Link between irritable bowel syndrome,depression,and colorectal cancer risk in young patients:Age-matched nationwide populationbased study

BACKGROUND There exists a link between irritable bowel syndrome(IBS)and depression.Similarly,chronic depression is known to increase the risk of cancer in general.In this population-based analysis,we investigated the prevalence and the odds of colorectal cancer(CRC)in young-depressed patients with IBS.AIM To investigate the relationship between IBS and CRC in young,depressed patients using a nationally representative United States inpatient sample.METHODS The 2019 National Inpatient Sample was used to identify young(18-44 years)patients admitted with comorbid depression in the presence vs absence of IBS using relevant International Classification of Diseases,Tenth Revision,Clinical Modification codes.Primary endpoint was the prevalence and odds of CRC in age matched(1:1)youngdepressed cohort hospitalized with IBS(IBS+)vs without IBS(IBS-).Multivariable regression analysis was performed adjusting for potential confounders.RESULTS Age-matched(1:1)young-depressed IBS+(83.9%females,median age 36 years)and IBS-(65.8%females,median age 36 years)cohorts consisted of 14370 patients in each group.IBS+cohort had higher rates of hypertension,uncomplicated diabetes,hyperlipidemia,obesity,peripheral vascular disease,chronic obstructive pulmonary disease,hypothyroidism,prior stroke,prior venous thromboembolism,anxiety,bipolar disorder,and borderline personality disorder(P<0.005)vs the IBS-cohort.However,prior myocardial infarction,acquired immunodeficiency syndrome,dementia,smoking,alcohol abuse,and drug abuse(P<0.005)are high in IBS-cohort.The rate of CRC was comparable in both cohorts[IBS+n=25(0.17%)vs IBS-n=35(0.24%)].Compared to the IBS-cohort,the odds ratio(OR)of developing CRC was not significantly higher[OR 0.71,95% confidence interval(CI)0.23-2.25]in IBS+cohort.Also,adjusting for baseline sociodemographic and hospital characteristics and relevant comorbidities,the OR was found to be non-significant(OR 0.89,95%CI 0.21-3.83).CONCLUSION This nationwide propensity-matched analysis revealed comparable prevalence and risk of CRC in youngdepressed patients with vs without IBS.Future large-scale prospective studies are needed to evaluate the long-term effects of depression and its treatment on CRC risk and outcomes in IBS patients.

Etiological and clinicopathologic characteristics of intrahepatic cholangiocarcinoma in young patients

AIM:To investigate the prevalence,risk factors,and clinicopathologic characteristics of intrahepatic cholangiocarcinoma(ICC)in young patients.METHODS:A retrospective analysis was performed in ICC patients referred to the Eastern Hepatobiliary Surgery Hospital in Shanghai,China.Among 317 consecutively enrolled patients,40 patients were aged ≤40 years(12.61%).We compared the risk factors and clinicopathologic characteristics of these patients(groupⅠ:n=40)with those aged>40 years(group Ⅱ:n=277).RESULTS:Group I had distinct features compared with groupⅡ,including a low frequency of hepatolithiasis(P=0.000);a high positive rate of serum hepatitis B surface antigen(P=0.000)and hepatitis B virus(HBV)associated cirrhosis(P=0.038);a high frequency ofα-fetoprotein(>400μg/L)(P=0.011);a low frequency of carbohydrate antigen 19-9(>37 U/mL)(P=0.017);and a high frequency of liver histological inflammation(P=0.002).Although there was no significant difference between the two groups in regards to hepatic schistosomiasis,alcohol-associated cirrhosis and cirrhosis due to other causes(P>0.05),they only occurred in the elderly group.CONCLUSION:The risk factors are significantly different between young and elderly ICC patients.HBV and HBV-associated cirrhosis are the most important risk factors for young ICC patients.

