2017年 · 第37卷第09期

IBD is a group of chronic non-specific intestinal inflammatory diseases whose etiology is not well established, including UC and CD. Anti-TNF-α monoclonal antibodies for the treatment of IBD include the human mouse chimeric IgG1 monoclonal antibody infliximab (IFX), the fully humanized monoclonal antibody adalimumab (ADA), and the fragment of antigen binding (Fab) certolizumab pegol (CZP) of polyethylene glycol humanized monoclonal antibody. At present, only IFX was officially approved for CD treatment by the State Food and Drug Administration (SFDA) in 2007, and ADA is still in the SFDA application approval stage. In view of the experience accumulated for nearly 10 years and the research results at home and abroad, the recommended protocol of Inflixi for the treatment of Crohn's disease (2011) was formulated in 2011^[1]Can no longer meet the current clinical needs. Therefore, in November 2016, the IBD group of the Gastroenterology Branch of the Chinese Medical Association organized experts to supplement, revise, discuss and vote on the original recommended protocol, and proposed the 2017 supplementary revised version of the expert consensus on anti-TNF monoclonal antibody for IBD treatment.

lymphoepithelioma-like carcinoma (LELC) is a type of poorly differentiated or undifferentiated carcinoma that occurs outside the nasopharynx and is morphologically similar to nasopharyngeal carcinoma (formerly known as nasopharyngeal lymphoepithelial carcinoma). Its morphology is characterized by undifferentiated carcinoma tissue with large lymphocyte infiltration^[1]。 LELC is common in salivary gland, thymus, etc., and can also occur in lung, kidney, cervix, liver, skin and other parts. LELC occurring in the digestive system is rare. At present, only a few literature reports in China, and most of them are case reports^[2,3]。 In this study, the pathological data of 5 patients with digestive LELC were collected and combined with literature review, in order to improve the understanding of the clinicopathological characteristics of this disease.

Pancreatic cancer has occult onset, rapid development and poor prognosis. It is a highly malignant tumor, ranking 4th among malignant tumors and 2nd among digestive system malignant tumors^[1,2,3]。 The incidence of pancreatic cancer in China is increasing year by year, and surgical resection is an effective treatment for localized pancreatic cancer. However, localized pancreatic cancer often has no typical clinical manifestations. Once patients see a doctor due to discomfort, most of them have entered the locally advanced stage, and their surgical radical cure rate has decreased significantly. Therefore, how to improve the clinical efficacy of patients with pancreatic cancer and prolong the survival period of patients is of great significance. At present, there is no satisfactory treatment for locally advanced pancreatic cancer that cannot be surgically resected, but concurrent chemotherapy and radiotherapy based on gemcitabine are alternative effective methods^[4]However, the benefit from this is limited. The efficacy and safety of percutaneous microwave coagulation therapy (PMCT) for lung cancer and liver cancer have been confirmed^[5,6]And applied to the treatment of pancreatic tumors^[7]However, few studies have reported the efficacy and safety of PMCT combined with gemcitabine-based concurrent chemotherapy and radiotherapy for locally advanced pancreatic cancer. This study aimed to evaluate the efficacy and safety of microwave ablation combined with gemcitabine-based concurrent chemotherapy and radiotherapy in patients with locally advanced pancreatic cancer.

The incidence of pancreatic cancer is increasing year by year, and it has become the fourth cause of cancer death, and it is expected to rise to the second cause of cancer death in 2030^[1,2,3]。 5-year survival in pancreatic cancer<5%, approximately 40% of patients have developed local or distant metastases at the time of diagnosis, losing the chance of radical surgery^[4]。 Chemotherapy can improve the survival rate of pancreatic cancer patients to some extent^[5], such as gemcitabine, but the drug resistance of pancreatic cancer makes its treatment not achieve the desired effect^[6]。 Therefore, it is urgent to conduct in-depth research on drug resistance of pancreatic cancer, enhance the sensitivity of pancreatic cancer cells to gemcitabine and improve the curative effect.

pneumatosis cystoides intestinalis (PCI), also known as colonic air cyst, is a gas sac appearing under the mucosa or serosa of the gastrointestinal tract. PCI can involve all or part of the esophagus to the rectum, but it mainly occurs in the small intestine and colon, and may also occur in the mesentery, omentum, hepatogastric ligament and other sites. The main symptoms of PCI are hematochezia and abdominal pain, the etiology is unknown and relatively rare. The data of multiple colonoscopy, pathological examination, small intestine CT examination, ultrasonic colonoscopy and other data of a patient with abdominal pain are analyzed and discussed, and suspected diagnoses such as other infections are excluded. Finally, PCI with lamina propria hemorrhage is considered. The specific diagnosis and treatment are as follows.

