新生儿高胆红素血症病因及高危因素分析

目的:探讨新生儿高胆红素血症的常见原因及高危因素。方法:对2113例新生儿高胆红素血症患儿的临床资料进行回顾性分析。结果:60.8%的新生儿高胆红素血症病因明确,常见病因依次为:感染435例(占20.59%)、ABO溶血症223例(占10.55%)、Rh溶血症6例(占2.8%)、母乳性黄疸230例(占10.88%)、头颅血肿123例(占5.8%)、多种病因272例(占12.87%)、G-6-PD缺乏症2例(占0.09%)等。结论:感染是新生儿高胆红素血症的首要原因,其中以呼吸道感染、肝炎综合征、败血症最常见,目前感染还是新生儿期疾病的主要原因之一,不容忽视。ABO溶血症是第2位常见病因。Rh溶血症、G-6-PD缺乏症在西安市很少见,G-6-PD缺乏症新生儿期发病的均为男性。

Investigation on Risk Factors of Cerebrocardiac Vascular Thrombotic Diseases in Patients with Obstructive Sleep Apnea Hypopnea Syndrome

Objective: To observe the risk factors of thrombosis in patients with obstructive sleep apnea hypopnea syndrome (OSAHS).Methods: From February 2001 to April 2003, 24 patients with moderate and severe OSAHS (OSAHS group) and 19 healthy adults (control group) were recruited. Their blood samples were drawn at 6∶00 and 16∶00 respectively for testing hemocrit, platelet aggregation (PAG), whole blood viscosity (WBV), prothrombin time (PT), activated partial thromboplastin time (APTT), plasma fibrinogen (Fng) and endothelin (ET).Results: There was a significantly higher hemocrit, WBV, Fng and ET as well as a significant shortening of PT and APTT at 6∶00 than that at 16∶00 in OSAHS group. However, there was no significant difference in all testing items between 6∶00 and 16∶00 in control group. The hemocrit, WBV, PAG, plasma Fng and ET were significantly higher, and PT and APTT were obviously shorter at 6∶00 in OSAHS group than those at 6∶00 in control group. A higher hemocrit, PAG, plasma Fng and ET, a longer PT and APTT were observed at 16∶00 in OSAHS group, compared with those at 16∶00 in control group.Conclusion: In OSAHS patients there were striking risk factors of thrombosis, which is more remarkable in the early morning than in the afternoon.

Clinical and epidemiological features of patients with clonorchiasis

AIM:To study the clinical and epidemiological features of patients with clonorchiasis so as to provide scientific evidences for the diagnosis and prevention of clonorchiasis. METHODS:Stools from 282 subjects suspected of having clonorchiasis were examined for helminth eggs with modified Kato's thick smear and sedimentation methods,and their sera were tested for HAV-DNA,HBV-DNA,HCV-RNA,HDV- RNA and HEV-RNA with polymerase chain reaction (PCR). Clinical symptoms of patients with clonorchiasis only were analyzed,and their blood samples were tested for circulating antigen (CAg) with Dot-ELISA,esoinophilic granulocyte count, and alanine aminotransferase (ALT).Meanwhile,they were asked to provide data of occupation,eating habit,hygienic habit and knowledge of donorchiasis.In addition,the ecosystem of the environment in epidemic areas was surveyed. RESULTS:Among the 282 patients,61 (21.43%) were infected with clonorchis sinensis only,97 (34.64%) were co-infected with clonorchis sinensis and other pathogens, 92 (32.86%) were infected with hepatitis virus only and 31 (11.07%) neither with clonorchis sinensis nor hepatitis virus. Among the 61 patients with clonorchiasis only,there were 14 (22.95%) subjects with discomfort over hepatic region or epigasfrium,12 (19.67%) with general malaise or discomfort and inertia in total body,6 (9.84%) with anorexia,indigestion and nausea,4 (6.56%) with fever,dizziness and headache (6.56%),and 25 (40.98%) without any symptoms;sixty one (100%) with CAg (+),98.33% (59160) with eosinophilic granulocytes increased and 65.00% (39/60) with ALT increased.B-mode ultrasonography revealed 61 cases with dilated and thickened walls of intrahepatic bile duct,and blurred patchy echo acoustic image in liver.Twenty-six cases had stones in the bile duct,39 cases had slightly enlarged liver with diffuse coarse spots in liver parenchyma.Twenty cases had enlarged gallbladder with thickened coarse wall and image of floating plagues,9 cases had slightly enlarged spleen.By analysis of epidemiological data,we found that the ecologic environment was favorable for the epidemiology of clonorchiasis.Most patients with clonorchiasis were lack of knowledge about the disease.Their living environment, hygienic habits,eating habits and their occupations were the related factors that caused the prevalence of the disease. CONCLUSION:The clinical symptoms of clonorchiasis are non-specific,and the main evidences for diagnosis of clonorchiasis should be provided by etiologic examination, B-mode ultrasonography and clinical history.The infection of clonorchis sinensis is related to occupations,bad eating habits and lack of knowledge about prevention of the disease.

