Neurogastroenterology and motility disorders of the upper gastrointestinal (GI) tract represent a complex and heterogeneous group of conditions that involve the interaction between the GI tract and the central nervous system. They constitute a significant number of outpatient gastroenterology visits, resulting in a high healthcare burden. These disorders often occur in the absence of identifiable structural causes on routine endoscopy and radiological imaging. A more targeted approach in the assessment of functional GI disorders is increasingly being integrated into routine clinical practice, given the recent advancements in technology and physiologic testing. When used in the appropriate clinical context, these tests not only elucidate the physiological basis for the patient's symptoms, but also prevent inappropriate treatment and repeated investigations. This review aims to summarise the advances in clinically available diagnostic tools for the evaluation of upper GI functional disorders.
Humans ; Gastrointestinal Diseases/physiopathology* ; Upper Gastrointestinal Tract/physiopathology* ; Gastrointestinal Motility ; Endoscopy, Gastrointestinal

At present, robotic surgery system, as a cutting-edge technique in minimally invasive surgery, has become a crucial component in the training programs for outstanding surgeons. Given the relatively late start of this technique and immature faculty resources, there is an urgent need to optimize and improve the teaching philosophies and methodologies for robotic skill training in China, and Sino-foreign cooperation has emerged as a significant pathway to promote this reform. Taking the "International Robotic Surgery Training Center (IRSTC)" jointly established by The First Affiliated Hospital of Sun Yat-sen University and University of California as an example, this article provides a comprehensive analysis of collaboration background, construction of the training system, curriculum design, cooperation channels, and localization practices, in order to provide a reference and valuable experiences for Sino-foreign cooperation in clinical skill training.

Objective:To investigate the characteristics of continuing medical education (CME) and continuing professional development (CPD) systems in China, the perceptions of health professionals regarding CME/CPD, and their views on the extent to which the current CME/CPD systems meet learning needs.Methods:A questionnaire survey method was employed. The Chinese version of the global CME/CPD questionnaire developed by the Association for Medical Education in Europe was used to conduct an online survey of 2 951 health professionals across 32 provinces, autonomous regions, and municipalities directly under the central government in mainland China from 2020 to 2021. The survey results were analyzed using descriptive statistics, chi-square tests, and content analysis.Results:Among the 2 951 respondents, internal medicine practitioners accounted for the highest proportion (664, 22.50%), and 2 050 (69.47%) of the respondents were located in the eastern region. In the past 12 months, 1 489 (50.46%) respondents participated in 11-30 hours of CME/CPD, and 2 406 (81.53%) considered that the existing activities met their learning needs. There were statistically significant differences ( P<0.05) in the learning needs for CME/CPD, participation in educational training and interprofessional continuing education, and satisfaction with industry-supported CME/CPD among health professionals with different years of practice. Conclusions:Health professionals in China have a high level of participation in CME/CPD. There are differences in their familiarity and satisfaction with the current systems. It is recommended to enhance the promotion of the CME/CPD systems, optimize the teaching content, improve education quality, and strengthen commercial interest regulation. These will better meet the learning needs of health professionals and promote high-quality development in medical education.

Objective:To construct a competency-oriented assessment index system based on entrustable professional activities (EPAs) for 5-year undergraduate clinical medical students in oncology internship.Methods:From June to December 2023, the scoping review approach and Bicomb 2.0 were used to construct and manage an item pool. The draft of EPAs and competencies was designed based on truncated word frequency. SPSS 25.0 was used for cluster analysis and UCINET 6.0 was used for visualization. Combining the characteristics and consensus of oncology, a multi-center expert group used the KJ method to draft the framework of EPAs and competencies. Subsequently, the expert group defined milestones and mapped the milestones to the framework to establish the assessment system.Results:Based on 26 included studies, a draft was created containing 19 EPA indicators and 72 competency characteristic indicators. After cluster analysis, 13 experts from 6 medical institutions established a framework including 13 EPAs and 10 competencies as well as 50 milestones, leading to the construction of the "EPAs-competencies-milestones" assessment system.Conclusions:The "EPAs-competencies-milestones" assessment system aligns with the trend of reform, demonstrating universality, specificity, and scientificity. It provides a reference for the development and assessment of oncology internship courses in medical universities.

