2016年 · 第36卷第11期

Whether it is hereditary (about 5%) or sporadic colorectal cancer (or colorectal cancer), environmental factors are important factors affecting its occurrence and progression. Because the pathways of sporadic colorectal cancer are roughly divided into adenoma → adenocarcinoma pathway (including serrated pathway caused by serrated adenoma), inflammation → cancer pathway andDe NovoThere are three ways, so the main precancerous diseases of colorectal cancer are adenoma (accounting for 85% to 90% of all precancerous diseases of colorectal cancer, or even higher) and IBD such as UC. Although stromal tumors and neuroendocrine tumors may occur in the colorectum, colorectal cancer and adenoma are usually collectively referred to as colorectal tumors in clinic. Most colorectal cancers are in the middle and late stage when diagnosed, and the curative effect is not good. Therefore, early detection and prevention of colorectal cancer are very important. In view of this, attention should be paid to the prevention of colorectal cancer. The prevention of colorectal cancer in turn includes the prevention and treatment of the aforementioned precancerous diseases, namely primary prevention (prevention of CRA) and secondary prevention (prevention of recurrence or malignancy after adenoma removal) of colorectal adenoma (CRA). Both of the above should be classified as the primary prevention of colorectal cancer. For secondary prevention of colorectal cancer, endoscopic management of early colorectal cancer and endoscopic follow-up should be included to prevent recurrence. 70% of sporadic colorectal cancers are related to lifestyle habits^[1]And 66% ~78% of colorectal cancer can be avoided by healthy living habits^[2]。 Endoscopic adenoma removal prevents 75% of colorectal cancers^[3]But the recurrence rate after removal is high^[4,5,6]And still needs to be prevented. Whether it is through improving diet and other lifestyle habits, or the application of drugs to prevent the initial occurrence or recurrence of adenoma after removal, and the prevention of carcinogenesis of IBD, it belongs to the broad chemoprevention of colorectal cancer, which is the content involved in this consensus opinion. For other comprehensive prevention, including screening and endoscopic adenoma removal, please refer to the "Consensus Opinions on Screening, Diagnosis and Treatment of Early Colorectal Cancer and Precancerous Lesions in China (2014, Chongqing)" jointly promulgated by the Collaborative Group of Early Cancer Endoscopy Diagnosis and Treatment of Department of Digestive Endoscopy of Chinese Medical Association, the Collaborative Group of Gastroenterology of Chinese Medical Association, the Enterology Group of Digestive Endoscopy of Chinese Medical Association and the Collaborative Group of Gastroenterology of Chinese Medical Association in 2014^[7]。

CD is a chronic non-specific intestinal inflammatory reactive disease whose etiology is not well defined, and its incidence is on the rise in recent years. infliximab monoclonal antibody (IFX) is a biological agent. Studies have proved that it can be used to treat most moderate to severe and active CD with definite efficacy^[1]。 However, there are still some CD patients who do not respond to IFX treatment, which is called primary failure to respond^[2]。 At present, the mechanism of primary failure to respond to IFX is unclear. This study analyzed the possible risk factors of primary failure to respond to IFX, and provided a reference for the treatment of CD and the use of IFX in clinical.

anti-neutrophil cytoplasmic antibody (ANCA) includes perinuclear ANCA and cytoplasmic ANCA, and the corresponding classical antibodies are anti-myeloperoxidase (MPO) -ANCA and anti-proteinase 3 (PR3) -ANCA, respectively, which are marker antibodies for polyangiitis and granulomatous polyangiitis under light microscope^[1]。 Perinuclear ANCA contributes to the differential diagnosis of UC and CD^[1,2]。 In recent years, foreign studies have found that PR3-ANCA exists in UC patients, which is also helpful for the differentiation of UC and CD, and the lesions of PR3-ANCA positive patients are wider^[1,3]。 At present, there are few domestic studies on the clinical value of PR3-ANCA in UC^[4]。 Through retrospective analysis, this study aims to explore the clinical significance of PR3-ANCA in UC patients in China.

