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Chronic liver disease has emerged as a significant global concern, with primary hepatocellular carcinoma (HCC) representing a critical consequence of this disease. However, early detection of HCC remains challenging in clinical practice. Recently, there has been a growing interest in applying endoscopic ultrasound (EUS) as a diagnostic tool for gastrointestinal diseases. Nevertheless, using EUS to diagnose and treat HCC is uncommon. In this review we described the diagnostic and therapeutic applications of EUS in primary HCC and evaluated its clinical significance. The diagnostic procedures primarily involve EUS‐guided fine‐needle biopsy or aspiration, assessment of metastatic lymph nodes and portal vein thrombosis, portal pressure monitoring, and portal vein blood collection. Treatment mainly includes EUS‐guided tumor ablation, brachytherapy, injectable chemotherapy, and managing variceal hemorrhage related to portal hypertension. [ABSTRACT FROM AUTHOR]

High energy efficiency with high performance, low energy consumption, and QoS support is one of the research challenges in cloud computing. According to this issue, the current studies trade off the three aspects o£ the issue by fixing one factor and optimizing the others, which lack an efficient energy efficiency calculation method and evaluation model that integrate the three aspects and describe the "degree" of the energy efficiency better. A QoS parameters reduction approach and a weighted energy efficiency model are proposed, which introduce the system performance as a key indicator into QoS, reduce the discrete QoS parameters into a unified dimension, establish the energy efficiency classification levels of the cloud data centers, describe the energy efficiency as a qualitative concept, and realize the energy efficiencys qualitative evaluation in cloud computing environments. Besides, the energy efficiencies of the cloud data centers in single-machine, homogenous, and heterogeneous cloud computing environments are evaluated, and experimental results show that the proposed energy efficiency model and evaluation method are effective for evaluating the QoS level and energy consumption in cloud computing environments. [ABSTRACT FROM AUTHOR]

Objective To investigate the success and recurrence rates and factors influencing the effect of endoscopic therapy for patients with biliary stricture after orthotopic liver transplantation ( OLT). Methods Data of 56 patients who underwent endoscopic therapy for biliary stricture after OLT from 2006 to 2009 were reviewed in this study. Their clinical data, laboratory parameters and endoscopic features were recorded. Results Biliary stricture was treated successfully in 47 patients (83.9%). Compared with those with treatment failure, there was a longer duration from OLT to initial presentations ( P = 0.02) in the successful group, fewer endoscopic retrograde cholangiopancreatography ( ERCP) treatments ( P < 0.01) and fewer stents inserted per patient ( P < 0.01). Multivariate analysis showed that the number of ERCP treatments per patient was negatively related with treatment success. Of the 47 patients successfully treated, stricture recurred in 13 (27.7%) during follow-up. Compared with those without recurrence, the recurrence group had a shorter initial presentation time after OLT, higher serum alanine aminotransferase, aspartate aminotransferase and γ-glutamyltransferase levels, higher numbers of ERCP treatments and stents used and a longer duration of treatment ( P < 0.01 for all). Multivariate analysis showed that the treatment duration was a risk factor for recurrence ( OR 2.33, 95% CI 1.34-4.05, P < 0.01). Conclusions Endoscopic treatment is a safe and effective modality for biliary stricture after OLT. The number of ERCP treatments per patient is negatively related with treatment success and long treatment duration was a risk factor for stricture recurrence. [ABSTRACT FROM AUTHOR]

