Clinical profile of early- and late-onset colorectal cancer patients in a referral medical center in Medellín, Colombia: A comparative analysis / Perfil clínico de pacientes con cáncer colorrectal de aparición temprana y tardía en un centro médico de referencia en Medellín, Colombia: Un análisis comparativo

Introduction. Incidence of early-onset colorectal cancer (EOCRC), defined as colorectal cancer (CRC) in individuals aged < 50 years, is rising worldwide. Despite the increasing international scientific production on EOCRC, research is limited in Colombia. The objective of this study was to characterize the clinical features of adults with EOCRC and late-onset CRC (LOCRC, CRC in individuals aged ≥ 50 years). Methods. An observational, retrospective, cross-sectional study was conducted with CRC patients ≥ 18 years old at one medical center in Medellín, Colombia. Clinical and pathological data were retrieved from the Institutional Cancer Registry. Two analysis groups were established: EOCRC and LOCRC. The Chi-Square test was applied to compare the variables of interest between both groups. Results. The sample included 1,202 patients, 53.5% were female (N=643) and the median age was 65 years (interquartile range: 55-73). EOCRC represented 15.9% (N=192). LOCRC tended to have more history of cardiometabolic diseases and smoking (p<0.001) than EOCRC. CRC family history was proportionally more frequent in EOCRC (7.3% vs 3.8%; p=0.028) than in LOCRC. Right-sided tumors were more common in LOCRC (30.4% vs 21.9%; p=0.041) and left-sided tumors in EOCRC (30.7% vs 23.2%; p=0.041). Only one patient had inflammatory bowel disease history. Conclusion. EOCRC is clinically distinct from LOCRC regarding pathological and toxicological history as well as tumor location. Our findings provide valuable insights for enhancing clinical decision-making, particularly in relation to age at onset in Colombian CRC patients.

Introducción. La incidencia de cáncer colorrectal (CCR) de aparición temprana (CCR-ATem), definido como CCR en individuos menores de 50 años, está aumentando en todo el mundo. A pesar del incremento en la producción científica internacional sobre CCR-ATem, la investigación es limitada en Colombia. El objetivo de este estudio fue caracterizar clínicamente los adultos con CCR-ATem y CCR de aparición tardía (CCR-ATar, CCR en individuos ≥ 50 años). Métodos. Estudio observacional, retrospectivo, transversal, en el que se incluyeron los pacientes adultos con CCR atendidos en un centro médico de Medellín, Colombia. Los datos se obtuvieron del Registro Institucional de Cáncer. Se establecieron dos grupos de análisis: CCR-ATem y CCR-ATar. Se aplicó la prueba de Chi cuadrado para comparar las variables de interés entre ambos grupos. Resultados. La muestra incluyó 1.202 pacientes, 53,5 % fueron mujeres (N=643), y la mediana de edad fue de 65 años (rango intercuartil: 55-73). CCR-ATem representó el 15,9 % (N=192). CCR-ATar tuvo más casos de enfermedades cardiometabólicas y tabaquismo (p<0,001). El antecedente familiar de CCR fue proporcionalmente más frecuente en CCR-ATem (7,3 % vs. 3,8 %; p=0,028). Los tumores del colon derecho fueron más frecuentes en CCR-ATar (30,4 % vs. 21,9 %; p=0,041) y los del colon izquierdo en CCR-ATem (30,7 % vs. 23,2 %; p=0,041). Solo un paciente tuvo antecedente de enfermedad inflamatoria intestinal. Conclusión. CCR-ATem es clínicamente distinto de CCR-ATar con respecto a antecedentes patológicos y toxicológicos, y localización tumoral. Nuestros hallazgos proporcionan información útil para mejorar la toma de decisiones clínicas, particularmente en relación con la edad de inicio en pacientes colombianos con CCR.

Analysis of clinical characteristics of autoimmune encephalitis with antibodies against contactin-associated protein-like 2 / 中华神经科杂志

Objective:To explore the clinical characteristics of patients with antibodies against contactin-associated protein-like 2 (CASPR2).Methods:The clinical data of 24 patients with anti-CASPR2 encephalitis diagnosed at the First Affiliated Hospital of Zhengzhou University from January 2018 to December 2022 were retrospectively analyzed. According to the age of first onset, the patients were divided into early onset group (10 cases, onset age<45 years) and late onset group (14 cases, onset age≥45 years). The clinical data including clinical manifestations, auxiliary examinations, and treatment response between these 2 groups were compared.Results:Among the 24 patients, there were 13 cases with epilepsy, 13 cases with cognitive decline, 13 cases with mental disorders, 14 cases with autonomic dysfunction, 8 cases with peripheral nerve hyperexcitability, 5 cases with Morvan syndrome, 5 cases with unstable walking, and 8 cases with sleep disorders. Among the 10 cases of the early onset group, 7 cases are females, and 8 cases showed epilepsy. The incidence rate of epilepsy in the early onset group was higher than that in the late onset group (5/14, Fisher exact probability, P=0.047). Among the 14 cases of the late onset group, 6 cases are females, 9 cases showed cognitive impairment and 8 cases presented with mental disorders. There were 6 cases with abnormal brain magnetic resonance imaging (MRI). The cerebrospinal fluid protein of the late onset group [0.37 (0.29, 0.58) g/L] was higher than that in the early onset group [0.22 (0.16, 0.30) g/L; Z=-2.667, P=0.008]. The modified Rankin Scale (mRS) scores before and after treatment were 3.29±0.83 and 1.50 (0.75, 2.25), which were higher than those in the early onset group [mRS scores before and after treatment were 2.10±0.99 and 0 (0, 1.00), t=-3.188, P=0.004; Z=-2.335, P=0.020]. Conclusions:There are various symptoms in patients with anti-CASPR2 encephalitis. The early onset patients are common in women, with a higher incidence of epilepsy. The late onset patients are common in males, with prominent manifestations of cognitive impairment and mental disorders, which have a greater impact on daily living abilities. And abnormal MRI findings are common, and the cerebrospinal fluid protein is higher in late onset patients. Anti-CASPR2 antibody may cause more severe immune damage to the nervous system in elderly patients.

