Connotation of distal bleeding based on modern pathophysiological mechanism and application of Huangtu Decoction for acute coronary syndrome complicated with acute upper gastrointestinal hemorrhage in critical care medicine / 中国中药杂志

Huangtu Decoction, first recorded in Essentials from the Golden Cabinet(Jin Kui Yao Lue) from ZHANG Zhong-jing in Han dynasty, is used to treat distal bleeding. It is mainly treated for the syndrome of failing to control blood with spleen-yang deficiency. The connotation of distal bleeding is more extensive, including not only upper gastrointestinal bleeding in the traditional sense such as peptic ulcer bleeding, gastrointestinal tumors, gastric mucosal lesions, vascular dysplasia, esophagogastric variceal bleeding, and pancreatic and biliary tract injury, but also other anorectal diseases such as part colon and rectal cancer swelling or polyps, hemorrhoids, and anal fissure and other parts of bleeding such as epistaxis, thrombocytopenia, functional uterine bleeding, threatened abortion, and unexplained hematuria. Distal bleeding also involves syndromes of failing to keep part deficient and cold fluids in interior, such as nocturia, enuresis, clear nose, sweating, cold tears, and leucorrhea, and excessive gastrointestinal bleeding caused by anti-plate and anticoagulant drugs, unexplained positive in the fecal occult blood test, and other modern clinical new problems. The indications of Huangtu Decoction include not only lower blood, defecation before blood, distant blood, hematemesis, epistaxis, and other diseases in traditional Chinese medicine, but also three types of clinical manifestations including bleeding, deficiency syndrome, and stagnant heat syndrome. In the clinic, Huangtu Decoction can be used to treat acute upper gastrointestinal bleeding, acute coronary syndrome complicated with acute upper gastrointestinal bleeding, bleeding events caused by excessive antiplatelet and anticoagulant drugs, unexplained positive in the fecal occult blood test, gastrointestinal tumor with bleeding, thrombocytopenia, and other acute and critical diseases. The dosage of Cooking Stove Earthkey, Rehmanniae Radix, and Asini Corii Colla in Huangtu Decoction is the key to hemostasis.

Indicadores de desempeño de un programa de rastreo de cáncer colorrectal en la provincia del Neuquén, Argentina, 2015-2019 / Performance indicators of a colorectal cancer screening program in the province of Neuquén, Argentina, 2015-2019

INTRODUCCIÓN: El cáncer colorrectal (CCR) es una causa frecuente de mortalidad en adultos. El objetivo de este estudio fue mostrar resultados de la implementación del Programa de Rastreo de Cáncer Colorrectal (PRCCR) en la provincia del Neuquén, Argentina. MÉTODOS: Se realizó un estudio retrospectivo con análisis de resultados de sangre oculta en materia fecal (SOMF) y videocolonoscopía (VCC) en personas de 50-75 años, en efectores del sistema de salud pública en 2015-2019. Se determinó porcentaje de participación, resultados de SOMF, realización de colonoscopía en pacientes con SOMF positiva y sus hallazgos, y valor predictivo positivo (VPP) para detección de lesiones y de CCR. RESULTADOS: Se analizaron 11 189 SOMF. La participación promedio fue 6,52% de la población objetivo. Tuvieron SOMF positiva el 24,6% de los participantes; de ellos, realizaron la VCC un 24%. Se encontró lesión significativa en el 24,8% (pólipos adenomatosos 21,9%, cáncer 2,9%), con un VPP para la detección de lesiones del 34,3%. Tuvieron adenomas avanzados el 7,4%. Repitieron la SOMF tras un resultado negativo (segunda o tercera ronda) el 17,6% de los pacientes, y realizaron una VCC de control tras el hallazgo de un pólipo adenomatoso el 13,7%. DISCUSIÓN: El PRCCR en Neuquén muestra algunos indicadores que deben mejorarse (cobertura, realización de VCC) y otros adecuados (frecuencia de lesiones). Ante las dificultades se pueden plantear medidas más focalizadas, como la aplicación de escalas de riesgo de CCR, rastreo bianual, etc.

INTRODUCTION: Colorectal cancer (CRC) is a leading cause of mortality among adults. The objective of this study was to show results of the implementation of the colorectal cancer screening program (CRCSP) in the province of Neuquén, Argentina. METHODS: A retrospective study was conducted, with analysis of fecal occult blood test (FOBT) results in people aged 50 to 75 years, in public hospitals between 2015- 2019. Participation rate, FOBT results, colonoscopy (CC) performance in patients with positive FOBT and their findings, and positive predictive value (PPV) for detection of lesions and CRC were determined. RESULTS: A total of 11,189 FOBT were requested. The average participation was 6.52% of the target population, 24.6% of the participants had positive FOBT, and 24% of them had a CC performed. A significant lesion was found in 24.8% (adenomatous polyps 21.9%, cancer 2.9%), with a PPV for the detection of lesions of 34.3%. Furthermore, 7.4% had advanced adenomas, 17.6% of the patients repeated the FOBT after a negative result (second or third round), and 13.7% had a control CC performed after the finding of an adenomatous polyp. DISCUSSION: The CRCSP in Neuquén shows some indicators that need to be improved (coverage, conduction of CC) and others that are adequate (frequency of findings). In view of these difficulties, some more focused screening measures can be considered, such as use of CRC risk scales, bi-annual screening, etc.

