OBJECTIVES: To analyze the disease burden of melanoma among middle-aged and elderly populations in China, and to predict the future trend. METHODS: Data from the Global Burden of Disease (GBD) 2021 were utilized to collect incidence and mortality rates of melanoma, disability-adjusted life years (DALYs), and corresponding age crude rates among the middle-aged and elderly population in China during 1990 and 2021. Additionally, the estimated annual percentage change (EAPC) was employed to assess the temporal trends. Age-period-cohort (APC) and Bayesian age-period-cohort (BAPC) models were utilized to compute age, period, and cohort effects on incidence and mortality rates of melanoma, as well as to predict future trends up to 2035. RESULTS: During 1990-2021, the incidence rate of melanoma for males was higher than that for females among the middle-aged and elderly population in China, and the overall incidence rate increased annually with an EAPC of 2.13 (1.90-2.36), while the overall mortality rate and DALY rate showed a declining trend with an EAPC of －0.28 (－0.41-－0.15) and －0.54 (－0.68-－0.41), respectively. The results of the APC model analysis revealed that age effects on both incidence and mortality rates of melanoma in China's middle-aged and elderly population were significant, with both increasing with age. Period and cohort effects showed an upward trend for incidence rates but a downward trend for mortality rates. Moreover, the period and cohort effects for mortality rates were not significant among females. In the BAPC prediction model, the number of incidences of melanoma in middle-aged and elderly people in China would increase dramatically. By 2035, the number of incidence cases is expected to reach approximately 9600 (males) and 10 300 (females), corresponding to an incidence rate of 2.66/10⁵ and 2.67/10⁵, respectively. The number of deaths is projected to be about 2600 (males) and 3500 (females) by 2035, corresponding to a mortality rate of 0.72/10⁵ and 0.91/10⁵, respectively. CONCLUSIONS The disease burden of melanoma among the middle-aged and elderly population in China remains substantial and is expected to increase over the next decade.
Humans ; Melanoma/mortality* ; China/epidemiology* ; Aged ; Middle Aged ; Male ; Female ; Incidence ; Disability-Adjusted Life Years ; Bayes Theorem ; Cost of Illness ; Skin Neoplasms/epidemiology*

Objective : To investigate the application of indocyanine green in near-infrared fluorescence imaging to determine the scope of necrotic bone resection in osteoradionecrosis of the jaw and to provide a reference for clinicians Methods : Eight patients with osteoradionecrosis of the jaws were enrolled. Indocyanine green was intravenously injected through the elbow vein 10 minutes before osteotomy. After conservative resection of necrotic bone lesions based on imaging results, the scope of potential dead bone resection in the area of low fluorescence intensity was gradually expanded at an initial distance of 0.3 cm. Near-infrared fluorescence imaging and fluorescence intensity determination of bone cross-section were performed before and after extended resection. Statistical differences were analyzed. All patients with osteonecrosis underwent regular follow-up to evaluate the postoperative efficacy Results: Indocyanine green was injected into all 8 patients with osteoradionecrosis for near-infrared fluorescence imaging and the scans were clear; the fluorescence intensity of fresh bone wounds with an expanded mandibular resection range of (0.95 ± 0.14) cm was (226.2 ± 15.8) au, which was higher than that based on intraoperative macroscopic observation and radiological results (108.8 ± 3.4) au, (t = 20.718, P<0.001). The postoperative follow-up improvement rate of 8 patients was 87.5%. Conclusion Near-infrared fluorescence imaging with indocyanine green can assist in the successful removal of necrotic bone until fresh bleeding of the jaw wound occurs, which has important clinical value in defining the resection range of osteoradionecrosis of the jaw.

Duodenal varices are an uncommon disease which occurs along the entire gastrointestinal tract outside the esophagus or stomach.Among ectopic varices,duodenal varices are the most common one.Cirrhosis,hepatic portal hypertension,extrahepatic portal vein occlusion and vasculitis contribute to the pathogenesis of ectopic variceal formation.The unusual pathophysiology,location,diversity and uncertain curative effect of DV are associated with its low detection rate and high mortality of patients.Therefore,the diagnosis and treatment of DV is one of the tough problems in clinical practice.This article reviews the current research advances in pathophysiology,diagnosis and treatment of duodenal varices to provide reference for clinical practice.

