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Computer-aided detection (CADe) and a mucosal exposure device can improve adenoma detection rate (ADR). Potential benefits of combining the 2 modalities have never been studied. This study aimed to compare ADR differences among CADe alone, endocuff-assisted colonoscopy (EAC) alone, and the combination of CADe and EAC (CADe+EAC) with standard colonoscopy. This prospective randomized controlled study included 1245 participants who underwent screening colonoscopy. Participants were randomized to CADe, EAC, CADe+EAC, and standard colonoscopy as a control. The primary outcome was ADR. Secondary outcomes were proximal ADR (pADR), advanced ADR (AADR), and the number of adenomas per colonoscopy (APCs). ADRs from the control, CADe, EAC, and CADe+EAC groups were 41.9%, 52.2%, 54.0%, and 58.8%, respectively; pADRs were 25.2%, 33.3%, 34.9%, and 37.0%, respectively; AADRs were 7.7%, 8.3%, 8.3%, and 13.6%, respectively; and APCs were.76, 1.11, 1.18, and 1.31, respectively. Significant increases in ADR and pADR were observed between the intervention and control groups (P <.05 in all comparisons). The AADR was significantly higher only in the CADe+EAC group than in the control group (P =.02). The adjusted incidence rate ratios of APCs were significantly higher in the intervention groups versus the control group (P <.01 in all comparisons). CADe+EAC significantly improve ADR and AADR over standard colonoscopy. However, although CADe or EAC alone can substantially increase the detection of adenomas, they do not lead to increased detection of advanced adenomas unless used in combination. (Clinical trial registration number: TCTR20200929003.) [ABSTRACT FROM AUTHOR]

By different mechanisms, image-enhancement techniques (linked color imaging [LCI]) and mucosal exposure devices (Endocuff-assisted colonoscopy [EAC]) can improve the adenoma detection rate (ADR) during screening colonoscopy. The impact of the combination of the 2 techniques has never been studied. This study aimed to compare the ADR between the combination of LCI and EAC (LCI+EAC), LCI alone, EAC alone, and standard high-definition (HD) colonoscopy. This prospective randomized controlled trial included participants who underwent screening colonoscopy. Participants were randomized to LCI+EAC, LCI, EAC, and standard HD colonoscopy. All colonoscopies were performed by endoscopists with a recorded ADR ≥35%. The primary outcome was the ADR. Secondary outcomes were proximal ADR (pADR) and the mean number of adenomas per colonoscopy (APC). One thousand participants were included in the study. The LCI+EAC group provided the highest ADR and pADR. The ADRs in the LCI+EAC, LCI, EAC, and standard HD colonoscopy groups were 57.2%, 52.8%, 51.6%, and 47.6%, respectively, with pADRs of 38.4%, 34.8%, 33.6%, and 28.0%, respectively. The mean numbers of APC were 1.28, 1.20, 1.16, and.89, respectively. After a multiple comparison adjustment, a significant difference in pADR was only observed between the LCI+EAC and standard HD colonoscopy groups (difference, 10.3 percentage points; 95% confidence interval,.02%-17.4%; P =.05). The incidence rate ratios of the adenoma numbers were significantly higher in the LCI+EAC (1.43), LCI (1.34), and EAC (1.30) groups relative to the standard HD colonoscopy group (.89) (P <.009 for all comparisons). The combination of LCI and EAC can significantly improve the detection of pADR and APC but not ADR by high-ADR performers. (Clinical trial registration number: TCTR20190319001.) [ABSTRACT FROM AUTHOR]

Background Stool-based colonoscopy is the preferred strategy for colorectal cancer (CRC) screening. The Asia-Pacific Colorectal Screening System (APCS) score also is helpful in stratifying the risk for advanced neoplasia in the asymptomatic population. The combination of the fecal immunochemical test (FIT) result and clinical risk stratification may be more helpful in stratifying the risk. Objective To evaluate the value of the combination of FIT and APCS scores in stratifying asymptomatic participants for colonoscopy. Design Cross-sectional study. Setting University hospital. Patients A total of 948 asymptomatic participants eligible for screening colonoscopy. Interventions FIT, APCS score evaluation, screening colonoscopy. Main Outcome Measurements The prevalence of colorectal neoplasia in 4 different groups of participants according to FIT and APCS score evaluations. Results The prevalence of non-advanced and advanced neoplasia in the 4 groups (high risk with positive FIT result, high risk with negative FIT result, moderate risk with positive FIT result, and moderate risk with negative FIT result) was 44% versus 36.9%, 30.1% versus 11.6%, 27.1% versus 12%, and 22.6% versus 6.4%, respectively ( P < .001). Participants with both high-risk scores and positive FIT results had a significantly higher detection rate of advanced neoplasia (6.15-fold, 95% confidence interval, 3.72-10.17) compared with the other 3 groups. Seven cancers were discovered; 4 were in the high-risk with positive FIT result group. Limitations Hospital-based study. Conclusion In countries with limited resources, participants with positive FIT results and high-risk scores by APCS should be given priority for colonoscopy because this group is most likely to have advanced neoplasia. However, this strategy needs to be confirmed for its cost-effectiveness in a large, population-based study. (Clinical trial registration number: TCTR20140228001.) [ABSTRACT FROM AUTHOR]

