Background and study aims:Scissor-type knives have shown safety and efficacy in endoscopic submucosal dissection (ESD) procedures, particularly in studies from Japan. However, the safety and efficacy of these devices in international settings, particularly outside Japan, is not well established. Patients and methods:This was a prospective, multicenter, observational study conducted across nine international centers, encompassing a total of 461 lesions from 460 patients. In subgroup analysis, 162 lesions came from four institutions in Japan (Japanese institutions group, JAG) and 299 lesions from five institutions outside Japan (non-Japanese institutions group [NJAG]). After 1:1 propensity score matching resulted in 120 matched pairs of lesions, key outcomes were compared between groups. Results:The overall perforation rate during ESD procedures was 0.87%. Intraoperative perforations were observed more frequently in NJAG than JAG (3 vs. 1 event, 1.9% vs. 0.33%, respectively), although not statistically significant ( P = 0.127). Overall incidence of delayed bleeding was also 0.87%, with no delayed bleeding reported in NJAG. Post propensity matching analysis revealed a significantly slower median resection speed in NJAG compared with JAG (9.12 0.86-56.57 vs 26.21 1.95-93.54 mm²/min, P < 0.001). Both histological complete resection and curative resection rates were significantly lower in NJAG than in JAG with rates of 88.3% vs 98.3% for histological complete resection and 83.3% vs 95% for curative resection (both P < 0.01). Conclusions:Use of scissor-type knives in colorectal ESD outside Japan demonstrated a favorable safety profile. However, certain performance outcomes, such as resection speed and resection success rates, were inferior to Japanese institutions.

目的 筛选结直肠癌术后患者发生异时性进展期腺瘤的危险因素,构建个体化风险筛查模型并验证模型的筛查效果.方法 将2007 年4 月至2017 年10 月行结直肠癌根治术的734 例患者分为建模组和验证组,术后3 年结肠镜随访.建模组采用单因素及多因素Logistic回归分析,建立风险筛查模型.利用验证组验证模型的筛查效果.结果 734 例患者包括建模组 485例,验证组 249 例.平均年龄为(64.6±11.5)岁,男性 440 例,女性 294 例.总的异时性进展期腺瘤发生率为 11.9％(建模组12.0％,验证组 11.6％).多因素Logistic回归分析显示,男性、糖尿病病史、右半结肠癌、中低分化腺癌、腺癌合并腺瘤,腺癌合并进展期腺瘤为异时性进展期腺瘤的独立预测因素.根据Logistic多因素分析结果,建立筛查结直肠癌术后出现异时性进展期腺瘤的模型,并建立风险筛查列线图.受试者工作特征(receiver operating characteristic,ROC)曲线分析结果显示,该模型的受试者工作特征曲线下面积(area under the curve,AUC)= 0.957(95％CI:0.935～0.973),模型筛查临界值为 0.9387.验证结果显示,构建的筛查模型的灵敏度=93.1％,特异度= 89.1％,并且筛查结果与实际结果的一致性较高(Kappa=0.62).结论 以男性、糖尿病病史、右半结肠癌、中低分化腺癌、腺癌合并腺瘤、腺癌合并进展期腺瘤七个因素,构建的结直肠癌术后出现异时性进展期腺瘤筛查模型,具有较高的真实性和与实际结果的一致性,有临床应用价值.

