Search

Background:The most appropriate strategy for completing a previous incomplete colonoscopy (IC) is not standardized. We aimed to compare the efficacy and safety of two strategies for completing a previous IC: colon capsule endoscopy (CCE) versus repeat conventional colonoscopy. Methods:A retrospective cohort study that included consecutive adult patients referred to our center after IC under sedation due to irreducible loop formation or colonic fixed angulation was performed. Patients underwent CCE (PillCam COLON2 Medtronic®) or repetition of conventional colonoscopy under sedation. In this setting, an appropriate CCE progression was defined as the capsule reaching the segment achieved during the previous IC. Repeated conventional colonoscopy was considered complete when cecal intubation was accomplished. We compared the rate of appropriate CCE colon progression with the cecal intubation rate from repeated conventional colonoscopy. Quality of colon preparation, diagnostic yield, and rate of adverse events for CCE and colonoscopy was also analyzed. Results:A total of 192 CCE and 181 colonoscopies were performed for IC, primarily due to fixed angulation of the left colon (69.2%, n= 258). There were no significant differences between the two groups (CCE vs. colonoscopy) concerning age, sex, overweight/obesity status, previous abdominal surgery, and reasons for IC. The rate of appropriate colon progression with CCE was not significantly different from the cecal intubation rate of repeated colonoscopy (95.3% vs. 90.1%, p= 0.073, respectively), even after adjusting for the quality of colon preparation (p= 0.122), which differed significantly between the groups (76.0% vs. 92.8%, p< 0.001, respectively). There were no significant differences in overall colorectal findings identified between the CCE and colonoscopy groups (55.2% vs. 62.4%, p= 0.172, respectively), and no adverse events were reported in either group. Conclusions:Our findings suggest that both CCE and repeat conventional colonoscopy are effective and safe options for completing a previous IC.

Introduction:Celiac disease has been associated with gastrointestinal malignancies, most commonly gastrointestinal lymphoma. Nevertheless, rarer malignancies have also been reported, such as small bowel adenocarcinoma, mainly located in the duodenum or jejunum. Case Presentation:We report a case of a female patient with celiac disease with poor adherence to a gluten-free diet who presented with small bowel obstruction due to a primary ileal adenocarcinoma. The patient remains asymptomatic, adherent to the gluten-free diet, and without clinical, biochemical, or imaging evidence of cancer recurrence. Discussion/Conclusion:This case should raise awareness about the importance of the gluten-free diet and the early diagnosis and appropriate management of rare small bowel malignant complications of celiac disease, namely, adenocarcinoma.

While common pancreatic diseases, such as acute pancreatitis (AP), chronic pancreatitis (CP), and pancreatic cancer (PC), may greatly impact the normal pancreatic physiology and contribute to malnutrition, the adequate nutritional approach when those conditions are present significantly influences patients’ prognosis. In patients with AP, the goals of nutritional care are to prevent malnutrition, correct a negative nitrogen balance, reduce inflammation, and improve outcomes such as local and systemic complications and mortality. Malnutrition in patients with CP is common but often a late manifestation of the disease, leading to decreased functional capacity and quality of life and increased risk of developing significant osteopathy, postoperative complications, hospitalization, and mortality. Cancer-related malnutrition is common in patients with PC, and it is now well recognized that early nutritional support can favorably impact survival, not only by increasing tolerance and response to disease treatments but also by improving quality of life and decreasing postoperative complications. The aim of this review was to emphasize the role of nutrition and to propose a systematic nutritional approach in patients with AP, CP, and PC.

