The ILux^(®) compared to the mechanical meibomian gland expression for the treatment of moderate and severe meibomian gland dysfunction

AIM:To compare the safety and effectiveness of eyelid treatment with the ILux®-MGD Treatment System in one session versus five sessions of mechanical meibomian gland expression(MMGE)in patients with moderate to severe meibomian gland dysfunction(MGD).METHODS:A prospective,randomized,open-label,and controlled clinical trial that compared one session of the ILux®MGD Treatment System versus five sessions of MMGE in both eyes of 130 patients aged≥18y with Ocular Surface Disease Index(OSDI)scores≥13,total meibomian gland scores(MGS)of<15 in the lower eyelid of each eye,and non-invasive tear break-up time(NI-TBUT)<10s,who were randomized 1:1 to ILux®or MMGE.RESULTS:The mean age was 58±17.49y.Baseline total MGS scores in both treatment groups were comparable.During follow-up,there were significant differences in total MGS and per sector with P<0.001.Multivariate analysis was performed using generalized estimating equations corresponding to the generalized linear model for repeated means to determine the treatment relationship with total MGS,NIBUT,and OSDI.There was a significant difference between ILux®and MMGE(P<0.001)at follow-up from the first to the twelfth month in MGS,NI-BUT,and OSDI scores.No adverse events were reported.CONCLUSION:ILux®treatment compared to MMGE significantly improves symptoms and signs in patients with moderate to severe MGD for one year without adverse events.

Cost-Effectiveness Analysis of Renalof® versus Extracorporeal Shockwave Lithotripsy (ESWL) for the Treatment of Kidney Stones ≤ 1 cm in Nicaragua

Objectives: To assess the efficiency in terms of cost-effectiveness (CE) of oral Renalof® treatment versus extracorporeal shockwave lithotripsy (ESWL) in the treatment of kidney stones ≤ 1 cm in Nicaragua. Methods: A cost-effectiveness economic evaluation was carried out based on the results obtained in the randomised, prospective, observational, single-blind, prospective, phase 2 clinical trial. Cost-effectiveness and the incremental cost-effectiveness ratio (ICER) were calculated. Economic data were obtained from the Economics Department of Clínica Senior in Managua, Nicaragua. The monetary cost was expressed in US dollars (USD). Results: Treatment with Renalof® yielded a CE of $1,323.08/% remission, while ESWL was $9,498.54/% remission. The ICER shows that, in order to achieve a high percentage of kidney stone remission with ESWL, an extra $4,734.70 per patient must be invested. Conclusions: The use of Renalof® is shown to be a more cost-effective option than ESWL. It is recommended for the treatment of kidney stones ≤ 1 cm in size.

Clinical features of chronic kidney disease in dogs with the serological presence of Leptospira spp.,Ehrlichia canis,and Anaplasma phagocytophilum

Chronic kidney disease is commonly diagnosed in dogs,and clinical signs may be aggravated when infected agents are involved.In this case report,33 dogs with chronic kidney disease were clinically evaluated and serologically tested for Leptospira spp.,Ehrlichia canis,and Anaplasma phagocytophilum.The seroprevalence for Leptospira spp.was 39.4%.The most frequent serovars found were Pyrogenes,Canicola,Bratislava and Australis,with serological titers between 1:100 to 1:800.Clinical signs included fever,depression,decreased body condition,vomiting and hema‑turia.Signifcant laboratory fndings were anemia,leukocytosis,thrombocytopenia,increased liver enzymes,urea and creatinine,hyperbilirubinemia and hyperphosphatemia.All leptospira seronegative dogs were positive for one or both monitored homoparasites(i.e.,E.canis and A.phagocytophilum);only three leptospira seropositive dogs were positive for one or both hemoparasites.Findings also suggest that endemic hemoparasites of dogs should be moni‑tored in dogs with a kidney condition for a better clinical picture of the patients and therapeutic approach.

