The clinical characteristics of focal acute pancreatitis based on imaging diagnosis: comparison with non-localized acute pancreatitis- a preliminary result.

BACKGROUND: Focal acute pancreatitis is a special type of acute pancreatitis, which diagnosis is based on image showing a focal mass formation in the pancreas. For acute pancreatitis with or without focal inflammatory enlargement, little is known on differences between them. Our purpose was to find differences between focal acute pancreatitis and non-localized acute pancreatitis. METHODS: We reviewed the medical records of a total of 24 patients diagnosed with focal acute pancreatitis by imaging and clinical diagnosis, and 27 cases of acute pancreatitis which manifest non-localized pancreas inflammation were selected as the control group. The differences of the two groups were compared to describe their clinical characteristics. RESULTS: Differences in bloating (4.2% VS 29.6%,P = 0.026), abdominal tenderness (58.3% VS 85.2%,P = 0.032), peripheral blood neutrophil ratio (60.1 ± 23.3VS 75.9 ± 12.6,P = 0.004), serum D-Dimer (0.40(0.25,0.98) VS 1.59(0.49,4.63),P = 0.008), serum GGT (40(25,91) VS120(22,383),P = 0.046), serum amylase(435(241,718) VS 591(394,1333),P = 0.044) and lipase(988(648,1067) VS 1686(525,2675),P = 0.027) between focal acute pancreatitis and non-localized acute pancreatitis groups were statistically significant. However, difference of the severity of two groups was not statistically significant (P = 1.000). CONCLUSION: Compared with non-localized acute pancreatitis, changes in symptoms, signs and laboratory indicators of focal acute pancreatitis are non-obvious, however, there was no significant difference in the severity of two groups, indicating that we should pay more attention to diagnosis of focal acute pancreatitis in clinical practice.

Fabrication of 2D/2D BiOBr/g-C3N4 with efficient photocatalytic activity and clarification of its mechanism.

Precise regulation of photoexcited charge carriers for separation and transportation is a core requirement for practical application in the photocatalysis field. Herein, a 2D/2D BiOBr/g-C3N4 heterojunction is prepared by a self-assembly method and exhibits enhanced and stable activity for photocatalytic degradation of bisphenol A (BPA) and norfloxacin (NFA) under visible light. Compared to pure g-C3N4, the kinetic constants of BPA and NFA degradation over BiOBr/g-C3N4 are enhanced by about 14.74 and 4.01 times, respectively. The separation and transportation mechanism for the photoexcited charge carriers is clarified by electron paramagnetic resonance (EPR), in situ X-ray photoelectron spectroscopy (in situ XPS), and theoretical calculations. The results show that BiOBr/g-C3N4 exhibits the feature of a relative p-n junction, in which the charges photoexcited on BiOBr/g-C3N4 with high redox potentials can be kept and spatially separated. Moreover, the built-in electric field with the direction of g-C3N4 → BiOBr and the opportune band curvature provide the driving force for charge separation and transportation. Additionally, BPA and NFA degradation intermediates are also detected by liquid chromatography-mass spectrometry. It is of great significance to fabricate efficient photocatalysts for environmental purification and other targeted reactions.

Prognostic significance of BRCA1, ERCC1, RRM1, and RRM2 in patients with advanced non-small cell lung cancer receiving chemotherapy.

