BACKGROUND Improved adenoma detection at colonoscopy has decreased the risk of developing colorectal cancer.However,whether image-enhanced endoscopy(IEE)further improves the adenoma detection rate(ADR)is controversial...BACKGROUND Improved adenoma detection at colonoscopy has decreased the risk of developing colorectal cancer.However,whether image-enhanced endoscopy(IEE)further improves the adenoma detection rate(ADR)is controversial.AIM To compare IEE with white-light imaging(WLI)endoscopy for the detection and identification of colorectal adenoma.METHODS This was a multicenter,randomized,controlled trial.Participants were enrolled between September 2019 to April 2021 from 4 hospital in China.Patients were randomly assigned to an IEE group with WLI on entry and IEE on withdrawal(n=2113)or a WLI group with WLI on both entry and withdrawal(n=2098).The primary outcome was the ADR.The secondary endpoints were the polyp detection rate(PDR),adenomas per colonoscopy,adenomas per positive colonoscopy,and factors related to adenoma detection.RESULTS A total of 4211 patients(966 adenomas)were included in the analysis(mean age,56.7 years,47.1%male).There were 2113 patients(508 adenomas)in the IEE group and 2098 patients(458 adenomas)in the WLI group.The ADR in two group were not significantly different[24.0%vs 21.8%,1.10,95%confidence interval(CI):0.99-1.23,P=0.09].The PDR was higher with IEE group(41.7%)than with WLI group(36.1%,1.16,95%CI:1.07-1.25,P=0.01).Differences in mean withdrawal time(7.90±3.42 min vs 7.85±3.47 min,P=0.30)and adenomas per colonoscopy(0.33±0.68 vs 0.28±0.62,P=0.06)were not significant.Subgroup analysis found that with narrowband imaging(NBI),between-group differences in the ADR,were not significant(23.7%vs 21.8%,1.09,95%CI:0.97-1.22,P=0.15),but were greater with linked color imaging(30.9%vs 21.8%,1.42,95%CI:1.04-1.93,P=0.04).the second-generation NBI(2G-NBI)had an advantage of ADR than both WLI and the first-generation NBI(27.0%vs 21.8%,P=0.01;27.0%vs 21.2.0%,P=0.01).CONCLUSION This prospective study confirmed that,among Chinese,IEE didn’t increase the ADR compared with WLI,but 2G-NBI increase the ADR.展开更多
The coronavirus disease 2019(COVID-19)has affected the whole globe since its outbreak in December 2019,[1]and many countries have tried several measures to protect and mitigate against its spread.Although the outbreak...The coronavirus disease 2019(COVID-19)has affected the whole globe since its outbreak in December 2019,[1]and many countries have tried several measures to protect and mitigate against its spread.Although the outbreaks have been effectively controlled in China,COVID-19 is still emerging as a public health crisis worldwide,causing massive panic.[2]Additionally,there are still scattered new cases being reported in China.[3]Therefore,in order to adhere to the policy of preventing imported cases and domestic resurgence,varied strategic countermeasures against COVID-19 have been enforced on a regular basis.As respiratory droplet and contact are the main modes of COVID-19 transmission,[4]all endoscopy centers have a higher risk of exposure to COVID-19 than other areas in a hospital.展开更多
BACKGROUND Left colon cancer surgery relies on laparoscopic hemicolectomy,with digestive tract reconstruction critical.End-to-side anastomosis(ESA)and side-to-side anastomosis(SSA)anastomoses are common,but their comp...BACKGROUND Left colon cancer surgery relies on laparoscopic hemicolectomy,with digestive tract reconstruction critical.End-to-side anastomosis(ESA)and side-to-side anastomosis(SSA)anastomoses are common,but their comparative outcomes,especially in splenic flexure handling and efficacy,need clarification.This study compares ESA and SSA to guide surgical practice.AIM To compare the clinical outcomes of laparoscopically assisted left hemicolectomy with ESA and SSA.METHODS A total of 334 patients were included,with 105 patients from the First Affiliated Hospital of Xiamen University and 229 patients from the First Affiliated Hospital of Fujian Medical University,between January 1,2012,and May 31,2020.The patients were divided into two groups:146 cases in the ESA group and 188 cases in the SSA group.Clinical data from both groups were compared,and the survival prognosis was followed up.RESULTS The operation time for the ESA group was significantly shorter than that of the SSA group(197.1±57.7 minutes vs 218.6±67.5 minutes,χ2=4.298,P=0.039).There were no significant differences between the two groups in intraoperative blood loss,postoperative pain score at 48 hours,time to first bowel movement,number of lymph nodes dissected,or postoperative complications such as anastomotic leakage,bleeding,stenosis.and adhesive intestinal obstruction at 6 months,12 months,and 24 months(P>0.05).Specifically,the incidence of complications like anastomotic leakage was 2.1%in the ESA group vs 4.3%in the SSA group(P=0.264).The 5-year disease-free survival(DFS)rate was 66.4%for the ESA group and 63.9%for the SSA group(P=0.693).There were no significant differences in the overall survival rate between the two groups.The incidence of splenic laceration was significantly higher in the SSA group(3.7%vs 0.7%,P=0.018).Overall,the 5-year DFS was 66.4%for ESA and 63.9%for SSA,with no significant difference in survival between the groups(P=0.693).CONCLUSION Both laparoscopically assisted left hemicolectomy with ESA and SSA are feasible and offer comparable long-term outcomes.ESA may reduce the need for splenic flexure dissociation,particularly when the tumor is located at the descending colon or its junction with the sigmoid colon,and especially in obese patients,elderly individuals with multiple complications,or those with severe adhesions in the splenic flexure of the surgical field.展开更多
AIM: To assess the use of dezocine combined with propofol for the anesthetization of patients undergoing indolent colonoscopy.METHODS: A cross-sectional survey of patients undergoing indolent colonoscopy in the Xinjia...AIM: To assess the use of dezocine combined with propofol for the anesthetization of patients undergoing indolent colonoscopy.METHODS: A cross-sectional survey of patients undergoing indolent colonoscopy in the Xinjiang people's Hospital was conducted from April 1 to April 30, 2015. The survey collected patient general information and anesthesia data, including overall medical experience and pain management. Thirty minutes after colonoscopy surgery, samples of venous blood were collected and the biochemical indicators of gastrointestinal function were analyzed. RESULTS: There were 98 female and 62 male respondents. Indolent colonoscopy was found to be more suitable for mid to older-aged patients. The necessary conditions for the diagnosis of digestive diseases were required in 65 of the 73 inpatients. Adverse reactions to the intraoperative process included two cases of body movement and two cases of respiratory depression. Gastrin and vasoactive intestinal peptide levels were slightly increased. However, somatostatin and endothelin levels were slightly decreased. CONCLUSION: This study revealed that dezocine combined with propofol can be successfully used for the anesthetization of indolent colonoscopy patients without pain and should be widely used.展开更多
AIM: To analyze the clinical characteristics of small bowel tumors detected by double-balloon enteroscopy (DBE) and to evaluate the diagnostic value of DBE in tumors. METHODS: Four hundred and forty consecutive DBE ex...AIM: To analyze the clinical characteristics of small bowel tumors detected by double-balloon enteroscopy (DBE) and to evaluate the diagnostic value of DBE in tumors. METHODS: Four hundred and forty consecutive DBE examinations were performed in 400 patients (250 males and 150 females, mean age 46.9 ± 16.3 years, range 14-86 years) between January 2007 and April 2012. Of these, 252 patients underwent the antegrade approach, and 188 patients underwent the retrograde approach. All the patients enrolled in our study were suspected of having small bowel diseases with a negative etiological diagnosis following other routine examinations, such as upper and lower gastrointestinal endoscopy and radiography tests. Data on tumors, such as clinical information, endoscopic findings and opera-tion results, were retrospectively collected. RESULTS: Small bowel tumors were diagnosed in 78 patients, of whom 67 were diagnosed using DBE, resulting in a diagnostic yield of 16.8% (67/400); the other 11 patients had negative DBE findings and were diagnosed through surgery or capsule endoscopy. Adenocarcinoma (29.5%, 23/78), gastrointestinal stromal tumor (24.4%, 19/78) and lymphoma (15.4%, 12/78) were the most common tumors. Among the 78 tumors, 60.3% (47/78) were located in the jejunum, and the overall number of malignant tumors was 74.4% (58/78). DBE examinations were frequently performed in patients with obscure gastrointestinal bleeding (47.4%) and abdominal pain (24.4%). The positive detection rate for DBE in the 78 patients with small bowel tumors was 85.9% (67/78), which was higher than that of a computed tomography scan (72.9%, 51/70). Based on the operation results, the accuracy rates of DBE for locating small bowel neoplasms, such as adenocarcinoma, gastrointestinal stromal tumor and lymphoma, were 94.4%, 100% and 100%, respectively. The positive biopsy rates for adenocarcinoma and lymphoma were 71.4% and 60%, respectively. CONCLUSION: DBE is a useful diagnostic tool with high clinical practice value and should be considered the gold standard for the investigation of small bowel tumors.展开更多
