Colorectal cancer,screening and primary care: A mini literature review

Colorectal cancer(CRC) is a common health problem,representing the third most commonly diagnosed cancer worldwide and causing a significant burden in terms of morbidity and mortality,with annual deaths estimated at 700000. The western way of life,that is being rapidly adopted in many regions of the world,is a well discussed risk factor for CRC and could be targeted in terms of primary prevention. Furthermore,the relatively slow development of this cancer permits drastic reduction of incidence and mortality through secondary prevention. These facts underlie primary care physicians(PCPs) being assigned a key role in health strategies that enhance prevention and prompt diagnosis. Herein,we review the main topics of CRC in the current literature,in order to better understand its pathogenesis,risk and protective factors,as well as screening techniques. Furthermore,we discuss preventive and screening policies to combat CRC and the crucial role served by PCPs in their successful implementation. Relevant articles were identified through electronic searches of MEDLINE and through manual searches of reference lists.

What is the most cost-effective strategy to screen for second primary colorectal cancers in male cancer survivors in Korea?

AIM:To identify a cost-effective strategy of second primary colorectal cancer (CRC) screening for cancer survivors in Korea using a decision-analytic model.METHODS: A Markov model estimated the clinical and economic consequences of a simulated 50-year-old male cancer survivors' cohort, and we compared the results of eight screening strategies: no screening, fecal occult blood test (FOBT) annually, FOBT every 2 years, sigmoidoscopy every 5 years, double contrast barium enema every 5 years, and colonoscopy every 10 years (COL10), every 5 years (COL5), and every 3 years (COL3). We included only direct medical costs, and our main outcome measures were discounted lifetime costs, life expectancy, and incremental cost-effectiveness ratio (ICER).RESULTS: In the base-case analysis, the non-dominated strategies in cancer survivors were COL5, and COL3. The ICER for COL3 in cancer survivors was $5593/life-year saved (LYS), and did not exceed $10000/LYS in one-way sensitivity analyses. If the risk of CRC in can- cer survivors is at least two times higher than that in the general population, COL5 had an ICER of less than $10500/LYS among both good and poor prognosis of index cancer. If the age of cancer survivors starting CRC screening was decreased to 40 years, the ICER of COL5 was less than $7400/LYS regardless of screening compliance.CONCLUSION: Our study suggests that more strict and frequent recommendations for colonoscopy such as COL5 and COL3 could be considered as economically reasonable second primary CRC screening strategies for Korean male cancer survivors.

Knowledge and Skills Gap of Midwives to Conduct Obstetric Ultrasonography Screening in Primary Health Care Facilities in Kajiado and Kisii Counties, Kenya

Background: Ultrasound remains a tool of much importance in maternity care with midwives regarded as key health professionals when it comes to care of pregnant mothers. There is however limited study on the knowledge and skills gaps of midwives in conducting obstetric ultrasonography screening. The purpose of this study was to assess the specific obstetric ultrasonography knowledge and skills gaps among midwives based in primary health care facilities. Methods: A cross-sectional study employing both qualitative and quantitative method was conducted between July and August 2019 with 274 midwives. A structured questionnaire was used to collect data while Focus group discussion and Key Informants Interview were used to collect qualitative data. Descriptive statistics were used to summarize the data test associations between variables while the qualitative data were used to compliment the questionnaire data in eliciting more information on the gaps. Findings: Almost all (94.5%) the midwives had never been trained on any basic obstetric ultrasound while six of those that had been trained in early stages by the project lacked equipment to practice the acquired skills. More than three quarters of the respondents opined that they wished to provide personalized care services to mothers/clients seeking Antenatal Care Services (ANC) in their community at a fee while only 13.9% had knowledge that obstetric screening should be done before 24 weeks gestation. Four out of ten of the respondents scored themselves a one (1) on the level of confidence they have using an ultrasound machines or technology. Conclusion: There still remains a huge gap as far as training of midwives on basic ultrasound screening is concerned. The lack of basic obstetric ultrasound screening skills is a barrier to rolling out Point of Care Ultrasound (POCUS) screening services. However, midwives are motivated and willing to learn basic ultrasonography skills to further the objectives of Universal Health Coverage (UHC). Concerted efforts should be made to train midwives on basic obstetric ultrasonography skills in addition to availing mobile/hand held ultrasound technology in Primary Health facilities for them to apply the transferred skills. A sustainable business model to enable mothers continuously afford the services is critical as well.

