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Endoscopic ultrasound-guided biliary drainage (EUS-BD) has dramatically spread and improved in the last two decades and is changing the paradigm of drainage in case of malignant biliary obstruction (MBO). EUS-BD can be achieved from different routes, including the common bile duct (choledochoduodenostomy), intrahepatic bile ducts (hepaticogastrostomy), and gallbladder as a rescue (cholecystogastrostomy/cholecystoduodenostomy). EUS-guided hepaticogastrostomy (EUS-HGS) is a valuable option for biliary drainage in MBO when ERCP fails or is not feasible. EUS-HGS has demonstrated high efficacy with a good rate of technical and clinical success. The safety profile is also overall favorable, although severe adverse events may occur in a significant proportion of patients. From a technical perspective, EUS-HGS is considered one of the most demanding procedures in biliopancreatic endoscopy, requiring multiple steps and high technical skills and experience. In this comprehensive review, technical tips and clinical outcomes of EUS-HGS are reviewed according to the latest evidence in the literature. [ABSTRACT FROM AUTHOR]

Dimension reduction is one of the most sought-after methodologies to deal with high-dimensional ever-expanding complex datasets. Non-negative matrix factorization (NMF) is one such technique for dimension reduction. Here, a multiple deconstruction multiple reconstruction deep learning model (DN3MF) for NMF targeted towards low rank approximation, has been developed. Non-negative input data has been processed using hierarchical learning to generate part-based sparse and meaningful representation. The novel design of DN3MF ensures the non-negativity requirement of the model. The use of Xavier initialization technique solves the exploding or vanishing gradient problem. The objective function of the model has been designed employing regularization, ensuring the best possible approximation of the input matrix. A novel adaptive learning mechanism has been developed to accomplish the objective of the model. The superior performance of the proposed model has been established by comparing the results obtained by the model with that of six other well-established dimension reduction algorithms on three well-known datasets in terms of preservation of the local structure of data in low rank embedding, and in the context of downstream analyses using classification and clustering. The statistical significance of the results has also been established. The outcome clearly demonstrates DN3MF’s superiority over compared dimension reduction approaches in terms of both statistical and intrinsic property preservation standards. The comparative analysis of all seven dimensionality reduction algorithms including DN3MF with respect to the computational complexity and a pictorial depiction of the convergence analysis for both stages of DN3MF have also been presented. [ABSTRACT FROM AUTHOR]

Introduction: Colorectal cancer (CRC) is one of the main causes of deaths worldwide. Early detection and diagnosis of its precursor lesion, the polyp, is key to reduce its mortality and to improve procedure efficiency. During the last two decades, several computational methods have been proposed to assist clinicians in detection, segmentation and classification tasks but the lack of a common public validation framework makes it difficult to determine which of them is ready to be deployed in the exploration room. Methods: This study presents a complete validation framework and we compare several methodologies for each of the polyp characterization tasks. Results: Results show that the majority of the approaches are able to provide good performance for the detection and segmentation task, but that there is room for improvement regarding polyp classification. Discussion: While studied show promising results in the assistance of polyp detection and segmentation tasks, further research should be done in classification task to obtain reliable results to assist the clinicians during the procedure. The presented framework provides a standarized method for evaluating and comparing different approaches, which could facilitate the identification of clinically prepared assisting methods. [ABSTRACT FROM AUTHOR]