Test para el diagnóstico precoz de lesiones premalignas de colon / A Test for Early Diagnosis of Premalignant Colonic Lesions

Introducción: El cáncer colorrectal en nuestro país ocupa la tercera causa de muerte por tumores malignos y constituye un problema de salud a nivel mundial, que en la actualidad es prevenible al realizar pruebas para la detección de lesiones premalignas. Objetivo: Evaluar el valor presuntivo de lesiones premalignas colónicas en pacientes con sangre oculta en las heces. Métodos: Se realizó estudio observacional, descriptivo, transversal, en pacientes con sangre oculta en las heces, atendidos en el Servicio de Gastroenterología del Hospital Docente Clínico Quirúrgico Diez de Octubre, a los cuales se les realizó colonoscopia, en el período comprendido de enero de 2016 a enero de 2017. Para evaluar las variables se utilizó el porcentaje como medida matemática y los resultados fueron expuestos en tablas. Resultados: Al finalizar el estudio se observó un predomino del sexo femenino. La pesquisa, el cambio del hábito intestinal y las diarreas crónicas fueron las indicaciones más frecuentes de sangre oculta en heces. Los pólipos y las lesiones de aspecto malignas fueron los diagnósticos colonoscópicos más frecuentes. Las lesiones de aspecto malignas se localizaron en mayor proporción en colon izquierdo. El diagnóstico histológico más frecuente fueron los adenomas y adenocarcinomas. Conclusiones: El test de sangre oculta en heces es un método predictivo en la pesquisa de lesiones premalignas y malignas de colon en pacientes atendidos en el primer nivel de atención(AU)

Introduction: In Cuba, colorectal cancer accounts for the third cause of death by malignant tumors, while it is a worldwide health problem, currently preventable by performing tests for the detection of premalignant lesions. Objective: To evaluate the presumptive value of colonic premalignant lesions in patients with fecal occult blood. Methods: An observational, descriptive and cross-sectional study was carried out in patients with fecal occult blood, who received attention in the gastroenterology service of Diez de Octubre Surgical Clinical Teaching Hospital and underwent colonoscopy, in the period from January 2016 to January 2017. To evaluate the variables, the percentage was used as a mathematical measure and the results were shown in tables. Results: At the end of the study, a predominance of the female sex was observed. Screening, change of bowel habit and chronic diarrhea were the most frequent indications of fecal occult blood. Polyps and malignant lesions were the most frequent colonoscopic diagnoses. Malignant-appearing lesions were mostly located in the left colon. The most frequent histological diagnosis was made up of adenomas and adenocarcinomas. Conclusions: The fecal occult blood test is a predictive method for the detection of premalignant and malignant lesions of the colon in patients who receive attention at the first level of care(AU)

Test de sangre oculta en deposiciones para programas de cribado de cáncer colorrectal: actualización / Fecal occult blood test for colorectal cancer screening

Screening programs for colorectal cancer (CRC) are standard in most developed countries because they reduce mortality and are cost-effective. Within them, colonoscopy allows to directly visualize the colon and remove neoplastic lesions. However, it is an expensive exam with low adherence in asymptomatic individuals. The fecal occult blood test (FOBT) is a low-cost and risk-free method for the user, which results in a high rate of adherence, explaining its use in most screening programs. This article analyzes the effectiveness of different fecal occult blood tests in screening programs. The main conclusions are that the sensitivity of the guaiac-based chemical test for the detection of colorectal cancer is lower than that observed with qualitative and quantitative immunological tests. Automated quantitative methods allow objective readings independent of the operator and the reaction reading time, necessary for the analysis of large numbers of samples. The participation rate with immunological FOBTs is higher than with chemical ones, which is why they are preferred by the different countries that have screening programs. The use of quantitative tests allows stratification of symptomatic and asymptomatic patients at higher risk, in the screening programs.

Rastreo de cáncer colorrectal Análisis de resultados en la provincia de Neuquén, Argentina, 2015-2019 / Colorectal cancer screening: analysis of results in the Province of Neuquén, Argentina, 2015-2019

INTRODUCCIÓN: El Programa de Prevención de Tumores de la Provincia del Neuquén recomienda la Sangre Oculta en Materia Fecal Inmunológica (SOMFi) como intervención de rastreo, con posterior confirmación por videocolonoscopía (VCC) en pacientes con resultado positivo. El objetivo del estudio fue conocer los resultados de la utilización de SOMFi, la realización de VCC confirmatoria y sus hallazgos. MÉTODOS: Se realizó un estudio retrospectivo, que analizó los resultados de SOMFi obtenidos en personas de 50 a 75 años en todos los efectores del Sistema de Salud Pública de Neuquén en el período 2015-2019 sobre la base de registros informáticos provinciales y de cada centro de endoscopía. Se determinó la frecuencia de resultados de SOMFi, de VCC en los pacientes con SOMFi positiva y sus hallazgos. RESULTADOS: De 9909 muestras analizadas, 23,1% fueron positivas. Se realizó VCC confirmatoria en 24,1% de los pacientes con SOMFi positiva; presentaron cáncer el 3,7% de los casos, pólipos el 35% y estudio normal el 61,3%. Los tipos histológicos de los pólipos fueron: tubular (49%), hiperplásico (21,3%), tubulovelloso (20%), aserrado (7,2%) y otros tipos (2,5%). DISCUSIÓN: La frecuencia de SOMFi positiva fue mayor a la publicada. Solo el 20% de los pacientes realizó VCC confirmatoria. La frecuencia de cáncer y pólipos encontrados fue similar a la de otros estudios publicados. Debe incrementarse la realización de VCC confirmatoria.(AU)

INTRODUCTION: Neuquén Province Cancer Prevention Program recommends Fecal Immunochemical Test (FIT) as a screening intervention, with subsequent confirmation by video-colonoscopy (VCC) in patients with a positive result. The objective of the study was to know the results of the use of FIT, the performance of confirmatory VCC and its findings. METHODS: A retrospective study was carried out. It analyzed the results of FIT in people aged 50-75 years, considering tests conducted in all agents of the Neuquén Public Health System in 2015- 2019 based on provincial computer records and data from each endoscopy center. The frequency of FIT results, VCC in patients with positive FIT and findings was determined. RESULTS: Of 9909 samples analyzed, 23.1% were positive. Confirmatory VCC was performed in 24.1% of the patients with positive FIT, with 3.7% having cancer, 35% with polyps and 61.3% of normal studies. The histological types of the polyps were tubular (49%), hyperplastic (21.3%), tubulovillous (20%), serrated (7.2%) and other types (2.5%). DISCUSSION: The frequency of positive FIT was higher than published. Only one in five patients with positive FIT underwent confirmatory VCC. The frequency of cancer and polyps was similar to the one found in other published studies. It is necessary to increase the number of confirmatory VCC.AU)

