Editorial article to: Animal experimental study on magnetic anchor technique-assisted endoscopic submucosal dissection of early gastric cancer.

In this editorial we comment on the article published in the recent issue of the World Journal of Gastrointestinal Endoscopy 2023; 15 (11): 634-680. Gastric cancer (GC) remains the fifth most common malignancy and the fourth leading cause of cancer-related death worldwide. The overall prevalence of GC has declined, although that of proximal GC has increased over time. Thus, a significant proportion of GC cases and deaths can be avoided if preventive interventions are taken. Early GC (EGC) is defined as GC confined to the mucosa or submucosa. Endoscopic resection is considered the most appropriate treatment for precancerous gastrointestinal lesions improving patient quality of life, with reduced rates of complications, shorter hospitalization period, and lower costs when compared to surgical resection. Endoscopic mucosal resection (EMR) and endoscopic sub-mucosal dissection (ESD) are representative endoscopic treatments for EGC and precancerous gastric lesions. Standard EMR implies injection of a saline solution into the sub-mucosal space, followed by excision of the lesion using a snare. Complete resection rates vary depending on the size and severity of the lesion. When using conventional EMR methods for lesions less than 1 cm in size, the complete resection rate is approximately 60%, whereas for lesions larger than 2 cm, the complete resection rate is low (20%-30%). ESD can be used to remove tumors exceeding 2 cm in diameter and lesions associated with ulcers or submucosal fibrosis. Compared with EMR, ESD has higher en bloc resection rates (90.2% vs 51.7%), higher complete resection rates (82.1 vs 42.2%), and lower recurrence rates (0.65% vs 6.05%). Thus, innovative techniques have been introduced.

Clinical outcomes for patients with cardiovascular diseases before, during, and after the COVID19 pandemic. A pooled analysis of 600.000 patients.

BACKGROUND: The unexpected virulence of the COVID19 pandemic brought to significant changes of generally accepted therapeutic approaches. The consequences of these changes were difficult to define during the pandemic period. METHODS: We analyzed the National Registries including 97% of hospital admissions in Italy, regarding data describing number of operations for aortic valve implantation or repair, carotid and coronary revascularization, AAA repair, and lower limb arterial reconstruction performed in the period 2015 to 2019 and in the pandemic years 2020, 2021, and 2022. Primary outcomes were number and type of surgical procedures, 30-days operative mortality. RESULTS: During the three years of the pandemic there was a statistically significant increase of the number of all-causes deaths in comparison with the mean of the previous five years (2015-2019). In Italy there was a total increase of all causes-deaths of 251.911 (+105900 in 2020; +66929 in 2021; and +79082 in 2022), and 73% of the excess of deaths was related with COVID19 infection and 27% occurred in COVID 19 negative patients. During the first year of the pandemic, worse clinical outcomes for hospitalized patients with CVD were registered. The medical system responded adequately and in the following two pandemic years clinical outcomes for hospitalized patients were similar with those of the pre-pandemic period. CONCLUSIONS: The unexpected virulence of COVID19 pandemic determined worse clinical outcomes for patients with CVD during the first year. The adopted preventive measures allowed in the following two pandemic years improved clinical outcomes, similar with those of the pre-pandemic period.

Trends towards increase of Cardiovascular diseases mortality in USA: A comparison with Europe and the importance of preventive care.

BACKGROUND: the aim of our study was to analyze exposure of the general population to established risk factors for cardiovascular disease (CVD), which might have determined the trend towards increased mortality rates related with CVD from 2015 to 2019 in USA. MATERIAL AND METHODS: We Analyzed epidemiological of data from the US National Health and Nutrition Examination Survey and from the European Health Interview Survey to determine trends for exposure to several established risk factors for CVD from 2000 to 2018-2019. Trends of prevalence of obesity, arterial hypertension, cigarettes smoking, high cholesterol level, diabetes in the period 2000 to 2018-2019 in USA were correlated with age adjusted mortality and burden related with CVD. We correlated these trends also with educational attainment, family income and national expenditure for preventive care. RESULTS: Cardiovascular Diseases Related Mortality And Burden Decreased Significantly In Usa In The Period 2000-2015; In The Period 2015-2019 there was a trend towards increasing mortality rates. The trend in the period 2015-2019 was associated with increased exposure to several established risk factors for CVD: obesity, diabetes, cigarettes smoking and arterial hypertension. Level of education attainment and family income, and national health expenditure for information, education and counseling were statistically correlated with reduced exposure to established risk factors. Similar trends were present in Western European countries. CONCLUSIONS: Attention is required to improve education and communication, health access and care for people with poor economic conditions, homeless, minorities, to reduce CVD related mortality and burden.

The role of education and information to prevent trends towards increase of cardiovascular mortality rates in Europe from 2015 TO 2019.

BACKGROUND: In Europe Cardio Vascular Disease (CVD) mortality rates decreased significantly in the last 25 years, with less decline in the last 5 years. The aim of our study was to analyze trends of risk factors which may explain plateauing of CVD mortality rates in the period 2015-2019 in Europe. METHODS: We analyzed data from the Global Burden Disease and EUROSTAT concerning trends of CVD mortality rates for 25 European countries and simultaneous changes of exposure to risk factors of the population RESULTS: CVD related mortality decreased significantly in the analyzed countries in the period 2000-2015; in the period 2015-2019 there was a trend towards plateauing of CVD related mortality rates, which was associated with an increased exposure to several established risk factors including cigarette smoking, obesity and arterial hypertension. A decrease in expenditure for information, education and counseling programs was documented in most countries in the same period. Level of exposure to risk factors was correlated with educational attainment . Exposure to risk factors in the interval 2014-2019 increased for people with lower education, whereas decreased in people with higher education (p<0.001). CONCLUSIONS: Organized information about risk factors for CVD have the potential to reduce mortality and burden, with diminished total health expenses. Education and information in this setting should consider the cultural and social level of the public.

Mortality and burden related with aortic aneurysms and dissections. The importance of information and education.

BACKGROUND: In this study we correlated changes of risk factors for cardiovascular diseases with trends of age standardized mortality rates and burden for aortic aneurysms and dissections. METHODS: We analyzed data from the Global Burden of Diseases and EUROSTAT. FINDINGS: There was a significant increase of expenditure for health from 1980 and 2019. In the period 1980-2000, despite higher health spending, age standardized mortality rates increased in almost all European countries. During the period 2000-2019, in Western European Countries and in Poland, Estonia, Latvia, Slovenia there was a correlation between higher health expenditure and decrease of ASMR. The most important changes between the period 1980-2000 and the period 2000-2019 was the proportion of health expenditure devoted to preventive care and to the increased use of aspirin and statins. INTERPRETATION: Information about risk factors for cardiovascular diseases have leads to decreased aortic aneurysm related mortality and burden.