Edge artificial intelligence wireless video capsule endoscopy

Gastrointestinal (GI) tract diseases are responsible for substantial morbidity and mortality worldwide, including colorectal cancer, which has shown a rising incidence among adults younger than 50. Although this could be alleviated by regular screening, only a small percentage of those at risk are screened comprehensively, due to shortcomings in accuracy and patient acceptance. To address these challenges, we designed an artificial intelligence (AI)-empowered wireless video endoscopic capsule that surpasses the performance of the existing solutions by featuring, among others: (1) real-time image processing using onboard deep neural networks (DNN), (2) enhanced visualization of the mucous layer by deploying both white-light and narrow-band imaging, (3) on-the-go task modification and DNN update using over-the-air-programming and (4) bi-directional communication with patient’s personal electronic devices to report important findings. We tested our solution in an in vivo setting, by administrating our endoscopic capsule to a pig under general anesthesia. All novel features, successfully implemented on a single platform, were validated. Our study lays the groundwork for clinically implementing a new generation of endoscopic capsules, which will significantly improve early diagnosis of upper and lower GI tract diseases.</p

Diagnostic value of whole-body-focused ultrasonography in high-acuity patients in the emergency department:a prospective single-center cross-sectional study

Background: A fast and diagnostic accurate tool to assess the unselected category of high-acuity patients, in whom the underlying pathology is not always obvious, is needed in the emergency departments (ED). We aim to describe the feasibility, validity and diagnostic yield of a routine whole-body-focused ultrasonography (wbf-us) in an unselected group of high-acuity ED patients. Methods: In a prospective observational study, a convenience sample of ED patients (≥ 18 years) with a high-acuity score or systolic blood pressure &lt; 100 mmHg received a routine wbf-us of the heart, lungs, abdomen and deep veins by two non-expert sonographers. Final diagnosis was established by experienced auditors. Investigators were blinded to the patients’ medical history and emergency physicians and auditors were blinded to the investigators assessments. Diagnostic accuracy was assessed by comparing the investigators’ ultrasonography findings to a structured double-blinded clinical audit of patient files. Results: We included 171 patients, initiated a whole-body-focused ultrasonography examination (wbf-us) in 160 and completed it in 128 patients with an average time of a full examination of 28 min. We found pathology in 65/171 (38%) of the patients whose most frequent symptoms upon arrival were cardiopulmonary. Among the patients who received wbf-us, we found the majority of pathology by wbf-us of the lungs (n = 50, 31%), the heart (n = 26, 16%), few in the abdomen (n = 5, 3%) and none in the deep veins. The overall sensitivity was 50–100%, specificity 84–94%, positive predictive value 11–44% and negative predictive value 94–100%. Conclusion: Focused cardiopulmonary ultrasonography might be considered for routine use in high-acuity ED patients with cardiopulmonary symptoms whereas focused ultrasonography of the abdomen and deep veins performed by non-expert sonographers only seems indicated in selected patients. Trial registration Danish Data Protection Agency (ID 13/12076). Committee on Biomedical Research Ethics for the Region of Southern Denmark (ID S-20130047).</p

The Diagnostic Yield of Colonoscopy Stratified by Indications

Introduction. Danish centers reserve longer time for screening colonoscopies and allocate the most experienced endoscopists to these cases. The objective of this study is to determine the diagnostic yield in colonoscopies for different indications to improve planning of colonoscopy activity and allocation of the highly skilled endoscopists. Methods. Nine hundred and ninety-nine randomly collected patients from a prospectively maintained database were grouped in defined referral indication groups. Five groups were compared in respect of the detection rate of adenomas and cancers. Results. Two hundred and eighty-nine of 1098 colonoscopies in 999 patients showed significant neoplastic findings, resulting in 591 adenoma resections. Eighty-five percent were treated with a snare resection, and 15% with endoscopic mucosa resection (EMR). Positive findings in the indication groups were (1) symptoms, 25%; (2) positive screening, 17%; (3) previous resection of adenomas, 45%; (4) previous resection of colorectal cancer, 15%; and (5) surveillance of patients with high-risk family history of cancer, 35%. Conclusion. The majority of adenomas found during colonoscopy can be treated with simple techniques. If individualized time slots are considered, the adenoma follow-up colonoscopies are likely to be the most time-consuming group with more than twice the number of adenomas detected as compared to other indications

Key research questions for implementation of artificial intelligence in capsule endoscopy

Background: Artificial intelligence (AI) is rapidly infiltrating multiple areas in medicine, with gastrointestinal endoscopy paving the way in both research and clinical applications. Multiple challenges associated with the incorporation of AI in endoscopy are being addressed in recent consensus documents. Objectives: In the current paper, we aimed to map future challenges and areas of research for the incorporation of AI in capsule endoscopy (CE) practice. Design: Modified three-round Delphi consensus online survey. Methods: The study design was based on a modified three-round Delphi consensus online survey distributed to a group of CE and AI experts. Round one aimed to map out key research statements and challenges for the implementation of AI in CE. All queries addressing the same questions were merged into a single issue. The second round aimed to rank all generated questions during round one and to identify the top-ranked statements with the highest total score. Finally, the third round aimed to redistribute and rescore the top-ranked statements. Results: Twenty-one (16 gastroenterologists and 5 data scientists) experts participated in the survey. In the first round, 48 statements divided into seven themes were generated. After scoring all statements and rescoring the top 12, the question of AI use for identification and grading of small bowel pathologies was scored the highest (mean score 9.15), correlation of AI and human expert reading-second (9.05), and real-life feasibility-third (9.0). Conclusion: In summary, our current study points out a roadmap for future challenges and research areas on our way to fully incorporating AI in CE reading

Increased incidence of postoperative infections during prophylaxis with cephalothin compared to doxycycline in intestinal surgery

