Screening and early detection of pancreatic cancer in high risk population

Pancreatic cancer is a serious growing health issue in developed countries.For patients diagnosed with pancreatic cancer,the five year survival rate is below 5%.One major important reason leads to the poor survival rate is lack of early detection of pancreatic cancer.Over 80% of the patients are diagnosed in advanced disease stages.Screening for pancreatic cancer is a desirable option for high risk individuals to allow early detection and treatment of curable pancreatic neoplasms at a pre-invasive stage.This article highlights the need,endpoint,population,method,diagnostic yield,and the problems of current screening programs.

ESTABLISHMENT OF HIGH RISK POPULATION AND PRECANCEROUS LESION OF NASOPHARYNGEAL CARCINOMA(NPC)

A prospective study was done by the examination of nasopharyngoscope, reaction of EB virus's antigens and antibodies, nasopharyngofibroscope, pathological and EB virus's DNA, EBERs, etc. of about 100000 persons in high risk area of NPC in Guangdong Province, China from 1986 to 1995. If any one of the following four conditions is present in some persons, i.e., (1) EBV VCA/IgA titer>1:80, (2) EBV EDAb>60%, (3) Dual or triple positiveness in VCA/IgA, EA/IgA and EDAb, (4) Any one of VCA/IgA, EA/IgA and EDAb keeps high titer or going up, they should be regarded as in precancerosis of NPC. The moderate or severe heteroplasia and heterometaplasia of nasopharyngeal mucosa are the precancerous lesions of NPC. Some individual who is in precancerosis or with precancerous lesion should be regarded as the high risk population of NPC. The results are of important scientific basis for screening and second degree prevention of NPC.

Current molecular methods for the detection of hepatitis C virus in high risk group population:A systematic review

Hepatitis C virus(HCV) is an emerging infection worldwide and the numbers of persons infected are increasing every year. Poor blood transfusion methods along with unsafe injection practices are potential sources for the rapid spread of infection. Early detection of HCV is the need of the hour especially in high riskgroup population as these individuals are severely immunocompromised. Enzyme Immunoassays are the most common detection techniques but they provide no evidence of active viremia or identification of infected individuals in the antibody-negative phase and their efficacy is limited in individuals within high risk group population. Molecular virological techniques have an important role in detecting active infection with utmost specificity and sensitivity. Technologies for assessment of HCV antibody and RNA levels have improved remarkably, as well as our understanding of how to best use these tests in patient management. This review aims to give an overview of the different serological and molecular methods employed in detecting HCV infection used nowadays. Additionally, the review gives an insight in the new molecular techniques that are being developed to improve the detection techniques particularly in High Risk Group population who are severely immunocompromised.

Age scope of high-risk population for esophageal cancer in Ci county

AIM: To define the age scope of high-risk population for esophageal cancer (EC) in Ci county.METHODS: The results of endoscopic examination of 2013 subjects, cytological screening of 16 763 persons and records of 9 265 patients with EC were analyzed by Ridit methods, the standard age group was 45-49 year group.RESULTS: The average age of patients with moderate esophageal epithelium dysplasia by endoscopic examination was 53.5 years, of severe esophageal epithelium dysplasia,51.4 years, early EC, 55.6 years. The average age of stage one severe epithelium dysplasia (SEEDI) by cytological screening was 51.2 years, of stage two severe epithelium esophageal dysplasia (SEED Ⅱ) 51.6 years, of advanced EC 61.7 years. In the group of 40-year olds,the value of Ridit by pathological diagnosis was 0.46, 95%CI, 0.45-0.47, that by cytological diagnosis was 0.45, 95%CI, 0.43-0.47. As the age increased at five-year intervals,the value of Ridit increased significantly.CONCLUSION: In Ci county of a high incidence area of EC, the age definition of high-risk population should be above 45 years.

A STUDY OF PRECANCEROUS GASTRIC LESIONS IN A HIGH RISK POPULATION

A study of precancerous gastric lesion was conducted in a randomly selected high risk population in Linqu, Shandong Province of China. 849 subjects aged from 30-64 were examined bioptically. There were 8 cases of gastric cancer, the prevalence rate was 0.9%. 169 subjects were diagnosed to be dysplasia, the prevalence rate of dysplasia was increased significantly with age. The regression equation was Y=0.47X-0.25. The prevalence of CAG was found in 36 per cent of the studied subjects and both dysplasia and CAG were more serious in the antrum than the. fundus. The results showed a natural history of precancerous gastric lesions in a high risk population in a high risk area.