Métodos de rastreo del cáncer de colon / Colon cancer screening methods

El cáncer colorrectal presenta un problema para la salud pública a nivel mundial. En Argentina, se diagnostican aproximadamente 13.500 casos cada año. El tamizaje como medida de prevención secundaria es una medida beneficiosa para lograr un abordaje temprano con mejores resultados. Los dos métodos más utilizados para el tamizaje son la videocolonoscopía y la prueba de sangre oculta en materia fecal, sobre todo la de tipo inmunoquímico que con el paso de los años fue reemplazando a la prueba de guayaco por su mayor practicidad. El primero es un método invasivo y que requiere anestesia, mientras que el segundo no tiene un efecto adverso directo pero debe realizarse con una cadencia mayor. El objetivo de los autores de este artículo fue evaluar la evidencia sobre la sensibilidad y especificidad de ambos métodos, como también sus beneficios y daños a partir de la consulta de un paciente a su médico de familia. Ninguna prueba parecería ser inferior para el tamizaje de cáncer colorrectal en una población de riesgo promedio, y ambas pueden usarse en programas de rastreo. Sin embargo, no existen estudios que comparen ambos métodos de manera directa, y toda prueba inmunoquímica fecal positiva debe ser seguida de una colonoscopía. La elección de la prueba puede depender de los valores y preferencias de los pacientes. (AU)

Colorectal cancer presents a public health problem worldwide. In Argentina, approximately 13,500 cases appear each year. Screening as a secondary prevention measure is a beneficial measure to achieve an early approach with better results. The two most used methods for screening are video colonoscopy and faecal immunochemical test, the former being invasiveand requiring anaesthesia, while the latter does not have a direct adverse effect but must be performed at a higher rate. The objective of this article was to evaluate the evidence for the sensitivity and specificity of both methods, as well as their benefits and harms. No test would appear to be inferior for colorectal cancer screening in an average-risk population, and both can be used in screening programs. However, there are no studies comparing both methods directly, and any positive faecal immunochemical test should be evaluated with a colonoscopy. The choice of the test may depend on the values and preferences of the patients. (AU)

Diagnostic efficacy of hypersensitivity quantitative fecal immunochemical test in colorectal cancer and advanced adenoma / 中华消化杂志

Objective:To evaluate the diagnostic efficiency of hypersensitivity quantitative fecal immunochemical test (hs-qFIT) in colorectal cancer (CRC) and advanced adenoma.Methods:From July to December 2020, consecutive patients aged 50 to 75 years who underwent colonoscopy in Qilu Hospital of Shandong University, and had the Asia-Pacific colorectal screening score of medium or high risk were enrolled. All patients were requested to complete two hs-qFIT before colonoscopy. The diagnostic efficacy of hs-qFIT for CRC and advanced adenoma were assessed. Receiver operating characteristic curve of hs-qFIT in CRC diagnosis was drawn and the area under the curve (AUC) was calculated.Results:A total of 811 patients including 20 (2.5%) cases of CRC, 47 (5.8%) cases of advanced adenoma, 206 (25.4%) cases of non-advanced adenoma, 219 (27.0%) cases of non-adenomatous polyp, 76 (9.4%) cases of other colorectal lesions and 243 (30.0%) cases of non-colorectal lesions were involved. When the fecal hemoglobin cut-off values were 10, 30, 50, 75 and 100 ng/mL, the positive rates of hs-qFIT detection were 17.9% (145/811), 10.9% (88/811), 8.3% (67/811), 7.4% (60/811) and 5.8% (47/811), respectively. When the cut-off value of fecal hemoglobin decreased from 100 ng/mL to 10 ng/mL, the sensitivity of hs-qFIT for CRC diagnosis increased from 90.0% to 100.0%, and the specificity decreased from 96.3% to 84.2%; and the sensitivity of hs-qFIT for the diagnosis of advanced adenoma increased from 19.1% to 66.0%, and the specificity decreased from 95.0% to 85.1%. The AUC of hs-qFIT for the diagnosis of CRC and advanced adenoma were 0.981 (95% confidence interval ( CI) 0.970 to 0.992) and 0.846 (95% CI 0.807 to 0.886), respectively. When the optimal cut-off values were taken, the sensitivity and specificity were 100.0% and 91.2% for the diagnosis of CRC, and 66.0% and 85.3% for the diagnosis of advanced adenoma, respectively. Conclusion:Hs-qFIT can help the early screening of CRC and advanced adenoma.

Research status of fecal detection for colorectal cancer markers / 国际肿瘤学杂志

There are four methods for fecal detection of colorectal cancer (CRC) markers: fecal occult blood test, fecal DNA test, fecal microRNA test, and fecal fusobacterium nucleatum (Fn) test. Fecal immunochemical test has been recommended by experts at home and abroad as the first choice for CRC screening. Fecal DNA test, due to its high price, has not yet been screened for large samples of people in China, so it is recommended as the second level of CRC screening. Fecal microRNA detection has been paid more and more attention by researchers. In recent years, the detection of fecal microbial markers has become more and more popular, especially fecal Fn detection, which is expected to become a microbial indicator for CRC screening.

Detection and correlative factors of salivary occult blood in police officers / 国际生物医学工程杂志

Objective:To study the risk factors of salivary occult blood in Tianjin public security police, and to explore feasible oral preventive and health care measures for police officers.Methods:The public security officers from all districts and counties of Tianjin who had physical examinations at the Health Examination Center of Tianjin Public Security Hospital from March 2012 to November 2012 were selected as the research objects. A stratified cluster random sampling method was used to draw samples of 388 cases. The salivary occult blood test paper was used to detect salivary occult blood. Then the self-designed "Tianjin public security police periodontal health questionnaire" was used to collect the relevant data of the subjects, and univariate analysis and multivariate unconditional Logistic regression analysis were carried out.Results:The univariate analysis result showed that salivary occult blood was significant correlated with age, police species, history of gingival bleeding, history of halitosis, history of alcohol consumption, family history and soft food preference (all P<0.005), but it was not correlated with education level, a regular oral examination, times of brushing teeth every day, time of brushing teeth every time, smoking history, hard food preference, sweet tooth preference and carbonated drinks preference(all P>0.05). Multivariate unconditional Logistic regression analysis result showed that criminal police, age, history of gingival bleeding, halitosis, smoking history were risk factors for periodontal disease, and brushing time of 2~3 minutes was protective factor for periodontal disease. Conclusions:The public security police lack the knowledge of oral health care and have not formed good daily oral health habits. Medical workers should carry out targeted oral health education to improve the awareness of the prevention and treatment of periodontal disease.

