Evaluation of GALAD Score in Diagnosis and Follow-up of Hepatocellular Carcinoma after Local Ablative Therapy.

Background and Aims: Strategies for detection of early hepatocellular carcinoma (HCC) are still limited. The GALAD score is a serum biomarker-based model designed to predict the probability of having HCC. We aimed to assess the ability of GALAD score to diagnose early HCC and its validity to follow patients after local ablation therapy. Methods: This multicenter prospective study included 108 patients in two groups, 58 HCC patients (67 focal lesions) with local ablative therapy (study group), and a control group of 50 patients with liver cirrhosis. The GALAD scores of the study and control groups, and of the HCC patients before and after ablative therapy were compared. Results: Most patients were men (74.1% in study group and 76% in controls) with hepatitis C virus infection (98.30% in the study group, and 94% in controls). GALAD scores were significantly higher in HCC patients than in those with benign cirrhosis (2.65 vs. -0.37, p=0.001). Ablative therapy was successful in 94.4% of focal lesions <2 cm, and in 86.10% of 2-5 cm lesions. The GALAD score was also significantly lower at 1 month after ablation in patients with well-ablated tumors (2.19 vs. 0.98, p=0.001). The best cutoff values of GALAD score for diagnosis of early HCC, and for prediction of well ablation of HCC were 0.74 and ≤3.31 (areas under the curve of 0.92 and 0.75, sensitivities of 84.48% and 76.19%, specificities of 89.13% and 83.33%, positive predictive values of 90.74% and 94.1%, and negative predictive values of 82% and 35.7% respectively). Conclusion: The GALAD score was effective for the diagnosis of early HCC and for follow-up after ablative therapy.

Christmas article: The gastrointestinal surgeon's perspective on the dilemma between roast duck or roast pork for Christmas dinner ­ a multicenter study.

Introduction For many Danes, Christmas is a traditional celebration linked with food, and Christmas dinner might be the most important dinner of the year. Whether the correct meal includes roast pork or roast duck is a deeply personal question. Methods We asked all patients who were admitted to the surgical gastrointestinal emergency clinics of the Capital Region in Denmark on Christmas Eve and Christmas Night what they have had for Christmas dinner. Results A total of 30 patients presented to the hospital, and 17 of these were successfully included. 71% had eaten roast duck and 65% had eaten roast pork. This result was non-significant compared with the general Danish population tested with chi-square (p = 0.955). Conclusion We found no significance in the ingestion of roast duck and roast pork between patients at surgical gastrointestinal emergency clinics and the Danish background population. Funding none. Trial registration none.

Magnetic resonance imaging datasets with anatomical fiducials for quality control and registration.

Tools available for reproducible, quantitative assessment of brain correspondence have been limited. We previously validated the anatomical fiducial (AFID) placement protocol for point-based assessment of image registration with millimetric (mm) accuracy. In this data descriptor, we release curated AFID placements for some of the most commonly used structural magnetic resonance imaging datasets and templates. The release of our accurate placements allows for rapid quality control of image registration, teaching neuroanatomy, and clinical applications such as disease diagnosis and surgical targeting. We release placements on individual subjects from four datasets (N = 132 subjects for a total of 15,232 fiducials) and 14 brain templates (4,288 fiducials), totalling more than 300 human rater hours of annotation. We also validate human rater accuracy of released placements to be within 1 - 2 mm (using more than 45,000 Euclidean distances), consistent with prior studies. Our data is compliant with the Brain Imaging Data Structure allowing for facile incorporation into neuroimaging analysis pipelines.

Pedestrian flow characteristics through different angled bends: Exploring the spatial variation of velocity.

