人工智能超声内镜胆胰识别系统有效性的交叉试验

目的探究人工智能超声内镜(artificial intelligence-endoscopic ultrasound, AI-EUS)胆胰识别系统用于辅助识别超声内镜检查术(endoscopic ultrasonography, EUS)图像的有效性。方法从武汉大学人民医院消化内科数据库前瞻性地纳入2019年12月—2020年8月期间因怀疑有胆胰系统疾病而接受EUS检查的受试者。28例受试者的28个视频用于胰腺标准站的识别;29例受试者的29个视频用于胆管标准站的识别。8名武汉大学人民医院消化内科的新手内镜医师在有AI-EUS胆胰识别系统辅助下和无辅助下, 分别阅读了57例EUS视频。比较有AI-EUS胆胰识别系统与无AI-EUS胆胰识别系统辅助时, 内镜医师对EUS胰腺和胆管标准站点识别的准确率。结果无AI-EUS辅助时, 新手内镜医师对胰腺标准站识别准确率为67.2%(903/1 344), 有AI-EUS辅助时, 准确率提高至78.4%(1 054/1 344);胆管标准站识别准确率由无辅助时的56.4%(523/928)提高至有辅助时的73.8%(685/928)。结论 AI-...     

基于深度学习的超声内镜分站和胰腺分割识别系统

目的 尝试构建1个基于深度学习的内镜超声检查（endoscopic ultrasonography,EUS）质量控制系统,并验证其价值。 方法 从武汉大学人民医院消化内镜中心数据库中,回顾性收集2016年12月—2019年12月间的269个EUS检查资料,分为：（1）用于训练模型的训练数据集A,包含205个检查,其中16 305张图像用于分类训练,1 953张图像用于分割训练;（2）用于评估模型性能的测试数据集B,包含44个检查,其中1 606张图像用于分类验证,480张图像用于分割验证;（3）用于内镜医师与模型进行比较的数据集C,包含20个检查,共150张图像。EUS专家（具有10年以上的EUS操作经验）甲和乙通过讨论对训练集A和测试集B、C的所有图像进行分类和标注,其结果用作金标准。EUS专家丙和高年资EUS医师（具有5年以上的EUS操作经验）丁、戊对数据集C中的图像进行分类和标注,其结果用于与深度学习模型进行比较。主要观察指标包括分类的准确率、分割的Dice（F1指数）和一致性分析的Kappa系数。 结果 在测试数据集B中,模型分类的平均准确率为94.1%,胰腺分割的平均Dice为0.826,血管分割的平均Dice为0.841。在数据集C中,模型的分类准确率达到90.0％,专家丙、高年资医师丁和戊分别为89.3％、88.7％和87.3％;模型的胰腺和血管分割Dice系数分别为0.740和0.859,专家丙分别为0.708和0.778,高年资医师丁分别为0.747和0.875,高年资医师戊分别为0.774和0.789,模型与专家的水平相当。一致性分析结果显示,模型与内镜医师之间达成了较好的一致性（Kappa系数分别为：模型与专家丙间0.823、模型与高年资医师丁间0.840、模型与高年资医师戊间0.799）。 结论 基于深度学习的EUS分站和胰腺分割识别系统可以用于胰腺EUS的质量控制,具有与EUS专家相当的分类和分割识别水平。     

内镜超声检查在肝门部胆管癌诊断和术前评价中的作用

目的 探讨内镜超声检查术（endoscopic ultrasonography, EUS）在肝门部胆管癌诊断和术前评价中的价值。方法 回顾性收集2016年4月—2019年12月在海军军医大学第三附属医院因肝门部胆管狭窄行EUS检查,并经手术后病理确诊为肝门部胆管癌的病例。记录并分析患者的临床信息、EUS影像特征和淋巴结情况。结果 最终纳入58例患者,肝门部病变EUS表现为血流不丰富的胆管占位和（或）胆管壁不对称增厚,其中胆管占位45例（77.6%）、胆管壁增厚32例（55.2%）,两者并存19例（32.8%）。EUS扫查发现血管侵犯共10例,其中侵犯门静脉3例、肝动脉4例,同时侵犯3例;术后病理发现血管侵犯共14例,诊断符合率为71.4%（10/14）。在53例患者中共扫查到101枚淋巴结,恶性淋巴结表现为低回声、圆形或椭圆形、内部回声均匀。与良性淋巴结相比,恶性淋巴结具有较高的形态学评分（11.41±0.6 比9.01±0.15,P<0.001）,而两者大小差异无统计学意义[（13.29±0.90）mm比(11.87±0.56) mm,P= 0.28]。以淋巴结EUS形态学评分≥12分为恶性诊断标准,EUS判断恶性淋巴结的准确率、敏感度、特异度、阳性预测值、阴性预测值分别为92.1%（93/101）、76.5%（13/17）、95.2%（80/84）、76.5%（13/17）、95.2%（80/84）。结论 EUS可显示整个肝外胆管及部分肝内胆管,明确病变范围,有助于肝门部胆管癌的诊断及指导制定手术方案。     

