1,720,988 research outputs found
Elective cholecystectomy after reversal of septic shock using multimodality endoscopic gallbladder drainage
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CO 2 vs. air insufflation in endoscopic ultrasonography: a prospective study
Full text linkBackground and study aims Carbon dioxide (CO 2 ) is being increasingly used for insufflation during endoscopy for safety and better tolerance. The role of CO 2 during endoscopic ultrasonography (EUS) has not been studied yet. Our main aim was to compare the effects of CO 2 vs. air insufflation on abdominal discomfort in patients undergoing EUS. Our secondary outcomes were to ascertain the effects of CO 2 insufflation on image quality/visual artifacts and on the amount of sedation. Patients and methods This was a prospective, controlled, single-blind, observational study. Abdominal discomfort was assessed before diagnostic EUS, and 1 and 3 hours post-procedure and recorded as a visual analogue scale. Image quality was also recorded as a 4-point scale from optimal to poor at four different scanning sites (esophagus, stomach, duodenal bulb and second portion). Results A total of 198 patients were enrolled. We observed that CO 2 resulted in less abdominal discomfort than air insufflation that was statistically significant at 3 hours ( P = 0.048) but not at 1 hour after EUS ( P = 0.112), probably due to the ongoing effects of sedation at the latter stage. On the other hand, no differences were found in the dose of sedation administered in the two groups. Image quality was significantly better in the CO 2 group compared to the air group at all four different scanning sites ( P < 0.01). Similarly, CO 2 correlated with less visual artifacts and need of suction ( P < 0.01). Conclusions Similarly to previous findings with other endoscopic procedures, EUS was associated with improved scores for abdominal discomfort with CO 2 rather than air insufflation. Moreover, overall EUS image quality was improved using CO 2 insufflation. Future studies are warranted to ascertain whether CO 2 insufflation should be regarded as the standard of care for diagnostic EUS
Contrast-enhanced endoscopic ultrasound for the differential diagnosis between benign and malignant lymph nodes: a meta-analysis
Full text linkBackground The differential diagnosis between benign and malignant lymph nodes (LNs) is crucial for patient management and clinical outcome. The use of contrast-enhanced endoscopic ultrasound (EUS) has been evaluated in several studies with diverse results. The aim of this meta-analysis was to evaluate the pooled diagnostic accuracy of contrast-enhanced EUS (CE-EUS) and contrast-enhanced harmonic EUS (CH-EUS) in this setting.Methods A systematic electronic search was performed, including all original papers dealing with assessment of the nature of the LNs using CE-EUS or CH-EUS. A meta-analysis was performed to obtain pooled sensitivity, specificity, positive and negative likelihood ratio, and diagnostic odds ratio. The Summary Receiver Operating Characteristic (ROC) Curve method was used to calculate the area under the curve. Statistical analysis was carried out using Meta-Disc V.1.4, Stata V.12.0 and Review Manager V.5.2.Results Among 210 pertinent studies, four (336 patients) were included in the analysis. The pooled sensitivity was 82.1% (75.1-87.7%) and pooled specificity was 90.7% (85.9-94.3%) with significant heterogeneity found in sensitivity; the positive-likelihood ratio (LR) was 7.77 (5.09-11.85) and the negative-LR was 0.15 (0.05-0.46); the pooled diagnostic odds ratio (DOR) was 54 (15-190). Subgroup analysis including studies performed using CH-EUS (two studies, 177 LNs) showed a pooled sensitivity of 87.7% (77.0-93.9%) and a pooled specificity of 91.8% (84.5%-96.4%) with no significant heterogeneity; the pooled positive-LR was 9.51 (4.95-18.28) and the pooled negative-LR was 0.14 (0.06-0.35); pooled DOR was 68.42 (15.5-301.4).Conclusions From these data, CE-EUS is not recommended due to inadequate sensitivity. On the other hand, CH-EUS studies showed optimal accuracy (pooled sensitivity 87.7% and specificity 91.8%), comparable to elastography and even EUS-guided fine needle aspiration (EUS-FNA), suggesting a role in the diagnostic algorithm
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
Influence of the Microbiota Through the Gut-Brain Axis in Neurological Diseases
