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Assessment of the triglyceride glucose index in adult patients with chronic diarrhea and constipation

World Journal of Clinical Cases 2024年第6期12卷 1094-1103页

作者： Jing-Yi Zhu Mu-Yun Liu Chang Sun Department of gastroenterology The First Affiliated Hospital of Naval Medical UniversityShanghai 200433China Department of gastroenterology Navy No.905 HospitalNaval Medical UniversityShanghai 200433China

BACKGROUND Accumulating evidence suggests that the gut microbiome is involved in the pathogenesis of insulin resistance(IR).However,the link between two of the most prevalent bowel disorders,chronic diarrhea and constipation,and the triglyceride glucose(TyG)index,a marker of IR,has not yet been investigated.AIM To investigate the potential association between TyG and the incidence of chronic diarrhea and constipation.METHODS This cross-sectional study enrolled 2400 participants from the National Health and Nutrition Examination Survey database from 2009-2010.TyG was used as an exposure variable,with chronic diarrhea and constipation as determined by the Bristol Stool Form Scale used as the outcome variables.A demographic investigation based on TyG quartile subgroups was performed.The application of multivariate logistic regression models and weighted generalized additive models revealed potential correlations between TyG,chronic diarrhea,and constipation.Subgroup analyses were performed to examine the stability of any potential associations.RESULTS In the chosen sample,chronic diarrhea had a prevalence of 8.00%,while chronic constipation had a prevalence of 8.04%.In multiple logistic regression,a more prominent positive association was found between TyG and chronic diarrhea,particularly in model 1(OR=1.45;95%CI:1.17-1.79,P=0.0007)and model 2(OR=1.40;95%CI:1.12-1.76,P=0.0033).No definite association was observed between the TyG levels and chronic constipation.The weighted generalized additive model findings suggested a more substantial positive association with chronic diarrhea when TyG was less than 9.63(OR=1.89;95%CI:1.05-3.41,P=0.0344),and another positive association with chronic constipation when it was greater than 8.2(OR=1.74;95%CI:1.02-2.95,P=0.0415).The results of the subgroup analyses further strengthen the extrapolation of these results to a wide range of populations.CONCLUSION Higher TyG levels were positively associated with abnormal bowel health.

关键词： Triglyceride glucose index National Health and Nutrition Examination Survey Chronic diarrhea Chronic constipation Cross-sectional study Bowel health

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Reveal more mechanisms of precondition mesenchymal stem cells inhibiting inflammation

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World Journal of Stem Cells 2024年第4期16卷 459-461页

作者： Yi Li Qian-Qian Chen En-Qiang Linghu Department of gastroenterology First Medical Center of Chinese PLA General HospitalBeijing 100853China Department of gastroenterology and Hepatology First Medical Center of Chinese PLA General HospitalBeijing 100853China

Hypoxia can get more ability to inhibit inflammation.But how it impact on survival time of mesenchymal stem cells(MSCs)is confusing and how preconditioned MSCs inhibiting inflammation are partially known.Those issues ... 详细信息

关键词： Mesenchymal stem cell Hypoxia-inducible factor 1α Hypoxia Inflammation Macrophage

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Clinical and socioeconomic determinants of survival in biliary tract adenocarcinomas

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World Journal of Gastrointestinal Oncology 2024年第4期16卷 1374-1383页

作者： Laura Sahyoun Kay Chen Cynthia Tsay George Chen Petr Protiva Department of gastroenterology and Hepatology Weill Cornell MedicineNew YorkNY 10065United States gastroenterology Section Jennifer Moreno VA San Diego Healthcare SystemSan DiegoCA 92161United States Division of gastroenterology Department of MedicineUniversity of California San DiegoLa JollaCA 92093United States Department of gastroenterology and Hepatology John Hopkins HospitalBaltimoreMD 21287United States Department of Digestive Diseases Yale New Haven HospitalNew HavenCT 06520United States Department of gastroenterology VA Connecticut Health Care SystemWest HavenCT 06516United States

BACKGROUND Despite advances in detection and treatments,biliary tract cancers continue to have poor survival outcomes.Currently,there is limited data investigating the significance of socioeconomic status,race/ethnicity,and environmental factors in biliary tract cancer survival.Data from the Surveillance,Epidemiology,and End Results database for biliary and gallbladder adenocarcinomas were extracted from 1975 to 2016.Socioe-conomic data included smoking,poverty level,education,adjusted household income,and percentage of foreign-born persons and urban population.Survival was calculated with Cox proportional hazards models for death in the 5-year period following diagnosis.RESULTS Our study included 15883 gallbladder,11466 intrahepatic biliary,12869 extrahepatic biliary and 7268 ampulla of Vater adenocarcinoma cases.When analyzing county-specific demographics,patients from counties with higher incomes were associated with higher survival rates[hazard ratio(HR)=0.97,P<0.05].Similarly,counties with a higher percentage of patients with a college level education and counties with a higher urban population had higher 5-year survival rates(HR=0.96,P=0.002 and HR=0.97,P=0.004,respectively).CONCLUSION Worse survival outcomes were observed in lower income counties while higher income and education level were associated with higher 5-year overall survival among gallbladder and biliary malignancies.

