Objective:To evaluate long-term outcomes of endoscopic papillectomy (EP) for duodenal papillary adenomas and to identify risk factors for incomplete resection.Methods:Clinical data of 180 patients diagnosed as having duodenal papillary adenoma via postoperative pathology after EP in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2010 to December 2022 were retrospectively analyzed. Patients were divided into two groups based on their postoperative margin status: the complete resection group (negative resection margins) and the incomplete resection group (positive/uncertain resection margins). Recurrence rates were compared between the two groups, and logistic regression analysis was performed to identify risk factors for incomplete resection.Results:Among the 180 patients included in the study, 137 underwent complete resection, and 43 had incomplete resections. Recurrence rate was significantly higher in the incomplete resection group than that in the complete resection group (30.2% VS 15.3%, χ2=4.75, P=0.029). logistic regression analysis indicated that high-grade intraepithelial neoplasia was an independent risk factor for incomplete resection ( OR=2.43, 95% CI:1.12-5.26, P=0.024). Conclusion:Patients with incomplete resection after EP have a higher recurrence rate in the long-term follow-up. High-grade intraepithelial neoplasia is an independent risk factor for incomplete resection. Close surveillance and aggressive management are warranted for patients with positive or uncertain resection margins to mitigate the recurrence risk.

Objective:To compare the clinical efficacy of direct versus double-balloon occlusion in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for benign and malignant gastric outlet obstruction (GOO).Methods:Clinical data of patients with GOO who underwent EUS-GE at Nanjing Drum Tower Hospital between April 2017 and July 2024 were analyzed in a retrospectively cohort study. The patients were divided into the direct technique group ( n=36) and the double-balloon occlusion technique group ( n=105). The technical success rate, clinical success rate, procedure time, postoperative stay, stent replacement rate, and incidence of adverse events were compared between the two groups. Results:The technical success rates of the two groups were comparable, 97.2% (35/36) and 94.3% (99/105) ( χ2=0.065, P=0.798), so were the clinical success rates, 94.4% (34/36) and 86.7% (91/105) ( χ2=0.932, P=0.334). However, the direct technique group demonstrated significantly shorter procedure time and postoperative stay compared to the double-balloon occlusion group [33.4 (23.2, 42.3) min VS 43.4 (31.7, 63.1) min, Z=-3.057, P=0.002; 4.0 (3.00, 5.75) days VS 6.0 (5.00, 9.00) days, Z=-4.031, P<0.001]. Adverse event rates [11.1% (4/36) VS 11.4% (12/105), χ2<0.001, P=1.000] and stent replacement rates [5.6% (2/36) VS 9.5% (10/105), χ2=0.152, P=0.696] showed no significant differences. Conclusion:Both EUS-GE techniques achieve comparable efficacy and safety for GOO. However, the direct technique showed significant advantages over the double-balloon occlusion technique in terms of shorter procedure time and reduced postoperative hospital stay.

Objective:To explore clinical validation standard for intelligent ventilation mode of ventilator and promote ventilator's clinical application.Methods:By real-time quantification of physiological parameters related to patient's ventilation and oxygenation,the change of respiratory function was analyzed,and the settings of ventilator's parameters were adjusted synchronously by using feedback signals to realize personalized support of ventilation.Combining with artificial intelligence(AI)technique,the clinical validation standard for intelligent ventilation mode was investigated from three aspects:requirements of clinical application and function of intelligent ventilation mode of ventilator,validation for platform of simulation experiment,and early clinical evaluation and interventional trials.Results:The clinical validation standards for intelligent ventilation mode of ventilator should meet the requirements of clinical application and function,and should complete preclinical evaluation of intelligent ventilation mode of ventilator,and assess safety and usability of that by the platform of simulation trials,and should conduct early clinical evaluations and interventional clinical trials so as to further assess safety and effectiveness of that before it was used formally in clinical application.Conclusion:The clinical validation standard of intelligent ventilation mode of ventilator can form standard validation process for intelligent ventilation mode,and promote the construction of standard validation platform,and facilitate clinical application and iterative optimization of intelligent ventilation mode,and improve medical quality.