Common geometrical layouts could potentially be bottlenecks, particularly during emergency and high density situations. When pedestrians are interacting with such complex geometrical settings, the congestion effect might not be uniform over the bottleneck area. This study uses the trajectory data collected through a controlled laboratory experiment to explore the spatial variation of speeds when a group of people navigates through bends. Four turning angles, i.e., 45°, 90°, 135° and 180°, with a straight corridor and two speed levels, i.e., normal speed walking and slow running (jogging), were considered in these experiments. Results explained that the speeds are significantly different over the space within the bend for all angles (except 0°) under both speed levels. In particular, average walking speeds are significantly lower near the inner corner of the bend as compared to the outer corner. Further, such speed variations are magnified when the angle of the bend and desired speed increase. These outcomes indicate that even smaller turning angles, e.g., 45° could create bottlenecks near the inner corner of the bend, particularly when the walking speeds are high. The findings of this study could be useful in understanding the congestion and bottleneck effects associated with complex geometrical settings, and calibrating microscopic simulation tools to accurately reproduce such effects.

Effect of saccharides on secondary compounds production from stem derived callus of Datura inoxia.

Datura inoxia is a subshrub plant known for its toxicity which results from the presence of the tropane alkaloid scopolamine and hyoscyamine. Saccharides are one of the most important elicitors that can alter physiological and biochemical responses in plants. This study targeted to increase the production of secondary metabolites in Datura inoxia avoiding genetic alteration and processes using different nontoxic and biodegradable compounds, utilizing calli induced from Datura inoxia stems to observe the effects of mannitol and sorbitol on the production of the two major secondary metabolites, scopolamine and hyoscyamine. Methanolic extract of the whole plant and callus was used to examine the production of two secondary metabolites in Datura inoxia using HPLC in a qualitative and quantitative manner which revealed the increased production of scopolamine and hyoscyamine in calli. The addition of mannitol and sorbitol in the media had a negative effect on both the fresh and dry weight of the calli but production of scopolamine and hyoscyamine increased significantly. In-vitro anti-microbial assay of hyoscyamine against Escherichia coli ATCC25922 and Candida albicans resulted in total inhibition of both the microbes in concentrations as low as 200 µg/ml.

Application of the anatomical fiducials framework to a clinical dataset of patients with Parkinson's disease.

Establishing spatial correspondence between subject and template images is necessary in neuroimaging research and clinical applications such as brain mapping and stereotactic neurosurgery. Our anatomical fiducial (AFID) framework has recently been validated to serve as a quantitative measure of image registration based on salient anatomical features. In this study, we sought to apply the AFIDs protocol to the clinic, focusing on structural magnetic resonance images obtained from patients with Parkinson's disease (PD). We confirmed AFIDs could be placed to millimetric accuracy in the PD dataset with results comparable to those in normal control subjects. We evaluated subject-to-template registration using this framework by aligning the clinical scans to standard template space using a robust open preprocessing workflow. We found that registration errors measured using AFIDs were higher than previously reported, suggesting the need for optimization of image processing pipelines for clinical grade datasets. Finally, we examined the utility of using point-to-point distances between AFIDs as a morphometric biomarker of PD, finding evidence of reduced distances between AFIDs that circumscribe regions known to be affected in PD including the substantia nigra. Overall, we provide evidence that AFIDs can be successfully applied in a clinical setting and utilized to provide localized and quantitative measures of registration error. AFIDs provide clinicians and researchers with a common, open framework for quality control and validation of spatial correspondence and the location of anatomical structures, facilitating aggregation of imaging datasets and comparisons between various neurological conditions.

Deep Brain Stimulation of the Habenula: Systematic Review of the Literature and Clinical Trial Registries.

