喉部分切除双蒂双肌瓣修复术远期疗效分析

目的评价喉部分切除双蒂双肌瓣修复术的远期疗效。方法对1993年1月至1996年1月间喉部分切除双蒂双肌瓣修复的111例喉鳞癌病人进行随访及疗效分析。其中,声门上水平部分喉切除54例,垂直部分喉切除44例,3/4部分喉切除13例。结果总的3、5年生存率分别为86.5%、76.6%,复发率12.6%,术后发音功能良好,83例于2～4周内恢复吞咽功能,气管套管拔除率91.0%。结论喉部分切除双蒂双肌瓣修复术在保证生存率的同时,有效地保留了喉功能,提高了生存质量,是一种较好的修复方法。     

Automatic laboratory-initiated reflex testing to identify patients with autoimmune hemolytic anemia

The clinical usefulness of automatic laboratory-initiated testing of patients with recent-onset normocytic anemia to diagnose autoimmune hemolytic anemia (AIHA) is uncertain. During a 28-month period, we performed 784,185 CBC counts. Patients without a history of anemia had reticulocyte count testing if hemoglobin values were less than 10 g/dL (< 100 g/L) and mean corpuscular volume was 80 microm3 (80 fL) or more. A direct antiglobulin test (DAT) was performed if the uncorrected reticulocyte count was 2% or more of the RBCs (> or equal 0.02). Of 784,185 CBC counts, 3,841 (0.49%) revealed recent-onset normocytic anemia, 424 (11.04%) with reticulocyte counts of 2% (0.02) or more. Of those with elevated reticulocytes counts, 52 (12.3%) had positive DAT results. Patient information was available for 40 patients. Physicians were unaware of the existence of AIHA in 33 (83%) of them. Of the 40 patients, 11 (28%) were treated with steroids and 6 (15%) were hospitalized; in 2 patients (5%), medications were stopped because they were suspected to have caused the hemolytic anemia. Automatic laboratory testing for patients with recent-onset normocytic anemia ensures recommended practices, probably saves physician visits, and, for some patients, results in more timely diagnosis and appropriate treatment.     

Administration of human insulin-like growth factor-binding protein-1 increases circulating levels of growth hormone in mice

GH is the major regulator of circulating IGF-I, which, in return, controls pituitary GH secretion by negative feedback. IGF-binding protein-1 (IGFBP-1) is believed to modify this feedback through its effects on free IGF-I. In the present study we investigated the potential influence of IGFBP-1 on GH secretion in the absence or presence of a GH receptor antagonist (GHRA) that specifically blocks peripheral GH action. We administered human (h) IGFBP-1 and GHRA to mice alone or in combination for 2 or 7 d. GHRA was administered in a dose previously shown to block GH action without an effect on circulating GH or IGF-I levels. hIGFBP-1 administration increased stimulated circulating GH levels and serum total IGF-I and IGFBP-3 levels. Coadministration of GHRA abolished the hIGFBP-1-induced increase in serum IGF-I and IGFBP-3 levels, whereas stimulated GH levels remained increased. Free IGF-I levels in serum were unchanged in all treatment groups. In conclusion, GH serum levels increased in response to hIGFBP-1 administration, even in the setting of normal IGF-I levels. This finding suggests a direct involvement of IGFBP-1 in GH secretion.     

Diagnostic performance of a faecal immunochemical test for patients with low-risk symptoms of colorectal cancer in primary care: an evaluation in the South West of England

Background The faecal immunochemical test (FIT) was introduced to triage patients with low-risk symptoms of possible colorectal cancer in English primary care in 2017, underpinned by little primary care evidence.Methods All healthcare providers in the South West of England (population 4 million) participated in this evaluation. 3890 patients aged ≥50 years presenting in primary care with low-risk symptoms of colorectal cancer had a FIT from 01/06/2018 to 31/12/2018. A threshold of 10 μg Hb/g faeces defined a positive test.Results Six hundred and eighteen (15.9%) patients tested positive; 458 (74.1%) had an urgent referral to specialist lower gastrointestinal (GI) services within three months. Forty-three were diagnosed with colorectal cancer within 12 months. 3272 tested negative; 324 (9.9%) had an urgent referral within three months. Eight were diagnosed with colorectal cancer within 12 months. Positive predictive value was 7.0% (95% CI 5.1–9.3%). Negative predictive value was 99.8% (CI 99.5–99.9%). Sensitivity was 84.3% (CI 71.4–93.0%), specificity 85.0% (CI 83.8–86.1%). The area under the ROC curve was 0.92 (CI 0.86–0.96). A threshold of 37 μg Hb/g faeces would identify patients with an individual 3% risk of cancer.Conclusions FIT performs exceptionally well to triage patients with low-risk symptoms of colorectal cancer in primary care; a higher threshold may be appropriate in the wake of the COVID-19 crisis.Subject terms: Digestive signs and symptoms, Diagnostic markers, Gastrointestinal cancer     

Higher carbohydrate intake is associated with increased risk of all‐cause and disease‐specific mortality in head and neck cancer patients: results from a prospective cohort study

No studies have evaluated associations between carbohydrate intake and head and neck squamous cell carcinoma (HNSCC) prognosis. We prospectively examined associations between pre‐ and post‐treatment carbohydrate intake and recurrence, all‐cause mortality, and HNSCC‐specific mortality in a cohort of 414 newly diagnosed HNSCC patients. All participants completed pre‐ and post‐treatment Food Frequency Questionnaires (FFQs) and epidemiologic surveys. Recurrence and mortality events were collected annually. Multivariable Cox Proportional Hazards models tested associations between carbohydrate intake (categorized into low, medium and high intake) and time to recurrence and mortality, adjusting for relevant covariates. During the study period, there were 70 deaths and 72 recurrences. In pretreatment analyses, high intakes of total carbohydrate (HR: 2.29; 95% CI: 1.23–4.25), total sugar (HR: 3.03; 95% CI: 1.12–3.68), glycemic load (HR: 2.10; 95% CI: 1.15–3.83) and simple carbohydrates (HR 2.26; 95% CI 1.19–4.32) were associated with significantly increased risk of all‐cause mortality compared to low intake. High intakes of carbohydrate (HR 2.45; 95% CI: 1.23–4.25) and total sugar (HR 3.03; 95% CI 1.12–3.68) were associated with increased risk of HNSCC‐specific mortality. In post‐treatment analyses, medium fat intake was significantly associated with reduced risk of recurrence (HR 0.08; 95% CI 0.01–0.69) and all‐cause mortality (HR 0.27; 95% CI 0.07–0.96). Stratification by tumor site and cancer stage in pretreatment analyses suggested effect modification by these factors. Our data suggest high pretreatment carbohydrate intake may be associated with adverse prognosis in HNSCC patients. Clinical intervention trials to further examine this hypothesis are warranted.