Background:The development of gastric cancer(GC)encompasses precancerous conditions like chronic atrophic gastritis(CAG)and premalignant lesions of gastric cancer(PLGC).In these situations,abnormal Notch signaling res...Background:The development of gastric cancer(GC)encompasses precancerous conditions like chronic atrophic gastritis(CAG)and premalignant lesions of gastric cancer(PLGC).In these situations,abnormal Notch signaling results in mucosal impairment and the initiation of cancer.Banxia Xiexin Decoction(BXD),a well-known formula in traditional Chinese medicine(TCM),shows promise in treating gastric disorders,but its mechanisms in gastric restoration remain unclear.Methods:Using MNNG-induced CAG and PLGC rat models,BXD was administered for 12 weeks.Gastric mucosal pathology was assessed via hematoxylin-eosin staining.Proliferation(Ki-67)and angiogenesis(VEGFA)markers were evaluated by immunohistochemistry.Network pharmacology identified BXD’s targets and pathways.Notch pathway components(Notch1,Jagged1,Dll4,Hes1)were analyzed via qPCR,Western blot,and immunohistochemistry.Results:BXD significantly ameliorated mucosal atrophy,glandular structural disorder,and dysplasia in CAG and PLGC rats.Network pharmacology revealed 323 overlapping targets between BXD and PLGC,with Notch signaling as a central pathway.BXD downregulated Notch1,Jagged1,Dll4,and Hes1 expression at transcriptional and protein levels,suppressed Ki-67(proliferation)and VEGFA(angiogenesis)overexpression,and restored gastric mucosal integrity.Conclusion:BXD inhibits Notch signaling,reduces aberrant proliferation and angiogenesis,and interrupts Correa’s gastric carcinogenesis cascade.This study provides mechanistic evidence supporting BXD as a TCM-based intervention for gastric precancerous lesions.展开更多
Gastric cancer(GC)has high morbidity and mortality worldwide.Due to the absence of noticeable symptoms,diagnosing GC at an early stage is very difficult,which consequently leads to advanced GC and poor prognosis.Effec...Gastric cancer(GC)has high morbidity and mortality worldwide.Due to the absence of noticeable symptoms,diagnosing GC at an early stage is very difficult,which consequently leads to advanced GC and poor prognosis.Effective biomarkers are essential for prolonging patients’survival.Helicobacter pylori(H.pylori)infection represents the most significant risk factor for GC,with nearly all cases linked to this infection.Many non-coding RNAs(ncRNAs)are dysregulated in H.pylori-infected GC,indicating that ncRNAs may serve as biomarkers of early-stage GC.In this editorial,we discuss the study by Chen et al.Although previous studies have identified roles for miR-136 in gastric cancer proliferation,apoptosis,and invasion,none have specifically explored its relationship with H.pylori-associated gastric carcinogenesis.展开更多
BACKGROUND Gastric cancer(GC)is one of the most common malignant tumors of the digestive system worldwide,the prognosis of patients with advanced GC remains poor.AIM To evaluate the combined expression characteristics...BACKGROUND Gastric cancer(GC)is one of the most common malignant tumors of the digestive system worldwide,the prognosis of patients with advanced GC remains poor.AIM To evaluate the combined expression characteristics of cancer stem cell markers CD24 and CD133 in GC pathological tissues,and to explore their association with patients’clinicopathological parameters and postoperative survival outcomes.METHODS A total of 304 GC patients who underwent surgical treatment in our hospital from January 2018 to January 2020 were retrospectively included.Immunohistochemistry was used to detect the protein expression of CD24 and CD133 in tumor tissues,adjacent tissues,and normal gastric mucosa tissues.Based on staining intensity and the proportion of positive cells,expression levels were classified into low and high expression,while clinicopathological parameters were recorded.χ2 test was used to evaluate the correlation between expression and categorical variables,Spearman rank correlation analysis was performed to assess the correlation between the expression intensities of the two markers,and multivariate regression models were applied to identify independent risk factors influencing co-expression.Kaplan-Meier survival curves and Log-rank test were used to compare survival differences among groups with different expression patterns.RESULTS Among the 304 patients,155 cases(50.99%)were CD24 positive,including 91 low-expression and 64 highexpression;133 cases(43.75%)were CD133 positive,including 81 low-expression and 52 high-expression.There were 74 cases(24.34%)with double positivity and 81 cases(26.64%)with double negativity.Compared with tumor tissues,the positive rates of CD24 and CD133 in normal gastric tissues and adjacent tissues were significantly lower(P<0.05).Univariate analysis showed that co-expression of CD24 and CD133 in GC tissues was significantly correlated with tumor size,Lauren classification,T stage,N stage,and vascular invasion(P<0.05),but not with patient age,gender,tumor site,World Health Organization histological classification,or M stage(P>0.05).Further multivariate regression analysis suggested that tumor size,T stage,N stage,and vascular invasion were independent risk factors promoting CD24 and CD133 double positivity.Spearman rank correlation analysis indicated a moderate positive correlation between their expression intensities(r=0.420,P<0.001).During follow-up,29 of 304 patients were lost(loss rate 9.54%);146 deaths occurred.According to expression combination,there were 89 cases of CD24 single positivity(39 deaths),68 cases of CD133 single positivity(31 deaths),81 cases of double negativity(25 deaths),and 66 cases of double positivity(51 deaths).Log-rank test showed significant differences in overall survival among the four groups(χ2=20.89,P<0.001),with CD24+/CD133+group showing the worst prognosis.CONCLUSION CD24 and CD133 exhibit high positive detection rates in GC tissues,and their co-positivity is closely associated with tumor stage progression and significantly indicates unfavorable survival outcomes.The co-expression of CD24/CD133 may reflect higher aggressiveness and metastatic potential of GC,serving as a potential prognostic marker and a direction for targeted therapeutic strategies.However,as this is a single-center retrospective study with limitations such as patient loss to follow-up and sample size,further prospective,multicenter,and mechanistic studies are required to validate its clinical applicability and biological role.展开更多
BACKGROUND Chemotherapy with an immune checkpoint inhibitor is one of the standard regimens for treating advanced gastric cancer(AGC).Ascites and peritoneal dissemination are common complications and poor prognostic f...BACKGROUND Chemotherapy with an immune checkpoint inhibitor is one of the standard regimens for treating advanced gastric cancer(AGC).Ascites and peritoneal dissemination are common complications and poor prognostic factors of AGC;however,reports regarding its efficacy and safety in patients with AGC and massive ascites are limited.AIM To evaluate the safety and efficacy of nivolumab combined with chemotherapy in patients with AGC and ascites.METHODS We retrospectively collected clinical data from 124 patients with AGC who received chemotherapy plus nivolumab as first-line treatment from July 2017 to December 2024.Based on computed tomography scans,massive or moderate ascites were classified as high ascites burden(HAB),whereas mild or no ascites were classified as low ascites burden.RESULTS Ascites was detected in 47 patients(38%);26(21%)were classified into the HAB group.Patients in the HAB group exhibited a significantly poorer performance status,a higher prevalence of diffuse-type histology,and lower programmed cell death ligand 1(PD-L1)expression.Combination therapy with FOLFOX and neutropenia was significantly more common in the HAB group.Progression-free survival(PFS)(4.4 months vs 9.3 months,P=0.0012)and overall survival(OS)(7.3 months vs 21.2 months,P<0.0001)were significantly poorer in the HAB group.However,an improvement in ascites was observed in 61.5%of patients in the HAB group.PD-L1 expression did not correlate with either PFS or OS in the HAB group.CONCLUSION Nivolumab plus chemotherapy demonstrated modest efficacy and acceptable toxicity in patients with AGC and HAB.展开更多
Delayed wound healing following radical gastrectomy remains an important yet underappreciated complication that prolongs hospitalization,increases costs,and undermines patient recovery.In An et al’s recent study,the ...Delayed wound healing following radical gastrectomy remains an important yet underappreciated complication that prolongs hospitalization,increases costs,and undermines patient recovery.In An et al’s recent study,the authors present a machine learning-based risk prediction approach using routinely available clinical and laboratory parameters.Among the evaluated algorithms,a decision tree model demonstrated excellent discrimination,achieving an area under the curve of 0.951 in the validation set and notably identifying all true cases of delayed wound healing at the Youden index threshold.The inclusion of variables such as drainage duration,preoperative white blood cell and neutrophil counts,alongside age and sex,highlights the pragmatic appeal of the model for early postoperative monitoring.Nevertheless,several aspects warrant critical reflection,including the reliance on a postoperative variable(drainage duration),internal validation only,and certain reporting inconsistencies.This letter underscores both the promise and the limitations of adopting interpretable machine learning models in perioperative care.We advocate for transparent reporting,external validation,and careful consideration of clinically actionable timepoints before integration into practice.Ultimately,this work represents a valuable step toward precision risk stratification in gastric cancer surgery,and sets the stage for multicenter,prospective evaluations.展开更多
BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate se...BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate selection for gastrectomy may result in overtreatment,adversely affecting patients’quality of life.Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC.To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’,we specifically assess the suitability of Japanese guidelines in non-Japanese populations.This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.AIM To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.METHODS A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022.Cases were categorized into three groups:Same-estimated(preoperative therapeutic indication with postoperative pathological criteria matched),underestimated(preoperative ESD indication but postoperative surgical criteria),and overestimated(preoperative surgical indication but postoperative ESD criteria).The rate of discrepancy and associated risk factors were assessed.RESULTS The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0%(321/430)and 76.0%(278/366),respectively.The overall discrepancy rate was 25.6%(204/796).Multivariate analysis identified tumor location in the upper-third stomach(odds ratio=2.158,95%confidence interval:1.373-3.390,P=0.001)was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy(odds ratio=2.005,95%confidence interval:1.036-3.879,P=0.039)was more likely to be overestimated.Significant differences were observed in tumor diameter(P<0.001),depth of infiltration(P<0.001),ulcerative findings(P<0.001),and histologic type(P<0.001)between preoperative and postoperative evaluations.CONCLUSION The accuracy of preoperative EGC indications is 74.4%.Upper-third stomach and undifferentiated histology are primary discrepancy predictors.Upper-third tumors are prone to underestimation,while undifferentiated tumors are prone to overestimation.展开更多
Gastric ulcer(GU)represents a clinically significant manifestation of peptic ulcer disease,driven by a complex interplay of microbial,environmental,and immuneinflammatory factors.A recent cross-sectional study by Shen...Gastric ulcer(GU)represents a clinically significant manifestation of peptic ulcer disease,driven by a complex interplay of microbial,environmental,and immuneinflammatory factors.A recent cross-sectional study by Shen et al systematically evaluated six complete blood count-derived inflammatory indices:Neutrophil-tolymphocyte ratio,monocyte-to-lymphocyte ratio,platelet-to-lymphocyte ratio,systemic immune-inflammation index,systemic inflammatory response index(SIRI),and aggregate index of systemic inflammation and demonstrated their positive associations with GU prevalence,identifying SIRI as the strongest predictor.This editorial contextualizes these findings within the broader literature,clarifies that these indices reflect systemic rather than GU-specific inflammation,highlights methodological strengths and major limitations,and proposes a conceptual clinical algorithm for integrating SIRI into GU risk assessment.Future multicenter studies incorporating Helicobacter pylori infection,non-steroidal antiinflammatory drug exposure,and prospective design are essential to validate and translate these findings into clinical practice.展开更多
Wu et al recently applied multi-region 16S rRNA sequencing to characterize the gastric cancer microbiome,demonstrating improved taxonomic resolution and detection sensitivity over conventional single-region approaches...Wu et al recently applied multi-region 16S rRNA sequencing to characterize the gastric cancer microbiome,demonstrating improved taxonomic resolution and detection sensitivity over conventional single-region approaches.While the study represents a valuable methodological step forward,it remains limited by singlecenter design,lack of quantitative calibration,and insufficient control for contamination and inter-laboratory variability.This editorial critically appraises these methodological gaps and emphasizes that future efforts must focus on harmonized,consensus-driven workflows to ensure reproducibility and clinical reliability.The translational potential of multi-region 16S lies in moving from descriptive microbial profiling to actionable clinical integration,particularly for recurrence prediction,treatment-response monitoring,and perioperative complication risk assessment.By addressing these methodological,economic,and ethical challenges,the field can advance toward evidence-based and clinically deployable microbiome-guided precision oncology.展开更多
Gastric cancer(GC)is the fifth most prevalent malignancy worldwide and remains a leading cause of cancer-related mortality.Major risk factors for GC include Helicobacter pylori infection,increasing age,high dietary sa...Gastric cancer(GC)is the fifth most prevalent malignancy worldwide and remains a leading cause of cancer-related mortality.Major risk factors for GC include Helicobacter pylori infection,increasing age,high dietary salt intake,and diets deficient in vegetables and fruits.Due to the often subtle and nonspecific early symptoms,coupled with the lack of routine screening programs,a significant proportion of GC cases are diagnosed at advanced stages.The etiology of GC is multifactorial,and diagnosis is confirmed histologically through endoscopic biopsy,followed by staging via computed tomography,positron emission tomography,staging laparoscopy,and endoscopic ultrasound.Treatment strategies typically involve a multidisciplinary approach including chemotherapy,surgical resection,radiotherapy,and emerging immunotherapeutic options.Despite advances in diagnostic and therapeutic modalities,the prognosis of advanced GC remains poor,with high rates of recurrence and metastasis.In recent years,increasing attention has been given to the role of tight junction(TJ)proteins in the pathogenesis and progression of GC.TJ proteins,critical components of epithelial barrier function,have been implicated in various stages of gastric carcinogenesis,from intestinal metaplasia to invasion and metastasis.Infection and inflammation,particularly due to Helicobacter pylori,disrupt TJ integrity,compromising the gastric mucosal barrier and facilitating neoplastic transformation.This review synthesizes current evidence from PubMed,EMBASE,Google Scholar,ScienceDirect,SpringerLink,and other reputable databases to provide a comprehensive overview of the involvement of TJ proteins in GC.By elucidating the molecular interplay between TJ dysregulation and gastric tumorigenesis,this work aims to highlight the potential of TJ proteins as novel diagnostic biomarkers and therapeutic targets in GC management.展开更多
BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector compu...BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector computed tomography(MDCT)and gastrointestinal endoscopy for GC screening,preoperative staging,and lymph node metastasis detection,thereby providing a reference for clinical diagnosis and treatment.METHODS In this retrospective study clinical and imaging data of 134 patients with suspected GC who were admitted between January 2023 and October 2024 were initially reviewed.According to the inclusion and exclusion criteria,102 patients were finally enrolled in the analysis.All enrolled patients had undergone both MDCT and gastrointestinal endoscopy examinations prior to surgical intervention.Preoperative clinical staging and lymph node metastasis findings were compared with pathological results.RESULTS The combined use of MDCT and gastrointestinal endoscopy demonstrated a sensitivity of 98.53%,specificity of 97.06%,accuracy of 98.04%,positive predictive value of 98.53%,and negative predictive value of 97.06%for diagnosing GC.These factors were all significantly higher than those of MDCT or endoscopy alone(P<0.05).The accuracy rates of the combined approach for detecting clinical T and N stages were 97.06%and 92.65%,respectively,outperforming MDCT alone(86.76% and 79.41%)and endoscopy alone(85.29% and 70.59%)(P<0.05).Among 68 patients with confirmed GC,50(73.53%)were pathologically diagnosed with lymph node metastasis.The accuracy for detecting lymph node metastasis was 66.00%with endoscopy,76.00%with MDCT,and 92.00% with the combined approach,all with statistically significant differences(P<0.05).CONCLUSION The combined application of MDCT and gastrointestinal endoscopy enhanced diagnostic accuracy for GC,provided greater consistency in preoperative staging,and improved the detection of lymph node metastasis,thereby demonstrating significant clinical utility.展开更多
