Role of artificial intelligence in colorectal cancer

The sphere of artificial intelligence(AI)is ever expanding.Applications for clinical practice have been emerging over recent years.Although its uptake has been most prominent in endoscopy,this represents only one aspect of holistic patient care.There are a multitude of other potential avenues in which gastrointestinal care may be involved.We aim to review the role of AI in colorectal cancer as a whole.We performed broad scoping and focused searches of the applications of AI in the field of colorectal cancer.All trials including qualitative research were included from the year 2000 onwards.Studies were grouped into pre-operative,intra-operative and post-operative aspects.Preoperatively,the major use is with endoscopic recognition.Colonoscopy has embraced the use for human derived classifications such as Narrow-band Imaging International Colorectal Endoscopic,Japan Narrow-band Imaging Expert Team,Paris and Kudo.However,novel detection and diagnostic methods have arisen from advances in AI classification.Intra-operatively,adjuncts such as image enhanced identification of structures and assessment of perfusion have led to improvements in clinical outcomes.Post-operatively,monitoring and surveillance have taken strides with potential socioeconomic and environmental savings.The uses of AI within the umbrella of colorectal surgery are multiple.We have identified existing technologies which are already augmenting cancer care.The future applications are exciting and could at least match,if not surpass human standards.

Exploratory systematic review and meta-analysis on period poverty

BACKGROUNDPeriod poverty is a global health and social issue that needs to be addressed.It has been reported that many females compromise their education,employment,and social commitments during their menstruation days due to a number of reasons,including lack of access to toilets or menstrual products.AIM To provide a comprehensive understanding on period poverty,including outcomes associated with menstruation.METHODS All observational and randomised clinical trials reporting menstruation challenges,menstrual poverty and menstrual products were included.Our search strategy included multiple electronic databases of PubMed,Web of Science,ScienceDirect,ProQuest and EMBASE.Studies published in a peer review journal in English between the 30th of April 1980 and the 30th of April 2022 were included.The Newcastle-Ottawa Scale was used to assess the risk of bias of the systematic included studies.Pooled odds ratios(ORs)together with 95%confidence intervals(CIs)are reported overall and for sub-groups.RESULTS A total of 80 studies were systematically selected,where 38 were included in the meta-analysis.Of the 38 studies,28 focused on children and young girls(i.e.,10-24 years old)and 10 included participants with a wider age range of 15-49 years.The prevalence of using disposable sanitary pads was 45%(95%CI:0.35-0.58).The prevalence of menstrual education pre-menarche was 68%(95%CI:0.56-0.82).The prevalence of good menstrual hygiene management(MHM)was 39%(95%CI:0.25-0.61).Women in rural areas(OR=0.30,95%CI:0.13-0.69)were 0.70 times less likely to have good MHM practices than those living in urban areas.CONCLUSION There was a lack of evidence,especially from low-and middle-income countries.Further research to better understand the scope and prevalence of period poverty should be considered.This will enable the development of improved policies to increase access to menstrual products and medical support where necessary.

High resolution colonoscopy in a bowel cancer screening program improves polyp detection

AIM:To compare high resolution colonoscopy(Olympus Lucera) with a megapixel high resolution system(Pentax HiLine) as an in-service evaluation.METHODS:Polyp detection rates and measures of performance were collected for 269 colonoscopy procedures.Five colonoscopists conducted the study over a three month period,as part of the United Kingdom bowel cancer screening program.RESULTS:There were no differences in procedure duration(χ2 P = 0.98),caecal intubation rates(χ2 P = 0.67),or depth of sedation(χ2 P = 0.64).Mild discomfort was more common in the Pentax group(χ2 P = 0.036).Adenoma detection rate was significantly higher in the Pentax group(χ2 test for trend P = 0.01).Most of the extra polyps detected were flat or sessile adenomas.CONCLUSION:Megapixel definition colonoscopes improve adenoma detection without compromising other measures of endoscope performance.Increased polyp detection rates may improve future outcomes in bowel cancer screening programs.

