Risk factors for metachronous colorectal cancer or advanced lesions after endoscopic resection of serrated polyps: a systematic review and meta-analysis

\ua9 2024 American Society for Gastrointestinal Endoscopy. Background and Aims: Serrated polyps (SPs) are precursors to 15% to 20% of colorectal cancers (CRCs). However, there are uncertainties regarding which SPs require surveillance and at what intervals, with recommendations adapted from those for adenomas in the absence of solid evidence. Our aim was to assess which SP risk characteristics relate to a higher risk of metachronous CRC or advanced polyps. Methods: We systematically searched PubMed, Embase, and Cochrane for cohort studies, case-control studies, and clinical trials from inception to December 31, 2023, of CRC or advanced polyps (advanced adenoma [AA] or advanced SP) incidence at surveillance stratified by baseline SP size, dysplasia, location, and multiplicity. We defined advanced SPs as those ≥10 mm or with dysplasia. CRC and advanced polyp incidence per 1000 person-years were estimated. We performed a meta-analysis by calculating pooled relative risks (RRs) using a random-effects model. Results: A total of 5903 studies were reviewed, and 14 were included with 493,949 patients (mean age, 59.5 years; 55% men). The mean follow-up was 4.9 years. CRC incidence per 1000 person-years was 2.09 (95% confidence interval [CI], 1.29-2.90) for advanced SPs, 1.52 (95% CI, 0.78-2.25) for SPs of ≥10 mm, 5.86 (95% CI, 2.16-9.56) for SPs with dysplasia, 1.18 (95% CI, 0.77-1.60) for proximal SPs, 0.52 (95% CI, 0.08-1.12) for ≥3 SPs, 0.50 (95% CI, 0.35-0.66) for nonadvanced SPs, and 0.44 (95% CI, 0.41-0.46) for normal colonoscopy findings. Metachronous CRC risk was higher in advanced SPs versus nonadvanced SPs (RR, 1.84; 95% CI, 1.11-3.04) and versus normal colonoscopy findings (RR, 2.92; 95% CI, 2.26-3.77), in SPs of ≥10 mm versus <10 mm (RR, 2.61; 95% CI, 1.43-4.77) and versus normal colonoscopy findings (RR: 3.52; 95% CI, 2.17-5.69); and in SPs with dysplasia versus normal colonoscopy findings (RR: 2.71; 95% CI, 2.00-3.67). No increase in CRC or advanced polyp risk was found in patients with proximal versus distal SPs, nor in ≥3 SPs versus 1 or 2 SPs. Conclusions: CRC risk is significantly higher in patients with baseline advanced SPs after 4.9 years of follow-up, with risk magnitudes similar to those described for AA, supporting the current recommendation for 3-year surveillance in patients with advanced SPs

A close look at the dwarf AGN of NGC 4395 : optical and near-IR integral field spectroscopy

Intermediate-mass black holes (103–105 M⊙) in the centre of dwarf galaxies are believed to be analogous to growing active galactic nuclei (AGNs) in the early Universe. Their characterization can provide insight about the early galaxies. We present optical and near-infrared integral field spectroscopy of the inner ∼50 pc of the dwarf galaxy NGC 4395, known to harbour an AGN. NGC 4395 is an ideal candidate to investigate the nature of dwarf AGN, as it is nearby (d ≈ 4.4 Mpc) enough to allow a close look at its nucleus. The optical data were obtained with the Gemini GMOS-IFU covering the 4500 –7300 Å spectral range at a spatial resolution of 10 pc. The J and K-band spectra were obtained with the Gemini NIFS at spatial resolutions of ∼5 pc. The gas kinematics show a compact, rotation disc component with a projected velocity amplitude of 25 kms−1. We estimate a mass of 7.7 × 105 M⊙ inside a radius of 10 pc. From the Hα broad-line component, we estimate the AGN bolometric luminosity as Lbol=(9.9±1.4)×1040 erg s−1 and a mass MBH=(2.5+1.0−0.8)×105 M⊙ for the central black hole. The mean surface mass densities for the ionized and molecular gas are in the ranges (1–2) M⊙ pc−2 and (1–4) × 10−3 M⊙ pc−2 and the average ratio between ionized and hot molecular gas masses is ∼500. The emission-line flux distributions reveal an elongated structure at 24 pc west of the nucleus, which is blueshifted relative to the systemic velocity of the galaxy by ≈30 kms−1. We speculate that this structure is originated by the accretion of a gas-rich small satellite or by a low-metallicity cosmic clou

The psychological impact of the COVID-19 pandemic on physicians in Puerto Rico: a cross-sectional study after the second wave in 2021

