Objective To investigate the risk factor for adverse events(AEs)after non-sedated esophagogastroduodenoscopy(EGD).Methods The data on clinical manifestations,adverse events after non-sedated EGD and common risk factors were collected and retrospectively analyzed with statistical methods in patients who underwent non-sedated EGD from May 2018 to June 2019.These patients were divided into AEs group and non-AEs group.Results Of 2 384 patients,57.67%(1 375/2 384)presented with nausea,12.79%(305/2 384)vomiting,and 5.79%(138/2 384)presented with pharyngalgia.Multivariate Logistic regression analysis was performed.Advanced age(≥65 years old)(OR=0.683,95%CI:0.506-0.921)was protective factors for nausea after non-sedated EGD.Hypertension(OR=1.361,95%CI:1.026-1.806),overweight(OR=1.399,95%CI:1.154-1.695),obesity(OR=2.594,95%CI:1.760-3.823)and inspection duration>15 min(OR=3.107,95%CI:2.296-4.206)were independent risk factors for nausea after non-sedated EGD.Advanced age(OR=0.393,95%CI:0.221-0.699)and imported equipment(OR=0.697,95%CI:0.546-0.890)were protective factors for vomiting after non-sedated EGD.Moreover,inspection duration>15 min(OR=1.641,95%CI:1.008-2.699)was independent risk factors for vomiting after non-sedated EGD.There was no difference in success rate of non-sedated EGD between two groups(P<0.05).Conclusion Hypertension,overweight and obesity were independent risk factors for nausea after non-sedated EGD.The advanced age and imported equipment were protective factors for vomiting after non-sedated EGD.In addition,inspection duration over 15 min is a risk factor for AEs such as nausea and vomiting after nonsedative EGD.Whether AEs occurred or not is non-related to success rate of non-sedated EGD.

Gastric cancer is a common clinical tumor,and its incidence and mortality rates rank among the top of malignant tumors.Helicobacter pylori(Hp)is an important carcinogenic factor for gastric cancer.Studies have found that in addition to Hp,other microorganisms in the stomach also play a key role in the progression of gastric cancer.The composition and diversity of the gastric microbiota vary significantly under different gastric disease conditions,which may affect the progression of gastric cancer.Hp can induce gastric epithelial inflammation and oxidative stress through various virulence factors,thereby promoting the occurrence of gastric cancer.Non-Hp microorganisms can be involved in the process of gastric cancer through pathways such as metabolic changes and immune regulation.In recent years,with the development of high-throughput sequencing technology,the complexity of gastric microbiota has gradually been revealed,which provides new insights for the early warning and intervention of gastric cancer.This article comprehensively review the role of gastric microbiota in the progression of gastric cancer.

