Differentiating Gastrointestinal Stromal Tumors From Leiomyomas of Upper Digestive Tract Using Convolutional Neural Network Model by Endoscopic Ultrasonography.

BACKGROUND: Gastrointestinal stromal tumors (GISTs) and leiomyomas are the most common submucosal tumors of the upper digestive tract, and the diagnosis of the tumors is essential for their treatment and prognosis. However, the ability of endoscopic ultrasonography (EUS) which could correctly identify the tumor types is limited and closely related to the knowledge, operational level, and experience of the endoscopists. Therefore, the convolutional neural network (CNN) is used to assist endoscopists in determining GISTs or leiomyomas with EUS. MATERIALS AND METHODS: A model based on CNN was constructed according to GoogLeNet architecture to distinguish GISTs or leiomyomas. All EUS images collected from this study were randomly sampled and divided into training set (n=411) and testing set (n=103) in a ratio of 4:1. The CNN model was trained by EUS images from the training set, and the testing set was utilized to evaluate the performance of the CNN model. In addition, there were some comparisons between endoscopists and CNN models. RESULTS: It was shown that the sensitivity and specificity in identifying leiomyoma were 95.92%, 94.44%, sensitivity and specificity in identifying GIST were 94.44%, 95.92%, and accuracy in total was 95.15% of the CNN model. It indicates that the diagnostic accuracy of the CNN model is equivalent to skilled endoscopists, or even higher than them. CONCLUSION: While identifying GIST or leiomyoma, the performance of CNN model was robust, which is highlighting its promising role in supporting less-experienced endoscopists and reducing interobserver agreement.

Exosome-delivered BMP-2 and polyaspartic acid promotes tendon bone healing in rotator cuff tear via Smad/RUNX2 signaling pathway.

Rotator cuff tear is the main form of shoulder joint injury, which seriously affects shoulder joint function. This study aimed to clarify the function and mechanism of exosomes containing polylactic acid (PLA), polylactic acid copolymer and BMP-2 in tendon bone healing of rotator cuff tear. First, CD44 expression in bone marrow mesenchymal stem cells (BMSCs) and CD90 and CD44 in exosomes were analyzed by flow cytometry. Then, stability and targeting identification of exosome-delivered bone morphogenetic protein (BMP)-2 and PLA microcapsules were measured by transmission electron microscopy (TEM), DiO/DiI staining. Finally, tendon-bone repair after acute rotator cuff rupture in rabbits was established, and the function of BMP-2 exosomes for tendon bone healing in rotator cuff tear was evaluated by micro-CT, biomechanical determination and histochemical staining methods. The results showed that the exosomes of polyaspartic acid-polylactic acid-glycolic acid copolymer (PASP-PLGA) microcapsules were successfully established which showed good stability and targeting. The bone mineral density (BMD), tissue mineral density (TMD) and bone volume fraction (BV/TV) were higher, while the stiffness and the ultimate load strength of the tendon interface were enhanced under treatment with exosomes of PASP-PLGA microcapsules. Histochemical staining showed that exosomes of PASP-PLGA microcapsules promoted tendon and bone interface healing after rotator cuff injury. The tendon regeneration- and cartilage differentiation-related protein expressions were significantly upregulated under treatment with exosomes of PASP-PLGA microcapsules. In conclusion, exosome-delivered BMP-2 and PLA promoted tendon bone healing in rotator cuff tear via Smad/RUNX2 pathway. Our findings may provide a new insight for promoting tendon healing.

Universal adversarial perturbations for CNN classifiers in EEG-based BCIs.

Objective. Multiple convolutional neural network (CNN) classifiers have been proposed for electroencephalogram (EEG) based brain-computer interfaces (BCIs). However, CNN models have been found vulnerable to universal adversarial perturbations (UAPs), which are small and example-independent, yet powerful enough to degrade the performance of a CNN model, when added to a benign example.Approach. This paper proposes a novel total loss minimization (TLM) approach to generate UAPs for EEG-based BCIs.Main results. Experimental results demonstrated the effectiveness of TLM on three popular CNN classifiers for both target and non-target attacks. We also verified the transferability of UAPs in EEG-based BCI systems.Significance. To our knowledge, this is the first study on UAPs of CNN classifiers in EEG-based BCIs. UAPs are easy to construct, and can attack BCIs in real-time, exposing a potentially critical security concern of BCIs.