Clinical characteristics and related factors of patients with schizophrenia in different ages of onset / 中国心理卫生杂志

Objective:To explore the clinical characteristics and related socio-demographic factors of schizo-phrenia patients with different ages of onset.Methods:Totally 2 016 patients with schizophrenia aged 15 to 70 were selected according to the diagnostic criteria for schizophrenia in the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition.All of the patients were interviewed by psychiatrists using the Mini International Neuropsy-chiatric Interview to diagnose schizophrenia,Clinical-Rated Dimensions of Psychosis Symptom Severity(CRDPSS)and the Positive and Negative Syndrome Scale(PANSS)to assess symptoms.The cut-off points were 18 and 25 years old for three age groups,i.e.early onset(EOS),youth onset(YOS)and adult onset(AOS).Statistical analy-ses were performed by analysis of variance Pearson correlation analysis,and multivariate linear regression.Results:The early-onset patients had the highest total PANSS score(73.8±28.0)and CRDPSS score(11.7±5.4).Fe-male gender,high education level,Han ethnicity,early onset age,and slower onset of illness were negatively corre-lated with the total and dimension score of PANSS scale and CRDPSS scale(standardized regression coefficient:0.04-0.47),and income level and smoking were negatively correlated with those score(standardized regression coefficient:-0.04--0.14).Conclusion:Early-onset schizophrenia patients have more severe symptoms,and fe-male,high education level,early-onset disease,and chronic onset are the risk factors of symptom severity in patients with schizophrenia.

Comparison of clinically relevant factors in bipolar disorder patients with different age of onset / 中国心理卫生杂志

Objective:To compare clinical characteristics,treatment patterns and physiological indicators in bipolar disorder(BD)patients with different age of onset.Methods:Totally 380 patients with DSM-5 BD were se-lected in this study.Psychiatrists diagnosed the patients using the Mini International Neuropsychiatric Interview.The clinical information questionnaire and the Global Assessment of Functioning scale were utilized to collected clinical characteristics,treatment status,and physiological indicators.The onset age of BD was divided into 21 and 35 years as cut-off points.Multivariate logistic regression and linear regression were used to analyze related factors.Results:Among the 380 patients with BD,199 cases were early-onset group(52.4％),121 cases were middle-onset group(31.8％),and 60 cases were late-onset group(15.8％).There were 26.6％of patients in the early-onset group in-itially diagnosed as depression,23.1％in the middle-onset group,and 11.7％in the late-onset group.Multivariate analysis revealed that compared to the early-onset group of BD,the middle-onset(OR=2.22)and late-onset(OR=4.99)groups had more risk to experience depressive episodes,and the late-onset group(OR=6.74)had 6.74 times of risk to suffer from bipolar Ⅱ disorder.Additionally,patients in the middle-onset(β=-1.52)and late-on-set(β=-4.29)groups had shorter durations of delayed treatment,and those in the middle-onset(β=-1.62)and late-onset(β=-3.14)groups had fewer hospitalizations.Uric acid levels were lower in both the middle-onset(β=-28.39)and late-onset(β=-31.47)groups,and total cholesterol level was lower in the middle-onset group(β=-0.23).Conclusion:Patients with BD in different age of onset show significant differences in clinical charac-teristics,treatment conditions and physiological indicators.

Hidden neuraxial pathology in idiopathic scoliosis: original research / Patologia neuroaxial oculta na escoliose idiopática: pesquisa original / Patología neuroaxial oculta en la escoliosis idiopática: investigación original

ABSTRACT Objective: To evaluate the prevalence of hidden neuraxial pathology (NAP) revealed in idiopathic scoliosis (IS) in neurologically normal patients. Methods: We selected 401 patients with IS who visited our clinic. We identified patterns of NAP and its frequency. In addition to the main part of the study, we assessed the reliability of Magnetic Resonance Imaging (MRI) measuring of the pedicles to plan screw width and trajectory. Results: Among the 401 patients, 53 (13%) presented NAP. The proportion of males in this group was higher (42% vs. 21%, p=0.004), the age of onset of the deformity was lower (8.9±3.77 vs. 9.9±3.93 years old, p=0.045), the left-sided thoracic curve was more frequent (21% vs. 8%, p=0.016), thoracic kyphosis was more pronounced (p=0.070), and the percentage of revision surgeries for deformity progression or non-fusion was higher (13% vs. 5%, p=0.147). Conclusions: The spine MRI should be performed in the early stages of IS, as in some cases of NAP (Chiari, tethered spinal cord), there is the possibility of an early neurosurgical operation that will prevent the development of scoliosis. The main signs of hidden NAP in IS are early-onset IS, IS with left-sided thoracic curve, male gender, and thoracic kyphosis > 40°Cobb. Level of Evidence II; Retrospective Study.

Resumo: Objetivo: Avaliar a prevalência das patologias neuroaxiais ocultas (PNO) reveladas na escoliose idiopática (EI) em pacientes neurologicamente normais. Métodos: Foram selecionados 401 pacientes com EI que visitaram nossa clínica. Identificamos padrões de PNO e sua frequência. Além disso, avaliamos a confiabilidade da medição por ressonância magnética (RM) dos pedículos para planejar a largura e a trajetória do parafuso. Resultados: Entre os 401 pacientes, 53 (13%) apresentaram PNO. A proporção de homens neste grupo foi maior (42% contra 21%, p=0,004), a idade de início da deformidade foi menor (8,9±3,77 contra 9,9±3,93 anos, p=0,045), a curva torácica do lado esquerdo foi mais frequente (21% contra 8%, p=0,016), a cifose torácica foi mais pronunciada (p=0,070) e a porcentagem de cirurgias de revisão para progressão da deformidade ou não fusão foi maior (13% contra 5%, p=0,147). Conclusões: A ressonância magnética da coluna deve ser realizada nos estágios iniciais da EI, pois em alguns casos de PNO (Chiari, medula espinhal amarrada) existe a possibilidade de uma operação neurocirúrgica precoce que impedirá o desenvolvimento de escoliose. Os principais sinais de PNO oculta na EI são: EI de início precoce, EI com curvatura torácica à esquerda, sexo masculino e cifose torácica > 40°Cobb. Nível de Evidência II; Estudo Retrospectivo.