目的 通过对 TCGA测序数据库的挖掘,筛选肝细胞癌(hepatocellular carainoma,HCC)预后相关铁死亡基因并构建 Signa-ture预后风险评估模型.方法 从 TCGA数据库获取 HCC测序数据,采用 R 语言进行铁死亡相关基因表达差异性分析,采用 Log Rank检验和单变量 Cox比例风险回归进行 K-M 生存分析.基于 time ROC分析及 LASSO Cox回归,构建 Signature预后模型.利用时间依赖 ROC曲线与 AUC对预后风险模型的预测能力进行评估.结果 初步筛选得到 21 个差异表达的铁死亡相关基因,经单变量 Cox比例风险回归和 K-M 生存分析,进一步筛选得到 7 个预后相关的铁死亡相关基因.基于上述预后相关铁死亡差异性基因集进行 Signature预后模型的构建,lambda.min=0.0317,Risk score=0.118×FANCD2+0.1514×SLC1A5+0.1632×SLC7A11.利用时间依赖 ROC曲线与 AUC 对预后风险模型的预测能力进行评估,结果显示,1 年预测效能 AUC= 0.773,3 年 AUC= 0.667,5 年 AUC= 0.658.结论 通过对 TCGA测序数据库的挖掘,筛选并构建基于 FANCD2、SLC1A5、SLC7A11 三个铁死亡相关差异基因构建的预后风险评估模型具有良好的诊断效能,对 HCC预后预测具有重要价值.

目的 纳入急性胰腺炎(acute pancreatitis,AP)患者入院24 h内简单、易获得的临床指标,构建病情严重程度预测模型并开发网页计算器,以早期预测急性胰腺炎的严重程度,帮助临床及时制定诊疗决策.方法 分析2012 年1 月至2022 年5 月在首都医科大学附属北京世纪坛医院住院的 378 例急性胰腺炎患者的临床资料,根据 2012 年亚特兰大分类标准,将其中 226 例轻症患者作为轻症(mild acute pancreatitis,MAP)组,152 例中重症(moderately severe acute pancreatitis,MSAP)和重症(severe acute pancreatitis,SAP)患者作为非轻症(non-mild acute pancreatitis,NMAP)组,通过单因素及多因素Logistic回归分析,筛选急性胰腺炎严重程度相关的高危因素,并以此构建Logistic回归预测模型,通过受试者工作特征(receiver operating characteristic,ROC)曲线筛选模型预测的临界值,计算灵敏度、特异度评价模型预测的真实性,计算Kappa中评价模型预测结果与实际结果的一致性.结果 本研究共纳入 378 例AP患者,其中男性 252 例(66.7％),女性 126 例(33.3％),其中MSAP 136 例,SAP 16 例.单因素分析发现年龄、糖尿病、高血压病、心率(heart rate,HR)、白细胞(white blood cell,WBC)、红细胞分布宽度(red blood cell distribution width,RDW)、粒细胞/淋巴细胞比值(neutrophils/lymphocyte ratio,NLR)、D-二聚体(D-dimer)、纤维蛋白原(fibrinogen,FIB)、门冬氨酸氨基转移酶(aspartate aminotransferase,AST)、乳酸脱氢酶(lactate dehydrogenase,LDH)、淀粉酶(amylase,AMY)、血糖(blood glucose,Glu)、尿素氮(blood urea nitrogen,BUN)、白蛋白(albumin,ALB)与急性胰腺炎的严重程度相关(P<0.05).将上述因素纳入多因素Logistic回归模型,得出预测模型方程为Y=-9.487+0.363×RDW(％)+0.525×FIB(g/L)+0.086×Glu(mmol/L)+0.417×LDH(U/L)+0.248×AMY(U/L).预测模型的曲线下面积(area under the curve,AUC)为0.825,大于相关指标和急性胰腺炎严重程度床边指数(bedside index of severity in acute pancreatitis,BISAP)评分的AUC.Calibration校准曲线显示列线图在预测NMAP风险与实际发生风险之间具有良好的一致性.临床决策曲线提示在阈概率为 0.4～1.0 时,使用此模型预测识别AP 发展为NMAP并采取相应的治疗措施能使患者在临床中获益.根据约登指数最大点筛选模型预测NMAP 的临界值为 0.321.以临界值≥0.321 预测为NMAP,模型预测的灵敏度=69.5％,特异度=86.2％;Kappa值=0.53,表明模型的预测结果具有一定真实性和与实际结果中度一致性,具有一定临床应用价值,但漏诊率相对较高.结论 基于入院 24 h内简单、易获得的临床指标RDW、FIB、Glu、LDH、AMY构建的预测模型,具有一定早期预测急性胰腺炎的严重程度的作用,但漏诊率相对较高,需要进一步完善.

