Screening Relevance of Sessile Serrated Polyps

Conventional adenomas have historically been considered to be the only screening-relevant colorectal cancer (CRC) precursor lesion. The prevailing paradigm was that most CRCs arise along the chromosomal instability pathway, where adenomas accumulate incremental genetic alterations over time, leading eventually to malignancy. However, it is now recognized that this "conventional" pathway accounts for only about two-thirds of CRCs. The serrated pathway is responsible for most of the remainder, and is a disproportionate contributor to postcolonoscopy CRC. Hallmarks of the serrated pathway are mutations in the BRAF gene, high levels of methylation of promoter CpG islands, and the sessile serrated polyp (SSP). Accumulating evidence shows that SSPs can be considered adenoma-equivalent from the standpoint of CRC screening. SSPs have a higher prevalence than previously thought, and appear to have a relatively long dwell time similar to that of conventional adenomas. In addition, SSPs, whether sporadic or as part of the serrated polyposis syndrome, are associated with increased risk of synchronous and metachronous neoplasia. These features collectively support that SSPs are highly relevant to CRC prevention

Reviewing the Evidence That Polypectomy Prevents Cancer

Colonoscopic polypectomy is fundamental to effective prevention of colorectal cancer. Polypectomy reduces colorectal cancer incidence and mortality by altering the natural history and progression of precancerous precursor polyps. Epidemiologic data from the United States, where colorectal cancer rates have been steadily declining in parallel with screening efforts, provide indisputable evidence about the effectiveness of polypectomy. Randomized controlled trials of fecal occult blood tests and flexible sigmoidoscopy, and observational colonoscopy studies, provide additional support. Longitudinal studies have shown variable levels of protection after polypectomy, highlighting the central importance of high quality and adequate surveillance of higher-risk patients

Advanced Colonoscopy Techniques and Technologies

Colonoscopy is the most frequently performed endoscopic procedure in the United States. It is the mainstay of diagnostic and therapeutic options for the practicing gastroenterologist. It plays a fundamental role in colorectal cancer (CRC) prevention, with a dominant position among the screening options for CRC and precancerous lesions. Over the past decade, there have been significant advances in the field of CRC and colonoscopy, including a better understanding of the importance of right-sided lesions, the sessile serrated pathway, and recognition of the significance of operator dependence in colonoscopy. This has been paralleled by an array of technological and technical advances that has transformed the field of colonoscopy and improved patient care. This article addresses the diverse and expanding field of advanced colonoscopy techniques and technologies. It is intended to be a primer on recent and effective developments in advanced technologies for screening or imaging, mucosal resection techniques, and endoscopic management of CRC

Does Increased Adenoma Detection Reduce the Risk of Colorectal Cancer, and How Good Do We Need to Be?

Purpose of Review Colorectal cancer (CRC) is largely preventable with colonoscopy and other screening modalities. However, the effectiveness of screening and surveillance depends on the quality of the colonoscopy exam. Adenoma detection rate (ADR) is the best-validated metric by which we measure individual physicians’ performance. Recent Findings Recent evidence suggests that ADR benchmarks may be inappropriately low. There is proof that improving ADR leads to significant reductions in post-colonoscopy CRC (PCCRC). Two studies have demonstrated that when a colonoscopy is performed by physicians with higher ADRs, patients are less likely to have advanced adenomas on surveillance and less likely to develop or die from PCCRC. Finally, there is at least some evidence that higher ADRs do not lead to more cumulative surveillance exams. Summary The ADR is a useful outcome measure that can provide individual endoscopists and their patients with information about the likelihood of developing PCCRC. To achieve the lowest possible PCCRC rate, we should be striving for higher ADRs. While strategies and innovations may help a bit in improving ADRs, our efforts should focus on ensuring a complete mucosal exam for each patient. Behavioral psychology theories may provide useful frameworks for studying motivating factors that drive a careful exam

Increasing reproductive rates of both sexes in dairy cattle breeding optimizes response to selection

