Gastrointestinal Diagnosis Research Articles

Recurrent Gastrointestinal Symptoms and Diagnosis of Superior Mesenteric Artery Syndrome

Recurrent Gastrointestinal Symptoms and Diagnosis of Superior Mesenteric Artery Syndrome

Epidemiology and outcome of medical emergency team calls within 48 hours of intensive care unit discharge.

Some patients experience early (within 48 h) clinical deterioration and medical emergency team (MET) review following intensive care unit (ICU) discharge. Few studies have explored early MET review, despite it being a recognised quality and safety indicator. To evaluate the (i) proportion of patients discharged from ICU receiving MET review and timing of reviews; (ii) characteristics of patients who received early MET review and (iii) predictors of early MET review and associations with clinical outcomes. This is a retrospective observational study of ICU discharges over 2 years in a tertiary hospital and involves descriptive and inferential statistics, including logistic regression analysis. Of 3712 patients, 312 (8.4%) had an early MET review. Patients with cardiothoracic, cardiovascular, gastrointestinal and general surgical diagnoses, higher illness severity or who received invasive ventilation had a higher risk of early MET review. On multivariable analysis, early MET review was associated with an increased risk of ICU re-admission (odds ratio (OR) 6.76, 95% confidence interval (CI) 5.01-9.13, P < 0.001), in-hospital mortality (OR 3.62, 95% CI 2.19-5.99, P < 0.001) and discharge to a nursing home (OR 2.49, 95% CI 1.25-4.97, P = 0.01). Length of stay was longer in patients requiring early post-ICU MET review compared to those who did not (median 16 days vs. 10 days, P < 0.001). One in 12 patients received post-ICU early MET review. This was more likely in patients who were invasively ventilated, had higher illness severity and had certain admission diagnoses. Such patients were at risk for worse outcomes. There is a need to identify reversible factors contributing to such increased risk.

Evaluation of unplanned reattendances to the pediatric emergency department – a five-year study

BackgroundUnplanned reattendances (UR) are an important quality indicator in the emergency department (ED). Understanding the risk factors associated with UR can aid clinicians in optimizing the allocation of time and resources, as well as targeted counselling for this specific group of patients. In this study, we aimed to compare patient characteristics between children who attended a pediatric emergency department (ED) with unplanned reattendances (UR) and those without UR. We also aimed to study the association between healthcare delivery factors such as timing of the attendance, patient load, changeover months for rotating junior doctors, presence of supervision, and rate of UR.Study designWe performed a retrospective, single-center cohort study of patients < 18 years old who visited the ED between January 2018 and March 2023. UR was defined as a revisit within 72 h of the index ED visit. We collected data on demographics, attendance data and clinical characteristics. Logistic regression was performed for factors independently associated with UR, after adjusting for age, patient acuity, timing of attendance, presence of senior doctor supervision, rotation months for junior doctors, and diagnostic category.ResultsOut of the 544,699 eligible children, 24,733 (4.5%) reattended the ED within 72 h, of which 10,915 (44.1%) of them were hospitalized on their reattendance visit. The independent factors associated with UR were young age (age < 3 years old: aOR 1.585 95%CI 1.481–1.698, p < 0.001), high acuity P2+ (aOR 1.398 95%CI 1.354–1.444, p < 0.001), attendance in the evening (aOR 1.086 95%CI 1.055–1.117, p < 0.001) and night (aOR 1.365 95%CI 1.314–1.417, p < 0.001), gastrointestinal diagnosis (aOR 1.528, CI 1.469–1.588; p < 0.001) and respiratory diagnosis (aOR 1.155, CI 1.121–1.189, p < 0.001).ConclusionsWe identified independent risk factors for UR that could guide resource allocation. Future studies should investigate if targeted interventions may reduce UR in these at-risk populations.