Clinical and demographic features of patients undergoing videocapsule endoscopy management:A descriptive study

BACKGROUND Video-capsule endoscopy(VCE)is an efficient tool that has proven to be highly useful in approaching several gastrointestinal diseases.VCE was implemented in Colombia in 2003,however current characterization of patients undergoing VCE in Colombia is limited,and mainly comes from two investigations conducted before the SARS-CoV-2 pandemic period.AIM To describe the characteristics of patients undergoing VCEs and establish the main indications,findings,technical limitations,and other outstanding features.METHODS A descriptive study was carried out using data from reports of VCE(PillCam SB3 system)use in a Gastroenterology Unit in Bogotá,Colombia between September 2019 and January 2023.Demographic and clinical variables such as indication for the VCE,gastric and small bowel transit times(GTT,SBTT),endoscopic preparation quality,and limitations were described[n(%),median(IQR)].RESULTS A total of 133 VCE reports were analyzed.Most were in men with a median age of 70 years.The majority had good preparation(96.2%),and there were technical limitations in 15.8%of cases.The main indications were unexplained anemia(91%)or occult bleeding(23.3%).The median GTT and SBTT were 14 and 30 minutes,respectively.The frequencies of bleeding stigma(3.79%)and active bleeding(9.09%)were low,and the most frequent abnormal findings were red spots(28.3%),erosions(17.6%),and vascular ectasias(12.5%).CONCLUSION VCE showed high-level safety.The main indication was unexplained anemia.Active bleeding was the most frequent finding.Combined with artificial intelligence,VCE can improve diagnostic precision and targeted therapeutic interventions.

Clinical impact of artificial intelligence-based solutions on imaging of the pancreas and liver

Artificial intelligence(AI)has experienced substantial progress over the last ten years in many fields of application,including healthcare.In hepatology and pancreatology,major attention to date has been paid to its application to the assisted or even automated interpretation of radiological images,where AI can generate accurate and reproducible imaging diagnosis,reducing the physicians’workload.AI can provide automatic or semi-automatic segmentation and registration of the liver and pancreatic glands and lesions.Furthermore,using radiomics,AI can introduce new quantitative information which is not visible to the human eye to radiological reports.AI has been applied in the detection and characterization of focal lesions and diffuse diseases of the liver and pancreas,such as neoplasms,chronic hepatic disease,or acute or chronic pancreatitis,among others.These solutions have been applied to different imaging techniques commonly used to diagnose liver and pancreatic diseases,such as ultrasound,endoscopic ultrasonography,computerized tomography(CT),magnetic resonance imaging,and positron emission tomography/CT.However,AI is also applied in this context to many other relevant steps involved in a comprehensive clinical scenario to manage a gastroenterological patient.AI can also be applied to choose the most convenient test prescription,to improve image quality or accelerate its acquisition,and to predict patient prognosis and treatment response.In this review,we summarize the current evidence on the application of AI to hepatic and pancreatic radiology,not only in regard to the interpretation of images,but also to all the steps involved in the radiological workflow in a broader sense.Lastly,we discuss the challenges and future directions of the clinical application of AI methods.

Randomized, Double-Blind, Double-Masked, Parallel Group Clinical Study to Compare the Effectiveness of Diclofenac Potassium 150 mg, LP OD, vs Diclofenac Potassium 50 mg, TID, Three Times a Day, in Knee Osteoarthritis

Background: Osteoarthritis is a chronic disease associated with pain, inflammation, stiffness and synovial effusion, with progressive functional limitation, compromising quality of life. It progressively leads to loss or decrease in joint function. Pharmacological and non-pharmacological therapy seeks symptomatic management, complicated by a lack of adherence. After acetaminophen, non-steroidal anti-inflammatory drugs such as diclofenac are the most widely used medications. Objectives: The primary objective compared the analgesic effect of diclofenac 150 mg once daily vs. 50 mg three times daily in patients with knee osteoarthritis. The secondary objective assessed changes in quality of life. Method: One group received diclofenac 150 mg OD with placebo TTD. Another group received placebo OD and 50 mg active diclofenac (reference) TTD, both for 30 days. The evaluation of pain was carried out by a visual analog scale (VAS), at the beginning, 2, 3, 4, 15 and 30 days, quality of life (the WOMAC scale) and adverse effects, at 15 and 30 days. Results: Pain decreased significantly on days 15 and 30, compared to day 0, in both groups, without differences between groups. The total results in the WOMAC scale showed a very marked improvement at 15 and 30 days, without differences between groups. The most frequent adverse effects were constipation 6% in the reference group, and gastric discomfort 30.3% in the reference group vs 28.1%, in the Test group. Conclusions: Prolonged-release diclofenac 150 mg OD is as effective as diclofenac 50 mg TID for the treatment of patients with knee osteoarthritis.

