高危型人乳头瘤病毒感染的影响因素分析

  目的  分析高危型人乳头瘤病毒(high-risk human papillomavirus,HR-HPV)感染的相关危险因素。  方法  选取2020年10月—2021年1月就诊于首都医科大学附属北京妇产医院妇科门诊的HR-HPV感染者作为感染组,同期于妇科门诊行子宫颈癌筛查且结果为HR-HPV阴性的患者作为对照组。两组均填写自行设计的《HR-HPV感染相关危险因素调查表》,统计分析HR-HPV感染相关危险因素。  结果  共纳入感染组患者125例,对照组患者53例。对两组进行单因素组间比较显示,感染组无业或职业社会经济地位较低、用洗剂清洁外阴、冲洗阴道频率高、性取向为同性、生育次数多、既往阴道炎病史、阴道分泌物量多、阴道分泌物性状异常和沙眼衣原体感染率均高于对照组(P均＜0.05)。多因素Logistic回归分析显示,生育史(OR=5.106,95% CI:1.521~17.145, P=0.008)、既往阴道炎病史(OR=3.910,95% CI:1.167~13.099, P=0.027)、阴道分泌物异常(OR=758.313,95% CI:58.151~9888.714, P＜0.001)是HR-HPV感染的危险因素。此外,用洗剂清洗外阴或冲洗阴道的清洁习惯(OR=2.004)、性取向为同性(OR=13.972)、沙眼衣原体阳性(OR=15.058)均显示出与HR-HPV感染具有较强的关联性,但由于对照组样本量较少,并未得出有统计学意义的结果。  结论  HR-HPV感染与多种因素相关,生育次数多、既往阴道炎病史、阴道分泌物性状异常是HR-HPV感染的危险因素,建议重视阴道分泌物变化,如有异常,及时就诊。在有条件的情况下,行宫颈HR-HPV筛查时加入阴道微生态的相关检查,如患有生殖道炎性疾病,应及时治疗,从多方面预防HR-HPV感染及降低HR-HPV持续感染的风险。     

西藏地区成人重症患者真菌检出情况及其影响因素分析

  目的  探究西藏地区成人重症患者真菌检出现状,并进一步分析真菌检出的影响因素。  方法  回顾性纳入2018年1月1日至2019年12月31日西藏自治区人民医院重症医学科诊治的全部成人重症患者。根据其送检标本真菌检出结果,分为真菌检出阳性组、真菌检出阴性组。通过电子病历系统收集两组患者的临床资料及其检出真菌的菌株分布情况。采用多因素Logistic回归法分析真菌检出的影响因素。  结果  共755例符合纳入和排除标准的成人重症患者(送检标本4917份)纳入本研究,其中真菌检出阳性组142例、真菌检出阴性组613例。共检出真菌192株,其中念珠菌183株(95.3%)、曲霉7株(3.7%)、其他真菌2株(1.0%)。念珠菌中,白色念珠菌164株(89.6%)、光滑念珠菌9株(4.9%)、近平滑念珠菌7株(3.8%)、克柔念珠菌2株(1.1%)、热带念珠菌1株(0.6%)。曲霉中,烟曲霉3株(42.8%)、黑曲霉2株(28.6%)、黄曲霉2株(28.6%)。多因素Logistic回归分析结果显示,高序贯性器官衰竭评分(OR=1.402, 95% CI: 1.277~1.538, P＜0.001)、消化系统重症(OR=2.671, 95% CI: 1.465~4.872, P=0.001)、气管插管时间≥48 h(OR=2.661, 95% CI: 1.611~4.397, P=0.000)、碳青霉烯类药物使用时间≥24 h(OR=2.825, 95% CI: 1.522~5.245, P=0.001)、头孢菌素类+β-内酰胺酶抑制剂类药物使用时间≥24 h(OR=2.678, 95% CI: 1.679~ 4.272, P=0.000)、长ICU住院时间(OR=1.043, 95% CI: 1.011~1.076, P=0.008)是成人重症患者真菌检出的独立危险因素,高居住地海拔(OR=0.999, 95% CI: 0.999~1.000, P=0.040)、高血红蛋白水平(OR=0.994, 95% CI: 0.988~0.999, P=0.020)是其保护因素。  结论  西藏地区成人重症患者真菌检出现象并非少见,白色念珠菌是检出的主要菌株。影响真菌检出的因素涉及多个方面,应基于西藏地区特征,针对危险因素采取相应的预防措施。     

