In endoscopic retrograde cholangiopancreatography (ERCP), common bile duct stones (CBDSs) can be removed through strategies, including endoscopic sphincterotomy (EST), endoscopic papillary balloon dilation (EPBD), and endoscopic sphincterotomy plus balloon dilation (ESBD). By comparing the efficacy and safety of these three methods, we aimed to determine the optimal technique for the removal of small CBDSs (≤ 10 mm in size). This was a multicenter, prospective, parallel controlled study involving patients with small CBDSs undergoing ERCP in three tertiary medical institutions in Jiangsu Province, China, who were randomly divided into the EST group, EPBD group, and ESBD group. The efficiencies of these three techniques were compared by analyzing the first-session and overall success rates of stone removal and the use of endoscopic mechanical lithotripsy (EML). Their safety was compared by measuring the incidences of post-ERCP pancreatitis (PEP) and other adverse events. A total of 350 patients were enrolled. Eligible patients were randomly assigned to the EST group (n = 116), EPBD group (n = 118), and ESBD group (n = 116). Sex, median age, number, and median size of small CBDSs were comparable. The first-session (all > 97

The consumption of probiotics has been extensively employed for the management or prevention of gastrointestinal disorders by modifying the gut microbiota and changing metabolites. Nevertheless, the probiotic-mediated regulation of host metabolism through the metabolism of bile acids (BAs) remains inadequately comprehended. The gut-liver axis has received more attention in recent years due to its association with BA metabolism. The objective of this research was to examine the changes in BAs and gut microbiota using an in vitro fermentation model. The metabolism and regulation of gut microbiota by commercial probiotics complex containing various species such as Lactobacillus, Bifidobacterium, and Streptococcus were investigated. The findings indicated that the probiotic strains had produced diverse metabolic profiles of BAs. The probiotics mixture demonstrated the greatest capacity for Bile salt hydrolase (BSH) deconjugation and 7α-dehydroxylation, leading to a significant elevation in the concentrations of Chenodeoxycholic acid, Deoxycholic acidcholic acid, and hyocholic acid in humans. In addition, the probiotic mixtures have the potential to regulate the microbiome of the human intestines, resulting in a reduction of isobutyric acid, isovaleric acid, hydrogen sulfide, and ammonia. The probiotics complex intervention group showed a significant increase in the quantities of Lactobacillus and Bifidobacterium strains, in comparison to the control group. Hence, the use of probiotics complex to alter gut bacteria and enhance the conversion of BAs could be a promising approach to mitigate metabolic disorders in individuals.

目的:评价透明帽辅助经内镜逆行阑尾炎治疗术(endoscopic retrograde appendicitis therapy,ERAT)治疗粪石性阑尾炎的临床疗效及安全性.方法:回顾性分析2020 年4 月至11 月在南京医科大学附属逸夫医院消化内科就诊的粪石性阑尾炎患者临床资料.计算ERAT插管成功率、取石成功率、术后并发症发生率,观察病程转归、评价肠道清洁度评分(Boston肠道准备量表)以及收集随访信息.结果:19 例患者中急性阑尾炎14 例,慢性阑尾炎5例;ERAT插管成功率为100%,取石成功率为100%;4 例肠镜下可见阑尾开口红肿、脓液流出,诊断为急性化脓性阑尾炎;术中采用取石球囊5 例(26.3%),取石网篮 1 例(5.3%),放置阑尾支架 3 例(15.8%);18 例术后腹痛缓解,1 例术后12h未缓解,转外科手术;ERAT诊治过程中肠镜检查发现结肠息肉 3 例,予以肠镜下切除,其中 1 例提示原位癌;术中及术后无穿孔并发症;术后3 个月复查,3 例阑尾支架自行脱落;术后每月随访(持续1 年)未发现阑尾粪石复发,患者均无腹痛发作;肠道清洁度评分平均8.2 分.结论:ERAT是一种可行、有效、微创的诊断和治疗粪石性阑尾炎的方法,患者术后并发症少,复发率低.

