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Article: Frequency of serrated polyposis syndrome recognition by community endoscopists.

McWhinney, Connor D / Lahr, Rachel E / Rex, Douglas K

2023 Volume 11, Issue 9, Page(s) E888–E892

Abstract: Background and study ... ...

Abstract	Background and study aims
Language	English
Publishing date	2023-10-06
Publishing country	Germany
Document type	Journal Article
ZDB-ID	2761052-4
ISSN	2196-9736 ; 2364-3722
ISSN (online)	2196-9736
ISSN	2364-3722
DOI	10.1055/a-2157-4125
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Article: Frequency of serrated polyposis syndrome recognition by community endoscopists

McWhinney, Connor D. / Lahr, Rachel E. / Rex, Douglas K.

Endoscopy International Open

2023 Volume 11, Issue 09, Page(s) E888–E892

Abstract: Background and study aims: Some data indicate serrated polyposis syndrome (SPS) is underdiagnosed. We determined the frequency of SPS diagnosis by community endoscopists prior to referral to a tertiary center.: Patients and methods: We performed a ... ...

Abstract	Background and study aims: Some data indicate serrated polyposis syndrome (SPS) is underdiagnosed. We determined the frequency of SPS diagnosis by community endoscopists prior to referral to a tertiary center. Patients and methods: We performed a retrospective analysis of a prospectively collected database of SPS patients at a tertiary academic hospital. There were 212 patients who were referred to our center for resection of one or more lesions detected at a prior colonoscopy and who had records available that allowed determination of whether SPS was diagnosed before referral. Results: Only 25 of 212 patients (11.8%) had a diagnosis or suspicion of a polyposis syndrome prior to referral, and only 12 patients (5.7%) had a specific SPS diagnosis made prior to referral. Among 187 patients diagnosed at our center, 39 had sufficient serrated lesions removed and documented in outside records to meet SPS criteria prior to referral, but the diagnosis was not made by the referring physician despite adequate numbers of lesions resected. The remaining cases required lesions removed at our center to meet SPS diagnostic criteria. Limitations were a single center, single expert endoscopist. Conclusions: SPS is the most common colorectal polyposis syndrome, but it remains underdiagnosed by community endoscopists. Underdiagnosis may contribute to post-colonoscopy colorectal cancer in patients with SPS.
Keywords	Polyps / adenomas / ... ; Endoscopy Lower GI Tract ; colonoscopy ; sessile serrated lesion ; serrated polyposis syndrome
Language	English
Publishing date	2023-08-21
Publisher	Georg Thieme Verlag KG
Publishing place	Stuttgart ; New York
Document type	Article
ZDB-ID	2761052-4
ISSN	2196-9736 ; 2364-3722 ; 2196-9736
ISSN (online)	2196-9736
ISSN	2364-3722 ; 2196-9736
DOI	10.1055/a-2157-4125
Database	Thieme publisher's database

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Article ; Online: Impact of Cold Snare vs Cold Forceps Resection of Diminutive Adenomas on Segmental Incomplete Resection Rate.

Van, Jeremy / Alsayid, Muhammad / Ma, Karen / Vemulapalli, Krishna / Rex, Douglas / Melson, Joshua

The American journal of gastroenterology

2023 Volume 118, Issue 8, Page(s) 1410–1418

Abstract: Introduction: Polypectomy technique, for diminutive lesion resection, is variable among colonoscopists using either cold snare polypectomy (CSP) or cold forceps polypectomy (CFP). While it is well described that CSP is a preferred technique to resect ... ...

