We aimed to develop a computer-aided diagnostic system (CAD) for predicting colorectal polyp histology using deep-learning technology and to validate its performance. Near-focus narrow-band imaging ...(NBI) pictures of colorectal polyps were retrieved from the database of our institution. Of these, 12480 image patches of 624 polyps were used as a training set to develop the CAD. The CAD performance was validated with two test datasets of 545 polyps. Polyps were classified into three histological groups: serrated polyp (SP), benign adenoma (BA)/mucosal or superficial submucosal cancer (MSMC), and deep submucosal cancer (DSMC). The overall kappa value measuring the agreement between the true polyp histology and the expected histology by the CAD was 0.614-0.642, which was higher than that of trainees (n = 6, endoscopists with experience of 100 NBI colonoscopies in <6 months; 0.368-0.401) and almost comparable with that of the experts (n = 3, endoscopists with experience of 2,500 NBI colonoscopies in ≥5 years) (0.649-0.735). The areas under the receiver operating curves for CAD were 0.93-0.95, 0.86-0.89, and 0.89-0.91 for SP, BA/MSMC, and DSMC, respectively. The overall diagnostic accuracy of the CAD was 81.3-82.4%, which was significantly higher than that of the trainees (63.8-71.8%, P < 0.01) and comparable with that of experts (82.4-87.3%). The kappa value and diagnostic accuracies of the trainees improved with CAD assistance: that is, the kappa value increased from 0.368 to 0.655, and the overall diagnostic accuracy increased from 63.8-71.8% to 82.7-84.2%. CAD using a deep-learning model can accurately assess polyp histology and may facilitate the diagnosis of colorectal polyps by endoscopists.
Chiral photonics has emerged as a key technology for future optoelectronics, such as quantum information and encryption, by making use of photonic waves from enantiomeric structures. An inevitable ...challenge for realizing such chiral optoelectronics is the development of near‐infrared circularly polarized (NIR CP) light‐sensing photodetectors that convert optical power and circular polarization direction into distinguishable electrical signals. Herein, a simple and promising strategy for high‐performance NIR CP light‐sensing organic phototransistors (NIR CPL‐OPTRs) applicable to highly secure optoelectronic encryption is proposed. By directly assembling a standalone cholesteric liquid‐crystal network film in a thin‐film NIR CPL‐OPTR, remarkable responsivity and distinguishability are achieved. The synergetic effect of amplification of the photocurrent signal by the applied electric field and improved light absorption by the reduced reflection in the multilayered structure leads to high responsivity. As a proof‐of‐concept, the chiral phototransistor arrays are demonstrated as a physically unclonable function device and exhibit enhanced cryptographic characteristics.
High‐performance near‐infrared circularly polarized light‐sensing organic phototransistors are realized by directly assembling a standalone cholesteric liquid‐crystal network film in the near‐infrared‐sensing organic phototransistor based on a small‐bandgap polymer semiconductor. A physical unclonable function device based on the chiral phototransistor arrays can enhance cryptographic characteristics by encoding the polarization direction of the circularly polarized light.
Thiopurine therapy, commonly used in autoimmune conditions, can be complicated by life-threatening leukopenia. This leukopenia is associated with genetic variation in TPMT (encoding thiopurine ...S-methyltransferase). Despite a lower frequency of TPMT mutations in Asians, the incidence of thiopurine-induced leukopenia is higher in Asians than in individuals of European descent. Here we performed an Immunochip-based 2-stage association study in 978 Korean subjects with Crohn's disease treated with thiopurines. We identified a nonsynonymous SNP in NUDT15 (encoding p.Arg139Cys) that was strongly associated with thiopurine-induced early leukopenia (odds ratio (OR) = 35.6; P(combined) = 4.88 × 10(-94)). In Koreans, this variant demonstrated sensitivity and specificity of 89.4% and 93.2%, respectively, for thiopurine-induced early leukopenia (in comparison to 12.1% and 97.6% for TPMT variants). Although rare, this SNP was also strongly associated with thiopurine-induced leukopenia in subjects with inflammatory bowel disease of European descent (OR = 9.50; P = 4.64 × 10(-4)). Thus, NUDT15 is a pharmacogenetic determinant for thiopurine-induced leukopenia in diverse populations.
Inflammatory bowel disease (IBD) has increased in incidence and prevalence in Asian countries since the end of the 20th century. Moreover, differences in the cause, phenotypes, and natural history of ...IBD between the East and West have been recognized. Therefore, the Asian Organization for Crohn's and Colitis and the Asia Pacific Association of Gastroenterology have established recommendations on medical management of IBD in Asia. Initially, the committee members drafted 40 recommendations, which were then assessed according to Grading of Recommendations Assessment, Development and Evaluation. Eight statements were rejected as this indicated that consensus had not been reached. The recommendations encompass pretreatment evaluation; medical management of active IBD; medical management of IBD in remission; management of IBD during the periconception period and pregnancy; surveillance strategies for colitis‐associated cancer; monitoring side effects of thiopurines and methotrexate; and infections in IBD.