Assessing the impact of a gastrointestinal cancer diagnosis on mental health claims among coinsured household family members

BackgroundGastrointestinal (GI) cancer diagnosis can adversely affect the mental health (MH) of household members, including spouses and children. We sought to examine potential changes in MH claims in households following an index patient’s GI cancer diagnosis. MethodsHouseholds of patients with a GI cancer diagnosis were identified using the IBM MarketScan database (2014–2019) and matched with households of patients without cancer. MH-related visits of spouses and children were assessed in the 12 months before and after the index date of diagnosis. Changes were compared between the two cohorts using difference-in-difference (DID) analysis. ResultsAmong 40,650 households in the spouse analysis and 20,014 households in the child analysis, 25.1% (n = 10,210) and 26.8% (n = 5,368) were households in which there was a patient with a GI cancer. Univariable DID analysis demonstrated that households with a GI cancer had a greater increase in anxiety-related (spouses, 2.2% vs 0.7%; children, 2.0% vs 1.1%), mental illness (MI)–related (spouses, 3.2% vs 1.2%; children, 3.0% vs 1.6%), and overall MH-related visits (spouses, 3.3% vs 1.4%) versus the control group (all P < .05). In adjusted DID analysis, spouses, children, and households with a GI cancer diagnosis had a 2.1%, 1.6%, and 2.3% absolute risk increase of MI-related visits, respectively, compared with non-cancer households (all P < .05). ConclusionIn a cohort of privately insured households, coinsured spouses and children of patients with a GI cancer diagnosis had a higher risk of MH-related claims versus households without a GI cancer diagnosis. The data highlight the importance of family counseling and psychological support when a loved one is diagnosed with cancer.

Implementation of standardized feeding pathways for infants with gastroschisis to improve patient outcomes: A quality improvement project in a level IV surgical NICU.

Gastroschisis is a leading cause of pediatric intestinal failure. Feeding guidelines may lead to improved patient outcomes including decreased time to reach full feeds, a reduction in the duration of parenteral nutrition, and reduced length of stay. However, there is limited evidence on what the ideal feeding guidelines are for this complex gastrointestinal diagnosis. In this quality improvement project, after completing a literature review, we created three pathways based on the complexity of the gastroschisis. We reviewed historical data without a defined feeding pathway/guideline to our newly created pathways in the intervention group. The study included 35 patients with varying degrees of gastroschisis complexity, consisting of 9 current patients (October 2021-December 2022) who were provided with defined feeding pathways and 26 historical patients before the protocol was implemented (January 2015-August 2021). There were no significant differences in the number of days required for full feeds between the two groups. However, the mean duration of parenteral nutrition was 18.9 days (95% CI, -31.8 to -7.0) shorter in the intervention group. Although not statistically significant, the patients in the intervention group had a mean length of stay that was 13.1 days (95% CI, -50.0 to 25.4) shorter than the historical group. The creation of standardized feeding guidelines for the gastroschisis population resulted ina statistically nonsignificant decrease in time to reach full enteral feeds, a statistically significant reduced duration of parenteral nutrition, and astatistically nonsignifiant decreased length of stay.

Cell membrane-functionalized bismuth oxyiodide nanodots as potential contrast agent for gastrointestinal tract imaging

Various noninvasive imaging modalities, including X-ray and computed tomography (CT) imaging, have provided significant advantages in accurately assessing the conditions of the gastrointestinal (GI) tract. The corresponding contrast agent with high resolution and biosafety is one of the most crucial focuses in the diagnosis of GI diseases. In this study, considering the requirements of good biocompatibility and biosafety, a novel imaging platform composed of the high-performance contrast agent based on macrophage membrane-coated BiOI nanodots (BiOI@M) was designed via a facile approach. The BiOI@M exhibited outstanding long-term stability and low toxicity. Significantly, BiOI@M demonstrated superior imaging ability compared to clinical barium sulfate. Higher CT values of BiOI@M were observed at equivalent concentrations to barium sulfate, thereby clearly outlining the stomach, small intestine, caecum, and colon after the oral administration of BiOI@M solutions in X-ray and CT imaging. Taken together, BiOI@M could serve as a novel efficient contrast agent in X-ray/CT imaging of the GI tract and diagnosis of GI diseases.

Decision Aid for Colectomy in Recurrent Diverticulitis: Development and Usability Study.