Background:The Qingjiehuagong decoction(QJHGD),which has been used in clinical trials to treat acute pancreatitis(AP),has demonstrated encouraging results.Methods:In this particular investigation,we used both metabolo...Background:The Qingjiehuagong decoction(QJHGD),which has been used in clinical trials to treat acute pancreatitis(AP),has demonstrated encouraging results.Methods:In this particular investigation,we used both metabolomics and network pharmacology to investigate the fundamental processes and targets that QJHGFD employs to cure AP.Results:Using a cerulein-induced rat model of AP,we showed that QJHGD effectively improved pancreatic tissue damage and reduced serum levels of AMY,LPS,IL-1β,IL-6,IL-8 and TNF-α.In total,28 blood entry compounds derived from QJHGD were identified by ultra-performance liquid chromatography-high resolution mass spectrometry technology.The intersecting target genes of 108 genes associated with identified compounds in QJHGD and AP disease genes were identified using a network pharmacology approach.The protein interaction network revealed AKT1,TNF-α,IL-6,VEGFA,and TP53 as important targets.Gene ontology analysis showed that response to stimulus,molecular function regulator and organelle part were the main functions,and Kyoto Encyclopedia of Genes and Genomes analysis showed that 20 pathways such as AGE-RAGE signaling pathway in diabetic complications and the IL-17 signaling pathway were the main pathways involved in the anti-AP effects of QJHGD.Thirty-two potential metabolic markers and 13 possible metabolic pathways were identified by metabolomics analysis.Combined network pharmacological analysis revealed that QJHGD affects four metabolic pathways(tryptophan metabolism;glycolysis and gluconeogenesis metabolism;valine,leucine and isoleucine degradation metabolism;the urea cycle and metabolism of arginine,proline,glutamate,aspartate and asparagine),five metabolites(indole-3-acetate,pyruvate,methylmalonate,L-citrulline,N-acetyl-l-glutamate)and four related targets(AKT1,ALDH2,NOS2,NOS3)to combat inflammation.The strong affinity of QJHGD’s interactions with its primary targets was established by molecular docking and molecular dynamics simulations.Conclusion:This research investigate the critical targets and mechanisms of QJHGFD for treating AP.The results of this investigation provide novel tactics and complementary techniques for the clinical treatment of AP.展开更多
BACKGROUND Currently,a variety of new nursing methods and routine nursing have been widely used in the nursing of gastrointestinal surgery patients.AIM To investigate the effect of follow-up protocol based on the Omah...BACKGROUND Currently,a variety of new nursing methods and routine nursing have been widely used in the nursing of gastrointestinal surgery patients.AIM To investigate the effect of follow-up protocol based on the Omaha System on self-care ability and quality of life of gastrointestinal surgery patients.METHODS A total of 128 patients with inflammatory bowel disease in gastrointestinal surgery in gastrointestinal surgery from March 2019 to August 2021 were divided into A(n=64)and B(n=64)groups according to different nursing methods.The group A received a follow-up program Omaha System-based intervention of the group B,whereas the group B received the routine nursing intervention.Medical Coping Modes Questionnaire,Crohn’s and Colitis Knowledge Score(CCKNOW),inflammatory bowel disease questionnaire(IBDQ),Exercise of Self-nursing Agency Scale(ESCA),The Modified Mayo Endoscopic Score,and Beliefs about Medicine Questionnaire(BMQ)were compared between the two groups.RESULTS Following the intervention,the group A were facing score significantly increased than group B,while the avoidance and yield scores dropped below of group B(all P<0.05);in group A,the level of health knowledge,personal care abilities,self-perception,self-awareness score and ESCA total score were more outstanding than group B(all P<0.05);in group A the frequency of defecation,hematochezia,endoscopic performance,the total evaluation score by physicians and the disease activity were lower than group B(all P<0.05);in the group A,the total scores of knowledge in general,diet,drug,and complication and CCKNOW were higher than group B(all P<0.05);in group A,the necessity of taking medicine,score of medicine concern and over-all score of BMQ were more significant than group B(all P<0.05);at last in the group A,the scores of systemic and intestinal symptoms,social and emotional function,and IBDQ in the group A were higher than group B(all P<0.05).CONCLUSION For gastrointestinal surgery patients,the Omaha System-based sequel protocol can improve disease awareness and intervention compliance,help them to face the disease positively,reduce disease activity,and improve patients’self-nursing ability and quality of life.展开更多
BACKGROUND Abscess formation is one of the complications after radical resection of rectal cancer;cases with delayed postoperative anastomotic abscess are rare.Here,we report a rare case of postoperative anastomotic a...BACKGROUND Abscess formation is one of the complications after radical resection of rectal cancer;cases with delayed postoperative anastomotic abscess are rare.Here,we report a rare case of postoperative anastomotic abscess with a submucosal neoplasm appearing after rectal surgery.Ultimately,the patient was diagnosed and treated by endoscopic fenestration.In addition,we review the literature on the appearance of an abscess as a complication after rectal cancer surgery.CASE SUMMARY A 57-year-old man with a history of rectal malignancy resection complained of a smooth protuberance near the anastomotic stoma.Endoscopic ultrasonography revealed a hypoechoic structure originating from the muscularis propria,and a submucosal tumor was suspected.The patient was subsequently referred to our hospital and underwent pelvic contrast-enhanced computed tomography,which revealed no thickening or strengthening of the anastomotic wall.In order to clarify the origin of the lesion and obtain the pathology,endoscopic fenestration was performed.After endoscopic procedure,a definitive diagnosis of delayed anastomotic submucosal abscess was established.The patient achieved good recovery and prognosis after the complete clearance of abscess.CONCLUSION Endoscopic fenestration may be safe and effective for the diagnosis/treatment of delayed intestinal smooth protuberance after rectal cancer surgery.展开更多
BACKGROUND Sporadic cases of extranasopharyngeal angiofibroma in children,especially preschool children,have been reported in the literature.CASE SUMMARY We present a case of extranasopharyngeal angiofibroma in a 4-ye...BACKGROUND Sporadic cases of extranasopharyngeal angiofibroma in children,especially preschool children,have been reported in the literature.CASE SUMMARY We present a case of extranasopharyngeal angiofibroma in a 4-year-old boy.The presenting symptoms,imaging findings,treatment,histological appearance,and follow-up data are described in detail.For this patient,we performed embolization on two occasions,and then,resected the tumor completely.During the treatment,the patient developed a soft-palate perforation due to aseptic necrosis.However,the healing ability was good,and the perforation healed spontaneously.We additionally reviewed all pediatric cases of extranasopharyngeal angiofibroma published up to 30 June 2020 in the PubMed,Baidu Scholar,Scopus,and Web of Science databases.We identified 45 pediatric patients[average(10.98±4.86),boys 39(86.7%)].The highest proportion of cases occurred in adolescence[22(48.9%)].The top three sites of occurrence of extranasopharyngeal angiofibroma in children were the maxillary sinus,nasal septum,and inferior turbinate.CONCLUSION Extranasopharyngeal angiofibromas can occur throughout childhood,and predominantly present with nasal obstruction and spontaneous rhinorrhagia.展开更多
Objective:Neuroendocrine neoplasms(NENs)are relatively rare and heterogeneous malignancies with two major subtypes:low-grade neuroendocrine tumor(NET)and high-grade neuroendocrine carcinoma(NEC).Comprehensive molecula...Objective:Neuroendocrine neoplasms(NENs)are relatively rare and heterogeneous malignancies with two major subtypes:low-grade neuroendocrine tumor(NET)and high-grade neuroendocrine carcinoma(NEC).Comprehensive molecular characterization of NENs is needed to refine our understanding of the biological underpinnings of different NEN subtypes and to predict disease progression more accurately.Methods:We performed whole-exome sequencing(WES)of NEN samples from 49 patients(25 NETs and 24 NECs)arising from the stomach,intestines or lung.Clinicopathologic features were assessed and associated with molecular events.Results:NENs generally harbor a low mutation burden,with TP53 being the top mutated gene found in 31%of patients.Consistent with other studies,p53 signaling pathway dysfunction is significantly enriched in NECs compared to NETs(P<0.01).Other than TP53,tissue type-specific mutation profiles of NENs were observed in our cohort compared to those reported in pancreatic NETs.Importantly,we observed significant genomic instability,with increased copy number alterations observed across the NEN genome,which was more profound in NECs and independently correlated with poor overall survival(OS)(P<0.001).NECs could be further stratified into two molecular subtypes based on OS(P<0.001)and the chromosomal instability score(CIS).Interestingly,we discovered that the gain of whole chromosome 5 occurred at the early stage of NEN development,followed by the loss of 5 q exclusively in NECs(P<0.001).Conclusions:These findings provide novel insights into the molecular characteristics of NENs and highlight the association of genomic stability with clinical outcomes.展开更多
