How secure can we expect the surveillance policies to be after the implementation in T1 polyps with carcinoma?

Approximately 7%of the polyps resected endoscopically have an adenocarcinoma focus,with no previous endoscopic evidence of malignancy.This raises the question of whether endoscopic resection has been curative.Furthermore,there is no consensus on what the endoscopic and histological criteria for good prognosis are,the appropriate follow-up strategy and what are the long-term results.The aim of the retrospective study by Fábián et al was to evaluate the occurrence of local relapse or distant metastasis in those tumors that were resected endoscopically compared to those that underwent oncologic surgery.They concluded that,regardless of the treatment strategy chosen,there was a higher recurrence rate than described in the literature and that adherence to follow-up was poor.The management approach for an endoscopically benign polyp histologically confirmed as adenocarcinoma depends on the presence of any of the previously described poor prognostic histological factors.If none of these factors are present and the polyp has been completely resected en bloc(R0),active surveillance is considered appropriate as endoscopic resection is deemed curative.These results highlight,once again,the need for further multicentric clinical practice studies to obtain more evidence for the purpose of establishing appropriate treatment and follow-up strategies.

The Teachers＇ Feedback Act Research of College English Classes

The Follow up Move Research has been deepening after it was first defined in 1975 by Sinclair and Coulthard, but it has not been paid attention in China, let alone study its effect in the classroom. In this essay based on the author＇s literature reading, the Follow up move functions and their language features are classified; its pragmatic motivations are researched and some factors which affect its relevance of occurrence are studied. Then with this guide of the frame four teachers classroom follow up moves are studied. Finally, the other scholars＇ findings in this field are commented and then the author＇s own insights are put forward.

Comparison of different nutritional assessments in detecting malnutrition among gastric cancer patients

AIM: To evaluate the prevalence of preoperative and postoperative malnutrition and the relationships between objective and subjective nutritional assessment of gastric cancer patients. METHODS: From October 2005 to July 2006, we studied 80 patients with no evidence of recurrent disease and no loss to follow-up after curative surgery for gastric cancer. In this group, 9 patients underwent total gastrectomy and 71 patients subtotal gastrectomy. At admission, 6 and 12 mo after surgery, the patients were assessed on the subjective global assessment (SGA), nutritional risk screening (NRS-2002), nutritional risk index (NRI) and by anthropometric measurements and laboratory data. Differences between the independent groups were assessed with the Student's t test and oneway analysis of variance. Spearman's rank correlation coefficients were calculated to evaluate the association between the scores and variables. RESULTS: The prevalence of malnutrition at admissionwas 31% by SGA and 43% by NRS-2002. At admission, the anthropometric data were lower in the malnourished groups defined by the SGA and NRS-2002 assessments, but did not differ between the groups using the NRI assessment. Body weight (BW), body mass index (BMI), triceps skin fold and midarm circumference were significantly reduced, but the total lymphocyte count, albumin, protein, cholesterol and serum iron levels did not decrease during the postoperative period. Six months after surgery, there was a good correlation between the nutritional assessment tools (SGA and NRS-2002) and the other nutritional measurement tools (BW, BMI, and anthropometric measurements). However, 12 mo after surgery, most patients who were assessed as malnourished by SGA and NRS-2002 had returned to their preoperative status, although their BW, BMI, and anthropometric measurements still indicated a malnourished status. CONCLUSION: A combination of objective and subjective assessments is needed for the early detection of the nutritional status in case of gastric cancer patients after gastrectomy.

Radiation risks associated with serial imaging in colorectal cancer patients:Should we worry?

To provide an overview of the radiation related cancer risk associated with multiple computed tomographic scans required for follow up in colorectal cancer patients. A literature search of the PubMed and Cochrane Library databases was carried out and limited to the last 10 years from December 2012. Inclusion criteria were studies where computed tomographic scans or radiation from other medical imaging modalities were used and the risks associated with ionizing radiation reported. Thirty-six studies were included for appraisal with no randomized controlled trials. Thirty-four of the thirty-six studies showed a positive association between medical imaging radiation and increased risk of cancer. The radiation dose absorbed and cancer risk was greater in children and young adults than in older patients. Most studies included in the review used a linear, no-threshold model to calculate cancer risks and this may not be applicable at low radiation doses. Many studies are retrospective and ensuring complete follow up on thousands of patients is difficult. There was a minor increased risk of cancer from ionizing radiation in medical imaging studies. The radiation risks of low dose exposure (< 50 milli-Sieverts) are uncertain. A clinically justified scan in the context of colorectal cancer is likely to provide more benefits than harm but current guidelines for patient follow up will need to be revised to accommodate a more aggressive approach to treating metastatic disease.

