Diverticular disease is common and has a high morbidity. Treatments are limited owing to the poor understanding of its pathophysiology. Here, to elucidate its etiology, we performed a genome-wide association study of diverticular disease (27,444 cases; 382,284 controls) from the UK Biobank and tested for replication in the Michigan Genomics Initiative (2,572 cases; 28,649 controls). We identified 42 loci associated with diverticular disease; 39 of these loci are novel. Using data-driven expression-prioritized integration for complex traits (DEPICT), we show that genes in these associated regions are significantly enriched for expression in mesenchymal stem cells and multiple connective tissue cell types and are co-expressed with genes that have a role in vascular and mesenchymal biology. Genes in these associated loci have roles in immunity, extracellular matrix biology, cell adhesion, membrane transport and intestinal motility. Phenome-wide association analysis of the 42 variants shows a common etiology of diverticular disease with obesity and hernia. These analyses shed light on the genomic landscape of diverticular disease.

The neural crest (NC) is a remarkable transient structure in the vertebrate embryo that gives rise to a highly versatile population of pluripotent cells that contribute to the formation of multiple tissues and organs throughout the body. In order to achieve their task, NC-derived cells have developed specialized mechanisms to promote (1) their transition from an epithelial to a mesenchymal phenotype, (2) their capacity for extensive migration and cell proliferation, and (3) their ability to produce diverse cell types largely depending on the microenvironment encountered during and after their migratory path. Following embryogenesis, these same features of cellular motility, invasion, and proliferation can become a liability by contributing to tumorigenesis and metastasis. Ample evidence has shown that cancer cells have cleverly co-opted many of the genetic and molecular features used by developing NC cells. This review focuses on tumors that arise from NC-derived tissues and examines mechanistic themes shared during their oncogenic and metastatic development with embryonic NC cell ontogeny. Developmental Dynamics 244:311-322, 2015. V C 2014 Wiley Periodicals, Inc.

The NCCN Guidelines for Colorectal Cancer (CRC) Screening describe various colorectal screening modalities as well as recommended screening schedules for patients at average or increased risk of developing sporadic CRC. They are intended to aid physicians with clinical decision-making regarding CRC screening for patients without defined genetic syndromes. These NCCN Guidelines Insights focus on select recent updates to the NCCN Guidelines, including a section on primary and secondary CRC prevention, and provide context for the panel’s recommendations regarding the age to initiate screening in average risk individuals and follow-up for low-risk adenomas.

Background Readmission rates are a measure of surgical quality and an object of clinical and regulatory scrutiny. Despite increasing efforts to improve quality and contain cost, 6–25% of patients are readmitted after colorectal surgery. Objective Define predictors and costs of readmission following colorectal surgery. Design Retrospective cohort study of elective and non-elective colectomy and/or proctectomy patients in the Healthcare Cost and Utilization Project Florida State Inpatient Database 2007–2011. Readmission defined as inpatient admission within 30 days of discharge. Univariate analyses of sex, age, Elixhauser score, race, insurance type, procedure, indication, readmission diagnosis, cost, and length of stay. Multivariate analysis performed by logistic regression. Sensitivity analysis of non-emergent admissions. Settings Florida acute care hospitals Patients Colectomy and proctectomy patients 2007–2011 Intervention(s) None Main Outcome Measure(s) Readmission, cost of readmission Results 93,913 patients underwent colectomy. 14.7% were readmitted within 30 days. From 2007 to 2011, readmission rates remained stable (14.6% to 14.2%, trend p=0.1585). After multivariate adjustment, patient factors associated with readmission included non-white race, age <65, and a diagnosis code other than neoplasm or diverticular disease (p<0.0001). Patients with Medicare or Medicaid were more likely to be readmitted than those with private insurance (p<0.0001). Patients with longer index admissions, those with stomas and those undergoing all procedures other than sigmoid or transverse colectomy were more likely to be readmitted (p<0.0001). High volume hospitals had higher rates of readmission (p<0.0001). Most common reason for readmission was infection (32.9%). Median cost of readmission care was $7,030 (IQR $4,220, $13,247). Fistulas caused the most costly readmissions ($15,174; IQR $6,725, $26,660). Limitations Administrative data, retrospective design Conclusions Readmissions rates after colorectal surgery remain common and costly. Non-private insurance, inflammatory bowel disease, and high hospital volume are significantly associated with readmission.