武汉地区目标人群结直肠癌筛查4年初步报告

目的 了解武汉地区结直肠癌的患病率,探索并分析开展城市居民恶性肿瘤二级预防的措施和序贯粪隐血筛检试验（SFOBT）方案的应用。方法采用整群分层随机抽样,选取19个筛查点的63961人作为目标人群,连续4年对筛查对象（40岁以上者）进行SFOBT,对阳性者行结肠镜精筛。结果目标人群中的筛查对象25837例（40．4％）,接受SFOBT者7784例（30．1％）,男女比例1．0：1．1．中位年龄56岁。SFOBT阳性者956例（12.3％）,其中240例（25．1％）接受结肠镜检查,检出有病变者214例（89．2％）,其中结直肠癌14例（6．5％）,TNMⅠ、Ⅱ期11例,占检出结直肠癌的78．6％;结直肠腺瘤53例（24．8％）;直肠炎75例（35．0％）;溃疡性结肠炎5例（2.3％）;痔和肛门疾病65例（30．4％）;胃癌2例（0．8％）。结论武汉地区40岁以上人群结直肠癌的患病率为6．5％,SFOBT方案能比较有效地从目标人群中检出早期结直肠癌和癌前病变。     

直肠指检和肠镜检查在直肠癌和大肠癌筛查中的效果评价

为评价直肠指检和肠镜检查在普通人群直肠癌和大肠癌筛查中的效果,本研究以问卷调查和免疫法大便隐血试验（FOBT）检查为初筛,直肠指检和肠镜检查为复筛,作为大肠癌筛查方案,以海宁市普通人群7831例初筛人群中1015例高危人群的直肠指检和肠镜检查结果为样本,定义距肛门≤10cm且直径≥1．0cm的肿块为直肠指检能够发现,距肛门〉10cm的肿块和肿块虽距肛门≤10cm但直径〈1．0cm,为直肠指检所不能发现。分析直肠指检和肠镜检查对直肠肿瘤和大肠肿瘤的检出效果。结果显示,距肛门≤10cm肿瘤占筛查发现的大肠肿瘤总例数的31．3％（56／179）;经直肠指检筛查,直肠肿瘤和大肠肿瘤的检出率分别为2．6％（3／115）和1．7％（3／179）,直肠癌和大肠癌的检出率分别为50．0％（2／4）和25．0％（114）,进展性直肠肿瘤和大肠肿瘤的检出率分别为40．0％（4／10）和14．8％（4／27）。结果表明,直肠指检在普通人群的直肠癌检查中至关重要,对大肠癌的筛查需进行肠镜检查。     

一项基于人群的筛检调查:结直肠癌患者一级亲属的结肠镜检查结果

对结直肠癌患者的一级亲属(FDRs)推荐行结肠镜检查进行筛检,现只有少数前瞻性对照研究评价了结肠镜检查在人群中的筛检效果。为了评价FDRs人群中结直肠肿瘤(腺瘤和腺癌)的患病率与一般人群的差别,并探索可能使FDRs患病风险增加的因素,Armelao F等采用横向研究的方法,对1 252位年龄为45～75岁的直肠癌患者的FDRs和765位一般人群行结     

半乳糖氧化酶试验在大肠癌诊断上的应用（附47例纤维结肠镜检对照分析）

半乳糖氧化酶试验（GO-S试验）用于临床筛检大肠癌，对47例进行直肠粘液GO-S试验，结果无论是阴笥或阳性者，均进行纤维结肠镜对照检查，结果表明：6例直肠癌阳性者4例（66.67%）；41例非癌组阳性者4例（9.75%）。其中腺瘤2例，32例正常人中仅2例阳性（6.25%）。本组资料表明该试验对大肠癌检出的敏感性为66.67%，特异性为90.24%，阳性预告值为50%。提示GO-S试验对大肠癌检出有较高的敏感性和特异性，弥补了潜血方法的不足，在临床上推广应用对于早期大肠癌的诊断有着十分积极的意义和广泛的前景。     

