Proton pump inhibitor-responsive oesophageal eosinophilia and eosinophilic oesophagitis: more similarities than differences

To discuss the clinical, endoscopic, and histologic features, pathogenesis, and disease mechanisms of proton pump inhibitor–responsive esophageal eosinophilia (PPI-REE), and to highlight similarities and differences with eosinophilic esophagitis (EoE)

Feature Extraction Techniques in Medical Imaging: A Systematic Review

With the surge in the development of various applications in the field of Computer Vision and Digital Image Processing, a significant amount of medical pictures are being produced. Thus, the patient-specific scan pictures represent the boundless volume of data that requires careful organization and supervision to assist clinical decision support systems. Now that retrieval, classification, segmentation, and other procedures have been completed, these devices assist doctors to uncover serious illnesses including skin conditions, tumors, and cancer. This imaging largely depends on characteristics to detect the afflicted region and perform the diagnosis visually. The authors of this paper present an overview of numerous feature extraction approaches used to extract features from medical images obtained via different modalities, but only used a handful of these techniques for this job and provided the findings

Distribution and Characteristics of Colonic Diverticula in a United States Screening Population

Colonic diverticula are the most common finding from colonoscopy examinations. Little is known about the distribution of colonic diverticula, which are responsible for symptomatic and costly diverticular disease. We aimed to assess the number, location, and characteristics of colonic diverticula in a large US screening population

Outcomes of Esophageal Dilation in Eosinophilic Esophagitis: Safety, Efficacy and Persistence of the Fibrostenotic Phenotype

Esophageal dilation is commonly performed in eosinophilic esophagitis (EoE), but there are few long-term data. The aims of this study were to assess the safety and long-term efficacy of esophageal dilation in a large cohort of EoE cases and determine the frequency and predictors of requiring multiple dilations

Diminishing Effectiveness of Long-Term Maintenance Topical Steroid Therapy in PPI Non-Responsive Eosinophilic Esophagitis

While topical corticosteroids are first-line therapy for eosinophilic esophagitis (EoE), the data regarding long-term effectiveness are lacking. We aimed to determine long-term histologic and endoscopic outcomes of maintenance therapy in EoE steroid responders

Autoimmune and viral risk factors are associated with achalasia: A case-control study

Background: Achalasia is a rare esophageal motility disorder of uncertain etiology. While past studies have indicated that autoimmune conditions and viral infections may be associated with development of achalasia, these associations are yet to be examined in large, population-based studies. Methods: A matched case-control study was performed using administrative claim data from the IBM MarketScan Commercial Claims and Encounters Database between 2000 and 2019. A history of selected autoimmune conditions and viral infections was assessed using past medical claims. Multivariable conditional logistic regression was used to account for the matched nature of the study design and further control for confounding by demographic and clinical characteristics when reporting adjusted odds ratios (aORs). Key Results: Among 6769 cases and 27,076 controls, presence of any of the autoimmune conditions studied was associated with increased odds of achalasia (aOR = 1.26, 95% CI: 1.11, 1.42). Scleroderma or systemic sclerosis (aOR = 8.13, 95% CI: 3.34, 19.80) and Addison's disease (aOR = 3.83, 95% CI: 1.83, 8.04) had the strongest associations with achalasia. Presence of any of the viral infections studied was also associated with an increased risk of achalasia (aOR = 1.58, 95% CI: 1.23, 2.01). Varicella zoster virus (aOR = 3.84, 95% CI: 1.94, 7.62) and human papillomavirus (aOR = 1.77, 95% CI: 1.15, 2.73) both had strong relationships with achalasia. Conclusions and Inferences: These findings suggest that achalasia may have autoimmune and viral components contributing to its etiology. Future mechanistic studies could target specific diseases and agents highlighted by this research

Modeling the formation and composition of secondary organic aerosol from diesel exhaust using parameterized and semi-explicit chemistry and thermodynamic models

