ABSTRACT
BACKGROUND: Colonoscopy is one of the primary methods of screening for colorectal cancer (CRC), a leading cause of cancer mortality in the United States. However, up to half of patients referred to colonoscopy fail to complete the procedure, and rates of adherence are lower in rural areas. OBJECTIVES: Colonoscopy Outreach for Rural Communities (CORC) is a randomized controlled trial to test the effectiveness of a centralized patient navigation program provided remotely by a community-based organization to six geographically distant primary care organizations serving rural patients, to improve colonoscopy completion for CRC. METHODS: CORC is a type 1 hybrid implementation-effectiveness trial. Participants aged 45-76 from six primary care organizations serving rural populations in the northwestern United States are randomized 1:1 to patient navigation or standard of care control. The patient navigation is delivered remotely by a trained lay-person from a community-based organization. The primary effectiveness outcome is completion of colonoscopy within one year of referral to colonoscopy. Secondary outcomes are colonoscopy completion within 6 and 9 months, time to completion, adequacy of patient bowel preparation, and achievement of cecal intubation. Analyses will be stratified by primary care organization. DISCUSSION: Trial results will add to our understanding about the effectiveness of patient navigation programs to improve colonoscopy for CRC in rural communities. The protocol includes pragmatic adaptations to meet the needs of rural communities and findings may inform approaches for future studies and programs. TRIAL REGISTRATION: National Clinical Trial Identifier: NCT05453630. TRIAL REGISTRATION: ClinicalTrials.gov. Identifier: NCT05453630. Registered July 6, 2022.
Subject(s)
Colonoscopy , Colorectal Neoplasms , Early Detection of Cancer , Patient Navigation , Rural Population , Humans , Colonoscopy/methods , Patient Navigation/organization & administration , Colorectal Neoplasms/diagnosis , Early Detection of Cancer/methods , Middle Aged , Aged , Female , Male , Primary Health Care/organization & administrationSubject(s)
Intestinal Polyps/complications , Jejunal Neoplasms/complications , Multiple Myeloma/complications , Protein-Losing Enteropathies/etiology , Stomach Neoplasms/complications , Female , Gastric Bypass , Humans , Hypoalbuminemia/etiology , Immunotherapy, Adoptive , Intestinal Polyps/pathology , Intestinal Polyps/therapy , Jejunal Neoplasms/pathology , Jejunal Neoplasms/therapy , Middle Aged , Multiple Myeloma/pathology , Multiple Myeloma/therapy , Obesity/surgery , Polyps/complications , Polyps/pathology , Polyps/therapy , Receptors, Chimeric Antigen , Stomach Neoplasms/pathology , Stomach Neoplasms/therapySubject(s)
Biliary Fistula/diagnosis , Common Bile Duct Diseases/diagnosis , Duodenal Ulcer/diagnosis , Hematemesis/etiology , Peptic Ulcer Hemorrhage/diagnosis , Peptic Ulcer Perforation/diagnosis , Abdominal Pain/etiology , Aged, 80 and over , Biliary Fistula/etiology , Common Bile Duct Diseases/etiology , Duodenal Ulcer/complications , Duodenal Ulcer/drug therapy , Endoscopy, Digestive System , Female , Humans , Melena/etiology , Nausea/etiology , Peptic Ulcer Hemorrhage/complications , Peptic Ulcer Hemorrhage/drug therapy , Peptic Ulcer Perforation/complications , Peptic Ulcer Perforation/drug therapy , Proton Pump Inhibitors/therapeutic use , Tomography, X-Ray ComputedABSTRACT
