摘要：Objective:To explore the impact of common gastrointestinal(GI)symptoms on psychological symptoms,sleep quality,and quality of life in patients with inflammatory bowel disease(IBD). Methods:A unified questionnaire was developed to collect clinical data on the mental psychology and quality of life of IBD patients from 42 hospitals in 22 provinces in P.R.China from September 2021 to May 2022.The general clinical characteristics,psychological symptoms,sleep quality,and quality of life of IBD patients with different numbers of GI symptoms were analyzed by descriptive sta-tistical analysis. Results:A total of 2,478 IBD patients were finally analysed in this study,including 365 without GI symptoms(14.7%),752 with single symptoms(30.4%),841 with double symptoms(33.9%),and 520 with three symptoms(21.0%).Compared with patients without GI symptoms,patients with only simple abdominalgia or diarrhea or hematochezia showed significantly higher levels of anxiety and depression and worse quality of life(all P<0.05).Compared with asymptomatic patients,patients with double symptoms(e.g.abdominalgia plus hematochezia,diarrhea plus hematochezia,abdominalgia plus diarrhea)and patients with three symptoms(abdominalgia,diarrhea,and hematochezia)showed significantly higher levels of anxiety and depression and worse sleep quality and quality of life(all P<0.05). Conclusion:Compared with IBD patients without gastrointestinal symptoms,patients with gastrointestinal symptoms were more likely to experience anxiety,depression,sleep disturbances,and poorer quality of life.

摘要：Background:Gastric varices(GV)with spontaneous portosystemic shunts(SPSS)pose considerable risks and challenges for adminis-tering 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 combina-tion 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 endo-scopic CYA injection in reducing late GV rebleeding in treating GV with SPSS.

摘要：Background:Metabolic dysfunction-associated fatty liver disease(MAFLD)is a common liver disease,the risk of which can be in-creased by poor diet.The objective of this study was to evaluate the associations between food items and MAFLD,and to propose rea-sonable dietary recommendations for the prevention of MAFLD. Methods:Physical examination data were collected from April 2015 through August 2017 at Nanping First Hospital(n=3,563).Dietary intakes were assessed using a semi-quantitative food frequency questionnaire.The association between food intake and the risk of MAFLD was assessed by using the inverse probability weighted propensity score. Results:Beverages(soft drinks and sugar-sweetened beverages)and instant noodles were positively associated with MAFLD risk,adjusting for smoking,drinking,tea intake,and weekly hours of physical activity[adjusted odds ratio(ORadjusted):1.568;P=0.044;ORadjusted:4.363;P=0.001].Milk,tubers,and vegetables were negatively associated with MAFLD risk(ORadjusted:0.912;P=0.002;ORadjusted:0.633;P=0.007;ORadjusted:0.962;P=0.028).In subgroup analysis,the results showed that women[odds ratio(OR):0.341,95％confidence interval(CI):0.172-0.676]had a significantly lower risk of MAFLD through consuming more tubers than men(OR:0.732,95％CI:0.564-0.951). Conclusions:These findings suggest that reducing consumption of beverages(soft drinks and sugar-sweetened beverages)and in-stant noodles,and consuming more milk,vegetables,and tubers may reduce the risk of MAFLD.

摘要：Background:Post-ERCP pancreatitis(PEP)is significantly influenced by the reflux of duodenal fluid.While gastrointestinal decom-pression represents a fundamental approach in acute pancreatitis management,the effectiveness of immediate duodenal decom-pression following ERCP to prevent PEP remains uncertain.This study aimed to investigate the impact of immediate duodenal decompression after ERCP on reducing the incidence of hyperamylasemia and PEP. Methods:This retrospective study encompassed patients with native papilla who underwent therapeutic ERCP for choledocholithia-sis at the Department of Gastroenterology,Chun’an Branch of Zhejiang Provincial People’s Hospital(Zhejiang,China)between January 2020 and June 2023.Based on the immediate placement of a duodenal decompression tube post-ERCP,patients were categorized into two groups:the duodenal decompression group and the conventional procedure group.Primary outcomes included the incidence of PEP and hyperamylasemia. Results:A total of 195 patients were enrolled(94 in the duodenal decompression group and 101 in the conventional procedure group).Baseline clinical and procedural characteristics exhibited no significant differences between the two groups.PEP occurred in 2 patients(2.1%)in the duodenal decompression group,in contrast to 11 patients(10.9%)in the conventional procedure group(Risk difference[RD]8.8%;95%confidence interval[CI]1.7%-16.5%,P=0.014).Hyperamylasemia was observed in 8 patients(8.5%)in the duodenal decompression group,compared to 20 patients(19.8%)in the conventional procedure group(RD 11.3%;95%CI 1.4%-21.0%;P=0.025).Patients with PEP in both groups showed improvement after receiving active treatment.No severe cases of PEP occurred in either group,and no serious adverse events related to duodenal catheter decompression were reported. Conclusion:Immediate duodenal decompression following ERCP demonstrates an effective reduction in the incidence of hyperamy-lasemia and PEP.

