ObjectiveTo establish a new noninvasive， simple， and convenient clinical predictive model by identifying independent predictive factors for rebleeding after endoscopic therapy in cirrhotic patients with esophagogastric variceal bleeding （EGVB）， and to provide a basis for individualized risk assessment and development of clinical intervention strategies. MethodsCirrhotic patients with EGVB who were diagnosed and treated in The First Affiliated Hospital of Xi’an Medical University from September 2018 to October 2023 were enrolled as subjects， and according to whether the patient experienced rebleeding within 1 year after endoscopic therapy， they were divided into rebleeding group with 93 patients and non-rebleeding group with 84 patients. Clinical data were collected and analyzed. The independent samples t-test was used for comparison of normally distributed continuous data between two groups， and the Mann-Whitney U test was used for comparison of non-normally distributed continuous data between two groups； the chi-square test was used for comparison of categorical data between two groups. A Logistic model was established based on the results of the univariate and multivariate analyses， and the receiver operating characteristic （ROC） curve and the area under the ROC curve （AUC） were used to assess the accuracy of the model. R software was used to visualize the model by plotting a nomogram， and the Bootstrap method was used for internal validation of the model. ResultsThe multivariate analysis showed that red blood cell count （RBC）， cholinesterase （ChE）， alkaline phosphatase （ALP）， albumin （Alb）， thrombin time （TT）， portal vein trunk diameter， sequential therapy， and primary prevention were independent predictive factors for rebleeding. Based on the results of the multivariate analysis， a logistic model was established as logit（P）=-0.805-1.978×（RBC）+0.001×（ChE）-0.020×（ALP）-0.314×（Alb）+0.567×（TT）+0.428×（portal vein trunk diameter）-2.303×［sequential therapy （yes=1， no=0）］-2.368×［primary prevention （yes=1， no=0）］. The logistic model （AUC=0.928， 95% confidence interval ［CI］： 0.893—0.964， P<0.001） had a better performance in predicting rebleeding than MELD score （AUC=0.603， 95%CI： 0.520—0.687， P=0.003）， Child-Pugh class （AUC=0.650， 95%CI： 0.578—0.722， P=0.001）， and FIB-4 index （AUC=0.587， 95%CI： 0.503—0.671， P=0.045）. The model had an optimal cut-off value of 0.607， a sensitivity of 0.817， and a specificity of 0.817. Internal validation confirmed that the model had good predictive performance and accuracy. ConclusionSequential therapy， implementation of primary prevention， an increase in RBC， and an increase in Alb are protective factors against rebleeding， while prolonged TT and widened main portal vein diameter are risk factors. The logistic model based on these independent predictive factors can predict rebleeding and thus holds promise for clinical application.

Objective To analyze the clinical characteristics of patients with acute esophageal injuries in order to improve clinicians'diagnosis and treatment of such diseases.Methods The general data and treatment methods of 61 patients with acute esophageal injury from January 2013 to March 2023 were retrospectively analyzed.Results Majority of the patients with esophageal and cardia mucosal tear syndrome were male(72.2%),age(52.04±17.96)years,triggering factor was gastroscopy in 29 patients(53.7%),and vomiting of blood and black stools was the main clinical manifestation(63.0%),the average length of hospital stay was(6.39±3.53)d and 13(24.1%)patients had anaemic complications,blood transfusion was given to 8 patients(14.8%),39 patients(72.2%)were discharged after conservative treatment with transfusion,and only 15 patients(27.8%)required endoscopic hemostasis.1 case of esophageal hematoma combined with esophageal cardia mucosal tear syndrome was an elderly male patient with a history of hypertension,cerebral infarction,and long term use of oral aspirin,complicated by severe anemia,who was given desiprofloxacin to stop the hemostasis endoscopically,the total length of hospital stay was 22 d.4 patients with esophageal hematoma were young and middle-aged males,2 patients had a predisposing factor of poor diet prior to the onset of the disease,2 patients presented with vomiting of blood,1 with chest pain and 1 with a foreign body sensation in the throat,2 patients were discharged with endoscopic intervention,and the remaining 2 patients were discharged after conservative treatment.2 patients with spontaneous esophageal rupture were young and middle-aged males,clinical manifestations were chest tightness or retrosternal discomfort,and one patient had esophageal rupture with left-sided liquid pneumothorax,esophageal rupture repair+pleural adhesion branding+open thoracic hemostasis+intrathoracic foreign body removal was performed,and an esophageal stent was placed endoscopically after the operation,and the patient was discharged from the hospital after 52 d,in another case,the patient's esophageal fistula was small,and a three-lumen nutrient tube was placed under gastroscopic guidance,the patient's esophagus recovered well after 7 d,and the patient was discharged from the hospital.Conclusion Acute esophageal injury is a clinical emergency,among them,esophageal hematoma and spontaneous esophageal rupture are relatively rare.Prompt endoscopic clot removal is a viable option for patients with ruptured esophageal hematomas who have failed conservative treatment,and patients with spontaneous esophageal rupture who have surgically placed esophageal stents have good mucosal recovery.Clinicians need to be vigilant for patients with esophageal injuries that are associated with anemia,or even require blood transfusion,should make a clear diagnosis at an early stage,with timely endoscopic or surgical intervention to avoid progression of the disease.

