Background/Aims: Obesity is associated with several gastrointestinal (GI) disorders and has been identified as a potential risk factor for various GI symptoms. Bowel frequency is an important indicator of bowel function. However, the causal link between obesity and gastrointestinal motility remains uncertain. This study aims to determine the causal effect of overall and central obesity on stool frequency. Methods: Four obesity-related anthropometric indicators–body mass index, body fat percentage, waist circumference (WC), and waist-tohip ratio (WHR)–were investigated. Individual-level baseline information from the UK Biobank was used to explore observational associations between obesity and stool frequency. Additionally, summary-level data from published genome-wide association studies were subjected to two-sample Mendelian randomization (MR) analyses to examine causal associations. Results: For all 4 indicators of obesity, higher levels of obesity were associated with more frequent bowel movements after adjusting for demographic characteristics, lifestyle, and dietary factors. After rigorous screening, 482 body mass index single nucleotide polymorphisms (SNPs), 7 body fat percentage SNPs, 48 WC SNPs, and 287 WHR SNPs were identified as instrument variables for MR analysis. The MR results were generally consistent with observational findings, proving that the associations observed in the overall obesity indicators were causal. For central obesity, the association between WHR and stool frequency remained consistent in both analysis phases, whereas WC showed a multidirectional association. Conclusions Obesity-related anthropometric indicators were causally associated with increased stool frequency in the overall and central obesity groups. Weight loss could be a potential approach to improve gastrointestinal regularity in individuals with obesity.

Background/Aims: Obesity is associated with several gastrointestinal (GI) disorders and has been identified as a potential risk factor for various GI symptoms. Bowel frequency is an important indicator of bowel function. However, the causal link between obesity and gastrointestinal motility remains uncertain. This study aims to determine the causal effect of overall and central obesity on stool frequency. Methods: Four obesity-related anthropometric indicators–body mass index, body fat percentage, waist circumference (WC), and waist-tohip ratio (WHR)–were investigated. Individual-level baseline information from the UK Biobank was used to explore observational associations between obesity and stool frequency. Additionally, summary-level data from published genome-wide association studies were subjected to two-sample Mendelian randomization (MR) analyses to examine causal associations. Results: For all 4 indicators of obesity, higher levels of obesity were associated with more frequent bowel movements after adjusting for demographic characteristics, lifestyle, and dietary factors. After rigorous screening, 482 body mass index single nucleotide polymorphisms (SNPs), 7 body fat percentage SNPs, 48 WC SNPs, and 287 WHR SNPs were identified as instrument variables for MR analysis. The MR results were generally consistent with observational findings, proving that the associations observed in the overall obesity indicators were causal. For central obesity, the association between WHR and stool frequency remained consistent in both analysis phases, whereas WC showed a multidirectional association. Conclusions Obesity-related anthropometric indicators were causally associated with increased stool frequency in the overall and central obesity groups. Weight loss could be a potential approach to improve gastrointestinal regularity in individuals with obesity.

Background/Aims: Obesity is associated with several gastrointestinal (GI) disorders and has been identified as a potential risk factor for various GI symptoms. Bowel frequency is an important indicator of bowel function. However, the causal link between obesity and gastrointestinal motility remains uncertain. This study aims to determine the causal effect of overall and central obesity on stool frequency. Methods: Four obesity-related anthropometric indicators–body mass index, body fat percentage, waist circumference (WC), and waist-tohip ratio (WHR)–were investigated. Individual-level baseline information from the UK Biobank was used to explore observational associations between obesity and stool frequency. Additionally, summary-level data from published genome-wide association studies were subjected to two-sample Mendelian randomization (MR) analyses to examine causal associations. Results: For all 4 indicators of obesity, higher levels of obesity were associated with more frequent bowel movements after adjusting for demographic characteristics, lifestyle, and dietary factors. After rigorous screening, 482 body mass index single nucleotide polymorphisms (SNPs), 7 body fat percentage SNPs, 48 WC SNPs, and 287 WHR SNPs were identified as instrument variables for MR analysis. The MR results were generally consistent with observational findings, proving that the associations observed in the overall obesity indicators were causal. For central obesity, the association between WHR and stool frequency remained consistent in both analysis phases, whereas WC showed a multidirectional association. Conclusions Obesity-related anthropometric indicators were causally associated with increased stool frequency in the overall and central obesity groups. Weight loss could be a potential approach to improve gastrointestinal regularity in individuals with obesity.

