Studies concerning the impact of air temperature on esophagogastric variceal bleeding (EGVB) have yielded conflicting results. Our study aimed to evaluate the correlation between air temperature and EGVB. A time-stratified case-crossover study design was performed. Patients received emergency gastroscopic hemostasis for upper gastrointestinal bleeding between Jan 1, 2014, and Dec 31, 2018 in the Fifth Medical Center of PLA General Hospital were enrolled. Conditional logistic regression analysis was applied to determine the association between air temperature and EGVB for different lag structures. A total of 4204 cirrhotic patients diagnosed with EGVB and received emergency gastroscopic hemostasis were enrolled. The mean number of daily EGVB cases peaked in October (2.65 ± 1.69) and fell to the lowest level in July (1.86 ± 1.38), and was 2.38 ± 1.58 in spring, 2.00 ± 1.46 in summer, 2.37 ± 1.58 in autumn, and 2.45 ± 1.58 in winter, respectively (P < 0.0001). In conditional logistic regression analysis, no significant correlations between air temperature and EGVB were observed and no significant difference were found when stratified by age, sex, etiology, liver cancer status, and grade of varices. Emergency admission for EGVB showed significant monthly and seasonal fluctuations, while in conditional logistic regression analysis, no association between minimum temperature and emergency admission for EGVB were observed.

ObjectiveTo investigate the influencing factors for the clinical effect of emergency endoscopic therapy in the treatment of patients with acute-on-chronic liver failure and gastroesophageal variceal bleeding. MethodsA total of 51 patients with acute-on-chronic liver failure and gastroesophageal variceal bleeding who underwent emergency endoscopic therapy in Beijing Shijitan Hospital and The Fifth Medical Center of Chinese PLA General Hospital from January 2016 to December 2018 were enrolled, among whom 26 had successful hemostasis and 25 had failed hemostasis. The two groups were compared in terms of general information, varices grade and bleeding manifestations under endoscope, blood biochemical parameters, ultrasound findings, Child-Pugh class, and Model for End-Stage Liver Disease (MELD) score, and the influencing factors for the outcome of hemostasis were analyzed. The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups, and the chi-square test was used for comparison of categorical data between two groups; the logistic regression model was used to perform the multivariate analysis. ResultsOf all patients, 26 achieved successful hemostasis, with a success rate of hemostasis of 51%. There were no significant differences between the two groups in sex, age, etiology of liver cirrhosis, presence or absence of liver cancer, presence or absence of portal vein thrombosis, bleeding for the first time or not, white blood cell count, hemoglobin, platelet count, prothrombin time activity, alanine aminotransferase, total bilirubin, albumin, cholinesterase, MELD score, and bleeding site and bleeding manifestations under gastroscope (all P＞0.05). Compared with the failed hemostasis group, the successful hemostasis group had a significantly longer course of disease (t=2.760, P=0.008) and significantly larger portal vein diameter and diameter of varicose veins under endoscope (t=-4.847, χ2=-6.590, both P＜0.05), and the failed hemostasis group had a significantly higher proportion of patients with Child-Pugh class C disease than the successful hemostasis group (χ2=5.684, P=0.017). Course of liver cirrhosis (odds ratio ［OR］=0.913, 95% confidence interval ［CI］: 0.838-0.994, P＜0.05), portal vein diameter (OR=1.925,95%CI: 1.516-2.443, P＜0.05), and diameter of varicose veins (OR=23.254, 95%CI: 2.250-240.352, P＜0.05) were independent influencing factors for the clinical effect of endoscopic hemostasis. ConclusionThere is a relatively low success rate of emergency endoscopic hemostasis in patients with acute-on-chronic liver failure, and course of liver cirrhosis, portal vein diameter, and diameter of varicose veins are independent influencing factors for the clinical effect of endoscopic hemostasis.

目的 应用Cre-LoxP技术构建自噬相关基因Eva1a肝细胞条件性敲除小鼠初步探讨Eva1a基因敲除对小鼠表型的影响.方法 LoxP标记的Eva1aflox/+小鼠与Alb-Cre工具鼠通过多次繁殖杂交,构建纯合型肝细胞条件性Eva1a基因敲除(Eva1aflox/flox:Alb-Cre)小鼠模型.选取Eva1aflox/flox:Alb-Cre小鼠与同窝野生(Eva1aflox/flox)小鼠雌雄进行体质量、肝指数、肝脏组织学、肝功能、糖脂代谢以及细胞自噬等表型分析.结果 Eva1a纯合型基因敲除小鼠无胚胎致死现象,出生后一般生理状况良好.常规饲养条件下,肝脏Eva1a基因条件性敲除在小鼠体质量、肝脏外观以及组织结构、肝指数、肝功能、糖脂代谢及自噬等与野生型小鼠差异无统计学意义.结论 肝细胞条件性Eva1a基因敲除对小鼠生理条件下的表型无显著影响,为进一步探讨Eva1 a在肝脏疾病状态下的作用及分子机制提供了动物模型.