Background:Endoscopic papillary large balloon dilation(EPLBD)has been proposed as an alternative to manage large bile duct stones.However,EPLBD alone or combined with sphincterotomy remains controversial.Methods:Betwe...Background:Endoscopic papillary large balloon dilation(EPLBD)has been proposed as an alternative to manage large bile duct stones.However,EPLBD alone or combined with sphincterotomy remains controversial.Methods:Between Jan.2014 and Dec.2017,195 consecutive patients with proven large common bile duct stones(size≥10 mm)were retrospectively analyzed.We compared the baseline characteristics,procedure time,success rate of stone removal and morbidity outcomes in different groups.Results:There were no significant difference between baseline characteristics of the groups compared.A total of 89.2%,95.4%,and 93.8% of the patients in the EPLBD,EPLBD+small sphincterotomy(SES),and EPLBD+complete sphincterotomy(CES)groups had stones cleared(P=0.473),respectively.There was no difference in terms of procedure time(33.5±10.2,34.8±9.0,34.9±8.2,in the EPLBD,EPLBD+SES,and EPLBD+CES groups,respectively).However,when assigned to tvvo groups according to bile duct stones diameter(bile duct stones<13 mm,bile duct stones≥13 mm).in the bile duct stones<13 mm group,the procedure time was significantly less in the EPLBD group than the EPLBD+SES group and the EPLBD+CES group(P=0.028).In the bile duct stones≥13 mm group,the mechanical lithotripsy rate of EPLBD was significantly higher compared to EPLBD+SES or EPLBD+CES(P=0.032).The complication rates were similar among all groups.Conclusions:The diameter of bile duct stones should be taken into consideration when choosing EPLBD alone or combined with small sphincterotomy for the removal of common bile duct stones.展开更多
BACKGROUND Colorectal cancer(CRC)is a major global health burden.B cell CLL/lymphoma 10(BCL10),a key component of the caspase recruitment domain protein-BCL10-mucosa-associated lymphoid tissue lymphoma paracaspase com...BACKGROUND Colorectal cancer(CRC)is a major global health burden.B cell CLL/lymphoma 10(BCL10),a key component of the caspase recruitment domain protein-BCL10-mucosa-associated lymphoid tissue lymphoma paracaspase complexes,is upregulated in CRC and associated with poor patient prognosis,suggesting its potential role in CRC development and progression.Cuproptosis,a novel form of programmed cell death,has emerged as a promising therapeutic strategy for cancer.AIM To explore the role of BCL10 in regulating the sensitivity of CRC cells to cuproptosis.METHODS A series of in vitro and in vivo experiments were conducted using CRC cell lines and CRC mouse models to evaluate the effects of BCL10 on CRC cell proliferation,migration,invasion,and sensitivity to copper-induced cell death.Mechanistic studies were performed to elucidate the underlying molecular pathways.RESULTS BCL10 promoted CRC cell proliferation,migration,and invasion,while its knockdown had the opposite effects.BCL10 also influenced the sensitivity of CRC cells to cuproptosis,with BCL10 overexpression enhancing resistance and its knockdown increasing sensitivity.The mechanism involved BCL10 modulating the expression of DLAT,a key protein in the copper-induced cell death pathway,through activation of the nuclear factor kappa-B(NF-κB)signaling pathway.CONCLUSION BCL10 promotes CRC growth and regulates the sensitivity of CRC cells to cuproptosis by activating the NF-κB signaling pathway and modulating DLAT expression.These findings provide a molecular basis for developing BCL10-targeted therapies for CRC.展开更多
The self-attention mechanism of Transformers,which captures long-range contextual information,has demonstrated significant potential in image segmentation.However,their ability to learn local,contextual relationships ...The self-attention mechanism of Transformers,which captures long-range contextual information,has demonstrated significant potential in image segmentation.However,their ability to learn local,contextual relationships between pixels requires further improvement.Previous methods face challenges in efficiently managing multi-scale fea-tures of different granularities from the encoder backbone,leaving room for improvement in their global representation and feature extraction capabilities.To address these challenges,we propose a novel Decoder with Multi-Head Feature Receptors(DMHFR),which receives multi-scale features from the encoder backbone and organizes them into three feature groups with different granularities:coarse,fine-grained,and full set.These groups are subsequently processed by Multi-Head Feature Receptors(MHFRs)after feature capture and modeling operations.MHFRs include two Three-Head Feature Receptors(THFRs)and one Four-Head Feature Receptor(FHFR).Each group of features is passed through these MHFRs and then fed into axial transformers,which help the model capture long-range dependencies within the features.The three MHFRs produce three distinct feature outputs.The output from the FHFR serves as auxiliary auxiliary features in the prediction head,and the prediction output and their losses will eventually be aggregated.Experimental results show that the Transformer using DMHFR outperforms 15 state of the arts(SOTA)methods on five public datasets.Specifically,it achieved significant improvements in mean DICE scores over the classic Parallel Reverse Attention Network(PraNet)method,with gains of 4.1%,2.2%,1.4%,8.9%,and 16.3%on the CVC-ClinicDB,Kvasir-SEG,CVC-T,CVC-ColonDB,and ETIS-LaribPolypDB datasets,respectively.展开更多
In this article we commented on an article published recently by Jiao et al.This retrospective study confirmed that the triple therapy of transarterial chemoembolization(TACE)combined with programmed death protein lig...In this article we commented on an article published recently by Jiao et al.This retrospective study confirmed that the triple therapy of transarterial chemoembolization(TACE)combined with programmed death protein ligand 1 inhibitors and molecular targeted therapy can significantly reverse TACE resistance in advanced hepatocellular carcinoma.Compared with TACE alone,the triple therapy reduced the resistance rate from 38.8%to 9.7%and increased the median progression-free survival and median overall survival by 92.3%and 26.8%,respectively.TACE induces tumor antigen release and upregulates programmed death protein ligand 1,activating the effect of immune checkpoint inhibitors while molecular targeted therapy inhibits postembolization vascular regeneration,forming a dynamic synergistic network of embolization-immune activation-vascular inhibition.The maximum tumor diameter,capsule loss,and bilateral distribution were identified as independent predictors.This study provided level I evidence and promoted the transformation of advanced hepatocellular carcinoma treatment from single local intervention to an integrated model of local control-systemic treatment.In the future it will be necessary to analyze the dynamic evolution rules of the tumor microenvironment through crossomics strategies,further explore biomarkers,optimize treatment sequences,and conduct multicenter prospective trials to verify long-term survival benefits and guide the optimization of individualized sequential treatment.展开更多
BACKGROUND Ras-related protein Rab24,which belongs to the small GTPase family,plays a crucial role in regulating intracellular protein trafficking.Dysregulation of Rab24 has been recently identified in hepatocellular ...BACKGROUND Ras-related protein Rab24,which belongs to the small GTPase family,plays a crucial role in regulating intracellular protein trafficking.Dysregulation of Rab24 has been recently identified in hepatocellular carcinoma(HCC).However,its clinical significance and tumor related effects remain to be further clarified.AIM To explore the expression pattern of Rab24 and its role in HCC progression.METHODS The expression profile of Rab24 was tested in HCC tissues together with adjacent tissues from transcriptional,mRNA,and protein levels.The prognostic role of Rab24 in HCC was assessed by univariate and multivariate analyses.Clinical outcomes were evaluated by the Kaplan-Meier analysis and log-rank test.The effect of Rab24 on cell proliferation was tested through cellular experiments and xenograft experiments.RESULTS Rab24 expression was elevated in HCC tissues compared to adjacent liver tissues.High expression of Rab24 was significantly associated with larger tumor size and advanced tumor stage.Moreover,HCC patients with high Rab24 expression showed poorer overall survival,and Rab24 was identified as an independent prognosis factor according to multivariate analysis.By using overexpression and shRNA knockdown strategies in HCC cell lines,we found that Rab24 can promote HCC proliferation.Finally,we validated that silencing Rab24 significantly attenuated xenograft growth in vivo.CONCLUSION Our study demonstrated that high expression of Rab24 was significantly correlated with poorer prognosis of HCC patients,indicating the potential of Rab24 as a novel clinical biomarker and therapeutic target.展开更多
