Oncogenic H-ras induces cyclin B1 expression in a p53-independent manner

Alcohol abuse is a major risk factor for cancer of the upper alimentary tract, the upper respiratory tract, and liver. Chromosome damage is used as early effect biomarker in the surveillance of human exposure to genotoxic carcinogens. In the present study, two genetic markers, namely chromosome aberrations (CAs) and micronuclei (MN), were used to evaluate genetic damage in peripheral lymphocytes from 20 alcoholics, 20 abstinent alcoholics, and 20 controls. Composition of the three groups was fairly similar as regards sex, age and smoking habits. A highly significant increase was observed in the frequencies of CA and MN in lymphocytes of alcoholics as compared both with controls and abstinent alcoholics. However, no correlation was found between the length of alcohol abuse and the frequencies of either biomarkers in alcoholics. CA and MN frequencies in abstinent alcoholics were similar than those in controls.Our data indicate that CA and MN can be two useful biomarkers to assess genetic damage associated with alcohol abuse. They could be included in programs for cancer prevention in alcoholics. Abstinence appears to normalize the frequency of both MN and CA. This could offer therapists another tool to help alcoholics change their lifestyle.     

上消化道造影和CT扫描诊断胃部肿瘤的应用价值比较

目的:比较上消化道造影和CT扫描诊断胃部肿瘤的临床应用价值。方法:选取我院胃外科收治的胃部肿瘤82例,随机分为两组,其中对照组41例,采用上消化道造影技术诊断;实验组41例,采用螺旋CT扫描,进行胃部肿瘤诊断。对比两组检查方式的诊断结果与病理诊断的符合率。结果:1进行螺旋CT扫描诊断与病理诊断符合率(95.12%,39/41)明显高于上消化道造影技术诊断符合率(80.49%,33/41),差异有统计学意义(P0.05);2淋巴结转移的敏感性和特异性比较中,螺旋CT明显高于上消化道造影技术,差异有统计学意义(P0.05)。结论:上消化道造影和CT扫描在诊断胃部肿瘤的临床应用中,上消化道造影技术是早期胃部肿瘤的首选检查方法,但是螺旋CT对胃部肿瘤正确诊断率要高,螺旋CT对淋巴结转移的敏感性和特异性较高,能够给确定胃部肿瘤分期提供依据,值得临床推广。     

中国肝细胞癌患者TACE术后死亡原因分析(英文)

目的:通过探讨中国肝细胞癌患者肝动脉化疗栓塞术(TACE)术后并发症及死亡原因,来提高临床治疗效果,并积累治疗经验。方法:通过联合检索CBM及CNKI上从1994年1月到2008年9月的关于中国肝细胞癌患者行TACE术后出现并发症的相关文章,分析总结肝细胞癌患者TACE术后死亡的原因及特点。结果:中国肝细胞癌患者TACE术后并发症较为危重,致死率较高,死亡原因有84%是肝功能衰竭、上消化道出血及肝癌破裂出血,且死亡病例发生在术后1月内的占78.7%,因此大多是早期死亡。结论:中国肝细胞患者TACE术后死亡原因主要是肝功能衰竭、上消化道出血及肝癌破裂出血,且术后死亡常为早期死亡,因此TACE术后严重并发症可直接影响患者的预后情况,我们需要提高对TACE术选择时机的重视程度,规范介入治疗手段和流程,尽量避免和减少严重并发症的发生。     

Course of acute hepatitis B in alcoholism

Clinical course of the acute hepatitis B has been analysed in 29 men chronically abusing alcohol. The most frequent source of the infection was surgery and hospitalizations. Clinical course and biochemical findings were similar in this group and in 30 men not drinking alcohol. A sole difference concerned higher GGTP activity in alcoholics. The persistence of HBs antigen was similar in both groups. Chronic alcohol abuse does not seem to have a significant effect on the course and convalescent phase of the acute hepatitis B.     

