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Supplemental material, sj-docx-2-tag-10.1177_17562848231153560 for Effectiveness and safety of ustekinumab in bio-naïve Crohn’s disease patients: a multicentre observational retrospective study by Valdés Delgado Teresa, Olmedo Martín Rául, Iborra Marisa, Herrera de Guisé Claudia, Fuentes-Valenzuela Esteban, Melcarne Luigi, Martín-Rodríguez Mª Mar, Kolle Casso Lilyan, De Castro Parga Luisa, Ponferrada Díaz Ángel, Vicente Lidón Raquel, Manceñido Marcos Noemí, Velayos Jiménez Benito, Lázaro Sáez Marta, López Cauce Beatriz, Mesonero Gismero Francisco, Gilabert Álvarez Pau and Argüelles-Arias Federico in Therapeutic Advances in Gastroenterology

Supplemental material, sj-docx-3-tag-10.1177_17562848231153560 for Effectiveness and safety of ustekinumab in bio-naïve Crohn’s disease patients: a multicentre observational retrospective study by Valdés Delgado Teresa, Olmedo Martín Rául, Iborra Marisa, Herrera de Guisé Claudia, Fuentes-Valenzuela Esteban, Melcarne Luigi, Martín-Rodríguez Mª Mar, Kolle Casso Lilyan, De Castro Parga Luisa, Ponferrada Díaz Ángel, Vicente Lidón Raquel, Manceñido Marcos Noemí, Velayos Jiménez Benito, Lázaro Sáez Marta, López Cauce Beatriz, Mesonero Gismero Francisco, Gilabert Álvarez Pau and Argüelles-Arias Federico in Therapeutic Advances in Gastroenterology

The diets of the Little Eagle Hieraaetus morphnoides and Wedge-tailed Eagle Aquila audax breeding sympatrically in the Australian Capital Territory during 2011–2019 were compared by analysis of pellets and prey remains (six Little Eagle territories and 13 Wedge-tailed Eagle territories; 69 and 49 collections for a total of 232 and 256 prey items, respectively). Little Eagles took 33% mammals (29% European Rabbits Oryctolagus cuniculus), 44% birds, 6% reptiles and 17% insects by number, and 65% mammals (62% Rabbits), 27% birds, 8% reptiles and

Renal squamous cell carcinoma is a rare neoplasm in adults, but with an aggressive behavior. It is diagnosed in most cases in advanced stages. The invasion of the digestive tract by this type of tumor is rare, due to the anatomical arrangement of the colon, however, when it occurs, it carries a poor prognosis for the patient. Digestive endoscopy allows us to reach a definitive diagnosis since these patients usually present digestive manifestations, such as diarrhoea, digestive bleeding or abdominal pain.

The use of premedication for upper gastrointestinal endoscopy (UGE) is not widely established in western countries. The primary aim was to compare gastric visibility according to the total visibility score (TVS). As secondary aim to assess complications, diagnostic yield, endoscopic procedure time, sedation dose and patient' satisfaction.Single center prospective cohort study including consecutive adults undergoing an UGE in the afternoon working shift. After completing enrolment in the control group, patients were administered 200 mg simethicone and 500 mg N-acetylcysteine diluted in 100 ml of water15 minutes before the procedure. All procedures were recorded and a single, blinded endoscopist evaluated the TVS after recruitment of both cohorts. Patient' satisfaction was evaluated using the Spanish translation of the American Society of Gastrointestinal Endoscopy satisfaction questionnaire.205 patients were included, 103 females (50.2%) with a median age of 54.8-years (IQR: 41.2-65.2). 104 were enrolled to the control group and 101 to the intervention group. Patients receiving premedication presented a higher rate of adequate gastric visibility (74.3% vs 45.2; difference 95% CI: 16,3-41,9%, p0.001) and excellent (23.8% vs 7.7%; difference 95% CI: 6,3-25,8%, p=0.002). Propofol dose was similar, although median procedure time was lower in the group of no intervention [5 (IQR: 4-7) vs 6 minutes (IQR: 5-7); p=0.03]. Procedure related adverse events were similar, except that patient without premedication experienced more nausea episodes. Major and minor endoscopic findings and the satisfaction questionnaire showed no differences between both groups.Patients receiving premedication with simethicone and N-acetylcysteine presented a better gastric visibility score, without increase in adverse events or affecting the patients' satisfaction.