Gastrointestinal endoscopy plays a major diagnostic and therapeutic role in most gastrointestinal disorders.However,limited data of clinical safety is available in pregnant patients.Large studies,preferably prospective,with follow-up of fetal outcome are needed to determine fetal safety of endoscopy.This article briefly analyzed the literature on the research progress of gastrointestinal endoscopy during pregnancy,which offered an evident base for diagnosis and treatment in digestive diseases.

Endoscopic submucosal dissection (ESD) is a widely accepted treatment for early gastrointestinal cancer. However, the steep learning curve of standard ESD procedures makes it less widely applied in clinical practice. Therefore, various traction devices and techniques have been applied previously to facilitate ESD, such as clip-with-line method, Spring-assisted method, S-O clip method, magnetic anchor method, and robot-assisted method. These methods create a clear field of vision and allow dissections to be performed more quickly and safely. In this article, we will discuss various techniques for achieving tractions during ESD on clinical decision, and their advantages and disadvantages.
Dissection ; Gastric Mucosa ; Humans ; Safety ; Surgical Instruments ; Traction

Objective To investigate the risk factors for early rebleeding after esophageal variceal ligation (EVL) through a multicenter retrospective study.Methods A total of 3289 patients who were hospitalized and underwent EVL in 17 upper second-class hospitals or hospitals of higher classes from January 1999 to May 2015were collected and screened according to the exclusion criteria.A total of 2531 patients were screened out,and a retrospective analysis was performed for their clinical data including age,sex,endoscopic findings,and results of laboratory examination (liver function,biochemical results,routine blood test,and coagulation function) to collect related data.According to the presence or absence of rebleeding within 1 month after EVL,the patients were divided into rebleeding group and non-rebleeding group.SPSS22.0 software was used for independent t-test and one-way analysis of variance,and P ＜ 0.05 was considered statistically significant.Results In the 2531patients who underwent EVL,the rate of early rebleeding after EVL was 6.6％,and the mortality rate was 12.0％.The results showed that sex (P =0.014),number of veins with varices (P =0.203),prothrombin time (P =0.001),prothrombin activity (P=0.014),albumin (P =0),total bilirubin (P =0.011),aspartate aminotransferase (P =0.004),white blood cell count (P =0.342),hepatic encephalopathy (P =0.021),ascites (P =0.027),Child-Pugh class (P =0),Child-Pugh score (P =0),glue injection for gastric varices (P =0.521),gastric varices (P =0.32),shunt (P =0.174),number ofligation points (P =0.001),number of ligation times (P =0.024),number of times of hematemesis before treatment (P =0),number of times of tarry stool (P =0.008),and volume of blood in hematemesis before treatment (P =0) were risk factors for early rebleeding after EVL.The regression analysis showed that male sex,a Child-Pugh score of ＞7.2,and volume of blood in hematemesis before treatment were independent risk factors for early rebleeding after EVL,while an albumin concentration of ＞ 31.5 g/L was the protective factor.Conclusion EVL has a good therapeutic effect in esophageal variceal rebleeding.Among all the factors analyzed,male sex,a Child-Pugh score of ＞ 7.2,and volume of blood in hematemesis before treatment are independent risk factors for earlyrebleeding after EVL,and an albumin concentration of＞ 31.5 g/L is a protective factor.

OBJECTIVETo investigate the risk factors of gastroesophageal varices rebleeding after therapeutic endoscopy.

METHODSMedline,EMBASE and the China Biology Medicine Database were searched for literature published between January 2000 to May 2013 on topics related to risk factors of gastroesophageal varices rebleeding after therapeutic endoscopy. Data from each study that meet the requirements for analysis were extracted and subjected to meta-analysis.