Adapting the PPRNet TRIP QI Model to Increase Colorectal Cancer Screening in Primary Care

Background: Established CRCS guidelines for providers and the public exist, but due to several versions of CRCS guidelines and the variety of test options, confusion often arises among patients and providers, adversely affecting CRCS rates. Improving providers’ opportunities to recommend CRCS through provider-directed office-system interventions is critical to increase CRCS rates. Objective: The purpose of this study was to demonstrate the feasibility of adapting provider-directed office-system interventions developed by the Practice Partner Research Network (PPRNet) Translation of Research into Practice (TRIP) Quality Improvement (QI) Model for implementation in an independent, rural West Virginia primary care practice, and to obtain estimates of variability for relevant outcome measures of the interventions to increase CRCS recommendation and rates. Methods: Retrospective and prospective patient data from medical records and electronic medical records were extracted to compare pre-with post-intervention CRCS rates and analyze any significant demographic data. Also, office staff participated in a focus group interview. Results: The pre-intervention CRCS status/completion rate was 4.3% and increased to 36.2%. CRCS recommendation rate rose from 4.3% to 42.1%. Patients in the post group were almost 7 times more likely to get CRCS recommendation compared to patients in the pre group, adjusting for demographic information. Similar to findings for CRCS recommendations, patients in the post group were more than 12 times more likely to have CRCS completion compared to their counterparts in the pre-group (OR 12.61, p < 0.000, CI: 8.30, 19.15). Conclusion: This study demonstrated the feasibility as well as statistically significant preliminary indications that CRCS rates will increase after implementation of this model.

Case-finding for mental distress in primary health care: An evaluation of the performance of a five-item screening instrument

Background: There is an increased interest in developing better and more accurate methods to recognize and manage mental health problems in primary care settings. Abbreviated screening instruments for mental distress are useful tools for research and clinical practice. The present study seeks to investigate whether only a few questionnaire items from the Self-Reporting- Questionnaire-10 (SRQ-10) can be a robust method in the screening for Mental Distress in Primary Health care. Methods: We compared the screening accuracy of a short, five-item (SRQ-5) version of the SRQ-10 with that of the SRQ-20, General Health Questionnaire 12 (GHQ-12) using the DSM-IV axis as a gold standard and analyzed its performance in different diagnostic entities. We also assessed the correlation, sensitivity and specificity between the 4 instruments. All the instruments were administered to 400 primary health care attendees. Results: The estimated prevalence of mental distress was 13.6% in the study sample (Depression 11%, anxiety disorders 1.8%). The SRQ-5 was highly correlated to SRQ-10 (0.923, p < 0.001), SRQ-20 (0.764, p < 0.001) and only moderately correlated to GHQ-12 (0.417, p < 0.001). The SRQ-5 had high properties for identifying mental distress. The AUC for overall mental distress was 0.925 while that for depression and anxiety were 0.915 and 0.849 respectively. Conclusion: This validation showed that in moving from SRQ with 10 or 20 items to one with merely 5 items, we do not seem to lose the screening prowess of the instrument. The SRQ-5 represents a simplified and less time-consuming screening instrument with strong performance characteristics. We therefore recommend it for inclusion into existing patient assessment protocols, thus enhancing case finding at primary health care level.

