Objective To investigate the role and molecular mechanism of SOX4 in Helicobacter pylori(H.pylori)-mediated gastric mucosal epithelial dysplasia.Methods The expression of SOX4 in gastric tissues and cells was analyzed with reverse transcription-polymerase chain reaction(RT-PCR),Western blotting,and immunohistochemical staining.The effects of SOX4 on gastric epithelial cell proliferation and colony formation were determined with CCK-8 and colony formation assays.A PCR array was used to screen downstream target genes involved in H.pylori-induced dysplasia mediated by SOX4.The transcriptional regulation and binding sites of the target gene MLH3 by SOX4 were elucidated with luciferase reporter assay,promoter truncation assay,and chromatin immunoprecipitation(ChIP).Results SOX4 expression was significantly increased in H.pylori-infected gastric tissues(P<0.05).Overexpression of SOX4 markedly enhanced the proliferation and colony formation abilities of normal gastric epithelial cells(P<0.05).Elevated SOX4 led to the dysregulation of MLH3 and other DNA damage repair-related molecules after H.pylori infection in gastric epithelial cells(|logFC|>1,P<0.05).H.pylori promoted MLH3 expression in gastric epithelial cells through SOX4.SOX4 transcriptionally activated MLH3 expression by binding to the 5th site of the MLH3 promoter.The increased expression of SOX4 and MLH3 is associated with poor prognosis of gastric cancer patients.Conclusion SOX4 is closely associated with H.pylori-induced dysplasia in gastric epithelial cells.Upregulation of SOX4 promotes H.pylori-related dysplasia by transcriptionally activating MLH3,leading to the imbalance of proliferation and colony formation in gastric epithelial cells.

Objective To analyze the clinical characteristics of esophageal foreign body impaction by gastroscopy intervention in adults.Methods A retrospective analysis was conducted on 470 patients who underwent gastroscopic intervention for esophageal foreign bodies at the Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,from January 2019 to January 2024.The patients' gender,age,underlying esophageal conditions,date of endoscopic examination,type of anesthesia,the type,size,and shape of the foreign bodies,as well as the severity of complications were compared and analyzed in this study.Results The median age of the patients was 62.5,with an equal male-to-female ratio of 1∶1.Totally 63.40％endoscopic examination were performed on weekdays.Local pharyngeal anesthesia was used in 96.17％of patients.The upper esophagus was the most common site of impaction(61.7％).Esophageal strictures were detected in 19.36％of patients during endoscopy.The size of the foreign bodies ranged from 0.4 cm to 13 cm,with an average of(2.44±1.03)cm.The most common foreign bodies were animal bones such as fish,chicken,and duck bones(47.02％),followed by jujube pits(19.36％).Female patients were significantly more likely to have jujube pit impactions(P＜0.001).Two pressure points were identified in 28.94％of the foreign bodies.Mild complications related to foreign body impaction occurred in 416 cases(88.51％),while severe complications occurred in 54 cases(11.49％).Among those with severe complications,a higher proportion were elderly(P=0.009),female(P=0.045),had foreign bodies larger than 2.0 cm(P＜0.05),jujube pits and had foreign bodies with two pressure points(P＜0.001).Swallowing jujube pits and having foreign bodies larger than 3.0 cm were independent risk factors for severe complications.Conclusion Elderly patients,female patients,foreign bodies larger than 2.0 cm,foreign bodies with two pressure points,and jujube pits are more likely to develop severe esophageal complications.Early endoscopic intervention is recommended for patients with these characteristics.

Objective To investigate the role and molecular mechanism of SOX4 in Helicobacter pylori(H.pylori)-mediated gastric mucosal epithelial dysplasia.Methods The expression of SOX4 in gastric tissues and cells was analyzed with reverse transcription-polymerase chain reaction(RT-PCR),Western blotting,and immunohistochemical staining.The effects of SOX4 on gastric epithelial cell proliferation and colony formation were determined with CCK-8 and colony formation assays.A PCR array was used to screen downstream target genes involved in H.pylori-induced dysplasia mediated by SOX4.The transcriptional regulation and binding sites of the target gene MLH3 by SOX4 were elucidated with luciferase reporter assay,promoter truncation assay,and chromatin immunoprecipitation(ChIP).Results SOX4 expression was significantly increased in H.pylori-infected gastric tissues(P<0.05).Overexpression of SOX4 markedly enhanced the proliferation and colony formation abilities of normal gastric epithelial cells(P<0.05).Elevated SOX4 led to the dysregulation of MLH3 and other DNA damage repair-related molecules after H.pylori infection in gastric epithelial cells(|logFC|>1,P<0.05).H.pylori promoted MLH3 expression in gastric epithelial cells through SOX4.SOX4 transcriptionally activated MLH3 expression by binding to the 5th site of the MLH3 promoter.The increased expression of SOX4 and MLH3 is associated with poor prognosis of gastric cancer patients.Conclusion SOX4 is closely associated with H.pylori-induced dysplasia in gastric epithelial cells.Upregulation of SOX4 promotes H.pylori-related dysplasia by transcriptionally activating MLH3,leading to the imbalance of proliferation and colony formation in gastric epithelial cells.

