hMLH1及hMSH2蛋白免疫组化结合微卫星不稳定性检测在遗传性非息肉病性结直肠癌家系筛选中的作用

目的 探讨hMLH1及hMSH2蛋白免疫组化结合微卫星不稳定性检测在遗传性非息肉病性结直肠癌家系筛选中的敏感性、特异性及临床应用价值。方法 对12例符合Amsterdam标准的HNPCC患者和16例散发性结直肠癌患者的肿瘤标本进行hMLH1及hMSH2蛋白免疫组化检查和微卫星不稳定性检测。结果 hMLH1及hMSH2蛋白免疫组化筛选HNPCC家系的敏感性为91．7％,特异性为87．5％;微卫星不稳定性检测的敏感性为100％,特异性为75．0％;两者结合敏感性为91．7％,特异性为93．8％。结论 hMLH1及hMSH2蛋白免疫组化结合微卫星不稳定性检测筛选HNPCC家系敏感性和特异性明显提高,而且方法简单、经济,适合在临床广泛应用。     

Screening for Prostate, Breast and Colorectal Cancer in Renal Transplant Recipients

American Society of Transplantation guidelines recommend screening renal transplant recipients for breast, colorectal and prostate cancer. However there is a lack of evidence to support this practice. Computer simulation modeling was used to estimate the years of life lost as a result of these cancers in 50-year-old renal transplant recipients and subjects in the general population. Renal transplant recipients lost fewer years of life to cancer than people in the general population largely because of reduced life expectancy. In nondiabetic transplant recipients, loss of life as a result of these cancers was comparable with that in the general population only under assumptions of increased cancer incidence and cancer-specific mortality risks. Even with two-fold higher cancer incidence and disease-specific mortality risks, diabetic transplant recipients lost considerably fewer life years to cancer than those in the general population. Recommended cancer screening for the general population may not yield the expected benefits in the average renal transplant recipient but the benefits will be considerably higher than for patients on dialysis. Transplanted patients at above-average cancer risk in good health may achieve the benefits of screening that are seen in the general population.     

Effect of a short structured session on medical student breast cancer screening knowledge

Formalized instruction in breast cancer screening during medical school may help improve early breast cancer detection and survival. Physicians-in-training must be proficient in skills relating to breast cancer screening. This study investigates the baseline breast cancer screening knowledge of medical students, the benefit of a structured lecture session, and its effect on improving medical students' knowledge of cancer screening. A self-administrated questionnaire relating to breast cancer screening was given to third-year medical students. A 60-minute structured lecture session was given to the medical students regarding breast cancer screening. A postintervention survey was administered immediately following the session. A total of 27 medical students were evaluated. There was a statistically significant improvement following the formalized teaching session (84% to 93%; p < 0.0016). While few students (15%) reported having previous instruction in cancer screening, most students (96%) felt that a formal session should be offered during medical school. While medical student knowledge of breast cancer screening may be adequate, formalized instruction in breast cancer health practices can improve medical student knowledge. Most students had limited previous instruction in breast cancer prevention and welcomed the opportunity for structured training in breast cancer prevention, education, and detection. Until a formal course becomes a fundamental aspect of medical education, a short structured session should be instituted.     

Hearing impairment and hearing aid usage in Singapore

Objective: To examine the epidemiological and audiological profile, pattern of hearing aid (HA) fitting and usage among HA users in Singapore. Design: Retrospective cross-sectional study. Study sample: Cohort of 1068 subjects issued with HAs at a tertiary hospital between 2001 and 2013. Results: Mean age was 70?years with 50.8% male. Mean hearing loss (HL) was 63.1?dB and 69.5% had at least moderate-severe HL. Sensorineural HL was present in 66.4% and 69.8% had symmetrical HL. “Behind-the-Ear” HAs were cheaper than “In-Ear” HAs. Standard “Behind-The-Ear” HAs were also cheaper than “Receiver-in-Canal” HAs. Among In-Ear HAs, “In-the-Canal” and “Completely-in-Canal” were more popular than “In-the-Ear” HAs despite costing more. HA was used ≥4?days/week by 85.6% but >7?h per day by only 35.7%. Only 18% received bilateral first HA fitting. In multivariate analysis, younger age and symmetrical HL were predictors of bilateral HA uptake while better Pure-Tone-Audiometry of aided ear and >7?h of daily HA usage were predictors of successive HA fitting. Conclusions: HA users in Singapore were elderly and presented with advanced HL. Bilateral HA adoption and average daily use were low compared to other developed countries. Future research on understanding the suboptimal HA usage should explore patients' motivation, hearing disability, and HA effectiveness.     

