Balloon-assisted endoscopic submucosal dissection for treating small intestinal lipomas:Report of two cases

BACKGROUND Most small intestinal lipomas are treated surgically,and some require repeated surgeries for multiple lipomas.However,application of endoscopic submucosal dissection(ESD)technology in the deep small intestine is rarely reported owing to the special anatomical structure of the small intestine,medical equipment limitations,and the lack of relevant experience among endoscopists.CASE SUMMARY Two patients with small intestinal lipomas treated at the Air Force Medical Center from November 2015 to September 2019 were selected to undergo balloonassisted ESD to treat the lipomas and explore the technical feasibility and safety of ESD for treating small intestinal lipomas.The two patients successfully underwent balloon-assisted ESD to treat four small intestinal lipomas,with a complete resection rate of 100%(4/4),without intraoperative or postoperative bleeding,perforation,or other complications.After 3-6 mo of postoperative follow-up,the clinical symptoms caused by the lipomas were significantly relieved or disappeared after treatment.CONCLUSION Balloon-assisted ESD is a safe and reliable new method for treating deep intestinal lipomas and shows good clinical feasibility.

泽布替尼治疗老年初诊套细胞淋巴瘤的效果及不良反应分析

目的探究泽布替尼一线治疗老年初诊套细胞淋巴瘤(MCL)的有效性及安全性。方法回顾性收集甘肃省肿瘤医院血液科自2020年8月至2022年7月收住经泽布替尼治疗的13例老年初诊MCL患者临床资料。13例患者给予泽布替尼初始剂量为160 mg/次,2次/d,治疗时间均大于4个周期(1个月为1个周期),记录患者疗效,计算客观缓解率(ORR)、无进展生存期(PFS)、总生存期、6及12个月无进展生存率和总生存率,分析不同因素对PFS、总生存期的影响。结果随访截至2022年11月1日,13例患者中,7例完全缓解(53.8%),2例部分缓解(15.4%),4例疾病进展(30.8%);ORR为69.2%(9/13);中位PFS为8个月(范围4~28个月),中位总生存期为10个月(范围5~28个月),6个月无进展生存率和总生存率分别为68.0%、92.0%,12个月无进展生存率和总生存率分别为23.0%、31.0%。单因素分析显示,美国东部肿瘤协作组评分、Ki-67指数、乳酸脱氢酶可能影响患者PFS,年龄、Ki-67指数、乳酸脱氢酶可能影响患者总生存期(均P<0.05),但多因素Cox回归分析结果未观测到有统计学意义的影响PFS、总生存期的因素(均P>0.05)。13例患者中,1例血液学毒性为轻度,4例非血液学毒性包括感染、继发恶性肿瘤、关节痛、恶心,所有不良反应经减量、停用泽布替尼及对症处理均安全可控,无治疗相关死亡发生。结论泽布替尼单药一线治疗老年初诊MCL,特别是对于体能状态差不能耐受化疗及个人意愿拒绝化疗的患者有较高的ORR、完全缓解率及较好的耐受性。

2种蚜虫取食诱导棉花对棉长管蚜与棉蚜取食行为的影响

为研究棉长管蚜Acyrthosiphon gossypii与棉蚜Aphis gossypii对蚜虫取食诱导棉花的取食适应性,揭示取食诱导下两种蚜虫的取食竞争机制,采用刺探电位图谱技术(electrical penetration graph, EPG)测定在健康棉花、棉长管蚜或棉蚜诱导的棉花上取食6 h的棉长管蚜和棉蚜的16个重要参数,比较两种蚜虫的取食行为。研究发现:1)取食健康棉花时,棉蚜在木质部(G波)的取食持续总时间长于棉长管蚜,棉蚜在木质部的取食能力大于棉长管蚜,但二者在韧皮部的取食能力相差不大。2)取食棉长管蚜诱导的棉花时,棉蚜取食韧皮部(E2波)持续的总时间为(2 531.33±60.86)s,显著大于棉长管蚜E2波持续总时间[(2 196.00±98.91)s];取食棉蚜诱导的棉花时,棉蚜取食韧皮部、木质部持续的总时间显著长于棉长管蚜(P<0.05),说明棉蚜对于棉蚜诱导棉花的取食耐受性大于棉长管蚜。棉蚜对两种蚜虫取食诱导棉花的适应性更强,更易在竞争中取得优势。棉长管蚜与棉蚜取食棉长管蚜或棉蚜诱导棉花的F波持续总时间长于健康棉花,说明经取食诱导的棉花具有一定的抗虫性。

Reactivation of hepatitis B virus infection – an important aspect of multifaceted problem

In this editorial we comment on the article published in the recent issue of the W orld Journal of Gastroenterology.We focus specifically on the problem of occult hepatitis B virus(HBV)infection,that is a result of previous hepatitis B(PHB)and a source for reactivation of HBV.The prevalence of PHB is underestimated due to the lack of population testing programs.However,this condition not only com-plicate anticancer treatment,but may be responsible for the development of other diseases,like cancer or autoimmune disorders.Here we unveil possible mecha-nisms responsible for realization of these processes and suggest practical approa-ches for diagnosis and treatment.