Candida esophagitis:Risk factors in non-HIV population in Pakistan

AIM:Candida esophagitis is a frequent infection in immunocompromised patients. This study was designed to determine its characteristics in non- human immune deficiency virus (HIV) infected patients attending a teaching hospital.METHODS: Clinical records of all patients coded by international classification of diseases 9th revision with clinical modifications'(ICD-9-CM), with candida esophagitis diagnosed by esophagogastroduodenoscopy (EGD) and histopathology over a period of 5 years were studied.RESULTS: Fifty-one patients (27 males, 24 females, range 21-77 years old and mean age 52.9 years) fulfilled the criteria (0.34% of the EGD). The common predisposing factors were carcinoma (OR 3.87, CI 1.00-14.99) and diabetes mellitus (OR 4.39, CI 1.34-14.42). The frequent clinical symptoms were retrosternal discomfort, dysphagia and epigastric abdominal pain with endoscopic appearance of scattered mucosal plaques. Another endoscopic lesion was associated with candida esophagitis in 15% patients.CONCLUSION: Carcinomas, diabetes mellitus, corticosteroid and antibiotic therapy are major risk factors for candida esophagitis in Pakistan. It is an easily managed complication that responds to treatment with nystatin.

The Relationship between AIDS High Risk Behaviors and Childhood Status, Perception of Gender Orientation and Rare Experiences/Psychology among Chinese Gays

Objectives: To probe some more important factors affecting the HIV epidemic by surveying the relationshipbetween AIDS high risk behaviors and childhood status,attitude/perception to gender of male/sex orientation andrare experiences/Psy-chology among Chinese gays. Methods: Data were collected from 240 Chinese gays whowere attracted by their same gender. Results: The extent of sex among China's Mainland gays issimilar to that of industrialized countries, and behaviorsthat exacerbate the HIV epidemic are universal.Perceptions 'being a girl is better',' Dislike toys likeswords or pistols in early childhood were predictors topassive anal intercourse in adulthood. Those gay men whobegan sexual intercourse younger than 16 years old tendedto have more sex partners and suffered more pain. Thosedisliked gender of male or self-regarded as female tended tohave more passive anal intercourse and related to childhoodcross-gender experience/psychology while those were raised as girls by their parentsdid not take on e above characters. Individuals who experienced sex coercion and drug abuse were the twosubgroups with the greatest high-risk behaviors. Individualswho had sex with females had the greatest number of malesex partners and were more prone to group sex. Individualswith pedophilia or gerontophilia had more casual sexpartners. Psychological problems encountered by Chinese Conclusions: The prospect of an extensive AIDSepidemic among Chinese gays does exist and somesubgroups of gays play more important roles in theepidemic. Some high risk behaviors among adult gays canbe foreseen explicitly by the predictors taking on inchildhood, and closely relate to attitude/perception, togender of male, to some rare experience/psychology.

Gender and metabolic differences of gallstone diseases

AIM： To investigate the risk factors for gallstone disease in the general population of Chengdu, China. METHODS： This study was conducted at the West China Hospital. Subjects who received a physical examination at this hospital between January and December 2007 were included. Body mass index, blood pressure, fasting plasma glucose, serum lipid and lipoproteins concentrations were analyzed. Gallstone disease was diagnosed by ultrasound or on the basis of a history of cholecystectomy because of gallstone disease. Unconditional logistic regression analysis was used to investigate the risk factors for gallstone disease, and the Chi-square test was used to analyze differences in the incidence of metabolic disorders between subjects with and without gallstone disease. RESULTS： A total of 3573 people were included, 10.7% （384/3573） of whom had gallstone diseases. Multiple logistic regression analysis indicated that the incidence of gallstone disease in subjects aged 40-64 or ≥65 years was significantly different from that in those aged 18-39 years （P 〈 0.05）; the incidence was higher in women than in men （P 〈 0.05）. In men,a high level of fasting plasma glucose was obvious in gallstone disease （P 〈 0.05）, and in women, hypertriglyceridemia or obesity were significant in gallstone disease （P 〈 0.05）. CONCLUSION： We assume that age and sex are profoundly associated with the incidence of gallstone disease; the metabolic risk factors for gallstone disease were different between men and women.