头颈部手术后非计划二次插管危险因素分析

  目的  探讨头颈部手术后非计划二次插管的危险因素。  方法  回顾性分析2014年1月1日至2018年12月31日于北京协和医院行头颈部手术患者的临床资料。以术后非计划二次插管患者为研究组,随机抽取一定量的成功拔管者为对照组,研究组与对照组患者比例为1:4。多因素Logistic回归分析头颈部手术后非计划二次插管的危险因素。  结果  共60例(研究组12例,对照组48例)符合纳入和排除标准的患者入选本研究。多因素Logistic回归分析结果显示,有全身麻醉史(OR=9.17, 95% CI:1.05~83.33, P=0.045)、Cormack-Lehane分级Ⅲ级(OR=18.87, 95% CI:1.53~250.00, P=0.022)、术中液体负荷≥20 mL/kg(OR=27.78, 95% CI:1.94~500.00, P=0.014)是头颈部手术后非计划二次插管的危险因素。研究组术后住院时间[7(3.0,17.0)d比2(2.0,5.0)d,P=0.013]、ICU停留时间[1(0.0,2.8)d比0(0.0,0.0)d,P＜0.001]均长于对照组。  结论  头颈部手术后非计划二次插管与有/无全身麻醉史、Cormack-Lehane分级及术中液体负荷有关,其发生不利于患者术后康复。     

中心静脉压峰值与体外循环心脏术后急性肾损伤的相关性

  目的  探究体外循环心脏手术(cardiopulmonary bypass surgery, CBS)后中心静脉压峰值(peak value of central venous pressure, CVPp)与急性肾损伤(acute kidney injury, AKI)的关系。  方法  回顾性收集2016年5月1日至2018年5月1日北京协和医院重症医学科所有CBS患者的临床资料。记录转入ICU后即刻中心静脉压(central venous pressure, CVP)(CVP 0h)、6 h时CVP(CVP 6h), 转入ICU 48 h内CVPp(CVPp 48h), 以及转入ICU 48 h后AKI发生率及院内死亡率。采用受试者操作特征(receiver operating characteristic, ROC)曲线评估CVP相关指标预测CBS术后发生AKI的临床价值并确定最佳临界值; 采用单因素与多因素Logistic回归分析CBS术后发生AKI、院内死亡的危险因素。  结果  共入选符合纳入和排除标准的CBS患者485例, AKI发生率为25.2%(122/485), 院内死亡率为2.5%(12/485)。ROC曲线分析显示, CVPp 48h预测CBS术后发生AKI的曲线下面积(area under the curve, AUC)为0.634(95% CI: 0.577~0.692, P＜0.001), 最佳临界值为14 mm Hg, 灵敏度为49.6%, 特异度为63.5%。多因素Logistic回归分析显示, 高血压(OR=2.505, 95% CI: 1.581~3.969, P＜0.001)、肺动脉高压(OR=2.552, 95% CI: 1.573~4.412, P＜0.001)、主动脉阻断时间延长(OR=1.009, 95% CI: 1.004~1.014, P=0.001)、CVPp 48h≥14 mm Hg(OR=1.613, 95% CI: 1.030~2.526, P=0.037)是CBS术后发生AKI的独立危险因素; CVPp 48h≥14 mm Hg是院内死亡的独立危险因素(OR=8.044, 95% CI: 1.579~40.979, P=0.012)。  结论  CVPp 48h升高可能增加CBS术后AKI发生风险, 对其动态监测有助于AKI的预防和早期识别。     

