Background:Acute pancreatitis(AP)is a common disease of the digestive system,among which severe acute pancreatitis(SAP)has a high mortality rate.Finding more accurate and convenient methods for early recognition of SAP is one of the major challenges in clinical treatment.Aims:To explore the application value of the controlled attenuation parameter(CAP)of ultrasound elastography in predicting SAP.Methods:A retrospective cohort study was conducted involving 135 AP patients admitted to Jiading Branch of Shanghai General Hospital from February to October 2024.Patients were categorized into non-SAP and SAP groups according to the severity of the disease.Clinical data,local complications,laboratory indicators,and CAP were compared between the two groups.Univariate and multivariate Logistic regression analyses were used to identify independent risk factors for SAP.A SAP prediction model based on CAP was constructed according to the identified risk factors and the minimum Akaike information criterion(AIC).ROC curve and Bootstrap method were used to evaluate the efficacy of the prediction model and conduct internal validation,respectively.Results:There were statistically significant differences between the non-SAP group and SAP group in body mass index(BMI),incidence of hyperlipidemia,etiological composition,incidence of pleural and ascitic fluid,length of hospital stay,incidence of peripancreatic effusion,incidence of pancreatic necrosis,white blood cell count(WBC),D-dimer(D-D)level,blood glucose,triglyceride(TG),C-reactive protein(CRP),neutrophil count,procalcitonin(PCT),interleukin-6(IL-6),free triiodothyronine(FT3),and CAP(all P<0.05).Multivariate Logistic regression analysis showed that pancreatic necrosis(OR=13.39,95%CI:3.10-57.94,P<0.001)and CAP(OR=1.01,95%CI:1.01-1.02,P=0.038)were independent risk factors for SAP.The SAP prediction model based on CAP was formulated as:Logit(P)=-5.884+0.010×CAP+2.839×pancreatic necrosis+0.169×D-D+0.132×blood glucose+0.006×CRP.The model showed an area under the curve(AUC)of 0.834 for predicting SAP,which was superior to CAP alone(P<0.05).Internal validation indicated that the prediction model had high stability and accuracy(C-index=0.808).Conclusions:The prediction model constructed based on CAP has good clinical value for predicting SAP,providing a new perspective and tool for early identification and prognostic assessment of AP.

Background:Duodenal papillary adenoma is a benign tumor with relatively low incidence but significant carcinogenesis potential.Despite the minimal invasiveness and low complication rate,endoscopic papillectomy is associated with a definite risk of recurrence for duodenal papillary adenoma.Investigating the driver genes of duodenal papillary adenoma and establishing predictive models for recurrence and malignant progression could facilitate the precision medicine.Aims:To identify the key driver genes for tumor occurrence,carcinogenesis and recurrence in duodenal papillary adenoma by integrating multi-dimensional bioinformatics approaches based on transcriptomics data,and validate clinically.Methods:Expression profiles of duodenal papillary adenoma and adenocarcinoma were obtained from the GEO database(including data sets GSE189035,GSE94919,GSE111156,and GSE102208).Differentially expressed genes(DEGs)between adenomatous and normal tissues were screened.Weighted gene co-expression network analysis(WGCNA)and pseudo-time analysis were combined to identify the core genes exhibiting an"initial rise followed by decline"expression pattern during the dynamic progression from normal tissue to adenoma and adenocarcinoma.Functional annotation,immune microenvironment profiling,and protein-protein interaction network analysis were performed to explore the tumor-promoting mechanisms of these core genes.Clinical validation was conducted using immunohistochemistry to estimate the gene expression level and its relationship with tumor recurrence.Results:A total of 469 common DEGs were identified.WGCNA revealed that the blue module(including 1 051 genes)was associated with adenoma development and progression(Cor=-0.29,0.15,and 0.11 for normal tissue,adenoma,and adenocarcinoma,respectively).Intersection with DEGs pinpointed four key genes:SLC12A2,BEST4,SLC37A2,and SOAT2.Pseudo-time analysis demonstrated that only SLC12A2 maintained sustained high expression in both adenoma and adenocarcinoma tissues.KEGG enrichment analysis indicated that SLC12A2 was linked to various malignant pathways(e.g.,PD-1/PD-L1 signaling pathway),and its high expression correlated with the reduced immune cell infiltration(e.g.,γδ T cells,CD8+T cells,etc.).Clinical validation by immunohistochemistry confirmed the trend of initial upregulation and subsequent downregulation of SLC12A2 expression in normal,adenoma,and adenocarcinoma tissues.Patients with tumor recurrence showed higher SLC12A2 expression level(P=0.004);likewise,SLC12A2 high expression was associated with an elevated recurrence risk(P=0.034).Conclusions:SLC12A2 serves as a critical driver of tumorigenesis and progression for duodenal papillary adenoma,and might be a promising biomarker for recurrence prediction.

