Objective:To investigate the correlationship between an artificial intelligence-based e-Boston bowel preparation scale (e-BBPS) system score and the adenoma miss rate.Methods:Colonoscopy images of 4 373 patients at the Endoscopy Center of Renmin Hospital of Wuhan University from December 21, 2017 to December 31, 2019 were collected for model training. Patients who underwent colonoscopy at the Eighth Affiliated Hospital of Sun Yat-sen University from October 8, 2021 to November 9, 2022 were prospectively included. Patient's bowel preparation was evaluated by the e-BBPS system and endoscopists based on BBPS score. If both the endoscopists and e-BPPS system believed that the bowel preparation was sufficient, the patient immediately proceeded to a second colonoscopy. Otherwise, the patient underwent bowel preparation again. The differences in adenoma and polyp miss rate between the qualified group (e-BBPS system score ≤3) and the unqualified group (e-BBPS system score >3) were compared.Results:The adenoma miss rate in the qualified group was significantly lower than that in the unqualified group [26.72% (62/232) VS 42.53% (37/87), χ2=7.384， P=0.007, OR=2.029 (95% CI: 1.212-3.396)], and the polyp miss rate in the qualified group was significantly lower than that in the unqualified group [27.28% (195/702) VS 41.24% (113/274), χ2=16.539， P<0.001, OR=1.825 (95% CI: 1.363-2.443)]. Conclusion:The deep learning-based e-BBPS system demonstrates accuracy and reliability in bowel preparation assessment, offering potential to standardize the process of evaluating bowel preparation and reduce missed lesions.

According to statistics from the Extracorporeal Life Support Organization(ELSO),as of October 2023,a total of 198 623 patients worldwide had received extracorporeal membrane oxygenation(EC-MO)support.In recent years,the number of ECMO treatment cases in China has increased rapidly,reaching 10 656 cases in 2022.It was previously believed that fat emulsions could easily lead to ECMO system failures due to their hydrophobic nature,thereby limiting their use during ECMO.However,many clinically used drugs are lipid-soluble,and restricting their use not only increases treatment difficulty for these patients but may e-ven affect their prognosis.With advancements in material technology and membrane lung manufacturing processes,intravenous lipid emulsion(ILE)now exerts significant effects on ECMO systems.This article re-views recent domestic and international research progress regarding the effects of ILE on ECMO systems,ai-ming to provide more evidence-based medical support for ILE application in ECMO patients.

Liver transplantation is the ultimate treatment for patients with end-stage liver disease.In recent years,significant progress has been made in technological innovation and perioperative management,but its efficacy is still limited by challenges such as donor liver shortage and postoperative cardiopulmonary fail-ure.Extracorporeal membrane oxygenation(ECMO),as a cardiopulmonary support technique,provides oxy-genation and hemodynamic stability through extracorporeal circulation,demonstrating multidimensional value in the field of liver transplantation,especially in donor liver preservation and the management of complex com-plications.This article reviews the research progress of ECMO application in liver transplantation,facilitating a deeper understanding of the current status and future development directions of this technology in liver transplantation,providing references for clinical practice and scientific research.

Objective:To investigate the correlationship between an artificial intelligence-based e-Boston bowel preparation scale (e-BBPS) system score and the adenoma miss rate.Methods:Colonoscopy images of 4 373 patients at the Endoscopy Center of Renmin Hospital of Wuhan University from December 21, 2017 to December 31, 2019 were collected for model training. Patients who underwent colonoscopy at the Eighth Affiliated Hospital of Sun Yat-sen University from October 8, 2021 to November 9, 2022 were prospectively included. Patient's bowel preparation was evaluated by the e-BBPS system and endoscopists based on BBPS score. If both the endoscopists and e-BPPS system believed that the bowel preparation was sufficient, the patient immediately proceeded to a second colonoscopy. Otherwise, the patient underwent bowel preparation again. The differences in adenoma and polyp miss rate between the qualified group (e-BBPS system score ≤3) and the unqualified group (e-BBPS system score >3) were compared.Results:The adenoma miss rate in the qualified group was significantly lower than that in the unqualified group [26.72% (62/232) VS 42.53% (37/87), χ2=7.384， P=0.007, OR=2.029 (95% CI: 1.212-3.396)], and the polyp miss rate in the qualified group was significantly lower than that in the unqualified group [27.28% (195/702) VS 41.24% (113/274), χ2=16.539， P<0.001, OR=1.825 (95% CI: 1.363-2.443)]. Conclusion:The deep learning-based e-BBPS system demonstrates accuracy and reliability in bowel preparation assessment, offering potential to standardize the process of evaluating bowel preparation and reduce missed lesions.

