Thermal ablation after endoscopic mucosal resection of large colorectal polyps: not only the margins, but also the base?

Message Thermal ablation of resection margins has been shown to reduce recurrence after endoscopic mucosal resection (EMR) of large non-pedunculated colorectal polyps, however, to a variable extent. In addition, residual or recurrent adenoma (RRA) may also arise from remnants in the resection base. We present a combined technique of margin and base ablation using submucosal injection followed by low energy argon beamer coagulation: Of 113 cases treated this way, RRA was found in one case only (0.9%). These data from multicentre registries were significantly lower compared with cases with margin ablation only (n=170; RRA rate 8.8%) or cases without (n=144; RRA rate 23.4%) in the same databases. This difference persisted when analysing only large lesions ≥40 mm (2.4 vs 12.5 vs 28.1%; overall n=137). Bleeding and perforation rates were similar across all groups. In more details Significant efforts have been expended to reduce RRAs after EMR. Thermal…

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Dicembre 2023

In Vivo Base Editing of Scn5a Rescues Type 3 Long QT Syndrome in Mice

Circulation, Ahead of Print. BACKGROUND:Pathogenic variants inSCN5Acan result in long QT syndrome type 3, a life-threatening genetic disease. Adenine base editors can convert targeted A T base pairs to G C base pairs, offering a promising tool to correct pathogenic variants.METHODS:We generated a long QT syndrome type 3 mouse model by introducing the T1307M pathogenic variant into theScn5agene. The adenine base editor was split into 2 smaller parts and delivered into the heart by adeno-associated virus serotype 9 (AAV9-ABEmax) to correct the T1307M pathogenic variant.RESULTS:Both homozygous and heterozygous T1307M mice showed significant QT prolongation. Carbachol administration induced torsades de pointes or ventricular tachycardia for homozygous T1307M mice (20%) but not for heterozygous or wild-type mice. A single intraperitoneal injection of AAV9-ABEmax at postnatal day 14 resulted in up to 99.20%Scn5atranscripts corrected in T1307M mice.Scn5amRNA correction rate >60% eliminated QT prolongation;Scn5amRNA correction rate

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Novembre 2023

Abstract 16419: Assessing the Evidence Base of Cardiology-Specific Oncology Guideline Recommendations: Implications for Health Policy

Circulation, Volume 148, Issue Suppl_1, Page A16419-A16419, November 6, 2023. Introduction:Oncology societies have been contributing guidelines/recommendations to the limited yet growing body of literature in cardio-oncology.Research Questions:What are the levels of evidence (LOE) and classes of recommendation (COR) for cardiology-specific recommendations produced by major oncology societies?Methods:We reviewed cardiology-specific recommendations published by the American Society of Clinical Oncology (ASCO), American Society of Hematology (ASoH), NCCN (National Comprehensive Cancer Network), and European Society of Cardiology (ESC). LOE and COR were noted for each recommendation.Results:The US oncologic societies have made 81 cardiac-specific recommendations (ASCO: 54 (67%); ASoH: 14 (17%); NCCN; 13 (16%) (Tables 1-3). For ASCO, 26 (48%) were COR 1, 23 (43%) COR 2, and 5 (9%) COR 3 supported by LOE A (9%), LOE B (39%), and LOE C (52%). For ASoH, 1(8%) was COR 1, 11(85%) COR 2, and 1(8%) COR 3 supported by LOE B (7%), and LOE C (93%). NCCN made 13 COR 2 recommendations and did not provide LOE classification. The most common recommendations addressed baseline (20%) and serial (24%) assessment, specific imaging modalities (9%), chemotherapy dosing (19%), and radiation therapy (20%). Most recommendations were unique without discrepant statements, but there were some redundancies. ESC produced 271 cardio-oncology recommendations (155 COR 1; 111 COR 2; 5 COR-3) with 3% LOE A, 21% LOE B, and 76% LOE C. The major areas for ESC recommendations included baseline (18%) and serial (33%) assessment, and medications (29%).Conclusions:Oncology and cardiology professional society guidelines have provided 352 cardiac related recommendations in the setting of cancer treatment and 73% have the lowest LOE. In this developing field with a limited evidence base, close collaboration between cardiologists and oncologists will be required to provide a cohesive set of recommendations for the cardiac issues associated with cancer treatment.

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Novembre 2023