Objective To investigate the correlation between atherogenic index of plasma (AIP) and the severity of hypertriglyceridemic acute pancreatitis (HTG-AP) and the value of AIP combined with Bedside Index for Severity in Acute Pancreatitis (BISAP) score in the early prediction of severe HTG-AP (sHTG-AP). Methods A retrospective analysis was performed for the clinical data of 170 patients with HTG-AP who were hospitalized in The General Hospital of Central Theater Command from January 2017 to December 2021, and according to related guidelines, they were divided into the sHTG-AP group with 28 patients and non-sHTG-AP group with 142 patients. Peripheral blood samples were collected from all patients within 24 hours after admission, and the two groups were compared in terms of sex, age, laboratory test results, AIP, BISAP score, and modified CT severity index (MCTSI) score. The chi-square test or the Fisher's exact test was used for comparison of categorical data between groups; the Mann-Whitney U test was used for comparison of continuous data between groups. The Spearman rank correlation test was used to investigate the correlation between each factor and the severity of HTG-AP, and the binary logistic regression analysis were used to investigate the independent risk factors for sHTG-AP. The receiver operating characteristic (ROC) curve was plotted to assess the predictive efficacy of each indicator. Results There were significant differences between the two groups in the medical history of diabetes, lymphocyte count, albumin, Ca 2+ , triglyceride, high-density lipoprotein cholesterol, AIP, BISAP score, MCTSI score, length of hospital stay, and hospital costs (all P < 0.05). The sHTG-AP group had a longer length of hospital stay, higher hospital costs, and a higher AIP value. AIP (odds ratio [ OR ]=1.244, 95% confidence interval [ CI ]: 1.062-1.458, P =0.007), BISAP score ( OR =5.525, 95% CI : 1.646-18.543, P =0.006), and MCTSI score ( OR =2.029, 95% CI : 1.245-3.305, P =0.004) were risk factors for sHTG-AP. AIP, BISAP score, and MCTSI score were positively correlated with the severity of HTG-AP ( r =0.291, 0.631, and 0.649, all P < 0.001), and AIP was positively correlated with BISAP score and MCTSI score ( r =0.190 and 0.215, both P < 0.05). AIP had an optimal cut-off value of 1.095 in predicting sHTG-AP, and AIP, BISAP score, and AIP combined with BISAP score had an area under the ROC curve of 0.759, 0.887, 0.925, respectively, a sensitivity of 0.821, 0.857, and 0.786, respectively, and a specificity of 0.627, 0.817, and 0.937, respectively (all P < 0.001). Conclusion AIP is a risk factor for sHTG-AP and is correlated with disease severity, and AIP combined with BISAP score has a relatively high value in the early prediction of sHTG-AP.

Colorectal cancer (CRC) is a common malignant tumor of the digestive tract, which seriously threatens human health. In recent years, many studies have found that Fusobacterium nucleatum (Fn) is positively related to the occurrence of CRC. In the process of CRC carcinogenesis, Fn can play an important role by inducing the expression of pro-inflammatory cytokines and triggering chronic inflammation, inhibiting the function of immune cells, inducing chemotherapy resistance, promoting the expressions of tumor genes and microRNAs and regulating glycolysis.