Acetaldehyde as an underestimated risk factor for cancer development: role of genetics in ethanol metabolism

Chronic ethanol consumption is a strong risk factor for the development of certain types of cancer including those of the upper aerodigestive tract, the liver, the large intestine and the female breast. Multiple mechanisms are involved in alcohol-mediated carcinogenesis. Among those the action of acetaldehyde (AA), the first metabolite of ethanol oxidation is of particular interest. AA is toxic, mutagenic and carcinogenic in animal experiments. AA binds to DNA and forms carcinogenic adducts. Direct evidence of the role of AA in alcohol-associated carcinogenesis derived from genetic linkage studies in alcoholics. Polymorphisms or mutations of genes coding for AA generation or detoxifying enzymes resulting in elevated AA concentrations are associated with increased cancer risk. Approximately 40% of Japanese, Koreans or Chinese carry the AA dehydrogenase 2*2 (ALDH2*2) allele in its heterozygous form. This allele codes for an ALDH2 enzyme with little activity leading to high AA concentrations after the consumption of even small amounts of alcohol. When individuals with this allele consume ethanol chronically, a significant increased risk for upper alimentary tract and colorectal cancer is noted. In Caucasians, alcohol dehydrogenase 1C*1 (ADH1C*1) allele encodes for an ADH isoenzyme which produces 2.5 times more AA than the corresponding allele ADH1C*2. In studies with moderate to high alcohol intake, ADH1C*1 allele frequency and rate of homozygosity was found to be significantly associated with an increased risk for cancer of the upper aerodigestive tract, the liver, the colon and the female breast. These studies underline the important role of acetaldehyde in ethanol-mediated carcinogenesis.     

血清HE4、FS、SMRP及CA125在卵巢癌患者中的表达及临床意义

目的:探讨血清人附睾蛋白4(HE4)、卵泡抑素(FS)、可溶性间皮素相关蛋白(SMRP)、糖类抗原125(CA125)在卵巢癌患者中的表达水平及临床意义。方法:选取2014年6月-2017年9月我院收治的卵巢癌患者60例作为卵巢癌组,另选取同期收治的卵巢良性肿瘤患者32例作为良性组,选取同期健康体检妇女40例作为对照组,检测三组受试者血清HE4、FS、SMRP、CA125水平,对比三组HE4、FS、SMRP、CA125阳性表达率,并分析血清HE4、FS、SMRP、CA125对卵巢癌的诊断价值。结果:三组受试者的HE4、FS、SMRP、CA125水平整体对比有统计学意义(P0.05),其中卵巢癌组与良性组HE4、FS、SMRP、CA125水平高于对照组,且卵巢癌组高于良性组,差异有统计学意义(P0.05)。三组受试者的HE4、FS、SMRP、CA125阳性表达率整体对比有统计学意义(P0.05),卵巢癌组与良性组HE4、FS、SMRP、CA125阳性表达率高于对照组,且卵巢癌组高于良性组,差异有统计学意义(P0.05)。联合检测的灵敏度高于FS、SMRP单项检测,差异有统计学意义(P0.05),联合检测的特异度高于HE4、FS、SMRP、CA125单项检测,但差异无统计学意义(P0.05)。结论:卵巢癌患者血清HE4、FS、SMRP、CA125水平及阳性表达率均较高,四项指标联合检测可提高诊断卵巢癌的灵敏度及特异度。     

超声胃镜小探头对上消化道黏膜下病变的诊断价值探讨

目的:探讨超声胃镜小探头对上消化道黏膜下病变的诊断价值.方法:使用超声胃镜小探头对我院2010年6月-2011年12月62例经电子胃镜检查的上消化道黏膜下病变患者进行检查,对病变的浸润范围与性质进行分析,结果与术后病理进行对比.结果:良性间质瘤43例,占69.35％,恶性间质瘤6例,占9.68％,异位胰腺5例,占8.06％,囊肿6例,占9.68％,脂肪瘤与静脉曲张各1例,占1.61％.所有结果均经病理检查证实,符合率100％,结果具有代表性(P＜0.05).结论:使用超声胃镜小探头能清楚显示上消化道各层管壁结构,确定上消化道黏膜下病变的性质,提高诊断率,具有极高的临床价值,可作为上消化道黏膜下病变的诊断方法在临床推广应用.     