Evaluation the effect of fertility-preserving surgery on young patients with malignant ovarian tumors

Objection： To evaluate the impact of fertility-preserving surgery and adjuvant chemotherapy on survival and fertility of young patients with ovarian malignant tumors. Methods： Retrospective analysis of 39 patients with ovarian malignant germ cell tumors, 23 patients with malignant epithelial tumors and 4 patients with sexual cord mesenchymal tumors receiving conservative treatments. Results： Two patients lost follow-up （we do not statistics them）. Fifty-nine among 64 patients were alive up to now （92.19%）. The overall survival rate for ovarian epithelial malignancies, malignant germ cell tumors and sexual cord mesenchymal tumors were 95.45%, 89.47% and 100% respectively. Fifteen patients received second operation and recurrence was found in 6 patients. Among the 59 surviving patients, 53 patients have normal menstruation. Thirteen patients among 20 patients who want to pregnant have 15 pregnancies and 9 successful deliveries. Conclusion： The management of fertility-preserving surgery on patients with ovarian malignant germ cell tumors, whatever the FIGO staging is, is a safe option. For patients with ovarian epithelial carcinomas, fertility-preserving surgery only confined to low-stage （stage Ⅰ）, low-grade （G1）, and patients who want keep fertility function seriously. Cisplatinum-based combination chemotherapy is necessary. Standardized chemotherapy has no affection on fertility function.

Treatment options for irreparable postero-superior cuff tears in young patients

Rotator cuff tears(RCTs) occur more commonly with advanced age,with most rotator cuff abnormalities in patients less than 30 years old being painful tendinoses or partial-thickness RCTs.Irreparable postero-superior cuff tears has been reported as frequent as 7% to 10% in the general population,and the incidence of irreparable RCTs in young patients is still unknown.Several surgical procedures have been proposed for young patients with irreparable postero-superior RCTs,such as rotator cuff debridement,partial rotator cuff repair,biceps tenotomy/tenodesis,rotator cuff grafting,latissimus dorsi tendon transfer,and reverse shoulder arthroplasty.After being thoroughly investigated in open surgery,arthroscopic techniques for latissimus dorsi tendon transfer have been recently described.They have been shown to be an adequate option to open surgery for managing irreparable postero-superior RCTs refractory to conservative management.

Prognostic factors of young patients with colon cancer after surgery

AIM： To investigate the prognostic factors of 96 young patients with colon cancer within a cancer center by univariate and multivariate analysis. METHODS： A total of 723 patients with colon cancer were treated surgically during a period of 10 years. Ninty six of them were 40 years old or younger. R0, R1 and R2 operations were performed in 69 （71.9%）, 4 （4.1%） and 23 patients （24%）, respectively. Left hemicolectomy was performed in 43 patients, right hemicolectomy in 37 patients, transverse colon resection in 9 patients and low anterior resection in 7 patients. Cox multivariate regression analysis was performed to identify predictors of survival. RESULTS： The operation mortality was 0%, 54 patients died within 111 mo after operation due to occurrence or metastases of the tumor. Liver, lung and bone metastases occurred in 3, 1 and 5 patients, respectively. The mean survival time for all patients was 77.9 ± 5.01 mo and the overall 3-, 5- and 10- year survival rates were 66.68%, 58.14% and 46.54%, respectively. In the univariate survival analysis, patient age, type of operation, radical resection, blood transfusion, histological type, diameter of tumor, depth of tumor invasion, lymphatic invasion, distant metastases, liver metastases and TNM stage were found to be predictors of survival in young patients with colon cancer. In the Cox-regression analysis, blood transfusion and lymphatic invasion were determined as independent prognostic factors of survival. CONCLUSIONS： Age, type of operation, radical resection, blood transfusion, histological type, diameter of tumor, depth of tumor invasion, lymphatic invasion, distant metastasis and TNM stage are the predictors of survival in young patients with colon cancer after surgery.

Bladder Cancer in Young Patients: Management and Outcomes

Background and Objective: Bladder cancer frequently occurs between the ages of 50 years and 70 years and rarely occurs before the age of 40 years. It accounts for 1% - 4% of all cases of cancer. This study focuses on the clinical, etiological, histological, therapeutic, and evolutive profiles of patients with bladder cancer aged less than 45 years. Materials and Methods: This retrospective study was carried out over seven years (from January 2014 to December 2020) on 15 patients below 45 years of age who were being treated for bladder cancer. The diagnosis was made in all patients via cystoscopy and abdominal computerized tomography, while the nature, grade, and degree of infiltration were determined via endoscopic resection and pathology. Results: The mean age of the 15 patients in this study was 34.4 ± 5.19 years. In 86.6% of cases, the patients had macroscopic hematuria as the main presenting complaint. Twelve patients (80%) had bladder tumors that did not infiltrate the muscle. These patients were followed up clinically. In 86.6% of cases, there was a single tumor with a mean diameter of 2.53 cm. In four patients (26.6%), mitomycin was started early. The overall rates of tumor recurrence and progression were 26.6% and 20%, respectively. Conclusion: Bladder cancer also occurs in young people, with similar clinical and epidemiological profiles as exists in elderly patients. The prognosis of bladder cancer in young people depends on the treatment method chosen by the physician.