Aimed to find a safe and effective drug to replace nitroimidazole drugs in aquaculture pro-duction for the prevention and treatment of Trichomoniasis in pigeons,which can improve the eco-nomic benefits of meat pigeon breeding and ensure food safety.Firstly,Trichomonas was isolated and cultured from the crop of diseased pigeons and identified.After stable passage,a quantitative method for in vitro detection of Trichomonas was established by combining an automated cell counter and quantitative real-time PCR technology.To prepared the drug,powders of Sophora fla-vescent and Philodendron were made into herbal water extracts(SFPA)and mixed with copper sulfate(CS)solution.Then added the drug to the culture medium of Trichomonas to determine the effective concentration of it.A total of 135 pairs each of Silver King and Mimas breeding pigeons in the same laying period were selected and randomly divided into three groups,with 6 replicates in each group and 15 pairs of breeding pigeons in each replicate.Four days before brooding,the three groups were fed with 200 mL of pure water,0.5 g/L metronidazole(MDZ)solution,and a mixed solution of 30 g/L SFPA and 0.5 g/L CS,respectively.The feeding experiment lasted for 26 d.Results showed that the mixed solution of SFPA and CS had a significant killing effect on Trichomonas in vitro(P＜0.05).Feeding the drug to breeding pigeons significantly reduced the in-fection rate of breeding pigeons by Trichomonas(P＜0.05).The drug had no significant effect on the serum biochemical indexes,antioxidant properties,immunoglobulin levels of breeding pigeons,the average cage weight,immune organ indexes,meat quality and slaughter performance of squabs(P＞0.05).The results suggested that adding SFPA and CS to pigeons can effectively prevent and treat Trichomoniasis and improve production performance.It can replace nitroimidazole drugs without affecting the immune level of breeding pigeons and the weight,immune level,slaughter performance and meat quality of squabs,thereby reduce drug residues in poultry products and en-hance the food safety.

Objective:To construct and validate a competency-oriented entrustable professional activities (EPAs)-Competency-Milestones system for assessment of laparoscopic skills (ESALS).Methods:A research team composed of 15 members from five medical institutions was established. Taking the Staged Training and Assessment of Laparoscopic Skills program as the basis for EPAs, ESALS was constructed through scoping review and behavioral event interviews and the use of the Kawakita Jiro method. ESALS was applied to evaluate 49 trainees and 10 specialists (including 5 novices and 5 experts) on basic and advanced laparoscopic skills, respectively, in comparison with two other assessment tools—the Training and Assessment of Basic Laparoscopic Techniques (TABLT) and the Global Operative Assessment of Laparoscopic Skills (GOALS). Perform Mann Whitney U test using SPSS 23.0 software, and use Spearman coefficient for correlation analysis.Results:Through reviewing 13 literuature articles and interviewing 10 senior surgeons, the ESALS was developed, comprising 10 EPAs, 8 dimensions of competency characteristics, and 5 entrustable levels. In the basic skills evaluation, the ESALS score was significantly positively correlated with the TABLT score ( R=0.881, P<0.001). In the advanced skills evaluation, significant differences were observed between the novice and expert groups in all the ESALS competency scores (all P<0.05), while no difference was detected in the GOALS score of tissue handling ability. Conclusions:ESALS provides comprehensive evaluation, detailed standards, and precise feedback, with comparable efficacy to conventional tools. Future work should focus on expanding sample size to verify its generalizability and developing an electronic tool to enhance application efficiency.

Liver Cancer is a prevalent malignant tumor worldwide,with various treatment options available. Among these, ablation therapy holds a significant role in liver cancer treatment due to its minimally invasive nature and lower complication rate. This article reviews the indications and contraindications of liver cancer ablation,the basic principles of different ablation techniques,and their advantages and limitations in clinical applications for liver cancer. Each ablation technique possesses unique characteristics regarding therapeutic efficacy,application scope,and complication profiles,necessitating the selection of the most appropriate approach tailored to the patient′s specific condition and tumor attributes. Furthermore,this article also discusses the potential role of ablation therapy in multidisciplinary treatment,highlighting its synergistic application with liver transplantation,interventional therapy,and immunotargeted therapy to significantly improve outcomes for unresectable liver cancer. Specifically,ablation therapy can induce an anti-tumor immune response by locally destroying the tumor,offering a potential application prospect for combining ablation with immunotherapy. Looking forward,with advances in nanotechnology,artificial intelligence,and image-guided techniques,ablation therapy is expected to progress towards higher precision,personalization,and safety,offering optimized treatment options for liver cancer patients.

