Functional dyspepsia treated with WangShiBaoChiWan: a randomized, double-blind, parallel-controlled, multicenter clinical study / 中华消化杂志

Objective:To compare the efficacy and safety between WangShiBaoChiWan and mosapride in the treatment of functional dyspepsia (FD).Methods:From September 2019 to September 2020, patients with postprandial fullness and early satiation who met the Rome Ⅳ criteria for FD diagnosis were enrolled from 15 hospitals, including the First Affiliated Hospital of Naval Medical University (Shanghai Changhai Hospital), Beijing Traditional Chinese Medicine Hospital Affiliated to Capital Medical College. The subjects were randomly divided into WangShiBaoChiWan (experimental) group and mosapride (control) group in the ratio of 1∶1. The treatment regimens were WangShiBaoChiWan+ mosapride simulator, WangShiBaoChiWan simulator+ mosapride, respectively with a treatment period of 2 weeks. The primary efficacy outcome was the improvement rates of main symptoms before and after treatment, the secondary efficacy primary efficacy outcome was the total clinical effective rate and the change of the single symptom score. And the safety indicator included adverse events. Independent sample t-test, paired t-test and chi-square test were used for statistical analysis. Results:A total of 251 FD patients were enrolled in the full analysis set, including 124 in the experimental group and 127 in the control group; 241 FD patients were in the per-protocol analysis set, including 117 in the experimental group and 124 in the control group. The analysis of per-protocol analysis set showed that the improvement rates of the main symptoms of the experimental group and the control group were (66±29)% and (60±30)%, respectively, and the difference was not statistically significant ( P>0.05). The improvement rate of the main symptoms of the experimental group reached 117% of that of the control group, which exceeded the expected non-inferiority standard of 80%. The total clinical effective rates of the experimental group and the control group were 76.07% (89/117) and 75.81% (94/124), respectively, and the difference was not statistically significant ( P>0.05). The results of full analysis set showed that the incidence of adverse events of the experimental group and the control group was 1.62% (2/124) and 1.57% (2/127), respectively, and the difference was not statistically significant ( P>0.05). There were no serious adverse events in the two groups. Conclusion:The improvement rate of the main symptoms of WangShiBaoChiWan is not inferior to that of mosapride in the treatment of FD, and it has good safety.

Study on Use of Somatostatin in Prevention of Rebleeding After Endoscopic Secondary Prophylaxis of Gastroesophageal Varices / 胃肠病学

Background:Gastrointestinal bleeding is caused by factors such as poor platelet and coagulation function,and damage to varicose veins during endoscopic secondary preventive treatment in cirrhosis patients with gastroesophageal varices.At present,there is no clear standard for the use of somatostatin and its analogues after endoscopic secondary preventive treatment.Aims:To investigate the clinical value of somatostatin in preventing rebleeding after endoscopic secondary prophylaxis in patients with gastroesophageal varices.Methods:Clinical data of cirrhotic patients with gastroesophageal varices underwent endoscopic secondary prevention(endoscopic variceal ligation,endoscopic injection sclerotherapy,endoscopic cyanoacrylate injection)from Sept.2020 to Aug.2023 in this region were retrospectively analyzed.And patients were divided into group A(conventional therapy)and group B(conventional therapy+somatostatin).The prognosis(rebleeding rate,mortality rate),treatment benefit(length of stay,hospitalization cost)and blood indicators of the two groups were compared.Results:There was no significant difference in bleeding rate 3 days and 6 weeks after surgery between group A and Group B(P>0.05),and no death occurred after surgery.Hospital stay and hospitalization cost in group A were significantly decreased than in group B(P<0.05).No significant difference in incidence of adverse reaction was found between the two groups(χ2=3.21,P>0.05).No significant differences in hemoglobin,platelets,creatinine and liver function Child grade 6 weeks after surgery in group A and group B were found when compared with before surgery(P>0.05),while D-Dimer level was significantly decreased(P<0.05).Conclusions:For patients with gastroesophageal varices,endoscopic secondary preventive surgery can be performed according to the characteristics of blood flow after preoperative CT examination,and somatostatin can be unnecessary after surgery to improve treatment compliance and reduce the economic burden of patients.

