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
BACKGROUND Digestive tract subepithelial lesions(SELs)are relatively common,and early diagnosis and treatment are critical for improving patient quality of life and prognosis.However,diagnostic uncertainty often leads...BACKGROUND Digestive tract subepithelial lesions(SELs)are relatively common,and early diagnosis and treatment are critical for improving patient quality of life and prognosis.However,diagnostic uncertainty often leads to negative psychological effects,including anxiety and depression.AIM To investigate the prevalence of anxiety and depressive symptoms and identify associated factors among patients with digestive tract SELs.METHODS This retrospective study included 296 consecutive patients diagnosed with digestive tract SELs at the Affiliated Hospital of North Sichuan Medical College Endoscopy Center between October 2024 and April 2025.Demographic and clinical data were collected through standardized questionnaires.Anxiety and depression were assessed using the Self-Rating Anxiety Scale and the Self-Rating Depression Scale,respectively,while sleep quality was evaluated using the Pittsburgh Sleep Quality Index.Participants were classified into anxiety vs nonanxiety and depression vs non-depression groups based on established cutoff scores,and potential determinants were examined.RESULTS Anxiety symptoms were observed in 35.8%of cases(mean Self-Rating Anxiety Scale score:46.56±9.13)and depressive symptoms in 33.1%(mean Self-Rating Depression scale score:48.64±8.30).Pittsburgh Sleep Quality Index scores were positively correlated with both anxiety and depression(P<0.05).Univariate analysis identified age,annual income,sleep disorders,and endoscopic ultrasonography(EUS)evaluation status as significant factors(P<0.05).Multivariable analysis revealed that low annual income(<10000 Chinese yuan)and sleep disorders were independent risk factors,whereas undergoing EUS examination and having disease awareness were protective factors against anxiety and depression(P<0.05).CONCLUSION Patients with digestive tract SELs are at increased risk for anxiety and depression,with poor sleep strongly linked to worsening psychological symptoms.Early diagnostic assessment with EUS appears to serve a protective role against the onset of these psychological disorders.展开更多
Recent evidence suggests that ferroptosis plays a crucial role in the occurrence and development of white matter lesions.However,the mechanisms and regulatory pathways involved in ferroptosis within white matter lesio...Recent evidence suggests that ferroptosis plays a crucial role in the occurrence and development of white matter lesions.However,the mechanisms and regulatory pathways involved in ferroptosis within white matter lesions remain unclear.Long non-coding RNAs(lnc RNAs)have been shown to influence the occurrence and development of these lesions.We previously identified lnc_011797 as a biomarker of white matter lesions by high-throughput sequencing.To investigate the mechanism by which lnc_011797 regulates white matter lesions,we established subjected human umbilical vein endothelial cells to oxygenglucose deprivation to simulate conditions associated with white matter lesions.The cells were transfected with lnc_011797 overexpression or knockdown lentiviruses.Our findings indicate that lnc_011797 promoted ferroptosis in these cells,leading to the formation of white matter lesions.Furthermore,lnc_011797 functioned as a competitive endogenous RNA(ce RNA)for mi R-193b-3p,thereby regulating the expression of WNK1 and its downstream ferroptosis-related proteins.To validate the role of lnc_011797 in vivo,we established a mouse model of white matter lesions through bilateral common carotid artery stenosis.The results from this model confirmed that lnc_011797 regulates ferroptosis via WNK1 and promotes the development of white matter lesions.These findings clarify the mechanism by which lnc RNAs regulate white matter lesions,providing a new target for the diagnosis and treatment of white matter lesions.展开更多
Background Quantitative flow ratio(QFR) holds significant value in guiding drug-coated balloon(DCB) treatment and enhancing outcomes. However, the predictive capability of post-angioplasty QFR for long-term clinical e...Background Quantitative flow ratio(QFR) holds significant value in guiding drug-coated balloon(DCB) treatment and enhancing outcomes. However, the predictive capability of post-angioplasty QFR for long-term clinical events in patients with de novo lesions who receive DCB treatment remains uncertain. The aim of this study was to explore the potential significance of post-angioplasty QFR measurements in predicting clinical outcomes in patients underwent DCB treatment for de novo lesions.Methods Patients who underwent DCB-only intervention for de novo lesions were enrolled. QFR was conducted after DCB treatment. The patients were then categorized based on post-angioplasty QFR. The primary endpoint was major adverse cardiac events(MACE), encompassing all-cause death, cardiovascular death, nonfatal myocardial infarction, stroke, and target vessel revascularization.Results A total of 553 patients with 561 lesions were included. The median follow-up period was 505 days, during which 66(11.8%) MACEs occurred. Based on post-procedural QFR grouping, there were 259 cases in the high QFR group(QFR > 0.93) and302 cases in the low QFR group(QFR ≤ 0.93). Kaplan-Meier analysis revealed a significantly higher cumulative incidence of MACE in the low QFR group(log-rank P = 0.004). The multivariate Cox proportional hazards model demonstrated a significant inverse correlation between QFR and the occurrence of MACEs(HR = 0.522, 95%CI: 0.289-0.942, P = 0.031). Landmark analysis indicated that high QFR had a significant reducing effect on the cumulative incidence of MACEs within 1 year(log-rank P = 0.016)and 1-5 years(log-rank P = 0.026).Conclusions In patients who underwent DCB-only treatment for de novo lesions, higher post-procedural QFR values(> 0.93)were identified as an independent protective factor against adverse prognosis.展开更多
This letter critically evaluates Jiang et al's article on the differentiation of benign and malignant liver lesions using Emax and platelet count.Despite notable findings,significant methodological and interpretat...This letter critically evaluates Jiang et al's article on the differentiation of benign and malignant liver lesions using Emax and platelet count.Despite notable findings,significant methodological and interpretative limitations are identified.The study lacks detailed assay conditions for Emax measurement,employs inadequate statistical methods without robust multivariate analysis,and does not provide clinically relevant threshold values.The nomogram's reliance on Emax as a major diagnostic contributor is questionable due to attenuation in hepatocellular carcinoma patients with cirrhosis.Moreover,the study's limitations,such as selection bias and confounding factors,are not adequately addressed.Future research should adopt more rigorous methodologies,including prospective studies with larger cohorts and standardized protocols for biomarker measurement,to enhance validity and clinical applicability.展开更多
Calvarial lesions are usually incidental and asymptomatic,rarely detected.However,these lesions can also present with pain,a palpable mass or a bone defect.Clinical information such as the patient’s age and medical h...Calvarial lesions are usually incidental and asymptomatic,rarely detected.However,these lesions can also present with pain,a palpable mass or a bone defect.Clinical information such as the patient’s age and medical history are helpful in making the correct diagnosis.Calvarial lesions may occur due to congenital and anatomical variants,traumatic and iatrogenic,idiopathic,infectious and inflammatory,metabolic,benign and malignant neoplastic causes.Calvarial lesions may be solitary,multiple or diffuse,and may be lytic,sclerotic or mixed.Although most calvarial lesions are benign,radiologic imaging features can help to determine whether the lesion is benign or malignant.Methods that can guide treatment and are currently in use include plain radiography,ultrasonography,computed tomography,magnetic resonance imaging,angiographic studies,and nuclear scintigraphy studies such as 18F-fluorodeoxyglucose positron emission tomography and whole-body bone scintigraphy.Defects,lysis and sclerosis in the bone structure are assessed by plain radiography and computed tomography,and the soft tissue components of the lesions and their relationship to the surrounding soft tissue are assessed by magnetic resonance imaging.This article reviews the imaging findings of benign and malignant calvarial lesions and normal variants that may be confused with systemic diseases and pathologies affecting the calvarium.展开更多
