Endoscopic resection for calcifying fibrous tumors of the gastrointestinal tract

BACKGROUND Calcifying fibrous tumors(CFTs)are rare mesenchymal lesions that can occur in various sites throughout the body,including the tubular gastrointestinal(GI)tract.AIM To analyze the clinical findings of 36 patients with GI tract CFTs to provide guidance for diagnosis and treatment.METHODS This retrospective study included 36 patients diagnosed with CFTs of the GI tract.We collected demographic and clinical information and conducted regular follow-ups to assess for local recurrence.RESULTS The stomach was the most commonly involved site,accounting for 72.2%of the 36 CFTs.Endoscopic mucosal resection(n=1,2.8%),endoscopic submucosal dissection(n=14,38.9%),endoscopic full-thickness resection(n=16,44.4%),and submucosal tunneling endoscopic resection(n=5,13.9%)were used to resect calcifying fibrous tumors.Overall,34(94.4%)CFTs underwent complete endoscopic resections with a mean procedure time of 39.8±29.8 min.The average maximum diameter of the tumors was 10.6±4.3 cm.No complications,such as bleeding or perforation,occurred during an average hospital stay of 2.9±1.2 d.In addition,two patients developed new growth of CFTs near the primary tumor sites,and none of the patients developed distant metastases during the follow-up period.CONCLUSION GI tract CFTs are rare and typically benign tumors that can be effectively managed with endoscopic procedures.

Prognostic value of T cell immunoglobulin and mucin-domain containing-3 expression in upper gastrointestinal tract tumors:A meta-analysis

BACKGROUND There is a lack of robust prognostic markers for upper gastrointestinal(GI)tract cancers,including esophageal,gastric,and esophagogastric junction cancers.T cell immunoglobulin and mucin-domain containing-3(TIM3)plays a key immunomodulatory role and is linked to the prognosis of various cancers.However,the significance of TIM3 in upper GI tract tumors is still uncertain.AIM To investigate the prognostic value of TIM3 expression in upper GI tract tumors.METHODS A literature search was conducted on the PubMed,Embase,and Web of Science databases for relevant studies published until June 2023.After screening and quality assessment,studies that met the criteria were included in the metaanalysis.Statistical methods were used for the pooled analysis to assess the association of TIM3 expression in upper GI tract tumors with the prognosis and clinicopathological parameters.The results were reported with the hazard ratio(HR)and 95%confidence interval(CI).RESULTS Nine studies involving 2556 patients with upper GI tract cancer were included.High TIM3 expression was associated with a worse prognosis in upper GI tract cancer(HR:1.17,95%CI:1.01-1.36).Positive expression of TIM3 in gastric cancer was correlated with the T and N stage,but the difference was not statistically significant.However,TIM3 overexpression was significantly correlated with the TNM stage(odds ratio:1.21,95%CI:0.63-2.33;P<0.05).TIM3 expression showed no association with the other clinicopathological parameters.CONCLUSION High expression of TIM3 in the upper GI tract cancer is associated with a worse prognosis and advanced T or N stages,indicating its potential value as a prognostic biomarker.These findings may provide a basis for the personalized treatment of upper GI tract cancers.

Efficacy of a Kiwifruit Extract (PhenActivTM) on Gastrointestinal Tract Function: A Randomised Double-Blind Placebo-Controlled Study