关键词： Biliary tract cancers Survival Outcomes research Socioeconomic factors Healthcare disparities

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Evaluation of the efficacy and safety of endoscopic band ligation in the treatment of bleeding from mild to moderate gastric varices type 1

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World Journal of gastroenterology 2024年第5期30卷 440-449页

作者： Yue Deng Ya Jiang Tong Jiang Ling Chen Hai-Jun Mou Bi-Guang Tuo Guo-Qing Shi Department of gastroenterology Digestive Disease HospitalThe Affiliated Hospital of Zunyi Medical UniversityZunyi 563000Guizhou ProvinceChina Department of gastroenterology Guizhou Hospital of the First Affiliated HospitalSun Yat-sen UniversityGuiyang 550000Guizhou ProvinceChina Department of gastroenterology Yinjiang Autonomous County People’s HospitalTongren 554300Guizhou ProvinceChina

BACKGROUND According to practice guidelines,endoscopic band ligation(EBL)and endoscopic tissue adhesive injection(TAI)are recommended for treating bleeding from esophagogastric varices.However,EBL and TAI are known to cause serious complications,such as hemorrhage from dislodged ligature rings caused by EBL and hemorrhage from operation-related ulcers resulting from TAI.However,the optimal therapy for mild to moderate type 1 gastric variceal hemorrhage(GOV1)has not been determined.Therefore,the aim of this study was to discover an individualized treatment for mild to moderate GOV1.AIM To compare the efficacy,safety and costs of EBL and TAI for the treatment of mild and moderate GOV1.METHODS A clinical analysis of the data retrieved from patients with mild or moderate GOV1 gastric varices who were treated under endoscopy was also conducted.Patients were allocated to an EBL group or an endoscopic TAI group.The differences in the incidence of varicose relief,operative time,operation success rate,mortality rate within 6 wk,rebleeding rate,6-wk operation-related ulcer healing rate,complication rate and average operation cost were compared between the two groups of patients.RESULTS The total effective rate of the two treatments was similar,but the efficacy of EBL(66.7%)was markedly better than that of TAI(39.2%)(P<0.05).The operation success rate in both groups was 100%,and the 6-wk mortality rate in both groups was 0%.The average operative time(26 min)in the EBL group was significantly shorter than that in the TAI group(46 min)(P<0.01).The rate of delayed postoperative rebleeding in the EBL group was significantly lower than that in the TAI group(11.8%vs 45.1%)(P<0.01).At 6 wk after the operation,the healing rate of operation-related ulcers in the EBL group was 80.4%,which was significantly greater than that in the TAI group(35.3%)(P<0.01).The incidence of postoperative complications in the two groups was similar.The average cost and other related economic factors were greater for the EBL than for the TAI(P<0.01).CONC

关键词： Gastric varices Type 1 gastric variceal hemorrhage Endoscopic band ligation Tissue adhesive injection

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Idiopathic mesenteric phlebosclerosis missed by a radiologist at initial diagnosis: A case report

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World Journal of Clinical Cases 2024年第10期12卷 1810-1816页

作者： Min Wang Yu-Xia Wan Jin-Wen Liao Fei Xiong Department of gastroenterology Changning County People’s HospitalYibin 644300Sichuan ProvinceChina Department of gastroenterology Qianwei People’s HospitalLeshan 614400Sichuan ProvinceChina Department of gastroenterology The People’s Hospital of Jianyang CityChengdu 641400Sichuan ProvinceChina Department of gastroenterology Sichuan Provincial People’s HospitalUniversity of Electronic Science and Technology of ChinaChengdu 610000Sichuan ProvinceChina

