Chinese translation of benefits and challenges in implementation of artificial intelligence in colonoscopy: World Endoscopy Organization position statement / 中华消化杂志

The number of artificial intelligence (AI) tools for colonoscopy on the market is increasing with supporting clinical evidence. Nevertheless, their implementation is not going smoothly for a variety of reasons, including lack of data on clinical benefits and cost-effectiveness, lack of trustworthy guidelines, uncertain indications, and cost for implementation. To address this issue and better guide practitioners, the World Endoscopy Organization has provided its perspective about the status of AI in colonoscopy as the position statement.

Clinical features of non－B， non－C hepatocellular carcinoma / 临床肝胆病杂志

ObjectiveTo investigate the change in the proportion of non－B， non－C hepatocellular carcinoma （NBNC－HCC） in hepatocellular carcinoma， and to compare and analyze the clinicopathological features of NBNC－HCC. MethodsA total of 3 090 patients with hepatocellular carcinoma （HCC） who were diagnosed in Sichuan Provincial People’s Hospital from January 2011 to December 2021 were enrolled， and according to the hepatitis markers， they were divided into hepatitis virus infection－associated HCC group with 2 472 patients and NBNC－HCC group with 618 patients. According to the liver disease and metabolic risk factors， the NBNC－HCC group was further divided into metabolic disorder HCC group with 289 patients， alcoholic liver disease （ALD）－associated HCC group with 174 patients， and other HCC group with 155 patients. General information， laboratory markers， and pathological findings were collected from all HCC patients. The Mann－Whitney U test was used for comparison of continuous data between two groups， and the Kruskal－Wallis H test was used for comparison between three groups； the chi－square test was used for comparison of categorical data between groups， and the chi－square trend test was used to investigate the trend of the change in the proportion of NBNC－HCC in HCC. ResultsThe proportion of patients with NBNC－HCC in HCC increased from 13.7% in 2011 to 20.1% in 2021 （χ2=5.529， P=0.019）， and compared with the hepatitis virus infection－associated HCC group， the NBNC－HCC group had a significantly higher proportion of patients with diabetes （28.0% vs 10.3%， χ2=129.482， P<0.001） or hypertension （33.2% vs 15.2%， χ2=105.079， P<0.001）， a significantly lower proportion of patients with liver cirrhosis （44.5% vs 68.4%， χ2=122.563， P<0.001） or vascular invasion （20.4% vs 29.6%， χ2=7.749， P=0.005）， and a significantly higher body mass index （BMI） （Z=－4.015， P<0.001）. Compared with the ALD－HCC group， the metabolic disorder HCC group had a significantly higher BMI， a significantly lower FIB－4 index， and a significantly lower proportion of patients with liver cirrhosis （all P<0.05）. ConclusionThere is a tendency of increase in the proportion of patients with NBNC－HCC in HCC， and NBNC－HCC often coexists with metabolic risk factors such as obesity， diabetes， and hypertension. Patients in the metabolic disorder HCC group may develop liver cancer in the absence of liver cirrhosis or in the early stage of liver fibrosis.

Role of gut microbiota and tryptophan metabolism in nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease (NAFLD) is a manifestation of multi-system dysfunction involving the liver, ranging from simple hepatic steatosis to nonalcoholic steatohepatitis, liver fibrosis, liver cirrhosis, and hepatocellular carcinoma. An increasing number of studies have shown the importance of the changes in gut microbiota dysbiosis and its metabolites in NAFLD. Tryptophan and its derivatives produced by gut microbiota have the effects on improving intestinal barrier function, regulating abnormal glucose and lipid metabolism, and alleviating insulin resistance and inflammatory response. This article reviews gut microbiota, tryptophan and its metabolites, and the effect of their interaction on NAFLD.