Objective:To investigate the incidences of metachronous advanced adenoma (MAA) in patients with simultaneous multiple primary colorectal cancer (CRC) and patients with sporadic CRC.Methods:From January 1, 2008 to September 30, 2022, at Beijing Shijitan Hospital, Capital Medical University, CRC patients who underwent surgery and 3 years follow-up with endoscopy were enrolled. The patients completed colonoscopy at least 2 times during follow-up in 6 to 36 months after surgery, and the interval between the 2 times colonoscopies was over 6 months. Clinical data including age, gender, and tumor location, stage, pathological features, combined underlying diseases, preoperative carcinoembryonic antigen, hemoglobin and other laboratory results, baseline colonoscopy results, and detection of MAA were collected. According to age (±2 years old), gender, location of primary lesion and stage of tumor, patients with simultaneous CRC or sporadic CRC were matched at 1∶1 ratio by propensity score matching. The cumulative risks of MAA in patients with simultaneous multiple primary CRC and patients with sporadic CRC were calculated. Cox proportional hazard regression was used to analyze the influencing factors in the occurrence of MAA.Results:A total of 814 CRC patients were enrolled and matched. After paired matching, there were 36 cases of simultaneous multiple primary CRC (78 lesions) and 78 cases of sporadic CRC (78 lesions). The cumulative incidences of MAA at 1, 2 and 3 years of simultaneous CRC group were 11.1%(4/36), 22.2%(8/36) and 33.3%(12/36), respectively. The cumulative incidences of MAA at 1-, 2- and 3-year of sporadic CRC group were 3.8%(3/78), 12.8%(10/78) and 20.5%(16/78), respectively.Simultaneous CRC was correlated with an increase in the 3-year cumulative incidence of MAA ( HR=4.163, 95% confidence interval(95% CI) 1.032 to 4.721, P=0.047). Especially in left-sided CRC, the risk of MAA in simultaneous CRC increased ( HR=7.186, 95% CI 1.602 to 20.787, P=0.010). The results of multivariate cox-regression analysis indicated that detection of simultaneous advanced adenoma at baseline endoscopy was an independent risk factor of MAA ( HR=3.175, 95% CI 1.411 to 7.142, P=0.005). Conclusion:Colouoscopy follow-up should be strengthened in patients with simultaneous multiple primary CRC and simultaneous advanced adenomas.