Objectives:Chromobox 4(CBX4),a polycomb protein family member linked to tumor pathogenesis via dysregulation,has an incompletely defined role in gastric cancer(GC).The study aimed to investigate the role and mechanism...Objectives:Chromobox 4(CBX4),a polycomb protein family member linked to tumor pathogenesis via dysregulation,has an incompletely defined role in gastric cancer(GC).The study aimed to investigate the role and mechanism of CBX4 in GC progression and evaluate its potential as a therapeutic target.Methods:CBX4 expression was assessed in GC tissues vs.adjacent non-cancerous tissues and in GC cell lines vs.normal gastric mucosal epithelial cells.Clinicopathological correlations were analyzed.Functional impacts of CBX4 were determined using knockdown and overexpression models in vitro(cell proliferation,migration,invasion)and in vivo(xenograft tumorigenesis in nude mice).Mechanistic studies evaluatedβ-catenin levels(total and nuclear)and transcriptional activity following CBX4 modulation.The functional dependency on Wnt/β-catenin signaling was tested using the pharmacological inhibitor XAV939 in CBX4-overexpressing cells.Results:CBX4 expression was significantly upregulated in GC tissues and cell lines.Elevated CBX4 levels strongly correlated with aggressive tumor characteristics,including larger tumor size,lymph node metastasis,and advanced Tumor,Node,Metastasis(TNM)stage.Functionally,CBX4 knockdown suppressed GC cell proliferation,migration,invasion in vitro,and tumorigenesis in vivo.Conversely,CBX4 overexpression enhanced these malignant traits.Mechanistically,CBX4 depletion reduced total and nuclearβ-catenin levels and inhibited its transcriptional activity,while CBX4 overexpression had the opposite effect.Critically,XAV939-mediated inhibition of Wnt/β-catenin signaling attenuated the oncogenic effects induced by CBX4 overexpression.Conclusion:CBX4 upregulation promotes GC progression viaβ-catenin signaling activation.The CBX4/β-catenin axis emerges as a promising therapeutic target,offering potential for the development of precision treatment strategies in GC management.展开更多
Background:This study focused on developing and optimizing a self-microemulsifying drug delivery system(SMEDDS)to improve Lafutidine’s solubility and bioavailability,thereby enhancing its effectiveness in treating ga...Background:This study focused on developing and optimizing a self-microemulsifying drug delivery system(SMEDDS)to improve Lafutidine’s solubility and bioavailability,thereby enhancing its effectiveness in treating gastric ulcers.Traditional formulations are less effective due to their limited water solubility and bioavailability.Methods:The study used solubility tests,pseudo-ternary phase diagrams,and central composite design(CCD)to optimize.The formulation was optimized by varying the oil concentration(10–40%)and surfactant/cosurfactant ratio(0.33–3.00),and then tested for droplet size,drug content,emulsification,phase stability,and in vitro dissolution.Results:The study found that the optimized formulation contained 14%Capmul PG 8NF oil,62%Labrasol surfactant,and 24%Tween 80 cosurfactant.This combination generated an average droplet size of 111.02 nm and improved drug release properties.Furthermore,the formulation was stable without phase separation,with a drug content of 88.2–99.8%.Conclusion:SMEDDS significantly improves lafutidine delivery by increasing solubility and absorption,thereby overcoming oral administration challenges.The system quickly formed small droplets in water and released the drug in 15 min.Enhancing lafutidine’s bioavailability may improve its efficacy in treating gastric ulcers,resulting in better patient outcomes and potentially lower dosing frequency.展开更多
AIM: To evaluate the current state-of-the-art of gastric electrical stimulation to treat obesity. METHODS: Systematic reviews of all studies have been conducted to evaluate the effect of different types of gastric ele...AIM: To evaluate the current state-of-the-art of gastric electrical stimulation to treat obesity. METHODS: Systematic reviews of all studies have been conducted to evaluate the effect of different types of gastric electrical stimulation(GES) on obesity.RESULTS: Thirty-one studies consisting of a total of 33 different trials were included in the systematic review for data analysis. Weight loss was achieved in most studies, especially during the first 12 mo, but only very few studies had a follow-up period longer than 1 year. Among those that had a longer follow-up period, many were from the Transcend(Implantable Gastric Stimulation) device group and maintained significant weight loss. Other significant results included changes in appetite/satiety, gastric emptying rate, blood pressure and neurohormone levels or biochemical markers such as ghrelin or HbA1 c respectively. CONCLUSION: GES holds great promises to be an effective obesity treatment. However, stronger evidence is required through more studies with a standardized way of carrying out trials and reporting outcomes, to determine the long-term effect of GES on obesity.展开更多
Gastric cancer(GC)remains a major global health challenge,because of its poor prognosis and limited treatment options in advanced stages1,2.Recent advancements in immunotherapy,highlighted by the findings of the CHECK...Gastric cancer(GC)remains a major global health challenge,because of its poor prognosis and limited treatment options in advanced stages1,2.Recent advancements in immunotherapy,highlighted by the findings of the CHECKMATE-649,ORIENT-16,and KEYNOTE-859 trials,have markedly transformed the treatment paradigm for advanced gastric cancer(AGC)3-5.展开更多
BACKGROUND The clinical effectiveness of magnetically controlled capsule endoscopy(MCE)is well established.However,problems,such as abdominal distension,insufficient gastric filling,and prolonged gastric retention tim...BACKGROUND The clinical effectiveness of magnetically controlled capsule endoscopy(MCE)is well established.However,problems,such as abdominal distension,insufficient gastric filling,and prolonged gastric retention time,persist with MCE gastric preparations.AIM To compare gastric filling using a carbonated soft drink with that using pure water during MCE.METHODS We performed an open-label randomised controlled trial at the Endoscopy Centre of Changhai Hospital in Shanghai.Patients aged 18-80 years,with or without gastrointestinal symptoms,scheduled for MCE were consecutively recruited.Those who provided informed consent were randomly assigned to the carbonated soft drink group(C group)or water group(W group)in a 1:1 ratio.For patients in the W group,1000 mL of water was ingested to distend the stomach,whereas for patients in the C group,550 mL of carbonated soft drink was provided,and patients were required to drink quickly while minimising burping.The primary endpoint was the number of patients with a gastric filling score of≥4 within 5 minutes after the capsule entered the stomach.RESULTS From December 3,2020 to May 17,2021,252 patients(141 men),aged 18-77 years,were assigned to the C(n=126)and W(n=126)groups.For the primary outcome,123 patients in the C group achieved a gastric filling score of≥4(97.62%vs 80.16%,P<0.0001).More patients in the C group had the highest gastric filling scores within the first 5 min(78.57%vs 29.37%,P<0.0001)and 10 minutes(54.76%vs 13.49%,P<0.0001)after the capsule entered the stomach.More patients in the W group required extra liquid for gastric refilling(1.59%vs 16.67%,P<0.0001).Transpyloric passage of the capsule under magnetic control was successfully performed in 43 patients in the C group(P<0.0001),accompanied by a shorter gastric transit time(53.27±53.83 minutes vs 71.12±52.19 minutes,P=0.001).CONCLUSION Carbonated soft drinks demonstrated superior and more sustained gastric filling compared with those of water alone,with the potential to promote gastric emptying.展开更多
Liver cirrhosis(LC)can cause a wide spectrum of gastric mucosal lesions,the main diagnostic method of which is esophagogastroduodenoscopy.In addition to gastric varices,portal hypertensive gastropathy,gastric antral v...Liver cirrhosis(LC)can cause a wide spectrum of gastric mucosal lesions,the main diagnostic method of which is esophagogastroduodenoscopy.In addition to gastric varices,portal hypertensive gastropathy,gastric antral vascular ectasia,portal hypertensive polyps,peptic ulcer disease can be detected.All of these leave LC patients susceptible to bleeding.If visual differential diagnosis is difficult,endoscopic ultrasound and new digital and optical endoscopic technologies such as magnifying endoscopy with narrow-band imaging may be useful.In many cases,endoscopic technologies are also the methods of choice for the treatment of gastric mucosal lesions in LC patients.In particular,argon plasma coagulation can be used for local treatment of portal hypertensive gastropathy bleeding,and argon plasma coagulation,radiofrequency ablation or endoscopic band ligation is recommended as the main method for local treatment of gastric antral vascular ectasia bleeding.Endoscopic therapy for peptic ulcer bleeding is carried out according to the current guidelines.Besides,endoscopic mucosal resection and endoscopic submucosal dissection may be used in LC patients for the treatment of early gastric cancer.The purpose of this review is to provide up–to-date information on the role of endoscopy in the diagnosis and treatment of gastric mucosal lesions in LC patients.展开更多