Resumen: Objetivo: Evaluar la prevalencia de las patologías neuroaxiales ocultas (PNO) reveladas en la escoliosis idiopática (EI) en pacientes neurológicamente normales. Métodos: Se seleccionaron 401 pacientes con EI que visitaron nuestra clínica. Se identificaron patrones de PNO y su frecuencia. Además, evaluamos la fiabilidad de la medición por resonancia magnética (RM) de los pedículos para planificar la anchura y la trayectoria del tornillo. Resultados: Entre los 401 pacientes, 53 (13%) presentaron PNO. La proporción de hombres en este grupo fue mayor (42% vs 21%, p=0,004), la edad de aparición de la deformidad fue menor (8,9±3,77 vs 9,9±3,93 años edad, p=0,045), la curva torácica del lado izquierdo se encontró con más frecuencia (21 % frente a 8 %, p=0,016), la cifosis torácica fue más pronunciada (p=0,070) y el porcentaje de cirugías de revisión por progresión de la deformidad o falta de fusión fue mayor (13% vs 5%, p=0,147). Conclusiones: La resonancia magnética de la columna debe realizarse en las primeras etapas de la EI, ya que en algunos casos de PNO (Chiari, médula anclada) existe la posibilidad de una operación neuroquirúrgica temprana que prevendrá el desarrollo de la escoliosis. Los principales signos de PNO oculta en EI son: EI de inicio temprano, EI con curvatura torácica izquierda, sexo masculino y cifosis torácica > 40°Cobb. Nivel de Evidencia II; Estudio Retrospectivo.

Factores asociados con la edad a la que inicia la menopausia. Un análisis de la ENASEM-2018 / Factors associated with age at onset of menopause. An analysis of MHAS-2018

Resumen OBJETIVO: Identificar los factores sociodemográficos, patológicos, psicosociales y de estilo de vida relacionados con la edad a la que inicia la menopausia. MATERIALES Y MÉTODOS: Estudio secundario de corte transversal de la ronda 2018 del Estudio Nacional de Salud y Envejecimiento en México (ENASEM) que cuenta con 17,114 registros de sujetos de uno y otro sexo provenientes de toda la República Mexicana. Criterios de inclusión: mujeres de 40 años, con información de las variables: edad al inicio de la menopausia, lugar de residencia, estado civil, escolaridad, peso, estatura, tabaquismo, ingesta de alcohol, sedentarismo, depresión, hipertensión arterial, diabetes mellitus, algún tipo de cáncer e histerectomía. Se hizo un análisis comparativo de la edad a la menopausia con cada uno de los factores y un análisis multivariado para determinar los factores asociados. Las mujeres con histerectomía, y un grupo de mujeres con ≤ 6 años en la posmenopausia, se analizaron aparte. RESULTADOS: De 9017 mujeres registradas (con límites de edad de 40 y 90 años), 7132 (81%) conservaban el útero y los ovarios. El promedio de edad a la menopausia, sin ajuste, fue 47.8 ± 4.5 años. La histerectomía la anticipa en 2.3 años y la escolaridad mayor a la secundaria la retrasa 5 meses. La edad ajustada fue 48.0 ± 4.3 años y en el grupo con menopausia reciente 50.0 ± 2.8 años. CONCLUSIÓN: La menopausia natural se inicia entre los 48 y 50 años, la histerectomía la adelanta hasta dos años y la escolaridad de secundaria y superior la retrasa 6 meses por cada incremento de nivel escolar. El hecho de vivir en una zona rural o urbana también influye en el tiempo en que comienza la menopausia natural.

Abstract OBJECTIVE: To identify sociodemographic, pathological, psychosocial, and lifestyle factors associated with age at menopause onset. MATERIALS AND METHODS: Secondary cross-sectional study of the 2018 round of the National Study of Health and Aging in Mexico (ENASEM), with 17,114 records of male and female subjects from all over Mexico. Inclusion criteria: women aged 40 years with information on the following variables: age at onset of menopause, place of residence, marital status, education, weight, height, smoking, alcohol consumption, sedentary lifestyle, depression, hypertension, diabetes mellitus, any type of cancer and hysterectomy. A comparative analysis of age at menopause was made with each of these factors and a multivariate analysis was performed to determine the associated factors. Women with hysterectomy and a group of women ≤ 6 years postmenopausal were analyzed separately. RESULTS: Of 9017 women enrolled (with age limits of 40 and 90 years), 7132 (81%) retained uterus and ovaries. The mean age at menopause without adjustment was 47.8 ± 4.5 years. Hysterectomy brought it forward by 2.3 years and education beyond high school delayed it by 5 months. The adjusted age was 48.0 ± 4.3 years and in the recent menopause group 50.0 ± 2.8 years. CONCLUSION: Natural menopause occurs between 48 and 50 years of age, hysterectomy brings it forward by up to two years, and secondary and higher education delays it by 6 months for each additional year of schooling. Living in a rural or urban area also influences the time of onset of natural menopause.

Involución de quistes simples de ovario con hormonales orales combinados en pacientes en edad fértil / Involvement of simple ovarian cysts with combined oral hormones in patients of chilbearing age

Resumen OBJETIVO: Establecer la evolución natural y los efectos, a dos meses, de los hormonales orales combinados indicados a pacientes en edad fértil, con quistes simples de ovario, y su diferencia con un grupo control. MATERIALES Y MÉTODOS: Estudio prospectivo, longitudinal, descriptivo, comparativo y experimental llevado a cabo en el servicio de Ginecoobstetricia del Hospital Civil de Guadalajara Fray Antonio Alcalde en pacientes atendidas entre abril del 2018 y marzo del 2019 con diagnóstico de quiste simple de ovario. Las pacientes se asignaron al azar a dos grupos de estudio: tratadas con etinil estradiol y drospirenona grupo A y las que solo recibieron placebo grupo B. Los grupos fueron similares en relación con la edad, estado civil, ocupación, embarazos y antecedente de quiste de ovario. RESULTADOS: Se estudiaron dos grupos de 40 pacientes cada uno. Al cabo de dos meses de tratamiento el grupo A tuvo regresión en 32 casos y en el grupo B solo hubo regresión en 22 casos, con una diferencia significativa. Ninguno de los quistes mayores de 65 mm remitió. CONCLUSIÓN: La edad más frecuente a la que aparecen los quistes simples de ovario es entre los 20 y 29 años. De la muestra estudiada en 32 de 40 pacientes con tratamiento hubo regresión, no así en los quistes ováricos mayores de 65 mm. Se recomienda la prescripción de anticonceptivos combinados orales en el tratamiento de pacientes con quistes simples de ovario entre 30 y 65 mm con el propósito de incrementar su tasa de regresión y, así, evitar un procedimiento quirúrgico.

