Comparison of Targeted vs Random Biopsies for Surveillance of Ulcerative Colitis-Associated Colorectal Cancer

Background & AimsA random biopsy is recommended for surveillance of ulcerative colitis (UC)-associated colorectal cancer. However, a targeted biopsy might be more effective. We conducted a randomized controlled trial to compare rates of neoplasia detection by targeted vs random biopsies in patients with UC.MethodsWe performed a study of 246 patients with UC for 7 years or more, seen at 52 institutions in Japan from October 1, 2008 through December 31, 2010. Patients were randomly assigned to the random group (4 random biopsies collected every 10 cm in addition to targeted biopsies, n = 122) or the target group (biopsies collected from locations of suspected neoplasia, n = 124). The primary end point was the number of neoplastic lesions detected in a single surveillance colonoscopy. We estimated the ratio and difference in the mean number of neoplastic lesions between the groups. We also evaluated the non-inferiority between the groups as an exploratory study. A non-inferiority margin of 0.65 (0.13 of 0.20) was considered for the ratio of the mean number of neoplastic lesions between groups.ResultsThe mean number of biopsies found to contain neoplastic tissue per colonoscopy was 0.211 (24 of 114) in the target group and 0.168 (18 of 107) in the random group (ratio of 1.251; 95% confidence interval, 0.679–2.306). The lower limit was above the non-inferiority margin of 0.65. Neoplasias were detected in 11.4% of patients in the target group and 9.3% of patients in the random group (P = .617). Larger numbers of biopsy samples per colonoscopy were collected in the random group (34.8 vs 3.1 in the target group; P < .001), and the total examination time was longer (41.7 vs 26.6 minutes in the target group; P < .001). In the random group, all neoplastic tissues found in random biopsies were collected from areas of the mucosa with a history or presence of inflammation.ConclusionsIn a randomized controlled trial, we found that targeted and random biopsies detect similar proportions of neoplasias. However, a targeted biopsy appears to be a more cost-effective method. Random biopsies from areas without any signs of present or past inflammation were not found to contain neoplastic tissues. Clinical Trial Registry: UMIN000001608

Two Competing Drivers of the Recent Walker Circulation Trend

Abstract The Pacific Walker circulation (PWC) weakens under global warming in climate change projections, supported by a global hydrological constraint. However, the PWC has strengthened over the past decades despite ongoing global warming, and the cause has been a puzzle. Because PWC is coupled with the pattern of sea surface temperature (SST) in the tropical Pacific, quantifying the relative impact of SST pattern change and global warming on the past PWC trend is important. We show, using an atmosphere model driven by observed boundary conditions for 1979–2013 and a hypothetical uniform surface warming trend with varying magnitude, that the PWC scales with warming and weakens by 8% per °C, but this effect cannot overcome the SST pattern effect that intensifies the circulation. Further attribution experiments show that the past strengthening of PWC is explained directly by the SST warming pattern in the narrow equatorial band, about 30% of which is induced by the Indian Ocean

Investigation of Nonequilibrium Ionization Plasma during a Giant Flare of UX Arietis Triggered with MAXI and Observed with NICER

We detected a giant X-ray flare from the RS CVn–type binary star UX Ari using the Monitor of All-sky X-ray Image on 2020 August 17 and started a series of Neutron star Interior Composition Explorer observations 89 minutes later. For a week, the entire duration of the flare was covered with 32 snapshot observations including the rising phase. The X-ray luminosity reached 2 × 10 ^33 erg s ^−1 , and the entire energy release was ∼10 ^38 erg in the 0.5–8.0 keV band. X-ray spectra characterized by continuum emission with lines of Fe xxv He α and Fe xxvi Ly α were obtained. We found that the temperature peaks before the flux does, which suggests that the period of plasma formation in the magnetic flare loop was captured. Using the continuum information (temperature, flux, and their delay time), we estimated the flare loop size to be ∼3 × 10 ^11 cm and the peak electron density to be ∼4 × 10 ^10 cm ^−3 . Furthermore, using the line ratio of Fe xxv and Fe xxvi , we investigated any potential indications of deviation from collisional ionization equilibrium (CIE). The X-ray spectra were consistent with CIE plasma throughout the flare, but the possibility of an ionizing plasma away from CIE was not rejected in the flux rising phase

Investigation of non-equilibrium ionization plasma during a giant flare of UX Arietis triggered with MAXI and observed with NICER

We detected a giant X-ray flare from the RS-CVn type binary star UX Ari using MAXI on 2020 August 17 and started a series of NICER observations 89 minutes later. For a week, the entire duration of the flare was covered with 32 snapshot observations including the rising phase. The X-ray luminosity reached 2$\times$10$^{33}$ erg s$^{-1}$ and the entire energy release was $\sim 10^{38}$ erg in the 0.5--8.0~keV band. X-ray spectra characterized by continuum emission with lines of Fe XXV He$\alpha$ and Fe XXVI Ly$\alpha$ were obtained. We found that the temperature peaks before that of the flux, which suggests that the period of plasma formation in the magnetic flare loop was captured. Using the continuum information (temperature, flux, and their delay time), we estimated the flare loop size to be $\sim 3 \times 10^{11}$ cm and the peak electron density to be $\sim 4\times10^{10}$ cm$^{-3}$. Furthermore, using the line ratio of Fe XXV and Fe XXVI, we investigated any potential indications of deviation from collisional ionization equilibrium (CIE). The X-ray spectra were consistent with CIE plasma throughout the flare, but the possibility of an ionizing plasma away from CIE was not rejected in the flux rising phase.Comment: 9 pages, 6 figures. Accepted by Ap