Mechanism of action of estrogen and its receptor in the development and progression of nonalcoholic fatty liver disease / 临床肝胆病杂志

The incidence rate of nonalcoholic fatty liver disease (NAFLD) has increased sharply, and there is still a lack of effective pharmacotherapy at present. Although great achievements have been made in the research on the pathogenesis of NAFLD, we still do not know enough about the gender differences of NAFLD. As an important sex hormone, estrogen affects the development and progression of NAFLD by regulating mood and energy homeostasis, adipose tissue function and distribution, inflammatory response, insulin resistance, liver fat accumulation, and liver immunity. An adequate understanding of the mechanism of action of estrogen and its receptor in NAFLD may provide new ideas for the treatment of NAFLD.

Research advances of portal vein thrombosis in nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease (NAFLD) is the most important chronic liver disease in China, with increasing morbidity and mortality rates of extrahepatic diseases such as cardiovascular diseases and portal vein thrombosis (PVT). NAFLD complicated by PVT has a different mechanism from liver cirrhosis. Starting from grade Ⅲ coagulation disorder, this article elaborates on the pathogenesis of NAFLD complicated by PVT from three different grades and in steps and describes the new concept of sports and exercise in the prevention and treatment of NAFLD complicated by PVT, which brings a technical challenge for liver transplantation recipients with NAFLD complicated by PVT and is of great significance to improve the prognosis and quality of life of patients.

Mechanism of action of intestinal farnesoid X receptor in nonalcoholic fatty liver disease and related targeted drugs / 临床肝胆病杂志

The incidence rate of nonalcoholic fatty liver disease (NAFLD) is gradually increasing in recent years, and the treatment of NAFLD is unsatisfactory due to the failure in lifestyle adjustment and a lack of effective drugs. Farnesoid X receptor (FXR), as the main bile acid receptor, may affect NAFLD by participating in glucose and fat metabolism, and intestinal FXR (iFXR) acts on the intestinal tract alone and may thus avoid the side effects of systemic release. Therefore, it may have potential value in the treatment of NAFLD, but there are also certain controversies. This article reviews the research advances in the role of iFXR in NAFLD.

Independent association between sarcopenia and nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease (NAFLD) is a metabolic disease which can progress to liver fibrosis, liver cirrhosis, and liver cancer. Sarcopenia is an age-related disease and metabolic factors play an important role in its pathogenesis. NAFLD and sarcopenia share a variety of metabolic pathophysiological mechanisms. Further studies are needed to determine whether there is an association between NAFLD and sarcopenia and whether they are predisposing factors or risk factors for disease progression for each other, in order to help with better prevention, treatment, and prognostic evaluation of the two diseases in clinical practice. This article reviews the independent association between NAFLD and sarcopenia.

Noninvasive diagnosis of progressive nonalcoholic fatty liver disease / 临床肝胆病杂志

Nonalcoholic fatty liver disease (NAFLD) is characterized by the pathological feature of hepatocyte fatty degeneration and lipid accumulation, and liver histopathology evolves from simple liver fatty degeneration to steatohepatitis with hepatocellular injury and finally progresses to liver fibrosis, liver cirrhosis, and even liver cancer. NAFLD is closely associated with metabolic syndrome and colorectal tumors and can even lead to disability and death, and therefore, it is of great importance to diagnose nonalcoholic steatohepatitis (NASH) as early as possible and clarify liver fibrosis degree. As the gold standard for determining the liver histopathological grade and stage of NAFLD, liver biopsy has always been a main method for the diagnosis of liver fibrosis. However, the limitations of liver biopsy have greatly promoted the rapid development of noninvasive diagnostic techniques in recent years. The sensitivity and specificity of serology models and imaging tests in the diagnosis of NASH and early-stage liver fibrosis need to be improved. This article reviews the advances in noninvasive diagnostic methods for progressive NAFLD.

