Dietary fiber and colorectal neoplasia

PURPOSE: Dietary fiber has been implicated in colorectal neoplasia, despite conflicting evidence. This is a review of the currently available data on the role of dietary fiber in colorectal carcinogenesis. METHODS: A literature search was conducted using the MEDLINE database. All case-control, longitudinal, and randomized, controlled studies published in English between 1988 and 2000 were identified, as were animal model studies in the period 1986 to 2000. Data from the various studies were tabulated and systematically analyzed, with particular emphasis on the effect of dietary fiber on tumor incidence and luminal parameters such as short chain fatty acids. RESULTS: Epidemiologic correlation studies show a high intake of dietary fiber to be associated with a lower risk of colorectal neoplasia. Thirteen of the 24 case-control studies reviewed demonstrated a protective effect of dietary fiber against colorectal neoplasia, and 16 showed a protective effect of vegetables or vegetable fiber. On the other hand, of 13 longitudinal studies in various cohorts, only 3 demonstrated a protective effect of fiber and 4 a protective effect of vegetables or vegetable fiber. The five published randomized, controlled trials all investigated the effect of increased fiber intake on short-term adenoma recurrence; however, none showed any significant protective effect. Among 19 experimental studies in animal models, 15 showed a protective effect of fiber against tumor induction compared with controls. Animal studies also showed that poorly fermentable fibers (e.g., wheat bran and cellulose) were more protective than soluble fibers (e.g., guar gum and oat bran), which sometimes enhanced carcinogenesis. No clear correlation was found between luminal pH or short chain fatty acids and tumor induction. CONCLUSIONS: On the basis of current data, there is little evidence to support the use of dietary fiber supplements to reduce the risk of colorectal neoplasia. Lifelong and early exposure may be important but are difficult to study. Other risk factors interact with the effects of dietary fiber.     

Pressure ulcer prevalence in people with spinal cord injury: age-period-duration effects

OBJECTIVE: To examine age-period-duration patterns of the prevalence of pressure ulcers in community-residing people with spinal cord injury (SCI). DESIGN: Multicenter cohort study. SETTING: Nine Model Spinal Cord Injury Systems throughout the United States. PARTICIPANTS: People with SCI (N=3361) injured between 1986 and 1995 and followed up thereafter on a yearly basis through 2002. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE: Physician-confirmed pressure ulcers of stage II or greater at the follow-up visits. RESULTS: The multivariable generalized estimating equations model showed a significant trend toward increasing pressure ulcer prevalence in the recent years (1994-2002 vs 1984-1993: odds ratio=1.4; 95% confidence interval, 1.2-1.6) not explained by aging, years since injury, or demographic and clinical factors. The risk of pressure ulcers appeared to be steady during the first 10 years and increased 15 years postinjury. Pressure ulcers were more common among the elderly, men, African Americans, singles, subjects with education less than high school, unemployed, subjects with complete injury, and subjects with history of pressure ulcers, rehospitalization, nursing home stay, and other medical conditions. Injury cause and level had no significant effect. CONCLUSIONS: These results highlight the need for research into factors that contribute to the increasing pressure ulcer prevalence.     

Auditory Sensory/Perceptual Alteration: Suggested Revision of Defining Characteristics

This correlational study of acutely ill geriatric patients examined (1) if psychosocial dysfunctioning is associated with hearing impairment, as popularly believed; (2) the utility of using psychosocial changes as cues for making the nursing diagnosis sensory/perceptual alterations: auditory; and (3) an alternative model of defining characteristics for predicting auditory perception using variables that have been reported in the literature as being associated with hearing loss but, to date, are not part of the approved diagnostic category. A random sample (n = 226) was drawn from daily admission lists of English-speaking patients 65 years of age or older, admitted to nonintensive care units of a medical center hospital. The major defining characteristics for sensory/perceptual alterations were operationalized as seven variables: depression, cognitive function, social contact with children, social contact with other relatives, social contact with friends, subject-reported hearing ability, and subject-reported overall health status. Auditory sensory perception was operationalized as number of tones heard on audiometric examination. Findings indicate that assessing psychosocial functions does not provide nurses with helpful cues for making the auditory alteration diagnosis. Rather results suggest that nurses can make a more accurate diagnosis merely by knowing the patient's age, self-rating of hearing, and checking ear canals for impacted cerumen.     