十二指肠隆起性病变超声内镜频率选择的临床研究

目的探讨超声内镜扫查不同大小十二指肠隆起性病变时频率的选择。方法对常规胃镜发现的201例患者210个十二指肠隆起性病灶,根据病灶特征和超声图像清晰度,选择不同扫查频率进行超声胃镜或者微型探头扫查。在征得患者同意后,对病灶进行相应的病理检查,并将病理检查结果与EUS诊断结果进行对比分析。结果EUS与病理诊断结果的符合率为81．4％（22／27）。低频扫描易于显示病灶全貌,对扫查直径≥1．5cm的病灶及高回声病灶具有优势,而高频扫描易于显示微细层次结构,扫查直径〈1．5cm病灶更为有利,联合使用多种频率扫描较大病灶能够提供更多影像信息。结论对于不同大小的隆起性病灶,选择合适的超声扫查频率或联合使用多种扫查频率有助于EUS对十二指肠隆起性病变的诊断。     

术前内镜评估结直肠侧向发育型肿瘤浸润深度的临床研究

目的对比放大染色内镜（MCE）、内镜超声检查术（EUS）术前评估结直肠侧向发育型肿瘤（LST）浸润深度的准确率。方法纳入104例结直肠LST,以病理诊断为金标准,回顾性比较MCE和EUS术前评估结直肠LST浸润深度的准确率。结果MCE和EUS的总体准确率分别为89.4%（93/104）和73.1%（76/104）（P＜0.05）。病变大小、检查医生因素会影响EUS评估的准确率（P=0.017,OR=3.561;P=0.035,OR=1.399）。在直径较大的结直肠LST病变中,EUS评估的准确率有下降趋势。结论MCE和EUS均为评估结直肠LST病变浸润深度的有效方法。MCE评估结直肠LST病变浸润深度的准确率可能高于EUS。病变直径大、检查医生经验不足可能是影响EUS检查准确率的危险因素。     

放大内镜窄带光成像联合内镜超声对早期食管癌浸润深度诊断的准确性分析

目的评估放大内镜窄带光成像（ME-NBI）、内镜超声检查术（EUS）及两者联合对早期食管癌浸润深度判断的准确性。方法选取2015年1月至2017年12月厦门大学附属第一医院行普通白光胃镜检查且病理诊断为早期食管癌的105例患者（105处病灶）,通过ME-NBI和EUS评估病灶浸润深度,依据检查结果确定手术方式。以术后病理结果为金标准,分析ME-NBI、EUS及两者联合判断病变浸润深度的准确性。结果ME-NBI判断病变浸润至黏膜上皮层/固有层和≥黏膜肌层的准确率分别为873%（69/79）和846%（22/26）,总体准确率867%（91/105）,灵敏度和特异度分别为945%（69/73）和688%（22/32）。EUS判断同样浸润深度的准确率分别为859%（67/78）和778%（21/27）,总体准确率838%（88/105）,灵敏度和特异度分别为918%（67/73）和656%（21/32）。EUS和ME-NBI二者皆提示病变浸润深度不超过黏膜固有层的准确率为917%（67/73）,而两种方法任一方法判断浸润深度≥黏膜肌层时,只有182%（6/33）的病变位于黏膜上皮层/固有层（Kappa=0978,P=0000）。结论ME-NBI、EUS对于早期食管癌浸润深度都具有较好的诊断准确性,而联合使用可进一步提高准确性,为治疗方案的选择提供较为可靠的依据。     

