摘要：Liver fibrosis is the common pathway from various chronic liver diseases and its progression leads to cirrhosis which carries a signif-icant risk for the development of portal hypertension-related complications and hepatocellular carcinoma.It is crucial to identify and halt the worsening of liver fibrosis given its important prognostic implication.Liver biopsy is the gold standard for assessing the degree of liver fibrosis but is limited due to its invasiveness and impracticality for serial monitoring.Many noninvasive tests have been developed over the years trying to assess liver fibrosis in a practical and accurate way.The tests are mainly laboratory-or imaging-based,or in combination.Laboratory-based tests can be derived from simply routine blood tests to patented laboratory parameters.Imaging modalities include ultrasound and magnetic resonance elastography,in which vibration-controlled transient elastography is the most widely validated and adopted whereas magnetic resonance elastography has been proven the most accu-rate liver fibrosis assessment tool.Nonetheless,noninvasive tests do not always apply to all liver diseases,nor does a common cut-off value of a test mean the same degree of liver fibrosis in different scenarios.In this review,we discuss the diagnostic and prognos-tic performance,as well as the confounders and limitations,of different noninvasive tests on liver fibrosis assessment in various liver diseases.

摘要：Background:Radiation-induced colorectal fibrosis(RICF)is a common pathological alteration among patients with rectal cancer undergoing neoadjuvant chemoradiotherapy(nCRT).Anastomotic stenosis(AS)causes symptoms and negatively impacts patients'quality of life and long-term survival.In this study,we aimed to evaluate the fibrosis signature of RICF and develop a nomogram to predict the risk of AS in patients with rectal cancer undergoing nCRT. Methods:Overall,335 pairs of proximal and distal margins were collected and randomly assigned at a 7:3 ratio to the training and testing cohorts.The RICF score was established to evaluate the fibrosis signature in the anastomotic margins.A nomogram based on the RICF score for AS was developed and evaluated by using the area under the curve,decision curve analysis,and the DeLong test. Results:The training cohort included 235 patients(161 males[68.51%];mean age,59.61 years)with an occurrence rate of AS of 17.4%,whereas the testing cohort included 100 patients(72 males[72.00%];mean age,57.17 years)with an occurrence rate of AS of 11%.The RICF total score of proximal and distal margins was significantly associated with AS(odds ratio,3.064;95%confidence interval[CI],2.200-4.268;P<0.001).Multivariable analysis revealed that the RICF total score,neoadjuvant radiotherapy,and surgical approach were independent predictors for AS.The nomogram demonstrated good discrimination in the training cohort(area under the receiver-operating characteristic curve,0.876;95%CI,0.816-0.937),with a sensitivity of 68.3%(95%CI,51.9%-81.9%)and a specificity of 85.5%(95%CI,78.7%-89.3%).Similar results were observed in the testing cohort. Conclusions:This study results suggest that the RICF total score of anastomotic margins is an independent predictor for AS.The pre-diction model developed based on the RICF total score may be useful for individualized AS risk prediction in patients with rectal can-cer undergoing nCRT and sphincter-preserving surgery.

摘要：Evidence-based research has confirmed the role of gastrointestinal microbiota in regulating intestinal inflammation.These data have generated interest in developing microbiota-based therapies for the prevention and management of inflammatory bowel dis-ease(IBD).Despite in-depth understanding of the etiology of IBD,it currently lacks a cure and requires ongoing management.Accumulating data suggest that an aberrant gastrointestinal microbiome,often referred to as dysbiosis,is a significant environmen-tal instigator of IBD.Novel microbiome-targeted interventions including prebiotics,probiotics,fecal microbiota transplant,and small molecule microbiome modulators are being evaluated as therapeutic interventions to attenuate intestinal inflammation by restoring a healthy microbiota composition and function.In this review,the effectiveness and challenges of microbiome-centered interven-tions that have the potential to alleviate intestinal inflammation and improve clinical outcomes of IBD are explored.

