分子诊断和粪便隐血试验在结直肠癌诊断中的意义

目的探讨联合检测粪便中肿瘤分子标志物和粪便隐血试验对结直肠癌早期诊断的敏感度和特异度。方法检测68例不同结直肠癌患者的粪便标本的粪便隐血和APC、K—ras及p533种肿瘤相关分子标记物的突变。同时检测43名健康体检者的粪便标本。结果35例癌症患者粪便隐血试验呈现阳性[51％；95％可信区间（95％CI）为37％-64％]。45例标本肿瘤分子标志物发生改变（66％；95％CI为51％-77％）。两种方式检测的一致性较弱（Kappa值为0．023），其联合应用的敏感度为94％（95％CI为83％-97％）；特异度为90％（95％CI为76％-95％）。结论粪便隐血试验和分子诊断联合应用的敏感度高于任何一种单独的非创伤性诊断方式，有利于对结直肠癌患者的早期诊断。     

粪便钙卫蛋白检测在结直肠癌筛查中的应用价值

目的 探讨粪便钙卫蛋白(FC)在结直肠癌筛查中的临床应用价值.方法 前瞻性纳入于2020年11～12月期间,在首都医科大学附属北京友谊医院行结肠镜检查的患者,于结肠镜检查前3 d内留取患者的粪便样本行FC和便潜血检测.用受试者工作特征(ROC)曲线设定FC诊断结直肠癌的临界值,评估FC诊断结直肠癌的敏感度、特异度、阳性...     

粪便脱落细胞学与粪隐血试验联合检测在大肠癌筛查中的作用

对粪便脱落细胞学与粪隐血试验联合检测在大肠癌筛查中的作用探讨如下。1对象和方法1.1对象我院作结肠镜检查的患者274例,大肠癌组:87例(均经病理证实),其中男51例,女36例;Dukes分期:A期6例,B期36例,C期33例,D期11例,分期不详11例;分化程度:高分化33例,中分化37例,低分化11例。非大肠癌组:正常结肠70例,腺瘤60例,溃疡性结肠炎18例,慢性炎症19例,上消化道癌20例。1.2方法每位患者在肠镜检查前,留取自然排泄粪便两份,一份进行粪便隐血试验,一份加固定液后做粪便脱落细胞学检查。免疫粪隐血试剂盒采用胶体金人血红蛋白单抗检测试剂盒-消康保(…     

粪便检测在结直肠癌筛查中的研究进展

粪便是反映消化道病变的一个常见窗口,消化道以外的肿瘤细胞一般不可能从粪便中排出。因此,粪便的检测在消化道疾病的诊断中有重要意义,尤其对结直肠癌的筛查,已成为国内外各学者研究的热点。作者通过查阅国内外文献,将粪便检测在结直肠癌筛查中的研究进展作一综述。     

粪便SDC2基因甲基化检测联合结肠镜在早期结直肠癌筛查中的意义

目的探讨粪便SDC2基因甲基化检测联合结肠镜在早期结直肠癌(CRC)筛查中的意义。方法选择2018年1月-2019年10月在深圳市宝安区中心医院体检的1 000例体检者作为研究对象,使用试剂盒分别检测粪便SDC2基因甲基化和血浆SEPT9基因甲基化,对两者任一结果为阳性者再行结肠镜检查。比较SDC2和SEPT9基因甲基化检测的阳性率以及两者联合结肠镜对进展性腺瘤和CRC的检出率。结果在1 000例筛查对象中,粪便SDC2基因甲基化检测阳性率明显高于血浆SEPT9基因甲基化〔18.10%(181/1 000)比9.80%(98/1 000)〕,差异有统计学意义(P<0.05);粪便SDC2基因甲基化检测联合结肠镜对进展性腺瘤和CRC的检出率均明显高于血浆SEPT9基因甲基化检测联合结肠镜筛查〔进展性腺瘤检出率:2.50%(25/1 000)比1.00%(10/1 000),CRC检出率:1.50%(15/1 000)比0.50%(5/1 000)〕,差异均有统计学意义(均P<0.05)。结论粪便SDC2基因甲基化检测是一种简单无创的CRC筛查新技术,患者接受程度更高,能够避免大规模肠镜筛查带来的弊端,联合结肠镜检测可作为CRC早期筛查的首选策略。     