BACKGROUND Non-magnifying endoscopy with narrow-band imaging(NM-NBI)has been frequently used in routine screening of esophagus squamous cell carcinoma(ESCC).The performance of NBI for screening of early ESCC is,howeve...BACKGROUND Non-magnifying endoscopy with narrow-band imaging(NM-NBI)has been frequently used in routine screening of esophagus squamous cell carcinoma(ESCC).The performance of NBI for screening of early ESCC is,however,significantly affected by operator experience.Artificial intelligence may be a unique approach to compensate for the lack of operator experience.AIM To construct a computer-aided detection(CAD)system for application in NMNBI to identify early ESCC and to compare it with our previously reported CAD system with endoscopic white-light imaging(WLI).METHODS A total of 2167 abnormal NM-NBI images of early ESCC and 2568 normal images were collected from three institutions(Zhongshan Hospital of Fudan University,Xuhui Hospital,and Kiang Wu Hospital)as the training dataset,and 316 pairs of images,each pair including images obtained by WLI and NBI(same part),were collected for validation.Twenty endoscopists participated in this study to review the validation images with or without the assistance of the CAD systems.The diagnostic results of the two CAD systems and improvement in diagnostic efficacy of endoscopists were compared in terms of sensitivity,specificity,accuracy,positive predictive value,and negative predictive value.RESULTS The area under receiver operating characteristic curve for CAD-NBI was 0.9761.For the validation dataset,the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of CAD-NBI were 91.0%,96.7%,94.3%,95.3%,and 93.6%,respectively,while those of CAD-WLI were 98.5%,83.1%,89.5%,80.8%,and 98.7%,respectively.CAD-NBI showed superior accuracy and specificity than CAD-WLI(P=0.028 and P≤0.001,respectively),while CAD-WLI had higher sensitivity than CAD-NBI(P=0.006).By using both CAD-WLI and CAD-NBI,the endoscopists could improve their diagnostic efficacy to the highest level,with accuracy,sensitivity,and specificity of 94.9%,92.4%,and 96.7%,respectively.CONCLUSION The CAD-NBI system for screening early ESCC has higher accuracy and specificity than CAD-WLI.Endoscopists can achieve the best diagnostic efficacy using both CAD-WLI and CAD-NBI.展开更多
Objective：To investigate the prevalence of long-term fatigue,anxiety,depression and social support,and the relationships among these symptoms in postoperative patients with breast cancer.Methods：A total of 180 posto...Objective：To investigate the prevalence of long-term fatigue,anxiety,depression and social support,and the relationships among these symptoms in postoperative patients with breast cancer.Methods：A total of 180 postoperative patients with breast cancer meeting criterion were recruited in this cross-sectional study.The Brief Fatigue Inventory （BFI）,Hospital Anxiety and Depression Scale （HADS） and The Social Support Survey-Chinese version were used to assessing the fatigue,anxiety and depression,Social support of participants.The magnitude of the relationship among the symptoms of fatigue and other variables was measured by Spearman Rho correlation.Results：The prevalence of long-term fatigue was 52.7％,and 18.3％ occurred moderate/severe fatigue.Two-thirds of patients had a basal social support,only 12.8％ of patients had better-perceived social support.Results of HADS showed that 16.7％ and 21.1 ％ of the participants have anxiety or depression disorder.Moderate/severe fatigue was negatively correlated with social support （r=-0.158,P=0.038） and positively correlated with age （r=0.132,P=0.042）,chemotherapy （r=0.297,P=0.027）,anxiety （r=0.324,P=0.018） and depression （r=0.211,P=0.034）.Conclusions：Long-term fatigue was highly prevalent among over half of postoperative patients with breast cancer,and moderate/severe fatigue was associated with social and psychological factors such as social support,anxiety and depression.Our results suggest that overall nursing care may be a more effective manner in improving fatigue and quality of life.展开更多
BACKGROUND This study aimed to evaluate the safety of enhanced recovery after surgery(ERAS)in elderly patients with gastric cancer(GC).AIM To evaluate the safety of ERAS in elderly patients with GC.METHODS The PubMed,...BACKGROUND This study aimed to evaluate the safety of enhanced recovery after surgery(ERAS)in elderly patients with gastric cancer(GC).AIM To evaluate the safety of ERAS in elderly patients with GC.METHODS The PubMed,EMBASE,and Cochrane Library databases were used to search for eligible studies from inception to April 1,2023.The mean difference(MD),odds ratio(OR)and 95%confidence interval(95%CI)were pooled for analysis.The quality of the included studies was evaluated using the Newcastle-Ottawa Scale scores.We used Stata(V.16.0)software for data analysis.RESULTS This study consists of six studies involving 878 elderly patients.By analyzing the clinical outcomes,we found that the ERAS group had shorter postoperative hospital stays(MD=-0.51,I2=0.00%,95%CI=-0.72 to-0.30,P=0.00);earlier times to first flatus(defecation;MD=-0.30,I²=0.00%,95%CI=-0.55 to-0.06,P=0.02);less intestinal obstruction(OR=3.24,I2=0.00%,95%CI=1.07 to 9.78,P=0.04);less nausea and vomiting(OR=4.07,I2=0.00%,95%CI=1.29 to 12.84,P=0.02);and less gastric retention(OR=5.69,I2=2.46%,95%CI=2.00 to 16.20,P=0.00).Our results showed that the conventional group had a greater mortality rate than the ERAS group(OR=0.24,I2=0.00%,95%CI=0.07 to 0.84,P=0.03).However,there was no statistically significant difference in major complications between the ERAS group and the conventional group(OR=0.67,I2=0.00%,95%CI=0.38 to 1.18,P=0.16).CONCLUSION Compared to those with conventional recovery,elderly GC patients who received the ERAS protocol after surgery had a lower risk of mortality.展开更多
BACKGROUND With the recent improvement of endoscopic techniques,endoscopic ultrasoundguided fine needle aspiration and endoscopic submucosal tunnel dissection(ESTD)have been widely used for accurate diagnosis and diss...BACKGROUND With the recent improvement of endoscopic techniques,endoscopic ultrasoundguided fine needle aspiration and endoscopic submucosal tunnel dissection(ESTD)have been widely used for accurate diagnosis and dissection acceleration of esophageal tumors.CASE SUMMARY We used a modified submucosal tunnel technique during endoscopic en bloc resection in a 58-year-old man with large esophageal submucosal gland duct adenoma(ESGDA).During modified ESTD,the oral end of the involved mucosa was cut transversely,followed by a submucosal tunnel created from the proximal to the distal end,and the anal end of the involved mucosa blocked by the tumor was incised.As a result of retaining submucosal injection solutions using the submucosal tunnel technique,it was possible to reduce the amount of injection required and increase the efficiency and safety of dissection.CONCLUSION Modified ESTD is an effective treatment strategy for large ESGDAs.Single-tunnel ESTD appears to be a time-saving procedure compared with conventional endoscopic submucosal dissection.展开更多
BACKGROUND Previous studies had shown endoscopic retrograde appendicitis therapy(ERAT)is an effective treatment for acute appendicitis.However,different studies reported conflicting outcomes regarding the effectivenes...BACKGROUND Previous studies had shown endoscopic retrograde appendicitis therapy(ERAT)is an effective treatment for acute appendicitis.However,different studies reported conflicting outcomes regarding the effectiveness of ERAT in comparison with laparoscopic appendectomy(LA).AIM To compare the effectiveness of ERAT with LA.METHODS Randomized controlled trials(RCTs)and retrospective studies of ERAT for acute uncomplicated appendicitis were searched in PubMed,Cochrane Library,Web of Science,Embase database,China National Knowledge Infrastructure(CNKI),the WanFang Database,and Chinese Scientific Journals Database(VIP)from the establishment date to March 12021.Heterogeneity was assessed using the Isquared statistic.Pooled odds ratios(OR),weighted mean difference(WMD),and standard mean difference(SMD),with 95%confidence intervals(CI)were calculated through either fixed-effects or random-effects model.Sensitivity analysis was also performed.Publication bias was tested by Egger's test,and Begg’s test.The quality of included RCT were evaluated by the Jadad scale,while Newcastle-Ottawa scale is adopted for assessing the methodological quality of case-control studies.All statistical analysis was performed using Stata 15.1 statistical software.All statistical analysis was performed using Stata 15.1 statistical software.This study is registered with PROSPERO,CRD42021243955.RESULTS After screening,10 RCTs and 2 case-control studies were included in the current systematic review.Firstly,the length of hospitalizations[WMD=-1.15,95%CI:-1.99,-0.31;P=0.007]was shorter than LA group.Secondly,the level of postoperative CRP[WMD=-10.06,95%CI:(-17.39,-2.73);P=0.007],TNF-α[WMD=-7.70,95%CI:(-8.47,-6.93);P<0.001],and IL-6 Levels[WMD=-9.78,95%CI:(-10.69,-8.88);P<0.001;P<0.001]in ERAT group was significantly lower than LA group.Thirdly,ERAT group had a lower incidence of intestinal obstruction than LA group.[OR=0.19,95%CI:(0.05,0.79);P=0.020].Moreover,the quality of 10 RCTs were low with 0-3 Jadad scores,while the methodological quality of two case-control studies were fair with a score of 2(each).CONCLUSION Compared with LA,ERAT reduces operation time,the level of postoperative inflammation,and results in fewer complications and shorter recovery time,with preserving the appendix and its immune and biological functions.展开更多
