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Clinical characteristics of acute non-varicose upper gastrointestinal bleeding and the effect of endoscopic hemostasis 被引量:4
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作者 Xiao-Juan Wang Yu-Peng Shi +4 位作者 Li Wang Ya-Ni Li Li-Juan Xu Yue Zhang Shuang Han 《World Journal of Clinical Cases》 SCIE 2024年第9期1597-1605,共9页
BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)constitutes a prevalent emergency within Gastroenterology,encompassing 80%-90%of all gastrointestinal hemorrhage incidents.This condition is distin... BACKGROUND Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)constitutes a prevalent emergency within Gastroenterology,encompassing 80%-90%of all gastrointestinal hemorrhage incidents.This condition is distinguished by its abrupt onset,swift progression,and notably elevated mortality rate.AIM To gather clinical data from patients with ANVUGIB at our hospital in order to elucidate the clinical characteristics specific to our institution and analyze the therapeutic effectiveness of endoscopic hemostasis.METHODS We retrospectively retrieved the records of 532 patients diagnosed with ANVUGIB by endoscopy at our hospital between March 2021 and March 2023,utilizing our medical record system.Data pertaining to general patient information,etiological factors,disease outcomes,and other relevant variables were meticulously collected and analyzed.RESULTS Among the 532 patients diagnosed with ANVUGIB,the male-to-female ratio was 2.91:1,with a higher prevalence among males.Notably,43.6%of patients presented with black stool as their primary complaint,while 27.4%had hematemesis as their initial symptom.Upon admission,17%of patients exhibited both hematemesis and black stool,while most ANVUGIB patients primarily complained of overt gastrointestinal bleeding.Urgent routine blood examinations at admission revealed that 75.8%of patients had anemia,with 63.4%experiencing moderate to severe anemia,and 1.5%having extremely severe anemia(hemoglobin<30 g/L).With regard to etiology,53.2%of patients experienced bleeding without a definitive trigger,24.2%had a history of using gastric mucosa-irritating medications,24.2%developed bleeding after alcohol consumption,2.8%attributed it to improper diet,1.7%to emotional excitement,and 2.3%to fatigue preceding the bleeding episode.Drug-induced ANVUGIB was more prevalent in the elderly than middle-aged and young individuals,while bleeding due to alcohol consumption showed the opposite trend.Additionally,diet-related bleeding was more common among the young age group compared to the middle-aged group.Gastrointestinal endoscopy identified peptic ulcers as the most frequent cause of ANVUGIB(73.3%),followed by gastrointestinal malignancies(10.9%),acute gastric mucous lesions(9.8%),and androgenic upper gastrointestinal bleeding(1.5%)among inpatients with ANVUGIB.Of the 532 patients with gastrointestinal bleeding,68 underwent endoscopic hemostasis,resulting in an endoscopic treatment rate of 12.8%,with a high immediate hemostasis success rate of 94.1%. 展开更多
关键词 Acute non-varicose upper gastrointestinal bleeding Clinical characteristics Cause of disease Endoscopic homeostatic therapy
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Abnormal uterine bleeding successfully treated via ultrasoundguided microwave ablation of uterine myoma lesions: Three case reports 被引量:1
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作者 Toshiyuki Kakinuma Kaoru Kakinuma +3 位作者 Rora Okamoto Kaoru Yanagida Michitaka Ohwada NobuhiroTakeshima 《World Journal of Clinical Cases》 SCIE 2024年第5期980-987,共8页
BACKGROUND Microwave endometrial ablation(MEA)is a minimally invasive treatment method for heavy menstrual bleeding.However,additional treatment is often required after recurrence of uterine myomas treated with MEA.Ad... BACKGROUND Microwave endometrial ablation(MEA)is a minimally invasive treatment method for heavy menstrual bleeding.However,additional treatment is often required after recurrence of uterine myomas treated with MEA.Additionally,because this treatment ablates the endometrium,it is not indicated for patients planning to become pregnant.To overcome these issues,we devised a method for ultrasound-guided microwave ablation of uterine myoma feeder vessels.We report three patients successfully treated for heavy menstrual bleeding,secondary to uterine myoma,using our novel method.CASE SUMMARY All patients had a favorable postoperative course,were discharged within 4 h,and experienced no complications.Further,no postoperative recurrence of heavy menstrual bleeding was noted.Our method also reduced the myoma’s maximum diameter.CONCLUSION This method does not ablate the endometrium,suggesting its potential appli-cation in patients planning to become pregnant. 展开更多
关键词 Uterine myoma MICROWAVE Heavy menstrual bleeding DYSMENORRHEA Fertility preservation Case report
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Automatic detection of small bowel lesions with different bleeding risks based on deep learning models 被引量:1
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作者 Rui-Ya Zhang Peng-Peng Qiang +5 位作者 Ling-Jun Cai Tao Li Yan Qin Yu Zhang Yi-Qing Zhao Jun-Ping Wang 《World Journal of Gastroenterology》 SCIE CAS 2024年第2期170-183,共14页