It was reasoned that technologies that increase the reproductive rate of males and females in dairy cattle would realize higher responses to selection. The authors tested this hypothesis using deterministic simulation of breeding schemes that resembled those of dairy cattle in Kenya. The response to selection was estimated for four breeding schemes and strategies. Two breeding schemes were simulated, based on artificial insemination (AI) and multiple ovulation and embryo transfer (MOET) reproductive technologies. The strategies were defined according to the use of conventional semen (CS) and X-chromosome-sorted semen (XS). The four strategies therefore were AI with CS (AI-CS) and XS (AI-XS), and MOET with CS (MOET-CS) and XS (MOET-XS). The four strategies were simulated based on the current dairy cattle breeding goal in Kenya. A two-tier closed nucleus breeding programme was considered, with 5% of the cows in the nucleus and 95% in the commercial. Dissemination of superior genetic materials in the nucleus was based on all four breeding strategies, while in the commercial only the AI-CS strategy was considered. The strategies that increased the reproductive rates of both males and females (MOET-CS and MOET-XS) realized 2.1, 1.4, and 1.3 times more annual genetic gain, return and profitability per cow, per year, respectively, than strategies that increased the reproductive rates only of males (AI-CS and AI-XS). The use of CS or XS, however, did not affect response to selection in the two schemes. The findings demonstrate that reproductive technologies such as MOET maximize response to selection in dairy cattle breeding.Keywords: artificial insemination, conventional semen, deterministic simulation, multiple ovulation and embryo transfer, X-chromosome-sorted seme

Relationship Between the Weight of a Low Birth Agency With Justice in The Hospital Bhayangkara Kediri City

Jaundice is a yellow stain on the skin, sclera, or mucous membranes as a result of excessive accumulation of bilirubin in the tissues. Low birth weight babies (LBW) are defined as birth weight 2,500 grams or less. In infants with low birth weight can experience various complications, one of which is hyperbilirubinemia (jaundice). This study aims to determine the relationship of Low Birth Weight Babies (LBW) with the incidence of jaundice in Bhayangkara Hospital in the city of Kediri. The research design used is correlational analytic research. The method used is a cross sectional approach. The sampling technique was carried out in total sampling as many as 105 samples of infants with LBW. Research data is taken from medical records. Data were analyzed univariately and bivariately using Spearman's Rho test. The results of the study showed that out of 105 infants with low birth weight who experienced physiological jaundice as many as 75 infants (71.4%) and pathological jaundice as many as 30 infants (28.6%). The results of the Spearman Rh Rho test analysis showed that the p value = 0.067 or less than α = 0.05 (0.067 0.05), which means that H0 is rejected and H1 is accepted, meaning that there is a relationship between the incidence of LBW and neonatal jaundice in Bhayangkara Hospital in the City Kediri in 2018. The strength of the relationship is based on the correlation coefficient of 0.196 which means that there is a moderate relationship between the incidence of LBW and jaundice in Bhayangkara Hospital in Kota Kadiri in 2018

Descriptive sensory quality of Kenya’s indigenous chicken meat from different ecotype- clusters reared under an intensive system

Indigenous chicken (IC) in Kenya performs a major food security and socio-economic function for most households, especially of the rural poor. The trend has been to move from rearing IC on free-range systems to more intensive and semi intensive systems. This study was conducted by use of Quantitative Descriptive Analysis (QDA) and the Just About Right (JAR) scale scores to quantify the appeal of the IC meat reared under intensive systems. The IC used in the study had been obtained from Taita,  Kakamega and Narok ecotype clusters kept under the intensive system at Indigenous Chicken Improvement Programme (INCIP) unit at Egerton University. During the intensive rearing, the chickens were given the same treatment in terms of feed, disease control at all the stages and water was given ad-libitum. The chickens were slaughtered at the same age and only cocks were used as control for sensorial differences accruing due to sex. Five cocks from each ecotype cluster were slaughtered after a feed  withdrawal period of 8-10 hours and their meat prepared by boiling for sensory evaluation after ageing on ice for 3-6 hours. A trained panel of tasters (13-15) was used to evaluate the descriptive and JAR sensorial quality of indigenous chickens’ meat from the breast and thighs. One commercial broiler (Kenbro) was used as a control. Results showed that there was significant effect at P<0.05 of the ecotype of the IC on its meat aroma, flavour and brown colour intensity. The JAR scale showed that the consumers’ scores for the colour, flavour, juiciness, tenderness of indigenous chicken was ‘just about right’ compared to broiler which was described by colour as too light, flavour too strong, too juicy in terms of expression of juiciness and too tender with regard to texture. The Principal Component Analysis results showed that there were two principal components (colour and texture) that accounted for 55.4 % and 11.6% and 53.9 and 19% for both descriptive scores and JAR scores for IC meat, respectively. This study indicates sensorial differences among the Kenyan Indigenous chicken ecotypes (of different genetic characteristics) under intensive systems and demonstrates significant difference among various attributes from the commercial broiler.Key words: Descriptive, sensory evaluation, Kenyan Indigenous chicken, ecotype cluster, intensive system