Pathological mineralizations in breast lesions are closely associated with disease progression and serves as a critical diagnostic indicator.However,systematic understanding remains lacking regarding the phase categor...Pathological mineralizations in breast lesions are closely associated with disease progression and serves as a critical diagnostic indicator.However,systematic understanding remains lacking regarding the phase categories,distribution patterns,and proportional occurrences of mineral phases across different breast lesion types.The diagnostic implications of specific phases,such as calcium oxalate,for distinguishing benign and malignant lesions remain controversial.This study employed polarizing microscopy,environmental scanning electron microscopy(SEM)with energy dispersive spectroscopy(EDS),transmission electron microscopy(TEM),Fourier transform infrared spectroscopy(FTIR),and Raman spectroscopy to analyze the phase composition of 61 mineralized samples from three lesion types:Invasive carcinoma,carcinoma in situ and benign lesions.Results demonstrate that breast lesion mineralizations predominantly comprise calcium phosphates,including hydroxyapatite(HA),amorphous calcium phosphate(ACP),and whitlockite,occasionally accompanied by calcium oxalate(monohydrate or dihydrate).Distinct distribution patterns and proportional occurrences of minerals were observed among the three types of lesion mineralizations.HA,as the predominant phase,was ubiquitously present across all three lesion categories.ACP,a mineralization precursor phase,emerged during early mineralization stages across all lesion types.Notably,whitlockite exclusively occurred in benign lesions and carcinoma in situ,with higher prevalence in benign cases,suggesting a progressive decline in Mg^(2+)concentration within the lesion microenvironment as malignancy advances.Calcium oxalate coexisted with HA in mineralized regions across all lesion types,and its presence in invasive carcinoma specimens warrants heightened clinical attention.展开更多
BACKGROUND Endoscopic ultrasound(EUS)is crucial for diagnosing solid pancreatic lesions,especially pancreatic ductal adenocarcinoma(PDAC),a highly aggressive cancer which represents the majority with a prevalence of a...BACKGROUND Endoscopic ultrasound(EUS)is crucial for diagnosing solid pancreatic lesions,especially pancreatic ductal adenocarcinoma(PDAC),a highly aggressive cancer which represents the majority with a prevalence of approximately 85%.AIM To identify EUS features that differentiate PDAC from other lesions such as neuroendocrine tumors(NETs)and helping in the differential diagnosis,by analyzing a large sample of solid pancreatic lesions.METHODS This observational,retrospective,multicenter study analyzed the endosonographic characteristics of 761 patients with a radiological diagnosis of solid pancreatic lesion,who underwent pancreatic EUS for typing and staging with needle biopsies between 2015 and 2023.General patient characteristics(age and sex)and solid lesion features were collected and described,such lesion size(Bmode),vessel involvement(compression or invasion),ductal dilation,lymphadenopathy,echogenicity,echopattern,margin regularity,multifocality,internal vascularization and elastography.Subsequently,a predictive analysis was performed through univariate and multivariate logistic regression to identify predictive features for PDAC or NET diagnoses.RESULTS Our study enrolled 761 patients,predominantly male with a mean age of 68.6.PDACs were generally larger(mean 33 mm×27 mm),often had irregular margins,and displayed significant upstream ductal dilation.Hypoechogenicity was common across malignant lesions.In contrast,NETs were smaller(mean 20 mm×17 mm)and typically had regular margins with multiple lesions.Vascular involvement,although predominant in PDAC,is a common feature of all malignant neoplasms.Multifocality,however,although a rare finding,is more typical of NETs and metastases,and practically absent in the remaining lesions.Predictive analyses showed that ductal dilation and irregular margins were the most significant predictors for PDAC[odds ratio(OR)=5.75 and 3.83],with hypoechogenicity,heterogeneous echopattern and lymphadenopathies also highly significant(OR=3.51,2.56 and 1.99).These features were inversely associated with NETs,with regular margins and absence of ductal involvement or lymphadenopathies(OR=0.24,0.86 and 0.45 respectively),as already shown by the descriptive analysis.Finally,age,despite achieving statistical significance,lacks clinical value given an OR trending towards 1.CONCLUSION This study provides a comprehensive overview of EUS features for solid pancreatic lesions,identifying distinct features like upstream ductal dilation and irregular margins for PDAC vs regular margins for NETs as strong diagnostic predictors.These findings enhance the understanding of pancreatic pathologies,offering valuable insights for improved differential diagnosis and clinical management,especially in complex cases.Further prospective studies could build on these results.展开更多
Objective:In recent years,the incidence and detection rate of pancreatic cystic lesions(PCLs)have increased significantly.Endoscopic ultrasound(EUS)plays an indispensable role in the diagnosis and differential diagnos...Objective:In recent years,the incidence and detection rate of pancreatic cystic lesions(PCLs)have increased significantly.Endoscopic ultrasound(EUS)plays an indispensable role in the diagnosis and differential diagnosis of PCLs.However,evidence comparing the diagnostic performance of EUS-guided fine-needle aspiration(EUS-FNA)and fine-needle biopsy(FNB)remains limited.This study aims to compare the diagnostic yield,adequacy of tissue acquisition,and safety between EUS-FNA and EUS-FNB in evaluating PCLs to inform clinical practice.Methods:A retrospective review was conducted on patients with PCLs who underwent either EUS-FNA or EUS-FNB between January 2014 and August 2021.The diagnostic yield,tissue acquisition adequacy,and incidence of adverse events were compared between the 2 groups.Results:A total of 90 patients with PCLs were included(52 in the FNA group and 38 in the FNB group).The diagnostic yield was similar between the FNA and FNB groups(94.2%vs 94.7%,P>0.05).The adequacy of tissue acquisition was 71.2%in the FNA group and 81.6%in the FNB group(P>0.05).No statistically significant difference was observed in the incidence of adverse events between the 2 groups(P>0.05).Conclusion:Both EUS-FNA and EUS-FNB demonstrate equally high diagnostic yields and tissue adequacy in PCLs,with excellent safety profiles.Both methods are safe and effective diagnostic tools for evaluating PCLs.展开更多
BACKGROUND Precancerous lesions of gastric cancer(PLGC)represent a critical pathological stage in the development of intestinal gastric cancer.Early detection and diagnosis are key to reducing the incidence of gastric...BACKGROUND Precancerous lesions of gastric cancer(PLGC)represent a critical pathological stage in the development of intestinal gastric cancer.Early detection and diagnosis are key to reducing the incidence of gastric cancer.Substantial advancements have been made in PLGC research in recent years,making it necessary to provide updated reviews using bibliometric methods.We hypothesize that this review will identify emerging trends,key research areas,and gaps in PLGC research,providing insights that could guide future studies and enhance prevention strategies.AIM To comprehensively review the current state of research on PLGC,examining development trends and research hotspots.METHODS We conducted a bibliometric analysis of PLGC-related studies published between 2004 and 2023 using the Web of Science Core Collection database.We employed Software,including VOSviewer,CiteSpace,R software,and SCImago Graphica,to map scientific networks and visualize knowledge trends in terms of publication volume,countries/regions,institutions,journals,authors,and keywords.RESULTS A total of 4097 articles were included,and overall publication volume showed an increasing trend.Over the past two decades,China published the most articles,followed by the United States,Japan,South Korea,and Italy.Among the top 10 contributors,the United States ranked highest in institutions,authors,and citations and demonstrated the strongest international collaboration.Research keywords in this field were clustered into three main categories:Risk factors,pathogenesis,and diagnosis and treatment.Pathogenesis and molecular biomarkers remain key areas of focus.Future research should explore the mechanisms of gut microbiota,immune microenvironment,metabolic reprogramming,and epigenetics.Advanced technologies,including single-cell sequencing,spatially resolved analysis,multi-omics approaches,artificial intelligence,and machine learning,will likely accelerate in-depth investigations of PLGC.CONCLUSION PLGC research has rapidly developed in recent years,gaining considerable attention.This bibliometric analysis reveals research state and emerging trends over the past 20 years,providing insights for future studies.展开更多