The habenula is a small bilateral epithalamic structure that plays a key role in the regulation of the main monoaminergic systems. It is implicated in many aspects of behavior such as reward processing, motivational behavior, behavioral adaptation, and sensory integration. A role of the habenula has been indicated in the pathophysiology of a number of neuropsychiatric disorders such as depression, addiction, obsessive-compulsive disorder, and bipolar disorder. Neuromodulation of the habenula using deep brain stimulation (DBS) as potential treatment has been proposed and a first successful case of habenula DBS was reported a decade ago. To provide an overview of the current state of habenula DBS in human subjects for the treatment of neuropsychiatric disorders we conducted a systematic review of both the published literature using PUBMED and current and past registered clinical trials using ClinicalTrials.gov as well as the International Clinical Trials Registry Platform. Using PRISMA guidelines five articles and five registered clinical trials were identified. The published articles detailed the results of habenula DBS for the treatment of schizophrenia, depression, obsessive-compulsive disorder, and bipolar disorder. Four are single case studies; one reports findings in two patients and positive clinical outcome is described in five of the six patients. Of the five registered clinical trials identified, four investigate habenula DBS for the treatment of depression and one for obsessive-compulsive disorder. One trial is listed as terminated, one is recruiting, two are not yet recruiting and the status of the fifth is unknown. The planned enrollment varies between 2 to 13 subjects and four of the five are open label trials. While the published studies suggest a potential role of habenula DBS for a number of indications, future trials and studies are necessary. The outcomes of the ongoing clinical trials will provide further valuable insights. Establishing habenula DBS, however, will depend on successful randomized clinical trials to confirm application and clinical benefit of this promising intervention.

A literature review of magnetic resonance imaging sequence advancements in visualizing functional neurosurgery targets.

OBJECTIVE: Historically, preoperative planning for functional neurosurgery has depended on the indirect localization of target brain structures using visible anatomical landmarks. However, recent technological advances in neuroimaging have permitted marked improvements in MRI-based direct target visualization, allowing for refinement of "first-pass" targeting. The authors reviewed studies relating to direct MRI visualization of the most common functional neurosurgery targets (subthalamic nucleus, globus pallidus, and thalamus) and summarize sequence specifications for the various approaches described in this literature. METHODS: The peer-reviewed literature on MRI visualization of the subthalamic nucleus, globus pallidus, and thalamus was obtained by searching MEDLINE. Publications examining direct MRI visualization of these deep brain stimulation targets were included for review. RESULTS: A variety of specialized sequences and postprocessing methods for enhanced MRI visualization are in current use. These include susceptibility-based techniques such as quantitative susceptibility mapping, which exploit the amount of tissue iron in target structures, and white matter attenuated inversion recovery, which suppresses the signal from white matter to improve the distinction between gray matter nuclei. However, evidence confirming the superiority of these sequences over indirect targeting with respect to clinical outcome is sparse. Future targeting may utilize information about functional and structural networks, necessitating the use of resting-state functional MRI and diffusion-weighted imaging. CONCLUSIONS: Specialized MRI sequences have enabled considerable improvement in the visualization of common deep brain stimulation targets. With further validation of their ability to improve clinical outcomes and advances in imaging techniques, direct visualization of targets may play an increasingly important role in preoperative planning.

Efficacy and safety of a novel pegylated interferon alpha-2a in Egyptian patients with genotype 4 chronic hepatitis C.

BACKGROUND: Hepatitis C virus (HCV) genotype 4 is a common infection in Egypt and is the leading cause of liver disease. OBJECTIVE: To study the efficacy and safety of a novel 20 kD pegylated interferon alpha-2a derived from Hansenula polymorpha in combination with ribavirin for the treatment of Egyptian patients with genotype 4 chronic hepatitis C (CHC). METHODS: One hundred seven patients with genotype 4 CHC were involved in the present study. Liver biopsy was performed in all patients. All patients received a fixed weekly dose of 160 µg of a novel pegylated interferon in combination with ribavirin in standard and adjusted doses. Serum HCV RNA levels were assessed by a real-time sensitive polymerase chain reaction assay at four, 12, 48 and 72 weeks after the start of therapy. Patients demonstrating an early virological response (EVR) completed a 48-week course of treatment. RESULTS: The overall sustained virological response (SVR) was 60.7%. The SVR in patients with a rapid virological response was significantly higher (91.7%) than in patients with complete EVR (67.74%) (P=0.033) and partial EVR (56.14%) (P=0.003). SVR was also significantly higher in patients with a low degree of liver fibrosis according to Metavir score (F1 and F2) (67.57%) compared with those with a high degree of liver fibrosis (F3 and F4) (45.45%) (P=0.017). The baseline viral load had no impact on SVR in the present series nor were any serious adverse events reported. CONCLUSION: The novel pegylated interferon alpha-2a assessed in the present study was effective for the treatment of patients with genotype 4 CHC, and was safe and well tolerated.