Objective:To investigate the endoscopic and pathological features and the independent risk factors for early esophageal cancer combined with multiple primary cancer.Methods:Endoscopic and pathological features of 324 patients diagnosed as having early esophageal cancer from January 2013 to January 2022 in Beijing Friendship Hospital were retrospectively collected. Independent risk factors for early esophageal cancer combined with multiple primary cancer were selected by multivariate logistic regression analysis.Results:Among the 324 patients with early esophageal cancer, 47 (14.51%) patients (29 metachronous and 18 synchronous) had multiple primary cancer. Multivariate logistic regression analysis showed that alcohol drinking ≥5 standard drinks/day ( OR=6.23, 95% CI: 2.49-15.57, P<0.001), submucosal layer invasion ( OR=2.80, 95% CI:1.07-7.30, P=0.036), lesion location at lower esophagus ( OR=4.18, 95% CI: 1.98-8.97, P<0.001) and multiple lesions in esophagus ( OR=3.30, 95% CI:1.57-6.92, P=0.002) were independent risk factors for early esophageal cancer combined with multiple primary cancer. Conclusion:Alcohol drinking ≥5 standard drinks/day, submucosal layer invasion, lower lesions location, and multiple lesions in the esophagus are independent risk factors that are more likely to develop multiple primary cancer in patients with early esophageal cancer. It is recommended to prioritize monitoring patients with these factors, and enhance endoscopic follow-up and assessment.

Objective:To identify risk factors associated with endoscopic atrophic progression of gastric mucosa after Helicobacter pylori ( HP) eradication and to develop a risk scoring system for establishing an individualized endoscopic follow-up strategy for patients with chronic gastritis. Methods:This retrospective cohort study included chronic gastritis patients with successful HP eradication at the Department of Gastroenterology, Beijing Friendship Hospital between January 2018 and October 2021. Demographic characteristics, endoscopic findings, and other clinical data were analyzed. Endoscopic outcomes of gastric mucosal atrophy before and after follow-up were compared to classify patients into progression and non-progression groups. Univariate and multivariate analyses were performed to identify independent risk factors for endoscopic atrophic progression. A risk scoring system was then constructed based on these factors. Results:A total of 218 patients with chronic gastritis were included, including 153 in the non-progression group and 65 in the progression group. Multivariate logistic regression analysis showed that gastric ulcer ( P=0.008, OR=4.24, 95% CI: 1.46-12.25), history of proton pump inhibitor use ( P=0.007, OR=4.06, 95% CI: 1.46-11.27), alcohol consumption ( P=0.002, OR=3.77, 95% CI: 1.64-8.67), high-salt diet ( P=0.008, OR=2.90, 95% CI: 1.32-6.41), and high red meat intake ( P=0.025, OR=2.33, 95% CI: 1.11-6.31) were independent risk factors for endoscopic atrophic progression after HP eradication. The predictive model based on these 5 factors demonstrated strong discriminative capacity, with an area under the receiver operating characteristic curve of 0.813 (95% CI: 0.755-0.876, P<0.001). The optimal cut-off value was 1.5 points, stratifying patients into low-risk (0-2 points) and high-risk (3-5 points) groups. Conclusion:Patients with chronic gastritis remain susceptible to progression even after successful HP eradication. Individualized endoscopic follow-up strategies should be considered based on patients' medical history, medication use, lifestyle, and dietary habits.

