Background: In recent years, stroke has remained one of the leading causes of morbidity and mortality worldwide. Globally, the incidence among adults ranges from 134.9 to 336.3 cases per 100,000 population annually, with mortality rates between 36.7 and 136.7 per 100,000. In Mongolian traditional medicine, stroke prevention is not only related to diet and lifestyle but also depends on an individual’s unique bodily constitution, age, strength, and life habits. Since people differ physiologically, the diseases arising from the four causative conditions manifest differently. Therefore, this study was conducted to explore the relationship between an individual’s constitutional type and stroke risk factors, aiming to contribute to stroke prevention. Aim: To study the relationship between individual constitutional types in Mongolian traditional medicine and stroke risk factors, specifically hypertension and dyslipidemia. Materials and Methods: A total of 2,086 participants were included from the Departments of Cardiology, Neurology, and Ultrasonography of the affiliated hospital of the Inner Mongolia National University. Data were collected through questionnaires, assessment of constitutional type, blood pressure measurement, and blood lipid analysis. Statistical processing was performed using SPSS 18.0 software. Chi-square (χ²), ANOVA tests, multivariate logistic regression, and correspondence analysis were used, with p<0.05 considered statistically significant. Results: Among the participants, those with the “Khurmal” (Hormal) and “Badgan-Khi” (Phlegm-Wind) constitutions accounted for the highest proportions (34.3% and 26.7%, respectively), showing a statistically significant association with stroke risk factors (p<0.05). In terms of the relationship between constitution and blood pressure, individuals with the Badgan-Khi type had a higher risk, and a statistically significant association was found between blood pressure, risk classification, and the Badgan-Khi and Khormal types (p<0.05). Regarding constitution and blood lipid levels, the proportions in the stroke population were: indeterminate lipid ratio (58.3%), dyslipidemia (33.3%), and normal blood lipids (8.3%). A statistically significant relationship was observed between blood lipid levels, risk classification, and the Khi-Shar and Badgan-Khi constitutions (p<0.05). Conclusion Stroke risk factors such as hypertension and dyslipidemia are associated with an individual’s body constitutional type. The study confirmed that individuals with a Khi-dominant constitution tend to have higher sympathetic nervous system activity, blood pressure, and vascular reactivity, providing a biological basis for increased stroke risk. For Badgan-dominant individuals, metabolic disturbances and lipid accumulation were identified as contributors to elevated stroke risk.

Background/Aims: The real-world efficacy of computer-aided detection (CADe) systems, such as GI Genius (Medtronic), is unclear. We examined the colonoscopy metrics using CADe alone and with a mucosal exposure device (EndoCuff; Olympus) in a real-world setting. Methods: We retrospectively reviewed screening and surveillance colonoscopies before, during, and after CADe use in a large tertiary care center. Outcomes included the adenomas per colonoscopy (APC), sessile serrated lesions per colonoscopy, adenoma detection rate (ADR), sessile serrated lesion detection rate (SSLDR), advanced ADR, total polyp detection rate, and true histology rate. The ADR and SSLDR were further examined according to size, colon location, and EndoCuff use. Results: A total of 798 colonoscopies were performed, including 386 pre-CADe, 178 CADe, and 234 post-CADe. In cases where CADe was used with the EndoCuff, the 1 to 5 mm ADR increased from 36.3% (pre-CADe) to 52.1% (CADe) (p=0.01). The 1 to 5 mm SSLDR increased from 9.6% (pre-CADe) to 17.1% (CADe) (p=0.02). The right-sided ADR increased from 30.8% (pre-CADe) to 42.7% (CADe) (p=0.03). The right-sided SSLDR increased from 12.3% (pre-CADe) to 24.8% (CADe) (p<0.001). No significant changes were observed when only CADe was used. No differences were found in other outcome measures. Post-CADe metrics returned to pre-CADe levels. Conclusions GI Genius is useful for identifying small and right-sided polyps only when used with the EndoCuff.

Background/Aims: The real-world efficacy of computer-aided detection (CADe) systems, such as GI Genius (Medtronic), is unclear. We examined the colonoscopy metrics using CADe alone and with a mucosal exposure device (EndoCuff; Olympus) in a real-world setting. Methods: We retrospectively reviewed screening and surveillance colonoscopies before, during, and after CADe use in a large tertiary care center. Outcomes included the adenomas per colonoscopy (APC), sessile serrated lesions per colonoscopy, adenoma detection rate (ADR), sessile serrated lesion detection rate (SSLDR), advanced ADR, total polyp detection rate, and true histology rate. The ADR and SSLDR were further examined according to size, colon location, and EndoCuff use. Results: A total of 798 colonoscopies were performed, including 386 pre-CADe, 178 CADe, and 234 post-CADe. In cases where CADe was used with the EndoCuff, the 1 to 5 mm ADR increased from 36.3% (pre-CADe) to 52.1% (CADe) (p=0.01). The 1 to 5 mm SSLDR increased from 9.6% (pre-CADe) to 17.1% (CADe) (p=0.02). The right-sided ADR increased from 30.8% (pre-CADe) to 42.7% (CADe) (p=0.03). The right-sided SSLDR increased from 12.3% (pre-CADe) to 24.8% (CADe) (p<0.001). No significant changes were observed when only CADe was used. No differences were found in other outcome measures. Post-CADe metrics returned to pre-CADe levels. Conclusions GI Genius is useful for identifying small and right-sided polyps only when used with the EndoCuff.