基于DO-178的机载软件重用方法研究

以DO-178B/C软件重用标准为基础,将先前开发软件分为已通过和未通过适航合格审定的PDS,构建了PDS软件的评估准则和评估方法,将PDS的评估结果与标准进行对照,能够快速定位PDS的重用要求和应采取的过程活动。实践表明,通过重用已通过适航合格审定的PDS软件的部分数据,可以有效提升软件开发效率。针对未通过适航合格审定的PDS软件重用,本文也提供了一种差距分析方法,对照分析PDS软件与目标要求的差距,用以评估所需的额外工作量。

Risk of hepatic decompensation from hepatitis B virus reactivation in hematological malignancy treatments

In this editorial,we discussed the apparent discrepancy between the findings described by Colapietro et al,in their case report and data found in the literature.Colapietro et al reported a case of hepatitis B virus(HBV)-related hepatic decompensation in a patient with chronic myeloid leukemia and a previously resolved HBV infection who was receiving Bruton’s tyrosine kinase(BTK)inhibitor therapy.First of all,we recapitulated the main aspects of the immune system involved in the response to HBV infection in order to underline the role of the innate and adaptive response,focusing our attention on the protective role of anti-HBs.We then carefully analyzed literature data on the risk of HBV reactivation(HBVr)in patients with previous HBV infection who were treated with either tyrosine kinase inhibitors or BTK inhibitors for their hematologic malignancies.Based on literature data,we suggested that several factors may contribute to the different risks of HBVr:The type of hematologic malignancy;the type of therapy(BTK inhibitors,especially second-generation,seem to be at a higher risk of HBVr than those with tyrosine kinase inhibitors);previous exposure to an anti-CD20 as first-line therapy;and ethnicity and HBV genotype.Therefore,the warning regarding HBVr in the specific setting of patients with hematologic malignancies requires further investigation.

Clinical Analysis of Placenta Previa Complicated with Previous Caesarean Section

Objective To investigate the clinical features and treatment of placenta previa complicated with previous caesarean section. Methods The clinical data of 29 patients with placenta previa complicated with a previous caesarean section (RCS group) admitted in Peking Union Medical College Hospital during a period from 2003 to 2011 were retrospectively reviewed and compared with those of 243 patients with placenta previa without a previous caesarean section (FCS group) during the same period. Results There was no difference in the mean age (28.9±3.6 vs. 28.1±4.5 years) and the average gravidity (2.35±1.48 vs. 2.21±1.53) between RCS group and FCS group (all P>0.05). The RCS group had more preterm births (24.1% vs. 13.2%), complete placenta previa (55.2% vs. 4.9%), placenta accreta (34.5% vs. 2.5%), more blood loss during caesarean section (1412±602 vs. 648±265 mL), blood transfusion (51.7% vs. 4.9%), disseminated intravascular coagulation (13.8% vs. 2.1%), and obstetric hysterectomy (13.8% vs. 0.8%) than the FCS group (all P<0.05). The preterm infant rate (30.0% vs. 13.0%), neonatal asphyxia rate (10.0% vs. 4.9%), and perinatal mortality rate (6.7% vs. 0.4%) of the RCS group were higher than those of the FCS group (all P<0.05). Conclusions More patients had complete placenta previa and placenta accreta, postpartum hemorrhage, transfusion, uterine packing, obstetric hysterectomy, and perinatal morbidity in the placenta previa patients with previous caesarean section. The patient should be informed of the risk and unnecessary first cesarean sections should be avoided.

Effects of Previously Fermented Juice on Nutritive Value and Fermentative Quality of Rice Straw Silage

The effects of Previously Fermented Juice （PFJ） on the fermentative quality and changes in chemical composition during fermentation of rice straw silage were investigated. The results showed that the PFJ and diluted the PFJ （dPFJ） treated silages had significantly （p〈0.05） lower pH and ammonia-nitrogen content, while significantly higher lactic acid content compared with treatments. This study confirmed that the applying of the PFJ and the dPFJ improved fermentation quality of silage.

