To describe the technique and results of bilateral vasovasostomy using a 3-mm vas cutting forceps angled at 15° (catalog no. NHF-3.15; ASSI) for vasal transection.
Retrospective chart review. ...Institutional review board approval was granted by Western Institutional Review Board.
Single vasectomy reversal center.
Men who underwent a bilateral vasovasostomy at a single institution by a single surgeon between 2001 and 2012 and had a minimum of one semen analysis postoperatively or a reported natural conception.
Before September 14, 2010, a straight-edge vas cutter was used on all vasovasostomy connections; 375 men received a bilateral vasovasostomy and met follow-up criteria. Beginning on September 14, 2010, an angled cutter was used on all vasovasostomy patients, with 194 men meeting the exclusion criteria.
A minimum of 1 × 10(6) sperm reported on a postoperative semen analysis, or a reported natural conception was used to establish patency.
The overall vasovasostomy patency rate using the angled vas cutter was 99.5% and was 95.7% using the straight vas cutter.
The development of an angled vas cutter provides an increased surface area for vasal wound healing to allow for larger tissue diameter for better healing, resulting in high patency rates after vasovasostomy.
Survey results showed treponemal infection among pet macaques in Southeast Asia, a region with a high prevalence of human yaws. This finding, along with studies showing treponemal infection in ...nonhuman primates in Africa, should encourage a One Health approach to yaws eradication and surveillance activities, possibly including monitoring of nonhuman primates in yaws-endemic regions.
Pesticide Toxicity and the Developing Brain Eskenazi, Brenda; Rosas, Lisa G.; Marks, Amy R. ...
Basic & clinical pharmacology & toxicology,
February 2008, Volume:
102, Issue:
2
Journal Article, Conference Proceeding
Peer reviewed
Open access
: Organochlorine pesticides are used in some countries for malaria control and organophosphate pesticides are widely used in agriculture and in homes. Previous literature documents children's ...exposure to these chemicals both in utero and during development. Animal studies suggest that many of these chemicals are neurodevelopmental toxicants even in moderate doses, but there are few studies in human beings. Associations of children's pesticide exposure with neurodevelopment from studies being conducted worldwide are summarized. In addition, we present the work of the CHAMACOS study, a longitudinal birth cohort study of Mexican‐American children living in the Salinas Valley of California. In this study, we investigated the relationship of children's neurodevelopment with maternal dichlorodiphenyltrichloroethane and dichlorodiphenyldichloroethylene serum levels, as well as prenatal and child organophosphate urinary metabolite levels. We have examined the association with children's performance on the Brazelton Neonatal Assessment Scales and at 6, 12 and 24 months on the Bayley Scales of Infant Development (mental development and psychomotor development) and mothers report on the Child Behaviour Checklist. We observed a negative association of prenatal dichlorodiphenyltrichloroethane exposure and child mental development. We also observed adverse associations of prenatal but not postnatal organophosphate pesticide exposure with mental development and pervasive developmental disorder at 24 months.
Existing literature suggests that metformin, the most commonly used biguanide, may lower colorectal cancer risk. Because most colorectal cancers originate in precancerous adenomas, we examined ...whether metformin use lowered colorectal adenoma risk after polypectomy in patients with type-2 diabetes.
Retrospective cohort study of 40- to 89-year-old Kaiser Permanente Northern California patients who had type 2 diabetes, and ≥1 adenoma detected at baseline colonoscopy during 2000 to 2009 and a repeat colonoscopy 1 to 10 years from baseline adenoma diagnosis through 2012. Cox models evaluated the association between metformin use during follow-up and subsequent adenoma diagnoses, controlling for age, race/ethnicity, sex, body mass index, and repeat examination indication.
Study included 2,412 patients followed for a median of 4.5 years; cumulatively, 1,117 (46%) patients had ≥1 adenoma at repeat colonoscopy. Compared with patients not receiving diabetes medications (n = 1,578), metformin-only use (n = 457) was associated with lower adenoma recurrence risk adjusted HR, 0.76; 95% confidence interval (CI), 0.65-0.89, and the association was stronger with increasing total metformin dose quartile (Q) 1: HR, 0.90; 95% CI, 0.72-1.12; Q2: HR, 0.89; 95% CI, 0.70-1.12; Q3: HR, 0.80; 95% CI, 0.63-1.01; Q4: HR, 0.50; 95% CI, 0.42-0.60, Ptrend < 0.001. Findings were unchanged in sensitivity analyses, including evaluating only outcomes during the 3- to 10-year period from baseline.
Our study suggests a potential benefit of metformin use in lowering the risk of subsequent adenomas after polypectomy in patients with type 2 diabetes.
Metformin may lower colorectal cancer risk by reducing the formation of precancerous lesions, reinforcing the potential additional benefits of its use.
Demand for surveillance colonoscopy can sometimes exceed capacity, such as during and following the coronavirus disease 2019 pandemic, yet no tools exist to prioritize the patients most likely to be ...diagnosed with colorectal cancer (CRC) among those awaiting surveillance colonoscopy. We developed a multivariable prediction model for CRC at surveillance comparing performance to a model that assigned patients as low or high risk based solely on polyp characteristics (guideline-based model).
