The elderly harbor greater proportions of advanced histology in subcentimeter adenomas: implications for screening colonoscopy approaches.

BACKGROUND: Screening and surveillance for colorectal cancer can reduce both the incidence of this disease and mortality rates attributed to it. Normally, surveillance intervals should be based on baseline colonoscopy findings, and clinicians focus on advanced polyps and perform patient risk stratification to devise surveillance schedules. The aim of the study was to determine differences in advanced colorectal polyp characteristics and consequent risk stratifications in patients of different age groups. MATERIAL AND METHODS: We retrospectively reviewed 14 312 patients during a 5-year period; a total of 13 842 polyps were stratified by their sizes, locations, and histologies. Participants were categorized into three age groups, the <45 years group, the 45-59 years group and the >59 years group, and each group was further stratified as normal, low risk, and high risk. RESULTS: The <45 years group included 2431 subjects, the 45-59 years group 6258 subjects, and the >59 years group 5623 subjects. The frequency of adenoma and advanced polyps in the proximal colon slightly increased with age. Only 1.0% in the <45 years and 1.3% in the 45-59 years groups of subcentimeter polyps were identified as advanced polyps, less than that in the >59 years group (2.1%). Most patients, especially the elderly, considered as high risk had multiple subcentimeter adenomas. CONCLUSION: The processing strategy proposed for subcentimeter polyps in the elderly still needs to be further explored in the future. Clinicians should recognize the importance of performing a detailed scan of the entire colon.

The effect of flipped classroom in multiple clinical skills training for clinical interns on Objective Structured Clinical Examinations (OSCE).

AIMS: The flipped classroom (FC) is a hybrid approach, combining online learning and face-to-face classroom activities. To comprehensively evaluate the role of the Flipped Classroom (FC) model in clinical skills teaching of medical interns and investigate the acceptance and recognition of FC and Objective Structured Clinical Examinations (OSCE). METHODS: In the teaching of clinical skills, the students were further grouped into two groups- A and B (A = 37, B = 42), using a computer-based random digital method. group A adopted the traditional classroom (TC) model, and group B adopted the FC model. OSCE was used to assess the clinical skills of the two groups of interns. Two independent sample t-test was used to analyze the difference of participant's demographic data and OSCE scores between the two different teaching model. We sent FC questionnaires to group A and OSCE questionnaires to groups A and B. RESULTS: The score of OSCE in group B was higher than that in group A (P = 0.024), especially in the heart physical examination (P < 0.050), lung physical examination (P < 0.050), and abdominal physical examination (P < 0.050). The result of the FC questionnaires showed that regarding online courses, most students in group B thought watching videos was a good way to prepare for class (97.6%), For offline courses, most medical interns said that it enhanced their learning ability (88.1%), and they could accept this form of teaching (85.7%). As for the form of OSCE questionnaires, most people in group A and B said that they knew more about this form of assessment (81.0%), that it truly reflected the clinical ability (82.3%). CONCLUSIONS: FC model has shown good results in clinical skills training, while FC and OSCE can be further promoted in future teaching and assessment.

Novel Biomarkers of Dynamic Blood PD-L1 Expression for Immune Checkpoint Inhibitors in Advanced Non-Small-Cell Lung Cancer Patients.

Background: Immune checkpoint inhibitors (ICIs) have become a high-profile regimen for malignancy recently. However, only a small subpopulation obtains long-term clinical benefit. How to select optimal patients by reasonable biomarkers remains a hot topic. Methods: Paired tissue samples and blood samples from 51 patients with advanced malignancies were collected for correlation analysis. Dynamic changes in blood PD-L1 (bPD-L1) expression, including PD-L1 mRNA, exosomal PD-L1 (exoPD-L1) protein and soluble PD-L1 (sPD-L1), were detected after 2 months of ICIs treatment in advanced non-small-cell lung cancer (NSCLC) patients. The best cutoff values for progression-free survival (PFS) and overall survival (OS) of all three biomarkers were calculated with R software. Results: In 51 cases of various malignancies, those with positive tissue PD-L1 (tPD-L1) had significantly higher PD-L1 mRNA than those with negative tPD-L1. In 40 advanced NSCLC patients, those with a fold change of PD-L1 mRNA ≥ 2.04 had better PFS, OS and best objective response (bOR) rate. In addition, a fold change of exoPD-L1 ≥ 1.86 was also found to be associated with better efficacy and OS in a cohort of 21 advanced NSCLC cases. The dynamic change of sPD-L1 was not associated with efficacy and OS. Furthermore, the combination of PD-L1 mRNA and exoPD-L1 could screen better patients for potential benefit from ICIs treatment. Conclusion: There was a positive correlation between bPD-L1 and tPD-L1 expression. Increased expression of PD-L1 mRNA, exoPD-L1, or both in early stage of ICIs treatment could serve as positive biomarkers of efficacy and OS in advanced NSCLC patients.

Study on the Efficacy of Peracetic Acid Disinfectant (Type III) on Gastrointestinal Endoscopy Disinfection.