Background/Aims: The real-world efficacy of computer-aided detection (CADe) systems, such as GI Genius (Medtronic), is unclear. We examined the colonoscopy metrics using CADe alone and with a mucosal exposure device (EndoCuff; Olympus) in a real-world setting. Methods: We retrospectively reviewed screening and surveillance colonoscopies before, during, and after CADe use in a large tertiary care center. Outcomes included the adenomas per colonoscopy (APC), sessile serrated lesions per colonoscopy, adenoma detection rate (ADR), sessile serrated lesion detection rate (SSLDR), advanced ADR, total polyp detection rate, and true histology rate. The ADR and SSLDR were further examined according to size, colon location, and EndoCuff use. Results: A total of 798 colonoscopies were performed, including 386 pre-CADe, 178 CADe, and 234 post-CADe. In cases where CADe was used with the EndoCuff, the 1 to 5 mm ADR increased from 36.3% (pre-CADe) to 52.1% (CADe) (p=0.01). The 1 to 5 mm SSLDR increased from 9.6% (pre-CADe) to 17.1% (CADe) (p=0.02). The right-sided ADR increased from 30.8% (pre-CADe) to 42.7% (CADe) (p=0.03). The right-sided SSLDR increased from 12.3% (pre-CADe) to 24.8% (CADe) (p<0.001). No significant changes were observed when only CADe was used. No differences were found in other outcome measures. Post-CADe metrics returned to pre-CADe levels. Conclusions GI Genius is useful for identifying small and right-sided polyps only when used with the EndoCuff.

Humans ; Sarcoma ; Transcription Factors ; Biomarkers, Tumor ; Oncogene Proteins, Fusion

Humans ; Meningioma/surgery* ; Tomography, X-Ray Computed ; Meningeal Neoplasms/surgery*

Objective: To investigate the clinicopathological characteristics of malignant gastrointestinal neuroectodermal tumors (GNET), and to describe their clinical, histological, immunophenotypic, ultrastructural, and molecular features, diagnosis and differential diagnosis. Methods: Three cases of malignant GNET were collected at Xijing Hospital of the Fourth Military Medical University, from 2013 to 2022. All patients underwent surgical resection of the tumor. Histological, immunohistochemical (IHC), ultrastructural and molecular genetic analyses were performed, and the patients were followed up for six months, three years and five years. Results: There were two males and one female patients. The tumors were located in the ileum, descending colon, and rectum, respectively. Grossly, the tumors were solid, firm, and poorly circumscribed, measured in size from 2 to 4 cm in greatest dimension, and had a greyish-white cut surface. These tumors were histologically characterized by a sheet-like or nested population of oval to spindled cells or epithelioid cells with weakly eosinophilic or clear cytoplasm, small nucleoli and scattered mitoses. Electron microscopy showed neuroendocrine differentiation, and no evidence of melanogenesis. IHC staining showed that the tumor cells were diffusely positive for S-100 protein, SOX10, CD56, synaptophysin and vimentin. They were negative for melanocytic markers, HMB45 and Melan A. All three cases showed split EWSR1 signals consistent with a chromosomal translocation involving EWSR1. Next-generation sequencing in one case confirmed the presence of EWSR1-ATF1 fusion. These patients were followed up for 6 months, 3 years and 5 years, respectively, and all of them developed possible lung or liver metastases, and one of them died of multiple pulmonary metastases. Conclusion: Malignant GNET has distinctive morphological, IHC, and molecular genetic features and it should be differentiated from other malignancies of the gastrointestinal tract, especially clear cell sarcoma and melanoma.
Male ; Humans ; Female ; Biomarkers, Tumor/analysis* ; Gastrointestinal Neoplasms/pathology* ; S100 Proteins/analysis* ; Melanoma

