Effect of computer-aided colonoscopy on adenoma miss rates and polyp detection: A systematic review and meta-analysis.

BACKGROUND AND AIM: Multiple computer-aided techniques utilizing artificial intelligence (AI) have been created to improve the detection of polyps during colonoscopy and thereby reduce the incidence of colorectal cancer. While adenoma detection rates (ADR) and polyp detection rates (PDR) are important colonoscopy quality indicators, adenoma miss rates (AMR) may better quantify missed lesions, which can ultimately lead to interval colorectal cancer. The purpose of this systematic review and meta-analysis was to determine the efficacy of computer-aided colonoscopy (CAC) with respect to AMR, ADR, and PDR in randomized controlled trials. METHODS: A comprehensive, systematic literature search was performed across multiple databases in September of 2022 to identify randomized, controlled trials that compared CAC with traditional colonoscopy. Primary outcomes were AMR, ADR, and PDR. RESULTS: Fourteen studies totaling 10 928 patients were included in the final analysis. There was a 65% reduction in the adenoma miss rate with CAC (OR, 0.35; 95% CI, 0.25-0.49, P < 0.001, I2  = 50%). There was a 78% reduction in the sessile serrated lesion miss rate with CAC (OR, 0.22; 95% CI, 0.08-0.65, P < 0.01, I2  = 0%). There was a 52% increase in ADR in the CAC group compared with the control group (OR, 1.52; 95% CI, 1.39-1.67, P = 0.04, I2  = 47%). There was 93% increase in the number of adenomas > 10 mm detected per colonoscopy with CAC (OR 1.93; 95% CI, 1.18-3.16, P < 0.01, I2  = 0%). CONCLUSIONS: The results of the present study demonstrate the promise of CAC in improving AMR, ADR, PDR across a spectrum of size and morphological lesion characteristics.

Metastatic Testicular Embryonal Carcinoma Presenting as Gastrointestinal Hemorrhage.

Testicular cancer is the most common malignancy in men aged 20-35 years, usually presenting with painless scrotal swelling. Metastases, should they occur, frequently involve retroperitoneal lymph nodes, which drain the testes. Gastrointestinal (GI) metastases are rare, and metastatic disease may not initially be considered in a young man presenting with GI hemorrhage. This case demonstrates the importance of evaluating for a primary underlying malignancy, especially if other causes of GI hemorrhage have been ruled out. Testicular primary should additionally be considered in men because early intervention may often lead to improved clinical outcomes.

Successful use of a novel dynamic rigidizing overtube in a patient with looping during colonoscopy.

Video 1This video is our description of use of the novel dynamic rigidizing overtube in a challenging colonoscopy case in which looping was causing significant bradycardia and inability to advance the colonoscope to the cecum. The rigidizing overtube, through sequential cycles of its flexible and rigidized state, allowed for easy movement of the colonoscope to the cecum.

Segmental Tibia Fractures: An Analysis of Complication and Healing Rates.

OBJECTIVES: To determine the most commonly associated injuries, complications, and healing rates of patients sustaining segmental tibial shaft fractures. DESIGN: Retrospective review. SETTING: Two Level I trauma centers. PATIENTS: A total of 108 patients with segmental tibial shaft fractures were identified between 2005 and 2013. INTERVENTION: None. MAIN OUTCOME MEASURES: Demographics, injury characteristics, treatments, and complications. Categories were evaluated and analyzed based on frequency of occurrence. Time to union was assessed based on serial radiographs. RESULTS: A total of 108 patients met the inclusion criteria. All fractures were OTA/AO type 42C2. Seventy-three patients (68%) sustained open fractures. There were 34 patients (31%) who had compartment syndrome. The median Injury Severity Score was 27 (range 4-75). Ninety-five patients underwent reamed intramedullary nailing of the tibia, 4 underwent open reduction internal fixation, and 2 patients were definitively treated with external fixation. The median length of hospital stay was 11 days (range 3-48). Outcome data (time to union/delayed union/malunion) was available for 101 patients. The median time to union was 26 weeks (range 14-48). The delayed union rate was 40% (40/101) and the nonunion rate was 10% (10/101). CONCLUSION: Segmental tibial shaft fractures are often associated with severe polytrauma and are most often open fractures. Reamed intramedullary nailing after appropriate resuscitative and stabilization methods can result in excellent alignment and union in these fractures, with low nonunion and infection rates at 1 year. LEVEL OF EVIDENCE: Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Comparison of methane production by co-digesting fruit and vegetable waste with first stage and second stage anaerobic digester sludge from a two stage digester.

Fruit and vegetable waste (FVW) was co-digested with first stage (FSS) and second stage anaerobic digester sludge (SSS) separately, over the course of 10 days, in batch reactors. Addition of FVW significantly increased the methane production in both sludges. After 10 days of digestion FSS + FVW produced 514 ± 57 L CH(4) kg VS(-1)(added) compared with 392 ± 16 L CH(4) for the SSS + FVW. The increased methane yield was most likely due to the higher inoculum substrate ratio of the FSS. The final VS and COD contents of the sewer sludge and FVW mixtures were not significantly different from the control values suggesting that all of the FVW added was degraded within 10 days. It is recommended that FVW be added to the first stage of the anaerobic digester in order to maximize methane generation.

Wood pellet fly ash and bottom ash as an effective liming agent and nutrient source for rye grass (Lolium perenne L.) and oats (Avena sativa).

Fly ash (FA) and bottom ash (BA) from a softwood pellet boiler were characterized and evaluated as soil amendments. In a greenhouse study, two plant species (rye grass, Lolium perenne L. and oats, Avena sativa) were grown in three different treatments (1% FA, 1% BA, non-amended control) of a silty loam soil. Total concentrations of plant nutrients Ca, K, Mg, P and Zn in both ashes were elevated compared to conventional wood ash. Concentrations of Cd, Cr, Pb, Se and Zn were found to be elevated in the FA relative to BA and the non-amended soil. At 28 d, oat above-ground biomass was found to be significantly greater in soil amended with FA. Potassium and Mo plant tissue concentrations were significantly increased by addition of either ash, and FA significantly increased Zn tissue concentrations. Cadmium and Hg tissue concentrations were elevated in some cases. As soil amendments, either pellet ash is an effective liming agent and nutrient source, but high concentrations of Cd and Zn in FA may preclude its use as an agricultural soil amendment in some jurisdictions. Lower ash application rates than those used in this study (i.e. <1%) may still provide sufficient nutrients and effective neutralization of soil acidity.

Increased biogas production in a wastewater treatment plant by anaerobic co-digestion of fruit and vegetable waste and sewer sludge - a full scale study.

Anaerobic digestion is a well established technology for the reduction of organic matter and stabilization of wastewater. Biogas, a mixture of methane and carbon dioxide, is produced as a useful by-product of the process. Current solid waste management at the city of Prince George is focused on disposal of waste and not on energy recovery. Co-digestion of fresh fruit and vegetable waste with sewer sludge can improve biogas yield by increasing the load of biodegradable material. A six week full-scale project co-digesting almost 15,000 kg of supermarket waste was completed. Average daily biogas production was found to be significantly higher than in previous years. Digester operation remained stable over the course of the study as indicated by the consistently low volatile acids-to-alkalinity ratio. Undigested organic material was visible in centrifuged sludge suggesting that the waste should have been added to the primary digester to prevent short circuiting and to increase the hydraulic retention time of the freshly added waste.