Diverticular disease is a common gastrointestinal diagnosis with over 2.7 million clinic visits yearly. National guidelines from the American Society of Colon and Rectal Surgeons state that "the decision to recommend elective sigmoid colectomy after recovery from uncomplicated acute diverticulitis should be individualized." However, tools to individualize this decision are lacking. This study aimed to develop an online educational decision aid (DA) to facilitate effective surgeon and patient communication about treatment options for recurrent left-sided diverticulitis. We used a modified design sprint methodology to create a prototype DA. We engaged a multidisciplinary team and adapted elements from the Ottawa Personal Decision Guide. We then iteratively refined the prototype by conducting a mixed methods assessment of content and usability testing, involving cognitive interviews with patients and surgeons. The findings informed the refinement of the DA. Further testing included an in-clinic feasibility review. Over a 4-day in-person rapid design sprint, including patients, surgeons, and health communication experts, we developed a prototype of a diverticulitis DA, comprising an interactive website and handout with 3 discrete sections. The first section contains education about diverticulitis and treatment options. The second section clarifies the potential risks and benefits of both clinical treatment options (medical management vs colectomy). The third section invites patients to participate in a value clarification exercise. After navigating the DA, the patient prints a synopsis that they bring to their clinic appointment, which serves as a guide for shared decision-making. Design sprint methodology, emphasizing stakeholder co-design and complemented by extensive user testing, is an effective and efficient strategy to create a DA for patients living with recurrent diverticulitis facing critical treatment decisions.

Using Social Media to Understand Primary Discussions in Gastrointestinal Cancers: Machine Learning Approach.

The incidence and mortality rates of gastrointestinal (GI) cancers are high in the United States as well as worldwide. The widespread use of social media provides unique opportunities to facilitate the dissemination of information, especially in the context of health. We aim to characterize the public's primary discussions, including perceptions, concerns, and interests toward GI cancers, from prevention, diagnosis, and treatment to survivorship care through the social media platform Twitter, using tweets posted by Twitter users. We analyzed 87 860 Twitter posts related to GI cancers. We used machine learning with natural language processing to identify salient topics and themes in the collected tweets. The most common themes across all GI cancer types included cancer risk prevention and awareness outreach programs, risk factors including lifestyles (primarily diet), and cancer survivorship-related discussions (primarily GI symptoms and quality of life). GI symptom-related tweets were prevalent in patients with colorectal and stomach cancers, whereas themes of newer clinical trials, end-of-life trials, palliative care trials, and disease prognosis were common in tweets related to liver/biliary and pancreatic cancers. Our research emphasizes the importance of individualized approaches in managing GI cancers, considering lifestyle and diet, the need for comprehensive survivorship care, raising awareness, delivering information, and improving targeted interventions related to GI cancers. Our study suggests utilizing Twitter data to better understand the real-world interest and concerns about GI cancers among the public, which can guide future patient-centered research in this field.

Hyperkinetic Biliary Dyskinesia: An Underrecognized Problem With Good Surgical Outcomes After Cholecystectomy.

Introduction While surgical indications for symptomatic cholelithiasis and biliary hypokinesia are clear, hyperkinetic biliary dyskinesia (HBD) is an underrecognized condition with poorly defined symptomology and management guidelines. HBD is typically defined as a gallbladder ejection fraction (EF) ≥ 80% on a hepatobiliary iminodiacetic acid (HIDA) scan. We aimed to identify the prevalence and radiographic reporting of HBD, physician referral patterns, and clinical outcomes following cholecystectomy. Methods A retrospective cohort study of patients with HIDA scans completed over 21 years at our tertiary care hospital was performed. Demographics, symptomatology, referral patterns, and operative data were collected. HBD was defined as HIDA EF ≥80%. Patients with HBD who underwent cholecystectomy were analyzed. ANOVA and chi-square tests were used to compare variables among patients with or without symptom improvement using Statistical Product and Service Solutions (SPSS;IBM SPSS Statistics for Windows, Armonk, NY). Results Of 1,997 patients (73% female, mean age 51.7 years) who had HIDA scans with reported EF, 730 (36.6%) had an EF≥80%. Only 13.7% of HIDA scans with EF≥80% were reported as hyperkinetic, and the rest are "normal". Cholecystectomy was performed in 57 (7.8%) patients with EF≥80%, most being elective (89.5%) and all minimally invasive. Primary care physicians (PCPs) referred most elective cases to surgery (61.4%). The median time from HIDA to cholecystectomy was 146 days. Chronic cholecystitis was common in pathology (82.5%), while 38.6% had cholelithiasis. Overall, 53 patients (93.0%) reported symptom improvement at a median follow-up of 17.0 days. Patients without improvement had a higher prevalence of chronic gastrointestinal conditions (p<0.05), but not significantly more cholelithiasis, cholecystitis, time to surgery, or elective surgery status. Conclusions HBD is common but often underdiagnosed and thus likely underrecognized by treating physicians. Most HBD patients benefit from cholecystectomy, regardless of cholelithiasis. Patients with persistent symptoms after cholecystectomy may have confounding gastrointestinal diagnoses. Increased awareness among radiologists, referring PCPs, gastroenterologists, and surgeons about HBD and postoperative outcomes is needed to ensure that HBD is adequately treated.

