Diagnostic value of a combined serology-based model for minimal hepatic encephalopathy in patients with compensated cirrhosis / 中华检验医学杂志

Objective:To investigate the diagnostic accuracy of serological indicators and evaluate the diagnostic value of a new established combined serological model on identifying the minimal hepatic encephalopathy (MHE) in patients with compensated cirrhosis.Methods:This prospective multicenter study enrolled 263 compensated cirrhotic patients from 23 hospitals in 15 provinces, autonomous regions and municipalities of China between October 2021 and August 2022. Clinical data and laboratory test results were collected, and the model for end-stage liver disease (MELD) score was calculated. Ammonia level was corrected to the upper limit of normal (AMM-ULN) by the baseline blood ammonia measurements/upper limit of the normal reference value. MHE was diagnosed by combined abnormal number connection test-A and abnormal digit symbol test as suggested by Guidelines on the management of hepatic encephalopathy in cirrhosis. The patients were randomly divided (7∶3) into training set ( n=185) and validation set ( n=78) based on caret package of R language. Logistic regression was used to establish a combined model of MHE diagnosis. The diagnostic performance was evaluated by the area under the curve (AUC) of receiver operating characteristic curve, Hosmer-Lemeshow test and calibration curve. The internal verification was carried out by the Bootstrap method ( n=200). AUC comparisons were achieved using the Delong test. Results:In the training set, prevalence of MHE was 37.8% (70/185). There were statistically significant differences in AMM-ULN, albumin, platelet, alkaline phosphatase, international normalized ratio, MELD score and education between non-MHE group and MHE group (all P<0.05). Multivariate Logistic regression analysis showed that AMM-ULN [odds ratio ( OR)=1.78, 95% confidence interval ( CI) 1.05-3.14, P=0.038] and MELD score ( OR=1.11, 95% CI 1.04-1.20, P=0.002) were independent risk factors for MHE, and the AUC for predicting MHE were 0.663, 0.625, respectively. Compared with the use of blood AMM-ULN and MELD score alone, the AUC of the combined model of AMM-ULN, MELD score and education exhibited better predictive performance in determining the presence of MHE was 0.755, the specificity and sensitivity was 85.2% and 55.7%, respectively. Hosmer-Lemeshow test and calibration curve showed that the model had good calibration ( P=0.733). The AUC for internal validation of the combined model for diagnosing MHE was 0.752. In the validation set, the AUC of the combined model for diagnosing MHE was 0.794, and Hosmer-Lemeshow test showed good calibration ( P=0.841). Conclusion:Use of the combined model including AMM-ULN, MELD score and education could improve the predictive efficiency of MHE among patients with compensated cirrhosis.

Characteristics of reflux and manifestation under probe-based confocal laser endoscopy in patients with endoscopic negative heartburn / 中华消化内镜杂志

Objective:To study reflux characteristics of patients with endoscopic negative heartburn and their manifestation under probe-based confocal laser endoscopy (pCLE) based on the Rome Ⅳ standard.Methods:Thirty-six endoscopic negative outpatients with typical heartburn at the Department of Gastroenterology of the Second Affiliated Hospital of Baotou Medical College from September 2020 to March 2021 were included, and underwent 24-hour multichannel intraluminal impedance-pH monitor and pCLE. According to Rome Ⅳ diagnostic process, patients were divided into non-erosive reflux disease (NERD) group ( n=16), reflux hypersensitivity (RH) group ( n=8) and functional heartburn (FH) group ( n=12). The Gerd-Q scale score, 24-hour pH monitoring results and microstructure changes under pCLE were compared among the three groups. Results:There was no significant difference in the total score, positive symptom score, negative symptom score or positive influence score of Gerd-Q scale among the three groups ( P>0.05). DeMeester score [28.45 (20.08, 34.53)] and acid reflux times (24.88±9.05) in the NERD group were significantly higher than those in the RH group [7.30 (3.90, 11.38), P<0.001; 13.63±5.76, P=0.003] and FH group [6.90 (4.80, 9.73), P<0.001; 7.42±8.32, P<0.001]. But there was no significant difference between the RH group and the FH group ( P>0.05). The diameter of intra-papillary capillary loop (IPCL) (18.68±2.12 μm) and dilation of intercellular space (3.95±0.97 μm) in the NERD group were significantly higher than those in the RH group (13.91±1.99 μm, P<0.001; 2.97±0.55 μm, P=0.006) and FH group (13.83±2.00 μm, P<0.001; 2.31±0.54 μm, P<0.001), but there was no significant difference between the RH group and the FH group ( P>0.05). The number of IPCL in the NERD group, RH group and FH group were 2.0 (1.00, 2.75), 2.0 (1.00, 2.75) and 1.5 (1.00, 2.00), respectively with no significant difference ( P=0.697). Conclusion:Gerd-Q scale is not suitable for differential diagnosis of patients with endoscopic negative heartburn. Compared with functional esophageal diseases (RH and FH), acid reflux and mucosal microstructure changes are of more important pathogenic significance in NERD.

