Significant Reduction in the Diagnosis of Barrett's Esophagus and Related Dysplasia During the COVID-19 Pandemic.

INTRODUCTION: The coronavirus disease 19 (COVID-19) pandemic disrupted endoscopy practices, creating unprecedented decreases in cancer screening and surveillance services. We aimed to assess the impact of the pandemic on the proportion of patients diagnosed with Barrett's esophagus (BE) and BE-related dysplasia and adherence to established quality indicators. METHODS: Data from all esophagogastroduodenoscopies in the GI Quality Improvement Consortium, a national repository of matched endoscopy and pathology data, were analyzed from January 2018 to December 2022. Four cohorts were created based on procedure date and COVID-19 data: pre-pandemic (January 2018 to February 2020), pandemic-phase I (March 2020 to July 2020), pandemic-phase II (August 2020 to May 2021), and pandemic-phase III (June 2021 to December 2022). Observed and expected number of BE and BE-related dysplasia cases per month and adherence to the Seattle biopsy protocol and recommended surveillance intervals for nondysplastic BE (NDBE) were evaluated. RESULTS: Among 2,446,857 esophagogastroduodenoscopies performed during the study period, 104,124 (4.3%) had pathology-confirmed BE. The histologic distribution was 87.4% NDBE, 1.8% low-grade dysplasia, 2.4% indefinite for dysplasia, and 1.4% high-grade dysplasia. The number of monthly BE (-47.9% pandemic-phase I, -21.5% pandemic-phase II, and -19.0% pandemic-phase III) and BE-related dysplasia (high-grade dysplasia: 41.2%, -27.7%, and -19.0%; low-grade dysplasia: 49.1%, -35.3%, and -26.5%; any dysplasia: 46.7%, -32.3%, and -27.9%) diagnoses were significantly reduced during the pandemic phases compared with pre-pandemic data. Adherence rates to the Seattle protocol and recommended surveillance intervals for NDBE did not decline during the pandemic. DISCUSSION: There was a significant decline in the number of BE and BE-related dysplasia diagnoses during the COVID-19 pandemic, with an approximately 50% reduction in the number of cases of dysplasia diagnosed in the early pandemic. The absence of a compensatory increase in diagnoses in the pandemic-phase II and III periods may result in deleterious downstream effects on esophageal adenocarcinoma morbidity and mortality.

Health systems performance for hypertension control using a cascade of care approach in South Africa, 2011-2017.

Hypertension is a major contributor to global morbidity and mortality. In South Africa, the government has employed a whole systems approach to address the growing burden of non-communicable diseases. We used a novel incident care cascade approach to measure changes in the South African health system's ability to manage hypertension between 2011 and 2017. We used data from Waves 1-5 of the National Income Dynamics Study (NIDS) to estimate trends in the hypertension care cascade and unmet treatment need across four successive cohorts with incident hypertension. We used a negative binomial regression to identify factors that may predict higher rates of hypertension control, controlling for socio-demographic and healthcare factors. In 2011, 19.6% (95%CI 14.2, 26.2) of individuals with incident hypertension were diagnosed, 15.4% (95%CI 10.8, 21.4) were on treatment and 7.1% had controlled blood pressure. By 2017, the proportion of individuals with diagnosed incident hypertension had increased to 24.4% (95%CI 15.9, 35.4). Increases in treatment (23.3%, 95%CI 15.0, 34.3) and control (22.1%, 95%CI 14.1, 33.0) were also observed, translating to a decrease in unmet need for hypertension care from 92.9% in 2011 to 77.9% in 2017. Multivariable regression showed that participants with incident hypertension in 2017 were 3.01 (95%CI 1.77, 5.13) times more likely to have a controlled blood pressure compared to those in 2011. Our data show that while substantial improvements in the hypertension care cascade occurred between 2011 and 2017, a large burden of unmet need remains. The greatest losses in the incident hypertension care cascades came before diagnosis. Nevertheless, whole system programming will be needed to sufficiently address significant morbidity and mortality related to having an elevated blood pressure.

Deep learning for histopathological segmentation of smooth muscle in the urinary bladder.