Abstract OBJECTIVE: To determine the natural evolution and effects, after two months, of combined oral hormonal drugs indicated for patients of childbearing age with simple ovarian cysts and their difference with a control group. MATERIALS AND METHODS: Prospective, longitudinal, descriptive, comparative and experimental study conducted in the Gynecobstetrics Service of the Civil Hospital of Guadalajara Fray Antonio Alcalde in patients attended between April 2018 and March 2019 with a diagnosis of simple ovarian cyst. Patients were randomized to two study groups: those treated with ethinyl estradiol and drospirenone group A and those who received only placebo group B. The groups were similar with respect to age, marital status, occupation, pregnancies, and history of ovarian cysts. RESULTS: Two groups of 40 patients each were studied. After two months of treatment, regression occurred in 32 cases in group A and in 22 cases in group B, with a significant difference. None of the cysts larger than 65 mm regressed. CONCLUSION: The most common age of onset of simple ovarian cysts is between 20 and 29 years. Of the sample studied, regression was observed in 32 of 40 patients treated, but not in ovarian cysts larger than 65 mm. The prescription of combined oral contraceptives is recommended in the treatment of patients with simple ovarian cysts between 30 and 65 mm to increase their regression rate and thus avoid surgery.

Trends in incidence of malignant tumors in Yongkang City from 2013 to 2019 / 预防医学

Objective @#To investigate the trends in incidence of malignant tumors in Yongkang City, Zhejiang Province from 2013 to 2019, so as to provide insights into formulation of the malignant tumor control strategy.@*Methods@#Data pertaining to the incidence of malignant tumors from 2013 to 2019 were captured from the Zhejiang Chronic Disease Monitoring Information System. Based on the International Classification of Diseases 10th Revision (ICD-10) and data from the national population census, the constituent ratio, crude incidence and Chinese population-standardized incidence of malignant tumors were estimated, and the trends in incidence of malignant tumors were investigated using annual percent change (APC).@*Results@#The annual mean crude incidence and Chinese population-standardized incidence of malignant tumors were 356.75/105 and 226.97/105, which both appeared an overall tendency towards a rise (APC=5.887% and 4.815%, both P<0.05). The crude incidence of malignant tumors appeared a tendency towards a rise among both men (APC=3.860%, P<0.05) and women (APC=8.534%, P<0.05) from 2013 to 2019, and the Chinese population-standardized incidence of malignant tumors appeared a tendency towards a rise among women (APC=8.392%, P<0.05). The largest increase in the crude incidence of malignant tumors was seen among women at ages of 15 to 44 years (APC=11.599%, P<0.05). In addition, the Chinese population-standardized incidence of lung cancer, colorectal cancer and thyroid cancer all showed a tendency towards a rise among men (all P<0.05), and the Chinese population-standardized incidence of lung cancer and thyroid cancer both appeared a tendency towards a rise among women (both P<0.05). @*Conclusions@#The incidence of malignant tumors showed a tendency towards a rise in Yongkang City from 2013 to 2019, and the elderly and young females are high-risk populations for malignant tumors. Lung cancer, thyroid cancer and colorectal cancer are cancers that should be given a high priority.

Analysis on the trends of incidence and age change for global female breast cancer / 中华肿瘤杂志

Objective: To analyze the trends of incidence and age change for global female breast cancer in different regions of the world according to the database from Cancer Incidence in Five Continents Time Trends (CI5plus) published by the International Association of Cancer Registries (IACR). Methods: The recorded annual female breast cancer (ICD-10: C50) incidence data and corresponding population at-risk data (1998-2012) were extracted from CI5plus published by IACR. The annual change percentage and average annual change percentage (AAPC) were calculated to examine the trends of incidence. The age-standardized mean age at diagnosis and proportion of incidence cases by age were calculated to analyze the relationship between incidence and age. Results: For crude incidence, except in Northern America, all other regions showed an upward trend, with Asia showing the most obvious upward trend (AAPC: 4.1%, 95% CI: 3.9%, 4.3%). For age-standardized incidence, in Asia, Latin America and Europe, the rising trends had slowed down, in Oceania and Africa, the trends began to be stable, and in Northern America, the trend showed a downward trend (APPC: -0.6%; 95% CI: -1.0%, -0.1%). The mean age at diagnosis were increased from 1998 to 2012 in Asia, Latin America, Oceania and Europe, with an annual increase of 0.12 years, 0.09 years, 0.04 years and 0.03 years, respectively. But after age-standardized, only Europe still kept increasing year by year, with an annual increase of 0.02 years, while Northern America showed a decreasing trend, with an annual decrease of about 0.03 years. Conclusions: From 1998 to 2012, the trends of incidence and age change for global female breast cancer vary in different regions of the world, and the global population aging is widespread, which affects the trend of the actual age change. Prevention and control strategies should be targeted at different age groups in different regions.

Focus on genetic modifiers of polyglutamine diseases / 中华神经科杂志

Polyglutamine (PolyQ) diseases are a group of clinically and genetically heterogeneous neurodegenerative diseases, due to an expanded CAG repeat in a coding region of the respective genes leading to neurodegenerative phenotypes by selective neuronal loss. Overall, only part of variance (50%-70%) in age at onset is explained by (CAG)n length, suggesting genetic modifying factors independent of (CAG)n size may contribute to clinical heterogeneity. Here, the research history of genetic modifiers in polyQ diseases is reviewed, and the major findings and current research status are discussed.

