Spleen stiffness: a new tool to predict high-risk varices in cirrhotic patients.

INTRODUCTION: Cirrhosis is one of the major causes of morbidity and mortality worldwide. Portal hypertension is the major contributor of cirrhosis-related complications and is defined as a hepatic venous pressure gradient (HVPG) > 5 mmHg. Measurement of HVPG is an invasive, difficult, and costly procedure. Therefore, it is only performed in specialized centers. Liver stiffness measured with transient elastography is one of the most studied noninvasive markers of portal hypertension, and spleen elastography has recently emerged as an important adjuvant tool. The development of a new probe (100 Hz) that more reliably reflect the grade of portal hypertension evaluated by spleen stiffness measurement has improved the accuracy of this technique. The aim of this work was to evaluate the accuracy of spleen stiffness with the new dedicated probe to predict the presence of high-risk varices, as well as to determine the ideal cutoff to predict it. METHODS: Prospective study of cirrhotic patients admitted to upper endoscopy that were also submitted to liver and spleen elastography with the 100-Hz probe by the same blinded operator in a tertiary center. RESULTS: We included 209 cirrhotic patients, with mean age of 61.9 years (±9.9), 77.0% male. The most common etiology was alcoholic liver disease (72.7%). The median value of liver elastography was 25.3 [4.5-75] kPa, and the median value of spleen elastography was 42.4 [7.6-100] kPa. At the cutoff of 53.25 kPa, we obtained sensitivity of 100% and specificity of 72.6% to predict high-risk varices, and, according to this cutoff, 133/175 of esophagogastroduodenoscopy could have been spared (76.0%), while according to Baveno guidelines, only 51/175 would have been spared (29.1%). CONCLUSION: In the era of noninvasive exams, spleen elastography with the 100-Hz probe emerges as an excellent tool for prediction of presence of high-risk varices. At the cutoff of 53.25 kPa, spleen elastography avoids upper endoscopy for screening for high-risk varices, promising to be become part of the hepatologists' daily routine.

Primary small bowel follicular lymphoma: the role of balloon-assisted enteroscopy in diagnosis and follow-up.

An asymptomatic 38-year-old male with no significant previous medical history performed routine laboratory studies that revealed iron-deficiency anemia. Esophagogastroduodenoscopy and colonoscopy were unremarkable and he undergone videocapsule endoscopy that revealed multiple small polyps along jejunum and ileum. Double-balloon enteroscopy confirmed the presence of scattered small whitish nodules and small polyps carpeting segments of jejunal mucosal and sometimes forming conglomerates with a nodular appearance. Histopathological examination showed lamina propria expansion by neoplastic follicles, predominantly composed by small lymphoid cells that, by immunohistochemistry, showed expression of CD20, CD10 and bcl-2. Computed tomography scan of abdomen and pelvis did not reveal systemic involvement, consistent with primary small bowel follicular lymphoma. Chemotherapy was started and, at reevaluation enteroscopy, although nodular jejunal segments persisted, biopsies did not show involvement by lymphoproliferative disease, which was interpreted as complete remission. Periodic clinical and biochemical evaluation and annual enteroscopic surveillance was maintained and, after three years, local recurrence of low-grade follicular lymphoma was detected. As previously, there was no evidence of systemic involvement and the decision was to maintain close surveillance. After one year, the patient remains asymptomatic and without evidence of disease progression. This case illustrates the essential role of balloon-assisted enteroscopy for diagnosis and surveillance of primary small bowel follicular lymphoma.

Artificial intelligence and capsule endoscopy: automatic detection of enteric protruding lesions using a convolutional neural network.

