Gastrointestinal tumors are a serious and threatening public health concern.Endoscopic minimally invasive treatment is an im-portant way to achieve early diagnosis and treatment of gastrointestinal tumors.Here,we summarize the history and current status of en-doscopic minimally invasive resection of early-stage gastrointestinal tumors,and explain the application of the new ERBEC concepts of endo-scopic minimally invasive surgery for the treatment of gastrointestinal tumors,which include elements,reservation-resection,bilateral-bene-fit,expansion,and collaboration.We also discuss the future direction of endoscopic minimally invasive resection for gastrointestinal tumors.

Objective:To explore the relationship between adipocytokine levels in bone marrow and the onset,progression,and prognosis of myelodysplastic syndromes(MDS).Methods:Retrospective analysis of adipocytokine levels in the bone marrow of 72 patients with MDS and 16 patients with MDS-related secondary acute myeloid leukemia(sAML),including adiponectin(ADP),leptin(LEP),visfatin/nicotinamide phosphoribosyltransferase(NAMPT),adipsin/complement factor D(CFD),and C1q/TNF-related protein 1(CTRP1),detected by enzyme-linked immunosorbent assay(ELISA)at The Affiliated Cancer Hospital of Zhengzhou University from February 2020 to February 2022.High-throughput sequencing was used to detect MDS-related genes in 70 patients and the relationship between adipocytokines and the clinical characteristics,disease subtypes,mutant genes,and prognosis of patients were analyzed.Seventy-eight MDS-related genes were identified.Results:Clinical characteristics showed that ADP(P=0.027)and LEP(P=0.019)levels were significantly lower in men than inwomen;ADP(P=0.020),CFD(P<0.001),and NAMPT(P=0.021)levels were significantly lower in patients aged<65 years than in patients aged≥65,where-as LEP levels were significantly higher(P=0.043).Adiponectin levels were significantly higher in patients with BMI<24 than in patients with BMI≥24(P=0.025),whereas LEP levels were significantly lower(P=0.020);NAMPT levels were significantly higher in the group with in-creased blasts than in the group with no blasts(P=0.037).The CTRP1 levels were significantly higher in the MDS group than in the sAML group(P=0.010).Abnormal gene correlation analysis showed that elevated CTRP1 levels were positively correlated with the occurrence of epigenetically related abnormal genes(P=0.001)and were positively correlated with the occurrence of TET2 and U2AF1(P<0.001 and P=0.036,respectively);ADP and CFD levels were positively correlated with the occurrence of NPM1(P=0.048 and P=0.026,respectively).Multifactorial Cox proportional hazards regression model analysis showed that LEP<0.2 ng/mL was an independent risk factor for progres-sion-free survival(PFS)and overall survival in patients with MDS(P=0.002 and P<0.001,respectively),whereas NAMPT<2.1 ng/mL was a protective factor for PFS in patients with MDS(P=0.043).Conclusions:Adipocytokines in the bone marrow microenvironment are closely as-sociated with the clinical characteristics,gene mutations,and prognosis of patients with MDS,with LEP<0.2 ng/mL being an independent prognostic risk factor and NAMPT<2.1 ng/mL being a prognostic protective factor.

Objective:To evaluate the effect of ultrasound-guided subserratus anterior plane block on postoperative analgesia in patients un-dergoing laparoscopic radical gastrectomy.Methods:Sixty patients who underwent elective laparoscopic radical gastrectomy were enrolled between May 2022 and October 2023 at Tianjin Medical University Cancer Institute&Hospital.Patients were assigned into two groups us-ing a random number table method:the control(group C)and the ultrasound-guided serratus anterior plane block(SAPB)(group S).Patient-controlled intravenous analgesia(PCIA)was administered at the end of the surgery.After surgery,visual analogue scale(VAS)of static pain scores was evaluated at 1,6,12,24,and 48 hours.PCIA pump was started at the VAS pain score≥4 after surgery,and sufentanil 0.1μg/kg was intravenously injected when the efficacy was inadequate.The requirement for PCIA use,time to first postoperative anal exhaust,first postoperative out-of-bed activity,first oral intake,and the duration of hospitalization stay were recorded for the two groups.Results:VAS scores were significantly lower at postoperative 1,6,and 12 h in group S than in group C(P<0.05).Additionally,the number of effective uses of PCIA,and rescue analgesia were significantly lower in group S[(6.1±0.4)(2)]than in group C[(18.6±1.4)(17)](P<0.001).The time to first postoperative anal exhaust,first postoperative out-of-bed activity,first oral intake,and duration of hospital stay were shortened in group S than in group C(P<0.05).There were no significant differences in other parameters between these two groups.Conclusion:Ultrasound-guided SAPB can reduce postoperative pain and facilitate fast recovery in laparoscopic radical gastrectomy patients.