Henoch-Schnlein purpura complicating adalimumab therapy for Crohn's disease

Anti-tumour necrosis factor-α(TNF) therapy has revolutionised the management of chronic inflammatory conditions.With ever increasing numbers of patients being treated with these agents,uncommon adverse reactions will inevitably occur more frequently.Cutaneous manifestations are associated with many of these chronic conditions and can complicate anti-TNF therapy in about 20% of cases.Vasculitic complications are rarely associated with anti-TNF therapy.Henoch-Schnlein purpura(HSP),a small vessel vasculitis,has been described following infliximab and etanercept therapy but never with adalimumab,a fully humanized TNF antibody.The risk of such immune-mediated reactions is theoretically less with adalimumab compared to infliximab but can still occur.Here we report the f irst case in the literature of HSP that can be attributed to the use of adalimumab in a 19-year-old male with recalcitrant Crohn's disease.

Healthcare staff well-being and use of support services during COVID-19:a UK perspective

Background The COVID-19 pandemic has drastically increased demands on healthcare workers(HCWs)leaving them vulnerable to acute psychological distress,burnout and post-traumatic stress.In response,supportive services in a central London hospital mobilised mental health support specifically for HCWs.Aims This rapid evaluation assessed HCW psychological welfare during the acute phase of the COVID-19 pandemic and their use of supportive services made available.Methods During the acute phase of COVID-19(April to May 2020)all staff working for the hospital were invited to complete an online survey assessing well-being(self-rated health,moral distress exposure,symptoms of burnout and psychological distress)and use of available supportive services(awareness of,use and perceived helpfulness).Associations among personal characteristics and psychological well-being were explored using correlations and linear regression.Results A total of 1127 staff participated in the rapid evaluation.On average,psychological distress was high(mean(SD):22(7.57))regardless of role,with 84%of this sample scoring above the general population mean(14.5).Nearly half of the sample reported feeling emotionally drained and a profile emerged displaying higher levels of psychological distress and burnout in those who were younger and exposed to morally distressing situations,with this group also exhibiting greater support service use.Greater levels of burnout were associated with increased psychological distress when controlling for personal factors.During this acute phase of the pandemic,majority of staff used at least one service and rated it as helpful.Conclusion HCWs experienced high levels of psychological distress requiring continued support as the COVID-19 pandemic evolved.Although HCWs were aware of supportive services,uptake varied.In order to mitigate the risk of burnout and post-traumatic stress,long-term,effective strategies that facilitate staff accessing support are urgently required.

Empathy assessment in healthcare students is highly heterogeneous: A systematic review and meta-analysis(2012-2016)

BACKGROUND Clinical empathy leads to improved patient satisfaction and better clinical outcomes. Currently, there are multiple empathy scales with minimal or no efforts to produce an integrated definition of clinical empathy which can be assessed sufficiently by only a few scales. Moreover, there is an unclear overall reliability of these empathy scales, hence limiting comparative evaluation.AIM To examine which empathy scales have been used in healthcare students and to estimate their overall internal consistency.METHODS A systematic review was performed with inclusion criteria any empirical study with quantitative data examining empathy of healthcare students toward patients between 2012 and 2016. A random effects model was used to produce a pooled estimate of the Cronbach's alphas. The Hakstian-Whalen transformation was used for analyses based on the Rodriguez-Maeda method. Heterogeneity was quantified using the I2 statistic and further investigated with subgroup analysis and meta-regression. Publication bias was assessed using funnel plots, Egger's test, Begg's test, and the trim and fill analysis.RESULTSThirteen scales have been used to assess clinical empathy in healthcare students from forty nine studies with total sample size 49384 students. The most frequently used scale is the Jefferson Scale of Physician Empathy followed by Davis' Interpersonal Reactivity Index. The overall reliability was 0.805(95%CI0.786-0.823), which is acceptable, but there was heterogeneity and publication bias. Some heterogeneity was explained by the different countries(regions) of the studies under investigation and student types but most heterogeneity remained unexplained.CONCLUSION The results indicate that scales have satisfactory internal consistency but there are a multitude of scales, definitions and empathy components. Future research should focus on standardizing scales and creating consensus statements regarding the definition of empathy and use of appropriate scales.