Radical gastrectomy with D2 lymphadenectomy has been widely performed as the standard surgery for patients with gastric cancer in major medical centers in China and abroad. However, the exact extent of lymph node dissection is still controversial. In the latest version of the Japanese Gastric Cancer Treatment Guidelines, No. 14v lymph nodes (along the root of the superior mesenteric vein) are again defined as loco-regional lymph nodes, and it is clarified that distal gastric cancer presenting with infra-pyloric regional lymph node (No.6) metastasis is recommended for D2+ superior mesenteric vein (No. 14v) lymph node dissection. To explore the relevance and clinical significance of No.6 and No.14v lymphadenectomy in radical gastric cancer surgery, a review of the national and international literature revealed that No.6 lymph node metastasis was associated with No.14v lymph node metastasis, that No.6 lymph node status was a valid predictor of No.14v lymph node negative status and false negative rate, and that for gastric cancer patients with No. 14v lymph node negative and No.6 lymph node positive, the dissection of No.14v lymph node may also have some significance. The addition of No. 14v lymph node dissection in radical gastrectomy is safe, but it is more important to distinguish the patients who can benefit from it. Professor Liang Han of Tianjin Medical University Cancer Hospital is currently leading a multicenter, large-sample, prospective clinical trial (NCT02272894) in China, which is expected to provide higher level evidence for the clinical significance of lymph node dissection in No.14v.
Humans ; Stomach Neoplasms/pathology* ; Lymphatic Metastasis/pathology* ; Prospective Studies ; Retrospective Studies ; Lymph Nodes/pathology* ; Lymph Node Excision ; Gastrectomy ; Multicenter Studies as Topic

Obstructive colorectal cancer is a common malignant bowel obstruction. Colostomy or colostomy following tumor resection may be the first choice for emergency surgery. The intestinal and systemic conditions of patients undergoing emergency surgery are often poor, and patients need to undergo multiple operations, which increase the surgical risk and economic burden and reduce the quality of life of patients. Poor intraoperative visualization may also affect the radical operation of emergency surgery. Transanal decompression tube (TDT) can rapidly decompress and drain the obstructed bowel, effectively relieve obstruction symptoms, and improve the success rate of primary radical resection. The TDT squeeze the tumor lightly, causing no spread of tumor cells, and is cheap, but the cavity of transanal decompression tube is small and easily blocked, and requires tedious flushing or regular replacement. Self-expanding metallic stents (SEMS) can relieve intestinal obstruction effectively, provide sufficient preparation time for preoperative examination and improvement of nutritional status. By improving patient's tolerance to radical surgery, SEMS might be used as an important treatment strategy choice for obstructive colorectal cancer. However, SEMS may squeeze the tumor, leading to the spread of tumor cells, increase the recurrence rate and metastasis rate, and reduce the survival rate. Moreover, intestinal wall edema still existed during the operation following SEMS, and the rate of ostomy after anastomosis was as high as 34%. We hypothesized that prolonging the interval between stent insertion and surgery to 2 months, with neoadjuvant chemotherapy administered during this interval (SEMS-neoadjuvant chemotherapy strategy), would help improve outcomes. The SEMS-neoadjuvant chemotherapy strategy is a safe, effective, and well tolerated treatment approach with a high laparoscopic resection rate, low stoma formation rate and improvement in the overall survival for patients with left-sided colon cancer obstruction. The patient physical status is improved, the primary tumor is downstaged, and intestinal wall edema is relieved during the relatively longer interval between SEMS placement and surgery. The SEMS-neoadjuvant chemotherapy strategy may be a preferred therapeutic strategy for obstructive left colon cancer.
Humans ; Quality of Life ; Self Expandable Metallic Stents/adverse effects* ; Colonic Neoplasms/surgery* ; Stents/adverse effects* ; Intestinal Obstruction/surgery* ; Treatment Outcome ; Colorectal Neoplasms/complications* ; Retrospective Studies

After the implementation of neoadjuvant chemoradiotherapy and total mesorectal excision, lateral local recurrence becomes the major type of local recurrence after surgery in rectal cancer. Most lateral recurrence develops from enlarged lateral lymph nodes on an initial imaging study. Evidence is accumulating to support the combined use of neoadjuvant chemoradiotherapy and lateral lymph node dissection. The accuracy of diagnosing lateral lymph node metastasis remains poor. The size of lateral lymph nodes is still the most commonly used variable with the most consistent accuracy and the cut-off value ranging from 5 to 8 mm on short axis. The morphological features, differentiation of the primary tumor, circumferential margin, extramural venous invasion, and response to chemoradiotherapy are among other risk factors to predict lateral lymph node metastasis. Planning multiple disciplinary treatment strategies for patients with suspected nodes must consider both the risk of local recurrence and distant metastasis. Total neoadjuvant chemoradiotherapy is the most promising regimen for patients with a high risk of recurrence. Simultaneous Integrated Boost Intensity-Modulated Radiation Therapy seemingly improves the local control of positive lateral nodes. However, its impact on the safety of surgery in patients with no response to the treatment or regrowth of lateral nodes remains unclear. For patients with smaller nodes below the cut-off value or shrunken nodes after treatment, a close follow-up strategy must be performed to detect the recurrence early and perform a salvage surgery. For patients with stratified lateral lymph node metastasis risks, plans containing different multiple disciplinary treatments must be carefully designed for long-term survival and better quality of life.
Humans ; Lymphatic Metastasis/pathology* ; Quality of Life ; Neoplasm Staging ; Retrospective Studies ; Lymph Nodes/pathology* ; Rectal Neoplasms/surgery* ; Lymph Node Excision/methods* ; Neoadjuvant Therapy/methods* ; Neoplasm Recurrence, Local/surgery*