Objective This study aimed to identify the clinical risk factors for colorectal sessile serrated lesions and to develop a diagnostic model to facilitate clinical diagnosis. Methods Patients who underwent electronic colonoscopy during hospitalization between June 2021 and June 2024 were enrolled. General clinical data were collected for univariate and multivariate logistic regression analyses. A nomogram-based risk prediction model was developed using R language software. Results Compared with patients without abnormalities on colonoscopy, those with colorectal sessile serrated lesions showed statistically significant differences in male sex, history of smoking, history of hypertension, and higher body mass index (p < 0.05). Multivariate logistic regression analysis demonstrated that a history of smoking and hypertension were independent risk factors for colorectal sessile serrated lesions, with odds ratios of 3.761 (95% confidence interval: 1.795–7.880; p = 0.000) and 1.919 (95% confidence interval: 1.026–3.589; p = 0.041), respectively. Conclusions A history of smoking and hypertension were identified as independent risk factors for colorectal sessile serrated lesions. Increased attention should be given to screening for colorectal sessile serrated lesions in patients with these risk factors.
Type I to III cervical transformation zones (TZ-1 to TZ-3) may have various effects on cervical cancer screening and diagnostic outcomes. This study aims to evaluate the clinical utility of the cytological PAX1/JAM3 methylation (CISCER) assay in cervical cancer screening, especially in TZ-3 women. Between November 2020 and October 2022, 1782 women referred for colposcopy underwent liquid-based cytology (LBC), high-risk human papillomavirus (hrHPV) genotyping, and CISCER testing. After applying inclusion criteria, 1398 women were analyzed, including 1190 with documented TZ classification. Diagnostic performance for detecting cervical intraepithelial neoplasia grade 3 or worse (CIN3+) was compared across TZ subgroups. For CIN3+ detection, CISCER showed sensitivities of 67.4%, 72.0%, 48.3%, and 81.5% and specificities of 91.0%, 94.2%, 91.3%, and 89.8% in all women, TZ-1, TZ-2, and TZ-3, respectively. Compared with LBC ≥ ASC-US, hrHPV positivity, or HPV16/18 positivity, CISCER achieved the highest diagnostic accuracy, with AUC values of 0.792, 0.831, 0.698, and 0.856 across the respective groups. In both the overall cohort and TZ-3 subgroup, CISCER positivity was associated with the highest CIN3+ risk (34.6% and 31.4%) and required the fewest colposcopy referrals per CIN3+ detected (2.9 and 3.2). Combining hrHPV testing with CISCER further improved risk stratification. CISCER demonstrated superior diagnostic performance across TZ types, particularly in TZ-3, enabling improved CIN3+ risk discrimination while substantially reducing unnecessary colposcopy referrals compared with conventional cytology and HPV genotyping.
Purpose Positive circumferential resection margin (CRM) is an important oncological quality indicator in rectal cancer surgery. This study aimed to explore factors associated with CRM positivity after transanal total mesorectal excision (taTME) using data from a multicenter registry. Methods Patients with rectal cancer who underwent primary taTME between 2017 and 2024 were identified from the Chinese TaTME Registry Collaborative. The primary outcome was pathological CRM positivity. Nine supervised machine learning algorithms were evaluated, including logistic regression, elastic net, decision tree, random forest, XGBoost, radial support vector machine, multilayer perceptron, LightGBM, and k-nearest neighbors. Model performance was assessed using the area under the receiver operating characteristic curve (AUC), and model interpretation was performed using SHapley Additive exPlanations. Results A total of 1,625 patients from 32 institutions were included, and the CRM positivity rate was 2.77%. In the validation cohort, the radial support vector machine model showed the highest apparent AUC of 0.84. SHAP analysis identified pathological N stage, threatened mesorectal fascia on preoperative MRI, and intersphincteric resection as the most influential variables. Conclusion This exploratory analysis identified clinically plausible factors associated with CRM positivity after taTME. Because the models included intraoperative and postoperative variables, they should not be interpreted as preoperative decision-support tools. Further studies using preoperative-only variables and external validation are required.
BACKGROUND:Cognitive impairment is a significant health concern among older adults, highlighting the need for non-pharmacological interventions, such as mind-body exercises. However, a comprehensive synthesis of the effects of various traditional Chinese exercises (TCEs) on cognitive function in older adults is lacking. METHODS:A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted. Six databases were searched from inception to 2 May 2024 for studies examining the effects of TCEs on cognitive outcomes in adults aged 60 years and older. Studies were included if they were RCTs involving TCEs and reported outcome measures for global cognition, or individual cognitive domains. RESULTS:Twenty-eight RCTs with a total of 2297 participants were included. Meta-analysis revealed that TCEs led to significant improvements in global cognition: Montreal Cognitive Assessment [mean differences (MD) = 1.67; 95% confidence interval (CI): (1.20, 2.14)], Mini-Mental State Examination [MD = 0.76; 95% CI: (0.04, 1.48)]; executive function: Trail Making Test (B-A) [MD = -7.96; 95% CI: (-15.34, -0.59)], Category Fluency for Animals [MD = 2.96, 95% CI (2.08, 3.85)]; working memory: Digit Span-Backwards [MD = 0.48; 95% CI: (0.07, 0.90)]; processing speed: Digit Symbol Coding [MD = 4.16; 95% CI: (1.82, 6.50)]; memory function: Memory Quotient [MD = 13.13; 95% CI: (4.06, 22.20)], Auditory Verbal Learning Test: immediate recall [MD = 1.13; 95% CI: (0.07, 2.20)], short-term delayed recognition [MD = 0.80; 95% CI: (0.28, 1.32)] and long-term delayed recognition [MD = 1.38; 95% CI: (0.68, 2.09)]. CONCLUSIONS:TCEs are effective in improving cognitive function in older adults, particularly in domains such as global cognition, executive function, working memory, processing speed and memory function. However, given the methodological limitations and heterogeneity of the included studies, these findings require confirmation in further large-scale, high-quality RCTs.
