前交叉韧带损伤的风险因素研究进展

前交叉韧带（anterior cruciate ligament,ACL）对于保持膝关节静态和动态稳定性非常重要。在运动中前交叉韧带通常因为膝外展和外翻位跳落、突然加速、变向、旋转等非接触机制造成损伤。可控风险因素和非可控风险因素使运动员处于前交叉韧带损伤高风险状态。前交叉韧带损伤后造成患者疼痛、膝关节不稳定、继发性膝关节损害、活动障碍等不良后果。因此,前交叉韧带损伤的风险因素研究逐渐增多。通过干预措施减少易感人群在运动活动中的可控风险因素来预防前交叉韧带损伤是治疗前交叉韧带损伤的重要研究方向。     

Psychological impact of health risk appraisal of Korean women at different levels of breast cancer risk: neglected aspect of the web-based cancer risk assessment tool

Objective: Health risk appraisal is often utilized to modify individual’s health behavior, especially concerning disease prevention, and web-based health risk appraisal services are being provided to the general public in Korea. However, little is known about the psychological effect of the health risk appraisal even though poorly communicated information by the web-based service may result in unintended adverse health outcomes. This study was conducted to explore the psychological effect of health risk appraisal using epidemiological risk factor profile. Methods: We conducted a randomized trial comparing risk factor list type health risk appraisal and risk score type health risk appraisal. We studied 60 women aged 30 years and older who had no cancer. Anxiety level was assessed using the Spielberger State-Trait Anxiety Inventory YZ. Results: The results of multivariate analysis showed that risk status was the independent predictors of increase of state anxiety after health risk appraisal intervention when age, education, health risk appraisal type, numeracy, state anxiety, trait anxiety, and health risk appraisal type by risk status interaction was adjusted. Women who had higher risk status had an odd of having increased anxiety that was about 5 times greater than women who had lower risk status. Conclusions: Our findings indicate that communicating the risk status by individual health risk appraisal service can induce psychological sequelae, especially in women having higher risk status. Hospitals, institutes, or medical schools that are operating or planning to operate the online health risk appraisal service should take side effects such as psychological sequelae into consideration.     

Performance of individual and joint risk stratification by an environmental risk score and a genetic risk score in a colorectal cancer screening setting

Early detection of colorectal neoplasms can reduce the disease burden of colorectal cancer by timely intervention of individuals at high risk. Our aim was to evaluate a joint environmental-genetic risk score as a risk stratification tool for early detection of advanced colorectal neoplasm (ACRN). Known environmental risk factors and high-risk genetic loci were summarized into risk scores for ACRN in 1014 eligible participants of a screening study. The performances of single and joint environmental-genetic scores were evaluated with estimates and 95% confidence intervals (CI) of the absolute risk, relative risk and predictive ability using the area under the curve (AUC). Individuals with higher environmental risk scores showed increasing ACRN risk, with 3.1-fold for intermediate risk and 4.8-fold for very high risk, compared to the very low environmental risk group. Similarly, individuals with higher genetic risk scores showed increasing ACRN risk, with 2.2-fold for intermediate risk and 3.5-fold for very high risk, compared to the lowest genetic risk group. Moreover, the joint environmental–genetic score improved the ACRN risk stratification and showed higher predictive values (AUC = 0.64; 95%CI = 0.60–0.67) with substantial difference (p = 0.0002) compared to the single environmental score (0.58; 0.55–0.62). The integration of environmental and genetic factors looks promising for improving targeting individuals at high-risk of colorectal neoplasm. Applications in practical screening programs require optimization with additional genetic and other biomarkers involved in colorectal carcinogenesis.     

甲状腺癌相关因素研究

研究证明肥胖为 DTC 发病危险因素；碘能增加甲状腺乳头状癌的发病风险，却能降低滤泡癌的发病风险；维生素 D 能降低 DTC 的发病风险，但仍没有足够证据证明维生素 A、C、E 能降低 DTC的发病风险；酒精可能降低 DTC 发病风险，但内在机制仍不清楚；摄入外源毒素增加 DTC 发病风险。明确保护因素与危险因素对于 DTC 的预防工作有十分重要的意义。     

Perceived risk of colorectal cancer: sources of risk judgments.

