Colorectal cancer diagnosis: Pitfalls and opportunities

Colorectal cancer (CRC) is a major health problem in the Western world. The diagnostic process is a challenge in all health systems for many reasons: There are often no specific symptoms; lower abdominal symptoms are very common and mostly related to non-neoplastic diseases, not CRC; diagnosis of CRC is mainly based on colonoscopy, an invasive procedure; and the resource for diagnosis is usually scarce. Furthermore, the available predictive models for CRC are based on the evaluation of symptoms, and their diagnostic accuracy is limited. Moreover, diagnosis is a complex process involving a sequence of events related to the patient, the initial consulting physician and the health system. Understanding this process is the first step in identifying avoidable factors and reducing the effects of diagnostic delay on the prognosis of CRC. In this article, we describe the predictive value of symptoms for CRC detection. We summarize the available evidence concerning the diagnostic process, as well as the factors implicated in its delay and the methods proposed to reduce it. We describe the different prioritization criteria and predictive models for CRC detection, specifically addressing the two-week wait referral guideline from the National Institute of Clinical Excellence in terms of efficacy, efficiency and diagnostic accuracy. Finally, we collected information on the usefulness of biomarkers, specifically the faecal immunochemical test, as non-invasive diagnostic tests for CRC detection in symptomatic patients.     

National cervical cancer prevention program in the Arab States: Strategies and cost-minimization study of the Tunisian case

BackgroundThe Arab states geographic region is marked by a low to moderate cervical cancer screening coverage rates and the absence of national human papillomavirus (HPV) vaccination programs, except for the United Arab Emirates. Knowing that the HPV prevalence among Tunisian woman is estimated to 4.9/100 000 according to the “HPV Center” data, this study aims to estimate the cost of a national cervical cancer prevention program in Tunisia using either the primary prevention method (the two-dose schedule anti-HPV vaccine according to the WHO recommendation for young adolescents) or the secondary prevention method (the Pap smear test according to three time-lapse periodicity).MethodsThe mean incremental cost of one avoided cervical cancer case was calculated for each prevention scenario.ResultsThe ascending incremental costs by avoided cervical cancer case are: 1- the national vaccination program through the GAVI support ($ 1803), 2- the cervical cancer screening according to 10-year periodicity ($ 8219), 3- the cervical cancer screening according to 5-year periodicity ($ 14,567), 4- the cervical cancer screening according to 3-year periodicity ($ 20,479), 5- and finally the national vaccination program according to the manufacturer marketed price ($ 36,854).ConclusionCurrently, the anti-HPV national vaccination program combined with cervical cancer screening according to 5-year periodicity present the best cost-effective strategy for cervical cancer prevention in Tunisia. This study gives Tunisian decision makers a basis for structured planning and cost apportionment to ensure effective roll-out of the cervical cancer prevention strategies.     

Ancillary Diagnostics in Gynecologic Cytology

Cytology has been the mainstay of cervical dysplasia and cancer screening in the United States. The specificity of a woman harboring a high-grade lesion when identified as high-grade squamous intraepithelial lesion on Pap test is high; however, the test suffers from low sensitivity. Epidemiology studies have demonstrated that human papillomavirus (HPV) types 16 and 18 account for most cervical squamous cell carcinomas. Tests have been developed to identify high-risk HPV, some specifically to identify HPV 16 and 18. Simultaneous to the increase in HPV detection methods, interdisciplinary groups are making recommendations on the managerial use of the tests.     

The inter-rater and test–retest reliability of the Self-care and Transfer scales,and intra-rater reliability of all scales of the Swedish Translation of the Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT-S)

Abstract

Objective: The Australian Therapy Outcome Measures for Occupational Therapy (AusTOMs-OT) are used internationally to measure the outcomes of occupational therapy services across diagnoses, ages, and health care settings. This study reports on the inter-rater and test–retest reliability of the Self-care and Transfer scales as well as the intra-rater reliability of all scales of the Swedish (AusTOMs-OT-S) translation. Methods: Fifteen occupational therapists rated 11 case study clients on two occasions, separated by two weeks. Test–retest reliability and inter-rater reliability were calculated for the Self-care scale and Transfer scales. Moreover, intra-rater reliability was calculated for each of the 15 therapists across all 12 scales. Results: The inter-rater reliability intraclass correlation coefficients (ICCs) were all found to be high to very high, ranging from ICC 0.762 to 0.904; the intra-rater reliability coefficients were also very good with 11 of the 15 therapists achieving ICCs of 0.745 or over, and finally the test–retest ICCs were also found to be high, ranging from 0.705 to 0.920. Conclusions: Although further research is required to confirm reliability, preliminary reliability of the AusTOMs-OT Swedish translation has been demonstrated and therapists can have confidence when using the scales.     

Aqueous solubility: Simple predictive methods (in silico,in vitro and bio-relevant approaches)

Aqueous solubility is a key physicochemical attribute required for the characterisation of an active pharmaceutical ingredient (API) during drug discovery and beyond. Furthermore, aqueous solubility is highly important for formulation selection and subsequent development processes. This review provides a summary of simple predictive methods used to assess aqueous solubility as well as an assessment of the more complex in silico methodologies and a review of the recent solubility challenge. In addition, a summary of experimental methods to determine solubility is included, with a discussion of some potential pitfalls.     