38例川崎病合并颈深间隙受累患儿临床特征及危险因素分析

  目的  对川崎病(Kawasaki disease, KD)合并颈深间隙受累(deep neck space involvement, DNSI)患儿的临床资料进行总结, 并分析KD患儿合并DNSI的危险因素。  方法  本研究为病例对照研究。研究对象为2018年1月—2020年12月深圳市儿童医院风湿免疫科住院治疗的KD合并DNSI患儿(DNSI组)及采用系统抽样法按1∶7比例选取的该时间段内单纯KD患儿(对照组)。比较两组临床资料差异, 采用多因素Logistic回归法分析KD患儿合并DNSI的危险因素。  结果  共入选符合纳入与排除标准的DNSI组患儿38例, 对照组患儿288例。DNSI组患儿中, 38例(100%)均存在发热伴颈部淋巴结肿大, 且颈部淋巴结肿大均在发病5 d内出现; 颈部淋巴结疼痛30例(78.9%), 颈部活动受限25例(65.8%)。相较于对照组, DNSI组患儿临床资料呈现出多种显著性变化: 在临床特征方面, DNSI组发病年龄更大, 住院时间更长, 颈部淋巴结肿大、颈部淋巴结疼痛、颈部活动受限、上气道阻塞的比例均更高(P均＜0.05);在实验室检测方面, DNSI组中性粒细胞计数及其百分比、C反应蛋白(C-reactive protein, CRP)、铁蛋白(ferritin, FER)、总胆汁酸、总胆红素、直接胆红素、球蛋白水平均更高, 血小板、淋巴细胞计数及其百分比均更低(P均＜0.05);在冠状动脉损害及治疗效果方面, DNSI组Kobayashi评分、Sano评分及激素治疗的比例均更高(P均＜0.05)。多因素Logistic回归分析显示, 颈部淋巴结疼痛(OR=5.523, 95% CI: 1.443~21.141, P=0.013)、颈部活动受限(OR=3.947, 95% CI: 1.044~14.928, P=0.043)、CRP(OR=1.016, 95% CI: 1.002~1.030, P=0.024)与FER(OR=1.004, 95% CI: 1.001~1.006, P=0.002)升高是KD合并DNSI的独立危险因素。  结论  多数KD合并DNSI患儿出现颈部淋巴结肿大、颈部淋巴结疼痛、颈部活动受限等临床症状, 血液学提示存在高强度炎症反应。以颈部疼痛及活动受限为主要临床表现并伴血清CRP与FER升高的KD患儿需警惕合并DNSI的可能性。     

平行双针法与单纯双针法两种布针模式对肝癌射频消融局部疗效的影响

  目的  比较采用平行双针法与单纯双针法两种布针模式行超声引导下射频消融术治疗肝癌的局部疗效。  方法  回顾性分析2014年1月至2018年12月于北京大学肿瘤医院行射频消融治疗的肝癌患者临床资料。根据射频消融布针模式分为平行双针组、单纯双针组。射频消融治疗后1个月,行增强CT或MRI检查测量消融范围(长径、宽径及厚径)并计算肿瘤灭活率。对患者随访,观察肿瘤局部进展情况。  结果  共281例(370个病灶)符合纳入及排除标准的患者入选本研究,经倾向评分匹配法校正后最终纳入分析111例(111个病灶),其中平行双针组37例(37个病灶),单纯双针组74例(74个病灶)。平行双针组消融厚径大于单纯双针组(均值差=0.39,95% CI:-0.63~-0.15, P=0.002),两组消融长径、宽径差异均无统计学意义(均值差=0.07,95% CI:-0.33~0.20,P=0.631;均值差=-0.03,95% CI:-0.20~0.24,P=0.844)。两组治疗后1个月肿瘤灭活率均为100%;中位随访时间6个月,平行双针组肿瘤局部进展率低于单纯双针组(2.70%比16.22%,P=0.037)。  结论  两种布针模式射频消融均具有较好的肿瘤灭活率,平行双针法可能更易形成较大的消融范围,以完全覆盖肿瘤组织,从而降低肿瘤局部进展率。     

炎症性肠病患者幽门螺杆菌感染调查及其危险因素分析

  目的  探究炎症性肠病(inflammatory bowel disease，IBD)患者幽门螺杆菌(Helicobacter pylori, Hp)感染现况，并初步分析其发生Hp感染的危险因素。  方法  2020年1月1日—2020年12月31日通过发送电子问卷的方式对北京协和医院长期随访IBD患者及年龄、性别与之相匹配的北京社区居民展开调查。收集两组人群一般资料、Hp感染相关信息、环境因素等资料。比较两组人群Hp阳性率差异并分析IBD患者Hp感染相关危险因素。  结果  经倾向性评分匹配后，最终纳入本研究IBD患者122例、社区居民1739例。两组人群倾向性评分直方图高度一致。IBD患者Hp阳性率显著低于社区居民(13.1%比42.7%，P＜0.001)，且两组Hp阳性率均随年龄增高呈逐渐升高趋势，但组内比较差异均无统计学意义(P均＞0.05)。单因素分析显示，IBD患者中Hp阳性者长期共餐者Hp感染的比例显著高于Hp阴性者(43.8% 比18.9%，P=0.006)。  结论  IBD患者Hp感染率较社区居民降低，其发生Hp感染可能与长期共餐者Hp阳性有关。     