BACKGROUND: Postreperfusion liver biopsy (PRB) can assess the degree of ischemia/reperfusion injury (IRI) after orthotopic liver transplantation (OLT). The influence of IRI on graft outcomes and overall survival is controversial. AIM: To determine the correlation between the severity of IRI in PRB and overall graft and patient survival and, secondarily, to identify factors on PRB that predict poor graft outcomes. METHODS: This is a retrospective analysis of all patients who underwent OLT using donation after brain death (DBD) with PRB. The severity of IRI in PRB was graded. Predictors of IRI were assessed using univariate and multivariate analysis and the Kaplan–Meier with log rank test for the graft and overall survival, respectively. RESULTS: We included 280 OLTs (64.7%). The histopathological assessment of IRI severity was as follows: no IRI (N = 96, 34.3%), mild IRI (N = 65; 23.2%), moderate IRI (N = 101; 36.1%), and severe IRI (N = 18; 6.4%). The incidence rates of initial good graft function (IGGF), primary nonfunction and early allograft dysfunction (EAD) were 32.5%, 3.9%, and 18.6%, respectively. Severe IRI was associated with a lower incidence of IGGF (OR: 0.34, 95% CI 0.12–0.92; P = 0.03). Patients with severe IRI tended to have a higher incidence of EAD (33.2% vs. 18.6, P = 0.23). The cold ischemia time was an independent predictor of severe IRI on the multivariate analysis. Severe IRI was associated with poor 1- and 5-year overall survival rates (67% and 44%, respectively, compared with 84 and 68% in nonsevere IRI). Patients with severe IRI exhibited worse graft and overall survival. CONCLUSIONS: Cold ischemia time predicts the development of severe IRI. Patients with severe IRI show worse graft and overall survival and a lower incidence of IGGF, suggesting that histopathological findings could be useful for identifying patients at high risk of worse outcomes after OLT.

Background and Aims Clinical trials and real-life studies with ustekinumab in Crohn’s disease [CD] have revealed a good efficacy and safety profile. However, these data are scarcely available in elderly patients. Therefore, we aim to assess the effectiveness and safety of ustekinumab in elderly patients with CD. Methods Elderly patients [>60 years old] from the prospectively maintained ENEIDA registry treated with ustekinumab due to CD were included. Every patient was matched with two controls under 60 years of age, according to anti-tumour necrosis factor use and smoking habit. Values for the Harvey–Bradshaw Index [HBI], endoscopic activity, C-reactive protein [CRP] and faecal calprotectin [FC] were recorded at baseline and at weeks 16, 32 and 54. Results In total, 648 patients were included, 212 of whom were elderly. Effectiveness was similar between young and elderly patients during the follow-up. Steroid-free remission was similar at week 16 [54.6 vs 51.4%, p = 0.20], 32 [53.0% vs 54.5%, p = 0.26] and 54 [57.8% vs 51.1%, p = 0.21]. Persistence of ustekinumab as maintenance therapy was similar in both age groups [log-rank test; p = 0.91]. There was no difference in the rate of adverse effects [14.2% vs 11.2%, p = 0.350], including severe infections [7.1% vs 7.3%, p = 1.00], except for the occurrence of de novo neoplasms, which was higher in older patients [0.7% vs 4.3%, p = 0.003]. Conclusions Ustekinumab is as effective in elderly patients with CD as it is in non-elderly patients. The safety profile also seems to be similar except for a higher rate of de novo neoplasms, probably related to the age of the elderly patients.

