Quality control can reduce variations in operators’ performance conducting magnetically controlled capsule gastroscopy (MCCG). However, an optimal method for quality control in routine MCCG procedures is still lacking. This study aimed to develop an automatic quality control system (AQCS) and assess its effectiveness in a clinical trial. We developed the AQCS using convolutional neural network (CNN) models to monitor inspection completeness, evaluate gastric cleanliness, and identify suspicious lesions. Then, patients were prospectively randomized to undergo routine MCCG with or without AQCS assistance. The primary outcome was the blind spot rate in the AQCS and control groups. The CNN model demonstrated specificity of 98.27–99.30

BACKGROUND:This study elucidates the mechanisms through which electroacupuncture (EA) at Zusanli acupoint, applied at different frequencies, alleviates diabetic gastroparesis (DGP). The modulation of the cyclic GMP-AMP synthase (cGAS)-stimulator of interferon genes (STING) pathway, its regulation of M2 macrophage pyroptosis, and the consequent protection of interstitial cells of Cajal (ICCs) were investigated. AIM:To investigate the mechanism by which EA alleviates DGP. METHODS:A DGP rat model was induced by feeding a high-fat/high-sucrose diet combined with a single intraperitoneal injection of streptozotocin (30 mg/kg). Rats successfully modeled were randomly assigned into four groups (n = 6 each): Untreated DGP, sham-EA (0 Hz, 0 mA), low-frequency EA (LEA, 10 Hz, 1-3 mA), and high-frequency EA (HEA, 100 Hz, 1-3 mA). EA was delivered at Zusanli acupoint for 60 minutes daily over 8 weeks. Gastric emptying rate and whole gut transit time were evaluated. Gastric antrum tissues were examined by immunofluorescence and western blotting to assess ICC integrity, M2 macrophage distribution, pyroptosis-related markers (Gasdermin D, NOD-like receptor family pyrin domain containing 3, caspase-1), inflammatory cytokines [interleukin (IL)-1β, IL-18], and cGAS-STING signaling proteins. RESULTS:The results of this study revealed that HEA significantly increased gastric emptying [0.69 (0.55, 0.72) vs DGP 0.44 (0.26, 0.48), P < 0.05] and reduced whole gut transit time (361.34 ± 10.51 vs DGP 537.33 ± 100.57, P < 0.01), with improved efficacy compared to LEA. In DGP rats, ICC counts were significantly reduced, transferase dUTP nick-end labeling-positive apoptotic markers were elevated, and CD206+ cells were diminished; these alterations were reversed mainly by EA, with HEA showing the greatest effect. Expression of cGAS-STING signaling components and pyroptosis-related proteins (Gasdermin D, NOD-like receptor family pyrin domain containing 3, caspase-1), along with secretion of IL-1β and IL-18, were significantly up-regulated in the DGP group. HEA significantly suppressed cGAS pathway activation, reduced pyroptosis-associated proteins and inflammatory mediators, and outperformed LEA (P < 0.05). CONCLUSION:HEA ameliorates gastric dysmotility in DGP by suppressing the cGAS-STING pathway, attenuating M2 macrophage pyroptosis and inflammatory responses, and preserving ICC networks. These findings identify a novel EA/cGAS-STING/pyroptosis axis and highlight its therapeutic potential as a mechanistic target for optimizing DGP treatment strategies.

