The optimal fecal occult blood test (FOBT) and hemoglobin (Hb) threshold for balancing diagnostic accuracy and endoscopic demand in colorectal cancer (CRC) screening among Chinese outpatients remained unclear. A prospective multicenter trial was conducted from January 2017 to April 2021 across eight tertiary hospitals. Eligible outpatients were enrolled, whose stool samples were analyzed using quantitative fecal immunochemical test (FIT), self-administered qualitative FIT, general qualitative FIT, and gFOBT. All participants underwent colonoscopy. The primary outcome was the sensitivity of FOBTs for CRC detection. A total of 2,930 participants were enrolled, with 2,618 participants meeting inclusion criteria and completing FOBTs and colonoscopies. At the threshold of 5.2 µg/g, quantitative FIT demonstrated comparable sensitivity for CRC detection (90.1%) to self-administered qualitative FIT (87.1%), general qualitative FIT (91.1%), and gFOBT (82.2%) (all P > 0.05). The positive rate of quantitative FIT (12.4%) was significantly lower than that of self-administered qualitative FIT (27.5%), general qualitative FIT (24.2%), and gFOBT (23.0%) (all P < 0.05). Quantitative FIT showed superior specificity (93.9%) compared to self-administered qualitative FIT (79.5%), general qualitative FIT (83.6%), and gFOBT (80.7%) (all P < 0.05). Furthermore, quantitative FIT at 5.2 µg/g exhibited higher PPV and LR + for CRC, advanced adenoma (AA) and advanced neoplasia (AN) than other FOBTs. Receiver operating characteristic (ROC) analysis and area under the curve (AUC) revealed excellent accuracy for CRC detection (AUC: 0.951, 95% CI: 0.920-0.981). The quantitative FIT with a threshold of 5.2 µg/g demonstrated superior performance for early CRC screening in Chinese outpatients.

BackgroundThe incidence of elderly-onset ulcerative colitis (EO-UC) has been gradually increasing. The unique characteristics of clinical manifestations, therapeutic strategies, and prognosis in EO-UC patients compared with adult-onset ulcerative colitis (AO-UC) patients remain unclear.MethodsWe retrospectively analyzed hospitalized ulcerative colitis (UC) patients from March 2010 to June 2024 at Peking University Third Hospital and Peking University International Hospital. We recruited 68 EO-UC patients (age at diagnosis≥60 years) and 136 AO-UC patients (age at diagnosis <60 years, matched ratio = 1:2). Follow-up lasted from the date of UC diagnosis to the earlier of two endpoints: January 31, 2025, or the date of the last clinical visit at our center. Subsequently, we analyzed the differences in clinical manifestations, therapeutic strategies, and prognosis between the two groups.ResultsThe male-to-female ratio in the EO-UC group was 1.8:1, and this group had milder clinical manifestations (abdominal pain 58.5% vs. 75.0%, p = 0.022; mucous bloody stool 50.0% vs. 74.3%, p < 0.001) and a higher comorbidity burden (p < 0.001) than the AO-UC group. The distribution of lesion locations differed significantly between the two groups (p = 0.001), with higher proportions of proctitis and left-sided colitis in the EO-UC group (14.7% vs. 2.2% and 22.1% vs. 18.4%). The use of corticosteroids and biologics before hospitalization was significantly lower in the EO-UC group than in the AO-UC group (13.2% vs. 42.6%, p < 0.001; 0.0% vs. 13.2%, p = 0.002). No significant differences were observed between the two groups in terms of concurrent infections, clinical remission rates, relapse patterns, rehospitalization, or complication occurrence. During follow-up, six surgical cases occurred in the adult-onset group, and two in-hospital all-cause mortality cases occurred in the elderly-onset group.ConclusionThe EO-UC group was predominantly male, and it exhibited higher comorbidity and concomitant medication rates and milder clinical manifestations than the AO-UC group, presenting challenges for clinical diagnosis. 5-Aminosalicylic acid (5-ASA) remains the first-line therapeutic regimen, and the EO-UC group demonstrated lower utilization rates of immunosuppressants and biologics than the AO-UC group, which may be related to distinct treatment considerations in elderly patients, although this did not translate into observable differences in clinical outcomes between the two groups. This study is preliminary and exploratory, and larger prospective studies with adequate sample sizes are needed to validate these findings in the future.