Objective:To investigate the influence of effects of transarterial chemoembo-lization (TACE) before liver transplantation on the prognosis of hepatocellular carcinoma.Methods:The retrospective cohort study was conducted. The clinicopathological data of 311 hepatocellular carcinoma patients undergoing TACE before liver transplantation who were admitted to the Third Medical Center of Chinese PLA General Hospital from January 2005 to December 2012 were collec-ted. There were 276 males and 35 females, aged from 47 to 59 years, with a median age of 52 years. All the 311 patients underwent TACE before liver transplantation. Observation indicators: (1) effects of hepatocellular carcinoma patients undergoing TACE and its relationship with clinicopathological factors; (2) follow-up; (3) influencing factors for prognosis of hepatocellular carcinoma patients after liver transplantation. Follow-up was conducted using outpatient examination or telephone interview to detect recurrence and metastasis of tumor and survival and graft loss of patients up to December 2017. The patients were followed up every 2 to 4 weeks within 3 months after liver transplantation, and once every 1 to 3 months thereafter. Measurement data with normal distri-bution were represented as Mean± SD, and comparison between groups was analyzed using the t test. Measurement data with skewed distribution were represented as M(range) or M( Q1, Q3), and comparison between groups was analyzed using the Mann-Whitney U test. Count data were described as absolute numbers or percentages, and comparison between groups was analyzed using the chi-square test. Comparison of ordinal data was analyzed using the nonparametric rank sum test. The COX regression model was used for univariate and multivariate analyses. The Kaplan-Meier method was used to draw survival curves and calculate survival rates, and the Log-rank test was used for survival analysis. Results:(1) Effects of hepatocellular carcinoma patients undergoing TACE and its relationship with clinicopathological factors. Of the 311 patients undergoing TACE, 57 cases had pathologic complete response (pCR) and 254 cases had pathologic partial response (pPR), respectively. Cases with alpha fetoprotein (AFP) <20 μg/L,20?400 μg/L, >400 μg/L, cases with microvascular invasion, cases with tumor number as single nodule, cases with tumor distribution at right lobe of liver, cases with tumor caliber of feeding artery (CFA) >1 mm were 26, 26, 5, 51, 6, 43, 46 in patients with pCR, versus 87, 64, 103, 158, 59, 125, 159 in patients with pPR, showing significant differences in the above indicators ( Z=3.35, χ2=4.54, 15.71, 12.89, 6.79, P<0.05). (2) Follow-up. All the 311 patients were followed up for 47.0 to 59.0 months, with a median follow-up time of 44.6 months. There were 11 cases undergoing tumor recurrence and 11 cases undergoing tumor metastasis in the 57 patients with pCR, and there were 96 cases undergoing tumor recurrence and 66 cases under-going tumor metastasis in the 254 patients with pPR. The 1-, 3-, 5-year tumor recurrence free rates were 98.2%, 91.1%, 80.3% in the 311 patients, respectively. The 1-, 3-, 5-year tumor recurrence free rates were 100.0%, 91.1%, 80.3% in the 57 patients with pCR, versus 82.0%, 68.4%, 59.4% in the 254 patients with pPR, showing significant differences in the above indicators ( χ2=13.47, P<0.05). Cases with graft loss were 11 and 96 in the 57 patients with pCR and the 254 patients with pPR, respectively, showing a significant difference ( χ2=7.06, P<0.05). (3) Influen-cing factors for prognosis of hepatocellular carci-noma patients after liver transplantation. Results of univariate analysis showed that gender, basic diseases as viral hepatitis C, AFP (20?400 μg/L, >400 μg/L), Milan criteria, microvascular invasion, tumor number, tumor distribution, tumor CFA, times of TACE, effects of TACE were related factors influencing prognosis of hepatocellular carcinoma patients after liver transplantation ( hazard ratio=0.49, 3.97, 1.78, 1.84, 2.41, 1.96, 3.00, 1.76, 0.19, 2.01, 3.07, 95% confidence interval as 0.30?0.81, 2.23?7.05, 1.03?3.06, 1.18?2.85, 1.63?3.56, 1.28?3.01, 2.04?4.40, 1.20?2.59, 0.13?0.28, 1.28?3.14, 1.63?5.76, P<0.05). Results of multi-variate analysis showed that AFP >400 μg/L, exceeding Milan criteria, tumor number as multiple nodule,effects of TACE as pPR were independent risk factors influencing prognosis of hepatocellular carcinoma patients after liver transplantation ( hazard ratio=1.59, 2.06, 1.99, 2.05, 95% confidence interval as 1.22?2.07, 1.35?3.13, 1.29?3.07, 1.02?4.10, P<0.05) and tumor CFA >1 mm was an independent protective factor influencing prognosis of hepatocellular carcinoma patients after liver transplantation ( hazard ratio=0.10, 95% confidence interval as 0.05?0.19, P<0.05). Conclusions:The effects of TACE are related to AFP, microvascular invasion, tumor number, tumor distribution and tumor CFA. AFP >400 μg/L, exceeding Milan criteria, tumor number as multiple nodule,effects of TACE as pPR are independent risk factors influencing prognosis of hepatocellular carcinoma patients after liver transplantation and tumor CFA >1 mm is an independent protective factor influencing prognosis of hepatocellular carcinoma patients after liver transplantation.

There are four methods for fecal detection of colorectal cancer (CRC) markers: fecal occult blood test, fecal DNA test, fecal microRNA test, and fecal fusobacterium nucleatum (Fn) test. Fecal immunochemical test has been recommended by experts at home and abroad as the first choice for CRC screening. Fecal DNA test, due to its high price, has not yet been screened for large samples of people in China, so it is recommended as the second level of CRC screening. Fecal microRNA detection has been paid more and more attention by researchers. In recent years, the detection of fecal microbial markers has become more and more popular, especially fecal Fn detection, which is expected to become a microbial indicator for CRC screening.