Introduction: The development of endoscopic ultrasonography (EUS) has enabled extra-anatomical transmural access to the bile ducts, thus making it possible to perform endoscopic biliary anastomoses with the gastrointestinal (GI) tract and obtain extra-anatomical transpapillary access. EUS provides an alternative to the existing methods of biliary drainage (BD) for cases in which endoscopic retrograde cholangiopancreatography (ERCP) is ineffective. Aim: This study aimed to evaluate the efficacy and safety of extraanatomical endoscopic biliary access methods for the treatment of benign and malignant biliary strictures. Material and methods: This retrospective analysis included treatment results of all patients with obstructive jaundice and biliary strictures who were treated endoscopically in our department between 2016 and 2023. The study group comprised patients in whom EUS-guided transmural access was used during ERCP because of biliary strictures and the lack of transpapillary access. Results: Twenty-eight patients (14.66%) underwent endoscopic transpapillary biliary stenting via a transmural approach under EUS guidance. The remaining 163 patients (85.34%) underwent extraanatomical transmural biliodigestive anastomosis. Technical success was achieved in 186 of 191 (97.38%) patients. Clinical success was achieved in 170 of 191 (89.01%) patients. Complications were reported for 32 of 191 (16.75%) patients, including fatal complications for 6 of 191 (3.14%) patients. Conclusions: Advanced endoscopic techniques involving EUS-guided transmural access are effective and safe for biliary strictures. They provide an alternative to other drainage techniques when ERCP is ineffective and improve the quality of life of patients undergoing palliative treatment for biliary strictures with unresectable cancer of the biliopancreatic area. [ABSTRACT FROM AUTHOR]

This study aims to provide valuable references for clinicians in selecting appropriate surgical methods for biliary tract stones based on patient conditions. In this paper, the advantages and disadvantages of various minimally invasive cholelithiasis surgical techniques are systematically summarized and innovative surgical approaches and intelligent stone removal technologies are introduced. The goal is to evaluate and predict future research priorities and development trends in the field of gallstone surgery. In recent years, the incidence of gallstone-related diseases, including cholecystolithiasis and choledocholithiasis, has significantly increased. This surge in cases has prompted the development of several innovative methods for gallstone extraction, with minimally invasive procedures gaining the most popularity. Among these techniques, PTCS, ERCP, and LCBDE have garnered considerable attention, leading to new surgical techniques; however, it must be acknowledged that each surgical method has its unique indications and potential complications. The primary challenge for clinicians is selecting a surgical approach that minimizes patient trauma while reducing the incidence of complications such as pancreatitis and gallbladder cancer and preventing the recurrence of gallstones. The integration of artificial intelligence with stone extraction surgeries offers new opportunities to address this issue. Regarding the need for preoperative preparation for PTCS surgery, we recommend a combined approach of PTBD and PTOBF. For ERCP-based stone extraction, we recommend a small incision of the Oddi sphincter followed by 30 s of balloon dilation as the optimal procedure. If conditions permit, a biliary stent can be placed post-extraction. For the surgical approach of LCBDE, we recommend the transduodenal (TD) approach. Artificial intelligence is involved throughout the entire process of gallstone detection, treatment, and prognosis, and more AI-integrated medical technologies are expected to be applied in the future. [ABSTRACT FROM AUTHOR]

The accurate early diagnosis of colorectal cancer significantly relies on the precise segmentation of polyps in medical images. Current convolution-based and transformer-based segmentation methods show promise but still struggle with the varied sizes and shapes of polyps and the often low contrast between polyps and their background. This research introduces an innovative approach to confronting the aforementioned challenges by proposing a Dual-Channel Hybrid Attention Network with Transformer (DHAFormer). Our proposed framework features a multi-scale channel fusion module, which excels at recognizing polyps across a spectrum of sizes and shapes. Additionally, the framework's dual-channel hybrid attention mechanism is innovatively conceived to reduce background interference and improve the foreground representation of polyp features by integrating local and global information. The DHAFormer demonstrates significant improvements in the task of polyp segmentation compared to currently established methodologies. [ABSTRACT FROM AUTHOR]

Learning with noisy labels aims to train neural networks with noisy labels. Current models handle instance-independent label noise (IIN) well; however, they fall short with real-world noise. In medical image classification, atypical samples frequently receive incorrect labels, rendering instance-dependent label noise (IDN) an accurate representation of real-world scenarios. However, the current IDN approaches fail to consider the typicality of samples, which hampers their ability to address real-world label noise effectively. To alleviate the issues, we introduce typicality- and instance-dependent label noise (TIDN) to simulate real-world noise and establish a TIDN-combating framework to combat label noise. Specifically, we use the sample's distance to decision boundaries in the feature space to represent typicality. The TIDN is then generated according to typicality. We establish a TIDN-attention module to combat label noise and learn the transition matrix from latent ground truth to the observed noisy labels. A recursive algorithm that enables the network to make correct predictions with corrections from the learned transition matrix is proposed. Our experiments demonstrate that the TIDN simulates real-world noise more closely than the existing IIN and IDN. Furthermore, the TIDN-combating framework demonstrates superior classification performance when training with simulated TIDN and actual real-world noise. [ABSTRACT FROM AUTHOR]