Self-Reported Nonceliac Gluten Sensitivity in Italian Young Adults: A Cross-Sectional Study. A Dietary Fad?

In different countries, the exact prevalence of people that refer symptoms after gluten ingestion is increasing and the unavailability of reliable laboratory tests to diagnose the condition known as nonceliac gluten sensitivity (NCGS) has opened the door to the spread of survey-based studies to hypothesize a prevalence of this condition with highly discordant results. We aim to describe the attitude toward gluten consumption in a large population of young adults in Italy. A questionnaire-based cross-sectional study was conducted in 13 Italian cities to investigate the dietary attitudes of more than 9,400 people distributed throughout the country about gluten consumption. Only those referring to gluten-related symptoms with a frequency equal to "always" or "most of the time" were considered self-reported NCGS (SR-NCGS) patients. Five thousand two hundred thirty-four of 9,432 eligible participants (55.5%) fully completed the questionnaire. Excluding those with previous gastrointestinal diagnoses of celiac disease and wheat allergy, we have finally analyzed 4,987 questionnaires. Four hundred eighty-seven participants indicated gluten-related symptoms always or most of the time (SR-NCGS subjects), while 121 already had a medical diagnosis of NCGS. The minimum prevalence figure of SR-NCGS is 6.4% (95% confidence interval 6.0-6.9), with a higher prevalence in women (79.9%). The most frequent gluten-related symptoms were bloating, abdominal pain, and tiredness. The high prevalence of people reporting symptoms after gluten ingestion requires that the diagnosis of NCGS should be ascertained with a double-blind controlled study to limit the number of people who improperly approach a gluten-free diet.

The heavy implications of racial and socioeconomic factors affecting cachexia incidence at gastrointestinal malignancy diagnosis: A single-institution study.

e13694 Background: Cachexia, a complicated metabolic syndrome often related to cancer, is associated with anorexia, decreased quality of life, and increased mortality in advanced disease. The overall prevalence of cachexia ranges from 40% at cancer diagnosis to 70% in advanced disease. Our team aimed to determine whether racial and socioeconomic factors are associated with incidence of cachexia or being underweight at diagnosis (UAD) in patients with gastrointestinal (GI) tract cancer in a diverse, multiethnic urban medical center with high Asian-American representation. Methods: Using ICD-10 codes, adult (age ≥18) patients with diagnosis of primary GI carcinoma between 1/1/2013 to 12/31/2022 were identified. Those with secondary GI involvement from non-GI malignancies were excluded. Patient height, weight at time of diagnosis (weight measured within 4-week window from pathologic diagnosis date), and highest weight within 6 months preceding diagnosis date were recorded. Demographic data included: race, primary language, tumor origin, cancer stage and social deprivation index (SDI). Cachexia was defined as weight loss within a 6-month period of &gt;5% of initial body weight, or weight loss &gt;2% if body mass index (BMI) was &lt;20kg/m2. UAD was defined as BMI &lt;18.5kg/m2 at the time of diagnosis. Results: Of 718 patients with newly diagnosed GI cancer, 366 were analyzable for weight change. 61.2% were male. Race distributions were: 62.0% White, 23.8% Asian, 11.5% Black, and 2.7% Other. The primary languages spoken were: 76.5% English, 19.4% Asian-language, and 4.1% Other. The tumor originated from the following areas: 63.7% lower GI tract, 27.0% upper GI tract, and 8.5% hepato-pancreaticobiliary. 8.5% were UAD and 26.4% met criteria for cachexia at the time of diagnosis. Race and UAD had a significant association; Asians (p=.002) and those speaking Asian languages (p&lt;.001) were more likely to present UAD. However, no significant relationship existed between race (p=.780) or language group (p=.656) on cachexia incidence. Tumor origin groups trended towards differences in cachexia incidence (p=.061). Mean SDI was significantly higher in those who were UAD (p=.026). The SDI was slightly higher among those who had cachexia, but this was not statistically significant (p=.244). Conclusions: GI cancer patients of Asian race, who primarily speak an Asian language, and those with higher SDI are more likely to present UAD, but these same factors are not associated with incidence of cachexia at diagnosis. Additional research is needed to determine if being UAD is associated with development of cachexia later in the illness trajectory or affects clinical outcomes for patient with GI cancer.

