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Bouveret syndrome masquerading as a gastric mass-unmasked with endoscopic luminal laser lithotripsy:A case report

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World Journal of Clinical Cases 2020年第22期8卷 5701-5706页

作者： Swetha Parvataneni Harshit S Khara david l diehl Department of Internal Medicine Geisinger Lewistown HospitalLewistownPA 17044United States Department of Gastroenterology and Hepatology Advanced EndoscopyGeisinger Health systemDanvillePA 17822United States Department of Gastroenterology and Nutrition Geisinger Medical CenterDanvillePA 17822United States

BACKGROUND Bouveret syndrome,also known as gallstone ileus,is a rare form of gastric outlet obstruction accounting for 1%-3%of *** condition is most often reported in *** diagnosis can be challenging and is often missed due to atypical presentations,which occasionally mimic gastric outlet obstruction symptoms such as nausea,vomiting,loss of appetite and *** symptoms vary with stone *** stones are managed with a surgical approach,but this carries increased morbidity and *** the past decade,the endoscopic approach has emerged as an alternative mode of treatment,but it is generally unsuccessful in the management of larger-sized stones.A literature review revealed cases of successful endoscopic treatment requiring multiple sessions for stone sizes measuring up to about 4.5 *** we present a unique case of an elderly patient with Bouveret syndrome with a 5 cm stone mimicking a gastric mass and causing gastric outlet obstruction,who was successfully managed in a single session using a complete endoscopic approach with laser *** SUMMARY An 85-year-old female patient presented with 1-month history of intermittent abdominal pain,vomiting,decreased appetite and weight *** abdominal computed tomography showed a 4.5 cm×4.7 cm partially calcified mass at the gastric pylorus causing gastric outlet *** showed an ulcerated fistulous opening and a large 5 cm impacted gallstone in the duodenal *** nets and baskets were used in an attempt to remove the stone,but this approach was *** her advanced age,poor physical condition and underlying comorbidities,she was deemed to be high-risk for ***,a minimally invasive approach using endoscopic laser lithotripsy was attempted and successfully treated the ***-procedure,the patient experienced complete resolution of her symptoms with no complications and was able to tolerate her *** was subsequently discharged home

关键词： Gastric outlet obstruction Bouveret syndrome laser lithotripsy Holmium laser lithotripsy Holmium and neodymium yttrium aluminum garnet lasers Case report

Esophageal stent fracture:case report and review of the literature

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World Journal of Gastroenterology 2014年第10期20卷 2715-2720页

作者： Harshit S Khara david l diehl Seth A Gross Department of Gastroenterology and Nutrition Geisinger Medical Center Danville PA 17822 United States Division of Gastroenterology NYU School of Medicine NYU Langone Medical Center New York NY 10028United States

Endoscopic esophageal stent placement is widely used in the treatment of a variety of benign and malignant esophageal *** expanding metal stents(SEMS)are associated with significantly reduced stent related mortality and morbidity compared to plastic stents for treatment of esophageal conditions;however they have known complications of stent migration,stent occlusion,tumor ingrowth,stricture formation,reflux,bleeding and perforation amongst others.A rare and infrequently reported complication of SEMS is stent fracture and subsequent migration of the broken *** have only been a handful of published case reports describing this *** this report we describe a case of a spontaneously fractured nitinol esophageal SEMS,and review the available literature on the unusual occurrence of SEMS fracture placed for benign or malignant obstruction in the *** fracture could be a potentially dangerous event and should be considered in a patient having recurrent dysphagia despite successful placement of an esopha-geal *** usually requires endoscopic therapy and may unfortunately require surgery for retrieval of a distally migrated *** recognition and prompt management may be able to prevent further problems.

关键词： Esophagus Self-expanding metal stent Stent complication Stent fracture Stent migration

Risk factors for colonoscopic perforation: A population-based study of 80118 cases

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World Journal of Gastroenterology 2013年第23期19卷 3596-3601页

作者： Uzair Hamdani Raza Naeem Fyeza Haider Pardeep Bansal Michael Komar david l diehl H lester Kirchner Department of Gastroenterology Geisinger Medical CenterDanville PA 17822 United States Department of Gastroenterology Good Samaritan HospitalVincennes IN 47591 United States Central Indiana Gastroenterology Anderson IN 46016 United States Division of Medicine Gesinger Medical CenterDanville PA 17822 United States