Perceived risk of disease plays a key role in health behaviors, making it an important issue for cancer-preventive behavior research. This study describes studies using complimentary methodologies to investigate the determinants of perceived risk of developing colorectal cancer. In study 1, questionnaires were mailed to a community sample of 1,056 adults ages 45 to 65 years. They assessed risk factors for colorectal cancer and perceived risk of colorectal cancer and asked respondents to explain why they had rated their risk as they had. Consistent with previous studies, risk factors for colorectal cancer were significantly correlated with perceived risk, although associations were relatively weak. The most frequently cited reasons for risk judgments were diet, family history, and symptoms/general health. Not surprisingly, correlations between each risk factor and perceived risk were stronger among participants who had attributed their risk to that factor. Study 2 used semi-structured interviews to explore individuals' explanations for their perceived risk of colorectal cancer. Adults (n = 18) ages 60 to 63 years volunteered a variety of explanations, but their experiences of cancer seemed to be most salient to their risk estimates. These studies suggest that attributions people make for their risk judgments are important in understanding how they conceptualize risk, but appreciation of experiential and affective influences may be useful in fully understanding perceptions of risk.     

Modifying attributions of colorectal cancer risk.

We report how a four-group risk communication intervention targeted to individuals in the carpentry trade affected their perceived causes (i.e., attributions) for increased colorectal cancer (CRC) risk. The intervention varied the amount of information presented on CRC risk factors and whether participants received tailored feedback on their risk factors. In baseline and 3-month follow-up telephone surveys, carpenters (N = 860) reported their perceived absolute and comparative CRC risks, perceived causes for increased CRC risk, and knowledge of CRC risk factors. At follow-up, neither the type or amount of information provided, nor the use of tailoring, appreciably and consistently affected whether participants mentioned their specific risk factor (e.g., lifestyle, occupational) emphasized in their intervention information. Furthermore, attributions did not affect CRC risk perceptions. These results suggest that participants do not integrate sufficiently CRC risk factor information into their conceptualizations of CRC risk, and that more effective methods are needed to contextualize risk factors information to achieve the goal of modifying CRC risk perceptions.     

EDUCATIONAL SECTION: risk analysis in surgical oncology-part I: concepts and tools.

All clinical procedures invoke risk. Many interventions in cancer management carry a particularly high element of risk, expressed through morbidity and premature death. Formal risk analysis is a discipline which is fundamental to engineering, to finance, to the airline industry and many other sectors of public life. Clinical risk analysis involves risk prediction, risk management and risk avoidance. Risk analysis is rarely invoked or taught in the clinical sciences, and management appraisals on individual patients almost never include a formal estimate of risk. Clinical decisions tend to be guided by qualitative judgements, and by the personality interactions of patients and clinicians. A formal evaluation of risk on a case by case and procedural basis might reduce morbidity and cost in surgical oncology practice. This article introduces the concepts, the spectrum and history of risk analysis and the tools for risk prediction.     

Estimation of individualized probabilities of developing breast cancer for Japanese women

BACKGROUND: Projecting individualized probabilities of developing breast cancer is needed for counseling and chemoprevention for Japanese women, in whom breast cancer incidence has been rapidly increasing. METHODS: We calculated individualized probabilities of developing breast cancer within 10-20 years and until life expectancy for Japanese women by multiplying the relative risk for each risk factor combination by the cumulative risk for the reference group. The risk factors used were age at menarche, age at first delivery, family history of breast cancer, and body mass index (BMI) (in post-menopausal women). The relative risk by menopausal status for each risk factor combination was estimated from a case control study conducted at Osaka Medical Center for Cancer and Cardiovascular Diseases (OMCC), Japan. The cumulative risk of breast cancer for the reference group within 10-20 years and until life expectancy was estimated to divide the corresponding cumulative risk for Japanese women by the weighted average of the relative risk. The weight is an expected proportion of those who have each risk factor combination among the general population. The cumulative risk for Japanese women was estimated using a data file from the Osaka Cancer Registry (OCR). RESULTS: We obtained cumulative risks for any age women within a certain range according to various risk factor combinations by menopausal state. For example, the highest risk group had about a 5 times higher risk probability of developing breast cancer than the general population at initial age 40, within 10-20 years, and until life expectancy. CONCLUSION: The cumulative risk of breast cancer varied according to individuals' risk factors among Japanese women. The availability of concrete individualized risk estimation figures will be of use to health care providers in encouraging Japanese women to seek counseling and to adopt self-control of body weight as a primary preventive measure, as well as to have breast cancer screening.     

