Hypertriglyceridemia-induced acute pancreatitis: A prospective, multicenter, international cohort analysis of 716 acute pancreatitis cases

Background Hypertriglyceridemia is the third most common cause of acute pancreatitis (AP). It has been shown that hypertriglyceridemia aggravates the severity and related complications of AP; however, detailed analyses of large cohorts are inadequate and contradictory. Our aim was to investigate the dose-dependent effect of hypertriglyceridemia on AP. Methods AP patients over 18 years old who underwent triglyceride measurement within the initial three days were included into our cohort analysis from a prospective international, multicenter AP registry operated by the Hungarian Pancreatic Study Group. Data on 716 AP cases were analyzed. Six groups were created based on the highest triglyceride level (Peer reviewe

A Multicenter, International Cohort Analysis of 1435 Cases to Support Clinical Trial Design in Acute Pancreatitis

L

A Novel Round Insulated Tip Papillotome as an Alternative to the Classic Needle-Knife for Precut Sphincterotomy in Endoscopic Retrograde Cholangiopancreatography

Objective. The purpose of this study was to investigate the efficacy and safety of a new round insulated tip papillotome (r-ITP) as compared to that of the classic needle-knife sphincterotome (NKS) in difficult-to-cannulate endoscopic retrograde cholangiopancreatography (ERCP) patients. Materials and Methods. Patients with no exclusion criteria and an intact papilla referred for ERCP were invited to participate in the study. “Difficult-to-cannulate” patients, defined as failure to achieve deep biliary cannulation within five minutes from the first touch of papilla, with no more than ten attempts permitted, were randomly assigned for precut sphincterotomy using either the classic NKS or r-ITP. Results. Seventy and 69 patients were randomly assigned to the NKS and r-ITP groups, respectively. The groups were comparable regarding age, sex, indications, and associated conditions. There was no statistically significant difference in terms of successful cannulation or post-ERCP complications between the two groups. Only five patients (3.6%) developed mild to moderate post-ERCP pancreatitis and two had mild bleeding. No perforations or deaths were encountered. Conclusions. Although the round insulated tip papillotome was not shown to be superior to the classic NKS concerning efficacy and safety when used by an experienced endoscopist, it remains a simple, safe, and efficacious alternative

Early prediction of the severe course, survival, and ICU requirements in acute pancreatitis by artificial intelligence

Objective: To evaluate the success of artificial intelligence for early prediction of severe course, survival, and intensive care unit(ICU) requirement in patients with acute pancreatitis(AP).Methods: Retrospectively, 1334 patients were included the study. Severity is determined according to the Revised Atlanta Classification(RAC). The success of machine learning(ML) method was evaluated by 13 simple demographic, clinical, etiologic, and laboratory features obtained on ER admission. Additionally, it was evaluated whether Balthazar-computerized tomography severity index(CTSI) at 48-h contributed to success. The dataset was split into two parts, 90% for ML(of which 70% for learning and 30% for testing) and 10% for validation and 5-fold stratified sampling has been utilized. Variable Importance was used in the selection of features during training phase of machine. The Gradient Boost Algorithm trained the machine by KNIME analytics platform. SMOTE has been applied to increase the minority classes for training. The combined effects of the measured features were examined by multivariate logistic regression analysis and reciever operating curve curves of the prediction and confidence of the target variables were obtained.Results: Accuracy values for the early estimation of Atlanta severity score, ICU requirement, and survival were found as 88.20%, 98.25%, and 92.77% respectively. When Balthazar-CTSI score is used, results were found as 91.02%, 92.25%, and 98% respectively.Conclusions: The ML method we used successfully predicted the severe course, ICU requirement and survival, with promising accuracy values of over 88%. If 48-h Balthazar-CTSI is included in the calculation, the severity score and survival rates increase even more

Use of artificial intelligence in the prediction of malignant potential of gastric gastrointestinal stromal tumors

Background and Aims This study aimed to investigate whether AI via a deep learning algorithm using endoscopic ultrasonography (EUS) images could predict the malignant potential of gastric gastrointestinal stromal tumors (GISTs). Methods A series of patients who underwent EUS before surgical resection for gastric GISTs were included. A total of 685 images of GISTs from 55 retrospectively included patients were used as the training data set for the AI system. Convolutional neural networks were constructed to build a deep learning model. After applying the synthetic minority oversampling technique, 70% of the generated images were used for AI training and 30% were used to test AI diagnoses. Next, validation was performed using 153 EUS images of 15 patients with GISTs. In addition, conventional EUS features of 55 patients in the training cohort were evaluated to predict the malignant potential of GISTs and mitotic index. Results The overall sensitivity, specificity, and accuracy of the AI system for predicting malignancy risk were 83%, 94%, and 82% in the training dataset, and 75%, 73%, and 66% in the validation cohort, respectively. When patients were divided into low-risk and high-risk groups, sensitivity, specificity, and accuracy increased to 99% in the training dataset and 99.7%, 99.7%, and 99.6%, respectively, in the validation cohort. No conventional EUS features were found to be associated with either malignant potential or mitotic index (P > 0.05). Conclusions AI via a deep learning algorithm using EUS images could predict the malignant potential of gastric GISTs with high accuracy. Graphi

7 günlük standard üçlü tedaviye C ve E vitamini eklenmesi Helikobakter pilori eradikasyon oranını arttırır