Aim/objective Tectonic penetrating keratoplasty is technically difficult to perform in cases of large corneal perforations. Indeed, severe ocular hypotonia makes it difficult to achieve high-quality trephination. Therefore, it is essential to create a normotensive eye. We investigated the use of a piece of sterile cardboard to seal the globe before recipient trephination. Methods This is a retrospective case series. Patients treated with a new technique of tectonic keratoplasty for the management of large corneal perforations were studied. Main outcome measures were achievement of recipient trephination, preservation of globe integrity preservation and visual acuities. Results This case series included 6 eyes of 6 patients, with a mean age of 51 years (range, 21–79 years). The perforations were 4–7 mm in diameter. Five out of the 6 patients had undergone unsuccessful prior multilayer amniotic membrane transplantations. Mean follow-up period was 14 months (range, 6–24 months). The use of a piece of sterile cardboard to seal the globe made it possible to carry out a circular recipient trephination with a diameter identical to that of the donor corneal graft in all cases. Conjunctival flap and partial tarsorrhaphy were used in three patients and in one patient, respectively. Preservation of globe integrity was achieved in all cases. Visual acuity had improved at the end of follow-up in four patients. Conclusions We describe here a new surgical technique allowing achievement of a circular recipient trephination with a diameter identical to that of the donor corneal graft.

We present the case of a 51-year-old female with a 2-month history of intense anal pain and rectal bleeding. A digital rectal exam revealed a possible lower rectal mass. A colonoscopy was then performed that showed a 5 x 6-cm lesion in the middle rectum and a second 3-cm lesion in the lower rectum, without affecting the anal canal. Multiple biopsies were taken and the histopathologic analysis revealed a moderately differentiated squamous-cell proliferation invading beyond the lamina propria. The CT scan confirmed a middle rectum T4N2bM0 and a lower rectum T3N0M0 synchronous neoplasia. These findings were compatible with a synchronous squamous-cell carcinoma (SCC).

Background & aims The evidence suggests that most vulnerable subjects to COVID-19 infection suffer from patients with comorbidities or immunosuppression, including liver transplant recipients. Liver graft dysfunction may be a rare complication. Some patients complain about the post-COVID-19 syndrome. The aim of this study was to assess medium- and short-term outcomes in liver transplant patients. Patients and methods A retrospective case series was performed at a tertiary referral center. We screened 845 patients who had liver transplant (LT) in our center. All consecutive LT patients with COVID-19 during the Spanish outbreak from March 2020 to April 2021 were included. Demographics, pre-existing comorbidities, clinical and radiological data of COVID-19 infection, complications, and liver graft function were assessed at diagnosis and 3-month follow-up. Results Overall, 20 LT patients were diagnosed with confirmed COVID-19. We included 16 patients that met the inclusion criteria, 8 nonhospitalized (50%) and 8 (50%) hospitalized patients were analyzed. The median follow-up was 5.33 months (IQR 3.06–8.26). One patient died during the follow-up. All patients presented some grade of respiratory or functional symptoms. Dyspnea and fatigue were the most prevalent symptoms during the 3-month follow-up. No liver graft dysfunction were reported despite of partial immunosuppression withdrawal in four patients (25%). One patient had cardiovascular complications. Conclusions Our results suggest the presence of post-COVID-19 syndrome with mild residual physical and psychological dysfunction in this subgroup of patients at 3 months after COVID-19. However, no cases of loss or liver graft dysfunction were reported.

We present the case of a 71-years-old male with a history of pulmonary adenocarcinoma with palliative treatment. He was admitted to our hospital with hematochezia and anemia (Hemoglobin 10.6 g/dl).

We appreciate the interest of Sánchez-Luna et al. in our article "Endoscopic internal drainage using transmural double-pigtail stents in leaks following upper gastrointestinal tract surgery", and find their suggestion about using softer urological double pigtail stents (DPS) for endoscopic internal drainage (EID) interesting.