Nanomedicine is an interdisciplinary area that utilizes nanoscience and technology in the realm of medicine. Rapid advances in science and technology have propelled the medical sector into a new era. The most commonly used nanotechnology in the field of medicine is nanoparticles. Due to their unique physicochemical properties, nanoparticles offer significant benefits of precision medicine for diseases such as inflammatory bowel disease that cannot be effectively treated by existing approaches. Nanomedicine has emerged as a highly active research field, with extensive scientific and technological studies being carried out, as well as growing international competition in the commercialization of this field. The accumulation of expertise in the key technologies relating to nanomedicine would provide strategic advantages in the development of cutting-edge medical techniques. This review presented a comprehensive analysis of the primary uses of nanoparticles in medicine, including recent advances in their application for the diagnosis and treatment of inflammatory bowel disease. Furthermore, we discussed the challenges and possibilities associated with the application of nanoparticles in clinical settings.
Inflammatory Bowel Diseases/diagnosis* ; Humans ; Precision Medicine/methods* ; Nanomedicine/methods* ; Nanoparticles/therapeutic use*

Objective:To analyze circRNAs specifically differentially expressed in esophageal squamous cell carcinoma (ESCC) based on high-throughput sequencing data.Methods:Six patients with pathologically confirmed ESCC in Tangdu Hospital of Air Force Medical University from March 2018 to March 2019 were selected as the research subjects, among which 3 were stage Ⅰ ESCC and 3 were stage Ⅲ ESCC. High-throughput sequencing technology was used to analyze the difference in the expression of circRNA in cancer tissues and adjacent tissues of patients. GO enrichment analysis, KEGG enrichment analysis and Venn analysis were performed on differentially expressed genes. The circRNA-miRNA-mRNA network was constructed using Cytoscape software. The most significantly differentially expressed genes in cancer tissues were verified in cells and tissues, and the relationships between circRNAs and clinical pathological indicators of patients were analyzed.Results:A total of 553 differentially expressed circRNAs were screened in paracancerous tissues and cancer tissues of 3 stage Ⅰ ESCC patients, of which 413 were up-regulated and 140 were down-regulated in cancer tissues; A total of 425 differentially expressed circRNAs were screened in paracancerous tissues and cancer tissues of 3 stage Ⅲ ESCC patients, of which 276 were up-regulated and 149 were down-regulated in cancer tissues. GO enrichment analysis showed that the host genes of differential circRNAs in patients with stage Ⅰ ESCC were mainly enriched in cell cycle-related biological processes such as mitotic G 2/M transition. The host genes of differential circRNAs in patients with stage Ⅲ ESCC were mainly enriched in biological processes related to cell division and tumor development, such as mitotic spindle checkpoint and cell matrix adhesion. KEGG enrichment analysis showed that the differential circRNAs in cancer tissues of stage Ⅰ and stage Ⅲ ESCC patients were mainly enriched in cancer-related biological pathways such as cell adhesion. The results of Venn analysis showed that in stage Ⅰ ESCC patients and stage Ⅲ ESCC patients, 2 and 8 circRNAs that were only specifically expressed in paracancerous tissues and had significant differences were screened out respectively, and were only specifically expressed in cancer tissues with significant differences were 11 and 14 respectively. The circRNA-miRNA-mRNA network showed that the cancer tissue-related circRNA-miRNA-mRNA network in stage Ⅰ ESCC patients consisted of 7 circRNA nodes, 10 miRNA nodes and 28 mRNA nodes, and the cancer tissue-related circRNA-miRNA-mRNA network in stage Ⅲ ESCC patients consisted of 7 circRNA nodes, 9 miRNA nodes and 49 mRNA nodes. The most significantly differentially expressed hsa-circ-0060927 and hsa-circ-0109301 in cancer tissues of patients with stage Ⅰ ESCC and stage Ⅲ ESCC were selected for cytological and histological verification. The results showed that the relative expression levels of hsa-circ-0060927 in ESCC cell lines TE1, TE13, KYSE30, KYSE170, and human normal esophageal epithelial cell line HEEC were 7.82±1.96, 12.69±2.68, 12.78±2.74, 7.53±1.75, and 2.43±0.17, respectively, with a statistically significant difference ( F=4.68, P=0.004). The relative expression levels of hsa-circ-0060927 in ESCC cell lines TE1, TE13, KYSE30, and KYSE170 were higher than that in human normal esophageal epithelial cell line HEEC, with statistically significant differences ( P=0.009; P=0.003; P=0.003; P=0.007). The relative expression levels of hsa-circ-0109301 in ESCC cell lines TE1, TE13, KYSE30, KYSE170, and human normal esophageal epithelial cell line HEEC were 5.16±1.32, 6.28±1.57, 4.89±1.13, 8.92±2.12, and 22.56±4.13, respectively, with a statistically significant difference ( F=4.31, P=0.022). The relative expression levels of hsa-circ-0109301 in ESCC cell lines TE1, TE13, KYSE30, and KYSE170 were lower than that in human normal esophageal epithelial cell line HEEC, with statistically significant differences ( P=0.027; P=0.015; P=0.024; P=0.008). The expression level of hsa-circ-0060927 in cancer tissues of 13 early ESCC patients was 12.89±2.67, significantly higher than 5.73±1.18 in paracancerous tissue, and there was a statistically significant difference ( t=15.02, P<0.001) ; the expression level of hsa-circ-0109301 in cancer tissues of 19 patients with advanced ESCC was 7.78±2.17, significantly lower than 16.32±3.15 in paracancerous tissue, and there was a statistically significant difference ( t=9.73, P<0.001). The expression of hsa-circ-0109301 was related to the degree of tumor differentiation in advanced ESCC patients ( P=0.023) . Conclusion:One circRNA (hsa-circ-0060927 and hsa-circ-0109301) with the most significanty differential expression is selected in early and advanced ESCC patients respectively, in which hsa-circ-0060927 is highly expressed in ESCC cancer tissues and hsa-circ-0109301 is lowly expressed in ESCC cancer tissues, and the expression of hsa-circ-0109301 is correlated with the degree of tumor differentiation.

