Surgical decompression for the management of abdominal compartment syndrome with severe acute pancreatitis: A narrative review

Intra-abdominal hypertension(IAH)and abdominal compartment syndrome(ACS)play a pivotal role in the pathophysiology of severe acute pancreatitis(SAP)and contribute to new-onset and persistent organ failure.The optimal management of ACS involves a multi-disciplinary approach,from its early recognition to measures aiming at an urgent reduction of intra-abdominal pressure(IAP).A targeted literature search from January 1,2000,to November 30,2022,revealed 20 studies and data was analyzed on the type and country of the study,patient demographics,IAP,type and timing of surgical procedure performed,post-operative wound management,and outcomes of patients with ACS.There was no randomized controlled trial published on the topic.Decom-pressive laparotomy is effective in rapidly reducing IAP(standardized mean difference=2.68,95%confidence interval:1.19-1.47,P<0.001;4 studies).The morbidity and complications of an open abdomen after decompressive laparotomy should be weighed against the inadequately treated but,potentially lethal ACS.Disease-specific patient selection and the role of less-invasive decompressive measures,like subcutaneous linea alba fasciotomy or component separation techniques,is lacking in the 2013 consensus management guidelines by the Abdominal Compartment Society on IAH and ACS.This narrative review focuses on the current evidence regarding surgical decompression techniques for managing ACS in patients with SAP.However,there is a lack of high-quality evidence on patient selection,timing,and modality of surgical decompression.Large prospective trials are needed to identify triggers and effective and safe surgical decompression methods in SAP patients with ACS.

Multi-sensor data merging of sea ice concentration and thickness

With the rapid change in the Arctic sea ice,a large number of sea ice observations have been collected in recent years,and it is expected that an even larger number of such observations will emerge in the coming years.To make the best use of these observations,in this paper we develop a multi-sensor optimal data merging(MODM)method to merge any number of different sea ice observations.Since such merged data are independent on model forecast,they are valid for model initialization and model validation.Based on the maximum likelihood estimation theory,we prove that any model assimilated with the merged data is equivalent to assimilating the original multi-sensor data.This greatly facilitates sea ice data assimilation,particularly for operational forecast with limited computational resources.We apply the MODM method to merge sea ice concentration(SIC)and sea ice thickness(SIT),respectively,in the Arctic.For SIC merging,the Special Sensor Microwave Imager/Sounder(SSMIS)and Advanced Microwave Scanning Radiometer 2(AMSR2)data are merged together with the Norwegian Ice Service ice chart.This substantially reduces the uncertainties at the ice edge and in the coastal areas.For SIT merging,the daily Soil Moisture and Ocean Salinity(SMOS)data is merged with the weekly-mean merged CryoSat-2 and SMOS(CS2SMOS)data.This generates a new daily CS2SMOS SIT data with better spatial coverage for the whole Arctic.

Comparison of Four Methods for Handing Missing Data in Longitudinal Data Analysis through a Simulation Study

Missing data can frequently occur in a longitudinal data analysis. In the literature, many methods have been proposed to handle such an issue. Complete case (CC), mean substitution (MS), last observation carried forward (LOCF), and multiple imputation (MI) are the four most frequently used methods in practice. In a real-world data analysis, the missing data can be MCAR, MAR, or MNAR depending on the reasons that lead to data missing. In this paper, simulations under various situations (including missing mechanisms, missing rates, and slope sizes) were conducted to evaluate the performance of the four methods considered using bias, RMSE, and 95% coverage probability as evaluation criteria. The results showed that LOCF has the largest bias and the poorest 95% coverage probability in most cases under both MAR and MCAR missing mechanisms. Hence, LOCF should not be used in a longitudinal data analysis. Under MCAR missing mechanism, CC and MI method are performed equally well. Under MAR missing mechanism, MI has the smallest bias, smallest RMSE, and best 95% coverage probability. Therefore, CC or MI method is the appropriate method to be used under MCAR while MI method is a more reliable and a better grounded statistical method to be used under MAR.

