BACKGROUND:Gastric cancer poses a serious threat to public health, and the current screening is of limited efficiency. Chromosomal copy number variation (CNV) is a major driver of gastric carcinogenesis, yet its stepwise evolution along the gastritis-carcinoma sequence remains poorly delineated. Dissecting the dynamic landscape of CNVs may yield crucial biomarkers for early risk stratification. METHODS:In this study, we performed cost-effective low-coverage whole-genome sequencing (LC-WGS) on 101 gastric mucosal specimens encompassing non-atrophic gastritis (NAG, n = 15), atrophic gastritis (AG, n = 35), high-grade intraepithelial neoplasia or early gastric cancer (HGIN/EGC, n = 33), and advanced gastric cancer (AGC, n = 18). RESULTS:The frequency of CNV at both the complete chromosome and chromosomal-arm level showed a stepwise increase along the gastritis-carcinoma sequence. Two novel quantitative indices, MaxZ and CountZ, were developed to respectively measure the magnitude and extent of chromosomal imbalance, both of which correlated strongly with histologic progression (ρ > 0.4, p < 0.001). Recurrent alterations included gains on chromosomes 20, 8q and 7p and losses on chromosomes 4, which accumulated along the sequence and may represent key CNV events underlying malignant transformation. Notably, clustering analysis identified a high-CNV subgroup within AG (n = 5) exhibiting CNV profiles resembling gastric cancer. CONCLUSIONS:These preliminary CNV signatures suggest potential value for identifying high-risk individuals in precancerous lesions, particularly within AG, and offer an exploratory molecular basis that may inform future early screening and diagnosis of gastric cancer.

ABSTRACTBackgroundEndoscopic submucosal dissection (ESD) is a widely utilized treatment for early esophageal cancer. However, the rising incidence of postoperative esophageal stricture poses a significant challenge, adversely affecting patients' quality of life and treatment outcomes. Developing precise predictive models is urgently required to enhance treatment outcomes.Materials and MethodsThis study retrospectively analyzed clinical data from 124 patients with early esophageal cancer who underwent ESD at Ningbo Medical Center Lihuili Hospital. Patients were followed up to assess esophageal stricture incidence. Binary logistic regression analysis was used to identify factors associated with post‐ESD esophageal stricture. A novel nomogram prediction model based on Systemic Immune‐inflammation Index (SII) was constructed and evaluated using receiver operating characteristic (ROC) curves, calibration curves, and decision curve analysis (DCA).ResultsROC curve analysis showed that the optimal value of SII for predicting esophageal stricture was 312.67. Both univariate and multivariate analyses identified lesion infiltration depth (< M2 vs. ≥ M2, p = 0.002), lesion longitudinal length (< 4 cm vs. ≥ 4 cm, p = 0.008), circumferential resection range (< 0.5, 0.5–0.75, ≥ 0.75, p = 0.014), and SII (< 312.67 vs. ≥ 312.67, p = 0.040) as independent risk factors for post‐ESD esophageal stricture. A novel nomogram prediction model incorporating these four risk factors was developed. Validation using ROC curve analysis demonstrated satisfactory model performance, while calibration curves indicated good agreement between model‐predicted risk and observed outcomes.ConclusionWe successfully constructed a novel nomogram prediction model based on SII, which can accurately and intuitively predict the occurrence of esophageal stricture after ESD, providing guidance for clinicians and improving treatment outcomes.

Pseudoaneurysms are uncommon but their rupture and bleeding can lead to serious complications and be fatal. We present here a case of a man in his late 70s who was transferred to our hospital with persistent gastrointestinal bleeding. One month prior to his admission, he had undergone surgery for a fracture to his left knee. Endoscopic examination found pulsating blood vessels on a duodenal ulcer, which suddenly ruptured and caused significant bleeding. Immediate endoscopic haemostasis was administered and the bleeding decreased. Considering the high rate of rebleeding that may occur with a pseudoaneurysm, the patient underwent interventional radiology that culminated in a diagnosis of a pseudoaneurysm originating from gastroduodenal artery (GDA); successful embolization was achieved. Tests showed that the patient had Helicobacter pylori infection. We hypothesised that the H. pylori infection had led to the occurrence of the duodenal bulb ulcer, and the patient’s left knee fracture and surgery a month previously had contributed to this predisposition for a pseudoaneurysm.

