Risk of gastrointestinal cancer in a symptomatic cohort after a complete colonoscopy:Role of faecal immunochemical test

BACKGROUND Faecal immunochemical test(FIT)has been recommended to assess symptomatic patients for colorectal cancer(CRC)detection.Nevertheless,some conditions could theoretically favour blood originating in proximal areas of the gastrointestinal tract passing through the colon unmetabolized.A positive FIT result could be related to other gastrointestinal cancers(GIC).AIM To assess the risk of GIC detection and related death in FIT-positive symptomatic patients(threshold 10μg Hb/g faeces)without CRC.METHODS Post hoc cohort analysis performed within two prospective diagnostic test studies evaluating the diagnostic accuracy of different FIT analytical systems for CRC and significant colonic lesion detection.Ambulatory patients with gastrointestinal symptoms referred consecutively for colonoscopy from primary and secondary healthcare,underwent a quantitative FIT before undergoing a complete colonoscopy.Patients without CRC were divided into two groups(positive and negative FIT)using the threshold of 10μg Hb/g of faeces and data from follow-up were retrieved from electronic medical records of the public hospitals involved in the research.We determined the cumulative risk of GIC,CRC and upper GIC.Hazard rate(HR)was calculated adjusted by age,sex and presence of significant colonic lesion.RESULTS We included 2709 patients without CRC and a complete baseline colonoscopy,730(26.9%)with FIT≥10μgr Hb/gr.During a mean time of 45.5±20.0 mo,a GIC was detected in 57(2.1%)patients:An upper GIC in 35(1.3%)and a CRC in 14(0.5%).Thirty-six patients(1.3%)died due to GIC:22(0.8%)due to an upper GIC and 9(0.3%)due to CRC.FIT-positive subjects showed a higher CRC risk(HR 3.8,95%CI:1.2-11.9)with no differences in GIC(HR 1.5,95%CI:0.8-2.7)or upper GIC risk(HR 1.0,95%CI:0.5-2.2).Patients with a positive FIT had only an increased risk of CRC-related death(HR 10.8,95%CI:2.1-57.1)and GIC-related death(HR 2.2,95%CI:1.1-4.3),with no differences in upper GIC-related death(HR 1.4,95%CI:0.6-3.3).An upper GIC was detected in 22(0.8%)patients during the first year.Two variables were independently associated:anaemia(OR 5.6,95%CI:2.2-13.9)and age≥70 years(OR 2.7,95%CI:1.1-7.0).CONCLUSION Symptomatic patients without CRC have a moderate risk increase in upper GIC,regardless of the FIT result.Patients with a positive FIT have an increased risk of post-colonoscopy CRC.

Light at night and lung cancer risk:A worldwide interdisciplinary and time-series study

Background:Light at night(LAN)has become a concern in interdisciplinary research in recent years.This global interdisciplinary study aimed to explore the exposure-lag-response association between LAN exposure and lung cancer incidence.Methods:LAN data were obtained from the Defense Meteorological Satellite Program’s Operational Linescan System.Data of lung cancer incidence,socio-demographic index,and smoking prevalence of populations in 201 countries/territories from 1992 to 2018 were collected from the Global Burden of Disease Study.Spearman correlation tests and population-weighted linear regression analysis were used to evaluate the correlation between LAN exposure and lung cancer incidence.A distributed lag nonlinear model(DLNM)was used to assess the exposure-lag effects of LAN exposure on lung cancer incidence.Results:The Spearman correlation coefficients were 0.286-0.355 and the population-weighted linear regression correlation coefficients were 0.361-0.527.After adjustment for socio-demographic index and smoking preva-lence,the Spearman correlation coefficients were 0.264-0.357 and the population-weighted linear regression correlation coefficients were 0.346-0.497.In the DLNM,the maximum relative risk was 1.04(1.02-1.06)at LAN exposure of 8.6 with a 2.6-year lag time.After adjustment for socio-demographic index and smoking prevalence,the maximum relative risk was 1.05(1.02-1.07)at LAN exposure of 8.6 with a 2.4-year lag time.Conclusion:High LAN exposure was associated with increased lung cancer incidence,and this effect had a specific lag period.Compared with traditional individual-level studies,this group-level study provides a novel paradigm of effective,efficient,and scalable screening for risk factors.

