收集2012年1月至2018年1月嘉兴市第一医院收治的诊断为肝硬化门静脉高压症食管-胃底静脉曲张破裂出血、手术后恢复良好且2年内未再复发的136例患者资料，运用机器学习随机森林算法建立肝硬化门静脉高压症食管-胃底静脉曲张破裂出血治疗方式预测模型。结果显示白细胞计数、血肌酐、凝血酶时间、血小板计数、活化部分凝血活酶时间和年龄是治疗方式的影响因素，且机器学习建立的预测模型精确度高。该模型为患者治疗方式的选择提供了科学依据，并且对大数据人工智能融入临床工作有一定启示。

Objective:To evaluate the new scoring system for gastric cancer screening and risk assessment of gastric precancerous lesions.Methods:A total of 442 patients who underwent endoscopy due to stomach discomfort at the First Hospital of Jiaxing from March 2018 to September 2019 were enrolled. The patients were divided into three groups based on the new scoring system for gastric cancer screening before endoscopy: low-risk group (0-11 points), median-risk group (12-16 points) and high-risk group (17-23 points). The detection rates of gastric cancer and atrophic gastritis in three groups were analyzed. According to the range or degree of atrophy or intestinal metaplasia, patients were divided into five groups of stage 0 to Ⅳ based on the operative link for gastritis assessment (OLGA) or operative link for gastritis intestinal metaplasia (OLGIM). The correlation between the new gastric cancer screening scoring system and OLGA or OLGIM staging system were evaluated.Results:Among 442 patients, 211 were assigned to low-risk group, 207 median-risk group and 24 high-risk group according to the new scoring system. For OLGA staging system, there were 241 cases of stage-0, 105 of stage-Ⅰ, 58 stage-Ⅱ, 27 stage-Ⅲ and 11 stage-Ⅳ. For OLGIM staging system, there were 224 cases of stage-0, 113 stage-Ⅰ, 61 stage-Ⅱ, 31 stage-Ⅲ and 13 stage-Ⅳ. The pepsinogen (PG) Ⅰ and pepsinogen ratio (PGR) levels had differences among different OLGA stages ( F=2.844, P=0.027; F=5.435, P=0.001), and these two variables at Stage-Ⅲ and Ⅳ were significantly lower than three other OLGA stages (all P<0.001). The PGR level had differences among different OLGIM stages ( F=3.887, P=0.008), which was significantly lower at Stage-Ⅳ than at other OLGIM stages (all P<0.001). Gamma coefficient analysis and Kendall′s tau-b analysis showed significant correlations between OLGA/OLGIM staging system and new gastric cancer screening scoring system ( P<0.001). Conclusion:The new scoring system is reliable for gastric cancer screening, and is closely linked with OLGA/OLGIM staging system in the risk assessment of gastric precancerous lesions.

目的 探讨血清PG、G-17结合窄带成像放大内镜对早期胃癌的诊断价值.方法 选择2017年1月至2020年4月因上腹不适等上消化道症状就诊的患者573例,同期进行普通白光胃镜检查及胃黏膜组织活检,根据病检结果分为A组(非萎缩性胃炎组)、B组(胃癌癌前病变组)和C组(早期胃癌组).比较各组血清PGⅠ、PGⅡ和G-17水平,利用ROC曲线分析PGⅠ、G-17单独或联合检测对早期胃癌的诊断价值.结果 573例患者均进行了白光内镜检查,218例行NBI+ME精查,其中92例行靶向活检,126例行ESD术,其中A组387例、B组123例、C组63例.与A组比较,B组和C组PGⅠ、PGR水平较低,G-17水平较高,差异有统计学意义(P<0.05);与B组比较,C组PGⅠ、PGR水平较低,G-17水平较高,差异有统计学意义(P<0.05).以血清PGⅠ<70.1?μg/L且血清G-17>14.1?pmol/L为标准,诊断早期胃癌的敏感度和特异度分别为85.7％和96.5％,联合诊断敏感度和特异度均高于单独诊断(P<0.05);三组血清学指标异常检出率分别为1.3％、7.3％和88.9％,B组、C组血清学指标异常检出率均高于A组(P<0.05),C组血清学指标异常检出率高于B组(P<0.05).结论 PGⅠ降低、G-17升高提示胃癌癌前病变、早期胃癌的高风险,PGⅠ与G-17联合检测结合白光内镜、NBI+ME精查、靶向活检及诊断性ESD可进一步提高诊断准确性.

Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastric Intestinal Metaplasia Assessment (OLGIM) were adopted to evaluate gastric risk stratification in five biopsy samples. This study aimed to evaluate the degree of gastric atrophy (GA) and intestinal metaplasia (IM) in five locations to detect a more representative biopsy sample in gastric cancer (GC) screening. Our study enrolled 368 patients and 5 biopsy pieces were acquired from them. Gastric risk stratification was calculated by OLGA and OLGIM staging system. The results revealed that the IM score in the incisura angularis was higher than that in the larger and lesser curvature of corpus mucosa (p = 0.037 and p = 0.030, respectively) and the IM score in the lesser curvature of antrum mucosa was higher than that in the incisura angularis mucosa (p= 0.018). IM is more frequently observed in the angulus region than in the lesser curvature of corpus in the mild degree (p= 0.004) and mild IM lesions in the lesser curvature of antrum were more frequently observed than in the incisura angularis mucosa (p = 0.004), Four biopsy pieces protocol (larger curvature and lesser curvature of the antrum, lesser curvature of the corpus and angulus) demonstrated accurate consistency (97.83% and 98.37%, respectively) with a Kendall's tau-b of higher than 0.990, along with low misdiagnosis rates of OLGA and OLGIM (III + IV) (9.76% and 5.00%, respectively). Three biopsy pieces protocol (lesser curvature of the antrum and corpus, angulus biopsy) in OLGA and OLGIM staging system was close to the standard protocol (five biopsy specimens) with a consistency of 94.84% and 94.29% and has a Kendall's tau-b higher than 0.950 and diagnostic omission rates of 9.76% and 5.00%, respectively, which was exactly the same with the four biopsy pieces protocol. Furthermore, it had the second-highestYouden index (0.902 and 0.950, respectively) and area under the ROC curve (0.992 and 0.996, respectively) for the screening of high-risk GC by OLGA and OLGIM stages. Thus, we recommended the angulus and the lesser curvature of antrum as a conventional biopsy and three biopsy pieces for further GC risk screening.

背景:血清胃蛋白酶原(PGs)作为评估胃黏膜萎缩的指标,可反映胃黏膜功能和形态学状态.OLGA/OLGIM是一种结合胃黏膜萎缩/肠化生程度和范围的胃炎分类方法,已逐步被接受并应用于胃癌筛查.目的:分析血清幽门螺杆菌(Hp)抗体联合PGs检测(ABC法)与组织学OLGA/OLGIM胃炎评价标准的相关性,评价PGs检测在胃癌前病变风险评估中的价值.方法:纳入2017年1月—2018年1月因上消化道症状在嘉兴市第一医院行胃镜检查的患者331例,分别采用血清学ABC法和组织学OLGA/OLGIM胃炎评价标准进行分组,比较不同OLGA/OLGIM组间Hp感染率、PGⅠ、PGⅡ水平和PGⅠ/PGⅡ比值(PGR)的差异,分析OLGA/OLGIM胃炎评价标准与ABC法的相关性.结果:OLGA/OLGIM分组中,stage-0组Hp感染率明显低于其他四组,stage-Ⅳ组则明显高于其他四组(P<0.05),PGR随分组等级升高逐渐降低(P<0.05);OLGA分组中,PGⅠ亦随分组等级的升高呈降低趋势(P<0.05).Gamma系数分析显示OLGA/OLGIM胃炎评价标准与ABC法之间存在较强的相关性(G=0.589,P<0.05;G=0.440,P<0.05).结论:血清学ABC法与组织学OLGA/OLGIM胃炎评价标准在胃癌前病变风险评估方面存在密切联系.血清PGs检测在我国可用于胃癌前病变筛查,为后续是否需作胃镜精查提供依据.

