Endoscopic grading of gastric intestinal metaplasia on risk assessment for early gastric neoplasia: can we replace histology assessment also in the West?

OBJECTIVES

To assess the value of endoscopic grading of gastric intestinal metaplasia (EGGIM), operative link on gastritis assessment (OLGA) and operative link on gastric intestinal metaplasia (OLGIM) on risk stratification for early gastric neoplasia (EGN) and to investigate other factors possibly associated with its development.

DESIGN

Single centre, case-control study including 187 patients with EGN treated endoscopically and 187 age-matched and sex-matched control subjects. Individuals were classified according to EGGIM, OLGA and OLGIM systems. EGN risk according to gastritis stages and other clinical parameters was further evaluated.

RESULTS

More patients with EGN had EGGIM of ≥5 than control subjects (68.6% vs 13.3%, p<0.001). OLGA and OLGIM stages III/IV were more prevalent in patients with EGN than in control subjects (68% vs 11%, p<0.001, and 61% vs 3%, p<0.001, respectively). The three systems were the only parameters significantly related to the risk of EGN in multivariate analysis: for EGGIM 1-4 (adjusted OR (AOR) 12.9, 95% CI 1.4 to 118.6) and EGGIM 5-10 (AOR 21.2, 95% CI 5.0 to 90.2); for OLGA I/II (AOR 5.0, 95% CI 0.56 to 44.5) and OLGA III/IV (AOR 11.1, 95% CI 3.7 to 33.1); for OLGIM I/II (AOR 11.5, 95% CI 4.1 to 32.3) and OLGIM III/IV (AOR 16.0, 95% CI 7.6 to 33.4).

CONCLUSION

This study confirms the role of histological assessment as an independent risk factor for gastric cancer (GC), but it is the first study to show that an endoscopic classification of gastric intestinal metaplasia is highly associated with that outcome. After further prospective validation, this classification may be appropriate for GC risk stratification and may simplify every day practice by reducing the need for biopsies.

Clinicopathologic Characteristics of Patients with Gastric Superficial Neoplasia and Risk Factors for Multiple Lesions after Endoscopic Submucosal Dissection in a Western Country

Background

Endoscopic submucosal dissection (ESD) is a treatment for early gastric neoplasms that preserves the stomach. However, the risk of multiple lesions persists.

Objectives

To assess clinicopathologic characteristics of patients with early gastric neoplasms in a Western country and evaluate risk factors for multiple gastric lesions, synchronous, or metachronous.

Methods

A retrospective cohort of 230 consecutive patients who underwent ESD for primary neoplasms from 2012 to 2017 (median follow-up: 33 months) was assessed to determine the clinicopathologic characteristics and risk factors for multiple lesions.

Results

The mean age was 68 years, and 53.9% were male. Current/former smoking status was present in 40.4%, and 29.5% had family history of gastric cancer. A third of the patients had only focal gastric atrophy/metaplasia (operative link on gastritis assessment/operative link on gastric intestinal metaplasia assessment [OLGA/OLGIM] I/II; endoscopic grading of gastric intestinal metaplasia [EGGIM] 1-4). Synchronous and me-tachronous lesions occurred in 14.3 and 8.6% of patients, respectively. There was a trend for higher risk of multiple lesions in smokers and patients with extensive metaplasia (EGGIM >4), but only older age was an independent risk factor (OR 3.30; 95% CI 1.05-10.34). Age >60 years (OR 10.10, 95% CI 1.40-88.04), current/former smoking status (OR 3.64, 95% CI 1.07-12.40), and OLGIM III/IV (OR 3.07, 95% CI 1.01-9.36) were independent risk factors for synchronous lesions. No risk factors for metachronous lesions were found.

Conclusions

Surveillance limited to patients with advanced stages of gastritis may miss some primary superficial neoplasms. Although older age increases the risk of multiple lesions, no risk factors were found for metachronous lesions. Therefore, endoscopic surveillance after ESD should be done equally in all patients.

Artrodese interfalângica: eficácia e retorno laboral com fios Kirschner e parafuso Acutrak®

A artrodese interfalângica (IF) é um procedimento osteoarticular frequente e os fios de Kirschner são os mais usados. Outras técnicas descritas são parafusos compressivos ou, recentemente, parafuso sem cabeça, completamente roscado, Acutrak® (Acumed LLC, Hillsboro, OR). Os autores propuseram comparar duas técnicas de artrodese IF: com fios Kirschner e parafusos Acutrak®. Trata-se de um estudo retrospectivo de 2009 a 2012 englobando 67 artrodeses. Destes foram excluídos doentes com infecção, osteopenia ou perda óssea como artrite reumatóide. Obteve-se um total de 53 artrodeses: 22 com fios Kirschner (grupo I) e 31 com parafusos Acutrak® (grupo II). Foi determinada a taxa e tempo de fusão, complicações e tempo de retorno laboral. Os resultados foram analisados pelo SPSS® 20 Statistics (p<0.05). No grupo I, verificou-se 77.3% de fusão com 9% de complicações menores. No grupo II ocorreu consolidação em 100%, na ausência de complicações. O tempo médio de fusão foi 9.6 (r: 6-14) semanas no grupo I e 5.1 (r: 4-8) semanas no grupo II. O retorno laboral foi às 11.5 semanas e 5.4 semanas, respectivamente. O parafuso Acutrak® permite uma artrodese mais eficaz que os fios Kirschner e retorno laboral precoce.

Lead hepatotoxicology: a study in an animal model

The increasing use of lead (Pb) for industrial purposes has resulted in the significant increase in environmental contamination of our planet especially in concern to water and food. In this study using the electron scanning microscopy (SEM), the authors showed the effects of this metal as a result of a chronic and cumulative process. As a primary method of detection of Pb in situ, SEM was chosen, coupled with a detection system Noran Voyager of basic microanalysis X-ray (SEM-XRM), with detection system energy dispersive spectrometry. Mice BALB/c was used as a study model. An animal model of inflammation was used, that consisted in the formation of a subcutaneous pocket of air. It was observed that 75% of Pb stock was captured by the liver, the main target organ in the capture of the metal, the kidney was the second organ to capture the Pb stock and the third was the spleen. It was verified that a low deposition of Pb was found in the lungs and the brain. The main results of this study showed how Pb is captured by different organs. We also demonstrated the vulnerability to inflammation of this metal.

[Current perspectives in screening for cardiac diseases which most frequently cause sudden death during the practice of a sports activity]

Sudden death during sports activities is extremely rare in athletes and sportsmen. Its occurrence was calculated at 0.77 to 13 deaths per 100,000 sportsmen/year. The most frequent causes were coronary heart disease, coronary muscular bridges, congenital coronary artery anomalies, subarachnoid hemorrhage, hypertrophic cardiomyopathy, arrhythmogenic right ventricular dysplasia, Marfan syndrome, aortic coarctation, myocarditis, pulmonary embolism, aortic stenosis, mitral valve prolapse and WPW syndrome. Clinical examination nearly identifies all cases of aortic stenosis, mitral valve prolapse with regurgitation, and aortic coarctation but misses the majority of cases of hypertrophic cardiomyopathy and coronary artery diseases. The use of Chest x-rays, ECG, Stress Test and Echocardiogram will provide the identification of most cases with increased risk of death. Although costs are not limited for professional athletes, this strategy does not totally overcome the problem because diagnostic errors are frequent (false positives and false negatives). Therefore it is important to admit the failure of these screening procedures and the necessity to adapt the strategy to cost-efficiency and time-efficiency in this population.