ObjectiveTo explore the effects of different dosage forms of Kaixinsan （KXS） on the morphology and function of mitochondria in rat models of Alzheimer's disease （AD） and potential mechanisms of action. MethodsMale SD rats were randomly assigned to a sham group， model group， treatment groups receiving KXS decoction， powders， and granules （3.08 g·kg^-1）， as well as donepezil group （0.51×10^-3 g·kg^-1）， with 10 rats in each group. AD model was created using intracerebroventricular injection of streptozocin （STZ）. After 30 days of administration， behavioral assessments were conducted， and mitochondrial morphology was observed using transmission electron microscopy. Mitochondrial respiratory chain complex content was measured via enzyme-linked immunosorbent assay （ELISA）. Changes in mitochondrial membrane potential were measured via JC-1 staining， and superoxide dismutase （SOD） activity and reactive oxygen species （ROS） levels were measured via biochemical assays. The mRNA expression of adenosine 5'-monophosphate-activated protein kinase （AMPK）， peroxisome proliferator-activated receptor gamma coactivator-1α （PGC-1α）， and silent information regulator 3 （SIRT3） was detected by real-time fluorescent quantitative polymerase chain reaction （Real-time PCR）， and Western blot was used to examine the protein expression levels of optic atrophy protein1 （OPA1）， mitochondrial fission protein 1 （FIS1）， AMPK， p-AMPK， PGC-1α， and SIRT3. ResultsCompared with the sham group， rats in the model group had significantly lower recognition index， spontaneous alternation rate， escape latency， number of platform crossings， time spent in the target quadrant， and percentage of distance traveled in the target quadrant distance （P<0.05， P<0.01）. Significant mitochondrial damage was observed in the hippocampal tissue， with a marked decrease in mitochondrial respiratory chain complex content （P<0.01） and reduced mitochondrial membrane potential （P<0.05）. Additionally， the SOD activity was reduced， while ROS levels were elevated （P<0.01）. The mRNA expression of PGC-1α and SIRT3 was significantly downregulated （P<0.01）， along with decreased protein expression levels of OPA1， p-AMPK/AMPK， PGC-1α， and SIRT3， whereas FIS1 protein expression was significantly upregulated （P<0.05， P<0.01）. Compared with the model group， rats in KXS-treated groups （various dosage forms） showed significant improvement in behavioral indexes （P<0.05， P<0.01）， reduced hippocampal mitochondrial damage， and more organized mitochondrial cristae. Mitochondrial respiratory chain complex content was significantly increased （P<0.05， P<0.01）， and mitochondrial membrane potentials were elevated （P<0.05）. SOD activity was elevated， and ROS levels were significantly reduced （P<0.05， P<0.01）. Furthermore， the mRNA expression of PGC-1α and SIRT3 was upregulated， with increased protein levels of OPA1， p-AMPK/AMPK， PGC-1α， and SIRT3， while FIS1 protein expression levels were significantly reduced （P<0.05， P<0.01）. Across the KXS-treated groups， the granule group showed a higher spontaneous alternation rate than the decoction and powder groups （P<0.05）. ConclusionKXS decoction， powders， and granules can improve the learning and memory ability of rats， with granules being the most effective. The mechanism of action may involve activation of the AMPK/PGC-1α/SIRT3 signaling pathway， improvement of the mitochondrial function， and subsequent amelioration of the brain energy metabolism disorders.

ObjectiveTo explore the effects of different dosage forms of Kaixinsan （KXS） on the morphology and function of mitochondria in rat models of Alzheimer's disease （AD） and potential mechanisms of action. MethodsMale SD rats were randomly assigned to a sham group， model group， treatment groups receiving KXS decoction， powders， and granules （3.08 g·kg^-1）， as well as donepezil group （0.51×10^-3 g·kg^-1）， with 10 rats in each group. AD model was created using intracerebroventricular injection of streptozocin （STZ）. After 30 days of administration， behavioral assessments were conducted， and mitochondrial morphology was observed using transmission electron microscopy. Mitochondrial respiratory chain complex content was measured via enzyme-linked immunosorbent assay （ELISA）. Changes in mitochondrial membrane potential were measured via JC-1 staining， and superoxide dismutase （SOD） activity and reactive oxygen species （ROS） levels were measured via biochemical assays. The mRNA expression of adenosine 5'-monophosphate-activated protein kinase （AMPK）， peroxisome proliferator-activated receptor gamma coactivator-1α （PGC-1α）， and silent information regulator 3 （SIRT3） was detected by real-time fluorescent quantitative polymerase chain reaction （Real-time PCR）， and Western blot was used to examine the protein expression levels of optic atrophy protein1 （OPA1）， mitochondrial fission protein 1 （FIS1）， AMPK， p-AMPK， PGC-1α， and SIRT3. ResultsCompared with the sham group， rats in the model group had significantly lower recognition index， spontaneous alternation rate， escape latency， number of platform crossings， time spent in the target quadrant， and percentage of distance traveled in the target quadrant distance （P<0.05， P<0.01）. Significant mitochondrial damage was observed in the hippocampal tissue， with a marked decrease in mitochondrial respiratory chain complex content （P<0.01） and reduced mitochondrial membrane potential （P<0.05）. Additionally， the SOD activity was reduced， while ROS levels were elevated （P<0.01）. The mRNA expression of PGC-1α and SIRT3 was significantly downregulated （P<0.01）， along with decreased protein expression levels of OPA1， p-AMPK/AMPK， PGC-1α， and SIRT3， whereas FIS1 protein expression was significantly upregulated （P<0.05， P<0.01）. Compared with the model group， rats in KXS-treated groups （various dosage forms） showed significant improvement in behavioral indexes （P<0.05， P<0.01）， reduced hippocampal mitochondrial damage， and more organized mitochondrial cristae. Mitochondrial respiratory chain complex content was significantly increased （P<0.05， P<0.01）， and mitochondrial membrane potentials were elevated （P<0.05）. SOD activity was elevated， and ROS levels were significantly reduced （P<0.05， P<0.01）. Furthermore， the mRNA expression of PGC-1α and SIRT3 was upregulated， with increased protein levels of OPA1， p-AMPK/AMPK， PGC-1α， and SIRT3， while FIS1 protein expression levels were significantly reduced （P<0.05， P<0.01）. Across the KXS-treated groups， the granule group showed a higher spontaneous alternation rate than the decoction and powder groups （P<0.05）. ConclusionKXS decoction， powders， and granules can improve the learning and memory ability of rats， with granules being the most effective. The mechanism of action may involve activation of the AMPK/PGC-1α/SIRT3 signaling pathway， improvement of the mitochondrial function， and subsequent amelioration of the brain energy metabolism disorders.

