Alcohol is a hepatotoxin that is commonly consumed worldwide and is associated with a spectrum of liver injury including simple steatosis or fatty liver, alcoholic hepatitis, fibrosis, and cirrhosis. Alcoholic liver d...Alcohol is a hepatotoxin that is commonly consumed worldwide and is associated with a spectrum of liver injury including simple steatosis or fatty liver, alcoholic hepatitis, fibrosis, and cirrhosis. Alcoholic liver disease(ALD) is a general term used to refer to this spectrum of alcohol-related liver injuries. Excessive or harmful alcohol use is ranked as one of the top five risk factors for death and disability globally and results in 2.5 million deaths and 69.4 million annual disability adjusted life years. All patients who present with clinical features of hepatitis or chronic liver disease or who have elevated serum elevated transaminase levels should be screened for an alcohol use disorder. The diagnosis of ALD can generally be made based on history, clinical and laboratory findings. However, the diagnosis of ALD can be clinically challenging as there is no single diagnostic test that confirms the diagnosis and patients may not be forthcoming about their degree of alcohol consumption. In addition, clinical findings may be absent or minimal in early ALD characterized by hepatic steatosis. Typical laboratory findings in ALD include transaminase levels with aspartate aminotransferase greater than alanine aminotransferase as well as increased mean cor-puscular volume, gamma-glutamyltranspeptidase, and IgA to IgG ratio. In unclear cases, the diagnosis can be supported by imaging and liver biopsy. The histological features of ALD can ultimately define the diagnosis according to the typical presence and distribution of hepatic steatosis, inflammation, and Mallory-Denk bodies. Because of the potential reversible nature of ALD with sobriety, regular screening of the general population and early diagnosis are essential.展开更多
目的探讨临床痴呆评定量表(clinical dementia rating,CDR)用于社区阿尔茨海默病早期筛查的效度。方法1281名50岁以上社区自愿者(男性580人、女性701人)来院接受临床访谈、实验室检查和系列心理评估,其中包含CDR、简易老年人认知筛查问...目的探讨临床痴呆评定量表(clinical dementia rating,CDR)用于社区阿尔茨海默病早期筛查的效度。方法1281名50岁以上社区自愿者(男性580人、女性701人)来院接受临床访谈、实验室检查和系列心理评估,其中包含CDR、简易老年人认知筛查问卷(brief elderly cognitive screening inventory,BECSI)、老年快速认知筛查量表(quickly cognitive screening scale for elderly,QCSS-E)、简明智能状况检查(mini-mental state examination,MMSE)和核心神经认知测验(core neurocognitive test,CNT)。依据访谈和检查结果以及DSM-5标准进行诊断分类:认知正常623人、轻度认知损害(mild cognitive impairment,MCI)570人和阿尔茨海默痴呆(dementia with Alzheimer's type,DAT)88人。结果(1)50岁以上社区自愿者CDR总评分(CDR global score,CDR-GS)分布为:0分506人(39.5%)、0.5分688人(53.7%)、1分72人(5.6%)、≥2分15人(1.2%)。(2)不同CDR得分被试的BECSI分、QCSS-E分、MMSE分和CNT分存在组间差异(P<0.01)。在总样本或痴呆样本中,CDR总分(CDR sum of boxes,CDR-SB)和CDR-GS与BECSI分(r=0.577~0.639)、QCSS-E分(r=-0.586~-0.680)、MMSE分(r=-0.570~-0.764)和CNT分(r=-0.244~-0.357)显著相关(P<0.01)。(3)CDR-GS筛查DAT的准确率(95.8%)和特异性(99.8%)略高于CDR-SB(91.1%,92.0%),其敏感性(65.9%)低于CDR-SB(82.5%)。CDR-GS筛查MCI的准确性(72.6%)、敏感性(81.9%)、特异性(64.0%)与CDR-SB筛查指标接近(分别为72.1%,83.3%,61.8%)。结论临床痴呆评定量表可用于社区阿尔茨海默病早期筛查,CDR-GS和CDR-SB计分各有优势,综合两者优势可提高筛查效能。展开更多
Pancreatic cancer is the fourth most common cause of cancer-related deaths in the United States, with over 38000 deaths in 2013. The opportunity to detect pancreatic cancer while it is still curable is dependent on ou...Pancreatic cancer is the fourth most common cause of cancer-related deaths in the United States, with over 38000 deaths in 2013. The opportunity to detect pancreatic cancer while it is still curable is dependent on our ability to identify and screen high-risk populations before their symptoms arise. Risk factors for developing pancreatic cancer include multiple genetic syndromes as well as modifiable risk factors. Genetic conditions include hereditary breast and ovarian cancer syndrome, Lynch Syndrome, familial adenomatous polyposis, Peutz-Jeghers Syndrome, familial atypical multiple mole melanoma syndrome, hereditary pancreatitis, cystic fibrosis, and ataxia-telangiectasia; having a genetic predisposition can raise the risk of developing pancreatic cancer up to 132-fold over the general population. Modifiable risk factors, which include tobacco exposure, alcohol use, chronic pancreatitis, diet, obesity, diabetes mellitus, as well as certain abdominal surgeries and infections, have also been shown to increase the risk of pancreatic cancer development. Several largevolume centers have initiated such screening protocols, and consensus-based guidelines for screening high-riskgroups have recently been published. The focus of this review will be both the genetic and modifiable risk factors implicated in pancreatic cancer, as well as a review of screening strategies and their diagnostic yields.展开更多