Classification of vegetative types in Changbai Mountain based on optical and microwave remote sensing data

Highly accurate vegetative type distribution information is of great significance for forestry resource monitoring and management.In order to improve the classification accuracy of forest types,Sentinel-1 and 2 data of Changbai Mountain protection development zone were selected,and combined with DEM to construct a multi-featured random forest type classification model incorporating fusing intensity,texture,spectral,vegetation index and topography information and using random forest Gini index(GI)for optimization.The overall accuracy of classification was 94.60%and the Kappa coefficient was 0.933.Comparing the classification results before and after feature optimization,it shows that feature optimization has a greater impact on the classification accuracy.Comparing the classification results of random forest,maximum likelihood method and CART decision tree under the same conditions,it shows that the random forest has a higher performance and can be applied to forestry research work such as forest resource survey and monitoring.

Mortality and Morbidity Following Surgery for Primary Malignant Musculoskeletal Tumors in the Pelvis and Limbs: A Retrospective Analysis Using the Japanese Diagnosis Procedure Combination Database

Introduction: Resection of malignant pelvic tumors has long been considered to be associated with higher postoperative mortality and morbidity than resection of malignant limb tumors. We compared the postoperative adverse events of pelvic tumor surgery and limb tumor surgery using a national inpatient database. Methods: We identified patients who underwent surgery for primary musculoskeletal malignant tumors of the pelvis or limbs between July and December in 2007- 2010 using the Japanese Diagnosis Procedure Combination inpatient database. We calculated the risk-adjusted odds ratio for the occurrence of postoperative complications following pelvic tumor surgery with reference to limb tumor surgery using a multivariable logistic regression analysis. Results: Of 3255 eligible patients, 3116 underwent limb tumor surgery and 139 underwent pelvic tumor surgery. In-hospital mortality was 0.6% and 0.7% and postoperative complication rates were 8.2% and 18.7%, respectively. The rate of blood transfusion and duration of anesthesia over 480 min were higher in the pelvic tumor group. Blood transfusion volume and duration of anesthesia were independently associated with worse outcomes, but there was no significant association between tumor location and occurrence of postoperative complications (odds ratio 1.18, 95% confidence interval 0.73 - 1.88, p = 0.502). Conclusions: Blood transfusion volume and duration of anesthesia were significant predictors of outcome. Our data demonstrate that the higher morbidity rate after pelvic tumor resection could result from the larger blood transfusion volume and longer anesthesia duration.

Multimorbidity and mortality among older patients with coronary heart disease in Shenzhen,China

BACKGROUND The current understanding of the magnitude and consequences of multimorbidity in Chinese older adults with coronary heart disease(CHD)is insufficient.We aimed to assess the association and population-attributable fractions(PAFs)between multimorbidity and mortality among hospitalized older patients who were diagnosed with CHD in Shenzhen,China.METHODS We conducted a retrospective cohort study of older Chinese patients(aged≥65 years)who were diagnosed with CHD.Cox proportional hazards models were used to estimate the associations between multimorbidity and all-cause and cardiovascular disease(CVD)mortality.We also calculated the PAFs.RESULTS The study comprised 76,455 older hospitalized patients who were diagnosed with CHD between January 1,2016,and August 31,2022.Among them,70,217(91.9%)had multimorbidity,defined as the presence of at least one of the predefined 14 chronic conditions.Those with cancer,hemorrhagic stroke and chronic liver disease had the worst overall death risk,with adjusted HRs(95%CIs)of 4.05(3.77,4.38),2.22(1.94,2.53),and 1.85(1.63,2.11),respectively.For CVD mortality,the highest risk was observed for hemorrhagic stroke,ischemic stroke,and chronic kidney disease;the corresponding adjusted HRs(95%CIs)were 3.24(2.77,3.79),1.91(1.79,2.04),and 1.81(1.64,1.99),respectively.All-cause mortality was mostly attributable to cancer,heart failure and ischemic stroke,with PAFs of 11.8,10.2,and 9.1,respectively.As for CVD mortality,the leading PAFs were heart failure,ischemic stroke and diabetes;the corresponding PAFs were 18.0,15.7,and 6.1,respectively.CONCLUSIONS Multimorbidity was common and had a significant impact on mortality among older patients with CHD in Shenzhen,China.Cancer,heart failure,ischemic stroke and diabetes are the primary contributors to PAFs.Therefore,prioritizing improved treatment and management of these comorbidities is essential for the survival prognosis of CHD patients from a holistic public health perspective.