PURPOSE: The purpose of this study was to evaluate the disinfection efficacy of peracetic acid disinfectant (Type III) on gastrointestinal endoscopy. METHODS: Endoscopes were disinfected, respectively, by 2% glutaraldehyde and peracetic acid disinfectant (Type III) according to the procedures stipulated by the 2016 version of "Regulation for cleaning and disinfection technique of flexible endoscope," then samples were collected through biopsy channel at the specified steps. The bacterial count and pathogenic bacteria of these samples were detected, and hepatitis B virus surface antigen, hepatitis C virus antibody, and Treponemiapallidum antibody were detected by chemiluminescent microparticle immunoassay in peracetic acid disinfectant (Type III) group. The samples from the peracetic acid disinfectant (Type III) group were collected for 5 days continuously. RESULTS: In total, 56 gastroscopes and 16 colonoscopes were disinfected by 2% glutaraldehyde (GA Group), 46 gastroscopes, and 15 colonoscopes were disinfected by peracetic acid disinfectant (Type III) (PAA Group). After disinfection, the bacterial count was significantly reduced in the 2 groups (P<0.05). In terms of the qualified rate of gastroscopes and total qualified rate, the PAA Group was better than GA Group [the qualified rate of gastroscopes: 97.83% (45/46) vs. 92.86% (52/56), P>0.05; total qualified rate: 98.36% (60/61) vs. 94.44% (68/72), P>0.05], the qualified rate of colonoscopes in the 2 groups were both 100.00% (15/15, 16/16). After disinfecting by peracetic acid disinfectant (Type III), hepatitis B virus surface antigen, anti-hepatitis C virus, and Treponemiapallidum antibody were negative. In term of colonies number detected for 5 days continuously, there was no significant difference at different collection steps (P>0.05). CONCLUSIONS: Peracetic acid disinfectant (Type III) can be well applied to clinical with meeting the standard of high-level disinfection for gastrointestinal endoscopy, and after disinfecting by peracetic acid disinfectant (Type III), there was no obvious bacterial residue in the biopsy channel.

lncARSR sponges miR-34a-5p to promote colorectal cancer invasion and metastasis via hexokinase-1-mediated glycolysis.

Aerobic glycolysis metabolic reprogramming is one of the most important hallmarks of malignant tumors. Increasing evidence indicates that long non-coding RNAs (lncRNAs) are able to regulate glycolysis metabolic reprogramming and promote cancer progression by functioning as competing endogenous RNAs. lncARSR is a newly identified onco-lncRNA in renal cancer, but its potential role in metastatic colorectal cancer (CRC) remains unclear. Here, we analyzed specimens from 89 patients with CRC and demonstrated that lncARSR was highly expressed in CRC tissues and negatively associated with survival. Positron emission tomography-computed tomography imaging with fluoro-2-d-deoxyglucose F18 to evaluate glucose uptake showed that lncARSR expression was positively correlated with maximum standardized uptake values. Functionally, ectopic expression of lncARSR promoted the invasion, metastasis, and glycolysis metabolic reprogramming of CRC cells in vitro and in vivo, while these activities were inhibited by silencing lncARSR expression. Molecularly, lncARSR sponged miR-34a-5p and further mediated hexokinase 1 (HK1)-related aerobic glycolysis in vitro and in vivo. Clinically, high lncARSR and HK1 expression predicted poor survival of patients with CRC, especially when combined with low miR-34a-5p expression. Collectively, we identified lncARSR as an onco-lncRNA in CRC and demonstrated that the combination of lncARSR/miR-34a-5p/HK1 may be a potential prognostic biomarker of CRC.

Radiosensitizing effects of miR-18a-5p on lung cancer stem-like cells via downregulating both ATM and HIF-1α.

Lung cancer is one of the main causes of cancer mortality globally. Most patients received radiotherapy during the course of disease. However, radioresistance generally occurs in the majority of these patients, leading to poor curative effect, and the underlying mechanism remains unclear. In the present study, miR-18a-5p expression was downregulated in irradiated lung cancer cells. Overexpression of miR-18a-5p increased the radiosensitivity of lung cancer cells and inhibited the growth of A549 xenografts after radiation exposure. Dual luciferase report system and miR-18a-5p overexpression identified ataxia telangiectasia mutated (ATM) and hypoxia inducible factor 1 alpha (HIF-1α) as the targets of miR-18a-5p. The mRNA and protein expressions of ATM and HIF-1α were dramatically downregulated by miR-18a-5p in vitro and in vivo. Clinically, plasma miR-18a-5p expression was significantly higher in radiosensitive than in radioresistant group (P < .001). The cutoff value of miR-18a-5p >2.28 was obtained from receiver operating characteristic (ROC) curve. The objective response rate (ORR) was significantly higher in miR-18a-5p-high group than in miR-18a-5p-low group (P < .001). A tendency demonstrated that the median local progression-free survival (PFS) from radiotherapy was longer in miR-18a-5p-high than in miR-18a-5p-low group (P = .082). The median overall survival (OS) from radiotherapy was numerically longer in miR-18a-5p-high than in miR-18a-5p-low group (P = .281). The sensitivity and specificity of plasma miR-18a-5p to predict radiosensitivity was 87% and 95%, respectively. Collectively, these results indicate that miR-18a-5p increases the radiosensitivity in lung cancer cells and CD133+ stem-like cells via downregulating ATM and HIF-1α expressions. Plasma miR-18a-5p would be an available indicator of radiosensitivity in lung cancer patients.