Objective:To explore the effect of mind mapping teaching of gastroenterology in the standardized training for general practitioners, and provide new ideas for general practice education.Methods:A total of 65 physicians who were enrolled in the standardized training of general practice from January to December 2017 were collected as the control group, and the traditional teaching method was adopted; another 58 physicians from January to December 2018 were selected as the experimental group, and the mind mapping was adopted based on the traditional teaching method. The learning effect (theoretical and operational results) and the satisfaction questionnaire of trainees and teachers were used as evaluation indicators. SPSS 21.0 was used for t test and chi-square test. Results:The theory exam and clinical skills examination results of experimental group (80.80±5.30, 82.66±5.90) were significantly higher than those of the control group (71.60±5.20, 75.72±4.57), and the difference was statistically significant ( P<0.05). Compared with the control group, the experimental group had better understanding of knowledge points of this discipline, clinical thinking ability, higher learning interest, teamwork ability, innovation ability and teacher satisfaction, with statistical significance ( P<0.05). Conclusion:The mind mapping has more advantages than traditional teaching methods in the standardized training for general practitioners, which can be further extended.

Objective:To explore the protective effect of vitexin on retinal ganglion stem cells (RGCs) from oxidative stress caused by retinal ischemia-reperfusion (RIR) in rats and its possible mechanism.Methods:Sixty male SD rats were randomly divided into the model group, vitexin group and normal control group by random number table, with 20 rats in each group.The right eyes were taken as experimental eyes.Rats in the model group and the vitexin group were treated with anterior chamber perfusion to establish RIR models.Rats in the vitexin group were given intraperitoneal injection of vitexin at a dose of 25 mg/(kg·d) for 7 days.Rats in the model group were intraperitoneally injected with the same volume of normal saline.For the normal control group, the experimental eyes underwent anterior chamber puncture without increasing the intraocular pressure, and were intraperitoneally injected with the same volume of normal saline.On the 7th day following modeling, the rats were sacrificed by overdose anesthesia.Histopathology staining was used to detect the thickness of retina and the number of RGCs.Retrograde tracing with Fluoro-Gold was used to detect the density of RGCs.TUNEL staining was used to detect the apoptosis of RGCs.Colorimetric method was used to detected superoxidate dismutase (SOD) activity and concentration of malondialdehyde (MDA) and nitric oxide (NO). Western blot method was used to detect the relative expression levels of cytoplasmic Nrf2, HO-1, NQO1, nuclear Nrf2 proteins in rat retina.The use and care of animals followed the ARVO Statement.This study protocol was approved by the Experimental Animal Ethics Committee of Henan Eye Hospital (No.HNEECA-2019-04).Results:The retinal thickness was (90.21±3.55)μm in the model group, which was significantly lower than (128.20±5.31)μm in the normal control group and (119.65±6.14)μm in the vitexin group, and the differences were statistically significant (both at P<0.05). The average density of RGCs was (1 300.85±14.00)/mm 2 in the model group, which was significantly lower than(2 330.12±15.05)/mm 2 in the normal control group and (1 921.64±11.78)/mm 2 in the vitexin group, and the differences were statistically significant (both at P<0.05). The