Short-term outcomes after laparoscopic colorectal surgery in patients with previous abdominal surgery: A systematic review

AIM: To perform a systematic review focusing on shortterm outcomes after colorectal surgery in patients with previous abdominal open surgery(PAOS).METHODS: A broad literature search was performed with the terms "colorectal", "colectomy", "PAOS", "previous surgery" and "PAOS". Studies were included if their topic was laparoscopic colorectal surgery in patients with PAOS, whether descriptive or comparative. Endpoints of interest were conversion rates, inadvertent enterotomy and morbidity. Analysis of articles was made according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses.RESULTS: From a total of 394 citations, 13 full-texts achieved selection criteria to be included in the study. Twelve of them compared patients with and without PAOS. All studies were retrospective and comparative and two were case-matched. The selected studies comprised a total of 5005 patients, 1865 with PAOS. Among the later, only 294(16%) had history of a midline incision for previous gastrointestinal surgery. Conversion rates were significantly higher in 3 of 12 studies and inadvertent enterotomy during laparoscopywas more prevalent in 3 of 5 studies that disclosed this event. Morbidity was similar in the majority of studies. A quantitative analysis(meta-analysis) could not be performed due to heterogeneity of the studies. CONCLUSION: Conversion rates were slightly higher in PAOS groups, although not statistical significant in most studies. History of PAOS did not implicate in higher morbidity rates.

Previous hepatitis B viral infection–an underestimated cause of pancreatic cancer

BACKGROUND The etiology of pancreatic cancer remains unclear. This limits the possibility of prevention and effective treatment. Hepatitis B virus(HBV) is responsible for the development of different types of cancer, but its role in pancreatic cancer is still being discussed.AIM To assess the prevalence of previous HBV infection and to identify viral biomarkers in patients with pancreatic ductal adenocarcinoma(PDAC) to support the role of the virus in etiology of this cancer.METHODS The data of 130 hepatitis B surface antigen-negative subjects were available for the final analysis,including 60 patients with PDAC confirmed by cytology or histology and 70 sex-and age-matched controls. All the participants were tested for HBV biomarkers in blood [antibody to hepatitis B core antigen(anti-HBc), antibody to hepatitis B surface antigen(anti-HBs) and HBV DNA], and for those with PDAC, biomarkers in resected pancreatic tissues were tested(HBV DNA, HBV pregenomic RNA and covalently closed circular DNA). We performed immunohistochemistry staining of pancreatic tissues for hepatitis B virus X antigen and Ki-67 protein. Non-parametric statistics were used for the analysis.RESULTS Anti-HBc was detected in 18/60(30%) patients with PDAC and in 9/70(13%) participants in the control group(P = 0.029). Accordingly, the odds of PDAC in anti-HBc-positive subjects were higher compared to those with no previous HBV infection(odds ratio: 2.905, 95% confidence interval: 1.191-7.084, standard error 0.455). HBV DNA was detected in 8 cases of PDAC and in 6 of them in the pancreatic tumor tissue samples only(all patients were anti-HBc positive). Blood HBV DNA was negative in all subjects of the control group with positive results of the serum anti-HBc test. Among 9 patients with PDAC, 5 revealed signs of replicative competence of the virus(covalently closed circular DNA with or without pregenomic RNA) in the pancreatic tumor tissue samples. Hepatitis B virus X antigen expression and active cell proliferation was revealed by immunohistochemistry in 4 patients with PDAC in the pancreatic tumor tissue samples.CONCLUSION We found significantly higher risks of PDAC in anti-HBc-positive patients. Detection of viral replication and hepatitis B virus X protein expression in the tumor tissue prove involvement of HBV infection in pancreatic cancer development.

Salvage living-donor liver transplantation to previously hepatectomized hepatocellular carcinoma patients:is it a reasonable strategy?

Salvage liver transplantation (LT) has been performed for recurred hepatocellular carcinoma(HCC) or for deterioration of liver function after resection of HCC. Controversies arise, howeverover the technical feasibility of salvage LT in patientswho underwent liver surgery,

Comment on anisometropia magnitude and visual deficits in previously untreated anisometropic amblyopia

Dear Editor,We read with great interest article titled'Anisometropia magnitude and visual deficits in previously untreated anisometropic amblyopia'by Chen et al[1].The authors have analysed subjects with previously untreated anisometropic amblyopia and found a significant correlation between high degree of anisometropia and deep amblyopia,worse contrast sensitivity,fusion and stereopsis functions.We commend the authors in addressing a very important problem and agree with the authors in the notation that children with anisometropia are usually detected later owing to lack of noticeable physical abnormalities.

