Impact of retroflexion vs. second forward view examination of the right colon on adenoma detection: a comparison study.

OBJECTIVES: Although screening colonoscopy is effective in preventing distal colon cancers, effectiveness in preventing right-sided colon cancers is less clear. Previous studies have reported that retroflexion in the right colon improves adenoma detection. We aimed to determine whether a second withdrawal from the right colon in retroflexion vs. forward view alone leads to the detection of additional adenomas. METHODS: Patients undergoing screening or surveillance colonoscopy were invited to participate in a parallel, randomized, controlled trial at two centers. After cecal intubation, the colonoscope was withdrawn to the hepatic flexure, all visualized polyps removed, and endoscopist confidence recorded on a 5-point Likert scale. Patients were randomized to a second exam of the proximal colon in forward (FV) or retroflexion view (RV), and adenoma detection rates (ADRs) compared. Logistic regression analysis was used to evaluate predictors of identifying adenomas on the second withdrawal from the proximal colon. RESULTS: A total of 850 patients (mean age 59.1±8.3 years, 59% female) were randomly assigned to FV (N=400) or RV (N=450). Retroflexion was successful in 93.5%. The ADR (46% FV and 47% RV) and numbers of adenomas per patient (0.9±1.4 FV and 1.1±2.1 RV) were similar (P=0.75 for both). At least one additional adenoma was detected on second withdrawal in similar proportions (10.5% FV and 7.5% RV, P=0.13). Predictors of identifying adenomas on the second withdrawal included older age (odds ratio (OR)=1.04, 95% confidence interval (CI)=1.01-1.08), adenomas seen on initial withdrawal (OR=2.8, 95% CI=1.7-4.7), and low endoscopist confidence in quality of first examination of the right colon (OR=4.8, 95% CI=1.9-12.1). There were no adverse events. CONCLUSIONS: Retroflexion in the right colon can be safely achieved in the majority of patients undergoing colonoscopy for colorectal cancer screening. Reexamination of the right colon in either retroflexed or forward view yielded similar, incremental ADRs. A second exam of the right colon should be strongly considered in patients who have adenomas discovered in the right colon, particularly when endoscopist confidence in the quality of initial examination is low.

Pheromone-mediated gene expression in the honey bee brain.

We tested the hypothesis that queen mandibular pheromone (QMP) causes changes in gene expression in the brain of the adult worker honey bee, and that these changes can be correlated to the downstream behavioral responses induced by QMP. In support of the first hypothesis, cage experiments revealed that QMP transiently regulated expression of several hundred genes and chronically regulated the expression of 19 genes. Several of these genes were also affected by QMP in experiments with bee colonies in the field, demonstrating robust gene regulation by pheromone. To evaluate the second hypothesis, we focused on one function of QMP: delaying the transition from working in the hive (e.g., brood care, or "nursing") to foraging. We compared the list of QMP-regulated genes with the lists of genes differentially regulated in nurse and forager brains generated in a separate study. QMP consistently activated "nursing genes" and repressed "foraging genes," suggesting that QMP may delay behavioral maturation by regulating genes in the brain that produce these behavioral states. We also report here on an ortholog of the Drosophila transcription factor kruppel homolog 1 that was strongly regulated by QMP, especially in the mushroom bodies of the bee brain. These results demonstrate chronic gene regulation by a primer pheromone and illustrate the potential of genomics to trace the actions of a pheromone from perception to action, and thereby provide insights into how pheromones regulate social life.