AIM: To assess the incidence and risk factors associated with colonic perforation due to colonoscopy. METHODS: This was a retrospective cross-sectional study. Patients were retrospectively eligible for inclusion if they were 18 years and older and had an inpatient or outpatient colonoscopy procedure code in any facility within the Geisinger Health System during the period from January 1, 2002 to August 25, 2010. Data are presented as median and inter-quartile range, for continuous variables, and as frequency and percentage for categorical variables. Baseline comparisons across those with and without a perforation were made using the two-sample t -test and Pearson's χ2 test, as ***: A total of 50 perforations were diagnosed out of 80118 colonoscopies, which corresponded to an incidence of 0.06% (95%CI: 0.05-0.08) or a rate of 6.2 per 10000 colonoscopies. All possible risk factors associated with colonic perforation with a P -value lusion in a multivariable logbinomial regression model predicting 7-d colonic perforation. The final model resulted in the following risk factors which were significantly associated with risk of colonic perforation: age, gender, body mass index, albumin level, intensive care unit (ICU) patients, inpatient setting, and abdominal pain and Crohn's disease as indications for colonoscopy. CONClUSION: The cumulative 7 d incidence of colonic perforation in this cohort was 0.06%. Advanced age and female gender were significantly more likely to have perforation. Increasing albumin and BMI resulted in decreased risk of colonic perforation. Having a colonoscopy indication of abdominal pain or Crohn's disease resulted in a higher risk of colonic perforation. Colonoscopies performed in inpatients and particularly the ICU setting had substantially greater odds of perforation. Biopsy and polypectomy did not increase the risk of perforation and only three perforations occurred with screening colonoscopy.

关键词： Colonoscopic perforation Colon cancer Endosocopy

A multi-sensor appiproach to calving detection

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Information Processing in Agriculture 2024年第1期11卷 45-64页

作者： Anita Z.Chang david l.Swain Mark G.Trotter Institute for Future Farming Systems School of HealthMedicaland Applied SciencesCentral Queensland UniversityRockhamptonQueensland 4700Australia

The advent of remote livestock monitoring systems provides numerous possibilities for improving on-farm productivity,efficiency,and *** potential application for these systems is for the detection of calving *** study describes the integration of data from multiple sensor sources,including accelerometers,global navigation satellite systems(GNsS),an accelerometer-derived rumination algorithm,a walk-over-weigh unit,and a weather station for parturition detection using a support vector machine *** best performing model utilised data from GNsS,the ruminating algorithm,and weather stations to achieve 98.6%accuracy,with 88.5%sensitivity and 100%*** topranking features of this model were primarily GNSS *** study provides an overview as to how various sensor systems could be integrated on-farm to maximise calving detection for improved production and welfare outcomes.

关键词： Accelerometer GNSS GPS Rumination Sensor WOW

Explainable artificial intelligence in breast cancer detection and risk prediction:A systematic scoping review

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Cancer Innovation 2024年第5期3卷 1-22页

作者： Amirehsan Ghasemi Soheil Hashtarkhani david l.Schwartz Arash Shaban‐Nejad Department of Pediatrics Center for Biomedical InformaticsCollege of MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA The Bredesen Center for Interdisciplinary Research and Graduate Education University of TennesseeKnoxvilleTennesseeUSA Department of Radiation Oncology College of MedicineUniversity of Tennessee Health Science CenterMemphisTennesseeUSA

With the advances in artificial intelligence(AI),data‐driven algorithms are becoming increasingly popular in the medical ***,due to the nonlinear and complex behavior of many of these algorithms,decision‐making by such algorithms is not trustworthy for clinicians and is considered a blackbox ***,the scientific community has introduced explainable artificial intelligence(XAI)to remedy the *** systematic scoping review investigates the application of XAI in breast cancer detection and risk *** conducted a comprehensive search on Scopus,IEEE Explore,PubMed,and Google Scholar(first 50 citations)using a systematic search *** search spanned from January 2017 to July 2023,focusing on peer‐reviewed studies implementing XAI methods in breast cancer *** studies met our inclusion criteria and were included in the *** results revealed that SHapley Additive exPlanations(SHAP)is the top model‐agnostic XAI technique in breast cancer research in terms of usage,explaining the model prediction results,diagnosis and classification of biomarkers,and prognosis and survival ***,the SHAP model primarily explained tree‐based ensemble machine learning *** most common reason is that SHAP is model agnostic,which makes it both popular and useful for explaining any model ***,it is relatively easy to implement effectively and completely suits performant models,such as tree‐based *** AI improves the transparency,interpretability,fairness,and trustworthiness of AI‐enabled health systems and medical devices and,ultimately,the quality of care and outcomes.