术中静脉输注利多卡因优化术后疼痛管理并加速胃肠功能恢复:回顾性队列研究

  目的  观察腹盆部手术中持续静脉输注利多卡因对术后疼痛管理及胃肠道功能恢复的影响。  方法  回顾性收集并分析2017年1月至2019年5月在北京协和医院接受全麻下腹盆部手术患者的临床资料, 试验组患者在全身麻醉的同时联合静脉输注利多卡因, 对照组采用传统全身麻醉模式。比较两组术后24 h内舒芬太尼的用量、静息及活动状态的疼痛视觉模拟评分(visual analogue score, VAS)、自控镇痛泵按压次数、恶心呕吐及排气情况。  结果  与对照组相比, 试验组术后24 h内舒芬太尼用量和镇痛泵按压次数均减少[(0.0372±0.0137)μg/(kg·h)比(0.0498±0.0447)μg/(kg·h), t=-2.190, P=0.030;(7.4±6.7)次比(11.1±10.6)次, t=-2.257, P=0.027], 术后24 h内的静息及活动状态疼痛VAS评分≤ 3分者比例均更高(97.0%比85.5%, χ²=3.938, P=0.047;68.7%比47.3%, χ²=5.710, P=0.017), 肠道排气率更高(26.9%比5.5%, χ²=9.717, P=0.002), 但恶心、呕吐发生率未见统计学差异。  结论  腹盆部手术术中输注利多卡因可能有助于术后疼痛管理, 加速胃肠道功能恢复。     

衰弱对住院老年冠心病患者短期预后的影响:前瞻性队列研究

  目的  探讨衰弱对住院老年冠心病患者短期预后的影响。  方法  前瞻性收集并分析2017年12月至2018年11月在北京协和医院住院治疗的老年冠心病患者临床资料。根据是否合并衰弱,将患者分为衰弱组和非衰弱组。对两组患者随访,终点事件包括非常规就诊、主要不良心脑血管事件(major adverse cardiac and cerebral events,MACCE)、全因死亡。采用多因素Cox回归分析衰弱与冠心病患者预后的关系。绘制两组无MACCE的Kaplan-Meier生存曲线,并采用Log-Rank检验进行比较。  结果  共345例符合纳入和排除标准的老年冠心病患者入选本研究,包括稳定性冠心病250例,急性冠状动脉综合征95例。衰弱组74例(21.4%),其中轻度衰弱38例、中度衰弱36例,非衰弱组271例(78.6%)。中位随访时间351(300, 394)d,失访3例。与非衰弱组比较,衰弱组非常规就诊发生率(36.1%比21.5%)、全因死亡率(11.1%比4.1%)均升高(P均＜0.05),MACCE发生率(9.7%比4.8%)无显著差异(P＞0.05)。多因素Cox回归分析结果显示,轻度和中度衰弱是稳定性冠心病患者全因死亡的危险因素(HR=4.169,95% CI:1.055~16.474,P=0.042),对其非常规就诊(HR=1.704,95% CI:0.947~3.066,P=0.075)、MACCE(HR=1.268,95% CI:0.331~4.863,P=0.729)无显著影响。在急性冠状动脉综合征患者中,轻度和中度衰弱对其非常规就诊(HR=1.159,95% CI:0.342~3.924,P=0.812)、MACCE(HR=0.822,95% CI:0.092~7.369,P=0.861)及全因死亡(HR=1.445,95% CI:0.210~9.964,P=0.708)均无显著影响。Kaplan-Meier生存曲线显示,衰弱组和非衰弱组患者的无MACCE生存曲线无显著差异(P＞0.05)。  结论  住院老年冠心病患者合并轻中度衰弱的比率较高,其可能增加稳定性冠心病患者近期死亡风险。     

