Advances in the removal of diminutive colorectal polyps

Diminutive polyps (<5 mm in diameter) represent the majority of polyps found during colonoscopy; about a half of them are adenomatous, with low risk of advanced neoplasia. Recent studies have demonstrated that cold polypectomy should be considered the recommended approach for resecting diminutive polyps and that cold snaring may be superior to cold forceps biopsy, at least for polyps of 4–5 mm. Recently, electronic chromoendoscopy has been applied to characterization of diminutive polyps to discriminate adenomatous from nonadenomatous lesions. Optical diagnosis of polyp histology could potentially exert huge cost savings by the ‘resect and discard’ strategy for diminutive polyps and ‘leaving-in’ for diminutive hyperplastic polyps in the recto-sigmoid colon. These policies represent the mainstay for adopting endoscopy-directed post-polypectomy surveillance strategies, endorsed by both American and European Endoscopy Societies. Accuracy of both histology and surveillance intervals predictions from academic centers have been encouraging, although the same performance has not been replicated in community practices.     

Narrow-band imaging observation of colorectal lesions using NICE classification to avoid discarding significant lesions

AIM: To assess the risk of failing to detect diminutive and small colorectal cancers with the “resect and discard” policy.METHODS: Patients who received colonoscopy and polypectomy were recruited in the retrospective study. Probable histology of the polyps was predicted by six colonoscopists by the use of NICE classification. The incidence of diminutive and small colorectal cancers and their endoscopic features were assessed.RESULTS: In total, we found 681 cases of diminutive (1-5 mm) lesions in 402 patients and 197 cases of small (6-9 mm) lesions in 151 patients. Based on pathology of the diminutive and small polyps, 105 and 18 were non-neoplastic polyps, 557 and 154 were low-grade adenomas, 18 and 24 were high-grade adenomas or intramucosal/submucosal (SM) scanty invasive carcinomas, 1 and 1 were SM-d carcinoma, respectively. The endoscopic features of invasive cancer were classified as NICE type 3 endoscopically.CONCLUSION: The risk of failing to detect diminutive and small colorectal invasive cancer with the “resect and discard” strategy might be avoided through the use of narrow-band imaging observation with the NICE classification scheme and magnifying endoscopy.     

Risk of cancer in small and diminutive colorectal polyps

The prevalence of cancer in small and diminutive polyps is relevant to “resect and discard” and CT colonography reporting recommendations.We evaluated a prospectively collected colonoscopy polyp database to identify polyps <10 mm and those with cancer or advanced histology (high-grade dysplasia or villous elements).Of 32,790 colonoscopies, 15,558 colonoscopies detected 42,630 polyps <10 mm in size. A total of 4790 lesions were excluded as they were not conventional adenomas or serrated class lesions.There were 23,524 conventional adenomas <10 mm of which 22,952 were tubular adenomas. There were 14,316 serrated class lesions of which 13,589 were hyperplastic polyps and the remainder were sessile serrated polyps. Of all conventional adenomas, 96 had high-grade dysplasia including 0.3% of adenomas ≤5 mm in size and 0.8% of adenomas 6–9 mm in size. Of all conventional adenomas, 2.1% of those ≤5 mm in size and 5.6% of those 6–9 mm in size were advanced. Among 36,107 polyps ≤5 mm in size and 6523 polyps 6–9 mm in size, there were no cancers.These results support the safety of resect and discard as well as current CT colonography reporting recommendations for small and diminutive polyps.     

Pragmatic approaches to genetic screening

Pragmatic approaches to genetic testing are discussed and appraised. Whilst there are various schools of pragmatism, the Deweyan appraoch seems to be the most appreciated in bioethics as it allows a historical approach indebted to Hegel. This in turn allows the pragmatist to specify and balance principles in various contexts. There are problems with where to draw a line between what is referred to here as the micro- and macro-level of doing bioethics, unless one is simply to be classified as a principlist. Whilst most discussions on genetics occur at a macro level, most specifying must be done also at a micro level – the clinical encounter. Whilst pragmatism encourages us to understand better social and scientific factors and puts into perspective statements like ‘playing God’, doubts are raised about the ‘consensus’ process and how one can put aside fundamental values such as the moral status of the embryo on which there is general disagreement. If those doing pragmatism do not endorse these values, there seems to be little ground for process and compromise with those who do. It seems therefore that pragmatism cannot ignore values, even those which are not endorsed by everyone.     