关键词： breast cancer deep learning explainable artificial intelligence interpretable AI machine learning XAI

Prevalence of Helicobacter pylori infection among patients with esophageal carcinoma

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World Journal of Gastroenterology 2024年第29期30卷 3479-3487页

作者： Miriam lópez-Gómez Maria Morales Rebeca Fuerte Marta Muñoz Pedro-david Delgado-lópez Jorge Francisco Gómez-Cerezo Enrique Casado Department of Medical Oncology Precision Oncology LaboratoryInfanta Sofía University HospitalSan Sebastián de los Reyes 28231MadridSpain Department of Medical Oncology Infanta Sofía University HospitalSan Sebastián de los Reyes 28702Spain Department of Internal Medicine Infanta Sofía University HospitalSan Sebastián de los Reyes 28703MadridSpain Department of Pathology Infanta Sofía University HospitalSan Sebastián de los Reyes 28702Spain Department of Neurosurgery Burgos University HospitalBurgos 09006Spain Department of Internal Medicine Infanta Sofía University Hospital and Henares University Hospital Foundation for Biomedical Research and InnovationSan Sebastian de los Reyes 28702MadridSpain Department of Medical Oncology Infanta Sofia University Hospital and Henares University Hospital Foundation for Biomedical Research and InnovationSan Sebastian de los Reyes 28702MadridSpain

BACKGROUND Helicobacter pylori(***)is a widespread microorganism related to gastric adenocarcinoma(AC).In contrast,it has been reported that an inverse association exists between *** infection and esophageal *** mechanisms underlying this supposedly protective effect remain *** To determine the prevalence of *** infection in esophageal carcinoma patients,we performed a retrospective observational study of esophageal tumors diagnosed in our *** We retrospectively reviewed the prevalence of *** infection in a cohort of patients diagnosed with esophageal *** or previous proton pump inhibitor(PPI)usage was also *** A total of 89 patients with esophageal carcinoma(69 males,77.5%),with a mean age of 66 years(range,26-93 years)were *** was the most frequent pathological variant(n=47,52.8%),followed by squamous cell carcinoma(n=37,41.6%).Fourteen ACs(29.8%)originated in the gastroesophageal junction and 33(70.2%)in the esophageal ***,54 patients(60.7%)presented at stages III and *** *** infection occurred only in 4 patients(4.5%),3 with AC(6.3%of all ACs)and 1 with squamous cell carcinoma(2.7%of all squamous cell tumors).All patients with previous *** infection had stage *** one patient had received prior *** eradication therapy,whereas 86(96.6%)had received previous or concomitant PPI *** In our cohort of patients,and after histologic evaluation of paraffin-embedded primary tumors,we found a very low prevalence of previous *** *** also reviewed the medical history of the patients,concluding that the majority had received or were on PPI *** minimal prevalence of *** infection found in this cohort of patients with esophageal carcinoma suggests a protective role.

关键词： Helicobacter pylori Eradication Esophageal tumor Dysbiosis Proton pump inhibitors Carcinogenesis Microbiota Incidence

Examining the effects of voluntary avoidance behaviour and policy-mediated behaviour change on the dynamics of SARS-CoV-2:A mathematical model

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Infectious Disease Modelling 2024年第3期9卷 701-712页

作者： Gabrielle Brankston david N.Fisman Zvonimir Poljak Ashleigh R.Tuite Amy l.Greer Department of Population Medicine University of GuelphCanada Dalla lana School of Public Health University of TorontoCanada Centre for Immunization Readiness Public Health Agency of CanadaOttawaOntarioCanada

Background Throughout the SARS-CoV-2 pandemic,policymakers have had to navigate between recommending voluntary behaviour change and policy-driven behaviour change to mitigate the impact of the *** individuals will voluntarily engage in self-protective behaviour when there is an increasing infectious disease risk,the extent to which this occurs and its impact on an epidemic is not *** This paper describes a deterministic disease transmission model exploring the impact of individual avoidance behaviour and policy-mediated avoidance behaviour on epidemic outcomes during the second wave of SARS-CoV-2 infections in Ontario,Canada(September 1,2020 to February 28,2021).The model incorporates an information feedback function based on empirically derived behaviour data describing the degree to which avoidance behaviour changed in response to the number of new daily cases *** Voluntary avoidance behaviour alone was estimated to reduce the final attack rate by 23.1%,the total number of hospitalizations by 26.2%,and cumulative deaths by 27.5%over 6 months compared to a counterfactual scenario in which there were no interventions or avoidance behaviour.A provincial shutdown order issued on December 26,2020 was estimated to reduce the final attack rate by 66.7%,the total number of hospitalizations by 66.8%,and the total number of deaths by 67.2%compared to the counterfactual *** Given the dynamics of SARS-CoV-2 in a pre-vaccine era,individual avoidance behaviour in the absence of government action would have resulted in a moderate reduction in disease however,it would not have been sufficient to entirely mitigate transmission and the associated risk to the population in *** action during the second wave of the COVID-19 pandemic in Ontario reduced infections,protected hospital capacity,and saved lives.