Tools for the diagnosis of hepatitis C virus infection and hepatic fibrosis staging

Hepatitis C virus(HCV)infection represents a major public health issue.Hepatitis C can be cured bytherapy,but many infected individuals are unaware of their status.Effective HCV screening,fast diagnosis and characterization,and hepatic fibrosis staging are highly relevant for controlling transmission,treating infected patients and,consequently,avoiding end-stage liver disease.Exposure to HCV can be determined with high sensitivity and specificity with currently available third generation serology assays.Additionally,the use of point-of-care tests can increase HCV screening opportunities.However,active HCV infection must be confirmed by direct diagnosis methods.Additionally,HCV genotyping is required prior to starting any treatment.Increasingly,high-volume clinical laboratories use different types of automated platforms,which have simplified sample processing,reduced hands-on-time,minimized contamination risks and human error and ensured full traceability of results.Significant advances have also been made in the field of fibrosis stage assessment with the development of non-invasive methods,such as imaging techniques and serum-based tests.However,no single test is currently available that is able to completely replace liver biopsy.This review focuses on approved commercial tools used to diagnose HCV infection and the recommended hepatic fibrosis staging tests.

Fluctuating temperature modifies heat-mortality association around the globe

Studies have investigated the effects of heat and temperature variability(TV)on mortality.However,few assessed whether TV modifies the heat-mortality association.Data on daily temperature and mortality in the warm season were collected from 717 locations across 36 countries.TV was calculated as the standard deviation of the average of the same and previous days’minimum and maximum temperatures.

INMA-Sabadell队列中孕期双酚A及邻苯二甲酸酯暴露与胎儿发育的超声测量(续完)

暴露于ΣMWPm与任何胎儿大小或胎儿发育结局（见补充材料，表8）及所评估的出生结局（表2及补充材料表S7）都没有显著相关性。代谢物MnBP与12-20孕周HC增长降低有显著相关性（-4．88％；95％CI：-8．36，-1．36），且与EFW增长减低也有显著相关性（-4．32％；95％CI：-8．33，-0．27）（图3及补充材料表S8）。

评估饮用水中化学物暴露与健康结局：认识和研究需求现状

[背景]安全的饮用水对于健康至关重要。虽然在全球范围内,微生物污染仍然是饮用水相关疾病发病率和死亡率的最主要原因,但在供水中的化学物也可能导致疾病,而其中一些的人体健康结局的证据有限或缺乏。[目的]旨在总结当前人们对这一问题的了解状况,找出认识差距,并为与饮用水中化学物相关的流行病学研究提供建议。[讨论]评估饮用水中化学物暴露与健康结局十分具有挑战性。暴露通常为低浓度,在水中测量是通常是不够的,化学物以混合物形式存在,暴露时间通常很长,可能涉及多个暴露途径,而能够反映相应暴露阶段的有效生物标志却很少。此外,相对风险的幅度具有变小趋势。[结论]研究应该包括:设计良好的流行病学研究,涵盖能够比较污染程度并具有足够样本量的地区;结合生物分析并整合复杂混合物影响的污染物产生综合评价;足够水中测量次数,以评估地理和时间变异性;有关导致暴露的个人生活习惯的详细信息(例如,摄入、淋浴、游泳和饮食);生物样本的采集,以测量相关的生物标志;先进的统计模型,以评估暴露和相对风险,并应考虑解决测量误差的方法。最后,纳入早期生物效应和遗传易感性的分子标志对于了解化学物作用机制是必不可少的。需要评估大量新出现的污染物的风险和人类暴露,但这些知识仍然缺乏。

人类生命早期暴露组(HELIX)：项目理念与设计(待续)

[背景]人类在生命早期的发育期间可能特别容易受到环境暴露的影响。有关这一主题的人体研究一般集中在单一暴露与健康效应之间的关系。而"暴露组"的概念涵盖了从受孕开始的的全部暴露,完善了基因组。[目的]人类生命早期暴露组(HELIX)项目是一个新的合作研究项目,目的是为了采用新的暴露评估和生物标志分析方法来描述生命早期多种环境因素的暴露,并将这些与生物标志组学和儿童健康结局相关联,从而刻画"生命早期暴露组"。本文描述了该项目的总体设计。[方法]HELIX将利用欧洲现有的6个出生队列研究来估计产前、产后暴露的一系列化学和物理暴露。建立全部队列中总共32 000对母亲和儿童的暴露模型,并在一个包含1 200对母亲和儿童的子队列中测量生物标志。嵌套重复采样的定组研究(n=150)将收集生物标志的变化数据,利用智能手机来评估流动性和体力活动,并监测个体暴露。采用组学技术确定与暴露相关的分子学特征(代谢组、蛋白质组、转录组和表观基因组)。对于多次暴露,采用统计方法估计胎儿和儿童的成长、肥胖、神经发育和呼吸系统结局中的暴露-效应关系。项目还将进行一项健康效应评估测试,以评价组合暴露的风险和收益。[结论]HELIX是描述欧洲人群生命早期暴露组并解开它与组学标志物和儿童健康之间关联的首次尝试之一。作为对暴露组学这一概念的验证,该项目向生命过程中暴露组迈出了重要的第一步。