A 47-year-old man with chronic hepatitis B had progressive elevated alpha-fetoprotein of 2 years' duration. A pancreatic tail tumor, instead of liver tumor, was detected. He underwent elective distal pancreatectomy and splenectomy and the pathology turned out to be acinar cell carcinoma of the pancreas. Serum level of alpha-fetoprotein returned to normal soon after surgery. No cancer recurrence was noted after 3 years of follow-up. Alpha-fetoprotein is commonly used as a tumor marker to screen for hepatocellular carcinoma in high-risk patients. However, elevated alpha-fetoprotein could occur in a much rarer disease, acinar cell carcinoma of the pancreas.

Coronary artery disease (CAD) is a common major disease. Revascularization with percutaneous coronary intervention (PCI) or coronary artery bypass graft (CABG) could relieve symptoms and myocardial ischemia. As the treatment improves and evolves, the number of aged patients with complex diseases and multiple comorbidities gradually increases. Furthermore, in patients with multivessel disease, 3-vessel PCI may lead to a higher risk of complications during the procedure, leading to further ischemia and higher long-term mortality than PCI for one vessel or two vessels. Nevertheless, the risk factors for accurately predicting patient mortality after 3-vessel PCI are unclear. Thus, a new risk prediction model for primary PCI (PPCI) patients’ needs to be established to help physicians and patients make decisions more quickly and accurately. This research aimed to construct a prediction model and find which risk factors will affect mortality in 3-vessel PPCI patients. This nationwide population-based cohort study crossed multiple hospitals and selected 3-vessel PPCI patients from January 2007 to December 2009. Then five different single machine learning methods were applied to select significant predictors and implement ensemble models to predict the mortality rate. Of the 2337 patients who underwent 3-vessel PPCI, a total of 1188 (50.83%) survived and 1149 (49.17%) died. Age, congestive heart failure (CHF), and chronic renal failure (CRF) are mortality’s most important variables. When CRF patients accept 3-vessel PPCI at ages between 68–75, they will possibly have a 94% death rate; Furthermore, this study used the top 15 variables averaged by each machine learning method to make a prediction model, and the ensemble learning model can accurately predict the long-term survival of 3-vessel PPCI patients, the accurate predictions rate achieved in 88.7%. Prediction models can provide helpful information for the clinical physician and enhance clinical decision-making. Furthermore, it can help physicians quickly identify the risk features, design clinical trials, and allocate hospital resources effectively.

Background and Aim: Vonoprazan as a new acid blocker has more potency and longer lasting acid suppression than proton pump inhibitors. Whether the efficacy of vonoprazan‐based triple therapy is comparable with or even better than that of currently recommended first‐line therapies is still unknown. Our study aims to compare the eradication rate and major adverse effects between 7‐day vonoprazan‐based triple therapy with high‐dose amoxicillin and 14‐day extended sequential therapy.Methods: We performed a retrospective analysis from the database of ¹³C‐urea breath test at Fu Jen Catholic University Hospital. All patients with a definite diagnosis of Helicobacter pylori infection by rapid urease test, urea breath test, stool antigen test, or pathology report were recruited. Patients receiving first‐line regimens with vonoprazan‐based triple therapy or extended sequential therapy were included. The respective eradication rate determined by ¹³C‐urea breath test and major adverse effects were demonstrated.Results: Totally, 106 patients were recruited in the vonoprazan‐based triple therapy group and 357 in the extended sequential therapy group. There was no significant difference in eradication rate between vonoprazan‐based triple therapy with high‐dose amoxicillin and extended sequential therapy (83.0 vs 88.8%, P = 0.12). Major adverse effects occurred in 13 of the extended sequential therapy group but none in the other group (0% vs 3.6%, P = 0.046).Conclusions: Seven‐day vonoprazan‐based triple therapy with high‐dose amoxicillin is a potential first‐line anti‐Helicobacter pylori regimen alternative to current standard treatment, with the advantages of simplicity, short treatment duration, low pill burden, and fewer major adverse effects.

The magnetic assisted capsule endoscope (MACE) with a hand-held magnetic field navigator (MFN) for upper gastrointestinal examination achieved satisfactory results in a healthy volunteer study. We evaluated the feasibility of upper gastrointestinal examination in the home care setting with the MACE system. Home care patients with upper gastrointestinal symptoms that received an MACE exam were enrolled in the study. MACE procedure time; completeness of observation of important anatomical landmarks; endoscopic diagnosis; patient tolerance during the procedure; and patient data, including age, sex, comorbidities, symptoms, body weight, and height, were retrieved from hospital information system for data analysis. A total of 16 participants were enrolled with a mean age 74.3 ± 15.4 years (47 to 99 years). One patient failed to swallow the capsule and was excluded. The average procedure time was 23.7 ± 10.0 min (14.1 to 42.5 min) to complete each endoscopic exam for the remaining 15 patients. The overall maneuverability in the esophagus, stomach, and duodenum was 93.75%, 87.5%, and 75%, respectively. Overall completeness in the aforementioned regions was 93.75%, 81.25%, and 75%, respectively. No severe adverse events were noted. The results clearly demonstrate the promise of using this MACE system to perform endoscopic examination outside the hospital for patients confined to the community and home.

Portable magnetic-assisted capsule endoscopy (MACE) provides satisfactory patient experience and safety with comparable performance in diagnosis of organic lesions when compared to conventional upper gastrointestinal endoscopy. In this study, a total of 58 homecare patients were included for MACE either in the hospital (n = 42) or at home (n = 16), with mean age of 71.1 ± 12.4 years. A total of 55 patients (94.83%) had completed the MACE with diagnosis of reflux esophagitis (43.6%), gastritis (54.5%), erosions (21.8%), fundic polyps (14.5%), peptic ulcers (25.9%), etc. Most patients (n = 47, 85.5%) were satisfied with the experience, and all patients who received MACE at home (n = 15, 100%) appreciated the convenience of endoscopy at home. Less than half of the patients (n = 24, 43.6%) could afford MACE if the expense was not covered by health insurance (USD 714). Time consumption from both traffic and capsule manipulation was also challenging for the physicians, as it took an average of 24.7 min to complete MACE, but it added up to a total of 92.7 min at home, which is about 15 times that of conventional endoscopy in hospital. More efforts are needed to ease the financial burden of patients, and optimization of workflow in community practice may help lift the obstacles revealed in this study.