A multivariate data analysis approach for investigating daily statistics of countries affected with COVID-19 pandemic.

BACKGROUND: To understand the impact and volume of coronavirus (COVID-19) crisis, univariate analysis is tedious for describing the datasets reported daily. However, to capture the full picture and be able to compare situations and consequences for different countries, multivariate analytical models are suggested in order to visualize and compare the situation of different countries more accurately and precisely. AIMS: We aimed to utilize data analysis tools that display the relative positions of data points in fewer dimensions while keeping the variation of the original data set as much as possible, and cluster countries according to their scores on the formed dimensions. METHODS: Principal component analysis (PCA) and Partitioning around medoids (PAM) clustering algorithms were used to analyze data of 56 countries, 82 countries and 91 countries with COVID-19 at three time points, eligible countries included in the analysis are those with total cases of 500 or more with no missing data. RESULTS: After performing PCA, we generated two scores: Disease Magnitude score that represents total cases, total deaths, total actives cases, and critically ill cases, and Mortality Recovery Ratio score that represents the ratio between total deaths to total recoveries in any given country. CONCLUSION: Accurate multivariate analyses can be of great value as they can simplify difficult concepts, explore and communicate findings from health datasets, and support the decision-making process.

Prepyloric gastric inflammatory fibroid polyp presenting as chronic epigastric discomfort in a 5th decade aged female: A case report.

INTRODUCTION: Inflammatory fibroid polyps is a rare entity that mostly occur in the stomach. Gastric type is usually asymptomatic or may show nonspecific symptoms. Diagnosis is mainly postoperative with limited roles of usual diagnostic techniques. PRESENTATION OF CASE: A 42 years old healthy female presenting with chronic symptoms for epigastric discomfort and mild nausea. Labs showed mild anemia. A gastric lesion was detected by Endoscopy and being studied by echo-endoscopy and needle aspirate. Gastric Inflammatory fibroid polyp was diagnosed after distal gastrectomy by histopathology and immunohistochemistry. CONCLUSION: Gastric inflammatory fibroid polyp is a preoperative diagnostic challenge of unclear pathogenesis. Histopathology and immunohistochemistry are the gold standard. Studies around this exact pathology are required for better management and prevention.

Complicated Gastric Duplication Cyst in an Adult Patient: Uncommon presentation of an uncommon disease.

Gastric duplication cyst is a very rare congenital anomaly accounting up to 4% of all gastrointestinal tract duplications. It is a quite rare anomaly in adults, the majority of the cases are diagnosed in the neonatal period. Gastric duplication cysts are usually asymptomatic or they do present with non-specific symptoms. They are usually discovered incidentally during endoscopy or laparotomy or very rarely after getting complicated. We describe herein, along with literature review, a case of an adult patient who presented with abdominal pain and bloody vomiting and turned out to have a gastric duplication cyst complicated by internal bleeding.

How to treat intestinal obstruction due to malignant recurrence after Whipple's resection for pancreatic head cancer: Description of 2 new endoscopic techniques.

The prognosis of pancreatic cancer remains poor, even after initial surgical therapy. Local recurrence after Whipple's pancreatico-duodenectomy may lead to intestinal obstruction at the level of the afferent limb or the alimentary limb. Endoscopic insertion of a self-expandable metal stent (SEMS) into the intestinal malignant stricture is the preferred method of choice for palliation. We describe two new endoscopic techniques to treat a malignant intestinal obstruction with the insertion of a SEMS into the afferent limb and the alimentary limb. A case of malignant gastric outlet obstruction after a Whipple's resection was treated by the creation of an endoscopic gastrojejunostomy by the insertion of a lumen apposing HotAxios stent in between the stomach and the alimentary limb under fluoroscopic and endoscopic ultrasound control. Biliary obstruction and jaundice caused by a malignant stricture of the afferent limb after a Roux-en-Y Whipple's resection was treated by the insertion of a SEMS by means of the single-balloon overtube-assisted technique under fluoroscopic control. Feasibility and advantages of both techniques are discussed.