Brief Resolved Unexplained Events Symptoms Frequently Result in Inappropriate Gastrointestinal Diagnoses and Treatment

ObjectiveTo determine associations between presenting symptoms and oropharyngeal dysphagia diagnoses, gastroesophageal reflux disease (GERD) diagnoses, and treatment with acid suppression medication in infants with brief resolved unexplained event (BRUE). Study designWe performed a prospective cohort study of infants with BRUE to review presenting symptoms and their potential impact on testing and treatment. Videofluoroscopic swallow study (VFSS) results and explanatory diagnoses were obtained from medical record review; acid suppression use was determined by parental survey. Binary and multivariable logistic regression models were used to evaluate associations between presenting symptoms and obtaining VFSS, VFSS results, GERD diagnoses, and acid suppression medication. ResultsPresenting symptoms were varied in 157 subjects enrolled at 51.0±5.3 days of age, with many symptoms that may be related to GERD or dysphagia. Of these, 28% underwent VFSS with 71% abnormal. Overall, 42% had their BRUE attributed to GERD and 33% were treated with acid suppression during follow-up. Presenting symptoms were significantly associated with the decision to obtain VFSS but not with abnormal VFSS results. Presenting symptoms were also associated with provision of GERD explanatory diagnoses. Both presenting symptoms and GERD explanatory diagnoses were associated with acid suppression use (aOR 2.3, 95% CI 1.03-5.3, p=0.04). ConclusionsPresenting symptoms may play a role in clinicians’ decisions about which BRUE patients undergo VFSS but are unreliable to make a diagnosis of oropharyngeal dysphagia. Presenting symptoms may also influence assignment of a GERD explanatory diagnoses that is associated with increased acid suppression medication use.

PFKFB3 controls acinar IP3R-mediated Ca2+ overload to regulate acute pancreatitis severity.

Acute pancreatitis (AP) is among the most common hospital gastrointestinal diagnoses; understanding the mechanisms underlying the severity of AP is critical for development of new treatment options for this disease. Here, we evaluate the biological function of phosphofructo-2-kinase/fructose-2,6-biphosphatase 3 (PFKFB3) in AP pathogenesis in 2 independent genetically engineered mouse models of AP. PFKFB3 was elevated in AP and severe AP (SAP), and KO of Pfkfb3 abrogated the severity of alcoholic SAP (FAEE-SAP). Using a combination of genetic, pharmacological, and molecular studies, we defined the interaction of PFKFB3 with inositol 1,4,5-trisphosphate receptor (IP3R) as a key event mediating this phenomenon. Further analysis demonstrated that the interaction between PFKFB3 and IP3R promotes FAEE-SAP severity by altering intracellular calcium homeostasis in acinar cells. Together, our results support a PFKFB3-driven mechanism controlling AP pathobiology and define this enzyme as a therapeutic target to ameliorate the severity of this condition.

Recent advancements in image-enhanced endoscopy in the pancreatobiliary field.