Abstract	Introduction: Polypectomy technique, for diminutive lesion resection, is variable among colonoscopists using either cold snare polypectomy (CSP) or cold forceps polypectomy (CFP). While it is well described that CSP is a preferred technique to resect small lesions, there is little data evaluating the impact resection techniques have on metachronous adenoma burden. The aim of this study was to evaluate the rate of incomplete resection attributable to CSP and CFP of diminutive adenomas. Methods: This is a 2-center retrospective cohort study evaluating the segmental incomplete resection rate (S-IRR) of diminutive tubular adenomas (TA). S-IRR was calculated by subtracting the segmental metachronous adenoma rate in a specific colonic segment without adenoma from segments with adenoma on index colonoscopy. The primary outcome was the S-IRR of diminutive TA resected by CSP or CFP on index colonoscopy. Results: A total of 1,504 patients were included in the analysis: 1,235 with TA <6 mm and 269 with TA 6-9 mm as the most advanced lesion. The S-IRR in a segment that had a <6-mm TA incompletely resected by CFP on index colonoscopy was 13%. The S-IRR in a segment that had a <6-mm TA incompletely resected by CSP was 0%. Among 12 included colonoscopists, the range of overall S-IRR was 1.1%-24.4% with an average S-IRR of 10.3%. Discussion: S-IRR was 13% higher with CFP resection of diminutive TA than with CSP. A proposed S-IRR metric of <5% is a target goal for all diminutive polyp resection because 3/12 colonoscopists achieved this low rate. S-IRR can be used as a methodology to compare and quantify the difference in segmental metachronous adenoma burden across various polypectomy removal methods.
MeSH term(s)	Humans ; Colonic Polyps/surgery ; Colonic Polyps/pathology ; Colonoscopy/methods ; Retrospective Studies ; Treatment Outcome ; Adenoma/surgery ; Adenoma/pathology ; Colorectal Neoplasms/surgery ; Colorectal Neoplasms/pathology ; Surgical Instruments
Language	English
Publishing date	2023-04-11
Publishing country	United States
Document type	Journal Article
ZDB-ID	390122-1
ISSN	1572-0241 ; 0002-9270
ISSN (online)	1572-0241
ISSN	0002-9270
DOI	10.14309/ajg.0000000000002289
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Article ; Online: Characterization of endoscopic features and histology of a distinct mucosal transition zone on the ileocecal valve (with video).

Rex, Douglas K / Lahr, Rachel E / Guardiola, John J / Dewitt, John M / Zhang, Dongwei

Gastrointestinal endoscopy

2023 Volume 98, Issue 3, Page(s) 400–404

Abstract: Background and aims: We have endoscopically encountered a zone of transitional mucosa between the colonic and ileal mucosa located in a 3- to 10-mm-wide ring around the ileocecal valve (ICV) orifice. We aimed to describe the features of the ICV ... ...

Abstract	Background and aims: We have endoscopically encountered a zone of transitional mucosa between the colonic and ileal mucosa located in a 3- to 10-mm-wide ring around the ileocecal valve (ICV) orifice. We aimed to describe the features of the ICV transitional zone mucosa. Methods: We used videos and photographs from normal ICVs and biopsy samples from normal colonic mucosa, transitional zone mucosa, and normal ileal mucosa to characterize the endoscopic and histologic features of the ICV transitional zone mucosa. Results: The ICV transitional zone is identifiable on every ICV without a circumferential adenoma or inflammation that obliterates the zone. The zone is characterized endoscopically by an absence of villi, which distinguishes it from the ileal mucosa, but the pits are more tubular and with more prominent blood vessels compared with normal colonic mucosa. Histologically, the villi of the transitional zone are blunted, and the amount of lymphoid tissue is intermediate between the colonic mucosa and ileal mucosa. Conclusions: This is the first description of the normal transitional zone of mucosa on the ICV. This zone has unique endoscopic features that should be recognized by colonoscopists and that can potentially create difficulty in identifying the margins of adenomas located on the ICV.
MeSH term(s)	Humans ; Ileocecal Valve ; Ileum/pathology ; Colon/pathology ; Cecum ; Intestinal Mucosa/pathology ; Adenoma/pathology
Language	English
Publishing date	2023-03-31
Publishing country	United States
Document type	Video-Audio Media ; Journal Article
ZDB-ID	391583-9
ISSN	1097-6779 ; 0016-5107
ISSN (online)	1097-6779
ISSN	0016-5107
DOI	10.1016/j.gie.2023.03.021
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Article ; Online: The predictive value of small versus diminutive adenomas for subsequent advanced neoplasia.

