The albumin-bilirubin(ALBI)score,which was proposed to assess the prognosis of patients with hepatocellular carcinoma,has gradually been extended to other liver diseases in recent years,including primary biliary chola...The albumin-bilirubin(ALBI)score,which was proposed to assess the prognosis of patients with hepatocellular carcinoma,has gradually been extended to other liver diseases in recent years,including primary biliary cholangitis,liver cirrhosis,hepatitis,liver transplantation,and liver injury.The ALBI score is often compared with classical scores such as the Child-Pugh and model for end-stage liver disease scores or other noninvasive prediction models.It is widely employed because of its immunity to subjective evaluation indicators and ease of obtaining detection indicators.An increasing number of studies have confirmed that it is highly accurate for assessing the prognosis of patients with chronic liver disease;additionally,it has demonstrated good predictive performance for outcomes beyond survival in patients with liver diseases,such as decompensation events.This article presents a review of the application of ALBI scores in various non-malignant liver diseases.展开更多
Stroke is the third-leading cause of disabilityadjusted life years(DALYs)and poses a significant public health challenge worldwide~([1]).Developing countries,including China,continue to face a substantial burden from ...Stroke is the third-leading cause of disabilityadjusted life years(DALYs)and poses a significant public health challenge worldwide~([1]).Developing countries,including China,continue to face a substantial burden from stroke.Since 1990,China has reported the highest global stroke burden,with 2.19 million deaths and 45.9 million DALYs recorded in 2019~([2]).展开更多
BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surg...BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surgical resection(SR)for gastric GISTs.METHODS We collected clinical data from patients diagnosed with GISTs who underwent either EFTR or SR at our hospital from October 2011 to July 2024.Patients were matched in a 1:1 ratio based on baseline characteristics and tumor clinical-pathological features using propensity score matching.We analyzed perioperative outcomes and follow-up data.The primary outcome measure was progressionfree survival(PFS).RESULTS Out of 912 patients,573 met the inclusion criteria.After matching,each group included 95 patients.The EFTR group demonstrated statistically significant advantages over the SR group in average operative time(P<0.001),length of hospital stay(P<0.001),time to resume liquid diet(P<0.001),incidence of adverse events(P=0.031),and hospitalization costs(P<0.001).The en bloc resection rate was significantly different,with SR group at 100%and EFTR group at 93.7%(P=0.038).The median follow-up was 2451.50 days.Recurrence occurred in 3 patients in the EFTR group and 4 patients in the SR group,with no statistically significant difference(P=1.000).Factors associated with PFS included age,tumor size,high-risk category in the modified National Institutes of Health(NIH)risk score,and resection status.Resection status was identified as an independent prognostic factor for PFS(P=0.0173,hazard ratios=0.0179,95%CI:0.000655-0.491).Notably,there was no statistically significant difference in PFS between the two groups.CONCLUSION This study is a non-inferiority design.The EFTR group significantly outperformed the SR group in terms of operative time,length of hospital stay,time to resume a liquid diet,incidence of adverse events,and hospitalization costs,demonstrating its higher economic efficiency and better tolerability.Additionally,although the en bloc resection rate was lower in the EFTR group compared to the SR group,there were no significant differences in tumor recurrence rates and progression-free survival between the two groups.This study found no statistical difference in the primary endpoint of postoperative recurrence rates between the two groups.However,due to sample size limitations,this result requires further validation in larger-scale studies.The current results should be viewed as exploratory evidence.展开更多
Pancreatic cancer is recognized as one of the leading causes of cancer mortality,representing the second most common source of cancer-related deaths within the gastrointestinal domain.Surgical resection is currently t...Pancreatic cancer is recognized as one of the leading causes of cancer mortality,representing the second most common source of cancer-related deaths within the gastrointestinal domain.Surgical resection is currently the only definitive treatment;however,the subtle emergence of symptoms often leads to a diagnosis at an advanced stage,with merely 10%-15%of patients being eligible for surgical intervention.The primary obstacle to achieving a potential radical resection is the presence of distant metastatic disease or invasion of adjacent major vascular structures.This review aims to highlight the critical role of endoscopic ultrasound in the diagnosis and staging of pancreatic tumors.We systematically searched PubMed,MEDLINE and Web of Science by using‘pancreatic cancer’and‘endoscopic ultrasonography’as keywords.Relevant studies were reviewed and analyzed.Endoscopic ultrasonography(EUS)is efficient in the diagnosis and staging of pancreatic cancer,past studies reported the accuracy of EUS is 63%to 94%for T-staging and 44%to 82%for N-staging but there are still limitations that need to be comprehensively applied with other diagnostic methods to evaluation of distant metastasis for surgical resectability.Our review aims to reveal the value for the staging of pancreatic cancer.展开更多
Objectives The in-hosptial palliative care consultation(PCC) is emerging as a routine service in some medical center in China. The current study evaluated how physicians in primary care team and consultation team perc...Objectives The in-hosptial palliative care consultation(PCC) is emerging as a routine service in some medical center in China. The current study evaluated how physicians in primary care team and consultation team perceive the PCC service for the purpose of investigating the effectiveness of this consultation model in a general hospital.Methods In-hosptial palliative care consultations have been carried out at Peking Union Medical College Hosptial by a dedicated consultation team, and 37 consultations were completed in 2016. A questionnaire was designed for physicians in terms of its benefits to patients,their family as well as the primary care team. Physicians who applied for consultation in 2016 formally(requested from the department other than the Geriatrics) and informally(by rotating residents and unemployed visiting doctors in geriatric department) were invited to participate in the survey by scanning a two dimentional code on social networking platform.Results There were 103 physicians participated in the survey, including primary care physicians from the department of Internal Medicine(n=8), Gynaecology(n=16) and Surgery(n=13), rotating residents(n=30), visiting doctors(n=16) in Geriatric department, and PCC team members(n=20). 94.0% of the non-PCC physicians agreed that PCC relieved the suffering of patients; 89.2% thought PCC improved the quality of patients' life; there were 91.6%, 95.2%, 90.4% physicians who felt it relieved the anxiety of patients, of family members and of care providers, respectively. There were 96.4% physicians who felt it could ease the tension in physician-patient relationship; 97.6% felt it lower the risk for medical negligence, and 96.4% of doctors who applied for PPC felt satisfied with PCC service in terms of process and achieving objectives of consultation. More primary-team physician agree "PCC service helps the physicians better understand palliative care" than PCC members(97.6% vs. 80%, P<0.05), while both were interested in learning more on palliative medicine(100% vs. 96.4%, P>0.05).Conclusion Palliative care consultation service in a general hospital is efficacious and acclaimed.The primary care physicians and the PCC members hold positive attitudes to the benefits that the PCC services bring to patients, family members, and physicians themselves. PCC for terminal patients in a general hospital may serve as a good modle for promotion of palliative care in China.展开更多