Ghost Module Based Residual Mixture of Self-Attention and Convolution for Online Signature Verification

Online Signature Verification (OSV), as a personal identification technology, is widely used in various industries.However, it faces challenges, such as incomplete feature extraction, low accuracy, and computational heaviness. Toaddress these issues, we propose a novel approach for online signature verification, using a one-dimensionalGhost-ACmix Residual Network (1D-ACGRNet), which is a Ghost-ACmix Residual Network that combines convolutionwith a self-attention mechanism and performs improvement by using Ghost method. The Ghost-ACmix Residualstructure is introduced to leverage both self-attention and convolution mechanisms for capturing global featureinformation and extracting local information, effectively complementing whole and local signature features andmitigating the problem of insufficient feature extraction. Then, the Ghost-based Convolution and Self-Attention(ACG) block is proposed to simplify the common parts between convolution and self-attention using the Ghostmodule and employ feature transformation to obtain intermediate features, thus reducing computational costs.Additionally, feature selection is performed using the random forestmethod, and the data is dimensionally reducedusing Principal Component Analysis (PCA). Finally, tests are implemented on the MCYT-100 datasets and theSVC-2004 Task2 datasets, and the equal error rates (EERs) for small-sample training using five genuine andforged signatures are 3.07% and 4.17%, respectively. The EERs for training with ten genuine and forged signaturesare 0.91% and 2.12% on the respective datasets. The experimental results illustrate that the proposed approacheffectively enhances the accuracy of online signature verification.

Mapping Air Quality Using Remote Sensing Technology: A Case Study of Nairobi County

Nairobi County experiences rapid industrialization and urbanization that contributes to the deteriorating state of air quality, posing a potential health risk to its growing population. Currently, in Nairobi County, most air quality monitoring stations use low-cost, inaccurate monitors prone to defects. The study’s objective was to map Nairobi County’s air quality using freely available remotely sensed imagery. The Air Pollution Index (API) formula was used to characterize the air quality from cloud-free Landsat satellite images i.e., Landsat 5 TM, Landsat 7 ETM+, and Landsat 8 OLI from Google Earth Engine. The API values were computed based on vegetation indices namely NDVI, TVI, DVI, and the SWIR1 and NIR bands on the QGIS platform. Qualitative accuracy assessment was done using sample points drawn from residential, industrial, green spaces, and traffic hotspot categories, based on a passive-random sampling technique. In this study, Landsat 5 API imagery for 2010 provided a reliable representation of local conditions but indicated significant pollution in green spaces, with recorded values ranging from -143 to 334. The study found that Landsat 7 API imagery in 2002 showed expected results with the range of values being -55 to 287, while Landsat 8 indicated high pollution levels in Nairobi. The results emphasized the importance of air quality factors in API calibration and the unmatched spatial coverage of satellite observations over ground-based monitoring techniques. The study recommends the recalibration of the API formula for characteristic regions, exploring newer satellite sensors like those onboard Landsat 9 and Sentinel 2, and involving key stakeholders in a discourse to develop a suitable Kenyan air quality index.

Modelling the Survival of Western Honey Bee Apis mellifera and the African Stingless Bee Meliponula ferruginea Using Semiparametric Marginal Proportional Hazards Mixture Cure Model

Classical survival analysis assumes all subjects will experience the event of interest, but in some cases, a portion of the population may never encounter the event. These survival methods further assume independent survival times, which is not valid for honey bees, which live in nests. The study introduces a semi-parametric marginal proportional hazards mixture cure (PHMC) model with exchangeable correlation structure, using generalized estimating equations for survival data analysis. The model was tested on clustered right-censored bees survival data with a cured fraction, where two bee species were subjected to different entomopathogens to test the effect of the entomopathogens on the survival of the bee species. The Expectation-Solution algorithm is used to estimate the parameters. The study notes a weak positive association between cure statuses (ρ1=0.0007) and survival times for uncured bees (ρ2=0.0890), emphasizing their importance. The odds of being uncured for A. mellifera is higher than the odds for species M. ferruginea. The bee species, A. mellifera are more susceptible to entomopathogens icipe 7, icipe 20, and icipe 69. The Cox-Snell residuals show that the proposed semiparametric PH model generally fits the data well as compared to model that assume independent correlation structure. Thus, the semi parametric marginal proportional hazards mixture cure is parsimonious model for correlated bees survival data.

