BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in ...BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in military personnel.Current guidelines in China state all patients with evidence of active infection with H.pylori are offered treatment.However,the prevalence of H.pylori infection and its regional distribution in the military population remain unclear,which hinders effective prevention and treatment strategies.Understanding the prevalence of H.pylori infection in the military population will aid in the development of customized strategies to better manage this infectious disease.AIM To investigate the prevalence of H.pylori infection in the Chinese military population in different geographic areas.METHODS This multicenter,retrospective study included 22421 individuals from five tertiary hospitals located in north,east,southwest,and northwest cities of China.H.pylori infection was identified using the urea breath test,which had been performed between January 2020 and December 2021.RESULTS Of the 22421 military service members,7416(33.1%)were urea breath test-positive.The highest prevalence of H.pylori was in the 30-39 years age group for military personnel,with an infection rate of 34.9%.The majority of infected subjects were younger than 40-years-old,accounting for 70.4%of the infected population.The individuals serviced in Lanzhou and Chengdu showed a higher infection prevalence than those in Beijing,Nanjing,and Guangzhou,with prevalence rates of 44.3%,37.9%,29.0%,31.1%,and 32.3%,respectively.CONCLUSION H.pylori infection remains a common infectious disease among military personnel in China and has a relatively high prevalence rate in northwest China.展开更多
Background:The risk of pancreatic ductal adenocarcinoma(PDAC)is increased in patients with diabetes mellitus(DM),particularly in new-onset diabetes(NOD).This study aimed to analyze the effect of NOD on the outcomes of...Background:The risk of pancreatic ductal adenocarcinoma(PDAC)is increased in patients with diabetes mellitus(DM),particularly in new-onset diabetes(NOD).This study aimed to analyze the effect of NOD on the outcomes of patients with PDAC after R0 resection.Methods:PDAC patients from six centers in China undergoing R0 resection from 2015 to 2022 were included.Patients were categorized as long-term diabetes(LTD),NOD,or non-diabetes mellitus(non-DM)based on the timing of diagnosis relative to pancreatic resection.We compared the effects of diabetes status on perioperative and oncological outcomes of PDAC.Results:Of 1211 patients,602(49.7%),127(10.5%),and 482(39.8%)were in the non-DM,LTD,and NOD groups,respectively.Patients with NOD suffered from higher rates of fatty pancreas and postoperative pancreatic fistula(POPF)(both P<0.05).When compared with the non-DM group,the NOD group had worse median overall survival(OS)(24.6 vs.29.4 months,P<0.001)and recurrence-free survival(RFS)(13.3 vs.15.8 months,P<0.001);and the LTD group also had worse median OS(25.2 vs.29.4 months,P=0.041)and RFS(13.8 vs.15.8 months,P=0.007)compared with non-DM group.However,there were no significant differences in survival between the NOD and the LTD groups.Multivariate analysis indicated that NOD,LTD,largest tumor size,and poor tumor differentiation were independently associated with worse OS and RFS(all P<0.05).Conclusions:Patients with PDAC undergoing R0 resection experienced a higher probability of POPF in the presence of concurrent NOD.Long-term survival prognosis was worse in NOD or LTD patients than in non-DM patients.展开更多
BACKGROUND Bile duct leaks(BDLs)are serious postsurgical adverse events.Typically,conservative management with ab-dominal drainage is the initial treatment option.However,prolonged abdominal drainage without improveme...BACKGROUND Bile duct leaks(BDLs)are serious postsurgical adverse events.Typically,conservative management with ab-dominal drainage is the initial treatment option.However,prolonged abdominal drainage without improvement can lead to biliary stricture and delay the optimal timing of endoscopic retrograde cholangiopancreatography(ERCP).AIM To identify the optimal timing for ERCP and the period during which clinical observation with conservative management is acceptable,balancing ERCP success and the risk of biliary strictures.METHODS We conducted a multicenter retrospective study involving 448 patients with BDLs between November 2002 and November 2022.The patients were divided into four groups based on the timing of ERCP:3 days,7 days,14 days,and 21 days.The primary outcome was clinical success,defined as the resolution of BDL and related symptoms within 6 months without additional percutaneous drainage,surgery,or death.The secondary outcome was incidence of biliary strictures.Univariate and multivariate logistic regression analyses were performed to identify factors associated with ERCP success and biliary stricture occurrence.RESULTS In a cohort of 448 consecutive patients diagnosed with BDLs,354 were excluded,leaving 94 patients who underwent ERCP.Clinical success was achieved in 84%of cases(79/94),with a median ERCP timing of 20 days(9.5-35.3 days).Biliary strictures were identified in 29(30.9%)patients.Performing ERCP within 3 weeks,compared to after 3 weeks,was associated with higher success rates[92.0%(46/50)vs 75.0%(33/44),P=0.032]and a lower incidence of biliary stricture incidence[18.0%(9/50)vs 45.5%(20/44),P=0.005].Subsequent multivariate analysis confirmed the association with higher success rates(odds ratio=4.168,P=0.045)and lower biliary stricture rates(odds ratio=0.256,P=0.007).CONCLUSION Performing ERCP for BDLs within 3 weeks may be associated with a higher success rate and a lower biliary stricture rate.If patients with BDLs do not respond to conservative treatment,ERCP is suggested to be performed within 3 weeks.展开更多
Objective This study aimed to compare the performance of standard-definition white-light endoscopy(SD-WL),high-definition white-light endoscopy(HD-WL),and high-definition narrow-band imaging(HD-NBI)in detecting colore...Objective This study aimed to compare the performance of standard-definition white-light endoscopy(SD-WL),high-definition white-light endoscopy(HD-WL),and high-definition narrow-band imaging(HD-NBI)in detecting colorectal lesions in the Chinese population.Methods This was a multicenter,single-blind,randomized,controlled trial with a non-inferiority design.Patients undergoing endoscopy for physical examination,screening,and surveillance were enrolled from July 2017 to December 2020.The primary outcome measure was the adenoma detection rate(ADR),defined as the proportion of patients with at least one adenoma detected.The associated factors for detecting adenomas were assessed using univariate and multivariate logistic regression.Results Out of 653 eligible patients enrolled,data from 596 patients were analyzed.The ADRs were 34.5%in the SD-WL group,33.5%in the HD-WL group,and 37.5%in the HD-NBI group(P=0.72).The advanced neoplasm detection rates(ANDRs)in the three arms were 17.1%,15.5%,and 10.4%(P=0.17).No significant differences were found between the SD group and HD group regarding ADR or ANDR(ADR:34.5%vs.35.6%,P=0.79;ANDR:17.1%vs.13.0%,P=0.16,respectively).Similar results were observed between the HD-WL group and HD-NBI group(ADR:33.5%vs.37.7%,P=0.45;ANDR:15.5%vs.10.4%,P=0.18,respectively).In the univariate and multivariate logistic regression analyses,neither HD-WL nor HD-NBI led to a significant difference in overall adenoma detection compared to SD-WL(HD-WL:OR 0.91,P=0.69;HD-NBI:OR 1.15,P=0.80).Conclusion HD-NBI and HD-WL are comparable to SD-WL for overall adenoma detection among Chinese outpatients.It can be concluded that HD-NBI or HD-WL is not superior to SD-WL,but more effective instruction may be needed to guide the selection of different endoscopic methods in the future.Our study’s conclusions may aid in the efficient allocation and utilization of limited colonoscopy resources,especially advanced imaging technologies.展开更多
Knowledge about the effect of different prostate biopsy approaches on the prostate cancer detection rate(CDR)in patients with gray-zone prostate-specific antigen(PSA)is limited.We performed this study to compare the C...Knowledge about the effect of different prostate biopsy approaches on the prostate cancer detection rate(CDR)in patients with gray-zone prostate-specific antigen(PSA)is limited.We performed this study to compare the CDR among patients who underwent different biopsy approaches and had rising PSA levels in the gray zone.Two hundred and twenty-two patients who underwent transrectal prostate biopsy(TRB)and 216 patients who underwent transperineal prostate biopsy(TPB)between June 2016 and September 2022 were reviewed in this study.In addition,110 patients who received additional targeted biopsies following the systematic TPB were identified.Clinical parameters,including age,PSA derivative,prostate volume(PV),and needle core count,were recorded.The data were fitted via propensity score matching(PSM),adjusting for potential confounders.TPB outperformed TRB in terms of the CDR(49.6%vs 28.3%,P=0.001).The clinically significant prostate cancer(csPCa)detection rate was not significantly different between TPB and TRB(78.6%vs 68.8%,P=0.306).In stratified analysis,TPB outperformed TRB in CDR when the age of patients was 65–75 years(59.0%vs 22.0%,P<0.001),when PV was 25.00–50.00 ml(63.2%vs 28.3%,P<0.001),and when needle core count was no more than 12(58.5%vs 31.5%,P=0.005).The CDR(P=0.712)and detection rate of csPCa(P=0.993)did not significantly differ among the systematic,targeted,and combined biopsies.TPB outperformed TRB in CDR for patients with gray-zone PSA.Moreover,performing target biopsy after systematic TPB provided no additional benefits in CDR.展开更多