The five-year survival rate of gastric cancer in China is close to those in European and North Americancountries but far lower than those in the Republic of Korea and Japan where national gastric cancerscreening syste...The five-year survival rate of gastric cancer in China is close to those in European and North Americancountries but far lower than those in the Republic of Korea and Japan where national gastric cancerscreening systems have been established.It is of great significance to build a high-quality gastric cancerscreening system adaptive to China's national conditions.Due to the large number of people at risk ofgastric cancer and the uneven distribution of medical resources,it is still difficult for China to carry out anationwide gastroscopy screening program for gastric cancer.Gastric oral contrast ultrasonography(OCUS)is a promising,non-invasive tool for initial gastric cancer screening,offering a painless,radiationfreealternative.Based on two 2020 OCUS consensuses,this document analyzes national gastric cancerscreening strategies and challenges to elaborate on the necessity,feasibility,and current problems ofpreliminary ultrasound screening in China.It details the key aspects of OCUS,including indications,contraindications,operator requirements,contrast agent standards,and essential scanning protocols.Italso introduces the standardized ultrasound sections and the Stomach Ultrasound Report and Data System(Su-RADS)and proposes the relevant consensus opinions.After several rounds of discussions and voting byexperts from multiple societies,a total of 17 consensus opinions have been formed on OCUS as a preliminary screening technique for gastric cancer,with the aim of standardizing the popularization ofOCUS.In addition,the consensus calls for conducting nationwide multicenter prospective studies toimprove the level of evidence and provide big data support for the construction of a preliminary gastriccancer ultrasound screening system that is in line with China's national conditions.展开更多
BACKGROUND The pathogenesis of non-ampullary duodenal epithelial tumors(NADETs)is not fully understood.NADETs that express gastric-type mucin phenotypes(GNADETs)are noteworthy because of their high malignancy.Gastric ...BACKGROUND The pathogenesis of non-ampullary duodenal epithelial tumors(NADETs)is not fully understood.NADETs that express gastric-type mucin phenotypes(GNADETs)are noteworthy because of their high malignancy.Gastric foveolar metaplasia,from which G-NADETs originate,protects the duodenal mucosa from gastric acidity.As gastric acid secretion is affected by endoscopic gastric mucosal atrophy(EGMA),we hypothesized that EGMA would be associated with GNADETs.AIM To evaluate the association between EGMA and the occurrence of G-NADETs.METHODS This cross-sectional retrospective study investigated the relationship between EGMA and NADETs in 134 patients.The duodenum was divided into parts 1(bulb),2(superior duodenal angle to the papilla),and 3(anal side of the papilla to the horizontal part).The effects of gastric acidity and presence of Brunner’s glands were considered.EGMA was divided into types C(no or mild atrophy)and O(severe atrophy).Mucin phenotype expressions in NADETs were divided into gastric,intestinal,gastrointestinal,and unclassifiable.RESULTS When NADETs were classified according to EGMA,105 were classified as type C and 29 as type O.G-NADETs were present in 11.9%(16 cases)of all cases,and all 16 cases were of type C.Among G-NADETs,93.8%(15 cases)were present in part 1 or 2.There was an association between G-NADETs and type C in part 1,and 50.0%(eight of 16 cases)of G-NADETs were associated with a current or previous Helicobacter pylori infection status.Additionally,all eight cases occurred in part 1.CONCLUSION G-NADETs were significantly associated with type C.Gastric acidity and Brunner's gland growth may be associated with G-NADETs.展开更多
BACKGROUND Detecting gastric precancerous lesions(GPLs)is critical for the early diagnosis and treatment of gastric cancer.Endoscopy combined with tissue examination is an important method for detecting GPLs.However,n...BACKGROUND Detecting gastric precancerous lesions(GPLs)is critical for the early diagnosis and treatment of gastric cancer.Endoscopy combined with tissue examination is an important method for detecting GPLs.However,negative biopsy results often increase patients’risks,economic burdens,and lead to additional healthcare costs.Improving the detection rate of GPLs and reducing the rate of negative biopsies is currently a key focus in endoscopic quality control.AIM To explore the relationships between the endoscopist biopsy rate(EBR),qualifications of endoscopists and endoscopic assistants,and detection rate of GPLs.METHODS EBR,endoscopists,and endoscopic assistants were divided into four groups:Low,moderate,high,and very high levels.Multivariable logistic regression analysis was used to analyze the relationships between EBR and the qualifications of endoscopists with respect to the detection rate of positive lesions.Pearson and Spearman correlation analyses were used to evaluate the correlation between EBR,endoscopist or endoscopic assistant qualifications,and the detection rate of positive lesions.RESULTS Compared with those in the low EBR group,the odds ratio(OR)values for detecting positive lesions in the moderate,high,and very high EBR groups were 1.12[95%confidence interval(CI):1.06-1.19,P<0.001],1.22(95%CI:1.14-1.31,P<0.001),and 1.38(95%CI:1.29-1.47,P<0.001),respectively.EBR was positively correlated with the detection rate of gastric precancerous conditions(atrophic gastritis/intestinal metaplasia)(ρ=0.465,P=0.004).In contrast,the qualifications of the endoscopists were positively correlated with GPLs detection(ρ=0.448,P=0.005).Compared to endoscopists with low qualification levels,those with moderate,high,and very high qualification levels endoscopists demonstrated increased detection rates of GPLs by 13%(OR=1.13,95%CI:0.98-1.31),20%(OR=1.20,95%CI:1.03-1.39),and 32%(OR=1.32,95%CI:1.15-1.52),respectively.Further analysis revealed that the qualifications of endoscopists were positively correlated with the detection rates of GPLs in the cardia(ρ=0.350,P=0.034),angularis(ρ=0.396,P=0.015)and gastric body(ρ=0.453,P=0.005)but not in the antrum(ρ=0.292,P=0.079).Moreover,the experience of endoscopic assistants was positively correlated with the detection rate of precancerous lesions by endoscopists with low or moderate qualifications(ρ=0.427,P=0.015).CONCLUSION Endoscopists and endoscopic assistants with high/very high qualifications,but not EBR,can improve the detection rate of GPLs.These results provide reliable evidence for the development of gastroscopic quality control indicators.展开更多
BACKGROUND Gastric cancer is a major global health concern,often diagnosed at advanced stages,leading to poor prognosis.Proximal and distal gastric cancers exhibit distinct clinicopathological features.AIM To investig...BACKGROUND Gastric cancer is a major global health concern,often diagnosed at advanced stages,leading to poor prognosis.Proximal and distal gastric cancers exhibit distinct clinicopathological features.AIM To investigate the diagnostic value of hematological and inflammatory markers in differentiating proximal and distal gastric cancers and to evaluate their association with clinical outcomes.METHODS A retrospective cohort study was conducted on 150 patients diagnosed with gastric adenocarcinoma through histopathological analysis.Patients were categorized into proximal gastric cancer and distal gastric cancer groups.Laboratory parameters were analyzed.RESULTS Of the 150 patients,84 had proximal gastric cancer and 66 had distal gastric cancer.Dysphagia was significantly more common in the proximal gastric cancer group,while anemia and higher platelet-to-lymphocyte ratio values were observed in the distal gastric cancer group(P=0.031).Tumor stage and neutrophil-to-lymphocyte ratio emerged as independent predictors of all-cause mortality.No significant differences were found in other laboratory or biochemical parameters between the groups.CONCLUSION Proximal and distal gastric cancers demonstrate distinct clinical and laboratory profiles.The platelet-to-lymphocyte ratio may serve as a valuable marker in differentiating cancer localization,while the neutrophil-to-lymphocyte ratio is a prognostic indicator for mortality.These findings highlight the potential of hematological markers in optimizing diagnosis and treatment strategies for gastric cancer.展开更多
基金supported by the National Natural Science Foundation of China(Grant No.82274442)the Key Research Project in Traditional Chinese Medicine of Tianjin Municipal Health Commission(Grant No.202007)the Integrated Traditional Chinese and Western Medicine Research Project of Tianjin Municipal Health Commission(Grant No.2023134).
