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Objective response rate was 83.7%. The median progression-free survival (PFS) and overall survival (OS) were 20.5 months (95% CI 14.5– 26.5) and 47.3 months (95% CI 36.7– 58.2), respectively. A high NLR predicted an inferior PFS (HR 1.90 [95% CI 1.02– 3.51], P = 0.042) and OS (HR 3.85 [95% CI 1.39– 10.66], P = 0.009). Patients with stage IVB disease were more likely to have a high baseline NLR than those with stage IIIB-IVA (33.9% vs 15.1%, P = 0.029). Other patients' characteristics did not correlate with the baseline NLR significantly. Patients with a high NLR had significantly more metastatic organs than those with a low NLR (2.5 ± 1.3 vs 1.8 ± 0.9, P = 0.012), particularly brain, liver, and bone metastasis. There was no significant association between NLR and intrathoracic metastasis. Conclusion: Baseline serum NLR could act as an important prognostic marker for EGFR-mutant NSCLC patients receiving first-line osimertinib. A high NLR was associated with higher metastatic burden, more extrathoracic metastases, and therefore, a worse outcome. [ABSTRACT FROM AUTHOR]

Adrenocorticotropic hormone (ACTH)‐producing neuroendocrine neoplasm (NEN) of the thymus is rare. Lymph nodes and bones are the most common metastatic sites. Most cases present with florid Cushing's syndrome (CS). Here, we reported a 58‐year‐old woman, who presented with intermittent flush and weight loss. Imaging studies revealed tumors in the mediastinum, pancreas, and bones. Contrast‐enhanced harmonic endoscopic ultrasound (EUS) of the pancreatic tumors showed heterogeneous and hyperenhancing characteristics. EUS elastography revealed a heterogeneous stiff pattern. EUS‐fine needle biopsy to the pancreatic lesion confirmed the NEN nature. Serum ACTH and cortisol levels were abnormally high. Immunohistochemical staining of the thymic and pancreatic specimens was positive for ACTH. However, the patient did not have obvious CS appearance. The patient underwent surgery, radiation, EUS‐guided ethanol injection, and anti‐cancer medications, but the disease still progressed. The patient died from infection 16 months after NEN was diagnosed. In conclusion, the pancreas can be a metastatic site for ACTH‐producing thymic NEN. EUS‐associated procedures can help in the diagnosis and treatment of pancreatic metastatic NEN. [ABSTRACT FROM AUTHOR]

Abstract: Background and Aims: The incidence and disease burden of colorectal cancer (CRC) in young adults were increasing. However, there was a dearth of advice on how to identify young population at risk for neoplastic colonic polyps (NCPs) and CRC. We aimed to identify risk factors for NCPs and CRC in young adults presenting with bloody stool. Methods: A total of 1496 subjects younger than 40 years old who underwent colonoscopy due to bloody stool from 2005 to 2014 were enrolled in this retrospective study as the study group, and 1481 age‐matched and gender‐matched asymptomatic subjects who underwent colonoscopy for health checkup from 2011 to 2016 were enrolled as the control group at a tertiary center hospital. Results: Multivariate analysis results showed that increasing age (odds ratio [OR] = 1.11, 95% confidence interval [CI]: 1.07–1.15, P < 0.001), higher body mass index (BMI) (OR = 1.07, 95%CI: 1.03–1.12, P = 0.001), diabetes mellitus (OR = 2.80, 95%CI: 1.06–7.42, P = 0.038), and positive family history of CRC (OR = 13.28, 95%CI: 5.70–30.97, P < 0.001) were identified as independent risk factors for NCPs in study group. The best cut‐off values by receiver operating characteristic curve for age and BMI were 32 years old and 24.8 kg/m2, respectively. More risk factors were associated with the higher risk for NCPs (OR = 2.17 every increasing one risk factor, P < 0.001). In the control group, no independent risk factors were identified. Conclusions: Adults aged ≤ 40 years with bloody stool who had increasing age (> 32 years old), higher BMI (> 24.8 kg/m2), diabetes mellitus, and positive family history of CRC had a higher detection rate of NCPs and CRC. [ABSTRACT FROM AUTHOR]

