Raman-based methods offer a promising approach for in vivo biological detection. However, the fluorescence of biological samples will significantly affect Raman measurement accuracy. Moreover, due to the existence of excitation wavelength-dependent fluorescent molecules in biological tissues, especially porphyrin molecules, the fluorescence also exhibits significant wavelength dependence. To achieve high-quality Raman spectra of biological tissue, in this work we proposed a dual-wavelength Raman method. Two lasers with different wavelengths were used to excite optical signals in the same region, and the ordinary fluorescence and additional wavelength-dependent fluorescence in the biological samples could be eliminated by two-step normalization calibration; thus, the accuracy of Raman measurement was significantly enhanced. We applied this method to early cancer diagnosis and identified several molecules and structures worthy of attention in carcinogenesis for esophageal tissue, such as phenylalanine and the CC bonds of porphyrins. Normal, precancerous, and early cancer samples were successfully identified by the changes in biomolecules with associated degrees of malignancy. Thus, the imaging and diagnosis of indefinite tumors were realized, which verified the potential of the dual-wavelength Raman method in biological detection.

Background: Gastric cancer is a malignant tumor with high morbidity and mortality. Therefore, the accurate recognition of prognostic molecular markers is the key to improving treatment efficacy and prognosis. Methods: In this study, we developed a stable and robust signature through a series of processes using machine-learning approaches. This PRGS was further experimentally validated in clinical samples and a gastric cancer cell line. Results: The PRGS is an independent risk factor for overall survival that performs reliably and has a robust utility. Notably, PRGS proteins promote cancer cell proliferation by regulating the cell cycle. Besides, the high-risk group displayed a lower tumor purity, higher immune cell infiltration, and lower oncogenic mutation than the low-PRGS group. Conclusions: This PRGS could be a powerful and robust tool to improve clinical outcomes for individual gastric cancer patients.

Few studies have provided data on the metabolomics characteristics of metabolic diseases such as hyperuricemia and hyperbilirubinemia in the Tibetan plateau. In the current study, we sought to investigate the serum metabolomics characteristics of hyperbilirubinemia and hyperuricemia in the Tibetan plateau, with the aim to provide a basis for further research on their pathogenesis, prevention, and treatment. The study participants were born in low-altitude areas below 1000 m and had no prior experience living in a high-altitude area before entering Golmud, Tibet (average elevation: 3000 m) and Yushu, Qinghai (average elevation: 4200 m). Thirty-four participants with hyperbilirubinemia (18 in Golmud and 16 in Yushu), 24 participants with hyperuricemia, and 22 healthy controls were enrolled. The serum samples of subjects were separated and then sent to a local tertiary hospital for biochemical examination. Serum widely targeted technology, based on the ultra-performance liquid chromatography tandem mass spectrometry (UPLC-MS/MS) platform, was used to detect serum metabolites and differential metabolites. Compared to the healthy controls, hyperbilirubinemia patients from Golmud showed 19 differential metabolites, hyperbilirubinemia patients from Yushu showed 12 differential metabolites, and hyperuricemia patients from Yushu showed 23 differential metabolites. Compared to the hyperbilirubinemia patients from Golmud that is at a low altitude, the Yushu groups had 33 different metabolites. Differential metabolites are primarily classified into amino acids and their derivatives, nucleotides and their derivatives, organic acids and their derivatives, and lipids/fatty acids. These are related to metabolic pathways such as caffeine metabolism, arachidonic acid metabolism, and tyrosine metabolism. Hyperbilirubinemia and hyperuricemia in the Tibetan plateau have unique serum metabolomics characteristics. Glycine derivatives and arachidonic acid and its derivatives were associated with plateau hyperbilirubinemia, and vanillic acid and pentadecafluorooctanoic acid were associated with plateau hyperuricemia.