BACKGROUND Idiopathic mesenteric phlebosclerosis(IMP)is a rare type of ischemic colitis characterized by thickening of the wall of the right hemicolon and calcification,sclerosis,and fibrosis of mesenteric veins.The diagnosis of IMP is based on typical clinical features and imaging findings.We report a case of IMP that was initially missed by the radiologist.CASE SUMMARY A 77-year-old woman was admitted to the hospital due to chronic diarrhea for over 2 months.She had been consuming Chinese patent medicines(CPM)containing fructus gardeniae for more than 15 years.Colonoscopy revealed an edematous mucosa,bluish-purple discoloration,erosions,and ulcerations throughout the colorectal area.Abdominal computed tomography(CT)showed diffuse mural thickening of the entire colorectum,with tortuous thread-like calcifications in the right hemicolon,left hemicolon,and rectum.Most of the calcifications were located in the mesenteric vein.The diagnosis of IMP was established based on medical history,colonoscopy,CT findings,and histopathological examination.The patient was treated conservatively with papaverine and rifaximin,and CPM was stopped.Her diarrhea symptoms improved,indicating the effectiveness of the treatment.Over the next several years,she took opium alkaloids for an extended period and did not require hospitalization for the aforementioned gastrointestinal disorder.CONCLUSION IMP is a rare gastrointestinal disease affecting Asian populations,possibly related to long-term herbal medicine intake.Accurate imaging analysis is crucial for diagnosis,but insufficient understanding of the disease can lead to misdiagnosis or missed diagnosis.Treatment strategies should be personalized.

关键词： Idiopathic mesenteric phlebosclerosis Computed tomography Colonoscopy Chinese patent medicines Fructus gardeniae Case report

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MH-STRALP:A scoring system for prognostication in patients with upper gastrointestinal bleeding

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World Journal of Gastrointestinal Surgery 2024年第3期16卷 790-806页

作者： Jun-Nan Hu Fei Xu Ya-Rong Hao Chun-Yan Sun Kai-Ming Wu Yong Lin Lan Zhong Xin Zeng Department of gastroenterology Shanghai East HospitalTongji University School of MedicineShanghai 200120China Department of gastroenterology Shanghai Changzheng HospitalNavy Military Medical UniversityShanghai 200003China

BACKGROUND Upper gastrointestinal bleeding(UGIB)is a common medical emergency and early assessment of its outcomes is vital for treatment decisions.AIM To develop a new scoring system to predict its prognosis.METHODS In this retrospective study,692 patients with UGIB were enrolled from two cen-ters and divided into a training(n=591)and a validation cohort(n=101).The clinical data were collected to develop new prognostic prediction models.The en-dpoint was compound outcome defined as(1)demand for emergency surgery or vascular intervention,(2)being transferred to the intensive care unit,or(3)death during hos-pitalization.The models’predictive ability was compared with previously esta-blished scores by receiver operating characteristic(ROC)curves.RESULTS Totally 22.2%(131/591)patients in the training cohort and 22.8%(23/101)in the validation cohort presented poor outcomes.Based on the stepwise-forward Lo-gistic regression analysis,eight predictors were integrated to determine a new post-endoscopic prognostic scoring system(MH-STRALP);a nomogram was de-termined to present the model.Compared with the previous scores(GBS,Rock-all,ABC,AIMS65,and PNED score),MH-STRALP showed the best prognostic prediction ability with area under the ROC curves(AUROCs)of 0.899 and 0.826 in the training and validation cohorts,respectively.According to the calibration cur-ve,decision curve analysis,and internal cross-validation,the nomogram showed good calibration ability and net clinical benefit in both cohorts.After removing the endoscopic indicators,the pre-endoscopic model(pre-MH-STRALP score)was conducted.Similarly,the pre-MHSTRALP score showed better predictive value(AUROCs of 0.868 and 0.767 in the training and validation cohorts,respectively)than the other pre-endoscopic scores.CONCLUSION The MH-STRALP score and pre-MH-STRALP score are simple,convenient,and accurate tools for prognosis prediction of UGIB,and may be applied for early decision on its management strategies.

关键词： Upper gastrointestinal bleeding Prognosis prediction Retrospective study Nomogram Post-endoscopic model Pre-endoscopic model

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Standard-definition White-light,High-definition White-light versus Narrow-band Imaging Endoscopy for Detecting Colorectal Adenomas:A Multicenter Randomized Controlled Trial

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Current Medical Science 2024年第3期44卷 554-560页

作者： Chang-wei DUAN Hui-hong ZHAI Hui XIE Xian-zong MA Dong-liang YU Lang YANG Xin WANG Yu-fen TANG Jie ZHANG Hui SU Jian-qiu SHENG Jun-feng XU Peng JIN Chinese PLA General Hospital and Medical School Beijing100853China Department of gastroenterology Xuanwu HospitalCapital Medical UniversityBeijing100053China Department of gastroenterology The Seventh Medical Center of Chinese PLA General HospitalBeijing100700China Senior Department of gastroenterology The First Medical Center of Chinese PLA General HospitalBeijing100853China

