目的:探讨青年人大肠癌临床表现、病理特点。方法:回顾性分析四川省成都市第五人民医院普外科1997年7月至2007年12月收治的23例35岁以下青年大肠癌患者临床资料。结果:23例青年大肠癌患者平均年龄24.5岁,男女比例为2.8∶1;病变部位以直肠多见,组织学分型以低分化腺癌与印戒细胞癌最多;Dukes分期:A期1例,B期3例,C期13例,D期6例。结论:青年大肠癌表现为病理分化程度低、Dukes分期晚,更具进展性。提高认识及早期行肠镜检查有助于早期诊断。
Objective To compare the effectiveness of arthroscopic osteochondral autologous transplantation (OAT) in the treatment of young and middle-aged patients with the articular cartilage injury. MethodsA clinical data of 43 patients (43 knees) with articular cartilage injury, who underwent OAT between January 2008 and August 2016, was retrospectively analyzed. There were 23 patients aged 20-40 years (young group) and 20 patients aged 40-60 years (middle-aged group). The difference in age between the two groups was significant (t=14.120, P=0.001). There was no significant difference in gender, body mass index, complications, affected side, lesion site, lesion area, and the International Cartilage Repair Society (ICRS) grade of cartilage injury between the two groups (P>0.05). The function of knee joint was evaluated by Lysholm score and International Knee Documentation Committee (IKDC) score during the follow-up. MRI examination was performed to observe the repair of both receiving and the donor sites. ResultsAll the incisions in the two groups were healed by first intention. All patients in the two groups were followed up with an average of 3.6 years (range, 2-8 years). At 2 years after operation, the Lysholm and IKDC scores were significantly improved in the two groups when compared with the preoperative scores (P<0.05). The Lysholm and IKDC scores in the young group were significantly better than those in the middle-aged group before operation and at 2 years after operation (P<0.05). However, there was no significant difference in the differences of the Lysholm and IKDC scores between pre- and post-operation between the two groups (P>0.05). The MRI examination at 2 years after operation showed that both receiving and the donor sites healed well in the two groups. ConclusionAccording to the texture, thickness, elasticity, and lesion area of the cartilage, arthroscopic OAT might be the first choice for the articular cartilage injury in middle-aged patients and can obtain the satisfactory short-term effectiveness.
ObjectiveTo investigate the clinical characteristics and prognosis of cerebral hemorrhage in young and elderly patients, to provide evidences for individual clinical diagnosis and treatment, and lay a foundation for building a predictive model of prognosis in cerebral hemorrhage.MethodsPatients with spontaneous cerebral hemorrhage in the Third People’s Hospital of Chengdu were recruited prospectively and continuously from January 2014 to January 2019. They were divided into the youth group (≤50 years old) and the elderly group (>50 years old), and their risk factors, disease characteristics, etiology, and prognosis were analyzed.ResultsA total of 757 patients were recruited. There were 160 cases (21.1%) in the youth group, including 120 males and 40 females, aged from 17 to 50 years, with an average age of (42.06±7.62) years old; 597 cases (78.9%) in the elderly group, including 361 males and 236 females, aged from 51 to 96 years, with an average age of (69.34±10.56) years old. The incidences of hypertension (74.2% vs. 51.2%), diabetes (15.1% vs. 4.4%), coronary heart disease (12.1% vs. 1.3%), and the level of blood glucose at admission [7.1 (5.8, 8.4) vs. 6.3 (5.3, 8.1) mmol/L] in the elderly group were higher than those in the youth group (P<0.05), respectively. However, the proportions of males (60.5% vs. 75.0%), smoking (24.5% vs. 36.9%), and the diastolic blood pressure at admission [(92.37±18.50) vs. (100.95±25.25) mm Hg (1 mm Hg=0.133 kPa)] in the elderly group were lower than those in the youth group (P<0.05), respectively. There was no significant difference between the two groups in systolic blood pressure at admission, Glasgow Coma Score, National Institutes of Health Stroke Scale score, initial hematoma volume, hematoma enlargement, brain hernia, location of hemorrhage, midline shift, hydrocephalus, combined subarachnoid hemorrhage, or intraventricular extension (P>0.05). Hypertension was the most common etiology in the two groups. There was a significant difference in the etiology of cerebral hemorrhage between the two groups (P<0.05), the difference was mainly reflected in cerebral amyloid angiopathy, cavernous hemangioma, and arteriovenous malformation. The fatality rate during hospitalization (9.4% vs. 20.9%), 3 months after discharge (10.3% vs. 26.3%), and at 1 year follow-up (19.0% vs. 37.6%) in the youth group was lower than that in the elderly group (P<0.05), respectively. The disability rate 3 months after discharge and at 1 year follow-up in the youth group was lower than that in the elderly group (32.1% vs. 44.2%, 16.9% vs. 34.4%; P<0.05), respectively.ConclusionsThe education of healthy lifestyles should be strengthened to reduce the adverse effects of smoking in young patients. Young patients should choose antihypertensives that can control diastolic blood pressure better. There are more structural abnormalities in young patients, so routine vascular examination is reasonable. It is necessary to focus on whether the original underlying diseases are stable in elderly patients. Cerebral amyloid angiopathy is an important cause of cerebral hemorrhage in elderly patients, and is a risk factor of recurrence. Anticoagulation or antiplatelet therapy should be cautious.