胶体金法和免疫比浊法大便隐血检测在结直肠癌筛查中的应用

目的 探讨胶体金法和免疫比浊法大便隐血检测在结直肠癌筛查中的应用。方法 选择魏县中医医院2019年1月—2020年1月收治的100例疑似结直肠癌患者作为研究对象,对所有患者进行胶体金法与免疫比浊法大便隐血检测。以病理检测为“金标准”,比较病理检测、胶体金法和免疫比浊法大便隐血检测的疾病检出率,分析胶体金法和免疫比浊法大便隐血检测对结直肠癌的诊断效能和检测用时。结果 病理检测与免疫比浊法大便潜血检测对结直肠癌的检出率均明显高于胶体金法大便潜血检测〔69.00%(69/100)、65.00%(65/100)比51.00%(51/100),均P<0.05〕。免疫比浊法大便潜血检测对结直肠癌诊断的敏感度、特异度、准确度、阳性预测值、阴性预测值分别为89.86%、90.23%、90.00%、95.38%、80.00%,均明显高于胶体金法大便潜血检测(分别为63.77%、77.42%、68.00%、86.27%、48.98%),差异均有统计学意义(均P<0.05)。胶体金法与免疫比浊法大便隐血检测用时比较差异无统计学意义(min：35.56±3.71比36.98±6.22,P>0...     

三维CT与结肠镜在结、直肠癌中的应用价值比较

目的：比较三维多层螺旋CT（MSCT）与结肠镜诊断结、直肠癌的临床价值。材料与方法：对261例结、直肠癌患者进行纤维结肠镜及全腹容积扫描，在工作站分别行多平面重建（MPR）、表面遮盖显示（SSD）、仿真内窥镜（CTVE）等多种重建成像，观察癌肿、局部浸润、淋巴结及远处转移的情况，并与结肠镜及手术病理对照。结果：MSCT能准确地显示肿瘤的大体分型与发生部位，诊断符合率为100%，并且可获得管腔外病变信息。结肠镜显示肿瘤直观、并可获得病理资料，但在肿瘤定位方面存在不足。结论：结肠三维CT快捷、安全、准确，对结、直肠癌的诊断具有很高的应用价值。与纤维结肠镜联合应用，可以全面客观地指导医生选择科学的手术方法，应该成为术前的常规检查项目。     

重视粪便血红蛋白免疫学检测在结直肠癌筛查中的应用及质量控制

结直肠癌(CRC)的发病率高且呈上升趋势，多数患者在就诊时已出现血便及局部浸润或转移。粪便血红蛋白免疫学检测(FIT)可筛查出一般风险人群中一定比例的结直肠进展期腺瘤(AA)和CRC,降低CRC的发病率和死亡率。FIT被广泛用于CRC的筛查。该文对FIT用于CRC筛查的风险和获益、一般风险人群的筛查策略、现实与理想筛查模型及其质量控制进行概述。     

胶体金法和免疫比浊法大便隐血检测在人群结直肠癌筛查中的应用价值

目的探讨胶体金法和免疫比浊法大便隐血检测在人群结直肠癌筛查中的应用价值。方法选取的80例研究对象是经我院确诊为结直肠癌患者,选取的时间段为2018年10月-2019年8月。所有患者均接受胶体金法和免疫比浊法两组检测方式,对其检测结果进行观察。结果免疫比浊法检测的敏感度、特异度以及诊断符合率均高于胶体金法检测方法,有统计学意义(P<0.05)。结论比起胶体金法检测方式,免疫比浊方法更具有显著优势,能够快速筛查结直肠癌患者,适用于易感人群的大规模筛查,便于进行治疗和促进疾病的早日康复。     

免疫法粪便潜血试验用于上消化道出血性疾病诊断的评价

粪便潜血试验(Fecal Occult blood,FOB)是临床诊断和监测消化道出血性疾病的一项重要常规检查项目[1],也是普查和筛选消化道肿瘤的有效手段之一[2,3].近年来国内外学者先后建立了以抗原抗体反应为原理检测粪便潜血的免疫学方法,使得潜血试验方法学的灵敏度和特异性有了较大提高[4].然而在实际应用中发现:免疫法粪便潜血试验在上消化道出血性疾病中的阳性率偏低[5,6]:为此我们对导致免疫法粪便潜血试验检测上消化道出血假阴性结果进行了分析,并提出了检测粪便潜血的项目内容、报告模式以及如何就实验结果向临床作出合理的解释.现将结果报告如.     

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.     