Impact of switching from ranibizumab to aflibercept on the number of intravitreous injection and follow up visit in wet AMD:results of real life ELU study

●AIM:To study if one of the two molecules could lead to a lower number of follow up visits and intra-vitreous injection(IVI)with the same efficacy.●METHODS:ELU(or"elected"in French)study is a retrospective study conducted in real life in patients presenting suboptimal response after ranibizumab IVI(phase 1)and secondary switched to aflibercept(phase 2).The number of follow up visits and IVI were compared in both phases.Visual acuity(VA)evolution and"switching"reasons were secondary analyzed.●RESULTS:We retrospectively included data of 33 patients(38 eyes)with age-related macular degeneration(AMD;mean age:77±7.7 y).The number of monthly follow up visits[median(Q1;Q3)]:was significantly lower with aflibercept(phase 2),respectively 1.0(0.81;1.49)visits in phase 1,versus 0.79(0.67;0.86)visits in phase 2.The median number of monthly IVI also significantly decreased in phase 2,respectively 0.67(0.55;0.90)IVI in phase 1,versus 0.55(0.45;0.67)IVI in phase 2.The mean VA evolution(VA final-VA initial)was similar in both phases,(P>0.05).Whatever the reason for"switching"(loss of efficacy,tachyphylaxis,tolerance problems),there was no incidence on VA evolution over the time.●CONCLUSION:Our results show that switching from ranibizumab to aflibercept in"suboptimal"patients significantly reduce the number of follow up visits and IVI,with a comparable efficacy.This decrease in visit number could improve patients’quality of life and reduce surgical risk by reducing the number of injections.

Long-term prognosis in patients with severe late radiation enteropathy:A prospective cohort study

AIM: To assess persistent symptoms and mortality in a cohort of patients with severe (grade 3-4) radiation enteropathy,59 patients were followed up after 15-18 years. METHODS: Fifty-nine patients were prospectively enrolled by twelve surgical departments. Primary malignant disease,radiation therapy and surgical management were recorded at inclusion. The cause of death or persistence of symptoms was examined in public death records or by interview of survivors. RESULTS: Thirty-nine patients had received radiation therapy for gynaecological cancers,twelve for urological cancers,four for gastrointestinal cancers and four for other malignancies. Forty-five patients (76%) required surgical intervention. Complications occurred in 11 (25%) operated patients. Forty-seven patients had died at the time of follow-up,seven (12%) died as a direct result of radiation enteropathy,while radiation enteropathy contributed to death in an additional seven patients. Four of the twelve surviving patients suffered from chronic debilitating symptoms of radiation enteropathy,while three had moderate symptoms. CONCLUSION: Patients with severe delayed radiation enteropathy have a high risk of persistence of symptoms after surgery. At least one in ten patients dies from radiation-induced bowel injury.

Somatostatin receptor scintigraphy in the follow up of neuroendocrine neoplasms of appendix