Liver microcirculation disturbance in nonalcoholic fatty liver disease / 临床肝胆病杂志

At present, the pathogenesis of nonalcoholic fatty liver disease (NAFLD) is not completely clear, but hepatic microcirculation perfusion is an important feature of disease progression, in which lipid accumulation in hepatocytes is the key to microvascular injury. This article introduces the function, structure, and neuromodulation of normal microcirculation, with a focus on the mechanism of liver microcirculation disturbance and the changes in cellular molecules and imaging findings due to such disturbance. Therefore, clarification of liver microcirculation disturbance can provide new insights into the pathophysiology of NAFLD, and optimized noninvasive diagnostic methods may help to identify high-risk populations and patients in the early stage of nonalcoholic steatohepatitis.

Early kidney injury in patients with non-alcoholic fatty liver disease: a cross-sectional study / 中华消化杂志

Objective To investigate early kidney injury in the patients with non-alcoholic fatty liver disease (NAFLD) without hypertension,diabetes and history of kidney diseases,as so to provide evidence for preventing early kidney injury in patients with NAFLD.Methods From December 2014 to January 2016,169 subjects visiting Sichuan Provincial People's Hospital were recruited.Among them,104 cases were in NAFLD group,31 cases were in simple obesity group (overweight or obesity),and 34 subjects were in the healthy control group.The general data,biochemical indexes,metabolic indexes,biochemical indexes of kidney,and early kidney injury makers,including serum β2-microglobulin,urinary albumin and creatinine ratio (ACR) and estimated glomerular filtration rate (eGFR),were detected.Least significant difference-t test,chi-square test and Spearman correlation analysis were performed for statistical analysis.Results Compared with simple obesity group,alanine aminotransferase (ALT),aspartate aminotransferase (AST),γ-glutamyl transpeptadase (GGT),fasting insulin level,homeostasis model assessment-insulin resistance (HOMA-IR),serum creatinine,ACR and β2 microglobulin were higher in NAFLD group ((21.13 ± 8.14) U/L vs.(66.20 ± 44.34) U/L,(24.80 ±9.57) U/Lvs.(49.78 ±25.41) U/L,(19.26 ±7.88) U/Lvs.(66.53 ±56.34) U/L,(7.03± 1.52) mU/Lvs.(9.55 ±5.41) mU/L,1.22 ±0.38 vs.2.23 ±2.01,(62.90 ± 10.01) μmol/L vs.(71.75 ±10.80) μmol/L,(4.41 ±1.16) μg/mg vs.(13.76 ±9.56) μg/mg,(1.46 ±0.26) mg/L vs.(2.01 ±0.53) mg/L);however the eGFR was lower (112.46 ±11.90) mL · min-1 · (1.73 m2) 1 vs.(101.09± 17.17) mL · min-1 · (1.73 m2)-1).The differences were statistically significant (t =9.825,8.250,8.288,4.229,4.121,4.007,9.732,7.792 and-3.443,all P ＜ 0.01).There was no statistically significant difference in the remaining indicators (all P ＞ 0.05).Compared with healthy control group,the renal injury indexes serum creatinine,ACR and 32 microglobulin of NAFLD group were higher ((58.78 ± 7.77) μmol/Lvs.(71.75±10.80) μmol/L,(1.01 ±0.32) μg/mg vs.(13.76 ±9.56) μg/mg,(1.12 ± 0.15) mg/L vs.(2.01 ±0.53) mg/L),and the eGFR was lower ((115.10 ± 12.59) mL · min-1 (1.73 m2)-1 vs.(101.09 ± 17.17) mL · min-1 · (1.73 m2)-1).The differences were statistically significant (t =7.621,13.591,15.126 and-5.120,all P ＜ 0.01).Compared with healthy control group,the renal injury indexes ACR and β2 microglobulin of simple obesity group were higher ((1.01 ± 0.32) μg/mg vs.(4.41 ± 1.16) μg/mg,(1.12 ± 0.15) mg/L vs.(1.46-± 0.26) mg/L),and the differences were statistically significant (t =9.732 and 7.792,both P ＜ 0.01).ACR of NAFLD patients was positively correlated with body mass index,waist circumference,triglyceride level,total cholesterol level,low density lipoprotein level,fasting blood glucose level,two-hour postprandial blood glucose,fasting insulin level and HOMA-IR (r =0.554,0.327,0.314,0.353,0.176,0.195,0.552,0.364 and 0.987,all P ＜ 0.05),and was negatively correlated with high density lipoprotein (r =-0.330,P ＜ 0.01).Conclusions NAFLD is closely related with chronic kidney disease at same baseline of gender,age,blood glucose,blood lipids,and blood pressure.Abnormal metabolism of glycolipids,obesity and insulin resistance may be the mechanisms of early kidney injury in NAFLD patients.Combination of ACR and β2 microglobulin are more sensitive than serum creatinine and eGFR in detecting early renal injury in NAFLD patients.