直肠癌术前容积调强与固定野调强技术的剂量学比较

  目的  比较对直肠癌术前患者应用固定野调强(fixed-field intensity-modulated radiotherapy, FF-IMRT)和容积调强(volumetric modulated arc therapy, VMAT)两种计划方式进行术前放射治疗的剂量学差异。  方法  选择15例直肠癌术前进行调强放疗的患者行CT模拟定位, 勾画靶区及危及器官, 对同一CT图像设计FF-IMRT计划和VMAT计划。评估靶区及危及器官的剂量分布。  结果  VMAT计划组和FF-IMRT计划组靶区覆盖度均能满足处方剂量要求。与FF-IMRT计划组相比, VMAT计划组计划靶区(planning target volume, PTV)105%覆盖度、Dmean及Dmax均增加(P=0.011, P=0.017, P=0.006), 适形度指数减低(P=0.008), 而均匀性指数差异无统计学意义(P=0.193)。与FF-IMRT计划组相比, VMAT计划组膀胱V₅₀增加约15%(P=0.009), Dmax平均值增加0.7 Gy(P=0.003);小肠V₃₀降低10%(P=0.004), Dmax平均值增加0.9 Gy(P=0.000);骨髓V₁₀、V₃₀、V₄₀分别降低2%、10%、10%(P=0.000, P=0.000, P=0.000), Dmean平均值降低1.7 Gy(P=0.000);左右股骨头D₅分别降低3.2 Gy、2.4 Gy(P=0.000, P=0.000);全身V₁₀、V₂₀、V₃₀、V₄₀也明显降低(P=0.003, P=0.000, P=0.000, P=0.004)。VMAT计划组较FF-IMRT计划组机器跳数(monitor units, MU)平均值减少50%(P=0.000)。  结论  直肠癌术前患者采用VMAT技术, 可以获得等同于或优于FF-IMRT计划的剂量分布, 患者治疗时间明显缩短, MU明显降低。     

Cost-Effectiveness of Multitarget Stool DNA Testing vs Colonoscopy or Fecal Immunochemical Testing for Colorectal Cancer Screening in Alaska Native People

ObjectiveTo estimate the cost-effectiveness of multitarget stool DNA testing (MT-sDNA) compared with colonoscopy and fecal immunochemical testing (FIT) for Alaska Native adults.Patients and MethodsA Markov model was used to evaluate the 3 screening test effects over 40 years. Outcomes included colorectal cancer (CRC) incidence and mortality, costs, quality-adjusted life-years (QALYs), and incremental cost-effectiveness ratios (ICERs). The study incorporated updated evidence on screening test performance and adherence and was conducted from December 15, 2016, through November 6, 2019.ResultsWith perfect adherence, CRC incidence was reduced by 52% (95% CI, 46% to 56%) using colonoscopy, 61% (95% CI, 57% to 64%) using annual FIT, and 66% (95% CI, 63% to 68%) using MT-sDNA. Compared with no screening, perfect adherence screening extends life by 0.15, 0.17, and 0.19 QALYs per person with colonoscopy, FIT, and MT-sDNA, respectively. Colonoscopy is the most expensive strategy: approximately $110 million more than MT-sDNA and $127 million more than FIT. With imperfect adherence (best case), MT-sDNA resulted in 0.12 QALYs per person vs 0.05 and 0.06 QALYs per person by FIT and colonoscopy, respectively. Probabilistic sensitivity analyses supported the base-case analysis. Under varied adherence scenarios, MT-sDNA either dominates or is cost-effective (ICERs, $1740-$75,868 per QALY saved) compared with FIT and colonoscopy.ConclusionEach strategy reduced costs and increased QALYs compared with no screening. Screening by MT-sDNA results in the largest QALY savings. In Markov model analysis, screening by MT-sDNA in the Alaska Native population was cost-effective compared with screening by colonoscopy and FIT for a wide range of adherence scenarios.     