BACKGROUND & AIMS: The Asia-Pacific Colorectal Screening (APCS) scoring system was developed to stratify the risk of colorectal advanced neoplasm (AN). We aimed to evaluate the performance of the APCS score combined with a stool DNA test used for colorectal cancer screening.METHODS: A total of 2842 subjects who visited outpatient clinics or cancer screening centers were enrolled. Age, sex, smoking status, and family history were recorded and APCS scores were calculated in 2439 participants. A stool DNA test (SDC2 and SFRP2 tests) and fecal immuno-chemical test (FIT) were performed and colonoscopy was used as the gold standard among 2240 subjects who completed all study procedures. We used a threshold of 4.4 mu g/g for the FIT, in addition to the manufacturer's recommended threshold of 20 mu g/g to match the specificity of a stool DNA test.RESULTS: Based on the APCS score, 38.8% (946 of 2439) of the subjects were categorized as high risk, and they had a 1.8-fold increase in risk for AN (95% CI, 1.4-2.3) compared with low and moderate risk. The APCS combined with the stool DNA test detected 95.2% of invasive cancers (40 of 42) and 73.5% of ANs (253 of 344), while the colonoscopy workload was only 47.1% (1056 of 2240). The sensitivity for AN of APCS combined with stool DNA test was significantly higher than that of APCS combined with FIT (73.5% vs 62.8% with FIT cut-off value of 20 mu g/g, and 73.5% vs 68.0% with FIT cut-off value of 4.4 mu g/g; both P < .01).CONCLUSIONS: The APCS score combined with a stool DNA test significantly improved the detection of colorectal ANs, while limiting colonoscopy resource utilization (Chictr.org.cn, ChiCTR-DDD-17011169).

Despite universal endoscopic screening, early detection of gastric cancer is challenging, led researchers to seek for a novel approach in detecting. Raman spectroscopy measurements as a fingerprint of biochemical structure, enable accurate prediction of gastric lesions non-destructively. This study aimed to evaluate the diagnostic power of Raman spectroscopy in early gastric cancer (EGC), and reveal dynamic biomolecular changes in vitro from normal to EGC. To clarify the biochemical alterations in Correa's cascade, Raman spectra of human normal gastric mucosa, intestinal metaplasia, dysplasia, and adenocarcinoma were compared at tissue and cellular levels based on a self-developed data processing program. For effectively identify EGC, Raman spectroscopy was used combined with multiple machine learning methods, including partial least-squares discriminant analysis (PLS-DA), support vector machine (SVM), and convolutional neural network (CNN) with leave-one-out (LOO) cross validation. A total of 450 Raman spectra were investigated in this study. The upregulation of nu sym(O-P-O) backbone (p < 0.001) was identified as a favorable factor for the diagnosis of EGC, the area under the ROC curve (AUC) was up to 0.918. In addition, higher levels of lactic acid (p < 0.001), lipids (p < 0.001), phenylalanine (p = 0.002), and carotenoids (p < 0.001) were detected in EGC. Multivariate machine learning methods for diagnosis of EGC based on Raman spectroscopy, the sensitivity, specificity, accuracy, and AUC were 91.0%, 100%, 94.8%, and 95.8% for SVM, and 84.8%, 92.0%, 88.8%, and 95.5% for CNN, respectively. Raman spec-troscopy can be used as a powerful tool for detecting EGC while elucidating biomolecular dynamics in tumor-igenesis. (Chictr.org.cn, ChiCTR2200060720.)

目的 探讨Over-The-Scope-Clip system(OTSC)治疗难治性消化道瘘的应用价值.方法 收集2018年11月至2021年12月于中国人民解放军总医院第七医学中心接受内镜下OTSC治疗的12例难治性消化道瘘患者临床资料,评价OTSC疗效.结果 12例难治性消化道瘘患者共17处病变,包括食管气管瘘5例,食管纵隔瘘、食管胃吻合口瘘、食管小肠吻合口瘘、十二指肠瘘各1例,直肠阴道瘘2例、直肠吻合口瘘1例,男6例,女6例,年龄(52.2±14.7)岁(23～75岁).瘘口形成时间为(6.3±6.7)个月(1～24个月);瘘口边缘全瘢痕占比83.3％;瘘口黏膜厚度(0.5±0.1)cm(0.2～0.8 cm);瘘口直径(0.6±0.6)cm(0.3～2.5 cm),其中<1.0 cm 8例、1.0～2.0 cm 3例、>2.0 cm 1例.术后随访,7例实现黏膜愈合,2例因瘘口未愈合追加外科手术,2例置入食管支架,1例自行愈合;OTSC治疗成功率为58.3％.进一步分析临床特征,OTSC操作成功率在直肠瘘中显著低于非直肠瘘,差异有统计学意义(0 vs 77.8％,P=0.045);失败组OTSC操作时间显著长于成功组,差异有统计学意义[(15.0±4.9)min vs(7.9±5.4)min,U=4.00,P=0.03].结论 OTSC是治疗难治性消化道瘘的有效方法,但需进一步掌握适应证、控制操作时间.