Decompression alone versus decompression with instrumented fusion for young patients with single-level lumbar disc herniation：a short-term prospective comparative study

Background For young patients,the surgical method for lumbar disc herniation remains controversial.The aim of this study was to prospectively determine the short-term clinical outcome after surgery for young patients with lumbar disc herniation.Methods In this prospective comparative study between April 2010 and August 2011,a total of 80 patients underwent primary surgery at a single level for lumbar disc herniation.The patients were divided into two groups：decompression alone and decompression with instrumented fusion.An independent examiner clinically evaluated the patients at preoperation and at 1,3,6,and 12 months after surgery.The patients filled out the instruments for back and leg pain using a Visual Analog Scale （VAS）,Oswestry Low Back Pain Disability Questionnaire （ODI）,and Japanese Orthopaedic Association （JOA） scores.The differences between the two groups were analyzed.Results The mean age of all the patients at the time of surgery was 33.7 years.Of the 80 patients,38 patients underwent decompression alone and 42 patients underwent posterior lumbar interbody fusion.Increasing complexity of surgery was associated with a longer surgery time,greater blood loss,and a longer hospital stay after surgery.Both methods of surgery independently improved outcomes compared with baseline status based on VAS,ODI,and JOA scores （P 〈0.05）,and no significant differences were found between the two groups at most of the measuring points in time,although patients with decompression alone had a higher JOA score （P=0.016） and higher JOA recovery rate （P=0.010） at the 3-month follow-up.Conclusions The short-term results of our study showed that both methods of surgery obtained effective clinical outcomes,but decompression alone had some advantages （shorter surgery time,less blood loss,shorter hospital stay,and lower cost） compared with decompression with instrumented fusion.Young patients with decompression alone could achieve great physical function earlier.

Clinicopathologic Characteristics and Surgical Outcome of Gastric Cancer in Patients Younger than 36 Years of Age

OBJECTIVE This study was designed to determine theclinicopathologic features of young patients who underwentgastrectomy for gastric cancer and to improve the clinicalmanagement of this disease.METHODS From 1981 to 2000,among 1,830 gastric cancerpatients were admitted in our hospital for surgical treatment,66of them were<36 years of age.The clinicopathologic data of theseyoung patients were collected and reviewed.RESULTS The male:female ratio was 1.2:1.Most tumors werelocated in the lower third of the stomach(63.1%).The overall5-year survival rate of 66 cases was 28.7%.The 5-year survivalrates in the patients with early stages and with advanced stages ofgastric carcinoma were 77.8%(7/9)and 21.1%(12/57),respectively.Unfavorable prognostic factors associated with poor 5-yearsurvival included the degree of the invasion in the gastric wall(P<0.05),and curability of resection(non-curative vs.curative;P<0.05).CONCLUSION Gastric cancer in young adults tends to be moreadvanced presentation when diagnosed.However,young patientswith early gastric cancer can tolerate radical treatments well.Itis important to promptly make a precise diagnosis for gastriccarcinoma in young patients and to treat it in early stage.

Long-term impact of initial surgical and medical therapy on young patients with papillary thyroid cancer and bilateral cervical metastases

Background There are few reviews on the clinical features and prognosis of young patients with papillary thyroid cancer and bilateral cervical metastases. We have investigated the long-term impact of initial surgical and medical therapy on such patients. Methods A retrospective study was performed on 24 young patients （11 females and 13 males） with papillary thyroid cancer and bilateral cervical lymph node metastases, ranging in age from 11 to 20 years （mean age, 16.6 years）, who were treated in our institution from 1 January 1970 to 31 December 1985. Results All the patients in this group were followed up for 20 years. The survival of the patients at 20 years was 91.7%. The recurrence of local tumor and distant metastases was 20.8% and 12.5%, respectively. Based on analysis of the clinical data, we determined that the completeness of the surgical excision had a significant correlation with tumor recurrence. Conclusion These young patients with papillary thyroid cancer and cervical metastases have a good prognosis after suitable treatment.