Estudio prospectivo acerca de la precisión diagnóstica del test inmunológico de sangre oculta en materia fecal en una única ronda para la realización de pesquisa del cáncer colorrectal en pacientes de riesgo promedio en la Argentina / Prospective study on the diagnostic accuracy of the immunochemical fecal occult blood test in a single round for colorectal cancer screening in average risk patients in Argentina

Introducción: El cáncer colorrectal (CCR) es la segunda causa de muerte por cáncer en Argentina. Debido a su alta prevalencia es fundamental normatizar un programa de pesquisa para la prevención y detección temprana. La precisión del test de sangre oculta en materia fecal inmunológico (SOMFi) para pesquisa de CCR en población de riesgo promedio ha demostrado ser adecuada según la bibliografía internacional, no habiendo, sin embargo, información a nivel local. El objetivo es evaluar en nuestro medio la precisión diagnóstica del test de SOMFi en una única ronda para la pesquisa de CCR en pacientes de riesgo promedio. Diseño: Prospectivo de precisión diagnóstica. Material y Método: Se incluyeron pacientes con riesgo promedio que consultaron para realizar una videocolonoscopía (VCC) por pesquisa de CCR en el Hospital Alemán de Buenos Aires, entre el 1 de junio del 2015 y 31 diciembre de 2017. Se excluyeron todos los pacientes con riesgo incrementado para CCR. Todos los pacientes realizaron el test de SOMFi y posteriormente la VCC. Los endoscopistas estaban ciegos para el resultado del test al momento de realizar la VCC. Se evaluó la precisión diagnóstica del test SOMFi para detectar lesiones neoplásicas avanzadas (LNA) calculando la sensibilidad (S), especificidad (E), valor predictivo positivo (VVP) y negativo (VVN), coeficiente de probabilidad positivo (CP+) y negativo (CP-). Se evaluó también la precisión para la detección de adenomas de bajo riesgo, pólipos aserrados y CCR. Resultados: Se incluyeron un total de 300 pacientes; 273 (91%) entregaron la muestra de materia fecal para realizar el test de SOMFi y completaron la VCC. La edad media de los pacientes fue de 56.9 (40-85) años y 54% fueron hombres. Del total de pacientes que realizaron ambos estudios (273), 53 pacientes (19%) presentaron al menos un adenoma de bajo riesgo, en 18 pacientes (6,59%) observamos al menos un adenoma aserrado sésil y en 21 pacientes (7,7%) al menos una lesión neoplásica avanzada (LNA). Solo 4 pacientes (1.5%) presentaron CCR. En cuanto a la precisión diagnóstica del test de SOMFi en una única ronda para detectar LNA observamos una S de 30%, E de 84%, VPP de 13% y un VPN de 94%. Para adenomas de bajo riesgo observamos una S de 13%, E de 84%, VPP de 17%, VPN de 79%. Para adenomas aserrados sésiles observamos una S de 16.7%, E de 87%, VPP de 11% y de VPN 91%. La precisión para el CCR fue la siguiente, S de 75%, E de 83%, VPP 6%, VPN 99%. No se observaron complicaciones post procedimientos. Conclusiones: La precisión diagnóstica del test de SOMFi en nuestro medio es comparable a los resultados internacionales. Sin embargo, la baja precisión observada en una única ronda realza la necesidad de realizarlo de forma anual o bianual para poder optimizar su precisión y lograr programas de pesquisa efectivos.(AU)

Background: Colorectal cancer (CRC) is the second leading cause of cancer death in Argentina. Due to its high prevalence, it is essential to standardize a screening program for prevention and early detection. According to international literature, the accuracy of the immunochemical fecal occult blood test (FIT) for CRC screening in an average-risk population has proven to be adequate, but there is no information at the local level. Objective: To evaluate the diagnostic accuracy of the FIT test in a single round for CRC screening in average-risk patients in our setting. Design: Diagnostic accuracy prospective study. Material and Methods: Average-risk patients who consulted for a CRC screening video colonoscopy (VCC) at the Hospital Alemán of Buenos Aires, between June 1, 2015 and December 31, 2017 were included. All patients with increased risk for CRC were excluded. All patients performed FIT and subsequently VCC. The endoscopists were blind to FIT result at the time of VCC. The diagnostic accuracy of FIT to detect advanced neoplastic lesions (ANL) was evaluated by calculating sensitivity (S), specificity (Sp), positive predictive value (PPV), negative (NPV), positive likelihood ratio (LR+) and negative likelihood ratio (LR-). The accuracy for the detection of low-risk adenomas, serrated polyps and CRC was also evaluated. Results: A total of 300 patients were included; 273 (91%) submitted the stool sample to perform FIT and completed VCC. The mean age of patients was 56.9 (40-85) years and 54% were men. Of the total number of patients who carried out both studies (273), 53 (19%) patients had at least one low-risk adenoma, 18 (6.59%) patients had at least one sessile serrated adenoma and 21 (7.7%) patients had at least one ANL. Only 4 (1.5%) patients presented CRC. The diagnostic accuracy of FIT in a single round to detect ANL was: S 30%, Sp 84%, PPV 13%, NPV 94%; for low-risk adenomas: S 13%, Sp 84%, PPV 17%, NPV 79%; for sessile serrated adenomas: S 16.7%, Sp 87%, PPV 11%, NPV 91% and for CRC: S 75%, Sp 83%, PPV 6%, NPV 99%. No post-procedure complications were observed. Conclusions: The diagnostic accuracy of FIT in our setting is comparable to international results. However, the low precision observed in a single round highlights the need to do it annually or biannually in order to optimize its accuracy and achieve effective screening programs. (AU)

Acurácia diagnóstica de teste quantitativo imunoquímico fecal com uma amostra ou com duas amostras para detectar neoplasia intestinal / Diagnostic accuracy of one sample or two samples quantitative fecal immunochemical tests for intestinal neoplasia detection

