目的 分析不明原因的慢性血生化异常(NCALBT)患者病因诊断及其肝组织学表现.方法 回顾性分析我院诊治的248 例NCALBT患者的临床资料.所有患者接受肝活检,采用改良Scheuer评分评估.常规检测血生化、血清学和病毒学指标.结果 在248 例NCALBT患者中,诊断药物性肝损伤(DILI)89 例(35.9%),自身免疫性肝病(AILD)67例(27.0%),非酒精性脂肪性肝病(NAFLD)39 例(15.7%),遗传代谢性肝病(IMLD)30 例(12.1%),特发性非硬化性门静脉高压(INCPH)20 例(8.1%)和其他肝病 3 例(1.2%);DILI和AILD患者血生化指标显著高于其他肝病患者(P<0.05);本组168 例(67.8%)NCALBT患者肝组织处于 G2-4/S2-4 状态,即有明显的炎症和纤维化损伤,DILI(61.8%)、AILD(95.5%)、NAFLD(56.4%)、INCPH(65.0%)和其他肝病(100.0%)均以G2-4/S2-4 为主,而IMLD患者肝组织G2-4/S2-4 只占36.7%.结论 NACLBT患者病因以常见病为主,综合血清和组织学检查往往可以明确诊断.

Background There are still clinical controversy on the efficacy and safety of endoscopic resection (ER) and laparoscopic resection (LR) in the treatment of gastrointestinal stromal tumors (GISTs). The present study aimed to evaluate the safety and efficacy of ER in the treatment of GISTs by comparing the relative outcomes of ER to LR. Methods PubMed, Web of Science, Cochrane Library, and Embase were searched. Data were retrieved from January 2010 to January 2020 and subjected to a meta-analysis based on the intraoperative and postoperative outcomes of ER and LR. The intervention arm was treated by LR while the comparator arm was treated by ER. Relevant literature was selected based on the inclusion criteria, data was extracted, and quality evaluation of the included literature was carried out. The Newcastle-Ottawa Scale (NOS) was applied for assessing the quality of included studies. Heterogeneity between studies was assessed using the Cochrane χ2 test and I2 statistic, and Funnel plots and Egger’s test were used to detect publication bias. Results The present analysis included 13 studies, comprising a total of 1,261 patients, (ER vs. LR: 543 vs. 718). The incidence rate of postoperative complications [odds ratio (OR), 0.400; P=0.001] was significantly lower in the ER group [3.3%; 95% confidence interval (CI), 0.015 to 0.055] than the LR group (8.9%; 95% CI, 0.03 to 0.17). The meta-analysis revealed that the recurrence rate following ER (1.7%; 95% CI, 0.005 to 0.033) was lower than that following LR (2.5%; 95% CI, 0.012 to 0.041). The R0 resection rate of ER (99%; 95% CI, 0.975 to 0.999) was similar to that of LR (100%; 95% CI, 0.995 to 1.000). No publication bias in this study (P>0.10), and the sensitivity analysis showed that the study was robust. Conclusions ER was safer and more efficient than LR in terms of all the outcomes, except the R0 resection rate. Thus, ER should be considered the treatment of choice. However, attention should be paid to the surgical margin status following ER.

Background: Fecal microbiota transplantation (FMT) as a promising therapy for ulcerative colitis (UC) remains controversial. We conducted a systematic review and meta-analysis to assess the efficiency and safety of FMT as a treatment for UC. Methods: The target studies were identified by searching PubMed, EMBASE, the Cochrane Library, Web of Science, and ClinicalTrials and by manual supplementary retrieval. We conducted a general review and quantitative synthesis of included studies. We used the RevMan and Stata programs in the meta-analysis. The outcomes were total remission, clinical remission, steroid-free remission, and serious adverse events. We also performed subgroup analyses based on different populations. Results: A total of 34 articles were included in the general review. Only 16 articles, including 4 randomized controlled trials, 2 controlled clinical trials, and 10 cohort studies, were selected for the meta-analysis. We found that donor FMT might be more effective than placebo for attaining total remission (risk ratio [RR]: 2.77, 95% confidence interval [CI]: 1.54–4.98; P = .0007), clinical remission (RR: 0.33, 95% CI: 0.24–0.41; P < .05), and steroid-free remission (RR: 3.63, 95% CI: 1.57–8.42; P = .003), but found no statistically significant difference in the incidence of serious adverse events (RR: 0.88, 95% CI: 0.34–2.31, P = .8). The subgroup analyses revealed significant differences between the pooled clinical remission rates for different regions, degrees of severity of the disease, and patients with steroid- or nonsteroid-dependent UC. Conclusions: FMT can achieve clinical remission and clinical response in patients with UC.

胃肠道间质瘤(GIST)是消化系统最常见的间叶性肿瘤,早期临床症状不典型,难以诊断.手术切除是GIST患者的主要治疗方式.随着新型医疗器械的出现和内镜医师技术的不断提高,GIST的治疗呈现微创化、多样化及跨学科合作的特点.但部分GIST患者手术治疗后复发率仍较高.近年关于基因水平的研究不断深入,靶向药物的运用对预防GIST患者的复发和转移起关键作用.目前内镜治疗GIST的安全性和有效性仍存在争议,且GIST的发病机制也尚未完全阐明,未来需深入研究.

