超声微探头辅助内镜对食管癌早期筛查及癌前病变诊断价值分析

目的:研究超声微探头辅助内镜对食管癌早期筛查及癌前病变的诊断价值。方法:选取内镜室常规胃镜检查显示食管黏膜可疑病变的200例(239处病变)患者作为研究对象,包括食管黏膜糜烂、粗糙与颜色异常等情况;所有患者均接受NBI、Lugol氏液染色检查及超声微探头内镜扫描;对联合NBI、Lugol氏液染色检查及超声微探头内镜扫描结果、病理结果进行分析。结果:食管癌病变的普通内镜、NBI、Lugol氏液染色诊断敏感性、特异性分别是(86.6%、13.3%)、(95.9%、28.9%)、(100.0%、44.4%);超声微探头诊断早期食管癌病变和术后组织病理检查结果的符合率是82.1%。结论:超声微探头辅助内镜联合Lugol氏液染色检查,能使早期食管癌病变及癌前病变的相关检出率得到有效提高,利于临床判断早期癌与其相关浸润程度。

952例新生儿听力筛查结果分析

听力异常是新生儿出生时较为常见疾病之一,国外研究表明,新生儿听力障碍发病率为0.1%～0.3%。国内流行病学资料显示,新生儿听力损失率为0.1%～0.2%。为贯彻《中华人民共和国母婴保健法》将听力保健作为儿童保健的一项服务内容,并早期发现先天性听力异常的儿童,及时进行干预,尽可能地提高听力障碍患儿的语言，认知和交往能力。我院对住院分娩的新生儿在出院前进行听力筛查，为了早期发现异常，同时探讨畸变产物耳声发射技术在新生儿听力筛查中的应用。

Screening for nasopharyngeal carcinoma in high-incidence regions——Next steps

Epstein-Barr virus(EBV)infection is a well-established risk factor in the development of nonkeratinizing and undifferentiated forms of nasopharyngeal carcinoma(NPC)common in parts of China and Southeast Asia.Early detection of NPC can significantly improve survival rates,as the 5-year survival rate for patients diagnosed at an early stage can exceed 90%after treatment.Studies have demonstrated that screening for NPC using EBV markers is an effective tool for identifying individuals with the disease.Future efforts should focus on implementing screening programs in high-incidence populations,assessing and refining screening algorithms,and exploring new,potentially more cost-effective screening methods.It is crucial to ensure that any new approaches are validated as superior or non-inferior to existing protocol before being adopted on a wider scale.The success of these screening tools in reducing NPC-related morbidity and mortality will depend on their effective implementation and ensuring access for the populations most in need of preventive interventions.This opinion piece briefly summarizes the current evidence supporting EBV-based screening for NPC detection and discusses future steps,including:1)the implementation of effective NPC screening programs,2)the evaluation of improvements in screening methodologies,and 3)the consideration of novel approaches to screening.

Isolation, Expression Characteristics and Chromosomal Locations of Three cDNA Fragments Under Salt Stress in Rice

cDNA libraries were constructed from the leaves of a rice (Oryza sativa L.) salt tolerancevariety Tesan抋i 2 growing in solutions with 150 mmol/L NaCl for 3 h or without salt stress. Three salt-responsive cDNA clones, Ts1, Ts2 and Ts3 were isolated by differential screening. Northern blottinganalysis showed that the transcription levels of Ts1 and Ts2 increased within 3 h salt stress and kept onincreasing within 24 h, while the transcription level of Ts3 reached its peak within 3 h. Sequence analysisindicated that there were no homologies between the three cDNA clones and any known gene. The threecDNA clones were mapped using a doubled haploid (DH) population derived from an indica variety ZYQ8,which was a salt tolerance parent of Tesan抋i 2, with a japonica variety JX17. Ts1, Ts2 and Ts3 werelocated on chromosomes 1, 3 and 7, respectively. It was noted that Ts1, Ts2, and Ts3 were in or near theregions of major or minor salt tolerance quantitative trait loci (QTLs), which were mapped in the same DHpopulation in a parallel study.

