INTRODUCTION:Endoscopic retrograde appendicitis therapy (ERAT) is a new and noninvasive endoscopic technique originally developed by Liu in China for the management of acute appendicitis. Although its safety and efficacy have been extensively validated in adult populations, evidence regarding its use in pediatric patients remains scarce. The aim of this study was to evaluate the clinical outcomes of ERAT in pediatric appendicitis. METHODS:This retrospective study analyzed pediatric patients who underwent ERAT in our hospital between January 2019 and August 2022. Data collected included patient demographics, the success rate of ERAT, and the duration of hospital stay. In addition, recurrence rates were assessed during the follow-up to evaluate the safety and long-term efficacy of the procedure. RESULTS:A total of 73 patients were included in this study. Appendiceal intubation was successfully performed in 72 of 73 patients (98.63%). Among these patients, 72.22% of patients had appendiceal fecal stones or food residue, and the success rate of stone removal was 94.23%. Overall, the clinical success rate of the procedure was 91.78%. The median procedure time was 22 minutes (interquartile range 15-36.5), and the median postoperative hospital stay was 2 days (interquartile range 1-4). During the 1-year follow-up, 14.92% of the patients had recurrent appendicitis. DISCUSSION:ERAT seems to be a safe and effective alternative approach to treat appendicitis in pediatric patients, especially for obstructive appendicitis with appendicolith.

Aims The aim of this study was to determine the baseline characteristics, diagnosis, and management of stump appendicitis (SA), and evaluate and compare the feasibility, safety and efficacy of treating SA with surgical approaches and endoscopic retrograde appendicitis therapy (ERAT).

Background The etiological diagnosis of biliary stricture remains a clinical challenge. Currently, endoscopic retrograde cholangiopancreatography (ERCP)-guided biliary biopsy is the most commonly used technique. This retrospective study aimed to evaluate the clinical value of percutaneous transhepatic intraluminal forceps biopsy (TIFB) in patients with biliary stricture after ERCP failure. Methods The clinical data of 240 consecutive patients with biliary strictures who sought further etiologic diagnosis at our center between April 2014 and January 2020 were collected. After the exclusion of 197 patients who underwent ERCP-guided biopsy, 43 patients who received TIFB after ERCP failure were included in the study. The primary outcomes were technical success, sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy. Secondary outcomes included procedure duration, radiation exposure, liver function [total bilirubin (TB), direct bilirubin (DB), γ-glutamyl transferase (GGT), alkaline phosphatase (ALP), alanine aminotransferase (ALT), and aspartate aminotransferase (AST)] preoperatively and at 2 weeks postoperatively, and complications. Results The technical success rate of TIFB was 100%. The diagnostic sensitivity, specificity, accuracy, PPV, and NPV of TIFB were 82.35%, 100%, 86.05%, 100%, and 60%, respectively. The accuracy of TIFB was significantly higher for cases with suspicious biliary tract invasion on imaging and intrabiliary malignant origin than it did for cases with no suspicious biliary tract invasion on imaging or extrabiliary malignant origin (P=0.007 and P=0.003, respectively). Only intrabiliary malignant origin (P=0.02) was an independent contributing factor for a true positive result in TIFB diagnosis. The mean procedure duration was 19.3 minutes and the mean radiation exposure was 315.6 mGy. All liver function markers were significantly reduced after 2 weeks (all P<0.001). Three (6.97%) complications occurred, including 1 (2.33%) case of cholangitis and 2 (4.65%) cases of hemobilia. Conclusions Percutaneous TIFB is an effective method with high sensitivity and accuracy for the etiological diagnosis of biliary stricture after ERCP failure.

Objective:To evaluate endoscopic retrograde appendicitis therapy in treatment of children with acute uncomplicated appendicitis.Methods:Sixty children patients were admitted at the Affiliated Hospital of Zhengzhou University from Oct 2019 to Jun 2021 and were divided into ERAT group ( n=30) and LA group ( n=30). Results:All operations were successfully performed . ERAT children started oral feeding earlier [(6.8±2.0) h vs. (12.3±2.0) h, t=-10.636, P<0.001], postoperative hospital stay was shorter [(3.2±1.3) d vs. (5.0±1.3) d, t=-5.360, P<0.001]. After 14 months follow up, the recurrence rate in the ERAT group was 6%. The complication rate of LA was 10%. Conclusion:ERAT is a safe and effective therapy in treating children with acute uncomplicated appendicitis with low,acceptable recurrence rate.