BACKGROUND AND AIMS: capsule endoscopy (CE) revolutionized the study of the small intestine. Nevertheless, reviewing CE images is time-consuming and prone to error. Artificial intelligence algorithms, particularly convolutional neural networks (CNN), are expected to overcome these drawbacks. Protruding lesions of the small intestine exhibit enormous morphological diversity in CE images. This study aimed to develop a CNN-based algorithm for the automatic detection small bowel protruding lesions. METHODS: a CNN was developed using a pool of CE images containing protruding lesions or normal mucosa from 1,229 patients. A training dataset was used for the development of the model. The performance of the network was evaluated using an independent dataset, by calculating its sensitivity, specificity, accuracy, positive and negative predictive values. RESULTS: a total of 18,625 CE images (2,830 showing protruding lesions and 15,795 normal mucosa) were included. Training and validation datasets were built with an 80 %/20 % distribution, respectively. After optimizing the architecture of the network, our model automatically detected small-bowel protruding lesions with an accuracy of 92.5 %. CNN had a sensitivity and specificity of 96.8 % and 96.5 %, respectively. The CNN analyzed the validation dataset in 53 seconds, at a rate of approximately 70 frames per second. CONCLUSIONS: we developed an accurate CNN for the automatic detection of enteric protruding lesions with a wide range of morphologies. The development of these tools may enhance the diagnostic efficiency of CE.

The Promise of Artificial Intelligence in Digestive Healthcare and the Bioethics Challenges It Presents.

With modern society well entrenched in the digital area, the use of Artificial Intelligence (AI) to extract useful information from big data has become more commonplace in our daily lives than we perhaps realize. Medical specialties that rely heavily on imaging techniques have become a strong focus for the incorporation of AI tools to aid disease diagnosis and monitoring, yet AI-based tools that can be employed in the clinic are only now beginning to become a reality. However, the potential introduction of these applications raises a number of ethical issues that must be addressed before they can be implemented, among the most important of which are issues related to privacy, data protection, data bias, explainability and responsibility. In this short review, we aim to highlight some of the most important bioethical issues that will have to be addressed if AI solutions are to be successfully incorporated into healthcare protocols, and ideally, before they are put in place. In particular, we contemplate the use of these aids in the field of gastroenterology, focusing particularly on capsule endoscopy and highlighting efforts aimed at resolving the issues associated with their use when available.

Deep-Learning and Device-Assisted Enteroscopy: Automatic Panendoscopic Detection of Ulcers and Erosions.

Background and Objectives: Device-assisted enteroscopy (DAE) has a significant role in approaching enteric lesions. Endoscopic observation of ulcers or erosions is frequent and can be associated with many nosological entities, namely Crohn's disease. Although the application of artificial intelligence (AI) is growing exponentially in various imaged-based gastroenterology procedures, there is still a lack of evidence of the AI technical feasibility and clinical applicability of DAE. This study aimed to develop and test a multi-brand convolutional neural network (CNN)-based algorithm for automatically detecting ulcers and erosions in DAE. Materials and Methods: A unicentric retrospective study was conducted for the development of a CNN, based on a total of 250 DAE exams. A total of 6772 images were used, of which 678 were considered ulcers or erosions after double-validation. Data were divided into a training and a validation set, the latter being used for the performance assessment of the model. Our primary outcome measures were sensitivity, specificity, accuracy, positive predictive value (PPV), negative predictive value (NPV), and an area under the curve precision-recall curve (AUC-PR). Results: Sensitivity, specificity, PPV, and NPV were respectively 88.5%, 99.7%, 96.4%, and 98.9%. The algorithm's accuracy was 98.7%. The AUC-PR was 1.00. The CNN processed 293.6 frames per second, enabling AI live application in a real-life clinical setting in DAE. Conclusion: To the best of our knowledge, this is the first study regarding the automatic multi-brand panendoscopic detection of ulcers and erosions throughout the digestive tract during DAE, overcoming a relevant interoperability challenge. Our results highlight that using a CNN to detect this type of lesion is associated with high overall accuracy. The development of binary CNN for automatically detecting clinically relevant endoscopic findings and assessing endoscopic inflammatory activity are relevant steps toward AI application in digestive endoscopy, particularly for panendoscopic evaluation.

Impacts of smoking on oral health-what is the role of the dental team in smoking cessation?