BACKGROUND Neuroendocrine tumors of appendix(ANETs)known as carcinoids,are rare endocrine neoplasms originated from enterochromaffin cells of gastrointestinal tract.ANETs are the third most frequent(16.7%)gastrointestinal neuroendocrine tumors,with the incidence of 0.08-0.2 cases/100000 during one year.Incidental ANETs occur in 0.2%-0.7%of emergency surgical resections because of suspected appendicitis which is usually the first manifestation of ANET.Although there are a lot of papers about application of somatostatin receptor scintigraphy in gastrointestinal neuroendocrine tumors,there are very rare sporadic cases described about ANETs particularly.AIM To establish the role of somatostatin receptor scintigraphy(SRS)in the management of patients with neuroendocrine tumors of appendix(ANET).METHODS The total of 35 patients was investigated,23 females and 12 males,average age(43.7±17.3 years).All patients had histological diagnosis of ANET(34 carcinoids of appendix and one tubular carcinoid).Majority of tumors have been found incidentally during surgery of:Acute appendicitis(n=15),perforated appendicitis(n=2),ileus(n=3),hysterectomy(n=3),ruptured ovarian cyst(n=2),caecal volvulus(n=1),while 9 patients had diagnosis of appendiceal tumor before the surgery.Seventeen patients had tumor grade(G)G1,12 G2 and 6 G3.The right hemicolectomy was performed in 13,while the rest of the patients had appendectomy only.SRS was done early(2 h)and late(24 h)after i.v.application of 740 MBq technetium-99 m ethylenediamine-N,N’-diacetic acid Hydrazinonicotinyl-Tyr3-Octreotide(technetium-99 m-Tektrotyd,Polatom,Poland).SRS was performed for restaging in all the patients after surgery.RESULTS There were 12 true positive(TP),19 true negative,3 false positive and 1 false negative SRS result.Sensitivity of the method was 92.31%,specificity was 86.36%,positive predictive value was 80.00%,negative predictive value was 95.00%and accuracy 88.57%.Receiver operating characteristics analysis showed that SRS scintigraphy is a good test for detection TP cases[area under the curve of 0.850,95%confidence interval(CI):0.710-0.990,P<001].Single photon emission computed tomography contributed diagnosis in 7 TP findings.In 10 patients Krenning score was 4 and in 2 was 3.In 8 patients SRS significantly changed the management of the patients(in two surgery was repeated,in 4 somatostatin analogues and in two peptide receptor radionuclide therapy).Median progression-free survival in SRS positive patients was 52 months(95%CI:39.7-117.3 mo)while in SRS negative patients it was 60 months(95%CI:42.8-77.1 mo),without statistically significant difference between the two groups(P=0.434).CONCLUSION In conclusion,our results confirmed the value of SRS in the follow-up of the patients with ANET after surgery,if recurrences or metastases are suspected.

立井井筒后注浆施工技术

建昌营铁东煤矿风井井筒冻结段双层钢筋混凝土井壁解冻出水后 ,采用壁间注浆 ,辅以壁后注浆 ,文中着重介绍了立井井壁后注浆施工技术 ,并对几个有关后注浆的问题进行有价值的分析论述。

支架成形术与单纯药物治疗老年症状性椎动脉狭窄患者的疗效比较

目的探讨血管内支架成形术治疗老年症状性椎动脉中重度狭窄患者的长期疗效。方法回顾性分析22例支架成形术及12例单纯药物治疗的老年症状性椎动脉中重度狭窄患者的临床资料,分析支架成形术组患者围手术期并发症发生率以及随访期内两组患者血管狭窄程度、再狭窄率、神经功能恢复情况、脑缺血事件发生率等对比其疗效。结果临床随访73~104个月,平均(90.41±10.86)个月,支架成形术组患者围手术期无严重并发症发生。治疗前两组患者血管狭窄率(82.50±9.17)%vs(79.83±6.42)%,差异无统计学意义(P>0.05);随访期末支架成形术组患者血管狭窄程度(9.00±15.85)%,显著低于药物治疗组(84.83±10.63)%,差异有统计学意义(P<0.01);支架成形术组有3例出现支架内狭窄,药物组有3例患者完全闭塞;随访期内支架成形术组患者总的缺血事件3例,明显低于药物治疗组8例(P<0.01)。结论支架成形术治疗老年症状性椎动脉中重度狭窄有较好的长期效果,对预防后循环缺血事件优于单纯药物治疗,但仍需要更大样本量对照研究证实。

Development of a telehealth monitoring service after colorectal surgery:A feasibility study

