Effectiveness and cost-effectiveness of colorectal cancer screening: Selecting the ideal strategy

Abstract Colorectal cancer is the second most common cancer killer of Americans. Recently developed and tested methods of screening and surveillance can effectively diagnose and treat the disease in most patients before symptoms develop when the chance of cure is high. It is also possible to prevent colorectal cancer by detecting and resecting premalignant adenomatous polyps. Evidence-based guidelines recommend that the average-risk population greater than age 50 be screened with annual faecal occult blood tests plus periodic flexible sigmoidoscopy. This approach is feasible, efficacious, affordable and cost-effective in a high-risk country such as the US. Widespread compliance with these recommendations could reduce the mortality from this malignancy by more than 50%.     

Wertigkeit der EKG-Telefon-Telemetrie in der Erfassung symptomatischer Herzrhythmus-Störungen

Summary The ECG-telephone-transmission (TTM) was used to record an ECG-strip during a typical symptomatic period in patients complaining of symptoms possibly caused by arrhythmias (palpitations, dizziness, paroxysm tachycardia, pulse irregularities; angina and dyspnea only if other reasons could be excluded). Patients complaining of syncope only were not admitted, because of the inability to make a telephon call successfully during such a symptomatic period. The ECG was transmitted to the CCU using a frequency modulation technique. In 60% of 196 patients an ECG-TTM could be achieved during a typical symptomatic period, whereas arrhythmias as cause for the symptoms could be excluded in 51 patients (26%). The remaining 66 patients (34%) demonstrated various arrhythmias ranging from simple SVPB and PVC to total AV-block and sustained VT.TTM, an easy-to-perform and cost-effective method allowed a successful ECG registration during a symptomatic period in almost two-thirds of symptomatic patients. In these patients arrhythmias could be verified or excluded as cause of the symptoms.

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Abkürzungsverzeichnis TTM EKG-Telefon-Telemetrie - HF Herzfrequenz - SA-Block sinu-aurikulärer Block - AV-Block atrio-ventrikulärer Block - SVES supraventrikuläre Extrasystole(n) - VES ventrikuläre Extrasysteole(n) - KHK koronare Herzkrankheit - VH-Flimmern Vorhof-Flimmern - parox. paroxysmal - C.C.I.T.T. Internationale Post-Organisation - Ö.P.T. Österreichische Post- u. Telegraphen-Verwaltung - LZ-EKG Langzeit-EKG     

Flexible versus rigid endoscopes for outpatient hysteroscopy: a prospective randomized clinical trial

To evaluate patient acceptance, optical properties and the clinical feasibility of flexible compared with rigid hysteroscopes, 142 patients undergoing outpatient hysteroscopy were included in a prospective, randomized clinical trial. The flexible hysteroscope was used in 70 patients, and the rigid instrument in 72. At different stages of the hysteroscopy the level of pain experienced by the women was assessed using a 10 cm visual analogue scale. Optical properties characterized by the parameters intrauterine visibility, hysteroscopic view and diagnostic accuracy were ranked by the surgeons using a 5-point scale (1 = excellent to 5 = insufficient), and duration of the hysteroscopy was measured. Hysteroscopy was successful in 87.5 and 100% of patients in the flexible and rigid groups respectively. With the use of rigid telescopes, discomfort at introduction and during the hysteroscopy was significantly greater (median 1.7 versus 0.7, P = 0.003; 3.1 versus 1.2, P < 0.001 respectively), but optical properties were judged to be far superior (P < 0.001 for all three comparisons) and procedure time was significantly shorter (median 70 versus 120 s, P = 0.003). In conclusion, outpatient hysteroscopy seems to be less painful when using flexible telescopes. However, rigid hysteroscopes provide superior optical qualities and permit a more rapid performance with higher success rates at much lower cost.     

洛赛克治疗症状性胃食管反流病95例临床观察

目的了解洛赛克强力抑酸作用对胃食管反流病(GERD)患者临床症状改善及胃镜下食管炎症改善情况.方法将95例GERD病人随机分为两组,用洛赛克(20mg qd)50例,雷尼替丁(150mg Bid)45例,疗程4周,停药2周后胃镜复查,观察临床症状及食管炎症改善情况.结果治疗组临床症状改善有效率为91.6%,对照组为50.4%.治疗组胃镜下食管炎症改善有效率为70%,对照组为29.2%.治疗组明显优于对照组.结论对GERD病人抑制胃酸分泌,减轻其对食管粘膜的损伤和改善临床症状洛赛克有较好的疗效,其作用已被公认,但在食管炎症愈合方面疗效不太满意,如与促动力药物合用,可望更高疗效.     

