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Background: Artificial intelligence systems recently demonstrated an increase in polyp and adenoma detection rate. Over the daytime, the adenoma detection rate decreases as tiredness leads to a lack of attention. It is not clear if a polyp detection system with artificial intelligence leads to constant adenoma detection over the day. Methods: We performed a database analysis of screening and surveillance colonoscopies with and without the use of AI. In both groups, patients were investigated with the same endoscopy equipment and by the same endoscopists. Only patients with good bowel preparation (BBPS >6) were included. We correlated the daytime, the investigational time, day of the week, and the adenoma and polyp detection. Results: A total of 303 colonoscopies were analyzed. 163 endoscopies in the AI+ group and 140 procedures in the AI− group were included. In both groups, the total adenoma detection rate was equal (AI+ 0.39 vs. AI− 0.43). The adenoma detection rate throughout the day had a significant decreasing trend in the group without the use of AI (p = 0.015), whereas this trend was not present in the investigations that have been performed with AI (p = 0.65). The duration of investigation did not show a significant difference between the groups (8.9 min in both groups). No relevant effect was noticed in adenoma detection between single days of the working week with or without the use of AI. Conclusion: AI helps overcome the decay in adenoma detection over the daytime. This may be attributed to a constant awareness caused by the use of the AI system. [ABSTRACT FROM AUTHOR]

Background/Aims: Switching from a three-drug regimen (3DR: boosted darunavir [bDRV] and two nucleoside reverse transcriptase inhibitors [NRTIs]) to a two-drug regimen (2DR: bDRV and dolutegravir [DTG]) demonstrated non-inferiority with regard to viral suppression in people living with HIV (PLWH) in the DUALIS study. This sub-analysis focuses on changes in metabolic and renal parameters when sparing the NRTI backbone. Methods: DUALIS was a randomized, open-label, multicenter (27) phase 3-trial. Participants were virologically suppressed (HIV-RNA < 50 copies/mL) on 3DR for at least 24 weeks. Subjects were either switched to DTG 50 mg + bDRV 800 mg (with ritonavir 100 mg) (2DR) or continued their regimen consisting of two NRTIs in combination with ritonavir-bDRV (3DR) once daily. Data of metabolic and renal parameters at baseline and week 48 were compared. Results: The LDL-fraction increased by + 13.3 (−3.0 to +31.3) mg/dL on 2DRs and was stable (−14.0 to +18.0 mg/dL) on 3DRs (p < 0.0010). PLWH gained +2.0 (−0.2 to +4.0) kg and +0.2 (−1.9 to +2.1) kg in body weight on 2DRs and 3DRs, respectively 3 (p = 0.0006). The MDRD eGFR decreased by −7,8 (−17.4 to −0.3) mL/min/1.73m2 and 0.4 (−8.8 to +5.7) mL/min/1.73m2 on 2DRs and 3DRs, respectively (p = 0.0002), while serum levels of cystatin C were stable in both arms (2DR: −0.1 to +0.1 mg/L; 3DR: 0.0 to +0.1 mg/L). Conclusions: While being non-inferior in terms of viral suppression, sparing the NRTI backbone showed a non-favorable profile in metabolic or renal parameters over 48 weeks. [ABSTRACT FROM AUTHOR]

Introduction: Artificial Intelligence (AI) is one of the most evolving fields in endoscopy. We aimed to test if a system for polyp detection and polyp characterization can be used to predict complete endoscopic resection of colon adenomas. Methods: We used the CAD-Eye AI system (Fujifilm Europe) in consecutive patients who received polypectomy using a cold snare. After resection, the submucosal space was flushed with water using an irrigation pump. Images were obtained using the CAD Eye system, and the characterization of the system was noted and afterward compared to histology of the removed specimen. Results: In total, 17 polypectomies were observed, and in no case the AI was able to give information about resection status. First, the resection plane itself was classified as being adenomatous in all cases, while, second, all adenomas were resected completely, thus harboring no potential for overlying misinterpretations in the images. Conclusion: An AI system trained to characterize polyps in healthy surrounding colorectal mucosa cannot predict the state of resection after removal of the adenoma. This is explained by the training and programming. Endoscopists using AI from now on should learn about the basics of AI and the pitfalls in interpreting results from AI. [ABSTRACT FROM AUTHOR]

