New complex physiological findings evolve hypothesized mechanisms of Dravet syndrome

Developmental and epileptic encephalopathies(DEEs)are neurological disorders generally involving medically intractable seizures and a diverse array of comorbid neuropsychiatric delays and deficits that may severely affect cognition,mood,sleep,social behavior,movement control,learning,and/or memory.Dravet syndrome(DS),also known as Severe Myoclonic Epilepsy of Infancy.

Cardiovascular risk burden and disability:findings from the International Mobility in Aging Study(IMIAS)

BACKGROUND The association of cardiovascular risk burden with disability is unclear.We examined the association between trajectories of the Framingham general cardiovascular disease risk score(FGCRS)with the trajectories of limitations of physical function in older adults.METHODS A total of 1219 participants with no disabilities from the International Mobility in Aging Study(IMIAS)study who had up to three repeated measures of FGCRS between 2012–2016 and without a history of stroke or coronary heart disease at baseline and follow-up were included.FGCRS at baseline was assessed and categorized into tertiles.Physical function was evaluated with the Short Physical Performance Battery(SPPB).The data were analyzed using linear mixed-effects models.RESULTS At baseline,FGCRS ranged between 3–94(mean score:24±15.8),participants were 32(2.6%),502(41.2%)and 685(56.2%)in lowest,middle,and highest tertiles,respectively.In the trajectories of limitations of physical function,the lowest FGCRS had no differences,while the middle and highest had a decrease in physical performance between 2012–2014(P=0.0001).Age,being female,living in Andes Mountains,having middle and highest FGCRS,higher alcohol consumption,being obese,lack of exercise and cognitive impairment increase the probability of disability(P<0.05).Alternatively,living in more developed regions and having a higher educational level reduced the probability of disability during the follow-up time(P<0.05).CONCLUSIONS Higher cardiovascular risk burden is associated with decreased physical performance,especially in gait.Results suggest SPPB may provide a measure of cardiovascular health in older adults.

Association between stress hyperglycemia ratio and in-hospital outcomes:findings from the improving Care for Cardiovascular Disease in China-Acute Coronary Syndrome(CCC-ACS)Project

BACKGROUND Stress hyperglycemia ratio(SHR)could provide accurate information on the acute status of hyperglycemia.The relationship between SHR and acute coronary syndrome(ACS)prognosis remains unclear.This study was conducted to identity the association between SHR and in-hospital outcomes in patients with ACS.METHODS A total of 12,010 patients were eventually enrolled in the study.The relationship between SHR and in-hospital major adverse cardiovascular events(MACEs)was then modeled by restricted cubic spline(RCS)curves,and all patients were divided into three groups according to the results.The multivariate logistic regression analysis was used to determine the associations between the SHR and in-hospital outcomes,described as odds ratios(ORs)and 95%confidence intervals(CIs).Subgroup analyses were also performed on different diseases.RESULTS The median age of this cohort was 63(54,71)years old,and 8942(74.5%)were male.Group 1 was defined as SHR<0.6(n=426),Group 2 was defined as SHR between 0.6 and 1(n=5821),and Group 3 was defined as SHR>1(n=5763).Compared with Group 2,Group 1(OR=1.891,95%CI:1.028-3.479,P<0.001)and Group 3(OR=1.868,95%CI:1.434-2.434,P<0.001)had higher risks of suffering from in-hospital MACEs.SHR was associated with higher risks of in-hospital MACEs in the subgroups of DM[OR=2.282,95%CI:1.477-3.524).CONCLUSIONS Both low and high SHR levels were independently associated with in-hospital MACEs.Young males with DM,hypertension,and decreased renal function had much higher risks of suffering from SHR-correlated MACEs.

Why caution should be applied when interpreting and promoting findings from Mendelian randomisation studies

Introduction In their article entitled‘Investigating genetic causal relationships between blood pressure and anxiety,depressive symptoms,neuroticism and subjective well-being’,Cai and colleagues1 presented the results of a two-sample Mendelian randomisation2(MR)study examining associations between blood pressure traits(systolic,diastolic,hypertension and pulse pressure)and psychological traits(anxiety,depression,neuroticism and subjective well-being).After correction for multiple testing.