Mental health impact of the Middle East respiratory syndrome,SARS,and COVID-19:A comparative systematic review and metaanalysis

BACKGROUND Over the last few decades,3 pathogenic pandemics have impacted the global population;severe acute respiratory syndrome coronavirus(SARS-CoV),Middle East respiratory syndrome coronavirus(MERS-CoV)and SARS-CoV-2.The global disease burden has attributed to millions of deaths and morbidities,with the majority being attributed to SARS-CoV-2.As such,the evaluation of the mental health(MH)impact across healthcare professionals(HCPs),patients and the general public would be an important facet to evaluate to better understand short,medium and long-term exposures.AIM To identify and report:(1)MH conditions commonly observed across all 3 pandemics;(2)Impact of MH outcomes across HCPs,patients and the general public associated with all 3 pandemics;and(3)The prevalence of the MH impact and clinical epidemiological significance.METHODS A systematic methodology was developed and published on PROSPERO(CRD42021228697).The databases PubMed,EMBASE,ScienceDirect and the Cochrane Central Register of Controlled Trials were used as part of the data extraction process,and publications from January 1,1990 to August 1,2021 were searched.MeSH terms and keywords used included Mood disorders,PTSD,Anxiety,Depression,Psychological stress,Psychosis,Bipolar,Mental Health,Unipolar,Self-harm,BAME,Psychiatry disorders and Psychological distress.The terms were expanded with a‘snowballing’method.Cox-regression and the Monte-Carlo simulation method was used in addition to I2 and Egger’s tests to determine heterogeneity and publication bias.RESULTS In comparison to MERS and SARS-CoV,it is evident SAR-CoV-2 has an ongoing MH impact,with emphasis on depression,anxiety and post-traumatic stress disorder.CONCLUSION It was evident MH studies during MERS and SARS-CoV was limited in comparison to SARS-CoV-2,with much emphasis on reporting symptoms of depression,anxiety,stress and sleep disturbances.The lack of comprehensive studies conducted during previous pandemics have introduced limitations to the“know-how”for clinicians and researchers to better support patients and deliver care with limited healthcare resources.

Mental health impact on Black,Asian and Minority Ethnic populations with preterm birth:A systematic review and meta-analysis

BACKGROUND Preterm birth(PTB)is one of the main causes of neonatal deaths globally,with approximately 15million infants are born preterm.Women from the Black,Asian,and Minority Ethnic(BAME)populations maybe at higher risk of PTB,therefore,the mental health impact on mothers experiencing a PTB is particularly important,within the BAME populations.AIM To determine the prevalence of mental health conditions among BAME women with PTB as well as the methods of mental health assessments used to characterise the mental health outcomes.METHODS A systematic methodology was developed and published as a protocol in PROSPERO(CRD420-20210863).Multiple databases were used to extract relevant data.I2 and Egger's tests were used to detect the heterogeneity and publication bias.A trim and fill method was used to demonstrate the influence of publication bias and the credibility of conclusions.RESULTS Thirty-nine studies met the eligibility criteria from a possible 3526.The prevalence rates of depression among PTB-BAME mothers were significantly higher than full-term mothers with a standardized mean difference of 1.5 and a 95%confidence interval(CI)29%-74%.The subgroup analysis indicated depressive symptoms to be time sensitive.Women within the very PTB category demonstrated a significantly higher prevalence of depression than those categorised as non-very PTB.The prevalence rates of anxiety and stress among PTB-BAME mothers were significantly higher than in full-term mothers(odds ratio of 88%and 60%with a CI of 42%-149%and 24%-106%,respectively).CONCLUSION BAME women with PTB suffer with mental health conditions.Many studies did not report on specific mental health outcomes for BAME populations.Therefore,the impact of PTB is not accurately represented in this population,and thus could negatively influence the quality of maternity services they receive.