Postoperative radiotherapy (PRT) is widely advocated for patients with squamous cell carcinomas of the head and neck that are considered to be at high risk of recurrence after surgical resection. The aims of this stud...Postoperative radiotherapy (PRT) is widely advocated for patients with squamous cell carcinomas of the head and neck that are considered to be at high risk of recurrence after surgical resection. The aims of this study were to evaluate the treatment outcomes of PRT for patients with laryngeal carcinoma and to identify the value of several prognostic factors. We reviewed the records of 256 patients treated for laryngeal squamous cell carcinoma between January 1993 and December 2005. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Log-rank test was employed to identify significant prognostic factors for DFS and OS. The Cox proportional hazards model was applied to identify covariates significantly associated with the aforementioned endpoints. Our results showed the 3-, 5-, and 10-year DFS for all patients were 69.9%, 59.5%, and 34.9%, respectively. The 3-, 5-, and 10-year OS rates were 80.8%, 68.6%, and 38.8%, respectively. Significant prognostic factors for both DFS and OS on univariate analysis were grade, primary site, T stage, N stage, overall stage, lymph node metastasis, overall treatment times of radiation, the interval between surgery and radiotherapy, and radiotherapy equipment. Favorable prognostic factors for both DFS and OS on multivariate analysis were lower overall stage, no cervical lymph node metastasis, and using 60Co as radiotherapy equipment. In conclusion, our data suggest that lower overall stage, no cervical lymph node metastasis, and using 60Co as radiotherapy equipment are favorable prognostic factors for DFS and OS and that reducing the overall treatment times of radiation to 6 weeks or less and the interval between surgery and radiotherapy to less than 3 weeks are simple measures to remarkably improve treatment outcome.展开更多
A pancreatic pseudocyst(PPC)is a collection of pancreatic fluid enclosed by a non-epithelialized,fibrous or granulomatous wall.Endoscopic pancreatic pseudocyst drainage(PPD)has been widely used clinically to treat PPC...A pancreatic pseudocyst(PPC)is a collection of pancreatic fluid enclosed by a non-epithelialized,fibrous or granulomatous wall.Endoscopic pancreatic pseudocyst drainage(PPD)has been widely used clinically to treat PPCs.The success and complications of endoscopic PPD are comparable with surgical interventions.Stent displacement is a rare complication after endoscopic PPD.Almost all the complications of endoscopic PPD have been managed surgically,and there is rare report involving the endoscopic treatment of intraperitoneal stent displacement.We report here a case of stent displacementafter endoscopic ultrasound-and fluoroscopy-guided PPD in a 41-year-old female patient with a PPC in the tail of the pancreas.The endoscopic treatment was successfully performed to remove the displaced stent.The clinical course of the patient was unremarkable.The cyst had significantly reduced and disappeared by 12 wk.We found that both endoscopic ultrasound and fluoroscopy should be used during endoscopic PPD to avoid stent displacement.The displaced stent can be successfully treated by endoscopic removal.展开更多
BACKGROUND Endoscopic ultrasound(EUS)-guided drainage is the optimal method for treatment of pancreatic fluid collections(PFCs),and is associated with ease,safety,and efficiency.Bleeding is one of the main procedure-r...BACKGROUND Endoscopic ultrasound(EUS)-guided drainage is the optimal method for treatment of pancreatic fluid collections(PFCs),and is associated with ease,safety,and efficiency.Bleeding is one of the main procedure-related complications,and often requires surgery or radiologic interventions.Indeed,endoscopic management of this complication is limited.CASE SUMMARY A 42-year-old man presented for evaluation of abdominal pain and distention for approximately 2 wk.Abdominal computed tomography revealed a pancreatic pseudocyst located in the tail of the pancreas.EUS-guided pancreatic pseudocyst was performed.After stent placement,massive bleeding was noted from the fistula.Finally,hemostasis was successfully achieved using hemostatic forceps within the fistula.CONCLUSION Bleeding vessel grasp and coagulation may represent a successful treatment for a fistula hemorrhage during EUS-guided drainage for a PFC,which may be tried before application of balloon or stent compression.展开更多
In this editorial,we comment on an article titled“Morphological and biochemical characteristics associated with autophagy in gastrointestinal diseases”,which was published in a recent issue of the World Journal of G...In this editorial,we comment on an article titled“Morphological and biochemical characteristics associated with autophagy in gastrointestinal diseases”,which was published in a recent issue of the World Journal of Gastroenterology.We focused on the statement that“autophagy is closely related to the digestion,secretion,and regeneration of gastrointestinal cells”.With advancing research,autophagy,and particularly the pivotal role of the macroautophagy in maintaining cellular equilibrium and stress response in the gastrointestinal system,has garnered extensive study.However,the significance of mitophagy,a unique selective autophagy pathway with ubiquitin-dependent and independent variants,should not be overlooked.In recent decades,mitophagy has been shown to be closely related to the occurrence and development of gastrointestinal diseases,especially inflammatory bowel disease,gastric cancer,and colorectal cancer.The interplay between mitophagy and mitochondrial quality control is crucial for elucidating disease mechanisms,as well as for the development of novel treatment strategies.Exploring the pathogenesis behind gastrointestinal diseases and providing individualized and efficient treatment for patients are subjects we have been exploring.This article reviews the potential mechanism of mitophagy in gastrointestinal diseases with the hope of providing new ideas for diagnosis and treatment.展开更多
