The impact of Endocuff-assisted colonoscopy on adenoma detection in an organized screening program.

BACKGROUND AND STUDY AIMS: Colorectal cancer (CRC) screening with biennial fecal occult blood test has been shown to reduce CRC mortality. For the effectiveness of the CRC screening program is crucial that a high-quality colonoscopy with a high adenoma detection rate (ADR) be performed. To improve ADR, various endoscopic devices have been developed. Endocuff, an endoscopic cap with finger-like projections, has been shown to improve ADR. The aim of this study was to compare in an organized CRC screening program ADR, advanced adenoma detection rate (AADR) and mean number of adenomas per patient (MAP) using standard colonoscopy (SC) and Endocuff-assisted colonoscopy (EAC). PATIENTS AND METHODS: We compared performance of SC (in 2014) and EAC (in 2015) in consecutive participants in an organized CRC screening program. RESULTS: SC and EAC were performed in 546 (284 males) and 519 (293 males) subjects, respectively (mean age 60 years). Cecal intubation rate was 97.4 % for SC and 97.1 % for EAC and not significantly different ( P  = 0.7). ADR was 47 % for SC and 52 % for EAC, P  = 0.1. MAP in SC and EAC were 0.87 (range: 0 - 7) and 1.11 (range: 0 - 13) respectively, P  = 0.02. AADR rate was 25 % and 23 % for SC and EAC, respectively, P  = 0.5. CONCLUSION: Endocuff-assisted colonoscopy does not improve the number of patients with at least one adenoma but it may increase the number of detected adenomas per procedure.

Ticks are more suitable than red foxes for monitoring zoonotic tick-borne pathogens in northeastern Italy.

BACKGROUND: Northeastern Italy is a hotspot for several tick-borne pathogens, transmitted to animals and humans mainly by Ixodes ricinus. Here we compare the results of molecular monitoring of ticks and zoonotic TBPs over a six-year period, with the monitoring of red foxes (Vulpes vulpes) in an endemic area. RESULTS: In the period 2011-2016, 2,578 ticks were collected in 38 sites of 20 municipalities of Belluno Province. Individual adults (264), pooled larvae (n = 330) and nymphs (n = 1984) were screened for tick-borne encephalitis virus, Borrelia burgdorferi (s.l.), Rickettsia spp., Babesia spp., Anaplasma phagocytophilum and "Candidatus Neoehrlichia mikurensis" by specific SYBR green real-time PCR assays and sequencing. The spleens of 97 foxes, culled in the period 2015-2017 during sport hunting or population control programs, were also screened. Overall, nine different pathogens were found in I. ricinus nymph and adult ticks: Rickettsia helvetica (3.69%); R. monacensis (0.49%); four species of the B. burgdorferi (s.l.) complex [B. afzelii (1.51%); B. burgdorferi (s.s.) (1.25%); B. garinii (0.18%); and B. valaisiana (0.18%)]; A. phagocytophilum (3.29%); "Candidatus N. mikurensis" (1.73%); and Babesia venatorum (0.04%). Larvae were collected and screened in the first year only and two pools (0.6%) were positive for R. helvetica. Tick-borne encephalitis virus was not found in ticks although human cases do occur in the area. The rate of infection in ticks varied widely according to tick developmental stage, site and year of collection. As expected, adults were the most infected, with 27.6% harboring at least one pathogen compared to 7.3% of nymphs. Pathogens with a minimum infection rate above 1% were recorded every year. None of the pathogens found in ticks were detectable in the foxes, 52 (54%) of which were instead positive for Babesia cf. microti (also referred to as Babesia microti-like, "Theileria annae", "Babesia annae" and "Babesia vulpes"). CONCLUSIONS: The results show that foxes cannot be used as sentinel animals to monitor tick-borne pathogens in the specific epidemiological context of northeastern Italy. The high prevalence of Babesia cf. microti in foxes and its absence in ticks strongly suggests that I. ricinus is not the vector of this pathogen.

A comparison of different strategies used to invite subjects with a positive faecal occult blood test to a colonoscopy assessment. A randomised controlled trial in population-based screening programmes.

