Understanding the contribution of family history to colorectal cancer risk and its clinical implications: A state‐of‐the‐science review

Persons with a family history (FH) of colorectal cancer (CRC) or adenomas that are not due to known hereditary syndromes have an increased risk for CRC. An understanding of these risks, screening recommendations, and screening behaviors can inform strategies for reducing the CRC burden in these families. A comprehensive review of the literature published within the past 10 years has been performed to assess what is known about cancer risk, screening guidelines, adherence and barriers to screening, and effective interventions in persons with an FH of CRC and to identify FH tools used to identify these individuals and inform care. Existing data show that having 1 affected first‐degree relative (FDR) increases the CRC risk 2‐fold, and the risk increases with multiple affected FDRs and a younger age at diagnosis. There is variability in screening recommendations across consensus guidelines. Screening adherence is <50% and is lower in persons under the age of 50 years. A provider's recommendation, multiple affected relatives, and family encouragement facilitate screening; insufficient collection of FH, low knowledge of guidelines, and poor family communication are important barriers. Effective interventions incorporate strategies for overcoming barriers, but these have not been broadly tested in clinical settings. Four strategies for reducing CRC in persons with familial risk are suggested: 1) improving the collection and utilization of the FH of cancer, 2) establishing a consensus for screening guidelines by FH, 3) enhancing provider‐patient knowledge of guidelines and communication about CRC risk, and 4) encouraging survivors to promote screening within their families and partnering with existing screening programs to expand their reach to high‐risk groups. Cancer 2016 . © 2016 American Cancer Society. Cancer 2016;122:2633–2645. © 2016 American Cancer Society.     

The effectiveness of an NaF rinse containing fTCP on eroded enamel remineralization

Objective

The authors investigated the effectiveness of a functionalized tricalcium phosphate (fTCP) combined with a low fluoride level in a mouthrinse to reharden eroded enamel lesions.

Methods

Ninety enamel slabs attached in pairs to removable appliances were randomly assigned to three treatment groups (n?=?30/group): (T1) NaF rinse (225 ppm F?+?40 ppm fTCP), (T2) NaF rinse (225 ppm F; ACT^®), and (T3) no mouthrinse (saliva). While wearing the in situ appliance for 14 days, subjects brushed their teeth with 1100 ppm F toothpaste (Crest©) for 2 min, rinsed with 15 ml of water for 10s, and then rinsed with 15 ml of their assigned treatment mouthrinse. Treatment efficacy was evaluated using surface microhardness (SMH) and transverse microradiography (TMR). Intra- and intergroup comparisons (α?=?0.05) were performed using the t-test and ANOVA followed by the Tukey test (HSD).

Results

With SMH, intragroup comparison (t-test) indicated significant rehardening of the eroded lesion with exposure to T1 (p?<?0.001) and T2 (p?<?0.01) but not with T3 However, with TMR, remineralization was only significant (p?=?0.01) with T1, but not with T2 and T3. In the intergroup comparison with percentage change in SMH, T1 was significantly different from T3 (p?<?0.01; Tukey HSD) but not from T2, and T2 was significantly different from T3. Intergroup comparison based on percentage mineral gain showed that T2 (p?=?0.02) and T3 (p?=?0.01) differed significantly from fTCP, but not between each other.

Conclusion

Addition of low level fluoride to functionalized β-tricalcium phosphate promoted rehardening of eroded enamel lesions.

     

Next generation sequencing in oral disease diagnostics

DNA sequencing is the method of identifying the precise order of DNA nucleotides within a molecule. The information of DNA sequencing is of prime requisite for basic biological research as well as in various clinical specialties. They can be used to determine the individual genetic sequence, larger genetic regions, chromosomes as well as to sequence RNA and proteins. Since the first DNA sequencing in 1970s, there has been tremendous advancements in the technologies aimed to determine the entire human genome. The need for rapid and accurate sequencing of human genome has resulted in the introduction of next generation sequencing (NGS) technology. NGS refers to the second-generation DNA sequencing technologies where millions of DNA can be sequenced simultaneously. Some of the next gen sequencing methods employed are Roche/454 life science, Illumina/Solexa, SOLiD system and HeliScope. Application of NGS in decoding the genomic database of various oral diseases may possess therapeutic and prognostic value. This presentation provides an overview of the basics of NGS and their potential applications in oral disease diagnostics.     

Use of the Heartmate 3 for biventricular support as a bridge to heart transplant‐first US implant

Right ventricular failure continues to be the Achilles heel in the management of heart failure patients. Traditionally, either high doses of inotropes and inhaled nitric oxide or jerry‐rigged temporary mechanical devices have been used to support failing right ventricles. No durable implantable right ventricular assist device has been developed to address this long‐standing concern. Because of this vacuum of innovation, surgeons have started using the third‐generation LVADs to support the right ventricle. The HeartMate 3 (Abbott) LVAD is a safe and effective therapy for the management of biventricular failure.     

A Cross-Sectional Survey Exploring the Impact of the COVID-19 Pandemic on the Cancer Care of Adolescents and Young Adults

We aimed to describe the negative and positive impacts of changes in cancer care delivery due to COVID-19 pandemic for adolescents and young adults (AYAs) in Canada, as well as the correlates of negative impact and their perspectives on optimization of cancer care. We conducted an online, self-administered survey of AYAs with cancer living in Canada between January and February 2021. Multiple logistic regression was used to identify factors associated with a negative impact on cancer care. Of the 805 participants, 173 (21.5%) experienced a negative impact on their cancer care including delays in diagnostic tests (11.9%), cancer treatment (11.4%), and appointments (11.1%). A prior diagnosis of mental or chronic physical health condition, an annual income of <20,000 CAD, ongoing cancer treatment, and province of residence were independently associated with a negative cancer care impact (p-value < 0.05). The majority (n = 767, 95.2%) stated a positive impact of the changes to cancer care delivery, including the implementation of virtual healthcare visits (n = 601, 74.6%). Pandemic-related changes in cancer care delivery have unfavorably and favorably influenced AYAs with cancer. Interventions to support AYAs who are more vulnerable to the adverse effects of the pandemic, and the thoughtful integration of virtual care into cancer care delivery models is essential.     

Spinal intradural haemorrhage in a patient with Wegener's Granulomatosis

We describe the case of a patient with known Wegener's Granulomatosis who developed a spontaneous intradural haematoma in the thoracic spine against a background of a recent relapse in her vasculitis. Decompression resulted in a rapid recovery of lower limb function. We propose involvement of the spinal meninges in the systemic vasculitis as the cause of haemorrhage.