Hybrid endoscopic submucosal dissection (H-ESD), a modified ESD with a snare, has become increasingly utilized to overcome the limitations of conventional ESD (C-ESD). This study aimed to compare the efficacy and safety of Planned H-ESD and C-ESD for colorectal lesions. Propensity score matching was performed to control for confounding variables in this retrospective study. Outcomes included en bloc resection and complete resection (R0) rates, procedure time, adverse event rates, and local recurrence rate. 1286 lesions were enrolled in the study. After matching, 263 lesions were assigned to each group. The Planned H-ESD group has lower en bloc rate but similar R0 resection rate compared to the C-ESD group (90.9

The dysfunction of innate immunity components is one of the major drivers for ulcerative colitis (UC), and increasing reports indicate that gut microbiome serves as an intermediate between genetic mutations and UC development. Here, we find that the IL-17 receptor subunit, CMTM4, is reduced in UC patients and DSS-induced colitis. The deletion of CMTM4 (Cmtm4-/-) in mice leads to a higher susceptibility to DSS-induced colitis in comparison to wildtype, and the gut microbiome significantly changes in the composition. The causal role of gut microbiome is confirmed with co-housing experiment. We further identify that S100a8/9 is significantly up-regulated in Cmtm4-/- colitis, with the block of its receptor RAGE that reverses the phenotype associated with the CMTM4 deficiency. CMTM4 deficiency rather suppresses S100a8/9 expression in vitro via the IL17 pathway, further supporting that the elevation of S100a8/9 in vivo is most likely a result of microbial dysbiosis. Taken together, the results suggest that CMTM4 is involved in the maintenance of the intestinal homeostasis, suppression of S100a8/9, and prevention of the colitis development. Our study further shows CMTM4 as a crucial innate immunity component, confirming its important role in the UC development and providing insights into potential targets for development of future therapies.

BACKGROUND:High perforation risk hinders the widespread adoption of ESD for colorectal neoplasms. This study was performed to determine the risk factors of colorectal endoscopic submucosal dissection (ESD)-induced perforation and develop a predictive model. METHODS:A total of 1046 colorectal neoplasms in 1011 patients were retrospectively enrolled from January 2011 to December 2021, in a single tertiary center as the derivation cohort. We identified independent risk factors for perforation using univariate analysis and multi-variate logistic regression. A nomogram was developed based on the logistic regression model and prospectively applied to 266 colorectal neoplasms as the validation cohort. The performance of the predictive model was evaluated with the receiver operating characteristic curve, calibration plot, and decision curve analysis. RESULTS:Independent pre-operative factors for colorectal ESD-induced perforation were tumor located in the left colon [odds ratio (OR) 2.39, P = 0.040], size ≥ 40 mm (OR 3.36, P < 0.001), ≥2/3 circumference (OR 7.55, P = 0.004), located across folds (OR 6.26, P < 0.001), and laterally spreading tumor (non-granular type, OR 2.34, P = 0.029; granular type, OR 2.46, P = 0.021). The nomogram model incorporating the pre-operative factors performed well in both the derivation and validation cohorts (areas under the curve of 0.750 and 0.806, respectively). Decision curve analysis demonstrated that the clinical benefit of the nomogram was favorable. CONCLUSIONS:The novel nomogram, developed and prospectively validated, incorporating tumor size, location, and morphology can successfully predict perforation during ESD for colorectal neoplasms.