SEXUALLY TRANSMITTED DISEASES:INCIDENCE AND DISTRIBUTION

The incidence of sexually transmitted diseases(STDs) increased from 26. 04 per 100 000 in 1987 to 104. 81 per 100 000 in 1993 in selected areas of the country. Gonorrhea is by far the most common STD but its constituent ratio declined because of a rapid increase of nongonococcal uretheritis and genital warts during most recent years. The incidence of syphilis is relatively low and cases of congenital infection are noted. The wide spread of resistant Neisseria gonorrhoeae infection gives a challenge to the therapeutical and control strategies of STDs. Sexually transmitted Chlamydia trachomatis infections, an important cause of urethritis. cervicitis and pelvic inflammatory disease. is becoming common in our country. Attention has been drawn on viral hepatitis in their means of transmission by sexually behaviors, and also, on the homosexuals, assumed to be the high risk group to catch STDs. Coordinated national efforts to control STDs in China have been taken.

Partner's Sexual Behaviora are an Important Risk Factor for Chlamydia Trachomatis Infection among STD Patients

Risk factors for genitourinary Chlamydia trachomatis (Ct) infection were investigated using an STD elative risk factor questionnaire among 176 patients and theirregular sexual partners. Twenty-four independent variableswere selected for analysis, nine of which were confirmed asfactors associated with C. trachomatis. Four of the nine factorswere significantly correlated to infection using a multifactorialunconditional logistic regression model which included: levelof education (odds ratios [ORs]: 2.144 for below junior middleschool), number of sexual partners (ORs: 4.503 for≥5),number of regular partner's sexual partner (ORs: 16.333 for≥5), STD history of regular partner (ORs: 18.417 for theirSTD history). These data demonstrate that regular partner'ssexual behaviors are also an important risk factor for Ctinfection among STD clinic clients.

Physical contributors to glenohumeral internal rotation deficit in high school baseball players

Background： Glenohumeral internal rotation deficit （GIRD） is a risk factor for shoulder and elbow injury in baseball players. Although this evidence forms a basis for recommending stretching, clinical measures of internal rotation range of motion （ROM） do not differentiate if GIRD is due to muscular, capsuloligamentous, or osseous factors. Understanding the contributions of these structures to GIRD is important for the development of targeted interventions. We hypothesize that the osseous component will have the greatest relative contribution to GIRD, followed by muscle stiffness and posterior capsule thickness. Methods： Internal rotation ROM, muscle stiffness （teres minor, infraspinatus, and posterior deltoid）, posterior capsule thickness, and humeral retrotorsion were evaluated on 156 baseball players. A side-to-side difference was calculated for each variable. Variables were entered into a multivariable linear regression to determine the significant predictors of GIRD. Results： The regression model was statistically significant （R2 = 0.134, F（1, 156） = 24.0, p 〈 0.01） with only humeral retrotorsion difference remaining as a significant predictor （β = -0.243, t156 = -4.9, p 〈 0.01）. A greater humeral retrotorsion side-to-side difference was associated with more GIRD. Conclusion： Humeral retrotorsion accounted for 13.3% of the variance in GIRD. The stiffness of the superficial shoulder muscles and capsular thickness, as measured in this study, were not predictors of GIRD. Factors not assessed in this study, such as deeper muscle stiffness, capsule/ ligament laxity, and neuromuscular regulation of muscle stiffness may also contribute to GIRD. Since it is the largest contributor to GIRD, causes of changes in humeral retrotorsion need to be identified. The osseous component only accounted for 13.3% of the variance in GIRD, indicating a large contribution from soft tissues factors that were not addressed in this study. These factors need to be identified to develop evidence-based evaluations and intervention programs to decrease the risk of injury in baseball players.

