Prediction of the severity of colorectal lesion by fecal hemoglobin concentration observed during previous test in the French screening program

BACKGROUND The rate of positive tests using fecal immunochemical test(FIT)does not decrease with subsequent campaigns,but the positive predictive value of advanced neoplasia significantly decreases in subsequent campaign after a first negative test.A relationship between the fecal hemoglobin concentration(Fhb)and the opportunity to detect a colorectal cancer in subsequent campaign has been shown.AIM To predict the severity of colorectal lesions based on Fhb measured during previous colorectal cancer screening campaign.METHODS This etiological study included 293750 patients aged 50-74,living in Auvergne-Rhone-Alpes(France).These patients completed at least two FIT[test_((-1))and test_((0))]between June 2015 and December 2019.Delay between test_((-1))and test_((0))was>1year and test_((-1))result was negative(<150 ngHb/mL).The severity of colorectal lesions diagnosed at test_((0))was described according to Fhb measured at test_((-1))[Fhb_((-1))].The relationship between the severity classified in seven ordinal categories and the predictive factors was analyzed in an ordered multivariate polytomous regression model.RESULTS The test_((0))positive rate was 4.0%,and the colonoscopy completion rate was 97.1%in 11594 patients who showed a positive test_((0)).The colonoscopy detection rate was 77.7%in those 11254 patients who underwent a colonoscopy.A total of 8748 colorectal lesions were detected(including 2182 low-risk-polyps,2400 high-riskpolyp,and 502 colorectal cancer).The colonoscopy detection rate varied significantly with Fhb_((-1))[0 ngHb/mL:75.6%,(0-50 ngHb/mL):77.3%,(50-100 ngHb/mL):88.7%,(100-150 ngHb/mL):90.3%;P=0.001].People with a Fhb_((-1))within(100-150 ngHb/mL)(P=0.001)were 2.6(2.2;3.0)times more likely to have a high severity level compared to those having a Fhb_((-1))value of zero.This risk was reduced by 20%in patients aged 55-59 compared to those aged<55[adjusted odds ratio:0.8(0.6;1.0)].CONCLUSION The study showed that higher Fhb_((-1))is correlated to an increased risk of severity of colorectal lesions.This risk of severity increased among first-time participants(age<55)and the elderly(≥70).To avoid the loss of chance in these age groups,the FIT positivity threshold should be reduced to 100 ngHb/mL.The other alternative would be to reduce the time between the two tests in these age groups from the current 2 years to 1 year.

Effect of pre-transplantation hemoglobin concentration on prognosis of renal transplant recipients

Background For the renal transplant recipients, anemia is one of the common complications and becomes a major medical issue before transplantation. Haemoglobin （Hb） is used as a prognostic indicator, although the optimal pre-transplantation Hb concentration associated with positive prognosis is still controversial. The aim of this study was to detect the optimal Hb concentration on predicting the graft survival and function.Methods A retrospective cohort study was conducted by reviewing the medical records of the patients who received renal transplantations at our center from January 2004 to June 2008. Patients were divided into two groups： high Hb group （＞100 g/L, n=79） and low Hb group （＜100 g/L, n=63）. There was no significant difference between the two groups regarding sex, age, blood type and tissue types. Renal function among the two groups was measured and compared.Panel reacting antigens （PRA） of all the recipients were negative. The effect of preoperative hemoglobin concentration on the postoperative renal function recovery in both groups was further analyzed.Results A total of 14 acute rejection episodes occurred, including 5 patients in the high Hb group （7.9%） and 9 in the low Hb group （11.4%, P ＞0.05）. The serum creatinine level at one-year post-transplantation of the low Hb group was significantly higher than that of the high Hb group （（117.8±36.3） μmol/L vs. （103.1±35.5） μmol/L, P ＜0.05）. For one-year actuarial patient and graft survival, incidence of delayed graft function （DGF）, serum creatinine concentrations at 1, 3, 6 months post-transplantation, the incidence of cytomegalovirus （CMV） infection, post-transplantation anemia （PTA） and post-transplantation diabetes mellitus （PTDM） of both groups, there were no statistically significant differences.Conclusion Pre-transplantation Hb concentration has significant effect on one-year creatinine concentration, but can not significantly affect acute rejection episodes, DGF, PTA, CMV infection and PTDM.