The safety and effectiveness of magnetic resonance-guided focused ultrasound thalamotomy has been broadly established and validated for the treatment of essential tremor.In 2018,the first magnetic resonance-guided foc...The safety and effectiveness of magnetic resonance-guided focused ultrasound thalamotomy has been broadly established and validated for the treatment of essential tremor.In 2018,the first magnetic resonance-guided focused ultrasound system in Chinese mainland was installed at the First Medical Center of the PLA General Hospital.This prospective,single center,open-label,single-arm study was part of a worldwide prospective multicenter clinical trial(ClinicalTrials.gov Identifier:NCT03253991)conducted to confirm the safety and efficacy of magnetic resonance-guided focused ultrasound for treating essential tremor in the local population.From 2019 to 2020,10 patients with medication refractory essential tremor were recruited into this open-label,single arm study.The treatment efficacy was determined using the Clinical Rating Scale for Tremor.Safety was evaluated according to the incidence and severity of adverse events.All of the subjects underwent a unilateral thalamotomy targeting the ventral intermediate nucleus.At the baseline assessment,the estimated marginal mean of the Clinical Rating Scale for Tremor total score was 58.3±3.6,and this improved after treatment to 23.1±6.4 at a 12-month follow-up assessment.A total of 50 adverse events were recorded,and 2 were defined as serious.The most common intraoperative adverse events were nausea and headache.The most frequent postoperative adverse events were paresthesia and equilibrium disorder.Most of the adverse events were mild and usually disappeared within a few days.Our findings suggest that magnetic resonance-guided focused ultrasound for the treatment of essential tremor is effective,with a good safety profile,for patients in Chinese mainland.展开更多
BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To ...BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To develop a risk prediction model for the pathological upgrading of gastric LGIN to aid clinical diagnosis and treatment.METHODS We retrospectively analyzed data from patients newly diagnosed with gastric LGIN who underwent complete endoscopic resection within 6 months at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2008 and December 2023.A risk prediction model for the pathological progression of gastric LGIN was constructed and evaluated for accuracy and clinical applicability.RESULTS A total of 171 patients were included in this study:93 patients with high-grade intraepithelial neoplasia or early gastric cancer and 78 with LGIN.The logistic stepwise regression model demonstrated a sensitivity and specificity of 0.868 and 0.800,respectively,while the least absolute shrinkage and selection operator(LASSO)regression model showed sensitivity and specificity values of 0.842 and 0.840,respectively.The area under the curve(AUC)for the logistic model was 0.896,slightly lower than the AUC of 0.904 for the LASSO model.Internal validation with 30%of the data yielded AUC scores of 0.908 for the logistic model and 0.905 for the LASSO model.The LASSO model provided greater utility in clinical decision-making.CONCLUSION A risk prediction model for the pathological upgrading of gastric LGIN based on white-light and magnifying endoscopic features can accurately and effectively guide clinical diagnosis and treatment.展开更多
BACKGROUND Most patients who were included in previous studies on achalasia had increased lower esophageal sphincter(LES)pressure.Peroral endoscopic myotomy(POEM)has been confirmed to be effective at relieving the cli...BACKGROUND Most patients who were included in previous studies on achalasia had increased lower esophageal sphincter(LES)pressure.Peroral endoscopic myotomy(POEM)has been confirmed to be effective at relieving the clinical symptoms of achalasia associated with increased LES pressure.AIM To identify the safety and efficacy of POEM for patients with normal LES integrated relaxation pressure(LES-IRP).METHODS The clinical data of patients who underwent POEM successfully in The First Medical Center of Chinese PLA General Hospital were retrospectively analyzed.A total of 481 patients who underwent preoperative high-resolution manometry(HRM)at our hospital were ultimately included in this research.According to the HRM results,the patients were divided into two groups:71 patients were included in the normal LES-IRP group(LES-IRP<15 mmHg)and 410 patients were included in the increased LES-IRP group(LES-IRP≥15 mmHg).Clinical characteristics,procedure-related parameters,adverse events,and outcomes were compared between the two groups to evaluate the safety and efficacy of POEM for patients with normal LES-IRP.RESULTS Among the 481 patients included in our study,209 were males and 272 were females,with a mean age of 44.2 years.All patients underwent POEM without severe adverse events.The median pre-treatment Eckardt scores of the normal LES-IRP and increased LES-IRP groups were 7.0 and 7.0(P=0.132),respectively,decreasing to 1.0 and 1.0 post-treatment(P=0.572).The clinical success rate of the normal LES-IRP group was 87.3%(62/71),and that of the increased LES-IRP group was 91.2%(374/410)(P=0.298).Reflux symptoms were measured by the GerdQ questionnaire,and the percentages of patients with GerdQ scores≥9 in the normal LES-IRP and increased LES-IRP groups were 8.5%and 10.7%,respectively(P=0.711).After matching,the rates of clinical success and the rates of GerdQ score≥9 were not significantly different between the two groups.CONCLUSION Our results suggest that POEM is safe and effective for achalasia and patients with normal LES-IRP.In addition,in patients with normal LES-IRP,compared with those with increased LES-IRP,POEM was not associated with a greater incidence of reflux symptoms.展开更多
Neuroendocrine neoplasms(NENs)are relatively rare tumors that arise from peptidergic neurons and neuroendocrine cells.NENs are highly heterogeneous and can occur in any part of the body,with a particular prevalence in...Neuroendocrine neoplasms(NENs)are relatively rare tumors that arise from peptidergic neurons and neuroendocrine cells.NENs are highly heterogeneous and can occur in any part of the body,with a particular prevalence in the digestive system.NENs consist of a range of tumor types and the biological behaviors exhibit significant differences.NENs are classified into well-differentiated neuroendocrine tumors(NETs)and poorly differentiated neuroendocrine carcinomas(NECs).NETs can be further classified and graded into the following three categories:low-grade NETs,grade 1(NET G1);intermediate-grade NET G2;and high-grade NET G3.NECs include large cell-type NEC(LCNEC)and small cell-type NEC(SCNEC),both of which are considered high grade.Currently,the main treatments for advanced NENs are biological treatments,targeted therapy,chemotherapy,and newer treatments that are still under development,such as immunotherapy and peptide receptor radionuclide therapy(PRRT).However,owing to the rarity of NENs,pharmaceutical company investment is limited and few phase Ⅲ studies have targeted advanced NENs.Most current research consists of investigator-initiated phase Ⅰ and Ⅱ clinical trials or largescale retrospective studies.NEN treatment should be chosen carefully because it is cumbersome and complicated,as indicated above.Herein,we comprehensively summarize the clinical application status and research progress for advanced NEN treatment regimens,especially for advanced NETs,which may help to create awareness on NENs among medical professionals across specialties.展开更多
Background and Objective Electromagnetic navigation technology has demonstrated significant potential in enhancing the accuracy and safety of neurosurgical procedures.However,traditional electromagnetic navigation sys...Background and Objective Electromagnetic navigation technology has demonstrated significant potential in enhancing the accuracy and safety of neurosurgical procedures.However,traditional electromagnetic navigation systems face challenges such as high equipment costs,complex operation,bulky size,and insufficient anti-interference performance.To address these limitations,our study developed and validated a novel portable electromagnetic neuronavigation system designed to improve the precision,accessibility,and clinical applicability of electromagnetic navigation technology in cranial surgery.Methods The software and hardware architecture of a portable neural magnetic navigation system was designed.The key technologies of the system were analysed,including electromagnetic positioning algorithms,miniaturized sensor design,optimization of electromagnetic positioning and navigation algorithms,anti-interference signal processing methods,and fast three-dimensional reconstruction algorithms.A prototype was developed,and its accuracy was tested.Finally,a preliminary clinical application evaluation was conducted.Results This study successfully developed a comprehensive portable electromagnetic neuronavigation system capable of achieving preoperative planning,intraoperative real-time positioning and navigation,and postoperative evaluation of navigation outcomes.Through rigorous collaborative testing of the system’s software and hardware,the accuracy of electromagnetic neuronavigation has been validated to meet clinical requirements.Conclusions This study developed a portable neuroelectromagnetic navigation system and validated its effectiveness and safety through rigorous model testing and preliminary clinical applications.The system is characterized by its compact size,high precision,excellent portability,and user-friendly operation,making it highly valuable for promoting navigation technology and advancing the precision and minimally invasive nature of neurosurgical procedures.展开更多