<p>Abstract</p> <p>Background</p> <p>The antibiotics used for prophylaxis during surgery may influence the rate of surgical site infections. Tetracyclines are attractive having a long half-life and few side effects when used in a single dose regimen. We studied the rate of surgical site infections during changing regimens of antibiotic prophylaxis in medium and major size surgery.</p> <p>Methods</p> <p>Prospective registration of surgical site infection following intestinal resections and hysterectomies was performed. Possible confounding procedure and patient related factors were registered. The study included 1541 procedures and 1489 controls. The registration included time periods when the regimen was changed from doxycycline to cephalothin and back again.</p> <p>Results</p> <p>The SSI in the colorectal department increased from 19% to 30% (p = 0.002) when doxycycline was substituted with cephalothin and decreased to 17% when we changed back to doxycycline (p = 0.005). In the gynaecology department the surgical site infection rate did not increase significantly. Subgroup analysis showed major changes in infections in rectal resections from 20% to 35% (p = 0.02) and back to 12% (p = 0.003).</p> <p>Conclusion</p> <p>Doxycycline combined with metronidazole, is an attractive candidate for antibiotic prophylaxis in medium and major size intestinal surgery.</p

Complement activation capacity in plasma before and during high-dose prednisolone treatment and tapering in exacerbations of Crohn's disease and ulcerative colitis

BACKGROUND: Ulcerative colitis (UC) and Crohn's disease (CD) are characterized by intestinal inflammation mainly caused by a disturbance in the balance between cytokines and increased complement (C) activation. Our aim was to evaluate possible associations between C activation capacity and prednisolone treatment. METHODS: Plasma from patients with exacerbations of UC (n = 18) or CD (n = 18) were collected before and during high dose prednisolone treatment (1 mg/kg body weight) and tapering. Friedman's two way analysis of variance, Mann-Whitney U test and Wilcoxon signed-rank sum test were used RESULTS: Before treatment, plasma from CD patients showed significant elevations in all C-mediated analyses compared to the values obtained from 38 healthy controls (p < 0.02), and in mannan binding lectin (MBL)-concentration and MBL-C4-activation capacity (AC) values compared to UC patients (p < 0.02). Before treatment, plasma from UC patients showed significant elevations only in the classical pathway-mediated C3-AC compared to values obtained from healthy controls (p < 0.01). After treatment was initiated, significant reductions, which persisted during follow-up, were observed in the classical pathway-mediated C3-AC and MBL-C4-AC in plasma from CD patients (p < 0.05). CONCLUSION: Our findings indicate that C activation capacity is up-regulated significantly in plasma from CD patients. The decreases observed after prednisolone treatment reflect a general down-regulation in immune activation

STAGES IN THE ORIGIN OF VERTEBRATES: ANALYSIS BY MEANS OF SCENARIOS

Vertebrates lack an epidermal nerve plexus. This feature is common to many invertebrates from which vertebrates differ by an extensive set of shared-derived characters (synapomorphies) derived from the neural crest and epidermal neurogenic placodes. Hence, the hypothesis that the developmental precursor of the epidermal nerve plexus may be homologous to the neural crest and epidermal neurogenic placodes. This account attempts to generate a nested set of scenarios for the prevertebrate-vertebrate transition, associating a presumed sequence of behavioural and environmental changes with the observed phenotypic ones. Toward this end, it integrates morphological, developmental, functional (physiological/behavioural) and some ecological data, as many phenotypic shifts apparently involved associated transitions in several aspects of the animals. The scenarios deal with the origin of embryonic and adult tissues and such major organs as the notochord, the CNS, gills and kidneys and propose a sequence of associated changes. Alternative scenarios are stated as the evidence often remains insufficient for decision. The analysis points to gaps in comprehension of the biology of the animals and therefore suggests further research.Peer Reviewedhttp://deepblue.lib.umich.edu/bitstream/2027.42/72629/1/j.1469-185X.1989.tb00471.x.pd

Atividade da colinesterase plasmática como biomarcador de impacto ambiental em tartarugas verdes (Chelonia mydas) no litoral do Arquipélago de Fernando de Noronha, Pernambuco

Biomarcadores podem ser usados de forma preditiva, permitindo que sejam tomadas ações de controle antes que ocorram danos ambientais irreversíveis com consequências ecológicas severas, no entanto, espécies sentinelas são necessárias para avaliação desses marcadores. As tartarugas marinhas são consideradas espécies sentinelas quando acometidas por fibropapilomas, sendo sinalizadora do desequilíbrio ambiental marinho nas suas áreas de ocorrência. Com o objetivo de propor a determinação da atividade da colinesterase plasmática em tartarugas verdes (Chelonia mydas) como biomarcador, procedeu-se a determinação da atividade enzimática em animais saudáveis e em localidade de baixo impacto antrópico (Arquipélago de Fernando de Noronha, Pernambuco, Brasil) para servir como referência para comparação com animais capturados em locais de maior impacto antrópico. Ao todo foram analisadas amostras de plasma heparinizado de 35 animais capturados. Todas as amostras analisadas apresentaram alguma atividade enzimática de colinesterase plasmática. Os valores obtidos de colinesterase variaram de 162 a 379 UI/L, com média e desvio padrão de 216,4 ± 51,4 UI/L. Nos estudos de repetibilidade e reprodutibilidade obtiveram-se coeficientes de variação menor que 5% em todas as análises, portanto a metodologia analítica utilizada se mostrou confiável. A longevidade das tartarugas marinhas da espécie C. mydas, o comportamento alimentar, juntamente com o fato de possuirem atividade enzimática detectável podem indicar essa espécie como bioindicadora de exposição a poluentes que influenciam na atividade da colinesterase plasmátic