Objective: Gastrointestinal (GI) discomfort is experienced by millions of people every day. This study aimed to evaluate the effect of PhenActivTM, a novel green kiwifruit extract, on gastrointestinal tract (GIT) function in otherwise healthy adults. Methods: 41 healthy adults with mild GI discomfort were enrolled in this double-blind, randomized, placebo-controlled study. Participants were randomized to either take 3.0 g/day of PhenActivTM or a placebo for 6 weeks. Interviews were conducted at baseline, week 3 and week 6, with participants completing questionnaires regarding GI symptoms. Frequency of bowel movements was self-recorded daily. Results: There were no differences in daily and weekly defecation frequency and stool characteristics in either group. The active and placebo groups significantly improve GSRS scores (p , only the active group had a significant improvement in the IBSSS and PAC-QOL scores (p < 0.05) from baseline. Neither group had changes in sleep quality, quality of life and fatigue, plasma zonulin concentrations or macular pigment optical density scores. The product was well tolerated with no GI disturbances or adverse events being reported. Conclusion: Supplementation of 3.0 g/day of PhenActivTM for 6 weeks did not improve defecation frequency or stool composition in healthy adults, but did improve perceived symptoms of GIT function, including symptoms of functional GIT disorders, IBS and constipation. The product was well tolerated and future trials investigating higher doses with more participants and/or a different population would be beneficial.

Association of plant-based diets with the risk of upper gastrointestinal tract cancers:A systematic review and meta-analysis

Background:Diets rich in red or processed meat have been linked to an increased risk of cancers within the digestive system.It has been suggested that a plant-based diet may have protective effects against digestive system cancers.This study aimed to determine the association between plant-based diets and upper gastrointestinal tract cancers(UGTC).Methods:We conducted a systematic review and meta-analysis of observational studies.We searched the PubMed,Medline,Embase,and Web of Science databases for articles published up to September 30,2023.We pooled the risk ratios(RR)with the corresponding 95%confi-dence intervals(CI)using fixed or random-effects models.Results:Our meta-analysis included 16 studies(30 results).The data revealed a strong inverse association between a high intake of plant-based diets and UGTC(RR=0.60,95%CI=0.49-0.72),specifically gastric cancer(GC,RR=0.53,95%CI=0.42-0.67)and esophageal can-cer(EC,RR=0.63,95%CI=0.42-0.96).This relationship was not significant for gastric cardia cancer(GCA)or esophagogastric junctional cancer(EGJC,RR=0.76,95%CI=0.47-1.22).A subgroup analysis showed the association was significant in studies from Asia and Europe,as well as in studies utilizing indices such as a vegetarian diet,Mediterranean diet,the plant-based diet index,and principal component analy-sis(PCA)dietary patterns.There was no indication of publication bias among the analyzed studies.Conclusions:This meta-analysis highlights the potential health benefits of plant-based diets in preventing UGTC,particularly regarding esophageal squamous cell carcinoma(ESCC)and GC.Nevertheless,additional research is required to validate these results and explore the un-derlying mechanisms.

Connection between inflammation and carcinogenesis in gastrointestinal tract: Focus on TGF-β signaling

Inflammation is a primary defense process against various extracellular stimuli,such as viruses,pathogens,foods,and environmental pollutants.When cells respond to stimuli for short periods of time,it results in acute or physiological inflammation.However,if the stimulation is sustained for longer time or a pathological state occurs,it is known as chronic or pathological inflammation.Several studies have shown that tumorigenesis in the gastrointestinal (GI) tract is closely associated with chronic inflammation,for which abnormal cellular alterations that accompany chronic inflammation such as oxidative stresses,gene mutations,epigenetic changes,and inflammatory cytokines,are shared with carcinogenic processes,which forms a critical cross-link between chronic inflammation and carcinogenesis.Transforming growth factor (TGF)-β is a multi-potent cytokine that plays an important role in regulation of cell growth,apoptosis and differentiation.Most importantly,TGF-β is a strong anti-inflammatory cytokine that regulates the development of effector cells.TGF-β has a suppressive effect on carcinogenesis under normal conditions by inhibiting abnormal cell growth,but on the other hand,many GI cancers originate from uncontrolled cell growth and differentiation by genetic loss of TGF-β signaling molecules or perturbation of TGF-β adaptors.Once a tumor has developed,TGF-β exerts a promoting effect on the tumor itself and stromal cells to enhance cell growth,alter the responsiveness of tumor cells to stimulate invasion and metastasis,and inhibited immune surveillance.Therefore,novel development of therapeutic agents to inhibit TGF-β-induced progression of tumor and to retain its growth inhibitory activities,in addition to anti-inflammatory actions,could be useful in oncology.In this review,we discuss the role of TGF-β in inflammation and carcinogenesis of the GI tract related to abnormal TGF-β signaling.

