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Background: The Italian Society of Echocardiography and Cardiovascular Imaging (SIECVI) conducted a national survey to understand better how different echocardiographic modalities are used and accessed in Italy. Methods: We analyzed echocardiography laboratory activities over a month (November 2022). Data were retrieved via an electronic survey based on a structured questionnaire, uploaded on the SIECVI website. Results: Data were obtained from 228 echocardiographic laboratories: 112 centers (49%) in the northern, 43 centers (19%) in the central, and 73 (32%) in the southern regions. During the month of observation, we collected 101,050 transthoracic echocardiography (TTE) examinations performed in all centers. As concern other modalities there were performed 5497 transesophageal echocardiography (TEE) examinations in 161/228 centers (71%); 4057 stress echocardiography (SE) examinations in 179/228 centers (79%); and examinations with ultrasound contrast agents (UCAs) in 151/228 centers (66%). We did not find significant regional variations between the different modalities. The usage of picture archiving and communication system (PACS) was significantly higher in the northern (84%) versus central (49%) and southern (45%) centers (P < 0.001). Lung ultrasound (LUS) was performed in 154 centers (66%), without difference between cardiology and noncardiology centers. The evaluation of left ventricular (LV) ejection fraction was evaluated mainly using the qualitative method in 223 centers (94%), occasionally with the Simpson method in 193 centers (85%), and with selective use of the three-dimensional (3D) method in only 23 centers (10%). 3D TTE was present in 137 centers (70%), and 3D TEE in all centers where TEE was done (71%). The assessment of LV diastolic function was done routinely in 80% of the centers. Right ventricular function was evaluated using tricuspid annular plane systolic excursion in all centers, using tricuspid valve annular systolic velocity by tissue

An electrostatic discharge (ESD)-protected one-time-programmable (OTP) memory front-end circuit, for high-voltage (HV) applications, designed and manufactured in silicon-on-insulator (SOI) technology, is presented. The SOI technology meets HV functional-isolation and level-shifting requirements but is not suitable for advanced analog circuits. The presented OTP memory is discussed as an introduction to digital programmability in the considered technology. The memory element consists of an antifuse type structure and is implemented using a 5-V nMOS with L=1µm and W=1.2µm. The cell memory allows for significant area and power savings in the adopted HV technology. Conditions for this require that an efficient ESD protection will guarantee safe operation, even in the presence of a small and fragile on-chip element whose undesired burning would compromise the programming mechanism, and consequently the reliability, of the circuit. Details about the circuit design implementation of the front-end circuit for both read and write circuits and ESD protection are described with experimental results validating the proposed implementation.

In Italy, recent legislation (Law No. 10/2020) has tuned regulations concerning the donation of one's postmortem body and tissues for study, training, and scientific research purposes. This study discusses several specific issues to optimise the applicability and effectiveness of such an important, novel regulatory setting. Critical issues arise concerning the learners, the type of training and teaching activities that can be planned, the position of academic anatomy institutes, the role of family members in the donation process, the time frame of the donation process, the eligibility of partial donation, or the simultaneous donation of organs and tissues to patients awaiting transplantation. In particular, a universal time limit for donations (i.e., one year) makes it impossible to plan the long-term use of specific body parts, which could be effectively preserved for the advanced teaching and training of medical students and surgeons. The abovementioned conditions lead to the limited use of corpses, thus resulting in the inefficiency of the whole system of body donation. Overall, the donors’ scope for the donation of their body could be best honoured by a more flexible and tuneable approach that can be used on a case-by-case basis. Furthermore, it is deemed necessary to closely monitor the events scheduled for corpses in public nonacademic institutions or private enterprises. This paper presents useful insights from Italian anatomists with the hope of providing inspiration for drafting the regulations. In conclusion, this paper focuses on the critical issues derived from the recently introduced Italian law on the donation and use of the body after death and provides suggestions to lawmakers for future implementations.

