Efficacy and Safety of Argon Plasma Coagulation for the Ablation of Barrett's Esophagus: A Systemic Review and Meta-Analysis.

Background/Aims: Argon plasma coagulation (APC) is an alternate ablative method to radiofrequency ablation for the treatment of Barrett's esophagus (BE), and it is preferred due to its lower cost and widespread availability. The present meta-analysis aimed to analyze the safety and efficacy of APC for the management of BE. Methods: A literature search from January 2000 to November 2022 was done for studies analyzing the outcome of APC in BE. The primary outcomes were clearance rate of intestinal metaplasia and adverse events (AE). Pooled event rates were expressed with summative statistics. Results: A total of 38 studies were included in the final analysis. The pooled event rate for clearance rate of intestinal metaplasia with APC in BE was 86.8% (95% confidence interval [CI], 83.5% to 90.2%), with high-power and hybrid APC having a higher rate compared to standard APC. The pooled incidence of AE with APC in BE was 22.5% (95% CI, 15.3% to 29.7%), without any significant difference between the subgroups, with self-limited chest pain being the commonest AE. The incidence of serious AE was only 0.4% (95% CI, 0.0% to 1.0%), while stricture development was seen only in 1.7% (95% CI, 0.9% to 2.6%) of cases. The pooled recurrence rate of BE was 16.1% (95% CI, 10.7% to 21.6%), with a significantly lower recurrence with high-power APC than standard APC. Conclusions: High-power and hybrid APC seem to have an advantage over standard APC in terms of clearance rate and recurrence rate. Further studies are required to compare the efficacy and safety of hybrid APC with standard APC and radiofrequency ablation.

Use of Balloon Occluded Retrograde Transvenous Obliteration (BRTO) for Treatment of Gastric Varices: A Narrative Review.

Gastric Varices occur as a result of portal hypertension. Balloon Retrograde Transvenous Obliteration (BRTO) is a modality for managing gastric varices. The ultimate goal of this review is to promote the broader adoption of BRTO in managing gastric varices and to promote further research to improve patient outcomes. Before this study, an electronic literature search was undertaken based on identified concepts, keywords, and other pertinent descriptions. Search databases were developed and included "Gastric varices" AND "BRTO" OR "intervention" OR "treatment" OR "procedure" OR "glue" OR "adhesive".  The databases selected and thoroughly searched were PubMed, Cochrane Library and ScienceDirect. Following the first search, 274 articles were found in total. By applying inclusion criteria of full-text articles and a period of fewer than five years, the database was reduced to 37 articles, which was then further filtered to include only articles on adults over 19 years old, leaving a total count of 17 articles. BRTO is a relatively simple procedure to perform once the essential skill is attained and helpful in both emergency and elective management of gastric varices. Its use still needs to be improved by the unavailability and lack of skills. However, there are side effects associated with BRTO as it causes elevation of portal hypertension, recurrent bleeding, hemoglobinuria and pain post procedure. This review emphasizes the need for further research in this field, focusing on refining patient selection criteria, improving the technical aspect of the procedure and enhancing long-term outcomes.

Assessment of Automating Safety Surveillance From Electronic Health Records: Analysis for the Quality and Safety Review System.

BACKGROUND AND OBJECTIVES: In an effort to improve and standardize the collection of adverse event data, the Agency for Healthcare Research and Quality is developing and testing a patient safety surveillance system called the Quality and Safety Review System (QSRS). Its current abstraction from medical records is through manual human coders, taking an average of 75 minutes to complete the review and abstraction tasks for one patient record. With many healthcare systems across the country adopting electronic health record (EHR) technology, there is tremendous potential for more efficient abstraction by automatically populating QSRS. In the absence of real-world testing data and models, which require a substantial investment, we provide a heuristic assessment of the feasibility of automatically populating QSRS questions from EHR data. METHODS: To provide an assessment of the automation feasibility for QSRS, we first developed a heuristic framework, the Relative Abstraction Complexity Framework, to assess relative complexity of data abstraction questions. This framework assesses the relative complexity of characteristics or features of abstraction questions that should be considered when determining the feasibility of automating QSRS. Questions are assigned a final relative complexity score (RCS) of low, medium, or high by a team of clinicians, human factors, and natural language processing researchers. RESULTS: One hundred thirty-four QSRS questions were coded using this framework by a team of natural language processing and clinical experts. Fifty-five questions (41%) had high RCS and would be more difficult to automate, such as "Was use of a device associated with an adverse outcome(s)?" Forty-two questions (31%) had medium RCS, such as "Were there any injuries as a result of the fall(s)?" and 37 questions (28%) had low RCS, such as "Did the patient deliver during this stay?" These results suggest that Blood and Hospital Acquired Infections-Clostridium Difficile Infection (HAI-CDI) modules would be relatively easier to automate, whereas Surgery and HAI-Surgical Site Infection would be more difficult to automate. CONCLUSIONS: Although EHRs contain a wealth of information, abstracting information from these records is still very challenging, particularly for complex questions, such as those concerning patient adverse events. In this work, we developed a heuristic framework, which can be applied to help guide conversations around the feasibility of automating QSRS data abstraction. This framework does not aim to replace testing with real data but complement the process by providing initial guidance and direction to subject matter experts to help prioritize, which abstraction questions to test for feasibility using real data.

Inhibition of amyloid fibril formation of lysozyme by ascorbic acid and a probable mechanism of action.

Amyloid fibrillation of proteins and polypeptides and their deposition in cells and tissues is associated with a number of pathological states collectively known as amyloid disorders. Inhibition of protein misfolding and aggregation is thus of utmost importance in the prevention and treatment of such diseases. There is a growing interest in identification of small molecules that can bind to native monomeric proteins or their partially unfolded states, thereby stabilizing them and preventing or delaying them from undergoing amyloid fibril formation. Here we report the inhibitory effect of ascorbic acid, an essential dietary component richly present in many natural food items, on the amyloid fibrillation of hen egg white lysozyme, a model protein for amyloid formation. The effect was dose dependent with more than 80% inhibition occurring even at only a five-fold molar excess of ascorbic acid. TEM images show complete absence of fibrils in the presence of ascorbic acid. From our spectroscopic and computational characterization of ascorbic acid binding to HEWL, we propose that ascorbic acid binds to the aggregation prone beta domain of HEWL, stabilizes the partially unfolded conformation and prevents further conformational changes leading to fibrillation. Hence ascorbic acid has a great therapeutic potential for amyloid disorders.