The aim of this study was to examine the prognostic value of breast cancer susceptibility gene 1 (BRCA1), excision repair cross-complementation 1 (ERCC1), ribonucleotide reductase subunit M1 (RRM1), and ribonucleotide reductase subunit M2 (RRM2) in patients with advanced non-small cell lung cancer (NSCLC) who received platinum-based chemotherapy. A total of 214 patients with histologically or cytologically confirmed advanced NSCLC were enrolled in this study. The relative complementary DNA (cDNA) quantification for BRCA1, ERCC1, RRM1, and RRM2 was conducted using a fluorescence-based, real-time detection method, and ß-actin was used as a reference gene. A strong correlation was observed between ERCC1 and RRM1 messenger RNA (mRNA) levels (P = 0.0385). There were inverse significant correlations between BRCA1 and ERCC1 (P < 0.0001) or RRM1 (P < 0.0001) mRNA levels. As BRCA1 levels increased, the probability of response increased (odds ratio [OR] = 0.49; P < 0.001) and the risk of progression (hazard ratio [HR] = 1.52; P = 0.034) and death (HR = 1.45; P = 0.024) decreased. As ERCC1, RRM1, and RRM2 levels increased, the probability of response decreased (ERCC1, OR = 0.42, P < 0.001; RRM1, OR = 0.85, P = 0.083; RRM2, OR = 0.42, P = 0.005) and the risk of progression (ERCC1, HR = 1.59, P = 0.002; RRM1, HR = 1.48, P = 0.039; RRM2, HR = 1.49, P = 0.041) and death (ERCC1, HR = 1.62, P = 0.008; RRM1, HR = 1.52, P = 0.023; RRM2, HR = 1.48, P = 0.017) increased. At multivariate analysis, low expression of ERCC1 was shown to be an independent predictive factor for response to chemotherapy (P = 0.018), time to progression (P = 0.025), and overall survival (P = 0.038). Furthermore, concomitant low expression levels of ERCC1, RRM1, and RRM2 and the high expression level of BRCA1 were predictive of a better outcome (P = 0.014). This study suggests that the efficacy of platinum-based chemotherapy can be improved when customized according to the mRNA expression of BRCA1, ERCC1, RRM1, and RRM2.

ERCC1 and BRCA1 mRNA expressions are associated with clinical outcome of non-small cell lung cancer treated with platinum-based chemotherapy.

We conducted a perspective study to investigate whether the expression of excision repair cross-complementing 1 (ERCC1), xeroderma pigmentosum group G (XPG), breast cancer 1 (BRCA1), and ribonucleotide reductase M1 (RRM1) is correlated with clinical outcome of non-small cell lung cancer (NSCLC). Patients with histologically confirmed inoperable stages IIIB and IV NSCLC were collected and followed up until January 2012. Relative cDNA quantification for ERCC1, XPG, BRCA1, and RRM1 was performed using a fluorescence-based, real-time detection method. Cox regression analysis indicated that a high level of ERCC1 was associated with shorter overall survival (OS) and progression-free survival (PFS) times when compared with low expression, with adjusted hazard ratios (HRs) (95% confidence interval (CI)) of 2.25 (1.18-4.39) and 2.63 (1.33-5.25), respectively. High expression of BRCA1 was correlated with shorter OS and PFS times when compared with low expression, and the adjusted HRs (95% CI) were 3.29 (1.72-6.39) and 5.94 (2.80-13.06), respectively. Moreover, we found a significant correlation between BRCA1 expression and age (χ(2) = 4.14, P = 0.04) and stage (χ(2) = 5.26, P = 0.02). Our results suggest that ERCC1 and BRCA1 mRNA expressions are associated with PFS and OS in advanced NSCLC patients treated with platinum-based chemotherapy.

Confocal laser endomicroscopy for in vivo detection of gastric intestinal metaplasia: a randomized controlled trial.

BACKGROUND AND STUDY AIMS: Gastric intestinal metaplasia (GIM) is associated with a risk for development of intestinal-type gastric cancer. This study aimed to compare the diagnostic yield of GIM from confocal laser endomicroscopy (CLE) and white light endoscopy (WLE). PATIENTS AND METHODS: In a prospective, double-blind, randomized study, patients were randomly assigned to receive either CLE with targeted biopsies (group A) or WLE with a standard biopsy protocol (group B). RESULTS: A total of 168 patients were finally analyzed (group A 85, group B 83). On a per-patient analysis, the diagnostic yields of GIM (including GIM with gastric intraepithelial neoplasia [GIN]) for groups A and B were 44.71 % and 31.33 %, respectively (P = 0.074). On a per-biopsy analysis, CLE-targeted biopsy gave a significantly higher diagnostic yield of GIM compared with WLE and standard biopsy, at 65.70 % (113 /172 biopsies) versus 15.73 % (81 /515 biopsies) (P < 0.001). Moreover, the diagnostic yield of the operative link on gastric intestinal metaplasia (OLGIM) assessment stages III and IV was higher at 20.93 % (36 /172 biopsies) in group A versus 4.08 % (21 /515 biopsies) in group B (P < 0.001). In addition, use of CLE-guided biopsy significantly decreased by 68 % (P < 0.001) the mean number of biopsies required per patient. CONCLUSIONS: CLE with targeted biopsies is superior to WLE with standard biopsies for the detection and surveillance of GIM. The number of biopsies needed to confirm GIM is about one third of that needed with WLE with standard biopsies.