The long-term outcomes of newborns exposed to SARS-CoV-2 infection in utero or during the first hours of life are still unknown. We performed a single-center, prospective, observational study of newborns born from mothers with microbiologically confirmed SARS-CoV-2 infection in pregnancy or at time of delivery. Infants were offered a multidisciplinary follow-up consisting of nasopharyngeal Polymerase Chain Reaction test at birth and at 48–72 h of life, auxological growth and neurological development, serologic testing, and audiological and ophthalmological assessments. One-hundred ninety-eight mothers and 199 newborns were enrolled. Of the 199 newborns, 171 underwent nasopharyngeal swab, four (2.3%) and two (1.15%) children tested positive at birth and 48–72 h of life, respectively. None had SARS-CoV-2 related symptoms. Auxologic and neurologic development were normal in all children during follow-up. Nine out of 59 infants had SARS-CoV-2 IgG at 3 months of life, which was associated with a positive nasopharyngeal swab at birth (P = 0.04). Twenty seven out of 143 (18.8%) newborns had pathologic transitory evoked otoacoustic emissions at birth, although 14/27 repeated after 1 month were normal. Audiological evaluation was completed with Auditory Brainstem Response between the third and sixth month of life in 34 children, showing in all normal hearing threshold. The ophthalmological evaluation found retinal vascular anomalies in 3/20 (15%) children, immature visual acuity in 5/20 (25%) children, and reduced distance attention in 6/20 cases (30%). Conclusions: Our study showed that the neonatal and mid-term multidisciplinary outcomes of newborns exposed to SARS-CoV-2 infection in utero or during the first hours of life are mostly positive, with the exception of ophthalmologic findings which, in a preliminary cohort, were abnormal in about 15% of cases. Further prospective, longitudinal studies are needed to better understand the clinical outcomes of

Objective: The aim of this study is to assess the impact of the COVID-19 pandemic on mental health, type of delivery, and neonatal feeding of pregnant women with or without SARS-CoV-2 infection during gestation. Study Design: The study was conducted online, and anonymous survey was distributed to mothers that delivered during the COVID-19 pandemic. Results: The survey was completed by 286 women, and 64 women (22.4%) had COVID-19 during pregnancy. Women that had SARS-CoV-2 infection during pregnancy or at time of delivery had a significantly higher probability of being separated from the newborn (p < 0.0001) and a significantly lower probability of breastfeeding (p < 0.0001). The Edinburg Postnatal Depression Scale, to assess if mothers had symptoms of postnatal depression, showed that items suggestive of postnatal depression were relatively frequent in the whole cohort. However, women with SARS-CoV-2 infection during pregnancy reported higher probability of responses suggestive of postnatal depression in eight out of 10 items, with statistically significant differences in three items. Conclusion: The COVID-19 pandemic affected the type of delivery and breastfeeding of pregnant women, particularly when they had SARS-CoV-2 infection. This, in turn, had an impact on the psychological status of the interviewed mothers, aspects that could benefit of special support.

A dV/dt self-adjusting architecture for driving new generations of power transistors is presented. Superjunction technology provided a real opportunity to significantly improve the overall performance/cost ratio of power conversion. However, due to the fast commutation speed capability of Superjunction devices, its switching characteristics are more susceptible to parasitic elements, such as the non-linear gate-drain capacitance. This element affects the slope, dV/dt, which must be a trade-off between switching loss reduction and electromagnetic interference compatibility specifications. A new driving strategy for hard-switching inverters stages is proposed, in order to make the whole system working in the optimum self-adjusting operating point.

We present the first results of a longitudinal study for the recognition and assessment of non-cognitive aspects of the candidates access to medicine course, and throughout the course. This study considered 8 CLMs equally distributed throughout the country and 980 students enrolled in the first year, in the academic year 2013-2014. Preliminary results obtained from the analysis of the questionnaire used in the research show that students expect a profession characterized by the aid for patients and socially useful, while they do not expect a low pay as well as a work activity risky for health. Students are motivated to the academic course mainly by the desire to care for others, while variously opportunistic aspects are much less relevant. Students show high capacity of self-regulation, a high level of empathy in its both aspects of propensity to engagement with others in their difficult moments, as well as of tendency to spontaneously take the perspective of others, while they are able to maintain a goal directed behavior even in the presence of suffering others. These students are basically satisfied, they show a confident and positive attitude towards life and a substantial psychological health. However, it is possible to identify a sub-group of students showing signals of psychological fragility who must be carefully monitored: their profiles will be analyzed in more detail, through in-depth interviews scheduled for the third/fourth year as part of faculties counselling services.

