I-Endoscope yezoNyango iTekhnoloji emnyama (5) iConfocal Laser Microendoscopy (CLE)

I-Confocal Laser Endoscopy (CLE) yinkqubela phambili yetekhnoloji "kwi-vivo pathology" kwiminyaka yakutshanje, enokufikelela kwimifanekiso yexesha lokwenyani yeeseli ekukhuliseni amaxesha angama-1000 ngexesha lovavanyo lwe-endoscopic, iguqula inkqubo yoxilongo lwemveli "ye-biopsy kuqala → i-pathology kamva". Apha ngezantsi luhlalutyo olunzulu lwetekhnoloji yokusika ukusuka kwimilinganiselo yesi-8:

1.Imigaqo yobugcisa kunye noyilo lwenkqubo

Indlela yomfanekiso ongundoqo:

Umgaqo we-confocal optics: I-laser beam igxininise kubunzulu obuthile (0-250 μ m), ifumana kuphela ukukhanya okubonakalisiweyo kwinqwelo-moya egxininisekileyo kunye nokuphelisa ukuphazamiseka kokusasazeka.

I-Fluorescence imaging: ifuna inaliti ye-intravenous/ukutshizwa kwendawo yee-fluorescent agents (ezifana ne-sodium fluorescein, i-acridine yellow)

Indlela yokuskena:

Indawo yokuskena (eCLE): Inqaku ngenqaku ukuskena, isisombululo esiphezulu (0.7 μ m) kodwa isantya esicothayo

Ukuskena komphezulu (pCLE): Ukuskena okunxuseneyo, isantya sefreyim ekhawulezayo (12fps) ukuqwalaselwa okuguquguqukayo

Ukwakhiwa kweSixokelelwano:

ILaser Generator (488nm Blue Laser Eqhelekileyo)

I-Micro confocal probe (enobuncinci bedayamitha eyi-1.4mm enokufakwa ngemijelo ye-biopsy)

Iyunithi yokulungisa umfanekiso (ukunciphisa ingxolo ngexesha lokwenyani + ukwakhiwa kwakhona kwe3D)

Imodyuli encedisiweyo yohlalutyo ye-AI (efana nokuchongwa okuzenzekelayo kokunqongophala kweseli ye-goblet)

2. Iinzuzo zempumelelo yetekhnoloji

3. Iimeko zesicelo seklinikhi

Iimpawu eziphambili:

Umhlaza wokugaya kwangethuba:

Umhlaza wesisu: ucalucalulo lwangempela lwe-intestinal metaplasia / dysplasia (izinga lokuchaneka kwe-91%)

Umhlaza we-colorectal: ulwahlulo lwemibhobho yamadlala (uhlelo lwe-JNET)

Izifo ze-gallbladder kunye ne-pancreatic:

Ukuxilongwa okwahlukileyo kwe-benign kunye ne-malignant bile duct stenosis (ubuntununtunu 89%)

Ukufanekisa udonga lwangaphakathi lwe-pancreatic cyst (i-IPMN subtypes eyahlukileyo)

izicelo zophando:

Uvavanyo lokuphumelela kweziyobisi (njengokuhlolwa okuguquguqukayo kokulungiswa kwe-mucosal yesifo sikaCrohn)

Uphononongo lweMicrobiome (ukuqwalasela ukuhanjiswa kwendawo kwegut microbiota)

Iimeko eziqhelekileyo zokusebenza:

(1) Isitofu se-intravenous ye-fluorescein sodium (10% 5ml)

(2) Confocal probe abafowunelwa mucosa ezikrokrelayo

(3) Ukubonwa kwexesha langempela lesakhiwo se-glaular / i-nuclear morphology

(4) I-AI incedise isigwebo sokuhlela i-Pit okanye ukuhlelwa kweVienna

4. Ukumela abavelisi kunye neeparitha zeemveliso

5. Imingeni yobugcisa kunye nezisombululo

Imiqobo ekhoyo:

Ijiko lokufunda lingumnqantsa: ukulawulwa kwangaxeshanye kwe-endoscopy nolwazi lwe-pathology luyafuneka (ixesha loqeqesho>iinyanga ezi-6)

Isisombululo: Phuhlisa iimephu zokuxilonga eziqhelekileyo ze-CLE (ezifana nokuhlelwa kwe-Mainz)

Izinto ezishukumayo: Iziphumo zokuphefumla / zeperistaltic zichaphazela umgangatho womfanekiso

Isisombululo: Ixhotyiswe nge-algorithm yembuyekezo eguqukayo

Unyino lwe-agent ye-Fluorescent: I-Sodium fluorescein ayikwazi ukubonisa iinkcukacha zenucleus yeseli