摘要：Introduction Hirschsprung disease(HD)is a congenital disorder of intestinal mo-tility characterized by the absence of enteric neurons at the end of the bowel[1].HD affects 1 in 5,000 live-bom infants and 90％of patients are diagnosed within the first year of life[2].Adult HD patients present with symptoms that begin in adulthood or child-hood due to failure of diagnosis[1,3].Patients with inflammatory bowel disease(IBD)are considered to be more susceptible to HD in infancy than those without IBD,with a relative risk ranging from 24 to 40 times higher[4].However,the rare co-morbidity of IBD and adult HD presenting after childhood is prone to missed diagnosis.Here,we report a case in which a patient was diagnosed with stric-turing Crohn's disease(CD)at the first visit,and pathological exam-ination after surgery revealed adult HD complicated by CD.

摘要：Background:There have been no studies on predicting human epidermal growth factor receptor 2(HER2)status in patients with re-sectable gastric cancer(GC)in the neoadjuvant and perioperative settings.We aimed to investigate the use of preoperative contrast-enhanced computed tomography(CECT)imaging features combined with clinical characteristics for predicting HER2 expression in GC. Methods:We retrospectively enrolled 301 patients with GC who underwent curative resection and preoperative CECT.HER2 status was confirmed by postoperative immunohistochemical analysis with or without fluorescence in situ hybridization.A prediction model was developed using CECT imaging features and clinical characteristics that were independently associated with HER2 status using multivariate logistic regression analysis.Receiver operating characteristic curves were constructed and the performance of the prediction model was evaluated.The bootstrap method was used for internal validation. Results:Three CECT imaging features and one serum tumor marker were independently associated with HER2 status in GC:en-hancement ratio in the arterial phase(odds ratio[OR]¼ 4.535;95%confidence interval[CI],2.220-9.264),intratumoral necrosis(OR¼2.64;95%CI,1.180-5.258),tumor margin(OR¼3.773;95%CI,1.968-7.235),and cancer antigen 125(CA125)level(OR¼5.551;95%CI,1.361-22.651).A prediction model derived from these variables showed an area under the receiver operating characteristic curve of 0.802(95%CI,0.740-0.864)for predicting HER2 status in GC.The established model was stable,and the parameters were accu-rately estimated. Conclusions:Enhancement ratio in the arterial phase,intratumoral necrosis,tumor margin,and CA125 levels were independently associated with HER2 status in GC.The prediction model derived from these factors may be used preoperatively to estimate HER2 status in GC and guide clinical treatment.

摘要：Introduction Abernethy malformation is a rare congenital vascular abnormal-ity characterized by portal venous blood draining into systemic veins through an abnormal shunt vein[1].There is a consensus that symptomatic Abernethy malformation should be treated.The proposed therapeutic option for Type 1 Abernethy malfor-mation is liver transplantation,while Type 2 can be treated with shunt closure[1-3].Many studies have shown that the symptoms of Type 2 can be alleviated after shunt closure,with no signifi-cant difference in effectiveness between surgical ligation and in-terventional closure[1,3-6].Interventional closure has become increasingly important due to its advantages in diagnosis and treatment,and it is minimally invasive[1].A transjugular or transfemoral approach is the conventional interventional ap-proach to the shunt vein.However,in some cases,the above approaches may be difficult,such as in the recently reported adult case,which is considered as the first to be treated using percutaneous transhepatic interventional closure[7].