BACKGROUND In recent years,the global prevalence of gastric cancer(GC)has witnessed a progressive decrease,accompanied by a step-growth in the incidence of gastric signet ring cell carcinoma(GSRCC).As precision medici...BACKGROUND In recent years,the global prevalence of gastric cancer(GC)has witnessed a progressive decrease,accompanied by a step-growth in the incidence of gastric signet ring cell carcinoma(GSRCC).As precision medicine concepts progress,GSRCC,a distinct sub-type of GC,has drawn considerable attention from researchers.However,there still persist some controversies regarding the associated research findings.AIM To summarize the current obstacles and potential future directions for research on GSRCC.METHODS To begin with,all literature related to GSRCC published from January 1,2004 to December 31,2023 was subjected to bibliometric analysis in this article.Additionally,this paper analyzed the research data using CiteSpace,GraphPad Prism v8.0.2,and VOSviewer,which was obtained from the Web of Science Core Collection database.The analysis results were visually represented.RESULTS This study provided a comprehensive overview of the statistical characteristics of the 995 English articles related to GSRCC,including cited references,authors,journals,countries,institutions,and keywords.The popular keywords and clusters contain"prognosis","survival","expression","histology",and"chemotherapy".CONCLUSION The prognosis,precise definition and classification,as well as chemoresistance of GSRCC,continue to be crucial areas of ongoing research,whose directions are closely tied to advancements in molecular biology research on GSRCC.展开更多
A recent single-center retrospective study proposed novel combinations of hematological parameters and scoring systems for predicting severe acute pancre-atitis.While these combinations showed promising predictive per...A recent single-center retrospective study proposed novel combinations of hematological parameters and scoring systems for predicting severe acute pancre-atitis.While these combinations showed promising predictive performance,several limitations warrant consideration,including the lack of calibration,the absence of key inflammatory markers such as procalcitonin,and practical challenges in integrating these models into routine clinical workflows.To improve predictive accuracy and clinical applicability,prospective validation and the inclusion of additional variables are recommended.展开更多
BACKGROUND Type Ⅲ choledochal cysts(CCs)are extremely rare,and they present as dilatations and herniations of the end of the common bile duct into the duodenum.Moreover,type Ⅱ CCs may be easily misdiagnosed as intra...BACKGROUND Type Ⅲ choledochal cysts(CCs)are extremely rare,and they present as dilatations and herniations of the end of the common bile duct into the duodenum.Moreover,type Ⅱ CCs may be easily misdiagnosed as intraduodenal polyps or tumors.Thus,adequate differential diagnosis and selection of appropriate treatment are important.CASE SUMMARY A young man with a duodenal mass presented with 3-year intermittent abdominal pain and acute pancreatitis 3 days before hospitalization.After evaluation by magnetic resonance imaging and endoscopic ultrasonography,the duodenal papilla was pressed,and the bile flowed out slowly,which was speculated to be the cause of his symptoms.The lesion was punctured with a submucosal injection needle,and golden clear fluid was aspirated.Laboratory tests of the aspirate after 50-fold dilution revealed significantly elevated total bilirubin,direct bilirubin,amylase and lipase.Taken together,these findings confirmed that the lesion was a type Ⅲ CC.The patient underwent fused surgical procedures.Fenestration plus internal drainage of the lesion was subsequently performed with a DualKnife.After drainage,the incision was sealed with tissue clips.During follow-up,the patient recovered well,and no abdominal pain symptoms or acute pancreatitis recurred.CONCLUSION Laboratory tests of cyst aspirates are beneficial for diagnosis,and endoscopic fenestration plus internal drainage works well to mitigate cysts.展开更多
BACKGROUND Complications arising from the polyps in Peutz-Jeghers syndrome(PJS)have historically been addressed through surgical treatment.Enteroscopic poly-pectomy is hypothesized to reduce the risk of surgery in PJS...BACKGROUND Complications arising from the polyps in Peutz-Jeghers syndrome(PJS)have historically been addressed through surgical treatment.Enteroscopic poly-pectomy is hypothesized to reduce the risk of surgery in PJS.However,the optimal timing for polyp screening and preventive intervention using entero-scopic polypectomy remains uncertain.This is primarily due to the extremely low incidence of the condition and the paucity of data regarding the natural risk of requiring surgery and its age distribution in PJS patients.In order to develop recommendations on the appropriate timing of polyp screening and preventive intervention in PJS,a comprehensive understanding of the natural surgical risks AIM To investigate the natural surgical risks associated with polyps in PJS and to clarify their age distribution.METHODS A web-based open survey was launched to collect information from Chinese individuals suspected of having PJS.The questionnaire was distributed to the PJS instant messaging groups using a quick response code method.The data were analyzed using descriptive statistical methods,and the cumulative incidence of surgery was calculated using the Kaplan-Meier method.RESULTS Of the 442 patients enrolled,301(68.10%)had undergone 506 surgical procedures prior to enteroscopy or the survey deadline.Among the 506 surgical procedures,388(76.68%)were performed on patients aged between 6 and 25 years.The cumulative incidence rates of the first surgical procedure at 5,10,15,20,25,and 30 years of age were 5.0%(95%confidence interval[CI]:2.9%-7.0%),20.6%(95%CI:16.6%-24.4%),40.5%(95%CI:35.5%-45.1%),58.0%(95%CI:52.7%-62.7%),72.6%(95%CI:67.3%-77.0%),and 82.4%(95%CI:77.0%-86.5%),respectively.The primary indications for the first surgical procedures were intussusception(81.40%),obstruction(13.95%),and gas-trointestinal bleeding(4.65%).The cumulative incidence rates of requiring a second surgical procedure within 1,3,5,10 and 15 years following the first surgical procedure were 3.7%(95%CI:1.5%-5.8%),12.5%(95%CI:8.6%-16.2%),20.3%(95%CI:15.6%-24.8%),37.0%(95%CI:33.1%-45.3%),54.2%(95%CI:46.8%-60.5%),respectively.Patients who underwent their first surgical procedure at the age of nine years or younger presented an elevated risk of requiring a second surgical procedure(P<0.01).CONCLUSION Chinese patients with PJS have a high natural risk of undergoing surgery.Without preventive intervention,these procedures may become necessary at an early age and may be repeated.Early screening and regular surveillance,with preventive intervention if necessary,should commence at six years of age.展开更多
Chronic obstructive pulmonary disease(COPD)is a persistent airflow obstructive disease caused by airway and/or alveolar abnormalities and has become the third leading cause of death worldwide.Dupilumab,the first fully...Chronic obstructive pulmonary disease(COPD)is a persistent airflow obstructive disease caused by airway and/or alveolar abnormalities and has become the third leading cause of death worldwide.Dupilumab,the first fully humanized monoclonal antibody targeting the IL-4 receptor subunit alpha(IL-4Rα),is mainly used to treat COPD patients with elevated blood eosinophils that cannot be effectively controlled by traditional drugs.Studies have shown that dupilumab effectively improves pulmonary function,reduces airway inflammation and exacerbation rate,and significantly improves quality of life in COPD patients by blocking interleukin-4(IL-4)and interleukin-13(IL-13)signaling.Several clinical trials and real-world studies have shown that dupilumab significantly reduces the rate of exacerbations,particularly in patients with high baseline eosinophil or FeNO levels.In addition,dupilumab showed positive efficacy in improving lung function,reducing airway inflammation and improving the quality of life of patients.Although the preliminary efficacy of dupilumab in the treatment of COPD is promising,its safety and efficacy need to be further validated,particularly in long-term use and in different patient subgroups.Future studies should focus on the precise classification of COPD,the exploration of relevant biomarkers,and the use of dupilumab at different stages of treatment in order to achieve personalized treatment.展开更多
BACKGROUND Immunotherapy has surfaced as a promising therapeutic modality for gastric cancer(GC).A comprehensive review of advancements,current status,and research trends in GC immunotherapy is essential to inform fut...BACKGROUND Immunotherapy has surfaced as a promising therapeutic modality for gastric cancer(GC).A comprehensive review of advancements,current status,and research trends in GC immunotherapy is essential to inform future investigative efforts.AIM To delineate the trends,advancements,and focal points in immunotherapy for GC.METHODS We performed a bibliometric analysis of 2906 articles in English concerning GC immunotherapy published from 2000 to December 20,2023,indexed in the Web of Science Core Collection.Data analysis and visualization were facilitated by CiteSpace(6.1.6R),VOSviewer v.1.6.17,and GraphPad Prism v8.0.2.RESULTS There has been an increase in the annual publication rate of GC immunotherapy research.China leads in publication volume,while the United States demonstrates the highest citation impact.Fudan University is notable for its citation frequency and publication output.Co-citation analysis and keyword frequency revealed and highlighted a focus on GC prognosis,the tumor microenvironment(TME),and integrative immunotherapy with targeted therapy.Emerging research areas include gastroesophageal junction cancer,adoptive immunotherapy,and the role of Treg cell in immunotherapy.CONCLUSION GC immunotherapy research is an expanding field attracting considerable scientific interest.With the clinical adoption of immunotherapy in GC,the primary goals are to enhance treatment efficacy and patient outcomes.Unlike hematological malignancies,GC's solid TME presents distinct immunological challenges that may attenuate the cytotoxic effects of immune cells on cancer cells.For instance,although CAR-T therapy is effective in hematological malignancies,it has underperformed in GC settings.Current research is centered on overcoming immunosuppression within the TME,with a focus on combinations of targeted therapy,adoptive immunotherapy,Treg cell dynamics,and precise prognosis prediction in immunotherapy.Additionally,immunotherapy's role in treating gastroesophageal junction cancer has become a novel research focus.展开更多