腹腔镜治疗青少年子宫内膜异位症

Objectives: To determine the frequency and severity of endometriosis in adolescent and teenager girls with chronic pelvic pain (CPP) who fail to respond to medical treatment and to evaluate the outcome of radical laparoscopic surgery for severe endometriosis. Design: Retrospective review of case records of all girls under the age of 21 years who underwent diagnostic and/or operative laparoscopy for CPP unresponsive to medical treatment between January 2001 and December 2003. The operative findings and the response to surgery were retrospectively reviewed. Results: Thirty-one girls were referred. No pelvic abnormalities were detected in 11 patients (35.5% ). Endometriosis was detected in 11 (35.5% ). Six had severe endometriosis. Other diagnoses included: non-functional non-endometrioticovarian cyst (4 patients), functional ovarian cyst (1 patient), hydrosalpinx (bilateral, 1 patient; unilateral, 1 patient) and obstructed uterine horn (2 patients). Of those with severe disease all six were treated laparoscopically without complications. Five were rendered pain free and one had an improvement in symptoms. Conclusions: Endometriosis can occur in adolescent and teenager girls. Laparoscopy should be carried out in all adolescents and teenagers with CPP unresponsive tomedical treatment. This the first study reporting the outcome of radical excision treatment for severe endometriosis in this age group and early results are encouraging.

Worldwide trends in esophageal cancer survival,by sub-site,morphology,and sex:an analysis of 696,974 adults diagnosed in 60 countries during 2000-2014(CONCORD-3)

Background Esophageal cancer survival is poor worldwide,though there is some variation.Differences in the distribution of anatomical sub-site and morphological sub-type may help explain international differences in survival for all esophageal cancers combined.We estimated survival by anatomic sub-site and morphological sub-type to understand further the impact of topography and morphology on international comparisons of esophageal cancer survival.Methods We estimated age-standardized one-year and five-year net survival among adults(15-99 years)diagnosed with esophageal cancer in each of 60 participating countries to monitor survival trends by calendar period of diagnosis(2000-2004,2005-2009,2010-2014),sub-site,morphology,and sex.Results For adults diagnosed during 2010-2014,tumors in the lower third of the esophagus were the most common,followed by tumors of overlapping sub-site and sub-site not otherwise specified.The proportion of squamous cell carcinomas diagnosed during 2010-2014 was generally higher in Asian countries(50%-90%),while adenocarcinomas were more common in Europe,North America and Oceania(50%-60%).From 2000-2004 to 2010-2014,the proportion of squamous cell carcinoma generally decreased,and the proportion of adenocarcinoma increased.Over time,there were few improvements in age-standardized five-year survival for each sub-site.Age-standardized one-year survival was highest in Japan for both squamous cell carcinoma(67.7%)and adenocarcinoma(69.0%),ranging between 20%-60%in most other countries.Age-standardized five-year survival from squamous cell carcinoma and adenocarcinoma was similar for most countries included,around 15%-20%for adults diagnosed during 2010-2014,though international variation was wider for squamous cell carcinoma.In most countries,survival for both squamous cell carcinoma and adenocarcinoma increased by less than 5%between 2000-2004 and 2010-2014.Conclusions Esophageal cancer survival remains poor in many countries.The distributions of sub-site and morphological sub-type vary between countries,but these differences do not fully explain international variation in esophageal cancer survival.

Pancreatic cancer survival trends in the US from 2001 to 2014:a CONCORD-3 study

Background:Survival from pancreatic cancer is low worldwide.In the US,the 5-year relative survival has been slightly higher for women,whites and younger patients than for their counterparts,and differences in age and stage at diagnosis[Corrections added Nov 16,2022,after first online publication:a new affiliation is added to Maja Nikšić]may contribute to this pattern.We aimed to examine trends in survival by race,stage,age and sex for adults(15-99 years)diagnosed with pancreatic cancer in the US.Methods:This population-based study included 399,427 adults registered with pancreatic cancer in 41 US state cancer registries during 2001-2014,with followup to December 31,2014.We estimated age-specific and age-standardized net survival at 1 and 5 years.Results:Overall,12.3%of patients were blacks,and 84.2%were whites.About 9.5%of patients were diagnosed with localized disease,but 50.5%were diagnosed at an advanced stage;slightly more among blacks,mainly among men.No substantial changes were seen over time(2001-2003,2004-2008,2009-2014).In general,1-year net survival was higher in whites than in blacks(26.1%vs.22.1%during 2001-2003,35.1%vs.31.4%during 2009-2014).This difference was particularly evident among patients with localized disease(49.6%in whites vs.44.6%in blacks during 2001-2003,60.1%vs.55.3%during 2009-2014).The survival gap between blacks and whites with localized disease was persistent at 5 years after diagnosis,and it widened over time(from 24.0%vs.21.3%during 2001-2003 to 39.7%vs.31.0%during 2009-2014).The survival gap was wider among men than among women.Conclusions:Gaps in 1-and 5-year survival between blacks and whites were persistent throughout 2001-2014,especially for patients diagnosed with a localized tumor,for which surgery is currently the only treatment modality with the potential for cure.