Background This study aimed to investigate the diagnostic and therapeutic value of a digital single-operator cholangioscope (SOC) system for endoscopic management of acute appendicitis. Methods 14 patients with acute uncomplicated simple or supportive appendicitis were evaluated between November 2018 and September 2020. The diagnosis of acute appendicitis was confirmed by direct colonoscopy imaging and cholangioscope. The success rate of digital SOC-assisted endoscopic retrograde appendicitis therapy (ERAT), the procedure time, postoperative length of hospital stay, complications, and recurrence rate were recorded. Results Technical success rate was 100%, with high quality imaging of the appendiceal cavity achieved using SOC in all 14 patients. The mean procedure time was 37.8 (standard deviation [SD] 22) minutes. All patients experienced immediate relief from abdominal pain after the procedure. Mean postoperative hospitalization was 1.9 (SD 0.7) days. No recurrence occurred during 2-24 months of follow-up. Conclusion Digital SOC-assisted ERAT provided a feasible, safe, and effective alternative approach for diagnosis and management of acute uncomplicated appendicitis without the need for X-ray or ultrasonic guidance.

A 19-year-old man presented to the emergency clinic with a 5-hour history of acute right lower abdominal pain. He had no associated fever, diarrhea, or vomiting and no obvious abnormal results from routine blood tests and C-reactive protein level. Physical examination showed tenderness in the right lower abdomen, no rebound pain, and muscle tension. Abdominal US, performed as part of the evaluation for appendicitis, revealed enlargement of the appendix, with a diameter of 8 mm and appendiceal fecaliths. Acute appendicitis was considered in the preliminary clinical diagnosis. Because he was a college student and had an important examination to take the next day, we decided to perform endoscopic retrograde appendicitis therapy after communicating with the patient. Endoscopic retrograde appendography revealed a long curved appendix, measuring approximately 18 cm (A). Several fecal stone shadows were seen after injection of sufficient contrast medium into the appendix cavity (B). We intubated the appendix through colonoscopy and rinsed it with normal saline solution to flush out the fecal stone (C). No filling defect was found by repeated appendography (D). The patient’s abdominal pain was relieved immediately, and he successfully participated in the examination the next day. He reported no recurrence of symptoms at a follow-up visit 2 years later.

To compare the efficacy and feasibility of endoscopic retrograde appendicitis therapy (ERAT) with appendectomy for treating acute uncomplicated appendicitis. This was a prospective multicenter randomized trial in which consecutive patients were randomized at a ratio of 1:1 to receive either ERAT or appendectomy. The outcomes included technical success rate, procedure time, postoperative pain relief, postoperative analgesic use, time to soft diet intake, length of postoperative hospital stay, postoperative complications, and recurrence rate. From August 2013 to December 2015, 110 patients with acute uncomplicated appendicitis were randomized to ERAT or appendectomy. The technical success rate was 94.55% for ERAT compared with 100% for appendectomy. Recurrence of appendicitis within 3-year follow-up occurred in 8 patients following ERAT. Postoperative abdominal pain was less frequent with ERAT than with appendectomy (21.15% [11/52] vs 87.27% [48/55], P  < 0.001). Soft diet intake begun earlier after ERAT than appendectomy (6 h vs 48 h, P  < 0.001), and post-procedure hospital stay was shorter (3 days vs 5 days, P  < 0.001), as was the use of analgesics postoperatively (9.09% vs 49.09%, P  < 0.001). ERAT is a feasible, safe, and effective alternative approach for the management of acute uncomplicated appendicitis. Compared with appendectomy, advantages of ERAT include no skin wound, organ preservation, reduced postoperative pain, early food intake, quick recovery, fewer postoperative complications, and shorter post-procedure hospitalization. The unsolved problem related to ERAT is the recurrence of appendicitis.