Purpose To compare the clinical and cardiovascular magnetic resonance(CMR)characteristics of hypertrophic cardiomyopathy(HCM)with and without diabetes mellitus,and to investigate the effect of diabetes mellitus on left ventricular remodeling in HCM patients.Materials and Methods A total of 96 HCM patients diagnosed with CMR in Chengdu Fifth People's Hospital from January 2021 to March 2023,retrospectively.They were divided into HCM with diabetes mellitus group(n=22)and HCM without diabetes mellitus group(n=74)according to whether they had diabetes mellitus.The clinical baseline and CMR data of HCM patients were analyzed,and left ventricular function and strain were compared between the two groups.Results The HCM group with diabetes mellitus was observed to have a significantly higher left ventricular mass index compared to HCM without diabetes mellitus group[(1.33±0.50)g/ml vs.(1.10±0.23)g/ml;t=3.002,P=0.003],along with a significantly lower left ventricular global circumferential strain[-19.69(-21.82,-17.06)%vs.-16.33(-20.84,-13.86)%;Z=543.000,P<0.05]and global longitudinal strain[(-8.69±3.94)%vs.(-10.74±3.62)%;t=2.227,P<0.05)].Furthermore,diabetes mellitus was identified as an independent factor associated with an increased left ventricular mass index(β=0.330,P<0.05)by multivariate linear regression analysis.Conclusion In patients with HCM,diabetes mellitus is independently associated with left ventricular remodeling.The global circumferential strain and longitudinal strain of HCM patients with diabetes mellitus decreases significantly,suggesting that diabetes mellitus has a significant impact on left ventricular strain in HCM patients.

Purpose To compare the clinical and cardiovascular magnetic resonance(CMR)characteristics of hypertrophic cardiomyopathy(HCM)with and without diabetes mellitus,and to investigate the effect of diabetes mellitus on left ventricular remodeling in HCM patients.Materials and Methods A total of 96 HCM patients diagnosed with CMR in Chengdu Fifth People's Hospital from January 2021 to March 2023,retrospectively.They were divided into HCM with diabetes mellitus group(n=22)and HCM without diabetes mellitus group(n=74)according to whether they had diabetes mellitus.The clinical baseline and CMR data of HCM patients were analyzed,and left ventricular function and strain were compared between the two groups.Results The HCM group with diabetes mellitus was observed to have a significantly higher left ventricular mass index compared to HCM without diabetes mellitus group[(1.33±0.50)g/ml vs.(1.10±0.23)g/ml;t=3.002,P=0.003],along with a significantly lower left ventricular global circumferential strain[-19.69(-21.82,-17.06)%vs.-16.33(-20.84,-13.86)%;Z=543.000,P<0.05]and global longitudinal strain[(-8.69±3.94)%vs.(-10.74±3.62)%;t=2.227,P<0.05)].Furthermore,diabetes mellitus was identified as an independent factor associated with an increased left ventricular mass index(β=0.330,P<0.05)by multivariate linear regression analysis.Conclusion In patients with HCM,diabetes mellitus is independently associated with left ventricular remodeling.The global circumferential strain and longitudinal strain of HCM patients with diabetes mellitus decreases significantly,suggesting that diabetes mellitus has a significant impact on left ventricular strain in HCM patients.