Comparison of Semi-Parametric Shared Frailty Models for Bees’Survival

Survival analysis is a fundamental tool in medical science for time-to-event data. However, its application to colony organisms like bees poses challenges due to their social nature. Traditional survival models may not accurately capture the interdependence among individuals within a colony. Frailty models, accounting for shared risks within groups, offer a promising alternative. This study evaluates the performance of semi-parametric shared frailty models (gamma, inverse normal, and positive stable-in comparison to the traditional Cox model using bees’ survival data). We examined the effect of misspecification of the frailty distribution on regression and heterogeneity parameters using simulation and concluded that the heterogeneity parameter was more sensitive to misspecification of the frailty distribution and choice of initial parameters (cluster size and true heterogeneity parameter) compared to the regression parameter. From the data, parameter estimates for covariates were close for the four models but slightly higher for the Cox model. The shared gamma frailty model provided a better fit to the data in comparison with the other models. Therefore, when focusing on regression parameters, the gamma frailty model is recommended. This research underscores the importance of tailored survival methodologies for accurately analyzing time-to-event data in social organisms.

利用开源软件和编程最佳实践研发可持续Web应用程序支撑海洋数据共享——以BCO-DMO为例

美国国家科学基金会(NSF)资助的生物和化学海洋学数据管理办公室(BCO-DMO)使用Drupal作为内容管理系统(CMS)来管理和发布服务NSF资助的子项目和其他项目的海洋元数据和数据。元数据对于使数据(在我们的案例中是海洋数据)可发现、可检索和可重用至关重要。虽然大多数元数据必须直接来自数据贡献者,但NSF资助的研究的元数据可以从NSF网站获得。本文描述了我们利用开源软件和编程最佳实践为可持续BCO-DMO Web应用程序提供支持的方法。我们选择建立一个中间网站和支持数据库,称之为NSF Tracker网站,位于NSF和BCO-DMO网站之间,使用Drupal实现,以获取、存储和预填充BCO-DMO元数据数据库。在NSF Tracker网站的开发过程中,我们使用了精心挑选的Drupal贡献的模块和开发的定制模块,并遵循NSF网站和BCO-DMO网站之间松散耦合的概念。为了实现两个网站的松散耦合,我们决定使用web服务在网站之间传递数据。这样,两个网站都不需要知道数据是如何存储或检索的。新版本得益于使用Drupal模块、Drupal表单应用程序编程接口(API)、jQuery、Ajax和PHP组件。这种方法提高了NSF Tracker实施的安全性、灵活性和可持续性。

子宫肌瘤在两种子宫切除术式的临床回顾分析

回顾比较了 87例用LAVH或VH手术治疗子宫肌瘤的病例。分析了决定术式选择和影响手术时间的因素。结果发现 ,LAVH组平均子宫重量为 2 71g明显大于VH组 15 7g(P <0 0 0 1) ,LAVH组需伴随附件切除和合并子宫内膜异位症的病人比例明显高于VH组 (P分别为 <0 0 5 ,<0 0 0 1)。手术医师的个人选择是唯一决定术式的重要因素。LAVH平均手术时间 12 4min显著长于VH(P <0 0 0 1)。LAVH手术时间的多因素logistic回归分析表明 ,重量 >4 0 0g时 ,手术时间延长的机会高出 2 5倍 (P <0 0 5 ) ;如果需附件切除 ,手术时间延长 >15 0min可能性增加 2 6倍 (P <0 0 5 ) ;普通妇科医师手术时间延长的机会高出内窥镜医师达 33倍 (P <0 0 0 1)。

Capecitabine treatment patterns in patients with gastroesophageal cancer in the United States

