Post-esophagectomy anastomotic leak(AL)is a severe complication following esophagectomy,contributing to increased morbidity,prolonged hospitalization,and a significant risk of mortality.Endoscopic vacuum-assisted clos...Post-esophagectomy anastomotic leak(AL)is a severe complication following esophagectomy,contributing to increased morbidity,prolonged hospitalization,and a significant risk of mortality.Endoscopic vacuum-assisted closure(EndoVac)has emerged as a promising first-line treatment,offering a highly effective approach for managing post-esophagectomy AL.EndoVac therapy utilizes continuous negative pressure within the esophageal lumen or mediastinal cavity,promoting granulation tissue formation,accelerating wound healing,and enhancing AL closure rates.Compared to stenting,EndoVac provides distinct advantages,including superior adaptability to varying leak sizes and locations,enhanced secretion drainage,and lower rates of reintervention.Clinical studies have demonstrated higher success rates,decreased post-intervention complications,and shorter hospital stays.Despite its advantages,challenges persist in patient selection,procedural expertise,and accessibility.EndoVac application requires experienced endoscopic teams and multidisciplinary expertise,which is best achieved in high-volume centers with specialized care.Variability in EndoVac protocols necessitate further refinement and standardization to optimize treatment outcomes.The integration of EndoVac into standardized treatment guidelines holds promise for improving patient outcomes and redefining the management approach for this challenging postoperative complication.展开更多
While rare,esophageal gastrointestinal stromal tumors(GISTs)have higher mali-gnant potential and are typically diagnosed at larger sizes compared to gastric GISTs.However,well-defined guidelines for their optimal mana...While rare,esophageal gastrointestinal stromal tumors(GISTs)have higher mali-gnant potential and are typically diagnosed at larger sizes compared to gastric GISTs.However,well-defined guidelines for their optimal management remain lacking.Most esophageal GISTs are surgically managed with enucleation,while esophagectomy is reserved for larger tumors.Recent advances in endoscopic techniques,such as endoscopic submucosal dissection and submucosal tunneling endoscopic resection(ER),have allowed for endoscopic removal of submucosal esophageal lesions,including GISTs.Xu et al reported on the clinical and on-cological outcomes of 32 patients with esophageal GISTs treated with ER.The study demonstrated high en bloc resection rates and favorable 5-year overall survival and disease-free survival.However,it primarily focused on small,inci-dentally detected GISTs,with 75%of cases classified as very low or low risk according to the National Institutes of Health criteria.The authors favored the submucosal tunneling ER technique despite its procedural challenges in the upper esophagus.In this editorial,we briefly discuss the advantages and limitations of endoscopic techniques compared to surgical approaches.We also emphasize the need to establish specific management criteria for submucosal esophageal lesions to guide clinical practice.展开更多
The retrospective study by Edwar et al reinforces the role of therapeutic penetrating keratoplasty(PK)as a vital intervention in severe,treatment-resistant infectious keratitis.In advanced cases—often complicated by ...The retrospective study by Edwar et al reinforces the role of therapeutic penetrating keratoplasty(PK)as a vital intervention in severe,treatment-resistant infectious keratitis.In advanced cases—often complicated by trauma,delayed presentation,and corneal perforation—PK restores globe integrity and provides limited visual recovery.However,its application is constrained by graft-related complications and donor shortages,particularly in low-resource settings.These limitations highlight the need for earlier,globe-sparing strategies to prevent progression and reduce surgical demand.Photoactivated chromophore for infectious keratitis-corneal collagen cross-linking(PACK-CXL)has emerged as a promising adjunct or alternative.With both antimicrobial and tissue-stabilizing effects,PACK-CXL may control infection and preserve corneal structure in earlier stages.A layered treatment framework that incorporates PACK-CXL as an initial intervention and reserves PK for refractory cases may help improve clinical outcomes.Further studies are needed to define their best use in practice.展开更多