We present the first results of a longitudinal study for the recognition and assessment of non-cognitive aspects of the candidates access to medicine course, and throughout the course. This study considered 8 CLMs equally distributed throughout the country and 980 students enrolled in the first year, in the academic year 2013-2014. Preliminary results obtained from the analysis of the questionnaire used in the research show that students expect a profession characterized by the aid for patients and socially useful, while they do not expect a low pay as well as a work activity risky for health. Students are motivated to the academic course mainly by the desire to care for others, while variously opportunistic aspects are much less relevant. Students show high capacity of self-regulation, a high level of empathy in its both aspects of propensity to engagement with others in their difficult moments, as well as of tendency to spontaneously take the perspective of others, while they are able to maintain a goal directed behavior even in the presence of suffering others. These students are basically satisfied, they show a confident and positive attitude towards life and a substantial psychological health. However, it is possible to identify a sub-group of students showing signals of psychological fragility who must be carefully monitored: their profiles will be analyzed in more detail, through in-depth interviews scheduled for the third/fourth year as part of faculties counselling services.

The article comments on the motions of the Permanent Conference of the Faculties and Schools of Medicine and Surgery and the Permanent Conference of Presidents of Bachelor’s Degree in Medicine and Surgery in response to the hypothesis of the Minister of Education plans (MIUR) to introduce the “French system” as a model for selecting the Bachelor of Medicine and Surgery. The article reiterates the lack of rationality of this hypothesis, and points out that the purpose of the selection must be to strive for a true selection process that is constantly monitored, evaluated and compared with the numerous examples of best evidence-based practices traceable within the international community. The outlines finally how the different “evidences” related to the Italian situation, already produced on this subject and the various research projects, still in progress, promoted by the two Permanent Conferences, should be taken into due consideration

The article comments on the motions of the Permanent Conference of the Faculties and Schools of Medicine and Surgery and the Permanent Conference of Presidents of Bachelor’s Degree in Medicine and Surgery in response to the hypothesis of the Minister of Education plans (MIUR) to introduce the “French system” as a model for selecting the Bachelor of Medicine and Surgery. The article reiterates the lack of rationality of this hypothesis, and points out that the purpose of the selection must be to strive for a true selection process that is constantly monitored, evaluated and compared with the numerous examples of best evidence-based practices traceable within the international community. The outlines finally how the different “evidences” related to the Italian situation, already produced on this subject and the various research projects, still in progress, promoted by the two Permanent Conferences, should be taken into due consideration

In compliance with the new norms governing access to medical faculties in Italy, which foresee a sole national ranking list, a comparative observational study was carried out on a sample of students from the country’s northern, central and southern areas (888 in all), the aim of which was to appraise the students’ O-level marks, the results of their national entrance examinations and the particular university campuses chosen by them. The preliminary results, based on a direct survey carried out at the end of the month of November 2013, seem to reveal that: A) the students from the south obtained better O-level results than those of the centre and north; B) the students from the north obtained higher scores at the entrance examination compared to those of the centre and south; C) the few students from the south who chose to sit for the test in a northern university obtained very high O-level marks and also high scores at the entrance exam; D) the students from the south who chose universities in the centre and north were strongly motivated in their choice, while those from the north who chose universities in the central or southern areas, usually did so for reasons of necessity but, probably, spurred by equally strong motivations. These preliminary results need to be integrated with the definitive results of the ranking list which was completed on March 5th. 2014. Test on well-being and attitudes was administered to the students themselves, the results of which, correlated with these students’ entrance-exam data and future academic results, will be availed of to provide “evidence” helpful to the improvement of the national entrance examination.