Background:Obesity has been confirmed as one of the risk factors for gastric cancer.Obesity can affect hormone levels,but studies on the impact of obesity-related hormones on gastric cancer are limited in China.Aims:To investigate the effects of obesity-related hormones on cardia gastric cancer(CGC)and non-cardia gastric cancer(NCGC).Methods:This case-control study included 316 patients diagnosed with gastric cancer at the Central Hospital of Enshi Tujia and Miao Autonomous Prefecture from July 2021 to June 2024,while 632 individuals who underwent physical examination during the same period were enrolled as the control group.According to the location of cancer,gastric cancer patients were divided into CGC and NCGC groups.General data and obesity-related hormone levels were compared among the three groups.Multivariate Logistic regression analysis was used to identify the risk factors for CGC and NCGC stratified by gender.Results:Compared with the control group,the levels of C-peptide and insulin-like growth factor-1(IGF-1)in both CGC and NCGC groups were significantly increased(all P<0.05),while the dehydroepiandrosterone(DHEA)level was significantly decreased(all P<0.05).The levels of leptin and sex hormone binding globulin(SHBG)in CGC group were significantly higher than those in the control group(all P<0.05).Compared with NCGC group,CGC group showed significantly higher levels of C-peptide,IGF-1,leptin and SHBG(all P<0.05),and significantly lower level of DHEA(P<0.05).Risk factors for male CGC included obesity,history of digestive system diseases,family history of gastric cancer,irregular meals,consumption of pickled food≥3 times/week,consumption of hot food≥3 times/week,smoking,Helicobacter pylori(Hp)infection,IGF-1≥250 ng/mL,leptin≥7 μg/L,DHEA<15 nmol/L,and SHBG≥80 mmol/L(all P<0.05),while education duration≥9 years was a protective factor(P<0.05).For female CGC,risk factors were history of digestive system diseases,family history of gastric cancer,irregular meals,consumption of pickled food≥3 times/week,smoking,Hp infection,C-peptide≥400 pmol/L,and IGF-1≥250 ng/mL(all P<0.05),while consumption of vegetables≥1 time/day and fruits≥3 times/week were protective factors(all P<0.05).For male NCGC,risk factors included history of mental illness,family history of gastric cancer,meat consumption≥3 times/week,smoking,alcohol drinking,Hp infection,and IGF-1≥250 ng/mL(all P<0.05),while education duration≥9 years and preference for light taste were protective factors(all P<0.05).For female NCGC,risk factors included family history of gastric cancer,irregular meals,consumption of fried food≥3 times/week,Hp infection,and C-peptide≥400 pmol/L(all P<0.05),while vegetables consumption≥1 time/day,fruits consumption≥3 times/week,and tea drinking were protective factors(all P<0.05).Conclusions:Some obesity-related hormones might have significant effects on the development of gastric cancer.

Small bowel Crohn's disease(CD)is a multi-ulcerative lesion that tends to occur in the small intestine,which leads to intestinal obstruction,stricture,and bleeding easily.With the clinical application of capsule endoscopy and balloon-assisted enteroscopy,the detection rate of small bowel CD has increased significantly.However,the treatment of small bowel CD is still a difficult issue which troubles clinical practice.It is of great significance to standardize the diagnosis and treatment process,optimize the diagnosis and treatment strategy,and further improve the diagnosis and treatment efficiency.Therefore,it is necessary to formulate an expert consensus on the endoscopic diagnosis and treatment of small bowel CD.Based on the evidence-based medicine and expert experience,the consensus focus on the clinical issues including the epidemiology,endoscopic and imaging diagnosis,enteroscopy treatment,drug treatment and follow-up of small bowel CD,and formulated relevant recommendations,so as to standardize the diagnosis and treatment process of small bowel CD and improve the prognosis of patients.