Background: Endoscopic stenting to manage malignant hilar biliary obstruction has no consensus regarding the optimal stenting strategy. In this multicenter study, we compared transpapillary parallel‐style bilateral metal stenting with bilateral plastic stenting, and evaluated short‐ and long‐term outcomes. Methods: We recruited 262 consecutive patients (Bismuth classification types II–IV) who underwent either bilateral metal or plastic stenting as primary therapy at four tertiary centers. To overcome selection bias, we performed 1:1 propensity score matching. Our primary outcome was overall survival. Results: After propensity score matching, each group comprised 96 patients, with no significant differences in any baseline characteristics. The median survival was significantly longer in the metal stenting group than in the plastic stenting group (7.2 months [95% CI 6.0–8.5] vs. 4.1 months [95% CI 2.9–5.3]; P = 0.015). The clinical success rates were significantly higher in the metal stenting group than in the plastic stenting group (99.0% vs. 71.9%, respectively; P < 0.001), and lower post‐procedure cholangitis incidence (7.3% vs. 26.0%; P < 0.001), longer median symptom‐free stent patency (9.2 months [95% CI 7.6–10.6] vs. 4.8 months [95% CI 4.2–5.3]; P < 0.001), and fewer total interventions (1.3 ± 0.6 vs. 2.0 ± 1.4; P < 0.001). In multivariate Cox analysis of the overall survival, metal stenting (HR 0.589, P = 0.002), hilar cholangiocarcinoma (HR 0.419, P = 0.009), and adjuvant treatment (HR 0.596, P = 0.006) were independent predictors of death. Conclusions: Endoscopic therapy using bilateral metal stenting is superior to bilateral plastic stenting, with prolonged overall survival, higher clinical success, and longer stent patency in patients with advanced hilar biliary malignancies. [ABSTRACT FROM AUTHOR]

Objective: To estimate the performance of the FibroTouch‐based ultrasound attenuation parameter (UAP) for assessing hepatic steatosis in nonalcoholic fatty liver disease (NAFLD), with magnetic resonance imaging proton density fat fraction (MRI‐PDFF) as the reference standard. Methods: This prospective, cross‐sectional study included 275 individuals in the training group and 110 individuals in the validation group, all of whom completed a standardized research visit, laboratory tests, MRI‐PDFF, and UAP measurements over 1 month. Pearson correlation coefficient and Bland–Altman analysis were used to assess the agreement between UAP and MRI‐PDFF for the detection of hepatic steatosis. The diagnostic value of UAP was evaluated by the area under the receiver operating characteristic (ROC) curve (AUROC). Confounding factors to UAP performance were identified by ROC curves and regression analyses. Results: The AUROC of UAP for detecting MRI‐PDFF at ≥5%, ≥10%, and ≥20% were 0.95 (95% confidence interval [CI] 0.92–0.97), 0.86 (95% CI 0.81–0.90), and 0.90 (95% CI 0.86–0.93), respectively, and their optimal thresholds were 259, 274, and 295 dB/m, respectively. The UAP measurements had higher diagnostic accuracy in participants with lower waist circumference (≤90 cm for men and ≤80 cm for women) compared to those with higher waist circumference (AUROC values: 0.97 vs 0.84, P < 0.05). Bland–Altman analysis showed good agreement between UAP and MRI‐PDFF (bias 0.00021). According to established regression analyses, hepatic steatosis could be accurately diagnosed using UAP estimation. Conclusions: FibroTouch‐UAP has a high diagnostic potential for hepatic steatosis in NAFLD patients and helps clinical assessment and monitoring. [ABSTRACT FROM AUTHOR]

Objectives: Endoscopic retrograde cholangiopancreatography (ERCP) in patients with Roux‐en‐Y reconstruction after total gastrectomy is difficult to be performed using routine tools. The aim of this study was to evaluate the feasibility and safety of cap‐assisted routine adult colonoscope (CARAC) for ERCP in these patients. Methods: Sixteen consecutive patients with indications of ERCP who had previously undergone total gastrectomy with Roux‐en‐Y reconstruction at two tertiary care endoscopy centers were identified. All ERCP procedures were carried out by using CARAC. The success rate of reaching the papilla, biliary cannulation and procedure‐related adverse events were analyzed. Results: The papilla was successful reached in 11 (68.8%) of the 16 cases, and biliary cannulation was subsequently reached in eight (72.7%) of the 11 cases. The procedures succeeded in three patients by using a percutaneous–endoscopic rendezvous procedure after failed cannulation. Overall clinical success was achieved in 11 (68.8%) of 16 patients. Procedure‐related mild acute pancreatitis was observed in 25.0% (4/16) of the cases and mild cholangitis in 18.8% (3/16). No serious adverse events were reported. Conclusions: CARAC for therapeutic ERCP is safe and effective in treating patients with Roux‐en‐Y reconstruction after total gastrectomy. [ABSTRACT FROM AUTHOR]

