Green energy innovation initiatives for environmental sustainability: current state and future research directions

Worldwide, all countries have been facing the crisis of climate change problem. They have been addressing this issue by focusing on implementing green energy innovation initiatives and promoting a sustainable future through environmental sustainability. In this research study, we focus on examining the role of green finance through green energy innovations, which are taking place in several sectors across different regions to promote environmental sustainability. The study has analysed 152 articles on this research domain through a systematic literature review to understand the present state of existing knowledge. The current study examines the Scopus-indexed research articles from the time period 2002 to 2023. Six emerging themes have been examined to understand their development and the potential impact of green initiatives for environmental sustainability. Various institutional theories have been explored to understand their association with the investigated research area. The paper has discussed multiple challenges that need to be addressed for the speedy implementation of green innovations. Finally, future research questions have been proposed based on the findings from the extant literature and the existing research gaps.

An artificial intelligence-generated model predicts 90-day survival in alcohol-associated hepatitis: A global cohort study

BACKGROUND AIMS

Alcohol-associated hepatitis (AH) poses significant short-term mortality. Existing prognostic models lack precision for 90-day mortality. Utilizing artificial intelligence (AI) in a global cohort, we sought to derive and validate an enhanced prognostic model.

APPROACH AND RESULTS

The Global AlcHep initiative, a retrospective study across 23 centers in 12 countries, enrolled AH patients per NIAAA criteria. Centers were partitioned into derivation (11 centers, 860 patients) and validation cohorts (12 centers, 859 patients). Focusing on 30 and 90-day post-admission mortality, three AI algorithms (Random Forest, Gradient Boosting Machines, and eXtreme Gradient Boosting) informed an ensemble model, subsequently refined via Bayesian updating, integrating the derivation cohort's average 90-day mortality with each center's approximate mortality rate to produce post-test probabilities. The ALCoholic Hepatitis Artificial INtelligence (ALCHAIN) Ensemble score integrated age, gender, cirrhosis, and 9 laboratory values, with center-specific mortality rates. Mortality was 18.7% (30-day) and 27.9% (90-day) in the derivation cohort, versus 21.7% and 32.5% in the validation cohort. Validation cohort 30 and 90-day AUCs were 0.811 (0.779 - 0.844) and 0.799 (0.769 - 0.830), significantly surpassing legacy models like Maddrey's Discriminant Function, MELD variations, ABIC, Glasgow, and modified Glasgow Scores (p<0.001). ALCHAIN Ensemble score also showcased superior calibration against MELD and its variants. Steroid use improved 30-day survival for those with an ALCHAIN Ensemble score>0.20 in both derivation and validation cohorts.

CONCLUSIONS

Harnessing AI within a global consortium, we pioneered a scoring system excelling over traditional models for 30 and 90-day AH mortality predictions. Beneficial for clinical trials, steroid therapy, and transplant indications, it's accessible at: https://aihepatology.shinyapps.io/ALCHAIN/.

Racial and Ethnic Minorities With Acute Pancreatitis Live in Neighborhoods With Higher Social Vulnerability Scores

OBJECTIVES

The primary objective was to determine differences in Social Vulnerability Index (SVI) scores among minorities (African-Americans and Hispanics) with acute pancreatitis (AP) compared with non-Hispanic whites (NHWs) with AP. The secondary objectives were to determine differences in diet, sulfidogenic bacteria gene copy numbers (gcn) and hydrogen sulfide (H2S) levels between the 2 groups.

MATERIALS AND METHODS

Patients with AP were enrolled during hospitalization (n = 54). Patient residential addresses were geocoded, and the Centers for Disease Control and Prevention's SVI scores were appended. Dietary intake and serum H2S levels were determined. Microbial DNAs were isolated from stool, and gcn of sulfidogenic bacteria were determined.

RESULTS

Minorities had higher SVI scores compared with NHWs ( P = 0.006). They also had lower consumption of beneficial nutrients such as omega-3 fatty acids [stearidonic ( P = 0.019), and eicosapentaenoic acid ( P = 0.042)], vitamin D ( P = 0.025), and protein from seafood ( P = 0.031). Lastly, minorities had higher pan-dissimilatory sulfite reductase A ( pan-dsrA ) gcn ( P = 0.033) but no significant differences in H2S levels ( P = 0.226).

CONCLUSION

Minorities with AP have higher SVI compared with NHWs with AP. Higher SVI scores, lower consumption of beneficial nutrients, and increased gcn of pan-dsrA in minorities with AP suggest that neighborhood vulnerability could be contributing to AP inequities.

Predictors and outcomes of withholding and withdrawal of life-sustaining treatments in intensive care units in Singapore: a multicentre observational study

BACKGROUND

Clinical practice guidelines on limitation of life-sustaining treatments (LST) in the intensive care unit (ICU), in the form of withholding or withdrawal of LST, state that there is no ethical difference between the two. Such statements are not uniformly accepted worldwide, and there are few studies on LST limitation in Asia. This study aimed to evaluate the predictors and outcomes of withholding and withdrawal of LST in Singapore, focusing on the similarities and differences between the two approaches.

METHODS

This was a multicentre observational study of patients admitted to 21 adult ICUs across 9 public hospitals in Singapore over an average of three months per year from 2014 to 2019. The primary outcome measures were withholding and withdrawal of LST (cardiopulmonary resuscitation, invasive mechanical ventilation, and vasopressors/inotropes). The secondary outcome measure was hospital mortality. Multivariable generalised mixed model analysis was used to identify independent predictors for withdrawal and withholding of LST and if LST limitation predicts hospital mortality.

RESULTS

There were 8907 patients and 9723 admissions. Of the former, 80.8% had no limitation of LST, 13.0% had LST withheld, and 6.2% had LST withdrawn. Common independent predictors for withholding and withdrawal were increasing age, absence of chronic kidney dialysis, greater dependence in activities of daily living, cardiopulmonary resuscitation before ICU admission, higher Acute Physiology and Chronic Health Evaluation (APACHE) II score, and higher level of care in the first 24 h of ICU admission. Additional predictors for withholding included being of Chinese race, the religions of Hinduism and Islam, malignancy, and chronic liver failure. The additional predictor for withdrawal was lower hospital paying class (with greater government subsidy for hospital bills). Hospital mortality in patients without LST limitation, with LST withholding, and with LST withdrawal was 10.6%, 82.1%, and 91.8%, respectively (p < 0.001). Withholding (odds ratio 13.822, 95% confidence interval 9.987-19.132) and withdrawal (odds ratio 38.319, 95% confidence interval 24.351-60.298) were both found to be independent predictors of hospital mortality on multivariable analysis.