This paper proposes a multiscale flow and transport model which can be used in three-dimensional fractal random fields. The fractal random field effectively describes a field with a high degree of variability to satisfy the one-point statistics of Levy-stable distribution and the two-point statistics of fractional Levy motion (fLm). To overcome the difficulty of using infinite variance of Levy-stable distribution and to provide the physical meaning of a finite domain in real space, truncated power variograms are utilized for the fLm fields. The fLm model is general in the sense that both stationary and commonly used fractional Brownian motion (fBm) models are its special cases. When the upper cutoff of the truncated power variogram is close to the lower cutoff, the stationary model is well approximated. The commonly used fBm model is recovered when the Levy index of fLm is 2. Flow and solute transport were analyzed using the first-order perturbation method. Mean velocity, velocity covariance, and effective hydraulic conductivity in a three-dimensional fractal random field were derived. Analytical results for particle displacement covariance and macrodispersion coefficients are also presented. The results show that the plume in an fLm field moves slower at early time and has more significant long-tailing behavior at late time than in fBm or stationary exponential fields. The proposed fractal transport model has broader applications than those of stationary and fBm models. Flow and solute transport can be simulated for various scenarios by adjusting the Levy index and cutoffs of fLm to yield more accurate modeling results. [ABSTRACT FROM AUTHOR]

Abstract: The use of open-cell metal foam in numerous technologies is increasing rapidly. Heat transfer measurements inside rectangular blocks of commercially available aluminum foam subjected to constant heat flux at one side are presented. Cases for different pore velocities, porosities and pore densities of the foam are given. Each foam block is cooled by a confined stream of ambient air. The temperature profile decays in an exponential fashion as the distance from the heat base increases. A two-dimensional, simplified analytical model for the heat transfer in the foam is summarized and adapted from the literature. The model neglects conduction in the fluid and invokes the local thermal equilibrium assumption for the solid and fluid phases in the foam. The model underestimated the temperature close to the foam’s entrance, and predicted the temperatures inside the foam within the experimental uncertainty for most of the data points. [Copyright &y& Elsevier]

Acute upper gastrointestinal bleeding (UGIB) in acute coronary syndrome (ACS) patients are not uncommon, particularly under dual antiplatelet therapy (DAPT). The efficiency and safety of early endoscopy (EE) for UGIB in these patients needs to be elucidated. This multicenter randomized controlled trial randomized recent ACS patients presenting acute UGIB to non-EE and EE groups. All eligible patients received intravenous proton pump inhibitor therapy. Those in EE group underwent therapeutic endoscopy within 24 h after bleeding. The data regarding efficacy and safety of EE were analyzed. It was early terminated because the UGIB rate was lower than expected and interim analysis was done. In total, 43 patients were randomized to non-EE (21 patients) and EE (22 patients) groups. The failure rate of control hemorrhage (intention-to-treat [ITT] 4.55% vs. 23.81%, p < 0.001; per-protocol [PP] 0% vs. 4.55%, p = 0.058) and 3-day rebleeding rate (ITT 4.55% vs. 28.57%, p = 0.033; PP 0% vs. 21.05%, p = 0.027) were lower in EE than non-EE group. The mortality, minor and major complication rates were not different between two groups. Male patients were at higher risk of minor and major complications after EE with OR (95% CI) of 3.50 (1.15–10.63) and 4.25 (1.43–12.63), respectively. In multivariate analysis, EE was associated with lower needs for blood transfusion (HR 0.13, 95% CI 0.02–0.98). Among patients who discontinued DAPT during acute UGIB, a higher risk (OR 5.25, 95% CI 1.21–22.74) of coronary artery stent re-thrombosis within 6 months was noticed. EE for acute UGIB in recent ACS patients has higher rate of bleeding control, lower 3-day rebleeding rate and lower needs for blood transfusion, but more complications in male patients. Further enrollment is mandatory to avoid bias from small sample size (ClinicalTrial.gov Number NCT02618980, registration date 02/12/2015). [ABSTRACT FROM AUTHOR]

The article presents a case study of a 84-year-old man with chronic hepatitis B-related liver cirrhosis with esophageal and gastric varices presented with significant body weight loss for 4 months. It discusses that computed tomography showed a pancreatic body tumor. It also mentions the potential risks associated with the endoscopic ultrasound-guided fine-needle aspiration such as pancreatitis, internal bleeding, and perforation, hepatic portal vein gas.