ABSTRACT BACKGROUND: Rectal bleeding is the most important symptom of intestinal neoplasia; thus, tests of occult blood detection in stools are widely used for pre neoplastic lesions and colorectal cancer (CRC) screening. OBJECTIVE: Evaluate the accuracy of OC-Sensor quantitative test (Eiken Chemical, Tokyo, Japan) at cut-off 10 µg Hb/g feces (50 ng/mL) in a cohort of subjects that had to undergo diagnostic colonoscopy, and if more than one sample collected in consecutive days would improve the diagnostic accuracy of the test. METHODS: Patients (mean age 56.3±9.7 years) that underwent colonoscopy prospectively randomly received one (1-sample FIT, FIT 1) or two (2-sample FIT, FIT 2) collection tubes. They collected the stool sample before starting colonoscopy preparation. Samples were analyzed by the OC-Auto Micro 80 (Eiken Chemical, Tokyo, Japan). The performance of FIT 1 and FIT 2 were compared to the colonoscopy findings. RESULTS: Among 289 patients, CRC was diagnosed in 14 (4.8%), advanced adenoma in 37 (12.8%), early adenoma in 71 (24.6%) and no abnormalities in 141 (48.8%). For FIT 1, the sensitivity for CRC was 83.3% (95%CI 36.5-99.1%), for advanced adenoma was 24% (95%CI 10.1-45.5%), with specificity of 86.9% (95%CI 77.3-92.9%). For FIT 2, the sensitivity for CRC was 75% (95%CI 35.6-95.5%), for advanced adenoma was 50% (95%CI 22.3-77.7%), with specificity of 92.9% (95%CI 82.2-97.7%). The positive likelihood ratios were 1.8 (95%CI 0.7-4.4 for FIT 1) and 7.1 (95%CI 2.4-21.4 for FIT 2) for advanced adenoma, and 6.4 (95%CI 3.3-12.3, for FIT 1) and 10.7 (95%CI 3.8-29.8, for FIT 2) for CRC. The negative likelihood ratio were 0.9 (95%CI 0.7-1, for FIT 1) and 0.5 (95%CI 0.3-0.9, for FIT 2) for advanced adenoma, and 0.2 (0.03-1.1, for FIT 1) and 0.3 (0.08-0.9, for FIT 2) for CRC. The differences between FIT 1 and FIT 2 performances were not significant. However, the comparison of the levels of hemoglobin in feces of patients of FIT 1 and FIT 2 showed that the differences between no polyp group and advanced adenoma and CRC were significant. CONCLUSION: The accuracy of OCR Sensor with 10 µg Hb/g feces cut-off was comparable to other reports and two-sample collection improved the detection rate of advanced adenoma, a pre neoplastic condition to prevent CRC incidence.

RESUMO CONTEXTO: Sangramento retal é o sintoma mais importante de neoplasia intestinal; portanto, testes para detecção de sangue oculto nas fezes são amplamente usados para rastreamento de lesões pré-neoplásicas e de câncer colorretal (CCR). OBJETIVO: Avaliar a acurácia do teste quantitativo OC-Sensor (Eiken Chemical, Tokyo, Japan) com o valor de corte de 10 µg Hb/g fezes (50 ng/mL) numa coorte de indivíduos que se submeteram à colonoscopia diagnóstica, e se mais de uma amostra coletada em dias consecutivos melhoraria a acurácia diagnóstica do teste. MÉTODOS: Pacientes (idade média 56,3±9,7 anos) que se submeteram à colonoscopia prospectivamente, randomicamente, receberam tubos de coleta: um (1-amostra FIT, FIT 1), ou dois (2-amostra FIT, FIT 2). Eles coletaram as amostras de fezes antes de iniciar o preparo da colonoscopia. As amostras foram analisadas pelo OC-Auto Micro 80 (Eiken Chemical, Tokyo, Japan). As performances do FIT 1 e do FIT 2 foram comparadas com os achados da colonoscopia. RESULTADOS: Entre 289 pacientes, CCR foi diagnosticado em 14 (4,8%), adenoma avançado em 37 (12,8%), adenoma precoce em 71 (24,6%) e sem anormalidades em 141 (48,8%). Para FIT 1, a sensibilidade para CCR foi 83,3% (95%IC 36,5-99,1%), para adenoma avançado foi 24% (95%IC 10,1-45,5%), com especificidade de 86,9% (95%IC 77,3-92,9%). Para FIT 2, a sensibilidade para CCR foi 75% (95%IC 35,6-95,5%), para adenoma avançado foi 50% (95%IC 22,3-77,7%), com especificidade de 92,9% (95%IC 82,2-97,7%). A razão de verossimilhança positiva foi 1,8 (95%IC 0,7-4,4 para FIT 1) e 7,1 (95%IC 2,4-21,4 para FIT 2) para adenoma avançado, e 6,4 (95%IC 3,3-12,3, para FIT 1) e 10,7 (95%IC 3,8-29,8, para FIT 2) para CCR. A razão de verossimilhança negativa foi 0,9 (95%IC 0,7-1, para FIT 1) e 0,5 (95%IC 0,3-0,9, para FIT 2) para adenoma avançado, e 0,2 (0,03-1,1, para FIT 1) e 0,3 (0,08-0,9, para FIT 2) para CCR. As diferenças de performance entre FIT 1 e FIT 2 não foram significantes. Entretanto, a comparação dos níveis de hemoglobina nas fezes dos pacientes de FIT 1 e FIT 2 mostraram que as diferenças entre sem pólipo e adenoma avançado e CCR foram significantes. CONCLUSÃO: A acurácia do OCR Sensor com valor de corte de 10 µg Hb/g de fezes foi comparável a outras publicações e a coleta de duas amostras melhorou a taxa de detecção de adenoma avançado, lesão pré-neoplásica, para prevenir CCR.