AIM To investigate the hepatic differentiation potential of human umbilical cord-derived mesenchymal stem cells(h UC-MSCs) and to evaluate their therapeutic effect on liver fibrosis/cirrhosis.METHODS A CCl4-induced li...AIM To investigate the hepatic differentiation potential of human umbilical cord-derived mesenchymal stem cells(h UC-MSCs) and to evaluate their therapeutic effect on liver fibrosis/cirrhosis.METHODS A CCl4-induced liver fibrotic/cirrhotic rat model was used to assess the effect of h UC-MSCs. Histopathology was assessed by hematoxylin and eosin(H&E), Masson trichrome and Sirius red staining. The liver biochemical profile was measured using a Beckman Coulter analyzer. Expression analysis was performed using immunofluorescent staining, immunohistochemistry, Western blot, and real-time PCR.RESULTS We demonstrated that the infused h UC-MSCs could differentiate into hepatocytes in vivo. Functionally, the transplantation of h UC-MSCs to CCl4-treated rats improved liver transaminases and synthetic function, reduced liver histopathology and reversed hepatobiliary fibrosis. The reversal of hepatobiliary fibrosis was likely due to the reduced activation state of hepatic stellate cells, decreased collagen deposition, and enhanced extracellular matrix remodeling via the up-regulation of MMP-13 and down-regulation of TIMP-1. CONCLUSION Transplanted h UC-MSCs could differentiate into functional hepatocytes that improved both the biochemical and histopathologic changes in a CCl4-induced rat liver fibrosis model. h UC-MSCs may offer therapeutic opportunities for treating hepatobiliary diseases, including cirrhosis.展开更多
Esophageal tuberculosis(ET)is a relatively rare clinical condition,characterized by often atypical clinical features.The lack of specificity in diagnostic methods,such as esophagogastroduodenoscopy and various imaging...Esophageal tuberculosis(ET)is a relatively rare clinical condition,characterized by often atypical clinical features.The lack of specificity in diagnostic methods,such as esophagogastroduodenoscopy and various imaging techniques,frequently leads to misdiagnosis and inappropriate treatments.Compared to esophagogastroduodenoscopy,endoscopic ultrasonography(EUS)offers a more comprehensive examination of esophageal tuberculosis lesions,including the extent of wall layer involvement and the internal structure characteristics of the lesions.Furthermore,when necessary,endoscopic ultrasonography-guided fine-needle aspiration can be employed to acquire deeper pathological tissue,significantly aiding diagnosis.When combined with the patient’s clinical presentation,endoscopic findings,and pathological features,EUS plays a crucial role in the definitive diagnosis of ET and in the differential diagnosis process.This article meticulously reviews both national and international literature to summarize the relevant features of ET,with a focus on its appearance under EUS,and to highlight the clinical value of EUS in enhancing the diagnosis of ET and in distinguishing it from other conditions.The aim is to offer guidance for the accurate diagnosis of ET.展开更多
Gastrointestinal stromal tumors(GISTs)feature a unique tumor microenvironment(TME)with abundant immune infiltrates,including CD8+T cells and tertiary lymphoid structures,alongside significant immune escape mechanisms ...Gastrointestinal stromal tumors(GISTs)feature a unique tumor microenvironment(TME)with abundant immune infiltrates,including CD8+T cells and tertiary lymphoid structures,alongside significant immune escape mechanisms such as indoleamine 2,3-dioxygenase(IDO)overexpression,MHC I loss,and regulatory T-cell activity.These factors contribute to an immunosuppressive TME,limiting the effectiveness of immune responses.Recent proteomic and immune profiling has identified distinct immune clusters,ranging from highly infiltrated"hot"tumors to immune-desert"cold"tumors,offering new insights into immune heterogeneity and prognostic stratification.While tyrosine kinase inhibitors(TKIs)like imatinib have shown immunomodulatory effects,clinical trials with immune checkpoint inhibitors(ICIs)alone or in combination have yielded modest outcomes.This editorial examines the immunologic landscape of GIST,explores the interplay between ICIs and TKIs,and highlights emerging therapeutic strategies such as IDO inhibition,bispecific antibodies,and patient selection based on TME characteristics.These insights pave the way for more effective immunotherapy approaches in GIST.展开更多