Lower body weight and female gender:Hyperphosphatemia risk factors after sodium phosphate preparations

Casals et al have reported an inverse correlation between serum phosphate and body weight after administration of sodium phosphate at a dose of 60 g. Our group has already described the relationship between body weight and hyperphosphatemia with these preparations, although our study was not quoted by Casals. We performed a pharmacokinetic study involving 13 volunteers who were divided into two groups on the basis of body weight： group I consisting of seven women with a median weight of 60 kg and group Ⅱ consisting of five men and one woman with a median weight of 119.2 kg. Group Ⅰdeveloped higher peak phosphate levels and maintained these levels above the subjects in Group Ⅱ for a prolonged time period despite adequate hydration being ensured with frequent monitoring of weight, fluid intake and total body weight. Our studydemonstrated that adequate hydration does not protect against the secondary effects of hyperphosphatemia. In the study by Casais et al, 66% of the study subjects were women, the correlation between serum phosphate and gender in their data also appears to be important. Women are at higher risk of acute phosphate nephropathy due to a diminished volume of distribution of the high dose of ingested phosphate. Decreased volume of distribution in women is due to diminished body weight. This is further compounded by decreased creatinine clearance in females.

Risk factors for prehypertension in Xinjiang Uygur population

Objective To assess the risk factors for prehypertension in Xinjiang Uygur population. Methods A cross-section study was conducted in a Xinjiang Uygur population（438 males and 716 females,aged 30 to 70 years）.The fasting lipid profiles,serum glucose,insulin,and uric acid were determined.Homeostasis model assessment of insulin resistance（HOMA-IR）index was used to assess insulin resistance（IR）.Binary logistic regression analysis was performed to determine risk factors for prehypertension.Blood pressure levels ofnormotensives and prehypertensives in different body mass index（BMI）categories were compared. Results Binary logistic regression analysis performed after adjustment for gender,lipids profiles,waist-to-hip ratio,uric acid,HOMA-IR,and lifestyle（alcohol drinking and smoking）showed a significantly increasing prevalence of prehypertension with BMI.The odds ratios for prehypertension against the lowest BMI group（separated by 24 and 28）were 1.934 and 2.490（95% confidence interval：1.435-2.606 and 1.825-3.399,respectively）.Age was independently correlated to the increasing prevalence of prehypertension.HOMA-IR was not associated with prehypertensive.The mean diastolic blood pressure（DBP）was significantly increased with BMI categories in either normotensives or prehypertensives（P〈0.001）while the mean systolic blood pressure（SBP）was significantly increased with BMI only in normotensives（P〈0.001）. Conclusions In Xinjiang Uygurs,BMI and age was the risk factors for prehypertension.DBP is significantly increased with BMI.IR is not associated with prehypertension.These findings emphasize the importance of management of obesity for the control of blood pressure and other cardiovascular complications.

Prognostic factors analysis of 138 patients with stage IV gastric cancer

Ab Objective： We evaluated the prognostic factors of patients with stage IV gastric cancer. Methods： In the current retrospective study, 138 patients of stage I gastric cancer treated with platinum-based chemotherapy were analyzed. Survival rate was estimated by using Kaplan-Meier method. The prognostic factors were analyzed using univariate （Log rank） and multivariate （Cox model） analysis methods. Results： Univariate analysis showed and multivariate analysis showed that poor performance status （P = 0.001）, weight loss （P = 0.001）, depth of invasion （P = 0.000）, presence of peritoneal metastasis （P = 0.005）, more than 1 metastatic site （P = 0.029） and elevated total bilirubin （P = 0.018） were confirmed as independent prognostic factors. According to the outcomes of the Cox model analysis, a formula of the prognostic index was developed. According to the values of PI, 16 patients were categorized as the good risk group, 28 patients were categorized as the moderate risk group and 8 patients were categorized as the poor risk group, respectively. The survival ratios of 6 months, 12 months and 24 months of the good risk group were 75.00%, 50.00%, 25.00%, respectively. The survival ratios of 6 month, 1-year and 2-year of the moderate risk group were 71.79%, 28.57%, 7.14%, respectively. While the survival ratios of 6 month, 12 months and 24 months of the poor risk group were 50%, 0, 0, respectively. The overall survival ratios of the 3 groups were compared in pairs. Conclusion： Poor performance status, depth of invasion, elevated total bilirubin, more than 1 metastatic site, presence of peritoneal metastasis ,weight loss were the independent prognostic factors. A formula of the prognostic index was developed, and it could help clinicians and patients in clinical decision-making and treatment tailoring based on the estimated prognosis.

The Risk Evaluation of Enterprise Technological Innovation Network Based on Extenics

Growing competition has prompted enterprises to choose construct Technological Innovation Network to promote innovation, however the innovation network is a risky innovation system, how to carry out a comprehensive risk assessment of the innovation network is particularly important. This paper focused on the technological innovation network risk analysis, used extenics to define which risk levels should these various risk factors in technological innovation network belongs to. And used Shanghai Caohejing hi tech park to do the empirical research, comfirmed risk factors which have the larger influence on technological innovation network.Enterprises can face them as the main objects of enterprise risk managemenL in order to improve the success rate of the innovation of the enterprise technological innovation network.

