Systematic review of colorectal cancer screening guidelines for average-risk adults: Summarizing the current global recommendations

AIM To summarize and compare worldwide colorectal cancer(CRC) screening recommendations in order to identify similarities and disparities.METHODS A systematic literature search was performed using MEDLINE, EMBASE, Scopus, CENTRAL and ISI Web of knowledge identifying all average-risk CRC screening guideline publications within the last ten years and/or position statements published in the last 2 years. In addition, a hand-search of the webpages of National Gastroenterology Society websites, the National Guideline Clearinghouse, the BMJ Clinical Evidence website,Google and Google Scholar was performed. RESULTS Fifteen guidelines were identified. Six guidelines were published in North America, four in Europe, four in Asia and one from the World Gastroenterology Organization. The majority of guidelines recommend screening average-risk individuals between ages 50 and 75 using colonoscopy(every 10 years), or flexible sigmoidoscopy(FS, every 5 years) or fecal occult blood test(FOBT, mainly the Fecal Immunochemical Test, annually or biennially). Disparities throughout the different guidelines are found relating to the use of colonoscopy, rank order between test, screening intervals and optimal age ranges for screening. CONCLUSION Average risk individuals between 50 and 75 years should undergo CRC screening. Recommendations for optimal surveillance intervals, preferred tests/test cascade as well as the optimal timing when to start and stop screening differ regionally and should be considered for clinical decision making. Furthermore, local resource availability and patient preferences are important to increase CRC screening uptake, as any screening is better than none.

Novel insights for improving the therapeutic safety and efficiency of mesenchymal stromal cells

Mesenchymal stromal cells(MSCs)have attracted great interest in the field of regenerative medicine.They can home to damaged tissue,where they can exert pro-regenerative and anti-inflammatory properties.These therapeutic effects involve the secretion of growth factors,cytokines,and chemokines.Moreover,the functions of MSCs could be mediated by extracellular vesicles(EVs)that shuttle various signaling messengers.Although preclinical studies and clinical trials have demonstrated promising therapeutic results,the efficiency and the safety of MSCs need to be improved.After transplantation,MSCs face harsh environmental conditions,which likely dampen their therapeutic efficacy.A possible strategy aiming to improve the survival and therapeutic functions of MSCs needs to be developed.The preconditioning of MSCs ex vivo would strength their capacities by preparing them to survive and to better function in this hostile environment.In this review,we will discuss several preconditioning approaches that may improve the therapeutic capacity of MSCs.As stated above,EVs can recapitulate the beneficial effects of MSCs and may help avoid many risks associated with cell transplantation.As a result,this novel type of cell-free therapy may be safer and more efficient than the whole cell product.We will,therefore,also discuss current knowledge regarding the therapeutic properties of MSC-derived EVs.

Midwives’ Professional Satisfaction and the Quality of Obstetric Care in Developing Country

Introduction: In Africa, poor working conditions affect the motivation of health care providers. The objective is to study midwives’ professional satisfaction on the technical quality of emergency obstetric care in Senegal. Material and Methods: This was a prospective study of 16 hospitals in Senegal. The job satisfaction of midwives was measured during a personal interview. The instrument used was validated in Senegal and Mali. Other data collected relate to professional and institutional characteristics. A treatment observation grid was used to measure the quality of obstetric care in labour wards. Mixed-model linear regression was used to estimate the effect of satisfaction on the quality of obstetric care. Results: A total of 65 midwives were interviewed and 325 patients observed. The average quality score was 8.7 ± 1.7. The satisfaction scores ranged from 42.2 ± 17.4 (salary) to 76.7 ± 12.1 (morale satisfaction). A positive and significant correlation was found between quality of care and management (cc = 0.56), remuneration (cc = 0.40), task (cc = 0.32), workload (cc = 0.24) and training (cc = 0.29). The linear mixed model shows that salary (β = 0.40), continuing education (β = 0.17) and management style (β = 0.42) improved the quality of care. Association between moral satisfaction and quality care was negative (β = ﹣0.53). Conclusion: The satisfaction of health professionals is a major determinant of the quality of obstetric care. Its inclusion in the fight against mortality has become imperative in developing.

Reliability and sensitivity to change of IW-TSE versus DESS magnetic resonance imaging sequences in the assessment of bone marrow lesions in knee osteoarthritis patients: Longitudinal data from the Osteoarthritis Initiative (OAI) cohort

Background: Bone marrow lesions (BMLs) are associated with osteoarthritis (OA). We assessed the performance of two commonly used MRI sequences, IW-TSE and DESS, for reliability in the detection of BMLs and sensitivity to estimate change over time. We suggested that the IW-TSE would demonstrate higher sensitivity to change than DESS in the assessment of BML prevalence and change over time. This study was performed using a subset of the Osteoarthritis Initiative (OAI) cohort. Methods: A sub-group of 144 patients was selected from the OAI progression cohort who all had IW-TSE and DESS MRI acquisitions at baseline and 24 months. BMLs were assessed using a semi-quantitative scale in the global knee, medial and lateral compartments, and subregions. Intra-reader reliability was assessed on a subset of 51 patients. Results: Intra-reader reliability was substantial for the global knee ≥ 0.64, medial ≥ 0.70, and lateral ≥ 0.63 compartments for IW-TSE and DESS. The prevalence of BML detected at baseline was only slightly greater for IW-TSE compared to DESS. The mean BML score at baseline was significantly higher (p ≤ 0.006) for the IW-TSE than the DESS. However, mean change at 24 months was similar for both sequences for all regions except the medial compartment (p = 0.034) and medial femur (p = 0.015) where they were significantly higher for DESS than IW-TSE. Moreover, the prevalence of BML change at 24 months was similar in all regions except the global knee (p = 0.047) and the lateral tibial plateau (p = 0.031). Conclusion: This study does not suggest superior sensitivity to change of one sequence over the other for almost all the regions. The only difference is a higher BML mean change over time detected by the DESS sequence in the medial compartment and femur. These data bring into perspective that both sequences seem equivalent regarding their use for the assessment of BML in clinical trials.