摘要：Background:Early-stage ampullary adenomas have only been reported in a small case series on endoscopic management.Hence,this study aimed to evaluate the long-term outcomes of early ampullary adenoma with endoscopic management and identify the risk factors for acute pancreatitis after endoscopic papillectomy(EP). Methods:In this study,115 patients who underwent EP at Changhai Hospital(Shanghai,China)between January 2012 and December 2018 were retrospectively analysed.Endoscopy was performed at 1,3,6,and 12 months after EP.Data were statistically analysed us-ing the t-test or the Mann-Whitney U test. Results:A total of 107 patients were included in this study and the follow-up period was 75±43 months.The average age of the 107 patients was 54.6 years and the average tumor size was 17 mm.The average age of the patients(53.7±10.7 years vs 55.2±10.5 years,P=0.482),minimum tumor size(13 vs 19 mm,P=0.063),and complete resection rate(84.78％ vs 85.25％,P=0.947)did not differ signif-icantly between the stent placement and non-stent placement groups.Post-EP acute pancreatitis rates in the non-stent placement and stent placement groups were 11.48％and 4.35％,respectively.The risk of post-EP acute pancreatitis was significantly associated with the preoperative carcinoembryonic antigen level in univariate analysis,but not in multivariate analysis.The risk of post-EP acute pancreatitis was not significantly associated with the placement of the pancreatic stent in either univariate or multivariate analysis.Moreover,delayed proximal pancreatic duct stenosis was not noted in either group during long-term follow-up. Conclusions:EP is a satisfactory option for treating adenomas of the ampulla of the duodenum.

摘要：Background:Endoscopic ultrasound(EUS)-guided transhepatic antegrade stone removal(TASR)has been reserved for choledocholi-thiasis after failed endoscopic retrograde cholangiopancreatography(ERCP)in recent years.The aim of this study was to evaluate the techniques,feasibility,and safety of simplified single-session EUS-TASR for choledocholithiasis in patients with surgically altered anatomy(SAA). Methods:A retrospective database of patients with SAA and choledocholithiasis from the Second Hospital of Hebei Medical University(Shijiazhuang,China)between August 2020 and February 2023 was performed.They all underwent single-session EUS-TASR after ERCP failure.Basic characteristics of the patients and details of the procedures were collected.The success rates and ad-verse events were evaluated and discussed. Results:During the study period,13 patients underwent simplified single-session EUS-TASR as a rescue procedure(8 males,median age,64.0[IQR,48.5-69.5]years).SAA consisted of four Whipple procedures,one Billroth II gastrectomy,four gastrectomy with Roux-en-Y anastomoses,and four hepaticojejunostomy with Roux-en-Y anastomoses.The technical success rate was 100%and successful bile duct stone removal was achieved in 12 of the patients(92.3%).Adverse events occurred in two patients(15.4%),while one turned to laparoscopic surgery and the other was managed conservatively. Conclusions:Simplified single-session EUS-TASR as a rescue procedure after ERCP failure appeared to be effective and safe in the management of choledocholithiasis in patients with SAA.But further evaluation of this technique is still needed,preferably through prospective multicenter trials.

摘要：During liver ischemia-reperfusion injury,existing mechanisms involved oxidative stress,calcium overload,and the activation of in-flammatory responses involve mitochondrial injury.Mitochondrial autophagy,a process that maintains the normal physiological ac-tivity of mitochondria,promotes cellular metabolism,improves cellular function,and facilitates organelle renewal.Mitochondrial autophagy is involved in oxidative stress and apoptosis,of which the PINK1-Parkin pathway is a major regulatory pathway,and the deletion of PINK1 and Parkin increases mitochondrial damage,reactive oxygen species production,and inflammatory response,play-ing an important role in mitochondrial quality regulation.In addition,proper mitochondrial permeability translational cycle regula-tion can help maintain mitochondrial stability and mitigate hepatocyte death during ischemia-reperfusion injury.This mechanism is also closely related to oxidative stress,calcium overload,and the aforementioned autophagy pathway,all of which leads to the augmentation of the mitochondrial membrane permeability transition pore opening and cause apoptosis.Moreover,the release of mitochondrial DNA(mtDNA)due to oxidative stress further aggravates mitochondrial function impairment.Mitochondrial fission and fusion are non-negligible processes required to maintain the dynamic renewal of mitochondria and are essential to the dynamic stability of these organelles.The Bcl-2 protein family also plays an important regulatory role in the mitochondrial apoptosis signaling pathway.A series of complex mechanisms work together to cause hepatic ischemia-reperfusion injury(HIRI).This article reviews the role of mitochondria in HIRI,hoping to provide new therapeutic clues for alleviating HIRI in clinical practice.