DATA SOURCES: Electronic searches were conducted on databases (PubMed, EMBASE, and Google Scholar). In addition, websites of national organisations (US Food and Drug Administration, National Cancer Institute, Centres for Disease Control and Prevention, American Dental Association, Office of Disease Prevention and Health Promotion, National Institute on Drug Abuse, Agency for Healthcare Research and Quality) were also searched. STUDY SELECTION: To achieve the objectives of the study, systematic reviews, controlled clinical trials, and observational studies published between October 2021 and February 2022 were considered. DATA EXTRACTION AND SYNTHESIS: This narrative review included articles which investigated the role of Dentistry professionals and their impact on smoking cessation and the effects resulting from tobacco use on oral health. RESULTS: The review revealed that smokers have a significantly higher likelihood of developing oral cancer (95% CI: 3.19-6.77) compared to non-smokers. Passive smokers also have an increased risk (1.51 times) of developing oral cancer (95% CI: 1.20-1.91). Additionally, smokers have an 80% increased risk of periodontitis (RR = 1.82; 95% CI: 1.43-2.31), an 85% worsened periodontal condition (RR = 1.85; 95% CI: 1.5-2.2), and a 36.6% increase in caries prevalence (OR = 1.84; 95% CI: 1.64-2.07). Smoking is also associated with a higher potential for dental implant failure in a dose-dependent manner. Brief educational interventions by the dental team resulted in a smoking cessation rate of 74/1000 individuals versus 27/1000 individuals in the control group. When combined with pharmacological therapy, these interventions may lead to an additional 50 to 70% increase in long-term smoking abstinence. CONCLUSIONS: Smoking is strongly linked to an increased risk of oral cancer, dental caries, implant failure, and periodontal disease. Dental teams play a vital role in identifying and addressing oral pathologies related to smoking and providing necessary care for smoking cessation. Brief educational interventions, either alone or in combination with pharmacotherapy, offer valuable approaches for the dental team to support smoking cessation. However, establishing a comprehensive training and continuing education program is crucial to integrate dental professionals into a multidisciplinary smoking cessation program.

Artificial intelligence and colon capsule endoscopy: Automatic detection of ulcers and erosions using a convolutional neural network.

BACKGROUND AND AIM: Colon capsule endoscopy (CCE) has become a minimally invasive alternative for conventional colonoscopy. Nevertheless, each CCE exam produces between 50 000 and 100 000 frames, making its analysis time-consuming and prone to errors. Convolutional neural networks (CNNs) are a type of artificial intelligence (AI) architecture with high performance in image analysis. This study aims to develop a CNN model for the identification of colonic ulcers and erosions in CCE images. METHODS: A CNN model was designed using a database of CCE images. A total of 124 CCE exams performed between 2010 and 2020 in two centers were reviewed. For CNN development, a total of 37 319 images were extracted, 33 749 showing normal colonic mucosa and 3570 showing colonic ulcers and erosions. Datasets for CNN training, validation, and testing were created. The performance of the algorithm was evaluated regarding its sensitivity, specificity, positive and negative predictive values, accuracy, and area under the curve. RESULTS: The network had a sensitivity of 96.9% and a specificity of 99.9% specific for the detection of colonic ulcers and erosions. The algorithm had an overall accuracy of 99.6%. The area under the curve was 1.00. The CNN had an image processing capacity of 90 frames per second. CONCLUSIONS: The developed algorithm is the first CNN-based model to accurately detect ulcers and erosions in CCE images, also providing a good image processing performance. The development of these AI systems may contribute to improve both the diagnostic and time efficiency of CCE exams, facilitating CCE adoption to routine clinical practice.

Capsule enteroscopy versus radionuclide scintigraphy for the diagnosis of obscure gastrointestinal bleeding.

BACKGROUND: capsule enteroscopy (CE) and 99mTc red blood cell (RBC) scintigraphy are frequently used in the investigation of obscure gastrointestinal bleeding (OGIB). There are few data comparing both diagnostic modalities. This study aimed to assess the performance of CE and scintigraphy for the diagnosis of OGIB. METHODS: patients who underwent CE and scintigraphy for OGIB were selected and analyzed retrospectively. The hemorrhagic potential of CE findings was rated using Saurin's classification. The concordance between both diagnostic techniques for bleeding detection and localization was analyzed. RESULTS: eighty-five patients (62 % female), with a median age of 63 years, were included in the study. Capsule enteroscopy identified 37 patients (43 %) with high hemorrhagic potential (P2) lesions. Most scintigraphy exams were positive for gastrointestinal bleeding (82 %). No concordance was found in the detection of lesions with hemorrhagic potential between CE and scintigraphy (kappa < 0). The distribution of P0, P1 and P2 findings was similar in patients with positive or negative scintigraphy (p = 0.526). There was no agreement regarding the location of P2 findings in CE and the bleeding detected by scintigraphy (kappa < 0). Patients with P2 lesions had significantly lower median levels of hemoglobin (p = 0.002) at presentation. No significant differences were found in hemoglobin values between patients with positive and negative scintigraphy (p = 0.058). CONCLUSION: significant diagnostic discrepancy was observed between CE and scintigraphy. The findings of CE correlated better with hemoglobin values at presentation than scintigraphy results. Therefore, scintigraphy does not appear to be useful in the diagnostic workup of OGIB.

