bluuebunny/crossref_metadata_2025_split huggingface dataset:
Short-term clinical outcomes of non-curative endoscopic submucosal dissection for early esophageal adenocarcinoma
Authors: Othman Mohamed O , Bahdi Firas , Ahmed Yahya , Gagneja Harish , Andrawes Sherif , Groth Shawn , Dhingra Sadhna 
Published: June 2021

Objectives
Few Western studies highlighted the outcomes of endoscopic submucosal dissection (ESD) for early esophageal adenocarcinoma (EAC). Data regarding the outcomes of noncurative ESDs remains scarce. In this study, we share our experience with ESD for early EAC with a focus on noncurative ESDs.

Methods
A retrospective single-center analysis of consecutive patients who underwent ESD for early EAC from August 2015 through February 2020. Primary outcomes included the clinical outcomes of noncurative ESDs along with overall en bloc, R0 and curative resection rates. Secondary outcomes included comparing results between T1a and T1b tumors.

Results
Final group included 23 T1a and 17 T1b EAC patients. Patients’ median Charlson comorbidity index was five. En bloc resection rate was (97.5%). Compared to the T1b group, the T1a group had a statistically significantly higher R0 (78.3 vs. 41.2%; P = 0.0235), curative (73.9 vs. 11.8%; P = 0.0001) and accumulative endoscopic curative resection rates (82.6 vs. 23.5%; P = 0.0003). A study flowchart is presented in (Fig. 1). Out of the 21 noncurative ESDs, 10 patients (47.6%) underwent R0 esophagectomy, 6 patients (28.6%) are undergoing surveillance endoscopies without additional therapy, 3 patients (14.3%) underwent repeat curative ESD and 1 patient (4.76%) is receiving chemotherapy with surveillance endoscopy. Over median endoscopic follow-up of 22.5 months (IQR, 14.25–30.75), 2 out of 10 patients with noncurative ESDs had recurrent disease.

Conclusions:
ESD achieved a higher curative resection rate in T1a EAC when compared to T1b. Despite a lower curative resection rate in T1b EAC, certain patients might benefit from a conservative multimodal therapy.
Advancing flexible endoscopy to natural orifice transluminal endoscopic surgery
Authors: Ullah Saif , Ali Faisal S. , Liu Bing-Rong 
Published: June 2021

Purpose of review
This review is an update on the recent advancements and clinical applications of flexible endoscopy in the context of natural orifice translumenal endoscopic surgery (NOTES). We focus on recent developments in gastrointestinal luminal and transluminal NOTES.

Recent findings
NOTES has evolved from a hybrid approach utilizing a laparoscopic assistant to pure NOTES without laparoscopic assistance. Current experimental and clinical studies focus on the implementation of new minimally invasive approaches as well as on the training in the use of these procedures. In recent years, flexible endoscopic-NOTES and endoluminal surgery have increasingly reported favorable results in preclinical and experimental settings using flexible endoscopic cholecystectomy, cholecystolithotomy, and appendectomy. Additionally, flexible endoscopic lymphadenectomy and thyroidectomy are among the new interventions that are opening new frontiers for endoscopists to explore.

Summary
Flexible endoscopy has paved way to new frontiers for endoscopists and surgeons. As the armamentarium of interventional endoscopy increases and the ability of endoscopists to perform advanced interventions safely fosters an inevitable step forward that will involve the integration of new technology with innovative thinking.
Interventional endoscopic ultrasound
Authors: Dietrich Christoph F. , Braden Barbara , Jenssen Christian 
Published: June 2021

Purpose of review
To update on recent advances in interventional endoscopic ultrasound (INVEUS) techniques.

Recent findings
The introduction of linear echoendoscopes with larger instrument channels and the combined development of new tools and devices have enabled various new applications of minimally invasive endoscopic ultrasound (EUS)-guided transluminal interventions of the pancreas, biliary system and peri-gastrointestinal structures. In this review, EUS-guided interventions are discussed and evaluated: drainage of peripancreatic fluid collections, access and drainage of bile ducts, gallbladder and pancreatic duct, treatment of gastrointestinal haemorrhage, coeliac plexus block and coeliac plexus neurolysis, fiducial placement, solid and cystic tumour ablation, drug delivery and brachytherapy, gastroenterostomy, angiotherapy and other EUS-guided applications. The EUS-guided interventions are classified based on the available evidence as established or experimental, standardized or nonstandardized procedures in common or rare diseases with well or little known complications and their established or nonestablished treatment.

