Background: Chronic kidney disease (CKD) attributable to hypertension represents a major global public health challenge. This study evaluates the global burden of CKD statistically attributable to high systolic blood pressure (SBP), with a focus on young adults aged 25-49 years. Aims: To analyze trends in mortality and disability-adjusted life years (DALYs) attributable to high SBP among individuals with CKD aged 25-49 years from 1990 to 2021 and to project the future attributable burden through 2050. Study Design: Observational study. Methods: Data were obtained from the Global Burden of Disease Study 2021. The analysis estimated the burden of CKD attributable to high SBP using a comparative risk assessment framework. Temporal trends were quantified using the estimated annual percentage change (EAPC). The association between attributable burden and the sociodemographic index (SDI) was also examined. Projections to 2050 were generated using autoregressive integrated moving average models. Results: From 1990 to 2021, global mortality and DALY rates for CKD attributable to high SBP among young adults increased significantly (mortality EAPC, 1.75%; DALYs EAPC, 1.6%). The attributable burden remained consistently higher in males and increased with age, peaking in the 45-49-year age group. Overall, low-and low-middle-SDI regions experienced the greatest relative increases, although substantial heterogeneity was observed within SDI strata. At the national level, Ukraine showed the largest increase in mortality rate (EAPC, 13.21%), whereas the Republic of Korea exhibited the largest decline (EAPC, -4.68%). Model-based projections suggest a continued increase in both attributable mortality and DALYs through 2050, with persistent disparities by sex, age, and geographic region. Conclusion: The burden of CKD attributable to high SBP among young adults has increased substantially over the past three decades and is projected to rise further, reflecting persistent global inequalities. These findings highlight the urgent need for strengthened and targeted strategies for hypertension prevention and management in younger populations worldwide.

BACKGROUND:Pro-inflammatory macrophage function is linked to an increase in mitochondrial fission. Melatonin has a positive impact on atherosclerosis and has a significant effect on the control of mitochondrial fission and fusion. Nevertheless, it is still unclear how melatonin contributes to slowing the advancement of atherosclerosis. METHODS:The ApoE-/- mice were fed a 16-week high-fat diet (HFD). 16 weeks were spent on melatonin therapy. After using 3-TYP to suppress Sirt3 function, we were able to measure the vascular tissue's biochemical, inflammatory, and mitochondrial fission characteristics as well as the shape of atherosclerotic plaque. RAW264.7 cells were stimulated by oxidized low-density lipoprotein (oxLDL), pretreated with or without 3-TYP or Melatonin. RESULTS:The study found that melatonin treatment decreased the area of atherosclerotic plaque, decreased lipid deposition, suppressed inflammatory cytokine levels, inhibited macrophage pro-inflammatory differentiation, inhibited mitochondrial fragmentation, increased the level of Sirt3, and decreased Drp1 expression in atherosclerosis (AS) mice. However, Sirt3 inhibition abolished the protective affects of melatonin in AS mice. Melatonin therapy upregulated Sirt3 expression in RAW264.7 cells subjected to ox-LDL, blocked Drp1-mediated mitochondrial fission, and reduced inflammatory cytokine levels. On the other hand, melatonin's inhibitory effects on Drp1 expression and mitochondrial fission were lessened by Sirt3 inhibition. Additionally, DRP1 siRNA knockdown inhibited mitochondrial fission and pro-inflammatory differentiation of macrophages induced by ox-LDL. CONCLUSION:Melatonin inhibits the growth of atherosclerosis and the pro-inflammatory differentiation of macrophages by blocking the Sirt3-Drp1 pathway, which prevents mitochondria from fission. Melatonin's suppression of mitochondrial fission may be a viable strategy for postponing cardiovascular problems in atherosclerosis patients.