Clinical and endoscopic findings in gastrointestinal amyloidosis: a single-center experience.

Gastrointestinal involvement occurs in approximately 4% of cases of systemic amyloidosis. The most common site of amyloid deposition is small bowel, followed by stomach, colorectum and esophagus. Although rare, gastrointestinal amyloidosis may be associated with severe complications including gastrointestinal bleeding or perforation and may be mistaken for malignancy.

Dairy versus other saturated fats source and cardiometabolic risk markers: Systematic review of randomized controlled trials.

To analyze the effects of dairy intake on cardiometabolic risk markers compared to other dietary fat sources in adults. Literature database and gray literature were searched for studies published up to October 2018. Two independent authors selected and extracted data from articles. Summary tables were constructed to present data for all outcomes. The intake of dairy appears to have a protective effect on some cardiovascular risk factors, or it is not worse than other SFA sources. The higher intake of dairy can decrease total cholesterol and reduce waist circumference and increase HDL cholesterol. However, it can also increase LDL and triglycerides, although those were small changes. It was observed that the effect of dairy on several serum lipids varied according to the type dairy product used on intervention. Dairy products seem to present a different effect on cardiometabolic risk factors than other fat sources, with evidence of improvement on metabolic parameters compared to another animal source of SFA.

Health risk behavior and cultural stress among Venezuelan youth: a person centered approach.

BACKGROUND: In recent years, more than 5 million Venezuelans have left their once prosperous country, with several hundred thousand settling in the United States (US). At present, our understanding of the health risk behavior profiles of Venezuelan émigré youth, and their links with cultural stress, remains limited. OBJECTIVES: Drawing from a sample of recently-immigrated Venezuelan youth in the US, we aim to identify subtypes of youth according to their involvement in health risk behaviors (i.e., substance use, sexual risk behavior, violence) and assess the associations between class membership and key constructs related to cultural stress theory (i.e., negative context of reception, family communication/support). METHOD: Latent profile analysis and multinomial regression were performed using data from a community-based convenience sample of 402 recently-arrived Venezuelan immigrant youth (ages 10-17; 56% male). RESULTS: We identified five subtype classes: (1) "Abstainer" (36%), (2) "Alcohol Only" (24%), (3) "Alcohol/Tobacco" (24%), (4) "Aggression" (8%), and (5) "Multidimensional Risk" (8%). Compared to Class #1, youth in Classes #3 and #5 reported significantly higher levels of negative context of reception and lower levels of family functioning while controlling for demographic factors. Youth in Class #5 reported the lowest levels of family economic hardship and the longest duration in the US. CONCLUSION: It is vital that we support both Venezuelan youth who abstain from risk behavior and, at the same time, develop and implement programs that target the needs of those who are at elevated risk for serious consequences related to substance use, sexual risk behavior, and violence.

A validation of the Perceived Negative Context of Reception Scale with recently-arrived Venezuelan immigrants in Colombia and the United States.

OBJECTIVES: Millions of Venezuelans have left their country in search of safety and stability in the United States (U.S.) and Colombia, two countries where recent increases in anti-immigrant rhetoric and sentiment have occurred. The Perceived Negative Context of Reception Scale captures the degree to which immigrants report feeling that people from their country are unwanted/marginalized within their new receiving context. In the present study, we examine the psychometric properties of the Perceived Negative Context of Reception Scale with recent Venezuelan immigrant adolescents and adults in the U.S. and Colombia. METHOD: We conducted confirmatory factor analysis using data from the Colombia and Miami's Newest Arrivals (CAMINAR) Study, which collected data from Venezuelan adults in Bogotá, Colombia, and South Florida in October-November 2017, and the Venezolanos en Nuevos Entornos (VENE) Youth Project which surveyed Venezuelan youth living in Florida between November 2018 and July 2019. RESULTS: We found that the negative context of reception evidenced strong psychometric properties among immigrants in both the U.S. and in Colombia, among adolescents and adults, and among male and female respondents. We also found that negative context of reception scores was associated with elevated scores on criterion-related factors-that is, perceived discrimination and depressive symptoms-in ways that are theoretically coherent and support measure validity. CONCLUSION: We provide new evidence that the Perceived Negative Context of Reception scale is reliable and valid for use with Venezuelan immigrants in the U.S. and Colombia. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Deep Learning and Device-Assisted Enteroscopy: Automatic Detection of Gastrointestinal Angioectasia.