Summary
Some EUS-guided interventions have sparse published evidence with only single-centre studies, case series or individual case reports, others like drainage of peripancreatic fluid collections have become widely accepted practice. INVEUS has been accepted as an alternative to several surgical approaches, EUS-guided techniques result in faster recovery times, shorter hospital stay and lower costs.
Iron Balance and Iron Nutritional Status in Preterm Infants During the First Four Months of Life
Authors: Cooke Richard J. , Griffin Ian 
Published: June 2021

ABSTRACT

Objectives:
To determine whether iron absorption occurs in a dose-dependent fashion and/or is a function of iron nutritional status (INS) in preterm infants during the first 4 months of life.

Methods:
Preterm very-low-birth-weight infants (VLBWI) were fed an iron-fortified (0.7 mg/dL) infant formula. Three 48 h balance studies were performed on each infant. INS was determined by serially measuring hemoglobin, mean corpuscular volume (MCV), hematocrit, ferritin, transferrin and transferrin saturation levels. The data were analyzed using ANOVA and stepwise regression.

Results:
Fifty-four balance studies were performed in 18 infants (birth weight, 1347 ± 201 g; gestation, 30 ± 1.3 weeks; mean ± standard deviation) at 33 ± 1.3, 34 ± 1.2, and 48 ± 0.5 weeks corrected age and weights of 1768 ± 260, 2298 ± 314, 5127 ± 939 g. No relationship was detected between iron intake and absorption. Intake decreased during the study (1.17 ± .08, 1.24 ± 0.11 > 1.1 ± 0.15 mg · kg−1 · day−1) but net (0.32 ± 0.26, 0.36 ± 31 < 0.49 ± .23 mg · kg−1 · day−1) and % (27 ± 22, 29 ± 23 < 46 ± 21) absorption increased (P < 0.01). Serum ferritin, transferrin saturation and MCV fell, while hematocrit and hemoglobin remained stable. No relationship was noted between serum ferritin and iron absorption but transferrin saturation (54%), MCV (7%), and hematocrit (6%) accounted for 67% of the variation in iron absorption (P < 0.001).

Conclusions:
At intakes of 0.8–1.4  mg · kg−1 · day−1, iron absorption is not dose-dependent nor affected by iron stores. Only when iron delivery to the tissues decreases does absorption increase to meet needs in these otherwise normal and rapidly growing infants.
Neutrophil to Lymphocyte Ratio and Gastrointestinal Involvement Among Henoch Schonlein Purpura Patients: A Systematic Review and Meta-Analysis
Authors: Milas Gerasimos Panagiotis , Fragkos Stefanos 
Published: June 2021

ABSTRACT
Neutrophil to lymphocyte ratio has been examined among several studies regarding Henoch Schonlein purpura patients with gastrointestinal involvement. The current meta-analysis aims to evaluate neutrophil to lymphocyte ratio differences between Henoch Schonlein purpura patients with and without gastrointestinal manifestations.
An extensive search of the available literature was done using MEDLINE (1966–2020), Clinicaltrials.gov (2008–2020), Cochrane Central Register of Controlled Trials (CENTRAL) (1999–2020) and Google Scholar (2004–2020) databases and statistical analysis was mainly conducted using RevMan 5.3 software.
The current meta-analysis is based on data from six studies. Neutrophil to lymphocyte ratio was higher in Henoch Schonlein patients with gastrointestinal involvement than those without with a mean difference of 0.88 (95% confidence interval [CI]: 0.55, 1.22 [P < 10–5, I
2 = 8%]). Low heterogeneity (I
2) was observed between the included studies. Subgroup analysis, leave one out meta-analysis and meta-regression analysis were performed which led to the lowering of I
2 to 0.
The findings of our meta-analysis suggest that the neutrophil to lymphocyte ratio could serve as a marker of gastrointestinal involvement in patients with Henoch Schonlein purpura; however, most of the included studies are case–control, therefore future cohort studies should clarify the value of this marker.
The Modified Bristol Stool Form Scale
Authors: Wegh Carrie A.M. , Hermes Gerben D.A. , Schoterman Margriet H.C. , Vaughan Elaine E. , Smidt Hauke , Belzer Clara , Benninga Marc A. 
Published: June 2021

