Is artificial intelligence the final answer to missed polyps in colonoscopy?

Lesions missed by colonoscopy are one of the main reasons for post-colonoscopy colorectal cancer, which is usually associated with a worse prognosis. Because the adenoma miss rate could be as high as 26%, it has been noted that endoscopists with higher adenoma detection rates are usually associated with lower adenoma miss rates. Artificial intelligence(AI), particularly the deep learning model, is a promising innovation in colonoscopy. Recent studies have shown that AI is not only accurate in colorectal polyp detection but can also reduce the miss rate. Nevertheless, the application of AI in real-time detection has been hindered by heterogeneity of the AI models and study design as well as a lack of long-term outcomes. Herein, we discussed the principle of various AI models and systematically reviewed the current data on the use of AI on colorectal polyp detection and miss rates. The limitations and future prospects of AI on colorectal polyp detection are also discussed.     

What the clinician needs to know about the relationship between inflammation and bone formation. Is blocking inflammation enough to prevent ossification?

In spondyloarthropathies, the distinctive evidence of skeletal damage is de novo bone formation in the form of an ossifying enthesopathy, be it axial or peripheral, and bony ankylosis. Biologic therapy that neutralize the tumor necrosis factor have shown to be effective controlling the inflammatory activity of these diseases. However, data from animal models, clinical imaging studies and ecographic data seem to indicate that inflammation and bone formation could be independent processes and that control of inflammation might not be enough to impede the development of ankylosis in these patients. In the osteoblasts' differentiation and activation that leads to bone formation, the Wnt (wingless) pathway and the bone morphogenic proteins acquire a special role and might be determinant in the onset and progression of enthesopathic ossification, as well as become therapeutic targets. On the other hand, clinical and imaging findings as well as the determination of bone markers support the hypothesis that that ossification is initially related to inflammation as a repair process. These facts are reviewed and the latest theories are exposed, in an attempt to establish a link between inflammation and bone formation.     

IBD-associated bone loss: Is inflammation the explanation?

This article has no abstract. To view the article, select the "View Print Version (PDF)" link above.     

Ceramide: A common pathway for atherosclerosis?

Plasma sphingomyelin concentration is correlated with the development of atherosclerosis. It has been found to exist in significantly higher concentrations in aortic plaque. This appears to have clinical relevance as well as it has been shown to be an independent predictor of coronary artery disease. Ceramide, the backbone of sphingolipids, is the key component which affects atherosclerotic changes through its important second-messenger role. This paper sheds light on some of the current literature supporting the significance of ceramide with respect to its interactions with lipids, inflammatory cytokines, homocysteine and matrix metalloproteinases. Furthermore, the potential therapeutic implications of modulating ceramide concentrations are also discussed.     

Is possible to prevent the Post-Pericardiotomy Syndrome?

The post-pericardiotomy syndrome (PPS) is not uncommon following cardiac surgery and may be a cause of severe complications (cardiac tamponade, large pleural effusion), hospital stay prolongation, and readmissions. The estimated incidence of the syndrome has a relatively wide range affecting from 10 to 40% of patients, depending on the adopted diagnostic criteria, institution, and type of cardiac surgery. On this basis, there is a need for standardized criteria for epidemiological and clinical purposes. These criteria should be adopted in future clinical trials and studies on the PPS as well. Such criteria should include both clinical and instrumental findings considering the spectrum of pleuropericardial involvement of the syndrome. In any case, pharmacologic preventive strategies are worthy of further investigation. At present, data from 2 RCTs enrolling a total of 471 patients, have shown that colchicine was associated with a reduced risk of PPS (OR=0.38 95% CI 0.22 to 0.65). Available evidence suggests that colchicine 0.5-1.0mg/day is effective for reducing recurrences of pericarditis and at the same doses is efficacious to prevent the PPS.     

Do we really need to pay attention to the less common crystals?

In addition to monosodium urate, calcium pyrophosphate dihydrate, and apatite crystals, a wide variety of less common crystals, artifacts, and, occasionally, some unidentified birefringent materials may be seen in synovial fluids in association with acute or chronic arthritis. These unusual crystals and their associated musculoskeletal manifestations may be confused with the more common crystals and their manifestations and sometimes may provide the clue for systemic disease because they may present with a pseudovasculitis syndrome. Important advances in understanding the molecular aspect and management of primary hyperoxalurias as well as nephropathic cystinosis provide important general information to be applied in research and in the search for a more effective management of other common crystal-induced arthritis.