Helicobacter pylori(H pylori) infection is a leading world-wide infectious disease as it affects more than half of the world population and causes chronic gastritis,peptic ulcer disease and gastric malignancies.The in...Helicobacter pylori(H pylori) infection is a leading world-wide infectious disease as it affects more than half of the world population and causes chronic gastritis,peptic ulcer disease and gastric malignancies.The infection elicits a chronic cellular inflammatory response in the gastric mucosa.However,the effects of this local inflammation may not be confi ned solely to the digestive tract but may spread to involve extraintestinal tissues and/or organs.Indeed,H pylori infection has been epidemiologically linked to extra-digestive conditions and diseases.In this context,it has been speculated that H pylori infection may be responsible for various endocrine disorders,such as autoimmune thyroid diseases,diabetes mellitus,dyslipidemia,obesity,osteoporosis and primary hyperparathyroidism.This is a review of the relationship between H pylori infection and these endocrine disorders.展开更多
文摘Post-esophagectomy anastomotic leak(AL)is a severe complication following esophagectomy,contributing to increased morbidity,prolonged hospitalization,and a significant risk of mortality.Endoscopic vacuum-assisted closure(EndoVac)has emerged as a promising first-line treatment,offering a highly effective approach for managing post-esophagectomy AL.EndoVac therapy utilizes continuous negative pressure within the esophageal lumen or mediastinal cavity,promoting granulation tissue formation,accelerating wound healing,and enhancing AL closure rates.Compared to stenting,EndoVac provides distinct advantages,including superior adaptability to varying leak sizes and locations,enhanced secretion drainage,and lower rates of reintervention.Clinical studies have demonstrated higher success rates,decreased post-intervention complications,and shorter hospital stays.Despite its advantages,challenges persist in patient selection,procedural expertise,and accessibility.EndoVac application requires experienced endoscopic teams and multidisciplinary expertise,which is best achieved in high-volume centers with specialized care.Variability in EndoVac protocols necessitate further refinement and standardization to optimize treatment outcomes.The integration of EndoVac into standardized treatment guidelines holds promise for improving patient outcomes and redefining the management approach for this challenging postoperative complication.
文摘While rare,esophageal gastrointestinal stromal tumors(GISTs)have higher mali-gnant potential and are typically diagnosed at larger sizes compared to gastric GISTs.However,well-defined guidelines for their optimal management remain lacking.Most esophageal GISTs are surgically managed with enucleation,while esophagectomy is reserved for larger tumors.Recent advances in endoscopic techniques,such as endoscopic submucosal dissection and submucosal tunneling endoscopic resection(ER),have allowed for endoscopic removal of submucosal esophageal lesions,including GISTs.Xu et al reported on the clinical and on-cological outcomes of 32 patients with esophageal GISTs treated with ER.The study demonstrated high en bloc resection rates and favorable 5-year overall survival and disease-free survival.However,it primarily focused on small,inci-dentally detected GISTs,with 75%of cases classified as very low or low risk according to the National Institutes of Health criteria.The authors favored the submucosal tunneling ER technique despite its procedural challenges in the upper esophagus.In this editorial,we briefly discuss the advantages and limitations of endoscopic techniques compared to surgical approaches.We also emphasize the need to establish specific management criteria for submucosal esophageal lesions to guide clinical practice.
文摘The retrospective study by Edwar et al reinforces the role of therapeutic penetrating keratoplasty(PK)as a vital intervention in severe,treatment-resistant infectious keratitis.In advanced cases—often complicated by trauma,delayed presentation,and corneal perforation—PK restores globe integrity and provides limited visual recovery.However,its application is constrained by graft-related complications and donor shortages,particularly in low-resource settings.These limitations highlight the need for earlier,globe-sparing strategies to prevent progression and reduce surgical demand.Photoactivated chromophore for infectious keratitis-corneal collagen cross-linking(PACK-CXL)has emerged as a promising adjunct or alternative.With both antimicrobial and tissue-stabilizing effects,PACK-CXL may control infection and preserve corneal structure in earlier stages.A layered treatment framework that incorporates PACK-CXL as an initial intervention and reserves PK for refractory cases may help improve clinical outcomes.Further studies are needed to define their best use in practice.