A prospective multicenter and real-world study on the diagnostic value of combination of number connection test-B and line tracing test in mild hepatic encephalopathy / 中华消化杂志

Objective:To investigate the diagnostic value of independent and combined subtests of the psychometric hepatic encephalopathy score (PHES) in mild hepatic encephalopathy(MHE) of patients with liver cirrhosis, so as to optimize the PHES.Methods:This was a prospective, multicenter and real-world study which was sponsored by the National Clinical Research Center of Infectious Diseases and the Portal Hypertension Consortium. Twenty-six hospitals from 13 provinces, autonomous regions and municipalities countrywide participated in this study, induding Tianjin Third Central Hospital, the Fourth People′s Hospital of Qinghai Province, the Second Affiliated Hospital of Baotou Medical College, the Third People′s Hospital of Taiyuan, the Fifth Medical Center of PLA General Hospital and so on. From October 2021 to February 2022, outpatients and hospitalized patients with liver cirrhosis and no obvious hepatic encephalopathy were consecutively enrolled. All patients received 5 PHES subjects in the same order: number connection test(NCT)-A, NCT-B, digit symbol test(DST), line tracing test(LTT) and serial dotting test(SDT), and the scores were calculated. The total score of PHES <-4 was taken as the cut-off value for diagnosing MHE. Compare the differences in each subtest between MHE group and non-MHE group. Receiver operating characteristic curve(ROC) and area under the curve(AUC) was performed to assess the diagnostic value of independent and combined subtests in MHE. Mann-Whitney U test and DeLong test were used for statistical analysis. Results:A total of 581 patients with liver cirrhosis were enrolled, 457 were diagnosed as MHE, and the incidence of MHE was 78.7%. The results of NCT-A, NCT-B, SDT, LTT, DST of MHE group were 60.00 s(47.01 s, 88.00 s), 90.45 s(69.32 s, 125.35 s), 74.00 s(57.65 s, 96.60 s), 74.72(60.00, 98.61) and 27.00(20.00, 36.00), respectively. Compared those of non-MHE group(34.00 s(29.15 s, 44.48 s), 50.00 s(40.98 s, 60.77 s), 50.00 s(41.07 s, 63.03 s), 46.23(38.55, 59.42) and 42.00(34.00, 50.75)), the differences were statistically significant( Z=12.37, 12.98, 9.83, 11.56, 10.66; all P<0.001). The AUC(95% confidence interval(95% CI)) of subtests of PHES NCT-B, NCT-A, LTT, DST and SDT alone in MHE diagnosis were 0.880(0.849 to 0.910), 0.862(0.828 to 0.896), 0.838(0.799 to 0.877), 0.812(0.772 to 0.851) and 0.788(0.743 to 0.832), respectively. The combination of 2 PHES subtests significantly increased the diagnostic efficacy. Among them the diagnostic efficacy of the combination of NCT-B and LTT was the best, the AUC(95% CI) was 0.924(0.902 to 0.947), the specificity was 91.9% and the sensitivity was 79.2%, which was better than a single PHES subtest (NCT-A, NCT-B, SDT, LTT and DST) and the combination of NCT-A and DST(AUC was 0.879, 95% CI0.847 to 0.910) which was recommended by guidelines on the management of hepatic encephalopathy in cirrhosis, the differences were statistically significant ( Z=3.78, 3.83, 5.57, 5.51, 5.38, 2.93; all P<0.01). Furthermore, compared between the combination of NCT-B and LTT and the combination of 3 subests of PHES, only the diagnostic efficacy of combination of NCT-B, LTT and SDT (AUC was 0.936, 95% CI 0.916 to 0.956) was better than that of the combination of NCT-B and LTT, the difference was statistically significant( Z=2.32, P=0.020). Conclusion:Based on the diagnostic efficacy and clinical feasibility of PHES subtests and their combinations, the combination of NCT-B and LTT is recommended for the diagnosis of MHE.