CONCLUSIONS

Differences in the independent predictors of withholding and withdrawal of LST exist. Even after accounting for baseline characteristics, both withholding and withdrawal of LST independently predict hospital mortality. Later mortality in patients who had LST withdrawn compared to withholding suggests that the decision to withdraw may be at the point when medical futility is recognised.

Can green finance facilitate Industry 5.0 transition to achieve sustainability? A systematic review with future research directions

Most of the world's rising carbon emission results from industrial activities. Previous industrial revolutions did not put much thought into safeguarding the natural world. Governments worldwide have been continuously implementing regulations and policies for the mitigation of climate change to promote sustainable development. To achieve decarbonization, the climate change discussion is merged with Industry 5.0 (I5.0) where green finance (GF) plays a crucial role. This technological metamorphosis of transition from Industry 4.0 (I4.0) to I5.0 will affect humans and their society. I5.0 forms a symbiotic relationship with different aspects of Society 5.0 (S5.0) such as social (human‒machine centricity), ecological (zero emissions), and technological (green innovations). Thus, the I5.0 transition prioritizes greening the economy in pursuit of achieving S5.0. Through a systematic review of 196 articles, this research study concisely summarizes the rapidly expanding body of information. The research domain gave six major themes: Green Innovations (GI), Green Manufacturing Practices (GMP), Circular Economy (CE), Green Supply Chain Management (GSCM), Emerging Economies, and Net Zero Economy (NZE). Finally, a framework has been provided that illustrates the supporting role of GF for the I5.0 transition eventually followed by S5.0. This study provides an overview of these themes with their propositions and future research directions. The present study addresses the knowledge gap by providing valuable contributions to the burgeoning research domain of I5.0 and GF. Moreover, it aims to garner the attention of different stakeholders to integrate these two concepts of research to attain the goal of sustainable development.

MELD 3.0 adequately predicts mortality and renal replacement therapy requirements in patients with alcohol-associated hepatitis

Background & Aims

Model for End-Stage Liver Disease (MELD) score better predicts mortality in alcohol-associated hepatitis (AH) but could underestimate severity in women and malnourished patients. Using a global cohort, we assessed the ability of the MELD 3.0 score to predict short-term mortality in AH.

Methods

This was a retrospective cohort study of patients admitted to hospital with AH from 2009 to 2019. The main outcome was all-cause 30-day mortality. We compared the AUC using DeLong's method and also performed a time-dependent AUC with competing risks analysis.

Results

A total of 2,124 patients were included from 28 centres from 10 countries on three continents (median age 47.2 ± 11.2 years, 29.9% women, 71.3% with underlying cirrhosis). The median MELD 3.0 score at admission was 25 (20-33), with an estimated survival of 73.7% at 30 days. The MELD 3.0 score had a better performance in predicting 30-day mortality (AUC:0.761, 95%CI:0.732-0.791) compared with MELD sodium (MELD-Na; AUC: 0.744, 95% CI: 0.713-0.775; p = 0.042) and Maddrey's discriminant function (mDF) (AUC: 0.724, 95% CI: 0.691-0.757; p = 0.013). However, MELD 3.0 did not perform better than traditional MELD (AUC: 0.753, 95% CI: 0.723-0.783; p = 0.300) and Age-Bilirubin-International Normalised Ratio-Creatinine (ABIC) (AUC:0.757, 95% CI: 0.727-0.788; p = 0.765). These results were consistent in competing-risk analysis, where MELD 3.0 (AUC: 0.757, 95% CI: 0.724-0.790) predicted better 30-day mortality compared with MELD-Na (AUC: 0.739, 95% CI: 0.708-0.770; p = 0.028) and mDF (AUC:0.717, 95% CI: 0.687-0.748; p = 0.042). The MELD 3.0 score was significantly better in predicting renal replacement therapy requirements during admission compared with the other scores (AUC: 0.844, 95% CI: 0.805-0.883).

Conclusions

MELD 3.0 demonstrated better performance compared with MELD-Na and mDF in predicting 30-day and 90-day mortality, and was the best predictor of renal replacement therapy requirements during admission for AH. However, further prospective studies are needed to validate its extensive use in AH.

Impact and implications

Severe AH has high short-term mortality. The establishment of treatments and liver transplantation depends on mortality prediction. We evaluated the performance of the new MELD 3.0 score to predict short-term mortality in AH in a large global cohort. MELD 3.0 performed better in predicting 30- and 90-day mortality compared with MELD-Na and mDF, but was similar to MELD and ABIC scores. MELD 3.0 was the best predictor of renal replacement therapy requirements. Thus, further prospective studies are needed to support the wide use of MELD 3.0 in AH.

Safety and Efficacy of Endoscopic Submucosal Dissection in the Management of Gastric Tube Cancers After Esophagectomy: A Systematic Review

Esophagectomy is the proposed standard of care for resectable primary esophageal cancers and recurrent lesions in the reconstructed gastric tube (GT); however, it carries significant morbidity and mortality. Endoscopic submucosal dissection (ESD) has established its role in the management of primary esophageal cancers with growing evidence of its safety in resecting recurrent primary lesions in GT. Our study aims to evaluate the safety and efficacy of ESD in the management of recurrent, localized primary esophageal cancers in GT. We searched PubMed, CENTRAL, EMBASE, Scopus, and clinical trial registries from inception to March 2023 for articles evaluating the safety and efficacy of ESD in the management of recurrent cancerous lesions in GT. Our primary outcome was the en bloc resection rate. Secondary outcomes were curative resection rate, complete resection rate, intra-procedural complication rate, post-procedure complication rate, and five-year survival rate. Seven studies with a total of 165 patients undergoing 192 ESDs were included in the review. The pooled en bloc resection rate was 92.5% (95% CI: 87.7-95.6), which was reported in all seven studies. Pooled complete resection rate was 78.9% (95% CI: 64.5-88.5) per three studies, pooled curative resection rate was 73.9% (95% CI: 63.5-82.2) per four studies, and pooled intra-procedural complication rate was 10.2% (95% CI: 1.5-46.3), which was reported in four studies. Only three studies reported a five-year survival rate that was 65.5% (95% CI: 56.0-73.9). ESD is safe and efficacious in the management of GT cancer after esophagectomy.

Exploring the relationship between digitalization, resilient agri-food supply chain management practices and firm performance

Purpose

This study aims to explore the mediating role of digital technologies-based supply chain integrating (SCI) strategies on the agri-supply chain performance (SCP) and firm performance (FP). This research has introduced recently emerged digital technologies such as Internet of Things (IoT). Further, based on theoretical support and an extensive literature review, this research has proposed some hypotheses, which have been quantitatively validated for their significance.

Design/methodology/approach

A conceptual model was formulated based on an extensive literature review. Data for this research were gathered from a survey completed by 119 respondents from different departments of agri-firms. Further, partial least square (PLS)-based structured equation modelling (SEM) was used to test the proposed hypothetical model.