摘要：Background:Horizontal duodenal papilla(HDP)is not an uncommon ectopic major papilla.The impact of HDP on the occurrence of pancreaticobiliary diseases remains unclear.Here,we explored the associations in patients who underwent magnetic resonance cholangiopancreatography(MRCP). Methods:Consecutive patients who underwent MRCP at Xijing Hospital(Xi’an,China)between January 2020 and December 2021 were eligible.Patients were divided into HDP and regular papilla(RP)according to the position of the major papilla.The primary out-come was the proportion of congenital pancreaticobiliary diseases. Results:A total of 2,194 patients were included,of whom 72(3.3%)had HDP.Compared with the RP group(n=2,122),the HDP group had a higher proportion of congenital pancreaticobiliary diseases,especially choledochal cyst(CC)or anomalous pancreaticobiliary junction(APBJ)(6.9%vs 1.4%,P=0.001).More gallbladder cancer(6.9%vs 1.2%,P<0.001)and pancreatic cysts(27.8%vs 16.3%,P=0.01)were also identified in the HDP group.Morphologically,the HDP group had a longer extrahepatic bile duct(8.4[7.6-9.3]cm vs 7.2[6.5-8.1]cm,P<0.001),and larger angles between the common bile duct-duodenum and pancreatic duct-duodenum.Multivariate analysis showed that the presence of HDP was an independent risk factor for gallbladder cancer. Conclusions:This study confirmed that HDP was not rare in patients underwent MRCP.A higher prevalence of congenital pancreati-cobiliary malformations(especially CC or APBJ),gallbladder cancer and pancreatic cysts was observed in patients with HDP,as well as distinctive morphologic features.

摘要：Background:Nasogastric tube(NGT)placement is part of the post-operative management of upper gastrointestinal perforation,but its routine use in esophageal perforation(EP)caused by foreign bodies remains unclear.The purpose of this research was to investi-gate the necessity for routine NGT placement in patients with EP after endoscopic foreign body removal. Methods:A total of 323 patients diagnosed with EP caused by foreign bodies at the First Affiliated Hospital of Nanchang University between January 2012 and December 2021 were included in this retrospective study.Patients were divided into the NGT group and the non-NGT group according to whether or not NGT placement was performed.The perforation healing rate,post-operative adverse events,hospital stay,and death rate were analysed using a 1:1 propensity score matching model. Results:Before matching,there were 263 patients in the NGT group and 60 patients in the non-NGT group.There were significant dif-ferences in the time to treatment,infection,albumin,and types of endoscopy between the two groups,while the length of hospital stay in the NGT group was significantly longer than that in the non-NGT group.After 1:1 propensity score matching,48 pairs of patients were matched between the two groups.The perforation healing rate,post-operative adverse events,length of hospital stay,and death rate did not show significant differences between the two groups. Conclusions:For patients with small EP caused by foreign bodies,routine NGT placement after endoscopic foreign body removal may be unnecessary.

摘要：Introduction In 2016,the Australian government spent more than 1 billion dol-lars to make hepatitis C virus(HCV)direct-acting antivirals(DAAs)available to all as part of a promising plan to eradicate HCV within a generation[1].

摘要：Introduction Gastrointestinal diseases and care in the USA account for a sig-nificant amount of healthcare resources and spending,recently totaling＞$119 billion dollars annually[1].In addition to ambula-tory sites and clinics,a substantial portion of gastrointestinal care occurs through the emergency department(ED).Though the overall rate of ED visits in the USA has remained stable over the past 10 years[2],the number of visits for gastrointestinal complaints has been increasing[1,3],contributing to rising healthcare costs.

摘要：Adequate oxygen supply is essential for maintaining the body's normal physiological function.In chronic inflammatory conditions such as inflammatory bowel disease(IBD),insufficient oxygen reaching the intestine triggers the regulatory system in response to environmental changes.However,the pathogenesis of IBD is still under investigation.Recent research has highlighted the significant role of hypoxia in IBD,particularly the involvement of hypoxia-inducible factors(HIF)and their regulatory mechanisms,making them promising therapeutic targets for IBD.This review will delve into the role of hypoxia,HIF,and the associated hypoxia-inflammatory microenvironment in the context of IBD.Potential interventions for addressing these challenging gastrointestinal inflammatory diseases will also be discussed within this framework.

摘要：Alcohol-associated liver disease(ALD)is a significant global health challenge,encompassing a spectrum from steatotic liver disease to cirrhosis and alcohol-associated hepatitis,and contributed to 25%of global cirrhosis deaths in 2019.The identification of both modifiable(e.g.heavy drinking,metabolic syndromes)and non-modifiable risk factors(e.g.genetic predispositions)is crucial for effective disease management.Alcohol use assessment and treatment,by using both behavioral therapy and pharmacotherapeutic modalities,nutrition support,and optimization of liver disease modifiers,form the cornerstone of management.Advances in medical therapies,such as fecal microbiota transplantation and novel agents such as IL-22,are being explored for their therapeutic potential.A unifying theme in ALD care is the need for a personalized approach to management,accounting for the spectrum of the disease and individual patient character-istics,to tailor interventions effectively.Finally,it is essential to address the challenges to effective ALD treatment,including socioeco-nomic,logistical,and stigma-related barriers,to improve patient outcomes.This review discusses the current knowledge on ALD,including epidemiology,pathophysiology,risk factors,and management strategies,highlighting the critical role of integrated care models.