The management of middle-aged and youth hypertension has become a challenge in clinical practice. The hypertension group of the Chinese Society of Cardiology published the expert consensus on the management of hypertension in young and middle-aged Chinese population in 2019. This paper interprets the key contents of the consensus and provides references for management of young and middle-aged hypertension.
Objective To explore the characteristics of diagnosis and treatment for the rectal cancer in the young patients （≤40 years）．Methods The domestic and abroad literatures about the research on the progress of rectal cancer in the young patients were reviewed, the clinical data of patients with rectal cancer were compared between the young patients and the other age patients, the characteristics of diagnosis and treatment for the rectal cancer in the young patients were summarized．Results The onsets of the young patients with rectal cancer were related to the diet，lifestyle, and genetic factors．Compared with the older patients, more later stage, higher percentage of poor differentiation, earlier lymph node metastasis were found in the young patients with rectal cancer．Rectal cancer of the young patients was often misdiagnosed and with a poor prognosis．Currently，surgery assisted with neoadjuvant therapy was generally acknowledged as a better method．Conclusions It has specificity in epidemiology, pathology, treatment, prognosis, and so on for rectal cancer in the young patients, but surgery needs further research．
Objective To investigate the methodology and efficacy evaluation of ceramic on ceramic hip prosthesis in total hip arthroplasty for young patients. Methods The cl inical data from 65 patients (75 hips) who received ceramic on ceramic hip prosthesis for total hip arthroplasty between February 2004 and September 2006, including unilateral replacementin 55 cases and bilateral replacement in 10 cases. Of 65 patients, there were 41 males and 24 females with an average age of 43.2 years (range, 18-56 years), including 6 cases of femoral head comminuted fractures, 44 cases of aseptic necrosis femoral head, 7 cases of developmental dysplasia of hip with osteoarthritis, 3 cases of congenital dislocation of hip, 2 cases of traumatic arthritis secondary to postoperative acetabulum fracture, 1 case of rheumatoid arthritis, and 2 cases of ankylosing spondyl itis. The Harris score was 54.3 ± 6.7. The disease duration was 1 year and 4 months to 10 years and 7 months with an average of 3 years and 2 months. Results Heal ing of incision by first intention was achieved in all patients; no dislocation, infection, and deep venous thrombosis of lower l imbs occurred. All patients were followed up 3 years and 2 months to 5 years and 7 months with an average of 4 years and 9 months. The Harris score was significantly improved to 89.0 ± 9.4 at last follow-up, showing significant difference when compared with preoperative one (P lt; 0.01). The mean eversion angle and anteversion angle of the acetabular component were (43.6 ± 8.4)° and (21.5 ± 3.5)°, respectively. In follow-up period, no prosthetic loosening, subsidence, dislocation, and ceramic component fracture occurred. Osteolysis was not found in all the cases. Conclusion Ceramic on ceramic hip prosthesis in total hip arthroplasty for young patients can effectively decrease the compl ications of prosthetic loosening and subsidence caused by wearing of joint interface; the surgical skill is important in decreasing dislocation and fraction of ceramic on ceramic hip prosthesis.