Objective To analyze the accuracy of staging among the combination of endoscopic biopsy sites,operative link for gastritis assessment (OLGA) and operative link for gastric intestinal metaplasia assessment (OLGIM) with five different biopsy sites.Methods From January 2014 to September 2015,patients with functional dyspepsia and undergoing gastroendoscopy examination were enrolled.According to update Sydney system,a total of five biopsy pieces were obtained from lesser curvature of gastric body,larger curvature of gastric body,gastric angle,larger curvature of antrum and lesser curvature of antrum.The degrees of atrophy and intestinal metaplasia were determined and staged according to OLGA and OLGIM.Kappa test and chi-square test were performed for the statistical analysis.Results A total of 268 patients were enrolled.The incidences of atrophy and intestinal metaplasia in different sites were as follow:30.4％ (113/372) and 31.0％ (111/358) in lesser curvature of antrum;26.1％(97/372) and 25.1％(90/358) in gastric angle;20.2％(75/372) and 15.4％(56/358) in larger curvature of antrum;14.8％(55/372) and 15.4％(55/358) in lesser curvature of gastric body;8.6％(32/372) and 8.1％(29/358) in larger curvature of gastric body.The incidences of atrophy and intestinal metaplasia of lesser curvature of antrum were significantly higher than those of larger curvature of gastric body,lesser curvature of gastric body and larger curvature of antrum (x2 =45.248,48.029,20.024,18.892,7.681 and 7.848;all P＜＜0.05).The incidences of atrophy and intestinal metaplasia of gastric angle were significantly higher than those of lesser curvature and larger curvature of gastric body(x2 =32.752,31.269,11.605 and 8.448;all P＜0.05).The incidences of atrophy and intestinal metaplasia of the lesser curvature of gastric body and larger curvature of antrum were higher than those of larger curvature of gastric body,and the differences were statistically significant (x2 =6.080,8.048,17.280,18.980,all P＜0.05).The incidences of mild atrophy and intestinal metaplasia of the lesser curvature of antrum were 20.2 ％ (75/ 372) and 21.2％ (76/358),respectively,which were higher than those of larger curvature of antrum (12.9％,48/372 and 12.8％,46/358),and the differences were statistically significant (x2 =5.927 and 7.377,both P＜0.05).The incidence of severe atrophy of lesser curvature of antrum was 2.4％ (9/372),respectively,which was higher than that of larger curvature of antrum (0.8％,3/372),and the difference was statistically significant (x2 =3.000,P =0.015).The incidences of mild atrophy and intestinal metaplasia of the lesser curvature of gastric body were 10.5％ (39/372) and 11.2％ (40/358),respectively,which were higher than those of larger curvature of gastric body (5.4 ％,20/372 and 5.9 ％,21/358),and the differences were statistically significant (x2 =6.119 and 5.918,both P＜0.05).The consistency of staging by three biopsy sites (lesser curvature of gastric body,gastric angle and lesser curvature of antrum) and five biopsy sites with OLGA and OLGIM was 94.0 ％ (95 ％ confidence interval (CI) =91.2％ to 96.9％,Kappa value=0.912,P＜0.01) and 92.9％ (95％CI:89.8％ to 96.0％,Kappa value=0.893,P＜0.01).Conclusion Three biopsy sites (lesser curvature of gastric body,gastric angle and lesser curvature of antrum) could accurately reflect gastric mucosa lesions with less biopsy tissues and it is worthy of clinical popularization and application.