Silencing of insulin-like growth factor-1 receptor enhances the radiation sensitivity of human esophageal squamous cell carcinoma in vitro and in vivo.

BACKGROUND: Esophageal squamous cell carcinoma (ESCC) is a prevalent fatal cancer worldwide, and the number of deaths due to this disease is increasing. Due to ESCC resistance to chemotherapy and radiation treatment, new therapies are urgently needed for the improvement of ESCC patient clinical outcomes. METHODS: Eca-109 and TE-1 cells were transfected with 100 nM IGF-1r siRNA, and a combination of IGF-1r siRNA and radiation therapy was tested in vitro and in vivo. The effects of IGF-1r siRNA were determined through Western blotting and flow cytometry experiments. RESULTS: After radiotherapy, the number of IGF-1r siRNA-transfected Eca-109 cells decreased by approximately 67.3%, and a 78.9% reduction was observed in the transfected TE-1 cells. In addition, the Eca-109 and TE-1 cells that were irradiated following IGF-1r knockdown contained 16.2% and 20.3% apoptotic cells, respectively. CONCLUSIONS: The results of the current study suggest that IGF-1r knockdown may enhance the radiation sensitivity of ESCC and increase the therapeutic effects of radiation both in vitro and in vivo. These results provide strong evidence that the targeted application of siRNA will enable the development of new therapeutic strategies for the clinical treatment of ESCC patients.

Surface maturation scoring for oesophageal squamous intraepithelial neoplasia: a novel diagnostic approach inspired by first endomicroscopic 3-dimensional reconstruction.

OBJECTIVE: Loss of surface maturation and cytonuclear atypia have been regarded as the pathological 'gold standard' for the diagnosis of oesophageal squamous cell intraepithelial neoplasia. However, there has been no satisfactory endomicroscopic method similar to this pathological approach to detect surface maturation and screen for oesophageal squamous cell intraepithelial neoplasia. The aim of this study was to apply a 3-dimensional (3D) confocal endomicroscopic imaging technique to investigate the surface maturation of the oesophageal epithelium and develop new 2-dimensional confocal endomicroscopic criteria based on surface maturation. DESIGN: In the 3D reconstruction phase, intrapapillary capillary loops were reconstructed to demonstrate the stereo configuration of the oesophageal epithelium, and a novel surface maturation scoring (SMS) method for plane confocal images was developed based on the interpretation of the 3D microstructure. In the SMS diagnostic phase, 1214 patients were screened and confocal images from 64 non-invasive oesophageal lesions were independently evaluated using SMS and previous methods. RESULTS: We successfully obtained and interpreted 3D confocal images of the human oesophageal epithelium for the first time. The sensitivity (81.0%, 95% CI 58.1% to 94.6%) and specificity (90.7%, 95% CI 77.9% to 97.4%) of the newly established SMS were superior to previous confocal approaches in distinguishing squamous intraepithelial neoplasia from other non-invasive lesions. CONCLUSIONS: 3D confocal endomicroscopic imaging provides valuable insight into the stereo configuration of the human oesophageal epithelium. SMS is a novel and promising diagnostic method to distinguish neoplasia during ongoing endoscopy.

Impact of pulmonary rehabilitation on patients with different chronic respiratory diseases during hospitalization.