BACKGROUND Deep learning provides an efficient automatic image recognition method for small bowel(SB)capsule endoscopy(CE)that can assist physicians in diagnosis.However,the existing deep learning models present some ... BACKGROUND Deep learning provides an efficient automatic image recognition method for small bowel(SB)capsule endoscopy(CE)that can assist physicians in diagnosis.However,the existing deep learning models present some unresolved challenges.AIM To propose a novel and effective classification and detection model to automatically identify various SB lesions and their bleeding risks,and label the lesions accurately so as to enhance the diagnostic efficiency of physicians and the ability to identify high-risk bleeding groups.METHODS The proposed model represents a two-stage method that combined image classification with object detection.First,we utilized the improved ResNet-50 classification model to classify endoscopic images into SB lesion images,normal SB mucosa images,and invalid images.Then,the improved YOLO-V5 detection model was utilized to detect the type of lesion and its risk of bleeding,and the location of the lesion was marked.We constructed training and testing sets and compared model-assisted reading with physician reading.RESULTS The accuracy of the model constructed in this study reached 98.96%,which was higher than the accuracy of other systems using only a single module.The sensitivity,specificity,and accuracy of the model-assisted reading detection of all images were 99.17%,99.92%,and 99.86%,which were significantly higher than those of the endoscopists’diagnoses.The image processing time of the model was 48 ms/image,and the image processing time of the physicians was 0.40±0.24 s/image(P<0.001).CONCLUSION The deep learning model of image classification combined with object detection exhibits a satisfactory diagnostic effect on a variety of SB lesions and their bleeding risks in CE images,which enhances the diagnostic efficiency of physicians and improves the ability of physicians to identify high-risk bleeding groups. 展开更多
关键词 Artificial intelligence Deep learning Capsule endoscopy Image classification Object detection bleeding risk
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Efficacy of transjugular intrahepatic portosystemic shunts in treating cirrhotic esophageal-gastric variceal bleeding 被引量:1
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作者 Xiao-Gang Hu Jian-Ji Dai +5 位作者 Jun Lu Gang Li Jia-Min Wang Yi Deng Rui Feng Kai-Ping Lu 《World Journal of Gastrointestinal Surgery》 SCIE 2024年第2期471-480,共10页
BACKGROUND Esophageal-gastric variceal bleeding(EGVB)represents a severe complication among patients with cirrhosis and often culminates in fatal outcomes.Interven-tional therapy,a rapidly developing treatment modalit... BACKGROUND Esophageal-gastric variceal bleeding(EGVB)represents a severe complication among patients with cirrhosis and often culminates in fatal outcomes.Interven-tional therapy,a rapidly developing treatment modality over the past few years,has found widespread application in clinical practice due to its minimally inva-sive characteristics.However,whether transjugular intrahepatic portosystemic shunt(TIPS)treatment has an impact on patient prognosis remains controversial.METHODS A retrospective study was conducted on ninety-two patients presenting with cirrhotic EGVB who were admitted to our hospital between September 2020 and September 2022.Based on the different modes of treatment,the patients were assigned to the study group(TIPS received,n=50)or the control group(per-cutaneous transhepatic varices embolization received,n=42).Comparative ana-lyses were performed between the two groups preoperatively and one month postoperatively for the following parameters:Varicosity status;hemodynamic parameters[portal vein flow velocity(PVV)and portal vein diameter(PVD);platelet count(PLT);red blood cell count;white blood cell count(WBC);and hepatic function[albumin(ALB),total bilirubin(TBIL),and aspartate transaminase(AST)].The Generic Quality of Life Inventory-74 was utilized to assess quality of life in the two groups,and the 1-year postoperative rebleeding and survival rates were compared.RESULTS Following surgical intervention,there was an improvement in the incidence of varicosity compared to the preoperative status in both cohorts.Notably,the study group exhibited more pronounced enhancements than did the control group(P<0.05).PVV increased,and PVD decreased compared to the preoperative values,with the study cohort achieving better outcomes(P<0.05).PLT and WBC counts were elevated postoperatively in the two groups,with the study cohort displaying higher PLT and WBC counts(P<0.05).No differences were detected between the two groups in terms of serum ALB,TBIL,or AST levels either preoperatively or postoperatively(P<0.05).Postoperative scores across all dimensions of life quality surpassed preoperative scores,with the study cohort achieving higher scores(P<0.05).At 22.00%,the one-year postoperative rebleeding rate in the study cohort was significantly lower than that in the control group(42.86%;P<0.05);conversely,no marked difference was obser-ved in the 1-year postoperative survival rate between the two cohorts(P>0.05).CONCLUSION TIPS,which has demonstrated robust efficacy in managing cirrhotic EGVB,remarkably alleviates varicosity and improves hemodynamics in patients.This intervention not only results in a safer profile but also contributes significantly to a more favorable prognosis. 展开更多
关键词 Liver cirrhosis Esophagogastric variceal bleeding Transjugular intrahepatic portosystemic shunt PROGNOSIS
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Outpatient management of obscure gastrointestinal bleeding:A new perspective in high-risk patients
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作者 Maria Elena Riccioni Clelia Marmo 《World Journal of Gastroenterology》 SCIE CAS 2024年第19期2502-2504,共3页