Oral sulfate solution versus polyethylene glycol for colonoscopy bowel preparation: a randomized controlled study in phase Ⅲ / 中华消化内镜杂志

Objective:To compare the efficacy of oral sulfate solution (OSS) and polyethylene glycol (PEG) electrolyte powder for colonoscopy bowel preparation.Methods:A total of 283 randomized patients from 9 centers in China taking OSS ( n=143) or PEG ( n=140) using two-day split bowel preparation regimen received colonoscopy and assessment. The primary index was the bowel preparation success rate [global Boston bowel preparation scale (BBPS)≥ 6 by independent assessment center]. Secondary indices included BBPS global and segmental scores, investigator satisfaction (5-point Likert scale) with the quality of bowel preparation, patient satisfaction assessed by questionnaires, and patient tolerance assessed by Sharma scale. Compliance and safety were compared between the two groups. Results:The bowel preparation success rates were 100.0% for OSS and 99.3% for PEG [adjusted difference 0.7% (95% CI: -5.3% - 6.7%), P<0.001 for non-inferiority]. The BBPS global score in OSS group was significantly higher than that in PEG group (8.1 VS 7.7, P<0.001). The segment BBPS scores were also higher in OSS group than those in PEG group for all 3 segments (right colon: 2.4 VS 2.3, P=0.002; transverse colon: 2.8 VS 2.7, P=0.018; left colon: 2.8 VS 2.7, P=0.007). Investigator Likert score in the OSS group was significantly higher than that in the PEG group (2.6 VS 2.3, P<0.001). There was no significant difference in compliance between OSS and PEG, except for the second dose (90.9% VS 82.6%, P=0.039). There was no significant difference in patient satisfaction, Sharma score or proportion of patients with tolerance-related symptoms between the two groups. Safety was comparable between the two groups, and all adverse events were mild to moderate. Conclusion:OSS has comparable efficacy with PEG, with higher BBPS scores in all segments, better investigator satisfaction, better compliance in split dose, and comparable patient tolerance and safety.

Construction of artificial intelligence assisted diagnosis model for colonoscopy / 中华消化内镜杂志

Objective To establish an artificial intelligence deep learning model using clinical colonoscopy images and video to assist the diagnosis by colonoscopy. Methods More than 600000 colonoscopy images were collected in endoscopic center of the Second Affiliated Hospital of Zhejiang University School of Medicine from 2014 to 2018, and endoscopic experts recorded a large number of high-quality operation video of colonoscopy as analysis data. After repeated discussion by six experts, the classified intestinal sites and pathological features were determined, and fuzzy and confusable images were deleted. The final selection result was approximately 1 out of 4. And then the features of images were marked using an independently developed software. The deep learning algorithm was developed using TensorFlow platform of Google. Results After repeated comparison and analysis of the results of machine training and judgment results combined with pathology from endoscopic experts, the sensitivity of the model for some diseases ( such as colon polyps) was 99％ under laboratory conditions. In the clinical colonoscopy test, the sensitivity, specificity, and overall accuracy of this model for diagnosis of colon polyps were 98. 30％(4187/4259), 88. 10％ (17620/20000), and 92. 92％ [2×98. 30％×88. 10％/(98. 30％+88. 10％)], respectively. The sensitivity and specificity for ulcerative colitis were 78. 32％ ( 2671/3410) , and 67. 06％(13412/20000), respectively. The diagnosis time spent on a single image was 0. 5±0. 03 s, and it was the real time for application, including system recognition, text prompt in video image, background record and storage. Conclusion The artificial intelligence assisted diagnosis model developed by our team can identify colonic polyps, colorectal cancer, colorectal eminence, colonic diverticulum, ulcerative colitis, etc. The auxiliary diagnosis model of colon disease can guide beginners to carry out colonoscopy, and can improve lesion detection rate, reduce misdiagnosis rate, and improve the overall operating efficiency of endoscopic center, which is conducive to the quality control of colonoscopy.