BACKGROUND:Although triple therapy plus bismuth (TTPB), comprising a proton pump inhibitor (PPI), two antibiotics, and bismuth, is widely used to eradicate Helicobacter pylori (H. pylori), eradication rates have been suboptimal. Potassium-competitive acid blockers (P-CABs) offer stronger and more stable gastric acid inhibition compared to PPIs. This study aimed to compare the efficacy, safety, and compliance of tegoprazan-based TTPB (TACB) vs. esomeprazole-based TTPB (EACB) in treatment-naïve patients with H. pylori infection. METHODS:In this nationwide, multicenter, double-blind, double-dummy, randomized controlled trial conducted from October 2022 to September 2023 across 41 centers in China, 561 eligible patients with H. pylori infection were randomized (1:1) to receive either TACB (tegoprazan 50 mg, amoxicillin 1000 mg, clarithromycin 500 mg, and bismuth 220 mg) or EACB (esomeprazole 20 mg, amoxicillin 1000 mg, clarithromycin 500 mg, and bismuth 220 mg), all administered twice daily for 14 days. H. pylori eradication was assessed using the 13C-urea breath test at 4-8 weeks post-treatment. The primary endpoint was eradication rate based on the full analysis set (FAS). Statistical analysis included the chi-squared tests, with a predefined non-inferiority margin of -10%. RESULTS:In the FAS population, eradication rates were 93.5% (95% confidence interval [CI]: 89.9-96.1%) in the TACB group and 86.4% (95% CI: 81.9-90.2%) in the EACB group. The between-group difference was 7.0% (95% CI: 2.1-12.0%), indicating that tegoprazan-based TTPB was non-inferior to esomeprazole-based TTPB. Furthermore, superiority tests found a significantly higher eradication rate in tegoprazan group compared with esomeprazole group (P = 0.006). Similar results were observed in the per-protocol set. The incidence of treatment-emergent adverse events was comparable between groups (75.5% in TACB vs. 73.4% in EACB), with most events being mild and transient. Compliance was high in both groups (98.4% vs. 98.8%). CONCLUSION:TACB was non-inferior to EACB in H. pylori eradication efficacy, with similar safety and compliance profiles in Chinese treatment-naïve patients. TRIAL REGISTRATION:ClinicalTrials.gov identifier: NCT05577468.

INTRODUCTION:X842 is a new type of gastric acid-suppressing agent with a rapid onset of action and a long duration of effect. We aim to investigate the efficacy and safety of different doses of X842 vs lansoprazole in the treatment of patients with erosive esophagitis (EE). METHODS:This phase 2 study included 90 patients with EE (Los Angeles grades A-D) who were randomized (1:1:1) to receive oral low-dose X842 (50 mg/d, n = 31), high-dose X842 (100 mg/d, n = 31), or lansoprazole (30 mg/d, n = 30) for 4 weeks. The main efficacy end point was the EE healing rate, which was the proportion of patients who achieved endoscopic healing after 4 weeks of treatment. RESULTS:For intention-to-treat analysis, the EE healing rates at 4 weeks were 93.6% (29/31), 79.3% (23/29), and 80.0% (24/30) for the X842 50 mg, the X842 100 mg, and the lansoprazole 30 mg groups. For per-protocol analysis, the EE healing rates at 4 weeks were 93.6% (29/31), 80.8% (21/26), and 82.1% (23/28) in the 3 groups, respectively. The EE healing rate did not significantly differ among the 3 groups in either the intention-to-treat ( P = 0.2351) or per-protocol ( P = 0.3320) analysis. The incidence of drug-related treatment-emergent adverse events did not differ among groups. No severe drug-related treatment-emergent adverse events occurred in the X842 group. DISCUSSION:Our findings confirmed that X842 had efficacy and a favorable safety profile similar to those of lansoprazole. Therefore, X842, a novel potassium-competitive acid blocker, is expected to become a promising therapeutic agent for EE.