Performance value of high risk factors in colorectal cancer screening in China

AIM:To analyze the performance value of high risk factors in population-based colorectal cancer(CRC) screening in China.METHODS:We compared the performance value of the immunochemical fecal occult blood test(iFOBT) and other high risk factors questionnaire in a population sample of 13 214 community residents who completed both the iFOBT and questionnaire investigation.Patients with either a positive iFOBT and/or questionnaire were regarded as a high risk population and those eligible were asked to undergo colonoscopy.RESULTS:The iFOBT had the highest positive predictive value and negative predictive value in screening for advanced neoplasia.The iFOBT had the highest sensitivity,lowest number of extra false positive results associated with the detection of one extra abnormality for screening advanced neoplasias and adenomas.A history of chronic cholecystitis or cholecystectomy,chronic appendicitis or appendectomy,and chronic diarrhea also had a higher sensitivity than a history of adenomatous polyps in screening for advanced neoplasias and adenomas.The sensitivity of a history of chronic cholecystitis or cholecystectomy was highest among the 10 high risk factors in screening for nonadenomatous polyps.A history of chronic appendicitis or appendectomy,chronic constipation,chronic diarrhea,mucous and bloody stool,CRC in first degree relatives,malignant tumor and a positive iFOBT also had higher sensitivities than a history of adenomas polyps in screening for non-adenomatous polyps.Except for a history of malignant tumor in screening for non-adenomatous polyps,the gain in sensitivity was associated with an increase in extra false positive results associated with the detection of one extra abnormality.CONCLUSION:The iFOBT may be the best marker for screening for advanced neoplasias and adenomas.Some unique high risk factors may play an important role in CRC screening in China.

Barriers to colorectal cancer screening:A case-control study

AIM:To investigate barriers to colorectal cancer(CRC) screening in a community population.METHODS:We conducted a community-based case-control study in an urban Chinese population by questionnaire.Cases were selected from those completing both a fecal occult blood test(FOBT) case and colonoscopy in a CRC screening program in 2004.Control groups were matched by gender, age group and community.Control 1 included those having a positive FOBT but refusing a colonoscopy.Control 2 included those who refused both an FOBT and colonoscopy.RESULTS:The impact of occupation on willingness to attend a colorectal screening program differed by gender.P for heterogeneity was 0.009 for case vs control group 1, 0.01 for case versus control group 2, and 0.80 for control group 1 vs 2.Poor awareness of CRC and its screening program, characteristics of screening tests, and lack of time affected the screening rate.Financial support, fear of pain and bowel preparation were barriers to a colonoscopy as a screening test.Eighty-two percent of control group 1 and 87.1% of control group 2 were willing attend if the colonoscopy was free, but only 56.3% and 53.1%, respectively, if it was self-paid.Multivariate odds ratios for case vs control group 1 were 0.10 among those unwilling to attend a free colonoscopy and 0.50 among those unwilling to attend a self-paid colonoscopy.CONCLUSION:Raising the public awareness of CRC and its screening, integrating CRC screening into the health care system, and using a painless colonoscopy would increase its screening rate.

A survey and evaluation of population-based screening for gastric cancer

Screening and early diagnosis of gastric cancer play important roles in reducing the mortality of gastric cancer. A vast amount of study data on gastric cancer screening and early diagnosis has been accumulated in and out of China in the past decades. The practice of gastric cancer screening has also been efficiently carried out in different countries and regions. However, no widely accepted principle of population screening for gastric cancer has been developed yet. Screening for gastric cancer requires extensive exploration both theoretically and practically. This article focuses on the method and program of gastric cancer screening based on population. Moreover, the current situation of gastric cancer screening and its evaluation are evaluated.

