Objective:To analyze and explore the diagnostic value of endoscopic submucosal dissection (ESD) for primary gastrointestinal lymphoma (PGIL).Methods:A retrospective analysis was conducted on the clinical and pathological data from 37 patients with suspected PGIL and admitted to Zhongshan Hospital, Fudan University and Xiamen Hospital, Zhongshan Hospital, Fudan University between January 2021 and December 2023. The diagnostic accuracy for PGIL of initial endoscopic conventional biopsies was compared with that of ESD biopsies.Results:Among these patients, 6 were diagnosed as having primary gastrointestinal lymphoma by routine endoscopic biopsy, with a diagnostic rate of 16.22% (6/37). Of the 22 patients who underwent ESD, 20 were diagnosed as having primary gastrointestinal lymphoma, achieving a diagnostic rate of 90.91% (20/22), which was significantly higher than that of initial endoscopic routine biopsies ( χ2=31.228, P<0.05). Conclusion:ESD demonstrates significant diagnostic value for PGIL.

Objective To establish a rat model of acclimatization to motion sickness(MS)induced by rotational stimulation.Methods To determine the stimulation conditions of MS,SD rats were divided into a static control group(SCG)and a single rotation stimulation group(SRG)before being subjected to the motion sickness index(MSI)measurement,open-field experiment and Morris water maze experiment after rotational stimulation to verify the feasibility of MS being induced in rats.Morris water maze experiments were performed to find out whether rotational stimulation could be used to induce MS in rats.During experiments on acclimatization,the SD rats were divided into the control group(Ctrl),one day of rotational stimulation group(Day1),three days of continuous rotational stimulation group(Day3),and seven days of continuous rotational stimulation group(Day7)before the changes in the MSI and behavior of these rats were recorded so as to explore the relationship between continuous stimulation and MS acclimatization in rats.Results After rotational stimulation,the rats showed a significant increase in the number of fecal pellets(P<0.0001)and in the MSI(P<0.0001)compared with the SCG.In the open field experiment,the rats showed a significant decrease in the spontaneous activity time(AT)(P<0.0001),total spontaneous activity distance(TD)(P<0.001)and distance moved by the center point per second(DMCPS)(P<0.001).The time taken to climb onto the platform(latency to find the platform,LP)(P<0.0001)and the total distance to the platform(distance to the platform,DP)(P<0.001)were significantly increased during the Morris water maze experiment.Acclimatization experiments revealed a significant increase in MSI and in the number of fecal pellets in the Day1 and Day3 groups of rotational stimulation compared to the Ctrl group(P<0.0001).AT(P<0.01),TD(P<0.05)and DMCPS(P<0.01)were significantly decreased,while LP and DP were significantly increased(P<0.0001),but there was no statistically significant difference in indices compared with the Day7 group(P>0.05).Conclusion Sinusoidal stimulation can induce MS in rats,and twice-a-day,continuous rotational stimulation for seven days can lead to acclimatization.The rat MS model can be assessed via behavioral experiments.

Objective To develop a 3D visualization endoscopic navigation system based on CT portal angiography (CTPA) and explore its clinical value in assisting precise treatment of esophageal and gastric varices (EGV). Methods Patients with EGV needing treatment in the Department of Gastroenterology of Zhongshan Hospital, Fudan University from September 2021 to April 2023 were collected. Preoperative examinations including CTPA and hematological examinations were performed, and a 3D visualization endoscopic navigation system was developed to assist endoscopic treatment. Real time comparison was made between the endoscopic 3D portal vein system image reconstructed by intelligent imaging and the actual endoscopic observation of the vascular morphology inside the cavity. The responsible blood vessels that are prone to bleeding were embolized using a sandwich injection method of “lauromacrogol+tissue adhesive+lauromacrogol”. For patients with portal shunting, ultrasound-guided coil insertion was performed. Postoperative endoscopic ultrasound or CTPA was used reexamination to evaluate vascular embolism and complications. Results A total of 13 patients successfully underwent endoscopic ultrasound-guided variceal embolization. The average maximum inner diameter of target veins was (3.3\begin{document}$ \pm $\end{document}1.3) cm; on average, implanted coil number was 1(0,2) in each patient, with median dosages of lauromacrogol and tissue adhesive were 9.5(7.8,10.0) mL and 1.5(1.0,2.1) mL respectively. Postoperatively, endoscopic ultrasound detecting confirmed complete occlusion of all target veins. At 8 weeks after treatment, none of the patients experienced rebleeding. At 24 weeks after treatment, rebleeding occurred in 3 patients, on postoperative days 107, 126 and 147, respectively. Conclusion The 3D visualization endoscopic navigation system based on CTPA can effectively and safely assist preoperative diagnosis and intraoperative localization of target blood vessels, which is beneficial for the precise treatment of EGV patients.