Importance High-quality colonoscopy reduces the risks of colorectal cancer by increasing the adenoma detection rate. Routine use of an automatic quality control system (AQCS) to assist in colorectal adenoma detection should be considered. Objective To evaluate the effect of an AQCS on the adenoma detection rate among colonoscopists who were moderate- and low-level detectors during routine colonoscopy. Design, Setting, and Participants This multicenter, single-blind, randomized clinical trial was conducted at 6 centers in China from August 1, 2021, to September 30, 2022. Data were analyzed from March 1 to June 30, 2023. Individuals aged 18 to 80 years were enrolled. Exclusion criteria were a history of inflammatory bowel disease, advanced colorectal cancer, and polyposis syndromes; known colorectal polyps without complete removal previously; a history of colorectal surgery; known stenosis or obstruction with contraindication for biopsy or prior failed colonoscopy; pregnancy or lactation; and refusal to participate. Intention-to-treat and per-protocol analysis was used. Interventions Standard colonoscopy or AQCS-assisted colonoscopy. Main Outcomes and Measures Adenoma detection rate. Results A total of 1254 participants (mean [SD] age, 51.21 [12.10] years; 674 [53.7%] male) were randomized (627 standard colonoscopy, 627 AQCS-assisted colonoscopy). Intention-to-treat analysis showed a significantly higher adenoma detection rate in the AQCS-assisted group vs standard colonoscopy group (32.7% vs 22.6%; relative risk [RR], 1.60; 95% CI, 1.23-2.09; P < .001). The adenoma detection rates were significantly higher in the AQCS group when considering pathology (nonadvanced adenomas, 30.1% vs 21.2%; RR, 1.52; 95% CI, 1.16-1.99; P = .002), and morphology (flat or sessile, 29.3% vs 20.4%, RR, 1.52; 95% CI, 1.16-2.00; P = .003). Use of AQCS significantly increased the adenoma detection rate of both the lower-level detectors (30.0% vs 20.0%; RR, 1.71; 95% CI, 1.24-2.35; P = .001) and the medium-level detectors (38.1% vs 27.7%; RR, 1.61; 95% CI, 1.07-2.43; P = .02). Similar increases were found for adenoma detection rates in the academic and nonacademic centers (academic: 29.3% vs 20.8%; RR, 1.58; 95% CI, 1.10-2.29; P = .01; nonacademic: 36.1% vs 24.5%; RR, 1.74; 95% CI, 1.23-2.46; P = .002). The number of adenomas per colonoscopy was significantly higher in the AQCS-assisted group (0.86 vs 0.48; RR, 1.50; 95% CI, 1.17-1.91; P = .001). The mean withdrawal time without intervention was slightly increased with AQCS assistance (6.78 vs 6.46 minutes; RR, 1.38; 95% CI, 1.26-1.52; P < .001). No serious adverse events were reported. Conclusions and Relevance In this randomized clinical trial, AQCS assistance during routine colonoscopy increased adenoma detection rates and several related polyp parameters compared with standard colonoscopy in the lower- and medium-level detectors in academic and nonacademic settings. Routine use of AQCS to assist in colorectal adenoma detection and quality improvement should be considered. Trial Registration ClinicalTrials.gov Identifier: NCT04901130

The molecular characteristics of acute graft-versus-host disease (aGVHD) in different lung lobes and the treatment of aGVHD with mesenchymal stem cells are still poorly understood. In addition, despite the important role of acetylation on lysine 27 of histone H3 (H3K27ac) in the inflammatory response, little is known about genome-wide H3K27ac in GVHD and MSC treatment. In this study, we described 55 paired transcriptomes and genome-wide H3K27ac in five lung lobes, with groups designated as follows: control, GVHD, human placenta-derived MSC (hPMSC)-treated, and PBS-treated groups. We observed that inflammatory pathways were upregulated in GVHD but downregulated in hPMSCs. One algorithm was designed to identify the genes implicated in the prevention of GVHD by hPMSCs (the Rein02 gene), shedding light on a gene set with 892 Rein02 genes that are shared by all lobes and enriched in inflammatory pathways such as TNF-α signaling via NF-κb. The genome-wide H3K27ac data revealed lobe-specific patterns in the lobe behind the heart (H) and the left lobe (L) in the control and hPMSC groups, whereas these patterns were confused in the GVHD and PBS groups. Gene set enrichment analysis revealed that the hPMSC-induced variations in genome-wide H3K27ac were concentrated in the L and R3 lobes. The genes showing accordant tendencies (a-DEGs) between the transcriptome and H3K27ac highly overlapped between the a-DEGs and the Rein02 genes when hPMSCs were compared with GVHD. Integrated multiomics analysis suggested that the a-DEGs were predominantly expressed on myeloid (Fam174a, Ifi204, Slc7a11, Chil3, Capza2, Clec5a, and Clec4a2), T and NK cells (Eif3f, Cited2, Crybg1, Ndufs4, and Emb), B cells (Fam174a, Eif3f, and Blnk), and epithelial cells (Alcam, Chmp2b, and Metap2). The subset with high expression levels of these genes tended to present anti-inflammatory effects and reduced cytotoxic activity. Our study may provide new insights into the development of potential therapeutic drugs that target H3K27ac to assist in MSC treatment.