Postprandial proximal gastric acid pocket and its association with gastroesophageal acid reflux in patients with short-segment Barrett's esophagus / 浙江大学学报（英文版）（B辑：生物医学和生物技术）

OBJECTIVE@#To determine the characteristics of postprandial proximal gastric acid pockets (PPGAPs) and their association with gastroesophageal acid reflux in patients with Barrett's esophagus (BE).@*METHODS@#Fifteen patients with BE (defined by columnar lined esophagus of ≥1 cm) and 15 healthy individuals that were matched for age, gender, and body mass index, were recruited. The fasting intragastric pH and the appearance time, length, lowest pH, and mean pH of the PPGAP were determined using a single pH electrode pull-through experiment. For BE patients, a gastroesophageal reflux disease questionnaire (GerdQ) was completed and esophageal 24-h pH monitoring was carried out.@*RESULTS@#The PPGAP was significantly longer (5 (3, 5) cm vs. 2 (1, 2) cm) and the lowest pH (1.1 (0.8, 1.5) vs. 1.6 (1.4, 1.9)) was significantly lower in patients with short-segment BE than in healthy individuals. The PPGAP started to appear proximally from the gastroesophageal pH step-up point to the esophageal lumen. The acidity of the PPGAP was higher in the distal segment than in the proximal segment. In short-segment BE patients, there were significant correlations between the acidity and the appearance time and length of the PPGAP. The length and acidity of the PPGAP were positively associated with gastroesophageal acid reflux episodes. The acidity of the PPGAP was associated with the DeMeester scores, the GerdQ scores, and the fasting intragastric pH.@*CONCLUSIONS@#In patients with short-segment BE, a PPGAP is commonly seen. Its length and acidity of PPGAP are associated with gastroesophageal acid reflux, the DeMeester score, and the GerdQ score in patients with short-segment BE.

Expressions of large tumor suppressor kinase 1 and large tumor suppressor kinase 2 in gastric cancer and their significances / 肿瘤研究与临床

Objective To investigate the expressions of large tumor suppressor kinase 1 (LATS1) and large tumor suppressor kinase 2 (LATS2) proteins in gastric cancer tissues, and to explore the correlation between expressions of LATS1 and LATS2 proteins and the occurrence and development of gastric cancer. Methods A total of 93 gastric cancer paraffin tissues and the corresponding adjacent gastric normal mucosa in the Department of Pathology in Baotou Cancer Hospital from September 2008 to June 2010 were collected. The immunohistochemistry was used to detect the expressions of LATS1 and LATS2 proteins in gastric cancer and adjacent normal tissues. The differences of the expressions of LATS1 and LATS2 proteins in gastric cancer and adjacent normal tissues were compared by usingχ2 test. The relationship between the expressions of LATS1 and LATS2 proteins and the clinicopathological features was also analyzed. Results In gastric cancer tissues, LATS1 was negatively expressed in 54 cases (58.1％), weakly positive expressed in 15 cases (16.1％), moderately positive expressed in 16 cases (17.2％), and strongly positive expressed in 8 cases (8.6％);in adjacent normal tissues, LATS1 was negatively expressed in 17 cases (18.3％), weakly positive expressed in 16 cases (17.2％), moderately positive expressed in 31 cases (33.3％), and strongly positive expressed in 29 cases (31.2％). The positive expression rate of LATS1 in gastric cancer tissues was lower than that in adjacent normal tissues, and the difference was statistically significant (χ2=37.460, P<0.01). In gastric cancer tissues, LATS2 was negatively expressed in 28 cases (30.1％), weakly positive expressed in 17 cases (18.3％), moderately positive expressed in 33 cases (35.5％), strongly positive expressed in 15 cases (16.1％);in adjacent normal tissues, LATS2 was negatively expressed in 5 cases (5.4％), weakly positive expressed in 7 cases (7.5％), moderately positive expressed in 32 cases (34.4％), strongly positive expressed in 49 cases (52.7％). The positive expression rate of LATS2 in gastric cancer tissues was lower than that in adjacent normal tissues, and the difference was statistically significant (χ2=38.275, P<0.01). The expressions of LATS1 and LATS2 were not related to patients'age, gender, lymph node metastasis, degree of differentiation and tumor diameter (all P>0.05). Conclusion LATS1 and LATS2 proteins may be involved in the occurrence of gastric cancer and have the inhibiting effect on the occurrence and development of gastric cancer.

Advances in Research on Etiology of Recurrent Acute Pancreatitis / 胃肠病学

Some patients with acute pancreatitis (AP)can relapse after initial cure. With the development and maturity of diagnosis and treatment technology,especially the rise of endoscopic technology,the detection rate of AP recurrence (such as bile duct stones,Oddi sphincter dysfunction,pancreas divisum,gene mutation,etc. )is increased. Recurrent acute pancreatitis (RAP)is characterized by various causes,and complex mechanisms. Understanding etiology and positive treatment play a pivotal role in reducing the incidence of RAP. This article reviewed the advances in study on etiology of RAP.