Non-steroidal anti-inflammatory drugs (NSAIDs) may cause gastroduodenal ulcers and its complications. Helicobacter pylori infection is recognized as an additional risk factor for ulcer development, its eradication in NSAIDs users being recommended. In this cross-sectional study, during a 1-week period, consecutive patients who were routinely visiting in 58 primary care clinics were enrolled. A questionnaire was used to collect clinical data on the patients who were chronically taking NSAIDs. Patients with age >65 years, a personal history of peptic ulcer, concomitant therapy with steroids, anti-coagulants, multiple NSAIDs, or relevant co-morbidities were considered at high risk for NSAIDs gastroduodenal complications. Data on H. pylori infection management were collected. Overall, H. pylori was searched for in 140 (16.1%) out of 869 patients receiving chronic NSAID therapy, and it was eventually cured in 43 (72.9%) of the infected cases. In detail, H. pylori status was not investigated in 670 (77.1%) of those patients at high risk of NSAID-related gastroduodenal lesions, including 516 patients ≥65 years old, and 154 younger, but with at least 1 adjunctive risk factor. In addition, 234 (35%) of these high-risk patients were not receiving any gastric mucosa protection. Our data find that H. pylori infection is investigated in fewer than one of every five NSAID-user patients in primary care. The low alertness towards such an infection in these patients suggests a need for prompt implementation of current guidelines.

To assess the appropriateness of gastroprotection in nonsteroidal anti-inflammatory drug (NSAID) users by primary care physicians.

Elderly patients are at increased risk for peptic ulcer and cancer. Predictive factors of relevant endoscopic findings at upper endoscopy in the elderly are unknown. This was a post hoc analysis of a nationwide, endoscopic study. A total of 3,147 elderly patients were selected. Demographic, clinical, and endoscopic data were systematically collected. Relevant findings and new diagnoses of peptic ulcer and malignancy were computed. Both univariate and multivariate analyses were performed. A total of 1,559 (49.5%), 213 (6.8%), 93 (3%) relevant findings, peptic ulcers, and malignancies were detected. Peptic ulcers and malignancies were more frequent in >85-year-old patients (OR 3.1, 95% CI = 2.0-4.7, p = 0.001). The presence of dysphagia (OR = 5.15), weight loss (OR = 4.77), persistent vomiting (OR = 3.68), anaemia (OR = 1.83), and male gender (OR = 1.9) were significantly associated with a malignancy, whilst overt bleeding (OR = 6.66), NSAIDs use (OR = 2.23), and epigastric pain (OR = 1.90) were associated with the presence of peptic ulcer. Peptic ulcer or malignancies were detected in 10% of elderly patients, supporting the use of endoscopy in this age group. Very elderly patients appear to be at higher risk of such lesions.

Caecal intubation fails up to 20% of colonoscopy in clinical practice. We aimed to assess whether (1) in patients with a prior incomplete colonoscopy with a standard adult colonoscope, a subsequent caecal intubation may be achieved with the same instrument; (2) there are factors predicting a repeated unsuccessful colonoscopy; and (3) how frequently completion can be further achieved by shifting to a standard gastroscope.

Different symptoms have been attributed to uncomplicated diverticular disease (DD). Poor absorbable antibiotics are largely used for uncomplicated DD, mainly for symptom treatment and prevention of diverticulitis onset. Controlled trials on cyclic administration of rifaximin in DD patients were evaluated. Four controlled, including 1 double-blind and 3 open-label, randomized studies were available. Following a long-term cyclic therapy, a significant difference emerged in the global symptoms score (range: 0-18) between rifaximin plus fibers (from 6-6.5 to 1-2) and fibers alone (from 6.7 to 2-3.8), although the actual clinically relevance of such a very small difference remains to be ascertained. Moreover, a similar global symptom score reduction (from 6 to 2.4) can be achieved by simply recommending an inexpensive high-fiber diet. Current data suggest that cyclic rifaximin plus fibers significantly reduce the incidence of the first episode of acute diverticulitis as compared to fibers alone (1.03% vs 2.75%), but a cost-efficacy analysis is needed before this treatment can be routinely recommended. The available studies have been hampered by some limitations, and definite conclusions could not be drawn. The cost of a long-life, cyclic rifaximin therapy administered to all symptomatic DD patients would appear prohibitive.

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Different remission rates of gastric low-grade, B-cell, mucosa-associated lymphoid tissue (MALT) lymphoma have been reported after Helicobacter pylori eradication. We assessed the long-term remission and relapse rates of early stage MALT lymphoma in patients treated only by H pylori eradication and identified factors that might predict outcome.

Inappropriateness of upper endoscopy (EGD) indication causes decreased diagnostic yield. Our aim of was to identify predictors of appropriateness rate for EGD among endoscopic centres.