Findings

The results confirm that IoT-based digital technologies and supply chain processes (organization integration [OI], information sharing and customer integration [CI]) have a significant positive correlation. Furthermore, supply chain practices are positively associated with SCP. Finally, it has been found that FP is positively impacted by SCP.

Research limitations/implications

This research is used to analyse the mediating impacts of digital supply chain processes as a linking strategy for SCP and FP. For practical purposes, this research provides investment decisions for implementing digital technologies in SC strategies. The findings have proposed implications for managers and practitioners in agri-firms based on existing theories: contingency theory (CT) and relational view theory. Also, this study suggests the deployment of smarter electronically based tags and readers, which improve the data analytics capabilities based on auto-captured data. Thus, the availability of quality information improves the data-driven decisional capabilities of managers at company level.

Originality/value

This is a unique and original study exploring the relationship between digitalization, resilient agri-food supply chain (AFSC) management practices and firm performance. This research may be extended to other industries in view of the results from SCP and impact of digitalization.

Are emerging technologies unlocking the potential of sustainable practices in the context of a net-zero economy? An analysis of driving forces

Increasing globalization and climate change have significantly affected business activities. Government and other stakeholders are creating pressure to have a sustainable business model for efficient resource utilization and minimizing negative environmental impact. Many organizations have started focusing on sustainable and cleaner production through the adoption of net-zero economy (NZE) practices. Certain technological advancements are required to put these concepts into practice. Firms have begun to adopt digital technologies (such as big data analytics, artificial intelligence, and internet of things), and have been widely used in practice to achieve NZE. Is digitalization unlocking the potential of sustainable practices in the context of a net-zero economy? This question is still unanswered; therefore, this study aims to identify and analyze the drivers of digitalization that ensure sustainable practices to achieve net-zero economy. Through an extensive literature review and experts' opinions, a list of drivers was identified. An empirical investigation was conducted to validate the identified drivers and further understand the influencing relationship among the drivers, Pythagorean fuzzy decision-making trial and evaluation laboratory (PF-DEMATEL) was employed. The findings of the study show that "high degree of automation," "enhancing the flexibility in the manufacturing process," and "real-time sensing capability" are the main influencer drivers among all cause group forces. The present study can be a source for industrial practitioners and academia that can provide significant guidance on how the adoption of digitalization can unlock the potential to achieve CE, which can lead us toward net-zero.

EUS-guided gallbladder drainage in a patient with Billroth II reconstruction

Video 1EUS-guided gallbladder drainage in a patient with Billroth II gastrojejunostomy.

Two years of COVID-19 pandemic: Understanding the role of knowledge-based supply chains towards resilience through bibliometric and network analyses

Coronavirus disease (COVID-19) catastrophically disrupted most of the global supply chains (SC). Knowledge-based SC can cope with the pandemic disruptions by the efficient use of data, information, knowledge, human intelligence and emerging technologies. This article aims to critically analyse the SC research during the two years of COVID-19 pandemic to understand the role of knowledge-based supply chain towards SC resilience. A review of the 281 shortlisted articles is presented, along with bibliometric and network analyses in order to create an intellectual map of the domain and to identify the emerging knowledge themes. Bibliometric analysis reveals that the knowledge focus during this short span has migrated from COVID-19 pandemic to SC risk management and finally to risk mitigation strategies. The network analysis identifies five emerging knowledge themes, namely impact of COVID-19 on SC; SC risk mitigation and resilience; supply chain viability; sustainable SC strategies; and food SC. This review also elucidates the strategies to mitigate COVID-19 disruptions for incorporating resilience in SC. Future research directions for a knowledge-based sustainable-leagile-resilient (S-leagilient) supply chain have also been propounded.

SABMIS: sparse approximation based blind multi-image steganography scheme

We hide grayscale secret images into a grayscale cover image, which is considered to be a challenging steganography problem. Our goal is to develop a steganography scheme with enhanced embedding capacity while preserving the visual quality of the stego-image as well as the extracted secret image, and ensuring that the stego-image is resistant to steganographic attacks. The novel embedding rule of our scheme helps to hide secret image sparse coefficients into the oversampled cover image sparse coefficients in a staggered manner. The stego-image is constructed by using the Alternating Direction Method of Multipliers (ADMM) to solve the Least Absolute Shrinkage and Selection Operator (LASSO) formulation of the underlying minimization problem. Finally, the secret images are extracted from the constructed stego-image using the reverse of our embedding rule. Using these components together, to achieve the above mentioned competing goals, forms our most novel contribution. We term our scheme SABMIS (Sparse Approximation Blind Multi-Image Steganography). We perform extensive experiments on several standard images. By choosing the size of the length and the width of the secret images to be half of the length and the width of cover image, respectively, we obtain embedding capacities of 2 bpp (bits per pixel), 4 bpp, 6 bpp, and 8 bpp while embedding one, two, three, and four secret images, respectively. Our focus is on hiding multiple secret images. For the case of hiding two and three secret images, our embedding capacities are higher than all the embedding capacities obtained in the literature until now (3 times and 6 times than the existing best, respectively). For the case of hiding four secret images, although our capacity is slightly lower than one work (about 2/3rd), we do better on the other two goals (quality of stego-image & extracted secret image as well as resistance to steganographic attacks). For our experiments, there is very little deterioration in the quality of the stego-images as compared to their corresponding cover images. Like all other competing works, this is supported visually as well as over 30 dB of Peak Signal-to-Noise Ratio (PSNR) values. The good quality of the stego-images is further validated by multiple numerical measures. None of the existing works perform this exhaustive validation. When using SABMIS, the quality of the extracted secret images is almost same as that of the corresponding original secret images. This aspect is also not demonstrated in all competing literature. SABMIS further improves the security of the inherently steganographic attack resistant transform based schemes. Thus, it is one of the most secure schemes among the existing ones. Additionally, we demonstrate that SABMIS executes in few minutes, and show its application on the real-life problems of securely transmitting medical images over the internet.

Tamoxifen retinopathy and macular telangiectasia: A comparative case series

PURPOSE

To report a case series of tamoxifen retinopathy (TR) with and without type 2 macular telangiectasia (MacTel) and compare their clinical and imaging findings.

METHODS

Retrospective comparative study. Female patients with tamoxifen use or with clinical diagnosis of type 2 MacTel were divided into 4 groups: Group A-tamoxifen use without retinopathy; Group B-tamoxifen use with retinopathy; Group C-type 2 MacTel with tamoxifen use and Group D-type 2 MacTel without tamoxifen use. Clinical and image analysis was conducted.