Functional Imaging of Breast Tissue and Clinical Application

A novel approach to image hemoglobin concentration（△Dhb） and oxygen saturation （△Doxy） of breast tissue is presented. The scenograph of dual-wavelength （760 and 850 nm） near infrared lights through breast tissue is acquired by high sensitive charge coupled device （CCD） camera. The evaluation criterion of the difference of △Dhh and △Doxy between detected and referenced breast tissue can be obtained by a calculation formula without complicate caculation. This approach is applied to clinic detection in breast tissue. The ongoing clinical experiments indicate that malignant tumor usually exhibits characterize of ＂higher △Dhb and lower △Doxy＂, while benign lesion often shows ＂lower △Dhb and higher △Doxy＂ or other characters. So it is useful to assist the diagnosis of breast disease.

Development and validation of a prognostic model for patients with hepatorenal syndrome:A retrospective cohort study

BACKGROUND Hepatorenal syndrome(HRS)is a severe complication of cirrhosis with high mortality,which necessitates accurate clinical decision.However,studies on prognostic factors and scoring systems to predict overall survival of HRS are not enough.Meanwhile,a multicenter cohort study with a long span of time could be more convincing.AIM To develop a novel and effective prognostic model for patients with HRS and clarify new prognostic factors.METHODS We retrospectively enrolled 1667 patients from four hospitals,and 371 eligible patients were finally analyzed to develop and validate a novel prognostic model for patients with HRS.Characteristics were compared between survivors and non-survivors,and potential prognostic factors were selected according to the impact on 28-d mortality.Accuracy in predicting 28-d mortality was compared between the novel and other scoring systems,including Model for End-Stage Liver Disease(MELD),Chronic Liver Failure-Sequential Organ Failure Assessment(CLIF-SOFA),and Chinese Group on the Study of Severe Hepatitis BAcute-on-Chronic Liver Failure(COSSH-ACLF).RESULTS Five prognostic factors,comprised of gender,international normalized ratio,mean corpuscular hemoglobin concentration,neutrophil percentage,and stage,were integrated into a new score,GIMNS;stage is a binary variable defined by the number of failed organs.GIMNS was positively correlated with MELD,CLIFSOFA,and COSSH-ACLF.Additionally,it had better accuracy[area under the receiver operating characteristic curve(AUROC):0.830]than MELD(AUROC:0.759),CLIF-SOFA(AUROC:0.767),and COSSH-ACLF(AUROC:0.759)in the derivation cohort(P<0.05).It performed better than MELD and CLIF-SOFA in the validation cohort(P<0.050)and had a higher AUROC than COSSH-ACLF(P=0.122).CONCLUSION We have developed a new scoring system,GIMNS,to predict 28-d mortality of HRS patients.Mean corpuscular hemoglobin concentration and stage were first proposed and found to be related to the mortality of HRS.Additionally,the GIMNS score showed better accuracy than MELD and CLIF-SOFA,and the AUROC was higher than that of COSSH-ACLF.

Development of a handheld diffuse optical breast cancer assessment probe

Diffuse Optical Spectroscopy(DOS)is a promising non-invasive and non-ionizing technique for breast anomaly detection.In this study,we have developed a new handheld DOS probe to measure optical properties of breast tissue.In the proposed probe,the breast tissue is illuminated with four near infrared(NIR)wavelengths light emitting diodes(LED),which are encapsulated in a package(eLEDs),and two PIN photodiodes measure the intensity of the scattered photons at two di®erent locations.The proposed technique of using eLEDs is introduced,in order to have a multi-wavelength pointed-beam illumination source instead of using the laser-coupledflberoptic technique,which increases the complexity,size,and cost of the probe.Despite the fact that the proposed technique miniaturizes the probe and reduces the complexity of the DOS,the study proves that it is accurate and reliable in measuring optical properties of the tissue.The measurements are performed at the rate of 10 Hz which is suitable for dynamic measurement of biological activity,in-vivo.The multi-spectral evaluation algorithm is used to reconstruct four main absorber concentrations in the breast including oxy-hemoglobin(cHb),deoxy-hemoglobin(cHbO_(2)),water(cH2O),fat(cFat),and average scattering coeficient of the medium,as well as concentration changes in Hb(
cHb)and HbO_(2)(
cHbO_(2)).Although the probe is designed for breast cancer diagnosis,it can be used in a wide range of applications for both static and dynamic measurements such as functional brain imaging.A series of phantoms,comprised of Delrinr,Intralipidr,PierceTM and Black ink,are used to verify performance of the device.The probe will be tested on human subjects,in-vivo,in the next phase.