The stomach is the most frequently involved site for extranodal lymphomas, accounting for nearly two-thirds of all gastrointestinal cases. It is widely accepted that gastric B-cell, low-grade mucosal-associated lymphoid tissue (MALT)-lymphoma is caused by Helicobacter pylori (H. pylori) infection. MALT-lymphomas may engender different clinical and endoscopic patterns. Often, diagnosis is confirmed in patients with only vague dyspeptic symptoms and without macroscopic lesions on gastric mucosa. H. pylori eradication leads to lymphoma remission in a large number of patients when treatment occurs at an early stage (I-II(1)). Neoplasia confined to the submucosa, localized in the antral region of the stomach, and without API2-MALT1 translocation, shows a high probability of remission following H. pylori eradication. When both bacterial infection and lymphoma recur, further eradication therapy is generally effective. Radiotherapy, chemotherapy and, in selected cases, surgery are the available therapeutic options with a high success rate for those patients who fail to achieve remission, while data on immunotherapy with monoclonal antibodies (rituximab) are still scarce. The 5-year survival rate is higher than 90%, but careful, long-term follow-up is required in these patients since lymphoma recurrence has been reported in some cases.

Selecting patients appropriately for upper endoscopy (EGD) is crucial for efficient use of endoscopy. The objective of this study was to compare different clinical strategies and statistical methods to select patients for EGD, namely appropriateness guidelines, age and/or alarm features, and multivariate and artificial neural network (ANN) models.

Primary clarithromycin resistance is increasing worldwide, and it has been regarded as the main factor reducing the efficacy of Helicobacter pylori therapy. However, the clinical consequence of either phenotypic or genotypic resistance still remains unclear. This study aimed to evaluate: (i) the concordance between phenotypic (culture) and genotypic (real-time PCR) tests in assessing primary clarithromycin resistance; and (ii) the role of both in therapeutic outcome.

To assess the clinical and endoscopic presentation of primary gastric lymphoma.

The most favourable therapeutic strategy for gastric MALT-lymphoma not responding to Helicobacter pylori eradication still remains unclear, neither official guidelines nor randomised studies being available. We therefore performed a systematic review of the literature to evaluate the efficacy of different therapeutic approaches in these patients. Data regarding 315 patients were valuable, and lymphoma remission following the first therapeutic attempt was achieved in 90.1% cases. The most used therapy was radiotherapy (112 patients), followed by surgery (80 patients) and chemotherapy (68 patients), whilst a combination therapy was less frequent. Radiotherapy achieved a higher remission rate as compared to chemotherapy (97.3 vs. 85.3%; P = 0.007), being similar to surgery (97.3 vs. 92.5%; P = 0.2). No difference emerged when comparing lymphoma remission rate achieved by a single therapy with that of combined treatments (89.6 vs. 96.4%; P = 0.6). This is the first pooled-data analysis assessing the efficacy of different oncologic therapeutic approaches to treat gastric MALT-lymphoma unresponsive to H. pylori eradication. Radiotherapy seems to be the most suitable treatment in these patients.

Some colorectal cancers have been unexpectedly diagnosed within one year after polypectomy in high-quality trials. The purpose of this study was to assess the clinical and economic impact of early surveillance colonoscopy one year after polypectomy in relation to detection of colorectal cancer.

To analyze the cost-effectiveness of adding computer-aided detection (CAD) to a computed tomographic (CT) colonography screening program and to compare it with other options of colorectal cancer (CRC) prevention.

Peptic ulcer disease incidence is decreasing. Both s1m1 and s1m2 vacA gene combinations of Helicobacter pylori have been associated with the development of major gastroduodenal diseases. This study assessed whether H. pylori vacA gene arrangement changed over 15 years in a Southern Italy area. H. pylori-positive patients observed in January-June 1989 and January-June 2005 were selected. Histological specimens were retrieved to extract DNA for vacA arrangement characterization (mid-m and peptide signal-s regions) by using the polymerase chain reaction. Fifty-nine patients in the first period and 56 matched patients in the second period were evaluated. A correlation between s1 presence and intestinal metaplasia at histology was found. Overall, the s1m1 combination increased (P < 0.01) and s2m2 decreased (P < 0.001) during the study period. In detail, s1m1 (P < 0.05) and s1m2 (P < 0.01) increased, and s2m2 decreased (P < 0.001) in dyspeptic patients, while only s1m1 increased (P < 0.01) in peptic ulcer patients. Finally, few cases of s2m1 combination in both series were found. Our results show some unexpected aspects that require confirmation. In detail, the increased prevalence of potential more virulent H. pylori strains contrasts with peptic ulcer incidence reduction.