Liquid biopsy is an emerging non-invasive detection technology, which mainly includes detection of circulating tumor cells, circulating tumor DNA and exosomes. It has a wide application prospect in the prevention and treatment of digestive system tumors. This article reviewed the types of liquid biopsy and its value in the diagnosis and treatment of digestive tract tumor, liver tumor, gallbladder tumor and pancreatic tumor.

More and more studies have found that red blood cell distribution width (RDW) can be used for acute pancreatitis (AP) classification, dynamic monitoring and evaluation of disease severity, mortality, prognosis and complication. Some inflammatory markers, such as procalcitonin (PCT), C-reactive protein (CRP), neutrophil-to-lymphocyte ratio (NLR) and pancreatitis scoring system are also associated with severity of AP, and can further improve the evaluation of AP severity when combined with RDW. This article reviewed the RDW and classification of AP, the dynamic changes of RDW and AP, RDW combined with inflammatory indices for prediction of severity of AP, and RDW combined with pancreatitis scoring system for prediction of severity of AP, so as to improve the understanding of predictive value of RDW in assessing the severity of AP.

Objective:To investigate if antiplatelet agents increase postoperative bleeding risk in patients receiving endoscopic resection of intestinal polyps.Methods:Data of 539 patients who received endoscopic polypectomy from January 2015 to December 2017 in Tianyou Hospital were collected in this retrospective study. Patients were divided into two groups, including antiplatelet therapy group (n=88), which consisted of aspirin-treated subgroup (n=59) and clopidogrel-treated subgroup (n=29), and non-antiplatelet therapy group (n=451). The bleeding incidences after endoscopic polypectomy were compared among groups by Chi-square test.Results:The postoperative bleeding incidence in all 539 patients was 3.0% (16/539). And the incidences in the antiplatelet groups and the non-antiplatelet group were 3.4% (3/88) and 2.9% (13/451), respectively ( P>0.05). Also, there was no statistical difference in the aspirin-treated subgroup (3.4%, 2/59), clopidogrel-treated subgroup (3.4%, 1/29) and non-antiplatelet treated group in the incidence of postoperative bleeding ( χ2=0.561, P=0.642). Conclusion:Antiplatelet agents including aspirin or clopidogrel may not increase the postoperative bleeding risk in patients receiving endoscopic resection of intestinal polyps.

Objective To investigate the improvement of symptoms of the patients after treatment in patients with Rome Ⅳ or non-Rome Ⅳ irritable bowel syndrome (IBS),and to explore the influence of IBS diagnosed by different criteria on the patients.Methods From June 2nd to 8th in 2016,at Outpatients Department of Gastroenterology,Union Hospital Affiliated to Tongji Medical College,Huazhong Uiversity of Science and Technology in Wuhan,1 500 outpatients aged over 18 years old and with intestinal symptom were selected for questionnaire.After treatment for six months,IBS patients,non-IBS patients,patients with Rome Ⅳ IBS and patients with non-Rome Ⅳ IBS were followed up by phone calls.After treatment,the improvement of symptoms of the patients was evaluated by irritable bowel syndrome symptom severity scale (IBS-SSS).The degree of influence of IBS diagnosed with different criteria on patients was evaluated by the patient's daily work whether to choose colonoscopy examination,whether to choose medication,and the efficacy of medicine.Student's t test,Mann-Whitney U test and chi-square test were performed for statistical analysis.Results A total of 352 patients with intestinal symptoms were followed-up,including 175 patients with IBS (84 patients with Rome Ⅳ IBS and 91 patients with non-Rome Ⅳ IBS) and 177 non-IBS patients,and 142 patients responded.There were no statistically significant differences in response rate between non-IBS patients and IBS patients (37.3％,66/177 vs.43.4％,76/175),and between patients with Rome Ⅳ IBS and patients with non-Rome Ⅳ IBS (40.5％,34/84 vs.46.2％,42/91) (x2 =1.379 and 0.573,P =0.240 and 0.449).Compared with the non-IBS patients,the degree of satisfaction of medicine was lower in IBS patients (71.4％,30/42 vs.47.5％,19/40).Compared with non-Rome Ⅳ IBS patients,Rome type Ⅳ IBS patients were more likely to receive colonoscopy (35.7％,15/42 vs.58.8％,20/34),and the differences were statistically significant (x2 =4.878 and 4.039,P =0.027 and 0.044).After six months of treatment,symptoms improved in both Rome Ⅳ IBS patients and non-Rome Ⅳ IBS patients (both P ＜ 0.05),however,the symptoms improved more significantly in Rome Ⅳ IBS patients and the total score of IBS-SSS was lower than that of non-Rome Ⅳ IBS patients (-130,-185 to 60 vs.-70,-100 to 28),and the difference was statistically significant (Z =-3.065,P =0.002).The difference was mainly showed the symptom of abdominal pain,and the IBS-SSS abdominal pain score of Rome Ⅳ IBS patients was lower than that of non-Rome Ⅳ IBS patients (-80,-100 to-40 vs.0,-40 to 0),and the difference was statistically significant (Z =-4.631,P ＜ 0.01).Conclusions IBS symptoms influence a lot on the satisfaction degree of treatment in outpatients.Even with similar good therapeutic effects,the Rome Ⅳ IBS symptoms have a more severe impact on patients than non-Rome Ⅳ IBS symptoms.