AIM To evaluate the feasibility of a text-messaging system to remotely monitor and support patients after discharge following elective colorectal surgery,within an enhanced recovery protocol.METHODS Florence(FLO) is a National Health Service telehealth solution utilised for monitoring chronic health conditions,such as hypertension,using text-messaging.Newalgorithms were designed to monitor the well-being,basic physiological observations and any patient-reported symptoms,and provide support messages to patients undergoing colorectal surgery within an enhanced recovery after surgery protocol for 30 d after discharge.All interactions with FLO and physiological readings were recorded and patients were invited to provide feedback.RESULTS Over a four-week period,16 out of 17 patients used the FLO telehealth service at home.These patients did not receive telephone follow-up at three days,as per our standard protocol,unless they reported being unwell or did not make use of the technology.Three patients were readmitted within 30 d,and two of these were identified as being unwell by FLO prior to readmission.No adverse events attributable to the use of the technology were encountered.CONCLUSION The utilisation of telehealth in the early follow-up of patients who have undergone major colorectal surgery after discharge is feasible.The use of this technology may assist in the early recognition and management of complications after discharge.

Non-alcoholic fatty liver disease is not independent risk factor for cardiovascular disease event:A cohort study

BACKGROUND There are no consistent results between previous studies for an independent association between non-alcoholic fatty liver disease(NAFLD)and cardiovascular disease(CVD)events.AIM To determine if there is an independent association between NAFLD and CVD events.METHODS In the present study,valid outcome data of 4808 subjects were available for phase 2 of our cohort study.These subjects had been followed up for seven years from phase 1,beginning in 2009-2010 to phase 2 during 2016-2017.Simple and multiple Cox proportional models were used to determine the association between NAFLD in the primary phase of the cohort and subsequent fatal and non-fatal CVD events during follow-up.RESULTS The incidence of non-fatal CVD events in males with NAFLD was significantly higher(P=0.004)than in males without NAFLD.A positive association was demonstrated between NAFLD and non-fatal CVD events in males(Hazard ratio=1.606;95%CI:1.166-2.212;P=0.004)by the simple Cox proportional hazard model,but no independent association was detected between these in the multiple Cox models.CONCLUSION No independent association was detected between NAFLD and CVD.It is likely that diabetes mellitus and age may be the principle mediators in this regard.

Com parison betw een Two Techniques Used in Im m ediatePostplacentalInsertion of TCu 380AIntrauterine Device:36-Month follow-up

Three hundred and eighty four women in Shanghai who delivered vaginally and chose IUD for contraception received the copper T 380A IUD inserted vaginally within 10 min after delivery of the placenta(i.e.,immediate postplacental insertion, IPPI). Among them, 98.70% were primipara. The women were randomly divided into two groups: IUD inserted by hand and IUD insreted by ring forceps. Using Life Table Method and χ 2 test, expulsion and other discontinuation rates were compared at 6, 12, 24, and 36 months post insertion between these two different groups. No uterine perforation, infection or prolonged period of lochia occurred in the 384 cases. Expulsions were the main reason for discontinuation. From 6 months to 36 months, the gross cumulative rates of all discontinuation events (expulsion, pregnancy, removal for bleeding/pain, etc.) were not statistically significantly different (P>0.05). The results suggest that these two different insertion techniques do not significantly affect discontinuation rate in vaginal IPPI using the TCu 380 A, which appears to be suitable for postpartum insertion in Chinese women. Other relevant issues, such as breast feeding and IUD position in uterine cavity, are also analyzed and discussed in this paper.

Rational use of antibiotics in children with diabetic ketoacidosis needs attention

Diabetic ketoacidosis(DKA)in children may lead to acute kidney injury(AKI).Among 45 children with DKA in our center,eight cases had AKI on admission,and in one child,his kidney function did not recover until 3 mo after discharge.This child was treated with antibiotics(cephalosporin),and we cannot rule out delayed AKI recovery due to the combined effects of the drug and the disease.Pediatricians should be concerned about the impact of nephrotoxic drug and disease interactions on children's kidney function,and need to follow up children with DKA and AKI to determine the development of AKI.