Ningbo Medical Centre Lihuili Hospital, China; Xiangshan County First People's Hopsital Medical Health Group, China; Ningbo Yinzhou Anorectal Hospital Co.,Ltd, China; Ningbo Municipal Hospital of TCM, China; Yuyao Hospital of T.C.M, China; Ninghai County Hospital of Traditional Chinese Medicine, China.

Background: To evaluate the value of the spectral CT parameters in predicting the risk of esophageal variceal bleeding in cirrhosis with portal hypertension and to provide a reference for clinical diagnosis and treatment. Methods: Seventy-eight patients were divided into an esophageal variceal bleeding group and a non- esophageal variceal bleeding group. A comparison of variables including age, gender, platelet count, Child-Pugh classification, and spectral parameters between the 2 groups was done. Baseline model and spectral model were constructed with conventional parameters and conventional parameters coupled with spectral parameters, respectively. The 2 models were analyzed by the Receiver Operating Characteristic (ROC) curve. Results: The baseline model was established based on 4 conventional parameters and evaluated by ROC curve analysis. The spectral model was constructed based on the variables in the baseline combined with normalized iodine density in the liver parenchyma for the arterial phase, normalized iodine density in the liver parenchyma for the portal phase, normalized iodine density in the splenic parenchyma for the portal phase, diameter of the main portal vein, diameter of the splenic vein, and normalized iodine density of the left gastric vein. Normalized iodine density of the left gastric vein, normalized iodine density in the liver parenchyma for the portal phase, and Child-Pugh classification were the influencing factors of esophageal variceal bleeding in cirrhosis patients. The Area Under Curve (AUC) for the baseline and spectral models were compared (0.664 vs. 0.860) and the difference was found to be statistically significant (P <.001). Conclusions: The use of spectral CT parameters in consort with the conventional parameters can improve the diagnostic effectiveness of esophageal variceal bleeding in cirrhosis cases and screen for high-risk esophageal variceal bleeding patients. It may also provide an objective basis for the clinical prevention and treatment of esophageal variceal bleeding.

Background Gastric varices (GV) with spontaneous portosystemic shunts (SPSS) pose considerable risks and challenges for administering endoscopic cyanoacrylate (CYA) injection. This study aimed to evaluate the efficacy and safety of EUS-guided coil embolization in combination with CYA injection compared to conventional endoscopic CYA injection for managing GV with SPSS. Methods This retrospective analysis included patients with SPSS treated with either EUS-guided coil embolization in combination with CYA injection or conventional CYA injection for gastric variceal bleeding at Ningbo Medical Center Lihuili Hospital (Zhejiang, China) between January 2018 and March 2023. Patient demographics, procedural details, and follow-up results were reviewed. Results The study evaluated 57 patients: 21 in the combined treatment group undergoing EUS-guided coil embolization in combination with CYA injection and 36 in the conventional group receiving conventional endoscopic CYA injection. Both cohorts achieved a 100% technical success rate. The mean volume of CYA used was significantly lower in the combined group (1.64 ± 0.67 mL) than in the conventional group (2.38 ± 0.72 mL; P < 0.001). Early GV rebleeding rates did not differ significantly between the groups; in contrast, the combined treatment group exhibited a considerably lower incidence of late GV rebleeding than the conventional group (4.8% vs 27.8%, P = 0.041). Conclusions EUS-guided coil embolization in combination with CYA injection demonstrated superiority over conventional endoscopic CYA injection in reducing late GV rebleeding in treating GV with SPSS.