Objective:To evaluate the effectiveness of a novel endoscopic oronasal shields in reducing aerosol transmission during upper gastrointestinal endoscopy.Methods:Patients undergoing sedated upper gastrointestinal endoscopy at Lhasa People's Hospital (December 2023-February 2024) were randomized 1∶1 via SAS 9.4 to shield or control groups. A six-channel particle counter (0.3, 0.5, 1.0, 2.5, 5.0, 10.0 μm) measured aerosol particles. The primary outcome was pre-/post-procedure aerosol variation at the endoscopist's facial position. The secondary outcome was device safety.Results:The study enrolled 100 patients (50 per group) with comparable baseline characteristics. Procedure duration showed no significant difference (7.8±3.9 min VS 8.1±4.2 min, t=0.500, P=0.615). The oronasal shield group demonstrated significantly reduced aerosol increases at 0.3 μm [(57.87±19.26)×10?/L VS (203.32±18.33)×10?/L, t=4.295, P<0.001], 0.5 μm [(19.36±3.60)×10?/L VS (64.61±12.67)×10?/L, t=4.949, P<0.001], 1.0 μm [(15.31±4.42)×10?/L VS (54.11±9.12)×10?/L, t=4.507, P<0.001], and 2.5 μm [(7.38±2.90)×10?/L VS (23.33±5.17)×10?/L, t=3.723, P<0.001]. Adverse event rates (cough, hiccups, hypoxemia, etc.) showed no significant differences ( P>0.05). Conclusion:Endoscopic oronasal shields safely reduce aerosol generation without prolonging procedure time, potentially mitigating exposure risks in endoscopy centers.

To investigate the clinical outcomes of endoscopic diagnosis and treatment in patients with duodenal variceal bleeding, a retrospective analysis was conducted on clinical data of patients with ectopic duodenal variceal bleeding diagnosed and treated endoscopically at the Digestive Endoscopy Center of Beijing Friendship Hospital, Capital Medical University, from August 2011 to December 2024. Five male patients (mean age 50.4 years) were included. Etiologies included alcohol-related cirrhosis (1 case), hepatitis B virus-related cirrhosis (2 cases), autoimmune disease-associated portal hypertension (1 case), and thrombophilia-related portal hypertension (1 case). Immediate hemostasis was achieved endoscopically in all cases. Two patients (1 alcohol-related and 1 hepatitis B virus-related cirrhosis) exhibited persistent decline in hemoglobin levels post-procedure and received sequential interventional therapy before discharge. The remaining 3 patients recovered uneventfully. Duodenal variceal bleeding, though rare and life-threatening, can be effectively managed through multidisciplinary collaboration. Endoscopic hemostasis should be prioritized when technically feasible.

Objective To analyze the clinical characteristics of esophageal foreign body impaction by gastroscopy intervention in adults.Methods A retrospective analysis was conducted on 470 patients who underwent gastroscopic intervention for esophageal foreign bodies at the Department of Gastroenterology,Beijing Friendship Hospital,Capital Medical University,from January 2019 to January 2024.The patients' gender,age,underlying esophageal conditions,date of endoscopic examination,type of anesthesia,the type,size,and shape of the foreign bodies,as well as the severity of complications were compared and analyzed in this study.Results The median age of the patients was 62.5,with an equal male-to-female ratio of 1∶1.Totally 63.40％endoscopic examination were performed on weekdays.Local pharyngeal anesthesia was used in 96.17％of patients.The upper esophagus was the most common site of impaction(61.7％).Esophageal strictures were detected in 19.36％of patients during endoscopy.The size of the foreign bodies ranged from 0.4 cm to 13 cm,with an average of(2.44±1.03)cm.The most common foreign bodies were animal bones such as fish,chicken,and duck bones(47.02％),followed by jujube pits(19.36％).Female patients were significantly more likely to have jujube pit impactions(P＜0.001).Two pressure points were identified in 28.94％of the foreign bodies.Mild complications related to foreign body impaction occurred in 416 cases(88.51％),while severe complications occurred in 54 cases(11.49％).Among those with severe complications,a higher proportion were elderly(P=0.009),female(P=0.045),had foreign bodies larger than 2.0 cm(P＜0.05),jujube pits and had foreign bodies with two pressure points(P＜0.001).Swallowing jujube pits and having foreign bodies larger than 3.0 cm were independent risk factors for severe complications.Conclusion Elderly patients,female patients,foreign bodies larger than 2.0 cm,foreign bodies with two pressure points,and jujube pits are more likely to develop severe esophageal complications.Early endoscopic intervention is recommended for patients with these characteristics.

