2017年 · 第37卷第11期

Since the National Symposium on Chronic Gastritis held in Shanghai in November 2012, the Consensus Opinions on Chronic Gastritis in China (Shanghai, 2012) has been formulated^[1]Since then, the international promulgation of theH.pyloriKyoto Global Consensus Opinion on Gastritis^[2], both emphasizingH.pyloriThe role of chronic gastritis, and pay more attention to the "operable gastritis assessment associated with gastric cancer risk (operative link for gastritis assessment, OLGA) "^[3,4]and even the "operative link on gastric intestinal metaplasia assessment (OLGIM)" grading and staging system, as well as ABC grading criteria, Maastricht-5 consensus^[5]And China's 5th NationalH.pyloriConsensus opinion on infection management^[6]Relationship between chronic gastritis and gastric cancer and eradicationH.pyloriThe role of chronic gastritis, the progress of endoscopic and pathological diagnosis methods, etc. all require an update of the consensus opinion. To this end, the 2017 National Consensus Conference on Diagnosis and Treatment of Chronic Gastritis, sponsored by the Gastroenterology Branch of Chinese Medical Association and hosted by the Department of Gastroenterology, Renji Hospital, Shanghai Jiaotong University School of Medicine and Shanghai Institute of Digestive Diseases, was held in Shanghai on July 1, 2017.

Gastric cancer is a highly malignant tumor of the digestive tract, which is the fourth most common type of tumor and the third leading cause of tumor death in the world^[1,2,3]。 With the development of surgery and the progress of multidisciplinary diagnosis and treatment technology, the clinical prognosis of gastric cancer has been greatly improved. The presence or absence of lymph node metastasis is the main factor affecting the prognosis of gastric cancer^[4]Therefore, accurate preoperative assessment of lymph node metastasis is of great value in the selection of surgical methods and prognostic evaluation of gastric cancer. The purpose of this study was to investigate the value of preoperative peripheral blood neutrophil to lymphocyte ratio (NLR) and platelet to lymphocyte ratio (PLR) in assessing lymph node metastasis in patients with gastric cancer.

Chronic liver disease is extremely common in China, and osteoporosis is a common type of hepatic osteodystrophy. When accompanied by spontaneous fracture or low-trauma fracture, it seriously affects the quality of life of patients and even endangers their lives. Vitamin D not only possesses the classical effects of calcium and phosphorus metabolism, but also has the functions of anti-inflammation, anti-infection and immunity. In recent years, the pleiotropy of its extraosseous effects has become a research focus^[1]。 Elderly patients often have multiple risk factors for vitamin D deficiency. Understanding the level of vitamin D in elderly patients and analyzing the causes of its deficiency can provide scientific basis for preventing vitamin D deficiency and preventing and treating some chronic diseases by improving vitamin D level. Kunshan was once one of the areas with serious schistosomiasis epidemic in China. At present, there are still many patients with schistosomiasis liver disease, especially in the elderly (over 65 years old). This study observed the changes of serum 25-hydroxyvitamin D level and immune function after splenectomy in elderly patients with advanced schistosomiasis liver disease, which are reported as follows.

Colorectal cancer accounts for 10% to 15% of tumors worldwide and is the second leading cause of tumor death^[1,2,3]。 At present, surgical treatment is still the main treatment mode, but chemotherapy is also an indispensable treatment for patients with colon cancer with distant metastasis in middle and advanced stages. Raltitrexed is a novel antifolic acid preparation, widely used in the treatment of digestive tract tumors^[4]。 However, some patients with colon cancer have been found to be less sensitive to raltitrexed in clinic. PD98059 is a specific inhibitor, which can block the phosphorylation activation of ERK by mitogen-activated extracellular signal-regulated kinase (MEK), hinder the transduction of extracellular stimulatory signals, thus affecting a series of biological effects such as cell proliferation, differentiation and apoptosis. Although PD98059 is not a first-line anti-tumor drug, its combination with other first-line anti-tumor drugs can not only show sensitizing effects, but also show superimposed or even synergistic effects. In this study, PD98059 and raltitrexed were used to treat colon cancer cells HT-29 together, to investigate whether PD98059 can improve the sensitivity of colon cancer cells to raltitrexed, and provide new ideas for the treatment of colon cancer.

Colorectal cancer is a common malignant tumor of the digestive system. In recent years, the incidence of colorectal cancer is increasing. The clinical treatment is mainly surgery, chemotherapy and radiotherapy, but the curative effect is not satisfactory^[1,2]。 Ras-related C3 botulinum toxin substrate 1 (Rac1) is positively expressed in lung cancer, breast cancer and other malignant tumor tissues, and is closely related to its invasion and metastasis^[3,4]。 However, there are few studies on the expression of Rac1 in colorectal cancer tissues and its clinical significance. In this study, the expression of Rac1 in colorectal cancer was detected, the relationship between Rac1 and the prognosis of colorectal cancer patients was analyzed, and the feasibility of Rac1 as a molecular marker to evaluate tumor invasion and prognosis was discussed, so as to provide theoretical basis for early diagnosis and individualized treatment.