RESULTS

There were 6 patients (11 eyes) in group A, 8 (13 eyes) patients in Group B, 2 patients (4 eyes) in Group C and 8 patients (14 eyes) in Group D respectively. TR patients were young, showed retinal crystals, perifoveal greying and no retinal pigment clumps (RPC) on examination. Foveal contour irregularity (n = 13, 100%) and outer retinal layer damage (n = 11, 85%) were common OCT findings seen in TR. In group C, all eyes showed 360° middle retinal layer (MRL) hyperreflectivity (100% vs 86%) and presence of outer retinal hyporeflective cavitation (100% vs 43%) on OCT compared to patients in group D. Abnormal autofluoroscence, detection and leakage from the telangiectatic vessels on fluorescein and OCT angiography was seen in type 2 MacTel disease.

CONCLUSION

Patients with TR showed retinal crystals and outer retinal hyporeflective foveal cavitation on OCT. Patients with type 2 MacTel having with tamoxifen intake showed hyporeflective outer retinal foveal cavitation and 360° perifoveal MRL hyperreflectivity on OCT. RPC was observed exclusively in the type 2 MacTel group.

Immunoglobulin G4 associated autoimmune cholangitis and pancreatitis following the administration of nivolumab: A case report

BACKGROUND

Immune checkpoint inhibitors have significantly improved survivals for an increasing range of malignancies but at the cost of several immune-related adverse events, the management of which can be challenging due to its mimicry of other autoimmune related disorders such as immunoglobulin G4 (IgG4) related disease when the pancreaticobiliary system is affected. Nivolumab, an IgG4 monoclonal antibody, has been associated with cholangitis and pancreatitis, however its association with IgG4 related disease has not been reported to date.

CASE SUMMARY

We present a case of immune-related pancreatitis and cholangiopathy in a patient who completed treatment with nivolumab for anal squamous cell carcinoma. Patients IgG4 levels was normal on presentation. She responded to steroids but due to concerns for malignant biliary stricture, she opted for surgery, the pathology of which suggested IgG4 related disease.

CONCLUSION

We hypothesize this case of IgG4 related cholangitis and pancreatitis was likely triggered by nivolumab.

Microbiological profile and infection potential of different cryopreserved skull flaps after decompressive hemicraniectomy. Is cryopreservation at - 80 ℃ better?

OBJECTIVE

Patterns of cryopreservation of explanted skull bone flaps have long been a matter of debate, in particular the appropriate temperature of storage. To the best of our knowledge no study to date has compared the microbiological profile and the infection potential of skull bone flaps cryostored at the same institution at disparate degrees for neurosurgical purposes. In the context of our clinical trial DRKS00023283, we performed a bacterial culture of explanted skull bone flaps, which were cryopreserved lege artis at a temperature of either - 23 °C or - 80 °C after a decompressive hemicraniectomy. In a further step, we contaminated the bone fragments in a s uspension with specific pathogens (S. aureus, S. epidermidis and C. acnes, Colony forming unit CFU 103/ml) over 24 h and conducted a second culture.

RESULTS

A total of 17 cryopreserved skull flaps (8: - 23 °C; 9: - 80 °C) explanted during decompressive hemicraniectomies performed between 2019 and 2020 as well as 2 computer-aided-designed skulls (1 vancomycin-soaked) were analyzed. Median duration of cryopreservation was 10.5 months (2-17 months). No microorganisms were detected at the normal bacterial culture. After active contamination of our skull flaps, all samples showed similar bacterial growth of above-mentioned pathogens; thus, our study did not reveal an influence of the storage temperature upon infectious dynamic of the skulls.

Sequential retinal pigment epithelium tears following intravitreal Ranibizumab injections for age-related macular degeneration

PURPOSE

To report a case of sequential retinal pigment epithelium (RPE) tears following intravitreal Ranibizumab injections for neovascular age-related macular degeneration (AMD).

METHODS

Retrospective, observational case.

CASE DESCRIPTION

A 75-year-old hypertensive male was diagnosed with active neovascular AMD and pre-existing RPE tear in the left eye. His presenting best-corrected visual acuity was counting finger @ 1 metre, <N36 in the right eye and 6/9, N8 in the left eye respectively. The right eye fundus had a scarred choroidal neovascular membrane (CNV) with extensive hard exudates. The left eye fundus showed active CNV, subretinal fluid and haemorrhage and a large RPE tear inferior to the fovea with rolled up margins. Following treatment with intravitreal Ranibizumab injection (Accentrix®, Alcon, 0.5 mg/0.05 ml) at monthly intervals, patient developed two extra RPE tears following each injection adjacent to the existing RPE tear. At the final follow-up visit, his CNV had regressed and visual acuity was maintained at 6/6, N6. No additional RPE tears were noted.

CONCLUSION

Pathogenesis of sequential RPE tears remains unclear. There is a need to look out for new RPE tears which can affect vision in a patient with neovascular AMD following CNV treatment.

Intercalary membrane break and detachment causes intrachoroidal cavitation in macular coloboma

PURPOSE

To describe the clinical and imaging features in a series of patients diagnosed with macular coloboma (MC) and intrachoroidal cavitation (ICC).

METHODS

Patients diagnosed with MC based on clinical examination between June 2017 and July 2021 were retrieved from the electronic medical record system and were included in the study. Colour fundus photographs, optical coherence tomography (OCT) and Multicolour® imaging scans of these patients were analysed.

RESULTS

We identified 16 eyes of 11 patients with MC on fundus examination. Based on OCT imaging features, conforming variant of MC was seen in 9 (56%) eyes and non-conforming variant in 7 (44%) eyes. No eyes with MC in the study showed features of both conforming and non-conforming varieties simultaneously. In the non-conforming variety of MC with presence of intercalary membrane break, ICC was identified in 5 (71%) of these eyes. ICC in MC appeared as flat, dark greenish areas with or without an orange-coloured boundary abutting the margin of the coloboma on Multicolour® imaging.

CONCLUSION

In 31% eyes, ICC was seen in non-conforming type of MC and was well-identified on Multicolour® imaging. It appears that presence of intercalary membrane break and detachment are prerequisites for developing ICC.

Predictors of poor bowel preparations and colonoscopy cancellations in inpatient colonoscopies, a single center retrospective study

BACKGROUND

An adequate bowel preparation prior to colonoscopy is a major quality-limiting factor that determines both the diagnostic and therapeutic yield of a colonoscopy. Colonoscopy is considered the gold standard for colon cancer screening and it is the primary approach to the workup of hematochezia, diarrhea and iron deficiency anemia (IDA). Several modifiable factors of bowel prep adequacy have been identified, that account for around 25% of inadequate bowel preparations in outpatient colonoscopies. However, the literature is sparse when examining the factors associated with inadequate preparations and procedure cancellations in an inpatient hospital setting. We aim to identify factors that affect bowel preparation adequacy and procedure cancellations among diagnostic colonoscopies performed during hospitalization.