A perspective on recent findings and future strategies for reactive aldehyde removal in spinal cord injury

Acrolein in spinal cord injury:The propensity of reactive aldehydes such as acrolein to both initiate and perpetuate tissue damage after spinal cord injury (SCI) is well established.Formed primarily from lipid peroxidation,acrolein is known to be one of the most reactive aldehydes.Acrolein will quickly overwhelm endogenous clearance mechanisms and antioxidants,and form adductswith lipids,proteins,and DNA.

Unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis

AIM: To investigate the prevalence and implications of unusual histopathological findings in appendectomy specimens from patients with suspected acute appendicitis. METHODS: The demographic and histopathological data of 1621 patients (≥ 16 years-old) who underwent appendectomy to treat an initial diagnosis of acute appendicitis between January 1999 and November 2011 were retrospectively assessed. Microscopic findings were used to classify the patients under six categories: appendix vermiformis, phlegmonous appendicitis, gan- grenous appendicitis, perforated appendicitis, supurative appendicitis, and unusual histopathologic findings. The demographic and clinicopathologic characteristics of patients with unusual histopathologic findings were evaluated in detail, and re-analysis of archived resected appendix specimens was carried out. RESULTS: A total of 912 males and 709 females, from16 to 94 years old, were included in the study and comprised 789 cases of suppurative appendicitis, 370 cases of appendix vermiformis, 243 cases of perforated gangrenous appendicitis, 53 cases of flegmaneous appendicitis, 32 cases of gangrenous appendicitis, and 134 (8.3%) cases of unusual histopathological findings. The unusual histopathological findings included fibrous obliteration (n = 62), enterobius vermicularis (n = 31), eosinophilic infiltration (n = 10), mucinous cystadenoma (n = 8), carcinoid tumor (n = 6), granulomatous inflammation (n = 5), adenocarcinoma (n = 4; one of them mucinous), and mucocele (n = 3), adenomatous polyp (n = 1), taenia sup (n = 1), ascaris lumbricoides (n = 1), appendiceal diverticula (n = 1), and B cell non-hodgkin lymphoma (n = 1). None of the 11 patients with subsequent diagnosis of tumor were suspected of cancer prior to the appendectomy. CONCLUSION: Even when the macroscopic appearance of appendectomy specimens is normal, histopathological assessment will allow early diagnosis of many unusual diseases.

Potential Toxicological and Cardiopulmonary Effects of PM2,5 Exposure and Related Mortality:Findings of Recent Studies Published during 2003-2013

Air pollution has environmental issue owing become a serious to its diverse harmful effects on the physical and biological environment. According to the Environmental Protection Agency （EPA） and the World Health Organization （WHO）, air pollution affects millions of people worldwide. Hundreds of thousands of deaths each year and a range of diseases, particularly among vulnerable groups （i.e., children, the elderly, and people with special medical conditions）, are attributed to air pollution. These effects are not always caused by single pollutant in the air; rather, they are considered consequences of the multi-pollutants to which people are simultaneously exposed.

Blastocystis in ulcerative colitis patients:Genetic diversity and analysis of laboratory findings

Objective:To determine Blastocystis frequency and subtypes(ST) in ulcerative colitis(UC) patients and analyse some laboratory findings between Blastocystis positive and negative cases.Methods:Faecal samples from 150 UC patients in Adnan Menderes University,Training and Research Hospital were examined by direct microscopy and cultivated in Jones medium.Blastocystis positive cultures were subjected to DNA isolation and subtypes were identified by sequencing of barcode region.A retrospective analysis was conducted on C reactive protein(CRP),leukocyte counts(WBC),neutrophil counts,and sedimentation rates.Results:The overall positive rate of Blastocystis was 8%(12 patients) and the most abundant subtype was ST3(eight isolates,66.7%),followed by ST1,ST2 and ST7.Laboratory findings between Blastocystis infected and non-infected UC patients were not significantly different.Blastocystisfrequency was 3.8% among the patients in active stage,while it was 11.8% among the patients in remission stage.Conclusions:The present study confirms previous findings that have indicated the predominance of Blastocystis ST3 in humans and contributes additional evidence that suggests the low colonization of Blastocystis infection in ulcerative colitis patients during active stage.