Colorectal cancer is a common malignant tumor of the digestive tract, with a high incidence at home and abroad^[1,2]。 In recent years, the continuous exploration of the pathogenesis of colorectal cancer makes its immunotherapy have a broad application prospect. Although the body's immune system can produce an immune response to tumor cells and eliminate tumors, there is still a certain proportion of primary tumors that grow in the host body and are prone to metastasis and recurrence, that is, the immune escape of tumors. The immune escape mechanism of colorectal cancer cells may be divided into three categories: low immunogenicity of colorectal cancer cells (mainly manifested by the loss or down-regulation of classical HLA class I molecules and the loss of Fas expression), abnormal effector cell function (mainly manifested by the high expression of CC chemokine receptor 5 (CCR5) in tumor infiltrating regulatory T cells, and the expression of immunosuppressive factors (mainly manifested by the high expression of Fas ligand and the high expression of non-classical HLA class I molecule HLA-E)^[3,4,5,6,7]。 So far, there are few reports at home and abroad that explore and expound the immune escape mechanism of early colorectal cancer cells. This study aims to analyze the expression evolution of immune escape-related molecules in normal colorectal epithelial cells during malignant transformation, and to explore the immune escape mechanism of early colorectal cancer cells.

UC is a kind of chronic non-specific inflammatory reaction disease with unknown etiology, which belongs to a kind of autoimmune disease. This disease is common in western countries, and the incidence of UC in China is also increasing in recent years. The lesions of UC are mostly continuous and diffuse, and most of them occur in the rectum and sigmoid colon, which can develop to the proximal colon and even involve the whole colon. Endoscopic studies found that in addition to inflammatory changes in the distal colon, inflammatory lesions were also seen in the mucosa around the appendix in a small number of patients. This jumping distribution was initially thought to be a manifestation of CD, but it was confirmed by pathological findings to be a special phenotype of UC^[1,2,3]。 Some studies suggest that the appendix contains a large number of immune cells, and the incidence of UC can be significantly reduced by appendicectomy^[4]。 The purpose of this study was to investigate the influence of peri-appendicular mucosal jumping lesions on the severity and prognosis of UC.

percutaneous coronary intervention (PCI), also known as coronary angioplasty, is a non-surgical treatment for coronary artery stenosis. It was first applied by Gruentzig in 1977 and has now become an important means of revascularization in coronary atherosclerotic heart disease. Dual antiplatelet therapy with aspirin and clopidogrel is the gold standard for the prevention of thrombotic events in patients after PCI^[1]。 At the same time, both aspirin and clopidogrel are high risk factors for upper gastrointestinal bleeding^[2]。 As one of the serious complications after PCI, upper gastrointestinal bleeding is life-threatening. This study aimed to analyze the risk factors of upper gastrointestinal bleeding after PCI by observing the general condition, medication status, metabolic typing and various blood biochemical indexes of patients after PCI.

Studies have found that eradicationH.pyloriCan reduce the risk of metachronous gastric cancer after endoscopic resection of early gastric cancer^[1]。 Therefore, the stomachH.pyloriInfection status judgment is very important for patients with high risk of gastric cancer. With the popularity of gastroscopy screening,H.pyloriInfection-related characteristic endoscopic findings are gradually gaining attention. This study was based on 11 endoscopic signs^[2,3,4]Patients undergoing gastroscopy due to upper abdominal discomfortH.pyloriEndoscopic diagnosis of infection status is reported below.