结直肠癌机会性筛查的临床应用探讨

目的 探讨结直肠癌机会性筛查（OS）的临床应用,旨在为进一步完善大肠癌筛查流程和提高筛查效率提供依据。方法 回顾性分析2019年1月-2020年12月该院3 398例结直肠癌OS阳性,并完成全结肠镜检查的患者的临床资料。完成高危因素问卷调查（HRFQ）和粪便免疫化学检测（FIT）后,建议对两种筛查方法中,任意一种结果呈阳性的患者,进行结肠镜检查。统计受检者的年龄、性别、病变检出情况和病变部位,根据初筛结果,比较不同筛查方法结直肠肿瘤检出率的情况。结果 3 398例受检者中,HRFQ(-) FIT （+）组进展期腺瘤和结直肠癌检出率高于HRFQ(+) FIT （-）组,差异均有统计学意义（P <0.05）。在非进展期腺瘤检出率方面,HRFQ(-) FIT （+）组明显低于HRFQ(+) FIT （+）组,差异有统计学意义（P <0.05）。FIT对结直肠肿瘤的敏感度总体上优于HRFQ,且FIT对远端结直肠肿瘤的敏感度高于近端,差异均有统计学意义（P <0.05）。结论 HRFQ与FIT组合,比FIT或HRFQ单独使用,能筛选出更多的高危人群,从而检测出更多的结直肠肿瘤,...     

Motives for non-adherence to colonoscopy advice after a positive colorectal cancer screening test result: a qualitative study

Setting Participants with a positive faecal immunochemical test (FIT) in screening programs for colorectal cancer (CRC) have a high risk for colorectal cancer and advanced adenomas. They are therefore recommended follow-up by colonoscopy. However, more than ten percent of positively screened persons do not adhere to this advice.Objective To investigate FIT-positive individuals’ motives for non-adherence to colonoscopy advice in the Dutch CRC screening program.Subjects Non-adherent FIT-positive participants of the Dutch CRC screening program.Design We conducted semi structured in-depth interviews with 17 persons who did not undergo colonoscopy within 6 months after a positive FIT. Interviews were undertaken face-to-face and data were analysed thematically with open coding and constant comparison.Results All participants had multifactorial motives for non-adherence. A preference for more personalised care was described with the following themes: aversion against the design of the screening program, expectations of personalised care, emotions associated with experiences of impersonal care and a desire for counselling where options other than colonoscopy could be discussed. Furthermore, intrinsic motives were: having a perception of low risk for CRC (described by all participants), aversion and fear of colonoscopy, distrust, reluctant attitude to the treatment of cancer and cancer fatalism. Extrinsic motives were: having other health issues or priorities, practical barriers, advice from a general practitioner (GP) and financial reasons.Conclusion Personalised screening counselling might have helped to improve the interviewees’ experiences with the screening program as well as their knowledge on CRC and CRC screening. Future studies should explore whether personalised screening counselling also has potential to increase adherence rates.

Key points

• Participants with a positive FIT in two-step colorectal cancer (CRC) screening programs are at high risk for colorectal cancer and advanced adenomas. Non-adherence after an unfavourable screening result happens in all CRC programs worldwide with the consequence that many of the participants do not undergo colonoscopy for the definitive assessment of the presence of colorectal cancer. Little qualitative research has been done to study the reasons why individuals participate in the first step of the screening but not in the second step. We found a preference for more personalised care, which was not reported in previous literature on this subject. Furthermore, intrinsic factors, such as a low risk perception and distrust, and extrinsic factors, such as the presence of other health issues and GP advice, may also play a role in non-adherence. A person-centred approach in the form of a screening counselling session may be beneficial for this group of CRC screening participants.

     

3.0 T MRI联合血清DR-70检测显著提高早期结直肠癌的诊断效能

  目的  探讨3.0 T MRI与血清纤维蛋白降解复合物（DR-70）联合检测在早期结直肠癌诊断中的价值。  方法  选取本院2018年8月~2020年8月收治的早期结直肠癌患者96例,另选取同期40例结直肠良性肿瘤患者,实施3.0 T MRI行动态增强和扩散加权成像等序列扫描和血清DR-70检测,利用Spearman相关性分析3.0 T MRI相关参数和血清DR-70水平与早期结直肠癌的关系,并采用ROC曲线评估这两种检测指标对早期结直肠癌的诊断效能。  结果  96例患者中本次共检出结直肠癌94例,漏诊2例,检出率为97.92%;3.0T MRI能较好地观察到肿瘤的病灶部位、形态、侵袭等情况,肿瘤病灶在T1图像呈中等偏低信号,T2图像呈略高信号,动态增强扫描早期呈不均匀强化,延迟期表现为稍低信号,在扩散加权成像中呈明显高信号,在表观扩散系数（ADC）图上呈低信号;观察组MRI参数ADC值低于对照组（P < 0.05）,而DR-70水平高于对照组（P < 0.05）;Spearman相关性分析显示ADC值与结直肠癌呈负相关（r=-0.383,P < 0.05）,而DR-70水平则与结直肠癌呈正相关（r=0.460,P < 0.05）;ROC曲线显示:ADC、DR-70联合诊断结直肠癌曲线下面积为0.850,明显高于各单项指标曲线下面积（P < 0.05）。  结论  结直肠癌患者利用3.0T MRI技术和DR-70联合检测能显著提高结直肠癌的诊断鉴别效能。      

