Primary imaging features and recent application of PET tracers in cerebral amyloid angiopathy

Cerebral amyloid angiopathy(CAA)is a small vessel disease of the brain characterized by the progressive deposition of amyloid-β(Aβ)plaques in the walls of cerebral blood vessels.It presents with a subtle course and sudden onset,and currently,there are no specific therapeutic interventions available.Accurate diagnosis of CAA could enable targeted interventions in the early stages of the disease,potentially mitigating the disease’s effects.Herein,we review the primary imaging biomarkers used in the diagnosis of CAA,including their mechanisms,imaging characteristics,and significance.We also provide an interpretation of the latest version(v2.0)of the Boston criteria,which are commonly used in the clinical diagnosis of CAA.Additionally,this study introduces various positron emission tomography(PET)tracers for CAA and reviews their application values in the diagnosis of CAA.

Alterations of intestinal immune function and regulatory effects of L-arginine in experimental severe acute pancreatitis rats

AIM： To discuss the changes of intestinal mucosal immune function in rats with experimental severe acute pancreatitis （SAP） and the regulatory effect of L-arginine. METHODS： Male adult Wistar rats were randomly divided into pancreatitis group, sham-operation group, and L-arginine treatment group. Animals were killed at 24, 48, and 72 h after SAP models were developed and specimens were harvested. Endotoxin concentration in portal vein was determined by limulus endotoxin analysis kit. CD3＋, CD4＋, CD8＋ T lymphoo/tes in intestinal mucosal lamina propria were examined by immunohistochemistry. Secretory immunoglobulin A （SIgA） in cecum feces was examined by radioimmunoassay. RESULTS： Compared to the control group, plasma endotoxin concentration in the portal vein increased, percentage of CD3＋ and CD4＋ T lymphocyte subsets in the end of intestinal mucosal lamina propria reduced significantly, CD4＋/CD8＋ ratio decreased, and SIgA concentrations in cecum feces reduced at 24, 48, and 72 h after SAP developed. Compared to SAP group, the L-arginine treatment group had a lower level of plasma endotoxin concentration in the portal vein, a higher CD3＋ and CD4＋ T lymphocyte percentage in the end of intestinal mucosal lamina propria, an increased ratio of CD4＋/CD8＋ and a higher SIgA concentration in cecum feces. CONCLUSION： Intestinal immune suppression occurs in the early stage of SAP rats, which may be the main reason for bacterial and endotoxin translocation. L-arginine can improve the intestinal immunity and reduce bacterial and endotoxin translocation in SAP rats.

Timing, distribution, and microbiology of infectious complications after necrotizing pancreatitis

BACKGROUND Acute pancreatitis(AP)is a common acute abdominal disease worldwide,and its incidence rate has increased annually.Approximately 20%of AP patients develop into necrotizing pancreatitis(NP),and 40%to 70%of NP patients have infectious complications,which usually indicate a worse prognosis.Infection is an important sign of complications in NP patients.AIM To investigate the difference in infection time,infection site,and infectious strain in NP patients with infectious complications.METHODS The clinical data of AP patients visiting the Department of General Surgery of Xuanwu Hospital of Capital Medical University from January 1,2014 to December 31,2018 were collected retrospectively.Enhanced computerized tomography or magnetic resonance imaging findings in patients with NP were included in the study.Statistical analysis of infectious bacteria,infection site,and infection time in NP patients with infectious complications was performed,because knowledge about pathogens and their antibiotic susceptibility patterns is essential for selecting an appropriate antibiotic.In addition,the factors that might influence the prognosis of patients were analyzed.RESULTS In this study,539 strains of pathogenic bacteria were isolated from 162 patients with NP infection,including 212 strains from pancreatic infections and 327 strains from extrapancreatic infections.Gram-negative bacteria were the main infectious species,the most common of which were Escherichia coli and Pseudomonas aeruginosa.The extrapancreatic infection time(9.1±8.8 d)was earlier than the pancreatic infection time(13.9±12.3 d).Among NP patients with early extrapancreatic infection(<14 d),bacteremia(25.12%)and respiratory tract infection(21.26%)were predominant.Among NP patients with late extrapancreatic infection(>14 d),bacteremia(15.94%),respiratory tract infection(7.74%),and urinary tract infection(7.71%)were predominant.Drug sensitivity analysis showed that P.aeruginosa was sensitive to enzymatic penicillins,thirdand fourth-generation cephalosporins,and carbapenems.Acinetobacter baumannii and Klebsiella pneumoniae were sensitive only to tigecycline;Staphylococcus epidermidis and Enterococcus faecium were highly sensitive to linezolid,tigecycline,and vancomycin.CONCLUSION In this study,we identified the timing,the common species,and site of infection in patients with NP.