Objective:To evaluate the short-term efficacy of endoscopic-laparoscopic regional gastric resection combined with sentinel lymph node basin dissection in patients with early-stage gastric cancer.Methods:This is a retrospective case series study. Data of 17 consecutive early gastric cancer patients from a prospective cohort at Beijing Friendship Hospital,Capital Medical University were analyzed between August 2023 and August 2024. Sixteen cases were from the department of general surgery and 1 from the department of gastroenterology. The cohort included 9 males and 8 females,with a mean age of 61.4 years (range: 46 to 79 years). Clinical data,including demographics,pathological features,surgical procedures,and follow-up outcomes,were collected through medical records and databases. All patients were followed for over 3 months,with follow-up ending on December 5,2024.Results:A total of 17 patients were involved. Among them, 5 patients underwent endoscopic submucosal dissection (ESD) combined with laparoscopic sentinel lymph node dissection (LSBD),and another 3 patients who underwent complete ESD resection received LSBD due to pathological stage meeting the expanded indications. 6 patients who underwent non-curative ESD resection received laparoscopic gastric regional resection (LRG) combined with LSBD,and another 3 patients directly received LRG combined with LSBD. The average number of sentinel lymph nodes dissected before surgery ( M(IQR)) was 8.9 (4.5) (range: 4 to 21),and the detection rate and accuracy rate were both 100%. Postoperative pathology confirmed that there was no metastasis in the sentinel lymph nodes of 5 patients who underwent ESD combined with LSBD and 3 patients who underwent LSBD after complete ESD resection. The vertical and horizontal margins of ESD were all negative. One patient was an absolute indication for ESD. For the 6 patients who underwent non-curative ESD resection combined with LRG and LSBD,the horizontal margins were all negative. Two patients showed 1 metastasis in each of the 21 and 9 sentinel lymph nodes during the operation,and additional distal gastrectomy was performed during the operation. Postoperatively,73 and 39 lymph nodes were retrieved respectively. The former had 1 additional metastasis,while the latter had no metastasis. Among the 3 patients who underwent direct LRG combined with LSBD,the horizontal margins were negative. One patient was confirmed as an absolute indication for ESD by postoperative pathology,and one patient had 1 metastasis in 8 sentinel lymph nodes during the operation,and additional distal gastrectomy was performed. Postoperatively,there was no metastasis in 54 lymph nodes. All patients had no complications such as infection,bleeding,perforation,or death after surgery. Among the 14 patients who did not receive additional radical surgery,they were able to pass gas and defecate within 3 days after surgery,with an average hospital stay of 6 days. The nutritional indicators and gastric radionuclide emptying imaging half-emptying time were similar to those before surgery at 3 months after surgery. Conclusions:Laparoscopic and endoscopic cooperative regional gastrectomy with sentinel lymph node basin dissection has the advantages of minimal invasiveness,preservation of gastric function,and precise treatment. It maybe suitable for patients with early-stage gastric cancer at high risk of lymph node metastasis and has good short-term efficacy.

Purpose To explore the application value of cardiac magnetic resonance(CMR)mapping and strain techniques in assessing ventricular function changes in patients with severe alcohol use disorder(AUD).Materials and Methods A retrospective analysis was conducted on 32 male patients with severe AUD as the study group in Hefei Fourth People's Hospital from January 2023 to April 2024,compared with 30 age-and gender-matched healthy subjects as the control group.Clinical data and CMR results were collected for all participants.CMR parameters included conventional functional parameters such as left and right ventricular ejection fraction,volume index and mass index;tissue characterization parameters such as Native T1,T2 mapping and extracellular volume fraction(ECV);and strain parameters including global longitudinal strain(GLS),global circumferential strain(GCS)and global radial strain(GRS)for both ventricles.The differences in the above indexes between the two groups were compared.Results The left ventricular end-diastolic volume index in the AUD group was significantly higher than in the control group(t=3.799,P<0.001).The left ventricular strain values(GLS,GCS,GRS)in the AUD group were significantly lower than those in the control group(t=4.459,4.435,-4.759,all P<0.001).The Native T1,T2 and ECV in the AUD group were significantly higher than those in the control group(t=6.301,5.650,7.069,all P<0.001).For the right ventricle,only right ventricular GLS and right ventricular GCS were significantly lower than in the control group(t=8.703,-2.814,both P<0.01).Conclusion CMR feature tracking technology can early identify ventricular function abnormalities in AUD patients.The increase in Native T1,T2 mapping and ECV suggests the presence of myocardial edema and fibrosis in AUD patients,which is closely related to left ventricular dysfunction.Multi-parameter CMR evaluation provides important diagnostic evidence for the early detection of cardiac involvement in severe AUD patients.