BACKGROUND:Serum pepsinogen (PG) test, as an indicator of gastric mucosal atrophy, reflects the functional and morphologic status of gastric mucosal and it is suggested to serve as a useful predictive marker for patients with gastric cancer (GC). The available classifications of gastritis, known as the Operative Link on Gastritis Assessment (OLGA) and Operative Link on Gastritis Intestinal Metaplasia (OLGIM), integrating the severity and topography of atrophy/intestinal metaplasia (IM), have been gradually accepted and used in screening for GC in recent years. GOALS:To assess whether serum pepsinogen test, including PGI, PGII, PGI/PGII and gastrin-17 (G-17) could reflect the extent and topography of gastric mucosal atrophy/IM. Furthermore, to discuss the relationship between OLGA/OLGIM staging system and serum pepsinogen test in assessment of gastric atrophy/IM. METHODS:The OLGA/OLGIM ranks the gastric staging according to both the topography and the severity of gastric atrophy/IM. A retrospective study was conducted with 331 patients who underwent endoscopy with consecutive biopsy sampling and reassessed according to OLGA/OLGIM staging system. Serum pepsinogen test, including PGI, PGII, PGI/PGII and G-17, as well as serological Helicobacter pylori (Hp) antibody were also measured. Results were presented as gastritis stage, serum pepsinogen level and Hp status. Baseline characteristics were compared using analysis of variance (ANOVA) test for continuous data and Pearson's χ2 test for categorical data. A logistic regression model was used for the correlation analysis between OLGA/OLGIM and serological pepsinogen test. RESULTS:A total of 177 non-atrophic gastritis and 154 atrophic gastritis were analyzed, among which 40 were antrum atrophy, 32 were corpus atrophy and 82 were pan-atrophy. All patients were assessed applying the OLGA/OLGIM criteria with a mean age of 54.7 ± 10.8 years. Patients among OLGA/OLGIM Stage III-IV were presented with a lower level of serum PGI and PGI/PGII (p < .05), especially for Stage IV (p = .01). For both Hp-positive patients and Hp-negative patients according to OLGA system, PGI/PGII level correlated inversely with the rising stage (p = .022; p = .028). As for OLGIM system, similar difference can be seen in PGI/PGII level in either Hp-positive patients, or Hp-negative patients (p = .036; p = .013). In addition, the percentage of G-17 <1 pmol/L combined with PG-negative in antrum atrophy group was much higher than that of non-atrophy group and corpus atrophy group (25 versus 15.8 versus 6.3%) (p = .029). The proportion of G-17 > 15 pmol/L combined with PG-positive was apparently higher in corpus atrophy group, compared with other two groups (25 versus 11.3 versus 8.1%) (p = .023). Logistic regression modeling showed there exist significant connections between OLGA/OLGIM stages and serum pepsinogen test in patient stratification for gastric mucosal atrophy assessment (p < .001, p < .001). CONCLUSIONS:Serum pepsinogen test has a strong correlation with OLGA/OLGIM gastritis stage and could provide important information in assessment of atrophy/intestinal metaplasia.

Intestinal barrier is formed by intestinal mucous layer,epithelial cells,cellular tight junction,enterocyte membrane,submucosal lamina propria and immunologic factors,and plays a pivotal role in maintaining gastrointestinal function. Different types of stress can induce intestinal barrier dysfunction and increased intestinal permeability,leading to a series of gastrointestinal diseases. This article reviewed the progress of research on pathological changes and mechanism of stress-related intestinal barrier dysfunction.

This study investigated the mechanism of protein disulfide-isornerase A3 (PDIA3)-induced visceral hypersensitivity in irritable bowel syndrome (IBS). Rats were treated with saline (control), acetic acid and restraint stress (IBS model), empty vector (RNAi control) and PDIA3-RNAi vector (PDIA3-RNAi). Mesenteric lymph node DCs (MLNDCs) and splenic CD4+/CD8+ T cells were isolated for co-cultivation. Compared with control, MLNDCs co-cultured with CD4+ or CD8+ T cells showed an increased ability to promote T cell proliferation and produced more IL-4 or IL-9 secretion. Compared with the RNAi control, MLNDCs from the PDIA3 knockdown models were less effective in promoting the proliferation of CD4+/CD8+ T cells. It is concluded that PDIA3 plays an important role in the development of IBS through the DC-mediated activation of T cells, resulting in degranulation of MCs and visceral hypersensitivity.