Lung cancer screening: Should we be excluding people with previous malignancy?

The National Lung Screening Trial(NLST) was a large,randomized, controlled study showing a 20% reduction of lung cancer mortality and 7% reduction of all cause mortality using annual low dose computed tomography(LDCT) in a high risk population. NLST excluded people with a previous history of cancer treatment within the past 5 years and all people with a history lung cancer. The aim of this work is to review how lung cancer screening trials addressed the confounding effect of previous malignancy. We also review the subsequent recommendations by the United States Preventative Task Force Services, multiple professional societies and the Center for Medicaid and Medicare Services which defer either to NLST criteria or, clinician judgment or refrain from asserting any recommendation on the topic, respectively. Implications of lung cancer screening in the setting of previous malignancies, specifically lung, head and neck, esophageal, gastric, breast, colorectal cancer and lymphoma are also discussed. With lung cancer screening, an antecedent malignancy introduces the possibility of discovering metastasis as well as lung cancer. In some circumstances diagnosis and treatment of oligometastatic disease may confer a survival benefit. The survival benefit of treating either lung cancer or oligometastatic disease as result of lung cancer screening has yet to be determined. Further studies are needed to determine the role of lung cancer screening in the setting of previous malignancy.

A Phase II Study of Erlotinib in Patients with Previously Treated Non-Small Cell Lung Cancer

Background: Erlotinib has been reported to be effective for the treatment of non-small cell lung cancer (NSCLC). To evaluate the efficacy and safety of erlotinib under conditions similar to daily clinical practice, a phase II trial was conducted in Japanese patients with previously treated NSCLC. Methods: The eligibility criteria were stage IIIB/IV NSCLC, a performance status (PS) of 0 - 2, and previous treatment with 1 - 2 non-EGFR-TKI regimens. Patients received erlotinib (150 mg/day) orally until disease progression or intolerable toxicity occurred. The primary endpoint was the objective response rate (ORR). In addition, the disease control rate (DCR), progression-free survival (PFS), overall survival (OS), safety, and EGFR gene mutation status were evaluated. Results: Thirty-eight patients were enrolled, and 37 patients were evaluated. The median age was 69 years (range, 50 - 80 years). Patient characteristics were as follows: 26 were male and 11 were female;12 had a PS of 0, 20 had a PS of 1, and 5 had a PS of 2;and 26 had adenocarcinoma, and 11 had non-adenocarcinoma histology. The ORR and DCR were 21.6% (95% confidence interval [CI], 11.4% - 37.2%) and 54.1% (95% CI, 35.9% - 66.6%), respectively. Twenty-seven patients could be evaluated for EGFR gene status (12, mutated;15, wild-type). The ORR for EGFR-mutated patients was 41.7%, while that for patients with wild-type EGFR was 13.3%. The median PFS was evaluated as 4.4 months (95% CI, 2.2 - 10.7 months). The median OS was 14.9 months (95% CI, 9.2 months - not reached). Common adverse events were tolerable skin toxicities, diarrhea, and stomatitis. In addition, interstitial lung disease occurred in 8.1% of patients. Conclusion: As efficacy and safety were similar to previous studies, erlotinib was found to be effective for Japanese patients with previously treated NSCLC in clinical practice.

Induction of Labor with PGE2 after One Previous Cesarean Section: 18 Years Experience in a University Hospital

Objective: To review the outcome of prostaglandin induction of labor in term pregnant women with previous one ce-sarean section compared to those without previous Cesarean section. Design: 18 years retrospective review of hospital records and case note review of index cases. Setting: University hospital. Population: Three hundred and twenty two women who had their labor induced with prostaglandin E2. One hundred and sixty one women had one previous Ce-sarean section. Methods: This study was conducted at King Fahad University Hospital, University of Dammam. It is a tertiary referral center with approximately 2300 births per year. We searched the hospital's records of deliveries from January 1992 to December 2009 and reviewed all indications and outcomes of prostaglandin induction of labor in women with one previous Cesarean section. The control group was composed of women who had their labor induced with prostaglandin but without previous Cesarean section. Main outcome measures: Labor outcome and uterine rup-ture Results: Three hundred and twenty two women were included. All received prostaglandin E2 for induction of labor. One hundred and sixty one women had one previous Cesarean section (study group) and the rest had no previous Ce-sarean section (control group). There was no difference in the rate of vaginal delivery between study and control group, 68.3% and 79.5% (p value 0.3), respectively. The rate of uterine rupture was 30 times higher in study group (2.5% Vs 0.033%). Conclusion: In women with one previous Cesarean section, induction of labor with prostaglandin leads to comparable rate of vaginal delivery similar to those without prior Cesarean section but with relatively high risk of uter-ine rupture.