BACKGROUND: Metabolic-associated fatty liver disease (MAFLD) is a common liver disease and may become the leading cause of severe liver disease in the future. The Global Burden of Disease (GBD) study assesses MAFLD's impact in countries and regions worldwide, providing insights into its prevalence. METHODS: Prevalence data for MAFLD from 1990 to 2021 by country and region in all sex and age groups were collected from the Global Health Data Exchange. The categorization of countries and geographic areas by development was performed using the Sociodemographic Index (SDI). RESULTS: Between 1990 and 2021, the global crude prevalence rate of MAFLD increased from 10.6% to 16.1% (beta-coefficient: 0.2%, 95% confidence interval [CI]: 0.2-0.2%, P  <0.001), and the age-standardized prevalence rate was increased from 12.1% to 15.0% (beta-coefficient: 0.1%, 95% CI: 0.1-0.1%, P  <0.001). In 2021, MAFLD was estimated to have affected 1.3 billion people worldwide. Significant uptrends were observed in all regions, super regions, and SDI categories. The fastest increase from 1990 to 2021 and the highest prevalence rate in 2021 were experienced by countries and territories with high-middle and middle SDI. An increase in the prevalence of MAFLD from 1990 to 2021 was demonstrated in all but six countries. CONCLUSIONS In 2021, the number of patients affected by MAFLD was doubled compared to 1990, and the prevalence rate increased by over 50%. The burden of MAFLD, as measured by prevalence, was more prominent in countries and territories with middle SDI and in those located in North African and Middle Eastern, possibly due to changes in lifestyle in these areas over the past 30 years.
Humans ; Global Burden of Disease ; Prevalence ; Male ; Female ; Middle Aged ; Adult ; Global Health ; Fatty Liver/epidemiology* ; Aged

Objective:To explore the clinical characteristics of patients with porto-sinusoidal vascular disease (PSVD) complicated with esophageal and gastric varices, and to evaluate the effect of portal vein pressure (PVP) on esophageal and gastric varices bleeding and rebleeding after endoscopic treatment.Methods:Patients who were hospitalized in the Department of Gastroenterology of the Zhongshan Hospital, Fudan University due to portal hypertension from July 2022 to October 2024, underwent liver biopsy for diagnosis of PSVD, and received direct PVP measurement were included. Their clinical manifestations, liver histopathological characteristics were analyzed, and the prognosis was followed up.Results:A total of 29 patients were included, and 19 patients had experienced rupture and bleeding of esophageal and gastric varices. Compared with the non-bleeding group, the hemoglobin level of patients in the bleeding group was lower and the international normalized ratio was higher (all P<0.05). There was no statistically significant difference between the two groups in other laboratory examination indicators, complications of portal hypertension, combined diseases, etc. (all P>0.05). The pathology of liver biopsy suggests that dilation of the hepatic sinuses and abnormalities of the central vein are common pathological changes. The direct PVP of patients in the bleeding group was significantly higher than that in the non-bleeding group [28.0(24.5-31.0)mmHg vs 18.5(10.5-23.8)mmHg, P=0.011]. However, there was no statistically significant difference in the measured values of liver wedge pressure, free pressure and hepatic venous pressure gradient (HVPG) between the two groups of patients (all P>0.05). Correlation analysis revealed that there was no significant correlation between HVPG and PVP ( R2=0.129 9, P=0.076 7). Grouped according to the median PVP value of 25 mmHg, the risk of esophageal and gastric variceal rupture and bleeding in the high PVP group (≥25 mmHg) was significantly higher than that in the low PVP group (<25 mmHg) (14/16 vs 5/13, P=0.016). The risk of rebleeding after endoscopic treatment in patients with high PVP (4/13) was higher than that in patients with low PVP (0/4). Conclusions:Patients with porto-sinusoidal vascular disease complicated with portal hypertension are often accompanied by rupture and bleeding of esophageal and gastric varices. HVPG cannot accurately reflect the portal vein pressure. The risk of rupture and bleeding of esophageal and gastric varices and rebleeding in patients with elevated portal vein pressure is significantly increased.