The impact of pulmonary rehabilitation (PR) on patients with different chronic respiratory diseases (CRDs) during hospitalization has not been thoroughly evaluated before. The objectives of the current research were to assess the effect of comprehensive PR management on inpatients' self-management skills, exercise capacity, nutrition assessment and mental health issues and explore whether impacts of PR vary in different CRDs. This retrospective study analyzed the clinical data from 272 inpatients with CRDs receiving PR management during hospitalization between October 2020 and March 2022 in Beijing Chao-Yang Hospital. Significant improvements were found in the patients' ability of daily living (ADL), dyspnea (assessed by modified medical research council dyspnea scale (MMRC)), handgrip strength, maximal inspiratory and expiratory pressure, anxiety (using the 7-item generalized anxiety disorder scale (GAD-7)) and depression (the 9-item patient health questionnaire score (PHQ-9)). There was no significant change in nutrition assessment pre-post PR management during hospitalization. The subgroup analyses were conducted on hospitalized patients with chronic obstructive pulmonary disease (COPD), bronchiectasis, asthma, interstitial lung diseases (ILDs) and other CRDs (e.g., lung cancer, diaphragm hemiparesis, obesity, etc.). The results showed that ADL, MMRC score, MIP, MEP, PHQ-9 score improved in all subgroups with CRDs. Handgrip strength of left hand was increased in COPD inpatients and anxiety was improved in all subgroups except for ILDs. Comprehensive PR management was necessary and beneficial for patients with different CRDs during hospitalization.

Clinical significance of MMP-7 and PTEN expression in colorectal cancer.

BACKGROUND/AIMS: The aim of this study was to investigate the expression of MMP-7 and PTEN protein in colorectal cancer and explore its correlation with clinicopathological parameters. METHODOLOGY: In colorectal cancer tissue samples (n=48) and normal rectal tissue samples (n=23), the expression of MMP-7 and PTEN was detected by immunohistochemistry. Using medical records, the relationship of MMP-7 and PTEN expression with clinicopathological parameters was analyzed. RESULTS: Compared to normal rectal tissue, MMP-7 expression was significantly higher in all grades of colorectal cancer. In contrast, PTEN expression was significantly lower than levels in normal rectal tissue. There was significant negative correlation between MMP-7 and PTEN expression in colorectal cancer (r=-0.403, p>0.05). MMP-7 and PTEN expression in colorectal cancer samples was correlated with differentiation, lymph node metastasis, serosa infiltration, and Duke's stage (p<0.05) but not with gender, age, or tumor size (p>0.05). CONCLUSIONS: Reduced PTEN expression and MMP-7 over-expression may play important roles in the pathogenesis of colorectal cancer. Combined detection may provide prognostic benefit towards colorectal cancer.

Microalterations of esophagus in patients with non-erosive reflux disease: in-vivo diagnosis by confocal laser endomicroscopy and its relationship with gastroesophageal reflux.

OBJECTIVES: Objectively diagnosing non-erosive reflux disease (NERD) is still a challenge. We aimed to evaluate the use of in-vivo confocal laser endomicroscopy (CLE) to examine the microalterations of the esophagus in patients with NERD and its relationship with reflux episodes monitored by multiple intraluminal impedance-pH (MII-pH). METHODS: Patients with gastroesophageal reflux symptoms completed reflux disease questionnaires. NERD was determined by negative gastroscopy. Patients without reflux symptoms were recruited as controls. Pilot clinical study was followed by prospective controlled blinded study. All subjects were examined by white-light mode of the endoscopy followed by the standard CLE mode and then MII-pH monitoring. The microalterations seen on CLE images and the correlation between CLE features and reflux episodes were evaluated, the correlation between CLE and transmission electron microscope (TEM) data was also analyzed. RESULTS: On CLE images, NERD patients had more intrapapillary capillary loops (IPCLs) per image than did controls (8.29 ± 3.52 vs. 5.69 ± 2.31, P=0.010), as well as the diameter of IPCLs (19.48 ± 3.13 vs. 15.87 ± 2.21 µm, P=0.041) and intercellular spaces of squamous cells (3.40 ± 0.82 vs. 1.90 ± 0.53 µm, P=0.042). The receiver operating characteristic analysis indicated that IPCLs number (optimal cutoff >6 per image, area under the curve (AUC) 0.722, 95% confidence interval (CI) 0.592-0.853, sensitivity 67.7%, specificity 71.6%), IPCLs diameter (optimal cutoff >17.2 µm, AUC 0.847, 95% CI 0.747-0.947, sensitivity 81%, specificity 76%), and the intercellular spaces of squamous cells (optimal cutoff >2.40 µm, AUC 0.935, 95% CI 0.875-0.995, sensitivity 85.7%, specificity 90.5%) diagnosed NERD with reasonable accuracy. Combined features of dilatation of intercellular space plus increased IPCLs provided 100% specificity in the diagnosis of NERD patients. The intercellular spaces of squamous cells observed on CLE were highly related to that on TEM findings (r=0.75, P<0.001). Multivariate progressive regression analysis showed that acidic reflux, especially in the supine position, was related to the increased number and dilation of IPCLs in the squamous epithelium (ß=0.063, t=2.895, P=0.038 and ß=0.156, t=1.023, P=0.04). CONCLUSIONS: CLE represents a useful and potentially significant improvement over standard endoscopy to examine the microalterations of the esophagus in vivo. Acidic reflux is responsible for the microalterations in the esophagus of patients with NERD.