Background Dolutegravir (DTG) and boosted darunavir (bDRV) are potent antiretrovirals with a high resistance barrier and might be valuable switch options for people with HIV (PWH). Methods DUALIS, a randomized, open-label, phase 3b, noninferiority clinical trial, compared the switch to DTG + bDRV (2DR) with continuation of 2 nucleoside reverse transcriptase inhibitors (2NRTI) + bDRV (3DR). PWH with HIV RNA <50 copies/mL taking 2NRTI + bDRV (3DR) for ≥24 weeks (1 accepted blip <200 copies/mL) were randomized to either switch to DTG 50 mg + DRV 800 mg (boosted with 100 mg of ritonavir) or continue taking 3DR. The primary end point (PE) was the proportion of HIV RNA <50 copies/mL at week (W) 48. Change in NRTI backbone was not classified as failure. The estimated sample size for PE analysis was 292; the noninferiority margin was ≤–10.0%. Results In total, 263 subjects were randomized and treated (2DR n = 131, 3DR n = 132; 90.1% male; 89.7% Caucasian; median age [interquartile range], 48 [39–54] years). At W48, 86.3% (n = 113/131) of the 2DR subject and 87.9% (n = 116/132) of the 3DR subjects had HIV RNA <50 copies/mL; the difference between arms was –1.6% (95.48% CI, based on the adjusted alpha level accounting for the interim analysis at W24, –9.9% to +6.7%; discontinuations due to adverse events: 2DR, 4.6% [n = 6]; 3DR, 0.8% [n = 1]). Kaplan-Meier estimates of confirmed HIV RNA ≥50 copies/mL at W48 were 1.6% (n = 2) in the 2DR and 3.1% (n = 4) in the 3DR group. Development of treatment-emergent resistance was not observed. Conclusions Switching to DTG + bDRV was noninferior to continuing 3DR in subjects already treated with bDRV. [ABSTRACT FROM AUTHOR]

Cannulation of a pseudocyst using a catheter with a wire alongside another wire can sometimes be challenging or unsuccessful because it is only possible if the cannulation can be performed in parallel to the axis of the first wire, which is sometimes hard. One-step, simultaneous double-wire technique facilitates pancreatic pseudocyst and abscess drainage (with videos). [Extracted from the article]

Background/Aims: Switching from a three-drug regimen (3DR: boosted darunavir [bDRV] and two nucleoside reverse transcriptase inhibitors [NRTIs]) to a two-drug regimen (2DR: bDRV and dolutegravir [DTG]) demonstrated non-inferiority with regard to viral suppression in people living with HIV (PLWH) in the DUALIS study. This sub-analysis focuses on changes in metabolic and renal parameters when sparing the NRTI backbone. Methods: DUALIS was a randomized, open-label, multicenter (27) phase 3-trial. Participants were virologically suppressed (HIV-RNA < 50 copies/mL) on 3DR for at least 24 weeks. Subjects were either switched to DTG 50 mg + bDRV 800 mg (with ritonavir 100 mg) (2DR) or continued their regimen consisting of two NRTIs in combination with ritonavir-bDRV (3DR) once daily. Data of metabolic and renal parameters at baseline and week 48 were compared. Results: The LDL-fraction increased by + 13.3 (-3.0 to +31.3) mg/dL on 2DRs and was stable (-14.0 to +18.0 mg/dL) on 3DRs ( p  < 0.0010).PLWH gained +2.0 (-0.2 to +4.0) kg and +0.2 (-1.9 to +2.1) kg in body weight on 2DRs and 3DRs, respectively 3 ( p  = 0.0006).The MDRD eGFR decreased by -7,8 (-17.4 to -0.3) mL/min/1.73m 2 and 0.4 (-8.8 to +5.7) mL/min/1.73m 2 on 2DRs and 3DRs, respectively ( p  = 0.0002), while serum levels of cystatin C were stable in both arms (2DR: -0.1 to +0.1 mg/L; 3DR: 0.0 to +0.1 mg/L). Conclusions: While being non-inferior in terms of viral suppression, sparing the NRTI backbone showed a non-favorable profile in metabolic or renal parameters over 48 weeks.