Introduction: Femoral fractures in elderly individuals present significant health challenges, often leading to increased morbidity and mortality. Acute kidney injury (AKI) during hospitalization further complicates outcomes, yet the interaction between AKI severity and comorbidities, as quantified by the Charlson Comorbidity Index (CCI), remains poorly understood in this population. This study aimed to assess the associations between AKI severity and the CCI and between AKI severity and one-year mortality postfemoral fracture in elderly patients. Methodology: This study utilized data from the Multiparameter Intelligent Monitoring in Intensive Care (MIMIC-IV) database and focused on elderly patients (> 65 years) admitted with hip fractures. Patients were categorized based on AKI stage according to the KDIGO criteria and CCI scores. The primary outcome assessed was all-cause mortality one year after hospital discharge. The statistical analyses included logistic regression, Cox proportional hazards regression and moderation analysis with the Johnson–Neyman technique to evaluate associations between AKI and long-term mortality and between the CCI and long-term mortality. Results: The analysis included 1,955 patients and revealed that severe AKI (stages 2 and 3) was independently associated with increased one-year mortality. Notably, the CCI moderated these associations significantly. A lower CCI score was significantly correlated with greater mortality in patients with severe AKI. The impact of severe AKI was greater for those with a CCI as low as 3, more than doubling the observed one-year mortality rate. In contrast, higher CCI scores (≥8) did not significantly impact mortality. Sensitivity analyses supported these findings, underscoring the robustness of the observed associations. Conclusion: This study elucidates the complex interplay between AKI severity and comorbidities and long-term mortality in elderly hip fracture patients. These findings underscore the importance of considering both AKI severity and comorbidity burden in prognostic assessments and intervention strategies for this vulnerable population. Targeted interventions tailored to individual risk profiles may help mitigate the impact of AKI on mortality outcomes, ultimately improving patient care and outcomes. Further research is warranted to explore the underlying mechanisms involved and refine risk stratification approaches in this population.

Aim/purpose– In this paper, we explore the contribution of Human Resource Management Systems (HRMS) to innovation in SMEs. We consider two HRMS with different orientations: Commitment HRMS (focusing on long-term career development to increase employees’ creativity) and Collaboration HRMS (focusing on the use of external human capital to achieve innovation). We believe that SMEs’ radical and incremental innovation follow different paths from a configurational perspective. We want to understand how the two HRMS influence radical and incremental innovation, consequently, we explore the contributions of Commitment HRMS and Collaboration HRMS.

Fuel efficiency in platooning systems is a central topic of interest because of its significant economic and environmental impact on the transportation industry. In platoon systems, Adaptive Cruise Control (ACC) is widely adopted because it can guarantee string stability while requiring only radar or lidar measurements. A key parameter in ACC is the desired time gap between the platoon's neighboring vehicles. A small time gap results in a short inter-vehicular distance, which is fuel efficient when the vehicles are moving at constant speeds due to air drag reductions. On the other hand, when the vehicles accelerate and brake a lot, a bigger time gap is more fuel efficient. This motivates us to find a policy that minimizes fuel consumption by conveniently switching between two desired time gap parameters. Thus, one can interpret this formulation as a dynamic system controlled by a switching ACC, and the learning problem reduces to finding a switching rule that is fuel efficient. We apply a Reinforcement Learning (RL) algorithm to find a time switching policy between two desired time gap parameters of an ACC controller to reach our goal. We adopt the proximal policy optimization (PPO) algorithm to learn the appropriate transient shift times that minimize the platoon's fuel consumption when it faces stochastic traffic conditions. Numerical simulations show that the PPO algorithm outperforms both static time gap ACC and a threshold-based switching control in terms of the average fuel efficiency

ABSTRACTBackgroundEarly diagnosing bacterial infection in cirrhotic patients is critical but challenging. Neutrophil-to-lymphocyte ratio (NLR) reflects systemic inflammation and is an emerging biomarker that replicates cirrhosis’ imbalanced immune response.AimAssess whether NLR levels associate with higher risk of infection in patients admitted with first cirrhosis decompensation.MethodsRetrospective, unicenter study, including patients with cirrhosis, admitted to the hospital at first decompensation. NLR was calculated at admission. Applying logistic regression models and testing for discriminative power, we correlated NLR with the outcome infection.ResultsWe included 139 patients. Forty-four infections to report (31.7%), 18 (12.9%) community infections and 26 (18.7%) hospital-acquired infections.Higher NLR values at admission were associated with increased infection risk in univariable and multivariable models – for each unit increase of NLR, infection odds increased 1.29 times (95%CI = 1.09–1.53; p = 0.003), after adjusting for covariates. We performed a classification tree based only on NLR to evaluate the risk of infection. A high-risk group (proportion of patients with infection = 87%) was identified, corresponding to NLR>14; patients with NLR <3.6 presented lower infection risk (17%).Regarding hospital-acquired infection, we were not able to discriminate groups of patients based on classification trees.ConclusionNLR is a straightforward approach to attest the individual infection risk on cirrhotic patients. We report NLR cutoffs 3.6 and 14 as optimal for overall infection diagnosing, mainly due to community infection.