OBJECTIVE:Liver cancer (LC) is a frequently occurring lethal malignancy worldwide, yet the molecular mechanisms of carcinogenesis and their development remain uncharacterized. In this study, bioinformatics methods were used to find candidate hub genes for prognosis assessment and clinical treatment of LC.METHODS:Differential analysis was carried out based on the evidence of gene expression profiling in LC on The Cancer Genome Atlas (TCGA). The differentially expressed genes (DEGs) were constructed into co-expression networks and divided into modules by virtue of weighted gene co-expression network analysis (WGCNA). Based on the Gene Ontology (GO) and the Kyoto Encyclopedia of Genes and Genomes (KEGG), the module genes were subjected to functional enrichment analysis. The LC microarray (GSE105130) in the Gene Expression Omnibus was selected to verify the hub genes' expression profiles. The validity of the hub genes was verified via survival analysis, as well as expression correlation with the clinicopathological features. Thereafter, gene set variation analysis (GSVA) and single-sample gene set enrichment analysis (GSEA) were applied to investigate the possible biological functions of the hub genes.RESULTS:In total, 3780 DEGs and 17 co-expression modules were obtained. The blue module had the strongest correlation with the tumour stage and the module genes were principally enriched in tumour-associated GO terms, as well as pathways such as Ras protein signal transduction, ERK1/2 cascade, Ras signal pathway, and ECM-receptor interaction. RASAL1, which is highly expressed in LC, was identified as a hub gene for LC progression. Its high expression suggested unfavorable patient prognosis and was correlated with T stage, gender and tumour stage. Further analysis identified that the overexpression of RASAL1 was substantially enriched in cancer-associated gene sets.CONCLUSION:RASAL1 is a hub gene that influences LC progression, constituting a novel biomarker and molecular target in the future diagnosis and therapy of LC.

目的 探讨能谱CT参数在评估肝硬化门脉高压患者的血流动力学变化及食管静脉曲张(EV)严重程度中的价值.方法 选取肝硬化门脉高压患者70例,在能谱碘图上测量肝动脉期和门脉期肝各叶碘浓度,同层面动脉期腹主动脉和门脉期门脉主干、脾实质、胃左静脉碘浓度.以胃镜为"金标准"将EV分为轻、中和重度,比较3组EV严重程度与每个能谱参数的差异及相关性.结果 3组肝动脉期标准化碘浓度(NIDLAP)、胃左静脉标准化碘浓度(LGVI)差异均有统计学意义(均P＜0.05),且与EV程度呈正相关(r=0.729、0.822,均P＜0.05).3组肝门脉期标准化碘浓度(NIDLVP)、脾实质门脉期标准化碘浓度(NIDSVP)差异均有统计学意义(均P＜0.05),轻度、中度组间差异无统计学意义(P＞0.05).NIDLVP与EV程度呈负相关(r=—0.477,P＜0.05),NIDSVP与EV程度呈正相关(r=0.378,P＜0.05).结论 能谱CT参数可客观反映肝脾血流动力学改变,评估肝硬化门脉高压患者EV的严重程度,其中LGVI与EV严重程度相关性最强,可作为EV严重程度的非侵入性随访观察指标.

目的 探讨内镜下黏膜剥离术(ESD)在非乳头十二指肠黏膜病变中的应用效果.方法 收集行ESD的十二指肠黏膜病变患者32例.评价ESD剥离效果,记录操作时间、术中及术后并发症及处理情况,分析剥离标本的病理学结果.结果 本组32例患者均一次性完整切除病变,剥离标本行全瘤病理检查,其中低级别上皮内瘤变6例,高级别上皮内瘤变8例,黏膜内腺癌5例,绒毛管状及管状腺瘤9例,淋巴瘤2例,Brunner腺瘤2例.手术操作时间45～112min,平均(60.7±25.4)min,切除标本长径1.0～3.5 cm.ESD术中发生小穿孔3例,均经内镜下软组织夹成功闭合,未发生气腹、腹膜炎、胆瘘、胰瘘等并发症.1例术中穿孔创口较大,内镜缝合未成功行外科腹腔镜修补,2例患者术后第3、4d出现大出血,经再次内镜止血夹治疗后出血停止.患者术后5～10d出院,术后3、6及12月内镜检查观察创面情况,随访3～30个月,3例患者因各种原因失访,其余患者随访病变无残留及复发.结论 ESD是一种治疗非乳头十二指肠黏膜病变安全、有效、简便的治疗方法,大部分病变都能完整剥离,由于十二指肠解剖结构的特殊性,更要警惕出血和穿孔等并发症的发生,必要时仍需要外科手术治疗.