Objective To investigate the clinical and endoscopic features of early colorectal cancer and grade Ⅲ adenoma.Methods A total of 177 patients with early colorectal cancer and 85 patients with grade Ⅲ colorectal adenoma from March 2015 to August 2018 were retrospectively analyzed, and multivariate analysis of clinical and endoscopic features was carried out. Results In terms of symptoms, there were more tenesmus [5.1%（9/177） vs. 0%（0/85）, P=0.034] and more positive fecal occult blood [49.7%（88/177） vs. 29.4%（25/85）, χ~2=9.653, P=0.002] in early colorectal cancer patients. In terms of endoscopic features, there were more cases with long diameter ＞ 15 mm under endoscopy [66.1%（117/177） vs. 43.5%（37/85）, χ~2=12.075, P=0.001], more cases located in the rectum [31.1%（55/177） vs. 17.6%（15/85）, χ~2=5.287, P=0.021], more cases with non-smooth mucous membranes（rough or villous feeling） [37.3%（66/177） vs. 22.4%（19/85）, χ~2=5.844, P=0.016], and more root leukoplakia [17.5%（31/177） vs. 8.2%（7/85）, χ~2=3.987, P=0.046] in early colorectal cancer patients. Multivariate logistic regression analysis showed that positive fecal occult blood（OR=2.141, 95% CI: 1.199-3.824, P=0.010） and long diameter ＞15 mm of the lesions（OR=2.025, 95% CI: 1.147-3.576, P=0.015） were independent influencing factors of early colorectal cancer. For clinical and endoscopic features of early colorectal cancer and grade Ⅲ adenoma with long diameter ≤ 15 mm, multivariate logistic regression analysis showed that age ≥ 55 years old（OR=3.228, 95% CI: 1.076-9.683, P=0.036）, anemia（OR=12.368, 95% CI: 1.396-109.565, P=0.024）, located in the rectum（OR=3.300, 95% CI: 1.055-10.329, P=0.040）, and root leucoplakia（OR=9.299, 95% CI: 1.695-51.022, P=0.010） were independent influencing factors of early colorectal cancer. Conclusions Compared with the grade Ⅲ adenoma, there were more positive fecal occult blood and a higher proportion of lesions with long diameter ＞15 mm in early colorectal cancer. For small lesions（long diameter ≤15 mm）, if the patient is more than 55 years old, has anemia, develops lesion located in the rectum, or has root leukoplakia, it is necessary to be alert to the possibility of early colorectal cancer.

背景:溃疡性结肠炎(UC)患者发生机会性感染的风险较健康人群显著增高,且对预后有不良影响.目的:分析UC患者的肠道机会性感染发生情况,以及合并机会性感染的危险因素.方法:回顾性收集2012年1月—2020年12月在北京大学第三医院住院治疗的UC病例,采集人口统计学、临床、实验室、内镜、病理和用药信息,采用单因素和多因素分析筛选合并肠道机会性感染的影响因素.结果:共275例UC患者纳入研究,肠道机会性感染检出率为26.2％,其中巨细胞病毒(CMV)、EB病毒(EBV)、真菌、艰难梭菌、阿米巴和多重感染率分别为13.5％、14.5％、5.1％、1.5％、1.1％和9.1％.多因素Logistic回归分析显示,疾病重度活动(OR=6.517,95％CI:1.487～28.552,P=0.013)、白蛋白<30 g/L(OR=3.895,95％CI:1.590～9.544,P=0.003)是合并CMV感染的独立危险因素.合并EBV感染的独立危险因素包括疾病重度活动(OR=11.260,95％CI:2.249～56.382,P=0.003)、白蛋白<30 g/L(OR=2.548,95％CI:1.096～5.927,P=0.030)和C反应蛋白(CRP)升高(OR=1.046,95％CI:1.007～1.086,P=0.019).对于UC合并真菌感染,慢性复发型患者发生风险较低(OR=0.278,95％CI:0.087～0.886,P=0.030).肠道多重感染主要由病毒感染构成,独立危险因素与肠道CMV、EBV感染相似.结论:UC合并肠道机会性感染以病毒感染为主.疾病活动度、炎症反应程度和白蛋白降低是UC合并肠道病毒感染的危险因素,而真菌感染风险仅与临床分型有关.