Mid-gastrointestinal bleeding accounts for approximately 5%-10%of all gastrointestinal bleeding cases,and vascular lesions represent the most frequent cause.The rebleeding rate for these lesions is quite high(about 42... Mid-gastrointestinal bleeding accounts for approximately 5%-10%of all gastrointestinal bleeding cases,and vascular lesions represent the most frequent cause.The rebleeding rate for these lesions is quite high(about 42%).We hereby recommend that scheduled outpatient management of these patients could reduce the risk of rebleeding episodes. 展开更多
关键词 Gastrointestinal bleeding Small bowel bleeding Recurrent bleeding Rebleeding risk REbleeding Outpatient management
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Comparative Analysis of Continuous versus Intermittent Proton Pump Inhibitor Therapy in Patients with Upper Gastrointestinal Bleeding Due to Ulcers
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作者 Abraamyan Feruza Misra P. Neeladri 《Open Journal of Gastroenterology》 CAS 2024年第3期99-107,共9页
Upper gastrointestinal bleeding (UGIB) presents as a prevalent clinical challenge, with annual incidence rates ranging from 80 to 150 cases per 100,000 individuals. Guidelines for managing patients with UGIB due to bl... Upper gastrointestinal bleeding (UGIB) presents as a prevalent clinical challenge, with annual incidence rates ranging from 80 to 150 cases per 100,000 individuals. Guidelines for managing patients with UGIB due to bleeding ulcers recommend a continuous infusion of proton pump inhibitors (PPI). However, studies comparing intermittent dosing of PPI therapy show that this regimen achieves similar clinical benefits. If the clinical efficacy remains equivalent, intermittent dosing will be more cost-effective for patients and the health care system. Our research study aims to analyze the comparative effectiveness of intermittent versus continuous PPI therapy after endoscopic treatment in patients with UGIB, focusing on such endpoints as rebleeding risk at 3-and 7-day mortality rates. Methods: Resources searched included MEDLINE, EMBASE, PUBMED, and the Cochrane Central Register of Controlled Trials databases from January 2010 through December 2023 with the inclusion of meta-analysis, systematic review, review, or ACG guideline recommendations. Results of the analysis show how recommendations regarding high vs. low PPI regimen changed over time: from no difference in regimen in 2010 to recommending continuous regimen in 2012 to declaring insufficient evidence between choosing one regimen over another in 2013 to determine that both regimens were comparable to each other in 2014-2018 and finally to recommending both regimens in 2021. To conclude, our review shows that in patients with bleeding ulcers and high-risk endoscopic findings, intermittent PPI therapy is non-inferior to continuous PPI infusion for three days, seven days bleeding risk or mortality rates;however, it remains challenging to determine the most optimal intermittent regimen due to heterogeneity of RCTs included in meta-analyses, and further trials will need to be performed. 展开更多
关键词 Upper Gastrointestinal bleeding PPI CONTINUOUS INTERMITTENT BOLUS REGIMENS Review
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Endoscopic hemostasis using self-expandable metal stent combinedwith PuraStat® for patient with high risk of post-endoscopicsphincterotomy bleeding (with video)
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作者 Takeshi Ogura Yuki Uba +2 位作者 Masahiro Yamamura Nobu Nishioka Hiroki Nishikawa 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2024年第1期94-96,共3页
To the Editor:Endoscopic sphincterotomy(EST)is an established technique for removal of bile duct stones and self-expandable metal stent(SEMS)deployment.However,bleeding can be considered an adverse event after EST,par... To the Editor:Endoscopic sphincterotomy(EST)is an established technique for removal of bile duct stones and self-expandable metal stent(SEMS)deployment.However,bleeding can be considered an adverse event after EST,particularly for patients with high risk of bleeding such as those on hemodialysis.Among the various techniques reported for obtaining endoscopic hemostasis[1-3]. 展开更多
关键词 bleeding STASIS ENDOSCOPIC
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Importance of risk assessment,endoscopic hemostasis,and recent advancements in the management of acute non-variceal upper gastrointestinal bleeding
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作者 Rick Maity Arkadeep Dhali Jyotirmoy Biswas 《World Journal of Clinical Cases》 SCIE 2024年第24期5462-5467,共6页
Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)is a common medical emergency in clinical practice.While the incidence has significantly reduced,the mortality rates have not undergone a similar reduction in... Acute non-variceal upper gastrointestinal bleeding(ANVUGIB)is a common medical emergency in clinical practice.While the incidence has significantly reduced,the mortality rates have not undergone a similar reduction in the last few decades,thus presenting a significant challenge.This editorial outlines the key causes and risk factors of ANVUGIB and explores the current standards and recent updates in risk assessment scoring systems for predicting mortality and endoscopic treatments for achieving hemostasis.Since ANUVGIB predominantly affects the elderly population,the impact of comorbidities may be responsible for the poor outcomes.A thorough drug history is important due to the increasing use of antiplatelet agents and anticoagulants in the elderly.Early risk stratification plays a crucial role in deciding the line of management and predicting mortality.Emerging scoring systems such as the ABC(age,blood tests,co-morbidities)score show promise in predicting mortality and guiding clinical decisions.While conventional endoscopic therapies remain cornerstone approaches,novel techniques like hemostatic powders and over-the-scope clips offer promising alternatives,particularly in cases refractory to traditional modalities.By integrating validated scoring systems and leveraging novel therapeutic modalities,clinicians can enhance patient care and mitigate the substantial morbidity and mortality associated with ANVUGIB. 展开更多