BACKGROUND According to the guidelines in the United States,individuals with a family history of colorectal cancer should be screened at the age of 40 years.Data on the prevalence of adenomas and sessile serrated lesi...BACKGROUND According to the guidelines in the United States,individuals with a family history of colorectal cancer should be screened at the age of 40 years.Data on the prevalence of adenomas and sessile serrated lesions(SSLs)in individuals aged 40-49 years in Japan are lacking.AIM To investigate the effect of family history on the detection of adenomas and SSLs during colonoscopy in Japan.METHODS This retrospective,single-center cohort study included individuals aged 40-79 years who underwent colonoscopy by expert endoscopists with an adenoma detection rate(ADR)≥40%between 2021 and 2024.The ADR and adenoma plus SSL detection rate(ASDR)were investigated according to age.Multivariable analyses were performed to examine the effects of first-degree family history of colorectal cancer,fecal immunochemical test,and sex on the ADR and ASDR for each age group.A binomial logistic regression model was used.RESULTS In 10248 participants,the overall ADR and ASDR were 53.6%and 59.1%,respectively.The ADR and ASDR increased with age.Among 2317 participants aged 40-49 years,the presence of a family history significantly increased the ADR(47.6%vs 38.2%).The odds ratio of a family history for the ADR adjusted by sex and fecal immunochemical test was 1.59(95%confidence interval:1.13-2.25).In contrast,there was no significant association between the ADR and family history in participants aged 50-59,60-69,and 70-79 years.Similarly,a family history significantly increased the ASDR(58.0%vs 43.7%)in participants aged 40-49 years.The odds ratio of a family history for the ASDR was 1.92(95%confidence interval:1.36-2.71).CONCLUSION Participants with a family history exhibited significantly elevated ADR(47.6%)and ASDR(58.0%),in their 40s.Individuals with a family history should initiate colonoscopy at 40 years old.展开更多
For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions ori...For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions originating from the muscularis propria.Lu et al presented an exploration of the effectiveness and safety of ligation-assisted endoscopic submucosal resection,aiming to provide a minimally invasive method for treatment.We discussed and analyzed this study from the aspects of sample screening,clinical pathological characteristics,casecontrol analysis,and follow-up data.展开更多
Some studies have reported that approximately 50%of appendiceal lesions are sessile serrated lesions(SSLs).Traditionally,surgical intervention has been the preferred method.Endoscopic procedures such as endoscopic muc...Some studies have reported that approximately 50%of appendiceal lesions are sessile serrated lesions(SSLs).Traditionally,surgical intervention has been the preferred method.Endoscopic procedures such as endoscopic mucosal resection(EMR)serve as alternative treatments for lesions at the appendiceal orifice(AO).However,EMR is not appropriate when the lesion margin within the AO cannot be visualized.When lesions extend into the lumen,extended laparoscopic appendectomy(ELA)or combined surgery can be used to resect the lesions.Compared with traditional surgery and EMR,ELA or combined surgery is a safer and more precise option that preserves the function of the ileocecal region.However,the need for coordination between surgeons and endoscopists,along with the requirement for staged procedures and multiple bowel preparations,increases the complexity of the treatment.In recent years,with the advancement of endoscopic full-thickness resection,endoscopic transcecal appendectomy(ETA)has been used to treat SSLs involving the AO.The use of choledochoscopy in conjunction with ETA can further enhance treatment precision.This integrated approach holds promise for replacing the combined endoscopic and laparoscopic surgical techniques.However,additional data are required to confirm its safety and efficacy.展开更多
Gastric precancerous lesions(GPL)represent a crucial stage in the complex process of gastric carcinogenesis that leads to gastric cancer(GC),one of the most prevalent cancers and a major source of cancer mortality wor...Gastric precancerous lesions(GPL)represent a crucial stage in the complex process of gastric carcinogenesis that leads to gastric cancer(GC),one of the most prevalent cancers and a major source of cancer mortality worldwide.Many studies have identified the gastrointestinal microbiota,or gut microbiota,as an important contributor to both the pathogenesis and treatment of GPL and GC,thus understanding its role in this transition is crucial.The purpose of this literature review is to introduce the current landscape of microbiota research associated with GPL and GC,with an emphasis on Helicobacter pylori(H.pylori)driven microbial dysbiosis and its modulation through Western medicine and traditional Chinese medicine(TCM)approaches.By elucidating the underlying mechanisms of H.pylori colonization,patterns,and interactions among microbiota,as well as the influence of microbial metabolites,this review highlights crucial driving factors of gastric carcinogenesis.The role of microbiota in conventional interventions,including H.pylori eradication,immunotherapy,as well as TCM herbal decoctions,is also discussed to provide a detailed understanding of the complex interactions between therapy and microbiota and how it could be potentially targeted for effective management of GPL and GC.Ultimately,microbiota-targeting therapeutics may represent a new path toward early detection,targeted treatment,improved prognosis,and potentially reduced incidence of GPL and GC.展开更多
BACKGROUND The incidence and mortality of colorectal cancer continue to rise.For early-stage colorectal cancer,endoscopic resection has become a preferred or important treatment option due to its significant advantage...BACKGROUND The incidence and mortality of colorectal cancer continue to rise.For early-stage colorectal cancer,endoscopic resection has become a preferred or important treatment option due to its significant advantages in operative time,extent of trauma,and medical costs.However,increasing lesion diameter significantly elevates the technical difficulty of endoscopic resection.Currently,robust evidence-based evidence regarding the upper size limit for safely and effectively resecting lesions endoscopically remains lacking.AIM To evaluate the efficacy and safety of endoscopic resection for colorectal lesions≥30 mm in diameter.METHODS This retrospective study reviewed data from 102 patients who underwent endoscopic resection for colorectal lesions measuring≥30 mm in diameter at General Hospital of Northern Theater Command between January 2023 and July 2024.RESULTS Among 102 patients who underwent endoscopic resection,99 received endoscopic submucosal dissection and 3 underwent endoscopic full-thickness resection.Four patients(3.9%)required conversion to surgical radical resection postoperatively.All patients exhibited favorable wound healing at the resection sites,and no long-term complications were observed during the 3-month postoperative colonoscopy follow-up.The primary perioperative complication was post-endoscopic submucosal dissection electrocoagulation syndrome(PEECS)(24/102,23.5%).Multivariate analysis identified lesion location in the transverse colon as an independent risk factor for PEECS occurrence(odds ratio=6.734,95%confidence interval:1.623-27.945,P=0.009).CONCLUSION Large colorectal lesion diameter does not constitute an absolute contraindication to endoscopic resection.Experienced endoscopic centers can achieve complete resection with a favorable efficacy and safety profile.Notably,lesion location in the transverse colon is identified as an independent risk factor for PEECS.展开更多
The study by Ohno et al provides valuable insights into the role of leucine-rich alpha-2-glycoprotein(LRG)as a potential biomarker for identifying small bowel lesions in Crohn's disease(CD).However,several methodo...The study by Ohno et al provides valuable insights into the role of leucine-rich alpha-2-glycoprotein(LRG)as a potential biomarker for identifying small bowel lesions in Crohn's disease(CD).However,several methodological challenges hinder its immediate use in clinical practice.Notably,the current research was retrospective,lacks comparative studies with fecal calprotectin,and did not provide long-term predictive data.Further prospective studies are needed to improve the applicability of LRG.Moreover,integrating LRG with additional biomarkers and employing artificial intelligence techniques may improve its effectiveness in disease monitoring.Future research should address interobserver variability,assess LRG's cost-effectiveness,and standardize endoscopic healing definitions to ensure broader applicability.Advancing these areas is vital for establishing LRG's role in precision medicine strategies for the management of CD.展开更多