STUDY ON SMALL HEPATOCELLULAR CARCINOMAAND ITS EXTENSION

This paper summarizes the 'study On small hepatocellular carcinoma and its extensionII in Liver CancerInstitute, Zhongshan Hospital Of Shanghai MedicaI University during the past 25 years. The results 1ndl-cated that it was an impOrtant approach to obtain long-term HCC survivOrs, of the 239 patients with 5-yearsurvival, small HCC resection accounted for 51. 4 %. It was an effective apprOach to lmprove the prognosisof HCC in the entire series, the 5-year survlval of lnpatients treated ln authorsI institution was 4. 8% in1958~1970, l2. 2 % in 197l ~ 1983, and 46. 7 % in l984~ 1995; which were correlated to the increaseProportion of small HCC resection in the series; it was more effective as compared to large HCC resection,the 5 year survival was 6l. 3 % (n= 645 ) versus 33. 6 % (n= 950). ExtensiOns of small HCC study includ-ed early detection and treatment of small recurrent HCC, Of the l47 patients wlth re-resection, the 5-yearsurvival was 48. 9% caIculated frOm the time Of first resectiOn. Another extenslon was conversiOn Of largeHCC intO small HCC, using multimodality combination treatment, 72 out of the 663 patients wlth surgical-ly verified unresectable HCCs have been converted to resectable, 5-year survival being 62' l %, wh1ch wascomparable tO that of small HCC resection. Studies on related basic aspect of small HCC such as cell originof recurrence, and mOlecular aspect of small HCC, indicated that biOlOgical characterlstics, particularly thetumor invasiveness, remalned the key link for further prolong survival after small HCC resection. Recent-ly, a'patient-like' human HCC metastatic medel in nude mice has been established. Experimental inter-ventions have also been tried. Clinical trials fOr preventiOn of recurrence after small HCC resection haveshown preliminary encouraging results. However, the IIcOst-effectivenessn Of screening, the invasiveness ofHCC, the multicentric origin, the coexisted Child C cirrhosis, etc., remained great chal1enge.

β-fibrinogen gene -455A/G polymorphism and plasma fibrinogen level in Chinese stroke patients

Abstract Objectives To investigate the relationship between the β-fibrinogen gene -455A/G polymorphism and plasma fibrinogen level and to determine the influence of the mutation on ischemic stroke. Methods Ninety-one patients (63.5±10.1 years) with ischemic stroke and 74 elderly control subjects (60.6±10.8 years) without any thromboembolic events and 98 healthy blood donators as young control (37.5±13.3 years) were enrolled in this trial. The β-fibrinogen gene -455A/G polymorphism was analyzed for all subjects by PCR-RFLP with the restrictive enzyme Hae Ⅲ, while plasma fibrinogen levels were obtained from the prothrombin time (PT) assay. For statistical analysis, the parameters were compared between any two different groups by the unpaired Student’s t test and the Chi-square test. Before analysis, log transformations for concentrations of fibrinogen were carried out.Results H2 allele frequency was higher in male ischemic stroke patients than in the elderly control (22.7% vs 7.1%, χ 2=5.56, P【0.02). There was no significant difference between the female groups. In those patients without any thromboembolic events (both elderly and young control groups), the frequency of H2 decreased with age (≤40, 21.3%; 41-59, 15.4%; and ≥60, 10.2%). In the male elderly and young control groups, the level of plasma fibrinogen was lower in the H1H1 genotype (287±96*!mg/dl and 234±58*!mg/dl) than in H1H2 and H2H2 (331±44*!mg/dl and 307±55*!mg/dl; t=2.53 and 9.67, P【0.05). In the female elderly groups, this tendency was not found.Conclusion Plasma fibrinogen expression is affected by the β-fibrinogen gene -455A/G polymorphism, and the H2 allele may be a risk factor for ischemic stroke in Chinese males.