摘要：The low incidence of combined hepatocellular cholangiocarcinoma(cHCC-CCA)is an important factor limiting research progression.Our study extensively included nearly three decades of relevant literature and assembled the most comprehensive database com-prising 5,742 patients with cHCC-CCA.We summarized the characteristics,tumor markers,and clinical features of these patients.Additionally,we present the evolution of cHCC-CCA classification and explain the underlying rationale for these classification stand-ards.We reviewed cHCC-CCA diagnostic advances using imaging features,tumor markers,and postoperative pathology,as well as treatment options such as surgical,adjuvant,and immune-targeted therapies.In addition,recent advances in more effective chemo-therapeutic regimens and immune-targeted therapies were explored.Furthermore,we described the molecular mutation features and potential specific markers of cHCC-CCA.The prognostic value of Nestin has been proven,and we speculate that Nestin will also play a role in classification and diagnosis.However,further research is needed.Moreover,we believe that the possibility of using machine learning liquid biopsy for preoperative diagnosis and establishing a scoring system are directions for future research.

摘要：Background:The oncological safety of transanal total mesorectal excision(taTME)remains uncertain,and its special surgical approach may contribute to tumor cell dissemination.Thus,we conducted a study to investigate the impact of surgical approach on circulating tumor cell(CTC)counts and phenotypes in rectal cancer. Methods:This is a prospective randomized controlled study(ClinicalTrials:NCT05109130).The patients were randomized to either the taTME(n¼49)or laparoscopic TME(laTME)(n¼48)groups.Blood samples were collected from the central vein to measure CTC counts and phenotypes at three time points:preoperative(t1),immediately post-tumor removal(t2),and one week post-surgery(t3).The effect of surgical procedure on CTCs at each time point was analyzed,with the primary endpoint being the change in CTC counts from t1 to t3 for each surgical approach.This study adheres to Consolidated Standards of Reporting Trials Guidelines. Results:The baseline clinicopathologic characteristics of the laTME and taTME groups were balanced.The change in CTC count from t1 to t3 was 1.81±5.66 in the laTME group and 2.18±5.53 in the taTME group.The taTME surgery was non-inferior to laTME in terms of changing CTC counts(mean difference[MD]:-0.371;95%confidence interval[CI]:-2.626 to 1.883,upper-sided 95%CI of 1.883<2,non-inferiority boundary value).Compared with that at t1,the CTC count at t2 did not change significantly.However,higher CTC counts were detected at t3 than at t2 in the taTME(P¼0.032)and laTME(P¼0.003)groups.From t1 to t3,CTC counts significantly in-creased in both the taTME(P¼0.008)and laTME(P¼0.031)groups.There were no significant differences in CTC phenotype changes between the two groups from t1 to t3. Conclusions:Compared with laTME,taTME did not affect CTC counts and phenotypes.Our findings indicate that taTME is not infe-rior to laTME in terms of CTC changes from an oncological perspective.

摘要：Background:Tumor regression grade(TRG)is evaluated by calculating the proportion of residual tumor to stromal fibrosis,which can reflect the tumor response to neoadjuvant chemoradiotherapy(NCRT)in patients with locally advanced rectal cancer(LARC).Overall,patients with TRG1 show good sensitivity to NCRT but the long-term survival for these patients remains different.This study aimed to assess the prognostic factors in patients with TRG1. Methods:LARC patients who underwent NCRT and radical surgery were included.TRG was evaluated according to the National Comprehensive Cancer Network guidelines.The association between clinicopathological factors and survival outcomes was assessed in patients with TRG1.Overall survival(OS)and disease-free survival(DFS)were evaluated using both Kaplan-Meier analyses and Cox proportional hazards models. Results:Of the 393 LARC patients,104(26.5%)were diagnosed with TRG1.The 5-year OS rates and 5-year DFS rates of patients with TRG1 were 90.9%and 72.2%,respectively.In patients with TRG1,the tumor regression pattern(P¼0.001),pathologic tumor node metastasis(TNM)stage(P¼0.002),neoadjuvant rectal score(P¼0.024),T downstaging(P¼0.022),and baseline carcinoembryonic antigen level(P¼0.038)were associated with DFS in univariate analysis.Only the tumor regression pattern showed prognostic significance for DFS in multivariate analysis(P¼0.003).The group with tumor shrinkage had a higher OS rate than the tumor fragmentation group but the differ-ence in the OS rates between the two groups was not significant(P¼0.196). Conclusions:TRG could be a prognostic variable for LARC patients receiving NCRT.In patients with TRG1,the tumor regression pattern may represent another useful prognostic factor to better individualize the prognosis.

