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从大肠息肉到肠癌

在美国大肠癌(结直肠癌)是第二大癌症致死原因,2016年估计13.4 万将诊断患有大肠癌,其中4.9万人将死于此癌。

2015中国新发大肠癌患者37万人,19万人死于大肠癌,全球范围内2012年结直肠癌估计新发病例136万(1,360,602例,占所有病例的9.7%),为第3位最常见恶性肿瘤。预防大肠癌需从其前身大肠息肉开始。

大肠息肉是肠黏膜表面上隆起性的病变,通俗地说,是长在肠管内面的“肉疙瘩”。如果我们肠道内长了息肉,自身是没有感觉的,绝大多数都是在体检或检查其他疾病时才被发现的。小的“肉疙瘩”称为息肉,继续生长可变为腺瘤,而腺瘤继续发展可能就会变成癌。

目前已明确至少80-95%的大肠癌都是从肠息肉一步步“进化”过来的:小息肉→大息肉→重度不典型增生→原位癌→浸润性癌。一般这个过程可能需要5-10年不等,但有的人也可以进展的很快。例如,有家族性腺瘤性息肉病的患者从很年轻时肠道就长满了大大小小的息肉,癌变再所难免。通常来说息肉的发生随着年龄增长而更容易出现,但有大肠癌家族史的人其可能在比较年轻时就已长出息肉,因此患癌的风险比一般人更大。

 

息肉主要的类型

   大肠息肉从性质上划分,常见的主要是炎性息肉和腺瘤性息肉,前者由肠道增生性炎症引起几乎不恶变;腺瘤性息肉恶变的几率较炎性息肉高,腺瘤属癌前病变已被公认。腺瘤分为管状腺瘤、绒毛状腺瘤和混合性腺瘤三种,绒毛状腺瘤的癌变率最高,管状腺瘤的癌变率最低。

   腺瘤性息肉不会自行消退,如果不及时处理,可慢慢长大,发生癌变的几率较高。炎性息肉相对安全些,有时很小的炎性息肉会自行消失,但炎性息肉长期受炎症刺激,也有向腺瘤发展可能。一般结肠镜检查发现息肉时应该予以内镜下切除,内镜下息肉切除创伤小,不需要住院,内窥镜下的微创手术就切断息肉癌变之路。

   虽然大部分医生根据经验,肉眼下大致可以判断良恶性,但活检后显微镜下的病理诊断才是金标准,其中因此检查出肠道息肉都需要活检做病理切片,在显微镜下确诊,判断其恶变的可能性。

 

治疗与复查

    目前阿司匹林等一些药物可能有助于预防息肉新生,但还没有药物能有效治疗已形成的息肉,内镜下切除或手术切除效果确切,是治疗的标准。通常来说肠镜检查过程中发现息肉,如果判断其是良性的、且小于2cm,可以在内镜下切除,如果怀疑息肉已经恶变或者直径>2cm一般先取活检,待诊断明确后做相应处理。

  发现息肉,即使是切除了息肉,肠道内环境没改变,有复发的可能,所以曾经有结肠息肉病史的病人,都应该复查。基本的原则是:

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Gamblers Anonymous has established a hotline for these dwelling in India to call to acquire additional information about accountable playing or dependancy, whether for themselves or somebody they know.
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The Supreme Court docket judges in India are expected
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Within the later levels of the event, stack-management becomes the necessary issue.

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Within mere months, licensed and unsolicited card rooms offering real money poker video
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There is no such thing as a particular thriller behind his nickname - it came mostly as a result of the opposite gamers took notice of his
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He then defined me what the sport is about and how he can not
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He is among the solely three players to win the World Sequence of Poker Most important Occasion twice consecutively and in addition one of many only 4 players to win the World Sequence of
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Discarding (Obligatory) - After drawing, you should study your cards
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Be taught more about what the float play is and how you need to use this to
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Learning your opponents' proclivities is a must in the event you intend to become
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Primarily based on this background and the opinions given by main legal luminaries and jurists we imagine that enjoying
online poker for money is completely legal in India.
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Some require you to play a very large amount of hands,
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Some TAGs will even fold prime pair or an overpair to those
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I own a set of Poker to Go chips (from MeepleSource), and though they are a definite enchancment over paper cash, I find them somewhat too small for straightforward dealing with in cash-intensive games like Power Grid. He gained €1 million on the Partouche Poker Tour Important Occasion in Cannes again in 2011, he finished runner up within the Large One for One Drop tournament in 2012, and also earned $2.1 million on the 2013 Aussie Hundreds of thousands in the same year. Poker Questions - Burn playing cards, golf equipment, areas, diamonds, hearts, the deck, neighborhood cards and so forth.

For Indian players who need to play on-line among the finest choices will be the fast rising Junglee TennPatti , however there are many 3 card poker casinos that cater extra for western players but which additionally accept Indian registrations. Vishaal: I beloved Rounders with Matt Damon and Edward Norton-very sturdy solid and good storyline regarding the ups and down within the life of a poker participant. Ranked by the highest card, so that AKQJT is one of the best straight flush, also known as a royal flush. There is five betting rounds, with a brand new card being dealt withstand the middle of the desk between each betting spherical.

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Nevertheless, since Android gadgets do not run your app/browser usage in isolation, you might collectively be consuming a better volume of knowledge by means of apps running within the background. We believe that any online poker web site of India that needs to interact in authorized enterprise should adjust to Indian laws like Indian Penal Code, 1860, Code of Criminal Process, 1973, Indian Information Know-how Act, 2000, the Public Gambling Act, 1867, International Alternate Management Act (FEMA) 1999, and so forth. If there are not any fingers such as those described above, then the person with the best card in his hand will win (here when you maintain the ace , for example).