文摘Background:The development of gastric cancer(GC)encompasses precancerous conditions like chronic atrophic gastritis(CAG)and premalignant lesions of gastric cancer(PLGC).In these situations,abnormal Notch signaling results in mucosal impairment and the initiation of cancer.Banxia Xiexin Decoction(BXD),a well-known formula in traditional Chinese medicine(TCM),shows promise in treating gastric disorders,but its mechanisms in gastric restoration remain unclear.Methods:Using MNNG-induced CAG and PLGC rat models,BXD was administered for 12 weeks.Gastric mucosal pathology was assessed via hematoxylin-eosin staining.Proliferation(Ki-67)and angiogenesis(VEGFA)markers were evaluated by immunohistochemistry.Network pharmacology identified BXD’s targets and pathways.Notch pathway components(Notch1,Jagged1,Dll4,Hes1)were analyzed via qPCR,Western blot,and immunohistochemistry.Results:BXD significantly ameliorated mucosal atrophy,glandular structural disorder,and dysplasia in CAG and PLGC rats.Network pharmacology revealed 323 overlapping targets between BXD and PLGC,with Notch signaling as a central pathway.BXD downregulated Notch1,Jagged1,Dll4,and Hes1 expression at transcriptional and protein levels,suppressed Ki-67(proliferation)and VEGFA(angiogenesis)overexpression,and restored gastric mucosal integrity.Conclusion:BXD inhibits Notch signaling,reduces aberrant proliferation and angiogenesis,and interrupts Correa’s gastric carcinogenesis cascade.This study provides mechanistic evidence supporting BXD as a TCM-based intervention for gastric precancerous lesions.
基金Supported by The Joint Fund of Zhejiang Provincial Natural Science Foundation of China,No.LKLY25H160002.
文摘Gastric cancer(GC)has high morbidity and mortality worldwide.Due to the absence of noticeable symptoms,diagnosing GC at an early stage is very difficult,which consequently leads to advanced GC and poor prognosis.Effective biomarkers are essential for prolonging patients’survival.Helicobacter pylori(H.pylori)infection represents the most significant risk factor for GC,with nearly all cases linked to this infection.Many non-coding RNAs(ncRNAs)are dysregulated in H.pylori-infected GC,indicating that ncRNAs may serve as biomarkers of early-stage GC.In this editorial,we discuss the study by Chen et al.Although previous studies have identified roles for miR-136 in gastric cancer proliferation,apoptosis,and invasion,none have specifically explored its relationship with H.pylori-associated gastric carcinogenesis.
基金National Natural Science Foundation of China,No.82003223and China Postdoctoral Science Foundation,No.2020M671398.
文摘BACKGROUND Gastric cancer(GC)is one of the most common malignant tumors of the digestive system worldwide,the prognosis of patients with advanced GC remains poor.AIM To evaluate the combined expression characteristics of cancer stem cell markers CD24 and CD133 in GC pathological tissues,and to explore their association with patients’clinicopathological parameters and postoperative survival outcomes.METHODS A total of 304 GC patients who underwent surgical treatment in our hospital from January 2018 to January 2020 were retrospectively included.Immunohistochemistry was used to detect the protein expression of CD24 and CD133 in tumor tissues,adjacent tissues,and normal gastric mucosa tissues.Based on staining intensity and the proportion of positive cells,expression levels were classified into low and high expression,while clinicopathological parameters were recorded.χ2 test was used to evaluate the correlation between expression and categorical variables,Spearman rank correlation analysis was performed to assess the correlation between the expression intensities of the two markers,and multivariate regression models were applied to identify independent risk factors influencing co-expression.Kaplan-Meier survival curves and Log-rank test were used to compare survival differences among groups with different expression patterns.RESULTS Among the 304 patients,155 cases(50.99%)were CD24 positive,including 91 low-expression and 64 highexpression;133 cases(43.75%)were CD133 positive,including 81 low-expression and 52 high-expression.There were 74 cases(24.34%)with double positivity and 81 cases(26.64%)with double negativity.Compared with tumor tissues,the positive rates of CD24 and CD133 in normal gastric tissues and adjacent tissues were significantly lower(P<0.05).Univariate analysis showed that co-expression of CD24 and CD133 in GC tissues was significantly correlated with tumor size,Lauren classification,T stage,N stage,and vascular invasion(P<0.05),but not with patient age,gender,tumor site,World Health Organization histological classification,or M stage(P>0.05).Further multivariate regression analysis suggested that tumor size,T stage,N stage,and vascular invasion were independent risk factors promoting CD24 and CD133 double positivity.Spearman rank correlation analysis indicated a moderate positive correlation between their expression intensities(r=0.420,P<0.001).During follow-up,29 of 304 patients were lost(loss rate 9.54%);146 deaths occurred.According to expression combination,there were 89 cases of CD24 single positivity(39 deaths),68 cases of CD133 single positivity(31 deaths),81 cases of double negativity(25 deaths),and 66 cases of double positivity(51 deaths).Log-rank test showed significant differences in overall survival among the four groups(χ2=20.89,P<0.001),with CD24+/CD133+group showing the worst prognosis.CONCLUSION CD24 and CD133 exhibit high positive detection rates in GC tissues,and their co-positivity is closely associated with tumor stage progression and significantly indicates unfavorable survival outcomes.The co-expression of CD24/CD133 may reflect higher aggressiveness and metastatic potential of GC,serving as a potential prognostic marker and a direction for targeted therapeutic strategies.However,as this is a single-center retrospective study with limitations such as patient loss to follow-up and sample size,further prospective,multicenter,and mechanistic studies are required to validate its clinical applicability and biological role.
文摘BACKGROUND Chemotherapy with an immune checkpoint inhibitor is one of the standard regimens for treating advanced gastric cancer(AGC).Ascites and peritoneal dissemination are common complications and poor prognostic factors of AGC;however,reports regarding its efficacy and safety in patients with AGC and massive ascites are limited.AIM To evaluate the safety and efficacy of nivolumab combined with chemotherapy in patients with AGC and ascites.METHODS We retrospectively collected clinical data from 124 patients with AGC who received chemotherapy plus nivolumab as first-line treatment from July 2017 to December 2024.Based on computed tomography scans,massive or moderate ascites were classified as high ascites burden(HAB),whereas mild or no ascites were classified as low ascites burden.RESULTS Ascites was detected in 47 patients(38%);26(21%)were classified into the HAB group.Patients in the HAB group exhibited a significantly poorer performance status,a higher prevalence of diffuse-type histology,and lower programmed cell death ligand 1(PD-L1)expression.Combination therapy with FOLFOX and neutropenia was significantly more common in the HAB group.Progression-free survival(PFS)(4.4 months vs 9.3 months,P=0.0012)and overall survival(OS)(7.3 months vs 21.2 months,P<0.0001)were significantly poorer in the HAB group.However,an improvement in ascites was observed in 61.5%of patients in the HAB group.PD-L1 expression did not correlate with either PFS or OS in the HAB group.CONCLUSION Nivolumab plus chemotherapy demonstrated modest efficacy and acceptable toxicity in patients with AGC and HAB.
文摘Delayed wound healing following radical gastrectomy remains an important yet underappreciated complication that prolongs hospitalization,increases costs,and undermines patient recovery.In An et al’s recent study,the authors present a machine learning-based risk prediction approach using routinely available clinical and laboratory parameters.Among the evaluated algorithms,a decision tree model demonstrated excellent discrimination,achieving an area under the curve of 0.951 in the validation set and notably identifying all true cases of delayed wound healing at the Youden index threshold.The inclusion of variables such as drainage duration,preoperative white blood cell and neutrophil counts,alongside age and sex,highlights the pragmatic appeal of the model for early postoperative monitoring.Nevertheless,several aspects warrant critical reflection,including the reliance on a postoperative variable(drainage duration),internal validation only,and certain reporting inconsistencies.This letter underscores both the promise and the limitations of adopting interpretable machine learning models in perioperative care.We advocate for transparent reporting,external validation,and careful consideration of clinically actionable timepoints before integration into practice.Ultimately,this work represents a valuable step toward precision risk stratification in gastric cancer surgery,and sets the stage for multicenter,prospective evaluations.
基金Supported by China Health&Medical Development Foundation,No.M2021551.
