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This prospective study examined the appropriate use of colonoscopy in an open-access system with the American Society for Gastrointestinal Endoscopy guidelines and determined whether the American Society for Gastrointestinal Endoscopy guidelines were associated with relevant endoscopic findings.In a cohort of 2221 consecutive patients referred for colonoscopy, the proportion of patients who underwent colonoscopy for appropriate indications was prospectively assessed. The relationship between appropriateness and the presence of clinically relevant endoscopic diagnoses was assessed by calculating (1) the positive and negative likelihood ratio of the indications; and (2) the change in the probability of relevant endoscopic diagnoses in the presence of the American Society for Gastrointestinal Endoscopy criteria.The rate for 'generally not indicated' colonoscopies was 37%. Relevant endoscopic diagnoses were present in 28.5% of cases with American Society for Gastrointestinal Endoscopy indications versus 20.1% of patients without appropriate indications. However, the risk of finding relevant diagnoses was significantly increased by American Society for Gastrointestinal Endoscopy criteria application (odds ratio (OR) 1.58; 99% CI 1.20-2.07; p0.01). Furthermore, in both endoscopic situations (appropriate and not appropriate), the likelihood ratio, positive and negative, varied very little, suggesting a low predictivity for serious pathologies by the appropriate procedure.The use of an appropriateness evaluation system makes it possible to increase the probability of finding relevant endoscopic diseases. However, the exclusive use of such a system for selecting patients to undergo colonoscopy involves a relatively high risk of colorectal neoplasms going undetected.

Robert Frost first famously penned “Poetry is what gets lost in translation.” In the world of advocacy, persuasion is what gets lost in translation. This article examines the distinctions in the common law and civil law methods of legal reasoning. It analyzes why, in form and substance, the traditional common law oral argument methods are neither effective nor persuasive when presented in a civil law jurisdiction. Although the common law and civil law legal traditions share similar social objectives, arguing based on stare decisis is incompatible with the Code-based method applied by civil law courts. This article explores how to transfer common law advocacy skills to create an effective civil law oral argument. By making this transition, a common law advocate will be able to garner a greater awareness of the civil law system, including an understanding of the rules that govern the court or tribunal that will be hearing the argument, an appreciation for the role of the judge hearing the argument, and an appreciation for the role of scholars in the civil law system. As a result, common law practitioners can hone their ability to effectively craft a persuasive civil law argument.

Background: High incidence rates of gastric cancer are associated with high incidence of so called pre-neoplastic lesions (chronic atrophic gastritis CAG, Intestinal Metaplasia IM and gastric epithelial dysplasia GED). However a reliable estimation of these values is lacking from many countries even those plagued by gastric cancer. Aim: To estimate, by a cross-sectional study, the incidence of CAG, IM and GED in a rural area of Northern Italy characterized by high incidence of gastric cancer. Subjects and Methods: 2792 subjects (77% of total) attending for Esophago-gastro-duodenoscopy (EGDS) in a 2 and half years period, underwent multiple biopsies from antrum-angulus, body and fundus; the percentage of cases affected by CAG, IM and GED was calculated (with 95% CI) globally and for different age classes and Helicobacter Pylori (HP) infection. Differences between percentages were considered significant at 0.05 if 95%CI did not overlap. Results: 134 cases of GED (4.8% of total EGDS), 472 of CAG (16.9%) and 1065 of IM (39.2%) were identified. These lesions were significantly more frequent in older patients (≥ 60 yrs) compared with younger ones: 8% vs 2.8% for GED; 25.8% vs 10.8% for CAG; 58% vs 25% for IM; p