A 46-year-old female was admitted to the hospital on 17 August 2016 due to "intermittent abdominal distension and vomiting for 5 months". Physical examination showed no obvious positive signs. Gastroscopy revealed multiple mucosal bulges of 0.3~0.7 cm in size in the fundus and body of the stomach, with smooth surface and the same color as the surrounding ones (Figure 1)。 The results of pathological examination showed that proliferating cell masses were seen in the tissues submitted for examination, infiltrating the mucosal muscle layer, and the tumor was to be removed (Figure 2)。 The results of immunohistochemical examination showed that cytokeratin (CK) (+), CK7 (-), CK20 (-), villin (+), anti-chromaffin A antibody (+), anti-synaptic antibody (+), CD56 (+), Ki-67 (+)<2%, CEA (-), E-cadherin (+), CD45 (-). Pathological morphology combined with immunohistochemical findings were diagnosed as gastric neuroendocrine neoplasms type 1 (G-NEN; carcinoid). Endoscopic ultrasonography showed that the mucosal layer at the lesion had a moderate echoic bulge, with a clear boundary and protruding into the cavity, with a cross section of 5.3 mm ×6.8 mm ~5.5 mm ×5.8 mm. It is considered to be multiple mucosal lesions in the stomach, with the same nature. Multi-slice CT scan of the stomach + enhanced stomach in the first phase (arterial phase) + enhanced scan of the whole abdomen in the first phase (equilibrium phase) showed changes in the stomach body, small curvature of the stomach, and descending duodenum, accompanied by lymph nodes in the peripheral and mesenteric areas, which should be combined with clinical and gastroscopic findings. According to the above examination results of the patient, considering the possibility of multiple gastric carcinoid tumors, endoscopic submucosal dissection (ESD) was performed at the endoscopic Center of Gastrointestinal Medicine, First Hospital of Jilin University;Figure 3) and endoscopic mucosal resection (EMR) to remove the lesions. The results of postoperative pathological examination showed that the whole tumors resected by ESD were all type 1 G-NEN (carcinoid), and there were no tumor cells in the horizontal and vertical margins. The other three tumors resected by EMR were also type 1 G-NEN (carcinoid). SeeFigure 4Immunohistochemical examination showed that CK (+), villin (+), anti-chromaffin A antibody (+), anti-synaptic antibody (+), CD56 (+), Ki-67 (+)<2%, CEA (-), E-cadherin (+), P53 (-). The patient refused endocrine therapy and wanted to undergo surgical treatment. He has been discharged from hospital for 1 month and has been adjusted for surgical treatment.

IBS is a common functional intestinal disease with a global prevalence of 1.1% ~35.5%. The main clinical manifestations are abdominal pain, abdominal distension, changes in defecation habits and abnormal fecal traits. There are no gastrointestinal structural changes and abnormal biochemical indexes. It is divided into irritable bowel syndrome with constipation (IBS-C) and irritable bowel syndrome with diarrhea (IBS-D) and irritable bowel syndrome mixed (mixed irritable bowel syndrome, IBS-M)^[1]。 In recent years, more and more evidence has shown that the brain-gut-microbiota axis plays an important role in the pathogenesis of IBS^[2,3]。 The research progress of IBS prevention and treatment strategies based on the brain-gut-micro-ecological axis is reviewed.

Intestinal flora participates in important physiological processes such as food digestion, nutrient metabolism and absorption, drug metabolism, energy supply, production of essential vitamins, immune regulation and maintenance of gastrointestinal homeostasis^[1]。 Intestinal flora imbalance is correlated with IBS, IBD, colon cancer, obesity, diabetes and other diseases^[2]。 Diet is the most direct connection between gastrointestinal tract and the outside world. More and more studies have shown that diet will affect the genes and composition of intestinal microorganisms, and the dominant flora of different metabolic substrates is obviously different, thus affecting the structure and function of intestinal flora.

Hepatic fibrosis is a damage repair response after chronic liver injury. Under the action of various pathogenic factors, liver damage and inflammatory reaction occur, and intrahepatic fibrogenesis and degradation are unbalanced, resulting in excessive extracellular matrix, especially collagen, deposited in the liver, resulting in fibrosis. Activated stellate cells are the main source of extracellular matrix production. If liver fibrosis is not interfered, it can further develop into cirrhosis, and eventually lead to liver failure and liver cancer. A large number of animal models and clinical trials have proved that liver fibrosis and even cirrhosis can be reversed, and the related cellular and molecular mechanisms have been continuously updated in recent years. At the same time, a large number of clinical trials have confirmed that the reversal of fibrosis in human body is related to clinical prognosis. However, there is no effective non-invasive diagnostic index to assess the degree of fibrosis. A simple cure of the primary disease does not completely reverse liver fibrosis or reduce the potential risk of liver cancer. Therefore, a deep understanding of the signaling pathways of extracellular matrix remodeling during fibrosis and the key regulators of structural repair when fibrosis is reversed is not only of great significance for exploring anti-fibrosis treatment, but also helps to improve the dynamic monitoring of fibrosis evolution. Based on the continuous expansion of knowledge related to liver fibrosis pathology and the continuous update of anti-fibrosis treatment strategies, it is still necessary to establish and improve non-invasive indicators to judge the degree of fibrosis as soon as possible to evaluate the clinical efficacy of anti-fibrosis interventions and shorten the observation time of clinical trials. With the steady development of knowledge related to liver fibrosis, anti-fibrosis treatment for patients with chronic liver disease has shown great application prospects, and it is also hoped to create a typical successful case from basic to clinical. The regulation of hepatic stellate cell activation, the molecular mechanism of hepatic fibrosis reversal, the evidence of reversal, and the progress in the diagnosis of hepatic fibrosis are reviewed.