文摘BACKGROUND Inappropriate selection of patients with early gastric cancer(EGC)for endoscopic submucosal dissection(ESD)may lead to non-curative resection,necessitating additional gastrectomy.Conversely,inappropriate selection for gastrectomy may result in overtreatment,adversely affecting patients’quality of life.Few have systematically evaluated the concordance between therapeutic indications under current Japanese guidelines and pathological criteria in EGC.To minimize noncurative resection risks while sparing unnecessary surgery for low-risk patients’,we specifically assess the suitability of Japanese guidelines in non-Japanese populations.This work aims to optimize clinical practice by refining endoscopic treatment criteria for adoption beyond Japan.AIM To evaluate EGC clinical decision accuracy by comparing therapeutic indication with postoperative pathological criteria and analyzing factors influencing discrepancies.METHODS A retrospective analysis was conducted on 796 EGC cases diagnosed at Peking University Third Hospital between January 2010 and December 2022.Cases were categorized into three groups:Same-estimated(preoperative therapeutic indication with postoperative pathological criteria matched),underestimated(preoperative ESD indication but postoperative surgical criteria),and overestimated(preoperative surgical indication but postoperative ESD criteria).The rate of discrepancy and associated risk factors were assessed.RESULTS The accuracy rates of preoperative evaluation for ESD and gastrectomy indications were 73.0%(321/430)and 76.0%(278/366),respectively.The overall discrepancy rate was 25.6%(204/796).Multivariate analysis identified tumor location in the upper-third stomach(odds ratio=2.158,95%confidence interval:1.373-3.390,P=0.001)was significantly associated with a higher likelihood of being underestimated and undifferentiated histologic type on preoperative biopsy(odds ratio=2.005,95%confidence interval:1.036-3.879,P=0.039)was more likely to be overestimated.Significant differences were observed in tumor diameter(P<0.001),depth of infiltration(P<0.001),ulcerative findings(P<0.001),and histologic type(P<0.001)between preoperative and postoperative evaluations.CONCLUSION The accuracy of preoperative EGC indications is 74.4%.Upper-third stomach and undifferentiated histology are primary discrepancy predictors.Upper-third tumors are prone to underestimation,while undifferentiated tumors are prone to overestimation.
基金Supported by the National Natural Science Foundation of China,No.82170406 and No.81970238.
文摘Gastric ulcer(GU)represents a clinically significant manifestation of peptic ulcer disease,driven by a complex interplay of microbial,environmental,and immuneinflammatory factors.A recent cross-sectional study by Shen et al systematically evaluated six complete blood count-derived inflammatory indices:Neutrophil-tolymphocyte ratio,monocyte-to-lymphocyte ratio,platelet-to-lymphocyte ratio,systemic immune-inflammation index,systemic inflammatory response index(SIRI),and aggregate index of systemic inflammation and demonstrated their positive associations with GU prevalence,identifying SIRI as the strongest predictor.This editorial contextualizes these findings within the broader literature,clarifies that these indices reflect systemic rather than GU-specific inflammation,highlights methodological strengths and major limitations,and proposes a conceptual clinical algorithm for integrating SIRI into GU risk assessment.Future multicenter studies incorporating Helicobacter pylori infection,non-steroidal antiinflammatory drug exposure,and prospective design are essential to validate and translate these findings into clinical practice.
文摘Wu et al recently applied multi-region 16S rRNA sequencing to characterize the gastric cancer microbiome,demonstrating improved taxonomic resolution and detection sensitivity over conventional single-region approaches.While the study represents a valuable methodological step forward,it remains limited by singlecenter design,lack of quantitative calibration,and insufficient control for contamination and inter-laboratory variability.This editorial critically appraises these methodological gaps and emphasizes that future efforts must focus on harmonized,consensus-driven workflows to ensure reproducibility and clinical reliability.The translational potential of multi-region 16S lies in moving from descriptive microbial profiling to actionable clinical integration,particularly for recurrence prediction,treatment-response monitoring,and perioperative complication risk assessment.By addressing these methodological,economic,and ethical challenges,the field can advance toward evidence-based and clinically deployable microbiome-guided precision oncology.
文摘Gastric cancer(GC)is the fifth most prevalent malignancy worldwide and remains a leading cause of cancer-related mortality.Major risk factors for GC include Helicobacter pylori infection,increasing age,high dietary salt intake,and diets deficient in vegetables and fruits.Due to the often subtle and nonspecific early symptoms,coupled with the lack of routine screening programs,a significant proportion of GC cases are diagnosed at advanced stages.The etiology of GC is multifactorial,and diagnosis is confirmed histologically through endoscopic biopsy,followed by staging via computed tomography,positron emission tomography,staging laparoscopy,and endoscopic ultrasound.Treatment strategies typically involve a multidisciplinary approach including chemotherapy,surgical resection,radiotherapy,and emerging immunotherapeutic options.Despite advances in diagnostic and therapeutic modalities,the prognosis of advanced GC remains poor,with high rates of recurrence and metastasis.In recent years,increasing attention has been given to the role of tight junction(TJ)proteins in the pathogenesis and progression of GC.TJ proteins,critical components of epithelial barrier function,have been implicated in various stages of gastric carcinogenesis,from intestinal metaplasia to invasion and metastasis.Infection and inflammation,particularly due to Helicobacter pylori,disrupt TJ integrity,compromising the gastric mucosal barrier and facilitating neoplastic transformation.This review synthesizes current evidence from PubMed,EMBASE,Google Scholar,ScienceDirect,SpringerLink,and other reputable databases to provide a comprehensive overview of the involvement of TJ proteins in GC.By elucidating the molecular interplay between TJ dysregulation and gastric tumorigenesis,this work aims to highlight the potential of TJ proteins as novel diagnostic biomarkers and therapeutic targets in GC management.
文摘BACKGROUND Early screening,preoperative staging,and diagnosis of lymph node metastasis are crucial for improving the prognosis of gastric cancer(GC).AIM To evaluate the diagnostic value of combined multidetector computed tomography(MDCT)and gastrointestinal endoscopy for GC screening,preoperative staging,and lymph node metastasis detection,thereby providing a reference for clinical diagnosis and treatment.METHODS In this retrospective study clinical and imaging data of 134 patients with suspected GC who were admitted between January 2023 and October 2024 were initially reviewed.According to the inclusion and exclusion criteria,102 patients were finally enrolled in the analysis.All enrolled patients had undergone both MDCT and gastrointestinal endoscopy examinations prior to surgical intervention.Preoperative clinical staging and lymph node metastasis findings were compared with pathological results.RESULTS The combined use of MDCT and gastrointestinal endoscopy demonstrated a sensitivity of 98.53%,specificity of 97.06%,accuracy of 98.04%,positive predictive value of 98.53%,and negative predictive value of 97.06%for diagnosing GC.These factors were all significantly higher than those of MDCT or endoscopy alone(P<0.05).The accuracy rates of the combined approach for detecting clinical T and N stages were 97.06%and 92.65%,respectively,outperforming MDCT alone(86.76% and 79.41%)and endoscopy alone(85.29% and 70.59%)(P<0.05).Among 68 patients with confirmed GC,50(73.53%)were pathologically diagnosed with lymph node metastasis.The accuracy for detecting lymph node metastasis was 66.00%with endoscopy,76.00%with MDCT,and 92.00% with the combined approach,all with statistically significant differences(P<0.05).CONCLUSION The combined application of MDCT and gastrointestinal endoscopy enhanced diagnostic accuracy for GC,provided greater consistency in preoperative staging,and improved the detection of lymph node metastasis,thereby demonstrating significant clinical utility.
基金funded by the National Natural Science Foundation of China(Grant No.82473566)the Science and Technology Plan Project of Jiangsu Province(Grant No.BE2022728)+2 种基金the Natural Science Foundation of the Higher Education Institutions of Jiangsu Province(Grant No.24KJB320015)the Postgraduate Research&Practice Innovation Program of Jiangsu Province(Grant Nos.SJCX24_1822 and SJCX21_1354)the Soochow University Open Topic from Jiangsu Engineering Laboratory of Novel Functional Polymeric Materials(Grant No.SDGC2312).