Clinical outcomes and complications of single anastomosis duodenal-ileal bypass with sleeve gastrectomy:A 2-year follow-up study in Bogotá,Colombia

BACKGROUND The global prevalence of obesity has increased over the past 40 years,and bariatric surgery has proven to be the most effective therapy for long-term weight loss.Its principles are based on modifying the brain-gut axis by altering the gastrointestinal anatomy and affecting the function of gastrointestinal hormones,thereby modifying satiety signals.Single anastomosis duodeno-ileal bypass with sleeve gastrectomy(SADI-S)combines both techniques and has become an alternative to gastric bypass and biliopancreatic diversion procedures for treating severe obesity and associated metabolic diseases in selected patients.AIM To describe the outcomes and complications of SADI-S.METHODS We retrospectively analyzed the data of patients who underwent SADI-S laparoscopically at the Clínica Reina Sofía in Bogotá,Colombia.This study assessed the therapeutic effectiveness of SADI-S in terms of short-term preoperative clinical characteristics,postoperative complications,comorbidities,nutritional deficiencies,and intraoperative complications during a 2-year follow-up.RESULTS Sixty-one patients with a mean body mass index(BMI)of 50±7.1 kg/m2 underwent laparoscopic SADI-S.The mean operative time and hospital stays were 143.8±42 min and 2.3±0.8 d,respectively.The mean follow-up period was 18 mo,and the mean BMI decreased to 28.5±12.2 kg/m2.The excess BMI loss was 41.8%±13.5%,and the weight loss percentage was 81.1%±17.0%.Resolution of obesity-related comorbidities,including type 2 diabetes mellitus,hypertension,dyslipidemia,and obstructive sleep apnea,was achieved and defined as complete or partial remission.No intraoperative complications were observed.Short-term complications were observed in four(6.8%)patients.However,larger studies with longer follow-up periods are required to draw definitive conclusions.CONCLUSION SADI-S has a low intraoperative and postoperative complication rate and is effective for weight loss and improving obesity-related comorbidities,including hypertension,type 2 diabetes mellitus,dyslipidemia,and sleep apnea syndrome.

Applications of artificial intelligence in, early detection of cancer, clinical diagnosis and personalized medicine

Artificial intelligence(AI)refers to the simulation of human intelligence in machines programmed to convert raw input data into decision-making actions,like humans.AI programs are designed to make decisions,often using deep learning and computer-guided programs that analyze and process raw data into clinical decision making for effective treatment.New techniques for predicting cancer at an early stage are needed as conventional methods have poor accuracy and are not applicable to personalized medicine.AI has the potential to use smart,intelligent computer systems for image interpretation and early diagnosis of cancer.AI has been changing almost all the areas of the medical field by integrating with new emerging technologies.AI has revolutionized the entire health care system through innovative digital diagnostics with greater precision and accuracy.AI is capable of detecting cancer at an early stage with accurate diagnosis and improved survival outcomes.AI is an innovative technology of the future that can be used for early prediction,diagnosis and treatment of cancer.