Objective:To explore clinical validation standard for intelligent ventilation mode of ventilator and promote ventilator's clinical application.Methods:By real-time quantification of physiological parameters related to patient's ventilation and oxygenation,the change of respiratory function was analyzed,and the settings of ventilator's parameters were adjusted synchronously by using feedback signals to realize personalized support of ventilation.Combining with artificial intelligence(AI)technique,the clinical validation standard for intelligent ventilation mode was investigated from three aspects:requirements of clinical application and function of intelligent ventilation mode of ventilator,validation for platform of simulation experiment,and early clinical evaluation and interventional trials.Results:The clinical validation standards for intelligent ventilation mode of ventilator should meet the requirements of clinical application and function,and should complete preclinical evaluation of intelligent ventilation mode of ventilator,and assess safety and usability of that by the platform of simulation trials,and should conduct early clinical evaluations and interventional clinical trials so as to further assess safety and effectiveness of that before it was used formally in clinical application.Conclusion:The clinical validation standard of intelligent ventilation mode of ventilator can form standard validation process for intelligent ventilation mode,and promote the construction of standard validation platform,and facilitate clinical application and iterative optimization of intelligent ventilation mode,and improve medical quality.

Objective:To evaluate long-term outcomes of endoscopic papillectomy (EP) for duodenal papillary adenomas and to identify risk factors for incomplete resection.Methods:Clinical data of 180 patients diagnosed as having duodenal papillary adenoma via postoperative pathology after EP in Nanjing Drum Tower Hospital, the Affiliated Hospital of Nanjing University Medical School from January 2010 to December 2022 were retrospectively analyzed. Patients were divided into two groups based on their postoperative margin status: the complete resection group (negative resection margins) and the incomplete resection group (positive/uncertain resection margins). Recurrence rates were compared between the two groups, and logistic regression analysis was performed to identify risk factors for incomplete resection.Results:Among the 180 patients included in the study, 137 underwent complete resection, and 43 had incomplete resections. Recurrence rate was significantly higher in the incomplete resection group than that in the complete resection group (30.2% VS 15.3%, χ2=4.75, P=0.029). logistic regression analysis indicated that high-grade intraepithelial neoplasia was an independent risk factor for incomplete resection ( OR=2.43, 95% CI:1.12-5.26, P=0.024). Conclusion:Patients with incomplete resection after EP have a higher recurrence rate in the long-term follow-up. High-grade intraepithelial neoplasia is an independent risk factor for incomplete resection. Close surveillance and aggressive management are warranted for patients with positive or uncertain resection margins to mitigate the recurrence risk.

Objective:To compare the clinical efficacy of direct versus double-balloon occlusion in endoscopic ultrasound-guided gastroenterostomy (EUS-GE) for benign and malignant gastric outlet obstruction (GOO).Methods:Clinical data of patients with GOO who underwent EUS-GE at Nanjing Drum Tower Hospital between April 2017 and July 2024 were analyzed in a retrospectively cohort study. The patients were divided into the direct technique group ( n=36) and the double-balloon occlusion technique group ( n=105). The technical success rate, clinical success rate, procedure time, postoperative stay, stent replacement rate, and incidence of adverse events were compared between the two groups. Results:The technical success rates of the two groups were comparable, 97.2% (35/36) and 94.3% (99/105) ( χ2=0.065, P=0.798), so were the clinical success rates, 94.4% (34/36) and 86.7% (91/105) ( χ2=0.932, P=0.334). However, the direct technique group demonstrated significantly shorter procedure time and postoperative stay compared to the double-balloon occlusion group [33.4 (23.2, 42.3) min VS 43.4 (31.7, 63.1) min, Z=-3.057, P=0.002; 4.0 (3.00, 5.75) days VS 6.0 (5.00, 9.00) days, Z=-4.031, P<0.001]. Adverse event rates [11.1% (4/36) VS 11.4% (12/105), χ2<0.001, P=1.000] and stent replacement rates [5.6% (2/36) VS 9.5% (10/105), χ2=0.152, P=0.696] showed no significant differences. Conclusion:Both EUS-GE techniques achieve comparable efficacy and safety for GOO. However, the direct technique showed significant advantages over the double-balloon occlusion technique in terms of shorter procedure time and reduced postoperative hospital stay.