女，3岁。因"确诊急性髓系白血病M5 1年余，转移性右下腹痛4天"于2020年5月11日转入郑州大学第一附属医院。2019年3月曾在郑州大学第一附属医院小儿内科确诊急性髓系白血病M5型，经规律化学药物治疗后获得完全缓解。2020年3月患儿复查骨穿结果提示AML-M5复发，入院续行DAH方案化学药物治疗。4 d前，患儿化学药物治疗期间出现脐周疼痛，而后疼痛转移至右下腹，伴发热，热峰38. 4 ℃，腹泻2次，大便呈稀糊状，无恶心、呕吐等不适。腹部彩色多普勒超声提示：右下腹阑尾区盲管样回声（考虑阑尾炎）。给予美罗培南及奥硝唑治疗后体温恢复正常，腹痛仍持续。经会诊后转入小儿外科。体格检查：体温36. 4℃，脉搏108次/min，呼吸27次/min，血压98/52 mmHg(1 mmHg=0. 133 kPa）。神志清，精神可。腹部平坦，脐周及右下腹压痛明显，无腹肌紧张、反跳痛，移动性浊音阴性，听诊肠鸣音3次/min，心肺体格检查未见异常。血常规结果：白细胞3. 79×10 9/L，血小板100×10 9/L，中性粒细胞百分数57. 7%，C反应蛋白20. 9 mg/L。超声提示：右下腹可见约18 mm×7. 7 mm的阑尾管状回声，壁厚约2. 7 mm，直径约6. 6 mm，其旁肠管增宽，内透声差，肠壁结构不清晰。右下腹肠间隙见明显不规则液性暗区。CT提示：阑尾增粗，内见钙化灶。

A 33-year-old pregnant woman experienced migratory right lower quadrant pain twice, before and after gestation, respectively. US at the local hospital indicated appendicitis. Fearing a relapse and surgery, she was referred to our department.

Background Endoscopic retrograde appendicitis therapy (ERAT) is a new and minimally invasive technique for the treatment of acute appendicitis. This study aimed to assess the efficacy and clinical outcomes of ERAT versus laparoscopic appendectomy for patients with uncomplicated acute appendicitis. Methods We adopted propensity score matching (1:1) to compare ERAT and laparoscopic appendectomy in patients with uncomplicated acute appendicitis between April 2017 and March 2020. We reviewed 2880 patients with suspected acute appendicitis, of whom 422 patients with uncomplicated acute appendicitis met the matching criteria (ERAT 79; laparoscopic appendectomy 343), yielding 78 pairs of patients. Results The rate of curative treatment within 1 year after ERAT was 92.1 % (95 % confidence interval [CI] 83.8 % to 96.3 %). The percentage of patients recording visual analog scale values of ≤ 3 for pain at 6 hours after treatment was 94.7 % (95 %CI 87.2 % to 97.9 %) in the ERAT group, which was significantly higher than that in the laparoscopic appendectomy group (83.3 %; 95 %CI 73.5 % to 90.0 %). Median procedure time and median hospital length of stay were significantly lower in the ERAT group compared with the laparoscopic appendectomy group. At 1 year, the median recurrence time was 50 days (interquartile range 25–127) in the ERAT group. The overall adverse event rate was 24.4 % (95 %CI 14.8 % to 33.9 %) in the laparoscopic appendectomy group and 18.4 % (95 %CI 9.7 % to 27.1 %) in the ERAT group, with no significant difference between the two groups. Conclusion ERAT was a technically feasible method of treating uncomplicated acute appendicitis compared with laparoscopic appendectomy.