OPTN/SRTR 2019 Annual Data Report: Deceased Organ Donors

SRTR uses data collected by OPTN to calculate metrics such as donation rate, organ yield, and rate of organs recovered for transplant but not transplanted. In 2019, there were 11,870 deceased donors, an increase from 10,721 in 2018; this number has been increasing since 2010. The number of deceased donor transplants increased to 32,313 in 2019, from 29,675 in 2018; this number has been increasing since 2012. The increase may be due in part to the rising number of deaths of young people due to the ongoing opioid epidemic. The number of organs transplanted included 17,425 kidneys, 1,018 pancreata, 8,275 livers, 81 intestines, 3,604 hearts, and 2,607 lungs. In 2019, 4,324 kidneys, 346 pancreata, 867 livers, 5 intestines, 31 hearts, and 148 lungs were discarded. These numbers suggest an opportunity to increase numbers of transplants by reducing discards.     

中药材的硫磺熏蒸养护方法——摒弃还是传承

硫磺熏蒸中药材是一种古老的药材养护方法,在药材的储藏和保管上曾发挥着一定的作用.但近些年来,随着硫磺熏蒸机制的进一步阐释以及人们对药品安全性的重视,中药材的硫磺熏蒸养护方法一度受到人们的质疑.笔者综述了近20年的文献,认为对于硫磺熏蒸养护方法不应该完全摒弃,而是要选择性的传承,并提出了一些建议,可供相关药监部门 参考.     

2006～2010年梧州市血液报废原因分析

目的:了解血液报废的原因,采取降低报废率的措施.方法:对本站2006～2010年在血液采集、检测、制备、保存、发放、运输、库存和收回过程中出现血液报废的原因进行分析.结果:2006～2010年血液总报废率为9.1％,以脂肪血(32.5％)、血液过期(22.8％)和ALT升高(21.3％)排前3位,占血液报废构成的76....     

Trends in Discard of Kidneys from Hepatitis C Viremic Donors in the United States

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Effects of group culture on the development of discarded human embryos and the construction of human embryonic stem cell lines

Purpose

To explore the effect of group culture on the developmental potential of discarded embryos in in vitro fertilization/intracytoplasmic sperm injection (IVF/ICSI) cycles and establish the human embryonic stem cell lines for future research.

Methords

Fresh discarded embryos were collected from the IVF/ICSI-ET program in the reproductive medical center of the first affiliated hospital of Zhengzhou university in this study. All zygotes were individually cultured from Day 1 to Day 3. On Day 3, discard embryos were then cultured in group of 1–4 embryos per droplet (30 μl/droplets) with a constant culture medium until Day 5 or 6. Mechanical method was used to isolate the inner cell mass (ICM) of blastocyst from the embryo. Then we inoculated the ICM on feeder layer. After identification of those cells, the human embryonic stem cell lines (hESCs) were established.

Results

In this study, we collected 1,223 fresh discarded embryos and they were sequential cultured to the blastocysts (18.07 %, 221/1,223), in which good quality blastocysts were 61(4.98 %, 61/1,223). There was no significant difference in the patients. The embryos from 1PN, 2PN, 3PN were sequential cultured to the blastocyst s(39.31 %,92/234;12.87 %,64/497;13.21 %,65/492),in which good quality blastocysts was 13.6 %(32/92),2.61 %(13/64), 3.04 %(15/65).1PN embryo’s blastulation rate and quality embryo formation rate was significantly higher than the 2PN and 3PN embryos’ (P <0.05). Three embryos group cultivation has the highest blastulation rate and quality embryo formation rate (P <0.05). In total, we successfully established 4 hESCs lines.

Conclusion

The group culture of human discard embryos can improve the blastulation rate and blastocyst quality to some extent. Three embryos group cultivate is the better culture number. Human discard embryos are good source for establishment of hESCs.     

Determinants of Discard of Expanded Criteria Donor Kidneys: Impact of Biopsy and Machine Perfusion

We examined factors associated with expanded criteria donor (ECD) kidney discard. Scientific Registry of Transplant Recipients (SRTR)/Organ Procurement and Transplantation Network (OPTN) data were examined for donor factors using logistic regression to determine the adjusted odds ratio (AOR) of discard of kidneys recovered between October 1999 and June 2005. Logistic and Cox regression models were used to determine associations with delayed graft function (DGF) and graft failure. Of the 12 536 recovered ECD kidneys, 5139 (41%) were discarded. Both the performance of a biopsy (AOR = 1.21, p = 0.02) and the degree of glomerulosclerosis (GS) on biopsy were significantly associated with increased odds of discard. GS was not consistently associated with DGF or graft failure. The discard rate of pumped ECD kidneys was 29.7% versus 43.6% for unpumped (AOR = 0.52, p < 0.0001). Among pumped kidneys, those with resistances of 0.26–0.38 and >0.38 mmHg/mL/min were discarded more than those with resistances of 0.18–0.25 mmHg/mL/min (AOR = 2.5 and 7.9, respectively). Among ECD kidneys, pumped kidneys were less likely to have DGF (AOR = 0.59, p < 0.0001) but not graft failure (RR = 0.9, p = 0.27). Biopsy findings and machine perfusion are important correlates of ECD kidney discard; corresponding associations with graft failure require further study.