ObjectiveTo observe the abnormal clinical manifestations of retinal blood vessels and the characteristic image characteristics of optical coherence tomography (OCT) in young myopia. MethodsA case observation study. From July to December 2020, 523 young patients with different myopia refractive powers who were treated in Department of Ophthalmology of The Second Hospital of Hebei Medical University were included in the study. Among them, 277 were males and 246 were females; the median age was 19.0 (5.0) years. All the affected eyes underwent best corrected visual acuity (BCVA), frequency domain OCT (SD-OCT) examination and axial length (AL) measurement. The BCVA examination was performed using the Snellen eye chart. The median myopia refractive power of the affected eye was 5.00 (3.25) D. Among them, low myopia, moderate myopia, and high myopia were 227, 405, and 414 eyes, respectively. The average AL of the affected eye was 25.6±2.8 mm. The frequency domain OCT instrument was used to scan the temporal side of the retina, the upper and lower nasal vascular arches and the macular fovea radially. The images of retinal vascular cysts, microfolds, and lamellar hole were acquired and stored. The prevalence, composition ratio, distribution rule and OCT imaging characteristics of retinal paravascular abnormalities were observed and analyzed. The distribution of paravascular abnormalities in the retina was compared by the χ2 test; the age, refractive power, and AL of different paravascular abnormalities were compared by the K-W rank sum test. ResultsOf the 1046 different diopters of myopic eyes, there were 227 eyes in mild myopia, 405 eyes in moderate myopia and 414 eyes in high myopia. Retinal paravascular abnormalities were detected by SD-OCT in 40 eyes (3.8%,40/1046). The prevalence of retinal paravascular abnormalities in moderate myopia was 0.7% (3/405) and high myopia was 8.9% (37/414). No retinal paravascular abnormalities were observed in mild myopia.Retinal paravascular cysts in 40 eyes (3.8%, 40/1046), retinal paravascular microfolds in 28 eyes (2.7%, 28/1046) and retinal paravascular lamellar holes in 13 eyes (1.2%, 13/1046). Of 40 eyes with retinal paravascular abnormalities, retinal paravascular cysts in all 40 eyes (100.0%, 40/40), retinal paravascular microfolds in 28 eyes (70.0%, 28/40) and retinal paravascular lamellar holes in 13 eyes (32.5%, 13/40). Twelve eyes with simple cyst cavity (30.0%, 12/40); 15 eyes were with cyst cavity with micro-wrinkles (37.5%, 15/40); 13 eyes were with cyst cavity, micro-wrinkles and lamellar holes (32.5%, 13/40). The temporal vascular arch retinal paravascular cysts (χ2=25.664), microfolds (χ2=14.973), and lamellar holes (χ2=13.499) were significantly more than those on the nasal side, and the difference was statistically significant (P＜0.001). ConclusionsThe total prevalence of retinal paravascular abnormalities in young myopia is 3.8%; it can occur in both moderate and high myopia. The paravascular cyst may be the earliest pathology of paravascular abnormalities in the retina. The three paravascular abnormalities are mostly distributed along the temporal arch of the retina.
ObjectiveTo explore the clinical features and prognosis of ischemic cerebral infarction in young population,and to provide a reference for clinical prevention of cerebral infarction in young population. MethodsA total of 547 patients with ischemic cerebral infarction diagnosed between January 2008 and June 2013 were included,and the difference in clinical data and outcomes between young and old patients were retrospectively compared. ResultsThe 547 patients included 233 young and 314 old patients,and there were more male patients in young group.As compared to the old group,the proportion of hypertension was significantly lower in young group (51.9%,64.3%;P=0.004);while smoking (51.9%,5.7%;P=0.000) and alcoholism (53.2%,28.3%;P=0.000) were significantly higher in young group.Moreover,there were more patients with vascular malformations in young group than that in old group (7.3%,3.2%;P=0.028).And there were also more patients in young group received thrombolytic therapy and antiplatelet therapy (98.3%,86.9;P=0.000),and the prognosis of young patients was significantly better than that of old patients. ConclusionThe prognosis of young patients with ischemic stroke prognosis is relatively good,and changing bad habits would be an effective measure to prevent and reduce the occurrence of ischemic cerebral infarction in young population.