人工智能胃镜在盲区监测和自主图像采集中的应用研究

目的 分析实时胃镜监控系统(即胃镜精灵)在胃镜检查中的盲区监测功能与自主图像采集功能。 方法 收集武汉大学人民医院消化内镜中心数据库2017年5月至2018年5月间的全部胃镜图像,根据入选排除标准,共选取38 522张胃镜图像训练和验证胃镜精灵。利用计算机产生随机数的随机方法,选取91个胃镜检查视频资料评估胃镜精灵部位识别准确率,选取45个胃镜检查视频资料及内镜医师采集的与之相匹配的胃镜图像资料,比较机械采图与人工采图胃镜检查部位覆盖个数及覆盖率。邀请2位水平相当的内镜医师,收集使用胃镜精灵的医师1使用胃镜精灵前后分别完成的45个胃镜检查图像资料,收集不使用胃镜精灵的医师2同期分别完成的20、22个胃镜检查图像资料,比较两者胃镜检查部位覆盖率。 结果 胃镜精灵的部位识别总体准确率为85125%（1 156/1 358）。使用胃镜精灵的医师1使用胃镜精灵前后胃镜检查部位覆盖率分别为(76790±8848)%和(87325±7065)%,未使用胃镜精灵的医师2相应时间段内胃镜检查部位覆盖率分别为(75926±11565)%和(75253±14662)%。使用胃镜精灵前,医师1和医师2水平相当(t=0324,P=0747);使用胃镜精灵后,医师1胃镜检查部位覆盖率高于使用前（t=6222,P=0001）,亦高于同期医师2（t′=3588,P=0002）。机器采图的胃镜检查部位覆盖个数为（20956±3406）个,部位覆盖率为（77613±12613）%,人工采图分别为（15467±2296）个、（57284±8503）%。机器采图部位覆盖个数（t=11523,P=0000）与覆盖率（t=11,523,P=0000）均高于人工采图。 结论 胃镜精灵可提高胃镜检查部位覆盖率及覆盖个数,改善传统胃镜检查时检查部位覆盖不全及采图不全面的情况。     

基于深度学习的人工智能技术在早期胃癌诊断中的应用

目的 构建和验证一个用于早期胃癌自动识别的深度学习模型,旨在提高早期胃癌的识别和诊断水平。 方法 从长海医院消化内镜中心数据库选取2014年5月至2016年12月期间5 159张胃镜图像,其中包括早期胃癌1 000张,良性病变及正常图像4 159张。首先选取4 449张图像（其中早期胃癌图像768张,其他良性病变及正常图像3 681张）用于深度学习模型的训练。然后将剩余的710张图像用于模型的验证,同时再交给4名内镜医师进行诊断。最后统计相关结果。 结果 深度学习模型用于早期胃癌诊断的准确率89.4％（635／710）、敏感度88.8％（206／232）、特异度89.7％（429／478）,每张图像的诊断时间为（0.30±0.02）s,均优于相比较的4名内镜医师。 结论 本研究构建的深度学习模型用于早期胃癌的诊断具有较高的准确率、特异度和敏感度,可在胃镜检查中辅助内镜医师进行实时诊断。     

超声胃镜在特发性胰腺炎病因诊断中的价值

目的评价超声内镜（EUS）对特发性胰腺炎（IP）病因诊断的价值。方法采用超声胃镜水囊法结合水充盈法,对30例临床诊断为IP的患者进行EUS检查,同时与ERCP、MRCP等影像学结果比较。结果 30例IP病因诊断阳性率依次为：EUS66.6%（18/27）,ERCP75.0%（21/28）,MRCP26.9%（7/26）。EUS与ERCP诊断符合率接近,差异无统计学意义（P〉0.05）;EUS对胆管微小结石,胰腺导管内乳头状黏液瘤（IPMNs）的诊断阳性率最高;而ERCP对胰腺分裂症、胆总管囊肿、肝吸虫感染及乳头括约肌功能不全（SOD）诊断价值最高。结论 EUS可作为IP病因诊断的首选筛查手段,联合EUS与ERCP、MRCP对特发性胰腺炎的病因诊断具有较高的价值。     

小探头超声内镜对早期胃癌浸润深度的评估价值

[目的]探讨小探头超声内镜(endoscopic ultrasonography,EUS)在早期胃癌浸润深度评估中的应用价值。[方法]回顾性分析接受诊治的35例早期胃癌患者的临床资料,所有患者于内镜或手术治疗前均接受小探头EUS扫查明确病变浸润深度,并与内镜或手术治疗后病理进行比较,评估小探头EUS对判断早期胃癌浸润深度的准确性。[结果]35例中超声扫查示病灶浸润黏膜层18例、黏膜下层15例、固有肌层2例,内镜黏膜下剥离术或手术治疗后病理提示累及黏膜层19例、黏膜下层16例。EUS对病灶浸润深度总体判断准确率74.3%、低估率8.6%、过判率17.1%;EUS对黏膜层病变的诊断准确率为83.3%,对黏膜下层病变的诊断准确率为73.3%,两者比较差异无统计学意义(P0.05)。[结论]小探头EUS对早期胃癌浸润层次判断的准确性高,可作为治疗方案选择的重要依据。     

