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Introduction The prognosis of dysplasia in patients with IBD is largely determined from observational studies from the pre-videoendoscopic era (pre-1990s) that does not reflect recent advances in endoscopic imaging and resection. Aims To better understand the risk of synchronous colorectal cancer and metachronous advanced neoplasia (ie high-grade dysplasia or cancer) associated with dysplasia diagnosed in the videoendoscopic era, and to stratify risk according to a lesion's morphology, endoscopic resection status or whether it was incidentally detected on biopsy of macroscopically normal colonic mucosa (ie invisible). Methods A systematic search of original articles published between 1990 and February 2020 was performed. Eligible studies reported on incidence of advanced neoplasia at follow-up colectomy or colonoscopy for IBD-dysplasia patients. Quantitative and qualitative analyses were performed. Results Thirty-three studies were eligible for qualitative analysis (five for the meta-analysis). Pooled estimated proportions of incidental synchronous cancers found at colectomy performed for a pre-operative diagnosis of visible high-grade dysplasia, invisible high-grade dysplasia, visible low-grade dysplasia and invisible low-grade dysplasia were 13.7% (95% CI 0.0-54.1), 11.4% (95% CI 4.6-20.3), 2.7% (95% CI 0.0-7.1) and 2.4% (95% CI 0.0-8.5) respectively. The lowest incidences of metachronous advanced neoplasia, for dysplasia not managed with immediate colectomy but followed up with surveillance, tended to be reported by the studies where high definition imaging and/or chromoendoscopy was used and endoscopic resection of visible dysplasia was histologically confirmed. Conclusions The prognosis of IBD-dysplasia diagnosed in the videoendoscopic era appears to have been improved but the quality of evidence remains low. Larger, prospective studies are needed to guide management. PROSPERO registration no: CRD42019105736.

Aim Serrated polyposis is a condition of the colon characterized by multiple serrated polyps. This review aims to provide a practical guide to the day-to-day management of serrated polyposis, including diagnosis, endoscopic identification of serrated polyps, surveillance, the role of endoscopic and surgical management and the screening of family members. Method The literature was searched using PubMed and MEDLINE databases for the terms “serrated polyp”, “serrated polyposis” and “hyperplastic polyposis”. English-language abstracts were read and the full article was retrieved if relevant to the review. Expert opinion from the authors was also sought. Results Advances in our knowledge of the molecular pathways involved in serrated polyposis and an improved clinical picture of the disease from retrospective studies have led to better understanding of its pathogenesis and natural history. However, there are still areas not answered by the literature, and hence empirical management or expert opinion has to be followed. Conclusion Improvements in our understanding of serrated polyposis, together with improvements in endoscopic equipment and technique, have enabled the endoscopist to be at the forefront of managing this condition from diagnosis to endoscopic surveillance and control of the polyps.

Aim The study aimed to investigate whether narrow-band imaging (NBI) can enhance adenoma detection in patients at high risk for adenomas compared with high-definition white-light endoscopy (WLE). High risk was defined as three or more adenomas at last colonoscopy, history of colorectal cancer and positive faecal occult blood test. Method Two hundred and fourteen patients were randomized 1:1 to examination with NBI or WLE. The primary outcome measure was the proportion of patients with at least one adenoma detected. Secondary outcomes included total adenomas and polyps, flat adenomas, nonadenomatous polyps, advanced adenomas and patients with three or five or more adenomas. A post hoc analysis to examine the effect of endoscopist and bowel preparation was performed. Results There was no significant difference in the proportion of patients with at least one adenoma: NBI 73%vs WLE 66%, odds ratio 1.40 (95% CI 0.78–2.52), P = 0.26. There was no significant difference for any secondary outcome measure except for the number of flat adenomas which was significantly greater with NBI [comparison ratio 2.66 (95% CI 1.52–4.63), P = 0.001]. Post hoc analysis indicated that one of three endoscopists performed significantly better for adenoma detection with NBI than WLE [comparison ratio 1.92 (95% CI 1.07–3.44), P = 0.03]. Good bowel preparation was associated with significantly improved adenoma detection with NBI [comparison ratio 1.55 (95% CI 1.01–2.22), P = 0.04] but not with fair preparation. Conclusion Overall NBI did not improve detection compared with WLE in a group of patients at high risk for colorectal adenomas, but specific subgroups might benefit.

Aim St Mark’s Bowel Cancer Screening Centre commenced screening in October 2006 as a contributor to the national programme. The first 35 months’ experience is reported. Method Individuals with a positive faecal occult blood test (FOBT) were offered colonoscopy or alternatives if they had significant comorbidity. All screening data were collected prospectively. Results Of the 98 815 FOBT kits issued, 42 523 were returned (43% uptake; 20.79% men). In total, 1339/1488 (90%) FOBT-positive participants attended the nurse clinic (57% men). Of these, 1057 had an index colonoscopy, 115 had a computed tomography colonoscopy (CTC) and eight had a flexible sigmoidoscopy. Five hundred and seventeen (44%) procedures were ‘normal’ (no polyps/cancers). Eighty (6%) individuals had colorectal cancer. The polyp detection rate in index procedures, including colonoscopy, CTC and flexible sigmoidoscopy, was 50%. The adenoma detection rate of all colonoscopies was 62.8%. The median polyp size was 5 (1–80) mm. In total, 1200 colonoscopies were performed by five accredited colonoscopists (96% completion rate). There were 13 (1%) adverse events with