Advances in Study on Pathogenesis of Irritable Bowel Syndrome / 胃肠病学

Irritable bowel syndrome(IBS)is a commonly seen functional gastrointestinal disorder. Its main clinical manifestations were abdominal pain,abdominal distention and altered bowel habits. Currently,the pathogenesis of IBS has not been clarified. Studies showed that IBS was caused by many factors,including life style,gene polymorphism,food hypersensitivity,psychological factors,brain-gut axis abnormality and intestinal flora disorder. This article reviewed the advances in study on pathogenesis of IBS.

Impact of Lifestyle and Dietary Factors on Colorectal Polyps in Inner Mongolia Area / 胃肠病学

Background:Colorectal polyp,especially adenomatous polyp is considered to be a precancerous lesion of colorectal cancer;its occurrence is associated with lifestyle,food habits and genetic factors. Aims:To explore the impact of lifestyle and dietary factors on occurrence of colorectal polyps in Inner Mongolia area. Methods:A colonoscopy-based case-control study was performed. In 2012-2013,100 cases of colorectal polyps and 200 sex-,age-and nationality-matched polyp-free cases were recruited at the Second Affiliated Hospital of Baotou Medical College and were asked to complete a questionnaire including information on demography,lifestyle,and food habits,etc. Multivariate conditional Logistic regression analysis was used to estimate the possible colorectal polyp-related factors which were statistically significant in univariate analysis. Results:In lifestyle factors,after adjusted for age,sex,nationality,marital status and educational level,cigarette smoking (OR=1. 3,95% CI:1. 0-1. 8)and alcohol drinking(OR=1. 5,95% CI:1. 1-2. 0)were identified as the risk factors for colorectal polyps by Logistic regression analysis,while physical activity at least 4 times per week was a protective factor (OR=0. 6,95% CI:0. 4-0. 8). In dietary factors,wheat flour and rice(OR=1. 7,95% CI:1. 2-2. 8),fatty meat (OR=1. 4,95% CI:1. 2-1. 9),salt/pickled food(OR=1. 4,95% CI:1. 1-1. 8)and barbecue/fried food(OR=1. 6, 95% CI:1. 1-2. 3)were identified as the risk factors,while vegetables(OR=0. 6,95% CI:0. 4-0. 9)and fruits(OR=0. 5,95% CI:0. 4-0. 7)were protective factors after adjustment. Conclusions:Occurrence of colorectal polyps in Inner Mongolia area is associated with unhealthy lifestyle and food habits. Cessation of cigarette smoking and alcohol drinking, more physical activity,frequent consumption of vegetables and fruits,and less animal fat and processed food might decrease the risk of colorectal polyps.

Endoscopic internal or external biliary drainage for various biliary obstructions:Report of 104 cases / 中国微创外科杂志

Objective To investigate the value of endoscopy in the diagnosis and treatment of biliary obstructions on different sites with variable causes. Methods The clinical records of biliary drainages under duodenoscope in 104 patients with biliary obstruction from October 1998 to November 2002 was reviewed retrospectively. Results Drainage was successfully completed in 97 patients, with a success rate of 93.3%(97/104). The patients were relieved of their symptoms of biliary obstruction (abdominal pain, jaundice and fever), and the effective rates of ENBD and ERBD were 93.0% (66/71) and 93.3% (28/30), respectively. Conclusions Endoscopic drainage for biliary obstruction has advantages of minimal invasion, rapid recovery, short hospital stay and apparent efficacy. Emphasis should be placed on the site of drainage and proper selection of operative method to further elevate its success rate.

Research about prevention of post-ERCP pancreatitis by pancreatic stents / 中国实用内科杂志

Post-ERCP pancreatitis(PEP) is the most common and serious complications about endoscopic retrograde cholangiopancreatography(ERCP).A number of studies have been confirmed that PEP can be prevented by pancreatic stents.We summarized earlier results in this field to expand the clinical use for this high-tech.

Study on the action of IgG,IgM and IL-8 in the pathogenesis of microscopic colitis / 中国实用内科杂志

Objective To investigate the action of immune factors(IgG and IgM)and cytokine(IL-8)in the pathogenesis of microscopic colitis.Methods Immunohistochemical methods and radioimmune methods were used to detect IgG and IgM in intestinal mucosa and IL-8 in serum respectively.The data of 32 cases who were diagnosed as microscopic colitis were compared with that of 71 irritable bowel syndrome(IBS)and 38 active ulcerative colitis(UC)patients who were assigned as the control group.Results The expression of IgG and IgM increased in MC group;there were significant differences compared with IBS group,but no significant differences compared with UC group;the level of IL-8 in MC group showed significant difference compared with UC group but had no significant difference compared with IBS group;the level of IL-8 in UC group increased obviously.Conclusion It is the disordered function of immune system that plays a main roles in the pathogenesis of MC,not inflammation.