To analyze the impact of adding computed tomographic (CT) imaging of the chest on the clinical effectiveness and cost-effectiveness of CT colonography to determine whether performing CT colonography and whole-body CT is a more clinically and cost-effective strategy than CT colonography alone when screening average-risk subjects.

Helicobacter pylori eradication is recognized as the initial therapy for gastric low-grade, B-cell, mucosa-associated lymphoid tissue (MALT) lymphoma. This study assesses (i) the H. pylori eradication rates for various first- and second-line and rescue therapies and (ii) the associated reinfection rates in patients.

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Issues on colonoscopy quality are crucial to reduce the advanced neoplasia miss rate of colonoscopy. Recently, a >6-min withdrawal time has been recommended. However, the relative prevalence of polyp detected during insertion and withdrawal phases of colonoscopy is unknown. Therefore, we designed this prospective, endoscopic study.

We present an 82-year-old woman with a 3-month history of progressive dysphagia and a normal initial upper gastrointestinal endoscopy. The diagnosis of pseudoachalasia was suspected by oesophageal manometric and barium swallow studies, and confirmed by biopsies revealing an intestinal type carcinoma of the stomach at a repeated endoscopy. In view of the history of heart disease, diabetes, and old age, this patient was treated by a partially covered Ultraflex self-expanding metal stent (Boston Scientific, Natick, MA, USA) placed into the oesophageal body with no direct complications and obtaining the relief from dysphagia. During the 11-month follow-up she was treated for an iron deficiency anaemia due to reflux oesophagitis with ulcerations in the oesophageal body and died from myocardial infarction. According to the localization of the cancer, the old age, and the presence of comorbidities, we should recommend the insertion of a partially covered self-expanding metal stent as a reasonable palliative treatment in selected subjects with pseudoachalasia.

Segmental colitis associated with diverticula (SCAD) has recently drawn a particular attention in the field of rare forms of colitis because of some peculiarities suggesting both its autonomy as a clinical entity and a resemblance with the most relevant forms of inflammatory bowel diseases (IBD). Aim of this review was to report the state of art on this topic.

The Helicobacter pylori (H. pylori) cure rate following standard triple therapies is decreasing worldwide. Therefore, further approaches aimed to improve standard triple therapy efficacy should be attempted. This prospective, pilot study aimed to evaluate the therapeutic role of either Lactobacillus reuteri (L. reuteri) or a high concentration of probiotics in addition to standard triple therapies for H. pylori eradication. The study enrolled 65 consecutive dyspeptic patients with H. pylori infection. All patients underwent upper endoscopy with gastric biopsies. Patients were assigned to receive one of the following therapies: (a) standard 7-day triple; (b) the same 7-day triple therapy plus L. reuteri supplementation; (c) the same 7-day triple therapy plus a probiotic mixture; and d) a 14-day standard triple therapy plus a probiotic mixture. H. pylori eradication was checked by using a 13C-urea breath test performed 4-6 weeks after treatment. No therapy regimen achieved > 80% eradication rate at both intention-to-treat (ITT) and per protocol (PP) analyses. Although the 14-day therapy plus a probiotic mixture tended to achieve higher eradication rate (71%), no statistically significant difference emerged among the different therapy regimens tested (range: 53-71%). The lowest incidence of side-effects was observed following the 7-day therapy plus L. reuteri (6%) and highest with the 14-day triple therapy plus probiotic mixture (33%), although the difference failed to reach the statistically significance. In conclusion, our data found that 7-14 days triple therapy with or without probiotic supplementation failed to achieved acceptable H. pylori eradication rates.

To investigate in a prospective study whether a simplified clinical score prior to endoscopy in upper gastrointestinal bleeding (UGIB) patients was able to predict endoscopic findings at urgent endoscopy.