Precancerous lesions of gastric cancer(PLGC)are crucial for the progression to gastric cancer,and early intervention in PLGC is pivotal in preventing its development into gastric cancer.In order to illustrate the mole...Precancerous lesions of gastric cancer(PLGC)are crucial for the progression to gastric cancer,and early intervention in PLGC is pivotal in preventing its development into gastric cancer.In order to illustrate the molecular mechanisms underlying PLGC and the roles of associated genes within these lesions,genetically engineered mouse models(GEMMs)have been developed.We systematically summarize the current GEMMs,and highlight the principal pathological mechanisms involved,including gastrin/gastric acid balance,inflammatory factors,the interplay between cancer-promoting and cancer-suppressing genes,and apoptotic pathways.We further discuss the mechanisms involved in the existing GEMMs of PLGC.展开更多
BACKGROUND As a minimally invasive technique,endoscopic submucosal dissection(ESD)is widely used in treating early colorectal cancer(ECRC)and precancerous lesions(PCLs).However,a common postoperative complication-dela...BACKGROUND As a minimally invasive technique,endoscopic submucosal dissection(ESD)is widely used in treating early colorectal cancer(ECRC)and precancerous lesions(PCLs).However,a common postoperative complication-delayed postoperative bleeding(DPOB)-can significantly hinder patient recovery.AIM To build and validate a predictive model for assessing post-ESD DPOB risk in ECRC and PCL patients,utilizing logistic regression methodology.METHODS A retrospective review was conducted on ECRC/PCL 302 patients who received ESD at our hospital between July 2021 and July 2024.The cohort was stratified based on the incidence of DPOB following ESD,forming DPOB and non-DPOB groups.Through allocation,they were further allocated into model and validation cohorts.Clinical variables from both cohorts were collated and subjected to univariate analysis to determine potential factors associated with post-ESD DPOB.Subsequently,we constructed a predictive model for DPOB risk employing logistic regression analysis.Model performance assessment used receiver operating characteristic curves in both the training and validation cohorts,with internal validation accomplished via 10-fold cross-validation.RESULTS The occurrence rate of DPOB was 9.93%.Univariate analysis revealed that the number of lesions,lesion size,lesion location,degree of submucosal fibrosis,and intraoperative bleeding were significantly associated with DPOB.Binary logistic regression analysis identified the number of lesions,lesion size,lesion location,and degree of submucosal fibrosis as independent DPOB determinants.A nomogram that was developed to quantify the DPOB risk exhibited that an increment in the total score corresponded to an increased risk.The model achieved area under the curve values of 0.831 and 0.821 in the model and validation groups,respectively,with P values of 0.853 and 0.203 in the Hosmer-Lemeshow test.The model demonstrated robust discriminative performance,with an average area under the curve of 0.795(95%confidence interval:0.702-0.887)in 10-fold cross-validation.CONCLUSION Collectively,the presence of multiple lesions,lesion size of≥3 cm,lesion localization in the rectum,and severe fibrosis are significant independent predictors of DPOB in patients undergoing surgery for ECRC or PCLs.The proposed risk prediction model,which integrates these factors,demonstrates excellent predictive accuracy and clinical utility,thereby providing a valuable tool for risk stratification and postoperative management in this patient population.展开更多
BACKGROUND Early gastric cancer(EGC)or precancerous lesions(PCLs)are generally small tumors and carry a diminished chance of nodal infiltration.Thus far,very few studies have examined how endoscopic submucosal dissect...BACKGROUND Early gastric cancer(EGC)or precancerous lesions(PCLs)are generally small tumors and carry a diminished chance of nodal infiltration.Thus far,very few studies have examined how endoscopic submucosal dissection(ESD)affects postoperative recovery and complications in such patients.AIM To evaluate the influence of ESD on postoperative recovery and complications in patients with EGC or PCL.METHODS The study population included patients with EGC and PCL admitted to The First People’s Hospital of Fuyang District between December 2022 and December 2024,who were divided into the research(n=65)and control(n=55)groups if they underwent ESD and laparoscopic radical gastrectomy,respectively.Therapeutic outcomes(en bloc and curative resection rates),surgical parameters(incision length,intraoperative bleeding,and operative duration),postoperative recovery indices(time to first ambulation/flatus/first oral intake,and hospital stay duration),complications(infection,outflow obstruction,bleeding,and perforation),and tumor markers[carcinoembryonic antigen(CEA)and carbohydrate antigen(CA)125/19-9]were comparatively evaluated.RESULTS Compared with the control group,the research group achieved a significantly higher en bloc resection rate but a notably lower curative resection rate.Additionally,the research group demonstrated shorter incision lengths,reduced intraoperative bleeding,and shorter operative duration.Regarding postoperative recovery,the research group demonstrated earlier ambulation,faster bowel function restoration,quicker oral intake resumption,and shorter hospital stays.Furthermore,an evidently lower overall complication rate was recorded in the research group,as well as markedly reduced postoperative CEA,CA125,and CA19-9 concentrations.CONCLUSION When performed for EGC and PCLs,ESD demonstrates advantages such as higher en bloc resection(although lower curative resection rates),surgical trauma minimization,shortened operative duration,and faster recovery.Moreover,it is effective in reducing serum tumor marker levels while maintaining favorable safety.展开更多
BACKGROUND Differential diagnosis among atypical hyperplasia(AH)(including reparative hyperplasia and intestinal metaplasia),low-grade dysplasia(LGD),high-grade dysplasia(HGD),and adenocarcinoma(AC)in gastric mucosal ...BACKGROUND Differential diagnosis among atypical hyperplasia(AH)(including reparative hyperplasia and intestinal metaplasia),low-grade dysplasia(LGD),high-grade dysplasia(HGD),and adenocarcinoma(AC)in gastric mucosal biopsies is challenging due to histomorphological overlaps,variability in pathological diagnosis consistency,and limited reproducibility.AIM To evaluate the diagnostic utility of P53,Ki67,P504S,and IMP3 in gastric cancer and its precancerous lesions,focusing on their effectiveness in distinguishing AH,LGD,HGD,and AC.METHODS From January 2018 to September 2020,a total of 185 gastric mucosal biopsy specimens were analyzed according to the pathological diagnostic criteria outlined in the World Health Organization Classification of Digestive System Tumors(2019).The specimens were categorized into four groups:AH,LGD,HGD,and AC.Immunohistochemistry was employed to assess the expression status of P53,Ki67,P504S,and IMP3.Intergroup comparisons were performed using theχ^(2)test or Fisher's exact probability test to compare the differences in immunohistochemical markers across the distinct lesion groups.RESULTS The expression rate of P504S was highest in the LGD group(53.3%,16/30),while IMP3 expression was highest in the AC group(41.9%,26/62),followed by the HGD group(33.3%).Significant differences in P504S and IMP3 expression levels were observed among the four lesion groups(P<0.001).Pairwise comparisons revealed statistically significant differences in P504S expression between the AH group and the LGD,HGD,and AC groups(P<0.001),as well as significant variations in IMP3 expression between the AH group and the HGD and AC groups,and between the LGD group and the HGD and AC groups(P<0.001).Additionally,significant correlations were found between P504S and the polarity expression pattern of Ki67,and between IMP3 and the mutation expression pattern of P53(P<0.001).The combined detection of P504S with Ki67 and IMP3 with P53 increased the diagnostic sensitivity for LGD and HGD/AC,respectively.CONCLUSION P504S is highly expressed in LGD and is associated with the Ki67“polarity”expression pattern.IMP3 is highly expressed in HGD/AC and is correlated with the P53 mutation expression pattern.The combined detection of P504S with Ki67 and IMP3 with P53 increased the diagnostic sensitivity for LGD and HGD/AC,respectively.The rational use of P504S,Ki67,IMP3,and p53 can help distinguish gastric cancer and precancerous lesions,improving the early cancer diagnosis rate.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 Nanchong Social Science Research“14^(th) Five-Year Plan”2025 Annual Project,No.NC25B244.