New Screening Approach for Ocular Diseases

Objective: Present a new screening approach for ocular diseases. Method: Transversal, retrospective, single center study that analyzed medical records of patients from a social project on the prevention of blindness and amblyopia, which aimed at: 1) Detect the main ocular disorders such as amblyopia, primary angle-closure suspect (PACS);glaucoma suspect (GS);predisposing retinal detachment lesions (PRDL);age-related macular degeneration (AMD), and diabetic retinopathy (DR);2) Perform cataract diagnosis;3) Provide guidance and treatment for allergic conjunctivitis. 4) Prescribe glasses for children until 14 years of age. Participants were examined by a single specialist, holder of a post-doctoral degree in ophthalmology, with 36 years of experience and a sub-specialization in retina and vitreous. All data were analyzed in 2022. Results: The examiner diagnosed 42 cases of PACS, 21 of GS, 8 of PRDL, 14 of AMD, 3 of DR, 40 of cataract and 31 cases of allergic conjunctivitis. Thirty-three participants younger than 14 were prescribed glasses. Other pathologies included retinal detachment, papilledema, corneal ulcer, suspected conjunctival squamous cell carcinoma, retinal vasculitis, strabismus, uveitis, bilateral papilla paleness and lacrimal duct obstruction. Out of the 297 cases examined, 168 participants presented some type of alteration that could compromise their vision. Conclusion: The examiner’s experience and knowledge were decisive factors for the quick diagnosis, advice, screening and/or treatment of several ocular diseases. The social project results reveal that the primary care and/or the screening performed by a specialist are likely to reduce blindness cases.

宁波市江北区中小学生脊柱侧弯情况调查及影响因素

目的 了解宁波市江北区中小学生脊柱侧弯初筛阳性情况并分析其影响因素,为青少年脊柱侧弯防治提供科学依据。方法 采用两阶段整群抽样的方法,抽取宁波市江北区2所小学、2所初中、2所普通高中的1 648名学生为调查对象,通过问卷收集基本信息、饮食运动、读写习惯、背包行为和行走姿态等资料;采用一般检查、前屈试验和脊柱侧弯测量仪初筛脊柱侧弯情况;采用Logistic回归分析脊柱侧弯的影响因素。结果 回收有效问卷1 639份,中小学生脊柱侧弯初筛阳性113例,检出率为6.89%;女生脊柱侧弯检出率(10.15%)高于男生(4.16%),差异有统计学意义(χ~2=22.730,P<0.05)。多因素Logistic回归分析结果显示,女性(OR=2.559,95%CI:1.698~3.855)、消瘦(OR=1.660,95%CI:1.123~2.455)是中小学生脊柱侧弯阳性的危险因素,父母偶尔或经常提醒读写姿势不正确(偶尔OR=0.557,95%CI:0.296~1.051,经常OR=0.430,95%CI:0.246~0.754)是中小学生脊柱侧弯阳性的保护因素(P<0.05)。结论 江北区中小学生脊柱侧弯问题较严重,应重视女生的健康教育,加强学生营养,父母应注重提醒学生及时纠正读写姿势。

多学科个性化动态营养干预对促进老年原发性肝癌患者术后恢复效果的影响

目的 分析多学科个性化动态营养干预对促进老年原发性肝癌患者术后恢复效果的影响。方法 选取开滦总医院2022年1―12月收治的接受营养风险筛查2002(nutritional risk screening 2002,NRS 2002)风险评估且存在营养不良风险的老年原发性肝癌患者80例作为研究对象,按随机数字表法分为对照组(n=40)和干预组(n=40)。对照组给予常规术后护理,干预组给予多学科个体化动态营养干预。比较两组患者术后恢复评分、术后恢复速度指标及护理前后患者的衰弱程度、绝望量表评分和营养指标。结果 干预组患者术后早期进食时间、肛门排气时间、达到目标70%进食量时间均显著早于对照组(均P <0.05),干预组患者住院天数显著短于对照组(P <0.05),干预组患者住院费用显著少于对照组(P <0.05)。干预组患者术后7 d恢复评分显著高于对照组(P <0.05)。两组患者护理后健康状况、社会支持、自制力、情绪指标评分均有所下降(均P <0.05),且干预组下降幅度均显著大于对照组(均P <0.05)。两组患者护理后对未来感觉评分和对未来期望评分均有所下降(均P <0.05),且干预组患者评分下降幅度均显著大于对照组(均P <0.05)。干预组患者术后并发症发生率明显显著低于对照组(P <0.05)。结论 多学科个性化动态营养干预促进老年原发性肝癌患者术后恢复的临床效果较好。