粪便 SDC2基因甲基化检测在东莞市石排镇居民结直肠癌早期筛查的应用价值研究

目的探讨粪便SDC2基因甲基化(mSDC2)检测在东莞市石排镇居民结直肠癌早期筛查的应用价值。方法本研究采用横断面研究方法。2021年5月至2022年2月期间, 东莞市石排镇政府采用整群抽样方法确定东莞市石排镇18个村的筛查范围, 对符合初筛标准的居民由东莞市石排医院开展粪便mSDC2检测, 确定高危人群, 初筛阳性者建议其接受肠镜复查。观察mSDC2检测初筛的阳性率、肠镜依从率、肠镜检出率以及筛查成本-效益。结果有效筛查人数共计10 708人, 筛查参与率54.99%(10 708/19 474), 合格率97.87%(10 708/10 941)。筛查对象中, 男性4 713例(44.01%), 女性5 995例(55.99%), 年龄为(54.52±9.64)岁;以年龄段分组, 40～49岁组3 770人(35.21%), 50～59岁组3 882人(36.25%), 60～69岁组2 017人(18.84%), 70～74岁组1 039人(9.70%)。通过初筛检出mSDC2阳性结果的居民共计821人, 初筛阳性率为7.67%(821/10 708), 521人接受了肠镜检查,...     

联合检测粪便中多基因突变进行大肠癌二级筛查的研究

目的通过研究p53、K-ras及APC在大肠癌组织及粪便中的突变情况,探讨粪便多基因联合检测进行大肠癌二级筛查的可行性。方法应用聚合酶链反应-单链构象多态性(PCR-SSCP)分析及硝酸银染色法,检测40例大肠癌患者的肿瘤组织与粪便及40例正常人肠黏膜组织与粪便中p53、K-ras及APC3种基因的突变情况,并比较多个基因联合检测与单基因检测基因突变率的灵敏性之间的差异。结果①40例大肠癌组织中p53、K-ras及APC基因突变率分别为57.50%、50.00%及60.00%,粪便中相应的基因突变率分别为42.86%、40.00%及51.43%,粪便基因突变与组织中相应基因突变的符合率分别为65.22%、70.00%及75.00%。40例正常肠黏膜组织及粪便中3种基因均未检出突变;②3种基因联合检测的突变率明显高于单基因检测(P<0.05);③粪便基因联合检测与粪便隐血试验比较,灵敏性之间差异无统计学意义,但前者的特异性明显高于后者(P<0.05)。结论粪便基因联合检测诊断大肠癌的灵敏性及特异性均较高,有望作为一种无创、特异、有效的筛查手段,与粪便隐血试验结合序贯进行大肠癌的筛查。     

纳布啡预防胃肠镜检查术患儿丙泊酚中长链脂肪乳注射痛的量效关系

目的:确定纳布啡预防胃肠镜检查术患儿丙泊酚中长链脂肪乳注射痛的量效关系。方法:选择胃肠镜检查术患儿,年龄3～8岁,ASA分级Ⅰ或Ⅱ。采用改良序贯法进行试验,第1例患儿静脉注射纳布啡0.2 mg/kg,5 min后静脉注射丙泊酚中长链脂肪乳2.5 mg/kg。采用Ambesh 4分法评价丙泊酚注射痛,注射痛预防无效,则下...     