Research on the average age of onset of endometrial cancer based on data mining / 中国医师杂志

Objective:To explore the average age at onset of endometrial cancer (EC) and the differences between domestic and international factors.Methods:Pubmed, Wanfang Database, VIP Information Resource System, and China National Knowledge Infrastructure (CNKI) were selected to extract clinical research data related to EC. Through data mining methods such as frequency analysis and cluster analysis, we compared the differences in the average age of onset of EC between domestic and foreign countries.Results:A total of 280 articles that met the inclusion criteria were selected, and frequency analysis found that the average age of onset of EC in the Chinese population was mostly concentrated under 57 years old, while in European and American countries, it was mainly concentrated above 57 years old. Through cluster analysis, it was found that the average age of onset in China was clustered in one category with most Asian countries, while European and American countries and Australian countries were clustered in another category. Through analysis of domestic and foreign articles, it was found that the average age of onset of EC did not show a significant upward or downward trend with years.Conclusions:There are differences in the average onset age of EC among different countries and regions. The onset age of EC in Asian populations is significantly earlier than that in European and American populations. The average onset age of EC in Chinese populations is 54 years old, and there is no trend towards a younger onset of EC.

Gender differences in clinicopathological characteristics and prognosis of rectal cancer patients under 50 years old / 国际外科学杂志

Objective:To explore whether there are gender differences in clinical and pathological characteristics and prognosis of young patients with rectal cancer (under 50 years old), and to analyze the risk factors affecting the prognosis of young patients with rectal cancer.Methods:The medical records of 85 young rectal cancer patients admitted to Beijing Friendship Hospital Affiliated to Capital Medical University from January 2015 to December 2020 were retrospectively collected. According to gender, they were divided into male group ( n=50) and female group ( n=35). The age was (43.67±5.50) years old, ranging from 26 to 50 years old. Primary outcome measures were sex, disease-free survival, and overall survival. Secondary outcomes were family history, body mass index (BMI), clinical stage, anemia, whether the female patient was menopausal, whether the female patient took oral estrogen, the location of the primary lesion, whether neoadjuvant therapy was performed, pathological stage, whether accompanied with vascular nerve invasion, and whether postoperative adjuvant therapy was performed. R4.0.2 software was used for statistical analysis. The measurement data with normal distribution in the collected data were expressed as mean±standard deviation ( ± s), and the comparison between groups was analyzed by t test. Count data were expressed as constituent ratio, and analyzed using the chi-square test or Fisher′s exact test. The survival curve was drawn by Kaplan-Meier method, and the difference in survival rate was tested by Log-rank test. Factors with statistical significance in univariate analysis were included in COX proportional regression model for multivariate analysis to screen independent risk factors affecting overall survival. Results:Compared with male patients, a higher proportion of young female patients with rectal cancer were diagnosed with anemia before surgery (42.9% vs 22.0%, P=0.040). The 1-year, 3-year and 5-year overall survival rates were 94.3%, 80.0% and 68.6% in young female patients, and 98.0%, 90.0% and 90.0% in young male patients, respectively. The median disease-free surival was 31.6 months for women and 34.4 months for men. Multivariate analysis showed that female( HR=3.799, 95% CI: 1.312-11.002, P=0.014)and BMI( HR=0.846, 95% CI: 0.724-0.989, P=0.036)were independent risk factors affecting the prognosis of young patients with rectal cancer. Conclusions:Young female patients have a worse prognosis than male patients. Female and BMI are independent risk factors for the prognosis of young rectal cancer patients, and gender should be the key research object of observation in young rectal cancer patients.

Analysis of clinical manifestations at different age of onset in systemic sclerosis / 中华风湿病学杂志

Objective:To investigate the clinical and laboratory characteristics of systemic sclerosis (SSc) patients at different age of onset.Methods:Data of SSc patients with onset age ≥18 years old who were registered in the Peking Union Medical College Hospital and Chinese Rheumatism Data Center from August 2008 to June 2020 were included. Patients were divided into 3 groups by the age of onset according to the age segmentation of the World Health Organization. Counting variables were presented as frequency (percentage). Quantitative results were presented as mean±standard deviation, or median, inter quartile range. Differences between groups were analyzed by analysis of variance, the Mann-Whitney test or the chi-square test, depen-ding on the distribution of the variables.Results:Six hundred and eighty-two SSc patients were included. Accor-ding to the age of onset, they were divided into three groups: youth group (18-44 years old), middle-aged group (45-59 years old) and elderly group (over 60 years old). There were 361 patients in the youth group,245 patients in the middle age group and 76 patients in the elderly group. The mean age of onset was (43.8±12.1) years. The variables with significant different among the groups were as the following: left ventricular diastolic dysfunction [14.0%(14/100), 38.8%(39/98), 65.4%(17/26); χ2=30.756, P<0.001]; cardiac arrhythmias [1.9% (7/361), 3.7% (9/361), 7.9% (6/76), χ2=7.38, P=0.024), Raynaud's phenomenon [94.7% (342/361), 89.4%(219/245), 89.5%(68/76), χ2=6.73, P=0.035], loss of finger pad substance [36.9%(133/360), 25.4% (62/244), 18.4% (14/76), χ2=15.184, P=0.001]; digital ulcer [31.0% (112/361), 23.0% (56/244), 15.8% (12/76), χ2=9.86, P=0.007]; arthritis [16.3%(59/361), 13.5%(33/245), 5.3%(4/76), χ2=6.49, P=0.039], digital contracture [11.6%(42/361), 5.7%(14/245), 9.2%(7/76), χ2=6.10, P=0.047]; positive anti-RNP antibody [32.3% (116/359), 20.7% (50/241), 17.3% (13/75), χ2=14.06, P=0.001]; and positive anti-centromere antibody [8.9% (32/351), 18.4%(45/239), 23.7%(18/76), χ2=17.78, P<0.001] were significantly different between the young age group and elder group. Conclusion:The predominant age of disease onset of SSc is middle and young age. Elder onset SSc patients are more likely to have left ventricular diastolic dysfunction, and young onset patients are more likely to have microvascular lesions, which needs more attentions by clinicians.