Background:With the widespread use of vonoprazan-based dual therapy for Helicobacter pylori(Hp)eradication,a comparative analysis of its efficacy and safety against bismuth-containing quadruple therapy is warranted.Aims:To compare the efficacy and safety of vonoprazan and amoxicillin-based 14-day dual therapy and 10-day bismuth-containing quadruple therapy for eradication of Hp infection.Methods:This study is a single-center,prospective,randomized,controlled,open-label,non-inferiority trial.Patients with chronic gastritis,diagnosed with Hp infection and scheduled for eradication therapy at Yuancheng District People's Hospital between December 2023 and December 2025 are planned to enroll in this study and randomly assigned into two groups.Patients in the control group received bismuth-containing quadruple therapy(vonoprazan 20 mg+bismuth potassium citrate 220 mg+amoxicillin 1.0 g+furazolidone 0.1 g,all twice daily)for 10 days,and those in the treatment group received dual therapy(vonoprazan 20 mg twice daily+amoxicillin 1.0 g three times daily)for 14 days.Both groups were supplemented with compound lactobacillus capsule.Adverse events were recorded during the treatment period.Hp eradication was assessed by 13C-or 14C-urea breath test at least four weeks after the completion of therapy.Results:As of the interim analysis,a total of 160 patients have been enrolled in the study,with 80 in each group.The per-protocol(PP)Hp eradication rates were 93.6%(95%CI:85.6%-97.9%)for the treatment group and 94.7%(95%CI:86.8%-98.5%)for the control group,with an intergroup difference of-1.147%(95%CI:-8.5%-6.1%).While in intention-to-treat(ITT)analysis,the Hp eradication rates were 91.2%(95%CI:82.9%-96.4%)for the treatment group and 90.0%(95%CI:81.2%-95.6%)for the control group,with an intergroup difference of 1.25%(95%CI:-7.8%-10.4%).Non-inferiority was confirmed for both PP and ITT analyses(P=0.012,P=0.021).No significant difference in symptoms relieve was observed between the two groups(92.1%vs.91.0%,P=0.81).The incidence of adverse events was significantly lower in the treatment group(7.7%vs.18.4%,P=0.043).The symptoms were mild and required no intervention.Conclusions:The 14-day vonoprazan-amoxicillin dual therapy is non-inferior to 10-day bismuth-containing quadruple therapy in Hp eradication rate with fewer adverse events,making it a preferred option for family-based management and primary care settings for Hp eradication.

Background:Along with the rising incidence of gastric and colorectal cancers,the incidence of multiple primary cancers is gradually increasing.Currently,there is no consensus on the diagnosis,treatment,and prognosis of synchronous dual primary gastric and colorectal cancers(SDPGCC),and the clinicopathological characteristics lack systematical analysis.Aims:To explore the clinicopathological characteristics of SDPGCC.Methods:The clinical data of SDPGCC patients admitted to the Affiliated Hospital of Jiangnan University from January 2021 to May 2024 were retrospectively analyzed.The diagnosis,treatment,clinicopathological characteristics,and prognosis were summarized.Results:A total of 14 patients with SDPGCC were enrolled,comprising 11 males and 3 females,with a mean age of(69.6±9.9)years.The locations of gastric cancer and colorectal cancer varied.Gastric cancer was primarily early-to-moderate stage adenocarcinoma,while colorectal cancer was mainly advanced adenocarcinoma.The results of immunohistochemistry and molecular pathology showed individual heterogeneity.The median follow-up of the 14 patients was 16.5 months,and the postoperative 1-year overall survival rate was 72.7%.Conclusions:Clinical attention should be paid to the early diagnosis of SDPGCC.There are individual differences among SDPGCC patients,and the high-risk factors need to be further investigated by more clinical studies.