Mucosal barrier defects in gastric intestinal metaplasia: in vivo evaluation by confocal endomicroscopy.

BACKGROUND: Helicobacter pylori infection and intestinal metaplasia (IM) are associated with gastric cancer. An impaired gastric mucosal barrier could be involved in this carcinogenesis. OBJECTIVE: To evaluate laser confocal laser endomicroscopy (CLE) for in vivo functional imaging of mucosal barrier defects in patients with IM. DESIGN: Prospective, controlled study. SETTING: A tertiary-care academic center. PATIENTS: This study involved patients with IM of the gastric mucosa who underwent CLE for surveillance. INTERVENTIONS: Specific IM mucosa and non-IM mucosa in patients were identified by CLE, and targeted biopsy samples were taken for histopathology and electron microscopy. MAIN OUTCOME MEASUREMENTS: Post-CLE assessment of paracellular fluorescein leakage was devised and validated by electron microscopy. We also evaluated the effect of H pylori eradication on the mucosal barrier. RESULTS: Forty-two patients were included. Of non-IM samples, the paracellular permeability was significantly increased in H pylori-positive samples compared with H pylori-negative controls (54 ± 31% vs 3 ± 6%, P < .05). Of IM samples, the permeability was significantly increased in both H pylori-negative and H pylori-positive samples (67 ± 34% and 72 ± 28% vs 3 ± 6%, both P < .05). The results of post-CLE assessment correlated well with the electron microscopy findings (R(2) 0.834, P < .0001). After the eradication of H pylori, the paracellular barrier dysfunction of non-IM mucosa was significantly improved as shown by electron microscopy and CLE (both P < .001). However, there was no significant change in IM mucosa. LIMITATIONS: Single-center study. CONCLUSIONS: CLE allows functional imaging of mucosal barrier defects. Gastric IM is associated with an impaired paracellular barrier irrespective of H pylori eradication.

Diagnostic value of confocal laser endomicroscopy for gastric superficial cancerous lesions.

BACKGROUND: The identification of gastric superficial cancerous lesions based on conventional white-light endoscopy (WLE) is challenging, and histological analysis remains the 'gold standard' for the final diagnosis. Confocal laser endomicroscopy (CLE) can provide in vivo histological observation without the need for biopsy. OBJECTIVE: To develop and evaluate CLE imaging criteria for gastric superficial cancerous lesions and to compare the diagnostic value of real-time integrated CLE (iCLE) and WLE alone in distinguishing gastric superficial cancerous lesions. DESIGN: Prospective study. SETTING: Qilu Hospital, Shandong University, Jinan, China. PATIENTS: A total of 182 patients were enrolled into phase I and 1786 patients were enrolled into phase II. INTERVENTIONS: CLE images were blindly evaluated after endoscopy in phase I, and real-time iCLE diagnosis during endoscopy was compared with WLE diagnosis by using histopathology as a gold standard in phase II. MAIN OUTCOME MEASUREMENTS: The validity and reliability of the CLE diagnosis for identifying gastric superficial cancerous lesions. RESULTS: Off-line CLE diagnosis for early gastric cancers had a high sensitivity (88.1%) and specificity (98.6%). When the two-tiered CLE classification of non-cancerous lesions and cancer/high-grade intraepithelial neoplasia (HGIN) lesions was introduced, CLE diagnosis led to a higher sensitivity (90.2%) and specificity (98.5%) (phase I). Real-time iCLE diagnosis had a higher sensitivity (88.9%), specificity (99.3%) and accuracy (98.8%) for gastric superficial cancer/HGIN lesions than WLE diagnosis (sensitivity, 72.2%; specificity, 95.1%; and accuracy, 94.1%) (p < 0.05) (phase II). Limitations This was a single-centre study. CONCLUSIONS: CLE can be used to identify gastric superficial cancer/HGIN lesions with high validity and reliability.