The gut microbiome is closely associated with human health and the development of diseases. Isolating, characterizing, and identifying gut microbes are crucial for research on the gut microbiome and essential for adva...The gut microbiome is closely associated with human health and the development of diseases. Isolating, characterizing, and identifying gut microbes are crucial for research on the gut microbiome and essential for advancing our understanding and utilization of it. Although culture-independent approaches have been developed, a pure culture is required for in-depth analysis of disease mechanisms and the development of biotherapy strategies. Currently, microbiome research faces the challenge of expanding the existing database of culturable gut microbiota and rapidly isolating target microorganisms. This review examines the advancements in gut microbe isolation and cultivation techniques, such as culturomics, droplet microfluidics, phenotypic and genomics selection, and membrane diffusion. Furthermore, we evaluate the progress made in technology for identifying gut microbes considering both non-targeted and targeted strategies. The focus of future research in gut microbial culturomics is expected to be on high-throughput, automation, and integration. Advancements in this field may facilitate strain-level investigation into the mechanisms underlying diseases related to gut microbiota.展开更多
BACKGROUND The prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms(PDGNENs)is dismal and related research is limited.AIM To investigate the prognostic factors,and validate a novel prognos...BACKGROUND The prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms(PDGNENs)is dismal and related research is limited.AIM To investigate the prognostic factors,and validate a novel prognostic nomogram for PDGNEN patients.METHODS We conducted a retrospective study using clinical and pathological data from PDGNEN patients treated at the First Medical Center of the Chinese PLA General Hospital from January 2000 to June 2023.Overall survival(OS)differences were assessed with the Log-rank test and Kaplan-Meier survival curves.Cox regression analysis identified independent risk factors for prognosis.Model performance was evaluated using Harrell’s concordance index,receiver operating characteristic analysis,area under the curve,calibration curves,and decision curve analysis(UDC),including the area under the UDC.RESULTS The study included 336 patients(227 with neuroendocrine carcinoma and 109 with mixed adenoneuroendocrine carcinoma).The average age was 62.7 years.The cohort comprised 80(24.7%)patients in stage I,146(42.9%)in stage II,62(18.1%)in stage III,and 48(14.3%)in stage IV.Significant differences in OS were observed across tumor-node-metastasis stages(P<0.001).Multivariate analysis showed age,Ki-67 index,invasion depth,lymph node metastasis,distant metastasis,and platelet-to-lymphocyte ratio as independent risk factors.We developed a nomogram with a concordance index of 0.779(95%confidence interval:0.743-0.858).Receiver operating characteristic analysis showed area under the curves for 1-year,3-year,and 5-year OS predictions of 0.865,0.850,and 0.890,respectively.The calibration curve demonstrated good agreement with actual outcomes.The area under the UDC for the nomogram vs the 8th American Joint Committee on Cancer tumor-node-metastasis staging system were 0.047 vs 0.027,0.291 vs 0.179,and 0.376 vs 0.216 for 1-year,3-year,and 5-year OS,respectively.CONCLUSION PDGNENs are predominantly found in older men,often in advanced stages at diagnosis,resulting in poor prognosis.The established nomogram demonstrates strong predictive capability and clinical utility.展开更多
BACKGROUND Current disinfection methods for gastrointestinal endoscopes consume a significant amount of water resources and produce a large volume of waste.AIM To achieve the objectives of efficiency,speed,and cost-ef...BACKGROUND Current disinfection methods for gastrointestinal endoscopes consume a significant amount of water resources and produce a large volume of waste.AIM To achieve the objectives of efficiency,speed,and cost-effectiveness,this study utilized vaporized hydrogen peroxide(VHP)generated from sodium percarbonate granules to conduct an anhydrous disinfection test on gastrointestinal endoscopes.METHODS The experimental device rapidly converts sodium percarbonate granules into VHP,and performs disinfection experiments on gastrointestinal endoscope models,disposable endoscopes,and various types of reusable gastrointestinal endoscopes.Variables such as the intraluminal flow rate(FR),relative humidity(RH),exposure dosage,and organic burden are used to explore the factors influencing the disinfection of long and narrow lumens with VHP.RESULTS The device generates a certain concentration of VHP that can achieve high-level disinfection of endoscope models within 30 minutes.RH,exposure dosage,and organic burden significantly affect the disinfection efficacy of VHP,whereas the intraluminal FR does not significantly impact disinfection efficacy.All ten artificially contaminated disposable endoscopes achieved satisfactory disinfection results.Furthermore,when this device was used to treat various types of reusable endoscopes,the disinfection and sterilization effects were not significantly different from those of automatic endoscope disinfection machines(using peracetic acid disinfectant solution)(P>0.05),and the economic cost of disinfectant required per endoscope was lower(1.5 China Yuan),with a shorter disinfection time(30 minutes).CONCLUSION The methods and results of this study provide a basis for further research on the use of VHP for the disinfection of gastrointestinal endoscopes,as well as for the development of anhydrous disinfection technology for gastrointestinal endoscopes.展开更多
Background:To comprehensively analyze the clinical characteristics of patients who underwent gastric endoscopic submucosal dissection(ESD)and explore the incidence and influencing factors of postoperative pain.Methods...Background:To comprehensively analyze the clinical characteristics of patients who underwent gastric endoscopic submucosal dissection(ESD)and explore the incidence and influencing factors of postoperative pain.Methods:The clinical data of patients who underwent gastric ESD at our center from 2009 to 2024 were retrospectively analyzed.Pain severity was assessed using a visual analogue scale,with a score≥4 defined as postoperative pain.Based on the presence or absence of postoperative pain,patients were divided into a pain group and a control group.Independent factors influencing postoperative pain were identified using multivariate logistic regression analysis.To control for confounding bias,patients in the case and control groups were matched by sex and lesion size,and the matched participants were further analyzed using a conditional logistic regression model.Results:In total,993 patients were analyzed.The incidence of postoperative pain was 9.1%(95%confidence interval[CI],7.3-11.1).In the univariate analysis,sex,operation duration,anesthesia method,intraoperative electrocoagulation,nasogastric tube placement,and postoperative vomiting were significantly associated with postoperative pain.Multivariate analysis identified eight independent factors:male sex(odds ratio[OR],0.61;95%CI,0.37-0.97;p=0.04),operation duration(OR,1.29;95%CI,1.03-1.63;p=0.02),protuberant lesions(OR,0.43;95%CI,0.26-0.71;p<0.01),antral lesions(OR,1.84;95%CI,1.10-3.05;p=0.01),intubation general anesthesia(OR,0.40;95%CI,0.22-0.72;p=0.002),intraoperative electrocoagulation(OR,0.32;95%CI,0.19-0.55;p<0.01),nasogastric tube placement(OR,2.005;95%CI,1.12-3.57;p=0.01),and postoperative vomiting(OR,3.24;95%CI,1.40-7.47;p=0.005).Conditional logistic regression analysis further identified diabetes mellitus(OR,2.50;95%CI,1.03-6.06;p=0.04).Conclusion:Female sex,diabetes mellitus,concave-type lesions,lesions in the gastric antrum,non-intubation general anesthesia,absence of intraoperative electrocoagulation,prolonged operation duration,nasogastric tube placement,and postoperative vomiting were independent factors associated with moderate to severe pain after gastric ESD.For patients at increased risk of postoperative pain,appropriate prophylactic and therapeutic measures during the perioperative period may effectively alleviate pain following gastric ESD.展开更多
文摘BACKGROUND Helicobacter pylori(H.pylori)infection is a prevalent disease encountered in military internal medicine and recognized as the main cause of dyspepsia,gastritis,and peptic ulcer,which are common diseases in military personnel.Current guidelines in China state all patients with evidence of active infection with H.pylori are offered treatment.However,the prevalence of H.pylori infection and its regional distribution in the military population remain unclear,which hinders effective prevention and treatment strategies.Understanding the prevalence of H.pylori infection in the military population will aid in the development of customized strategies to better manage this infectious disease.AIM To investigate the prevalence of H.pylori infection in the Chinese military population in different geographic areas.METHODS This multicenter,retrospective study included 22421 individuals from five tertiary hospitals located in north,east,southwest,and northwest cities of China.H.pylori infection was identified using the urea breath test,which had been performed between January 2020 and December 2021.RESULTS Of the 22421 military service members,7416(33.1%)were urea breath test-positive.The highest prevalence of H.pylori was in the 30-39 years age group for military personnel,with an infection rate of 34.9%.The majority of infected subjects were younger than 40-years-old,accounting for 70.4%of the infected population.The individuals serviced in Lanzhou and Chengdu showed a higher infection prevalence than those in Beijing,Nanjing,and Guangzhou,with prevalence rates of 44.3%,37.9%,29.0%,31.1%,and 32.3%,respectively.CONCLUSION H.pylori infection remains a common infectious disease among military personnel in China and has a relatively high prevalence rate in northwest China.