关键词 Non-variceal upper gastrointestinal bleeding Upper gastrointestinal bleeding Gastrointestinal bleeding Risk stratification Risk assessment scores PROGNOSTICATION ENDOSCOPY ESOPHAGOGASTRODUODENOSCOPY Endoscopic hemostasis
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Appendiceal bleeding caused by vascular malformation: A case report
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作者 Qin Ma Jin-Jie Du 《World Journal of Clinical Cases》 SCIE 2024年第14期2457-2462,共6页
BACKGROUND Acute lower gastrointestinal bleeding(LGIB)is a common occurrence in clinical practice.However,appendiceal bleeding is an extremely rare condition that can easily be overlooked and misdiagnosed.The preopera... BACKGROUND Acute lower gastrointestinal bleeding(LGIB)is a common occurrence in clinical practice.However,appendiceal bleeding is an extremely rare condition that can easily be overlooked and misdiagnosed.The preoperative detection of appen-diceal bleeding often poses challenges due to the lack of related guidelines and consensus,resulting in controversial treatment approaches.CASE SUMMARY We presented a case of a 33-year-old female who complained of hematochezia that had lasted for 1 d.Colonoscopy revealed continuous bleeding in the appen-diceal orifice.A laparoscopic appendectomy was performed immediately,and a pulsating blood vessel was observed in the mesangium of the appendix,accor-dingly,active bleeding into the appendicular lumen was considered.Pathological examination revealed numerous hyperplastic vessels in the appendiceal mucosa and dilated capillary vessels.CONCLUSION The preoperative detection of appendiceal bleeding is often challenging,colo-noscopy is extremely important,bowel preparation is not routinely recommend-ed for patients with acute LGIB or only low-dose bowel preparation is recom-mended.Laparoscopic appendectomy is the most appropriate treatment for appendiceal bleeding. 展开更多
关键词 Lower gastrointestinal bleeding Appendiceal bleeding COLONOSCOPY Vas-cular malformation Laparoscopic appendectomy Case report
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Efficacy and safety of over-the-scope-clips in the therapy of acute nonvariceal upper gastrointestinal bleeding:Meta-analysis
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作者 Xue-Zhu Yang Dan-Li Yu +1 位作者 Zhi Wang Zhi-Long Gao 《World Journal of Clinical Cases》 SCIE 2024年第21期4680-4690,共11页
BACKGROUND Acute nonvariceal upper gastrointestinal bleeding(ANVUGIB)is a frequent lifethreatening acute condition in gastroenterology associated with high morbidity and mortality.Over-the-scope-clip(OTSC)is a new end... BACKGROUND Acute nonvariceal upper gastrointestinal bleeding(ANVUGIB)is a frequent lifethreatening acute condition in gastroenterology associated with high morbidity and mortality.Over-the-scope-clip(OTSC)is a new endoscopic hemostasis technique,which is being used in ANVUGIB and is more effective.AIM To summarize and analyze the effects of the OTSC in prevention of recurrent bleeding,clinical success rate,procedure time,hospital stay,and adverse events in the treatment of ANVUGIB,to evaluate whether OTSC can replace standard endoscopic therapy as a new generation of treatment for ANVUGIB.METHODS The literature related to OTSC and standard therapy for ANVUGIB published before January 2023 was searched in PubMed,Web of Science,EMBASE,Cochrane,Google,and CNKI databases.Changes in recurrent bleeding(7 or 30 days),clinical results(clinical success rate,conversion rate to surgery,mortality),therapy time(procedure time,hospital stay),and adverse events in the OTSC intervention group were summarized and analyzed,and the MD or OR of 95%CI is calculated by Review Manager 5.3.RESULTS This meta-analysis involved 11 studies with 1266 patients.Total risk of bias was moderate-to-high.For patients in the OTSC group,7-and 30-days recurrent bleeding rates,as well as procedure time,hospital stay,and intensive care unit stay,were greatly inhibited.OTSC could significantly improve the clinical success rate of ANVUGIB.OTSC therapy did not cause serious adverse and was effective in reducing patient mortality.CONCLUSION OTSC may provide more rapid and sustained hemostasis,and thus,promote recovery and reduce mortality in patients with ANVUGIB.In addition,the safety of OTSC is assured. 展开更多
关键词 Acute nonvariceal upper gastrointestinal bleeding Over-the-scope-clips Recurrent bleeding Adverse events META-ANALYSIS
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Challenges in Diagnosing and Managing Dieulafoy’s Lesions: A Case Report Highlighting the Importance of Clinical Suspicion and Multidisciplinary Approach in Obscure Gastrointestinal Bleeding
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作者 Feruza Abraamyan Neeladri Misra +3 位作者 Kenneth Tran Khalid Mahmood Benjamin Coombs Shilpa Lingala 《Open Journal of Gastroenterology》 CAS 2024年第3期80-86,共7页