Objective:To analyze the clinical characteristics,diagnosis,and treatment of renal cell carcinoma in kidney transplant recipients.Methods:The clinical data of 27 kidney transplant recipients(2 female and 25 male patients)with renal cell carcinoma admitted to Tianjin First Center Hospital between March 2011 and March 2023 were retrospectively analyzed.Twenty-four of the 27 patients underwent radic-al nephrectomy,including one who underwent bilateral surgery and one who underwent nephroureterectomy.Three patients were conser-vatively treated.The surgical approaches included open,laparoscopic,and robot-assisted laparoscopic procedures,and analyses were per-formed on the diagnosis and treatment process,pathological features,and surgical prognoses of patients.Results:The surgical duration was 148 min(range,100-210 min),and the postoperative hospital stay was 7 d(range,4-10 d).Twenty-four cases of renal cell carcinoma were detected in native kidneys,with an average diameter of(4.03±2.49)cm,including 6 cases of papillary renal cell carcinomas,1 case of chro-mophobe cell carcinoma,and 17 cases of clear cell carcinomas.One of the conservatively treated patients with graft clear renal cell car-cinoma was pathologically confirmed via biopsy puncture.The clinical stages of the 27 patients were divided based on the extent of the tu-mor(T),extent of spread to the lymph nodes(N),and presence of metastasis(M),referred to as the TNM staging criteria as follows:T1aN0M0 in 18 cases,T1bN0M0 in 4 cases,T2aN0M0 in 2 cases,and T4N1M1 in 3 cases.The average age at the first tumor diagnosis after transplantation was(51.21±7.60)years.Median dialysis time before transplantation was 19 months(range,1.2-72 months).The median time from tumor diagnosis to transplantation surgery was 95 months(range,12-180 months).The median follow-up time of the 27 patients was 47 months(range,3-147 months),and two patients died after 129 and 95 months of follow-up because of pneumonia and sepsis,re-spectively.Conclusions:Early diagnosis of renal cancer after renal transplantation is difficult because of multiple cystic changes and necrotic tendencies.In addition,it is especially important to have a standardized follow-up plan and determine the timing of prophylactic surgery.

Objective:To enhance comprehension of undifferentiated embryonal sarcoma of the liver(UESL)in children by analyzing ultra-sound,CT,and MRI imaging features.Methods:A retrospective analysis was conducted on 11 cases of UESL in children,confirmed through surgery and pathology,at the Children's Hospital,Affiliated Capital Institute of Pediatrics from December 2009 to December 2021.We ana-lyzed the ultrasound,CT,and MRI imaging features of all patients and summarized their characteristics.Results:All 11 cases presented with solitary hepatic masses ranging from 11.5 to 19.8 cm in diameter.Imaging manifestations of UESL correlated with component proportion and distribution within the masses.Lesions displayed clear boundaries in all cases.CT scans revealed mixed low density in 11 cases,with ir-regular floc soft tissue density shadows observed at the edge of cystic density areas or around partitions in a few cases.Ultrasound images of all six cases showed solid space-occupying masses,with varying sizes of anechoic regions within the solid mass.MRI T1WI showed mixed low intensity signal in three cases and strip/large high intensity signal areas in the lesion.T2WI revealed mixed high intensity signal and strip low intensity signal areas in 3 lesions.In the arterial phase,lesions displayed slightly to moderately heterogeneous strip/patch enhancement,primarily marginal enhancement in nine cases and thickened,tortuous arterial shadows in eight cases.In the delayed phase,lesions showed continuous uneven enhancement,with enhancement at the edge and peripheral-to-central filling observed in eight cases.Additionally,the enhancement range continuously increased in eight cases,with the false capsule sign identified in eight cases in the delayed stage.Conclu-sions:Imaging features of UESL in children exhibit distinct characteristics.Understanding these features,in conjunction with clinical findings,may aid in early diagnosis.

Radiomics-based early prediction and treatment efficacy evaluation is critical for personalized treatment strategies in patients with colorectal cancer liver metastases(CCLM).Owing to the high artificial intelligence(AI)participation,repeatability,and reliable perform-ance,deep learning(DL)based on convolutional neural networks enhances the predictive efficacy of the models,enabling its potential clinic-al application more promising.Subsequent to the gradual construction of a multimodal fusion model and multicenter large sample database,radiomics and DL will become increasingly essential in the management of CCLM.This review focuses on the main steps of radiomics and DL,and summarizes the value of its application in early state prediction and treatment efficacy evaluation of different treatment modalities in CCLM,we also look forward to the potential of its in-depth application in the clinical management of CCLM.