Background and Objectives: Device-assisted enteroscopy (DAE) allows deep exploration of the small bowel and combines diagnostic and therapeutic capacities. Suspected mid-gastrointestinal bleeding is the most frequent indication for DAE, and vascular lesions, particularly angioectasia, are the most common etiology. Nevertheless, the diagnostic yield of DAE for the detection of these lesions is suboptimal. Deep learning algorithms have shown great potential for automatic detection of lesions in endoscopy. We aimed to develop an artificial intelligence (AI) model for the automatic detection of angioectasia DAE images. Materials and Methods: A convolutional neural network (CNN) was developed using DAE images. Each frame was labeled as normal/mucosa or angioectasia. The image dataset was split for the constitution of training and validation datasets. The latter was used for assessing the performance of the CNN. Results: A total of 72 DAE exams were included, and 6740 images were extracted (5345 of normal mucosa and 1395 of angioectasia). The model had a sensitivity of 88.5%, a specificity of 97.1% and an AUC of 0.988. The image processing speed was 6.4 ms/frame. Conclusions: The application of AI to DAE may have a significant impact on the management of patients with suspected mid-gastrointestinal bleeding.

Cultural Stress and Substance Use Risk among Venezuelan Migrant Youth in the United States.

BACKGROUND: Since 2015, more than four million Venezuelans have fled their once prosperous nation, prompting an ever-intensifying refugee crisis. Recent research with Venezuelan parents suggests that many are exposed to elevated migration-related stress, experience behavioral health problems, and express profound concern for their children's post-migration wellbeing. We examine the relationships between stress, family functioning, and substance use risk with a cultural stress theoretical lens. Methods: Survey data were collected between November 2018 and June 2019 from 402 recently-arrived Venezuelan immigrant youth ages 10-17. Outcomes include perceived discrimination, negative context of reception, family support/communication, and substance use intentions and normative beliefs. Structural equation modeling was used to examine the relationships between variables. Results: Structural equation modeling results indicated that negative context of reception was associated with permissive substance use norms (via family communication; B = 0.070, p < .01) and intentions to use (via family support; B = 0.051, p < .01). Discrimination was not mediated by family functioning, rather it exerted a direct effect on substance use norms (ß = 0.20, p < .01) and intentions (ß = 0.33, p < .001). Discussion: We see clear evidence that negative context of reception and discrimination are related to substance use risk, both directly (in the case of discrimination) and indirectly (in the case of negative context of reception). Given the manifold stressors faced by Venezuelan immigrants both prior to migration and in the process of resettling in the US, it is critical that practitioners and policymakers support this rapidly-growing population.

Docking Prediction, Antifungal Activity, Anti-Biofilm Effects on Candida spp., and Toxicity against Human Cells of Cinnamaldehyde.

OBJECTIVE: This study evaluated the antifungal activity of cinnamaldehyde on Candida spp. In vitro and in situ assays were carried out to test cinnamaldehyde for its anti-Candida effects, antibiofilm activity, effects on fungal micromorphology, antioxidant activity, and toxicity on keratinocytes and human erythrocytes. Statistical analysis was performed considering α = 5%. RESULTS: The minimum inhibitory concentration (MIC) and minimum fungicidal concentration (MFC) of cinnamaldehyde ranged from 18.91 µM to 37.83 µM. MIC values did not change in the presence of 0.8 M sorbitol, whereas an 8-fold increase was observed in the presence of ergosterol, suggesting that cinnamaldehyde may act on the cell membrane, which was subsequently confirmed by docking analysis. The action of cinnamaldehyde likely includes binding to enzymes involved in the formation of the cytoplasmic membrane in yeast cells. Cinnamaldehyde-treated microcultures showed impaired cellular development, with an expression of rare pseudo-hyphae and absence of chlamydoconidia. Cinnamaldehyde reduced biofilm adherence by 64.52% to 33.75% (p < 0.0001) at low concentrations (378.3-151.3 µM). Cinnamaldehyde did not show antioxidant properties. CONCLUSIONS: Cinnamaldehyde showed fungicidal activity through a mechanism of action likely related to ergosterol complexation; it was non-cytotoxic to keratinocytes and human erythrocytes and showed no antioxidant activity.