Gastric metaplasia of the duodenum: in vivo diagnosis by endomicroscopy and its relationship with functional dyspepsia.

BACKGROUND AND AIM: Gastric metaplasia (GM) of the duodenum is difficult to assess because of its patchy distribution, and the role of GM in functional dyspepsia (FD) is not clear. The aims of this study were to determine if endomicroscopy could identify GM of the duodenum and whether GM has associations with FD. METHODS: A series of 51 patients with FD and 25 asymptomatic controls were enrolled. Confocal laser endomicroscopy was performed to evaluate villi changes in vivo. Targeted biopsy specimens were then compared with histopathological results. RESULTS: The accuracy of the endomicroscopy diagnosis of GM during endoscopy was 92.8%, and the sensitivity, specificity, and positive and negative predictive values were 86.2%, 97.4%, 89.3%, and 96.6%, respectively. The mean κ-value for interobserver agreement was 0.89. GM in the duodenal bulb was more frequent in patients with FD than in the controls (33.3% vs 12%, P<0.05), especially in patients with epigastric pain syndrome (47.6% vs 12%, P<0.01). CONCLUSIONS: Endomicroscopy is useful for identifying GM, and GM might be related to FD. These findings could have potential applicability for duodenal screening, and suggest a possible targeting therapy in FD.

Comparison of performances of conventional and deep learning-based methods in segmentation of lung vessels and registration of chest radiographs.

Conventional machine learning-based methods have been effective in assisting physicians in making accurate decisions and utilized in computer-aided diagnosis for more than 30 years. Recently, deep learning-based methods, and convolutional neural networks in particular, have rapidly become preferred options in medical image analysis because of their state-of-the-art performance. However, the performances of conventional and deep learning-based methods cannot be compared reliably because of their evaluations on different datasets. Hence, we developed both conventional and deep learning-based methods for lung vessel segmentation and chest radiograph registration, and subsequently compared their performances on the same datasets. The results strongly indicated the superiority of deep learning-based methods over their conventional counterparts.

Bayesian Meta-Analysis of Myopia Control with Multifocal Lenses.

The aim of this study is to provide reliable guidelines for the mean percentage efficacy together with the 95% credibility interval in slowing down progression of myopia by a specific intervention over defined time periods, derived from a substantial number of randomised controlled clinical trials (RCTs) with consistent outcomes. Multifocal spectacles and contact lenses represent interventions with the largest number of RCTs carried out. Our meta-analyses considered 10 RCTs involving 1662 children which have tested the efficacy of progressive addition spectacle lenses (PALs). In a separate model for comparison purposes nine RCTs with 982 children trialling soft multifocal contact lenses (MFCLs) were analysed. Bayesian random-effects hierarchical models were fitted. The highest efficacy in retarding progression of the scaled sphere equivalent refraction was achieved after 12 M follow-up with the mean 28% reduction in progression and the 95% credibility interval between 21% and 35%. For comparison, the 95% credibility interval for the mean efficacy of soft MFCLs at 12 M follow up is 21% to 37%. We conclude that both multifocal spectacle and contact lenses moderately slow down progression of myopia, relative to single-vision spectacle lenses (SVLs) in the first 12 months after intervention. The relative efficacy of PALs tends to weaken after the first 12 months.

Classification of inflammation activity in ulcerative colitis by confocal laser endomicroscopy.

