Objective To explore the diagnosis and surgical treatment of ileosigmoid fistulas (ISF) complicated by Crohn's disease (CD).Methods 13 CD patients with ISF were collected.Patients' clinical data,diagnostic methods,surgical procedures and outcomes were reviewed.Results Suspected or definite diagnosis was suggested by preoperative imaging in 12 patients.All 13 patients received surgery.Ileal lesions were all removed,while sigmiod fistula were repaired in 11 patients and partially resected in 2 patients.11 patients had a temporary ileostomy.All the patients recovered well,with 3 cases suffering from postoperative complications.Conclusions The diagnosis of ISF can be established preoperatively,and treatment should be individualized to patient' condition.

Objective To evaluate the feasibility and safety of laparoscopy in complex Crohn's disease.Methods A retrospective study of patients with complex Crohn's disease from Jan 2013 to Dec 2015 was conducted.The clinical data and the surgical outcome were evaluated.Results 137 patients with complex Crohn's disease were involved in the study.81 patients underwent laparoscopic procedure,the conversion rate was 30％.56 patients underwent conventinal laparotomy.The blood loss (50ml vs.100 ml,Z =-4.84,P ＜ 0.001),stoma rate (28％ vs.45％,x2 =6.03,P =0.05),interval to bowel movement (3 d vs.4 d,Z=-3.69,P =0.001) and postoperative hospital stay (8 d vs.14 d,Z=-5.41,P＜0.001) were more favourable in laparoscopic surgery group than in laparotomy group.Conclusion Laparoscopy is feasible and safe in complex Crohn's disease.In well indicated patients,preoperative optimization and surgical expertise can improve the outcome of Crohn's disease.

Objective To investigate the predictive factors for postoperative intra-abdominal septic complications (IASCs) after intestinal resection in patients with Crohn's Disease (CD).Methods Clinical data from patients who underwent intestinal resection for CD at Sir Run Run Shaw Hospital between June 2011 and July 2016 were retrospectively analysed.The patients were divided into IASCs group and non-IASCs groups by whether suffering from postoperative IASCs.Univariate analysis and multivariate logistic regression analysis were performed to identify the predictive factors for postoperative IASCs,and the receiver operating characteristic curve (ROC) was used to analyse the diagnostic value of the results.Results Among one hundred and seventy-three patients who underwent intestinal resection for CD,15(8.7％) patients experienced postoperative IASCs.The results of univariate and multivariate analysis showed that preoperative CRP ≥ 10 mg/L (OR =4.920,95％ CI:1.137-21.287,P =0.033) was an independent trisk factor for postoperative IASCs,and the laparoscopic surgery (OR =0.070,95％ CI:0.007-0.701,P =0.024) was the independent protective factor for postoperative IASCs.By analyzing ROC curve,preoperative CRP level had the diagnostic value of predicting the postoperative IASCs.The areas under the ROC curves of preoperative CRP for postoperative IASCs were 0.729 with an optimal diagnostic cut-off value of 10.75 mg/L,and with sensitivity of 80.0％ and a specificity of 67.1％.Conclusions Preoperative CRP level is an independent risk factor for postoperative IASCs,and laparoscopic surgery is an independent protective factor for IASCs.

Objective:To explore the value of constrast-enhanced ultrasound-micro flow imaging (CEUS-MFI) in the differential diagnosis of benign and malignant renal tumors.Methods:Totally 96 patients with renal space occupying found in two-dimensional gray-scale ultrasound examination in the First Affiliated Hospital, College of Medicine, Zhejiang University from November 2020 to August 2021 were collected, and 97 lesions were examined by CEUS-MFI and constrast-enhanced ultrasound(CEUS), respectively. The microvascular morphology and contrast-enhanced characteristics of renal tumors were recorded, ROC curves were constructed, and the diagnostic efficacies of the two methods were compared.Results:In the CEUS examination, the enhancement modes of malignant tumors were mainly fast wash-in(52/66, 78.8%) and fast wash-out (49/66, 74.2%) and high perfusion (56/66, 84.8%), and ring enhancement can be seen in 48.5%(32/66) of the lesions. The enhancement patterns of benign tumors were mainly slow wash-in (17/31, 54.8%) and slow wash-out (20/31, 64.5%) and low perfusion (18/31, 58.1%), and no circular blood flow was found in 31 lesions.In the CEUS-MFI examination, the vascular morphology of malignant tumors was mainly irregular (46/66, 69.7%), 93.9%(62/66) of malignant tumors had circular blood flow. Most of benign tumors were of linear vascular structure(12/31, 38.7%) and dendritic vascular structures (14/31, 45.2%), 93.5% (29/31) of benign tumors showed no circular blood flow. The detection rate of the annular blood flow in malignant tumors by CEUS-MFI was higher than that by CEUS, and the difference was statistically significant (93.9% vs 48.5%, P<0.001). The accuracy, sensitivity, and specificity of diagnosing renal tumors for using CEUS-MFI were 90.7%, 93.9% and 83.8%, respectively; and 84.5%, 92.4% and 67.7%, respectively, for using CEUS. The areas under the ROC curve were 0.898 and 0.814 for using CEUS-MFI and CEUS, respectively, the difference between the two techniques was not significant ( P=0.151). Conclusions:CEUS-MFI can sensitively and clearly display the microvascular morphology inside the tumor, and greatly improve the detection rate of annular blood flow in renal malignant tumors, which provides a new method for clinicians to identify benign and malignant renal tumors.