BACKGROUND:The most widely used noninvasive screening tests for colorectal cancer are fecal occult blood tests. Stool DNA test was developed in recent years. However, direct comparative analyses of these tests within the same population are still sparse.METHODS:A total of 2,842 participants who visited outpatient clinics or cancer screening centers were enrolled. Stool DNA test-I (KRAS, BMP3, NDRG4, and hemoglobin immunochemical tests), stool DNA test-II (SDC2 and SFRP2 tests), and fecal immunochemical test (FIT) alone were performed and colonoscopy was used as the gold standard among 2,240 participants. Forty-two and 302 participants had colorectal cancer and advanced adenomas (AA), respectively.RESULTS:The sensitivity for colorectal cancer of stool DNA test-I, -II, and FIT was 90.5%, 92.9%, and 81.0%, respectively. The sensitivity for advanced neoplasm (AN; colorectal cancer plus AA) of stool DNA test-I, -II, and FIT was 34.9%, 42.2%, and 25.9%, respectively. The specificity of stool DNA test-I, -II, and FIT was 91.4%, 93.3%, and 96.8%, respectively, among those with negative results on colonoscopy. When the specificity of FIT was adjusted to match that of stool DNA tests by changing the threshold, no significant difference was seen in the sensitivities among the three tests for detecting colorectal cancer. For AN, the sensitivity of FIT was higher than DNA test-I and similar to DNA test-II under the same specificities.CONCLUSIONS:There was no significant advantage of the two stool DNA tests compared with FIT in detecting colorectal cancer or AN in this study.IMPACT:Our findings do not support extensive use of stool DNA tests instead of FIT.

目前炎症性肠病(IBD)发病率逐年升高,但缺乏特效的治疗方法,严重影响患者健康和生活质量.IBD的病因尚未明确,通过肠-脑轴进行的心理-神经-内分泌-免疫调节可能在IBD发病机制中具有重要作用.研究显示,IBD患者患抑郁风险增加,超过20％的IBD患者出现抑郁,发生率为一般人群的2～4倍.抗抑郁治疗在部分IBD患者中具有较好的疗效,可能的作用机制主要包括影响肠-脑轴、抑制炎症、改善情绪等.但相关研究尚少,抗抑郁治疗在IBD治疗中的价值尚需大样本随机对照研究进一步证实.本文就抗抑郁治疗在IBD中的应用作一综述.

OBJECTIVE:To investigate the demographics and diagnostic yield in a cohort of Chinese pediatric patients undergoing colonoscopy in one institution over 12 years.METHODS:The study participants were consecutive patients aged <18 years that underwent their first colonoscopy in the endoscopy center at Peking University Third Hospital between Jan. 1, 2005 and Dec. 31, 2017. Demographic, endoscopic, and pathological findings were collected. According to the age of the patients, they were divided into 0-3 year-old group, 4-6 year-old group, 7-14 year-old group and 15-17 year-old group. The patients were also divided into 2005-2011 group and 2012-2017 group, according to the time of colonoscopy.RESULTS:The cohort consisted of 326 patients, including 205 boys (62.9%) and 121 girls (37.1%). In the study, 31 patients (9.5%) were in 0-3 year-old group, 28 (8.6%) were in 4-6 year-old group, 96 (29.4%) were in 7-14 year-old group and 171 (52.5%) in 15-17 year-old group. The terminal ileum intubation success rate was 90.5% (295/326). No serious complications such as hemorrhage or perforation occurred during the procedures. The cleaning effect was good in 92.3% (301/326) of the patients. A total of 204 patients (62.6%) received a positive diagnosis under colonoscopy. 27.0% (88/326) of the patients was diagnosed as nonspecific colitis or terminal ileitis. 46 (14.1%) with inflammatory bowel disease (IBD) and 39 (12.0%) with polyp. The diseases were significantly different among the different age groups. The highest IBD diagnostic rate was found in 0-3 year-old group (7/31, 22.5%), while the highest polyp finding rate was in 4-6 year-old group (8/28, 28.6%). The number of the patients in 0-3 year-old group was significantly increasing in 2012-2017 group compared with 2005-2011 group (27/191 vs. 4/135, P=0.001), while the terminal ileum intubation success rate was higher (179/191 vs. 116/135, P=0.037). However, comparisons between years 2005-2011 and 2012-2017 showed that neither IBD nor polyp detection rate changed significantly (P=0.850).CONCLUSION:Colonoscopy in pediatric patients was a safe and effective procedure. Colitis or terminal ileitis was the primary finding during colonoscopy while IBD was the second one, and polyp was the third. However, the diagnostic yield did not change significantly. IBD was not as quickly increased in our hospital as it was in South China.