This study reports the complication and disease recurrence rates for ileocecal resection for pediatric and adult Crohn's disease (CD) and identifies perioperative risk factors for these adverse outcomes in the two groups. Patients who underwent ileocecal resection for CD in a tertiary hospital in Italy (2010–2021) were included. Risk factors for postoperative complications and clinical and surgical disease recurrences were investigated with multivariate models. A total of 96 patients were included (children, 25%). There were no intraoperative complications. Thirty-one (32.3%) patients experienced 35 (36.5%) postoperative complications, and five (5.2%) were severe (Clavien–Dindo III–IV–V), with no intergroup difference for either overall postoperative complication rate (p = 0.257) or severe postoperative complication rate (p = 0.097). Most of these (77.1%) occurred within 30 days after surgery, especially in adults (p = 0.013). The multivariate analysis did not show risk factors for postoperative complications. Clinical and surgical recurrence rates after 5 years were 46.8% and 14.6%, respectively, with no intergroup rate differences. Clinical disease recurrence was positively correlated with previous abdominal surgery (p = 0.047) and negatively correlated with preoperative Hb levels (p = 0.046). A positive correlation was found between perianal disease and both clinical (p = 0.045) and surgical disease recurrences (p = 0.045). Urgent surgery was positively associated with surgical disease recurrence (p = 0.045). Notably, no children underwent urgent surgery in this study. In conclusion, the risk of postoperative complications among CD patients receiving ileocecal resection remains high, but most of them are nonserious. Some factors, such as urgent surgery, may increase the risk of disease recurrences. [ABSTRACT FROM AUTHOR]

Introduction: Goal-oriented practices involve practitioners working collaboratively with clients to identify, develop and focus on objectives for the therapeutic work. It has been suggested that the key mechanism underpinning goal-oriented practices with young people is the development of epistemic trust via the foundation of open communication, along with shared decision-making: including young people in decisions about their care. However, goal-oriented work in practice is variable in scope and content, with no research consensus on what it entails, the mechanisms of change and reported outcomes., Method: This research aims to map the extent, range and nature of the evidence-base for goal-oriented practices, including gaps, through a synthesis of the available empirical evidence from the past 20 years. A scoping review of 9783 studies published from 2003 onwards was conducted., Results: In total, 116 studies were identified for inclusion in the review, focusing on goal-oriented practices specifically related to the mental health and wellbeing of children and young people aged 0-18 (including caregivers as relevant). Alongside presentation of the key elements of the included studies, three themes were developed relating to the features of mental health and wellbeing goal-oriented practice in the contexts of the studies: Conceptual and Empirical Constructs of Goal-Oriented Practices, Quality and Making 'Good' Goals, and The Socio-Cultural Contexts of Goal-Oriented Practice., Conclusion: Several areas for future research are identified that will build on this evidence, and further understanding in this area. Work towards the development of best practice principles will move practice towards transparency in the understanding and delivery of goal-oriented practices., (© 2024 The Author(s). Psychology and Psychotherapy: Theory, Research and Practice published by John Wiley & Sons Ltd on behalf of The British Psychological Society.)

Background: Malignant Distal Biliary Obstruction (MBDO) is a common event occurring along the natural history of both pancreatic cancer and cholangiocarcinoma. Epidemiological and biological features make MBDO one of the key elements of the clinical management of patients suffering for of pancreatic cancer or cholangiocarcinoma. The development of dedicated biliary lumen-apposing metal stents (LAMS) is changing the clinical work up of patients with MBDO. i-EUS is an Italian network of clinicians and scientists with a special interest in biliopancreatic endoscopy, EUS in particular., Methods: The scientific methodology was chosen in line with international guidance and in a fashion similar to those applied by broader scientific associations. PICO questions were elaborated and subsequently voted by a broad panel of experts within a simplified Delphi process., Results and Conclusions: The manuscripts describes the results of a consensus conference organized by i-EUS with the aim of providing an evidence based-guidance for the appropriate use of the techniques in patients with MBDO., (© 2024. The Author(s).)

