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Background:To search for H. pyloriinfection and gastric precancerous lesions in cirrhotic patients is worthwhile when considering the high incidence of peptic ulcers and gastric cancer in these patients. We tested if gastric juice analysis allows to avoid unrewarding gastric biopsies. Methods:This prospective study enrolled consecutive patients with liver cirrhosis who underwent upper endoscopy with standard gastric biopsies. Real-time gastric juice analysis was performed with a specific device (EndoFaster®) that test ammonium concentration for H. pyloridiagnosis, and pH values to suspect extensive atrophy/metaplasia involving gastric body mucosa. Sensitivity, specificity, positive predictive value, negative predictive value (NPV), the overall accuracy, and the likelihood ratio were calculated for both H. pyloriinfection and extensive precancerous lesions on gastric mucosa. Results:A total of 78 cirrhotic patients (males: 55; mean age: 66 ± 12 years) were enrolled. When considering as positive EndoFaster®results when at least one of two (ammonium and pH levels) tests were positive, the NPVs were as high as 89% and 86%, respectively, to rule out H. pyloriand extensive precancerous lesions on gastric mucosa, with an overall accuracy of 83% and 74%. Conclusions:This study supports the evidence that real-time gastric juice analysis allows to avoid clinically unrewarding and potentially unsafe gastric biopsies in a definite portion of cirrhotic patients, but more data are needed.

This paper presents a framework for teaching English in synchronous computer-mediated environments. This research shows the components of the framework, how it materializes in the teachers' pedagogical practices, and in the students' perceptions of lessons designed using the framework. The sources of data for this investigation are a questionnaire for students, in-depth interviews with teachers, and an analysis of the transcripts of synchronous sessions that were planned and executed using the framework. This investigation presents suitable guidelines to plan, carry out, and close lessons delivered synchronously. This study shows that when the framework is used, it helps teachers plan activities, and it supports the creation of a suitable environment for learning English online. This investigation also shows that when the framework is employed, it promotes a risk-free environment. It encourages collaboration, and it fosters the linking of ideas and the comprehension of fundamental concepts.