Study on Online Follow-up Methods on Prevention and Treatment of Coronavirus Disease 2019 with Traditional Chinese Medicine in Community

Objective:To explore the follow-up methods about prevention and treatment of Coronavirus Disease 2019 with traditional Chinese medicine in community quarantined people in new major public health incidents under the mobile"Internet+medical"anti-epidemic model.Methods:The method was summarized from the online follow-up practice of Coronavirus Disease 2019.Results:The online follow-up of Coronavirus Disease 2019 could be regulated by establishing follow-up mechanism,improving follow-up quality and sorting out follow-up problems.Conclusion:The online follow-up of traditional Chinese medicine for the prevention and treatment of Coronavirus Disease 2019 in the community isolated population is a practice of real-world data collection,which can provide a reference for the follow-up work of major public health emergencies.

糖耐量低减者二年后的转归

对１９９２年诊断的３４６例糖耐量低减（ＩＧＴ）患者于１９９４年进行了复查。结果显示２年后１７．９％的ＩＧＴ患者转变为ＤＭ。除ＯＧＴＴ后１小时和２小时血糖外，ＢＭＩ、ＨｂＡ１Ｃ、ＵＡＥ也是ＩＧＴ转变为ＤＭ的独立危险因素，而仅ＯＧＴＴ后１小时血糖为ＩＧＴ的独立保护因素。

Application of autologous peripheral blood stem cell transplantation in children with malignant tumor

Objective To investigate if low dose total body irradiation (TBI, 6.0- 9.0 Gy) combined with intensified chemotherapy followed by autologous peripheral blood stem cell transplantation results in better survival in children with refractory leukemia or solid tumors.Methods Twenty-one children with malignant tumors were included in this study. There were 14 males and 7 females aged 3.5- 12 years. Underlying disease included high-risk acute lymphoblastic leukemia (ALL, CR1 in 3 children and CR2 in 5 children), acute myeloblastic leukemia (AML, 9 children), nonHodgkin' s lymphoma stage Ⅳ (2 children), and neuroblastoma stage Ⅳ (2 children). The peripheral hematopoietic stem cells were collected six to eleven months after complete response, mobilized with high dose chemotherapy alone or combined with GM-CSF or G-CSF. The conditioning regimen consisted of chemotherapy with two to three combinations of the following drugs: cyclophosphamide,arabinosylcytosine, McNU, etopside, and Idarubicin on the basis of TBI (6.0-9.0Gy). A mean of (1.8 ± 0.5) × 108/kg autologous mononuclear cells were transplanted. The patients were followed up after transplantation.Results Severe bone marrow suppression occurred in all patients around day + 7. Peripheral white blood cell count decreased to 0 in all patients at day + 4.8 ± 2.9, and platelet count decreased to less than 20× 109/L at day + 9.0 ± 2.6. Successful engraftment was achieved in 21 patients, but four died of infection at day + 17, + 20, + 31 and + 67, respectively. Recovery of white blood cell (WBC) to 10 × 109/L, absolute neutrophil count to 0.5 × 109/L, platelet count to 20 × 109/L occurred on 21 ± 12,26± 13, and 27 ± 10 days, respectively. During the follow up period, three patients relapsed at + 5months, + 1.5 years, and + 2 years 10 months, respectively. One patient died of intracranial hemorrhage at +8 months. Thirteen patients had event-free survival for 2 - 12 years, with a mean of 6.7±3.4 years.Conclusion Our preliminary data suggest that myeloablative therapy with low dose TBI (6.0 - 9.0 Gy)combined with intensified chemotherapy followed by autologous paripheral blood stem cell transplantation might be associated with favorable results in children with refractory leukemia or solid tumors.

Incidence and risk factors of tuberculosis among the elderly population in China:a prospective cohort study