Hartstein, Joseph D / Vemulapalli, Krishna C / Rex, Douglas K

Gastrointestinal endoscopy

2019 Volume 91, Issue 3, Page(s) 614–621.e6

Abstract: Background and aims: Patients with previous colorectal adenomas are at increased risk of colorectal cancer. Current guidelines for postpolypectomy surveillance intervals treat all tubular adenomas 1 to 9 mm in size with low-grade dysplasia as carrying ... ...

Abstract	Background and aims: Patients with previous colorectal adenomas are at increased risk of colorectal cancer. Current guidelines for postpolypectomy surveillance intervals treat all tubular adenomas 1 to 9 mm in size with low-grade dysplasia as carrying the same level of risk. We evaluated whether 6 to 9 mm adenomas detected at colonoscopy are associated with greater risk of advanced neoplasia at follow-up compared with baseline 1 to 5 mm adenomas. Methods: We retrospectively evaluated a colonoscopy database at a single U.S. academic center. Patients with baseline examinations demonstrating tubular adenomas 1 to 9 mm in size with low-grade dysplasia and no advanced adenomas were included. Follow-up colonoscopies were performed at least 200 days later and were assessed for incident advanced neoplasia (cancer, high-grade dysplasia, adenoma ≥10 mm in size, or villous elements). Results: There were 2477 qualifying baseline colonoscopies. The absolute risk of metachronous advanced neoplasia increased from 3.6% in patients with 1 to 5 mm adenomas to 6.9% in patients with at least 1 adenoma of 6 to 9 mm (P = .001). Patients with 5 or more adenomas 1 of which was at least 6 to 9 mm had the highest risk of advanced neoplasia at follow-up (10.4%, P = .006). When only screening colonoscopies were considered, all baseline groups (1-2 adenomas, 3-4 adenomas, ≥5 adenomas) with adenomas 6 to 9 mm in size had an increased risk for metachronous advanced neoplasia (odds ratio [OR], 4.07; 95% confidence interval [CI], 1.50-11.04; OR, 4.91; 95% CI, 1.44-16.75; OR, 4.71; 95% CI, 1.30-17.05, respectively). Conclusions: Patients with baseline small (6-9 mm) adenomas have an increased risk of advanced lesions on follow-up compared with patients with only diminutive (1-5 mm) adenomas. Postpolypectomy guidelines should consider risk stratification based on small versus diminutive adenomas.
MeSH term(s)	Adenoma/diagnosis ; Adenoma/pathology ; Adenoma/surgery ; Aftercare ; Aged ; Colonic Polyps/diagnosis ; Colonic Polyps/pathology ; Colonic Polyps/surgery ; Colonoscopy ; Colorectal Neoplasms/diagnosis ; Colorectal Neoplasms/pathology ; Databases, Factual ; Disease Progression ; Female ; Humans ; Male ; Middle Aged ; Neoplasms, Second Primary/diagnosis ; Neoplasms, Second Primary/pathology ; Prognosis ; Retrospective Studies ; Risk Assessment ; Risk Factors
Language	English
Publishing date	2019-09-13
Publishing country	United States
Document type	Comparative Study ; Journal Article
ZDB-ID	391583-9
ISSN	1097-6779 ; 0016-5107
ISSN (online)	1097-6779
ISSN	0016-5107
DOI	10.1016/j.gie.2019.08.047
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Article: Post-polypectomy recurrence: Low detector or high-risk polyp?