Chemical, biological, radiological and nuclear (CBRN) threats pose many challenges to address in terms of reconnaissance, detection, personnel protection and countermeasures comprising a common set of techniques and procedures that fit in the concept of “all hazard” approach. The scientific and technological developments that led to the use of unmanned aerial systems (UAS) in an ubiquitous manner, enables its integration in CBRN operations, as sensors platforms for detection. In this scope, the GammaEx project targets to validate the concepts of operation using a specifically developed UAS with ATmosphères EXplosives (ATEX) compliance, equipped with chemical and radiological sensors for detection in CBRN scenarios. This paper aims to review the main concepts and challenges involving the sensors integration in UAS for specific CBRN environments considering the ATEX compliance, followed by the GammaEx project description and the presentation of the preliminary results of the laboratory and field comparative assays concerning the specifically developed sensors for the project and the commercial of the shelf sensors, follow on activities and future trends.

Biometric recognition and presentation attack detection (PAD) methods strongly rely on deep learning algorithms. Though often more accurate, these models operate as complex black boxes. Interpretability tools are now being used to delve deeper into the operation of these methods, which is why this work advocates their integration in the PAD scenario. Building upon previous work, a face PAD model based on convolutional neural networks was implemented and evaluated both through traditional PAD metrics and with interpretability tools. An evaluation on the stability of the explanations obtained from testing models with attacks known and unknown in the learning step is made. To overcome the limitations of direct comparison, a suitable representation of the explanations is constructed to quantify how much two explanations differ from each other. From the point of view of interpretability, the results obtained in intra and inter class comparisons led to the conclusion that the presence of more attacks during training has a positive effect in the generalisation and robustness of the models. This is an exploratory study that confirms the urge to establish new approaches in biometrics that incorporate interpretability tools. Moreover, there is a need for methodologies to assess and compare the quality of explanations.

Introduction:Although upper gastrointestinal bleeding (UGIB) management has improved substantially in the last decades, there is still much controversy regarding the optimal timing for performance of endoscopy. Recent guidelines suggest performing an early endoscopy within 24 h of nonvariceal UGIB (NVUGIB) presentation, although its impact on patients with different bleeding risks remains unclear. Aim:To evaluate the impact of performing endoscopy within 24 h on NVUGIB outcomes and to compare it in patients with lower-risk vs. higher-risk bleeding. Methods:This is a retrospective cohort study including consecutive patients undergoing upper endoscopy for suspected NVUGIB over 4 years. Demographic, clinical, biochemical, endoscopic, and outcome data were collected. Lower-risk bleeding was defined as a Glasgow-Blatchford score (GBS) <12 and higher-risk bleeding was defined as a GBS ≥12. Results:A total of 298 patients with suspected NVUGIB were included, 55% of whom had higher-risk bleeding. Endoscopy was performed within 24 h in 62.1% of the patients. In lower-risk bleeding patients, performance of endoscopy within 24 h was associated with a higher need for endoscopic treatment (OR = 2.6; 95% CI 1.2–5.7; p= 0.004), a lower 30-day mortality (OR = 0.41; 95% CI 0.27–0.63; p= 0.03), and a lower need for transfusion (OR = 0.58; 95% CI 0.36–0.92; p= 0.02). In higher-risk bleeding patients, there were no statistically significant differences in NVUGIB outcomes in performing endoscopy within 24 h. Conclusion:Endoscopy within 24 h of presentation was associated with a lower need for transfusion, a higher need for endoscopic treatment, and a lower 30-day mortality in lower-risk NVUGIB patients. Thus, performing endoscopy within the first 24 h of presentation can have a positive impact on NVUGIB outcomes even in lower-risk bleeding.

Morphing attacks keep threatening biometric systems, especially face recognition systems. Over time they have become simpler to perform and more realistic, as such, the usage of deep learning systems to detect these attacks has grown. At the same time, there is a constant concern regarding the lack of interpretability of deep learning models. Balancing performance and interpretability has been a difficult task for scientists. However, by leveraging domain information and proving some constraints, we have been able to develop IDistill, an interpretable method with state-of-the-art performance that provides information on both the identity separation on morph samples and their contribution to the final prediction. The domain information is learnt by an autoencoder and distilled to a classifier system in order to teach it to separate identity information. When compared to other methods in the literature it outperforms them in three out of five databases and is competitive in the remaining.