Objective:To investigate the mechanism of 6-sialyllactose (6-SL) in interfering the immune checkpoint inhibitor-induced colitis (ICIC) through the bacterial 16S rDNA sequencing.Methods:BALB/c mice were randomly divided into the normal control (NC) group ( n = 7), dextran sulfate sodium (DSS) group ( n = 6), ICIC group ( n = 6), and ICIC+6-SL group ( n = 6). The DSS group was continuously fed with 3.5% DSS drinking water for 7 days to induce colonic inflammation; the ICIC group was administered cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4, 150 μg) intraperitoneally on days 0 and 4 in addition to 3.5% DSS drinking water to establish the ICIC mouse model; the ICIC+6-SL group was given 6-SL [150 mg/ (kg·d) ] by gavage simultaneously with the establishment of the ICIC model. Changes in mouse body weight and disease activity index (DAI) were statistically analyzed, and all mice were sacrificed on day 7 to observe gross and histopathological morphological changes in the colon and to tally histopathological scores; the fresh colonic feces were collected for 16S rDNA sequencing to statistically analyze the diversity and species differences in the microbiota of mice of each group. Results:The success rate of the ICIC model was 100%, with all mice surviving. At the endpoint of the study (day 7), compared with the NC and DSS groups, the ICIC group had lower mouse body weight ( P < 0.05), higher DAI ( P < 0.05), damaged integrity of colonic mucosal tissue, and typical ulcerative lesions; the ICIC+6-SL group showed significant alleviation of body weight loss, significantly lower DAI scores, and lower pathological scores compared to the ICIC group, with all differences being statistically significant (all P < 0.05). 16S rDNA sequencing of mouse intestinal feces indicated that the alpha diversity of colonic microbiota in the ICIC group was lower than that in the NC and DSS groups (both P < 0.05), while the ICIC+6-SL group had higher alpha diversity than the ICIC group ( P < 0.05). In beta diversity analysis, the ANOSIM statistical value R = 0.376, P = 0.001 for the PCoA analysis of colonic microbiota and a Stress value of 0.125, P = 0.001 for the NMDS analysis indicated differences in the composition of colonic microbiota among the groups, with the greatest difference between the NC and ICIC groups, and the ICIC+6-SL group's microbiota composition was closer to that of the NC group compared to the ICIC group. Lefse analysis and Kruskal-Wallis test-based differential microbiota analysis showed that at the phylum level, compared to the NC group, the abundance of Bacteroidetes was significantly reduced in the ICIC group, while Campilobacterota was increased, and 6-SL administration could increase the abundance of Bacteroidetes and Campilobacterota in the ICIC group. At the genus level, compared to other groups, the abundance of unclassified_f_Lachnospiraceae and norank_f_Muribaculaceae was the lowest in the ICIC group, while Helicobacter, Akkermansia, and Escherichia-Shigella were enriched. Compared to the ICIC group, the abundance of unclassified_f_Lachnospiraceae and norank_f_ Muribaculaceae was increased in the ICIC+6-SL group, while the abundance of Helicobacter and Escherichia-Shigella was significantly suppressed. Conclusions:6-SL, an oligosaccharide derived from human milk, alleviates intestinal inflammatory injury in ICIC mice, reducing disease activity. This beneficial effect may be related to its regulation of gut microbiota profiling, an increased diversity of microbiota, a restoration of Bacteroidetes, and an inhibition of the growth advantage of pathogenic bacteria such as Helicobacter and Escherichia-Shigella.

Objective:To study the immunotherapeutic effect of chimeric hepatitis B core protein virus-like particles in subcutaneous lung adenocarcinoma mouse model, lays the foundation for the progression of tumor nano-therapeutic technology development.Methods:The plasmid was constructed by inserting a B-cell epitope of the human epidermal growth factor receptor-2 (HER-2) at hepatitis B core protein′s major immunodominant region (MIR). The recombinant virus nanoparticle, denoted as HBc-HER2, was obtained by E. coli expression system, followed by a series of purification steps. The immune response to this recombinant protein nanoparticle was assessed by measuring levels of anti-HER-2 antibody levels and characterizing antibody isotypes in a subcutaneous tumor mice model of lung adenocarcinoma. While tumor therapeutic efficacy was evaluated by measuring tumor size changes with an electronic caliper and MRI photography of subcutaneous tumor in mice.Results:A high-purity HBc-HER2 recombinant protein was obtained and could assemble into nanoparticle. Animal studies had demonstrated the robust immunogenicity of this vaccine in inducing high levels of HER-2 specific antibodies, yielding positive therapeutic outcomes against tumors.Conclusions:The engineered HBc-HER2 demonstrated notable tumor therapy efficacy in a subcutaneous lung adenocarcinoma mouse model, offering a foundation for tumor therapeutic nanotechnology vaccine research.

