Participation in faecal occult blood screening for colorectal cancer in a well defined French population: results of five screening rounds from 1988 to 1996

OBJECTIVE

To evaluate the influence on compliance of demographic variables and of the way of proposing a faecal occult blood test in a colorectal cancer mass screening programme.

SETTING

Well defined population in Burgundy (France).

METHODS

From 1988 to 1996 five screening rounds were conducted in people aged 45 to 74 on entering the study. The screening test was provided free of charge by primary care physicians over a four month period, then mailed to non-consultants, followed by a potential reminder letter. The whole population was invited to participate in each screening campaign.

RESULTS

During the five successive rounds, compliance was 52.8%, 54.0%, 57.3%, 58.3%, and 56.2%. It was higher in women than in men, in those initially aged 50 to 69 than in the extreme age groups, and in urban than in rural areas. Overall, 68.7% of the invited population completed at least one screening test and 37.2% completed the five rounds. Among those who participated once in a screening campaign, between 79.6% and 87.6% participated in the succeeding ones. Compliance was higher when the test was proposed by GPs (varying between 85.2% and 94.0% according to the screening campaign) than when it was sent by post (varying between 26.0% and 33.7%).

CONCLUSION

In France, a participation rate of over 50% can be achieved in colorectal cancer screening by means of a faecal occult blood test. To achieve this, primary care physicians have to play an active part in the programme and the test must be mailed to non-consultants.

Heart transplantation in children: indications. Report of the Ad Hoc Subcommittee of the Pediatric Committee of the American Society of Transplantation (AST)

This review details the indications for heart transplantation in children. Contraindications have evolved from absolute to relative. Controversial issues remain and this paper represents a consensus of more than a dozen centers that have programs that remain active performing pediatric heart transplants.

Heart transplant in a factor VIII-deficient patient with a high-titre inhibitor: perioperative management using high-dose continuous infusion factor VIII and recombinant factor VIIa

Four years prior to transplantation, a 14-year-old boy with severe haemophilia A and a high-responding factor VIII (FVIII) inhibitor developed an anteroseptal myocardial infarct while receiving high doses of an activated prothrombin complex concentrate (PCC). Cardiac transplantation was required for survival because of the ensuing cardiomyopathy. At surgery, the patient's inhibitor titre was 1.8 Bethesda units (BU). High-dose bolus therapy, followed by a continuous infusion of FVIII provided excellent operative and initial postoperative haemostasis without additional blood-product support. Once anamnaesis developed on day 6 postoperatively, recombinant factor VIIa (rFVIIa) therapy was initiated. Haemostasis remained excellent, except for the transient increase in chest-tube bleeding that was noted on day 7. epsilon-Aminocaproic acid was added and haemostasis was re-established. On day 15, rFVIIa was replaced with alternate day infusions of prothrombin complex concentrates (PCCs). On day 21 following the transplant, the patient was discharged, remaining on daily FVIII immune tolerance and thrice-weekly PCC prophylaxis. He remains well 24 months after transplant with an inhibitor titre of 39 BU. This paper describes the second case of cardiac transplantation complicated by haemophilia and an inhibitor, and discusses preoperative planning and operative and postsurgical haemostasis management.

Incidence, characterization, and impact of newly detected donor-specific anti-HLA antibody in the first year after pediatric heart transplantation: A report from the CTOTC-04 study

Data on the clinical importance of newly detected donor-specific anti-HLA antibodies (ndDSAs) after pediatric heart transplantation are lacking despite mounting evidence of the detrimental effect of de novo DSAs in solid organ transplantation. We prospectively tested 237 pediatric heart transplant recipients for ndDSAs in the first year posttransplantation to determine their incidence, pattern, and clinical impact. One-third of patients developed ndDSAs; when present, these were mostly detected within the first 6 weeks after transplantation, suggesting that memory responses may predominate over true de novo DSA production in this population. In the absence of preexisting DSAs, patients with ndDSAs had significantly more acute cellular rejection but not antibody-mediated rejection, and there was no impact on graft and patient survival in the first year posttransplantation. Risk factors for ndDSAs included common sensitizing events. Given the early detection of the antibody response, memory responses may be more important in the first year after pediatric heart transplantation and patients with a history of a sensitizing event may be at risk even with a negative pretransplantation antibody screen. The impact on late graft and patient outcomes of first-year ndDSAs is being assessed in an extended cohort of patients.