This phase I clinical trial (NCT01935843) is to evaluate the safety, feasibility, and activity of chimeric antigen receptor-engineered T cell (CART) immunotherapy targeting human epidermal growth factor receptor 2 (HER2) in patients with advanced biliary tract cancers (BTCs) and pancreatic cancers (PCs). Eligible patients with HER2-positive (>50%) BTCs and PCs were enrolled in the trial. Well cultured CART-HER2 cells were infused following the conditioning treatment composed of nab-paclitaxel (100-200 mg/m) and cyclophosphamide (15-35 mg/kg). CAR transgene copy number in the peripheral blood was serially measured to monitor the expansion and persistence of CART-HER2 cells in vivo. Eleven enrolled patients received 1 to 2-cycle CART-HER2 cell infusion (median CAR T cell 2.1 × 10/kg). The conditioning treatment resulted in mild-to-moderate fatigue, nausea/vomiting, myalgia/arthralgia, and lymphopenia. Except one grade-3 acute febrile syndrome and one abnormal elevation of transaminase (>9 ULN), adverse events related to the infusion of CART-HER2 cells were mild-to-moderate. Post-infusion toxicities included one case of reversible severe upper gastrointestinal hemorrhage which occurred in a patient with gastric antrum invaded by metastasis 11 days after the CART-HER2 cell infusion, and 2 cases of grade 1-2 delayed fever, accompanied by the release of C-reactive protein and interleukin-6. All patients were evaluable for assessment of clinical response, among which 1 obtained a 4.5-months partial response and 5 achieved stable disease. The median progression free survival was 4.8 months (range, 1.5-8.3 months). Finally, data from this study demonstrated the safety and feasibility of CART-HER2 immunotherapy, and showed encouraging signals of clinical activity.
Aged ; Biliary Tract Neoplasms ; immunology ; therapy ; Female ; Humans ; Immunotherapy, Adoptive ; Male ; Middle Aged ; Pancreatic Neoplasms ; immunology ; therapy ; Receptor, ErbB-2 ; immunology ; Receptors, Chimeric Antigen ; immunology ; T-Lymphocytes ; immunology

AIM:To investigate the potential role of Sonic hedgehog (Shh) signaling pathways in the radioresistance of esophageal cancer.METHODS:Radioresistant cell line Eca109R was established by repeating X-ray irradiation at dose of 60 Gy in total using Eca109 cells as parental cells.The radiosensitivity of the parental and radioresistant cells was confirmed by colony formation assay.The cell viability was detected by CCK-8 assay.The intracellular protein levels of Shh and Gli1 were determined by Western blot and immunofluorescence.RESULTS:The survival fractions at dose of 2 Gy for Eca109R cells and Eca109 cells were 0.937±0.013 and 0.499±0.042, respectively.The inhibitory rate of cell viability decreased gradually in the Eca109R cells (P<0.05), suggesting that the radioresistant cell line was successfully established.The results of Western blot indicated that the protein expression of Shh and Gli1 was much higher in the Eca109R cells than that in the Eca109 cells (P<0.05).Immunofluorescence staining showed that Gli1 was expressed in the cytoplasm and nucleus, and presented nuclear clustering in the Eca109R cells.The positive rate of Gil1 expression in Eca109 cells was 52.3%± 0.035%, while that in Eca109R cells was 87.6%±0.021% (P<0.05).CONCLUSION:The radioresistance of esophageal cancer may be related to the activation of Shh signaling pathways with over-expression of Gli1 and other related proteins.