Esophageal squamous cell carcinoma(ESCC)has a poor prognosis,and its invasion and metastasis are the main cause of decreased patients'quality of life and survival rate.The invasion and metastasis of ESCC involve multiple mechanisms,including extracellular matrix degradation,epithelial-mesenchymal transition(EMT),and tumor angiogenesis,accompanied by molecular abnormalities at multiple levels,such as non-coding RNAs,EMT-related proteins,matrix metalloproteinases,vascular endothelial growth factor,exosomes,and circulating tumor cells.Predicting the risk of ESCC invasion and metastasis and implementing active interventions are crucial for effective treatment of ESCC and improvement of patients'quality of life and survival rate.This article reviewed the research progress on molecular markers related to invasion and metastasis of ESCC,aiming to provide insights for the early diagnosis and treatment of ESCC.

Background:Acute pancreatitis(AP)is a common clinical gastrointestinal emergency with a high mortality rate.Intestinal dysfunction is one of the common complications of AP and can aggravate the disease condition.Therefore,early and accurate assessment of the disease severity and intestinal dysfunction of AP is of great significance for improving the prognosis of patients.Aims:To investigate the correlation of early serum levels of interleukin-1β(IL-1β),C-reactive protein(CRP),endotoxin(ET),D-lactic acid(D-LA),and diamine oxidase(DAO)with disease severity and intestinal dysfunction in AP patients.Methods:A total of 52 AP patients admitted to the Second Affiliated Hospital of Baotou Medical College from September 2023 to September 2024 were enrolled,and 10 healthy individuals recruited during the same period were served as the control group.AP patients were classified into mild acute pancreatitis(MAP),moderately severe acute pancreatitis(MSAP)and severe acute pancreatitis(SAP)groups according to the severity of the disease.Intestinal function was evaluated using the acute gastrointestinal injury(AGI)grading system.ELISA was used to detect the early serum levels of IL-1β,CRP,ET,D-LA,and DAO,and the correlation of these indicators with the severity of AP and AGI grade were analyzed by Spearman correlation coefficient.Results:Serum levels of IL-1β,CRP,ET,D-LA,and DAO in the MAP,MSAP,and SAP groups were significantly higher than those in the control group(all P<0.05);serum levels of IL-1β,CRP,ET,D-LA,and DAO in the MSAP group were significantly higher than those in the MAP group(all P<0.05);serum levels of IL-1β,CRP,ET,D-LA,and DAO in the SAP group were significantly higher than those in the MAP and MSAP groups(all P<0.05).Compared with AGI grade 0-Ⅰ subjects,serum levels of IL-1β,CRP,ET,D-LA,and DAO in patients with AGI grade Ⅱ,Ⅲ and Ⅳ were significantly increased(all P<0.05).Compared with AGI grade Ⅱ patients,serum D-LA level in patients with AGI grade Ⅲ was significantly increased(P<0.05).Compared with AGI grade Ⅲ patients,serum D-LA level in patients with AGI grade Ⅳ was significantly increased(P<0.05).Serum levels of IL-1β,CRP,ET,D-LA,and DAO were positively correlated with the severity of AP and AGI grade(all P<0.05).Conclusions:Early serum levels of IL-1β,CRP,ET,D-LA,and DAO in AP patients are significantly increased and closely related to the disease severity and intestinal dysfunction.