摘要：Background:Traditional right hemicolectomy(TRH)is the standard treatment for patients with nonmetastatic right colon cancer.However,the ileocecum,a vital organ with mechanical and immune functions,is removed in these patients regardless of the tumor location.This study aimed to evaluate the technical and oncological safety of laparoscopic ileocecal-sparing right hemicolec-tomy(LISH). Method:Patients who underwent LISH at two tertiary medical centers were matched 1:2 with patients who underwent TRH by pro-pensity score matching based on sex,age,body mass index,tumor location,and disease stage.Data on surgical and perioperative outcomes were collected.Oncological safety was evaluated in a specimen-oriented manner.Lymph nodes(LNs)near the ileocolic ar-tery(ICA)were examined independently in the LISH group.Disease outcomes were recorded for patients who completed one year of follow-up. Results:In all,34 patients in the LISH group and 68 patients in the TRH group were matched.LISH added 8 minutes to the dissection of LNs around the ileocolic vessels(groups 201/201d,202,and 203 LNs),without affecting the total operation time,blood loss,or peri-operative adverse event rate.Compared with TRH,LISH had a comparable lymphadenectomy quality,specimen quality,and safety margin while preserving a more functional bowel.The LISH group had no cases of LN metastasis near the ICA.No difference was detected in the recurrence rate at the 1-year follow-up time point between the two groups. Conclusion:In this dual-center study,LISH presented comparable surgical and oncological safety for patients with hepatic flexure or proximal transverse colon cancer.

摘要：This article presents an overview of endoscopic retrograde appendicitis therapy(ERAT),an innovative and minimally invasive treat-ment for appendicitis with an appendix-preserving manner.Since its initial application in 2009,ERAT has gained significant popular-ity in China,due to its rapid recovery and minimal risk of complications.The ERAT procedures comprise several steps,including appendiceal orifice access and intubation,appendiceal lumen imaging,decompression and irrigation,fecalith removal,and stenting.ERAT has been used in various forms of complicated appendicitis,such as in pregnant women and children,with continuous improvements in both technique and safety.It has the potential to become the preferred diagnostic and treatment method for ap-pendicitis.Until 2023,over 10,000 ERAT procedures have been successfully conducted in China,and the technique has gained more attention worldwide.However,challenges remain,including training,standardization of ERAT practice,research and technology im-provement,enhancing public awareness,and fostering international collaboration.In summary,ERAT can be the standard treatment for appendicitis treatment,which represents a paradigm shift in the conventional clinical practice.

摘要：Background:Robotic-assisted pancreatoduodenectomy(RPD)has been routinely performed in a few of centers worldwide.This study aimed to evaluate the perioperative outcomes and the learning curves of resection and reconstruction procedures in RPD by one single surgeon. Methods:Consecutive patients undergoing RPD by a single surgeon at the First Affiliated Hospital of Sun Yat-sen University(Guangzhou,China)between July 2016 and October 2022 were included.The perioperative outcomes and learning curves were retro-spectively analysed by using cumulative sum(CUSUM)analyses. Results:One-hundred and sixty patients were included.According to the CUSUM curve,the times of resection and reconstruction procedures were shortened significantly after 30 cases(median,284 vs 195 min;P<0.001)and 45 cases(median,138 vs 120 min;P<0.001),respectively.The estimated intraoperative blood loss(median,100 vs 50 mL;P<0.001)and the incidence of clinically relevant post-operative pancreatic fistula(29.2%vs 12.5%;P=0.035)decreased significantly after 20 and 120 cases,respectively.There were no significant differences in the total number of lymph nodes examined,post-operative major complications,or post-operative length-of-stay between the two groups. Conclusions:Optimization of the resection procedure and the acquisition of visual feedback facilitated the performance of RPD.RPD was a safe and feasible procedure in the selected patients.