Background: Poor performance and inadequate training in colonoscopy in the UK has been reported. Several centers across the UK run intensive hands-on training courses but their efficacy has not been established. Methods: To assess the benefit of the accelerated colonoscopy training course, an audit was conducted for the 50 trainees who individually attended the course. The course objectives were to increase core knowledge and improve the basic hand skills required for colonoscopy on a one-to-one basis. This includes three microteaching, two computer simulator and four hands-on training sessions within 4 days. They performed two multiple-choice question (MCQ) papers. Performance parameters measured at the beginning and end of the course were the Direct Observation of Procedural Skills (DOPS) using visual analog scales for all aspects of colonoscopy technique. Results: The MCQ score significantly increased: mean score 57%vs 66% (P

BACKGROUND Expanded vermiculite is widely used in many fields, especially as an ameliorant in agriculture. Although it is known as a cation-exchanger, in a search for a new cesium adsorbent for environmental conservation, the ion-exchange behaviour of cesium on vermiculite in various grain sizes was investigated. The adsorption of cesium from artificial seawater was also investigated. RESULTS The effect of the vermiculite grain size was clearly identified. The preferred gain size for general use was found to be 500 µm. The amount of adsorption was low in these artificial seawater samples, however, almost similar ion-exchange behaviour was observed in both of the pure water and artificial seawater samples. CONCLUSION Adjustment of grain size according to the end use enables unlimited availability for application as an adsorbent of cesium. The results showed that vermiculite is a promising material for the recovery of cesium from contaminated seawater. © 2013 Society of Chemical Industry

1. The effects of combined treatment with pioglitazone.HCl and metformin on diabetes and obesity were investigated in Wistar fatty rats, which are hyperglycaemic and hypertriglyceridaemic and have higher plasma levels of total ketone bodies than lean rats. 2. Plasma glucose was significantly decreased when pioglitazone.HCl or metformin was administered alone and combined treatment accentuated this decrease. The administration of pioglitazone.HCl, but not metformin, also decreased plasma levels of triglyceride and total ketone bodies. 3. The glycogen content of skeletal muscle was not increased by pioglitazone.HCl or metformin alone, but was increased by combined treatment (P=0.003, ANOVA). 4. Pioglitazone.HCl produced increased food intake and bodyweight in hyperphagic Wistar fatty rats; however, concurrent administration of metformin significantly ameliorated these pioglitazone.HCl-induced increases. 5. These results indicate that combined treatment with pioglitazone.HCl and metformin induces a marked hypoglycaemic effect accompanied by a reduction in plasma levels of total ketone bodies and prevention of excessive bodyweight gain in Wistar fatty rats. These favourable effects suggest that the combination would be beneficial in treating patients with type 2 diabetes.

The bromination of 2-alkyl- and 2-phenyl-1-cycloalkanones with N-bromosuccinimide and subsequent dehydrobromination with aniline gave the corresponding 2-cycloalken-1-ones

Embelin, a major constituent of Embelia ribes BURM. (Myrsinaceae) was transformed into different types of compounds through dimerization during preparation of a decoction. Two of the products are proposed to have furanylidene benzofuranone and 1, 4-dibenzofurandione skeletons on the basis of spectroscopic means. The transformation of embelin in boiling water is markedly accelerated by the presence of fatty acids.

The H+/MA+ ion-exchange reaction of layered γ-titanium and γ-zirconium phosphates, MT(HPO4)2·nH2O, was examined, where MA is an alkali metal and MT is Ti or Zr. They showed remarkably high ion-exch...

Chronic treatment with antiepileptic drugs (AED) is known to reduce serum thyroid hormone levels. Serum thyrotropin (TSH) level is unchanged despite low thyroxine (T4) level. We studied serum tri-iodothyronine (T3), T4 and TSH in 30 epileptic patients prior to discontinuation and 2, 4, 8 and 16 weeks after AED discontinuation. One AED was discontinued in each patient. Serum T3 levels were reduced consistently after AED discontinuation. Serum T4 and rT3 levels were increased, but not persistently. Serum TSH levels were unchanged. Our results suggest that during AED treatment serum T3 level was increased. This could be an increased conversion of T4 to T3. An acceleration of thyroid hormones degradation by enzyme induction is physiologically balanced by an increased conversion of T4 to T3.

A 7 year old girl with epilepsy and spastic quadriplegia secondary to an episode of status epilepticus at 4 months of age is reported. At the age of 6 years, she began to experience increased generalized myoclonic and tonic seizures during treatment with carbamazepine (CBZ) 200 mg/day and clonazepam 1.5 mg/day. When the CBZ was increased to 400 mg/day, the seizures increased dramatically in frequency. Following discontinuation of CBZ, the seizure frequency decreased to a level less than that prior to starting CBZ. Serial electroencephalograms displayed multifocal independent epileptiform discharges (MIED) characterized by shifting localization, which could be one of the risk factors for exacerbation by CBZ. In this case MIED may indicate widespread rather than localized cerebral dysfunction.

A male infant with myoclonic astatic epilepsy showed myoclonic seizures of the eyelids by closing of the eyes. There was no photosensitivity in EEG with flash-stimulation and he could induce seizures even in total darkness. The latency between a lid closure and onset of seizure discharges on EEG was relatively long (0.3-0.5 second). Epileptic seizures in this patient may be induced via a brainstem reticular formation, and elevated Bell's position seems to be the necessary stimulus to produce seizures.