An assessment of the potential impact of the introduction of male mammographers into the National Health Service breast screening programme

IntroductionThe NHS breast screening programme only employs female mammographers to carry out breast screening. The screening service is experiencing a shortage of staff and introducing male mammographers into the service is a potential solution. This research aimed to determine if the introduction of male mammographers would impact acceptance rates of the offer of screening, how women feel about the potential change and what the impact would be at a programme level.MethodsThe research was conducted in 3 stages. Initially 24 face-to-face interviews were conducted with women aged 45–70 and 19 interviews over the telephone with stakeholders; these interviews explored what women's reaction would be to the introduction of male mammographers. These interviews informed the content of a questionnaire that was completed online by 1000 women aged 50–71. It explored what women would do if offered a test with a male mammographer and how they felt about the potential change.ResultsOver half, 53.4% stated they would attend a routine mammogram if the mammographer was male, 15.3% said they would attend if a female chaperone was present, and 31.3% stated they would refuse to attend. The face-to-face interviews suggested women view routine breast screening differently to other healthcare interactions because it is an optional service and not a treatment. As a result, participants had higher expectations both in terms of expecting a choice over the gender of the mammographer and a need to feel comfortable.Conclusion and implications for practiceThe findings indicate that the percentage of eligible women attending breast screening may decrease if male mammographers were introduced. This impact of introducing male mammographers would need to be carefully weighed up against the potential gains in workforce numbers in opening up mammography to male practitioners.     

婴儿发育性髋关节发育不良早期筛查的情况分析

目的分析临床结合超声检查对婴儿发育性髋关节发育不良(developmental dysplasia of the hip,DDH)进行早期筛查的结果,为DDH早期干预提供科学依据,降低DDH的致残率。方法对我院筛选DDH体征阳性4896例患儿行超声进一步检查。结果体格检查可疑阳性婴儿4896例,经过超声检查,正常髋关节3591例,占73.3%(3591/4896),可疑异常髋关节1196例,占24.5%(1196/4896),异常髋关节109例,占2.2%(109/4896),其中脱位型髋关节7例,占0.14%(7/4896)。对确诊患儿进行临床治疗,106例异常髋关节转为Graf I型髋关节,治愈率达97.2%(106/109)。结论对婴儿髋关节进行早期筛查对提高婴儿DDH检出率有重要意义,对确诊患儿给予早期干预可促使发育异常的髋关节结构向正常的髋关节转化,改善婴儿髋关节功能,具有重要的经济意义与社会意义。     

Improving State-Mandated Breast Density Notifications

PurposeEffective written communication directly affects health care outcomes. Since 2016, the complex language of state-mandated breast density notifications (BDNs) has been challenged, because it is perceived to be beyond the comprehension of most patients. The aim of this study was to assess whether a revised BDN written at a lower reading grade level improves understanding compared with the current state-mandated BDN.MethodsA revised notification with similar content to the current state-mandated BDN was developed. Both notifications were presented to patients for direct comparison, using a paper survey asking questions that evaluated patients’ perceptions and convictions associated with breast density. Surveys were distributed at four outpatient imaging centers to screening mammography patients.ResultsThe current BDN’s mean readability metric was 13.4, and that of the revised BDN was 6.6. Five hundred surveys were analyzed. Survey data demonstrated that 56.6% of all women perceived that dense breast tissue results indicated a “high” associated lifetime breast cancer risk from the current state-mandated BDN compared with only 2.2% with the revised notification (P < .001). Nearly all women were more likely to initiate discussions with their providers regarding their breast tissue density after reading the revised notification (96.0%) as opposed to the current state-mandated BDN (32.8%; P < .001).ConclusionsA significant portion of women misinterpret the intended messages of the current state-mandated BDN. Thus, a revised notification at a lower reading grade level may improve understanding of breast density, leading to improved individualized breast cancer screening for women with dense breasts.     

Management of Lung Nodules and Lung Cancer Screening During the COVID-19 Pandemic: CHEST Expert Panel Report

BackgroundThe risks from potential exposure to coronavirus disease 2019 (COVID-19), and resource reallocation that has occurred to combat the pandemic, have altered the balance of benefits and harms that informed current (pre-COVID-19) guideline recommendations for lung cancer screening and lung nodule evaluation. Consensus statements were developed to guide clinicians managing lung cancer screening programs and patients with lung nodules during the COVID-19 pandemic.MethodsAn expert panel of 24 members, including pulmonologists (n = 17), thoracic radiologists (n = 5), and thoracic surgeons (n = 2), was formed. The panel was provided with an overview of current evidence, summarized by recent guidelines related to lung cancer screening and lung nodule evaluation. The panel was convened by video teleconference to discuss and then vote on statements related to 12 common clinical scenarios. A predefined threshold of 70% of panel members voting agree or strongly agree was used to determine if there was a consensus for each statement. Items that may influence decisions were listed as notes to be considered for each scenario.ResultsTwelve statements related to baseline and annual lung cancer screening (n = 2), surveillance of a previously detected lung nodule (n = 5), evaluation of intermediate and high-risk lung nodules (n = 4), and management of clinical stage I non–small-cell lung cancer (n = 1) were developed and modified. All 12 statements were confirmed as consensus statements according to the voting results. The consensus statements provide guidance about situations in which it was believed to be appropriate to delay screening, defer surveillance imaging of lung nodules, and minimize nonurgent interventions during the evaluation of lung nodules and stage I non–small-cell lung cancer.ConclusionsThere was consensus that during the COVID-19 pandemic, it is appropriate to defer enrollment in lung cancer screening and modify the evaluation of lung nodules due to the added risks from potential exposure and the need for resource reallocation. There are multiple local, regional, and patient-related factors that should be considered when applying these statements to individual patient care.