Self-Guided Online Cognitive Behavioral Strategies for Chemotherapy-Induced Peripheral Neuropathy: A Multicenter,Pilot, Randomized,Wait-List Controlled Trial

The purpose of this pilot, parallel, randomized controlled trial was to examine the efficacy of a self-guided online cognitive and behaviorally-based pain management intervention (Proactive Self-Management Program for Effects of Cancer Treatment [PROSPECT]) to reduce “worst” pain for individuals with chronic painful chemotherapy-induced peripheral neuropathy (CIPN). Secondary outcomes included “average” pain, nonpainful CIPN symptom severity, impression of change, and pain interference. Sixty patients with chronic painful CIPN were recruited from 5 outpatient academic and community cancer centers. Patients were randomized in a 1:1 ratio to receive either 8 weeks of PROSPECT or usual care. A 7-day electronic “worst” pain intensity diary and standardized measures of pain interference, nonpainful CIPN symptom severity, impression of change, and “average” pain were administered pre/post intervention. Postintervention mean scores were evaluated between groups using analysis of covariance adjusting for baseline. Individuals who received the PROSPECT intervention (n?=?19) had significantly greater improvements in “worst pain” compared with individuals receiving usual care (n?=?19; P?=?.046, d?=?.58). There were no significant differences in mean scores between groups for the secondary outcomes (n?=?42). A larger, adequately powered study testing the PROSPECT intervention is needed to determine if improvements in pain may be sustained, evaluate the effect of the intervention on the secondary outcomes, and identify mediators of pain intensity-related improvement.

Written Pain Neuroscience Education in Fibromyalgia: A Multicenter Randomized Controlled Trial

Mounting evidence supports the use of face‐to‐face pain neuroscience education for the treatment of chronic pain patients. This study aimed at examining whether written education about pain neuroscience improves illness perceptions, catastrophizing, and health status in patients with fibromyalgia. A double‐blind, multicenter randomized controlled clinical trial with 6‐month follow‐up was conducted. Patients with FM (n = 114) that consented to participate were randomly allocated to receive either written pain neuroscience education or written relaxation training. Written pain neuroscience education comprised of a booklet with pain neuroscience education plus a telephone call to clarify any difficulties; the relaxation group received a booklet with relaxation education and a telephone call. The revised illness perception questionnaire, Pain Catastrophizing Scale, and fibromyalgia impact questionnaire were used as outcome measures. Both patients and assessors were blinded. Repeated‐measures analyses with last observation carried forward principle were performed. Cohen's d effect sizes (ES) were calculated for all within‐group changes and between‐group differences. The results reveal that written pain neuroscience education does not change the impact of FM on daily life, catastrophizing, or perceived symptoms of patients with FM. Compared with written relaxation training, written pain neuroscience education improved beliefs in a chronic timeline of FM (P = 0.03; ES = 0.50), but it does not impact upon other domains of illness perceptions. Compared with written relaxation training, written pain neuroscience education slightly improved illness perceptions of patients with FM, but it did not impart clinically meaningful effects on pain, catastrophizing, or the impact of FM on daily life. Face‐to‐face sessions of pain neuroscience education are required to change inappropriate cognitions and perceived health in patients with FM.     

Effectiveness of Immersive Virtual Reality in People with Cancer Undergoing Antiblastic Therapy: A Randomized Controlled Trial

ObjectivesThis study aims to assess the effects of immersive Virtual Reality in people with cancer undergoing antiblastic therapy, on anxiety, fatigue and pain.Data SourcesThis is a randomized controlled three-arm trial. Seventy-four cancer patients were recruited from a regional hospital in Italy, and randomly allocated into three groups: a Virtual Reality group (n=25), a narrative medicine group (n=25) and a standard care group (n=24). The primary outcome was anxiety. Secondary outcomes included fatigue and pain. The outcomes were evaluated immediately before and after the interventions. The findings showed that anxiety decreased more in the Virtual Reality group (Δpre-post = 6.24, 95% CI 2.578 to 9.902, p=.001, d = 0.63) than in the narrative medicine group, whereas it did not change for those in the standard care group. Fatigue decreased in the Virtual Reality group (Δpre-post = 0.576, 95% CI 0.246 to 0.907, p=.001, d = 0.23), while remaining stable in the narrative medicine group, and increasing in the standard care group. Average levels of pain did not change before and after the intervention [F(1,71) = 1.06, p=.307, ηp2 = .015].ConclusionFindings show that virtual reality is effective to reduce anxiety and fatigue in people with cancer undergoing antiblastic therapy.Implications for Nursing PracticeVirtual Reality can be recommended as an complementary intervention to manage anxiety and fatigue in people with cancer during antiblastic therapy.Trial registrationClinicalTrials.gov NCT05629507.     