Summary
Background/Aim
We aimed to validate clinical decision support tools (CDSTs) to predict real‐life effectiveness of vedolizumab (VDZ) in patients with inflammatory bowel disease.
Methods
We ...retrospectively enrolled patients with Crohn's disease (CD) or ulcerative colitis (UC) treated with VDZ at 10 tertiary referral centres in Korea between January 2017 and November 2021. We assessed clinical remission (CREM) and response (CRES), corticosteroid‐free clinical remission (CSF‐CREM) and response (CSF‐CRES), biochemical response based on C‐reactive protein (BioRESCRP) and faecal calprotectin (BioRESFC), endoscopic healing (EH), and the need to optimise or switch drugs based on CDST‐defined response groups. Additionally, the area under the receiver operating characteristics curve (AUC) for the CDSTs was calculated.
Results
We included 143 patients with CD and 219 with UC. We observed incremental trends on CSF‐CRES at week 14 (W14) (ptrend = 0.004) and decreasing trends for the need to optimise or switch drugs (ptrend = 0.016) in CD from the low to high probability groups. Except for CSF‐CREM at W54, we noticed incremental trends for all clinical responses at W14, W26 and W54 (ptrend <0.001) in UC. W26 and W54 BioRESCRP and W14 EH also showed increasing trends (ptrend <0.05) in UC. With increasing probabilities of response, drug optimisation or switching was less frequently required in UC (ptrend = 0.013). With 26 points cut‐off, CDSTs effectively identified W14 CSF‐CRES, W26 BioRESCRP, BioRESFC and W54 BioRESCRP in UC, all with AUCs >0.600, whereas CDSTs showed poor accuracy in CD.
Conclusions
CDSTs for VDZ had acceptable accuracy in predicting effectiveness outcomes including clinical and biochemical outcomes in UC. However, their utility in CD was limited.
When applied to Korean patients with inflammatory bowel disease, clinical decision support tools designed for patients receiving intravenous vedolizumab therapy demonstrated acceptable accuracy in predicting effectiveness outcomes, including clinical and biochemical outcomes in cases of ulcerative colitis. However, their utility in the context of Crohn's disease was found to be limited.
Polylactide (PLA), a commercially available thermoplastic derived from plant sugars, finds applications in consumer products, disposable packaging, and textiles, among others. The widespread ...application of this material is limited by its brittleness, as evidenced by low tensile elongation at break, impact strength, and fracture toughness. Herein, a multifunctional vegetable oil, acrylated epoxidized soybean oil (AESO), was investigated as a biodegradable, renewable additive to improve the toughness of PLA. AESO was found to be a highly reactive oil, providing a dispersed phase with tunable properties in which the acrylate groups underwent cross-linking at the elevated temperatures required for processing the blends. Additionally, the presence of hydroxyl groups on AESO provided two routes for compatibilization of PLA/AESO blends: (1) reactive compatibilization through the transesterification of AESO and PLA and (2) synthesis of a PLA star polymer with an AESO core. The morphological, thermal, and mechanical behaviors of PLA/oil blends were investigated, in which the dispersed oil phase consisted of AESO, soybean oil (SYBO), or a 50/50 mixture of AESO/SYBO. The oil additives were found to toughen the PLA matrix, with significant enhancements in the elongation at break and tensile toughness values, while maintaining the glass transition temperature of neat PLA. In particular, the blend containing PLA, AESO, SYBO, and the PLA star polymer was found to exhibit a uniform oil droplet size distribution with small average droplet size and interparticle distance, resulting in the greatest enhancements of PLA tensile properties with no observable plasticization.
Low-volume bowel preparation solutions, including 1-L polyethylene glycol plus ascorbate (PEG-A), have been developed to improve tolerability. The oral sodium sulfate tablet (OST) is a new agent with ...simethicone as a preloaded component. We investigated the efficacy, safety, and tolerability of OST compared to 1-L PEG-A.
A single-center, prospective, controlled study was performed with randomization into the OST (group A) and 1-L PEG-A (group B) groups. Bowel preparation efficacy was assessed on the Boston Bowel Preparation Scale (BBPS) and Bubble Scale. Safety and tolerability were evaluated using a questionnaire and laboratory examination.
Final analysis was performed on 171 patients (group A: 87, group B: 84). The proportion of bowel preparation success (BBPS ≥ 2 for each colonic segment) in group A was not inferior compared to group B (95.4% vs 96.4%, P = 0.736, 1-sided 97.5% lower confidence limit -7.0%). The adenoma detection rate was not different (59.6% vs 41.9%; P = 0.087). The bubble scale was better in group A (0.2 ± 0.9 vs 1.9 ± 1.7, P < 0.001). All adverse events were mild in both groups. Nausea was less frequent in group A (14.9% vs 38.1%, P = 0.001). Overall satisfaction was better in group A (8.1 ± 2.1 vs 6.4 ± 2.8, P < 0.001). No clinically significant laboratory abnormality developed in both groups. These findings were similarly shown in old patients ≥65 years.