文摘Alcohol is a hepatotoxin that is commonly consumed worldwide and is associated with a spectrum of liver injury including simple steatosis or fatty liver, alcoholic hepatitis, fibrosis, and cirrhosis. Alcoholic liver disease(ALD) is a general term used to refer to this spectrum of alcohol-related liver injuries. Excessive or harmful alcohol use is ranked as one of the top five risk factors for death and disability globally and results in 2.5 million deaths and 69.4 million annual disability adjusted life years. All patients who present with clinical features of hepatitis or chronic liver disease or who have elevated serum elevated transaminase levels should be screened for an alcohol use disorder. The diagnosis of ALD can generally be made based on history, clinical and laboratory findings. However, the diagnosis of ALD can be clinically challenging as there is no single diagnostic test that confirms the diagnosis and patients may not be forthcoming about their degree of alcohol consumption. In addition, clinical findings may be absent or minimal in early ALD characterized by hepatic steatosis. Typical laboratory findings in ALD include transaminase levels with aspartate aminotransferase greater than alanine aminotransferase as well as increased mean cor-puscular volume, gamma-glutamyltranspeptidase, and IgA to IgG ratio. In unclear cases, the diagnosis can be supported by imaging and liver biopsy. The histological features of ALD can ultimately define the diagnosis according to the typical presence and distribution of hepatic steatosis, inflammation, and Mallory-Denk bodies. Because of the potential reversible nature of ALD with sobriety, regular screening of the general population and early diagnosis are essential.
文摘目的探讨临床痴呆评定量表(clinical dementia rating,CDR)用于社区阿尔茨海默病早期筛查的效度。方法1281名50岁以上社区自愿者(男性580人、女性701人)来院接受临床访谈、实验室检查和系列心理评估,其中包含CDR、简易老年人认知筛查问卷(brief elderly cognitive screening inventory,BECSI)、老年快速认知筛查量表(quickly cognitive screening scale for elderly,QCSS-E)、简明智能状况检查(mini-mental state examination,MMSE)和核心神经认知测验(core neurocognitive test,CNT)。依据访谈和检查结果以及DSM-5标准进行诊断分类:认知正常623人、轻度认知损害(mild cognitive impairment,MCI)570人和阿尔茨海默痴呆(dementia with Alzheimer's type,DAT)88人。结果(1)50岁以上社区自愿者CDR总评分(CDR global score,CDR-GS)分布为:0分506人(39.5%)、0.5分688人(53.7%)、1分72人(5.6%)、≥2分15人(1.2%)。(2)不同CDR得分被试的BECSI分、QCSS-E分、MMSE分和CNT分存在组间差异(P<0.01)。在总样本或痴呆样本中,CDR总分(CDR sum of boxes,CDR-SB)和CDR-GS与BECSI分(r=0.577~0.639)、QCSS-E分(r=-0.586~-0.680)、MMSE分(r=-0.570~-0.764)和CNT分(r=-0.244~-0.357)显著相关(P<0.01)。(3)CDR-GS筛查DAT的准确率(95.8%)和特异性(99.8%)略高于CDR-SB(91.1%,92.0%),其敏感性(65.9%)低于CDR-SB(82.5%)。CDR-GS筛查MCI的准确性(72.6%)、敏感性(81.9%)、特异性(64.0%)与CDR-SB筛查指标接近(分别为72.1%,83.3%,61.8%)。结论临床痴呆评定量表可用于社区阿尔茨海默病早期筛查,CDR-GS和CDR-SB计分各有优势,综合两者优势可提高筛查效能。
文摘Pancreatic cancer is the fourth most common cause of cancer-related deaths in the United States, with over 38000 deaths in 2013. The opportunity to detect pancreatic cancer while it is still curable is dependent on our ability to identify and screen high-risk populations before their symptoms arise. Risk factors for developing pancreatic cancer include multiple genetic syndromes as well as modifiable risk factors. Genetic conditions include hereditary breast and ovarian cancer syndrome, Lynch Syndrome, familial adenomatous polyposis, Peutz-Jeghers Syndrome, familial atypical multiple mole melanoma syndrome, hereditary pancreatitis, cystic fibrosis, and ataxia-telangiectasia; having a genetic predisposition can raise the risk of developing pancreatic cancer up to 132-fold over the general population. Modifiable risk factors, which include tobacco exposure, alcohol use, chronic pancreatitis, diet, obesity, diabetes mellitus, as well as certain abdominal surgeries and infections, have also been shown to increase the risk of pancreatic cancer development. Several largevolume centers have initiated such screening protocols, and consensus-based guidelines for screening high-riskgroups have recently been published. The focus of this review will be both the genetic and modifiable risk factors implicated in pancreatic cancer, as well as a review of screening strategies and their diagnostic yields.