Background Multiple studies have reported the association between Helicobacter pylori (H. pylori) infection and children's growth. The results of these studies are controversial. Our meta-analysis aimed to evaluate the association between H. pylori infection and growth outcomes in children. Methods We searched PubMed, Embase, Web of Science, and Cochrane Library, as well as two Chinese databases, Wanfang, and CNKI from inception to September 2019. Odds ratios (ORs) and standardized mean differences (SMDs) with their 95% confidence interval (95% CI) were selected as the effect size. We assessed pooled data using a random-effects model. Subgroup and sensitivity analyses were conducted. Results In total, 29 studies provided data from 9384 subjects. The meta-analysis results indicated a significant association of H. pylori infection with ponderal growth disorders (OR: 2.47; 95% CI: 1.13, 5.37; p = 0.02) and linear growth disorders (OR =1.76; 95% CI: 1.15, 2.69, p = 0.01). H. pylori infection has an adverse impact on children's height-for-age Z (HAZ) scores (SMD = -0.41; 95% CI: -0.69, -0.13; p < 0.01). Pooling SMDs by other outcomes (height, weight, BMI, weight-for-age and BMI-for-age Z scores, weight-for-age percentile scores, and linear and ponderal growth velocity with/without infection and eradication/non-eradication) all indicated no significant association. Conclusion The current evidence supports the hypothesis that H. pylori infection is associated with growth outcomes in children, mainly HAZ scores. Clinicians might consider H. pylori infection in investigating linear growth disorders in children.

Choledocholithiasis is a chronic common disease.The incidence of cholelithiasis is 5%-15%, of which 5%-30% are combined with Choledocholithiasis.Although endoscopic cholangiopancreatography (ERCP) + endoscopic sphincterotomy (EST) is the most common treatment procedure, which clearance rate is up to 95%, the incidence of recurrent choledocholithiasis was 4%-25%.The risk factors of recurrence after choledocholithiasis clearance are the focuses of current researches, which are caused by multiple factors.We first systematically summarize the risk factors of common bile duct stones (CBDS) recurrence into five aspects: first-episode stone related factors, congenital factors, biological factors, behavioral intervention factors, and the numbers of stone recurrence.

原发性肺癌常常发生转移。肺鳞癌更容易发生淋巴转移，而转移至胆总管比较罕见。本文报告1例患者表现为梗阻性黄疸，经内镜逆行胆管造影+内镜下乳头括约肌切开术+胆管活检+胆管刷检+病理免疫组化检查，诊断为肺鳞癌胆总管转移。患者经胆管扩张、支架置入等治疗，梗阻解除，症状明显改善。

Background Pathogenesis of Helicobacter Pylori (HP) vacuolating toxin A (vacA) depends on polymorphic diversity within the signal (s), middle (m), intermediate (i), deletion (d) and c-regions. These regions show distinct allelic diversity. The s-region, m-region and the c-region (a 15 bp deletion at the 3′-end region of the p55 domain of the vacA gene) exist as 2 types (s1, s2, m1, m2, c1 and c2), while the i–region has 3 allelic types (i1, i2 and i3). The locus of d-region of the vacA gene has also been classified into 2 genotypes, namely d1 and d2. We investigated the “d-region”/“loop region” through bioinformatics, to predict its properties and relation to disease. One thousand two hundred fifty-nine strains from the NCBI nucleotide database and the dryad database with complete vacA sequences were included in the study. The sequences were aligned using BioEdit and analyzed using Lasergene and BLAST. The secondary structure and physicochemical properties of the region were predicted using PredictProtein. Results We identified 31 highly polymorphic genotypes in the “d-region”, with a mean length of 34 amino acids (9 ~ 55 amino acids). We further classified the 31 genotypes into 3 main types, namely K-type (strains starting with the KDKP motif in the “d-region”), Q-type (strains starting with the KNQT motif), and E-type (strains starting with the ESKT motif) respectively. The most common type, K-type, is more prevalent in cancer patients (80.87%) and is associated with the s1i1m1c1 genotypes ( P < .01). Incidentally, a new region expressing sequence diversity (2 aa deletion) at the C-terminus of the p55 domain of vacA was identified during bioinformatics analysis. Conclusions Prediction of secondary structures shows that the “d-region” adopts a loop conformation and is a disordered region.