Objective:To explore the effect of inflammatory cell levels on the anticoagulant efficacy in patients with liver cirrhosis complicated with portal vein thrombosis (PVT).Methods:A total of 106 patients with liver cirrhosis complicated with PVT who visited the Zhongshan Hospital, Fudan University from 2017 to 2022 were prospectively included. The PVT grade and recanalization were evaluated by imaging. Cox regression was used to analyze the predictive factors of anticoagulation efficacy. The time-dependent receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value of inflammatory cells for predicting anticoagulation efficacy. The Kaplan-Meier method was used to compare the 1-year PVT recanalization rate of patients with different levels of inflammatory cells.Results:Univariate analysis showed that Child-Pugh score ( HR=1.41), D-dimer ( HR=0.98), platelet ( HR=0.98), C-reactive protein to lymphocyte ratio ( HR=1.01), monocyte ( HR=0.21), lymphocyte ( HR=0.34), and prothrombin time( HR=1.32) was related to the improvement of PVT (all P<0.05). Multivariate analysis confirmed that lymphocytes ( HR: 0.41, 95% CI: 0.20-0.85, P=0.016) and prothrombin time ( HR: 1.23, 95% CI: 1.01-1.50, P=0.036) were independent predictors of anticoagulant efficacy. Grouped according to the ROC cutoff value, the 1-year recanalization rate of PVT in the high-level lymphocyte group (4.55% vs 32.84%, P=0.012) and the high-level monocyte group (5.56% vs 31.4%, P=0.028) was significantly lower than that in the low-level group. After excluding patients undergoing splenectomy, the recurrence rate in the high-level lymphocyte group was still lower than that in the low-level group (6.25% vs 33.77%, P=0.038). Conclusions:Among patients with liver cirrhosis accompanied by PVT, high levels of lymphocytes and monocytes are the key factors for the poor efficacy of anticoagulation therapy. For PVT patients with poor anticoagulation efficacy, the therapeutic strategy of anti-inflammatory combined with anticoagulation can be considered for exploration in the future.

Objective:To analyze the application of Sengstaken-Blakemore tubes combined with endoscopic intervention on the prognosis of patients with acute esophageal and gastric variceal rupture and bleeding due to portal hypertension in liver cirrhosis, and to explore the impact of Sengstaken-Blakemore tubes combined with endoscopic intervention on the prognosis of patients.Methods:A retrospective study included patients with liver cirrhosis who visited the Zhongshan Hospital, Fudan University from January 2023 to July 2024 due to acute upper gastrointestinal bleeding, had no response to drug treatment and unstable hemodynamics, and received the Sengstaken-Blakemore tubes compression hemostasis. According to whether endoscopic intervention was received or not, the patients were divided into the endoscopic intervention group and the non-endoscopic intervention group. The medication and subsequent treatment of the patients were analyzed, and the survival of the patients 28 days after bleeding was followed up. Kaplan-Meier survival analysis and Cox regression analysis were used to evaluate the effect of endoscopic intervention on the 28-day mortality rate of patients.Results:A total of 31 cases successfully had three-lumen two-cystic tubes indwelled. Among them, 8 cases further received endoscopic examination and intervention, and 23 cases did not receive endoscopic examination. During the 28-day follow-up after bleeding, a total of 20 cases died. The Kaplan-Meier survival analysis showed that the 28-day mortality rate in the endoscopic intervention group was significantly lower than that in the non-endoscopic intervention group (25.0% vs 78.3%, P=0.007). Multivariate Cox regression analysis showed that endoscopic intervention was an independent protective factor for 28-day mortality ( HR: 0.14, 95% CI: 0.03-0.63, P=0.01). In addition, the severity of bleeding and prothrombin time were also important factors affecting the prognosis of patients. Conclusions:The Sengstaken-Blakemore tubes, as an important hemostasis method for acute esophageal and gastric variceal rupture and bleeding, can buy time for subsequent endoscopic treatment, but the risk of complications is relatively high. Creating conditions for early endoscopic intervention as early as possible can significantly reduce the mortality rate of patients and improve the prognosis of patients with liver cirrhosis.

Portal hypertension, as a clinical manifestation of the progression of various liver diseases, its concurrent rupture and bleeding of esophageal and gastric varices, ascites and hepatic encephalopathy, etc., seriously affect the prognosis of patients and have always been a key concern in clinical diagnosis and treatment. Although traditional imaging techniques play a key role in the diagnosis and evaluation of portal hypertension, their diagnostic efficacy is limited by subjective film reading, making it difficult to accurately quantify and deeply analyze the pathophysiological characteristics. In recent years, radiomics has gradually demonstrated its potential in the diagnosis and management of portal hypertension by extracting a large number of quantitative features from medical images and constructing predictive models in combination with artificial intelligence algorithms such as machine learning. This article systematically reviews the research progress of radiomics in portal hypertension, with a focus on discussing the current application status of radiomics characteristics in risk assessment, hemodynamic analysis, and prognosis prediction of portal hypertension, in order to promote the progress of radiomics from technical verification to clinical transformation.

