High yield of synchronous lesions in referred patients with large lateral spreading colorectal tumors

Background and Aims There are few data on the prevalence of synchronous colorectal lesions in patients who have large lateral spreading tumors (LLSTs). We sought to describe the rate of synchronous lesions found in patients who underwent endoscopic resection of large sessile adenomas and serrated lesions. Methods This is a retrospective assessment of a prospectively created database of 728 consecutive patients with resected LLSTs who underwent complete clearing of the colon during 2 colonoscopies by a single expert endoscopist. Results The 728 patients with resected LLSTs and complete clearing had 4578 synchronous lesions, including 584 patients (80.2%) with at least 1 synchronous conventional adenoma, 132 (18.1%) with at least 1 synchronous conventional adenoma ≥ 20 mm in size, 294 (40.4%) with at least 1 synchronous advanced conventional adenoma, and 6 patients with a synchronous lesion with cancer. Patients with an index large sessile conventional adenoma compared with those with an index large serrated lesion had on average more synchronous conventional adenomas (4.8 vs 2.9, P = .001) and fewer synchronous serrated lesions (1.4 vs 4.5, P < .001). Of the 97 patients with a serrated class index lesion, 28 (28.9%) met criteria for serrated polyposis. Conclusions There is a very high prevalence of synchronous lesions, including other large and advanced synchronous lesions, in patients with flat or sessile conventional adenomas and serrated colorectal polyps. Patients with LLSTs in the colon need detailed clearing of the rest of the colon. Patients referred for endoscopic resection of serrated lesions ≥ 20 mm have a very high prevalence of serrated polyposis. This study has potential implications for further stratification of high-risk patient groups in postpolypectomy surveillance guidelines

Regional center for complex colonoscopy: yield of neoplasia in patients with prior incomplete colonoscopy

Background and Aims Incomplete colonoscopy increases the risk of incident proximal colon cancer postcolonoscopy. Incomplete colonoscopy is often followed by barium enema or CT colonography. We sought to describe the yield of completion colonoscopy in a regional center for complex colonoscopy. Methods This is a retrospective cohort study of 520 consecutive patients referred to a single colonoscopist over a 14-year period for completion colonoscopy after a previous incomplete examination. Results Colonoscopy was completed to the cecum in 506 of 520 patients (97.3%). A total of 913 conventional adenomas was removed in 277 patients (adenoma detection rate 53.3%). There were 184 adenomas ≥ 1 cm in size or with advanced pathology. There were 525 serrated-class lesions removed in 175 patients, including 54 sessile serrated polyps in 26 patients and 41 hyperplastic polyps greater than 1 cm in 26 patients. Nine colorectal cancers were found. We estimated that approximately 57% of the conventional adenomas, 58% of the sessile serrated polyps, 27% of the hyperplastic polyps, and all 9 cancers detected by the completion colonoscopy were beyond the extent of the previous examination. Conclusions The yield of completion colonoscopy in a cohort of patients with previous failed cecal intubation was substantial. Regional centers for complex colonoscopy can provide high rates of cecal intubation in cases of incomplete colonoscopy and high yields of lesions in these cases. The regional center for complex colonoscopy is an important medical service

Equity in newborn care, evidence from national surveys in low- and middle-income countries

BACKGROUND: High coverage of care is essential to improving newborn survival; however, gaps exist in access to timely and appropriate newborn care between and within countries. In high mortality burden settings, health inequities due to social and economic factors may also impact on newborn outcomes. This study aimed to examine equity in co-coverage of newborn care interventions in low- and low middle-income countries in sub-Saharan Africa and South Asia. METHODS: We analysed secondary data from recent Demographic and Health Surveys in 16 countries. We created a co-coverage index of five newborn care interventions. We examined differences in coverage and co-coverage of newborn care interventions by country, place of birth, and wealth quintile. Using multilevel logistic regression, we examined the association between high co-coverage of newborn care (4 or 5 interventions) and social determinants of health. RESULTS: Coverage and co-coverage of newborn care showed large between- and within-country gaps for home and facility births, with important inequities based on individual, family, contextual, and structural factors. Wealth-based inequities were smaller amongst facility births compared to non-facility births. CONCLUSION: This analysis underlines the importance of facility birth for improved and more equitable newborn care. Shifting births to facilities, improving facility-based care, and community-based or pro-poor interventions are important to mitigate wealth-based inequities in newborn care, particularly in countries with large differences between the poorest and richest families and in countries with very low coverage of care