The immunoneuroendocrine role of melatonin

Abstract: A tight, physiological link between the pineal gland and the immune system is emerging from a series of experimental studies. This link might reflect the evolutionary connection between self-recognition and reproduction. Pinealectomy or other experimental methods which inhibit melatonin synthesis and secretion induce a state of immunodepression which is counteracted by melatonin. In general, melatonin seems to have an immunoenhancing effect that is particularly apparent in immunodepressive states. The negative effect of acute stress or immunosuppressive pharmacological treatments on various immune parameters are counteracted by melatonin. It seems important to note that one of the main targets of melatonin is the thymus, i.e., the central organ of the immune system. The clinical use of melatonin as an immunotherapeutic agent seems promising in primary and secondary immunodeficiencies as well as in cancer immunotherapy. The immunoenhancing action of melatonin seems to be mediated by T-helper cell-derived opioid peptides as well as by lymphokines and, perhaps, by pituitary hormones. Melatonin-induced-immuno-opioids (MHO) and lymphokines imply the presence of specific binding sites or melatonin receptors on cells of the immune system. On the other hand, lymphokines such as -γ-interferon and interleukin-2 as well as thymic hormones can modulate the synthesis of melatonin in the pineal gland. The pineal gland might thus be viewed as the crux of a sophisticated immunoneuroendocrine network which functions as an unconscious, diffuse sensory organ.     

Response of rat pineal melatonin to calcium, magnesium, and lithium is circadian stage dependent

Abstract: Herein we documented the response of pineal melatonin production to electrolytes known to be effective on pineal function in view of a possible circadian stage dependence. We studied the release of melatonin by perifused rat pineal glands at 2 different circadian stages corresponding to the middle of the light and dark periods, i.e., respectively, 7 and 19 HALO (Hours After Light Onset, L:D = 12:12). The initial efflux rates were, as expected, much higher in the perifusates of glands removed from rats sacrificed during the dark phase than of those removed during the light phase. After 3 hr of perifusion, melatonin release reached similar levels which were found constant up to the 8th hr of perifusion, whatever the circadian stage. Perifusion of the glands with physiological concentrations for the rat of calcium (5.2 mmol/1) and magnesium (1.34 mmol/1) resulted in a stimulatory effect on the pineal glands removed from rats sacrificed in the middle of the dark period (19 HALO), whereas no effects were observed on the pineal glands removed from rats sacrificed during the light (7 HALO). Lithium (0.28 and 0.55 mmol/1) was ineffective on melatonin release in pineal glands removed 7 and 19 HALO. Our results show differences in the initial efflux rates of melatonin and in the response of perifused pineal glands to calcium and magnesium according to the circadian stage.     

Changes in connexin43, the gap junction protein of astrocytes, during development of the rat pineal gland

Abstract: The abundance of gap junctions between rat pineal astrocytes formed by connexin43 (Cx43) was studied during development. Levels and distribution of Cx43 were measured by immunoblotting and indirect immunofluorescence, respectively. The amount of Cx43 in cells located within the gland was low until about the 7th postnatal day and increased to adult values between the 14th and 21st days postpartum. Although astrocytes, recognized by their vimentin immunoreactivity, were scarce before birth, they were abundant by the 7th postnatal day suggesting that the low levels of Cx43 found at this age corresponded to a low expression of this protein. Localization of the immunoreactivity to Cx43 and vimentin showed a close correlation, indicating that mature or immature pineal astrocytes form gap junctions made of Cx43. Since Cx43 levels attained their adult values at about the time the innervation and the functional state of the gland reached maturity (2–3 weeks after birth), it is proposed that astrocyte gap junctions are involved in the function of the adult rat pineal gland.     

Conservative management of perforated duodenal diverticulum： A case report and review of the literature

Duodenal diverticula are a relatively common condition. They are asymptomatic, unless they become complicated, with perforation being the rarest but most severe complication. Surgical treatment is the most frequently performed approach. We report the case of a patient with a perforated duodenal diverticulum, which was diagnosed early and treated conservatively with antibiotics and percutaneous drainage of secondary retroperitoneal abscesses. We suggest this method could be an acceptable option for the management of similar cases, provided that the patient is in good general condition and without septic signs.     