摘要：Introduction Endoscopic submucosal dissection(ESD)has evolved into a viable treatment modality for early esophageal cancer,with a distinct advantage of the ability to perform en-bloc resection and accu-rate histopathological assessment.The most common adverse events of ESD in the esophagus include perforation and stricture.In this report,we present a case of a rare complication of esopha-geal ESD,which happened during the procedure and was re-solved successfully based on our experience.

摘要：Background:Biliary tract infection is a common complication of choledocholithiasis.This study aimed to analyse the distribution of pathogenic bacteria in bile cultures from patients with choledocholithiasis combined with biliary tract infection to guide clinical application of antimicrobials and reduce the emergence of drug resistance. Methods:A total of 880 patients were enrolled in this retrospective study from 30 March 2017 to 31 August 2022 at the Affiliated Hospital of Qingdao University in China.Bile specimens were extracted for microbiological culture under aseptic conditions using en-doscopic retrograde cholangiopancreatography.Bacterial culture,strain identification,and antimicrobial susceptibility testing were conducted according to the standard protocol.Baseline data were retrieved from patient files. Results:Overall,90.34%(795/880)of bile samples showed positive microbiological results and 37.50%(330/880)demonstrated polymi-crobial infections.Among the 795 bile specimens with positive culture results,1,216 pathogenic bacteria were detected,with gram-negative bacilli accounting for 56.33%,gram-positive cocci for 41.86%,and fungi for 1.81%.The predominant gram-negative bacilli in the bile cultures were Escherichia coli(30.43%)and Klebsiella pneumoniae(13.98%),whereas the main gram-positive cocci were Enterococcus faecium(14.04%)and E.casseliflavus(4.28%).The annual trend analysis revealed a gradual decrease in the proportion of gram-negative bacilli and a gradual increase in the proportion of gram-positive cocci,with a concomitant decrease in the dominance of E.coli.Both E.faecium and E.coli showed high resistance to conventional antibiotics but high sensitivity to piperacillin/tazobactam,carbapenems,amikacin,and vancomycin. Conclusions:A significant change has occurred in the bile bacterial spectrum in patients with choledocholithiasis and biliary tract infection.The incidence of gram-positive cocci infections has increased annually,while that of gram-negative bacilli and E.coli infec-tions has decreased.Antibiotic administration should be tailored based on the local bacterial profile.

摘要：Introduction Anal cancer is a rare cancer accounting for?2％of all gastroin-testinal tract malignancies[1].Among anal cancers,squamous cell cancer(SCC)is the most common and lymphoma is one of the least frequent.The gastrointestinal tract is the most common site for extranodal non-Hodgkin's lymphoma(NHL),and diffuse large B-cell lymphoma(DLBCL)is the most common histologic subtype.

摘要：Background:KRAS/BRAF mutations(mutKRAS/mutBRAF)are unfavorable prognostic factors for colorectal cancer(CRC)metastases to the liver and lungs.However,their effects on the prognosis for patients with synchronous peritoneal metastasis(S-PM)of CRC after cytoreductive surgery(CRS)and hyperthermic intraperitoneal chemotherapy(HIPEC)are controversial.In the study,we aimed to de-termine the effects of mutKRAS/mutBRAF on the prognosis for patients with S-PM who received CRS. Methods:A total of 142 patients diagnosed with S-PM between July 2007 and July 2019 were included in this study.The demo-graphics,mutKRAS/mutBRAF status,overall survival(OS),and progression-free survival(PFS)of the patients were evaluated.The Kaplan-Meier method and log-rank test were used to estimate the difference in survival between groups. Results:Among 142 patients,68(47.9%)showed mutKRAS and 42(29.5%)showed mutBRAF.The median OS values were 8.4 and 34.3 months for patients with mutBRAF and BRAF wild-type,respectively(P<0.01).However,KRAS status was not significantly associ-ated with median OS(P=0.76).Multivariate analysis revealed carcinoembryonic antigen,CRS,HIPEC,and mutBRAF as independent predictors for OS.Based on these findings,a nomogram was constructed.The C-index was 0.789(95%confidence interval,0.742-0.836),indicating good predictive ability of the model.Furthermore,the 1-and 2-year survival calibration plots showed good agreement be-tween the predicted and actual OS rates.The area under curves of the 1-and 2-year survival predictions based on the nomogram were 0.807 and 0.682,respectively.Additionally,mutBRAF was significantly associated with lower PFS(P<0.001). Conclusions:mutBRAF is an independent prognostic risk factor for S-PM.The established nomogram predicted the OS of patients with CRC having S-PM with high accuracy,indicating its usefulness as a valuable prognostic tool for the designated patient cohort.