Upper gastrointestinal bleeding remains a significant cause of hospital admissions. Even though the incidence of peptic ulcer disease and gastritis is decreasing, the incidence rates in neoplasm, Dieulafoy’s lesions,... Upper gastrointestinal bleeding remains a significant cause of hospital admissions. Even though the incidence of peptic ulcer disease and gastritis is decreasing, the incidence rates in neoplasm, Dieulafoy’s lesions, angiodysplasia, and esophagitis are trending up, which necessities physicians to be aware of those pathologies and their specifics. Here, we represent a case of a 62-year-old male on dual antiplatelet therapy who was transferred to our hospital due to severe melena with suspicion of upper gastrointestinal bleeding. Due to hemodynamic instability, the patient was intubated and started on vasopressors. However, several repeated EGDs and CTs of the abdomen with GI bleeding protocol did not reveal the location of active bleeding to stop it. At the same time, clinically, the patient was hemodynamically unstable with continued melena. On the last EGD, a small area of concern resembling gastric varix was clipped for identification purposes, and the patient underwent a selective angiogram with further diagnosis of Dieulafoy’s lesion, which was successfully embolized. Our case demonstrates that Dieulafoy’s lesions can present as severe life-threatening hemorrhage, hard to diagnose with traditional methods such as EGD or CTs, in which case it is recommended to proceed with an angiogram sooner rather than later for further diagnosis and treatment if needed. 展开更多
关键词 Upper Gastrointestinal bleeding Dieulafoy’s Lesion ANGIODYSPLASIA MELENA HEMATOCHEZIA EGD ANGIOGRAM EMBOLIZATION
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Advancements in hemostatic strategies for managing upper gastrointestinal bleeding: A comprehensive review
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作者 Ah Young Lee Joo Young Cho 《World Journal of Gastroenterology》 SCIE CAS 2024年第15期2087-2090,共4页
Upper gastrointestinal(GI)hemorrhage presents a substantial clinical challenge.Initial management typically involves resuscitation and endoscopy within 24 h,although the benefit of very early endoscopy(<12 h)for hi... Upper gastrointestinal(GI)hemorrhage presents a substantial clinical challenge.Initial management typically involves resuscitation and endoscopy within 24 h,although the benefit of very early endoscopy(<12 h)for high-risk patients is debated.Treatment goals include stopping acute bleeding,preventing rebleeding,and using a multimodal approach encompassing endoscopic,pharmacological,angiographic,and surgical methods.Pharmacological agents such as vasopressin,prostaglandins,and proton pump inhibitors are effective,but the increase in antithrombotic use has increased GI bleeding morbidity.Endoscopic hemostasis,particularly for nonvariceal bleeding,employs techniques such as electrocoagu-lation and heater probes,with concerns over tissue injury from monopolar electrocoagulation.Novel methods such as Hemospray and Endoclot show promise in creating mechanical tamponades but have limitations.Currently,the first-line therapy includes thermal probes and hemoclips,with over-the-scope clips emerging for larger ulcer bleeding.The gold probe,combining bipolar electrocoagulation and injection,offers targeted coagulation but has faced device-related issues.Future advancements involve combining techniques and improving endoscopic imaging,with studies exploring combined approaches showing promise.Ongoing research is crucial for developing standardized and effective hemorrhage management strategies. 展开更多
关键词 Upper gastrointestinal bleeding HEMOSTASIS ENDOSCOPY Probe SPRAY CLIP
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Comprehensive approach to esophageal variceal bleeding:From prevention to treatment
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作者 Sahib Singh Saurabh Chandan +3 位作者 Rakesh Vinayek Ganesh Aswath Antonio Facciorusso Marcello Maida 《World Journal of Gastroenterology》 SCIE CAS 2024年第43期4602-4608,共7页
Esophageal variceal bleeding is a severe complication often associated with portal hypertension,commonly due to liver cirrhosis.Prevention and treatment of this condition are critical for patient outcomes.Preventive s... Esophageal variceal bleeding is a severe complication often associated with portal hypertension,commonly due to liver cirrhosis.Prevention and treatment of this condition are critical for patient outcomes.Preventive strategies focus on reducing portal hypertension to prevent varices from developing or enlarging.Primary prophylaxis involves the use of non-selective beta-blockers,such as propranolol or nadolol,which lower portal pressure by decreasing cardiac output and thereby reducing blood flow to the varices.Endoscopic variceal ligation(EVL)may also be employed as primary prophylaxis to prevent initial bleeding episodes.Once bleeding occurs,immediate treatment is essential.Initial management includes hemodynamic stabilization followed by pharmacological therapy with vasoactive drugs such as octreotide or terlipressin to control bleeding.Endoscopic intervention is the cornerstone of treatment,with techniques such as EVL or sclerotherapy applied to directly manage the bleeding varices.In cases where bleeding is refractory to endoscopic treatment,transjugular intrahepatic portosystemic shunt may be considered to effectively reduce portal pressure.Long-term management after an acute bleeding episode involves secondary prophylaxis using betablockers and repeated EVL sessions to prevent rebleeding,complemented by monitoring and managing liver function to address the underlying disease.In light of new scientific evidence,including the findings of the study by Peng et al,this editorial aims to review available strategies for the prevention and treatment of esophageal varices. 展开更多
关键词 Esophageal varices Portal hypertension CIRRHOSIS bleeding PREVENTION TREATMENT
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Computed tomography-based multi-organ radiomics nomogram model for predicting the risk of esophagogastric variceal bleeding in cirrhosis
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作者 Yu-Jie Peng Xin Liu +3 位作者 Ying Liu Xue Tang Qi-Peng Zhao Yong Du 《World Journal of Gastroenterology》 SCIE CAS 2024年第36期4044-4056,共13页