Reliability of Endoscopic Ultrasound Using Miniprobes and Grayscale Histogram Analysis in Diagnosing Upper Gastrointestinal Subepithelial Lesions.

BACKGROUND: To assess the role of endoscopic ultrasound (EUS) in the diagnosis of upper gastrointestinal subepithelial lesions (SELs) and to investigate EUS combined with a grayscale histogram analysis for the differentiation of leiomyomas and gastrointestinal stromal tumors (GISTs). METHODS: A retrospective study of 709 patients with upper gastrointestinal SELs was conducted by EUS before endoscopic resection. The EUS findings of SELs and pathological results after endoscopic resection were compared. The EUS images of SELs, particularly, leiomyoma and GIST, were further analyzed via a grayscale histogram to differentiate between the two tumors. RESULTS: Of the 709 patients, 47 cases were pathologically undetermined. The diagnostic consistency of EUS with endoscopic resection was 88.2% (584/662), including 185 muscularis mucosa, 61 submucosa, and 338 muscularis propria, respectively. The diagnostic consistency of EUS with pathology was 80.1% (530/662). The gray value of GISTs was significantly higher than that of leiomyomas (58.9 ± 8.3 vs. 39.5 ± 5.9, t = 57.0, P < 0.0001). The standard deviation of leiomyomas was significantly lower than that of GISTs (20.6 ± 7.0 vs. 39.8 ± 9.3, t = 23.7, P < 0.0001). The grayscale histogram analysis of GISTs showed higher echo ultrasound, and the echo of leiomyoma was more uniform. CONCLUSION: EUS is the preferred procedure for the evaluation of upper gastrointestinal SELs. EUS combined with a grayscale histogram analysis is an effective method for the differentiation of leiomyomas and GISTs.

[Comparison of long Gamma 3 nail and proximal femur locking plate for the treatment of femoral subtrochanteric fractures].

OBJECTIVE: To compare clinical efficacy of long Gamma 3 nail and proximal femur locking plate (PFLP) in treating femoral subtrochanteric fractures. METHODS: From January 2010 to January 2017, clinical data of 58 patients with subtrochanteric fractures followed more than 12 months were retrospective analyzed. Among them, 35 patients were treated with long Gamma 3 nail including 18 males and 17 females aged from 25 to 78 years old with an average of(66.5±23.5) years old;Causes of injury included fall on the ground in 18 cases, traffic accidents in 7 cases, and fall from height in 10 cases. The other 23 patients were treated with PFLP fixation including 8 males and 15 females aged from 31 to 81 years old with an average of (63.4±22.4) years old;Causes of injury included fall on the ground in 12 cases, traffic accidents in 6 cases, and fall from height in 5 cases. Operative time, blood loss (intraoperative and hidden blood loss), hospital stays, bone healing and complications were observed and compared. Harris hip score after 1-year following-up was used to evaluate postoperative clinical effect. RESULTS: Fifty-one patients were followed up from 14 to 36 months with an average of 24.8 months, including 31 patients were treated with long Gamma 3 and 20 patients were treated with PFLP. Blood loss(intraoperative and hidden blood loss) in PFLP group was less than that of long Gamma 3 nail group(P<0.05). There was no significant in operative time, hospital stays and complications between two groups(P>0.05). There was no significant differences in healing time of fractures between long Gamma 3 nail group (17.2±2.4) weeks and PFLP group (18.1±2.6) weeks(P<0.05). At 1-year following-up, there was no significant differences in Harris hip score between long Gamma 3 nail group(80.29±10.28) and PFLP group (76.49±12.28)(P<0.05). No complications such as pulmonary embolism and nonunion occurred. Two patients were treated with fitler whose occurred deep vein thrombosis. Postoperative pulmonary infection curred in 4 cases and was cured by anti-infection therapy. CONCLUSIONS: Both of long Gamma 3 nail and PFLP in treating patients with femoral subtrochanteric fractures can receive good clinical effects, long Gamma 3 nail is not suitable for the patients of the narrow medullary cavity and prominent anterior arch. PFLP is eccentric fixation, so early weight-bearing was not stress.