专科护士参与的住院患者脑卒中风险筛查及随访管理

目的探讨专科护士参与的住院患者脑卒中风险筛查及随访管理效果,为全面落实脑卒中一级预防提供借鉴。方法构建住院患者脑卒中风险筛查模式,对内外科≥40岁的住院患者进行脑卒中风险筛查。由病区责任护士对患者进行初筛、专科护士对高危风险患者进行卒中一级预防管理,进行1年的随访。结果2021年9月从内外科36个病区中筛查出脑卒中风险患者3416例,其中高危513例(15.02%),中危1926例(56.38%),低危977例(28.60%);对3类患者实施分级管理,其中高危患者由神经内科进一步诊疗;完成1年随访的197例高危患者,随访后血压、血脂、运动等达标率显著高于随访前(均P<0.05),健康自我管理能力得分显著提高(均P<0.05)。结论专科护士参与的住院患者脑卒中风险筛查模式有利于早期发现脑卒中风险患者,落实一级预防,从而降低脑卒中发生率。

初筛谷丙转氨酶结果偏高献血者的补救方法

目的 通过初筛无偿献血者谷丙转氨酶(ALT),对献血前ALT初筛结果偏高的献血者制定相应补救措施,一定程度上解决生理因素引起的献血前ALT异常造成的献血者流失问题。方法 采用干式生化法,对2022年1—6月至河南省某血站的所有无偿献血者进行ALT初筛,对于ALT>45 U·L^(-1)且乙肝和血红蛋白初筛合格的献血者重复初筛检测3次,取3次结果的平均值,如仍>45 U·L^(-1)则进行相应干预措施,献血后采用速率法复检ALT,比较干预前后献血合格率及血液ALT报废率情况。结果 对乙肝和血红蛋白初筛合格的献血员,ALT水平在45~50 U·L^(-1)者,嘱其安静休息30 min复测ALT。结果显示,在安静休息30 min后,ALT轻度偏高的献血者,初筛ALT检测值越低,复测ALT合格率越高,实施补救措施的献血员献血后追踪复检ALT合格率为99.9%。对于安静休息30 min后复测ALT仍不合格者,嘱其清淡饮食、避免饮酒和熬夜,5~7 d后1 250名该类人员参与献血健康检查,其中430名初筛ALT合格,献血后追踪复检ALT合格率为99.7%。结论 对于初筛ALT不合格献血员,通过实施相应干预措施,可使部分ALT异常的献血者降至正常,提升献血合格率,在一定程度上缓解临床用血紧张。

基于激光光幕的高速小目标信噪比研究

通过对目标过靶时光电探测器与运算放大器所产生信号和噪声的研究,推导出信噪比与激光出射功率、原向反射屏逆反射效率的理论关系;进行多组实验验证激光功率、反射效率对信号信噪比的影响。结果表明所设计的激光光幕系统,通过适当提高激光功率、采用逆反射效率高的反射屏,可以有效提升高速小目标过靶信号的信噪比。

‘Prediabetes’ as a practical distinctive window for workable fruitful wonders: Prevention and progression alert as advanced professionalism

Diabetes is a devastating public health problem.Prediabetes is an intermediate stage in the disease processes leading to diabetes,including types 1 and 2 diabetes.In the article“Prediabetes in children and adolescents:An updated review,”the authors presented current evidence.We simplify and systematically clearly present the evidence and rationale for a conceptual framework we term the‘3ASs’:(1)Awareness Sensible;(2)Algorithm Simple;and(3)Appealing Strategies.Policy makers and the public need to be alerted.The prevalence of prediabetes should send alarm bells ringing for parents,individuals,clinicians,and policy makers.Prediabetes is defined by the following criteria:impaired fasting glucose(100-125 mg/dL);impaired glucose tolerance(2 h postprandial glucose 140-199 mg/dL);or hemoglobin A1c values of 5.7%–6.4%.Any of the above positive test alerts for intervention.Clinical guidelines do not recommend prioritizing one test over the others for evaluation.Decisions should be made on the strengths and shortfalls of each test.Patient preferences and test accessibility should be taken into consideration.An algorithm based on age,physiological stage,health status,and risk factors is provided.Primordial prevention targeting populations aims to eliminate risk factors through public education and encouraging practices through environmental modifications.Access to healthy foods is provided.Primary prevention is for individuals with a prediabetes diagnosis and involves a structured program to reduce body weight and increase physical activity along with a healthy diet.An overall methodical move to a healthy lifestyle for lifelong health is urgently needed.Early energetic prediabetes action is necessary.