METHODS

We retrospectively reviewed the electronic medical records of 1,500 consecutive patients who had a diagnostic colonoscopy as an inpatient at a tertiary level hospital over a 2-year period. All patients were administered a clear liquid diet the day prior to the colonoscopy. Patients were then instructed to drink 4 L of polyethylene glycol (PEG, Golytely) between 5 am to 9 am on the day of the procedure. The clinical course of each case was followed to identify quality of preparations, cancelled procedures and the reasons for cancellations. We applied univariate and multivariate logistic regression analysis to identify variables to predict cancellation and poor preparation.

RESULTS

A total of 1,029 patients were included in the study. 194 (18.8%) patients had colonoscopy cancellations and 268 (26.0%) had poor bowel preparations. Multivariate analysis revealed these factors to be associated with colonoscopy cancellations: education at the graduate school level [odds ratio (OR) =1.93, P=0.04], Hispanic ethnicity (OR =0.47, P<0.01), hemoglobin level <10 g/dL (OR =1.41, P=0.05) and if the colonoscopy was done for other indications (OR =0.53, P=0.04). Factors associated with poor bowel preparation on multivariate analysis, were dementia (OR =2.44, P=0.02), gastroparesis (OR =3.97, P=0.01) and inpatient opioids use (OR =1.69, P=0.04).

CONCLUSIONS

The rate of colonoscopy cancellations and poor bowel preparations in inpatient colonoscopies were high, and we were able to identify predictors of inadequate colon preparation and procedure cancellations. Exploring more individualized colon preparation regimens based on personal risk factors could reduce the number of inadequate and cancelled colonoscopies in an inpatient setting.

Phytochemical, UV-Visible and FTIR Assessment along with in vitro Antioxidant Activity of Methanolic Extract of Tephrosia purpurea Linn Root

Aims: The original phytochemical, UV-Visible, and FTIR Spectral estimation of Tephrosia purpuria root was the subject of this study. Natural phytoconstituents were all found in methanolic extracts from the root of Tephrosia purpuria. Study Design:  Experimental research work. Methodology: Furthermore, using UV Visible spectrophotometer equipment, the extract was scanned in the range of 380 to 900 nm, and the characteristic peaks were identified. Results: The UV-VIS data indicated peaks at 382.70, 413.68, 536.18, 610.37, and 664.61 nm, with absorption values of 2.7930, 2.5932, 0.3114, 0.4185, and 1.5966 respectively. The presence of Natural phytoconstituents is confirmed by FTIR spectra. The findings confirm that this plant has key bioactive elements that are beneficial to our health, indicating that more research is needed. Conclusion: Natural phytoconstituents were all found in methanolic extracts from the root of Tephrosia purpuria.

Expression of IL-6, TNF-α, and hs-CRP in the serum of patients undergoing single-sitting and multiple-sitting root canal treatment: A comparative study

Background:

In recent times, single-sitting root canal therapy has gained momentum over multiple-sitting root canal therapy due to its superior clinical outcome and less time required for treating the patient. Aim: Thus, the aim of current study was to compare the expression of interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), and high-sensitivity C-reactive protein (hs-CRP) in the serum of patients undergoing single-sitting and multiple-sitting root canal treatment.

Materials and Methods:

This cross-sectional experimental study was conducted on 300 subjects who were indicated for root canal treatment. Subjects were categorized into Group I (single visit) and Group II (multiple visits).Clinical data was obtained and serum samples were collected both before and after 1 week of treatment completion. Inclusion criteria were those patients (a) over 18 years of age, (b) without any disease of inflammatory etiology, and (c) who had not previously received endodontic treatment or any related therapeutic treatment. Exclusion criteria were those (a) without a complete clinical history, (b) with greater than one indicated tooth, (c) who did not complete their treatment, and (d) with any periodontal disease. Chi-square and Student’s t-test were applied.

Results:

It was found that in single-sitting root canal treatment, there was a statistically significant reduction in these inflammatory biomarkers, although no difference in clinical efficacy was observed.

Conclusion:

Single-visit root canal treatment is a better option for treatment of pulpitis compared to multiple-sitting treatment.

Comparison of Effect of Yoga versus Aerobic Exercise on Waist Circumference, Waist-Hip Ratio and Body Mass Index in Overweight and Obese Adult Individuals

Background Obesity is becoming serious global public health issue due to sedentary lifestyle and bad eating habits. Dietary and lifestyle practices are directly related to obesity, which can cause serious health problems like cardiac ailments, diabetes, and hypertension etc. Vast varieties of options are available for weight reduction including physical exercises, various diet plans and also the pharmacological agents. Physical activity improves the fitness of the individual and helps in reducing the ill effects of the obesity. Objective To compare the effects of Yoga and Aerobic Exercise on weight circumference, waisthip ratio (WHR) and body mass index (BMI) in overweight and obese individuals. Method An experimental study was started with purposive sampling. Sixty overweight and obese individuals from the community were divided equally into two groups, one group was given supervised yoga asana and the other group was given supervised aerobic exercise for 6 weeks. Waist circumference, waist hip ratio and body mass index were taken pre and post intervention. Result Statistically significant difference was seen in pre and post intervention value of waist circumference, waist hip ratio and body mass index in both the groups with the p value < 0.05. However there was no statistical significant difference noted in waist hip ratio in individuals performing aerobic exercises as p value was > 0.05. Conclusion Both the interventions showed significant reduction in waist circumference, waist hip ratio and body mass index, while better results were noted in the individuals performing yoga asanas.

Analysis of Drivers of Digital Learning in COVID-19 and Post-COVID-19 Scenario Using an ISM Approach

Learning through Internet is becoming necessary for easy understanding of complex problems and knowledge sharing process. A new pedagogy is being demanded in the teaching process which includes digital platforms for better understanding. Moreover, software and hardware have been developed for ease of access to the materials and smooth learning. The COVID-19 pandemic brought various challenges in livelihood of human life. One of these challenges is teaching and learning process. Although teaching and learning include usage of digital media, there exist a need to digitalize the education system. In this regard, this study aimed to analyse the drivers of digital learning in COVID-19 and post-COVID-19 scenario. Sixteen drivers pertaining to digital learning have been considered for analysis. Interpretive structural modelling (ISM) approach has been used to analyse drivers of digital learning and to develop a structural model. The developed structural model was further validated using MICMAC analysis. Results reveal that low Internet cost and government supports are the two prominent drivers of digital learning. The implementation of developed ISM model would create smooth learning environment in COVID-19 and motivates for innovation in post-COVID-19 scenario.