Large Population Screening Identified the Main Risk Factors of Stroke in Shashi District of Jingzhou City

Objective: This paper aims to screen and analyze the current status of high-risk stroke patients in Shashi District of Jingzhou City and the exposure levels of related risk factors, and provides suggestions as the references for prevention and treatment of stroke. Methods: Using cluster sampling, on-site investigations were conducted on 1060 permanent residents aged 40 years and over at 3 townships and 2 communities in Shashi District of Jingzhou City from January 2018 to December 2018. Risk assessment of stroke is based on the stroke risk screening form. Statistical analysis was performed by using SPSS 22.0 software. Results: After making a stroke risk assessment, a total of 313 high-risk stroke patients were screened, and the detection rate was 29.53%. The exposure rate of risk factors from high to low was hypertension (70.93%), dyslipidemia (46.33%), less physical exercise (46.01%), diabetes (36.10%), overweight (33.55%), smoking (33.23%), family history of stroke (24.92%), atrial fibrillation or valvular heart disease (7.35%). There are statistically significant differences among all risk factors between the high-risk group and middle and low-risk groups (P Conclusion: The detection rate of high-risk stroke patients in Shashi District of Jingzhou City is high. Hypertension, dyslipidemia and less physical exercise are the main risk factors of stroke occurrence and recurrence in the region. The prevention and treatment of risk factors for stroke should be strengthened to control the incidence and recurrence rate of stroke.

MODIFIED CLASSIC RISK FACTORS FOR CORONARY ARTERY DISEASE IN CHINESE HAN POPULATION

Objective To investigate the levels of cardiovascular disease risk factors and their relations to clinical phenotype associated with coronary artery disease(CAD).Methods The subjects were recruited from five independent cardiovascular centers.Coronary angiography was employed to define the CAD with stenosis in each major vessel ≥70% and control with stenosis <10% in every lesion.The classic risk factors including family history,body mass index,smoking habits,hypertension,diabetes mellitus,and serum lipid levels were surveyed according to established criteria.Associations between risk levels and clinical phenotypes were assessed by case control and correlation analysis.Results A total of 762 individuals were collected,including 481 men and 281 women,aged from 17 to 81(mean 60±10) years.The patients with CAD accounted for 55.5% of all participants,and controls 44.5%,respectively.Compared with the pattern in published data,our study showed that mean serum high density lipoprotein cholesterol(HDL-C) level was significantly lower(P<0.001) and triglycerides was significantly higher(P<0.001),while total cholesterol(TC) and low density lipoprotein cholesterol levels were comparative(both P>0.05).The prevalence of low HDL-C(<40 g/L) and hypertriglyceridemia(>150 g/L) were 27.2% and 41.4%,respectively.Mean serum levels of HDL-C and apolipoprotein A1 were significantly higher in female subjects than in male(P<0.001).Lower HDL-C functioned as an independent risk factor for CAD only in men(RR=2.8,95%CI:1.5-4.2,P<0.001),yet increased non-HDL cholesterol combined with diabetes mellitus and obesity seemed to play a key role in the development ofCAD in women.Similarity in risk association with CAD was found for hypertension and TC/HDL ratio in male and female subjects,while family history had no relationship with the presence of CAD.Conclusion It is remarkable that emphasis of intervention in future should be given on the prevalent low serum HDL-C and its strong risk correlation with the presence of CAD in male subjects of Chinese Han population.

早期胃癌预测模型对胃癌高危人群疾病进展的预测价值

目的:分析基于幽门螺杆菌(helicobacter pylori,Hp)状态与外周血胃蛋白酶原I(pepsinogenⅠ,PGⅠ)、PGⅡ、胃泌素-17(gastrin-17,G-17)水平组成的预测模型对于胃癌高危人群疾病进展的预测价值。方法:回顾性选取2023年1月至2024年1月于天津大学津南医院完善PGⅠ、PGⅡ、G-17、C14尿素呼气试验和胃镜取组织病理活检的126例胃癌高危人群临床资料,根据胃镜取组织病理活检结果将胃癌高危人群分为对照组、癌前病变组、早期胃癌组,比较各组患者PGⅠ、PGⅡ、G-17、C14尿素呼气试验等指标的诊断效能,并构建预测模型。结果:早期胃癌组Hp阳性率为82.35%、PGⅡ为22.73 ng/mL均高于癌前病变组、对照组,PGⅠ为51.36 ng/mL低于癌前病变组、对照组,癌前病变组G-17为5.17 pmoL/L低于对照组、早期胃癌组(P<0.05)。PGⅠ、PGⅡ、G-17与Hp联合时,其受试者工作特征(receiver operating curve,ROC)曲线下面积(area under curve,AUC)可达到0.899,敏感度为94.12%,特异度为95.65%,对胃癌的诊断效能最为理想。根据预测模型,癌前病变分值界限为10分,早期癌症的临界值为19分。结论:对胃癌高危人群实施C14尿素呼气试验与PGⅠ、PGⅡ、G-17联合检测,有助于分析胃癌高危人群疾病进展情况。