Treatment of chronic hepatitis B in clinical practice with entecavir or tenofovir

Results from phase III clinical trials clearly demonstrate the efficacy and safety of entecavir and tenofovir in the controlled environment of randomized clinical studies. There are several studies with both drugs performed in clinical practice (also called &#x0201c;real life studies&#x0201d;). Despite the pros and cons, studies performed in real life conditions represent everyday practice and add important information about long term treatment effectiveness and safety in this clinical setting. This review shows that patients treated with first line nucleos(t)ide analogs at referral centres, with good clinical follow-up and adherence to international guidelines, can achieve high treatment response rates with a very low rate of adverse events.

Cancer stem cell impact on clinical oncology

Cancer is a widespread worldwide chronic disease. In most cases, the high mortality rate from cancer correlates with a lack of clear symptoms, which results in late diagnosis for patients, and consequently, advanced tumor disease with poor probabilities for cure, since many patients will show chemo-and radio-resistance. Several mechanisms have been studied to explain chemo-and radio-resistance to anti-tumor therapies, including cell signaling pathways, anti-apoptotic mechanisms, stemness, metabolism, and cellular phenotypes. Interestingly, the presence of cancer stem cells(CSCs), which are a subset of cells within the tumors, has been related to therapy resistance. In this review, we focus on evaluating the presence of CSCs in different tumors such as breast cancer, gastric cancer, lung cancer, and hematological neoplasias, highlighting studies where CSCs were identified in patient samples. It is evident that there has been a great drive to identify the cell surface phenotypes of CSCs so that they can be used as a tool for anti-tumor therapy treatment design. We also review the potential effect of nanoparticles, drugs, natural compounds, aldehyde dehydrogenase inhibitors, cell signaling inhibitors, and antibodies to treat CSCs from specific tumors. Taken together, we present an overview of the role of CSCs in tumorigenesis and how research is advancing to target these highly tumorigenic cells to improve oncology patient outcomes.

Effect of heat treatment on the mechanical and biocorrosion behaviour of two Mg-Zn-Ca alloys

The effect of heat treatment on the mechanical and biocorrosion behaviour of the Mg-1 wt.%Zn-1 wt.%Ca(ZX11)and Mg-3 wt.%Zn-0.4 wt.%Ca(ZX30)alloys was evaluated.For this purpose,three-point bending tests as well as electrochemical and immersion tests in Hank’s solution were performed on both alloys in four different thermal conditions:as-cast,solution-treated,peak-aged and over-aged.Microstructural examinations revealed that the as-cast ZX11 and ZX30 alloys exhibit a microstructure composed ofα-Mg grains separated by large Mg_(2)Ca and Ca_(2)Mg_(6)Zn_(3) particles and by large Ca_(2)Mg_(6)Zn_(3) particles,respectively.During solution treatment,the Ca_(2)Mg_(6)Zn_(3) precipitates at the grain boundaries(GBs)are fully dissolved in the ZX11 alloy,but mainly redistributed to form a more connected configuration in the ZX30 alloy,showing a poor age-hardening response.Consequently,after solution-treatment,galvanic corrosion and corrosion rate decreases in the former,but increases in the latter.The peak-aged condition displays the highest corrosion rate for both alloys,maybe due to an excessive number density of fine Ca_(2)Mg_(6)Zn_(3) particles acting as cathodic sites.However,the over-aged condition shows the lowest corrosion rate for the ZX11 alloy and a very similar one to that of the as-cast sample for the ZX30 alloy.The ZX11 alloy shows generally better biocorrosion behaviour than the ZX30 alloy to its lower content in the Ca_(2)Mg_(6)Zn_(3) phase and thus reduced galvanic corrosion.The Mg_(2)Ca phase present in the studied ZX11 alloy has been proved to exhibit an increased corrosion potential,which has been related to an observed enrichment with Zn.