Hyperlipidemia intensifies cerulein-induced acute pancreatitis associated with activation of protein kinase C in rats

AIM： To investigate the effects of hyperlipidemia on acute pancreatitis （AP） and the possible mechanisms. METHODS： Rat models of hyperlipidemia and AP were established by Triton WR1339 and cerulein respectively. Human albumin was used to treat AP complicated by hyperlipidemia. In each group, we compared the histological score, volume of ascites, ratio of pancreatic wet/dry weight, serum amylase （AMY） and pancreatic acinar cell apoptosis. The level of protein kinase C （PKC） membrane translocation in pancreatic tissue was detected by Western blot.RESULTS： In the hyperlipidemia model established by Triton WR1339, triglyceride （TG） increased remarkably and reached its peak 6 h after injection, and most rats developed mild acute pancreatitis. Histological score, volume of ascites, ratio of wet/dry weight and serum AMY in AP animals with hyperlipidemia were obviously higher than those in AP animals （P 〈 0.05） and decreased after albumin therapy but not significantly （P 〉 0.05）. Apoptotic cells detected by terminal deoxynucleotidyl transferase-mediated dUTP-biotin nick end labeling （TUNEL） increased in AP animals with hyperlipidemia and did not change distinctly after albumin therapy. PKC membrane translocation level increased in AP animals with hyperlipidemia and decreased remarkably after albumin therapy （P 〈 0.05）.CONCLUSION： Hyperlipidemia may induce AP or intensify pancreatic injury. Albumin therapy can not alleviate pancreatic lesion effectively. PKC activation may be one mechanism by which AP is intensified by hyperlipidemia.

Evaluation of characteristics of left-sided colorectal perfusion in elderly patients by angiography

BACKGROUND Handling of the inferior mesenteric artery(IMA)and maintaining anastomotic perfusion are important in radical resection of left-sided colorectal cancer.However,the branching of this artery and the drainage patterns of this vein vary among individuals,and the characteristics and perfusion region of this artery in elderly patients remain unclear.AIM To evaluate the characteristics and perfusion region of the IMA in elderly patients using angiography.METHODS We enrolled 154 patients(>65 years old)who underwent digital subtraction angiography of the IMA.The characteristics,bifurcation,and distribution of the IMA and termination of the anastomotic perfusion of the left colon and rectum were examined using digital subtraction angiography.Collateral arterial arches and the IMA hemoperfusion region were also recorded.Perfusion regions were cross-referenced with clinical and anatomical features by the univariate analysis.RESULTS Of 154 patients,25(16.2%)had IMA lesions.The left colic artery arose independently from the IMA in 44.2%of patients,shared a trunk with the sigmoid artery in 35.1%,shared an opening with the sigmoid and superior rectal arteries in 16.9%,and was absent in 5.1%.The IMA perfusion region stopped at the splenic flexure in 50(32.5%)patients.The collateral circulation existed in the colonic perfusion region,including the marginal artery(Drummond’s artery),the ascending branch of the left colonic artery to supply the transverse colon,and the arc of Riolan with a frequency of 100%,22.7%,and 1.9%,respectively.The IMA perfusion region was independently associated with the comorbidity of atherosclerosis,IMA atherosclerotic lesion,branching pattern,collateral circulation,and marginal artery integrity.CONCLUSION The IMA and its branches are prone to arteriosclerosis,and IMA perfusion may be interrupted at the splenic flexure in elderly patients.The applicability and precision of preoperative angiography for evaluating the IMA branching and perfusion patterns could facilitate geriatric laparoscopic left-sided colorectal cancer surgery with suspicion of poor IMA perfusion.

