Recommended core outcomes have been insufficiently used in randomized controlled trials about postoperative pain in children, which hinders comparability of studies and makes synthesis of evidence difficult.

Background and Aims: Accurate polyp size measurement is important for guideline conforming choice of polypectomy techniques and subsequent surveillance interval assignments. Some endoscopic tools (biopsy forceps [BF] or endoscopic rulers [ER]) exist to help with visual size estimation. A virtual scale endoscope (VSE) has been developed that allows superimposing a virtual measurement scale during live endoscopies. Our aim was to evaluate the performance of VSE when compared to ER and BF-based measurement. Methods: We conducted a preclinical randomized trial to evaluate the relative accuracy of size measurement of simulated colorectal polyps when using: VSE, ER, and BF. Six endoscopists performed 60 measurements randomized at a 1:1:1 ratio using each method. Primary outcome was relative accuracy in polyp size measurement. Secondary outcomes included misclassification of sizes at the 5, 10, and 20mm thresholds. Results: A total of 360 measurements were performed. The relative accuracy of BF, ER, and VSE was 78.9% (95%CI=76.2-81.5), 78.4% (95%CI=76.0-80.8), and 82.7% (95%CI=80.8-84.8). VSE had significantly higher accuracy compared to BF (p=0.02) and ER (p=0.006). VSE misclassified a lower percentage of polyps >5mm as ≤5mm (9.4%) compared to BF (15.7%) and ER (20.9%). VSE misclassified a lower percentage of ≥20mm polyps as <20mm (8.3%) compared with BF (66.7%) and ER (75.0%). 25.6%, 25.5%, and 22.5% of polyps ≥10mm were misclassified as <10mm with ER, BF, and VSE, respectively. Conclusions: VSE had significantly higher relative accuracy in measuring polyps compared to ER or biopsy forceps assisted measurement. VSE improves correct classification of polyps at clinically important size thresholds.

Objectives The virtual scale endoscope (VSE) allows projection of a virtual scale onto colorectal polyps allowing real‐time size measurements. We studied the relative accuracy of VSE compared to visual assessment (VA) for the measuring simulated polyps of different size and morphology groups. Methods We conducted a blinded randomized controlled trial using simulated polyps within a colon model. Sixty simulated polyps were evenly distributed across four size groups (1–5, >5–9.9, 10–19.9, and ≥20 mm) and three Paris morphology groups (flat, sessile, and pedunculated). Six endoscopists performed polyp size measurements using random allocation of either VA or VSE. Results A total of 359 measurements were completed. The relative accuracy of VSE was significantly higher when compared to VA for all size groups >5 mm (P = 0.004, P < 0.001, P < 0.001). For polyps ≤5 mm, the relative accuracy of VSE compared to VA was not significantly higher (P = 0.186). The relative accuracy of VSE was significantly higher when compared to VA for all morphology groups. VSE misclassified a lower percentage of >5 mm polyps as ≤5 mm (2.9%), ≥10 mm polyps as <10 mm (5.5%), and ≥20 mm polyps as <20 mm (21.7%) compared to VA (11.2%, 24.7%, and 52.3% respectively; P = 0.008, P < 0.001, and P = 0.003). Conclusion Virtual scale endoscope had significantly higher relative accuracies for every polyp size group or morphology type aside from diminutive. VSE enables the endoscopist to better classify polyps into correct size categories at clinically relevant size thresholds of 5, 10, and 20 mm.

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Objective. The objective of this study was to compare the efficacy and safety of two rituximab (RTX) regimens for the induction of remission in severe antineutrophil cytoplasm antibody-associated vasculitis (AAV): the four-dose (375 mg/m 2 intravenously weekly) versus the two-dose (1000 mg intravenously biweekly) regimen.Methods. A systematic review was performed to identify studies using the four-and/or two-dose RTX regimens for induction of remission in severe AAV. Disease status 6 months after RTX infusion was required for inclusion. Patients were excluded if they received concomitant cyclophosphamide or plasma exchange. The primary end point was the proportion of patients in complete remission at 6 months. The pooled estimate was obtained by using meta-analysis methods for proportions with random effects. Secondary end points included antineutrophil cytoplasm antibody status, number of patients with B-cell depletion, mean prednisone dose, infections, and death.Results. A total of 27 studies and 506 patients were included for analysis: 361 patients received the four-dose regimen, and 145 patients received the two-dose regimen. Most patients had relapsing disease at inclusion (83% and 92% of patients, respectively). There was no significant difference between the four-and two-dose regimens, with a complete remission achieved in 85% (95% confidence interval [CI]: 70-96) and 91% (95% CI: 79-99) of patients, respectively. At 6 months, both regimens were associated with a similar mean daily prednisone dose (8.1 mg), infections (12% in both), and death (1% vs 0%, respectively). Conclusion.No difference was found in terms of efficacy or safety between the four-and two-dose RTX regimens for induction of remission in severe AAV.Dr. Durand's work was supported by a clinician-researcher salary award from the Fonds de Recherche du Québec-Santé.