We aimed to assess the tolerability and efficacy of finotonlimab (an anti-programmed cell death protein-1 antibody) in combination with SCT510, a bevacizumab biosimilar, versus sorafenib in unresectable advanced HCC. This randomized phase 2 and 3 study (ClinicalTrials.gov, NCT04560894; Chinadrugtrials.org.cn, CTR20201976 and CTR20201974) was performed at 67 hospitals in China. HCC patients (n = 398) were included between 11 November 2020 and 28 September 2022. In phase 2, patients received intravenous finotonlimab (200 mg every 3 weeks) combined with SCT510 (15 mg/kg every 3 weeks). In phase 3, 346 patients were randomized (2:1) to either the finotonlimab plus SCT510 (dual-agent) group or the sorafenib group. The median follow-up time for the dual-agent therapy and sorafenib groups was 19.9 and 19.0 months, respectively. Median PFS, assessed by BICR according to RECIST 1.1, was significantly longer in the dual-agent group (7.1 months [95% confidence intervals {CI}: 6.1, 8.4]) than in the sorafenib group (2.9 months [95% CI: 2.8, 4.1]; stratified hazard ratio [HR]: 0.5, 95% CI: 0.38, 0.65, p < 0.0001). Median OS was also significantly longer in patients receiving finotonlimab plus SCT510 (22.1 months [18.6, not available]) than in those receiving sorafenib (14.2 months [95% CI: 10.2, 15.8]; HR: 0.60 [95% CI: 0.44, 0.81], p < 0.0008). Finotonlimab in combination with bevacizumab demonstrated favorable efficacy, in comparison to sorafenib, as a first-line treatment for unresectable HCC, with a manageable safety profile.

Peripheral artery disease (PAD), caused by atherosclerosis resulting in reduced blood flow in the lower extremities, impairs both skeletal muscle mass and function in humans, and its molecular mechanism is not clear. Recent studies have demonstrated that Nicotinamide phosphoribosyl transferase (NAMPT) influences skeletal muscle mass and function by modulating NAD+ levels and cellular Ca²⁺ homeostasis. However, its role in muscle fiber type transition remains to be elucidated. NAMPT is downregulated in ischemic skeletal muscle and CoCl2-treated C2C12 myotubes. NAMPT enhances the functional performance of ischemic limbs, reduces apoptosis, increases the formation of oxidative muscle fibers, and improves mitochondrial function. The cGMP‒PKG pathway is activated by NAMPT in ischemic limbs. Exogenous inhibition of cGMP-PKG signaling inhibits the formation of oxidative muscle fibers induced by NAMPT. NAMPT protects against ischemic limb injury via the cGMP‒PKG signaling pathway, suggesting that it is a promising therapeutic and predictive target for myopathy associated with PAD. Not applicable.

At present, the incidence and mortality of gastric cancer rank in the top five of all cancers, which seriously endangers people’s life and health, and the detection of early gastric cancer can greatly improve the survival rate of gastric cancer patients. Based on the features of early gastric cancer in gastroscopy, this paper studies the intelligent detection of early gastric cancer by using object detection technology. Detection Transformer (DETR) is a mainstream object detection framework at present, it shows good detection effect on COCO data set, but it is rarely used in medical image object detection. Through in-depth study of DETR model, we find that DETR has shortcomings in multi-object and smaller object detection, which will affect the effect of detection. So, we propose a multi-scale feature fusion method for early gastric cancer detection (MF-DETR) based on the DETR model. The main improvements include multi-scale feature fusion module and hybrid encoder design. We rely on early gastric cancer cases provided by Chongqing University Cancer Hospital, and then enhance the data to form 2062 images as an early gastric cancer data set. Through experiments, MF-DETR can achieve 97.79% AP 50 , 92.31% precision, and 93.91% recall rate. Compared with DETR, it has 2.68% improvement in $\mathrm{AP}_{50}, 1.12 \%$ improvement in precision, and 3.91% improvement in recall. Finally, the effectiveness of multi-scale feature fusion design and hybrid encoder design are verified by ablation experiments.

Anomaly detection aims to distinguish normal from abnormal images, with applications in industrial defect detection and medical imaging. Current methods using textual information often focus on designing effective textual prompts but overlook their full utilization. This paper proposes a multimodal fusion network that integrates image and text information to improve anomaly detection. The network comprises an image encoder, text encoder, and stacked cross-attention module. To address the absence of text during inference, an image-only branch is introduced, guided by the multimodal fusion network through knowledge distillation. Experiments on industrial anomaly detection and medical image datasets demonstrate the effectiveness of our approach, achieving AUROC and AUPR scores of 96.5% and 89.2% on VisA, respectively. The code is available at https://github.com/lilianoa/Multimodal-guide-AD.