Multiple primary malignant tumors of upper gastrointestinal tract:A novel role of ^(18)F-FDG PET/CT

AIM: To evaluate the capacity of 18F-fluorodeoxyglucose positron emission tomography/computed tomography (18F-FDG PET/CT) for detecting multiple primary cancer of upper gastrointestinal (UGI) tract. METHODS: Fifteen patients (12 without cancer histories and 3 with histories of upper GI tract cancer) were investigated due to the suspicion of primary cancer of UGI tract on X-ray barium meal and CT scan. Subsequent whole body 18F-FDG PET/CT scan was carried out for initial staging or restaging. All the patients were fi nally confi rmed by endoscopic biopsy or surgery. The detection rate of multiple primary malignant cancers was calculated based on 18F-FDG PET/CT and endoscopic examinations.RESULTS: 18F-FDG PET/CT scan was positive in 32 suspicious lesions, 30/32 were true positive primary lesions, and 2/32 were false positive. In 15 suspicious lesions with negative 18F-FDG PET/CT scan, 12/15 were true negative and 3/15 were false negative. Among the 15 patients, 12 patients had 29 primary synchronous tumors confirmed by pathology, including 8 cases of esophageal cancers accompanied with gastric cancer and 4 of hypopharynx cancers with esophageal cancer. The other 3 patients had 4 new primary metachronous tumors, which were multiple primary esophageal cancers. PET/CT imaging detected local lymph node metastases in 11 patients. Both local lymph node metastases and distant metastases were detected in 4 patients. On a per-primary lesion basis, the sensitivity, specificity, accuracy, negative predictive value and positive predictive value of 18F-FDG PET/CT for detecting multiple primary cancer of UGI tract were 90.9%, 85.7%, 89.4%, 80% and 93.7%, respectively. CONCLUSION: The whole body 18F-FDG PET/CT may play an important role in evaluating the multiple primary malignant tumors of UGI tract cancer.

Mucosal lesions of the upper gastrointestinal tract in patients with ulcerative colitis:A review

Ulcerative colitis(UC)is a chronic,nonspecific,relapsing inflammatory bowel disease.The colorectum is considered the chief target organ of UC,whereas upper gastrointestinal(UGI)tract manifestations are infrequent.Recently,emerging evidence has suggested that UC presents complications in esophageal,stomachic,and duodenal mucosal injuries.However,UC-related UGI tract manifestations are varied and frequently silenced or concealed.Moreover,the endoscopic and microscopic characteristics of UGI tract complicated with UC are nonspecific.Therefore,UGI involvement may be ignored by many clinicians.In addition,no standard criteria have been established for patients with UC who should undergo fibrogastroduodenoscopy.Furthermore,specific treatment recommendations may be needed for patients with UC-associated UGI lesions.Herein,we review the esophageal,gastric,and duodenal mucosal lesions of the UC-associated UGI tract,as well as the potential pathogenesis and therapy.

Calcifying fibrous tumor of the gastrointestinal tract: A clinicopathologic review and update

Calcifying fibrous tumor(CFT)is a rare mesenchymal lesion that has been documented throughout the gastrointestinal tract.Gastrointestinal CFTs may occur at virtually any age,with a predilection for adults and for females.They occur most commonly in the stomach and the small and large intestines.CFTs are most often found incidentally,cured by local resection,and have a low risk of recurrence.Histology shows three characteristic features:Spindle cell proliferations within a densely hyalinized stroma,scattered calcifications,and lymphoplasmacytic inflammation.CFTs are immunoreactive for CD34,vimentin and factor XIIIa,helping to distinguish them from other benign mesenchymal neoplasms.The differential diagnosis of CFTs includes sclerosing gastrointestinal stromal tumor,leiomyoma,schwannoma,solitary fibrous tumor,inflammatory myofibroblastic tumor,plexiform fibromyxoma,fibromatosis,sclerosing mesenteritis,and reactive nodular fibrous pseudotumor.The pathogenesis of CFTs remains unclear,but some have hypothesized that they may be linked to IgG4-related disease,inflammatory myofibroblastic lesions,hyaline vascular type Castleman disease,sclerosing angiomatoid nodular transformation of the spleen,or trauma.