RESULTSSixteen studies were collected for use in this meta-analysis. The odds ratio (OR) value of portal vein embolus was 7.88 (P<0.00001). The OR value of beta-blockers or nitrate medications was 0.53 (P=0.0008). The standardized mean difference (SMD) value of number of ligation points was 0.94 (P<0.01). The SMD value of albumin in the subgroup with follow-up time of less than or equal to 14 days was-0.89 (P<0.00001), while the SMD value of prothrombin time in the subgroup with follow-up time of less than or equal to 14 days was 1.78 (P<0.00001).

CONCLUSIONSPortal vein embolus, hepatocellular carcinoma, diameter of the portal vein, Child-Pugh classification C, moderate/excessive ascites, prothrombin time, and number of ligation points were risk factors of gastroesophageal varices early rebleeding after therapeutic endoscopy. Portal vein embolus, hepatocellular carcinoma, and diameter of the portal vein were risk factors of gastroesophageal varices long-term rebleeding after therapeutic endoscopy. Beta blockers or nitrate medications were protective factors of gastroesophageal varices rebleeding after therapeutic endoscopy.

Carcinoma, Hepatocellular ; China ; Endoscopy, Digestive System ; Esophageal and Gastric Varices ; Gastrointestinal Hemorrhage ; Humans ; Ligation ; Liver Neoplasms ; Portal Vein ; Risk Factors

Objective To observe the efficacy and safety of endoscopic ultrasonography submucosal resection for treatment of gastric muscularis propria mesenchymal tumor.Methods Endoscopic ultrasonography preliminary diagnosis of 19 cases were diagnosed stromal tumors originating from gastric muscularis propria layer,the endoscopic ultrasonography diagnosis the source,echo,size,blood supply,etc.than treated by endoscopic submucosal excavation.To observe the therapeutic effect and complications.Results Eighteen patients were the full excavation,1 patient was failed.Intraoperative perforation was seen in 2 cases,the wound was healed by the titanium clamp.A small amount of bleeding happened in operation and bleeding was stopped by hot biopsy forceps or argon coagulation.No delayed bleeding happened.Conclusion Submucosal resection for gastric muscularis propria mesenchymal tumors is safe and effective,endoscopic ultrasonography has important value in the strict assessment.

Minichromosome maintenance protein 7 (MCM7) is an important regulator of DNA replication,and plays an important role in replication initiation and elongation steps.Recent studies show that MCM7 is closely related with the formation and growth of digestive tumors.The detection of MCM7 protein can provide new ideas for the early diagnosis,treatment and prognosis of the digestive tumors.

Objective To probe into the application of argon laser photo-coagulation (APC) in interventional endoscopic treatment of digestive diseases. Method 62 patients suffering from digestive diseases were treated with interventional endoscopic treatment with the aid of APC, including 393 cases of gastrointestinal polyps, 122 cases of gastritis verrucosa, 5 cases of Barrett's esophageal ulcer and 42 cases of hemorrhage of digestive tract. The effectiveness of the treatment was observed. Result For 350 cases of gastrointestinal polyp, in which the diameter of the polyp was less than 5 mm, the lesions were eliminated when checked by endoscopy 3 months after APC treatment, the curative ratio was 100%. For 43 cases of gastrointestinal polyps, in which the diameter of the polyp was larger than 5 mm, no residual lesions were found in 38 cases, and remarkable improvement was found in another 5 cases of Peutz-Jeghers syndrome. For 122 case of gastritis verrucosa, 116 cases recovered thoroughly, the curative ratio reached 95.1%. In 42 cases of hemorrhage of digestive tract, no hemorrhage was found in 41 cases after APC treatment. In 5 cases of Barrett′s esophageal ulcer treated with APC accompanied by PPIs, squamous cell epithelium was found to have recovered as shown by endoscopy and biopsy 3 months after the treatment, and no recurrence 12 months later. Conclusion APC can be widely used in digestive diseases including gastrointestinal polyps, hemorrhage of digestive tract, Barrett's syndrome, gastritis verrucosa, etc. APC has a special value for the treatment of gastrointestinal polyp when the diameter of the polyp was less than 5 mm, and also gastritis verrucosa.