Approximately half of the world's gastric cancer cases and deaths occur in China. In addition, the incidence and mortality rates of gastric cancer in Gansu province in China are much higher than the average nationwide levels. The present study investigated microRNA (miRNA/miR) profiles in early gastric cancer (EGC) without specific symptoms. miRNA expression levels in five pairs of EGC tissues and adjacent non-cancerous mucosa tissues of patients from Gansu province in China were analyzed using a miRNA microarray. A total of 47 differentially expressed miRNAs (DEMs) were identified. Subsequently, mRNA expression profiles of three pairs of cancer tissues and adjacent non-cancerous tissues from 3 Asian patients with stage I or stage II gastric cancer (stage I/II; American Joint Committee on Cancer classification, Eighth Edition) were obtained from The Cancer Genome Atlas database, and differentially expressed genes (DEGs) were identified. The target genes of DEMs were filtered from the DEGs using the miRDB database and a miRNA-gene network was constructed. The functions of DEMs were evaluated using the tool for annotations of human miRNAs database, and via Gene Ontology analysis, Kyoto Encyclopedia of Genes and Genomes analysis and Gene Set Enrichment Analysis of the target genes. Finally, survival analyses of DEMs, which were in the miRNA-gene network, was performed. The results suggested that a number of miRNAs, including hsa-let-7a-5p, hsa-miR-27a-3p, hsa-miR-126-5p and hsa-miR-424-5p, may serve critical roles in EGC. The present study could provide a basis for the identification of EGC screening biomarkers. Furthermore, the present study may provide a basis for the exploration of the cause of the high incidence of gastric cancer in Gansu province from the perspective of miRNAs.

胰腺癌是目前世界上最严重的癌症之一,其死亡率高,预后差.由于早期临床表现不明显且不具特异性,胰腺癌的早期诊断相对困难,临床上明确诊断时疾病已进展至中晚期,错过治疗的最佳时机,手术机会小,且胰腺癌对常规放化疗具有很强的耐药性.因此急需寻找新的方法来提高胰腺癌的早期诊断率,进而提高其治愈率和延长生存期.作为一门研究代谢小分子的新兴科学,代谢组学以肿瘤细胞的代谢变化为基础来寻找可靠的生物标志物,以为早期诊断胰腺癌提供新思路与方法.

PurposeImmunotherapy is regarded as the most promising treatment for cancer. However, immune checkpoint inhibitors (ICIs) are not effective for all patients. Herein, we conducted a systematic review and meta-analysis to explore whether tumor mutational burden (TMB) can be used as a potential prognostic biomarker for cancer patients treated with ICIs.MethodsWe systematically retrieved relevant literature published in the PubMed, Embase, Web of Science, and Cochrane databases up to December 28, 2020. All cohort studies and clinical trials that reported hazard ratios (HRs) for overall (OS) and progression-free survival (PFS), as well as the corresponding 95% confidence intervals (CIs) of high and low TMB patients, were included. All statistical analyses were performed using the R software.ResultsPooled results from a total of 32 studies with 6,131 participants showed significantly increased OS (HR: 0.61, 95% CI: 0.53–0.71; P <0.01) and PFS (HR: 0.51, 95% CI: 0.44–0.60; P <0.01) for the high TMB group receiving ICIs as compared to the low TMB group. Particularly, results were found to be more significant in studies with larger sample sizes (≥30), Western patients, higher TMB cutoff values (≥20 mut/Mb), anti–PD-1 therapy, and when the sample source was tissue and tumor type was either melanoma, small cell lung cancer, or gastric cancer.ConclusionTMB is a promising independent prognostic biomarker for cancer patients receiving ICIs, which could provide a new potential therapeutic strategy for high TMB patients who have failed traditional therapy. Furthermore, consistency in the key aspects of TMB assessment is expected in the future.Systematic Review Registration[https://www.crd.york.ac.uk/PROSPERO], Prospective Register of Systematic Reviews (PROSPERO), identifier: CRD42021229016.

Coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) induced a worldwide pandemic. The main clinical manifestations of COVID-19 patients have been fever, cough, dyspnea, and other respiratory symptoms. However, some patients’ initial symptoms have been nausea, vomiting, diarrhea and other gastrointestinal symptoms, and SARS-CoV-2 RNA could be found in their stool samples. Studies have shown that the gastrointestinal tract highly-expressed angiotensin-converting enzyme 2 is used by SARS-CoV-2 to enter cells. Therefore, exploring the damage caused by SARS-CoV-2 to the gastrointestinal tract and whether it could replicate in the gastrointestinal tract and transmit through fecal-oral route has significance for the diagnosis, treatment and prevention of COVID-19. We combined the current clinical data about COVID-19 patients with gastrointestinal symptoms as well as its pathogenic mechanism and prevention methods herein to review the relationship between the disease and gastrointestinal symptoms.

We have read Char's comment1 . Thanks for readers' attention and valuable feedback on our article. Following was our response to Char's question about data overlap. Firstly, the meta-analysis reprocessed the existing data about COVID-19 patients in published articles, and involved no other information outside of the article. This article is protected by copyright. All rights reserved.