Acute pancreatitis caused by intragastric balloon: A case report.

Obesity represents a global hazard that predisposes to many serious health problems. Various solutions have been proposed to overcome obesity ranging from dietary balance to bariatric surgery. Intragastric balloons are a widely used measure to decrease weight, although they are advocated as safe devices, some major complications have been reported. We report a case of acute pancreatitis after insertion of a gastric balloon for weight reduction. Abdominal pain associated with nausea and vomiting maybe due to acute pancreatitis caused by compression of the pancreas by the balloon. It is advisable that physicians recognise these complications early to avoid serious and severe end-results.

Therapeutic enteroscopy using a new single-balloon enteroscope: a case series.

BACKGROUND AND STUDY AIMS: Balloon-assisted enteroscopy allows therapeutic intervention in the small bowel, and even of the biliopancreatic system in patients with altered anatomy. However, the conventional single-balloon enteroscope (SBE) has limited therapeutic use because of its small-caliber working channel and the lack of an additional water jet channel. The new single-balloon enteroscope prototype XSIF-180JY has been developed to overcome these problems. We present experience with use of the new SBE prototype during 14 therapeutic endoscopy procedures, which illustrates its advantages. PATIENTS AND METHODS: During a 2-month period, 16 SBE procedures were performed (2 antegrade, 2 retrograde and 12 ERCP procedures) using the XSIF-180JY prototype, 14 of which were done with therapeutic intent. RESULTS: The XSIF-180JY SBE allowed deep enteroscopy with balloon dilation and multiple intestinal polypectomies. Moreover, 14 ERCP procedures were successfully performed in 12 patients with Roux-en-Y altered anatomy. Sphincterotomy, balloon dilation, stone extraction and 7 Fr plastic stent placement were performed through the 3.2-mm working channel. The additional water jet was useful for flushing away stone fragments from the intrahepatic bile ducts and the retrieval basket and for flushing away blood from a bleeding sphincterotomy. No complications related to the enteroscope were encountered. CONCLUSIONS: The new therapeutic XSIF-180JY SBE permitted therapeutic enteroscopy and ERCP through its 3.2-mm working channel and the additional water jet channel proved useful in flushing away biliary stones and blood without the need to clear the working channel. This newly developed SBE has the advantage of a larger working channel and an additional water jet, improving therapeutic enteroscopy.

Possible carcinogenic potential of dimethyl dimethoxy biphenyl dicarboxylate in experimental animals.

Dimethyl dimethoxy biphenyl dicarboxylate (DDB) has been extensively used in the treatment of liver diseases accounting for 1-6% of the global disease burden. Cell replication, DNA synthesis, and proliferation, providing significant information about behavior of cells were examined in mice exposed to subchronic administration with DDB. Conventional liver functions specifically gamma-glutamyltransferase (γ-GT), a marker expressing liver canceration was also investigated. Normal mice were allocated into two groups each of 10 mice. The 1(st) and 2(nd) groups were treated with DDB in a dose of 50 mg/kg/day, 5 days/week for 1 month and 3 months, respectively. Comparable groups of normal mice were left without treatment as controls. Compared to normal control group, animals receiving DDB for 3 months showed marked elevations of both alanine aminotransferase and γ-GT, significant inhibition in cytochrome P450, a significant increase in the mean ploidy and 4C with moderate to marked increase in S-phase populations and the number of proliferating cell nuclear antigen-positive cells. In conclusion, this is the first report on the potential relationship between the subchronic administration of DDB and the increase in the hepatocyte proliferation, cell replication and DNA synthesis that may raise an alarm regarding possible DDB insult on the biological behavior of cells.

