INTRODUCTION: Although the 9-minute mean withdrawal time (m-WT) is often reported to be associated with the optimal adenoma detection rate (ADR), no randomized trials of screening colonoscopy have confirmed the impact of a 9-minute m-WT on adenoma miss rate (AMR) and ADR. METHODS: A multicenter tandem trial was conducted in 11 centers. Seven hundred thirty-three asymptomatic participants were randomized to receive segmental tandem screening colonoscopy with a 9-minute withdrawal, followed by a 6-minute withdrawal (9-minute-first group, 9MF, n = 366) or vice versa (6-minute-first group, 6MF, n = 367). The primary outcome was the lesion-level AMR. RESULTS: The intention-to-treat analysis revealed that 9MF significantly reduced the lesion-level (14.5% vs 36.6%, P < 0.001) and participant-level AMR (10.9% vs 25.9%, P < 0.001), advanced adenoma miss rate (AAMR, 5.3% vs 46.9%, P = 0.002), multiple adenomas miss rate (20.7% vs 56.5%, P = 0.01), and high-risk adenomas miss rate (14.6% vs 39.5%, P = 0.01) of 6MF without compromising detection efficiency ( P = 0.79). In addition, a lower false-negative rate for adenomas ( P = 0.002) and high-risk adenomas ( P < 0.05), and a lower rate of shortening surveillance schedule ( P < 0.001) were also found in 9MF, accompanying with an improved ADR in the 9-minute vs 6-minute m-WT (42.3% vs 33.5%, P = 0.02). The independent inverse association between m-WT and AMR remained significant even after adjusting ADR, and meanwhile, 9-minute m-WT was identified as an independent protector for AMR and AAMR. DISCUSSION: In addition to increasing ADR, 9-minute m-WT also significantly reduces the AMR and AAMR of screening colonoscopy without compromising detection efficiency.

Establishment and validation of a computer-assisted colonic polyp localization system based on deep learning

INTRODUCTION: Several studies have investigated the role of linaclotide in bowel preparation; however, dosage and timing still warrant further exploration. METHODS: This noninferiority randomized controlled study was performed in 16 medical centers. The eligible subjects were randomly assigned to 3 groups: the Lct + 3 L polyethylene glycol (PEG) group (group A), the 3 L PEG group (group B), or the Lct + 2 L PEG group (group C). The primary outcome was the adequate bowel preparation rate based on the Boston Bowel Preparation Scale. Safety was assessed based on the incidence of adverse reactions. RESULTS: A total of 1,607 eligible subjects were enrolled, and 1,545 colonoscopy videos were uploaded. In the intention-to-treat analysis, the results of the noninferiority test indicated that the adequate bowel preparation rate in group C (87.58%, 95% confidence interval [CI] 85.08%–90.62%) was neither inferior to that of group A (88.79%, 95% CI 86.11%–91.46%) nor group B (83.99%, 95% CI 80.88%–87.09%). The overall incidence of adverse reactions in group A was higher than that in group C (13.64% vs 8.19%, P = 0.012). There were no significant differences in polyp detection rate ( P = 0.089), adenoma detection rate ( P = 0.776), and bowel preparation completion rate ( P = 0.052). DISCUSSION: The adequate bowel preparation rate of the combination of 3-day linaclotide and 2 L PEG was neither inferior to the combination of 3-day linaclotide and 3 L PEG nor 3 L PEG alone in the average-risk population.

INTRODUCTION: The learning process for probe-based confocal laser endomicroscopy (pCLE) is challenging, and standardized training protocols are currently lacking. The main purpose of this study was to establish and evaluate a preliminary pCLE training system. METHODS: This prospective diagnostic trial was performed based on the nationwide training program. The training system included online theoretical courses and a 2-day offline training. All patients underwent pCLE and magnifying endoscopy (ME). The diagnostic performances of baseline levels, pCLE trainees, pCLE experts, and ME experts were evaluated and compared. The primary outcomes were the diagnostic accuracy, sensitivity, and specificity of gastric cancerous lesions. Linear regression analysis was adopted to explore the influence factors on the accuracy of trainees. RESULTS: A total of 150 lesions and 127 endoscopists were enrolled. All diagnostic indicators for pCLE trainees exhibited significant improvement versus baseline levels (all P < 0.001). pCLE trainees exhibited significantly lower accuracy than pCLE experts ( P = 0.036). There were no significant differences in accuracy, sensitivity, and specificity between pCLE trainees and ME experts. pCLE experts showed significantly higher accuracy ( P = 0.039) and specificity ( P = 0.022) than ME experts. Professional title, hospital level, gastroscopy experience, ME experience, and educational degree exerted no significant influence on the accuracy of pCLE trainees. DISCUSSION: Short-term systematic pCLE training demonstrated significant efficacy, and the diagnostic performance of pCLE trainees was comparable with that of mature ME technology. pCLE can serve as an effective method to promptly enhance the diagnostic proficiency of endoscopists, especially novices, for gastric cancerous lesions.

Secondary cavity-nesting birds can utilize artificial nest boxes provided by humans for breeding, making nest boxes important approaches for attracting birds. Artificial nest boxes are therefore widely used in fields such as ornithological research and avian diversity conservation. Under natural conditions, the location of nests often affects the reproductive success of birds. Therefore, understanding the impact of nest box hanging positions on the breeding success of secondary cavity-nesting birds is of great significance for guiding the placement of artificial nest boxes. In this study, we explored the potential factors, including nest-box location, that affect the reproductive success of the russet sparrow (Passer cinnamomeus) by monitoring the nest-site characteristics and reproductive parameters such as clutch size and brood size of those breeding in artificial nest boxes near Dongzhai National Nature Reserve, Henan, China, from April to July 2024. Russet sparrow nesting in boxes on coniferous trees and utility poles showed no significant differences in clutch size, hatching rate, brood size, pre-laying nest-abandonment rate, and whether the breeding was ultimately successful. Nests with earlier egg-laying dates had larger clutch sizes, higher hatching rates, and greater brood sizes. However, the number of fledglings and fledging success were not affected by laying date, and fledging success was not affected by either the distance from the nest site to the nearest road, or the brood size. Both larger brood size and greater distance from the nearest road were associated with increased numbers of fledglings. Furthermore, russet sparrows nesting in boxes on coniferous trees produced significantly more fledglings and exhibited higher fledging success compared to those nesting on utility poles, suggesting that nest boxes’ hanging position may influence russet sparrow reproductive success. These findings not only supplement existing ecological data on russet sparrow reproduction in artificial nest boxes but also provide important insights for avian conservation practices, highlighting the necessity of fully considering hanging position when deploying artificial nest boxes for birds.