rate of TUNEL positive RGCs was (68.34±5.04)% in the model group, which was significantly higher than (3.01±0.18)% in the normal control group and (35.51±2.04)% in the vitexin group, and the differences were statistically significant (both at P<0.05). Compared with the normal control group and the vitexin group, the SOD activity in the retinal tissue of the rats was lower and the concentrations of MDA and NO were higher in the model group, and the differences were statistically significant (all at P<0.05). The expression level of cytoplasmic Nrf2 protein was the lowest in the vitexin group, then following the model group and the normal control group, and the relative expression levels of HO-1, NQO1 and nuclear Nrf2 protein were the highest in the vitexin group, then followed the model group and normal control group, and the differences were statistically significant (all at P<0.05). Conclusions:Vitexin can reduce the apoptosis of RGCs and alleviate oxidative stress damage of retina in RIR rat model.This protective effect may be achieved by activating Nrf2-related signaling pathway.

Non-coding RNAs (ncRNAs) is a kind of RNA without protein coding function. A large number of studies in recent years have shown that the occurrence and development of colorectal cancer (CRC) are closely related to the aberrant expression of ncRNAs. ncRNAs can be used as non-invasive biomarkers for early diagnosis of CRC. We review the research progress of ncRNAs in early diagnosis of CRC, and summarize the potential clinical value of ncRNAs detection, which can provide a theoretical basis for improving the early diagnosis rate of CRC.

Objective:To investigate the impact of multidisciplinary diagnosis and treatment on postoperative 30-day mortality and complications in elderly patients with hip fracture.Methods:A retrospective analysis was conducted of the 260 elderly patients with hip fracture who had been treated by the mode of multidisciplinary diagnosis and treatment at Department of Orthopedics, Shenzhen Second People's Hospital from June 2018 to October 2019. The multidisciplinary group consisted of 66 males and 194 females with an age of 78.7 years ± 5.1 years, and 141 femoral neck fractures, 114 intertrochanteric fractures and 5 subtrochanteric fractures. They were compared with the 242 elderly patients with hip fracture (traditional group) who had been treated by the traditional mode from January 2017 to May 2018. The 2 groups were compared in terms of preoperative waiting time, 48-hour operation rate, 30-day mortality, and incidences of postoperative pneumonia and pressure ulcer.Results:There were no statistically significant differences in the preoperative general data or operative procedures between the 2 groups, showing comparability ( P>0.05). For the multidisciplinary group, preoperative waiting time was 41.9 h ± 36.5 h, significantly shorter than that for the traditional group (71.4 h ± 13.9 h), 48-hour operation rate 66.5% (173/260), significantly higher than that for the traditional group(8.7%, 21/242), incidence of postoperative pneumonia 3.1%(8/260), significantly lower than that for the traditional group(9.9%, 24/242), incidence of postoperative pressure ulcer (5.4%, 14/260), significantly lower than that for the traditional group(11.2%, 27/242), and 30-day mortality(2.3%, 6/260), significantly lower than that for the traditional group(5.8%, 14/242) (all P<0.05). Conclusions:Establishment of a mode of multidisciplinary diagnosis and treatment can significantly reduce the prolonged preoperative waiting time for elderly patients with hip fracture, thereby greatly reducing postoperative complications and postoperative 30-day mortality.

