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：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：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：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：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.