been routinely implemented in underdeveloped and developing countries.

Clinical Characteristics and Prognosis of Influenza B Virus-Related Hospitalizations in Northern China during the 2017-18 Influenza Season: A Multicenter Case Series.

BACKGROUND: By weekly monitoring of China's influenza situation, Chinese National Influenza Center observed that the 2017-18 season was predominated by influenza B virus (IBV)/Yamagata. No studies regarding hospitalizations in adults with IBV infections have been performed. We aimed to describe the clinical characteristics of hospitalized patients with IBV infection in northern China. METHODS: In this multicenter and retrospective study, we reviewed all consecutive adult patients with confirmed IBV infections at two level A tertiary teaching hospitals in northern China during the 2017-18 influenza season. Patients' clinical and diagnostic findings, as well as administered treatments and mortality data, were analyzed. RESULTS: A total of 573 patients with a confirmed diagnosis of IBV infection were identified, of whom 22 cases were analyzed because of IBV-related hospitalization. Most patients were admitted to the intensive care unit (ICU) and had at least one underlying disease. The total in-hospital mortality was 27.3%. An elevated initial pneumonia severity index score, elevated direct bilirubin values, and lower platelet levels were associated with mortality (p=0.020, 0.013, and 0.049, respectively). The quick development of bilateral diffuse alveolar infiltrates was the most common imaging characteristics, following consolidation and pleural effusion(s). Risk factors such as HIV infection, pregnancy, underlying medical conditions, coinfections, and treatment delays were not associated with mortality. CONCLUSIONS: IBV should not be neglected because of its significant mortality. The elderly and patients with comorbidities, such as hypertension, diabetes, and connective tissue diseases, are more likely to have severe IBV-related pneumonia. Higher heart rates, direct bilirubin levels, initial PSI scores, and lower platelet levels are correlated with hospital mortality. Increased uptake in tetravalent influenza vaccine should be very helpful in preventing future cases of IBV hospitalizations.

Computer-aided detection of diagnostic and therapeutic operations in colonoscopy videos.

Colonoscopy is an endoscopic technique that allows a physician to inspect the inside of the human colon and to perform--if deemed necessary-at the same time a number of diagnostic and therapeutic operations. In order to see the inside of the colon, a video signal of the internal mucosa of the colon is generated by a tiny video camera at the tip of the endoscope and displayed on a monitor for real-time analysis by the physician. We have captured and stored these videos in digital format and call these colonoscopy videos. Based on new algorithms for instrument detection and shot segmentation, we introduce new spatio-temporal analysis techniques to automatically identify an operation shot--a segment of visual data in a colonoscopy video that corresponds to a diagnostic or therapeutic operation. Our experiments on real colonoscopy videos demonstrate the effectiveness of the proposed approach. The proposed techniques and software are useful for 1) postprocedure review for causes of complications due to diagnostic or therapeutic operations; 2) establishment of an effective content-based retrieval system to facilitate endoscopic research and education; 3) development of a systematic approach to assess and improve the procedural skills of endoscopists.

Arthemis: annotation software in an integrated capturing and analysis system for colonoscopy.

Colonoscopy is an endoscopic technique that allows physicians to inspect the inside of the human colon. During a colonoscopic procedure, a tiny video camera at the tip of the endoscope generates a video signal of the internal mucosa of the colon. In current practice, the entire colonoscopic procedure is not routinely captured. Software tools providing easy access to important contents of videos that are digitally captured during colonoscopy are not available. Hence, it is very time consuming to review an entire video, locate important contents, annotate them, and extract the annotated contents for research, teaching, and training purposes. Arthemis, a software application, was developed to facilitate this process. For convenient data sharing, Arthemis allows annotation according to the European Gastrointestinal Society for Endoscopy (ESGE) Minimal Standard Terminology (MST), an internationally accepted standard for digestive endoscopy. Arthemis is part of our integrated capturing and content analysis system for colonoscopy called Endoscopic Multimedia Information System (EMIS). This paper presents Arthemis as a component of EMIS, the design and implementation of Arthemis, and key lessons learned from the development process.

Measuring objective quality of colonoscopy.

Advances in video technology are being incorporated into today's healthcare practices. Colonoscopy is regarded as one of the most important diagnostic tools for colorectal cancer. Indeed, colonoscopy has contributed to a decline in the number of colorectal-cancer-related deaths. Although colonoscopy has become the preferred screening modality for prevention of colorectal cancer, recent data suggest that there is a significant miss rate for the detection of large polyps and cancers, and methods to investigate why this occurs are needed. To address this problem, we present a new computer-based method that analyzes a digitized video file of a colonoscopic procedure and produces a number of metrics that likely reflect the quality of the procedure. The method consists of a set of novel image-processing algorithms designed to address new technical challenges due to uncommon characteristics of videos captured during colonoscopy. As these measurements can be obtained automatically, our method enables future quality control in large-scale day-to-day medical practice, which is currently not feasible. In addition, our method can be adapted to other endoscopic procedures such as upper gastrointestinal endoscopy, enteroscopy, and bronchoscopy. Last but not least, our method may be useful to assess progress during colonoscopy training.

Quadrant coverage histogram: a new method for measuring quality of colonoscopic procedures.

Colonoscopy is an endoscopic technique that allows a physician to inspect the inside of the human colon. Although millions of colonoscopic procedures are performed annually, an objective method that estimates how much effort was undertaken to insure maximal inspection of the visible parts of the inside of the colon, does not exist. Experts agree that it is desirable to inspect all quadrants of the colon wall while the endoscope is gradually withdrawn. In this paper, we present a new computer-based method that constructs a Quadrant Coverage Histogram to determine the number of quadrants of the colon wall inspected during the withdrawal phase of colonoscopy. The proposed method is part of our novel computer-aided quality control system for colonoscopy intended for use in routine clinical practice.

Automatic classification of images with appendiceal orifice in colonoscopy videos.

Colonoscopy is an endoscopic technique that allows a physician to inspect the inside of the human colon. In current practice, videos captured from colonoscopic procedures are not routinely stored for either manual or automated post-procedure analysis. In this paper, we introduce new algorithms for automated detection of the presence of the shape of the opening of the appendix in a colonoscopy video frame. The appearance of the appendix in colonoscopy videos indicates traversal of the colon, which is an important measurement for evaluating the quality of colonoscopic procedures. The proposed techniques are valuable for (1) establishment of an effective content-based retrieval system to facilitate endoscopic research and education; and (2) assessment and improvement of the procedural skills of endoscopists, both in training and practice.