Utility of current thrombophilia screening in young patients with stroke and TIA

Introduction Approximately 40%of strokes in young adults are cryptogenic.The diagnostic yield of thrombophilia screening remains controversial.We aimed to determine utility of current thrombophilia testing for young patients with stroke and transient ischaemic attack(TIA).Methods We present a retrospective review of all patients with stroke and TIA≤60 years presenting to University College London Hospital stroke unit and daily TIA clinic from 1 January 2015 to 1 August 2016.Consecutive clinical records and thrombophilia tests,including factor V Leiden(FVL),prothrombin G20210A mutation(PGM),antiphospholipid antibody(APA),and protein S,C and antithrombin(AT)levels,were reviewed.results The mean age of 628 patients with stroke and TIA was 49.1 years(SD 9.2).Thrombophilia testing was performed in 360(57%)patients,including 171 with stroke and 189 with TIA.Positive tests were found in 50(14%)patients,of whom 24 patients were<50 years.Positive results were found in 36(10%)with acute ischaemic stroke,4(1%)with haemorrhagic stroke and 10(3%)with TIA.Thirteen patients(4%)had homozygous/heterozygous FVL or PGM,and 27(7.5%)had positive APA(anticardiolipin antibody,anti-β2 glycoprotein antibody or lupus anticoagulant).Of 27(7.5%)patients with protein C,S or AT deficiency,10(2.8%)had primary deficiency,presumed hereditary with other secondary causes excluded.9%of patients with protein C,S or AT and 27%with APA were followed by confirmatory testing.Conclusion Thrombophilia testing was positive in only 14%of cases overall.Thrombophilia mutations and protein C,S or AT abnormalities were found rarely and were very uncommon in patients with TIA.Follow-up of abnormal results was generally poor for all groups,which further limited the impact of the thrombophilia testing policy.

不确定事宜 加巴喷丁对不明原因慢性盆腔痛妇女有效吗？

女性慢性盆腔痛是初级医疗诊疗中常见的一种主诉。疼痛持续或反复发作至少6个月以上，导致精神痛苦，影响生理功能、生活质量和生育能力。在英国，每年约有3．8％的女性受到慢性盆腔痛的困扰。估计全球女性慢性盆腔痛的发病率为2．1％～24％。

Syringoceles of Cowper’s ducts and glands in adult men

Cowper’s syringoceles are uncommon,usually described in children and most commonly limited to the ducts.We describe more complex variants in an adult population affecting with varying degrees of severity,the glands themselves,and the complications they may lead to.One hundred consecutive urethrograms of patients with unreconstructed strictures were reviewed.Twenty-six patients(mean age:41.1 years)with Cowper’s syringoceles who were managed between 2009 and 2016 were subsequently evaluated.Presentation,radiological appearance,treatment(when indicated),and outcomes were assessed.Of 100 urethrograms in patients with strictures,33.0%demonstrated filling of Cowper’s ducts or glands,occurring predominantly in patients with bulbar strictures.Only 1 of 26 patients with non-bulbar strictures had a visible duct/gland.Of 26 symptomatic patients,15 presented with poor flow.In four patients,a grossly dilated Cowper’s duct obstructed the urethra.In the remaining 11 patients,a bulbar stricture caused the symptoms and the syringocele was identified incidentally.Eight patients presented with perineal pain.In six of them,fluoroscopy and magnetic resonance imaging(MRI)revealed complex multicystic lesions within the bulbourethral glands.Four patients developed perineoscrotal abscesses.In the 11 patients with strictures,the syringocele was no longer visible after urethroplasty.In three of four patients with urethral obstruction secondary to a dilated Cowper’s duct,this resolved after transperineal excision(n=2)and endoscopic deroofing(n=1).Five of six patients with complex syringoceles involving Cowper’s glands were excised surgically with symptomatic relief in all.In conclusion,Cowper’s syringocele in adults is more common than previously thought and may cause lower urinary tract symptoms or be associated with serious complications which usually require surgical treatment.