[Advanced progress on the treatment of anterior approach to the thoracolumbar vertebral fractures].

Thoracolumbar fractures are common and severe traumas. Anterior approaches can achieve adirect spinal cord decompression and reconstruct anterior column height what load bearing the major load distribution of the spine. Therefore, anterior approach is an important method in the treatment of thoracolumbar fractures. With the application of pedicle screw, most of the patients were treated with posterior approaches.Because of the unique advantages of anterior approach, the posterior approach can not be replaced it.The review summarizes the biomechanical characteristics? indications? fixation devices? bone grafting method and technique of the anterior approach and in order to provide better evidence for clinical treatment of thoracolumbar fractures.

Controlled study on Gamma nail and proximal femoral locking plate for unstable intertrochanteric femoral fractures with broken lateral wall.

The gamma nail and proximal femoral locking plate (PFLP) are both used for fractures. A controlled study was performed to determine the optimal implant. To assess and analyze the clinical effects of gamma nails and PFLPs for patients with unstable intertrochanteric femoral fractures, specifically with broken lateral walls. Thirty-six patients with unstable intertrochanteric femoral fractures and broken lateral walls were treated with gamma nails or PFLPs and retrospectively studied. The clinical data were compared. Duration of surgery and early full weight-bearing time were significantly longer in the PFLP group compared to the gamma nail group (P < 0.05). However, intraoperative fluoroscopy frequency and total blood loss in the PFLP group were significantly less than those in the gamma nail group (P < 0.05). No significant differences were found in hospitalized days, Parker Palmer mobility scores, Harris hip scores, and complications between the two groups. No difference in hip-functional recovery was found between the gamma nail group and the PFLP group, indicating that both the gamma nail and PFLP were effective for unstable intertrochanteric femoral fractures with a broken lateral wall. However, early weight bearing on the fractures was not encouraged in patients treated with PFLP.

Endoscopic Ultrasound Imaging for Differential Diagnosis of Pancreatic Neoplasms: A 7-Year Study in a Chinese Population.

BACKGROUND Currently, non-invasive methods for screening pancreatic cancer are lacking. There is little information regarding whether endoscopic ultrasound (EUS) imaging has a discriminatory ability for detecting benign and malignant pancreatic neoplasms. In this study, we retrospectively analyzed the demographic, clinicopathologic, and EUS features and follow-up information. MATERIAL AND METHODS A total of 58 patients with pancreatic neoplasms who underwent endoscopic ultrasound-guided fine-needle aspiration (EUS-FNA) over a 7-year period (2009-2016) at our Department of Digestive Diseases were enrolled in our study. RESULTS Of the 58 patients, 38 (65.5%) were diagnosed with malignant pancreatic neoplasms and 20 (34.5%) were benign ones. Of all the EUS findings, size of neoplasm (P=0.037) and regularity of margin (P=0.011) were significantly different between malignant and benign pancreatic neoplasms. However, age, sex, location, echo pattern, and dilation of main pancreatic duct did not show any significant difference (P>0.05). Size combined with regularity to detect malignant pancreatic neoplasms showed the following diagnostic values: sensitivity, 73.68%; specificity, 90%; positive predictive value, 76.60%; negative predictive value 81.82%; and area under the receiver operating characteristic curve, 0.887 (95% CI: 0.777-0.955, P<0.0001). CONCLUSIONS Our results showed the high value of EUS for differentiating malignant pancreatic neoplasms from benign ones. Due to this and its non-invasive nature, EUS should be the first-line method for detection of neoplastic pancreatic lesions.

Treatment of Neer IIb Distal Clavicle Fractures Using Anatomical Locked Plate Fixation With Coracoclavicular Ligament Augmentation.