Background:Ribosomal protein L22-like 1(RPL22L1)exerts regulatory effects on various malignant tumors such as lung cancer,prostate cancer,and cervical cancer.However,its role in colorectal cancer(CRC)remains unclear.Aims:To investigate the expression of RPL22L1 in CRC and its role in patients' prognosis and glucose metabolism of tumor cells.Methods:A total of 142 newly diagnosed CRC patients admitted to the Taizhou First People's Hospital from February 2022 to June 2024 were enrolled.The expression levels of RPL22L1 mRNA and protein were detected by quantitative real-time PCR and immunohistochemistry,respectively.The correlation between RPL22L1 expression and clinicopathological characteristics was analyzed.Kaplan-Meier survival analysis was used to evaluate the impact of RPL22L1 expression on the prognosis of CRC patients.RPL22L1 siRNA was transfected into SW480 cells to establish a low-expression cell model.Cell proliferation was assessed by CCK-8 assay,cell migration by Transwell chamber assay,and apoptosis by flow cytometry.Gene set enrichment analysis(GSEA)was performed to evaluate the effect of RPL22L1 on glucose metabolism of tumor cells.Results:The expression levels of RPL22L1 mRNA and protein were significantly higher in CRC tissues than in adjacent normal tissues(all P<0.05).The expression level of RPL22L1 mRNA was correlated with the TNM stage and carcinoembryonic antigen level of CRC(all P<0.05).Kaplan-Meier analysis showed that the cumulative survival rate of high RPL22L1 mRNA expression group was significantly lower than that of low-expression group(P=0.027).The expression level of RPL22L1 mRNA was significantly higher in SW480 cells than in normal intestinal epithelial cells(P<0.001).After inhibiting RPL22L1 expression,the proliferation and migration capacities of SW480 cells were significantly decreased(all P<0.05),the apoptosis rate was significantly increased(P=0.005),and the lactate level and relative glucose uptake level were significantly reduced(all P<0.05).GSEA indicated that RPL22L1 gene was associated with glycolysis/gluconeo-genesis(P=0.02).Conclusions:RPL22L1 is highly expressed in CRC and is associated with poor prognosis of patients,suggesting its potential as a molecular target for CRC therapy.Furthermore,RPL22L1 may promote the tumorigenesis and progression of CRC by modulating glucose metabolism.

Background:Acute pancreatitis(AP)is a common clinical gastrointestinal emergency with a high mortality rate.Intestinal dysfunction is one of the common complications of AP and can aggravate the disease condition.Therefore,early and accurate assessment of the disease severity and intestinal dysfunction of AP is of great significance for improving the prognosis of patients.Aims:To investigate the correlation of early serum levels of interleukin-1β(IL-1β),C-reactive protein(CRP),endotoxin(ET),D-lactic acid(D-LA),and diamine oxidase(DAO)with disease severity and intestinal dysfunction in AP patients.Methods:A total of 52 AP patients admitted to the Second Affiliated Hospital of Baotou Medical College from September 2023 to September 2024 were enrolled,and 10 healthy individuals recruited during the same period were served as the control group.AP patients were classified into mild acute pancreatitis(MAP),moderately severe acute pancreatitis(MSAP)and severe acute pancreatitis(SAP)groups according to the severity of the disease.Intestinal function was evaluated using the acute gastrointestinal injury(AGI)grading system.ELISA was used to detect the early serum levels of IL-1β,CRP,ET,D-LA,and DAO,and the correlation of these indicators with the severity of AP and AGI grade were analyzed by Spearman correlation coefficient.Results:Serum levels of IL-1β,CRP,ET,D-LA,and DAO in the MAP,MSAP,and SAP groups were significantly higher than those in the control group(all P<0.05);serum levels of IL-1β,CRP,ET,D-LA,and DAO in the MSAP group were significantly higher than those in the MAP group(all P<0.05);serum levels of IL-1β,CRP,ET,D-LA,and DAO in the SAP group were significantly higher than those in the MAP and MSAP groups(all P<0.05).Compared with AGI grade 0-Ⅰ subjects,serum levels of IL-1β,CRP,ET,D-LA,and DAO in patients with AGI grade Ⅱ,Ⅲ and Ⅳ were significantly increased(all P<0.05).Compared with AGI grade Ⅱ patients,serum D-LA level in patients with AGI grade Ⅲ was significantly increased(P<0.05).Compared with AGI grade Ⅲ patients,serum D-LA level in patients with AGI grade Ⅳ was significantly increased(P<0.05).Serum levels of IL-1β,CRP,ET,D-LA,and DAO were positively correlated with the severity of AP and AGI grade(all P<0.05).Conclusions:Early serum levels of IL-1β,CRP,ET,D-LA,and DAO in AP patients are significantly increased and closely related to the disease severity and intestinal dysfunction.