BACKGROUND: The incidence of colorectal cancer is rising rapidly in some Asian countries. OBJECTIVE: To determine the prevalence and the distribution of colorectal neoplasm in Asian populations. DESIGN: A multicenter colonoscopy survey. PATIENTS: Between July 2004 and April 2005, consecutive symptomatic patients undergoing colonoscopic examinations in 10 different Asian countries. SETTING: The location and the histologic features of all colonic neoplasms were recorded. Advanced neoplasm was defined as adenoma larger than 10 mm in size, with >25% villous features or with high-grade dysplasia or invasive carcinoma. MAIN OUTCOME MEASUREMENTS: The prevalence and the distribution of colorectal neoplasm and advanced neoplasm. RESULTS: A total of 5464 eligible patients underwent colonoscopy. Advanced neoplasm was found in 512 patients (9.4%). Factors associated with the presence of advanced neoplasm in this symptomatic Asian population included male sex (relative risk [RR] 1.52, 95% confidence interval [CI] 1.26-1.84), older age (RR 1.05, 95% CI 1.04-1.06), and ethnicity (P = .001). Advanced proximal neoplasm was detected in 136 patients (2.5%); 83 (61.0%) of the patients had normal distal colon. The RR of proximal advanced neoplasm was 2.5, 95% CI 1.7-3.7 in those with any adenoma in the distal colon compared with those with normal distal colon. LIMITATIONS: Possible underrepresentation of some ethnic groups because of uneven ethnic group distribution and the lack of population-based registry. CONCLUSIONS: This was the first multicenter colonoscopy survey that examined the characteristics of colorectal neoplasm in Asia. The results will have important implications on the planning for future colorectal cancer screening in this region. [ABSTRACT FROM AUTHOR]

Many agents affect the transmission of ultraviolet light to human skin. These include naturally occurring photoprotective agents (ozone, pollutants, clouds, and fog), naturally occurring biologic agents (epidermal chromophores), physical photoprotective agents (clothing, hats, make-ups, sunglasses, and window glass), and ultraviolet light filters (sunscreen ingredients and sunless tanning agents). In addition, there are agents that can modulate the effects of ultraviolet light on the skin (antioxidants and others). All of the above are reviewed in this article. Learning objective: At the conclusion of this learning activity, participants should be able to provide an overview of all aspects of photoprotection. [Copyright &y& Elsevier]

The production of volatile fatty acid (VFA)-rich leachate as feedstock for methane production is an essential and rate-limiting step in two-stage grass biogasification. Batch experiments were conducted to investigate the influence of leachate dilution, inoculum, recirculation, and buffering agent addition on the acidification of Napier grass in anaerobic leach bed reactors (AnLBRs). Four AnLBRs with 14.17 L effective volume were operated at ambient temperature for 28 days in each experiment. The results clearly demonstrate the significance of the control parameters, particularly leachate dilution and inoculum, in the regulation of grass solubilization. Different dilutions of leachate produced different grass degradation rates. These different dilutions generated 95.62–112.63 g of soluble chemical oxygen demand (SCOD) or 0.52–0.62 g SCOD/g VS added for those diluted at 1.0–7.0-day intervals compared to 51.50 g SCOD or 0.28 g SCOD/g VS added for those without dilution. Adding inoculums of 10–30% increased the SCOD to 67.01–115.65 g SCOD or 0.40–0.59 g SCOD/g VS added. While leachate recirculation and the addition of a buffering agent had less influence on solubilization, which increased by only 6.80–16.41% of SCOD produced. These produced leachates contained orderly acetic, propionic, and butyric acids. The proposed conditions (20% of added inoculum and leachate dilution at a 3.0-day interval), yielded practical degrees of solubilization and acidification of 46.61% and 62.21%, respectively, or 0.56 g SCOD/g VS added and 0.26 g VFA/g VS added. These results demonstrate that beneficial control conditions can promote the rapid and practical production of VFAs from grass biomass via an AnLBR. [ABSTRACT FROM AUTHOR]