ObjectiveTo investigate the value of Baveno Ⅶ criteria versus Expanded Baveno Ⅶ criteria in screening for high-risk varices (HRV) in patients with compensated advanced chronic liver disease (cACLD). MethodsA total of 146 patients with cACLD who were admitted to Beijing Shijitan Hospital, Capital Medical University, from January 2016 to December 2018 were enrolled, and according to the absence or presence of HRV based on gastroscopy, they were divided into HRV group with 68 patients and control group with 78 patients. Clinical data, liver stiffness measurement (LSM), and gastroscopy findings were analyzed, and different Baveno Ⅶ criteria were analyzed in terms of their sensitivity and specificity in the diagnosis of HRV. The Mann-Whitney U test and the McNemar test were used for comparison of continuous data between groups, and the chi-square test was used for comparison of categorical data between groups. A univariate logistic regression analysis was performed for the variables used to predict HRV, and a multivariate analysis was performed for the variables with P＜0.1. The two sets of Baveno Ⅶ criteria were compared in terms of their sensitivity and specificity in the diagnosis of HRV. ResultsA total of 146 patients were enrolled in the study, among whom 68 (46.6%) were found to have HRV. The median age was 54 years (range 29-84 years), male patients accounted for 65.8%, and hepatitis B virus was the main etiology observed in 115 patients (78.8%). The univariate logistic regression analysis showed that LSM and platelet count (PLT) were associated with HRV (both P＜0.05). The multivariate analysis showed that based on Baveno Ⅶ criteria, LSM ＞20 kPa or PLT ＜150×109/L was associated with HRV (both P＜0.05), and based on Expanded Baveno Ⅶ criteria, LSM ＞25 kPa or PLT ＜110×109/L was associated with HRV (both P＜0.05). LSM and PLT had an area under the ROC curve of 0.797 (95% confidence interval ［CI］: 0.723-0.859) and 0.789 (95% CI: 0.714-0.852), respectively, in the diagnosis of HRV. There were significant differences in the prevalence rates of esophageal and gastric varices and HRV between the patients who met Baveno Ⅶ criteria and those who did not meet such criteria (χ2=23.14 and 23.14, both P＜0.001), as well as between the patients who met Expanded Baveno Ⅶ criteria and those who did not meet such criteria (χ2=43.51 and 25.71, both P＜0.001). Although a higher proportion of patients were exempted from gastroscopy based on Expanded Baveno Ⅶ criteria (32.9% vs 13.7%), Baveno Ⅶ criteria had higher sensitivity (0.98 vs 0.88) and negative predictive value (095 vs 0.83) and could better avoid the missed diagnosis of HRV (1.0% vs 9.3%). ConclusionBaveno Ⅶ criteria are more suitable for the screening for HRV in cACLD patients in China.

Esophageal cancer (EC) is one of the most common digestive system malignancies in the world. The combined modality treatment of EC is usually surgery and radiation therapy, however, its clinical efficacy for advanced patients is relatively limited. Ferroptosis, a new type of iron-dependent programmed cell death, is different from apoptosis, necrosis and autophagy. In recent years, many studies have further enlightened that ferroptosis plays an essential role in the occurrence, development and metastasis of tumors. Targeting ferroptosis stimulates a new direction for further exploration of oncologic treatment regimens. Furthermore, ferroptosis has a critical role in the immune microenvironment of tumors. This paper reviews the mechanism of ferroptosis and the ferroptosis research progress in the treatment of EC. We further elaborate the interaction between ferroptosis and immunotherapy, and the related mechanisms of ferroptosis participation in the immunotherapy of EC, so as to provide new directions and ideas for the treatment of EC.

BACKGROUND:The aim of this study is to investigate the occurrence of metachronous neoplasms at 2-year surveillance colonoscopy for synchronous colorectal cancer patients and the relative risk factors.METHODS:Synchronous colorectal cancer patients who underwent surgery or endoscopic resection for colorectal cancer between January 2008 and December 2019 were enrolled. All patients underwent surveillance colonoscopies at least twice within 2 years after operation. Univariate and multivariate analyses were conducted to assess the risk factors for the metachronous neoplasms.RESULTS:Totally 38 patients (male/female: 26/12) were included, with an average age of 64.6 years (±11.5 years) and a mean surveillance interval of 23.47 ± 4.39 months. In 21 of 38 patients (55.3%), metachronous adenoma was detected, including 6 metachronous advanced adenomas. Two patients were detected with metachronous carcinomas. In univariate analysis, male sex, elderly age at diagnosis, and the presence of synchronous adenomas/synchronous advanced adenoma at baseline colonoscopy were associated with the development of metachronous adenoma (P = .037, .047, .013, .039), but not associated with metachronous advanced adenoma (P = 0.455, .746, .503, .269). Patients tends to occur less metachronous advanced adenoma if index colorectal tumors were treated by endoscopic resection (P = .010), but the tendency was not discovered in metachronous adenoma (P = .289). Tumor location (with/ without rectum cancer) was not associated with the development of metachronous lesions (P = .526, .382). On multivariate analysis, the presence of synchronous adenomas at baseline colonoscopy was an independent risk factor for MA during follow-up (odds ratio = 15.0; 95% CI: 1.55-145.22).CONCLUSION:For postoperative synchronous colorectal cancer patients, doctors should design individual surveillance strategies according to sex, baseline colonoscopy, and operative (or endoscopic) approach of resection.