Background: Third space endoscopy technique facilitates therapeutic endoscopy in subepithelial space. This study aimed to investigate peroral endoscopic tumor resection (POET) with preserved mucosa technique for upper gastrointestinal tract subepithelial tumors (UGI-SETs) removal. Methods: Between February 2011 and December 2019, consecutive patients with SETs of esophagus and stomach who underwent POET for enlarging size during follow-up, malignant endoscopic ultrasound features or by patient's request were enrolled. Demographic, endoscopic and pathological data were analyzed retrospectively. Results: Totally 18 esophageal (mean ± SD age, 55.23 ± 4.15 year-old, 38.89% female) and 30 gastric (52.65 ± 2.43 year-old, 53.33% female) SETs in 47 patients (one with both esophageal and gastric lesions) were resected. The mean (± SD) endoscopic/pathological tumor size, procedure time, en-bloc/complete resection rate, and hospital stays of esophageal and gastric SET patients were 12.36 (± 7.89)/11.86 (± 5.67) and 12.57 (± 6.25)/12.35 (± 5.73) mm, 14.86 (± 6.15) and 38.21 (± 15.29) minutes, 88.89%/94.44% and 86.77%/93.30%, and 4.14 (± 0.21) and 4.17 (± 0.20) days, respectively. The overall complication rate was 18.75%, including 6 self-limited fever and 3 pneumoperitoneum relieved by needle puncture. There was no mortality or recurrence reported with mean follow-up period of 23.74 (± 4.12) months. Conclusions: POET is a safe and efficient third space endoscopic resection technique for removal of UGI-SETs less than 20 mm. Long term data are warranted to validate these results. [ABSTRACT FROM AUTHOR]

Pancreatic fluid collections (PFCs) including pancreatic pseudocyst (PP) and walled-off necrosis (WON) are complications after acute pancreatitis. We aimed to evaluate the efficacy and safety of endoscopic ultrasound (EUS)-guided lumen-apposing metal stent (LAMS) placement to manage PFCs. Between June 2019 and May 2023, patients with symptomatic PFCs who underwent EUS-guided electrocautery-enhanced LAMS drainage were enrolled retrospectively from eight tertiary centers in Taiwan. In total, 33 [14 (42.42%) PP and 19 (57.58%) WON] patients were enrolled. Gallstones (27.27%) and abdominal pain (72.73%) were the most common etiology and indication for drainage. The technical and clinical success rates were 100% and 96.97%, respectively, and the mean procedure time was 30.55 (± 16.17) min. Complications included one (3.03%) case of self-limited bleeding; there were no cases of mortality. Seven (21.21%) patients had recurrence. Patients with disconnected pancreatic duct syndrome (DPDS) had a higher recurrence rate than those without (71.43% vs. 38.46%, p = 0.05). After replacing LAMSs with transmural double-pigtail plastic stents (DPSs) in the DPDS patients, the DPS migration rate was higher in the patients with recurrence (100% vs. 33.33%, p = 0.04). In conclusion, drainage of symptomatic PFCs with EUS-guided electrocautery-enhanced LAMS appears to be efficient and safe. Replacing LAMSs with DPSs in DPDS patients was associated with a lower recurrence rate. [ABSTRACT FROM AUTHOR]