基金supported by grants from the Young Elite Sci-entists Sponsorship Program by CAST(2023QNRC001)the Young Elite Scientists Sponsorship Program by BAST(BYESS2024001)the National Key Research and Development Program of China(2022YFC2407402).
文摘Background:The risk of pancreatic ductal adenocarcinoma(PDAC)is increased in patients with diabetes mellitus(DM),particularly in new-onset diabetes(NOD).This study aimed to analyze the effect of NOD on the outcomes of patients with PDAC after R0 resection.Methods:PDAC patients from six centers in China undergoing R0 resection from 2015 to 2022 were included.Patients were categorized as long-term diabetes(LTD),NOD,or non-diabetes mellitus(non-DM)based on the timing of diagnosis relative to pancreatic resection.We compared the effects of diabetes status on perioperative and oncological outcomes of PDAC.Results:Of 1211 patients,602(49.7%),127(10.5%),and 482(39.8%)were in the non-DM,LTD,and NOD groups,respectively.Patients with NOD suffered from higher rates of fatty pancreas and postoperative pancreatic fistula(POPF)(both P<0.05).When compared with the non-DM group,the NOD group had worse median overall survival(OS)(24.6 vs.29.4 months,P<0.001)and recurrence-free survival(RFS)(13.3 vs.15.8 months,P<0.001);and the LTD group also had worse median OS(25.2 vs.29.4 months,P=0.041)and RFS(13.8 vs.15.8 months,P=0.007)compared with non-DM group.However,there were no significant differences in survival between the NOD and the LTD groups.Multivariate analysis indicated that NOD,LTD,largest tumor size,and poor tumor differentiation were independently associated with worse OS and RFS(all P<0.05).Conclusions:Patients with PDAC undergoing R0 resection experienced a higher probability of POPF in the presence of concurrent NOD.Long-term survival prognosis was worse in NOD or LTD patients than in non-DM patients.
基金Supported by the National Key Research and Development Program,China,No.2022YFC2503603.
文摘BACKGROUND Bile duct leaks(BDLs)are serious postsurgical adverse events.Typically,conservative management with ab-dominal drainage is the initial treatment option.However,prolonged abdominal drainage without improvement can lead to biliary stricture and delay the optimal timing of endoscopic retrograde cholangiopancreatography(ERCP).AIM To identify the optimal timing for ERCP and the period during which clinical observation with conservative management is acceptable,balancing ERCP success and the risk of biliary strictures.METHODS We conducted a multicenter retrospective study involving 448 patients with BDLs between November 2002 and November 2022.The patients were divided into four groups based on the timing of ERCP:3 days,7 days,14 days,and 21 days.The primary outcome was clinical success,defined as the resolution of BDL and related symptoms within 6 months without additional percutaneous drainage,surgery,or death.The secondary outcome was incidence of biliary strictures.Univariate and multivariate logistic regression analyses were performed to identify factors associated with ERCP success and biliary stricture occurrence.RESULTS In a cohort of 448 consecutive patients diagnosed with BDLs,354 were excluded,leaving 94 patients who underwent ERCP.Clinical success was achieved in 84%of cases(79/94),with a median ERCP timing of 20 days(9.5-35.3 days).Biliary strictures were identified in 29(30.9%)patients.Performing ERCP within 3 weeks,compared to after 3 weeks,was associated with higher success rates[92.0%(46/50)vs 75.0%(33/44),P=0.032]and a lower incidence of biliary stricture incidence[18.0%(9/50)vs 45.5%(20/44),P=0.005].Subsequent multivariate analysis confirmed the association with higher success rates(odds ratio=4.168,P=0.045)and lower biliary stricture rates(odds ratio=0.256,P=0.007).CONCLUSION Performing ERCP for BDLs within 3 weeks may be associated with a higher success rate and a lower biliary stricture rate.If patients with BDLs do not respond to conservative treatment,ERCP is suggested to be performed within 3 weeks.
基金supported by the Beijing Municipal Science and Technology Commission(BMSTC,No.D171100002617001).
文摘Objective This study aimed to compare the performance of standard-definition white-light endoscopy(SD-WL),high-definition white-light endoscopy(HD-WL),and high-definition narrow-band imaging(HD-NBI)in detecting colorectal lesions in the Chinese population.Methods This was a multicenter,single-blind,randomized,controlled trial with a non-inferiority design.Patients undergoing endoscopy for physical examination,screening,and surveillance were enrolled from July 2017 to December 2020.The primary outcome measure was the adenoma detection rate(ADR),defined as the proportion of patients with at least one adenoma detected.The associated factors for detecting adenomas were assessed using univariate and multivariate logistic regression.Results Out of 653 eligible patients enrolled,data from 596 patients were analyzed.The ADRs were 34.5%in the SD-WL group,33.5%in the HD-WL group,and 37.5%in the HD-NBI group(P=0.72).The advanced neoplasm detection rates(ANDRs)in the three arms were 17.1%,15.5%,and 10.4%(P=0.17).No significant differences were found between the SD group and HD group regarding ADR or ANDR(ADR:34.5%vs.35.6%,P=0.79;ANDR:17.1%vs.13.0%,P=0.16,respectively).Similar results were observed between the HD-WL group and HD-NBI group(ADR:33.5%vs.37.7%,P=0.45;ANDR:15.5%vs.10.4%,P=0.18,respectively).In the univariate and multivariate logistic regression analyses,neither HD-WL nor HD-NBI led to a significant difference in overall adenoma detection compared to SD-WL(HD-WL:OR 0.91,P=0.69;HD-NBI:OR 1.15,P=0.80).Conclusion HD-NBI and HD-WL are comparable to SD-WL for overall adenoma detection among Chinese outpatients.It can be concluded that HD-NBI or HD-WL is not superior to SD-WL,but more effective instruction may be needed to guide the selection of different endoscopic methods in the future.Our study’s conclusions may aid in the efficient allocation and utilization of limited colonoscopy resources,especially advanced imaging technologies.