Objective To explore the efficacy and safety of enhanced external counterpulsation(EECP)in elderly patients with acute ischemic stroke(AIS)complicated by coronary heart dis-ease(CHD).Methods A total of 65 AIS patients with CHD admitted in our hospital from Janu-ary to June 2023 were recruited and randomly divided into a control group(drug secondary pre-vention,n=32)and a treatment group(drug combined with EECP therapy,n=33).Their NIHSS score,mRS score and Canadian Cardiovascular Society(CCS)angina grade were evaluated before and after treatment and compared between the two groups.The incidences of recurrent ischemic stroke,new hemorrhagic stroke and major adverse cardiovascular events(MACE)were also recor-ded during treatment.Results The NIHSS score and mRS score were significantly decreased in both groups after treatment(P＜0.01).After treatment,the NIHSS score(2.67±1.63 vs 3.56± 1.83),mRS score[1.0(0.0,1.0)vs 2.0(1.0,2.0)]and CCS grade[1.0(1.0,2.0)vs 2.0(1.0,2.0)]were obviously lower in the treatment group than the control group(P＜0.05,P＜0.01).There were no statistical differences in the incidence rates of recurrent ischemic stroke,new-onset hem-orrhagic stroke,and MACE between the control group and the treatment group(9.4％vs 6.1％,6.3％vs 3.0％,12.5％vs 6.1％,P＞0.0 5).Conclusion EECP is a safe and effective treatment option for elderly AIS patients with CHD.

Objective To investigate the diagnostic value of high-resolution magnetic resonance im-aging(HRMRI)in elderly patients with non-cardioembolic acute ischemic stroke(NCAIS).Meth-ods A retrospective analysis was conducted on 101 elderly NCAIS patients having HRMRI in our hospital from July 2022 to July 2023.Stroke subtypes were classified according to the Trial of Org 10172 in Acute Stroke Treatment(TOAST)system and the Chinese Ischemic Stroke Sub-classification(CISS)system.The constituent ratio distribution of each subtype classification was compared before and after HRMRI in both classification systems.Results TOAST system identi-fied 8 cases of small-artery occlusion(SAO),1 case of other determined etiology(SOE),5 cases of undetermined etiology(SUE)and then reclassified as large artery atherosclerosis(LAA),1 case of SUE which was reclassified as SAO,and 7 cases of LAA and 4 cases of SUE being reclas-sified as SOE after HRMRI.In total,the diagnosis of 26 cases(25.74％)was modified.In the CISS system,10 cases of penetrating artery disease(PAD),1 case of other etiologies(OE),and 4 cases of undetermined etiology(UE)were reclassified as LAA.Furthermore,9 cases of LAA and 3 cases of UE were reclassified as OE after HRMRI.In total,the diagnosis of 27 cases(26.73％)was modified.There were statistical differences in the constituent ratio before and after HRMRI in both TOAST(x2=15.425,P＜0.01)and CISS(x2=17.300,P＜0.01)systems.Conclusion HRMRI is of diagnostic value and significance in accurately diagnosing the etiology of AIS in eld-erly patients without cardioembolic causes.

Compared with traditional drug therapy, nanomedicines exhibit intriguing biological features to increase therapeutic efficiency, reduce toxicity and achieve targeting delivery. This review provides a snapshot of nanomedicines that have been currently launched or in the clinical trials, which manifests a diversified trend in carrier types, applied indications and mechanisms of action. From the perspective of indications, this article presents an overview of the applications of nanomedicines involving the prevention, diagnosis and treatment of various diseases, which include cancer, infections, blood disorders, cardiovascular diseases, immuno-associated diseases and nervous system diseases, etc. Moreover, the review provides some considerations and perspectives in the research and development of nanomedicines to facilitate their translations in clinic.

Objective:To investigate the risk factors for synchronous multiple early gastric cancer (SMEGC).Methods:A retrospective analysis was conducted on data of 390 patients with early gastric cancer, including 353 cases of solitary early gastric cancer (SEGC group) and 37 cases of SMEGC (SMEGC group), who underwent endoscopic submucosal dissection (ESD) in Chinese PLA General Hospital from January 2017 to June 2019. The differences in clinical characteristics (gender, age, body mass index, smoking status, drinking status, family history of gastrointestinal cancer and other cancers, etc.) and pathological characteristics (size, location, morphology, differentiation degree, invasion depth, with or without Helicobacter pylori infection, intestinal metaplasia, ulcers and atrophic gastritis of lesions, etc.) between the two groups were compared by t test, Mann-Whitney U test, Chi-square test, or Fisher′s exact test. Logistic regression (forward LR) was used to screen the independent risk factors for SMEGC. Results:There were no significant differences in the general clinical characteristics between SMEGC group and SEGC group ( P>0.05). Significant statistical differences were observed in the location of lesions ( χ2=8.375, P=0.015), the proportion of atrophic gastritis [48.6% (18/37) VS 23.8% (84/353), χ2=10.710, P=0.001] and the proportion of intestinal metaplasia [81.1% (30/37) VS 43.1% (152/353), χ2=19.452, P<0.001] between the two groups, but there were no significant differences in other pathological characteristics ( P>0.05). Multivariate logistic regression analysis showed that location of lesions in the middle 1/3 of stomach (VS upper 1/3: P=0.036, OR=3.38, 95% CI: 1.08-10.53), in the lower 1/3 of stomach (VS upper 1/3: P=0.049, OR=2.59, 95% CI: 1.00-6.69), presence of intestinal metaplasia ( P=0.001, OR=4.38, 95% CI: 1.77-10.86) and atrophic gastritis ( P=0.043, OR=2.24, 95% CI: 1.04-5.07) were independent risk factors for SMEGC. Conclusion:Patients with early gastric cancer located in the middle or lower 1/3 of stomach, with intestinal metaplasia and atrophic gastritis are prone to SMEGC and should be carefully evaluated and closely followed up after ESD.