A qualitative study of the experiences and expectations of women receiving in-patient postnatal care in one English maternity unit

Background Studies consistently highlight in-patient postnatal care as the area of maternity care women are least satisfied with. As part of a quality improvement study to promote a continuum of care from the birthing room to discharge home from hospital, we explored women’s expectations and experiences of current inpatient care. Methods For this part of the study, qualitative data from semi-structured interviews were transcribed and analysed using content analyses to identify issues and concepts. Women were recruited from two postnatal wards in one large maternity unit in the South of England, with around 6,000 births a year. Results Twenty women, who had a vaginal or caesarean birth, were interviewed on the postnatal ward. Identified themes included; the impact of the ward environment; the impact of the attitude of staff; quality and level of support for breastfeeding; unmet information needs; and women’s low expectations of hospital based postnatal care. Findings informed revision to the content and planning of in-patient postnatal care, results of which will be reported elsewhere. Conclusions Women’s responses highlighted several areas where changes could be implemented. Staff should be aware that how they inter-act with women could make a difference to care as a positive or negative experience. The lack of support and inconsistent advice on breastfeeding highlights that units need to consider how individual staff communicate information to women. Units need to address how and when information on practical aspects of infant care is provided if women and their partners are to feel confident on the woman’s transfer home from hospital

Inherited causes of clonal haematopoiesis in 97,691 whole genomes

Age is the dominant risk factor for most chronic human diseases, but the mechanisms through which ageing confers this risk are largely unknown1. The age-related acquisition of somatic mutations that lead to clonal expansion in regenerating haematopoietic stem cell populations has recently been associated with both haematological cancer2,3,4 and coronary heart disease5—this phenomenon is termed clonal haematopoiesis of indeterminate potential (CHIP)6. Simultaneous analyses of germline and somatic whole-genome sequences provide the opportunity to identify root causes of CHIP. Here we analyse high-coverage whole-genome sequences from 97,691 participants of diverse ancestries in the National Heart, Lung, and Blood Institute Trans-omics for Precision Medicine (TOPMed) programme, and identify 4,229 individuals with CHIP. We identify associations with blood cell, lipid and inflammatory traits that are specific to different CHIP driver genes. Association of a genome-wide set of germline genetic variants enabled the identification of three genetic loci associated with CHIP status, including one locus at TET2 that was specific to individuals of African ancestry. In silico-informed in vitro evaluation of the TET2 germline locus enabled the identification of a causal variant that disrupts a TET2 distal enhancer, resulting in increased self-renewal of haematopoietic stem cells. Overall, we observe that germline genetic variation shapes haematopoietic stem cell function, leading to CHIP through mechanisms that are specific to clonal haematopoiesis as well as shared mechanisms that lead to somatic mutations across tissues

Anticoagulant treatment in primary health care in Sweden – prevalence, incidence and treatment diagnosis: a retrospective study on electronic patient records in a registered population

BACKGROUND: The indications for warfarin treatment in primary health care are increasing. An undertreatment with warfarin is reported in the prevention of embolic stroke in patients with chronic atrial fibrillation, and can be suspected for other indications. Information on the prevalence and incidence of diseases treated with warfarin would reveal useful data for audits concerning management of anticoagulant treatment. We aimed to assess warfarin treatment in primary health care with regard to prevalence, incidence, treatment diagnosis and patient characteristics. METHODS: A one-year retrospective study of electronic patient records up to May 2000 in primary health care in Stockholm, Sweden. Five primary health care centres with a registered population of 75 146. Main outcome measures were prevalence, incidence and treatment diagnosis. RESULTS: Five hundred and seven patients, mean age 71.9 years, were on warfarin treatment. The prevalence was 0.67% (age-adjusted 0.75%), and it was significantly higher for men (0.78%) than for women (0.58%) (p = 0.01). In the age group 75–84 years the prevalence was 4.54%. The most prevalent treatment diagnosis was chronic atrial fibrillation (0.28%), which was more predominant for males (p = 0.02), followed by cerebrovascular disease (0.13%) and deep venous thrombosis (0.13%). The yearly incidence of warfarin treatment was 0.17%, with chronic atrial fibrillation as the predominant treatment diagnosis. CONCLUSION: Warfarin treatment in primary health care is prevalent among the elderly. Chronic atrial fibrillation is the main treatment diagnosis. There is a gender difference favouring men in general and chronic atrial fibrillation as the treatment diagnosis

