Diagnosing pancreatic cancer in general practice: a cross-sectional study on associations between suspicion of cancer,urgent referral and time to diagnosis

ObjectiveThis study aimed to investigate the first point of contact in patients diagnosed with pancreatic cancer, and to study factors associated with the GP’s suspicion of cancer, Cancer Patient Pathway (CPP) referral and long diagnostic interval.DesignCross-sectional study combining register and survey data.PatientsPatients with incident pancreatic cancer recorded in the Danish National Patient Register (n = 303).Main outcome measuresThe patient’s first point of symptoms presentation, GP’s cancer suspicion, CPP referral and diagnostic interval.ResultsGeneral practice was the first point of contact for 85.5% of the population. At the first consultation, cancer was suspected in 32.7% and 22.9% were referred to a CPP. The GPs were more likely to suspect cancer or serious illness in patients aged >70 years (prevalence rate ratio (PRR) 1.34, 95% CI 1.09–1.66) and among patients with high comorbidity (PRR 1.23, 95% CI 1.04–1.47). A CPP referral was less likely among patients with low education. The median diagnostic interval was 39 days (interquartile range: 15–72). When the GP initially did not suspect cancer, the likelihood of longer diagnostic interval increased.ConclusionThe majority of patients with pancreatic cancer began their diagnostic route in general practice. Diagnosing pancreatic cancer swiftly in general practice was challenging; the GP did often not initially suspect cancer or refer to a CPP and several of the patient characteristics were associated with the GPs initial suspicion of cancer or CPP referral. Thus, there may be room for improvements in the diagnostics of pancreatic cancer in general practice.

Key points

• Patients with pancreatic cancer have a poor prognosis, as pancreatic cancer is often diagnosed in late stage.
• The majority of patients with pancreatic cancer began their diagnostic process in general practice.
• General practitioners (GPs) suspected cancer at the first consultation in one out of three patients with pancreatic cancer; more often in older and comorbid patients.
• The GPs suspicion of cancer was associated with urgent referral and shorter time to diagnosis.

     

急性缺血性脑卒中患者家属参与早期活动方案的研究

目的探讨科学、可行的家属参与急性缺血性脑卒中患者早期活动方案。方法在文献回顾、半结构式访谈的基础上,基于互动式患者参与患者安全理论框架,初步形成急性缺血性脑卒中患者家属参与早期活动方案。通过19名专家进行2轮德尔菲法专家咨询,修订急性缺血性脑卒中患者家属参与早期活动方案。结果 2轮专家咨询的问卷回收率分别为89.47%和100%,专家权威系数为0.786和0.797。最终形成的急性缺血性脑卒中患者家属参与早期活动方案包括决策性参与、照护性参与、诉求性参与及安全保障方案4项一级指标,二级指标8项,三级指标29项。结论患者家属参与急性缺血性脑卒中患者早期活动方案的制订可提高家属对患者活动的关注与支持,对促进卒中患者康复有积极作用。     

联合检测BRD4、SSBP1与PCDH17在胃癌早期诊断中的应用价值

目的 探讨溴结构域蛋白4（bromodomain protein 4,BRD4）、线粒体单链DNA结合蛋白（single-stranded DNA binding protein,SSBP1）与原钙黏附蛋白17（ proto-cadherin 17,PCDH17）诊断早期胃癌的临床价值。 方法 收集胃癌组织50例,癌前病变组织50例、正常胃黏膜组织50例,应用免疫组织化学染色法分别测定组织标本中BRD4、SSBP1及PCDH17蛋白的表达,分析不同组织样本中BRD4、SSBP1及PCDH17的表达情况,分别采集3组血液标本,检测3组相关血清指标,应用ROC曲线分析BRD4、SSBP1及PCDH17诊断胃癌的价值。 结果 胃癌组织中BRD4和SSBP1呈高表达,而PCDH17呈低表达。3组组织样本中BRD4、SSBP1及PCDH17的阳性率比较差异有统计学意义（P＜0.05）;3组血清癌抗原199（carbohydrate antigen,CA199）、血清胃蛋白酶原（pepsinogen,PG）Ⅰ、PGⅡ、胃泌素17（gastrin-17,G-17）水平及幽门螺杆菌（helicobacter pylori,HP）阳性率差异有统计学意义（P＜0.05）;胃癌组织组患者血清CA199、PGⅠ、G-17水平及HP阳性率明显高于癌前病变组织和正常胃黏膜组织组,而PGⅡ水平低于癌前病变组织和正常胃黏膜组织组,差异有统计学意义（P＜0.05）;临床分期为Ⅲ期~Ⅳ期、发生淋巴结转移的胃癌组织中BRD4、SSBP1、PCDH17的阳性率比较差异有统计学意义（P＜0.05）;BRD4+SSBP1+PCDH17联合诊断的敏感度和特异度均高于单一指标。 结论 联合检测BRD4、SSBP1与PCDH17有利于胃癌的鉴别诊断。     

Prediction of early recurrence of hepatocellular carcinoma after resection based on Gd-EOB-DTPA enhanced magnetic resonance imaging: a preliminary study

