Multicenter retrospective cohort of EUS-guided anterograde pancreatic duct access.

Pancreatic duct (PD) cannulation may be difficult during conventional endoscopic retrograde cholangiopancreatography (ERCP) due to underlying pathology, anatomical variants or surgically altered anatomy. Pancreatic access in these cases previously necessitated percutaneous or surgical approaches. Endoscopic ultrasound (EUS) allows for an alternative and can be combined with ERCP for rendezvous during the same procedure, or for other salvage options.

Effect of Genotype and Environment on Food-Related Traits of Organic Winter Naked Barleys.

This study aimed to understand how genetics and environment influence organic winter naked barley composition and functionality, and to identify traits that might effectively categorize basic physicochemical functionality of food barley. Across three years, two locations, and 15 genotypes, genotype significantly influenced all 10 food-related traits and was the dominant influence for three. Location significantly influenced eight traits and was dominant for three.

Learning Predictive and Interpretable Timeseries Summaries from ICU Data.

Machine learning models that utilize patient data across time (rather than just the most recent measurements) have increased performance for many risk stratification tasks in the intensive care unit. However, many of these models and their learned representations are complex and therefore difficult for clinicians to interpret, creating challenges for validation. Our work proposes a new procedure to learn summaries of clinical timeseries that are both predictive and easily understood by humans.

Effectiveness and Safety of Lumen-Apposing Metal Stents in Endoscopic Interventions for Off-Label Indications.

Background: Although released only for drainage of pseudocyst and walled-off necrosis (WON) with ≤ 30% solid debris, the utilization of lumen-apposing metal stent (LAMS) in "real-world" practice has deviated from approved indications. We evaluated the contemporary use of LAMS and associated clinical, procedural outcomes in the setting of a tertiary referral center in the USA.

Methods: Data from 303 consecutive patients who underwent LAMS placement were analyzed.

Effect of polyphenols on mixing properties and solvent retention of wheat flour doughs.

Background: The effect of polyphenol addition on dough mixing properties and flour functionality was examined using flours from different wheat varieties.

Results: Both the mixograph and farinograph experiments showed that polyphenol addition affected dough stability and optimum mixing time. These effects were most apparent in hard wheat flour with the addition of catechin.

Economic burden of enhanced practices of duodenoscopes reprocessing and surveillance: balancing risk and cost containment.

 Recent outbreaks attributed to contaminated duodenoscopes have led to the development of enhanced surveillance and reprocessing techniques (enhanced-SRT) aimed at minimizing cross-contamination. Common enhanced-SRT include double high-level disinfection (HLD), ethylene oxide (EtO) gas sterilization, and culture-based monitoring of reprocessed scopes. Adoption of these methods adds to the operational costs and we aimed to assess its economic impact to an institution.

The characterisation and provenance of crude oils stranded on the South Australian coastline. Part II: Potential parent petroleum systems.

In 2014-2016 more than 600 specimens of semi-solid crude oil were recovered from 30 ocean beaches along the coastline of South Australia, as part of the recently completed Great Australian Bight Research Program. All are believed to be products of submarine oil seepage. Their source-specific biomarker signatures provide the basis for their assignment to sixteen oil families, some previously unrecognised.

Single-use duodenoscope for ERCP performed by endoscopists with a range of experience in procedures of variable complexity.

Background And Aims: Expert endoscopists previously reported ERCP outcomes for the first commercialized single-use duodenoscope. We aimed to document usability of this device by endoscopists with different levels of ERCP experience.

Methods: Fourteen "expert" (>2000 lifetime ERCPs) and 5 "less-expert" endoscopists performed consecutive ERCPs in patients without altered pancreaticobiliary anatomy.

The characterisation and provenance of crude oils stranded on the South Australian coastline. Part I: Oil types and their weathering.

Semi-solid crude oil has been known to wash ashore along the South Australian coastline for over 120 years. The early reports pre-date offshore petroleum exploration and tanker shipping activities in Australian waters, suggesting that this stranded oil originates from natural offshore seepage. Three physically distinct varieties are represented: waxy bitumen, asphaltite and tar.

The natural hydrocarbon loading of the South Australian coastline.

Crude oil released from natural offshore seeps may strand in coastal environments. Understanding the different types of oil which accumulate on a given coastline, in addition to their spatial distribution and abundance, may be used to establish an environmental baseline for natural "background" petroleum contamination. Here we summarise the hydrocarbon loading of thirty beaches on Australia's southern margin based on three annual surveys in 2014-2016.

Endoscopic full-thickness resection of polyps involving the appendiceal orifice: a multicenter international experience.

Background: Endoscopic resection of lesions involving the appendiceal orifice remains a challenge. We aimed to report outcomes with the full-thickness resection device (FTRD) for the resection of appendiceal lesions and identify factors associated with the occurrence of appendicitis.

Methods: This was a retrospective study at 18 tertiary-care centers (USA 12, Canada 1, Europe 5) between November 2016 and August 2020.