基金Supported by the National Key R&D Program of China,No. 2018YFC1315005National Natural Science Foundation of China,No. 82002515+1 种基金Shanghai Sailing Program,No. 20YF1407200China Postdoctoral Science Foundation,No. 2020M681177
文摘BACKGROUND Improved adenoma detection at colonoscopy has decreased the risk of developing colorectal cancer.However,whether image-enhanced endoscopy(IEE)further improves the adenoma detection rate(ADR)is controversial.AIM To compare IEE with white-light imaging(WLI)endoscopy for the detection and identification of colorectal adenoma.METHODS This was a multicenter,randomized,controlled trial.Participants were enrolled between September 2019 to April 2021 from 4 hospital in China.Patients were randomly assigned to an IEE group with WLI on entry and IEE on withdrawal(n=2113)or a WLI group with WLI on both entry and withdrawal(n=2098).The primary outcome was the ADR.The secondary endpoints were the polyp detection rate(PDR),adenomas per colonoscopy,adenomas per positive colonoscopy,and factors related to adenoma detection.RESULTS A total of 4211 patients(966 adenomas)were included in the analysis(mean age,56.7 years,47.1%male).There were 2113 patients(508 adenomas)in the IEE group and 2098 patients(458 adenomas)in the WLI group.The ADR in two group were not significantly different[24.0%vs 21.8%,1.10,95%confidence interval(CI):0.99-1.23,P=0.09].The PDR was higher with IEE group(41.7%)than with WLI group(36.1%,1.16,95%CI:1.07-1.25,P=0.01).Differences in mean withdrawal time(7.90±3.42 min vs 7.85±3.47 min,P=0.30)and adenomas per colonoscopy(0.33±0.68 vs 0.28±0.62,P=0.06)were not significant.Subgroup analysis found that with narrowband imaging(NBI),between-group differences in the ADR,were not significant(23.7%vs 21.8%,1.09,95%CI:0.97-1.22,P=0.15),but were greater with linked color imaging(30.9%vs 21.8%,1.42,95%CI:1.04-1.93,P=0.04).the second-generation NBI(2G-NBI)had an advantage of ADR than both WLI and the first-generation NBI(27.0%vs 21.8%,P=0.01;27.0%vs 21.2.0%,P=0.01).CONCLUSION This prospective study confirmed that,among Chinese,IEE didn’t increase the ADR compared with WLI,but 2G-NBI increase the ADR.
基金This work was supported by the National Natural Science Foundation of China(82103496).
文摘The coronavirus disease 2019(COVID-19)has affected the whole globe since its outbreak in December 2019,[1]and many countries have tried several measures to protect and mitigate against its spread.Although the outbreaks have been effectively controlled in China,COVID-19 is still emerging as a public health crisis worldwide,causing massive panic.[2]Additionally,there are still scattered new cases being reported in China.[3]Therefore,in order to adhere to the policy of preventing imported cases and domestic resurgence,varied strategic countermeasures against COVID-19 have been enforced on a regular basis.As respiratory droplet and contact are the main modes of COVID-19 transmission,[4]all endoscopy centers have a higher risk of exposure to COVID-19 than other areas in a hospital.
文摘BACKGROUND Left colon cancer surgery relies on laparoscopic hemicolectomy,with digestive tract reconstruction critical.End-to-side anastomosis(ESA)and side-to-side anastomosis(SSA)anastomoses are common,but their comparative outcomes,especially in splenic flexure handling and efficacy,need clarification.This study compares ESA and SSA to guide surgical practice.AIM To compare the clinical outcomes of laparoscopically assisted left hemicolectomy with ESA and SSA.METHODS A total of 334 patients were included,with 105 patients from the First Affiliated Hospital of Xiamen University and 229 patients from the First Affiliated Hospital of Fujian Medical University,between January 1,2012,and May 31,2020.The patients were divided into two groups:146 cases in the ESA group and 188 cases in the SSA group.Clinical data from both groups were compared,and the survival prognosis was followed up.RESULTS The operation time for the ESA group was significantly shorter than that of the SSA group(197.1±57.7 minutes vs 218.6±67.5 minutes,χ2=4.298,P=0.039).There were no significant differences between the two groups in intraoperative blood loss,postoperative pain score at 48 hours,time to first bowel movement,number of lymph nodes dissected,or postoperative complications such as anastomotic leakage,bleeding,stenosis.and adhesive intestinal obstruction at 6 months,12 months,and 24 months(P>0.05).Specifically,the incidence of complications like anastomotic leakage was 2.1%in the ESA group vs 4.3%in the SSA group(P=0.264).The 5-year disease-free survival(DFS)rate was 66.4%for the ESA group and 63.9%for the SSA group(P=0.693).There were no significant differences in the overall survival rate between the two groups.The incidence of splenic laceration was significantly higher in the SSA group(3.7%vs 0.7%,P=0.018).Overall,the 5-year DFS was 66.4%for ESA and 63.9%for SSA,with no significant difference in survival between the groups(P=0.693).CONCLUSION Both laparoscopically assisted left hemicolectomy with ESA and SSA are feasible and offer comparable long-term outcomes.ESA may reduce the need for splenic flexure dissociation,particularly when the tumor is located at the descending colon or its junction with the sigmoid colon,and especially in obese patients,elderly individuals with multiple complications,or those with severe adhesions in the splenic flexure of the surgical field.
文摘AIM: To assess the use of dezocine combined with propofol for the anesthetization of patients undergoing indolent colonoscopy.METHODS: A cross-sectional survey of patients undergoing indolent colonoscopy in the Xinjiang people's Hospital was conducted from April 1 to April 30, 2015. The survey collected patient general information and anesthesia data, including overall medical experience and pain management. Thirty minutes after colonoscopy surgery, samples of venous blood were collected and the biochemical indicators of gastrointestinal function were analyzed. RESULTS: There were 98 female and 62 male respondents. Indolent colonoscopy was found to be more suitable for mid to older-aged patients. The necessary conditions for the diagnosis of digestive diseases were required in 65 of the 73 inpatients. Adverse reactions to the intraoperative process included two cases of body movement and two cases of respiratory depression. Gastrin and vasoactive intestinal peptide levels were slightly increased. However, somatostatin and endothelin levels were slightly decreased. CONCLUSION: This study revealed that dezocine combined with propofol can be successfully used for the anesthetization of indolent colonoscopy patients without pain and should be widely used.
文摘AIM: To analyze the clinical characteristics of small bowel tumors detected by double-balloon enteroscopy (DBE) and to evaluate the diagnostic value of DBE in tumors. METHODS: Four hundred and forty consecutive DBE examinations were performed in 400 patients (250 males and 150 females, mean age 46.9 ± 16.3 years, range 14-86 years) between January 2007 and April 2012. Of these, 252 patients underwent the antegrade approach, and 188 patients underwent the retrograde approach. All the patients enrolled in our study were suspected of having small bowel diseases with a negative etiological diagnosis following other routine examinations, such as upper and lower gastrointestinal endoscopy and radiography tests. Data on tumors, such as clinical information, endoscopic findings and opera-tion results, were retrospectively collected. RESULTS: Small bowel tumors were diagnosed in 78 patients, of whom 67 were diagnosed using DBE, resulting in a diagnostic yield of 16.8% (67/400); the other 11 patients had negative DBE findings and were diagnosed through surgery or capsule endoscopy. Adenocarcinoma (29.5%, 23/78), gastrointestinal stromal tumor (24.4%, 19/78) and lymphoma (15.4%, 12/78) were the most common tumors. Among the 78 tumors, 60.3% (47/78) were located in the jejunum, and the overall number of malignant tumors was 74.4% (58/78). DBE examinations were frequently performed in patients with obscure gastrointestinal bleeding (47.4%) and abdominal pain (24.4%). The positive detection rate for DBE in the 78 patients with small bowel tumors was 85.9% (67/78), which was higher than that of a computed tomography scan (72.9%, 51/70). Based on the operation results, the accuracy rates of DBE for locating small bowel neoplasms, such as adenocarcinoma, gastrointestinal stromal tumor and lymphoma, were 94.4%, 100% and 100%, respectively. The positive biopsy rates for adenocarcinoma and lymphoma were 71.4% and 60%, respectively. CONCLUSION: DBE is a useful diagnostic tool with high clinical practice value and should be considered the gold standard for the investigation of small bowel tumors.