A novel multitarget stool DNA test for colorectal cancer screening

Review of: Imperiale TF, Ransohoff DF, Itzkowitz SH, Levin TR, Lavin P, Lidgard GP, Ahlquist DA, Berger BM. Multitarget stool DNA testing for colorectal-cancer screening. N Engl J Med 2014;370(14):1287–97.

This Practice Pearl reviews the results of a prospective, multicenter, cross-sectional clinical study that evaluated the performance of a new multitarget stool DNA (or mt-sDNA) screening test for colorectal cancer (CRC) and compared it with a fecal immunochemical test (FIT) in individuals at average risk for CRC. The potential impact of this test on the future of CRC screening is also discussed in a brief commentary. mt-sDNA testing is a noninvasive screening test designed to detect DNA biomarkers associated with colorectal neoplasia and occult hemoglobin in the stool. The sensitivity of mt-sDNA testing for detection of CRC was 92.3%, compared with 73.8% for FIT (p = 0.002). Sensitivity for detecting advanced precancerous lesions was 42.4% for mt-sDNA testing and 23.8% for FIT (p < 0.001). The specificities of mt-sDNA testing and FIT were 86.6% and 94.9%, respectively (p < 0.001). mt-sDNA testing thus may be a first-line screening option for asymptomatic individuals at average risk for CRC who do not want to have a colonoscopy.     

Health Care Provider Characteristics Associated With Colorectal Cancer Screening Preferences and Use

ObjectiveTo assess health care provider (HCP) preferences related to colorectal cancer (CRC) screening overall, and by HCP and patient characteristics.Participants and MethodsWe developed a survey based on the Theoretical Domains Framework to assess factors associated with CRC screening preferences in clinical practice. The survey was administered online November 6 through December 6, 2019, to a validated panel of HCPs drawn from US national databases and professional organizations. The final analysis sample included 779 primary care clinicians (PCCs) and 159 gastroenterologists (GIs).ResultsHCPs chose colonoscopy as their preferred screening method for average-risk patients (96.9% (154/159) for GIs, 75.7% (590/779) for PCCs). Among PCCs, 12.2% (95/779) preferred multi-target stool DNA (mt-sDNA), followed by fecal immunochemical test (FIT), (7.3%; 57/779) and guaiac-based fecal occult blood test (gFOBT) (4.8%; 37/779). Preference among PCCs and GIs generally shifted toward noninvasive screening options for patients who were unable to undergo invasive procedures; concerned about taking time from work; unconvinced about need for screening; and refusing other screening recommendations. Among PCCs, preference for mt-sDNA over FIT and gFOBT was less frequent in larger compared with smaller clinical practices. Additionally, preference for mt-sDNA over FIT was more likely among PCCs with more years of clinical experience, higher patient volumes (> 25/day), and practice locations in suburban and rural settings (compared to urban).ConclusionBoth PCCs and GIs preferred colonoscopy for CRC screening of average-risk patients, although PCCs did so less frequently and with approximately a quarter preferring stool-based tests (particularly mt-sDNA). PCCs’ preference varied by provider and patient characteristics. Our findings underscore the importance of informed choice and shared decision-making about CRC screening options.     