Both OST and 1-L PEG-A were efficacious, safe, and tolerable for bowel preparation of colonoscopy. The OST showed fewer bubbles and slightly better tolerability.
Over the past decades, there has been a rapid increase in the incidence and prevalence of inflammatory bowel disease (IBD) in Asia. The natural history of IBD in Asian patients could be different ...from that in Western patients due to variations in disease phenotypes and genotypes as well as the healthcare environment between the 2 populations. To adequately cope with this disease, it is important to fully understand the potential differences in its natural history among different populations. In this review, we evaluated the differences in the clinical course of IBD between Asian and Western patients with regards to phenotypic progression, hospitalization, major surgery, risk of colorectal cancer, and mortality, mainly based on the results of population-based studies. The findings of our narrative review suggest that the clinical course of Asian patients with IBD, especially ulcerative colitis, is better than that of Western patients, as indicated by the lower rates of major surgery and hospitalization. In addition, similar to Western patients, the clinical course of Asian patients with IBD has been improving as evidenced by the decreasing rates of disease behavior progression (in Crohn’s disease), hospitalization, and major surgery.
This study aimed to investigate the effect of stenting-related factors, including endoscopists' expertise, on clinical outcomes after bridge-to-surgery (BTS) stenting for obstructive colorectal ...cancer (CRC).
We analyzed BTS stenting-related factors, including stenting expertise and the interval between stenting and surgery, in 233 patients (63 13 years, 137 male) who underwent BTS stenting for obstructive CRC. We evaluated the influence of these factors on post-BTS stenting clinical outcomes such as stent-related complications and cancer recurrence.
The interval between stenting and surgery was ≤ 7 days in 79 patients (33.9%) and > 7 days in 154 patients (66.1%). BTS stenting was performed by endoscopists with ≤ 50, 51-100, and > 100 prior stenting experiences in 94, 43, and, 96 patients, respectively. The clinical success rate of BTS stenting was 93.1%. Stent-related and postoperative complications developed in 19 (8.2%) and 20 (8.6%) patients, respectively. Cancer recurrence occurred in 76 patients (32.6%). Short BTS interval of ≤ 7 days increased the risk of postoperative complications (odds ratio OR, 2.61 1.03-6.75; P = 0.043). Endoscopists' stenting experience > 100 showed greater clinical success of stenting (OR, 5.50 1.45-28.39; P = 0.021) and fewer stent-related complications (OR, 0.26 0.07-0.80; P = 0.028) compared with stenting experience ≤ 50. BTS stenting-related factors did not affect long-term oncological outcomes.
Greater expertise of endoscopists was associated with better short-term outcomes, including high stenting success rate and low rate of stent-related complications after BTS stenting for obstructive CRC. An interval of > 7 days between BTS stenting and surgery was required to decrease postoperative complications.
Background and Aim
Data comparing the outcomes of cyclosporin A (CsA) and infliximab (IFX) as rescue therapy for steroid‐refractory acute severe ulcerative colitis (SR‐ASUC) among Asians are scarce.
...Methods
In this single‐center study, we retrospectively reviewed 121 patients with SR‐ASUC according to the Truelove and Witts' criteria who received CsA or IFX as rescue therapy between 1995 and 2015. The cumulative rates of treatment failure and colectomy at 3 months were compared. Treatment failure was defined as colectomy, switch to other medications, acute flare‐up events requiring steroid treatment, or adverse events leading to drug interruption.
Results
Among 121 patients with SR‐ASUC (male, 55.6%; median disease duration, 47.1 months; extensive colitis, 61.2%), 23 received CsA as rescue therapy. Baseline characteristics (e.g. age at diagnosis, sex, disease duration, disease extent at rescue therapy, and Mayo score at treatment initiation) were comparable between the two groups. During follow‐up (median, 45 months; interquartile range 29.3–61.8), 84 patients (69.4%) experienced treatment failure, and 25 patients (20.7%) underwent colectomy. The CsA group and the IFX group did not show significant differences in the cumulative rates of treatment failure (39.1% vs 34.7%, P = 0.714) and colectomy (26.1% vs 13.3%, P = 0.198) at 3 months. Previous use of azathioprine (odds ratio OR = 2.309, 95% confidence interval CI = 1.076–4.951, P = 0.032) was associated with treatment failure at 3 months. Mayo score > 10 at the time of rescue therapy was significantly associated with colectomy at 3 months (OR = 8.444, 95% CI = 2.592–27.506, P < 0.001).
Conclusion
Among Korean patients with SR‐ASUC, the rates of treatment failure and colectomy at 3 months were not significantly different between the CSA and the IFX treatment groups.
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