文摘Background:The Qingjiehuagong decoction(QJHGD),which has been used in clinical trials to treat acute pancreatitis(AP),has demonstrated encouraging results.Methods:In this particular investigation,we used both metabolomics and network pharmacology to investigate the fundamental processes and targets that QJHGFD employs to cure AP.Results:Using a cerulein-induced rat model of AP,we showed that QJHGD effectively improved pancreatic tissue damage and reduced serum levels of AMY,LPS,IL-1β,IL-6,IL-8 and TNF-α.In total,28 blood entry compounds derived from QJHGD were identified by ultra-performance liquid chromatography-high resolution mass spectrometry technology.The intersecting target genes of 108 genes associated with identified compounds in QJHGD and AP disease genes were identified using a network pharmacology approach.The protein interaction network revealed AKT1,TNF-α,IL-6,VEGFA,and TP53 as important targets.Gene ontology analysis showed that response to stimulus,molecular function regulator and organelle part were the main functions,and Kyoto Encyclopedia of Genes and Genomes analysis showed that 20 pathways such as AGE-RAGE signaling pathway in diabetic complications and the IL-17 signaling pathway were the main pathways involved in the anti-AP effects of QJHGD.Thirty-two potential metabolic markers and 13 possible metabolic pathways were identified by metabolomics analysis.Combined network pharmacological analysis revealed that QJHGD affects four metabolic pathways(tryptophan metabolism;glycolysis and gluconeogenesis metabolism;valine,leucine and isoleucine degradation metabolism;the urea cycle and metabolism of arginine,proline,glutamate,aspartate and asparagine),five metabolites(indole-3-acetate,pyruvate,methylmalonate,L-citrulline,N-acetyl-l-glutamate)and four related targets(AKT1,ALDH2,NOS2,NOS3)to combat inflammation.The strong affinity of QJHGD’s interactions with its primary targets was established by molecular docking and molecular dynamics simulations.Conclusion:This research investigate the critical targets and mechanisms of QJHGFD for treating AP.The results of this investigation provide novel tactics and complementary techniques for the clinical treatment of AP.
基金Yantai Science and Technology Plan Project,No.2019YD061.
文摘BACKGROUND Currently,a variety of new nursing methods and routine nursing have been widely used in the nursing of gastrointestinal surgery patients.AIM To investigate the effect of follow-up protocol based on the Omaha System on self-care ability and quality of life of gastrointestinal surgery patients.METHODS A total of 128 patients with inflammatory bowel disease in gastrointestinal surgery in gastrointestinal surgery from March 2019 to August 2021 were divided into A(n=64)and B(n=64)groups according to different nursing methods.The group A received a follow-up program Omaha System-based intervention of the group B,whereas the group B received the routine nursing intervention.Medical Coping Modes Questionnaire,Crohn’s and Colitis Knowledge Score(CCKNOW),inflammatory bowel disease questionnaire(IBDQ),Exercise of Self-nursing Agency Scale(ESCA),The Modified Mayo Endoscopic Score,and Beliefs about Medicine Questionnaire(BMQ)were compared between the two groups.RESULTS Following the intervention,the group A were facing score significantly increased than group B,while the avoidance and yield scores dropped below of group B(all P<0.05);in group A,the level of health knowledge,personal care abilities,self-perception,self-awareness score and ESCA total score were more outstanding than group B(all P<0.05);in group A the frequency of defecation,hematochezia,endoscopic performance,the total evaluation score by physicians and the disease activity were lower than group B(all P<0.05);in the group A,the total scores of knowledge in general,diet,drug,and complication and CCKNOW were higher than group B(all P<0.05);in group A,the necessity of taking medicine,score of medicine concern and over-all score of BMQ were more significant than group B(all P<0.05);at last in the group A,the scores of systemic and intestinal symptoms,social and emotional function,and IBDQ in the group A were higher than group B(all P<0.05).CONCLUSION For gastrointestinal surgery patients,the Omaha System-based sequel protocol can improve disease awareness and intervention compliance,help them to face the disease positively,reduce disease activity,and improve patients’self-nursing ability and quality of life.
基金Supported by National Natural Science Foundation of China,No.81900601University Innovation Team and Innovative Talent Support Program of Liaoning Province,No.LR2019073and Outstanding Scientific Fund of Shengjing Hospital,No.201702.
文摘BACKGROUND Abscess formation is one of the complications after radical resection of rectal cancer;cases with delayed postoperative anastomotic abscess are rare.Here,we report a rare case of postoperative anastomotic abscess with a submucosal neoplasm appearing after rectal surgery.Ultimately,the patient was diagnosed and treated by endoscopic fenestration.In addition,we review the literature on the appearance of an abscess as a complication after rectal cancer surgery.CASE SUMMARY A 57-year-old man with a history of rectal malignancy resection complained of a smooth protuberance near the anastomotic stoma.Endoscopic ultrasonography revealed a hypoechoic structure originating from the muscularis propria,and a submucosal tumor was suspected.The patient was subsequently referred to our hospital and underwent pelvic contrast-enhanced computed tomography,which revealed no thickening or strengthening of the anastomotic wall.In order to clarify the origin of the lesion and obtain the pathology,endoscopic fenestration was performed.After endoscopic procedure,a definitive diagnosis of delayed anastomotic submucosal abscess was established.The patient achieved good recovery and prognosis after the complete clearance of abscess.CONCLUSION Endoscopic fenestration may be safe and effective for the diagnosis/treatment of delayed intestinal smooth protuberance after rectal cancer surgery.
文摘BACKGROUND Sporadic cases of extranasopharyngeal angiofibroma in children,especially preschool children,have been reported in the literature.CASE SUMMARY We present a case of extranasopharyngeal angiofibroma in a 4-year-old boy.The presenting symptoms,imaging findings,treatment,histological appearance,and follow-up data are described in detail.For this patient,we performed embolization on two occasions,and then,resected the tumor completely.During the treatment,the patient developed a soft-palate perforation due to aseptic necrosis.However,the healing ability was good,and the perforation healed spontaneously.We additionally reviewed all pediatric cases of extranasopharyngeal angiofibroma published up to 30 June 2020 in the PubMed,Baidu Scholar,Scopus,and Web of Science databases.We identified 45 pediatric patients[average(10.98±4.86),boys 39(86.7%)].The highest proportion of cases occurred in adolescence[22(48.9%)].The top three sites of occurrence of extranasopharyngeal angiofibroma in children were the maxillary sinus,nasal septum,and inferior turbinate.CONCLUSION Extranasopharyngeal angiofibromas can occur throughout childhood,and predominantly present with nasal obstruction and spontaneous rhinorrhagia.
文摘Objective:Neuroendocrine neoplasms(NENs)are relatively rare and heterogeneous malignancies with two major subtypes:low-grade neuroendocrine tumor(NET)and high-grade neuroendocrine carcinoma(NEC).Comprehensive molecular characterization of NENs is needed to refine our understanding of the biological underpinnings of different NEN subtypes and to predict disease progression more accurately.Methods:We performed whole-exome sequencing(WES)of NEN samples from 49 patients(25 NETs and 24 NECs)arising from the stomach,intestines or lung.Clinicopathologic features were assessed and associated with molecular events.Results:NENs generally harbor a low mutation burden,with TP53 being the top mutated gene found in 31%of patients.Consistent with other studies,p53 signaling pathway dysfunction is significantly enriched in NECs compared to NETs(P<0.01).Other than TP53,tissue type-specific mutation profiles of NENs were observed in our cohort compared to those reported in pancreatic NETs.Importantly,we observed significant genomic instability,with increased copy number alterations observed across the NEN genome,which was more profound in NECs and independently correlated with poor overall survival(OS)(P<0.001).NECs could be further stratified into two molecular subtypes based on OS(P<0.001)and the chromosomal instability score(CIS).Interestingly,we discovered that the gain of whole chromosome 5 occurred at the early stage of NEN development,followed by the loss of 5 q exclusively in NECs(P<0.001).Conclusions:These findings provide novel insights into the molecular characteristics of NENs and highlight the association of genomic stability with clinical outcomes.