The intestinal microbiome plays a crucial role in colorectal adenomas and the mucosa associated microbiota are thought to play a more critical role in interactions with the host immune system. Current omics approaches, offer a holistic assessment of the gut microbiome and the human host interaction. To enhance the value of data from these sequencing methods, appropriate sample collection is vital. We evaluated the potential use of endoscopic brush samples for mucosal microbiota analysis in colorectal adenomas and compared it with direct adenoma tissue sequencing in terms of microbial gene sequencing. The results showed a significant increase in microbial diversity in samples collected by the endoscopic brush, which did not interfere with pathological biopsy. This study found that utilizing endoscopic brush sampling for the microbiome analysis of colorectal adenomas offers several advantages over the direct examination of microbiomes within tumor tissues, including the capacity to accurately collect gut microbiome from different locations in the intestine, circumventing interference from tissue genes, providing more abundant microbial data and enabling inclusion of small adenomas without disrupting pathological biopsies.

4092 Background: Hepatocellular carcinoma (HCC) is a significant health concern in China, and it has been a leading cause of cancer-related deaths. Immunotherapy combined with anti-vascular growth therapy is the first recommended therapy. In this study, we evaluated the safety and efficacy of SCT-I10A (an anti-programmed death 1 [PD-1] monoclonal antibody) combined with SCT510 (a bevacizumab biosimilar) compared to sorafenib as the first-line treatment for advanced HCC. Methods: In this open-label, multicenter, phase 3 trial (NCT04560894) conducted in China, patients with advanced HCC who had not received prior system therapy were enrolled and randomly assigned (2:1) to receive SCT-I10A (200 mg every three weeks [Q3W]) plus SCT510 (a bevacizumab biosimilar, 15 mg/kg Q3W) or sorafenib (400 mg orally twice daily) until no clinical benefit or unacceptable toxicity. Randomization was stratified by ECOG performance status (0 vs. 1), baseline alpha-fetoprotein level (<400ng/ml vs. ≥400ng/ml), macrovascular invasion or extrahepatic metastasis (yes vs. no). The co-primary endpoints were overall survival (OS) and progression-free survival (PFS) as assessed by the blinded independent central review (BICR) according to Response Evaluation Criteria in Solid Tumors (RECIST) version 1.1 in the full analysis set. Results: At the data cutoff for the interim analysis (November 2, 2023), a total of 346 patients were enrolled and received at least one dose (SCT-I10A plus SCT510 group, n=230; sorafenib group, n=116), and the median follow-up was 19.7 months. The SCT-I10A plus SCT510 group exhibited a significantly longer median OS than that in the sorafenib group (22.1 vs. 14.2 months, hazard ratio [HR] 0.60; 95% confidence interval [CI]: 0.44, 0.81; p=0.0008). Median PFS was prolonged significantly in the SCT-I10A plus SCT510 group compared to the sorafenib group (7.1 vs. 2.9 months; HR 0.50; 95%CI: 0.38, 0.65; p<0.0001). The objective response rate (ORR) was higher in the SCT-I10A plus SCT510 group (32.8% [75/229]) than in the sorafenib group (4.3% [5/116]). Grade ≥3 treatment-related adverse events (TRAEs) were observed in 42.6% (98/230) of patients in the SCT-I10A plus SCT510 group and 33.6% (39/116) of patients in the sorafenib group. The most common grade ≥3 TRAE was hypertension (SCT-I10A plus SCT510 group vs. sorafenib group: 7.8% [18/230] vs. 4.3% [5/116]). Three drug-related deaths (unknown cause, hemorrhage intracranial, or upper gastrointestinal hemorrhage in 1 patient each) occurred and were related to SCT510. Conclusions: The combination of SCT-I10A and SCT510 showed substantial clinical advantages and an acceptable safety profile in patients with advanced HCC, thereby supporting its suitability as a first-line treatment option for HCC. Clinical trial information: NCT04560894 .

A 54-year-old woman was referred to our hospital for an incidentally found 26-mm laterally spreading tumor of the papilla (LST-P) ([Fig. 1]). Magnifying endoscopy with narrow-band imaging showed irregular pits with a dilated subepithelial capillary network. A biopsy showed the polyp to be a tubular adenoma. Endoscopic ultrasound (EUS) revealed that this adenoma was limited to the mucosa and had no intraductal extension into the pancreatic duct or the common bile duct ([Fig. 2]). Endoscopic mucosal resection (EMR) of large (10–29 mm) LST-P carries a risk of delayed bleeding and perforation [1]. In terms of shortening the operation time and reducing the perforation, we innovatively use alligator forceps to achieve sufficient traction for duodenal piecemeal endoscopic mucosal resection (pEMR).