Clinical and genetic findings in a Chinese family with VDR-associated hereditary vitamin D-resistant rickets

Hereditary vitamin D-resistant rickets （HVDRR） is a rare autosomal recessive disorder characterized by severe rickets, hypocalcemia, hypophosphatemia, secondary hyperparathyroidism, and elevated alkaline phosphatase. This disorder is caused by homogeneous or heterogeneous mutations affecting the function of the vitamin D receptor （VDR）, which lead to complete or partial target organ resistance to the action of 1,25- dihydroxy vitamin D~ A non-consanguineous family of Chinese Han origin with one affected individual demonstrating HVDRR was recruited, with the proband evaluated clinically, biochemically and radiographically. To identify the presence of mutations in the VDR gene, all the exons and exon-intron junctions of the VDR gene from all family members were amplified using PCR and sequenced. The proband showed rickets, progressive alopecia, hypocalcemia, hypophosphatemia, secondary hyperparathyroidism, and elevated alkaline phosphatase. She also suffered from epilepsy, which is rarely seen in patients with HVDRR. Direct sequencing analysis revealed a homozygous missense mutation c.122G 〉 A （p.C41Y） in the VDR gene of the proband, which is located in the first zinc finger of the DNA-binding domain. Both parents had a normal phenotype and were found to be heterozygous for this mutation. We report a Chinese Han family with one individual affected with HVDRR. A homozygous missense mutation c.122G 〉 A （p.C41Y） in the VDR gene was found to be responsible for the patient＇s syndrome. In contrast to the results of treatment of HVDRR in other patients, our patient responded well to a supplement of oral calcium and a low dose of calcitriol.

Non-alcoholic steatohepatitis and influence of age and gender on histopathologic findings

AIM:To characterize the histopathologic specifications of non-alcoholic steatohepatitis(NASH)according to age and gender.METHODS:An analytical cross-sectional study was conducted in two private gastroenterology clinics on biopsy proven patients suffering from NASH.Biopsy histopathologic findings as well as demographic and laboratory data of the patients at the time of biopsy were gathered retrospectively from clinical records.The grading and staging of histopathologic findings were performed according to the Brunt method after reevaluation of the slides by a pathologist.Patients were divided into two groups according to age(belowand above 55 years).Mean quantitative grade of all pathologic findings were also calculated according to Brunt scoring values.RESULTS:A total number of 77 NASH patients,consisting of 58 males(75.3%)and 19(24.7%)females with a mean age of 41.99±11.80 years(range,18-70 years),were enrolled.The mean age(48.72±13.99 years vs 39.74±10.16 years,P=0.004)and aspartate aminotransferase level(75.11±29.68 U/L vs 52.78± 25.00 U/L,P=0.002)was significantly higher in female patients.Mean quantitative grade of hepatosteatosis was significantly higher in females(2.00±0.82 vs 1.59 ±0.68,P=0.031)compared to males.Fifty four percent(34/65)of young patients had mild hepatosteatosis (GradeⅠ)while only one patient(11.2%)in the older group had gradeⅠhepatosteatosis.Patients aged≥55 had significantly more severe hepatosteatosis(GradeⅢ) (44.4%vs 9.5%,P=0.007)and the mean quantitative grade of hepatosteatosis was significantly higher among them(2.33±0.71 vs 1.56±0.67,P=0.002).Multivariate analysis after omitting the confounding role of age revealed a higher grade of hepatosteatosis in female patients(P=0.010).CONCLUSION:These findings point toward the possible influence of age in the severity of steatohepatitis,portal and lobar inflammation in patients suffering from NASH while gender independently might contribute to the level of steatohepatitis.

Spectrum of magnetic resonance imaging findings in congenital lumbar spinal stenosis

AIM: To investigate whether congenital lumbar spinal stenosis(CLSS) is associated with a specific degenerative changes of the lumbar spine. METHODS: The lumbar spine magnetic resonance imaging studies of 52 subjects with CLSS and 48 control subjects were retrospectively evaluated. In each examination, the five lumbar levels were assessed for the presence or absence of circumferential or shallow annular bulges, annular tears, anterior or posterior disc herniations, epidural lipomatosis, Schmorl's nodes,spondylolisthesis, pars defects, and stress reactions of the posterior vertebral elements. RESULTS: Compared to control individuals, subjects with CLSS exhibited increased incidence of circumferential and shallow annular bulges, annular tears, discherniations and spondylolisthesis(P < 0.05). CONCLUSION: CLSS is associated with increased incidence of degenerative changes in specific osseous and soft-tissue elements of the lumbar spine.