Background and Aims: in Turkey, the estimated prevalence of Helicobacter pylori infection is approximately 80%. the eradication rate has been decreasing over time with standard triple therapy regimens including a proton pump inhibitor plus amoxicillin plus clarithromycin. These regimens have been supplemented with probiotics and various antioxidants to increase the eradication rate. the aim of this study was to evaluate whether supplementation of the 7-day standard triple therapy with vitamins C and E for 14 days would increase the Helicobacter pylori eradication rate. Materials and Methods: This study included 53 patients with Helicobacter pylori-positive non-ulcer dyspepsia. All patients received lansoprazole 30 mg BID, amoxicillin 1000 mg BID, and clarithromycin 500 mg BID for 7 days, as well as vitamin C 500 mg BID and vitamin E 200 IU BID for 14 days. Eradication rates were calculated using both intention-to-treat and per-protocol analyses. Results: Fiftythree patients were analyzed using intention-to-treat analysis. Fifty patients completed the study. Helicobacter pylori eradication was achieved in 31 (58.5%) of the 53 patients included in the intention-to-treat analysis and in 31 (62%) of the 50 patients included in the per-protocol analysis. Conclusions: Although this eradication rate is lower than the accepted 80% eradication rate, it is higher than eradication rates achieved in previous studies with 7-day standard triple therapy. Supplementation with antioxidants increases the eradication rate.Giriş ve Amaç: Türkiye’de Helikobakter pilori prevalansı yaklaşık %80’dir. Proton pompa inhibitörü, amoksisilin ve klaritromisinden oluşan standard üçlü tedavi rejimi ile eradikasyon oranı zamanla azalmaktadır. Eradikasyon oranını arttırmak amacı ile bu rejimlere probiyotikler ve çeşitli vitaminler eklenmiştir. Bu çalışmanın amacı 7 günlük standard üçlü tedaviye 14 gün süre ile C ve E vitamini eklenmesinin Helikobakter pilori eradikasyon oranını arttırıp arttırmayacağını araştırmaktır. Gereç ve Yöntem: Bu çalışmaya 53 Helikobakter pilori pozitif nonülser dispepsili hasta dahil edildi. Tüm hastalar 7 günlük lansoprazol 30 mg BID, amoksisilin 1000 mg BID ve klaritromisin 500 mg BID ile birlikte 14 günlük vitamin C 500 mg BID ve vitamin E 200 IU BID aldı. Eradikasyon oranları intention-to-treat ve per-protocol analizleri ile hesaplandı. Bulgular: Elli hasta çalışmayı tamamladı. Helikobakter pilori eradikasyonu intention-to-treat analizde 53 hastanın 31’inde (58,5%), per-protocol analizde 50 hastanın 31’inde(62%) sağlandı. Sonuç: Bu çalışmada elde edilen eradikasyon oranı başarılı olarak kabul edilen %80’in altında olsa da daha önceki çalışmalarda 7 günlük standard üçlü tedavi ile elde edilen oranlardan daha yüksektir. Tedaviye antioksidan C ve E vitaminlerinin eklenmesi eradikasyon oranını arttırmaktadı

Efficacy of rifaximin on circulating endotoxins and cytokines in patients with nonalcoholic fatty liver disease

WOS: 000356588500012PubMed ID: 26043290ObjectiveRecent studies have suggested that endotoxin-induced cytokines play an important role in nonalcoholic fatty liver disease (NAFLD). Rifaximin is a nonabsorbable antibiotic that might act on Gram-negative bacteria, thereby inhibiting endotoxin proinflammatory cytokine production in patients with NAFLD. Our aim was to investigate the efficacy of rifaximin on NAFLD.MethodsForty-two patients with biopsy-proven NAFLD [15 steatosis, 27 nonalcoholic steatohepatitis (NASH)] were included in this prospective, open-label, observational cohort study. BMI and serum aspartate aminotransferase, alanine aminotransferase (ALT), gamma glutamyl transferase, lipid profile, ferritin, C-reactive protein, glucose, insulin, homeostatic model assessment as well as endotoxin, serum Toll-like receptor 4 (TlR4), interleukin-1 (IL-1), IL-6, IL-10, IL-12, and tumor necrosis factor- (TNF-) levels were measured before and after a 28-day administration of rifaximin (1200mg/daily). Results were analyzed using nonparametric Wilcoxon signed-rank tests.ResultsA mild reduction in the mean BMI (32.36.9 vs. 31.9 +/- 6.8, P=0.02) and a significant reduction in the endotoxin (0.9 +/- 0.34 vs. 0.8 +/- 0.13, P=0.03) and IL-10 (4.08 +/- 0.9 vs. 3.73 +/- 0.7, P=0.006) levels in the NASH group were noted. A significant reduction was observed in serum aspartate aminotransferase (50.4 +/- 39 vs. 33 +/- 14, P=0.01), ALT (72 +/- 48 vs. 45.2 +/- 26.3, P=0.0001), gamma glutamyl transferase (52 +/- 33 vs. 41.2 +/- 21.1, P=0.02), LDL (137 +/- 34 vs. 127 +/- 27.5, P=0.03), and ferritin (142 +/- 214 vs. 89.3 +/- 123, P=0.0001) in the NASH group, but only in ALT (50.4 +/- 26 vs. 35.5 +/- 23.25, P=0.01), and ferritin (73.6 +/- 83 vs. 55 +/- 76, P=0.004) levels decreased significantly in the steatosis group. Treatment with rifaximin did not exert a significant effect on serum levels of TLR-4, IL-1, IL-6, IL-12, or TNF- in either group.ConclusionIn NAFLD and especially in NASH, short-term administration of rifaximin appears to be safe and effective.Scientific Research Project Council of the Bezmialem Vakif University (BAP) [6.2013/4]This work is supported by the Scientific Research Project Council of the Bezmialem Vakif University (BAP No. 6.2013/4