Colorectal cancer (CRC), a commonly diagnosed cancer often develops slowly from benign polyps called adenoma to carcinoma. Altered gut microbiota is implicated in colorectal carcinogenesis. It is warranted to find non-invasive progressive microbiota biomarkers that can reflect the dynamic changes of the disease. This study aimed to identify and evaluate potential progressive fecal microbiota gene markers for diagnosing advanced adenoma (AA) and CRC. Metagenome-wide association was performed on fecal samples from different cohorts of 871 subjects (247 CRC, 234 AA, and 390 controls). We characterized the gut microbiome, identified microbiota markers, and further constructed a colorectal neoplasms classifier in 99 CRC, 94 AA, and 62 controls, and validated the results in 185 CRC, 140 AA, and 291 controls from 3 independent cohorts. 21 species and 277 gene markers were identified whose abundance was significantly increased or decreased from normal to AA and CRC. The progressive gene markers were distributed in metabolic pathways including amino acid and sulfur metabolism. A diagnosis model consisting of four effect indexes was constructed based on the markers, the sensitivities of the Adenoma Effect Index 1 for AA, Adenoma Effect Index 2 for high-grade dysplasia (HGD) adenoma were 71.3

Objective:To study the effectiveness of a strategy for detecting early gastric cancer using high-definition gastroscopy.Methods:A total of 849 patients over 35 years old who underwent gastroscopy in the Seventh Medical Center of PLA General Hospital from December 2018 to January 2019 were enrolled to a prospective study. During gastroscopy, biopsies were taken at any suspicious lesions in patients who had never been infected with Helicobacter pylori. In ulcer-type lesions, biopsies were taken at the edge of the ulcer. Outside the atrophic area, biopsies were taken at lesions in the cardia which were reddish under white light, or lesions in the non-cardiac area which were white or showed clear borders under white light. Inside the atrophic area, biopsies were taken at elevated lesions with clear borders or irregular depressions on the top, or flat/depressed lesions with irregular borders or being ocherous under narrow band imaging. In addition, biopsies were performed on any lesion that did not meet the above standard but was considered necessary. The high-risk patients were followed up by gastroscopy to observe the detection and missed diagnosis of neoplasm that meet the above standard, and to determine the sensitivity and positive predictive value of the strategy. Results:A total of 548 patients were biopsied (781 lesions). Among the 327 lesions that met the above standard, 16 lesions (4.9%) were diagnosed as epithelial neoplasm, of which 10 (3.1%) were high-grade neoplasm. Among the 454 lesions that did not meet the standard, only 1 (0.2%) epithelial neoplasm was diagnosed, and there was no high-grade neoplasm. The positive predictive value of this screening strategy for gastric epithelial neoplasm and high-grade neoplasm was higher than those who did not meet the standard (4.9% VS 0.2%, χ2=19.49, P<0.01; 3.1% VS 0, P<0.001). There were 146 patients (17.2%, 146/849) followed up by gastroscopy. During the follow-up, 2 high-grade intramucosal neoplasms were found. 84.2% (16/19) of epithelial tumors and 83.3% (10/12) of high-grade neoplasm were detected during the initial gastroscopy. Conclusion:This screening strategy can efficiently detect early gastric cancer under high-definition gastroscopy.