Effects of professional rehabilitation training on the recovery of neurological function in young stroke patients

Young stroke patients have a strong desire to return to the society, but few studies have been conducted on their rehabilitation training items, intensity, and prognosis. We analyzed clinical data of young and middle-aged/older stroke patients hospitalized in the Department of Neurological Rehabilitation, China Rehabilitation Research Center, Capital Medical University, China from February 2014 to May 2015. Results demonstrated that hemorrhagic stroke （59.6%） was the primary stroke type found in the young group, while ischemic stroke （60.0%） was the main type detected in the middle-aged/older group. Compared with older stroke patients, education level and incidence of hyperhomocysteinemia were higher in younger stroke patients, whereas, incidences of hypertension, diabetes, and heart disease were lower. The average length of hospital stay was longer in the young group than in the middle-aged/older group. The main risk factors observed in the young stroke patients were hypertension, drinking, smoking, hyperlipidemia, hyperhomocysteinemia, diabetes, previous history of stroke, and heart disease. The most accepted rehabilitation program consisted of physiotherapy, occupational therapy, speech therapy, acupuncture and moxibustion. Average rehabilitation training time was 2.5 hours/day. Barthel Index and modified Rankin Scale scores were increased at discharge. Six months after discharge, the degree of occupational and economic satisfaction declined, and there were no changes in family life satisfaction. The degrees of other life satisfaction （such as friendship） improved. The degree of disability and functional status improved significantly in young stroke patients after professional rehabilitation, but the number of patients who returned to society within 6 months after stroke was still small.

Oxidative Stress During Antituberculous Therapy in Young and Elderly Patients

Using allantoin (ATN ) as a marker for reactive oxygen species (ROS), oxidative stress during antituberculous (anti-TB) therapy was compared in 10 young and 9 elderly patients.Before treatment, ATN plasma concentrations in patients were similar to that of volunteers. Administration of a combination of isoniazid (INH ), rifampicin (RIF) and pyrazinamid e (PZA) increased plasma ATN in both groups of patients. ATN concentrations (M± SE) at six hours were higher (P <0.05 ) in elderly than in young patients on day one,8.22 ± 1.50 vs 1.89 ± 0.98 μg/mL); day 30, (5.85 ± 0.82 vs 0.87 ± 0.57 μg/mL; and day 90, (4.84 ± 1.24 vs 0.52 ± 0.50μg/mL). Because total amount of ATN excreted was similar in both groups on the three occasions, more ATN was formed in elderly than young patients. In conclusion, there was more oxidative stress in elderly than young patients. It is thereby suggested that Anti-TB drugs induce formation of ROS and elderly patients are at a greater risk of toxicity probably because of poor antioxidant mechanisms

Complex proximal femoral fracture in a young patient followed up for 3 years: A case report

BACKGROUND Ipsilateral femoral neck and intertrochanteric fractures in young patients are extremely rare,and there is no reference for fracture classification and treatment options.CASE SUMMARY We report a 27-year-old male patient who sustained ipsilateral femoral neck and intertrochanteric fractures and was treated with a proximal femoral locking compression plate(PFLCP).The literature on these fractures was also reviewed.At the last follow-up three years after surgery,the patient had no obvious pain in the hip,and the range of motion in the hip joint was slightly limited,but met the normal life and work needs.There were no complications such as necrosis of the femoral head.CONCLUSION The PFLCP can be used to treat these complex proximal femoral fractures,and selection should be based on the patient's specific fractures.