如皋市116715例适龄妇女宫颈癌筛查结果分析及筛查策略研究

目的对35~64岁适龄妇女宫颈癌筛查结果进行分析,探讨不同筛查模式在宫颈癌筛查中的应用价值。方法选择116715例宫颈癌筛查的适龄妇女为研究对象,其中TCT初筛57780例,HPV初筛58935例。对后续检查的随访情况、指标完成情况进行评价,并对比TCT初筛、HPV初筛宫颈癌阳性、阴道镜检查、宫颈病理学检查结果及宫颈病变随访治疗情况。结果初筛宫颈癌总体阴道镜随访率、宫颈组织病理学随访率分别为96.68%、99.53%,HPV初筛阴道镜随访率、宫颈组织病理学随访率分别为97.55%、99.76%,TCT初筛阴道镜随访率、宫颈组织病理学随访率分别为95.74%、99.23%,HPV初筛阴道镜随访率、宫颈组织病理学随访率均高于TCT初筛,差异有统计学意义(P<0.05);HPV初筛阳性率、阴道镜异常检出率分别为12.72%、79.99%,TCT初筛阳性率、阴道镜异常检出率分别为4.02%、71.93%,HPV初筛阳性率、阴道镜异常检出率均高于TCT初筛,差异有统计学意义(P<0.05);总体宫颈癌前病变检出率、宫颈癌检出率、早诊率分别为500.36/10万、53.12/10万、91.24%,HPV初筛宫颈癌前病变检出率为605.75/10万,TCT初筛宫颈癌前病变检出率392.87/10万,HPV初筛宫颈癌前病变检出率高于TCT初筛,差异有统计学意义(P<0.05);HPV初筛宫颈癌检出率、早诊率分别62.78/10万、91.75%,TCT初筛宫颈癌检出率、早诊率分别为43.27/10万、90.62%,HPV初筛与TCT初筛宫颈癌检出率、早诊率比较差异均无统计学意义(P>0.05);宫颈病变随访治疗率为97.28%,达到项目≥95%的指标要求。结论如皋市35~64岁妇女“两癌”筛查工作取得了一定的成效,但在阳性病例后续管理仍有缺口,需采取分层次的宣教模式做好健康宣教,提高参检妇女主动配合后续管理的意识。HPV初筛筛查模式符合如皋市实际且行之有效。

机采血小板献血者血液初筛不合格情况的原因调查研究

目的调查研究机采血小板献血者血液初筛不合格的原因。方法将驻马店市中心血站2022年6月至2022年12月480例机采血小板献血者作为研究对象。在单采血小板献血前,所有献血者均采集肘静脉血4 m L并进行血样初筛,依据《血站技术规程2019版》确定血液筛查结果,统计480例机采血小板献血者血液初筛结果与初筛不合格项目;另外对比男性、女性初筛不合格项目。结果共计筛查480例,其中共40例出现血液初筛不合格,初筛不合格率为8.33%;机采血小板献血者血液初筛不合格项目中,丙氨酸转氨酶(ALT)检测值>50 U/L占比为17.50%、血小板计数检测值<150×10^(9)/L占比为25.00%、血细胞比容(HCT)检测值<0.36占比为25.00%、血红蛋白(Hb)检测值不合格占比为2.50%、白细胞计数(WBC)检测值不合格占比为15.00%、乳糜血不合格占比为12.50%、乙型肝炎病毒表面抗原(HBs Ag)阳性占比为2.50%;男性、女性机采血小板献血者血液初筛不合格项目中ALT检测值>50 U/L、Hb检测值不合格率对比差异有统计学意义(P<0.05),其余对比差异无统计学意义(P>0.05)。结论机采血小板献血者血液初筛不合格的项目主要包括ALT检测值>50 U/L、血小板计数检测值<150×10^(9)/L、HCT检测值<0.36占比最高,男性初筛不合格项目主要以ALT检测值>50 U/L为主,女性则主要以Hb检测值不合格为主。

