Who comes first. rescheduling endoscopic activity after the acute phase of the Covid 19 pandemic

The current health emergency caused by the COVID19 pandemic has caused an abrupt reduction in all ordinary endoscopic activities [1]. Our endoscopy unit, usually overloaded with procedures, has reduced its activities to immediate urgencies only, as recommended by position statements of many scientific societies [2–4]. After the most critical phase of the emergency, the need to evaluate the relative urgency of the endoscopic procedures was addressed. In our endoscopic academic tertiary referral unit, about 300 endoscopic procedures from March 16 to May 2 were suspended. According to local (hospital) and regional health department indications, outpatient services have been reorganised, by remodulating time slots for procedures, controlling and filtering patients’ access to the unit and reviewing the indications for each single endoscopic procedure programmed but not performed. Procedures initially classified as urgent (by 48 hours, n. 77) and short (by 10 days, n. 68) were directly rescheduled and performed. Furthermore, we decided to interview all the patients of postponed endoscopic procedures by phone calls carried out by trainees, tutored by a senior component of the endoscopy unit. A systematic questionnaire was developed based on the following items: demographic and clinical patient characteristics, current conditions, gastrointestinal signs and symptoms, exam indications and priority classes assigned by the general practitioner or other physicians, time and results of previous endoscopic examinations, laboratory tests, ongoing treatments. Results of the phone interview and any additional clinical documentation e-mailed by the patient was evaluated and archived including date and time of the interview with the patient’s informed consent. Based on the results of the reassessment, patients were rescheduled stratifing the procedures in the following 4 priority cl

Systematic review and meta-analysis. Artificial intelligence for the diagnosis of gastric precancerous lesions and Helicobacter pylori infection

Background: The endoscopic diagnosis of Helicobacter-pylori ( H.pylori ) infection and gastric precancerous lesions(GPL), namely atrophic-gastritis and intestinal-metaplasia, still remains challenging. Artificial intel- ligence(AI) may represent a powerful resource for the endoscopic recognition of these conditions. Aims: To explore the diagnostic performance(DP) of AI in the diagnosis of GPL and H.pylori infection. Methods: A systematic-review was performed by two independent authors up to September 2021. Inclu- sion criteria were studies focusing on the DP of AI-system in the diagnosis of GPL and H.pylori infection. The pooled accuracy of studies included was reported. Results: Overall, 128 studies were found (PubMed-Embase- Cochrane Library) and four and nine studies were finally included regarding GPL and H.pylori infection, respectively. The pooled- accuracy(random effects model) was 90.3%(95%CI 84.3–94.9) and 79.6%(95%CI 66.7–90.0) with a signifi- cant heterogeneity[I 2 = 90.4%(95%CI 78.5–95.7);I 2 = 97.9%(97.2–98.6)] for GPL and H.pylori infection, respec- tively. The Begg’s-test showed a significant publication-bias( p = 0.0371) only among studies regarding H.pylori infection. The pooled-accuracy(random-effects-model) was similar considering only studies using CNN-model for the diagnosis of H.pylori infection: 74.1%[(95%CI 51.6–91.3);I 2 = 98.9%(95%CI 98.5–99.3)], Begg’s-test( p = 0.1416) did not show publication-bias. Conclusion: AI-system seems to be a good resource for an easier diagnosis of GPL and H.pylori infection, showing a pooled-diagnostic-accuracy of 90% and 80%, respectively. However, considering the high het- erogeneity, these promising data need an external validation by randomized control trials and prospective real-time studies

Effect of atorvastatin on circulating hsCRP concentrations: A sub-study of the Achieve Cholesterol Targets Fast with Atorvastatin Stratified Titration (ACTFAST) study

Background: Elevated C-reactive protein (CRP) concentration is a risk factor for cardiovascular events that may add prognostic information. Statin treatment is associated with significant reductions in CRP concentrations, which appear to be unrelated to the magnitude of LDL-cholesterol reduction. We investigated the effect of atorvastatin, across its dose range, on high sensitivity (hs)CRP in subjects at high cardiovascular risk. Methods: ACTFAST was a 12 week, prospective, multicenter, open-label trial in which high-risk subjects were assigned a starting dose of atorvastatin (10, 20, 40 or 80 mg/d) based on LDL-C and status of statin use at screening (1345 statin-free [ SF] and 772 previously statin-treated [ST]). Results: At baseline, ST subjects had significantly lower hsCRP levels than SF subjects (ST group 2.31, 95% CI 2.15, 2.48 mg/L vs. SF group 3.16, 95% CI 2.98, 3.34 mg/L, p<0.05). In the SF group, atorvastatin 10 to 80 mg significantly (p<0.01) reduced hsCRP levels in a dose dependent-manner. In ST group, additional hsCRP reductions were observed over the statin used at baseline, which were not dose-dependent. Atorvastatin significantly decreased hsCRP concentrations in subjects with or without diabetes or the metabolic syndrome. Conclusions: Atorvastatin treatment at different doses, particularly 80 mg, significantly reduced hsCRP serum concentrations. This reduction was observed in both SF and ST groups and was independent of the presence of metabolic syndrome and/or diabetes. The beneficial effect of atorvastatin was evident at 6 weeks, supporting the practice of early introduction of higher doses of atorvastatin in high-risk patients

Therapeutic efficacy of autologous non-mobilized enriched circulating endothelial progenitors in patients with critical limb ischemia ― The scelta trial

Background: The therapeutic efficacy of bone marrow mononuclear cells (BM-MNC) autotransplantation in critical limb ischemia (CLI) has been reported. Variable proportions of circulating monocytes express low levels of CD34 (CD14 + CD34 low cells) and behave in vitro as endothelial progenitor cells (EPCs). The aim of the present randomized clinical trial was to compare the safety and therapeutic effects of enriched circulating EPCs (ECEPCs) with BM-MNC administration. Methods and Results: ECEPCs (obtained from non-mobilized peripheral blood by immunomagnetic selection of CD14 + and CD34 + cells) or BM-MNC were injected into the gastrocnemius of the affected limb in 23 and 17 patients, respectively. After a mean of 25.2±18.6-month follow-up, both groups showed significant and progressive improvement in muscle perfusion (primary endpoint), rest pain, consumption of analgesics, pain-free walking distance, wound healing, quality of life, ankle-brachial index, toe-brachial index, and transcutaneous PO 2 . In ECEPC-treated patients, there was a positive correlation between injected CD14 + CD34 low cell counts and the increase in muscle perfusion. The safety profile was comparable between the ECEPC and BM-MNC treatment arms. In both groups, the number of deaths and major amputations was lower compared with eligible untreated patients and historical reference patients. Conclusions: This study supports previous trials showing the efficacy of BM-MNC autotransplantation in CLI patients and demonstrates comparable therapeutic efficacy between BM-MNC and EPEPCs