Objective To investigate the risk factor for adverse events(AEs)after non-sedated esophagogastroduodenoscopy(EGD).Methods The data on clinical manifestations,adverse events after non-sedated EGD and common risk factors were collected and retrospectively analyzed with statistical methods in patients who underwent non-sedated EGD from May 2018 to June 2019.These patients were divided into AEs group and non-AEs group.Results Of 2 384 patients,57.67%(1 375/2 384)presented with nausea,12.79%(305/2 384)vomiting,and 5.79%(138/2 384)presented with pharyngalgia.Multivariate Logistic regression analysis was performed.Advanced age(≥65 years old)(OR=0.683,95%CI:0.506-0.921)was protective factors for nausea after non-sedated EGD.Hypertension(OR=1.361,95%CI:1.026-1.806),overweight(OR=1.399,95%CI:1.154-1.695),obesity(OR=2.594,95%CI:1.760-3.823)and inspection duration>15 min(OR=3.107,95%CI:2.296-4.206)were independent risk factors for nausea after non-sedated EGD.Advanced age(OR=0.393,95%CI:0.221-0.699)and imported equipment(OR=0.697,95%CI:0.546-0.890)were protective factors for vomiting after non-sedated EGD.Moreover,inspection duration>15 min(OR=1.641,95%CI:1.008-2.699)was independent risk factors for vomiting after non-sedated EGD.There was no difference in success rate of non-sedated EGD between two groups(P<0.05).Conclusion Hypertension,overweight and obesity were independent risk factors for nausea after non-sedated EGD.The advanced age and imported equipment were protective factors for vomiting after non-sedated EGD.In addition,inspection duration over 15 min is a risk factor for AEs such as nausea and vomiting after nonsedative EGD.Whether AEs occurred or not is non-related to success rate of non-sedated EGD.

Gastric cancer is a common clinical tumor,and its incidence and mortality rates rank among the top of malignant tumors.Helicobacter pylori(Hp)is an important carcinogenic factor for gastric cancer.Studies have found that in addition to Hp,other microorganisms in the stomach also play a key role in the progression of gastric cancer.The composition and diversity of the gastric microbiota vary significantly under different gastric disease conditions,which may affect the progression of gastric cancer.Hp can induce gastric epithelial inflammation and oxidative stress through various virulence factors,thereby promoting the occurrence of gastric cancer.Non-Hp microorganisms can be involved in the process of gastric cancer through pathways such as metabolic changes and immune regulation.In recent years,with the development of high-throughput sequencing technology,the complexity of gastric microbiota has gradually been revealed,which provides new insights for the early warning and intervention of gastric cancer.This article comprehensively review the role of gastric microbiota in the progression of gastric cancer.