Hassan, C / Repici, A / Rex, D K

United European gastroenterology journal

2018 Volume 6, Issue 4, Page(s) 509–510

Language	English
Publishing date	2018-05
Publishing country	England
Document type	Editorial
ISSN	2050-6406
ISSN	2050-6406
DOI	10.1177/2050640618758847
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Article: A network map of apelin-mediated signaling.

Dagamajalu, Shobha / Rex, D A B / Philem, Pushparani Devi / Rainey, Jan K / Keshava Prasad, T S

Journal of cell communication and signaling

2021 Volume 16, Issue 1, Page(s) 137–143

Abstract: The apelin receptor (APLNR) is a class A (rhodopsin-like) G-protein coupled receptor with a wide distribution throughout the human body. Activation of the apelin/APLNR system regulates AMPK/PI3K/AKT/mTOR and RAF/ERK1/2 mediated signaling pathways. APLNR ... ...

Abstract	The apelin receptor (APLNR) is a class A (rhodopsin-like) G-protein coupled receptor with a wide distribution throughout the human body. Activation of the apelin/APLNR system regulates AMPK/PI3K/AKT/mTOR and RAF/ERK1/2 mediated signaling pathways. APLNR activation orchestrates several downstream signaling cascades, which play diverse roles in physiological effects, including effects upon vasoconstriction, heart muscle contractility, energy metabolism regulation, and fluid homeostasis angiogenesis. We consolidated a network map of the APLNR signaling map owing to its biomedical importance. The curation of literature data pertaining to the APLNR system was performed manually by the NetPath criteria. The described apelin receptor signaling map comprises 35 activation/inhibition events, 38 catalysis events, 4 molecular associations, 62 gene regulation events, 113 protein expression types, and 4 protein translocation events. The APLNR signaling pathway map data is made freely accessible through the WikiPathways Database ( https://www.wikipathways.org/index.php/Pathway:WP5067 ).
Language	English
Publishing date	2021-04-02
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2299380-0
ISSN	1873-961X ; 1873-9601
ISSN (online)	1873-961X
ISSN	1873-9601
DOI	10.1007/s12079-021-00614-6
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Article: SARS-CoV-2 signaling pathway map: A functional landscape of molecular mechanisms in COVID-19.

Rex, D A B / Dagamajalu, Shobha / Kandasamy, Richard K / Raju, Rajesh / Prasad, T S Keshava

Journal of cell communication and signaling

2021 Volume 15, Issue 4, Page(s) 601–608

Abstract: Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has been declared a pandemic by WHO. The clinical manifestation and disease progression in COVID-19 patients varies from minimal symptoms ... ...

Abstract	Coronavirus disease (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). COVID-19 has been declared a pandemic by WHO. The clinical manifestation and disease progression in COVID-19 patients varies from minimal symptoms to severe respiratory issues with multiple organ failure. Understanding the mechanism of SARS-CoV-2 interaction with host cells will provide key insights into the effective molecular targets for the development of novel therapeutics. Recent studies have identified virus-mediated phosphorylation or activation of some major signaling pathways, such as ERK1/2, JNK, p38, PI3K/AKT and NF-κB signaling, that potentially elicit the cytokine storm that serves as a major cause of tissue injuries. Several studies highlight the aggressive inflammatory response particularly 'cytokine storm' in SARS-CoV-2 patients. A depiction of host molecular dynamics triggered by SARS-CoV-2 in the form of a network of signaling molecules will be helpful for COVID-19 research. Therefore, we developed the signaling pathway map of SARS-CoV-2 infection using data mined from the recently published literature. This integrated signaling pathway map of SARS-CoV-2 consists of 326 proteins and 73 reactions. These include information pertaining to 1,629 molecular association events, 30 enzyme catalysis events, 43 activation/inhibition events, and 8,531 gene regulation events. The pathway map is publicly available through WikiPathways: https://www.wikipathways.org/index.php/Pathway:WP5115 .
Language	English
Publishing date	2021-06-28
Publishing country	Netherlands
Document type	Journal Article
ZDB-ID	2299380-0
ISSN	1873-961X ; 1873-9601
ISSN (online)	1873-961X
ISSN	1873-9601
DOI	10.1007/s12079-021-00632-4
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Article ; Online: Anaesthetic efficacy and postinduction hypotension with remimazolam compared with propofol: a multicentre randomised controlled trial.