关键词： Mathematical modelling COVID-19 SARS-CoV-2 Human behaviour

Electrifying Ba_(0.5)Sr_(0.5)Co_(0.8)Fe_(0.2)O_(3-δ) for focalized heating in oxygen transport membranes

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Journal of Energy Chemistry 2024年第4期91卷 99-110页

作者： Marwan laqdiem Julio García-Fayos laura Almar Alfonso J.Carrillo Álvaro Represa JoséM.lópez Nieto Sonia Escolástico david Catalán-Martinez Jose M.Serra Instituto de Tecnología Química(Universitat Politècnica de València–Consejo Superior de Investigaciones Científicas) Av.Los Naranjos s/nE-46022 ValenciaSpain

Industry decarbonization requires the development of highly efficient and flexible technologies relying on renewable energy resources,especially biomass and solar/wind *** the case of pure oxygen production,oxygen transport membranes(OTMs)appear as an alternative technology for the cryogenic distillation of air,the industrially-established process of producing ***,OTMs could provide oxygen from different sources(air,water,CO_(2),etc.),and they are more flexible in adapting to current processes,producing oxygen at 700^(-1)000℃.Furthermore,OTMs can be integrated into catalytic membrane reactors,providing new pathways for different *** first part of this study was focused on electrification on a traditional OTM material(Ba_(0.5)Sr_(0.5)Co_(0.8)Fe_(0.2)O_(3-δ)),imposing different electric currents/voltages along a capillary *** to the emerging Joule effect,the membrane-surface temperature and the associated O_(2) permeation flux could be ***,the OTM is electrically and locally heated and reaches 900℃on the surface,whereas the surrounding of the membrane was maintained at 650℃.The O_(2)permeation flux reached for the electrified membranes was~3.7 Nml min^(-1)cm^(-2),corresponding to the flux obtained with an OTM non-electrified at 900℃.The influence of depositing a porous Ce_(0.8)Tb_(0.2)O_(2-δ) catalytic/protective layer on the outer membrane surface revealed that lower surface temperatures(830℃)were detected at the same imposed electric ***,the electrification concept was demonstrated in a catalytic membrane reactor(CMR)where the oxidative dehydrogenation of ethane(ODHE)was carried *** reaction is very sensitive to temperature,and here,we demonstrate an improvement of the ethylene yield by reaching moderate temperatures in the reaction chamber while the O_(2) injection into the reaction can be easily fine-tuned.

关键词： Oxygen permeation Oxidative dehydrogenation of ethane Oxygen transport membranes Joule effect Mixed ionic-electronic conductors Catalytic membrane reactors

Functional mechanism study of the allelochemical myrigalone A identifies a group of ultrapotent inhibitors of ethylene biosynthesis in plants

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Plant Communications 2024年第6期5卷 246-262页

作者： George Heslop-Harrison Kazumi Nakabayashi Ana Espinosa-Ruiz Francesca Robertson Robert Baines Christopher R.l.Thompson Katrin Hermann david Alabadí Gerhard leubner-Metzger Robin S.B.Williams Centre for Biomedical Sciences Department of Biological SciencesRoyal Holloway University of LondonEgham TW200EXUK Centre for Plant Molecular Sciences Department of Biological SciencesRoyal Holloway University of LondonEgham TW200EXUK Instituto de Biología Molecular y Celular de Plantas(CSIC-UPV) 46022 ValenciaSpain Centre for life’s Origins and Evolution Department of GeneticsEvolution and EnvironmentUniversity College LondonLondonUK Syngenta Crop Protection AGSteinSwitzerland

Allelochemicals represent a class of natural products released by plants as root,leaf,and fruit exudates that interfere with the growth and survival of neighboring *** how allelochemicals function to regulate plant responses may provide valuable new approaches to better control plant *** such allelochemical,Myrigalone A(MyA)produced by Myrica gale,inhibits seed germination and seedling growth through an unknown ***,we investigate MyA using the tractable modelDictyostelium discoideum and reveal that its activity depends on the conserved homolog of the plant ethylenesynthesis protein 1-aminocyclopropane-1-carboxylic acid oxidase(ACO).Furthermore,in silico modeling predicts the direct binding of MyA to ACO within the catalytic *** ***,ablation of ACO mimics the MyA-dependent developmental delay,which is partially restored by exogenous ethylene,and MyA reduces ethylene *** Arabidopsis thaliana,MyA treatment delays seed germination,and this effect is rescued by exogenous *** also mimics the effect of established ACO inhibitors on root and hypocotyl extension,blocks ethylenedependent root hair production,and reduces ethylene ***,in silico binding analyses identify a rangeof highlypotentethylene inhibitorsthatblock ethylene-dependent responseand reduce ethyleneproduction in ***,we demonstrate a molecular mechanism by which the allelochemical MyA reduces ethylene biosynthesis and identify a range of ultrapotent inhibitors of ethylene-regulated responses.

关键词： 1-aminocyclopropane-1-carboxylic acid ACC ACC oxidase ACO allelochemicals ethylene synthesis inhibitors structure-activity relationship