103例大肠癌早期诊断的临床体会

目的探讨大肠癌早期诊断方法。方法回顾性分析103例大肠癌临床资料。结果主要临床表现:大便习惯改变(即便频、腹泻、便秘或二者交替、便形变细等)64例,粘液便、血便、里急后重76例,贫血、乏力、食欲下降、消瘦16例,发热、腹痛、腹胀15例。79例经首诊、贯序检查(直肠指诊、粪潜血试验、直肠镜及纤维结肠镜等)即确诊。24例误漏诊,误诊疾病:缺铁性贫血13例,肠梗阻12例,慢性肠炎12例,慢性阑尾炎4例,痔3例,肛周脓肿3例,大肠多原发癌漏诊1例。结论警惕大肠癌早期信号,对肠道症状仔细鉴别,合理贯序检查及正确的操作技术是早期诊断大肠癌的关键。     

进展期大肠癌围手术期及化疗期中药序贯治疗30例

目的：探讨中药序贯治疗在进展期大肠癌围手术期及化疗期的疗效。方法：选择30例进展期大肠癌患者,术前用大承气汤加味,术后用增液承气汤加味,化疗期间用八珍汤加味治疗,化疗采用FOLFOX-4方案。并与前期单纯手术和化疗的30例作回顾性对照。结果：中药序贯治疗组围手术期及化疗期胃肠功能恢复、下床活动时间、不良反应及生活质量KPS评分,与对照组差异有显著意义（P〈0.01）。结论：中药序贯治疗在进展期大肠癌围手术期能促进术后恢复,在化疗期能减轻毒副作用,提高生活质量。     

武汉地区目标人群结直肠癌筛查4年初步报告

例(89.2%),其中结直肠癌14例(6.5%),TNM Ⅰ、Ⅱ期11例,占检出结直肠癌的78.6%;结直肠腺瘤53例(24.8%);直肠炎75例(35.0%);溃疡性结肠炎5例(2.3%);痔和肛门疾病65例(30.4%);胃癌2例(0.8%).结论 武汉地区40岁以上人群结直肠癌的患病率为6.5%,SFOBT方案能比较有效地从目标人群中检出早期结直肠癌和癌前病变.     

Vasopressor hormone response following mesenteric traction during major abdominal surgery

Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI₂) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI₂), TXB₂ (stabile metabolite of thromboxane A₂) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI₂ release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF_1α (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB² (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI₂ release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A₂, presumably contributing to hemodynamic stability within 30 min after MT.     

A Teaspoon Pump for Pumping Blood with High Hydraulic Efficiency and Low Hemolysis Potential

Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.     

Microspheres Based Detoxification System: A New Method in Convective Blood Purification

Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.     

Tissue perfusion in relation to cardiac output during continuous positive-pressure ventilation and administration of propranolol or verapamil

Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H₂O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg⁻¹ followed by 0.15 mg · kg⁻¹ · h⁻¹, n=8) or verapamil (0.1 mg · kg⁻¹ followed by 0.3 mg · kg⁻¹ · h⁻¹, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.     

Bariatric Surgery in Some "Central and East-European (former Eastern bloc)"Countries - Current Status and Prediction for the Next Millennium

Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.     

Volatile anaesthetics reduce adhesion of blood platelets under low-flow conditions in the coronary system of isolated guinea pig hearts

Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.     

Synergistic interaction between the effects of propofol and midazolam with fentanyl on phrenic nerve activity in rabbits

Background: It has been shown that the depressive effects of both propofol and midazolam on consciousness are synergistic with opioids, but the nature of their interactions on other physiological systems, e. g. respiration, has not been fully investigated. The present study examined the effect of propofol and midazolam alone and in combination with fentanyl on phrenic nerve activity (PNA) and whether such interactions are additive or synergistic. Methods: PNA was recorded in 27 anaesthetised and artificially ventilated rabbits. In three groups, propofol, fentanyl and midazolam were administered intravenously in incremental doses to construct dose-response curves for the depressant effects of each one on PNA. In another two groups, the effect of pretreatment with either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. on the effects of propofol and fentanyl respectively on PNA were studied. Results: Propofol and fentanyl caused a dose-dependent depression of PNA with complete abolition at the highest total doses of 16 mg · kg^?1 i. v. and 32 μg · kg^?1 i. v., respectively. In contrast, midazolam in incremental doses to a total of 0.8 mg · kg^?1 reduced mean PNA by 63%, but approximately 12% of PNA remained at a total dose as high as 6.4 mg · kg^?1. The mean ED₅₀s, calculated from dose-response curves, were 5.4 mg · kg^?1, 3.9 μg · kg^?1 and 0.4 mg · kg^?1 for propofol, fentanyl and midazolam, respectively. Initial doses of either fentanyl 1 μg · kg^?1 i. v. or midazolam 0.05 mg · kg^?1 i. v. acted synergistically with subsequent doses of either propofol or fentanyl to abolish PNA at total doses of 8 mg · kg^?1 and 8 μg · kg^?1, respectively. Conclusion: Fentanyl has a synergistic interaction with both propofol and midazolam on PNA and hence potentially on respiration.     