Introduccion: la pandemia mundial por SARS-CoV-2 obligo a paralizar las unidades de endoscopia. Previamente a la reanudacion de la actividad endoscopica disenamos un protocolo de valoracion de gastroscopias y colonoscopias, desprogramadas durante la pandemia, denegando las no indicadas y priorizando las indicadas. Metodos: establecimos dos tipos de denegacion: a) contexto covid-19 en ≤ 50 anos sin sintomas de alarma y baja probabilidad de hallazgos endoscopicos relevantes; y b) contexto inadecuado por no ser acordes con las guias o protocolos clinicos. Las denegaciones se archivaron en la historia clinica del paciente. Clasificamos las adecuadas en preferentes, convencionales y seguimiento. Comparamos las denegadas por especialidad. Valoramos los hallazgos de las preferentes. Resultados: valoramos 1.658 peticiones (44 % gastroscopias, 56 % colonoscopias) entre el 16 marzo y el 30 junio de 2020. Se consideraron adecuadas 1.164 (70 %), de ellas preferentes el 8,5 %, convencionales el 48 %, seguimiento el 43 % y no valorables el 0,5 %. Se denegaron 494 (30 %): 20 % “contexto covid-19” y 80 % “contexto inadecuado”. Los motivos de denegacion en las gastroscopias fueron: seguimiento de lesiones (33 %), sintomas insuficientemente estudiados (20 %) y sintomas recidivantes con gastroscopia previa (18 %). Los motivos de denegacion en las colonoscopias fueron: vigilancia pospolipectomia (25 %), cancer colorrectal intervenido (21 %) y antecedentes familiares de cancer (13 %). Encontramos diferencias significativas en la denegacion segun la especialidad: Cirugia General (52 %), Hematologia (37 %) y Atencion Primaria (29 %). Un 31 % de las preferentes mostraron hallazgos relevantes. Conclusiones: un 24 % de nuestras endoscopias son discordantes con las recomendaciones cientificas. Su denegacion y la priorizacion de las adecuadas optimizan la utilizacion de recursos.

The intestinal spirochaetosis is defined as the presence of spirochetes on the colonic surface. We present the case of a 57-years-old male, with a history of 4-5 months of diffuse abdominal pain, watery diarrhoea due to this infection. The colonoscopy revealed a serpiginous ulcer in the cecum. The biopsy was positive for intestinal spirochaetosis. It is rare infection, more common among immunocompromised patients and HIV, with a faecal-oral transmission. Most cases are incidental findings in the endoscopic screening. In symptomatic patients the watery diarrhoea and non-specific abdominal pain are the most common symptoms. The macroscopic appearance on the colonoscopy is often normal or non-specific lesions can be identified. The diagnosis is based on the biopsy with haematoxylin and eosin and the confirmation can be made with a Warthin-Starry stain. In symptomatic patients the metronidazole is the preferred treatment option. Although it is rare infection, clinicians should be aware of it in patients with common gastrointestinal symptoms.

INTRODUCTION different endoscopic procedures have been proposed for the management of surgical leaks. Endoscopic internal drainage using trans-fistulary double-pigtail plastic stents has emerged as an alternative strategy, especially in fistulae presenting after laparoscopic gastric sleeve. METHODS a retrospective case series was performed at a single tertiary care center including all upper gastrointestinal post-surgical leaks primarily managed with endoscopic trans-fistulary insertion of double-pigtail plastic stents. Clinical success was defined as the absence of extravasation of oral radiographic contrast and radiological resolution of the collection with adequate oral intake Results: nine patients were included, six (66.6 %) females with a median age of 52.6 years (IQR 47-60). Five cases presented after laparoscopic gastric sleeve, two cases after distal esophagectomies, one after a Roux-en-Y gastric bypass and another one after a pancreaticoduodenectomy. Fistulae measured < 10 mm in five patients (55.6 %) and 10-20 mm in four patients (44.4 %). Six were early leaks. Technical and clinical success was achieved in nine (100 %) and seven (77.8 %) cases, respectively. Seven (77.8 %) patients required ≤ 3 endoscopic procedures. The median hospital stay after the first endoscopic procedure was 12 days (IQR 6.5-17.5 days), while the overall median time until leak healing was 118.5 days (IQR 84.5-170). One patient with a post-esophagectomy intrathoracic leak developed an esophageal-tracheal fistula 37 days after stent deployment. CONCLUSIONS our results support the use of endoscopic internal drainage in postsurgical abdominal leaks, regardless of the type of surgery. Although only two patients with intrathoracic dehiscence were included.

In this paper, model-predictive control is used as a framework for implementing a quasi-time-optimal speed controller for a permanent-magnet synchronous motor. The scheme consists of an inner predictive torque control, which makes use of the full actuation range provided by a two-level voltage source inverter, although with the use of pulsewidth modulation. An outer speed controller, based on classical results for the time-optimal control of the double integrator, constitutes a good example application of the proposed torque controller. The overall scheme achieves both fast transient dynamics (as fast as the physics of the system and the control constraints allow) and acceptable steady-state performance.