Logistic regression was used for model development among patients receiving surveillance colonoscopy in 2014–2019. Candidate predictors included index colonoscopy indication, findings, and endoscopist adenoma detection rate, and patient and clinical characteristics at surveillance. Patients were randomly divided into model development (n = 36,994) and internal validation cohorts (n = 15,854). External validation was performed on 30,015 patients receiving surveillance colonoscopy in 2020–2022, and the multivariable model was then updated and retested.
One hundred fourteen, 43, and 71 CRCs were detected at surveillance in the 3 cohorts, respectively. Polyp size ≥10 mm, adenoma detection rate <32.5% or missing, patient age, and ever smoked tobacco were significant CRC predictors; this multivariable model outperformed the guideline-based model (internal validation cohort area under the receiver-operating characteristic curve: 0.73, 95% confidence interval (CI): 0.66–0.81 vs 0.52, 95% CI: 0.45–0.60). Performance declined at external validation but recovered with model updating (operating characteristic curve: 0.72 95% CI: 0.66–0.77).
When surveillance colonoscopy demand exceeds capacity, a prediction model featuring common clinical predictors may help prioritize patients at highest risk for CRC among those awaiting surveillance. Also, regular model updates can address model performance drift.
Background
Fecal immunochemical test (FIT) screening detects most asymptomatic colorectal cancers. Combining FIT screening with stool-based genetic biomarkers increases sensitivity for cancer, but ...whether DNA biomarkers (biomarkers) differ for cancers detected versus missed by FIT screening has not been evaluated in a community-based population.
Aims
To evaluate tissue biomarkers among Kaiser Permanente Northern California patients diagnosed with colorectal cancer within 2 years after FIT screening.
Methods
FIT-negative and FIT-positive colorectal cancer patients 50–77 years of age were matched on age, sex, and cancer stage. Adequate DNA was isolated from paraffin-embedded specimens in 210 FIT-negative and 211 FIT-positive patients. Quantitative allele-specific real-time target and signal amplification assays were performed for 7
K-ras
mutations and 10 aberrantly methylated DNA biomarkers (
NDRG4
,
BMP3
,
SFMBT2_895
,
SFMBT2_896
,
SFMBT2_897
,
CHST2_7890
,
PDGFD
,
VAV3
,
DTX1
,
CHST2_7889
).
Results
One or more biomarkers were found in 414 of 421 CRCs (98.3%). Biomarker expression was not associated with FIT status, with the exception of higher
SFMBT2_897
expression in FIT-negative (194 of 210; 92.4%) than in FIT-positive cancers (180 of 211; 85.3%;
p
= 0.02). There were no consistent differences in biomarker expression by FIT status within age, sex, stage, and cancer location subgroups.
Conclusions
The biomarkers of a currently in-use multi-target stool DNA test (
K
-
ras
,
NDRG4
, and
BMP3
) and eight newly characterized methylated biomarkers were commonly expressed in tumor tissue specimens, independent of FIT result. Additional study using stool-based testing with these new biomarkers will allow assessment of sensitivity, specificity, and clinical utility.
Reliable estimates of adenoma detection rates (ADRs) are needed to inform colonoscopy quality standards, yet little is known about the contributions of patient demographics to variation in ADRs. We ...evaluated the effects of adjusting for patient age, race/ethnicity, and family history of colorectal cancer on variations in ADRs and the relative rank order of physicians.
In a retrospective cohort study, we collected data from Kaiser Permanente Northern California members who were ≥ 50 years old who received colonoscopies from 2006 through 2008. We evaluated ADRs (before and after adjustment for age, sex, race/ethnicity, and family history of colorectal cancer) for 102 endoscopists who performed 108,662 total colonoscopies and 20,792 screening colonoscopies. Adenomas were identified from the pathology database, and cancers were detected by using the Kaiser Permanente Northern California cancer registry.
About two-thirds of examiners had unadjusted ADRs for screening exams that met gastroenterology society guidelines (>25% for men and >15% for women), although rates of detection varied widely (7.7%-61.5% for male patients and 1.7%-45.6% for female patients). Adjusting for case mix reduced the variation in detection rates (from 8-fold to 3-fold for male patients and from 27-fold to 5-fold for female patients), but the median change in physician order by detection rate was just 2 ranks, and few physicians changed quartiles of detection. For example, only 3 of 102 endoscopists moved into and 3 out of the lowest quartile of ADR.
In a community-based setting, most endoscopists met the ADR standards, although there was wide variation in ADRs, which was similar to that reported from academic and referral settings. Case-mix adjustment reduced variability but had only small effects on differences in ADRs between physicians, and only a small percentage of physicians changed quartiles of detection. Adjustments to ADRs are therefore likely only needed in settings in which physicians have very different patient demographics, such as in sex or age. Moderate differences in patient demographics between physicians are unlikely to substantially change rates of adenoma detection.
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