Comparison of safety,efficacy,and long-term follow-up between“one-step”and“step-up”approaches for infected pancreatic necrosis

BACKGROUND Although the“Step-up”strategy is the primary surgical treatment for infected pancreatic necrosis,it is not suitable for all such patients.The“One-step”strategy represents a novel treatment,but the safety,efficacy,and long-term follow-up have not yet been compared between these two approaches.AIM To compare the safety,efficacy,and long-term follow-up of two surgical approaches to provide a reference for infected pancreatic necrosis treatment.METHODS This was a retrospective analysis of infectious pancreatic necrosis patients who underwent“One-step”or“Step-up”necrosectomy at Xuan Wu Hospital,Capital Medical University,from May 2014 to December 2020.The primary outcome was the composite endpoint of severe complications or death.Patients were followed up every 6 mo after discharge until death or June 30,2021.Statistical analysis was performed using SPSS 21.0 and GraphPad Prism 8.0,and statistical significance was set at P<0.05.RESULTS One-hundred-and-fifty-eight patients were enrolled,of whom 61 patients underwent“One-step”necrosectomy and 97 patients underwent“Step-up”necrosectomy.During the long-term follow-up period,40 patients in the“Onestep”group and 63 patients in the“Step-up”group survived.The time from disease onset to hospital admission(53.69±38.14 vs 32.20±20.75,P<0.001)and to initial surgical treatment was longer in the“Step-up”than in the“One-step”group(54.38±10.46 vs 76.58±17.03,P<0.001).Patients who underwent“Step up”necrosectomy had a longer hospitalization duration(65.41±28.14 vs 52.76±24.71,P=0.02),and more interventions(4.26±1.71 vs 3.18±1.39,P<0.001).Postoperative inflammatory indicator levels were significantly lower than preoperative levels in each group.Although the incisional hernia incidence was higher in the“One-step”group,no significant difference was found in the composite outcomes of severe complications or death,new-onset organ failure,postoperative complications,inflammatory indicators,long-term complications,quality of life,and medical costs between the groups(P>0.05).CONCLUSION Compared with the“Step-up”approach,the“One-step”approach is a safe and effective treatment method with better long-term quality of life and prognosis.It also provides an alternative surgical treatment strategy for patients with infected pancreatic necrosis.

Benign giant-cell tumor of the common bile duct:A case report

Primary giant-cell tumors rarely arise in the common bile duct. We herein report a case of primary giant-cell tumor of the common bile duct. The patient was an 81-year-old male who was diagnosed with a well-defined 1.2-cm mass projecting into the lumen of the middle common bile duct. Excision of the gallbladder and extrahepatic bile duct and a Roux-en-Y cholangiojejunostomy were performed. Histologically, the tumor had no association with carcinomas of epithelial origin and was similar to giant-cell tumors of the bone. The tumor consisted of a mixture of mononuclear and multinucleated osteoclast-like giant cells. The mononuclear cells showed no atypical features, and their nuclei were similar to those of the multinucleated giant cells. CD68 was expressed on the mononuclear and multinucleated osteoclast-like giant cells, whereas CD163 immunoreactivity was restricted to the mononuclear cells. Six months after the operation, the patient was still alive and had no recurrence. The interest of this case lies in the rarity of this entity, the difficulty of preoperative diagnosis, and this tumor&#x02019;s possible confusion with other malignant tumors.