Background: The endoscopic resection of suspected gastric high-grade intraepithelial neoplasia (HGIN) may incidentally cause the patient to suffer from early gastric cancer (EGC), complicating the subsequent clinical management. Identifying the risk factors for such misstaging may help guide the clinical management. Methods: The information obtained from 123,460 patients, who underwent conventional upper gastrointestinal endoscopy at the First Affiliated Hospital of Nanjing Medical University from January 2010 to December 2015, were retrospectively reviewed. Patients with an initial diagnosis of HGIN underwent endoscopic submucosal dissection (ESD), and received a final diagnosis of EGC. The risk factors for the upgraded pathology and noncurative resection were analyzed. Results: Among the 134 patients initially diagnosed with HGIN, 35 (26.12%) patients were finally diagnosed with EGC after ESD. A lesion size of ≥2 cm (odds ratio [OR] = 5.16, 95% confidence interval [CI] = 2.04-13.05; P < .01), ≤4 biopsies taken (OR = 2.73, 95% CI = 1.15-6.48; P < .05), and the presence of upper gastrointestinal bleeding (UGIB; OR = 15.64, 95% CI = 1.29-189.75; P < .05) were the independent risk factors for upgraded pathology. In addition, patients >65 years old (OR = 0.022, 95% CI = 0.901-6.549; P < .05) or with a lesion size of ≥2 cm (OR = 4.237, 95% CI = 1.650-10.878; P < .01) were more likely to endure the noncurative resection. Conclusion: For suspected gastric HGIN patients, age, lesion size, the number of biopsies, and UGIB should be taken into account before deciding on the ESD.

Helicobacter pylori (H. pylori) infection is associated with some gastric diseases, such as gastritis, peptic ulcer, and gastric cancer. CagA and VacA are known virulence factors of H. pylori, which play a vital role in severe clinical outcomes. Additionally, the expression of outer membrane proteins (OMPs) helps H. pylori attach to gastric epithelial cells at the primary stage and increases the virulence of H. pylori. In this review, we have summarized the paralogs of H. pylori OMPs, their genomic loci, and the different receptors of OMPs identified so far. We focused on five OMPs, BabA (HopS), SabA (HopP), OipA (HopH), HopQ, and HopZ, and one family of OMPs: Hom. We highlight the coexpression of OMPs with other virulence factors and their relationship with clinical outcomes. In conclusion, OMPs are closely related to the pathogenic processes of adhesion, colonization, persistent infection, and severe clinical consequences. They are potential targets for the prevention and treatment of H. pylori–related diseases.

幽门螺杆菌(H.pylori)的外膜蛋白(OMPs)是细菌外膜的重要组成部分,包括脂蛋白、孔蛋白、铁调节蛋白、泵蛋白等.黏附是H.pylori感染的第1步,也是其定植和致病的关键,部分OMPs有助于H.pylori在感染早期通过不同的受体黏附于胃黏膜上皮细胞发挥毒力作用,可以诱导炎症反应、介导细菌分泌系统转运毒力因子,如细胞毒素相关蛋白和细胞空泡毒素,在多种胃部疾病如胃炎、消化性溃疡和胃腺癌的发生与发展中起着重要作用.随着对OMPs研究的深入,OMPs相关性疫苗的研究也逐渐成为热点,并有望成为预防感染的有效方式.