Evapotranspiration(ET)is a crucial variable in the terrestrial water,carbon,and energy cycles.At present,a large number of multi source ET products exist.Due to sparse observations,however,great challenges exist in th...Evapotranspiration(ET)is a crucial variable in the terrestrial water,carbon,and energy cycles.At present,a large number of multi source ET products exist.Due to sparse observations,however,great challenges exist in the evaluation and integration of ET products in remote and complex areas such as the Tibetan Plateau(TP).In this paper,the applicability of the multiple collocation(MC)method over the TP is evaluated for the first time,and the uncertainty of multisource ET products(based on reanalysis,remote sensing,and land surface models)is further analyzed,which provides a theoretical basis for ET data fusion.The results show that(1)ET uncertainties quantified via the MC method are lower in RS-based ET products(5.95 vs.7.06 mm month^(-1))than in LSM ET products(10.22 vs.17.97 mm month^(-1))and reanalysis ET estimates(7.27 vs.12.26 mm month-1).(2)A multisource evapotranspiration(MET)dataset is generated at a monthly temporal scale with a spatial resolution of 0.25°across the TP during 2005-15.MET has better performance than any individual product.(3)Based on the fusion product,the total ET amount over the TP and its patterns of spatiotemporal variability are clearly identified.The annual total ET over the entire TP is approximately 380.60 mm.Additionally,an increasing trend of 1.59±0.85 mm yr^(-1)over the TP is shown during 2005-15.This study provides a basis for future studies on water and energy cycles and water resource management over the TP and surrounding regions.展开更多
Endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)is a means to procure adequate specimens for histological and cytologic analysis.The ideal EUS-FNA should be safe,accurate,and have a high sample adequacy ra...Endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)is a means to procure adequate specimens for histological and cytologic analysis.The ideal EUS-FNA should be safe,accurate,and have a high sample adequacy rate and low adverse events rate.In recent years,many guidelines and trials on EUS-FNA have been published.The purpose of this article is to provide an update on the influence of some of the main factors on the diagnostic efficiency of EUS-FNA as well as a rare but serious complication known as needle tract seeding.展开更多
Digestive-system cancers represent major threats to human health;however,the mechanisms underlying tumorigenesis and radiochemotherapy resistance have remained elusive.Therefore,an urgent need exists for identifying k...Digestive-system cancers represent major threats to human health;however,the mechanisms underlying tumorigenesis and radiochemotherapy resistance have remained elusive.Therefore,an urgent need exists for identifying key drivers of digestive system tumorigenesis and novel targeted therapeutics.The checkpoint kinase 2(Chk2)regulates cell-cycle progression,and Chk2 dysregulation or Chk2 mutations can lead to the development of various cancers,which makes Chk2 an important research topic.This review summarizes the roles of Chk2 in DNA-damage responses,cell-cycle regulation,autophagy,and homeostasis maintenance.We describe relationships between tumorigenesis and cell-cycle dysregulation induced by Chk2 mutations.In addition,we summarize evidence indicating that Chk2 can serve as a novel therapeutic target,based on its contributions to radiochemotherapy-resistance reversion and progress made in developing antitumor agents against Chk2.The prevailing evidence supports the conclusion that further research on Chk2 will provide a deeper understanding of digestive-system tumorigenesis and should suggest novel therapeutic targets.展开更多
AIM To analyze the diagnostic value of a circular RNA(circR NA), circ-LDLRAD3, in pancreatic cancer.METHODS Expression levels of circ-LDLRAD3 were tested in both cells and clinical samples; the latter included 30 pair...AIM To analyze the diagnostic value of a circular RNA(circR NA), circ-LDLRAD3, in pancreatic cancer.METHODS Expression levels of circ-LDLRAD3 were tested in both cells and clinical samples; the latter included 30 paired pancreatic cancer tissues and adjacent non-tumorous tissues, 31 plasma samples from patients with pancreatic cancer, and 31 plasma samples from healthy volunteers. Real-time quantitative reverse transcriptionpolymerase chain reaction(q RT-PCR) was performed to measure expression levels of circ-LDLRAD3 in cells and clinical samples; then, the relationship between clinicopathological factors of patient samples and expression of circ-LDLRAD3 in pancreatic cancer was analyzed. The diagnostic value of circ-LDLRAD3 was verified by receiver operating characteristic(ROC) curve analysis.RESULTS Circ-LDLRAD3 was up-regulated in pancreatic cancer cell lines(P < 0.01), pancreatic cancer tissues(P < 0.01), and plasma samples from patients with pancreatic cancer(P < 0.01). High expression of circLDLRAD3 was significantly associated with venous invasion, lymphatic invasion, and metastasis. The area under the ROC curve of circ-LDLRAD3 alone or combination with CA19-9 was 0.67 and 0.87, respectively, with a sensitivity and specificity of 0.5738(alone) and 0.7049(alone), and 0.8033(combination) and 0.9355(combination), respectively.CONCLUSION These data suggest that circ-LDLRAD3 may be a biomarker in the diagnosis of pancreatic cancer.展开更多
AIM To analyze the effects of premedication with Pronase for endoscopic ultrasound(EUS) examination of the stomach.METHODS This was a prospective, randomized and controlled clinical study. All patients were randomly a...AIM To analyze the effects of premedication with Pronase for endoscopic ultrasound(EUS) examination of the stomach.METHODS This was a prospective, randomized and controlled clinical study. All patients were randomly assigned to either the Pronase group or placebo group. The pretreatment solution was a mixed solution of 20000 U of Pronase and 60 m L sodium bicarbonate solution in the Pronase group, while an equal amount of sodium bicarbonate solution was administered to the placebo group. All operators, image evaluators and experimental recorders in EUS did not participate in the preparation and allocation of pretreatment solution. Two blinded investigators assessed the obscurity scores for the EUS images according to the size of artifacts(including ultrasound images of the gastric cavity and the gastric wall). Differences in imaging quality, the duration of examination and the usage of physiological saline during the examination process between the Pronase group and the control group were compared.RESULTS No differences existed in patient demographics between the two groups. For the gastric cavity, the Pronase group had significantly lower mean obscurity scores than the placebo group(1.0476 ± 0.77 vs 1.6129 ± 0.96, respectively, P = 0.000). The mean obscurity scores for the gastric mucosal surface were significantly lower in the Pronase group than the placebo group(1.2063 ± 0.90 vs 1.7581 ± 0.84, respectively, P = 0.001). The average EUS procedure duration for the Pronase group was 11.60 ± 3.32 min, which was significantly shorter than that of the placebo group(13.13 ± 3.81 min, P = 0.007). Less saline was used in the Pronase group than the placebo group, and the difference was significant(417.94 ± 121.38 m L vs 467.42 ± 104.52 mL, respectively, P = 0.016).CONCLUSION The group that had Pronase premedication prior to the EUS examination had clearer images than the placebo group. With Pronase premedication, the examination time was shorter, and the amount of saline used during the EUS examination was less.展开更多