静脉右美托咪定对剖宫产术中镇静效果和不良反应的影响

  目的  观察静脉右美托咪定用于腰硬联合麻醉下剖宫产术的镇静效果和对术中不良反应的影响。  方法  选择单胎足月妊娠拟在腰硬联合麻醉下行剖宫产术的产妇50名, 随机数字表法分为右美托咪定组(研究组, 25名)和生理盐水组(对照组, 25名)。蛛网膜下腔穿刺成功后, 给予重比重0.5%布比卡因8 mg, 胎儿娩出后, 研究组予右美托咪定负荷剂量1 μg/kg静脉泵注, 10 min输完后改为0.5 μg/(kg·h)静脉泵注, 对照组予等量生理盐水静脉泵注, 直至术毕。术中每30 min记录产妇的Ramsay镇静评分, 记录术中不良反应和药物副作用发生率, 并记录新生儿出生1、5 min的Apgar评分。  结果  研究组的Ramsay镇静评分显著高于对照组(3.4±0.7比2.2±0.4, P=0.001)。对于术中不良反应, 研究组寒战(0比16%, P=0.001)、恶心呕吐(8%比36%, P=0.019)、手术牵拉导致的腹部不适发生率(12%比48%, P=0.006)均显著低于对照组。对于药物副作用, 研究组心动过缓发生率显著高于对照组(24%比0, P=0.011), 而两组低血压、过度镇静和呼吸抑制发生率差异无统计学意义。两组新生儿Apgar评分差异亦无统计学意义。  结论  静脉右美托咪定可为行腰硬联合麻醉下剖宫产术的产妇提供良好镇静效果, 增加其术中安静合作程度, 降低术中不良反应的发生率, 同时药物副作用较小, 对新生儿无不良影响。     

基于磁共振T2加权图像的纹理分析评估直肠癌化疗后疗效的价值

  目的  通过磁共振T2加权图像的纹理分析评估直肠癌化疗后疗效的价值。  方法  选取我院2019年1月~2021年4月经临床与病理明确诊断的直肠癌患者117例,分为完全缓解组（n=38）和非完全缓解组（n=79）;受试者化疗前和治疗结束后均采用3.0T MRI扫描;采用Omni Kineitics软件提取受试者纹理特征,计算纹理特征的峰度、方差、熵和能量参数;绘制ROC曲线分析磁共振T2加权图像的纹理,评估直肠癌化疗后病理完全缓解的价值。  结果  治疗后完全缓解组受试者方差、熵明显低于未完全缓解组（1534±312 vs 2312±586、5.43±0.41 vs 6.42±0.29）峰度、能量明显高于未完全缓解组（4.85±0.66 vs 3.72±0.49、0.016±0.002 vs 0.013±0.02）,差异有统计学意义（P < 0.05）。  结论  采用磁共振T2加权图像的纹理分析可评估化疗后的疗效,并可预测直肠癌化疗后病理完全缓解情况。      

FIT false-positives in colorectal cancer screening experience psychological distress up to 6 weeks after colonoscopy

Purpose

Screening programs for colorectal cancer aim at reducing cancer mortality. We assessed psychological effects of being invited to an immunochemical fecal test (FIT)-based screening program.

Methods

Asymptomatic persons aged 50–74 years were invited to a Dutch screening pilot. The Psychological Consequences Questionnaire (PCQ) was used to measure the psychological effects of screening. Screen positives had two additional measurements: before undergoing the colonoscopy and 4 weeks after receiving the colonoscopy findings.

Results

A number of 3,828 invitees (46 % male, mean age 60 years) completed the first PCQ. FIT positives had a higher mean total PCQ score (8.32, SD 8.84; score range 0–36) than those who declined participation (3.72, SD 6.30); participants still waiting for their FIT result had a mean score of 2.74 (SD 5.11), and those with a negative FIT result had the lowest score (2.06, SD 4.43) (p?<?0.001). In the 373 FIT positives who underwent colonoscopy, 195 completed the pre-colonoscopy questionnaire and 253, the post-colonoscopy questionnaire. Mean total, physical, and social PCQ scores had decreased significantly between the first questionnaire and the pre-colonoscopy one, but scores on the emotional subscale did not. In false-positives, mean total, physical, and emotional PCQ scores decreased significantly, while in true-positives, a significant decrease in mean emotional PCQ score was observed.

Conclusion

Psychological consequences for invitees to a Dutch FIT-based colorectal cancer screening pilot differ, depending on timing and FIT result. FIT positives are more distressed than FIT negatives. FIT positives still experience psychological distress 6 weeks after a normal colonoscopy.