Prevalence of and risk factors associated with alcohol abuse in Moshi, northern Tanzania

This study aimed to assess the prevalence of and risk factors associated with alcohol abuse among women and men in Moshi in northern Tanzania. Alcohol abuse was measured by a CAGE score of 2-4, versus 0-1 for no alcohol abuse (Ewing, 1984). Crude and adjusted logistic regression models determined odds ratios (OR) and 95% confidence intervals (95% CI) of alcohol abuse by characteristics of, respectively, women with partners (n=1200), women without partners (n=614) and men (n=788) (women's partners). Prevalence of alcohol abuse was 7.0% (95% CI: 5.6-8.4) among women with partners, 9.3% (95% CI: 7.0-11.6) among women without partners, and more than double among men at 22.8% (95% CI: 19.9-25.8). In general, Christians had higher alcohol abuse than Muslims or other religions, as did Chagga men compared with men of other ethnic groups. Other socio-demographic characteristics, such as education or income, were not significant. Sexual behaviours were significant predictors of alcohol abuse. For example, women without partners who reported more than two partners in the last year had higher alcohol abuse compared with women reporting no partners (OR=8.75; 95% CI: 2.37-32.31), as did men reporting it is 'OK to hit a partner' for any reason (OR=1.79; 95% CI: 1.16-2.77) compared with men who did not. HIV-1 infection was not significantly associated with alcohol abuse by women or men. The Christian Church in Moshi should consider raising awareness about the harmful effects of high alcohol use among its adherents. Comprehensive programmes focusing on reducing number of partners and alcohol use, particularly by men, are needed in this community.     

Dietary intakes,resting metabolic rates,and body composition in benign and malignant gastrointestinal disease.

Dietary protein and energy intakes were assessed in 42 patients with cancer and 24 with benign conditions of the gastrointestinal tract. The relations of dietary intake to body composition was examined. Resulting metabolic rate was measured in 51 patients. No significant differences in dietary intake or metabolic rate were found between patients with cancer and those with benign disease. There were significant positive correlations between protein and energy intakes and the ratio of total body potassium to total body water in patients with benign disease but not in those with cancer. Weight loss was probably due to inadequate food intake, the main defect being energy deficiency, since protein intake was usually well maintained. Supplementing with energy the voluntary ingested diet of patients with cancer would probably prevent weight loss in most cases.     

Population based cohort study of the association between alcohol intake and cancer of the upper digestive tract

Objective: To examine the relation between different types of alcoholic drinks and upper digestive tract cancers (oropharyngeal and oesophageal). Design: Population based study with baseline assessment of intake of beer, wine, and spirits, smoking habits, educational level, and 2-19 years’ follow up on risk of upper digestive tract cancer. Setting: Denmark. Subjects: 15 117 men and 13 063 women aged 20 to 98 years. Main outcome measure: Number and time of identification of incident upper digestive tract cancer during follow up. Results: During a mean follow up of 13.5 years, 156 subjects developed upper digestive tract cancer. Compared with non-drinkers (drinkers of <1 drink/week), subjects who drank 7-21 beers or spirits a week but no wine were at a risk of 3.0 (95% confidence interval 1.5 to 6.1), whereas those who had the same total alcohol intake but with wine as ⩾30% of their intake had a risk of 0.5 (0.2 to 1.4). Drinkers of >21 beers and spirits but no wine had a relative risk of 5.2 (2.7 to 10.2) compared with non-drinkers, whereas those who drank the same amount, but included wine in their alcohol intake, had a relative risk of 1.7 (0.6 to 4.4). Conclusion: A moderate intake of wine probably does not increase the risk of upper digestive tract cancer, whereas a moderate intake of beer or spirits increases the risk considerably.

Key messages

• Alcohol is a strong risk factor for oropharyngeal and oesophageal cancer
• The carcinogenic effect of alcohol has been assumed to be independent of type of alcohol drunk
• Resveratrol, a substance in grapes and wine, has been shown to inhibit the initiation, promotion, and progression of cancer
• Wine drinkers may be at a lower risk of developing upper digestive tract cancer than drinkers who have a similar intake of beer or spirits

     

A case-control study of alcohol consumption and drinking behaviour in patients with acute gout.