Overexpression of endogenous stress-tolerance related genes in Saccharomyces cerevisiae improved strain robustness and production of heterologous cellobiohydrolase

To enable Saccharomyces cerevisiae to produce renewable fuels from lignocellulose in a consolidated bioprocess, a heterologous cellulase system must be engineered into this yeast. In addition, inherently low secretion titers and sensitivity to adverse environmental conditions must be overcome. Here, two native S. cerevisiae genes related to yeast stress tolerance, YHB1 and SET5, were overexpressed under transcriptional control of the constitutive PGK1 promoter and their effects on heterologous secretion of Talaromyces emersonii cel7A cellobiohydrolase was investigated. Transformants showed increased secreted enzyme activity that ranged from 22% to 55% higher compared to the parental strains and this did not lead to deleterious growth effects. The recombinant strains overexpressing either YHB1 or SET5 also demonstrated multi-tolerant characteristics desirable in bioethanol production, i.e. improved tolerance to osmotic and heat stress. Quantitative reverse transcriptase PCR analysis in these strains showed decreased transcription of secretion pathway genes. However, decreased unfolded protein response was also observed, suggesting novel mechanisms for enhancing enzyme production through stress modulation. Overexpression of YHB1 in an unrelated diploid strain also enhanced stress tolerance and improved ethanol productivity in medium containing acetic acid. To our knowledge, this is the first demonstration that improved heterologous secretion and environmental stress tolerance could be engineered into yeast simultaneously.

Specchio-COVID19: a digital cohort study to improve public involvement in epidemiological research

Background

To manage the sanitary crisis and rapidly assess the seroprevalence of anti-SARS-CoV-2 antibodies in the canton of Geneva, we invited previous participants of an annual health survey of the general population to a first serological test. As the pandemic progressed, it become clear that there would be a significant longer impact on health and wellbeing of population. Moreover, there was a need to assess the adherence of the population regarding COVID-19 prevention measures, over time, as well as to provide scientific knowledge about antibodies dynamics and protection from new infections. For all these reasons, a long-term follow-up has been settled via the dedicated digital platform Specchio-COVID19 and on-line questionnaires and repeated serological tests.

Methods

Several measures were designed to maintain high retention and involvement, including regular electronic newsletters with links to a “News” webpage, a “Research” webpage for dissemination of publications and the organization of webinars specifically dedicated to participants. A specific email address and a dedicated hotline were set up so that participants can get in touch with the Specchio-COVID19 team.

Results

Specchio-COVID19 was launched in November, 2020. Up to February 2022, 10'946 individuals (57% women, median age 48) joined the project. Over time, participation rate remains around 65% for each release of questionnaire. 550 participants (5%) definitely dropped out.

Conclusions

Our digital cohort facilitates participants’ involvement, allowing participation from remote locations, organizing webinar, promoting news and scientific information via newsletters and specific webpages and enabling interaction between researchers and participants.

Key messages

• When designing the Specchio-COVID19 digital cohort, the purpose was not only to collect data.

• But to establish a reciprocal exchange of information between researchers and participants, fostering long-term involvement and health empowerment.

Participation in mass screening for colorectal cancer: results of screening and rescreening from the Burgundy study

A controlled study was made in Burgundy (France) to assess the acceptability and efficiency of colorectal cancer screening using the Hemoccult test. A total of 91,000 people aged 45 to 74 years were included. The first screening campaign was made from January to July 1988 or 1989, and rescreening occurred from January to July 1990. During the first 4 months of the campaign, the General Practitioners (GPs) offered the test to their patients. It was then mailed to all subjects who had not completed it with a recall letter, if necessary, one month later. The overall compliance rate was 54.0% in the first campaign and 55.5% in the second campaign. A total of 63.7% subjects had completed at least one screening test over the two screening campaigns. Compliance was lower among men than women; compliance rate was also lower in the youngest and oldest age group than in the intermediate age groups. During the second screening campaign, the participation rate was 83.6% among participants in the first screening campaign and 20.9% among non-participants. Compliance during the medical offer phase was higher (81.4% during the first campaign, 82.9% during the second campaign) than during the postal offer phase (respectively, 33.8% and 28.5%). It was easier for GPs to propose the test when they had to offer it than when they had to prescribe it. These results suggest that a satisfactory participation rate can be obtained in France if GPs are actively involved in the screening programme. The final objective is to find a 25% difference in 5-year mortality by large bowel cancer between the screened and the test population.