Fechner, J / El-Boghdadly, K / Spahn, D R / Motsch, J / Struys, M M R F / Duranteau, O / Ganter, M T / Richter, T / Hollmann, M W / Rossaint, R / Bercker, S / Rex, S / Drexler, B / Schippers, F / Morley, A / Ihmsen, H / Kochs, E

Anaesthesia

2024 Volume 79, Issue 4, Page(s) 410–422

Abstract: Remimazolam, a short-acting benzodiazepine, may be used for induction and maintenance of total intravenous anaesthesia, but its role in the management of patients with multiple comorbidities remains unclear. In this phase 3 randomised controlled trial, ... ...

Abstract	Remimazolam, a short-acting benzodiazepine, may be used for induction and maintenance of total intravenous anaesthesia, but its role in the management of patients with multiple comorbidities remains unclear. In this phase 3 randomised controlled trial, we compared the anaesthetic efficacy and the incidence of postinduction hypotension during total intravenous anaesthesia with remimazolam vs. propofol. A total of 365 patients (ASA physical status 3 or 4) scheduled for elective surgery were assigned randomly to receive total intravenous anaesthesia with remimazolam (n = 270) or propofol (n = 95). Primary outcome was anaesthetic effect, quantified as the percentage of time with Narcotrend® Index values ≤ 60, during surgery (skin incision to last skin suture), with a non-inferiority margin of -10%. Secondary outcome was the incidence of postinduction hypotensive events. Mean (SD) percentage of time with Narcotrend Index values ≤ 60 during surgery across all patients receiving remimazolam (93% (20.7)) was non-inferior to propofol (99% (4.2)), mean difference (97.5%CI) -6.28% (-8.89-infinite); p = 0.003. Mean (SD) number of postinduction hypotension events was 62 (38.1) and 71 (41.1) for patients allocated to the remimazolam and propofol groups, respectively; p = 0.015. Noradrenaline administration events (requirement for a bolus and/or infusion) were also lower in patients allocated to remimazolam compared with propofol (14 (13.5) vs. 20 (14.6), respectively; p < 0.001). In conclusion, in patients who were ASA physical status 3 or 4, the anaesthetic effect of remimazolam was non-inferior to propofol.
MeSH term(s)	Humans ; Propofol ; Anesthetics ; Benzodiazepines ; Hypotension/chemically induced
Chemical Substances	Propofol (YI7VU623SF) ; remimazolam (7V4A8U16MB) ; Anesthetics ; Benzodiazepines (12794-10-4)
Language	English
Publishing date	2024-01-14
Publishing country	England
Document type	Randomized Controlled Trial ; Multicenter Study ; Clinical Trial, Phase III ; Journal Article
ZDB-ID	80033-8
ISSN	1365-2044 ; 0003-2409
ISSN (online)	1365-2044
ISSN	0003-2409
DOI	10.1111/anae.16205
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Article ; Online: Preventing colorectal cancer and cancer mortality with colonoscopy: what we know and what we don't know.

Rex, D K

Endoscopy

2010 Volume 42, Issue 4, Page(s) 320–323

MeSH term(s)	Clinical Competence ; Colonoscopy ; Colorectal Neoplasms/genetics ; Colorectal Neoplasms/mortality ; Colorectal Neoplasms/prevention & control ; Humans
Language	English
Publishing date	2010-04
Publishing country	Germany
Document type	Editorial
ZDB-ID	80120-3
ISSN	1438-8812 ; 0013-726X
ISSN (online)	1438-8812
ISSN	0013-726X
DOI	10.1055/s-0029-1244067
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