三脂清中7种成分的含量测定及醇提工艺优化

目的 采用HPLC-MS/MS同时测定蒙药三脂清中胡椒碱、荜茇宁、柯里拉京、没食子酸、鞣花酸、槲皮素、芦丁的含量，并优化三脂清的醇提工艺。方法 采用Shim-pack GIST-HP C₁₈色谱柱（2.1 mm×100 mm，3 mm），以0.1%甲酸水溶液-甲醇为流动相，梯度洗脱，流速为0.25 mL·min^-1，进样量2 μL；质谱采用电喷雾离子源，正、负离子扫描切换，多重反应监测模式进行定量分析。采用L₉（3⁴）正交试验设计，以上述7种成分含量的综合评分为考察指标，以料液比、乙醇浓度、提取时间、提取次数为考察因素进行三脂清醇提工艺优化。结果 三脂清中7种成分的峰面积和质量浓度在一定范围内均呈现良好的线性关系（r ≥ 0.999 1），仪器精密度、重复性、稳定性试验的RSD均<5%；加样回收率为99.54%~105.32%，RSD为1.39%~4.33%。最佳醇提工艺条件为料液比1：8，乙醇浓度40%，提取时间0.5 h，提取3次。3次放大试验验证结果显示，上述7种成分的平均含量分别为9.852，0.587，16.247，3.657，8.663，0.119，0.104 mg·g^-1。结论 建立的方法简便、灵敏、高效，可用于三脂清中多种主要活性成分的含量测定；优化所得的醇提取工艺稳定、可行。     

两种尿沉渣分析仪在临床上的应用评价

目的对Diasys R／S2003和普利生尿沉渣分析系统进行性能及临床应用的评估。方法分别对两台尿沉渣仪与牛鲍氏计数板法进行可比性试验，并对两仪器作准确性、重复性、线性检测；对Diasys进行携带污染率检查。结果Diasys R／S2003和普利生均与牛鲍氏计数板法显示相关（r〉r0．01）且有非常显著性意义（P〈0．01）；准确率分别为124．2％和95．8％；重复性低值CV％分别为6．5％和3．6％，高值CV％分别为6．2％和3．7％；且均显示良好线性；而Diasys的携带污染率为0．14％。结论两台仪器均符合NCCLS尿沉渣定量分析标准，检测结果与临床相符，具有准确性好、精密度高、操作简便、污染少、成本低等优点，因此两者都是目前比较理想的尿沉渣分析仪。     

安徽省420株结核分枝杆菌对一线和二线抗结核药物药敏结果分析

目的研究并分析安徽地区420例结核分枝杆菌对一线、二线抗结核药物菌耐药情况，为结核病临床治疗和结核病控制提供科学依据。方法采用绝对浓度法对420例结核分枝杆菌临床分离株进行一线、二线抗结核药物敏感试验。结果对一线抗结核药物总耐药率和耐多药率分别是29．05％和14．52％；其中初治耐药率和耐多药率分别是15．93％、6．79％，复治耐药率和耐多药率分别是52．86％、30．0％；RIF、INH、SM、EMB耐药率分别是22．14％、20．0％、17．38％和0．95％。抗二线结核药物总耐药率为22．62％，其中左氧氟沙星和丙硫乙烟胺的耐药率较高，分别为13．33％（56／420）和12．86％（54／420），年龄段41～60岁耐药率均显著高于其他年龄段（P〈0．05）；男性和女性病例组间均无统计学显著性差异（P〉0．05）。结论安徽地区结核菌耐药情况仍然十分严重，应加强抗结核药物的耐药性监测，同时根据药敏试验结果选择科学有效的化疗方案。     

Safety assessment and toxicological profiling of a novel combinational sunprotective dermal formulation containing melatonin and pumpkin seed oil

Ultraviolet (UV) radiation exposure has been known to cause irreparable damages to human skin. The daunting risk of UV radiation exposure faced by military personnel led to the development of a sunscreen formulation which has superior sun protection factor combined with the ability to counteract reactive oxygen species. The present work deals with the preclinical safety evaluation of the sunscreen formulation comprising of four US FDA approved UV filters; namely avobenzone, octinoxate, oxybenzone, titanium dioxide along with melatonin and pumpkin seed oil, via OECD protocols of assessing acute oral and dermal toxicity; skin sensitizing; skin irritating; ocular irritating and genotoxic potential. Both oral and dermal LD₅₀ values were found to be ˃2000 mg/kg body weight in adult Wistar albino rats using acute dermal and oral toxicity tests. The sunscreen formulation was found to be non-sensitizing to the skin of guinea pigs and non-irritating to both skin and eyes of rabbits. The sunscreen formulation was also found to be non-mutagenic which was affirmed by a battery of genotoxicity and muagenicity assays. The results obtained from this preclinical study indicated that the sunscreen formulation is non toxic and safe in animal models. This study along with additional preclinical evaluations may serve as a basis for considering the formulation as a potential candidate for further trials to establish its efficacy, tolerability and applicability.