Chemoprevention of colorectal cancer in general population and high-risk population: a systematic review and network meta-analysis / 中华医学杂志(英文版)

BACKGROUND@#Many nutritional supplements and pharmacological agents have been reported to show preventive effects on colorectal adenoma and colorectal cancer (CRC). We performed a network meta-analysis to summarize such evidence and assess the efficacy and safety of these agents.@*METHODS@#We searched PubMed, Embase, and the Cochrane Library for studies published in English until October 31, 2021 that fit our inclusion criteria. We performed a systematic review and network meta-analysis to assess the comparative efficacy and safety of candidate agents (low-dose aspirin [Asp], high-dose Asp, cyclooxygenase-2 inhibitors [coxibs], calcium, vitamin D, folic acid, ursodeoxycholic acid [UDCA], estrogen, and progesterone, alone or in combination) for preventing colorectal adenoma and CRC. Cochrane risk-of-bias assessment tool was employed to evaluate the quality of each included study.@*RESULTS@#Thirty-two randomized controlled trials (278,694 participants) comparing 13 different interventions were included. Coxibs significantly reduced the risk of colorectal adenoma (risk ratio [RR]: 0.59, 95% confidence interval [CI]: 0.44-0.79, six trials involving 5486 participants), advanced adenoma (RR: 0.63, 95% CI: 0.43-0.92, four trials involving 4723 participants), and metachronous adenoma (RR: 0.58, 95% CI: 0.43-0.79, five trials involving 5258 participants) compared with placebo. Coxibs also significantly increased the risk of severe adverse events (RR: 1.29, 95% CI: 1.13-1.47, six trials involving 7109 participants). Other interventions, including Asp, folic acid, UDCA, vitamin D, and calcium, did not reduce the risk of colorectal adenoma in the general and high-risk populations compared with placebo.@*CONCLUSIONS@#Considering the balance between benefits and harms, regular use of coxibs for prevention of colorectal adenoma was not supported by the current evidence. Benefit of low-dose Asp for chemoprevention of colorectal adenoma still requires further evidence.@*REGISTRATION@#PROSPERO, No. CRD42022296376.

Clinicopathological characteristics of rectal neuroendocrine neoplasms / 中华内科杂志

Objective:Clinicopathological characteristics of neuroendocrine neoplasms are highly heterogeneous based on variable origins.Our study aims to explore the clinical features of rectal neuroendocrine neoplasm (RNEN).Methods:Patients with histologically diagnosed rectal neuroendocrine neoplasms were retrospectively analyzed between January 2012 and December 2020. Epidemiological characteristics, clinical manifestations, complete blood count, endoscopy findings, and pathological features were recorded and analyzed. T-test was used for measurement data analysis, Chi-square test was performed for classification data analysis, and Binary logistic regression was applied for analyzing risk factors of metastasis.Results:Among 172 patients, the male to female ratio was 107 to 65 with an average age of (52±12) years (16-77 years). Altered bowel habit was the most common initial symptom (58/172, 33.7%), followed by abdominal pain (36/172, 20.9%) and loss of body weight (27/172, 15.7%). One hundred and sixty-one cases were neuroendocrine tumors, 9 were neuroendocrine carcinomas and 2 were mixed neuroendocrine-non-neuroendocrine neoplasms. Most endoscopic presentations were polypoid lesions (147/172, 85.5%), mainly limited to mucosa (48/172, 27.9%) and submucosa (96/172, 55.8%). Twenty-nine patients developed lymph node invasion or distant metastasis at diagnosis. There were statistical difference of neutrophil-to-lymphocyte ratios (NLR) among groups with different tumor size (<10 mm vs. 10-20 mm vs.>20 mm, mean NLR 1.79±0.55 vs. 2.27±1.23 vs. 2.95±0.66, P<0.01. Compared with non-metastatic group, the metastatic group presented higher NLR(2.61±0.81 vs. 1.89±0.80, P<0.01). Tumor size (<10 mm vs. 10-20 mm vs.>20 mm, OR 1.00 vs. 2.10 vs. 5.25×10 9, P =0.001), invasion to bowel wall (mucosa vs. submucosa vs. muscularis vs. serosa invasion, OR 1.00 vs. 3.26 vs. 14.11 vs. 39.42, P=0.008), and NLR (NLR<2.25 vs. NLR≥2.25, OR 1.00 vs. 5.19, P =0.024) were risk factors for metastasis. Conclusion:Metastasis of RNEN is related with tumor size, degree of bowel invasion and NLR. High NLR is a poor prognostic factor of RNEN.

Medium-and long-term effects of DSA-guided foam sclerotherapy for lower extremity varicosities / 中国介入影像与治疗学

Objective: To observe the effect of DSA-guided foam sclerotherapy for lower extremity varicose veins and its influence on patients' quality of life. Methods: Totally 573 patients (744 limbs) with lower extremity varicosities were treated with DSA-guided foam sclerotherapy and were followed up for 4 years. The health survey short form 12 (SF-12) and venous clinical severity score (VCSS) were counted before treatment and 1, 2, 3 and 4 years after treatment. The expectation for efficacy and treatment satisfaction were collected through filling questionnaires for the lower extremity symptom improvement 4 years after treatment. Results: All the limbs were successfully treated, the average usage of the foam was (21.62±10.83) ml/limb, and no severe side effects such as deep venous thrombosis or pulmonary embolism happened during or after procedures. Both physical component summary (PCS) score and mental component summary (MCS) score in SF-12 scale increased 1, 2, 3 and 4 years after treatment compared with that before treatment (all P<0.05), while VCSS decreased compared with that before treatment (all P<0.01). Upon the time of 4-year follow-up, the proportions of patients' expectations for improvement of appearance, pain, itching, swelling and heaviness of the affected limbs exceeded expectations + reached expectations were 100% (91/91), 100% (36/36), 93.55% (29/31), 88.46% (23/26) and 91.38% (53/58), respectively. The patients' overall satisfaction on the treatment was 100% (72/72). Conclusion: The medium- and long-term efficacy of DSA-guided foam sclerotherapy for lower extremity varicose veins were good, and the quality of life was improved.

Influence of Intestinal Microbiota on Brain-gut Axis and Functional Dyspepsia / 胃肠病学

Intestinal microbiota can act as a pathogenic factor for a variety of diseases of digestive system and nervous system. Studies have revealed the bidirectional connection between intestinal microbiota and brain-gut axis. And it is illustrated that the intestinal microbiota plays a significant role in the regulation of nervous system as well as gastrointestinal function. Functional dyspepsia (FD)is a common functional gastrointestinal disorder,and the pathogenesis has not yet been fully elucidated. In recent years,studies have indicated that intestinal microbiota may influence the genesis of FD. This article reviewed the effects of intestinal microbiota on brain-gut axis and FD.