文摘BACKGROUND Digestive tract subepithelial lesions(SELs)are relatively common,and early diagnosis and treatment are critical for improving patient quality of life and prognosis.However,diagnostic uncertainty often leads to negative psychological effects,including anxiety and depression.AIM To investigate the prevalence of anxiety and depressive symptoms and identify associated factors among patients with digestive tract SELs.METHODS This retrospective study included 296 consecutive patients diagnosed with digestive tract SELs at the Affiliated Hospital of North Sichuan Medical College Endoscopy Center between October 2024 and April 2025.Demographic and clinical data were collected through standardized questionnaires.Anxiety and depression were assessed using the Self-Rating Anxiety Scale and the Self-Rating Depression Scale,respectively,while sleep quality was evaluated using the Pittsburgh Sleep Quality Index.Participants were classified into anxiety vs nonanxiety and depression vs non-depression groups based on established cutoff scores,and potential determinants were examined.RESULTS Anxiety symptoms were observed in 35.8%of cases(mean Self-Rating Anxiety Scale score:46.56±9.13)and depressive symptoms in 33.1%(mean Self-Rating Depression scale score:48.64±8.30).Pittsburgh Sleep Quality Index scores were positively correlated with both anxiety and depression(P<0.05).Univariate analysis identified age,annual income,sleep disorders,and endoscopic ultrasonography(EUS)evaluation status as significant factors(P<0.05).Multivariable analysis revealed that low annual income(<10000 Chinese yuan)and sleep disorders were independent risk factors,whereas undergoing EUS examination and having disease awareness were protective factors against anxiety and depression(P<0.05).CONCLUSION Patients with digestive tract SELs are at increased risk for anxiety and depression,with poor sleep strongly linked to worsening psychological symptoms.Early diagnostic assessment with EUS appears to serve a protective role against the onset of these psychological disorders.
基金supported by the Qingdao Medical Health Research Project,No.2023-WJZD212(to XX)。
文摘Recent evidence suggests that ferroptosis plays a crucial role in the occurrence and development of white matter lesions.However,the mechanisms and regulatory pathways involved in ferroptosis within white matter lesions remain unclear.Long non-coding RNAs(lnc RNAs)have been shown to influence the occurrence and development of these lesions.We previously identified lnc_011797 as a biomarker of white matter lesions by high-throughput sequencing.To investigate the mechanism by which lnc_011797 regulates white matter lesions,we established subjected human umbilical vein endothelial cells to oxygenglucose deprivation to simulate conditions associated with white matter lesions.The cells were transfected with lnc_011797 overexpression or knockdown lentiviruses.Our findings indicate that lnc_011797 promoted ferroptosis in these cells,leading to the formation of white matter lesions.Furthermore,lnc_011797 functioned as a competitive endogenous RNA(ce RNA)for mi R-193b-3p,thereby regulating the expression of WNK1 and its downstream ferroptosis-related proteins.To validate the role of lnc_011797 in vivo,we established a mouse model of white matter lesions through bilateral common carotid artery stenosis.The results from this model confirmed that lnc_011797 regulates ferroptosis via WNK1 and promotes the development of white matter lesions.These findings clarify the mechanism by which lnc RNAs regulate white matter lesions,providing a new target for the diagnosis and treatment of white matter lesions.
基金supported by grants from the National Natural Science Foundation of China (82070408)the Traditional Chinese Medicine Science and Technology Project of Zhejiang Province (2023ZL496)。
文摘Background Quantitative flow ratio(QFR) holds significant value in guiding drug-coated balloon(DCB) treatment and enhancing outcomes. However, the predictive capability of post-angioplasty QFR for long-term clinical events in patients with de novo lesions who receive DCB treatment remains uncertain. The aim of this study was to explore the potential significance of post-angioplasty QFR measurements in predicting clinical outcomes in patients underwent DCB treatment for de novo lesions.Methods Patients who underwent DCB-only intervention for de novo lesions were enrolled. QFR was conducted after DCB treatment. The patients were then categorized based on post-angioplasty QFR. The primary endpoint was major adverse cardiac events(MACE), encompassing all-cause death, cardiovascular death, nonfatal myocardial infarction, stroke, and target vessel revascularization.Results A total of 553 patients with 561 lesions were included. The median follow-up period was 505 days, during which 66(11.8%) MACEs occurred. Based on post-procedural QFR grouping, there were 259 cases in the high QFR group(QFR > 0.93) and302 cases in the low QFR group(QFR ≤ 0.93). Kaplan-Meier analysis revealed a significantly higher cumulative incidence of MACE in the low QFR group(log-rank P = 0.004). The multivariate Cox proportional hazards model demonstrated a significant inverse correlation between QFR and the occurrence of MACEs(HR = 0.522, 95%CI: 0.289-0.942, P = 0.031). Landmark analysis indicated that high QFR had a significant reducing effect on the cumulative incidence of MACEs within 1 year(log-rank P = 0.016)and 1-5 years(log-rank P = 0.026).Conclusions In patients who underwent DCB-only treatment for de novo lesions, higher post-procedural QFR values(> 0.93)were identified as an independent protective factor against adverse prognosis.
文摘This letter critically evaluates Jiang et al's article on the differentiation of benign and malignant liver lesions using Emax and platelet count.Despite notable findings,significant methodological and interpretative limitations are identified.The study lacks detailed assay conditions for Emax measurement,employs inadequate statistical methods without robust multivariate analysis,and does not provide clinically relevant threshold values.The nomogram's reliance on Emax as a major diagnostic contributor is questionable due to attenuation in hepatocellular carcinoma patients with cirrhosis.Moreover,the study's limitations,such as selection bias and confounding factors,are not adequately addressed.Future research should adopt more rigorous methodologies,including prospective studies with larger cohorts and standardized protocols for biomarker measurement,to enhance validity and clinical applicability.
文摘Calvarial lesions are usually incidental and asymptomatic,rarely detected.However,these lesions can also present with pain,a palpable mass or a bone defect.Clinical information such as the patient’s age and medical history are helpful in making the correct diagnosis.Calvarial lesions may occur due to congenital and anatomical variants,traumatic and iatrogenic,idiopathic,infectious and inflammatory,metabolic,benign and malignant neoplastic causes.Calvarial lesions may be solitary,multiple or diffuse,and may be lytic,sclerotic or mixed.Although most calvarial lesions are benign,radiologic imaging features can help to determine whether the lesion is benign or malignant.Methods that can guide treatment and are currently in use include plain radiography,ultrasonography,computed tomography,magnetic resonance imaging,angiographic studies,and nuclear scintigraphy studies such as 18F-fluorodeoxyglucose positron emission tomography and whole-body bone scintigraphy.Defects,lysis and sclerosis in the bone structure are assessed by plain radiography and computed tomography,and the soft tissue components of the lesions and their relationship to the surrounding soft tissue are assessed by magnetic resonance imaging.This article reviews the imaging findings of benign and malignant calvarial lesions and normal variants that may be confused with systemic diseases and pathologies affecting the calvarium.
