Optical Fibre Communication Feature Analysis and Small Sample Fault Diagnosis Based on VMD-FE and Fuzzy Clustering

To solve the problems of a few optical fibre line fault samples and the inefficiency of manual communication optical fibre fault diagnosis,this paper proposes a communication optical fibre fault diagnosis model based on variational modal decomposition(VMD),fuzzy entropy(FE)and fuzzy clustering(FC).Firstly,based on the OTDR curve data collected in the field,VMD is used to extract the different modal components(IMF)of the original signal and calculate the fuzzy entropy(FE)values of different components to characterize the subtle differences between them.The fuzzy entropy of each curve is used as the feature vector,which in turn constructs the communication optical fibre feature vector matrix,and the fuzzy clustering algorithm is used to achieve fault diagnosis of faulty optical fibre.The VMD-FE combination can extract subtle differences in features,and the fuzzy clustering algorithm does not require sample training.The experimental results show that the model in this paper has high accuracy and is relevant to the maintenance of communication optical fibre when compared with existing feature extraction models and traditional machine learning models.

External anal sphincter electromyography in multiple system atrophy:implications for diagnosis,clinical correlations,and novel insights into prognosis

Multiple system atrophy is a sporadic,progressive,adult-onset,neurodegenerative disorder characte rized by autonomic dysfunction symptoms,parkinsonian features,and cerebellar signs in va rious combinations.An early diagnosis of multiple system atrophy is of utmost impo rtance for the proper prevention and management of its potentially fatal complications leading to the poor prognosis of these patients.The current diagnostic criteria incorporate several clinical red flags and magnetic resonance imaging marke rs supporting diagnosis of multiple system atrophy.Nonetheless,especially in the early disease stage,it can be challenging to differentiate multiple system atrophy from mimic disorders,in particular Parkinson’s disease.Electromyography of the external anal sphincter represents a useful neurophysiological tool for diffe rential diagnosis since it can provide indirect evidence of Onuf’s nucleus degeneration,which is a pathological hallmark of multiple system atrophy.However,the diagnostic value of external anal sphincter electromyography has been a matter of debate for three decades due to controve rsial reports in the literature.In this review,after a brief ove rview of the electrophysiological methodology,we first aimed to critically analyze the available knowledge on the diagnostic role of external anal sphincter electromyography.We discussed the conflicting evidence on the clinical correlations of neurogenic abnormalities found at external anal sphincter electro myography.Finally,we repo rted recent prognostic findings of a novel classification of electromyography patterns of the external anal sphincter that could pave the way toward the implementation of this neurophysiological technique for survival prediction in patients with multiple system atrophy.

Artificial intelligence for characterization of diminutive colorectal polyps:A feasibility study comparing two computer-aided diagnosis systems

BACKGROUND Artificial intelligence(AI)has potential in the optical diagnosis of colorectal polyps.AIM To evaluate the feasibility of the real-time use of the computer-aided diagnosis system(CADx)AI for ColoRectal Polyps(AI4CRP)for the optical diagnosis of diminutive colorectal polyps and to compare the performance with CAD EYE^(TM)(Fujifilm,Tokyo,Japan).CADx influence on the optical diagnosis of an expert endoscopist was also investigated.METHODS AI4CRP was developed in-house and CAD EYE was proprietary software provided by Fujifilm.Both CADxsystems exploit convolutional neural networks.Colorectal polyps were characterized as benign or premalignant and histopathology was used as gold standard.AI4CRP provided an objective assessment of its characterization by presenting a calibrated confidence characterization value(range 0.0-1.0).A predefined cut-off value of 0.6 was set with values<0.6 indicating benign and values≥0.6 indicating premalignant colorectal polyps.Low confidence characterizations were defined as values 40%around the cut-off value of 0.6(<0.36 and>0.76).Self-critical AI4CRP’s diagnostic performances excluded low confidence characterizations.RESULTS AI4CRP use was feasible and performed on 30 patients with 51 colorectal polyps.Self-critical AI4CRP,excluding 14 low confidence characterizations[27.5%(14/51)],had a diagnostic accuracy of 89.2%,sensitivity of 89.7%,and specificity of 87.5%,which was higher compared to AI4CRP.CAD EYE had a 83.7%diagnostic accuracy,74.2%sensitivity,and 100.0%specificity.Diagnostic performances of the endoscopist alone(before AI)increased nonsignificantly after reviewing the CADx characterizations of both AI4CRP and CAD EYE(AI-assisted endoscopist).Diagnostic performances of the AI-assisted endoscopist were higher compared to both CADx-systems,except for specificity for which CAD EYE performed best.CONCLUSION Real-time use of AI4CRP was feasible.Objective confidence values provided by a CADx is novel and self-critical AI4CRP showed higher diagnostic performances compared to AI4CRP.