PURPOSE: The purpose of this study was to evaluate the clinical and radiographic outcomes of Neer type IIb distal clavicle fractures treated with anatomical locking plate fixation combined with coracoclavicular ligament augmentation. METHODS: Twelve patients with Neer Type IIb distal clavicle fractures treated with anatomical locking plate fixation combined with suture anchor augmentation of the coracoclavicular ligament, were retrospectively studied. Clinical outcomes were assessed using the Constant score and the Disabilities of the Arm, Shoulder, and Hand (DASH) score. Coracoclavicular distance was measured on plain radiographs. RESULTS: All patients were reexamined at a mean follow-up of 26.3 months (range, 25-30 months). Bony union occurred in all cases within 12 weeks and no major complications were encountered. At the final follow-up, the mean Constant score was 94 (range, 87-100) and the DASH score was 10.4 (range, 2-20). The mean postoperative coracoclavicular distance on the injured side was decreased by 40% compared with the preoperative status. CONCLUSIONS: Surgical fixation of Neer type IIb distal clavicle fractures using anatomical locking plate fixation combined with suture anchor augmentation of the coracoclavicular ligament was associated with a satisfactory functional outcome and low complication rate. TYPE OF STUDY/LEVEL OF EVIDENCE: Therapeutic IV.

[A medium term therapeutic effects of anatomic locking plate for femoral intertrochanteric with lateral femoral wall fractures].

OBJECTIVE: To retrospectively study medium term follow-up outcomes of the femoral intertrochanteric with lateral femoral wall fractures using anatomic locking plate fixation. METHODS: From June 2010 to January 2013, 18 cases of the unstable femoral intertrochanteric with lateral femoral wall fractures were treated with the anatomic locking plate, included 8 males and 10 females with an average age of 75.5 years ranging from 19 to 83 years old. There were 8 cases of traffic accident injuries, 6 cases of falls injuries, and 4 cases of falling from high place. The time from injury to operation was ranged from 1 to 14 days with an average of 4.5 days. The operation time, intraoperative blood loss and the length of hospitalization were recorded and analyzed. The fracture union was assessed by follow-up radiographs and hip functional recovery by PPMS and Harris hip scoring. RESULTS: All patients were followed up from 36 to 68 months with a mean of(44.8±8.8) months. The mean operative time was (61.02±38.28) min;the mean blood loss was (226.00±162.52) ml;the mean length of hospitalization was (10.8±9.2) days. During the follow-up period, no infection, deep veintllrombosis, screwed cut-out and implant failure occurred in all patients. Coxa vara with shortening deformity was noted in 2 cases. Bone union was found in all the cases. The bone healing time was ranged from 4 to 10 months with an average of 6.2 months. The mean PPMS score at the final follow-up was 7.22±2.36. The Harris score was 79.46±11.02, 5 cases were classified as excellent, 9 as good and 2 as fair. CONCLUSIONS: Proximal femoral anatomic locking plate can be used in treating intertrochanteric fractures with compromised lateral wall, which has a satisfied medium term follow-up outcomes, especially for complex fractures patterns in which intramedullary nailing may be difficult, and should not emphasis on premature loading.

[Inversive LISS plate in treating intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures].

OBJECTIVE: To study clinical effects of inversive LISS(less invasive stabilization system, LISS) plate for the treatment of intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures. METHODS: From January 2012 to January 2015, 24 patients with intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures were treated with inversive LISS plate, included 16 males and 8 females with an average age of 62.5 years old ranged from 35 to 81 years old. There were 8 cases of traffic accident injuries, 3 cases of falling from high place, and 13 cases of falls injuries. The time from injury to operation was ranged from 2 to 12 days with an average of 5.2 days. The operation time, intraoperative blood loss and the length of hospitalization were analyzed. The fracture union was assessed by follow-up radiographs and hip functional recovery by Harris hip scoring. RESULTS: All patients were followed up for 16.2 months (ranged, 18 to 36 months). The mean operative time was (68.22±48.36) min;the mean blood loss was (256.28±182.46) ml;the mean time of hospitalization was(14.8±5.2) days. There were no complications such as deep infection, deep vein thrombosis, pulmonary embolism and bone nonunion during the follow up period. The bone healing was ranged from 3 to 8 months with an average of 4.8 months. The mean Harris score was 76.49±12.28 at the final follow-up, 15 cases were classified as excellent, 6 as good and 3 as fair. CONCLUSIONS: Inversive LISS plate can be used in treating with intertrochanteric and subtrochanteric fractures combined with femoral shaft fractures, and should not emphasis on premature loading.

[Comparison of anatomical locking plate and Gamma nail for the treatment of intertrochanteric fracture with external wall fractures].