BACKGROUND Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications.However,most current studies predict the risk of esophageal variceal bleeding(EVB)based on image features... BACKGROUND Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications.However,most current studies predict the risk of esophageal variceal bleeding(EVB)based on image features at a single level,which results in incomplete data.Few studies have explored the use of global multi-organ radiomics for non-invasive prediction of EVB secondary to cirrhosis.AIM To develop a model based on clinical and multi-organ radiomic features to predict the risk of first-instance secondary EVB in patients with cirrhosis.METHODS In this study,208 patients with cirrhosis were retrospectively evaluated and randomly split into training(n=145)and validation(n=63)cohorts.Three areas were chosen as regions of interest for extraction of multi-organ radiomic features:The whole liver,whole spleen,and lower esophagus–gastric fundus region.In the training cohort,radiomic score(Rad-score)was created by screening radiomic features using the inter-observer and intra-observer correlation coefficients and the least absolute shrinkage and selection operator method.Independent clinical risk factors were selected using multivariate logistic regression analyses.The radiomic features and clinical risk variables were combined to create a new radiomics-clinical model(RC model).The established models were validated using the validation cohort.BACKGROUND Radiomics has been used in the diagnosis of cirrhosis and prediction of its associated complications.However,most current studies predict the risk of esophageal variceal bleeding(EVB)based on image features at a single level,which results in incomplete data.Few studies have explored the use of global multi-organ radiomics for non-invasive prediction of EVB secondary to cirrhosis.AIM To develop a model based on clinical and multi-organ radiomic features to predict the risk of first-instance secondary EVB in patients with cirrhosis.METHODS In this study,208 patients with cirrhosis were retrospectively evaluated and randomly split into training(n=145)and validation(n=63)cohorts.Three areas were chosen as regions of interest for extraction of multi-organ radiomic features:The whole liver,whole spleen,and lower esophagus–gastric fundus region.In the training cohort,radiomic score(Rad-score)was created by screening radiomic features using the inter-observer and intra-observer correlation coefficients and the least absolute shrinkage and selection operator method.Independent clinical risk factors were selected using multivariate logistic regression analyses.The radiomic features and clinical risk variables were combined to create a new radiomics-clinical model(RC model).The established models were validated using the validation cohort.RESULTS The RC model yielded the best predictive performance and accurately predicted the EVB risk of patients with cirrhosis.Ascites,portal vein thrombosis,and plasma prothrombin time were identified as independent clinical risk factors.The area under the receiver operating characteristic curve(AUC)values for the RC model,Rad-score(liver+spleen+esophagus),Rad-score(liver),Rad-score(spleen),Rad-score(esophagus),and clinical model in the training cohort were 0.951,0.930,0.801,0.831,0.864,and 0.727,respectively.The corresponding AUC values in the validation cohort were 0.930,0.886,0.763,0.792,0.857,and 0.692.CONCLUSION In patients with cirrhosis,combined multi-organ radiomics and clinical model can be used to non-invasively predict the probability of the first secondary EVB. 展开更多
关键词 Artificial intelligence CIRRHOSIS Radiomics Esophagogastric variceal bleeding
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Recent advances in promising drugs for primary prevention of gastroesophageal variceal bleeding with cirrhotic portal hypertension
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作者 Ji-Yao Sheng Zi-Fan Meng +1 位作者 Qiao Li Yong-Sheng Yang 《Hepatobiliary & Pancreatic Diseases International》 SCIE CAS CSCD 2024年第1期4-13,共10页
Background:Gastroesophageal variceal bleeding is one of the most severe complications of patients with cirrhosis.Although primary prevention drugs,including non-selectiveβ-blockers,have effectively reduced the incide... Background:Gastroesophageal variceal bleeding is one of the most severe complications of patients with cirrhosis.Although primary prevention drugs,including non-selectiveβ-blockers,have effectively reduced the incidence of bleeding,their efficacy is limited due to side effects and related contraindications.With recent advances in precision medicine,precise drug treatment provides better treatment efficacy.Data sources:Literature search was conducted in PubMed,MEDLINE and Web of Science for relevant articles published up to May 2022.Information on clinical trials was obtained from https://clinicaltrials.gov/and http://www.chictr.org.cn/.Results:The in-depth understanding of the pathogenesis and advances of portal hypertension has enabled the discovery of multiple molecular targets for promising drugs.According to the site of action,these drugs could be classified into four classes:intrahepatic,extrahepatic,both intrahepatic and extrahepatic targets and others.All these classes of drugs offer advantages over traditional treatments in prevention of gastroesophageal variceal bleeding in patients with cirrhotic portal hypertension.Conclusions:This review classified and summarized the promising drugs,which prevent gastroesophageal variceal bleeding by targeting specific markers of pathogenesis of portal hypertension,demonstrating the significance of using the precision medicine strategy to discover and develop promising drugs for the primary prevention of gastroesophageal variceal bleeding in patients with cirrhotic portal hypertension. 展开更多