ABSTRACTObjective:The aim of the study was to assess whether the modified Bristol Stool Form Scale (m‐BSFS) is reliable, valid and user‐friendly to use by parents, grandparents, and day childcare employees to evaluate stool consistency in toilet and nontoilet‐trained toddlers in the Netherlands.Study design:Translation to Dutch and validity of the m‐BSFS (scoring 32 general stool pictures) for 1 to 3 year old toddlers (n = 89) was evaluated by parents, grandparents, and day childcare employees. A subgroup of participants scored an additional 7 pictures of stools in a diaper to validate the m‐BSFS for non‐toilet‐trained toddlers (n = 16). To determine inter‐rater reliability, 2‐way random effects single‐rater intraclass correlation coefficient (ICC)consistency was used. Intra‐rater reliability was measured by Cohen kappa (κ) by rating the same pictures in random order twice, with at least 1 week between the first and second scoring.Results:Inter‐ and intra‐rater reliability of the m‐BSFS were above recommended minimal standards of 0.61 for the 32 general stool pictures as well as for the 7 pictures of stools in a diaper. ICCconsistency for the general stool pictures of the first and second ratings were 0.71 (n = 89) and 0.79 (n = 77), respectively, with a κ of 0.71 (n = 77). ICCconsistency for the stools in diaper pictures of the first and second ratings were 0.93 (n = 16) and 0.93 (n = 15), respectively, with a κ of 0.77 (n = 15).Conclusions:The m‐BSFS is reliable, valid and user‐friendly to use by Dutch‐speaking parents, grandparents, and day childcare workers to evaluate stool consistency in both toilet‐ and nontoilet‐trained toddlers in the Netherlands.
Comparison of Symptom Control in Pediatric Gastroparesis Using Endoscopic Pyloric Botulinum Toxin Injection and Dilatation
Authors: Mercier Clémence , Ley Delphine , Aumar Madeleine , Lemale Julie , Fabre Alexandre , Colinet Stéphanie , Duhamel Alain , Gottrand Frédéric 
Published: June 2021

ABSTRACT

Objectives:
The objective of this study was to assess the tolerance and efficacy of endoscopic intrapyloric botulinum toxin injection compared with pyloric dilatation in children with gastroparesis.

Methods:
This was a retrospective descriptive multicentre study that included pediatric patients treated between 2010 and 2018 at 4 tertiary hospitals.

Results:
Data were collected for 24 patients. The median age at diagnosis was 2.5 years (range 0.5–4.7). A total of 46 endoscopic procedures were performed. The endoscopic procedure was multiple in 63% of patients. Among the interventions, 76% were successful and 15% were unsuccessful. The recurrence rate was 57% and the median time to recurrence was 3.7 months (0.1–73). The efficacy did not differ significantly between the 2 methods at the first intervention and as a second-line treatment. The recurrence rate also did not differ significantly between the 2 methods. No complications were reported. The median follow-up was 19.8 months (1.7–61.7).

Conclusions:
In this retrospective multicentre study, endoscopic management of gastroparesis by balloon dilatation or botulinum toxin was safe in children and seemed to be partially efficient within the first months. Symptoms recurred frequently and required repetition of the interventions.
Epstein-Barr Virus Status and Subsequent Thiopurine Exposure Within a Paediatric Inflammatory Bowel Disease Population
Authors: Harris Rachel E. , Hegde Vikas , Curtis Lee , Garrick Vikki , Gervais Lisa , Armstrong Lawrence , Delahunty Caroline , Eccleston Andrew , Al-Hourani Ghassan , Flynn Diana M. , Merrick Victoria , Barclay Andrew R. , Tayler Rachel , Hansen Richard , Russell Richard K. 
Published: June 2021

ABSTRACT
The use of thiopurine therapy in Epstein-Barr virus (EBV)-naïve inflammatory bowel disease (IBD) patients remains controversial due to a risk of EBV-associated complications. We evaluated EBV status and outcomes within our paediatric IBD population over an 8-year period; finding that 217 of 409 (53%) screened patients were seropositive for EBV at IBD diagnosis; that thiopurines were used in 189 of 217 (87%) seropositive and 159 of 192 (83%) seronegative patients (P = 0.22); and that 7 of 192 (4%) previously seronegative patients subsequently tested positive for EBV with 6 of 7 (86%) patients having concurrently recorded thiopurine use. All six patients continued thiopurine with/without a period of cessation; no EBV-associated lymphoproliferative disorders/serious complications were recorded within our cohort. A significant proportion of our patients would not receive thiopurine therapy should their use be avoided in EBV-negative patients (47%) or seronegative males (30%). The small but significant risks of thiopurine treatment must be balanced against the potential benefits of successful IBD management; further research into this is required.
Regional Gastrointestinal Motility in Healthy Children
Authors: Brinck Christian Emil , Mark Esben Bolvig , Ejerskov Cecilie , Johansen Klaus Birkelund , Sutter Nanna , Schlageter Vincent , Drewes Asbjørn Mohr , Krogh Klaus 
Published: June 2021