Comparison of occult blood loss after unicompartmental knee arthroplasty and total knee arthroplasty / 中国组织工程研究

BACKGROUND: The intraoperative blood loss of unicompartmental knee arthroplasty is lower than that of total knee arthroplasty, but the difference of postoperative occult blood loss between them has not been widely studied. OBJECTIVE: To compare the difference of occult blood loss between unicompartmental knee arthroplasty and total knee arthroplasty, and to analyze whether patients with preoperative anemia can also undergo unicompartmental knee arthroplasty without the risk of blood transfusion. METHODS: 148 patients with knee osteoarthritis treated in 904 Hospital of the Joint Service Support Force of Chinese PLA from January 2014 to December 2016 were selected. Among them, 58 cases underwent unicompartmental knee arthroplasty and 90 cases underwent total knee arthroplasty. Hemoglobin levels and hematocrit were measured before and 1, 4, 21 and 42 days after operation, and the occult blood loss and blood transfusion rate were calculated. The trial was approved by the Ethics Committee of 904 Hospital of the Joint Service Support Force of Chinese PLA (approval No. 2019-01-03). RESULTS AND CONCLUSION: (1) The hemoglobin level of unicompartmental knee arthroplasty group was higher than that of total knee arthroplasty group at 1 and 4 days after operation (P 0.05). (2) Hematocrit in the unicompartmental knee arthroplasty group was higher than that in the total knee arthroplasty group at 1 and 4 days after operation (P 0.05).(3) From day one to day four after surgery, there was no occult blood loss in the female of unicompartmental knee arthroplasty group, and the average occult blood loss in the male was 4 g/L. The average occult blood loss was 10 g/L in female and 7 g/L in male in total knee arthroplasty group. The occult blood loss in male and female in unicompartmental knee arthroplasty group was lower than that in total knee arthroplasty group (P < 0.05 or P < 0.01). (4) The blood transfusion rate was 0% in unicompartmental knee arthroplasty group and 4.4% in total knee arthroplasty group. In patients with preoperative moderate anemia (hemoglobin 60-89 g/L), there was no need for blood transfusion in unicompartmental knee arthroplasty group (n=3), but blood transfusion was needed in 2 of 6 patients in total knee arthroplasty group (33%). (5) The results showed that unicompartmental knee arthroplasty had obvious advantages over total knee arthroplasty in postoperative occult blood loss.

Quantitative immunochemical fecal occult blood test in health check-up population / 中华全科医师杂志

Objective@#To assess the application of quantitative immunochemical fecal occult blood test (qFIT) in screening of gastrointestinal diseases for health check-up population.@*Methods@#Total 19 633 health check-up subjects, who received qFIT in AiKang Guobin Physical Examination Center from January 2018 to June 2019 qFIT, were enroll in the study. The positive rate of subjects who received qFIT were analyzed. Gastrointestinal endoscopy were used to diagnose gastrointestinal lesions. The application of qFIT in screening gastrointestinal diseases, especially colorectal cancer and precancerous lesions was evaluated.@*Results@#Total 718 (3.66%) subjects were positive for qFIT, among whom 103 (42.3%) underwent gastrointestinal endoscopic examinations. Finally, 33 (42.3%) cases of colon adenoma, 9 (11.5%) cases of peptic ulcer, and 4 (3.1%) cases of colorectal cancer were detected; and other conditions including gastroenteritis and hemorrhoids were were also diagnosed. There were 87 cases whose qFIT were negative performed colon endoscopy, 5 (5.7%) cases of colon adenoma, no colorectal cancer were detected. The mean value of qFIT for colon cancer was higher than that for polyps (3 569±1 085)μg/L vs. (823±106) μg/L, P=0.01]. The detection rate of colon polyps in qFIT positive subjects was higher than that in qFIT negative subjects [32%(33/103) vs.5.7% (5/87)], and the detective rate of colon cancer in qFIT positive subjects was higher than that in qFIT negative subjects [3.9%(4/103) vs.0(0/87)].@*Conclusion@#Quantitative immunochemical fecal occult blood test can improve the detection rate of colorectal cancer and precancerous lesions in screening of gastrointestinal diseases.

Association of fecal occult blood tests results with colonoscopic findings in a general hospital and validation of the screening test / Achados colonoscópicos em pacientes submetidos a exame de sangue oculto nas fezes e validacão deste teste de triagem

ABSTRACT Globally, colorectal cancer is the third leading cause of cancer death among men and the second among women, corresponding to about 10% of all cancers. The Brazilian Ministry of Health and National Cancer Institute recommend the screening of colorectal cancer for people over 50 years-old with Fecal Occult Blood Test. Endoscopy is limited to patients with positive screening results. The aim of this study is to evaluate the incidence of malignant or premalignant lesions diagnosed by endoscopy in patients with positive or negative Fecal Occult Blood Test and assess the efficacy of Fecal Occult Blood Test to predict the finding of a malignant colorectal lesion. We carried out a cross-sectional study among patients with a Fecal Occult Blood Test result that were submitted to colonoscopy, in the same hospital, from March 2016 to July 2017. Sensitivity, specificity, positive and negative predictive value of Fecal Occult Blood Test compared to colonoscopy neoplastic findings was calculated. The total of 92 patients were enrolled, 52 (56.5%) were female, Fecal Occult Blood Test was positive in 42.4% of them and in 41 (44.6%) the colonoscopy showed abnormal findings. Polyps were the most frequent alteration, found in 20 patients (21.7%). Among the patients with polyps, 15 (16.3%) had neoplastic and 5 (5.4%) presented non-neoplastic polyps. The Fecal Occult Blood Test sensitivity for detection of neoplastic polyps was 66.7%, specificity 62.3%, positive predictive value 11% and negative predictive value was 94.2%. Considering the need for a screening method, Fecal Occult Blood Test showed to be an effective and reliable screening test that can be applied in public health programs to detect and prevent colorectal cancer.