Background/Aims: Endoscopic ultrasound (EUS)-guided hepaticogastrostomy (EUS-HGS) is useful for patients with biliary cannulation failure or inaccessible papillae. However, it can lead to serious complications such as bile peritonitis in patients with ascites; therefore, development of a safe method to perform EUS-HGS is important. Herein, we evaluated the safety of EUS-HGS with continuous ascitic fluid drainage in patients with ascites. Methods: Patients with moderate or severe ascites who underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after the procedure at our institution between April 2015 and December 2022, were included in the study. We evaluated the technical and clinical success rates, EUS-HGS-related complications, and feasibility of re-intervention. Results: Ten patients underwent continuous ascites drainage, which was initiated before EUS-HGS and terminated after completion of the procedure. Median duration of ascites drainage before and after EUS-HGS was 2 and 4 days, respectively. Technical success with EUS-HGS was achieved in all 10 patients (100%). Clinical success with EUS-HGS was achieved in 9 of the 10 patients (90%). No endoscopic complications such as bile peritonitis were observed. Conclusions: In patients with ascites, continuous ascites drainage, which is initiated before EUS-HGS and terminated after completion of the procedure, may prevent complications and allow safe performance of EUS-HGS. [ABSTRACT FROM AUTHOR]

With emergence of Internet of Things (IoT) and subsequent technologies, smart devices are being increasingly used in various domains such as smart homes, smart parking, intelligent transportation etc. Vast amount of image and video data has been produced by IoT based systems in the form of continuous and possibly infinite image and video streams. This demands the development of advanced predictive vision systems which exploits stream mining concepts for intelligent processing of visual data streams. Among other challenges faced by visual data streams, a major challenge is concept drift, which is caused by overtime change in data distribution. In the presence of skewed data, the detection of concept drift becomes more challenging. When analyzing the data generated from smart devices and other performance critical wireless sensors, concept drift affects data integrity and accuracy of prediction results. EWMA for Concept Drift Detection (ECDD) has been proposed in the literature for detecting data streams. However, ECDD has a high prediction error rate which makes it less useful for performance critical data streams generated by imaging and video data streams. In this paper, Vision based Drift Detection Method (VisDDM) is proposed, which systematically handles abrupt and gradual concept drift in data streams. Experiments have been performed using synthetic and real world datasets from different application domains. Our proposed VisDDM algorithm is able to handle abrupt and gradual drift types and outperformed the existing drift detection methods in terms of accuracy and mean evaluation time. [ABSTRACT FROM AUTHOR]

Endoscopic ultrasound (EUS)-guided biliary drainage (EUS-BD) includes EUS-guided hepaticogastrostomy (EUS-HGS), EUS-guided choledochoduodenostomy (EUS-CDS), EUS-guided gallbladder drainage (EUS-GBD), EUS-guided antegrade stenting (EUS-AG) and EUS-guided rendezvous (EUS-RV). While EUS-HGS, EUS-CDS and EUS-GBD are transluminal drainage procedures, EUS-AG is a traspapillary drainage procedure and EUS-RV is a procedure intended to facilitate endoscopic retrograde cholangio pancreatography (ERCP) in instances of failed cannulation. These procedures were initially developed as options for endoscopic salvage of failed ERCP, but have evolved to become first-line interventions also for select indications over time as the technique and expertise improved. Several randomised controlled trials have demonstrated EUS-BD, especially EUS-CDS has similar or even better outcomes as compared to ERCP in malignant biliary obstruction. However, widespread adoption of these modalities is limited by the availability of expertise, steep learning curve, lack of standardization of techniques and cost. In this review, we aim to provide an overview of various EUS-BD procedures including the indications, accessories, technique, outcomes and follow-up of each of these procedures., (© 2024. Indian Society of Gastroenterology.)