目的 系统评价利福昔明治疗肠易激综合征(irritable bowel disease,IBS)的疗效与安全性.方法 计算机检索PubMed、EMBASE、Web of Science、The Cochrane Central Register of Controlled Trials等外文数据库(1966年9月-2014年9月)及中国期刊全文数据库(CNKI)、中国生物医学文献数据库、万方学位论文数据库等中文数据库(1978年9月-2014年9月)中关于利福昔明用于IBS治疗的随机对照试验(RCT),由2位研究者按照Cochrane系统评价手册5.0.1标准独立评价文献质量、提取资料并交叉核对,采用RevMan 5.20软件对数据进行Meta分析.结果 共纳入6项RCT,包括2 415例患者.Meta分析结果显示:(1)IBS总体症状缓解率:利福昔明组疗效优于对照组(OR=1.53,95％CI:1.30～ 1.81,P＜0.01);(2)IBS相关腹胀缓解率:利福昔明组疗效优于安慰剂组(OR=1.56,95％CI:1.32 ～1,85,P＜0.01);(3) IBS相关腹痛及大便性状改变缓解率:利福昔明组疗效优于安慰剂组(OR=1.44,95％ CI:1.20 ～1.74,P＜0.01);(4)不良事件发生率:利福昔明组与安慰剂组在不良事件发生率方面差异无统计学意义(P＞0.05).结论 利福昔明能有效改善IBS总体症状、IBS相关腹胀、IBS相关腹痛及大便性状改变等一系列症状,且有较好的安全性.

OBJECTIVE:To observe the changes of intestinal inflammation on PDIA3 gene knockout IBS rats and its effect on immune function.METHODS:36 SD rats were randomly divided into four groups: the control group (n = 8); IBS- empty virus group (IBS-GFP, which); IBS-PDIA3 knockout group (n = 12); IBS- the control group (n = 12). After modeling, colon and ileocecal tissue pathology in each group were observed separately. Changes of immune and inflammatory markers were measured. At the same time, ultrastructural changes in each group were observed by electron microscopy.RESULTS:Compared with the IBS control group, inflammation was reduced significantly in IBS-PDIA3 knockout group. IgE, IL-4 and IL-9 and the level of intestinal trypsin type were decreased significantly. Furthermore, mast cell degranulation and PAR 2 receptor reduced significantly.CONCLUSION:PDIA3 may play an important role in the development of IBS by mediating through immune responses of mucosal abnormalities. However, the mechanism needs to be confirmed in further study.

Background/AimsDendritic cells (DCs) are a significant contributor to the pathology of numerous chronic inflammatory autoimmune disorders; however, the effects of Corticotropin-releasing factor (CRF) on intestinal DCs are poorly understood. In this study, we investigated the role of CRF in alterations of intestinal dendritic cell phenotype and function.MethodsMouse mesenteric lymph node dendritic cells (MLNDCs) were obtained using magnetic bead sorting. Surface expression of CRF receptor type 1 (CRF-R1) and CRF-R2 was determined by double-labeling immunofluorescence and quantitative polymerase chain reaction (qPCR) and MLNDCs were subsequently exposed to CRF in the presence or absence of CRF-R1 and CRF-R2 antagonists. Expression of surface molecules (MHC-I and MHC-II) and co-stimulatory molecules (CD80 and CD86) was determined by flow cytometric and western blot analyses, and the T cell stimulatory capacity of MLNDCs was evaluated by mixed lymphocyte reaction.ResultsImmunofluorescent staining and quatitative polymerase chain reaction indicated that both the CRF receptors (CRF-R1 and CRF-2) are expressed on the surface of MLNDCs. Exposure to CRF increased the expression of MHC-II on MLNDCs as well as their capacity to stimulate T cell proliferation. MLNDCs treated with CRF-R1 antagonist exhibited a phenotype characterized by a less activated state and reduced surface expression of MHC-II, and consequently showed reduced capacity to stimulate T cells. In contrast, treatment of MLNDCs with CRF-R2 antagonist yielded an opposite result.ConclusionsCRF can alter the phenotype and function of intestinal DCs through direct action on CRF-R1 and CRF-R2, and activation of the CRF-R1 and CRF-R2 pathways yields opposing outcomes.