The alcohol intake and drinking behaviour of 24 patients who presented with acute gout in a family practice over a 5-year period were compared with these features of a control population matched for sex, age, weight and use of hyperuricemia-inducing diuretics. The average weekly alcohol intake of the group with gout was twice that of the control group (p less than 0.02), and a statistically significant relation was found between alcohol abuse and acute gout (p less than 0.05). About half of the patients with gout drank excessively. Acute gout should be considered a possible clinical sign of alcohol abuse.     

Clinical versus laboratory detection of alcohol abuse: the alcohol clinical index.

To determine reliable indicators of alcohol abuse a comprehensive set of clinical and laboratory information was acquired from three groups of subjects with a wide range of drinking histories: 131 outpatients with alcohol problems, 131 social drinkers, and 52 patients from family practice. Findings from clinical examination provided greater diagnostic accuracy than laboratory tests for detecting alcohol abuse. Logistic regression analysis produced an overall accuracy of 85-91% for clinical signs, 84-88% for items from the medical history, and 71-83% for laboratory tests in differentiating the three groups. Further analyses showed 17 clinical signs and 13 medical history items that formed a highly diagnostic instrument (alcohol clinical index) that could be used in clinical practice. A probability of alcohol abuse exceeding 0.90 was found if four or more clinical signs or four or more medical history items from the index were present. Despite recent emphasis on the laboratory diagnosis of alcohol abuse simple clinical measures seem to provide better diagnostic accuracy.     

Duodenoscopy in the diagnosis of upper gastrointestinal disease

Duodenoscopy was undertaken in 143 patients with upper gastrointestinal tract symptoms. There were no complications of the procedure. The duodenum was successfully entered in 98% of attempts, and in 90% of patients the examination was judged to be technically successful. When compared with radiological assessment, the findings at duodenoscopy significantly altered diagnosis and management in 21% of patients. The endoscopic appearance of the non-ulcerated duodenal mucosa could not be consistently correlated with changes found in biopsy tissue obtained under direct vision. Duodenoscopy is a valuable adjunct in the clinical assessment of upper gastrointestinal tract symptoms suspected to be due to pathological changes in the duodenum.     

Tumour Cells in the Circulating Blood of Patients with Carcinoma of the Breast and of the Gastrointestinal Tract

In view of the differences in the frequency of tumour cells in various reported series and the difficulty in reconciling the presence of these cells with survival, three groups of patients were studied in the following manner. In one group of 20 patients with breast cancer, multiple 20-ml. blood samples were studied. In another group of 18 patients, a single 100-ml. sample was used. Using this technique, tumour cells were found in 82.5% of patients in Group 1 and in 89% in Group 2. Similarly, in 44 patients with cancer of the gastrointestinal tract, tumour cells were identified in 70% of the patients, using the multiple-sampling technique. It seems therefore that if a sufficient volume of blood is studied, tumour cells are present in every patient with cancer of the breast and gastrointestinal tract. The presence of tumour cells in the peripheral blood does not mean that hematogenous metastases will invariably develop, and the presence of these cells is only one of many factors responsible for the development of such metastases.     

Performance of the immunochemical fecal occult blood test in predicting lesions in the lower gastrointestinal tract

Background:

Previous studies have suggested that the immunochemical fecal occult blood test has superior specificity for detecting bleeding in the lower gastrointestinal tract even if bleeding occurs in the upper tract. We conducted a large population-based study involving asymptomatic adults in Taiwan, a population with prevalent upper gastrointestinal lesions, to confirm this claim.

Methods:

We conducted a prospective cohort study involving asymptomatic people aged 18 years or more in Taiwan recruited to undergo an immunochemical fecal occult blood test, colonoscopy and esophagogastroduodenoscopy between August 2007 and July 2009. We compared the prevalence of lesions in the lower and upper gastrointestinal tracts between patients with positive and negative fecal test results. We also identified risk factors associated with a false-positive fecal test result.