RESUMO Globalmente, o carcinoma colorretal é a terceira principal causa de morte por neoplasia entre homens e a segunda entre mulheres, correspondendo a 10% de todas as neoplasias. O Ministério da Saúde Brasileiro e o Instituto Nacional do Câncer recomendam a triagem do câncer colorretal para indivíduos acima de 50 anos, utilizando a Pesquisa de Sangue Oculto nas fezes. A endoscopia é reservada para aqueles com Pesquisa de Sangue Oculto nas fezes positiva. O objetivo deste estudo é avaliar a incidência de lesões malignas/pré-malignas diagnósticas na colonoscopia e correlacionar com os resultados prévios da Pesquisa de Sangue Oculto e verificar a eficácia da Pesquisa de Sangue Oculto para predizer uma lesão colorretal maligna. Realizamos um estudo transversal em pacientes que apresentavam resultados positivos ou negativos de Pesquisa de Sangue Oculto nas fezes e foram submetidos à colonoscopia, na mesma instituição, entre março de 2016 e julho de 2017. Dos 92 participantes; 52 (56,5%) eram do sexo feminino, a Pesquisa de Sangue Oculto nas fezes foi positiva em 42,4%; e em 41 (44,6%) a colonoscopia mostrou alterações. Em 20 pacientes (21,7%) havia pólipos; 15 (16,3%) eram neoplásicos e 5 (5,4%) não neoplásicos. A sensibilidade da Pesquisa de Sangue Oculto nas fezes para detecção de pólipos neoplásicos foi 66,7%; a especificidade 62,3%; o valor preditivo positivo 11% e o valor preditivo negativo 94,2%. Considerando a necessidade de um método de triagem, a Pesquisa de Sangue Oculto nas fezes mostrou ser um exame de triagem eficaz e confiável para ser aplicado em programas de saúde pública com o objetivo de detectar e prevenir o carcinoma colorretal.

Application of urinary 5-aminolevulinic acid detection in screening and identification of colorectal cancer and adenomatous polyps / 中国医师进修杂志

Objective@#To study the application of urinary 5-aminolevulinic acid (5-ALA)detection in screening and identification of colorectal cancer and adenomatous polyps.@*Methods@#The clinical data of 500 high-risk patients(including 22 cases with colorectal cancer, 134 cases with adenomatous polyps, and 344 cases with other patients) at the First Affiliated Hospital of Hebei North University from January 2018 to October 2018 were collected. High performance liquid chromatography(HPLC) was used to detect urinary 5-ALA and fecal occult blood test was used to detect faeces. Sensitivity and specificity of two methods was compared. At the same time, urine samples of 431 cases(including 22 cases with colorectal cancer, 134 cases with adenomatous polyps and 275 cases with colorectal normal mucosa)were collected, and the difference of the content of urinary 5-ALA among three groups was compared.@*Results@#The sensitivity of urinary 5-ALA for the colorectal cancer screening was74.9%, and the specificity was 72.5%. The sensitivity of urinary 5-ALA for the adenomatous polyps screening was 70.1%, and the specificity was75.0%. The sensitivity of fecal occult blood test for the colorectal cancer screening was 63.6%, and the specificity was 62.1%. The sensitivity of fecal occult blood test for the adenomatous polyps screening was 42.3%, and the specificity was 62.5%. The content of urinary 5-ALA of the colorectal cancer group [(9.35 ± 0.46) μmol/g] was significantly higher than that of the adenomatous polyps group [(7.24 ± 0.64) μmol/g] (P < 0.05) and normal colorectal mucosa group [(3.12 ± 0.24) μmol/g] (P < 0.05), and the content of urinary 5-ALA of the adenomatous polyps group was significantly higher than that of colorectal normal mucosa group (P < 0.05).@*Conclusions@#For screening of colorectal cancer and adenomatous polyps, the content of urinary 5-ALA by HPLC is better than fecal occult blood test, and this approach can do great help to identify colorectal cancer, adenomatous polyps and normal colorectal mucosa.

The application of quantitative immune fecal occult blood test for the screening of colorectal cancer in health check?up participants / 中华健康管理学杂志

Objective To evaluate the application value of quantitative immune fecal occult blood test (FOBT) in colonoscopy for the screening of colorectal cancer in health check-up participants. Methods The subjects were selected from July 2017 to June 2018 in the Health Management Center of the Second Affiliated Hospital of Suzhou University. The subjects were the healthy individuals who chose quantitative immune FOBT or chemical method plus immunogold double-method FOBT (referred to as"double-method FOBT"), excluding those who had interfering factors. Individuals with a positive result in primary screening were selected and conducted with colorectal cancer by colonoscopy. If the polyploidy lesions were observed during colonoscopy, the biopsy or excision was performed, and the pathological diagnosis was performed. The positive rate of primary screening, compliance rate of colonoscopy and pathological results of colonoscopy were compared between the two methods. Quantitative immunoassay FOBT was analyzed in different gender, age group, physical examination nature, positive rate of primary screening, compliance rate of colonoscopy and pathological results of colonoscopy. Results 18 728 people chose quantitative immunoassay FOBT and 6 212 people chose double-method FOBT at the same time. There was no significant difference in gender and age between the two groups (all P>0.05), which was comparable. The detection rate of quantitative immune FOBT was higher than double-method FOBT (74.62% vs 32.23%, P<0.001). The positive rate of quantitative immune FOBT in primary screening was lower than double-method FOBT (4.11% vs 5.34%, P=0.003). The colonoscopy screening rate in positive population by quantitative immune FOBT was higher than double-method FOBT (27.83% vs 13.08%, P=0.001). These differences were statistically significant. The detection rate of total lesions by colonoscopy was 71.88% in positive population by quantitative immune FOBT. It was 42.86% in double-method FOBT. There was no statistical difference between the two methods (P=0.05). The detection rates of quantitative immune FOBT were significantly different among different genders, ages and physical properties (all P<0.001). The detection rate was higher in males than in females (79.14% vs 68.75%). The detection rate was highest in the group between 40 and 59 years old (79.96%). The individual detection rate was higher than the group (90.08% vs 66.07%). The positive rates in primary screening were significantly different among different ages (P=0.001).It was highest in the group aged 60 or above (5.59%). The colonoscopy screening rate in positive population by quantitative immune FOBT was highest in the group aged 50 or above (36.96%). The detection rate of inflammatory lesions were significantly different among different ages (P<0.001). The detection rate of colorectal cancer in males was higher than in females (11.11% vs 0.00%, P=0.009). In addition, with the increasing of fecal occult blood value, the detection rate of cancer was increased (P=0.041). Conclusion The quantitative immune FOBT is an ideal non-invasive examination for early screening of colorectal cancer. It has important application values.