No full textThe gut microbiotaMicrobiota strongly interacts with brain, creating the microbiota gut-brain axis. The central nervous system (CNS) is significantly impacted by the gut microbiotaMicrobiota through various pathways, including activation of the vagus nerve, production of metabolites with neuroendocrine functions, and stimulation of immunological responses. Conversely, the brain, in conjunction with the enteric nervous system, exerts control over gastrointestinal tract motility and permeability, intestinal mucus secretion and immune response. Therefore, also the brain has an influence on composition of gut microbiota. Biological communication between the gastrointestinal and CNS is crucial in the pathophysiology and pathogenesis of numerous conditions affecting these systems. As such, the expanding field of microbiota-gut-brain axis research provides a promising framework to further expanding our understanding of disease mechanisms. This chapter aims to synthesize current knowledge in this domain, highlighting recent preclinical and clinical evidence linking the intestinal microbiome and immune system to various neurological disorders. Specifically, we examine involvement of the microbiotaMicrobiota in the onset of several prominent neurological diseases. Additionally, we discuss emerging studies exploring treatments for neurological diseases through manipulation of the gut microbiota such as probioticsProbiotics, prebioticsPrebiotics, synbiotics, and fecal microbiotaMicrobiota transplantation—leveraging interactions along the gut-brain axis
Exploring ChatGPT effectiveness in addressing direct patient queries on colorectal cancer screening
Full text linkBackground and study aims: Recent studies showed that large language models (LLMs) could enhance understanding of colorectal cancer (CRC) screening, potentially increasing participation rates. However, a limitation of these studies is that questions posed to LLMs are generated by experts. This study aimed to investigate ChatGPT-4o effectiveness in answering CRC screening queries directly generated by patients. Patients and methods: Ten consecutive subjects aged 50 to 69 years who were eligible for the Italian national CRC screening program but not actively involved were enrolled. Four possible scenarios for CRC screening were presented to each participant and they were asked to formulate one question per scenario to gather additional information. These questions were then posed to ChatGPT in two separate sessions. The responses were evaluated by five senior experts, who rated each answer based on three criteria: accuracy, completeness, and comprehensibility, using a 5-point Likert scale. In addition, the same 10 patients who created the questions assessed the answers, rating each response as complete, understandable, and trustworthy on a dichotomous scale (yes/no). Results: Experts rated the responses with mean scores of 4.1 ± 1.0 for accuracy, 4.2 ± 1.0 for completeness, and 4.3 ± 1.0 for comprehensibility. Patients rated responses as complete in 97.5%, understandable in 95%, and trustworthy in 100% of cases. Consistency over time was confirmed by an 86.8% similarity between session responses. Conclusions: Despite variability in questions and answers, ChatGPT confirmed good performances in answering CRC screening queries, even when used directly by patients
Variations on the Author
Full text link“Variations on the Author” discusses two of Eduardo Coutinho’s recent films (Um Dia na Vida, from 2010, and Últimas Conversas, posthumously released in 2015) and their contribution to the general question of documentary authorship. The director’s filmography is characterized by a consistent yet self-effacing form of authorial self-inscription: Coutinho often features as an interviewer that rather than express opinions propels discourses; an interviewer that is good at listening. This mode of self-inscription characterizes him as an author who is not expressive but who is nonetheless markedly present on the screen. In Um Dia na Vida, however, Coutinho is completely absent form the image, while Últimas Conversas, on the contrary, includes a confessional prologue that moves the director from the margins to the center of his films. This article examines the ways in which these works stand out in the filmography of a director who offers new insights into the notion of cinematic authorship
Appropriate Similarity Measures for Author Cocitation Analysis
Full text linkWe provide a number of new insights into the methodological discussion about author cocitation analysis. We first argue that the use of the Pearson correlation for measuring the similarity between authors’ cocitation profiles is not very satisfactory. We then discuss what kind of similarity measures may be used as an alternative to the Pearson correlation. We consider three similarity measures in particular. One is the well-known cosine. The other two similarity measures have not been used before in the bibliometric literature. Finally, we show by means of an example that our findings have a high practical relevance.information science;Pearson correlation;cosine;similarity measure;author cocitation analysis
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