文摘Objectives:Chromobox 4(CBX4),a polycomb protein family member linked to tumor pathogenesis via dysregulation,has an incompletely defined role in gastric cancer(GC).The study aimed to investigate the role and mechanism of CBX4 in GC progression and evaluate its potential as a therapeutic target.Methods:CBX4 expression was assessed in GC tissues vs.adjacent non-cancerous tissues and in GC cell lines vs.normal gastric mucosal epithelial cells.Clinicopathological correlations were analyzed.Functional impacts of CBX4 were determined using knockdown and overexpression models in vitro(cell proliferation,migration,invasion)and in vivo(xenograft tumorigenesis in nude mice).Mechanistic studies evaluatedβ-catenin levels(total and nuclear)and transcriptional activity following CBX4 modulation.The functional dependency on Wnt/β-catenin signaling was tested using the pharmacological inhibitor XAV939 in CBX4-overexpressing cells.Results:CBX4 expression was significantly upregulated in GC tissues and cell lines.Elevated CBX4 levels strongly correlated with aggressive tumor characteristics,including larger tumor size,lymph node metastasis,and advanced Tumor,Node,Metastasis(TNM)stage.Functionally,CBX4 knockdown suppressed GC cell proliferation,migration,invasion in vitro,and tumorigenesis in vivo.Conversely,CBX4 overexpression enhanced these malignant traits.Mechanistically,CBX4 depletion reduced total and nuclearβ-catenin levels and inhibited its transcriptional activity,while CBX4 overexpression had the opposite effect.Critically,XAV939-mediated inhibition of Wnt/β-catenin signaling attenuated the oncogenic effects induced by CBX4 overexpression.Conclusion:CBX4 upregulation promotes GC progression viaβ-catenin signaling activation.The CBX4/β-catenin axis emerges as a promising therapeutic target,offering potential for the development of precision treatment strategies in GC management.
文摘Background:This study focused on developing and optimizing a self-microemulsifying drug delivery system(SMEDDS)to improve Lafutidine’s solubility and bioavailability,thereby enhancing its effectiveness in treating gastric ulcers.Traditional formulations are less effective due to their limited water solubility and bioavailability.Methods:The study used solubility tests,pseudo-ternary phase diagrams,and central composite design(CCD)to optimize.The formulation was optimized by varying the oil concentration(10–40%)and surfactant/cosurfactant ratio(0.33–3.00),and then tested for droplet size,drug content,emulsification,phase stability,and in vitro dissolution.Results:The study found that the optimized formulation contained 14%Capmul PG 8NF oil,62%Labrasol surfactant,and 24%Tween 80 cosurfactant.This combination generated an average droplet size of 111.02 nm and improved drug release properties.Furthermore,the formulation was stable without phase separation,with a drug content of 88.2–99.8%.Conclusion:SMEDDS significantly improves lafutidine delivery by increasing solubility and absorption,thereby overcoming oral administration challenges.The system quickly formed small droplets in water and released the drug in 15 min.Enhancing lafutidine’s bioavailability may improve its efficacy in treating gastric ulcers,resulting in better patient outcomes and potentially lower dosing frequency.
文摘AIM: To evaluate the current state-of-the-art of gastric electrical stimulation to treat obesity. METHODS: Systematic reviews of all studies have been conducted to evaluate the effect of different types of gastric electrical stimulation(GES) on obesity.RESULTS: Thirty-one studies consisting of a total of 33 different trials were included in the systematic review for data analysis. Weight loss was achieved in most studies, especially during the first 12 mo, but only very few studies had a follow-up period longer than 1 year. Among those that had a longer follow-up period, many were from the Transcend(Implantable Gastric Stimulation) device group and maintained significant weight loss. Other significant results included changes in appetite/satiety, gastric emptying rate, blood pressure and neurohormone levels or biochemical markers such as ghrelin or HbA1 c respectively. CONCLUSION: GES holds great promises to be an effective obesity treatment. However, stronger evidence is required through more studies with a standardized way of carrying out trials and reporting outcomes, to determine the long-term effect of GES on obesity.
基金supported by The National Key Research and Development Program of China(Grant no.2021YFA0910100)Healthy Zhejiang One Million People Cohort(Grant no.K-20230085)+5 种基金Post-doctoral Innovative Talent Support Program(Grant no.BX2023375)Lingyan Project of Zhejiang Provincial Department of Science and Technology(Grant no.2025C02059)the National Natural Science Foundation of China(Grant nos.82304946,82473489,and 82403546)Natural Science Foundation of Zhejiang Province(Grant nos.LR21H280001,LGF22H160056,ZCLQN25H1602,and LMS25H160006)Medicine and Health Science Fund of Zhejiang Province Health Commission(Grant nos.2025KY047 and 2022KY658)Traditional Chinese Medicine Science and Technology Project of Zhejiang Provincial Health Commission(Grant no.2022ZA023).
文摘Gastric cancer(GC)remains a major global health challenge,because of its poor prognosis and limited treatment options in advanced stages1,2.Recent advancements in immunotherapy,highlighted by the findings of the CHECKMATE-649,ORIENT-16,and KEYNOTE-859 trials,have markedly transformed the treatment paradigm for advanced gastric cancer(AGC)3-5.
基金Supported by Shanghai Municipal Hospital Emerging Frontier Technology Joint Project,No.SHDC12019105Shanghai Science and Technology Development Funds,No.24YF2758200National Natural Science Foundation of China,No.82100699.
文摘BACKGROUND The clinical effectiveness of magnetically controlled capsule endoscopy(MCE)is well established.However,problems,such as abdominal distension,insufficient gastric filling,and prolonged gastric retention time,persist with MCE gastric preparations.AIM To compare gastric filling using a carbonated soft drink with that using pure water during MCE.METHODS We performed an open-label randomised controlled trial at the Endoscopy Centre of Changhai Hospital in Shanghai.Patients aged 18-80 years,with or without gastrointestinal symptoms,scheduled for MCE were consecutively recruited.Those who provided informed consent were randomly assigned to the carbonated soft drink group(C group)or water group(W group)in a 1:1 ratio.For patients in the W group,1000 mL of water was ingested to distend the stomach,whereas for patients in the C group,550 mL of carbonated soft drink was provided,and patients were required to drink quickly while minimising burping.The primary endpoint was the number of patients with a gastric filling score of≥4 within 5 minutes after the capsule entered the stomach.RESULTS From December 3,2020 to May 17,2021,252 patients(141 men),aged 18-77 years,were assigned to the C(n=126)and W(n=126)groups.For the primary outcome,123 patients in the C group achieved a gastric filling score of≥4(97.62%vs 80.16%,P<0.0001).More patients in the C group had the highest gastric filling scores within the first 5 min(78.57%vs 29.37%,P<0.0001)and 10 minutes(54.76%vs 13.49%,P<0.0001)after the capsule entered the stomach.More patients in the W group required extra liquid for gastric refilling(1.59%vs 16.67%,P<0.0001).Transpyloric passage of the capsule under magnetic control was successfully performed in 43 patients in the C group(P<0.0001),accompanied by a shorter gastric transit time(53.27±53.83 minutes vs 71.12±52.19 minutes,P=0.001).CONCLUSION Carbonated soft drinks demonstrated superior and more sustained gastric filling compared with those of water alone,with the potential to promote gastric emptying.
文摘Liver cirrhosis(LC)can cause a wide spectrum of gastric mucosal lesions,the main diagnostic method of which is esophagogastroduodenoscopy.In addition to gastric varices,portal hypertensive gastropathy,gastric antral vascular ectasia,portal hypertensive polyps,peptic ulcer disease can be detected.All of these leave LC patients susceptible to bleeding.If visual differential diagnosis is difficult,endoscopic ultrasound and new digital and optical endoscopic technologies such as magnifying endoscopy with narrow-band imaging may be useful.In many cases,endoscopic technologies are also the methods of choice for the treatment of gastric mucosal lesions in LC patients.In particular,argon plasma coagulation can be used for local treatment of portal hypertensive gastropathy bleeding,and argon plasma coagulation,radiofrequency ablation or endoscopic band ligation is recommended as the main method for local treatment of gastric antral vascular ectasia bleeding.Endoscopic therapy for peptic ulcer bleeding is carried out according to the current guidelines.Besides,endoscopic mucosal resection and endoscopic submucosal dissection may be used in LC patients for the treatment of early gastric cancer.The purpose of this review is to provide up–to-date information on the role of endoscopy in the diagnosis and treatment of gastric mucosal lesions in LC patients.