Identification of optimal therapeutic window for steroid use in severe alcohol-associated hepatitis: A worldwide study

BACKGROUND & AIMS

Corticosteroids are the only effective therapy for severe alcohol-associated hepatitis (AH), defined by a model for end-stage liver disease (MELD) score >20. However, there are patients who may be too sick to benefit from therapy. Herein, we aimed to identify the range of MELD scores within which steroids are effective for AH.

METHODS

We performed a retrospective, international multicenter cohort study across 4 continents, including 3,380 adults with a clinical and/or histological diagnosis of AH. The main outcome was mortality at 30 days. We used a discrete-time survival analysis model, and MELD cut-offs were established using the transform-the-endpoints method.

RESULTS

In our cohort, median age was 49 (40-56) years, 76.5% were male, and 79% had underlying cirrhosis. Median MELD at admission was 24 (19-29). Survival was 88% (87-89) at 30 days, 77% (76-78) at 90 days, and 72% (72-74) at 180 days. A total of 1,225 patients received corticosteroids. In an adjusted-survival-model, corticosteroid use decreased 30-day mortality by 41% (hazard ratio [HR] 0.59; 0.47-0.74; p <0.001). Steroids only improved survival in patients with MELD scores between 21 (HR 0.61; 0.39-0.95; p = 0.027) and 51 (HR 0.72; 0.52-0.99; p = 0.041). The maximum effect of corticosteroid treatment (21-30% survival benefit) was observed with MELD scores between 25 (HR 0.58; 0.42-0.77; p <0.001) and 39 (HR 0.57; 0.41-0.79; p <0.001). No corticosteroid benefit was seen in patients with MELD >51. The type of corticosteroids used (prednisone, prednisolone, or methylprednisolone) was not associated with survival benefit (p = 0.247).

CONCLUSION

Corticosteroids improve 30-day survival only among patients with severe AH, especially with MELD scores between 25 and 39.

LAY SUMMARY

Alcohol-associated hepatitis is a condition where the liver is severely inflamed as a result of excess alcohol use. It is associated with high mortality and it is not clear whether the most commonly used treatments (corticosteroids) are effective, particularly in patients with very severe liver disease. In this worldwide study, the use of corticosteroids was associated with increased 30-day, but not 90- or 180-day, survival. The maximal benefit was observed in patients with an MELD score (a marker of severity of liver disease; higher scores signify worse disease) between 25-39. However, this benefit was lost in patients with the most severe liver disease (MELD score higher than 51).

Impact of I4.0 technologies and their interoperability on performance: future pathways for supply chain resilience post-COVID-19

Purpose

This study aims to investigate the impact of I4.0 technologies and their interoperability on supply chains (SCs) performance and how the integration of such technologies and their interoperability can create pathways for SCs resilience post-COVID-19. This is of paramount importance in the context of COVID-19 as the investigation around I4.0 technologies may provide relevant insights on how SCs may better respond to unexpected situations like the current pandemic with the use of digital technologies.

Design/methodology/approach

A survey research method was designed based on some constructs extracted from the literature regarding the main disruptive technologies, interoperability, elements of supply chains processes (SCPs) performance such as integration, collaboration, transparency, efficiency, responsiveness and profitability. The data were collected from March to July 2020 from different regions of the world when the peak of the first wave of the pandemic had occurred. The survey resulted in 115 valid responses. The study used a combination of descriptive, correlation and multiple regression methods to analyse the data.

Findings

The study indicates that disruptive technologies significantly impact SCPs performance (integration, collaboration, responsiveness and transparency) and their resilience. The findings did not support the notion that these technologies improve the efficiency of SCs, a significant contrast to the existing literature. Our findings also refute the existing understanding that interoperability moderates the impact of disruptive technologies on SCPs performance and enhancing the resilience of SCs. However, the findings show that the integration of I4.0 technologies and their interoperability has a positive impact on SCPs profitability.

Research limitations/implications

The findings strongly advocate that this integration plays an important role in improving SC performance, and a future pathway of SC resiliency post-COVID-19. Considering that the I4.0 trend will impact SCs in the coming years, this study brings a relevant contribution to researchers and practitioners.

Originality/value

This study makes a unique contribution by investigating a novel causal relationship between the main elements (I4.0 technologies, interoperability, processes performance and strategic outcomes) related to the SC in this new context.

Is artificial intelligence an enabler of supply chain resiliency post COVID-19? An exploratory state-of-the-art review for future research

The challenging situations and disruptions that occurred due to the outbreak of the COVID-19 pandemic have created a severe need for supply chain resiliency (SCR). There has been a growing interest among researchers to investigate the resiliency in supply chain operations to overcome risks and disruptions and to achieve successful project management. The supply chain of every business requires innovative projects to accomplish competitive advantage in the market. This study was conducted to identify the significance of artificial intelligence (AI) for creating a sustainable and resilient supply chain, and also to provide optimum solutions for supply chain risk mitigation. A systematic literature review has been conducted to examine the potential research contribution or directions in the field of AI and SCR. In total, 162 articles were shortlisted from the SCOPUS database in the chosen field of research. Structural Topic Modeling (STM), a big data-based approach, was employed to generate several thematic topics of AI in SCR based on the shortlisted articles, and all topics were discussed. Furthermore, the bibliometric analysis was conducted using R-package to investigate the research trends in the area of AI in SCR. Based on the conducted review of literature, a research framework was proposed for AI in SCR that will facilitate researchers and practitioners to improve technological development in supply chain firms. The purpose is to combat sudden risks and disruptions so that project management will perform well Post COVID-19. The study will be also helpful for future researchers and practitioners to identify research directions based on existing literature covered in this paper in the field of SCR. Future research directions are proposed for AI-enabled resilient supply chain management. This study will also provide several implications for supply chain managers to achieve the required resilience in their supply chains post COVID-19 by focusing on the elements of the proposed research framework.

Hatred and trolling detection transliteration framework using hierarchical LSTM in code-mixed social media text

The paper describes the usage of self-learning Hierarchical LSTM technique for classifying hatred and trolling contents in social media code-mixed data. The Hierarchical LSTM-based learning is a novel learning architecture inspired from the neural learning models. The proposed HLSTM model is trained to identify the hatred and trolling words available in social media contents. The proposed HLSTM systems model is equipped with self-learning and predicting mechanism for annotating hatred words in transliteration domain. The Hindi–English data are ordered into Hindi, English, and hatred labels for classification. The mechanism of word embedding and character-embedding features are used here for word representation in the sentence to detect hatred words. The method developed based on HLSTM model helps in recognizing the hatred word context by mining the intention of the user for using that word in the sentence. Wide experiments suggests that the HLSTM-based classification model gives the accuracy of 97.49% when evaluated against the standard parameters like BLSTM, CRF, LR, SVM, Random Forest and Decision Tree models especially when there are some hatred and trolling words in the social media data.