BACKGROUND: Hypertrophic cardiomyopathy (HCM) is an underdiagnosed genetic heart disease worldwide. The management and prognosis of obstructive HCM (HOCM) and non-obstructive HCM (HNCM) are quite different, but it also remains challenging to discriminate these two subtypes. HCM is characterized by dysmetabolism, and myocardial amino acid (AA) metabolism is robustly changed. The present study aimed to delineate plasma AA and derivatives profiles, and identify potential biomarkers for HCM. METHODS: Plasma samples from 166 participants, including 57 cases of HOCM, 52 cases of HNCM, and 57 normal controls (NCs), who first visited the International Cooperation Center for HCM, Xijing Hospital between December 2019 and September 2020, were collected and analyzed by high-performance liquid chromatography-mass spectrometry based on targeted AA metabolomics. Three separate classification algorithms, including random forest, support vector machine, and logistic regression, were applied for the identification of specific AA and derivatives compositions for HCM and the development of screening models to discriminate HCM from NC as well as HOCM from HNCM. RESULTS: The univariate analysis showed that the serine, glycine, proline, citrulline, glutamine, cystine, creatinine, cysteine, choline, and aminoadipic acid levels in the HCM group were significantly different from those in the NC group. Four AAs and derivatives (Panel A; proline, glycine, cysteine, and choline) were screened out by multiple feature selection algorithms for discriminating HCM patients from NCs. The receiver operating characteristic (ROC) analysis in Panel A yielded an area under the ROC curve (AUC) of 0.83 (0.75-0.91) in the training set and 0.79 (0.65-0.94) in the validation set. Moreover, among 10 AAs and derivatives (arginine, phenylalanine, tyrosine, proline, alanine, asparagine, creatine, tryptophan, ornithine, and choline) with statistical significance between HOCM and HNCM, 3 AAs (Panel B; arginine, proline, and ornithine) were selected to differentiate the two subgroups. The AUC values in the training and validation sets for Panel B were 0.83 (0.74-0.93) and 0.82 (0.66-0.98), respectively. CONCLUSIONS The plasma AA and derivatives profiles were distinct between the HCM and NC groups. Based on the differential profiles, the two established screening models have potential value in assisting HCM screening and identifying whether it is obstructive.
Humans ; Amino Acids ; Cysteine ; Cardiomyopathy, Hypertrophic/diagnosis* ; Biomarkers ; Proline ; Arginine ; Ornithine ; Glycine ; Choline

Objective: Victims with shock-able initial arrest rhythms (ventricular fibrillation or pulse-less ventricular tachycardia, VF/VT) have much better outcomes from out-of-hospital cardiac arrest (OHCA) than those with non-shock-able initial rhythms (pulse-less electrical activities, PEA or asystole). Prompt defibrillation is believed pivotal to terminate lethal shock-able arrest rhythms. In this study, we were to identify those pre-hospital epidemiological factors which were associated with likelihood of shock-able rhythms first recorded when out-of-hospital cardiac arrest occurred. Methods: A multicenter, secondary, retrospective and observational analysis was performed on all adult non-traumatic OHCA in the Resuscitation Outcome Consortium (ROC) PRIMED study from June 2007 through November 2009. Of a total of 17 177 OHCA cases in PRIMED study, 13 421 of them were enrolled in this study when those OHCA patients with DNR order, or initial rhythms unknown, or arrest caused by obvious cause were excluded. We reported their demographics and episode characteristics for all enrolled cases. Multivariable logistic regression was employed to identify factors which were associated with likelihood of VF/VT recorded as shock-able initial rhythms. Results: Among 13 421 adult non-traumatic OHCA cases with initial rhythms recorded, 3 527 (26.3%) of them had shock-able rhythms, while 9 894 (73.7%) patients were in non-shock-able rhythms. Of the OHCA with shock-able arrest rhythms, 1 850(52.5%) obtained return of spontaneous circulation (ROSC) in the field, while 912 (25.9%) survived to hospital discharge. On the other hand, 2489(25.2%) of the OHCA with non-shock-able arrest rhythms obtained ROSC in the field, while 325 (3.3%) of them survived to hospital discharge. Multivariable regression analysis revealed those factors which indicated likelihood of shock-able rhythms recorded were: age(OR: 0.991,95%CI 0.988-0.993), male gender (OR1.887,95%CI1.718-2.073), pre-hospital Emergency Medical System(EMS) response time(OR0.950,95%CI 0.931-0.970), cardiac arrest witnessed by EMS providers(OR1.709,95%CI 1.423-2.054) or bystander(OR3.199,95%CI 2.921-3.504) and those with bystanders CPR (OR1.357,95%CI 1.239-1.487),public place of cardiac arrest (OR2.705,95%CI 2.437-3.003). Conclusions Some demographics and pre-hospital characteristics were proved associated with likelihood of shock-able arrest rhythms first recorded in OHCA victims, which might help develop corresponding strategies to deliver prompt shock on initially shock-able patients and improve their outcomes.