非酒精性脂肪性肝病(NAFLD)被认为是代谢综合征的肝脏表现,与结直肠肿瘤的发生发展密切相关.简述了NAFLD和结直肠腺瘤、结直肠癌的相关性及可能机制,认为NAFLD促进结直肠腺瘤、结直肠癌的发生并影响其预后,胰岛素抵抗、脂肪细胞因子、炎症反应、肠道菌群、免疫等多种因素可能参与其中.

ObjectiveTo investigate the risk factors for failure in emergency endoscopic injection sclerotherapy (EIS) combined with sequential histoacryl injection (HI) for esophagogastric variceal bleeding (EGVB) with portal vein embolus (PVE). MethodsA total of 109 EGVB patients with PVE who underwent emergency gastroscopy in Beijing Shijitan Hospital, Capital Medical University, and The Fifth Medical Center of Chinese PLA General Hospital from January 2018 to December 2019 were enrolled, and according to the outcome of hemostatic treatment under emergency gastroscopy, the patients were divided into hemostatic failure group with 28 patients and hemostatic success group with 81 patients. The two groups were compared in terms of general information, varices and bleeding manifestations under gastroscopy, blood biochemical parameters, Child-Pugh class, and Model for End-Stage Liver Disease (MELD) score, and the risk factors for hemostatic failure were analyzed. The t-test or the Mann-Whitney U test was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups; a logistic regression analysis was used for multivariate analysis. ResultsCompared with the hemostatic success group, the hemostatic failure group had significantly higher peripheral white blood cell count (WBC), total bilirubin (TBil), Child-Pugh class, and MELD score (Z=3.794, Z=4.751, χ2=40.104, Z=6.412, all P＜0001) and significantly lower prothrombin time activity (PTA), albumin (Alb), and cholinesterase (CHE) (t=9.653, Z=3.093, Z=4.092, P＜0.001, P=0.002, and P＜0.001). WBC (odds ratio ［OR］=28.543, 95% confidence interval ［CI］: 1.285-634.113, P＜0.05), PTA(OR=0.194, 95%CI: 0.045-0.835, P＜0.05), TBil (OR=2.197, 95%CI: 1.004-4.810, P＜0.05), Alb (OR=0448, 95%CI: 0.209-0.961, P＜0.05), and Child-Pugh class (OR=5.164, 95%CI: 1.307-20.406, P＜0.05) were independent risk factors for hemostatic failure. ConclusionWBC, PTA, TBil, Alb, and Child-Pugh class are independent risk factors for failure in emergency EIS combined with sequential HI in the treatment of EGVB with PVE, and adequate preoperative evaluation and correction may help to improve the success rate of hemostasis.

BACKGROUND Glomus tumors (GTs) are rare mesenchymal neoplastic lesions derived from cells of the glomus body. GTs rarely occurs in the visceral organs, where there may be few or no glomus bodies, and the majority of GTs are benign, rarely demonstrating aggressive or malignant behavior and histological features. CASE SUMMARY We report a patient with malignant GTs of the intestinal ileum with multiorgan metastases who was admitted due to moderate anemia. Capsule endoscopy revealed a bleeding mass in the intestinal ileum, and the patient underwent segmental ileal resection through laparoscopic surgery. The histopathological and immunohistochemical diagnoses were consistent with malignant GT. Long-term follow-up showed that the GT had metastasized to multiple organs such as the colon, brain, and possibly the lung. CONCLUSION This case was characterized by the highest degree of malignancy and by multiorgan metastases, and it was the first case of intestinal GT uncovered by capsule endoscopy.

急诊胃镜下止血是治疗食管胃静脉曲张破裂出血的有效方法，止血失败的患者预后差，早期识别止血治疗失败的危险因素尤为重要。本研究通过回顾性分析比较急诊胃镜下止血治疗失败与止血成功的肝硬化食管胃静脉曲张破裂出血患者的临床资料，探究急诊胃镜下止血治疗失败的危险因素。结果表明凝血酶原活动度、血红蛋白降低值、Child-Pugh分级、门静脉栓子形成是肝硬化食管胃静脉曲张破裂出血患者急诊胃镜下止血治疗失败的独立危险因素( P<0.05)。因此，在急诊胃镜检查治疗前应对上述因素进行合理评估，以提高止血成功率。

肉瘤样癌( sarcomatoid carcinoma , SC)是一种由癌性成分和肉瘤样成分紧密结合在一起共同构成的恶性肿瘤[1].可发生于全身各器官,多见于肺[2-3] ,原发于肝胆胰的SC较少见,其恶性程度高、增长速度快,侵袭性强,预后差[4].本文回顾性分析了6例经病理证实的肝胆胰SC患者的临床、影像及病理资料,并复习文献,旨在探讨该病的特点,提高对SC的认识水平,为后续患者的诊治提供依据.