Value of combined measurement of serum cystatin C and urinary neutrophil gelatinase-associated lipocalin in diagnosis of acute kidney injury secondary to cirrhotic ascites / 临床肝胆病杂志

Objective To investigate the value of combined measurement of serum cystatin C (Cys C) and urinary neutrophil gelatinase-associated lipocalin (NGAL) in the diagnosis of AKI secondary to cirrhotic ascites. Methods A total of 105 patients with cirrhotic ascites who were admitted to Sichuan Provincial People's Hospital from January 2015 to June 2016 were enrolled and divided into AKI group with 56 patients and non-AKI group with 49 patients. Meanwhile, 40 healthy persons who underwent physical examination were enrolled as controls. The indices including serum Cys C, urinary NGAL, serum creatinine (Scr), and glomerular filtration rate (GFR) were observed. The 105 patients with cirrhotic ascites were divided into subgroups according to Child-Pugh class, and the changes in serum Cys C, urinary NGAL, Scr, and GFR were compared between these subgroups. The independent samples t-test was used for comparison of continuous data between two groups; a one-way analysis of variance was used for comparison between multiple groups, and the SNK-q test was used for further comparison between any two groups. The chi-square test was used for comparison of categorical data between groups, and a Pearson correlation analysis was also performed. Results There were significant differences in the levels of serum Cys C and urinary NGAL between the AKI group and the non-AKI group, as well as between the AKI group and the healthy control group (all P ＜ 0. 01) . AKI stage was determined for all AKI patients, and the AKI patients with a higher stage had significantly higher levels of serum Cys C and urinary NGAL than those with a lower stage (all P ＜ 0. 05) . Of all 56 AKI patients, 11 (19. 6％ ) died; the patients who died had significantly higher levels of serum Cys C and urinary NGAL than those who survived (t =-7. 742 and-3. 209, both P ＜ 0. 01) . The correlation analysis showed that the levels of serum Cys C and urinary NGAL were negatively correlated with GFR (r =-0. 915 and-0. 793, both P ＜ 0. 01) . The levels of serum Cys C and urinary NGAL increased significantly and GFR decreased significantly with the increase in Child-Pugh class (all P ＜0. 05) . Conclusion Combined measurement of serum Cys C and urinary NGAL can be used for the early diagnosis of AKI secondary to cirrhotic ascites and the evaluation of the severity and prognosis of AKI.

Serological noninvasive diagnosis of nonalcoholic steatohepatitis / 临床肝胆病杂志

Nonalcoholic steatohepatitis is a progressive disease that can lead to hepatic fibrosis, liver cirrhosis, and liver cancer, and its early diagnosis is of great significance for delaying disease progression. In recent years, more and more serological markers and models have been found, and the application models based on the combination of various indicators have been updated; these models have a certain diagnostic efficiency for both nonalcoholic steatohepatitis and hepatic fibrosis. This article reviews the research on serological noninvasive diagnosis of nonalcoholic steatohepatitis and hepatic fibrosis.