BACKGROUND:A mid-esophageal diverticulum is an outpouching located in the midsection of the esophagus, posterior to the bifurcation of the right and left bronchi. The condition is characterized by an outward protrusion of the inner esophageal wall. Mid-esophageal diverticula are relatively rare and may coexist with diffuse esophageal spasm. However, the potential esophageal motility disorders associated with these lesions are frequently overlooked in clinical practice. The use of endoscopic interventions may offer a novel approach for the alleviation of dysphagia associated with this condition. CASE SUMMARY:We present a case of a 74-year-old woman with dysphagia, diagnosed with mid-esophageal diverticulum and diffuse esophageal spasm. Due to her physical condition, submucosal tunneling endoscopic septum division (STESD) was initially performed for the diverticulum. One month later, the esophageal spasm was treated using per-oral endoscopic myotomy (POEM). This combined treatment significantly improved her dysphagia, and she was discharged. CONCLUSION:STESD and POEM are effective and safe for the treatment of dysphagia caused by mid-esophageal diverticula with diffuse esophageal spasm.

Importance: High-quality colonoscopy reduces the risks of colorectal cancer by increasing the adenoma detection rate. Routine use of an automatic quality control system (AQCS) to assist in colorectal adenoma detection should be considered. Objective: To evaluate the effect of an AQCS on the adenoma detection rate among colonoscopists who were moderate- and low-level detectors during routine colonoscopy. Design, setting, and participants: This multicenter, single-blind, randomized clinical trial was conducted at 6 centers in China from August 1, 2021, to September 30, 2022. Data were analyzed from March 1 to June 30, 2023. Individuals aged 18 to 80 years were enrolled. Exclusion criteria were a history of inflammatory bowel disease, advanced colorectal cancer, and polyposis syndromes; known colorectal polyps without complete removal previously; a history of colorectal surgery; known stenosis or obstruction with contraindication for biopsy or prior failed colonoscopy; pregnancy or lactation; and refusal to participate. Intention-to-treat and per-protocol analysis was used. Interventions: Standard colonoscopy or AQCS-assisted colonoscopy. Main outcomes and measures: Adenoma detection rate. Results: A total of 1254 participants (mean [SD] age, 51.21 [12.10] years; 674 [53.7%] male) were randomized (627 standard colonoscopy, 627 AQCS-assisted colonoscopy). Intention-to-treat analysis showed a significantly higher adenoma detection rate in the AQCS-assisted group vs standard colonoscopy group (32.7% vs 22.6%; relative risk [RR], 1.60; 95% CI, 1.23-2.09; P < .001). The adenoma detection rates were significantly higher in the AQCS group when considering pathology (nonadvanced adenomas, 30.1% vs 21.2%; RR, 1.52; 95% CI, 1.16-1.99; P = .002), and morphology (flat or sessile, 29.3% vs 20.4%, RR, 1.52; 95% CI, 1.16-2.00; P = .003). Use of AQCS significantly increased the adenoma detection rate of both the lower-level detectors (30.0% vs 20.0%; RR, 1.71; 95% CI, 1.24-2.35; P = .001) and the medium-level detectors (38.1% vs 27.7%; RR, 1.61; 95% CI, 1.07-2.43; P = .02). Similar increases were found for adenoma detection rates in the academic and nonacademic centers (academic: 29.3% vs 20.8%; RR, 1.58; 95% CI, 1.10-2.29; P = .01; nonacademic: 36.1% vs 24.5%; RR, 1.74; 95% CI, 1.23-2.46; P = .002). The number of adenomas per colonoscopy was significantly higher in the AQCS-assisted group (0.86 vs 0.48; RR, 1.50; 95% CI, 1.17-1.91; P = .001). The mean withdrawal time without intervention was slightly increased with AQCS assistance (6.78 vs 6.46 minutes; RR, 1.38; 95% CI, 1.26-1.52; P < .001). No serious adverse events were reported. Conclusions and relevance: In this randomized clinical trial, AQCS assistance during routine colonoscopy increased adenoma detection rates and several related polyp parameters compared with standard colonoscopy in the lower- and medium-level detectors in academic and nonacademic settings. Routine use of AQCS to assist in colorectal adenoma detection and quality improvement should be considered.