Pedobarographic outcome after subtalar screw arthroereisis in flexible juvenile flatfoot

BackgroundFlatfoot is a frequent skeletal deformity in childhood that can be minimally invasively treated by arthroereisis. Question: Does the motion of juvenile flexible flatfoot normalize after arthroereisis?MethodPedographic measurements were obtained from 39 patients preoperatively, six months postoperatively and compared to a healthy group. The footprints were divided into 8 areas. The selected parameters were: contact area and force-time-integral.ResultsAfter surgery, a load shift from the medial to the lateral areas was detected under the midfoot and forefoot. The force-time-integral under the hallux normalized. However, under the lateral midfoot, the postoperative force-time-integral was significantly higher than in the control group.SignificanceThe study shows that arthroereisis is able to correct the medially displaced load distribution of juvenile flexible flatfoot. However, further investigations are required to find out if the higher punctual loading under the lateral midfoot may cause problems in the long term.     

Immune cell landscape in symptomatic and asymptomatic SARS-CoV-2 infected adults and children in urban Dhaka,Bangladesh

ObjectivesThe study of cellular immunity to SARS-CoV-2 is crucial for evaluating the course of the COVID-19 disease and for improving vaccine development. We aimed to assess the phenotypic landscape of circulating lymphocytes and mononuclear cells in adults and children who were seropositive to SARS-CoV-2 in the past 6 months.MethodsBlood samples (n = 350) were collected in a cross-sectional study in Dhaka, Bangladesh (Oct 2020-Feb 2021). Plasma antibody responses to SARS-CoV-2 were determined by an electrochemiluminescence immunoassay while lymphocyte and monocyte responses were assessed using flow cytometry including dimensionality reduction and clustering algorithms.ResultsSARS-CoV-2 seropositivity was observed in 52% of adults (18–65 years) and 56% of children (10–17 years). Seropositivity was associated with reduced CD3⁺T cells in both adults (beta(β) = ?2.86; 95% Confidence Interval (CI) = ?5.98, 0.27) and children (β = ?8.78; 95% CI = ?13.8, ?3.78). The frequencies of T helper effector (CD4⁺T_EFF) and effector memory cells (CD4⁺T_EM) were increased in seropositive compared to seronegative children. In adults, seropositivity was associated with an elevated proportion of cytotoxic T central memory cells (CD8⁺T_CM). Overall, diverse manifestations of immune cell dysregulations were more prominent in seropositive children compared to adults, who previously had COVID-like symptoms. These changes involved reduced frequencies of CD4⁺T_EFF cells and CD163⁺CD64⁺ classical monocytes, but increased levels of intermediate or non-classical monocytes, as well as CD8⁺T_EM cells in symptomatic children.ConclusionSeropositive individuals in convalescence showed increased central and effector memory T cell phenotypes and pro-resolving/healing monocyte phenotypes compared to seronegative subjects. However, seropositive children with a previous history of COVID-like symptoms, displayed an ongoing innate inflammatory trait.     

仙附,芪地强心口服液治疗老年人慢性心功能不全

目的：寻求老年人心功能不全有效、安全的治法方药。方法：用仙附、芪地强心口服液与巯甲丙脯酸对照治疗老年心功能不全,观察心脏功能和血浆血管活性肽、临床症状、体征及药物安全性。结果：仙附、芪地强心口服液和巯甲丙脯酸治疗心功能不全总有效率分别为８７．５％（２８／３２）、９０．３％（２８／３１）、９０．６％（２９／３２）,三者差别无显著性（Ｐ＞０．０５）;在临床近期治愈率方面,分别为４３．８％（１４／３２）、５１．６（１６／３１）、２５．０％（８／３２）,芪地组优于巯甲丙脯酸对照组;对改善患者临床症状、体征、心脏功能和血浆血管活性肽指标等方面都显示明显效果。结论：老年人心功能不全可以益气养阴、温阳治本、活血利水治标为基本大法,仙附、芪地强心口服液是治疗本病的安全有效方药     

软式膀胱尿道镜检查技巧

目的 :提高软式膀胱尿道镜检查的技术水平。方法 :报告软式膀胱尿道镜检查的成功经验及所遇问题。结果 :软式膀胱尿道镜对膀胱、尿道的观察均具有明显的优势 ,可完成活检、插管、取异物等多项操作。结论 :软式膀胱尿道镜检查痛苦小 ,可替代硬式膀胱尿道镜 ,使用广泛 ;熟练掌握软式膀胱尿道镜的操作技巧是检查成功及延长使用寿命的关键     

双氯芬酸钠柔性脂质体的制备及其对离体小鼠皮肤的透皮效果

利用同离子效应制备双氯芬酸钠柔性脂质体,并考察脂质浓度对包封率的影响.同时比较了双氯芬酸钠乳膏、传统脂质体与柔性脂质体对离体小鼠皮肤的透皮效果.结果表明,同离子效应可显著增大柔性脂质体的包封率,较理想的脂质浓度为卵磷脂-胆酸钠为6∶1.2(g,w/w),离体小鼠皮肤12h累积透过率依次为:柔性脂质体＞＞传统脂质体＞乳膏.     

Outcomes of Carotid Revascularization in Patients with Contralateral Carotid Artery Occlusion

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