Comparison of breast cancer recurrence risk and cardiovascular disease incidence risk among postmenopausal women with breast cancer

The majority of breast cancers are diagnosed in postmenopausal women. Competing comorbidities, particularly cardiovascular disease (CVD), should be considered when individualizing adjuvant therapies for these women. We compared the 10-year predicted breast cancer recurrence risk with CVD risk among postmenopausal women with hormone receptor-positive (HR+), non-metastatic breast cancer. CVD risk factor data were prospectively collected from postmenopausal women with stage I-III, HR+?breast cancer initiating adjuvant aromatase inhibitor therapy. We compared predicted 10-year CVD risk, including the composite index heart age, computed from modified Framingham risk score, with predicted 10-year risk of breast cancer recurrence using Adjuvant! Online. We created multivariable logistic regression models to estimate the odds ratios (OR) and 95% confidence intervals (CI) for greater CVD risk than breast cancer recurrence risk. Among 415 women, mean age and heart age were 60 and 67?years, respectively. Overall, 43% of women had a predicted 10-year CVD risk equivalent to breast cancer recurrence risk and 37% had CVD risk higher than breast cancer recurrence risk. Predicted CVD risk was higher than breast cancer recurrence risk for stage I disease (OR: 6.1, 95% CI: 3.4-11.2) or heart age >65 (OR: 12.4, 95% CI: 7.0-22.6). The majority of postmenopausal women with HR+ early breast cancer had a predicted 10-year CVD risk that was equivalent to or higher than breast cancer recurrence risk. Physicians should weigh competing risks and offer early screening and cardiac prevention strategies for women at a greater risk for CVD.     

术前营养风险对膀胱癌根治术患者预后的影响

目的:探讨术前营养风险对膀胱癌根治术患者预后的影响。方法:回顾性分析2010年02月至2018年05月我院泌尿外科收治的186例行根治性全膀胱切除术患者的临床资料。术前采用营养风险评估表(NRS-2002)筛查患者营养风险,根据NRS-2002评分结果将患者分为有营养风险组（总评分≥3分）96例和无营养风险组（总评分＜3分）90例。比较两组患者临床资料;采用Kaplan-Meier模型对两组患者的肿瘤无复发生存期(recurrence free survival,RFS)和总生存期(overall survival,OS)进行分析;患者RFS和OS的独立危险因素采用多因素Cox比例风险回归模型分析。结果:有营养风险组和无营养风险组在病理T分期、肿瘤大小、是否淋巴结转移、肾积水方面比较差异有统计学意义(P＜0.05);有营养风险组和无营养风组险5年RFS率分别为29.17％(28/96)、45.56％(41/90),5年OS率分别为43.75％(42/96)、58.89％(53/90);Kaplan-Meier分析结果显示,有营养风险组患者的RFS和OS均短于无营养风险组(P＜0.05);Cox比例风险回归模型显示,术前营养风险是影响膀胱癌根治术患者RFS和OS的独立危险因素(P＜0.05)。结论:术前有营养风险是膀胱癌根治术患者RFS和OS的独立危险因素,有营养风险的患者术后预后更差。     

Association of screening status,polygenic risk score and environmental risk factors with colorectal cancer incidence and mortality risks

Whether screening can attenuate the influence of genetic risk and environmental risk factors for colorectal cancer (CRC) mortality risk remains unknown. Our study is to investigate the association of the screening history, genetic risk and environmental risk factors with CRC incidence and mortality risks using UK Biobank data. Screening history was associated with lower CRC incidence (hazard ratio [HR]: 0.63, 95% confidence interval [CI]: 0.58-0.69) and mortality risk (HR: 0.56, 95% CI: 0.49-0.63). Compared to the HRs of participants with a low genetic risk, low environmental risk and no screening history, the HRs of participants with a high genetic risk, high environmental risk and no screening history were 3.42 (95% CI: 2.76-4.24) for CRC incidence and 3.36 (95% CI: 2.48-4.56) for CRC mortality. In contrast, the HRs of participants with a high genetic risk and no screening history, but a low environmental risk, were 1.92 (95% CI: 1.55-2.36) for CRC incidence and 1.88 (95% CI: 1.39-2.53) for CRC mortality. Furthermore, the HRs of participants with a high genetic risk and a low environmental risk, but a screening history were 1.62 (95% CI: 1.15-2.28) for CRC incidence and 1.77 (95% CI: 1.08-2.89) for CRC mortality. Participants benefited more substantially from screenings for CRC mortality than for CRC incidence risk. A higher environmental risk was associated with higher risk of CRC incidence and mortality within each category of genetic risk. These findings emphasize the importance of CRC screening and identifying environmental factors to reduce CRC incidence and mortality risks.     