BACKGROUND The appearance of the intestinal mucosa during endoscopy varies among patients with primary intestinal lymphangiectasia (PIL). AIM To classify the endoscopic features of the intestinal mucosa in PIL under endoscopy, combine the patients' imaging and pathological characteristics of the patients, and explain their causes. METHODS We retrospectively analyzed the endoscopic images of 123 patients with PIL who were treated at the hospital between January 1, 2007 and December 31, 2018. We compared and analyzed all endoscopic images, classified them into four types according to the endoscopic features of the intestinal mucosa, and analyzed the post-lymphographic computed tomography (PLCT) and pathological characteristics of each type. RESULTS According to the endoscopic features of PIL in 123 patients observed during endoscopy, they were classified into four types: nodular-type, granular-type, vesicular-type, and edematous-type. PLCT showed diffuse thickening of the small intestinal wall, and no contrast agent was seen in the small intestinal wall and mesentery in the patients with nodular and granular types. Contrast agent was scattered in the small intestinal wall and mesentery in the patients with vesicular and edematous types. Analysis of the small intestinal mucosal pathology revealed that nodular-type and granular-type lymphangiectasia involved the small intestine mucosa in four layers, whereas ectasia of the vesicular- and edematous-type lymphatic vessels largely involved the lamina propria mucosae, submucosae, and muscular layers. CONCLUSION Endoscopic classification, combined with the patients' clinical manifestations and pathological examination results, is significant and very useful to clinicians when scoping patients with suspected PIL.

Background Current guidelines do not establish an individual scheme for surveillance colonoscopy in postoperative colorectal cancer (CRC) patients. Aims The purpose of the study was to screen possible risk factors for the development of metachronous adenoma in postoperative CRC patients and to develop a risk prediction model and verify it. Methods Consecutive postoperative patients with CRC were enrolled from April 2007 to December 2013 as the derivation group. Baseline data of patients and clinicopathological features of the tumor were collected, logistic regression analysis was performed, and clinical model was established and was verified internally. The model was externally validated in an independent cohort (validation group) from January 2014 to October 2017 in the same hospital. Results A total of 734 patients were included, with average (64.6 +/- 11.5) years old. The overall incidence of metachronous adenoma was 35.4%. There was no significant difference in the incidence of metachronous adenoma between the derivation group and validation group (P > 0.05). Age, diabetes mellitus, right colon cancer, moderately to poorly differentiated adenocarcinoma and synchronous adenoma were independent risk factors for metachronous adenoma. The C-index of the metachronous adenoma line chart model was 0.932, and the index decreased by 0.022 after internal verification. The C-index of external validation was 0.910. The Hosmer-Lemeshow test showed that the P value of metachronous adenoma risk prediction model was 0.247. Conclusions Individual surveillance strategies should be designed for postoperative patients with CRC. For high-risk patients, it is appropriate to undergo more than two colonoscopies in 36 months after operation.

目的 探讨胶囊内镜对小肠钩虫病的诊断价值.方法 收集2014年1月至2020年12月首都医科大学附属北京世纪坛医院诊治的小肠钩虫病患者4例,回顾性分析其临床资料,包括一般情况、临床表现、实验室检查、影像学检查、胶囊内镜图像、诊治及转归.结果 4例患者中男3例,平均年龄为67岁.易感因素中3例务农,1例有海南旅居史.3例以消化道出血及贫血为主要临床表现,1例以腹痛来诊.实验室检查中2例粪便检虫卵阳性,且伴有外周血嗜酸性粒细胞增多.4例胃镜及结肠镜检查均未见钩虫虫体.4例均经胶囊内镜见明确钩虫虫体而确诊.经治疗后患者病情均缓解,随访无复发.结论 小肠钩虫病临床表现不典型时诊断困难,不明原因腹痛、消化道出血患者,特别是有流行病学史者需要警惕该疾病.胶囊内镜可作为小肠钩虫病的重要诊断方法.

