Young patients with colorectal cancer had clinical and pathological presentation similar to that of older patients.

BackgroundColorectal cancer is a major cause of morbidity and mortality and can arise through the adenoma-carcinoma sequence. Colonoscopy is considered the method of choice for population-wide cancer screening.AimTo assess the characteristics of endoscopically resected polyps in a consecutive series of patients who underwent colonoscopy at a university hospital and compare histopathology findings according to patient age and polyp size.MethodsRetrospective, cross-sectional of 1950 colonoscopy reports from consecutively examined patients. The sample was restricted to reports that mentioned colorectal polyps. A chart review was carried out for collection of demographic data and histopathology results. Data were compared for polyps sized ≤0.5 cm and ≥0.6 cm and then for polyps sized ≤1.0 cm and ≥1.1 cm. Finally, all polyps resected from patients aged 49 years or younger were compared with those resected from patients aged 50 years or older.ResultsA total of 272 colorectal polyps were resected in 224 of the 1950 colonoscopies included in the sample (11.5%). Polyps >1 cm tended to be pedunculated (p=0.000) and were more likely to exhibit an adenomatous component (p=0.001), a villous component (p=0.000), and dysplasia (p=0.003). These findings held true when the size cutoff was set at 0.5 cm. Patients aged 50 years or older were more likely to have sessile polyps (p=0.023) and polyps located in the proximal colon (p=0.009). There were no significant differences between groups in histopathology or presence of dysplasia.ConclusionPolyp size is associated with presence of adenomas, a villous component, and dysplasia, whereas patient age is more frequently associated with sessile polyps in the proximal colon.

We use the surface detector of the Pierre Auger Observatory to search for air showers initiated by photons with an energy above 1019 eV. Photons in the zenith angle range from 30∘ to 60∘ can be identified in the overwhelming background of showers initiated by charged cosmic rays through the broader time structure of the signals induced in the water-Cherenkov detectors of the array and the steeper lateral distribution of shower particles reaching ground. Applying the search method to data collected between January 2004 and June 2020, upper limits at 95% CL are set to an E-2 diffuse flux of ultra-high energy photons above 1019 eV, 2 × 1019 eV and 4 × 1019 eV amounting to 2.11 × 10-3, 3.12 × 10-4 and 1.72 × 10-4 km-2 sr-1 yr-1, respectively. While the sensitivity of the present search around 2 × 1019 eV approaches expectations of cosmogenic photon fluxes in the case of a pure-proton composition, it is one order of magnitude above those from more realistic mixed-composition models. The inferred limits have also implications for the search of super-heavy dark matter that are discussed and illustrated.

-Background -Anal sphincter tone is routinely assessed by digital rectal examination in patients with fecal incontinence, although its accuracy in detecting sphincter defects or separating competent from incompetent muscles has not been established. Objective -In this setting, we aimed to evaluate the accuracy of digital rectal examination in grading anal defects in order to separate small from extensive cases as depicted on 3D endoanal ultrasound, using a scoring sphincter defect and correlate anal tone to anal pressures. Methods -Women with fecal incontinence were divided into two groups: small or extensive defects according to the ultrasound scoring system. Sensitivity, specificity, positive and negative predictive values of digital rectal examination in grading global and external sphincter defects were calculated. Anal tone at digital rectal examination was compared to resting and incremental pressures. Results -A cohort of 76 consecutive incontinent women were enrolled. The median Wexner score was 9. Sixty-eight showed sphincter defects on 3D endoanal ultrasound. Anal tone at digital rectal examination was considered abnormal in 62 cases. Abnormal digital rectal examination showed a sensitivity of 90%, specificity of 27.78% in distinguishing small from extensive defects of both sphincters. Five out of eight women with no sphincter defects had only abnormal squeeze tone at digital rectal examination. Abnormal squeeze tone at digital rectal examination had a sensitivity of 65.31% in distinguishing small from extensive external anal sphincter defects. Digital rectal examination sensitivity increased linearly from small to extensive external anal sphincter defects (P=0.001). Women with abnormal resting tone had lower resting pressures than women with normal tone at digital rectal examination (P=0.0001). Women with abnormal squeeze tone had lower incremental pressures than women with normal tone at digital rectal examination (P=0.017). Conclusion -Digital rectal examination had good sensitivity and poor specificity in discerning small from severe global anal sphincter defects. Moreover, digital rectal examination had fair sensitivity and poor specificity in grading external anal sphincter defects, and its best accuracy was on complete external anal sphincter lesions. Anal resting and squeeze tone were correlated to anal pressures.