文摘Background:Endoscopic papillary large balloon dilation(EPLBD)has been proposed as an alternative to manage large bile duct stones.However,EPLBD alone or combined with sphincterotomy remains controversial.Methods:Between Jan.2014 and Dec.2017,195 consecutive patients with proven large common bile duct stones(size≥10 mm)were retrospectively analyzed.We compared the baseline characteristics,procedure time,success rate of stone removal and morbidity outcomes in different groups.Results:There were no significant difference between baseline characteristics of the groups compared.A total of 89.2%,95.4%,and 93.8% of the patients in the EPLBD,EPLBD+small sphincterotomy(SES),and EPLBD+complete sphincterotomy(CES)groups had stones cleared(P=0.473),respectively.There was no difference in terms of procedure time(33.5±10.2,34.8±9.0,34.9±8.2,in the EPLBD,EPLBD+SES,and EPLBD+CES groups,respectively).However,when assigned to tvvo groups according to bile duct stones diameter(bile duct stones<13 mm,bile duct stones≥13 mm).in the bile duct stones<13 mm group,the procedure time was significantly less in the EPLBD group than the EPLBD+SES group and the EPLBD+CES group(P=0.028).In the bile duct stones≥13 mm group,the mechanical lithotripsy rate of EPLBD was significantly higher compared to EPLBD+SES or EPLBD+CES(P=0.032).The complication rates were similar among all groups.Conclusions:The diameter of bile duct stones should be taken into consideration when choosing EPLBD alone or combined with small sphincterotomy for the removal of common bile duct stones.
基金Supported by the National Natural Science Foundation of China,No.82073299Special Project for Health Research Talents of Jilin Province,No.2023SCZ25.
文摘BACKGROUND Colorectal cancer(CRC)is a major global health burden.B cell CLL/lymphoma 10(BCL10),a key component of the caspase recruitment domain protein-BCL10-mucosa-associated lymphoid tissue lymphoma paracaspase complexes,is upregulated in CRC and associated with poor patient prognosis,suggesting its potential role in CRC development and progression.Cuproptosis,a novel form of programmed cell death,has emerged as a promising therapeutic strategy for cancer.AIM To explore the role of BCL10 in regulating the sensitivity of CRC cells to cuproptosis.METHODS A series of in vitro and in vivo experiments were conducted using CRC cell lines and CRC mouse models to evaluate the effects of BCL10 on CRC cell proliferation,migration,invasion,and sensitivity to copper-induced cell death.Mechanistic studies were performed to elucidate the underlying molecular pathways.RESULTS BCL10 promoted CRC cell proliferation,migration,and invasion,while its knockdown had the opposite effects.BCL10 also influenced the sensitivity of CRC cells to cuproptosis,with BCL10 overexpression enhancing resistance and its knockdown increasing sensitivity.The mechanism involved BCL10 modulating the expression of DLAT,a key protein in the copper-induced cell death pathway,through activation of the nuclear factor kappa-B(NF-κB)signaling pathway.CONCLUSION BCL10 promotes CRC growth and regulates the sensitivity of CRC cells to cuproptosis by activating the NF-κB signaling pathway and modulating DLAT expression.These findings provide a molecular basis for developing BCL10-targeted therapies for CRC.
基金supported by Xiamen Medical and Health Guidance Project in 2021(No.3502Z20214ZD1070)supported by a grant from Guangxi Key Laboratory of Machine Vision and Intelligent Control,China(No.2023B02).
文摘The self-attention mechanism of Transformers,which captures long-range contextual information,has demonstrated significant potential in image segmentation.However,their ability to learn local,contextual relationships between pixels requires further improvement.Previous methods face challenges in efficiently managing multi-scale fea-tures of different granularities from the encoder backbone,leaving room for improvement in their global representation and feature extraction capabilities.To address these challenges,we propose a novel Decoder with Multi-Head Feature Receptors(DMHFR),which receives multi-scale features from the encoder backbone and organizes them into three feature groups with different granularities:coarse,fine-grained,and full set.These groups are subsequently processed by Multi-Head Feature Receptors(MHFRs)after feature capture and modeling operations.MHFRs include two Three-Head Feature Receptors(THFRs)and one Four-Head Feature Receptor(FHFR).Each group of features is passed through these MHFRs and then fed into axial transformers,which help the model capture long-range dependencies within the features.The three MHFRs produce three distinct feature outputs.The output from the FHFR serves as auxiliary auxiliary features in the prediction head,and the prediction output and their losses will eventually be aggregated.Experimental results show that the Transformer using DMHFR outperforms 15 state of the arts(SOTA)methods on five public datasets.Specifically,it achieved significant improvements in mean DICE scores over the classic Parallel Reverse Attention Network(PraNet)method,with gains of 4.1%,2.2%,1.4%,8.9%,and 16.3%on the CVC-ClinicDB,Kvasir-SEG,CVC-T,CVC-ColonDB,and ETIS-LaribPolypDB datasets,respectively.
基金Supported by the National Natural Science Foundation of China,No.82404058Shanghai Municipal Commission of Health and Family Planning,No.2024ZZ2049Beijing Xisike Clinical Oncology Research Foundation,No.Y-HS202401-0011.
文摘In this article we commented on an article published recently by Jiao et al.This retrospective study confirmed that the triple therapy of transarterial chemoembolization(TACE)combined with programmed death protein ligand 1 inhibitors and molecular targeted therapy can significantly reverse TACE resistance in advanced hepatocellular carcinoma.Compared with TACE alone,the triple therapy reduced the resistance rate from 38.8%to 9.7%and increased the median progression-free survival and median overall survival by 92.3%and 26.8%,respectively.TACE induces tumor antigen release and upregulates programmed death protein ligand 1,activating the effect of immune checkpoint inhibitors while molecular targeted therapy inhibits postembolization vascular regeneration,forming a dynamic synergistic network of embolization-immune activation-vascular inhibition.The maximum tumor diameter,capsule loss,and bilateral distribution were identified as independent predictors.This study provided level I evidence and promoted the transformation of advanced hepatocellular carcinoma treatment from single local intervention to an integrated model of local control-systemic treatment.In the future it will be necessary to analyze the dynamic evolution rules of the tumor microenvironment through crossomics strategies,further explore biomarkers,optimize treatment sequences,and conduct multicenter prospective trials to verify long-term survival benefits and guide the optimization of individualized sequential treatment.
文摘BACKGROUND Ras-related protein Rab24,which belongs to the small GTPase family,plays a crucial role in regulating intracellular protein trafficking.Dysregulation of Rab24 has been recently identified in hepatocellular carcinoma(HCC).However,its clinical significance and tumor related effects remain to be further clarified.AIM To explore the expression pattern of Rab24 and its role in HCC progression.METHODS The expression profile of Rab24 was tested in HCC tissues together with adjacent tissues from transcriptional,mRNA,and protein levels.The prognostic role of Rab24 in HCC was assessed by univariate and multivariate analyses.Clinical outcomes were evaluated by the Kaplan-Meier analysis and log-rank test.The effect of Rab24 on cell proliferation was tested through cellular experiments and xenograft experiments.RESULTS Rab24 expression was elevated in HCC tissues compared to adjacent liver tissues.High expression of Rab24 was significantly associated with larger tumor size and advanced tumor stage.Moreover,HCC patients with high Rab24 expression showed poorer overall survival,and Rab24 was identified as an independent prognosis factor according to multivariate analysis.By using overexpression and shRNA knockdown strategies in HCC cell lines,we found that Rab24 can promote HCC proliferation.Finally,we validated that silencing Rab24 significantly attenuated xenograft growth in vivo.CONCLUSION Our study demonstrated that high expression of Rab24 was significantly correlated with poorer prognosis of HCC patients,indicating the potential of Rab24 as a novel clinical biomarker and therapeutic target.
基金Supported by National Key R&D Program of China,No.2018YFC1315000,No.2018YFC1315005,No.2019YFC1315800,and No.2019YFC1315802National Natural Science Foundation of China,No.81861168036 and No.81702305+2 种基金Science and Technology Commission Foundation of Shanghai Municipality,No.19411951600,and No.19411951601Macao SAR Science and Technology Development Foundation,No.0023/2018/AFJDawn Program of Shanghai Education Commission,No.18SG08.