BACKGROUND: Histological assessment of smooth muscle is a critical step particularly in staging malignant tumors in various internal organs including  the urinary bladder. Nonetheless, manual segmentation and classification of muscular tissues by pathologists is often challenging. Therefore, a fully automated and reliable smooth muscle image segmentation system is in high demand. METHODS: To characterize muscle fibers in the urinary bladder, including muscularis mucosa (MM) and muscularis propria (MP), we assessed 277 histological images from surgical specimens, using two well-known deep learning (DL) model groups, one including VGG16, ResNet18, SqueezeNet, and MobileNetV2, considered as a patch-based approach, and the other including U-Net, MA-Net, DeepLabv3 + , and FPN, considered as a pixel-based approach. All the trained models in both the groups were evaluated at pixel-level for their performance. RESULTS: For segmenting MP and non-MP (including MM) regions, MobileNetV2, in the patch-based approach and U-Net, in the pixel-based approach outperformed their peers in the groups with mean Jaccard Index equal to 0.74 and 0.79, and mean Dice co-efficient equal to 0.82 and 0.88, respectively. We also demonstrated the strengths and weaknesses of the models in terms of speed and prediction accuracy. CONCLUSIONS: This work not only creates a benchmark for future development of tools for the histological segmentation of smooth muscle but also provides an effective DL-based diagnostic system for accurate pathological staging of bladder cancer.

Comparison of Zenker's per-oral endoscopic myotomy (Z-POEM) with standard flexible endoscopic septotomy for Zenker's diverticulum: a prospective study with 2-year follow-up.

BACKGROUND: Flexible endoscopic therapy of Zenker's diverticulum using submucosal tunneling (Z-POEM) similar to esophageal Per-Oral Endoscopic Myotomy (POEM) is becoming increasingly common. However, data comparing Z-POEM with traditional flexible endoscopic septotomy (FES) are sparse. The aim of this study was to compare outcomes of Z-POEM with traditional FES over a medium-term follow-up period. METHODS: This was a prospective study of patients who underwent Z-POEM for treatment of Zenker's diverticulum between 2018 and 2020 at a tertiary academic medical center compared to prior patients who had FES (between 2015 and 2018). Procedural characteristics and clinical outcomes (technical and clinical success, and adverse events) were compared between patients who underwent each treatment. RESULTS: A total of 28 patients underwent ZD therapy during the study period. 13 patients (mean age 70 years; 77% male) underwent Z-POEM and 15 patients (mean age 72 years; 73% male) underwent traditional FES. The mean Zenker's diverticulum size was 2.4 ± 0.6 cm in the ZPOEM group vs 2.5 ± 0.8 cm in the FES group. The mean procedure time was similar between groups: 43.9 min (range 26-66) in the Z-POEM group and 60.2 min (range 25-92) in the traditional FES group (t = 1.74 p = 0.19). Overall technical success was seen in 100% of patients. There was one adverse event in the FES group (dehydration resulting in near-syncope) (1/28, 3.6%). Overall clinical success was seen in 92.8% (26/28) of patients and was not significantly different between groups (Z-POEM; 13/13, 100% vs FES; 13/15, 86.7%, t = - 1.36 p = 0.18). CONCLUSION: This prospective study suggests that ZPOEM is an effective technique for the treatment of Zenker's diverticulum with no significant differences in clinical outcomes or adverse event rates when compared to traditional FES.

An optimized EBRSA-Bi LSTM model for highly undersampled rapid CT image reconstruction.

COVID-19 has spread all over the world, causing serious panic around the globe. Chest computed tomography (CT) images are integral in confirming COVID positive patients. Several investigations were conducted to improve or maintain the image reconstruction quality for the sample image reconstruction. Deep learning (DL) methods have recently been proposed to achieve fast reconstruction, but many have focused on a single domain, such as the image domain of k-space. In this research, the highly under-sampled enhanced battle royale self-attention based bi-directional long short-term (EBRSA-bi LSTM) CT image reconstruction model is proposed to reconstruct the image from the under-sampled data. The research is adapted with two phases, namely, pre-processing and reconstruction. The extended cascaded filter (ECF) is proposed for image pre-processing and tends to suppress the noise and enhance the reconstruction accuracy. In the reconstruction model, the battle royale optimization (BrO) is intended to diminish the loss function of the reconstruction network model and weight updation. The proposed model is tested with two datasets, COVID-CT- and SARS-CoV-2 CT. The reconstruction accuracy of the proposed model with two datasets is 93.5 % and 97.7 %, respectively. Also, the image quality assessment parameters such as Peak-Signal to Noise Ratio (PSNR), Root Mean Square Error (RMSE) and Structural Similarity Index metric (SSIM) are evaluated, and it yields an outcome of (45 and 46 dB), (0.0026 and 0.0022) and (0.992, 0.996) with two datasets.