Background:Colorectal cancer is a chronic disease particularly detrimental to human health. Although there have been many studies on colorectal cancer and extracellular vesicles (EVs), it is unknown whether SKI II, an inhibitor of sphingosine kinase 1 (SphK1), uses EVs as transporters to inhibit colorectal cancer migration. This research aimed to investigate whether EVs, which were isolated from SphK1 inhibitor SKI II-medium, affected on E-cadherin and vimentin and the cell migration of colorectal cancer cells. Methods:EVs were extracted from RKO cells using an exosome extraction and purification kit, and the extracted EVs were identified to evaluate whether the EVs extracted by this kit met the experimental requirements. RKOEVs were extracted from RKO exosom-free serum culture medium, and RKO-SKEVs were extracted from RKO exosom-free serum culture medium with SKI II intervention. PKH67-labeled EVs were added to the cells. EVs inhibitor GW4869, RKOEVs, and RKO-SKEVs were used to intervene in RKO cells, and RKOEVs and RKO-SKEVs were used to intervene in HT29 cells. The E-cadherin and vimentin expression were tested by western blotting. Transwell assay was used to detect cell migration ability. Results:Compared with the control group, after GW4869 treatment, E-cadherin was increased, vimentin was decreased, and the number of migrating cells was decreased. After RKOEVs intervention, the expression of E-cadherin, vimentin and cell migration number were opposite. Compared with RKOEVs intervention in RKO cells, E-cadherin was increased, vimentin was decreased and the number of migrating cells decreased after RKO-SKEVs intervention. Similarly, compared with RKOEVs intervention in HT29 cells, after RKO-SKEVs intervention, E-cadherin was increased, vimentin was decreased, and the number of migrating cells decreased. Conclusions:EVs isolated from SphK1 inhibitor SKI II-medium affect E-cadherin and vimentin expression in colorectal cancer and inhibit cell migration.

BACKGROUND:Helicobacter pylori (H. pylori) is a Gram-negative bacterium that relies on flagellar motility to colonize the stomach, damaging the gastric mucosa through various mechanisms and leading to various digestive disorders. Accurate assessment and precise treatment are essential in initial intensive therapy. AIM:To investigate the efficacy and safety of a vonoprazan (VPZ)-based triple regimen for first-line eradication of H. pylori in China. METHODS:This multicenter noninferior randomized controlled trial (June 2022 to November 2023) involved 524 H. pylori-positive patients across 19 centers in Shandong, China. Participants were randomized to 14-day esomeprazole/bismuth/amoxicillin/clarithromycin (EBAC), 14-day VPZ/amoxicillin/clarithromycin (VACa), or 10-day VPZ/amoxicillin/clarithromycin (VACb) - all administered twice daily. Primary outcomes (eradication rates) were assessed via intention-to-treat (ITT) and per-protocol (PP) analyses. Secondary endpoints included adverse events and adherence. Noninferiority testing and χ 2 tests were used for statistical comparisons. RESULTS:A total of 524 patients participated in this study. In ITT analysis, the eradication rates of the EBAC, VACa, and VACb groups were 72.6% (127/175), 88.0% (154/175), and 83.3% (145/174), respectively (P = 0.001). The difference in the eradication rate between the EBAC and VPCa groups was 15.4% [95% confidence interval (CI): 7.3-23.6, P < 0.001], and that between the EBAC and VACb groups was 10.8% (95%CI: 2.1-19.4, P = 0.018). In PP analysis, the eradication rates of the EBAC, VACa, and VACb groups were 81.4% (127/156), 93.9% (154/164), and 90.6% (145/160), respectively (P = 0.001). There was no significant difference in the incidence of adverse reactions among the three groups, which were 36.6%, 33.8% and 29.6%, respectively (P = 0.50). CONCLUSION:VPZ-based triple therapies demonstrate noninferiority to 14-day bismuth-containing regimens, with the 10-day regimen showing comparable efficacy and similar adverse event rates.

