Explore the vast range of titles available.

Colorectal cancer (CRC) is the second most common cause of cancer death in the United States. Every 3 years, the American Cancer Society provides an update of CRC occurrence based on incidence data (available through 2016) from population-based cancer registries and mortality data (through 2017) from the National Center for Health Statistics. In 2020, approximately 147,950 individuals will be diagnosed with CRC and 53,200 will die from the disease, including 17,930 cases and 3,640 deaths in individuals aged younger than 50 years. The incidence rate during 2012 through 2016 ranged from 30 (per 100,000 persons) in Asian/Pacific Islanders to 45.7 in blacks and 89 in Alaska Natives. Rapid declines in incidence among screening-aged individuals during the 2000s continued during 2011 through 2016 in those aged 65 years and older (by 3.3% annually) but reversed in those aged 50 to 64 years, among whom rates increased by 1% annually. Among individuals aged younger than 50 years, the incidence rate increased by approximately 2% annually for tumors in the proximal and distal colon, as well as the rectum, driven by trends in non-Hispanic whites. CRC death rates during 2008 through 2017 declined by 3% annually in individuals aged 65 years and older and by 0.6% annually in individuals aged 50 to 64 years while increasing by 1.3% annually in those aged younger than 50 years. Mortality declines among individuals aged 50 years and older were steep-est among blacks, who also had the only decreasing trend among those aged younger than 50 years, and excluded American Indians/Alaska Natives, among whom rates remained stable. Progress against CRC can be accelerated by increasing access to guideline-recommended screening and high-quality treatment, particularly among Alaska Natives, and elucidating causes for rising incidence in young and middle-aged adults.

ObjectiveEvaluate effectiveness, harms and burdens of faecal blood testing, sigmoidoscopy and colonoscopy screening for colorectal cancer over 15 years.DesignWe performed an update of a Cochrane systematic review, and performed network meta-analysis comparing randomised trials evaluating colorectal cancer screening with guaiac faecal occult blood test (gFOBT) (annual, biennial), faecal immunochemical test (FIT) (annual, biennial), sigmoidoscopy (once-only) or colonoscopy (once-only) in a healthy population, aged 50–79 years. We conducted subgroup analysis on sex. Follow-up >5 years was required for analysis of colorectal cancer incidence and mortality.Results12 randomised trials proved eligible. Compared with no-screening, we found high certainty evidence for sigmoidoscopy screening slightly reducing colorectal cancer incidence (relative risk (RR) 0.76; 95% confidence interval (CI 0.70 to 0.83) and mortality (RR 0.74; 95% CI 0.69 to 0.80), while gFOBT screening had little or no difference on colorectal cancer incidence, but slightly reduced colorectal cancer mortality (annual: RR 0.69; 95% CI 0.56 to 0.86, biennial: RR 0.88; 95% CI 0.82 to 0.93). No screening test reduced mortality nor incidence by more than six per 1000 screened over 15 years. Sigmoidoscopy had a greater effect in men, for both colorectal cancer incidence (women: RR 0.86; 95% CI 0.81 to 0.92, men: RR 0.75, 95% CI 0.71 to 0.79), and mortality (women: RR 0.85; 95% CI 0.71 to 0.96, men: RR 0.67; 95% CI 0.61 to 0.75) (moderate certainty).ConclusionsIn a 15-year perspective, sigmoidoscopy reduces colorectal cancer incidence, while sigmoidoscopy, annual and biennial gFOBT all reduce colorectal cancer mortality. Sigmoidoscopy may reduce colorectal cancer incidence and mortality more in men than in women.PROSPERO registration numberCRD42018093401.

Measurement of ethanol above the skin surface (supradermal) is used to monitor blood alcohol concentrations (BAC) in both legal and consumer settings. Previously, the relationship between supradermal alcohol concentration (SAC) and BAC was described using partial and ordinary differential equations (PDE model: J. Appl. Physiol. 100: 649‐55, 2006). Using a range of BAC profiles by varying absorption times and peak concentrations, the PDE model accurately predicted experimental measures of SAC. Recently, other mathematical models have relied on the PDE model. This paper proposes a new approach to modeling transdermal ethanol kinetics using a mass transfer coefficient and only ordinary differential equations (ODE model). Using a range of BAC profiles, the ODE model performed very similarly to the PDE model. The ODE model had slightly slower washout rates and slightly slower times to peak SAC and to zero SAC. Similar to the PDE model, a sensitivity analysis on the ODE model showed changes in solubility and diffusivity within the stratum corneum, stratum corneum thickness, and the volume of gas above the skin affected model performance. This new model will streamline integration into larger physiologic models, reduce computation time, and decrease the time to transform skin alcohol measurements to blood alcohol concentrations.