Optical diagnosis of colorectal polyps using convolutional neural networks

Colonoscopy remains the gold standard investigation for colorectal cancer screening as it offers the opportunity to both detect and resect pre-malignant and neoplastic polyps.Although technologies for image-enhanced endoscopy are widely available,optical diagnosis has not been incorporated into routine clinical practice,mainly due to significant inter-operator variability.In recent years,there has been a growing number of studies demonstrating the potential of convolutional neural networks(CNN)to enhance optical diagnosis of polyps.Data suggest that the use of CNNs might mitigate the inter-operator variability amongst endoscopists,potentially enabling a“resect and discard”or“leave in”strategy to be adopted in real-time.This would have significant financial benefits for healthcare systems,avoid unnecessary polypectomies of non-neoplastic polyps and improve the efficiency of colonoscopy.Here,we review advances in CNN for the optical diagnosis of colorectal polyps,current limitations and future directions.

Diagnosis of lacrimal punctum lesions using optical coherence tomography: a preliminary study

AIM:To study the imaging characteristics of lacrimal punctum lesion with optical coherence tomography(OCT),and provide imaging basis for the diagnosis and treatment of lacrimal punctum diseases.METHODS:A total of 25 patients(28 eyes)with epiphora and lacrimal puncta lesions were enrolled.Lacrimal puncta lesions included:punctum membrane obstruction in 7 cases(9 eyes),punctum agenesis in 1 case(1 eye),a mass protruded from the punctum in 1 case(1 eye),slit puncta in 1 case(1 eye),peri-puncta mass in 2 cases(2 eyes),chronic dacryocystitis in 4 cases(4 eyes),and primary puncta stenosis in 9 cases(10 eyes;3 eyes mild,4 eyes moderate and 3 eyes severe).All patients were examined by slit lamp microscopy and OCT to observe the morphological characteristics of abnormal punctum.RESULTS:Two types of complete membrane obstruction and incomplete membrane obstruction of puncta were observed in OCT images of 7 patients.No lacrimal punctum and lacrimal canalicular cavity were found in 1 case with punctum agenesis.OCT images showed that a narrow lumen remained in the lacrimal puncta in 1 patient with a mass protruded from the punctum.OCT of punctum in a patient with slit punctum after stent placement showed stent and abnormal lacrimal structure.No abnormal intraluminal structure was found in 2 cases of peri-puncta mass after OCT scan,and the lacunar space was narrower than that of the contralateral eye.OCT of puncta in 4 patients with chronic dacryocystitis showed that pus floated in tear with lump-like medium-low reflex.In 9 patients with primary lacrimal puncta stenosis,OCT image could clearly show the changes of puncta lumen in different degrees and shapes.CONCLUSION:OCT is feasible for the examination of pathological punctum,and can provide imaging basis for the diagnosis and treatment of punctum disease.

Non-invasive diagnosis of gastric mucosal atrophy in an asymptomatic population with high prevalence of gastric cancer