The prevalence of diverticulosis and colorectal cancer (CRC) is markedly increased in the last century. Both diseases are highly frequent in Western countries and in aged people. Western diet--low in fiber and rich in dietary fat--has been largely regarded to play a major role in the pathogenesis of both conditions. A causal relationship between diverticulosis and CRC has been suggested in different studies. Epidemiologic series found a more frequent rectosigmoid localization of neoplastic lesions (advanced adenoma and CRC) in patients with diverticulosis as compared with controls, particularly in those with a previous diverticulitis episode or with an extensive disease. However, data are still controversial, with other studies failing to confirm this observation. Such discrepancy could be referred to the highly heterogeneous study design and setting in the different epidemiologic series. Pathologic studies showed that either macroscopic and microscopic chronic inflammation--which is regarded as risk factor for CRC development--is present in the colonic mucosa of some patients with diverticula. Moreover, alterations in the extracellular matrix, also involved in colorectal carcinogenesis, have been depicted in diverticulosis. In addition, an upward shifting of cell proliferation occurs in diverticular mucosa, and in nondiverticular patients with advanced adenomas. Finally, aberrant crypt foci--which are considered potential markers of CRC risk in ulcerative colitis--have been detected in colonic mucosa of patients with diverticulosis. Despite this substantial amount of evidence, however, the available data are not yet strong enough to suggest a more aggressive CRC prevention in diverticular as compared with nondiverticular subjects.

The primary aim of this model analysis was to compare the clinical and economic impacts of immediate polypectomy versus 3-year CT colonography (CTC) surveillance for small (6- to 9-mm) polyps detected at CTC screening.

Determination of the appropriateness of an indication for colonoscopy has been advanced as a means to help rationalize the use of endoscopic resources. However, the efficacy and cost effectiveness of the current guidelines used to select patients for colonoscopy are largely unknown. The goal of this study was to assess the clinical and economic impact of American Society for Gastrointestinal Endoscopy and the European Panel on the appropriateness of Gastrointestinal Endoscopy appropriateness guidelines in selecting patients who are referred for colonoscopy, in relation to colorectal cancer (CRC) detection.

In addition to detecting colorectal neoplasia, abdominal computed tomography (CT) with colonography technique (CTC) can also detect unsuspected extracolonic cancers and abdominal aortic aneurysms (AAA).The efficacy and cost-effectiveness of this combined abdominal CT screening strategy are unknown.

The impressive and brisk evolution of medical science prevents many physicians from a thorough update on all the research fields. Colorectal cancer diagnosis, screening and follow-up is well known to require a multi-disciplinary approach, as it is faced by several specialties such as primary care physicians, gastroenterologists, non-gastroenterologist internists, radiologists and surgeons. To address this issue in a mutual perspective, we focused on the main points of the epidemiology, diagnosis, screening and follow-up of colorectal neoplasia by using a simple "Question & Answers" structure.

The objective of this study was to assess the clinical and economic impact of colonoscopic referral for small and diminutive polyps detected at CT colonography (CTC) screening.

Delta over baseline (DOB) values of 13C-urea breath test (UBT) have been shown to be predictive of H. pylori eradication following therapy. This was a post hoc analysis of a large, double-blind, randomized trial. Consecutive patients with a positive UBT underwent upper endoscopy. H. pylori strains were tested for clarithromycin resistance. All patients received an eradication therapy with either a standard 10-day triple therapy or a 10-day sequential regimen. The infection was considered cured when two consecutive UBTs were negative. Basal DOB values were categorized as low (<16), intermediate (16-35), or high (>35). A total of 282 patients were selected. Eradication rates did not differ between patients with high and low DOB values. No significant difference in DOB values emerged between patients infected with clarithromycin-susceptible and clarithromycin-resistant strains. Under multivariate analysis, DOB values did not influence the bacterial eradication, which was significantly affected only by the presence of clarithromycin resistance. This large analysis failed to demonstrate a role for DOB value in H. pylori eradication with either a 10-day triple or sequential therapy.

The impact of a primary colorectal cancer screening with computerized tomographic colonography on current radiological capacity is unknown. The multispecialty needs for computerized tomographic examinations raise some doubts on the feasibility of a mass colorectal cancer screening with computerized tomographic colonography.