Laboratory-based studies have shown that combustion sources emit volatile organic compounds that can be photooxidized in the atmosphere to form secondary organic aerosol (SOA). In some cases, this SOA can exceed direct emissions of primary organic aerosol (POA). Jathar et al. (2017a) recently reported on experiments that used an oxidation flow reactor (OFR) to measure the photochemical production of SOA from a diesel engine operated at two different engine loads (idle, load), two fuel types (diesel, biodiesel), and two aftertreatment configurations (with and without an oxidation catalyst and particle filter). In this work, we used two different SOA models, the Volatility Basis Set (VBS) model and the Statistical Oxidation Model (SOM), to simulate the formation and composition of SOA for those experiments. Leveraging recent laboratory-based parameterizations, both frameworks accounted for a semi-volatile and reactive POA; SOA production from semi-volatile, intermediate-volatility, and volatile organic compounds (SVOC, IVOC and VOC); NOx-dependent parameterizations; multigenerational gas-phase chemistry; and kinetic gas–particle partitioning. Both frameworks demonstrated that for model predictions of SOA mass to agree with measurements across all engine load–fuel–aftertreatment combinations, it was necessary to model the kinetically limited gas–particle partitioning in OFRs and account for SOA formation from IVOCs, which were on average found to account for 70&thinsp;% of the model-predicted SOA. Accounting for IVOCs, however, resulted in an average underprediction of 28&thinsp;% for OA atomic O&thinsp;:&thinsp;C ratios. Model predictions of the gas-phase organic compounds (resolved in carbon and oxygen space) from the SOM compared favorably to gas-phase measurements from a chemical ionization mass spectrometer (CIMS), substantiating the semi-explicit chemistry captured by the SOM. Model–measurement comparisons were improved on using SOA parameterizations corrected for vapor wall loss. As OFRs are increasingly used to study SOA formation and evolution in laboratory and field environments, models such as those developed in this work can be used to interpret the OFR data.</p

The extremely narrow-caliber esophagus is a treatment-resistant subphenotype of eosinophilic esophagitis

Some patients with eosinophilic esophagitis (EoE) have an extremely narrowed esophagus, but the characteristics of this group have not been extensively described. We aimed to characterize the narrow-caliber phenotype of EoE, determine associated risk factors, and identify differences in treatment response in this sub-group of patients

Increased Risk of Esophageal Eosinophilia and Eosinophilic Esophagitis in Patients With Active Celiac Disease on Biopsy

The possible association between eosinophilic esophagitis (EoE) and celiac disease (CD) is controversial as prior results have been contradictory. We aimed to determine the relationship between EoE and CD among patients with concomitant esophageal and duodenal biopsies

Utility and Cost-Effectiveness of a Nonendoscopic Approach to Barrett's Esophagus Surveillance After Endoscopic Therapy

BACKGROUND & AIMS: A non-endoscopic approach to Barrett's esophagus (BE) surveillance after radiofrequency ablation (RFA) would offer a less invasive method for monitoring. We assessed the test characteristics and cost-effectiveness of the Cytosponge® in post-RFA patients. METHODS: We performed a multicenter study of dysplastic BE patients after at least one round of RFA. A positive Cytosponge® before endoscopy was defined as intestinal metaplasia (IM) on cytological assessment and/or TFF3 immunohistochemistry. Sensitivity, specificity, and receiver operator characteristic (ROC) curves were calculated. Multivariable regression was used to estimate the odds of a positive Cytosponge® in BE. A microsimulation cost-effectiveness model was performed to assess outcomes of various surveillance strategies: endoscopy-only, Cytosponge®-only, and alternating endoscopy/Cytosponge®. RESULTS: Of 234 patients, Cytosponge® adequately sampled the distal esophagus in 175 (75%). Of the 142 with both endoscopic and histologic data, 19 (13%) had residual/recurrent BE. For detecting any residual Barrett's, Cytosponge® had a sensitivity of 74%, specificity of 85%, accuracy of 84%, and ROC curve showed an area under the curve of 0.74. The adjusted odds of a positive Cytosponge® in BE were 17.1 (95% CI: 5.2-55.9). Cytosponge®-only surveillance dominated all the surveillance strategies, being both less costly and more effective. Cytosponge®-only surveillance required <1/4th the endoscopies, resulting in only 0.69 additional EAC cases/1,000 patients, and no increase in EAC deaths when compared to currently-practiced endoscopy-only surveillance. CONCLUSIONS: A positive Cytosponge® test was strongly associated with residual BE after ablation. While the assay needs further refinement in this context, it could serve as a cost-effective surveillance examination