高危人群低剂量CT与肿瘤标志物联合检查早期肺癌的效能研究

目的探讨低剂量螺旋CT(low dose spiral computed tomography,LDCT)扫描联合细胞角质蛋白片段21-1(CYFRA21-1)、鳞状上皮细胞癌抗原(SCC)、神经特异性烯醇化酶(NSE)、胃泌素释放肽前体(GRP)、癌胚抗原(CEA)、糖类抗原125(CA125)等6种肺癌肿瘤标志物(tumor Markers,TM)检测对高危人群早期肺癌筛查的效能。方法统计分析2015年-2019年间在本院进行LDCT检查且有病理结果的受试者以及CT结果阴性受试者相关数据,对比分析CT、血清TM的水平以及CT征象及血清TM联合检测对肺癌的诊断价值。结果CT检出肺癌的敏感性为81.48%,特异度为50.00%;TM检出肺癌的敏感性为66.67%,特异度为66.67%;CT联合TM对肺癌的灵敏度为62.96%,漏诊率37.04%,特异度为100.00%。肺癌组患者TM明显高于LDCT结果阴性受试者组,而CT结果阴性受试者的TM检测结果均为阴性,两组差异有统计学意义(P<0.05),结论LDCT敏感性较高,特异度低,肿瘤标志物特异度高,LDCT与TM检测较高合理组合应用,可以优势互补,减少LDCT的假阳性率,对早期肺癌的筛查具有较大价值,可作为辅助筛查手段。而对CT结果阴性者不建议常规做TM检测。

高危人群癌症风险感知测评工具的研究进展

总结癌症风险感知测评工具的研究进展,包括普适性与特异性测评工具的主要内容、信效度及应用现状。提出癌症高危人群癌症风险感知测评工具的研究对于高危人群早期筛查方案及干预策略的制定具有重要意义;目前癌症风险感知测评工具繁多,未来研究者应研制更适合中国国情的测评工具,以利于针对性策略的制定。

健康体检人群心脏代谢指数与脑血管功能积分值的相关性分析

目的探讨健康体检人群心脏代谢指数(CMI)与脑血管功能积分值(CVHI)的相关性。方法本研究为横断面研究,选取2023年1-7月在新疆医科大学第一附属医院健康管理中心参加健康体检的1636例体检人员为研究对象。收集一般资料,完成相关体格检查和实验室检查。根据CVHI积分值的最佳截断点(75分)分为CVHI正常组和CVHI异常组,采用Logistic回归分析探讨影响CVHI积分值的因素,受试者工作特征(ROC)曲线下面积(AUC)评估CMI对CVHI积分值的预测价值。结果在1636例体检人员中,使用脑血管功能检测仪筛检出脑卒中风险高危人群419例(25.6%)。CVHI正常组与异常组在年龄、性别、高血压、糖尿病、血脂异常、运动缺乏等方面比较,差异有统计学意义(P均<0.05)。CVHI异常组的收缩压、舒张压、体质指数、腰围、腰臀比、腰高比、总胆固醇、甘油三酯、空腹血糖、尿酸、肌酐、尿素、心脏代谢指数均高于CVHI正常组(P<0.05)。年龄、高血压、糖尿病、收缩压、尿酸、CMI是CVHI积分值的影响因素(P<0.05)。CMI预测CVHI积分值<75人群的ROC曲线下面积为0.602。CVHI积分值随着CMI水平的增高而降低(P<0.05),CMI≥0.4918的CVHI积分值异常率(31.0%)明显高于CMI<0.4918的CVHI积分值异常率(18.7%)(P<0.05)。CVHI积分值与CMI呈负相关(r=-0.143,P<0.05)。结论随着CMI的增加,CVHI积分值逐渐降低,筛选出脑卒中高危人群的风险逐步增加,这对脑卒中高危人群的筛检具有一定的参考价值。