ABSTRACTObjective:The aim of the study was to evaluate the safety and use of the 3D-Transit system (Motilis SA, Lausanne, Switzerland) and to describe regional gastrointestinal transit times, segmental colonic transit times, and colonic movement patterns in healthy children.Methods:Twenty-one healthy children (11 girls, median age 10.5 years, range 7–15 years) were included. For evaluation of gastrointestinal transit times and colonic movement patterns, we used the minimally invasive electromagnetic 3D-Transit system. A small electromagnetic capsule (21.5 mm × 8.3 mm) was ingested and tracked through the gastrointestinal tract by a body-worn detector. Regional gastrointestinal transit times were assessed as time between capsule passage of anatomical landmarks. Colonic movement patterns were described and classified based on capsule movement velocity, direction, and distance.Results:One child could not swallow the capsule and 20 children completed the study without any discomfort or side-effects. Median whole gut transit time was 33.6 (range 10.7–80.5) hours, median gastric emptying time was 1.9 (range 0.1–22.1) hours, median small intestinal transit time was 4.9 (range 1.1–15.1) hours, and median colonic transit time was 26.4 (range 6.8–74.5) hours. Median ascending colon/cecum transit time was 9.7 (range 0.3–48.1) hours, median transverse colon transit time was 5.6 (range 0.0–11.6) hours, median descending colon transit time was 2.6 (range 0.01–22.3) hours, and median sigmoid colon/rectum transit time was 7.5 (range 0.1–31.6) hours. Colonic movement patterns among children corresponded to those previously described in healthy adults.Conclusions:The 3D-Transit system is a well-tolerated and minimally invasive method for assessment of gastrointestinal motility in children.
Association of Delayed Treatment of Chlamydial Infection and Gonorrhea in Pregnancy and Preterm Birth
Authors: Burdette Emily R. , Young Marisa R. , Dude Carolynn M. , Wall Kristin M. , Haddad Lisa B. 
Published: June 2021

Background
Treating chlamydia and gonorrhea in pregnancy has been shown to decrease the associated risk of preterm birth in some studies. Delayed treatment of these infections among nonpregnant patients carries known consequences. It is unclear whether delayed treatment in pregnancy similarly increases adverse outcomes.

Methods
We conducted a retrospective cohort study of women who delivered at a safety-net hospital from July 2016 to June 2018. Women with at least one visit who were tested for chlamydia and gonorrhea were included. Women diagnosed after 36 weeks (preterm analysis) or 31 weeks (early preterm analysis) were excluded. We used multivariable logistic regression to examine the association between no infection, timely treatment (<1 week), and delayed treatment (>1 week, not treated) with preterm (<37 weeks) and early preterm (<32 weeks) birth.

Results
Among 3154 deliveries, 389 (12%) were preterm. Among 3107 deliveries, 74 (2%) were early preterm. In adjusted models, women with timely (adjusted odds ratio [aOR]; 1.7, 95% confidence interval [CI], 1.0–2.7) and delayed (aOR, 1.7; 95% CI, 1.1–2.5) treatments had increased odds of preterm birth. Similarly, women with timely (aOR, 2.5; 95% CI, 1.0–6.2) and delayed (aOR, 2.4; 95% CI, 1.2–4.9) treatments had increased odds of early preterm birth. Among women who tested positive, multiple infections were not associated with an increase in preterm birth (preterm: 17% vs. 20%, P = 0.53; early preterm: 5% vs. 6%, P = 0.74).

Conclusions
Chlamydia and gonorrhea are associated with preterm and early preterm births, regardless of time to treatment. Creative solutions are needed to improve the prevention of these infections in pregnancy.
Case Series: Application of Topography-guided Contoura Refractive Surgery in Highly Irregular Cornea
Authors: Wang Xiangjun , Xu Wenwen , Xu Yanyun , Wang Chuanyu , Mu Guoying 
Published: June 2021

SIGNIFICANCE
Highly irregular cornea leads to poor vision, glare, and starbursts. Although treatment is still at the exploration stage, topography-guided Contoura surgery has excellent potential for the treatment of highly irregular corneas.