摘要：For patients with different clinical stages of rectal cancer,tailored surgery is urgently needed.Over the past 10 years,our team has conducted numerous anatomical studies and proposed the"four fasciae and three spaces"theory to guide rectal cancer surgery.Enlightened by the anatomical basis of the radical hysterectomy classification system of Querleu and Morrow,we proposed a new classification system of radical surgery for rectal cancer based on membrane anatomy.This system categorizes the surgery into four types(A-D)and incorporates corresponding subtypes based on the preservation of the autonomic nerve.Our surgical classification unifies the pelvic membrane anatomical terminology,validates the feasibility of classifying rectal cancer surgery using the theory of"four fasciae and three spaces,"and lays the theoretical groundwork for the future development of unified and standardized classifi-cation of radical pelvic tumor surgery.

摘要：Background:Localization of the primary tumor and ensuring safe distal surgical margins(DSMs)following neoadjuvant chemoradio-therapy(nCRT)are challenging in locally advanced rectal cancers(LARCs).This study investigated the effectiveness of carbon nano-particles suspension(CNS)for labeling the primary tumor and allowing precise tumor resection after nCRT. Methods:Clinicopathological data of LARC patients who underwent nCRT followed by laparoscopic radical anal preservation surgery at our center between January 2018 and February 2023 were prospectively collected.The patients were divided into the CNS tattooed(CNS)and non-tattooed(control)groups.In the CNS group,CNS was injected in four quadrants on the anal side 1 cm away from the lower tumor margin.DSMs were determined through intraoperative distal rectal examination in the control group and observation of CNS tattoos in the CNS group.DSM lengths and positive DSM rates were compared between the two groups to analyse the feasibil-ity and effectiveness of CNS for labeling LARCs before nCRT. Results:There was no statistically significant difference in the basic demographic data,effectiveness of nCRT,or post-operative re-covery rates between the two groups(all P>0.05).In the CNS group,CNS tattoos were observed on the outside of the rectal wall,with an overall efficiency of 87.1%(27/31).The CNS group had fewer positive DSMs and safer DSM lengths(2.73±0.88 vs 2.12±1.15 cm,P=0.012)than the control group(P<0.05). Conclusions:Endoscopic ultrasound-guided injection of CNS tattoos before nCRT could effectively label the LARCs,ensuring safe DSMs during anus-preserving surgeries(Chictr.org.cn No.:ChiCTR2300068991).

摘要：Introduction Chronic intestinal pseudo-obstruction(CIPO),defined as chronic constipation without mechanical obstruction of the gastrointesti-nal tract[1,2],often presents with a truly chameleon-like symp-tomatology including irregular defecation,abdominal pain and distension,nausea,vomiting,and sometimes fluid/electrolyte imbalance.Although diarrhea was found in ≤17％of CIPO cases,its nature,however,has not been precisely described.Serious deviations of electrolyte and acid-base status,to the best of our knowledge,have not been reported.

摘要：Introduction Cholestatic jaundice in infancy occurs in～1 in 2,500 term infants and 25％of cases are genetically determined[1].An accurate diag-nosis is crucial for clinicians to provide timely and personalized management.Despite the increasing application of whole-exome sequencing(WES),the genetic diagnosis of some patients remains unclear.