Image-enhanced endoscopy (IEE) has advanced gastrointestinal disease diagnosis and treatment. Traditional white-light imaging has limitations in detecting all gastrointestinal diseases, prompting the development of IEE. In this review, we explore the utility of IEE, including texture and color enhancement imaging and red dichromatic imaging, in pancreatobiliary (PB) diseases. IEE includes methods such as chromoendoscopy, optical-digital, and digital methods. Chromoendoscopy, using dyes such as indigo carmine, aids in delineating lesions and structures, including pancreato-/cholangio-jejunal anastomoses. Optical-digital methods such as narrow-band imaging enhance mucosal details and vessel patterns, aiding in ampullary tumor evaluation and peroral cholangioscopy. Moreover, red dichromatic imaging with its specific color allocation, improves the visibility of thick blood vessels in deeper tissues and enhances bleeding points with different colors and see-through effects, proving beneficial in managing bleeding complications post-endoscopic sphincterotomy. Color enhancement imaging, a novel digital method, enhances tissue texture, brightness, and color, improving visualization of PB structures, such as PB orifices, anastomotic sites, ampullary tumors, and intraductal PB lesions. Advancements in IEE hold substantial potential in improving the accuracy of PB disease diagnosis and treatment. These innovative techniques offer advantages paving the way for enhanced clinical management of PB diseases. Further research is warranted to establish their standard clinical utility and explore new frontiers in PB disease management.

Gut microbiome composition and metabolic activity in women with diverticulitis

The etiopathogenesis of diverticulitis, among the most common gastrointestinal diagnoses, remains largely unknown. By leveraging stool collected within a large prospective cohort, we performed shotgun metagenomic sequencing and untargeted metabolomics profiling among 121 women diagnosed with diverticulitis requiring antibiotics or hospitalizations (cases), matched to 121 women without diverticulitis (controls) according to age and race. Overall microbial community structure and metabolomic profiles differed in diverticulitis cases compared to controls, including enrichment of pro-inflammatory Ruminococcus gnavus, 1,7-dimethyluric acid, and histidine-related metabolites, and depletion of butyrate-producing bacteria and anti-inflammatory ceramides. Through integrated multi-omic analysis, we detected covarying microbial and metabolic features, such as Bilophila wadsworthia and bile acids, specific to diverticulitis. Additionally, we observed that microbial composition modulated the protective association between a prudent fiber-rich diet and diverticulitis. Our findings offer insights into the perturbations in inflammation-related microbial and metabolic signatures associated with diverticulitis, supporting the potential of microbial-based diagnostics and therapeutic targets.

Gastrointestinal Pathologies in Pediatric Patients With Cystic Fibrosis Undergoing Endoscopy: A Single-Center Retrospective Review Over 15 Years.

Introduction Previous studies have demonstrated an increased incidence of gastrointestinal (GI) pathologies, specifically celiac disease (CD) and eosinophilic esophagitis (EoE), in patients with cystic fibrosis (CF). However, there is minimal data available regarding endoscopic findings in pediatric patients with CF and GI mucosal disease. Methods A retrospective chart review was performed on patients with CF under 18 years of age who underwent esophagogastroduodenoscopy (EGD) or colonoscopy with biopsy over a 15-year period at our institution. Patient characteristics including assigned sex at birth, CF genetic mutations (if identified), and cystic fibrosis transmembrane conductance regulator (CFTR) modulator use were recorded.Data obtained at the time of biopsy included body mass index (BMI), indication for the procedure, exocrine pancreatic status, visual endoscopic findings, and histologic findings. Results A total of 72 patients with CF were included in the study. 24% (n=17) were found to have abnormal endoscopic biopsy results. EoE (13% of all patients, n=9) and CD (6% of all patients, n=4) were the most common GI diagnoses present on endoscopic biopsy. All 3 patients taking CFTR modulator medications at the time of endoscopy had normal biopsy results. Of the 17 patients found to have abnormal pathology results, 14 (82%) were taking proton-pump inhibitor (PPI) medication at the time of endoscopy. Conclusion This study highlights the probable increased frequency of GI disease in the pediatric CF population. These findings underscore the importance of maintaining a broad differential diagnosis while considering utilization of endoscopy with biopsy in pediatric patients with CF who have GI symptoms.

Short-Term Biological Toxicity Prediction of [177Lu]Lutetium-Oxodotreotide: An Original Retrospective Analysis.