Diagnostic performance of Neutrophil CD64 index,procalcitonin,and C-reactive protein for early sepsis in hematological patients

BACKGROUND Patients with hematological diseases are immunosuppressed due to various factors,including the disease itself and treatments,such as chemotherapy and immunotherapy,and are susceptible to infection.Infections in these patients often progress rapidly to sepsis,which is life-threatening.AIM To evaluate the diagnostic efficacy of the neutrophil CD64(nCD64)index,compared to procalcitonin(PCT)and high-sensitivity C-reactive protein(hs-CRP),for the identification of early sepsis in patients with hematological diseases.METHODS This was a prospective analysis of patients with hematological diseases treated at the Fuxing Hospital affiliated with Capital Medical University,between March 2014 and December 2018.The nCD64 index was quantified by flow cytometry and the Leuko64 assay software.The factors which may affect the nCD64 index levels were compared between patients with different infection statuses(local infection,sepsis,and no infection),and the control group and the nCD64 index levels were compared among the groups.The diagnostic efficacy of the nCD64 index,PCT,and hs-CRP for early sepsis was evaluated among patients with hematological diseases.RESULTS A total of 207 patients with hematological diseases(non-infected group,n=50;locally infected group,n=67;sepsis group,n=90)and 26 healthy volunteers were analyzed.According to the absolute neutrophil count(ANC),patients with hematological diseases without infection were divided into the normal ANC,ANC reduced,and ANC deficiency groups.There was no statistically significant difference in the nCD64 index between these three groups(P=0.586).However,there was a difference in the nCD64 index among the non-infected(0.74±0.26),locally infected(1.47±1.10),and sepsis(2.62±1.60)groups(P<0.001).The area under the diagnosis curve of the nCD64 index,evaluated as the difference between the sepsis and locally infected group,0.777,which was higher than for PCT(0.735)and hs-CRP(0.670).The positive and negative likelihood ratios were also better for the nCD64 index than either PCT and hs-CRP.CONCLUSION Our results indicate the usefulness of the nCD64 index as an inflammatory marker of early sepsis in hematological patients.

Short-term application of low-dose growth hormone in surgical patients: Effects on nitrogen balance and blood glucose

AIM： To investigate the effectiveness and safety of recombinant human growth hormone （rhGH） in postoperative patients. METHODS： A total of 48 consecutive patients undergoing abdominal operations were randomized to receive either subcutaneous rhGH （0.15 IU/kg） or placebo （menstruum） injections daily for 7 d after surgery. The two groups had similar nutritional intake. Blood samples for serum fibronecUn, albumin, prealbumin, transferrin and the total lymphocyte count, as well as glucose levels were collected to study the rhGH effect. Basal laboratory evaluation, and nutritional status were estimated on d 1 before as baseline and d 3 and 10 after operation using standard laboratory techniques. Nitrogen balance was measured from d 3 to 9 after operation. RESULTS： The cumulative nitrogen balance was significantly improved in rhGH group compared with the placebo group （11.37 ± 16.82 vs -9.11 ± 17.52, P = 0.0003）. Serum fibronectin was also significantly higher in the rhGH group than in the placebo group （104.77 ± 19.94 vs 93.03 ± 16.03, P 〈 0.05）, whereas changes in serum albumin, prealbumin, transferrin and total lymphocyte counts were not statistically significant. Mean blood glucose levels were significantly higher in the rhGH group from d 3 to 6 after operation. CONCLUSION： If blood glucose can be controlled, lowdose growth hormone together with hypocaloric nutrition is effective on improving positive nitrogen balance and protein conservation and safe is in postoperative patients.