基金financially supported by the National Natural Science Foundation of China(41772033,41272048).
文摘Pathological mineralizations in breast lesions are closely associated with disease progression and serves as a critical diagnostic indicator.However,systematic understanding remains lacking regarding the phase categories,distribution patterns,and proportional occurrences of mineral phases across different breast lesion types.The diagnostic implications of specific phases,such as calcium oxalate,for distinguishing benign and malignant lesions remain controversial.This study employed polarizing microscopy,environmental scanning electron microscopy(SEM)with energy dispersive spectroscopy(EDS),transmission electron microscopy(TEM),Fourier transform infrared spectroscopy(FTIR),and Raman spectroscopy to analyze the phase composition of 61 mineralized samples from three lesion types:Invasive carcinoma,carcinoma in situ and benign lesions.Results demonstrate that breast lesion mineralizations predominantly comprise calcium phosphates,including hydroxyapatite(HA),amorphous calcium phosphate(ACP),and whitlockite,occasionally accompanied by calcium oxalate(monohydrate or dihydrate).Distinct distribution patterns and proportional occurrences of minerals were observed among the three types of lesion mineralizations.HA,as the predominant phase,was ubiquitously present across all three lesion categories.ACP,a mineralization precursor phase,emerged during early mineralization stages across all lesion types.Notably,whitlockite exclusively occurred in benign lesions and carcinoma in situ,with higher prevalence in benign cases,suggesting a progressive decline in Mg^(2+)concentration within the lesion microenvironment as malignancy advances.Calcium oxalate coexisted with HA in mineralized regions across all lesion types,and its presence in invasive carcinoma specimens warrants heightened clinical attention.
基金Supported by the Italian Ministry of Health-Current research IRCCS(Funds Dedicated to the Research of the Gastroenterology and Digestive Endoscopy Unit,Fondazione IRCCS Ca’Granda,Ospedale Maggiore Policlinico,Milano).
文摘BACKGROUND Endoscopic ultrasound(EUS)is crucial for diagnosing solid pancreatic lesions,especially pancreatic ductal adenocarcinoma(PDAC),a highly aggressive cancer which represents the majority with a prevalence of approximately 85%.AIM To identify EUS features that differentiate PDAC from other lesions such as neuroendocrine tumors(NETs)and helping in the differential diagnosis,by analyzing a large sample of solid pancreatic lesions.METHODS This observational,retrospective,multicenter study analyzed the endosonographic characteristics of 761 patients with a radiological diagnosis of solid pancreatic lesion,who underwent pancreatic EUS for typing and staging with needle biopsies between 2015 and 2023.General patient characteristics(age and sex)and solid lesion features were collected and described,such lesion size(Bmode),vessel involvement(compression or invasion),ductal dilation,lymphadenopathy,echogenicity,echopattern,margin regularity,multifocality,internal vascularization and elastography.Subsequently,a predictive analysis was performed through univariate and multivariate logistic regression to identify predictive features for PDAC or NET diagnoses.RESULTS Our study enrolled 761 patients,predominantly male with a mean age of 68.6.PDACs were generally larger(mean 33 mm×27 mm),often had irregular margins,and displayed significant upstream ductal dilation.Hypoechogenicity was common across malignant lesions.In contrast,NETs were smaller(mean 20 mm×17 mm)and typically had regular margins with multiple lesions.Vascular involvement,although predominant in PDAC,is a common feature of all malignant neoplasms.Multifocality,however,although a rare finding,is more typical of NETs and metastases,and practically absent in the remaining lesions.Predictive analyses showed that ductal dilation and irregular margins were the most significant predictors for PDAC[odds ratio(OR)=5.75 and 3.83],with hypoechogenicity,heterogeneous echopattern and lymphadenopathies also highly significant(OR=3.51,2.56 and 1.99).These features were inversely associated with NETs,with regular margins and absence of ductal involvement or lymphadenopathies(OR=0.24,0.86 and 0.45 respectively),as already shown by the descriptive analysis.Finally,age,despite achieving statistical significance,lacks clinical value given an OR trending towards 1.CONCLUSION This study provides a comprehensive overview of EUS features for solid pancreatic lesions,identifying distinct features like upstream ductal dilation and irregular margins for PDAC vs regular margins for NETs as strong diagnostic predictors.These findings enhance the understanding of pancreatic pathologies,offering valuable insights for improved differential diagnosis and clinical management,especially in complex cases.Further prospective studies could build on these results.
基金supported by the Special Project for the Construction of Innovative Provinces in Hunan Province,China(2020SK2013)。
文摘Objective:In recent years,the incidence and detection rate of pancreatic cystic lesions(PCLs)have increased significantly.Endoscopic ultrasound(EUS)plays an indispensable role in the diagnosis and differential diagnosis of PCLs.However,evidence comparing the diagnostic performance of EUS-guided fine-needle aspiration(EUS-FNA)and fine-needle biopsy(FNB)remains limited.This study aims to compare the diagnostic yield,adequacy of tissue acquisition,and safety between EUS-FNA and EUS-FNB in evaluating PCLs to inform clinical practice.Methods:A retrospective review was conducted on patients with PCLs who underwent either EUS-FNA or EUS-FNB between January 2014 and August 2021.The diagnostic yield,tissue acquisition adequacy,and incidence of adverse events were compared between the 2 groups.Results:A total of 90 patients with PCLs were included(52 in the FNA group and 38 in the FNB group).The diagnostic yield was similar between the FNA and FNB groups(94.2%vs 94.7%,P>0.05).The adequacy of tissue acquisition was 71.2%in the FNA group and 81.6%in the FNB group(P>0.05).No statistically significant difference was observed in the incidence of adverse events between the 2 groups(P>0.05).Conclusion:Both EUS-FNA and EUS-FNB demonstrate equally high diagnostic yields and tissue adequacy in PCLs,with excellent safety profiles.Both methods are safe and effective diagnostic tools for evaluating PCLs.
基金the National Natural Science Foundation of China,No.82374292,82205095,and 82305179the Horizontal Development Foundation of Beijing University of Chinese Medicine,No.BUCM-2021-JS-KF-065the China Postdoctoral Science Foundation Grant,No.2022M720520.
文摘BACKGROUND Precancerous lesions of gastric cancer(PLGC)represent a critical pathological stage in the development of intestinal gastric cancer.Early detection and diagnosis are key to reducing the incidence of gastric cancer.Substantial advancements have been made in PLGC research in recent years,making it necessary to provide updated reviews using bibliometric methods.We hypothesize that this review will identify emerging trends,key research areas,and gaps in PLGC research,providing insights that could guide future studies and enhance prevention strategies.AIM To comprehensively review the current state of research on PLGC,examining development trends and research hotspots.METHODS We conducted a bibliometric analysis of PLGC-related studies published between 2004 and 2023 using the Web of Science Core Collection database.We employed Software,including VOSviewer,CiteSpace,R software,and SCImago Graphica,to map scientific networks and visualize knowledge trends in terms of publication volume,countries/regions,institutions,journals,authors,and keywords.RESULTS A total of 4097 articles were included,and overall publication volume showed an increasing trend.Over the past two decades,China published the most articles,followed by the United States,Japan,South Korea,and Italy.Among the top 10 contributors,the United States ranked highest in institutions,authors,and citations and demonstrated the strongest international collaboration.Research keywords in this field were clustered into three main categories:Risk factors,pathogenesis,and diagnosis and treatment.Pathogenesis and molecular biomarkers remain key areas of focus.Future research should explore the mechanisms of gut microbiota,immune microenvironment,metabolic reprogramming,and epigenetics.Advanced technologies,including single-cell sequencing,spatially resolved analysis,multi-omics approaches,artificial intelligence,and machine learning,will likely accelerate in-depth investigations of PLGC.CONCLUSION PLGC research has rapidly developed in recent years,gaining considerable attention.This bibliometric analysis reveals research state and emerging trends over the past 20 years,providing insights for future studies.