文章总结了眼科部分常见病、全身疾病的眼部并发症和眼科急诊的临床表现、治疗方法和必要的全科处理策略,为全科医生及时正确地诊治上述疾病提供了良好的指引,从而提高了全科医生处理眼科疾病的诊疗能力,为培养出高水平的全科人才提供了理论依据,使全科医生能更好地承担"健康守门人"的工作.

Esophageal stenosis is a common complication after endoscopic submucosal dissection (ESD) for early esophageal cancer [1] [2]. Post-ESD esophageal stenosis is considered to be related to scar tissue proliferation and fibrosis during the healing process [3]. Symptom relief can be achieved through dilation and radial incision in 83% [4]. However, these invasive strategies do not allow visual control of the operation, and it is difficult to control complications such as bleeding or perforation caused by these treatments.

Esophageal squamous cell carcinoma (ESCC) is a common malignant tumor of the digestive tract. The most effective method of reducing the disease burden in areas with a high incidence of esophageal cancer is to prevent the disease from developing into invasive cancer through screening. Endoscopic screening is key for the early diagnosis and treatment of ESCC. However, due to the uneven professional level of endoscopists, there are still many missed cases because of failure to recognize lesions. In recent years, along with remarkable progress in medical imaging and video evaluation technology based on deep machine learning, the development of artificial intelligence (AI) is expected to provide new auxiliary methods of endoscopic diagnosis and the treatment of early ESCC. The convolution neural network (CNN) in the deep learning model extracts the key features of the input image data using continuous convolution layers and then classifies images through full-layer connections. The CNN is widely used in medical image classification, and greatly improves the accuracy of endoscopic image classification. This review focuses on the AI-assisted diagnosis of early ESCC and prediction of early ESCC invasion depth under multiple imaging modalities. The excellent image recognition ability of AI is suitable for the detection and diagnosis of ESCC and can reduce missed diagnoses and help endoscopists better complete endoscopic examinations. However, the selective bias used in the training dataset of the AI system affects its general utility.

Background Hepatic encephalopathy (HE) is a neurological and psychiatric syndrome. Recent evidence suggests that HE is not only a disease of the liver and brain but is also related to the gut. Small intestinal bacterial overgrowth (SIBO) is well known to be associated with cirrhosis, but the relationship between SIBO and HE is unclear. We conducted this comprehensive systematic review and meta-analysis to determine the association between SIBO and HE in cirrhotic patients. Methods We conducted a comprehensive literature search of all studies on the association of SIBO and HE in cirrhotic patients using the PubMed and Embase electronic databases. Studies were screened, and relevant data were extracted and analysed. We calculated the number of cases of SIBO in patients with HE and controls. We then compared the prevalence of SIBO between the two groups to calculate the odds ratios (ORs) and 95% confidence intervals (CIs). Funnel plots were constructed to identify potential publication bias. Results Six studies with 414 participants (219 HE patients and 195 controls) met the inclusion criteria. The prevalence of SIBO in cirrhotic patients with HE was significantly higher than that in those without HE. The combined OR was 4.43 (95% CI 1.73-11.32, P = 0.002). The heterogeneity was moderate (I2 = 66%), and the funnel plot suggested no significant publication bias. Subgroup analysis showed that the OR was 1.95 (95% CI 0.63–6.09) in studies using the lactulose breath test (LBT) and 7.60 (95% CI 3.50–16.50) in studies using the glucose breath test (GBT). The prevalence of SIBO in cirrhotic patients was also related to the severity of liver disease. Conclusions Our meta-analysis identified a strong association between SIBO and HE, and the risk of SIBO was 4.43 times higher among cirrhotic patients with HE than among those without HE. SIBO could be a predisposing factor for the development of HE in cirrhotic patients. Therefore, the importance of SIBO should be emphasized in patients with HE.