Social media has been an increasingly utilized communication tool, and it has gained popularity among adolescent athletes. Our aim here was to investigate whether a positive and honest self-presentation on social media increased adolescent athletes' self-esteem, and we examined the moderating effect of perceived responsiveness. After receiving informed consent of participants and their parents/legal guardians, we recruited 468 adolescent athletes/participants (244 males, 224 females; M age = 15.39 years, SD = 1.61) through purposive sampling and engaged them in completing face-to-face or online self-report measures of their: (a) self-presentation on social media, (b) perceived responsiveness of others, and (c) Rosenberg self-esteem scales. Given the continuous nature of our moderating variable (i.e., perceived responsiveness), we conducted regression analysis using Hayes's PROCESS macro in SPSS software. A positive self-presentation showed no significant relationship with self-esteem, except when the level of perceived responsiveness was high. Conversely, an honest self-presentation was positively related to higher self-esteem, and the relationship between honest self-presentation and self-esteem was moderated by perceived responsiveness. Our findings extend existing psychological theory into the online environment and have practical implications. These data highlight the link between social media self-presentation and self-esteem among adolescent athletes and illustrate the crucial role of perceived responsiveness in the social media context. [ABSTRACT FROM AUTHOR]

Purpose: Accurately predicting the treatment response in patients with Crohn's disease (CD) receiving infliximab therapy is crucial for clinical decision-making. We aimed to construct a prediction model incorporating radiomics and body composition features derived from computed tomography (CT) enterography for identifying individuals at high risk for infliximab treatment failure. Methods: This retrospective study included 137 patients with CD between 2015 and 2021, who were divided into a training cohort and a validation cohort with a ratio of 7:3. Patients underwent CT enterography examinations within 1 month before infliximab initiation. Radiomic features of the intestinal segments involved were extracted, and body composition features were measured at the level of the L3 lumbar vertebra. A model that combined radiomics with body composition was constructed. The primary outcome was the occurrence of infliximab treatment failure within 1 year. The model performance was evaluated using discrimination, calibration, and decision curves. Results: Fifty-two patients (38.0%) showed infliximab treatment failure. Eight significant radiomic features were used to develop the radiomics model. The model incorporating radiomics model score, skeletal muscle index (SMI), and creeping fat showed good discrimination for predicting infliximab treatment failure, with an area under the curve (AUC) of 0.88 (95% CI 0.81, 0.95) in the training cohort and 0.83 (95% CI 0.66, 1.00) in the validation cohort. The favorable clinical application was observed using decision curve analysis. Conclusions: We constructed a comprehensive model incorporating radiomics and muscle volume, which could potentially be used to facilitate the individualized prediction of infliximab treatment response in patients with CD. [ABSTRACT FROM AUTHOR]

We report the first case of lumen apposing metal stent (LAMS) use in malignant stricture of the duodenal apex to treat gastric outlet obstruction (GOO) and to facilitate endoscopic retrograde management of synchronous malignant biliary obstruction due to pancreatic head adenocarcinoma. This technique may be an effective alternative and a simpler approach than current methodology to this endoscopically challenging condition. [ABSTRACT FROM AUTHOR]

Objectives: Parents are one of the main social agents that shape young athletes' experiences and participation in sports, but they are also the least explored group in the literature. Therefore, the purpose of this study was to conduct a systematic review of research on the role of parents in the motivation of young athletes. Method: The systematic literature review consisted of four electronic databases from which 29 articles published in English and in full-text form in peer-reviewed journals between 1999 and 2023 were retrieved. Results: A total of 29 studies met the eligibility criteria. These studies collectively surveyed 9,185 young athlete participants and 2,191 parent participants. The sample comprised 26 quantitative studies and 3 qualitative studies. The findings underscore that parents play both unique and synergistic multidimensional roles in motivating young athletes. Parents' positive goals and values, autonomysupportive parenting styles, moderate parental involvement, positive parent-child relationships, and a parent-initiated task climate are identified as optimal parenting strategies. Conclusion: While parents undeniably play a crucial role in motivating young athletes, the manner and extent of their involvement are key. [ABSTRACT FROM AUTHOR]