Graft rejection after intestinal transplantation remains challenging. We aimed to use endoscopy for rejection prediction. Patients ≥7 years old who underwent intestinal transplantation between November 2016 and September 2019 were prospectively enrolled. Magnifying endoscopy under narrow-band imaging was performed through ileostomy. Endoscopic findings were reported as five components (each graded from 0–2): "V" (villi appearance), "E" (erythema), "N" (capillary network), "C" (crypt widening), and "H" (heterogeneity). The correlation between histological severity and endoscopic score was analyzed. Ninety-nine endoscopic biopsies from three female and one male patient were analyzed. The mean ± SD age was of 41.25±13.77 (range 29–58) years. Three short bowel syndrome patients after multiple intestinal resections and one with chronic intestinal pseudo-obstruction were indicated for intestinal transplantation. Sensitivity, specificity, and accuracy of V, E, N, C, and H scores for predicting rejection were 97.4%, 45.9%, 65.7%; 94.7%, 70.5%, 79.8%; 97.4%, 52.5%, 69.7%; 94.7%, 54.1%, 69.7%; and 97.4%, 62.3%, 75.8%, respectively. Pearson's correlation coefficients between total and individual V, E, N, C, H scores and histological rejection were 0.79, 0.64, 0.70, 0.71, 0.73, and 0.66, respectively (P <.001). To predict mild and moderate/severe rejection, total scores more than 4 and 6 had the sensitivity/specificity of 87.50%/57.38% and 96.67%/85.25%, respectively (area under the ROC 0.791 and 0.987). Endoscopic VENCH scoring is promising for predicting rejection after IT. More studies are warranted to validate such results. (ClinicalTrials.gov number, NCT03616548.) • Rejection is one of the most important reasons for graft failure after intestinal transplantation (IT). • Histopathology remains the gold standard for the diagnosis of graft rejection but delay after endoscopy. • Early changes of graft mucosa in rejection after IT could be observed by magnifying endoscopy with narrow-band imaging system. • VENCH endoscopic scoring system is a promising tool for earlier diagnosis of graft rejection after IT than histopathology. [ABSTRACT FROM AUTHOR]

Objectives: Esophageal second primary tumors (SPTs) in head and neck cancer (HNC) patients is not uncommon. The impact of image-enhanced endoscopy (IEE) screening for esophageal SPT on the outcome of HNC patients has not been well clarified.Methods and Methods: Patients with malignancies of the head and neck region and esophagus were recruited from a hospital-based cancer registry between July 2000-December 2016. IEE screening included magnifying endoscopy with narrow-band imaging and chromoendoscopy with Lugol's solution. Biopsied specimens with revised Vienna classification categories 1 and 2 were defined as group I, and those with categories 3 to 5 were defined as group II. The Kaplan-Meier estimate and Cox regression model were used for survival analysis.Results: Totally 1577 HNC and 501 esophageal cancer patients were enrolled. The 5-year overall survival (OS) rates of stage I/II HNC, stage III/IV HNC and esophageal cancer patients were 58%, 29%, and 8%, respectively (p < 0.01). The 5-year OS rate of HNC patients with negative IEE results was higher than that of HNC patients without IEE screening, followed by IEE screening groups I, II and esophageal cancer patients (44% vs. 39% vs. 35% vs. 11% vs. 8%, respectively, p for trend <0.01). Among advanced HNC patients, those who received IEE screening had a trend of better prognosis than those without screening (5-year OS rate of 31% vs. 28%, p = 0.17).Conclusions: IEE screening for esophageal SPTs is helpful in risk stratification and prognosis prediction for HNC patients. Routine IEE screening is recommended in HNC patients. [ABSTRACT FROM AUTHOR]

Abstract: Acetylation of calix[4]arene 1,3-dialkyl ethers yielded the corresponding monoacetates. The 1H NMR spectral analysis indicated that the products’ alkoxy moieties were ‘rotation restricted’. Acylation of calix[4]arene monoalkyl ethers with acetyl chloride yielded monoacetates and/or 2,3-diacetates in different reaction conditions. A simple recrystallization process was able to isolate 2,3-diacetates in good yield. The 1H NMR spectra of the diacetylated products indicated that those compounds also possessed the ‘rotation restricted’ alkoxy moieties. In the presence of K2CO3 as reaction base, alkylation of 2,3-diacetates produced the acetyl-migrated 1,3-dialkyloxy derivatives. Basic hydrolysis of the acetyl-migrated compounds yielded the known 1,3-dialkoxycalix[4]arenes. In the presence of NaH as reaction base, 2,3-diacetates were alkylated with and without the acetyl-migration. For the highly reactive benzyl bromide and allyl bromide, the majority of alkylation proceeded without acetyl-migration. In the other alkyl halides, the products were the acetyl-migrated 1,3-dialkoxy derivatives along with less than one-fourth the amount of non-migrated 1,2-dialkoxy derivatives. [Copyright &y& Elsevier]