Enteral immunonutrition (EIN) has been extensively applied in cancer patients; however, its role in esophageal cancer (EC) patients receiving esophagectomy remains unclear. We performed this network meta-analysis to investigate the impact of EIN on patients undergoing surgery for EC and further determine the optimal time of applying EIN. We searched PubMed, EMBASE, Cochrane library, and China National Knowledgement Infrastructure (CNKI) to identify eligible studies. Categorical data was expressed as the odds ratio with 95% confidence interval (CI), and continuous data was expressed as mean difference (MD) with 95% CI. Meta-analysis with head-to-head approach and network meta-analysis was performed to evaluate the impact of EIN on clinical outcomes using RevMan 5.3 and ADDIS V.1.16.8 software. The surface under the cumulative ranking curve (SUCRA) was calculated to rank all nutritional regimes. Total 14 studies involving 1071 patients were included. Meta-analysis with head-to-head approach indicated no difference between EIN regardless of the application time and standard EN (SEN); however, subgroup analyses found that postoperative EIN was associated with decreased incidence of total infectious complications (OR = 0.47; 95%CI = 0.26 to 0.84; p = 0.01) and pneumonia (OR = 0.47; 95%CI = 0.25 to 0.90; p = 0.02) and shortened the length of hospitalization (LOH) (MD =  − 1.01; 95%CI =  − 1.44 to − 0.57; p < 0.001) compared to SEN, which were all supported by network meta-analyses. Ranking probability analysis further indicated that postoperative EIN has the highest probability of being the optimal option in terms of these three outcomes. Postoperative EIN should be preferentially utilized in EC patients undergoing esophagectomy because it has optimal potential of decreasing the risk of total infectious complications and pneumonia and shortening LOH. 10.17605/OSF.IO/KJ9UY

Objectives Although oral sulfate solution (OSS) has been revealed to be not only safe and efficacious but also noninferior to polyethylene glycol with ascorbic acid (PEG + ASC), it is unclear whether OSS can ultimately increase the polyp detection rate (PDR) and adenoma detection rate (ADR). We performed this meta-analysis to estimate the effect of OSS on PDR and ADR during colonoscopy. Methods We searched PubMed, EMBASE, and the Cochrane Library to identify relevant randomized controlled trials (RCTs) investigating the comparative effect of OSS versus PEG + ASC on the PDR and ADR during colonoscopy. Cecal intubation time (CIT), cecal intubation rate (CIR), and bowel preparation score were also evaluated. Review Manager (RevMan) version 5.3.0 was used to perform statistical analysis. Results Eight RCTs involving 2059 patients fulfilled the selection criteria. Meta-analysis suggested that OSS significantly increased the PDR (47.34% vs. 40.14%, risk ratio [RR] 1.13, 95% confidence interval [CI] 1.03-1.24, P = 0.01) and ADR (44.60% vs. 38.14%, RR 1.17, 95% CI 1.03-1.33, P = 0.01) during colonoscopy. Subgroup analysis showed that the beneficial effects of OSS on PDR and ADR were consistent among patients with mean age >55 years and with body mass index <25 kg/m(2) receiving outpatient colonoscopy, morning colonoscopy, and the 2-L bowel preparation protocol. Meanwhile, patients receiving OSS had a beneficial bowel preparation score. Conclusion Compared with polyethylene glycol-based regimens, the OSS bowel preparation regimen significantly increased the PDR and ADR in patients undergoing colonoscopy.

目的:探讨IL-17A通过抑炎介质内皮细胞发育调节基因-1(DEL-1)参与慢性乙型肝炎(CHB)发病的可能机制.方法:分离CHB患者组(80例)及健康对照组(40例)外周血清及外周血单个核细胞(PBMC),ELISA和qPCR分别检测血清、PBMC中IL-17A与DEL-1的蛋白及mRNA水平;分别采用HBV病毒上清液(VS)、重组IL-17A与DEL-1蛋白体外刺激对照组PBMC、人髓系白血病单核细胞(THP-1)与人正常肝细胞(LO2),qPCR及Western blot分别检测细胞IL-17A与DEL-1的mRNA和蛋白水平.结果:与对照组相比,CHB组血清DEL-1显著降低(P<0.001),并与血清IL-17A及谷丙转氨酶含量均呈负相关(r<0,P<0.01);DEL-1 mRNA在2组人群PBMC中差异无统计学意义(P=0.829),且VS刺激不影响PBMC或THP-1细胞中DEL-1含量,但可上调IL-17A表达,该上调作用能被重组DEL-1剂量依赖性地抑制;LO2细胞表达高丰度的DEL-1蛋白,其不受VS刺激影响,但可被重组IL-17A剂量依赖性地下调.结论:CHB患者高水平的血清IL-17A可能通过抑制肝细胞DEL-1表达促进HBV感染引发肝组织损伤.