Multi-disciplinary team for diagnosis and treatment of inflammatory bowel disease / 中华全科医师杂志

Inflammatory bowel disease ( IBD ) is a group of chronic non-specific inflammatory conditions of the intestine with unknown etiology.IBD has variety of intestinal manifestations and complications and there is lack of gold standard for diagnosis, so the disease should be diagnosed on the basis of clinical manifestations, endoscopic findings and histopathological examination.Most patients require surgical treatment and long-term maintenance of medication.Multi-disciplinary team (MDT), consisting of gastroenterologist, general surgeon, anorectal surgeon, nutritionist and psychologist, is needed for individualized treatment of patients.This article introduces the MDT model of diagnosis and treatment, and its application in inflammatory bowel disease.

Houpu Paiqi mixture in treatment of functional dyspepsia:a multicenter randomized controlled study / 中华消化杂志

Objective To evaluate the efficacy and safety of Houpu Paiqi mixture in treatment of functional dyspepsia (FD)with abdominal distension symptom.Methods From July 2014 to June 2015 , in nine centers,a total of 162 FD patients with abdominal distension symptom and met Rome Ⅲpostprandial distress syndrome (PDS)diagnostic criteria were enrolled.All patients were randomly divided into trial group and control group,81 patients in either group.The patients of trial group and control group took Houpu Paiqi mixture or placebo,respectively,25 mL per time,twice daily,and both the courses of treatment were two weeks.Before and after the treatment,the improvement of main symptoms,total clinical efficacy rate and efficacy of traditional medicine between two groups were compared.Chi square test,Fisher exact probability method and Wilcoxon test were performed for statistical analysis.Results According to the results of per-protocol (PP)analysis,the total efficacy rate of trial group and control group was 69.4% (50/72)and 59.2% (42/71),respectively,and there was no statistically significant difference in total efficacy rate between the two groups (χ2 =1 .650,P =0.199 ). And there was no statistically significant difference in the improvement of PDS main symptoms(postprandial fullnessand early satiety)between the two groups (56.3% ±27.9% vs 54.4% ±32.1%,t =0.606,P =0.727 ).For those with baseline symptom score over 14,median early satiety score of trial group after the treatment was 0,which was lower than that of control group,and the difference was statistically significant (Z =-2.370,P =0.018).The total efficacy rate of traditional medicine of trial group was 80.8% (59/73 )and that of control group was 72.0% (54/75 ),and the difference was not statistically significant (χ2 = 0.676,P =0.411 ).Conclusion Houpu Paiqi mixture has certain efficacy in FD with abdominal distension,and could be used for the treatment of PDS-predominant FD.

The anticancer activity of genistein on implanted tumor of human primary gastric carcinoma cells in nude mice / 中国病理生理杂志

AIM: To investigate the apoptosis of implanted tumor of primary human gastric cancer cells in nude mice induced by genistein and the relation between this apoptosis and expression of bcl - 2 and bax. METHODS: Establishing a transplanted tumor model by injecting human primary gastric cancer cells into subcutaneous tissue of nude mice. The different doses of genistein (0.5mg/kg, 1mg/kg and 1.5 mg/kg ) were directly injected beside tumor body respectively,for six times at an interval of two days. Then changes of tumor volume were measured continuously and tumor inhibition rate of each group was calculated. We observed the morphologic alteration by electron microscope, measured the apoptotic rate by TUNEL staining method, detected the expression of apoptosis - regulated gene bcl - 2 and bax by immunohistochemical staining and RT- PCR. RESULTS: Genistein could significantly inhibit carcinoma growth when it was injected near the carcinoma. Genistein induced implanted tumors cells to undergo apoptosis with apoptotic characteristics by transmission electron microscope. The apoptosis index of above three groups was increased progressively. Positive rate of Bcl - 2 protein of above three groups was decreased progressively and positive rate of Bax protein of above three groups was increased progressively by immunohistochemical staining. The density of bcl -2 mRNA decreased progressively and the density of bax mRNA increased progressively with elongation of time by RT - PCR. CONCLUSION: Genistein is able to induce the apoptosis of transplanted tumor cells. This apoptosis may be mediated by down - regulating bcl - 2 and up - regulating bax mRNA and its protein.