Organoids are novel in vitro models that can effectively simulate the complexities of tumor microenvironments.Compared to tra-ditional preclinical models,organoids retain most of the histological and molecular properties of the primary tumor;therefore,they are more useful for studying tumor heterogeneity,underlying functional pathways,and immune microenvironments as well as for research on biomarker discovery,drug screening,and individual chemotherapy.Furthermore,current limitations,challenges such as low modeling suc-cess rates,high costs,and lack of standardization are expected to be overcome by continued innovations in bioengineering technologies and interdisciplinary integration.This article reviews the advantages,establishment processes,and prospects and challenges associated with the clinical application of organoids in bladder cancer.

Acute myeloid leukemia(AML)is a heterogeneous myeloid malignancy.Currently,chemotherapy combined with hematopoietic stem cell transplantation is the primary treatment option;however,over-all prognosis remains poor.Gemtuzumab ozogamicin(GO)is a hu-manized CD33 monoclonal antibody conjugated with calicheamicins.It is primarily used to treat CD33-positive AML.Although studies have found that GO can improve the prognosis of patients with CD33-positive AML,some patients with AML do not benefit from it.Recent stud-ies have found that the effect of GO on AML is primarily associated with the expression of CD33 and its single nucleotide polymorphism(SNP),ATP-binding cassette subfamily B member 1(ABCB1)gene and SNP,as well as specific molecular biology and cytogenetics.This paper reviews the research progress on the factors influencing efficacy of GO for treating AML.

Objective:To assess the application value of low-dose contrast agent combined with bolus tracking technique in radiotherapy localization for nasopharyngeal carcinoma (NPC).Methods:One hundred patients with NPC for radiotherapy localization were enrolled prospectively and randomly divided into observation ( n = 50) and control ( n = 50) group using random number table. All patients in the control group underwent routine computerized tomography (CT) for radiotherapy localization with an intravenous bolus of 80 ml iodinated contrast media. Images were obtained at a fixed delay of 50 s from the beginning of contrast injection. Patients in the observation group underwent CT scan using a bolus tracking technique with an intravenous bolus of 50-60 ml iodinated contrast media. By observing the time-CT value monitoring curve, the scanning was manually triggered when the peak fell. The score of image quality, enhanced CT value, iodine contrast dose, and dose calculation variance of planning target volume were compared between the two different dose groups. The differences of dose were compared using independent sample t-tests and the differences in graph scores were compared using Wilcoxon rank sum tests. Results:The dosage of iodine contrast agent in the observation group was 28.75% less than that in the control group, and the difference achieved statistical significance ( t=-42.11, P<0.001). The enhanced CT value of carotid artery and jugular vein in the control group increased 32.58% and 21.02% compared with patients in the observation group, respectively ( t=-8.11 and -4.82, P<0.001 for both). No statistically significant differences in the enhanced CT value were found for the gross tumor volume (GTV) of nasopharynx or sternocleidomastoid between the two groups ( P>0.05). The images in both groups can met the requirements of target volume delineation, and the difference of subjective score was not statistically significant ( Z=-1.36, P=0.175). There were no significant differences in the signal-to-noise ratio (SNR) or contrast-to-noise ratio (CNR) of nasopharynx between the two groups ( P>0.05). The results of subjective score and GTV target area showed high consistency between the two doctors with a κ value of 0.77. The differences in dose calculation variance of planning target volume between the two different dose groups was also not statistically significant ( P>0.05). Conclusions:In the radiotherapy localization for nasopharyngeal carcinoma, the application of low-dose contrast agent combined with bolus tracking technique could obtain good images for target delineation and effectively reduce the intake of iodine contrast agent and the risk of adverse reactions. Based on these results, low-dose contrast agent combined with bolus tracking technique has wide range of application.

Objective:To investigate the clinical efficacy and safety of anlotinib combined with radiotherapy as a third-line treatment regimen for extensive stage small-cell lung cancer (ES-SCLC) in a real-world background.Methods:Forty ES-SCLC patients enrolled in a single center of Affiliated Cancer Hospital of Xinjiang Medical University in China between November 2018 and July 2021 were treated with radiotherapy added on anlotinib as a third-line treatment regimen. Overall survival (OS), progression-free survival (PFS), safety, and quality of life were analyzed, and the survival status was statistically analyzed using Kaplan-Meier method.Results:Among the 40 patients, partial remission, stable disease, and progressive disease was confirmed in 7, 24 and 9 patients, respectively. The obtained objective remission rate (ORR) was 18%, the disease control rate (DCR) was 78%, and median PFS and median OS were 4.5 months and 9 months, respectively. The most common adverse reactions included fatigue (28%), bleeding (20%), anorexia (13%), and hand-foot syndrome (8%). Most of them were grade 1-2 in severity, 4 cases were documented as ≥grade 3, and no grade 5 toxicity was recorded.Conclusions:In the real world, radiotherapy added on anlotinib as a third-line regimen can prolong PFS and OS of the ES-SCLC patients, and the adverse reactions are generally tolerated. This combination treatment regimen is worthy of further investigation.