文摘AIM To investigate the hepatic differentiation potential of human umbilical cord-derived mesenchymal stem cells(h UC-MSCs) and to evaluate their therapeutic effect on liver fibrosis/cirrhosis.METHODS A CCl4-induced liver fibrotic/cirrhotic rat model was used to assess the effect of h UC-MSCs. Histopathology was assessed by hematoxylin and eosin(H&E), Masson trichrome and Sirius red staining. The liver biochemical profile was measured using a Beckman Coulter analyzer. Expression analysis was performed using immunofluorescent staining, immunohistochemistry, Western blot, and real-time PCR.RESULTS We demonstrated that the infused h UC-MSCs could differentiate into hepatocytes in vivo. Functionally, the transplantation of h UC-MSCs to CCl4-treated rats improved liver transaminases and synthetic function, reduced liver histopathology and reversed hepatobiliary fibrosis. The reversal of hepatobiliary fibrosis was likely due to the reduced activation state of hepatic stellate cells, decreased collagen deposition, and enhanced extracellular matrix remodeling via the up-regulation of MMP-13 and down-regulation of TIMP-1. CONCLUSION Transplanted h UC-MSCs could differentiate into functional hepatocytes that improved both the biochemical and histopathologic changes in a CCl4-induced rat liver fibrosis model. h UC-MSCs may offer therapeutic opportunities for treating hepatobiliary diseases, including cirrhosis.
基金This work was supported by Regional Collaborative Innovation Project of Xinjiang Uygur Autonomous Region(2022E02044).
文摘Esophageal tuberculosis(ET)is a relatively rare clinical condition,characterized by often atypical clinical features.The lack of specificity in diagnostic methods,such as esophagogastroduodenoscopy and various imaging techniques,frequently leads to misdiagnosis and inappropriate treatments.Compared to esophagogastroduodenoscopy,endoscopic ultrasonography(EUS)offers a more comprehensive examination of esophageal tuberculosis lesions,including the extent of wall layer involvement and the internal structure characteristics of the lesions.Furthermore,when necessary,endoscopic ultrasonography-guided fine-needle aspiration can be employed to acquire deeper pathological tissue,significantly aiding diagnosis.When combined with the patient’s clinical presentation,endoscopic findings,and pathological features,EUS plays a crucial role in the definitive diagnosis of ET and in the differential diagnosis process.This article meticulously reviews both national and international literature to summarize the relevant features of ET,with a focus on its appearance under EUS,and to highlight the clinical value of EUS in enhancing the diagnosis of ET and in distinguishing it from other conditions.The aim is to offer guidance for the accurate diagnosis of ET.
文摘Gastrointestinal stromal tumors(GISTs)feature a unique tumor microenvironment(TME)with abundant immune infiltrates,including CD8+T cells and tertiary lymphoid structures,alongside significant immune escape mechanisms such as indoleamine 2,3-dioxygenase(IDO)overexpression,MHC I loss,and regulatory T-cell activity.These factors contribute to an immunosuppressive TME,limiting the effectiveness of immune responses.Recent proteomic and immune profiling has identified distinct immune clusters,ranging from highly infiltrated"hot"tumors to immune-desert"cold"tumors,offering new insights into immune heterogeneity and prognostic stratification.While tyrosine kinase inhibitors(TKIs)like imatinib have shown immunomodulatory effects,clinical trials with immune checkpoint inhibitors(ICIs)alone or in combination have yielded modest outcomes.This editorial examines the immunologic landscape of GIST,explores the interplay between ICIs and TKIs,and highlights emerging therapeutic strategies such as IDO inhibition,bispecific antibodies,and patient selection based on TME characteristics.These insights pave the way for more effective immunotherapy approaches in GIST.
文摘Helicobacter pylori(H pylori) infection is a leading world-wide infectious disease as it affects more than half of the world population and causes chronic gastritis,peptic ulcer disease and gastric malignancies.The infection elicits a chronic cellular inflammatory response in the gastric mucosa.However,the effects of this local inflammation may not be confi ned solely to the digestive tract but may spread to involve extraintestinal tissues and/or organs.Indeed,H pylori infection has been epidemiologically linked to extra-digestive conditions and diseases.In this context,it has been speculated that H pylori infection may be responsible for various endocrine disorders,such as autoimmune thyroid diseases,diabetes mellitus,dyslipidemia,obesity,osteoporosis and primary hyperparathyroidism.This is a review of the relationship between H pylori infection and these endocrine disorders.
