BACKGROUND Hepatic cirrhosis is associated with greater adverse event rates following surgical procedures and is thought to have a higher risk of complications with interventional procedures in general.However,these s...BACKGROUND Hepatic cirrhosis is associated with greater adverse event rates following surgical procedures and is thought to have a higher risk of complications with interventional procedures in general.However,these same patients often require interventional gastrointestinal procedures such as endoscopic retrograde cholangiopancreatography(ERCP)and endoscopic ultrasound(EUS).While studies examining this scenario exist,the overall body of evidence for adverse event rates associated with ERCP/EUS procedures is more limited.We sought add to the literature by examining the incidence of adverse events after ERCP/EUS procedures in our safety-net hospital population with the hypothesis that severity of cirrhosis correlates with higher adverse event rates.AIM To examine whether increasing severity of cirrhosis is associated with greater incidence of adverse events after interventional ERCP/EUS procedures.METHODS We performed a retrospective study of patients diagnosed with hepatic cirrhosis who underwent ERCP and/or EUS-guided fine needle aspirations/fine needle biopsies from January 1,2016 to March 14,2019 at our safety net hospital.We recorded Child-Pugh and Model for End-stage Liver Disease(MELD-Na)scores at time of procedure,interventions completed,and 30-day post-procedural adverse events.Statistical analyses were done to assess whether Child-Pugh class and MELD-Na score were associated with greater adverse event rates and whether advanced techniques(single-operator cholangioscopy,electrohydraulic lithotripsy/laser lithotripsy,or needle-knife techniques)were associated with higher complication rates.RESULTS 77 procedures performed on 36 patients were included.The study population consisted primarily of middle-aged Hispanic males.30-d procedure-related adverse events included gastrointestinal bleeding(7.8%),infection(6.5%),and bile leak(2%).The effect of Child-Pugh class C vs class A and B significantly predicted adverse events(β=0.55,P<0.01).MELD-Na scores also significantly predicted adverse events(β=0.037,P<0.01).Presence of advanced techniques was not associated with higher adverse events(P>0.05).When MELD-Na scores were added as predictors with the effect of Child-Pugh class C,logistic regression showed MELD-Na scores were a significant predictor of adverse events(P<0.01).The findings held after controlling for age,gender,ethnicity and repeat cases.CONCLUSION Increasing cirrhosis severity predicted adverse events while the presence of advanced techniques did not.MELD-Na score may be more useful in predicting adverse events than Child-Pugh class.展开更多
Four-dimensional scanning transmission electron microscopy,coupled with a wide array of data analytics,has unveiled new insights into complex materials.Here,we introduce a straightforward unsupervised machine learning...Four-dimensional scanning transmission electron microscopy,coupled with a wide array of data analytics,has unveiled new insights into complex materials.Here,we introduce a straightforward unsupervised machine learning approach that entails dimensionality reduction and clustering with minimal hyperparameter tuning to semi-automatically identify unique coexisting structures in metallic alloys.Applying cepstral transformation to the original diffraction dataset improves this process by effectively isolating phase information from potential signal ambiguity caused by sample tilt and thickness variations,commonly observed in electron diffraction patterns.In a case study of a NiTiHfAl shape memory alloy,conventional scanning transmission electron microscopy imaging struggles to accurately identify a low-contrast precipitate at lower magnifications,posing challenges for microscale analyses.We find that our method efficiently separates multiple coherent structures while using objective means of determining hyperparameters.Furthermore,we demonstrate how the clustering result facilitates more robust strain mapping to provide immediate and quantitative structural insights.展开更多
文摘BACKGROUND Hepatic cirrhosis is associated with greater adverse event rates following surgical procedures and is thought to have a higher risk of complications with interventional procedures in general.However,these same patients often require interventional gastrointestinal procedures such as endoscopic retrograde cholangiopancreatography(ERCP)and endoscopic ultrasound(EUS).While studies examining this scenario exist,the overall body of evidence for adverse event rates associated with ERCP/EUS procedures is more limited.We sought add to the literature by examining the incidence of adverse events after ERCP/EUS procedures in our safety-net hospital population with the hypothesis that severity of cirrhosis correlates with higher adverse event rates.AIM To examine whether increasing severity of cirrhosis is associated with greater incidence of adverse events after interventional ERCP/EUS procedures.METHODS We performed a retrospective study of patients diagnosed with hepatic cirrhosis who underwent ERCP and/or EUS-guided fine needle aspirations/fine needle biopsies from January 1,2016 to March 14,2019 at our safety net hospital.We recorded Child-Pugh and Model for End-stage Liver Disease(MELD-Na)scores at time of procedure,interventions completed,and 30-day post-procedural adverse events.Statistical analyses were done to assess whether Child-Pugh class and MELD-Na score were associated with greater adverse event rates and whether advanced techniques(single-operator cholangioscopy,electrohydraulic lithotripsy/laser lithotripsy,or needle-knife techniques)were associated with higher complication rates.RESULTS 77 procedures performed on 36 patients were included.The study population consisted primarily of middle-aged Hispanic males.30-d procedure-related adverse events included gastrointestinal bleeding(7.8%),infection(6.5%),and bile leak(2%).The effect of Child-Pugh class C vs class A and B significantly predicted adverse events(β=0.55,P<0.01).MELD-Na scores also significantly predicted adverse events(β=0.037,P<0.01).Presence of advanced techniques was not associated with higher adverse events(P>0.05).When MELD-Na scores were added as predictors with the effect of Child-Pugh class C,logistic regression showed MELD-Na scores were a significant predictor of adverse events(P<0.01).The findings held after controlling for age,gender,ethnicity and repeat cases.CONCLUSION Increasing cirrhosis severity predicted adverse events while the presence of advanced techniques did not.MELD-Na score may be more useful in predicting adverse events than Child-Pugh class.
基金supported by the U.S.National Science Foundation(GrantNo.DMR 2226478).
文摘Four-dimensional scanning transmission electron microscopy,coupled with a wide array of data analytics,has unveiled new insights into complex materials.Here,we introduce a straightforward unsupervised machine learning approach that entails dimensionality reduction and clustering with minimal hyperparameter tuning to semi-automatically identify unique coexisting structures in metallic alloys.Applying cepstral transformation to the original diffraction dataset improves this process by effectively isolating phase information from potential signal ambiguity caused by sample tilt and thickness variations,commonly observed in electron diffraction patterns.In a case study of a NiTiHfAl shape memory alloy,conventional scanning transmission electron microscopy imaging struggles to accurately identify a low-contrast precipitate at lower magnifications,posing challenges for microscale analyses.We find that our method efficiently separates multiple coherent structures while using objective means of determining hyperparameters.Furthermore,we demonstrate how the clustering result facilitates more robust strain mapping to provide immediate and quantitative structural insights.