The human gut microbiota represents a complex ecosystem that is composed of bacteria, fungi, viruses, and archaea. It affects many physiological functions including metabolism, inflammation, and the immune response. The gut microbiota also plays a role in preventing infection. Chemotherapy disrupts an organism's microbiome, increasing the risk of microbial invasive infection; therefore, restoring the gut microbiota composition is one potential strategy to reduce this risk. The gut microbiome can develop colonization resistance, in which pathogenic bacteria and other competing microorganisms are destroyed through attacks on bacterial cell walls by bacteriocins, antimicrobial peptides, and other proteins produced by symbiotic bacteria. There is also a direct way. For example, Escherichia coli colonized in the human body competes with pathogenic Escherichia coli 0157 for proline, which shows that symbiotic bacteria compete with pathogens for resources and niches, thus improving the host's ability to resist pathogenic bacteria. Increased attention has been given to the impact of microecological changes in the digestive tract on tumor treatment. After 2019, the global pandemic of novel coronavirus disease 2019 (COVID-19), the development of novel tumor-targeting drugs, immune checkpoint inhibitors, and the increased prevalence of antimicrobial resistance have posed serious challenges and threats to public health. Currently, it is becoming increasingly important to manage the adverse effects and complications after chemotherapy. Gastrointestinal reactions are a common clinical presentation in patients with solid and hematologic tumors after chemotherapy, which increases the treatment risks of patients and affects treatment efficacy and prognosis. Gastrointestinal symptoms after chemotherapy range from nausea, vomiting, and anorexia to severe oral and intestinal mucositis, abdominal pain, diarrhea, and constipation, which are often closely associated with the dose and toxicity of chemotherapeutic drugs. It is particularly important to profile the gastrointestinal microecological flora and monitor the impact of antibiotics in older patients, low immune function, neutropenia, and bone marrow suppression, especially in complex clinical situations involving special pathogenic microbial infections (such as clostridioides difficile, multidrug-resistant Escherichia coli, carbapenem-resistant bacteria, and norovirus).

Numb regulates cell proliferation and differentiation through endocytosis and ubiquitination of signaling molecules. Besides, Numb controls the migration of epithelial cells by regulating intercellular junctions. Studies have shown that Numb promotes or inhibits tumor progression in different tumors. However, its role and mechanism in colorectal cancer remain unclear. We found that the expression level of Numb in colon tumor tissues has a great variety in different patients. Numb expression was negatively correlated with TNM stage and lymph node metastasis but positively correlated with tumor size. Elevated expression of Numb was associated with a good prognosis. Inhibiting Numb expression promoted the migration and invasion of colon cancer cells induced by TGF-β, up-regulated the expression of EMT-related molecule Snail, and prevented the expression of E-cadherin. We also found that Numb promoted the proliferation and clones formation while inhibiting colon cancer cells' late apoptosis. In addition, Numb inhibited the RhoA activation and ROCK inhibitor Y-27632 or interfered with ROCK expression, partially inhibiting Numb-regulated cell proliferation and migration. In vivo tumorigenesis assay in nude mice also found that Numb promoted the proliferation of colon cancer cells, inhibited the expression of E-cadherin, and strengthened the expression of Snail. In conclusion, our study found that Numb plays multiple roles in the occurrence and progression of colon cancer by regulating the RhoA/ROCK signaling pathway, which provides a new theoretical molecular basis for the pathogenesis of colon cancer.

Background and Aim: Chromoendoscopy with iodine staining is an important diagnostic method for esophageal carcinomas or precancerous lesions. Unfortunately, iodine staining can be associated with numerous adverse events (AEs). We found that the starting position of spraying iodine solution is likely the main reason of causing AEs. We conducted this work to determine whether clinical outcomes from anterograde iodine staining were superior to those achieved after retrograde iodine staining.Methods: A total of 134 subjects with a health risk appraisal flushing (HRA-F) score of >6 for esophageal cancer were randomly assigned to receive anterograde or retrograde iodine staining in the esophagus. The primary endpoints were the pain and the amount of iodine solution consumption. The secondary endpoints were iodine-staining effect, detection yield, and response to starch indicator.Results: Nine patients suffered from pain and six patients revealed positive response to starch indicator in retrograde iodine-staining group; however, no patient reported pain (0/67) and all patients revealed a negative response to starch indicator in anterograde iodine-staining group. The amount of iodine solution consumption in anterograde iodine-staining group (4.97 mL) was significantly lower than that (6.23 mL) in retrograde iodine-staining group; however, the iodine-staining effect and detection yield were comparable between the two groups.Conclusions: Anterograde iodine staining during Lugol chromoendoscopy appears to be as effective, but significantly safer than retrograde iodine staining.