Typical gastroduodenal endoscopic findings in a Crohn's disease patient in remission stage

A 39-year-old patient with Crohn's disease (CD) was referred to our hospital for maintenance treatment of CD.He was diagnosed as having CD of the small and large intestines at 32 years old.He underwent partial resection of the ileum at 35 years old because of ileal perforation.He had received enteral nutritional supplement (1200 kcal/d) and metronidazole preparation (500 mg/d),and was in remission Crohn's disease activity index 73.We performed a routine gastroduodenal endoscopic examination,which revealed the representative endoscopic findings of gastroduodenal lesions in CD,namely,bamboo-joint-like appearance of the gastric body and cardia and a notched sign in the duodenum.These findings were clearly observed by using indigo carmine dye spraying.In our patient,typical gastroduodenal findings were observed even in the remission stage,suggesting that these findings would contribute to the early diagnosis of CD not only in the active stage but also during remission.

Inaccuracy of Self-reported Low Sodium Diet among Chinese: Findings from Baseline Survey for Shandong & Ministry of Health Action on Salt and Hypertension(SMASH) Project

This study was aimed to evaluate the agreement between the self-reported sodium intake level and 24-h urine sodium excretion level in Chinese. The 24-h urine collection was conducted among 2112 adults aged 18-69 years randomly selected in Shandong Province, China. The subjects were asked whether their sodium intake was low, moderate, or high. The weighted kappa statistics was calculated to assess the agreement between 24-h urine sodium excretion level and self-reported sodium intake level. One third of the subjects reported low sodium intake level. About 70% of the subjects had mean 24-h sodium excretion 〉9 g/d, but reported low or moderate sodium intake.

Imaging findings of primary pulmonary synovial sarcoma with secondary distant metastases:A case report

BACKGROUND Synovial sarcoma(SS)accounting for 6%-10%of primary soft tissue malignancies mainly occurs in deep soft tissue adjacent to joints of the limbs.Primary pulmonary SS(PPSS)is rare and has a poor prognosis.Cases of secondary distant metastases of PPSS occur rarely and there is a lack of corresponding imaging reports.We summarized the imaging findings of PPSS with multiple metastases confirmed by surgery and pathology,and shared valuable information on PPSS.CASE SUMMARY A 43-year-old female patient had a solid space occupying lesion in the right upper lobe of the lung.The results of a hemogram,erythrocyte sedimentation rate(ESR)and tumor markers were all within the normal range,tuberculin skin test(5 TU PPD)was negative(-).Chest computed tomography examination showed similar round soft tissue density in the posterior segment of the right upper lobe.Thoracoscopic-assisted wedge resection of the right upper lobe of the lung,right upper lobe resection and lymph node dissection were performed.Nine months after surgery,ultrasound examination showed multiple metastases on the chest wall and kidney.CONCLUSION PPSS is a rare malignant lung tumor with strong invasiveness,early distant metastasis and poor prognosis.There are very few imaging reports.PPSS is often manifested as irregular tumor and calcification,and the metastases have extremely low echo on ultrasonography.Contrast-enhanced ultrasound indicates that the arterial phase of tumor metastases shows rapid centripetal high enhancement,manifested as“fast forward and fast regression”.

Primary Lymphoma of Bone: Imaging Findings to Improve Diagnosis of a Rarely Considered Disease Prior to Biopsy

Objective: Primary lymphoma of bone (PLB) is a rare malignant bone tumor often presenting in the fifth-sixth decades involving appendicular long bones. Published radiological findings indicate that PLB typically presents as a moth-eaten osteolytic lesion with periosteal reaction, while MRI commonly demonstrates marrow infiltration with extraosseous extension. Given rarity and variable appearances, PLB may not be primarily considered prior to biopsy. Our objective was to evaluate preoperative imaging findings in effort to increase awareness and improve a perceived deficiency in preoperative diagnosis. Materials and Methods: Following IRB approval, retrospective review identified 60 patients with newly diagnosed bone lesions proven to represent PLB in accordance with WHO definition. Preoperative radiographs (n = 46), MRI (n = 33) and PET (n = 37) were independently reviewed by two radiologists. At radiography, lesions were classified: purely lytic, mixed, purely sclerotic, or occult;lytic lesions were graded utilizing Lodwick’s classification. At MRI, lesions were defined as focal or infiltrative and the presence or absence of extraosseous disease was recorded. Extraosseous masses were defined as small (1 cm) and subjectively correlated with degree of cortical destruction. At PET, lesions were recorded as FDG-avid or not. Primary radiograph reports when available (n = 33) were reviewed and exact wording of differential considerations was recorded. Results: Radiographs demonstrated mixed (n = 22), lytic (n = 15), and sclerotic (n = 8) appearances;one radiographically occult lesion was seen by MRI. Lytic lesions were graded: IB (n = 3), IC (n = 5), II (n = 4), and III (n = 3);none were IA. At MRI, 30 lesions were infiltrative and 3 were focal;11 were not associated with extraosseous extension, while 22 showed bony disease with small (n = 7) or large (n = 15) soft tissue mass. Of large masses, 13 demonstrated minimal cortical destruction. At PET, 36 demonstrated FDG uptake;one study was technically limited. Review of reports found that only 5 included “lymphoma” as a diagnostic consideration. Conclusion: Contrary to most published data, we suggest that PLB typically demonstrates some degree of osteosclerosis, often a mixed pattern of sclerosis and lucency;purely lytic lesions may be less common. Similar to existing reports, MRI commonly demonstrates marrow infiltration with extraosseous extension of disease, typically a large soft tissue mass with disproportionate (minimal) cortical destruction. Familiarity with these findings should improve preoperative consideration of PLB in the appropriate clinical scenario when a new osteoblastic lesion is identified.