Expression and clinical significance of mismatch repair gene in colorectal cancer / 中国肿瘤临床

Objective: To investigate the expression and clinical significance of mismatch repair genes (MMR) MLH1, MSH2, MSH6, and PMS2 in colorectal carcinoma. Methods: Colorectal cancer tissues, collected from 607 patients enrolled in Sichuan Provincial People's Hospital from January 2015 to September 2016, were assigned into two groups based on whether the samples were positive or nega-tive for MMR expression to determine the relationship between MMR expression and clinicopathology. We then evaluated the diag-nostic value of MMR expression in the screening of Lynch syndrome and sporadic colorectal cancer. Results: The deletion rate of MMR protein was 35.58%. No statistically significant difference in age, sex, tumor size, P53, CD34, and D2-40 expression was detected be-tween the negative group with MMR protein deficiency and the positive group with normal expression (P>0.05). Differences in tumor location, differentiation, TNM stage, lymph node metastasis, and VEGF and Ki-67 expression between the two groups were statistically significant (P<0.05). The combined detection of MLH1, MSH2, PSM2, and MSH6 proteins may serve as a simple and economical meth-od for screening patients with Lynch syndrome. Conclusions: The risk of colorectal cancer can be reduced by MMR detection of surgi-cal specimens from colorectal cancer patients, screening of patients with Lynch syndrome and their family members, and assisting with proper management and intervention.

Clinical Observation of Itopride Combined with Esomeprazole Magnesium in the Treatment of Esophageal Motility Dysfunction-induced Gastroesophageal Reflux Disease / 中国药房

OBJECTIVE:To investigate the clinical efficacy of itopride combined with esomeprazole magnesium in the treat-ment of esophageal motility dysfunction-induced gastroesophageal reflux disease(GERD). METHODS:A total of 100 patients with esophageal motility dysfunction-induced GERD were selected from our hospital during Sept. 2015-Sept. 2016,and then divided into control group and observation group according to random number table,with 50 cases in each group. Control group was given Esomeprazole magnesium enteric-coated tablets 40 mg,po,qd. Observation group was additionally given Itopride hydrochloride tablets 50 mg,po,tid,on the basis of control group. Both groups received treatment for consecutive 6 weeks. Clinical efficacies of 2 groups were observed,and symptom scores,LES resting pressure,liquid and solid swallowing and peristaltic pressure of esopha-geal body were observed before and after treatment. The occurrence of ADR was recorded. RESULTS:Total response rate of obser-vation group was 94.0％,which was significantly higher than 78.0％ of control group,with statistical significance(P<0.05). Be-fore treatment,there was no statistical significance in symptom scores,LES resting pressure,liquid and solid swallowing or peri-staltic pressure of esophageal body between 2 groups(P>0.05). After treatment,symptom scores of 2 groups were decreased sig-nificantly,and observation group was significantly lower than control group,with statistical significance (P<0.05). Compared with before treatment,LES resting pressure of observation group was increased significantly,and significantly higher than that of control group,with statistical significance (P<0.05). Success rate of liquid swallowing increased significantly in 2 groups,and that of observation group was significantly higher than that of control group,with statistical significance(P<0.05). Success rate of solid swallowing,liquid and solid peristaltic pressure of esophageal body(near segment,middle segment and far segment)in con-trol group were higher than before treatment,without statistical significance (P>0.05). Success rate of solid swallowing, liquid and solid peristaltic pressure of esophageal body(near segment,middle segment and far segment)in observation group were signifi-cantly higher than before treatment,and significantly higher than control group at corresponding period,with statistical significance (P<0.05). No obvious ADR was found in 2 groups during treatment. CONCLUSIONS:For esophageal motility dysfunction-in-duced GERD,itopride combined with esomeprazole magnesium can significantly improve clinical symptom,effectively increase LES resting pressure,strengthen esophageal motor function,improve success rate of esophageal swallowing and enhance anti-gas-troesophageal reflux ability with good safety.