AIM： To assess the use of capecitabine-based therapy and associated complication rates in patients with gastroesophageal cancer （GEC） in a real-world treat- ment setting. METHODS： Patients with claims between 2004 and 2005 were identified from the Thomson Reuters MarketScan databases. Capecitabine regimens were compared with 5-fluorouracU （5-FU） and other chemotherapy regimens, and were stratified by treatment setting. RESULTS： We identified 1013 patients with GEC： approximately half had treatment initiated with a 5-FU regimen, whereas 11% had therapy initiated with a capecitabine regimen. The mean capecitabine dose overall was 2382 ± 1118 mg/d, and capecitabine was used as monotherapy more often than in combination. Overall, 5-FU regimens were the most common treat- ment option in neoadjuvant and adjuvant settings, while other non-capecitabine regimens were used more widely in first- and second-line settings. The overall unadjusted complication rate for capecitabine regimens was about half of that seen with 5-FU regimens. In multivariate analyses, capecitabine recipients had a 51% （95% CI： 26%-81%） lower risk of developing any complication than 5-FU recipients did. The risk of developing bone marrow, constitutional, gastrointestinal tract, infectious, or skin complications was lower with capecitabine therapy than with 5-FU.CONCLUSION： Capecitabine appeared to have a favorable side effect profile compared with 5-FU, which indicates that it may be a treatment option for GEC.

Influence of geographic, knowledge and behavioral factors on Opisthorchis viverrini infection in the Northeast of Thailand

Objective:To determine the influence of geographic,knowledge and behavioral factors on Opisthorchis(O.)viverrini infection in the Northeast of Thailand.Methods:This cross-sectional study was conducted by using four datasets of years 2016 and 2017.Generalized linear mixed model was employed to analyze association between geographic,knowledge and behavioral factors and O.viverrini infection.Results:Totally there were 1885 participants.The prevalence of O.viverrini infection was 10.03%.Geographic factors that showed statistically significant association with O.viverrini infection in the Northeast region were featured by at least a dam and reservoir(Adj.OR=4.21,95%CI:2.49-7.13,P<0.001),at least a weir(Adj.OR=1.74,95%CI:1.09-2.77,P=0.020),>50 dogs and cats per village(Adj.OR=3.40,95%CI:2.17-5.31,P<0.001),and rice fields covered>50%of its areas(Adj.OR=1.91,95%CI:1.04-4.01,P=0.036),as well as low to moderate levels of knowledge(Adj.OR=1.60,95%CI:1.32 to 1.94,P<0.001),consumed raw fish(Adj.OR=1.90,95%CI:1.02 to 3.52,P=0.040)and consumed processed raw fish(Adj.OR=3.03,95%CI:2.20 to 4.18,P<0.001).Other significant covariates were gender and age of the respondents.Conclusions:O.viverrini infection still remains a public health problem of the Northeast of Thailand.Geographic and demographic factors,knowledge,and consumption behaviors of raw fish products are significantly associated with O.viverrini infection.

Artificial Intelligence and Autonomous Machines: Influences, Consequences, and Dilemmas in Human Care

In the field of robotics and in the health sciences, transitions have been occurring in the control of robots operating with predetermined logic and rules. Robotics in health care are influencing human caring dynamics in many ways such as enhancing dependency and surrender to machine technologies. Situations such as these are charged with possibilities of legal liabilities triggered by influences and consequences of advancing robotic technology dependency. The purpose of this paper is to identify, describe, and explain legal issues and/or dilemmas centered on robotics in healthcare while providing engaging opportunities to limit consequent legalities thus forming beneficial human health care outcomes. Laying bare these liabilities will provide critically informative data that can foster proactive encounters which can or may deter health care liabilities while ensuring quality healthcare outcomes. An attempt is made to re-conceptualize how to view agency, causality, liability responsibility, culpability, and autonomy for the new age of autonomous robots. While it is still not clear how this would turn out, a clear framing of the problem is the first step in the project.

Indistinguishable cellular changes in gastric mucosa between Helicobacter pylori infected asymptomatic tribal and duodenal ulcer patients