Crohn's disease (CD) is a chronic inflammatory bowel disease with different phenotypes of presentation, inflammatory, penetrating, or stricturing disease, that significantly impacts patient well-being and quality of life. Despite advances in medical therapy, surgery sometimes represents the only treatment to address complications, such as strictures, fistulas, or abscesses. Minimizing postoperative recurrence (POR) remains a major challenge for both clinicians and patients; consequently, various therapeutic strategies have been developed to prevent or delay POR. The current review outlines an updated overview of POR management. We focused on diagnostic assessment, which included endoscopic examination, biochemical analyses, and cross-sectional imaging techniques, all crucial tools used to accurately diagnose this condition. Additionally, we delved into the associated risk factors contributing to POR development. Furthermore, we examined recent advances in the prophylaxis and treatment of POR in CD. [ABSTRACT FROM AUTHOR]

Endoscopic retrograde cholangiopancreatography (ERCP) is the workhorse for biliary and pancreatic ductal interventions. Despite advances in both endoscopes and accessories for ERCP, it still has limitations in the presence of altered anatomy, luminal obstruction hindering access to the papilla, and proximal duct obstructions by tight stricture, calculi or intraductal growth. Endoscopic ultrasound-guided biliary drainage (EUS-BD) and EUS-guided pancreatic duct drainage (EUS-PDD) have expanded the rescue procedures after failed ERCP. This review discusses the techniques and results of various EUS-BD procedures, as well as EUS-PDD. [ABSTRACT FROM AUTHOR]

This article, published in Frontiers in Psychology, explores the field of sport psychology and its role in empowering athletes and coaches to achieve their best performance. It discusses the diverse nature of sport psychology, including different sports, competition levels, age groups, and gender considerations. The article emphasizes the importance of applied research in addressing key issues such as understanding the psychological aspects of sports participation, managing stress, and utilizing artificial intelligence. It also discusses the challenges faced in the field and the need for recovery, optimization, and training from a sport psychology perspective. The article highlights the role of sport psychology in supporting athletes and coaches during training, improving performance under pressure, and promoting psychological well-being. It concludes by mentioning the relevance of sport psychology in both traditional sports and esports, and suggests future research areas such as techniques for enhancing coach performance, interventions for handling pressure, the relationship between emotions and performance, and the impact of stakeholders on athletes. The article includes references to relevant research articles on these topics. [Extracted from the article]

Recent advancements in deep learning have significantly improved the intelligent classification of gastrointestinal (GI) diseases, particularly in aiding clinical diagnosis. This paper seeks to review a computer-aided diagnosis (CAD) system for GI diseases, aligning with the actual clinical diagnostic process. It offers a comprehensive survey of deep learning (DL) techniques tailored for classifying GI diseases, addressing challenges inherent in complex scenes, clinical constraints, and technical obstacles encountered in GI imaging. Firstly, the esophagus, stomach, small intestine, and large intestine were located to determine the organs where the lesions were located. Secondly, location detection and classification of a single disease are performed on the premise that the organ's location corresponding to the image is known. Finally, comprehensive classification for multiple diseases is carried out. The results of single and multi-classification are compared to achieve more accurate classification outcomes, and a more effective computer-aided diagnosis system for gastrointestinal diseases was further constructed., (© 2024. International Federation for Medical and Biological Engineering.)

This article discusses the endoscopic closure of a refractory urethroanal fistula using an innovative wound closure device. Gastrointestinal (GI) fistulas are rare chronic diseases that can greatly impact a patient's quality of life. The endoscopic management of GI fistulas involves a combination of endoscopic submucosal dissection (ESD) and mechanical closure of the orifice. The authors report a case of a 29-year-old man with a refractory urethroanal fistula, and they successfully used a new flexible needle holder with a barbed suture to suture the edges of the fistula tract. This novel device allowed for effective closure in a tight area. The procedure was technically successful, with no adverse events reported. The authors suggest that this new needle holder could be added to the range of existing closure methods for gastrointestinal fistulas. [Extracted from the article]