Introduction: [177Lu]Lutetium (Lu)-oxodotreotide is a radiopharmaceutical drug used as peptide receptor radionuclide therapy (PRRT) for somatostatin receptor-expressing neuroendocrine neoplasms. It provides an additional effective alternative treatment for these rare cancers. Although well tolerated, its safety profile must continue to be characterized to support its use as a first-line treatment or for additional cycles. This study evaluated factors associated with the occurrence of [177Lu]Lu-oxodotreotide induced short-term toxicity. Materials and Methods: A retrospective observational monocentric study was carried out from July 2013 to October 2021. Inclusion criteria were defined as follows: patients who received at least four cycles of [177Lu]Lu-oxodotreotide and were followed up for 6 months after the last injection. Graduated toxicity was defined using the National Cancer Institute Common Terminology Criteria for Adverse Events 5.0. Cox regression was used in the analysis. Results: Forty patients were included. The most frequent toxicities occurred during the first cycle and were graded as G1 or G2. As expected, toxicities were predominantly hematological and hepatic, with incomplete reversibility after each cycle. The following factors were significantly related to the occurrence of hematological or hepatic toxicity during PRRT: gastrointestinal primary tumor diagnosis, bone metastases, peritoneal metastases, pancreatic metastases or pulmonary metastases, and high tumor grade. Conclusion: Knowledge and consideration of these factors in adjusting [177Lu]Lu-oxodotreotide treatment regimen could help prevent or reduce the severity of these toxicities. Further studies are still warranted to refine these results and improve treatment management.

Development of a multi-fusion convolutional neural network (MF-CNN) for enhanced gastrointestinal disease diagnosis in endoscopy image analysis.

Gastrointestinal (GI) diseases are prevalent medical conditions that require accurate and timely diagnosis for effective treatment. To address this, we developed the Multi-Fusion Convolutional Neural Network (MF-CNN), a deep learning framework that strategically integrates and adapts elements from six deep learning models, enhancing feature extraction and classification of GI diseases from endoscopic images. The MF-CNN architecture leverages truncated and partially frozen layers from existing models, augmented with novel components such as Auxiliary Fusing Layers (AuxFL), Fusion Residual Block (FuRB), and Alpha Dropouts (αDO) to improve precision and robustness. This design facilitates the precise identification of conditions such as ulcerative colitis, polyps, esophagitis, and healthy colons. Our methodology involved preprocessing endoscopic images sourced from open databases, including KVASIR and ETIS-Larib Polyp DB, using adaptive histogram equalization (AHE) to enhance their quality. The MF-CNN framework supports detailed feature mapping for improved interpretability of the model's internal workings. An ablation study was conducted to validate the contribution of each component, demonstrating that the integration of AuxFL, αDO, and FuRB played a crucial part in reducing overfitting and efficiency saturation and enhancing overall model performance. The MF-CNN demonstrated outstanding performance in terms of efficacy, achieving an accuracy rate of 99.25%. It also excelled in other key performance metrics with a precision of 99.27%, a recall of 99.25%, and an F1-score of 99.25%. These metrics confirmed the model's proficiency in accurate classification and its capability to minimize false positives and negatives across all tested GI disease categories. Furthermore, the AUC values were exceptional, averaging 1.00 for both test and validation sets, indicating perfect discriminative ability. The findings of the P-R curve analysis and confusion matrix further confirmed the robust classification performance of the MF-CNN. This research introduces a technique for medical imaging that can potentially transform diagnostics in gastrointestinal healthcare facilities worldwide.

BFE-Net: bilateral fusion enhanced network for gastrointestinal polyp segmentation

Accurate segmentation of polyp regions in gastrointestinal endoscopic images is pivotal for diagnosis and treatment. Despite advancements, challenges persist, like accurately segmenting small polyps and maintaining accuracy when polyps resemble surrounding tissues. Recent studies show the effectiveness of the pyramid vision transformer (PVT) in capturing global context, yet it may lack detailed information. Conversely, U-Net excels in semantic extraction. Hence, we propose the bilateral fusion enhanced network (BFE-Net) to address these challenges. Our model integrates U-Net and PVT features via a deep feature enhancement fusion module (FEF) and attention decoder module (AD). Experimental results demonstrate significant improvements, validating our model's effectiveness across various datasets and modalities, promising advancements in gastrointestinal polyp diagnosis and treatment.

Impact of large scale, multicomponent intervention to reduce proton pump inhibitor overuse in integrated healthcare system: difference-in-difference study

ObjectiveTo determine how a large scale, multicomponent, pharmacy based intervention to reduce proton pump inhibitor (PPI) overuse affected prescribing patterns, healthcare utilization, and clinical outcomes.DesignDifference-in-difference study.SettingUS Veterans Affairs Healthcare System,...