Ocular findings in children with thalassemia major in Eastern Mediterranean

AIM: To investigate ophthalmologic findings in children with thalassemia major(TM) and compare the findings with healthy controls. ·METHODS: In a cross-sectional study,43 children with thalassemia major from pediatric hematology outpatient clinics from two university hospitals and age/sex matched 47 healthy children were included in the study. After a complete ophthalmic examination,tear function tests including the Schirmer test,fluorescein tear breakup time(BUT),ultrasound pachymetry,and axial length measurement were performed. Obtained data was recorded for statistical analysis and the values of right eyes were compared between groups. ·RESULTS: The mean best corrected visual acuity was 1.34 ±0.75 in TM and 1.08 ±0.28 in controls. It was found lower than 0.1 logMAR unit in 10(23.2%) children with TM and 2(4.2%) in controls,and the difference was statistically significant(P 【0.05). The mean central corneal thickness was 540±26.95 in children with TM and 536.98± 20.45μm in controls(P 】0.05). The mean axial length was 22.53±0.50 in TM and 22.57±0.43mm in the control group. The mean Schirmer test score was 19.94±6.91 in TM and 24.22±3.95mm in the control group(P 【0.01). The mean BUT score was 9.62 ±1.28 in TM and 9.73 ±0.6s in the control group(P 】0.05). ·CONCLUSION: In TM,while corneal thickness,axial length,and BUT are close to controls,the Schirmer scores are less than normal. The study revealed that TM may be affected by the tear function and visual acuity.

Incidental findings at MRI-enterography in patients with suspected or known Crohn's disease

AIM:To determine the frequency and clinical impact of incidental findings detected with magnetic resonance imaging(MRI)-enterography in patients with suspected or known Crohn's disease(CD). METHODS:Incidental findings were defined as unexpected lesions outside the small intestine,not previously known or suspected at the time of referral, and not related to inflammatory bowel disease.Through a systematic review of medical charts we analyzed the clinical impact of incidental findings,and compared the MRI findings with subsequent diagnostic procedures. RESULTS:A total of 283 patients were included in the analysis,and MRI detected active CD in 31%,fistula in 1.4%and abscess in 0.7%.Extra-intestinal findings notrelated to CD were recorded in 72 patients(25%),of which 58 patients(20%)had 74 previously unknown lesions.Important or incompletely characterized findings were detected in 17 patients(6.0%).Incidental findings led to 12 further interventions in 9 patients(3.2%) revealing previously unknown pathological conditions in 5(1.8%).One patient(0.4%)underwent surgery and one patient was diagnosed with a malignant disease. MRI detected incidental colonic lesions in 16 patients of which additional work-up in 4 revealed normal anatomy. Two patients(0.7%)benefitted from the additional examinations,whereas incidental findings led to unnecessary examinations in 9(3.2%). CONCLUSION:In a minority of patients with suspected or known CD,important incidental findings are diagnosed at MRI-enterography.However,a substantial number of patients experience unnecessary morbidity because of additional examinations of benign or normal conditions.