Insulin resistance: a major factor associated with significant liver fibrosis in Egyptian patients with genotype 4 chronic hepatitis C.

BACKGROUND AND AIMS: The role of insulin resistance (IR) in chronic hepatitis C genotype 4 (CHC-4) patients is still under assessment. The aims of this study are to assess the prevalence and predictors of IR and its influence along with clinical, metabolic, virological, and histological factors on the severity of liver fibrosis in 100 Egyptian patients with CHC-4. PATIENTS AND METHODS: In 100 untreated patients with CHC-4, IR was assessed using the Homeostasis Model Assessment and defined greater than 3. By logistic regression (LR), independent factors associated with IR and significant fibrosis (SF=fibrosis, Metavir score≥F2) were assessed in nondiabetic and noncirrhotic patients. RESULTS: One hundred patients were included; 54% were men and 46% were women. The mean age of the patients was 40.46±9.41 years. Of the total patients, 55% were overweight and 28% were obese. Metabolic syndrome was observed in 26% of patients; five of them were known to be diabetic. All patients were genotype 4. Most of our patients had mild viremia (<2 00 000 IU/ml), whereas only 16% had higher viral load (>2 00 000 IU/ml). There was no correlation between IR and hepatitis C virus viremia (r=-0.069; P=0.492). Necroinflammation was moderate-severe (A2-A3) in 25% of patients. SF (F2-F4) was found in 46% of patients and 11% had cirrhosis (F4). Most of our patients, 54%, had moderate steatosis and 21% had severe steatosis. IR was present in 46% of patients; 39 (42.9%) were nondiabetic, which is correlated significantly with BMI (r=0.395; P<0.01). IR was found to increase significantly with the fibrosis stage (P=0.001), insignificant fibrosis, 18.5%, SF (F2-F4), 71.4%, and cirrhosis (F4), 100%. By LR, IR was independently and significantly associated with age more than 40 years, obesity (BMI>30 kg/m), SF, and severe steatosis (>30%). IR was also significantly associated with metabolic syndrome. SF was present in 46 patients (46%). It was associated with IR, moderate-severe necroinflammation, and severe steatosis. By LR, in noncirrhotic patients, SF was associated with age more than 40 years, obesity (BMI>30 kg/m), moderate/severe liver inflammation, and severe steatosis. CONCLUSION: In CHC-4 patients, IR is highly prevalent and independently associated with age, obesity, SF, and severe steatosis. Management of IR might significantly improve the prognosis of CHC-4 patients.

One for the road! A study to assess the efficacy of single low-dose regimen of rasburicase in controlling hyperuricaemia in patients with tumour lysis syndrome due to haematological malignancies.

We conducted a retrospective audit of six patients with various haematological malignancies (two acute lymphoblastic leukaemia, one acute myeloid leukaemia, and three non-Hodgkin lymphoma); these patients were eligible to receive rasburicase, being at high risk of development of tumour lysis syndrome (TLS). They received a fixed single low-dose regimen of rasburicase (7.5 mg) mainly due to financial restriction, as patients were not supported by the National Health Service and did not have health insurance. We compared uric acid, creatinine levels, and electrolytes (i.e. phosphate, potassium, and calcium) before and after rasburicase administration and also assessed the need for renal replacement therapy after treatment. All six patients had a significant reduction in uric acid levels on the first day, achieving a response rate of 100% (p = 0.008994); creatinine, phosphate, and potassium were reduced significantly as well, with the p values of 0.0439, 0.014326, and 0.002008, respectively; only one patient needed renal replacement therapy in the form of haemodialysis, due to concerns about hyperphosphataemia. Financial difficulties faced either because patients lacked insurance or because of the restricted National Health Service budget in Egypt have resulted in the unavailability of certain modalities of treatment in cancer care and the need to consider more economic yet efficient approaches. Our experience suggests that a single low-dose rasburicase injection (7.5 mg) is an efficient and cost-effective method to control hyperuricaemia in patients with a high risk of developing TLS when compared with the more expensive and extended standard regimen and doses recommended.