Does Age Have a Role in Color and Whiteness Variations After Dehydration and Rehydration in Maxillary Anterior Teeth? An In Vivo Study.

OBJECTIVE: To determine the influence of in vivo dehydration and rehydration on color and whiteness variations in maxillary anterior teeth of younger, middle-aged, and older individuals. METHODS AND MATERIALS: The spectrophotometric shade of maxillary anterior teeth from younger (20 to 30 years, n=20), middle-aged (50 to 60 years, n=20) and older (65 to 80 years, n=20) participants were assessed at baseline and every 10 minutes for 30 minutes after rubber dam isolation (dehydration). The teeth were then allowed to rehydrate, and shade values were assessed every 10 minutes for 30 minutes, after 24 hours, and after 48 hours. Data were collected as International Commission on Illumination (CIE) L*a*b* color coordinates. Color differences (ΔE*ab) and whiteness differences (ΔWID) were evaluated. Statistical analysis was performed using one-way analysis of variance with the Tukey Honest Significant Difference test. RESULTS: The color and whiteness changes of maxillary anterior teeth in older individuals after dehydration for 30 minutes were significantly lower than that of younger and middle-aged individuals. In younger participants, after 10 minutes of dehydration, mean ΔE*ab values of maxillary anterior teeth were above the acceptability threshold (AT), while mean ΔWID values were above AT only in maxillary canines. In middle-aged participants, mean ΔE*ab values were above AT, and mean ΔWID values were above the perceptibility threshold (PT) and below AT after 10 minutes of dehydration. In older participants, mean ΔE*ab values were above PT and below AT at 20 minutes of dehydration, while mean ΔWID values were above PT at 10 minutes of dehydration, and both were above AT at 30 minutes of dehydration. The mean ΔE*ab values were above AT after 20 minutes of rehydration in younger and middle-aged participants, while they were below AT in older participants after 10 minutes of rehydration. Mean ΔWID values were below AT for older participants after 20 minutes of rehydration. All mean ΔWID values were below AT and above PT after 30 minutes of rehydration except central incisors of younger participants. After 24 hours of rehydration, mean ΔE*ab and mean ΔWID values of participants in all age groups were below AT. After 48 hours of rehydration, mean ΔE*ab and ΔWID values of participants in all age groups were below PT except mean ΔE*ab values of canines and mean ΔWID values of central incisors in younger participants. L*, a*, and b* values were significantly different between age groups at 30 minutes of dehydration and after 48 hours of rehydration (p<0.05). CONCLUSION: Color and whiteness changes due to dehydration were less pronounced in older participants. Dehydration for 10 minutes in most maxillary anterior teeth of younger and middle-aged participants led to perceptible and clinically unacceptable color and whiteness changes. Maxillary anterior teeth of older participants showed color and whiteness changes that were perceptible at 10 minutes of dehydration but clinically acceptable up to 30 minutes of dehydration. After 30 minutes of dehydration, a 10- and 20-minute rehydration was needed, respectively, for color and whiteness changes to be clinically acceptable in maxillary anterior teeth of older individuals, while a 30-minute rehydration was recommended for the middle aged group and for maxillary laterals and canines of the younger group. Color and whiteness changes in most maxillary anterior teeth were imperceptible only after 48 hours of rehydration.

Proximal Biliary Stent Migration Causing Cardiac Tamponade.

Plastic biliary stents are commonly placed during endoscopic retrograde cholangiopancreatography for various indications, and stent-related complications are uncommon. We describe a case in which a plastic biliary stent migrated proximally through the liver capsule and diaphragm after endoscopic retrograde cholangiopancreatography, leading to pericardial effusion and cardiac tamponade. It is important for clinicians managing patients with biliary stents to be aware of this significant adverse event.