Gastrointestinal(GI)tumors,including liver,pancreatic,gastric,and colorectal cancers,have a high incidence rate and low survival rate due to the lack of effective therapeutic methods and frequent relapses.Surgery and ...Gastrointestinal(GI)tumors,including liver,pancreatic,gastric,and colorectal cancers,have a high incidence rate and low survival rate due to the lack of effective therapeutic methods and frequent relapses.Surgery and postoperative chemoradiotherapy have largely reduced the fatality rates for most GI tumors,but these therapeutic approaches result in poor prognoses due to severe adverse reactions and the development of drug resistance.Recent studies have shown that ferroptosis plays an important role in the onset and progression of GI tumors.Ferroptosis is a new non-apoptotic form of cell death,which is iron-dependent,non-apoptotic cell death characterized by the accumulation of lipid reactive oxygen species(ROS).The activation of ferroptosis can lead to tumor cell death.Thus,regulating ferroptosis in tumor cells may become a new therapeutic approach for tumors,making it become a research hotspot.Current studies suggest that ferroptosis is mainly triggered by the accumulation of lipid ROS.Furthermore,several studies have indicated that ferroptosis may be a new approach for the treatment of GI tumors.Here,we review current research progress on the mechanism of ferroptosis,current inducers and inhibitors of ferroptosis,and the role of ferroptosis in GI tumors to propose new methods for the treatment of such tumors.展开更多
BACKGROUND Pancreatic cancer is a highly malignant tumor of the gastrointestinal system whose emerging resistance to chemotherapy has necessitated the development of novel antitumor treatments.Scoparone,a traditional ...BACKGROUND Pancreatic cancer is a highly malignant tumor of the gastrointestinal system whose emerging resistance to chemotherapy has necessitated the development of novel antitumor treatments.Scoparone,a traditional Chinese medicine monomer with a wide range of pharmacological properties,has attracted considerable attention for its antitumor activity.AIM To explore the potential antitumor effect of scoparone on pancreatic cancer and the possible molecular mechanism of action.METHODS The target genes of scoparone were determined using both the bioinformatics and multiplatform analyses.The effect of scoparone on pancreatic cancer cell proliferation,migration,invasion,cell cycle,and apoptosis was detected in vitro.The expression of hub genes was tested using quantitative reverse transcription polymerase chain reaction(qRT-PCR),and the molecular mechanism was analyzed using Western blot.The in vivo effect of scoparone on pancreatic cancer cell proliferation was detected using a xenograft tumor model in nude mice as well as immunohistochemistry.RESULTS The hub genes involved in the suppression of pancreatic cancer by scoparone were obtained by network bioinformatics analyses using publicly available databases and platforms,including SwissTargetPrediction,STITCH,GeneCards,CTD,STRING,WebGestalt,Cytoscape,and Gepia;AKT1 was confirmed using qRT-PCR to be the hub gene.Cell Counting Kit-8 assay revealed that the viability of Capan-2 and SW1990 cells was significantly reduced by scoparone treatment exhibiting IC50 values of 225.2μmol/L and 209.1μmol/L,respectively.Wound healing and transwell assays showed that scoparone inhibited the migration and invasion of pancreatic cancer cells.Additionally,flow cytometry confirmed that scoparone caused cell cycle arrest and induced apoptosis.Scoparone also increased the expression levels of Bax and cleaved caspase-3,decreased the levels of MMP9 and Bcl-2,and suppressed the phosphorylation of Akt without affecting total PI3K and Akt.Moreover,compared with the control group,xenograft tumors,in the 200μmol/L scoparone treatment group,were smaller in volume and lighter in weight,and the percentages of Ki65-and PCNA-positive cells were decreased.CONCLUSION Our findings indicate that scoparone inhibits pancreatic cancer cell proliferation in vitro and in vivo,inhibits migration and invasion,and induces cycle arrest and apoptosis in vitro through the PI3K/Akt signaling pathway.展开更多
BACKGROUND Gastrointestinal stromal tumors(GISTs)with a diameter of<2 cm are called small GISTs.Currently,endoscopic ultrasound(EUS)is widely used as a regular followup method for GISTs,which can also provide a pre...BACKGROUND Gastrointestinal stromal tumors(GISTs)with a diameter of<2 cm are called small GISTs.Currently,endoscopic ultrasound(EUS)is widely used as a regular followup method for GISTs,which can also provide a preliminary basis for judging the malignancy potential of lesions.However,there are no studies on the accuracy of EUS to assess the malignant potential of small GISTs.AIM To evaluate the efficacy of EUS in the diagnosis and risk assessment of small GISTs.METHODS We collected data from patients with small GISTs who were admitted to Shengjing Hospital of China Medical University between October 2014 and July 2019.The accurate diagnosis and risk classifications of patients were based on the pathological assessment according to the modified National Institute of Health criteria after endoscopic resection or laparoscopic surgery.Preoperative EUS features(marginal irregularity,cystic changes,homogeneity,ulceration,and strong echogenic foci)were retrospectively analyzed.The assessment results based on EUS features were compared with the pathological features.RESULTS A total of 256 patients(69 men and 187 women)were enrolled.Pathological results included 232,16,7,and 1 very low-,low-,intermediate-,and high-risk cases,respectively.The most frequent tumor location was the gastric fundus(78.1%),and mitoses were calculated as>5/50 high power field in 8(3.1%)patients.Marginal irregularity,ulceration,strong echo foci,and heterogeneity were detected in 1(0.4%),2(0.8%),22(8.6%),and 67(65.1%)patients,respectively.However,cystic changes were not detected.Tumor size was positively correlated with the mitotic index(P<0.001).Receiver operating curve analysis identified 1.48 cm as the best cut-off value to predict malignant potential(95%confidence interval:0.824–0.956).EUS heterogeneity with tumor diameters>1.48 cm was associated with higher risk classification(P<0.05).CONCLUSION Small GISTs(diameters>1.48 cm)with positive EUS features should receive intensive surveillance or undergo endoscopic surgery.EUS and dissection are efficient diagnostic and therapeutic approaches for small GISTs.展开更多
文摘The albumin-bilirubin(ALBI)score,which was proposed to assess the prognosis of patients with hepatocellular carcinoma,has gradually been extended to other liver diseases in recent years,including primary biliary cholangitis,liver cirrhosis,hepatitis,liver transplantation,and liver injury.The ALBI score is often compared with classical scores such as the Child-Pugh and model for end-stage liver disease scores or other noninvasive prediction models.It is widely employed because of its immunity to subjective evaluation indicators and ease of obtaining detection indicators.An increasing number of studies have confirmed that it is highly accurate for assessing the prognosis of patients with chronic liver disease;additionally,it has demonstrated good predictive performance for outcomes beyond survival in patients with liver diseases,such as decompensation events.This article presents a review of the application of ALBI scores in various non-malignant liver diseases.