Factors Associated with Coronary Artery Disease in Young Population(Age≤40):Analysis with 217 Cases

Objective To investigate the relevant factors of coronary artery disease （CAD） in young people under 40 years of age. Methods The study population was 292 young patients accepting coronary angiography in Fuwai Hospital from July to December 2006, including 272 men and 20 women, with the mean age being 36.7±3.7 years. The diagnosis of CAD was made in the cases presenting ~ 50% stenosis in coronary lumen in coronary angiography. Based on the diagnosis, 217 patients （204 men, 13 women） were assigned to CAD group, and 75 （68 men, 7 women） to non-CAD group. Clinical data and metabolic characteristics of the patients were collected and analyzed using t-test, Z2 test, and multinomial logistic regression with SPSS 8.0 software. Results Most study subjects were current smokers （209/292, 71.6%）, and more than half had body mass index （BMI）〉24 kg/m2 （230/292, 78.8%） and usually took high-fat diet （162/292, 55.5%）. The proportion of heavy smokers （smoking history ≥10 years and t〉20 cigarettes per clay） were significantly higher in the CAD group than in the non-CAD group [20.7% （45/217） vs. 9.3% （7/75）, P=0.015）]. Heavy smoking [odds ratio （OR）, 1.89; 95% confidence interval （CI）, 1.74-2.05], hypertension （OR, 1.56; 95% CI, 1.48-1.65）, alcohol （OR, 1.37; 95% CI, 1.30-1.46）, type 2 diabetes mellitus （OR, 1.37; 95% CI, 1.25-1.50）, high-fat diet （OR, 1.35; 95% CI, 1.28-1.43）, and BMI〉24 kg/m2 （OR, 1.09; 95% CI, 1.03-1.17） were factors related to CAD in the young patients （all P〈0.05）. Total cholesterol （4.56_±1.46 mmol/L vs. 4.09_±1.00 mmol/L）, low-density lipoprotein cholesterol （2.38±1.11 mmol/L vs. 2.14±0.63 rnmol/L）, lipoprotein a （134.97±109.70 mg/L vs. 101.58±58.39 mg/L）, uric acid （359.89_±100.09 μmol/L vs. 336.75±94.36 μmol/L）, erythrocyte sedimentation rate （9.98± 12.19 ram/hour vs. 4.89_±4.92 mm/hour）, high-sensitivity C-reactive protein （3.42±4.39 mg/L vs. 2.80±_3.77 mg/L） and Big endothelin-1 （1.41±1.50 fmol/mL vs. 0.77_±1.13 fmol/mL） in plasma were significantly increased in the CAD group compared with the non-CAD group （all P〈0.05）. Conclusions Heavy smoking, hypertension, alcohol consumption, type 2 diabetes mellitus, high-fat diet and BMI〉24 kg/m2 were significantly related to CAD in patients aged ≤40, with heavy smoking presenting the highest OR. Metabolic syndrome and inflammation were also more common in young CAD patients than in non-CAD patients.

Diverticulitis in the young patient-Is it different?

AIM： To prospectively study the incidence and the natural history of acute diverticulitis in young patients. METHODS： A total of 207 patients hospitalized at our hospital between January 2000 to February 2005 with the diagnosis of acute diverticulitis were included. Their demographic characteristics, medical history, physical, radiographic and endoscopic findings as well as therapy were recorded. Patients were followed every 6 mo for the first year and later annually. RESULTS： The mean patients＇ age was 61 （range 27-92） years. Twenty- five patients （12%） were younger than 45 years. Acute diverticulitis was significantly more prevalent among male in the young age group as compared to the older age group （19/25, 76% vs 61/182, 33%, respectively, P = 0.0001）. Complications occurred more often in the young age group; 32% vs 13%, （P = 0.002）. During follow-up, 6 patients （28%） remained asymptomatic in the young age group as compared to 87 patients （55%） in the older age group （P = 0.024）. As a result, sigmoidectomies were performed twice as often in the young age group （38% vs 13%, P = 0.002）. CONCLUSION： Diverticulitis in young patients has a male predominance, a more aggressive course with a higher rate of complications and a higher recurrence rate. An earlier surgical approach might be considered in young patients with acute diverticulitis.

Choroidal vascular occlusion in a young male patient with sickle cell trait

Dear Editor,Choroidal vascular occlusion is a rare finding. Choroidal perfusion disorders may range from focal infarction of the choriocapillaris to fibrinoid arteriolar necrosis. Vascular occlusion due to microembolism is more common in choroidal than in retinal vasculature. Due to its unique hemodynamic characteristics, which involve one of the highest rates of blood flow in the body and the fact that it is functionally an end artery system, the choroidal circulation is prone to platelet emboli associated with cardiovascular disease and other pathologies with increased risk of microembolismt.