Occurrence of Lead and Other Toxic Metals Derived from Drinking-Water Systems in Three West African Countries.

BACKGROUND: Exposure to toxic metals (TMs) such as lead can cause lifelong neurodevelopmental impairment and other adverse outcomes. TMs enter drinking water from human activity, geogenic contamination, and corrosion of water system components. Several studies report TM contamination in piped systems and private wells in high-income countries (HICs). However, few robust studies report on TM contamination in low- and middle-income countries (LMICs). OBJECTIVES: We characterized the occurrence and investigated sources of TM contamination in 261 rural water systems in three West African LMICs to inform prevention and management. METHODS: Water samples were collected from 261 community water systems (handpumps and public taps) across rural Ghana, Mali, and Niger. Scrapings were collected from accessible components of a subset of these systems using a drill with acid-washed diamond-tipped bits. Samples were analyzed by inductively coupled plasma (ICP) mass spectrometry or ICP optical emission spectroscopy. RESULTS: Of the TMs studied, lead most frequently occurred at levels of concern in sampled water system components and water samples. Lead mass fractions exceeded International Plumbing Code (IPC) recommended limits (0.25% wt/wt) for components in 82% (107/130) of systems tested; brass components proved most problematic, with 72% (26/36) exceeding IPC limits. Presence of a brass component in a water system increased expected lead concentrations in drinking-water samples by 3.8 times. Overall, lead exceeded World Health Organization (WHO) guideline values in 9% (24/261) of drinking-water samples across countries; these results are broadly comparable to results observed in many HICs. Results did not vary significantly by geography or system type. DISCUSSION: Ensuring use of lead-free (<0.25%) components in new water systems and progressively remediating existing systems could reduce drinking-water lead exposures and improve health outcomes for millions. However, reflexive decommissioning of existing systems may deprive users of sufficient water for health or drive them to riskier sources. Because supply chains for many water system components are global, TM monitoring, prevention, and management may be warranted in other LMICs beyond the study area as well. https://doi.org/10.1289/EHP7804.

Machine learning predicts nucleosome binding modes of transcription factors.

BACKGROUND: Most transcription factors (TFs) compete with nucleosomes to gain access to their cognate binding sites. Recent studies have identified several TF-nucleosome interaction modes including end binding (EB), oriented binding, periodic binding, dyad binding, groove binding, and gyre spanning. However, there are substantial experimental challenges in measuring nucleosome binding modes for thousands of TFs in different species. RESULTS: We present a computational prediction of the binding modes based on TF protein sequences. With a nested cross-validation procedure, our model outperforms several fine-tuned off-the-shelf machine learning (ML) methods in the multi-label classification task. Our binary classifier for the EB mode performs better than these ML methods with the area under precision-recall curve achieving 75%. The end preference of most TFs is consistent with low nucleosome occupancy around their binding site in GM12878 cells. The nucleosome occupancy data is used as an alternative dataset to confirm the superiority of our EB classifier. CONCLUSIONS: We develop the first ML-based approach for efficient and comprehensive analysis of nucleosome binding modes of TFs.

Incidence, Survival, and Predictors of Lymph Node Involvement in Early-Stage Gastric Signet Ring Cell Carcinoma in the US.

INTRODUCTION: The incidence, survival, and propensity for nodal metastasis in early-stage gastric signet ring cell carcinoma have not been defined in the United States. These data are critical determinants for treatment allocation. METHODS: Cases of gastric signet ring cell carcinoma were extracted from the national SEER database for the years 2004-2013. Age-standardized incidence was derived. Survival was calculated using the Kaplan-Meier method. Univariate and multivariate analyses were performed to identify predictors of nodal metastasis. Exclusion criteria included neoadjuvant radiotherapy and lack of histologic or nodal data. RESULTS: A total of 10,624 cases were initially identified. The analysis cohort included 506 cases with early T-stage N0M0 disease following exclusions. The incidence was 0.094 per 100,000 person-years. The 5-year survival rate was 82.8%. Tumor stage (p < 0.001) and size (p < 0.001) were independent predictors of nodal metastasis. The incidence of nodal involvement for T1a tumors <2 cm was 5.4% (p < 0.004). CONCLUSION: The incidence of potentially resectable signet ring gastric carcinoma has not changed significantly over the past decade. While presenting with predominantly high-grade histology, early T-stage disease has a high survival rate. Small T1a tumors have low rates of nodal metastasis, suggesting that an endoscopic resection could be considered in this subset.

