High definition versus standard definition white light endoscopy for detecting dysplasia in patients with Barrett's esophagus

High‐definition endoscopy systems provide superior image resolution. The aim of this study was to assess the utility of high definition compared with standard definition endoscopy system for detecting dysplastic lesions in patients with Barrett's esophagus. A retrospective cohort study of patients with non‐dysplastic Barrett's esophagus undergoing routine surveillance was performed. Data were retrieved from the central hospital electronic database. Procedures performed for non‐surveillance indications, Barrett's esophagus Prague C0M1 classification with no specialized intestinal metaplasia on histology, patients diagnosed with any dysplasia or cancer on index endoscopy, and procedures using advanced imaging techniques were excluded. Logistic regression models were constructed to estimate adjusted odds ratios and 95% confidence intervals comparing outcomes with standard definition and high‐definition systems. The high definition was superior to standard definition system in targeted detection of all dysplastic lesions (odds ratio 3.27, 95% confidence interval 1.27–8.40) as well as overall dysplasia detected on both random and target biopsies (odds ratio 2.36, 95% confidence interval 1.50–3.72). More non‐dysplastic lesions were detected with the high‐definition system (odds ratio 1.16, 95% confidence interval 1.01–1.33). There was no difference between high definition and standard definition endoscopy in the overall (random and target) high‐grade dysplasia or cancers detected (odds ratio 0.93, 95% confidence interval 0.83–1.04). Trainee endoscopists, number of biopsies taken, and male sex were all significantly associated with a higher yield for dysplastic lesions. The use of the high‐definition endoscopy system is associated with better targeted detection of any dysplasia during routine Barrett's esophagus surveillance. However, high‐definition endoscopy cannot replace random biopsies at present time.     

Guidelines for standardizing cleansing and disinfection of gastrointestinal endoscopes

As part of the activities toward standardizing endoscopy procedures, the Japan Gastroenterological Endoscopy Society has prepared guidelines for cleansing and disinfection of gastrointestinal endoscopes. The environment of gastrointestinal endoscopy differs between Japan and advanced Western countries. In advanced Western countries, gastrointestinal endoscopy is performed almost exclusively at specialized facilities, where strict provisions are observed for cleansing and disinfecting endoscopes. In Japan, however, gastrointestinal endoscopy is performed even in small clinics, and the annual number of gastrointestinal endoscopy cases is enormous. In addition, the method for cleansing and disinfecting endoscopes differs among hospitals. Although there is a distinct lack of evidence for how gastrointestinal endoscopes are cleaned and disinfected, it is necessary to standardize the method for doing so to advance the field of endoscopic medicine.     

长眼轴患者白内障超声乳化术后角膜生物力学的变化

目的　观察长眼轴患者行白内障超声乳化术后角膜生物力学的变化。方法　收集拟接受白内障手术的患者58例68眼，将其分为长眼轴组（28例34眼）和正常眼轴组（30例34眼），应用可视化角膜生物力学分析仪（corneal visualization scheimpflug technology，Corvis ST）对患者术前及术后1周、1个月的角膜生物力学参数进行测量。结果　术前及术后1周、1个月两组峰距、中央角膜厚度、矫正眼压、眼压及长眼轴组第二压平时间和最大形变幅度的总体比较，差异均有统计学意义（均为P＜0.05）；术后1周与术前相比，两组峰距、中央角膜厚度、矫正眼压、眼压明显增大，长眼轴组最大形变幅度较术前减小，差异均有统计学意义（均为P＜0.05），但术后1个月正常眼轴组峰距、中央角膜厚度、矫正眼压、眼压均恢复到术前水平（均为P＞0.05），而长眼轴组最大形变幅度较术前减小，矫正眼压、眼压较术前均增高（均为P＜0.05）。术后1个月与术后1周比较，两组峰距、中央角膜厚度、矫正眼压、眼压均有减小趋势（均为P＜0.05）。长眼轴组术后1周中央角膜厚度、矫正眼压及最大形变幅度的变化量与眼轴长度均存在正相关性（r=0.493，P=0.003；r=0.575，P＜0.001；r=0.587，P＜0.001），而正常眼轴组的相关参数的变化量与眼轴长度均无相关性（均为P＞0.05）。结论　白内障超声乳化术能影响角膜生物力学，且长眼轴患者较正常眼轴者术后更易引起角膜生物力学改变，在白内障术后应注意其用药时间及激素类药物的使用，防止伤口愈合不良导致迁延感染及高眼压的发生。     