急性眩晕:获得正确的诊断

头晕是急诊室和初级医疗机构常见的主诉^(1-2),其定义为空间定向力紊乱或受损而不伴有运动感知错误或扭曲的感觉^(3)。不同研究显示,社区全科实践中头晕的患病率不同^(4),但大约是20%^(5-6),其患病率随年龄增大而增长。尽管患者常常都用头晕来描述他们的症状,但是其内涵包括多种不同的症候群,其中有眩晕(框图1)。

Funneling of the bladder neck - radiological appearance after radical retropubic prostatectomy and clinical relevance

Several authors have commented on the anatomical changes following radical prostatectomy(RP)for prostate cancer and their characteristic radiological appearances.1,2 Most of these relate to periurethral fibrosis and its clinical significance in patients with postprostatectomy sphincter weakness incontinence.3,4 On magnetic resonance imaging(MRI),this postsurgical fibrosis appears as a focus of low-signal intensity in the periurethral tissues at and around the level of the vesicourethral anastomosis(VUA)which is appreciable on both T1-and T2-weighted images.

Thermal ablation in colorectal liver metastases-the paradox of equipoise

Approximately 25%of individuals with colorectal cancer(CRC)present with metastatic disease,and it is estimated that throughout the course of the disease,up to 50%of individuals may develop liver metastases,the majority of which are unresectable(1).However,thermal ablation is a treatment modality increasingly used to manage individuals with liver metastases.Recently Takahashi et al.published a comprehensive review of the various approaches to thermal ablation and summarised the recent evidence demonstrating an associated survival benefit supporting its use in the management of metastatic CRC(mCRC)(2).It is however critical to analyse the studies evaluated to ensure the strength of the evidence presented.

瑞芬太尼在无痛分娩中的应用

分娩镇痛所需的理想全身性镇痛药物应安全、有效、易于管理，起效与消除迅速，与子宫收缩的时间一致，且对胎儿没有影响。虽然椎管内麻醉是无痛分娩的“金标准”，但当椎管内麻醉存在禁忌、产妇不接受或临产时没有机会施行，或熟练操作的麻醉医生不在场时，就需要采用全身性镇痛。由于瑞芬太尼独特的药理学性质，其在临床上用于静脉无痛分娩得到了广泛研究。本文就瑞芬太尼用于无痛分娩的效果、剂量、分布、对产妇与胎儿或新生儿的安全性以及未来的研究范围等，进行了重点综述回顾。

苏格兰成为第一个免费提供经期产品的国家

苏格兰将免费提供经期产品,这是世界上第一个对此立法的国家。2020年11月24日1,一项要求所有地方政府确保经期产品随时可以获取的议案在苏格兰议会全票通过。各大院校的卫生间必须免费提供,而且政府有权要求其他公共设施采取同样的措施。各种经期产品的获取必须相对容易获得,并维护使用者的尊严。议案由苏格兰议会议员Monica Lennon提出,她也是工党健康与社会服务的发言人。

60秒采访:当医生玩起了抖音

不,我们谈的是短视频社交软件抖音(TikTok)。此软件在疫情暴发期间风靡全球,为更多宅家的人们提供娱乐和消遣。我不需要在抖音上提供问诊咨询,对吧?不,现在不需要。然而,有些医生正通过这个平台与大众分享新型冠状病毒肺炎(COVID-19)和非COVID-19的医学知识。视频内容包罗万象,从重症监护的床位,医院氧气供应不足,到我们为什么会打喷嚏,以及成为一名医生需要多久。