OBJECTIVE: To investigate the value of positive lymph node ratio (LNR) in predicting the prognosis of patients with esophageal cancer. METHODS: We retrieved the data of a total of 862 patients with esophageal cancer with complete clinical pathology data archived in SEER database in 2010 to 2015. The best cutoff point of LNR was selected using X-tile software. Univariate and multivariate COX proportional hazard models were used to assess the value of LNR in predicting the prognosis of patients after propensity score matching (PSM). RESULTS: The best cut-off point of LNR determined using X-tile 3.6.1 software was 0.16. The patients with LNR < 0.16 and those with LNR≥0.16 showed significant differences in the number of positive lymph nodes, pathological type, T stage and M stage. After 1:1 propensity score matching, the two groups showed no significant difference in the clinical data or pathological parameters. Matched univariate and multivariate COX regression analyses showed that LNR, primary tumor site and M staging were all independent risk factors affecting the prognosis of patients, and among them LNR had the most significant predictive value (LNR < 0.16 LNR≥0.16: HR=1.827, 95% : 1.140-2.929; =0.000). The median survival time of patients with LNR < 0.16 was 31 months (95%: 22.556-39.444 months), as compared with 16 months (95%: 12.989-19.011) in patient with LNR≥0.16 (Log Rank χ=27.392, < 0.0001). LNR had a better accuracy than N stage for assessing the patients' prognosis with an area under the ROC curve of 0.617 (95%: 0.567-0.666), as compared with 0.515 (95%: 0.463-0.565) of N stage (=3.008, =0.0026). CONCLUSIONS LNR≥0.16 is an independent risk factor affecting the prognosis of patients with esophageal cancer and has better prognostic value than N stage.
Esophageal Neoplasms ; Humans ; Lymph Node Excision ; Lymph Node Ratio ; Lymph Nodes ; Lymphatic Metastasis ; Neoplasm Staging ; Prognosis ; Retrospective Studies ; Risk Factors

Objective:To compare the clinical characteristics of patients with non-erosive gastroesophageal reflux disease (NERD), reflux hypersensitivity (RH) and functional heartburn (FH), in order to help the differential diagnosis and treatment of the three diseases.Methods:From October 2016 to February 2019, 64 patients with persistent heartburn who had negative endoscopy in the Department of Gastroenterology, the Second Affiliated Hospital of Xi′an Jiaotong University and with negative results of endoscopy examination were consecutively selected, which included 26 NERD patients (NERD group), 12 RH patients (RH group) and 26 FH patients (FH group). The gender, age, body mass index (BMI), presence of hiatus hernia, proton pump inhibitor (PPI) treatment effect, the score and incidence of gastroesophageal symptoms within one month before visit, and the incidence of overlapping functional dyspepsia (FD), postprandial distress syndrome (PDS) and epigastric pain syndrome (EPS) of the three groups were compared. One-way analysis of variance, least-significant difference, Kruskal-Wallis H test, Mann-Whitney U test and chi-square test were used for statistical analysis. Results:There were no statistically significant differences in gender, age or incidence of esophageal hiatal hernia between NERD group, RH group and FH group (all P>0.05). BMI of NERD group was higher than that of FH group ((23.74±3.10) kg/m 2 vs. (21.26±2.75) kg/m 2), and the difference was statistically significant ( t=3.066, P=0.003). The effective rate of PPI treatment in NERD group was higher than those of RH group and FH group (19, 4, and 11 cases, respectively), the differences were statistically significant ( χ2=5.428 and 5.042, P=0.020 and 0.025). The score and incidence of burning sensation in upper abdomen of NERD group were both lower than those of FH group (0, 0 to 0 vs. 0, 0 to 5; 7.7%, 2/26 vs. 38.5%, 10/26), and the differences were statistically significant ( Z=-2.756, P=0.006; χ2=6.933, P=0.008). There were no statistically significant differences in the score of heartburn symptoms, or the scores and incidence of chest pain, reflux, globular sensation of hysteria, burning sensation of throat, cough, epigastric pain, early satiety or post meal fullness, belching, nausea or vomiting between NERD group, RH group and FH group (all P>0.05). There were no statistically significant differences in the incidence of overlapping FD or overlapping PDS between the NERD group, RH group and FH group (both P>0.05), but the incidence of overlapping EPS of FH group was higher than that of NERD group (46.2%, 12/26 vs. 11.5%, 3/26), and the difference was statistically significant ( χ2=7.589, P=0.013). Conclusions:There are certain differences in the clinical characteristics of patients with NERD, RH or FH, mainly reffected in the PPI treatment effects and whether overlapping EPS. The higher incidence of FH overlapping EPS further strengthens the hypothesis that functional gastrointestinal disorders have a common pathophysiological mechanism.