BACKGROUND: Preclinical data demonstrate that activation of the renin-angiotensin system (RAS) contributes to mucosal inflammation, and RAS inhibition by angiotensin-converting-enzyme inhibitors (ACEI) and angiotensin receptor blockers (ARB) improves colitis in animal models. Less is known regarding the effects of RAS inhibition on clinical outcomes in inflammatory bowel disease (IBD) patients. AIM: Evaluate the impact of ACEI and ARB on clinical outcomes in IBD. METHODS: Rates of IBD-related hospitalizations, operations, and corticosteroid use were evaluated retrospectively in two groups. First, 111 IBD patients taking an ACEI or ARB were compared to nonusers matched 1:1 based on sex, age, diagnosis, disease location, and hypertension diagnosis. Second, outcomes in a cohort of 130 IBD patients were compared prior to and during ACEI/ARB exposure. RESULTS: Compared to matched controls, all IBD patients together with ACEI/ARB exposure had fewer hospitalizations (OR 0.26, p < 0.01), operations (OR 0.08, p = 0.02), and corticosteroid prescriptions (OR 0.5, p = 0.01). Comparing outcomes before and during ACEI/ARB use, there were no differences in hospitalizations, operations, or corticosteroid use for all IBD patients together, but patients with UC had increased hospitalizations (0.08 pre- vs. 0.16 during ACEI/ARB exposure, p = 0.03) and decreased corticosteroid use (0.24 pre-ACEI/ARB vs. 0.12 during ACEI/ARB exposure, p < 0.01) during ACEI/ARB use. CONCLUSIONS: IBD patients with ACEI/ARB exposure had fewer hospitalizations, operations, and corticosteroid use compared to matched controls. No differences in outcomes were observed in individuals on ACEI/ARB therapy when compared to a period of time prior to medication exposure.
Subject(s)
Adrenal Cortex Hormones/therapeutic use , Angiotensin Receptor Antagonists/therapeutic use , Angiotensin-Converting Enzyme Inhibitors/therapeutic use , Colectomy , Colitis, Ulcerative/therapy , Crohn Disease/therapy , Patient Admission , Renin-Angiotensin System/drug effects , Adrenal Cortex Hormones/adverse effects , Aged , Angiotensin II/metabolism , Angiotensin Receptor Antagonists/adverse effects , Angiotensin-Converting Enzyme Inhibitors/adverse effects , Colectomy/adverse effects , Colitis, Ulcerative/diagnosis , Colitis, Ulcerative/metabolism , Colitis, Ulcerative/physiopathology , Crohn Disease/diagnosis , Crohn Disease/metabolism , Crohn Disease/physiopathology , Female , Humans , Male , Middle Aged , Retrospective Studies , Signal Transduction , Time Factors , Treatment OutcomeABSTRACT
Species B human adenoviruses (Ads) are increasingly associated with outbreaks of acute respiratory disease in U.S. military personnel and civil population. The initial interaction of Ads with cellular attachment receptors on host cells is via Ad fiber knob protein. Our previous studies showed that one species B Ad receptor is the complement receptor CD46 that is used by serotypes 11, 16, 21, 35, and 50 but not by serotypes 3, 7, and 14. In this study, we attempted to identify yet-unknown species B cellular receptors. For this purpose we used recombinant Ad3 and Ad35 fiber knobs in high-throughput receptor screening methods including mass spectrometry analysis and glycan arrays. Surprisingly, we found that the main interacting surface molecules of Ad3 fiber knob are cellular heparan sulfate proteoglycans (HSPGs). We subsequently found that HSPGs acted as low-affinity co-receptors for Ad3 but did not represent the main receptor of this serotype. Our study also revealed a new CD46-independent infection pathway of Ad35. This Ad35 infection mechanism is mediated by cellular HSPGs. The interaction of Ad35 with HSPGs is not via fiber knob, whereas Ad3 interacts with HSPGs via fiber knob. Both Ad3 and Ad35 interacted specifically with the sulfated regions within HSPGs that have also been implicated in binding physiologic ligands. In conclusion, our findings show that Ad3 and Ad35 directly utilize HSPGs as co-receptors for infection. Our data suggest that adenoviruses evolved to simulate the presence of physiologic HSPG ligands in order to increase infection.