关键词 Cirrhotic portal hypertension Target drug Primary prevention bleeding
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Uremic Bleeding in 2 Patients with Dieulafoy’s Lesion: Case Report and Literature Review
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作者 Gustavo Adolfo Hernández Valdez Diana Estefanía Ibarra García +7 位作者 Juan Antonio Contreras Escamilla Janette Alejandra Gamiño Gutierrez Francisco Manuel Tonatiuh Carrillo Beltran Ulises Solis Gomez Jocelyn Nataly Quintero Meléndez Ivan Alejandro Medina Jimenez Marco Antonio González Villar Jorge Rojas Morales 《Open Journal of Gastroenterology》 CAS 2024年第5期167-173,共7页
Dieulafoy’s lesions are rare vascular malformations of the gastrointestinal tract. A Dieulafoy’s lesion is an aberrant vessel that does not reduce in caliber when it extends from the submucosa to the mucosa. Damage ... Dieulafoy’s lesions are rare vascular malformations of the gastrointestinal tract. A Dieulafoy’s lesion is an aberrant vessel that does not reduce in caliber when it extends from the submucosa to the mucosa. Damage to this artery can cause severe and intermittent arterial bleeding from small vascular stumps that are difficult to visualize. Furthermore, these catastrophic bleeding episodes frequently result in hemodynamic instability and the need for transfusion of multiple blood products. Recently, uremic syndrome has been identified as a risk factor for gastric mucosal lesions. We present two clinical cases of acute digestive bleeding due to Dielafoy lesion with chronic kidney disease as the main cause, where two different therapies were performed endoscopically. We concluded with the results of our patients that the best therapy was the application of the hemostatic hemoclip on the injury vs the injection with adrenaline on the wound site. Uremia is identified as a risk factor for upper gastrointestinal bleeding in patients with pre-existing Dieulafoy’s lesion, as well as a higher incidence of new bleeding. 展开更多
关键词 Dieulafoy’s Lesion Gastrointestinal bleeding ENDOSCOPY ENDOSCOPY Hemostatic Clips Kidney Disease ADRENALINE Thermal Coagulation DIEULAFOY
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Predictive factors for percutaneous nephrolithotomy bleeding risks
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作者 U Phun Loo Chun Hou Yong Guan Chou Teh 《Asian Journal of Urology》 CSCD 2024年第1期105-109,共5页
Objective:This study aimed to identify predictive factors for percutaneous nephrolithotomy(PCNL)bleeding risks.With better risk stratification,bleeding in high-risk patient can be anticipated and facilitates early ide... Objective:This study aimed to identify predictive factors for percutaneous nephrolithotomy(PCNL)bleeding risks.With better risk stratification,bleeding in high-risk patient can be anticipated and facilitates early identification.Methods:A prospective observational study of PCNL performed at our institution was done.All adults with radio-opaque renal stones planned for PCNL were included except those with coagulopathy,planned for additional procedures.Factors including gender,co-morbidities,body mass index,stone burden,puncture site,tract dilatation size,operative position,surgeon's seniority,and operative duration were studied using stepwise multivariate regression analysis to identify the predictive factors associated with higher estimated hemoglobin(Hb)deficiency.Results:Overall,4.86%patients(n=7)received packed cells transfusion.The mean estimated Hb deficiency was 1.3(range 0-6.5)g/dL and the median was 1.0 g/dL.Stepwise multivariate regression analysis revealed that absence of hypertension(p=0.024),puncture site(p=0.027),and operative duration(p=0.023)were significantly associated with higher estimated Hb deficiency.However,the effect sizes are rather small with partial eta-squared of 0.037,0.066,and 0.038,respectively.Observed power obtained was 0.621,0.722,and 0.625,respectively.Other factors studied did not correlate with Hb difference.Conclusion:Hypertension,puncture site,and operative duration have significant impact on estimated Hb deficiency during PCNL.However,the effect size is rather small despite adequate study power obtained.Nonetheless,operative position(supine or prone),puncture number,or tract dilatation size did not correlate with Hb difference.The mainstay of reducing bleeding in PCNL is still meticulous operative technique.Our study findings also suggest that PCNL can be safely done by urology trainees under supervision in suitably selected patient,without increasing risk of bleeding. 展开更多
关键词 Percutaneous nephrolithotomy Predictive factor Risk factor bleeding Blood loss
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Heterosis Analysis in Endogenous Substances in Root Bleeding Sap of Sorghum
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作者 Renjie Zhao Yueqiao Li +4 位作者 Chen Xu Zhian Zhang Ziyang Zhou Yihan Zhou Zexin Qi 《Phyton-International Journal of Experimental Botany》 SCIE 2024年第8期1963-1980,共18页