Influence of dopexamine hydrochloride on haemodynamics and regulators of circulation in patients undergoing major abdominal surgery

Background: Catecholaminergic support is often used to improve haemodynamics in patients undergoing major abdominal surgery. Dopexamine is a synthetic vasoactive catecholamine with beneficial microcirculatory properties. Methods: The influence of perioperative administration of dopexamine on cardiorespiratory data and important regulators of macro- and microcirculation were studied in 30 patients undergoing Whipple pancreaticduodenectomy. The patients received randomized and blinded either 2 μg · kg^?1 · min^?1 of dopexamine (n=15) or placebo (n=15, control group). The infusion was started after induction of anaesthesia and continued until the morning of the first postoperative day. Endothelin-1 (ET-1), vasopressin, atrial natriuretic peptide (ANP), and catecholamine plasma levels were measured from arterial blood samples. Measurements were carried out after induction of anaesthesia, 2 h after onset of surgery, at the end of surgery, 2 h after surgery, and on the morning of the first postoperative day. Results: Cardiac index (CI) increased significantly in the dopexamine group (from 2.61±0.41 to 4.57±0.78 1 · min^?1 · m^?2) and remained elevated until the morning of the first postoperative day. Oxygen delivery index (DO₂I) and oxygen consumption index (VO₂I) were also significantly increased in the dopexamine group (DO₂I: from 416±91 to 717±110 ml/m² · m²; VO₂I: from 98±25 to 157±22 ml/m² · m²), being significantly higher than in the control group. pHi remained stable only in the dopexamine patients, indicating adequate splanchnic perfusion. Vasopressive regulators of circulation increased significantly only in the untreated control patients (vasopressin: from 4.37±1.1 to 35.9±12.1 pg/ml; ET-1: from 2.88±0.91 to 6.91±1.20 pg/ml). Conclusion: Patients undergoing major abdominal surgery may profit from prophylactic perioperative administration of dopexamine hydrochloride in the form of improved haemodynamics and oxygenation as well as beneficial influence on important regulators of organ blood flow.     

Systemic analgesia adapted to the children's condition

A concept of balanced analgesia using nonsteroidal anti-inflammatory drugs (NSAIDs), paracetamol (acetaminophen), opioids, and corticosteroids can also be used in patients with pre-existing illnesses. NSAIDs are the most effective treatment for acute pain of moderate intensity in children; however, these drugs should be avoided in patients at increased risk for serious side effects, e.g. patients with renal impairment, bleeding tendency, or extreme prematurity. NSAIDs can be given with minimal risks to the younger child with mild to moderate asthma, and, in these patients, the use of steroids can be encouraged; in addition to their antiemetic and analgesic action, a beneficial effect on asthma symptoms can be expected. In the non-intubated child with cerebral trauma, exaggerated sedation caused by opioids and increased bleeding tendency caused by NSAIDs must be avoided. In neonates and small infants, the oral administration of sucrose or glucose is helpful to minimize pain reaction during short uncomfortable interventions.     

A comparison of the inhibitory effects of four volatile anaesthetics on the metabolism of chlorzoxazone, a substrate for CYP2E1, in rabbits

Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.