Lymph node metastasis in early gastric adenocarcinoma in the United States of America.

BACKGROUND AND STUDY AIMS: Localized approaches are being increasingly used in the management of early gastric adenocarcinoma; however, there are limited data on lymph node metastasis in the US population. This study examined the incidence and predictors of lymph node involvement for early-stage gastric adenocarcinomas in the USA. PATIENTS AND METHODS: Data were abstracted from the national SEER database from 2004 to 2013. Exclusion criteria included: cases with unknown tumor characteristics, unknown patient characteristics, metastatic disease, neoadjuvant radiation, and lack of surgical resection or lymph node evaluation. Univariate and multivariable analyses were conducted to assess the relationship of tumor stage, grade, and size, and patient sex, race, and age with nodal involvement. RESULTS: 43 769 cases of gastric adenocarcinoma were initially abstracted. After exclusions, 1577 patients remained for analysis. Multivariable analysis revealed that tumor stage (P < 0.001), grade (P = 0.008), and size (P < 0.001) were independent predictors of nodal metastasis. For low grade T1a tumors, nodal metastasis was present in 1.7 %, 1.7 %, 4.5 %, 4.1 %, and 20 % of tumors 0 - 1 cm, 1 - 2 cm, 2 - 3 cm, 3 - 4 cm, and ≥ 4 cm in size, respectively (P < 0.001), and in 8.4 %, 18.0 %, 19.5 %, 22.0 %, and 35.8 % of T1b tumors, respectively (P < 0.001). CONCLUSIONS: Low grade T1a tumors < 4 cm in size have low rates of nodal metastasis in the US population and may warrant consideration for local resection. Larger, higher grade T1b tumors have high rates of nodal metastasis in the US population and lymph node dissection may be indicated for patients who are surgical candidates.

Evaluation of Clinical Significance of Dermoscopy in Alopecia Areata.

BACKGROUND: Alopecia areata (AA) is a common, chronic inflammatory disease characterized by nonscarring hair loss on the scalp or any hair-bearing area of the body. Recently, dermoscopy, a noninvasive diagnostic procedure, has been employed for the diagnosis of AA. AIM: To evaluate various dermoscopic patterns in AA and correlate these patterns with the disease activity and severity. MATERIALS AND METHODS: Dermoscopy was performed on AA patients using DL1 dermoscope (magnification ×10 was used). The dermoscopic patterns recorded were analyzed to identify any correlation with the disease activity and severity. RESULTS: A total of fifty patients of AA were recruited in the study. Female outnumbered males with the ratio being 1.173:1. Mean age of the patients was 25.06 years. Mean duration of disease was 14 months. The most common site involved was scalp (80%) and type noted was patchy (84%). Various dermoscopic patterns noted were yellow dots (YD) (88%), short vellus hair (66%), black dots (BD) (58%), broken hairs (BHs) (56%), tapering hair (TH) (26%), Coudability hairs (14%), pigtail hair (14%), and Pohl-Pinkus constrictions (2%). Statistically significant correlation was observed between BD, BHs, THs, and disease activity. No significant correlation was found between severity and any of the dermoscopic features. CONCLUSION: The most common dermoscopic pattern in our study was YD. Presence of BDs, BHs, and THs indicate active disease. Dermoscopic patterns were not affected by severity of the disease.

Dentigerous Cysts of Maxillofacial Region- Clinical, Radiographic and Biochemical Analysis.