文摘Knowledge about the effect of different prostate biopsy approaches on the prostate cancer detection rate(CDR)in patients with gray-zone prostate-specific antigen(PSA)is limited.We performed this study to compare the CDR among patients who underwent different biopsy approaches and had rising PSA levels in the gray zone.Two hundred and twenty-two patients who underwent transrectal prostate biopsy(TRB)and 216 patients who underwent transperineal prostate biopsy(TPB)between June 2016 and September 2022 were reviewed in this study.In addition,110 patients who received additional targeted biopsies following the systematic TPB were identified.Clinical parameters,including age,PSA derivative,prostate volume(PV),and needle core count,were recorded.The data were fitted via propensity score matching(PSM),adjusting for potential confounders.TPB outperformed TRB in terms of the CDR(49.6%vs 28.3%,P=0.001).The clinically significant prostate cancer(csPCa)detection rate was not significantly different between TPB and TRB(78.6%vs 68.8%,P=0.306).In stratified analysis,TPB outperformed TRB in CDR when the age of patients was 65–75 years(59.0%vs 22.0%,P<0.001),when PV was 25.00–50.00 ml(63.2%vs 28.3%,P<0.001),and when needle core count was no more than 12(58.5%vs 31.5%,P=0.005).The CDR(P=0.712)and detection rate of csPCa(P=0.993)did not significantly differ among the systematic,targeted,and combined biopsies.TPB outperformed TRB in CDR for patients with gray-zone PSA.Moreover,performing target biopsy after systematic TPB provided no additional benefits in CDR.
基金sponsored by Insightec Co.Ltd.(Israel)China National Clinical Research Center for Geriatrics,No.NCRCG-PLAGH-2019005 (to LP)
文摘The safety and effectiveness of magnetic resonance-guided focused ultrasound thalamotomy has been broadly established and validated for the treatment of essential tremor.In 2018,the first magnetic resonance-guided focused ultrasound system in Chinese mainland was installed at the First Medical Center of the PLA General Hospital.This prospective,single center,open-label,single-arm study was part of a worldwide prospective multicenter clinical trial(ClinicalTrials.gov Identifier:NCT03253991)conducted to confirm the safety and efficacy of magnetic resonance-guided focused ultrasound for treating essential tremor in the local population.From 2019 to 2020,10 patients with medication refractory essential tremor were recruited into this open-label,single arm study.The treatment efficacy was determined using the Clinical Rating Scale for Tremor.Safety was evaluated according to the incidence and severity of adverse events.All of the subjects underwent a unilateral thalamotomy targeting the ventral intermediate nucleus.At the baseline assessment,the estimated marginal mean of the Clinical Rating Scale for Tremor total score was 58.3±3.6,and this improved after treatment to 23.1±6.4 at a 12-month follow-up assessment.A total of 50 adverse events were recorded,and 2 were defined as serious.The most common intraoperative adverse events were nausea and headache.The most frequent postoperative adverse events were paresthesia and equilibrium disorder.Most of the adverse events were mild and usually disappeared within a few days.Our findings suggest that magnetic resonance-guided focused ultrasound for the treatment of essential tremor is effective,with a good safety profile,for patients in Chinese mainland.
基金Supported by the National Key Research and Development Program of China,No.2022YFC2503600。
文摘BACKGROUND The discrepancy between endoscopic biopsy pathology and the overall pathology of gastric low-grade intraepithelial neoplasia(LGIN)presents challenges in developing diagnostic and treatment protocols.AIM To develop a risk prediction model for the pathological upgrading of gastric LGIN to aid clinical diagnosis and treatment.METHODS We retrospectively analyzed data from patients newly diagnosed with gastric LGIN who underwent complete endoscopic resection within 6 months at the First Medical Center of Chinese People’s Liberation Army General Hospital between January 2008 and December 2023.A risk prediction model for the pathological progression of gastric LGIN was constructed and evaluated for accuracy and clinical applicability.RESULTS A total of 171 patients were included in this study:93 patients with high-grade intraepithelial neoplasia or early gastric cancer and 78 with LGIN.The logistic stepwise regression model demonstrated a sensitivity and specificity of 0.868 and 0.800,respectively,while the least absolute shrinkage and selection operator(LASSO)regression model showed sensitivity and specificity values of 0.842 and 0.840,respectively.The area under the curve(AUC)for the logistic model was 0.896,slightly lower than the AUC of 0.904 for the LASSO model.Internal validation with 30%of the data yielded AUC scores of 0.908 for the logistic model and 0.905 for the LASSO model.The LASSO model provided greater utility in clinical decision-making.CONCLUSION A risk prediction model for the pathological upgrading of gastric LGIN based on white-light and magnifying endoscopic features can accurately and effectively guide clinical diagnosis and treatment.
文摘BACKGROUND Most patients who were included in previous studies on achalasia had increased lower esophageal sphincter(LES)pressure.Peroral endoscopic myotomy(POEM)has been confirmed to be effective at relieving the clinical symptoms of achalasia associated with increased LES pressure.AIM To identify the safety and efficacy of POEM for patients with normal LES integrated relaxation pressure(LES-IRP).METHODS The clinical data of patients who underwent POEM successfully in The First Medical Center of Chinese PLA General Hospital were retrospectively analyzed.A total of 481 patients who underwent preoperative high-resolution manometry(HRM)at our hospital were ultimately included in this research.According to the HRM results,the patients were divided into two groups:71 patients were included in the normal LES-IRP group(LES-IRP<15 mmHg)and 410 patients were included in the increased LES-IRP group(LES-IRP≥15 mmHg).Clinical characteristics,procedure-related parameters,adverse events,and outcomes were compared between the two groups to evaluate the safety and efficacy of POEM for patients with normal LES-IRP.RESULTS Among the 481 patients included in our study,209 were males and 272 were females,with a mean age of 44.2 years.All patients underwent POEM without severe adverse events.The median pre-treatment Eckardt scores of the normal LES-IRP and increased LES-IRP groups were 7.0 and 7.0(P=0.132),respectively,decreasing to 1.0 and 1.0 post-treatment(P=0.572).The clinical success rate of the normal LES-IRP group was 87.3%(62/71),and that of the increased LES-IRP group was 91.2%(374/410)(P=0.298).Reflux symptoms were measured by the GerdQ questionnaire,and the percentages of patients with GerdQ scores≥9 in the normal LES-IRP and increased LES-IRP groups were 8.5%and 10.7%,respectively(P=0.711).After matching,the rates of clinical success and the rates of GerdQ score≥9 were not significantly different between the two groups.CONCLUSION Our results suggest that POEM is safe and effective for achalasia and patients with normal LES-IRP.In addition,in patients with normal LES-IRP,compared with those with increased LES-IRP,POEM was not associated with a greater incidence of reflux symptoms.
文摘Neuroendocrine neoplasms(NENs)are relatively rare tumors that arise from peptidergic neurons and neuroendocrine cells.NENs are highly heterogeneous and can occur in any part of the body,with a particular prevalence in the digestive system.NENs consist of a range of tumor types and the biological behaviors exhibit significant differences.NENs are classified into well-differentiated neuroendocrine tumors(NETs)and poorly differentiated neuroendocrine carcinomas(NECs).NETs can be further classified and graded into the following three categories:low-grade NETs,grade 1(NET G1);intermediate-grade NET G2;and high-grade NET G3.NECs include large cell-type NEC(LCNEC)and small cell-type NEC(SCNEC),both of which are considered high grade.Currently,the main treatments for advanced NENs are biological treatments,targeted therapy,chemotherapy,and newer treatments that are still under development,such as immunotherapy and peptide receptor radionuclide therapy(PRRT).However,owing to the rarity of NENs,pharmaceutical company investment is limited and few phase Ⅲ studies have targeted advanced NENs.Most current research consists of investigator-initiated phase Ⅰ and Ⅱ clinical trials or largescale retrospective studies.NEN treatment should be chosen carefully because it is cumbersome and complicated,as indicated above.Herein,we comprehensively summarize the clinical application status and research progress for advanced NEN treatment regimens,especially for advanced NETs,which may help to create awareness on NENs among medical professionals across specialties.
基金funded by National Natural Science Foundation of China(No.82272134)Innovative Research Group Project of the National Natural Science Foundation of China(No.82272134,Xiao-lei Chen).