目的 探讨累及消化系统的白塞病的临床特征,提高临床医师对该病的认识.方法 回顾性分析首都医科大学附属北京世纪坛医院2008年5月至2020年7月收治的以消化系统为主要表现的白塞病患者42例.结果 42例白塞病患者中,男25例,女17例,年龄(40.4±15.9)岁(17～84岁),中位病程(9.8±8.0)年,90.5％的消化系统症状发生在其他症状之后,主要症状为腹痛、腹胀(78.6％),其次为腹泻、吞咽疼痛、消化道出血等.内镜下表现以溃疡为主,部位以回肠末段、回盲部、升结肠最常见.5例布加综合征中2例下腔静脉血栓,3例下腔静脉合并肝静脉血栓.32例行组织病理学检查,8例提示血管炎.采用糖皮质激素联合免疫抑制剂及抗肿瘤坏死因子-α 拮抗剂治疗,85.7％的患者症状好转,3例行手术治疗,手术原因:合并穿孔2例,合并肠梗阻1例.结论 白塞病患者以青壮年发病为主,消化系统表现多样,以腹痛腹胀为主,部分患者可出现严重并发症,内镜下表现有一定特点,有消化道症状者应积极完善内镜检查,少部分患者可出现布加综合征,在临床工作中应加强对白塞病的认识.

Objective:To explore whether the regular feedback system in opportunistic screening of colorectal cancer can improve the adenoma detection rate (ADR) of endoscopists.Methods:This study was an observational study, divided into three stages: the baseline stage before intervention (the pre-intervention period), the regular feedback stage (the intervention period) and the post-intervention stage (the post-intervention period). In the pre-intervention period, all patients who underwent opportunistic screening of colorectal cancer in Department of Gastroenterology in Beijing Shijitan Hospital Affiliated to Capital Medical University from June 2017 to May 2018 were reviewed, and the ADR of each endoscopist was calculated. In the intervention period from June 2018 to November 2018, colonoscopies were performed on patients for opportunistic screening of colorectal cancer by endoscopists who participated in the feedback. The ADR of each endoscopist during the previous month was calculated at the beginning of each month and feedback was provided in the form of a report. In the post-intervention period from December 2018 to January 2019, colonoscopies were performed on patients for opportunistic screening of colorectal cancer by endoscopists who participated in the feedback. The ADR of each endoscopist was calculated after the feedback stopped. ADR and polyp detection rate (PDR) of three stages were compared.Results:A total of 1 768, 1 308 and 344 patients were enrolled for opportunistic screening of colorectal cancer during the pre-intervention, the intervention and the post-intervention period respectively. Eight endoscopists participated in the whole process of this study. The total ADR increased from 23.70% (419/1 768) in the pre-intervention period to 33.72% (441/1 308) in the intervention period ( χ2=37.449, P<0.05). Two months after intervention, ADR decreased slightly to 33.14% (114/344), but was still higher compared with before ( χ2=13.602, P<0.05). The total PDR increased from 47.17% (834/1 768) in the pre-intervention period to 52.68% (689/1 308) in the intervention period ( χ2=9.111, P<0.05). Two months after the intervention, PDR increased slightly to 53.78% (185/344), and still higher compared with before ( χ2=5.035, P<0.05). Conclusion:Regular feedback to endoscopists can improve ADR in opportunistic screening of colorectal cancer.