Representative analysis of elderly subjects in clinical trials of prostate cancer drugs / 中华老年医学杂志

Objective:To analyze whether the sample of elderly subjects in clinical trials of prostate cancer drugs is representative.Methods:From the level of trial design, the age distribution of subjects in clinical trials of prostate cancer drugs for elderly patients from January 2019 to December 2021 was inquired on the platform of drug clinical trial registration and information disclosure.From the actual enrollment level, the prostate cancer drug clinical trials initiated and completed by a hospital from January 2010 to June 2022 were collected.The age information of subjects in all centers was collected for multicenter trials with a summary report, and the age data of subjects in the center was collected for trials without a summary report or single-center trials.The average age of prostate cancer onset and the incidence of prostate cancer in different age groups were compared with the Chinese Cancer Registry System, so as to compare whether the two were consistent.Results:Most of the trials(72.1%、44/61)did not set upper age limit at the protocol design level.Phase Ⅲ and phase Ⅳ trials did not set an upper age limit for enrolled subjects in the protocol.From the actual enrollment level, a total of 19 studies were included in this study, with 1 402 subjects, and the average age of subjects was 67.1±8.6 years old, which was significantly different from the average age of prostate cancer in China and Beijing(all P<0.001). The age group with the largest number of participants was 60-64 years old(34.2%、479/1 402). The population aged ≥75 years was the least(21.5%, 301/1 402), which was different from the high incidence age group of prostate cancer in China in 2017(421.77/100 000). Conclusions:Clinical trials of prostate cancer drugs are designed to cover all age groups of elderly patients, but the actual sample representation of the enrolled elderly subjects is insufficient.Under the premise of protecting the safety of subjects, the trial population who are matched for the average age of prostate cancer onset and the incidence of prostate cancer in age groups, should be gradually increased.

Clinical characteristics of 272 437 patients with different histopathological subtypes of primary esophageal malignant tumors / 中华内科杂志

Objective:To characterize the histopathological subtypes and their clinicopathological parameters of gender and onset age by common, rare and sparse primary esophageal malignant tumors (PEMT).Methods:A total of 272 437 patients with PEMT were enrolled in this study, and all of the patients were received radical surgery. The clinicopathological information of the patients was obtained from the database established by the State Key Laboratory of Esophageal Cancer Prevention & Treatment from September 1973 to December 2020, which included the clinical treatment, pathological diagnosis and follow-up information of esophagus and gastric cardia cancers. All patients were diagnosed and classified by the criteria of esophageal tumor histopathological diagnosis and classification (2019) of the World Health Organization (WHO). The esophageal tumors, which were not included in the WHO classification, were analyzed separately according to the postoperative pathological diagnosis. The χ 2 test was performed by the SPSS 25.0 software on count data, and the test standard α=0.05. Results:A total of 32 histopathological types were identified in the enrolled PEMT patients, of which 10 subtypes were not included in the WHO classification. According to the frequency, PEMT were divided into common (esophageal squamous cell carcinoma, ESCC, accounting for 97.1%), rare (esophageal adenocarcinoma, EAC, accounting for 2.3%) and sparse (mainly esophageal small cell carcinoma, malignant melanoma, etc., accounting for 0.6%). All the common, rare, and sparse types occurred predominantly in male patients, and the gender difference of rare type was most significant (EAC, male∶ female, 2.67∶1), followed with common type (ESCC, male∶ female, 1.78∶1) and sparse type (male∶ female, 1.71∶1). The common type (ESCC) mainly occurred in the middle thoracic segment (65.2%), while the rare type (EAC) mainly occurred in the lower thoracic segment (56.8%). Among the sparse type, malignant melanoma and malignant fibrous histiocytoma were both predominantly located in the lower thoracic segment (51.7%, 66.7%), and the others were mainly in the middle thoracic segment.Conclusion:ESCC is the most common type among the 32 histopathological types of PEMT, followed by EAC as the rare type, and esophageal small cell carcinoma and malignant melanoma as the major sparse type, and all of which are mainly occur in male patients. The common type of ESCC mainly occur in the middle thoracic segment, while the rare type of EAC mainly in the lower thoracic segment. The mainly sparse type of malignant melanoma and malignant fibrous histiocytoma predominately occur in the lower thoracic segment, and the remaining sparse types mainly occur in the middle thoracic segment.

High risk for psychiatric disorders in bipolar offspring. A four years prospective study / Riesgo elevado de trastornos psiquiátricos en hijos de padres con trastorno bipolar. Estudio prospectivo de cuatro años de duración

ABSTRACT Bipolar disorder (BD) has a large hereditary component. It is a disorder that begins in early adulthood, but about which it has been described a premorbid period preceding the onset of BD. During this herald expression psychiatric disorders and symptoms, such as depressive, manic, psychotic, anxious and others, may appear. Objective: To determine the psychopathological profile of a Bipolar Offspring (BO) group compared with the Community Control Offspring (CCO) group, and its evolution over time, including subthreshold symptoms and mental disorders. Methods: We conducted an observational mixed cohort study, with a prospective design. We included subjects from six to 30 years of age, from the region of Antioquia, Colombia. A total of 131 subjects from the risk group BO and 150 subjects from the CCO group were evaluated through validated psychiatric diagnostic interviews (K-SADS-PL and DIGS) at baseline and at 4 years follow up. All interviews were carried out by a staff blind to parent diagnoses. Follow-up assessment were complete in 72% of the offspring. Forty-two subjects were excluded as they surpassed the age of 30 years, and only 46 subjects were not followed (change of address or did not consent to participate). Results: Compared with the CCO group, the BO group had a higher frequency of affective disorder, psychotic disorder, externalizing disorders and use of the psychoactive substances during both assessments at time 1 and 2. The magnitude of the differences between the groups increased when they reach time 2. The BO group had a greater risk for presenting subthreshold symptoms and definitive psychiatric disorders, such as affective disorders, psychotic disorders and externalizing disorders. In addition, the BO group had a younger age of onset for psychoactive substances consumption. Conclusion: During the follow-up period, the BO group had a higher risk of presenting mental disorders compared with the CCO group. The most relevant symptoms and disorders that could precede the onset of BD were depressive, bipolar not otherwise specified, psychotic and substance use.