To investigate the effects of ventricular shunt placement in children with post-infective hydrocephalus.
 Methods: A total of 24 cases of post-infectious hydrocephalus, who received ventricular shunt, were enrolled. Age, gender, disease progression, clinical manifestation, laboratory data, treatment, prognosis, complication, and sequela for each patient were retrospectively reviewed.
 Results: Of the 24 cases, 8 had a full recovery, 11 had slight sequela, 2 had severe sequela, 1 was in vegetative state, and 2 died because of bacterial meningitis and tubercular meningitis. Epilepsy, mental impairment, visual and hearing damage were the main sequelae.
 Conclusion: Ventricular shunt is the preferred treatment in children with post-infective hydrocephalus, which shows positive clinical efficacy and can improve the long-term prognosis of such patients.
Child ; Humans ; Hydrocephalus ; Retrospective Studies ; Treatment Outcome ; Tuberculosis, Meningeal ; Ventriculoperitoneal Shunt

Objective: To explore the clinical effect of percutaneous low frequency electric stimulation on prevention of venous indwelling needle thrombotic blockage in patients with coronary heart disease. Methods: A total of 150 patients admitted to the department of cardiovascular medicine from May 2017 to January 2018 who met the inclusion and exclusion criteria were selected. It was divided into the intervention group and the control group by the random number table method, including 75 cases in the intervention group and 75 cases in the control group. In the control group, the routine nursing method was adopted for the maintenance of intravenous indwelling needle. In the intervention group, on the basis of routine nursing, the percutaneous low frequency electrical stimulation was added. The incidence of thrombosis, occlusion, mean retention time, patient satisfaction and intravenous infusion complications were compared between the two groups. Results: The incidence of thrombosis was 40.0% (30/75) and64.0% (48/75) in the intervention group and the control group, and the blockage rate was 28.0% (21/75) and 52.0% (39/75) in the intervention group and the control group, respectively. There were significant differences between the two groups (χ²=8.654, 9.000, all P< 0.01). The incidence of phlebitis, drug exosmosis and subcutaneous bruising were 13.33% (10/75), 13.33% (10/75) and 18.67% (14/75) in the intervention group, 33.33% (25/75), 40.00% (30/75) and 41.33% (31/75) in the control group, respectively. There were significant differences between the two groups (χ² = 8.385, 13.636, 9.175, all P< 0.01). The indwelling time and patient satisfaction of the intervention group were (2.817±0.221) d and 82.67% (62/75) respectively, while those of the control group were (2.291±0.127) d and 50.67% (38/75), respectively. There were significant differences between the two groups (t=17.926, χ²=17.280, all P<0.01). Conclusions Percutaneous low frequency electrical stimulation has positive significance for improving the formation of thrombus at the point of intravenous indwelling needle and preventing the blockage of catheter caused by thrombosis.