Background Nonalcoholic fatty liver disease (NAFLD) increases the risk of hepatocellular carcinoma, which is currently the leading cause of obesity-related cancer deaths in middle-aged men. Methods Probiotics with lipid-lowering function were screened from the fecal microbiota of healthy adults. Polysaccharide from different sources was screened for improving insulin resistance. The combination of probiotics and Salvia miltiorrhiza polysaccharide (LBM) was investigated for alleviating hepatic steatosis. Results First, Bifidobacterium bifidum V (BbV) and Lactobacillus plantarum X (LpX) were obtained from the fecal microbiota of healthy adults. Second, to improve insulin resistance, a Salvia miltiorrhiza Bunge polysaccharide showing good performance in reducing insulin resistance was obtained. The liver total cholesterol (TC) and total triglyceride (TG) levels and the serum levels of free fatty acid, alanine transaminase, aspartate transaminase, low density lipoprotein cholesterol, TG, and TC can be significantly reduced through supplementation with LpX-BbV (LB) in NAFLD mice. Interestingly, the function of the probiotic LB can be enhanced by S. miltiorrhiza Bunge polysaccharide. Furthermore, the gut microbiota was modulated by LpX-BbV+S. miltiorrhiza Bunge polysaccharide (LBM). The lipopolysaccharide concentration of the LBM group was decreased by 73.6% compared to the NAFLD group. Ultimately, the mRNA concentrations of the proinflammatory cytokines (tumor necrosis factor α, interleukin 1β [IL-1β], and IL-6) decreased with LB and LBM treatment. Conclusion The results of this this study indicate that the LBM combination can be used as a therapeutic for ameliorating NAFLD via modulating the gut microbiota and improving insulin resistance.

Objective To investigate the correlation between the diversity of biliary bacterial flora and the recurrence of common bile duct stones.Methods From September 2018 to March 2019,48 patients underwent endoscopic retrograde cholangiopancreatography (ERCP) at the First Affiliated Hospital of Nanjing Medical University were enrolled and divided into primary choledocholithiasis (primary group,38 patients) and recurrent choledocholithiasis group (recurrent group,10 patients).The bile of the patients of the two groups was collected and analyzed with high-throughput sequencing of 16S rRNA.The Chao1 estimator indicated the richness of the biliary bacterial flora,and Shannon index and Simpson index demonstrated the diversity of biliary bacterial flora.The bacterial flora distribution was explored from different levels of phylum,class,order,family,genus and species.Chi-square test and t test were performed for statistical analysis.Results The Chao1 estimator of the primary group was higher than that of the recurrent group (419.413 ± 118.704 vs.396.000 ± 70.483),and the difference was statistically significant (t =3.130,P =0.003).At the level of the phylum,the highest abundance of bacteria in the primary group was Firmicute (56.48％),the highest abundance of bacteria in the recurrent group was Proteobacteria (57.79％).The dominant bacteria of the recurrent group was Proteobacteria,which was inconsistent with that of the primary group,and there were significant differences in the distribution of Proteobacteria and Firmicute between two groups (x2 =0.962 and-2.619,both P ＜ 0.05).At the genus level,the abundance of Bacillus and Lactococcus of the recurrent group were both lower than those of the primary group (9.75％ vs.20.77％,10.86％ vs.22.01％,respectively),and the differences were statistically significant (x2 =0.354 and 0.503,both P ＜ 0.05).The abundance of Morganella of the recurrent group was higher than that of the primary group (9.00％ vs.0.44％),and the difference was statistically significant (x2 =-2.025,P =0.049).At the species level,the abundance of Bacillus unclassified,Carnobacterium maltaromaticum and Bacillus circulans of the primary group were all higher than those of the recurrent group (17.78％ vs.8.84％,2.39％ vs.1.11％,2.59％ vs.0.74％,respectively),and the differences were all statistically significant (x2 =2.540,2.643 and 2.515,all P ＜ 0.05).The abundance of Aeromonas veronii of recurrent group was higher than that of the primary group (2.04％ vs.0.01 ％),and the difference was statistically significant (x2 =-2.397,P =0.021).The bacteria that had significant effects in the primary group included Lactococcus (P =0.012),Lactobacillus (P =0.033) and Geobacillus (P =0.021),while in the recurrent group,which included Enterobacter (P =0.007),Aeromonadaceae (P =0.001),Actinomycetes (P =0.009),and Aeromonas (P =0.001).Conclusions There are differences in abundance and composition of biliary bacterial flora between the recurrent group and the primary group.It remains to be further studied whether the changes of some bacterial flora correlated with the recurrence of common bile duct stones.