目的:制作一种适用于内镜黏膜下剥离术(ESD)操作训练的人工血液灌注离体猪胃模型.方法:取离体6h内的,保留有食管下段、胃周围网膜、十二指肠的新鲜(屠宰后6h内)完整的离体猪胃,分别于胃贲门部小弯侧、胃体部大弯侧、胃窦部小弯侧进行动脉和静脉插管.将离体猪胃套在塑料胃模型外侧,经插管动脉用静脉输液器以120 cmH2 O(1 cmH2 O=0.098 kPa)的压力输注抗凝猪全血,收集从静脉流出的灌注液再重复用于动脉灌注.利用该模型进行ESD操作训练.结果:人工血液灌注后离体猪胃呈粉红色,有血液灌注的胃黏膜色泽红润.贲门处灌注范围主要是胃小弯贲门侧2/3胃壁,胃大弯灌注部位主要是胃底和胃体大弯侧,胃窦四壁均可得到血液供应.ESD操作过程中可以观察到胃黏膜和黏膜下层的出血,出血程度为活动性渗血,未有喷射状出血.结论:人工血液灌注离体猪胃模型制备成功,并适用于ESD训练.

目的:探讨高氨诱导的肝细胞中凋亡相关长链非编码RNA(LncRNA)表达谱的变化.方法:将人正常肝细胞LO2细胞分为3组,对照组常规培养,高氨1组、高氨2组分别用10 mmol/L氯化铵溶液诱导24、48 h,以制备高氨肝细胞模型.应用人凋亡通路LncPathTM芯片筛选3组肝细胞差异表达的LncRNA和mRNA,并进行GO注释和KEGG通路分析,使用Cytoscope构建ceRNA网络图.结果:3组间差异表达的LncRNA有8个,差异表达的mR-NA有13个.GO注释和KEGG通路分析结果显示,差异表达LncRNA及mRNA主要参与的信号通路有孕激素介导的卵母细胞成熟通路、神经营养因子信号通路、卵母细胞减数分裂和MAPK信号通路;ceRNA网络分析结果提示MAPK12是LncRNA BAIAP3的靶基因.结论:LncRNA BAIAP3可能通过靶向MAPK12在高氨致肝细胞凋亡过程中发挥重要作用.

Background Alcohol-induced intestinal dysbiosis disrupts and inflammatory responses are essential in the development of alcoholic fatty liver disease (AFLD). Here, we investigated the effects of Fmo5 on changes in enteric microbiome composition in a model of AFLD and dissected the pathogenic role of Fmo5 in AFLD-induced liver pathology. Methods The expression profile data of GSE8006 and GSE40334 datasets were downloaded from the GEO database. The WGCNA approach allowed us to investigate the AFLD-correlated module. DEGs were used to perform KEGG pathway enrichment analyses. Four PPI networks were constructed using the STRING database and visualized using Cytoscape software. The Cytohubba plug-in was used to identify the hub genes. Western blot and immunohistochemistry assays were used to detect protein expression. ELISA assay was used to detect the levels of serum inflammatory cytokines. Lipid droplets in the cytoplasm were observed using Oil Red O staining. Apoptosis was detected using a TUNEL assay and flow cytometry analysis. ROS levels were detected using flow cytometry analysis. Nuclear translocation of NF-κB p65 was observed using immunofluorescence staining. Co-immunoprecipitation was used to detect the co-expression of PPARα and Fmo5 in L02 cells. 16S rDNA sequencing defined the bacterial communities in mice with AFLD. Results Fmo5 is a key DEG and is closely associated with the gut microbiota and PPAR signaling pathway. Gut microbiome function in AFLD was significantly related to the PPAR signaling pathway. AFLD induced shifts in various bacterial phyla in the cecum, including a reduction in Bacteroidetes and increased Firmicutes . Fmo5 and PPARα co-expression in cell and animal models with AFLD, which decreased significantly. Silencing of Fmo5 and PPARα aggravated the functions of AFLD inducing apoptosis and inflammatory response, promoting liver injury, and activating the NF-κB signaling pathway in vivo and in vitro . The NF-κB inhibitor abolished the functions of silencing of Fmo5 and PPARα promoting AFLD-induced apoptosis, inflammatory response, and liver injury. Conclusion Our data indicated that the co-expression of Fmo5 and PPARα was involved in AFLD-related gut microbiota composition and alleviated AFLD-induced liver injury, apoptosis, and inflammatory response by inhibiting the nuclear translocation of NF-κB p65 to inhibit the NF-κB signaling pathway.