OBJECTIVE: The purpose of this parallel randomised controlled trial was to compare compliance with different modalities used to invite patients with a positive immunochemical faecal occult blood test (FIT+) for a total colonoscopy (TC). METHOD: FIT+ patients from nine Italian colorectal cancer screening programmes were randomised to be invited for a TC initially by mail or by phone and, for non-compliers, to be recalled by mail, for counselling with a general practitioner, or to meet with a specialist screening practitioner (nurse or healthcare assistant). RESULTS: In all, 3777 patients were randomised to different invitation strategies. Compliance with an initial invitation by mail and by phone was similar (86.0% vs. 84.0%, relative risk - RR: 1.02; 95%CI 0.97-1.08). Among non-responders to the initial invitation, compliance with a recall by appointment with a specialist practitioner was 50.4%, significantly higher than with a mail recall (38.1%; RR:1.33; 95%CI 1.01-1.76) or with a face-to-face counselling with the GP (30.8%; RR:1.45;95%CI 1.14-1.87). CONCLUSION: Compliance with an initial invitation for a TC by mail and by phone was similar. A personal meeting with a specialist screening practitioner was associated with the highest compliance among non-compliers with initial invitations, while the involvement of GPs in this particular activity seemed less effective.

Distribution and habitat characterization of the recently introduced invasive mosquito Aedes koreicus [Hulecoeteomyia koreica], a new potential vector and pest in north-eastern Italy.

BACKGROUND: The container breeding species belonging to the genus Aedes (Meigen) are frequently recorded out of their place of origin. Invasive Aedes species are proven or potential vectors of important Arboviruses and their establishment in new areas pose a threat for human and animal health. A new species of exotic mosquito was recorded in 2011 in north-eastern Italy: Aedes (Finlaya) koreicus [Hulecoeteomyia koreica]. The aim of this study was to characterize the biology, the environment and the current distribution of this mosquito in north-eastern Italy. Morphological details useful to discriminate this species from other invasive Aedes mosquitoes are also given (see Additional files). METHODS: All possible breeding sites for larval development were monitored. In addition, ovitraps and traps for adults were used to collect eggs and adults. The mosquitoes (larvae and adults) were identified morphologically and molecularly. Environmental data and climatic variables during the period of mosquito activity (from April to October) were considered. RESULTS: Aedes koreicus was found in 37 municipalities (39.4%) and was detected in 40.2% of places and in 37.3% of larval habitats monitored, in a range of altitude from 173 to 1250 m.a.s.l.. Garden centres were the most common locations (66.7%), followed by streets/squares (57.1%), private gardens (46.4%) and cemeteries (21.1%) (p < 0.01). The main larval habitats were catch basins (48.5%) and artificial water containers (41.8%). As for Aedes albopictus [Stegomyia albopicta], ovitraps were attractive for adult females resulting in the higher rate of positivity (15/21; 71.4%) among breeding sites. The period of Ae. koreicus activity ranged from March 29 to October 29. CONCLUSION: The species is clearly established in the area and is now overlapping with other vectors such as Ae. albopictus and colonizing areas over 800 m.a.s.l, not yet or sporadically reached by the tiger mosquito. The data collected are essential to assess the risk of colonization of other parts of Italy and Europe, as well as the risk of spreading of pathogens transmitted. These findings stress the importance of implementing entomological surveillance for early detection of invasive species, which is necessary for eradication or limitation of its further spread.

Persistence of immunity to tick-borne encephalitis after vaccination and natural infection.

Long-term persistence of immunity was assessed in 66 patients who had contracted tick-borne encephalitis (TBE) and in 126 subjects who had completed primary TBE immunization using a conventional three-dose schedule from 3 to 8 years earlier. Immunity was tested in the subjects stratified by age as follows: ≤40 years (N = 37); 41-60 years (N = 100); and over 60 years (N = 55). Antibody levels decreased significantly with increasing age in the vaccinated cohort by comparison with the individuals who had previously contracted TBE. Consistently higher geometric mean antibody levels were found in the patients infected naturally. When the vaccinated subjects were compared, subjects ≤40 years old had significantly higher antibody levels than either of the older groups. Analyzing immunity to TBE over time revealed a remarkable (50%) decline in seroprotection rates in the vaccinated group at 50 months of follow-up, while stable, high levels persisted in all subjects after natural TBE infection. In the vaccinees over 60 years old, the TBE antibody levels reached 60% at 60 months, and 20% at 70 months of follow-up; in contrast, in the 41-60-year-old group, the antibody levels remained high for 70 months, and then fell rapidly. For people aged <60 years old, booster doses are recommended every 5 years after the fourth dose of vaccine, which should be administered 3 years after primary immunization. In subjects aged 60 years or older, booster doses should be given every 3 years.