沂源县中小学生视力健康情况调研报告

目的调研沂源县中小学生视力健康状况,明确中小学生存在的视力健康问题,并初步分析引发视力健康问题的危险因素,为青少年近视防控提供数据支持。方法2021年4月—2021年8月,根据国家卫健委办公厅出台的《儿童青少年近视防控适宜技术指南》(2019版)制定《沂源县儿童青少年近视综合防控推进计划》,对沂源县各中小学的在校生进行视力普查。结果沂源县4所高中(10791人)、18所初中(16909人)、51所小学(19796人)的47496人参与本次视力普查,剔除无效数据后,共计43434(91.45%)人的视力情况纳入最终分析。不同年级间的视力健康情况比较,差异有统计学意义(χ^(2)=10597.452,P<0.001),不同性别的青少年视力健康情况比较,差异有统计学意义(χ^(2)=32.710,P<0.001)。结论家长和学校应在青少年出现视力异常情况时尽早进行联合干预,保障青少年的视力健康。

Screening of unknown atrial fibrillation through handheld device in the elderly

Objective To estimate the prevalence of unknown atrial fibrillation(AF)in the elderly population of the Veneto Region,Italy.Methods 1820 patients aged≥65 years with no history of AF and not anticoagulated were enrolled in primary-care settings.They underwent an opportunistic electrocardiogram screening with a handheld device(My Diagnostick)designed to specifically detect AF.The electrocardiogram recordings were reviewed by the researchers,who confirmed the presence of AF.Results The device detected an arrhythmia in 143 patients,which was confirmed as AF in 101/143(70.6%),with an overall prevalence of AF of 5.5%(101/1820).Prevalence of unknown AF resulted in 3.6%in patients aged 65–74 years,and 7.5%in patients age 75 or older,and increased according to CHA2 DS2-VASc score:3.5%in patients with a score of 1 or 2,5.6%in patients with a score of 3,7.0%in patients with a score of 4,and 7.2%in patients with a score≥5.The detection rate was significantly higher in patients with mild symptoms compared to asymptomatic counterparts(24.1%vs.4.0%,P<0.0001).At multivariate analysis,congestive heart failure and age≥75 years-old were independent predictors for screen-detected AF.Conclusions An opportunistic screening with handheld device revealed an unexpectedly high prevalence of unknown AF in elderly patients with mild symptoms.Prevalence increased with age and CHA2DS2-VASc score.

Primary stratification and identification of suspected corona virus disease 2019(COVID-19) from clinical perspective by a simple scoring proposal

In this Commentary,we would like to comment on the article titled"A rapid advice guideline for the diagnosis and treatment of 2019 novel coronavirus(2019-nCoV)infected pneumonia(standard version)"as a featured article in Military Medical Research.In the guideline,except for"confirmed cases","suspected cases","close contact"and"suspicious exposure"were defined by clinical perspective based on epidemiological risk,clinical symptoms and auxiliary examination.Combined with our experience,we introduced a simple scoring proposal additionally based on not only CT imaging as strongly recommended by the guideline but also blood routine test,especially for primary screening of such patients in the out-patient department.

FORGET: Pilot of an Innovative and Simple History Based Screening Tool for Dementia Community Clinics and Acute Medical Hospitals

The aim of this study is to pilot FORGET as screening tool for dementia in community OP clinic and acute medical hospital assessments. Sample size included 30 each of memory clinic and acute medical hospital patients. Assessments included FORGET and MMSE. Psychometric test parameters were calculated for FORGET (Cut-off >1 in OP clinic and >3 in acute medical hospital). Of 30 referrals to memory clinic, 25 had dementia. A score >1 on FORGET had sensitivity 80%, specificity 80%, PPV 95.24%, NPV 44.44%, OR 16.00 (p = 0.02) for diagnosis of dementia. Of 30 acute hospital referrals, 20 had dementia. A score >3 on FORGET had sensitivity 95%, specificity 90%, PPV 95% and NPV 90%, OR 171 (p = 0.0005). FORGET at a score of >1 in community and >3 in acute medical hospital is a useful screening tool for dementia.