OBJECTIVE: To compare clinical efficacy of anatomic locking plate and Gamma nail in treating unstable femoral intertrochanteric fractures with external wall fractures. METHODS: From June 2010 to June 2014,clinical data of 44 patients with intertroehanteric fractures associated with lateral wall fractures (type 31A2.2-3.3) followed more than 12 months,which treated with Gamma nail or anatomic locking plate,were retrospective analyzed. Sixteen patients were treated with anatomic locking plate, including 6 males and 10 females aged from 32 to 83 years old with an average of 56.5 years old. Twenty-eight patients were treated with Gamma nail including 17 males and 11 females aged from 26 to 87 years old with an average of 60.4 years old. Operative time, intraoperative fluoroscopy times, blood loss (intraoperative and hidden blood loss), hospital stays were observed and compared. PPMS and HHS scoring were used to evaluate postoperative clinical effect. RESULTS: All patients were followed up from 12 to 24 months with an average of 16.2 months. Operative time in Gamma nail was shorter than anatomic locking plate; while blood loss( intraoperative and hidden blood loss) and intraoperative fluoroscopy times in anatomic locking plate were less than that of in Gamma nail. There was no significant meaning in hospital stays between two groups. Postoperative full weight-bearing time in anatomic locking plate was prolonged than Gamma nail. At the final following-up, PPMS in Gamma nail was 7.50 ± 1.78 and 6.82 ± 1.38 in anatomic locking plate, and there was no obvious meaning between two groups (t = 2.341, P = 0.132); there was no significant differences in HHS score between Gamma nail (83.25 ± 11.18) and anatomic locking plate (86.14 ± 12.36) (t = 1.923, P = 0.243). The incidence of complications in Gamma nail was less than anatomic lock-ing plate (P = 0.005). CONCLUSION: Anatomic locking plate for intertrochanteric fractures with external wall fractures could avoid re-injury of external wall, especially for severe comminuted fractures, difficult for intramedullary nailing, and there was no significant meaning in hip joint function compared with Gamma nail, while postoperative incidence of complications was higher than Gamma nail, so early weight-bearing was not stress.

Hemostatic effect of topical hemocoagulase spray in digestive endoscopy.

AIM: To evaluate the hemostatic effect of topical hemocoagulase spray in digestive endoscopy. METHODS: Eighty-nine patients who developed oozing bleeding during endoscopic treatment from September 2014 to October 2014 at Center for Digestive Endoscopy, Tianjin Medical University General Hospital were randomly divided into either a study group (n = 39) or a control group (n = 50). The study group was given topical hemocoagulase spray intraoperatively, while the control group was given traditional 8% norepinephrine spray. Hemostatic efficacy was compared between the two groups. Bleeding site, wound cleanliness and perforation were recorded, and the rates of perforation and late bleeding were compared. RESULTS: Successful hemostasis was achieved in 39 (100%) patients of the study group and in 47 (94.0%) patients of the control group, and there was no significant difference in the rate of successful hemostasis between the two groups. Compared with the control group, after topical hemocoagulase spray in the study group, the surgical field was clearer, the bleeding site was more easily identified, and the wound was cleaner. There was no significant difference in the rate of perforation between the study and control groups (16.7% vs 35.0%, P = 0.477), but the rates of late bleeding (0% vs 15.8%, P = 0.048) and overall complications (P = 0.032) were significantly lower in the study group. CONCLUSION: Topical hemocoagulase spray has a definite hemostatic effect for oozing bleeding in digestive endoscopy, and this method is convenient, safe, and reliable. It is expected to become a new method for endoscopic hemostasis.

[DNA methylation of microRNA-34b/c and microRNA-124a in gastric cancer].

OBJECTIVE: To explore the effects of DNA methylation of microRNA (miRNA) gene on their expressions in patients with gastric carcinoma. METHODS: A total of 80 subjects were divided into gastric carcinoma group (n = 40) and control group (n = 40). The DNA methylation status of miRNA-34b/c and miRNA-124a gene promoters was detected by DNA methylation specific polymerase chain reaction (MSP) in gastric carcinoma tissues and normal mucosal tissues. RESULTS: The positive rate of DNA methylation of miRNA-34b/c gene promoter was 77.5% (31/40) and 5.0% (2/40) in gastric carcinoma and control groups respectively. There was statistically significant difference between two groups (P < 0.05). The positive rate of DNA methylation of miRNA-124a gene promoter was 60.0% (24/40) and 0 in these two groups respectively. There was statistically significant difference between two groups (P < 0.05). Also the hypermethylation positivity of gene promoter of miRNAs was correlated with the clinicopathological features of gastric carcinoma. CONCLUSION: The hypermethylation of miRNA-34b/c and miRNA-124a gene promoters may play a crucial role in the occurrence and development of gastric carcinoma.