基金Supported by Qingdao Key Medical and Health Discipline Project(2025060)Qingdao Municipal Science and Technology Special Program for the Public(23-2-8-smjk-18-nsh)+1 种基金Shandong Public Health Association Program(No.SGWXH202303)Qingdao Outstanding Health Professional Development(2020-2022.2022-2024)。
文摘Stroke is the third-leading cause of disabilityadjusted life years(DALYs)and poses a significant public health challenge worldwide~([1]).Developing countries,including China,continue to face a substantial burden from stroke.Since 1990,China has reported the highest global stroke burden,with 2.19 million deaths and 45.9 million DALYs recorded in 2019~([2]).
文摘BACKGROUND Endoscopic full-thickness resection(EFTR)is increasingly used for treating gastrointestinal stromal tumors(GISTs)in the stomach.AIM To compare the efficacy,tolerability,and clinical outcomes of EFTR vs surgical resection(SR)for gastric GISTs.METHODS We collected clinical data from patients diagnosed with GISTs who underwent either EFTR or SR at our hospital from October 2011 to July 2024.Patients were matched in a 1:1 ratio based on baseline characteristics and tumor clinical-pathological features using propensity score matching.We analyzed perioperative outcomes and follow-up data.The primary outcome measure was progressionfree survival(PFS).RESULTS Out of 912 patients,573 met the inclusion criteria.After matching,each group included 95 patients.The EFTR group demonstrated statistically significant advantages over the SR group in average operative time(P<0.001),length of hospital stay(P<0.001),time to resume liquid diet(P<0.001),incidence of adverse events(P=0.031),and hospitalization costs(P<0.001).The en bloc resection rate was significantly different,with SR group at 100%and EFTR group at 93.7%(P=0.038).The median follow-up was 2451.50 days.Recurrence occurred in 3 patients in the EFTR group and 4 patients in the SR group,with no statistically significant difference(P=1.000).Factors associated with PFS included age,tumor size,high-risk category in the modified National Institutes of Health(NIH)risk score,and resection status.Resection status was identified as an independent prognostic factor for PFS(P=0.0173,hazard ratios=0.0179,95%CI:0.000655-0.491).Notably,there was no statistically significant difference in PFS between the two groups.CONCLUSION This study is a non-inferiority design.The EFTR group significantly outperformed the SR group in terms of operative time,length of hospital stay,time to resume a liquid diet,incidence of adverse events,and hospitalization costs,demonstrating its higher economic efficiency and better tolerability.Additionally,although the en bloc resection rate was lower in the EFTR group compared to the SR group,there were no significant differences in tumor recurrence rates and progression-free survival between the two groups.This study found no statistical difference in the primary endpoint of postoperative recurrence rates between the two groups.However,due to sample size limitations,this result requires further validation in larger-scale studies.The current results should be viewed as exploratory evidence.
文摘Pancreatic cancer is recognized as one of the leading causes of cancer mortality,representing the second most common source of cancer-related deaths within the gastrointestinal domain.Surgical resection is currently the only definitive treatment;however,the subtle emergence of symptoms often leads to a diagnosis at an advanced stage,with merely 10%-15%of patients being eligible for surgical intervention.The primary obstacle to achieving a potential radical resection is the presence of distant metastatic disease or invasion of adjacent major vascular structures.This review aims to highlight the critical role of endoscopic ultrasound in the diagnosis and staging of pancreatic tumors.We systematically searched PubMed,MEDLINE and Web of Science by using‘pancreatic cancer’and‘endoscopic ultrasonography’as keywords.Relevant studies were reviewed and analyzed.Endoscopic ultrasonography(EUS)is efficient in the diagnosis and staging of pancreatic cancer,past studies reported the accuracy of EUS is 63%to 94%for T-staging and 44%to 82%for N-staging but there are still limitations that need to be comprehensively applied with other diagnostic methods to evaluation of distant metastasis for surgical resectability.Our review aims to reveal the value for the staging of pancreatic cancer.
基金supported by the Educational Reform Project of Peking Union Medical College(2015zlgc012)~~
文摘Objectives The in-hosptial palliative care consultation(PCC) is emerging as a routine service in some medical center in China. The current study evaluated how physicians in primary care team and consultation team perceive the PCC service for the purpose of investigating the effectiveness of this consultation model in a general hospital.Methods In-hosptial palliative care consultations have been carried out at Peking Union Medical College Hosptial by a dedicated consultation team, and 37 consultations were completed in 2016. A questionnaire was designed for physicians in terms of its benefits to patients,their family as well as the primary care team. Physicians who applied for consultation in 2016 formally(requested from the department other than the Geriatrics) and informally(by rotating residents and unemployed visiting doctors in geriatric department) were invited to participate in the survey by scanning a two dimentional code on social networking platform.Results There were 103 physicians participated in the survey, including primary care physicians from the department of Internal Medicine(n=8), Gynaecology(n=16) and Surgery(n=13), rotating residents(n=30), visiting doctors(n=16) in Geriatric department, and PCC team members(n=20). 94.0% of the non-PCC physicians agreed that PCC relieved the suffering of patients; 89.2% thought PCC improved the quality of patients' life; there were 91.6%, 95.2%, 90.4% physicians who felt it relieved the anxiety of patients, of family members and of care providers, respectively. There were 96.4% physicians who felt it could ease the tension in physician-patient relationship; 97.6% felt it lower the risk for medical negligence, and 96.4% of doctors who applied for PPC felt satisfied with PCC service in terms of process and achieving objectives of consultation. More primary-team physician agree "PCC service helps the physicians better understand palliative care" than PCC members(97.6% vs. 80%, P<0.05), while both were interested in learning more on palliative medicine(100% vs. 96.4%, P>0.05).Conclusion Palliative care consultation service in a general hospital is efficacious and acclaimed.The primary care physicians and the PCC members hold positive attitudes to the benefits that the PCC services bring to patients, family members, and physicians themselves. PCC for terminal patients in a general hospital may serve as a good modle for promotion of palliative care in China.
