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Background: Colorectal polyp is a common lower gastrointestinal disease. Study of its risk factors is of great significance for prevention and treatment of colorectal polyps in clinical practice. Aims: To construct and verify a prediction model for risk of colorectal polyps. Methods: According to the inclusion and exclusion criteria, 254 subjects who were hospitalized for health examination in the Special Internal Medicine Ward of Shanghai Huadong Hospital from January 2019 to June 2021 were enrolled in the study. They were allocated into colorectal polyps group and non⁃polyp group based on the results of colonoscopy. The relevant risk factors of colorectal polyp were collected, including gender, age, cigarette smoking, alcohol drinking, hypertension, diabetes, hyperlipidemia, hyperuricemia, polyps/stones of gallbladder, fatty liver, etc. After screened by LASSO regression model, the selected factors were analyzed by multivariate Logistic regression to build the prediction model and nomogram. Furthermore, the prediction model was evaluated by ROC curve, C index, calibration curve and decision curve, and validated by internal samples. Results: Of the 254 subjects enrolled in the study, 116 cases were in colorectal polyps group and 138 in non⁃polyp group. The risk prediction model identified that gender (OR=2.11, 95% CI: 1.06⁃4.27), age (OR=2.76, 95% CI: 1.17⁃6.73), hypertension (OR=3.23, 95% CI: 1.52⁃7.12), diabetes (OR=4.37, 95% CI: 1.52⁃14.64), hyperlipidemia (OR=3.20, 95% CI: 1.74⁃5.95) and fatty liver (OR= 2.21, 95% CI: 1.13⁃4.35) were independent risk factors for colorectal polyps. The model showed good area under the ROC curve (0.807) and C index (0.807). The decision curve demonstrated that if the threshold probability of colorectal polyps was more than 12%, the model would be of clinical significance. Internal samples were randomly selected for validation, and the C index was 0.793. Conclusions: The prediction model and nomogram constructed by combination of risk factors including gender, age, hypertension, diabetes, hyperlipidemia and fatty liver have a substantial reference value for risk prediction of colorectal polyps.
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The elderly are a special group, with their unique pathophysiology and disease characteristics.The measures and goals of diagnosis and treatment for the elderly are different from those for children, young and middle-aged people.Taking into consideration of the national and international literature, the insight from our long-term clinical practice and in-depth reflections, the authors have written this article as a reference for our colleagues in geriatric care.
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Gastric cancer is a common malignant tumor in China, which seriously threatens the health of people. With the deepening of research on the prevention and treatment of gastric cancer in China, especially the effective control of risk factors related to gastric cancer and the continuous improvement of the level of screening and diagnosis and treatment of gastric cancer, the prevalence and mortality of gastric cancer in China are declining year by year. Although great progress has been made in the prevention and treatment of gastric cancer in China, due to the aging of population and large population base, gastric cancer is still the third most common malignant tumor and the second most lethal malignant tumor in China. It is still one of the major diseases endangering the health of Chinese people, and there is still a long way to go for its prevention and treatment, and further efforts should be made. This article reviewed the epidemiological changes and implications of gastric cancer in China.
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Objective To investigate the value of CEUS in differential diagnosis of benign and malignant cervical lymph nodes with different size. Methods Totally 142 cervical enlarged lymph nodes (68 benign and 74 malignant nodes) confirmed by pathology were divided into 3 groups according to the maximum diameter length: 2 cm groups. Conventional ultrasonic characteristics and perfusion patterns of lymph nodes in 3 groups were observed and compared with pathologic findings. Results Among benign lymph nodes, 55.88% (38/68) showed uniform and high enhancement, while 26.47% (18/68) showed nonuniform or circular enhancement with regular unenhanced areas. Among malignant lymph nodes, 72.97% (54/74) showed nonuniform enhancement with irregular perfusion defects and 14.86% (11/74) showed weak enhancement. The accuracy of conventional ultrasound in differential diagnosis of benign and malignant cervical lymph nodes of 2 cm groups were 62.16% (23/37), 69.49% (41/59) and 78.26% (36/46), of CEUS were 81.08% (30/37), 86.44% (51/59)and 86.96% (40/46).Compared with conventional ultrasound, CEUS improved diagnostic accuracy of 1-2 cm lymph node (P=0.02). Conclusion CEUS is valuable for differential diagnosis of benign and malignant lymph nodes, especially for 1-2 cm lymph nodes.