RESUMEN El trastorno bipolar (TB) tiene un gran componente hereditario. Es un trastorno que comienza en la edad adulta temprana, pero acerca del cual se ha descrito un período premórbido que precede al inicio de TB. Durante esta expresión heraldo, pueden aparecer trastornos y síntomas psiquiátricos, como depresivos, maníacos, psicóticos, ansiosos y otros. Objetivo: Determinar el perfil psicopatológico de un grupo de hijos de padres con TB (BO) en comparación con el grupo de hijos de padres control de la misma comunidad (CCO), y su evolución en el tiempo. Los síntomas subumbrales y los trastornos mentales serán incluidos. Métodos: Nosotros llevamos a cabo un estudio observacional mixto de cohorte, con diseño prospectivo. Incluimos sujetos de seis a 30 anos de edad, de la región de Antioquia, Colombia. Un total de 131 sujetos del grupo de riesgo BO y 150 sujetos del grupo CCO fueron evaluados a través de entrevistas de diagnóstico psiquiátricas validadas (K-SADS-PL y DIGS), al inicio yalos4anos de seguimiento. Todas las entrevistas se llevaron a cabo por personal ciego a los diagnósticos de los padres. La evaluación de seguimiento se completó en el 72% de la descendencia. Cuarenta y dos sujetos fueron excluidos ya que superaron la edad de 30 anos, y solo 46 sujetos no fueron seguidos (cambio de dirección o no dieron su consentimiento para participar). Resultados: En comparación con el grupo CCO, el grupo BO tuvo una mayor frecuencia de trastorno afectivo, el trastorno psicótico, los trastornos de externalización y el uso de las sustancias psicoactivas durante ambas evaluaciones en los tiempos 1 y 2. La magnitud de las diferencias entre los grupos aumentó cuando alcanzaron el tiempo 2. El grupo BO tuvo un mayor riesgo de presentar síntomas subumbrales y trastornos psiquiátricos definitivos, tales como trastornos afectivos, trastornos psicóticos y trastornos de externalización. Además, el grupo BO tuvo una edad de comienzo más baja para el consumo de sustancias psicoactivas. Conclusión: Durante el período de seguimiento, el grupo BO tuvo un mayor riesgo de presentar trastornos mentales en comparación con el grupo CCO. Los síntomas y trastornos más importantes que preceden al inicio del TB fueron: depresivo, bipolar no especificado de otra manera, psicóticos y el uso de sustancias.

Epidemiological analysis on pneumoconiosis cases in Liuzhou from 2006 to 2018 / 公共卫生与预防医学

Objective To understand the epidemiological characteristics of pneumoconiosis through analyzing the data of pneumoconiosis cases in Liuzhou from 2006 to 2018, and to provide a scientific basis for the prevention and control of pneumoconiosis in Liuzhou. Methods The information of pneumoconiosis cases in Liuzhou was collected through the “health hazard factors monitoring information system”, a subsystem of China's disease prevention and control system, and the epidemiological characteristics of pneumoconiosis were statistically analyzed by descriptive statistics. Results A total of 160 cases of pneumoconiosis was collected, mainly stage I silicosis, accounting for 70.0% of total cases (n=112). Most of the cases were from the metal smelting and rolling industry, accounting for 82.5% of total cases (n=132). The occupation of patients was mainly smelting and auxiliary work, sintering, and mining, accounting for 23.13% (n=37), 27.50% (n=44) and 18.13% (n=29) of the total number of pneumoconiosis cases, respectively. Among them, 83.75% (n=134) were from large-scale enterprises. Most of the pneumoconiosis cases had 15 to 35 years of dust exposure, with an average dust exposure of 23.78±10.36 years. The age of onset was mainly concentrated in 45 to 60 years old, and the average age of onset was 55.61±10.28 years. Conclusion The cases of pneumoconiosis in Liuzhou existed in sporadic form in recent years, and the cases were mainly concentrated in large metal smelting enterprises, with smelting and auxiliary workers and sintering workers being the most serious. It is necessary to strengthen the occupational health management of large metal smelting enterprises to effectively prevent and control the occurrence of pneumoconiosis.

Difference in clinical characteristics of patients with primary Sj?gren's syndrome by gender and age of disease onset / 中华风湿病学杂志