COVID-19 pandemic:Pathophysiology and manifestations from the gastrointestinal tract

The pandemic of coronavirus disease 2019(COVID-19),caused by a newly identifiedβ-coronavirus(SARS-CoV-2)has emerged as a dire health problem,causing a massive crisis for global health.Primary method of transmission was firstly thought to be animal to human transmission.However,it has been observed that the virus is transmitted from human to human via respiratory droplets.Interestingly,SARS-CoV-2 ribonucleic acid(RNA)has been isolated from patient stools,suggesting a possible gastrointestinal(GI)involvement.Most commonly reported clinical manifestations are fever,fatigue and dry cough.Interestingly,a small percentage of patients experience GI symptoms with the most common being anorexia,diarrhea,nausea and vomiting.The presence of viral RNA in stools is also common and fecal tests can be positive even after negative respiratory samples.The exact incidence of digestive symptoms is a matter of debate.The distribution of Angiotensin converting enzyme type 2 receptors in multiple organs in the body provides a possible explanation for the digestive symptoms’mechanism.Cases with solely GI symptoms have been reported in both adults and children.Viral RNA has also been detected in stool and blood samples,indicating the possibility of liver damage,which has been reported in COVID-19 patients.The presence of chronic liver disease appears to be a risk factor for severe complications and a poorer prognosis,however data from these cases is lacking.The aim of this review is firstly,to briefly update what is known about the origin and the transmission of SARS-CoV-2,but mainly to focus on the manifestations of the GI tract and their pathophysiological background,so that physicians on the one hand,not to underestimate or disregard digestive symptoms due to the small number of patients exhibiting exclusively this symptomatology and on the other,to have SARS-CoV-2 on their mind when the“gastroenteritis”type symptoms predominate.

Immunocytochemical Identification and Localization of Diffuse Neuroendocrine System (DNES) Cells in Gastrointestinal Tract of Channel Catfish (Ictalurus punctatus)

To detect distribution and relative frequency of diffuse neuroendocrine system （DNES） cells in the gastrointestinal tract of channel catfish （lctalurus punctatus）, the intestinal tract of channel catfish was divided into seven portions from proximal to distal： the enlarged area after oesophagus, cardia, fundus, pylorus, and anterior, middle, and posterior intestine. Immunohistochemical method using the strept avidin-biotin-complex （SABC） was employed. All antisera between seven portions of the channel catfish were compared statistically using statistical package for the social science （SPSS）. Five types of DNES ceils were determined： neuropeptide Y-immunoreactive （NPY-IR） cells were demonstrated in both anterior and middle intestine; serotonin （5-HT） immunoreactive cells were detected throughout the whole gastrointestinal tract; vasoactive intestinal peptide （VIP） positive cells were at the highest frequency in pylorus; glucagon-immunoreactive （GLU-IR） cells were moderate in number in the fundus and anterior, middle intestine, and no immunoreactivity was determined in the other portions; somatostatin （SOM） positive cells were more abundant in the anterior and middle intestine. The regional distribution and relative frequency of immunoreactive cells in the channel catfish, Ictalurus punctatus, are essentially similar to those of other fish. However, some characteristics are observed in this species, which further proved that the diversity of the physiological function of DNES cells was based on their morphology.