OBJECTIVE To study the phenotypic alteration of intestinal dendritic cells (DC) in a rat model of irritable bowel syndrome (IBS) and the change of mitogen-activated protein kinase (MAPK) signaling pathway, in order to explore the potential mechanism of ERK1/2 pathway mediation in abnormal DC immune response. METHODS IBS rat model was established by combining neonatal maternal separation and colorectal distension in 10 SD rats, and 10 healthy rats served as controls. Visceral sensitivity was evaluated with abdominal withdrawal reflex (AWR). Mesenteric lymph node DC (MLNDC) was isolated and purified by magnetic label-based technique after modeling. Expression of surface major histocompatibility complex (MHC)-Ⅱin control rats was determined by flow cytometric analyses. Western-blot was used to determine the expression of MHC-Ⅱ, p-p38, p38, phosphorylated extracellular regulated protein kinase (p-ERK1/2), ERK1/2, phosphorylated c-Jun N-terminal kinase (p-JNK), and JNK in MLNDC. RESULTS Visceral sensitivity was significantly higher in the IBS group than in the control group. The purity of the OX62 positivity MLNDC following magnetic sorting was about 85.57%±7.67%. MLNDC in the control group expressed high level of MHC-Ⅱ. The expression of MHC-Ⅱ and p-ERK1/2 in MLNDC in the IBS group were higher than those in the control group (1.05±0.13 vs 0.67±0.18, t=-2.973, P=0.041; 3.21±0.48 vs 2.34±0.85, t=-3.130, P=0.035); while there was no significant difference in the expressions of p-JNK and p-p38 compared with the control groups (0.95±0.17 vs 0.76±0.36, t=0.808, P=0.464; 1.07±1.13 vs 1.19±0.91, t=0.137, P=0.897). CONCLUSION The intestinal DC in IBS rats show a upregulated expression of MHC-Ⅱ, which may be related to the activation of intracellular ERK1/2 pathway.

背景:近年来益生菌广泛应用于炎症性肠病(IBD)的治疗,但其诱导和维持缓解的疗效仍存在争议.目的:系统评价益生菌对IBD诱导和维持缓解的疗效.方法:计算机检索PubMed、CENTRAL、Embase、Web of Science、CNKI、CBM和万方数据库,收集益生菌用于IBD诱导和(或)维持缓解的随机对照试验(RCTs).由2名研究者独立提取文献资料并交叉核对,以Cochrane偏倚风险评估工具和Jadad评分评价文献质量.应用RevMan 5.20软件进行meta分析.结果:共纳入22项RCTs,包括溃疡性结肠炎(UC)和克罗恩病(CD)患者1 870例.Meta分析显示:①UC活动期诱导缓解率:益生菌疗效优于对照组(OR =2.34,95％ CI:1.56～3.52,P＜0.000 1);②UC缓解期临床复发率:益生菌疗效优于安慰剂(OR =0.15,95％ CI:0.04 ～0.60,P=0.008),与美沙拉秦无明显差异(OR=1.00,95％ CI:0.68～1.45,P=0.98);③CD活动期诱导缓解率:益生菌疗效与对照组无明显差异(OR=0.92,95％ CI:0.32～2.64,P=0.88);④CD缓解期临床复发率:益生菌疗效与对照组无明显差异(OR=1.00,95％ CI:0.65～1.55,P=0.98);⑤不良反应发生率:益生菌与对照组无明显差异(OR=1.06,95％ CI:0.73 ～1.55,P=0.76).结论:益生菌在UC诱导和维持缓解方面均有较好疗效,对CD则未显示出治疗优势.