OBJECTIVES: The assessment of inflammation activity in ulcerative colitis (UC) includes endoscopy and histology. Confocal laser endomicroscopy (CLE) combines real-time endoscopy and histology. This study was aimed at evaluating the application of CLE in the assessment of inflammation activity in UC. METHODS: In total, 73 consecutive patients with UC who visited Qilu Hospital for colonoscopy surveillance underwent CLE. Inflammation activity was first assessed by the colonoscopy Baron score, then by CLE with a 4-grade classification of crypt architecture, as well as by analysis of microvascular alterations and fluorescein leakage. Targeted biopsy samples were taken for histological analysis. Stored CLE images were subjected to post-CLE objective assessment. RESULTS: Both assessment of crypt architecture and fluorescein leakage with CLE showed good correlations with histological results (Spearman's rho, both P<0.001). CLE seemed to be more accurate than conventional white-light endoscopy for evaluating macroscopical normal mucosa. More than half of the patients with normal mucosa seen on conventional white-light endoscopy showed acute inflammation on histology, whereas no patients with normal mucosa or with chronic inflammation seen on CLE showed acute inflammation on histology. Assessment of microvascular alterations by CLE showed good correlation with histological findings (P<0.001). On post-CLE objective assessment, subjective architectural classifications were supported by the number of crypts per image (P<0.001) but not fluorescein leakage results by gray scale (P=0.194). CONCLUSIONS: CLE is reliable for real-time assessment of inflammation activity in UC. Crypt architecture, microvascular alterations, and fluorescein leakage are promising markers in CLE evaluation.

Confocal laser endomicroscopy for in vivo diagnosis of gastric intraepithelial neoplasia: a feasibility study.

BACKGROUND: Confocal laser endomicroscopy (CLE) is a novel endoscopic modality that allows subsurface analysis of the gastric mucosa during ongoing endoscopy. Several studies have reported that this technique is of value in the diagnosis of premalignant lesions in the GI tract, but as yet no investigations have reported its application in the analysis of gastric intraepithelial neoplasia (GIN). OBJECTIVE: To assess the feasibility of CLE for the identification and grading of GIN. DESIGN: Prospective double-blind feasibility study. SETTING: Qilu Hospital, Shandong University, Jinan, China. PATIENTS: CLE images of 33 patients were first evaluated to establish the diagnostic criteria for gastric lesions. Eligible patients were then prospectively investigated by CLE using the newly established criteria. INTERVENTIONS: All endoscopically suspicious lesions were examined by CLE, and CLE diagnoses were compared with corresponding histopathologic results. MAIN OUTCOME MEASUREMENTS: Sensitivity, specificity, and positive and negative likelihood ratios of CLE diagnosis of biopsy-proven intraepithelial neoplasia by per-lesion analysis. RESULTS: The sensitivity, specificity, and positive and negative likelihood ratios of CLE diagnosis of GIN were 77.8%, 81.8%, 4.28, and 0.27, respectively. The mean κ value for interobserver agreement for the diagnosis of GIN was 0.70 among endoscopists and 0.71 between endoscopist and GI pathologist. Intraepithelial neoplasia score ≥5 differentiated high-grade from low-grade intraepithelial neoplasia with a sensitivity of 66.7% and a specificity of 88.0%. LIMITATIONS: Nonrandomized single-center study, limited number of patients. CONCLUSIONS: CLE is an acceptable and potentially useful technology for the identification and grading of GIN in vivo. The diagnostic accuracy needs to be improved.

Confocal laser endomicroscopy for diagnosis of Helicobacter pylori infection: a prospective study.