AIM： To investigate the changing pattern of different histological parameters occurring in the stomach tissue of Helicobacter pylori （H pylori） infected tribal populations and duodenal ulcer patients among ethnic Bengalis and correlation of the genotypes of H pylori with different histological parameters. METHODS： One hundred and twelve adult individuals were enrolled into this study between 2002 and 2004. Among them, 72 had clinical features of duodenal ulcer （DU） from ethnic Bengali population and 40 were asymptomatic ethnic tribals. Endoscopic gastric biopsy samples were processed for histology, genotyping and rapid urease test. Histologically, haematoxylin and eosin staining was applied to assess the pathomorphological changes and a modified Giemsa staining was used for better detection of Hpylori. For intestinal metaplasia, special stainings, i.e. Alcian blue periodic acid-Schiff and high iron diamine-Alcian blue staining, were performed. PCR was performed on bacterial DNA to characterize the presence or absence of virulence-associated genes, like cagA, and distribution of different alleles of vacA and iceA. RESULTS： Intraglandular neutrophil infiltration, a hallmark of activity of gastritis, was present in 34 （94%） of tribals （TRs） and 42 （84%） of DU individuals infected with H pylori. Lymphoid follicles and aggregates, which are important landmarks in H pylori infection, were positive amongst 15 （41%） of TRs and 20 （40%） of DU subjects. Atrophic changes were observed in 60% and 27.7%, respectively, among DU cases and tribals （P 〉 0.003）. Metaplastic changes were detected in low numbers in both groups. Moderate to severe density distribution of Hpylori in the gastric mucosa was 63% among TRs, whereas it was 62% in DU subjects. There were no significant differences in the distribution of virulence-associated genes like cagA, vacA and iceA of H pylori strains carried by these two populations. CONCLUSION： Our study showed almost similar distribution of inflammatory cells among asymptomatic tribals and DU Bengali patients. Interestingly, the tribal population are free from any clinical symptoms despite evidence of active histologic gastritis and infection with Hpylori strains carrying similar virulence markers as of strains isolated from patients with DU. There was an increased cellular response, especially in terms of neutrophil infiltration, but much lower risk of developing atrophy and metaplastic changes among the tribal population.

Bacterial Urinary Tract Infections among Males with Lower Urinary Tract Obstruction at Komfo Anokye Teaching Hos-pital, Kumasi, Ghana

Purpose: We describe the commonest pathology responsible for lower urinary tract obstruction (LUTO) and associated symptoms such as UTI, etc. among males at the Komfo Anokye Teaching Hospital (KATH) in Kumasi. Materials and Methods: Between January and December 2009, prospective cross sectional hospital based study was conducted involving 103 subjects. Patients with symptoms of LUTO and who were on short admission (up to 48 hours) at the accident and emergency unit of KATH were identified as potential study subjects. All the patients presented with acute retention of urine at the emergency unit of KATH and urethral catheterization was attempted to relieve them of the retention under sterile conditions. Those patients whose initial catheterization failed went through suprapubic cystostomy (suprapubic catheterization). Urine specimens for culture and sensitivity tests were then collected into sterile urine containers immediately after the catheterization (irrespective of type). Ultrasound Scan was requested for all the patients to assist in diagnosing enlargement of the prostate and other associated urological pathologies. Retrograde urethrogram was however, requested for those patients with suprapubic catheterization and which helped in the diagnosis of the urethral stricture. For a particular child, urethral catheter was passed under sterile condition and Micturicting Cysto-Urethrogram (MCUG) was done to assist in diagnosing posterior urethral valve and other conditions. Those subjects whose urinalysis revealed pyuria and positive urine culture and who had voluntarily agreed to enter the study were enrolled. Subjects whose urine culture had multiple bacteria growth that was deemed to be contaminants were excluded from the study. Results: The mean age for males with LUTO was 62 years. The youngest male with LUTO was aged 2 years whilst the maximum age was 93 years. LUTO due to prostatic hyperplasia was found in 79 (76.7%) men;23 (22.3%) had LUTO due to urethral stricture and 1 (1.0%) (youngest male). The mean age of patients that had LUTO due to urethral stricture was approximately 39 years. The youngest patient with LUTO due to urethral stricture aged 22 years whilst the maximum age was 72 years. Microbiological results indicated that Escherichia coli caused 53 (51.5%) of urinary tract infection (UTI) due to LUTO;Klebsiella = 23 (22.3%);Staphylococcus aureus = 14 (14.6%);Pseudomonas spp. = 8 (7.8%) Proteus = 2 (2.0%);Citrobacter = 1 (1.0%) and Salmonella spp. =1 (1.0%). Conclusion: The most common cause of lower urinary tract obstruction (LUTO) in Kumasi, Ghana is prostatic hyperplasia and the commonest causative organism of the associated UTI symptom is Escherichia coli.