Determination of the Effectiveness of Informing With the Guidance of an Education Booklet in Patients Undergoing Colonoscopy—A Randomized Controlled Trial

PurposeThe aim of this study was to determine the effect of precolonoscopy information with the guidance of an education booklet on anxiety and bowel preparation adequacy in patients undergoing colonoscopy.DesignA randomized controlled study.MethodsThe education group was informed face to face by the researcher with the guidance of the colonoscopy education booklet and provided the education booklet. The control group received usual care.FindingsThe mean state and trait anxiety scores of the patients in the education group were found to be significantly lower than the control group. In the education group, the bowel preparation adequacy was determined to be higher compared with the control group.ConclusionsInforming patients with the guidance of the education booklet before the colonoscopy decreased patients' state and trait anxiety levels and increased their bowel preparation adequacy.     

Effects of Ivermectin in Patients With COVID-19: A Multicenter,Double-blind,Randomized, Controlled Clinical Trial

PurposeGiven the coronavirus disease 2019 (COVID-19) pandemic, there is a global urgency to discover an effective treatment for patients withthis disease. This study aimed to evaluate the effects of the widely used antiparasitic drug ivermectin on outcomes in patients with COVID-19.MethodsIn this randomized, double-blind clinical trial, patients with COVID-19 admitted to 2 referral tertiary hospitals in Mazandaran, Iran, were randomly divided into 2 groups: intervention and control. In addition to standard treatment for COVID-19, the intervention group received a single weight-based dose (0.2 mg/kg) of ivermectin; the control group received the standard of care. Demographic, clinical, laboratory, and imaging data from participants were recorded at baseline. Patients were assessed daily for symptoms and disease progression. The primary clinical outcome measures were the durations of hospital stay, fever, dyspnea, and cough; and overall clinical improvement.FindingsSixty-nine patients were enrolled (mean [SD] ages: ivermectin, 47.63 [22.20] years; control, 45.18 [23.11] years; P = 0.65). Eighteen patients (51.4%) in the ivermectin group and 18 (52.9%) in control group were male (P = 0.90). The mean durations of dyspnea were 2.6 (0.4) days in the ivermectin group and 3.8 (0.4) days in the control group (P = 0.048). Also, persistent cough lasted for 3.1 (0.4) days in the ivermectin group compared to 4.8 (0.4) days in control group (PP = 0.019). The mean durations of hospital stay were 7.1 (0.5) days versus 8.4 (0.6) days in the ivermectin and control groups, respectively (P = 0.016). Also, the frequency of lymphopenia decreased to 14.3% in the ivermectin group and did not change in the control group (P = 0.007).ImplicationsA single dose of ivermectin was well-tolerated in symptomatic patients with COVID-19, and important clinical features of COVID-19 were improved with ivermectin use, including dyspnea, cough, and lymphopenia. Further studies with larger sample sizes, different drug dosages, dosing intervals and durations, especially in different stages of the disease, may be useful in understanding the potential clinical benefits ivermectin. Iranian Registry of Clinical Trials identifier: IRCT20111224008507N3.     

Effectiveness of a Web-Based Direct-to-User Transfer Training Program: A Randomized Controlled Trial

ObjectiveTo determine the effectiveness of a web-based, direct-to-user transfer training program in improving transfer quality and maintaining improvements for up to 1 month after training as compared with a control group.DesignRandomized controlled trial with participants randomized to an immediate intervention group (IIG) or waitlist control group (WLCG) that received the training after a 6-month delay.SettingWherever the participants accessed the web-based training, likely the home environment.ParticipantsConvenience sample of full-time wheelchair users (N=72; IIG, n=34; WLCG, n=38 for between-group analysis, n=48 for combined within-group analysis) with spinal cord injury or disorder who were able to independently perform a lateral scoot transfer.InterventionsSelf-paced, web-based transfer training module.Main Outcome MeasuresTransfer Assessment Instrument Questionnaire (TAI-Q) score at baseline, 1 month, and 6 months postbaseline (WLCG only), immediately posttraining, and 1 month posttraining. The TAI-Q is an 18-item self-assessment that covers several aspects of a quality transfer.ResultsThe IIG significantly increased particpants’ baseline TAI-Q score from 6.91±0.98 to 7.79±1.12 (P<.001) by 1 month posttraining. The WLCG also increased from baseline to the 1-month postbaseline assessment (from 6.52±1.13 to 7.00±1.09; P=.014), potentially from learning effects secondary to self-assessment with the TAI-Q. The extent of change over time did not differ significantly between the IIG and WLCG from baseline to 1 month (P=.169). However, significant improvements in TAI-Q scores were still evident after the training for the WLCG (P<.001). Those with a lower pretraining TAI-Q score and more shoulder pain were most likely to benefit from the training.ConclusionsRepeated TAI-Q self-assessments likely contributed to improved transfer quality, with web-based training having an additive effect. Wheelchair users are likely to benefit from transfer training and self-assessment of transfer quality in their home environments. This has the potential to decrease injury risk while avoiding barriers to in-person training.