Population-based study of DNA image cytometry as screening method for esophageal cancer

AIM:To explore the DNA image cytometry (DNA-ICM) technique as a primary screening method for esopha-geal squamous precancerous lesions.METHODS:This study was designed as a population-based screening study.A total of 582 local residents aged 40 years-69 years were recruited from Linzhou in Henan and Feicheng in Shandong.However,only 452 subjects had results of liquid-based cytology,DNA-ICM and pathology.The sensitivity and specificity of DNA-ICM were calculated and compared with liquid-based cytology in moderate dysplasia or worse.RESULTS:Sensitivities of DNA-ICM ranging from at least 1 to 4 aneuploid cells were 90.91%,86.36%,79.55% and 77.27%,respectively,which were better than that of liquid-based cytology (75%).Specifici-ties of DNA-ICM were 70.83%,84.07%,92.65% and 96.81%,but the specificity of liquid-based cytology was 91.91%.The sensitivity and specificity of a combination of liquid-based cytology and DNA-ICM were 84.09% and 85.78%,respectively.CONCLUSION:It is possible to use DNA-ICM tech-nique as a primary screening method for esophageal squamous precancerous lesions.

Results of mass endoscopic examination for gastric cancer in Kamigoto Hospital,Nagasaki Prefecture

AIM:To examine how the introduction of endoscopy to gastric cancer screening affected survival prognosis in a regional population. METHODS: The subjects comprised 4261 residents of Kamigoto,Nagasaki Prefecture,who underwent gastric X-ray examination for gastric cancer screening from 1991 to 1995,and all 7178 residents who underwent endoscopic examination for the same purpose from 1996 to 2003. The analysis evaluated trends in age-adjusted gastric cancer mortality rates and standard mortality ratios (SMRs) among the Kamigoto residents. RESULTS: According to demographic statistics,the 1995 and 2000 age-adjusted gastric cancer mortality rates in Nagasaki Prefecture (per 100 000 population) were 42.6 and 37.3 for males and 18.6 and 16.0 for females,while the corresponding rates in Kamigoto before and after the introduction of endoscopic screening were respectively 51.9 and 28.0,and 26.6 and 6.9. The data obtained in this study were divided into those for two periods,1990-1996 and 1997-2006,and SMRs were calculated separately for males and females. For the first period,the SMR was 1.04 (95% CI 0.50-1.58) for males and 1.54 (95% CI 0.71-2.38) for females,while for the second period the SMR was 0.71 (95% CI 0.33-1.10) for males and 0.62 (95% CI 0.19-1.05) for females. CONCLUSION: Following the introduction of endoscopic examination,gastric cancer death rates decreased in Kamigoto.

Stool-based DNA testing,a new noninvasive method for colorectal cancer screening,the first report from Iran

AIM： To detect tumor-associated DNA changes in stool samples among Iranian patients with colorectal cancer （CRC） compared to healthy individuals using BAT-26, p16 hypermethylation and long DNA markers. METHODS： Stool DNA was isolated from 45 subjects including 25 CRC patients and 20 healthy individuals using a new, fast and easy extraction method. Long DNA associated with tumor was detected using polymerase chain reaction method. Microsatellite studies were performed utilizing denaturating polyacrylamide gel to determine the instability of BAT-26. Methylation status of p16 promoter was analyzed using methylation-specific PCR （MSP）. RESULTS： The results showed a significant difference in existence of long DNA （16 in patients vs 1 in controls, P 〈 0.001） and p16 （5 in patients vs none in controls, P = 0.043） in the stool samples of two groups. Long DNA was detected in 64% of CRC patients; whereas just one of the healthy individuals was positive for Long DNA. p16 methylation was found in 20% of patients and in none of healthy individuals. Instability of BATo26 was not detected in any of stool samples. CONCLUSION： We could detect colorectal cancer related genetic alterations by analyzing stool DNA with a sensitivity of 64% and 20% and a specificity of 95% and 100% for Long DNA and p16 respectively. A non- invasive molecular stool-based DNA testing can provide a screening strategy in high-risk individuals. However, additional testing on more samples is necessary from Iranian subjects to determine the exact specificity and sensitivity of these markers.

Colorectal cancer screening in Europe

Colorectal cancer(CRC)is the second most frequent malignant disease in Europe.Every year,412 000people are diagnosed with this condition,and 207 000patients die of it.In 2003,recommendations forscreening programs were issued by the Council of the European Union(EU),and these currently serve as thebasis for the preparation of European guidelines forCRC screening.The manner in which CRC screening iscarried out varies significantly from country to countrywithin the EU,both in terms of organization and thescreening test chosen.A screening program of onesort or another has been implemented in 19 of 27 EUcountries.The most frequently applied method is testing stool for occult bleeding(fecal occult blood test,FOBT).In recent years,a screening colonoscopy hasbeen introduced,either as the only method(Poland)orthe method of choice(Germany,Czech Republic).