Anterior abdominal abscess-a rare manifestation of severe acute pancreatitis:A case report

BACKGROUND Severe acute pancreatitis(SAP)is a common critical disease of the digestive system.In addition to the clinical manifestations and biochemical changes of acute pancreatitis,SAP is also accompanied by organ failure lasting more than 48 h.SAP is characterized by focal or extensive pancreatic necrosis,hemorrhage and obvious inflammation around the pancreas.The peripancreatic fat space,fascia,mesentery and adjacent organs are often involved.The common local complications include acute peripancreatic fluid collection,acute necrotic collection,pancreatic pseudocyst,walled off necrosis and infected pancreatic necrosis.After reviewing the literature,we found that in very few cases,SAP patients have complications with anterior abdominal wall abscesses.CASE SUMMARY We report a 66-year-old Asian male with severe acute pancreatitis who presented with intermittent abdominal pain and an increasing abdominal mass.The abscess spread from the retroperitoneum to the anterior abdominal wall and the right groin.In the described case,drainage tubes were placed in the retroperitoneal and anterior abdominal wall by percutaneous puncture.After a series of symptomatic supportive therapies,the patient was discharged from the hospital with a retroperi-toneal drainage tube after the toleration of oral feeding and the improvement of nutritional status.CONCLUSION We believe that patients with SAP complicated with anterior abdominal abscess can be treated conservatively to avoid unnecessary exploration or operation.

Dysregulation of PARP1 is involved in development of Barrett's esophagus

AIM To investigate the potential role of poly(ADP-ribose) polymerase 1(PARP1) in the development of Barrett's esophagus(BE).METHODS A BE mouse model was established to examine the esophageal morphological changes and molecular changes. Microarray analysis was performed to compare the gene expression profiles between BE patients and healthy controls. q PCR was used to examine the PARP1 expression in cell lines after treatment with H_2O_2 and bile acids(p H 4). Immunofluorescence staining, comet assay, and annexin V staining were used to evaluate the impact of PARP1 activity on cell survival and DNA damage response after oxidative stress.RESULTS The gene expression profile in normal and BE esophageal epithelial cells showed that PARP1, the major poly(ADP-ribose) polymerase, was overexpressed in BE. In the mouse model of BE, positive staining for NF-κB, γH2 AX, and poly(ADP-ribose)(PAR) was observed. H_2O_2 and bile acids(p H 4) increased the PARP1 m RNA expression level in normal esophageal epithelial cells. Using sh RNA-PARP1 to suppress PARP1 activity decreased the cell viability after treatment with H_2O_2 and bile acids(p H 4), and increased the oxidative damage as demonstrated by an increase in the levels of H_2O_2 , intracellular reactive oxygen species(ROS), oxidative DNA damage, double-strand breaks, and apoptosis(P < 0.01).CONCLUSION The dysfunction of PARP1 in esophageal epithelial cells increases the levels of ROS and oxidative DNA damage, which could be common risk factors for BE and esophageal adenocarcinoma.

Restoration of cell polarity and bile excretion function of hepatocytes in sandwich-culture

Objective： To investigate the nature of the restoration of cell polarity and bile excretion function in Sandwich-cultured hepatocytes. Methods ： Freshly isolated hepatocytes from male Sprague-Dawley rats were cultured in a double layer collagen gel Sandwich configuration. Morphological changes were observed under a inverted microscope. The domain specific membrane associated protein DPP IV was tested by immunofluorescence, and the bile excretion function was determined by using fluorescein diacetate. Hepatocytes cultured on a single layer of collagen gel were taken as control. Results.. Adult rat hepatocytes cultured in a double layer collagen gel sandwich configuration regained its morphological and functional polarity and maintained polygonal morphology for at least 4 weeks. Immunofluorescence studies using antibodies against DPP IV showed polarity restoration as early as 48 h. After cultured in the double layer collagen gel Sandwich configuration for 96 h the hepatocytes began to excrete bile; while hepatocytes cultured on a single layer collagen gel had no bile excretion. Conclusion.. Hepatocytes cultured in a double layer collagen gel Sandwich configuration are able to regain their morphological and functional polarity given certain conditions. Hepaotcyte culture is a useful tool for the study of polarity restoration.