Aimed to find a safe and effective drug to replace nitroimidazole drugs in aquaculture pro-duction for the prevention and treatment of Trichomoniasis in pigeons,which can improve the eco-nomic benefits of meat pigeon breeding and ensure food safety.Firstly,Trichomonas was isolated and cultured from the crop of diseased pigeons and identified.After stable passage,a quantitative method for in vitro detection of Trichomonas was established by combining an automated cell counter and quantitative real-time PCR technology.To prepared the drug,powders of Sophora fla-vescent and Philodendron were made into herbal water extracts(SFPA)and mixed with copper sulfate(CS)solution.Then added the drug to the culture medium of Trichomonas to determine the effective concentration of it.A total of 135 pairs each of Silver King and Mimas breeding pigeons in the same laying period were selected and randomly divided into three groups,with 6 replicates in each group and 15 pairs of breeding pigeons in each replicate.Four days before brooding,the three groups were fed with 200 mL of pure water,0.5 g/L metronidazole(MDZ)solution,and a mixed solution of 30 g/L SFPA and 0.5 g/L CS,respectively.The feeding experiment lasted for 26 d.Results showed that the mixed solution of SFPA and CS had a significant killing effect on Trichomonas in vitro(P＜0.05).Feeding the drug to breeding pigeons significantly reduced the in-fection rate of breeding pigeons by Trichomonas(P＜0.05).The drug had no significant effect on the serum biochemical indexes,antioxidant properties,immunoglobulin levels of breeding pigeons,the average cage weight,immune organ indexes,meat quality and slaughter performance of squabs(P＞0.05).The results suggested that adding SFPA and CS to pigeons can effectively prevent and treat Trichomoniasis and improve production performance.It can replace nitroimidazole drugs without affecting the immune level of breeding pigeons and the weight,immune level,slaughter performance and meat quality of squabs,thereby reduce drug residues in poultry products and en-hance the food safety.

Objective:To investigate the characteristics of continuing medical education (CME) and continuing professional development (CPD) systems in China, the perceptions of health professionals regarding CME/CPD, and their views on the extent to which the current CME/CPD systems meet learning needs.Methods:A questionnaire survey method was employed. The Chinese version of the global CME/CPD questionnaire developed by the Association for Medical Education in Europe was used to conduct an online survey of 2 951 health professionals across 32 provinces, autonomous regions, and municipalities directly under the central government in mainland China from 2020 to 2021. The survey results were analyzed using descriptive statistics, chi-square tests, and content analysis.Results:Among the 2 951 respondents, internal medicine practitioners accounted for the highest proportion (664, 22.50%), and 2 050 (69.47%) of the respondents were located in the eastern region. In the past 12 months, 1 489 (50.46%) respondents participated in 11-30 hours of CME/CPD, and 2 406 (81.53%) considered that the existing activities met their learning needs. There were statistically significant differences ( P<0.05) in the learning needs for CME/CPD, participation in educational training and interprofessional continuing education, and satisfaction with industry-supported CME/CPD among health professionals with different years of practice. Conclusions:Health professionals in China have a high level of participation in CME/CPD. There are differences in their familiarity and satisfaction with the current systems. It is recommended to enhance the promotion of the CME/CPD systems, optimize the teaching content, improve education quality, and strengthen commercial interest regulation. These will better meet the learning needs of health professionals and promote high-quality development in medical education.

Background/Aims: Anti-reflux mucosal ablation (ARMA) is a promising endoscopic intervention for proton pump inhibitor (PPI)-dependent gastroesophageal reflux disease (GERD). However, the effect of ARMA on esophageal motility remains unclear. Methods: Twenty patients with PPI-dependent GERD receiving ARMA were prospectively enrolled. Comprehensive self-report symptom questionnaires, endoscopy, 24-hour impedance-pH monitoring, and high-resolution impedance manometry were performed and analyzed before and 3 months after ARMA. Results: All ARMA procedures were performed successfully. Symptom scores, including GerdQ (11.16 ± 2.67 to 9.11 ± 2.64, P = 0.026) and reflux symptom index (11.63 ± 5.62 to 6.11 ± 3.86, P = 0.001), improved significantly, while 13 patients (65%) reported discontinuation of PPI. Total acid exposure time (5.84 ± 4.63% to 2.83 ± 3.41%, P = 0.024) and number of reflux episodes (73.05 ± 19.34 to 37.55 ± 22.71, P < 0.001) decreased significantly after ARMA. Improved esophagogastric junction (EGJ) barrier function, including increased lower esophageal sphincter resting pressure (13.89 ± 10.78 mmHg to 21.68 ± 11.5 mmHg, P = 0.034), 4-second integrated relaxation pressure (5.75 ± 6.42 mmHg to 9.99 ± 5.89 mmHg, P = 0.020), and EGJ-contractile integral(16.42 ± 16.93 mmHg · cm to 31.95 ± 21.25 mmHg · cm, P = 0.016), were observed. Esophageal body contractility also increased significantly (distal contractile integral, 966.85 ± 845.84 mmHg · s · cm to 1198.8 ± 811.74 mmHg · s · cm, P = 0.023). Patients with symptom improvement had better pre-AMRA esophageal body contractility. Conclusions ARMA effectively improves symptoms and reflux burden, EGJ barrier function, and esophageal body contractility in patients with PPIdependent GERD during short-term evaluation. Longer follow-up to clarify the sustainability of ARMA is needed.