We have read Charu0027s comment(1) . Thanks for readersu0027 attention and valuable feedback on our article. Following was our response to Charu0027s question about data overlap. Firstly, the meta-analysis reprocessed the existing data about COVID-19 patients in published articles, and involved no other information outside of the article. This article is protected by copyright. All rights reserved.

The aim of this study was to analyze the clinical data, discharge rate, and fatality rate of COVID-19 patients for clinical help. The clinical data of COVID-19 patients from December 2019 to February 2020 were retrieved from four databases. We statistically analyzed the clinical symptoms and laboratory results of COVID-19 patients and explained the discharge rate and fatality rate with a single-arm meta-analysis. The available data of 1994 patients in 10 literatures were included in our study. The main clinical symptoms of COVID-19 patients were fever (88.5%), cough (68.6%), myalgia or fatigue (35.8%), expectoration (28.2%), and dyspnea (21.9%). Minor symptoms include headache or dizziness (12.1%), diarrhea (4.8%), nausea and vomiting (3.9%). The results of the laboratory showed that the lymphocytopenia (64.5%), increase of C-reactive protein (44.3%), increase of lactic dehydrogenase (28.3%), and leukocytopenia (29.4%) were more common. The results of single-arm meta-analysis showed that the male took a larger percentage in the gender distribution of COVID-19 patients 60% (95% CI [0.54, 0.65]), the discharge rate of COVID-19 patients was 52% (95% CI [0.34,0.70]), and the fatality rate was 5% (95% CI [0.01,0.11]).

RNA干扰(RNAi)是经典的基因表达下调工具,多数实验室将RNAi的序列设计工作委托公司完成.本研究以BAIAP2L1和DDIAS基因为例,选择ThermoFisher公司的BLOCK-iTTM RNAi Designer设计工具自行设计siRNA序列,并通过实时荧光定量PCR检测基因表达水平,验证干扰效果.结果 显示基因表达水平下调能够达到70％以上,实现良好的RNAi效果,表明通过BLOCK-iTTM RNAi Designer自行设计获得的siRNA序列能够满足预期的基因表达下调.

已知肠道微生物区系在人体免疫调节及对抗病毒性肺炎中发挥重要作用,对于降低病毒感染风险和加速感染后病毒清除具有重要意义.本研究阐述了呼吸道病毒感染后肠道微生物区系的变化和肠道微生物的改变又反过来影响呼吸系统及其作用机制,也就是近年来研究逐渐深入的"肠—肺轴",强调了贯穿于"肠—肺轴"始终的免疫作用,以及微生物制剂在抗呼吸道病毒感染中的作用及其机制,从而将益生菌用于新型冠状病毒肺炎防治的潜在作用作一展望.

炎症性肠病(IBD)是一组病因尚不十分明确的慢性非特异性肠道炎性疾病,主要包括溃疡性结肠炎(UC)和克罗恩病(CD).目前,随着免疫学和生物学的发展,针对其发病过程中不同靶点的生物制剂,如抗肿瘤坏死因子、抗黏附分子、抗白细胞介素-12/23(IL-12/23)、JAK抑制剂等,被不断开发应用于临床治疗.相对于传统治疗,生物制剂疗效显著,且安全性值得肯定,为IBD的治疗带来了里程碑式的意义.本文对现今生物制剂治疗IBD的一些最新的研究进展和与之相关的风险作一简述.

It is known that intestinal microflora plays an important role in human immune regulation and fighting against viral pneumonia, thus being of great significance in reducing the risk of viral infection and accelerating virus clearance after infection In this article, we explained the changes of the intestinal microflora after virus infection of the respiratory tract, which in turn affected the respiratory system and its action mechanism The study was also reflected the fact that the“intestinal-lung axis”theory has been deepened gradually in studies in recent years More importantly, we emphasized the immune function throughout the“intestinallung axis”and the role and mechanism of microbial agents in the prevention and treatment of virus infection of the respiratory tract, thus presenting a prospect of the potential role of probiotics in the prevention and treatment of Corona Virus Disease 2019

目的:探讨消化内镜治疗胃间质瘤的有效性、安全性.方法:回顾性分析2012年3月至2018年4月甘肃省第二人民医院和武威肿瘤医院经消化内镜治疗的85例胃间质瘤患者临床资料,并随访.结果:行内镜黏膜下切除术80例,内镜下圈套切除术2例,腹腔镜辅助胃镜下切除术3例.术中穿孔16例,其中2例发生腹膜炎,瘤体部位与大小是穿孔发生的主要影响因素,差异有统计学意义(P＜0.05).85例术中均未出现内镜无法控制的大出血、术后迟发性出血及迟发性穿孔.术后随访2-61个月,平均(19.36±14.23)个月,1例患者行内镜下圈套切除术5年后出现原位局部复发,其余84例均无复发及死亡.结论:超声内镜对胃间质瘤的病变起源有很重要的诊断价值.消化内镜治疗胃间质瘤,尤其瘤体大小≤2cm者,是安全、有效的.