The impact of introducing widespread colorectal cancer (CRC) screening with CT colonography (CTC) on current resource capacity is unknown. Although a relatively large number of MDCT scanners are currently in operation throughout the United States, these existing units already perform studies for a wide array of indications. Our aim was to assess the ability of the available MDCT capacity in the United States to provide population screening with CTC.

The pathogenesis of segmental colitis associated with diverticula (SCAD) is unclear, but tumour necrosis factor alpha (TNF-alpha) has been shown to play a pivotal role in the pathogenesis of inflammatory bowel diseases. The aim of this study was to assess TNF-alpha levels in patients with SCAD. In a post hoc analysis of a prospective multicenter study, tissue samples from 13 patients diagnosed with SCAD were subjected to histological analyses. The severity of the inflammation was assessed by means of a histological score and histomorphometry (number of inflammatory cells/mm2). Immunohistochemical staining with an antibody against TNF-alpha was performed on all biopsies and the degree of staining expressed as the percentage of positive stromal cells/1000 counted (TNF-alpha score). Matched patients with irritable bowel syndrome (IBS) were used as controls. Over-expression of TNF-alpha was found in all SCAD patients (38.6 +/- 10.4%), and it was associated with a high histological score (2.5 +/- 0.5) and neutrophil cell count (16.3 +/- 3/mm2). These values were distinctly higher than those found in the IBS controls. Our data suggest that TNF-alpha activity is involved in SCAD pathogenesis, similarly to what occurs in Crohn's disease and ulcerative colitis.

Capsule endoscopy (Pillcam Colon) has recently shown acceptable accuracy in detecting colonic lesions when compared with colonoscopy. The aim of this analysis is to provide a model to assess the cost and effectiveness of population-based screening for colorectal cancer (CRC) using capsule endoscopy and to compare the cost-effectiveness with that of a colonoscopy screening program.

Antimicrobial resistance has decreased eradication rates for Helicobacter pylori infection worldwide.

Peptic ulcer bleeding is a frequent and dramatic event with both a high mortality rate and a substantial cost for healthcare systems worldwide. It has been found that age is an independent predisposing factor for gastrointestinal bleeding, with the risk increasing significantly in individuals aged>65 years and increasing further in those aged>75 years. Indeed, bleeding incidence and mortality are distinctly higher in elderly patients, especially in those with co-morbidities. NSAID therapy and Helicobacter pylori infection are the most prevalent aetiopathogenetic factors involved in peptic ulcer bleeding. The risk of bleeding seems to be higher for NSAID- than for H. pylori-related ulcers, most likely because the antiplatelet action of NSAIDs impairs the clotting process. NSAID users may be classified as low or high risk, according to the absence or presence of one or more of the following factors associated with an increased risk of bleeding: co-morbidities; corticosteroid or anticoagulant co-therapy; previous dyspepsia, peptic ulcer or ulcer bleeding; and alcohol consumption. Different types of NSAIDs have been associated with different bleeding risk, but no anti-inflammatory drug, including selective cyclo-oxygenase (COX)-2 inhibitors, is completely safe for the stomach. Furthermore, even low-dose aspirin (acetylsalicylic acid) [<325 mg/day] and a standard dose of non-aspirin antiplatelet treatment (clopidogrel or ticlopidine) have been found to cause bleeding and mortality. No clear risk factor favouring H. pylori-related ulcer bleeding has been identified. Peptic ulcer bleeding prevention remains a challenge for the physician, but data are now available on use of a safer and cheaper strategy for both low- and high-risk patients. Unfortunately, despite the fact that several society and national guidelines have been formulated, these are poorly followed in clinical practice. Proton pump inhibitor (PPI) or misoprostol therapy and H. pylori eradication in NSAID-naiv

Prior cost-effectiveness models analyzing computed tomography colonography (CTC) screening have assumed that patients with diminutive lesions (or=6 mm. The purpose of the current study was to assess the potential harms, benefits, and cost-effectiveness of CTC screening without the reporting of diminutive lesions compared with other screening strategies.

Standard triple therapies are the most used treatment in clinical practice. However, a critical fall in the H pylori eradication rate following these therapies has been observed in the last few years. The sequential regimen is a novel, promising therapeutic approach.