Accessory renal arteries-a source of hypertension:A case report

BACKGROUND Secondary hypertension is a relatively rare condition most commonly caused by renovascular disease due to atherosclerotic vascular disease or fibromuscular dysplasia.Although accessory renal arteries are frequent,to date,only six cases of secondary hypertension determined by their existence have been reported.CASE SUMMARY We describe a case of a 39-year-old female who came to the emergency department with an urgent hypertensive crisis and hypertensive encephalopathy.Despite normal renal arteries,the computed tomography angiography revealed an inferior polar artery with 50%stenosis of its diameter.Conservative treatment with amlodipine,indapamide and perindopril was adopted,leading to blood pressure control within one month.CONCLUSION To the best of our knowledge,there are controversies regarding accessory renal arteries as a potential etiology for secondary hypertension,but the seven similar cases already described,along with the current case,could reinforce the necessity of more studies concerning this subject.

Colorectal cancer and pollution

The incidence of colorectal carcinoma is increasing in young patients, in contrast to the well established wisdom that it is exclusively diagnosed in patients older than 40 years. In this survey, we examined all possible risk factors, and we recommend a number of measures for early detection in young patients who are at risk of developing this malignant tumor.

Comparison of efficacy between electroacupuncture and the combination of collateral bloodletting,cupping,and acupoint application for cervical spondylosis radiculopathy(CRS)

Objective To observe the efficacy of treating young patients with cervical spondylosis radiculopathy （CRS） by collateral bloodletting, cupping, and acupoint application. Methods Sixty-one CRS patients were randomly divided into an acupoint application group （group A, 31 cases） and an electroacupuncture group （group B, 30 cases）. Both sides of the spine and scapula were treated with collateral bloodletting, cupping, and acupoint application over Ashi points in group A. The following points received electroacupuncture in group B： Jiaji （夹脊 EX-B2）, Fengchi （风池 GB 20）, Jianjing （肩井 GB 21）, Jianyu （肩髃 LI 15）, Waiguan （外关 TE 5）, Houxi （后溪 SI 3） and Dazhui （大椎 GV 14）. Patients in the two groups were compared in terms of scores for total symptoms and signs, and the theraputic effect of each method was analyzed. Results Total score of symptoms and signs of the two groups were both more significantly improved compared to that before treatment （9.96 ± 2.02 vs 15.87 ± 1.84, P〈0.05 in group A; 10.02 ± 1.76 vs 13.59 ± 1.52, P〈0.05 in group B）. The differences in two groups before and after treatment were 5.91 ± 1.95 in group A, 3.53 ± 1.68 in group B, they were statistically significant （P〈0.05）. The total effective rate of group A [93.6% （29/31）] was better than that of group B [83.3% （25/30）], and the differences were statistically significant （P〈0.05）. Conclusion Good therapeutic effects can be achieved in treating young CRS patients with collateral bloodletting, cupping, and acupoint application.

Use of tricortical iliac crest strut autograft in comminuted posterior wall acetabular fractures： A case series

Purpose： The results for fixation of comminuted posterior wall acetabular fractures are not very promising with reported complications in terms of osteoarthritis, nonunion and malunion which subsequently require conversion to total hip arthroplasty. The conversion to total hip arthroplasty is possible in patients over 50 years of age but not in younger patients. So this requires new methods for salvage of the native hip in young patients. Methods： There were six patients in our series with highly comminuted posterior wall acetabular frac- tures where the fragments were excised and the gap filled with tricortical anterior iliac-crest strut autograff, fixed with screws and plate. Results： Good results were achieved in four out of six patients analyzed clinically using the Merle d＇Aubinge score modified by Matta and radiologically by Matta scoring. These patients have returned to original work and are walking independently. The good result in one patient deteriorated from good to poor between one and two years. One patient developed infection and excision arthroplasty was done, The graft incorporated well in five out of six patients. Conclusion： The use of iliac crest autograff is a better, advanced and promising technique as it provides a new wall to the weight bearing dome of the acetabulum for articulation with the femoral head. The rates of nonunion, malunion, post traumatic osteoarthritis are less as compared to the fixation of the comminuted fragments. The need for conversion to total hio arthroolastv is also less.