Presence of immunoreactive growth hormone and prolactin in the ovine pineal gland

Abstract: The use of antisera raised against bovine growth hormone (GH) and ovine prolactin (PRL) enabled the detection of related immunoreactive (ir) sequences of proteins in ovine pineal tissue. The isolation of PRL-like ir-material was accomplished using a 0.25 M ammonium sulphate (pH 5.5) extraction followed by ethanol precipitation, whereas the resulting 2.0 M ammonium sulphate (pH 7.0) precipitate contained a GH-like immunoreactivity. Gel chromatography of the GH-like immunoreactivity (Sephadex G-100) indicated the presence of several GH-like fragments ranging in the M_r range of 7,000 to 55,000. Analyses of the PRL-like ir-material found in pineal tissue on HPLC using a TSK 545-DEAE column led to the resolution into a single peak of immunoreactivity. A single peak of activity was also observed following chromatofocusing and hydrophobic interaction chromatography of the ir-peak from the TSK 545-DEAE column. The PRL-like ir-material inhibited the binding of [¹²⁵I]ovine PRL-S14 to anti-ovine PRL antibodies without showing an affinity for binding to anti-rat PRL or anti-bovine GH antibodies. Scatchard analysis of the binding of pineal PRL-like ir-material and pituitary ovine PRL-S14 to liver membranes from day-20 pregnant rats revealed similar affinity constants (K_a of 4.7 ± 0.2 × 10⁹ M^-1). In addition, the replication of Nb 2 Node rat lymphoma cells was stimulated by pineal PRL-like ir-material, an effect known to be specific for lactogenic hormones. The pineal PRL-like immunoreactivity appeared on sodium dodecyl sulfate polyacrylamide gels as a single major band of M_r 24,000. The functional status of PRL-and GH-like ir-material in the ovine pineal remains to be determined, but evidence is presented that the overall protein synthesis rate of the rat pineal responded to circulating concentrations of PRL.     

Microbiology of human immunodeficiency virus anorectal disease

PURPOSE: Individuals who are seropositive for the human immunodeficiency virus are at high risk for opportunistic infection and anorectal disorders. Little prospective information is available regarding anorectal pathogens in these patients. METHODS: One hundred sixty-three HIV-seropositive patients presented to the colorectal clinic between 1989 and 1992. Forty-seven (29 percent) patients were thought to have an infectious process and were prospectively studied using a standardized multiculture protocol. RESULTS: Mean age was 33 (range, 19–59) years. All were male; high-risk behavior accounted for 87 percent of HIV transmissions. Presenting complaints included anorectal pain (79 percent), pus per anum (28 percent), and blood per anum (26 percent). Examination revealed perianal tenderness (60 percent), condyloma (38 percent), perianal ulcers (38 percent), and anal fissures (34 percent). Sixty-six sets of cultures were performed; 28 patients had one set, 15 had two sets, and 4 had three sets. Thirty-two of these 47 patients (68 percent) had positive cultures including herpes (50 percent), cytomegalovirus (25 percent),Neisseria gonorrhoeae (16 percent), chlamydia (16 percent), acidfast bacilli (2 percent), and others (9 percent). Six of 32 patients with positive cultures had more than one organism cultured. Sixteen (50 percent) patients with positive cultures were treated medically, 8 (25 percent) were treated surgically and 8 (25 percent) were treated with both modalities. Sixty-one procedures were performed on 17 patients for condylomata. Eighteen patients had 20 procedures for abscesses, 50 percent of whom had positive cultures for other than common bowel flora; all improved. Fourteen patients underwent 33 procedures for perianal fistulas.Mycobacterium fortuitum was cultured from one patient who required 13 procedures for abscesses and fistulas. Forty-five (96 percent) patients were followed for an average of 12.5 months ±2.9 SEM (range, 1–94 months). Symptoms were improved or resolved in 22 of 32 (69 percent) patients with positive cultures and in 11 of 13 (84 percent) with negative cultures. CONCLUSIONS: Specific pathogens may often be identified in human immunodeficiency virus-seropositive patients with anorectal disorders if aggressively sought. Although patients without specific pathogens identified may be expected to improve with planned empiric treatment, positive identification allows more directed therapy.