Postoperative paediatric pain prevalence: A retrospective analysis in a university teaching hospital

BackgroundOverall pain prevalence in paediatric patients is well documented, but relatively little attention has been paid to pain prevalence and intensity on specific postoperative days within the first week following an operation.ObjectivesTo evaluate reported pain prevalence on the day of surgery and each day during the following week and to analyse pain trajectories.DesignRetrospective study.SettingSingle centre university hospital.Participants815 postoperative children and adolescents (age ≤ 18 years) were included (female: 36%, age 9.8 ± 5.8). Children with ear, nose, throat (e.g. tonsillectomy), eye (e.g. strabismus repair) or dental surgery (e.g. dental extraction) were treated at other departments and therefore were not included in this study.MethodsRetrospective analysis of the overall and clinically relevant (pain score ≥4/10) postoperative pain prevalence in children and adolescents during the first week after surgery. Possible influencing factors (age, sex, body mass index, type of anaesthesia, type of surgery and duration of surgery) on pain trajectories are analysed using mixed model techniques.ResultsOverall, 36% of 815 analysed children and adolescents suffered from pain ≥4 during their entire hospital stay. Compared to the day of surgery, the number of patients with pain ≥4 was slightly higher on day 1 after surgery (21% vs. 25%, respectively). In self-reported pain intensity rating (done for patients age ≥ 4 years) the type of surgery (p < .001) was the only significant variable influencing pain intensity. In observational pain assessment (age < 4 years) pain scores increased with patient's age (p = .004). In this patient group, pain intensity ratings did not differ between types of surgery (p = .278).ConclusionType of surgery is an important predictor for self-reported pain intensity ratings in children but not for observational pain assessment in younger children. In younger children observational pain assessment ratings increase with age.     

新发涂阳肺结核治疗失败的影响因素研究

目的 探讨影响新发涂阳肺结核治疗失败的危险因素,为减少新发涂阳肺结核治疗失败提供建议。 方法 选择2003-2009年广州市367例户籍新发涂阳肺结核治疗失败病例,按同区、同性别、年龄相差不超过2岁、与治疗日期最接近的治愈病人进行1∶1的病例对照研究;采用单因素和多因素条件logistic回归分析。 结果 单因素分析有22项因素差异有统计学意义（P<0.05）,其中OR值较高的前10位依次为不规则服药（19.54）、减量治疗（7.92）、3个月末痰涂阳性（7.88）、药物不良反应中的肝功能损害（7.79）、肺外结核中的支气管结核（6.05）、2个月末痰涂阳性（5.17）、初治耐药（4.26）、低蛋白血症(3.01)、服药管理中的自服药（2.91）、合并糖尿病（1.84）;多因素分析有有13项因素被选入回归方程。其中OR值较高的因素有不规则服药（15.93）、减量治疗(8.91)、初始耐药(5.02)、3月末涂片仍阳性(3.21)、药物不良反应(2.30)、2月末涂片仍阳性(2.70),其中自觉经济状况(1.51)较好是保护因素。 结论 不规则服药、减量治疗、初始耐药、2、3个月末痰仍阳性、药物不良反应等因素是治疗失败的主要影响因素,经济状况好是保护因素;在新发涂阳肺结核的临床治疗中,针对危险性因素采取相应的干预措施,对减少治疗失败具有重要意义。     