ObjectiveTo investigate the clinical effect of endoscopic variceal ligation (EVL), endoscopic injection sclerotherapy (EIS), and tissue adhesive injection in the treatment of esophagogastric junctional variceal bleeding, and to provide a reference for reasonable selection of different hemostasis methods. MethodsA total of 1264 patients with liver cirrhosis and esophagogastric junctional variceal bleeding who underwent emergency gastroscopic hemostasis in Beijing Shijitan Hospital and The Fifth Medical Center of Chinese PLA General Hospital from June 2017 to June 2019 were enrolled and divided into EVL, EIS, HI groups based on the method of emergency gastroscopic hemostasis. These groups were compared in terms of success rate of operation, success rate of hemostasis, early rebleeding rate, and postoperative complications. The patients were also divided into groups based on bleeding site, and the success rates of different hemostasis methods at different sites were compared. An analysis of variance was used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. ResultsThe success rate of EIS and tissue adhesive injection was significantly higher than that of EVL, and the success rate of EIS was significantly higher than that of tissue adhesive injection (χ2=75.01, P＜0.05). Tissue adhesive injection had a significantly higher success rate of hemostasis than EVL and EIS (χ2=9.885, P＜0.05). There was no significant difference in early rebleeding rate between groups (χ2=0.29，P=0.865). The patients undergoing EVL had a significantly higher incidence rate of aspiration and pneumonia than those undergoing EIS or tissue adhesive injection (χ2=19.08, P＜0.05); the patients undergoing tissue adhesive injection had a significantly higher proportion of patients with postoperative pyrexia than those undergoing EVL or EIS (χ2=23.94, P＜005); the patients undergoing EVL or tissue adhesive injection had a significantly higher incidence rate of postoperative retrosternal discomfort than those undergoing EIS (χ2=19.56, P＜0.05). EIS and EVL had a high success rate of hemostasis for the bleeding sites at 1-5 cm above the esophagogastric junction (EGJ); EIS and tissue adhesive injection had a similar success rate of hemostasis for the bleeding sites from 1 cm above the EGJ to 2 cm below the EGJ; tissue adhesive injection had a high success rate of hemostasis for the bleeding sites at 2-5 cm below the EGJ. ConclusionEVL, EIS, and tissue adhesive injection are effective methods for the treatment of esophagogastric junctional variceal bleeding, and the selection of hemostasis method based on the location of bleeding site can improve the outcome of hemostasis.

BACKGROUND Occult hepatitis B virus (HBV) infection (OBI) in blood donors was investigated in the Baoji area of North China, and OBI‐related viral mutations in donors were characterized. STUDY DESIGN AND METHODS In total, 110,843 blood donor samples that were consecutively collected from December 2011 to March 2015 at the Baoji Blood Center were examined. Hepatitis B surface antigen‐negative and HBV DNA‐positive OBI samples were amplified for sequence analysis of OBI‐related mutations in the HBV preS/S region. HBV genomes from 108 adult patients with chronic hepatitis B from North China were used as controls. RESULTS OBI was detected in 60 (1:1847) individual blood donors. All OBI samples were negative for hepatitis B e‐antigen, and 55 were positive for anti‐hepatitis B core antigen. The preS/S genes were successfully sequenced for 43 OBI samples. OBI‐related S gene mutations in the major hydrophilic region were detected more frequently in blood donors with OBI than that in controls (51.16 vs. 12.96%; p < 0.01). Specifically, the incidence of five OBI‐related major hydrophilic region mutations (sS117T, sT118K, sT131N, sT134Y/L, and sD144E) was significantly higher in blood donors with OBI than in controls. In addition, the coexistence of multiple OBI‐related mutations in the major hydrophilic region was detected more frequently in donors than in controls (30.23 vs. 1.85%; p < 0.01), and preS deletions greater than 33 base pairs also were detected more frequently in blood donors with OBI than in controls. CONCLUSION OBI in blood donors should be addressed attentively in the Baoji area of North China, and HBV preS/S gene mutations may play an important role in OBI prevalence in the area.