BackgroundMagnetic capsule gastroscopy (MCG) is a non-invasive diagnostic method for the digestive tract. However, its efficiency in visualizing the gastric cardia is often compromised due to the capsule's rapid passage. This study introduces a novel sugar-glued tether-assisted technique inspired by a traditional Chinese snack-making process to enhance cardia visualization and patient comfort during MCG.MethodsThis pilot, open-label, single-center, randomized controlled, non-inferiority study was conducted at Binzhou Medical University Hospital. Seventy-eight patients were enrolled and divided into three groups: conventional MCG, suction cup tether-assisted MCG, and sugar-glued tether-assisted MCG. The primary outcomes included safety, comfort level, and gastric cardia visualization quality. Secondary outcomes assessed technique-associated performance and clinical factors.ResultsThe sugar-glued tether-assisted MCG demonstrated comparable cardia visualization quality to the suction cup method, with significantly better results than conventional MCG. Comfort levels were significantly higher in the sugar-glued group compared to the suction cup group. The number of swallow attempts was significantly lower in the sugar-glued group, with no adverse events reported. Secondary outcomes showed no significant differences in MCG assembly time and ingestion-to-detachment period between the suction cup and sugar-glued groups.ConclusionThe sugar-glued tether-assisted MCG is a feasible and safe modification that enhances gastric cardia visualization while improving patient comfort. This technique provides a cost-effective alternative to the suction cup method, warranting further investigation in larger, multi-center studies.

Introduction: Keverprazan is a novel potassium-competitive acid blocker. The advantages of keverprazan as a potent acid suppressor in Helicobacter pylori eradication have not yet been demonstrated. The aim of this study was to evaluate the efficacy of keverprazan as a component of bismuth quadruple therapy in H. pylori treatment. Methods: Adult patients with H. pylori infection were enrolled and randomised to take keverprazan (KEV group)- or esomeprazole (ESO group)-quadruple therapy. The regimens contained keverprazan 20 mg or esomeprazole 20 mg, clarithromycin 500 mg, amoxicillin 10 0 0 mg and bismuth potassium citrate 240 mg and were administered twice daily for 14 days. The primary endpoint was the H. pylori eradication rate at 4 weeks after treatment. Results: The full analysis set showed that the H. pylori eradication rates were 87.8% (252/287) and 82.52% (236/286) for the KEV and ESO groups, respectively (difference: 5.29%; 95% confidence interval [CI]: 0.55-11.18). Keverprazan was superior to esomeprazole in terms of eradication rate in the per protocol set ( P = 0.0382). The eradication rates for patients resistant or non-resistant to clarithromycin were both numerically higher in the KEV group than the ESO group (83.45% vs. 76.98% for clarithromycin-resistance; 92.31% vs. 88.16% for clarithromycin-non-resistance). The incidence of adverse events was similar in the KEV and ESO groups (76.31% vs. 77.62%), with most adverse events ( > 90%) being mild in severity. No TEAEs led to death in either group. Conclusions: Keverprazan 20 mg twice daily, used as a component of bismuth quadruple therapy, provided effective H. pylori eradication and was non-inferior to an esomeprazole-based regimen. (c) 2024 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/)

Background: Inflammatory bowel disease (IBD) is characterized by chronic progressive intestinal inflammation. Sacral nerve stimulation (SNS) ameliorates colon inflammation caused by IBD. The aim of this study was to investigate the antiinflammatory benefits of SNS in colitis rats and explore the roles of the cholinergic antiinflammatory pathway, macrophage autophagy, and nucleotide oligomerization domain-like receptor thermal protein domain associated protein 3 (NLRP3) inflammatory bodies. Materials and Methods: Rats were divided into four groups: healthy control, dextran sulfate sodium (DSS), DSS + sham-SNS, and DSS + SNS groups. An electrode was surgically placed in the right sacral nerve (S3) for stimulation. The disease activity index (DAI) score was recorded each day, and the degree of inflammatory injury was evaluated using hematoxylin and eosin staining. The alpha7 nicotinic acetylcholine receptor (alpha 7nAChR) and autophagy- and NLRP3-related factors were assessed using immunoflu- orescence staining and Western blotting. Results: The DSS group showed a higher DAI score, colon shortening, upregulated proinflammatory action, and colon damage, and the DSS + SNS group showed significantly improved symptoms. The number of alpha 7nAChR+ cells and the expression level of autophagy decreased in the DSS group but increased in the DSS + SNS group. Conversely, the DSS group showed increased activation of NLRP3 inflammatory bodies, whereas the DSS + SNS group showed decreased activation of NLRP3 inflammatory bodies. Conclusion: In this study, SNS ameliorated colon inflammation by enhancing macrophage autophagy and inhibiting the activation of NLRP3 inflammatory bodies, which may be related to the opening of the cholinergic antiinflammatory pathway.