目的 探究C-反应蛋白(CRP)及转化生长因子-β1(TGF-β1)和微小RNA-146a(miR-146a)在幽门螺杆菌(Hp)感染患者的表达及意义.方法 选取2019年2月-2020年2月于宁波市医疗中心李惠利东部医院消化内科收治的胃炎患者,根据是否为H p感染分为H p感染组181例和非H p感染组80例,采用酶联免疫吸附试验(ELISA)法检测CRP、TGF-β1水平,采用荧光定量PCR法(qRT-PCR)检测miR-146a表达量.结果 与非感染组比较,Hp感染组患者miR-146a、CRP、TGF-β1表达量均升高(P<0.05);miR-146a、CRP、TGF-β1表达量与Hp感染组患者性别、年龄无统计学差异;胃痛、反酸、烧心患者miR-146a、CRP、TGF-β1表达水平升高,差异均具有统计学意义(P<0.05);Pearson相关性分析显示,miR-146a与TGF-β1之间正相关(r=0.154,P=0.038);TGF-β1与CRP之间正相关(r=0.150,P=0.043);miR-146a与CRP之间正相关(r=0.161,P=0.029).结论 CRP、TGF-β1、miR-146a在幽门螺杆菌感染患者中呈现异常高表达,且与患者有无胃痛、有无反酸、有无烧心等症状相关,且三者呈正相关.

目的 探讨血清钙离子(Ca2+)水平与炎症性肠病(inflammatory bowel disease,IBD)疾病活动性的关系.方法 选取2007年1月至2018年12月宁波市医疗中心李惠利医院消化内科收治的IBD患者共120例,其中克罗恩病(CD)患者60例和溃疡性结肠炎(UC)患者60例,并选取同期在本院体检中心行常规体检的健康人群60例作为正常对照组,采用克罗恩病活动指数(CDAI)评分和简单临床结肠炎活动指数(SCCAI)评分分别用于评估CD和UC患者的疾病活动性,Spearman相关分析血清Ca2+水平与SCCAI、CDAI评分、PLT及CRP的相关性.结果 CD及UC组血清Ca2+及PLT水平比较差异均无统计学意义(均P>0.05),而在CD与正常组及UC与正常组之间的差异均有统计学意义(均P<0.05).UC患者血清Ca2+水平与SCCAI评分呈负相关(rs=-0.27,P<0.05),CD患者血清Ca2+水平与CDAI评分不相关(rs=-0.21,P>0.05).进一步分析CD患者的血清Ca2+水平与PLT及CRP的相关性,两者均呈负相关(rs=-0.32、-0.31,均P<0.05).结论 血清Ca2+水平在IBD患者的疾病诊断和疾病活动性评估中具有重要的临床意义.

目的 比较放大内镜(ME)、放大内镜联合窄带成像技术(ME-NBI)、放大内镜联合靛胭脂染色(ME-IDC)及放大内镜联合靛胭脂染色与窄带成像技术(ME-IDC-NBI)对早期胃癌的诊断价值.方法 因癌前病变或早期胃癌行内镜下黏膜剥离术治疗患者185例,先后行ME、ME-NBI、ME-IDC及ME-IDC-NBI检查,以术后病理结果为“金标准”,统计分析各项检查与病理诊断的一致性,并比较其对早期胃癌诊断的准确性.结果 185例患者术后病理结果显示,癌性病变107例,非癌性病变78例.ME、ME-NBI及ME-IDC与病理诊断一致性一般(k=0.62、0.74、0.72,均P＜0.01),ME-IDC-NBI与病理诊断一致性好(k=0.86,P＜ 0.01).MEI-NBI、ME-IDC及ME-IDC-NBI诊断早期胃癌准确率均高于ME(均P＜0.05);ME-IDC-NBI准确率均高于ME-NBI与ME-IDC(均P＜ 0.05).结论 ME联合NBI或IDC均能提高对早期胃癌的诊断准确性,与病理结果有较好的一致性,而ME与NBI及IDC相结合后,对早期胃癌的诊断则更具优势.