Role of ELMOs in cancer cell migration and engulfment

Metastasis is responsible for the majority of deaths related to cancer and results from several interconnected processes including cell proliferation,angiogenesis,chemotaxis,cell adhesion,migration,and invasion into the surrounding tissue.SDF-1αinduced chemotaxis plays an important role in cancer chemotaxis and metastasis.Binding of SDF-1α(CXCL12)to CXCR4 triggers activation of heterotrimeric G proteins that regulate actin polymerization and migration of cancer cells.

Acinous cell AR42J-derived exosome miR125b-5p promotes acute pancreatitis exacerbation by inhibiting M2 macrophage polarization via PI3K/AKT signaling pathway

BACKGROUND The incidence rate of acute pancreatitis(AP), which is a pathophysiological process with complex etiology, is increasing globally. miR-125b-5p, a bidirectional regulatory miRNA, is speculated to exhibit anti-tumor activity. However,exosome-derived miR-125b-5p in AP has not been reported.AIM To elucidate the molecular mechanism of exosome-derived miR-125b-5p promoting AP exacerbation from the perspective of the interaction between immune cells and acinar cells.METHODS Exosomes derived from AR42J cells were isolated and extracted in active and inactive states by an exosome extraction kit, and were verified via transmission electron microscopy, nanoparticle tracking analysis, and western blotting. RNA sequencing assay technology was used to screen differentially expressed miRNAs in active and inactive AR42J cell lines, and bioinformatics analysis was used to predict downstream target genes of miR-125b-5p. The expression level of miR-125b-5p and insulin-like growth factor 2(IGF2) in the activated AR42J cell line and AP pancreatic tissue were detected by quantitative real-time polymerase chain reaction and western blots. The changes in the pancreatic inflammatory response in a rat AP model were detected by histopathological methods. Western Blot was used to detect the expression of IGF2, PI3K/AKT signaling pathway proteins, and apoptosis and necrosis related proteins.RESULTS miR-125b-5p expression was upregulated in the activated AR42J cell line and AP pancreatic tissue,while that of IGF2 was downregulated. In vitro experiments confirmed that miR-125b-5p could promote the death of activated AR42J cells by inducing cell cycle arrest and apoptosis. In addition,miR-125b-5p was found to act on macrophages to promote M1 type polarization and inhibit M2type polarization, resulting in a massive release of inflammatory factors and reactive oxygen species accumulation. Further research found that miR-125b-5p could inhibit the expression of IGF2 in the PI3K/AKT signaling pathway. Additionally, in vivo experiments revealed that miR-125b-5p can promote the progression of AP in a rat model.CONCLUSION miR-125b-5p acts on IGF2 in the PI3K/AKT signaling pathway and promotes M1 type polarization and inhibits M2 type polarization of macrophage by inhibiting IGF2 expression, resulting in a large release of pro-inflammatory factors and an inflammatory cascade amplification effect, thus aggravating AP.

Impacts of pancreatic exocrine insufficiency on gut microbiota

Pancreatic exocrine insufficiency(PEI)can be induced by various kinds of diseases,including chronic pancreatitis,acute pancreatitis,and post-pancreatectomy.The main pathogenetic mechanism of PEI involves the decline of trypsin synthesis,disorder of pancreatic fluid flow,and imbalance of secretion feedback.Animal studies have shown that PEI could induce gut bacterial overgrowth and dysbiosis,with the abundance of Lactobacillus and Bifidobacterium increasing the most,which could be partially reversed by pancreatic enzyme replacement therapy.Clinical studies have also confirmed the association between PEI and the dysbiosis of gut microbiota.Pancreatic exocrine secretions and changes in duodenal p H as well as bile salt malabsorption brought about by PEI may affect and shape the abundance and composition of gut microbiota.In turn,the gut microbiota may impact the pancreatic exocrine acinus through potential bidirectional crosstalk.Going forward,more and higher-quality studies are needed that focus on the mechanism underlying the impact of PEI on the gut microbiota.

