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Objective To assess the comparative efficacy of different methods for difficult biliary cannulation in endoscopic retrograde cholangio-pancreatography (ERCP) through a network meta-analysis. Methods Randomized controlled trials (RCTs) that compared the efficacy of different adjunctive methods (early or late needle-knife technique, pancreatic guidewire-assisted technique, pancreatic stent-assisted technique, transpancreatic sphincterotomy, persistent standard cannulation technique) for difficult biliary cannulation with each other were identified. The success rate of biliary cannulation and the incidence of post-ERCP pancreatitis (PEP) were the outcomes of interest. Pairwise and network meta-analysis and ranking according to surface under the cumulative ranking curve(SUCRA) for all methods were performed. Results Eighteen RCTs were identified according to selection criteria, and 2 033 patients were enrolled. The use of transpancreatic sphincterotomy over persistent standard cannulation technique (RR=1.34, 95% CI: 1.02-1.77) and over pancreatic guidewire-assisted technique（RR=1.26, 95% CI: 1.00-1.60）significantly increased the success rate of biliary cannulation. Based on SUCRA ranking, transpancreatic sphincterotomy followed by early needle-knife techniques were ranked highest in terms of increasing the success rate of biliary cannulation. Only early needle-knife technique significantly decreased PEP rate when compared with persistent standard cannulation technique (RR=0.53, 95％CI: 0.30-0.94), whereas both early needle-knife techniques and transpancreatic sphincterotomy led to lower PEP rates as compared with pancreatic guidewire-assisted technique (RR=0.41， 95％CI: 0.17-0.99; RR=0.49， 95％CI: 0.25-0.96; respectively). Based on SUCRA ranking, early needle-knife technique followed by transpancreatic sphincterotomy were ranked highest for decreasing the PEP rate of biliary cannulation. Conclusions Transpancreatic sphincterotomy increases the success rate of difficult biliary cannulation in ERCP; early needle-knife technique and transpancreatic sphincterotomy are superior to other interventions in decreasing PEP rates and should be considered as a choice of difficult biliary cannulation.

Objectives: To develop and validate an ultrasound‐based radiomics model to predict synchronous liver metastases (SLM) in rectal cancer (RC) patients preoperatively. Methods: Two hundred and thirty‐nine RC patients were included in this study and randomly divided into training and validation cohorts. A total of 5936 radiomics features were calculated on the basis of ultrasound images to build a radiomic model and obtain a radiomics score (Rad‐score) using logistic regression. Meanwhile, clinical characteristics were collected to construct a clinical model. The radiomics–clinical model was developed and validated by integrating the radiomics features with the selected clinical characteristics. The performances of three models were evaluated and compared through their discrimination, calibration, and clinical usefulness. Results: The radiomics model was developed based on 13 radiomic features. The radiomics–clinical model, which incorporated Rad‐score, CEA, and CA199, exhibited favorable discrimination and calibration with areas under the receiver operating characteristic curve (AUC) of 0.920 (95% CI: 0.874–0.965) in the training cohorts and 0.855 (95% CI: 0.759–0.951) in the validation cohorts. And the AUC of the radiomics–clinical model was 0.849 (95% CI: 0.771–0.927) for the training cohorts and 0.780 (95% CI: 0.655–0.905) for the validation cohorts, the clinical model was 0.811 (95% CI: 0.718–0.905) for the training cohorts and 0.805 (95% CI: 0.645–0.965) for the validation cohorts. Moreover, decision curve analysis (DCA) further confirmed the clinical utility of the radiomics–clinical model. Conclusions: The radiomics–clinical model performed satisfactory predictive performance, which can help improve clinical diagnosis performance and outcome prediction for SLM in RC patients. [ABSTRACT FROM AUTHOR]

Objective: To assess the diagnostic performance of the contrast‐enhanced ultrasound liver imaging reporting and data system (CEUS LI‐RADS) version 2017 for small hepatic lesions of ≤3 cm before and after changing the LR‐M criteria. Methods: We retrospectively analyzed the CEUS examination of 179 patients who were at high risk of hepatocellular carcinoma (HCC) with focal hepatic lesions ≤3 cm (194 lesions in total) and evaluated the diagnostic capability of the American College of Radiology and modified CEUS LI‐RADS algorithms. Results: Revision of the early washout time to 45 seconds increased the sensitivity of LR‐5 in predicting HCC (P =.004), with no significant decrease in specificity (P =.118). It also made better the specificity of LR‐M in predicting non‐HCC malignancies (P =.001), with no significant decrease in sensitivity (P =.094). However, using within 3 minutes as the criterion for marked washout time improved the LR‐5 sensitivity (P <.001) but decreased its specificity (P =.009) in predicting HCC, whereas the specificity of LR‐M in predicting non‐HCC malignancies increased (P <.001), but the sensitivity decreased (P =.027). Conclusions: CEUS LI‐RADS (v2017) is a valid method for predicting HCC risk in high‐risk patients. The diagnostic performance of LR‐5 and LR‐M could boost when the early washout time is revised to 45 seconds. [ABSTRACT FROM AUTHOR]

Context: It is unknown whether rural isolation may affect birth outcomes and infant mortality differentially for Indigenous versus non-Indigenous populations. We assessed birth outcomes and infant mortality by the degree of rural isolation among First Nations (North American Indians) and non-First Nations populations in Manitoba, Canada, a setting with universal health insurance. Methods: A geocoding-based birth cohort study of 25,143 First Nations and 125,729 non-First Nations live births to Manitoban residents, 1991-2000. Degree of rural isolation was defined by an indicator of urban influence (no, weak, moderate/strong) based on the percentage of the workforce commuting to urban areas. Findings: Preterm birth and low birth weight rates were somewhat lower in all rural areas regardless of the degree of isolation as compared to urban areas for both First Nations and non-First Nations. Infant mortality rates were not significantly different across areas for First Nations (10.7, 9.9, 7.9, and 9.7 per 1,000 in rural areas with no, weak, moderate/strong urban influence, and urban areas, respectively), but rates were significantly lower in less isolated areas for non-First Nations (7.4, 6.0, 5.6, and 4.6 per 1,000, respectively). Adjusted odds ratios showed similar patterns. Conclusions: Living in less isolated areas was associated with lower infant mortality only among non-First Nations. First Nations infants do not seem to have similarly benefited from the better health care facilities in urban centers, suggesting a need to improve urban First Nations' infant care in meeting the challenges of increasing urban migration.