早期踝肱指数对下肢动脉硬化性疾病无症状高危人群的预测价值

目的探讨下肢动脉硬化性疾病无症状高危人群的危险因素及踝肱指数(ankle-brachial index,ABI)的预测价值。方法选取2020年1月至2022年12月成武县人民医院110例无下肢动脉硬化性疾病症状的高危人群为研究对象,均接受ABI测量,根据ABI将其分为异常组和正常组,对比两组基线资料,并分析影响下肢动脉硬化性疾病无症状高危人群的危险因素及ABI的预测价值。结果经ABI测量显示,ABI≤0.9共31例,占比28.18%。异常组年龄,有高血压史、糖尿病史、吸烟史占比,C反应蛋白及同型半胱高于正常组,总胆固醇及ABI低于正常组(P均<0.05)。年龄、高血压史、糖尿病史、吸烟史、同型半胱氨酸、ABI是下肢动脉硬化性疾病无症状高危人群的影响因素(P均<0.05)。年龄、同型半胱氨酸、ABI预测下肢动脉硬化性疾病无症状高危人群的曲线下面积(area under curve,AUC)分别为0.959、0.965、0.986,ABI预测的敏感度优于年龄和同型半胱氨酸预测(P均<0.05)。结论早期检测ABI对下肢动脉硬化性疾病无症状高危人群具有预测作用。

734例慢性阻塞性肺疾病高危人群临床症状及中医证素分布特征

目的:分析慢性阻塞性肺疾病(COPD)高危人群患病特点及中医证素分布特点,为COPD早期干预和诊治提供参考。方法:2022年5月—2022年11月在安徽部分地区对COPD高危人群进行横断面调查,从临床表现提取病位及病性证素。使用SPSS 21.0软件,采用频次分析和聚类分析分别对症状和证素进行分析。结果:共纳入734例COPD高危人群,咳嗽、咳痰、健忘、腰膝酸软、口干口苦、气促、乏力为高频症状,高危人群中患呼吸系统疾病的占34.74%,包括慢性支气管炎、过敏性鼻炎、支气管哮喘、咽炎、肺气肿、肺大疱、肺结节等。对734例COPD高危人群进行证素分析,得到病位证素7个,病性证素10个。病位证素降序排列为肺(49.59%)、肾(28.20%)、脾(26.70%)、肝(17.44%)、卫表(12.81%)、心(神)(7.36%)、胃(6.95%);病性证素降序排列为气虚(53.00%)、痰(26.3%)、湿(13.22%)、阴虚(11.58%)、阳虚(11.44%)、热(10.63%)、血瘀(4.77%)等。聚类分析发现6种组合规律:(1)病位证素肺、脾、胃+病性证素痰、气虚、湿;(2)病位证素肾+病性证素阴虚、阳虚;(3)病位证素血瘀;(4)病位证素肝+病性证素阳亢、热、气滞;(5)病位证素心(神);(6)病位证素卫表。结论:COPD高危人群在发展为COPD前已经有肺气虚的表现,COPD的发展以肺气虚为始,进一步损伤脾、肾,逐步演变为虚实夹杂。

聚焦解决模式对老年冠心病高危人群自我管理能力及负性情绪的影响

目的 探讨聚焦解决模式对老年冠心病高危人群自我管理能力及负性情绪的影响。方法 选取2021年4至10月江苏省镇江市京口区健康路社区服务中心收治的120例老年冠心病高危人群,按照随机数字表法分为两组,每组60例。对照组给予常规的健康宣教,观察组在对照组基础上给予聚焦解决模式的护理干预,干预6个月。比较两组干预前后自我管理能力和负性情绪。结果 干预后,两组自我管理能力评分均高于干预前,且观察组高于对照组(P<0.05)。干预后,两组抑郁自评量表、焦虑自评量表评分均低于干预前,且观察组低于对照组(P<0.05)。结论 聚焦解决模式可有效提升老年冠心病高危人群自我管理能力,缓解其负性情绪,减少冠心病发病风险,提高冠心病的一级预防能力。

郑州市上消化道恶性肿瘤高危人群内镜筛查现状及其影响因素

目的分析郑州市上消化道恶性肿瘤高危人群内镜筛查现状及其影响因素。方法于2017年10月至2022年10月参照《癌症早诊早治项目技术方案(2011年版)》,采用整群随机抽样法以郑州市常住居民为研究对象,通过评估筛查出上消化道恶性肿瘤高危人群共18500例。分析上消化道恶性肿瘤高危人群的基本情况;比较郑州市不同特征上消化道恶性肿瘤高危人群内镜筛查现状;采用多因素Logistic回归分析郑州市上消化道恶性肿瘤高危人群内镜筛查参与情况。结果18500例上消化道恶性肿瘤高危人群中有3407例参与了消化道内镜筛查,参与率为18.42%。女性、45~64岁、初中及以上学历、未婚/离异/丧偶、既往吸烟、正在饮酒、有反流性食管炎史、浅表性胃炎史、胃溃疡史、十二指肠溃疡史、胃息肉史、上消化道癌家族史的上消化道恶性肿瘤高危人群内镜筛查参与率高于其他特征人群,差异具有统计学意义(P<0.05)。女性、45~64岁、初中及以上学历、未婚/离异/丧偶、既往吸烟、正在饮酒、有反流性食管炎史、浅表性胃炎史、胃溃疡史、十二指肠溃疡史、胃息肉史、上消化道癌家族史是上消化道恶性肿瘤高危人群内镜筛查参与情况的影响因素(P<0.05)。结论郑州市上消化道恶性肿瘤高危人群进行内镜筛查的参与率较低,女性、45~64岁、初中及以上学历等人群进行内镜筛查的依从性较好。