文摘Background and Objective Electromagnetic navigation technology has demonstrated significant potential in enhancing the accuracy and safety of neurosurgical procedures.However,traditional electromagnetic navigation systems face challenges such as high equipment costs,complex operation,bulky size,and insufficient anti-interference performance.To address these limitations,our study developed and validated a novel portable electromagnetic neuronavigation system designed to improve the precision,accessibility,and clinical applicability of electromagnetic navigation technology in cranial surgery.Methods The software and hardware architecture of a portable neural magnetic navigation system was designed.The key technologies of the system were analysed,including electromagnetic positioning algorithms,miniaturized sensor design,optimization of electromagnetic positioning and navigation algorithms,anti-interference signal processing methods,and fast three-dimensional reconstruction algorithms.A prototype was developed,and its accuracy was tested.Finally,a preliminary clinical application evaluation was conducted.Results This study successfully developed a comprehensive portable electromagnetic neuronavigation system capable of achieving preoperative planning,intraoperative real-time positioning and navigation,and postoperative evaluation of navigation outcomes.Through rigorous collaborative testing of the system’s software and hardware,the accuracy of electromagnetic neuronavigation has been validated to meet clinical requirements.Conclusions This study developed a portable neuroelectromagnetic navigation system and validated its effectiveness and safety through rigorous model testing and preliminary clinical applications.The system is characterized by its compact size,high precision,excellent portability,and user-friendly operation,making it highly valuable for promoting navigation technology and advancing the precision and minimally invasive nature of neurosurgical procedures.
基金Supported by National Natural Science Foundation of China,No.82073192,and No.82273231Beijing Science and Technology Program,No.Z221100007422125.
文摘BACKGROUND In recent years,the global prevalence of gastric cancer(GC)has witnessed a progressive decrease,accompanied by a step-growth in the incidence of gastric signet ring cell carcinoma(GSRCC).As precision medicine concepts progress,GSRCC,a distinct sub-type of GC,has drawn considerable attention from researchers.However,there still persist some controversies regarding the associated research findings.AIM To summarize the current obstacles and potential future directions for research on GSRCC.METHODS To begin with,all literature related to GSRCC published from January 1,2004 to December 31,2023 was subjected to bibliometric analysis in this article.Additionally,this paper analyzed the research data using CiteSpace,GraphPad Prism v8.0.2,and VOSviewer,which was obtained from the Web of Science Core Collection database.The analysis results were visually represented.RESULTS This study provided a comprehensive overview of the statistical characteristics of the 995 English articles related to GSRCC,including cited references,authors,journals,countries,institutions,and keywords.The popular keywords and clusters contain"prognosis","survival","expression","histology",and"chemotherapy".CONCLUSION The prognosis,precise definition and classification,as well as chemoresistance of GSRCC,continue to be crucial areas of ongoing research,whose directions are closely tied to advancements in molecular biology research on GSRCC.
文摘A recent single-center retrospective study proposed novel combinations of hematological parameters and scoring systems for predicting severe acute pancre-atitis.While these combinations showed promising predictive performance,several limitations warrant consideration,including the lack of calibration,the absence of key inflammatory markers such as procalcitonin,and practical challenges in integrating these models into routine clinical workflows.To improve predictive accuracy and clinical applicability,prospective validation and the inclusion of additional variables are recommended.
文摘BACKGROUND Type Ⅲ choledochal cysts(CCs)are extremely rare,and they present as dilatations and herniations of the end of the common bile duct into the duodenum.Moreover,type Ⅱ CCs may be easily misdiagnosed as intraduodenal polyps or tumors.Thus,adequate differential diagnosis and selection of appropriate treatment are important.CASE SUMMARY A young man with a duodenal mass presented with 3-year intermittent abdominal pain and acute pancreatitis 3 days before hospitalization.After evaluation by magnetic resonance imaging and endoscopic ultrasonography,the duodenal papilla was pressed,and the bile flowed out slowly,which was speculated to be the cause of his symptoms.The lesion was punctured with a submucosal injection needle,and golden clear fluid was aspirated.Laboratory tests of the aspirate after 50-fold dilution revealed significantly elevated total bilirubin,direct bilirubin,amylase and lipase.Taken together,these findings confirmed that the lesion was a type Ⅲ CC.The patient underwent fused surgical procedures.Fenestration plus internal drainage of the lesion was subsequently performed with a DualKnife.After drainage,the incision was sealed with tissue clips.During follow-up,the patient recovered well,and no abdominal pain symptoms or acute pancreatitis recurred.CONCLUSION Laboratory tests of cyst aspirates are beneficial for diagnosis,and endoscopic fenestration plus internal drainage works well to mitigate cysts.
文摘BACKGROUND Complications arising from the polyps in Peutz-Jeghers syndrome(PJS)have historically been addressed through surgical treatment.Enteroscopic poly-pectomy is hypothesized to reduce the risk of surgery in PJS.However,the optimal timing for polyp screening and preventive intervention using entero-scopic polypectomy remains uncertain.This is primarily due to the extremely low incidence of the condition and the paucity of data regarding the natural risk of requiring surgery and its age distribution in PJS patients.In order to develop recommendations on the appropriate timing of polyp screening and preventive intervention in PJS,a comprehensive understanding of the natural surgical risks AIM To investigate the natural surgical risks associated with polyps in PJS and to clarify their age distribution.METHODS A web-based open survey was launched to collect information from Chinese individuals suspected of having PJS.The questionnaire was distributed to the PJS instant messaging groups using a quick response code method.The data were analyzed using descriptive statistical methods,and the cumulative incidence of surgery was calculated using the Kaplan-Meier method.RESULTS Of the 442 patients enrolled,301(68.10%)had undergone 506 surgical procedures prior to enteroscopy or the survey deadline.Among the 506 surgical procedures,388(76.68%)were performed on patients aged between 6 and 25 years.The cumulative incidence rates of the first surgical procedure at 5,10,15,20,25,and 30 years of age were 5.0%(95%confidence interval[CI]:2.9%-7.0%),20.6%(95%CI:16.6%-24.4%),40.5%(95%CI:35.5%-45.1%),58.0%(95%CI:52.7%-62.7%),72.6%(95%CI:67.3%-77.0%),and 82.4%(95%CI:77.0%-86.5%),respectively.The primary indications for the first surgical procedures were intussusception(81.40%),obstruction(13.95%),and gas-trointestinal bleeding(4.65%).The cumulative incidence rates of requiring a second surgical procedure within 1,3,5,10 and 15 years following the first surgical procedure were 3.7%(95%CI:1.5%-5.8%),12.5%(95%CI:8.6%-16.2%),20.3%(95%CI:15.6%-24.8%),37.0%(95%CI:33.1%-45.3%),54.2%(95%CI:46.8%-60.5%),respectively.Patients who underwent their first surgical procedure at the age of nine years or younger presented an elevated risk of requiring a second surgical procedure(P<0.01).CONCLUSION Chinese patients with PJS have a high natural risk of undergoing surgery.Without preventive intervention,these procedures may become necessary at an early age and may be repeated.Early screening and regular surveillance,with preventive intervention if necessary,should commence at six years of age.
文摘Chronic obstructive pulmonary disease(COPD)is a persistent airflow obstructive disease caused by airway and/or alveolar abnormalities and has become the third leading cause of death worldwide.Dupilumab,the first fully humanized monoclonal antibody targeting the IL-4 receptor subunit alpha(IL-4Rα),is mainly used to treat COPD patients with elevated blood eosinophils that cannot be effectively controlled by traditional drugs.Studies have shown that dupilumab effectively improves pulmonary function,reduces airway inflammation and exacerbation rate,and significantly improves quality of life in COPD patients by blocking interleukin-4(IL-4)and interleukin-13(IL-13)signaling.Several clinical trials and real-world studies have shown that dupilumab significantly reduces the rate of exacerbations,particularly in patients with high baseline eosinophil or FeNO levels.In addition,dupilumab showed positive efficacy in improving lung function,reducing airway inflammation and improving the quality of life of patients.Although the preliminary efficacy of dupilumab in the treatment of COPD is promising,its safety and efficacy need to be further validated,particularly in long-term use and in different patient subgroups.Future studies should focus on the precise classification of COPD,the exploration of relevant biomarkers,and the use of dupilumab at different stages of treatment in order to achieve personalized treatment.
基金National Natural Science Foundation of China,No.82073192 and No.82273231Beijing Science and Technology Program,No.Z221100007422125The Chinese People's Liberation Army General Hospital Medical Engineering Laboratory Project,No.2022SYSZZKY16.
