Background Adenoma detection rate (ADR) has recently been used as a quality measure for screening colonoscopy. We hypothesize that the adenoma detection rate (ADR) will increase with each decade of life after 50 years. Objective The aim of this study is to define age-based goals for adenoma detection rate and advanced neoplasia to improve the quality of colonoscopy. Methods Utilizing the Clinical Outcomes Research Initiative (CORI) database, patients who underwent screening colonoscopy between 2005-2006 were identified. Pathology of polyp findings was reviewed and the ADR and the prevalence of advanced neoplasia were calculated based on age and gender. Results There were 7,756 (44.9%) polypectomies performed on 17,275 patients between 2005-2006. 56.3% (4,363) of these polyps were adenomas or more advanced lesions. The ADR was higher in men than women and increased with age. The ADR in men under age 50 was 24.7 [95% CI 18.2-31.2]; 50-59 years: 27.8 [26.5-29.1]; 60-69 years: 33.6 [31.7-35.4]; 70-79 years: 34.3 [31.5-37.1]; > 80 years: 40.0 [32.9-47.1]. The ADR in women under 50 years old was 12.6 [6.8-18.4]; 50-59 years: 17.0 {15.9-18.1]; 60-69 years: 22.4 {20.8-24.0]; 70-79 years: 26.1 {23.7-28.5]; > 80 years: 26.9 [21.4-32.5]. Limitations The CORI database offers access to demographic information as well as endoscopy and pathology data but there is limited clinical information about patients in the database. Conclusion Adenoma detection rate, and importantly, the rate of advanced neoplasia, increased with each decade of life over 50 and are higher in men than women in each decade of life.

Cytomegalovirus (CMV) is the leading transmittable cause of congenital brain abnormalities in children and infection results in fatal ventriculoencephalitis in advanced AIDS patients. Pathology associated with CMV brain infection is seen predominantly in the periventricular region, an area known to harbor neural stem cells (NSCs). In the present study, using an adult model of murine CMV brain infection, we demonstrated that nestin-positive NSCs in the subventricular zone are susceptible to murine CMV infection. Furthermore, primary NSC cultures supported productive murine CMV replication with a 1000-fold increase in viral titers by 5 d post-infection (d p.i). Previous studies from our laboratory demonstrated that CD8 lymphocytes were essential in protecting the brain against murine CMV infection. In the present study we found that interferon (IFN)-gamma treatment increased the expression of MHC class I on NSCs. Viral infection, on the other hand, inhibited this IFN-gamma-induced MHC upregulation. In addition to increasing MHC class I expression, IFNgamma (but not tumor necrosis factor [TNF]-alpha, interleukin [IL]-1beta, or IL-10) also suppressed NSC proliferation in vitro. This decrease in proliferation was not accompanied by apoptosis or extracellular release of cellular lactate dehydrogenase (LDH), suggesting that the effects were not due to direct cytotoxicity. These studies demonstrate that NSCs are susceptible to murine CMV infection and inflammatory mediators, such as IFN-gamma, alter cellular characteristics which may have an impact on their reparative functions.

Background Melena can be caused by bleeding from lower GI sources. Colonoscopy is frequently used to investigate melena after a nondiagnostic EGD. Objective To determine the diagnostic yield and rate of therapeutic intervention during colonoscopy in patients with melena and a nondiagnostic EGD. Design Retrospective case-control study. Setting Community and academic centers over a diverse geographic area in the United States. Patients This study involved patients in the Clinical Outcomes Research Initiative database with a colonoscopy performed to investigate melena within 30 days of a nondiagnostic EGD for the same indication. A control group had colonoscopies performed for average-risk screening. Main Outcome Measurements The endoscopic finding of a suspected bleeding source defined as right-sided arteriovenous malformation, colitis, polyp 20 mm, tumor, or ulcer. Rate of therapeutic intervention during colonoscopy. Results Colonoscopy found a suspected bleeding source in 4.8% of patients with melena, more frequently than in the control group (odds ratio [OR] 2.17; 95% confidence interval [CI], 1.65–2.86; P .0001). The rate of therapeutic intervention during melena-related colonoscopy was 1.7%. Patients with melena were more likely to have a colon tumor (OR 2.87; 95% CI, 1.82–5.51; P .0001) than were control patients. Limitations Retrospective design, conclusions being dependent on the accuracy of database input, and lack of pertinent clinical data (eg, hemoglobin). Conclusion The diagnostic yield of colonoscopy to investigate melena after nondiagnostic EGD is low. The need for therapeutic intervention during colonoscopy for this indication is very low. This population should undergo colonoscopy because they are at increased risk of colorectal cancer. Colonoscopy can potentially be performed electively in stable patients without continued bleeding.