文摘BACKGROUND According to the guidelines in the United States,individuals with a family history of colorectal cancer should be screened at the age of 40 years.Data on the prevalence of adenomas and sessile serrated lesions(SSLs)in individuals aged 40-49 years in Japan are lacking.AIM To investigate the effect of family history on the detection of adenomas and SSLs during colonoscopy in Japan.METHODS This retrospective,single-center cohort study included individuals aged 40-79 years who underwent colonoscopy by expert endoscopists with an adenoma detection rate(ADR)≥40%between 2021 and 2024.The ADR and adenoma plus SSL detection rate(ASDR)were investigated according to age.Multivariable analyses were performed to examine the effects of first-degree family history of colorectal cancer,fecal immunochemical test,and sex on the ADR and ASDR for each age group.A binomial logistic regression model was used.RESULTS In 10248 participants,the overall ADR and ASDR were 53.6%and 59.1%,respectively.The ADR and ASDR increased with age.Among 2317 participants aged 40-49 years,the presence of a family history significantly increased the ADR(47.6%vs 38.2%).The odds ratio of a family history for the ADR adjusted by sex and fecal immunochemical test was 1.59(95%confidence interval:1.13-2.25).In contrast,there was no significant association between the ADR and family history in participants aged 50-59,60-69,and 70-79 years.Similarly,a family history significantly increased the ASDR(58.0%vs 43.7%)in participants aged 40-49 years.The odds ratio of a family history for the ASDR was 1.92(95%confidence interval:1.36-2.71).CONCLUSION Participants with a family history exhibited significantly elevated ADR(47.6%)and ASDR(58.0%),in their 40s.Individuals with a family history should initiate colonoscopy at 40 years old.
文摘For the treatment method of esophageal subepithelial lesions originating from the muscularis propria,conventional endoscopic resection techniques are timeconsuming and lack efficacy for small subepithelial lesions originating from the muscularis propria.Lu et al presented an exploration of the effectiveness and safety of ligation-assisted endoscopic submucosal resection,aiming to provide a minimally invasive method for treatment.We discussed and analyzed this study from the aspects of sample screening,clinical pathological characteristics,casecontrol analysis,and follow-up data.
文摘Some studies have reported that approximately 50%of appendiceal lesions are sessile serrated lesions(SSLs).Traditionally,surgical intervention has been the preferred method.Endoscopic procedures such as endoscopic mucosal resection(EMR)serve as alternative treatments for lesions at the appendiceal orifice(AO).However,EMR is not appropriate when the lesion margin within the AO cannot be visualized.When lesions extend into the lumen,extended laparoscopic appendectomy(ELA)or combined surgery can be used to resect the lesions.Compared with traditional surgery and EMR,ELA or combined surgery is a safer and more precise option that preserves the function of the ileocecal region.However,the need for coordination between surgeons and endoscopists,along with the requirement for staged procedures and multiple bowel preparations,increases the complexity of the treatment.In recent years,with the advancement of endoscopic full-thickness resection,endoscopic transcecal appendectomy(ETA)has been used to treat SSLs involving the AO.The use of choledochoscopy in conjunction with ETA can further enhance treatment precision.This integrated approach holds promise for replacing the combined endoscopic and laparoscopic surgical techniques.However,additional data are required to confirm its safety and efficacy.
文摘Gastric precancerous lesions(GPL)represent a crucial stage in the complex process of gastric carcinogenesis that leads to gastric cancer(GC),one of the most prevalent cancers and a major source of cancer mortality worldwide.Many studies have identified the gastrointestinal microbiota,or gut microbiota,as an important contributor to both the pathogenesis and treatment of GPL and GC,thus understanding its role in this transition is crucial.The purpose of this literature review is to introduce the current landscape of microbiota research associated with GPL and GC,with an emphasis on Helicobacter pylori(H.pylori)driven microbial dysbiosis and its modulation through Western medicine and traditional Chinese medicine(TCM)approaches.By elucidating the underlying mechanisms of H.pylori colonization,patterns,and interactions among microbiota,as well as the influence of microbial metabolites,this review highlights crucial driving factors of gastric carcinogenesis.The role of microbiota in conventional interventions,including H.pylori eradication,immunotherapy,as well as TCM herbal decoctions,is also discussed to provide a detailed understanding of the complex interactions between therapy and microbiota and how it could be potentially targeted for effective management of GPL and GC.Ultimately,microbiota-targeting therapeutics may represent a new path toward early detection,targeted treatment,improved prognosis,and potentially reduced incidence of GPL and GC.
基金Supported by the Shenyang Science and Technology of Liaoning Province,No.22-321-32-15.
文摘BACKGROUND The incidence and mortality of colorectal cancer continue to rise.For early-stage colorectal cancer,endoscopic resection has become a preferred or important treatment option due to its significant advantages in operative time,extent of trauma,and medical costs.However,increasing lesion diameter significantly elevates the technical difficulty of endoscopic resection.Currently,robust evidence-based evidence regarding the upper size limit for safely and effectively resecting lesions endoscopically remains lacking.AIM To evaluate the efficacy and safety of endoscopic resection for colorectal lesions≥30 mm in diameter.METHODS This retrospective study reviewed data from 102 patients who underwent endoscopic resection for colorectal lesions measuring≥30 mm in diameter at General Hospital of Northern Theater Command between January 2023 and July 2024.RESULTS Among 102 patients who underwent endoscopic resection,99 received endoscopic submucosal dissection and 3 underwent endoscopic full-thickness resection.Four patients(3.9%)required conversion to surgical radical resection postoperatively.All patients exhibited favorable wound healing at the resection sites,and no long-term complications were observed during the 3-month postoperative colonoscopy follow-up.The primary perioperative complication was post-endoscopic submucosal dissection electrocoagulation syndrome(PEECS)(24/102,23.5%).Multivariate analysis identified lesion location in the transverse colon as an independent risk factor for PEECS occurrence(odds ratio=6.734,95%confidence interval:1.623-27.945,P=0.009).CONCLUSION Large colorectal lesion diameter does not constitute an absolute contraindication to endoscopic resection.Experienced endoscopic centers can achieve complete resection with a favorable efficacy and safety profile.Notably,lesion location in the transverse colon is identified as an independent risk factor for PEECS.
文摘The study by Ohno et al provides valuable insights into the role of leucine-rich alpha-2-glycoprotein(LRG)as a potential biomarker for identifying small bowel lesions in Crohn's disease(CD).However,several methodological challenges hinder its immediate use in clinical practice.Notably,the current research was retrospective,lacks comparative studies with fecal calprotectin,and did not provide long-term predictive data.Further prospective studies are needed to improve the applicability of LRG.Moreover,integrating LRG with additional biomarkers and employing artificial intelligence techniques may improve its effectiveness in disease monitoring.Future research should address interobserver variability,assess LRG's cost-effectiveness,and standardize endoscopic healing definitions to ensure broader applicability.Advancing these areas is vital for establishing LRG's role in precision medicine strategies for the management of CD.