Objective: Inflammatory bowel disease (IBD) is a heterogeneous complex disease referring to two chronic disorders: Crohn's disease (CD) and ulcerative colitis (UC). To clarify the relationship between IL-12B gene polymorphisms and susceptibility to CD and UC, a meta-analysis was conducted. Methods: A comprehensive search of the PubMed, Web of Science, Embase and Cochrane databases was conducted up to Oct 2019. Studies evaluating the relationship between risk of IBD and variants of IL-12B (rs6887695, rs3212227 and rs10045431) were included. Odds ratio (OR) and 95% confidence interval (CI) were calculated. Trial sequential analysis (TSA) was implemented to estimate the required information size (RIS) and evaluate the credibility of the meta-analysis results. Results: Seventeen studies containing 9827 patients with CD, 7583 patients with UC and 16044 controls were included. The results showed significant association between rs6887695 polymorphism and susceptibility to CD (allele model: OR = 1.17, 95% CI: 1.12-1.22) and UC (allele model: OR = 1.16, 95% CI: 1.09-1.23), and "C" allele carriers had a higher risk, with TSA conclusive. For rs10045431, no significant association with CD susceptibility was identified, while a significantly increased risk in UC was found (allele mode: OR = 1.16, 95% CI: 1.07-1.25), both results were conclusive according to TSA. No significant association between rs3212227 and CD or UC susceptibility was found, and TSA research warranted further investigation to certify the results. No significant heterogeneity was found. Conclusion: IL-12B rs6887695 polymorphism was associated with increased risk of CD and UC, while IL-12B rs10045431 polymorphism might only be correlated with the risk of UC.

DNA proficient mismatch repair colon cancer (pMMR CC) is the most common subtype of sporadic CC. We aimed to investigate the role of long noncoding RNAs (lncRNAs) in pMMR CC carcinogenesis. In the present study, we conducted transcriptomic analysis of lncRNAs-mRNAs in five low-grade intraepithelial neoplasia (LGIN), five high-grade intraepithelial neoplasia (HGIN), four pMMR CC, and five normal control (NC) tissues. Gene Ontology (GO), Kyoto Encyclopedia of Genes and Genomes (KEGG) enrichment pathway, and coexpression network analyses were performed to elucidate the functions of lncRNAs and mRNAs as well as their interactions. Quantitative real-time polymerase chain reaction (qRT-PCR) was used to validate five dysregulated lncRNAs in a large set of colon tissues. Receiver-operating characteristic (ROC) curves were employed to evaluate the performance of the candidate lncRNAs. A set of 5783 differentially expressed lncRNAs and 4483 differentially expressed mRNAs were detected among the LGIN, HGIN, pMMR CC, and NC samples. These differentially expressed lncRNAs and mRNAs were assigned to 275 significant GO terms and 179 significant KEGG enriched pathways. qRT-PCR confirmed that the expression of five selected lncRNAs (ENST00000521815, ENST00000603052, ENST00000609220, NR_026543, and ENST00000545920) were consistent with the microarray data. ROC analysis showed that four lncRNAs (ENST00000521815, ENST00000603052, ENST00000609220, and NR_026543) had larger area under the ROC curve (AUC) values compared to serum carcinoembryonic antigens, thereby distinguishing NC from pMMR CC. In conclusion, several lncRNAs play various roles in the adenoma-carcinoma sequence and may serve as potential biomarkers for the early diagnosis of pMMR CC.

目的 分析原发性胃淋巴瘤(primary gastric lymphoma,PGL)及内镜下疑诊PGL患者的临床病理和内镜特征,提高PGL的诊断准确率.方法 选取2010年12月至2018年12月在首都医科大学附属北京世纪坛医院消化内科明确诊断为PGL患者43例(病理确诊组)、病理否定PGL患者75例(病理否定组,病理诊断阴性15例、胃癌60例),回顾性分析其内镜及临床病理特征.结果 腹痛是PGL、疑似PGL患者典型症状,分别占41.9％和32.0％,两组之间性别、年龄、临床症状差异无统计学意义(P＞0.05).病理确诊组内镜下表现:53.5％溃疡性病变,34.9％隆起性病变,11.6％浸润性生长病变.病理否定组内镜下表现:28.0％浸润性生长病变,37.3％溃疡性病变,34.7％隆起性病变,两组患者的内镜表现比较,差异有统计学意义(P＜0.05).病理类型以弥漫大B细胞淋巴瘤居多.结论 PGL和疑诊PGL患者具有相似的临床症状,内镜表现均以溃疡性病变为主,虽然PGL的诊断率相对较低,但可以通过内窥镜进行鉴别.为了提高诊断准确率,应进行重复的内窥镜活检,并在未来开发新的内镜技术.