Results:

Of the 2796 participants, 397 (14.2%) had a positive fecal test result. The sensitivity of the test for predicting lesions in the lower gastrointestinal tract was 24.3%, the specificity 89.0%, the positive predictive value 41.3%, the negative predictive value 78.7%, the positive likelihood ratio 2.22, the negative likelihood ratio 0.85 and the accuracy 73.4%. The prevalence of lesions in the lower gastrointestinal tract was higher among those with a positive fecal test result than among those with a negative result (41.3% v. 21.3%, p < 0.001). The prevalence of lesions in the upper gastrointestinal tract did not differ significantly between the two groups (20.7% v. 17.5%, p = 0.12). Almost all of the participants found to have colon cancer (27/28, 96.4%) had a positive fecal test result; in contrast, none of the three found to have esophageal or gastric cancer had a positive fecal test result (p < 0.001). Among those with a negative finding on colonoscopy, the risk factors associated with a false-positive fecal test result were use of antiplatelet drugs (adjusted odds ratio [OR] 2.46, 95% confidence interval [CI] 1.21–4.98) and a low hemoglobin concentration (adjusted OR 2.65, 95% CI 1.62–4.33).

Interpretation:

The immunochemical fecal occult blood test was specific for predicting lesions in the lower gastrointestinal tract. However, the test did not adequately predict lesions in the upper gastrointestinal tract.The fecal occult blood test is a convenient tool to screen for asymptomatic gastrointestinal bleeding.¹ When the test result is positive, colonoscopy is the strategy of choice to investigate the source of bleeding.^2,3 However, 13%–42% of patients can have a positive test result but a negative colonoscopy,⁴ and it has not yet been determined whether asymptomatic patients should then undergo evaluation of the upper gastrointestinal tract.Previous studies showed that the frequency of lesions in the upper gastrointestinal tract was comparable or even higher than that of colonic lesions^5–9 and that the use of esophagogastroduodenoscopy may change clinical management.^10,11 Some studies showed that evaluation of the upper gastrointestinal tract helped to identify important lesions in symptomatic patients and those with iron deficiency anemia;^12,13 however, others concluded that esophagogastroduodenoscopy was unjustified because important findings in the upper gastrointestinal tract were rare^14–17 and sometimes irrelevant to the results of fecal occult blood testing.^18–21 This controversy is related to the heterogeneity of study populations and to the limitations of the formerly used guaiac-based fecal occult blood test,^5–20 which was not able to distinguish bleeding in the lower gastrointestinal tract from that originating in the upper tract.The guaiac-based fecal occult blood test is increasingly being replaced by the immunochemical-based test. The latter is recommended for detecting bleeding in the lower gastrointestinal tract because it reacts with human globin, a protein that is digested by enzymes in the upper gastrointestinal tract.²² With this advantage, the occurrence of a positive fecal test result and a negative finding on colonoscopy is expected to decrease.We conducted a population-based study in Taiwan to verify the performance of the immunochemical fecal occult blood test in predicting lesions in the lower gastrointestinal tract and to confirm that results are not confounded by the presence of lesions in the upper tract. In Taiwan, the incidence of colorectal cancer is rapidly increasing, and Helicobacter pylori-related lesions in the upper gastrointestinal tract remain highly prevalent.²³ Same-day bidirectional endoscopies are therefore commonly used for cancer screening.²⁴ This screening strategy provides an opportunity to evaluate the performance of the immunochemical fecal occult blood test.     

超声检查联合MMP-2、MMP-9水平检测对甲状腺癌的诊断价值

目的:探讨超声检查联合基质金属蛋白酶-2(MMP-2)、基质金属蛋白酶-9(MMP-9)水平检测对甲状腺癌的诊断价值。方法:选取2014年6月-2016年6月我院收治的480例甲状腺结节患者作为研究对象,根据患者病情分为良性结节患者412例(良性结节组)和甲状腺癌患者68例(甲状腺癌组)。对所有患者进行超声检查与MMP-2、MMP-9水平检测,比较两组MMP-2、MMP-9水平,并比较超声检查与超声联合MMP-2、MMP-9水平检测对甲状腺癌的诊断价值。结果:甲状腺癌组MMP-2、MMP-9水平均显著高于良性结节组(P0.05),且甲状腺癌组超声弹性图像评分多为3~4分,良性结节组则多为0~2分,两组超声弹性成像评分所占比例比较差异有统计学意义(P0.05);超声联合MMP-2、MMP-9诊断良性甲状腺结节的阴性率和甲状腺癌的阳性率均高于超声诊断,差异有统计学意义(P0.05);超声联合MMP-2、MMP-9的灵敏性、特异性、准确性分别为89.7%、85.2%、85.8%,均显著高于超声诊断的76.5%、68.7%、69.8%,差异有统计学意义(P0.05)。结论:超声检查联合MMP-2、MMP-9水平检测能够有效鉴别甲状腺癌,其灵敏性、特异性、准确性均较高,值得在临床上推广。     