目的 探究超声造影定量分析在脾脏钝性创伤中的预测价值.方法 对2015年1月—2018年8月间于宁波市医疗中心李惠利东部医院就诊的可疑脾脏顿性创伤的腹部外伤患者86例进行回顾性分析,所有患者均行多通道增强螺旋CT(CE-MDCT)、超声造影(CEUS)和多普勒超声(US)检查,以CE-MDCT对脾脏钝性创伤的诊断作为金标准,将腹部外伤的患者分为脾脏创伤组(34例)和非脾脏创伤组(52例),比较不同脾脏创伤情况患者的临床资料,绘制受试者工作曲线(ROC)并评价CEUS定量分析和US预测脾脏钝性创伤的效能.结果 脾脏创伤组患者的US定量值、AT、TTP和WT明显高于非脾脏创伤组,PI显著低于非脾脏创伤组(均P ＜0.05).ROC曲线显示,CEUS中的AT、TTP、WT和PI预测脾脏钝性创伤的AUC显著高于US(均P ＜0.05),但AT、TTP、WT和PI之间的AUC差异无统计学意义(均P＞ 0.05).其中,CEUS各指标预测脾脏钝性创伤的最佳截点为AT≥8.187 s,TTP≥61.482 s,WT≥88.351 s,PI≥18.731 db,AT、TTP、WT和PI预测脾脏钝性创伤的诊断灵敏度均明显高于US.结论 CEUS定量分析在预测脾脏钝性创伤中有较高价值,其中AT≥8.187 s,TTP≥61.482 s,WT≥88.351 s,PI≥18.731 db可作为脾脏钝性创伤的参考指标.

Background.The aim of our study was to investigate whether serum cholinesterase (ChE) levels were associated with inflammatory bowel disease (IBD).Materials and Methods. We conducted a retrospective case-control study to clarify the relationship between serum ChE levels and IBD that included 142 patients with ulcerative colitis (UC), 60 patients with Crohn's disease (CD), and 264 healthy controls (HCs). We used ROC curves to evaluate the diagnostic value of serum ChE levels for IBD.Results. Substantially lower serum ChE levels were detected in patients with UC than in HCs (6376 U/L versus 8418 U/L,P<0.001) and in patients with CD than in HCs (5181 U/L versus 8418 U/L,P<0.001). Additionally, patients with CD displayed significantly lower serum ChE levels than patients with UC (5181 U/L versus 6376 U/L,P<0.01). We also found that there was a negative association between serum ChE levels and the Crohn's Disease Activity Index (CDAI) score of patients with CD (P=0.011) and the Simple Clinical Colitis Activity Index (SCCAI) score of patients with UC (P=0.018). The area under the curve (AUC) for serum ChE for the diagnosis of IBD was 0.826, and the AUCs of serum ChE for the diagnosis of CD and UC were 0.890 and 0.800, respectively.Conclusions. Serum ChE levels have important clinical significance in the diagnosis and assessment of clinical activity in patients with IBD, and the cholinergic anti-inflammatory pathway may provide new ideas for targeted treatment of IBD.

目的 探讨胃黏膜病变经内镜下黏膜剥离术(ESD)后影响溃疡愈合的危险因素.方法 回顾性分析2015年11月至2018年10月因胃黏膜病变行胃ESD患者的临床资料,应用logistic回归统计分析相关因素:(1)患者因素:性别,年龄,是否有高血压、糖尿病、其他慢性病等既往病史,是否有手术史、吸烟、饮酒史,幽门螺杆菌(Hp)感染等;(2)病变因素:病变大小,病变部位,病变形态、病理类型.结果 纳入病例152例,有11例患者ESD术后复查胃镜提示溃疡未愈合.通过logistic回归分析发现,ESD术后溃疡未愈合主要与Hp感染相关.3例患者有2次早期胃癌ESD手术病史,且2次手术间隔>1年,并均有Hp感染,但由于病例数偏少,未能进一步统计分析.结论 Hp感染是影响胃ESD术后溃疡愈合的危险因素,而术后未及时根除Hp或Hp根除后再感染可能是导致ESD术后异时性胃癌发生的可能原因.

