Pancreatic cystic lesions (PCLs) are well-known precursors of pancreatic cancer. Their diagnosis can be challenging as their behavior varies from benign to malignant disease. Precise and timely ...management of malignant pancreatic cysts might prevent transformation to pancreatic cancer. However, the current consensus guidelines, which rely on standard imaging features to predict cyst malignancy potential, are conflicting and unclear. This has led to an increased interest in radiomics, a high-throughput extraction of comprehensible data from standard of care images. Radiomics can be used as a diagnostic and prognostic tool in personalized medicine. It utilizes quantitative image analysis to extract features in conjunction with machine learning and artificial intelligence (AI) methods like support vector machines, random forest, and convolutional neural network for feature selection and classification. Selected features can then serve as imaging biomarkers to predict high-risk PCLs. Radiomics studies conducted heretofore on PCLs have shown promising results. This cost-effective approach would help us to differentiate benign PCLs from malignant ones and potentially guide clinical decision-making leading to better utilization of healthcare resources. In this review, we discuss the process of radiomics, its myriad applications such as diagnosis, prognosis, and prediction of therapy response. We also discuss the outcomes of studies involving radiomic analysis of PCLs and pancreatic cancer, and challenges associated with this novel field along with possible solutions. Although these studies highlight the potential benefit of radiomics in the prevention and optimal treatment of pancreatic cancer, further studies are warranted before incorporating radiomics into the clinical decision support system.
•Pancreatic cystic lesions (PCLs) are well known radiographic identifiable precursors of pancreatic ductal adenocarcinoma.•Precise and timely management of malignant pancreatic cysts might prevent transformation to pancreatic cancer.•Radiomics can be used as a diagnostic and decision making tool to differentiate benign PCLs from malignant ones.•We review the radiomics studies done in PCLs, challenges associated with radiomics along with possible solutions.
Background
Several routes of fecal microbiota transplantation (FMT) administration are available for treating recurrent
Clostridioides difficile
infections (CDI), the most recent of which are ...capsules.
Aim
To assess the efficacy of colonoscopy, capsule, enema, and nasogastric tube (NGT) FMT for the treatment of recurrent CDI.
Methods
We reported clinical outcomes of colonoscopy, capsule, enema, and NGT FMT for the treatment of recurrent CDI according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. During January 2000 to January 2018, three databases were searched: PubMed, EMBASE, and CINAHL. Primary outcome was overall cure rate which was assessed using a random effects model; secondary outcomes included adverse effects as well as subgroup analyses comparing donor relationship, sample preparation, and study design.
Results
Twenty-six studies (1309 patients) were included in the study. FMT was administered using colonoscopy in 16 studies (483 patients), NGT in five studies (149 patients), enema in four studies (360 patients), and capsules in four studies (301 patients). The random effects of pooled FMT cure rates were colonoscopy 94.8% (CI 92.4–96.8%;
I
2
15.6%), capsule 92.1% (CI 88.6–95.0%;
I
2
7.1%), enema 87.2% (CI 83.4–90.5%;
I
2
0%), and NGT/NDT 78.1% (CI 71.6–84.1%;
I
2
0%). On subgroup analysis of colonoscopy FMT, sample preparation methods had comparable cure rates: fresh 94.9% compared to 94.5%. Similarly, cure rates were unaffected by donor relationship: mixed 94.5% compared to unrelated donor 95.7%.
Conclusion
CDI cure rates with FMT performed with colonoscopy are superior to enema and NGT FMT, while those with FMT with colonoscopy and capsule are comparable.
Pancreatic ductal adenocarcinoma (PDAC) is an incredibly deadly disease with a 5-year survival rate of 9%. The presence of pancreatic cystic lesions (PCLs) confers an increased likelihood of future ...pancreatic cancer in patients placing them in a high-risk category. Discerning concurrent malignancy and risk of future PCL progression to cancer must be carefully and accurately determined to improve survival outcomes and avoid unnecessary morbidity of pancreatic resection. Unfortunately, current image-based guidelines are inadequate to distinguish benign from malignant lesions. There continues to be a need for accurate molecular and imaging biomarker(s) capable of identifying malignant PCLs and predicting the malignant potential of PCLs to enable risk stratification and effective intervention management. This review provides an update on the current status of biomarkers from pancreatic cystic fluid, pancreatic juice, and seromic molecular analyses and discusses the potential of radiomics for differentiating PCLs harboring cancer from those that do not.
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Background
Nonalcoholic fatty liver disease (NAFLD) has become the most common form of chronic liver disease in the USA. Interestingly, most patients with NAFLD are unaware of having any liver ...disease (LD). We aimed to assess the awareness of suspected NAFLD and factors associated with being aware of LD.
Methods
Adult subjects with suspected NAFLD (BMI > 25) with elevated ALT in the absence of secondary causes of LD who participated in the continuous national health and nutrition examination survey (NHANES) during 2001–2016 were identified and analyzed. Trends of NAFLD awareness were then assessed in periods of 4 years each. Multivariable logistic regression analysis was performed to assess factors associated with LD awareness.
Results
A total of 7033 subjects were included in the final analysis (1731, 1757, 1711, and 1834 subjects for the periods of 2001–2004, 2005–2008, 2009–2012, and 2013–2016, respectively). Over the study duration, an increase in BMI, waist circumference, diabetes, and HbA1c; and a decrease in the number of smokers, platelets count, bilirubin, total cholesterol, and LDL level were noticed (
p
< 0.001). Awareness of having LD across study periods has increased over time from 1.5% in the 2001–2004 periods to 3.1% in the 2013–2016 periods. Multivariable logistic regression analysis showed that older age, ethnicity (non-black), having fewer drinks/week, metabolic syndrome, higher ALT, ALP, and GGT were associated with being aware of having LD.
Conclusions
Awareness of having LD among subjects with suspected NAFLD has increased over the last two decades, but more than 95% of these patients are still unaware of having LD. Educational programs to increase awareness of LD and risk factors for NAFLD should be implemented on a large scale.
Clinical Trial Registration Number
Not required, as we used de-identified NHANES data.
...these data come from experienced advanced endoscopists. Methods: This was a multicenter, retrospective analysis of all patients who underwent EGBD, performed by 7 early career advanced ...endoscopists. Patient and Procedural Characteristics Indication N = 21 patients Acute Cholecystitis 18 (86%) Symptomatic Cholelithiasis 3 (14%) Patient characteristics Female 10 (48%) Age 75 years (SD 12) Inpatient 17 (81%) Chronic kidney disease 3 (14%) Diabetes mellitus 11 (52%) Cirrhosis 1 (5%) Platelet count (K/cmm) 247 (SD 64) INR 1.2 (SD 0.22) Anticoagulation use Apixaban Enoxaparin 8 (38%) 7 (33%) 1 (5%) Procedure characteristics Site of Lumen Apposing Metal Stent placement Stomach Duodenum 15 (71%) 6 (29%) Size of Lumen Apposing Metal Stent 10 mm x 10 mm 15 mm x 10 mm 14 (67%) 7 (33%) Outcomes Technical success 21 (100%) Clinical success 21 (100%) Stent removed 10 (48%; average 41 days) Recurrent Cholecystitis 0 Length of follow-up (days, median) 75 Adverse events Any adverse event 2 (10%) Need for admission following procedure 1 (5%) Post-procedural pain within 30-days 1 (5%) Death within 30-days 0
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