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Bowel preparation with 1L polyethylene glycol and ascorbate NER1006 doubles the chance to detect three or more adenomas in overweight or obese males.

ABSTRACT: Background and study aims Men have more colon cleansing failures, colorectal adenomas, and colorectal cancers than women. We analyzed whether 1-liter (1 L) polyethylene glycol (PEG) NER1006 improves high-quality (HQ) colon cleansing and adenoma detection in males versus two mid-volume alternatives. Patients and methods The analysis of 1028 adult patients in two randomized clinical trials was performed. Adenoma detection and HQ cleansing were compared for overnight split dosing regimens with NER1006 (n = 513) versus combined oral sulfate solution or 2 L PEG + ascorbate (OSS/2 L PEG) (n = 515). Analyses included males versus females, overweight or obese (OO) males versus lean males, and NER1006 versus OSS/2 L PEG. In male patients, the adenoma detection rate of at least 3 (ADR3 +) was predicted with multiple logistic regression and statistical comparisons used the two-sided t-test. Results ADR3 + was greater in males versus females (10.7 % [56/524] versus 5.8 % [29/504]; P = 0.004) despite comparable adequate cleansing success rates (93.2 % [479/514] versus 93.0 % [466/501]; P = 0.912) and more HQ-scores in females (41.6 % [1069/2570] versus 45.3 % [1134/2505]; P = 0.008). ADR was almost twice as high in OO versus lean males (43.4 % [184/424] versus 23.1 % [21/91]; P < 0.001). Multivariate logistic regression predicted ADR3 + detection to be twice as likely in OO males using NER1006 versus OSS/2 L PEG (odds ratio (95 % confidence interval [CI]) = 2.049 (1.082-3.973); P = 0.030) and 90 % more likely in all males (1.902 (1.045-3.526); P = 0.037). In males, including OO males, NER1006 attained more HQ-scores per trial than OSS or 2 L PEG (P ≤ 0.017 for all comparisons). Conclusions NER1006 predicted the detection of more males for frequent surveillance than OSS/2 L PEG.

SUBMITTER: Epstein M

PROVIDER: S-EPMC8367431 | biostudies-literature |

REPOSITORIES: biostudies-literature

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Project description:Molecular dynamics (MD) simulations are reported for [polyethylene glycol (PEG)200], a polydisperse mixture of ethylene glycol oligomers with an average molar weight of 200 g·mol-1. As a first step, available force fields for describing ethylene glycol oligomers were tested on how accurately they reproduced experimental properties. They were found to all fall short on either reproducing density, a static property, or the self-diffusion coefficient, a dynamic property. Discrepancies with the experimental data increased with the increasing size of the tested ethylene glycol oligomer. From the available force fields, the optimized potential for liquid simulation (OPLS) force field was used to further investigate which adjustments to the force field would improve the agreement of simulated physical properties with experimental ones. Two parameters were identified and adjusted, the (HO)-C-C-O proper dihedral potential and the polarity of the hydroxy group. The parameter adjustments depended on the size of the ethylene glycol oligomer. Next, PEG200 was simulated with the OPLS force field with and without modifications to inspect their effects on the simulation results. The modifications to the OPLS force field significantly decreased hydrogen bonding overall and increased the propensity of intramolecular hydrogen bond formation at the cost of intermolecular hydrogen bond formation. Moreover, some of the tri- and more so tetraethylene glycol formed intramolecular hydrogen bonds between the hydroxy end groups while still maintaining strong intramolecular interactions with the ether oxygen atoms. These observations allowed the interpretation of the obtained RDFs as well as structural properties such as the average end-to-end distances and the average radii of gyration. The MD simulations with and without the modifications showed no evidence of preferential association of like-oligomers to form clusters nor any evidence of long-range ordering such as a side-by-side stacking of ethylene glycol oligomers. Instead, the simulation results support the picture of PEG200 being a random mixture of its ethylene glycol oligomer components. Finally, additional MD simulations of a binary mixture of tri-and hexaethylene glycol with the same average molar weight as PEG200 revealed very similar structural and physical properties as for PEG200.

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Bowel preparation with 1L polyethylene glycol and ascorbate NER1006 doubles the chance to detect three or more adenomas in overweight or obese males.

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