Severe acute pancreatitis in the elderly: Etiology and clinical characteristics

AIM: To investigate the etiology and clinical characteristics of severe acute pancreatitis (SAP) in elderly patients (≥ 60 years of age). METHODS: We reviewed retrospectively all the SAP cases treated in Xuanwu Hospital in Beijing between 2000 and 2007. RESULTS: In 169 patients with SAP, 94 were elderly and 16 died. Biliary and idiopathic etiologies were the first two causes that accounted for over 90% of SAP in the elderly. Biliary, hyperlipemic and alcoholic etiologies were the first three causes in the young. The proportion of co- morbidity of cholelithiasis, biliary infection, hypertension and coronary heart disease in the aged was significantly higher than that in their young partners. The scores of APACHE Ⅱ and Ranson were also significantly higher in the elderly except the CT score. Organ failures were more common in the elderly, but the local pancreatic complications were not different between the two groups. Mortality of the aged was correlated with the severity of SAP, multiple co-morbidity and incidence of multiple organ dysfunction syndrome (MODS). MODS was the main cause of death. CONCLUSION: The etiology of SAP in the elderly is quite different from that in the young. Biliary and unknown factors are main causes in the aged. The elderly are subject to major organ failures but there is no difference in the occurrence of local pancreatic complications between the elderly and the young. It is crucial to monitor and improve the functions of major organs so as to prevent MODS in the aged with SAP.

Nissen fundoplication vs proton pump inhibitors for laryngopharyngeal reflux based on p H-monitoring and symptom-scale

AIM To compare the outcomes between laparoscopic Nissen fundoplication(LNF)and proton pump inhibitors(PPIs)therapy in patients with laryngopharyngeal reflux(LPR)and typeⅠhiatal hernia diagnosed by oropharyngeal p H-monitoring and symptom-scale assessment.METHODS From February 2014 to January 2015,70 patients who were diagnosed with LPR and type I hiatal hernia and referred for symptomatic assessment,oropharyngeal p H-monitoring,manometry,and gastrointestinal endoscopy were enrolled in this study.All of the patients met the inclusion criteria.All of the patients underwent LNF or PPIs administration,and completed a2-year follow-up.Patients’baseline characteristics and primary outcome measures,including comprehensive and single symptoms of LPR,PPIs independence,and satisfaction,and postoperative complications were assessed.The outcomes of LNF and PPIs therapy were analyzed and compared. RESULTS There were 31 patients in the LNF group and 39patients in the PPI group.Fifty-three patients(25 in the LNF group and 28 in the PPI group)completed reviews and follow-up.Oropharyngeal p H-monitoring parameters were all abnormal with high acid exposure,a large amount of reflux,and a high Ryan score,associated reflux symptom index(RSI)score.There was a significant improvement in the RSI and LPR symptom scores after the 2-year follow-up in both groups(P<0.05),as well as typical symptoms of gastroesophageal reflux disease.Improvement in the RSI(P<0.005)and symptom scores of cough(P=0.032),mucus(P=0.011),and throat clearing(P=0.022)was significantly superior in the LNF group to that in the PPI group.After LNF and PPIs therapy,13 and 53 patients achieved independence from PPIs therapy(LNF:44.0%vs PPI:7.14%,P<0.001)during follow-up,respectively.Patients in the LNF group were more satisfied with their quality of life than those in the PPI group(LNF:62.49±28.68 vs PPI:44.36±32.77,P=0.004).Body mass index was significantly lower in the LNF group than in the PPI group(LNF:22.2±3.1kg/m^2 vs PPI:25.1±2.9 kg/m^2,P=0.001).CONCLUSION Diagnosis of LPR should be assessed with oropharyngeal p H-monitoring,manometry,and the symptom-scale.LNF achieves better improvement than PPIs for LPR with type I hiatal hernia.