AIM: To validate a non-invasive method to detect gastric mucosal atrophy in a Chilean population with high prevalence of gastric cancer and a poor survival rate. METHODS: We first determined the optimal cut-off level of serum pepsinogen (PG)-1, PG-1/PG-2 ratio and 17-gastrin in 31 voluntary symptomatic patients (mean age: 66.1 years), of them 61% had histologically confirmed gastric atrophy. Then, in a population-based sample of 536 healthy individuals (209 residents in counties with higher relative risk and 327 residents in counties with lower relative risk for gastric cancer), we measured serum anti-H pylori antibodies, PG and 17-gastrin and estimated their risk of gastric cancer. RESULTS: We found that serum PG-1 < 61.5 μg/L, PG-1/PG-2 ratio < 2.2 and 17-gastrin > 13.3 pmol/L had a high specificity (91%-100%) and a fair sensitivity (56%-78%) to detect corpus-predominant atrophy. Based on low serum PG-1 and PG-1/PG-2 ratio together as diagnostic criteria, 12.5% of the asymptomatic subjects had corpus-predominant atrophy (0% of those under 25 years and 20.2% over 65 years old). The frequency of gastric atrophy was similar (12% vs 13%) but H pylori infection rate was slightly higher (77% vs 71%) in the high-risk compared to the low-risk counties. Based on their estimated gastric cancer risk, individuals were classified as: low-risk group (no H pylori infection and no atrophy; n = 115; 21.4%); moderate-risk group(H pylori infection but no atrophy; n = 354, 66.0%); and high-risk group (gastric atrophy, with or without H pylori infection; n = 67, 12.5%). The high-risk group was significantly older (mean age: 61.9 ± 13.3 years), more frequently men and less educated as compared with the low-risk group. CONCLUSION: We propose to concentrate on an upper gastrointestinal endoscopy for detection of early gastric cancer in the high-risk group. This intervention model could improve the poor prognosis of gastric cancer in Chile.

Role of optical spectroscopy using endogenous contrasts in clinical cancer diagnosis

Optical spectroscopy has been intensively studied for cancer management in the past two decades.This review paper first introduces the background of optical spectroscopy for cancer management,which includes the advantages of optical techniques compared to other established techniques,the principle of optical spectroscopy and the typical setup of instrumentation.Then the recent progress in optical spectroscopy for cancer diagnosis in the following organs is reviewed:the brain,breast,cervix,lung,stomach,colon,prostate and the skin.Reviewed papers were selected from the PubMed database with keywords combining the terms of individual optical spectroscopy techniques and cancers.The primary focus is on the in vivo applications of optical spectroscopy in clinical studies.Ex vivo studies are also included for some organs to highlight special applications or when there are few in vivo results in the literature.Practical considerations of applying optical spectroscopy in clinical settings such as the speed,cost,complexity of operation,accuracy and clinical value are discussed.A few commercially available clinical instruments that are based on optical spectroscopy techniques are presented.Finally several technical challenges and standard issues are discussed and firm conclusions are made.

Optical diagnosis of colorectal polyps using high-definition i-scan: An educational experience

AIM:To examine performances regarding prediction of polyp histology using high-definition (HD) i-scan in a group of endoscopists with varying levels of experience. METHODS:We used a digital library of HD i-scan still images, comprising twin pictures (surface enhancement and tone enhancement), collected at our university hospital. We defined endoscopic features of adenomatous and non-adenomatous polyps, according to the following parameters:color, surface pattern and vascular pattern. We familiarized the participating endoscopists on optical diagnosis of colorectal polyps using a 20-min didactic training session. All endoscopists were asked to evaluate an image set of 50 colorectal polyps with regard to polyp histology. We classified the diagnoses into high confidence (i.e., cases in which the endoscopist could assign a diagnosis with certainty) and low confidence diagnoses (i.e., cases in which the endoscopist preferred to send the polyp for formal histology). Mean sensitivity, specificity and accuracy per endoscopist/image were computed and differences between groups tested using independent-samples t tests. High vs low confidence diagnoses were compared using the pairedsamples t test. RESULTS:Eleven endoscopists without previous experience on optical diagnosis evaluated a total of 550 images (396 adenomatous, 154 non-adenomatous). Mean sensitivity, specificity and accuracy for diagnosing adenomas were 79.3%, 85.7% and 81.1%, respectively. No significant differences were found between gastroenterologists and trainees regarding performances of optical diagnosis (mean accuracy 78.0%vs 82.9%,P = 0.098). Diminutive lesions were predicted with a lower mean accuracy as compared to non-diminutive lesions (74.2% vs 93.1%, P = 0.008). A total of 446 (81.1%) diagnoses were made with high confidence. High confidence diagnoses corresponded to a significantly higher mean accuracy than low confidence diagnoses (84.0% vs 64.3%, P = 0.008). A total of 319 (58.0%) images were evaluated as having excellent quality. Considering excellent quality images in conjunction with high confidence diagnosis, overall accuracy increased to 92.8%. CONCLUSION:After a single training session, endoscopists with varying levels of experience can already provide optical diagnosis with an accuracy of 84.0%.