Duodenoscope as a Vector for Transmission.

Elevator-based endoscope-related infections from patient cross-contamination is a multifactorial problem related to device design, maintenance, and function, with additional risk incurred from a high-level disinfection process that lacks quality controls. This article reviews the historical context for these outbreaks, technical aspects of scope design contributing to this risk, and innovations in endoscope technology that have the potential to overcome these shortcomings. Also reviewed are interim solutions and the data that support use of some of these interventions.

Rectus Sheath Hematoma Causing Bladder Outlet Obstruction.

A 93-year-old woman on Coumadin with history of atrial fibrillation and chronic obstructive pulmonary disease (COPD) presented with urinary retention for one day. Computed tomography (CT) of abdomen and pelvis demonstrated grade 3 rectus sheath hematoma (RSH), with the hematoma dissecting between the transversalis fascia and muscle into the prevesical space. The large-sized hematoma caused compression at the bladder outflow tract causing urinary retention.

Assessment of a Prediction Model for Antidepressant Treatment Stability Using Supervised Topic Models.

Importance: In the absence of readily assessed and clinically validated predictors of treatment response, pharmacologic management of major depressive disorder often relies on trial and error.

Objective: To assess a model using electronic health records to identify predictors of treatment response in patients with major depressive disorder.

Design, Setting, And Participants: This retrospective cohort study included data from 81 630 adults with a coded diagnosis of major depressive disorder from 2 academic medical centers in Boston, Massachusetts, including outpatient primary and specialty care clinics from December 1, 1997, to December 31, 2017.

Incidence and Significance of Biliary Stricture in Chronic Pancreatitis Patients Undergoing Extracorporeal Shock Wave Lithotripsy for Obstructing Pancreatic Duct Stones.

Background/aims: This study assessed the significance of biliary stricture in symptomatic chronic pancreatitis patients requiring extracorporeal shock wave lithotripsy (ESWL) and endoscopic retrograde cholangiopancreatography (ERCP) to remove obstructing pancreatic calculi.

Methods: A total of 97 patients underwent ESWL followed by ERCP to remove pancreatic calculi between October 2014 and October 2017 at Virginia Mason Medical Center. Significant biliary stricture (SBS) was defined as a stricture with upstream dilation on computed tomography scan or magnetic resonance cholangiopancreatography scans accompanied by cholestasis and/or cholangitis.

Complicated postoperative course secondary to kratom withdrawal: a case report.

We herein report a case of a 55-year-old female with an unusual case of post-operative kratom withdrawal. The patient's withdrawal symptoms subsequently contributed to complications and admission to the intensive care unit. Features of this case are discussed, alongside the management of kratom withdrawal and the implications of supplementation with unregulated herbal medications.

Clinical Evaluation of a Single-Use Duodenoscope for Endoscopic Retrograde Cholangiopancreatography.

Background & Aims: Disposable, single-use duodenoscopes might reduce outbreaks of infections associated with endoscope reuse. We tested the feasibility, preliminary safety, and performance of a new single-use duodenoscope in patients undergoing endoscopic retrograde cholangiopancreatography (ERCP).

Methods: We conducted a case-series study of the outcomes of ERCP with a single-use duodenoscope from April through May 2019 at 6 academic medical centers.

Novel single-use duodenoscope compared with 3 models of reusable duodenoscopes for ERCP: a randomized bench-model comparison.

Background And Aims: Multidrug-resistant infectious outbreaks associated with duodenoscope reuse have been documented internationally. A single-use endoscope could eliminate exogenous patient-to-patient infection associated with ERCP.

Methods: We conducted a comparative bench simulation study of a new single-use and 3 models of reusable duodenoscopes on a synthetic anatomic bench model.

Long-Term Outcomes of Endoscopic Papillectomy for Ampullary Adenomas.

Background And Aims: Endoscopic papillectomy is a safe and effective treatment for ampullary adenomas and has mostly replaced surgical local resection. Recent data have discussed the role of endoscopic removal of laterally spreading adenomas associated with ampullary adenomas. We evaluated our long-term results of endoscopic papillectomy for ampullary adenomas.

EUS-guided gallbladder drainage with a lumen-apposing metal stent versus endoscopic transpapillary gallbladder drainage for the treatment of acute cholecystitis (with videos).

Background And Aims: There is an evolving role for EUS-guided transmural gallbladder (GB) drainage. Endoscopic transpapillary GB drainage is a well-established, nonoperative treatment for acute cholecystitis. We compared the outcomes of 78 cases of EUS-guided versus transpapillary GB drainage at a single, U.

Remotely constraining the temporal evolution of offshore oil systems.

An understanding of the temporal evolution of a petroleum system is fundamental to interpreting where hydrocarbons may be trapped in the subsurface. However, traditional exploration methods provide few absolute constraints on the timing of petroleum generation. Here we show that Re/Os geochronology may be applied to natural crude oil seepage to determine when petroleum generation occurred in offshore sedimentary basins.