From September 22 to 24, 2016, the 16th National Congress of Gastroenterology China (CGC) of Chinese Medical Association was successfully held in Suzhou International Expo Center. This conference is sponsored by Chinese Medical Association and Gastroenterology Branch of Chinese Medical Association, and hosted by Jiangsu Medical Association. There were 4,724 registered representatives, 13,533 live online viewers, and a total of more than 18,000 people participated in the academic exchange and study of this conference. For the first time, the audience of China's Digestive Diseases Academic Conference exceeded 10,000, which is the largest academic event with first-class academic level in China's digestive field. World Gastroenterology Organization (WGO), World Endoscopy Organization (WEO), Asia Pacific Association of Gastroenterology (APAGE), Asian Pacific Digestive Week Federation (APDWF), The presidents of the American Society for Gastrointestinal Endoscopy (ASGE), the United European Gastroenterology Federation (UEGF), the Korean Society for Gastrointestinal Endoscopy, the Taiwan Society of Gastroenterology, the Hong Kong Society of Gastroenterology and other organizations and academic associations attended the meeting to congratulate and give keynote speeches. At the opening ceremony of the conference held on September 23rd, Professor Yang Yunsheng, the chairman of the conference, announced the playing of the national anthem and the opening of the conference. Du Zhiqin, deputy secretary-general of Chinese Medical Association, and Liu Yanqun, vice president and secretary-general of Jiangsu Medical Association, attended the conference to congratulate and deliver speeches.

A 17-year-old female was admitted to the hospital on 22 March 2012 due to repeated nausea and epigastric pain for 2 years and recurrent exacerbation for 1 month. Two years before admission, the patient often experienced upper abdominal distension, nausea, and sometimes vomited stomach contents after eating. After waking up in the morning, he often felt abdominal pain, nausea, dry mouth, bitter mouth, dry stool, and defecation once every 3 to 6 days, and often needed to use Kaiselu and laxative tea; One month before admission, abdominal pain and nausea were more frequent and worse than before, and fear of food. Family history is not special. Physical examination: No abnormalities in the heart and lungs, soft abdomen, tenderness under the xiphoid process and left lower abdomen, and no abnormalities. All the indexes of blood routine were normal, there were no abnormalities in fecal routine and urine routine, and liver function, renal function, blood sugar, blood lipid and blood electrolyte were all normal. The electrocardiogram showed sinus bradycardia with a heart rate of 52 beats/min.¹³C Breath test negative. Chest X-ray and digestive ultrasound were normal. Gastroscopy revealed chronic non-atrophic gastritis (moderate) with bile reflux. Colonoscopy showed that the vascular texture of the local mucosa of sigmoid colon was blurred or disappeared, accompanied by local flaky congestion and erosion; The rectal mucosa is rough, with clusters, dense granular and small polypoid lesions near the anal end, with a maximum diameter of 0.1~0.4 cm. The surface mucosa is smooth and non-congested, seeFigure 1。 Pathological examination of rectal polyps revealed inflammatory polyps of the rectum. The diagnosis was chronic gastritis, multiple polyps of the rectum (inflammatory), inflammatory reaction-like changes of the sigmoid colon and rectal mucosa, and chronic constipation. Pantoprazole sodium, aluminum magnesium carbonate tablets, domperidone tablets, bifidobacterium triple live bacteria enteric-coated capsules and polyethylene glycol 4000 powder were administered orally for 7 days, and 100 mL of metronidazole sodium chloride injection was used to retain enema every night for 7 days. The patient's abdominal pain and nausea disappeared, and the constipation improved to defecation once in 1 to 2 days, and then he was discharged from hospital. After discharge, the patient continued oral medication and went to the Department of Gastroenterology of the First Affiliated Hospital of Kunming Medical College for further diagnosis or endoscopic treatment on the 10th day, but colonoscopy showed no abnormalities in colorectal mucosa, seeFigure 2。

nonalcoholic fatty liver disease (NAFLD) is the main form of metabolic syndrome in the liver, and its pathogenesis is caused by the combination of individual genetic background and dietary environment factors. NAFLD includes simple hepatic steatosis, nonalcoholic steatohepatitis (NASH), disease progression leading to corresponding liver fibrosis, liver cirrhosis and some serious life-threatening complications, hepatocellular carcinoma, etc. Animal experiments have shown that the occurrence of NAFLD is related to many factors, among which intestinal flora is the potential factor leading to the onset and progression of NAFLD. At present, there are different opinions on the mechanism of intestinal flora regulating NAFLD, and how the flora composition changes and the dominant bacterial species are not well understood. The purpose of this paper is to expound the pathogenesis of NAFLD, analyze the causal relationship between intestinal flora and NAFLD, and seek new and potentially effective therapeutic options.