Origin and genomic characteristics of SARS-CoV-2 and its interaction with angiotensin converting enzyme type 2 receptors, focusing on the gastrointestinal tract

The emergence of coronavirus disease-2019 induced by a newly identified bcoronavirus, namely severe acute respiratory syndrome coronavirus 2(SARSCoV-2) has constituted a public health emergency. Even though it was considered a zoonotic disease, the virus has also spread among humans via respiratory secretions. The expression and distribution of angiotensin converting enzyme type 2(ACE2) in various human organs might also show other possible infection routes. High ACE2 ribonucleic acid expression has been identified in the gastrointestinal tract(GI) indicating its importance as a possible infection pathway of SARS-CoV-2. ACE2 induces viral entry into the host and most importantly has been found to be associated with the function of the gut. Its deficiency has been implicated in several pathologies such as colorectal inflammation. The renin-angiotensin system(RAS) is an essential regulatory cascade operating both at a local tissue level and at the systemic or circulatory level. The RAS may be important in the pathogenesis of chronic liver disease and is associated with the up-regulation of ACE2. Thus, the aim of this review is firstly, the analysis of some important general and genome characteristics of SARS-CoV-2 and secondly, and most importantly, to focus on the utility of ACE2 receptors in both SARS-CoV-2 replication and pathogenesis, especially in the GI tract.

Feasibility and safety of self-expandable metal stent in nonmalignant disease of the lower gastrointestinal tract

In recent years,self-expandable metal stents(SEMSs)have been employed to treat benign gastrointestinal strictures secondary to several conditions:Acute diverticulitis,radiation colitis,inflammatory bowel disease(IBD),and postanastomotic leakages and stenosis.Other applications include endometriosis and fistulas of the lower gastrointestinal tract.Although it may be technically feasible to proceed to stenting in the aforementioned benign diseases of the lower gastrointestinal tract,the outcome has been reported to be poor.In fact,in some settings(such as complicated diverticulitis and postsurgical anastomotic strictures),stenting seems to have a limited evidence-based benefit as a bridge to surgery,while in other settings(such as endometriosis,IBD,radiation colitis,etc.),even society guidelines are not able to guide the endoscopist through decisional algorithms for SEMS placement.The aim of this narrative paper is to review the scientific evidence regarding the use of SEMSs in nonmalignant diseases of the lower gastrointestinal tract,both in adult and pediatric settings.

Effect of hypertransfusion on the gastrointestinal tract after cardiac arrest in a porcine model

BACKGROUND:This study aimed to determine the potential protective effect of inducing hypertransfusion to the gastrointestinal tract following a porcine model of cardiac arrest and cardiopulmonary resuscitation(CPR) by evaluating the influence of gastrointestinal ultrastructure,ATPase and serum diamine oxidase.METHODS:Ventricular fibrillation was induced by programmed electrical stimulation in 16 male domestic pigs(n=8/group).Four minutes after ventricular fibrillation,CPR was performed.The pigs that successfully restored spontaneous circulation received intravenous infusion of either norepinephrine to maintain the mean arterial pressure at 130%of the baseline before ventricular fibrillation or normal saline.Serum diamine oxidase and gastrointestinal ATPase activity were determined,and histopathological examination of the gastrointestinal tract was performed by light and electron microscopy.RESULTS:CPR caused significant injury to the gastrointestinal tract,elevating serum diamine oxidase and causing destruction of intestinal microvillus in control animals.Na^+-K^+ ATPase and Ca^(2+)ATPase activity in gastric tissue were significantly elevated in animals receiving hypertransfusion treatment compared with the control animals.Hypertransfusion also significantly reduced serum diamine oxidase to below control levels after CPR.Moreover,severe injury sustained by the gastrointestinal tissue was markedly ameliorated under hypertransfusion conditions compared with the control animals.CONCLUSIONS:Gastrointestinal injury and abnormal energy metabolism were strikingly evident following CPR.Hypertransfusion inducing hypertension can improve energy metabolism and ameliorate gastrointestinal mucosal injury,indicating that hypothermia significantly ameliorates gastrointestinal injury sustained following cardiac arrest.