PURPOSE
This case series reviews three patients (one with abnormal back elevation, one with corneal scar after fungal keratitis, and one with post–laser-assisted in situ keratomileusis central islands) treated with topography-guided Contoura surgery.

CASE REPORTS
In case 1, a 19-year-old man underwent topography-guided Contoura refractive surgery in the left eye and wavefront-optimized ablation in the right eye. Post-operative topography of the right eye showed marked inferior steepening and central irregular astigmatism compared with the contralateral eye. In case 2, a 53-year-old man presented with corneal scarring on the right eye after recovering from fungal keratitis. The patient first underwent phototherapeutic keratectomy and photorefractive keratectomy to remove the scarring primarily. He then underwent Contoura to correct hyperopia, which flattened the cornea and improved his vision significantly. In case 3, a 25-year-old man presented with central steepening on topography maps after undergoing laser-assisted in situ keratomileusis. He underwent topography-guided ablation, which improved his visual acuity and normalized the cornea.

CONCLUSIONS
Therapy for highly irregular corneas includes wavefront-guided surgery, conservative treatment, corneal transplantation, rigid gas-permeable lenses, and so on. In this case series, topography-guided Contoura refractive surgery provided an excellent option for reducing topographic abnormalities and improving vision.
Ischemic Heart Disease Related Sudden Cardiac Death in Autopsied Cases
Authors: Fnon Nora F. , Hassan Hanan H. , Ibrahim Mahrous A. 
Published: June 2021

Abstract
Diagnosis of the underlying cause of sudden unexpected death in a previously healthy individual remains one of the important challenges in forensic practice. Ischemic heart disease is the most common cause of sudden death. The current study aims to investigate the incidence and pathology of sudden ischemic cardiac death in Egypt. All cases of sudden cardiac death (SCD) examined by different forensic departments throughout Egypt during the period of January 2010 through December 2014 were included. Cases underwent complete autopsy examination including a thorough gross and microscopic examination of the heart and great blood vessels. Of 535 cases of SCD diagnosed during the period of the study, coronary atherosclerosis was the principle finding in 420 (78.5%) cases. The highest numbers of deaths were reported in fifth and sixth decades with male preference. Other causes of SCD included myocarditis, cardiomyopathies, valvular heart disease, and hypertensive heart disease (7.8%, 4.1%, 4.1%, and 2.8%, respectively). There was severe stenosis (>75%) of at least 1 coronary artery in 74% of cases. Type VI atherosclerosis was found in 40.7% of cases. The left anterior descending branch was the most affected artery by atherosclerosis. Acute coronary pathological events were demonstrated in 27.6% of cases. Recent myocardial infarction was evident in 55.5% of cases, whereas old infarcts were demonstrated in 44.5% of cases. Features of hypertensive heart disease were present in 18.3% of cases. In conclusion, ischemic heart disease is the leading cause of SCD in Egypt.
Kratom-Associated Fatalities in Northern Nevada—What Mitragynine Level Is Fatal?
Authors: Schmitt Jessicia , Bingham Kaileigh , Knight Laura D. 
Published: June 2021

Abstract

Mitragyna speciosa, commonly known as the kratom tree, has been utilized in Southeast Asia for centuries for its opioid-like effects. Kratom has been available in the United States for the past decade and has grown increasingly popular despite a lack of clinical research to determine its safety. With its widespread use, there have been an increasing number of fatalities. This study aims to establish a potential lethal range for mitragynine, the active compound in kratom, by investigating the toxicology reports of 35 deaths in Northern Nevada between 2015 and 2020. Mitragynine concentrations ranged from 8.7 to 1800 ng/mL (n = 27) in cases with drug toxicity as the cause of death; in 1 case, the sole intoxicant was mitragynine with a blood concentration of 950 ng/mL. In cases with nonmitragynine causes of death, the concentration was 110 to 980 ng/mL (n = 8). There was no statistically significant difference in blood concentrations between cases where mitragynine was not listed as a cause of death (mean, 315 ± 297.2 ng/mL) and cases in which mitragynine contributed to death (mean, 269.4 ± 382.5 ng/mL; P < 0.201). A literature review is also presented.