A randomized trial of specialist genetic assessment: psychological impact on women at different levels of familial breast cancer risk

The aim was to compare the psychological impact of a multidisciplinary specialist genetics service with surgical provision in women at high risk and those at lower risk of familial breast cancer. Women (n=735) were randomized to a surgical consultation with (trial group) or without (control group) specialist genetic risk assessment and the possible offer of presymptomatic genetic testing. Participants completed questionnaires before and immediately after the consultation to assess anxiety, cancer worry, perceived risk, interest in genetic testing and satisfaction. Responses of subgroups of women stratified by clinicians as low, moderate, or high risk were analyzed. There were no significant main effects of study intervention on any outcome variable. Regardless of risk information, there was a statistically significant reduction in state anxiety (P<0.001). Reductions in cancer worry and perceived risk were significant for women at low or moderate risk (P<0.001) but not those at high risk, and satisfaction was significantly lower in the high risk group (P<0.001). In high risk women who received specialist genetic input, there was a marginally significant trend towards increased perceived risk. The effect of risk information on interest in genetic testing was not significant. Breast care specialists other than geneticists might provide assessments of breast cancer risk, reassuring women at reduced risk and targeting those at high risk for specialist genetic counselling and testing services. These findings are discussed in relation to the existing UK Calman-Hine model of service delivery in cancer genetics. DOI: 10.1038/sj/bjc/6600051 www.bjcancer.comCopyright 2002 The Cancer Research Campaign     

食管癌高、低发区胃粘膜活检的病理比较分析

本文对食管癌高发区辉县及低发区范县的内镜活检胃粘膜进行了组织学对比分析。结果表明,不论高、低发区慢性胃炎都很常见,高发区总检出率为77.66％,低发区为68.64％,前者明显高于后者(P<0.01),各型胃炎中萎缩性胃炎的检出率高发区明显高于低发区(P<0.01),肠化出现率高发区也比低发区高(P<0.05),由此可见,食管癌高发区慢性胃炎患病情况较低发区更严重。     

胃癌围手术期营养风险和并发症影响因素分析

目的 胃癌是最常见的消化道恶性肿瘤,围手术期营养风险和并发症发生率较高,本研究旨在分析胃癌患者围手术期营养风险和并发症的影响因素.方法 收集2011-11-01-2014-11-01山东大学附属山东省肿瘤医院胃肠外科876例胃癌手术患者的营养风险、营养支持和围手术期并发症等数据,分析营养风险以及并发症的相关因素,进一步分析营养支持和并发症的关系.结果 (1)有营养风险492例,发生率为56.2％,其中积分3分占27.1％,4～7分占29.1％.单因素分析结果显示,年龄、临床分期、病理鲍曼分型和并发症与营养风险相关;多因素分析显示,年龄＞65岁、病理Ⅲ期和并发症是独立危险因素.(2)有并发症158例,发生率为18.0％.单因素分析显示,年龄、病理分期、鲍曼分型、术中出血量、ASA评分、营养风险和并发症与并发症显著相关;多因素分析显示,年龄＞65岁、病理分期Ⅲ期、营养风险、ASA评分和并发症是独立危险因素.(3)分层分析显示,有风险者营养支持并发症为17.9％,低于无规范营养支持的29.2％,无营养风险者营养支持对并发症无显著性影响.结论 影响胃癌营养风险和并发症的独立危险因素有年龄、病理分期和并发症,营养风险为并发症的独立危险因素,规范的营养支持为营养风险者并发症的保护性因素.     

Uncertainty of calculated risk estimates for secondary malignancies after radiotherapy

PURPOSE: The significance of risk estimates for fatal secondary malignancies caused by out-of-field radiation exposure remains unresolved because the uncertainty in calculated risk estimates has not been established. This work examines the uncertainty in absolute risk estimates and in the ratio of risk estimates between different treatment modalities. METHODS AND MATERIALS: Clinically reasonable out-of-field doses and calculated risk estimates were taken from the literature for several prostate treatment modalities, including intensity-modulated radiotherapy (IMRT), and were recalculated using the most recent risk model. The uncertainties in this risk model and uncertainties in the linearity of the dose-response model were considered in generating 90% confidence intervals for the uncertainty in the absolute risk estimates and in the ratio of the risk estimates. RESULTS: The absolute risk estimates of fatal secondary malignancy were associated with very large uncertainties, which precluded distinctions between the risks associated with the different treatment modalities considered. However, a much smaller confidence interval exists for the ratio of risk estimates, and this ratio between different treatment modalities may be statistically significant when there is an effective dose equivalent difference of at least 50%. Such a difference may exist between clinically reasonable treatment options, including 6-MV IMRT versus 18-MV IMRT for prostate therapy. CONCLUSION: The ratio of the risk between different treatment modalities may be significantly different. Consequently risk models and associated risk estimates may be useful and meaningful for evaluating different treatment options. The calculated risk of secondary malignancy should be considered in the selection of an optimal treatment plan.     