文摘BACKGROUND Non-magnifying endoscopy with narrow-band imaging(NM-NBI)has been frequently used in routine screening of esophagus squamous cell carcinoma(ESCC).The performance of NBI for screening of early ESCC is,however,significantly affected by operator experience.Artificial intelligence may be a unique approach to compensate for the lack of operator experience.AIM To construct a computer-aided detection(CAD)system for application in NMNBI to identify early ESCC and to compare it with our previously reported CAD system with endoscopic white-light imaging(WLI).METHODS A total of 2167 abnormal NM-NBI images of early ESCC and 2568 normal images were collected from three institutions(Zhongshan Hospital of Fudan University,Xuhui Hospital,and Kiang Wu Hospital)as the training dataset,and 316 pairs of images,each pair including images obtained by WLI and NBI(same part),were collected for validation.Twenty endoscopists participated in this study to review the validation images with or without the assistance of the CAD systems.The diagnostic results of the two CAD systems and improvement in diagnostic efficacy of endoscopists were compared in terms of sensitivity,specificity,accuracy,positive predictive value,and negative predictive value.RESULTS The area under receiver operating characteristic curve for CAD-NBI was 0.9761.For the validation dataset,the sensitivity,specificity,accuracy,positive predictive value,and negative predictive value of CAD-NBI were 91.0%,96.7%,94.3%,95.3%,and 93.6%,respectively,while those of CAD-WLI were 98.5%,83.1%,89.5%,80.8%,and 98.7%,respectively.CAD-NBI showed superior accuracy and specificity than CAD-WLI(P=0.028 and P≤0.001,respectively),while CAD-WLI had higher sensitivity than CAD-NBI(P=0.006).By using both CAD-WLI and CAD-NBI,the endoscopists could improve their diagnostic efficacy to the highest level,with accuracy,sensitivity,and specificity of 94.9%,92.4%,and 96.7%,respectively.CONCLUSION The CAD-NBI system for screening early ESCC has higher accuracy and specificity than CAD-WLI.Endoscopists can achieve the best diagnostic efficacy using both CAD-WLI and CAD-NBI.
文摘Objective：To investigate the prevalence of long-term fatigue,anxiety,depression and social support,and the relationships among these symptoms in postoperative patients with breast cancer.Methods：A total of 180 postoperative patients with breast cancer meeting criterion were recruited in this cross-sectional study.The Brief Fatigue Inventory （BFI）,Hospital Anxiety and Depression Scale （HADS） and The Social Support Survey-Chinese version were used to assessing the fatigue,anxiety and depression,Social support of participants.The magnitude of the relationship among the symptoms of fatigue and other variables was measured by Spearman Rho correlation.Results：The prevalence of long-term fatigue was 52.7％,and 18.3％ occurred moderate/severe fatigue.Two-thirds of patients had a basal social support,only 12.8％ of patients had better-perceived social support.Results of HADS showed that 16.7％ and 21.1 ％ of the participants have anxiety or depression disorder.Moderate/severe fatigue was negatively correlated with social support （r=-0.158,P=0.038） and positively correlated with age （r=0.132,P=0.042）,chemotherapy （r=0.297,P=0.027）,anxiety （r=0.324,P=0.018） and depression （r=0.211,P=0.034）.Conclusions：Long-term fatigue was highly prevalent among over half of postoperative patients with breast cancer,and moderate/severe fatigue was associated with social and psychological factors such as social support,anxiety and depression.Our results suggest that overall nursing care may be a more effective manner in improving fatigue and quality of life.
基金Supported by Chongqing Medical University Program for Youth Innovation in Future Medicine,No.W0190.
文摘BACKGROUND This study aimed to evaluate the safety of enhanced recovery after surgery(ERAS)in elderly patients with gastric cancer(GC).AIM To evaluate the safety of ERAS in elderly patients with GC.METHODS The PubMed,EMBASE,and Cochrane Library databases were used to search for eligible studies from inception to April 1,2023.The mean difference(MD),odds ratio(OR)and 95%confidence interval(95%CI)were pooled for analysis.The quality of the included studies was evaluated using the Newcastle-Ottawa Scale scores.We used Stata(V.16.0)software for data analysis.RESULTS This study consists of six studies involving 878 elderly patients.By analyzing the clinical outcomes,we found that the ERAS group had shorter postoperative hospital stays(MD=-0.51,I2=0.00%,95%CI=-0.72 to-0.30,P=0.00);earlier times to first flatus(defecation;MD=-0.30,I²=0.00%,95%CI=-0.55 to-0.06,P=0.02);less intestinal obstruction(OR=3.24,I2=0.00%,95%CI=1.07 to 9.78,P=0.04);less nausea and vomiting(OR=4.07,I2=0.00%,95%CI=1.29 to 12.84,P=0.02);and less gastric retention(OR=5.69,I2=2.46%,95%CI=2.00 to 16.20,P=0.00).Our results showed that the conventional group had a greater mortality rate than the ERAS group(OR=0.24,I2=0.00%,95%CI=0.07 to 0.84,P=0.03).However,there was no statistically significant difference in major complications between the ERAS group and the conventional group(OR=0.67,I2=0.00%,95%CI=0.38 to 1.18,P=0.16).CONCLUSION Compared to those with conventional recovery,elderly GC patients who received the ERAS protocol after surgery had a lower risk of mortality.
基金Supported by Young and Middle-aged Mainstay Talent Training Program of Fujian Provincial Health System,China,No. 2017-ZQN-16
文摘BACKGROUND With the recent improvement of endoscopic techniques,endoscopic ultrasoundguided fine needle aspiration and endoscopic submucosal tunnel dissection(ESTD)have been widely used for accurate diagnosis and dissection acceleration of esophageal tumors.CASE SUMMARY We used a modified submucosal tunnel technique during endoscopic en bloc resection in a 58-year-old man with large esophageal submucosal gland duct adenoma(ESGDA).During modified ESTD,the oral end of the involved mucosa was cut transversely,followed by a submucosal tunnel created from the proximal to the distal end,and the anal end of the involved mucosa blocked by the tumor was incised.As a result of retaining submucosal injection solutions using the submucosal tunnel technique,it was possible to reduce the amount of injection required and increase the efficiency and safety of dissection.CONCLUSION Modified ESTD is an effective treatment strategy for large ESGDAs.Single-tunnel ESTD appears to be a time-saving procedure compared with conventional endoscopic submucosal dissection.
文摘BACKGROUND Previous studies had shown endoscopic retrograde appendicitis therapy(ERAT)is an effective treatment for acute appendicitis.However,different studies reported conflicting outcomes regarding the effectiveness of ERAT in comparison with laparoscopic appendectomy(LA).AIM To compare the effectiveness of ERAT with LA.METHODS Randomized controlled trials(RCTs)and retrospective studies of ERAT for acute uncomplicated appendicitis were searched in PubMed,Cochrane Library,Web of Science,Embase database,China National Knowledge Infrastructure(CNKI),the WanFang Database,and Chinese Scientific Journals Database(VIP)from the establishment date to March 12021.Heterogeneity was assessed using the Isquared statistic.Pooled odds ratios(OR),weighted mean difference(WMD),and standard mean difference(SMD),with 95%confidence intervals(CI)were calculated through either fixed-effects or random-effects model.Sensitivity analysis was also performed.Publication bias was tested by Egger's test,and Begg’s test.The quality of included RCT were evaluated by the Jadad scale,while Newcastle-Ottawa scale is adopted for assessing the methodological quality of case-control studies.All statistical analysis was performed using Stata 15.1 statistical software.All statistical analysis was performed using Stata 15.1 statistical software.This study is registered with PROSPERO,CRD42021243955.RESULTS After screening,10 RCTs and 2 case-control studies were included in the current systematic review.Firstly,the length of hospitalizations[WMD=-1.15,95%CI:-1.99,-0.31;P=0.007]was shorter than LA group.Secondly,the level of postoperative CRP[WMD=-10.06,95%CI:(-17.39,-2.73);P=0.007],TNF-α[WMD=-7.70,95%CI:(-8.47,-6.93);P<0.001],and IL-6 Levels[WMD=-9.78,95%CI:(-10.69,-8.88);P<0.001;P<0.001]in ERAT group was significantly lower than LA group.Thirdly,ERAT group had a lower incidence of intestinal obstruction than LA group.[OR=0.19,95%CI:(0.05,0.79);P=0.020].Moreover,the quality of 10 RCTs were low with 0-3 Jadad scores,while the methodological quality of two case-control studies were fair with a score of 2(each).CONCLUSION Compared with LA,ERAT reduces operation time,the level of postoperative inflammation,and results in fewer complications and shorter recovery time,with preserving the appendix and its immune and biological functions.