Objective To systematically evaluate the efficacy and safety of endoscopic resection and laparoscopic surgery for gastrointestinal stromal tumors(GIST)(diameter<3. 5 cm). Methods According to the Cocharane system search strategy,Chinese and English literature comparing endoscopic with laparoscopic treatment of GIST published from January 2000 to March 2018 were collected. Ten articles meeting the inclusion criteria were included and analyzed with Revman 5. 3. Results Of the 10 articles,1 was a prospective randomized controlled trial and 9 were retrospective non-randomized controlled trials. The total number of patients was 1062. There were 732 cases in the endoscopic treatment group,and 330 cases in the laparoscopic surgery group. The meta-analysis results showed that the endoscopic treatment group had shorter operation time (MD= -30. 58 min,95％CI:-39. 31--21. 84,P<0. 05),less blood loss (MD= -12. 99 mL, 95％CI:- 16. 40-- 9. 57,P < 0. 05),shorter hospital stay (MD = - 3. 17 d,95％CI:-4. 76--1. 59,P <0. 05),and less total cost (MD= -1. 63 ten thousand RMB,95％CI:-2. 42--0. 84,P<0. 05)than those of the laparoscopic group. But there were no significant differences in the positive rate of margin(RR = 2. 35, 95％CI:0. 52-10. 69,P= 0. 27)or perioperative complications(RR= 1. 08,95％CI:0. 48-2. 42,P= 0. 85). Conclusion Existing studies have shown that endoscopic treatment for GIST is effective,minimally invasive,economical with better prognosis,ensuring complete resection.

Objective To evaluate the diagnostic accuracy of miniprobe endoscopic ultrasonography(EUS)in assessment of tumor invasion depth in early gastric cancer. Methods We searched on the PubMed, Cochrane Library, Embase, CNKI, WanFang data, VIP data for relevant studies published.Stata 14.2 software was used to perform the Meta-analysis for sensitivity, specificity, positive likelihood ratio(LR), and negative LR, diagnostic odds ratio and 95% CI.A summary receiver-operating characteristic(SROC)curve was constructed, the area under the curve(AUC)was calculated, and the diagnostic value was evaluated.Furthermore, to explore the potential sources of heterogeneity, we used meta-regression to estimate the effect of the characteristics of the studies on the diagnostic accuracy of miniprobe EUS, and a subgroup analysis was performed.We assessed the publication bias using Deeks′Funnel plot. Results Sixteen studies with a total of 3 168 tumors were included in the analysis.The pooled sensitivity, specificity, positive likelihood ratio(LR), negative LR, diagnostic odds ratio and 95% CI and area under curve(AUC)were 0.85(95% CI: 0.78-0.90), 0.73(95% CI: 0.65-0.80), 3.2(95% CI: 2.4-4.1), 0.20(95% CI: 0.14-0.30), 16(95% CI: 9-26). The AUC of SROC curve was 0.85.No significant publication bias was found with Deeks′Funnel plot. Conclusion Miniprobe EUS can not accurately diagnose or exclude the M/SM1 layer invasion in early gastric cancer, but it still can greatly improve the diagnostic accuracy of invasion depth in early gastric cancer. Key words: Miniprobe endoscopic ultrasonography; Early gastric cancer; Invasion depth; Meta-analysis

Gastric protruding lesions are common during digestive endoscopic examination.According to the origin of lesions, they can be divided into mucosal layer derived, submucosal layer derived and extrinsic compression caused.Common mucosal originated lesions include hyperplastic polyps, gastric fundus polyps, gastric adenoma.Submucosal tissue originated lesions include gastrointestinal stromal tumors, ectopic pancreas, lipoma, gastric cysts, inflammatory fibrous polyps, which can be collectively referred to submucosal tumors.The extrinsic compression lesions may due to hepatomegaly, hepatocarcinoma and adjacent organs.Gastric protruding lesions are lack of significant clinical manifestations, however lesions like fundic gland polyps, gastric adenoma, gastrointestinal stromal tumors and some other lesions have malignant potential.Changing in people′s diet, health awareness with the popularization of endoscopic examination, the detection rate and cure rate of gastric protruding lesions have dramatically improved, which lead to a better prevention of gastric cancer and early treatment of gastric cancer. Key words: Gastric protruding lesions; Gastric polyps; Submucosal tumors; Early gastric cancer