摘要：Introduction Cholangioscopy has become a prevalent method for treating common bile duct(CBD)stones.Two primary types of cholangio-scopes are commonly used:through-the-scope cholangioscopy and peroral direct cholangioscopy(PDCS).In the literature,three kinds of endoscopes are documented for PDCS:ultra-slim endo-scopes,double-bending cholangioscopes and standard endo-scopes[1].Among these options,standard endoscopes offer superior advantages,including better image quality,larger work-ing channels and more available accessories[2].Particularly in cases where patients exhibit significant CBD dilation,typically with a diameter exceeding 12 mm,a standard endoscope proves to be an effective choice for PDCS.Consequently,we presented a successful case where a giant CBD stone was effectively treated using PDCS through a standard gastroscope.

摘要：Background:Currently,the prognosis for metastatic colorectal cancer(mCRC)still remains poor.The management of mCRC has be-come manifold because of the varied advances in the systemic and topical treatment approaches.For patients with limited number of metastases,radical local therapy plus systemic therapy can be a good choice to achieve long-term tumor control.In this study,we aimed to explore the efficacy and safety of the combination of fruquintinib,tislelizumab,and stereotactic ablative radiotherapy(SABR)in mCRC(RIFLE study). Methods:RIFLE was designed as a single-center,single-arm,prospective Phase Ⅱ clinical trial.A total of 68 mCRC patients who have failed the first-line standard treatment will be recruited in the safety run-in phase(n=6)and the expansion phase(n=62),respec-tively.Eligible patients will receive SABR followed by fruquintinib(5 mg,d1-14,once every day)and tislelizumab(200 mg,d1,once every 3 weeks)within 2 weeks from completion of radiation.The expansion phase starts when the safety of the treatment is deter-mined(dose limiting toxicity occur in no more than one-sixth of patients in the run-in phase).The primary end point is the objective response rate.The secondary end points include the disease control rate,duration of response,3-year progression-free survival rate,3-year overall survival rate,and toxicity. Conclusions:The results of this trial will provide a novel insight into SABR in combination with PD-1 antibody and vascular endothe-lial growth factor receptor inhibitor in the systematic treatment of metastatic colorectal cancer,which is expected to provide new therapeutic strategies and improve the prognosis for mCRC patients. Trial registration:NCT04948034(ClinicalTrials.gov).

摘要：Background:Neoadjuvant chemotherapy(NCT)alone can achieve comparable treatment outcomes to chemoradiotherapy in locally advanced rectal cancer(LARC)patients.This study aimed to investigate the value of texture analysis(TA)in apparent diffusion coef-ficient(ADC)maps for identifying non-responders to NCT. Methods:This retrospective study included patients with LARC after NCT,and they were categorized into nonresponse group(pTRG 3)and response group(pTRG 0-2)based on pathological tumor regression grade(pTRG).Predictive texture features were extracted from pre-and post-treatment ADC maps to construct a TA model using RandomForest.The ADC model was developed by manually measuring pre-and post-treatment ADC values and calculating their changes.Simultaneously,subjective evaluations based on mag-netic resonance imaging assessment of TRG were performed by two experienced radiologists.Model performance was compared using the area under the curve(AUC)and DeLong test. Results:A total of 299 patients from two centers were divided into three cohorts:the primary cohort(center A;n¼194,with 36 non-responders and 158 responders),the internal validation cohort(center A;n¼49,with 9 non-responders)and external validation cohort(center B;n¼56,with 33 non-responders).The TA model was constructed by post_mean,mean_change,post_skewness,post_entropy,and entropy_change,which outperformed both the ADC model and subjective evaluations with an impressive AUC of 0.997(95%confidence interval[CI],0.975-1.000)in the primary cohort.Robust performances were observed in internal and external validation cohorts,with AUCs of 0.919(95%CI,0.805-0.978)and 0.938(95%CI,0.840-0.985),respectively. Conclusions:The TA model has the potential to serve as an imaging biomarker for identifying nonresponse to NCT in LARC patients,providing a valuable reference for these patients considering additional radiation therapy.