Effects of Helicobacter pylori infection in gastrointestinal tract malignant diseases:From the oral cavity to rectum

Helicobacter pylori(H.pylori)has infected approximately fifty percent of humans for a long period of time.However,improvements in the public health environment have led to a decreased chance of H.pylori infection.However,a high infection rate is noted in populations with a high incidence rate of gastric cancer(GC).The worldwide fraction of GC attributable to H.pylori is greater than 85%,and a high H.pylori prevalence is noted in gastric mucosa-associated lymphoid tissue lymphoma patients.These results indicate that the majority of GC cases can be prevented if H.pylori infection is eliminated.Because H.pylori exhibits oral-oral or fecal-oral transmission,the relationship between this microorganism and other digestive tract malignant diseases has also attracted attention.This review article provides an overview of H.pylori and the condition of the whole gastrointestinal tract environment to further understand the correlation between the pathogen and the host,thus allowing improved realization of disease presentation.

Effects of Dietary Fiber and Grit on Performance, Gastrointestinal Tract Development, Lipometabolism, and Grit Retention of Goslings

This study investigated effects of dietary ifbre and grit on growth performance, gastrointestinal tract （GIT） development, serum indexes and grit retention of Sichuan white goslings in China. The experiment was a 3×2 factorial design consisting of dietary crude ifbre （CF） at 2.0, 4.0 and 6.0%levels by adding grass meal and with or without grit supplementation. A total of 720 1-d-old male goslings were randomly allocated into 36 pens of 20 goslings/pen （n=6 pens/treatment）. At 21 d of age, GIT, blood samples and grit in gizzards were collected. Body weight （BW）, empty BW （without GIT）, average daily gain （ADG） and average daily feed intake （ADFI） were affected by CF levels and the medium （4.0%） had the highest value. Adding grit improved BW, empty BW, ADG and ADFI. CF affected relative weight or length of proventriculus, gizzard and duodenum. Increasing CF levels decreased jejunum villus height and affected caecal crypt depth and villus height to crypt depth ratio. Higher CF levels decreased serum triglyceride. Adding grit increased relative weight of abdominal fat. Grit addition increased grit weight in gizzard and the ratio of grit in 0.45-1 and 1-2 mm while decreasing the ratio of grit〈0.45 and 2-3 mm. In conclusion, moderate CF level and grit addition increased performance of goslings without interaction. Dietary CF levels affected the development of upper GIT and serum triglyceride. Grit needed by goslings should be less than 2 mm. Goslings’ gizzard would accumulate grit from feed when other grit could not be acquired.

Gastrointestinal tract injuries after thermal ablative therapies for hepatocellular carcinoma:A case report and review of the literature

BACKGROUND Radiofrequency ablation(RFA)and microwave ablation(MWA)represent the standard of care for patients with early hepatocellular carcinoma(HCC)who are unfit for surgery.The incidence of reported adverse events is low,ranging from 2.4%to 13.1%for RFA and from 2.6%to 7.5%for MWA.Gastrointestinal tract(GIT)injury is even more infrequent(0.11%),but usually requires surgery with an unfavourable prognosis.Due to its low incidence and the retrospective nature of the studies,the literature reporting this feared complication is heterogeneous and in many cases lacks information on tumour characteristics,comorbidities and treatment approaches.CASE SUMMARY A 77-year-old man who had undergone extended right hepatectomy for HCC was diagnosed with early disease recurrence with a small nodule compatible with HCC in the Sg4b segment of the liver with a subcapsular location.He was treated with percutaneous RFA and a few week later he was urgently admitted to the Surgery ward for abdominal pain and fever.A subcutaneous abscess was diagnosed and treated by percutaneous drainage.A fistulous tract was then documented by the passage of contrast material from the gastric antrum to the abdominal wall.The oesophagogastroduodenoscopy confirmed a circular wall defect at the lesser curvature of gastric antrum, leading directly to the purulentabdominal collection. An over-the-scope clip (OTSC) was used to successfullyclose the defectCONCLUSIONThis is the first reported case of RFA-related GIT injury to have been successfullytreated with an OTSC, which highlights the role of this endoscopic treatment forthe management of this complication.