Objective:To explore the clinical characteristics of patients with porto-sinusoidal vascular disease (PSVD) complicated with esophageal and gastric varices, and to evaluate the effect of portal vein pressure (PVP) on esophageal and gastric varices bleeding and rebleeding after endoscopic treatment.Methods:Patients who were hospitalized in the Department of Gastroenterology of the Zhongshan Hospital, Fudan University due to portal hypertension from July 2022 to October 2024, underwent liver biopsy for diagnosis of PSVD, and received direct PVP measurement were included. Their clinical manifestations, liver histopathological characteristics were analyzed, and the prognosis was followed up.Results:A total of 29 patients were included, and 19 patients had experienced rupture and bleeding of esophageal and gastric varices. Compared with the non-bleeding group, the hemoglobin level of patients in the bleeding group was lower and the international normalized ratio was higher (all P<0.05). There was no statistically significant difference between the two groups in other laboratory examination indicators, complications of portal hypertension, combined diseases, etc. (all P>0.05). The pathology of liver biopsy suggests that dilation of the hepatic sinuses and abnormalities of the central vein are common pathological changes. The direct PVP of patients in the bleeding group was significantly higher than that in the non-bleeding group [28.0(24.5-31.0)mmHg vs 18.5(10.5-23.8)mmHg, P=0.011]. However, there was no statistically significant difference in the measured values of liver wedge pressure, free pressure and hepatic venous pressure gradient (HVPG) between the two groups of patients (all P>0.05). Correlation analysis revealed that there was no significant correlation between HVPG and PVP ( R2=0.129 9, P=0.076 7). Grouped according to the median PVP value of 25 mmHg, the risk of esophageal and gastric variceal rupture and bleeding in the high PVP group (≥25 mmHg) was significantly higher than that in the low PVP group (<25 mmHg) (14/16 vs 5/13, P=0.016). The risk of rebleeding after endoscopic treatment in patients with high PVP (4/13) was higher than that in patients with low PVP (0/4). Conclusions:Patients with porto-sinusoidal vascular disease complicated with portal hypertension are often accompanied by rupture and bleeding of esophageal and gastric varices. HVPG cannot accurately reflect the portal vein pressure. The risk of rupture and bleeding of esophageal and gastric varices and rebleeding in patients with elevated portal vein pressure is significantly increased.

Objective:To explore the effect of inflammatory cell levels on the anticoagulant efficacy in patients with liver cirrhosis complicated with portal vein thrombosis (PVT).Methods:A total of 106 patients with liver cirrhosis complicated with PVT who visited the Zhongshan Hospital, Fudan University from 2017 to 2022 were prospectively included. The PVT grade and recanalization were evaluated by imaging. Cox regression was used to analyze the predictive factors of anticoagulation efficacy. The time-dependent receiver operating characteristic (ROC) curve was used to determine the optimal cutoff value of inflammatory cells for predicting anticoagulation efficacy. The Kaplan-Meier method was used to compare the 1-year PVT recanalization rate of patients with different levels of inflammatory cells.Results:Univariate analysis showed that Child-Pugh score ( HR=1.41), D-dimer ( HR=0.98), platelet ( HR=0.98), C-reactive protein to lymphocyte ratio ( HR=1.01), monocyte ( HR=0.21), lymphocyte ( HR=0.34), and prothrombin time( HR=1.32) was related to the improvement of PVT (all P<0.05). Multivariate analysis confirmed that lymphocytes ( HR: 0.41, 95% CI: 0.20-0.85, P=0.016) and prothrombin time ( HR: 1.23, 95% CI: 1.01-1.50, P=0.036) were independent predictors of anticoagulant efficacy. Grouped according to the ROC cutoff value, the 1-year recanalization rate of PVT in the high-level lymphocyte group (4.55% vs 32.84%, P=0.012) and the high-level monocyte group (5.56% vs 31.4%, P=0.028) was significantly lower than that in the low-level group. After excluding patients undergoing splenectomy, the recurrence rate in the high-level lymphocyte group was still lower than that in the low-level group (6.25% vs 33.77%, P=0.038). Conclusions:Among patients with liver cirrhosis accompanied by PVT, high levels of lymphocytes and monocytes are the key factors for the poor efficacy of anticoagulation therapy. For PVT patients with poor anticoagulation efficacy, the therapeutic strategy of anti-inflammatory combined with anticoagulation can be considered for exploration in the future.