[The predictive value of end-stage liver disease model for spontaneous bacterial peritonitis in cirrhotic patients with ascites].

OBJECTIVE: Spontaneous bacterial peritonitis (SBP) is a severe complication in cirrhotics with ascites. Early identification of high-risk patients is crucial for prognostic improvement. We aimed to investigate the predictive value of model for end-stage liver disease (MELD) score at admission in predicting incidence rate of SBP in cirrhotic patients with ascites, so as to evaluate its use in early diagnosis and prognosis of this complication. METHODS: A retrospective study enrolling 254 consecutive patients with cirrhosis and ascites between June 2003 and June 2006 was carried out. The data collected included the age, sex, etiology of liver disease, serum creatinine, total bilirubin, prothrombin time with international normalized ratio and ascitic fluid analysis of the patients. The patients were graded with MELD formula into 4 groups (MELD < or = 9, 10-19, 20-29, MELD > or = 30). The incidence rate of SBP was compared in the 4 groups according to the MELD score. The predictive accuracy in patients with and without SBP was evaluated with receiver operating characteristic (ROC) curve. RESULTS: SBP developed in 65 (26%) patients during hospitalization. The clinical characteristics were similar between the patients with and without SBP. The mean MELD score for patients with SBP was 23 and for those without was 14 (P < 0.01). Patients with 10-19 had an odds ratio of 1.44 (P > 0.05) for SBP, as compared with patients with MELD < or = 9. The frequency of spontaneous bacterial peritonitis was higher in the patients with MELD > or = 20 than those with MELD < or = 19. The incidence rate of SBP with MELD < or = 19, 20-29 and MELD > or = 30 were 12.5%, 52.38%, and 66.67% respectively. Patients with MELD > or = 30 had an odds ratio of 14 (95% CI 5.41-36.20) for SBP, as compared with patients with MELD < or = 19. Patients with 20-29 had an odds ratio of 7.7 (95% CI 4.17-14.20) for SBP, as compared with patients with MELD < or = 19. Area under curve (AUC) of MELD was 0.774 (95% CI 0.689-0.855). CONCLUSION: The cirrhotic patients with complicating ascites with higher MELD score have a greater risk of SBP. High MELD score might be an useful predictor of SBP in cirrhotic patients with ascites.

[The inhibitory effect of curcumin on the proliferation of HT-29 colonic cancer cell induced by deoxycholic acid].

OBJECTIVE: To assess the effect of curcumin on deoxycholic acid (DCA) induced cell proliferation in human HT-29 colon cancer cell line and to discuss its underlying anti-cancer mechanisms. METHODS: The effect of curcumin on cell proliferation was tested in vitro with MTT assay. RT-PCR was applied to measure cyclooxygenase-2 (COX-2) mRNA transcription. Cellular immunochemical stain was applied to label COX-2 protein expression. Radio immunoassay was applied to assess prostaglandin E(2) (PGE(2)) level. RESULTS: DCA increased cell proliferation, COX-2 mRNA expression and PGE(2) concentration of HT-29 cell line. Curcumin inhibited DCA-induced cell proliferation of HT-29 cell in a dose and time depended manner. Curcumin may inhibit DCA-induced COX-2 mRNA transcription at 6 hour with more than 5 micromol/L and at 12 hour with more than 0.5 micromol/L. However, Curcumin may decrease DCA-induced COX-2 expression and PGE(2) synthesis at 24 - 48 hour with more than 1 micromol/L and at 6-12 hour with more than 5 micromol/L. CONCLUSIONS: Curcumin may inhibit HT-29 cell proliferation, COX-2 mRNA transcription, COX-2 protein expression and PGE(2) synthesis induced by DCA in HT-29 cell line. These data provide new insights into the mechanism of its anti-cancer properties.