Objective To investigate the clinical features of patients with ischemic bowel disease, and to compare the clinical features between the young patients and the elderly.Methods The clinical data of 224 patients diagnosed as ischemic bowel disease was retrospectively analyzed.The disease history, clinical features, results of imaging examinations and colonoscopy were investigated.The statistical analysis was applied to different subtypes and different age groups.Results Among 224 patients,ischemic colitis accounted for 70.5%,acute mesenteric ischemia accounting for 16.1% and chronic mesenteric ischemia accounting for 13.4%.Patients older than 60 years accounted for 56.7%.The positive rate of B mode ultrasonography, CTA and angiography showed statistical difference(P<0.05).There was no statistical difference in the clinical symptoms between the young and the elderly.While the incidence rate of smoking (P<0.001), rheumatic heart disease (P=0.046), polycythemia vera (P=0.046), primary thrombocytosis disease (P=0.021), transverse colon involvement (P=0.021), ascending colon involvement (P=0.006), ulceration (P=0.034) and narrow lumen (P=0.021) showed statistical difference between young patients and elderly.Conclusions Ischemic colitis is the most common type of ischemic bowel disease,with no specific clinical symptoms.Colonoscopy should be chosen as the first line examination for the patients suspected as ischemic colitis, while CTA and angiography should be a priority for the patients suspected as acute mesenteric ischemia or chronic mesenteric ischemia.Smoking, rheumatic heart disease, polycythemia vera and primary thrombocytosis disease are risk factors in the young.Transverse colon involvement and ascending colon involvement, ulceration and narrow lumen were common in the elderly, which suggest the severity of the disease.

Objective: The purpose of this study was to determine the lifestyle and lifestyle-related comorbidities independently associated with colorectal adenoma (CRA) recurrence in elderly Chinese people. Methods: During the 5-year follow-up after the initial colonoscopy, participants aged >60 years with the diagnosis and removal of CRA underwent a complete surveillance colonoscopy, and 152 participants with CRA recurrence plus 152 participants free of recurrence were included in this analysis. Results: Participants with CRA recurrence were more likely to consume less vegetables and fruits, and more red meats compared with the control group (P<0.05 for all). Lifestyle-related comorbidities, including hypertension and nonalcoholic fatty liver disease (NAFLD), were more common in participants with CRA recurrence than in the control group (P<0.05 for all). In the multivariate analysis, pack-years of smoking were independently associated with an increased CRA recurrence (odds ratio [OR]: 1.03; P<0.05). Eating less vegetables (OR: 099; P<0.05) and fruits (OR: 0.98; P<0.05) was identified as a statistically independent factor influencing CRA recurrence, as was eating more red meats (OR: 1.01; P<0.05). Hypertension was also found to be a factor independently associated with an increased CRA recurrence (OR: 2.44; P<0.05). NAFLD had an independent association, with an increased CRA recurrence (OR: 3.43; P<0.05). Conclusion: Smoking cigarettes, high consumption of red meats, low intake of fruits and vegetables, and the presence of hypertension and NAFLD were independently associated with an increased CRA recurrence in elderly Chinese people. This conclusion helps elderly Chinese people to make effective behavioral changes, such as smoking cessation, substitution of fruits and vegetables for red meats, and timely treatment of hypertension and NAFLD, to reduce CRA recurrence and colorectal cancer risk.