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The hand with the very best value card wins or if the best cards are the same, the value of the second highest playing cards determines the winner and so on. We additionally do full custom decks (e.g. card sizes, scorching & foil stamping, embossing, spot UV, and so forth) and board recreation improvement & packaging Chances are high, in the event you want it, we will do it! If all three playing cards are the same coloration the payoff is 3 to 1. Nonetheless when included with the vendor hand if all six playing cards are the same coloration then the payoff is elevated to 4 to 1. The home benefit on this wager is 3.sixty two%.

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By the time the 2007 World Series of Poker rolled around the
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Any participant worth a pair of deuces will let you know
that poker is a recreation of skill. If the board incorporates playing cards of the same suit or playing cards sequential to one another, watch out of the Flip
card and the River card, as individuals will stick
round in the pot if they have a good likelihood
to improve their hand at a later avenue. However whereas M&Ms will technically work, most individuals will probably
be used to utilizing at the very least an inexpensive set of pink, white, and blue plastic chips.
Phillip Hellmuth, arguably the most successful poker participant, has received the WSOP bracelet 14 occasions.

A Straight is a troublesome hand to obtain and carries
with it an fascinating poker strategy depending on the poker
variation at play.

Based on this background and the opinions given by leading legal luminaries and jurists we imagine that taking part in on-line poker for cash is completely legal
in India. If two gamers had 4 of a form the ranking
of the playing cards would come into play with
aces highest. The absolute best five-card poker hand, using exactly two gap playing cards
and three neighborhood playing cards, wins the pot.
These articles not solely cover the easy poker palms order
info, additionally they introduce the brand new player
to the assorted rounds of betting, when the playing cards are dealt, and easy methods to form a profitable Texas Maintain 'em hand.

So, you've got invited 10 willing Texas Hold'em nuts, and you have picked the
sport and purchase-in; now you need to pay money for some equipment.
Basically, no hand is made, and the only factor of any
potential meaning in the hand is the highest card. He comes out critical of Negreanu's play and
as always explains every mistake from preflop to showdown. Can't overlook the WSOP 2009, with so many
dealers and rules from in all places...good experience, however actually
frustrating. OTP affirmation and other security measures are
taken so as to present most protection for
our players. Nevertheless dealing seems a bit stacked - I noticed throughout showdowns a
high percentage of face cards dealt to players
with larger purchase-ins or VIP status.

The Digital Maintain ‘Em Poker game promotion is in impact from
September 6, 2016 by December 7, 2016. He has a small group of trusted buddies
he Skypes with, spending hours day-after-day reviewing and
analyzing the palms they've played - a frightening process, on condition that they each play over a hundred,000 palms each month.
The percentages of winning this hand was 12.02%
and can win against playing cards corresponding to K/J and
A/9. Texas Maintain'em : You may play Texas Hold'em poker online which is the
most well-liked variation of poker on this planet on In Hold'em,
every participant is dealt two personal playing cards, and 5 group cards are dealt face-up on the
game desk and the player has to make use of one or two of their personal hole cards to make the absolute best five-card
poker hand utilizing any mixture of the seven playing cards.

If there are not sufficient cards left within the deck for all gamers, all of the playing cards are dealt
except the final card, which is blended with the burn cards (and any cards faraway from the
deck, as within the earlier rule). They will
typically increase the minimal with marginal arms for concern of shedding chips in the event that they get beat and can regularly fold to scare
cards. We're actually not conscious of any Indian being prosecuted or
charged for the offence of utilizing a gambling web site.
That is what I got down to determine in analysis recently
printed in PLOS One , with colleagues Rogier Potter van Loon on the Erasmus University Rotterdam
and Martijn van den Assem at VU College Amsterdam.

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Nowhere the Supreme Court docket has held that of online poker, on-line
rummy, online card games, and many others are authorized in India.
You can Play Omaha poker on-line, Pot Limit Omaha, Omaha Hi/Lo, Texas maintain'em and on the identical time learn to play poker on-line with free poker video games.
Most on-line poker rooms have a wide range of characters which you can choose
from to represent your self.

The player must have at least 5 playing
cards eight or lower that are not duplicated
so as to have a qualifying low hand. Due to the increased protection of poker events, poker
execs became celebrities, with poker fans all over the world getting into into tournaments for the
possibility to compete with them. You'll be able to always discover the
highest 10 poker palms back in the proper column of the PokerHarder web site.
It's onerous to be a greater participant, however relatively
straightforward to be playing better poker with proper set ups comparable to mentioned
above.

In Texas Maintain'em, the perfect poker hand is a royal flush, followed by a straight flush
after which on down. The suits are Hearts, Golf equipment, Diamonds and Spades: ♥
♣ ♦ ♠ - In poker (generally speaking) the suits have no difference in rating.
As soon as you're used to taking part in free poker games, you may choose a poker sort and play
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and it's best to change your Ip. The Royal Flush is the technical answer when asked what are the very best poker
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To place this into perspective, most on-line gamers are more likely to play 1,500 hands in 19 to 25 hours
- and fewer than that if they play a number of tables on the same time.
After seeing his or her gap cards, each participant now has the option to play his or her hand
by calling or elevating the big blind. The straight with the highest-rating playing cards on the head of
the sequence is the winner in opposition to another straight hand.

PokerStars vous permet de faire des dépôts en argent réel
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After confirming hand rankings with my pal who took me to a sport in Golden Aces 6 years
in the past. In case you are offended (or depressed, burdened
and many others.) that is likely going to spill over to the poker tables and affect your play as well.
No Restrict: a form of poker through which there isn't any ceiling on the quantity bet on each betting spherical.
A hand would have 5 cards and the best hand or the very best hand would win the pot.
The Spartan Poker in the present day has several experienced people as part of
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