基金supported by a grant from the Natural Science Foundation of Guangdong Province, P. R. China (No. 9151008901000223)
文摘Postoperative radiotherapy (PRT) is widely advocated for patients with squamous cell carcinomas of the head and neck that are considered to be at high risk of recurrence after surgical resection. The aims of this study were to evaluate the treatment outcomes of PRT for patients with laryngeal carcinoma and to identify the value of several prognostic factors. We reviewed the records of 256 patients treated for laryngeal squamous cell carcinoma between January 1993 and December 2005. Disease-free survival (DFS) and overall survival (OS) were estimated using the Kaplan-Meier method. Log-rank test was employed to identify significant prognostic factors for DFS and OS. The Cox proportional hazards model was applied to identify covariates significantly associated with the aforementioned endpoints. Our results showed the 3-, 5-, and 10-year DFS for all patients were 69.9%, 59.5%, and 34.9%, respectively. The 3-, 5-, and 10-year OS rates were 80.8%, 68.6%, and 38.8%, respectively. Significant prognostic factors for both DFS and OS on univariate analysis were grade, primary site, T stage, N stage, overall stage, lymph node metastasis, overall treatment times of radiation, the interval between surgery and radiotherapy, and radiotherapy equipment. Favorable prognostic factors for both DFS and OS on multivariate analysis were lower overall stage, no cervical lymph node metastasis, and using 60Co as radiotherapy equipment. In conclusion, our data suggest that lower overall stage, no cervical lymph node metastasis, and using 60Co as radiotherapy equipment are favorable prognostic factors for DFS and OS and that reducing the overall treatment times of radiation to 6 weeks or less and the interval between surgery and radiotherapy to less than 3 weeks are simple measures to remarkably improve treatment outcome.
文摘A pancreatic pseudocyst(PPC)is a collection of pancreatic fluid enclosed by a non-epithelialized,fibrous or granulomatous wall.Endoscopic pancreatic pseudocyst drainage(PPD)has been widely used clinically to treat PPCs.The success and complications of endoscopic PPD are comparable with surgical interventions.Stent displacement is a rare complication after endoscopic PPD.Almost all the complications of endoscopic PPD have been managed surgically,and there is rare report involving the endoscopic treatment of intraperitoneal stent displacement.We report here a case of stent displacementafter endoscopic ultrasound-and fluoroscopy-guided PPD in a 41-year-old female patient with a PPC in the tail of the pancreas.The endoscopic treatment was successfully performed to remove the displaced stent.The clinical course of the patient was unremarkable.The cyst had significantly reduced and disappeared by 12 wk.We found that both endoscopic ultrasound and fluoroscopy should be used during endoscopic PPD to avoid stent displacement.The displaced stent can be successfully treated by endoscopic removal.
文摘BACKGROUND Endoscopic ultrasound(EUS)-guided drainage is the optimal method for treatment of pancreatic fluid collections(PFCs),and is associated with ease,safety,and efficiency.Bleeding is one of the main procedure-related complications,and often requires surgery or radiologic interventions.Indeed,endoscopic management of this complication is limited.CASE SUMMARY A 42-year-old man presented for evaluation of abdominal pain and distention for approximately 2 wk.Abdominal computed tomography revealed a pancreatic pseudocyst located in the tail of the pancreas.EUS-guided pancreatic pseudocyst was performed.After stent placement,massive bleeding was noted from the fistula.Finally,hemostasis was successfully achieved using hemostatic forceps within the fistula.CONCLUSION Bleeding vessel grasp and coagulation may represent a successful treatment for a fistula hemorrhage during EUS-guided drainage for a PFC,which may be tried before application of balloon or stent compression.
基金Supported by the National Natural Science Foundation of China,No.82100700Fundamental Scientific Research Project from the Educational Department of Liaoning Province,No.LJKMZ20221191+1 种基金High-quality Development Fund Project from the Science and Technology of Liaoning Province,No.2023JH2 and No.20200063345 Talent Project of Shengjing Hospital,No.52-30B.
文摘In this editorial,we comment on an article titled“Morphological and biochemical characteristics associated with autophagy in gastrointestinal diseases”,which was published in a recent issue of the World Journal of Gastroenterology.We focused on the statement that“autophagy is closely related to the digestion,secretion,and regeneration of gastrointestinal cells”.With advancing research,autophagy,and particularly the pivotal role of the macroautophagy in maintaining cellular equilibrium and stress response in the gastrointestinal system,has garnered extensive study.However,the significance of mitophagy,a unique selective autophagy pathway with ubiquitin-dependent and independent variants,should not be overlooked.In recent decades,mitophagy has been shown to be closely related to the occurrence and development of gastrointestinal diseases,especially inflammatory bowel disease,gastric cancer,and colorectal cancer.The interplay between mitophagy and mitochondrial quality control is crucial for elucidating disease mechanisms,as well as for the development of novel treatment strategies.Exploring the pathogenesis behind gastrointestinal diseases and providing individualized and efficient treatment for patients are subjects we have been exploring.This article reviews the potential mechanism of mitophagy in gastrointestinal diseases with the hope of providing new ideas for diagnosis and treatment.
基金funded by the Second Tibetan Plateau Scientific Expedition and Research(STEP)Program(Grant No.2019QZKK0103)National Natural Science Foundation of China(Grant Nos.41875031,42230610,41522501,41275028)CLIMATE-Pan-TPE in the framework of the ESA-MOST Dragon 5 Programme(Grant ID 58516)。
文摘Evapotranspiration(ET)is a crucial variable in the terrestrial water,carbon,and energy cycles.At present,a large number of multi source ET products exist.Due to sparse observations,however,great challenges exist in the evaluation and integration of ET products in remote and complex areas such as the Tibetan Plateau(TP).In this paper,the applicability of the multiple collocation(MC)method over the TP is evaluated for the first time,and the uncertainty of multisource ET products(based on reanalysis,remote sensing,and land surface models)is further analyzed,which provides a theoretical basis for ET data fusion.The results show that(1)ET uncertainties quantified via the MC method are lower in RS-based ET products(5.95 vs.7.06 mm month^(-1))than in LSM ET products(10.22 vs.17.97 mm month^(-1))and reanalysis ET estimates(7.27 vs.12.26 mm month-1).(2)A multisource evapotranspiration(MET)dataset is generated at a monthly temporal scale with a spatial resolution of 0.25°across the TP during 2005-15.MET has better performance than any individual product.(3)Based on the fusion product,the total ET amount over the TP and its patterns of spatiotemporal variability are clearly identified.The annual total ET over the entire TP is approximately 380.60 mm.Additionally,an increasing trend of 1.59±0.85 mm yr^(-1)over the TP is shown during 2005-15.This study provides a basis for future studies on water and energy cycles and water resource management over the TP and surrounding regions.