Objective This study aimed to compare the performance of standard-definition white-light endoscopy(SD-WL),high-definition white-light endoscopy(HD-WL),and high-definition narrow-band imaging(HD-NBI)in detecting colorectal lesions in the Chinese population.Methods This was a multicenter,single-blind,randomized,controlled trial with a non-inferiority design.Patients undergoing endoscopy for physical examination,screening,and surveillance were enrolled from July 2017 to December 2020.The primary outcome measure was the adenoma detection rate(ADR),defined as the proportion of patients with at least one adenoma detected.The associated factors for detecting adenomas were assessed using univariate and multivariate logistic regression.Results Out of 653 eligible patients enrolled,data from 596 patients were analyzed.The ADRs were 34.5%in the SD-WL group,33.5%in the HD-WL group,and 37.5%in the HD-NBI group(P=0.72).The advanced neoplasm detection rates(ANDRs)in the three arms were 17.1%,15.5%,and 10.4%(P=0.17).No significant differences were found between the SD group and HD group regarding ADR or ANDR(ADR:34.5%vs.35.6%,P=0.79;ANDR:17.1%vs.13.0%,P=0.16,respectively).Similar results were observed between the HD-WL group and HD-NBI group(ADR:33.5%vs.37.7%,P=0.45;ANDR:15.5%vs.10.4%,P=0.18,respectively).In the univariate and multivariate logistic regression analyses,neither HD-WL nor HD-NBI led to a significant difference in overall adenoma detection compared to SD-WL(HD-WL:OR 0.91,P=0.69;HD-NBI:OR 1.15,P=0.80).Conclusion HD-NBI and HD-WL are comparable to SD-WL for overall adenoma detection among Chinese outpatients.It can be concluded that HD-NBI or HD-WL is not superior to SD-WL,but more effective instruction may be needed to guide the selection of different endoscopic methods in the future.Our study’s conclusions may aid in the efficient allocation and utilization of limited colonoscopy resources,especially advanced imaging technologies.

关键词： standard-definition white-light endoscopy high-definition white-light endoscopy narrow-band imaging colonoscopy colorectal cancer screening adenoma detection rate

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Colorectal cancer screening:A review of current knowledge and progress in research

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World Journal of Gastrointestinal Oncology 2024年第4期16卷 1119-1133页

作者： Sara Ramos Lopes Claudio Martins Inês Costa Santos Madalena Teixeira Élia Gamito Ana Luisa Alves Department of gastroenterology Centro Hospitalar de SetúbalSetúbal 2910-446Portugal

Colorectal cancer(CRC)is one of the most prevalent malignancies worldwide,being the third most commonly diagnosed malignancy and the second leading cause of cancer-related deaths globally.Despite the progress in screening,early diagnosis,and treatment,approximately 20%-25%of CRC patients still present with metastatic disease at the time of their initial diagnosis.Furthermore,the burden of disease is still expected to increase,especially in individuals younger than 50 years old,among whom early-onset CRC incidence has been increasing.Screening and early detection are pivotal to improve CRC-related outcomes.It is well established that CRC screening not only reduces incidence,but also decreases deaths from CRC.Diverse screening strategies have proven effective in decreasing both CRC incidence and mortality,though variations in efficacy have been reported across the literature.However,uncertainties persist regarding the optimal screening method,age intervals and periodicity.Moreover,adherence to CRC screening remains globally low.In recent years,emerging technologies,notably artificial intelligence,and non-invasive biomarkers,have been developed to overcome these barriers.However,controversy exists over the actual impact of some of the new discoveries on CRC-related outcomes and how to effectively integrate them into daily practice.In this review,we aim to cover the current evidence surrounding CRC screening.We will further critically assess novel approaches under investigation,in an effort to differentiate promising inno-vations from mere novelties.