Comparison of efficacy of lamivudine plus adefovir dipivoxil de novo combination therapy with optimization monotherapy in patients with decompensated hepatitis B cirrhosis / 重庆医学

Objective To compare the efficacy of lamivudine (LAM) plus adefovir dipivoxil (ADV) de novo combination therapy to optimization monotherapy for hepatitis B virus-related compensated cirrhosis,and analyze the prediction factors of early response of antivirus treatment.Methods A total of 158 cases of patients with hepatitis B virus-related compensated cirrhosis were selected and randomly assigned to combined group (n=81) and optimized group (n =77) according to randomized digital table.The patients in the combined group accepted LAM combined ADV.The patients in the optimized group were firstly treated with LAM or ADV,then they were given optimized therapy with ADV or LAM if they had poor response or virological breakthrough at week 24.The clinical efficaeies were compared between the two groups,and the prediction factors of early response were analyzed.Results At week 12,the decline level of HBV DNA in the combined group was higher than that in the optimized group (P＜ 0.05),but no statistically significant difference was found in the negative transformation rate of HBV DNA between the two groups (P＞ 0.418).At week 24,the decline level of HBV DNA,rate of undetectable HBV DNA and rate of complete response were higher than those in the optimized group,and rate of virological breakthrough was lower than that in the optimized group (P＜0.05).At week 48,the decline level and negative transformation rate of HBV DNA,negative transformation rate and seroconversion rate of HBeAg were higher than those in the optimized group,and serum levels of hyaluronic acid and a2-macroglobulin were lower than those in the optimized group (P＜0.05).There was no statistically significant difference in the recover rate of alanine aminotransferase (ALT),rate of complete response and rate of virological breakthrough between the two groups at week 48 (P＞0.05).Logistic regression analysis showed that the complete response at week 24 was correlated with HBV DNA load,expression of HBeAg,level of ALT and initial treatment (P＜0.05).Layered evaluation showed that the rate of early complete response in the combined group was significantly higher than that in the optimized group,regardless of HBV DNA load,expression of HBeAg,and level of ALT (P＜0.05).Conclusion LAM combined with ADV can reduce resistance and improve the rate of early complete response,which has stronger antiviral activity.In addition,it can improve the liver function and partially reverse cirrhosis.

Comparison of efficacy of lamivudine plus adefovir dipivoxil de novo combination therapy with optimization monotherapy in patients with decompensated hepatitis B cirrhosis / 重庆医学

Objective To compare the efficacy of lamivudine (LAM) plus adefovir dipivoxil (ADV) de novo combination therapy to optimization monotherapy for hepatitis B virus-related compensated cirrhosis,and analyze the prediction factors of early response of antivirus treatment.Methods A total of 158 cases of patients with hepatitis B virus-related compensated cirrhosis were selected and randomly assigned to combined group (n=81) and optimized group (n =77) according to randomized digital table.The patients in the combined group accepted LAM combined ADV.The patients in the optimized group were firstly treated with LAM or ADV,then they were given optimized therapy with ADV or LAM if they had poor response or virological breakthrough at week 24.The clinical efficaeies were compared between the two groups,and the prediction factors of early response were analyzed.Results At week 12,the decline level of HBV DNA in the combined group was higher than that in the optimized group (P＜ 0.05),but no statistically significant difference was found in the negative transformation rate of HBV DNA between the two groups (P＞ 0.418).At week 24,the decline level of HBV DNA,rate of undetectable HBV DNA and rate of complete response were higher than those in the optimized group,and rate of virological breakthrough was lower than that in the optimized group (P＜0.05).At week 48,the decline level and negative transformation rate of HBV DNA,negative transformation rate and seroconversion rate of HBeAg were higher than those in the optimized group,and serum levels of hyaluronic acid and a2-macroglobulin were lower than those in the optimized group (P＜0.05).There was no statistically significant difference in the recover rate of alanine aminotransferase (ALT),rate of complete response and rate of virological breakthrough between the two groups at week 48 (P＞0.05).Logistic regression analysis showed that the complete response at week 24 was correlated with HBV DNA load,expression of HBeAg,level of ALT and initial treatment (P＜0.05).Layered evaluation showed that the rate of early complete response in the combined group was significantly higher than that in the optimized group,regardless of HBV DNA load,expression of HBeAg,and level of ALT (P＜0.05).Conclusion LAM combined with ADV can reduce resistance and improve the rate of early complete response,which has stronger antiviral activity.In addition,it can improve the liver function and partially reverse cirrhosis.