Efficacy of leukocyte esterase dipstick test as a rapid test in diagnosis of spontaneous bacterial peritonitis

AIM: To evaluate the efficacy of dipstick test in diagnosis of spontaneous bacterial peritonitis (SBP) in cirrhotic patients who underwent abdominal paracentesis based on the locally available dipstick test. METHODS: There were 200 consecutive samples from cirrhotic patients who underwent abdominal paracentesis. Urine dipstick (Combur10 Test?M, Roche, Mannheim, Germany) was used as a screening test. A manual cell count with differential study was done in all samples by experienced technicians. The polymorphonuclear (PMN) cell count more than 250 cells/mm3 was used as a diagnostic cut off level. One to three plus dipstick results were used as cut off levels for a positive result. The dipstick test results had to be agreed by three experienced readers. The sensitivity, specificity, positive and negative predictive values and accuracy of two different colorimetric cut off scales (1+ and 2+) were calculated and compared. RESULTS: The prevalence of SBP diagnosed by manual cell count was 21.0%. There were 128 specimens that had a true negative result by dipstick. The sensitivity, specificity, positive and negative predictive values and accuracy of 1+ and 2+ cut off scale to diagnose SBP were 88%, 81%, 55%, 96% and 83% respectively, and 63%, 96%, 82%, 81% and 89% respectively. CONCLUSION: Dipstick test can be used as a rapid test for screening of SBP. The higher cut off colorimetric scale has a better specificity and positive predictive value but a lower sensitivity.

Pancreatic ductal adenocarcinoma screening:New perspectives

Pancreatic ductal adenocarcinoma accounts for more than 90% of all pancreatic cancers and its incidence has increased significantly worldwide.Patients with pancreatic ductal adenocarcinoma have a poor outcome and more than 95% of the people affected die from the disease within 12 mo after diagnosis.Surgery is the first-line treatment in the case of resectable neoplasm,but only 20% of patients are candidates for this approach.One of the reasons there are few candidates for surgery is that,during the early phases of the disease,the symptoms are poor or non-specific.Early diagnosis is of crucial importance to improve patient outcome;therefore,we are looking for a good screening test.The screening test must identify the disease in an early stage in order to be effective;having said this,a need exists to introduce the concept of "early" ductal adenocarcinoma.It has been reported that at least five additional years after the occurrence of the initiating mutation are required for the acquisition of metastatic ability of pancreatic adenocarcinoma and patients die an average of two years thereafter.We have reviewed the most recent literature in order to evaluate the present and future perspectives of screening programs of this deadly disease.

Review of screening for pancreatic cancer in high risk individuals

Pancreatic cancer is difficult to diagnose at an early stage and is associated with a very poor survival.Ten percent of pancreatic cancers result from genetic susceptibility and/or familial aggregation.Individuals from families with multiple affected first-degree relatives and those with a known cancer-causing genetic mutation have been shown to be at much higher risk of developing pancreatic cancer.Recent efforts have focused on detecting disease at an earlier stage to improve survival in these high-risk groups.This article reviews high-risk groups,screening methods,and current screening programs and their results.

Stomach cancer screening and preventive behaviors in relatives of gastric cancer patients

AIM:To investigate gastric cancer screening and preventive behaviors among the relatives of patients with gastric cancer[i.e.,gastric cancer relatives(GCRs)].METHODS:We examined the Korean National Health and Nutrition Examination Survey 2005(KNHANESⅢ) database and compared the gastric cancer screening and preventive behaviors of GCRs(n=261)with those of non-GCRs(n=454)and controls without a family history of cancer(n=2842).RESULTS:The GCRs were more likely to undergo gastric cancer screening compared with the control group(39.2%vs 32.3%,adjusted odds ratio:1.43,CI:1.05-1.95),although the absolute screening rate was low.Dietary patterns and smoking rates did not differ significantly between the groups,and a high proportion of GCRs reported inappropriate dietary habits(i.e.,approximately 95%consumed excessive sodium,30% were deficient in vitamin C,and 85%were deficient in dietary fiber).CONCLUSION:The gastric cancer screening and preventive behaviors of GCRs have yet to be improved.To increase awareness among GCRs,systematic family education programs should be implemented.