Introduction:Although different scores have been suggested to predict outcomes in the setting of upper gastrointestinal bleeding (UGIB), few comparative studies between simplified versions of older scores and recent scores have been published. We aimed to evaluate the accuracy of pre- (PreRS) and postendoscopic Rockall scores (PostRS), the Glasgow-Blatchford score (GBS) and its simplified version (sGBS), as well as the AIMS65 score in predicting different clinical outcomes. Methods:In this retrospective study, PreRS, PostRS, GBS, sGBS, and AIMS65 score were calculated, and then, areas under the receiver operating characteristic curve were used to evaluate the performance of each score to predict blood transfusion, endoscopic therapy, surgery, admission to intensive/intermediate care unit, length of hospital stay, as well as 30-day rebleeding or mortality. Results:PreRS, PostRS, GBS, and sGBS were calculated for all the 433 included patients, but AIMS65 calculation was only possible for 315 patients. Only the PreRS and PostRS were able to fairly predict 30-day mortality. The GBS and sGBS were good in predicting blood transfusion and reasonable in predicting surgery. None of the studied scores were good in predicting the need for endoscopic therapy, admission to intensive/intermediate care unit, length of hospital stay, and 30-day rebleeding. Conclusions:Owing to the identified limitations, none of the 5 studied scores could be singly used to predict all the clinically relevant outcomes in the setting of UGIB. The sGBS was as precise as the GBS in predicting blood transfusion and surgery. The PreRS and PostRS were the only scores that could predict 30-day mortality. An algorithm using the PreRS and the sGBS as an initial approach to patients with UGIB is presented and suggested.

This review aims to analyze and synthesize the literature produced so far on investor behavior in the cryptocurrency market. We use VOSviewer 1.6.17 software to perform a bibliometric analysis and elaborate a systematic literature review on investor behavior in the cryptocurrency market on a sample of 166 papers published in journals ranked in the ABS 2021 journal list, considering the different fields of knowledge. We found a growing body of literature on the presence of herding behavior in the cryptocurrency market, where there are indications that the main intentions behind crypto investment are mostly affected by social influence or public sentiment; the crypto market is dominated by irrational investors who base their investment decisions on market sentiment; the uncertainty of the fundamentals leads to investors’ dispersed beliefs, which in turn leads to high trading and speculative bubbles. Additionally, we demonstrate some sociodemographic characteristics of crypto investors and some characteristics of the crypto market that affect investors’ behavior, such as market inefficiency. Our study helps researchers and academics, investors, and regulators by providing a structured network analysis for literature strands, with relevant information for future studies on crypto investor behavior. In addition, it shows the most relevant factors that influence the behavior of the crypto market and its investors, providing the basis for better regulation and protection of investors in the cryptocurrency market.

Gastric antral vascular ectasia (GAVE) is a capillary-type vascular malformation of the gastric antrum and an infrequent cause of chronic gastrointestinal blood loss and iron deficiency anemia.

Background:Despite several investigations suggesting that obesity is a risk indicator for periodontitis, little is known about the effect of obesity on periodontal treatment response. The aim of this study is to evaluate the effects of scaling and root planing (SRP) on clinical parameters and circulating levels of leptin and adiponectin in patients with obesity with chronic periodontitis (CP). Methods:Twenty‐four patients with obesity and CP and 24 patients without obesity with CP were submitted to SRP. Clinical parameters were assessed at baseline and 3 and 6 months after therapy. Serum levels of leptin and adiponectin were evaluated at all time points, using enzyme‐linked immunosorbent assay. Results:SRP improved the clinical parameters of both groups at 3 and 6 months (P<0.05). Nonetheless, the patients without obesity presented a lower mean probing depth (PD) at 6 months after therapy and a greater reduction in PD from baseline to 6 months in the full‐mouth analysis (primary outcome variable) and in initially deep sites (P<0.05). Leptin serum levels were higher in patients with obesity than in patients without obesity at all time points (P<0.05). No changes in the serum levels of leptin and adiponectin were observed in groups with and without obesity after therapy (P>0.05). Conclusions:Patients with obesity and CP presented lower reductions in PD than patients without obesity with CP at 6 months after SRP. Furthermore, the treatment did not affect the circulating levels of leptin and adiponectin in any group.