Comparative Effectiveness of Fecal Immunochemical Tests versus Flexible Sigmoidoscopy for Colorectal Cancer Screening: A Systematic Review and Meta-Analysis of Randomized Clinical Trials

BACKGROUND AND AIMS

Fecal immunochemical tests (FITs) and flexible sigmoidoscopies are commonly used modalities for colorectal cancer (CRC) screening. We performed a systematic review and meta-analysis to compare the effectiveness of FIT and sigmoidoscopy in CRC screening.

METHODS

PRISMA statement and Cochrane guidelines were followed for this review. Digital dissertation databases were searched from inception till December 1st 2020 and randomized clinical trials comparing the detection rates of CRC for FIT and sigmoidoscopy were included. Outcomes for analysis included participation rates and detection rates of CRC, advanced adenomas and advanced colorectal neoplasia for both screening modalities.

RESULTS

Five randomized clinical trials with a total of 261,755 patients were included for the analysis. The participation rate for FIT was significantly higher compared to flexible sigmoidoscopy (OR 2.11, 95% CI 1.29-3.44, p=0.003). In intention-to-screen analysis, the detection rate for advanced colorectal neoplasia was significantly lower with FIT (OR 0.62, 95% CI 0.45-0.84, p=0.002) as compared to flexible sigmoidoscopy but not statistically different for CRC (OR 1.15, 95% CI 0.65-2.02, p=0.63).

CONCLUSION

Despite lower participation amongst patients, CRC screening with flexible sigmoidoscopy leads to higher detection of advanced colorectal neoplasia, when compared to a single round of fecal immunochemical testing.

Identifying predictors and evaluating the role of steroids in the prevention of post-embolization syndrome after transarterial chemoembolization and bland embolization

Background

Transarterial chemoembolization (TACE) and bland embolization (TAE), performed for hepatocellular carcinoma (HCC), are often complicated by post-embolization syndrome (PES). There are limited data regarding the incidence of PES after TAE and the role of steroids in PES. We report the incidence of PES post TACE and TAE, identify predictors, and evaluate the role of steroids in PES.

Methods

Demographic and clinical variables of patients who underwent embolization were collected and PES was identified. Risk factors for PES, TACE and TAE were derived by logistic regression. We compared patients who received dexamethasone to those who did not, regarding baseline characteristics, occurrence of PES, and hospital stay.

Results

A total of 171 patients, average age 60.5 years, underwent the procedure, 77.8% were male, and 87.7% had cirrhosis. Of these 171, 107 underwent TACE and 64 TAE. Dexamethasone was given to 106 (61.9%) patients, of whom 85 had TACE and 21 TAE. One hundred twenty-four patients (72.5%) developed PES. PES occurred in more patients who underwent TACE, 80 (74.7%) vs. 44 (68.7%), and resulted in a longer hospital stay (1.47 vs. 1.12 days, P=0.034). Predictive factors for PES included female sex (odds ratio [OR] 2.76, 95% confidence interval [CI] 1.04-7.34; P=0.041), and alcohol-related HCC (OR 3.14, 95%CI 1.42-6.95; P=0.005). Dexamethasone did not affect the length of hospital stay (1.43 vs. 1.29 days, P=0.422) or the rate of prolonged hospitalization (18.8% vs. 15.4%, P=0.561).

Conclusion

There was no difference in the incidence of PES following TACE or TAE and the use of dexamethasone did not reduce the incidence of PES or the duration of hospital stay.

Integration of continuous improvement strategies with Industry 4.0: a systematic review and agenda for further research

Purpose

The purpose of this paper is to provide a review of the history, trends and needs of continuous improvement (CI) and Industry 4.0. Four strategies are reviewed, namely, Lean, Six Sigma, Kaizen and Sustainability.

Design/methodology/approach

Digitalization and CI practices contribute to a major transformation in industrial practices. There exists a need to amalgamate Industry 4.0 technologies with CI strategies to ensure significant benefits. A systematic literature review methodology has been followed to review CI strategy and Industry 4.0 papers (n = 92).

Findings

Various frameworks of Industry 4.0, their advantages and disadvantages were explored. A conceptual framework integrating CI strategies and Industry 4.0 is being presented in this paper.

Practical implications

The benefits and practical application of the developed framework has been presented.

Originality/value

The article is an attempt to review CI strategies with Industry 4.0. A conceptual framework for the integration is also being presented.

Perioperative intravenous contrast administration and the incidence of acute kidney injury after major gastrointestinal surgery: prospective, multicentre cohort study

BACKGROUND

This study aimed to determine the impact of preoperative exposure to intravenous contrast for CT and the risk of developing postoperative acute kidney injury (AKI) in patients undergoing major gastrointestinal surgery.

METHODS

This prospective, multicentre cohort study included adults undergoing gastrointestinal resection, stoma reversal or liver resection. Both elective and emergency procedures were included. Preoperative exposure to intravenous contrast was defined as exposure to contrast administered for the purposes of CT up to 7 days before surgery. The primary endpoint was the rate of AKI within 7 days. Propensity score-matched models were adjusted for patient, disease and operative variables. In a sensitivity analysis, a propensity score-matched model explored the association between preoperative exposure to contrast and AKI in the first 48 h after surgery.

RESULTS

A total of 5378 patients were included across 173 centres. Overall, 1249 patients (23·2 per cent) received intravenous contrast. The overall rate of AKI within 7 days of surgery was 13·4 per cent (718 of 5378). In the propensity score-matched model, preoperative exposure to contrast was not associated with AKI within 7 days (odds ratio (OR) 0·95, 95 per cent c.i. 0·73 to 1·21; P = 0·669). The sensitivity analysis showed no association between preoperative contrast administration and AKI within 48 h after operation (OR 1·09, 0·84 to 1·41; P = 0·498).

CONCLUSION

There was no association between preoperative intravenous contrast administered for CT up to 7 days before surgery and postoperative AKI. Risk of contrast-induced nephropathy should not be used as a reason to avoid contrast-enhanced CT.

1156 Polysomnographic Total Sleep Time: A Novel Biomarker For Dementia

Introduction

Neuroprotection, early diagnosis, and behavioral intervention are national priorities for dementia research. Sleep duration is emerging as an important potential remediable risk factor. In this study, we examined whether total sleep time (TST) derived from attended overnight polysomnography (PSG) studies is associated with an increased prevalence of dementia diagnosis and determined the optimal cut-point.