Breast cancer risk perception: what do we know and understand?

Women's perceptions of breast cancer risk are largely inaccurate and are often associated with high levels of anxiety about cancer. There are interesting cultural differences that are not well researched. Genetic risk counselling significantly improves accuracy of women's perceptions of risk, but not necessarily to the correct level. Reasons for this are unclear, but may relate to personal beliefs about susceptibility and to problems or variations in risk communication. Research into the impact of demographic and psychological factors on risk perception has been inconclusive. An understanding of the process of developing a perception of risk would help to inform risk counselling strategies. This is important, because knowledge of risk is needed both for appropriate health care decision making and to reassure women who are not at increased risk.     

Identification and management of the woman at increased risk for breast cancer development

Multiple factors which increase a woman's breast cancer risk have been identified. These range from conditions such as lobular carcinomain situ which increase risk to relatively high levels, to reproductive factors such as nulliparity which are associated with only a small increase in risk. When determining an individual's risk, all her potential breast cancer risk factors must be considered. In order for risk information to be meaningful to a woman, risk must be expressed as absolute risk over a defined time interval since there is no uniform agreement on what risk level is high enough to require intervention. At present, careful follow-up or prophylactic mastectomy are the management options available for the woman at increased risk. The efficacy of follow-up including breast self exam, physician exams, and screening mammography for early detection of cancer in a high risk population is unknown. Prophylactic mastectomy, while highly effective, does not provide complete protection from breast cancer and is more radical than the surgery done for established cancer in many cases. Which of these options is chosen by an individual woman is dependent on how much risk she is willing to assume.     

Delivering Information about Cancer Genetics via Letter to Patients at Low and Moderate Risk of Familial Cancer: A Pilot Study in Wales

Increasing demands upon specialist cancer genetics services have resulted in a need to explore alternative means of delivering genetic risk information to individuals at low-risk of familial cancer. This pilot study investigates patient satisfaction with a letter to low and moderate risk individuals notifying them of their risk. Sixty-six people completed a questionnaire designed to measure satisfaction with the way they had been notified of their cancer risk. Two key findings emerge from the data: first of all, whilst many respondents indicated overall satisfaction with the risk letter, a substantial number wanted more information about their risk; and secondly, low-risk individuals in this study are less reassured by and less satisfied with the risk letter than those at moderate risk. The optimal service provision for delivery of genetic risk information is likely to be one which can best respond to individual differences in information-seeking, distress and risk comprehension. There is a need therefore, for a randomised control trial to compare the effectiveness of a risk notification letter with more traditional telephone risk counselling and the implications of each mode of delivery upon the resources of specialist cancer genetics services.     

Population risk, actual risk, perceived risk, and cancer control: a discussion

Given the difficulty of converting population-based estimates of cancer risk into precise statements of individual risk, it is not surprising that (a) individual differences in risk perception are at best poorly correlated to the best available determination of "actual risk" and to behaviors to prevent and detect and treat cancer, and (b) success in bringing perceived risk into line with actual risk has been limited. These inconsistencies are of concern because individual perceptions of risk are thought to be important motivators of action for the prevention and early detection and treatment of cancer. Following the reviewer's suggestion that risk perceptions are readily influenced by contextual factors, we suggest examining risk perception in a self-regulatory framework in which both risk judgments and motivated action are products of underlying representations of cancer and the self. Self-assessments of risk may access only a part of the data necessary for motivation, whereas motivation to sustain action calls on a larger number of concrete features of the database (symptoms, time loss, consequences). Studies of cancer risk perception can make a major contribution to our understanding of processes involved in self-appraisals and self-management to maximize well-being and to avoid catastrophic disease.     

Modifiers of risk of hereditary breast cancer

Mutations in the BRCA1 and BRCA2 genes confer a high lifetime risk of breast and ovarian cancer. The risk varies from individual to individual, and it appears that the risk has increased in recent generations. These observations imply that non-genetic factors may modify the inherited risk. To date, the factors that appear most strongly to modify the risk include reproductive histories and exogenous hormones. Oral contraceptives are associated with a profound reduction in the risk of ovarian cancer, and with little or no increase in the risk of breast cancer. Other modifying factors include age of menarche, parity, breastfeeding and oophorectomy. The effect of parity is different in BRCA1 and BRCA2 carriers. Multiparity appears to be protective in BRCA1 carriers, but is associated with an increase in risk in BRCA2 carriers. Oophorectomy has been associated with reductions in both the risk of breast and ovarian cancer. Knowledge of these risk factors will be useful for managing risk and for developing prevention strategies.