Objective:To compare the clinical characteristics of patients with primary Sj?gren's syndrome (pSS) by gender and age of disease onset.Methods:Clinical data of hospitalized patients with pSS in China-Japan Friendship Hospital from March 2014 to August 2020 were retrospectively analyzed. Patients were divided into different groups according to their genders and ages of disease onset (young grong <30 years, middle-age group 30-59 years, elderly group ≥60 years). Chi-square test and Mann-Whitney U test were used to compare data in subgroups, and logistic regression was performed to analyze data after control covariates. Results:Five hundred and forty one patients with pSS were included in this study and 481 of them were women (88.9%) Women had higher ratio than men in dry mouth [ OR (95% CI) =2.172(1.091, 4.323), P=0.027], dry eyes [ OR(95% CI)=2.179(1.062, 4.469), P=0.034], leukocytopenia [ OR(95% CI)=3.789(1.150, 12.482), P=0.029], ANA titer≥1∶160 [ OR(95% CI)=2.233(1.279, 3.898), P<0.01], positive anti-SSA [ OR(95% CI)=2.919(1.644, 5.183), P<0.01], positive anti-Ro52 [ OR(95% CI)=3.018(1.685, 5.405), P<0.01], while men had higher ratio than women in parotid enlargement [ OR(95% CI)=2.345(1.281, 4.325), P<0.01], and interstitial lung disease (ILD) [ OR(95% CI)=2.593(1.460, 4.606), P<0.01]. Compared with patients in young group, patients in middles age group had higher ratio in dental caries [ OR(95% CI)=5.940(2.230, 15.819), P<0.01], xero-phthalmia [ OR(95% CI)=2.904(1.313, 6.425), P<0.01], arthralgia [ OR(95% CI)=1.959(1.039, 3.694), P=0.038] and ILD [ OR(95% CI)=2.247(1.018, 4.959), P=0.045], but lower ratio in renal involvement [ OR(95% CI)=0.402(0.211, 0.766), P<0.01]; patients in elderly group had higher ratio in dental caries [ OR(95% CI)=7.437(2.441, 22.656), P<0.01], xerophthalmia [ OR(95% CI)=6.084(1.901, 19.468), P<0.01], and ILD [ OR(95% CI)=4.857(2.029,11.627), P<0.01]. Compared with patients in elderly group, patients in young group had higher positive rate in anti-SSA [ OR(95% CI)=2.836(1.245, 6.459), P=0.013], anti-SSB [ OR(95% CI)=3.075(1.413, 6.690), P<0.01], rheumatoid factors (RF) [ OR(95% CI)=3.323(1.620, 6.817), P<0.01] and elevated immunoglobulin G (IgG)[ OR(95% CI)=3.567(1.747, 7.284), P<0.01]; patients in middle age group had higher positive rate in anti-SSB[ OR(95% CI)=2.330(1.315, 4.130), P<0.01], RF [ OR(95% CI)=2.026(1.279, 3.208), P<0.01], and elevated IgG [ OR(95% CI)=2.077(1.297, 3.327), P<0.01]. Conclusion:Women with pSS present a higher ratio in dry mouth, dry eyes, leukocytopenia and positive autoantibodies than men, while parotid enlargement and ILD are more common in men than women. Young patients are prone to renal involvement, middle-aged patients are prone to arthralgia, while elderly patients are prone to dental caries and xerophthalmia. With the growth of age, the positive rates of autoantibodies and elevated IgG are decreased gradually in patients with pSS, but the ratios of dental caries, xerophthalmia and ILD is increased gradually.

Clinical features of atopic dermatitis and evaluation of its diagnostic criteria: a retrospective analysis of 165 inpatients with atopic dermatitis from 2000 to 2020 / 中华皮肤科杂志

Objective:To analyze and summarize clinical characteristics of atopic dermatitis (AD) , and to discuss differences and consistency among the Williams′, Japanese and Chinese diagnostic criteria for AD.Methods:A retrospective analysis was performed on 165 hospitalized patients with AD diagnosed according to the Williams′ criteria or the Chinese Zhang′s criteria in Southwest Hospital of Army Medical University from October 2000 to May 2020. Clinical data were re-evaluated according to the Williams′, Japanese and Chinese diagnostic criteria, and differences were analyzed among these criteria. Measurement data were compared by using t test, analysis of variance or rank sum test, and enumeration data were compared by using chi-square test or Fisher′s exact test. Results:Among the 165 patients, 66 (40.00%) developed AD before the age of 2 years; 95 (57.58%) had a personal and/or family history of atopic diseases, of whom 75 had a personal history of atopic diseases (mainly including allergic rhinitis [28.48%] and asthma[20.00%]) , 50 had a family history of atopic diseases, and 30 had both a personal and a family history of atopic diseases. A total of 98 patients (59.39%) were allergic to dust mites, including 48 with grade Ⅵ allergy. According to the total IgE level, 130 (78.79%) patients were diagnosed with exogenous AD, and 35 (21.21%) with endogenous AD. There were significant differences in the age at onset and blood eosinophil count between the patients with exogenous AD and those with endogenous AD (both P < 0.001) . After re-evaluation, 142 (86.06%) patients met the Williams′ criteria, 23 did not, and there was a significant difference in the age at onset between the two groups of patients ( P = 0.007) ; 150 (90.91%) patients met the Chinese Zhang′s criteria, 15 did not, and there was a significant difference in blood eosinophil counts between the two groups of patients ( P = 0.001) ; 160 (96.97%) patients met the Chinese Yao′s criteria; all patients met the Japanese criteria. There were no significant differences in the age at onset, total IgE level or blood eosinophil counts among patients meeting the Williams′ criteria, meeting the Japanese criteria, meeting the Zhang′s criteria, and those meeting the Yao′s criteria (all P > 0.05) . Conclusion:Patients with early-onset AD were prone to develop the highest-grade dust mite allergy; patients with exogenous AD were characterized by lower age at onset and higher eosinophil counts compared with those with endogenous AD; patients who met the Williams′ criteria showed lower age at onset than those who did not, while patients who met the Chinese Zhang′s criteria showed higher eosinophil counts than those who did not.

Disability and socio-occupational functioning in persons with schizophrenia

Background: Schizophrenia is a chronic mental illness which severely affects the functioning of individuals in their daily life. Functional disability in chronic illness is one of the major concerns for mental health professionals. The study aims to assess the disability of persons with schizophrenia and its relationship with age of onset, total duration of illness, and socio-occupational functioning. Methods and materials: The present study is a descriptive cross-sectional study. Sixty persons with schizophrenia were selected using simple random sampling from the outpatient department (OPD). Written informed consent was taken from the participants who fulfilled the inclusion and exclusion criteria. Clarifications were made regarding the basic purpose of the study before administration of tools. The study was undertaken with the permission of the Scientific Advisory and Institute Ethics committees. Sociodemographic datasheet, the revised Kuppuswamy scale, the Brief Psychiatric Rating Scale (BPRS), the Indian Disability Evaluation and Assessment Scale (IDEAS), and the Social Occupational Functioning Scale (SOFS) were administered. Collected data were analysed using the software (Statistical Package for the Social Sciences [SPSS] 25.0) using the statistical methods of mean, standard deviation, frequency, percentage, and Pearson correlation. Results: The findings showed that most of the respondents (71.7%) were having moderate level of disability and moderate impairment (40%) in socio-occupational functioning. The global score of disability has a significant positive correlation with total duration of illness (r=0.255, p<0.05) and negative correlation with age of onset of illness (r=-0.075), and there is significant positive correlation (r=0.829, p<0.01) between socio-occupational functioning and global disability. Conclusion: Disability has an impact on socio-occupational functioning in persons with schizophrenia. A higher level of disability can lead to higher level of impairment.