上海市宝山区心血管病高危人群颈动脉健康状况调查

目的了解宝山区心血管病高危人群颈动脉健康情况及其相关影响因素,为加强宝山区居民心血管病的预防干预提供科学依据。方法于2018年7月—2019年3月采用分层抽样法,对宝山区常住居民进行问卷调查、体格检查及快速血糖血脂检测,选出高危人群1738人,并进行统计学分析。结果在高危对象中,男性有570(32.8%),女性有1168例(67.2%)。颈动脉血管正常人群的平均年龄为(60.15±8.12)岁。71~75岁年龄组左右颈动脉的CCA-IMT增厚与斑块的发病比例较高。CCA-IMT增厚的影响因素有年龄、性别、户籍、是否抽烟、高血压、体重变化明显、空腹血糖、LDL-C/HDL-C。颈动脉斑块的影响因素包括年龄、性别、户籍、抽烟、糖尿病、高血压、高龄亲属、体重变化。结论上海市宝山区心血管病高危人群中存在颈动脉异常,需要在控制传统的高血压、糖尿病等危险因素的基础上,加强慢病患者的分层管理,对不同特征的居民采用针对性防制举措。

结合案例情景模拟在康复科高危跌倒患者跌倒管理中的应用

目的探讨结合案例情景模拟在康复科高危跌倒患者跌倒管理中的应用。方法选择2020年1~12月皖南医学院第二附属医院康复医学科住院治疗的高危跌倒患者70例为研究对象,采用抽签法随机分为干预组和对照组,每组35例。对照组给予常规预防跌倒知识和技能教育,干预组在对照组基础上实施结合案例情景模拟教育。比较两组患者防跌倒知识和行为水平、跌倒发生率及伤害发生情况的差异。结果干预前,两组预防跌倒知识和行为得分比较,差异均无统计学意义(P>0.05);干预后,干预组预防跌倒知识得分、行为得分均高于对照组(P<0.05),干预组干预前后预防跌倒知识差值、行为差值均高于对照组,差异均有统计学意义(P<0.05)。干预后,患者跌倒发生率从1.18%降至0.146%,差异有统计学意义(P<0.05);2级以上伤害发生率从75%降至0。结论结合案例情景模拟能提高康复科高危跌倒患者防跌倒知识及技能水平,降低跌倒发生率和2级及以上伤害发生率,值得临床推广使用。

高植被覆盖下铁路隧道口危岩落石风险评估

山区铁路选线受地形条件制约,高陡边坡或陡崖地段的隧道洞口常面临危岩落石风险,传统人工调查方法困难,尤其是高植被覆盖地区,受现场条件限制不能完全查明危岩分布,同时常用的落石运动轨迹模拟缺少横向范围控制,存在一定的安全隐患。以某铁路隧道进口工程为研究对象,以机载LiDAR和三维倾斜摄影数据为基础,查明了危岩形成机制及分布特征,利用自主研发的Rockfall Hunter软件分析不同破坏形式的危岩三维运动特征,并给出防护措施建议。研究表明:(1)基于定性分析和定量计算,建立的“数据、方法、意义”三阶段高植被覆盖区危岩落石风险综合评估方案行之有效;(2)利用精细化三维实景模型可准确提取危岩体几何信息,危岩落石发育区数字地表灰度影像表面坎坷不平、具粗糙感,危岩体截面地面点棱角显著、地势陡峭,原生孤石或滚石截面呈凸起状、有明显界限;(3)研究发现可能对工程造成危害的危岩体120处,总体积约15541 m^(3),以倾倒、坠落式破坏为主,局部发生组合式破坏;(4)落石进入隧址区最大速度为17.3 m/s,最大弹跳高度为12.5 m,最大冲击能量超过8000 kJ,建议采用避让、清理、加固等措施。