IntroductionHealth care providers faced a challenge with the emergence of COVID-19 and its rapid spread. Early studies measuring the psychological impact of COVID-19 on the general population found high levels of anxiety and sleep disorders. The primary goal of this project was to assess the psychological impact of COVID-19 on physicians in Puerto Rico.Materials and methodsA cross-sectional study of physicians in Puerto Rico was conducted anonymously and electronically from February 2021 through April 2021. The electronic survey included socio-demographic data and 4 self-administered assessment tools (Generalized Anxiety Disorder-7, Perceived Stress Scale-10, Pittsburgh Sleep Quality Index and COVID-19 Organizational Support) for anxiety, perceived stress, sleep disturbances, and organizational support during the COVID-19 pandemic.ResultsA total of 145 physicians completed the survey, with a female predominance of 53.5% and a majority practicing in the San Juan metropolitan area (50.3%). Mild anxiety symptoms were reported in 26.9% of physicians, and 33.8% had moderate to severe anxiety symptoms. Moderate to high perceived stress was found in 69.9% of participants, and women reported statistically significantly higher levels of anxiety symptoms (8.84 ± 5.99; p = 0.037) and stress (19.0 ± 6.94, p = 0.001). The Pittsburgh Sleep Quality Index reported 67.9% of physicians with global scores associated with poor sleep quality. Assessment of perceived organizational support found a high perception of work support (65.7%) but low perception of personal support (43.4%) and risk support (30.3%). A correlation analysis found a negative correlation for work and personal support, but a positive correlation for risk support, all statistically significant.ConclusionCOVID-19 had a lasting psychological impact in health care providers in Puerto Rico a year after the beginning of the pandemic. Our data supports the importance of organizational support and its correlation with the development of anxiety. It is thus essential to develop strategies to identify individuals at risk of experiencing psychological disturbances and to provide effective support for medical professionals during medical emergencies for their well-being and optimal delivery of patient care

Fermi/LAT discovery of gamma-ray emission from a relativistic jet in the narrow-line quasar PMN J0948+0022

We report the discovery by the Large Area Telescope (LAT) onboard the Fermi Gamma-ray Space Telescope of high-energy gamma-ray emission from the peculiar quasar PMN J0948+0022 (z=0.5846). The optical spectrum of this object exhibits rather narrow Hbeta (FWHM(Hbeta) ~ 1500 km s^-1), weak forbidden lines and is therefore classified as a narrow-line type I quasar. This class of objects is thought to have relatively small black hole mass and to accrete at high Eddington ratio. The radio loudness and variability of the compact radio core indicates the presence of a relativistic jet. Quasi simultaneous radio-optical-X-ray and gamma-ray observations are presented. Both radio and gamma-ray emission (observed over 5-months) are strongly variable. The simultaneous optical and X-ray data from Swift show a blue continuum attributed to the accretion disk and a hard X-ray spectrum attributed to the jet. The resulting broad band spectral energy distribution (SED) and, in particular, the gamma-ray spectrum measured by Fermi are similar to those of more powerful FSRQ. A comparison of the radio and gamma-ray characteristics of PMN J0948+0022 with the other blazars detected by LAT shows that this source has a relatively low radio and gamma-ray power, with respect to other FSRQ. The physical parameters obtained from modelling the SED also fall at the low power end of the FSRQ parameter region discussed in Celotti & Ghisellini (2008). We suggest that the similarity of the SED of PMN J0948+0022 to that of more massive and more powerful quasars can be understood in a scenario in which the SED properties depend on the Eddington ratio rather than on the absolute power.Comment: 10 pages, 5 figures, accepted for publication on ApJ Main Journal. Corresponding author: L. Foschin

Multiwavelength monitoring of the enigmatic Narrow-Line Seyfert 1 PMN J0948+0022 in March-July 2009

Following the recent discovery of gamma rays from the radio-loud narrow-line Seyfert 1 galaxy PMN J0948+0022 (z=0.5846), we started a multiwavelength campaign from radio to gamma rays, which was carried out between the end of March and the beginning of July 2009. The source displayed activity at all the observed wavelengths: a general decreasing trend from optical to gamma-ray frequencies was followed by an increase of radio emission after less than two months from the peak of the gamma-ray emission. The largest flux change, about a factor of about 4, occurred in the X-ray band. The smallest was at ultraviolet and near-infrared frequencies, where the rate of the detected photons dropped by a factor 1.6-1.9. At optical wavelengths, where the sampling rate was the highest, it was possible to observe day-scale variability, with flux variations up to a factor of about 3. The behavior of PMN J0948+0022 observed in this campaign and the calculated power carried out by its jet in the form of protons, electrons, radiation and magnetic field are quite similar to that of blazars, specifically of flat-spectrum radio quasars. These results confirm the idea that radio-loud narrow-line Seyfert 1 galaxies host relativistic jets with power similar to that of average blazars.Comment: 39 pages, 12 figures. Accepted for publication on ApJ Main Journal. Corresponding author: Luigi Foschin

Beam test performance of a prototype module with Short Strip ASICs for the CMS HL-LHC tracker upgrade