Isalathiso sokuphumelela: Iiprobe zemolekyuli ekujoliswe kuzo (ezifana ne-anti EGFR fluorescent antibodies)

Izakhono zokusebenza:

Itekhnoloji yokuskena i-Z-axis: ukubonwa okucwangcisiweyo kwesakhiwo somaleko ngamnye we-mucosa

Iqhinga le-virtual biopsy: ukuphawula iindawo ezingaqhelekanga kunye nokuthatha iisampulu ngokuchanekileyo

6. Inkqubela yophando yamva nje

Ukuhamba phambili komda ngo-2023-2024:

Uhlalutyo lobungakanani be-AI:

Iqela leHarvard liphuhlisa umfanekiso weCLE wenkqubo yamanqaku ezenzekelayo (Gastroenterology 2023)

Ukuqondwa ngokunzulu kwegoblet cell density (ukuchaneka 96%)

Ukudityaniswa kweefoto ezininzi:

Iqela laseJamani liqaphela i-CLE + ye-harmonic imaging yesibini (SHG) edityanisiweyo yokuqwalaselwa kwesakhiwo se-collagen

Nano probe:

IAkhademi yaseTshayina yezeNzululwazi iphuhlisa iCD44 echongelwe i-quantum dot probe (ngokukodwa ileyibhelishe iiseli zesikhondo somhlaza wesisu)

Imiba ephambili yolingo lwezonyango:

Uphononongo lwe-PRODIGY: Inqanaba lotyando elikhokelwa yi-CLE ekhokelwa yi-ESD linyuke laya kutsho kuma-98%.

Uvavanyo lwe-CONFOCAL-II: ukuchaneka kwe-cyst ye-pancreatic 22% ephezulu kune-EUS

7. IiNdlela zoPhuhliso lwexesha elizayo

Ukuvela kobuchwepheshe:

Ukuphumelela kwesisombululo esiphezulu: I-STED-CLE iphumelele<200nm isisombululo (kufutshane ne-electron microscopy)

Imifanekiso engabhalwanga: ubuchule obusekwe kwi-fluorescence ezenzekelayo/ukusasazeka kweRaman

Unyango oludibeneyo: i-probe ehlakaniphile kunye nomsebenzi odibeneyo wokukhupha i-laser

Ukongezwa kwesicelo seklinikhi:

Ukuqikelelwa kwe-tumor immunotherapy efficacy (uqwalaselo lwe-T cell infiltration)

Uvavanyo olusebenzayo lwezicubu ze-neuroendocrine

Ukubekwa esweni kwangethuba kokusabela kokulahlwa kwelungu lokutshintshwa

8. Ukuboniswa kweemeko eziqhelekileyo

Ityala 1: Ukujongwa kommizo kaBarrett

Ukufunyaniswa kwe-CLE: ukuphazamiseka kwesakhiwo sedlala+ukulahleka kwepolarity yenyukliya

Ukuxilongwa kwangoko: I-dysplasia ephezulu (HGD)

Ukulandela unyango: unyango lwe-EMR kunye nokuqinisekiswa kwe-pathological ye-HGD

Ityala lesi-2: Isilonda sezilonda

I-endoscopy yesiNtu: ukuxinana kwe-mucosal kunye ne-edema (akukho zilonda zifihliweyo zifunyenweyo)

Umboniso we-CLE: ukutshatyalaliswa kwe-crypt Architecture+fluorescein ukuvuza

Isigqibo seklinikhi: Ukuphuculwa koNyango lwebhayoloji

Isishwankathelo kunye nembonakalo

Itekhnoloji ye-CLE iqhuba ukuxilongwa kwe-endoscopic kwixesha "lexesha lokwenyani le-pathology kwinqanaba leselula":

Ixesha elifutshane (i-1-3 iminyaka): Iinkqubo ezincedisayo ze-AI zithintelo ezisezantsi zokusetyenziswa, izinga lokungena lidlula i-20%

Ixesha eliphakathi (iminyaka emi-3 ukuya kwemi-5): Ii-molecular probes zifezekisa ukuleyibhile okuthe ngqo kwethumba

Ixesha elide (iminyaka emi-5 ukuya kweli-10): inokubuyisela ezinye ii-biopsies zoxilongo

Le teknoloji iya kuqhubeka nokubhala kwakhona i-paradigm yezonyango 'into oyibonayo yile nto uyixilongayo', ekugqibeleni ifezekise injongo yokugqibela ye-'in vivo molecular pathology'.