BACKGROUND AND AIM: Confocal laser endomicroscopy (CLE) is a new endoscopy technique for subsurface analysis of the gastric mucosa and in vivo histology examination during endoscopy. We aimed to compare the clinical applicability and predictive power of CLE with the diagnosis of Helicobacter pylori infection in patients with gastrointestinal symptoms. METHODS: A total of 103 consecutive patients scheduled to undergo endoscopy were enrolled. CLE image criteria for H. pylori infection were established in a pilot study of 20 patients, then images for 83 consecutive patients were prospectively evaluated, and data were correlated with the final diagnosis of H. pylori infection in a blinded manner. RESULTS: We found good association between histopathology and CLE findings. H. pylori infection was identified by CLE with any of the following three features: white spots, neutrophils and microabscesses. The accuracy, sensitivity and specificity of CLE diagnosis of H. pylori infection were 92.8%, 89.2% and 95.7%, respectively. The mean kappa-value for interobserver agreement in the prediction of H. pylori infection was 0.78. Neutrophils were the best diagnostic feature and had good sensitivity (83.8%) and specificity (97.8%). H. pylori-associated changes were more common in the antrum than in the corpus among infected patients (P < 0.001). CONCLUSIONS: H. pylori infection can be identified by specific cellular and subcellular changes of the surface gastric mucosa with CLE. CLE is a novel, useful method for predicting H. pylori infection in vivo during endoscopy.

Characterization and identification of gastric hyperplastic polyps and adenomas by confocal laser endomicroscopy.

BACKGROUND: Management of gastric polyps depends on their histologic composition. A real-time in vivo histologic diagnosis would be valuable to an "on table" management decision. Confocal laser endomicroscopy (CLE), a new diagnostic tool, allows real-time in vivo histologic evaluations of gastrointestinal lesions. This study aimed to assess the feasibility and practicability of using CLE to identify and differentiate gastric hyperplastic polyps and adenomas. METHODS: A total of 66 patients with previously diagnosed polyps were recruited for this study between January 2007 and August 2008 at Qilu Hospital, Shandong University, China. The CLE imaging of hyperplastic polyps and adenomas was performed, and the CLE diagnosis was compared with the gold standard of histopathologic diagnosis. RESULTS: Imaging by CLE was successfully performed for 60 lesions of gastric hyperplastic polyps and 27 lesions of gastric adenomas. Compared with the surrounding background mucosa, gastric hyperplastic polyps and adenomas showed typical distinct appearances, respectively, by CLE. The overall accuracy of the in vivo CLE diagnosis of gastric hyperplastic polyps and adenomas during ongoing endoscopy was 90% (95% confidence interval [CI], 83-96%), and the overall accuracy of differentiating gastric hyperplastic polyps and adenomas by CLE was 97% (95% CI, 90-99%) after endoscopy. Intraobserver agreement was perfect (kappa = 0.92; 95% CI, 0.82-0.99), and interobserver agreement was also good (kappa = 0.83, 95% CI, 0.70-0.96). CONCLUSIONS: This study characterized confocal images of gastric hyperplastic polyps and adenomas as well as the high accuracy of differentiating hyperplastic polyps and adenomas using CLE.

The effect of pulmonary vessel suppression on computerized detection of nodules in chest CT scans.

PURPOSE: In chest computed tomography (CT) scans, pulmonary vessel suppression can make pulmonary nodules more evident, and therefore may increase the detectability of early lung cancer. The purpose of this study was to develop a computer-aided detection (CAD) system with a vessel suppression function and to verify the effectiveness of the vessel suppression on the performance of the pulmonary nodule CAD system. METHODS: A CAD system with a vessel suppression function capable of suppressing vessels and detecting nodules was developed. First, a convolutional neural network (CNN)-based pulmonary vessel suppression technique was employed to remove the vessels from lungs while preserving the nodules. Then, a CNN-based pulmonary nodule detector was utilized to sequentially generate nodule candidates and reduce false positives (FPs). The performance levels of CAD systems with and without the vessel suppression function were compared using 888 three-dimensional chest CT scans from the Lung Nodule Analysis 2016 (LUNA16) dataset. The pulmonary nodule detection results were quantitatively evaluated using the average sensitivity at seven predefined FP rates: 0.125, 0.25, 0.5, 1, 2, 4, and 8 FPs per scan. RESULTS: The developed pulmonary nodule CAD system improved the average sensitivity to 0.977 from 0.950 owing to the addition of the vessel suppression function. CONCLUSIONS: The vessel suppression function considerably improved the performance of the CAD system for pulmonary nodule detection. In practice, it would be embedded in CAD systems to assist radiologists in detecting pulmonary nodules in chest CT scans.