Non-guided self-learning program for high-proficiency optical diagnosis of diminutive and small colorectal lesions: A single-endoscopist pilot study

BACKGROUND The implementation of optical diagnosis(OD) of diminutive colorectal lesions in clinical practice has been hampered by differences in performance between community and academic settings. One possible cause is the lack of a standardized learning tool. Since the factors related to better learning are not well described, strong evidence upon which a consistent learning tool could be designed is lacking. We hypothesized that a self-designed learning program may be enough to achieve competency in OD of diminutive lesions of the colon.AIM To assess the accuracy of OD of diminutive lesions in real colonoscopies after application of a self-administered learning program.METHODS This was a single-endoscopist prospective pilot study, in which an experienced endoscopist followed a self-designed, self-administered learning program in OD of colorectal lesions. An assessment phase divided in two halves with a 6-mo period in between without performance of OD was developed in a populationbased colorectal cancer screening program. The accomplishment of the Preservation and Incorporation of Valuable Endoscopic Innovations criteria and performance measures were calculated overall and in the two halves of the assessment phase, assessing their response to the 6-mo stopping period. The evolution of performance through blocks of 50 lesions was also assessed.RESULTS Overall, 152 patients and 522 lesions(≤ 5 mm: 399, and 6-9 mm: 123) were included. The negative predictive value for the OD of adenoma in rectosigmoid lesions diagnosed with high confidence was 91.7% [95% confidence interval(CI):87.3-96.6]. The proportion of agreement on surveillance interval between OD and pathological diagnosis was higher than 95%. Overall accuracy for diminutive lesions diagnosed with high confidence was 89.5%(95%CI: 86.3-92.7). The overall accuracy of OD was similar in the two halves of the assessment phase [90.1(95%CI: 85.6-94.7) vs 88.2(95%CI: 87.9-95.9)]. All the other performance parameters were also equivalent, except for specificity. Specificity, negative predictive value and accuracy were the parameters most affected by the stopping period between the two halves. Upon analyzing trends on blocks of 50 lesions, an improvement on sensitivity(P = 0.02) was detected only in the first half and an improvement on accuracy(P = 0.01) was detected only in the second half.CONCLUSION A self-administered learning program is sufficient to achieve expert-level OD. To maintain performance, continuous practice is needed, with a refresher course following any long non-practice period.

Birth Defects of the Child Optic Disc: Diagnostic Challenges and Prospects for Care

Introduction: Congenital optic disc anomalies in children refer to structural variations of the optic nerve head present from birth. These deformations involve the size, shape, color, and vessels of the optic disc. Although often asymptomatic, these anomalies can impact the visual development of the child, underscoring the importance of a thorough fundus examination for early detection and appropriate medical follow-up. We present two cases of congenital optic disc anomalies in children, illustrating the diagnostic challenges and complexity of their management. Case 1: A 3-year-old girl presented with a white spot in her left eye present since birth. Uncorrected distance visual acuity was 2/10 in the right eye, while she could perceive hand movements at 2 meters with the left eye. Normal examination in the right eye showed leukocoria, microphthalmia, and a white mass at the center of the optic disc on fundus examination in the left eye. Ocular imaging, including ultrasound and optical coherence tomography (OCT), confirmed the diagnosis of persistent hyperplastic primary vitreous (PHPV) in its mixed form in the left eye. Management included prescribing full optical correction and functional rehabilitation, without resorting to surgery. The course was marked by persistent amblyopia leading to a poor prognosis. Case 2: A 7-year-old girl consulted for vision disturbance in her right eye. Visual acuity was finger counting at 2 meters in the right eye and 10/10 in the left eye. Anterior segment examination revealed no abnormalities in both eyes. However, fundus examination highlighted a large funnel-shaped excavation associated with central glial proliferation, wheel spoke vessels, and neuroretinal ring atrophy in the right eye. Optical coherence tomography (OCT) of the right eye confirmed the diagnosis of isolated unilateral Morning Glory syndrome. Management included full optical correction and orthoptic rehabilitation. The course was marked by the absence of ocular complication and maintenance of visual stability in the right eye. The prognosis seemed favorable. Conclusion: Congenital optic disc anomalies in children exhibit great clinical variability and require an individualized diagnostic and therapeutic approach.