BACKGROUND Computed tomography (CT) small bowel three-dimensional (3D) reconstruction is a powerful tool for the diagnosis of small bowel disease and can clearly show the intestinal lumen and wall as well as the outside structure of the wall. The horizontal axis position can show the best adjacent intestinal tube and the lesion between the intestinal tubes, while the coronal position can show the overall view of the small bowel. The ileal end of the localization of the display of excellent, and easy to quantitative measurement of the affected intestinal segments, the sagittal position for the rectum and the pre-sacral lesions show the best, for the discovery of fistulae is also helpful. Sagittal view can show rectal and presacral lesions and is useful for fistula detection. It is suitable for the assessment of inflammatory bowel disease, such as assessment of disease severity and diagnosis and differential diagnosis of the small bowel and mesenteric space-occupying lesions as well as the judgment of small bowel obstruction points. CASE SUMMARY Bleeding caused by small intestinal polyps is often difficult to diagnose in clinical practice. This study reports a 29-year-old male patient who was admitted to the hospital with black stool and abdominal pain for 3 months. Using the combination of CT-3D reconstruction and capsule endoscopy, the condition was diagnosed correctly, and the polyps were removed using single-balloon enteroscopy-endoscopic retrograde cholangiopancreatography without postoperative complications. CONCLUSION The role of CT-3D in gastrointestinal diseases was confirmed. CT-3D can assist in the diagnosis and treatment of gastrointestinal diseases in combination with capsule endoscopy and small intestinal microscopy.

Background:Curcumin (Cur) is a natural phytochemical that is expected to become an indispensable drug for the treatment of colorectal cancer. A comprehensive understanding of the anti-tumor mechanism of Cur will provide a better reference for its clinical application. This study aimed to examine the effects of extracellular vesicles (EVs) isolated from Cur-medium on RKO colorectal cancer cell proliferation, apoptosis, and migration. Methods:RKO cells were cultured in various concentrations of Cur-medium, and the EVs were isolated from the Cur-medium. The EVs were identified by transmission electron microscopy and western blotting. The effects of the EVs on RKO cell proliferation, apoptosis, and migration were analyzed, as was the expression of proliferating cell nuclear antigen (PCNA), Bax, vimentin, and E-cadherin. The expression of nuclear factor κB (NF-κB) p65 in the EVs was also detected. Results:Our results showed that the EVs isolated from the Cur-medium weakened RKO cell proliferation and migration but had no effect on cell apoptosis. Cur suppressed the expression of NF-κB p65 in the EVs. Overall, this study revealed that Cur exerts anti-tumor effects by suppressing NF-κB p65 in EVs to weaken RKO cell proliferation and migration. Conclusions:In conclusion, the packaging of Cur into EVs is expected to become an indispensable treatment of colorectal cancer in the future.

Objective To investigate the safety and efficacy of endoscopic subserosal dissection for patients with submucosal tumors in the upper gastrointestinal tract. Methods This retrospective single-center study included 16 patients who underwent ESSD. All patients were enrolled from July 2018 to Dec 2021. Parameters such as demographics, size, resection margin, complications, pathological features, procedure time and follow-up were investigated and analyzed. Results Our study achieved 100% en bloc resection and 100% R0 resection. The most common location was the corpus with a mean tumor size of 2.78 ± 1.56 cm. The mean age, procedure time, were 53.4 ± 10.3 years, 85.31 ± 46.64 minutes respectively. Acocording to National Institutes of Health classification, 7 (13, 53.85%), 5 (13, 38.46%) ,and 1 (13, 7.69%) objects belonged to the very low, low, and intermediate classification, respectively. Immunohistochemistry results showed a 100% positive rate of CD34, DOG-1, CD117, and Ki67. A mean follow-up of 9.3 ± 2.5 months showed no recurrence or metastasis. Conclusions ESSD is effective and safe surgical procedure for curative removal of gastrointestinal submucosal tumors in the upper gastrointestinal tract, and it can be preferred for patients with no metastasis.