结核感染T细胞斑点试验在不同患者群中的检测结果分析

目的 探讨影响结核感染T细胞斑点试验(T-SPOT.TB)检测结果的因素。方法收集2014年5月至2015年4月同济大学附属上海市肺科医院共1537例住院患者的临床资料。以《临床诊疗指南:结核病分册》的标准将患者分为临床诊断结核病组(1159例)和临床诊断非结核病组(378例);再经病原学诊断及随访排除不能做出最终诊断的39例患者后,将患者分为结核病组(1103例;包括经分枝杆菌培养及菌种鉴定确诊的229例和最终临床诊断的874例)和非结核病组(395例;包括既往有结核病史或肺部存在陈旧性病灶者94例,无病史者301例);1103例结核病组患者中,肺结核557例,结核性胸膜炎107例,淋巴结结核16例,骨关节结核51例,脑结核7例,多组织器官结核363例,其他肺外结核2例;395例非结核病组患者中,经分枝杆菌培养及菌种鉴定确诊的非结核分枝杆菌(NTM)感染患者93例。回顾性分析临床诊断结核病组和结核病组患者T-SPOT.TB检测结果的敏感度、特异度,结核病组与非结核病组患者T-SPOT.TB检测反应强度,不同结核病类型T-SPOT.TB检测阳性率,以及NTM感染患者与结核病患者的年龄差异。结果 (1)临床诊断结核病组T-SPOT.TB检测的敏感度为81.97% (950/1159)、特异度为53.44%(202/378);结核病组T-SPOT.TB检测的敏感度为83.77%(924/1103)、特异度为54.43%(215/395);结核病组中抗酸染色阳性患者T-SPOT.TB检测阳性率为90.73%(235/259);培养阳性患者T-SPOT.TB检测阳性率为92.58%(212/229)。(2)非结核病组有结核病史或肺部显示陈旧性结核病灶的患者与无病史者T-SPOT.TB检测的阳性率分别为69.15%(65/94)和38.21%(115/301),两组间差异有统计学意义(χ ²=27.65,P=0.000)。(3)结核病组与非结核病组T-SPOT.TB检测结果以斑点计数表示反应强度,结核病组对A、B抗原刺激出现阳性反应(斑点数≥1)的患者中,明显阳性及超强阳性(斑点数≥11)的比率分别为69.81%(652/934)和69.67%(627/900),明显高于非结核病组[分别为46.83%(96/205)和46.63%(83/178)];经曼-惠特尼秩和检验,差异有统计学意义(Z值分别为-14.20、-14.63,P值均<0.01)。(4)1103例结核病组患者中,T-SPOT.TB检测阳性率以淋巴结结核(87.50%,14/16)为最高,随后依次为多组织器官结核(87.33%,317/363)、肺结核(86.54%,482/557)、结核性胸膜炎(74.77%,80/107),脑结核(57.14%,4/7)和骨关节结核(50.98%,26/51)相对较低。(5)T-SPOT.TB检测阳性的NTM感染患者的平均年龄[(53.61±18.43)岁]较T-SPOT.TB检测阳性的确诊结核病患者[(44.98±18.88)岁]高,差异有统计学意义(t=-2.63,P=0.009)。结论 T-SPOT.TB检测结果受结核病诊断依据、痰菌量、既往结核病史或肺部陈旧性结核病灶、NTM感染、结核病灶存在的部位等多种因素的影响;T-SPOT.TB检测用于指导结核病诊断时,需综合考虑各项因素。     

MR imaging in intracystic hemorrhage of simple hepatic cysts

Intracystic hemorrhage of simple hepatic cysts is one of the most frequent complications. Ul-trasonography (US) and computed tomography (CT) may show abnormal findings and mimic other diseases. We describe magnetic resonance (MR) imaging in four patients with intracystic hemorrhage confirmed by surgery or percutaneous aspiration. In all cases the lesions were hyperintense on both T1- and T2-weighted sequences. In three of the four cases the signal was heterogeneous on T1-weighted sequences. Two cases of a thickened wall and one case of a fluid-fluid level were also observed. We suggest that MR imaging may be helpful to differentiate intracystic hemorrhage from other cystic lesions by showing high signal on T1- and T2-weighted sequences.