BACKGROUND: Dentigerous cyst is the second most common type of odontogenic cysts that encloses the crown of an unerupted tooth by expansion of its follicle due to the collection of cystic fluid. In view of the capability of these lesions attaining a marked size if not diagnosed early and treated properly, the present study was done based on the clinical and radiographic presentation of the dentigerous cyst in addition to the analysis of the cystic contents. OBJECTIVE: The present study reported 14 cases of dentigerous cysts (DC) with their incidence and relative distribution of the maxillofacial region along with the clinical and radiographic features and biochemical analysis of cystic fluid. METHOD: The study was conducted at Sri Govind Tricentenary Dental College, Hospital and Research Institute, Gurgaon, Haryana for a period of one year and six months. A detailed case history and thorough clinical examination was done for the patients who were provisionally found to have odontogenic cysts. Necessary radiographs, aspiration of the cystic fluid and incisional biopsy were performed to the 14 patients who were provisionally diagnosed with dentigerous cysts (DC) after obtaining the informed consent and the cystic fluid was subjected to biochemical analysis. RESULTS: Majority of the affected patients with DC were in their second decade and showed more predilection for mandible with a male predominance. The area of predilection was third molar region in the mandible and it is the canine region in maxilla. All the cases were associated with impacted teeth and majority showed expansion of the buccal/labial cortical plate. The various biochemical variables (total protein content, albumin, globulin and albumin: globulin ratio) were also assessed in the present study. CONCLUSION: The awareness of protean features of DC evident through this study is essential for the general as well as specialty practitioners for the accurate diagnosis and proper treatment planning of these non cancerous but potentially destructive lesions and also opens new avenues for further research.

Infantile pericardial round cell tumor.

Cardiac malignancies presenting in infancy are rare. Desmoplastic small round cell tumor (DSRCT) is a rare occurrence in this age group. No case of intrapericardial DSRCT has been reported in the literature in infants.

Residual cyst associated with calcifications in an elderly patient.

A residual cyst, as the name implies, is a radicular, lateral periodotal, dentigerous or any other cyst that has persisted after it's associated tooth has been lost. Residual cysts show more predilection in males and they commonly affect the maxillary region. Usually, residual cysts are asymptomatic and calcifications occurring in the residual cysts are quite rare. We are reporting a case of symptomatic residual cyst, associated with calcifications involving the anterior region of the body of the mandible in a 60-year-old male patient. The pathogenesis, clinical, radiological features and differential diagnosis have been discussed.

Back propagation neural network modelling of biodegradation and fermentative biohydrogen production using distillery wastewater in a hybrid upflow anaerobic sludge blanket reactor.

In a hybrid upflow anaerobic sludge blanket (HUASB) reactor, biodegradation in association with biohydrogen production was studied using distillery wastewater as substrate. The experiments were carried out at ambient temperature (34±1°C) and acidophilic pH of 6.5 with constant hydraulic retention time (HRT) of 24h at various organic loading rates (OLRs) (1-10.2kgCODm(-3)d(-1)) in continuous mode. A maximum hydrogen production rate of 1300mLd(-1) was achieved. A back propagation neural network (BPNN) model with network topology of 4-20-1 using Levenberg-Marquardt (LM) algorithm was developed and validated. A total of 231 data points were studied to examine the performance of the HUASB reactor in acclimatisation and operation phase. The statistical qualities of BPNN models were significant due to the high correlation coefficient, R(2), and lower mean absolute error (MAE) between experimental and simulated data. From the results, it was concluded that BPNN modelling could be applied in HUASB reactor for predicting the biodegradation and biohydrogen production using distillery wastewater.

Biohydrogen production and kinetic modeling using sediment microorganisms of Pichavaram mangroves, India.

Mangrove sediments host rich assemblages of microorganisms, predominantly mixed bacterial cultures, which can be efficiently used for biohydrogen production through anaerobic dark fermentation. The influence of process parameters such as effect of initial glucose concentration, initial medium pH, and trace metal (Fe(2+)) concentration was investigated in this study. A maximum hydrogen yield of 2.34, 2.3, and 2.6 mol H2 mol(-1) glucose, respectively, was obtained under the following set of optimal conditions: initial substrate concentration-10,000 mg L(-1), initial pH-6.0, and ferrous sulphate concentration-100 mg L(-1), respectively. The addition of trace metal to the medium (100 mg L(-1) FeSO4 ·7H2O) enhanced the biohydrogen yield from 2.3 mol H2 mol(-1) glucose to 2.6 mol H2 mol(-1) glucose. Furthermore, the experimental data was subjected to kinetic analysis and the kinetic constants were estimated with the help of well-known kinetic models available in the literature, namely, Monod model, logistic model and Luedeking-Piret model. The model fitting was found to be in good agreement with the experimental observations, for all the models, with regression coefficient values >0.92.