Background:China is facing challenges of the shifting presentation of tuberculosis(TB)from younger to elderly due to an ageing population,longer life expectancy and reactivation disease.However,the burden of elderly TB and influence factors are not yet clear.To fill the gap,we generated a cohort study to measure the magnitude of TB incidence and associated factors among the elderly population aged 65 years and above in China.Methods:In this cohort established in 2013 through a prevalence survey conducted in selected sites,a total of 34076 elderlies without TB were enrolled into two-year follow-up.We used both active and passive case findings to find out all TB patients among them.The person-year(PY)incidence rates for both bacteriologically positive TB and active TB were calculated.Cox proportional regression model was performed to test effect of risk factors,and the population attributable fraction(PAF)of each risk factor contributing to incident TB among elderlies was calculated.Results:Over the two-year follow-up period,a total of 215 incident active TB were identified,62 of which were bacteriologically positive.The incidence rates for active TB and bacteriologically positive TB were 481.8 per 100000 PY(95%CI:417.4–546.2 per 100000 PY)and 138.9 per 100000 PY(95%CI:104.4–173.5 per 100000 PY),respectively.Incident cases detected by active case finding were significantly higher(P<0.001).Male,non-Han nationality,previously treated TB,ex/current smoker and body mass index(BMI)<18.5 presented as independent predictors for developing TB disease.For developing bacteriologically positive TB,the biggest contribution was from self-reported ex or current smoker(18.06%).And,for developing active TB,the biggest contribution was from non-Han nationality(35.40%),followed by male(26.80%)and age at 75 years and above(10.85%).Conclusions:Ageing population in China had a high TB incidence rate and risk to develop TB disease,implying that National TB Program(NTP)needs to prioritize for elderly.Active case finding should be applied capture more active TB cases among this particular population,especially for male,non-Han nationality,and those with identified risk factors.

Compliance among infants exposed to hepatitis B virus in a post-vaccination serological testing program in four provinces in China

Background:Mother to child transmission of hepatitis B virus(HBV)remains the most common form of HBV infection in China.Prevention of HBV vertical transmission involves timely administration of the complete hepatitis B vaccine(HepB)series and hepatitis B immunoglobulin.Post-vaccination serological testing(PVST)is utilized to determine an infant's outcome after HBV exposure and completion of HepB series.We aim to determine the frequency of compliance with a PVST testing cascade for HBV infected mothers and analyze factors associated with infant lost to follow up(LTFU).Methods:We conducted a retrospeaive cohort review of previously collected data in Fujian,Jiangxi,Zhejiang and Chongqing provinces in China from 1 June 2016-31 December 2017.The study population included all HBV-exposed infants and their mothers.SAS software was used for statistical analyses.Bivariate and multivariate regression analyses(presented in odds ratio[OR]with 95%confidence intervals[CI])were used to compare the proportional differences of factors associated with PVST not being completed.Results:Among enrolled 8474 target infants,40%of them transferred out of the study provinces without further information and 4988 were eligible for PVST.We found 20%(994)of infants were not compliant with the testing cascade:55%of LTFU occurred because parents refused venous blood sample collection or failure of sample collection in the field,16%transferred out after 6 months of age,and 10%of families chose to have independent,confidential PVST completed without reporting results.High PVST noncompliance rates were more likely to be from Fujian(aOR=17.0,95%CI:9.7-29.9),Zhejiang(aOR=5.7,95%Cl:3.2-10.1)and Jiangxi(aOR=1.9,95%CI:1.0-3.4),and from HBV e antigen positive mother(aOR=1.2,95%CI:1.1-1.4).Conclusions:This study found that the LTFU rate reached 20%in PVST program,which was a significant problem.We recommend implementing a national elearonic information system for tracking HBV at risk mother-infant pairs;encourage further research in developing a less invasive means of completing PVST,and take effective measures nationally to reduce HBV stigma.Without reducing the loss to follow up rate among infants eligible for PVST,elimination of vertical HBV transmission will be impossible.

Modelling follow up time at a single-lane roundabout

The follow up time is an important parameter for estimating the entry capacity of roundabouts. However, its variability and contributing factors have long been ignored in the literatures. In this study, 171 follow up samples and contributing factors （traffic volume, vehicle position, waiting vehicles behind, vehicle type, and drivers＇ gender） are collected at a roundabout in Pacific Pines, Australia. It is found that the follow up time is indeed significantly affected by traffic volume, waiting vehicles behind, vehicle type, and drivers＇ gender. In order to establish the relationship between the follow up time and its contributing factors, an inverse Gaussian regression model is further developed. This relationship could be applied to estimate the entry capacities by taking into account the variability of follow up samples. According to the model, the traffic volume and vehicle types are the most important contributing factors.