A multicenter study assessing the prevalence of germline genetic alterations in Chinese gastric-cancer patients

Background Approximately 10%of patients with gastric cancer(GC)have a genetic predisposition toward the disease.However,there is scant knowledge regarding germline mutations in predisposing genes in the Chinese GC population.This study aimed to determine the spectrum and distribution of predisposing gene mutations among Chinese GC patients known to have hereditary high-risk factors for cancer.Methods A total of 40 GC patients from 40 families were recruited from seven medical institutions in China.Next-generation sequencing was performed on 171 genes associated with cancer predisposition.For probands carrying pathogenic/likely pathogenic germline variants,Sanger sequencing was applied to validate the variants in the probands as well as their relatives.Results According to sequencing results,25.0%(10/40)of the patients carried a combined total of 10 pathogenic or likely pathogenic germline variants involving nine different genes:CDH1(n=1),MLH1(n=1),MSH2(n=1),CHEK2(n=1),BLM(n=1),EXT2(n=1),PALB2(n=1),ERCC2(n=1),and SPINK1(n=2).In addition,129 variants of uncertain significance were identified in 27 patients.Conclusions This study indicates that approximately one in every four Chinese GC patients with hereditary high risk factors may harbor pathogenic/likely pathogenic germline alterations in cancer-susceptibility genes.The results further indicate a unique genetic background for GC among Chinese patients.

Predictive factors of cardiac rupture in patients with ST-elevation myocardial infarction

Cardiac rupture （CR） is a potentially fatal mechanical complication of ST-elevation myocardial infarction （STEMI）. We aimed to determine the incidence and risk factors of CR in Chinese STEMI patients. A total of 9798 consecutive STEMI patients from four centers in China were retrospectively analyzed, among which 178 patients had CR. STEMI patients without CR were chosen as a control group. Clinical characteristics were compared between STEMI patients with CR and those without CR. The incidence of CR in STEMI patients was 1.82%, and the 30-d mortality was up to 61.2%. CR patients were significantly older, more female, and associated with a longer time from onset of pain to hospital admission than their non-CR counterparts （P〈0.001）. More patients with anterior myocardial infarction （82.1%） were found in the CR group, and CR patients had significantly higher heart rates than the control group （（91±19） bpm vs. （71±16） bpm; P〈0.001）. In multiple-adjusted models, the independent risk factors of CR were advanced age, female gender, anaemia, increased heart rate, anterior myocardial infarction, increased white blood cell （WBC） count, delayed admission, and renal dysfunction. The level of hemoglobin remained a significant deter- minant factor of CR （OR （95% CI）： 0.82 （0.75-0.89）; P〈0.001） after adjusting for various potential confounding factors. Counts of WBC also remained a significant determinant of the CR （OR （95% CI）： 1.08 （1.04-1.12）; P〈0.001）. A number of variables were independently related to CR. This study indicated, for the first time, that both hemoglobin and WBC levels were independently correlated with occurrence of CR.

Screening for colorectal cancer in Tianhe,Guangzhou:results of combining fecal immunochemical tests and risk factors for selecting patients requiring colonoscopy

Objective:To explore the performance of a protocol combining fecal immunochemical test(FIT)and a high-risk factor questionnaire(HRFQ)for selecting patients requiring colonoscopy as part of a population-based colorectal cancer(CRC)screening program in China.Methods:From 2015 to 2016,we conducted a CRC screening program for all residents aged 45 years or older in Tianhe District,Guangzhou City,China.Participants underwent an FIT and received an HRFQ as part of primary screening.Those with positive FIT and/or HRFQ results were considered to be at high risk and were recommended to undergo colonoscopy.Results:A total of 10074 subjects were recruited and enrolled in the screening program.In the enrolled population,17.5%had positive FIT results and 19.4%had positive HRFQ results.Of those recommended to undergo diagnostic colonoscopy,773 did so.The screening method’s overall positive predictive value(PPV)was 4.9%for non-adenomatous polyps,11.4%for low-risk adenomas(LRAs),15.9%for high-risk adenomas(HRAs)and 1.6%for CRC.The PPVs of positive FIT results for nonadenomatous polyps,LRAs,HRAs and CRC were 5.2%,15.9%,22.5%and 2.5%,respectively.The PPVs of positive HRFQ results for non-adenomatous polyps,LRA,HRA and CRC were 4.1%,10.2%,14.3%and 1.4%,respectively.The PPVs associated with combined positive FIT and HRFQ results for non-adenomatous polyps,LRAs,HRAs and CRC were 4.5%,16.4%,23.7%and 2.8%,respectively.Conclusion:Our results suggest that this two-step CRC screening strategy,involving a combination of FIT and HRFQ followed by colonoscopy,is useful to identify early-stage CRC.The high detection rates and PPVs for CRC and adenomas encourage this strategy’s use in ongoing screening programs.