BackgroundEarly recurrence (ER) after radical resection of hepatocellular carcinoma (HCC) affects the prognosis of patients. Gadolinium ethoxybenzyl-diethylenetriaminepentaacetic acid (Gd-EOB-DTPA)-enhanced magnetic resonance imaging (MRI) can improve the detection rate of small HCC. This study innovatively introduces a new quantitative index combined with qualitative index to compare the differences in clinical and imaging characteristics between ER and non-ER groups and evaluate the feasibility of Gd-EOB-DTPA-enhanced MRI in predicting ER.MethodsA total of 68 patients with HCC confirmed by operation and pathology in the Shandong Cancer Hospital and Institute were included retrospectively. All participants were examined by Gd-EOB-DTPA-enhanced MRI within 3 weeks before surgery. Regular follow-up was performed every 2 months within 1 year after operation. Among them, 18 cases with new lesions were in ER group, and 50 cases without new lesions were in non-ER group. The clinical and imaging data of the 2 groups were collected, and the differences of clinical data and preoperative MRI signs between the ER group and non-ER group were compared. The predictive factors of ER after HCC were analyzed by multivariate logistic regression.ResultsThe quantitative parameter lesion-to-liver contrast enhancement ratio (LLCER) can predict the pathological grade of HCC (P=0.023). The results of univariate analysis between the ER group and non-ER group showed that there were significant differences in pathological grade (P=0.008), lesion morphology (P=0.011), peritumoral low signal intensity in hepatobiliary phase (HBP) (P<0.001), satellite nodules (P<0.001), and LLCER (P<0.001) between the 2 groups. Multivariate logistic regression analysis showed that HBP peritumoral low signal intensity [odds ratio (OR) =7.214, 95% confidence interval (CI): 1.230–42.312, P=0.029], satellite nodules (OR =9.198, 95% CI: 1.402–60.339, P=0.021), and parameter LLCER value (OR =0.906, 95% CI: 0.826–0.995, P=0.039) were independent predictors of ER of HCC after resection.ConclusionsPreoperative Gd-EOB-DTPA enhanced MRI has important predictive value for early recurrence after radical resection of hepatocellular carcinoma.     

农村生活饮用水安全调查及安全策略

  目的  探索地理信息系统（GIS）技术应用于农村饮用水水质监测分析及疾病监测预警的可行性和适用性。  方法  监测100个有代表性的农村水厂水源水样微生物污染状况,利用健康管理大数据分析平台获取水质监测、法定肠道传染病和感染性腹泻病例信息,应用地理信息系统对数据进行整合与可视化处理,实现农村饮水安全的监测预警和地图展示。  结果  河水（水源水）菌落总数与大肠菌群、大肠埃希菌检出值呈显著正相关（r = 0.850、0.566,P < 0.01）,大肠菌群与大肠埃希菌检出值呈显著正相关（r = 0.501,P < 0.01）,大肠埃希菌与沙门菌检出值呈明显相关性（r = 0.632,P < 0.05）。应用GIS技术将农村水源、水厂、供水区域范围、覆盖人群、疾病、水质监测等数据整合与可视化处理,绘制出农村饮水安全风险监测与预警展示地图,地理信息系统对水质监测和病例聚集情况可直观展示和智能预警。  结论  河水可采用大肠埃希菌作为沙门菌的指示菌,基于GIS技术的农村饮用水微生物污染风险监测预警系统可作为疾病防控和卫生应急处置的重要技术支撑。     

大学生睡眠质量与心理健康状况的相关性研究

  目的  了解中山市成年居民失眠症状现况。  方法  2017年2 — 5月,采用随机抽样方法对中山市25个乡镇和城区的12 182名 > 18岁成年居民进行失眠症状调查。  结果  中山市成年居民失眠症状检出率为10.02 %,其中女性的检出率为11.76 %,男性为8.17 %;成年居民失眠症状总得分为（1.19 ± 0.01）分,入睡困难得分为（0.37 ± 0.01）分,再入睡困难得分为（0.48 ± 0.01）分,早醒得分为（0.35± 0.01）分;回归分析结果显示,除了学历和家庭所在地之外,性别、年龄、职业、婚姻状况、子女人数和家庭经济水平均为失眠症状的影响因素(P < 0.05)。  结论  中山市成人失眠症状的检出率较高;性别、年龄、职业、婚姻状况、子女人数和家庭经济水平等都是失眠症状的主要影响因素。     

Functional asymmetries in early learning during right,left, and bimanual performance in right‐handed subjects

Purpose:

To elucidate differences in activity and connectivity during early learning due to the performing hand.

Materials and Methods:

Twenty right‐handed subjects were recruited. The neural correlates of explicit visuospatial learning executed with the right, the left hand, and bimanually were investigated using functional magnetic resonance imaging. Connectivity analyses were carried out using the psychophysiological interactions model, considering right and left anterior putamen as index regions.

Results:

A common neural network was found for the three tasks during learning. Main activity increases were located in posterior cingulate cortex, supplementary motor area, parietal cortex, anterior putamen, and cerebellum (IV–V), whereas activity decrements were observed in prefrontal regions. However, the left hand task showed a greater recruitment of left hippocampal areas when compared with the other tasks. In addition, enhanced connectivity between the right anterior putamen and motor cortical and cerebellar regions was found for the left hand when compared with the right hand task.

Conclusion:

An additional recruitment of brain regions and increased striato‐cortical and striato‐cerebellar functional connections is needed when early learning is performed with the nondominant hand. In addition, access to brain resources during learning may be directed by the dominant hand in the bimanual task. J. Magn. Reson. Imaging 2013;37:619–631. © 2012 Wiley Periodicals, Inc.