The Optical Diagnosis of Underwater Positive Sparks and Corona Discharges

In this paper, two types of underwater discharges, spark discharge and corona discharge, are investigated by optical diagnosis using a high speed framing camera （HSFC） with the framing time within nanoseconds under the same experimental conditions. In order to capture the photographs of streamer propagation, the influence of the randomicity of the prebreakdown duration is taken into consideration. By increasing the conductivity of water, the randomicity reduces effectively. Experimental results show that, for a spark discharge, the process can be separated into three stages： the generation and propagation of a streamer, the generation and expansion of the discharge channel, and the development and annihilation of the plasma. The streamers do not directly move to the opposite electrode, but form a bush-like figure. With the increase of the number of branches, the velocity of streamer propagation slows down. The trajectory of the initial channel between electrodes is not straight. However, with the channel expanding, its shape transforms into a straight column. For a corona discharge, there are two stages： the generation and propagation of a streamer, and the stagnation and annihilation of the streamer. The initial streamer in a corona discharge is generated later than in a spark discharge. The forms of streamers for both kinds of discharge are similar; however, streamers generated by a corona discharge propagate with a slower velocity and the number of branches is less compared with a spark discharge. When the energy injection stops, the luminescence of plasma inside the discharge channel （spark discharge） or streamers （corona discharge） becomes weaker and weaker, and finally disappears.

Role of the ultra-wide-field imaging system in the diagnosis of pigmented paravenous chorioretinal atrophy

Dear Editor,P igmented paravenous chorioretinal atrophy(PPCRA), which was first described by Hewiston-Brown in 1937, is a rare pigmentary retinopathy affecting the retina and choroid;most patients mainly manifest symmetrical retinal choroid in both eyes, except for a small number of patients with monocular manifestations[1].

OPTICAL COHERENCE TOMOGRAPHY FOR BLADDER CANCER DIAGNOSIS:FROM ANIMAL STUDY TO CLINICAL DIAGNOSIS

This paper summarizes the recent technological development in our lab on cystoscopic optical coherence tomography(COCT)by integrating time-domain OCT(TDOCT)and spectral-domain OCT(SDOCT)with advanced MEMS-mirror technology for endoscopic laser scanning imaging.The COCT catheter can be integrated into the instrument channel of a commercial 22Fr rigid cystoscopic sheath for in vivo imaging of human bladder under the cystosocopic visual guidance;the axial/transverse resolutions of the COCT catheter are roughly 9μm and 12μm,respectively,and 2D COCT imaging can be performed with over 110dB dynamic range at 4–8 fps.To examine the utility and potential limitations of OCT for bladder cancer diagnosis,systemic ex vivo rat bladder carcinogenesis studies were performed to follow various morphological changes induced by tumor growth and in vivo porcine study was performed to examine the feasibility of COCT for in vivo imaging.Justified by promising results of the animal studies,preliminary clinical study was conducted on patients scheduled for operating-room cystoscopy for bladder cancers.Double-blind clinical results reveal that COCT can delineate detailed bladder architectures(e.g.,urothelium,lamina propria,muscularis)at high resolution and detect bladder cancers based on enhanced urothelial heterogeneity as a result of excessive growing nature of bladder cancers.The diagnostic sensitivity and specificity can be enhanced to 92%and 85%,respectively.Results also suggest that due to reduced imaging depth of COCT in cancerous lesions,staging of bladder cancers may be limited to Ta or T1 for non-outgrowing cancerous lesions.

Axial uniformity diagnosis of coaxial surface wave linear plasma by optical emission spectroscopy

The coaxial surface wave linear plasma with preeminent axial uniformity is developed with the 2.45 GHz microwave generator.By optical emission spectroscopy,parameters of the argon linear plasma with a length over 600 mm are diagnosed under gas pressure of 30 and 50 Pa and different microwave powers.The spectral lines of argon and Hβ(486.1 nm)atoms in excited state are observed for estimating electron excitation temperature and electron density.Spectrum bands in305–310 nm of diatomic OH(Σ-Π+A X22 i)radicals are used to determine the molecule rotational temperature.Finally,the axial uniformity of electron density and electron excitation temperature are analyzed emphatically under various conditions.The results prove the distinct optimization of compensation from dual powers input,which can narrow the uniform coefficient of electron density and electron excitation temperature by around 40%and 22%respectively.With the microwave power increasing,the axial uniformity of both electron density and electron excitation temperature performs better.Nevertheless,the fluctuation of electron density along the axial direction appeared with higher gas pressure.The axial uniformity of coaxial surface wave linear plasma could be controlled by pressure and power for a better utilization in material processing.