目的 探究同时性多发早期胃癌(SMEGC)的临床病理学特征以及主要病灶与次要病灶之间的相关性.方法 回顾性研究2016年1月-2019年4月在宁波市医疗中心李惠利医院经内镜黏膜下剥离术(ESD)治疗的305例早期胃癌患者的病历资料,收集患者的年龄、性别、肿瘤宏观形态、位置、直径、有无溃疡、表面有无发红、组织病理学类型和浸润深度等情况,分析SMEGC与单发早期胃癌的临床病理特征的差异以及主次病灶之间的相关性.结果 所有早期胃癌患者中,25例(8.2％)为SMEGC,280例(91.8％)为单发早期胃癌;SMEGC患者年龄>60岁的比例(76.0％,19/25)高于单发早期胃癌(52.9％,148/280);肿瘤直径≤2.00 cm的比例(68.0％,17/25)高于单发早期胃癌(46.1％,129/280),差异有统计学意义(P<0.05).两组患者性别、肿瘤宏观形态、位置、有无溃疡、表面有无发红、组织病理学类型、浸润深度差异均无统计学意义(P>0.05).SMEGC主要病灶直径明显大于次要病灶,差异有统计学意义(P<0.05).而主次病灶的肿瘤宏观形态、位置、有无溃疡、表面有无发红、组织病理学类型和浸润深度差异均无统计学意义(P>0.05).结论 SMEGC的预测危险因素是60岁以上的患者、直径不超过2.00 cm的肿瘤,主次病灶的临床病理特征相似,包含这些因素的早期胃癌患者应该进行更仔细的内镜检查,注意主次病灶间的相关性,提高SMEGC的检出率.

BACKGROUND:The short-term and long-term effect of Helicobacter pylori (H pylori) eradication on the gut microbiota is controversial; hence, this study aimed to clarify changes in the gut microbiome and microbial diversity after H pylori eradication. MATERIALS AND METHODS:Articles published in PubMed, MEDLINE, and EMBASE were searched up to March 20, 2020, with English-language restriction. The outcomes including gut microbiota and alpha diversity were extracted to analysis. And then, Review Manager 5.3 software was used to conduct the data analysis. RESULTS:At phylum level, next-generation sequencing was performed. Meta-analysis results showed that Actinobacteria decreased compared with baseline throughout the follow-up period. Proteobacteria increased during short-term follow-up and then returned to normal. In addition, Bacteroidetes decreased and Firmicutes increased only during long-term follow-up. At family or genus level, conventional microbiological culturing was performed. Enterobacteriaceae and Enterococcus both increased during the short-term and interim follow-up. In addition, Lactobacillus only showed a decreasing trend during short-term follow-up, but it appeared statistical decreasing during interim follow-up. Moreover, relatively sufficient evidence showed that alpha diversity decreased during short-term follow-up, and no reliable data were obtained to confirm the change of alpha diversity during interim and long-term follow-up. CONCLUSION:In different follow-up periods after H pylori eradication, changes in gut microbiota were inconsistent. Microbial diversity decreased in the short-term follow-up, while there was no data to confirm subsequent alterations. The results provided a basis for the rational selection of probiotics in the eradication process. However, further studies are needed to obtain more clues.

本文报道1例早期胃癌合并胃黏膜相关淋巴组织淋巴瘤伴原位滤泡肿瘤的患者.通过术前精查,内镜黏膜下剥离术的选择,术后根据病理制定治疗方案及严密随访等规范化治疗,为早癌合并多种淋巴瘤的诊治提供新的借鉴.

目的 探讨超声内镜引导下弹簧线圈置入联合组织胶注射栓塞治疗胃底静脉曲张伴自发性分流的安全性及治疗效果.方法 对6例确诊为胃底静脉曲张伴自发性分流的患者进行回顾性研究,观察术中栓塞治疗后曲张静脉的闭塞成功率,术后48 h及1周的再出血率,异位栓塞等其他不良事件的发生率以及1个月后复查的超声内镜.结果 所有患者在超声内镜引导下均成功置入弹簧线圈及注射组织胶,手术过程顺利,操作结束后经多普勒证实所有患者曲张静脉血流均消失,靶血管均成功闭塞,术后48 h及1周均未发生再出血.术后1周复查门静脉CTA,弹簧线圈均留置于靶血管,均未出现移位,所有患者均未出现异位栓塞.术后1个月复查超声胃镜,所有患者靶血管曲张静脉血流消失,成功闭塞.结论 超声内镜引导下弹簧线圈置入联合组织胶注射栓塞治疗胃底静脉曲张伴自发性分流患者的近期治疗效果是安全且有效的.