Background and Aim: To evaluate changes in the prevalence rates of ultrasonographic fatty liver (FL) in a specific population. Methods: An analysis of the medical records of BaoSteel Group (Shanghai, China) employees was done to evaluate the prevalence of FL in this population, in which health examinations were performed biennially between 1995 and 2002. Results: The study reviewed a database of 59 131 employees, of which 27.1% received medical check-ups four times within the study period, 26.6% three times, and 24.0% twice. The prevalence rates of obesity and metabolic disorders were high at baseline and increased significantly with time. The prevalence of ultrasonographic FL increased from 3.87% to 14.04% in the overall population, while there was an increase from 4.44% to 14.64% in men and 1.56% to 11.37% in women over the 6-year study period. Increased rates of FL were also noted, from 25.88% to 51.39%, among patients with elevated serum alanine aminotransferase (ALT) levels (>40 U/L). The highest overall prevalence rates of FL were found in individuals aged 50–60 years, with all age-associated prevalence significantly higher in males than females. Conclusion: The prevalence of FL increased rapidly over the study period with increased rates of obesity and metabolic disorders; FL is becoming a major cause of abnormal ALT levels in the specific population. [ABSTRACT FROM AUTHOR]

Objective: To evaluate whether patients with malignant biliary obstruction (MBO) benefit from balloon dilation before the placement of a self‐expanding metal stent (SEMS) for palliative biliary drainage. Methods: Consecutive patients who underwent endoscopic retrograde cholangiopancreatography with SEMS placement for palliative management of MBO were retrospectively included. Comparative analyses of serum bilirubin levels, post‐procedural adverse events, stent patency time, stent dysfunction, and patient survival were performed between the dilation and non‐dilation groups. Results: A total of 221 patients underwent palliative endoscopic SEMS implantation for MBO from January 2014 to June 2018. Dilation significantly improved the percentage of serum bilirubin improvement (37.0% vs 14.3%, P = 0.001), with a decreasing trend in the incidence of post‐procedural cholangitis (2.5% vs 7.8%, P = 0.075), while the rates of other complications such as pancreatitis and bleeding were not increased. The patency time of SEMS and patient survival did not significantly differ between patients with and without dilation. Patients had endoscopic nasobiliary drainage (ENBD) but not dilation showed similar short‐term outcomes as patients underwent dilation but without ENBD. Conclusions: Dilation with a small‐caliber balloon catheter before the placement of SEMS is a safe and effective approach for MBO. Balloon dilation may improve the short‐term efficacy of SEMS placement, while long‐term outcomes are not obviously affected. The short‐term effect of stricture dilation may be achieved by ENBD. Further studies are needed to confirm our results. [ABSTRACT FROM AUTHOR]

Aims/Introduction The present study aimed to explore the incidence of type 2 diabetes, and to develop a risk-scoring model for predicting diabetes among the adult health check-up population in East China. Materials and Methods Participants from the Shanghai Baosteel Cohort (age ≥20 years) without diabetes at baseline were recruited in a 6-year follow-up study. In order to explore risk factors for diabetes, this cohort was categorized into two groups: new diabetes and no diabetes. Three models were developed by Cox regression analysis. The model accuracy was assessed using the area under the receiver operating characteristic curve. Results A total of 6,542 individuals were included in the Shanghai Baosteel Cohort Study. Of them, 368 (5.6%) developed type 2 diabetes at the end of the follow-up period. Cox regression analysis found a close association between incident type 2 diabetes and several risk factors including non-alcoholic fatty liver diseases at baseline. The Shanghai Baosteel Score including advanced age (2 points), hypertriglyceridemia (2 points), obesity (2 points), non-alcoholic fatty liver diseases (2 points) and impaired fasting glucose (3 points) had a good diagnostic performance with estimated area under the receiver operating characteristic curve (0.724), sensitivity (57.9%) and specificity (72.2%) at a cut-off point of >3. Conclusions A risk-scoring system including non-alcoholic fatty liver diseases can help identify individuals at a high risk of diabetes in the East Chinese population. [ABSTRACT FROM AUTHOR]