Association of insertion-deletions polymorphisms with colorectal cancer risk and clinical features

AIM To investigate the association between 16 insertiondeletions(INDEL) polymorphisms, colorectal cancer(CRC) risk and clinical features in an admixed population.METHODS O n e h u n d re d a n d fo r ty p a t i e n t s w i t h C R C a n d 140 cancer-free subjects were examined. Genomic DNA was extracted from peripheral blood samples. Polymorphisms and genomic ancestry distribution were assayed by Multiplex-PCR reaction, separated by capillary electrophoresis on the ABI 3130 Genetic Analyzer instrument and analyzed on Gene Mapper ID v3.2. Clinicopathological data were obtained by consulting the patients' clinical charts, intra-operative documentation, and pathology scoring.RESULTS Logistic regression analysis showed that polymorphism variations in IL4 gene was associated with increased CRC risk, while TYMS and UCP2 genes were associated with decreased risk. Reference to anatomical localization of tumor Del allele of NFKB1 and CASP8 were associated with more colon related incidents than rectosigmoid. In relation to the INDEL association with tumor node metastasis(TNM) stage risk, the Ins alleles of ACE, HLAG and TP53(6 bp INDEL) were associated with higher TNM stage. Furthermore, regarding INDEL association with relapse risk, the Ins alleles of ACE, HLAG, and UGT1A1 were associated with early relapse risk, as well as the Del allele of TYMS. Regarding INDEL association with death risk before 10 years, the Ins allele of SGSM3 and UGT1A1 were associated with death risk.CONCLUSION The INDEL variations in ACE, UCP2, TYMS, IL4, NFKB1, CASP8, TP53, HLAG, UGT1A1, and SGSM3 were associated with CRC risk and clinical features in an admixed population. These data suggest that this cancer panel might be useful as a complementary tool for better clinical management, and more studies need to be conducted to confirm these findings.

Bioactive Compounds and Insecticidal Activity of Hysterionica pinifolia, a Native South American Plant

Phytochemical investigation of the purified fractions of the active dichloromethane extract of Hysterionica pinifolia (Poir.) Baker led to the identification of five compounds. New acetylenic alcohol (E)-undec-3-en-5,7-diyne-1-ol (1) and three other compounds (3), (4), and (5) were reported for the first time in this species. Furthermore, forty-six components from the volatile fraction of H. pinifolia were identified. These compounds were elucidated using 1D and 2D NMR spectroscopy as well as MS-ESI and GC-FID-MS experiments. The dichloromethane extract, its fractions, and the methanolic extract were tested for insecticidal activity against Tribolium castaneum under laboratory conditions. The dichloromethane extract and the fraction F2 were found to be active, showing high larval mortality. The dichloromethane extract was also active against T. castaneum adults. The results have shown that H. pinifolia could be considered, in a near future, as a potential source for the development of a botanical insecticide for pest control.

Glucocorticosteroid therapy in inflammatory bowel diseases: From clinical practice to molecular biology

Inflammatory bowel diseases(IBDs),such as ulcerative colitis and Crohn's disease,are chronic pathologies associated with a deregulated immune response in the intestinal mucosa,and they are triggered by environmental factors in genetically susceptible individuals.Exogenous glucocorticoids(GCs)are widely used as anti-inflammatory therapy in IBDs.In the past,patients with moderate or severe states of inflammation received GCs as a first line therapy with an important effectiveness in terms of reduction of the disease activity and the induction of remission.However,this treatment often results in detrimental side effects.This downside drove the development of second generation GCs and more precise(non-systemic)drugdelivery methods.Recent clinical trials show that most of these new treatments have similar effectiveness to first generation GCs with fewer adverse effects.The remaining challenge in successful treatment of IBDs concerns the refractoriness and dependency that some patients encounter during GCs treatment.A deeper understanding of the molecular mechanisms underlying GC response is key to personalizing drug choice for IBDs patients to optimize their response to treatment.In this review,we examine the clinical characteristics of treatment with GCs,followed by an in depth analysis of the proposed molecular mechanisms involved in its resistance and dependence associated with IBDs.This thorough analysis of current clinical and biomedical literature may help guide physicians in determining a course of treatment for IBDs patients and identifies important areas needing further study.

Management of nonalcoholic fatty liver disease:An evidence-based clinical practice review

AIM: To build a consensus among Chilean specialists on the appropriate management of patients with nonalcoholic fatty liver disease (NAFLD) in clinical practice.