Comparison of different endoscopic methods for infiltration depth of early esophageal cancer / 中华消化内镜杂志

Objective To compare the clinical value of different endoscopic methods for infiltration depth of early esophageal cancer. Methods Patients with suspected esophageal cancer, examined in Sichuan Provincial People′s Hospital from August 2013 to February 2016 were enrolled to this study. The patients underwent narrow band imaging( NBI) with magnifying endoscopy( including IPCL?type and B?type methods) and endoscopic ultrasonography(EUS) to estimate infiltration depth and then underwent iodine staining and biopsy. All lesions, which included the identified moderate?severe hyperplasia, high?grade intraepithelial neoplasia and early esophageal cancer and those which were diagnosed as possible cancer by white light and NBI with the negative pathological results, were given endoscopic or surgical procedure depending on patients′ choices. A total of 54 cases were diagnosed as early esophageal cancer, with pathological results as the gold standard. The diagnostic accuracy of invasion depth of these patients was compared by the statistic kappa values. Results Type B of NBI was highly consistent with the final pathological results(Kappa=0?802). White light endoscopy and IPCL type had poorer results(Kappa=0?596, Kappa = 0?601 ) compared with the final pathological results. However, EUS had the lowest consistency with the final pathological results( Kappa=0?132) . For the mucosal layer( M1?M2) infiltration of the esophageal cancer, type B showed the highest accuracy ( 86?7%, 26/30 ) , followed by white light endoscopy(76?7%, 23/30) and IPCL type(73?3%, 22/30). And EUS showed the lowest diagnostic accuracy(30?0%, 9/30) and the highest over?diagnostic rate(70?0%,21/30). For the cancer infiltration depth( M3?SM1 ) , type B also showed slightly higher accuracy rate ( 89?5%, 17/19 ) than IPCL type (78?9%, 15/19) and white light endoscopy (73?7%, 14/19). And EUS still showed the lowest accuracy rate( 42?1%, 8/19 ) and the highest over?diagnostic rate ( 52?6%, 10/19 ) . Conclusion White light endoscopy is still valuable for the invation depth of early esophageal cancer. But B type and IPCL?type of NBI are superior to white light endoscopy. B type presents higher accuracy rate than others, and it seems much easier to operate than IPCL?type for beginners. Accuracy rate of EUS is unsatisfactory, and the over?diagnostic rate is much higher than others. Diagnosis with EUS alone is not recommended.

Nonalcoholic fatty liver disease and hepatocellular carcinoma / 临床肝胆病杂志

As the etiology of hepatocellular carcinoma (HCC) has been changing, the incidence of HCC related to nonalcoholic fatty liver disease (NAFLD) is gradually increasing in developed countries in Europe and America and some countries in Asia. This article introduces the close association between NAFLD and HCC, risk factors, clinicopathological features, and prevention and screening, and points out that although the incidence of NAFLD is not as high as that of hepatitis B- or hepatitis C-related HCC, there are a large absolute number of NAFLD patients, especially the high-risk patients with diabetes and obesity, or liver fibrosis/cirrhosis, due to a huge base number of NAFLD patients. NAFLD-related HCC is commonly seen in the elderly with various comorbidities and a poor prognosis. This article also points out that the prevention should focus on the effective treatment of NAFLD. The strict screening of high-risk population is the strategy for the diagnosis of early-stage HCC. At present, the sensitivity of alpha-fetoprotein is relatively low, and imaging examinations including computed tomography are the main screening methods; however, there are no measures for early warning of NAFLD-related HCC.