摘要：Introduction Herbal and dietary supplements(HDS)-induced liver injury has garnered interest in recent years for the increasing trend world-wide[1].Chinese oral herbal paste,a popular herbal formula to enhance immunity as HDS in a Chinese medicine clinic,has been less reported to induce liver injury.Here we reported a case of drug reaction with eosinophilia and systemic symptoms(DRESS)syndrome with abrupt transaminitis,which was caused by daily consumption of herbal formulas for 4 weeks.

摘要：Anorexia nervosa(AN)is one of the most common psychiatric disorders among young adults and is associated with a substantial risk of death from suicide and medical complications.Transaminase elevations are common in patients with AN at the time of hospital admission and have been associated with longer lengths of hospital stay.Multiple types of hepatitis may occur in these patients,including two types that occur only in patients with AN:starvation hepatitis and refeeding-induced hepatitis.Starvation hepatitis is characterized by severe transaminase elevation in patients in the advanced phase of protein-energy deprivation and is associated with complications of severe starvation,such as hypoglycaemia,hypothermia,and hypotension.Refeeding-induced hepatitis is characterized by a milder increase in transaminases that occurs in the early refeeding phase and is associated with hypophosphatemia,hypokalemia,and hypomagnesaemia.Among the most common forms of hepatitis,drug-induced liver injury is particularly relevant in this patient cohort,given the frequent use and abuse of methamphetamines,laxatives,antidepressants,and antipsychotics.In this review,we provided an overview of the different forms of anorexic-associated hepatitis,a diagnostic approach that can help the clinician to correctly frame the problem,and indications on their management and treatment.

摘要：Background:Visceral fat represents a metabolically active entity linked to adverse metabolic sequelae of obesity.We aimed to determine if celiac artery mesenteric fat thickness can be reliably measured during endoscopic ultrasound(EUS),and if these meas-urements correlate with metabolic disease burden. Methods:This was a retrospective analysis of patients who underwent celiac artery mesenteric fat measurement with endosonogra-phy(CAMEUS)measurement at a tertiary referral center,and a validation prospective trial of patients with obesity and nonalcoholic steatohepatitis who received paired EUS exams with CAMEUS measurement before and after six months of treatment with an intra-gastric balloon. Results:CAMEUS was measured in 154 patients[56.5%females,mean age 56.5±18.0 years,body mass index(BMI)29.8±8.0 kg/m2]and was estimated at 14.7±6.5 mm.CAMEUS better correlated with the presence of non-alcoholic fatty liver disease(NAFLD)(R2=0.248,P<0.001)than BMI(R2=0.153,P<0.001),and significantly correlated with metabolic parameters and diseases.After six months of intragastric balloon placement,the prospective cohort experienced 11.7%total body weight loss,1.3 points improvement in hemoglo-bin A1c(P=0.001),and a 29.4%average decrease in CAMEUS(-6.4±5.2 mm,P<0.001).CAMEUS correlated with improvements in weight(R2=0.368),aspartate aminotransferase to platelet ratio index(R2=0.138),and NAFLD activity score(R2=0.156)(all P<0.05). Conclusions:CAMEUS is a novel measure that is significantly correlated with critical metabolic indices and can be easily captured during routine EUS to risk-stratify susceptible patients.This station could allow for EUS access to sampling and therapeutics of this metabolic region.

摘要：Inflammatory bowel disease(IBD)is an immune-mediated inflammatory condition involving both the innate and adaptive immune systems.Recently,the role of intestinal fungal flora and their downstream immune pathways has been highlighted in the pathogen-esis of IBD.Cytokines as primary immune mediators require a delicate balance for maintaining intestinal homeostasis.Although most cytokines have a predictable role in either amplifying or attenuating inflammation in IBD,a few cytokines have shown a dual function in the inflammatory state of the intestine.Some of these dual-faced cytokines are also involved in mucosal anti-microbial defense pathways,particularly against intestinal fungal residents.Here,we reviewed the role of these cytokines in IBD pathogenesis to achieve a better understanding of the fungal interactions in the development of IBD.