OBJECTIVE To investigate the effects of GSTP1， XRCC1， ABCB1， MTHFR gene polymorphisms on efficacy and toxic effect of chemotherapy regimen containing oxaliplatin in patients with stage Ⅲ and Ⅳ colorectal cancer patients. METHODS Clinical data of 76 patients with stage Ⅲ and Ⅳ colorectal cancer who received chemotherapy regimen containing oxaliplatin （XELOX，FOLFOX） were collected from the Second Affiliated Hospital of Soochow University from September 2018 to March 2020. The correlation of genotypes with progression-free survival （PFS） and toxic effect was analyzed by using univariate and multivariate COX regression model. RESULTS Carriers of the ABCB1 3435T＞C locus C allele （TC/CC） had a significantly higher risk of progression compared to TT genotype patients [HR＝2.39， 95%CI （1.05，5.50）， P＝0.038]. The risk of progression in patients at stage Ⅳ was significantly higher than those at stage Ⅲ [HR＝8.11， 95%CI（3.39，19.40）， P＜0.001]. Chemotherapy regimen， Karnofsky performance status score and tumor site had no significant effect on disease progression （P＞0.05）. Mutations in gene loci were not correlated with adverse reactions （P＞0.05）. CONCLUSIONS Patients carrying ABCB1 TC/CC and receiving chemotherapy regimen containing oxaliplatin have a higher risk of disease progression， which may be associated with longer PFS in patients （TT genotype） with stage Ⅳ colorectal cancer receiving the chemotherapy， while GSTP1， XRCC1， and MTHFR gene polymorphisms have no significant impact.

Objective:To investigate the mechanism of 6-sialyllactose (6-SL) in interfering the immune checkpoint inhibitor-induced colitis (ICIC) through the bacterial 16S rDNA sequencing.Methods:BALB/c mice were randomly divided into the normal control (NC) group ( n = 7), dextran sulfate sodium (DSS) group ( n = 6), ICIC group ( n = 6), and ICIC+6-SL group ( n = 6). The DSS group was continuously fed with 3.5% DSS drinking water for 7 days to induce colonic inflammation; the ICIC group was administered cytotoxic T-lymphocyte-associated antigen 4 (CTLA-4, 150 μg) intraperitoneally on days 0 and 4 in addition to 3.5% DSS drinking water to establish the ICIC mouse model; the ICIC+6-SL group was given 6-SL [150 mg/ (kg·d) ] by gavage simultaneously with the establishment of the ICIC model. Changes in mouse body weight and disease activity index (DAI) were statistically analyzed, and all mice were sacrificed on day 7 to observe gross and histopathological morphological changes in the colon and to tally histopathological scores; the fresh colonic feces were collected for 16S rDNA sequencing to statistically analyze the diversity and species differences in the microbiota of mice of each group. Results:The success rate of the ICIC model was 100%, with all mice surviving. At the endpoint of the study (day 7), compared with the NC and DSS groups, the ICIC group had lower mouse body weight ( P < 0.05), higher DAI ( P < 0.05), damaged integrity of colonic mucosal tissue, and typical ulcerative lesions; the ICIC+6-SL group showed significant alleviation of body weight loss, significantly lower DAI scores, and lower pathological scores compared to the ICIC group, with all differences being statistically significant (all P < 0.05). 16S rDNA sequencing of mouse intestinal feces indicated that the alpha diversity of colonic microbiota in the ICIC group was lower than that in the NC and DSS groups (both P < 0.05), while the ICIC+6-SL group had higher alpha diversity than the ICIC group ( P < 0.05). In beta diversity analysis, the ANOSIM statistical value R = 0.376, P = 0.001 for the PCoA analysis of colonic microbiota and a Stress value of 0.125, P = 0.001 for the NMDS analysis indicated differences in the composition of colonic microbiota among the groups, with the greatest difference between the NC and ICIC groups, and the ICIC+6-SL group's microbiota composition was closer to that of the NC group compared to the ICIC group. Lefse analysis and Kruskal-Wallis test-based differential microbiota analysis showed that at the phylum level, compared to the NC group, the abundance of Bacteroidetes was significantly reduced in the ICIC group, while Campilobacterota was increased, and 6-SL administration could increase the abundance of Bacteroidetes and Campilobacterota in the ICIC group. At the genus level, compared to other groups, the abundance of unclassified_f_Lachnospiraceae and norank_f_Muribaculaceae was the lowest in the ICIC group, while Helicobacter, Akkermansia, and Escherichia-Shigella were enriched. Compared to the ICIC group, the abundance of unclassified_f_Lachnospiraceae and norank_f_ Muribaculaceae was increased in the ICIC+6-SL group, while the abundance of Helicobacter and Escherichia-Shigella was significantly suppressed. Conclusions:6-SL, an oligosaccharide derived from human milk, alleviates intestinal inflammatory injury in ICIC mice, reducing disease activity. This beneficial effect may be related to its regulation of gut microbiota profiling, an increased diversity of microbiota, a restoration of Bacteroidetes, and an inhibition of the growth advantage of pathogenic bacteria such as Helicobacter and Escherichia-Shigella.