Objective: To report a family diagnosed with Allan-Herndon-Dudley syndrome (AHDS) due to SLC16A2 gene mutation and to summarize the phenotypes, genotypes, diagnosis, treatment, and prognosis. Methods: The clinical features of a family of AHDS diagnosed in Xiangya Hospital of Central South University in November 2017 were analyzed. Related literature was searched at Online Mendelian Inheritance in Man (OMIM), PubMed, CNKI and Wanfang database (from the establishment of databases to June 2018) by using "Allan-Herndon-Dudley syndrome" , and "AHDS" as keywords and the case reports from April 2013 to June 2018 were reviewed. Results: The proband was a boy aged 8 months who presented with global developmental retardation, inability to hold up the head, disability to sit independently or grab, no language development, elongated face, big ears, esotropia, scoliosis, hypotonia in the trunk, hypertonia in extremities, and hyperreflexia. Brain magnetic resonance imaging (MRI) showed widening of the extracerebral space and delayed myelination. Thyroid function tests revealed increased FT3, decreased FT4 and normal TSH. Whole exome sequencing (WES) revealed the SLC16A2 gene c.431-1 (IVS1) G>C hemizygous mutation. The infant's mother and grandmother are carriers, but whose father had no related mutation. One uncle from maternal side had severe psychomotor retardation as well as dystonia and died at one year of age with unknown etiology. A total of 97 articles were retrieved in which 19 case reports were reviewed. Forty-two cases (22 from 8 families and 20 sporadic) were reported. Among these 42 cases (all males), all of them presented with moderate to severe cognitive dysfunction, 15 with seizures; 36 were bedridden, only 4 could walk; 31 had no language development, 2 could speak sentences, 4 could speak few words, 1 had babbling sounds. Furthermore,16 had microcephaly, 18 had facial dysmorphism, 6 had esotropia, 2 had hearing loss,14 had scoliosis, 11 had joint contracture, 30 had low body weight/muscle wasting, 37 had hypotonia in trunk or extremities, 32 had progressive spastic paraplegia or hypertonia. In terms of thyroid function, 33 had abnormal results, within whom 30 had increased T3, 25 had decreased T4 and 3 had increased TSH. Brain MRI showed delayed myelination in 22 cases, within which one normalized with development. Genetic tests showed that 31 had missense mutation (14 sporadic), 5 had deletion mutation (3 sporadic, and 1 due to frameshift mutation), 5 had insertion mutation (2 sporadic), and 1 had repeated mutation. The prognosis was poor as patients often died of recurrent respiratory tract infection. Conclusions The main clinical manifestations of AHDS are severe global developmental retardation, hypotonia, spastic paraplegia, abnormal serum levels of thyroid hormone and delayed brain myelination. SLC16A2 c. 431-1 (IVS1) G > C mutation is accountable for this disease.

Background and purpose:The effective rate of ifrst-line chemotherapy for advanced lung cancer is 30%-40%. The purpose of this study was to evaluate the efifcacy and adverse effects of pemetrexed combined with carboplatin or cisplatin in the treatment of patients with advanced non-squamous non-small cell lung cancer (NSCLC). Methods:One hundrend and twenty-one patients with advanced non-squamous NSCLC were enrolled in this study and all of these patients had been conifrmed with pathology or cytology. Among the 121 cases, 60 cases were male and 61 were female, the median age was 59 years, adnenocarcinoma in 113 patients and large cell carcinoma in 8 patients. Combination regimen: patients received pemetrexed 500 mg/m2 on day 1 and carboplatin 300 mg/m2 or cisplatin 70 mg/m2 on day 1 by intravenous infusion, administrated every 3 weeks for 2 to 6 cycles. All patients who received 2 or more cycles could be evaluated. Disease control rate (DCR) was the primary end point; secondary end points included progression-free survival (PFS), 1-year survival rate and safety.Results:There was 1 case with complete response (CR), 44 cases achieved partial response (PR), 50 had stable disease (SD) and 26 cases had progressive disease (PD) in the overall cases. ORR and DCR were 37.2% (45/121) and 78.5% (95/121), respectively. The median PFS time was 5.2 months and 1-year survival rate was 59.0%. In pemetrexed combined with carboplatin group, the ORR and DCRwere 38.3% (23/60) and 78.3% (47/60), respectively; The median PFS was 5.1 months (95%CI: 3.8-6.4 month) and 1-year survival rate was 55.2%. The patients treated with pemetrexed plus cisplatin, the ORR and DCR were 36.1% (22/61) and 78.7% (48/61), respectively. Median PFS was 6.2 months (95%CI: 4.3-8.1 month) and 1-year survival rate was 62.5%. There were no statistical differences between carboplatin/pemetrexed and cisplatin/pemetrexed for both ORR, DCR, PFS and 1-year survival rate (P>0.05). The major adverse effects were leukopenia, neutropenia, fatigue and gastrointestinal reaction.Conclusion:Pemetrexed plus platinum chemotherapy could be considered as the ifrst-line treatment option for advanced non-squamous NSCLC patients. Pemetrexed combined with carboplatin/ cisplatin regimen has efifcacy with mild toxicity and better tolerability.