Objective:To evaluate the clinical value of suspensory incision and suture technique in endoscopic full-thickness resection (EFTR) for muscularis propria tumor of gastric fundus.Methods:A retrospective analysis was performed on the data of 20 patients with muscularis propria tumor in gastric fundus and undergoing EFTR in the First Medical Center of PLA General Hospital from June 2017 to June 2019. Patients were divided into the observation group (9 cases) treated with suspensory incision and suture technique in EFTR and the control group (11 cases) treated with traditional EFTR method. The baseline data and perioperative data of the two groups were analyzed.Results:EFTR was successfully performed on all 20 patients. The tumor size of the observation group and the control group was 10.0 (7.5, 21.0) mm and 14.0 (10.0, 20.0) mm, respectively. The resection time of the two groups was 26.4±6.3 min and 35.5±11.4 min, respectively. The postoperative hospital stay was 6.4±1.0 d and 7.7±1.5 d, respectively. No postoperative delayed bleeding, perforation, or other complications occurred in the two groups.Conclusion:Using suspensory incision and suture technique is safe and effective during EFTR for muscularis propria tumor in gastric fundus, and can reduce operation time. This technique is worth applying in clinic.

Objective To assess the efficacy and safety of autologous skin-grafting surgery ( ASGS) in the prevention of esophageal stenosis after complete circular endoscopic submucosal tunnel dissection ( ESTD) for early esophageal cancer. Methods Between January 2018 and March 2018, five patients with early esophageal cancer underwent complete circular ESTD and ASGS in Chinese PLA General Hospital. The skin-graft survival situation, and occurrence of esophageal stenosis and complications were observed by endoscopy follow-up. Results Complete circular ESTD and ASGS were successfully performed in all 5 patients, and no complications including perforation, bleeding, wound infection or stent migration occurred. The mean skin-graft survival rate was 86. 0％. Four patients did not experience esophageal stenosis over the mean follow-up of 9. 5 months. One patient experienced esophageal stenosis after operation, and underwent endoscopic balloon dilatation. No stenosis occurred in 8 months of follow-up. Conclusion ASGS is a safe and effective method to prevent esophageal stenosis after complete circular ESTD.

Objective: To understand the consistency of ALK Ventana-D5F3 immunohistochemistry (IHC) interpretation in Chinese lung adenocarcinoma among histopathologists from different hospitals, and to recommend solution for the problems found during the interpretation of ALK IHC in real world, with the aim of the precise selection of patients who can benefit from ALK targeted therapy. Methods: This was a multicenter and retrospective study. A total of 109 lung adenocarcinoma cases with ALK Ventana-D5F3 IHC staining were collected from 31 lung cancer centers in RATICAL research group from January to June in 2018. All cases were scanned into digital imaging with Ventana iSCANcoreo Digital Slide Scanning System and scored by 31 histopathologists from different centers according to ALK binary (positive or negative) interpretation based on its manufacturer′s protocol. The cases with high inconsistency rate were further analyzed using FISH/RT-PCR/NGS. Results: There were 49 ALK positive cases and 60 ALK negative cases, confirmed by re-evaluation by the specialist panel. Two cases (No. 2302 and No.2701) scored as positive by local hospitals were rescored as negative, and were confirmed to be negative by RT-PCR/FISH/NGS. The false interpretation rate of these two cases was 58.1% (18/31) and 48.4% (15/31), respectively. Six out of 31 (19.4%) pathologists got 100% accuracy. The minimum consistency between every two pathologists was 75.8%.At least one pathologist gave negative judgement (false negative) or positive judgement (false positive) in the 49 positive or 60 negative cases, accounted for 26.5% (13/49), 41.7% (25/60), respectively, with at least one uncertainty interpretation accounted for 31.2% (34/109). Conclusion There are certain heterogeneities and misclassifications in the real world interpretation of ALK-D5F3 IHC test, which need to be guided by the oncoming expert consensus based on the real world data.