Despite hybrid dominance contributing to the genetic improvement of crops,little is known about heterosis and inheritance patterns of endogenous substances in sorghum(Sorghum bicolor(L.)Moench)root bleeding sap.In thi... Despite hybrid dominance contributing to the genetic improvement of crops,little is known about heterosis and inheritance patterns of endogenous substances in sorghum(Sorghum bicolor(L.)Moench)root bleeding sap.In this study,six sterile and six restorer lines of sorghum and 36 hybrid sorghum combinations formulated as incomplete double-row crosses were selected as test materials,and heterosis,combining ability,heritability,and their interrelationships of root bleeding sap endogenous substances in different hybrid sorghum combinations and their parents were investigated.The results showed that the root bleeding sap of the F1 generation of hybrid sorghum had a high heterosis in both soluble sugar content and amino acid content at the flowering stage,and the average high-parent heterosis was 129.34%and 74.57%,respectively.Indole-3-acetic acid(IAA),cytokinins(CTK),gibberellic acid(GA_(3)),abscisic acid(ABA),soluble sugar,amino acid,and root bleeding intensity were mainly affected by non-additive genetic effects of the genes.Soluble protein was affected by additive genetic effects of the genes and had a high narrow heritability(75.50%),which could be selected at low generations in breeding.The combining ability analyses showed that the sterile lines 521A and 170A,and the restorer lines Ji318R and 0–30 were promising parents with high general combining ability.Correlation analysis showed that all endogenous substances of root bleeding sap were positively correlated with the sum of parental general combining ability(GCA)at highly significant levels,and IAA,CTK,GA_(3),ABA,soluble sugar,amino acid,and root bleeding intensity were positively correlated with male GCA at significant or highly significant levels.Therefore,the GCA of the restorer lines root bleeding sap endogenous material or the sum of both parents’GCA can be used to predict the performance of wounding endogenous material in the F1 generation of hybrid sorghum.Overall,this study results can help elucidate heterosis mechanisms of root bleeding sap endogenous material and improve sorghum quality. 展开更多
关键词 SORGHUM HETEROSIS root bleeding sap combining ability HERITABILITY
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Community Knowledge about Bleeding Control in Jazan, KSA: Is There a Need for First Aid Educational Programs
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作者 Md Mazharul Hoque Hamoud Yahya Alsuriha +10 位作者 Mohamed E. Moukhyer Bahja Siddig Mohamed Mubarak Almaki Amna Moukhyer Fawaz Yahya Masswadi Mofareh Salman Harubi Elias Yosef Modabish Talal Omar Khasawi Yaser Mohammed Hantool Mohammed Awaji Mohammed Madkhali Aziza Mukhayer 《Journal of Biosciences and Medicines》 2024年第6期64-84,共21页
The current study aimed to evaluate the first aid knowledge and general awareness of bleeding control, and their relations with different variables among the population of Jazan City, Saudi Arabia, in 2023. A cross-se... The current study aimed to evaluate the first aid knowledge and general awareness of bleeding control, and their relations with different variables among the population of Jazan City, Saudi Arabia, in 2023. A cross-sectional study was conducted in Jazan City, Saudi Arabia between April 2023 and May 2023. Participants, >13 years old, living in Jazan City, were self-enrolled. Data collection was carried out by distributing a self-reported online survey questionnaire via email and social media apps. A validated, pretested online self-report questionnaire was used for data collection, with data analysis performed using (MS) Excel 2022 and SPSS version 26. A Chi-square test was used to determine the association of sociodemographic variables and Bleeding Control (BC) knowledge with, significance set at p < 0.05. A total of 250 participants completed the questionnaire, predominantly aged between 16 - 25 years, with 152 (60.8%) being male, and about 90% being Saudi citizens. Only 53 (21.2%) participated in previous first aid training concentrating on bleeding control. Only 76 (30.4%) of participants had good knowledge, while 131 (52.4%) exhibited positive attitude towards BC first aid. There were no statistically significant associations between BC knowledge and age, gender, occupation, nationality, and education. However, a significant association was observed between previous BC training and knowledge (Chi-test = 40.373, d.f = 1, p = 0.000) at p < 0.05. Conclusion: The prevalence of poor knowledge of bleeding control among community members in Jazan City was high. The findings of this study should be carefully considered by various healthcare organizations to implement educational first-aid programs and activities aimed at enhancing community awareness and knowledge of bleeding control. 展开更多
关键词 INJURY Uncontrolled bleeding First Aid Knowledge ATTITUDE Jazan City
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Artificial intelligence in detection of small bowel lesions and their bleeding risk:A new step forward
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作者 Silvia Cocca Giuseppina Pontillo +1 位作者 Giuseppe Grande Rita Conigliaro 《World Journal of Gastroenterology》 SCIE CAS 2024年第18期2482-2484,共3页
The present letter to the editor is related to the study with the title“Automatic detection of small bowel(SB)lesions with different bleeding risk based on deep learning models”.Capsule endoscopy(CE)is the main tool... The present letter to the editor is related to the study with the title“Automatic detection of small bowel(SB)lesions with different bleeding risk based on deep learning models”.Capsule endoscopy(CE)is the main tool to assess SB diseases but it is a time-consuming procedure with a significant error rate.The development of artificial intelligence(AI)in CE could simplify physicians’tasks.The novel deep learning model by Zhang et al seems to be able to identify various SB lesions and their bleeding risk,and it could pave the way to next perspective studies to better enhance the diagnostic support of AI in the detection of different types of SB lesions in clinical practice. 展开更多
关键词 Capsule endoscopy Small bowel Artificial intelligence bleeding risk Vascular lesions
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