Methods

We identified 69,847 PSG sleep studies using CPT code 95810 from 2000-19 in the US Department of Veteran Affairs (VA) national database of patient care. We used natural language processing to verify PSG reports and extract TST values from the patient free-text notes. We examined a TST of 240-420 minutes in 10-minute increments using a run chart (time series) approach to determine the optimal cut-point for determining greater odds of dementia.

Results

Patients had a mean age of 55.4±13.8, 91.5% were male, and 64% were Caucasian. PSG studies revealed a mean TST of 310.6±79.5 minutes. The run chart time series analysis revealing &lt; 360 minutes being the optimal cut-point for increased odds of dementia (OR: 1.64, 95% CI: 1.36-1.99, p&lt;.05).

Conclusion

Lower TST predicted higher prevalence of dementia diagnosis. TST of 360 minutes may serve as the optimal cut-point to determine greater odds of dementia. This is an important study examining PSG sleep duration and the prevalence of dementia across 19 years in the largest integrated healthcare system in the US. TST may function as a potential biomarker for developing dementia.

Support

This material is based upon work supported in part by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). Dr. Nowakowski is also supported by a National Institutes of Health (NIH) Grant (R01NR018342).

1180 The Use Of Natural Language Processing To Extract Data From Psg Sleep Study Reports Using National Vha Electronic Medical Record Data

Introduction

In 2007, Congress asked the Department of Veteran Affairs to pay closer attention to the incidence of sleep disorders among veterans. We aimed to use natural language processing (NLP), a method that applies algorithms to understand the meaning and structure of sentences within Electronic Health Record (EHR) patient free-text notes, to identify the number of attended polysomnography (PSG) studies conducted in the Veterans Health Administration (VHA) and to evaluate the performance of NLP in extracting sleep data from the notes.

Methods

We identified 481,115 sleep studies using CPT code 95810 from 2000-19 in the national VHA. We used rule-based regular expression method (phrases: “sleep stage” and “arousal index”) to identify attended PSG reports in the patient free-text notes in the EHR, of which 69,847 records met the rule-based criteria. We randomly selected 178 notes to compare the accuracy of the algorithm in mining sleep parameters: total sleep time (TST), sleep efficiency (SE) and sleep onset latency (SOL) compared to human manual chart review.

Results

The number of documented PSG studies increased each year from 963 in 2000 to 14,209 in 2018. System performance of NLP compared to manually annotated reference standard in detecting sleep parameters was 83% for TST, 87% for SE, and 81% for SOL (accuracy benchmark ≥ 80%).

Conclusion

This study showed that NLP is a useful technique to mine EHR and extract data from patients’ free-text notes. Reasons that NLP is not 100% accurate included, the note authors used different phrasing (e.g., “recording duration”) which the NLP algorithm did not detect/extract or authors omitting sleep continuity variables from the notes. Nevertheless, this automated strategy to identify and extract sleep data can serve as an effective tool in large health care systems to be used for research and evaluation to improve sleep medicine patient care and outcomes.

Support

This material is based upon work supported in part by the Department of Veteran Affairs, Veterans Health Administration, Office of Research and Development, and the Center for Innovations in Quality, Effectiveness and Safety (CIN 13-413). Dr. Nowakowski is also supported by a National Institutes of Health (NIH) Grant (R01NR018342).

Does an association exist between liver fibrosis and non-HCC cancers

e16594

Background: The association between liver fibrosis and hepatocellular cancer (HCC) is well established, however there is limitation of data on liver fibrosis and non-HCC cancers. The aim of this study was to explore the link between the degree of liver fibrosis and other cancers. Methods: We searched the electronic medical records of Stroger Hospital who underwent liver elastography from January 1st, 2014 to December 31st, 2018 and had cancer. We extracted variables: demographics, cancer histology and metastatic status and then stratified patient into categories based the fibrosis stage. Results: Our analysis identified 103 patients with non-advanced fibrosis (F0-F2) and 74 with advanced fibrosis (F3-F4). HCC was seen in 33.3% of the patients with advanced fibrosis while genitourinary (GU) was the second most common cancer. Adenocarcinoma comprised 21% of these cancers and around 46% were metastatic. Of the 104 patients with non-advanced fibrosis, HCC was seen in 3.77% while gastrointestinal (GI) and GU cancers were seen in 24.27% and 12.62% respectively. Adenocarcinoma was most common (40%) in this group as well (Table). Conclusions: Our study not only reiterates the fact that the degree of liver fibrosis is proportional to the presence of HCC, but it also reports the association of liver fibrosis with several non-HCC cancers. The meaning of these associations is unclear, but it provides an area of further research to explore if causality exists. [Table: see text]

Non-hepatic Cancers Independently Predict Liver Decompensation Events

BACKGROUND

Advanced liver fibrosis and cirrhosis represent independent risk factors for hepatocellular carcinoma (HCC). There is also evidence suggesting that several etiologies of chronic liver disease elevate the risk for non-hepatic cancers, including nonalcoholic fatty liver disease (NAFLD), alcohol abuse, and hepatitis C infection. In the present study, we aim to characterize the cancer incidence in patients with chronic liver disease and assess the prognostic value of non-hepatic cancer on the decompensation events of this population.

METHODS

We retrospectively reviewed the electronic medical records of patients who underwent transient elastography (TE) of liver, at John H. Stroger Hospital in Cook County, Chicago, IL. We identified patients who had decompensation of cirrhosis. We also extracted their cancer history. The cancer profiles of the cohort were compared by the presence or absence of advanced liver fibrosis. We then performed univariate and multivariate forward stepwise Cox regression analysis to identify the significant risk factors for the decompensation events and plotted Kaplan-Meier curve to demonstrate the significance of cancer in the prediction of decompensation events.

RESULTS

We identified a total of 3097 patients who underwent TE. A total of 45 liver decompensation events were documented. In the univariate Cox regression model, MELD-Na score (hazard ratio (HR) 1.25, p < 0.001), liver stiffness measurement (HR 1.05, p = 0.004), and history of any cancer (HR 3.81, p = 0.001) emerged as predictors of decompensation. Non-hepatic cancer proved to be a significant predictor of decompensation (HR 3.57, p = 0.002).

CONCLUSION

The present study represents the first attempt to the best of our knowledge to describe the cancer incidence in this high-risk population. We found that non-HCC cancers independently predict hepatic decompensation events, which is an intriguing finding. We propose that physicians should be more vigilant to cancer history of patients with chronic liver disease as it might provide valuable prognostic information and guide individualized treatment and surveillance plans.

Psychosocial Factors in Mainstreaming Visually Impaired Adults

Seven visually impaired men in India were extensively interviewed regarding their attitudes toward mainstreaming and the problems they were facing. Their IQs and levels of anxiety were also assessed. It was found that, for successful mainstreaming, the characteristics of individuals are as important as the social environments in which they are placed.