基金supported by the CAMS Innovation Fund for Medical Sciences(2023-I2M-C&T-B-016)lthe National High Level Hospital Clinical Research Funding(2022-PUMCH-C-048)l the Noncommunicable Chronic Diseases-National Science and Technology Major Project(2024ZD0520600).
文摘The five-year survival rate of gastric cancer in China is close to those in European and North Americancountries but far lower than those in the Republic of Korea and Japan where national gastric cancerscreening systems have been established.It is of great significance to build a high-quality gastric cancerscreening system adaptive to China's national conditions.Due to the large number of people at risk ofgastric cancer and the uneven distribution of medical resources,it is still difficult for China to carry out anationwide gastroscopy screening program for gastric cancer.Gastric oral contrast ultrasonography(OCUS)is a promising,non-invasive tool for initial gastric cancer screening,offering a painless,radiationfreealternative.Based on two 2020 OCUS consensuses,this document analyzes national gastric cancerscreening strategies and challenges to elaborate on the necessity,feasibility,and current problems ofpreliminary ultrasound screening in China.It details the key aspects of OCUS,including indications,contraindications,operator requirements,contrast agent standards,and essential scanning protocols.Italso introduces the standardized ultrasound sections and the Stomach Ultrasound Report and Data System(Su-RADS)and proposes the relevant consensus opinions.After several rounds of discussions and voting byexperts from multiple societies,a total of 17 consensus opinions have been formed on OCUS as a preliminary screening technique for gastric cancer,with the aim of standardizing the popularization ofOCUS.In addition,the consensus calls for conducting nationwide multicenter prospective studies toimprove the level of evidence and provide big data support for the construction of a preliminary gastriccancer ultrasound screening system that is in line with China's national conditions.
文摘BACKGROUND The pathogenesis of non-ampullary duodenal epithelial tumors(NADETs)is not fully understood.NADETs that express gastric-type mucin phenotypes(GNADETs)are noteworthy because of their high malignancy.Gastric foveolar metaplasia,from which G-NADETs originate,protects the duodenal mucosa from gastric acidity.As gastric acid secretion is affected by endoscopic gastric mucosal atrophy(EGMA),we hypothesized that EGMA would be associated with GNADETs.AIM To evaluate the association between EGMA and the occurrence of G-NADETs.METHODS This cross-sectional retrospective study investigated the relationship between EGMA and NADETs in 134 patients.The duodenum was divided into parts 1(bulb),2(superior duodenal angle to the papilla),and 3(anal side of the papilla to the horizontal part).The effects of gastric acidity and presence of Brunner’s glands were considered.EGMA was divided into types C(no or mild atrophy)and O(severe atrophy).Mucin phenotype expressions in NADETs were divided into gastric,intestinal,gastrointestinal,and unclassifiable.RESULTS When NADETs were classified according to EGMA,105 were classified as type C and 29 as type O.G-NADETs were present in 11.9%(16 cases)of all cases,and all 16 cases were of type C.Among G-NADETs,93.8%(15 cases)were present in part 1 or 2.There was an association between G-NADETs and type C in part 1,and 50.0%(eight of 16 cases)of G-NADETs were associated with a current or previous Helicobacter pylori infection status.Additionally,all eight cases occurred in part 1.CONCLUSION G-NADETs were significantly associated with type C.Gastric acidity and Brunner's gland growth may be associated with G-NADETs.
基金Supported by Jiangsu Science and Technology Project,No.BK20211039the Top Talent Support Program for Young and Middle-Aged People of the Wuxi Health Committee,No.BJ2023008+3 种基金the Major Program of Wuxi Medical Center,Nanjing Medical University,No.WMCM202305the Cohort and Clinical Research Program of Wuxi Medical Center,Nanjing Medical University,No.WMCC202302the Scientific Research Program of Wuxi Health Commission,No.Z202208Wuxi Municipal Health and Health Commission Precision Medicine Project,No.J202104.
文摘BACKGROUND Detecting gastric precancerous lesions(GPLs)is critical for the early diagnosis and treatment of gastric cancer.Endoscopy combined with tissue examination is an important method for detecting GPLs.However,negative biopsy results often increase patients’risks,economic burdens,and lead to additional healthcare costs.Improving the detection rate of GPLs and reducing the rate of negative biopsies is currently a key focus in endoscopic quality control.AIM To explore the relationships between the endoscopist biopsy rate(EBR),qualifications of endoscopists and endoscopic assistants,and detection rate of GPLs.METHODS EBR,endoscopists,and endoscopic assistants were divided into four groups:Low,moderate,high,and very high levels.Multivariable logistic regression analysis was used to analyze the relationships between EBR and the qualifications of endoscopists with respect to the detection rate of positive lesions.Pearson and Spearman correlation analyses were used to evaluate the correlation between EBR,endoscopist or endoscopic assistant qualifications,and the detection rate of positive lesions.RESULTS Compared with those in the low EBR group,the odds ratio(OR)values for detecting positive lesions in the moderate,high,and very high EBR groups were 1.12[95%confidence interval(CI):1.06-1.19,P<0.001],1.22(95%CI:1.14-1.31,P<0.001),and 1.38(95%CI:1.29-1.47,P<0.001),respectively.EBR was positively correlated with the detection rate of gastric precancerous conditions(atrophic gastritis/intestinal metaplasia)(ρ=0.465,P=0.004).In contrast,the qualifications of the endoscopists were positively correlated with GPLs detection(ρ=0.448,P=0.005).Compared to endoscopists with low qualification levels,those with moderate,high,and very high qualification levels endoscopists demonstrated increased detection rates of GPLs by 13%(OR=1.13,95%CI:0.98-1.31),20%(OR=1.20,95%CI:1.03-1.39),and 32%(OR=1.32,95%CI:1.15-1.52),respectively.Further analysis revealed that the qualifications of endoscopists were positively correlated with the detection rates of GPLs in the cardia(ρ=0.350,P=0.034),angularis(ρ=0.396,P=0.015)and gastric body(ρ=0.453,P=0.005)but not in the antrum(ρ=0.292,P=0.079).Moreover,the experience of endoscopic assistants was positively correlated with the detection rate of precancerous lesions by endoscopists with low or moderate qualifications(ρ=0.427,P=0.015).CONCLUSION Endoscopists and endoscopic assistants with high/very high qualifications,but not EBR,can improve the detection rate of GPLs.These results provide reliable evidence for the development of gastroscopic quality control indicators.
基金This study was approved by the Agrı Training and Research Hospital Scientific Research Ethics Committee(No.E-95531838-050.99-86900)conducted in accordance with the Declaration of Helsinki.
文摘BACKGROUND Gastric cancer is a major global health concern,often diagnosed at advanced stages,leading to poor prognosis.Proximal and distal gastric cancers exhibit distinct clinicopathological features.AIM To investigate the diagnostic value of hematological and inflammatory markers in differentiating proximal and distal gastric cancers and to evaluate their association with clinical outcomes.METHODS A retrospective cohort study was conducted on 150 patients diagnosed with gastric adenocarcinoma through histopathological analysis.Patients were categorized into proximal gastric cancer and distal gastric cancer groups.Laboratory parameters were analyzed.RESULTS Of the 150 patients,84 had proximal gastric cancer and 66 had distal gastric cancer.Dysphagia was significantly more common in the proximal gastric cancer group,while anemia and higher platelet-to-lymphocyte ratio values were observed in the distal gastric cancer group(P=0.031).Tumor stage and neutrophil-to-lymphocyte ratio emerged as independent predictors of all-cause mortality.No significant differences were found in other laboratory or biochemical parameters between the groups.CONCLUSION Proximal and distal gastric cancers demonstrate distinct clinical and laboratory profiles.The platelet-to-lymphocyte ratio may serve as a valuable marker in differentiating cancer localization,while the neutrophil-to-lymphocyte ratio is a prognostic indicator for mortality.These findings highlight the potential of hematological markers in optimizing diagnosis and treatment strategies for gastric cancer.