目的 探讨不同辅助插管技术在经内镜逆行胰胆管造影(ERCP)选择性困难胆管插管中的应用,评价其疗效及安全性.方法 选取2015年11月—2019年6月在江苏大学附属医院和南京医科大学附属逸夫医院行ERCP选择性困难胆管插管且进一步使用辅助插管技术的137例患者作为研究对象,按辅助插管技术的不同分为双导丝组(94例)和预切开技术组(43例)两组.分析困难胆管插管发生率、使用辅助插管技术后困难胆管插管成功率、比较两组辅助插管技术的成功率、并发症发生率.结果 2015年11月—2019年6月纳入符合困难胆管插管标准的患者137例,占比11.5％.使用辅助插管技术后成功128例,成功率93.4％.双导丝组成功91例,成功率96.8％,预切开组成功37例,成功率86.0％,两组成功率比较,差异有统计学意义(P<0.05).总体发生并发症21例,占比15.3％,其中双导丝组并发症11例(术后轻症胰腺炎9例,术后轻度出血1例,术后胆管炎1例),预切开组并发症10例(术后轻症胰腺炎7例,术中轻度出血3例),两组并发症比较,差异无计学意义(P>0.05).ERCP术后胰腺炎发生率双导丝组9.6％,预切开组16.3％,两组差异无统计学意义(P>0.05).结论 ERCP常规插管失败后,尽早采用辅助插管技术可以进一步提高插管成功率.双导丝技术和预切开技术具有相似的操作安全性,但双导丝技术具有较高的插管成功率.

[目的]探讨小肠细菌过度生长(SIBO)阳性患者的回盲瓣舒缩功能变化及其意义.[方法]将97例同期门诊健康体检结肠镜的人群,先通过葡萄糖氢呼气试验(GHBT)分别检测其SIBO情况,其中SIBO阳性58例(SIBO阳性组)、SIBO阴性39例(SIBO阴性组),再进行结肠镜检查,剔除回肠末端/结肠病变的患者后,SIBO阳性组27例、SIBO阴性组36例,记录2组插镜前、后回盲瓣开放、闭合时间,且对比分析结果.[结果]SIBO阳性组、SIBO阴性组合并回肠末端/结肠病变发生率分别为53.45％(31/58)、7.69％(3/39),2组比较差异有统计学意义(P＜0.01).剔除病变后,SIBO阳性组较SIBO阴性组插镜前的开放时间明显延长,闭合时间明显缩短,差异有统计学意义(P＜0.01);SIBO阳性组插镜后回盲瓣开放时间进一步延长,差异有统计学意义(P＜0.05),闭合时间差异无统计学意义(P＞0.05);SIBO阴性组插镜后回盲瓣开放时间亦延长,闭合时间缩短,差异有统计学意义(P＜0.01).[结论]SIBO阳性易合并较高的回肠末端/结肠病变发生率、易伴有回盲瓣舒缩功能异常.