Optic diagnosis of neutral beam injection on HL-1M

During the operation of a high-power neutral beam injection (NBI) system on theHL-1M tokamak, an optical diagnostic means using CCD camera was developed to characterize theNBI performance. The vacuum valve opening process and NBI period in the HL-1M experimentwere displayed by a lot of photos taken with this means. Thus, the Hα emission profiles of theneutral beam (NB) and its interaction with plasma were given. Finally, the reason possible forplasma breakdown during NBI mode Ⅱ discharge was investigated. Therefore, this in-situ diagnosiscan provide more information of the NBI.

Differential Diagnosis for Multiple Sclerosis-related Optic Neuritis

Purpose:.To analyze clinical features and main causes of multiple sclerosis-related optic neuritis(MS-ON), providing evidence for the differential diagnosis of MS-ON.Methods: Clinical data were collected from 527 patients, 123 males and 404 females, diagnosed with MS-ON between June2008 and June 2013. Visual acuity, optometry, visual field,slit-lamp microscopy, indirect ophthalmoscopy(20D), optical coherence tomography(OCT) and magnetic resonance imaging(MRI) were performed. Venous blood was sampled for detection of autoimmune antibodies and Aquaporin(AQP-4).Results:.Fifty nine cases were diagnosed with neuromyelitis optica-related optic neuritis.(NMO-ON),.27 Sjogren's syndrome-related optic neuropathy,.22 tumors,.21 anterior ischemic optic neuropathy, 15 radiation-induced optic neuropathy, 14 optic neuropathy-related infection, 17 genetic eye diseases and 10 open angle glaucoma. Among168 MS-ON patients undergoing optic nerve MRI,90 cases(53.57%) had a lesion < 15 mm in size, 15-30 mm in 76(45.24%) and > 30 mm in two(1.19%).Conclusion:.MS-ON is more commonly misdiagnosed with NMO-ON and Sjogren's syndrome, when compared to optic neuropathy, tumors and ischemic optic neuropathy.

Considerations on the concept, definition, and diagnosis of amyotrophic lateral sclerosis

The concept, definition, and diagnosis of amyotrophic lateral sclerosis(ALS) currently present some problems. This article systematically reviews the literature on the history, current concepts, definition, and diagnosis of ALS, and discloses the present problems based on the retrieved literature and the authors' clinical experience. The current concepts and definitions of ALS have not yet been unified or standardized in clinical practice, and are sometimes vague or inaccurate, which can cause difficulties for neurologists in the clinical treatment of ALS. The concept and definition of ALS need to be further ascertained, and the current diagnostic criteria for ALS require further development. The identification of effective and objective biomarkers may be a feasible method for the early and accurate diagnosis of ALS. Therefore, future research should focus on the identification of reliable biomarkers—especially neuroimaging biomarkers—through autopsy. Standardizing the concept and definition of ALS and formulating clear diagnostic criteria will largely avoid many uncertainties in the future clinical research and treatment of ALS, which will greatly benefit patients.

An acupuncture meta-analysis for optic atrophy Seven randomized,controlled trials