Small bowel enteroscopy - A joint clinical guideline by the Spanish and Portuguese small-bowel study groups.

The present evidence-based guidelines are focused on the use of device-assisted enteroscopy in the management of small-bowel diseases. A panel of experts selected by the Spanish and Portuguese small-bowel study groups reviewed the available evidence focusing on the main indications of this technique, its role in the management algorithm of each indication, and its diagnostic and therapeutic yield. A set of recommendations was issued accordingly.

Comparison of different histological indexes in the assessment of UC activity and their accuracy regarding endoscopic outcomes and faecal calprotectin levels.

OBJECTIVE: Histological remission is being increasingly acknowledged as a therapeutic endpoint in patients with UC. The work hereafter described aimed to evaluate the concordance between three histological classification systems-Geboes Score (GS), Nancy Index (NI) and RobartsHistopathologyIndex (RHI), as well as to evaluate their association with the endoscopic outcomes and the faecal calprotectin (FC) levels. DESIGN: Biopsy samples from 377 patients with UC were blindly evaluated using GS, NI and RHI. The results were compared with the patients' Mayo Endoscopic Score and FC levels. RESULT: GS, NI and RHI have a good concordance concerning the distinction between patients in histological remission or activity. RHI was particularly close to NI, with 100% of all patients classified as being in remission with NI being identified as such with RHI and 100% of all patients classified as having activity with RHI being identified as such with NI. These scores could also predict the Mayo Endoscopic Score and the FC levels, with their sensitivity and specificity levels depending on the chosen cut-offs. Moreover, higher FC levels were statistically associated with the presence of neutrophils in the epithelium, as well as with ulceration or erosion of the intestinal mucosa. CONCLUSIONS: GS, NI and RHI histopathological scoring systems are comparable in what concerns patients' stratification into histological remission/activity. Additionally, FC levels are increased when neutrophils are present in the epithelium and the intestinal mucosa has erosions or ulcers. The presence of neutrophils in the epithelium is, indeed, the main marker of histological activity.

Hepatic granulomas: a 17-year single tertiary centre experience.

AIMS: Hepatic granulomas have an estimated prevalence of 5% in liver biopsies, with a wide range of aetiologies globally. Our aim was to assess the clinical relevance, presenting features and underlying aetiology in a non-transplant, tertiary referral centre from a western country. METHODS AND RESULTS: This was a retrospective, single-centre review of clinical, laboratory and histological data including all adult patients for whom a liver biopsy was performed from January 1998 to December 2014. A total of 297 cases with hepatic granulomas were found in 9374 biopsies, but 57 were excluded from analysis either because they were lipogranulomas or the biopsy/aetiological work-up had not been performed at our institution. Overall, the most common aetiology was tuberculosis (35.8%), followed by primary biliary cholangitis (PBC) - 15.0%. In 30 patients (12.5%) granulomas were classified as idiopathic. From 1998 to June 2006 there were 147 granulomas in 5304 biopsies (2.8%), a frequency that did not change significantly compared to the period from July 2006 to December 2014 (93 granulomas in 4070 biopsies, 2.3%, P > 0.05). However, for the majority of cases (61.9%) there was a shift in granuloma aetiology during the former time-period that infectious diseases were responsible, whereas in the latter, autoimmune liver diseases (43%) were the main aetiology. In addition, while three cases of drug-induced granulomas were found from 1998 to June 2006, we report two cases in the second time-period. CONCLUSIONS: Hepatic granulomas can result from various infectious and non-infectious diseases. During recent years, an epidemiological shift regarding granuloma aetiology was observed, from systemic infectious diseases to non-infectious, mainly immune-mediated primary liver disorders. With an appropriate work-up the aetiology can be identified in the vast majority of cases (~90%), rendering its histological identification and characterisation essential, as disease-specific therapies are becoming available.