Objective: To evaluate the consistency between prostate biopsy and postoperative pathological grade, analyze the influencing factors that may lead to upgrade or downgrade, and to establish a prediction model. Methods: The clinical data of biopsy GS3+ 3=6(GR1, 330 cases) and GS3+ 4=7(GR2, 340 cases) patients from January 2013 to December 2018 in the first affiliated hospital, College of Medicine of Zhejiang university were retrospectively analyzed. The median age was 67 years old(ranging 35 to 100 years old). The median BMI was 23.74 kg/m²(ranging 16.22-38.74 kg/m²). The Median tPSA was 10.266 ng/ml(ranging 0.017-147.575 ng/ml). The median prostate volume was 29.43 ml(5.92-187.20 ml). The median PSAD was 0.34 (ranging 0.01-4.02). The median percentage of positive puncture cores was 0.25 (ranging 0.08-1.00). There were 161 patients in clinical stage ≤T_1c, 344 patients in T_2a-T_2c and 165 patients in clinical stage ≥T₃. 670 cases all accepted the radical prostatectomy. Consistency of prostate biopsy and radical prostatectomy Gleason grade was recorded. If the postoperative Gleason grade was higher than that in biopsy, it was defined as upgrade. Otherwise, it was defined as downgrade. Multivariate logistic regression model was used to evaluate the influencing factors leading to upgrades in GR1 patients or downgrades in GR2 patients. Nomograms were drawn based on the models with AUC and Horsmer-Lemeshaw test conducted to test the discrimination and calibration of the models. Results: Among the 670 patients included, 165 cases (50.0% of GR1) upgrades and 27 cases (7.9% of GR2) downgrades. PSAD≥0.25(OR=3.015) and clinical stage≥T_2b(OR=7.185)were independent influencing factors for the upgrade in GR1 patients, while PSAD<0.15(OR=4.208) and clinical stage≤T_1c(OR=4.530) were independent influencing factors for downgrade. The nomograms were drawn with the above variables. The AUC of the model (0.781 for GR1 group, 0.741 for GR2 group) and the hosmer-remeshaw test results (P=0.993 for GR1 group, P=0.234 for GR2 group) show that the nomograms have good discrimination and calibration. Conclusions PSAD and clinical stage are independent influencing factors for the upgrade or downgrade. Nomograms may provide help for clinicians to judge the accuracy of prostate biopsy. However, the nomograms still needs to be verified in clinical practice

Objective: To investigate the current situation of emotional and behavioral problems and analyze the influencing factors of middle school students. Methods: The general information questionnaire, the strengths and difficulties questionnaire (student version), and the illinois bullying scale were used to evaluate 680 students in two middle schools in Hunan province.Statistical analysis was performed using t test, analysis of variance, Pearson correlation analysis and stepwise multiple regression analysis. Results: (1) The detection rate of total difficulty (12.09±5.67), conduct problem (2.42±1.66), hyperactivity/attention defect (3.65±2.08), emotional (2.82±2.32), peer relationship problem (3.21±1.79) and pre-socialization behavior (7.02±2.39) were 11.2%, 11.2%, 7.7%, 6.9%, 11.0% and 14.5%.(2)The scores of total difficulties, conduct problem, hyperactivity/attention deficit and peer relationship problems of boys were higher than that of girls(t=2.79, 4.03, 2.44, 3.40, all P<0.05), while the score of pre-socialization behavior of boys was lower than that of girls (t=-5.29, P<0.05). (3) The scores of total difficulties, conduct and peer relations, pre-socialization of rural students were significantly different with those of urban students(t=-3.93, -2.55, -7.00, 5.26, all P<0.05). (4) The score of total difficulties, conduct problem, hyperactivity/attention deficit and emotional symptoms of left-behind students were higher than that of un-left-behind students (t=-3.18, -2.50, -2.67, -2.40, 2.19, all P<0.05). (5) Middle school students with different fathers' education levels showed different scores of total difficulties, peer relationship problem and pre-socialized behavior(F=3.84, 7.10, 6.20, all P<0.05), while middle school students with different mothers' education levels showed different scores of total difficulties and peer relationship problem(F=3.97, 7.38, both P<0.05). (6) The scores of total difficulties, emotional symptoms, conduct problems, and hyperactivity/attention deficit of the middle school students were significantly positively correlated with the total score of the bullying total scale, the bullish subscale, the bullying subscale, and the fighting subscale(r=0.165-0.430, P<0.05). (7) Gender, urban and rural areas, left-behind or not, maternal education level, bullying, being bullied, fighting were the influencing factors of middle school students' emotion and behavior problems(β=0.010-0.533, P<0.05). Conclusion Some middle school students in Hunan province have emotional and behavioral problems and more attention should bo paid to mental health education.