Application of urinary 5- aminolevulinic acid detection in screening and identification of colorectal cancer and adenomatous polyps / 中国医师进修杂志

Objective To study the application of urinary 5-aminolevulinic acid (5-ALA) detection in screening and identification of colorectal cancer and adenomatous polyps. Methods The clinical data of 500 high-risk patients(including 22 cases with colorectal cancer, 134 cases with adenomatous polyps, and 344 cases with other patients) at the First Affiliated Hospital of Hebei North University from January 2018 to October 2018 were collected. High performance liquid chromatography (HPLC) was used to detect urinary 5-ALA and fecal occult blood test was used to detect faeces. Sensitivity and specificity of two methods was compared. At the same time, urine samples of 431 cases (including 22 cases with colorectal cancer, 134 cases with adenomatous polyps and 275 cases with colorectal normal mucosa)were collected, and the difference of the content of urinary 5-ALA among three groups was compared. Results The sensitivity of urinary 5-ALA for the colorectal cancer screening was 74.9% , and the specificity was 72.5% . The sensitivity of urinary 5-ALA for the adenomatous polyps screening was 70.1% , and the specificity was75.0% . The sensitivity of fecal occult blood test for the colorectal cancer screening was 63.6% , and the specificity was 62.1% . The sensitivity of fecal occult blood test for the adenomatous polyps screening was 42.3%, and the specificity was 62.5%. The content of urinary 5-ALA of the colorectal cancer group [(9.35 ± 0.46) μmol/g] was significantly higher than that of the adenomatous polyps group [(7.24 ± 0.64) μmol/g] (P<0.05) and normal colorectal mucosa group [(3.12 ± 0.24) μmol/g] (P<0.05), and the content of urinary 5-ALA of the adenomatous polyps group was significantly higher than that of colorectal normal mucosa group (P<0.05). Conclusions For screening of colorectal cancer and adenomatous polyps, the content of urinary 5-ALA by HPLC is better than fecal occult blood test, and this approach can do great help to identify colorectal cancer, adenomatous polyps and normal colorectal mucosa.

Annual Report of the Korean Association of External Quality Assessment Service on Urinalysis and Fecal Occult Blood Testing (2018) / 임상검사와정도관리

In 2018, external quality assessment trials for urinalysis and fecal occult blood (FOB) were performed using 1,590 participants. Urine chemistry tests were performed thrice while urine sediment and FOB tests twice. Urine chemistry tests comprised of pH, protein, glucose, ketone body, bilirubin, blood, urobilinogen, nitrite, leukocyte, and specific gravity analyses. The results of urine chemistry and specific gravity tests showed accuracy rates >95%, except for the pH test. The accuracy rate of urine sediments was low, especially for atypical calcium oxalate crystal and red blood cell cast. In the FOB quality test, reagents showed accuracy rates >90%, except for SD and GC Genedia FOB reagents. In the FOB quantitative test, Alfresa NS-Plus C instrument showed falsely high values in the FOB negative specimens.

Characteristics of BK polymavirus infection in kidney transplant recipients / 南方医科大学学报

OBJECTIVE@#To analyze the characteristics of BK polymavirus (BKV) infection and the optimal time window for intervention in kidney transplant recipients (KTRs).@*METHODS@#We retrospectively analyzed the clinical data and treatment regimens in 226 KTRs in our center between January, 2013 and January, 2018. Among the recipients, 157 had a urine BKV load ≥1.0×10 copy/mL after transplantation, and 69 had a urine BKV load below 1.0×10 copy/mL (control group).@*RESULTS@#Among the 157 KTRs, 60 (38.2%) recipients were positive for urine BKV, 66 (42.0%) had BKV viruria, and 31(19.7%) had BKV viremia. The incidence of positive urine occult blood was significantly higher in BKV-positive recipients than in the control group ( < 0.05). The change of urine BKV load was linearly related to that of Tacrolimus trough blood level (=0.351, < 0.05). In urine BKV positive group, the average estimated glomerular filtration rate (eGFR) was below the baseline level (60 mL·min·1.73 m) upon diagnosis of BKV infection reactivation, and recovered the normal level after intervention. In patients with BKV viruria and viremia, the average eGFR failed to return to the baseline level in spite of improvement of the renal function after intervention.@*CONCLUSIONS@#Positive urine occult blood after transplantation may be associated with BKV infection reactivation in some of the KTRs. BKV infection is sensitive to changes of plasma concentration of immunosuppressive agents. Early intervention of BKV replication in KTRs with appropriate dose reduction for immunosuppression can help to control virus replication and stabilize the allograft function.

Performance Evaluation of SENTiFIT 270 and FOB Gold Reagent for Detecting Fecal Occult Blood / 대한임상미생물학회지

BACKGROUND: Fecal occult blood tests have been widely used to screen for colorectal cancer. SENTiFIT 270 (Sentinel diagnostics, Italy) is a fecal occult blood test with an immunochemical method that utilizes FOB Gold reagents. We evaluated the performance of SENTiFIT 270 using the FOB Gold reagent. In addition, FOB Gold was evaluated with the HITACHI 7180 (Hitachi Ltd., Japan). METHODS: The precision and linearity of the SENTiFIT 270 was evaluated in accordance with applicable Clinical and Laboratory Standard Institute guidelines. The comparison study between SENTiFIT 270-FOB Gold and the OC-Sensor (Eiken chemical Co., Japan) was performed using stool specimens. RESULTS: In the precision evaluation, the total precision of SENTiFIT 270-FOB Gold was 4.94% and 2.54% at high and low concentrations, respectively. The HITACHI 7180-FOB Gold had excellent precision of 4.60% and 2.09% at high and low concentrations, respectively. Linearity was also excellent for the SENTiFIT 270-FOB Gold and HITACHI 7180-FOB Gold at 0.9987 and 0.9986, respectively. The SENTITIF 270-FOB Gold showed excellent agreement with a kappa value of 0.830 and a concordance rate of 93.6%. The HITACHI 7180-FOB Gold showed high agreement with a kappa value of 0.832 and a concordance rate of 93.9%. CONCLUSION: The SENTiFIT 270-FOB Gold showed excellent performance in accuracy, linearity, and comparative inspection ability.