Recent Borexino results and prospects for the near future

The Borexino experiment, located in the Gran Sasso National Laboratory, is an organic liquid scintillator detector conceived for the real time spectroscopy of low energy solar neutrinos. The data taking campaign phase I (2007 - 2010) has allowed the first independent measurements of 7Be, 8B and pep fluxes as well as the first measurement of anti-neutrinos from the earth. After a purification of the scintillator, Borexino is now in phase II since 2011. We review here the recent results achieved during 2013, concerning the seasonal modulation in the 7Be signal, the study of cosmogenic backgrounds and the updated measurement of geo-neutrinos. We also review the upcoming measurements from phase II data (pp, pep, CNO) and the project SOX devoted to the study of sterile neutrinos via the use of a 51Cr neutrino source and a 144Ce-144Pr antineutrino source placed in close proximity of the active material.Comment: 8 pages, 11 figures. To be published as proceedings of Rencontres de Moriond EW 201

Spectroscopy of geo-neutrinos from 2056 days of Borexino data

We report an improved geo-neutrino measurement with Borexino from 2056 days of data taking. The present exposure is $(5.5\pm0.3)\times10^{31}$ proton$\times$yr. Assuming a chondritic Th/U mass ratio of 3.9, we obtain $23.7 ^{+6.5}_{-5.7} (stat) ^{+0.9}_{-0.6} (sys)$ geo-neutrino events. The null observation of geo-neutrinos with Borexino alone has a probability of $3.6 \times 10^{-9}$ (5.9$\sigma$). A geo-neutrino signal from the mantle is obtained at 98\% C.L. The radiogenic heat production for U and Th from the present best-fit result is restricted to the range 23-36 TW, taking into account the uncertainty on the distribution of heat producing elements inside the Earth.Comment: 4 pages, 4 figure

Measurement of neutrino flux from the primary proton--proton fusion process in the Sun with Borexino detector

Neutrino produced in a chain of nuclear reactions in the Sun starting from the fusion of two protons, for the first time has been detected in a real-time detector in spectrometric mode. The unique properties of the Borexino detector provided an oppurtunity to disentangle pp-neutrino spectrum from the background components. A comparison of the total neutrino flux from the Sun with Solar luminosity in photons provides a test of the stability of the Sun on the 10$^{5}$ years time scale, and sets a strong limit on the power production in the unknown energy sources in the Sun of no more than 4\% of the total energy production at 90\% C.L.Comment: 15 pages, 2 tables, 3 figure

Solar neutrino with Borexino: results and perspectives

Borexino is a unique detector able to perform measurement of solar neutrinos fluxes in the energy region around 1 MeV or below due to its low level of radioactive background. It was constructed at the LNGS underground laboratory with a goal of solar $^{7}$Be neutrino flux measurement with 5\% precision. The goal has been successfully achieved marking the end of the first stage of the experiment. A number of other important measurements of solar neutrino fluxes have been performed during the first stage. Recently the collaboration conducted successful liquid scintillator repurification campaign aiming to reduce main contaminants in the sub-MeV energy range. With the new levels of radiopurity Borexino can improve existing and challenge a number of new measurements including: improvement of the results on the Solar and terrestrial neutrino fluxes measurements; measurement of pp and CNO solar neutrino fluxes; search for non-standard interactions of neutrino; study of the neutrino oscillations on the short baseline with an artificial neutrino source (search for sterile neutrino) in context of SOX project.Comment: 15 pages, 4 figure