文摘Endoscopic ultrasound-guided fine-needle aspiration(EUS-FNA)is a means to procure adequate specimens for histological and cytologic analysis.The ideal EUS-FNA should be safe,accurate,and have a high sample adequacy rate and low adverse events rate.In recent years,many guidelines and trials on EUS-FNA have been published.The purpose of this article is to provide an update on the influence of some of the main factors on the diagnostic efficiency of EUS-FNA as well as a rare but serious complication known as needle tract seeding.
基金supported by the National Natural Science Foundation of China(No.82100700 to F.Y.)the China Postdoctoral Science Foundation(No.2020M670101ZX to F.Y.)+1 种基金the Fundamental Scientific Research Project from the Educational Department of Liaoning Province,China(No.LJKMZ20221191 to F.Y.)the 345 Talent Project of Shengjing Hospital of China Medical University(No.52-30B to F.Y.).
文摘Digestive-system cancers represent major threats to human health;however,the mechanisms underlying tumorigenesis and radiochemotherapy resistance have remained elusive.Therefore,an urgent need exists for identifying key drivers of digestive system tumorigenesis and novel targeted therapeutics.The checkpoint kinase 2(Chk2)regulates cell-cycle progression,and Chk2 dysregulation or Chk2 mutations can lead to the development of various cancers,which makes Chk2 an important research topic.This review summarizes the roles of Chk2 in DNA-damage responses,cell-cycle regulation,autophagy,and homeostasis maintenance.We describe relationships between tumorigenesis and cell-cycle dysregulation induced by Chk2 mutations.In addition,we summarize evidence indicating that Chk2 can serve as a novel therapeutic target,based on its contributions to radiochemotherapy-resistance reversion and progress made in developing antitumor agents against Chk2.The prevailing evidence supports the conclusion that further research on Chk2 will provide a deeper understanding of digestive-system tumorigenesis and should suggest novel therapeutic targets.
基金This work was supported by key projects of National Natural Science Foundation of China(No.81830110)Heilongjiang Province key research and development plan(No.2022ZX02C04).
基金Supported by Natural Science Foundation of Liaoning Province,No.20170541024the Shengjing Free Researcher Project Foundation,No.200812
文摘AIM To analyze the diagnostic value of a circular RNA(circR NA), circ-LDLRAD3, in pancreatic cancer.METHODS Expression levels of circ-LDLRAD3 were tested in both cells and clinical samples; the latter included 30 paired pancreatic cancer tissues and adjacent non-tumorous tissues, 31 plasma samples from patients with pancreatic cancer, and 31 plasma samples from healthy volunteers. Real-time quantitative reverse transcriptionpolymerase chain reaction(q RT-PCR) was performed to measure expression levels of circ-LDLRAD3 in cells and clinical samples; then, the relationship between clinicopathological factors of patient samples and expression of circ-LDLRAD3 in pancreatic cancer was analyzed. The diagnostic value of circ-LDLRAD3 was verified by receiver operating characteristic(ROC) curve analysis.RESULTS Circ-LDLRAD3 was up-regulated in pancreatic cancer cell lines(P < 0.01), pancreatic cancer tissues(P < 0.01), and plasma samples from patients with pancreatic cancer(P < 0.01). High expression of circLDLRAD3 was significantly associated with venous invasion, lymphatic invasion, and metastasis. The area under the ROC curve of circ-LDLRAD3 alone or combination with CA19-9 was 0.67 and 0.87, respectively, with a sensitivity and specificity of 0.5738(alone) and 0.7049(alone), and 0.8033(combination) and 0.9355(combination), respectively.CONCLUSION These data suggest that circ-LDLRAD3 may be a biomarker in the diagnosis of pancreatic cancer.
基金Supported by the National Natural Science Foundation of China,No.81470908
文摘AIM To analyze the effects of premedication with Pronase for endoscopic ultrasound(EUS) examination of the stomach.METHODS This was a prospective, randomized and controlled clinical study. All patients were randomly assigned to either the Pronase group or placebo group. The pretreatment solution was a mixed solution of 20000 U of Pronase and 60 m L sodium bicarbonate solution in the Pronase group, while an equal amount of sodium bicarbonate solution was administered to the placebo group. All operators, image evaluators and experimental recorders in EUS did not participate in the preparation and allocation of pretreatment solution. Two blinded investigators assessed the obscurity scores for the EUS images according to the size of artifacts(including ultrasound images of the gastric cavity and the gastric wall). Differences in imaging quality, the duration of examination and the usage of physiological saline during the examination process between the Pronase group and the control group were compared.RESULTS No differences existed in patient demographics between the two groups. For the gastric cavity, the Pronase group had significantly lower mean obscurity scores than the placebo group(1.0476 ± 0.77 vs 1.6129 ± 0.96, respectively, P = 0.000). The mean obscurity scores for the gastric mucosal surface were significantly lower in the Pronase group than the placebo group(1.2063 ± 0.90 vs 1.7581 ± 0.84, respectively, P = 0.001). The average EUS procedure duration for the Pronase group was 11.60 ± 3.32 min, which was significantly shorter than that of the placebo group(13.13 ± 3.81 min, P = 0.007). Less saline was used in the Pronase group than the placebo group, and the difference was significant(417.94 ± 121.38 m L vs 467.42 ± 104.52 mL, respectively, P = 0.016).CONCLUSION The group that had Pronase premedication prior to the EUS examination had clearer images than the placebo group. With Pronase premedication, the examination time was shorter, and the amount of saline used during the EUS examination was less.
基金China Postdoctoral Science Foundation,No.2020M670101ZXDoctoral Scientific Research Foundation of Liaoning Province,No.2019-BS-276+3 种基金Science and Technology Program of Shenyang,No.19-112-4-103Youth Support Foundation of China Medical University,No.QGZ2018058Scientific Fund of Shengjing Hospital,No.201801345 Talent Project of Shengjing Hospital,No.52-30C.