Concordance of non-invasive mechanical and serum tests for liver fibrosis evaluation in chronic hepatitis C

AIM To determine the sensitivity and specificity of liver stiffness measurement(LSM) and serum markers(SM) for liver fibrosis evaluation in chronic hepatitis C.METHODS Between 2012 and 2014,81 consecutive hepatitis C virus(HCV) patients had METAVIR score from liver biopsy compared with concurrent results from LSM [transient elastography(TE) [FibroS can~/ARFI technology(Virtual Touch~)] and SM [FIB-4/aspartate aminotransferase-toplatelet ratio index(APRI)].The diagnostic performance of these tests was assessed using receiver operating characteristic curves.The optimal cut-off levels of each test were chosen to define fibrosis stages F ≥ 2,F ≥ 3 and F = 4.The Kappa index set the concordance analysis.RESULTS Fifty point six percent were female and the median age was 51 years(30-78).Fifty-six patients(70%) weretreatment-na?ve.The optimal cut-off values for predicting F ≥ 2 stage fibrosis assessed by TE were 6.6 kP a,for acoustic radiation force impulse(ARFI) 1.22 m/s,for APRI 0.75 and for FIB-4 1.47.For F ≥ 3 TE was 8.9 kP a,ARFI was 1.48 m/s,APRI was 0.75,and FIB-4 was 2.For F = 4,TE was 12.2 kP a,ARFI was 1.77 m/s,APRI was 1.46,and FIB-4 was 3.91.The APRI could not distinguish between F2 and F3,P = 0.92.The negative predictive value for F = 4 for TE and ARFI was 100%.Kappa index values for F ≥ 3 METAVIR score for TE,ARFI and FIB-4 were 0.687,0.606 and 0.654,respectively.This demonstrates strong concordance between all three screening methods,and moderate to strong concordance between them and APRI(Kappa index = 0.507).CONCLUSION Given the costs and accessibility of LSM methods,and the similarity with the outcomes of SM,we suggest that FIB-4 as well as TE and ARFI may be useful indicators of the degree of liver fibrosis.This is of particular importance to developing countries.

Doppler-guided hemorrhoidal dearterialization/transanal hemorrhoidal dearterialization: Technical evolution and outcomes after 20 years

In the setting of Hemorrhoidal Disease treatment, the option of conventional hemorrhoidectomy is highly effective, but it is still associated with postoperative pain and discomfort. For this reason, technical alternatives have been developed in order to reduce complications and to provide better postoperative recovery. To accomplish this aim, non-excisional techniques such as stapled hemorrhoidectomy and Doppler-guided hemorrhoidal ligation have been introduced into clinical practice with high expectations. The aim of this article is to revise the literature about transanal hemorrhoidal dearterialization technique in the treatment of hemorrhoidal disease, looking into its evolution, results and possible benefits over other modalities of surgical treatment. The literature review showed that Dopplerguided hemorrhoidal dearterialization is a safe and effective method to treat grades II to IV hemorrhoidal disease. Outcomes in patients presenting prolapse are satisfactory and the association of anopexy is an important aspect of this operation. Anal physiology disturbances are rarely observed and mainly transitory. This technique is an excellent option for every patient, especially in those with previous anal surgeries and in patients with previous alterations of fecal continence, when an additional procedure might represent a risk of definitive incontinence.

Clinical applications of advanced magnetic resonance imaging techniques for arthritis evaluation

Magnetic resonance imaging(MRI) has allowed a comprehensive evaluation of articular disease, increasing the detection of early cartilage involvement, bone erosions, and edema in soft tissue and bone marrow compared to other imaging techniques. In the era of functional imaging, new advanced MRI sequences are being successfully applied for articular evaluation in cases of inflammatory, infectious, and degenerative arthropathies. Diffusion weighted imaging, new fat suppression techniques such as DIXON, dynamic contrast enhanced-MRI, and specific T2 mapping cartilage sequences allow a better understanding of the physiopathological processes that underlie these different arthropathies. They provide valuable quantitative information that aids in their differentiation and can be used as potential biomarkers of articular disease course and treatment response.