Signals Analysis and Clinical Validation of Blood and Oxygen Data in Human Brain

With a self-made near-infrared analytical instrument to blood and oxygen parameters in human brain, 80 cases in which 20 are healthy persons and 30 are anaesthetised cases and others are patients with heart function lack is taken to examine, and the data of blood and oxygen in brain tissue were collected and analyzed by the method of power spectrum and correlation function. The results indicate that: (1) The average brain oxygen saturation of healthy persons and anaesthetised cases is about 80%, in accord with normal parameter of physiology. Contrastively, the average brain oxygen saturation of patients with heart function lack is 72.8%, which is obviously less than that of healthy persons and anaesthetised cases. The probability of medical statistics is less than 0.01. (2) The shapes of wave of brain blood and oxygen for the healthy person and the anaesthetised case reveal small periodical fluctuations with stable shape and base line, and the trend of increase or decrease of blood and oxygen parameters in brain tissue is synchronous and a phase reversal, but for the patient with heart function lack in a brain oxygen lack state, the shapes of wave are irregular. This is a hint that near infrared light passing through tissue can reflect the intuitionistic change of brain blood and oxygen parameters.(3) The power spectra of brain blood and oxygen for the healthy person and the anaesthetised case has a clear main peak, narrow bandwidth and perfect superposition each other, but the power spectra for the patient with heart function lack in a brain oxygen lack state is on the contrary.(4) The average cross correlation coefficient of brain blood and oxygen for healthy persons and anaesthetised cases is -0.9825±0.1027 close to -1. But the average cross correlation coefficient for patients with heart function lack in a brain oxygen lack state is merely -0.8923±0.1035 which is obviously greater than -1 and the probability of medical statistics is less than 0.01. The clinic experiments have proved that the shapes of waves, the power spectrum and cross correlation coefficient of brain blood and oxygen are useful to analyze the physiological status and changes of blood and oxygen in human brain.

Plasma Hemoglobin Was Decreased in Elderly With Primary Hypertension and/or Type 2 Diabetes Complicated With End-stage Renal Disease

Objectives To study the change in plasma hemoglobin concentration in elderly patients with primary hypertension and/or type 2 diabetes complicated with end-stage renal disease （ESRD） determined by estimated glomerular filtration rate. Methods Two hundred and thirty cases of Chinese patients aged 60 years or older with primary hypertension and/or type 2 diabetes complicated with chronic kidney disease were enrolled in the study. Patients with chronic kidney disease were divided into ESRD group with estimated glomemlar filtration rate less than 15 mL . min^-1.1.73 m^-2 （7.80 ± 3. 14 mL. min^-1 . 1.73 m^-2） and non-ESRD group with estimated glomerular filtration rate 15 mL.min^-1 . 1.73 m^-2（29. 76 ± 12. 90 mL.min^-1 . 1.73 m^-2） or higher. The plasma hemoglobin concentration was compared between the above two groups retrospectively. Results There was significant decrease in plasma hemoglobin concentration in ESRD group compared with non-ESRD group （74.4 ± 22. 5 g/L vs 100. 8 ± 23.0 g/L, P 〈 0. 05 ）. After stratification by sex, there was also significant decrease in plasma hemoglobin concentration both in male and female of ESRD groups compared with their respective non-ESRD groups（77. 2±22. 0 g/L vs 104. 9 ±20. 7 g/L; 69. 7 ±22. 8 g/L vs 96.4± 24.8 g/L, P 〈 0. 05, respectively）. Plasma hemoglobin concentration was positively related to estimated glomerular filtration rate significantly in patients with ESRD （ P 〈 0. 05 ）. Conclusions Plasma hemoglobin concentration is decreased significantly, and is positively related to estimated glomerular filtration rate significantly in elderly patients with primary hypertension and/or type 2 diabetes complicated with ESRD determined by estimated glomerular filtration rate.