In this work, a quasi-time-optimal, nonlinear state-feedback control for the torsional torque of a two-mass system is proposed. The scheme considers constraints in the stator voltage and currents of the driving machine: a permanent-magnet synchronous motor. Its design is based on results of the general framework of optimal control and leverages the assumption of a bang–bang structure for the actuation. In order to render its implementation feasible, the proposed algorithm exploits the geometrical properties displayed by the system state trajectories in the state space, when steered under a time-optimal regime. Spurious chattering is avoided switching to a smoother linear quadratic regulator, once the state reaches the vicinity of the target. The performance of the proposed controller is validated with experimental results, which consider an external proportional-integral controller for the load speed, tuned for relatively high bandwidth.

This paper presents the design of a predictive speed controller for electrical drives. The control scheme does not have a cascaded structure; instead, it uses a single optimization algorithm to generate the control action to be applied at the next sampling instant. The control is based on the optimization of a cost function, which is designed using the insight given by the solution of the minimum-time control problem for a simplified system, namely, the double integrator, which is a reasonable model of the machine dynamic behavior. The experimental results obtained with a permanent-magnet synchronous motor and an induction machine, fed by a two-level three-phase inverter, confirm that this approach reaches a very good dynamic performance without a high computational effort.

This paper presents a predictive strategy for the speed control of a two-mass system driven by a permanent magnet synchronous motor (PMSM). The proposed approach allows to manipulate all the system variables simultaneously, including mechanical and electrical variables in a single control law. The state feedback is achieved with a reduced order extended Kalman filter, which observes the non-measured variables as well as reduces the impact of measurement noise. The performance of the control strategy is shown through simulation and experimental results in a 4 [kW] laboratory prototype.

Multilevel converters can reach medium-voltage operation increasing the efficiency of high-power applications. Among the existing multilevel converter topologies, the modular multilevel converter (MMC) provides the advantages of high modularity, availability, and high power quality. Moreover, the main advantage compared to cascaded multilevel converters is the lack of an input transformer which results in a reduction of cooling requirements, size, and cost. One of the drawbacks of this topology when used as an ac-ac converter is the input and output frequency components in the control loop, resulting in a more complex controller design. In this paper, a single-phase ac-ac MMC predictive control approach is proposed. The controller minimizes the input, output, and circulating current errors and balances the dc voltages. Experimental results show the performance of the proposed predictive control scheme.

Recent concern about the decline of the Little Eagle (Hieraaetus morphnoides) in southeastern Australia has raised questions about whether Wedge-tailed Eagles (Aquila audax) might be implicated in this decline. The ecology, including the diet, of Little Eagles is rather poorly known. The diet of the Wedge- tailed Eagle is better documented, but the overlap in prey used by the two eagles has been little studied. Near Canberra between July 2002 and January 2008, we identified 1421 and 192 prey items from nests of Wedge-tailed Eagles and Little Eagles, respectively. Wedge-tailed Eagles' diet was similar to that reported elsewhere. In addition to European rabbits (Oryctolagus cuniculus), Little Eagles specialized on birds, but tended to avoid macropods, a main prey of Wedge-tailed Eagles, and there was little overlap in prey used by the two eagle species. Although Standardised Food Niche Breadth and Shannon Diversity Index were similar for the two eagles, Wedge-tailed Eagles captured significantly larger prey, as indicated by the difference in Geometric Mean Prey Weight, 1298 g for Wedge-tailed Eagles and 249 g for Little Eagles, which reflected the fivefold difference in mass between male Little Eagles and male Wedge-tailed Eagles. We suggest that direct competition for prey probably was not the cause of the Little Eagle decline.

This paper presents a predictive strategy for the control of a permanent magnet synchronous motor (PMSM). Our approach allows one to simultaneously manipulate speed and electrical variables, without using any auxiliary linear controller. The high sampling rate, characteristic of this technique, and the limited precision of the typical angle measurement devices, present serious difficulties for this technique to work in practice. These issues are dealt with in the paper and a solution based on an extended Kalman filter is proposed. The effectiveness of the proposed approach is evaluated through simulations.

This paper presents the use of a predictive technique to control the currents in a PMSM, driven by a voltage source inverter. This method allows for a high quality current control without using linear controllers and modulators, resulting in a conceptually simple solution. Simulation an experimental results confirm the good performance of the drive controlled by this method.