Factors associated with use of gastric cancer screening services in Korea

AIM: To identify the factors associated with participation in gastric cancer screening programs. METHODS: Using data from the Korea National Health and Nutrition Examination Survey 2005 (KNHANES Ⅲ), a nationwide health-related surveyin Korea, a cross-sectional study was performed to investigate the multiple factors associated with gastric cancer screening attendance among persons aged at least 40 years. The study population included 4593 individuals who completed a gastric cancer screening questionnaire and had no previous cancer history. Four groups ofindividual-level or environmental level covariates were considered as potential associated factors.RESULTS: Using KNHANES Ⅲdata, an estimated31.71% of Korean individuals aged at least 40 years adhered to gastric cancer screening recommendations. Subjects who graduated from elementary school[adjusted odds ratio (aOR), 1.66; 95% CI: 1.21-2.26], middle/high school (aOR, 1.38; 95% CI: 1.01-1.89), and university or higher (aOR, 1.64; 95% CI: 1.13-2.37) were more likely to undergo gastric cancer screening than those who received no formal education at all. The population with the highest income tertile had more attendance at gastric screening compared to those with the lowest income tertile (aOR, 1.36; 95% CI: 1.06-1.73). Gastric screening was also negatively associated with excessive alcohol consumption (aOR, 0.71; 95% CI: 0.53-0.96). A positive attitude to preventive medical evaluation was significantly associated with better participation in gastric cancer screening programs (aOR, 5.26; 95% CI: 4.35-6.35). CONCLUSION: Targeted interventions for vulnerable populations and public campaigns about preventive medical evaluation are needed to increase gastric cancer screening participation and reduce gastric cancer mortality.

Screening for metronidazole-resistance associated gene fragments of H pylori by suppression subtractive hybridization

AIM： To screen for metronidazole （MTZ）-resistance associated gene fragments of H pylori by suppression subtractive hybridization （SSH）. METHODS： Five MTZ-resistant （tester, T） and 1 MTZ- susceptible （driver, D） clinical H pylori isolates were selected. Genomic DNAs were prepared and submitted to Rsa I digestion. Then two different adaptors were ligated respectively to the 5＇-end of two aliquots of the tester DNA fragments and SSH was made between the tester and driver DNAs. The specific inserts of tester strains were screened and MTZ-resistance related gene fragments were identified by dot blotting. RESULTS： Among the randomly selected 120 subtractive colonies, 37 DNA fragments had a different number of DNA copies （≥ 2 times） in resistant and susceptible strains and 17 of them had a significantly different number of DNA copies （≥ 3 times）. Among the sequences obtained from the 17 DNA fragments, new sequences were found in 10 DNA fragments and duplicated sequences in 7 DNA fragments, representing respectively the sequences of depeptide ABC transporter periplasmic dipeptide-binding protein （dppA）, permease protein （dppB）, ribosomal protein S4 （rps4）, ribonuclease Ⅲ （rnc）, protease （pqqE）, diaminopimelate epimerase （dapF）, acetatekinase （ackA）, H pylori plasmid pHP51 and Hpylori gene 1334. CONCLUSION： Gene fragments specific to MTZ-resistant H pylori strains can be screened by SSH and may be associated with MTZ-resistant Hpylori.