Background/Aims: To correlate the endoscopic characteristics with the histopathology of specimens of esophageal high-grade intraepithelial neoplasia obtained by endoscopic submucosal dissection (ESD). Methods: This was a retrospective study developed from January 2010 to December 2015. The study included 169 patients who underwent ESD and were diagnosed with esophageal high-grade intraepithelial neoplasia according to endoscopic forceps biopsy, Lugol staining, endoscopic ultrasonography, computed tomography, and Narrow-Band Imaging. The demographic, endoscopic, and histopathologic characteristics were analyzed. Results: A total of 19 cases (11.2%) had a change in diagnosis after histopathology exam and 16 (9.5%) needed a change in established treatment. An increase in the severity of disease was correlated with a lesion size > 2 cm, less than 4 samples in biopsy, and depressed or excavated patterns (p < 0.05). One hundred forty patients (82.8%) underwent curative resection. Lesions with leukoplakia (p < 0.001) and negative Lugol staining (p = 0.028) were independent risk factor for non-curative resection. Conclusion: This study confirms that lesion size > 2 cm, depressed and excavated patterns, and ≤4 biopsy samples are independent risk factors for histological grade changes compared to pre-endoscopic treatment diagnosis. Similarly, leukoplakia and no Lugol staining of lesions are independent risk factors for non-curative resection.

Piwi like RNA-mediated gene silencing 1 (Hiwi) is a human homolog of the Piwi gene family that has been reported to be upregulated in hepatocellular carcinoma (HCC). The present study aimed to investigate the role of Hiwi in the initiation and development of HCC in vitro and in vivo. Adenovirus-mediated Hiwi overexpression was established in primary murine hepatocytes and SMMC7721 HCC cells. Cell viability and proliferation were assessed using MTT and EdU assays, respectively. Cell migration was measured using a scratch migration assay. The cell cycle was assessed using flow cytometry, and the expression of genes associated with the epithelial mesenchymal transition (EMT) was assessed using reverse transcription-quantitative polymerase chain reaction. SMMC7721 cells that stably express Hiwi were also generated and injected subcutaneously into the nude mice, and tumor growth was examined. Recombinant adenovirus encoding green fluorescent protein or Hiwi was delivered by injection into the tail vein, and its effect on murine hepatocyte gene expression was studied. The present study revealed that the overexpression of Hiwi did not affect the proliferation or migration of liver cancer cells and failed to suppress perifosine- or doxorubicin-induced apoptosis in vitro. The tumors of mice that were injected with Hiwi-expressing SMMC7721 cells were not significantly larger compared with mice that were injected with control SMMC7721 cells. Hiwi overexpression did not noticeably alter the expression of genes involved in EMT, either in vitro or in vivo. The results of the present study indicate that although expression of Hiwi is associated with HCC development and progression in the clinic, it does not act as an oncogene in liver cancer cells.

With the improvement of infrastructures and techniques, “Big Data” provides great opportunities to health informatics, but at the same time raises unparalleled challenges to data scientists. As an interdisciplinary field, the health data are not limited to electronic health record (EHR), as more and more molecular-level data are used for disease diagnosis and prognosis in clinics. Effectively integrating and mining these data holds an indispensable key to translate theoretical models into clinical applications in precision medicine. In this chapter, we briefly demonstrate different data levels involved in health informatics. Then we introduce some general data mining approaches applied to different levels of health data. Finally, a case study is illustrated as an example for applying computational methods on mining long-term EHR data in epidemiological studies.

The human body is believed to house over 100 trillion microbes. These microbial communities have a tremendously influential impact on their human hosts. Although increasing evidence indicated a key role for the specific microbial species in carcinogenesis, such as Helicobacter pylori (H. pylori), Epstein-Barr virus, Human papillomavirus, and Hepatitis C virus, the underlying roles of human microbiome in cancers are still unclear. Using the bioinformatics algorithms and tools to integrate the microbiological data and clinical data could be very helpful to better understand the mechanisms of diseases. During the past decade, we have kept working on microbiome research and utilized bioinformatics methods to discover host-pathogen interactions, relationships between microbiome dynamics and diseases, and correlations between bacterial sequence variation and clinical outcomes. In this chapter, we use H. pylori as an example to demonstrate the procedure of related data integration, virulence classification, and prognosis model construction.