Impact of a colorectal cancer screening program implantation on delays and prognosis of non-screening detected colorectal cancer

BACKGROUND The implementation of a colorectal cancer(CRC)screening programme may increase the awareness of Primary Care Physicians,reduce the diagnostic delay in CRC detected outside the scope of the screening programme and thus improve prognosis.AIM To determine the effect of implementation of a CRC screening programme on diagnostic delays and prognosis of CRC detected outside the scope of a screening programme.METHODS We performed a retrospective intervention study with a pre-post design.We identified 322 patients with incident and confirmed CRC in the pre-implantation cohort(June 2014–May 2015)and 285 in the post-implantation cohort(June 2017-May 2018)in the Cancer Registry detected outside the scope of a CRC screening programme.In each patient we calculated the different healthcare diagnostics delays:global,primary and secondary healthcare,referral and colonoscopyrelated delays.In addition,we collected the initial healthcare that evaluated the patient,the home location(urban/rural),and the CRC stage at diagnosis.We determined the two-year survival and we performed a multivariate proportional hazard regression analysis to determine the variables associated with survival.RESULTS We did not detect any differences in the patient or CRC baseline-related variables.A total of 20.1%of patients was detected with metastatic disease.There was a significant increase in direct referral to colonoscopy from primary healthcare(25.5%,35.8%;P=0.04)in the post-implantation cohort.Diagnostic delay was reduced by 24 d(106.64±148.84 days,82.84±109.31 d;P=0.02)due to the reduction in secondary healthcare delay(46.01±111.65 d;29.20±60.83 d;P=0.02).However,we did not find any differences in CRC stage at diagnosis or in two-year survival(70.3%;P=0.9).Variables independently associated with twoyear risk of death were age(Hazard Ratio-HR:1.06,95%CI:1.04-1.07),CRC stage(II HR:2.17,95%CI:1.07-4.40;III HR:3.07,95%CI:1.56-6.08;IV HR:19.22,95%CI:9.86-37.44;unknown HR:9.24,95%CI:4.27-19.99),initial healthcare consultation(secondary HR:2.93,95%CI:1.01-8.55;emergency department HR:2.06,95%CI:0.67-6.34),hospitalization during the diagnostic process(HR:1.67,95%CI:1.17-2.38)and urban residence(HR:1.44,95%CI:1.06-1.98).CONCLUSION Although implementation of a CRC screening programme can reduce diagnostic delays for CRC detected in symptomatic patients,this has no effect on CRC stage or survival.

De novo multiple primary carcinomas in a patient after liver transplantation:A case report

BACKGROUND Liver transplantation(LT)is the most effective treatment strategy for advanced liver diseases.With the increasing survival rate and prolonged survival time,the postoperative long-term complications of LT recipients are becoming an important concern.Among them,the newly developed cancer after LT is the second complication and cause of LT-related death after cardiovascular disease.At present,few papers have reported multiple primary carcinomas(MPCs)after LT.Herein,we retrospectively analyzed an MPC case with gastric cancer and lung cancer after LT.CASE SUMMARY Herein,we retrospectively analyzed an MPC case with de novo gastric cancer and lung cancer after LT with no obvious complaints.Forty-one months after LT,the patient underwent radical distal gastrectomy(Billroth II)for intramucosal signet ring cell carcinoma,and then thoracoscopic wedge resection of the right lower lobe of the right lung and localized lymph node dissection 2 mo later.Therefore,paying attention to follow-up in LT recipients with early detection and intervention of de novo MPCs is the key to improving the survival rate and quality of life of LT recipients.CONCLUSION De novo MPCs after LT are rare,and the prognosis is poorer.However,early detection and related intervention can significantly improve the prognosis of patients.Therefore,we recommend that liver transplant recipients should be followed and screened for newly developed malignant tumors to improve the survival rate and quality of life.