AIM To evaluate clinical response to initial corticosteroid (CS) treatment in Chinese ulcerative colitis patients (UC) and identify predictors of clinical response. METHODS Four hundred and twenty-three UC patients who were initially treated with oral or intravenous CS from 2007 to 2011 were retrospectively reviewed at eight inflammatory bowel disease centers in China, and 101 consecutive cases with one-year follow-up were analyzed further for clinical response and predictors. Short-term outcomes within one month were classified as primary response and primary non-response. Long-term outcomes within one year were classified as prolonged CS response, CS dependence and secondary non-response. CS refractoriness included primary and secondary non-response. Multivariate analyses were performed to identify predictors associated with clinical response. RESULTS Within one month, 95.0% and 5.0% of the cases were classified into primary response and non-response, respectively. Within one year, 41.6% of cases were assessed as prolonged CS response, while 49.5% as CS dependence and 4.0% as secondary non-response. The rate of CS refractoriness was 8.9%, while the cumulative rate of surgery was 6.9% within one year. After multivariate analysis of all the variables, tenesmus was found to be a negative predictor of CS dependence (OR = 0.336; 95%CI: 0.147-0.768; P = 0.013) and weight loss as a predictor of CS refractoriness (OR = 5.662; 95%CI: 1.111-28.857; P = 0.040). After one-month treatment, sustained high Sutherland score (≥ 6) also predicted CS dependence (OR = 2.347; 95%CI: 0.935-5.890; P = 0.014). CONCLUSION Tenesmus was a negative predictor of CS dependence, while weight loss and sustained high Sutherland score were strongly associated with poor CS response.

Objective To compare the teaching effects in prosthodontic internship education of an integrated method that combined with team-based learning (TBL),case-based learning (CBL) and problem-based learning(PBL) and the traditional lecture-based learning method.Methods Forty one students of grade 2004 in Peking University School of stomatology were divided into four groups.Each group accepted either the Integrated method of TBL,CBL,PBL or the traditional lecture-based learning method randomly and there were two groups respectively for each method,after clinical practice,a questionnaire and department-organized examinations on clinical skills and clinical theory were given to each student.Results The integrated method that combined with TBL,CBL,and PBL had better teaching effects in the internship phase of prosthodontic with enhanced studying interests,learning initiatives,confidence in treating patients,and better scores in examination of clinical skills (P ＜ 0.05).Conclusions The integrated method that combined with team-based learning (TBL),case-based learning (CBL)and problem-based learning (PBL) maybe obtain more better effects than the traditional lecture-based learning method in the internship education of prosthodontics.

Objective To analyze the differences in the clinical characteristics,endoscopy,pathology and therapy between the patients with new onset ulcerative colitis(UC)in the elderly versus youth and middle-aged patients.Methods A review analysis was carried out in the 178hospitalized patients with UC in Third Hospital of Peking University from 1994 to 2010.The patients were divided into two groups according to the age of onset:UC onset at age of 60 years and older were enrolled in elderly

目的 比较内镜黏膜下剥离术(endoscopic submucosal dissection,ESD)、内镜下黏膜切除术(endoscopic mucosal resection,EMR)和深凿活检钳除术治疗消化道类癌的效果.方法 回顾性分析我院2007年1月~2012年12月经病理确诊的49例消化道类癌的临床资料,结合超声内镜检查表现,比较ESD(n=25)、EMR(n=16)和内镜深凿活检钳除(n=8)治疗消化道类癌的组织学完全切除率、并发症及内镜随访情况.结果 内镜治疗消化道类癌的组织学完全切除率为59 2%(29/49).ESD组的组织完全切除率76.0%(19/25)明显高于EMR组43.8%(7/16)和深凿活检钳除组37.5%(3/8),差异有统计学意义(P=0.048),其中ESD组组织完全切除率明显高于EMR组(χ2=4.374,P=0.036).直径≥1 cm的11例类癌中,4例(36.4%)组织学不完全切除.组织学不完全切除的20例中,仅3例术前进行了超声内镜检查,占超声内镜检查的15.0%(3/20);组织学完全切除的29例中,17例进行了超声内镜检查,占超声内镜检查85.0%(17/20).1例ESD治疗后发生出血,其余患者未出现并发症.22例(44.9%,22/49)随访1~23个月(平均10.4月),均未复发.结论与EMR相比,ESD在组织完全切除方面更具有优势.超声内镜检查对于术前评估具有重要意义.