Objective:To study the safety and effectiveness of endoscopic full-thickness resection(EFR) in the treatment of large gastric stromal tumors with diameter of 5-7 cm.Methods:Data of 36 patients with large gastric stromal tumors (5-7 cm) who received EFR or surgery (including laparoscopic and open surgery) in the First Affiliated Hospital of Zhengzhou University and confirmed by postoperative histopathology from January 2017 to October 2018 were retrospectively analyzed. Patients were divided into endoscopic group (9 cases) and surgical group (27 cases) according to different resection methods. The perioperative indicators and the total incidence of complications in the two groups were compared.Results:In terms of perioperative indicators, the median operation time of the endoscopic group was significantly longer than that of the surgical group (4.0 hours VS 2.0 hours, P<0.01), and the postoperative fasting time (4.55±0.88 days VS 6.22±2.24 days, t=-2.15, P=0.03) and hospital stay (6.88±1.26 days VS 10.03±2.90 days, t=-3.13, P<0.01) were significantly shorter than those of the surgical group. The median visual analogue scores (VAS) of abdominal pain of the endoscopic group on the first postoperative day (3 VS 6, P<0.01)and the third postoperative day (1 VS 3, P<0.01) were significantly lower than those of the surgical group. The hospitalization cost was significantly less than that of the surgical group (55±14.7 thousand yuan VS 73±24.3 thousand yuan, t=-2.11, P=0.04). In term of the total incidence of complications, the endoscopic group was 11.1% (1/9), which was higher than that of the surgical group [7.4% (2/27)], but there was no statistically significant difference( P=1.00). Conclusion:EFR is safe and effective in the treatment of large gastric stromal tumors (5-7 cm), and has the advantages of less invasiveness, rapid postoperative recovery, and lower hospitalization cost. But how to shorten the operation time is an urgent problem to be solved.

Question: A 26-year-old man presented with acute right lower abdominal pain was diagnosed with uncomplicated acute appendicitis after sonogram (Figure A, black arrow) and underwent endoscopic retrograde appendicitis therapy (ERAT). After routine bowel preparation, a colonoscope (GIT-H260; Olympus, Tokyo, Japan) was advanced and appendiceal orifice swelling was observed. A cone-shaped transparent cap was used to push Gerlach's valve aside, and a zebra guidewire was inserted into the appendiceal lumen, in which the catheter was guided.

Both endoscopic (laparoscopic) and robotic approaches to minimally invasive thyroidectomy have been developed, but none has gained widespread acceptance. 1 Camenzuli C. Schembri Wismayer P. et al. Transoral endoscopic thyroidectomy: a systematic review of the practice so far. JSLS. 2018; 22 (e2018.00026) Crossref PubMed Scopus (33) Google Scholar ,2 Holsinger F.C. Chung W.Y. Robotic thyroidectomy. Otolaryngol Clin North Am. 2014; 47: 373-378 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar Laparoscopic surgery requires 3 ports and a large working space. Transoral endoscopic thyroidectomy and hybrid natural orifice transluminal endoscopic surgery (NOTES) with the use of a vestibular approach has had success in producing a scar-free thyroidectomy 3 Anuwong A. Ketwong K. Jitpratoom P. et al. Safety and outcomes of the transoral endoscopic thyroidectomy vestibular approach. JAMA Surg. 2018; 153: 21-27 Crossref PubMed Scopus (157) Google Scholar ,4 Anuwong A. Transoral endoscopic thyroidectomy vestibular approach: a series of the first 60 human cases. World J Surg. 2016; 40: 491-497 Crossref PubMed Scopus (215) Google Scholar but also requires a large working space. Inspired by our pure NOTES experience, we hypothesized that flexible endoscopic thyroidectomy could be done by using a single operating channel and thus obviate the need for hybrid NOTES or laparoscopic instrument-assisted rigid endoscopic operations. We used an animal model to test this hypothesis. The study was undertaken after approval by and under the guidance of the ethics committee of the First Affiliated Hospital of Zhengzhou University.