OBJECTIVE： To evaluate the efficacy and safety of acupuncture for optic atrophy. DATA SOURCES： A computer-based online search was conducted in Medline （1966-2008）, Embase （1986-2008）, the Cochrane Library （up to 2008）, Chinese Biomedical Literature Database （1975-2008）, China National Knowledge Infrastructure （1994-2008）, VIP Database （1989-2008）, Wanfang Database （1980-2008） and the National Research Register for ongoing trials. DATA SELECTION： Randomized, controlled trials addressing acupuncture treatment for patients with optic atrophy were included in this review. Inclusion criteria evaluated all forms of acupuncture therapy, such as filiform needle, electro-acupuncture, laser-acupuncture, acupressure, and auricular-acupuncture. Comparisons between acupuncture therapy and no treatment （blank） or placebo or Chinese medicine or Western medicine, as well as between acupuncture as an adjuvant and other treatments, were included. Exclusion criteria included studies comparing different forms of acupuncture therapy, different manipulations of acupuncture, and different acupuncture prescriptions, as well as non-randomized, controlled trials and animal studies. The domain-based evaluation criteria recommended by the guidelines in Chapter 8 of the Cochrane Handbook for Systematic Reviews of Interventions 5.0.1 was used to assess quality of the included studies. According to the type of outcome index, measurement data as assessed by weighted mean difference or standardized mean difference and 95% confidence interval; numeration data was estimated by relative risk and 95% confidence interval. Heterogeneity was analyzed by Meta-analysis using RevMan 5.0 software. MAIN OUTCOME MEASURES： Improved visual acuity and visual field was sought between treatment and control groups in the included articles. RESULTS： Seven randomized, controlled trials were included after screening and application of inclusion and exclusion criteria. However, the studies were of low methodological quality and lacked comparisons between acupuncture and no treatment or placebo. Applying visual acuity as the outcome index, meta-analysis indicated： the effect of medicine combined with acupuncture was superior to the medicine alone （relative risk = 1.41, 95% confidence interval 1.14-1.70, P 〈 0.01 ）, the efficacy of acupuncture was better than medicine alone （relative risk =1.42, 95% confidence interval 1.14-1.77, P 〈 0.01 ）. Using visual field as the other outcome index, meta-analysis revealed： effectiveness of acupuncture or acupuncture in combination with medicine was superior to medicine alone （relative risk = 1.47, 95% confidence interval 1.27-1.69, P 〈 0.01 ）. The 7 included articles were incorporated in a sensitivity analysis, and the overall effect showed a significant difference （relative risk = 1.35, 95% confidence interval 1.16-1.56, P 〈 0.01）. Acupuncture was not associated with any adverse events in any of the studies. CONCLUSION： Acupuncture therapy was determined to be superior to medicine in terms of improved visual acuity and visual field. However, well-designed, randomized, controlled trials with adequate controls and scientific rigor are urgently needed.

High interpretable machine learning classifier for early glaucoma diagnosis

AIM:To develop a classifier for differentiating between healthy and early stage glaucoma eyes based on peripapillary retinal nerve fiber layer(RNFL)thicknesses measured with optical coherence tomography(OCT),using machine learning algorithms with a high interpretability.METHODS:Ninety patients with early glaucoma and 85 healthy eyes were included.Early glaucoma eyes showed a visual field(VF)defect with mean deviation>-6.00 d B and characteristic glaucomatous morphology.RNFL thickness in every quadrant,clock-hour and average thickness were used to feed machine learning algorithms.Cluster analysis was conducted to detect and exclude outliers.Tree gradient boosting algorithms were used to calculate the importance of parameters on the classifier and to check the relation between their values and its impact on the classifier.Parameters with the lowest importance were excluded and a weighted decision tree analysis was applied to obtain an interpretable classifier.Area under the ROC curve(AUC),accuracy and generalization ability of the model were estimated using cross validation techniques.RESULTS:Average and 7 clock-hour RNFL thicknesses were the parameters with the highest impor tance.Correlation between parameter values and impact on classification displayed a stepped pattern for average thickness.Decision tree model revealed that average thickness lower than 82μm was a high predictor for early glaucoma.Model scores had AUC of 0.953(95%CI:0.903-0998),with an accuracy of 89%.CONCLUSION:Gradient boosting methods provide accurate and highly interpretable classifiers to discriminate between early glaucoma and healthy eyes.Average and 7-hour RNFL thicknesses have the best discriminant power.

Gastric atrophy,diagnosing and staging

Hpylori is now accepted as the cause of gastritis and gastritis-associated diseases, such as duodenal ulcer, gastric ulcer, gastric carcinoma, and gastric MALT lymphoma. The natural history of H pylori gastritis includes inflammation progressing from the antrum into the adjacent corpus resulting in an atrophic front of advancing injury leading to a reduction in acid secretion and eventual loss of parietal cells and development of atrophy. Sub-typing intestinal metaplasia has no clinical value to the patient, the pathologist, or the endoscopist. The pattern, extent, and severity of atrophy, with or without intestinal metaplasia, is a far more important predictor than is intestinal metaplasia subtype. The challenge remains to identify a reliable marker that relates to pre-malignant potential.