肠易激综合征（irritable bowel syndrome，IBS）是常见的功能性胃肠病，其病因和发病机制尚未完全阐明。近年来，越来越多的证据表明,IBS可能是急性传染性胃肠炎感染后的不良后果，即所谓的感染后IBS（post infectious IBS，PI-IBS）。一项系统回顾和荟萃分析表明，胃肠道感染后引起IBS的风险，相比对照组增加了6倍[1]。关于PI-IBS的发病机制，目前认为可能与肠动力改变、肠道通透性增加、肠道持续性炎症、肠道菌群紊乱等因素有关。笔者查阅了有关资料，现就PI-IBS的研究进展作一综述。

贲门失弛缓症是吞咽后食管体部无蠕动、贲门括约肌弛缓不良的一种食管动力障碍性疾病,主要表现为吞咽困难、未消化的食物反流、胸痛、呼吸道症状(夜间咳嗽、肺炎)和体质量减轻[1].目前认为其发病机制可能主要与病毒感染、自身免疫、遗传因素等有关.贲门失弛缓症的诊断主要依靠病史、临床表现和辅助检查相结合,通过食管测压、内镜及影像学检查得以明确.一经确诊,应当尽早治疗.其主要治疗方法包括药物治疗、内镜下治疗和外科手术治疗,其主要目的在于降低食管下括约肌(low esophageal sphincter,LES)压力,以促进食管内容物的排空,现就贲门失弛缓症的治疗现状和进展进行综述。

Objective The aim of this study was to explore the establishment method of an animal model of irritable bowel syndrome ( IBS) and the evaluation of this animal model.Methods 30 adult SD rats were randomly divided into two groups: acetic acid irritation and bondage stress group ( n=10 ) , bondage stress group ( n =10 ) , and normal control group ( n=10 ) .The rats of the intervention group received an intra-colonic infusion of 0.4% acetic acid irritation combined with bondage stress to establish an animal model of IBS.The colonic sensitivity of the intervention group rats was assessed by stool test and colorectal distension ( CRD) test.Hydrochloric acid toluidine blue staining was used to observe the number degranulation phenomenon of mast cells in the ileocecum.Results On the 7th day, the number of soft feces was 8 and loose stool was 4 in the model group, significantly higher than that in the bondage stress group(0 and 0) (P<0.05),and normal control group (1 and 0) (P<0.05).On the 10th day, when the AWR=2, the average rectal distension volume was 1.2 mL, significantly lower than that in the bondage stress group(1.37mL) (P <0.05),also significantly lower than in the normal control group (1.49 mL) (P<0.05), and when the AWR=4, the average rectal distension volume was 1.49 mL, significantly lower than that in the bondage stress group(1.74mL) (P<0.05),and the normal control group (1.77 mL) (P<0.05).These results indicated that the visceral sensitivity of the model group was significantly higher than that in the bondage stress group and normal control group.Histological analysis showed that the rats of all groups had no obvious inflammatory changes.Conclusions Chronic bondage stress combined with intra-colonic infusion of 0.4%acetic acid irritation can be used to increase the visceral sensitivity and amount and degranulation of mast cells in the intestinal tissue in rats.This established rat model shows pathogenetic changes resembling the pathogenesis of human irritable bowel syndrome, and provides a useful animal model for further studies of the pathogenesis of this disease.

Epithelial-mesenchymal transition( EMT ) and mesenchymal-epithelial transition are involved in the process of development of tissues and organs in embryonic stage. Currently studies are focused on the relationship between EMT and tumor invasion and metastasis. This article reviewed the role of EMT in the occurrence and development of gastric cancer by analyzing the relationship between EMT and gastritis,gastric mucosal barrier,initiation of gastric carcinogenesis, metastasis and invasion,drug resistance and immune escape which may provide insights to the pathologic mechanism and approaches to prevent and treat gastric cancer.