文摘BACKGROUND Immunotherapy has surfaced as a promising therapeutic modality for gastric cancer(GC).A comprehensive review of advancements,current status,and research trends in GC immunotherapy is essential to inform future investigative efforts.AIM To delineate the trends,advancements,and focal points in immunotherapy for GC.METHODS We performed a bibliometric analysis of 2906 articles in English concerning GC immunotherapy published from 2000 to December 20,2023,indexed in the Web of Science Core Collection.Data analysis and visualization were facilitated by CiteSpace(6.1.6R),VOSviewer v.1.6.17,and GraphPad Prism v8.0.2.RESULTS There has been an increase in the annual publication rate of GC immunotherapy research.China leads in publication volume,while the United States demonstrates the highest citation impact.Fudan University is notable for its citation frequency and publication output.Co-citation analysis and keyword frequency revealed and highlighted a focus on GC prognosis,the tumor microenvironment(TME),and integrative immunotherapy with targeted therapy.Emerging research areas include gastroesophageal junction cancer,adoptive immunotherapy,and the role of Treg cell in immunotherapy.CONCLUSION GC immunotherapy research is an expanding field attracting considerable scientific interest.With the clinical adoption of immunotherapy in GC,the primary goals are to enhance treatment efficacy and patient outcomes.Unlike hematological malignancies,GC's solid TME presents distinct immunological challenges that may attenuate the cytotoxic effects of immune cells on cancer cells.For instance,although CAR-T therapy is effective in hematological malignancies,it has underperformed in GC settings.Current research is centered on overcoming immunosuppression within the TME,with a focus on combinations of targeted therapy,adoptive immunotherapy,Treg cell dynamics,and precise prognosis prediction in immunotherapy.Additionally,immunotherapy's role in treating gastroesophageal junction cancer has become a novel research focus.
文摘The gut microbiome is closely associated with human health and the development of diseases. Isolating, characterizing, and identifying gut microbes are crucial for research on the gut microbiome and essential for advancing our understanding and utilization of it. Although culture-independent approaches have been developed, a pure culture is required for in-depth analysis of disease mechanisms and the development of biotherapy strategies. Currently, microbiome research faces the challenge of expanding the existing database of culturable gut microbiota and rapidly isolating target microorganisms. This review examines the advancements in gut microbe isolation and cultivation techniques, such as culturomics, droplet microfluidics, phenotypic and genomics selection, and membrane diffusion. Furthermore, we evaluate the progress made in technology for identifying gut microbes considering both non-targeted and targeted strategies. The focus of future research in gut microbial culturomics is expected to be on high-throughput, automation, and integration. Advancements in this field may facilitate strain-level investigation into the mechanisms underlying diseases related to gut microbiota.
文摘BACKGROUND The prognosis of patients with poorly differentiated gastric neuroendocrine neoplasms(PDGNENs)is dismal and related research is limited.AIM To investigate the prognostic factors,and validate a novel prognostic nomogram for PDGNEN patients.METHODS We conducted a retrospective study using clinical and pathological data from PDGNEN patients treated at the First Medical Center of the Chinese PLA General Hospital from January 2000 to June 2023.Overall survival(OS)differences were assessed with the Log-rank test and Kaplan-Meier survival curves.Cox regression analysis identified independent risk factors for prognosis.Model performance was evaluated using Harrell’s concordance index,receiver operating characteristic analysis,area under the curve,calibration curves,and decision curve analysis(UDC),including the area under the UDC.RESULTS The study included 336 patients(227 with neuroendocrine carcinoma and 109 with mixed adenoneuroendocrine carcinoma).The average age was 62.7 years.The cohort comprised 80(24.7%)patients in stage I,146(42.9%)in stage II,62(18.1%)in stage III,and 48(14.3%)in stage IV.Significant differences in OS were observed across tumor-node-metastasis stages(P<0.001).Multivariate analysis showed age,Ki-67 index,invasion depth,lymph node metastasis,distant metastasis,and platelet-to-lymphocyte ratio as independent risk factors.We developed a nomogram with a concordance index of 0.779(95%confidence interval:0.743-0.858).Receiver operating characteristic analysis showed area under the curves for 1-year,3-year,and 5-year OS predictions of 0.865,0.850,and 0.890,respectively.The calibration curve demonstrated good agreement with actual outcomes.The area under the UDC for the nomogram vs the 8th American Joint Committee on Cancer tumor-node-metastasis staging system were 0.047 vs 0.027,0.291 vs 0.179,and 0.376 vs 0.216 for 1-year,3-year,and 5-year OS,respectively.CONCLUSION PDGNENs are predominantly found in older men,often in advanced stages at diagnosis,resulting in poor prognosis.The established nomogram demonstrates strong predictive capability and clinical utility.
基金Supported by the Joint Logistics Support Force Comprehensive Equipment Research Project,No.LB2023B010100-09.
文摘BACKGROUND Current disinfection methods for gastrointestinal endoscopes consume a significant amount of water resources and produce a large volume of waste.AIM To achieve the objectives of efficiency,speed,and cost-effectiveness,this study utilized vaporized hydrogen peroxide(VHP)generated from sodium percarbonate granules to conduct an anhydrous disinfection test on gastrointestinal endoscopes.METHODS The experimental device rapidly converts sodium percarbonate granules into VHP,and performs disinfection experiments on gastrointestinal endoscope models,disposable endoscopes,and various types of reusable gastrointestinal endoscopes.Variables such as the intraluminal flow rate(FR),relative humidity(RH),exposure dosage,and organic burden are used to explore the factors influencing the disinfection of long and narrow lumens with VHP.RESULTS The device generates a certain concentration of VHP that can achieve high-level disinfection of endoscope models within 30 minutes.RH,exposure dosage,and organic burden significantly affect the disinfection efficacy of VHP,whereas the intraluminal FR does not significantly impact disinfection efficacy.All ten artificially contaminated disposable endoscopes achieved satisfactory disinfection results.Furthermore,when this device was used to treat various types of reusable endoscopes,the disinfection and sterilization effects were not significantly different from those of automatic endoscope disinfection machines(using peracetic acid disinfectant solution)(P>0.05),and the economic cost of disinfectant required per endoscope was lower(1.5 China Yuan),with a shorter disinfection time(30 minutes).CONCLUSION The methods and results of this study provide a basis for further research on the use of VHP for the disinfection of gastrointestinal endoscopes,as well as for the development of anhydrous disinfection technology for gastrointestinal endoscopes.
基金supported by Beijing Natural Science Foundation(L232101).
文摘Background:To comprehensively analyze the clinical characteristics of patients who underwent gastric endoscopic submucosal dissection(ESD)and explore the incidence and influencing factors of postoperative pain.Methods:The clinical data of patients who underwent gastric ESD at our center from 2009 to 2024 were retrospectively analyzed.Pain severity was assessed using a visual analogue scale,with a score≥4 defined as postoperative pain.Based on the presence or absence of postoperative pain,patients were divided into a pain group and a control group.Independent factors influencing postoperative pain were identified using multivariate logistic regression analysis.To control for confounding bias,patients in the case and control groups were matched by sex and lesion size,and the matched participants were further analyzed using a conditional logistic regression model.Results:In total,993 patients were analyzed.The incidence of postoperative pain was 9.1%(95%confidence interval[CI],7.3-11.1).In the univariate analysis,sex,operation duration,anesthesia method,intraoperative electrocoagulation,nasogastric tube placement,and postoperative vomiting were significantly associated with postoperative pain.Multivariate analysis identified eight independent factors:male sex(odds ratio[OR],0.61;95%CI,0.37-0.97;p=0.04),operation duration(OR,1.29;95%CI,1.03-1.63;p=0.02),protuberant lesions(OR,0.43;95%CI,0.26-0.71;p<0.01),antral lesions(OR,1.84;95%CI,1.10-3.05;p=0.01),intubation general anesthesia(OR,0.40;95%CI,0.22-0.72;p=0.002),intraoperative electrocoagulation(OR,0.32;95%CI,0.19-0.55;p<0.01),nasogastric tube placement(OR,2.005;95%CI,1.12-3.57;p=0.01),and postoperative vomiting(OR,3.24;95%CI,1.40-7.47;p=0.005).Conditional logistic regression analysis further identified diabetes mellitus(OR,2.50;95%CI,1.03-6.06;p=0.04).Conclusion:Female sex,diabetes mellitus,concave-type lesions,lesions in the gastric antrum,non-intubation general anesthesia,absence of intraoperative electrocoagulation,prolonged operation duration,nasogastric tube placement,and postoperative vomiting were independent factors associated with moderate to severe pain after gastric ESD.For patients at increased risk of postoperative pain,appropriate prophylactic and therapeutic measures during the perioperative period may effectively alleviate pain following gastric ESD.