Clinical Observation of Citalopram in the Treatment of Functional Gastrointestinal Disorders Complicated with Anxiety or Depression / 中国药房

OBJECTIVE:To observe the clinical efficacy and safety of citalopram in the treatment of functional gastrointesti-nal disorders complicated with anxiety or depression. METHODS:62 patients with functional gastrointestinal disorders complicat-ed with anxiety or depression were randomly divided into treatment group(34 cases)and control group(28 cases). Control group was given routine treatment,treatment group was additionally given Citalopram tablet with initial dose of 10 mg,qd,increasing to 40 mg qd,according to the situation of patients,on the basis of control group. Treatment course of 2 groups lasted for 3 months. The gastrointestinal symptom integral,HAMD and HAMA were compared between 2 groups before and after treatment,and clini-cal efficacy and the occurrence of ADR were observed. RESULTS:There was no statistical significance in gastrointestinal symptom integral,HAMD and HAMA between 2 groups before treatment (P>0.05). After Treatment,above scores of 2 groups decreased significantly,and the treatment group was lower than the control group,with statistical significance(P<0.05). Total effective rate of treatment group was significantly higher than that of control group (94.12% vs. 67.86%),with statistical significance (P<0.05). Olny 4 patients of treatment group suffered from mild ADR. CONCLUSIONS:Citalopram shows significant therapeutic effi-cacy in the treatment of functional gastrointestinal disorders complicated with anxiety or depression,and can improve digestive tract symptom and anxiety or depression,and help to improve patients’gastrointeseinal symptoms with good safety.

Primary study on the significance of ascites microRNA in the differential diagnosis of tuberculous and tumor / 中华消化杂志

Objective To explore the value of microRNA in differential diagnosis of tuberculous ascites and cancerous ascites.Methods From January 2011 to October 2013,31 patients with ascites were enrolled in this study,19 cases of whom had cancerous ascites (two cases of ovarian cancer,three cases of liver cancer,one case of bile duct carcinoma,five cases of gastric cancer,three cases of pancreatic cancer,four cases of colon cancer and one case of peritoneal mesothelioma) and 12 cases had tuberculous ascites.Ascites was collected for microRNA microarray detection,and the possible differential expressed microRNA was screened.The results of microarray were confirmed by TaqMan stem-loop real-time polymerase chain reaction (PCR) method.The t test,receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) were performed for statistical analysis.Results The results of microRNA expression profiles indicated that there were differences between tuberculous ascites and cancerous ascites.The findings of TaqMan real-time PCR showed the expression of microRNA-21 in cancerous ascites was 39.3±11.6,which was much higher than that of tuberculous ascites (12.6 ±4.1),and the difference was statistically significant (t=4.921,P＜0.05).The expression of microRNA-134 in cancerous ascites was 68.2±20.4,which was lower than that of tuberculous ascites (210.2±37.2),and the difference was statistically significant (t =3.430,P ＜ 0.05).The AUC of microRNA-21 and microRNA-134 in differential diagnosis of tuberculous ascites and cancerous ascites was 0.882 (95 ％ CI 0.816-0.917) and 0.877 (95％ CI 0.782-0.901).The AUC of combined microRNA-21 and microRNA-134 in differential diagnosis of tuberculous ascites and cancerous ascites was 0.915 (95％ CI 0.863-0.967).Conclusions There are differences in microRNA expression profiles between tuberculous ascites and cancerous ascites.The detection of microRNA-21 and microRNA-134 expression in ascites is of great importance in differential diagnosis.