The Short Strip ASIC (SSA) is one of the four front-end chips designed for the upgrade of the CMS Outer Tracker for the High Luminosity LHC. Together with the Macro-Pixel ASIC (MPA) it will instrument modules containing a strip and a macro-pixel sensor stacked on top of each other. The SSA provides both full readout of the strip hit information when triggered, and, together with the MPA, correlated clusters called stubs from the two sensors for use by the CMS Level-1 (L1) trigger system. Results from the first prototype module consisting of a sensor and two SSA chips are presented. The prototype module has been characterized at the Fermilab Test Beam Facility using a 120 GeV proton beam

Test beam performance of a CBC3-based mini-module for the Phase-2 CMS Outer Tracker before and after neutron irradiation

The Large Hadron Collider (LHC) at CERN will undergo major upgrades to increase the instantaneous luminosity up to 5–7.5×10$^{34}$ cm$^{-2}$s$^{-1}$. This High Luminosity upgrade of the LHC (HL-LHC) will deliver a total of 3000–4000 fb-1 of proton-proton collisions at a center-of-mass energy of 13–14 TeV. To cope with these challenging environmental conditions, the strip tracker of the CMS experiment will be upgraded using modules with two closely-spaced silicon sensors to provide information to include tracking in the Level-1 trigger selection. This paper describes the performance, in a test beam experiment, of the first prototype module based on the final version of the CMS Binary Chip front-end ASIC before and after the module was irradiated with neutrons. Results demonstrate that the prototype module satisfies the requirements, providing efficient tracking information, after being irradiated with a total fluence comparable to the one expected through the lifetime of the experiment

Selection of the silicon sensor thickness for the Phase-2 upgrade of the CMS Outer Tracker

During the operation of the CMS experiment at the High-Luminosity LHC the silicon sensors of the Phase-2 Outer Tracker will be exposed to radiation levels that could potentially deteriorate their performance. Previous studies had determined that planar float zone silicon with n-doped strips on a p-doped substrate was preferred over p-doped strips on an n-doped substrate. The last step in evaluating the optimal design for the mass production of about 200 m$^{2}$ of silicon sensors was to compare sensors of baseline thickness (about 300 μm) to thinned sensors (about 240 μm), which promised several benefits at high radiation levels because of the higher electric fields at the same bias voltage. This study provides a direct comparison of these two thicknesses in terms of sensor characteristics as well as charge collection and hit efficiency for fluences up to 1.5 × 10$^{15}$ n$_{eq}$/cm$^{2}$. The measurement results demonstrate that sensors with about 300 μm thickness will ensure excellent tracking performance even at the highest considered fluence levels expected for the Phase-2 Outer Tracker

Comparative evaluation of analogue front-end designs for the CMS Inner Tracker at the High Luminosity LHC

The CMS Inner Tracker, made of silicon pixel modules, will be entirely replaced prior to the start of the High Luminosity LHC period. One of the crucial components of the new Inner Tracker system is the readout chip, being developed by the RD53 Collaboration, and in particular its analogue front-end, which receives the signal from the sensor and digitizes it. Three different analogue front-ends (Synchronous, Linear, and Differential) were designed and implemented in the RD53A demonstrator chip. A dedicated evaluation program was carried out to select the most suitable design to build a radiation tolerant pixel detector able to sustain high particle rates with high efficiency and a small fraction of spurious pixel hits. The test results showed that all three analogue front-ends presented strong points, but also limitations. The Differential front-end demonstrated very low noise, but the threshold tuning became problematic after irradiation. Moreover, a saturation in the preamplifier feedback loop affected the return of the signal to baseline and thus increased the dead time. The Synchronous front-end showed very good timing performance, but also higher noise. For the Linear front-end all of the parameters were within specification, although this design had the largest time walk. This limitation was addressed and mitigated in an improved design. The analysis of the advantages and disadvantages of the three front-ends in the context of the CMS Inner Tracker operation requirements led to the selection of the improved design Linear front-end for integration in the final CMS readout chip

The CMS Phase-1 pixel detector upgrade

The CMS detector at the CERN LHC features a silicon pixel detector as its innermost subdetector. The original CMS pixel detector has been replaced with an upgraded pixel system (CMS Phase-1 pixel detector) in the extended year-end technical stop of the LHC in 2016/2017. The upgraded CMS pixel detector is designed to cope with the higher instantaneous luminosities that have been achieved by the LHC after the upgrades to the accelerator during the first long shutdown in 2013–2014. Compared to the original pixel detector, the upgraded detector has a better tracking performance and lower mass with four barrel layers and three endcap disks on each side to provide hit coverage up to an absolute value of pseudorapidity of 2.5. This paper describes the design and construction of the CMS Phase-1 pixel detector as well as its performance from commissioning to early operation in collision data-taking.Peer reviewe