Objective:To investigate the application of 18F-FDG PET/MR and its derived parameters in the diagnosis and staging of bladder cancer. Methods:Forty patients (32 males, 8 females; age (66.8±11.2) years) with suspected bladder cancer between December 2019 and March 2022 were retrospectively included and underwent 18F-FDG PET/MR in Nanjing First Hospital. Parameters including SUV max, SUV mean, maximum tumor diameter and mean of apparent diffusion coefficient (ADC mean) were obtained, and bladder cancer muscle invasiveness and lymph node involvement were determined. The efficacy of 18F-FDG PET/MR and its derived parameters for tumor diagnosis and staging was analyzed using transurethral resection of bladder tumor (TUR-BT) or radical cystectomy (RC) and extended pelvic lymph node dissection (ePLND) histopathology as the " gold standard". Independent-sample t test, Mann-Whitney U test or χ2 test was used to analyze the data, and Delong test was used to compare different AUCs. Results:Of 40 patients, 8 were non-muscle invasive bladder cancer (NMIBC), 32 were muscle invasive bladder cancer (MIBC), and 5 were pathologically confirmed to have lymph node metastasis. The sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and accuracy of 18F-FDG PET/MR for identifying MIBC were 96.9%(31/32), 7/8, 96.9%(31/32), 7/8, 95.0%(38/40), respectively, and those for lymph node metastasis were 4/5, 90.0%(18/20), 4/6, 18/19, 88.0%(22/25), respectively. For pathological tumor (pT) staging, significant differences were observed between pT2-3 and pT1 groups in maximum tumor diameter ( t=-2.37, P=0.024), SUV mean( Z=-2.11, P=0.035), and ADC mean( t=2.91, P=0.006). The AUCs of maximum tumor diameter, SUV mean and ADC mean in distinguishing MIBC were 0.781, 0.746, and 0.825, respectively. The sensitivity, specificity, PPV, NPV, and accuracy of MRI alone in identifying MIBC were 87.5%(28/32), 1/8, 80.0%(28/35), 1/5 and 72.5%(29/40), respectively, with the AUC of 0.500. The AUC of 18F-FDG PET/MR in identifying MIBC was 0.796, which was better than MRI alone ( Z=5.54, P<0.001), and the accuracy of PET/MR was also higher than MRI alone ( χ2=7.44, P=0.006). Conclusion:Compared with MRI alone, 18F-FDG PET/MR significantly improves the diagnostic efficacy of bladder cancer and the accuracy of pT staging.

Objective:To investigate the relationship between sarcopenic obesity(SO), defined by various obesity indicators, and mortality risk in older adults based on a prospective cohort from multiple nursing homes.Methods:Sarcopenia was diagnosed according to the 2019 consensus of the Asian Working Group for Sarcopenia.Obesity was defined using six different indicators: waist circumference(WC), waist-hip ratio(WHR), waist-height ratio(WHTR), body mass index(BMI), visceral fat area(VFA), and percentage of body fat(PBF).A prospective cohort of adults aged 60 and above was established across 15 nursing homes in Zigong City, with annual follow-ups on survival status conducted over two consecutive years.Cox proportional hazards regression models were employed to analyze the association between SO, defined by different obesity indicators, and mortality risk, calculating hazard ratios( HR)and their 95% confidence intervals( CI). Results:A total of 695 older adults were included in the study, of whom 67.1% were male.During the 2-year follow-up period, 88 participants died.The prevalence of SO as defined by WC, WHR, WHTR, BMI, VFA, PBF was found to be 17.6%, 30.1%, 48.9%, 3.0%, 28.3%, and 58.7%, respectively.When SO was defined using WC, WHR, WHTR, BMI, and VFA, there was no statistically significant difference in mortality rates between the SO and non-SO groups.However, when defined by PBF, the SO group exhibited a significantly higher mortality rate compared to the non-SO group(16.9% vs.6.6%, P<0.01).Cox proportional hazards regression analysis revealed that, compared to the non-SO group, the SO group defined by PBF had a significantly increased mortality risk( HR=2.81, 95% CI: 1.67-4.73, P<0.001).After adjusting for potential confounding factors, the mortality risk for the SO group remained significantly higher than that of the non-SO group( HR=1.97, 95% CI: 1.14-3.38, P=0.015). Conclusions:The prevalence of SO varies significantly across different obesity indicators.SO defined by PBF is significantly associated with mortality risk in nursing home residents.This study provides new evidence for further optimizing the diagnostic criteria for SO in this population.