Colorectal cancer screening behavior and willingness

The outpatient-based study by Deng et al [World J Gastroenterol 2011 July 14; 17(26): 3133-3139] on the factors that may influence the colorectal cancer (CRC) screening feasibility, encouraged our curiosity. Establishing a simple method for quickly assessing the educational level of patients and modulating a questionnaire for each type of patient, may be an effective protocol to increase the people participation, mainly in countries where sufficient medical resources and financial support are lacking. In fact, the knowledge directly affects the feasibility when screening is offered. Patient educational level influences the understanding of the knowledge and the screening method. This factor may affect patient's priority level on the study participation, the understanding of questions, and the motivation to complete the questionnaire and, consequently, the screening success. Recent studies have found a relationship between high educational level and CRC screening participation, and emphasized the question-naire ineffectiveness in the illiterate people. Although the questionnaire is an excellent method for this kind of evaluation, physician's contribution could be the most important factor associated with the screening method. Thus, further studies should be conducted to explore the compliance of patients with low educational level and to look for the best solutions for their enrollment.

The initial results of Epstein-Barr virus (EBV)-encoded latent membrane protein-1 (LMP-1) for screening nasopharyngeal carcinoma (NPC)

Objective: Early diagnosis of nasopharyngeal carcinoma (NPC) is an important method to improve the survival rate.However,the sensitivity and specificity of the screening protocols which was widely used in clinic now are considered to be unsatisfactory.Epstein-Barr virus (EBV)-encoded latent membrane protein-1 (LMP-1) is one of the proteins that have been suggested to be a classic oncogene with transformation properties.The current study set out to discuss the clinical significance of LMP-1 on the screening of NPC.Methods: Three hundred patients who visited our institution (Department of Radiation Oncology,Fujian Provincial Cancer Hospital,Fuzhou,China) with ENT symptoms between 2007 and 2008 were involved in this study,and all of them were agreed to be involved in this investigation.Not only did they undergo nasopharyngeal swab to obtain cells for the LMP-1 polymerase chain reaction (PCR) analysis,but also nasopharyngeal biopsy were taken to identify the diagnosis.Results: An amount of DNA that was sufficient for PCR was extracted from 243 (81%) swab samples,the positive rate of LMP-1 of those with non-nasopharyngeal carcinoma was 3.85% (4/108),which was much lower than those with nasopharyngeal carcinoma (P < 0.05).By detecting LMP-1 in nasopharyngeal swabs,NPC was diagnosed with a sensitivity of 88.15% (119 of 135 patients),specificity of 96.30% (104 of 108 patients),a positive predictive value of 95.2% (119 of 123 patients),a negative predictive value of 86.67% (104 of 120 patients),accuracy of 91.77%,and Youden index of 84.45%.Conclusion: The nasopharyngeal swab coupled with PCR-based EBV LMP-1 detection have high sensitivity and specificity,and also good repeatability,it could serve as part of the screening program for high-risk populations.

Barium meal follow through with pneumocolon:Screening test for chronic bowel pain

AIM： To study the sensitivity, specificity and cost effectiveness of barium meal follow through with pneumocolon （BMFTP） used as a screening modality for patients with chronic abdominal pain of luminal origin in developing countries. METHODS： Fifty patients attending the Gastroenterology Unit, SMS Hospital, whose clinical evaluation revealed chronic abdominal pain of bowel origin were included in the study. After routine testing, BMFT, BMFTP, contrast enhanced computed tomography （CECT） of the abdomen, barium enema and colonoscopy were performed. The sensitivity, specificity and cost effectiveness of these imaging modalities in the detection of small and/or large bowel lesions were compared. RESULTS： Out of fifty patients, structural pathology was found in ten. Nine out of these ten patients had small bowel involvement while seven had colonic involvement alone or in combination with small bowel involvement. The sensitivity of BMFTP was 100% compared to 88.89% with BMFT when detecting small bowel involvement （BMFTP detected one additional patient with ileocecal involvement）. The sensitivity and specificity of BMFTP for the detection of colonic pathology were 85.71% and 95.35% （41/43）, respectively. Screening a patient with chronic abdominal pain （bowel origin） using a combination of BMFT and barium enema cost significantly more than BMFTP while their sensitivity was almost comparable. CONCLUSION： BMFTP should be included in the investigative workup of patients with chronic abdominal pain of luminal origin, where either multiple sites （small and large intestine） of involvement are suspected or the site is unclear on clinical grounds. BMFTP is an economical, quick and comfortable procedure which obviates the need for colonoscopy in the majority of patients.