PillCamColon2 after incomplete colonoscopy-A prospective multicenter study

AIM To evaluate the ability of PillCamColon2 to visualize colonic segments missed by incomplete optical colonoscopy(OC) and to assess the diagnostic yield.METHODS This prospective multicentre study included 81 patients from nine centres who underwent second-generation colon capsule endoscopy(CCE) following incomplete OC performed by an experienced gastroenterologist(> 1000 colonoscopies). Patients with stenosis were excluded. According to patient preferences, CCE was performed the following day(protocol A) after staying on clear liquids and 0.75 L Moviprep in the morning or within 30 d after new split-dose Moviprep(protocol B). Boosts consisted of 0.75 L and 0.25 L Moviprep, and phospho-soda was given as a rescue if the capsule was not excreted after seven hours.RESULTS Seventy-four patients were analysed(51% of them in group A; 49% in group B). Bowel cleansing was adequate in 67% of cases, and CCE could visualize colonic segments missed by incomplete colonoscopy in 90% of patients under protocol A and 97% of patients under protocol B(P = 0.35, n.s.). Significant polyps including adenocarcinoma were detected in 24% of cases. Detection rates for all polyps and significant polyps per patient were similar in both protocols. Polyps were found predominantly in the right colon(86%) in segments that were not reached by OC. Extracolonic findings-such as reflux esophagitis, suspected Barrett esophagus, upper GI-bleeding, gastric polyps, gastric erosions and angiectasia-were detected in eight patients. Pill Cam Colon2 capsule was retained in the ileum of one patient(1.4%) without symptoms and removed during an uneventful resection for unknown Crohn's disease that was diagnosed as the cause of anemia, which was the indication for colonoscopy. CCE was well tolerated. One patient suffered from selflimiting vomiting after consuming the phospho-soda.CONCLUSION Second-generation CCE using a low-volume preparation is useful after incomplete OC, and it allows for the detection of additional relevant findings, but cleansing efficiency could be improved.

The prevalence of depression among students in Chinese universities over the past decade: A meta-analysis

Objective:Morbidity rate of depression among students in Chinese universities over the pass 10 years was evaluated to reveal the prevalence of depression within the group.Providing reference for future implement of anti-depression measures in universities.Methods:Multiple electronic databases were searched including Pubmed,Ebase,the Cochcrane Library,Chinese National Knowledge Infrastructure,Wanfang Database,Weipu Database.Cross sectional studies reporting on the prevalence of depression among students in Chinese universities were included.The extracted data was then Meta analyzed by R.3.6.1 software.Results:37 validated studies with a total sample of 52,622 participants were covered.The prevalence of depression among students in Chinese universities over the pass 10 years ranged within 8.00%-74%.The pooled morbidity rate by random-effects model was 31.38%(95%Cl=26.31%,36.44%).Subgroup analysis implicated the research outcome is influenced by gender,region,grade,place of birth and the quality of the study.Conclusion:An increasing tendency of the prevalence of depression among students in Chinese universities over the pass 10 years was concluded,Greater awareness was suggested to universities considering the psychiatric health of students.

Dysregulation of microRNA in cholangiocarcinoma identified through a meta-analysis of microRNA profiling

BACKGROUND In the past decades,the potential of microRNA(miRNA)in cancer diagnostics and prognostics has gained a lot of interests.In this study,a meta-analysis was conducted upon the pooled miRNA microarray data of cholangiocarcinoma(CCA).AIM To identify differentially expressed(DE)miRNAs and perform functional analyses in order to gain insights to understanding miRNA-target interactions involved in tumorigenesis pathways of CCA.METHODS Raw data from 8 CCA miRNA microarray datasets,consisting of 443 samples in total,were integrated and statistically analyzed to identify DE miRNAs via comparison of levels of miRNA expression between CCA and normal bile duct samples using t-tests(P<0.001).The 10-fold cross validation was performed in order to increase the robustness of the t-test results.Our data showed 70 up-regulated and 48 down-regulated miRNAs in CCA. GeneOntology and pathway enrichment analyses revealed that mRNA targets of DEmiRNAs were significantly involved in several biological processes. The mostprominent dysregulated pathways included phosphatidylinositol-3 kinases/Akt,mitogen-activated protein kinase and Ras signaling pathways.CONCLUSIONDE miRNAs found in our meta-analysis revealed dysregulation in major cancerpathways involved in the development of CCA. These results indicated thenecessity of understanding the miRNA-target interactions and the significance ofdysregulated miRNAs in terms of diagnostics and prognostics of cancers.