Interactive training versus self-driven training in the prediction of colorectal polyp histology by trainees using the NICE classification.

BACKGROUND: The COVID-19 pandemic has impacted endoscopic training of the Narrow Band Imaging International Colorectal Endoscopic (NICE) classification, which could accurately predict pathology of colorectal polyps. This study aimed to evaluate the diagnostic performance by trainees of self-driven training vs. interactive training in the prediction of colorectal polyp histology. METHODS: This was a prospective randomized controlled study at five academic centers from January 1, 2021 to May 31, 2021. Trainees with no previous formal training of narrow band imaging or blue light imaging for prediction of colorectal polyp histology were randomly allocated to the self-driven training group or interactive training group. Before and after the training, all trainees were given 20 selected cases of colorectal polyp for testing. Their diagnostic performance was analyzed. RESULTS: Overall, the two training groups showed similar accuracy of NICE classification (79.3% vs. 78.1%; P = 0.637), vessel analysis (77.8% vs. 77.6%, P = 0.939), and surface pattern analysis (78.1% vs. 76.9%, P = 0.616). The accuracy of color analysis in the interactive training group was better (74.4% vs. 80.0%, P = 0.027). For high-confidence predictions, the self-driven training group showed higher accuracy of NICE classification (84.8% vs. 78.7%, P < 0.001) but no difference for analysis of color (79.6% vs. 81.0%), vessel pattern (83.0% vs. 78.5%), and surface pattern (81.8% vs. 78.5%). CONCLUSIONS: Overall, self-driven training showed comparable accuracy of NICE classification, vessel pattern, and surface pattern to interactive training, but lower accuracy of color analysis. This method showed comparable effectiveness and is more applicable than interactive training. It is worth spreading during the COVID-19 pandemic. Trial registration Name of the registry: Chinese Clinical Trial Registry, Trial registration number: ChiCTR2000031659, Date of registration: 06/04/2020, URL of trial registry record: http://www.chictr.org.cn/showproj.aspx?proj=51994.

Role of Neuroimmune Interactions in COVID-19-related Cardiovascular Damage.

Coronavirus disease 2019 (COVID-19) has caused a global pandemic impacting over 200 countries/regions and more than 200 million patients worldwide. Among the infected patients, there is a high prevalence of COVID-19-related cardiovascular injuries. However, the specific mechanisms linking cardiovascular damage and COVID-19 remain unclear. The COVID-19 pandemic also has exacerbated the mental health burden of humans. Considering the close association between neuroimmune interactions and cardiovascular disease, this review assessed the complex pathophysiological mechanisms connecting neuroimmune interactions and cardiovascular disease. It was revealed that the mental health burden might be a pivotal accomplice causing COVID-19-associated cardiovascular damage. Specifically, the proinflammatory status of patients with a terrible mood state is closely related to overdrive of the hypothalamus-pituitary-adrenal (HPA) axis, sympathovagal imbalance, and endothelial dysfunction, which lead to an increased risk of developing cardiovascular injury during COVID-19. Therefore, during the prevention and treatment of cardiovascular complications in COVID-19 patients, particular attention should be given to relieve the mental health burden of these patients.

SARS-CoV-2 infection induces inflammatory bone loss in golden Syrian hamsters.

Extrapulmonary complications of different organ systems have been increasingly recognized in patients with severe or chronic Coronavirus Disease 2019 (COVID-19). However, limited information on the skeletal complications of COVID-19 is known, even though inflammatory diseases of the respiratory tract have been known to perturb bone metabolism and cause pathological bone loss. In this study, we characterize the effects of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection on bone metabolism in an established golden Syrian hamster model for COVID-19. SARS-CoV-2 causes significant multifocal loss of bone trabeculae in the long bones and lumbar vertebrae of all infected hamsters. Moreover, we show that the bone loss is associated with SARS-CoV-2-induced cytokine dysregulation, as the circulating pro-inflammatory cytokines not only upregulate osteoclastic differentiation in bone tissues, but also trigger an amplified pro-inflammatory cascade in the skeletal tissues to augment their pro-osteoclastogenesis effect. Our findings suggest that pathological bone loss may be a neglected complication which warrants more extensive investigations during the long-term follow-up of COVID-19 patients. The benefits of potential prophylactic and therapeutic interventions against pathological bone loss should be further evaluated.

Association of Lung Ultrasound Score with Mortality and Severity of COVID-19: A Meta-Analysis and Trial Sequential Analysis.

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic has rapidly spread all over the world. Lung ultrasound (LUS) has emerged as a useful tool for diagnosing many respiratory diseases. The prognostic role of LUS in COVID-19 patients has not yet been established. METHODS: Several databases were searched on 09 April 2021. The difference in LUS score between the death and survival groups, and the relationship between LUS score and COVID-19 severity were both assessed. RESULTS: The LUS score was significantly higher in the death group compared with the survival group (weighted mean difference (WMD) = 8.21, 95% CI: 4.74-11.67, P < 0.001), which was confirmed by trial sequential analysis. Those with mild/moderate, severe and critical COVID-19 had a progressively higher LUS score (critical vs. severe: WMD = 8.78, 95% CI: 4.17-13.38; P < 0.001; critical vs. mild/moderate/severe: WMD = 10.00, 95% CI: 6.83-13.17, P < 0.001; severe vs. moderate: WMD = 5.96, 95% CI: 3.48-8.44, P < 0.001; severe vs. mild/moderate: WMD = 7.31, 95% CI: 4.45-10.17, P < 0.001). CONCLUSIONS: The LUS score was associated with mortality and severity of COVID-19. The LUS score might be a risk stratification tool for COVID-19 patients.