Cathepsin L, transmembrane peptidase/serine subfamily member 2/4, and other host proteases in COVID-19 pathogenesis – with impact on gastrointestinal tract

Severe acute respiratory syndrome coronavirus-2(SARS-CoV-2)seems to employ two routes of entrance to the host cell;via membrane fusion(with the cells expressing both angiotensin converting enzyme 2(ACE2)and transmembrane peptidase/serine subfamily member 2/4(TMPRSS2/4))or via receptor-mediated endocytosis(to the target cells expressing only ACE2).The second mode is associated with cysteine cathepsins(probably cathepsin L)involvement in the virus spike protein(S protein)proteolytic activation.Also furin might activate the virus S protein enabling it to enter cells.Gastrointestinal tract(GIT)involvement in SARS-CoV-2 infection is evident in a subset of coronavirus disease 2019(COVID-19)patients exhibiting GIT symptoms,such as diarrhea,and presenting viral-shedding in feces.Considering the abundance and co-localization of ACE2 and TMPRSS2 in the lower GIT(especially brush-border enterocytes),these two receptors seem to be mainly involved in SARS-CoV-2 invasion of the digestive tract.Additionally,in vitro studies have demonstrated the virions capability of infection and replication in the human epithelial cells lining GIT.However,also furin and cysteine cathepsins(cathepsin L)might participate in the activation of SARS-CoV-2 spike protein contributing to the virus invasiveness within GIT.Moreover,cathepsin L(due to its involvement in extracellular matrix components degradation and remodeling,the processes enhanced during SARS-CoV-2-induced inflammation)might be responsible for the dysregulation of absorption/digestion functions of GIT,thus adding to the observed in some COVID-19 patients symptoms such as diarrhea.

Gastrointestinal Tract Infections Classification Using Deep Learning

Automatic gastrointestinal(GI)tract disease recognition is an important application of biomedical image processing.Conventionally,microscopic analysis of pathological tissue is used to detect abnormal areas of the GI tract.The procedure is subjective and results in significant inter-/intraobserver variations in disease detection.Moreover,a huge frame rate in video endoscopy is an overhead for the pathological findings of gastroenterologists to observe every frame with a detailed examination.Consequently,there is a huge demand for a reliable computer-aided diagnostic system(CADx)for diagnosing GI tract diseases.In this work,a CADx was proposed for the diagnosis and classification of GI tract diseases.A novel framework is presented where preprocessing(LAB color space)is performed first;then local binary patterns(LBP)or texture and deep learning(inceptionNet,ResNet50,and VGG-16)features are fused serially to improve the prediction of the abnormalities in the GI tract.Additionally,principal component analysis(PCA),entropy,and minimum redundancy and maximum relevance(mRMR)feature selection methods were analyzed to acquire the optimized characteristics,and various classifiers were trained using the fused features.Open-source color image datasets(KVASIR,NERTHUS,and stomach ULCER)were used for performance evaluation.The study revealed that the subspace discriminant classifier provided an efficient result with 95.02%accuracy on the KVASIR dataset,which proved to be better than the existing state-of-the-art approaches.

Clinical application and research progress of extracellular slow wave recording in the gastrointestinal tract

The physiological function of the gastrointestinal(GI)tract is based on the slow wave generated and transmitted by the interstitial cells of Cajal.Extracellular myoelectric recording techniques are often used to record the characteristics and propagation of slow wave and analyze the models of slow wave transmission under physiological and pathological conditions to further explore the mechanism of GI dysfunction.This article reviews the application and research progress of electromyography,bioelectromagnetic technology,and high-resolution mapping in animal and clinical experiments,summarizes the clinical application of GI electrical stimulation therapy,and reviews the electrophysiological research in the biliary system.

Gastrointestinal tract post-transplant lymphoproliferative disorder after liver transplantation

To the Editor:Post-transplant lymphoproliferative disorder（PTLD）is a rare and potentially fatal complication occurring after all types of solid organ transplantation.;PTLD accounts for 20%of all de novo post-transplant tumors.;The most important risk factors for PTLD are prolonged intense immunosuppression and Epstein-Barr virus（EBV）