文摘Gastrointestinal(GI)tumors,including liver,pancreatic,gastric,and colorectal cancers,have a high incidence rate and low survival rate due to the lack of effective therapeutic methods and frequent relapses.Surgery and postoperative chemoradiotherapy have largely reduced the fatality rates for most GI tumors,but these therapeutic approaches result in poor prognoses due to severe adverse reactions and the development of drug resistance.Recent studies have shown that ferroptosis plays an important role in the onset and progression of GI tumors.Ferroptosis is a new non-apoptotic form of cell death,which is iron-dependent,non-apoptotic cell death characterized by the accumulation of lipid reactive oxygen species(ROS).The activation of ferroptosis can lead to tumor cell death.Thus,regulating ferroptosis in tumor cells may become a new therapeutic approach for tumors,making it become a research hotspot.Current studies suggest that ferroptosis is mainly triggered by the accumulation of lipid ROS.Furthermore,several studies have indicated that ferroptosis may be a new approach for the treatment of GI tumors.Here,we review current research progress on the mechanism of ferroptosis,current inducers and inhibitors of ferroptosis,and the role of ferroptosis in GI tumors to propose new methods for the treatment of such tumors.
基金Supported by National Natural Science Foundation of China,No.817706555Special Project from the Central Government of Liaoning Province,No.2018107003+6 种基金Liaoning Province Medical Science and Technology Achievements Transformation Foundation,No.2018225120China Postdoctoral Science Foundation,No.2020M670101ZXDoctoral Scientific Research Foundation of Liaoning Province,No.2019-BS-276Science and Technology Program of Shenyang,No.19-112-4-103Youth Support Foundation of China Medical University,No.QGZ2018058Scientific Fund of Shengjing Hospital,No.201801345 Talent Project of Shengjing Hospital,No.52-30C.
文摘BACKGROUND Pancreatic cancer is a highly malignant tumor of the gastrointestinal system whose emerging resistance to chemotherapy has necessitated the development of novel antitumor treatments.Scoparone,a traditional Chinese medicine monomer with a wide range of pharmacological properties,has attracted considerable attention for its antitumor activity.AIM To explore the potential antitumor effect of scoparone on pancreatic cancer and the possible molecular mechanism of action.METHODS The target genes of scoparone were determined using both the bioinformatics and multiplatform analyses.The effect of scoparone on pancreatic cancer cell proliferation,migration,invasion,cell cycle,and apoptosis was detected in vitro.The expression of hub genes was tested using quantitative reverse transcription polymerase chain reaction(qRT-PCR),and the molecular mechanism was analyzed using Western blot.The in vivo effect of scoparone on pancreatic cancer cell proliferation was detected using a xenograft tumor model in nude mice as well as immunohistochemistry.RESULTS The hub genes involved in the suppression of pancreatic cancer by scoparone were obtained by network bioinformatics analyses using publicly available databases and platforms,including SwissTargetPrediction,STITCH,GeneCards,CTD,STRING,WebGestalt,Cytoscape,and Gepia;AKT1 was confirmed using qRT-PCR to be the hub gene.Cell Counting Kit-8 assay revealed that the viability of Capan-2 and SW1990 cells was significantly reduced by scoparone treatment exhibiting IC50 values of 225.2μmol/L and 209.1μmol/L,respectively.Wound healing and transwell assays showed that scoparone inhibited the migration and invasion of pancreatic cancer cells.Additionally,flow cytometry confirmed that scoparone caused cell cycle arrest and induced apoptosis.Scoparone also increased the expression levels of Bax and cleaved caspase-3,decreased the levels of MMP9 and Bcl-2,and suppressed the phosphorylation of Akt without affecting total PI3K and Akt.Moreover,compared with the control group,xenograft tumors,in the 200μmol/L scoparone treatment group,were smaller in volume and lighter in weight,and the percentages of Ki65-and PCNA-positive cells were decreased.CONCLUSION Our findings indicate that scoparone inhibits pancreatic cancer cell proliferation in vitro and in vivo,inhibits migration and invasion,and induces cycle arrest and apoptosis in vitro through the PI3K/Akt signaling pathway.
基金National Natural Science Foundation of China,No.81900601The University Innovation Team and Innovative Talent Support Program of Liaoning Province,No.LR2019073Shenyang Young and Middle-aged Science and Technology Innovation Talent Support Program,No.RC200438.
文摘BACKGROUND Gastrointestinal stromal tumors(GISTs)with a diameter of<2 cm are called small GISTs.Currently,endoscopic ultrasound(EUS)is widely used as a regular followup method for GISTs,which can also provide a preliminary basis for judging the malignancy potential of lesions.However,there are no studies on the accuracy of EUS to assess the malignant potential of small GISTs.AIM To evaluate the efficacy of EUS in the diagnosis and risk assessment of small GISTs.METHODS We collected data from patients with small GISTs who were admitted to Shengjing Hospital of China Medical University between October 2014 and July 2019.The accurate diagnosis and risk classifications of patients were based on the pathological assessment according to the modified National Institute of Health criteria after endoscopic resection or laparoscopic surgery.Preoperative EUS features(marginal irregularity,cystic changes,homogeneity,ulceration,and strong echogenic foci)were retrospectively analyzed.The assessment results based on EUS features were compared with the pathological features.RESULTS A total of 256 patients(69 men and 187 women)were enrolled.Pathological results included 232,16,7,and 1 very low-,low-,intermediate-,and high-risk cases,respectively.The most frequent tumor location was the gastric fundus(78.1%),and mitoses were calculated as>5/50 high power field in 8(3.1%)patients.Marginal irregularity,ulceration,strong echo foci,and heterogeneity were detected in 1(0.4%),2(0.8%),22(8.6%),and 67(65.1%)patients,respectively.However,cystic changes were not detected.Tumor size was positively correlated with the mitotic index(P<0.001).Receiver operating curve analysis identified 1.48 cm as the best cut-off value to predict malignant potential(95%confidence interval:0.824–0.956).EUS heterogeneity with tumor diameters>1.48 cm was associated with higher risk classification(P<0.05).CONCLUSION Small GISTs(diameters>1.48 cm)with positive EUS features should receive intensive surveillance or undergo endoscopic surgery.EUS and dissection are efficient diagnostic and therapeutic approaches for small GISTs.