This document is the first update of the American College of Gastroenterology (ACG) colorectal cancer (CRC) screening recommendations since 2000. The CRC screening tests are now grouped into cancer prevention tests and cancer detection tests. Colonoscopy every 10 years, beginning at age 50, remains the preferred CRC screening strategy. It is recognized that colonoscopy is not available in every clinical setting because of economic limitations. It is also realized that not all eligible persons are willing to undergo colonoscopy for screening purposes. In these cases, patients should be offered an alternative CRC prevention test (flexible sigmoidoscopy every 5-10 years, or a computed tomography (CT) colonography every 5 years) or a cancer detection test (fecal immunochemical test for blood, FIT).

Specifically, we will discuss 6 key questions that address the following 3 tasks: endoscopic recognition of colorectal polyps with deep submucosal invasion that should be referred directly to surgery; optimal endoscopic resection techniques and specimen handling when an increased risk of superficial submucosally invasive polyp is identified; and weighing the risks and benefits of surgery when an endoscopically removed polyp is found to have submucosal invasion. Grading of Evidence The US Multi-Society Task Force on Colorectal Cancer (USMSTF) consists of gastroenterologists with expertise in colorectal neoplasia (ie, CRC and precursor lesions, such as polyps). According to this classification, malignant polyps would fall under category 5.2 (submucosal carcinoma and beyond).Table 2. [...]the use of terms such as carcinoma or cancer in describing lesions confined to the mucosa may cause undue alarm to endoscopists, surgeons, patients, or primary care providers, and can lead to unnecessary surgery.

Colorectal cancer (CRC) remains the second leading cause of cancer-related death in the U.S. This study aimed to evaluate national CRC incidence from 2021 to 2024 using a large, multi-payer claims database. This retrospective, cross-sectional study used a national multi-payer claims database to estimate annual CRC incidence from 2021 to 2024. Adults aged 45 to 75 years were included if they had no history of CRC diagnosis from 2015 through the year prior to the given calendar year (2021, 2022, 2023, or 2024) and had at least 1 medical or pharmacy event in a 3-year window centered on that year. CRC incidence was defined as a new diagnosis claim during each study year. Annual incidence rates per 100,000 individuals were calculated and stratified by sociodemographic characteristics. Associations between CRC incidence status (new diagnosis vs. no diagnosis) and sociodemographic subgroups were assessed using Pearson’s chi-square tests. From 2021 to 2024, CRC incidence declined from 136.9 to 115.9 per 100,000 among 145 to 161 million eligible individuals, with declines in those aged 50 to 64 (120.8–101.7) and 65 to 75 (203.6–162.5). In contrast, incidence among those aged 45 to 49 increased from 59.5 to 63.1 over the same period. Incidence remained higher in males than females (129.4 vs. 104.3 in 2024), and although it decreased, it remained highest among Black individuals (225.1–156.8). Medicare Advantage enrollees had the highest incidence throughout (276.8–214.0), while those with commercial insurance had one of the lowest (112.8–93.4). Regional differences narrowed from 2021 to 2024 across the Northeast, Midwest, South, and West; CRC incidence status remained significantly associated with region (Pearson’s chi-square P < 0.001). Overall, CRC incidence declined from 2021 to 2024, though rising rates among adults aged 45 to 49 highlight a growing early-onset burden. Associations between CRC incidence status and age, sex, race/ethnicity, insurance type, and region were observed, suggesting disparities that may reflect underlying equity gaps in prevention.

Colorectal cancer (CRC) is a leading cause of cancer-related deaths in the United States, despite available screening programs, making regular screening essential for early detection and prevention. This study evaluated adherence to repeat multitarget stool DNA (mt-sDNA) testing and follow-up colonoscopy rates among average-risk individuals in the United States This retrospective study used mt-sDNA lab data linked to a national multipayer claims database from 2017 to 2023. Adults aged 45 to 75 years at average risk for CRC who underwent repeat mt-sDNA screening after one or more prior negative results were included. The primary outcome was adherence to repeat mt-sDNA testing, defined as the return of a successfully completed test with valid results within 365 days of shipment. The secondary outcome was the rate of follow-up colonoscopy after a positive mt-sDNA result. Baseline characteristics, adherence rates, and follow-up colonoscopy rates were summarized descriptively. Logistic regression was used to identify factors independently associated with adherence. The study included 326,329 individuals, predominantly female (62.0%) and White (62.5%). Adherence to repeat mt-sDNA screening was high across all racial and ethnic subgroups, exceeding 80% in every group analyzed. White individuals had the highest adherence at 86.6%, followed by Asian individuals at 85.7%, Black individuals at 83.1%, and Hispanic or Latino individuals at 82.7% (P < 0.001).Among those with two prior mt-sDNA tests, adherence increased to 90.6%. The rate of follow-up colonoscopy among those with a positive mt-sDNA result was 76.0%. Logistic regression analysis showed higher odds of mt-sDNA adherence among individuals aged 65–75 years (OR: 1.27; 95% CI: 1.25–1.30; P < 0.001), those residing in rural (OR: 1.21; 95% CI: 1.13–1.28; P < 0.001), patients whose tests were ordered by OB/GYNs (OR: 1.19; 95% CI: 1.13–1.28; P < 0.001), individuals receiving digital outreach (OR: 1.34; 95% CI: 1.30–1.37; P < 0.001), and individuals with two or more prior mt-sDNA tests (OR: 1.44; 95% CI: 1.31–1.58; P < 0.001). The mt-sDNA test was associated with high repeat screening adherence (86.1%) and a follow-up colonoscopy rate of 76.0%, with mt-sDNA adherence exceeding 80% in most subgroups. These findings support its utility as a reliable, home-based CRC screening option.