Thermo-Viscoelastic Response of 3D Braided Composites Based on a Novel FsMsFE Method

A homogenization-based five-step multi-scale finite element (FsMsFE) simulation framework is developed to describe the time-temperature-dependent viscoelastic behavior of 3D braided four-directional composites. The current analysis was performed via three-scale finite element models, the fiber/matrix (microscopic) representative unit cell (RUC) model, the yarn/matrix (mesoscopic) representative unit cell model, and the macroscopic solid model with homogeneous property. Coupling the time-temperature equivalence principle, multi-phase finite element approach, Laplace transformation and Prony series fitting technology, the character of the stress relaxation behaviors at three scales subject to variation in temperature is investigated, and the equivalent time-dependent thermal expansion coefficients (TTEC), the equivalent time-dependent thermal relaxation modulus (TTRM) under micro-scale and meso-scale were predicted. Furthermore, the impacts of temperature, structural parameters and relaxation time on the time-dependent thermo-viscoelastic properties of 3D braided four-directional composites were studied.     

Epileptogenic modulation index and synchronization in hypsarrhythmia of West syndrome secondary to perinatal arterial ischemic stroke

ObjectivePerinatal arterial ischemic stroke (PAIS) is associated with epileptic spasms of West syndrome (WS) and long term Focal epilepsy (FE). The mechanism of epileptogenic network generation causing hypsarrhythmia of WS is unknown. We hypothesized that Modulation index (MI) [strength of phase-amplitude coupling] and Synchronization likelihood (SL) [degree of connectivity] could interrogate the epileptogenic network in hypsarrhythmia of WS secondary to PAIS.MethodsWe analyzed interictal scalp electroencephalography (EEG) in 10 WS and 11 FE patients with unilateral PAIS. MI between gamma (30–70 Hz) and slow waves (3–4 Hz) was calculated to measure phase-amplitude coupling. SL between electrode pairs was analyzed in 9-frequency bands (5-delta, theta, alpha, beta, gamma) to examine inter- and intra-hemispheric connectivity.ResultsMI was higher in affected hemispheres in WS (p = 0.006); no differences observed in FE. Inter-hemispheric SL of 3-delta, theta, alpha, beta, gamma bands was significantly higher in WS (p < 0.001). In WS, modified Z-Score of intra-hemispheric SL values in 3-delta, theta, alpha, beta and gamma in the affected hemispheres were significantly higher than those in the unaffected hemispheres (p < 0.001) as well as 0.5–4 Hz (p = 0.004).ConclusionsThe significantly higher modulation in affected hemisphere and stronger inter- and intra-hemispheric connectivity generate hypsarrhythmia of WS secondary to PAIS.SignificanceEpileptogenic cortical-subcortical transcallosal networks from affected hemisphere post-PAIS provokes infantile spasms.     

上海市长宁区中学生智能终端成瘾现况及其相关因素研究

目的 了解长宁区中学生智能终端的成瘾现况及其相关因素,为指导中学生科学、合理地使用智能终端提供依据。方法 2017年5月采用分层整群抽样的方法在长宁区中学抽取949名学生,通过问卷调查的方式收集学生智能终端的成瘾现况,参考Young网络成瘾评价方法进行成瘾是否的判定,分别通过K10 量表和ULS-8量表收集学生的心理健康状况及孤独感,探讨学生智能终端成瘾的相关因素。结果 中学生智能终端成瘾检出率为14.33%(136/949)。单因素分析显示年级段、学习成绩、使用安排方式、使用目的均与成瘾检出率有关(χ²分别为43.046、8.711、21.652、13.970,P<0.05),成瘾组学生K10量表及USL-8量表总分均高于非成瘾组(Z值分别为-7.998、-7.297)。多因素分析显示年级高中(OR=1.822,95%CI:1.167~2.585)、使用目的为娱乐(OR=1.572,95%CI:1.060~2.330)、K10量表总分>14分(OR=2.788,95%CI:1.786~4.352)、USL-8量表总分>14分(OR=2.013,95%CI:1.320~3.071)是智能终端成瘾的危险因素(P<0.05)。结论 长宁区中学生智能终端成瘾检出率较高,其与年级段及使用目的有关,智能终端成瘾还与心理健康及孤独程度有关,应引起关注。