Effect of age on visual and refractive results after LASIK: mechanical microkeratome versus femtosecond laser

AIM: To evaluate the effect of age on visual and refractive results after laser in situ keratomileusis(LASIK) obtained with a mechanical microkeratome or a femtosecond laser.METHODS: Retrospective, nonrandomized, cohort study. A total of 3826 eyes were included in the study(1725 eyes treated with mechanical LASIK and 2101 eyes treated with femtosecond LASIK). The relationship between patient age and the 3-month postoperative visual and refractive results of both procedures were analyzed by linear regression analysis.RESULTS: Three months postoperatively, we found a significant correlation between age and the postoperative spherical equivalent(SE; r2=0.004, P=0.006), efficacy(r2=0.006, P=0.001), and safety indexes(r2=0.05, P=0.0001) in the mechanical LASIK group. On the other hand, we found a significant correlation between age and the postoperative SE(r2=0.02, P=0.0001) and the efficacy index(r2=0.01, P=0.0001) but not the safety index in the femtosecond laser group. Mechanical LASIK provided slightly but significantly better efficacy and predictability in patients 18 to 40 years of age and femtosecond LASIK did so in patients older than 40 years of age. The femtosecond laser provided better safety results than the mechanical microkeratome in both age groups. CONCLUSION: A tendency toward undercorrection and less predictability is found with aging after myopic LASIK regardless of whether the flap was created with a mechanical microkeratome or a femtosecond laser. However, femtosecond laser provides significantly betteroutcomes in terms of efficacy, safety and predictability compared to mechanical microkeratome for the correction of myopia in patients over 40 y.

Jejunostomy in the palliative treatment of gastric cancer:A clinical prognostic score

BACKGROUND Clinical stage IV gastric cancer(GC)may need palliative procedures in the presence of symptoms such as obstruction.When palliative resection is not possible,jejunostomy is one of the options.However,the limited survival of these patients raises doubts about who benefits from this procedure.AIM To create a prognostic score based on clinical variables for 90-d mortality for GC patients after palliative jejunostomy.METHODS We performed a retrospective analysis of Stage IV GC who underwent jejunostomy.Eleven preoperative clinical variables were selected to define the score categories,with 90-d mortality as the main outcome.After randomization,patients were divided equally into two groups:Development(J1)and validation(J2).The following variables were used:Age,sex,body mass index(BMI),American Society of Anesthesiologists classification(ASA),Charlson Comorbidity index(CCI),hemoglobin levels,albumin levels,neutrophil-lymphocyte ratio(NLR),tumor size,presence of ascites by computed tomography(CT),and the number of disease sites.The score performance metric was determined by the area under the receiver operating characteristic(ROC)curve(AUC)to define low and high-risk groups.RESULTS Of the 363 patients with clinical stage IVCG,80(22%)patients underwent jejunostomy.Patients were predominantly male(62.5%)with a mean age of 62.4 years old.After randomization,the binary logistic regression analysis was performed and points were assigned to the clinical variables to build the score.The high NLR had the highest value.The ROC curve derived from these pooled parameters had an AUC of 0.712(95%CI:0.537–0.887,P=0.022)to define risk groups.In the validation cohort,the diagnostic accuracy for 90-d mortality based on the score had an AUC of 0.756,(95%CI:0.598–0.915,P=0.006).According to the cutoff,in the validation cohort BMI less than 18.5 kg/m2(P<0.001),CCI≥1(P=0.001),ASA III/IV(P=0.002),high NLR(P=0.012),and the presence of ascites on CT exam(P=0.004)were significantly associated with the high-risk group.The risk groups showed a significant association with first-line(P=0.012),second-line chemotherapy(P=0.009),30-d(P=0.013),and 90-d mortality(P<0.001).CONCLUSION The scoring system developed with 11 variables related to patient’s performance status and medical condition was able to distinguish patients undergoing jejunostomy with high risk of 90 d mortality.