Flat and depressed colon neoplasms are an increasingly recognized precursor for colorectal cancer (CRC) in Western populations. High-definition chromoscopy is used to increase the yield of colonoscopy for flat and depressed neoplasms; however, its role in average-risk patients undergoing routine screening remains uncertain. Average-risk patients referred for screening colonoscopy at four U.S. medical centers were randomized to high-definition chromocolonoscopy or high-definition white light colonoscopy. The primary outcomes, patients with at least one adenoma and the number of adenomas per patient, were compared between the two groups. The secondary outcome was patients with flat or depressed neoplasms, as defined by the Paris classification. A total of 660 patients were randomized (chromocolonoscopy: 321, white light: 339). Overall, the mean number of adenomas per patient was 1.2+/-2.1, the mean number of flat polyps per patient was 1.4+/-1.9, and the mean number of flat adenomas per patient was 0.5+/-1.0. The number of patients with at least one adenoma (55.5% vs. 48.4%, absolute difference 7.1%, 95% confidence interval (-0.5% to 14.7%), P=0.07), and the number of adenomas per patient (1.3+/-2.4 vs. 1.1+/-1.8, P=0.07) were marginally higher in the chromocolonoscopy group. There were no significant differences in the number of advanced adenomas per patient (0.06+/-0.37 vs. 0.04+/-0.25, P=0.3) and the number of advanced adenomas<10 mm per patient (0.02+/-0.26 vs. 0.01+/-0.14, P=0.4). Two invasive cancers were found, one in each group; neither was a flat neoplasm. Chromocolonoscopy detected significantly more flat adenomas per patient (0.6+/-1.2 vs. 0.4+/-0.9, P=0.01), adenomas<5 mm in diameter per patient (0.8+/-1.3 vs. 0.7+/-1.1, P=0.03), and non-neoplastic lesions per patient (1.8+/-2.3 vs. 1.0+/-1.3, P<0.0001). High-definition chromocolonoscopy marginally increased overall adenoma detection, and yielded a modest increase in flat adenoma and small adenoma detection, compared with high-definition white light colonoscopy. The yield for advanced neoplasms was similar for the two methods. Our findings do not support the routine use of high-definition chromocolonoscopy for CRC screening in average-risk patients. The high adenoma detection rates observed in this study may be due to the high-definition technology used in both groups.

Background The ketone bodies β‐hydroxybutyrate (BOHB) and acetone are generated as a byproduct of the fat metabolism process. In healthy individuals, ketone body levels are ∼0.1 mM for BOHB and ∼1 part per million for breath acetone (BrAce). These levels can increase dramatically as a consequence of a disease process or when used therapeutically for disease treatment. For example, increased ketone body concentration during weight loss is an indication of elevated fat metabolism. Ketone body measurement is relatively inexpensive and can provide metabolic insights to help guide disease management and optimize weight loss. Methods This review of the literature provides metabolic mechanisms and typical concentration ranges of ketone bodies, which can give new insights into these conditions and rationale for measuring ketone bodies. Results Diseases such as heart failure and ketoacidosis can affect caloric intake and macronutrient management, which can elevate BOHB 30‐fold and BrAce 1000‐fold. Other diseases associated with obesity, such as brain dysfunction, cancer, and diabetes, may cause dysfunction because of an inability to use glucose, excessive reliance on glucose, or poor insulin signaling. Elevating ketone body concentrations (e.g., nutritional ketosis) may improve these conditions by forcing utilization of ketone bodies, in place of glucose, for fuel. During weight loss, monitoring ketone body concentration can demonstrate program compliance and can be used to optimize the weight‐loss plan. Conclusions The role of ketone bodies in states of pathologic and therapeutic ketosis indicates that accurate measurement and monitoring of BOHB or BrAce will likely improve disease management. Bariatric surgery is examined as a case study for monitoring both types of ketosis.