既往免疫经治的晚期非小细胞肺癌患者接受安罗替尼联合PD-1单抗的疗效及安全性

目的 旨在探讨既往免疫经治的晚期非小细胞肺癌(non-small cell lung cancer,NSCLC)患者接受安罗替尼联合PD-1单抗治疗方案的疗效和安全性。方法 纳入临床实践中接受安罗替尼联合PD-1单抗治疗的既往免疫经治的52例晚期NSCLC患者。安罗替尼为临床常规用法用量,PD-1单抗为目前已经在中国上市的PD-1单抗,包括信迪利单抗,卡瑞利珠单抗和帕博利珠单抗。回顾性地收集患者治疗过程中的疗效及安全性数据,并对患者进行定期的随访获取长期生存的数据。结果 最佳的疗效结果提示接受安罗替尼联合PD-1单抗治疗的既往免疫经治的晚期NSCLC患者中取得部分缓解患者12例,疾病稳定患者32例,疾病进展患者8例。因此,该方案的客观缓解率为23.1%(95%CI:12.5%~36.8%),疾病控制率为84.6%(95%CI:71.9%~93.1%)。中位无进展生存期为6.3个月(95%CI:2.64~9.96),中位的总生存期为16.6个月(95%CI:8.08~25.12)。既往免疫相关方案不耐受的患者(10例)接受该方案治疗时具有相对较好的预后(中位OS:23.4个月vs. 11.5个月,P=0.034)。安全性分析结果提示在接受安罗替尼联合PD-1单抗的总体不良反应安全可控。结论 在既往免疫经治的晚期NSCLC患者中安罗替尼联合PD-1单抗的治疗方案具有潜在的疗效和较好的安全性。既往免疫相关方案不耐受的患者可能从该方案中获益。研究结论尚需要大样本研究进一步验证。

Space Charge Effects in CSL Gauge——with previously assumed charge distribution

The "cascade static lens （CSL） gauge" has a high sensitivity（S） because the emitted electrons repeat the go and back oscillation before they are received by the electrodes. (S=18.6 Pa-1 (2480 Torr-1 in a

Switch from previous major depression comorbid with CLIPPERS to mania-like episode following glucocorticosteroid therapy:a case report

Bipolar disorder is associated with high rates of general medical conditions, but few cases of overlap between bipolar disorder and chronic lymphocytic infammation with pontine perivascular enhancement responsive to steroids （CLIPPERS） have been reported in the current literature. The following is a case of a 29-year-old patient with a previous major depressive episode comorbid with CLIPPERS. Following glucocorticosteroid therapy, the patient switched to mania-like presentation and was diagnosed with bipolar disorder due to another medical condition. So it is strongly suggested that high-dose corticosteroid pulse therapy could easily induce psychiatric disturbances for patients with previous psychiatric symptoms, and there may be potential links between bipolar disorder and CLIPPERS in the area of infammation.

Measurements of the Lower Uterine Segment at Term in Women with Previous Cesarean Delivery

Purpose: To evaluate the accuracy of sonographic measurements of the lower uterine segment (LUS) thickness at term in predicting uterine scar defects in women with previous Cesarean delivery (CD). Methods: Eighty-nine pregnant women who underwent CD between 37 and 41 weeks of gestation from 2013 to 2015 were enrolled in this study and divided into two groups. Group A consisted of women with previous CD, and Group B consisted of women with previous vaginal deliveries. We performed an ultrasound evaluation of the myometrial and full thickness of LUS (mLUS and fLUS) transvaginally before a CD and evaluated the appearance of LUS during surgery, which was defined as follows: grade I, well-developed;grade II, thin without visible content;grade III, translucent with visible content;and grade IV, either dehiscence or rupture. Results: The median mLUS and fLUS were 1.50 and 4.07 mm in the group A, and 2.75 and 5.37 mm in the group B. We observed significant differences in the median mLUS and fLUS between grades I/II (2.07 and 4.37 mm) and grades III/IV (0.67 and 2.52 mm). Both mLUS and fLUS were predictive factors for grades III/IV and cutoff values were 0.97 mm of mLUS and 3.13 mm of fLUS, having a sensitivity of 87.5% and 75.0%, and a specificity of 87.7% and 91.4% in mLUS and fLUS measurement, respectively. Conclusion: Sonographic measurements of LUS at term may be a feasible and reliable method to predict uterine rupture or uterine dehiscence in women with prior CD.