Abdominal pain is a common clinical problem in elderly patients. After careful collection of medical history, careful physical examination and auxiliary examination results, most of them can be diagnosed definitively. However, in a few cases, elderly patients may have some rare etiologies at the same time. Removing confounding factors as soon as possible and defining the etiology is the key to improve their prognosis and survival rate. Through a multidisciplinary discussion of a case of chronic abdominal pain with acute exacerbation in an elderly patient, the aim is to review the diagnostic ideas of abdominal pain and broaden the understanding of the rare causes of abdominal pain.

A 60-year-old female was admitted to Yuxi People's Hospital on December 13, 2016 due to repeated upper abdominal pain for 2 months. Two months ago, the patient developed dull pain in the upper abdomen without obvious trigger, radiating to the lower back, accompanied by nausea, vomiting, sweating, etc., without fever, jaundice, acid reflux, belching, diarrhea, abdominal distension, chest tightness, palpitations, chest pain, etc. The patient was diagnosed with "gallbladder stones" in the local hospital. After treatment (details unknown), the abdominal pain still did not relieve, so he was transferred to the Department of General Surgery of Yuxi People's Hospital for magnetic resonance cholangiopancreatography (MRCP), and was diagnosed with "gallbladder stones and common bile duct stones". After anti-inflammatory and symptomatic treatment, his condition improved, and he was admitted to the Department of Gastroenterology for endoscopic retrograde cholangio-pancreatography (ERCP) and common bile duct lithotomy.

A 41-year-old female was admitted to the Department of Gastroenterology, the First Affiliated Hospital of Zhejiang University of Traditional Chinese Medicine on December 8, 2016 due to repeated right lower abdominal pain with melena for 20 years and sudden lower abdominal pain with bloody stool for 2 days. CT examination of small intestine of the patient on December 25, 2013 showed that the small intestine (middle and distal ileum) of groups 5 and 6 was thickened and the mucosal layer was enhanced, which was considered to be CD (Figure 1)； On January 3, 2014, transanal enteroscopy showed no obvious abnormalities in the colonic mucosa, and multiple longitudinal ulcers in the small intestine, 1.0~1.2 cm long, covered with yellow coating, and congestion of the marginal mucosa (Figure 2), the pathological examination showed moderate chronic active inflammation of the ileal mucosa with erosion (Figure 3)。 On July 17, 2014, due to repeated right lower abdominal pain with melena for 20 years, capsule endoscopy was performed, and multiple longitudinal deep concave ulcers in the ileum were found. After excluding other diseases such as tuberculosis and lymphoma, it was considered as CD (Figure 4)。 On the morning of December 7, 2016, the patient suffered from sudden lower abdominal cramps. The pain was relieved after defecation. He had 4 defecations, which were thin and shapeless, and had bright red bloody stool, accompanied by nausea and no vomiting. He took 4 tablets of Changweikang (0.24 g/tablet) and 1 bag of montmorillonite powder (3 g) by himself, but the efficacy was not good, so he was hospitalized on the second day. The patient had an average physique in the past. He had an anal fistula operation in 2000 and two cesarean sections in 2001 and 2003. He denied any other surgical history. Has a history of chronic cholecystitis and cholelithiasis for more than 10 years, and has taken ursodeoxycholic acid 250 mg (once/d) for more than half a year; The patient experienced amenorrhea six months after taking thalidomide and regularly took didrogesterone 10 mg (2 times/d) from February 2015 until December 9, 2016. After taking thalidomide, the patient had long-term constipation and intermittently took lactulose, but the feces were still dry and knotty.

Gastric cancer is a common malignant tumor in China^[1]。 According to the current accepted evolution model of "normal gastric mucosa → chronic superficial gastritis → chronic atrophic gastritis → intestinal metaplasia → dysplasia → gastric cancer"^[2]The dysplasia/intraepithelial neoplasia of gastric mucosal cells is an important precancerous lesion and a key link in the process of gastric cancer^[3]。 This paper reviews the recent progress in the development of gastric intraepithelial neoplasia (GIN) and the genetic mechanism of its evolution to gastric cancer.

HBV infection is a major global health problem, with approximately 400 million HBV carriers^[1]。 Patients with chronic hepatitis B are at risk of developing HBV-associated cirrhosis and liver malignancies, and approximately 1 million people die each year from cirrhosis, liver failure and liver cancer caused by HBV infection^[2]。 HBV is a non-cytotoxic hepatotropic DNA virus. Hepatocyte damage is caused by the immune response to HBV antigen. Different clinical results caused by HBV infection are closely related to different immune states of the body. Low immune function and disorder of immune regulatory system are one of the important causes of chronic liver injury, among which cellular immunity is considered to be the main cause of hepatocyte injury after HBV infection and the main mechanism of clearing out intracellular virus.

cytokeratin (CK) is a silk protein, which belongs to the category of intermediate microfilaments. It forms the cytoskeleton and has a supporting role. Its type I is composed of low relative molecular weight acidic protein CK9-20, and type II is composed of high relative molecular weight basic protein C1-8^[1]。 CYFRA21-1 is a fragment of CK19, which is widely distributed in lamellar or squamous epithelial cells of all gastrointestinal tract, liver, biliary tract, alveoli, bladder and other organs. Under normal conditions, the content of CK is small, but its content will increase when epithelial cells are malignant transformation. Due to necrosis of tumor cells, the soluble fragment of CK is released into the blood. This soluble fragment specifically binds to two monoclonal antibodies KS19-1 and BM19.21, so it is called CYFRA21-1^[2]。