内镜止血在急性非静脉曲张性上消化道出血治疗中的临床应用

目的:探讨内镜下金属钛夹止血在急性非静脉曲张性上消化道出血治疗中的应用价值。方法:按照随机数字表法将2014年1月-2014年12月我院收治的40例急性非静脉曲张性上消化道出血患者分为观察组(n=20)及对照组(n=20),观察组行内镜下金属钛夹止血治疗,对照组予以内镜下药物注射,比较两组治疗后的止血效果、临床疗效及并发症情况。结果:观察组患者治疗后的有效止血率、即时止血率为95.00%、100.00%,分别高于对照组的65.00%、75.00%,差异有统计学意义(P0.05)。治疗后观察组临床疗效优于对照组,差异有统计学意义(P0.05)。治疗后两组患者均未出现严重并发症。结论:内镜下金属钛夹止血用于急性非静脉曲张性上消化道出血具有止血效果好、并发症少等特点,临床有重要的参考价值。     

Similar colorectal cancer risk in patients with monoallelic and biallelic mutations in the MYH gene identified in a population with adenomatous polyposis

A large proportion of non-FAP non-HNPCC patients with multiple colorectal adenomas have been reported to carry germline mutations on the MYH gene. Although the number of adenomas appears to be dependent on the number of mutated MYH alleles present in a patient, little is known on the relation of this number with cancer risk. Four hundred fifty-three APC-negative patients with more than five colorectal adenomas were screened for mutations on the entire coding sequence of the MYH gene. Pathogenic mutations were initially found in 74 patients without extradigestive tumors (22.5%) and subsequently in 75 at-risk relatives. Polyposis was more severe in cases with biallelic mutations. However, mutation copy number was correlated neither with the age at diagnosis of adenomas or adenocarcinomas, nor with the presence of a family history of colorectal tumors. Heterozygous and homozygous MYH mutation carriers were both at high risk for synchronous cancers (24% in colorectum and 16% in the upper gastrointestinal tract), but did not demonstrate an increased risk for extradigestive tumors. MYH-associated polyposis is a frequent inherited colorectal cancer predisposition with a strong dominance component. From age 25-30, MYH mutation carriers should be proposed an early screening program, which includes endoscopies of the upper digestive tract and the colorectum every 2 years.     

心理护理在急性肝炎合并上消化道大出血患者的临床价值研究

目的:探讨心理护理对急性肝炎合并上消化道大出血患者焦虑程度、满意度及康复效果的影响。方法:将60例急性肝炎合并上消化道大出血患者随机分为对照组(30例)和观察组(30例),对照组按常规护理,观察组在常规护理基础上加用心理护理,两组患者临床抢救方法与用药情况基本一致,分析比较两组患者治疗前后焦虑程度、满意度及康复效果的差异。结果:与对照组相比,观察组患者整体的焦虑度明显低于对照组(P<0.05),对护理满意度高于对照组(P<0.05)。观察组患者临床康复时间略短于对照组(P≥0.05),但观察组患者的康复效果满意度明显好于对照组(P<0.05)。结论:心理护理可明显减轻急性肝炎合并上消化道大出血患者焦虑程度,提高了患者对护理的整体满意度及康复效果的满意度,值得广泛使用。     

360例肺癌患者血清TSGH检测的临床分析

目的探讨肿瘤特异性生长因子(TSGF)在肺癌患者中检测的诊断价值。方法采用TSGF检测试剂对360例确诊肺癌患者、170例肺部良性病患者和30例正常人的血清进行TSGF检测分析。结果360例肺癌患者,检出恶性TSGF,阳性315例,占87.5%;170例肺部良性疾病,阳性24例,占14.1%;30例正常人,阳性0例。其中,肺癌组与各组相比较,差异具有统计学意义。肺癌组的TSGF阳性率明显高于其他各组(P0.01)。结论检测血清TSGF可辅助肺癌的诊断,在正常人体检筛查肺癌中具有一定的价值。