关键词： Colorectal cancer Screening Review Oncology Artificial intelligence

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Novel lactylation-related signature to predict prognosis for pancreatic adenocarcinoma

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World Journal of gastroenterology 2024年第19期30卷 2575-2602页

作者： Tian Peng Fang Sun Jia-Chun Yang Mei-Hong Cai Man-Xiu Huai Jia-Xing Pan Fei-Yu Zhang Lei-Ming Xu Department of gastroenterology Xinhua Hospital Affiliated to Shanghai Jiao Tong UniversityShanghai 200092China

BACKGROUND Lactate,previously considered a metabolic byproduct,is pivotal in cancer progression and maintaining the immunosuppressive tumor microenvironment.Further investigations confirmed that lactate is a primary regulator,introducing recently described post-translational modifications of histone and non-histone proteins,termed lysine lactylation.Pancreatic adenocarcinomas are characterized by increased glycolysis and lactate accumulation.However,our understanding of lactylation-related genes in pancreatic adenocarcinomas remains limited.AIM To construct a novel lactylation-related gene signature to predict the survival of patients with pancreatic cancer.METHODS RNA-seq and clinical data of pancreatic adenocarcinoma(PDAC)were obtained from the GTEx(Genotype-Tissue Expression)and TCGA(The Cancer Genome Atlas)databases via Xena Explorer,and GSE62452 datasets from GEO.Data on lactylation-related genes were obtained from publicly available sources.Differential expressed genes(DEGs)were acquired by using R package“DESeq2”in R.Univariate COX regression analysis,LASSO Cox and multivariate Cox regressions were produced to construct the lactylation-related prognostic model.Further analyses,including functional enrichment,ESTIMATE,and CIBERSORT,were performed to analyze immune status and treatment responses in patients with pancreatic cancer.PDAC and normal human cell lines were subjected to western blot analysis under lactic acid intervention;two PDAC cell lines with the most pronounced lactylation were selected.Subsequently,RT-PCR was employed to assess the expression of LRGs genes;SLC16A1,which showed the highest expression,was selected for further investigation.SLC16A1-mediated lactylation was analyzed by immunofluorescence,lactate production analysis,colony formation,transwell,and wound healing assays to investigate its role in promoting the proliferation and migration of PDAC cells.In vivo validation was performed using an established tumor model.RESULTS In this study,we successfully identified 10 differentially e

关键词： Pancreatic adenocarcinoma Lactylation Prognosis Immunotherapy Tumor microenvironment

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Optimized sequential therapy vs 10- and 14-d concomitant therapy for eradicating Helicobacter pylori: A randomized clinical trial

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World Journal of gastroenterology 2024年第6期30卷 556-564页

作者： Hassan Seddik Jihane Benass Sanaa Berrag Asmae Sair Reda Berraida Hanae Boutallaka Department of gastroenterology II Mohammed V Military Teaching Hospital of RabatRabat 10100Morocco Department of gastroenterology Mohammed V University in RabatRabat 10100Morocco Department of gastroenterology I Mohammed V Military Teaching Hospital of RabatRabat 10100Morocco

BACKGROUND A cure for Helicobacter pylori(H.pylori)remains a problem of global concern.The prevalence of antimicrobial resistance is widely rising and becoming a challenging issue worldwide.Optimizing sequential therapy seems to be one of the most attractive strategies in terms of efficacy,tolerability and cost.The most common sequential therapy consists of a dual therapy[proton-pump inhibitors(PPIs)and amoxicillin]for the first period(5 to 7 d),followed by a triple therapy for the second period(PPI,clarithromycin and metronidazole).PPIs play a key role in maintaining a gastric pH at a level that allows an optimal efficacy of antibiotics,hence the idea of using new generation molecules.This open-label prospective study randomized 328 patients with confirmed H.pylori infection into three groups(1:1:1):The first group received quadruple therapy consisting of twice-daily(bid)omeprazole 20 mg,amoxicillin 1 g,clarith-romycin 500 mg and metronidazole 500 mg for 10 d(QT-10),the second group received a 14 d quadruple therapy following the same regimen(QT-14),and the third group received an optimized sequential therapy consisting of bid rabe-prazole 20 mg plus amoxicillin 1 g for 7 d,followed by bid rabeprazole 20 mg,clarithromycin 500 mg and metronidazole 500 mg for the next 7 d(OST-14).AEs were recorded throughout the study,and the H.pylori eradication rate was determined 4 to 6 wk after the end of treatment,using the 13C urea breath test.RESULTS In the intention-to-treat and per-protocol analysis,the eradication rate was higher in the OST-14 group compared to the QT-10 group:(93.5%,85.5%P=0.04)and(96.2%,89.5%P=0.03)respectively.However,there was no statist-ically significant difference in eradication rates between the OST-14 and QT-14 groups:(93.5%,91.8%P=0.34)and(96.2%,94.4%P=0.35),respectively.The overall incidence of AEs was significantly lower in the OST-14 group(P=0.01).Furthermore,OST-14 was the most cost-effective among the three groups.CONCLUSION The optimized 14-d sequential therapy is a safe and effective alt

关键词： Helicobacter pylori Quadruple therapy Sequential Proton-pump inhibitor Optimization

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