摘要：Introduction Solitary Peutz-Jeghers polyps are hamartomatous lesions in the gastrointestinal(GI)tract.They are rare and can be diagnosed in both children and adults(Figure 1A).Microscopically,Peutz-Jeghers polyps can have a characteristic morphology,making it possible to distinguish them from other polyps(Figure 1B and C).

摘要：Introduction Autoimmune pancreatitis(AIP)is one of the recently established immunoglobulin G4-related diseases(IgG4-RD)[1].The detailed pathogenic mechanisms have been an intensive research area for prophylactic and therapeutic purposes because aberrant im-mune activation and tissue fibrosis in AIP are the major factors that worsen the disease outcomes in these patients.

摘要：Background:Tumor heterogeneity is contributed by tumor cells and the microenvironment.Dynamics of tumor heterogeneity dur-ing colorectal cancer(CRC)progression have not been elucidated. Methods:Eight single-cell RNA sequencing(scRNA-seq)data sets of CRC were included.Milo was utilized to reveal the differential abundance of cell clusters during progression.The differentiation trajectory was imputed by using the Palantir algorithm and meta-bolic states were assessed by using scMetabolism.Three spatial transcription sequencing(ST-seq)data sets of CRC were used to vali-date cell-type abundances and colocalization.Cancer-associated regulatory hubs were defined as communication networks affecting tumor biological behaviors.Finally,quantitative reverse transcription polymerase chain reaction and immunohistochemistry stain-ing were performed for validation. Results:TM4SF1+,SOX4+,and MKI67+tumor cells;CXCL12+cancer-associated fibroblasts;CD4+resident memory T cells;Treg;IgA+plasma cells;and several myeloid subsets were enriched in stage Ⅳ CRC,most of which were associated with overall survival of patients.Trajectory analysis indicated that tumor cells from patients with advanced-stage CRC were less differentiated,when meta-bolic heterogeneity showed a highest metabolic signature in terminal states of stromal cells,T cells,and myeloid cells.Moreover,ST-seq validated cell-type abundance in a spatial context and also revealed the correlation of immune infiltration between tertiary lymphoid structures and tumors followed by validation in our cohort.Importantly,analysis of cancer-associated regulatory hubs revealed a cascade of activated pathways including leukocyte apoptotic process,MAPK pathway,myeloid leukocyte differentiation,and angiogenesis during CRC progression. Conclusions:Tumor heterogeneity was dynamic during progression,with the enrichment of immunosuppressive Treg,myeloid cells,and fibrotic cells.The differential state of tumor cells was associated with cancer staging.Assessment of cancer-associated reg-ulatory hubs suggested impaired antitumor immunity and increased metastatic ability during CRC progression.

摘要：The prevalence of liver disease is rising and more patients with liver disease are considered for surgery each year.Liver disease poses many potential complications to surgery;therefore,assessing perioperative risk and optimizing a patient's liver health is necessary to decrease perioperative risk.Multiple scoring tools exist to help quantify perioperative risk and can be used in combination to best educate patients prior to surgery.In this review,we go over the various scoring tools and provide a guide for clinicians to best assess and optimize perioperative risk based on the etiology of liver disease.

摘要：Background:Postoperative recurrence(POR)remains a major challenge for patients with Crohn's disease(CD).Gut microbial dysbiosis has been reported to be involved in the pathogenesis of POR.This study aims to investigate the relationship between fecal microbiome and endoscopic recurrence in patients with CD after ileocolonic resection. Methods:This is a cross-sectional study.Fecal samples were collected from 52 patients with CD after surgical intervention from 6 to 12 months before endoscopic examination.Endoscopic recurrence was defined as Rutgeerts score≥i2.The microbiome was analyzed by sequencing the V3-V4 hypervariable regions of the 16S rRNA gene. Results:A total of 52 patients were included and classified into POR(n=27)and non-POR(n=25)groups.Compared with the non-POR group,the POR group had a significantly lower community richness(Chao1 index:106.5 vs 124,P=0.013)and separated microbial community(P=0.007 for Adonis,P=0.032 for Anosim),combined with different distribution of 16 gut microbiotas and decrease of 11 predicted metabolic pathways(P<0.05).Lactobacillus and Streptococcus were identified to closely correlate to non-POR(P<0.05)after controlling for confounding factors.Kaplan-Meier analysis indicated that the patients with higher abundance of Streptococcus experienced longer remission periods(P<0.01),but this was not for Lactobacillus.The predicted ethylmalonyl-coA pathway related to increased amount of succinate was positively correlated with Streptococcus(r>0.5,P<0.05). Conclusions:The characteristic alterations of fecal microbiota are associated with postoperative endoscopic recurrence in patients with CD;particularly,high abundance of Streptococcus may be closely related to endoscopic remission.