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Objective To campare the diagnostic value of contrast-enhanced ultrasound(CEUS) and International Ovarian Tumor Analysis (IOTA) simple rules in the differential diagnosis of adnexal tumors . Methods For the 101 suspicious malignant adnexal tumors discovered by conventional ultrasound ,IOTA simple rules and CEUS were performed before operation . Tumors were divided into benign ,uncertain and malignant according to IOTA simple rules . Tumors were scored by CEUS according to the membrane integrity ,coating thickness uniformity ,separation enhancement ,enhance strength ( no enhancement ,low enhancement ,equal or high enhancement) ,and enhanced performance( uniform and non-uniform) . The ROC curve was drawn with the pathological results as the gold standard ,and the best boundary value was obtained . Finally ,the diagnostic efficiency of the diagnostic methods were analyzed . Results ①According to the ROC curve analysis ,the area under the curve of IOTA simple rules was 0 .757( P ＝0 .000) . When the uncertainty type was classified as benign ,the random index was 0 .41 ,the sensitivity was 61 .54% ,and the specificity was 79 .59% . When the uncertainty type was classified as malignant ,the random index was 0 .31 ,the sensitivity was 96 .15% ,and the specificity was 34 .69% . When the uncertain types were excluded the Youden index was 0 .77 ,the sensitivity was 76 .19% ,and the specificity was 89 .47% . ②The differences in the membrane integrity , coating thickness uniformity , separation enhancement , enhance strength , enhanced performance between benign and malignant tumors were statistically significant( P ＜ 0 .01) . ③According to the ROC curve analysis ,the area under the curve of CEUS was 0 .914( P ＝ 0 .000) ,cut-off value was 3 score . The Youden index ,sensitivity and specificity of evaluating benign and malignant adnexal tumors were 0 .80 ,78 .85% and 91 .84% respectively . ④ The tumors evaluated as benign by IOTA simple rules was classified as benign . The tumors evaluated as malignant by IOTA simple rules were classified as malignant . The tumors evaluated as uncertain by IOTA simple rules and scored less than or equal to 3 points according to CEUS were classified as benign . The tumors evaluated as uncertain by IOTA simple rules and scored more than 3 points according to CEUS were classified as malignant . According to the ROC curve analysis ,the area under the curve of CEUS combined with IOTA simple rules was 0 .831 ( P ＝0 .000) . The Youden index ,sensitivity and specificity in evaluating benign and malignant adnexal tumors were respectively 0 .66 ,86 .54% and 79 .59% respectively . Conclusions CEUS has a higher diagnostic efficiency than IOTA Simple Rules and the two combined in the diagnosis of adnexal tumors .
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Objective:To explore the relations among childhood trauma,autistic traits and dysexecutive functions in college students.Methods:Totally 2757 college students were assessed with the Childhood Trauma Questionnaire (CTQ).Sixty-three college students were randomly selected as the abused group according to the subscale cutoff point of CTQ Scale defined by Bernstein,and 93 students were randomly selected from students without history of childhood trauma as the control group.They were assessed with the Self-Rating Depression Scale (SDS),Autism Spectrum Quotient (AQ) and Dysexecutive Questionnaire (DEX) to measure depression,autistic traits and abnormality of executive functions,respectively.The individuals from the top and below 27％ of CTQ and AQ scores were defined as higher or lower-level different types of abused group and higher or lower-level autistic traits group,respectively.Results:The differences of DEX scores between higher or lower-level four types of CTQ (emotional abuse,physical abuse,sexual abuse,emotional neglect and physical neglect) and between higher or lower-level autistic traits group were significant (Ps ＜0.05).DEX scores in all higher-level groups were higher than all lower-level groups.Regression analysis showed that DEX score could be positively predicted by scores of emotional abuse,AQ and SDS (β =0.17-0.32,P ＜0.05).SDS score was a mediator between scores of emotional abuse and DEX,and between scores of autistic traits and DEX (95％ confidence interval were 0.05-0.32 and 0.07-0.55,respectively).Conclusion:Childhood trauma and autistic traits may positively predict dysexecutive function,and depression may play a mediating role between emotional abuse and dysexecutive function,and between autistic traits and dysexecutive function.
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Objective To investigate the application value of solution focused brief therapy in the caring of patients with ulcerative colitis (UC). Methods A total of 180 active UC patients were assigned into control group (90 cases) and observation group (90 cases) using random number table. The two groups were given continuous nursing. For the observation group, the patients received the intervention of solution-focused brief therapy. SF-36 Health Survey (SF-36), Self-rating Anxiety Scale (SAS), Self-rating Depression Scale (SDS) and treatment efficacy rate before and after the interventions were compared between the two groups. Univariate analysis was used to determine the related factors of effective treatment of UC. Results Before the intervention, there was no significant difference in the eight scales of SF-36 between the two groups (P>0.05). After the intervention, the eight scales of SF-36, ie, physical functioning, role limitations due to physical health problems, bodily pain, vitality, general health, social functioning, role limitations due to emotional health problems, and mental health were (70.0±20.9), (72.2± 16.3), (71.9 ± 21.7), (68.7 ± 18.2), (70.4 ± 19.3), (69.5 ± 20.4), (68.9 ± 19.3), (72.6 ± 19.7) points in the observation group, and (62.2 ± 18.7), (66.3 ± 18.8), (65.7 ± 15.2), (62.6 ± 17.4), (62.9 ± 14.9), (63.5 ± 14.6), (61.9±15.2), (64.1±14.5) points in the control group, and there was significant difference between the two groups (t=2.220-3.291, P<0.01). Before the intervention, there was no significant difference in SAS and SDS between the two groups(P>0.05). After the intervention, SASand SDS was (37.3±10.8), (36.8±10.6) points in the observation group and (41.0 ± 11.6), (41.3 ± 12.7) points in the control group, and there was significant difference between the two groups (t=2.215, 2.581, P<0.05) . The efficacy rate was 88.9％(80/90) in the observation group, and 73.3％(66/90) in the control group, and there was significant difference between the two groups (χ2=7.420, P=0.024). Solution focused brief therapy was the related factor of effective treatment in UC patients (χ2=7.107, P=0.008). Conclusions Solution focused brief therapy could improve the quality of life, reduce anxiety and depression, and increase the treatment efficacy in patients with UC, which was an effective intervention method with clinical application value.