基金Supported by the National Administration of Traditional Chinese Medicine National Superior Specialty Project of Traditional Chinese Medicine,No.[2024]90Shanghai Municipal Administrator of Traditional Chinese Medicine Policy Letter[2024],No.20+1 种基金Science and Technology Development Fund of Shanghai University of Traditional Chinese Medicine,No.23KFL102Shuguang Hospital Siming Foundation Research Special Project,No.SGKJ-202304。
文摘Precancerous lesions of gastric cancer(PLGC)are crucial for the progression to gastric cancer,and early intervention in PLGC is pivotal in preventing its development into gastric cancer.In order to illustrate the molecular mechanisms underlying PLGC and the roles of associated genes within these lesions,genetically engineered mouse models(GEMMs)have been developed.We systematically summarize the current GEMMs,and highlight the principal pathological mechanisms involved,including gastrin/gastric acid balance,inflammatory factors,the interplay between cancer-promoting and cancer-suppressing genes,and apoptotic pathways.We further discuss the mechanisms involved in the existing GEMMs of PLGC.
文摘BACKGROUND As a minimally invasive technique,endoscopic submucosal dissection(ESD)is widely used in treating early colorectal cancer(ECRC)and precancerous lesions(PCLs).However,a common postoperative complication-delayed postoperative bleeding(DPOB)-can significantly hinder patient recovery.AIM To build and validate a predictive model for assessing post-ESD DPOB risk in ECRC and PCL patients,utilizing logistic regression methodology.METHODS A retrospective review was conducted on ECRC/PCL 302 patients who received ESD at our hospital between July 2021 and July 2024.The cohort was stratified based on the incidence of DPOB following ESD,forming DPOB and non-DPOB groups.Through allocation,they were further allocated into model and validation cohorts.Clinical variables from both cohorts were collated and subjected to univariate analysis to determine potential factors associated with post-ESD DPOB.Subsequently,we constructed a predictive model for DPOB risk employing logistic regression analysis.Model performance assessment used receiver operating characteristic curves in both the training and validation cohorts,with internal validation accomplished via 10-fold cross-validation.RESULTS The occurrence rate of DPOB was 9.93%.Univariate analysis revealed that the number of lesions,lesion size,lesion location,degree of submucosal fibrosis,and intraoperative bleeding were significantly associated with DPOB.Binary logistic regression analysis identified the number of lesions,lesion size,lesion location,and degree of submucosal fibrosis as independent DPOB determinants.A nomogram that was developed to quantify the DPOB risk exhibited that an increment in the total score corresponded to an increased risk.The model achieved area under the curve values of 0.831 and 0.821 in the model and validation groups,respectively,with P values of 0.853 and 0.203 in the Hosmer-Lemeshow test.The model demonstrated robust discriminative performance,with an average area under the curve of 0.795(95%confidence interval:0.702-0.887)in 10-fold cross-validation.CONCLUSION Collectively,the presence of multiple lesions,lesion size of≥3 cm,lesion localization in the rectum,and severe fibrosis are significant independent predictors of DPOB in patients undergoing surgery for ECRC or PCLs.The proposed risk prediction model,which integrates these factors,demonstrates excellent predictive accuracy and clinical utility,thereby providing a valuable tool for risk stratification and postoperative management in this patient population.
文摘BACKGROUND Early gastric cancer(EGC)or precancerous lesions(PCLs)are generally small tumors and carry a diminished chance of nodal infiltration.Thus far,very few studies have examined how endoscopic submucosal dissection(ESD)affects postoperative recovery and complications in such patients.AIM To evaluate the influence of ESD on postoperative recovery and complications in patients with EGC or PCL.METHODS The study population included patients with EGC and PCL admitted to The First People’s Hospital of Fuyang District between December 2022 and December 2024,who were divided into the research(n=65)and control(n=55)groups if they underwent ESD and laparoscopic radical gastrectomy,respectively.Therapeutic outcomes(en bloc and curative resection rates),surgical parameters(incision length,intraoperative bleeding,and operative duration),postoperative recovery indices(time to first ambulation/flatus/first oral intake,and hospital stay duration),complications(infection,outflow obstruction,bleeding,and perforation),and tumor markers[carcinoembryonic antigen(CEA)and carbohydrate antigen(CA)125/19-9]were comparatively evaluated.RESULTS Compared with the control group,the research group achieved a significantly higher en bloc resection rate but a notably lower curative resection rate.Additionally,the research group demonstrated shorter incision lengths,reduced intraoperative bleeding,and shorter operative duration.Regarding postoperative recovery,the research group demonstrated earlier ambulation,faster bowel function restoration,quicker oral intake resumption,and shorter hospital stays.Furthermore,an evidently lower overall complication rate was recorded in the research group,as well as markedly reduced postoperative CEA,CA125,and CA19-9 concentrations.CONCLUSION When performed for EGC and PCLs,ESD demonstrates advantages such as higher en bloc resection(although lower curative resection rates),surgical trauma minimization,shortened operative duration,and faster recovery.Moreover,it is effective in reducing serum tumor marker levels while maintaining favorable safety.
基金Supported by The Science and Technology Research Project of Anyang,No.2022C01SF074。
文摘BACKGROUND Differential diagnosis among atypical hyperplasia(AH)(including reparative hyperplasia and intestinal metaplasia),low-grade dysplasia(LGD),high-grade dysplasia(HGD),and adenocarcinoma(AC)in gastric mucosal biopsies is challenging due to histomorphological overlaps,variability in pathological diagnosis consistency,and limited reproducibility.AIM To evaluate the diagnostic utility of P53,Ki67,P504S,and IMP3 in gastric cancer and its precancerous lesions,focusing on their effectiveness in distinguishing AH,LGD,HGD,and AC.METHODS From January 2018 to September 2020,a total of 185 gastric mucosal biopsy specimens were analyzed according to the pathological diagnostic criteria outlined in the World Health Organization Classification of Digestive System Tumors(2019).The specimens were categorized into four groups:AH,LGD,HGD,and AC.Immunohistochemistry was employed to assess the expression status of P53,Ki67,P504S,and IMP3.Intergroup comparisons were performed using theχ^(2)test or Fisher's exact probability test to compare the differences in immunohistochemical markers across the distinct lesion groups.RESULTS The expression rate of P504S was highest in the LGD group(53.3%,16/30),while IMP3 expression was highest in the AC group(41.9%,26/62),followed by the HGD group(33.3%).Significant differences in P504S and IMP3 expression levels were observed among the four lesion groups(P<0.001).Pairwise comparisons revealed statistically significant differences in P504S expression between the AH group and the LGD,HGD,and AC groups(P<0.001),as well as significant variations in IMP3 expression between the AH group and the HGD and AC groups,and between the LGD group and the HGD and AC groups(P<0.001).Additionally,significant correlations were found between P504S and the polarity expression pattern of Ki67,and between IMP3 and the mutation expression pattern of P53(P<0.001).The combined detection of P504S with Ki67 and IMP3 with P53 increased the diagnostic sensitivity for LGD and HGD/AC,respectively.CONCLUSION P504S is highly expressed in LGD and is associated with the Ki67“polarity”expression pattern.IMP3 is highly expressed in HGD/AC and is correlated with the P53 mutation expression pattern.The combined detection of P504S with Ki67 and IMP3 with P53 increased the diagnostic sensitivity for LGD and HGD/AC,respectively.The rational use of P504S,Ki67,IMP3,and p53 can help distinguish gastric cancer and precancerous lesions,improving the early cancer diagnosis rate.