Infection recurrence following minimally invasive treatment in patients with infectious pancreatic necrosis

BACKGROUND In recent decades,an increasing number of patients have received minimally invasive intervention for infected pancreatic necrosis(IPN)because of the benefits in reducing postoperative multiple organ failure and mortality.However,there are limited published data regarding infection recurrence after treatment of this patient population.AIM To investigate the incidence and prediction of infection recurrence following successful minimally invasive treatment in IPN patients.METHODS Medical records for 193 IPN patients,who underwent minimally invasive treatment between February 2014 and October 2018,were retrospectively reviewed.Patients,who survived after the treatment,were divided into two groups:one group with infection after drainage catheter removal and another group without infection.The morphological and clinical data were compared between the two groups.Significantly different variables were introduced into the correlation and multivariate logistic analysis to identify independent predictors for infection recurrence.Sensitivity and specificity for diagnostic performance were determined.RESULTS Of the 193 IPN patients,178 were recruited into the study.Of them,9(5.06%)patients died and 169 patients survived but infection recurred in 13 of 178 patients(7.30%)at 7(4-10)d after drainage catheters were removed.White blood cell(WBC)count,serum C-reactive protein(CRP),interleukin-6,and procalcitonin levels measured at the time of catheter removal were significantly higher in patients with infection than in those without(all P<0.05).In addition,drainage duration and length of the catheter measured by computerized tomography scan were significantly longer in patients with infection(P=0.025 and P<0.0001,respectively).Although these parameters all correlated positively with the incidence of infection(all P<0.05),only WBC,CRP,procalcitonin levels,and catheter length were identified as independent predictors for infection recurrence.The sensitivity and specificity for infection prediction were high in WBC count(≥9.95×109/L)and serum procalcitonin level(≥0.05 ng/mL)but moderate in serum CRP level(cut-off point≥7.37 mg/L).The catheter length(cut-off value≥8.05 cm)had a high sensitivity but low specificity to predict the infection recurrence.CONCLUSION WBC count,serum procalcitonin,and CRP levels may be valuable for predicting infection recurrence following minimally invasive intervention in IPN patients.These biomarkers should be considered before removing the drainage catheters.

Postoperative chemotherapy with S-1 plus oxaliplatin versus S-1alone in locally advanced gastric cancer(RESCUE-GC study): a protocol for a phase Ⅲ randomized controlled trial

Background： The ACTS-GC study had shown postoperative adiuvant therapy with S-1 improved survival of patients with locally advanced gastric cancer. Addition of oxaliplatin to S-1 is considered to be acceptable as one of the treatment options for gastric cancer patients after radical gastrectomy with D2 lymph node excision. Methods： We have commenced a randomized phase III trial in December 2016 to evaluate S-I plus oxaliplatin compared with S-1 alone in the adjuvant setting for locally advanced gastric cancer. A total of 564 patients will be accrued from 13 Chinese institutions in two years. The primary endpoint is 3-year relapse-free survival. The secondary endpoints are 5-year overall survival, proportion of patients who complete the postoperative chemotherapy and incidence of adverse events. Ethic and dissemination： The trial has been approved by the institutional review board of each participating institution and it was activated on December, 2016. The enrollment will be finished in December, 2018. Patient＇s follow-up will be ended until December, 2023. Trial registration： ClinicalTrials.gov, identifier： NCT02867839. Registered on August 4, 2016.

Exosomes:Promising biomarkers and targets for cancer

The review article entitled"Exosomes as potential diagnosis and treatment for liver cancer"recently published in World Journal of Gastrointestinal Oncology 2022;14:334-347 concluded that exosomes can be used as effective biomarkers or therapeutic biotargets in liver cancer.Exosomes are a hot spot in the field of tumor diagnosis and treatment research.We had also previously published a review on exosomes and tumors.In this letter to the editor,we summarize the clinical application prospects and current challenges of exosomes.