Resveratrol induces apoptosis in human primary gastric carcinoma cells / 中国病理生理杂志

AIM: To investigate the apoptosis in primary gastric cancer cells induced by resveratrol, and the relation between this apoptosis and expression of bcl- 2 and bax. METHODS: In in vitro experiments, MTT assay was used to determine the cell gowth inhibitory rate. Transmission electron microscopy and TUNEL staining were used to quantitatively and qualitively detect the apoptosis of primary gastric cancer cells before and after the resveratrol treatment. Immunohistochemical staining and RT - PCR was used to detect the expression of apoptosis - regulated gene bcl - 2 and bax. RESULTS: Resveratrol inhibited the growth of primary gastric cancer cells in a dose - and time - dependent manner. Resveratrol induced primary gastric cancer cells to undergo apoptosis with typically apoptotic characteristics. TUNEL assay showed that after the treatment of primary gastric cancer cells with resveratrol for 24, 48, 72, 96 hours, the apoptotic indexs were 4.93% ± 0.19%, 16.74% ± 0.43%, 27.88% ±0.36%, 36.84% ± 1.07 % respectively. Immunohistochemical staining showed that after the treatment of primary gastric cancer cells with resveratrol for 24, 48, 72, 96 hours, the positive rates of Bcl - 2 proteins were 20.68% ± 0.49%, 10.84% ±0.33%, 6.80% ± 0.34%, 3.91% ± 0.15% and the positive rates of Bax proteins were 19.79% ± 0.98%, 30.74% ±0.85%, 40.14% ± 1.17%, 60.08% ± 1.64%. After exposed to resveratrol for 24 h, 48 h, 72 h and 96 h, the density of bcl- 2 mRNA decreased progressively with elongation of time and the density of bax mRNA increased progressively with elongation of time by RT- PCR. CONCLUSION: Resveratrol is able to induce the apoptosis in primary gastric cancer. This apoptosis may be mediated by down- regulation of Bcl- 2 and up- regulation of Bax.

Effects on different concentrations of antisense oligodeoxynucleotides on human pancreatic cancer cell line PaTu8988s / 中华消化杂志

Objective To study the effects of different concentrations of antisense oligodeoxynucleotides (ASODN) on human pancreatic cancer cell line PaTu8988s. Methods Human pancreatic cancer cell line PaTu8988s in exponent growth stage are adopted. We observe the effect of different time point on the PaTu8988s cell at 12、24、48 and 72 hour. Results The inhibitory rate on PaTu8988s cell line is 42.25%、66.29%、69.55%、74.58% and 66.20%、91.43%、98.18%、98.33% for ASODN concentrations of 50 ?g/ml and 100 ?g/ml at 12、24、48 and 72 hour, respectively. Conclusion The inhibitory effect of ASODN began from 12 hour and becomes more obvious at 48～72 hour. The higher the concentration of ASODN, the earlier the peak of inhibited rate.

Apoptosis of implanted tumor of human primary gastric cancer cells in nude mice induced by resveratrol / 中国病理生理杂志

AIM: To investigate the molecular mechanism of the apoptosis of implanted tumor of human primary gastric cancer cells in nude mice induced by resveratrol. METHODS: Human primary gastric cancer cells were planted into nude mice to establish the cancer model. Resveratrol at different doses were injected near the carcinoma on the nude mice. After treatment, transmission electron microscope and TUNEL staining method were used to detect the apoptosis of implanted tumor cells. Immunohistochemical staining and RT-PCR were used to detect the expression of apoptosis-related genes bcl-2 and bax in implanted tumor. RESULTS: Resveratrol significantly inhibited carcinoma growth when it was injected near the carcinoma. The apoptotic cells in implanted tumor induced by resveratrol were detected by transmission electron microscope and TUNEL staining, immunohistochemical staining and RT-PCR showed resveratrol inhibited bcl-2 expression and increased bax expression in human primary gastric cancer cells. CONCLUSION: Resveratrol inhibits implanted tumor of human primary gastric cancer cells in nude mice through inducing apoptosis. This apoptosis may be mediated by down-regulation of bcl-2 expression and up-regulation of bax expression.