Activity

OBJECTIVES Severe acute pancreatitis (SAP) is still a big challenge. Accumulated data showed that overexpression of cyclooxygenase-2 (COX-2) in acute pancreatitis and experimental pancreatitis could be attenuated with COX-2 inhibitors. This study was aimed to evaluate whether the occurrence of SAP could be prevented by selective COX-2 inhibitors. METHODS A total of 190 patients with predicted SAP were randomized into convention group or convention plus COX-2 inhibitors (C+COX-2-Is) group. Besides conventional treatment to all patients in 2 groups, parecoxib (40 mg/d intravenous injection for 3 days) and celecoxib (200 mg oral or tube feeding twice daily for 7 days) were sequentially administrated to the patients in the C+COX-2-Is group. The primary outcome was predefined as the occurrence of SAP. The serum levels of interleukin-6 (IL-6) and tumor necrosis factor-α (TNF-α) for all of the patients were measured. RESULTS The occurrence of SAP in the C+COX-2-Is group was decreased 47.08% compared with the convention group, 21.05% (20/95) vs 39.78% (37/93), P = 0.005. A reduction of late local complications was also shown in the C+COX-2-Is group, 18.95% (18/93) vs 34.41% (32/95), P = 0.016. The serum levels of IL-6 and TNF-α were significantly lower in the C+COX-2-Is group than those in the convention group, P less then 0.05. Parecoxib relieved abdominal pain more rapidly and decreased the consumption of meperidine. An incremental reduction of cost for 1% decrease of SAP occurrence was RMB475. DISCUSSION Sequential administration of parecoxib and celecoxib in patients with predicted SAP obtained about half-reduction of SAP occurrence through decreasing serum levels of TNF-α and IL-6. This regimen presented good cost-effectiveness.Cap-assisted and chromo-colonoscopy are 2 techniques which may increase adenoma detection; however, chromo-colonoscopy is limited by increased time requirement. In this edition of The American Journal of Gastroenterology, Kim et al. present data from a randomized controlled trial comparing standard colonoscopy with an arm using both techniques (CAP/CHROMO). The indigo carmine was applied using a simpler method than previous studies, resulting in shorter times. The CAP/CHROMO adenoma detection was higher than the controls (54.4% vs 44.9%; P less then 0.001), but there was no difference for advanced neoplasia. If endoscopists find these data convincing, they should trial these techniques separately because each technique may have a different impact.PURPOSE OF REVIEW There has been a striking decline in the annual volumes of adult intestinal transplants performed in the United States from a peak in 2008, reaching its lowest volume in 2019. The current review examines the pattern and potential reasons for the decline. RECENT FINDINGS We observe that while improvements in intestinal rehabilitation may be contributing to some of the decline, movements of key personnel and the paucity of experts in a rarefied field may also be contributing to declining volumes. SUMMARY We suggest that the decline in volumes of adult intestinal transplants are likely to be multifactorial. At a time of improving transplant outcomes, the indications for intestinal transplant suggested by the Centers for Medicare and Medicaid Services, may be outdated and worthy of revision.PURPOSE OF REVIEW The current review discusses the system of liver allocation in the United States, the adoption of the national liver review board (NLRB), and the pending major change to the system of distribution (acuity circle model). RECENT FINDINGS The system of liver allocation in the United States is based on the model for end-stage liver disease (MELD) score, a formula which uses commonly available tests (international normalized ratio, bilirubin, creatinine, and recently, sodium) prioritizes candidates on the waitlist according to likelihood of death without access to transplant. This review provides an overview of modifications to MELD allocation and well as a summary of the benefits and weaknesses. The review also details the pending major revision to the distribution of liver allografts, which attempts to reduce the geographic disparity in access by sharing across a broader geographic area. Finally, the review describes the implementation of the NLRB, which replaced the previous system in May 2019. SUMMARY The system of liver allocation and distribution in the United States has been subject to ongoing optimization, though the recent adoption of the NLRB, and pending change to distribution will significantly impact the system with the goal of reducing geographic disparity.OBJECTIVE Physical activity has been shown to impact future health outcomes in adults, but little is known about the long-term impact of physical activity in toddlers. Accurately measuring the specific types and amounts of physical activity in toddlers will help us to understand, predict, and better affect their future health outcomes. Although activity recognition has been extensively developed for adults as well as older children, toddlers move in ways that are significantly different from older children, indicating the need for a more tailored approach. APPROACH In this study, 22 toddlers wore Actigraph waist-worn accelerometers which recorded their movements during guided play. The toddlers were videotaped and their activities were later annotated for the following eight distinct activity classes lying down, being carried, riding in a stroller, sitting, standing, running/walking, crawling, and climbing up/down. Accelerometer data were extracted in 2 s signal windows and paired with the activities the toddlers were performing during that time interval. MAIN RESULTS A variety of classifiers were tuned to a validation set. A random forest classifier was found to achieve the highest accuracy of 63.8% in a test set. To improve the accuracy, a hidden Markov model (HMM) was applied by providing the predictions of the static classifiers as observations. click here The HMM was able to improve the accuracy to 64.8% with all five classifiers increasing the accuracy an average of 1.3% points (95% confidence interval  =  0.7-1.9, p    less then   0.01). When the three most misclassified activities (sitting, standing, and riding in a stroller) were collapsed together, the accuracy increased to 79.3%. SIGNIFICANCE Further refinement of the toddler activity recognition classifier will enable more accurate measurements of toddler activity and improve future health outcomes of toddlers.