Previous studies have suggested that enteral nasogastric nutrition is more effective and safer for patients with moderate-severe acute pancreatitis (MSAP). The aim of this study was to compare the efficacy and safety of nasogastric feeding (NGF) with total parenteral nutrition (TPN) in patients diagnosed with MSAP. Patients were divided into two groups according to the type of feeding they received (117 in the NGF group and 70 in the TPN group), after which the ratio of transferred to severe acute pancreatitis (SAP), ICU admission rate, mortality, feeding associated complications (diarrhea, abdominal distension, abdominal pain), extra-pancreatic infection, hospitalization time were compared. No difference in the ratio of transferred to SAP and the ICU admission rate was found between groups (2.7% vs. 2.6% and 2.7% vs. 2.6%, respectively). No patient died in any of the two groups. The feeding associated complications (diarrhea, abdominal distension, abdominal pain) were seen more often in the NGF group than in the TPN group, yet no significantly statistical difference was observed. Moreover, the NGF group had significantly shorter hospitalization time (8.9 d vs. 10.9 d, P = 0.032) and a lower rate of extrapancreatic infection compared to the TPN group (2.7% vs. 3.9%; P = 0.025). To sum up, NGF seems to be safer and more effective than TPN when treating patients with MSAP. (C) 2021 Published by Elsevier Masson SAS on behalf of Societe francophone nutrition clinique et metabolisme (SFNCM).

患者男，64岁，因常规健康体检时行结肠镜发现直肠黏膜下肿物和直肠腺瘤入住首都医科大学附属北京世坛医纪院治疗。腹部CT检查示小肠软组织结节，胶囊内镜证实为小肠黏膜下病变，于消化内科行结肠镜下直肠肿物和结肠腺瘤切除术，术后病理提示直肠神经内分泌肿瘤(G1)、直肠绒毛管状腺瘤(G1)，Ki-67(1%阳性)。遂转入普外科，行腹腔镜小肠黏膜下肿物切除术，术后病理提示小肠异位胰腺。该患者同时罹患小肠异位胰腺、直肠神经内分泌肿瘤、直肠腺瘤3种肠道疾病，甚是罕见，提示临床工作中不应满足于1或2种疾病的诊断，需提高对于消化道疾病的全面认识。

Appropriate treatment options for early colorectal cancer (ECRC) smaller than 20 mm remains controversial. Here, we studied the efficacy and safety of endoscopic therapy for ECRC smaller than 20 mm. About 191 patients with colorectal lesions entered into our study from January 2017 to December 2019. Lesions were divided into two groups according to sizes: smaller than 10 mm group and 10-20 mm group. Most cases of ECRC were found in the left colon (70.15%), and the male to female ratio was 1.81:1. A very smaller proportion of colorectal lesions smaller than 10 mm in size were submucosal carcinoma (0.077%), whereas 3.85% of colorectal lesions between 10 mm and 20 mm in size were submucosal carcinoma (P=0.049). Cold snare polypectomy (CSP) was found to be a safe and efficient for lesions smaller than 10 mm. For the lesions smaller than 10 mm, the rate of en bloc resection reached 100%, whereas only 81.82% of the lesions of 10-20 mm in size could be resected en bloc and for these cases, endoscopic mucosal resection (EMR) were better therapeutic options. Endoscopic CSP is an appropriate therapeutic approach for ECRC of less than 10 mm in size, whereas for lesions smaller than 10 mm in size but with submucosal infiltration, EMR should be considered. For submucosal carcinoma (SM-carcinoma), endoscopic submucosal dissection (ESD) or surgery should be considered as better options.