Pedestrian Mortality between 2006 and 2010 in China: Findings from Non-police Reported Data

Pedestrian safety in China is an important but largely neglected issue, in part due to the substantial under-reporting within police data. In this study we aimed to examine changes in pedestrian fatality between 2006 and 2010 in China using non-police reported data. A multi-year study was conducted based on the mortality data during 2006-2010 from the Disease Surveillance Points （DSP） data in China. Between 2006 and 2010, the crude pedestrian mortality increased from 7.0 to 10.5 per 100 000 populations. Annual pedestrian mortality from DSP data was 13 times in 2006 and 55 times in 2010 mortality for pedestrians and passengers from police-reported data in the corresponding years. After controlling for sex, age,

Imaging Findings in Chest Computed Tomography: Initial Experience in a Developing Country

Background:?High resolution chest computed tomography (HRCT) is an established imaging modality that accurately assesses disease processes that are non-specific on conventional chest radiography. Chest Computed Tomography (CT) has proven invaluable in the evaluation of various diseases of the chest providing precise diagnosis that have great impact on the course of management. In this study, our aim is to evaluate the spectrum of radiological findings in all patients that had chest CTs at a tertiary health Institution in a developing Country. Method: This is a 6-year retrospective study of all patients that had Chest CT from 2009 till 2015. All patient data were retrieved and their Chest CT images reviewed and radiological findings and diagnosis documented. Results: Age range of patients was 1 - 84 years with a mean of 52.36 ± 22.9 years. Ten patients were children (12%). There were more males 53 (63.1%) than females 31 (36.9%) in the study. Referral for imaging was predominantly from internal medicine 33 (47.1%) and Surgery 27 (38.6%) departments. Most of the patients, 53 (63.1%) did not have previous chest radiographs. Consolidative changes were the most common parenchymal finding (77.4%). Few mediastinal masses were found in the study population. CT angiography constituted only 10.7% of all chest CTs done in adults. Conclusion: Few chest CT evaluations are performed compared to CTs of other parts of the body done in the same period. Chest CT is generally under-utilized even in a tertiary institution. There is a need to educate chest physicians on the role and advantages of CT use for the management of their patients.

Follow-up outcomes in patients with negative initial colon capsule endoscopy findings

BACKGROUND Colon capsule endoscopy(CCE),which became clinically applicable in 2006,is a simple and noninvasive procedure to evaluate colonic diseases;the accuracy of second-generation CCE,introduced in 2009,has dramatically improved.Currently,CCE is used as an alternative method for colorectal cancer screening,as well as for evaluating the mucosal lesions of inflammatory bowel disease,in cases where performing colonoscopy(CS)is difficult.However,the outcomes of CCE are uncertain.AIM To investigate the outcomes of Japanese patients with negative findings(no polyps or colorectal cancer)on initial CCE.METHODS This retrospective,single-center study was conducted at the Endoscopic Center at Aishinkai Nakae Hospital.This study included patients who underwent continuous CCE between November 2013 and August 2019,that exhibited no evidence of polyps or colorectal cancer at the initial CCE,and could be followed up using either the fecal immunochemical test(FIT),CS,or CCE.The observational period,follow-up method,presence or absence of polyps and colorectal cancer,pathological diagnosis,and number of colorectal cancer deaths were evaluated.RESULTS Thirty-one patients(mean age,60.4±15.6 years;range,28–84 years;14 men and 17 women)were enrolled in this study.The reasons for performing the first CCE were screening in 12,a positive FIT in six,lower abdominal pain in nine,diarrhea in two,and anemia in two patients.The mean total water volume at the time of examination was 3460±602 mL(2250–4800 mL),and a total CS was performed in 28 patients(90%).The degree of cleanliness was excellent in 15 patients and good in 16,and no poor cases were observed.No adverse events,such as retention or capsule aspiration,were observed in any of the patients.The mean follow-up period was 3.1±1.5 years(range,0.3–5.5 years).Follow-up included FIT in nine,CS in 20,and CCE in four patients(including duplicate patients).The FIT was positive in two patients,while CS revealed five polyp lesions(three in the ascending colon,one in the transverse colon,and one in the descending colon),with sizes ranging between 2 mm and 8 mm.Histopathological findings revealed a hyperplastic polyp in one patient,and adenoma with low grade dysplasia in four patients;colorectal cancers were not recognized.In the follow-up example by CCE,polyps and colorectal cancer could not be recognized.During the follow-up period,there were no deaths due to colorectal cancer in any of the patients.CONCLUSION We determined the outcomes in patients with negative initial CCE findings.